[Study on liver tissue derived-extracellular vesicles regulating the osteogenic differentiation ability of mesenchymal stem cells and promoting the healing of jaw bone defects]

Objective: To explore the biological process of liver tissue-derived extracellular vesicle (LT-EV) in promoting osteogenic differentiation of mesenchymal stem cells and healing of jaw defects to provide a feasible treatment method for the clinical treatment of jaw bone defects. Methods: Enzymatic hydrolysis and differential centrifugation were used to extract LT-EV, scanning electron microscopy, Western blotting, and nanoparticle tracking analyzers were used to identify and characterize LT-EV, and further to explore the biological functions of LT-EV through proteomics and Kyoto Encyclopedia of Genes and Genomes. Flow cytometry was used to detect LT-EV plasma concentration and to calculate the plasma half-life of LT-EV. Small animal in vivo imaging system was used to detect the biological distribution of LT-EV 24 hours after injection. Six C57BL/6 mice were divided into control group and LT-EV group (3 mice in each group) by simple random sampling method. All mice underwent jaw bone defect surgery and tail vein injection every 7 days (the control group was injected with phosphoric buffer saline, LT-EV group was injected with LT-EV), micro-CT was used to evaluate the degree of mouse jaw bone healing 28 days after surgery, HE staining was used to analyze the multi-organ biosafety of LT-EV, and immunofluorescence staining was used to detect the jaw bone expression of osteogenic marker proteins in the defect area. Human jaw bone mesenchymal stem cells (hJBMSC) induced by osteogenic differentiation were treated with LT-EV (obtained from orthognathic surgery patients provided by the Department of Traumatology and Orthognathic Surgery of School of Stomatology of The Fourth Military Medical University resected normal jaw bone fragments), and the difference in osteogenic differentiation ability between the hJBMSC group and the control group (phosphate buffer saline treatment) was compared, and the in vitro bone differentiation promoting effect of LT-EV was verified through alkaline phosphatase (ALP) staining and real-time fluorescence quantitative PCR. Results: The yield of LT-EV was high, and proteomics and Kyoto Encyclopedia of Genes and Genomes showed that LT-EV contained a series of proteins that regulated cell biological functions. LT-EV injected into the tail vein could reach the mouse jaw bone defect area and promote the regeneration and repair of the jaw bone defect [the bone volume fractions of the LT-EV group and the control group were (36.06±4.20)% and (18.58±5.61)%, respectively; t=4.32, P=0.013], and had good biosafety. LT-EV could promote osteogenic differentiation of hJBMSC in vitro. Compared to the control group, ALP staining and osteogenic gene expression levels were significantly enhanced after osteogenic differentiation of hJBMSC (P<0.05). Conclusions: LT-EV exhibits a high yield, ease of acquisition, high biological safety, and excellent bone-promoting effects. It holds promise as a novel cell-free therapy strategy for regenerating craniofacial bone defects.

Exploration of gastric carcinogenesis from the relationship between bile acids and intestinal metaplasia and intragastric microorganisms (H. pylori and non-H. pylori)

Gastric cancer (GC) is a prevalent form of cancer, with Helicobacter pylori (H. pylori) infection being the most common risk factor. Recent studies have highlighted the role of long-term irritation of the gastric mucosa caused by bile reflux in the development of cancer. Bile acids (BAs), which are a significant component in bile reflux, have the potential to promote gastric carcinogenesis through various mechanisms. These mechanisms include the induction of intestinal metaplasia (IM), inhibition of H. pylori activity, modification of H. pylori colonization, and alteration of the abundance and composition of microorganisms in the stomach. Defining the mechanism of bile acid-induced gastric carcinogenesis could potentially be an effective approach to prevent GC. Hence, this paper aims to review the mechanism of bile acid-induced IM, the association between BAs and H. pylori infection as well as microorganisms in the stomach, and the correlation between BAs and gastric carcinogenesis. The ultimate goal is to elucidate the role of BAs in the development of GC.

[Management of menopausal syndrome in women with dyslipidemia]

The prevalence of dyslipidemia is increased in postmenopausal women due to dysregulation of lipid metabolism and deficiency of estrogen levels. At the same time, some postmenopausal women also have menopausal syndromes such as vasomotor symptoms, physical physiology, mental psychology, and urogenital tract atrophy. Menopausal hormone therapy is the most effective measure to alleviate menopausal syndrome. And initiating MHT in early menopause can reduce cardiovascular damage. However, menopausal hormone therapy can also bring the risk of thromboembolic diseases such as venous embolism, myocardial infarction and stroke. Different drug regimens have different effects on lipid metabolism. Women with menopausal syndrome should take individualized treatment plans for different types of dyslipidemia. Therefore, this article reviews the management and treatment of menopausal syndrome in women with dyslipidemia, so as to provide a reference for personalized management of dyslipidemia in postmenopausal women.

Early Awake Prone Position Combined with High-Flow Nasal Oxygen Therapy in Severe COVID-19: A Case Series

Background

Awake prone positioning has been used for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure, but the results are contradictory. We aimed to highlight the role of awake prone positioning combined with high-flow nasal oxygen therapy in severe COVID-19 patients infected with the Delta variant of SARS-CoV-2.

Methods

From June 12 to December 7, 2021, we successfully performed prone position(PP) combined with high-flow nasal oxygen(HFNO) therapy on two patients infected with the delta variant of SARS-CoV-2. HFNO was prescribed to reach SpO₂ ≥ 92%. PP was proposed to patients with PaO₂/FiO₂(P/F) < 150 mmHg. Arterial blood gas (ABG) and hemodynamic were monitored before and after PP sessions. The target time of PP was more than 12 h per day and could be appropriately shortened according to the patient's tolerance. Relevant clinical data, HFNO parameters, PICCO parameters, P/F ratio and PP duration were obtained from medical records.

Results

A total of 23 PP sessions and 6 PP sessions combined with HFNO were performed in case 1 and case 2, respectively. Compared with values before PP, GEDI, ELWI and Qs/Qt decreased significantly (GEDI: 869.50 ± 60.50 ml/m² vs. 756.86 ± 88.25 ml/m²; ELWI: 13.64 ± 2.82 ml/kg vs. 12.43 ± 2.50 ml/kg; Qs/Qt: 15.32 ± 6.52% vs. 12.24 ± 5.39%; all p < 0.05), Meanwhile, the oxygenation improved significantly (P/F: 184.50 ± 51.92 mmHg vs. 234.21 ± 88.84 mmHg, p < 0.05), The chest CT revealed the lung infiltrates improved significantly after PP. Both cases were discharged to a dedicated COVID-19 ward without requiring intubation.

Conclusions

Combining PP with HFNO could be a useful treatment strategy for avoiding intubation in severe COVID-19 patients infected with the Delta variant of SARS-CoV-2 to improve pulmonary vascular involvement, improve oxygenation and avoid intubation, but further studies are needed to validate our approach.

POS0195 PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS HAVE AN INCREASED RISK OF MORTALITY, MECHANICAL VENTILATION, AND HOSPITALIZATION FROM COVID-19

Background

Patients with systemic lupus erythematosus (SLE) may have an increased risk of mortality from COVID-19 due to underlying immunosuppression, comorbidities, and abnormalities in the innate immune system. Studies have shown that autoimmune diseases and some immunosuppressive agents are risk factors for hospitalization, ventilation, and mortality from COVID-19.

Objectives

To compare the outcomes of patients with or without SLE who were diagnosed with COVID-19 and to identify the factors associated with 30-day hospitalization, mechanical ventilation, and mortality. We hypothesized that patients with SLE had a higher risk of adverse outcomes.

Methods

This retrospective cohort study used the deidentified Optum COVID-19 electronic health record dataset to identify adult patients with COVID-19 diagnosis from 1/1/2020 – 12/31/2020. The SLE cohort was defined as patients who had two or more international classification of diseases (ICD) 9 or 10 diagnosis codes of 710.0 or M32.xx but not M32.0 within one year before COVID-19 diagnosis and were on either antimalarial or immunosuppressive therapy. The general cohort excluded patients with SLE. We matched SLE cases with controls at a ratio of 1:10 by age, sex, race and ethnicity, and month of COVID-19 diagnosis via a propensity score matching with exact matching for the latter three variables. Outcomes included 30-day mortality, hospitalization, and mechanical ventilation after COVID-19 diagnosis. We performed multivariable logistic regression models to estimate the odds of 30-day mortality, hospitalization, and mechanical ventilation after adjusting for age, sex, race and ethnicity, COVID-19 diagnosis quarter, insurance, region, severe obesity, smoking status, and comorbidities.

Results

We included 687 SLE cases matched with 6,870 controls. After matching, the 30-day mortality for SLE and control was 3.6% and 1.8% (p <0.001), the 30-day mechanical ventilation was 6.0% and 2.5% (p <0.001), and 30-day hospitalization was 31.0% and 17.7% (p <0.001). After multivariable adjustment (Table 1) for age, sex, race, COVID-19 diagnosis quarter, insurance, region, severe obesity, and smoking status, patients with SLE had higher odds of death (Odds Ratio (OR)=2.09; 95% CI 1.31-3.32), mechanical ventilation (OR=2.43; 95% CI 1.67-3.54) and hospitalization (OR=2.06; 95% CI 1.71-2.49). After additionally adjusting for comorbidities, the OR decreased to 1.39 (95%CI 0.79-2.44), 1.81 (95%CI 1.16-2.82), and 1.32 (95%CI 1.05-1.65) for mortality, mechanical ventilation, and hospitalization respectively. Older age, male sex, Hispanic ethnicity or Black race, severe obesity, and smoking had increased risk of adverse outcomes.

Table 1.

Multivariable logistic regression model of 30-day mortality, 30-day mechanical ventilation, and 30-day hospitalization on matched cohort adjusting for demographic and comorbidity score

VariablesModel 1*Odds Ratio (95% CI)Model 2**Odds Ratio (95% CI)MortalityControl11SLE2.09 (1.31 to 3.32)1.39 (0.79 to 2.44)30-day mechanical ventilationControl11SLE2.43 (95% CI 1.67 to 3.54)1.81 (1.16 to 2.82)HospitalizationControl11SLE2.06 (1.71 to 2.49)1.32 (1.05 to 1.65)

SLE: systemic lupus erythematosus; CI: confidence interval.

*Model 1 includes adjustments for age, sex, race, COVID-19 diagnosis date (by quarter), insurance, region, severe obesity, smoking status, and skilled nursing facility stay three months before COVID-19 diagnosis.

**Model 2 includes adjustments from model 1 and comorbidities (excluding SLE).

Conclusion

Patients with SLE have an increased risks of mortality, mechanical ventilation, and hospitalization within 30 days of COVID-19 diagnosis. The risks decreased after adjustment for comorbidities but remained statistically significant for mechanical ventilation and hospitalization.

Disclosure of Interests

Sebastian Bruera: None declared, Xiudong Lei: None declared, Hui Zhao: None declared, Jinoos Yazdany Consultant of: She has performed consulting for Aurinia, Astra Zeneca, and Pfizer, unrelated to this work., Grant/research support from: Dr. Yazdany has research grants from Astra Zeneca, Gilead and the Bristol Myers Squibb Foundation unrelated to this work., Mariana Chavez-Macgregor: None declared, Sharon Giordano: None declared, Maria Suarez-Almazor Consultant of: Dr, Suarez-Almazor has been a consultant for Pfizer, Eli Lilly, Chemosentryx, Bristol Myers Squibb.

All unrelated to the topic of this study.

Evaluation of the Accuracy of Six Simple Screening Tools for Sarcopenia in Schizophrenic Patients

OBJECTIVES

Our objective was to evaluate if SARC-F, SARC-CalF, SARC-F-EBM, calf circumference (CC), mid-upper-arm circumference (MUAC) and Ishii test can be used to accurately screen for sarcopenia in schizophrenic patients.

METHOD

We enrolled schizophrenic patients aged 50 or older, who were regularly taking antipsychotic medications, at two mental health centres. Bioimpedance-based muscle-mass was analysed with an InBody 770 instrument, while muscle strength was measured with a digital grip-strength dynamometer. The physical performance of the patients was gauged from their gait speed over 6 m. Standard AWGS2019 diagnostic criteria were used, and the accuracies of the six screening methods were indicated by the sensitivity, negative predictive value (NPV), and area under receiver operating characteristic curve (AUC).

RESULTS

A total of 339 stable schizophrenic patients were enrolled. The overall prevalence of sarcopenia was 53.1%, and the prevalence was 55.6% and 47.66%, respectively, for males and females. The prevalence of sarcopenia obesity in the total population was 16.22%, and that of males and females was 18.97% and 10.28%, respectively. The SARC-F, SARC-CalF, SARC-F-EBM, CC, MUAC and Ishii test sensitivity/NPV in screening for sarcopenia were 41.86%/0.52, 79.07%/0.7, 28.68%/0.51, 78.3%/0.71, 76.74%/0.7, 89.92%/0.84, respectively, in males and 45.1%/0.59, 94.12%/0.91, 54.9%/0.7, 92.16%/60.91, 74.51%/0.77, 96.08%/0.94, respectively, in females. In males, the AUCs of the SARC-F, SARC-CalF, SARC-F-EBM, CC, MUAC and Ishii test were 0.601 (95%CI, 0.528-0.673), 0.754 (95%CI,0.69-0.817), 0.657 (95%CI,0.588-0.727), 0.8 (95%CI, 0.744-0.856), 0.781 (95%CI, 0.721-0.84) and 0.88 (95%CI, 0.837-0.922), respectively, and in females, they were 0.587(95%CI,0.479-0.696), 0.794 (95%CI,0.709-0.878), 0.799 (95%CI,0.71-0.888), 0.893 (95%CI, 0.833-0.953), 0.843 (95%CI, 0.772-0.915) and 0.855 (95%CI, 0.784-0.926), respectively.

CONCLUSION

The prevalence of sarcopenia in schizophrenic patients is high. Clinical doctors should screen for sarcopenia in schizophrenic patients and provide timely interventions to reduce the occurrence of adverse events. The above six tools can be used as screening tools, and the Ishii test is the most suitable for screening.

Association between the Severity of Sarcopenia and Pneumonia in Patients with Stable Schizophrenia: A Prospective Study

OBJECTIVES

This study investigates the associations between the severity of sarcopenia and pneumonia in patients with stable schizophrenia.

MATERIALS AND METHODS

This is a prospective study that includes patients from the rehabilitation wards of two mental health centres in western China, who were diagnosed with stable schizophrenia. Baseline data were collected from these patients between September 1 and September 30, 2020, while patients' data associated with pneumonia, diagnosed and treated by clinicians, were collected between October 2020 and October 2021. The severity of sarcopenia was diagnosed according to the diagnostic criteria defined by the Asian Working Group for Sarcopenia (AWGS) 2019. The association between the severity of sarcopenia and pneumonia in patients with schizophrenia was analyzed with the use of logistic regression analysis.

RESULTS

Three hundred and thirty-five patients with stable schizophrenia were enrolled in the prospective study, among whom 242 (72.24%) were≥60 years old, and 229 (68.36%) were males. Among the patients with stable schizophrenia, 130 (38.8%) were diagnosed with non-severe sarcopenia, whereas 47 (14.0%) had severe sarcopenia. Eighty-two (24.5%) of patients with schizophrenia fought pneumonia. Our study showed that the severe sarcopenia group had the highest incidence of pneumonia, followed by the non-severe sarcopenia group (severe sarcopenia vs. non-severe sarcopenia vs. normal, 38.3% vs. 28.46% vs. 17.09%, p=0.005). Compared with the normal group, the non-severe sarcopenia group (OR=1.93, 95%CI: 1.1-3.389) and the severe sarcopenia group (OR=3.011, 95%CI: 1.467-6.183) had a higher risk of pneumonia. We further adjusted the potential confounders such as sex, smoking history, chronic obstructive pulmonary disease (COPD), Patient Health Questionnaire (PHQ-9) score, and benzhexol and confirmed that only the severe sarcopenia group had an increased risk of pneumonia (OR=2.366, 95%CI: 1.078-5.191).

CONCLUSIONS

We have demonstrated that severe sarcopenia was associated with pneumonia in patients diagnosed with stable schizophrenia.

Psychosocial adjustment mediates impacts of playmate positive support on body mass index and overweight risk in adolescents

OBJECTIVES

We examined the mediation effects of psychosocial adjustment on the impact of playmate positive support throughout childhood and early adolescence (from age 54 months to 11 years) on later body mass index (BMI) and overweight risk in middle adolescence (age 15 years).

STUDY DESIGN

This was a prospective cohort study.

METHODS

Among 844 children and their families, positive support between child-playmate dyads was repeatedly assessed from child's age 54 months to Grade 5. Long-term positive support between child-playmate dyads throughout childhood and early adolescence was prospectively linked to child's BMI and overweight/obesity status at age 15 years. The average scores of repeated assessments of internalizing and externalizing behavior problems from Grades 3 to 6 were used as mediators.

RESULTS

Significant mediations of internalizing and externalizing behavior problems were observed on pathways from positive support between child-playmate dyads to later BMI and overweight/obesity status at age 15 years. The observed mediations were mainly sustained with pronounced magnitudes in girls, but not in boys.

CONCLUSIONS

Our findings demonstrated a significant mediating role of psychosocial adjustment. Future research efforts are highly encouraged to replicate our findings and further explore this underlying mediation mechanism.

COPB2: a transport protein with multifaceted roles in cancer development and progression

The Coatomer protein complex subunit beta 2 (COPB2) is involved in the formation of the COPI coatomer protein complex and is responsible for the transport of vesicles between the Golgi apparatus and the endoplasmic reticulum. It plays an important role in maintaining the integrity of these cellular organelles, as well as in maintaining cell homeostasis. More importantly, COPB2 plays key roles in embryonic development and tumor progression. COPB2 is regarded as a vital oncogene in several cancer types and has been implicated in tumor cell proliferation, survival, invasion, and metastasis. Here, we summarize the current knowledge on the roles of COPB2 in cancer development and progression in the context of the hallmarks of cancer.

FRI0516 FACTORS ASSOCIATED WITH DECREASED CERVICAL CANCER SCREENING IN WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that carries an increased risk for both viral illnesses and malignancies, including a greater risk for both human papilloma virus (HPV) infection and cervical cancer. Due to this increased risk, the American Society of Colposcopy and Cervical Pathology guidelines for SLE patients recommend more frequent cervical cancer screening. Few studies have examined patient characteristics associated with decreased cervical cancer screening in patients with autoimmune disease, specifically SLE.

Objectives:

To estimate cervical cancer screening rates in women with recently diagnosed SLE, and to identify characteristics associated with decreased screening.

Methods:

We identified women with an initial diagnosis of SLE in the United States MarketScan Commercial Claims and Encounter (CCAE, age 18-64) administrative claims database. We included patients with at least three claims with a lupus diagnosis (first and last at least >90 days apart), no lupus claims within the year before initial claim, and who had been on antimalarial drugs for at least 90 days. We excluded all patients with a previous claim for hysterectomy.

Cervical cancer screening was ascertained using diagnosis and procedure codes within 1 year before and 2 years after the first SLE claim. Our covariates included the year of first SLE claim (2001-2014), age at first SLE claim, comorbidity score, insurance type, geographical region, and prescriptions for multiple types of corticosteroids. Control patients included age-matched females without autoimmune disease. Univariate comparison and multivariate logistic regression models were built to evaluate determinants of screening.

Results:

We included 4,316 SLE patients (median age 45) and 86,544 control patients. The screening rate in SLE patients was 73.4% vs 58.5% in the controls (P < 0.001). The screening rate was 71% in 2001, increased to 75% in 2004, then decreased to 70% in 2014 (trend P =0.005). In the multivariate model the following factors were associated with decreased cervical cancer screening: year of first SLE claim 2012-2014 versus 2001-2005 (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.53 – 0.84, P < 0.001); older age 61-64 versus 21-30 (OR 0.27, 95% CI 0.19 – 0.39, P < 0.001); comorbidity score of ≥2 versus <2 (OR 0.71, 95% CI 0.6 – 0.83, P < 0.001); and use of corticosteroids for ≥ 90 days versus <90 days (OR 0.73, 95% CI 0.59 – 0.9, P = 0.003). Insurance type and geographical region were not associated with cervical cancer screening.

Conclusion:

About three quarters of women with SLE underwent cervical cancer screening within 3 years of their first lupus claim, at higher rates than controls. However, there was a concerning downward trend in screening rates in recent years. In addition, higher risk populations for cervical cancer (older age, increased comorbidities, and longer duration of corticosteroids) had lower screening rates. These findings highlight the need to enhance education for healthcare providers to improve utilization of screening in women with SLE at high risk of cervical cancer.

Disclosure of Interests:

Sebastian Bruera: None declared, Richard Zogala: None declared, Xiudong Lei: None declared, Xerxes Pundole: None declared, Hui Zhao: None declared, Sharon Giordano: None declared, Jessica Hwang Grant/research support from: MERCK grant funding unrelated to SLE., Maria Suarez-Almazor: None declared

[Efficacy comparison between robot-assisted and laparoscopic surgery for mid-low rectal cancer: a prospective randomized controlled trial]

Objective: To compare the short- and long-term outcomes of robot-assisted and laparoscopic radical resection for mid-low rectal cancer. Methods: A prospective randomized controlled trial was conducted. A total of 130 patients with mid-low rectal cancer (inclusion criteria: age > 18 or ≤80 years old; pathological diagnosis of rectal adenocarcinoma by colonoscopy; distance from tumor to the anal verge ≤12 cm; no distant metastasis; cT1-3N0-1 or ycT1-3 after neoadjuvant radiotherapy and chemotherapy; suitable for laparoscopic and robotic surgery) at the Department of Colorectal Surgery of the First Affiliated Hospital of Nanchang University from October 2016 to September 2018 were prospectively enrolled. According to computer-generated random number method, patients were randomly divided into the robot group (n=66) and laparoscopy group (n=64), and underwent robot-assisted surgery or laparoscopic surgery respectively. Clinicopathological data of all the patients were collected and analyzed. The demographic parameters, short- and long-term outcomes were compared between two groups. Results: One patient in robot group whose postoperative sample was diagnosed as rectal adenoma by pathology was excluded. There were no statistically significant differences in age, sex, BMI, ASA classification, distance from tumor to the anal verge, serum CEA level, CA199 level between two groups (all P>0.05). Operations were successfully performed in all the patients without conversion to open operation. Robotic surgery was found to be associated with less intraoperative blood loss than laparoscopic surgery [(73.4±49.7) ml vs. (119.1±65.7) ml, t=-4.461, P<0.001], while there were no statistically significant differences in surgical procedures, operation time, time to first flatus, time to first liquid intake, time to removal of catheter or postoperative hospital stay between two groups (all P>0.05). Besides, there was no significant difference in the morbidity of postoperative complication between two groups [10.8% (7/65) vs. 12.5 (8/64), χ(2)=4.342, P=0.720]. The median number of harvested lymph node in the robot group and the laparoscopy group was 15.7±6.2 and 13.8±6.1 (t=1.724, P=0.087). There were no significant differences between two groups in tumor sample length, distance between proximal and distal resection margin, integrity grade of TME specimen, number of positive lymph nodes, postoperative pathological stage and tumor differentiation (all P>0.05). The distal resection margin of samples in two groups was all negative. One case in the robot group was found to have positive circumferential resection margin. The median follow up was 24 (9 to 31) months. In the robot group and the laparoscopy group, the 2-year overall survival rate was 95.4% and 90.6% respectively; the 2-year disease-free survival rate was 90.8% and 85.9% respectively, whose differences were not significant (both P>0.05). Conclusion: Robot-assisted radical resection for mid-low rectal cancer can achieve similar short-term and long-term outcomes of laparoscopic resection, while robot-assisted surgery can decrease blood loss during operation, leading to more precise practice in minimally invasive surgery.

[The clinical significance of serum autoantibodies and HLA-B(27) molecule testing in Uygur patients with human immunodeficiency virus infection]

Objective: To explore the clinical value of serum autoantibodies and human leukocyte antigen (HLA-B(27)) molecular testing in Uygur patients with human immunodeficiency virus (HIV) infection. Method: A total of 727 HIV-infected Uygur patients who visited Kuche infectious diseases hospital during May 2016 to March 2017 were include in this study. The other 390 healthy people were enrolled as controls. Serum antinuclear antibodies (ANA), anti-cyclic citrullinated peptide (CCP) antibody, anti-extractable nuclear antigen (ENAs) antibody and HLA-B(27) molecule were tested. Result: Among 727 HIV-infected Uygur patients, 317 were males and 410 were females with mean age (35.52±13.44) years old. The mean duration of disease was (6.34±3.05) years. There were 697 (95.87%) patients receiving highly active antiretroviral therapy (HAART) with mean duration of treatment (5.52±3.47) years. The mean CD4(+)T cell count was (520±271) cells/μl in 202 HIV-infected patients, and mean virus load was (108 139±20 498) copies/ml in 20 HIV-infected patients. Rheumatic manifestations were recorded in 238 (32.74%) HIV-infected Uygur patients, mainly with dry mouth and dry eye (15.41%) , alopecia (9.90%) , arthralgia (8.94%) , ect. Compared with the health controls, positive ANA was more common in HIV infected Uygur patients (33.43% vs. 17.43%, P<0.001) with low titers (ANA titer:1∶100) . HIV-infected Uygur patients had higher positive anti-u1-RNP antibodies positive rate (1.10%), but lower anti-SSA antibodies positive rate (0.14%) and anti-CCP antibodies positive rate (0.28%). Patients with positive ANA in HAART group were significantly less than that in non-treatment group (32.71% vs. 50.00%, P=0.049). There were no correlations between ANA and duration of HAART, CD4(+)T cell counts and virus load (r values 0.061, 0.047, 0.121, respectively. P>0.05). Only one female patient was HLA-B(27) positive (0.14%), which was significantly lower than that in healthy controls (3.08%) (P<0.001). Also, only one patient was diagnosed with rheumatoid arthritis (RA). Conclusion: Autoimmune manifestations are common in HIV-infected Uygur patients. Several autoantibodies are positive, but the coincidence of rheumatic diseases is rare. It's noted that patients with autoimmune manifestations should be considered as a differential diagnosis of HIV infection.

Toll-like receptors and radiation protection

Exposure to ionizing radiation (IR) causes severe injuries to the human body, and normal tissue toxicity also limits the further application of cancer radiotherapy. However, current clinically used radioprotective agents are difficult to produce satisfactory effects. Toll-Like receptor (TLR) is a kind of pattern recognition receptor (PRR) that has been extensively studied for radioprotection in recent years. Several TLR family members are closely related to radioprotection. In cultured cells, TLR2, TLR5 or TLR9 agonist was proved to inhibit radiation-induced apoptosis and increase cell survival. TLR5 ligand CBLB502 was reported to alleviate bone marrow and intestinal injuries in mice and rhesus monkeys. Activation of TLR4 by its agonist LPS can protect bone marrow damage and lower mice mortality after irradiation. TLR9 ligand also exhibited protective effects on mid jejunum. Moreover, some kinds of TLR agonists, such as TLR2/6 co-agonist CBLB613, were reported to be more effective in radioprotection than single TLR agonist. In conclusion, TLRs and their ligands provide novel strategies for radiation protection in nuclear accidents as well as protection of normal tissues during cancer radiotherapy.

Abstract P4-10-02: Impact of raloxifene adherence in breast cancer risk

BACKGROUND: Raloxifene is a selective estrogen receptor modulator that has demonstrated to reduce breast cancer risk and reduce the incidence of vertebral fractures. Based on these effects, raloxifene is used as a risk reduction agent and to prevent osteoporosis in postmenopausal women. Little is known about the raloxifene adherence rates or the relationship between adherence and breast cancer incidence.

METHODS: Women 60 years or older without a breast cancer history were identified in the MarketScan database (2008-2015). We identified women who received raloxifene by searching for prescription claims. Proportion of days covered (PDC) were calculated, adherence was defined as a PDC &gt;80% in the first year after initial prescription claim. We identified factors associated with adherence. ICD-9 codes were used to identify incident cases of invasive breast cancer and cumulative incidence rates were calculated. A multivariable Cox model with propensity score method (matching variables included year of claim, age, comorbidities and family history of breast cancer) was used to evaluate the association between raloxifene adherence and breast cancer risk. All statistical tests were two-sided.

RESULTS: A total of 16,179 women were included in the analysis. We identified that during the first year of treatment 6,716 (40.2%) women had a PDC &gt;80% and thus were considered to be adherent. Factors associated with increased adherence included the use of generic drug, mail order of 90 days supply and family history of breast cancer (all p&lt;0.001). Using propensity score matching, the 5 year-cumulative incidence of invasive breast cancer was 1.5% among those not adherent and 0.9% among those adherent to raloxifene (p=0.01). Similarly, the 9 year-cumulative rates were 3.6% and 1.9% respectively (p=0.01). After adjusting for potential confounders, patients that were adherent to raloxifene during the first year of treatment had a lower risk of invasive breast cancer compared to those that were non-adherent (HR=0.64; 95%CI 0.04-0.9).

CONCLUSIONS: Among women 60 years of age or older receiving raloxifene, adherence to therapy was associated with lower risk of invasive breast cancer. Efforts to ensure adherence and compliance are crucial so patients can receive full benefit from this therapy.

Citation Format: Chavez-MacGregor M, Lei X, Zhao H, Bevers TB, Brewster A, Giordano SH. Impact of raloxifene adherence in breast cancer risk [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-02.

Erratum to: Measurement of the W boson polarisation in t t ¯ events from pp collisions at s = 8 TeV in the lepton + jets channel with ATLAS

[This corrects the article DOI: 10.1140/epjc/s10052-017-4819-4.].

Search for electroweak production of supersymmetric particles in final states with two or three leptons at s = 13 TeV with the ATLAS detector

A search for the electroweak production of charginos, neutralinos and sleptons decaying into final states involving two or three electrons or muons is presented. The analysis is based on 36.1 fb- 1 ofs = 13  TeV proton-proton collisions recorded by the ATLAS detector at the Large Hadron Collider. Several scenarios based on simplified models are considered. These include the associated production of the next-to-lightest neutralino and the lightest chargino, followed by their decays into final states with leptons and the lightest neutralino via either sleptons or Standard Model gauge bosons; direct production of chargino pairs, which in turn decay into leptons and the lightest neutralino via intermediate sleptons; and slepton pair production, where each slepton decays directly into the lightest neutralino and a lepton. No significant deviations from the Standard Model expectation are observed and stringent limits at 95% confidence level are placed on the masses of relevant supersymmetric particles in each of these scenarios. For a massless lightest neutralino, masses up to 580 GeV are excluded for the associated production of the next-to-lightest neutralino and the lightest chargino, assuming gauge-boson mediated decays, whereas for slepton-pair production masses up to 500 GeV are excluded assuming three generations of mass-degenerate sleptons.

Performance of missing transverse momentum reconstruction with the ATLAS detector using proton-proton collisions at s = 13 TeV

The performance of the missing transverse momentum ( E T miss ) reconstruction with the ATLAS detector is evaluated using data collected in proton-proton collisions at the LHC at a centre-of-mass energy of 13 TeV in 2015. To reconstruct E T miss , fully calibrated electrons, muons, photons, hadronically decaying τ -leptons , and jets reconstructed from calorimeter energy deposits and charged-particle tracks are used. These are combined with the soft hadronic activity measured by reconstructed charged-particle tracks not associated with the hard objects. Possible double counting of contributions from reconstructed charged-particle tracks from the inner detector, energy deposits in the calorimeter, and reconstructed muons from the muon spectrometer is avoided by applying a signal ambiguity resolution procedure which rejects already used signals when combining the various E T miss contributions. The individual terms as well as the overall reconstructed E T miss are evaluated with various performance metrics for scale (linearity), resolution, and sensitivity to the data-taking conditions. The method developed to determine the systematic uncertainties of the E T miss scale and resolution is discussed. Results are shown based on the full 2015 data sample corresponding to an integrated luminosity of 3.2 fb - 1 .

Measurement of colour flow using jet-pull observables in t t ¯ events with the ATLAS experiment at s = 13 TeV

Previous studies have shown that weighted angular moments derived from jet constituents encode the colour connections between partons that seed the jets. This paper presents measurements of two such distributions, the jet-pull angle and jet-pull magnitude, both of which are derived from the jet-pull angular moment. The measurement is performed in t t ¯ events with one leptonically decaying W boson and one hadronically decaying W boson, using 36.1 fb - 1 of pp collision data recorded by the ATLAS detector ats = 13 TeV delivered by the Large Hadron Collider. The observables are measured for two dijet systems, corresponding to the colour-connected daughters of the W boson and the two b-jets from the top-quark decays, which are not expected to be colour connected. To allow the comparison of the measured distributions to colour model predictions, the measured distributions are unfolded to particle level, after correcting for experimental effects introduced by the detector. While good agreement can be found for some combinations of predictions and observables, none of the predictions describes the data well across all observables.

Measurement of the Soft-Drop Jet Mass in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector

Jet substructure observables have significantly extended the search program for physics beyond the standard model at the Large Hadron Collider. The state-of-the-art tools have been motivated by theoretical calculations, but there has never been a direct comparison between data and calculations of jet substructure observables that are accurate beyond leading-logarithm approximation. Such observables are significant not only for probing the collinear regime of QCD that is largely unexplored at a hadron collider, but also for improving the understanding of jet substructure properties that are used in many studies at the Large Hadron Collider. This Letter documents a measurement of the first jet substructure quantity at a hadron collider to be calculated at next-to-next-to-leading-logarithm accuracy. The normalized, differential cross section is measured as a function of log_{10}ρ^{2}, where ρ is the ratio of the soft-drop mass to the ungroomed jet transverse momentum. This quantity is measured in dijet events from 32.9  fb^{-1} of sqrt[s]=13  TeV proton-proton collisions recorded by the ATLAS detector. The data are unfolded to correct for detector effects and compared to precise QCD calculations and leading-logarithm particle-level Monte Carlo simulations.

Measurement of the Effective Weak Mixing Angle in pp[over ¯]→Z/γ^{*}→ℓ^{+}ℓ^{-} Events

We present a measurement of the effective weak mixing angle parameter sin^{2}θ_{eff}^{ℓ} in pp[over ¯]→Z/γ^{*}→μ^{+}μ^{-} events at a center-of-mass energy of 1.96 TeV, collected by the D0 detector at the Fermilab Tevatron Collider and corresponding to 8.6  fb^{-1} of integrated luminosity. The measured value of sin^{2}θ_{eff}^{ℓ}[μμ]=0.23016±0.00064 is further combined with the result from the D0 measurement in pp[over ¯]→Z/γ^{*}→e^{+}e^{-} events, resulting in sin^{2}θ_{eff}^{ℓ}[comb]=0.23095±0.00040. This combined result is the most precise measurement from a single experiment at a hadron collider and is the most precise determination using the coupling of the Z/γ^{*} to light quarks.

Measurement of the inclusive and fiducial t t ¯ production cross-sections in the lepton+jets channel in pp collisions at s = 8 TeV with the ATLAS detector

The inclusive and fiducial t t ¯ production cross-sections are measured in the lepton+jets channel using 20.2 fb - 1 of proton-proton collision data at a centre-of-mass energy of 8 TeV recorded with the ATLAS detector at the LHC. Major systematic uncertainties due to the modelling of the jet energy scale and b-tagging efficiency are constrained by separating selected events into three disjoint regions. In order to reduce systematic uncertainties in the most important background, the W +\,jets process is modelled using Z + jets events in a data-driven approach. The inclusive t t ¯ cross-section is measured with a precision of 5.7% to beσ inc ( t t ¯ ) = 248.3 ± 0.7 ( stat . ) ± 13.4 ( syst . ) ± 4.7 ( lumi . ) pb , assuming a top-quark mass of 172.5 GeV. The result is in agreement with the Standard Model prediction. The cross-section is also measured in a phase space close to that of the selected data. The fiducial cross-section isσ fid ( t t ¯ ) = 48.8 ± 0.1 ( stat . ) ± 2.0 ( syst . ) ± 0.9 ( lumi . ) pb with a precision of 4.5%.

[Clinical presentations of neuromyelitis optica spectrum disorders with ultra-longitudinally extensive transverse myelitis]

Objective: To analyze the clinical presentations of neuromyelitis optica spectrum disorders (NMOSD) with ultra-longitudinally extensive transverse myelitis (uLETM), in order to improve the diagnostic accuracy of this disorder. Methods: Twenty-two uLETM patients was recruited and retrospectively analyzed for general clinical characteristics, laboratory tests and MRI characteristics, as well as therapeutic. Results: (1)The Male-to-female ratio was 1∶6. The median onset age was 31 years old. The duration from the first relapse to the onset was 5.5 months. (2)The positive rate of serum water channel aquaporin-4 antibody (AQP4-Ab) in the acute phase was 86.4%. The positive rate of cerebrospinal fluid (CSF) AQP4-Ab in the acute phase was 69.2%. The positive rate of autoimmune antibodies was 72.7%. There was a remarkable difference (Z=-12.632, P=0.000) in serum AQP4-Ab titer levels between with the acute and remission period (median titer of 1∶244.78 to 1∶139.63). There was a remarkable difference (Z=-20.161, P=0.000) in geometric mean of serum AQP4-Ab titer levels between with CSF AQP4-Ab positive (1∶289.8) and negative (1∶36.2). (3)63.6% of the uLETM patients had 10-15 contiguous segments, 31.8% had 16-19 contiguous segments and 4.5% had whole spinal cord affected. 72.7% of the lesions of uLETM were sliver. The detection rate of optic nerve lesion by MRI was 63.6% and brain sliver lesions was seen in 63.6% of the patients.(4) All patients improved after treatment with high-dose glucocorticoids (GCs) in the acute phase. 15 cases treated with long-term oral administration of low-dose GCs in remission stage of NMOSD. 6 cases treated with mycophenolate mofetil. 1 case treated with intravenous immunoglobulins. Conclusions: NMOSD with uLETM is predominantly seen in young woman. The high risk period of relapse is 5.5 months after the onset. A high portion of NMOSD patients with uLETM have serum and CSF AQP4-Ab in acute phase. The therapy of GCs is recommended in acute phase. Combination of GCs with immunosuppressant can achieve stable and satisfactory effect in remission period of NMOSD.

Search for a new heavy gauge-boson resonance decaying into a lepton and missing transverse momentum in 36 fb - 1 of pp collisions at s = 13 TeV with the ATLAS experiment

The results of a search for new heavy W ' bosons decaying to an electron or muon and a neutrino using proton-proton collision data at a centre-of-mass energy ofs = 13  TeV are presented. The dataset was collected in 2015 and 2016 by the ATLAS experiment at the Large Hadron Collider and corresponds to an integrated luminosity of 36.1 fb - 1 . As no excess of events above the Standard Model prediction is observed, the results are used to set upper limits on the W ' boson cross-section times branching ratio to an electron or muon and a neutrino as a function of the W ' mass. Assuming a W ' boson with the same couplings as the Standard Model W boson, W ' masses below 5.1 TeV are excluded at the 95% confidence level.

Search for a Structure in the B_{s}^{0}π^{±} Invariant Mass Spectrum with the ATLAS Experiment

A search for the narrow structure, X(5568), reported by the D0 Collaboration in the decay sequence X→B_{s}^{0}π^{±}, B_{s}^{0}→J/ψϕ, is presented. The analysis is based on a data sample recorded with the ATLAS detector at the LHC corresponding to 4.9  fb^{-1} of pp collisions at 7 TeV and 19.5  fb^{-1} at 8 TeV. No significant signal was found. Upper limits on the number of signal events, with properties corresponding to those reported by D0, and on the X production rate relative to B_{s}^{0} mesons, ρ_{X}, were determined at 95% confidence level. The results are N(X)<382 and ρ_{X}<0.015 for B_{s}^{0} mesons with transverse momenta above 10 GeV, and N(X)<356 and ρ_{X}<0.016 for transverse momenta above 15 GeV. Limits are also set for potential B_{s}^{0}π^{±} resonances in the mass range 5550 to 5700 MeV.

Search for heavy ZZ resonances in the ℓ + ℓ - ℓ + ℓ - and ℓ + ℓ - ν ν ¯ final states using proton-proton collisions at s = 13 TeV with the ATLAS detector

A search for heavy resonances decaying into a pair of Z bosons leading toℓ + ℓ - ℓ + ℓ - andℓ + ℓ - ν ν ¯ final states, where ℓ stands for either an electron or a muon, is presented. The search uses proton-proton collision data at a centre-of-mass energy of 13  TeV corresponding to an integrated luminosity of 36.1  fb - 1 collected with the ATLAS detector during 2015 and 2016 at the Large Hadron Collider. Different mass ranges for the hypothetical resonances are considered, depending on the final state and model. The different ranges span between 200 and 2000  GeV . The results are interpreted as upper limits on the production cross section of a spin-0 or spin-2 resonance. The upper limits for the spin-0 resonance are translated to exclusion contours in the context of Type-I and Type-II two-Higgs-doublet models, while those for the spin-2 resonance are used to constrain the Randall-Sundrum model with an extra dimension giving rise to spin-2 graviton excitations.

Collective effects of common single nucleotide polymorphisms and genetic risk prediction in type 1 diabetes

Type 1 diabetes (T1D) is a common autoimmune disease and may be related to multiple genetic and environmental risk factors. Previous genetic studies have focused on looking for individual polymorphic risk variants. Here, we studied the overall levels of genetic diversity in T1D patients by making use of a previously published study including 1865 cases and 2828 reference samples with genotyping data for 500 K common single nucleotide polymorphisms (SNPs). We determined the minor allele (MA) status of each SNP in the reference samples and calculated the total number of MAs or minor allele contents (MAC) of each individual. We found the average MAC of cases to be greater than that of the reference samples. By focusing on MAs with strong linkage to cases, we further identified a set of 112 SNPs that could predict 19.19% of cases. These results suggest that overall genetic variation over a threshold level may be a risk factor in T1D and provide a new genetic method for predicting the disorder.

A search for pair-produced resonances in four-jet final states at s = 13 TeV with the ATLAS detector

A search for massive coloured resonances which are pair-produced and decay into two jets is presented. The analysis uses 36.7 fb- 1 of s = 13 TeV pp collision data recorded by the ATLAS experiment at the LHC in 2015 and 2016. No significant deviation from the background prediction is observed. Results are interpreted in a SUSY simplified model where the lightest supersymmetric particle is the top squark, t ~ , which decays promptly into two quarks through R-parity-violating couplings. Top squarks with masses in the range 100 GeV < m t ~ < 410   GeV are excluded at 95% confidence level. If the decay is into a b-quark and a light quark, a dedicated selection requiring two b-tags is used to exclude masses in the ranges 100 GeV < m t ~ < 470   GeV and 480 GeV < m t ~ < 610   GeV . Additional limits are set on the pair-production of massive colour-octet resonances.

Search for doubly charged Higgs boson production in multi-lepton final states with the ATLAS detector using proton-proton collisions at s = 13 TeV

A search for doubly charged Higgs bosons with pairs of prompt, isolated, highly energetic leptons with the same electric charge is presented. The search uses a proton-proton collision data sample at a centre-of-mass energy of 13 TeV corresponding to 36.1 fb - 1 of integrated luminosity recorded in 2015 and 2016 by the ATLAS detector at the LHC. This analysis focuses on the decaysH ± ± → e ± e ± ,H ± ± → e ± μ ± andH ± ± → μ ± μ ± , fitting the dilepton mass spectra in several exclusive signal regions. No significant evidence of a signal is observed and corresponding limits on the production cross-section and consequently a lower limit on m ( H ± ± ) are derived at 95% confidence level. Withℓ ± ℓ ± = e ± e ± / μ ± μ ± / e ± μ ± , the observed lower limit on the mass of a doubly charged Higgs boson only coupling to left-handed leptons varies from 770 to 870 GeV (850 GeV expected) for B ( H ± ± → ℓ ± ℓ ± ) = 100 % and both the expected and observed mass limits are above 450 GeV for B ( H ± ± → ℓ ± ℓ ± ) = 10 % and any combination of partial branching ratios.

Measurement of differential cross-sections of a single top quark produced in association with a W boson at s = 13 TeV with ATLAS

The differential cross-section for the production of a W boson in association with a top quark is measured for several particle-level observables. The measurements are performed using36.1 fb - 1 of pp collision data collected with the ATLAS detector at the LHC in 2015 and 2016. Differential cross-sections are measured in a fiducial phase space defined by the presence of two charged leptons and exactly one jet matched to a b-hadron, and are normalised with the fiducial cross-section. Results are found to be in good agreement with predictions from several Monte Carlo event generators.

Measurement of quarkonium production in proton-lead and proton-proton collisions at 5.02 TeV with the ATLAS detector

The modification of the production of J / ψ , ψ ( 2 S ) , and Υ ( n S ) ( n = 1 , 2 , 3 ) in p+Pb collisions with respect to their production in pp collisions has been studied. The p+Pb and pp datasets used in this paper correspond to integrated luminosities of 28 nb - 1 and 25 pb - 1 respectively, collected in 2013 and 2015 by the ATLAS detector at the LHC, both at a centre-of-mass energy per nucleon pair of 5.02 TeV. The quarkonium states are reconstructed in the dimuon decay channel. The yields of J / ψ and ψ ( 2 S ) are separated into prompt and non-prompt sources. The measured quarkonium differential cross sections are presented as a function of rapidity and transverse momentum, as is the nuclear modification factor, R p Pb for J / ψ and Υ ( n S ) . No significant modification of the J / ψ production is observed while Υ ( n S ) production is found to be suppressed at low transverse momentum in p+Pb collisions relative to pp collisions. The production of excited charmonium and bottomonium states is found to be suppressed relative to that of the ground states in central p+Pb collisions.

Measurement of τ polarisation in Z / γ ∗ → τ τ decays in proton-proton collisions at s = 8 TeV with the ATLAS detector

This paper presents a measurement of the polarisation of τ leptons produced in Z / γ ∗ → τ τ decays which is performed with a dataset of proton-proton collisions ats = 8 TeV, corresponding to an integrated luminosity of 20.2 fb- 1 recorded with the ATLAS detector at the LHC in 2012. The Z / γ ∗ → τ τ decays are reconstructed from a hadronically decaying τ lepton with a single charged particle in the final state, accompanied by a τ lepton that decays leptonically. The τ polarisation is inferred from the relative fraction of energy carried by charged and neutral hadrons in the hadronic τ decays. The polarisation is measured in a fiducial region that corresponds to the kinematic region accessible to this analysis. The τ polarisation extracted over the full phase space within the Z / γ ∗ mass range of 66 < m Z / γ ∗ < 116 GeV is found to beP τ = - 0.14 ± 0.02 ( stat ) ± 0.04 ( syst ) . It is in agreement with the Standard Model prediction ofP τ = - 0.1517 ± 0.0019 , which is obtained from the ALPGEN event generator interfaced with the PYTHIA 6 parton shower modelling and the TAUOLA τ decay library.

Search for the direct production of charginos and neutralinos in final states with tau leptons in s = 13 TeV pp collisions with the ATLAS detector

A search for the direct production of charginos and neutralinos in final states with at least two hadronically decaying tau leptons is presented. The analysis uses a dataset of pp collisions corresponding to an integrated luminosity of 36.1 fb- 1 , recorded with the ATLAS detector at the Large Hadron Collider at a centre-of-mass energy of 13 TeV. No significant deviation from the expected Standard Model background is observed. Limits are derived in scenarios of pair production and of and production in simplified models where the neutralinos and charginos decay solely via intermediate left-handed staus and tau sneutrinos, and the mass of theτ ~ L state is set to be halfway between the masses of the and the . Chargino masses up to 630 GeV are excluded at 95% confidence level in the scenario of direct production of for a massless . Common and masses up to 760 GeV are excluded in the case of production of and assuming a massless . Exclusion limits for additional benchmark scenarios with large and small mass-splitting between the and the are also studied by varying theτ ~ L mass between the masses of the and the .