Surgical Treatment of Multiple Large Tuberous and Tendinous Xanthoma Secondary to Familial Hypercholesterolaemia: A Case Report

Xanthomas are well-circumscribed skin lesions that are commonly seen in patients with familial hypercholesterolemia (FH). The aim of this report is to present a rare case of multiple large tuberous and tendinous xanthomas. A 17-year-old female patient in this report presented with multiple asymptomatic and papulo-nodular masses in both sides of palms, elbows, buttocks, knees, and Achilles tendons. Surgical removal of the masses was carried out in combination with lipid-lowering therapy. A following up of 3 months showed all wounds were healing well, and no recurrence of masses was observed. Therefore, for patients with xanthomas related with familial hypercholesterolaemia, lipid-lowering therapy has reportedly reduced the size of masses, but surgical treatment may be essential for large xanthomas caused pain or limitation of daily activities.

Abnormal cell wall structure caused by boron nutrient imbalance in orchards could affect psyllid feeding behaviour, resulting in epidemic variation of Asian citrus psyllid

The control of Huanglongbing (HLB), one of the most destructive pests of citrus, relies heavily on the reduction of Asian citrus psyllid (ACP), Diaphorina citri Kuwayama. An in-depth understanding of ACP feeding behaviours among citrus plants is urgent for comprehensive management of orchards. An investigation was conducted in 37 citrus orchards in HLB epidemic areas, sampling shoots in the area with aggregation feeding of ACP (ACPf) and shoots in a neighbouring area without ACP feeding (CK), to study the interaction between leaf chemical composition and ACP psyllid feeding behaviours. Results of FTIR showed a strong absorption peak intensity, mainly representing functional groups originating from cell wall components in the leaf with ACP feeding. As compared with the control, cell wall components, such as alkali-soluble pectin, water-soluble pectin, total soluble pectin, cellulose, and hemicellulose, of the cell wall of ACPf increased by 134.0%, 14.0%, 18.0%, 12.5%, and 20.35%, respectively. These results suggest that cell wall mechanical properties significantly decreased in the term of decreases in pectin performance and cellulose mechanical properties. In addition, there was a remarkably lower boron (B) content in leaves and cell wall components with ACP feeding. Further analysis indicated that leaf B content significantly affected leaf cell wall components. Taken together, we provide evidence to demonstrate that the regional distribution of nutrient imbalance in orchards could affect psyllid feeding behaviour by weakening the cell wall structure, resulting in epidemic variation in ACP. This could help us to understand the management of psyllid infections in orchards with unbalanced nutrition.

Intestinal Translocation of Live Porphyromonas gingivalis Drives Insulin Resistance

Periodontitis has been emphasized as a risk factor of insulin resistance-related systemic diseases. Accumulating evidence has suggested a possible "oral-gut axis" linking oral infection and extraoral diseases, but it remains unclear whether periodontal pathogens can survive the barriers of the digestive tract and how they play their pathogenic roles. The present study established a periodontitis mouse model through oral ligature plus Porphyromonas gingivalis inoculation and demonstrated that periodontitis aggravated diet-induced obesity and insulin resistance, while also causing P. gingivalis enrichment in the intestine. Metabolic labeling strategy validated that P. gingivalis could translocate to the gastrointestinal tract in a viable state. Oral administration of living P. gingivalis elicited insulin resistance, while administration of pasteurized P. gingivalis had no such effect. Combination analysis of metagenome sequencing and nontargeted metabolomics suggested that the tryptophan metabolism pathway, specifically indole and its derivatives, was involved in the pathogenesis of insulin resistance caused by oral administration of living P. gingivalis. Moreover, liquid chromatography-high-resolution mass spectrometry analysis confirmed that the aryl hydrocarbon receptor (AhR) ligands, mainly indole acetic acid, tryptamine, and indole-3-aldehyde, were reduced in diet-induced obese mice with periodontitis, leading to inactivation of AhR signaling. Supplementation with Ficz (6-formylindolo (3,2-b) carbazole), an AhR agonist, alleviated periodontitis-associated insulin resistance, in which the restoration of gut barrier function might play an important role. Collectively, these findings reveal that the oral-gut translocation of viable P. gingivalis works as a fuel linking periodontitis and insulin resistance, in which reduction of AhR ligands and inactivation of AhR signaling are involved. This study provides novel insight into the role of the oral-gut axis in the pathogenesis of periodontitis-associated comorbidities.

Incremental yield of whole-genome sequencing over chromosomal microarray analysis and exome sequencing for congenital anomalies in prenatal period and infancy: systematic review and meta-analysis

OBJECTIVES

First, to determine the incremental yield of whole-genome sequencing (WGS) over quantitative fluorescence polymerase chain reaction (QF-PCR)/chromosomal microarray analysis (CMA) with and without exome sequencing (ES) in fetuses, neonates and infants with a congenital anomaly that was or could have been detected on prenatal ultrasound. Second, to evaluate the turnaround time (TAT) and quantity of DNA required for testing using these pathways.

METHODS

This review was registered prospectively in December 2022. Ovid MEDLINE, EMBASE, MEDLINE (Web of Science), The Cochrane Library and ClinicalTrials.gov databases were searched electronically (January 2010 to December 2022). Inclusion criteria were cohort studies including three or more fetuses, neonates or infants with (i) one or more congenital anomalies; (ii) an anomaly which was or would have been detectable on prenatal ultrasound; and (iii) negative QF-PCR and CMA. In instances in which the CMA result was unavailable, all cases of causative pathogenic copy number variants > 50 kb were excluded, as these would have been detectable on standard prenatal CMA. Pooled incremental yield was determined using a random-effects model and heterogeneity was assessed using Higgins' I2 test. Subanalyses were performed based on pre- or postnatal cohorts, cases with multisystem anomalies and those meeting the NHS England prenatal ES inclusion criteria.

RESULTS

A total of 18 studies incorporating 902 eligible cases were included, of which eight (44.4%) studies focused on prenatal cohorts, incorporating 755 cases, and the remaining studies focused on fetuses undergoing postmortem testing or neonates/infants with congenital structural anomalies, constituting the postnatal cohort. The incremental yield of WGS over QF-PCR/CMA was 26% (95% CI, 18-36%) (I2  = 86%), 16% (95% CI, 9-24%) (I2  = 85%) and 39% (95% CI, 27-51%) (I2  = 53%) for all, prenatal and postnatal cases, respectively. The incremental yield increased in cases in which sequencing was performed in line with the NHS England prenatal ES criteria (32% (95% CI, 22-42%); I2  = 70%) and in those with multisystem anomalies (30% (95% CI, 19-43%); I2  = 65%). The incremental yield of WGS for variants of uncertain significance (VUS) was 18% (95% CI, 7-33%) (I2  = 74%). The incremental yield of WGS over QF-PCR/CMA and ES was 1% (95% CI, 0-4%) (I2  = 47%). The pooled median TAT of WGS was 18 (range, 1-912) days, and the quantity of DNA required was 100 ± 0 ng for WGS and 350 ± 50 ng for QF-PCR/CMA and ES (P = 0.03).

CONCLUSION

While WGS in cases with congenital anomaly holds great promise, its incremental yield over ES is yet to be demonstrated. However, the laboratory pathway for WGS requires less DNA with a potentially faster TAT compared with sequential QF-PCR/CMA and ES. There was a relatively high rate of VUS using WGS. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Case report: acute isolated cilioretinal artery occlusion secondary to percutaneous coronary intervention

INTRODUCTION

This case report aims to describe in detail the acute isolated cilioretinal artery occlusion (CLRAO) secondary to complicated therapeutic percutaneous coronary intervention (PCI).

CASE DESCRIPTION

A 68-year-old Chinese man with coronary artery disease (CAD) complained of sudden, sharp chest pain. Coronary angiography revealed severe stenoses of the coronary arteries. The patient was then treated with PCI. One hour after the procedure, the patient presented with a sudden reduction in vision in the right eye. The patient was diagnosed with acute isolated CLRAO and treated with Salvia miltiorrhiza injections.

CONCLUSIONS

This is the report to provide a detailed description of acute isolated CLRAO secondary to therapeutic PCI treated with Salvia miltiorrhiza. The visual prognosis of the untreated patients is poor. Suitable management and prevention are essential for interventional cardiologists to prevent these complications.

Performance of Adaptive Deep Learning Models for Dose Predictions on High-Quality Cone-Beam Computed Tomography Images

PURPOSE/OBJECTIVE(S)

Online plan generation remains a patient-specific and time-consuming process that can place a significant burden on clinics strained with staffing shortages. As previous research show that dose-volume histogram (DVH) prediction plays a crucial role in automatic treatment planning, the objective of this study is to assess the capability of adaptive deep learning models in predicting dose information in volumetric modulation radiotherapy plans using the high-quality CBCT images and contour information of organs-at-risk (OARs).

MATERIALS/METHODS

The relationship between dose-volume histograms (DVHs) in radiotherapy plans and the geometric information of organs-at-risk (OAR) and planning target volume (PTV) has been well established. To evaluate the performance of the current state-of-the-art convolutional neural network (CNN) models including VIT3D and Unet3D, and intuitive machine learning methods (i.e., SVM and MLP), we implemented those models for dose prediction and conducted a comprehensive analysis with treatment plans created from images acquired from patients who consented to participate an IRB-approved imaging study designed to evaluate the imaging performance of the system. In total, 20 plans created by certified medical dosimetrists were employed in this study, with 15 used for training the machine-learning models and the remaining 5 used for performance testing. Two evaluation metrics were used: 1) root mean square error (RMSE) of the predicted dose and true dose and 2) time spent on dose prediction.

RESULTS

The results of the analysis showed that the ViT-3D (Transformer) model had the lowest RMSE of 3.682 ±0.010, followed by the Unet-3D (CNN) model with an RMSE of. 3.973 ±0.021 The MLP model had an RMSE of 8.007 ±0.019 while the SVM model had the highest RMSE of 9.156 ±0.032. For a fair comparison, we use 4-fold cross validation (each has 15 training plans and 5 testing plans), and report the mean value with standard deviation. All models are optimized with Adam optimizer of a learning rate 0.01, and the training process is stopped after 100 epochs. These findings indicate that the ViT-3D (Transformer) model performed the best in terms of predicting the dose information in volumetric modulation radiotherapy plans based on the CBCT images and contour information of OARs. For tested plan which contains 81 CT images (512 × 512 resolution), the inference time to predict dose information with a general CPU machine (6-Core Intel Core i7) is about 1.5 minutes. With GPU resources, such as NVIDIA A100, the inference process can be finished within seconds.

CONCLUSION

The study demonstrated that current state-of-the-art machine-learning models can achieve promising accuracy in dose prediction using high-quality CBCT images. A well-trained machine-learning model could offer clinicians a quick and reliable prediction of the true dose to patients in the case of significant anatomical changes or provide patient-specific optimization objectives if replanning is warranted.

Nrf2 regulates iron-dependent hippocampal synapses and functional connectivity damage in depression

Neuronal iron overload contributes to synaptic damage and neuropsychiatric disorders. However, the molecular mechanisms underlying iron deposition in depression remain largely unexplored. Our study aims to investigate how nuclear factor-erythroid 2 (NF-E2)-related factor 2 (Nrf2) ameliorates hippocampal synaptic dysfunction and reduces brain functional connectivity (FC) associated with excessive iron in depression. We treated mice with chronic unpredictable mild stress (CUMS) with the iron chelator deferoxamine mesylate (DFOM) and a high-iron diet (2.5% carbonyl iron) to examine the role of iron overload in synaptic plasticity. The involvement of Nrf2 in iron metabolism and brain function was assessed using molecular biological techniques and in vivo resting-state functional magnetic resonance imaging (rs-fMRI) through genetic deletion or pharmacologic activation of Nrf2. The results demonstrated a significant correlation between elevated serum iron levels and impaired hippocampal functional connectivity (FC), which contributed to the development of depression-induced CUMS. Iron overload plays a crucial role in CUMS-induced depression and synaptic dysfunction, as evidenced by the therapeutic effects of a high-iron diet and DFOM. The observed iron overload in this study was associated with decreased Nrf2 levels and increased expression of transferrin receptors (TfR). Notably, inhibition of iron accumulation effectively attenuated CUMS-induced synaptic damage mediated by downregulation of brain-derived neurotrophic factor (BDNF). Nrf2-/- mice exhibited compromised FC within the limbic system and the basal ganglia, particularly in the hippocampus, and inhibition of iron accumulation effectively attenuated CUMS-induced synaptic damage mediated by downregulation of brain-derived neurotrophic factor (BDNF). Activation of Nrf2 restored iron homeostasis and reversed vulnerability to depression. Mechanistically, we further identified that Nrf2 deletion promoted iron overload via upregulation of TfR and downregulation of ferritin light chain (FtL), leading to BDNF-mediated synapse damage in the hippocampus. Therefore, our findings unveil a novel role for Nrf2 in regulating iron homeostasis while providing mechanistic insights into poststress susceptibility to depression. Targeting Nrf2-mediated iron metabolism may offer promising strategies for developing more effective antidepressant therapies.

[Study on the relationship between secondhand smoke exposure and dyslipidemia in adult residents in Beijing]

Objective: To understand the relationship between secondhand smoke exposure and dyslipidemia among adults in Beijing and to provide a scientific basis for relevant intervention. Methods: Data were from Beijing Adult Non-communicable and Chronic Diseases and Risk Factors Surveillance Program in 2017. A total of 13 240 respondents were selected by multistage cluster stratified sampling method. The monitoring contents include a questionnaire survey, physical measurement, collection of fasting venous blood, and determination of related biochemical indicators. SPSS 20.0 software was used for the chi-square test and multivariate logistic regression analysis. Results: The prevalence of total dyslipidemia (39.27%), hypertriglyceridemia (22.61%), and high LDL-C (6.03%) were the highest among those exposed to daily secondhand smoke. Among the male respondents, the prevalence of total dyslipidemia (44.42%) and hypertriglyceridemia (26.12%) were the highest among those exposed to secondhand smoke daily. Multivariate logistic regression analysis after adjustment for confounding factors showed that compared with no exposure to secondhand smoke, the population with an average exposure frequency of 1-3 days per week had the highest risk of total dyslipidemia (OR=1.276, 95%CI: 1.023-1.591). Among the patients with hypertriglyceridemia, those exposed to secondhand smoke daily had the highest risk (OR=1.356, 95%CI: 1.107-1.661). Among the male respondents, those exposed to secondhand smoke for 1-3 days per week had a higher risk of total dyslipidemia (OR=1.366, 95%CI: 1.019-1.831), and the highest risk of hypertriglyceridemia (OR=1.377, 95%CI: 1.058-1.793). There was no significant correlation between the frequency of secondhand smoke exposure and the risk of dyslipidemia among female respondents. Conclusions: Secondhand smoke exposure in Beijing adults, especially men, will increase the risk of total dyslipidemia, especially hyperlipidemia. Improving personal health awareness and minimizing or avoiding exposure to secondhand smoke is necessary.

[Diagnostic value of multiparametric MRI-based models in the assessment of extra-prostatic extension of prostate cancer]

Objective: To evaluate the diagnostic value of multiparametric magnetic resonance imaging (mpMRI) based models in the assessment of extra-prostatic extension (EPE) of prostate cancer. Methods: This retrospective study included 168 consecutive men with prostate cancers [aged 48 to 82 (66.6±6.8) years] who underwent radical prostatectomy and preoperative mpMRI examinations at the First Medical Center of the PLA General Hospital from January 2021 to February 2022. According to European Society of Urogenital Radiology (ESUR) score, EPE grade and mEPE score, all cases were independently evaluated by two radiologists, with disagreement reviewed by a senior radiologist as the final result. The diagnostic performance of each MRI-based model for pathologic EPE prediction was assessed using receiver operating characteristic curve (ROC), and the differences between the corresponding area under the curve (AUC) were compared using the DeLong test. The weighted Kappa test was used to evaluate the inter-reader agreement of each MRI-based model. Results: A total of 62 (36.9%) prostate cancer patients had pathologic confirmed EPE after radical prostatectomy. The AUC of ESUR score, EPE grade and mEPE score for predicting pathologic EPE were 0.836 (95%CI: 0.771-0.888), 0.834 (95%CI: 0.769-0.887) and 0.785 (95%CI: 0.715-0.844), respectively. The AUC of ESUR score and EPE grade were both superior to that of mEPE score with significant differences (all P<0.05), while there was no significant difference between the ESUR score and EPE grade models (P=0.900). EPE grading and mEPE score had good inter-reader consistency, with weighted Kappa values of 0.65 (95%CI: 0.56-0.74) and 0.74 (95%CI: 0.64-0.84), respectively. The inter-reader consistency of ESUR score was moderate, and the weighted Kappa value was 0.52 (95%CI: 0.40-0.63). Conclusion: All MRI-based models showed good preoperative diagnostic value in predicting EPE, among which the EPE grade resulted in more reliable performance with substantial inter-reader agreement.

[A descriptive analysis of hyperlipidemia in adult twins in China]

Objective: To describe the distribution characteristics of hyperlipidemia in adult twins in the Chinese National Twin Registry (CNTR) and explore the effect of genetic and environmental factors on hyperlipidemia. Methods: Twins recruited from the CNTR in 11 project areas across China were included in the study. A total of 69 130 (34 565 pairs) of adult twins with complete information on hyperlipidemia were selected for analysis. The random effect model was used to characterize the population and regional distribution of hyperlipidemia among twins. The concordance rates of hyperlipidemia were calculated in monozygotic twins (MZ) and dizygotic twins (DZ), respectively, to estimate the heritability. Results: The age of all participants was (34.2±12.4) years. This study's prevalence of hyperlipidemia was 1.3% (895/69 130). Twin pairs who were men, older, living in urban areas, married,had junior college degree or above, overweight, obese, insufficient physical activity, current smokers, ex-smokers, current drinkers, and ex-drinkers had a higher prevalence of hyperlipidemia (P<0.05). In within-pair analysis, the concordance rate of hyperlipidemia was 29.1% (118/405) in MZ and 18.1% (57/315) in DZ, and the difference was statistically significant (P<0.05). Stratified by gender, age, and region, the concordance rate of hyperlipidemia in MZ was still higher than that in DZ. Further, in within-same-sex twin pair analyses, the heritability of hyperlipidemia was 13.04% (95%CI: 2.61%-23.47%) in the northern group and 18.59% (95%CI: 4.43%-32.74%) in the female group, respectively. Conclusions: Adult twins were included in this study and were found to have a lower prevalence of hyperlipidemia than in the general population study, with population and regional differences. Genetic factors influence hyperlipidemia, but the genetic effect may vary with gender and area.

[A descriptive analysis on hypertension in adult twins in China]

Objective: To describe the distribution characteristics of hypertension among adult twins in the Chinese National Twin Registry (CNTR) and to provide clues for exploring the role of genetic and environmental factors on hypertension. Methods: A total of 69 220 (34 610 pairs) of twins aged 18 and above with hypertension information were selected from CNTR registered from 2010 to 2018. Random effect models were used to describe the population and regional distribution of hypertension in twins. To estimate the heritability, the concordance rates of hypertension were calculated and compared between monozygotic twins (MZ) and dizygotic twins (DZ). Results: The age of all participants was (34.1±12.4) years. The overall self-reported prevalence of hypertension was 3.8%(2 610/69 220). Twin pairs who were older, living in urban areas, married, overweight or obese, current smokers or ex-smokers, and current drinkers or abstainers had a higher self-reported prevalence of hypertension (P<0.05). Analysis within the same-sex twin pairs found that the concordance rate of hypertension was 43.2% in MZ and 27.0% in DZ, and the difference was statistically significant (P<0.001). The heritability of hypertension was 22.1% (95%CI: 16.3%- 28.0%). Stratified by gender, age, and region, the concordance rate of hypertension in MZ was still higher than that in DZ. The heritability of hypertension was higher in female participants. Conclusions: There were differences in the distribution of hypertension among twins with different demographic and regional characteristics. It is indicated that genetic factors play a crucial role in hypertension in different genders, ages, and regions, while the magnitude of genetic effects may vary.

[Study on the relationship between indexes of different abnormal weight and dyslipidemia in adults in Beijing City]

Objective: To analyze the relationship and consistency between indexes of different abnormal weight and dyslipidemia in adults in Beijing City. Methods: From August to December of 2017, 4 975 residents aged 18 to 79 years old in 5 districts of Beijing were randomly selected as subjects by using a multi-stage stratified cluster sampling method. Questionnaire, physical examination and laboratory tests were conducted. The prevalence of overweight/obesity, high body fat rate, central obesity, and high waist-to-height ratio was calculated. Partial correlation was used to analyze the correlation of blood lipid with body mass index (BMI), body fat rate, waist circumference and waist-height ratio. Logistic regression analysis for complex sampling was used to analyze the relationship between indexes of different abnormal weight and dyslipidemia after controlling for relevant risk factors, including age, sex, smoking status, drinking, insufficiency intake of vegetable and fruit, physical inactivity. Kappa value was computed to analyze the consistency between indexes of different abnormal weight. Results: The weighted prevalence of dyslipidemia was 30.48%, and it was higher in men than that in women (40.16% vs. 20.52%, P<0.01). The weighted rate of overweight/obesity, high body fat rate, central obesity, and high waist-to-height ratio was 56.65%, 47.52%, 42.48% and 59.45%, respectively. BMI, body fat rate, waist circumference and waist-to-height ratio were positively correlated with the level of total cholesterol, triglyceride, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol, and negatively correlated with high-density lipoprotein cholesterol. Logistic regression analysis for complex sampling showed that the high body fat rate (OR=1.67, 95%CI: 1.35-2.07), overweight/obesity (OR=1.65, 95%CI: 1.26-2.14) and high waist-to-height ratio (OR=1.46, 95%CI: 1.09-1.96) were associated with dyslipidemias. Kappa values of high body fat rate with overweight/obesity, high waist-to-height ratio and central obesity were 0.65, 0.53 and 0.58, respectively (P<0.05). Conclusion: In 2017, the prevalence of dyslipidemia in adults in Beijing City is high, especially in men. Overweight/obesity, high body fat rate and high waist-to-height ratio are associated with dyslipidemia. The high body fat rate is most associated with dyslipidemia.

Experiences of nurses working in nurse-led clinics in Traditional Chinese Medicine hospitals: A focused ethnographic study

BACKGROUND

Traditional Chinese Medicine (TCM) nurse-led clinics (NLC) is an innovative working model in China, representing the specialization and extension of nurses' role. However, as a pioneer in TCM nursing, this new model of working is facing both opportunities and challenges because it is known little about the operational status of NLCs.

AIMS

To explore the experiences of nurses who work in NLC in TCM hospitals.

MATERIALS & METHODS

A focused ethnographic study was conducted in three TCM hospitals affiliated with Guangzhou University of Chinese Medicine. We interviewed eleven nurses in those hospitals and observed seven of them working with patients. We used snowball sampling for data collection including interview, non-participant observation and documents from medical records. All the data were processed as following steps: (a) coding for descriptive labels; (b) sorting for patterns; (c) identifying outliers or negative cases; (d) generalizing with construction and theories and (e) noting reflective remarks.

RESULTS

Nurse-led clinics help nurses develop their skills and knowledge that are highly recognized by public since they meet the growing needs of patients and also relieve the workload of physicians in the hospitals. However, lack of specialization is still a major challenge in NLCs due to insufficiency of full-time staff with specialized education, nurse-led practice without standardized guidelines, restrictions on prescription right of nurses, and also inadequate support from hospitals.

DISCUSSIONS

As a revolutionary innovation of working model for nurses in TCM hospitals, NLCs could improve quality of care and lead to a comprehensive promotion of nursing career. However, there are several challenges on providing high quality care for patients whilst improving educational development of nurses. This study suggests that nurses, hospital administration and the government should cooperate with each other to develop standard nursing programs for NLCs.

CONCLUSIONS

It is imperative to identify nursing roles, collect available resources, and develop supportive policies and training programs to enhance the quality of NLCs.

[Heritability and genetic correlation of body mass index and coronary heart disease in Chinese adult twins]

Objective: To examine the heritability of body mass index (BMI) and coronary heart disease (CHD), and to explore whether genetic factors can explain their correlation. Methods: Participants were from 11 provinces/municipalities reqistered in the Chinese National Twin Registry (CNTR) from 2010 to 2018. Participants data were collected from face-to-face questionnaire survey. Bivariate structure equation model was used to estimate the heritability and the genetic correlation of BMI and CHD. Results: A total of 20 340 pairs of same-sex twins aged ≥25 years were included in this study. After adjusting for age and gender, the heritability of BMI and CHD was 0.52 (95%CI: 0.49-0.55) and 0.76 (95%CI: 0.69-0.81), respectively. Further, a genetic correlation was identified between BMI and CHD (r_A=0.10, 95%CI:0.02-0.17). Conclusion: In Chinese adult twin population, BMI and CHD are affected by genetic factors, and their correlation can be attributed to the common genetic basis.

P-719 Effect of frozen and thawed embryo transfer on metabolism of children in early childhood

Study question

We aimed to investigate the metabolic profile at age 1.5 – 4 years in chidren conceived from FET.

Summary answer

Plasma concentration of ApoE , fasting insulin and 11 small molecule metabolities were different beween FET group and the NC group.

What is known already

Rencently,we showed that FET-conceived male mouse offspring presented glucose metabolism dysfunction mainly manifesting insulin resistance. Observations from human studies indicate that body fat composition in IVF children is disturbed and children conceived by IVF/ICSI have a less favourable glucose and cardiovascular metabolic profile in childhood when compared with naturally conceived. But human study emphasised on metabolic profile of children concieved from FET is limited, one follow-up study have suggested that children conceived by FET often show abnormal lipid metabolism.

Study design, size, duration

284 children at early childhood (1.5-4 years) conceived from FET or naturally conceived were recruited based on the data from electronic Case Report Forms (e-CRF) in the International Peace Maternity and Child Health Hospital (IPMCHH) from September 2018 to November 2019. A total of 147 children (with 118 born after FET and 29 conceived naturally) was included for biochemical examination and metabolomics analysis.

Participants/materials, setting, methods

The peripheral venous blood of 147 children aged 1.5 - 4 years (with 118 born after FET and 29 conceived naturally) was drawn in the fasting state (&gt;8h). FBG was measured using a glucometer, plasma concentrations of TC,TG, HDL , LDL were measured by chemistry analyzer, commercial ELISA kits were used for the measurment of Apolipoprotein, insulin, leptin, CRP,FT3, FT4, and TSH. Metabolomic analysis was performed on an UPLC-MS/MS system against 210 metabolites.

Main results and the role of chance

The results of present study revealed that the chidren conceived from FET have different metabolite profile than the naturally conceived children. Except for the higher BMI of chidren from FET group, ApoE and insulin were found respectivedly higher and lower in chidren from FET group than in NC group. As for metabolomic analysis,small metabolities which reflect intestinal fermentation such as second bile acid and short chain fatty acids was significantly higher in children conceived from FET; unsaturated fatty acids which are crucial for neurodevelopment was significanty lower in FET group.

Limitations, reasons for caution

Firstly, due to the small sample size, larger sample size and a longer follow-up period will be needed to observe the long-term metabolic profile and neurobehavioral performance of offspring conceived from FET. Secondly, we did not rule out other factors that may have influence on the metabolism of children.

Wider implications of the findings

To our knowledged, we demenstrated the metabolic profile of chidren born after FET in early childhood by metabolomic analysis for the first time.The fast insulin level was significant decreased in FET group than NC group, which is opposes to previous findings.

Trial registration number

2016YFC1000203

Bilateral vertebral arteries entering the C4 foramen transversarium with the left vertebral artery originating from the aortic arch

Vertebral arteries (VAs) serve as major blood vessels to the central nervous system. VAs typically arise from the subclavian arteries and ascend separately within the transverse foramina of the cervical vertebrae (C6-C1) before entering the skull at the foramen magnum and joining at the base of the pons to form the basilar artery of the vertebrobasilar circulation. Therefore, variations in the origin and anatomic course of the VAs have implications for invasive medical procedures involving the superior thoracic/cervical regions or the cervical vertebrae. The current case report describes variation in the entry point of both VAs and the site of origin of the left vertebral artery. The variation was revealed during routine dissection of a 72-year-old female cadaver. It was found that the left vertebral artery originated directly from the aortic arch to abnormally enter the transverse foramen of C4 instead of the transverse foramen of C6. The right vertebral artery arose as usual from the right subclavian artery. However, the right vertebral artery also directly entered the transverse foramen of C4 instead of the transverse foramen of C6.

Effects of residual feed intake divergence on growth performance, carcass traits, meat quality, and blood biochemical parameters in small-sized meat ducks

Feed efficiency (FE) is a major economic trait of meat duck. This study aimed to evaluate the effects of residual feed intake (RFI) divergence on growth performance, carcass traits, meat quality, and blood biochemical parameters in small-sized meat ducks. A total of 500 healthy 21-day-old male ducks were housed in individual cages until slaughter at 63 d of age. The growth performance was determined for all the ducks. The carcass yield, meat quality, and blood biochemical parameters were determined for the selected 30 high-RFI (HRFI) and 30 low-RFI (LRFI) ducks. In terms of growth performance, the RFI, feed conversion ratio (FCR), and average daily feed intake (ADFI) were found to be significantly lower in the LRFI group (P < 0.01), whereas no differences were observed in the BW and body weight gain (P > 0.05). For slaughter performance, no differences were observed in the carcass traits between the LRFI and HRFI groups (P > 0.05). For meat quality, the shear force of breast muscle was significantly lower in the LRFI group (P < 0.05), while the other meat quality traits of breast and thigh muscles demonstrated no differences (P > 0.05). For blood biochemical parameters, the serum concentrations of triglycerides (TG) and glucose (GLU) were significantly lower in the LRFI group (P < 0.05), while the other parameters showed no differences (P > 0.05). The correlation analysis demonstrated a high positive correlation between RFI, FCR, and ADFI (P < 0.01). The RFI demonstrated a negative effect on the breast muscle and lean meat yields, but a positive effect on the shear force of breast muscle (P < 0.05). Further, the RFI demonstrated a positive effect on the TG and GLU levels (P < 0.05). These results indicate that the selection for low RFI could improve the FE of small-sized meat ducks without affecting the production performance. This study provides valuable insight into the biological processes underlying the variations in FE in small-sized meat ducks.

[Impact of nonsteroidal anti-inflammatory drugs on efficacy of anti-PD-1 therapy for primary liver cancer]

OBJECTIVE

To assess the impact of nonsteroidal anti-inflammatory drugs (NSAIDs) on clinical outcomes of patients receiving anti-PD-1 immunotherapy for hepatocellular carcinoma.

METHODS

We conducted a retrospective study among 215 patients with primary liver cancer receiving immunotherapy between June, 2018 and October, 2020. The patients with balanced baseline characteristics were selected based on propensity matching scores, and among them 33 patients who used NSAIDs were matched at the ratio of 1∶3 with 78 patients who did not use NSAIDs. We compared the overall survival (OS), progression-free survival (PFS), and disease control rate (DCR) between the two groups.

RESULTS

There was no significant difference in OS between the patients using NSAIDs (29.7%) and those who did not use NSAIDs (70.2%). Univariate and multivariate analyses did not show an a correlation of NSAIDs use with DCR (univariate analysis: OR=0.602, 95% CI: 0.299-1.213, P=0.156; multivariate analysis: OR=0.693, 95% CI: 0.330-1.458, P=0.334), PFS (univariate analysis: HR=1.230, 95% CI: 0.789-1.916, P=0.361; multivariate analysis: HR=1.151, 95% CI: 0.732-1.810, P=9.544), or OS (univariate analysis: HR=0.552, 95% CI: 0.208-1.463, P=0.232; multivariate analysis: HR=1.085, 95% CI: 0.685-1.717, P=0.729).

CONCLUSION

Our results show no favorable effect of NSAIDs on the efficacy of immunotherapy in patients with advanced primary liver cancer, but this finding still needs to be verified by future prospective studies of large cohorts.

[Gene-lifestyle interaction on coronary heart disease in adult twins of China]

Objective: To explore the gene-lifestyle interaction on coronary heart disease (CHD) in adult twins of China. Methods: Participants were selected from twin pairs registered in the Chinese National Twin Registry (CNTR). Univariate interaction model was used to estimate the interaction, via exploring the moderation effect of lifestyle on the genetic variance of CHD. Results: A total of 20 477 same-sex twin pairs aged ≥25 years were recruited, including 395 CHD cases, and 66 twin pairs both had CHD. After adjustment for age and sex, no moderation effects of lifestyles, including current smoking, current drinking, physical activity, intake of vegetable and fruit, on the genetic variance of CHD were found (P>0.05), suggesting no significant interactions. Conclusion: There was no evidence suggesting statistically significant gene-lifestyle interaction on CHD in adult twins of China.

Exploring the diagnostic utility of genome sequencing for fetal congenital heart defects

OBJECTIVE

The diagnostic yield for congenital heart defects (CHD) with routine genetic testing is around 10-20% when considering the pathogenic CNVs or aneuploidies as positive findings. This is a pilot study to investigate the utility of genome sequencing (GS) for prenatal diagnosis of CHD.

METHODS

Genome sequencing (GS, 30X) was performed on 13 trios with CHD for which karyotyping and/or chromosomal microarray results were non-diagnostic.

RESULTS

Trio GS provided a diagnosis for 4/13 (30.8%) fetuses with complex CHDs and other structural anomalies. Findings included pathogenic or likely pathogenic variants in DNAH5, COL4A1, PTPN11, and KRAS. Of nine cases without a possibly genetic etiology by GS, we had follow-up on eight. For five of them (60%), the parents chose to keep the pregnancy. A balanced translocation [46,XX,t(14;22)(q32.33;q13.31)mat] was detected in a trio with biallelic DNAH5 mutations, which together explained the recurrent fetal situs inversus and dextrocardia that was presumably due to de novo Phelan-McDermid syndrome. A secondary finding of a BRCA2 variant and carrier status of HBB, USH2A, HBA1/HBA2 were detected in the trio.

CONCLUSIONS

GS expands the diagnostic scope of mutation types over conventional testing, revealing the genetic etiology for fetal heart anomalies. Patients without a known genetic abnormality indicated by GS likely opted to keep pregnancy especially if the heart issue could be repaired. We provide evidence to support the application of GS for fetuses with CHD. This article is protected by copyright. All rights reserved.

[Characteristics of high-risk cardiovascular disease among residents aged 35-75 in 8 districts of Beijing]

Objective: To understand the characteristics and current situation of high risks related to cardiovascular disease among residents aged 35-75 in Beijing and to provide scientific reference for the formulation and improvement of cardiovascular disease prevention and control strategies and measures. Methods: According to the data of the Cardiovascular Disease Screening and Management Program in Beijing, 93 520 participants aged 35-75 in 8 districts of Beijing were selected for analysis. We used the χ² test to compare the high-risk prevalence of cardiovascular disease in different population characteristics. The multivariate logistic regression model was used to analyze the relationship between population characteristics and the high risks of cardiovascular disease. Results: The prevalence of high-risk cardiovascular disease was 20.82% (19 471/93 520). The prevalence of high-risk population in the 65-75 years-old was significantly higher than those of other age groups [29.05% (5 151/17 733), χ²=3 359.37, P<0.001], and the prevalence increased with age (trend χ²=3 121.75, P<0.05). The prevalence of high risk in males was significantly higher than that of women (31.19%, 10 752/34 476 vs. 14.77%, 8 719/59 044, χ²=3 559.87, P<0.05). The most common clustered risk factors appeared as hypertension and diabetes (29.80%, 5 802/19 471), hypertension with smoking (37.84%, 4 069/10 752) in males, and hypertension with diabetes mellitus in females (49.32%, 4 300/8 719), in urban areas (33.62%, 2 571/7 647) and in suburbs (27.33%, 3 231/11 824). Lower education [high school (OR=1.56,95%CI:1.46-1.66), middle school (OR=1.99,95%CI:1.88-2.12), primary school and below (OR=2.28,95%CI:2.12-2.45)], non-Han ethnicity (OR=1.19, 95%CI: 1.07-1.33), unmarried (OR=1.16, 95%CI: 1.08-1.24), drinking alcohol (OR=3.06, 95%CI: 2.94-3.19), obesity (OR=1.85, 95%CI: 1.77-1.93), overweight (OR=1.41, 95%CI: 1.36-1.47), etc., were positively correlated with the high risk of cardiovascular disease. Conclusions: We noticed that the prevalence of high-risk groups of cardiovascular disease aged 35-75 years was around 20% in Beijing, and the proportion in males was higher than females. Low education, drinking, overweight, and obesity were positively correlated with the risks of cardiovascular disease.

[Current status of regular exercise and influencing factors in 18-64 year old labor force population in Beijing]

Objective: To understand the regular exercise status and influencing factors in 18-64 year-old labor force population in Beijing, and provide evidences for behavioral intervention. Methods: Data were collected from Beijing Adult Non-communicable and Chronic Diseases and Risk Factors Surveillance Program from August to December, 2017. The stratified cluster sampling method was used to select 13 240 survey subjects throughout the city. The valid sample size included in this study were 11 604 persons aged 18 to 64 years. Questionnaire was used to collection the information about basic demographic characteristics, chronic disease history and physical activity prevalence of the study subjects. The body height and weight were measured by standard methods. Fasting venous blood samples were collected for the detection of fasting blood glucose, blood lipids and other biochemical indicators. Software SPSS 20.0 was used fort complex sampling sample weighting and data analysis. Results: The proportions of the study subjects who did regular exercise and never had leisure-time activity in 18-64 year-old labor force population in Beijing were 23.74% (95%CI: 21.51%-26.12%) and 64.34% (95%CI: 61.66%-66.94%) respectively; The average daily physical activity time was 23.44 min (95%CI: 21.16-25.71), and the total daily sedentary behavior time was 6.96 hours (95%CI: 6.80-7.13). With the increase of age, the proportions of the study subjects who did regular exercise and never had leisure-time activity increased (P=0.006, P<0.001). With the increase of educational level, the proportion of those who did regular exercise increased (P<0.001), and the proportion of those who never had leisure-time activity decreased (P<0.001); the higher the level of physical activity, the higher the regular exercise proportion (P<0.001); the proportions of employed people who did regular exercise was lower than those in unemployed people (P<0.001); the proportions of women never had leisure-time activity was higher than those in men (P=0.024). The results of multivariate analysis showed that older age and higher education level were positive factors for regular exercise (35- years old: OR=0.653, 95%CI: 0.530-0.804, P<0.001; 50-64 years old: OR=0.695, 95%CI: 0.560-0.864, P=0.001; high school/technical secondary school/technical School: OR=0.679, 95%CI: 0.593-0.777, P<0.001; college graduation: OR=0.478, 95%CI: 0.387-0.590, P<0.001; bachelor degree and above: OR=0.435, 95%CI: 0.347-0.546, P<0.001), while employment (OR=1.631, 95%CI: 1.330-2.000, P<0.001) and married/cohabitation (OR=1.340, 95%CI: 1.093-1.644, P=0.038) were negative factors for regular exercise. Conclusions: The rate of regular exercise in 18-64 year-old labor force population in Beijing needs to be improved. Older age and high educational level were positive factors for regular exercise, while being married and employed were negative factors for it.

[Investigation on knowledge, attitude and behavior of salt reduction in adults of Beijing in 2017]

Objective: To explore the knowledge, attitude and behavior of salt reduction in adults of Beijing in 2017. Methods: Based on the monitoring data of chronic diseases and corresponding risk factors in adults of Beijing in 2017, the indicators of salt reduction knowledge, attitude and behavior of 13 240 participants aged 18-79 years old were analyzed. The awareness rate, attitude support rate and behavior rate were calculated by complex weighting method, and compared among different age groups, genders, residential areas, and history of hypertension. The proportion of people taking various salt reduction measures to the total number of people was compared. Results: The awareness rate of recommended daily salt intake, the awareness of hypertension caused or aggravated by more salt intake, the attitude support rate and behavior rate of adults were 31.77%, 88.56%, 90.27% and 53.86%, respectively. After weighted adjustment, the awareness rate of recommended daily salt intake was 31.08%, which increased with age (χ²_trend=431.56, P<0.001) and education level (χ²_trend=95.44, P<0.001). The awareness rate of women was higher than that of men (χ²=118.89, P<0.001), and the awareness rate of population in urban areas was higher than that of population in suburban areas (χ²=34.09, P=0.001). The awareness rate of hypertension caused or aggravated by eating more salt was 86.73%. The support rate of salt reduction attitude was 90.45%. The rate of salt-reducing behavior was 54.05%. Among different salt reduction measures, reducing salt when cooking was the most common measure (52.41%), while the least common one (35.22%) was using low sodium salt. Logistic regression model analysis showed that the gender, age, education level, self-reported history of hypertension, awareness of salt recommendation, awareness of hypertension caused or aggravated by eating more salt, and salt reduction attitude were significantly associated with salt reduction behavior. Conclusion: In 2017, adults in Beijing have a basic understanding of the impact of high-salt diet on health and support salt reduction, but the rate of salt reduction behavior is still relatively low. There are obvious gender and age differences, and the salt reduction measure is simple. Targeted measures should be taken to promote the formation of salt reduction behavior.

[Analysis of the current status and related factors of oral nutritional supplements intake among 18-79 years old in Beijing in 2017]

Objective: To understand the current status of taking nutrient supplements for residents aged 18 to 79 years old in Beijing and its related factors. Methods: Data were gathered from the 2017 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified cluster sampling method was used, and participants aged 18-79 were sampled from 16 districts. The questionnaire included chronic diseases and related risk factors, health knowledge, and oral nutritional supplements within 12 months. Multivariate logistic regression models were established to analyze associated factors that affect the intake of nutrient supplements. Results: The weighted prevalence of supplements use was 13.1% among 12 696 subjects within the past 12 months. The proportions of multivitamins (4.7%), B vitamins (4.5%), and folic acid (3.2%) were higher. The prevalence of supplement use of young people (18-39 years old) and the elderly (60-79 years old) was higher than middle-aged people (40-59 years old) (χ²=54.09, P<0.001). Except for the age group of 70-79 years old, the consumption rate of women was significantly higher than that of men (P<0.05). After adjusting age and sex, among patients with hypertension, diabetes, or dyslipidemia, the control rates of blood pressure, glucose and lipids of patients who take nutrient supplements were higher than those who do not (P<0.05). And participants who took nutrient supplements had a more heightened awareness rate of health knowledge, such as the hazards of smoking and second-hand smoke, and recommended amount of salt per day (P<0.001). The multi-factor logistic analysis found that nutrient supplement-related factors include women, old age, higher education level, living in urban, insufficient physical activity, sleeping problems, active physical examination, blood pressure control among patients, and health knowledge (P<0.05). Conclusions: The factors of nutrient supplements use were related to sex, age, education level, health status, and health literacy. We should pay attention to key populations and guide them to establish the correct concept of taking nutrient supplements.

Caloric restriction and Roux-en-Y Gastric Bypass promote white adipose tissue browning in mice

PURPOSE

Caloric restriction (CR) and Roux-en-Y Gastric Bypass (RYGB) are considered effective means of body weight control, but the mechanism by which CR and RYGB protect against high-fat diet (HFD)-induced obesity remains elusive. The browning of white adipose tissue (WAT) is a potential approach to combat obesity. Here we assess whether browning of WAT is involved in CR- and RYGB-treatment.

METHODS

The average size of adipocytes was determined by histological analysis. Expression of thermogenic genes in both human subjects and mice were measured by quantitative real-time PCR and immunohistochemical staining.

RESULTS

The average size of adipocytes was bigger, while the expression of thermogenic genes such as uncoupling protein 1 (UCP1), nuclear factor erythroid-2 like 1 (NRF1) and PPARγ coactivator-1 α (PGC1α) were lower in the WAT of obese subjects when compared to lean controls. Both CR and RYGB promoted weight and fat loss. Increment of the average adipocytes size and down-regulation of thermogenic genes were significantly reversed by both CR and RYGB in the WAT of obese mice.

CONCLUSIONS

Our findings showed that CR and RYGB significantly improved high-fat diet-induced lipid accumulation by promoting the browning of WAT.

Combined rs-fMRI study on brain functional imaging and mechanism of RAGE-DAMPs of depression: Evidence from MDD patients to chronic stress-induced depression models in cynomolgus monkeys and mice

More and more evidence show that major depressive disorder (MDD) is closely related to inflammation caused by chronic stress, which seriously affects human physical and mental health. However, the inflammatory mechanism of depression and its effect on brain function have not been clarified. Based on resting-state functional magnetic resonance imaging (rs-fMRI), we investigated change of brain functional imaging and the inflammatory mechanism of damage-related molecular patterns (DAMPs)-receptor of advanced glycation protein end product (RAGE) in MDD patients and depressive-like cynomolgus monkeys and mice models induced by chronic stress. The regional homogeneity (ReHo) and functional connectivity (FC) were analyzed using MATLAB and SPM12 software. We detected the expression of DAMPs-RAGE pathway-related proteins and mRNA in MDD peripheral blood and in serum and brain tissue of cynomolgus monkeys and mice. Meanwhile, RAGE gene knockout mice, RAGE inhibitor, and overexpression of AVV9RAGE adeno-associated virus were used to verify that RAGE is a reliable potential biomarker of depression. The results showed that the ReHo value of prefrontal cortex (PFC) in MDD patients and depressive-like cynomolgus monkeys was decreased. Then, the PFC was used as a seed point, the FC of ipsilateral and contralateral PFC were weakened in depressive-like mice. At the same time, qPCR showed that RAGE and HMGB1 mRNA were upregulated and S100β mRNA was downregulated. The expression of RAGE-related inflammatory protein in PFC of depressive-like monkeys and mice were consistent with that in peripheral blood of MDD patients. Moreover, the results were confirmed in RAGE-/- mice, injection of FPS-ZM1, and overexpression of AAV9RAGE in mice. To sum up, our findings enhance the evidence that chronic stress-PFC-RAGE are associated with depression. These results attempt to establish the links between brain functional imaging, and molecular targets among different species will help to reveal the pathophysiological mechanism of depression from multiple perspectives.

Xiaoyaosan Exerts Antidepressant Effect by Downregulating RAGE Expression in Cingulate Gyrus of Depressive-Like Mice

Xiaoyaosan (XYS), as a classic Chinese medicine compound, has been proven to have antidepressant effect in many studies, but its mechanism has not been clarified. In our previous studies, we found that chronic stress can induce depressive-like behavior and lead to emotion-related cingulate gyrus (Cg) dysfunction, as well as the decrease of neurotrophic factors and the increase of inflammatory-related proteins. Therefore, we speculated that XYS may play an antidepressant role by regulating the inflammation-related receptor of advanced glycation protein end product (RAGE) to affect the functional connectivity (FC) signal of the Cg and improve the depressive-like behavior. In order to verify this hypothesis, we analyzed the FC and RAGE expression in the Cg of depressive-like mice induced by chronic unpredictable mild stress (CUMS) and verified it with RAGE knockout mice. At the same time, we detected the effect of XYS on the depressive-like behavior, expression of RAGE, and the FC of the Cg of mice. The results showed that the FC of the Cg of depressive-like mice induced by CUMS was weakened, and the expression of RAGE was upregulated. The antidepressant effect of XYS is similar to that of fluoxetine hydrochloride, which can significantly reduce the depressive-like behavior of mice and inhibit the expression of the RAGE protein and mRNA in the Cg, and increase the FC of the Cg in mice. In conclusion, XYS may play an antidepressant role by downregulating the expression of RAGE in the Cg of depressive-like mice induced by CUMS, thereby affecting the functional signal and improving the depressive-like behavior.

[Gene-body mass index interaction on coronary heart disease in Chinese adult twins]

Objective: To explore the gene-body mass index (BMI) interaction on coronary heart disease (CHD) in the Chinese adult twins. Methods: A total of 20 340 same-sex twin pairs registered in the Chinese National Twin Registry (CNTR) were enrolled in this study. Classical twin structure equation model was used to estimate the gene-BMI interaction on CHD. Results: After adjusting for age, we found that genetic variance of CHD differed as the function of BMI in male twins, which indicated the presence of a gene-BMI interaction on CHD (P=0.008).The genetic moderating effect (β_a) was -0.14 (95%CI: -0.22--0.04), indicating that for each logarithmic transformation value of BMI increase, genetic path parameters would decrease by 0.14, which would result in the decrease of genetic variance of CHD. And the heritability of CHD was 0.77 (95%CI: 0.65-0.86) among the male twins with lower BMI (<24.0 kg/m²), but 0.56 (95%CI: 0.33-0.74) among the male twins with high BMI (≥24.0 kg/m²). However, there was no evidence suggesting that BMI could moderate genetic variants of CHD in female. Conclusion: We found a significant gene-BMI interaction on CHD in the Chinese male adult twins in China, and the heritability of CHD was higher among the twins whose BMI was <24.0 kg/m².

Expert Consensus on Clinical Practice of Burn Units in Shanghai During the COVID-19 Epidemic

In response to coronavirus disease 2019 (COVID-19), the Shanghai Burn Clinical Quality Control Center organized experts to formulate and implement a set of rapid, simple, and effective prevention and control measures, and there have not been any cases of health care professionals or inpatients in burn units suspected or confirmed with COVID-19. This article elaborates on the specific measures in burn units in response to the epidemic, including the implementation of standardized procedures, remote consultations, strengthened follow-up, exchange of experience, and popular science, among others. We share experience from Shanghai to benefit related disciplines in other countries and regions.

[Modification of physical activity on genetic effects of type 2 diabetes mellitus: a twin pairs cohort study in China]

Objective: To explore the modification effect of physical activity on the genetic effects of type 2 diabetes mellitus (T2DM). Methods: The univariate moderation model was fitted to calculate the modifying effect of physical activity on the genetic effects of T2DM based on the data of 12 107 pairs of same gender twins aged 30 years and older enrolled by the Chinese National Twin Registry in 11 provinces/cities in China. Results: After adjusting for age and gender, the heritability of T2DM was 0.56 (0.31-0.84). Qualified physical activity could attenuate the genetic effects of T2DM. The heritability of T2DM in twin pairs with qualified physical activity was 0.46 (0.06-0.88), which was lower than that in twin pairs without qualified physical activity during the same model [0.68(0.36-0.94)]. Conclusion: T2DM is a moderate genetic disease, physical activity can modify the genetic effects of T2DM.

[A descriptive analysis on body mass index distribution in adult twin pairs in China]

Objective: To describe the differences in body mass index (BMI) distribution in adult twins registered in Chinese National Twin Registry (CNTR), and provide evidence for the risk factor analysis and prevention and control of overweight or obesity. Methods: A total of 32 725 twin pairs aged 18 years and above who completed the questionnaire survey during 2010-2018 and had complete registered information in CNTR and normal body weight and length were included in the analysis on the population and region specific distributions of BMI of twin pairs and the difference in BMI in twin pairs. Results: The twin pairs included in the analysis were aged (34.6±12.4) years, the twin pairs of same gender accounted for 79.7%. The average BMI was 22.5 kg/m². The overall prevalence of obesity and overweight was 4.9% and 23.7%, respectively. Participants who were men, 50-59 years old, married, had lower education level, and lived in northern China had higher overweight rate and obesity rate (P<0.001). The difference in overweight or obesity prevalence between monozygotic (MZ) twin pars and dizygotic (DZ) twin pairs was not significant, but firstborn twin pairs had slightly higher rates of overweight and obesity than later-born twin pairs (P<0.05). The analysis in same gender-twin pairs indicated that the difference in BMI was associated with age (trend test: P<0.001), and the difference was more obvious in DZ twin pair in MZ pair and this difference increased with age. The concordant rate of BMI was higher in MZ twin pairs than DZ twin pairs (P<0.05). Conclusion: The distribution of BMI of twin pairs varied with population and region and BMI varied with age due to its genetic nature.

Fizeau drag in graphene plasmonics

Dragging of light by moving media was predicted by Fresnel¹ and verified by Fizeau's celebrated experiments² with flowing water. This momentous discovery is among the experimental cornerstones of Einstein's special relativity theory and is well understood^3,4 in the context of relativistic kinematics. By contrast, experiments on dragging photons by an electron flow in solids are riddled with inconsistencies and have so far eluded agreement with the theory^5-7. Here we report on the electron flow dragging surface plasmon polaritons^8,9 (SPPs): hybrid quasiparticles of infrared photons and electrons in graphene. The drag is visualized directly through infrared nano-imaging of propagating plasmonic waves in the presence of a high-density current. The polaritons in graphene shorten their wavelength when propagating against the drifting carriers. Unlike the Fizeau effect for light, the SPP drag by electrical currents defies explanation by simple kinematics and is linked to the nonlinear electrodynamics of Dirac electrons in graphene. The observed plasmonic Fizeau drag enables breaking of time-reversal symmetry and reciprocity¹⁰ at infrared frequencies without resorting to magnetic fields^11,12 or chiral optical pumping^13,14. The Fizeau drag also provides a tool with which to study interactions and nonequilibrium effects in electron liquids.

Pathophysiological regulation of lung function by the free fatty acid receptor FFA4

Increased prevalence of inflammatory airway diseases including asthma and chronic obstructive pulmonary disease (COPD) together with inadequate disease control by current frontline treatments means that there is a need to define therapeutic targets for these conditions. Here, we investigate a member of the G protein-coupled receptor family, FFA4, that responds to free circulating fatty acids including dietary omega-3 fatty acids found in fish oils. We show that FFA4, although usually associated with metabolic responses linked with food intake, is expressed in the lung where it is coupled to G_q/11 signaling. Activation of FFA4 by drug-like agonists produced relaxation of murine airway smooth muscle mediated at least in part by the release of the prostaglandin E₂ (PGE₂) that subsequently acts on EP₂ prostanoid receptors. In normal mice, activation of FFA4 resulted in a decrease in lung resistance. In acute and chronic ozone models of pollution-mediated inflammation and house dust mite and cigarette smoke-induced inflammatory disease, FFA4 agonists acted to reduce airway resistance, a response that was absent in mice lacking expression of FFA4. The expression profile of FFA4 in human lung was similar to that observed in mice, and the response to FFA4/FFA1 agonists similarly mediated human airway smooth muscle relaxation ex vivo. Our study provides evidence that pharmacological targeting of lung FFA4, and possibly combined activation of FFA4 and FFA1, has in vivo efficacy and might have therapeutic value in the treatment of bronchoconstriction associated with inflammatory airway diseases such as asthma and COPD.

Gastrodin protects against high glucose-induced cardiomyocyte toxicity via GSK-3β-mediated nuclear translocation of Nrf2

Diabetic cardiomyopathy (DCM) is one of the major complications of diabetes that causes mortality and morbidity in diabetic patients. Gastrodin (GSTD) is a bioactive phenolic glucoside component of an ancient Chinese herb Tianma (Gastrodia elata Bl.), which is widely used for cardiovascular and cerebrovascular diseases by ancient Chinese. Up to now, whether GSTD has a beneficial effect on DCM is unclear. Therefore, this study aimed to investigate the effect of GSTD on high glucose-induced injury in H9c2 rat cardiomyocytes and HL-1 mouse cardiomyocytes, and its underlying mechanisms. High glucose (33 mM) treatment caused cardiomyocyte toxicity, oxidative stress and apoptosis in both H9c2 and HL-1 cells. Under both normal (5.5 mM glucose) and high glucose conditions, GSTD showed protective effect against high glucose-induced cytotoxicity and promoted the nuclear translocation of Nrf2 in a concentration and time-dependent manner in H9c2 and HL-1 cells. Knockdown of Nrf2 expression using siRNA specifically targeting Nrf2 attenuated the protective effect of GSTD. Furthermore, GSTD promoted the nuclear translocation of Nrf2 via activating glycogen synthase kinse-3β (GSK-3β) signaling pathway. 4-benzyl, 2-methyl, 1, 2, 4-thiadiazolidine, 3, 5 dione (TDZD-8), an inhibitor of GSK-3β, inhibited the nuclear translocation of Nrf2 induced by GSTD, and attenuated the protective effect of GSTD as Nrf2 knockdown did. In summary, GSTD could protect against high glucose-induced cardiomyocyte toxicity via GSK-3β-mediated nuclear translocation of Nrf2.

[The current status and trend of disease burden of neoplasms in 1990 and 2016 for Beijing people]

Objective: To investigate the current status and trend of disease burden of neoplasms in 1990 and 2016 for Beijing people. Methods: The incidence situation, deaths status and disease burden of neoplasms in Beijing were described by using the results of the global burden of diseases study 2016 (GBD 2016). The measurement index included incidence, death, years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted years (DALY). Using the average world population from 2000 to 2025 as standard population to calculate the age-standardized incidence rate, mortality rate, DALY rate, YLL rate and YLD rate. Results: The age-standardized incidence rate of neoplasms in 2016 was 250.68 per 100 000, which increased by 30.03% than in 1990. The age-standardized mortality rate was 115.83 per 100 000, which decreased by 26.71% than in 1990. The DALY, YLL and YLD of neoplasms in 2016 were 671.2, 651.1 and 20.1 thousand person-years, respectively, which increased by 85.83%, 82.79% and 302.00% than those in 1990. The age-standardized DALY rate and YLL rate were 2 549.00 and 2 469.84 per 100 000, which decreased by 33.22% and 34.30% than those in 1990. The age-standardized YLD rate was 79.16 per 100 000, which increased by 37.17% than that in 1990. The male DALY, YLL and YLD in 2016 were 428.8, 417.8 and 11.0 thousand person-years, and female were 242.4, 233.3 and 9.1 thousand person-years, respectively.Among different neoplasms, the top three neoplasms of DALY and YLL were lung cancer, liver cancer, colon and rectum cancer, the top three of YLD were lung cancer, colon and rectum cancer, breast cancer. The topped group of disease burden of neoplasms was aged from 50 to 69 years old, the DALY of which was 323.6 thousand person-years, accounted for 48.21% of all DALY, and increased by 87.70% than that in 1990. Conclusions: The disease burden of neoplasms in Beijing is dominated by YLL, and the YLD increases rapidly. The burden is severe in the group of aged from 50 to 69 years old, and the male is severer than female. Lung cancer ranks the first of the disease burden of neoplasms. The DALY of colorectal cancer has increased. Comprehensive strategies should be promoted, including cultivating a good lifestyle and implementing prevention and control of neoplasm risk factors as early as teenage group, early screening of high-risk population, and enhancing the instruction of patients' treatment and rehabilitation.

Contributions of epiphytic microbiota on the fermentation characteristics and microbial composition of ensiled six whole crop corn varieties

AIMS

The present study is aimed to reveal the variations in epiphytic microbial composition among six whole crop corn (WCC) varieties and their contributions on ensiling characteristics and microbial composition of WCC silage.

METHODS AND RESULTS

Six WCC varieties (JS06, YS23, BS20, JS39, JS40 and JS26) were ensiled for 90 days. All WCC varieties were well fermented with low pH value (<4·0) and high LA (73·6-124 g kg^-1 DM, dry matter) concentration. Of six varieties, JS40 had the highest LA (124 g kg^-1 DM) concentration, which was supported by highest relative abundance of Lactobacillus. Pantoea was the most dominant epiphytic bacteria in all fresh WCC varieties; however, the secondary dominant genera among six WCC were absolutely difference. Lactobacillus became predominant genus in 90-day silages except YS23. YS23 kept the more bacterial genus from fresh to 90-day silages than other silages, meanwhile Acinetobacter and Enterobacter were the dominant bacteria in YS23 silages.

CONCLUSIONS

Among six WCC varieties, JS40 silage had the highest LA. The variations in epiphytic microbiomes among fresh WCC affected terminal microbial community of 90-day silages. There were differences in fermentation characteristics among six WCC varieties, which might be partly attributed to variations in epiphytic microbiomes among fresh WCC.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study not only enriches the research on microbial communities of plant phyllosphere but also provides theoretical basis for selecting WCC varieties and inoculants for the forage production.

Blockade of Indoleamine 2, 3-dioxygenase 1 ameliorates hippocampal neurogenesis and BOLD-fMRI signals in chronic stress precipitated depression

Indoleamine 2, 3-dioxygenase 1 (IDO1) has been implicated in the pathogenesis of depression, though its molecular mechanism is still poorly understood. We investigated the molecular mechanism of IDO1 in depression by using the chronic unpredictable mild stress (CUMS) model in Ido1-/- mice and WT mice. The brain blood oxygen level dependent (BOLD) signals in mice were collected by functional magnetic resonance imaging (fMRI) technology. IDO1 inhibitor INCB024360 was intervened in dorsal raphe nucleus (DRN) through stereotactic injection. We found an elevation of serum IDO1 activity and decreased 5-HT in CUMS mice, and the serum IDO1 activity was negatively correlated with 5-HT level. Consistently, IDO1 was increased in hippocampus and DRN regions, accompanied by a reduction of hippocampal BDNF levels in mice with CUMS. Specifically, pharmacological inhibition of IDO1 activity in the DRN alleviated depressive-like behaviour with improving hippocampal BDNF expression and neurogenesis in CUMS mice. Furthermore, ablation of Ido1 exerted stress resistance and decreased the sensitivity of depression in CUMS mice with the stable BOLD signals, BDNF expression and neurogenesis in hippocampus. Thus, IDO1 hyperactivity played crucial roles in modulating 5-HT metabolism and BDNF function thereby impacting outcomes of hippocampal neurogenesis and BOLD signals in depressive disorder.

[Development and application of a fundus image quality assessment system based on computer vision technology]

Objective: To develop a fundus image quality assessment system based on computer vision technology and to verify its accuracy by comparing the results of artificial discrimination and using this system. Methods: The process of image evaluation was divided into four modules: fundus image preprocessing, fundus image quality evaluation, fundus image content detection and evaluation result output. The system was designed to automatically evaluate the image quality of each fundus image, identify the optic disc and macula, and judge whether the image was qualified or not according to the image quality discrimination rules. A total of 2 397 fundus images of 787 type 2 diabetes patients were selected as the test data set. The average age of the patients, including 384 males and 403 females, was (69.65±19.09) years old. The images were taken by the staff of community health service centers in Shanghai with a fundus camera. The fundus image quality assessment system was used to conduct quality control and classification of the data set. At the same time, 12 professional fundus picture readers were employed to conduct manual quality control and classification of this data set. The system quality control results and artificial quality discrimination results were compared and analyzed. Results: The fundus image quality assessment system automatically recognized left and right eyes and eye positions on the input fundus images. The quality control interface included four indicator lights, which respectively corresponded to the images with the optic disc or macula as the center of the left or right eye. Evaluation of each fundus image was completed within 1 second, and the results were automatically displayed on the user interface. The 2 397 fundus photos were identified manually as 1 846 qualified photos and 551 unqualified photos. Among the unqualified images, 62 (11.27%) were too dark, 51 (9.27%) were too bright, 59 (10.73%) were not clear in the macular area, 36 (6.54%) showed no macula or optic disc, 125 (22.73%) could not present the fundus structure, 175 (31.82%) were blurred, and 42 (7.64%) were blocked. The results of the system and manual assessment were consistent in 1 788 qualified images (96.86%) and 550 unqualified images (99.82%), with an overall consistency rate of 97.54%. Conclusion: The fundus image quality assessment system can achieve highly consistent results with the professional judgment of ophthalmologists and has the characteristics of objectivity. (Chin J Ophthalmol, 2020, 56:920-927).

[Comprehensive control rate and related factros of diabetes mellitus in Beijing]

Objective: To investigate the comprehensive control situation and related factors of diabetes mellitus. Methods: From August to December of 2017, 13 259 residents aged 18 to 79 years old were randomly selected as the subjects by stratified multi-stage cluster sampling method. Questionnaire, physical examination and laboratory tests were conducted. The effective sample size was 13 240. A total of 1 592 diabetes patients were found. In this study, 917 diabetes patients who had been diagnosed before the investigation were selected as subjects. The comprehensive control of diabetes patients was analyzed. The situation of diabetes patients with hypertension, dyslipidemia, overweight and obesity, coronary heart diseases was analyzed. Logistic regression analysis of complex sampling was used to analyze the related factors of diabetes comprehensive control. Results: The average age of 917 patients with diabetes was (58.5±0.7) years old. The proportion of people who participated in diabetes follow-up management was 29.0%. There were 89.5% diabetes patients with one or more chronic diseases. The comprehensive control rate of diabetes mellitus was 2.0%, men and women were 1.8% and 2.3%, respectively (P>0.05). The rate of comprehensive control among those diabetes patients with chronic diseases was 0.4%, lower than that of those without chronic diseases (15.6%, P<0.05). The comprehensive control rate of people who participated in diabetes follow-up management was 1.4%. The control rate of blood glucose, blood pressure, blood lipid and weight of diabetes mellitus was 30.9%, 30.2%, 17.4% and 27.7%, respectively. Logistic regression analysis of complex sampling showed that excessive intake of red meat, with chronic diseases and qualified core knowledge were all related with comprehensive control of diabetes mellitus, OR value was 31.41, 39.98 and 0.29, P<0.05. Conclusion: The comprehensive control rate of diabetes mellitus was low. Excessive intake of red meat, with chronic diseases and qualified core knowledge were all related with comprehensive control of diabetes mellitus.

MiR-497 inhibits cell proliferation and invasion ability by targeting HMGA2 in pancreatic ductal adenocarcinoma

OBJECTIVE

MicroRNAs have been implicated to play a crucial regulating role in human cancers. The study aims to explore the role and clinical significance of miR-497 in pancreatic ductal adenocarcinoma (PDAC).

PATIENTS AND METHODS

The relative expression of miR-497 in human PDAC tissue samples and adjacent normal tissues was measured using the quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Cell Counting Kit (CCK-8) assay, cell migration, and invasion assays were performed to detect cell proliferation and invasion ability. Downstream target gene was confirmed by using luciferase activity assays. QRT-PCR and Western blotting assays also were performed.

RESULTS

We found that miR-497 expression was significantly downregulated in PDAC tissues and cells. Lower miR-497 expression associated with lymph node metastasis and predicts a poor prognosis in PDAC patients. In in vitro assay, we demonstrated that miR-497 overexpression inhibited cell proliferation, migration, and invasion of PDAC. Furthermore, we demonstrated that HMGA2 was a direct target of miR-497 in PDAC cells. MiR-497 inhibited cell proliferation and invasion by regulating HMGA2 expression.

CONCLUSIONS

Our results indicated that miR-497 may serve as a predictor for PDAC and could be a novel target of PDAC treatment.

SIRT5 deficiency enhances the proliferative and therapeutic capacities of adipose-derived mesenchymal stem cell via metabolic switching

Background

Mesenchymal stem/stromal cells (MSCs) render potential therapies for multiple ischemic diseases. However, in vitro expansion of MSCs before application leads to a metabolic switch from glycolysis to oxidative phosphorylation, drastically impairing their proliferative and therapeutic capacities.

Purpose

Here we aim to identify the role of SIRT5, a master metabolic regulator, in culture expansion of adipose-derived MSCs (ADMSCs).

Methods

SIRT5 deficiencyADMSCs was obtained from Sirt5−/− mice and their metabolic pattern and proliferation capacity were tested during in vitro expansion. Hind limb ischemic model was established to evaluated the therapeutic function of Sirt5−/−ADMSCs.

Results

SIRT5 protein level was upregulated in ADMCSs undergoing culture expansion. Sirt5−/−ADMSCs during in vitro expansion exhibited higher proliferation rate, delayed senescence and enhanced antioxidant capacity. SIRT5 deficiency induced hypersuccinylation of metabolic-related proteins, leading to attenuated mitochondrial respiration with elevated glycolysis and pentose phosphate pathway. Furthermore, lowering succinylation level by glycine treatment reversed the altered metabolism and enhanced proliferation of Sirt5−/−ADMSCs. In mice hind limb ischemic model, SIRT5−/−ADMSCs treatment achieved better blood flow recovery and angiogenesis compared to WT ADMSCs treatment.

Conclusion

We reveal that SIRT5 is a key regulator of ADMSCs undergoing in vitro culture. Ablation of SIRT5 leads to reversed metabolic pattern, enhanced proliferative capacity and improved therapeutic outcomes. Our data provide a potential target for enhancing MSC functional properties during bio-manufacturing in future MSC therapy. Such work may not only benefit MSC cell therapy, but could extent to a wide variety of other stem cells that share similar metabolic pattern.

Graphic Abstract

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Major Research Plan of the National Natural Science Foundation of China. National Science Fund for Distinguished Young Scholars.