A comparison of the burden of knee osteoarthritis attributable to high body mass index in China and globally from 1990 to 2019

BackgroundExcess body mass index (BMI) plays a key role in the onset and progression of knee osteoarthritis (knee OA). However, the burden of knee OA attributable to high BMI at the global, Chinese, and regional levels have received far too little attention. The aim of this study is to provide evidence to support the design of policy by investigating long-term trends of years lived with disability (YLDs) for knee OA.MethodsTo illustrate the trends of YLDs for knee OA attributable to high BMI and the temporal trends of the YLDs rate by age, period, and cohort, Joinpoint regression software and age-period-cohort (APC) were used to analyze the YLDs data of knee OA from the Global Burden of Disease (GBD) 2019.ResultsIn China, there were 549,963.5 YLDs for knee OA attributable to high BMI in 2019, which had increased by 460.7% since 1990. From 1990 to 2019, age-standardized disability-adjusted life year rate (ASDR) of knee OA attributable to high BMI trended upwards. The average annual percent change (AAPC) of knee OA attributable to high BMI in China and globe were 3.019, 1.419%, respectively. The longitudinal age curve of the APC model showed that the YLDs rates of knee OA due to high BMI increased with age, and YLDs rates were higher among females than males. The period rate ratios (RRs) of knee OA due to high BMI increased significantly. The cohort RRs of knee OA due to high BMI increased among those born between 1900 and 1970. The net drifts of knee OA attributable to high BMI in China and globe were above 1. Compared with global condition, the net drift values of knee OA attributable to high BMI in China was higher. Compared with females, males had higher net drift value. Countries with high socio-demographic index (SDI) have a much higher burden of knee OA caused by high BMI than countries with low SDI.ConclusionIn China, high BMI is a substantial cause of knee OA, the incidence of which has been increasing since 1990. In addition, women and the elderly are more vulnerable to knee OA caused by high BMI. The Chinese government must take the long-term impact of high BMI on knee OA into account and implement effective public health policies and resort to interventions to reduce the burden as soon as possible

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Early diagnostic method for sepsis based on neutrophil MR imaging

Purpose: This paper aims to evaluate in vitro the labelling efficiency of normal mouse and human neutrophils and neutrophils under sepsis analog conditions with two kinds of superparamagnetic iron oxide nanoparticles (SPIONs) and explore their detection and quantification by MRI at 3T. Materials and methods: Freshly isolated mouse and human neutrophils were treated with LPS at a concentration of 10 ng/mL as neutrophils under sepsis analog condition. Then control neutrophils and sepsis analog neutrophils were respectively labelled with iron particles in a diameter of 40 nm and 200 nm. The derived four kind of neutrophils were cultured in medium for 1 h. The labelling efficiency was determined with Prussian blue staining and magnetic resonance imaging (3T) for presence of intracellular iron. Data were expressed as the mean ± SD and Student t test was used to test statistically significant differences. Results: Labelled with mannan-coated SPION, both LPS-treated mouse and human neutrophils showed higher iron uptakes by Prussian blue staining and higher T2 signal loss than control group. When labelled with Dextran-coated SPION (Feridex), both mouse and human control and sepsis analog neutrophils displayed lower iron uptake by Prussian blue stain and slighter T2 signal loss. Conclusion: Mouse and human neutrophils could be more effectively labelled by Mannan-coated SPION in vitro than Feridex. Sepsis analog neutrophils labelled by Mannan-coated SPIONs could be efficiently detected on MR images, which may serve as an early diagnostic method for sepsis

Peripheral blood T-cell subset and its clinical significance in lupus nephritis patients

Objectives Lupus nephritis (LN) is a common and severe manifestation of SLE. Memory T (TM) cells have been implicated in the pathogenesis of SLE. This study aimed to investigate the clinical significance of T-cell subsets in a cohort of patients with LN.Method The peripheral blood T cells of 24 patients with LN and 13 patients with idiopathic membranous nephropathy (iMN) were analysed by flow cytometry. SLE disease activity was evaluated by SLE Disease Activity Index-2000 (SLEDAI-2K). Patients with LN were followed up for >6 months.Results Patients with LN presented lower frequency of CD4+ cells and higher percentage of CD8+ cells than patients with iMN, which was primarily due to lower CD4+ cell count. Interestingly, patients with LN under immunosuppressants had lower CD8+CD45RO+ TM frequency (p=0.007), fewer regulatory CD4+ T cells (p=0.04) than those without immunosuppressants. Most CD4+ and CD8+ TM cells in patients with LN showed an effector memory (CD45RO+CCR7+) phenotype. The frequency of CD8+CD45RO+ TM cells among the CD8+ T cells was negatively correlated with white blood cell count, haemoglobin, platelet and serum levels of complements C3 and C4, but was positively correlated with serum IgG, erythrocyte sedimentation rate and SLEDAI score (p<0.05 each). Consistently, the frequency of CD8+CD45RO+ TM cells was higher in patients with LN with positive antidouble-stranded DNA antibody, active renal disease, extrarenal manifestations and with sclerotic glomeruli or moderate-to-severe mesangial hypercellularity in renal pathology (p<0.05). Additionally, CD8+CD45RO+ TM cell frequency was significantly lower in patients with LN with renal complete remission than that in non-remission LN (18.7% vs 31.2%, p<0.05). None of these significant correlations was observed in CD4+ TM cells.Conclusion The frequency of CD8+ TM cells correlates with disease activity and treatment response to immunosuppressant in patients with LN. CD8+ TM monitoring in patients with LN could provide more helpful indices for the monitoring and management of this disease

A Heterogeneity-Aware Replacement Policy for the Partitioned Cache on Asymmetric Multi-Core Architectures

In an asymmetric multi-core architecture, multiple heterogeneous cores share the last-level cache (LLC). Due to the different memory access requirements among heterogeneous cores, the LLC competition is more intense. In the current work, we propose a heterogeneity-aware replacement policy for the partitioned cache (HAPC), which reduces the mutual interference between cores through cache partitioning, and tracks the shared reuse state of each cache block within the partition at runtime to guide the replacement policy to keep cache blocks shared by multiple cores in multithreaded programs. In the process of updating the reuse state, considering the difference of memory accesses to LLC by heterogeneous cores, the cache replacement policy tends to keep cache blocks required by big cores, to better improve the LLC access efficiency of big cores. Compared with LRU and the SRCP, which are the state-of-the-art cache replacement algorithms, the performance of big cores can be significantly improved by HAPC when running multithreaded programs, while the impact on little cores is almost negligible, thus improving the overall performance of the system

Characteristics and renal survival of patients with lupus nephritis with glomerular immunoglobulin G4 deposition: a single-centre retrospective analysis

Objective Renal injury is common in SLE. Immune complex deposition plays an important role in the development of lupus nephritis (LN), while little is known about glomerular IgG4 deposition in patients with LN. This study aimed to investigate the characteristics and renal outcome of patients with LN with glomerular IgG4 deposition.Methods This is a single-centre retrospective study enrolling 89 patients with biopsy-proven LN. Clinicopathological features, treatment responses and renal outcomes were collected and compared between patients with and without glomerular IgG4 deposition. Renal outcome events include progression of renal dysfunction and end-stage renal disease.Results Thirty (33.7%) patients had glomerular IgG4 deposition. Patients with glomerular IgG4 deposition had lower serum albumin level (25.06±8.61 g/L vs 28.29±6.31 g/L, p=0.05), more class V LN (60.0% vs 35.6%, p=0.03), more positive phospholipase A2 receptor (PLA2R) staining (43.3% vs 18.6%, p=0.01), more IgG1 deposits (96.7% vs 64.4%, p=0.01) and less C3 deposits (46.7% vs 72.9%, p=0.02) than those without glomerular IgG4 deposition. They also had better renal survival than those without glomerular IgG4 deposition (96.7% vs 79.7%, p=0.03). Multivariate Cox regression showed that high serum creatinine level (relative risk (RR)=1.005, 95% CI 1.002 to 1.008, p=0.01) and high Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores (RR=1.078, 95% CI 1.004 to 1.157, p=0.04) independently correlated with poor renal outcome, while glomerular IgG4 deposition tended to correlate with good renal outcome (RR=5.95, 95% CI 0.759 to 45.97, p=0.09). Further, patients with both glomerular IgG4 and PLA2R positivity (n=13) had higher levels of serum C3 and C4 and less glomerular C3 deposits compared with those with positive IgG4 but negative PLA2R in the glomerulus (n=17), and had a tendency of low SLEDAI score (p=0.07).Conclusions Patients with LN with glomerular IgG4 deposits may have better renal survival, and patients with LN with simultaneous glomerular IgG4 and PLA2R deposits may have low disease activity