Prediction of squamous cell carcinoma cases from squamous cell hyperplasia in throat lesions using CT radiomics model

Objectives:

To differentiate squamous cell hyperplasia (SCH) (benign) from squamous cell carcinoma (SCC) malignant) using textural features extracted from CT images and thereby, facilitate the preoperative medical diagnosis and treatment of throat cancers without the need for sample biopsies.

Methods:

In total, 100 throat cancer patients were selected for this retrospective study. The cases were collected from the Second Hospital of Jilin University, Changchun, China, from June 2017 to January 2019. The patients were separated into a training and validation cohort consisting of 70 and 30 cases, respectively. The Artificial Intelligence Kit software (A.K. software) was used to extract the radiomics features from the CT images. These features were further processed using the minimum redundancy maximum relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) methods to obtain a subset of optimal features. The radiomics model was validated based on area-under-the-curve (AUC) values, accuracy, specificity, and sensitivity using the R-studio software.

Results:

The diagnostic accuracy, specificity, PPV, NPV, and AUC values obtained for the training cohort was 0.91, 0.9, 0.93, 0.9, and 0.96 CT angiography (CTA), 0.93, 0.93, 0.95, 0.90, and 0.96 computed tomography normal (CTN), and 0.92, 0.87, 0.91, 0.96, and 0.96 CT venogram (CTV). These values were subsequently confirmed in the validation cohort.

Conclusion:

The radiomics-based prediction model proposed in this study successfully differentiated between SCH and SCC throat cancers using CT imaging, thereby facilitating the development of accurate preoperative diagnosis based on specific biomarkers and cancer phenotypes.

Cost-Effectiveness of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease and Acute Coronary Syndromes in the US Medicare Program

Background Coronary revascularization provides important long-term clinical benefits to patients with high-risk presentations of coronary artery disease, including those with chronic kidney disease. The cost-effectiveness of coronary interventions in this setting is not known. Methods and Results We developed a Markov cohort simulation model to assess the cost-effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with chronic kidney disease who were hospitalized with acute myocardial infarction or unstable angina. Model inputs were primarily drawn from a sample of 14 300 patients identified using the Medicare 20% sample. Survival, quality-adjusted life-years, costs, and cost-effectiveness were projected over a 20-year time horizon. Multivariable models indicated higher 30-day mortality and end-stage renal disease with both PCI and CABG, and higher stroke with CABG, relative to medical therapy. However, the model projected long-term gains of 0.72 quality-adjusted life-years (0.97 life-years) for PCI compared with medical therapy, and 0.93 quality-adjusted life-years (1.32 life-years) for CABG compared with PCI. Incorporation of long-term costs resulted in incremental cost-effectiveness ratios of $65 326 per quality-adjusted life-year gained for PCI versus medical therapy, and $101 565 for CABG versus PCI. Results were robust to changes in input parameters but strongly influenced by the background costs of the population, and the time horizon. Conclusions For patients with chronic kidney disease and high-risk coronary artery disease presentations, PCI and CABG were both associated with markedly increased costs as well as gains in quality-adjusted life expectancy, with incremental cost-effectiveness ratios indicating intermediate value in health economic terms.

Left Ventricular Assist Device Implantation in a COVID-19 Positive Patient

Introduction

Case Report

Summary

EpsR Negatively Regulates Streptococcus mutans Exopolysaccharide Synthesis

Streptococcus mutans is considered the primary etiological agent of human dental caries. Glucosyltransferases (Gtfs) from S. mutans play important roles in the formation of biofilm matrix and the development of cariogenic oral biofilm. Therefore, Gtfs are considered an important target to prevent the development of dental caries. However, the role of transcription factors in regulating gtf expression is not yet clear. Here, we identify a MarR (multiple antibiotic resistance regulator) family transcription factor named EpsR (exopolysaccharide synthesis regulator), which negatively regulates gtfB expression and exopolysaccharide (EPS) production in S. mutans. The epsR in-frame deletion strain grew slowly, aggregated more easily in the presence of dextran, and displayed different colony morphology and biofilm structure. Notably, epsR deletion resulted in altered 3-dimensional biofilm architecture, increased water-insoluble EPS production, and upregulated GtfB protein content and activity. In addition, global gene expression profiling revealed differences in the expression levels of 69 genes in which gtfB was markedly upregulated. The conserved DNA motif for EpsR binding was determined by electrophoretic mobility shift assay and DNase I footprinting assays. Moreover, analysis of β-galactosidase activity suggested that EpsR acted as a repressor and inhibited gtfB expression. Taken together, our findings indicate that EpsR is an important transcription factor that regulates gtfB expression and EPS production in S. mutans. These results add new aspects to the complexity of regulating the expression of genes involved in the cariogenicity of S. mutans, which might lead to novel strategies to prevent the formation of cariogenic biofilm that may favor diseases.

Diagnosis and follow-up value of endoscopic ultrasonography (EUS) in primary gastric non-Hodgkin’s lymphoma

Background

The lesion of primary gastric non-Hodgkin’s lymphoma (PGL) originates from the submucosa, so conventional gastroscopy has limited diagnostic potential. This study evaluated the diagnosis and follow-up value of endoscopic ultrasonography (EUS) in PGL.

Methods

Seventy-nine patients diagnosed with PGL either by EUS and biopsy pathology or by postoperative pathology were included in the study. All subjects underwent EUS with deep targeted biopsy and regular follow-up.

Results

We found sensitivity and specificity of EUS combined with deep targeted biopsy for PGL as 87.3% (69/79) and 80.0% (20/25) respectively, and the diagnostic accuracy as 85.6% (89/104). EUS combined with deep targeted biopsy had significantly greater diagnostic accuracy than gastroscopy [85.6% (89/104) vs. 57.7% (60/104); (P<0.001)]. The diagnostic accuracy of T tumor staging and N tumor staging of EUS were 13/13 and 11/13 respectively compared with postoperative staging. The mean time of complete remission of lymphoma after eradication treatment in the H. pylori-negative (successful eradication) group (3.2±0.7 months) was shorter than that in H. pylori-positive patients (failed eradication) group (4.5±0.8 months), there was statistically significant difference between the two groups (t=4.3, P<0.001).

Conclusions

This study demonstrated that EUS combined with deep targeted biopsy was associated with increased detection of Primary gastric non-Hodgkin’s lymphoma (PGL), in terms of depth and extent of the lesion to guide treatment selection and to evaluate treatment efficacy.

Clinical Outcomes Associated With Chronic Kidney Disease in Elderly Medicare Patients With Multiple Myeloma

BACKGROUND

Chronic kidney disease (CKD) is common in patients with multiple myeloma (MM) and is associated with a poor prognosis. We assessed CKD-associated clinical outcomes among elderly patients with MM initiating chemotherapy in the United States.

MATERIALS AND METHODS

We identified elderly Medicare beneficiaries (≥66 years) diagnosed with MM who initiated first-line therapy from 2008 to 2014. We identified CKD using diagnosis codes. We followed patients for death, time to next treatment (TTNT), and myeloma-defining events (anemia, hypercalcemia, skeletal-related events, progression to/of CKD) until September 30, 2015. We estimated overall survival, TTNT, and cumulative incidence of myeloma-defining events using the Kaplan-Meier method and risk of CKD-associated outcomes using Cox proportional hazards models, adjusting for demographics and comorbid conditions.

RESULTS

Of 22,484 included patients, 8704 (39%) had CKD at first-line therapy initiation. Compared with patients without CKD, patients with CKD had shorter median overall survival (2.1 vs. 3.6 years) and median TTNT (10.0 vs. 12.4, 9.7 vs. 11.2, 8.3 vs. 9.2, and 6.9 vs. 8.3 months at first- to fourth-line therapy). Probability of CKD progression for patients at stages 1 to 5 was higher than the probability of developing CKD for patients without CKD (3-year cumulative incidence [95% confidence interval, CI], 47% [45-48%] vs. 27% [24-26%]). Adjusted hazard ratios for CKD versus non-CKD were: all-cause death, 1.23 (95% CI, 1.18-1.28); anemia, 1.34 (95% CI, 1.24-1.45); hypercalcemia, 1.23 (95% CI, 1.09-1.38); skeletal-related events, 0.85 (95% CI, 0.90-0.91); and TTNT, from 1.03 (95% CI, 0.96-1.10) at third-line therapy to 1.15 (95% CI, 1.04-1.27) at fourth-line therapy.

CONCLUSION

Data from the study suggest that CKD-associated clinical burden is substantial in elderly patients with MM.

Impacts of Glycemic Control on Intracranial Plaque in Patients with Type 2 Diabetes Mellitus: A Vessel Wall MRI Study

BACKGROUND AND PURPOSE

The relationship between glycemic control in patients with type 2 diabetes mellitus and intracranial atherosclerotic plaque features has remained understudied. This study aimed to investigate the association of type 2 diabetes mellitus and glycemic control with the characteristics of intracranial plaques using vessel wall MR imaging.

MATERIALS AND METHODS

In total, 311 patients (217 [69.8%] men; mean age, 63.24 ± 11.44 years) with intracranial atherosclerotic plaques detected on vessel wall MR imaging were enrolled and divided into 3 groups according to type 2 diabetes mellitus and glycemic control statuses: the non-type 2 diabetes mellitus group, the type 2 diabetes mellitus with good glycemic control group, and the type 2 diabetes mellitus with poor glycemic control group. The imaging features of intracranial plaque were analyzed and compared among the groups. The clinical risk factors for atherosclerosis were also analyzed using logistic regression analysis.

RESULTS

The plaque length and thickness were significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus group. The prevalence of strongly enhanced plaques was significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus and type 2 diabetes mellitus with good glycemic control groups (92.9%, 63.4%, and 72.7%, respectively; P < .001). Multivariate logistic regression analysis showed a significant association of poor glycemic control with the plaque length (OR = 1.966; 95% CI, 1.170-3.303; P = .011), plaque thickness (OR = 1.981; 95% CI, 1.174-3.340; P = .010), and strongly enhanced plaque (OR = 5.448; 95% CI, 2.385-12.444; P < .001).

CONCLUSIONS

Poor glycemic control, compared with the history of diabetes, might have a greater impact on the burden and vulnerability of intracranial atherosclerotic plaques.

Improved Stability and Photothermal Performance of Polydopamine-Modified Fe3 O4 Nanocomposites for Highly Efficient Magnetic Resonance Imaging-Guided Photothermal Therapy

Magnetic nanomaterials are a promising class of contrast agents for magnetic resonance imaging (MRI). However, their poor stability and low relaxivity are major challenges hindering their clinical applications. In this study, magnetic theranostic nanoagents based on polydopamine-modified Fe₃ O₄ (Fe₃ O₄ @PDA) nanocomposites are fabricated for MRI-guided photothermal therapy (PTT) cancer treatments. Their high transverse relaxivity of 337.8 mM^-1 s^-1 makes these Fe₃ O₄ @PDA nanocomposites a promising T₂ -weighted MRI contrast agent for cancer diagnosis and image-guided cancer therapy. Due to the good photothermal effect of polydopamine (PDA), the tumors of 4T1 tumor-bearing mice are completely excised by PTT. Most importantly, the PDA shell also improves the stability of the Fe₃ O₄ @PDA nanocomposites, which contributes to their excellent, long-term performance in MRI and PTT applications. Their good stability, high T₂ relaxivity, robust biocompatibility, and satisfactory treatment effect give these Fe₃ O₄ @PDA nanocomposites great potential for use in cancer theranostics.

Discharge status and post-discharge healthcare costs after skeletal-related event hospitalizations among medicare patients with bone metastatic solid tumors or multiple myeloma

•

Most elderly cancer patients (>75%) require healthcare facility support after skeletal-related event-related hospitalization, with substantial associated costs.

•

The largest proportion of bone metastases patients were discharged to skilled nursing facilities (SNF) (32.9%), then home health agency (HHA) (13.7%), hospice (13.5%), and long-term care (LTC) (11.3%).

•

The largest proportion of multiple myeloma (MM) patients were discharged to SNF (35.9%), then HHA (18.2%), hospice (7.2%), and LTC (1.5%).

•

Mean Medicare cost per patient per facility stay was < $10,000 for hospice, and from $15,517 for LTC nursing home to $49,729 for LTC hospital for MM patients.

Background

Previous studies have quantified direct inpatient costs of skeletal-related events (SREs); however, costs associated with subsequent post-SRE care have not been examined.

Methods

We identified two study cohorts using 2011–2015 Medicare 20% sample data: patients diagnosed with 1) bone metastases from solid tumors or 2) multiple myeloma (MM), both with SRE-related hospitalization discharge dates January 1, 2011-September 30, 2015. We assessed discharge status and costs from discharge to the earliest of death, end of Medicare enrollment, or December 31, 2015. Discharge status was defined as: skilled nursing facility (SNF), rehabilitation facility, hospice, home health agency (HHA), long-term care (LTC) nursing home, LTC hospital, or rehospitalization within or after 30 days. Percentage, stay duration, and Medicare costs were calculated for each setting. All analyses were descriptive.

Results

We identified 7988 bone metastases patients and 4277 MM patients discharged from index SRE-related hospitalizations; corresponding mean ages were 76.9 and 76.6 years. The largest proportion of bone metastases patients were discharged to SNF (32.9%), then HHA (13.7%), hospice (13.5%), and LTC (11.3%); the pattern was similar for MM patients (SNF, 35.9%; HHA, 18.2%; hospice, 7.2%; LTC, 1.5%). Almost 10% of patients in both cohorts were re-hospitalized within 30 days. Mean Medicare cost per patient per facility stay was < $10,000 for hospice, and from $15,517 for LTC nursing home to $49,729 for LTC hospital for MM patients.

Conclusion

Most elderly cancer patients (>75%) require healthcare facility support after SRE-related hospitalization, with substantial associated costs. Post-discharge management is clinically and economically important.

Global, regional and national burden of gout, 1990-2017: a systematic analysis of the Global Burden of Disease Study

OBJECTIVES

The burden of gout has been increasing globally. However, little is known about the global, regional and national distribution and time trend of this disease. We present a comprehensive analysis of the Global Burden of Disease Study 2017 on gout burden estimates for 195 countries or territories between 1990 and 2017.

METHODS

Age-standardized prevalence and disability-adjusted life-years of gout were reported between 1990 and 2017 in 195 countries and territories, and associations between these estimates and sociodemographic index (SDI) were further explored. Total and annual percent change between 1990 and 2017 were calculated to quantify the time trends of gout burden.

RESULTS

Age-standardized prevalence rates (95% uncertainty interval) per 100 000 persons were 790.90 (706.10-881.90) and 253.49 (225.69-284.02) in 2017 in males and females, respectively. The annual percent change in age-standardized prevalence (males, 0.22%; females, 0.38%) and disability-adjusted life-years (males, 0.21%; females, 0.38%) of gout increased every year from 1990 to 2017, globally. The highest increase was detected in high-SDI countries, especially in high-income North America. A non-linear association was observed between burden of gout and SDI, with the lowest estimates of gout burden when SDI value was about 0.6. High BMI was the leading risk factor for the burden of gout.

CONCLUSION

These study results suggest a globally rising trajectory of gout burden between 1990 and 2017. More effective interventions, such as detailed and intensive dietary managements and other prevention strategies for reducing obesity, should be carried out to reverse this trend, especially in females and high-SDI countries.

Duration of short-acting granulocyte colony-stimulating factor for primary prophylaxis and risk of neutropenia-related hospitalization in older patients with cancer

PURPOSE

Evaluate the relationship between duration of primary prophylactic short-acting granulocyte colony-stimulating factor (PP-sG-CSF) and risk of neutropenia-related hospitalization (NRH) in older patients receiving myelosuppressive chemotherapy.

METHODS

Using the Medicare claims database, we conducted a nested case-control study in a cohort of patients aged ≥66 years with breast, colorectal, lung, ovarian, or prostate cancer, or non-Hodgkin lymphoma who initiated a first cycle of any myelosuppressive chemotherapy January 1, 2008-September 30, 2016, and received PP-sG-CSF. We matched up to four controls to each NRH case by age, cancer type, regimen febrile neutropenia (FN) risk category, and year using incidence density sampling. We used conditional logistic regression adjusted for race, sex, and modified Charlson comorbidity index (CCI) to estimate relative risk of NRH related to duration of PP-sG-CSF categorized as <5 and ≥ 5 days.

RESULTS

Of 2148 patients receiving PP-sG-CSF, 108 (5%) experienced NRH in the first cycle. We matched 333 controls to 96 cases. Cases were similar to controls in mean age, tumor type, and intermediate/high-risk regimen, but were more likely to have CCI ≥5 and less likely to use PP-sG-CSF ≥5 days (31% vs. 39%). Adjusted ORs (95% CI) for NRH were 0.69 (0.40-1.19) for ≥5 vs. <5 days of PP-sG-CSF among patients receiving any myelosuppressive chemotherapy, 0.43 (0.21-0.89) for intermediate/high-risk regimen, and 0.42 (0.19-0.89) for any myelosuppressive chemotherapy with all agents given on cycle day one only.

CONCLUSIONS

Among older patients with cancer who are receiving PP-sG-CSF, ≥5 days of use was associated with substantial reduction in NRH risk.

Intrinsic Fluoride Tolerance Regulated by a Transcription Factor

Fluoride facilitates the remineralization of dental hard tissues and affects bacterial activities. Therefore, it is extensively used as an anti-caries agent in clinical practice and daily life. Although some studies focused on understanding Streptococcus mutans' response to fluoride, the mechanism regulating intrinsic fluoride tolerance is not yet clear. Since the TetR family of transcription factors is associated with multidrug resistance, our aim was to evaluate whether they are related to fluoride tolerance in S. mutans. A mutant library including each S. mutans TetR gene was constructed and the transcription factor fluoride related transcriptional regulator (FrtR) was identified. The in-frame deletion of the S. mutans frtR gene resulted in decreased cell viability under fluoride in both the planktonic state and single-/dual-species biofilms. This in-frame frtR mutant was used for RNA-sequencing and the fluoride related permease gene (frtP) was found as 1 of the downstream genes directly regulated by FrtR. The recombinant FrtR protein was purified, and conserved DNA binding motifs were determined using electrophoretic mobility shift and DNase I footprinting assays. Finally, a series of mutant and complement strains were constructed to perform the minimum inhibitory concentration (MIC) assays, which indicated that frtP upregulation led to the increase of fluoride sensitivity. Collectively, our results indicate that FrtR is an important transcription factor regulating the frtP expression in S. mutans, thus affecting the intrinsic fluoride tolerance. Therefore, this study provides novel insights into a potential target to increase the S. mutans sensitivity to fluoride for a better prevention of dental caries.

Discriminating between bronchiolar adenoma, adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung with CT

PURPOSE

To identify computed tomography (CT) features that may help distinguish bronchiolar adenoma (BA) from lung adenocarcinomas in situ (AIS) and minimally invasive adenocarcinomas (MIA) among lung lesions presenting as ground-glass nodules (GGNs).

MATERIALS AND METHODS

A total of 140 patients with GGNs confirmed by surgery and pathology, were reviewed retrospectively. There were 68 men and 72 women with a mean age of 64.3±8.9 (SD) years (range: 31 - 85 years). The CT features of BA, AIS, and MIA were analyzed and compared. CT features, including percentage of solid component, maximum diameter of solid component, lesion density, location, margin, shape, pseudo-cavitation, calcification, ill-defined peripheral opacity, and air bronchogram, were analyzed using multivariate logistic regression and receiver operating characteristic curves.

RESULTS

There were 11/140 (7.9%) patients with BA (mean age, 67.7±7.5 [SD]; range 45 - 77 years), 63/140 (45.0%) patients with AIS (mean age, 62.5±8.6 [SD]; range 36 - 69 years) and 66/140 (47.1%) patients with MIA (mean age, 63.5±7.9 [SD]; range 35 - 72 years). By comparison with AIS and MIA, significantly different CT features of BA included tumor size, solid component diameters, low CT attenuation of the ground-glass component, irregular shape, ill-defined peripheral opacity, pseudo-cavitation, and abnormal pulmonary vein. Ill-defined peripheral opacity (odds ratio, 1.060; 95% confidence interval [CI]: 1.020 - 1.380) and pseudo-cavitation (odds ratio, 1.236; 95% CI: 1.070 - 1.565) were variables independently associated with the diagnosis of BA.

CONCLUSION

CT provides morphological features that allow differentiating between BA and AIS-MIA among lung lesions presenting as GGNs.

Severe obstructive sleep apnea in patients with chronic obstructive pulmonary disease is associated with an increased prevalence of mild cognitive impairment

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are associated with mild cognitive impairment (MCI). However, this association is unclear. This study aimed to assess the prevalence of MCI in patients with overlap syndrome, determine whether OSA increases the risk of MCI in patients with COPD, and investigate the potential mechanisms for this association.

METHODS

Participants with stable Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2-4 COPD and complaints of snoring in 2016-2018 were enrolled in this cross-sectional observational study. All were free of asthma, acute left-sided congestive heart failure, unstable coronary heart disease, uncontrolled hypertension, diabetes, encephalitis, and epilepsy. They underwent pulmonary function tests and overnight polysomnography and completed the Montreal Cognitive Assessment (MoCA). MCI was defined by an MoCA score of <23, while OSA was defined by an apnea-hypopnea index (AHI) of ≥15 per hour. The association between MCI, demographics, and comorbidities was tested by logistic regression analysis with adjustment for confounders. Sleep-disordered breathing measures were investigated as potential mechanisms underlying this relationship.

RESULTS

MCI was significantly more common in patients with overlap syndrome than in those with COPD (40.6% [43/106] vs 24.6% [42/171]). After adjustment, severe OSA was an independent contributor to MCI (odds ratio, OR 2.27; 95% confidence interval, CI 1.12-4.62). Increased percent of night-time spent with oxygen saturation <90% (TSat₉₀) was associated with increased odds of MCI (odds ratio 4.75, 95% CI 2.73-11.13).

CONCLUSIONS

MCI is more prevalent in overlap syndrome than in COPD. OSA may contribute to MCI in COPD. The mechanism may involve TSat₉₀.

The Impact of Whole Genome Data on Therapeutic Decision-Making in Metastatic Prostate Cancer: A Retrospective Analysis

BACKGROUND

While critical insights have been gained from evaluating the genomic landscape of metastatic prostate cancer, utilizing this information to inform personalized treatment is in its infancy. We performed a retrospective pilot study to assess the current impact of precision medicine for locally advanced and metastatic prostate adenocarcinoma and evaluate how genomic data could be harnessed to individualize treatment.

METHODS

Deep whole genome-sequencing was performed on 16 tumour-blood pairs from 13 prostate cancer patients; whole genome optical mapping was performed in a subset of 9 patients to further identify large structural variants. Tumour samples were derived from prostate, lymph nodes, bone and brain.

RESULTS

Most samples had acquired genomic alterations in multiple therapeutically relevant pathways, including DNA damage response (11/13 cases), PI3K (7/13), MAPK (10/13) and Wnt (9/13). Five patients had somatic copy number losses in genes that may indicate sensitivity to immunotherapy (LRP1B, CDK12, MLH1) and one patient had germline and somatic BRCA2 alterations.

CONCLUSIONS

Most cases, whether primary or metastatic, harboured therapeutically relevant alterations, including those associated with PARP inhibitor sensitivity, immunotherapy sensitivity and resistance to androgen pathway targeting agents. The observed intra-patient heterogeneity and presence of genomic alterations in multiple growth pathways in individual cases suggests that a precision medicine model in prostate cancer needs to simultaneously incorporate multiple pathway-targeting agents. Our whole genome approach allowed for structural variant assessment in addition to the ability to rapidly reassess an individual's molecular landscape as knowledge of relevant biomarkers evolve. This retrospective oncological assessment highlights the genomic complexity of prostate cancer and the potential impact of assessing genomic data for an individual at any stage of the disease.

Detection of somatic structural variants from short-read next-generation sequencing data

Somatic structural variants (SVs), which are variants that typically impact >50 nucleotides, play a significant role in cancer development and evolution but are notoriously more difficult to detect than small variants from short-read next-generation sequencing (NGS) data. This is due to a combination of challenges attributed to the purity of tumour samples, tumour heterogeneity, limitations of short-read information from NGS and sequence alignment ambiguities. In spite of active development of SV detection tools (callers) over the past few years, each method has inherent advantages and limitations. In this review, we highlight some of the important factors affecting somatic SV detection and compared the performance of seven commonly used SV callers. In particular, we focus on the extent of change in sensitivity and precision for detecting different SV types and size ranges from samples with differing variant allele frequencies and sequencing depths of coverage. We highlight the reasons for why some SV callers perform well in some settings but not others, allowing our evaluation findings to be extended beyond the seven SV callers examined in this paper. As the importance of large SVs become increasingly recognized in cancer genomics, this paper provides a timely review on some of the most impactful factors influencing somatic SV detection that should be considered when choosing SV callers.

Formation of haloacetic acids from different organic precursors in swimming pool water during chlorination

Haloacetic acids (HAAs) were reported to be the most abundant category of DBPs in swimming pool water. In this study, the formation of HAAs from different organic precursors in swimming pool water, including UV filters, human body fluids, and natural organic matter (NOM), during chlorination was examined, and the effects of chlorine dose and halide concentrations on the formation of HAAs were evaluated. The results show that the total HAA yields from benzophenone-3 (BP-3) and Suwannee River humic acid (SRHA) were the highest among the nine organic precursors, and the yields of dichloroacetic acid and bromochloroacetic acid were higher than that of the other HAA species. In all the chlorinated samples of different organic precursors, longer chlorination time enhanced HAA formation. Both chlorine dose and bromide concentration significantly affected the formation of HAAs from BP-3 and SRHA during chlorination. With the increasing chlorine dose, the total HAA yields from SRHA and BP-3 significantly increased. Besides, the proportion of trihaloacetic acids (THAAs) rose while that of dihaloacetic acids (DHAAs) and monohaloacetic acids (MHAAs) declined with the increasing chlorine dose. With the increasing bromide concentration, HAA formation from SRHA increased while that of BP-3 decreased. The bromine incorporation factor (BIF) of the formed MHAAs, DHAAs and THAAs from SRHA and BP-3 both increased with the increasing bromide concentration in the following order: BIF_DHAAs > BIF_THAAs > BIF_MHAAs, indicating that bromine was easier to be incorporated into DHAAs rather than MHAAs or THAAs. Moreover, bromide promoted the formation of Br-HAAs.

Formation and Decomposition of New Iodinated Halobenzoquinones during Chloramination in Drinking Water

Previously four chlorinated and brominated halo-benzoquinones were reported as new disinfection byproducts (DBPs) in drinking water, which have drawn great concern due to their high toxicity. In this study, three new iodinated halobenzoquinones, including 2-chloro-6-iodo-1,4-benzoquinone (2,6-CIBQ), 2-bromo-6-iodo-1,4-benzoquinone (2,6-BIBQ), and 2,6-diiodo-1,4-benzoquinone (2,6-DIBQ), were detected and identified in drinking water for the first time. Their cytotoxicity was evaluated, and their formation under various conditions was examined. Since they were not stable during chloramination, their further decomposition during chloramination was also explored. The results indicated that the concentrations of 2,6-CIBQ, 2,6-BIBQ, and 2,6-DIBQ in drinking water were in the ranges of 0.7-1.3, 1.8-8.0, and 0.4-15.9 ng/L, respectively. Compared with 2,6-dibromo-1,4-benzoquinone, the iodinated halobenzoquinones were generally more cytotoxic. The formation of 2,6-DIBQ during chloramination was significantly affected by the iodide concentration, pH, and natural organic matter. The five tested iodinated halobenzoquinones decomposed during chloramination following pseudo-first-order decay, with the decomposition rate constants in the rank order of 2,6-CIBQ > 2,6-BIBQ > 2,6-DIBQ > 2,3-diiodo-1,4-benzoquinone >2-iodo-1,4-benzoquinone. Nine polar halogenated intermediates as well as ten aliphatic halogenated DBPs were detected as the decomposition products of 2,6-DIBQ during chloramination, based on which the decomposition pathways of 2,6-DIBQ during chloramination were proposed and verified.

HIF-1α Stabilization Enhances Angio-/Vasculogenic Properties of SHED

The outcome of regenerative procedures could be augmented by enhancing the biological performances of stem cells prior to their transplantation. The current study aimed to investigate whether hypoxic preconditioning through stabilization of hypoxia-inducible factor 1α (HIF-1α) could enhance the angio-/vasculogenic properties of stem cells from human exfoliated deciduous teeth (SHED). HIF-1α expression in SHED under normoxia was stabilized by silencing the expression of prolyl hydroxylase domain-containing protein 2 (PHD2) via lentiviral small hairpin RNA. This in turn significantly increased the expression of an angiogenic factor: vascular endothelial growth factor. Conditioned medium of HIF-1α-stabilized SHED increased the migration and proliferation of human umbilical vein endothelial cells (HUVECs), indicating enhanced paracrine signaling of SHED following PHD2 knockdown (P < 0.05). Furthermore, the coculture of HIF-1α-stabilized SHED with HUVECs directly and in fibrin beads demonstrated significantly longer vascular sprouts through juxtacrine and paracrine effects (P < 0.05). When HIF-1α-stabilized SHED were added to a preformed HUVEC vascular tube network on Matrigel, it not only stabilized the vessels, as shown by the increased thickness (P < 0.05) and junctional area (P < 0.01) of tubes, but also gave rise to new sprouting (P < 0.01). This observation, with the morphologic changes and increased CD31 expression, suggested that HIF-1α stabilization enhanced the endothelial differentiation capacity of SHED through autocrine signaling. In vivo Matrigel plug assay demonstrated that HIF-1α-stabilized SHED alone could give rise to a vasculature that was significantly higher than that of control SHED ± HUVECs and similar to that of HIF-1α-stabilized SHED + HUVECs. In addition to vasculogenesis by endothelial differentiation, HIF-1α-stabilized SHED recruited host blood vessels into the implant by exerting a significant paracrine effect. Taken together, our results confirmed that HIF-1α-stabilized SHED could replace the function of HUVECs and act as the sole cell source of vascularization. Thus, targeting PHD2 to stabilize HIF-1α expression is an appealing strategy that enables the use of a single cell source for achieving vascularized tissue regeneration.

Detection of vascularity of femoral head using sub-millimeter resolution steady-state magnetic resonance angiography-initial experience

OBJECTIVE

The purpose of this study was to use the steady-state (SS) magnetic resonance angiography (MRA) with a sub-millimeter resolution to detect the arteries supplying to the femoral head (FH).

MATERIALS AND METHOD

SS MRA scanning of hips was performed bilaterally in 15 healthy volunteers. A blood pool contrast agent was used. The scanning protocol included a 0.8-mm³ isotropic T1-fast field echo sequence with spectral fat suppression technique. Two highly qualified radiologists independently evaluated the medial circumflex femoral artery (MCFA), the lateral circumflex femoral artery (LCFA), and the three retinacular arteries including superior retinacular artery (SRA), inferior retinacular artery (IRA), and anterior retinacular artery (ARA). The intraosseous branches of the three retinacular arteries were also evaluated. An orthopaedic surgeon was consulted in case of disagreement. Observation by the two radiologists and support from the orthopaedic surgeon served as the end result. Agreement between the two observer radiologists was evaluated.

RESULTS

Interobserver agreement between the two radiologists was found to be substantial to perfect. Of the 30 hips, the LCFA and MCFA were detected in all hips; the SRA and IRA were detected in most hips (100%, 90%), and the ARA was detected in 13 hips (43%). The intraosseous branches of SRA and IRA were detected in 30 and 22 hips (100%, 73%), respectively, while the intraosseous branches of ARA were detected in 11 hips (37%).

CONCLUSION

The main arteries supplying the FH can be detected by the SS MRA, making it a novel method to detect the vascularity of FH.

Direct observation of imploded core heating via fast electrons with super-penetration scheme

Fast ignition (FI) is a promising approach for high-energy-gain inertial confinement fusion in the laboratory. To achieve ignition, the energy of a short-pulse laser is required to be delivered efficiently to the pre-compressed fuel core via a high-energy electron beam. Therefore, understanding the transport and energy deposition of this electron beam inside the pre-compressed core is the key for FI. Here we report on the direct observation of the electron beam transport and deposition in a compressed core through the stimulated Cu Kα emission in the super-penetration scheme. Simulations reproducing the experimental measurements indicate that, at the time of peak compression, about 1% of the short-pulse energy is coupled to a relatively low-density core with a radius of 70 μm. Analysis with the support of 2D particle-in-cell simulations uncovers the key factors improving this coupling efficiency. Our findings are of critical importance for optimizing FI experiments in a super-penetration scheme.

Recent advancement of imidazolate framework (ZIF-8) based nanoformulations for synergistic tumor therapy

As a new kind of porous material, zeolitic imidazolate frameworks (ZIF-8) are built from zinc ions and 2-methylimidazolate and possess unique merits including high porosity, good structural regularity and tunability, adjustable surface functionality and intrinsic pH induced biodegradability. These advantages endow ZIF-8 with multiple functionalities and stimuli-responsive controlled release of loaded payloads by endogenous or exogenous means. In this review, we will summarize the recent advancement of ZIF-8 as nanocarriers for the loading of various molecules including chemotherapeutic drugs, photosensitizers, photothermal agents, and proteins to fabricate multifunctional nanocomposites for synergistic cancer therapy. In addition, the challenges and future developments in this area will be highlighted.

Prevalence and incidence of systemic lupus erythematosus and associated outcomes in the 2009-2016 US Medicare population

OBJECTIVES

We aimed to update data on the prevalence and incidence of systemic lupus erythematosus (SLE) in the Medicare population and describe associated outcomes.

METHODS

This observational study used Medicare 20% random sample data 2007-2016 to estimate SLE prevalence and incidence 2009-2016. The study population included patients aged ≥18 years (stratified by <65 and ≥65 years) with Medicare fee-for-service coverage. The SLE definition was based on a published and validated algorithm. All-cause death, hospitalizations, and kidney disease incidence were defined for a prevalent SLE cohort 2011-2015. Unadjusted event rates during 5-year follow-up were reported per 100 patient-years.

RESULTS

The study included > 5 million eligible patients for each year 2009-2016. There were 19,518 (10,898, aged ≥65; 8620, aged <65) in 2016, extrapolated to 97,590 (54,490 aged ≥65; 43,100 aged <65) in the overall 2016 Medicare population. Age- and sex-adjusted prevalence rates (per 100,000 Medicare population) ranged from 301.1 in 2009 to 366.6 in 2016, all ages, and 184.0-239.9, ≥65 years. There were 2614 (1844 aged ≥65; 770 aged <65) incident patients in 2016; age-/sex-adjusted incidence rates (per 100,000 Medicare population) ranged from 46.9 in 2009 to 49.0 in 2016, all ages, and 37.5-40.8, ≥65. Five-year unadjusted mortality, elderly vs. younger, was 8.8 vs. 3.8, morbidity 34.5 vs. 32.4, and kidney disease incidence 19.8 vs. 18.0 per 100 patient-years.

CONCLUSIONS

Prevalence rates steadily increased while incidence was relatively stable 2009-2016. Our data should be interpreted with caution due to our elderly study population.

Characterization of Cre recombinase mouse lines enabling cell type-specific targeting of postnatal intervertebral discs

Cre/loxP technology is an important tool for studying cell type-specific gene functions. Cre recombinase mouse lines, including Agc1-CreER^T2 , Col2a1-Cre; Col2a1-CreER^T2 , Shh-Cre, Shh-CreER^T2 , and Osx-Cre, have been proven to be valuable tools to elucidate the biology of long bones, yet the information for their activity in postnatal intervertebral disc (IVD) tissues was very limited. In this study, we used R26-mTmG fluorescent reporter to systematically analyze cell specificity and targeting efficiency of these six mouse lines in IVD tissues at postnatal growing and adult stages. We found that Agc1-CreER^T2 is effective to direct recombination in all components of IVDs, including annulus fibrosus (AF), nucleus pulposus (NP), and cartilaginous endplate (CEP), upon tamoxifen induction at either 2 weeks or 2 months of ages. Moreover, Col2a1-Cre targets most of the cells in IVDs, except for some cells in the outer AF (OAF) and NP. In contrast, the activity of Col2a1-CreER^T2 is mainly limited to the IAF of IVD tissues at either stage of tamoxifen injection. Similarly, Shh-Cre directs recombination specifically in all NP cells, whereas Shh-CreER^T2 is active only in a few NP cells when tamoxifen is administered at either stage. Finally, Osx-Cre targets cells in the CEP, but not in the NP or AF of IVDs tissues at these two stages. Thus, our data demonstrated that all these Cre lines can direct recombination in IVD tissues at postnatal stages with different cell type specificity and/or targeting efficiency, and can, therefore, serve as valuable tools to dissect cell type-specific gene functions in IVD development and homeostasis.

Decomposition of β-N-methylamino-L-alanine (BMAA) and 2,4-diaminobutyric acid (DAB) during chlorination and consequent disinfection byproducts formation

β-N-methylamino-L-alanine (BMAA) and 2,4-diaminobutyric acid (DAB) are two newly identified algal toxins, and they may react with chlorine to undergo decomposition and generate disinfection byproducts (DBPs) during pre-chlorination as well as chlorine disinfection. In this study, the decomposition of BMAA and DAB during chlorination and the consequent DBPs formation were investigated. The BMAA and DAB concentrations in source waters were determined, the decomposition kinetics of BMAA and DAB and the formation of DBPs during chlorination were studied, the formation pathways of DBPs from BMAA and DAB were explored, and the factors which may affect the decomposition and DBPs formation were examined. The results revealed that BMAA and DAB were commonly detected in source waters from Taihu Lake, and the highest level of BMAA reached 230.8 ng/L, while the concentrations of DAB were generally around 2.0 ng/L. The decomposition of BMAA and DAB during chlorination both followed pseudo-first-order decay while the decomposition rate constant of DAB was significantly higher than that of BMAA. Trihalomethanes (THMs), haloacetic acids (HAAs), and haloacetonitriles (HANs) were all generated during the chlorination of BMAA and DAB with relatively high yields. Notably, the THMs, HAAs, and HANs yields of each carbon atom from BMAA and DAB were significantly higher than that from other organic precursors, and the formation of HANs from DAB was significantly higher than that from BMAA. The formation pathways of DBPs from BMAA and DAB were tentatively proposed and verified through theoretical calculations. Of note, the proposed formation pathways of THMs and HAAs from BMAA were similar to that from DAB, while the proposed formation pathways of HANs from BMAA and DAB showed some differences. Chlorine dose, pH and temperature all affected the decomposition of BMAA and DAB and DBPs formation during chlorination.

Trihalomethane yields from twelve aromatic halogenated disinfection byproducts during chlor(am)ination

As the first identified category of disinfection byproducts (DBPs), trihalomethanes (THMs) have received continuous attention. Previous studies have demonstrated that the transformation of aromatic halogenated DBPs during chlor (am)ination resulted in the formation of THMs, which may occur in both water treatment plants and drinking water distribution systems. In this study, THM yields from aromatic chlorinated/brominated DBPs during chlorination and aromatic iodinated DBPs during chloramination were investigated. The trichloromethane (TCM) yields from 3,5-dichloro-4-hydroxybenzaldehyde, 3,5-dichlorosalicylic acid, 2,6-dichloro-4-nitrophenol, and 2,4,6-trichlorophenol were in the range of 0-11.4%, 0-8.4%, 0-6.4%, and 0-17.8%, respectively. The THM₄ (TCM, bromodichloromethane (BDCM), dibromochloromethane (DBCM), and tribromomethane (TBM)) yields from 3,5-dibromo-4-hydroxybenzaldehyde, 3,5-dibromosalicylic acid, 2,6-dibromo-4-nitrophenol, and 2,4,6-tribromophenol were in the range of 0-12.9%, 0-27.0%, 0-8.6%, and 0-29.4%, respectively. The TCM and triiodomethane (TIM) yields from 3,5-diiodo-4-hydroxybenzaldehyde, 3,5-diiodosalicylic acid, 2,6-diiodo-4-nitrophenol, and 2,4,6-triiodophenol were in the range of 0-5.2%, 0-7.0%, 0-2.2%, and 0-10.6%, respectively. After 72 h, TCM yields from aromatic chlorinated DBPs were generally higher than that from their brominated analogues; TBM yields from aromatic brominated DBPs were significantly lower than TCM yields, BDCM yields, and DBCM yields; and among aromatic halogenated DBPs, 2,4,6-trihalophenol had the highest THM yields while 2,6-dihalo-4-nitrophenol had the lowest THM yields. Moreover, the results revealed that alkaline conditions and higher temperatures favored the THM yields from the twelve aromatic halogenated DBPs during chlor (am)ination, and chlorine/monochloramine dose affected the yields and speciation of THMs from the aromatic halogenated DBPs.

Comparative Effectiveness of Medical Therapy, Percutaneous Revascularization, and Surgical Coronary Revascularization in Cardiovascular Risk Subgroups of Patients With CKD: A Retrospective Cohort Study of Medicare Beneficiaries

RATIONALE & OBJECTIVE

Prior studies suggesting that medical therapy is inferior to percutaneous (percutaneous coronary intervention [PCI]) or surgical (coronary artery bypass grafting [CABG]) coronary revascularization in chronic kidney disease (CKD) have not adequately considered medication optimization or baseline cardiovascular risk and have infrequently evaluated progression to kidney failure. We compared, separately, the risks for kidney failure and death after treatment with PCI, CABG, or optimized medical therapy for coronary disease among patients with CKD stratified by cardiovascular disease risk.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

34,385 individuals with CKD identified from a national 20% Medicare sample who underwent angiography or diagnostic stress testing without (low risk) or with (medium risk) prior cardiovascular disease or who presented with acute coronary syndrome (high risk).

EXPOSURES

PCI, CABG, or optimized medical therapy (defined by the addition of cardiovascular medications in the absence of coronary revascularization).

OUTCOMES

Death, kidney failure, composite outcome of death or kidney failure.

ANALYTICAL APPROACH

Adjusted relative rates of death, kidney failure, and the composite of death or kidney failure estimated from Cox proportional hazards models.

RESULTS

Among low-risk patients, 960 underwent PCI, 391 underwent CABG, and 6,426 received medical therapy alone; among medium-risk patients, 1,812 underwent PCI, 512 underwent CABG, and 9,984 received medical therapy alone; and among high-risk patients, 4,608 underwent PCI, 1,330 underwent CABG, and 8,362 received medical therapy alone. Among low- and medium-risk patients, neither CABG (HRs of 1.22 [95% CI, 0.96-1.53] and 1.08 [95% CI, 0.91-1.29] for low- and medium-risk patients, respectively) nor PCI (HRs of 1.14 [95% CI, 0.98-1.33] and 1.02 [95% CI, 0.93-1.12], respectively) were associated with reduced mortality compared with medical therapy, but in low-risk patients, CABG was associated with a higher rate of the composite, death or kidney failure (HR, 1.25; 95% CI, 1.02-1.53). In high-risk patients, CABG and PCI were associated with lower mortality (HRs of 0.57 [95% CI, 0.51-0.63] and 0.70 [95% CI, 0.66-0.74], respectively). Also, in high-risk patients, CABG was associated with a higher rate of kidney failure (HR, 1.40; 95% CI, 1.16-1.69).

LIMITATIONS

Possible residual confounding; lack of data for coronary angiography or left ventricular ejection fraction; possible differences in decreased kidney function severity between therapy groups.

CONCLUSIONS

Outcomes associated with cardiovascular therapies among patients with CKD differed by baseline cardiovascular risk. Coronary revascularization was not associated with improved survival in low-risk patients, but was associated with improved survival in high-risk patients despite a greater observed rate of kidney failure. These findings may inform clinical decision making in the care of patients with both CKD and cardiovascular disease.

Occurrence and ecological risk assessment of disinfection byproducts from chlorination of wastewater effluents in East China

Effluents containing disinfection byproducts (DBPs) from wastewater treatment plants (WWTPs) may be discharged to the receiving water bodies or reused for irrigation, landscaping, and environmental supplies as well as a source to replenish groundwater. Thus the formation and risk of the DBPs in disinfected wastewater effluents should be concerned. In this study, the occurrence of 44 DBPs including 6 trihalomethanes (THMs), 9 haloaceticacids (HAAs), 2 haloketones (HKs), 9 halonitromethanes (HNMs), 9 haloacetonitriles (HANs) and 9 nitrosamines (NAs) was investigated in 12 chlorinated WWTP effluents from five cities of East China. The contribution of each class of DBPs to the total DBPs concentration and additive toxicity was calculated. The average concentrations of the 6 classes of DBPs were ranked as follows: HAAs (47.0 μg/L) > THMs (28.0 μg/L) > HANs (9.9 μg/L) > HNMs (2.9 μg/L) > HKs (0.79 μg/L) > NAs (0.69 μg/L). The significant positive correlations were observed between the formation of THMs and HAAs, THMs and HANs, as well as HAAs and HANs. The results showed that HAAs and THMs were the dominant DBPs on a mass concentration basis and accounted for 54% and 29%, respectively in the total measured DBPs, but they made a minor contribution to the calculated DBP-associated cytotoxicity. HANs and NAs dominated the DBP-associated cytotoxicity, accounting for 50% and 34% on an additive toxicity basis despite the minor contributions to the mass concentration with 10% and 1%, respectively. The risk quotients for three taxonomic groups (fish, daphnid, and green algae) were calculated to assess the ecological risk of DBPs, and the results demonstrated that both HAAs and HANs had high ecological risk for green algae in chlorinated wastewater effluents.

A ten-inch manipulator (TIM) based fast-electron spectrometer with multiple viewing angles (OU-ESM)

The measurement of angularly resolved energy distributions of mega-electron-volt electrons is important for gaining a better understanding of the interaction of ultra-intense laser pulses with plasma, especially for fast-ignition laser-fusion research. It is also crucial when evaluating the production of suprathermal (several 10-keV) electrons through laser-plasma instabilities in conventional hot-spot-ignition and shock-ignition research. For these purposes, we developed a 10-in. manipulator-based multichannel electron spectrometer-the Osaka University electron spectrometer (OU-ESM)-that combines angular resolution with high-energy resolution. The OU-ESM consists of five small electron spectrometers set at every 5°, with an energy range from ∼40 keV to ∼40 MeV. A low-magnetic-field option provides a higher spectral resolution for an energy range of up to ∼5 MeV. We successfully obtained angularly resolved electron spectra for various experiments on the OMEGA and OMEGA EP laser systems.

Risk of neutropenia-related hospitalization (NRH) related to duration of short-acting granulocyte colony stimulating factor (sG-CSF) for primary prophylaxis

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Background: In clinical trials, efficacy of 10–11 days of primary prophylactic (PP) sG-CSF is similar to a single dose of pegfilgrastim for preventing febrile neutropenia (FN). However, most patients receive < 10 days of PP sG-CSF in clinical practice. This study assessed the effect of PP sG-CSF duration on the risk of NRH. Methods: Using Medicare 20% sample data, we conducted a nested case-control study within a cohort of patients aged ≥66 y with breast, colorectal, lung, ovarian, or prostate cancer or NHL who initiated first cycle of chemotherapy 1/1/2008–9/30/2016, had ≥1 y continuous coverage in Medicare parts A and B before cycle day 1 (baseline), and received PP sG-CSF. We identified NRH cases (ICD-9, 288.0X; ICD-10, D70.X) from cycle day 5 to end of cycle 1. We matched each case to up to 4 controls based on age (± 1 y), tumor type, regimen risk for FN (intermediate/high [ > 10%], other), and year using incidence density sampling. Duration of sG-CSF (days of use from cycle day 1 to the day before case date) was categorized as < 5 and ≥5 days. We used conditional logistic regression adjusted for race, sex, and Charlson comorbidity index (CCI) at baseline to estimate relative risk of NRH related to duration of sG-CSF. Results: Of 1431 patients receiving PP sG-CSF, 68 cases matched 231 controls. Cases were similar to controls in age (76 vs 75 y), tumor type (NHL, 62% vs 62%; lung cancer, 25% vs 25%), intermediate-/high-risk regimen (65% vs 67%), and male sex (50% vs 48%) but had slightly higher CCI (3.9 vs 3.3). The percentage of patients with ≥5 days of PP sG-CSF use was 26% in cases and 41% in controls. The adjusted OR (95% CI) for NRH was 0.48 (0.25–0.93) for ≥5 vs < 5 days of PP sG-CSF; results were consistent across sensitivity analyses (Table). Conclusions: Among elderly cancer patients receiving PP sG-CSF, ≥5 days of sG-CSF use was associated with substantial reduction in the risk of NRH.[Table: see text]

[Clinical features of cerebral amyloid angiopathy characterized by cortical superficial siderosis]

Objective: To study the clinical and imaging characteristics of cerebral amyloid angiopathy characterized by cortical superficial siderosis and improve clinicians' understanding of the disease. Methods: Retrospective analysis was performed on 16 patients with cerebral amyloid angiopathy characterized by cortical superficial siderosis from June 2013 to August 2016 in Beijing Hospital, and the information including epidemiological data, clinical features, cranial MRI and electroencephalogram (EEG) results were analyzed. Results: The ratio of male to female in 16 patients was 1.67∶1, and the average age of onset was 73 (69-79) years. The most common clinical symptoms were transient focal neurological episodes (TFNEs)(12/16). Cranial MRI showed localized (9/16) and diffuse type cortical superficial siderosis (7/16); few of them were associated with different degrees of cerebral microbleeds. Most of the EEG findings were normal (6/9) and a few showed focal slow waves (3/9). During a mean follow-up of 17 (17±11) months, 5 patients developed repeated TFNE, of which 1 had cerebral hemorrhage. Conclusions: Cerebral amyloid angiopathy characterized by cortical superficial siderosis occurs predominantly in the elderly. TFNE is the most common clinical manifestation. Cranial MRI is the most important diagnostic method, and antithrombotic therapy should be avoided as much as possible.

EphrinB2/EphB4 Signaling Regulates DPSCs to Induce Sprouting Angiogenesis of Endothelial Cells

Dental pulp stem cells (DPSCs) are capable of facilitating angiogenesis resembling pericytes when located adjacent to endothelial cells (ECs). Nevertheless, the precise mechanisms orchestrating their proangiogenic functions remain unclear. Using a 3-dimensional (3-D) fibrin gel model, we aimed to investigate whether EphrinB2/EphB4 signaling in DPSCs plays a role in supporting vascular morphogenesis mediated by ECs, together with the underlying mechanism involved. The EphrinB2/EphB4 signaling was inhibited either by a pharmacological inhibitor of EphB4 receptor or by knocking down the expressions of EphrinB2 and EphB4 using lentiviral small hairpin RNA (shRNA). DPSCs were either encapsulated in fibrin gel together with human umbilical vein endothelial cells (HUVECs) or cultured as a monolayer on top of HUVECs to investigate both paracrine and juxtacrine interactions simultaneously. Following 10 d of direct coculture, we found that pharmacological inhibition of EphrinB2/EphB4 signaling severely impaired vessel formation and laminin deposition. When directly cocultured with HUVECs, knockdown of EphrinB2 or EphB4 in DPSCs significantly inhibited endothelial sprouting, resulting in less capillary sprouts with reduced vessel length (P < 0.05). By contrast, when DPSCs were not in direct contact with HUVECs, attenuation of EphrinB2 or EphB4 expression levels in DPSCs did not exert any significant effects on capillary morphogenesis. Noticeably, exogenous stimulation with soluble EphrinB2-Fc or EphB4-Fc (1 µg/mL) enhanced vascular endothelial growth factor (VEGF) secretion from DPSCs, thereby moderately promoting angiogenic cascades in the fibrin matrix. This study, for the first time, reveals a crucial role of EphrinB2/EphB4 signaling in regulating the capacity of DPSCs to induce sprouting angiogenesis. These findings advance our understanding of postnatal angiogenesis and may have future regenerative medicine applications.

Revealing the role of a surfactant in the nucleation and crystal growth of thiamine nitrate: experiments and simulation studies

This work combines experiments and simulations to investigate the inhibition effects of a surfactant on the nucleation and crystal growth rate of thiamine nitrate.

Formation of iodinated trihalomethanes and haloacetic acids from aromatic iodinated disinfection byproducts during chloramination

Iodinated disinfection byproducts (DBPs) are widely present in disinfected drinking waters and wastewater effluents, and they have drawn increasing concern owing to their high toxicity. To date, the reported iodinated DBPs mainly include aliphatic and aromatic ones, and iodinated trihalomethanes (THMs) and haloacetic acids (HAAs) are the most commonly detected aliphatic iodinated DBPs in disinfected waters. In this study, the formation of iodinated THMs and HAAs from aromatic iodinated DBPs during chloramination was investigated. The decomposition kinetics of the aromatic iodinated DBPs and the formation of iodinated THMs and HAAs were studied, the formation pathways of iodinated THMs and HAAs from the aromatic iodinated DBPs were explored, the factors affecting the formation were examined, and the toxicity change was evaluated. The results revealed that four aromatic iodinated DBPs (2,4,6-triiodophenol, 3,5-diiodo-4-hydroxybenzaldehyde, 3,5-diiodosalicylic acid, and 2,6-diiodo-4-nitrophenol) all underwent transformation to form triiodomethane (TIM), monoiodoacetic acid (MIAA), and diiodoacetic acid (DIAA) during chloramination. The decomposition of the aromatic iodinated DBPs all followed a pseudo-first-order decay during chloramination, and the rank order of the decomposition rate constants was as follows: 2,4,6-triiodophenol > 3,5-diiodo-4-hydroxybenzaldehyde ≥ 3,5-diiodosalicylic acid > 2,6-diiodo-4-nitrophenol. Several polar iodinated intermediates were detected and identified (e.g., 2,6-diiodo-1,4-benzoquinone and iodobutenedioic acid) during chloramination of 2,4,6-triiodophenol, based on which the formation pathways of TIM, MIAA, and DIAA from 2,4,6-triiodophenol during chloramination were proposed and further validated. The results also revealed that monochloramine dose, pH, temperature, and short free chlorine contact time all affected the formation of TIM, MIAA, and DIAA from 2,4,6-triiodophenol during chloramination. The cytotoxicity order of the eight iodinated DBPs was MIAA > 2,6-diiodo-4-nitrophenol > 2,4,6-triiodophenol > 2,6-diiodo-1,4-benzoquinone > DIAA ≥ 3,5-diiodosalicylic acid >3,5-diiodo-4-hydroxybenzaldehyde > TIM. The toxicity of the chloraminated 2,4,6-triiiodophenol sample first decreased and then increased over time due to the transformation.

Molecularly imprinted solid phase extraction coupled with gas chromatography-mass spectrometry for determination of N-Nitrosodiphenylamine in water samples

In this study, the molecularly imprinted polymers (MIPs) with high specific surface area and extraction efficiency of N-Nitrosodiphenylamine (NDPhA) were successfully prepared and a highly sensitive and selective method was developed for determination of NDPhA in water samples using MIPs solid-phase extraction (SPE) coupled with gas chromatography mass spectrometry (GC-MS) detection. The MIPs were successfully prepared using the method of precipitation polymerization and using methacrylic acid as the functional monomer, ethylene glycol dimethacrylate as the cross-linker, and N, N-Diphenylformamide as the template molecule. The newly synthesized MIPs were characterized and used as SPE sorbents. Under the optimized conditions, the average recoveries of NDPhA spiked in ultrapure water were higher than 94% ± 2.9% at three different concentrations and the limit of detection and limit of quantitation were 0.8 ng L^-1 and 2.4 ng L^-1, respectively. Moreover, the high selectivity of MIPs was attained and the satisfactory recoveries of NDPhA which were spiked in to real samples were achieved in the range of 92-107% with relative standard deviations (RSDs) within 0.3-7.9%. The low levels of NDPhA were detected in the two of twelve wastewater samples with concentrations of 5.6 ng L^-1 and 3.6 ng L^-1 with RSDs of 5.6% and 2.8%, respectively. The developed MIP-SPE method was proved to be practically feasible for selective extraction and enrichment of NDPhA in real water samples.

The 677C→T variant of MTHFR is the major genetic modifier of biomarkers of folate status in a young, healthy Irish population

Background

Genetic polymorphisms can explain some of the population- and individual-based variations in nutritional status biomarkers.

Objective

We sought to screen the entire human genome for common genetic polymorphisms that influence folate-status biomarkers in healthy individuals.

Design

We carried out candidate gene analyses and genome-wide association scans in 2232 young, healthy Irish subjects to evaluate which common genetic polymorphisms influence red blood cell folate, serum folate, and plasma total homocysteine.

Results

The 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C→T (rs1801133) variant was the major genetic modifier of all 3 folate-related biomarkers in this Irish population and reached genome-wide significance for red blood cell folate (P = 1.37 × 10-17), serum folate (P = 2.82 × 10-11), and plasma total homocysteine (P = 1.26 × 10-19) concentrations. A second polymorphism in the MTHFR gene (rs3753584, P = 1.09 × 10-11) was the only additional MTHFR variant to exhibit any significant independent effect on red blood cell folate. Other MTHFR variants, including the 1298A→C variant (rs1801131), appeared to reach genome-wide significance, but these variants shared linkage disequilibrium with MTHFR 677C→T and were not significant when analyzed in MTHFR 677CC homozygotes. No additional non-MTHFR modifiers of red blood cell or plasma folate were detected. Two additional genome-wide significant modifiers of plasma homocysteine were found in the region of the dipeptidase 1 (DPEP1) gene on chromosome 16 and the Twist neighbor B (TWISTNB) gene on chromosome 7.

Conclusions

The MTHFR 677C→T variant is the predominant genetic modifier of folate status biomarkers in this healthy Irish population. It is not necessary to determine MTHFR 677C→T genotype to evaluate folate status because its effect is reflected in concentrations of standard folate biomarkers. The MTHFR 1298A→C variant had no independent effect on folate status biomarkers. To our knowledge, this is the first genome-wide association study report on red blood cell folate and the first report of an association between homocysteine and TWISTNB.

Rapid and complete dehalogenation of halonitromethanes in simulated gastrointestinal tract and its influence on toxicity

Halonitromethanes (HNMs) as one typical class of nitrogenous disinfection byproducts in drinking water and wastewater are receiving attentions due to their high toxicity. This study applied a simulator of the human gastrointestinal tract to determine the dehalogenation processes of trichloronitromethane, bromonitromethane and bromochloronitromethane for the first time. Influence of digestion process of HNMs on gut microbiota and hepatotoxicity was further analyzed. Results showed that the three HNMs were rapidly and completely dehalogenated in the gastrointestinal tract, especially in the stomach (2 h retention Time) and small intestine (4 h retention Time). Mucin, cysteine, pancreatin and bile salts in the digestive juice played major roles in the dehalogenation process. HNMs and their dehalogenation products in the resulting fluids of stomach induced the highest toxicity followed by those in intestine and colon, exhibiting dose-dependent effects. Although most HNMs were degraded in the stomach and small intestine, residual HNMs entered into colon changed the microbial community. Abundance of several genera, such as Bacteroides, Lachnospiraceae_unassigned and Lactobacillus had high correlation with exposure concentration of HNMs. This study sheds new light on dehalogenation and toxic processes of HNMs by oral exposure, which provides basic data for their human health risk assessment.

Proinflammatory macrophages promote degenerative phenotypes in rat nucleus pulpous cells partly through ERK and JNK signaling

Intervertebral disc (IVD) degeneration is the major contributor to low back pain, a highly prevalent musculoskeletal problem that represents the leading cause of disability. Proinflammatory M1 macrophages were identified in degenerated IVDs. However, their role in the pathogenesis of IVD degeneration and the underlying mechanism was largely unknown. In this study, we explored the combined effects of molecules secreted by M1 macrophages on nucleus pulposus cells, by treating rat nucleus pulposus cells (rNP) with the conditioned medium collected from M1-polarized RAW264.7 cells (MФCM). We found that MФCM caused molecular changes associated with IVD degeneration, including increased expression of key matrix catabolic genes (Adamts4, Adamts5, Mmp3, and Mmp13), reduced the expression of major matrix-associated anabolic genes ( Sox9, Acan, and Col2a1), and upregulated transcription of inflammation-related genes ( IL-1b, IL-6, Ccl2, and Ccl3), in rNP cells. Moreover, we found that MФCM activated both ERK and JNK pathways in these cells, and that inhibition of JNK pathway attenuated MФCM-induced expression of both catabolic and inflammatory genes, whereas ERK inhibition only suppressed induction of catabolic, but not inflammatory genes. Together, our data demonstrated that proinflammatory macrophages promoted the degenerative phenotypes in rNP cells in part through ERK and JNK signaling, and suggested that inhibition of these pathways may serve as a potential therapeutic approach for the treatment of IVD degeneration.

Tracing the sources of iodine species in a non-saline wastewater

There are two types of wastewater in Hong Kong, non-saline and saline wastewaters. When it comes to disinfection, iodide is an important inorganic ion in concern because it may involve in the formation of iodinated disinfection byproducts, which show significantly higher toxicity than their brominated and chlorinated analogues. In this study, it was found that a non-saline wastewater in Hong Kong contained an unexpected high level of iodine. To trace the iodine sources of this non-saline wastewater, the information of the corresponding area was collected to find the possible iodine sources; then, the water samples from the possible iodine sources were collected; the concentrations of iodine species (iodide, iodate and organic iodine) in these collected water samples were determined; finally, the contribution percentages of iodine species from different sources were calculated. The results revealed that a specific domestic wastewater was the major iodine source, contributing to 68.6% of total iodine, 66.3% of iodide, 57.0% of iodate, and 112% of organic iodine in the non-saline wastewater, while landfill leachate, industrial and hospital wastewaters were the minor iodine sources, contributing to 6.6%, 3.1%, and 3.0% of total iodine in the non-saline wastewater, respectively. Furthermore, it was found that the extensive use of salt might result in high levels of iodine in the domestic wastewater and thus lead to the high level of iodine in the non-saline wastewater.

Simultaneous determination of iodinated haloacetic acids and aromatic iodinated disinfection byproducts in waters with a new SPE-HPLC-MS/MS method

Iodinated disinfection byproducts (DBPs) are an emerging category of halogenated DBPs in concern due to their high toxicity. Among them, polar iodinated DBPs, mainly including iodinated haloacetic acids (HAAs) and aromatic iodinated DBPs, were reported to be especially toxic. Thus, simultaneous determination of these polar iodinated DBPs in disinfected waters is of great significance for DBP studies. In this study, it was found that traditional liquid-liquid extraction, which was adopted for the determination of polar iodinated DBPs, was actually not suitable for the determination of monoiodoacetic acid (MIAA) and diiodoacetic acid (DIAA) due to the low recoveries, and thus a new SPE-HPLC-MS/MS method was developed for the simultaneous determination of iodinated HAAs and aromatic iodinated DBPs. The parameters for SPE pretreatment were optimized, including SPE cartridge, eluent volume, formic acid content in eluent, and sample pH before SPE. The new method was demonstrated to be sensitive and accurate with detection limits of 0.15, 0.04, 0.03, 0.02, 0.06, and 0.06 ng/L, quantitation limits of 0.48, 0.13, 0.10, 0.06, 0.19, and 0.19 ng/L, and precision of 8.3%, 6.0%, 12.3%, 8.8%, 11.4%, and 15.6% for MIAA, DIAA, 3,5-diiodo-4-hydroxybenzaldehyde, 3,5-diiodosalicylic acid, 2,6-diiodo-4-nitrophenol and 2,4,6-triiodophenol, respectively. The recoveries of these six polar iodinated DBPs were all in the range of 70-110%. The new method was applied to the determination of iodinated HAAs and aromatic iodinated DBPs in nine tap water samples, and they were detected with concentrations ranging from 0.03 to 3.97 ng/L, among which MIAA was detected in all the samples with the highest concentrations.

The familial aggregation of atopic diseases and depression or anxiety in children

Background

Children with asthma and atopic diseases have an increased risk of depression or anxiety. Each of these diseases has strong genetic and environmental components; therefore, it seems likely that there is a shared liability rather than causative risk.

Objective

To investigate the existence and nature of familial aggregation for the comorbidity of atopic diseases and depression or anxiety.

Methods

Participants came from the Childhood and Adolescent Twin Study in Sweden (CATSS), n = 14 197. Current and ever asthma, eczema, hay fever and food allergy were reported by parents. Internalizing disorders were identified using validated questionnaires. Familial co‐aggregation analysis compared monozygotic (MZ) twins and same‐sex dizygotic (DZ) twins for atopic disease in 1 twin with internalizing disorder in the other to test for genetic liability. Several familial liability candidates were also tested including parental education, recent maternal psychological stress, childhood family trauma and parental country of birth.

Results

Familial co‐aggregation analysis found that if 1 twin had at least 1 current atopic disease the partner twin was at risk of having an internalizing disorder regardless of their own atopic status (adjusted OR 1.22 (95% CI 1.08, 1.37). Similar results were found for each atopic disease ever and current. MZ associations were not higher than DZ associations, suggesting that the liability is not genetic in nature. Including other familial candidates to the models made little difference to effect estimates.

Conclusions and Clinical Relevance

Atopic diseases and depression or anxiety tend to occur together in families; therefore, when treating for 1 disease, the physician should consider comorbidity in both the individual and the individual's siblings. We did not find evidence to support a genetic explanation for comorbidity, and further exploration is needed to disentangle the environmental and epigenetic reasons for familial aggregation.

Genome-wide association study of rice grain width variation

Seed size is variable within many plant species, and understanding the underlying genetic factors can provide insights into mechanisms of local environmental adaptation. Here we make use of the abundant genomic and germplasm resources available for rice (Oryza sativa) to perform a large-scale genome-wide association study (GWAS) of grain width. Grain width varies widely within the crop and is also known to show climate-associated variation across populations of its wild progenitor. Using a filtered dataset of >1.9 million genome-wide SNPs in a sample of 570 cultivated and wild rice accessions, we performed GWAS with two complementary models, GLM and MLM. The models yielded 10 and 33 significant associations, respectively, and jointly yielded seven candidate locus regions, two of which have been previously identified. Analyses of nucleotide diversity and haplotype distributions at these loci revealed signatures of selection and patterns consistent with adaptive introgression of grain width alleles across rice variety groups. The results provide a 50% increase in the total number of rice grain width loci mapped to date and support a polygenic model whereby grain width is shaped by gene-by-environment interactions. These loci can potentially serve as candidates for studies of adaptive seed size variation in wild grass species.

Inhibition of TGF-β Signaling in SHED Enhances Endothelial Differentiation

Low efficiency of deriving endothelial cells (ECs) from adult stem cells hampers their utilization in tissue engineering studies. The purpose of this study was to investigate whether suppression of transforming growth factor beta (TGF-β) signaling could enhance the differentiation efficiency of dental pulp-derived stem cells into ECs. We initially used vascular endothelial growth factor A (VEGF-A) to stimulate 2 dental pulp-derived stem cells (dental pulp stem cells and stem cells from human exfoliated deciduous teeth [SHED]) and compared their differentiation capacity into ECs. We further evaluated whether the vascular endothelial growth factor receptor I (VEGF-RI)-specific ligand placental growth factor-1 (PlGF-1) could mediate endothelial differentiation. Finally, we investigated whether the TGF-β signaling inhibitor SB-431542 could enhance the inductive effect of VEGF-A on endothelial differentiation, as well as the underlying mechanisms involved. ECs differentiated from dental pulp-derived stem cells exhibited the typical phenotypes of primary ECs, with SHED possessing a higher endothelial differentiation potential than dental pulp stem cells. VEGFR1-specific ligand-PLGF exerted a negligible effect on SHED-ECs differentiation. Compared with VEGF-A alone, the combination of VEGF-A and SB-431542 significantly enhanced the endothelial differentiation of SHED. The presence of SB-431542 inhibited the phosphorylation of Suppressor of Mothers Against Decapentaplegic 2/3 (SMAD2/3), allowing for VEGF-A-dependent phosphorylation and upregulation of VEGFR2. Our results indicate that the combination of VEGF-A and SB-431542 could enhance the differentiation of dental pulp-derived stem cells into endothelial cells, and this process is mediated through enhancement of VEGF-A-VEGFR2 signaling and concomitant inhibition of TGF-β-SMAD2/3 signaling.

Transformation among Aromatic Iodinated Disinfection Byproducts in the Presence of Monochloramine: From Monoiodophenol to Triiodophenol and Diiodonitrophenol

Aromatic iodinated disinfection byproducts (DBPs) are a newly identified category of highly toxic DBPs. Among the identified aromatic iodinated DBPs, 2,4,6-triiodophenol and 2,6-diiodo-4-nitrophenol have shown relatively widespread occurrence and high toxicity. In this study, we found that 4-iodophenol underwent transformation to form 2,4,6-triiodophenol and 2,6-diiodo-4-nitrophenol in the presence of monochloramine. The transformation pathways were investigated, the decomposition kinetics of 4-iodophenol and the formation of 2,4,6-triiodophenol and 2,6-diiodo-4-nitrophenol were studied, the factors affecting the transformation were examined, the toxicity change during the transformation was evaluated, and the occurrence of the proposed transformation pathways during chloramination of source water was verified. The results revealed that 2,4,6-triiodophenol and 2,6-diiodo-4-nitrophenol, which could account for 71.0% of iodine in the transformed 4-iodophenol, were important iodinated transformation products of 4-iodophenol in the presence of monochloramine. The transformation pathways of 4-iodophenol in the presence of monochloramine were proposed and verified. The decomposition of 4-iodophenol in the presence of monochloramine followed a pseudo-second-order decay. Various factors including monochloramine dose, pH, temperature, nitrite concentration, and free chlorine contact time (before chloramination) affected the transformation. The cytotoxicity of the chloraminated 4-iodophenol samples increased continuously with contact time. The proposed transformation pathways occurred during chloramination of source water.