Properties of Heavy Secondary Fluorine Cosmic Rays: Results from the Alpha Magnetic Spectrometer

Precise knowledge of the charge and rigidity dependence of the secondary cosmic ray fluxes and the secondary-to-primary flux ratios is essential in the understanding of cosmic ray propagation. We report the properties of heavy secondary cosmic ray fluorine F in the rigidity R range 2.15 GV to 2.9 TV based on 0.29 million events collected by the Alpha Magnetic Spectrometer experiment on the International Space Station. The fluorine spectrum deviates from a single power law above 200 GV. The heavier secondary-to-primary F/Si flux ratio rigidity dependence is distinctly different from the lighter B/O (or B/C) rigidity dependence. In particular, above 10 GV, the F/Si/B/O ratio can be described by a power law R^{δ} with δ=0.052±0.007. This shows that the propagation properties of heavy cosmic rays, from F to Si, are different from those of light cosmic rays, from He to O, and that the secondary cosmic rays have two classes.

blaNDM and mcr-1 to mcr-5 Gene Distribution Characteristics in Gut Specimens from Different Regions of China

Antibiotic resistance has become a global public health concern. To determine the distribution characteristics of mcr and bla_NDM in China, gene screening was conducted directly from gut specimens sourced from livestock and poultry, poultry environments, human diarrhea patients, and wild animals from 10 regions, between 2010–2020. The positive rate was 5.09% (356/6991) for mcr and 0.41% (29/6991) for bla_NDM, as detected in gut specimens from seven regions, throughout 2010 to 2019, but not detected in 2020. The detection rate of mcr showed significant differences among various sources: livestock and poultry (14.81%) > diarrhea patients (1.43%) > wild animals (0.36%). The detection rate of bla_NDM was also higher in livestock and poultry (0.88%) than in diarrhea patients (0.17%), and this was undetected in wildlife. This is consistent with the relatively high detection rate of multiple mcr genotypes in livestock and poultry. All instances of coexistence of the mcr-1 and bla_NDM genes, as well as coexistence of mcr genotypes within single specimens, and most new mcr subtypes came from livestock, and poultry environments. Our study indicates that the emergence of mcr and bla_NDM genes in China is closely related to the selective pressure of carbapenem and polymyxin. The gene-based strategy is proposed to identify more resistance genes of concern, possibly providing guidance for the prevention and control of antimicrobial resistance dissemination.

Properties of Iron Primary Cosmic Rays: Results from the Alpha Magnetic Spectrometer

We report the observation of new properties of primary iron (Fe) cosmic rays in the rigidity range 2.65 GV to 3.0 TV with 0.62×10^{6} iron nuclei collected by the Alpha Magnetic Spectrometer experiment on the International Space Station. Above 80.5 GV the rigidity dependence of the cosmic ray Fe flux is identical to the rigidity dependence of the primary cosmic ray He, C, and O fluxes, with the Fe/O flux ratio being constant at 0.155±0.006. This shows that unexpectedly Fe and He, C, and O belong to the same class of primary cosmic rays which is different from the primary cosmic rays Ne, Mg, and Si class.

Allelopathic inhibitory effect of the macroalga Pyropia haitanensis (Rhodophyta) on harmful bloom-forming Pseudo-nitzschia species

The blooms of harmful microalgae represent a prominent threat to fisheries, public health, and economies throughout the world. Recent studies have shown that certain macroalgae release allelochemicals that can inhibit the growth of bloom-forming microalgae. In this study, we found that the macroalga Pyropia haitanensis significantly inhibited growth of the harmful bloom-forming microalgae Pseudo-nitzschia pungens and Pseudo-nitzschia multiseries. The inhibitory-effect of the live thali of P. haitanensis was highest, followed by that of dry powder, water-soluble extract, and culture medium filtrate. The Pseudo-nitzschia species died 96 h after exposure to 5-10 g fresh-weight L^-1 of P. haitanensis live thalli. Furthermore, an aqueous extract of P. haitanensis suppressed the growth of P. pungens and P. multiseries, thereby indicating that P. haitanensis contains stable allelopathic substances that cause the observed inhibitory-effects. On the basis of these findings, we conclude that the macroalga P. haitanensis would have potential utility in controlling the blooms of Pseudo-nitzschia species.

Has-miR-17 increases the malignancy of gastric lymphoma by HSP60/TNFR2 pathway

The purpose of this study was to investigate the expression and mechanism of miR-17 in gastric lym-phoma. miR-17mimics, miR-17 inhibitors and negative controls were transfected into human gastric lymphoma cell line cyp6d. The proliferation, invasion and apoptosis of cyp6d cells were detected by CCK-8, Transwell and TUNEL methods, respectively. The expression and clinicopathological features of miR-17 in gastric lymphoma were analyzed by real-time quantitative PCR. The target gene of miR-17 was predicted by targetscan 7.2, and the expression of miR-17 related protein was detected by Western blot. The results showed that the expression of miR-17 in gastric lymphoma was significantly higher than that in normal tissues (P < 0.05), which was closely related to lymph node metastasis, tumor size and distant metastasis (P < 0.05). The high expression of miR-17 significantly promoted the proliferation and invasion of cyp6d cells and inhibited apoptosis (P < 0.05). The high expression of miR-17 can regu¬late the expression of HSP60 and TNFR2. It has been found that miR-17 can promote the development of gastric lymphoma by regulating HSP60/TNFR2 pathway, which is a potential molecular target for the diagnosis and treatment of gastric lymphoma.

MicroRNA-28-5p regulates glioma cell proliferation, invasion and migration by targeting SphK1

The article "MicroRNA-28-5p regulates glioma cell proliferation, invasion and migration by targeting SphK1, by H.-S. Chen, A.-Q. Lu, P.-Y. Yang, J. Liang, Y. Wei, Y.-W. Shang, Q. Li, published in Eur Rev Med Pharmacol Sci 2019; 23 (15): 6621-6628-DOI: 10.26355/eurrev_201908_18551-PMID: 31378904" has been withdrawn from the authors stating that "after our follow-up experiments and in-depth research, we found that the previous experimental data had some loopholes and deviations. After the experiment was improved, we found that some experimental data could not be repeated again. To avoid academic adverse effects, we ask the magazine to withdraw the manuscript". The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/18551.

[Initial implantation experience and short-term follow-up results of implanting leadless intracardiac transcatheter pacing system]

Objective: To explore the utility and safety of leadless intracardiac transcatheter pacing system. Methods: The study was a prospective observational study. Patients underwent Micra transcatheter pacing system in Beijing Anzhen hospital from December 2019 to January 2020 were enrolled. The baseline characteristics, platelet count, hemoglobin, anticoagulation and/or antiplatelet therapy, mean procedural time, average fluoroscopy time, number of deployment and electrical parameters (threshold, R-wave amplitude, impedance) were recorded. Ultrasonography of bilateral femoral and iliac veins was performed in all patients. Patients were followed including access site complication, adverse event and device evaluation at implant, hospital discharge, 1 and 3 months post-implant. R-wave≥5 mV, impedance between 400 and 1 500 Ω and threshold increase≤1.5 V than implant is considered a stable parameter. Femoral access site complications included hematoma, hemorrhage, pseudoaneurysm, and arteriovenous fistula. Adverse events included dislodgement, cardiac effusion/perforation and infection. Left ventricular end diastolic diameter and ejection fraction before and at 1 month after implant were reported. Results: Five patients were enrolled and pacemaker implantation was successful in all 5 patients. Patients were all males and the average age was (78.4±8.4) years. 2 patients received aspirin and clopidogrel therapy, 1 patient suffered from anemia and thrombocytopenia occurred in 1 patient. No stenosis, occlusion and vascular malformation of bilateral femoral and iliac veins was observed. The mean implant time was (39.6±1.7) minutes. The average fluoroscopy time was (9.2±1.3) minutes and the number of deployment was (1.40±0.55). Electrical parameters(threshold, R-Wave amplitude and impedance) were as follows: (0.40±0.10) V/0.24 ms, (10.80±3.72) mV and (822.00±162.23) Ω at implant; (0.45±0.07) V/0.24 ms, (13.04±2.41) mV, and (748.0±91.5) Ω at discharge, (0.40±0.06) V/0.24 ms, (14.26±4.11) mV, and (700.0±91.7) Ω at 1 month post-implant and (0.39±0.05) V/0.24 ms, 14.40±3.97 mV, and (682.0±96.0) Ω at 3 months post-implant, respectively. Threshold increase was ≤1.5 V compared to that during implantation, electrical parameters were acceptable and stable. There was no difference in LVEDD [(44.00±5.24) mm vs. (44.00±5.34) mm,P=1.000] and EF [(62.00±3.39)% vs. (62.20±3.56)%, P=0.861] before and 1 month post-implant. No incidence of access site complications, cardiac effusion/perforation, dislodgment or infections occurred during the 3 months. Conclusions: The leadless transcatheter pacemaker implantation performed in our study archived a high implant success rate and favorable safety profile as well as associated with low and stable pacing thresholds. The long-term safety and benefit of leadless pacemaker need to be evaluated in future clinical studies.

MicroRNA-28-5p regulates glioma cell proliferation, invasion and migration by targeting SphK1

OBJECTIVE

MicroRNAs (miRNAs) are a conserved class of endogenous and short non-coding RNAs that post-transcriptionally regulate the expression of genes involved in diverse cellular processes. MiR-28-5p has been reported to be associated with several cancers, including human glioma. However, the roles of miR-28-5p in glioma development are poorly understood.

MATERIALS AND METHODS

Sixteen human glioma tissues and paired adjacent normal tissues were acquired through the Gansu Provincial Hospital. We performed quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) to detect the miR-28-5p expression between 16 paired adjacent normal and glioma tissues, as well as the miR-28-5p expression between normal human astrocytes cells and five glioma cell lines. To examine the functional roles of the downregulated miR-28-5p in glioma, cell viability and colony formation assays were performed for the analysis of cell growth. We overexpressed miR-28-5p by transient transfection of miRNAs mimics and performed the transwell Matrigel invasion assay and transwell migration (without Matrigel) assay. To investigate the roles of miR-28-5p in SphK1 expression, Western blot and Real Time-Polymerase Chain Reaction assays were performed.

RESULTS

In this work, we demonstrated that miR-28-5p is downregulated in glioma tissues compared to the adjacent normal tissues. Functional studies showed that miR-28-5p overexpression inhibited the cell viability, colony formation and proliferation; meanwhile, it induced the cell apoptosis. The transwell invasion assay indicated that miR-28-5p blocked the invasion and migration of glioma cells. SphK1 (Sphingosine kinase 1 antibody) is predicted as a targeted candidate of miR-28-5p. Then, the Luciferase reporter assay, Western blot and Real Time-Polymerase Chain Reaction (PCR) validated that miR-28-5p negatively regulated SphK1 expression by directly targeting its 3'untranslated regions (3'UTR) in U87 cells. Furthermore, rescue assay suggested that overexpression of SphK1 without its 3'UTR could prevent the miR-28-5p from inducing the inhibition of glioma tumor cells.

CONCLUSIONS

Our findings showed that miR-28-5p could suppress the growth, invasion and migration of glioma cells by suppressing the SphK1 expression. The results demonstrated that miR-28-5p might serve as an important potential therapeutic target for glioma.

Informing urban climate planning with high resolution data: the Hestia fossil fuel CO2 emissions for Baltimore, Maryland

BACKGROUND

Cities contribute more than 70% of global anthropogenic carbon dioxide (CO2) emissions and are leading the effort to reduce greenhouse gas (GHG) emissions through sustainable planning and development. However, urban greenhouse gas mitigation often relies on self-reported emissions estimates that may be incomplete and unverifiable via atmospheric monitoring of GHGs. We present the Hestia Scope 1 fossil fuel CO2 (FFCO2) emissions for the city of Baltimore, Maryland-a gridded annual and hourly emissions data product for 2010 through 2015 (Hestia-Baltimore v1.6). We also compare the Hestia-Baltimore emissions to overlapping Scope 1 FFCO2 emissions in Baltimore's self-reported inventory for 2014.

RESULTS

The Hestia-Baltimore emissions in 2014 totaled 1487.3 kt C (95% confidence interval of 1158.9-1944.9 kt C), with the largest emissions coming from onroad (34.2% of total city emissions), commercial (19.9%), residential (19.0%), and industrial (11.8%) sectors. Scope 1 electricity production and marine shipping were each generally less than 10% of the city's total emissions. Baltimore's self-reported Scope 1 FFCO2 emissions included onroad, natural gas consumption in buildings, and some electricity generating facilities within city limits. The self-reported Scope 1 FFCO2 total of 1182.6 kt C was similar to the sum of matching emission sectors and fuels in Hestia-Baltimore v1.6. However, 20.5% of Hestia-Baltimore's emissions were in sectors and fuels that were not included in the self-reported inventory. Petroleum use in buildings were omitted and all Scope 1 emissions from industrial point sources, marine shipping, nonroad vehicles, rail, and aircraft were categorically excluded.

CONCLUSIONS

The omission of petroleum combustion in buildings and categorical exclusions of several sectors resulted in an underestimate of total Scope 1 FFCO2 emissions in Baltimore's self-reported inventory. Accurate Scope 1 FFCO2 emissions, along with Scope 2 and 3 emissions, are needed to inform effective urban policymaking for system-wide GHG mitigation. We emphasize the need for comprehensive Scope 1 emissions estimates for emissions verification and measuring progress towards Scope 1 GHG mitigation goals using atmospheric monitoring.

Value of contrast-enhanced ultrasound in the diagnosis of breast US-BI-RADS 3 and 4 lesions with calcifications

AIM

To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for Breast Imaging-Reporting and Data System for Ultrasound (US-BI-RADS) 3 and 4 lesions with calcifications.

MATERIALS AND METHODS

A retrospective study of 168 breast lesions with calcifications detected on both mammography and conventional ultrasonography (US) in 152 patients were categorised as US-BI-RADS 3-4 at US between June 2009 and June 2018. CEUS scores were obtained based on a CEUS five-point scoring system. The combination of US-BI-RADS and CEUS scores created the Rerated BI-RADS (referred to as CEUS-BI-RADS). All results were compared with the histological findings. The diagnostic performances of US and CEUS-BI-RADS were compared.

RESULTS

The diagnostic sensitivity, specificity, and accuracy of US were 81.8% (95% confidence interval [CI]: 71.6%, 92%), 85% (95% CI: 78.4%, 91.5%), and 83.9% (95% CI: 78.4%, 89.5%), respectively, while those for CEUS-BI-RADS were 98.2% (95% CI: 94.7%, 100%), 90.3% (95% CI: 84.8%, 95.7%), and 92.9% (95% CI: 89%, 96.8%), respectively. The diagnostic sensitivity and accuracy values of CEUS-BI-RADS greatly improved compared with those of US (p=0.003 and p=0.004, respectively). The areas under the receiver operating characteristic (ROC) curves for US and CEUS-BI-RADS were 0.888 (95% CI: 0.840, 0.936) and 0.963 (95% CI: 0.936, 0.989), respectively. The diagnostic efficacy of CEUS-BI-RADS was significantly higher than that of US alone (p=0.004).

CONCLUSION

CEUS-BI-RADS significantly improves the diagnostic accuracy for breast US-BI-RADS 3 and 4 lesions with calcifications compared with US.

Nocardioides jishulii sp. nov.,isolated from faeces of Tibetan gazelle (Procapra picticaudata)

Two novel Gram-stain-positive, irregular rod-shaped bacterial strains, dk3136^T and dk3543, were isolated from the faeces of Tibetan gazelle (Procapra picticaudata) in the Qinghai-Tibet Plateau of PR China. The cells were aerobic, oxidase-negative and catalase-positive. Colonies were yellowish, circular without any observable aerial mycelium after culturing at 28 ℃ for 3 days on brain-heart infusion (BHI) agar with 5 % sheep blood. The cells grew optimally at 28 °C, pH 7.5 and with 1 % (w/v) NaCl on BHI agar supplemented with 5 % sheep blood. Phylogenetic analysis of the 16S rRNA gene sequences revealed that their nearest phylogenetic relative was Nocardioides solisilvae Ka25^T (97.9 % similarity). The results of 16S rRNA gene sequence and phylogenetic/phylogenomic analyses illustrated that N. solisilvae Ka25^T, Nocardioides gilvus XZ17^T, Nocardioides houyundeii 78^T and Nocardioides daphniae D287^T were their nearest phylogenetic neighbours. The DNA G+C contents of strains dk3136^T and dk3543 were 70.3 mol% and 70.4 mol%, respectively. Their genomes exhibit lower than threshold (95-96 %) average nucleotide identity to known species of the genus Nocardioides. ll-2,6-diaminopimelic acid was the diagnostic diamino acid and MK-8(H₄) was the predominant respiratory quinone. The major polar lipids were diphosphatidylglycerol and phosphatidylglycerol. The two strains had C_18 : 1 ω9c, iso-C_16 : 0 and C_17 : 1 ω8c as the major fatty acids, and rhamnose and galactose as the main whole-cell sugars. On the basis of the results of our genotypic, phenotypic and biochemical analyses, we conclude that strains dk3136^T and dk3543 represent a novel species in genus Nocardioides, for which the name Nocardioides jishulii sp. nov. is proposed. The type strain is dk3136^T (=CGMCC 4.7570^T=JCM 33496^T=KCTC 49314^T).

pH-Responsive Antibacterial Resin Adhesives for Secondary Caries Inhibition

Secondary caries caused by dental plaque is one of the major reasons for the high failure rate of resin composite restoration. Although antimicrobial agent-modified dental restoration systems have been researched for years, few reported intelligent anticaries materials could respond to the change of the oral environment and help keep oral eubiosis. Herein, we report tertiary amine (TA)-modified resin adhesives (TA@RAs) with pH-responsive antibacterial effect to reduce the occurrence of secondary caries. Two kinds of newly designed TA monomers were synthesized: DMAEM (dodecylmethylaminoethyl methacrylate) and HMAEM (hexadecylmethylaminoethyl methacrylate). In the minimum inhibitory concentration and minimum bactericidal concentration test against Streptococcus mutans, Streptococcus sanguinis, and Streptococcus gordonii, they exhibited antibacterial effect only in acidic medium, which preliminarily verified the acid-activated effect of TAs. Then DMAEM and HMAEM were incorporated into adhesive resin at the mass fraction of 5%, yielding TA@RAs. In vivo and in vitro tests showed that the mechanical properties and biocompatibility of the adhesive were not affected. A S. mutans biofilm model in acidic and neutral medium was used and confirmed that TA@RAs could respond to the critical pH value of de-/remineralization and acquire reversible antibiofilm effect via the protonation and deprotonation of TAs. Meanwhile, the stability of antibacterial effect was confirmed via a 5-d pH-cycling experiment and a saliva-derived biofilm aging model. Furthermore, 16S rRNA gene sequencing showed that TA@RAs could increase the diversity of the saliva-derived biofilms, which implied that the novel materials could help regulate the microbial community to a healthy one. Finally, an in vitro demineralization model and in vivo secondary caries model were applied and demonstrated that TA@RAs could prevent secondary dental caries effectively. In summary, the reversible pH-responsive and non-drug release antibacterial resin adhesives ingeniously overcome the defect of the present materials and hold great promise for clinical application.

Suppression of p38/HBP1 pathway alleviates hyperosmotic stress-induced senescent progression of chondrocyte senescence

This study aims to explore the effect of p38 mitogen-activated protein kinase and its downstream target HMG-box transcription factor 1 (HBP1) in the chondrocyte (CH) senescence caused by hyperosmotic stress. Human cartilage tissue with or without osteoarthritis (OA) were collected to detect the differential expression of p38 and HBP1 by Western blot. CHs were isolated from cartilage without OA and used the hyperosmotic medium to accelerate CH senescence in vitro. A p38 inhibitor and siRNA were used to mediate the expression of p38 and HBP1. The viability of CHs was determined by cell counting kit 8 (CCK8) assay. CH-related mRNA expression was analyzed by quantitative real-time polymerase chain reaction (RT-PCR). Immunofluorescence was also used to detect collagen II and beta-galactosidase expression. Senescent cells were increased in both OA cartilage and hyperosmotic stress treatment with a marked upregulation of p38 and HBP1. Suppression of p38 activation reversed the hyperosmotic stress-induced CH senescence and led to an inhibition of HBP1, p16, Runx-2, MMP-13, collagen X expression, and an upregulation of collagen II and SOX-9 expression. Moreover, the silencing of HBP1 also played a protective effect on CH senescence. The suppression of the p38/HBP1 pathway alleviates the hyperosmotic stress-induced senescent progression of CHs.

A randomised controlled trial of fibrinogen concentrate during scoliosis surgery

Bleeding and blood transfusion are common after scoliosis surgery. Fibrinogen is essential for blood clot formation and depletes quickly during haemorrhage. We randomly allocated 102 children 12-18 years old having surgery for idiopathic scoliosis, 51 to intra-operative fibrinogen concentrate 30 mg.kg^-1 (maximum 2 g) and 51 to saline placebo. Fibrinogen reduced peri-operative blood loss by a median (95%CI) volume of 155 (5-320) ml, from a median (IQR [range]) of 1035 (818-1420 [400-3030]) ml to 885 (755-1155 [270-2645]) ml, p = 0.04. Seven and four children received allogeneic red blood cell transfusion after fibrinogen and placebo, respectively, p = 0.34. There were no side-effects.

Acupuncture for recurrent urinary tract infection in women: a systematic review and meta-analysis

BACKGROUND

Increasing antibiotic resistance has motivated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (rUTI).

OBJECTIVES

To conduct a systematic review of the current state of evidence of acupuncture for uncomplicated rUTI in women.

SEARCH STRATEGY

Nine databases (PubMed, Embase, CENTRAL, CINAHL, AMED, CBM, CNKI, CQVIP, Wanfang) were searched from inception to February 2019.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating the effects of acupuncture and related therapies for prophylaxis or treatment of uncomplicated rUTI in women were included.

DATA COLLECTION AND ANALYSIS

Risk of bias was assessed, and the quality and strength of evidence evaluated using the GRADE framework. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).

MAIN RESULTS

Five RCTs involving 341 participants were included. Methodological quality of studies and strength of the evidence were low to moderate. The chance of achieving a composite cure with acupuncture therapies was greater than that with antibiotics (three studies, 170 participants, RR 1.92, 95% CI 1.31-2.81, I²  = 38%). The risk of UTI recurrence was lower with acupuncture than with no treatment (two studies, 135 participants, RR 0.39, 95% CI 0.26-0.58, I²  = 0%) and sham acupuncture (one study, 53 participants, RR 0.45, 95% CI 0.22-0.92).

CONCLUSIONS

Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs, noting the limitations of the current evidence. Given the growing challenge of antibiotic resistance, there is a need for high-quality RCTs of non-pharmacological interventions such as acupuncture.

TWEETABLE ABSTRACT

This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women.

AB1301-HPR COMORBIDITIES AND FACTORS INFLUENCING RECURRENT GOUT ATTACK IN PATIENTS WITH GOUT: A CROSS-SECTIONAL STUDY

Background:

Gout attack is characterized by painful arthritis, loss of function and reduced quality of life. Frequent gout attacks can exert negative an influence on gout management [1].

Objectives:

The objective was to identify the comorbidities of gout, to compare gender difference and to identify independent factors of multiple gout attacks.

Methods:

A cross-sectional study was performed to collect demographic, clinical variables, self-reported comorbidities, and relevant testing. Group comparison and correlation of serum uric acid (sUA) levels with other variables was performed. Univariate and multivariate logistic regression was used to detect independent risk factors of sUA.

Results:

653 gout patients were enrolled, including 553 (84.7%) males. The mean age was 48.3±15.8 years old, with a disease duration of 8.0±6.4 years. 170 (26.0%) patients had hypertension, and 57 (8.7%) had hyperlipidemia. Elevated total cholesterol (TC) was observed in 173 (26.5%) cases. 42 (37.1%) cases presented with increased triglycerides (TG) and 270 (41.3%) had increased low-density lipoprotein (LDL-C). Abnormalities including nephrolithiasis (29.4%), hydronephrosis (3.2%), and gallstones (11.9%) were detected in the patients who underwent ultrasound examination. Although female patients had a longer disease duration, they had lower levels of sUA, creatine and C-reactive protein (CRP). A positive correlation with sUA was found in TG and CRP (P<0.05) in female patients, which was not observed in males. Only gout duration (OR=1.406,P<0.001), sUA (OR=1.006,P<0.001) and LDL-C (OR=0.530,P=0.006) were independent factors of gout attack (>20 times).

Conclusion:

Comorbidity screening involving dyslipidemia is often neglected in gout patients. Gout duration and sUA level are risk factors of multiple gout attacks.

References:

[1]Wang Y, Yan S, Li C et al. Risk Factors for Gout Developed From Hyperuricemia in China: A Five-Year Prospective Cohort Study.Rheumatol Int. 2013; 3: 705-10.

Table 1.

Comparisons of clinical and laboratory variables between male and female patients with gout

VariableMale (n=553)Female (n=100)pAge (years)47.7±15.951.3±14.50.040*BMI (kg/ m2)24.5 (22.0-27.0)23.3 (20.3-25.3)0.001*Gout duration (years)6.0 (3.0-11.0)9.5 (4.0-15.0)0.001*Gout attack times•≤5209 (37.5)33 (33.0)•6-1097 (17.5)22 (22.0)•11-2070 (12.7)22 (23.0)•>20177 (32.0)23 (23.0)ComorbidiesHypertension, n (%)138 (25.0)32 (32.0)0.140Coronary heart disease, n (%)57 (10.3)10 (10.0)0.926Fatty liver disease53 (9.6)4 (4.0)0.069Laboratory testing•ALT(U/L)25.0 (17.0-40.0)19.2 (14.6-29.0)0.003*•ALB(g/L)43.5±6.342.4±3.90.025*•TB (μmol/L)12.7 (9.0-17.3)14.5 (12.1-17.4)0.002*•BUN (mmol/L)4.85 (3.98-6.27)4.85 (3.91-4.82)0.588•Creatine (mmol/L)94.0 (81.4-108.1)73.8 (67.4-87.2)<0.001*•UA (μmol/L)528.4±141.1363.8±122.9<0.001*•Glucose (mmol/L)5.62±1.675.43±1.170.317•TC (mmol/L)5.05±1.155.09±1.100.726•TG (mmol/L)2.11±1.661.94±1.860.335•HDL-C (mmol/L)1.14±0.301.52±0.41<0.001*•LDL-C (mmol/L)3.25±0.973.39±0.920.182•ESR (mm/h)40.1±32.437.4±20.80.402•CRP (mg/L)28.0±40.310.5±18.6<0.001*

*p< 0.05; BMI: body mass index; sUA: serum uric acid; ALT: alanine aminotransferase; ALB: albumin; TB: Total bilirubin; BUN: blood urea nitrogen; UA: uric acid; TC: total cholesterol; TG: triglycerides; HDL-C: high-density lipoprotein; LDL-C: Low-density lipoprotein; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein

Acknowledgments:

None.

Disclosure of Interests:

None declared

0568 Physiologic OSA Traits and CPAP Adherence Among Patients with Coronary Artery Disease and OSA

Introduction

Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), but adherence to continuous positive airway pressure (CPAP) in this population is poor. Low arousal threshold (ArTH), a pathophysiologic OSA trait, is associated with low rates of regular CPAP use in sleep clinic populations. We aimed to determine whether ArTH or other physiologic OSA traits (i.e. pharyngeal collapsibility, muscle compensation, loop gain) are associated with CPAP adherence in patients with CAD and OSA.

Methods

A secondary analysis of a randomized controlled trial of OSA treatment in patients with CAD (RICCADSA) was performed. OSA (apnea hypopnea index, AHI≥5/hour) was assessed by polysomnography. Arousal threshold (% eupneic ventilation, %Ve), loop gain (LG), pharyngeal collapsibility (%Ve) and compensation (%Ve) were estimated from polysomnography using a validated method. Adherence to auto-titrated CPAP (hours/night) was obtained from machine downloads at 1, 3, 6, 12 and 24 months. Mixed modelling was used to assess the association between OSA traits and CPAP adherence.

Results

Participants (n=262) were 64.1±7.9 years old, with BMI of 29.2±4.2 and 86% were men. The mean AHI was 40.8±23.6 events/hour with oxygen nadir of 81.3±7.1%. The median (IQR) CPAP adherence (hrs/night) was 3.0 (0.9, 5.8) at 1-mo and 3.0 (0.0, 5.6) at 24-mo. Compared to reference studies, the CAD patients exhibited an elevated LG 0.63 (0.53, 0.79), similar ArTH (%Ve) of 117.5% (106.5%, 136.4%), higher collapsibility (%Ve) at 90.1% (82.3%, 94.8%) and lower compensation (%Ve) at 3.7% (-0.7%, 8.7%).Only increasing pharyngeal muscle compensation was associated with lower CPAP adherence (β -0.04, p-value 0.048), effect modified by pharyngeal collapsibility (Compensation x Collapsibility, β &lt;0.01, p-value 0.042).

Conclusion

In this group of patients with CAD, increasing muscle compensation was associated with lower CPAP adherence. Physiologic OSA traits may provide insight into prediction of CPAP adherence among patients with OSA and CAD.

Support

Zinchuk: Parker B. Francis Fellowship Program in Clinical Research. Sands: American Heart Association. Peker: Swedish Research Council, Swedish Heart-Lung Foundation.

0627 Cognitive Perceptions Impact Short-Term CPAP Adherence in Asian Patients with Obstructive Sleep Apnea

Introduction

Adherence for the gold standard Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea (OSA) is poor worldwide. Studies have explored factors impacting CPAP adherence but data is limited for Asian patients where cultural and social norms differ. This study aimed to examine the role of disease and treatment-related perceptions in short-term CPAP adherence among patients from a multi-ethnic Southeast Asian country.

Methods

34 patients with newly diagnosed OSA were recruited from Changi General Hospital, a 1000-bed tertiary hospital in Singapore between September 2018 and February 2019. Psychological factors of self-efficacy, risk-perception and outcome expectancies were assessed with the Self-Efficacy Measure for Sleep Apnea (SEMSA) questionnaire. The SEMSA questionnaire has been previously validated for the evaluation of adherence-related cognitions. Patients were administered the SEMSA questionnaire before commencement of CPAP treatment and 1 month after.

Results

73.5% (25/34) of the patients were male (82.4% Chinese, 11.8% Malays, 2.9% Indians, 2.9% others). Mean age was 43.3 ± 11.8 years, mean apnea hypopnea index (AHI) was 45.2 ± 29.6 events/hr and mean CPAP usage at one month was 3.6±2.0 hours. 47% were adherent to CPAP, defined as average device use &gt; 4 hrs/day. Pre-treatment self-efficacy was significantly correlated with CPAP adherence (r = 0.498, P&lt;0.01). Outcome expectancies and self-efficacy measured after one-month CPAP use were significantly correlated with CPAP adherence (r = 0.702, P&lt;0.01; r = 0.467, P&lt;0.01, respectively). However, no association between risk perception and CPAP adherence was noted at either time points.

Conclusion

Consistent with previous literature in Western population, our study demonstrated that patients’ cognitive perceptions of outcome expectancies and sense of self-efficacy have an impact on CPAP adherence in a Southeast Asian population. Strategies targeting these aspects would be important in designing patient education programs.

Support

 

WISP1 Predicts Clinical Prognosis and Is Associated With Tumor Purity, Immunocyte Infiltration, and Macrophage M2 Polarization in Pan-Cancer

Cancer is becoming the leading cause of death and a major public health problem. Although many advanced treatment strategies are currently in use, the general prognosis of cancer patients remains dismal due to the high frequency of recurrence, metastasis. The identification of effective biomarkers is important for predicting survival of cancer patients and improving treatment efficacy. In this study, we comprehensively analyzed WNT1-inducible-signaling pathway protein 1 (WISP1) expression and explored its correlation with prognosis in pan-cancer using tumor IMmune Estimation Resource (TIMER) and Gene Expression Profiling Interactive Analysis 2 (GEPIA2). We also examined correlations between WISP1 and immunocyte infiltration using TIMER. We identified genes co-expressed with WISP1 using the LinkedOmics database and analyzed associated gene ontology using Metascape. Finally, we constructed protein-protein interaction networks and examined correlations between genes co-expressed with WISP1 and immunocyte infiltration in pan-cancer. WISP1 level differed between human pan-cancer tissues and normal tissues, indicating its potential as a prognostic biomarker. WISP1 expression was correlated with tumor purity and immunocyte infiltration, especially monocyte-macrophage trafficking and M2 polarization. Genes co-expressed with WISP1 were mainly associated with extracellular matrix organization, with collagen members COL6A3, COL5A1, and COL8A1 being key genes correlated with macrophage infiltration and M2 polarization in pan-cancer. Conversely, in certain types of cancer with better prognoses, WISP1 was associated with low M2 macrophage infiltration. These results suggest that WISP1 affect clinical prognosis through associations with tumor purity, immune cell infiltration, and macrophage M2 polarization in pan-cancer, with collagen member proteins may serving as effector molecules of WISP1.

A 51 bp indel polymorphism within the PTH1R gene is significantly associated with chicken growth and carcass traits

Parathyroid hormone (PTH) is a crucial regulator of calcium homeostasis and bone remodeling, and the parathyroid hormone 1 receptor (PTH1R) belongs to a class II G-protein-coupled receptor. PTH activates PTH1R, which mediates catabolic and anabolic processes in the skeleton. However, the functional mechanism of PTH1R has not been thoroughly elucidated in organisms. This study identified a 51 bp indel mutation in the first intron of the PTH1R gene and elucidated the effect of this gene mutation on the growth and carcass traits in chickens. The results indicated that the 51 bp indel was significantly associated with subcutaneous fat thickness, abdominal fat weight, body weight and daily gain over 4-8 weeks. Furthermore, we found that PTH1R gene expression was highest in the kidney and liver tissues, and it showed a trend of decreasing in leg and breast muscle tissues at different embryonic stages. In addition, we examined the expression of the three genotypes of the PTH1R gene in the liver, breast muscle and abdominal fat and found that the II genotype was significantly higher than the DD and ID genotypes. In summary, these findings suggest that the PTH1R gene can serve as a potential molecular marker for chicken breeding.

Regulation of the small GTPase Ran by miR-802 modulates proliferation and metastasis in colorectal cancer cells

Background

The small GTPase Ran is upregulated in multiple cancers and fundamental for cancer cell survival and progression, but its significance and molecular mechanisms in colorectal cancer (CRC) remain elusive.

Methods

Ran expression was detected in CRC cell lines and tumour tissues. In vitro and in vivo functional assays were performed to examine the effects of Ran on cell proliferation and metastasis. The pathways and effectors regulated by Ran were explored by an unbiased screening. Bioinformatics prediction and experimental validation were used to identify the miRNA regulator for Ran.

Results

Ran expression was frequently increased in metastatic CRC cells and tissues, especially in metastatic tissues. The upregulation of Ran correlated with poor CRC patient prognosis. Ran silencing reduced proliferation and metastasis of CRC cells both in vitro and in vivo. Ran regulated the expression of EGFR and activation of ERK and AKT signalling pathways. miR-802 was identified as an upstream regulator of Ran and miR-802 overexpression resulted in antiproliferative and antimetastatic activities.

Conclusion

Our study demonstrates the oncogenic roles and underlying mechanisms of Ran in CRC and the novel miR-802/Ran/EGFR regulatory axis may provide potential biomarkers for the treatment of CRC.

Super-dominant pathobiontic bacteria in the nasopharyngeal microbiota as causative agents of secondary bacterial infection in influenza patients

The source of secondary lower respiratory tract bacterial infections in influenza patients is not fully understood. A case–control study was conducted during the 2017–2018 influenza epidemic period in Beijing, China. Nasopharyngeal swabs were collected from 52 virologically confirmed influenza patients and 24 healthy medical staff. The nasopharyngeal microbiota taxonomic composition was analysed using high-throughput sequencing of the 16S rRNA gene V3–V4 regions. The super-dominant pathobiontic bacterial genus (SDPG) was defined as that accounting for >50% of sequences in a nasopharyngeal swab. We attempted to isolate bacteria of this genus from both nasopharyngeal swabs and lower-respiratory tract samples and analyse their genetic similarities. We observed a significantly lower taxonomy richness in influenza cases compared with healthy controls. A SDPG was detected in 61% of severe cases but in only 24% of mild cases and 29% of healthy controls. In 10 cases, the species isolated from lower-respiratory tract infection sites were identified as belonging to the nasopharyngeal microbiota SDPG. Genetically identical strains were isolated from both nasopharyngeal swabs and lower-respiratory tract infection sites, including 23 Acinetobacter baumannii strains from six severe cases, six Klebsiella pneumoniae strains from two severe cases, five Pseudomonas aeruginosa strains from one severe and one mild case, and four Corynebacterium striatum strains from two severe cases. The SDPG in the nasopharyngeal microbiota are the likely cause of subsequent infection in influenza patients.

Risk assessment of mycotoxins in stored maize: case study of Shandong, China

Risk characterisation of dietary exposure of aflatoxins (AFs), fumonisins (FBs), deoxynivalenol (DON), zearalenone (ZEA) in maize from Shandong Province was conducted in this study. A total of 520 maize samples were collected after harvesting in 2014 and 2015 from 26 selected villages in Shandong Province, China. A deterministic approach was used in the current study. The dietary intake data of maize was obtained from ‘Shandong Statistical Yearbook 2018’. The risk characterisation of FBs, DON, and ZEA was evaluated in 4 population groups (2 to 6-year-old children, standard adults, city adults and village adults) based on probable intake. 2 to 6-year-old children and adults were exposed to FBs (0.42 and 0.20 μg/kg body weight (bw)/day), DON (0.04 and 0.019 μg/kg bw/day), and ZEA (0.0024 and 0.0011 μg/kg bw/day) through mean maize consumption in diets, which was lower than the provisional maximum tolerable daily intake of each mycotoxin established by JECFA. Risk assessments showed a low risk for liver cancer due to consumption of aflatoxin B1 (0.027-0.21 cases per 100,000 persons per year) contaminated maize compared with China’s current liver cancer incidence of 24.6 cases per 100,000 persons per year.

The efficacy and safety of immunotherapy targeting the PD-1 pathway for advanced urothelial carcinoma: a meta-analysis of published clinical trials

INTRODUCTION

Urothelial carcinoma (UC) is an aggressive malignancy and has a poor prognosis in the metastatic state. Treatment of UC remains a challenge, and as a first-line regimen for advanced UC, standard platinum-based chemotherapy is unfit for many patients due to numerous comorbidities and poor performance status. Recently, five immune checkpoint inhibitors have been approved for the treatment of patients with advanced UC who were ineligible for platinum-based regimens or suffered tumor progression in post-platinum setting. However, not long ago, the U.S. Food and Drug Administration restricted the use of two common immune checkpoint blockades, atezolizumab and pembrolizumab, due to uncertain survival benefit as mono-therapy. In this scenario, we reviewed rapidly surfacing clinical trials to assess the efficacy and safety of immunotherapy targeting the PD-1 pathway for advanced UC.

METHODS

A comprehensive search was conducted in PubMed, EMBASE and Cochrane Library for all clinical trials where the efficacy and safety were reported. Our primary outcome was efficacy evaluated by objective response rate (ORR), 1-year overall survival (OS) rate and 1-year progression-free survival (PFS) rate, and second outcome was safety assessed by any grade and grade 3-4 treatment-related adverse events (TRAEs). We chose percentages with 95% confidence intervals (CI) as the evaluation indexes and used a random-effects model to account for heterogeneity.

RESULTS

We included 14 clinical trials with 2674 total patients in this meta-analysis. After removing unqualified studies on the basis of sensitivity analyses, 13 studies were pooled to evaluate the overall ORR, 8 studies for the 1-year OS rate and 6 studies for the 1-year PFS rate. The pooled data of ORR, 1-year OS rate, and 1-year PFS rate were 0.20 (95% CI 0.18-0.22, I² = 38.4%, P = 0.078), 0.50 (95% CI 0.46-0.53, I² = 30.3%, P = 0.186), and 0.17 (95% CI 0.14-0.20, I² = 0.0%, P = 0.668), respectively. Similarly, 13 trials were utilized to compute the pooled rate of any-grade TRAEs. The pooled estimation of any-grade was 0.65 (95% CI 0.63-0.67, I² = 1.7%, P = 0.429). The pooled rate of grade 3-4 TRAEs subgroups with Atezolizumab, Pembrolizumab, Durvalumab, Nivolumab and Avelumab were 0.11 (95% CI 0.06-0.15, I² = 83.5%, P = 0.000), 0.15 (95% CI 0.13-0.18, I² = 0.0%, P = 0.971), 0.06 (95% CI 0.03-0.09, I² = 0.0%, P = 0.566), 0.19 (95% CI 0.15-0.23, I² = 0.0%, P = 0.480) and 0.08 (95% CI 0.05-0.11, I² = 0.0%, P = 0.702), respectively.

CONCLUSION

This study showed that the immunotherapy targeting the PD-1 pathway had durable efficacy and acceptable safety in patients with advanced UC. The comprehensive role of immune checkpoint inhibitors in comparison to other treatments needs further confirmation basing on RCTs.

[Surveillance of echinococcosis in Yixing City from 2011 to 2018]

OBJECTIVE

To analyze the results of echinococcosis surveillance in Yixing City from 2011 to 2018, so as to provide insights into echinococcosis control in the city.

METHODS

All echinococcosis cases reported in Yixing City since 2007 that were captured from the China National Notifiable Infectious Disease Reporting Information System of Chinese Center for Disease Control and Prevention received a case study, and serological test and transabdominal B-mode ultrasound screening were performed among permanent residents and mutton market workers in Fangdong and Fangzhuang villages of Yixing City from 2011 to 2018. The cyst, mass and tubercle were detected in the liver and lung of the sheep from the mutton markets, and the Echinococcus coproantigen was detected in the canine stool samples from Fangdong and Fangzhuang villages. In addition, the awareness of echinococcosis prevention and control knowledge was investigated in the two villages using a questionnaire survey from 2011 to 2018.

RESULTS

A total of 7 cases with echinococcosis had been reported in Yixing City since 2007, with prevalence of 0.56/100 000, and all cases were E. granulosus-infected patients, including 2 cases with a history to travel to echinococcosis-endemic areas and 5 cases with a history of working in local mutton markets or dog contacts. From 2011 to 2018, a total of 1 861 residents received serological tests, with 0.54% seropositivity, and no seropositives were detected since 2016. Among the 1 807 individuals receiving transabdominal B-mode ultrasound screening, suspected cysts were found in 143 individuals (7.91%), and 1.40% (2/143) seropositivity was detected in these individuals. The mean positive rate of the Echinococcus coproantigen was 0.67% (3 /446) in the canine stool samples. Among the 4 010 sheep liver and lung specimens sampled from the mutton markets, 7 specimens (0.17%) were detected with cysts or tubercles. In addition, the mean awareness rate of echinococcosis prevention and control knowledge was 76.95% among the 538 subjects receiving questionnaire surveys from 2011 to 2018, and the overall awareness appeared a tendency towards a rise year after year.

CONCLUSIONS

Although the prevalence of echinococcosis and the seropositivity of anti-Echinococcus antibodies are low, there is still a risk of transmission of echinococcosis in Yixing City. The surveillance of echinococcosis should continue to be intensified and related control interventions are required.

Retrospective Screening and Analysis of mcr-1 and bla NDM in Gram-Negative Bacteria in China, 2010-2019

Currently, Gram-negative bacteria have developed multidrug and broad-spectrum drug resistance, and the numbers of species and strains carrying mcr or bla_NDM genes are increasing. In this study, mcr-1 and bla_NDM distribution of 12,858 Gram-negative bacteria isolated from wildlife, patients, livestock, poultry and environment in 14 provinces of China from 2010 to 2019 and the antibiotics resistance in regard to polymyxins (polymyxin B and colistin) and carbapenems of positive strains were investigated. A total of 70 strains of 10 species carried the mcr-1 gene, positive rates of patients, livestock and poultry, and environmental strains were 0.62% (36/5,828), 4.07% (29/712), 5.43% (5/92), respectively. Six strains of 3 species carrying the bla_NDM gene all came from patients 0.10% (6/5,828). Two new mcr-1 gene variants (GenBank: MK965883, MK965884) were identified, one of which contains premature stop codon. The drug susceptibility results showed that all mcr-1 carriers were sensitive to carbapenems, among which, 66 strains were resistant and 4 were sensitive to polymyxins. The strains with the bla_NDM gene had different degrees of resistance to carbapenems and were sensitive to polymyxins. The findings that species carrying mcr-1 or bla_NDM genes were limited and mostly normal flora of opportunistic or low pathogenic organisms indicated that transfer of mcr-1 and bla_NDM genes between bacteria was relatively limited in China. The none detection among wildlife compared with other sources supports the speculation that the emergence of and increase in polymyxins and carbapenem-resistant strains was mainly related to the selective pressure of antibiotics.

Survival comparision of three-dimensional radiotherapy alone with concurrent chemoradiotherapy for non-surgical esophageal carcinoma

PURPOSE

Radiotherapy is the main treatment method for patients with locally advanced, unresectable esophageal cancer. The aim of this study is to compare overall survival (OS) using 3D radiotherapy (3DRT) alone with concurrent chemoradiotherapy (CCRT) in 296 non-surgical esophageal carcinoma patients.

PATENTS AND METHODS

Over 10 years, of the 480 patients with esophageal carcinoma treated with 3DRT with or without chemotherapy, 148 patients each comprised 3DRT and CCRT groups after propensity score matching.

RESULTS

The 5- and 10-year OS (P=0.337) and PFS (P=0.715) rates for 3DRT alone were 22.0%, 14.4% and 26.1%, 23.2%, respectively, compared with 28.8%, 18.6% and 34.7%, 29.1% for CCRT, respectively. CCRT did not improve 5-year and 10-year OS or PFS in 60-70Gy group (OS: 27.5% and 25.2%; 17.9% and 17.0%, P=0.938; PFS: 38.3% and 31.8%; 31.9% and 27.8%, P=0.890) nor reduce 10-year hematogenous metastasis (31.7% and 28.3%, P=0.698). CCRT improved 5-year OS and PFS of 50.0-59.9Gy group (OS: 33.3% and 12.0%, P=0.029; PFS: 33.1% and 10.6%, P=0.081). For 3DRT, the 5-year OS and PFS rates were significantly better in the 60-70Gy group (P=0.017) compared with 50.0-59.9Gy group (P=0.002). For CCRT group, 5-year OS and PFS favored the 50.0-59.9Gy group, but the difference was insignificant. Major toxicities were greater with CCRT compared with 3DRT.

CONCLUSION

For non-surgical esophageal carcinoma patients, 3DRT combined with CCRT was effective in prolonging both OS and PFS.

miR-302a Inhibits Metastasis and Cetuximab Resistance in Colorectal Cancer by Targeting NFIB and CD44

Introduction: Metastasis and drug resistance contribute substantially to the poor prognosis of colorectal cancer (CRC) patients. However, the epigenetic regulatory mechanisms by which CRC develops metastatic and drug-resistant characteristics remain unclear. This study aimed to investigate the role of miR-302a in the metastasis and molecular-targeted drug resistance of CRC and elucidate the underlying molecular mechanisms.

Methods: miR-302a expression in CRC cell lines and patient tissue microarrays was analyzed by qPCR and fluorescence in situ hybridization. The roles of miR-302a in metastasis and cetuximab (CTX) resistance were evaluated both in vitro and in vivo. Bioinformatic prediction algorithms and luciferase reporter assays were performed to identify the miR-302a binding regions in the NFIB and CD44 3'-UTRs. A chromatin immunoprecipitation assay was performed to examine NFIB occupancy in the ITGA6 promoter region. Immunoblotting was performed to identify the EGFR-mediated pathways altered by miR-302a.

Results: miR-302a expression was frequently reduced in CRC cells and tissues, especially in CTX-resistant cells and patient-derived xenografts. The decreased miR-302a levels correlated with poor overall CRC patient survival. miR-302a overexpression inhibited metastasis and restored CTX responsiveness in CRC cells, whereas miR-302a silencing exerted the opposite effects. NFIB and CD44 were identified as novel targets of miR-302a. miR-302a inhibited the metastasis-promoting effect of NFIB that physiologically activates ITGA6 transcription. miR-302a restored CTX responsiveness by suppressing CD44-induced cancer stem cell-like properties and EGFR-mediated MAPK and AKT signaling. These results are consistent with clinical observations indicating that miR-302a expression is inversely correlated with the expression of its targets in CRC specimens.

Conclusions: Our findings show that miR-302a acts as a multifaceted regulator of CRC metastasis and CTX resistance by targeting NFIB and CD44, respectively. Our study implicates miR-302a as a candidate prognostic predictor and a therapeutic agent in CRC.