A Framework for Sharing Radiation Dose Distribution Maps in the Electronic Medical Record for Improving Multidisciplinary Patient Management

Radiation oncology practices use a suite of dedicated software and hardware that are not common to other medical subspecialties, making radiation treatment history inaccessible to colleagues. A radiation dose distribution map is generated for each patient internally that allows for visualization of the dose given to each anatomic structure volumetrically; however, this crucial information is not shared systematically to multidisciplinary medical, surgery, and radiology colleagues. A framework was developed in which dose distribution volumes are uploaded onto the medical center's picture archiving and communication system (PACS) to rapidly retrieve and review exactly where, when, and to what dose a lesion or structure was treated. The ability to easily visualize radiation therapy information allows radiology clinics to incorporate radiation dose into image interpretation without direct access to radiation oncology planning software and data. Tumor board discussions are simplified by incorporating radiation therapy information collectively in real time, and daily onboard imaging can also be uploaded while a patient is still undergoing radiation therapy. Placing dose distribution information into PACS facilitates central access into the electronic medical record and provides a succinct visual summary of a patient's radiation history for all medical providers. More broadly, the radiation dose map provides greater visibility and facilitates incorporation of a patient's radiation history to improve oncologic decision making and patient outcomes. Keywords: Brain/Brain Stem, CNS, MRI, Neuro-Oncology, Radiation Effects, Radiation Therapy, Radiation Therapy/Oncology, Radiosurgery, Skull Base, Spine, Technology Assessment Supplemental material is available for this article. © RSNA, 2021 See also commentary by Khandelwal and Scarboro in this issue.

[Investigation on seroprevalence of Toxoplasma gondii infections among neonates in Fujian Province]

OBJECTIVE

To investigate the seroprevalence of Toxoplasma gondii infections among neonates in Fujian Province, so as to provide insights into the development of interventions for the prevention and control of congenital toxoplasmosis.

METHODS

A total of 1 045 neonates delivered in Fujian Province from 2017 to 2018 were recruited, including 387 preterm infants and 658 full-term infants. Umbilical cord blood was sampled from all neonates, and the seroprevalence of anti-T. gondii IgG antibody was detected and compared between preterm and full-term infants. In addition, elbow venous blood samples were collected from neonates'mothers, and the seroprevalence of anti-T. gondii IgG antibody was detected and compared between preterm and full-term infants'mothers.

RESULTS

The overall seroprevalence of anti-T. gondii IgG antibody was 9.38% among the 1 045 neonates in Fujian Province. The seroprevalence of anti-T. gondii IgG antibody was 18.35% in the 387 preterm infants, and there was no significant difference in the seroprevalence of anti-T. gondii IgG antibody between male and female infants (17.69% vs. 18.75%, χ² = 0.07, P > 0.05). The seroprevalence of anti-T. gondii IgG antibody was 4.10% in the 658 full-term infants, and there was no significant difference in the seroprevalence of anti-T. gondii IgG antibody between male and female infants (4.14% vs. 4.08%, χ² = 0, P > 0.05). In addition, the overall seroprevalence of anti-T. gondii IgG antibody was 15.02% in all neonates' mothers, and the seroprevalence was significantly greater in preterm infants'mothers than in full-term infant's mothers (20.93% vs. 11.55%, χ² = 16.79, P < 0.01).

CONCLUSIONS

The seroprevalence of T. gondii infections is significantly higher in preterm infants and their mothers than in full-term infants and their mothers. Prenatal detection of T. gondii infections and health education pertaining to toxoplasmosis prevention and control knowledge are required to be strengthened to effectively reduce the incidence of congenital toxoplasmosis.

Genome-wide association studies for mottled eggs in chickens using a high-density single-nucleotide polymorphism array

Mottled eggs in layer chickens are gaining increasing attention because of the economic impact on the egg industry caused by the reduced sale value of commodity eggs. However, the genetic architecture underlying mottled eggs is not well understood. The genetic architecture underlying the mottled egg trait was investigated using genome-wide association studies (GWAS) by high-density arrays, using a total of 407 pink eggs and 799 blue eggs from an F₂ resource population generated by crossing Dongxiang Blue-shelled and White Leghorn chickens. The mottled egg score in blue eggs was found to be higher than that in pink eggs. The single-nucleotide polymorphism heritability of mottled egg at laying day and storage for 7 days was 0.18 and 0.20, respectively. Bivariate GWAS provided 29 significant loci, mainly located on GGA2, GGA3, GGA8, GGA10, GGA15, GGA17, and GGA23, affecting mottled egg on laying day. Candidate genes RIMS2, SLC25A32, RIMBP2, VPS13B, and RGS3 were obtained for mottled eggshell by bivariate GWAS and gene annotation. Our findings provide new insights into the genetic architecture of mottled egg in hens, and demonstrate that a genomic selection method would be profitable for breeding out the mottled egg trait.

Circular RNA hsa_circ_0006168 contributes to cell proliferation, migration and invasion in esophageal cancer by regulating miR-384/RBBP7 axis via activation of S6K/S6 pathway

OBJECTIVE

Esophageal cancer (EC) ranks as the sixth leading cause of cancer-related mortality worldwide. Circular RNAs (circRNAs) are involved in the pathogenesis of different cancers. However, the regulatory mechanism of circ_0006168 in EC progression is still unclear.

MATERIALS AND METHODS

The expression of circ_0006168, microRNA (miR)-384, and retinoblastoma binding protein 7 (RBBP7) in tumors and cells was measured by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The stability of circ_0006168 was analyzed after RNase R treatment. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay was conducted to evaluate cell viability. Transwell assay was applied to determine cell migration and invasion. Glucose consumption and lactate production were detected using glucose detection and lactic acid detection kits. The interaction between miR-384 and circ_0006168 or RBBP7 was certified by Dual-Luciferase reporter system. Protein expression of pyruvate kinase (PK), RBBP7, S6 ribosomal protein kinase (S6K), phosphorylated S6K (p-S6K), S6, phosphorylated S6 (p-S6) was analyzed by Western blot.

RESULTS

Circ_0006168 and RBBP7 were over-expressed while miR-384 was low-expressed in EC tumors and cells. The repression of circ_0006168 attenuated cell proliferation, migration, invasion, and glycolysis in EC. Of note, circ_0006168 functioned as a sponge while RBBP7 acted as a target of miR-384 in EC. Rescue experiment revealed that miR-384 inhibitor abrogated circ_0006168 silencing-induced repression on cell proliferation, migration, and invasion in EC. Meanwhile, upregulation of RBBP7 restored the inhibition of miR-384 on EC cell progression. Moreover, circ_0006168 was able to improve RBBP7 level by interacting with miR-384. Also, circ_0006168 could activate S6K/S6 pathway by regulating RBBP7 expression.

CONCLUSIONS

Abundance of circ_0006168 contributes to cell proliferation, migration, invasion, and glycolysis in EC by competitively sponging miR-384 to facilitate RBBP7 expression, representing prospective targets for EC therapy.

Evaluation of a centralized toxicity view in the electronic health record (EHR) for physician-recorded Common Terminology Criteria for Adverse Events (CTCAE)

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Background: Patients’ treatment-related acute and late toxicities are essential clinical data, yet this information is widely dispersed among notes in the EHR. This lack of structure impedes clinician ability to efficiently and comprehensively integrate toxicity information into clinical management. We aimed to consolidate toxicity data to improve clinician efficiency in accessing this information, and to evaluate the utility of this tool in radiation oncology. Methods: We developed an auto-updating flowsheet view (“Synopsis”) in the Epic EHR that longitudinally integrates physician-graded CTCAE toxicity selected using a SmartForm embedded in EHR notes. Physicians timed themselves performing 4 tasks to assess acute and post-treatment toxicity information for patients seen in follow-up, alternating with vs. without use of Synopsis. Wilcoxon Rank-Sum testing compared recorded task times with and without Synopsis. A survey was sent to physicians regarding qualitative utility of Synopsis. Results: Six physicians reviewed 98 patients seen in follow-up (49 with Synopsis, 49 without Synopsis) at median 8.1 months (Synopsis) and 6.5 months (no Synopsis) since completion of radiation (p = 0.88). Use of Synopsis was associated with significantly faster assessment of: overall toxicity history (median 50 vs. 93 seconds, p = 0.0007), highest acute toxicity during treatment (median 19 vs. 40 seconds, p = 0.0002), highest post-treatment toxicity (11 vs. 65 seconds, p < 0.0001), and longitudinal review of a single symptom (8 vs. 61 seconds, p < 0.0001). Among 10 physician survey respondents, 100% reported that Synopsis improved efficiency and 30% reported it led to a change in management. All physicians felt it was important to understand a patient’s toxicity history, but 80% reported that time required with the note-based EHR structure was prohibitive; with use of Synopsis, 90% reported that this task was now feasible. Specific domains most improved included ability to: identify high-grade toxicities (100%), contextualize new symptoms (80%), summarize treatment-related toxicity (80%), navigate in the EHR to a time of high-grade toxicity (60%), evaluate the success of an intervention (30%), and decide whether to discuss a reported new symptom (30%). Conclusions: A centralized toxicity view in the EHR improves clinician efficiency in evaluating longitudinal toxicity data and enhances clinician ability to comprehensively integrate toxicity information into patient care.

MiR-15 suppressed the progression of bladder cancer by targeting BMI1 oncogene via PI3K/AKT signaling pathway

OBJECTIVE

To investigate the role of microRNA-15 (miR-15) in the progression of bladder cancer (BC) cell and its underlying mechanism.

PATIENTS AND METHODS

Human BC specimens were collected from BC patients during operations. BC cell lines (T24, BIU87, and HT1376) and normal uroepithelial cell lines SV-HUV-1 were cultured. The abilities of cell proliferation and invasion were detected by Methyl thiazolyl tetrazolium (MTT) and transwell assay, respectively. Additionally, the relevant mRNA and protein expressions were measured by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR), Western blot and immunohistochemistry, respectively. Furthermore, the luciferase reporter assay was used to verify the target gene of miR-15. Besides, Xenograft tumor formation assay was performed to confirm the effect of miR-15 on tumor growth.

RESULTS

A low expression of miR-15 was detected by qRT-PCR, whereas the high expression of B cell-specific Moloney murine leukemia virus integration site 1 (BMI1) was detected by immunocytochemical assay in BC tissues. Moreover, miR-15 expression and BMI1 expression were significantly associated with the overall survival of BC patients. MTT and transwell assay results stated that the up-regulation of miR-15 inhibited BC cell proliferation, migration, and invasion. BMI-1 was verified as a direct target of miR-15 in BC using Luciferase reporter assay. Besides, miR-15 regulated epithelial-mesenchymal transition (EMT)-related makers, protein kinase B (AKT), and the phosphorylation of AKT protein levels in BC using the Western blot assay. Xenograft tumor formation assay indicated that the over-expression of miR-15 inhibited the tumor growth.

CONCLUSIONS

We stated that miR-15 suppressed BC cell progression by targeting BMI1 through the phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway, which provided a potential target for BC treatment.

An analysis of the variations and clinical applications of the lateral circumflex femoral artery

BACKGROUND

Identifying the arterial variation of the lateral circumflex femoral artery (LCFA) is a vital step in planning surgical and radiological approach. The aim of the study was to evaluate the variations and discuss the clinical correlates of the LCFA.

MATERIALS AND METHODS

Fifty eight adult cadavers (male 45, female 13) with 115 usable sides were used to assess and classify the origin and branches of the LCFA. Also its external diameter, distance from mid-inguinal ligament to sites of origin from the profunda femoris artery or femoral arteries.

RESULTS

There were seven types of LCFA variations in this sample. We classified them as types A to G, of which type A was normal, that is, the one showing a single LCFA arising from the profunda femoris artery. Nearly 50.43% of the sample had type B-G variations, each having 13, 10, 23, 4, 4, and 3 cases, accounting for 11.30%, 8.70%, 20.00%, 3.48%, 3.48%, and 2.61%, respectively.

CONCLUSIONS

There are many variant types in the LCFA. To avoid iatrogenic injuries, clinicians must have a sound understanding of the variation types of this important blood vessel.

Efficacy evaluation of selenium-enriched yeast in laying hens: effects on performance, egg quality, organ development, and selenium deposition

The aim of this study was to compare the dynamic changes of egg selenium (Se) deposition and deposition efficiency and to evaluate the efficacy of selenium-enriched yeast (SY) in laying hens over the 84 d feeding period after SY supplementation. A total of one thousand one hundred fifty-two 30-wk-old, Hy-Line Brown hens were randomly assigned to 1 of 6 groups (192 laying hens per group) with 6 replicates of 32 birds each, fed a basal diet (without Se supplementation), basal diet with 0.3 mg/kg of Se from sodium selenite (SS) or basal diets with 0.1, 0.2, 0.3, or 0.4 mg/kg of Se from SY, respectively. The results showed that the Se concentrations in the eggs and breasts from hens fed a SY-supplemented diet were significantly higher than those from hens fed a SS-supplemented diet or a basal diet (P < 0.001). There was a positive linear and quadratic correlation between Se concentrations in the eggs from hens fed a SY-supplemented diet and dietary Se supplementation on days 28, 56, and 84 (r² = 0.931, 0.932, 0.976, P < 0.001; r² = 0.946, 0.935, 0.976, P < 0.001), respectively. The Se deposition efficiency in whole eggs from hens fed a basal or SY-supplemented diet weresignificantly higher than those in eggs from hens fed a SS-supplemented diet on days 28, 56, and 84 (P < 0.001), respectively. In addition, there was a positive linear and quadratic correlation between Se concentrations in the eggs from hens fed SY-supplemented diet (r² = 0.655, 0.779, 0.874, 0.781, P < 0.001; r² = 0.666, 0.863, 0.944, 0.781, P < 0.001) or SS-supplemented diet (r² = 0.363, P = 0.002; r² = 0.440, P = 0.002) and number of feeding days. In conclusion, the organic Se from SY has higher bioavailability and deposition efficiency of Se in whole eggs as compared with inorganic Se from SS. The Se concentrations and Se deposition efficiency in the eggs increased from hens fed a SS- or SY-supplemented diet but decreased from hens fed a basal diet with the extension of the experimental duration. The results indicate that the dietary Se supplementation from SY should be limited to a maximum of 0.1 mg Se/kg complete feed when the eggs and meat produced from hens fed a SY-supplemented diet are used as food for humans directly, whereas up to 0.4 mg/kg organic Se from SY can be used to supplement the diets for laying hens when the products are used as raw materials for producing Se-enriched food.

The role of cyanide-resistant respiration in Solanum tuberosum L. against high light stress

Cyanide-resistant respiration in potato mitochondria is an important pathway for energy dissipation. It can be activated by high light; however, it is unclear what roles cyanide-resistant respiration plays in the response to high light stress in potato. We designed a CRISPR vector for the functional gene StAOX of the potato cyanide-resistant respiratory pathway. Agrobacterium tumefaciens GV3101 was transformed into potato. Hydrogen peroxide level, MDA content, antioxidant activity and cyanide-resistant respiratory capacity of potato leaves under high light stress were determined. Photosynthetic efficiency and chlorophyll content were determined. In addition, the operation of the malate-oxaloacetate shuttle route and transcription level of photorespiration-related enzymes were also examined. The results showed that two base substitutions occurred at the sequencing target site on leaves of the transformed potato. Accumulation of ROS and increased membrane lipid peroxidation were detected in the transformed potato leaves and lower photosynthetic efficiency was observed. The transcription level of the malate-oxaloacetate shuttle route and photorespiration-related enzymes also significantly increased. These results indicate that the cyanide-resistant respiration is an important physiological pathway in potato in response to high light stress. It also suggests that plant cyanide-resistant respiration is closely related to photosynthesis. This implies the unexplored importance of plant cyanide-resistant respiration in plant photosynthesis, energy conversion and carbon skeleton formation.

MicroRNA-590-5p suppresses the proliferation and invasion of non-small cell lung cancer by regulating GAB1

OBJECTIVE

Some specific microRNAs (miRNAs) have been identified to regulate the tumorigenesis of non-small cell lung cancer (NSCLC). MiR-590-5p was found to involve in the carcinogenesis of human cancers. This study aims at exploring the role of miR-590-5p in the pathogenesis of NSCLC.

PATIENTS AND METHODS

The expressions of miR-590-5p and GAB1 were measured by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) and Western blot, respectively. The biological functions of miR-590-5p and GAB1 on cell viability and invasion were investigated through MTT and transwell assays. The binding site between miR-590-5p and GAB1 was verified by dual-luciferase reporter gene assay (DLR).

RESULTS

MiR-590-5p expression was downregulated in NSCLC. MiR-590-5p overexpression inhibited the proliferation and invasion of NSCLC cells. Furthermore, miR-590-5p was confirmed to directly target GAB1. GAB1 knockdown had the same effect as overexpression of miR-590-5p in NSCLC. Moreover, overexpression of GAB1 partially reversed the suppressive effect of miR-590-5p on NSCLC.

CONCLUSIONS

MiR-590-5p suppressed cell proliferation and invasion of NSCLC by inhibiting GAB1 expression, indicating that miR-590-5p was a suppressive miRNA in NSCLC.

miR-497 promotes the progression of cutaneous squamous cell carcinoma through FAM114A2

OBJECTIVE

To explore the possible role and mechanism of miR-497 in cutaneous squamous cell carcinoma.

PATIENTS AND METHODS

Quantitative Real-time polymerase chain reaction (qRT-PCR) was used to detect miR-497 and FAM114A2 expression level in 38 cases of cutaneous squamous cell carcinoma (CSCC) and 22 normal skin tissues as well as in CSCC cell lines (A431, HSC-5) and normal cells (HaCaT). MiR-497 effects on cell proliferation and cell cycle were examined by CCK8 assays and flow cytometry. Dual luciferase reporter gene assay was performed to detect the regulating relationship between miR-497 and FAM114A2. In addition, the expression of FAM114A2 after overexpression or knockdown of miR-497 was detected by Western blot to evaluate whether miR-497 could regulate proliferation and cell cycle by regulating the expression of FAM114A2.

RESULTS

MiR-497mRNA expression in CSCC tissues and cell lines was markedly lower than that in normal tissues and cells. Meanwhile, FAM114A2 mRNA and protein levels in CSCC tissues were markedly higher when compared to than that in normal tissues. miR-497 overexpression or knockdown could inhibit or promote the cell proliferation and cell cycle of A431, HSC-5. The dual luciferase reporter gene assay suggested that FAM114A2 might be a direct target gene of miR-497, and that FAM114A2 expression had a significant negative correlation with miR-497. Overexpression of miR-497 could inhibit FAM114A2 protein expression. Besides, FAM114A2 knockdown reversed the inhibitory effect of low expression of miR-497 on proliferation rate of A431 or HSC-5 cells.

CONCLUSIONS

MiR-497 was lowly expressed in squamous cell carcinoma tissues and cells, which can participate in the regulation of cell proliferation through FAM114A2, thus promoting the progression of CSCC.

MicroRNA-138 inhibits proliferation and induces apoptosis of laryngeal carcinoma via targeting MAPK6

OBJECTIVE

To explore whether microRNA-138 could regulate the incidence and progression of laryngeal carcinoma through modulating proliferation and apoptosis of laryngeal carcinoma cells via MAPK6.

PATIENTS AND METHODS

MicroRNA-138 expression in laryngeal carcinoma tissues and paracancerous tissues were detected by qRT-PCR (Quantitative Real-Time Polymerase Chain Reaction). The regulatory effects of microRNA-138 on proliferation and apoptosis of laryngeal carcinoma cells were detected by colony formation assay and flow cytometry, respectively. Target gene of microRNA-138 was predicted by online software and verified by luciferase reporter gene assay. Corresponding plasmids of microRNA-138 and the target gene were constructed. Rescue experiments were conducted to explore the regulatory effect of microRNA-138 on the target gene.

RESULTS

MicroRNA-138 was downregulated in laryngeal carcinoma tissues than that of paracancerous tissues. MicroRNA-138 knockdown resulted in increased proliferation and decreased apoptosis of laryngeal carcinoma cells. MAPK6 was predicted as the target gene of microRNA-138. Luciferase reporter gene assay further verified that MAPK6 could directly bind to microRNA-138. Both mRNA and protein levels of MAPK6 were downregulated after microRNA-13 overexpression in laryngeal carcinoma cells. Rescue experiment results indicated that increased proliferation and decreased apoptosis of laryngeal carcinoma cells resulted from microRNA-13 knockdown were partially reversed by MAPK6 overexpression.

CONCLUSIONS

MicroRNA-138 is downregulated in laryngeal carcinoma patients. MicroRNA-138 knockdown promotes proliferation and inhibits apoptosis of laryngeal carcinoma cells via inhibiting MAPK6 expression.

Integrating transcriptome-wide association study and mRNA expression profiling identified candidate genes and pathways associated with osteomyelitis

Objective: Osteomyelitis (OM) is an acute or chronic inflammatory process, characterized by severe inflammation and progressive bone destruction. Limited efforts have been made to explore the genetic basis of OM.Method: The genome-wide association study data set of OM was obtained from the UK Biobank. A transcriptome-wide association study (TWAS) of OM was conducted by the FUSION tool using the gene expression reference weights of lymphocytes and blood. The OM-associated genes identified by TWAS were subjected to gene ontology (GO) enrichment analysis to explore OM-related gene sets. The TWAS results of OM were finally compared with a genome-wide mRNA expression profiling of OM to detect common genes and gene sets.Results: TWAS of OM detected 86 genes for lymphocytes and 387 genes for blood. Comparing the genes identified by TWAS and mRNA expression profiling detected eight common genes for OM, including VWF (p_TWAS = 0.0030, p_mRNA = 3.44 × 10^-9), CCDC50 (p_TWAS = 0.0130, p_mRNA = 0.0003), and TPD52 (p_TWAS = 0.0180, p_mRNA = 1 × 10^-6). GO analysis of the genes identified by TWAS detected multiple OM-associated GO terms, e.g. peroxisomal matrix (p_TWAS = 0.0082), extracellular exosome (p_TWAS = 0.0248), and monooxygenase activity (p_TWAS = 0.0040). Further comparing the GO results of TWAS and mRNA expression profiling detected one common GO term, named extracellular exosome (p_TWAS = 0.0248, p_mRNA = 0.0027).Conclusion: This integrative study of TWAS and mRNA expression profiling detected multiple candidate genes and GO terms for OM. Our results provide novel clues for understanding the pathogenesis of OM.