[Progress on clinical trials of common gastrointestinal cancer drugs in China from 2012 to 2021]

Objective: Systematically summarize the research progress of clinical trials of gastric cancer oncology drugs and the overview of marketed drugs in China from 2012 to 2021, providing data and decision-making evidence for relevant departments. Methods: Based on the registration database of the drug clinical trial registration and information disclosure platform of Food and Drug Administration of China and the data query system of domestic and imported drugs, the information on gastric cancer drug clinical trials, investigational drugs and marketed drugs from January 1, 2012 to December 31, 2021 was analyzed, and the differences between Chinese and foreign enterprises in terms of trial scope, trial phase, treatment lines and drug type, effect and mechanism studies were compared. Results: A total of 114 drug clinical trials related to gastric tumor were registered in China from 2012 to 2021, accounting for 3.7% (114/3 041) of all anticancer drug clinical trials in the same period, the registration number showed a significant growth rate after 2016 and reached its peak with 32 trials in 2020. Among them, 85 (74.6%, 85/114) trials were initiated by Chinese pharmaceutical enterprise. Compared with foreign pharmaceutical enterprise, Chinese pharmaceutical enterprise had higher rates of phase I trials (35.3% vs 6.9%, P=0.001), but the rate of international multicenter trials (11.9% vs 67.9%, P<0.001) was relatively low. There were 76 different drugs involved in relevant clinical trials, of which 65 (85.5%) were targeted drugs. For targeted drugs, HER2 is the most common one (14 types), followed by PD-1 and multi-target VEGER. In the past ten years, 3 of 4 marketed drugs for gastric cancer treatment were domestic and included in the national medical insurance directory. Conclusions: From 2012 to 2021, China has made some progress in drug research and development for gastric carcinoma. However, compared with the serious disease burden, it is still insufficient. Targeted strengthening of research and development of investment in many aspects of gastric cancer drugs, such as new target discovery, matured target excavating, combination drug development and early line therapy promotion, is the key work in the future, especially for domestic companies.

[Observation of PD-1+CXCR5+CD4+T lymphocyte and sPD-1 levels in HBeAg positive chronic hepatitis B virus carriers treated with entecavir]

Objective: To dynamically observe the clinical efficacy of entecavir and the changes of PD-1⁺CXCR5⁺CD4⁺T lymphocytes and sPD-1 levels in peripheral blood of HBeAg-positive chronic hepatitis B virus carriers treated with entecavir, and further explore its clinical significance. Methods: There were 31 cases of chronic hepatitis B virus carriers in the treatment group (A), 32 cases of chronic hepatitis B virus carriers in the treatment group (B), and 15 cases of chronic hepatitis B virus carriers in the non-treatment group (C).Three groups peripheral blood samples and clinical data at 0, 24 and 48 weeks were collected and compared. PD-1⁺CXCR5⁺CD4⁺T lymphocytes were detected by flow cytometry, and the level of sPD-1 was detected by enzyme-linked immunosorbent assay. ANOVA and Spearman correlation analysis were performed on the measurement data among the three groups. Results: At week 0, the serum levels of HBsAg, HBeAg and HBV DNA were significantly higher in groups A and C than group B. PD-1⁺CXCR5⁺CD4⁺T lymphocytes in peripheral blood were significantly higher in group B (4.70%±1.58%) than group A (3.25%±1.01%) and group C (2.77%±0.67%) (F=16.65, P<0.05). There was no significant difference between group A and group C (P>0.05). Peripheral blood sPD-1 in group B [(1 866.62±1 472.70) pg/ml] was significantly higher than group A [(824.86±538.66) pg/ml] and group C [(618.19±602.62) pg/ml] (F=10.95, P<0.05). There was no significant difference between group A and group C (P>0.05). At 48 weeks, the serum HBsAg did not decrease significantly in groups A and C than baseline (P>0.05), but were significantly higher than group B (P<0.05). Serum HBeAg levels were decreased significantly in groups A and B than baseline (P<0.05). <0.05), but group A was significantly higher than group B (P<0.05), and there was no significant difference between group A and group C (P>0.05). Serum HBV DNA level was significantly lower in groups A and B than group C (P<0.05), and there was no significant difference between group A and group B (P>0.05). Peripheral blood PD-1⁺CXCR5⁺CD4⁺T lymphocytes were significantly lower in Group A (1.56%±0.73%) and group B (1.32%±0.43%) than group C (2.64%±0.85%) (P<0.05). Peripheral blood sPD-1 were significantly lower in group A [(289.05±215.86) pg/ml] and group B [(236.01±173.92) pg/ml] than group C [(650.34±598.46) pg/ml] (P<0.05). There was no significant difference between group A and group B. Correlation analysis results: In group A at 48 weeks, the decreased level of PD-1⁺CXCR5⁺CD4⁺T lymphocyte ratio had no correlation with the decreased level of HBsAg and HBV DNA, but was positively correlated with the decreased level of HBeAg (r=0.376, P<0.05). The decreased level of sPD-1 had no correlation with the changes of HBsAg, but was positively correlated with the decreased levels of HBeAg and HBV DNA (r=0.598 and 0.384, P<0.05). In group B at 48 weeks, the decreased levels of PD-1⁺CXCR5⁺CD4⁺T lymphocytes and sPD-1 were positively correlated with the decreased levels of HBsAg, HBeAg, and HBV DNA (P<0.05). Conclusion: Hepatitis B virus replication and expressions in HBeAg-positive chronic hepatitis B virus carriers were significantly inhibited after 48 weeks of antiviral treatment, which is related not only to entecavir treatment, but also to the immunological mechanism involved in sPD-1. Moreover, the inhibition of HBeAg expression is associated with a decrease in the number and/or activity of PD-1⁺CXCR5⁺CD4⁺T lymphocytes.

Post-Partum Spontaneous Coronary Artery Dissection with Occluded Left Anterior Descending Artery

Presentation We present a case of spontaneous coronary artery dissection (SCAD) in a 35-year-old lady who was 4 months post-partum. Despite a lack of typical risk factors, initial presentation and investigations were strongly suggestive of ACS. Diagnosis Coronary angiography revealed an occluded proximal left anterior descending (LAD) artery with TIMI 0 flow. Angiographic appearances and intravascular ultrasound (IVUS) were consistent with SCAD. Treatment A single drug-eluting stent was deployed, successfully restoring good flow, without extending the dissection flap. Discussion SCAD should be considered as an important and underdiagnosed cause of ACS, predominantly in young women without other apparent risk factors.

Effect of Aspect Ratio of Whisker on the Fibrillation of Liquid Crystalline Polymer in Polysulfone Matrix

The influence of content and aspect ratio of whiskers, calcium carbonate and aluminum borate, on the morphology evolution of liquid crystalline polymer (LCP) was investigated in polysulfone (PSF) matrix. The study showed that the deformation of LCP droplets was significantly promoted by adding whiskers into PSF/LCP blends, and the longer whisker produced a more pronounced fibrillation effect. The analysis of flow field and elasticity of system showed that the addition of longer whiskers increased the elasticity of materials more efficiently and enhanced the vortex in the converging flow area at the entry of capillary, which resulted in an increase of the elongational stress and promoted the formation of longer LCP fibrils in PSF/whisker system.

Study of Z Bosons Produced in Association with Charm in the Forward Region

Events containing a Z boson and a charm jet are studied for the first time in the forward region of proton-proton collisions. The data sample used corresponds to an integrated luminosity of 6  fb^{-1} collected at a center-of-mass energy of 13 TeV with the LHCb detector. In events with a Z boson and a jet, the fraction of charm jets is determined in intervals of Z-boson rapidity in the range 2.0<y(Z)<4.5. A sizable enhancement is observed in the forwardmost y(Z) interval, which could be indicative of a valencelike intrinsic-charm component in the proton wave function.

Evidence for a New Structure in the J/ψp and J/ψp[over ¯] Systems in B_{s}^{0}→J/ψpp[over ¯] Decays

An amplitude analysis of flavor-untagged B_{s}^{0}→J/ψpp[over ¯] decays is performed using a sample of 797±31 decays reconstructed with the LHCb detector. The data, collected in proton-proton collisions between 2011 and 2018, correspond to an integrated luminosity of 9  fb^{-1}. Evidence for a new structure in the J/ψp and J/ψp[over ¯] systems with a mass of 4337_{-4}^{+7} _{-2}^{+2}  MeV and a width of 29_{-12}^{+26} _{-14}^{+14}  MeV is found, where the first uncertainty is statistical and the second systematic, with a significance in the range of 3.1 to 3.7σ, depending on the assigned J^{P} hypothesis.

Analysis of Neutral B-Meson Decays into Two Muons

Branching fraction and effective lifetime measurements of the rare decay B_{s}^{0}→μ^{+}μ^{-} and searches for the decays B^{0}→μ^{+}μ^{-} and B_{s}^{0}→μ^{+}μ^{-}γ are reported using proton-proton collision data collected with the LHCb detector at center-of-mass energies of 7, 8, and 13 TeV, corresponding to a luminosity of 9  fb^{-1}. The branching fraction B(B_{s}^{0}→μ^{+}μ^{-})=(3.09_{-0.43-0.11}^{+0.46+0.15})×10^{-9} and the effective lifetime τ(B_{s}^{0}→μ^{+}μ^{-})=2.07±0.29±0.03  ps are measured, where the first uncertainty is statistical and the second systematic. No significant signal for B^{0}→μ^{+}μ^{-} and B_{s}^{0}→μ^{+}μ^{-}γ decays is found and upper limits B(B^{0}→μ^{+}μ^{-})<2.6×10^{-10} and B(B_{s}^{0}→μ^{+}μ^{-}γ)<2.0×10^{-9} at the 95% C.L. are determined, where the latter is limited to the range m_{μμ}>4.9  GeV/c^{2}. The results are in agreement with the standard model expectations.

[China guideline for the screening and early detection of prostate cancer (2022, Beijing)]

Prostate cancer (PC) is one of the malignant tumors of the genitourinary system that occurs more often in elderly men. Screening, early diagnosis, and treatment of the PC high risk population are essential to improve the cure rate of PC. The development of the guideline for PC screening and early detection in line with epidemic characteristics of PC in China will greatly promote the homogeneity and quality of PC screening. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated and convened a working group comprising multidisciplinary experts. This guideline strictly followed the World Health Organization Handbook for Guideline Development and combined the most up-to-date evidence of PC screening, China's national conditions, and practical experience in cancer screening. A total of fifteen detailed evidence-based recommendations were provided with respect to the screening population, technology, procedure management, and quality control in the process of PC screening. This guideline aimed to standardize the practice of PC screening and improve the effectiveness and efficiency of PC prevention and control in China.

[Investigation on awareness of schistosomiasis control knowledge among residents going to Africa in Taizhou City]

OBJECTIVE

To understand the awareness of schistosomiasis control knowledge among people going to Africa in Taizhou City, to provide insights into the development of control measures for imported schistosomiasis.

METHODS

During the period from July to October, 2019, a face-to-face questionnaire survey was conducted among people that had gone to African countries between 2015 and 2018 and return to China now, including awareness of schistosomiasis control knowledge, type of living and drinking water and contact with river and lake water.

RESULTS

A total of 573 peoples going to Africa were investigated, and 572 eligible questionnaires were recovered. Among the 572 people interviewed, senior high school and above was the predominant education level (509 people, 89.0%), labor was the predominant aim (543 people, 94.9%), and Angola (52.3%) and Algeria (15.9%) were predominant destiny countries. There were 7.2% of the interviewees hearing about African schistosomiasis, 19.8% knowing infections by contact with infested water, and 36 people with a history of contact with river and lake water. In addition, 270 interviewees used running water as drinking water and 276 used running water as living water.

CONCLUSIONS

The awareness rate of schistosomiasis control knowledge is low among people going to Africa in Taizhou City. Health education pertaining to schistosomiasis control is required to be improved among those going to Africa in Taizhou City to increase the awareness of schistosomiasis prevention and avoid parasitic infections.

Comparison of Different Laboratory Methods for Clinical Detection of Brucella Infection

The rapidity, accuracy, and detection abilities of different laboratory methods (tube agglutination test (SAT), indirect ELISA, fluorescence polarization test (FPA), and blood culture methods) to detect Brucella in the laboratory. The study included 95 patients with documented and 42 patients with suspected brucellosis and 56 healthy control subjects. For the tests, the positive rates of Brucella infection detection in the confirmed group were significantly higher than in group with suspected infection (p<0.01) and in healthy controls (p<0.01). There was no significant difference between indirect ELISA and FPA in detecting antibodies to Brucella in acute (χ²=0.335), subacute (χ²=0.660), and chronic cases (χ²=5.332). Among the detection methods, indirect ELISA showed the highest sensitivity (98.9%), specificity (100%), and Youden index (0.989). The sensitivity and specificity of FPA were 96.8 and 96.4%, respectively. In order to easily and rapidly diagnose brucellosis in clinical practice, a combination of detection methods is recommended, in which Brucella antibodies are screened by FPA and then confirmed by indirect ELISA.

[Progression in clinical application of cryopreserved vascular allografts in the treatment of abdominal aortic graft infection]

Once an abdominal aortic graft infection occurs,it is often catastrophic associated without high morbidity and mortality.Standard surgical treatment includes removing infected grafts,arteries,and surrounding tissues,and revascularization of blood supply to organs and limbs. Extra-anatomical vascular bypass and in-situ reconstruction are the main surgical treatment methods,and many factors affect the prognosis of surgical treatment. So far,there are a variety of vascular grafts used to restore revascularization in clinical practice,mainly including rifampicin or silver-coated artificial blood vessels,autologous veins,cryopreserved allogeneic blood vessels,or bovine pericardium and other biological materials. There is no consensus on the selection of the best vascular graft. In recent years,clinical application studies have confirmed that the results of cryopreserved allogeneic blood vessels for the treatment of graft infectious diseases are acceptable,but the complications related to grafts should not be ignored. This article reviews the clinical application progress of cryopreserved allogeneic blood vessels for the treatment of abdominal aortic graft infection.

SIRT6 inhibits endothelial-to-mesenchymal transition through attenuating the vascular endothelial inflammatory response

Endothelial-to-mesenchymal transition (EndMT) is a process of transdifferentiation in which endothelial cells gradually adopt the phenotypic characteristics of mesenchymal cells. Emerging studies demonstrate the importance of EndMT in endothelial dysfunction during inflammation. Sirtuin 6 (SIRT6), a member of the mammalian NAD⁺-dependent deacetylase sirtuin family, plays a critical role in cardiovascular diseases by regulating the inflammatory response. However, little is known about the effect of SIRT6 on EndMT during vascular inflammation. Therefore, we aimed to investigate the effect of SIRT6 on EndMT in endothelium-specific SIRT6 knockout (ecSIRT6^-/-) mice and human umbilical vein endothelial cells (HUVECs) stimulated with inflammatory cytokines. First, we found that TNF-α and IL-1β co-treatment induced EndMT and down-regulated SIRT6 expression in HUVECs. Adenovirus-mediated SIRT6 overexpression suppressed inflammation-induced EndMT in HUVECs. In contrast, SIRT6 knockdown further promoted EndMT. Our findings also revealed that SIRT6 attenuated the inflammatory response of HUVECs. Additionally, vascular inflammation was induced by carotid artery ligation in ecSIRT6^-/- mice. Results showed that the intima of ligated carotid arteries in ecSIRT6^-/- mice was significantly thickened compared to that in ecSIRT6^+/+ ligated mice. Moreover, endothelium-specific SIRT6 knockout promoted EndMT and increased the expression of proinflammatory cytokines in the carotid arteries of mice. These results suggest that SIRT6 inhibits EndMT through attenuating the vascular endothelial inflammatory response. These findings may have significance for reducing the occurrence of EndMT and ameliorating certain aspects of vascular inflammation.

LGE-cMRI assessment of volume controlled reperfusion method in primary percutaneous coronary intervention in patients with ST elevated myocardial infarction

Objectives

We create a procedure based on postconditioning and gradual reperfusion, “Volume Controlled Reperfusion Revascularization” method (VCR)in primary percutaneous coronary intervention. The aim of this experimental study is to assess feasibility and effect of VCR and if this method will attenuate reperfusion injury in microvascular obstruction.

Methods

VCR method, Basically, contemporaneous forward blood flow balloon inflation blocking at the occlusion site and prolonged distal reperfusion via aspiration catheter. Active NC balloon inflation at occlusion site, while keeping NC balloon inflation, aspiration catheter was positioned 10–15mm advanced of NC balloon, intra-aspiration catheter infusion of mixture solution (artery blood 10ml+ heparin NS 10ml), 20ml/min for 10mins, adjust volume and speed according to blood pressure and heart rate variation. Stent or DCB as usual. After several successful operation on RCA, 10 patients with acute ST-segment elevation myocardial infarction (STEMI)with angiography confirmed proximal complete occlusion on dominant blood vessel were non-randomly enrolled (symptom to angiography &lt;12h). 5 cases in VCR group with volume-controlled reperfusion revascularization method, 5 cases in control group with conventional PCI method. Microvascular obstruction (MVO) has been calculated by late gadolinium-enhanced cardiovascular magnetic resonance (LGE-cMRI). Base line information, angiographic features before and after procedure, in-hospital status and MVO were compared.

Results

Successful PCI procedure, safe in-hospital treatment and LGE-cMRI assessment for MVO. Group difference were found in age group and PCI to MRI interval (53.8±7.6 vs 70.2±4.44, P=0.0031; 7.4±2.3 vs 10.4±1.67, P=0.046) between VCR and control group, respectively. There was no statistic difference in other base line information, peak myocardial enzyme, and BNP. MVO and MVO mass ratio was significantly lower in VCR group (0.78±0.96 vs 2.80±1.37, P=0.0317; 0.00585±0.00080 vs 0.02493±0.01501, P=0.0372). TIMI III blood flow found in VCR group. Re-myocardial infraction nor target vessel revascularization was documented in-hospital or 30-days follow up.

Conclusion

Among the selected small sample cases, volume-controlled reperfusion method procedure was clinical safe and feasible without additional side effect. TIMI III blood flow and less MVO were documented.

Funding Acknowledgement

Type of funding sources: None. LGE-cMRI results in VCR and controlCase illustration of VCR procedure

Circulating proteomic biomarkers related to the development of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism

Background

Chronic thromboembolic pulmonary hypertension (CTEPH), known as a complication of acute pulmonary embolism (PE), can be attributed to both persistent organized thrombi and small-vessel disease. It has been reported that patients with acute PE are more likely to develop CTEPH or have a worse prognosis in follow-up if they have pulmonary hypertension (PH) or right ventricular dysfunction in their acute phase; in acute PE, increased pulmonary arterial pressure can be induced by a combination of mechanical obstruction and pulmonary vasoconstriction. However, it remains unknown whether contributors to the increase pulmonary arterial pressure in acute phase would persistently influence the pulmonary vasculature, which could further lead to the development and progression of CTEPH.

Purpose

To investigate underlying contributors related to pulmonary hypertension in acute PE that would persistently influence the pulmonary vasculature in the development of CTEPH, and to explore potential biomarkers predictive of CTEPH in acute PE.

Methods

Plasma from patients with acute PE were collected and classified into Group 1 (with PH) and Group 2 (without PH) according to the presence of PH, which was defined by echocardiographic estimated “high probability” of PH as recommended in the 2015 ESC/ERS Guidelines for the diagnosis and treatment of PH. In addition, plasma from patients with acute PE who had not developed PH both in their acute and follow-up phase but had persistent thrombi (Group 3) were also studied and compared to that of CTEPH patients (Group 4). Differential expression proteins (DEPs) between 4 groups were identified in terms of data-independent acquisition-based quantitative proteomic analysis.

Results

Twenty-two DEPs were identified between Group1 and Group 2, and 105 DEPs were identified between Group 3 and Group 4. Among two groups of DEPs, 8 proteins were in common: antithrombin-III, osteopontin, properdin, desmoplakin, C1QA (complement C1q subcomponent subunit A), LDHA (L-lactate dehydrogenase A chain), IGKV1D-33 (immunoglobulin kappa variable 1D-33) and PEPD (Xaa-Pro dipeptidase). The level of LDHA, antithrombin-III, osteopontin and properdin were decreased both in acute PE patients with PH and CTEPH patients, while the level of desmoplakin, C1QA and IGKV1D-33 were increased in the above two groups. Regarding PEPD, its level was lower in acute patients with PH but was higher in CTEPH. Based on underlying pathogenic mechanism and the percentage of missing value, osteopontin, properdin, desmoplakin, C1QA, LDHA and PEPD were further validated as potential biomarkers predictive of CTEPH in acute PE.

Conclusions

Contributors to the increase pulmonary arterial pressure in acute PE can be further involved in the development of CTEPH, and these proteins can be potential biomarkers to help guide the management and follow-up strategy in acute PE.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS; No. 2017-12M-1-009); National Key Research and Development Program of China (No: 2016YFC1304400) Differential expression proteinsRelative intensity of proteins

Cell-free DNA from bile outperformed plasma as a potential alternative to tissue biopsy in biliary tract cancer

BACKGROUND

Biliary tract cancers (BTCs) are rare and highly heterogenous malignant neoplasms. Because obtaining BTC tissues is challenging, the purpose of this study was to explore the potential roles of bile as a liquid biopsy medium in patients with BTC.

PATIENTS AND METHODS

Sixty-nine consecutive patients with suspected BTC were prospectively enrolled in this study. Capture-based targeted sequencing was performed on tumor tissues, whole blood cells, plasma, and bile samples using a large panel consisting of 520 cancer-related genes.

RESULTS

Of the 28 patients enrolled in this cohort, tumor tissues were available in eight patients, and plasma and bile were available in 28 patients. Somatic mutations were detected in 100% (8/8), 71.4% (20/28), and 53.6% (15/28) of samples comprising tumor tissue DNA, bile cell-free DNA (cfDNA), and plasma cfDNA, respectively. Bile cfDNA showed a significantly higher maximum allele frequency than plasma cfDNA (P = 0.0032). There were 56.2% of somatic single-nucleotide variant (SNVs)/insertions and deletions (indels) shared between bile and plasma cfDNA. When considering the genetic profiles of tumor tissues as the gold standard, the by-variant sensitivity and positive predictive value for SNVs/indels in bile cfDNA positive for somatic mutations were both 95.5%. The overall concordance for SNVs/indels in bile was significantly higher than that in plasma (99.1% versus 78.3%, P < 0.0001). Moreover, the sensitivity of CA 19-9 combined with bile cfDNA achieved 96.4% in BTC diagnosis.

CONCLUSION

We demonstrated that bile cfDNA was superior to plasma cfDNA in the detection of tumor-related genomic alterations. Bile cfDNA as a minimally invasive liquid biopsy medium might be a supplemental approach to confirm BTC diagnosis.

Branching Fraction Measurements of the Rare B_{s}^{0}→ϕμ^{+}μ^{-} and B_{s}^{0}→f_{2}^{'}(1525)μ^{+}μ^{-} Decays

The branching fraction of the rare B_{s}^{0}→ϕμ^{+}μ^{-} decay is measured using data collected by the LHCb experiment at center-of-mass energies of 7, 8, and 13 TeV, corresponding to integrated luminosities of 1, 2, and 6  fb^{-1}, respectively. The branching fraction is reported in intervals of q^{2}, the square of the dimuon invariant mass. In the q^{2} region between 1.1 and 6.0  GeV^{2}/c^{4}, the measurement is found to lie 3.6 standard deviations below a standard model prediction based on a combination of light cone sum rule and lattice QCD calculations. In addition, the first observation of the rare B_{s}^{0}→f_{2}^{'}(1525)μ^{+}μ^{-} decay is reported with a statistical significance of 9 standard deviations and its branching fraction is determined.

[Clinical features and perinatal outcomes of 48 cases of pregnancy complicated with placental cystic lesions]

Objective: To investigate the clinical characteristics and perinatal outcomes of pregnancy with placental cystic lesions. Methods: A retrospective study was carried out on 48 pregnant women diagnosed as pregnancy complicated with placental cystic lesions from January 2000 to January 2020 at the Women's Hospital, Zhejiang University School of Medicine. The clinical features, pathological diagnosis and perinatal outcome were analyzed. Results: The age of 48 cases was (30±5) years, and the diagnostic gestational week of ultrasound was (24±8) weeks. Twenty-five cases in which showed a cystic mass at the fetal surface were diagnosed as placental cyst. The live birth rate was 100% (25/25) and the premature birth rate was 20% (5/25). Twenty-three cases showed "honeycomb like" cystic echo. Cystic lesions of 10 cases were located in the uterine cavity connected with the margin of the normal placenta, and finally diagnosed as hydatidiform mole and coexisting fetus (HMCF). Six cases of HMCF terminated pregnancy, and the live birth rate was 4/10, the premature delivery rate was 2/4. Cystic lesions of 13 cases were located in the placenta substance, and finally diagnosed as 4 cases of placental mesenchymal dysplasia (PMD) and 9 cases of focal chorionic edema; the live birth rate was 6/13 and the premature delivery rate was 4/6. The median hCG was lower in focal chorionic edema group [80 kU/L (60-110 kU/L)] than in the groups of HMCF [240 kU/L (180-430 kU/L)] and PMD [360 kU/L (210-700 kU/L)], and the differences were statistically significant (all P<0.01). Conclusions: For pregnancy complicated with placental cystic lesions, prenatal ultrasound should be performed to evaluate the shape, location and blood flow of the lesions. Maternal serological examination and invasive prenatal diagnosis are helpful for prenatal diagnosis and treatment. Due to the difference of perinatal outcomes, maternal and fetal complications, individualized pregnancy management should be carried out.

[Expert consensus on graded management of antineoplastic drugs]

The standardized diagnosis and treatment of tumor and the rational use of antineoplastic drugs are not only the central issue of the government and society, but also the difficulty of medical quality control. In order to implement "the Administrative Measures for the Clinical Application of Antineoplastic Drugs (Trial)" issued by the National Health Commission of the People's Republic of China, on the basis of extensive investigation and through Delphi method and several rounds of expert discussion, an expert consensus on the guiding road map and management points of drug classification was formed. Suggestions are provided to guide other medical institutions to do the related work in the graded management of antineoplastic drugs.

Revascularisation versus apexification for treatment of immature teeth based on periapical healing and root development: A systematic review and meta-analysis

AIM

Immature necrotic teeth are frequent findings in adolescents that may lead to thin root walls and open apexes. The absence of an apical stop becomes a challenge for endodontic treatment because it is difficult or impossible to seal the immature root canal with conventional endodontic techniques. Revascularisation therapy (RET) may be more suitable for the treatment of immature necrotic teeth. However, clinicians are still more inclined to choose apexification (AP) when considering the predictability of treatment results.

METHODS

The literature was searched via PubMed/MEDLINE and the Cochrane Library, Web of Science data from June, 2001 to September, 2020 and randomised clinical trials were selected that compared RET with AP for the treatment of immature necrotic teeth assessing clinical and radiographic results.

RESULTS

A total of 556 articles were retrieved, though only five studies were included. There were no differences in the periapical healing rate, overall effective rate/invalid rate, or apical closure rate between RET and AP. The root length was significantly increased in the RET group compared with the AP group quantitatively (pooled difference in means=1.28, 95% CI: [1.08, 1.48], Z=12.69, P<0.00001) and qualitatively (pooled RR=4.12, 95% CI: [2.44, 6.97]), Z=5.28, P<0.00001). The effective rate of root thickness was significantly increased in the RET group compared with the AP group (pooled RR=22.63, 95% CI: [6.08, 84.26]), Z=4.65, P<0.00001).

CONCLUSIONS

Both RET and AP were effective options regarding the healing of periapical periodontitis or the closure of open apices. Pulp revascularisation is more effective for root elongation and thickening without higher risk of overall invalid treatment.

Observation of the Mass Difference between Neutral Charm-Meson Eigenstates

A measurement of mixing and CP violation in neutral charm mesons is performed using data reconstructed in proton-proton collisions collected by the LHCb experiment from 2016 to 2018, corresponding to an integrated luminosity of 5.4  fb^{-1}. A total of 30.6 million D^{0}→K_{S}^{0}π^{+}π^{-} decays are analyzed using a method optimized for the measurement of the mass difference between neutral charm-meson eigenstates. Allowing for CP violation in mixing and in the interference between mixing and decay, the mass and decay-width differences are measured to be x_{CP}=[3.97±0.46(stat)±0.29(syst)]×10^{-3} and y_{CP}=[4.59±1.20(stat)±0.85(syst)]×10^{-3}, respectively. The CP-violating parameters are measured as Δx=[-0.27±0.18(stat)±0.01(syst)]×10^{-3} and Δy=[0.20±0.36(stat)±0.13(syst)]×10^{-3}. This is the first observation of a nonzero mass difference in the D^{0} meson system, with a significance exceeding seven standard deviations. The data are consistent with CP symmetry and improve existing constraints on the associated parameters.

Large ultrafast-modulated Voigt effect in noncollinear antiferromagnet Mn3Sn

The time-resolved magneto-optical (MO) Voigt effect can be utilized to study the Néel order dynamics in antiferromagnetic (AFM) materials, but it has been limited for collinear AFM spin configuration. Here, we have demonstrated that in Mn₃Sn with an inverse triangular spin structure, the quench of AFM order by ultrafast laser pulses can result in a large Voigt effect modulation. The modulated Voigt angle is significantly larger than the polarization rotation due to the crystal-structure related linear dichroism effect and the modulated MO Kerr angle arising from the ferroic ordering of cluster magnetic octupole. The AFM order quench time shows negligible change with increasing temperature approaching the Néel temperature (T_N), in markedly contrast with the pronounced slowing-down demagnetization typically observed in conventional magnetic materials. This atypical behavior can be explained by the influence of weakened Dzyaloshinskii–Moriya interaction rather than the smaller exchange splitting on the diminished AFM order near T_N. The temperature-insensitive ultrafast spin manipulation can pave the way for high-speed spintronic devices either working at a wide range of temperature or demanding spin switching near T_N.

Mn3Sn is an anti-ferromagnetic material which displays a large magneto-optical Kerr effect, despite lacking a ferromagnetic moment. Here, the authors show that likewise, Mn3Sn, also presents a particularly large magneto-optical Voigt signal, with a negligible change in the quench time over a wide temperature range.

[Establishment and validation of a new predictive equation with multiple risk factors for the development of cardiorenal syndrome type 1 in patients with acute myocardial infarction]

Objective: To investigate the independent risk factors of cardiorenal syndrome type 1 (CRS1) in patients with acute myocardial infarction (AMI) and to build a predictive equation for the development of CRS1 in these patients. Method: Consecutive inpatients with AMI, who hospitalized from January 2017 to December 2018 in the Hunan Provincial People's Hospital, were enrolled in this case-control study. Patients were divided into CRS1 group and non-CRS1 group according to the presence or absence of CRS1.The clinical data were collected through the electronic medical record system of Hunan Provincial People's Hospital. The matching process was conducted with a minimum-distance scoring method and a 1∶1 match between the CRS1 group and the no-CRS1 group, the propensity score was calculated through the logistic regression model. Factors with statistically significant differences in univariate analysis were included in the multivariate logistic regression model to analyze the risk factors of AMI patients with CRS1, then the independent risk factors were used to establish a predicting equation for CRS1 by logistic regression function for model building. Area under the curve (AUC) value and the best cut-off value of the combined predictors was determined according to the ROC curve. Python 3.8 software was used to perform 10-fold cross-validation on modeling samples. Results: A total of 942 patients were included, there were 113 cases in CRS1 group and 829 cases in non-CRS1 group. Ultimately, 99 CRS1 patients were successfully matched to 99 non-CRS1 patient using 1∶1 matching. After propensity score matching, the baseline age and sex along with heart rate, mean arterial pressure, percentage of people with a history of diabetes, hypertension, ST-segment elevation myocardial infarction, myocardial ischemia time, angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor blockers use, and β receptor blocker use were similar between the two groups(all P>0.05). The contrast agent dosage was also similar between the two groups (P=0.266). The peak cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide(NT-proBNP), white blood cell count, base estimated glomerular filtration rate (eGFR), albumin and hemoglobin levels were statistically significant between the two groups (all P<0.05). Multivariate logistic regression analysis showed that decreased baseline eGFR, increased NT-proBNP, peak cTnI concentrations and white blood cell count were independent risk factors of CRS1 in AMI patients (all P<0.01).The predicting equation of the combined predictor was established by transforming the logistic model equation, L=0.031×cTnI+0.000 2×NT-proBNP-0.024×eGFR+0.254×white blood cell count, where L represented the combined predictor. ROC curve analysis indicated that the AUC of the peak cTnI, NT-proBNP, baseline eGFR, white blood cell count, and combined predictor were 0.76, 0.85, 0.79, 0.81, and 0.92 respectively (all P<0.05), and the cutoff value of combined predictor was 2.6. The AUC of ROC curve after the model's ten-fold cross validation was 0.89. Conclusions: Decreased baseline eGFR, increased NT-proBNP, peak cTnI concentrations and white blood cell count are the independent risk factors for CRS1 in AMI patients. The combined predictor equation based on the above 4 biomarkers presents a good predictive value for CRS1 in AMI patients.

Observation of New Resonances Decaying to J/ψK^{+} and J/ψϕ

The first observation of exotic states with a new quark content cc[over ¯]us[over ¯] decaying to the J/ψK^{+} final state is reported with high significance from an amplitude analysis of the B^{+}→J/ψϕK^{+} decay. The analysis is carried out using proton-proton collision data corresponding to a total integrated luminosity of 9  fb^{-1} collected by the LHCb experiment at center-of-mass energies of 7, 8, and 13 TeV. The most significant state, Z_{cs}(4000)^{+}, has a mass of 4003±6_{-14}^{+4}  MeV, a width of 131±15±26  MeV, and spin parity J^{P}=1^{+}, where the quoted uncertainties are statistical and systematic, respectively. A new 1^{+}  X(4685) state decaying to the J/ψϕ final state is also observed with high significance. In addition, the four previously reported J/ψϕ states are confirmed and two more exotic states, Z_{cs}(4220)^{+} and X(4630), are observed with significance exceeding 5 standard deviations.

[MicroRNA-424 inhibits autophagy and proliferation of hepatocellular carcinoma cells by targeting ATG14]

OBJECTIVE

To determine whether miR-424 affects cancer cell proliferation and autophagy through ATG14 in hepatocellular carcinoma (HCC) cells.

METHODS

We detected miR-424-5p and ATG14 expression levels in surgical specimens of HCC and adjacent tissues and in different HCC cell lines (HepG2, SMMC-7721, Huh-7, MHCC97H, and HCCLM3) and normal human hepatocyte LO2 cells using qRT-PCR and Western blotting. In the cell transfection experiments, we observed the effects of miR-424-5p knockdown in Huh-7 cells and the effects of overexpression miR-424-5p and ATG14 in HCCLM3 cells on the proliferation, cell cycle, apoptosis and expression levels of autophagy-related proteins (LC3, Beclin1 and p62). Dual luciferase reporter assay was used to verify the possible interaction between miR-424-5p and ATG14.

RESULTS

In HCC tissues and cells, ATG14 was highly expressed and miR-424-5p expression was downregulated. In HCC cells, overexpression of miR-424-5p obviously suppressed cell proliferation and promoted cell apoptosis (P < 0.05), while inhibiting miR-424-5p or overexpressing ATG14 significantly promoted cell proliferation and inhibited cell apoptosis (P < 0.05). Dual luciferase reporter assay indicated that miR-424-5p inhibits HCC cells by targeting ATG14. In addition, inhibition of miR-424-5p and overexpression of ATG14 both enhanced the expressions of LC3-ΙΙ/LC3-Ι and Beclin1 and decreased p62 expression (P < 0.05), but miR-424-5p overexpression reduced the expressions of LC3-ΙΙ/LC3-Ι and Beclin1 and increased p62 expression (P < 0.05).

CONCLUSION

MiR-424 inhibits HCC cell autophagy and proliferation through regulating ATG14.

[Design, screening and antibacterial activity evaluation of the novel antibacterial peptide KR-1]

OBJECTIVE

To design novel antimicrobial peptides with high activity and low toxicity and evaluate their effect against Streptococcus mutans and other oral bacteria for prevention and treatment of dental caries.

OBJECTIVE

We synthesized two antimicrobial peptides (KR-1 and KR-2) using Dhvar4 (a histatins5 mimic) as the template. The antimicrobial peptides with high activity and low toxicity were screened using minimal inhibitory concentration (MIC) test, hemolysis test, and CCK-8 assay. Streptococcus mutans biofilms cultured in 96-well plates were divided into experimental group (KR-1) and positive control group (CHX) and treated with concentration gradients (0.6×, 0.8×, 1× and 2× MICs) of KR-1 and CHX, respectively. Crystal violet staining was used for quantitative analysis of the changes of the biofilms after the treatments. The structural changes of the biofilms were observed with laser confocal microscopy after KR-1 treatment at 10 × MIC. The antimicrobial activity of KR-1 against oral Streptococcus was analyzed based on the time required for sterilization after KR-1 treatment.

OBJECTIVE

The MIC of KR-1 and KR-2 for S. mutans was 3.2 μmol/L and 12.8 μmol/L, respectively. Under the effective concentration, KR-1 and KR-2 resulted in hemolysis rates of 0.35% and 48.8% in rabbit red blood cells and lowered the survival rates of gingival fibroblasts to 88.7% and 21.94%, respectively. KR-1 treatment significantly reduced biofilm formation with a minimum biofilm inhibition concentration (MBIC₅₀) lower than 1.92 μmol/L, and showed an even stronger antimicrobial than CHX at the concentration of 2.56 μmol/L (P=0.001). Confocal laser scanning microscopy revealed that the biofilm structure became loosened after KR-1 treatment, which was capable of killing about 90% of the bacteria within 5 min.

OBJECTIVE

The antimicrobial peptide KR-1 has a stronger antibacterial activity and a low toxicity with a good inhibitory effect against S. mutans biofilm.

[Clinical application and curative effect observation of follicular unit extraction and transplantation in the treatment of cicatricial alopecia]

Objective: To observe the clinical effect of treatment with follicular unit extraction (FUE) and transplantation in treating cicatricial alopecia. Methods: The retrospective cohort study was conducted. From January 2012 to January 2018, 56 patients (36 males and 20 females, aged (25±9) years, 1% to 30% alopecia area of the whole scalp area) who met the inclusion criteria visited the outpatient department of the First Affiliated Hospital of Xi'an Medical University. They were treated with FUE transplantation. The procedure of treatment was performed through the preoperative planning, follicular extraction, follicular preparation, punching recipient site and hair transplantation. The survival rate of hair and density of survived hair were calculated, hair growth and complication were observed. The evaluation was conducted through questionnaire survey by 4 levels: very satisfied, satisfied, not satisfied, and not at all satisfied with effects. Results: After a follow-up of 9 to 24 months, the survival rate of hair in 56 patients was (70±9)%, and the density of survived hair was (35±8) roots/cm². In the evaluation of the curative effect after the first stage surgery, 34 cases (60.7%) were very satisfied, 16 cases (28.6%) were satisfied, and 6 cases (10.7%)thought the treatment was effective but not satisfied. Six unsatisfactory patients and 16 satisfactory patients underwent the second-stage transplantation, with 19 (86.4%) of them being very satisfied and 3 cases (13.6%) satisfied after the second-stage operation. None of the patients underwent the third-stage surgery. The transplanted hairs grew naturally, and there were no serious complications in all cases. Conclusions: FUE transplantation can effectively treat and improve cicatricial alopecia with less trauma, fewer complication, no scar in the donor site and rapid post-operative recovery, so it is worthy of clinical promotion.

[Controversy on the age of initiation in colorectal cancer screening]

Colorectal cancer is a significant public health issue all over the world. Screening has been shown effective in improving the survival rate and decreasing the deaths of colorectal cancer. Several organizations have released guidelines for colorectal cancer screening. However, detailed recommendations like the age to begin remain controversial. This paper summarizes the recommended different age groups in initiating the colorectal cancer screening program from a few guidelines and analyzes the reasons for the inconsistency, thus facilitating the drafting of colorectal cancer screening guidelines in China.

Transcriptomic analysis reveals the inhibition of reproduction in rice brown planthopper, Nilaparvata lugens, after silencing the gene of MagR (IscA1)

MagR (IscA1) is a member of the iron-sulphur cluster assembly proteins, which plays vital roles in many physiological processes, such as energy metabolism, electron transfer, iron homeostasis, heme biosynthesis and physiologically magnetic response. Its deletion leads to the loss of mitochondrial DNA, inactivation of iron-sulphur proteins and abnormal embryonic development in organisms. However, the physiological roles of MagR in insects are unclear. This study characterized the effects and molecular regulatory mechanism of MagR gene silencing on the reproduction of brachypterous female adults of Nilaparvata lugens. After silencing the MagR gene using RNAi approach, the duration of reproductive period was shortened and the fecundity and hatchability reduced significantly. A total of 479 differentially expressed genes (DEGs) were identified for female adults after 2 days of dsRNA injection through RNA-sequencing technology, including 352 significantly upregulated DEGs and 127 significantly downregulated DEGs, among which 44 DEGs were considered the key genes involved in the effects of NlMagR silencing on the reproduction, revealing the regulatory mechanism of MagR at RNA transcription level and providing a new strategy for the control of N. lugens.