Chinese expert group consensus on diagnosis and clinical management of osteoradionecrosis of the mandible

Osteoradionecrosis of the mandible (MORN) is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of the mandible as the main manifestation. Clinically, MORN-related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorders, refractory orocutaneous fistula, bone exposure, and even pathological fracture. MORN has become a challenging clinical problem for oral and maxillofacial surgeons to deal with, but thus far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Because of the nonexistence of standardized treatment criteria, most clinical treatment against MORN nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the diagnosis and treatment of MORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in MORN from 16 domestic medical colleges and affiliated hospitals to discuss the spectrum of diagnosis and and formulate treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This 'expert consensus statement on diagnosis and clinical management of MORN' is for clinical reference.

[Study on the characteristics of major birth defects in 1.69 million cases of fetus in Guangxi Zhuang Autonomous Region]

Objective: Tracking the information on 1.69 million fetal cases across Guangxi Zhuang Autonomous Region (Guangxi) so as to study the occurrences of total and major birth defects in order to evaluate the ability on related prevention and control programs in Guangxi. Methods: Using the self-developed "Gui Women's System" to establish a database of 1.69 million fetal cases in Guangxi and to analyze the distribution of time, space and population, as well as the outcomes of pregnancy, using the big data. Results: During the 29 months of observation, the overall live birth rate was 99.25%, with stillbirth rate during pregnancy as 0.44%, stillbirth rate during birth as 0.02%, and the 0-6 days mortality rate as 0.14%. The total detection rate on birth defects was 197.63/10 000; the incidence rate was 103.04/10 000, the birth rate was 102.55/10 000. The overall discovery rate of major birth defects was 48.33/10 000, with the incidence rate as 783 000, the birth rate as 0.58/10 000. The discovery rates of major birth defects in 14 cities were between 35 and 68/10 000, and the birth rate dropped significantly to less than 1.00 in 10 000. Nationalities showed that the number of pregnant women with birth defects more than 50 000 would include Hui (9.68/10 000), Yao (9.57/10 000), and Jing (9.37/10 000). With the increasing age of gestation, number of birth defects, incidence of major birth defects also increased. Ninety-five percent of the major birth defects were found within <28 weeks and with the top 5 kinds of major birth defects as complicated congenital heart disease (9.11/10 000), alpha thalassemia (8.36/10 000), and 21-trisomy syndrome (7.85/10 000), beta thalassemia (5.32/10 000) and fetal edema syndrome (4.92/10 000). The top 5 major birth defects appeared as complicated congenital heart disease (9.11/10 000), alpha thalassemia (8.36/10 000), and 21-trisomy syndrome (7.85/10 000), beta thalassemia (5.32/10 000) and fetal edema syndrome (4.92/10 000). Conclusion: Programs leading to increase the rate on discovery of major birth defects were fundamental in effectively reducing the major birth defects.

Integrated analysis of different mRNA and miRNA profiles in human hypopharyngeal squamous cell carcinoma sensitive and resistant to chemotherapy

The purpose of this study was to identify potential miRNAs and mRNAs involved in chemotherapy insensitivity in hypopharyngeal squamous cell carcinoma (HSCC) and to explore the underlying mechanisms involved to provide diagnostic markers and therapeutic targets for HSCC. We used microarrays to identify differences in both the mRNA and miRNA expression profiles between a group (twelve patients) sensitive to chemotherapy and a resistant group (nine patients). We then employed bioinformatics tools to examine the functions and pathways involved. The genes and miRNAs most related to chemotherapy sensitivity in HSCC were screened. Finally, a miRNA-mRNA-phenotype network was constructed with an integrated analysis based on the identified miRNAs and mRNAs. Nine differentially expressed miRNAs and one hundred differentially expressed mRNAs were identified, and the functions of these genes and miRNAs were predicted. Bioinformatics analysis revealed a regulatory network consisting of eight genes and two miRNAs that influenced HSCC chemosensitivity. According to our analysis, CCL4L1 may be a potential molecular marker for HSCC chemotherapy, and excess CCL4L1 leads to the upregulation of PRAME and the downregulation of miR-375, thus decreasing HSPB8 expression and promoting chemotherapy sensitivity. Our work provides reliable data for further studies investigating the mechanism of HSCC chemotherapy sensitivity.

Expression of Raptor and Rictor and their relationships with angiogenesis in colorectal cancer

Mammalian target of rapamycin (mTOR) has two subtypes, i.e., mTORC1 and mTORC2, which contain the Raptor and Rictor core molecules, respectively. The effect of Raptor and Rictor on hypoxia inducible factor (HIF)-1α, HIF-2α, and vascular endothelial growth factor (VEGF) in colorectal cancer (CRC) is unclear. In this work, we investigated the correlations among Raptor, Rictor, HIF-1α, HIF-2α, and VEGF expression in CRC. We subsequently analyzed the clinicopathological features of patients. Immunohistochemistry, western blot, and RT-PCR analyses were performed to detect the expression of Raptor, Rictor, HIF-1α, HIF-2α, and VEGF in 120 cases of CRC and 60 cases of normal colorectal mucosa. CD34 was used to label microvascular density (MVD), which was found to be higher in patients with positive Raptor or Rictor than in those with negative Raptor or Rictor. The positive rates of Raptor, Rictor, HIF-1α, HIF-2α, and VEGF in CRC were significantly higher than in normal colorectal mucosa. Raptor expression was positively correlated with HIF-1α and VEGF but not with HIF-2α expression. By contrast, Rictor expression was positively correlated with HIF-2α and VEGF but not with HIF-1α expression. Survival analysis further indicated that Raptor, Rictor, HIF-1α, HIF-2α, VEGF and lymph node metastasis were independent prognostic factors in CRC. To conclude, Raptor and Rictor expression was related to the initiation and development of CRC and angiogenesis in different ways. The combined detection of Raptor and Rictor is important for patients with colorectal carcinoma in prognosis and optimal therapy.

On the glacial-interglacial variability of the Asian monsoon in speleothem δ18O records

While Asian monsoon (AM) changes have been clearly captured in Chinese speleothem oxygen isotope (δ¹⁸O) records, the lack of glacial-interglacial variability in the records remains puzzling. Here, we report speleothem δ¹⁸O records from three locations along the trajectory of the Indian summer monsoon (ISM), a major branch of the AM, and characterize AM rainfall over the past 180,000 years. We have found that the records close to the monsoon moisture source show large glacial-interglacial variability, which then decreases landward. These changes likely reflect a stronger oxygen isotope fractionation associated with progressive rainout of AM moisture during glacial periods, possibly due to a larger temperature gradient and suppressed plant transpiration. We term this effect, which counteracts the forcing of glacial boundary conditions, the moisture transport pathway effect.

Surface transformation multi-physics for controlling electromagnetic and acoustic waves simultaneously

A multi-physics null medium that performs as a perfect endoscope for both electromagnetic and acoustic waves is designed by transformation optics, which opens a new way to control electromagnetic and acoustic waves simultaneously. Surface transformation multi-physics, which is a novel graphical method to design multi-physics devices, is proposed based on the directional projecting feature of a multi-physics null medium. Many multi-physics devices, including beam shifters, scattering reduction, imaging devices and beam steering devices, for both electromagnetic and acoustic waves can be simply designed in a surface-corresponding manner. All devices designed by surface transformation multi-physics only need one homogeneous anisotropic medium (null medium) to realize, which can be approximately implemented by a brass plate array without any artificial sub-wavelength structures. Numerical simulations are given to verify the performances of the designed multi-physics devices made of brass plate array.

[The diagnostic utility of thin-slice CT navigation combined with radial endobronchial ultrasound for peripheral pulmonary lesions]

Objective: To evaluate the diagnostic value of thin-slice CT navigation combined with radial endobronchial ultrasound in peripheral lung lesions. Methods: The clinical data of patients with peripheral lung lesions diagnosed by thin-slice CT navigation combined with radial endobronchial ultrasound in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from November 2015 to August 2018 were retrospectively analyzed. The success rate of thin-slice CT for guiding radial endobronchial ultrasound was statistically analyzed, and the diagnostic rate, sensitivity and specificity of thin-slice CT combined with radial endobronchial ultrasound were analyzed. Results: 140 consecutive patients with 145 lesions were included, 139 lesions in 136 patients were found by thin-layer CT guidance, the success rate was 95.9%; 137 lesions in 135 patients were examined by histology and/or cytology, and 106 lesions were finally diagnosed, the diagnostic rate was 77.37%; and the diagnosis sensitivity and specificity was 88.45% and 99.96%. Histological and cytological diagnostic rate, sensitivity and specificity was 72.18% versus 63.50%, 70.58% versus 66.85%, 100% versus 88.23%, respectively. Factors influencing the diagnostic rate of thin-slice CT navigation combined with radial endobronchial ultrasound include the relationship between the lesion and the target bronchus, the location of the probe and the lesion, and the size of the lesion, and the difference between the farthest generation of bronchoscopy insertion and the bronchial generation of lesions. Five patients had mild bleeding and one ultrasonic probe was damaged. Conclusion: Thin-slice CT has a higher positive rate in guiding peripheral lung lesions with radial ultrasound, and this method has a higher diagnostic value for peripheral lung lesions.

Colossal Enhancement of Near-Field Thermal Radiation Across Hundreds of Nanometers between Millimeter-Scale Plates through Surface Plasmon and Phonon Polaritons Coupling

Coupling modes between surface plasmon polaritons (SPPs) and surface phonon polaritons (SPhPs) play a vital role in enhancing near-field thermal radiation but are relatively unexplored, and no experimental result is available. Here, we consider the NFTR enhancement between two identical graphene-covered SiO₂ heterostructures with millimeter-scale surface area and report an experimentally record-breaking ∼64-fold enhancement compared to blackbody (BB) limit at a gap distance of 170 nm. The energy transmission coefficient and radiation spectra show that the physical mechanism behind the colossal enhancement is the coupling between the surface plasmon and phonon polaritons.

Thermal surface transformation and its applications to heat flux manipulations

A new method to control heat flux, called thermal surface transformation (TST), is introduced from transformation thermodynamics. Compared with transformation thermodynamics, TST has many advantage. First, there is no mathematical calculation during the whole process in TST (novel thermal devices can be designed graphically in a surface-to-surface way). Second, all thermal devices of various functions, shapes and sizes designed by TST only require one homogenous anisotropic thermal medium, i.e., thermal-null medium (TNM). With the help of the effective medium theory, TNM can be realized by layered copper and expanded polystyrene, whose performance on controlling heat flux by TST is verified by numerical simulations. Many examples are given, including thermal imaging devices, thermal unidirectional cloak, concentrator, rotator and thermal focusing devices.

Genome-wide association study shows that microtia in Altay sheep is caused by a 76 bp duplication of HMX1

Microtia is a congenital malformation of the external ear that can be observed in many species including sheep. However, the genetic basis of microtia still remains unclear. Here, a GWAS was conducted to investigate the genetic basis underlying microtia. A total of 55 samples from 26 microtia and 29 normal animals were genotyped with Illumina OvineHD BeadChip. The strongest significant SNP was identified on OAR6, approximating the evolutionarily conserved region of the HMX1 gene, which is related to congenital malformations of the external ear in other species such as cattle and rats. Sequencing an evolutionarily conserved region surrounding HMX1 revealed a duplication of 76 bp, which is concordant with microtia, suggesting a dominant inheritance mode. Identification of this causal mutation in the HMX1 gene indicates the role of this particular gene in the development of the external ear and provides a genetic marker for selection against microtia.

Channel competition in emitter-plasmon coupling

When an emitter is close to a plasmonic nanoantenna, besides coupling to the dipolar antenna mode, the emitter also considerably couples to a superposition of the high-order modes, referred to as a pseudomode. We comprehensively investigate the differences between the dipolar mode channel and the pseudomode channel in a representative system where a dipole emitter couples to a silver nanorod. The two channels are shown to be distinct in their mechanisms, characteristics (including chromatic dispersion and field distribution), and dependences on system parameters (including emitter-antenna distance, antenna geometry, and material loss). The study provides physical insight and reveals important design rules for controlling the competition between the two channels.

P5250Diastolic strain rate ratio as determined on MRI on detecting left ventricle stiffness and predict heart failure in post-STEMI patients

Background

ST-elevation myocardial infarction (STEMI) Patients suffered from progressive heart failure, for which progressive and aggravated Left ventricle stiffness was one of the major culprit. Myocardial deformation in the early diastole is largely affected by the left ventricle compliance which could partly reflect chamber stiffness and potentially predict left ventricular remodeling for post-STEMI patients.

Purpose

To determine the value of diastolic strain rate in detecting left ventricle stiffness and early heart failure in post-STEMI patients.

Methods

A number of 52 (M/F: 46/6, age: 54.27 [46.8–62.3]yrs) patients with STEMI three months ago were prospectively recruited from 2016 to 2017. Follow-up was done until 2018. The primary end points were the symptoms of heart failure (NYHA II-IV). Consent was acquired from each patient and 3.0 T MRI was arranged. Imaging analysis was performed on Cvi 42 (V5.9.3 Canada). Peak radial strain (PS) and strain rate (SR) were extracted both from 2D short- and long-axis cine images, while peak circumferential parameters only from the short axis slices and longitudinal the long axis slices. The diastolic strain rate ratios (DSRRs) were calculated as the peak early diastolic SR divided by the peak late diastolic SR, which were derived from the two peak points on the corresponding curve of time-to-SR curve in the diastole (Figure 1a). Receiver-operating characteristics curve analysis and Logistic regression test were done for statistical analysis on R project and P<0.05 was considered as significant.

Results

Three patients were excluded due to unsatisfied cine images. Among the 52 patients, none of the patients died or had congestive heart failure. 23/52 (44.2%) patients complained of heart failure symptoms at the one-year follow-up. No significant difference was found in LVEF and three directional peak strain values or systolic peak strain rates between the patients with and without heart failure. Patients with symptoms had lower Longitudinal PS (P=0.049), early diastolic radial SR (P=0.01798), longitudinal SR (P=0.0042), and decreased DSRR in all directions (Figure 1b). Multivariate Logistic regression test showed that only DSRR in the radial direction on the short axis (DSRR-SR) was the independent predictor of the heart failure symptoms (6.59; range, 6.71–3.68; P=0.026). ROC analysis demonstrated that the DSRR-SR of 2.35 had sensitivity 91.3% and specificity 58.6% for the prediction of heart failure (Figure 1c).

Figure 1

Conclusion

DSRR especially DSRR-SR was more sensitive to left ventricle stiffness change and help predict the progression of heart failure for Post-STEMI patients. Further studies were needed to verify the its association with other cardiovascular clinical events.

Acknowledgement/Funding

the National Natural Science Foundation of China (81600299,81471721, 81471722, 81771887, and 81771897,);

Capacity of different anthropometric measures to predict diabetes in a Chinese population in southwest China: a 15-year prospective study

AIM

To investigate whether conicity index, abdominal volume index, body adiposity index, body roundness index, cardiometabolic index and lipid accumulation product compared with waist circumference could predict future diabetes in a 15-year prospective study.

METHODS

The data were collected in 1992 and recollected in 2007 from the same group of 687 individuals. Anthropometric indices and biochemical data were obtained. Cox's proportional hazards regression models were used to estimate the hazard ratios of anthropometric measures. The discriminatory power of anthropometric measures for incident diabetes were assessed by Harrell's C-statistic.

RESULTS

During follow-up, 74 participants were newly diagnosed with diabetes. In multivariable Cox regression analysis after adjusting potential for confounders, log₁₀ -conicity index [HR: 1.67 (95% CI: 1.31-2.11) per sd; P < 0.0001], log₁₀ -abdominal volume index [HR: 1.95 (95% CI: 1.50-2.55) per sd; P < 0.0001], log₁₀ -body adiposity index [HR: 1.82 (95% CI: 1.33-2.50) per sd; P < 0.0001], log₁₀ -body roundness index [HR: 2.16 (95% CI: 1.63-2.88) per sd; P < 0.0001], log₁₀ -cardiometabolic index [HR: 1.70 (95% CI: 1.39-2.09) per sd; P < 0.0001], log₁₀ -lipid accumulation product [HR: 2.06 (95% CI: 1.56-2.73) per sd; P < 0.0001] and log₁₀ -waist circumference [HR: 1.99 (95% CI: 1.51-2.46) per sd; P < 0.0001] were significantly associated with incident diabetes. Additionally, lipid accumulation product had the highest Harrell's C-statistic at 0.715 (95% CI: 0.656-0.775), followed by body roundness index at 0.714 (95% CI: 0.658-0.770) and cardiometabolic index at 0.704 (95% CI: 0.643-0.764) then by waist circumference at 0.701 (95% CI: 0.644-0.759).

CONCLUSIONS

Conicity index, abdominal volume index, body adiposity index, body roundness index, cardiometabolic index and lipid accumulation product were independent predictors of future diabetes. The discriminatory power of body roundness index, cardiometabolic index and lipid accumulation product for diabetes prediction were higher than that of waist circumference.

Overwater light-sheet Scheimpflug lidar system for an underwater three-dimensional profile bathymetry

The feasibility of an overwater light-sheet Scheimpflug lidar system for underwater three-dimensional (3D) profiling is considered. Corrections for the refraction at the air-water interface are proposed. Applications for profiling marine ecosystems are explored in distance up to several meters, and millimeter precision is accomplished. The experimental results demonstrate that our system is suitable for underwater 3D profiling and has great potential in marine biological detection.

Finite element analysis on the hollow porous design at the proximal end of cementless femoral prosthesis stem

Aims

The present study aims to improve the design of cementless femoral prosthesis stem and achieve better bone ingrowth and long-term stability.

Materials and Methods

Four models with different directional hollow holes at the proximal end of femoral prosthesis were designed and finite element analysis was applied to calculate the magnitude of conducting force within the differently angled holes and the stress distribution of the femur and prosthesis.

Results

Holes in prostheses make no difference on the stress values of femoral inner walls. The conducting forces in models trepanned on the lateral plane were 6.60N (0° pore) and 8.40N (45° pore) while forces in models trepanned on the anterior-posterior planes were 0.45N (upper 0° pore), 0.48N (lower 0° pore) and 1.57N (upper 45° pore), 1.51N (lower 45° pore), respectively.

Conclusion

The position and direction of hollow holes influenced the conducting force in holes but had no influence on stress values of femoral inner walls. Prostheses with one 45° hole trepanned on the lateral plane of proximal prostheses presented best in elevating conducting force.

Controlled Multistep Self-Assembling of Colloidal Droplets at a Nematic Liquid Crystal-Air Interface

We present a controlled cascade of self-assemblings of colloidal droplets at a nematic liquid crystal-air interface into large-scale ordered structures. Changing the tilt of the droplet-induced elastic dipoles via its dependence on the nematic film thickness, we are able to control the dipole-dipole interaction and thus the self-assembling regime. For a progressively large tilt, droplets form anisotropic lattices, which then transform into arrays of repulsive chains, then to bands of half-period-shifted densely bound chains. These structures with chain order at the inner scale aggregate into different large-scale clusters that have a pronounced circular pattern and are stabilized by the many-body elastocapillary attraction.

[Clinical application of the Chinese version of Cornell assessment of pediatric delirium: a pilot study]

Objective: To evaluate the clinical application of Chinese version of Cornell assessment of pediatric delirium (CAPD) scale in children by a pilot study. Methods: A prospective observational study. From June 2017 to December 2017, the original CAPD screen was translated into Chinese and debugged cross-culturally according to the guidelines, which was further applied in the Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University. The clinical data of 250 patients who were evaluated with the Chinese version of CAPD scale and Richmond agitation-sedation scale were extracted and analyzed with chi-square test or Mann-Whitney U test. Cronbach's α coefficient,Split-half coefficient and intra-group correlation coefficient were used to evaluate the reliability, while exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The result was compared with the gold standard diagnostic results to evaluate the diagnostic efficacy of the CAPD. Results: Sixty-one (24.4%) patients had delirium during pediatric intensive care unit hospitalization,and significant differences existed between them and 189 patients without delirium in age (χ(2)=11.220, P=0.011), rates of mechanical ventilation (χ(2)=6.691, P=0.010) and length of PICU hospitalization (Z=10.656, P=0.001). The Chinese version of the CAPD scale had high discrimination among the 8 items in the main table without skewed distribution and discrete items. The internal and external reliability of the scale were preferable as the Cronbach's α coefficient was 0.819 and ICC value was 0.835. The KMO value of EFA was 0.834 and Bartlett spherical test showed statistical significance (χ(2)=661.440, P<0.01). CFA constructed a two-factor structural equation model with favorable fit index:Chi-square/degree of freedom (DF) ratio was 1.786 (χ(2)=33.930, P=0.019), goodness of fit index (GFI) was 0.967,adjusted GFI was 0.938,root mean square of the approximate error (RMSEA) was 0.056. A good diagnostic efficacy of this scale was demonstrated by receiver operating characteristic curve analysis as when the cut-off was 10, the area under curve was 0.99 (95%CI: 0.97-0.99), sensitivity was 96.7% (95%CI: 88.7-99.6), specificity was 93.1% (95%CI: 88.5-96.3), positive likelihood ratio was 14.0 (95%CI: 13.2-14.9), and the negative likelihood ratio was 0.035 (95%CI: 0.008-0.200). Conclusion: The Chinese version of the CAPD Scale has favorable reliability,validity,diagnostic efficacy, as well as feasibility, which should be applied in evaluation of pediatric delirium in clinical observation and research in the future.

Monolithic chip-scale structural color filters fabricated with simple UV lithography

We demonstrate an improved approach to integrate various color filters on a chip-scale by using stepwise metal-insulator-metal FP cavities. The cavity is composed of a thick silver mirror, an SU8 gap layer of controlled thickness, and a thin nickel layer. Reflective colors from red to blue can be generated from these filters through a simple UV lithography process. The filters were also fabricated on a flexible substrate which could be incorporated into wearable devices. This method can realize large-scale filter arrays with simple processing and may facilitate the use of structural color filters in displays and sensing.

Interaction With Social Robots: Improving Gaze Toward Face but Not Necessarily Joint Attention in Children With Autism Spectrum Disorder

It is widely recognized that robot-based interventions for autism spectrum disorders (ASD) hold promise, but the question remains as to whether social humanoid robots could facilitate joint attention performance in children with ASD. In this study, responsive joint attention was measured under two conditions in which different agents, a human and a robot, initiated joint attention via video. The participants were 15 children with ASD (mean age: 4.96 ± 1.10 years) and 15 typically developing (TD) children (mean age: 4.53 ± 0.90 years). In addition to analyses of fixation time and gaze transitions, a longest common subsequence approach (LCS) was employed to compare participants' eye movements to a predefined logical reference sequence. The fixation of TD toward agent's face was earlier and longer than children with ASD. Moreover, TD showed a greater number of gaze transitions between agent's face and target, and higher LCS scores than children with ASD. Both groups showed more interests in the robot's face, but the robot induced a lower proportion of fixation time on the target. Meanwhile participants showed similar gaze transitions and LCS results in both conditions, suggesting that they could follow the logic of the joint attention task induced by the robot as well as human. We have discussed the implications for the effects and applications of social humanoid robots in joint attention interventions.

A Protocol for Transverse Cardiac Slicing and Optical Mapping in Murine Heart

Thin living tissue slices have recently emerged as a new tissue model for cardiac electrophysiological research. Slices can be produced from human cardiac tissue, in addition to small and large mammalian hearts, representing a powerful in vitro model system for preclinical and translational heart research. In the present protocol, we describe a detailed mouse heart transverse slicing and optical imaging methodology. The use of this technology for high-throughput optical imaging allows study of electrophysiology of murine hearts in an organotypic pseudo two-dimensional model. The slices are cut at right angles to the long axis of the heart, permitting robust interrogation of transmembrane potential (Vm) and calcium transients (CaT) throughout the entire heart with exceptional regional precision. This approach enables the use of a series of slices prepared from the ventricles to measure Vm and CaT with high temporal and spatial resolution, allowing (i) comparison of successive slices which form a stack representing the original geometry of the heart; (ii) profiling of transmural and regional gradients in Vm and CaT in the ventricle; (iii) characterization of transmural and regional profiles of action potential and CaT alternans under stress (e.g., high frequency pacing or β-adrenergic stimulation) or pathological conditions (e.g., hypertrophy). Thus, the protocol described here provides a powerful platform for innovative research on electrical and calcium handling heterogeneity within the heart. It can be also combined with optogenetic technology to carry out optical stimulation; aiding studies of cellular Vm and CaT in a cell type specific manner.

Generation of high-power 780 nm femtosecond pulses by an all-polarization-maintaining Er-doped fiber amplification system

A 187 fs pulse laser with 2.3 W of output power at 1560 nm is built for second-harmonic generation (SHG), which is the highest average power output reported from an all-polarization-maintaining single-mode Er-doped chirped pulse amplification system. By subsequently using an MgO-doped periodically poled lithium niobate (MgO:PPLN) crystal as frequency doubler, a 183 fs pulse laser with 1.1 W output power at 778 nm is generated. Benefitting from a polarization-stable fundamental laser input and the temperature control of the PPLN crystal, the power fluctuation of the frequency doubled laser is less than 0.5% during 24 h. To the best of our knowledge, the 1.1 W output at 780 nm band is also the highest average power generated from a frequency doubled femtosecond Er-doped fiber laser.

Deep Learning-Based Automatic Segmentation of Lumbosacral Nerves on CT for Spinal Intervention: A Translational Study

BACKGROUND AND PURPOSE

3D reconstruction of a targeted area ("safe" triangle and Kambin triangle) may benefit the viability assessment of transforaminal epidural steroid injection, especially at the L5/S1 level. However, manual segmentation of lumbosacral nerves for 3D reconstruction is time-consuming. The aim of this study was to investigate the feasibility of deep learning-based segmentation of lumbosacral nerves on CT and the reconstruction of the safe triangle and Kambin triangle.

MATERIALS AND METHODS

A total of 50 cases of spinal CT were manually labeled for lumbosacral nerves and bones using Slicer 4.8. The ratio of training/validation/testing was 32:8:10. A 3D U-Net was adopted to build the model SPINECT for automatic segmentations of lumbosacral structures. The Dice score, pixel accuracy, and Intersection over Union were computed to assess the segmentation performance of SPINECT. The areas of Kambin and safe triangles were measured to validate the 3D reconstruction.

RESULTS

The results revealed successful segmentation of lumbosacral bone and nerve on CT. The average pixel accuracy for bone was 0.940, and for nerve, 0.918. The average Intersection over Union for bone was 0.897 and for nerve, 0.827. The Dice score for bone was 0.945, and for nerve, it was 0.905. There were no significant differences in the quantified Kambin triangle or safe triangle between manually segmented images and automatically segmented images (P > .05).

CONCLUSIONS

Deep learning-based automatic segmentation of lumbosacral structures (nerves and bone) on routine CT is feasible, and SPINECT-based 3D reconstruction of safe and Kambin triangles is also validated.

400 mW narrow linewidth single-frequency fiber ring cavity laser in 2 um waveband

We present a single-frequency thulium-doped fiber laser (TDFL) with a narrow linewidth of 20 kHz. Stable single-longitudinal-mode (SLM) lasing operation at 1957 nm is achieved using a segment of un-pumped polarization-maintaining thulium-doped fiber (PM-TDF) as an ultra-narrow bandwidth filter. A high optical signal-to-noise ratio (OSNR) of over 60 dB is obtained and a high power of over 400 mW is achieved with a high slope-efficiency (~45.8%) thulium-doped fiber amplifier (TDFA).

Miniaturized optical fiber tweezers for cell separation by optical force

In advanced biomedicine and microfluidics, there is a strong desire to sort and manipulate various cells and bacteria based on miniaturized microfluidic chips. Here, by integrating fiber tweezers into a T-type microfluidic channel, we report an optofluidic chip to selectively trap Escherichia coli in human blood solution based on different sizes and shapes. Furthermore, we simulate the trapping and pushing regions of other cells and bacteria, including rod-shaped bacteria, sphere-shaped bacteria, and cancer cells based on finite-difference analysis. With the advantages of controllability, low optical power, and compact construction, the strategy may be possibly applied in the fields of optical separation, cell transportation, and water quality analysis.

Angular-spectrum modeling of focusing light inside scattering media by optical phase conjugation

Focusing light inside scattering media by optical phase conjugation has been intensively investigated due to its potential applications, such as in deep tissue imaging. However, no existing physical models explain the impact of the various factors on the focusing performance inside a dynamic scattering medium. Here, we establish an angular- spectrum model to trace the field propagation during the entire optical phase conjugation process in the presence of scattering media. By incorporating fast decorrelation components, the model enables us to investigate the com- petition between the guide star and fast tissue motions for photon tagging. Other factors affecting the focusing performance are also analyzed via the model. As a proof of concept, we experimentally verify our model in the case of focusing light through dynamic scattering media. This angular-spectrum model allows analysis of a series of scattering events in highly scattering media and benefits related applications.

[Submucosal tunneling endoscopic resection for submucosal tumors originating from muscularis propria layer at esophagogastric junction]

Objective: To evaluate the short-term outcomes and safety of submucosal tunneling endoscopic resection (STER) for submucosal tumors (SMT) originating from muscularis propria (MP) layer at esophagogastric junction. Methods: The clinical data of 31 patients with SMT originating from MP layer at esophagogastric junction underwent STER were collected and retrospectively analyzed. Results: The success rate of STER of the thirty-one patients was 100%. The mean tumor size was (2.5±1.3) cm and the average operative time was (95.9±56.7) min. Perforation occurred in 3 patients and was successfully clipped by endo-clips during operation. One patient developed delayed bleeding and the bleeding was stopped by endoscopic hemostasis. Twenty-nine leiomyomas and two stromal tumors (GIST) were finally pathologically diagnosed. No local recurrence and distant metastasis were noted during the mean 15.4 months follow-up of 20 cases. According to the lesion size, 31 patients who received STER were divided into two groups. The operation time of maximum diameter ≥3.5 cm group was (134.0±70.6) min, significantly longer than (80.3±42.6) min of maximum diameter <3.5 cm group (P=0.014). However, the en bloc removal rate, postoperative hospital stay and the complication incidence between the two groups had no obvious differences (P>0.05). Univariate analysis showed that the piecemeal removal group had longer tumor diameter, higher incidence of irregular tumor morphology, and longer operative time than the en bloc removal group (all P<0.05). Stepwise logistic regression analysis showed that irregular shape was a risk factor for failure of en bloc removal (OR=18.000, 95% CI: 1.885~171.88, P=0.012). Conclusion: As a new method of minimally invasive treatment, STER technology appears to be a safe and effective option for patients with SMT originating from MP layer at esophagogastric junction.

Abstract P4-13-02: Selective androgen receptor modulator RAD140 inhibits the growth of endocrine-resistant breast cancer models with defined genetic backgrounds

Estrogen receptor α-positive (ER+) breast cancer is routinely treated with therapies targeting the ER axis. However, de novo and acquired resistance to the standard-of-care treatment occur in a significant subset of patients. Multiple mechanisms have been proposed for the resistance, among which genetic alterations to the coding gene of ERα, ESR1, have been extensively studied. Notably, ESR1 hotspot mutations within the ligand binding domain (LBD), novel fusion proteins consisting of the N-terminal domain of ER and the C-terminal domain of a partner gene, and ESR1 gene amplification have been found to be enriched in endocrine-resistant, metastatic breast cancers. Together these ER gene alterations present new challenges in the management of ER+ breast cancer and call for the development of new agents to supplement the current standard-of-care. Around 90% of the ER+ breast cancer cases are also androgen receptor (AR) positive (AR+). Mounting preclinical evidence has demonstrated that AR agonists suppress AR and ER positive (AR/ER+) breast cancer cell growth, in line with clinical activity of androgens. We recently reported the oral selective androgen receptor modulator (SARM) RAD140 is a potent, tissue-selective AR agonist in breast cancer cells which significantly inhibited the growth of AR/ER+ patient-derived xenograft (PDX) models, partly via inhibiting ESR1 gene expression and ER signaling. It also elicited enhanced tumor growth inhibition when combined with a CDK4/6 inhibitor.

Here we further examine the activity of RAD140 in AR/ER+ breast cancer models that are endocrine-independent with a spectrum of ESR1 genetic alterations. In PDX models harboring ESR1 amplification or fusion, RAD140 inhibited tumor growth to a greater degree than fulvestrant, a standard-of-care selective ER degrader (SERD). These results are consistent with the clinical history of the donor patients whose diseases relapsed from or progressed rapidly on fulvestrant. In PDX models with ESR1 Y537S mutation, RAD140 showed anti-tumor activity comparable to that of fulvestrant. Notably, RAD140 treatment also led to substantial reduction of proliferation and colony formation in cell line models recapitulating resistance to the combination of estrogen deprivation and CDK4/6 inhibition.

In summary, RAD140 showed marked anti-tumor activity in AR/ER+, endocrine-resistant breast cancer models with defined genetic background. Importantly, in models with ESR1 amplification and fusion, the AR-targeting RAD140 exhibited more profound inhibitory activity compared with fulvestrant. In models with an ESR1 mutation, the efficacy of RAD140 and fulvestrant was comparable. These results lend support to a clinical hypothesis that AR/ER+, endocrine-resistant tumors with these genetic backgrounds may benefit from AR agonist-based treatment. RAD140 is currently being evaluated in hormone receptor positive (HR+) breast cancer patients (NCT03088527).

Citation Format: Yu Z, He S, Miller C, Saeh J, Hattersley G, O'Neill A. Selective androgen receptor modulator RAD140 inhibits the growth of endocrine-resistant breast cancer models with defined genetic backgrounds [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-13-02.

Broadband optical switch for multiple spatial modes based on a silicon densely packed waveguide array

A broadband thermo-optic 2×2 Mach-Zehnder switch that can control two spatial modes simultaneously on a silicon chip is demonstrated in this Letter. A broadband multimode 3 dB coupler is first realized based on symmetrically coupled waveguides with a sub-wavelength structure. The length of the coupler is only 24.2 μm. By employing such a multimode 3 dB coupler together with symmetrical delay arms, an optical switching functionality is realized experimentally with excess losses less than 1.3 dB and crosstalks less than -15  dB over a 60 nm bandwidth for the two spatial modes. An arbitrary splitting ratio at two output ports for the two modes simultaneously is also demonstrated when applying different currents on the heater.

Illusion Optics: Disguising with Ordinary Dielectric Materials

Illusion devices are usually designed using transformation optics. Here, a new method is proposed to achieve optical illusions without external devices by elaborately manipulating the scattering potential of an object. In contrast to the conventional transformation optics method, which completely replaces one object by the image of another object using complementary\restoring media and a superlens, the method described here is more of a cosmetic operation for an object, which modifies the scattering pattern of the object to mimic another object by exchanging their scattering potentials in two symmetrical areas in the wave vector domain. Only positive isotropic nonmagnetic materials are introduced in the present method, which is impossible using the conventional method because superlenses require negative-index materials. Both numerical simulations and experimental demonstrations are used to verify the performance of the illusion devices of this method.

Discrete multitone transmission for underwater optical wireless communication system using probabilistic constellation shaping to approach channel capacity limit

Probabilistic constellation shaping (PCS) is utilized to approach the channel capacity limit in discrete multitone (DMT) transmission for underwater optical wireless communication (UOWC) system. A fixed quadrature amplitude modulation (QAM) format with various probabilistic distributions is individually allocated for different subcarriers to obtain achievable maximum channel capacity in accordance with the pre-estimated signal-to-noise ratio. By using a 450-nm directly modulated laser diode (LD) with an available modulation bandwidth of ∼2.75  GHz, DMT with PCS technique is experimentally realized with a net data rate of 18.09 Gbit/s over 5 m, 17.21 Gbit/s over 25 m, and 12.62 Gbit/s over 35 m underwater transmission, giving substantial capacity improvement of 32.22%, 30.03%, and 27.55%, respectively, in comparison with the widely used regular QAM formats in DMT with bit-power loading scheme. The figure of merit of the UOWC system in terms of entropy, generalized mutual information (GMI), and normalized GMI are also presented. To the best of our knowledge, this is the first time to employ PCS-QAM-DMT in a UOWC system, and it is also the highest data rate ever reported for a single LD in UOWC.

Upconversion enhancement by a dual-resonance all-dielectric metasurface

Upconversion nanoparticles (UCNPs) have drawn much attention in the past decade due to their superior physicochemical features and great potential in biomedical and biophotonic studies. However, their low luminescence efficiency often limits their applications. Here, we demonstrated a dual-resonance all-dielectric metasurface to enhance the signals emitted by upconversion nanoparticles (NaYF4:Yb/Tm). An averaged upconversion signal enhancement of around 400 times is detected experimentally. The electric and magnetic dipole resonances of the metasurface are designed to enhance the local excitation field and the quantum efficiency of the upconversion nanoparticles, respectively. Furthermore, the collection efficiency is enhanced due to the directional emission of the UCNPs on the metasurface. Our approach provides a powerful tool to extend the sensing application potential of upconversion nanoparticles.

An Ethanol Vapor Sensor Based on a Microfiber with a Quantum-Dot Gel Coating

An ethanol vapor sensor based on a microfiber with a quantum-dot (QD) gel coating is proposed and demonstrated. The QD gel was made from UV glue as the gel matrix and CdSe/ZnS QDs with a concentration of 1 mg/mL. The drawing and coating processes were conducted by using a simple and low-cost system developed for this study. Bending, ethanol sensing, temperature response, and time response tests were carried out, respectively. The experimental results showed that the fabricated sensor had a high sensitivity of −3.3%/ppm, a very low temperature cross-sensitivity of 0.17 ppm/°C, and a fast response time of 1.1 s. The easily fabricated robust structure and the excellent sensing performance render the sensor a promising platform for real ethanol sensing applications.

Negative Association of Serum URIC Acid with Peripheral Blood Cellular Aging Markers

OBJECTIVES

We aimed to explore the association between serum UA and cellular aging markers.

DESIGN

The current cross-sectional analysis was based on data collected within a type 2 diabetes project.

SETTINGS

Serum uric acid (UA), which has both antioxidant and pro-oxidant properties, is thought to be involved in cellular aging processes.

PARTICIPANTS

There are 536 participants included in total, 65.3% of which are women. The average serum UA in women was 267.8 umol/l, lower than in men of 337.7 umol/l (P<0.001).

MEASUREMENTS

Serum UA, blood lipid profile, HbA1c, plasma glucose and insulin were determined. The peripheral blood leukocyte telomere length (LTL) and mitochondrial DNA copy number (mtDNAcn) were assessed using a real-time PCR assay. Logistic regressions were used to analyze the associations between serum UA and cellular aging markers.

RESULTS

In Spearman's correlation analysis, there were significantly negative correlations between serum UA and LTL in both women and men (r=-0.162, P=0.006; and r=-0.232, P=0.004, respectively). The logistic regression adjusted for age, BMI, WC, daily energy intake, HbA1c, TG, and LDL-C revealed that the ORs of shorter LTL comparing the extreme serum UA quintiles was 5.52 (95% CI 1.69-18.02; P for trend =0.025) in women and 6.49 (95% CI 1.38-30.45; P for trend =0.108) in men. Furthermore, the OR (95% CI) for shorter LTL per 1 SD increment in serum UA was 1.51(1.10-2.07) in women and 1.64(1.01-2.65) in men. In regard to mtDNAcn, the association between elevated serum UA and lower mtDNAcn only reached significance in men when comparing the second and fifth quintiles with reference quintile (OR=3.73(1.07-13.04) and 3.76(1.01-14.09) , separately, and P for trend=0.066).

CONCLUSIONS

Our results indicate a significant negative association between serum UA and peripheral blood cellular aging markers. Serum UA might play a role in promoting cellular aging.

SHG-enhanced NIR-excited in vitro photodynamic therapy using composite nanoparticles of barium titanate and rose Bengal

Near infrared (NIR) light excited photodynamic therapy (PDT) has been considered as a possible way to increase the therapy depth. Besides the traditional two-photon excited PDT and upconversion PDT by rare-earth ion materials, SHG has drawn much attention recently to act as an additional choice to achieve NIR light excited PDT. Herein, by using the electrostatic absorption method, barium titanate and rose Bengal composite nanoparticles (BT@PAH/RB/PAH, BT–RB) were synthesized. Compared with rose Bengal (RB) molecules and a mixture of barium titanate nanoparticles and RB (BT + RB), BT–RB nanoparticles were shown to be able to produce more reactive oxygen species (ROS) ex vivo and in vitro. Afterwards, the SHG-enhanced localized PDT was applied on Hela cells, in which BT–RB nanoparticles showed a better performance than BT + RB. Our work has shown that the SHG-enhanced PDT has good prospects and the close combination of harmonic nanoparticles and photosensitizers may facilitate the development of novel reagents for NIR light excited PDT.

Composite nanoparticles of barium titanate and rose Bengal are used to achieve second harmonic generation (SHG) enhanced photodynamic therapy excited by near infrared (NIR) light.

High throughput trapping and arrangement of biological cells using self-assembled optical tweezer

Lately, a fiber-based optical tweezer that traps and arranges the micro/nano-particles is crucial in practical applications, because such a device can trap the biological samples and drive them to the designated position in a microfluidic system or vessel without harming them. Here, we report a new type of fiber optical tweezer, which can trap and arrange erythrocytes. It is prepared by coating graphene on the cross section of a microfiber. Our results demonstrate that thermal-gradient-induced natural convection flow and thermophoresis can trap the erythrocytes under low incident power, and the optical scattering force can arrange them precisely under higher incident power. The proposed optical tweezer has high flexibility, easy fabrication, and high integration with lab-on-a-chip, and shows considerable potential for application in various fields, such as biophysics, biochemistry, and life sciences.

16.6 Gbps data rate for underwater wireless optical transmission with single laser diode achieved with discrete multi-tone and post nonlinear equalization

In this paper, we experimentally demonstrate a 450-nm laser underwater wireless optical transmission system by using adaptive bit-power loading discrete multi-tone (DMT) and Volterra series based post nonlinear equalization. Post nonlinear equalization mitigates the nonlinear impairment of the UWOC system. By incorporating post nonlinear equalization with a 3rd-order diagonal plane kernel, the received signal-to-noise ratio (SNR) can be improved by ~2 dB compared with a linear equalization method. The measured transmission capacity of the UWOC system is 16.6 Gbps over 5 m, 13.2 Gbps over 35 m, and 6.6 Gbps over 55 m tap water channel, with bit error rates (BERs) below the standard hard-decision forward error correction (HD-FEC) limit of 3.8 × 10^-3. The used electrical signal bandwidth is 2.75 GHz, corresponding to electrical spectrum efficiency of ∼6 bit/s/Hz. The distance-datarate product reaches 462 Gbps*m at 35 m tap water transmission. To the best of our knowledge, both the data rate and distance-data rate product are the largest reported for single laser diode.

[Resting metabolic rate estimated by bioelectrical impedance analysis and its determinants in maintenance hemodialysis patients]

Objective: To explore the level of resting energy expenditure (REE) estimated by bioelectrical impedance analysis and the association of resting metabolic rate (RMR) with clinical related factors, and provide new ideas for improving protein energy wasting (PEW) in maintenance hemodialysis (MHD) patients. Methods: Seven hundred and sixty-five subjects receiving MHD between July 2015 and September 2016 in 11 hemodialysis centers in Guizhou province were enrolled in this cross-sectional study. Bioelectrical impedance analysis was used to measure RMR and body composition, such as lean body mass, fat mass and body cell mass (BCM). Baseline characteristics, routine blood test indexes and biochemical data of hemodialysis patients were collected. The level of RMR and body composition in hemodialysis patients was compared by gender grouping. Then the patients were divided into four groups according to the cutoff value of RMR quartile. Spearman correlation analysis and multiple linear regression analysis were used to analyze the relationships between RMR and clinical related factors. Results: The average age of MHD patients was (54.96±15.78) years and the duriation of dialysis was (42.3±9.0) months. The level of RMR in male patients (474 cases, 61.96%) was significantly higher than that in female patients [1 591(1 444, 1 764) kcal/d vs 1 226 (1 104, 1 354) kcal/d, P<0.001]. However, this significant difference of RMR between different genders disappeared after adjusting for lean body mass (P=0.193). Multiple linear regression analysis showed that RMR was positively correlated with body surface area (β=0.817) and lactate dehydrogenase (LDH) (β=0.198), and negatively correlated with age (β=-0.141), all P<0.05. Conclusion: RMR levels in patients with maintenance hemodialysis are associated with lactate dehydrogenase level, which may become a new index to evaluate energy consumption.

[The application of cineMRI in evaluation of upper airway obstruction levels in complicated pediatric OSAS]

Objective:The aim of this study is to explore the role of cineMRI in the localization of upper airway obstruction in complicated pediatric OSAS. Method:Eleven persistent OSAS and 11 complex OSAS patients underwent cineMRI. Each patient was imaged midline sagittal and axial magnetic resonance cine image. The obtained sagittal and axial images were displayed in cine format, creating a real time "movie" of airway motion, to make a personalized treatment for each child. Polysomnography was performed to evaluate the effectiveness of cineMRI directed treatment for pediatric OSAS. Result:cineMRI could effectively define the upper airway obstruction level. There was a significant improvement in AHI (P=0.019) and saturation nadir (P<0.01). Conclusion:cineMRI is an effective method for assessing the level of airway obstruction on persistent or complex pediatric OSAS.