Sudomotor dysfunction is associated with impaired left ventricular diastolic function in persons with type 2 diabetes: a cross-sectional study

BACKGROUND

The incidence of preserved ejection fraction heart failure has significantly increased in persons with type 2 diabetes mellitus (T2DM). Left ventricular (LV) diastolic dysfunction is an early and important manifestation of preserved ejection fraction heart failure. The onset of heart failure in persons with diabetes is associated with diabetic neuropathy. However, the relationship among sudomotor function, which is an early manifestation of small fiber neuropathy, and LV diastolic function remains unclear. This study aimed to explore the association between sudomotor function and LV diastolic function in persons with T2DM.

METHODS

In total, 699 persons with T2DM were enrolled and divided into three groups according to electrochemical skin conductance (ESC) assessed using the SUDOSCAN device: "no dysfunction" group (NSF), "moderate dysfunction" group (MDF), and "severe dysfunction" group (SDF). LV diastolic function was assessed using Doppler echocardiography. To evaluate the relationship between ESC and echocardiographic parameters, Pearson's correlation analysis was performed. Additionally, logistic regression analysis was used to determine the association between LV diastolic function and ESC. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of sudomotor function indicators in detecting impaired cardiac diastolic function.

RESULTS

There were 301 persons (43.06%) in the NSF group, 232 (33.19%) in the MDF group, and 166 (23.75%) in the SDF group. Compared to the NSF group, the MDF and SDF groups had higher A and E/e' and lower e' values (all p < 0.05). Pearson's correlation analysis showed that A and E/e' were negatively associated with foot ESC (FESC) and hand ESC (HESC), whereas e' was positively associated with FESC and HESC (all p < 0.05). After adjusting for confounding factors, binary logistic regression analysis showed that ESC was independently associated with impaired LV diastolic function (p = 0.003). The area under the ROC curve values for FESC and HESC were 0.621 and 0.635, respectively (both p < 0.05).

CONCLUSIONS

Deteriorating sudomotor function was associated with reduced diastolic function indicators. ESC can be used as a biomarker for detecting LV diastolic impairment.

Timing of first abdominal operation in Crohn's disease based on a diagnostic model

This study aims to develop a clinical diagnostic model for assessing the need for initial abdominal surgery in patients diagnosed with Crohn's disease (CD) and create a nomogram to facilitate clinical decision-making. A total of 164 surgical CD patients and 230 control CD patients were included in this retrospective analysis. Least Absolute Shrinkage and Selection Operator (Lasso) regression and binomial logistic regression were employed to select clinical variables. The 394 CD patients were randomly allocated to a training set and a validation set in a 7:3 ratio. The filtered variables were used to establish a diagnostic model and nomogram in the training set, subsequently validated in the testing set. Decision Curve Analysis (DCA) and clinical impact curve were constructed to validate the clinical applicability of the model. Binomial logistic regression analysis identified seven clinical variables with a p-value less than 0.01, including Biomarker (B), Waist-to-Height Ratio (WHtR), Intestinal obstruction, Albumin (ALB), Crohn's Disease Activity Index (CDAI), Myocardial Flow Index (MFI), and C-reactive protein (CRP). These variables were utilized to establish the diagnostic model. Calibration curves showed good alignment, with a C-index of 0.996 in the training set and 0.990 in the testing set. DCA and clinical impact curve demonstrated that the diagnostic model had good clinical efficiency and could provide clinical benefits. A validated diagnostic model for determining the timing of the first abdominal operation in CD patients was established and evaluated, showing high discriminative ability, calibration, and clinical efficiency. It can be utilized by clinicians to assess the optimal timing for transitioning CD patients from medical treatment to surgical intervention, providing valuable references for individualized treatment decisions for CD patients.

The effect of curcumin on on intravitreal proinflammatory cytokines, oxidative stress markers, and vascular endothelial growth factor in an experimental model of diabetic retinopathy

The prevalence of diabetic retinopathy (DR) is high among individuals with diabetes. Curcumin (CUR) has been suggested as a possible treatment for this condition. This study aimed to investigate the impact of CUR on pro-inflammatory cytokines, oxidative stress markers, and vascular endothelial growth factor (VEGF) in an experimental model of DR. The study used Spontaneously Diabetic Torii (SDT) rats and divided them into groups to receive various CUR doses (10, 50, 100 mg/kg/day) or distilled water for four weeks. Non-diabetic Sprague-Dawley (SD) rats were used as a control group. Pro-inflammatory cytokines (interleukin (IL)-1, IL-6, tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ)) (by ELISA), oxidative stress markers (superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GPX), catalase (CAT)), and VEGF expression (by RT-PCR) and content (by Western-blot and immunostaining) were assessed as outcome measures. The study found that diabetic rats who received varying doses of CUR showed a decrease in pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1), oxidative stress markers (SOD, MDA, GPX, CAT), and VEGF expression and content in the vitreous. The decrease in these markers was dose-dependent and significantly different from diabetic rats who did not receive CUR (p<0.01). However, there was no significant difference in the vitreous level of IL-6 between the groups (p=0.35). The study concluded that CUR has the potential to alleviate inflammation and oxidative stress induced by diabetes in the vitreous microenvironment of rats. CUR also reduced the increase in VEGF levels in the vitreous of diabetic rats. These findings suggest that CUR could be a viable therapeutic option for the treatment of DR.

[Pelvic exenteration for late complications of radiation-induced pelvic injury: a preliminary study]

Objective: To investigate the safety and efficacy of total pelvic exenteration (TPE) for treating late complications of radiation-induced pelvic injury. Methods: This was a descriptive case series study. The inclusion criteria were as follows: (1) confirmed radiation-induced pelvic injury after radiotherapy for pelvic malignancies; (2) late complications of radiation-induced pelvic injury, such as bleeding, perforation, fistula, and obstruction, involving multiple pelvic organs; (3) TPE recommended by a multidisciplinary team; (4) patient in good preoperative condition and considered fit enough to tolerate TPE; and (5) patient extremely willing to undergo the procedure and accept the associated risks. The exclusion criteria were as follows: (1) preoperative or intraoperative diagnosis of tumor recurrence or metastasis; (2) had only undergone diversion or bypass surgery after laparoscopic exploration; and (3) incomplete medical records. Clinical and follow-up data of patients who had undergone TPE for late complications of radiation-induced pelvic injury between March 2020 and September 2022 at the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed. Perioperative recovery, postoperative complications, perioperative deaths, and quality of life 1 year postoperatively were recorded. Results: The study cohort comprised 14 women, nine of whom had recto-vagino-vesical fistulas, two vesicovaginal fistulas, one ileo-vesical fistula and rectal necrosis, one ileo-vesical and rectovaginal fistulas, and one rectal ulcer and bilateral ureteral stenosis. The mean duration of surgery was 592.1±167.6 minutes and the median blood loss 550 (100-6000) mL. Ten patients underwent intestinal reconstruction, and four the Hartmann procedure. Ten patients underwent urinary reconstruction using Bricker's procedure and 7 underwent pelvic floor reconstruction. The mean postoperative hospital stay was 23.6±14.9 days. Seven patients (7/14) had serious postoperative complications (Clavien-Dindo IIIa to IVb), including surgical site infections in eight, abdominopelvic abscesses in five, pulmonary infections in five, intestinal obstruction in four, and urinary leakage in two. Empty pelvis syndrome (EPS) was diagnosed in five patients, none of whom had undergone pelvic floor reconstruction. Five of the seven patients who had not undergone pelvic floor reconstruction developed EPS, compared with none of those who had undergone pelvic floor reconstruction. One patient with EPS underwent reoperation because of a pelvic abscess, pelvic hemorrhage, and intestinal obstruction. There were no perioperative deaths. During 18.9±10.1 months of follow-up, three patients died, two of renal failure, which was a preoperative comorbidity, and one of COVID-19. The remaining patients had gradual and significant relief of symptoms during follow-up. QLQ-C30 assessment of postoperative quality of life showed gradual improvement in all functional domains and general health at 1, 3, and 6 months postoperatively (all P<0.05). Conclusions: TPE is a feasible procedure for treating late complications of radiation-induced pelvic injury combined with complex pelvic fistulas. TPE is effective in alleviating symptoms and improving quality of life. However, the indications for this procedure should be strictly controlled and the surgery carried out only by experienced surgeons.

Quantitative analysis of adipose tissue for predicting Crohn's disease postoperative endoscopic recurrence and anastomotic ulcer

OBJECTIVE

Inflammation and ulcers at the anastomotic site are frequently observed after intestinal resection surgery for Crohn's disease (CD), which often signify postoperative recurrence. Crohn's disease causes abnormalities in whole-body fat metabolism, and alterations in subcutaneous and visceral fat are potential indicators of disease development. This study aimed to quantify the areas of subcutaneous (SFA) and visceral fat (VFA) and investigate the relationship between fat tissue and endoscopic recurrence and anastomotic ulceration after Crohn's disease surgery.

METHODS

We conducted a retrospective analysis of clinical data from 279 patients diagnosed with Crohn's disease. Using abdominal CT (Computed Tomography) scans at the level of the umbilicus, we measured the area of subcutaneous and visceral fat, and calculated the Mesenteric Fat Index (MFI), which is defined as the ratio of the area of visceral fat to subcutaneous fat. We compared the changes in fat tissue between surgical Crohn's disease patients and non-surgical patients in remission, as well as changes in fat tissue before and after surgery, and between patients with and without endoscopic recurrence after surgery.

RESULTS

The MFI value of the surgical group was higher than that of the non-surgical group(0.88(1.27 ± 1.26) VS 0.39(0.44 ± 0.21), P < 0.001), while the SFA value was lower(70.16(92.97 ± 78.23) VS 157.64(175.96 ± 101.58), P < 0.001). Of the 134 surgical patients who underwent abdominal CT examination after surgery, the SFA value was significantly higher after surgery(143.61 ± 81.86 VS 90.87 ± 71.93, P < 0.001), and the MFI value decreased accordingly(0.57 ± 0.36 VS 1.30 ± 1.35, P < 0.001). Multivariate Cox analysis indicated that high VFA and MFI values, smoking history, and preoperative biologic therapy were all risk factors for postoperative endoscopic recurrence(p < 0.05), while high MFI values and preoperative biologic therapy were also risk factors for anastomotic ulcers(p < 0.05). The Kaplan-Meier analysis showed that these factors increased the risk of reaching the endpoint with time(p < 0.05). The ROC curve results showed that MFI value had high diagnostic value for postoperative endoscopic recurrence [AUC:0.831, 95% CI: 0.75-0.91, p < 0.001] and anastomotic ulcers [AUC:0.801, 95% CI: 0.71-0.89, p < 0.001].

CONCLUSIONS

Surgical CD patients have significantly higher MFI values but the values decline after surgery. When the preoperative MFI value is > 0.82, the risk of postoperative endoscopic recurrence increases significantly, and when the MFI value is ≥ 1.10, the risk of anastomotic ulceration after surgery increases significantly. Meanwhile, biologic therapy preoperatively also is a high-risk factor for early postoperative endoscopic recurrence or anastomotic ulcers after intestinal resection surgery.

[Observational study on perioperative outcomes of pelvic exenteration]

Objective: To investigate the surgical indications and perioperative clinical outcomes of pelvic exenteration (PE) for locally advanced, recurrent pelvic malignancies and complex pelvic fistulas. Methods: This was a descriptive study.The indications for performing PE were: (1) locally advanced, recurrent pelvic malignancy or complex pelvic fistula diagnosed preoperatively by imaging and pathological examination of a biopsy; (2)preoperative agreement by a multi-disciplinary team that non-surgical and conventional surgical treatment had failed and PE was required; and (3) findings on intraoperative exploration confirming this conclusion.Contraindications to this surgical procedure comprised cardiac and respiratory dysfunction, poor nutritional status,and mental state too poor to tolerate the procedure.Clinical data of 141 patients who met the above criteria, had undergone PE in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to September 2022, had complete perioperative clinical data, and had given written informed consent to the procedure were collected,and the operation,relevant perioperative variables, postoperative pathological findings (curative resection), and early postoperative complications were analyzed. Results: Of the 141 included patients, 43 (30.5%) had primary malignancies, 61 (43.3%) recurrent malignancies, 28 (19.9%) complex fistulas after radical resection of malignancies,and nine (6.4%)complex fistulas caused by benign disease. There were 79 cases (56.0%) of gastrointestinal tumors, 30 cases (21.3%) of reproductive tumors, 16 cases (11.3%) of urinary tumors, and 7 cases (5.0%) of other tumors such mesenchymal tissue tumors. Among the 104 patients with primary and recurrent malignancies, 15 patients with severe complications of pelvic perineum of advanced tumors were planned to undergo palliative PE surgery for symptom relief after preoperative assessment of multidisciplinary team; the other 89 patients were evaluated for radical PE surgery. All surgeries were successfully completed. Total PE was performed on 73 patients (51.8%),anterior PE on 22 (15.6%),and posterior PE in 46 (32.6%). The median operative time was 576 (453,679) minutes, median intraoperative blood loss 500 (200, 1 200) ml, and median hospital stay 17 (13.0,30.5)days.There were no intraoperative deaths. Of the 89 patients evaluated for radical PE surgery, the radical R0 resection was achieved in 64 (71.9%) of them, R1 resection in 23 (25.8%), and R2 resection in two (2.2%). One or more postoperative complications occurred in 85 cases (60.3%), 32 (22.7%)of which were Clavien-Dindo grade III and above.One patient (0.7%)died during the perioperative period. Conclusion: PE is a valid option for treating locally advanced or recurrent pelvic malignancies and complex pelvic fistulas.

Effect of bulky anions on the liquid-liquid phase transition in phosphonium ionic liquids: Ambient and high-pressure dielectric studies

Although the first-order liquid-liquid phase transition (LLT) has been reported to exist in various systems (i.e., phosphorus, silicon, water, triphenyl phosphite, etc.), it is still one of the most challenging problems in the field of physical science. Recently, we found that this phenomenon occurs in the family of trihexyl(tetradecyl)phosphonium [P_666,14]⁺ based ionic liquids (ILs) with different anions (Wojnarowska et al in Nat Commun 13:1342, 2022). To understand the molecular structure-property relationships governing LLT, herein, we examine ion dynamics of two other quaternary phosphonium ILs containing long alkyl chains in cation and anion. We found that IL with the anion containing branched -O-(CH₂)₅-CH₃ side chains does not reveal any signs of LLT, while IL with shorter alkyl chains in the anion brings a hidden LLT, i.e., it overlaps with the liquid-glass transition. Ambient pressure dielectric and viscosity measurements revealed a peculiar behavior of ion dynamics near T_g for IL with hidden LLT. Moreover, high-pressure studies have shown that IL with hidden LLT has relatively strong pressure sensitivity compared to the one without first-order phase transition. At the same time, the former exposes the inflection point indicating the concave-convex character of logτ_σ(P) dependences.

Cardiovascular magnetic resonance myocardial feature tracking for the determination of left atrial strain in hypertensive left ventricular hypertrophy and hypertrophic cardiomyopathy

AIM

To measure the left atrial (LA) function in patients with hypertrophic cardiomyopathy (HCM; with [OHCM] and without obstruction [NOHCM]) and hypertension-related left ventricular hypertrophy (H-LVH) using cardiovascular magnetic resonance imaging feature tracking (CMR-FT).

MATERIALS AND METHODS

Patients who met the criteria for HCM (n=68), H-LVH (n=46), and 30 healthy controls participated. Left atrial strain was analysed using CMR-FT in cine images with two and four chambers.

RESULTS

The strain rate and LA strain measurements showed that patients with HCM, and H-LVH had impaired conduit and reservoir functions (versus controls). These capacities were more severely impaired in OHCM than those seen in NOHCM and H-LVH. The LA volume parameters (LAVIpac, LAVImin and LAVImax) from the OHCM group were higher than both the NOHCM and H-LVH groups (all p<0.05). There were differences between the OHCM and H-LVH groups in terms of the parameters for LA reservoir function (εs), booster pump function (SRa), and conduit function (SRe, LA passive EF, εe; p<0.05). The strongest correlations included the associations between LA total EF and εs, εe and LA passive EF, and SRe and LA passive EF.

CONCLUSION

CMR-FT can reliably identify LA dysfunction and deformation in the early stages of HCM and H-LVH.

SOX2 como posible biomarcador pronóstico y diana molecular en el cáncer de pulmón: metaanálisis

OBJECTIVE

To determine the association of SOX2 with the prognosis in lung cancer, studies providing survival information were selected based on multivariate Cox regression analysis.

MATERIAL AND METHODS

PubMed, Embase, and Web of Science databases were searched to identify eligible studies before June 19, 2021. The hazard ratios (HR) with 95% confidence intervals (CI) were calculated to assess the prognostic impact of SOX2 based on multivariate Cox regression analysis. Publication bias was used to assess the risk of bias. Functional analysis of SOX2 was also conducted.

RESULTS

13 studies with a total of 2008 patients with lung cancer were included. SOX2 expression was not correlated with overall survival in lung cancer (10 studies with 1591 cases). Between-study heterogeneity was noted (I²=85.6%, p<0.0001). Subgroup analysis suggested that no correlation was found between SOX2 expression and overall survival in non-small cell lung cancer (NSCLC: eight studies with 1319 cases) and small-cell lung cancer (SCLC: two studies with 272 cases). SOX2 expression was significantly associated with worse time-to-progression (two studies with 104 cases: HR=3.50, 95% CI=1.34-9.15) and recurrence-free survival (two studies with 335 cases: HR=1.45, 95% CI=1.12-1.87) in NSCLC. Function analysis demonstrated that SOX2 was involved in DNA repair, cell cycle, regulation of stem cell population maintenance, and Hippo signaling pathway.

CONCLUSION

SOX2 may be an independent prognostic factor in time-to-progression and recurrence-free survival and may become a promising therapeutic target. More studies are essential to further our findings.

[Research advances on the construction of an ideal scar model in vitro based on innovative tissue engineering technology]

The scar brings a huge economic burden and creates a serious psychological shadow for patients. Although the current methods for scar treatment tend to be diversified, the treatment method that can truly achieve the goal of "perfect healing" or "scarless healing" after human skin injury is quite scarce. With the wide application of tissue engineering technologies in medicine research, technologies such as three-dimensional bioprinting, organoid culture, and organ chip technologies are constantly emerging. Disease models in vitro based on these innovative technologies showed more advantages than traditional animal disease models. The article introduces the current hotspot technologies in skin tissue engineering such as organoid culture, three-dimensional bioprinting, and organ chip technologies, focuses on summarizing the three key elements to be mastered for constructing an ideal scar model in vitro, and puts forward the future prospect of constructing an ideal scar model in vitro based on our research team's long-term experience in skin tissue repair and regeneration research.

[Effects of in situ cross-linked graphene oxide-containing gelatin methacrylate anhydride hydrogel on wound vascularization of full-thickness skin defect in mice]

Objective: To prepare graphene oxide (GO)-containing gelatin methacrylate anhydride (GelMA) hydrogel and to investigate the effects of in situ photopolymerized GO-GelMA composite hydrogel in wound vascularization of full-thickness skin defect in mice. Methods: The experimental study method was used. The 50 μL of 0.2 mg/mL GO solution was evenly applied onto the conductive gel, and the structure and size of GO were observed under field emission scanning electron microscope after drying. Human skin fibroblasts (HSFs) were divided into 0 μg/mL GO (without GO solution, the same as below) group, 0.1 μg/mL GO group, 1.0 μg/mL GO group, 5.0 μg/mL GO group, and 10.0 μg/mL GO group treated with GO of the corresponding final mass concentration, and the absorbance value was detected using a microplate analyzer after 48 h of culture to reflect the proliferation activity of cells (n=6). HSFs and human umbilical vein vascular endothelial cells (HUVECs) were divided into 0 μg/mL GO group, 0.1 μg/mL GO group, 1.0 μg/mL GO group, and 5.0 μg/mL GO group treated with GO of the corresponding final mass concentration, and the migration rates of HSFs at 24 and 36 h after scratching (n=5) and HUVECs at 12 h after scratching (n=3) were detected by scratch test, and the level of vascular endothelial growth factor (VEGF) secreted by HSFs after 4, 6, and 8 h of culture was detected by enzyme-linked immunosorbent assay method (n=3). The prepared GO-GelMA composite hydrogels containing GO of the corresponding final mass concentration were set as 0 μg/mL GO composite hydrogel group, 0.1 μg/mL GO composite hydrogel group, 1.0 μg/mL GO composite hydrogel group, and 5.0 μg/mL GO composite hydrogel group to observe their properties before and after cross-linking, and to detect the release of GO after soaking with phosphate buffer solution for 3 and 7 d (n=3). The full-thickness skin defect wounds were made on the back of 16 6-week-old female C57BL/6 mice. The mice treated with in situ cross-linked GO-GelMA composite hydrogel containing GO of the corresponding final mass concentration were divided into 0 μg/mL GO composite hydrogel group, 0.1 μg/mL GO composite hydrogel group, 1.0 μg/mL GO composite hydrogel group, and 5.0 μg/mL GO composite hydrogel group according to the random number table, with 4 mice in each group. The general condition of wound was observed and the wound healing rate was calculated on 3, 7, and 14 d of treatment, the wound blood perfusion was detected by laser Doppler flowmetry on 3, 7, and 14 d of treatment and the mean perfusion unit (MPU) ratio was calculated, and the wound vascularization on 7 d of treatment was observed after hematoxylin-eosin staining and the vascular density was calculated (n=3). The wound tissue of mice in 0 μg/mL GO composite hydrogel group and 0.1 μg/mL GO composite hydrogel group on 7 d of treatment was collected to observe the relationship between the distribution of GO and neovascularization by hematoxylin-eosin staining (n=3) and the expression of VEGF by immunohistochemical staining. Data were statistically analyzed with analysis of variance for repeated measurement, one-way analysis of variance, and Tukey's method. Results: GO had a multilayered lamellar structure with the width of about 20 μm and the length of about 50 μm. The absorbance value of HSFs in 10.0 μg/mL GO group was significantly lower than that in 0 μg/mL GO group after 48 h of culture (q=7.64, P<0.01). At 24 h after scratching, the migration rates of HSFs were similar in the four groups (P>0.05); at 36 h after scratching, the migration rate of HSFs in 0.1 μg/mL GO group was significantly higher than that in 0 μg/mL GO group, 1.0 μg/mL GO group, and 5.0 μg/mL GO group (with q values of 7.48, 10.81, and 10.20, respectively, P<0.01). At 12 h after scratching, the migration rate of HUVECs in 0.1 μg/mL GO group was significantly higher than that in 0 μg/mL GO group, 1.0 μg/mL GO group, and 5.0 μg/mL GO group (with q values of 7.11, 8.99, and 14.92, respectively, P<0.01), and the migration rate of HUVECs in 5.0 μg/mL GO group was significantly lower than that in 0 μg/mL GO group and 1.0 μg/mL GO group (with q values of 7.81 and 5.33, respectively, P<0.05 or P<0.01 ). At 4 and 6 h of culture, the VEGF expressions of HSFs in the four groups were similar (P>0.05); at 8 h of culture, the VEGF expression of HSFs in 0.1 μg/mL GO group was significantly higher than that in 0 μg/mL GO group and 5.0 μg/mL GO group (with q values of 4.75 and 4.48, respectively, P<0.05). The GO-GelMA composite hydrogels in the four groups were all red liquid before cross-linking, which turned to light yellow gel after cross-linking, with no significant difference in fluidity. The GO in the GO-GelMA composite hydrogel of 0 μg/mL GO composite hydrogel group had no release of GO at all time points; the GO in the GO-GelMA composite hydrogels of the other 3 groups was partially released on 3 d of soaking, and all the GO was released on 7 d of soaking. From 3 to 14 d of treatment, the wounds of mice in the 4 groups were covered with hydrogel dressings, kept moist, and gradually healed. On 3, 7, and 14 d of treatment, the wound healing rates of mice in the four groups were similar (P>0.05). On 3 d of treatment, the MPU ratio of wound of mice in 0.1 μg/mL GO composite hydrogel group was significantly higher than that in 0 μg/mL GO composite hydrogel group, 1.0 μg/mL GO composite hydrogel group, and 5.0 μg/mL GO composite hydrogel group (with q values of 10.70, 11.83, and 10.65, respectively, P<0.05 or P<0.01). On 7 and 14 d of treatment, the MPU ratios of wound of mice in the four groups were similar (P>0.05). The MPU ratio of wound of mice in 0.1 μg/mL GO composite hydrogel group on 7 d of treatment was significantly lower than that on 3 d of treatment (q=14.38, P<0.05), and that on 14 d of treatment was significantly lower than that on 7 d of treatment (q=27.78, P<0.01). On 7 d of treatment, the neovascular density of wound of mice on 7 d of treatment was 120.7±4.1 per 200 times of visual field, which was significantly higher than 61.7±1.3, 77.7±10.2, and 99.0±7.9 per 200 times of visual field in 0 μg/mL GO composite hydrogel group, 1.0 μg/mL GO composite hydrogel group, and 5.0 μg/mL GO composite hydrogel group (with q values of 12.88, 7.79, and 6.70, respectively, P<0.01), and the neovascular density of wound of mice in 1.0 μg/mL GO composite hydrogel group and 5.0 μg/mL GO composite hydrogel group was significantly higher than that in 0 μg/mL GO composite hydrogel group (with q values of 5.10 and 6.19, respectively, P<0.05). On 7 d of treatment, cluster of new blood vessels in wound of mice in 0.1 μg/mL GO composite hydrogel group was significantly more than that in 0 μg/mL GO composite hydrogel group, and the new blood vessels were clustered near the GO; a large amount of VEGF was expressed in wound of mice in 0.1 μg/mL GO composite hydrogel group in the distribution area of GO and new blood vessels. Conclusions: GO with mass concentration lower than 10.0 μg/mL had no adverse effect on proliferation activity of HSFs, and GO of 0.1 μg/mL can promote the migration of HSFs and HUVECs, and can promote the secretion of VEGF in HSFs. In situ photopolymerized of GO-GelMA composite hydrogel dressing can promote the wound neovascularization of full-thickness skin defect in mice and increase wound blood perfusion in the early stage, with GO showing an enrichment effect on angiogenesis, and the mechanism may be related to the role of GO in promoting the secretion of VEGF by wound cells.

E2F7/8 is involved in cardiomyocyte polyploidy but does not affect myocardial reperfusion injury recovery

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): CSC fellowship

Background

Polyploidy cells consist of more than two complete sets of homologous chromosomes. Although a characteristic feature of cardiomyocytes and observed in all mammalian species, its molecular mechanism and biological functions are still unknown. Cardiomyocytes polyploidy in rodents occurs mainly through incomplete cytokinesis and increases with age. Studies have demonstrated that E2F7/8 transcription factors are key regulators of polyploidy in the liver and pancreas, however, it remains unclear if E2F7/8 control the generation of polyploidy cardiomyocytes and what the functional consequence is post-myocardial infarction (MI).

Methods

By using a tamoxifen inducible Cre/LoxP approach in new-born mice, we deleted E2F7/8 transcription factors ubiquitously and evaluated the biological significance of postnatal E2F7/8 loss. Mice underwent myocardial ischemia reperfusion injury (IRI) and heart function was assessed by 4D-echocardiography. Cardiomyocyte nucleus polyploidy was measured by FACS and microscope.

Results

Deficiency of E2F7/8 significantly suppress cardiomyocyte mononucleated and multinucleated polyploidy, as well as dramatically decreased hepatocytes polyploidy. E2F7/8 defect also led to a decrease in cardiac stress related marker lever such as ANP, BNP, MMP2, β-MHC/α-MHC and an increase in CD31 expression level. Surprisingly, E2F7/8 deletion did not have impact on cardiac function and dimensions post-IRI.

Conclusion

In summary, we identified that E2F7/8 activity is involved in the cellular polyploidy in the heart but did not affect myocardial function after myocardial injury.

POS0152 DIRECT AND INDIRECT EFFECT OF TNF INHIBITORS ON SPINAL MOBILITY IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS AND THE MEDIATOR ROLE OF DISEASE ACTIVITY

Background

Although it may be difficult to detect changes in spinal mobility on the short term, spinal mobility is considered an important measure to assess the efficacy of drugs used to treat axial spondyloarthritis (axSpA). However, few studies evaluated the long-term impact of biologic treatment on spinal mobility.

Objectives

To describe the long-term effect of TNF inhibitors (TNFi) on spinal mobility in patients with axSpA, and to determine whether the use of TNFi treatment influences spinal mobility, and if this due to a direct or indirect effect (mediated by disease activity).

Methods

We performed a retrospective observational study, using data collected from patients with a clinical diagnosis of axSpA treated with TNFi at a tertiary care centre where disease activity and metrology assessments are routinely done. Adult patients with at least two Bath Ankylosing Spondylitis Metrology Index (BASMI) measurements were included. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS). The longitudinal association between TNFi and improvement in BASDAI/ASDAS was tested using a linear mixed effects model with BASMI as dependent variable. To test whether TNFi had a direct effect on BASMI, not mediated by disease activity, we tested that TNFi treatment was not conditionally independent of BASMI given BASDAI/ASDAS (Figure 1). We tested whether the nodes TNFi and BASMI were disconnected if we removed BASDAI and ASDAS. To test this conditional independence, we first built a linear mixed effects model for BASMI given BASDAI or ASDAS when the patient was under TNFi and used this model to predict a 95% confidence interval (CI) for BASMI given the data for BASDAI/ASDAS when the patient was without TNFi. We checked whether the true value of BASMI lay within this 95% CI and performed a hypothesis test for binomial distribution where H0: p=0.95. To test for the indirect effect of TNFi on BASMI reduction, mediated through the disease activity, we regressed BASMI on BASDAI/ASDAS, TNFi (if there was a direct effect), demographics, presence of radiographic (r-) axSpA and HLA-B27 positivity, using a linear mixed effects model adjusted for within-patient correlation.

Figure 1.

Indirect effect of TNFi on BASMI (represented by the full line), through the influence of TNFi on disease activity, adjusted by other confounders and direct effect of TNFi on BASMI (dashed line), independently of disease activity.

Results

Data from 188 patients and 1326 visits were analysed. Mean age was 45.6 (SD 11.6) years, mean disease duration was 15.8 (SD 9.64) years, 152 (80.9%) were male, 120 (73.6%) had r-axSpA, and 83 (74.8%) were HLA-B27 positive. Mean follow-up time was 8.0 (SD 4.4) years, ranging from 0.8 to 18.2 years. Treatment with TNFi was significantly associated with long-term improvement in BASMI (B=-0.423, 95% CI=[-0.553,-0.292], p<0.001). An indirect effect of TNFi on BASMI improvement was observed, mediated by reduction in disease activity, measured by BASDAI (B=0.146, 95% CI=[0.092, 0.200], p<0.001) or ASDAS (B=0.405, 95% CI=[0.260, 0.549], p<0.001). Using conditional independence tests, a direct effect of TNFi on BASMI improvement was also observed, independently of disease activity, when BASDAI was used (p<0.001) as a covariate, but not when ASDAS was used (p=0.3104). The direct effect of TNFi (B=-0.300, 95% CI=[-0.576,-0.025], p<0.001) on BASMI was estimated in the BASDAI-adjusted mixed effects model.

Conclusion

TNFi are effective at improving BASMI in patients with axSpA, in a real-life setting. This effect is mainly explained by the reduction in disease activity. However, a direct effect of TNFi on BASMI could also be demonstrated, when disease activity was measured by BASDAI, suggesting that ASDAS captures additional factors that can influence spinal mobility. These potential factors deserve further investigation, but they could for example include biomechanical properties of tendons and myofascial tissue.

Disclosure of Interests

Ana Sofia Pinto: None declared, Bohao Yao: None declared, Claire Harris: None declared, Rhys Hayward: None declared, Andrew Keat: None declared, Pedro Machado Speakers bureau: Received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this

manuscript, Consultant of: Received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this

manuscript

Correlation between microRNA-766 expression in patients with advanced gastric cancer and the efficacy of platinum-containing chemotherapy

OBJECTIVE

We aimed at observing the correlation between microRNA-766 expression and the efficacy of platinum-containing chemotherapy in patients with stage IV gastric cancer (GCa).

PATIENTS AND METHODS

Tissue specimens were obtained from 100 patients with stage IV GCa who received platinum-based chemotherapy, and microRNA-766 expression in these samples was examined by quantitative real-time polymerase chain reaction (qPCR) analysis. Survival analysis was carried out through Kaplan-Meier test. The influencing factors of survival were assessed through COX univariate and multivariate regression.

RESULTS

GCa tissues contained significant lower expression of microRNA-766 than adjacent tissues. The degree of tumor differentiation and peritoneal metastasis were confirmed to have great relevance to microRNA-766 level. Patients with high microRNA-766 expression have better chemotherapy efficacy and longer progression-free survival.

CONCLUSIONS

Our study shows for the first time that the highly expressed microRNA-766 in tumor tissues of patients with stage Ⅳ GCa predicts better platinum-containing chemotherapy efficacy and prognosis.

LINC00707 accelerates the proliferation, migration and invasion of clear cell renal cell carcinoma

OBJECTIVE

Long noncoding RNAs (lncRNAs) have been well concerned in tumor researches, which are believed to influence tumorigenesis and tumor progression. This study aims to uncover the role of LINC00707 in clear cell renal cell carcinoma (ccRCC) and the underlying mechanism.

MATERIALS AND METHODS

Differentially expressed lncRNAs in ccRCC tissues and renal epithelial tissues were analyzed in The Cancer Genome Atlas (TCGA), and LINC00707 was screened out. Expression level of LINC00707 in ccRCC cell lines was determined as well. Regulatory effects of LINC00707 on influencing proliferative, migratory, and invasive abilities of 786-O and 769-P cells were assessed. At last, relative levels of epithelial-mesenchymal transition (EMT)-related genes E-cadherin and N-cadherin in 786-O and 769-P cells were detected by quantitative real time-polymerase chain reaction (qRT-PCR) and Western blot.

RESULTS

LINC00707 was upregulated in ccRCC tissues and cell lines. Silence of LINC00707 attenuated proliferative, migratory, and invasive abilities of 786-O and 769-P cells. Moreover, knockdown of LINC00707 upregulated E-cadherin and downregulated N-cadherin in ccRCC cells at both mRNA and protein levels.

CONCLUSIONS

LINC00707 is upregulated in ccRCC, which could promote cancer cells to proliferate, migrate, and invade. LINC00707 accelerates the progression of ccRCC by activating EMT pathway.

The integration of artificial intelligence in medical imaging practice: Perspectives of African radiographers

INTRODUCTION

The current technological developments in medical imaging are centred largely on the increasing integration of artificial intelligence (AI) into all equipment modalities. This survey assessed the perspectives of African radiographers on the integration of AI in medical imaging in order to offer unique recommendations to support the training of the radiography workforce.

METHODS

An exploratory cross-sectional online survey of radiographers working within Africa was conducted from March to August 2020. The survey obtained data about their demographics and perspectives on AI implementation and usage. Data obtained were analysed using both descriptive and inferential statistics.

RESULTS

A total of 1020 valid responses were obtained. Majority of the respondents (n = 883,86.6%) were working in general X-ray departments. Of the respondents, 84.9% (n = 866) indicated that AI technology would improve radiography practice and quality assurance for efficient diagnosis and improved clinical care. Fear of job losses following the implementation of AI was a key concern of most radiographers (n = 625,61.3%).

CONCLUSION

Generally, radiographers were delighted about the integration of AI into medical imaging, however; there were concerns about job security and lack of knowledge. There is an urgent need for stakeholders in medical imaging infrastructure development and practices in Africa to start empowering radiographers through training programmes, funding, motivational support, and create clear roadmaps to guide the adoption and integration of AI in medical imaging in Africa.

IMPLICATION FOR PRACTICE

The current study offers unique suggestions and recommendations to support the training of the African radiography workforce and others in similar resource-limited settings to provide quality care using AI-integrated imaging modalities.

Using functional connectivity changes associated with cognitive fatigue to delineate a fatigue network

Cognitive fatigue, or fatigue related to mental work, is a common experience. A growing body of work using functional neuroimaging has identified several regions that appear to be related to cognitive fatigue and that potentially comprise a "fatigue network". These include the striatum of the basal ganglia, the dorsolateral prefrontal cortex (DLPFC), the dorsal anterior cingulate cortex (dACC), the ventro-medial prefrontal cortex (vmPFC) and the anterior insula. However, no work has been conducted to assess whether the connectivity between these regions changes as a function of cognitive fatigue. We used a task-based functional neuroimaging paradigm to induce fatigue in 39 healthy individuals, regressed the signal associated with the task out of the data, and investigated how the functional connectivity between these regions changed as cognitive fatigue increased. We observed functional connectivity between these regions and other frontal regions largely decreased as cognitive fatigue increased while connectivity between these seeds and more posterior regions increased. Furthermore the striatum, the DLPFC, the insula and the vmPFC appeared to be central 'nodes' or hubs of the fatigue network. These findings represent the first demonstration that the functional connectivity between these areas changes as a function of cognitive fatigue.

[Influence of the stiffness of three-dimensionally bioprinted extracellular matrix analogue on the differentiation of bone mesenchymal stem cells into skin appendage cells]

Objective: To observe the influence of the stiffness of three-dimensionally bioprinted extracellular matrix analogue on the differentiation of bone marrow mesenchymal stem cells (BMSCs) into skin appendage cells. Methods: (1) Sodium alginate of 1 g and 4 g gelatin, 3 g sodium alginate and 8 g gelatin were mixed respectively, and the two mixtures were dissolved in 100 mL ultra-pure water respectively to prepare two sodium alginate-gelatin composite hydrogels, named 1A4G hydrogel and 3A8G hydrogel, which were used in the subsequent experiments. The morphology of the two hydrogels at room temperature, after condensation for 15-30 min at 4 ℃ (the same condensation condition below), after condensation and cross-linking with 25 g/L calcium chloride solution (the same cross-linking condition below), and after condensation and three-dimensional printing with a three-dimensional bioprinter (the same three-dimensional printer below) and cross-linking were observed respectively. Young's modulus (stiffness) of the two kinds of hydrogels was measured by Young's modulus tester after condensation and cross-linking (n=3). Two kinds of hydrogels were cross-linked and freeze-dried, and their pore structure was observed by scanning electron microscope. Two hydrogels were cross-linked and freeze-dried, and the porosity was detected by anhydrous ethanol replacement method (n=3). (2) BMSCs were isolated from femur and tibia of 20 C57BL/6 mice (no limitation with sex, born 7 days) and cultured, and the second passage of cells was used for further test. The BMSCs single cell suspension (1.0×10(7) /mL) was mixed with 1A4G hydrogel and 3A8G hydrogel respectively at 1∶9 volume ratio to prepare BMSCs-loaded 1A4G hydrogel and BMSCs-loaded 3A8G hydrogel for three-dimensional printing. One construct was printed with 1 mL cell-loaded hydrogel (the same dosage for printing below). Mesenchymal stem cells (MSCs) specific medium was added after cross-linking, and the printed constructs were divided into 1A4G group and 3A8G group according to the hydrogel. One construct of each group cultured for 7 days was tested with live/dead kit to count the live cells and dead cells in 50-fold field of view. Nine printed constructs from each of the two groups were taken, and BMSCs of nine wells (1.0×10(6) per well) cultured with 2 mL MSCs specific medium were set as two-dimensional culture group. After 1, 3, 5 day (s) of culture, three printed constructs from 1A4G group and 3A8G group respectively and three wells of cells from two-dimensional culture group were taken to detect the absorbance value in culture medium by cell counting kit 8, denoting the cell proliferation activity. (3) BMSCs-loaded 1A4G hydrogel and BMSCs-loaded 3A8G hydrogel of 10 mL respectively were prepared as in experiment (2), which were respectively mixed with 0.5 mL plantar dermis homogenate extracted from 10 C57BL/6 mice of 1 day postnatal with unknown sex, then three-dimensionally printed, cross-linked, cultured with MSCs specific medium for 3 days and then changed to sweat gland specific medium. The printed constructs were divided into 1A4G group and 3A8G group according to their hydrogel. After 7 days of culture with sweat gland specific medium, the expressions of epithelial cell surface markers cytokeratin-5 (CK5) and CK14, sweat gland cell surface markers CK18 and Na(+) /K(+) -ATPase (NKA), and hair follicle cell surface markers CK17 and alkaline phosphatase (ALP) at protein level in cells of printed constructs in the two groups were detected by immunofluorescence method. The expressions of CK5, CK14, CK18, NKA (detecting ATP1a1), CK17, and ALP at mRNA level in cells of printed constructs in the two groups were detected with real-time fluorescent quantitative reverse transcription polymerase chain reaction (n=3). Data were statistically analyzed with independent sample t test, Fisher's exact probability test, analysis of variance for factorial design, and Bonferroni method. Results: (1) Compared with that of 3A8G hydrogel, 1A4G hydrogel had lower viscosity and better fluidity at room temperature. Both kinds of hydrogels were gel-like after condensation, based on which, the shape of cross-linked hydrogels was uniform and regular, with three-dimensional printing and cross-linking made hrdrogels forming solid crisscross cylindrical constructs. The Young's modulus of 1A4G hydrogel was (52±6) kPa, which was obviously lower than (218±5) kPa of 3A8G hydrogel (t=40.470, P<0.01). The pore structure of the two hydrogels was similar, with all the cross-sections showing porous network structure. The porosity of the two hydrogels was similar (t=0.930, P>0.05). (2) The distribution of live/dead cells between 1A4G group and 3A8G group was similar after 7 days of culture (P>0.05), most of which were live cells. The absorbance value in culture medium of printed constructs among 1A4G group, 3A8G group, and two-dimensional culture group didn't show statistically significant differences after 1, 3, 5 day (s) of culture (P>0.05). Compared with that after 1 day of culture within each group, the absorbance value in culture medium of printed constructs in 1A4G group and 3A8G group was significantly increased after 3 and 5 days of culture (P<0.05 or P<0.01), and the absorbance value in culture medium of cells in two-dimensional culture group was significantly increased after 5 days of culture (P<0.01). Compared with that after 3 days of culture within each group, the absorbance value in culture medium of printed constructs in 1A4G group and 3A8G group and that of cells in two-dimensional culture group was significantly increased after 5 days of culture (P<0.01). (3) After 7 days of culture with sweat gland specific medium, the CK5, CK14, CK18, NKA, CK17, and ALP were positively expressed at protein level in cells of printed constructs in the two groups. After 7 days of culture with sweat gland specific medium, the expressions of CK5, CK14, CK18, and NKA at mRNA level in cells of printed constructs were close between the two groups (t=0.362, 0.807, 0.223, 1.356, P>0.05); the expressions of CK17 and ALP at mRNA level in cells of printed constructs in 3A8G group were 1.96±0.21 and 55.57±11.49, respectively, which were significantly higher than 1.05±0.42 and 2.01±0.27 in 1A4G group (t=3.333, 8.074, P<0.05 or P<0.01). Conclusions: BMSCs cultured three-dimensionally in 1A4G and 3A8G hydrogels tend to differentiate into sweat gland cells, but the BMSCs cultured three-dimensionally in 3A8G hydrogel show a stronger tendency to differentiate into hair follicle cells than the cells cultured in 1A4G hydrogel. It suggests that relatively high stiffness of three-dimensionally bioprinted extracellular matrix analogue facilitates not only differentiation of BMSCs into sweat gland cells, but also their differentiation into hair follicle cells.

[Preparation and preliminary research on the characteristics of modified nano-bioglass hydrogel]

Objective: To explore the preparation and preliminary research on the characteristics of modified nano-bioglass hydrogel. Methods: (1) The nano-bioglass suspension was prepared by adding 67 mL nano-silica suspension into 400 mL saturated calcium hydroxide solution, and its suspension stability was observed. (2) The hydrogel with final mass fraction of 10% gelatin and 1% sodium alginate was prepared and set as control group. On the basis of the hydrogel in control group, the nano-bioglass suspension prepared in experiment (1) was added to prepare the hydrogel with the final mass fraction of 0.5% bioglass, 10% gelatin, and 1% sodium alginate, and the hydrogel was set as the experimental group. The gelling time at 4 and 25 ℃and the dissolution time at 37 ℃ of hydrogel in 2 groups were recorded, and the gelation at 4 and 25 ℃and dissolution condition at 37 ℃of the hydrogel in 2 groups were observed. The hydrogel in 2 groups were collected and cross-linked with 25 g/L calcium chloride solution after cold bath at 4 ℃, and the compression modulus was measured by Young's modulus tester. In addition, the hydrogel in 2 groups were collected and cross-linked as before, and freeze-drying hydrogel was made at -20 ℃. The relative volumes were measured and the porosity of hydrogel in 2 groups was calculated. The number of sample in the experiment was 3. (3) Fibroblasts (Fbs) were isolated and cultured from 12 C57BL/6J mice of 24 hours old and the morphology was observed by inverted microscope, and the third passage of Fbs were cultured for the following experiment. Fbs were collected to make single cell suspension with the cell concentration of 1×10(5)/mL. The single cell suspension was divided into experimental group and control group according the random number table (the same grouping method below), which were added with hydrogel in experimental group and control group prepared in experiment (2), respectively. At culture hour 12, 24, and 48, cells of 3 wells in each group were collected to detect the survival rate by cell counting kit 8 method. (4) The third passage Fbs were collected to prepare the single cell suspension with the cell concentration of (3.0~4.5)×10(7)/mL, which was divided into experimental group and control group, with 1 tube in each group. The single cell suspension in 2 groups were added with green fluorescent probe DIO for staining and then added with 9 mL hydrogel in experimental group and control group prepared in experiment (2), respectively. The mixed solution of Fbs and hydrogel in 2 groups was cross-linked as before to make cell-loaded hydrogel. On culture day 3, the survival of cells in the hydrogel was observed by laser confocal microscope. The cell-loaded hydrogel was prepared as before and without added with green fluorescent probe DIO. On culture day 7, the adhesion and extension of cells in the hydrogel were observed by scanning electron microscope. (5) Twelve 6-week-old female BALB/c-nu nude mice were collected and divided into experimental group and control group, with 6 mice in each group. A round full-thickness skin defect wound with diameter of 1 cm was made on the back of each mouse. Immediately after injury, one cell-loaded hydrogel block in the experimental group and the control group prepared in experiment (4) was placed in the wound of each mouse in the experimental group and the control group, respectively. On post injury day (PID) 7 and 14, 3 nude mice in each group were sacrificed to collect the wound and wound margin tissue, which was stained with hematoxylin-eosin to observe the wound healing. Data were statistically analyzed with independent sample t test. Results: (1) The nano-bioglass particles could be uniformly dispersed in water and had good suspension stability. (2) The hydrogels of the 2 groups were molten at 37 ℃, and no precipitation of particle was observed. The dissolving time of the hydrogel in the experimental group and the control group at 37 ℃ was 5 and 10 min, respectively. The gelation time of the hydrogel in the experimental group and the control group at 25 ℃ was 30 and 180 min, respectively, and the gelation time of the 2 groups at 4 ℃ was 5 and 10 min, respectively. The compression modulus of hydrogel in the experimental group was (53±6) kPa, which was significantly higher than (23±6) kPa in the control group (t=6.364, P<0.01). The porosity of the hydrogel in the experimental group was (86.1±2.1)%, which was similar to (88.2±4.4)% in the control group (t=1.210, P>0.05). (3) The cells were in long fusiform, and the proportion of nuclei was high, which was accorded with the morphological characteristics of Fbs. At culture hour 12, 24, and 48, the survival rate of cells in the experimental group was (84±4)%, (89±4)%, and (130±10)%, which was similar to (89±5)%, (90±4)%, and (130±11)% in the control group, respectively (t=1. 534, 0.611, 0.148, P>0.05). (4) On culture day 3, the cells in the two groups had complete morphology in the hydrogel, no nuclear lysis or disappearance were observed, the cytoplasm remained intact, and the fluorescence intensity of the cells in the experimental group was significantly stronger than that in the control group. On culture day 7, the cells in the experimental group and the control group adhered and stretched in the hydrogel, and the number of cells in the experimental group adhered to the hydrogel was significantly more than that in the control group. On PID 7, the wound area of the nude mice in the control group and the experimental group were reduced, the reduction area of mice in the experimental group was more obvious, and a large amount of inflammatory cells were seen in and around the wound in the 2 groups. On PID 14, the wound area of the nude mice in the control group was larger than that of the experimental group, and the number of inflammatory cells in and around the wound was significantly more than that in the experimental group. Conclusions: Nano-bioglass hydrogel possesses good physical, chemical, and biological properties, cell loading potential, and the ability to promote wound healing, which means it has a good potential in clinical application.

Fuels, power and chemical periodicity

The insatiable-and ever-growing-demand of both the developed and the developing countries for power continues to be met largely by the carbonaceous fuels comprising coal, and the hydrocarbons natural gas and liquid petroleum. We review the properties of the chemical elements, overlaid with trends in the periodic table, which can help explain the historical-and present-dominance of hydrocarbons as fuels for power generation. However, the continued use of hydrocarbons as fuel/power sources to meet our economic and social needs is now recognized as a major driver of dangerous global environmental changes, including climate change, acid deposition, urban smog and the release of many toxic materials. This has resulted in an unprecedented interest in and focus on alternative, renewable or sustainable energy sources. A major area of interest to emerge is in hydrogen energy as a sustainable vector for our future energy needs. In that vision, the issue of hydrogen storage is now a key challenge in support of hydrogen-fuelled transportation using fuel cells. The chemistry of hydrogen is itself beautifully diverse through a variety of different types of chemical interactions and bonds forming compounds with most other elements in the periodic table. In terms of their hydrogen storage and production properties, we outline various relationships among hydride compounds and materials of the chemical elements to provide some qualitative and quantitative insights. These encompass thermodynamic and polarizing strength properties to provide such background information. We provide an overview of the fundamental nature of hydrides particularly in relation to the key operating parameters of hydrogen gravimetric storage density and the desorption/operating temperature at which the requisite amount of hydrogen is released for use in the fuel cell. While we await the global transition to a completely renewable and sustainable future, it is also necessary to seek CO2 mitigation technologies applied to the use of fossil fuels. We review recent advances in the strategy of using hydrocarbon fossil fuels themselves as compounds for the high capacity storage and production of hydrogen without any CO2 emissions. Based on these advances, the world may end up with a hydrogen economy completely different from the one it had expected to develop; remarkably, with 'Green hydrogen' being derived directly from the hydrogen-stripping of fossil fuels. This article is part of the theme issue 'Mendeleev and the periodic table'.

Sleep disturbances among medical workers during the outbreak of COVID-2019

Background

The outbreak of Corona Virus Disease-2019 (COVID-19) has posed unprecedented pressure and threats to healthcare workers in Wuhan and the entire country.

Aims

To assess the effect of the COVID-19 outbreak on the sleep quality of healthcare workers in a children’s healthcare centre in Wuhan.

Methods

A cross-sectional, anonymized, self-reported questionnaire survey was conducted at the Children’s Healthcare Centre of Renmin Hospital, Wuhan University, Wuhan, China. The questionnaire consisted of three parts, including socio-demographic characteristics and COVID-19 epidemic-related factors, the Pittsburgh sleep quality index (PSQI), and Zung’s self-rating anxiety scale (SAS) and self-rating depression scale (SDS).

Results

In total, 47 out of 123 (38%) participants with PSQI scores > 7 were identified as having sleep disturbance. A logistic regression analysis showed that sleep disturbance was independently associated with being an only child (adjusted odds ratio (OR) and 95% confidence interval (CI) 3.40 (1.21–9.57), P < 0.05), exposure to COVID-19 patients (adjusted OR and 95% CI 2.97 (1.08–8.18), P < 0.05) and depression (adjusted OR and 95% CI 2.83 (1.10–7.27), P < 0.05).

Conclusions

We observed that, during the outbreak of COVID-19, sleep disturbance was highly prevalent among paediatric healthcare workers, and sleep disturbance was independently associated with being an only child, exposure to COVID-19 patients and depression. Therefore, more mental health services are required for front-line paediatric healthcare workers in Wuhan.

Down-regulation of miR-339 promotes differentiation of BMSCs and alleviates osteoporosis by targeting DLX5

OBJECTIVE

It was the aim of this study to investigate whether miR-339 may affect osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs) by targeting DLX5, thereby alleviating osteoporosis.

MATERIALS AND METHODS

BMSCs were isolated from the bone marrow of mice. The expression levels of miR-339 and DLX5 during the process of osteogenesis was detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Meanwhile, the expression of downstream osteogenesis-associated proteins, such as runt-related transcription factor 2 (RUNX2) and osteopontin (OPN), were also detected after overexpression or inhibition of miR-339. The alkaline phosphatase (ALP) activity was measured in cells by ALP activity assay kit. Alizarin red staining was performed to reveal the cell mineralization ability. The luciferase reporter gene assay was used to identify the targeted pairings of miR-339 and DLX5 genes. In addition, the expression of DLX5 was detected by Western blot analysis after overexpression or knockdown of miR-339. Rescue test was applied to evaluate whether miR-339 could affect the differentiation of BMSCs by inhibiting the expression of DLX5.

RESULTS

QRT-PCR showed that miR-339 expression gradually decreased while the expression of DLX5 increased during the induction culture of BMSCs. After overexpression of miR-339 in BMSCs, the expression levels of ALP, RUNX2, and OPN were reduced. Besides, ALP activity assay showed a decreased cell ALP activity. RUNX2 protein expression was also decreased. In addition, Alizarin red staining detected a significant increase in cell mineralization, whereas silencing miR-339 resulted in an opposite result. These results indicated that miR-339 could regulate the osteogenic differentiation of BMSCs. Subsequently, we predicted using bioinformatics software that miR-339 might target DLX5, and validated this hypothesis by luciferase reporter assay. Finally, Western blot and ALP activity assay revealed that DLX5 could reverse the inhibitory effect of overexpression of miR-339 on osteogenic differentiation of BMSCs.

CONCLUSIONS

Down-regulation of miR-339 can promote osteogenic differentiation of BMSCs by targeting DLX5, thereby relieving osteoporosis.

Post-traumatic maxillofacial reconstruction with vascularized flaps and digital techniques: 10-year experience

The aim of this study was to present a treatment protocol for the individual repair of post-traumatic maxillofacial bone defects with vascularized flaps assisted by digital techniques. This study reviewed 20 patients with post-traumatic maxillofacial bone defects who underwent reconstruction with composite vascularized bone flaps assisted by digital techniques between April 2009 and July 2019. Preoperative computed tomography (CT) data were imported into ProPlan CMF software to complete virtual fracture reduction and reconstruction. Surgical navigation, three-dimensionally (3D) printed surgical plates, and prefabricated titanium mesh/plates were used to guide the actual surgery. All patients underwent open reduction and internal fixation and reconstruction surgery in one stage. CT data obtained at 1 week postoperative were imported into Geomagic Control software to evaluate the accuracy of the virtual surgical plan. The mean follow-up interval was 24 months (range 6-96 months). Donor and recipient site morbidity and second-stage procedures to rehabilitate the dentition and cosmetic organs were recorded. The flap success rate was 100%. Nine patients had deep circumflex iliac artery flaps and eleven patients had fibula flaps. The accuracy of computer-assisted surgery was 4.4±0.8mm. There were no postoperative complications. This study is novel in presenting a treatment protocol for individual computer-assisted reconstruction for post-traumatic maxillofacial bone defects with vascularized flaps.

[Related factors for microalbuminuria in adult type 1 diabetes patients of short disease duration]

Objective: To investigate related factors for microalbuminuria in adult type 1 diabetes (T1D) patients of short disease duration (less than 5 years), and provide evidence for prevention of early diabetic kidney disease in this population. Methods: All adult patients enrolled in the Guangdong T1D translational medicine study between 2011 and 2017 with a disease duration of less than 5 years were included in this analysis. At enrollment, patients' demographic and clinical data were documented, and blood and urine samples were collected for the measurements of blood lipids, glycated hemoglobin A1c and urine albuminuria. Insulin resistance was evaluated by estimated glucose disposal rate (eGDR). Patients were categorized into groups based on urine albumin creatitine ratio (UACR): normoalbuminuric group (UACR<30 mg/g) and microalbuminuric group (UACR≥30 mg/g). Stepwise multivariate linear regression analysis was used to analyze risk factors for microalbuminuria in adult T1D patients of short disease duration. Results: A total of 384 patients were included in this analysis, and 51.3% (197/384) of which was female. The onset age of patients was (24.6±12.5) years, with a disease duration of 2.1(0.6, 3.5) years, body mass index of (19.8±3.2) kg/m(2), waist hip ratio of 0.85±0.21, and glycated hemoglobin A1c of (9.8±3.3)% at enrollment. Microalbuminuria occurred in 62 patients (16.1%). Multivariate linear analysis showed that higher glycated hemoglobin A1c, higher systolic blood pressure and more severe insulin resistance were related factors for microalbuminuria (t=2.322, 2.868 and -2.373, respectively, all P<0.05). Conclusions: Microalbuminuria was not rare in adult T1D patients of short disease duration. Inadequate glycemic control and insulin resistance were independent related factors for microalbuminuria in this population.

[Awareness of preconceptional care and its related factors in women of child-bearing age with type 1 diabetes]

Objective: To investigate the awareness of preconception care among women of child-bearing age with type 1 diabetes (T1DM) and their self-management status, in order to provide evidence for establishment of management pathway for women with T1DM in pregnancy in China. Methods: This cross-sectional survey recruited female participants of child-bearing age from the cohort of Guangdong Type 1 Diabetes Translational Medicine Study conducted between June 2011 and December 2017. The participants were asked to fill out a questionnaire on the awareness of preconception care, their frequency of self-monitoring of blood glucose (SMBG) and other related variables. Chi-squared test or chi-squared test for trend was used in comparisons of categorical variables, and logistic regression analysis was performed to assess associated factors. Results: Totally, 441 women of child-bearing age with T1DM were investigated. The results show that their awareness of preconception care was poor (15.42%, 68/441). Higher educational level (χ(2trend)=3.990, P=0.046), experience of post-diabetes education evaluation (P<0.001), and better coverage of different modules in diabetes education (survival skills: χ(2)=7.525, P=0.004; basic knowledge: χ(2)=8.598, P=0.002; advanced knowledge: P<0.001) were associated with better awareness of preconception care. The average frequency of SMBG in these participants was 0.29 (0.14, 2.00) times per day, and only 8.5% (37/435) of them reached the frequency (≥4 times per day) recommended by guidelines. Moreover, 21.1% (92/435) of them hardly ever performed SMBG. Conclusion: Child-bearing age women with T1DM in Gunangdong had poor awareness of preconception care, with a much lower SMBG frequency than recommendation.

[Clinical characteristics and classification diagnosis of newly diagnosed diabetes onset with ketosis or ketoacidosis in adult patients]

Objective: To describe the clinical characteristics and classification diagnosis of newly diagnosed diabetes onset with ketosis or ketoacidosis in adult patients. Methods: Medical records of newly diagnosed diabetes onset with ketosis or ketoacidosis in the Third Affiliated Hospital of Sun Yat-sen University between January 2011 and August 2016 were reviewed. Patients aged 18 years or older were included, while other diseases that may cause urinary ketoacidosis and special types of diabetes were excluded. Patients were classified as type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) or diabetes mellitus untyped based on discharged diagnosis, and groups were compared for differences in clinical profiles. Then the patient's medication, final diagnosis and outcome within 2 years of discharge were tracked through the inpatient and the outpatient medical record systems. Receiver operating characteristics (ROC) curves were analyzed to check the ability of clinical indicators such as onset age, body mass index (BMI) and C-peptide to discriminate T1DM from T2DM, and to find the best diagnostic cut-off points. Results: A total of 123 patients (88 males) were enrolled [with a mean age of (41.1±13.6) years old], with 37 patients (30.1%) diagnosed as T1DM, 60 patients (48.8%) diagnosed as T2DM and 26 patients (21.1%) diagnosed as Untyped. There was a statistically significant difference in onset age, BMI, blood pressure, blood gas pH and bicarbonate, blood lipids, fasting, 0.5 h and 2 h C-peptide level, any diabetic antibody and anti-glutamic acid decarboxylase antibody (GADA) positive rate, combined fatty liver ratio and family history among the three groups (all P<0.05). ROC curve analysis was performed on patients diagnosed with T1DM (n=36) and T2DM (n=87) after 2 years follow-up, and the area under the curve (AUC) of onset age, BMI, fasting C-peptide, 0.5 h and 2 h C-peptide was 0.735, 0.813, 0.855, 0.898, and 0.882, respectively. Conclusion: The ROC curve analysis indicates that C-peptide, onset age and BMI can provide effective diagnostic value, and the diagnostic value of C peptide is better than BMI and onset age.

Effects of neratinib on health-related quality of life in women with HER2-positive early-stage breast cancer: longitudinal analyses from the randomized phase III ExteNET trial

BACKGROUND

We report longitudinal health-related quality-of-life (HRQoL) data from the international, randomized, double-blind, placebo-controlled phase III ExteNET study, which demonstrated an invasive disease-free survival benefit of extended adjuvant therapy with neratinib over placebo in human epidermal growth factor receptor-2-positive early-stage breast cancer.

PATIENTS AND METHODS

Women (N  = 2840) with early-stage HER2-positive breast cancer who had completed trastuzumab-based adjuvant therapy were randomly assigned to neratinib 240  mg/day or placebo for 12  months. HRQoL was an exploratory end point. Patients completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) and EuroQol 5-Dimensions (EQ-5D) questionnaires at baseline and months 1, 3, 6, 9, and 12. Changes from baseline were compared using analysis of covariance with no imputation for missing values. Sensitivity analyses used alternative methods. Changes in HRQoL scores were regarded as clinically meaningful if they exceeded previously reported important differences (IDs).

RESULTS

Of the 2840 patients (intention-to-treat population), 2407 patients were evaluable for FACT-B (neratinib, N  = 1171; placebo, N  = 1236) and 2427 patients for EQ-5D (neratinib, N  = 1186; placebo, N  = 1241). Questionnaire completion rates exceeded 85%. Neratinib was associated with a decrease in global HRQoL scores at month 1 compared with placebo (adjusted mean differences: FACT-B total, -2.9 points; EQ-5D index, -0.02), after which between-group differences diminished at later time-points. Except for the FACT-B physical well-being (PWB) subscale at month 1; all between-group differences were less than reported IDs. The FACT-B breast cancer-specific subscale showed small improvements with neratinib at months 3-9, but all were less than IDs. Sensitivity analyses exploring missing data did not change the results.

CONCLUSIONS

Extended adjuvant neratinib was associated with a transient, reversible decrease in HRQoL during the first month of treatment, possibly linked to treatment-related diarrhea. With the exception of the PWB subscale at month 1, all neratinib-related HRQoL changes did not reach clinically meaningful thresholds. ClinicalTrials.gov: NCT00878709.

[Glycemic control and its associated factors in children and adolescents with type 1 diabetes mellitus]

A higher frequency of SMBG is one of the key factors to achieve sufficient glycemic control among children and adolescents with T1DM treated with CSII.

[Using peripheral perfusion index and venous-to-arterial CO(2) difference/arterial-central venous O(2) difference ratio to assess lactate clearance in septic patients after resuscitation]

Objective: The relationship of venous-to-arterial CO(2) difference(Pv-aCO(2))/arterial-central venous O(2) difference (Ca-vO(2)) ratio, peripheral perfusion index(PI) and lactate clearance(LC) were investigated during resuscitation in septic patients. And, the meaning of the combination PI and Pv-aCO(2)/Ca-vO(2) ratio to interpret incoherence of lactate clear was explored. Methods: The patients with sepsis were prospectively observed, who admitted to critically care medicine department of Peking Union Medical College Hospital. The hemodynamic parameters, simultaneous arterial and central venous blood gas analysis and PI were obtained at the enrollment (T0) and 8 hours (T8) during resuscitation. The lactate clearance was defined as 8h-LC≥10% and non-lactate clearance was defined as 8h-LC ≤ 10%. Additionally, the patients were divided as three sub-groups according to the PI value at T8: the normalized PI group with PI≥1.4,the mild impaired PI with 1.4<PI<0.6 and severe impaired PI with PI≤0.6. Results: A total of 84 patients were enrolled in this study. There was no significant difference in Pv-aCO(2)/Ca-vO(2) ratio in the three groups. However, the PI≤0.6 group had a significantly higher Pv-aCO(2) than other groups. Moreover, the patients with non-lactate clearance (13/32) had a higher Pv-aCO(2)/Ca-vO(2) ratio than the patients with lactate clearance in PI≥1.4 group (1.9±0.7 vs. 1.3±1.0, P=0.01). Multivariate analysis showed both Pv-aCO(2)/Ca-vO(2) ratio [Exp(B) 2.235, 95% CI 1.232-4.055, P=0.008] and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) [Exp (B) 1.087, 95%CI 1.022-1.156, P=0.008] were independent risk factor of non-lactate clearance. 8h-PI was significantly negative correlated with the 8 h Pv-aCO(2) gap (r=-0.311, P=0.004), but not significantly with Pv-aCO(2)/Ca-vO(2) ratio (r=-0.094, P=0.385). Conclusions: Both high Pv-aCO(2)/Ca-vO(2) ratio and low PI were related to non-lactate clearance after resuscitation in sepsis. Combined PI and Pv-aCO(2)/Ca-vO(2) ratio could interpret incoherence of latacte clearance after resuscitation.

Body mass index and the risk of mortality among Chinese adults with Type 2 diabetes

AIMS

To examine the associations between BMI and the risks of all-cause, cardiovascular disease (CVD)-specific and cancer-specific mortality among people with Type 2 diabetes, and thus provide recommendations for weight management in the population.

METHODS

This retrospective cohort study was conducted among 52 763 people with newly diagnosed Type 2 diabetes between 1 January 2004 and 31 December 2014 in Shanghai, China. All cases of death were identified by linking to the Shanghai Vital Statistics. Some 52 488 people were included in the analysis. Survival curves for people with different BMI categories were plotted using the Kaplan-Meier method. Cox proportional hazard models within or without restricted cubic spline functions were applied to examine the potential non-linear or linear relationship between BMI and the risk of mortalities respectively.

RESULTS

A total of 4777 deaths were identified during an average of 6-year follow-up. An L-shaped association was observed between BMI and all-cause mortality in men (P for overall association < 0.001 and P for non-linearity < 0.001) while a U-shaped association was found in women (P for overall association < 0.001 and P for non-linearity< 0.001). In men, no significant association was observed for BMI with cancer-specific and CVD-specific mortality. In women, an increased risk of cancer-specific mortality was observed with increasing BMI, whereas decreasing BMI was associated with the increased CVD-specific mortality rate.

CONCLUSION

The increased all-cause mortality in men with low BMI and in women with either low or high BMI indicate the importance of keeping BMI in a normal range for Chinese adults with Type 2 diabetes.

Abstract P1-13-03: Effects of neratinib after trastuzumab-based adjuvant therapy in hormone receptor-positive HER2+ early-stage breast cancer: Exploratory analyses from the phase III ExteNET trial

Background: The international, randomized, placebo-controlled phase III ExteNET trial showed that a 1-year course of neratinib after trastuzumab-based adjuvant therapy significantly improved 2-year invasive disease-free survival (iDFS) in patients with early-stage HER2+ breast cancer (BC) (hazard ratio 0.67; 95% CI 0.50–0.91; p=0.009) [Chan et al. Lancet Oncol 2016]. The significant iDFS benefit with neratinib was maintained after a median 5 years' follow-up (hazard ratio 0.73; 95% CI 0.57-0.92; p=0.008) [Martin et al. ESMO 2017]. At both time-points, marked benefit with neratinib was evident in patients with hormone receptor (HR)+ tumors, whereas in patients with HR– disease, initial improvements with neratinib diminished after completing treatment. We report exploratory analyses from the ExteNET trial done to better characterize the effects of neratinib in the HR+ subgroup.

Methods: Patients with early-stage HER2+ BC were randomly assigned to oral neratinib 240 mg/day or placebo for 1 year after standard primary therapy and trastuzumab-based adjuvant therapy. Randomization was stratified by HR status (locally assessed), nodal status, and trastuzumab regimen. Adjuvant endocrine therapy was recommended for patients with HR+ disease. Data concerning disease recurrences were collected prospectively during year 1-2 post-randomization, and from medical records during year 3–5 post-randomization. Primary endpoint: iDFS. Secondary endpoints: DFS including ductal carcinoma in situ (DFS-DCIS); time to distant recurrence (TTDR); distant DFS (DDFS); cumulative incidence of central nervous system (CNS) recurrences; overall survival (OS). Hazard ratios (95% CI) were estimated using Cox proportional-hazards models. Data cut-off: March 2017. Clinicaltrials.gov: NCT00878709.

Results: 2840 patients were randomized (neratinib, n=1420; placebo, n=1420); 1631 (57%) patients had HR+ tumors (neratinib, n=816; placebo, n=815). 93% and 94% of HR+ patients in the neratinib and placebo groups, respectively, were receiving adjuvant endocrine therapy at baseline. Efficacy outcomes in the HR+ cohort after a median follow-up of 5.2 years are shown in the table. In subgroup analyses of the HR+ cohort, hazard ratios for iDFS were 0.49 in centrally confirmed HER2+ patients (n=951), and 0.58 in patients who had completed prior trastuzumab ≤12 months before randomization (n=1334). CNS recurrence and OS data are not yet mature.

 Updated 2-year analysis5-year analysis  Hazard ratiobP-value Hazard ratiobP-value Δ, %a(95% CI)(2 sided)Δ, %a(95% CI)(2 sided)iDFS4.10.49 (0.31–0.75)0.0014.40.60 (0.43–0.83)0.002DFS-DCIS4.80.45 (0.29–0.69)&lt;0.0015.10.57 (0.42–0.79)&lt;0.001DDFS3.10.52 (0.32–0.84)0.0084.00.60 (0.42–0.85)0.004TTDR2.90.52 (0.31–0.85)0.013.80.61 (0.42–0.86)0.006a. Difference in event rates between neratinib vs placebo; b. Neratinib vs placebo

Conclusions: Neratinib was associated with an absolute iDFS benefit of 4.4% in patients with HR+/HER2+ BC after 5 years' follow-up. HR/HER2 receptor cross-talk may underpin the notable effect of neratinib in patients with HR+ tumors when given in combination with endocrine therapy.

Citation Format: Chia SKL, Martin M, Iwata H, Moy B, Lalani AS, Holmes FA, Mansi J, von Minckwitz G, Buyse M, Delaloge S, Ejlertsen B, Yao B, Murias Rosales A, Hellerstedt B, Cold S, Inoue K, Shen Z-Z, Galeano T, Barrios CH, Chan A. Effects of neratinib after trastuzumab-based adjuvant therapy in hormone receptor-positive HER2+ early-stage breast cancer: Exploratory analyses from the phase III ExteNET trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-03.

Diagnostic performance of cytology for assessment of hepatic lipid content in dairy cattle

The objective of our study was to characterize the diagnostic performance of cytology for assessing hepatic lipid content (HLC) in dairy cows by comparing microscopic evaluation of lipid vacuolation in touch imprint slide preparations of liver biopsies with quantitative measurement of triglyceride concentration ([TG]; mg/mg of wet weight) in paired biopsy samples. Our study also sought to compare the diagnostic performance of liver cytology, plasma nonesterified fatty acid concentration ([NEFA]), and plasma β-hydroxybutyrate concentration ([BHB]) derived from a measurement performed on whole blood, for assessing HLC. Chemical extraction of TG from liver tissue remains the gold standard for quantifying HLC, largely because available blood tests, although useful for detecting some types of pathology, such as increased lipid mobilization, ketosis, or hepatocellular injury, are nonspecific as to etiology. Veterinary practitioners can sample bovine liver for cytological evaluation in a fast, minimally invasive, and inexpensive manner. Thus, if highly predictive of HLC, cytology would be a practical diagnostic tool for dairy veterinarians. In our study, liver biopsy samples from Holstein cows (219 samples from 105 cows: 52 from cows 2 to 20 d prepartum, 105 from cows 0 to 10 d in milk, 62 from cows 18 to 25 d in milk) were used to prepare cytology slides and to quantify [TG] using the Folch extraction method followed by the Hantzch condensation reaction and spectrophotometric measurement. An ordinal scale (0-4) based on amount of hepatocellular cytoplasm occupied by discrete clear vacuoles was used by 3 blinded, independent observers to rank HLC in Wright-Giemsa-stained slides. Interobserver agreement in cytology scoring was good. Corresponding plasma [NEFA] and [BHB] measurements were available for 187 and 195 of the 219 samples, respectively. Liver [TG] correlated more strongly with cytology score than with NEFA or BHB, and receiver operating characteristic curve analysis showed that cytology had better diagnostic performance than either NEFA or BHB for correctly categorizing [TG] at thresholds of 5, 10, and 15%. Hepatic lipidosis in high-producing dairy cows is of major clinical and economic importance, and this study demonstrates that cytology is an accurate means of assessing HLC. Additional work is indicated to evaluate the diagnostic utility of liver cytology.

Radiation pneumonitis in non-small-cell lung cancer patients treated with helical tomotherapy

OBJECTIVE

In this study, we investigated the incidence of radiation pneumonitis (RP) in non-small-cell lung cancer (NSCLC) patients undergoing helical tomotherapy (HT) and the clinical and dosimetric factors associated with it.

MATERIALS AND METHODS

We analyzed data from the treatment protocols of 62 NSCLC patients. The median total radiation dose was 64 Gy (range 57.6-66 Gy) at 1.8-2.2 Gy/fraction. Thirty-four of these patients underwent HT alone and 28 underwent HT in combination with chemotherapy. Treatment-related pneumonitis was graded according to the Common Terminology Criteria for Adverse Events, version 3.0.

RESULTS

We found that RP grades 1, 2, 3 and 5 occurred in 29 (46.8%), 23 (37.1%), 8 (12.9%), and 2 (3.2%) patients, respectively. Using univariate analyses, we found that a grade ≥3 RP was associated with poor performance status (PS), age, planning target volume, mean lung dose, and relative V5through V25, in increments of 5 Gy (P < 0.005). We determined that PS and V5V15were the most significant factors associated with grade ≥3 RP using multivariate analysis.

CONCLUSIONS

We found that poor PS and V5-V15 were the risk factors associated with grade ≥3 RP in NSCLC patients treated with HT. Thus, for NSCLC patients treated with HT, the volume of total lung with low-dose region (V5-V15) should be carefully regulated and the use of HT should be restricted in patients with Eastern Cooperative Oncology Group ≥2.

[Insulin regimes and impact on glycemic control in patients with type 1 diabetes]

Objective: To describe the insulin regimens and their associations with glycemic control and to explore factors associated with intensive insulin therapy. Methods: Patients with type 1 diabetes (T1DM) were recruited from Guangdong Type 1 Diabetes Mellitus Translational Medicine Study which was conducted in 16 centers in Guangdong province. The demographic and clinical data were collected. Patients were grouped according to different insulin regimens: insulin pump (R1), basal insulin plus regular insulin or short-acting insulin (R2), insulin injection 1-3 times per day (R3). Distribution of insulin regimens and the relationships between insulin regimens and hemoglobin A1c (HbA1c) were described. Multivariate logistic regression was used to identify factors associated with intensive insulin therapy. Results: A total of 1 421 patients with the age of 27.8 (19.4, 38.3) years and a duration of T1DM of 3.3 (0.5, 7.1) years were recruited. There was 12.3% of patients in R1 (n=175), 35.5% in R2 (n=504), and 52.2% in R3 (n=742), respectively. HbA1c was 8.0 (6.8, 9.3)%, 8.9 (7.1, 11.8)%, and 9.2 (7.5, 11.4)% in R1, R2, R3, respectively, and it was associated with insulin regimens (P<0.001). HbA1c target rate was 32.3%, 21.1%, 17.8% in R1, R2, R3, respectively (P=0.002). Older age (OR=1.01, P=0.027), higher education level (college or above) (OR=1.56, P=0.003), and higher household income (>30 000 yuan per year per person)(OR=1.45, P=0.009) were associated with intensive insulin therapy in adult patients. Conclusions: The study suggested that insulin therapy need to be optimized in patients with T1DM. The optimization of insulin regimens and diabetes education may be helpful for improvement of glycemic control.

[Study on sweat gland regeneration induced by microenvironment of three-dimensional bioprinting]

Sweat glands are abundant in the body surface and essential for thermoregulation. Sweat glands fail to conduct self-repair in patients with large area of burn and trauma, and the body temperature of patients increases in hot climate, which may cause shock or even death. Now, co-culture system, reprogramming, and tissue engineering have made progresses in inducing sweat gland regeneration, but the inductive efficiency and duration need to be improved. Cellular microenvironment can regulate cell biological behavior, including cell migration and cell differentiation. This article reviews the studies of establishment of microenvironment in vitro by three-dimensional bioprinting technology to induce sweat gland regeneration.

Wax: A benign hydrogen-storage material that rapidly releases H2-rich gases through microwave-assisted catalytic decomposition

Hydrogen is often described as the fuel of the future, especially for application in hydrogen powered fuel-cell vehicles (HFCV's). However, its widespread implementation in this role has been thwarted by the lack of a lightweight, safe, on-board hydrogen storage material. Here we show that benign, readily-available hydrocarbon wax is capable of rapidly releasing large amounts of hydrogen through microwave-assisted catalytic decomposition. This discovery offers a new material and system for safe and efficient hydrogen storage and could facilitate its application in a HFCV. Importantly, hydrogen storage materials made of wax can be manufactured through completely sustainable processes utilizing biomass or other renewable feedstocks.