Vesical Imaging-Reporting and Data System (VI-RADS) as a grouping imaging biomarker combined with a decision-tree mode to preoperatively predict the pathological grade of bladder cancer

AIM

To investigate whether the Vesical Imaging-Reporting and Data System (VI-RADS) could be used to develop a new non-invasive preoperative grade-prediction system to partially predict high-grade bladder cancer (HG-BC).

MATERIALS AND METHODS

The present study enrolled 89 primary BC patients prospectively from March 2022 to June 2023. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of VI-RADS for predicting HG-BC and muscle-invasive bladder cancer (MIBC) in the entire group. In the low VI-RADS (≤2) group, the decision tree-based method was used to obtain significant predictors and construct the decision-tree model (DT model). The performance of the DT model and low VI-RADS scores for predicting HG-BC was determined using ROC, calibration, and decision curve analyses.

RESULTS

At a cut-off of ≥3, the specificity and positive predictive value of VI-RADS for predicting HG-BC in the entire group was 100%, and the area under the ROC curve (AUC) was 0.697. Among 65 patients with low VI-RADS scores, the DT model showed an AUC of 0.884 in predicting HG-BC compared to 0.506 for low VI-RADS scores. Calibration and decision curve analyses showed that the DT model performed better than the low VI-RADS scores.

CONCLUSION

Most VI-RADS scores ≥3 correspond to HG-BCs. VI-RADS could be used as a grouping imaging biomarker for a pathological grade-prediction procedure, which in combination with the DT model for low VI-RADS (≤2) populations, would provide a potential preoperative non-invasive method of predicting HG-BC.

Association between coronary artery disease and clinical outcome in cancer patients: A propensity score matching analysis

Objective

The aim of this study was to evaluate the prognostic value of coronary artery disease (CAD) detected by coronary computed tomography angiography (CTA) to predict the risk of all-cause mortality in cancer patients in a propensity score matching (PSM) analysis.

Methods

A total of 331 patients who previously had cancer and underwent coronary CTA from January 2015 to December 2019 were included. Multivariate Cox proportional hazards regression analysis and propensity-score matching analysis were performed. The primary endpoint was all-cause of mortality.

Results

In total, 125 with CAD and 206 with no CAD during a median follow-up of 3.3 years were included in this study. After PSM, age (HR, 1.040; 95%CI, 1.001-1.081; p = 0.014) and CAD (HR, 2.164; 95%CI, 1.057-4.430; p = 0.035) remained significant factors for all-cause mortality.

Conclusion

CAD evaluated by coronary CTA was found to be at higher risk for all-cause mortality in cancer patients. Due to the retrospective design and lack of information on some medical history and treatments, especially immune checkpoint inhibitors, a large-scale prospective study is needed to further determine the prognostic value of coronary CTA in cancer patients.

Sensitivity and specificity of folate receptor α-positive circulating tumour cells in gastric cancer

PURPOSE

We aimed to investigate whether folate receptor α (FRα)-positive circulating tumour cells (CTCs) could be used as a noninvasive liquid biopsy approach in gastric cancer (GC).

METHODS

Tissue microarray and bioinformatic analyses were used to evaluate FRα expression in GC. Patients with FRα-positive CTC examinations at our institute between July 2021 and May 2022 were retrospectively evaluated. Receiver operating characteristic curves were used to evaluate the diagnostic performance of FRα-positive CTCs in GC.

RESULTS

FRα was highly expressed and associated with poor prognosis in GC based on public database. Data for 163 patients (20 with benign disease and 143 with GC) were retrospectively collected. FRα-positive CTC levels were significantly higher in the GC group than in the benign disease group (12.15 ± 1.47 FU/3 ml vs. 10.47 ± 1.63 FU/3 ml, P < 0.01). FRα-positive CTC levels were also elevated in GC patients with vessel/neuron invasion or extra-nodal tumour deposits (12.31 ± 1.47 FU/3 ml vs. 11.77 ± 1.38 FU/3 ml, P = 0.037). Areas under the curve of FRα-positive CTC levels for GC and early GC were 0.774 (P < 0.001) and 0.736 (P = 0.005). With a cut-off value of 10.95 FU/3 ml, the Youden indexes for GC and early GC were 0.502 (sensitivity = 85.2% and specificity = 65.0%) and 0.450 (sensitivity = 80.0% and specificity = 65.0%), respectively.

CONCLUSION

FRα-positive CTC detection by noninvasive liquid biopsy is a useful and effective approach for screening of patients with GC.

KEY MESSAGES

[Migratory pulmonary ground glass opacities caused by SARS-CoV-2 infection in a patient on B-cell depletion therapy]

In immunosuppressed individuals, the manifestation of viral pneumonia due to SARS-CoV-2 infection differs from that in healthy individuals. We reported a unique case of a 58-year-old male patient with B-cell depletion following treatment with the anti-CD20 monoclonal antibody. He presented to the Department of Pulmonary and Critical Care Medicine with complaints of intermittent fever and cough for three months, aggravated by shortness of breath for one month. He was previously diagnosed with stage IVA follicular lymphoma in April 2022 and underwent chemotherapy with Obinutuzumab (anti-CD20 monoclonal antibody). His last treatment was on November 3, 2022. On December 20, 2022, after contact with a SARS-CoV-2-infected person, he exhibited symptoms of fever peaking at 39.0 ℃, cough, and sputum production. A positive SARS-CoV-2 nucleic acid result was confirmed from a pharyngeal swab. Nine days later (December 29, 2022), the patient still had a fever. Chest CT showed multiple small pieces of ground glass opacities (GGOs) in both lower lungs. The diagnosis of viral pneumonia due to SARS-CoV-2 infection was confirmed. After five days of treatment with nirmatrelvir/ritonavir (Paxlovid) and intravenous dexamethasone (5 mg/d), his fever subsided. However, a subsequent chest CT on January 9, 2023 showed partial resorption of multiple GGOs in both lungs, accompanied by novel focal lesions. The patient developed a fever again on January 29, 2023, after which he had recurrent symptoms of fever, cough, and sputum, with intermittent short courses of antibiotics and dexamethasone, which never completely resolved. Multiple chest CTs during this period showed recurrent GGOs and consolidations in both lungs, demonstrating a migratory pattern. The patient was admitted to our hospital on March 7, 2023, with a peripheral blood test suggesting lymphocytopenia, a CD19+B lymphocyte count of zero, and negative IgG and IgM for SARS-CoV-2. A bronchoscopy and bronchoalveolar lavage fluid (BALF) analysis indicated a significantly elevated lymphocyte percentage and the presence of SARS-CoV-2 nucleic acid. Given the three-month history of chronic fever and respiratory symptoms, changing bilateral pulmonary infiltrates, and lack of SARS-CoV-2 humoral immunity, a diagnosis of persistent SARS-CoV-2 infection was considered. Subsequent treatment with Paxlovid for 15 days resulted in the resolution of all symptoms. A follow-up chest CT one month later showed almost complete normalization.

Identification and functional characterization of eight novel tpp family genes from Bacillus thuringiensis

BACKGROUND

Bacillus thuringiensis (Bt) and its transgenic crops are widely used as biological control agents for agricultural pests. The tpp family is a branch of Bt insecticidal genes and consists of a few members. Research on the Tpp family proteins has focused on the binary toxins Gpp34Ab/Tpp35Ab and Tpp1/Tpp2, which need to function together to achieve insecticidal activity. However, only a few tpp family genes have been reported to exert insecticidal activity independently. This study aimed to identify and characterize tpp family genes that independently perform insecticidal functions.

RESULTS

A total of 162 nucleotide sequences homologous to the single component Bt insecticidal gene tpp78Aa were obtained from the genome data of 1368 wild-type Bt strains, and 25 new full-length tpp family genes were identified. Eight new tpp family genes were successfully cloned and expressed, and bioassays of the expressed products were performed against five different pests. Bioassay results showed that these proteins exerted high insecticidal activity only against Laodelphax striatellus, a globally important rice pest, and were named Tpp78Ab1, Tpp78Bb1, Tpp78Ca1, Tpp78Da1, Tpp80Aa3, Tpp80Ac1, Tpp80Ad1, and Tpp80Ae1. The LC50 values of Tpp78Ab1, Tpp78Bb1, Tpp78Ca1, and Tpp80Ae1 against L. striatum were 8.1, 8.6, 10.1, and 9.6 μg mL-1 , respectively. The phylogenetic tree and conserved motifs indicated that the Tpp family had a common evolutionary ancestor. During evolution, the C-terminal pore-forming domain of the Tpp family adopted a similar arrangement; however, the N-terminal conserved motif showed high variability.

CONCLUSION

Twenty-five full-length tpp family genes were identified. Eight new tpp family genes were cloned successfully, which could independently achieve insecticidal activity against L. striatellus. This provides abundant genetic resources for the biological control of important rice pests. In this study, we found that the relative conservation of the Tpp family proteins in the lengthy evolutionary process and the diversity generated for adapting to the environment can lay a theoretical foundation for an in-depth analysis of the function and evolution of the Tpp family. © 2023 Society of Chemical Industry.

[Preliminary evaluation of immunogenicity and protective effect of multicomponent recombinant protein vaccine EPRHP014 against tuberculosis]

Objective: To evaluate the immunogenicity and protective effect of a multicomponent recombinant protein vaccine EPRHP014 constructed independently and provide a scientific basis for developing new tuberculosis (TB) vaccine and effective prevention and control of TB. Methods: Three full-length Mycobacterium (M.) tuberculosis protein antigens (EsxH, Rv2628, and HspX) and two epitope-predicted and optimized epitope-dominant protein antigens (nPPE18 and nPstS1) were selected, from which five protein antigens were used to construct a protein antigen composition EPRHP014, including a fusion expression multi-component protein antigen (EPRHP014f) and a multi-component mixed protein antigen (EPRHP014m) formed with the five single protein using clone, purification, and purification respectively. Multicomponent protein vaccines EPRHP014f and EPRHP014m were prepared with aluminum adjuvant, and the BCG vaccine was used as a control. ELISA detected the titer of serum-specific antibodies, the secretion of various cytokines was detected by ELISpot and Luminex, and immune protection was observed by the M. tuberculosis growth inhibition test in vitro. The results were statistically analyzed by t-test or rank sum test, and P<0.05 was considered a statistically significant difference. Results: Mice Immunized with EPRHP014m and EPRHP014f could produce highly effective IgG antibodies and their subtypes IgG1 and IgG2a, and the antibody titers were similar to those of mice immunized with BCG, with no statistical significance (P>0.05). The number of spot-forming cells (SFC) secreting IFN-γ and IL-4 induced by EPRHP014f group was significantly higher than those by EPRHP014m group and BCG group (P<0.05), but there was no significant difference in the number of SFC for IFN-γ and IL-4 induced between EPRHP014m group and BCG group (P>0.05). The secretion levels of GM-CSF and IL-12p70 induced by the EPRHP014m group were higher than those of the BCG group (P<0.05), but there was no significant difference in the levels of IL-6 and IL-10 induced between EPRHP014m group and BCG group (P>0.05). There was no significant difference in the secretions of IL-6, IL-10, IL-12, and GM-CSF between the EPRHP014f and BCG groups (P>0.05). EPRHP014m group, EPRHP014f group, and BCG group had obvious antibacterial effects in vitro, and the difference was insignificant (P>0.05). Conclusion: Both EPRHP014f and EPRHP014m can induce strong humoral and cellular immune responses in mice after immunization, and have a strong ability to inhibit the growth of M. tuberculosis in vitro, indicating that the antigen composition EPRHP014 has good potential in the development and application of TB vaccine.

Genome-Wide Identification and Evolution of the GRF Gene Family and Functional Characterization of PbGRF18 in Pear

Proteins encoded by the G-box regulating factor (GRF, also called 14-3-3) gene family are involved in protein-protein interactions and mediate signaling transduction, which play important roles in plant growth, development, and stress responses. However, there were no detailed investigations of the GRF gene family in pear at present. In this study, we identified 25 GRF family members in the pear genome. Based on a phylogenetic analysis, the 25 GRF genes were clustered into two groups; the ε group and the non-ε group. Analyses of the exon-intron structures and motifs showed that the gene structures were conserved within each of the ε and non-ε groups. Gene duplication analysis indicated that most of the PbGRF gene expansion that occurred in both groups was due to WGD/segmental duplication. Phosphorylation sites analysis showed that the main phosphorylation sites of PbGRF proteins were serine residues. For gene expression, five PbGRF genes (PbGRF7, PbGRF11, PbGRF16, PbGRF21, and PbGRF23) were highly expressed in fruits, and PbGRF18 was highly expressed in all tissues. Further analysis revealed that eight PbGRF genes were significantly differentially expressed after treatment with different sugars; the expression of PbGRF7, PbGRF8, and PbGRF11 significantly increased, implying the involvement of these genes in sugar signaling. In addition, subcellular localization studies showed that the tested GRF proteins localize to the plasma membrane, and transgenic analysis showed that PbGRF18 can increase the sugar content in tomato leaves and fruit. The results of our research establish a foundation for functional determination of PbGRF proteins, and will help to promote a further understanding of the regulatory network in pear fruit development.

NEK8 regulates colorectal cancer progression via phosphorylating MYC

Radiotherapy and chemotherapy remain the mainstay of treatment for colorectal cancer (CRC), although their efficacy is limited. A detailed understanding of the molecular mechanisms underlying CRC progression could lead to the development of new therapeutic strategies. Although it has been established that MYC signaling is dysregulated in various human cancers, direct targeting MYC remains challenging due to its "undruggable" protein structure. Post-translational modification of proteins can affect their stability, activation, and subcellular localization. Hence, targeting the post-translational modification of MYC represents a promising approach to disrupting MYC signaling. Herein, we revealed that NEK8 positively regulates CRC progression by phosphorylating c-MYC protein at serine 405, which exhibited enhanced stability via polyubiquitination. Our findings shed light on the role of NEK8/MYC signaling in CRC progression, offering a novel and helpful target for colorectal cancer treatment. Video Abstract.

Association of statin use and increase in lipoprotein(a): a real-world database research

BACKGROUND

There is an increased concern that statins may have an unintended effect of elevated lipoprotein(a) [Lp(a)]. We conducted a large sample real-world study to test the association.

METHODS

This retrospective cohort study was conducted using data from an integrated SuValue database, which includes 221 hospitals across China covering more than 200,000 of population with longitudinal follow-up to 10 years. Propensity score matching was applied to identify two comparable cohorts with statin users and non-statin users. Detailed follow-up information such as Lp(a) levels were extracted. The hazard ratio was calculated on Lp(a) changes based on the statin usage cohorts. Detailed subgroup and different characteristic cohorts' analyses were also conducted.

RESULTS

After baseline propensity score matching, a total of 42,166 patients were included in a 1:1 matched ratio between statin users and non-statin users. In the case of no difference in low density lipoprotein (LDL-C), Lp(a) was increased significantly with the use of statins (adjusted HR 1.47; 95% confidence interval [CI] 1.43-1.50). Lp(a) increase was observed in various subgroup analyses and different cohorts. The dose intensity of statin was positively associated with the evaluated Lp(a) level.

CONCLUSION

The use of statins was associated with an increased risk of Lp(a) elevation compared with non-statin use counterparts. The clinical relevance of these increases needs to be addressed in surrogate marker trials and/or large, cardiovascular outcomes trials.

Prognostic value of coronary CTA-based classifications for predicting major events without obstructive coronary artery disease

We aim to explore the classifications based on coronary computed tomography angiography (CTA) for predicting the risk of major adverse cardiovascular events (MACE) in patients with suspected non-obstructive coronary artery disease (CAD) and compare with traditional non-obstructive CAD (NOCAD) classification, Duke prognostic NOCAD index, Non-obstructive coronary artery disease reporting and data system (NOCAD-RADS). 4378 consecutive non-obstructive CAD patients were assessed by coronary CTA for traditional NOCAD classification, Duke prognostic NOCAD index, NOCAD-RADS and a new classification (stenosis proximal involvement, SPI) from two medical centrals. We defined proximal involvement as any plaque was present in the main or proximal segments of coronary artery (left main, left anterior descending artery, left circumflex artery, or right coronary artery). The main outcome was MACE. During a median follow-up of 3.7 years, a total of 310 patients experienced MACE event. Kaplan-Meier survival curves showed the cumulative events increased significantly associated with traditional NOCAD, Duke NOCAD index, NOCAD-RADS and SPI classifications (all P < 0.001). In multivariate Cox regressions, the risk for the events increased from HR 1.20 (95% CI 0.78-1.83, P = 0.408) for SPI 1 to 1.35 (95% CI 1.05-1.73, P = 0.019) for SPI 2, using SPI 0 as the reference group. Coronary CTA based SPI classification provided important prognostic information for all cause-mortality risk and MACE prediction in patients with non-obstructive CAD, which was non-inferior than traditional NOCAD, Duke NOCAD Index and NOCAD-RADS classifications. The plaque location information by coronary CTA may provide additional risk prediction in patients with non-obstructive CAD.

Non-obstructive CAD and Risk of All-cause Mortality in Middle-aged and Older Patients: a Nine-Year Follow-up and Multicentre Study

AIM

We aimed to examine all-cause mortality risk in relation to the extent of non-obstructive coronary artery disease (CAD) by coronary computed tomography angiography (CTA) in Chinese middle-aged and older patients in a multicenter study with nine-year follow-up.

METHODS

This was a retrospective, observational, multicentre study. The study population consisted of 3,240 consecutive middle-aged and older patients (age ≥ 40 years) with suspected CAD who underwent coronary CTA between June 2011 and December 2013 at three hospitals in Wuhan, China. Patients were grouped according to CAD extent for the final analysis: no CAD, 1-vessel non-obstructive CAD, 2-vessels non-obstructive CAD, and 3-vessels non-obstructive CAD. The primary endpoint was all-cause mortality. Kaplan-Meier method and Cox proportional hazards regression models were used for analysis.

RESULTS

A total of 2,522 patients were included in the present analysis. Of these, 188 (7.5%) deaths occurred during the median 9.0 years (interquartile range 8.6-9.4) of study follow-up. The annualized all-cause mortality rate was 0.54 (95% CI: 0.44-0.68), 0.91 (95% CI: 0.68-1.21), 1.44 (95% CI: 1.01-1.93), and 2.00 (95% CI: 1.46-2.69) for the no CAD, 1-vessel non-obstructive CAD, 2-vessels non-obstructive CAD, and 3-vessels non-obstructive CAD group, respectively. Kaplan-Meier survival curves showed a significant increase in the cumulative events associated with the extent of non-obstructive CAD (P < 0.001). In multivariate Cox regression, after adjustment for age and sex, the presence of 3-vessels non-obstructive CAD was a significant predictor of all-cause mortality (HR 1.60, 95% CI: 1.04-2.45, P = 0.032).

CONCLUSION

In this cohort of Chinese middle-aged and older patients undergoing coronary CTA, the presence and extent of non-obstructive CAD, compared to no CAD, were associated with a significantly greater nine-year risk of all-cause mortality. The present findings suggest the clinical importance of the stage of non-obstructive CAD and warrant investigation of the optimal risk stratification to improve outcomes among these patients.

Polystyrene microplastics enhance the microcystin-LR-induced gonadal damage and reproductive endocrine disruption in zebrafish

The coexistence of eutrophication and plastic pollution in the aquatic environment is becoming a realistic water pollution problem worldwide. To investigate the microcystin-LR (MC-LR) bioavailability and the underlying reproductive interferences in the presence of polystyrene microplastic (PSMPs), zebrafish (Danio rerio) were exposed to individual MC-LR (0, 1, 5, and 25 μg/L) and combined MC-LR + PSMPs (100 μg/L) for 60 d. Our results showed that the existence of PSMPs increased the accumulation of MC-LR in zebrafish gonads compared to the MC-LR-only group. In the MC-LR-only exposure group, seminiferous epithelium deterioration and widened intercellular spaces were observed in the testis, and basal membrane disintegration and zona pellucida invagination were noticed in the ovary. Moreover, the existence of PSMPs exacerbated these injuries. The results of sex hormone levels showed that PSMPs enhanced MC-LR-induced reproductive toxicity, which is tightly related to the abnormal increase of 17β-estradiol (E2) and testosterone (T) levels. The changes of gnrh2, gnrh3, cyp19a1b, cyp11a, and lhr mRNA levels in the HPG axis further proved that MC-LR combined with PSMPs aggravated reproductive dysfunction. Our results revealed that PSMPs could increase the MC-LR bioaccumulation by serving as a carrier and exaggerate the MC-LR-induced gonadal damage and reproductive endocrine disruption in zebrafish.

Comparison of prognostic value between CAD-RADS 1.0 and CAD-RADS 2.0 evaluated by convolutional neural networks based CCTA

Objectives

The aim of the present study was to investigate the prognostic value of the novel coronary artery disease reporting and data system (CAD-RADS) 2.0 compared with CAD-RADS 1.0 in patients with suspectedcoronary artery disease (CAD) evaluated by convolutional neural networks (CNN) based coronary computed tomography angiography (CCTA).

Methods

A total of 1796 consecutive inpatients with suspected CAD were evaluated by CCTA for CAD-RADS 1.0 and CAD-RADS 2.0 classifications. Kaplan-Meier and multivariate Cox models were used to estimate major adverse cardiovascular events (MACE) inclusive of all-cause mortality or myocardial infarction (MI). The C-statistic was used to assess the discriminatory ability of the two classifications.

Results

In total, 94 (5.2%) MACE occurred over the median follow-up of 45.25 months (interquartile range 43.53-46.63 months). The annualized MACE rate was 0.014 (95% CI: 0.011-0.017). Kaplan-Meier survival curves indicated that the CAD-RADS classification, segment involvement score (SIS) grade, and Computed Tomography Fractional Flow Reserve (CT-FFR) classification were all significantly associated with the increase in the cumulative MACE (all P < 0.001). CAD-RADS classification, SIS grade, and CT-FFR classification were significantly associated with endpoint in univariate and multivariate Cox analysis. CAD-RADS 2.0 showed a further incremental increase in the prognostic value in predicting MACE (c-statistic 0.702, 95% CI: 0.641-0.763, P = 0.047), compared with CAD-RADS 1.0.

Conclusions

The novel CAD-RADS 2.0 evaluated by CNN-based CCTA showed higher prognostic value of MACE than CAD-RADS 1.0 in patients with suspected CAD.

Natural variations in the PbCPK28 promoter regulate sugar content through interaction with PbTST4 and PbVHA-A1 in pear

Soluble sugars play an important role in plant growth, development and fruit quality. Pear fruits have demonstrated a considerable improvement in sugar quality during their long history of selection. However, little is known about the underlying molecular mechanisms accompanying the changes in fruit sugar content as a result of selection by horticulturists. Here, we identified a calcium-dependent protein kinase (PbCPK28), which is located on LG15 and is present within a selective sweep region, thus linked to the quantitative trait loci for soluble solids. Association analysis indicates that a single nucleotide polymorphism-13 variation (SNP13^T/C ) in the PbCPK28 regulatory region led to fructose content diversity in pear. Elevated expression of PbCPK28 resulted in significantly increased fructose levels in pear fruits. Furthermore, PbCPK28 interacts with and phosphorylates PbTST4, a proton antiporter, thereby coupling the sugar import into the vacuole with proton export. We demonstrated that residues S277 and S314 of PbTST4 are crucial for its function. Additionally, PbCPK28 interacts with and phosphorylates the vacuolar hydrogen proton pump PbVHA-A1, which could provide proton motive forces for PbTST4. We also found that the T11 and Y120 phosphorylation sites in PbVHA-A1 are essential for its function. Evolution analysis and yeast-two-hybrid results support that the CPK-TST/CPK-VHA-A regulatory network is highly conserved in plants, especially the corresponding phosphorylation sites. Together, our work identifies an agriculturally important natural variation and an important regulatory network, allowing genetic improvement of fruit sugar contents in pears through modulation of PbCPK28 expression and phosphorylation of PbTST4 and PbVHA-A1.

Sub-chronic ammonia exposure induces hepatopancreatic damage, oxidative stress, and immune dysfunction in red swamp crayfish (Procambarus clarkii)

Ammonia, as one of the primary water pollutants in aquaculture, has been shown to induce a wide range of ecotoxicological effects on aquatic animals. In order to investigate the antioxidant and innate immune responses in crustaceans disrupted by ammonia, red swamp crayfish (Procambarus clarkii) were exposed to 0, 15, 30, and 50 mg/L total ammonia nitrogen for 30 d, the alterations of antioxidant responses as well as innate immunity were studied. The results showed that the severity of hepatopancreatic injury were aggravated by the increasing ammonia levels, which were mainly characterized by tubule lumen dilatation and vacuolization. The swollen mitochondria and disappeared mitochondria ridges suggested that oxidative stress induced by ammonia targets the mitochondria. Concurrently, enhanced MDA levels, and decreased GSH levels as well as the decreased transcription and activity of antioxidant enzymes, including SOD, CAT, and GPx were noticed, which suggested that high concentrations of ammonia exposure induce oxidative stress in P. clarkii. Furthermore, a significant decrease of the hemolymph ACP, AKP, and PO along with the significant downregulation of immune-related genes (ppo, hsp70, hsp90, alf1, ctl) jointly indicated that ammonia stress inhibited the innate immune function. Our findings demonstrated that sub-chronic ammonia stress induced hepatopancreatic injury and exert suppressive effects on the antioxidant capacity as well as innate immunity of P. clarkii. Our results provide a fundamental basis for the deleterious effects of ammonia stress on aquatic crustaceans.

International Validation of a Methicillin-Resistant Staphylococcus aureus Risk Assessment Tool for Skin and Soft Tissue Infections

INTRODUCTION

To promote judicious prescribing of methicillin-resistant Staphylococcus aureus (MRSA)-active therapy for skin and soft tissue infections (SSTI), we previously developed an MRSA risk assessment tool. The objective of this study was to validate this risk assessment tool internationally.

METHODS

A multicenter, prospective cohort study of adults with purulent SSTI was performed at seven international sites from July 2016 to March 2018. Patient MRSA risk scores were computed as follows: MRSA infection/colonization history (2 points); previous hospitalization, previous antibiotics, chronic kidney disease, intravenous drug use, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), diabetes with obesity (1 point each). Predictive performance of MRSA surveillance percentage, MRSA risk score, and estimated MRSA probability (surveillance percentage adjusted by risk score) were quantified using the area under the receiver operating characteristic curves (aROC) and compared. Performance characteristics of different risk score thresholds across varying baseline MRSA prevalence were examined.

RESULTS

Two hundred three patients were included. Common SSTI were wounds (28.6%), abscess (25.1%), and cellulitis with abscess (20.7%). Patients with higher risk scores were more likely to have MRSA (P < 0.001). The MRSA risk score aROC (95%CI) [0.748 (0.678-0.819)] was significantly greater than MRSA surveillance percentage [0.646 (0.569-0.722)] (P = 0.016). Estimated MRSA probability aROC [0.781 (0.716-0.845)] was significantly greater than surveillance percentage (P < 0.001) but not the risk score (P = 0.192). The estimated negative predictive value (NPV) of an MRSA score ≥ 1 (i.e., a score of 0) was greater than 90% when MRSA prevalence was 30% or less.

CONCLUSION

The MRSA risk score and estimated MRSA probability were significantly more predictive of MRSA compared with surveillance percentage. An MRSA risk score of zero had high predictive value and could help avoid unnecessary empiric MRSA coverage in low-acuity patients. Further study, including impact of such risk assessment tools on prescribing patterns and outcomes are required before implementation.

An identical-by-descent segment harbors a 12-bp insertion determining fruit softening during domestication and speciation in Pyrus

BACKGROUND

Although the wild relatives of pear originated in southwest China, this fruit crop was independently domesticated and improved in Asia and Europe, and there are major phenotypic differences (e.g., maturity and fruit firmness) between Asian and European pears.  RESULTS: In this study, we examined the genomes of 113 diverse pear accessions using an identity-by-descent (IBD) approach to investigate how historical gene flow has shaped fruit firmness traits in Asian and European pears. We found a 3-Mbp IBD-enriched region (IBD-ER) that has undergone "convergent domestication" in both the Asian and European pear lineages, and a genome-wide association study (GWAS) of fruit firmness phenotypes strongly implicated the TRANSLOCON AT THE INNER CHLOROPLAST ENVELOPE55 (TIC55) locus within this 3-Mbp IBD-ER. Furthermore, we identified a tandem duplication that includes a 12-bp insertion located in the first exon of TIC55 that is uniquely present in Asian pears, and expression analysis showed that the pear TIC55 gene is highly expressed in Asian pear, while it is weakly or not expressed in European pear; this could contribute to the differences in fruit firmness between Asian and European pear fruits.

CONCLUSIONS

Our findings provide insights into how pear fruit softening has been impacted during domestication, and we identified candidate genes associated with fruit softening that can contribute to the breeding and improvement of pear and other fruit crops.

Distinct vulnerability to oxidative stress determines the ammonia sensitivity of crayfish (Procambarus clarkii) at different developmental stages

Red swamp crayfish (Procambarus clarkii) has increasingly become a high-value freshwater product in China. During the intensive cultivation, excessive ammonia exposure is an important lethal factor of crayfish. We investigated the toxic effects and mechanisms of ammonia on crayfish at two different developmental stages. A preliminary ammonia stress test showed a 96-h LC₅₀ of 135.10 mg/L and 299.61 mg/L for Stage_1 crayfish (8.47 ± 1.68 g) and Stage_2 crayfish (18.33 ± 2.41 g), respectively. During a prolonged ammonia exposure (up to 96 h), serum acid phosphatase and alkaline phosphatase showed a time-dependent decrease. Histological assessment indicated the degree of hepatopancreatic injury, which was mainly characterized as tubule lumen dilatation, degenerated tubule, vacuolization and dissolved hepatic epithelial cell, increased with exposure time. Enhanced malondialdehyde level and reduced antioxidant capacity of hepatopancreas were also observed. The mRNA expression and activity of catalase and superoxide dismutase showed an initial up-regulation within 24 h, and then gradually down-regulated with the exposure time. In the post-treatment recovery period, the Stage_2 crayfish exerted a stronger antioxidant and detoxification capacity than that of the Stage_1 crayfish, and thus quickly recovered from the ammonia exposure. Our findings provide a further understanding of the adverse effects of ammonia stress and suggest guidelines for water quality management during crayfish farming.

The crystal structure of Cry78Aa from Bacillus thuringiensis provides insights into its insecticidal activity

Genetically modified plants with insecticidal proteins from Bacillus thuringiensis (Bt) have been successfully utilized to control various kinds of pests in crop production and reduce the abuse of pesticides. However, a limited number of genes are available for the protection of crops from rice planthopper. Recently, Cry78Aa protein from Bt strain C9F1 has been found to have high insecticidal activity against Laodelphax striatellus and Nilaparvata lugens. It is the first reported single-component protein in the world to combat rice planthoppers, making it very promising for use in transgenic crops. The ambiguous mechanism of Cry78Aa functions prevented further engineering or application. Here, we report the crystal structure of Cry78Aa, which consists of two domains: a C-terminal β-pore forming domain belonging to the aerolysin family and an N-terminal trefoil domain resembling the S-type ricin B lectin. Thus, Cry78Aa could represent a distinctive type of β-pore forming toxin. We also found that Cry78Aa binds carbohydrates such as galactose derivatives and is essential for insecticidal activity against Laodelphax striatellus. Our results suggest a mechanism underlying the function of Cry78Aa against rice planthoppers and pave the way to maximizing the usage of the toxin.

The crystal structure of the Bacillus thuringiensis protein Cry78Aa shows it consists of a C-terminal β-pore forming domain and an N-terminal trefoil domain and suggests a mechanism underlying the function of Cry78Aa against rice planthoppers.

Short-term outcomes of D2 lymphadenectomy plus complete mesogastric excision for gastric cancer: a propensity score matching analysis

BACKGROUND

Our previous study has demonstrated the surgical advantages of D2 lymphadenectomy plus complete mesogastric excision (D2 + CME) in gastric cancer surgery. To further verify the safety of D2 + CME procedure, we conducted this large-scale, observational cohort study and applied propensity score matching (PSM) approach to compare D2 + CME with conventional D2 in terms of short-term outcomes in gastric cancer patients.

METHODS

Data on 855 patients from Tongji Hospital who underwent laparoscopic-assisted distal gastrectomy (LADG) with R0 resection (496 in the conventional D2 cohort and 359 in the D2 + CME cohort) between Dec 12, 2013 and Dec 28, 2017 were retrieved from prospectively maintained clinical database. After PSM analysis at a 1:1 ratio, each cohort included 219-matched patients. Short-term outcomes, including surgical results, morbidity, and mortality within 30 days after the operation, were collected and analyzed.

RESULTS

In this large-scale, observational cohort study based on PSM analysis, the D2 + CME procedure showed less intra-laparoscopic blood loss, more lymph node harvest, and faster postoperative flatus than the conventional D2 procedure. However, both the overall and severe postoperative adverse events (Clavien-Dindo classification grade ≥ III a) seemed comparable between two cohorts.

CONCLUSION

The present study showed that D2 + CME was associated with better short-term outcomes than conventional D2 dissection for patients with resectable gastric cancer.

The Dual Roles of MAGE-C2 in p53 Ubiquitination and Cell Proliferation Through E3 Ligases MDM2 and TRIM28

The tumor suppressor p53 is critical for the maintenance of genome stability and protection against tumor malignant transformation, and its homeostasis is usually regulated by ubiquitination. MDM2 is a major E3 ligase of p53 ubiquitination, and its activity is enhanced by TRIM28. TRIM28 also independently ubiquitinates p53 as an E3 ligase activated by MAGE-C2. Moreover, MAGE-C2 is highly expressed in various cancers, but the detailed mechanisms of MAGE-C2 involved in MDM2/TRIM28-mediated p53 ubiquitination remain unknown. Here, we found that MAGE-C2 directly interacts with MDM2 through its conserved MHD domain to inhibit the activity of MDM2 on p53 ubiquitination. Furthermore, TRIM28 acts as an MAGE-C2 binding partner and directly competes with MAGE-C2 for MDM2 interaction, thus releasing the inhibitory role of MAGE-C2 and promoting p53 ubiquitination. MAGE-C2 suppresses cell proliferation in TRIM28-deficient cells, but the overexpression of TRIM28 antagonizes the inhibitory role of MAGE-C2 and accumulates p53 ubiquitination to promote cell proliferation. This study clarified the molecular link of MAGE-C2 in two major E3 systems MDM2 and TRIM28 on p53 ubiquitination. Our results revealed the molecular function of how MAGE-C2 and TRIM28 contribute to p53 ubiquitination and cell proliferation, in which MAGE-C2 acts as a potential inhibitor of MDM2 and TRIM28 is a vital regulator for MAGE-C2 function in p53 protein level and cell proliferation. This work would be helpful to understand the regulation mechanism of tumor suppressor p53.

Somatic mosaicism reveals clonal distributions of neocortical development

The structure of the human neocortex underlies species-specific traits and reflects intricate developmental programs. Here we sought to reconstruct processes that occur during early development by sampling adult human tissues. We analysed neocortical clones in a post-mortem human brain through a comprehensive assessment of brain somatic mosaicism, acting as neutral lineage recorders^1,2. We combined the sampling of 25 distinct anatomic locations with deep whole-genome sequencing in a neurotypical deceased individual and confirmed results with 5 samples collected from each of three additional donors. We identified 259 bona fide mosaic variants from the index case, then deconvolved distinct geographical, cell-type and clade organizations across the brain and other organs. We found that clones derived after the accumulation of 90-200 progenitors in the cerebral cortex tended to respect the midline axis, well before the anterior-posterior or ventral-dorsal axes, representing a secondary hierarchy following the overall patterning of forebrain and hindbrain domains. Clones across neocortically derived cells were consistent with a dual origin from both dorsal and ventral cellular populations, similar to rodents, whereas the microglia lineage appeared distinct from other resident brain cells. Our data provide a comprehensive analysis of brain somatic mosaicism across the neocortex and demonstrate cellular origins and progenitor distribution patterns within the human brain.

[A nomogram for predicting lymph node metastasis in early gastric cancer]

Objective: To explore the independent risk factors of lymph node metastasis (LNM) in early gastric cancer, and to use nomogram to construct a prediction model for above LNM. Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) primary early gastric cancer as stage pT1 confirmed by postoperative pathology; (2) complete clinicopathological data. Exclusion criteria: (1) patients with advanced gastric cancer, stump gastric cancer or history of gastrectomy; (2) early gastric cancer patients confirmed by pathology after neoadjuvant chemotherapy; (3) other types of gastric tumors, such as lymphoma, neuroendocrine tumor, stromal tumor, etc.; (4) primary tumors of other organs with gastric metastasis. According to the above criteria, 1633 patients with early gastric cancer who underwent radical gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital First Medical Center from December 2005 to December 2020 were enrolled as training set, meanwhile 239 patients with early gastric cancer who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital Fourth Medical Center from December 2015 to December 2020 were enrolled as external validation set. Risk factors of LNM in early gastric cancer were identified by using univariate and multivariate logistic regression analyses. A nomogram prediction model was established with significant factors screened by multivariate analysis. Area under the receiver operating characteristic curve (AUC) was used for assessing the predictive value of the model. Calibration curve was drawn for external validation. Results: Among 1633 patients in training set, the mean number of retrieved lymph nodes was 20 (13-28), and 209 patients (12.8%) had lymph node metastasis. Univariate analysis showed that gender, resection range, tumor location, tumor morphology, lymph node clearance, vascular invasion, lymphatic cancer thrombus, tumor length, tumor differentiation, microscopic presence of signet ring cells and depth of tumor invasion were associated with LNM (all P<0.05). Multivariate analysis revealed that females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa, and poor differentiation were independent risk factors for LNM in early gastric cancers (all P<0.05). Receiver operating characteristic curve indicated that AUC of training set was 0.818 (95%CI: 0.790-0.847) and AUC of external validation set was 0.765 (95%CI: 0.688-0.843). The calibration curve showed that the LNM probability predicted by nomogram was consistent with the actual situation (C-index: 0.818 in training set and 0.765 in external validation set). Conclusions: Females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa and poor differentiation are independent risk factors for LNM of early gastric cancer. The establishment of a nomogram prediction model for LNM in early gastric cancer has great diagnostic value and can provide reference for treatment selection.

[Advances in pathogen diagnosis of respiratory infection diseases in 2021]

Respiratory tract infections (RTI) are a common and highly prevalent disease in the population, which can develop into acute respiratory distress syndrome (ARDS) in severe cases.A large variety of microorganisms can cause RTI, including bacteria, respiratory viruses, and fungi. The timely and accurate detection of these pathogens is the prerequisites of effective treatment of RTI. However, more than 50% of RTI patients failed to diagnosis of causative agents due to unavailability of qualified samples, antimicrobial treatment prior to sample collection, high variety of respiratory pathogens, and influence of the normal flora in respiratory tract. In recent years, progress on molecular diagnosis, especially the novel approaches such as clinical metagenomics and CRSIPR (Clustered regularly interspaced short palindromic repeats), has not only improved our capacity for RTI pathogen detection but also brought new challenges. In this review, we summed up the advances in RTI pathogen diagnosis in 2021 and discussed the clinical benefits and challenges from novel approaches, which provided a clinical perspective on the development and application of these diagnostic tools in the real world.

[Analysis of influence factors for short-term recurrence of retroperitoneal liposarcoma after complete resection]

Objective: To examine the influence factors of short-term recurrence after complete surgical resection of retroperitoneal liposarcoma. Methods: The clinicopathological data of retroperitoneal liposarcoma at Department of General Surgery, the First Medical Center, People's Liberation Army General Hospital from January 1, 2000 to January 31, 2020 were retrospectively analyzed. There were 60 males and 31 females, aged (52.1±9.9) years (range: 30 to 84 years). Tumor recurrence within 12 months after complete resection was defined as short-term recurrence, and tumor recurrence more than 12 months was defined as non-short-term recurrence. The t test, rank-sum test, χ² test and Fisher exact test were conducted for inter-group comparison. Logistic regression analysis was used to analyze the independent influence factors for the short-term recurrence of retroperitoneal liposarcoma after complete resection. The Kaplan-Meier curve was used to calculate the recurrence-free survival, and the Log-rank test was adopted for the comparison between the groups. Results: The univariate analysis results showed that irregular tumor morphology, multiple pathological subtypes, pathological scores>3, and multiple primary tumors are influence factors for short-term recurrence after complete resection of retroperitoneal liposarcoma (χ²: 4.422 to 7.773, all P<0.05). Regression analysis of the above risk factors showed that multiple primary tumors was the independent risk factor (OR=2.918, 95%CI: 1.127 to 7.556, P=0.027). In the short-term recurrence group, Kaplan-Meier curve analysis showed that patients with multiple primary tumors had a shorter median recurrence time than patients with unifocal tumor (6 months vs. 9 months, P=0.028). Conclusions: Multiple primary tumor is an independent risk factor for short-term recurrence after complete resection of retroperitoneal liposarcoma. It suggests that the frequency of follow-up after surgery should be increased for such patients.

Modified Nuss operation using introducer-bar complex for pectus excavatum in adults: a retrospective study

Background

Shortcoming of traditional Nuss operation on adults is gradually found in the clinical practice. A new kind of introducer-bar complex was introduced. However, there is limited evidence regarding its safety and efficacy. Therefore, a single center, retrospective study was conducted to address this issue.

Methods

Patients with pectus excavatum who underwent surgery between January 2015 and June 2017 were consecutively enrolled in this study. In all, 52 patients underwent the modified procedure using the introducer-bar complex (new procedure group), whereas 48 underwent the traditional anti-Nuss procedure (traditional procedure group). Outcomes analysis of balanced baseline was performed to compare the intraoperative and postoperative short-term outcomes.

Results

All patients in the new procedure group had shorter operation duration (51.54 ± 20.32 vs. 79.45 ± 13.88 min, p = 0.017), postoperative hospitalizations (4.77 ± 1.62 vs. 6.86 ± 2.18 days, p = 0.028), plate removal surgery durations (39.30 ± 8.97 vs. 60.30 ± 10.49 min, p < 0.001), and less blood loss during operation (6.25 ± 4.88 vs. 10.90 ± 5.75 ml, p = 0.003) than patients in the traditional procedure group. There was no significant difference in the length of incision, postoperative Haller index, cost, number of steel bars, postoperative surgical outcome and incidence of complications between the two groups.

Conclusion

Through the main clinical outcome were similar, our results shown that modified procedure may have the shorter operation time, postoperative hospital stay, and operation time for plate removal and less blood loss, which may bring potential clinical benefits to patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13019-021-01624-6.

Developmental and temporal characteristics of clonal sperm mosaicism

Throughout development and aging, human cells accumulate mutations resulting in genomic mosaicism and genetic diversity at the cellular level. Mosaic mutations present in the gonads can affect both the individual and the offspring and subsequent generations. Here, we explore patterns and temporal stability of clonal mosaic mutations in male gonads by sequencing ejaculated sperm. Through 300× whole-genome sequencing of blood and sperm from healthy men, we find each ejaculate carries on average 33.3 ± 12.1 (mean ± SD) clonal mosaic variants, nearly all of which are detected in serial sampling, with the majority absent from sampled somal tissues. Their temporal stability and mutational signature suggest origins during embryonic development from a largely immutable stem cell niche. Clonal mosaicism likely contributes a transmissible, predicted pathogenic exonic variant for 1 in 15 men, representing a life-long threat of transmission for these individuals and a significant burden on human population health.

[Risk factors and clinical prognosis analysis of carbapenem-resistant Enterobacterales bacteria nosocomial infection]

Objective: To explore the risk factors for carbapenem-resistant Enterobacterales (CRE) infection and death. Methods: A case-control analysis of 482 inpatients in 18 secondary or tertiary hospitals in Beijing in 2018 was conducted. Patients infected by CRE were selected as the case group (n=247), and infected by carbapenem susceptible Enterobacterales (CSE) as the control group (n=235). The risk factors and clinical prognosis of CRE infection were analyzed by single factor analysis and multivariate logistic regression analysis. Results: CRE were resistant to most antimicrobials, but were highly sensitive to colistin and tigecycline, with sensitivity of 94.0% and 99.5%, respectively. Multivariate analysis showed that prior 30-day tracheal intubation (OR=2.607, 95%CI: 1.655-4.108, P<0.001), empirical treatment using third or fourth generation cephalosporins (OR=2.339, 95%CI: 1.438-3.803, P=0.001), carbapenems (OR=2.468, 95%CI: 1.610-3.782, P<0.001) and quinolones (OR=2.042, 95%CI: 1.268-3.289, P=0.003) were independent risk factors for CRE infection. Mechanical ventilation (OR=3.390, 95%CI: 1.454-7.904, P=0.005), heart failure (OR=4.679, 95%CI: 1.975-11.083, P<0.001), moderate or severe liver disease (OR=3.057, 95%CI: 1.061-8.806, P=0.038), prior 30-day quinolones exposure (OR=2.882, 95%CI: 1.241-6.691, P=0.014) and septic shock (OR=7.772, 95%CI: 3.505-17.233, P<0.001) were independent risk factors for death after CRE infection. Conclusions: Reducing the use of antimicrobials and invasive procedures such as prior 30-day tracheal intubation may reduce the probability of CRE infection. Grading the severity of the underlying disease in patients with CRE infection, as well as predicting and preventing the occurrence of septic shock will help reduce the risk of death.

Complete mesogastric excision for locally advanced gastric cancer: short-term outcomes of a randomized clinical trial

Implementation of complete mesogastric excision in gastric cancer surgery, named D2 lymphadenectomy plus complete mesogastric excision (D2+CME), has recently been proposed as an optimal procedure. However, the safety and efficacy of D2+CME remain uncertain. In this randomized controlled trial, patients receiving D2+CME exhibit less intraoperative blood loss, more lymph node harvesting, and earlier postoperative flatus than patients receiving conventional D2 radical surgery. Univariate Cox regression analysis reveals that the risk ratio for postoperative flatus in D2+CME group is 1.247 (p = 0.044). Overall postoperative complications are comparable between the two groups, but complications are significantly less severe in the D2+CME group than the D2 group (Clavien-Dindo classification grade ≥ IIIa: 4 D2+CME patients [11.8%] versus 9 D2 patients [33.3%]; p = 0.041). In conclusion, our work shows that D2+CME is associated with better short-term outcomes and surgical safety than conventional D2 dissection for patients with advanced gastric cancer.

Gastric cancer patients receiving D2+CME exhibit less intraoperative blood loss

The number of lymph nodes harvested with D2+CME is significantly improved

D2+CME surgery could provide faster postoperative flatus

D2+CME is less likely to cause severe complications than conventional surgery

The novel interaction mode among centromere sub-complex CENP-O/P/U/Q/R

The kinetochore is essential for the accurate segregation of sister chromosome in the eukaryote cell. Among the kinetochore subunits, five proteins CENP-O/P/U/Q/R form a stable complex, referred to as CENP-O class, and are required for proper kinetochore function. Although the function and structure of yeast COMA complex (CENP-O/P/U/Q homologs) have been revealed extensively, the assembly mechanism and detail interactions among human CENP-O class are significantly different and remain largely unclear. Here, we identified the fragment (residues 241-360) of CENP-U and the C-terminal half of CENP-Q are essential to form a hetero-complex and interact with CENP-O/P sub-complex in vitro. We for the first time showed that CENP-R does not directly interact with CENP-O/P in vitro, but indeed interact with CENP-U and CENP-Q. Furthermore, both the N- and C-terminus of CENP-R are required for the interaction with CENP-U and CENP-Q. Our research pinpointed a novel interaction pattern that might shed light on the assembly mechanism of vertebrate CENP-O class.

Effects of Bt Cry78Ba1 Toxin on Larvae and Adults of Apis mellifera (Hymenoptera: Apidae)

Cry78Ba1 is Bacillus thuringiensis Berliner (Bacillales: Bacillaceae) (Bt) protein found with high insecticidal activity against the piercing-sucking insect Laodelphax striatellus Fallén (Homoptera: Delphacidae) and has broad application prospects for control of the rice planthopper. As honey bees may be exposed to Bt Cry78Ba1 rice pollen by feeding, we evaluated the risk of Bt Cry78Ba1 toxin to Apis mellifera L. workers. A dietary exposure experiment was conducted on worker larvae and adults under controlled laboratory conditions to examine the effects of Cry78Ba1 toxin on honey bees. Worker bee larvae were fed a diet containing Cry78Ba1 toxin (0.01, 0.1, 1, and 10 mg/liter) on day 2 through day 5 after grafting, and adults were exposed to syrup containing Cry78Ba1 for up to 16 d. Negative control (no test substance added), solvent control (1 mM Tris-HCl), and positive control (dimethoate 45 mg/liter for the larva test, 1 and 45 mg/liter for the adult test) groups were established. Compared with the negative control, larvae and adults that consumed food containing Cry78Ba1 toxin exhibited no significant differences in survival, larval weight, or pollen or syrup consumption. This result indicates that chronic oral exposure to Cry78Ba1 toxin has no negative effects on honey bees at the maximum tested concentration.

[Risk factors of postoperative complication after total gastrectomy in advanced gastric cancer patients receiving neoadjuvant chemotherapy]

Objective: At present, there are few studies focusing on the factors short-term complications after total gastrectomy in patients with advanced gastric cancer receiving neoadjuvant chemotherapy (NACT). The purpose of this study is to provide a reference for clinical prevention of complications in these patients. Methods: A retrospective case-control study was conducted. Case inclusion criteria: (1) clinical stage II-III gastric cancer diagnosed by preoperative gastroscopy, pathology, abdominal CT, EUS or PET-CT; (2) evaluated suitable for NACT by MDT discussion; (3) no previous history of other malignant tumors and no concurrent tumor; (4) undergoing total gastrectomy+ D2 lymphadenectomy after NACT. Exclusion criteria: (1) age <18 or >80 years old; (2) severe concurrent diseases, and ASA classification>grade III; (3) stump gastric cancer or history of gastric surgery; (4) incomplete clinicopathological data. According to the above criteria, clinicopathological data of 140 advanced gastric cancer patients who underwent total gastrectomy after NACT in Chinese PLA General Hospital between June 2012 and June 2019 were collected, including 109 males and 31 females with mean age of (56.9±11.4) years and body mass indey (BMI) of (23.3±3.1) kg/m(2). Logistic analysis was used to analyze the relationship between postoperative complication and clinicopathological data. Factors in univariate analysis with P<0.05 were included in the multivariate analysis. Results: Postoperative complications (Clavien-Dindo classification ≥ II) occurred in 35 cases (25.0%) and severe complications (Clavien-Dindo classification ≥ IIIa) occurred in 4 cases (2.9%), including 1 case of esophago-jejunal anastomotic leakage, 1 case of vena cava thrombosis, 1 case of pleural effusion, 1 case of septic shock during perioperative days resulting in death. Univariate analysis showed that BMI (P=0.011), cycle of NACT (P=0.027), tumor diameter (P=0.021), and vascular invasion (P=0.033) were associated with postoperative complication within 30 days, while open/laparoscopic total gastrectomy were not associated with postoperative complication (P=0.926). Multivariate analysis revealed that BMI ≥ 25 kg/m(2) (OR=3.294, 95% CI: 1.343-8.079, P=0.009) and < 4 cycles of NACT (OR=2.922, 95% CI: 1.217-7.016, P=0.016) were independent risk factors for postoperative complication. The 3-year overall survival rates of patients with or without complication were 54.4% and 64.0%, respectively (P=0.395), and 3-year disease-free survival rates were 47.4% and 52.9%, respectively (P=0.587). Conclusions: Higher BMI and fewer cycles of NACT are independent risk factors of postoperative complication in advanced gastric cancer patients undergoing total gastrectomy after NACT. No obvious association is found between postoperative complication and surgical approaches.

Effect of Composite Nanoparticle CeO₂ on Myocardial Ischemic Re-Infusion of Cardio Myocyte Apoptosis in Mouse

The myocardial I/R damage is very complicated. Apoptosis is considered to its a critical mechanism. During the cardiac muscle I/R process, oxygen-free radicals play a pivotal role. Arrhythmias, as well as enlargement of the area of myocardial infarction after cardiac muscle I/R process, are caused by adequate blast generated O^2- ion free radicals. During the ischemia-reperfusion process, a large amount of O^2- ion free radicals destroyed the cell structure, and it undergoes lipid peroxidation with unsaturated fatty acids that contain a large number of phospholipids in the cell membrane, causing membrane proteins such as ion channels and enzymes on the cell membrane. The activity of cell is reduced, which affects the function of cell membrane and organelle membrane, destroys its integrity and reduces fluidity.We observed the effects of cerium dioxide nanoparticles on glutathione peroxidase as well as superoxide dismutase, also propionate in myocardial tissue of I/R injury in the mouse. Its effects of malondialdehyde and apoptosis were explored to see its protective effect and to provide more preventive measures for ischemia-reperfusion injury.

Alterations in leaf photosynthetic electron transport in Welsh onion (Allium fistulosum L.) under different light intensity and soil water conditions

Welsh onions (Allium fistulosum L.) are often affected by stressful environments, such as high light and drought, during summer cultivation, which hinders their growth. We used CO₂ assimilation, OJIP transient and MR curves to analyse the photosynthetic characteristics of Welsh onion. The results showed that single high light stress caused a decrease in the net photosynthesis rate through stomatal limitation, while the single drought treatment and the combined stress induced nonstomatal limitation. F_O and F_J increased, F_m decreased, and a distinct K-phase was induced. High light and drought stress blocked MR transients, leading to a gradual decrease in V_PSI and V_PSII-PSI . In general, photosynthesis of Welsh onion was inhibited by high light and drought, which destroyed the receptor and donor side of PSII and reduced electron transport capacity of PSII and PSI.

High-Fat Diet Promotes Macrophage-Mediated Hepatic Inflammation and Aggravates Diethylnitrosamine-Induced Hepatocarcinogenesis in Mice

It has been reported that diet and nutrition play important roles in the occurrence and development of hepatocellular carcinoma (HCC). In this study, we investigated the potential tumor-promoting mechanisms of a high-fat diet (HFD) in mice with dietondiethylnitrosamine (DEN)-induced hepatocarcinogenesis. HFD significantly decreased the survival rate and induced severe liver dysfunction in DEN-induced mice, as indicated by increased serum glutamic-pyruvic transaminase (ALT), glutamic oxalacetic transaminase (AST), and alkaline phosphatase (ALP) levels and increased liver index, liver nodule count, and γ-glutamyltransferase (γ-GT) activity. Moreover, an increased number of fat droplets and HCCs were found in the livers of the HFD mice, who displayed little collagen in and around the liver cancer groove and the infiltration of large number of inflammatory cells, such as macrophages, compared with the control mice. HFD also significantly increased proliferating cell nuclear antigen (PCNA), nuclear factor-κB (NF-κB), cyclin D1, tumor necrosis factor (TNF), and interleukin-1 (IL-1) expression levels in the liver. In vitro, we found that the inducible nitric oxide synthase (iNOS) percentage increased in macrophages after palmitic acid treatment, as well as the secretion of inflammatory factors and cytokines such as interleukin-6(IL-6), interleukin-10(IL-10), CCL2, Interferon γ (IFN-γ), and TNF. Thus, our results demonstrate that an HFD may promote DEN-induced hepatocarcinogenesis in mice by destroying liver function and enhancing the inflammatory response by recruiting and polarizing macrophages in the liver. This study could therefore provide new insights into the tumor promoting effects of an HFD in HCC.

REPORT-Parenteral selenium for the clinical effect of sepsis: A meta-analysis of randomized controlled trials

Previous studies have shown that selenium and its compounds play a role in immunomodulatory, antioxidant stress and so on. If selenium can improve the prognosis of patients with sepsis, it will be another weapon in the treatment of sepsis. At present, there are some randomized controlled trials (RCTs) about parenteral selenium for the treatment of sepsis. However, the results of those studies are not consistent. Studies were searched from electronic databases including PubMed, Cochrane, and Embase. RCTs which applied the selenium to septic patients as the inference measure were collected. After data extraction and the evaluation for eventual inclusion literatures, the data were analyzed by the statistical software RevMan 5.3. A total of 11 RCTs were included, containing 1916 septic patients. Meta-analysis showed that there is no statistically significant difference between the selenium group and the control group in mortality (RR=0.95, 95%CI=0.83-1.08, P=0.42), ICU length of stay (MD=1.56, 95%CI=-0.66-3.79, P=0.17) and new infections (RR=0.95, 95%CI=0.73-1.24, P=0.69). The present study suggests that there is no sufficient evidence that the parenteral selenium can improve the prognosis of septic patients.

An Optimal Surgical Approach for Suprapancreatic Area Dissection in Laparoscopic D2 Gastrectomy with Complete Mesogastric Excision

BACKGROUND

During the radical operation, the suprapancreatic area is featured by anatomical complexity, and the lymph node dissection for this area is technically difficult and demanding.^1-4 Previously, we have demonstrated the presence of disseminated cancer cells in the mesogastrium^5,6 and presented a mesogastrium model for gastrectomy.⁷ As a consequence, laparoscopic D2 lymphadenectomy plus complete mesogastric excision (D2+CME) was proposed as a new concept in the surgical treatment of advanced gastric cancer.⁸ D2+CME procedure has been shown to be associated to lower number of free intraperitoneal cancer cells and with a better disease-free survival than conventional D2 gastrectomy.⁹ Under the concept of mesogastrium model, the proposed D2+CME procedure could help surgeons better define the anatomical boundaries of suprapancreatic mesogastrium, thus using it to achieve a complete and standard excision of the suprapancreatic area dissection. Here, we briefly present perioperative results of our case series with the laparoscopic curative subtotal gastrectomy and D2+CME with a R0 resection and present a video to detail the technical aspects of a laparoscopic D2+CME approach for suprapancreatic area dissection.

METHODS

All patients in this study underwent laparoscopic subtotal gastrectomy (D2+CME) with a curative R0 resection. This study was approved by the Tongji Hospital Ethics Committee (Unique Reference Number: TJ-IRB20180811). The procedures in the video are described as follows. Based on our previous mesogastrium model (also named "Table model", Supplemental Figure 1), the suprapancreatic mesogastrium is attached to the lesser curvature or the posterior gastric wall and extended to the suprapancreatic area, respectively.⁷ Surgeon stands on patient left side, and the assistant lifts the stomach upward and cephalic to expose the suprapancreatic mesogastrium including left gastric mesentery (LGM), right gastric mesentery (RGM) and posterior gastric mesentery (PGM). First of all, towards to the left side of the suprapancreatic area, the "tri-junction" point of LGM is exposed. Using an energy devise, surgeon opens serosa layer and identifies the retrogastric space. The LGM and PGM are mobilized bluntly, between which a fusion retrogastric space is revealed. Both the LGM and PGM are covered by smooth and shiny surfaces of fascial propria and regarded as the "meso-bed" mutually. Secondly, at the inner side of duodenum, surgeon bluntly separates the adjuvant tissues along gastro-duodenal artery (GDA) upward and exposes right gastric mesentery (RGM). Next, after mobilizing the left gastric mesentery, surgeon removes the adipose tissue adherent to the common hepatic artery (CHA) and exposes the root of the left gastric artery after dissecting the perivascular sheath with triple-clips. Then, surgeon dissects RGM along the CHA and portal vein (HPV) towards the right side of the suprapancreatic area; afterwards, the right gastric vessels and RGM are identified and ligated. Lastly, the superior border of splenic vessels is dissected. The anterior lobe of the PGM is raised up with ligated posterior gastric vessels. Remarkably, posterior gastric vessels may be absent in some cases. Reconstruction of the alimentary tract is Roux-en-Y method. Standard recovery protocols are followed in postoperative treatments.

RESULTS

Between August 28th 2017 and December 27th 2018, 107 patients receiving laparoscopic curative subtotal gastrectomy (D2+CME) with a R0 resection were retrospective collected in this study. After exposing the suprapancreatic mesogastrium including RGM, PGM and LGM with D2+CME procedure, the LNs and fat tissues around 7, 9, 8a, 12a and 11p were removed en bloc in all patients. This study recruited 67 males and 40 females. The median age was 55 years, with body mass index (BMI) 23.0 kg/m² (Supplemental Table 1). The median number of retrieved regional lymph nodes was 31 (range 25-41), including 22 (range 17-27.5) suprapancreatic lymph nodes. The median volume of blood loss was 14 ml (range 6-34). The median total operation time was 287 min (range 265.5-313.5) and laparoscopic surgery time was 132 min (range 116-142) (Supplemental Table 2). Postoperative morbidity occurred at a rate of 9.3 %, and the mortality rate was 0% (Supplemental Table 3). The median follow-up was 10 months (range 8-13). No patient was lost during follow-up (Supplemental Table 4).

CONCLUSION

A laparoscopic subtotal gastrectomy with D2+CME procedure provides for a complete and standardized en bloc excision of the suprapancreatic area dissection.

[Potential antiviral therapeutics for 2019 Novel Coronavirus]

The recent outbreak of respiratory illness in Wuhan, China is caused by a novel coronavirus, named 2019-nCoV, which is genetically close to a bat-derived coronavirus. 2019-nCoV is categorized as beta genus coronavirus, same as the two other strains-severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Antiviral drugs commonly used in clinical practice, including neuraminidase inhibitors (oseltamivir, paramivir, zanamivir, etc.), ganciclovir, acyclovir and ribavirin, are invalid for 2019-nCoV and not recommended. Drugs are possibly effective for 2019-nCoV include: remdesivir, lopinavir/ritonavir, lopinavir/ritonavir combined with interferon-β, convalescent plasma, and monoclonal antibodies. But the efficacy and safety of these drugs for 2019-nCoV pneumonia patients need to be assessed by further clinical trials.