A phase I study to evaluate the safety, pharmacokinetics, and pharmacodynamics of PF-06939999 (PRMT5 inhibitor) in patients with selected advanced or metastatic tumors with high incidence of splicing factor gene mutations

BACKGROUND

Protein arginine methyltransferase 5 (PRMT5) methylates multiple substrates dysregulated in cancer, including spliceosome machinery components. PF-06939999 is a selective small-molecule PRMT5 inhibitor.

PATIENTS AND METHODS

This phase I dose-escalation and -expansion trial (NCT03854227) enrolled patients with selected solid tumors. PF-06939999 was administered orally once or twice a day (q.d./b.i.d.) in 28-day cycles. The objectives were to evaluate PF-06939999 safety and tolerability to identify maximum tolerated dose (MTD) and recommended part 2 dose (RP2D), and assess pharmacokinetics (PK), pharmacodynamics [changes in plasma symmetric dimethylarginine (SDMA) levels], and antitumor activities.

RESULTS

In part 1 dose escalation, 28 patients received PF-06939999 (0.5 mg q.d. to 6 mg b.i.d.). Four of 24 (17%) patients reported dose-limiting toxicities: thrombocytopenia (n = 2, 6 mg b.i.d.), anemia (n = 1, 8 mg q.d.), and neutropenia (n = 1, 6 mg q.d.). PF-06939999 exposure increased with dose. Steady-state PK was achieved by day 15. Plasma SDMA was reduced at steady state (58%-88%). Modulation of plasma SDMA was dose dependent. No MTD was determined. In part 2 dose expansion, 26 patients received PF-06939999 6 mg q.d. (RP2D). Overall (part 1 + part 2), the most common grade ≥3 treatment-related adverse events included anemia (28%), thrombocytopenia/platelet count decreased (22%), fatigue (6%), and neutropenia (4%). Three patients (6.8%) had confirmed partial response (head and neck squamous cell carcinoma, n = 1; non-small-cell lung cancer, n = 2), and 19 (43.2%) had stable disease. No predictive biomarkers were identified.

CONCLUSIONS

PF-06939999 demonstrated a tolerable safety profile and objective clinical responses in a subset of patients, suggesting that PRMT5 is an interesting cancer target with clinical validation. However, no predictive biomarker was identified. The role of PRMT5 in cancer biology is complex and requires further preclinical, mechanistic investigation to identify predictive biomarkers for patient selection.

Piperine promotes PI3K/AKT/mTOR-mediated gut-brain autophagy to degrade α-Synuclein in Parkinson's disease rats

ETHNOPHARMACOLOGICAL RELEVANCE

Piper longum L., a medicinal and food homologous herb, has a traditional history of use in treating gastrointestinal and neurological disorders. Piperine (PIP) the main alkaloid of P. longum, exists neuroprotective effects on various animal models of Parkinson's disease (PD). Nevertheless, the underlying mechanism, particularly the role of PIP in promoting gut-brain autophagy for α-Synuclein (α-Syn) degradation in PD, remains incompletely understood.

AIM OF THE STUDY

To explore the role of PIP in regulating the gut-brain autophagy signaling pathway to reduce α-Syn levels in both the colon and substantia nigra (SN) of PD model rats.

MATERIALS AND METHODS

Behavioral experiments were conducted to assess the impact of PIP on 6-hydroxydopamine (6-OHDA)-induced PD rats. The intestinal microbiome composition and intestinal metabolites were analyzed by metagenomics and GC-MS/MS. The auto-phagosomes were visualized by transmission electron microscopy. Immunohistochemistry, immunofluorescence, and western blotting were performed to assess the levels of tyrosine hydroxylase (TH), α-Syn, LC3II/LC3I, p62, and the PI3K/AKT/mTOR pathway in both the SN and colon of the rats. The pathway-related inhibitor and agonist were used to verify the autophagy mechanism in the SH-SY5Y cells overexpressing A53T mutant α-Syn (A53T-α-Syn).

RESULTS

PIP improved autonomic movement and gastrointestinal dysfunctions, reduced α-Syn aggregation and attenuated the loss of dopaminergic neurons in 6-OHDA-induced PD rats. After oral administration of PIP, the radio of LC3II/LC3I increased and the expression of p62 was degraded, as well as the phosphorylation levels of PI3K, AKT and mTOR decreased in the SN and colon of rats. The effect of PIP on reducing A53T-α-Syn through the activation of the PI3K/AKT/mTOR-mediated autophagy pathway was further confirmed in A53T-α-Syn transgenic SH-SY5Y cells. This effect could be inhibited by the autophagy inhibitor bafilomycin A1 and the PI3K agonist 740 Y-P.

CONCLUSIONS

Our findings suggested that PIP could protect neurons by activating autophagy to degrade α-Syn in the SN and colon, which were related to the suppression of PIP on the activation of PI3K/AKT/mTOR signaling pathway.

gcPathogen: a comprehensive genomic resource of human pathogens for public health

Here, we present the manually curated Global Catalogue of Pathogens (gcPathogen), an extensive genomic resource designed to facilitate rapid and accurate pathogen analysis, epidemiological exploration and monitoring of antibiotic resistance features and virulence factors. The catalogue seamlessly integrates and analyzes genomic data and associated metadata for human pathogens isolated from infected patients, animal hosts, food and the environment. The pathogen list is supported by evidence from medical or government pathogenic lists and publications. The current version of gcPathogen boasts an impressive collection of 1 164 974 assemblies comprising 986 044 strains from 497 bacterial taxa, 4794 assemblies encompassing 4319 strains from 265 fungal taxa, 89 965 assemblies featuring 13 687 strains from 222 viral taxa, and 646 assemblies including 387 strains from 159 parasitic taxa. Through this database, researchers gain access to a comprehensive 'one-stop shop' that facilitates global, long-term public health surveillance while enabling in-depth analysis of genomes, sequence types, antibiotic resistance genes, virulence factors and mobile genetic elements across different countries, diseases and hosts. To access and explore the data and statistics, an interactive web interface has been developed, which can be accessed at https://nmdc.cn/gcpathogen/. This user-friendly platform allows seamless querying and exploration of the extensive information housed within the gcPathogen database.

AI's deep dive into complex pediatric inguinal hernia issues: a challenge to traditional guidelines?

OBJECTIVE

This study utilized ChatGPT, an artificial intelligence program based on large language models, to explore controversial issues in pediatric inguinal hernia surgery and compare its responses with the guidelines of the European Association of Pediatric Surgeons (EUPSA).

METHODS

Six contentious issues raised by EUPSA were submitted to ChatGPT 4.0 for analysis, for which two independent responses were generated for each issue. These generated answers were subsequently compared with systematic reviews and guidelines. To ensure content accuracy and reliability, a content analysis was conducted, and expert evaluations were solicited for validation. Content analysis evaluated the consistency or discrepancy between ChatGPT 4.0's responses and the guidelines. An expert scoring method assess the quality, reliability, and applicability of responses. The TF-IDF model tested the stability and consistency of the two responses.

RESULTS

The responses generated by ChatGPT 4.0 were mostly consistent with the guidelines. However, some differences and contradictions were noted. The average quality score was 3.33, reliability score was 2.75, and applicability score was 3.46 (out of 5). The average similarity between the two responses was 0.72 (out of 1), Content analysis and expert ratings yielded consistent conclusions, enhancing the credibility of our research.

CONCLUSION

ChatGPT can provide valuable responses to clinical questions, but it has limitations and requires further improvement. It is recommended to combine ChatGPT with other reliable data sources to improve clinical practice and decision-making.

Academic clinician frontline-worker wellbeing and resilience during the COVID-19 pandemic experience: Were there gender differences?

Prior research suggests COVID-19 has amplified stress on Academic Clinician Frontline-Workers (ACFW). The aim of this paper is: (1) to better understand the experiences of ACFW during the COVID-19 pandemic including their mental-emotional wellbeing, academic productivity, clinical experiences, and (2) to examine any gender differences. A cross-sectional survey was administered to University of Minnesota/M Health Fairview systems' faculty February-June 2021. Of the 291 respondents, 156 were clinicians, with 91 (58 %) identifying as Frontline-Workers (ACFW). Faculty wellbeing was assessed using validated measures in addition to measures of productivity and sociodemographics. For example, ACFW reported a higher Work-Family Conflict (WFC) scores compared to non-ACFW (26.5 vs. 24.1, p = 0.057) but did not report higher Family-Work Conflict (FWC) scores (17.7 vs. 16.3, p = 0.302). Gender sub-analyses, revealed that women ACFW compared to men ACFW reported higher WFC scores (27.7 vs. 24.1, p = 0.021) and FWC (19.3 vs. 14.3, p = 0.004). Academically, ACFW reported submitting fewer grants and anticipated delays in promotion and tenure due to the COVID-19 (p = 0.035). Results suggest COVID-19 has exacerbated ACFW stress and gender inequities. Reports of anticipated delay in promotion for ACFW may pose a challenge for the long-term academic success of ACFW, especially women ACFW. In addition, women may experience higher FWC and WFC as compared to men. Schools of academic medicine should consider re-evaluating promotion/tenure processes and creating resources to support women ACFW as well as ACFW caregivers.

Identification and Automated Delineation of Radioresistant Biological Tumor Volume in Nasopharyngeal Carcinoma Based on Magnetic Resonance Imaging Radiomics

PURPOSE/OBJECTIVE(S)

Widespread use of intensity modulated radiotherapy (IMRT) has improved the tumor control rate of nasopharyngeal carcinoma (NPC). However, nearly 20% of the patients with local-advanced NPC would relapse after precise irradiation and 80% of the recurrent lesions occur within the high dose field, suggesting that there are radiation-resistant cancer cell subsets within the tumor. In this context, identification and contouring of radiation resistance region of NPC for dose escalation at primary IMRT could be advantageous. In this work, we proposed a two-step radiomics workflow to predict local relapse and the recurrent region of NPC before primary IMRT.

MATERIALS/METHODS

In this single-center, retrospective study, pre-treatment magnetic resonance (MR) sequences of T1-weighted imaging (T1-w) and contrast-enhanced T1-weighted imaging (CET1-w) were collected from 800 patients of newly diagnosed and non-metastatic NPC between April 2009 and December 2015. The primary gross tumor volume (GTVp) of all patients and the actual recurrent lesion (GTVr) of patients who suffered from local recurrence were manually contoured for further analysis. A two-step complete radiomics workflow was designed to predict tumor recurrence and segment the region. First, least absolute shrinkage and selection operator (LASSO) was utilized for radiomics features selection of GTVp and support vector machine (SVM) was adopted to predict the recurrence. If the model predicts a recurrence, then the workflow utilizes an improved 3D U-Net to segment the recurrent region. Area under receiver operating characteristic curve (ROC-AUC) was used to evaluate the performance of tumor recurrence prediction, and Dice similarity coefficient (DSC) was used to assess the consistence between the actual and predicted GTVr.

RESULTS

Of 800 NPC patients, 95 (11.9%) patients developed in-field local recurrence. For recurrence risk prediction, the SVM ensemble model (T1-w+CET1-w) was selected for further application with higher sensitivity. The average ROC-AUC, specificity, sensitivity of the SVM ensemble model in a 5-fold cross-validation and in the independent test set of 160 patients were 0.922, 0.922, 0.777 and 0.928, 0.915, 0.737, respectively. Moreover, for recurrent region segmentation, the multi-modality (T1-w+CET1-w) model was superior to the single-modality (T1-w or CET1-w) model. In an independent test set of 15 patients, the DSC, sensitivity and 95% Hausdorff Distance between actual and predicted GTVr was 0.549±0.176, 0.696±0.118 and 9.813±4.788 which was superior to 0.444±0.188, 0.497±0.218 and 12.047±5.361 of original 3D U-Net.

CONCLUSION

The proposed two-step radiomics workflow showed a good performance in predicting tumor recurrence of NPC. The predicted location of the recurrence lesion was all accurate, but there was still a certain difference between the volume of the automated delineated and actual GTVr, which needed to be further optimized to be used as biological tumor volume.

Automated Contouring of Cervical Lymph Nodes and Clinical Target Volumes for Nasopharyngeal Carcinoma Based on Deep Learning and Experience Constraints

PURPOSE/OBJECTIVE(S)

Application of artificial intelligence (AI) for automated contouring of tumor volumes and organs at risk (OARs) for radiotherapy of nasopharyngeal carcinoma (NPC) leads to improved contouring accuracy and efficiency. However, few studies have involved the automated contouring of gross tumor volume of cervical lymph nodes (GTVn) and clinical target volumes (CTVs). In this work, we proposed an AI automated contouring tool for GTVn and CTVs for radiotherapy of NPC on the plain scans of planning compute tomography (CT).

MATERIALS/METHODS

In this retrospective study, plain scan datasets of planning CT covering the nasopharynx and neck from 139 patients with NPC between March 2022 and December 2022 were collected and divided into training, validation, and testing cohorts of 95, 24, and 20 patients, respectively. Ground truth contours of primary gross tumor volume (GTVp), GTVn (divided into GTVn_L in left neck and GTVn_R in right neck), CTVs (including high risk CTV1 contains GTVp and low risk CTV2 contains GTVp and cervical nodal levels) and OARs were delineated and were defined by consensus of two experts. We first proposed a three-dimensional (3D) U-net using GTVp and OARs as experience constrains to guide the automated delineation of GTVn and CTVs. The average Dice similarity coefficient (DSC) and average surface distance (ASD) were used to quantify the performance of the AI tool. Next, five prospective patients were enrolled for clinical evaluation of our AI tool. DSC between automated contours and radiation oncologist-revised contours and time consuming of the revision were record.

RESULTS

Clinical characteristics of 139 retrospective and 5 prospective patients are list in Table 1. In the independent testing set of 20 patients, our AI tool showed high performance in GTVn and CTVs contouring when compared with the ground truth contours. The mean DSC were 0.73 ± 0.07, 0.74 ± 0.05, 0.93 ± 0.03, and 0.88 ± 0.03, and the mean ASD were 1.01 ± 0.43 mm, 1.14 ± 0.61 mm, 0.51 ± 0.13 mm, 1.17 ± 0.43 mm for GTVn_L, GTVn_R, CTV1 and CTV2, respectively. In the five prospective patients, mean DSC were 0.74 ± 0.07, 0.74 ± 0.10, 0.95 ± 0.01 and 0.89 ± 0.04, respectively. The median time consuming for GTVn and CTVs revision was 2minutes and 10 seconds (range, 1 minutes to 3 minutes).

CONCLUSION

The proposed AI tool integrating clinical experience as constrains showed high accuracy for contouring GTVn and CTVs of NPC. With the assistance of AI contours, contouring efficiency could be probably increased, which is promising in online adaptive radiotherapy of NPC.

The axial and sagittal CT values of the 7th thoracic vertebrae in screening for osteoporosis and osteopenia

AIM

To evaluate the difference in computed tomography (CT) attenuation value of different planes of the 7th thoracic vertebra and investigate the efficacy of axial and sagittal vertebral CT measurements in predicting osteoporosis.

MATERIALS AND METHODS

Patients who underwent routine chest CT and dual-energy X-ray absorptiometry (DXA) within 1 month were included in this retrospective study. The CT attenuation values of different planes were compared. Logistic regression and receiver operating characteristic (ROC) were used to analyse the difference of each plane in the diagnosis of osteoporosis.

RESULTS

The study included 1,338 patients (mean age of 61.9±11.9; 54% female). The CT attenuation values decreased successively in the normal group, osteopenia group, and osteoporosis group. The paired t-test results showed that the mid-axial measurements were greater than mid-sagittal measurements, with a mean difference of 9 HU, the difference was statistically significant (p<0.001, 95% confidence interval [CI] = 7.8-10.1). For each one-unit reduction in mid-sagittal CT attenuation value, the risk of osteopenia or osteoporosis increased by 3.6%. To distinguish osteoporosis from non-osteoporosis (osteopenia + normal), the sensitivity was 90% and the specificity was 52.4% at the mid-sagittal threshold of 113.7 HU.

CONCLUSIONS

The CT attenuation values of mid-sagittal plane have higher diagnostic efficacy than axial planes in predicting osteoporosis. For patients with a sagittal CT attenuation value of <113.7 HU in the T7, further DXA examination is warranted.

Mercury intoxication disrupts tonic signaling in B cells, and may promote autoimmunity due to abnormal phosphorylation of STIM-1 and other autoimmunity risk associated phosphoproteins involved in BCR signaling

Epidemiological studies link exposure to mercury with autoimmune disease. Unfortunately, in spite of considerable effort, no generally accepted mechanistic understanding of how mercury functions with respect to the etiology of autoimmune disease is currently available. Nevertheless, autoimmune disease often arises because of defective B cell signaling. Because B cell signaling is dependent on phosphorylation cascades, in this report, we have focused on how mercury intoxication alters phosphorylation of B cell proteins in antigen-non stimulated (tonic) mouse (BALB/c) splenic B cells. Specifically, we utilized mass spectrometric techniques to conduct a comprehensive unbiased global analysis of the effect of inorganic mercury (Hg2+) on the entire B cell phosphoproteome. We found that the effects were pleotropic in the sense that large numbers of pathways were impacted. However, confirming our earlier work, we found that the B cell signaling pathway stood out from the rest, in that phosphoproteins which had sites which were affected by Hg2+, exhibited a much higher degree of connectivity, than components of other pathways. Further analysis showed that many of these BCR pathway proteins had been previously linked to autoimmune disease. Finally, dose response analysis of these BCR pathway proteins showed STIM1_S575, and NFAT2_S259 are the two most Hg2+ sensitive of these sites. Because STIM1_S575 controls the ability of STIM1 to regulate internal Ca2+, we speculate that STIM1 may be the initial point of disruption, where Hg2+ interferes with B cell signaling leading to systemic autoimmunity, with the molecular effects pleiotropically propagated throughout the cell by virtue of Ca2+ dysregulation.

[Correlation between gene polymorphisms of killer cell immunoglobulin-like receptors and their ligands and Graves' disease]

Objective: To explore the relationship between gene polymorphism of killer cell immunoglobulin-like receptor (KIR) and its ligand-specific human leukocyte antigen C (HLA-C) and Graves' disease (GD). Methods: Case-control study. A total of 118 unrelated GD patients (GD group) admitted to Shandong Provincial Hospital from January 2011 to December 2017 and 108 age-and sex-matched healthy controls (healthy control group) were included. The KIR genotype and its ligand HLA-C allele were detected by polymerase chain reaction sequence-specific primers (PCR-SSP). The distribution of KIR/HLA-C gene combination in GD patients and control population was analyzed to explore its association with the occurrence of GD. Results: In GD group, there were 29 males and 89 females, aged (38±14) years. In the healthy control group, there were 28 males and 80 females, aged (37±13) years. Compared with the healthy control group, the occurrence frequency of HLA-Cw01 was higher in GD group[36.4%(43/118) vs 18.5%(20/108), P=0.003], and the occurrence frequency of HLA-Cw03 and HLA-Cw06 was lower in GD group[11.9%(14/118) vs 39.8%(43/108), P<0.001; 9.3%(11/118) vs 18.5%(20/108), P=0.045]. The frequency of KIR2DL1/HLA-C2 gene combination in GD group was lower than that in control group [17.8%(21/118) vs 34.3%(37/108), P=0.005]. Logistic regression analysis showed that KIR2DL1/HLA-C2 gene combination was a protective factor for GD occurrence (OR=0.308, 95%CI: 0.126-0.752, P=0.010). Conclusions: The polymorphism of KIR/HLA-C gene is related to GD. The low expression of KIR2DL1/HLA-C2 in GD patients may be a protective factor for GD.

Validation of the International Trauma Questionnaire-Child and Adolescent Version (ITQ-CA) in a Chinese mental health service seeking adolescent sample

BACKGROUND

The International Trauma Questionnaire-Child and Adolescent version (ITQ-CA) is a self-report measure that assesses posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) based on the diagnostic formulation of the 11th version of the International Classification of Diseases (ICD-11). This study aimed to provide a Chinese translation and psychometric evaluation of the ITQ-CA using a sample of mental-health service seeking adolescents in Mainland China.

METHODS

The ITQ-CA was translated and back-translated from English to simplified Chinese and finalized with consensus from an expert panel. Adolescents ages 12-17 were recruited via convenience sampling from an outpatient psychiatric clinic in Mainland China. Participants completed the ITQ-CA; measures of four criterion variables (depression, anxiety, stress, adverse childhood experiences); and the PTSD Checklist for DSM-5 (PCL-5). Construct validity, concurrent validity, and comparison of PTSD caseness between ICD-11 and DSM-5 measures were assessed.

RESULTS

The final sample consisted of 111 Chinese adolescents (78% female; mean age of 15.23), all diagnosed with a major depressive disorder. Confirmatory factor analysis indicated the two-factor second-order model provided optimal fit. All criterion variables were positively and significant correlated with the six ITQ-CA symptom cluster summed scores. In the present sample, 69 participants (62.16%) met symptom criteria for ICD-PTSD or CPTSD using the ITQ-CA, and 73 participants (65.77%) met caseness for DSM-5 PTSD using the PCL-5. Rates of PTSD symptom cluster endorsement and caseness deriving from both diagnostic systems were comparable.

CONCLUSIONS

The Chinese ITQ-CA has acceptable psychometric properties and confers additional benefits in identifying complex presentations of trauma-related responses in younger people seeking mental health services.

[The influence of differential parenting in early life on the physical and mental health of middle-aged and elderly women]

Objective: To explore the influence of differential parenting in early life on the physical and mental health of middle-aged and elderly women, and analyze the mediating effect of early life health. Methods: Based on 8 204 women aged 45-84 years from the China Health and Retirement Longitudinal Study (CHARLS) in 2018, the life course survey data of CHARLS 2014 were matched by ID number. Logistic regression analysis models were used to analyze the direct impact of differential parenting in early life on chronic diseases and depression of middle-aged and elderly women, and the KHB method was used to analyze the mediating effect of early life health. Results: The prevalence of chronic diseases in middle-aged and elderly women was 81.05% and the detection rate of depression among them was 41.46%. After adjusting for other confounding factors, parents' preference for boys in early life increased the possibility of chronic diseases of middle-aged and elderly women by 18.2% (OR=1.182, 95%CI: 1.013-1.381). Compared with the women whose parents had no differential upbringing in early life, the parents' preference for boys or brothers/sisters in early life increased the possibility of depression in middle-aged and elderly women by 16.1% (OR=1.161, 95%CI:1.030-1.309) and 17.4% (OR=1.174, 95%CI:1.032-1.336),respectly. Early life health was one of the mediating factors that parents' preference for brothers and sisters could affect the mental health status of middle-aged and elderly women, and the mediating effect accounted for 8.603% of the total effect. Conclusion: Differential parenting in early life may have an impact on the physical and mental health of middle-aged and elderly women. Differential parenting could affect the early life health status of women, and then affect the mental health in their middle and old age.

Association between awareness of vulnerability and disaster preparedness in an infrastructure-resilient city: a population-based study

OBJECTIVES

Factors associated with an individual's awareness of vulnerability can be modified by the infrastructure of a city. These factors may impact disaster preparedness among local populations in an infrastructure-resilient city, which further influences the health risks of various population subgroups.

STUDY DESIGN

This was a population-based study.

METHODS

Four population subgroups, which have previously been reported to be related to awareness of vulnerability (i.e. past experiences, sociodemographic deprivation, poor housing conditions and family medical needs), were analysed for their impacts on disaster preparedness. Validated population-based phone interviews (n = 856) were conducted in Hong Kong. Three types of disaster preparedness were studied: (1) physical preparedness; (2) social preparedness; and (3) education preparedness.

RESULTS

Previous experience of social hazards, accidental hazards and epidemics increased disaster preparedness among the local population. Specifically, experiences of accidental hazards and social hazards were positively associated with physical preparedness (odds ratios 1.626, 95% confidence interval [95% CI] 1.215, 2.172) and 1.501 [95% CI 1.114, 2.024], respectively). However, experiences of natural hazards did not increase preparedness, even in Hong Kong, which is a city with high 'disaster resilience' because of its well-developed infrastructure. Moreover, individuals with a low educational level or low income had lower education preparedness, unmarried individuals had lower social preparedness, and poor housing conditions of non-private-housing households had negative associations with education preparedness. These findings partially align with local disaster responses to the 2018 Typhoon Mangkhut, the 2019 social unrest and the 2020 COVID-19 pandemic, all of which were observed after the 2018 survey reported in this study.

CONCLUSIONS

Social and environmental interventions should be targeted to marginalised subpopulations through location-based community strategies to encourage increased environmental knowledge and participation in disaster preparedness activities.

Implication of a de novo Variant in ciliary rootlet coiled- coil (CROCC) with assimilation of atlas (AOA)

Assimilation of atlas is a rare skeletal malformation causing nerve compression with high risk of fatal. However, the genetic etiology of assimilation of atlas AOA is currently lacking. In this paper, the whole-exome sequencing (WES) analysis was employed to study a Chinese family having a sporadic proband son of assimilation of atlas AOA but other healthy family members. We identified a novel variant in ciliary rootlet coiled-coil gene (NM_014675.5 (CROCC): c.4702C>T (r.4702c>u, p.(Arg1568Cys)). The variant had different genotypes between the proband and healthy family members but with high conservations of “damage” to protein structure based on MutationTaster and SIFT prediction. CROCC gene can be obtained in both healthy (n=220) and non-mutated assimilation of atlas AOA patient samples (n=68) but absented in five sporadic patients with the novel variant. Furthermore, abnormal of cilia was observed after editing the target sequence on CROCC using CRISPR-Cas9. These results suggested that assimilation of atlas AOA might be caused by the mutation of CROCC: c.4702C>T (r.4702c>u, p.(Arg1568Cys)). With strong amino acid conservation and interaction regulation, the variant mutation could cause the signal disorder of skeletal development which may lead to the defective bone formation and finally cause the development of assimilation of atlas AOA.

[Effect of childhood living environment sanitation on chronic diseases in middle-aged and elderly rural residents]

Objective: To explore the effect of childhood living environment sanitation on the prevalence of chronic diseases in middle-aged and elderly rural residents and test the mediating product of childhood health status. Methods: Based on the data of 12 506 rural residents jointly interviewed by the latest survey of China Health and Retirement Longitudinal Survey (CHARLS) in 2018 and the life course survey in 2014, the χ² test, Rank sum test, logistic regression analysis model, Propensity score weighting method, negative binomial regression model and KHB analysis method were used for analysis. Results: After adjusting for other confounding factors, compared with rural residents with better living environment sanitation in childhood, the risk of asthma in middle-aged and elderly rural residents with poor childhood living environment sanitation increased by 23.7% (OR=1.237,95%CI: 1.060-1.445), and the risk of liver disease, kidney disease, and digestive system disease increased by 16.4% (OR=1.164,95%CI: 1.006-1.347) and 22.4% (OR=1.224,95%CI: 1.083-1.383) and 19.6% (OR=1.196,95%CI: 1.103-1.296), the possibility of dyslipidemia and heart disease increased by 26.6% (OR=1.266,95%CI: 1.153-1.390) and 13.6% (OR=1.136,95%CI: 1.031-1.253). The negative binomial regression model analysis results show that, on average, the number of chronic diseases of middle-aged and elderly rural residents with poor living environment sanitation in childhood is 0.176 more than that of middle-aged and elderly rural residents with better living environment sanitation in childhood. Childhood health status played an intermediary role of 7.143%. Conclusion: There is a statistical correlation between residential environmental sanitation in childhood and the prevalence and number of chronic diseases in middle-aged and elderly rural residents. Childhood health status plays a partial intermediary role. Attention should be paid to the construction and management of rural residents' residential environment to provide a clean and hygienic growth environment for children and adolescents to promote the health of rural residents in the whole life cycle.

Intravoxel incoherent motion diffusion-weighted imaging as a quantitative tool for evaluating disease activity in patients with axial spondyloarthritis

AIM

To determine the correlations between four quantitative magnetic resonance imaging (MRI) parameters derived from intravoxel incoherent motion diffusion-weighted images (IVIM DWI) and the semi-quantitative Spondyloarthritis Research Consortium of Canada (SPARCC) score of the sacroiliac joint (SIJ) and five clinical activity indices in patients with axial spondyloarthritis (axSpA).

AND METHODS

A total of 75 patients with axSpA and complete clinical activity indices and SIJ MRI were enrolled to this prospective study. Univariable and multivariable linear regression analyses were performed to evaluate correlations between MRI parameters and clinical activity indices after controlling for confounders. All data were further analysed using Pearson's correlation coefficients (r).

RESULTS

Only pure diffusion coefficient (D) and incoherent perfusion related microcirculation (D∗) were found to be independently positively correlated with several clinical activity indices (all p<0.05). Positive correlations were observed between D and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Patient Global Assessment (PGA), extent of influence of pain, with r of 0.605, 0.402, 0.319, and 0.485 (all p<0.0125). D∗ correlated positively with BASDAI, BASFI, and PGA (r=0.436, 0.356, 0.301, respectively; all p<0.0125).

CONCLUSION

D and D∗ derived from IVIM DWI could be associated with some disease activity indices in patients with axSpA; apparent diffusion coefficient (ADC) and SPARCC scores were not correlated with these indices. IVIM DWI may be a useful tool for the quantitative assessment of disease activity in patients with axSpA.

Precision Methylome and In Vivo Methylation Kinetics Characterization of Klebsiella pneumoniae

Klebsiella pneumoniae (K. pneumoniae) is an important pathogen that can cause severe hospital- and community-acquired infections. To systematically investigate its methylation features, we determined the whole-genome sequences of 14 K. pneumoniae strains covering varying serotypes, multilocus sequence types, clonal groups, viscosity/virulence, and drug resistance. Their methylomes were further characterized using Pacific Biosciences single-molecule real-time and bisulfite technologies. We identified 15 methylation motifs [13 N6-methyladenine (6mA) and two 5-methylcytosine (5mC) motifs], among which eight were novel. Their corresponding DNA methyltransferases were also validated. Additionally, we analyzed the genomic distribution of GATC and CCWGG methylation motifs shared by all strains, and identified differential distribution patterns of some hemi-/un-methylated GATC motifs, which tend to be located within intergenic regions (IGRs). Specifically, we characterized the in vivo methylation kinetics at single-base resolution on a genome-wide scale by simulating the dynamic processes of replication-mediated passive demethylation and MTase-catalyzed re-methylation. The slow methylation of the GATC motifs in the replication origin (oriC) regions and IGRs implicates the epigenetic regulation of replication initiation and transcription. Our findings illustrate the first comprehensive dynamic methylome map of K. pneumoniae at single-base resolution, and provide a useful reference to better understand epigenetic regulation in this and other bacterial species.

A184 REPURPOSING DRUGS FOR SPLEEN TYROSINE KINASE (SYK) PEDIATRIC PATIENTS USING HIGH-THROUGHPUT SCREENING

Background

Spleen Tyrosine Kinase (SYK) is a cytosolic, non-receptor tyrosine kinase with an imperative role in immune and non-immune processes. Recently, we identified six gain-of-function SYK variants in patients that presented multi-organ inflammation and immune dysregulation. The SYK variants displayed constitutive SYK phosphorylation in human embryonic kidney (HEK) 293T, colonic epithelial cells (SW480), and in knock-in heterozygous SYK mice. These observations mark SYK as a therapeutic target for autoimmune diseases.

Phenotype drug discovery accelerates this process and can be done successfully with an appropriate phenotype. A possible phenotype displayed by SYK variants is SYK phosphorylation, as high-throughput screening can identify hit compounds that reduce the constitutive activation of phosphorylated SYK (p-SYK).

Aims

Aim 1: Determine the screening phenotype with wildtype (WT) and SYK S550Y variant in HEK293T cells. Recently, we observed increased phosphorylation in gain-of-function SYK variants We hypothesize that we can use phosphorylated-SYK (p-SYK) levels to identify hit compounds that can decrease the kinase activity in these variants. With stable transfected SYK WT and SYK S550Y HEK293T cell-line, protein analyses will be completed to characterize the appropriate screening phenotype.

Aim 2

Establish an assay for high-throughput drug screening. We will utilize homogenous time-resolved fluorescence (HTRF) assay. The signal measured from HTRF is positively proportional to the level of p-SYK; therefore, we expect that S550Y cells will have a higher signal than the WT.

Aim 3

Validate hit compounds in HEK293T and zebrafish. We will create a dose-response curve with the hit compounds in in vitro and in vivo models.

Methods

We will use stable transfection to established overexpressing SYK WT and S550Y HEK293T cells. We will apply homogenous time-resolved fluorescence (HTRF) to quantify p-SYK levels during the drug screening.

Results

Protein analyses have verified high expression of p-SYK in stable transfected HEK293T cells. No stimulation was required, as the cells showed an increased phosphorylation level at baseline. Downstream signaling partners such as p-ERK and p-JNK of the MAPK pathway displayed an upregulation. This suggests that the sustained activation of p-SYK may consequently affect cellular processes and contribute to the clinical manifestations observed in patients.

Conclusions

This research study will identify hit compounds that can produce a safe and effective biological response in pediatric patients with gain-of-function SYK variants. Personalizing medicine throughout high-throughput drug screening can accelerate drug repurposing for pediatric patients with multiple systemic diseases and immune dysregulation.

Funding Agencies

None

[Dihydromyricetin reverses Herceptin resistance by up-regulating miR-98-5p and inhibiting IGF1R/HER2 dimer formation in SKBR3 cells]

OBJECTIVE

To explore the effect of dihydromyricetin on the expression of miR-98-5p and its mechanism in the development of Herceptin resistance in SKBR3 cells.

METHODS

The expression of IGF2 and miR-98-5p and their interaction relationship were analyzed by bioinformatics analysis through TargetScan online databases. SKBR3 cells and drug-resistant SKBR3-R cells were cultured in cell experiments. Xenograft tumor mice were constructed by SKBR3 and SKBR3-R cells. Proteins were detected by western blotting and immunohistochemistry. Transfected cells were constructed by shRNA lentivirus vectors. RT-QPCR was used to detect RNA. Cell proliferation was detected by MTS method. Cell jnvasion was detected by Transwell assay. Luciferase reporting assays were used to verify RNA interactions. IGF-1R/HER2 heterodimer was determined by immunocoprecipitation.

RESULTS

The expression of IGF2, p-IGF1R, p-Akt and p-S6K in SKBR3-R cells were significantly higher than those in SKBR3 cells, while the expression of PTEN protein was lower in SKBR3-R cells (P < 0.05). IGF1R/HER2 heterodimer in SKBR3-R cells was significantly increased (P < 0.01).The expression of IGF2 and invasion ability were significantly reduced while transfected with miR-98-5p in SKBR3-R cells (P < 0.05), but the IGF2 mRNA were no difference in both cells (P > 0.05). The expression of miR-98-5p was up-regulated and IGF2 was decreased in drug-resistant xenograft tumor mice after feeding with dihydromyricetin, and the tumor became more sensitivity to Herceptin (P < 0.05).

CONCLUSION

Dihydromyricetin could induce the expression of miR-98-5p, which binds to IGF2 mRNA to reduce IGF2 expression, inhibit the IGF-1R/HER2 formation, thereby reversing cell resistance to Herceptin in SKBR3-R cells.

Seed bulb size influences the effects of exogenous brassinolide on yield and quality of Pinellia ternata

In recent years, natural Pinellia ternata populations of have gradually been exhausted, while the cultivated yield has been limited due to lack of research and uncertain climate condition. Therefore, it is necessary to explore methods of improving yield and quality in P. ternata using brassinolide (BR) treatments and choice of a suitable seed bulb size. This article reports the effects of BR and two seed bulb sizes (diameter: 0.5-1.0 cm and 1.0-1.5 cm) on active and nutrient components and antioxidant activity in P. ternata. The experiment included six levels of BR (0, 0.05, 0.10, 0.50, 1.00 and 2.00 mg l^-1 ). The tuber yield of the two seed bulb sizes and bulbil yield of small seed bulbs increased 5.67%, 22.66% and 69.23% by day 105 after 0.50 mg l^-1 BR treatment, compared with the control. On day 105, only 0.05 mg l^-1 BR increased scores in principal components analysis (PCA) in tubers of small seed bulbs by 167.29%, and 0.05 and 0.50 mg l^-1 BR increased PCA score in bulbils of large seed bulbs by 145.66% and 252.97%, respectively, compared with the control. Significant BR × seed bulb size interactions were found on yield and quality of P. ternata. The results indicate that BR effects on yield and quality of tubers and bulbils of P. ternata are not only related to BR concentration but also to seed bulb size.

Dietary Intervention With α-Amylase Inhibitor in White Kidney Beans Added Yogurt Modulated Gut Microbiota to Adjust Blood Glucose in Mice

White kidney beans contain α-amylase inhibitors that can be used in diet for weight reduction. In this study, we investigated the potential of white kidney bean (phaseolus vulgaris L.) extract enriched in α-amylase inhibitor as a food additive in yogurt to regulate blood glucose in hyperglycemic animals. Five groups of C57BL/6J mice were fed for 8 weeks with standard chow diets, high-fat diets (HFD), or high-fat diets with supplement of α-amylase inhibitor in white kidney beans (P. vulgaris extract, PVE), yogurt (Y), and PVE added yogurt (YPVE), respectively. The HFD weakened glucose tolerance and caused insulin resistance in mice, and changed the characteristics of intestinal flora. The intervention of Y, PVE, and YPVE decreased blood glucose, insulin, hyperlipidemia, and inflammatory cytokine levels in mice fed with HFD. Moreover, the YPVE could regulate the components of host intestinal microbiota toward a healthy pattern, significantly increased the metabolic-related flora Corynebacterium, Granulicatella, and Streptococcus, while it decreased Paraprevotella and Allobaculum. Thus, YPVE markedly increased functions of "Amino Acid Metabolism," "Energy Metabolism," "Nucleotide Metabolism," and declined functions of "Glycan Biosynthesis and Metabolism." Consequently, YPVE could be developed as a new functional food because of its beneficial prebiotic properties in the metabolic syndrome.

Adherence to antihypertensive medications for secondary prevention of cardiovascular disease events: a dose-response meta-analysis

OBJECTIVES

The aim of the study was to explore the association between adherence to antihypertensive medications (AHMs) and the risk of recurrence of cardiovascular disease (CVD) events in patients with a history of CVD events from cohort studies.

STUDY DESIGN

This is a dose-response meta-analysis.

METHODS

PubMed and Embase databases were searched up to March 4, 2021, to identify English-language reports of cohort studies that assessed the association of AHM adherence with risk of recurrence of CVD events. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated by using a fixed- or random-effects model. Restricted cubic splines were used to evaluate the possible linear or non-linear association.

RESULTS

We included nine cohort studies (54,349 patients) in the present meta-analysis. The pooled RR of CVD events was 0.66 (95% CI, 0.54-0.78) for the highest versus lowest AHM adherence category. We did not find any evidence of non-linearity association between AHM adherence and risk of CVD events (P_{non-linearity} = 0.534); for patients with a history of CVD events, the risk of CVD events was reduced by 9% for each 20% increase in AHM adherence (RR, 0.91; 95% CI, 0.85-0.97). The results of sensitivity analysis and subgroup analysis were virtually unchanged.

CONCLUSIONS

The high level of adherence to AHM is an effective strategy for preventing recurrence of CVD events. Patients with a history of CVD events should adhere to AHM.

Heterogeneous Nuclear Ribonucleoprotein A1 Loads Batched Tumor-Promoting MicroRNAs Into Small Extracellular Vesicles With the Assist of Caveolin-1 in A549 Cells

MicroRNAs in small extracellular vesicle (sEV-miRNAs) have been widely investigated as crucial regulated molecules secreted by tumor cells to communicate with surroundings. It is of great significance to explore the loading mechanism of sEV-miRNAs by tumor cells. Here, we comprehensively illustrated a reasoned loading pathway of batched tumor-promoting sEV-miRNAs in non-small cell lung cancer (NSCLC) cell line A549 with the application of a multi-omics method. The protein heterogeneous nuclear ribonucleoprotein A1 (hnRNPA1) was strictly selected as a powerful sEV-miRNA loading protein from miRNA-binding proteome and further verified through small RNA sequencing after hnRNPA1 silence. In terms of the mechanism, SUMOylated hnRNPA1 in sEVs was verified to control sEV-miRNA loading. Subsequently, as a scaffolding component of caveolae, caveolin-1 (CAV1) was detailedly demonstrated to assist the loading of SUMOylated hnRNPA1 and its binding miRNAs into sEVs. Inhibition of CAV1 significantly prevented SUMOylated hnRNPA1 from encapsulating into sEVs, resulting in less enrichment of sEV-miRNAs it loaded. Finally, we confirmed that hnRNPA1-loaded sEV-miRNAs could facilitate tumor proliferation and migration based on database analysis and cytological experiments. Our findings reveal a loading mechanism of batched tumor-promoting sEV-miRNAs, which may contribute to the selection of therapeutic targets for lung cancer.

Toxicity mechanisms of nanoparticles in the male reproductive system

The field of nanotechnology has allowed for increasing nanoparticle (NP) exposure to the male reproductive system. Certain NPs have been reported to have adverse consequences on male germ and somatic cells. Germ cells are the bridge between generations and are responsible for the transmission of genetic and epigenetic information to future generations. A number of NPs have negative impacts on male germ and somatic cells which could ultimately affect fertility or the ability to produce healthy offspring. These impacts are related to NP composition, modification, concentration, agglomeration, and route of administration. NPs can induce severe toxic effects on the male reproduction system after passing through the blood-testis barrier and ultimately damaging the spermatozoa. Therefore, understanding the impacts of NPs on reproduction is necessary. This review will provide a comprehensive overview on the current state of knowledge derived from the previous in vivo and in vitro research on effects of NPs on the male reproductive system at the genetic, cellular, and molecular levels.

Disequilibrium in chicken gut microflora with avian colibacillosis is related to microenvironment damaged by antibiotics

The avian colibacillosis outbreak is a disease that threatens public health, poultry production, and economic interests, even after antibiotic feed addition. It is known that avian pathogenic E. coli is a major pathogenic factor; however, the systemic characteristics of gut flora in disease samples and how pathogens grow remain unknown. To study these issues in depth, we used the whole microbial genome shotgun sequencing technique to compare entire microbes in diseased and healthy broiler chickens. We found that it was not only E. coli that increased substantially, but most pathogenic flora also increased significantly in diseased samples. Subsequently, we proved that aminoglycoside antibiotic resistance genes were mainly found in non-E. coli strains. This suggests that E. coli survival under antibiotic stress was due to the cooperative resistance from non-E. coli strains. Among all these increasing strains, attaching and effacing pathogens could damage host intestinal epithelial cells to release oxygen in the gut to make the microenvironment more adaptable for E. coli strains. Furthermore, we observed that the functions of the T4SS/T6SS secretion system were dramatically enhanced, which could help E. coli to compete and enlarge their living spaces. Ultimately, pathogenic E. coli accumulated to cause avian colibacillosis. This study provides a new insight into intestinal microecology in diseased individuals, which would propose new treatment options for avian colibacillosis from a metagenome perspective.

A167 UNDERSTANDING THE IMPACT OF DOWNSTREAM OF KINASE 4 (DOK4) DAMAGING GENETIC VARIANTS IN THE PATHOGENESIS OF PEDIATRIC INFLAMMATORY BOWEL DISEASE (IBD)

Background

IBD is a chronic inflammatory disorder of the gastrointestinal (GI) tract whose precise pathological mechanisms remain elusive. It is thought that in pediatric IBD, pathogenic exposure does not appear sufficient to cause disease, thus genetic variations are critical to disease pathogenesis. The Muise Lab uses genetic sequencing of patients with IBD from all over the world to identify crucial genetic variations that are critical to IBD development.

We report two patients with IBD from unrelated families with mutations in DOK4. Both patients had profound extra-intestinal disease complicating their IBD.

Downstream of kinase (DOK) proteins are a family of adaptor molecules that are important in regulating cell signaling, especially in immune cells. They are known to suppress MAPK and PI3K/AKT pathways, whose dysregulation result in cancer. DOK4 has not been extensively studied, but research suggests that this gene produces two isoforms. It is known to have negative regulatory effects on immune cell activation but is also expressed across various other tissues, where its function is yet to be determined.

Aims

We hypothesize that these variations in DOK4 lead to immune cell dysregulation, which manifests in both gastrointestinal and systemic chronic inflammatory disease. Through this study, we aim to elucidate the mechanism of novel genetic defects in DOK4.

Methods

It will be critical to understand how variants within both patients are contributing to the onset of IBD through in vitro studies. Therefore, we will characterize and quantify how changes in expression of DOK4 alters essential cell signaling pathways. We have established immortalized cell lines from patients bearing these mutations to specifically characterize potential immune defects. We will also be using knock out cell models to understand the effect of loss of function of DOK4 in different cell types.

Results

Preliminary data shows variation in expression of the protein within patient peripheral blood mononuclear cells (PBMCs) compared to a healthy donor. Overexpression in HEK293T cells shows changes in MAPK and NFkB signaling.

Conclusions

With this study, we hope to identify new therapeutic targets for patients with DOK4 mutations.

Funding Agencies

CIHRThe Leona M. and Harry B. Helmsley Charitable Trust

Estimation of Patient Eye-Lens Dose During Neuro-Interventional Procedures using a Dense Neural Network (DNN)

The patient's eye-lens dose changes for each projection view during fluoroscopically-guided neuro-interventional procedures. Monte-Carlo (MC) simulation can be done to estimate lens dose but MC cannot be done in real-time to give feedback to the interventionalist. Deep learning (DL) models were investigated to estimate patient-lens dose for given exposure conditions to give real-time updates. MC simulations were done using a Zubal computational phantom to create a dataset of eye-lens dose values for training the DL models. Six geometric parameters (entrance-field size, LAO gantry angulation, patient x, y, z head position relative to the beam isocenter, and whether patient's right or left eye) were varied for the simulations. The dose for each combination of parameters was expressed as lens dose per entrance air kerma (mGy/Gy). Geometric parameter combinations associated with high-dose values were sampled more finely to generate more high-dose values for training purposes. Additionally, dose at intermediate parameter values was calculated by MC in order to validate the interpolation capabilities of DL. Data was split into training, validation and testing sets. Stacked models and median algorithms were implemented to create more robust models. Model performance was evaluated using mean absolute percentage error (MAPE). The goal for this DL model is that it be implemented into the Dose Tracking System (DTS) developed by our group. This would allow the DTS to infer the patient's eye-lens dose for real-time feedback and eliminate the need for a large database of pre-calculated values with interpolation capabilities.

Association of iodine-related knowledge, attitudes and behaviours with urinary iodine excretion in pregnant women with mild iodine deficiency

BACKGROUND

Subsequent to the implementation of the universal salt iodisation policy, China has all but eliminated the iodine deficiency disorders. However, pregnant women are still experiencing mild iodine deficiency. The present study explored factors that could relate to mild iodine deficiency in pregnant women.

METHODS

In total, 2400 pregnant women were enrolled using a multistage, stratified, random sampling method in Shanghai. Data were collected via a standardised questionnaire. The urine samples and household cooking salt samples were collected for the detection of urinary iodine and salt iodine concentrations.

RESULTS

The median urinary iodine concentration (MUIC) was 148.0 μg L^-1 for all participants, and 155.0 μg L^-1 , 151.0 μg L^-1 and 139.6 μg L^-1 in the first, second and third trimesters. The MUIC in the third trimester was significantly lower than that of the first trimester (P < 0.05). The usage rates of iodised salt and qualified-iodised salt were 71.5% and 59.4%, respectively. Iodine-related knowledge score composition ratio was significantly different between the high and low UIC groups (P < 0.05). Participants' MUIC increased significantly with the increases in iodine-related knowledge score (P < 0.001). The third trimester was a significant risk factor for high UIC, whereas high iodine-related knowledge score, actively learning dietary knowledge and having a habit of consuming iodine-rich food were significant protective factors for high UIC (P < 0.05).

CONCLUSIONS

Iodine level is adequate among pregnant women in Shanghai during the first and the second trimesters, although it is is insufficient in the third trimester. Good iodine-related knowledge, attitudes and behaviours are important for pregnant women with respect to maintaining adequate urinary iodine.

High level of CD10 expression is associated with poor overall survival in patients with head and neck cancer

CD10 is a common zinc-dependent metalloid protease that is expressed in numerous tissues, including malignant cells. Genomic alterations of CD10 are frequently observed in haematopoietic and non-haematopoietic tumours. In the present study, we analysed the CD10 expression in head and neck squamous cell carcinoma (HNSCC) and its association with tumour prognosis using bioinformatic analysis and explored the potential of a CD10-driven signalling pathway in a tumour-immune microenvironment. Briefly, data mining analysis showed strengthened CD10 expression in HNSCC patients. High CD10 expression was associated with unfavourable overall survival (OS) and recurrence-free survival (RFS). In addition, the correlation between CD10 expression and interleukin (IL)-6/IL-8-mediated M1 macrophage activity could potentially explain the poor prognosis of HNSCC. Among 692 genes co-expressed with CD10 in HNSCC, Rap1 signalling pathway, regulation of actin cytoskeleton, protein digestion and absorption, proteoglycans in cancer, PI3K-Akt signalling pathway, focal adhesion and extracellular matrix-receptor interaction were the candidate signalling pathways driven by the CD10 gene. Further investigation of immune-associated signalling pathways regulated by CD10 may be beneficial to improve the prognosis of HNSCC patients by immunotherapy.

Altered gut microbiota in Parkinson's disease patients/healthy spouses and its association with clinical features

INTRODUCTION

Increasing evidence shows that gut microbiota dysbiosis may play important roles in the occurrence and progression of Parkinson's disease (PD), but the findings are inconsistent. Besides, the effect of family environment on gut microbiota dysbiosis remains unclear.

METHODS

We characterized the gut microbial compositions of 63 PD patients, 63 healthy spouses (HS) and 74 healthy people (HP) using 16S rRNA sequencing. Clinical phenotypes and microbial composition were analyzed comprehensively.

RESULTS

There were markedly different microbial compositions among PD, HS and HP samples by alpha/beta diversity. We also found differential microbial compositions among Hoehn & Yahr stage/disease duration. Eight inflammation-associated microbial genera shared a continuously increase trend with increased Hoehn & Yahr stage and disease duration, indicating characteristic bacteria associated with deterioration in PD. Additionally, seven bacterial markers were identified for accurately differentiating PD patients from the controls (area under the curve [AUC]: 0.856).

CONCLUSIONS

Our study shows altered gut microbiota in PD patients. Importantly, inflammation-associated microbial genera may play roles in PD progression. Differential microbial compositions in HS and HP samples demonstrate that the gut microbiota are also affected by family environment. Disease-associated metagenomics studies should consider the family environmental factor. Our research provides an important reference and improves the understanding of gut microbiota in PD patients.

[Clinical features of patients with hypertrophic obstructive cardiomyopathy combining obstructive sleep apnea]

Objective: To investigate the clinical features of patients with hypertrophic obstructive cardiomyopathy (HOCM) combined with obstructive sleep apnea (OSA). Methods: From 2010 to 2018, a total of 299 patients who were diagnosed with hypertrophic cardiomyopathy and underwent sleep monitoring at Fuwai Hospital were retrospectively analyzed. General clinical features, data of echocardiography, and sleep breathing parameters were recorded. OSA was diagnosed by apnea-hypopnea index ≥ 5 events/hour. Clinical characteristics were compared between patients with and without OSA. Results: A total of 156 (52.2%) HOCM patients were diagnosed with OSA. Compared with patients without OSA, patients with OSA were older((54±10) years vs (45±14) years, P<0.001), had a higher body mass index ((27±3) kg/m(2) vs (25±3) kg/m(2), P<0.001), a higher prevalence of hypertension (54.4% (85/156) vs 21.0% (30/143), P<0.001), hyperlipidemia (37.2% (58/156) vs 13.3% (19/143), P<0.001) and smoking history (48.1% (75/156) vs 35.0% (50/143), P=0.022). Patients with OSA also had a higher incidence of New York Heart Association functional class Ⅱ or Ⅲ (P=0.017), atrial fibrillation (P=0.005), and higher levels of systolic and diastolic blood pressure, fast glucose and high-sensitive c-reactive protein (all P<0.001). Left ventricular end-diastolic diameter as well as ascending aorta diameter in patients with OSA were also greater than those without OSA (both P<0.001). Apnea-hypopnea index (AHI) value positively correlated with left ventricular end-diastolic diameter (r=0.346), ascending aorta diameter (r=0.357) and high-sensitive c-reactive protein (r=0.230) (all P<0.001). Conclusions: A high prevalence of OSA occurs in patients with HOCM. Severity of OSA correlates with cardiac remodeling and serum inflammatory factor level. As for HOCM patients, clinicians should actively monitor the sleep breathing parameters in order to recognize and treat potential OSA, thereby improving the prognosis of patients with HOCM.

RBUD: A New Functional Potential Analysis Approach for Whole Microbial Genome Shotgun Sequencing

Whole metagenome shotgun sequencing is a powerful approach to detect the functional potential of microbial communities. Currently, the read-based metagenomics profiling for established database (RBED) method is one of the two kinds of conventional methods for species and functional annotations. However, the databases, which are established based on test samples or specific reference genomes or protein sequences, limit the coverage of global microbial diversity. The other assembly-based metagenomics profiling for unestablished database (ABUD) method has a low utilization rate of reads, resulting in a lot of biological information loss. In this study, we proposed a new method, read-based metagenomics profiling for unestablished database (RBUD), based on Metagenome Database of Global Microorganisms (MDGM), to solve the above problems. To evaluate the accuracy and effectiveness of our method, the intestinal bacterial composition and function analyses were performed in both avian colibacillosis chicken cases and type 2 diabetes mellitus patients. Comparing to the existing methods, RBUD is superior in detecting proteins, percentage of reads mapping and ontological similarity of intestinal microbes. The results of RBUD are in better agreement with the classical functional studies on these two diseases. RBUD also has the advantages of fast analysis speed and is not limited by the sample size.

Enhancement of bone perfusion through cortical perforations to improve healing of medication-related osteonecrosis of the jaw: a retrospective study

Medication-related osteonecrosis of the jaw (MRONJ) is generally difficult to treat. So far, no optimal strategy for MRONJ has been established. The aim of this study was to determine whether a new surgical technique, i.e. curettage with cortical perforations of healthy adjacent bone that enhances bone perfusion would be more effective than standard curettage in treating patients with MRONJ. Twenty-eight MRONJ patients who underwent curettage treatment with or without cortical perforation technique at our institution between June 2014 and May 2016 were included in this retrospective study. Ten cases treated using cortical perforation technique were completely cured after primary wound closure with mucoperiosteal flap. During a long-term follow-up, two cases from the cortical perforation group relapsed at the mandibular sites 6 and 40 months post-operation, respectively, while in the control group, 77.8% (14/18) cases relapsed due to infected mucosa fistula or bone exposure 1-3 months after treatment. It was concluded that the new treatment approach might be more effective in treating patients with MRONJ caused by antiresorptive drugs. However, more extensive randomized trials are needed to further evaluate its efficacy in clinic.

[Gender difference in efficacy of intra-aortic balloon pump in acute myocardial infarction patients complicating with cardiogenic shock]

Objective: To investigate the effect of gender on the efficacy of intra-aortic balloon pump(IABP) applied in patients with cardiogenic shock complicated by acute myocardial infarction(AMI). Methods: A total of 209 patients diagnosed as cardiogenic shock complicated by AMI admitted in Fuwai Hospital from June 2012 to May 2018 were enrolled in our study. We collected the data from medical records and investigated their clinical manifestation and laboratory examination and IABP support, as well as 28-day (from diagnosis of cardiogenic shock) mortality retrospectively. Kaplan-Meier survival analysis was used to compare the 28-day survival rates of patients of different genders/with or without IABP treatment. Adjustment for age, systolic blood pressure, ST segment elevation myocardial infarction, dual antiplatelet, coma, APACHEⅡ score and SAPSⅡ score, Cox regression analysis was used to detect the affect of IABP treatment on the risk of all-cause mortality in different crowd, and using Z test to evaluate the modification effect of gender on IABP treatment efficacy. Results: A total of 209 patients were included in this study, with 148 males (80 (54.05%) cases received IABP support) and 61 females (22 (36.06%) cases received IABP support). A total of 102 patients received IABP treatment. The 28-day survival rate of male patients was higher than that of females (39.2% (58/148) vs. 26.2% (16/61), Log-rank P=0.034). The 28-day survival rate of patients receiving IABP was significantly higher than that of non-IABP groups (46.1% (47/102) vs. 25.2% (27/107), Log-rank P=0.001 7). Among female patients, there was no statistically significant difference in 28-day survival rate between those who received IABP and those who did not receive IABP (P=0.889). While in male patients, the 28-day survival rate of those who received IABP was higher than that of those who did not receive IABP (51.2% (41/80) vs. 25.0% (17/68), P=0.001). The survival rate of male patients treated with IABP was higher than that of male patients who did not receive IABP, female patients who did not receive IABP and female patients who received IABP (all P<0.05). After multiple regression analysis and adjustment of confounding factors, it was found that IABP implantation can significantly reduce the 28-day mortality risk in male patients (HR=0.44, 95%CI 0.25-0.77 P=0.004). While it had no inpact on the death risk in female patients(P= 0.401). The impact of IABP implantation in patients of different genders was significantly different (Z=-2.32, P=0.020). Conclusion: In AMI patients complicating cardiogenic shock, there is a gender difference in the impact of IABP implantation on the 28-day mortality risk, and protective effects are seen only in men.

Plasminogen improves lung lesions and hypoxemia in patients with COVID-19

BACKGROUND

Lungs from patients with coronavirus disease 2019 (COVID-19) have shown typical signs of acute respiratory distress syndrome (ARDS), formation of hyaline membrane mainly composed of fibrin and 'ground-glass' opacity. Previously, we showed plasminogen itself is a key regulator in fibrin degradation, wound healing and infection.

AIM

We aimed to investigate whether plasminogen can improve lung lesions and hypoxemia of COVID-19.

DESIGN

Thirteen clinically moderate, severe or critical COVID-19 patients were treated with atomization inhalation of freeze-dried plasminogen.

METHODS

Levels of their lung lesions, oxygen saturation and heart rates were compared before and after treatment by computed tomography scanning images and patient monitor.

RESULTS

After plasminogen inhalation, conditions of lung lesions in five clinically moderate patients have quickly improved, shown as the decreased range and density of 'ground glass' opacity. Improvements of oxygen saturation were observed in six clinically severe patients. In the two patients with critical conditions, the oxygen levels have significantly increased from 79-82% to 91% just about 1 h after the first inhalation. In 8 of 13 patients, the heart rates had slowed down. For the five clinically moderate patients, the difference is even statistically significant. Furthermore, a general relief of chest tightness was observed.

CONCLUSION

Whereas it is reported that plasminogen is dramatically increased in adults with ARDS, this study suggests that additional plasminogen may be effective and efficient in treating lung lesions and hypoxemia during COVID-19 infections. Although further studies are needed, this study highlights a possible hope of efficiently combating this rapid epidemic emergency.

Clinical significance of epithelial-mesenchymal transition typing of circulating tumour cells in colorectal cancer

AIM

The aim was to determine the diagnostic value of epithelial-mesenchymal transition typing of circulating tumour cells (CTCs) in colorectal cancer (CRC).

METHOD

Peripheral blood samples were collected from 51 CRC patients before anti-tumour treatment from April 2016 to June 2018 at the Peking University Shenzhen Hospital. The blood samples were analysed using the CanPatrol CTC typing technique (SurExam, Guangzhou, China), which combines nanomembrane enrichment with mRNA in situ hybridization. Based on the marker expression, the CTCs were classified into epithelial, epithelial mesenchymal and mesenchymal (M-CTC) types. The correlation between the CTC counts and clinicopathological characteristics such as gender, age, TNM stage, lymph node metastasis and distant metastasis were analysed by univariate and multivariate Cox regression models. The overall survival and progression-free survival (PFS) of patients demarcated by CTC typing were analysed using the Kaplan-Meier method and log-rank tests.

RESULT

M-CTCs were detected more frequently in patients with lymph node metastasis (N2 81.8%; N1 72.7%; N0 38.9%) as well as distant metastasis (M0 50%; M1a 81.25%; M1b 85.7%) compared to those without metastasis. In addition, the presence of M-CTCs was significantly correlated with distant metastasis (P < 0.01). Univariate analysis showed that lymph node metastasis (P = 0.035), distant metastasis (P < 0.001) and total CTC count ≥ 4 (P = 0.007) and M-CTC count ≥ 1 (P < 0.001) were significantly associated with unfavourable PFS, and lymph node metastasis (P = 0.04), distant metastasis (P = 0.01) and M-CTC count ≥ 1 (P < 0.001) were significantly associated with unfavourable overall survival. Multivariate analysis showed that the presence of M-CTCs was the only independent prognostic factor for poor PFS, and patients with M-CTCs had significantly shorter PFS than those without (P = 0.011).

CONCLUSION

M-CTCs are significantly associated with CRC severity and metastasis, and M-CTC count is an independent predictor of prognosis.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.