Changes of college students' psychological stress during the COVID-19 pandemic in China: A two-wave repeated survey

COVID-19 has posed unprecedented challenges to the mental health of college students worldwide. We examined the trends in students' stress levels during and after China's first wave of COVID-19 outbreaks by analyzing their demographics, behavior, mental health status, career confidence, and Chinese Perceived Stress Scale (CPSS) scores. Our findings indicate an increase in students' stress levels since the COVID-19 onset, with more students experiencing higher stress levels after the first outbreak than during it (OR = 2.03, 95% CI 1.79, 2.30). Several factors were identified as being associated with higher CPSS scores, including higher class levels, residence in rural or town areas, low family income, and lack of familiarity with COVID-19, among others. Our study highlighted the urgency of developing and implementing effective strategies to cope with students' stress during and after a global pandemic.

Extreme terahertz magnon multiplication induced by resonant magnetic pulse pairs

Nonlinear interactions of spin-waves and their quanta, magnons, have emerged as prominent candidates for interference-based technology, ranging from quantum transduction to antiferromagnetic spintronics. Yet magnon multiplication in the terahertz (THz) spectral region represents a major challenge. Intense, resonant magnetic fields from THz pulse-pairs with controllable phases and amplitudes enable high order THz magnon multiplication, distinct from non-resonant nonlinearities such as the high harmonic generation by below-band gap electric fields. Here, we demonstrate exceptionally high-order THz nonlinear magnonics. It manifests as 7th-order spin-wave-mixing and 6th harmonic magnon generation in an antiferromagnetic orthoferrite. We use THz two-dimensional coherent spectroscopy to achieve high-sensitivity detection of nonlinear magnon interactions up to six-magnon quanta in strongly-driven many-magnon correlated states. The high-order magnon multiplication, supported by classical and quantum spin simulations, elucidates the significance of four-fold magnetic anisotropy and Dzyaloshinskii-Moriya symmetry breaking. Moreover, our results shed light on the potential quantum fluctuation properties inherent in nonlinear magnons.

Opsin mutants alter host plant selection by color vision in the nocturnal invasive pest Tuta absoluta

In insects, vision is crucial in finding host plants, but its role in nocturnal insects is largely unknown. Vision involves responses to specific spectra of photon wavelengths and opsins plays an important role in this process. Long-wavelength sensitive opsin (LW opsin) and blue-sensitive opsin (BL opsin) are main visual opsin proteins and play important in behavior regulation.We used CRISPR/Cas9 technology to mutate the long-wavelength-sensitive and blue wavelength-sensitive genes and explored the role of vision in the nocturnal invasive pest Tuta absoluta. Light wave experiments revealed that LW2(-/-) and BL(-/-) mutants showed abnormal wavelength tropism. Both LW2 and BL mutations affected the preference of T. absoluta for the green environment. Mutations in LW2 and BL are necessary to inhibit visual attraction. The elimination of LW2 and BL affected the preference of leaf moths for green plants, and mutations in both induced a preference in moths for white plants. Behavioral changes resulting from LW2(-/-) and BL(-/-) mutants were not affected by sense of smell, further supporting the regulatory role of vision in insect behavior. To the best of our knowledge, this is the first study to reveal that vision, not smell, plays an important role in the host-seeking behavior of nocturnal insects at night, of which LW2 and BL opsins are key regulatory factors. These study findings will drive the development of the "vision-ecology" theory.

An "All-In-One" Immunomodulator-Engineered Clinical Translatable Immunotherapy of Advanced Hepatocellular Carcinoma

Clinical treatment of advanced hepatocellular carcinoma (HCC) remains a significant challenge. Utilizing 1-bromoacetyl-3,3-dinitroazetidine (RRx-001) to downregulate the expression of innate immune checkpoint molecule, cluster of differentiation 47 (CD47), provides a powerful means for treating advanced HCC containing abundant immunosuppressive macrophages. Herein engineering of a previously optimized Doxorubicin (DOX)-delivery nanoplatform based on sodium alginate is reported to further co-deliver RRx-001 (biotinylated aldehyde alginate-doxorubicin micelle prodrug nanoplatform, BEA-D@R) for efficient immunotherapy of advanced HCC. This groundbreaking  technique reveals the "all-in-one" immunotherapeutic functionalities of RRx-001. Besides the previously demonstrated functions of downregulating CD47 expression and increasing reactive nitrogen species (RNS) generation, another key function of RRx-001 for downregulating the expression of the adaptive immune checkpoint molecule programmed cell death 1 ligand 1 (PDL1) is first uncovered here. Combined with the reactive oxygen species (ROS) generation and an upregulated "eat me" signal level of DOX, BEA-D@R collectively increases RNS generation, enhances T-cell infiltration, and maximizes macrophage phagocytosis, leading to an average of 40% tumor elimination in a mice model bearing an initial tumor volume of ≈300 mm3 that mimics advanced HCC. Overall, the "all-in-one" immunotherapeutic functionalities of a clinical translatable nanoplatform are uncovered for enhanced immunotherapy of advanced HCC.

Improved Immune Response for Colorectal Cancer Therapy Triggered by Multifunctional Nanocomposites with Self-Amplifying Antitumor Ferroptosis

Ferroptosis, as a type of regulated cell death, can trigger the release of damage-associated molecular patterns from cancer cells and lead to the enhancement of immune recognition. Fenton reaction-mediated chemodynamic therapy could initiate ferroptosis by generating lipid peroxides, but its efficiency would be greatly restricted by the insufficient H2O2 and antioxidant system within the tumor. Herein, this work reports the successful preparation of H2O2 self-supplied and glutathione (GSH)-depletion therapeutic nanocomposites (Cu2O@Au) through in situ growth of Au nanoparticles on the surface of cuprous oxide (Cu2O) nanospheres. Upon delivery into cancer cells, the released Cu2O could consume endogenous H2S within colorectal cancer cells to form Cu31S16 nanoparticles, while the released Au NPs could catalyze glucose to generate H2O2 and gluconic acid. The self-supplying endogenous H2O2 and lower acidity could amplify the Cu ion-induced Fenton-like reaction. Meanwhile, the consumption of glucose would reduce GSH generation by disrupting the pentose phosphate pathway. Additionally, the Cu2+/Cu+ catalytic cycle promotes the depletion of GSH, leading to lipid peroxide accumulation and ferroptosis. It was found that the onset of ferroptosis triggered by Cu2O@Au could initiate immunologic cell death, promote dendritic cell maturation and T-cell infiltration, and finally enhance the antitumor efficacy of the PD-L1 antibody. In summary, this collaborative action produces a remarkable antitumor effect, which provides a promising treatment strategy for colorectal cancer.

Electroactive properties of EABs in response to long-term exposure to polystyrene microplastics/nanoplastics and the underlying adaptive mechanisms

Given widespread presence of polystyrene (PS) microplastics/nanoplastics (MPs/NPs), the electroactive responses and adaptation mechanisms of electroactive biofilms (EABs) exposed long-term to PS-containing aquatic environments remain unclear. Therefore, this study investigated the impacts of PS MPs/NPs on electroactivity of EABs. Results found that EABs exhibited delayed formation upon initially exposure but displayed an increased maximum current density (Imax) after subsequent exposure for up to 55 days. Notably, EABs exposure to NH2PS NPs (EAB-NH2PSNPs) demonstrated a 50% higher Imax than the control, along with a 17.84% increase in viability and a 58.10% increase in biomass. The cytochrome c (c-Cyts) content in EAB-NH2PSNPs rose by 178.35%, benefiting the extracellular electron transfer (EET) of EABs. Moreover, bacterial community assembly indicated the relative abundance of electroactive bacteria increased to 87.56% in EAB-NH2PSNPs. The adaptability mechanisms of EABs under prolonged exposure to PS MPs/NPs predominantly operate by adjusting viability, EET, and bacterial community assembly, which were further confirmed a positive correlation with Imax through structural equation model. These findings provide deeper insights into long-term effects and mechanisms of MPs/NPs on the electroactive properties of EABs and even functional microorganisms in aquatic ecosystems.

[Research hot spots and trends of keratoconus in China: a bibliometric analysis]

Objective: To review the studies related to keratoconus in China, investigate research hotspots and development trends in this field, and provide reference for future research. Methods: This is a bibliometrics study. The relevant literature written in Chinese was retrieved from the WanFang DATA and the China National Knowledge Infrastructure, English articles were collected from the Web of Science Core Collection database. Searched for journal articles related to keratoconus VOSviewer software, CiteSpace, and Bibliometrix in the R language were employed to create the knowledge map. The analysis encompassed the distribution of published journals, research collaboration networks of countries/regions, institutions, and authors. Additionally, core authors, high-frequency keyword co-occurrence, keyword topic maps, and keyword emergence time ranking were examined. Results: The study ultimately included 1 100 Chinese articles and 668 English articles. Chinese literature and English literature began to increase in 1997 and 2009, respectively, indicating that the field is currently in a developmental stage. The publications involved 244 Chinese journals and 150 English journals, predominantly in the field of ophthalmology. The United States collaborated the most with China, contributing to 123 articles, followed by other countries such as the United Kingdom and Switzerland. Chinese literature and English literature involved 552 and 883 institutions, respectively. The institution with the highest number of Chinese literature publications was the Eye Institute of Shandong First Medical University (63 papers), while Wenzhou Medical University had the highest number of English literature publications (91 papers). Chinese literature involved 2 435 authors, and English literature involved 2 073 authors. The largest collaboration cluster in Chinese literature was formed by the teams of Xie Lixin and Shi Weiyun, while the Gao Hua team formed the largest cluster in English literature. However, collaboration between authors was primarily limited to within each team. A total of 622 and 1 611 keywords were extracted from Chinese and English literature, respectively. The node centrality of the four Chinese keywords, "keratoconus", "cornea", "corneal transplantation" and "myopia" as well as the three English keywords, "keratoconus", "collagen cross-linking" and "penetrating keratoplasty" was greater than 0.1. "Collagen", "riboflavin", "corneal transplantation" and "ultraviolet A" were identified as common core hotspots and important research topics in Chinese and English literature on keratoconus. Keyword emergence analysis indicated that the keywords with the highest intensity of emergence in Chinese and English literature were "myopia" (13.54) and "penetrating keratoplasty" (9.99), respectively. The longest emergence time was observed for "contact lenses" (1995-2006) and "penetrating keratoplasty" (2003-2014). Conclusions: At present, research on keratoconus in China is on the rise, with research hotspots including pathogenesis, various new surgical methods, and improvement in quality of life. The future research trend mainly focuses on early diagnosis and screening methods, artificial intelligence, biomechanical examination, subclinical keratoconus, and small incision lenticule extraction.

China's prevention and control experience of echinococcosis: A 19-year retrospective

Echinococcosis poses a significant threat to public health. The Chinese government has implemented prevention and control measures to mitigate the impact of the disease. By analyzing data from the Chinese Center for Disease Control and Prevention and the State Council of the People's Republic of China, we found that implementation of these measures has reduced the infection rate by nearly 50% between 2004 to 2022 (from 0.3975 to 0.1944 per 100,000 person-years). Nonetheless, some regions still bear a significant disease burden, and lack of detailed information limites further evaluation of the effects on both alveolar and cystic echinococcosis. Our analysis supports the continuing implementation of these measures and suggests that enhanced wildlife management, case-based strategies, and surveillance systems will facilitate disease control.

Molecular and Functional Characterization of Three General Odorant-Binding Protein 2 Genes in Cydia pomonella (Lepidoptera: Tortricidae)

General odorant-binding proteins (GOBPs) play a crucial role in the detection of host plant volatiles and pheromones by lepidopterans. Previous studies identified two duplications in the GOBP2 gene in Cydia pomonella. In this study, we employed qRT-PCR, protein purification, and fluorescence competitive binding assays to investigate the functions of three GOBP2 genes in C. pomonella. Our findings reveal that CpomGOBP2a and CpomGOBP2b are specifically highly expressed in antennae, while CpomGOBP2c exhibits high specific expression in wings, suggesting a potential divergence in their functions. Recombinant proteins of CpomGOBP2a, CpomGOBP2b, and CpomGOBP2c were successfully expressed and purified, enabling an in-depth exploration of their functions. Competitive binding assays with 20 host plant volatiles and the sex pheromone (codlemone) demonstrated that CpomGOBP2a exhibits strong binding to four compounds, namely butyl octanoate, ethyl (2E,4Z)-deca-2,4-dienoate (pear ester), codlemone, and geranylacetone, with corresponding dissolution constants (Ki) of 8.59993 μM, 9.14704 μM, 22.66298 μM, and 22.86923 μM, respectively. CpomGOBP2b showed specific binding to pear ester (Ki = 17.37481 μM), while CpomGOBP2c did not exhibit binding to any tested compounds. In conclusion, our results indicate a functional divergence among CpomGOBP2a, CpomGOBP2b, and CpomGOBP2c. These findings contribute valuable insights for the development of novel prevention and control technologies and enhance our understanding of the evolutionary mechanisms of olfactory genes in C. pomonella.

Research Note: Transcriptome analysis of skeletal muscles of black-boned chickens, including 2 types (wild and mutated) of Taihe black-boned silky fowl and 1 type (wild) of Yugan black-boned chicken

The large amount of melanin deposited in Taihe black-boned silky fowl and other black-boned chicken breeds is a highly valued trait due to its desirable nutritional and functional properties, such as antiaging, immune-enhancing, and antifatigue properties. To identify the candidate genes and pathways potentially responsible for melanogenesis in Taihe black-boned silky fowl, digital gene expression tag (DGE-tag)-based transcriptome analyses were performed for 2 groups: wild-type Taihe black-boned silky fowl (TH-1245) vs. mutated Taihe black-boned silky fowl (BY-1245) and TH-1245 vs. wild-type Yugan black-boned chicken (YG-1245). In total, 430 and 765 differentially expressed genes (DEGs) were identified and 13 DEGs displaying different gene expression patterns between the 2 groups were considered valuable for further investigation, such as ANKRD1, MYOZ2, and MYOD1. Furthermore, 6 functionally grouped networks composed of 36 significant GO terms, mainly involved in muscle-related and signaling-related biological processes, were screened by functional enrichment network analysis. In addition, protein-protein interaction (PPI) network analysis identifies 2 top clusters containing 20 hub genes for 2 comparison groups. MYL1 and RPS14 were considered the most potential candidate genes among all hub genes. The Gene Set Enrichment Analysis (GSEA) results showed that the terms and pathways, such as muscle system process, arachidonic acid metabolism, melanogenesis, and tyrosine metabolism, may play important roles in the melanogenesis and further investigations were needed to clarify the relationships between these pathways and melanin. Overall, these results are helpful for furthering our understanding of melanogenesis in breast muscle of Taihe black-boned silky fowl and Yugan black-boned chicken.

[Effect of changes in posterior tibial slope on the mid-term clinical outcomes of Oxford unicompartmental knee arthroplasty]

Objective: To investigate the impact of changes in the posterior tibial slope (PTS) in Oxford unicompartmental knee arthroplasty (OUKA) on the mid-term clinical outcomes of postoperative patients. Methods: This study was a follow-up study. The data of 135 patients (150 knees) who underwent OUKA at the China-Japan Friendship Hospital from January 2012 to January 2013 were analyzed retrospectively. The patients were followed-up for at least ten years. According to the changes in PTS of the medial tibial plateau before and after surgery, patients were divided into three groups: group A (PTS decreased by more than 5°), group B (PTS changed by 5° or less), and group C (PTS increased by more than 5°). The Knee Society Clinical Score (KSS-C), Knee Society Functional Score (KSS-F), Oxford Knee Score (OKS), Forgotten Joint Score (FJS), and knee range of motion (ROM) among the three groups were compared at the last follow-up. Results: Prior to the final follow-up assessment, six patients expired, and an additional nine patients were lost to follow-up. A total of 120 patients (135 knees) were enrolled in this study (30 males and 90 females). The mean age was (66.29±8.62) years, and the follow-up time was (10.54±0.72) years. Group A consisted of 32 patients (34 knees), group B comprised 77 patients (90 knees), and group C included 11 patients (11 knees). One knee in group A suffered prosthesis loosening, and two knees in group C experienced postoperative bearing dislocation, one knee encountered bearing fragmentation. The incidence of postoperative complications differed significantly among the three groups (P<0.05). The preoperative OKS was (33.91±6.59) points, KSS-F was (43.46±8.99) points, KSS-C was (41.05±5.70) points and ROM was 115.23°±13.53°; after the surgery, they changed to (18.82±7.01) points, (81.51±7.34) points, (82.64±7.94) points, and 119.07°±8.62°, respectively, and all the differences were statistically significant (all P<0.001). In terms of postoperative outcomes, group A had an OKS of (21.44±8.46) points and a FJS of (63.83±11.40) points, group B had an OKS of (17.07±5.81) points and a FJS of (70.49±12.45) points, group C had an OKS of (25.09±5.07) points and a FJS score of (59.48±10.09) points; the differences among the three groups were all statistically significant (all P<0.05), but there were no significant differences in the postoperative KSS scores and ROM among the three groups (all P>0.05). Conclusions: After OUKA, better mid-term clinical outcomes are achieved when ΔPTS is<5°. Although the recommended central value for PTS in OUKA is 7° according to Oxford, it should be individualized, and it is recommended to consider the preoperative angle, with a change of less than 5° before and after surgery.

Identification and characterization of CLEC11A and its derived immune signature in gastric cancer

Introduction

C-type lectin domain family 11 member A (CLEC11A) was characterized as a growth factor that mainly regulates hematopoietic function and differentiation of bone cells. However, the involvement of CLEC11A in gastric cancer (GC) is not well understood.

Methods

Transcriptomic data and clinical information pertaining to GC were obtained and analyzed from publicly available databases. The relationships between CLEC11A and prognoses, genetic alterations, tumor microenvironment (TME), and therapeutic responses in GC patients were analyzed by bioinformatics methods. A CLEC11A-derived immune signature was developed and validated, and its mutational landscapes, immunological characteristics as well as drug sensitivities were explored. A nomogram was established by combining CLEC11A-derived immune signature and clinical factors. The expression and carcinogenic effects of CLEC11A in GC were verified by qRT-PCR, cell migration, invasion, cell cycle analysis, and in vivo model analysis. Myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs), M2 macrophages, and T cells in tumor samples extracted from mice were analyzed utilizing flow cytometry analysis.

Results

CLEC11A was over-expressed in GC, and the elevated CLEC11A expression indicated an unfavorable prognosis in GC patients. CLEC11A was involved in genomic alterations and associated with the TME in GC. Moreover, elevated CLEC11A was found to reduce the benefit of immunotherapy according to immunophenoscore (IPS) and the tumor immune dysfunction, exclusion (TIDE). After validation, the CLEC11A-derived immune signature demonstrated a consistent ability to predict the survival outcomes in GC patients. A nomogram that quantifies survival probability was constructed to improve the accuracy of prognosis prediction in GC patients. Using shRNA to suppress the expression of CLEC11A led to significant inhibitions of cell cycle progression, migration, and invasion, as well as a marked reduction of in vivo tumor growth. Moreover, the flow cytometry assay showed that the knock-down of CLEC11A increased the infiltration of cytotoxic CD8+ T cells and helper CD4+ T into tumors while decreasing the percentage of M2 macrophages, MDSCs, and Tregs.

Conclusion

Collectively, our findings revealed that CLEC11A could be a prognostic and immunological biomarker in GC, and CLEC11A-derived immune signature might serve as a new option for clinicians to predict outcomes and formulate personalized treatment plans for GC patients.

Remaining Useful Life Prediction of Rolling Bearings Based on ECA-CAE and Autoformer

In response to the need for multiple complete bearing degradation datasets in traditional deep learning networks to predict the impact on individual bearings, a novel deep learning-based rolling bearing remaining life prediction method is proposed in the absence of fully degraded bearng data. This method involves processing the raw vibration data through Channel-wise Attention Encoder (CAE) from the Encoder-Channel Attention (ECA), extracting features related to mutual correlation and relevance, selecting the desired characteristics, and incorporating the selected features into the constructed Autoformer-based time prediction model to forecast the degradation trend of bearings' remaining time. The feature extraction method proposed in this approach outperforms CAE and multilayer perceptual-Attention Encoder in terms of feature extraction capabilities, resulting in reductions of 0.0059 and 0.0402 in mean square error, respectively. Additionally, the indirect prediction approach for the degradation trend of the target bearing demonstrates higher accuracy compared to Informer and Transformer models, with mean square error reductions of 0.3352 and 0.1174, respectively. This suggests that the combined deep learning model proposed in this paper for predicting rolling bearing life may be a more effective life prediction method deserving further research and application.

Solitary sacral osteochondroma growing into the spinal canal: Case report and review of the literature

Osteochondroma is one of the most common benign bone tumors, mainly involving the bone ends of long bones, and involving the spine is rare. It often involves the competing, followed by the thoracic and lumbar spine, and rarely involves the sacrum. We report the imaging findings of a solitary osteochondroma of the sacrum. The patient was a 37-year-old woman who presented clinically with progressive low back pain associated with left buttock pain and discomfort. CT and MRI showed that the lesion originated from the left lamina of S1 and grew anteriorly and superiorly, resulting in compressive resorption of the L5 vertebral bone, left foraminal stenosis and adjacent nerve root swelling. The patient underwent surgery and the mass was completely excised and recovered well postoperatively. Osteochondroma arising from the sacrum is rare and can lead to compressive resorption of adjacent bone, and imaging techniques are conducive to the localization and characterization of the lesion and provide useful information for clinical treatment.

Multiparametric MRI-based radiomics nomogram for predicting the hormone receptor status of HER2-positive breast cancer

AIM

To investigate the value of multiparametric magnetic resonance imaging (MRI)-based radiomics nomograms for predicting the hormone receptor (HR) status of HER2-positive breast cancer.

MATERIALS AND METHODS

Patients with HER2-positive invasive breast cancer were divided randomly into training (68 patients) and validation (30 patients) sets. All were classified as either HR-positive (HR+) or negative (HR-) at histopathology. Two radiologists outlined the three-dimensional (3D) volumetric regions of interest (VOI) on the MRI images. Features (n=1,096) were extracted from the T2-weighted imaging (WI), apparent diffusion coefficient (ADC), and dynamic contrast-enhanced (DCE) images separately. Dimensionality was reduced using feature screening. Binary radiomics prediction models were established using a logistic regression classifier and were validated in the validation set. To construct a nomogram, independent predictors were identified using multivariate logistic regression analysis. The predictive efficacy of the model was assessed using the area under the receiver operating characteristic curve (AUC).

RESULTS

Ten radiomics features were obtained after feature dimensionality reduction based on the merged T2WI, ADC, and DCE images. The diagnostic efficacy of the radiomics signature using the three sequences was better than that of any single sequence (training set AUC: 0.797; validation set AUC: 0.75). Using multivariate logistic regression analysis, the independent predictors for identifying HR status were combined radiomics signature and peritumoural oedema. Nomograms constructed by combining the radiomics signature and peritumoural oedema showed good discrimination in both the training and validation sets (AUC: 0.815 and 0. 805, respectively).

CONCLUSION

A multiparametric MRI-based nomogram incorporating the radiomics signature and peritumoural oedema can assess the HR status of HER2-positive breast cancer. The resulting model can improve diagnostic accuracy, improving patient outcomes.

Endochondral Repair of Jawbone Defects Using Periosteal Cell Spheroids

Recapitulation of the natural healing process is receiving increasing recognition as a strategy to induce robust tissue regeneration. Endochondral ossification has been recognized as an essential reparative approach in natural jawbone defect healing. However, such an approach has been overlooked in the recent development of cell-based therapeutics for jawbone repair. Therefore, this study aimed to explore a bioinspired stem cell-based strategy for jawbone repair by mimicking the mesenchymal condensation of progenitor cells during the early endochondral ossification process. For this purpose, passage 3 of jawbone periosteum-derived cells (jb-PDCs) was cultured in our previously reported nonadherent microwells (200 µm in diameter, 148 µm in depth, and 100 µm space in between) and self-assembled into spheroids with a diameter of 96.4 ± 5.8 µm after 48 h. Compared to monolayer culture, the jb-PDC spheroids showed a significant reduction of stemness marker expression evidenced by flow cytometry. Furthermore, a significant upregulation of chondrogenic transcription factor SOX9 in both gene and protein levels was observed in the jb-PDC spheroids after 48 h of chondrogenic induction. RNA sequencing and Western blotting analysis further suggested that the enhanced SOX9-mediated chondrogenic differentiation in jb-PDC spheroids was attributed to the activation of the p38 MAPK pathway. Impressively, inhibition of p38 kinase activity significantly attenuated chondrogenic differentiation jb-PDC spheroids, evidenced by a significant decline of SOX9 in both gene and protein levels. Strikingly, the jb-PDC spheroids implanted in 6- to 8-wk-old male C57BL/6 mice with critical-size jawbone defects (1.8 mm in diameter) showed an evident contribution to cartilaginous callus formation after 1 wk, evidenced by histological analysis. Furthermore, micro-computed tomography analysis showed that the jb-PDC spheroids significantly accelerated bone healing after 2 wk in the absence of exogenous growth factors. In sum, the presented findings represent the successful development of cell-based therapeutics to reengineer the endochondral bone repair process and illustrate the potential application to improve bone repair and regeneration in the craniofacial skeleton.

Rapid Intrafibrillar Mineralization Strategy Enhances Adhesive-Dentin Interface

Biomimetic mineralization of dentin collagen appears to be a promising strategy to optimize dentin bonding durability. However, traditional postbonding mineralization strategies based on Ca/P ion release still have some drawbacks, such as being time-consuming, having a spatiotemporal mismatch, and having limited intrafibrillar minerals. To tackle these problems, a prebonding rapid intrafibrillar mineralization strategy was developed in the present study. Specifically, polyacrylic acid-stabilized amorphous calcium fluoride (PAA-ACF) was found to induce rapid intrafibrillar mineralization of the single-layer collagen model and dentin collagen at just 1 min and 10 min, as identified by transmission electron microscopy, scanning electron microscopy, and atomic force microscopy. This strategy has also been identified to strengthen the mechanical properties of demineralized dentin within a clinically acceptable timeframe. Significantly, the bonding strength of the PAA-ACF-treated groups outperformed the control group irrespective of aging modes. In addition, the endogenous matrix metalloproteinases as well as exogenous bacterial erosion were inhibited, thus reducing the degradation of dentin collagen. High-quality integration of the hybrid layer and the underlying dentin was also demonstrated. On the basis of the present results, the concept of "prebonding rapid intrafibrillar mineralization" was proposed. This user-friendly scheme introduced PAA-ACF-based intrafibrillar mineralization into dentin bonding for the first time. As multifunctional primers, PAA-ACF precursors have the potential to shed new light on prolonging the service life of adhesive restorations, with promising significance.

[The effect of visual-vestibular sensory input consistency on standing stability and electroencephalogram brain network characteristics in the elderly]

Aging is a crucial factor influencing postural stability control and contributing to frequent falls, yet its underlying mechanisms remain incompletely understood. This study aims to explore the effects of aging on postural stability control by comparing differences in postural stability and node strength of electroencephalogram (EEG) brain network between elderly and young people under the conditions of congruent and incongruent visual-vestibular sensory inputs. Eighteen elderly volunteers without neuromuscular disorders and eighteen young individuals participated in the present study. Virtual reality (VR) technology was employed to manipulate visual rotation stimuli (clockwise and counterclockwise), and a horizontal rotating platform was used for vestibular rotation stimuli (clockwise). Based on the directional disparity of sensory input in the horizontal plane, visual-vestibular input consistency was categorized as congruent and incongruent. Postural stability was assessed by the center of pressure (COP) trajectory, and EEG signals were collected and analyzed using directed network analysis to observe EEG brain network node connectivity strength. The results revealed that, under conditions of incongruent visual-vestibular sensory inputs, the elderly exhibited significantly inferior postural stability performance in terms of COP anterior-posterior (Y-axial) sway speed, total path length, anterior-posterior and medial-lateral sample entropy, compared to the young adults. Moreover, the node connectivity strength of visual cortex in the elderly was notably higher, while node connectivity strength of superior temporal cortex was significantly lower than that in the young adults. These findings suggest that the elderly have a heightened reliance on visual information in postural control and an impaired ability to cope with sensory conflicts arising from incongruent visual-vestibular sensory inputs, leading to compromised postural stability. The outcomes of this study hold significant implications for future assessments of balance function in the elder and fall prevention trainings.

Effect of ibuprofen (IBU) on the sulfur-based and calcined pyrite-based autotrophic denitrification (SCPAD) systems with two filling modes: Performance and toxic response mechanism

To investigate the effect of ibuprofen (IBU) on the sulfur-based and calcined pyrite-based autotrophic denitrification (SCPAD) systems, two individual reactors with the layered filling (L-SCPAD) and mixed filling (M-SCPAD) systems were established via sulfur and calcined pyrite. Effluent NO3--N concentration of the L-SCPAD and M-SCPAD systems was first increased to 6.44, 0.93 mg/L under 0.5 mg/L IBU exposure and gradually decreased to 1.66 mg/L, 0 mg/L under 4.0 mg/L IBU exposure, indicating that NO3--N removal performance of the M-SCPAD system was better than that of the L-SCPAD system. The variation of extracellular polymeric substances (EPS) characteristics demonstrated that more EPS was secreted in the M-SCPAD system compared to the L-SCPAD system, which contributed to forming a more stable biofilm structure and protecting microorganisms against the toxicity of IBU in the M-SCPAD system. Moreover, the increased electron transfer impedance and decreased cytochrome c implied that IBU inhibited the electron transfer efficiency of the L-SCPAD and M-SCPAD systems. The decreased adenosine triphosphate (ATP) and electron transfer system activity (ETSA) content showed that IBU inhibited metabolic activity, but the M-SCPAD system exhibited higher metabolic activity compared to the L-SCPAD system. In addition, the analysis of the bacterial community indicated a more stable abundance of nitrogen removal function bacteria (Bacillus) in the M-SCPAD system compared to the L-SCPAD system, which was conducive to maintaining a stable denitrification performance. The toxic response mechanism based on the biogeobattery effect was proposed in the SCPAD systems under IBU exposure. This study provided an important reference for the long-term toxic effect of IBU on the SCPAD systems.

Immunohistochemical localisation of aquaporin 2 and vasopressin type 2 receptor in the human endolymphatic sac

OBJECTIVE

This study aimed to determine the distribution and subcellular localisation of aquaporin 2 and vasopressin type 2 receptor in the human endolymphatic sac.

METHODS

Ten samples of human endolymphatic sac were collected during acoustic neurinoma removal using the translabyrinthine approach. Immunohistochemistry and immunofluorescence were performed using aquaporin 2 and vasopressin type 2 receptor monoclonal antibodies.

RESULTS

Confocal microscopy demonstrated that vasopressin type 2 receptor labelling was expressed in both the apical and basolateral plasma membranes, and in the cytoplasm of the endolymphatic sac epithelium, whereas aquaporin 2 was strongly expressed at the basolateral site of the endolymphatic sac epithelium, in both the intraosseous and extraosseous parts of the endolymphatic sac.

CONCLUSION

Both aquaporin 2 and vasopressin type 2 receptor were detected in the epithelial cells of the human endolymphatic sac, suggesting that this channel may be involved in inner-ear fluid homeostasis. However, strong basolateral expression of aquaporin 2 in endolymphatic sac epithelium suggested that the function of aquaporin 2 may differ between the endolymphatic sac and kidney.

Laparoscopic Inguinal Hernia Repair and Synchronous Peritoneal Dialysis Catheter Placement: A Single-Center Experience

Background: Peritoneal dialysis (PD) is a common method for treating end-stage renal disease (ESRD). Occurrence of inguinal hernia before and during PD is considered to be the main cause of treatment discontinuation, failure, and conversion to hemodialysis. In this study, we present a single-center experience about laparoscopic inguinal hernia repair and synchronous PD catheter placement and evaluated the feasibility and outcomes. Methods: During May 2018 to May 2022, a total of 216 consecutive patients with ESRD underwent laparoscopic PD catheter placement. Among them, 41 patients (27.7%) with coexistent inguinal hernia were included in this study. Individual information, complications, recurrent and new-onset hernias, and catheter survival were retrospectively analyzed. Results: Forty-one patients underwent laparoscopic inguinal hernia repair and synchronous PD catheter placement, 9 patients had bilateral inguinal hernia, and another 32 patients had unilateral inguinal hernia. The mean age was 46.49 years (range, 28-72 years), including 39 males and 2 females. There was no recurrent hernia and only 1 patient (2.4%) developed incisional hernia (trocar site hernia) which required hernia repair and discontinuation of PD. No postoperative complications were observed, such as bleeding, infection, and dialysate leakage. After a median follow-up of 37 months (20-58 months), there were no deaths and 97.6% (40/41) catheters were still working. Conclusions: Laparoscopic hernia repair and synchronous PD catheter placement is an effective and safe treatment for ESRD patients with coexisting inguinal hernia in virtue of low postoperative complications and high catheter survival.

Pneumonia-Plus: a deep learning model for the classification of bacterial, fungal, and viral pneumonia based on CT tomography

OBJECTIVES

This study aims to develop a deep learning algorithm, Pneumonia-Plus, based on computed tomography (CT) images for accurate classification of bacterial, fungal, and viral pneumonia.

METHODS

A total of 2763 participants with chest CT images and definite pathogen diagnosis were included to train and validate an algorithm. Pneumonia-Plus was prospectively tested on a nonoverlapping dataset of 173 patients. The algorithm's performance in classifying three types of pneumonia was compared to that of three radiologists using the McNemar test to verify its clinical usefulness.

RESULTS

Among the 173 patients, area under the curve (AUC) values for viral, fungal, and bacterial pneumonia were 0.816, 0.715, and 0.934, respectively. Viral pneumonia was accurately classified with sensitivity, specificity, and accuracy of 0.847, 0.919, and 0.873. Three radiologists also showed good consistency with Pneumonia-Plus. The AUC values of bacterial, fungal, and viral pneumonia were 0.480, 0.541, and 0.580 (radiologist 1: 3-year experience); 0.637, 0.693, and 0.730 (radiologist 2: 7-year experience); and 0.734, 0.757, and 0.847 (radiologist 3: 12-year experience), respectively. The McNemar test results for sensitivity showed that the diagnostic performance of the algorithm was significantly better than that of radiologist 1 and radiologist 2 (p < 0.05) in differentiating bacterial and viral pneumonia. Radiologist 3 had a higher diagnostic accuracy than the algorithm.

CONCLUSIONS

The Pneumonia-Plus algorithm is used to differentiate between bacterial, fungal, and viral pneumonia, which has reached the level of an attending radiologist and reduce the risk of misdiagnosis. The Pneumonia-Plus is important for appropriate treatment and avoiding the use of unnecessary antibiotics, and provide timely information to guide clinical decision-making and improve patient outcomes.

CLINICAL RELEVANCE STATEMENT

Pneumonia-Plus algorithm could assist in the accurate classification of pneumonia based on CT images, which has great clinical value in avoiding the use of unnecessary antibiotics, and providing timely information to guide clinical decision-making and improve patient outcomes.

KEY POINTS

• The Pneumonia-Plus algorithm trained from data collected from multiple centers can accurately identify bacterial, fungal, and viral pneumonia. • The Pneumonia-Plus algorithm was found to have better sensitivity in classifying viral and bacterial pneumonia in comparison to radiologist 1 (5-year experience) and radiologist 2 (7-year experience). • The Pneumonia-Plus algorithm is used to differentiate between bacterial, fungal, and viral pneumonia, which has reached the level of an attending radiologist.

Regulating Movement in Pandemic Times

As COVID-19 and its variants spread across Australia at differing paces and intensity, the country's response to the risk of infection and contagion revealed an intensification of bordering practices as a form of risk mitigation with disparate impacts on different segments of the Australian community. Australia's international border was closed for both inbound and outbound travel, with few exceptions, while states and territories, Indigenous communities, and local government areas were subject to a patchwork of varying restrictions. By focusing on borders at various levels, our research traces how the logics of medico-legal bordering have filtered down from the international to the intra-national, and indeed, into hyper-local spaces. This is not just apparent in the COVID-19 moment but in previous pandemics of 1918 to 1919 influenza and smallpox, in which practices of quarantine and lockdowns were both unevenly distributed and implemented on multiple scales of social organization. An interdisciplinary approach between history and law reveals that human movement during pandemic times in Australia has been regulated in a manner that sees mobility as a risk to public health capable of mitigation through the strict enforcement of borders as a technology of both confinement and exclusion.

[Resistance to deltamethrin and its association with mutation sites in the sodium iron channel domain III gene in Rhipicephalus microplus in Huaihua City of Hunan Province]

OBJECTIVE

To investigate the level of deltamethrin resistance and mutation sites in the sodium iron channel gene in Rhipicephalus microplus in Huaihua City, Hunan Province, and to examine the correlation between deltamethrin resistance and mutation sites in the sodium iron channel gene in Rh. microplus.

METHODS

Rh. microplus was sampled from multiple yellow cattle farms in Huaihua City, Hunan Province from June to September 2022, and the level of resistance to deltamethrin was determined in ticks using the adult immersion test. The sodium iron channel domain III gene was amplified in deltamethrin-resistant and wild-type Rh. microplus using PCR assay. Following sequencing and sequence alignment, mutation sites were detected in bases. The sodium iron channel domain III gene in Rh. microplus was translated, and the signal peptide, transmembrane domain, and phosphorylation and glycosylation sites were detected in amino acid sequences. The tertiary structures of the sodium iron channel domain III protein of deltamethrin-resistant and wild-type Rh. microplus were deduced and compared, and the association be tween mutation sites in bases and resistance to deltamethrin was examined in Rh. microplus according the level of deltamethrin resistance, sequence alignment and protein tertiary structure.

RESULTS

The median (LC50) and 95% lethal concentrations (LC95) of deltamethrin were 121.39 mg/L and 952.61 mg/L against Rh. microplus, with a resistance factor of 9.24 and level II resistance. The sequence of the sodium ion channel domain III gene was 1 010 bp in size, and mutation sites were detected in two neighboring bases in the sequence of the sodium ion channel domain III gene in deltamethrin-resistant Rh. microplus. Although no signal peptides were found in the sodium iron channel domain III protein of deltamethrin-resistant or wild-type Rh. microplus, 6 trans-membrane domains, 42 phosphorylation sites and 8 glycosylation sites were identified, with a significant difference in the tertiary structure of the sodium iron channel domain III protein between deltamethrin-resistant and wild-type Rh. microplus.

CONCLUSIONS

Level II resistance to deltamethrin is detected in Rh. microplus in Huaihua City, Hunan Province, and two mutation sites that correlate with the emergence of deltamethrin resistance are identified in the sequence of the sodium iron channel domain III gene in deltamethrin-resistant Rh. microplus.

A Genome-Wide Analysis of Serine Protease Inhibitors in Cydia pomonella Provides Insights into Their Evolution and Expression Pattern

Serine protease inhibitors (serpins) appear to be ubiquitous in almost all living organisms, with a conserved structure and varying functions. Serpins can modulate immune responses by negatively regulating serine protease activities strictly and precisely. The codling moth, Cydia pomonella (L.), a major invasive pest in China, can cause serious economic losses. However, knowledge of serpin genes in this insect remain largely unknown. In this study, we performed a systematic analysis of the serpin genes in C. pomonella, obtaining 26 serpins from the C. pomonella genome. Subsequently, their sequence features, evolutionary relationship, and expression pattern were characterized. Comparative analysis revealed the evolution of a number of serpin genes in Lepidoptera. Importantly, the evolutionary relationship and putative roles of serpin genes in C. pomonella were revealed. Additionally, selective pressure analysis found amino acid sites with strong evidence of positive selection. Interestingly, the serpin1 gene possessed at least six splicing isoforms with distinct reactive-center loops, and these isoforms were experimentally validated. Furthermore, we observed a subclade expansion of serpins, and these genes showed high expression in multiple tissues, suggesting their important roles in C. pomonella. Overall, this study will enrich our knowledge of the immunity of C. pomonella and help to elucidate the role of serpins in the immune response.

Clinical and histopathological characteristics, diagnosis and treatment, and comorbidities of Bowen's disease: a retrospective study

Background

Bowen's disease (BD) is a slow-growing precancerous skin condition, often concurrent with other diseases, with a high misdiagnosis rate. Previous studies show that patients with BD in different populations have differentiated characteristics.

Materials and methods

A retrospective study was conducted in a tertiary hospital in Shenzhen, China. Data about demographic information, diagnosis and treatment, clinical and pathological characteristics, and comorbidities of 50 patients with BD were collected and analyzed.

Results

Clinical data of onset age and disease course of 43 patients with BD were available, the average onset age of male and female patients are 55.1 (standard deviation (SD) = 15.29) and 58.2 (SD = 15.59) years old, respectively; the average disease course of male and female patients are 25.3 (SD = 28.63) and 33.9 (SD = 49.65) months, respectively. The onset age (p = 0.52) and disease course (p = 0.49) between male and female patients are not significantly different. Interestingly, there is a negative correlation between onset age and disease course (r = -0.245, p = 0.11). The correct rate of clinical diagnosis is relatively low (54.00%); Some patients with BD are misdiagnosed as Bowenoid papulosis (10.00%), actinic keratosis (8.00%), basal cell carcinoma (8.00%), seborrheic keratosis (6.00%), and pigmented naevus (4.00%). Trunk and limbs are the most common distribution sites of BD lesions, and 94.00% patients with BD are treated with surgical resection; 66.00% patients with BD had comorbidities, including skin diseases (48.48%), cardiovascular diseases (39.39%), gastrointestinal diseases (30.30%), respiratory diseases (27.27%), and tumors (18.18%). The most commonly observed histopathological characteristics of BD are squamous-cell hyperplasia (86.00%), disordered maturation with atypical keratinocytes (74.00%), atypical mitoses (60.00%), hyperkeratosis with hypokeratosis (48.00%), dermal inflammatory cell infiltration (36.00%), and koilocytosis (22.00%).

Conclusion

BD often occurs in middle-aged and elderly people and is easily misdiagnosed. The onset age and disease course of patients with BD are not significantly different between males and females, whereas there is a negative correlation between the onset age and disease course. BD is more likely to occur in trunk and limbs in the Chinese population, and most patients with BD are concurrent with comorbidities.

Tetraphenylporphyrin-based Chelating Ligand Additive as a Molecular Sieving Interfacial Barrier toward Durable Aqueous Zinc Metal Batteries

The sustained water consumption and uncontrollable dendrite growth strongly hamper the practical applications of rechargeable zinc (Zn) metal batteries (ZMBs). Herein, for the first time, we demonstrate that trace amount of chelate ligand additive can serve as a "molecular sieve-like" interfacial barrier and achieve highly efficient Zn plating/stripping. As verified by theoretical modeling and experimental investigations, the benzenesulfonic acid groups on the additive molecular not only facilitates its water solubility and selective adsorption on the Zn anode, but also effectively accelerates the de-solvation kinetics of Zn2+ . Meanwhile, the central porphyrin ring on the chelate ligand effectively expels free water molecules from Zn2+ via chemical binding against hydrogen evolution, and reversibly releases the captured Zn2+ to endow a dendrite-free Zn deposition. By virtue of this non-consumable additive, high average Zn plating/stripping efficiency of 99.7 % over 2100 cycles together with extended lifespan and suppressed water decomposition in the Zn||MnO2 full battery were achieved, thus opening a new avenue for developing highly durable ZMBs.

The crucial roles of m6A RNA modifications in cutaneous cancers: Implications in pathogenesis, metastasis, drug resistance, and targeted therapies

N6-methyladenosine (m6A) is the most abundant internal modification on RNA. It is a dynamical and reversible process, which is regulated by m6A methyltransferase and m6A demethylase. The m6A modified RNA can be specifically recognized by the m6A reader, leading to RNA splicing, maturation, degradation or translation. The abnormality of m6A RNA modification is closely related to a variety of biological processes, especially the occurrence and development of tumors. Recent studies have shown that m6A RNA modification is involved in the pathogenesis of skin cancers. However, the precise molecular mechanisms of m6A-mediated cutaneous tumorigenesis have not been fully elucidated. Therefore, this review will summarize the biological characteristics of m6A modification, its regulatory role and mechanism in skin cancers, and the recent research progress of m6A-related molecular drugs, aiming to provide new ideas for clinical diagnosis and targeted therapy of cutaneous cancers.

NCBP1 Improves Cognitive Function in Mice by Reducing Oxidative Stress, Neuronal Loss, and Glial Activation After Status Epilepticus

Status epilepticus (SE) is a severe manifestation of epilepsy which can cause neurologic injury and death. This study aimed to identify key proteins involved in the pathogenesis of epilepsy and find a potential drug target for SE treatment. Tandem mass tag (TMT)-based quantitative proteomic analysis was applied to screen differentially expressed proteins (DEPs) in epilepsy. The adeno-associated virus was employed to overexpress candidate DEP in mice, and kainic acid (KA) was used to generate a mouse model of epilepsy. Then histopathological examination of the hippocampal tissue was performed, and the inflammatory factors levels in serum and hippocampus were measured. The IP-MS analysis was carried out to identify the interacting protein of nuclear cap-binding protein 1 (NCBP1). The results were that NCBP1 was downregulated in the epileptic hippocampus. NCBP1 overexpression alleviated KA-induced cognitive impairment in mice and reduced the apoptosis and damage of hippocampal neurons. Additionally, overexpressed NCBP1 increased the expression of NeuN and reduced the expression of GFAP and IBA-1 in the hippocampus of the mice. Further study indicated that NCBP1 overexpression inhibited the expression of IL-6, IL-1β, and IFN-γ in serum and hippocampus as well as MDA and LDH in the hippocampus, whereas it increased the SOD levels, suggesting that overexpression of NCBP1 could diminish KA-induced inflammatory responses and oxidative stress. The IP-MS analysis identified that ELAVL4 was the NCBP1-interacting protein. In conclusion, this finding suggests that NCBP1 may potentially serve as a drug target for the treatment of epilepsy.

Data-Driven Optimal Tracking Control for Discrete-Time Nonlinear Systems With Unknown Dynamics Using Deterministic ADP

This article aims to solve the optimal tracking problem (OTP) for a class of discrete-time (DT) nonlinear systems with completely unknown dynamics. A novel data-driven deterministic approximate dynamic programming (ADP) algorithm is proposed to solve this kind of problem with only input-output (I/O) data. The proposed algorithm has two advantages compared to existing data-driven deterministic ADP algorithms for the OTP. First, our algorithm can guarantee optimality while achieving better performance in the aspects of time-saving and robustness to data. Second, the near-optimal control policy learned by our algorithm can be implemented without considering expected control and enable the system states to track the user-specified reference signals. Therefore, the tracking performance is guaranteed while simplifying the algorithm implementation. Furthermore, the convergence and stability of the proposed algorithm are strictly proved through theoretical analysis, in which the errors caused by neural networks (NNs) are considered. At the end of this article, the developed algorithm is compared with two representative deterministic ADP algorithms through a numerical example and applied to solve the tracking problem for a two-link robotic manipulator. The simulation results demonstrate the effectiveness and advantages of the developed algorithm.

Mechanistic insights into the response of electroactive biofilms to Cd2+ shock: bacterial viability and electron transfer behavior at the cellular and community levels

Electroactive biofilms (EABs) play a crucial role in environmental bioremediation due to their excellent extracellular electron transfer (EET) capabilities. However, Cd2+ can have toxic effects on the electrochemical performance of EABs, and the comprehensive inhibition mechanism of EABs in response to Cd2+ shock remains elusive. This study indicated that Cd2+ shock significantly reduced biomass and increased oxidative stress in EABs at the cellular level. The bacterial viability of EABs in phase III under 0.5 mM Cd2+ shock (EABCd2+-III0.5) decreased by 16.31% compared to EABCK-III. Moreover, intracellular NADH, c-Cyts, and the abundance of electroactive species were essential indicators to evaluate EET behavior of EABs. In EABCd2+-III0.5, these indicators decreased by 26.32%, 33.40%, and 20.65%, respectively. Structural equation modeling analysis established quantitative correlations between core components and electrochemical activity at cellular and community levels. The correlation analysis revealed that the growth and electron transfer functions of EABs were predictive indicators for their electrochemical performance, with standardized path coefficients of 0.407 and 0.358, respectively. These findings enhance our understanding of EABs' response to Cd2+ shock and provide insights for improving their performance in heavy metal wastewater.

Failure Mode and Effects Analysis Prior to the Introduction of AI Generated GTVs for Brain Metastases in the Clinical Workflow

PURPOSE/OBJECTIVE(S)

AI autosegmentation of organs-at-risk (OARs) is common practice at many radiotherapy clinics. Despite the abundance of gross tumor volume (GTV) autosegmentation algorithms, adoption in clinical care has been slow due to the high risk associated with errors in GTV delineation. Here we present a failure mode and effects analysis (FMEA) to evaluate the risk associated with introducing AI derived GTVs in patients treated with stereotactic radiosurgery (SRS).

MATERIALS/METHODS

An AI GTV autosegmentation algorithm for brain metastases was developed in-house based on a V-Net 3D CNN. Registered CT and MR images and a contour of the brain are input into the software and all identified lesions are returned in a DICOM-RT structure set. Following algorithm evaluation, a workflow was developed to enable AI GTV autosegmentation to be introduced clinically for every SRS patient. The following steps were added to existing procedures: 1) workflow to send CT/MR and brain structure to external server, 2) autosegmentation run on the server, 3) AI GTV structures with a standard nomenclature added to existing OAR structure set, and 4) MD review, editing, and approval of AI GTVs. After successfully completing the physics evaluation testing of the new process, we formed a team of 10 faculty and staff including physicists, residents, physicians, and planners to perform the FMEA prior to clinical implementation. The team met to map the process, identify potential failure modes, and score their frequency of occurrence, severity, and detectability. A 3-point scale (1, 3, or 5) was used to simplify the scoring process. Occurrence was defined as rare, sometimes, or often; severity as low, medium, or high; and detectability as obvious, possible, or challenging. The risk probability numbers (RPNs) were calculated and the steps in the process with the highest RPNs were flagged for further discussion.

RESULTS

The FMEA team completed their process map and analysis primarily in 4 meetings. The process map began with acquisition of the patients CT simulation scan and ended with physician approval of final volumes for treatment planning. We identified 17 process steps and 72 possible failure modes, of which 26 were associated with the new workflow. Eighteen failure modes had an RPN greater than 30 (highest risk score in at least one category) and were flagged to assess mitigation strategies. Five were unique to the new AI GTV workflow and mitigation strategies will be designed prior to clinical use. Those involved risks related to inaccurate AI GTV contours, false positives, and an incomplete review stemming from over-reliance by team members on AI.

CONCLUSION

AI is increasingly being employed at every step of radiotherapy to automate and streamline processes. The FMEA analysis resulted in the identification of the riskiest parts of using AI GTV autosegmentation. This can be an effective tool in the development of checks to ensure that GTV autosegmentation methods can be safely introduced in support of patient care.

Primary Small Cell Carcinoma of the Esophagus in a Large Multicenter Cohort: Prognostic Factors and Treatment Strategies in the Modern Era

PURPOSE/OBJECTIVE(S)

Primary small cell carcinoma of esophageal (PSCCE) is a rare malignancy with aggressive behavior associated with a perceived poor prognosis. Due to its rarity, the clinical characteristics and the optimal clinical management have not yet been defined, therefore, we designed a multicenter retrospective study to analyze the prognostic factors and the impact of treatment on the prognosis of PSCCE patients.

MATERIALS/METHODS

We retrospectively evaluated 704 consecutive patients with PSCCE from five participating centers between April 2008 and July 2021. The PSCCE was diagnosed based on the World Health Organization classification. Treatment strategies included surgery, radiotherapy (RT), or chemotherapy only, and combination of 2-3 treatment modalities (surgery, RT and chemotherapy). The estimated hazard rates provide the trajectory of progression and death overtime. Univariate survival analysis was conducted by using Kaplan-Meier plots, and the log-rank test was used to compare survival differences. Cox regression analysis was used to determine the independent prognostic factors in multivariate analysis.

RESULTS

Overall, 69.0% (486/704) of the patients were male, with a median age of 63 years (range 38-96). Most of the patients were regional lymph node positive (N+, 64.0%), and nearly half with advanced stage (M+, 47.2%). With a median follow-up time of 16 months, 472 patients (67.0%) exhibited disease progression and 429 patients (60.9%) died. Following initial treatment, 85.1% (402/472) of progression/death and 80.1% (344/429) of mortalities occurred within 24 months. Consistently, the maximum annual death and progression/death hazards are highest in the 15.6 months and 9.6 months. The overall survival (OS) rates at 1, 3 and 5 years for all patients were 65.1%, 26.5% and 18.3%, respectively. Univariate survival analysis showed that ECOG score, alcohol abuse, TNM stage, N stage, and M stage were correlated with OS (P <0.05). Multivariate analysis showed that the N stage (HR: 1.378, P = 0.018) and M stage (HR: 1.945, P <0.001) carried independent prognostic factors for OS. In the term of treatment, the OS rates for M- patients treated with combined modality therapy (CMT, surgery±radiotherapy/chemotherapy) were better than those treated with surgery alone or radiotherapy/chemotherapy (3-year OS: 36.7% VS 25.6% VS 32.2%; P = 0.045). The OS rates for M+ patients treated with chemotherapy alone, radiotherapy alone, or radiotherapy combined with chemotherapy were no significant differences (3-year OS: 12.2% VS 19.4% VS 11.1%; P = 0.400).

CONCLUSION

PSCCE is characterized by a high degree of malignancy with high risks of lymphatic and distant metastasis, N and M stages are the most important prognostic factor. In terms of treatment, comprehensive treatment is most likely to benefit patients without distant metastasis.

The Role of Radiotherapy in Patients with Refractory Hodgkin Lymphoma after Brentuximab Vedotin and -/or Immune Checkpoint Inhibitors

PURPOSE/OBJECTIVE(S)

Brentuximab vedotin (BV) and immune checkpoint inhibitors (ICIs) had important roles in the treatment of relapse or refractory (R/R) Hodgkin lymphoma (HL). Treatment of refractory disease after BV and -/or ICIs remains a challenge. This study was conducted to evaluate the efficacy and safety of radiotherapy for R/R HL after failure to BV or ICIs.

MATERIALS/METHODS

We retrospectively analyzed patients in two institutions with R/R HL who had failed after first-line therapy, and were refractory to BV or ICIs, and received radiotherapy (RT) thereafter. The overall response rate (ORR), duration of response (DOR), progression-free survival (PFS) and overall survival (OS) were analyzed.

RESULTS

A total of 19 patients were enrolled. First-line systemic therapy consisted of ABVD (84.2%), AVD + ICIs (10.5%) and BEACOPP (5.3%), respectively. After first-line therapy, 15 patients (78.9%) were refractory, and 4 patients (21.1%) relapsed. After diagnosis of R/R HL, 8 patients (42.1%) received BV, and 17 patients (89.5%) received ICIs. RT was delivered in all 19 patients who failed after BV or ICIs. In 16 efficacy-evaluable patients, the ORR and CR rate were 100% and 100%. The median DOR was 17.2 months (range, 7.9 to 46.7 months). 3 patients progressed at outside of the radiation field. The in-field-response rate was 100%. The 12-month PFS and OS were 84.4% and 100%, respectively. No patients were reported with sever adverse events.

CONCLUSION

This study concluded that radiotherapy was effective and safe for refractory HL after BV or ICIs. Further prospective studies were warranted.

Role of Toll-Like Receptors in Common Infectious Diseases of the Female Lower Genital Tract

The female reproductive tract consists of the vagina, cervix, uterus, and fallopian tubes. In particular, the lower region of the reproductive tract, which contains the vagina and cervix, is often attacked by various pathogenic microorganisms such as bacteria, fungi, and viruses. The immune response of the female lower genital tract is the first line of defense against pathogenic microorganisms. The toll-like receptors (TLRs), a critical pattern recognition receptor, are essential for fighting infections in the female lower genital tract. Here we give an overview of the current research on TLR expression in the female lower genital tract and review the role of TLRs and their signaling pathways in the identification of numerous pathogens in female lower genital tract infections. Our review will contribute to a deeper understanding of the connection between TLRs and the pathological mechanisms of female lower reproductive tract infections, serving as a reference for both fundamental research and preventative strategies for these diseases.

Synthesis, Antioxidant, and Antifungal Activities of β-Ionone Thiazolylhydrazone Derivatives and Their Application in Anti-Browning of Freshly Cut Potato

In order to develop a new type of antioxidants with high efficiency, a series of β-ionone thiazolylhydrazone derivatives were designed and synthesized from β-ionone, and their structures were characterized by 1H-NMR, 13C-NMR, FT-IR, and HR-MS. The antioxidant test in vitro indicated that most of the target compounds had high biological activity. Among them, compound 1k exhibited very strong DPPH (1,1-diphenyl-2-picrylhydrazyl radical)-scavenging activity with a half-maximal effective concentration (IC50) of 86.525 μM. Furthermore, in the ABTS (2,2-azinobis (3-ethylbenzothiazoline-6-sulfonate) diammonium salt)-scavenging experiment, compound 1m exhibited excellent activity with an IC50 of 65.408 μM. Their biological activities were significantly better than those of the positive control Trolox. These two compounds, which have good free-radical-scavenging activity in vitro, were used as representative compounds in the anti-browning experiment of fresh-cut potatoes. The results showed that 1k and 1m had the same anti-browning ability as kojic acid, and they were effective browning inhibitors. In addition, it is well known that microbial infection is one of the reasons for food oxidation. Therefore, we investigated the antifungal activity of 25 target compounds against eight plant fungi at a concentration of 125 mg/L. The results indicated that these compounds all have some antifungal activity and may become new potential fungicides. Notably, compound 1u showed the best inhibitory effect against Poria vaporaria, with an inhibition rate as high as 77.71%; it is expected to become the dominant structure for the development of new antifungal agents.

Transcriptome analysis used to identify and characterize odorant binding proteins in Agasicles hygrophila (Coleoptera: Chryspmelidae)

The transcriptomes of Agasicles hygrophila eggs and first instar larvae were analyzed to explore the olfactory mechanism of larval behavior. The analysis resulted in 135,359 unigenes and the identification of 38 odorant-binding proteins (OBPs), including 23 Minus-C OBPs, 8 Plus-C OBPs, and 7 Classic OBPs. Further analysis of differentially expressed genes (DEGs) revealed 10 DEG OBPs, with 5 (AhygOBP5, AhygOBP9, AhygOBP12, AhygOBP15 and AhygOBP36) up-regulated in first instar larvae. Verification of expression patterns of these 5 AhygOBPs using qPCR showed that AhygOBP9 and AhygOBP36 were mainly expressed in the adult stage with gradually increasing expression in the larval stage. AhygOBP5, AhygOBP12, and AhygOBP15 were not expressed in eggs and pupae, and their expression in larvae and adults showed no clear pattern. These 5 AhygOBPs may play an olfactory role in larval behavior, providing a basis for further investigation of their specific functions and clarifying the olfactory mechanism of A. hygrophila.

Association Between Nasal Colonization of Staphylococcus aureus and Eczema of Multiple Body Sites

PURPOSE

Staphylococcus aureus is the critical pathogenic bacterium of eczema. The relationship between nasal colonization by S. aureus and eczema has not been well studied. We aimed to evaluate the associations between nasal colonization by S. aureus and eczema of multiple body sites, including persistent and ever-reported eczema. We further examined the associations between eczema and different subtypes of S. aureus, that is, methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA).

METHODS

The real-world data from the US National Health and Nutrition Examination Survey were used. The associations were calculated using survey-weighted multinomial logistic regression models and further calculated in subgroups stratified by demographic factors.

RESULTS

In total, 2,941 adults were included. The prevalence rate of S. aureus nasal carriage was significantly higher in adults with persistent hand eczema (51.0%) than in those with ever-reported hand eczema (23.3%) and never eczema (26.9%). S. aureus nasal colonization was associated with an approximately two-fold increased risk of persistent hand eczema (odds ratios ranges in different models: 2.86-3.06) without significant heterogeneity in the association by demographic factors. No significant associations between S. aureus nasal colonization and persistent eczema of other body sites or ever-reported eczema of multiple body sites (including hands) were observed. Furthermore, similar significant association between nasal colonization of MSSA and persistent hand eczema was seen; the association was much stronger (odds ratios ranges in different models: 4.64-6.54) for MRSA, although with borderline significant.

CONCLUSIONS

Nasal colonization of S. aureus was associated with increased risk of persistent hand eczema. Our findings imply that preventive measures targeting S. aureus for the anterior nares should be considered in preventing and treating eczema.

Network pharmacology analysis and clinical verification of Jishe Qushi capsules in rheumatoid arthritis treatment

The study aimed to elucidate the effective chemical composition and molecular mechanism of rheumatoid arthritis (RA) treatment with Jishe Qushi capsules (JSQS) and perform clinical validation. The effective chemical components were screened by a database. We used Cytoscape software to construct the key target-RA composite target network of JSQS. Gene Ontology biofunctional analysis and Kyoto encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed for the key targets, followed by molecular docking validation of core key targets. Ninety-nine patients chosen were divided into 49 cases in the treatment group and 50 cases in the control group according to the random number table method. The control group was treated with the combination of methotrexate (MTX) plus Glucosidorum Tripterygll Totorum. The treatment group was treated with MTX plus JSQS. The treatment effects of the 2 groups were evaluated. A total of 118 key anti-RA targets were obtained for JSQS. Quercetin in Panax notoginseng, vanillic acid, scopoletin, physcion in Gardneria angustifolia, 3,5-dimethyl-4-hydroxybenzaldehyde in Zaocys dhumnades, kaempferol in Radix Paeoniae Alba, and protocatechuic aldehyde in Cibotium barometz were the main active chemical components in the composite target network. Topology analysis yields core key targets, such as TP53, INS, IL6, VEGFA, MYC, CASP3, ESR1, EGF, CCND1, PPARG, ERBB2, NFKBIA, TLR4, RELA, and CASP8, and the results of KEGG enrichment analysis showed that JSQS mainly works through pathways in cancer, phosphatidylinositol-3-kinaseRAC-serine/threonine-protein kinase signaling, and mitogen-activated protein kinase (MAPK) signaling pathway, and aryl hydrocarbon receptor nuclear translocator signaling pathway. Molecular docking results showed that the binding fraction of PPARG, VEGFA and the effective active ingredients of ridged snake dispelling capsule was >70. In the clinical trial, morning stiffness, joint pain, and VAS scores of post-treatment in the treatment group were lower than those in the control group (P < .05). Additionally, ESR, CRP, RF, anti-CCP, TNF-α, IL-6, IL-17, and Th17/Treg were lower in the treatment group than in the control group (P < .05). JSQS exert multicomponent, multipathway, and multitarget synergistic actions in RA treatment. It can significantly improve the clinical symptoms and quality of life and delay the progression of RA disease.

[The application value of shear wave dispersion and shear wave elastography combined with serological indicators in the evaluation of liver fibrosis]

Objective: To explore the application value of shear wave dispersion (SWD) and shear wave elastography (SWE) combined with serological indicators in the evaluation of liver fibrosis. Methods: A total of 219 patients with liver disorders who underwent liver biopsy were prospectively collected in Huashan Hospital, Fudan University from January 2021 to September 2022, including 130 males and 89 females, aged from 18 to 76 (42±12) years. All patients underwent SWD and SWE examinations before liver biopsy. Serological indicators including alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP)) and γ-glutamyl transpeptadase (GGT) were also collected. Based on pathological diagnosis of liver fibrosis stage (from S0 to S4), the distribution of dispersion slope and liver elastic modulus at different fibrosis stages were analyzed in all patients. All patients were divided 7: 3 into training set (156 cases) and validation set (63 cases) in chronological order. In training set, factors influencing liver fibrosis≥S2 stage and S4 stage were analysed using binary logistic regression. The predictive models were established for diagnosing liver fibrosis≥S2 stage and S4 stage by using R language, and the models were evaluated by the area under curve (AUC) and calibrated for validation. Results: The dispersion slope and elastic modulus increased with the severity of fibrosis, with statistically significant differences in different fibrosis stages (both P<0.001). In training set, dispersion slope, elastic modulus, ALT, AST, and GGT were influential factors in liver fibrosis≥S2 stage and S4 stage(both P<0.05), and prediction models were constructed based on these indicators. In training set, the AUCs of the predictive model, SWD and SWE for diagnosingliver fibrosis≥S2 stage were 0.743 (95%CI: 0.665-0.821), 0.709 (95%CI: 0.628-0.790) and 0.725 (95%CI: 0.647-0.804), respectively; for diagnosing liver fibrosis S4 stage, the AUCs were 0.988 (95%CI: 0.968-1.000), 0.908 (95%CI: 0.852-0.963) and 0.974 (95%CI: 0.945-1.000), respectively. In validation set, the AUC of the predictive model, SWD and SWE for diagnosing liver fibrosis≥S2 stage were 08.735 (95%CI: 0.612-0.859), 0.658 (95%CI:0.522-0.793) and 0.699 (95%CI:0.570-0.828), respectively; for diagnosing liver fibrosis S4 stage, the AUC were 0.976 (95%CI: 0.937-1.000), 0.872 (95%CI: 0.757-0.988) and 0.948 (95%CI: 0.889-1.000), respectively. The calibration curves of the prediction models were consistent in the training and validation sets. Conclusion: The predictive model of SWD and SWE combined with serological indicators is helpful in the diagnosis of stage of liver fibrosis non-invasively.

The battle between the innate immune cGAS-STING signaling pathway and human herpesvirus infection

The incidence of human herpesvirus (HHVs) is gradually increasing and has affected a wide range of population. HHVs can result in serious consequences such as tumors, neonatal malformations, sexually transmitted diseases, as well as pose an immense threat to the human health. The cGAS-STING pathway is one of the innate immune pattern-recognition receptors discovered recently. This article discusses the role of the cGAS-STING pathway in human diseases, especially in human herpesvirus infections, as well as highlights how these viruses act on this pathway to evade the host immunity. Moreover, the author provides a comprehensive overview of modulators of the cGAS-STING pathway. By focusing on the small molecule compounds based on the cGAS-STING pathway, novel targets and concepts have been proposed for the development of antiviral drugs and vaccines, while also providing a reference for the investigation of disease models related to the cGAS-STING pathway. HHV is a double-stranded DNA virus that can trigger the activation of intracellular DNA sensor cGAS, after which the host cells initiate a cascade of reactions that culminate in the secretion of type I interferon to restrict the viral replication. Meanwhile, the viral protein can interact with various molecules in the cGAS-STING pathway. Viruses can evade immune surveillance and maintain their replication by inhibiting the enzyme activity of cGAS and reducing the phosphorylation levels of STING, TBK1 and IRF3 and suppressing the interferon gene activation. Activators and inhibitors of the cGAS-STING pathway have yielded numerous promising research findings in vitro and in vivo pertaining to cGAS/STING-related disease models. However, there remains a dearth of small molecule modulators that have been successfully translated into clinical applications, which serves as a hurdle to be overcome in the future.

A CT-based radiomics nomogram for distinguishing between malignant and benign Bosniak IIF masses: a two-centre study

AIM

To establish and assess a computed tomography (CT)-based radiomics nomogram for identifying malignant and benign Bosniak IIF masses.

MATERIALS AND METHODS

In total, 150 patients with Bosniak IIF masses were separated into a training set (n=106) and a test set (n=44) in a ratio of 7:3. A radiomics signature was calculated based on extracted features from the three phases of CT images. A clinical model was constructed based on clinical characteristics and CT features, and a nomogram incorporating the radiomics signature and independent clinical variables was established. The calibration ability, discrimination accuracy, and clinical value of the nomogram model were assessed.

RESULTS

Twelve features derived from CT images were applied to establish the radiomics signature. The performance levels of three machine-learning models were improved by adding the synthetic minority oversampling technique algorithm. The optimised machine learning model was a combination of the minimum redundancy maximum relevance-least absolute shrinkage and selection operator feature screening method + logistic regression classifier + synthetic minority oversampling technique algorithm, which demonstrated excellent identification ability on the test set (area under the curve [AUC], 0.970; 95% confidence interval [CI], 0.940-1.000). The nomogram model displayed outstanding discrimination ability on the test set (AUC, 0.972; 95% CI, 0.942-1.000).

CONCLUSIONS

The CT-based radiomics nomogram was useful for discriminating between malignant and benign Bosniak IIF masses, which improved the precision of preoperative diagnosis.

A Sodium Alginate-Based Multifunctional Nanoplatform for Synergistic Chemo-Immunotherapy of Hepatocellular Carcinoma

Efficient hepatocellular carcinoma (HCC) treatment remains a significant challenge due to the inherent limitations of traditional strategies. The exploration of polysaccharides' natural immunity for HCC immunotherapy is rarely explored. For this purpose, facile construction of a multifunctional nanoplatform, biotinylated aldehyde alginate-doxorubicin nano micelle (BEACNDOXM) is reported in this study for synergistic chemo-immunotherapy by using constant β-D-mannuronic acid (M) units and modulated α-L-guluronic acid (G) units in the alginate (ALG) structure. The M units show natural immunity and specific binding ability with mannose receptors (MRs) via strong receptor-ligand interactions, and the G units serve as highly reactive conjugation sites for biotin (Bio) and DOX. Therefore, this formulation not only integrates the natural immunity of ALG and the immunogenic cell death (ICD) triggering function of DOX, but also shows dual targeting properties to HCC cells via MRs and Bio receptors (BRs)-mediated endocytosis. Notably, BEACNDOXM mediates a tumor inhibitory efficiency 12.10% and 4.70% higher than free DOX and single targeting aldehyde alginate-doxorubicin nano micelle controls, respectively, at an equivalent DOX dose of 3 mg kg-1 in Hepa1-6 tumor-bearing mice. This study reports the first example of integrating the natural immunity of ALG and the ICD effect of anticancer drugs for enhanced chemo-immunotherapy of HCC.

Preoperative contrast-enhanced CT-based radiomics signature for predicting hypoxia-inducible factor 1α expression in retroperitoneal sarcoma

AIM

To develop and test a contrast-enhanced computed tomography (CECT)-based radiomics signature (RS) to preoperatively predict hypoxia-inducible factor 1α (HIF-1α) expression in retroperitoneal sarcoma (RPS).

MATERIALS AND METHODS

This study included 129 patients with RPS retrospectively who underwent CECT, including 64 male and 65 female patients (55 [2-84] years). Participants were divided into a training set comprising 85 patients and a test set comprising 44 patients. Clinical data and CECT findings of all patients were collected. RS construction was performed by the minimum redundancy maximum relevance method and least absolute shrinkage and selection operator algorithm. The clinical information was analysed by univariate and multivariate logistic regression analysis. The RS and risk factors were included to build a radiomics nomogram. The predictive efficacy of different models was evaluated by accuracy, area under the receiver operating characteristic curve (AUC), and decision curve analysis.

RESULTS

The RS combined signature was constructed on the basis of multi-phase CECT and had an accuracy of 0.795 and an AUC of 0.719 (95% confidence interval [CI], 0.552-0.886) in the test set, which were higher than that of the radiomics nomogram (accuracy: 0.636; AUC: 0.702 [95% CI, 0.547-0.857]) and the clinical model (accuracy: 0.682; AUC: 0.486 [95% CI, 0.324-0.647]). The decision curve analysis showed that the RS combined signature provided better clinical application than the clinical model and radiomics nomogram.

CONCLUSIONS

The multi-phase CECT-based RS constructed can be used as a powerful tool for predicting HIF-1α expression in patients with RPS.

Metaplastic breast carcinoma with osseous differentiation: A report of a rare case and literature review

Metaplastic matrix-producing breast carcinoma is a type of metaplastic breast carcinoma (MBC), which is a rare malignancy, accounting for 0.2-1% of breast carcinomas. A 52-year-old female visited a hospital because of a palpable painless mass in the right breast and was diagnosed with Breast Imaging Reporting and Data System (BI-RADS) category 4A via ultrasound (US) with a suspected positive lymph node at the right axillary region. Excision of the breast mass was performed and histopathologically confirmed that it was MBC with osseous differentiation. No distant metastasis was revealed before a modified radical mastectomy; however, metastasis to a lymph node of the right axillary region was observed (1/22). She received six cycles of TEC scheme chemotherapy (docetaxel, epirubicin, and cyclophosphamide, 21 days) and 5 weeks of radiotherapy (48 Gy/25 f/5 days a week), but without any follow-up examinations since radiotherapy. Twenty-four months after surgery, distant metastases to lungs and liver were confirmed and died 3 months later. This case provides valuable information for clinicians on MBC and suggests that further examination or biopsy should be performed to US BI-RADS 4A masses before surgery. In addition, regular postoperative follow-up plays important roles in detecting metastases early and improving prognosis.