Component separation repair of incisional hernia: evolution of practice and review of long-term outcomes in a single center

PURPOSE

To review the long-term outcomes of complex abdominal wall reconstruction using anterior and posterior component separation (CS) techniques in our center.

METHODS

This was a descriptive analytical study. Analysis of data from a prospectively collected database of patients who had undergone Component Separation (CS) repair of incisional hernias was performed. Two techniques were used. Anterior component separation (ACS) and posterior component separation with transversus abdominis release (PCS/TAR). Follow-up was clinical review at 6 weeks, 6 months, and 12 months with direct access telephone review thereafter. Long-term outcome data was obtained from electronic records and based on either clinical or CT assessment. Minimum physical follow-up was 6 months for all patients.

RESULTS

89 patients with large incisional hernias underwent CS repair. 29 patients had ACS while 60 underwent PCS/TAR. Mean follow-up was 60 months (range 6-140 months) in the ACS group and 20 months (range 6-72 months) in the PCS group. Twenty-five patients (28%) had simultaneous major procedures including 21 intestinal anastomoses. Twenty-six (29%) of patients had associated stomas. Twenty-seven (30.3%) of the patients had undergone previous hernia repairs. Seromas occurred in 24 (26.97%) patients. Wound infections were more common after ACS. There have been 10 (11.2%) recurrences to date.

CONCLUSION

Component separation repair techniques result in good long-term outcomes with acceptable complication rates. They can be performed simultaneously with gastrointestinal procedures with low morbidity. Appropriate patient selection and use of appropriate mesh are important.

Mettl3‑mediated m6A RNA methylation regulates osteolysis induced by titanium particles

Peri‑prosthetic osteolysis (PPO) induced by wear particles is considered the primary cause of titanium prosthesis failure and revision surgery. The specific molecular mechanisms involve titanium particles inducing multiple intracellular pathways, which impact disease prevention and the targeted therapy of PPO. Notably, N6‑methyladenosine (m6A) serves critical roles in epigenetic regulation, particularly in bone metabolism and inflammatory responses. Thus, the present study aimed to determine the role of RNA methylation in titanium particle‑induced osteolysis. Results of reverse transcription‑quantitative PCR (RT‑qPCR), western blotting, ELISA and RNA dot blot assays revealed that titanium particles induced osteogenic inhibition and proinflammatory responses, accompanied by the reduced expression of methyltransferase‑like (Mettl) 3, a key component of m6A methyltransferase. Specific lentiviruses vectors were employed for Mettl3 knockdown and overexpression experiments. RT‑qPCR, western blotting and ELISA revealed that the knockdown of Mettl3 induced osteogenic inhibition and proinflammatory responses comparable with that induced by titanium particle, while Mettl3 overexpression attenuated titanium particle‑induced cellular reactions. Methylated RNA immunoprecipitation‑qPCR results revealed that titanium particles mediated the methylation of two inhibitory molecules, namely Smad7 and SMAD specific E3 ubiquitin protein ligase 1, via Mettl3 in bone morphogenetic protein signaling, leading to osteogenic inhibition. Furthermore, titanium particles induced activation of the nucleotide binding oligomerization domain 1 signaling pathway through methylation regulation, and the subsequent activation of the MAPK and NF‑κB pathways. Collectively, the results of the present study indicated that titanium particles utilized Mettl3 as an upstream regulatory molecule to induce osteogenic inhibition and inflammatory responses. Thus, the present study may provide novel insights into potential therapeutic targets for aseptic loosening in titanium prostheses.

Uncertainties and opportunities in delivering environmentally sustainable surgery: the surgeons' view

Surgery is a carbon-heavy activity and creates a high volume of waste. Surgical teams around the world want to deliver more environmentally sustainable surgery but are unsure what to do and how to create change. There are many interventions available, but resources and time are limited. Capital investment into healthcare and engagement of senior management are challenging. However, frontline teams can change behaviours and drive wider change. Patients have a voice here too, as they would like to ensure their surgery does not harm their local community but are concerned about the effects on them when changes are made. Environmentally sustainable surgery is at the start of its journey. Surgeons need to rapidly upskill their generic knowledge base, identify which measures they can implement locally and take part in national research programmes. Surgical teams in the NHS have the chance to create a world-leading programme that can bring change to hospitals around the world. This article provides an overview of how surgeons see the surgical team being involved in environmentally sustainable surgery.

Prognostic model of ER-positive, HER2-negative breast cancer predicted by clinically relevant indicators

PURPOSE

To study the clinicopathological variables connected with disease-free survival (DFS) as well as overall survival (OS) in patients who are ER-positive or HER2-negative and to propose nomograms for predicting individual risk.

METHODS

In this investigation, we examined 585 (development cohort) and 291 (external validation) ER-positive, HER2-negative breast cancer patients from January 2010 to January 2014. From January 2010 to December 2014, we retrospectively reviewed and analyzed 291 (external validation) and 585 (development cohort) HER2-negative, ER-positive breast cancer patients. Cox regression analysis, both multivariate and univariate, confirmed the independence indicators for OS and DFS.

RESULTS

Using cox regression analysis, both multivariate and univariate, the following variables were combined to predict the DFS of development cohort: pathological stage (HR = 1.391; 95% CI = 1.043-1.855; P value = 0.025), luminal parting (HR = 1.836; 95% CI = 1.142-2.952; P value = .012), and clinical stage (HR = 1.879; 95% CI = 1.102-3.203; P value = 0.021). Endocrine therapy (HR = 3.655; 95% CI = 1.084-12.324; P value = 0.037) and clinical stage (HR = 6.792; 95% CI = 1.672-28.345; P value = 0.009) were chosen as predictors of OS. Furthermore, we generated RS-OS and RS-DFS. According to the findings of Kaplan-Meier curves, patients who are classified as having a low risk have considerably longer DFS and OS durations than patients who are classified as having a high risk.

CONCLUSION

To generate nomograms that predicted DFS and OS, independent predictors of DFS in ER-positive/HER2-negative breast cancer patients were chosen. The nomograms successfully stratified patients into prognostic categories and worked well in both internal validation and external validation.

Control of lipolysis by a population of oxytocinergic sympathetic neurons

Oxytocin (OXT), a nine-amino-acid peptide produced in the hypothalamus and released by the posterior pituitary, has well-known actions in parturition, lactation and social behaviour1, and has become an intriguing therapeutic target for conditions such as autism and schizophrenia2. Exogenous OXT has also been shown to have effects on body weight, lipid levels and glucose homeostasis1,3, suggesting that it may also have therapeutic potential for metabolic disease1,4. It is unclear, however, whether endogenous OXT participates in metabolic homeostasis. Here we show that OXT is a critical regulator of adipose tissue lipolysis in both mice and humans. In addition, OXT serves to facilitate the ability of β-adrenergic agonists to fully promote lipolysis. Most surprisingly, the relevant source of OXT in these metabolic actions is a previously unidentified subpopulation of tyrosine hydroxylase-positive sympathetic neurons. Our data reveal that OXT from the peripheral nervous system is an endogenous regulator of adipose and systemic metabolism.

Comprehensive Need as a Mediator Between Psychological Stress and Quality of Life Among Caregivers of Patients With Cancer

BACKGROUND

Caregivers of patients with cancer are susceptible to profound psychological distress and low quality of life owing to the substantial demands of caregiving. The comprehensive needs of caregivers are closely linked to their quality of life. However, little is known about the relationship between these factors.

OBJECTIVE

This study aimed to determine whether comprehensive needs mediate the relationships between psychological stress and quality of life in caregivers of patients with cancer.

METHODS

A cross-sectional design was used to recruit 382 participants through convenience sampling. Psychological stress, comprehensive needs, and quality of life were measured using a questionnaire.

RESULTS

Psychological stress was associated with higher comprehensive needs (r = 0.30, P < .01) and lower quality of life (r = -0.20, P < .01). Comprehensive needs were negatively associated with quality of life (r = -0.28, P < .01). Mediation analysis findings revealed that both the indirect effect of psychological stress on quality of life via comprehensive needs (β = -0.10; P < .001) and its direct effect on quality of life (β = -0.16; P < .01) were statistically significant, suggesting a partial mediatory effect of comprehensive needs between psychological stress and quality of life.

CONCLUSIONS

Our findings suggest that reducing psychological stress can improve quality of life by promoting satisfaction with comprehensive needs.

IMPLICATIONS FOR PRACTICE

Interventions that help reduce psychological stress and meet the comprehensive needs of caregivers of patients with cancer can improve their quality of life.

The disulphide cleavage derivative (C42-4) of 11'-deoxyverticillin A (C42) fails to induce apoptosis and genomic instability in HeLa cells

Our previous study revealed 11'-deoxyverticillin A (C42), a natural product isolated from the Ophiocordyceps-associated fungus Clonostachys rogersoniana and a member of the epipolythiodioxopiperazines (ETPs), induced both apoptosis and autophagy in HCT116 cells; however, the role of disulphide/polysulphide bridges of C42 in the regulation of autophagy remains unexplored. Here, we revealed that C42 activated both caspase-dependent apoptosis and autophagy in HeLa cells, whereas its disulphide cleavage derivative C42-4 failed to induce the cleavage of both caspase-3 and PARP-1. In contrast, both C42 and C42-4 increased the formation of autophagosomes, punctate staining of LC3, and the ratio of LC3-II to actin, suggesting that disulphide/polysulphide bridges are dispensable for the induction of the autophagic process. Moreover, we found that C42 but not C42-4 led to nuclear instability by increasing the formation of micronuclei and expression of phosphorylated histone H2AX (γ-H2AX), a widely used marker for DNA double strand breaks (DSBs), while Rad51, a protein pivotal for DNA repair, was decreased upon challenge with C42. These results demonstrate that the disulphide bonds in ETPs play an essential role in the induction of caspase-dependent apoptosis and nuclear stability.

Mindfulness-based stress reduction combined with early cardiac rehabilitation improves negative mood states and cardiac function in patients with acute myocardial infarction assisted with an intra-aortic balloon pump: a randomized controlled trial

Objective

To investigate the clinical effects of mindfulness-based stress reduction (MBSR) intervention combined with early cardiac rehabilitation (CR) on patients with acute myocardial infarction (AMI) assisted with an intra-aortic balloon pump (IABP).

Methods

A total of 100 AMI patients with IABP assistance due to hemodynamic instability at Wuhan Asia Heart Hospital were enrolled in the study. The participants were divided into two groups using the random number table method (n = 50 each group). Patients receiving routine CR were assigned to the CR control group, while patients receiving MBSR plus CR were assigned to the MBSR intervention group. The intervention was performed twice a day until the removal of the IABP (5-7 days). Each patient's level of anxiety/depression and negative mood state were evaluated before and after intervention using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and profiles of mood state scale (POMS). The results of the control and intervention groups were compared. IABP-related complications and left ventricular ejection fraction (LVEF), measured with echocardiography, were also assessed and compared between the two groups.

Results

The SAS, SDS, and POMS scores were lower in the MBSR intervention group than in the CR control group (P < 0.05). There were also less IABP-related complications in the MBSR intervention group. LVEF was significantly improved in both groups, but the degree of LVEF improvement was more significant in the MBSR intervention group than in the CR control group (P < 0.05).

Conclusions

MBSR combined with early CR intervention can assist in alleviating anxiety, depression, and other negative mood states, reduce IABP-related complications, and further improve cardiac function in AMI patients with IABP assistance.

Spatial-temporal patterns of high-temperature and drought during the maize growing season under current and future climate changes in Northeast China

BACKGROUND

Under the background of global warming, the intensity and frequency of extreme meteorological events in the maize growing season in Northeast China are increasing. In order to clarify the occurrence characteristics of extreme meteorological events in Northeast China, this study focused on three extreme agrometeorological events, i.e., high temperatures, drought, and the compound events of high-temperature and drought during the maize growing season (May to September), impacting maize production in Northeast China.

RESULTS

Based on historical (1981-2017) and future (2021-2060) climate data, we analyzed the spatial-temporal patterns of these three events with different intensities in Northeast China. The results indicated that slight high temperatures and moderate and severe droughts occurred more frequently in the study area during the historical period. The frequency of the different grades of the compound events of high-temperature and drought will exhibit an increasing trend in the future, as will the frequency of the compound events of high-temperature and drought. This is particularly evident in the northwest of the study area.

CONCLUSION

The compound events of high-temperature and drought mainly occurred in late July and early August, encompassing the flowering stage of early-, middle-, and late-maturing maize varieties. It is important to identify the area and time of major extreme weather events to implement the necessary preventive measures. This article is protected by copyright. All rights reserved.

Pan-Cancer Analysis of Prognostic and Immune Infiltrates for the TMEM65, Especially for the Breast Cancer

Introduction

Transmembrane protein 65 (TMEM65) is an inner mitochondrial membrane protein, which played important role in mediating autophagy, smooth muscle contraction, protein glycosylation, and immune response. In recent years, the interest had risen for exploring the function of the TMEM genes in the cancer fields. As a consequence, in our pan-cancer research of the TMEM65, we explored the function of the gene in kinds of database and tried to apply the finding in the clinical practice.

Methods

In this research, we provide a comprehensive investigation of TMEM65 expression in a pan-cancer manner containing 33 cancer types. We evaluated the association of TMEM65 with the prognosis, immune infiltration, drug sensitivity analysis, GSVA enrichment analysis, TMB, MSI, NEO, and hotspot mechanisms.

Results

TMEM65 was abnormally expressed in 24 types of cancers and showed correlation with the OS for 6 cancers and PFI for 9 cancers and kpI for 3 types. Moreover, the TME score, CD8 T effector, and immune checkpoint scoring systems showed a close correlation with the TMEM65. Moreover, TMEM65 was strongly correlated with some of the most common tumor-related genes and certain pathways (TGF beta signaling, TNFA signaling, hypoxia, pyroptosis, DNA repairing, autophagy, ferroptosis, and other related genes). Additionally, the TMEM65 showed correlations with the tumor mutational burden (TMB), microsatellite instability (MSI), NEO, and drug sensitivity. Finally, we confirmed several pathways by the GSEA and GSVA for the TMEM65 at the breast cancer aspects. Nomogram prediction model was also established for the breast tumors based on the TMEM65 level and other variables.

Conclusion

Above all, the TMEM65 played important roles in predicting the prognosis of the cancers and correlated with the tumor immunity in the pan-cancer analysis.

Characteristics of sludge-based pyrolysis biochar and its application of enhancing denitrification

A modified biochar for enhanced denitrification was developed through a facile pyrolysis method using sewage sludge as raw material and melamine as nitrogen source. Through electrochemical analysis, sludge-based pyrolysis biochar (SPBC) has superior electrical conductivity and poor redox activity. SPBC can increase the electron transfer through the geoconductor mechanism. The effect and the mechanism of SPBC on denitrification were studied. The nitrate treatment efficiency increased with the increase of SPBC dosage. From the perspective of molecular biology, the activities of NAR and NIR enzymes, the degradation efficiency of glucose and the ETSA of bacteria were all promoted with the increase of SPBC, thereby promoting the removal of NO₃^-. In addition, SPBC had a certain screening effect on microbial communities, and biodiversity decreased with the increase of SPBC dosage. Although the biodiversity decreased, the relative abundance of microorganisms conducive to denitrification increased with the increase of SPBC dosage. The transformation strategy of SPBC proposed in this paper provides a technical solution for sludge recycling and application for strengthening denitrification.

Diffusion Tensor Imaging Analysis Along the Perivascular Space Index in Primary Parkinson's Disease Patients With and Without Freezing of Gait

Parkinson's disease (PD) is a common neurodegeneration disease associated with the abnormal deposition and spread of misfolded proteins (α-synuclein and Tau protein), which progressively damages the glymphatic system. This research intended to investigate the activity of the glymphatic system in PD individuals with freezing of gait (PD-FOG) and PD patients without it (PD-nFOG), as well as their relationship to the clinical neural scale. Diffusion tensor imaging (DTI) was performed in 28 PD-FOG individuals, 31 PD-nFOG individuals, and 34 healthy controls (HC). The DTI analysis along the perivascular space (DTI-ALPS) index was computed after post-processing of DTI images, representing brain glymphatic functions. The DTI-ALPS index was assessed for the association with the clinical variables. Compared to the HC group, the DTI-ALPS index of both PD-FOG and PD-nFOG patients was significantly decreased; however, no notable difference was found between the PD-FOG and PD-nFOG group. In addition, the DTI-ALPS index of PD-nFOG patients were positively correlated with disease duration, Unified Parkinson's Disease Rating-III Right (UPDRS-III R), UPDRS-III TOTAL, UPDRS-IV. Taken together, these findings highlighted the weakening of function of the glymphatic system in PD individuals, which is associated with motor symptoms and treatment complications. We speculate that treatment aimed at enhancing the flow and clearance of the glymphatic system may alleviate clinical symptoms of PD.

[Multi-omics technology and its applications to life sciences: a review]

With technological advances in high-throughput sequencing, high resolution mass-spectrometry, and multi-omics data integrative tools and data repositories, the omics research in life sciences are evolving from single-omics strategy to multi-omics strategy. The research of system biology driven by multi-omics will bring a new paradigm in life sciences. This paper briefly summarizes the development of genomics, epigenomics, transcriptomics, proteomics and metabolomics, highlights the composition and function of multi-omics platforms as well as the applications of multi-omics technology, and prospects future applications of multi-omics in synthetic biology and biomedicine.

New 8-prenylated quercetin glycosides from the flowers of Epimedium acuminatum and their testosterone production-promoting activities

Phytochemical investigation was carried out for the flowers of Epimedium acuminatum Franchet. by first conducting LC-MS analysis, leading to the identification of 32 compounds. Furthermore, guided by LC-MS profiling, three new 8-prenylated quercetin glycosides (3′-hydroxylikarisoside C, 3′-hydroxylepimedoside E, 3′-hydroxyldiphylloside B), one new anthocyanin (delphinidin-3-O-p-coumaroyl-sophoroside) and six known compounds were isolated from the flowers of E. acuminatum for the first time, and their structures were characterized based on spectroscopic methods including 1D and 2D NMR, and HRESIMS. Combining our discoveries and literature survey, a revised classification of Epimedium flavonols was proposed as Type A (8-prenylated kaempferol based), which was further subdivided into subtype icaritin and subtype demethylicaritin, and Type B (8-prenylated quercetin based), which was further subdivided into subtype 3′-hydroxylicaritin and subtype 3′-hydroxyldemethylicaritin. The structure-activity relationship (SAR) study was carried out by comparing testosterone production-promoting activities of all the new compounds along with nine related Epimedium flavonols, revealing that the new 8-prenylated quercetin glycosides (subtype 3′-hydroxyldemethylicaritin in Type B) exhibited lower testosterone production-promoting activities in rat primary Leydig cells than Epimedium flavonols of subtype demethylicaritin in Type A, but possessed higher activities than the Epimedium flavonols of subtype icaritin in Type A. These results suggested that either methylation at C-4′ position or hydroxylation at C-3′ position of ring B could significantly reduce the testosterone production-promoting activities of Epimedium flavonols.

Phospholipid peroxidation inhibits autophagy via stimulating the delipidation of oxidized LC3-PE

Phospholipid peroxidation of polyunsaturated fatty acids at the bis-allylic position drives ferroptosis. Here we identify a novel role for phospholipid peroxidation in the inhibition of autophagy. Using in vitro and in vivo models, we report that phospholipid peroxidation induced by glutathione peroxidase-4 inhibition and arachidonate 15-lipoxygenase overexpression leads to overload of peroxidized phospholipids and culminate in inhibition of autophagy. Functional and lipidomics analysis further demonstrated that inhibition of autophagy was associated with an increase of peroxidized phosphatidylethanolamine (PE) conjugated LC3. We further demonstrate that autophagy inhibition occurred due to preferential cleavage of peroxidized LC3-PE by ATG4B to yield delipidated LC3. Mouse models of phospholipid peroxidation and autophagy additionally supported a role for peroxidized PE in autophagy inhibition. Our results agree with the recognized role of endoplasmic reticulum as the primary source for autophagosomal membranes. In summary, our studies demonstrated that phospholipid peroxidation inhibited autophagy via stimulating the ATG4B-mediated delipidation of peroxidized LC3-PE.

Propafenone as potential AgoKir: exploration of long-term effects and mechanisms of propafenone on Kir2.1 channel

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chinese Scholarship Council

Background

Inward rectifying potassium (Kir) channel expression and activity are tightly regulated within the heart. Kir channels play key roles in shaping cardiac action potentials, having a reduced conductance at depolarized potentials but contributing to the final stage of repolarization and resting membrane stability. The Kir2.1 channel protein has polyamine binding residues in both the transmembrane (D172) and the cytoplasmic domains (E224,E299), responsible for the process of inward rectification. A reduced functioning of Kir2.1 causes 1) Andersen-Tawil Syndrom and 2) is present in a subset of heart failure patients. Restoration of normal Kir2.1 function by agonists of Kir2.1 (AgoKirs) would be beneficial. The drug propafenone is identified as an AgoKir, but its long-term effects on Kir2.1 protein expression and subcellular localisation is unknown.

Purpose

To investigate propafenone's long-term effect on Kir2.1 expression and its underlying mechanisms in cell systems.

Methods

GFP, Dendra2 or non-tagged wildtype (WT) and mutant Kir2.1 expression constructs were transiently or stably (HEK-KWGF; CHO-KD cell lines) expressed in Human Embryonic Kidney and Chinese Hamster Ovary cells. Kir2.1 carried currents were measured by single cell patch clamp electrophysiology. Kir2.1 proteins expression levels were determined by Western blot analysis, whereas conventional immunofluorescence and advanced live-imaging microscopy were used to assess the subcellular localisation of Kir2.1 proteins. Propafenone was dissolved in DMSO,BaCl2 was used as Kir2.1 channel inhibitor.

Results

Acute administration of 0.1 and 0.5 µM propafenone increased Kir2.1 carried outward current confirming the drug's Agokir status. Propafenone dose-dependently increased WT Kir2.1 expression levels (2.63±0.40 fold increase at 25 µM and 2.75±0.56 fold increase at 50 µM, 24h) in a process that is independent of the E224, E299 and D172 polyamine binding sites, and the R312 residue which is adjacent to the proposed propafenone binding site. Propafenone (25, 50 µM, 24h) induced intracellular accumulation of WT and mutant Kir2.1 proteins in the late endosome/lysosome compartment (Figure). Channel inhibition by BaCl2 did not affect the propafenone responses on Kir2.1 expression levels or subcellular localisation.

Conclusion

Acute administration of propafenone at low concentrations increases Kir2.1 currents. Chronic propafenone treatment at only 25-100 times higher concentrations results in increased Kir2.1 protein expression levels and intracellular accumulation in late endosomes and/or lysosomes. Our data support the ability of propafenone at low concentrations to function as AgoKirs without disturbing Kir2.1 protein handing.

Sorbicillinoid Derivatives with the Radical Scavenging Activities from the Marine-Derived Fungus Acremonium chrysogenum C10

Sorbicillinoids are a class of structurally diverse hexaketide metabolites with good biological activities. To explore new structural sorbicillinoids and their bioactivities, the marine-derived fungus Acremonium chrysogenum C10 was studied. Three new sorbicillinoid derivatives, acresorbicillinols A–C (1–3), along with five known ones, trichotetronine (4), trichodimerol (5), demethyltrichodimerol (6), trichopyrone (7) and oxosorbicillinol (8), were isolated. The structures of new sorbicillinoids were elucidated by analysis of nuclear magnetic resonance (NMR) and high-resolution electrospray ionization mass spectroscopy (HRESIMS). The absolute configurations of compounds 1–3 were determined by comparison of the experimental and calculated electronic circular dichroism (ECD) spectra. Compound 3 exhibited a strong 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity, with the IC₅₀ value ranging from 11.53 ± 1.53 to 60.29 ± 6.28 μM in 24 h. Additionally, compounds 2 and 3 showed moderate activities against Staphylococcus aureus and Cryptococcus neoformans, with IC₅₀ values of 86.93 ± 1.72 and 69.06 ± 10.50 μM, respectively. The boundary of sorbicillinoid biosynthetic gene cluster in A. chrysogenum was confirmed by transcriptional analysis, and the biosynthetic pathway of compounds 1–8 was also proposed. In summary, our results indicated that A. chrysogenum is an important reservoir of sorbicillinoid derivatives, and compound 3 has the potential for new natural agents in DPPH radical scavenging.

A novel strategy for optimal component formula of anti-PRRSV from natural compounds using tandem mass tag labeled proteomic analyses

BACKGROUND

Porcine Reproductive and Respiratory Syndrome (PRRS) is one of the most important porcine viral diseases which have been threatening the pig industry in China. At present, most commercial vaccines fail to provide complete protection because of highly genetic diversity of PRRSV strains. This study aimed to optimize a component formula from traditional Chinese medicine(TCM)compounds with defined chemical characteristics and clear mechanism of action against PRRSV.

METHODS

A total of 13 natural compounds were screened for the anti-PRRSV activity using porcine alveolar macrophages (PAMs). Three compounds with strong anti-PRRSV activity were selected to identify their potential protein targets by proteomic analysis. The optimal compound formula was determined by orthogonal design based on the results of proteomics. MTT assay was used to determine the maximum non-cytotoxic concentration (MNTC) of each compound using PAMs. QPCR and western blot were used to investigate the PRRSV N gene and protein expression, respectively. The Tandem Mass Tag (TMT) technique of relative quantitative proteomics was used to detect the differential protein expression of PAMs treated with PRRSV, matrine (MT), glycyrrhizic acid (GA) and tea saponin (TS), respectively. The three concentrations of these compounds with anti-PRRSV activity were used for orthogonal design. Four formulas with high safety were screened by MTT assay and their anti-PRRSV effects were evaluated.

RESULTS

MT, GA and TS inhibited PRRSV replication in a dose-dependent manner. CCL8, IFIT3, IFIH1 and ISG15 were the top four proteins in expression level change in cells treated with MT, GA or TS. The relative expression of IFIT3, IFIH1, ISG15 and IFN-β mRNAs were consistent with the results of proteomics. The component formula (0.4 mg/mL MT + 0.25 mg/mL GA + 1.95 μg/mL TS) showed synergistic anti-PRRSV effect.

CONCLUSIONS

The component formula possessed anti-PRRSV activity in vitro, in which the optimal dosage on PAMs was 0.4 mg/mL MT + 0.25 mg/mL GA + 1.95 μg/mL TS. Compatibility of the formula was superposition of the same target with GA and TS, while different targets of MT. IFN-β may be one of the targets of the component formula possessed anti-PRRSV activity.

Posterior stabilization with polyetheretherketone (PEEK) rods and transforaminal lumbar interbody fusion (TLIF) with titanium rods for single-level lumbar spine degenerative disease in patients above 70 years of age

BACKGROUND

Given the lack of guidelines regarding the operative management of elderly patients needing lumbar spine fusion for degenerative disease, it is often difficult to balance between invasiveness respecting the fragile spine and geriatric comorbidities.

AIM

To compare reoperation rates and clinical outcome in patients above 70 years of age undergoing Transforaminal Lumbar Interbody Fusion (TLIF) with titanium rods or posterior stabilization with Polyetheretherketone (PEEK) rods for the treatment of one-level lumbar spine degenerative disease.

METHODS

Retrospective review of baseline characteristics, reoperation rates as well as the clinical and radiological outcomes of patients, older than 70 years, undergoing posterolateral fusion with PEEK rods (n = 76, PEEK group) or TLIF with titanium rods (n = 67, TLIF group) for a single-level lumbar degenerative disease from 2014 to 2020. Additional subanalysis on the patients above 80 years of age was performed.

RESULTS

Our results showed similar reoperation rates and outcomes in the TLIF and PEEK groups. However, intraoperative blood loss, administration of tranexamic acid, and operation time were significantly higher in the TLIF group. In patients older than 80 years, reoperation rates at first follow-up were significantly higher in the TLIF group, too.

CONCLUSION

According to our results, posterior stabilization with PEEK rods is less invasive and was associated with significantly lower blood loss, administration of blood products and shorter operation time. Moreover, in patients above 80 years of age reoperations rates were lower with PEEK rods, as well. Nevertheless, the benefits of PEEK rods for foraminal stenosis still have to be investigated.

Treatment-related adverse events as predictive biomarkers of efficacy in patients with advanced neuroendocrine tumors treated with surufatinib: results from two phase III studies

Background

No validated biomarkers currently exist for predicting the efficacy outcomes in patients with neuroendocrine tumors (NETs) treated with antiangiogenic therapy. We aimed to evaluate the association between treatment-related adverse events (TRAEs) and efficacy outcomes of surufatinib in patients with advanced NET.

Patients and methods

We included patients with NET treated with surufatinib in two multicenter, randomized, double-blind, placebo-controlled, phase III trials (SANET-p and SANET-ep) in this study. The main exposure was the presence of any of the TRAEs including hypertension, proteinuria, and hemorrhage in the first 4 weeks of surufatinib treatment. The primary outcome of the study was investigator-assessed progression-free survival (PFS). PFS outcomes were estimated using the Kaplan–Meier method with the log-rank test. Hazard ratios (HRs) were calculated by using univariable and multivariable Cox proportional hazard regression models. Blinded independent image review committee (BIIRC) assessments and 4-week landmark analysis were also performed as supportive evaluations.

Results

During the study period, a total of 242 patients treated with surufatinib were included in the analysis, and 164 (68%) patients had at least one of hypertension, proteinuria, and hemorrhage in the first 4 weeks of treatment. The presence of TRAEs in the first 4 weeks was associated with prolonged median PFS [11.1 versus 9.2 months; HR 0.67, 95% confidence interval (CI) 0.47-0.97; P = 0.036]. In multivariable Cox regression analysis, the presence of TRAEs was also significantly associated with longer PFS (HR 0.65, 95% CI 0.44-0.97; P = 0.035). Similar results were obtained in the BIIRC assessments and 4-week landmark analysis.

Conclusions

Treatment-related hypertension, proteinuria, and hemorrhage could be potential biomarkers to predict antitumor efficacy of surufatinib in patients with advanced NET. Future prospective studies are needed to validate the findings.

Trial registration

ClinicalTrials.govNCT02589821; https://clinicaltrials.gov/ct2/show/NCT02589821 and ClinicalTrials.gov NCT02588170; https://clinicaltrials.gov/ct2/show/NCT02588170

•

Treatment-related hypertension, proteinuria, or hemorrhage is associated with longer survival in NETs.

•

The association is confirmed by the BIIRC assessments and 4-week landmark analysis.

•

TRAEs can be biomarkers to predict antitumor efficacy in patients with NET.

The compound effects of drought and high temperature stresses will be the main constraints on maize yield in Northeast China

Compound climate extremes such as drought and high temperature have a greater impact on agricultural production than the individual extremes. An increasing frequency and intensity of the compound climate extremes has been observed and projected under climate change, yet partitioning the total impacts to individual ones on crop yield has not been well assessed. In this study, we assessed the compound and separate effects of drought and high temperature on maize yield under 9 climate-year types (CYTs) with different combinations of precipitation and temperature in Northeast China (NEC). The well-validated Agricultural Production Systems Simulator (APSIM) model was used to simulate the maize yield, driven by historical (1981-2017) and future climate data (2021-2060). The results show that CYTs of warm (warm-dry, warm-wet, warm) are prominent in the future under both Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios. However, CYT of warm-wet increased mostly (11.5%) under RCP8.5, while warm-dry increased most (12.3%) under RCP4.5. The magnitude of maize yield loss caused by the compound of high temperature and drought (18.75%) is higher than the individual ones (drought 17.32% and high temperature 1.27%). There are variations in the effects of stresses on maize yield among CYTs and the yield reductions by the compound effects of drought and high temperature were warm-dry > warm > rainless > warm-wet > normal > cold-dry > cold > rainy > cold-wet. In addition, the yield loss was negatively correlated with T_max and VPD_max but positively correlated with Prec. These findings imply the importance of fully considering the selection of heat and drought-resistant varieties and implementing supplementary irrigation for future climate mitigation strategies during maize production in NEC.

Machine learning analysis including social determinants of health for predication of mortality following transcatheter aortic valve implantation: a single center experience

Funding Acknowledgements

Type of funding sources: None.

Introduction

Social determinants of health (SDOH) are increasingly being recognized as critical, independent prognosticators in cardiovascular disease. Despite this, little is known about the role of SDOH in predicting outcomes following transcatheter aortic valve implantation (TAVI).

Purpose

To assess the value of adding census-derived SDOH in developing machine learning (ML) models for prediction of all-cause mortality in patients following TAVI.

Methods

A total of 398 patients, who underwent TAVI in 2019, were studied. Clinical, demographic, echocardiographic (echo) and census-derived SDOH data were collected. All-cause mortality at 1 year was the endpoint. A general linear ML model was fit with 100 iterations and a 70:30 training-test split. We compared the predictive performance of the model with and without adding SDOH. The SDOH included in the ML model were race (white vs. non-white), % zip code population as female, and zip code average yearly income less than $45,000.

Results

Baseline SDOH, demographic, clinical, and echo data are shown in Table 1. Following univariate and multivariate predictor analysis, the following input data were used for the ML model without the SDOH: post TAVI all-cause hospitalizations, history of outpatient hemodialysis, atrial fibrillation, heart failure with reduced ejection fraction, myocardial infarction, coronary artery disease and beta-blockers. The ML model with SDOH used the same input as well as the SDOH variables. The model with vs. without SDOH had a median AUC of 0.75 vs. 0.73 (p = 0.9957).

Conclusions

Despite not reaching statistical significance, our ML model provides a holistic picture of mortality predictors. Larger studies are needed to more assess the predictive value of SDOH post TAVI. Abstract Figure. Baseline patient characteristics  Abstract Figure. ML Model: Area Under Curve

The unique Akt inhibitor SC66 suppressed AMPK activity and abolished autophagy through the EGFR-p62 pathway

Akt is usually considered to be a negative regulator of both autophagy and adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) signaling. In the present study, we found that SC66, a pyridine-based allosteric Akt inhibitor, suppressed basal and H₂ O₂ -induced autophagy concurrent with decreased phosphorylation and activity of AMPK. SC66 treatment led to the formation of a high molecular weight (HMW) form of SQSTM1/p62 (p62), which is an autophagic substrate and is essential for selective autophagy. Moreover, we observed that SC66 inhibited the binding of p62 and microtubule-associated protein light chain 3 (LC3). The immunoprecipitation results revealed the interaction between p62 and epidermal growth factor receptor (EGFR), and knockdown of EGFR reversed SC66-mediated autophagy inhibition without affecting the phosphorylation of acetyl-CoA carboxylase (ACC), a well-known substrate of AMPK. SC66 increased the interaction between EGFR and Beclin 1 and markedly decreased the association of EGFR with VPS34, a critical protein for autophagy induction. Collectively, the data presented here indicate that EGFR-p62 pathway plays a critical role in Akt-mediated positive regulation of autophagy.

Utilization of 2D Barcode Technology to Create Surgical Pathology Reports

Introduction/Objective

After professional transcription service is eliminated, pathologists inevitably undertake the task of diagnostic data entry into pathology repot by adapting a variety of methods such as speech recognition, manual typing, and pre-texted command. Errors and inefficiency in reporting remain common problems, especially for information with unusual syntax such as genotype or nucleotide sequences. To overcome these shortcomings, we introduce here a novel application of a well-established technology as a complementary method, namely 2- dimensional (2D) barcode symbology.

Methods/Case Report

Commonly used diagnostic wordings of pathology reports including specimen type, surgical procedure, diagnosis, and test results are collated and organized by organ (specimen type) and by their frequency of usage/occurrence. Next, 2D data matrix barcodes are created for these diagnostic wordings using a on-line tool (www.free-barcode-generator.net/datamatrix/). The 2D barcodes along with their text are displayed on the computer screen (or printed out as a booklet). A 2D barcode scanner (Symbol LS2208, Motorola) was used to retrieve the text information from the barcodes and transfer into the pathology report. To assess the efficacy of this barcode method, we evaluated the time of data entry into reports for 117 routine cases using an on-line stopwatch and compared with those by other data entry methods.

Results (if a Case Study enter NA)

Unlike manual typing or speech recognition, the barcode method did not introduce typographic or phonosemantic errors since the method simply transferred pre-texted and proof-read text content to report. It was also faster than manual typing or speech recognition, and its speed was comparable to that of the pre-text method integrated in LIS but did not require human memorization of innumerable text commands to retrieve desired diagnosis wordings.

Conclusion

Our preliminary results demonstrated that the diagnostic data entry time was reduced from 28.5% by other methods to 22.1% by the barcode method although due to the small sample size, statistical analysis was not conclusive.

Electro-optically Q-switched operation of a high-peak-power Tb:LiYF4 green laser

We report on an electro-optically Q-switched Tb:LiYF₄ green laser pumped by a frequency-doubled optically pumped semiconductor blue laser. The electro-optically Q-switched characteristics were studied under a wide range of repetition rates from 200 Hz to 50 kHz using a KD₂PO₄ Q-switch. Up to 198 µJ of pulse energy was obtained with a pulse width of 248 ns at a repetition rate of 200 Hz, corresponding to a peak power of 797 W at 544 nm.

[Five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymph node dissection for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction]

Objective: Surgical operation is the main treatment for advanced adenocarcinoma of esophagogastric junction (AEG). Due to its special anatomic location and unique lymph node reflux mode, the surgical treatment of Siewert II AEG is controversial. Lower mediastinal lymph node dissection is one of the most controversial points and a standard technique has not yet been established. This study is aim to explore the safety and feasibility of five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymph node dissection for Siewert type II AEG. Methods: A descriptive case series study was conducted. The intraoperative and postoperative data of 25 patients with Siewert type II AEG who underwent five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymph node dissection in Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2019 to April 2021 were retrospectively analyzed. Five-step maneuver was as follows: In the first step, the subcardiac sac was exposed; the right pulmonary ligament lymph nodes and the anterior thoracic paraaortic lymph nodes were dissected cranial to inferior pericardium, left to left edge of thoracic aorta. In the second step, the left diaphragm was opened, and a 12 mm trocar was placed through the 6-7 rib in the left anterior axillary line. The supra-diaphragmatic nodes were dissected through the thoracic operation hole. In the third step, the left inferior pulmonary ligament was severed. The anterior fascia of thoracic aorta was incised to join the anterior space of thoracic aorta formed in the first step and then the lymphatic tissue was dissected upward until the exposure of left inferior pulmonary vein. In the fourth step, the posterior pericardium was denuded retrogradely from ventral side to oral side to the level of left inferior pulmonary vein, right to right pleura, and then the right pulmonary ligament lymph nodes were completely removed. In the fifth step, the esophagus was denuded, and the esophagus was transected 5 cm above the tumor using a linear stapler to complete the dissection of lower thoracic paraesophageal lymph nodes. Results: Operations were successfully completed in 25 patients without conversion, intra-operative complication and perioperative death. Total gastrectomy was performed in 19 cases and proximal gastrectomy in 6 cases. The mean operative time was (268.7±85.6) minutes, the mean estimated blood loss was (90.4±44.2) ml, the mean time of lower mediastinal lymph node dissection was (38.6±10.3) minutes, and the mean harvested number of lower mediastinal lymph node was 5.9±2.9. The length of esophageal invasion was >2 cm in 7 cases and ≤ 2 cm in 18 cases. Eight patients (33.0%) had lower mediastinal lymph node metastasis, including 3 cases with esophageal invasion >2 cm and 5 cases with esophageal invasion ≤ 2 cm. The mean time to postoperative first flatus was (5.5±3.1) days. The average time of postoperative thoracic drainage was (5.9±2.9) days. The mean hospital stay was (9.7±3.1) days. Two patients (8.0%) developed postoperative grade IIIa complications according to the Clavien-Dindo classification, including 1 case of pancreatic fistula and 1 case of pleural effusion, both of whom were cured by puncture drainage. Conclusions: Five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymph nodes dissection for Siewert type II AEG is safe and feasible. Which can ensure sufficient lower mediastinal lymph node dissection to the level of left inferior pulmonary vein.

Characterisation of a well-type NaI(Tl) detector by means of a Monte Carlo simulation for radionuclide metrology application

A well-type NaI(Tl) detector was modelled and characterised by means of a Monte Carlo simulation, as part of a project to develop a 4πβ (Plastic Scintillator)-4πγ instrument to be used for the primary standardisation of radionuclides at ANSTO. The simulation based on GEANT4 was used to characterise the 4πγ detector in terms of potential dead layer/inactive materials, full energy peak efficiency, coincidence-summing correction, and energy resolution. An excellent agreement was obtained between the simulation results and the experimental measurements.

Bilateral idiopathic corneal opacity: A report of Ascher ring and a review of the literature

Purpose

To present a case of a rare entity of Ascher ring, a bilateral corneal stromal opacification.

Observation

A 70-year-old male with no ocular history who presented for cataract evaluation was found to have idiopathic bilateral circular stromal corneal rings.

Conclusions

After completion of extensive history, examination, imaging analyses, and laboratory studies for workup of corneal opacities, we arrived at a diagnosis of Ascher corneal ring, an extremely rare entity.

Importance

A rare entity should be considered after excluding other etiologies.

Neurotensin is an anti-thermogenic peptide produced by lymphatic endothelial cells

The lymphatic vasculature plays important roles in the physiology of the organs in which it resides, though a clear mechanistic understanding of how this crosstalk is mediated is lacking. Here, we performed single-cell transcriptional profiling of human and mouse adipose tissue and found that lymphatic endothelial cells highly express neurotensin (NTS/Nts). Nts expression is reduced by cold and norepinephrine in an α-adrenergic-dependent manner, suggesting a role in adipose thermogenesis. Indeed, NTS treatment of brown adipose tissue explants reduced expression of thermogenic genes. Furthermore, adenoviral-mediated overexpression and knockdown or knockout of NTS in vivo reduced and enhanced cold tolerance, respectively, an effect that is mediated by NTSR2 and ERK signaling. Inhibition of NTSR2 promoted energy expenditure and improved metabolic function in obese mice. These data establish a link between adipose tissue lymphatics and adipocytes with potential therapeutic implications.

POS0094 EFFECTS OF RANKL INHIBITION ON PROMOTING HEALING OF BONE EROSION IN RHEUMATOID ARTHRITIS USING HR-pQCT: A 2-YEAR, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Background:

Partial repair of bone erosions in rheumatoid arthritis (RA) is known from high-resolution peripheral quantitative computer tomography (HR-pQCT) studies in patients with moderate to high disease activity using biologics [1]. Whether RANKL inhibition by denosumab is efficacious in healing existing erosions in RA patients with low disease activity or in remission on conventional synthetic DMARDs is uncertain.

Objectives:

To evaluate the effects of denosumab on erosion healing at 2-4 metacarpophalangeal head as determined by HR-pQCT in patients with RA with stable disease.

Methods:

This was a randomized, placebo-controlled, double-blind study. RA patients with disease activity score 28 joints (DAS28) ≤5.1 were randomized (1:1) to subcutaneous denosumab 60 mg or placebo once every six months for 24 months. The primary outcome was erosion healing at MCP 2-4 on HR-pQCT at 12 months. The effects of denosumab on erosion and joint space parameters on HR-pQCT and radiographs, disease activity and health assessment questionnaire-disability index (HAQ-DI) were also examined.

Results:

At 24 months, HR-pQCT images were analyzed in 98 patients. Baseline demographic, clinical characteristics and imaging parameters were comparable between the two treatment groups (table 1). Seventeen patients in each group (placebo group: 17/52, 32.6%; denosumab group: 17/50, 34.0%) achieved sustained low disease activity (DAS28 ≤ 3.2) throughout the 24 months. At 12 months, changes in erosion parameters on HR-pQCT were similar between the two groups. At 24 months, new erosions (19% vs 9%, p=0.009) and erosion progression (34% vs 16%, p<0.001) were more common in the placebo group than the denosumab group. Erosion healing was seen in a significantly higher proportion of patients in the denosumab group (20% vs 6%, p=0.045) at 24 months. The details of the changes in HR-pQCT erosion parameters are shown in figure 1. No significant differences in the changes in joint space parameters on HR-pQCT, van der Heijde-Sharp erosion score, DAS28 and HAQ-DI were observed between the two groups at 12 and 24 months.

Table 1.

Baseline clinical, demographic, disease activity parameters and medications

Placebo (n=55)Denosumab (n=55)Total (n=110)Age56.5 ± 7.157.2 ± 8.556.8 ± 7.8Gender (Female)47 (86)41 (75)88 (80)Disease duration (years)8.5 ± 6.87.3 ± 6.97.9 ± 6.8Rheumatoid factor positive40 (72)38 (69)78 (71)ACPA positive43 (78)44 (80)87 (79)DAS28-CRP2.43 ± 0.832.6 ± 0.922.51 ± 0.88DAS28-CRP>3.28 (15)13 (24)21 (19)HAQ-DI (0-3)0.31 ± 0.380.46 ± 0.470.39 ± 0.43csDMARDs49 (89)52 (95)101 (92)Combination csDMARDs26 (47)33 (60)59 (54)Glucocorticoids5 (10)5 (9)10 (9)vdH- Sharp erosion score10.4 ± 18.48.9 ± 13.89.6 ± 16.2vdH- Sharp JSN score12.4 ± 17.711.5 ± 17.211.9 ± 17.4Lumbar spine aBMD, g/cm20.914 ± 0.1470.930 ± 0.1430.922 ± 0.145Total hip aBMD, g/cm20.837 ± 0.1020.847 ± 0.1460.841 ± 0.125Femoral neck aBMD, g/cm20.681 ± 0.0990.695 ± 0.1280.687 ± 0.114

Data are reported as mean ± SD or number (%). ACPA: Anti-cyclic citrullinated peptide antibody; DAS28: disease activity score 28; csDMARDs: conventional synthetic disease modifying anti-rheumatic drug. HAQ-DI: health assessment questionnaire disability index; vdH- Sharp score: Van der Heijde- Sharp score; aBMD: areal bone mineral density

Conclusion:

Although no differences in erosion parameters were observed at 12 months, denosumab was more efficacious than placebo in erosion repair on HR-pQCT after 24 months.

References:

[1]Finzel S, Rech J, Schmidt S, et al. Interleukin-6 receptor blockade induces limited repair of bone erosions in rheumatoid arthritis: a micro CT study. Ann Rheum Dis 2013;72:396-400.

Figure 1.

Changes in erosion parameters by HR-pQCT. (A) Percentage of patients with overall erosion healing; (B) Outcome of individual erosion with healing, progression and new erosion detected across study period; change in (C) mean erosion volume; (D) total erosion volume; (E) erosion width; (F) erosion depth and (G) marginal osteosclerosis per patient.

Disclosure of Interests:

Ho SO: None declared, Isaac T. Cheng: None declared, Sze-Lok Lau: None declared, Evelyn Chow: None declared, Tommy Lam: None declared, Vivian W Hung: None declared, Edmund Li: None declared, James F Griffith: None declared, Vivian WY Lee: None declared, Lin Shi: None declared, Junbin Huang: None declared, Yan Kitty Kwok: None declared, Isaac C Yim: None declared, Tena K. Li: None declared, Vincent Lo: None declared, Jolly M Lee: None declared, Jack Jock Wai Lee: None declared, Ling Qin: None declared, Lai-Shan Tam Grant/research support from: Grants from Novartis and Pfizer

Profiling retrospective thyroid function data in complete thyroidectomy patients to investigate the HPT axis set point (PREDICT-IT)

BACKGROUND

The homeostatic euthyroid set point of the hypothalamus-pituitary-thyroid axis of any given individual is unique and oscillates narrowly within substantially broader normal population ranges of circulating free thyroxine (FT4) and thyroid-stimulating hormone (TSH), otherwise termed 'thyroid function test (TFT)'. We developed a mathematical algorithm codenamed Thyroid-SPOT that effectively reconstructs the personalized set point in open-loop situations and evaluated its performance in a retrospective patient sample.

METHODS

We computed the set points of 101 patients who underwent total thyroidectomy for non-functioning thyroid disease using Thyroid-SPOT on each patient's own serial post-thyroidectomy TFT. Every predicted set point was compared against its respective healthy pre-operative euthyroid TFT per individual and their separation (i.e. predicted-observed TFT) quantified.

RESULTS

Bland-Altman analysis to measure the agreement between each pair of an individual's predicted and actual set points revealed a mean difference in FT4 and TSH of + 3.03 pmol/L (95% CI 2.64, 3.43) and - 0.03 mIU/L (95% CI - 0.25, 0.19), respectively. These differences are small compared to the width of the reference intervals. Thyroid-SPOT can predict the euthyroid set point remarkably well, especially for TSH with a 10-16-fold spread in magnitude between population normal limits.

CONCLUSION

Every individual's equilibrium euthyroid set point is unique. Thyroid-SPOT serves as an accurate, precise and reliable targeting system for optimal personalized restoration of euthyroidism. This algorithm can guide clinicians in L-thyroxine dose titrations to resolve persistent dysthyroid symptoms among challenging cases harbouring "normal TFT" within the laboratory ranges but differing significantly from their actual euthyroid set points.

LncRNA FGD5-AS1 accelerates cell proliferation in pancreatic cancer by regulating miR-520a-3p/KIAA1522 axis

In recent years, FGD5 antisense RNA 1 (FGD5-AS1) was confirmed to be the long non-coding RNAs (lncRNAs) that could accelerate the development of multiple cancers. Nevertheless, specific biological functions and latent mechanism of FGD5-AS1 were not yet clear in pancreatic cancer (PC). This research was aimed to search the functions of FGD5-AS1 on the PC progression. The expression of FGD5-AS1 in PC cells was tested by using RT-qPCR assay. Colony formation assay, EdU assay, flow cytometry assay and transwell assay as well as western blot were adopted to test the cell abilities of proliferation, apoptosis and migration, separately. Furthermore, RIP experiment and pull down assay were applied for validating the correlation FGD5-AS1, miR-520a-3p and KIAA1522. As a result, the abnormal high expression of FGD5-AS1 was observed in PC cells. And cell proliferative and migratory abilities could be restrained via FGD5-AS1 depletion. Moreover, FGD5-AS1 was proven to combine with miR-520a-3p directly. It was also confirmed that KIAA1522 could be targeted by miR-520a-3p. Rescue assay results indicated that overexpressed KIAA1522 could reverse the repressive function of silencing FGD5-AS1 on PC progression. Taken together, FGD5-AS1 accelerated cell proliferation and migration via sponging miR-520a-3p and upregulating KIAA1522.

81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study

Introduction

Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week.

Methodology

A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions.

Results

95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients.

Conclusion

The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

Improvement in left atrial reservoir strain following hematopoietic stem cell transplant in patients with systemic sclerosis

Funding Acknowledgements

Type of funding sources: None.

Introduction

Systemic sclerosis (SSc) can cause cardiac complications as a result of multi-organ fibrosis. The study of left atrial (LA) mechanics can offer insights into the pathophysiology of cardiac involvement in SSc. LA strain measured by speckle-tracking echocardiography (STE) has been shown to be a sensitive marker of LA function. The impact of a disease modifying treatment like hematopoietic stem cell transplant (HSCT) on LA mechanics is not known.

Aim

To study the effect of HSCT on LA mechanics using both conventional echocardiography and STE.

Methods

Patients with SSc who underwent comprehensive 2D echo evaluation pre- and post-HSCT were identified. Patients with pulmonary hypertension on right heart catheterization (RHC) were excluded. The modified Rodnan skin score (mRSS) was evaluated for each patient pre- and post-HSCT. Speckle tracking software was utilized to measure myocardial strain (TomTec, Unterschleissheim, Germany). LA reservoir strain was measured from the apical 2-, and 4-chamber views. The ratio of E/e’ to LA reservoir strain was used to non-invasively estimate LA stiffness. Paired student’s t-test and Pearson"s correlation were used in data analysis.

Results

Among 89 patients with SSc (average age 46 ± 11 years, 75% female) who underwent HSCT, the mRSS significantly improved after HSCT. The mean pulmonary capillary wedge pressure (PCWP) measured by RHC prior to HSCT was 9.6 ± 4.1 mmHg. LA reservoir strain was abnormal at baseline and significantly improved following HSCT. Although LA volume index and E/e’ remained unchanged, LA stiffness index decreased significantly post-HSCT. There was no correlation between LA reservoir strain and PCWP at baseline or between change in LA reservoir strain and change in LA volume index or E/e’.

Conclusions

Patients undergoing HSCT for SSc show significant improvement in LA reservoir strain and LA stiffness despite no significant change in LA volumes or estimates of LV filling pressures. This improvement in LA mechanics following HSCT thus appears to be independent of loading conditions and could represent an improvement in intrinsic LA performance.

Key clinical and echo characteristics Pre-HSCT Post-HSCT P value Median mRSS (25th - 75th percentile) 20 (13-34) 9 (4-20) &lt;0.01 LA volume index (ml/m2) 24.6 ± 8.3 24.1 ± 7.1 0.66 E/e’ 8.0 ± 2.4 8.3 ± 2.6 0.30 LA stiffness index 0.24 ± 0.12 0.18 ± 0.08 &lt;0.01 LA reservoir strain (%)* 35.8 ± 8.6 47.7 ± 11.2 &lt;0.01 All values are presented as mean ± SD unless indicated otherwise. *Normal LA reservoir strain is defined in this study as being greater than 39%.

Heterogeneous pattern of improvement in right ventricular mechanics following hematopoietic stem cell transplant in patients with systemic sclerosis

Funding Acknowledgements

Type of funding sources: None.

Introduction

Systemic sclerosis (SSc) is an autoimmune disorder that causes fibrosis in the skin and internal organs, including the heart. Patients with SSc can have right ventricular (RV) systolic dysfunction in the absence of pulmonary hypertension. Studies have shown a predilection for impairment of the mid and apical segments of the RV free wall compared to controls. The effect of hematopoietic stem cell transplant (HSCT) – a disease modifying treatment for SSc – on RV mechanics is not known.

Aim

To study the effect of HSCT on RV mechanics using speckle-tracking echocardiography.

Methods

Patients with SSc who underwent comprehensive 2D echocardiographic evaluation pre- and post-HSCT were identified. The modified Rodnan skin score (mRSS) was evaluated for each patient pre- and post-HSCT. Speckle tracking software was utilized to measure myocardial strain (TomTec, Unterschleissheim, Germany). RV strain was measured from the RV focused apical 4-chamber view. Paired student’s t-test and linear regression analysis were used in data analysis.

Results

Among 89 patients with SSc (average age 46 ± 11 years, 75% female) who underwent HSCT, the mRSS significantly improved after HSCT. The mean pulmonary arterial pressure measured by right heart catheterization prior to HSCT was 18.5 ± 4.5 mmHg. There was a significant improvement in RV global longitudinal strain (GLS) and free wall strain (FWS) following HSCT. The improvement in strain was significant in the mid and apical segments of the RV free wall, but not so in the basal segment. The change in RV strain was linearly related to pre-HSCT strain. The lower the RV GLS and FWS, the greater the improvement in strain after HSCT.

Conclusions

There was a significant improvement in RV strain in patients undergoing HSCT, specifically within the mid and apical segments of the RV free wall. The improvement in strain after HSCT was directly related to the baseline strain. This suggests that HSCT may directly improve RV mechanics with the preferential enhancement of the less robust mid and apical RV free wall segments.

Key clinical and echo characteristics Pre-HSCT Post-HSCT P value Median mRSS (25th - 75th percentile) 20 (13-34) 9 (4-20) &lt;0.01 RV GLS (%) -18.13 ± 3.88 -20.06 ± 4.51 &lt;0.01 RV FWS (%) -20.79 ± 5.30 -23.21 ± 5.61 &lt;0.01 RV basal free wall (%) -27.97 ± 9.33 -27.84 ± 7.94 0.93 RV mid free wall (%) -20.68 ± 9.61 -23.75 ± 7.91 0.05 RV apical free wall (%) -15.26 ± 8.57 -20.84 ± 8.92 &lt;0.01 All values are presented as mean ± SD unless indicated otherwise. Abstract Figure. Pre-HSCT RV strain vs change in strain

Patterns of mental health problems before and after easing COVID-19 restrictions: Evidence from a 105248-subject survey in general population in China

BACKGROUND

The COVID-19 pandemic has alarming implications for individual and population level mental health. Although the future of COVID-19 is unknown at present, more countries or regions start to ease restrictions. The findings from this study have provided the empirical evidence of prevalence and patterns of mental disorders in Chinese general population before and after easing most COVID-19 restrictions, and information of the factors associated with these patterns.

METHODS

A cross-sectional population-based online survey was carried out from February to March 2020 in the general population across all provinces in China. The 12-item General Health Questionnaire (GHQ-12) was incorporated in the survey. Latent class analyses were performed to investigate the patterns of mental disorders and multinomial logistic regressions were used to examine how individual and regional risk factors can predict mental disorder patterns.

RESULTS

Four distinctive patterns of mental health were revealed in the general population. After the ease of most COVID-19 restrictions, the prevalence of high risk of mental disorders decreased from 25.8% to 20.9% and prevalence of being high risk of unhappiness and loss of confidence decreased from 10.1% to 8.1%. However, the prevalence of stressed, social dysfunction and unhappy were consistently high before and after easing restrictions. Several regional factors, such as case mortality rate and healthcare resources, were associated with mental health status. Of note, healthcare workers were less likely to have mental disorders, compared to other professionals and students.

CONCLUSIONS

The dynamic management of mental health and psychosocial well-being is as important as that of physical health both before and after the ease of COVID-19 restrictions. Our findings may help in mental health interventions in other countries and regions while easing COVID-19 restrictions.

Peniterpenoids A-C, new sesquiterpenoid metabolites from a wheat cyst nematode Penicillium janthinellum

Three new sesquiterpenoids, peniterpenoids A - C (1-3), together with six known metabolites (4-9) were isolated from an entomogenous fungus Penicillium janthinellum (LB1.20090001) collected from a wheat cyst nematode. The structures of the new compounds were elucidated based on NMR and HRESIMS spectroscopic analyses. The absolute configuration of the C-8 secondary alcohol of peniterpenoid B (2) was determined by [Rh₂(OCOCF₃)₄]-induced ECD experiment. Subsequently, the antimicrobial and DPPH scavenging activities were determined. Compounds 6-8 exhibited moderate antibacterial activities against Staphylococcus aureus (CGMCC1.2465) with MIC values of 25.0, 50.0 and 12.5 μg/mL, respectively.

Aberrant Amplitude of Low-Frequency Fluctuations in Different Frequency Bands in Patients With Parkinson's Disease

Previous studies reported abnormal spontaneous neural activity in Parkinson's disease (PD) patients using resting-state functional magnetic resonance imaging (R-fMRI). However, the frequency-dependent neural activity in PD is largely unknown. Here, 35 PD patients and 35 age- and education-matched healthy controls (HCs) underwent R-fMRI scanning to investigate abnormal spontaneous neural activity of PD using the amplitude of low-frequency fluctuation (ALFF) approach within the conventional band (typical band: 0.01-0.08 Hz) and specific frequency bands (slow-5: 0.010-0.027 Hz and slow-4: 0.027-0.073 Hz). Compared with HCs, PD patients exhibited increased ALFF in the parieto-temporo-occipital regions, such as the bilateral inferior temporal gyrus/fusiform gyrus (ITG/FG) and left angular gyrus/posterior middle temporal gyrus (AG/pMTG), and displayed decreased ALFF in the left cerebellum, right precuneus, and left postcentral gyrus/supramarginal gyrus (PostC/SMG) in the typical band. PD patients showed greater increased ALFF in the left caudate/putamen, left anterior cingulate cortex/medial superior frontal gyrus (ACC/mSFG), left middle cingulate cortex (MCC), right ITG, and left hippocampus, along with greater decreased ALFF in the left pallidum in the slow-5 band, whereas greater increased ALFF in the left ITG/FG/hippocampus accompanied by greater decreased ALFF in the precentral gyrus/PostC was found in the slow-4 band (uncorrected). Additionally, the left caudate/putamen was positively correlated with levodopa equivalent daily dose (LEDD), Hoehn and Yahr (HY) stage, and disease duration. Our results suggest that PD is related to widespread abnormal brain activities and that the abnormalities of ALFF in PD are associated with specific frequency bands. Future studies should take frequency band effects into account when examining spontaneous neural activity in PD.

Different Role of Raptor and Rictor in Regulating Rasfonin-Induced Autophagy and Apoptosis in Renal Carcinoma Cells

Both Raptor and Rictor are the key components in the complexes of mammalian target of rapamycin (mTOR), which play a vital role in mediating autophagy. Unlike mTOR, the regulatory role of either Raptor or Rictor in the regulation of autophagic process is relatively less explored. In present study, we found that rasfonin, which isolated from Talaromyces sp. 3656-A1 and was a fungal natural product, activated both caspase-dependent apoptosis and autophagy in ACHN, a renal carcinoma cell line. Knockdown of Raptor decreased both rasfonin-induced autophagic flux and PARP-1 cleavage, and in contrast, Rictor silencing increased apoptosis concomitantly enhancing rasfonin-induced autophagy. Unexpectedly, API-2, which was widely used as an inhibitor of Akt, promoted rasfonin-dependent autophagy in Raptor-depleted but not Rictor-deprived cells. Collectively, these results demonstrated that Raptor and Rictor could play a distinctly regulatory role in rasfonin-enhanced autophagy and apoptosis.

Impaired Topographical Organization of Functional Brain Networks in Parkinson's Disease Patients With Freezing of Gait

Objective: This study aimed to explore alterations in the topological properties of the functional brain network in primary Parkinson’s disease (PD) patients with freezing of gait (PD-FOG).

Methods: Resting-state functional magnetic resonance imaging (Rs-fMRI) data were obtained in 23 PD-FOG patients, 33 PD patients without FOG (PD-nFOG), and 24 healthy control (HC) participants. The whole-brain functional connectome was constructed by thresholding the Pearson correlation matrices of 90 brain regions, and topological properties were analyzed by using graph theory approaches. The network-based statistics (NBS) method was used to determine the suprathreshold connected edges (P < 0.05; threshold T = 2.725), and statistical significance was estimated by using the non-parametric permutation method (5,000 permutations). Statistically significant topological properties were further evaluated for their relationship with clinical neurological scales.

Results: The topological properties of the functional brain network in PD-FOG and PD-nFOG showed no abnormalities at the global level. However, compared with HCs, PD-FOG patients showed decreased nodal local efficiency in several brain regions, including the bilateral striatum, frontoparietal areas, visual cortex, and bilateral superior temporal gyrus, increased nodal local efficiency in the left gyrus rectus. When compared with PD-nFOG patients and HCs, PD-FOG showed increased betweenness centrality in the left hippocampus. Moreover, compared to HCs, both PD-FOG and PD-nFOG patients displayed reduced network connections by using the NBS method, mainly involving the sensorimotor cortex (SM), visual network (VN), default mode network (DMN), auditory network (AN), dorsal attention network (DAN), subcortical regions, and limbic network (LIM). The local node efficiency of the right temporal pole: superior temporal gyrus in PD-FOG patients was positively correlated with the Freezing of Gait Questionnaire (FOGQ) scores.

Conclusions: This study demonstrates the disrupted regional topological organization in PD-FOG patients, especially associated with damage to the subcortical regions and multiple cortical regions. Our results provide insights into the dysfunctional mechanisms of the relevant networks and indicate potential neuroimaging biomarkers of PD-FOG.

Elevated microRNA-7 inhibits proliferation and tumor angiogenesis and promotes apoptosis of gastric cancer cells via repression of Raf-1

OBJECTIVE

Since the essential involvement of microRNAs (miRNAs) in the development and progression of GC, the study was for the exploration of the value of microRNA-7 (miR-7) in the evaluation of neoadjuvant chemotherapy for gastric cancer (GC) and its effects on apoptosis, proliferation and angiogenesis of GC.

METHODS

miR-7 expression in serum of GC patients before and after neoadjuvant chemotherapy were detected to explore its role in neoadjuvant chemotherapy of GC. The GC cells were transfected with miR-7 mimics/inhibitors, or siRNA-Raf-1 to figure out their roles in proliferation, migration, invasion, cycle distribution and apoptosis. Tumor xenograft was conducted to test tumor growth. Microvessel density (MVD) in tumors was tested by immunohistochemical staining.

RESULTS

miR-7 expression in serum of GC patients was lower than that of healthy controls while it was elevated after neoadjuvant chemotherapy. Moreover, higher miR-7 expression was exhibited in chemotherapy-effective patients rather than chemotherapy-ineffective patients (P < 0.01). miR-7 expression in serum was connected with tumor size, degree of differentiation, TNM stage and lymphatic metastasis.miR-7 was decreased and Raf-1 was elevated in GC cells (both P < 0.05). Elevated miR-7 or declined Raf-1 inhibited GC cell migration, proliferation and invasion, cell cycle entry, xenografted tumor growth and MVD and stimulated apoptosis (all P < 0.05). Down-regulated Raf-1 reversed the impacts of miR-7 knockdown on GC cells (all P < 0.05).

CONCLUSION

Our study highlights that elevated miR-27a indicates the good efficacy of neoadjuvant chemotherapy in GC and miR-7 targets Raf-1 to suppress tumor development and angiogenesis of GC cells.

CD8+ T-cells infiltrate Alzheimer's disease brains and regulate neuronal- and synapse-related gene expression in APP-PS1 transgenic mice

Neuroinflammation is a major contributor to disease progression in Alzheimer's disease (AD) and is characterized by the activity of brain resident glial cells, in particular microglia cells. However, there is increasing evidence that peripheral immune cells infiltrate the brain at certain stages of AD progression and shape disease pathology. We recently identified CD8⁺ T-cells in the brain parenchyma of APP-PS1 transgenic mice being tightly associated with microglia as well as with neuronal structures. The functional role of CD8⁺ T-cells in the AD brain is however completely unexplored. Here, we demonstrate increased numbers of intra-parenchymal CD8⁺ T-cells in human AD post-mortem hippocampus, which was replicated in APP-PS1 mice. Also, aged WT mice show a remarkable infiltration of CD8⁺ T-cells, which was more pronounced and had an earlier onset in APP-PS1 mice. To address their functional relevance in AD, we successfully ablated the pool of CD8⁺ T-cells in the blood, spleen and brain from 12 months-old APP-PS1 and WT mice for a total of 4 weeks using an anti-CD8 antibody treatment. While the treatment at this time of disease stage did neither affect the cognitive outcome nor plaque pathology, RNAseq analysis of the hippocampal transcriptome from APP-PS1 mice lacking CD8⁺ T-cells revealed highly altered neuronal- and synapse-related gene expression including an up-regulation for neuronal immediate early genes (IEGs) such as the Activity Regulated Cytoskeleton Associated Protein (Arc) and the Neuronal PAS Domain Protein 4 (Npas4). Gene ontology enrichment analysis illustrated that the biological processes "regulation of neuronal synaptic plasticity" and the cellular components "postsynapses" were over-represented upon CD8⁺ T-cell ablation. Additionally, Kegg pathway analysis showed up-regulated pathways for "calcium signaling", "long-term potentiation", "glutamatergic synapse" and "axon guidance". Therefore, we conclude that CD8⁺ T-cells infiltrate the aged and AD brain and that brain CD8⁺ T-cells might directly contribute to neuronal dysfunction in modulating synaptic plasticity. Further analysis will be essential to uncover the exact mechanism of how CD8⁺ T-cells modulate the neuronal landscape and thereby contribute to AD pathology.

circCYFIP2 Acts as a Sponge of miR-1205 and Affects the Expression of Its Target Gene E2F1 to Regulate Gastric Cancer Metastasis

Accumulating evidence suggested that circular RNAs (circRNAs) play critical roles in the initiation and progression of malignant cancers. However, the roles of circRNAs in gastric cancer (GC) remain largely unknown. In the present study, we investigated the expression of circRNAs in 5 GC tissues with metastasis and 5 GC tissues without metastasis by microarray analysis. We focused on hsa_circ_0003506, which was spliced from CYFIP2 gene located at chr5:156786012-156788606 and finally formed a sense-overlapping circular transcript of 366 nt, and thus we named it circCYFIP2. circCYFIP2 was found to be significantly upregulated in GC tissues and cell lines. High expression of circCYFIP2 was associated with metastasis and poor prognosis of GC patients. Function assays revealed that overexpression or knockdown of circCYFIP2 significantly enhanced or reduced GC cell proliferation and invasion abilities. In mechanism, we found that circCYFIP2 might serve as a competing endogenous RNA (ceRNA) of microRNA-1205 (miR-1205) in GC progression. Besides, E2F1 was found to be a target of miR-1205. Collectively, our findings suggested that circCYFIP2 might serve as an oncogenic circRNA to promote GC progression via the miR-1205/E2F1 axis, which provided a potential therapeutic target for the treatment of GC.