[Take-home messages from the 2nd COPD 2023 Biennial of the French Society of Respiratory Diseases. Placing the patient at the center of the care pathway]

INTRODUCTION

The second COPD Biennial organized by the COPD working group of the French Society of Respiratory Diseases took place in Paris (Cochin) on 13th December 2023.

STATE OF THE ART

Major trends in 2023 were discussed; they encompassed concepts, definitions, biologics, care pathways, pulmonary rehabilitation and complex situations entailed by respiratory infections, cardiovascular comorbidities and pulmonary hypertension, and modalities of oxygen therapy and ventilation.

PERSPECTIVES

The different talks underlined major changes in COPD including the concepts of pre-COPD, etiotypes, health trajectories and new definitions of exacerbation. Recent results in biologics for COPD open the door to new pharmacological options. Assessment of current care pathways in France highlighted some causes for concern. For example, pulmonary rehabilitation is a key but insufficiently practiced element. Respiratory infections require careful assessment and treatments. Diagnosis and treatment of cardiovascular comorbidities and pulmonary hypertension are of paramount importance. As of late, oxygen therapy and ventilation modalities have evolved, and are beginning to afford more personalized options.

CONCLUSIONS

As regards COPD, a personalized approach is crucial, placing the patient at the center of the care pathway and facilitating coordination between healthcare providers.

Tailoring Ultrafast Near-Band Gap Photoconductive Response in GeS by Zero-Valent Cu Intercalation

Zero-valent intercalation of atomic metals into the van der Waals gap of layered materials can be used to tune their electronic, optical, thermal, and mechanical properties. Here, we report the impact of intercalating ∼3 atm percent of zero-valent copper into germanium sulfide (GeS). Advanced many-body calculations predict that copper introduces quasi-localized intermediate band states, and time-resolved THz spectroscopy studies demonstrate that those states have prominent effects on the photoconductivity of GeS. Cu-intercalated GeS exhibits a faster rise of transient photoconductivity and a shorter lifetime of optically injected carriers following near-gap excitation with 800 nm pulses. At the same time, Cu intercalation improves free carrier mobility from 1100 to 1300 cm2 V-1 s-1, which we attribute to the damping of acoustic phonons observed in Brillouin scattering and consequent reduction of phonon scattering.

Efficacy, safety, and pharmacokinetics of capsid assembly modulator linvencorvir plus standard of care in chronic hepatitis B patients

BACKGROUND/AIMS

Four-week treatment of linvencorvir (RO7049389) was generally safe and well tolerated, and showed anti-viral activity in chronic hepatitis B (CHB) patients. This study evaluated the efficacy, safety, and pharmacokinetics of 48-week treatment with linvencorvir plus standard of care (SoC) in CHB patients.

METHODS

This was a multicentre, non-randomized, non-controlled, open-label phase 2 study enrolling three cohorts: nucleos(t)ide analogue (NUC)-suppressed patients received linvencorvir plus NUC (Cohort A, n=32); treatment-naïve patients received linvencorvir plus NUC without (Cohort B, n=10) or with (Cohort C, n=30) pegylated interferon-α (Peg-IFN-α). Treatment duration was 48 weeks, followed by NUC alone for 24 weeks.

RESULTS

68 patients completed the study. No patient achieved functional cure (sustained HBsAg loss and unquantifiable HBV DNA). By Week 48, 89% of treatment-naïve patients (10/10 Cohort B; 24/28 Cohort C) reached unquantifiable HBV DNA. Unquantifiable HBV RNA was achieved in 92% of patients with quantifiable baseline HBV RNA (14/15 Cohort A, 8/8 Cohort B, 22/25 Cohort C) at Week 48 along with partially sustained HBV RNA responses in treatment-naïve patients during follow-up period. Pronounced reductions in HBeAg and HBcrAg were observed in treatment-naïve patients, while HBsAg decline was only observed in Cohort C. Most adverse events were grade 1-2, and no linvencorvir-related serious adverse events were reported.

CONCLUSION

48-week linvencorvir plus SoC was generally safe and well tolerated, and resulted in potent HBV DNA and RNA suppression. However, 48-week linvencorvir plus NUC with or without Peg-IFN did not result in the achievement of functional cure in any patient.

Effects of Gadolinium Retention in the Brains of Type 2 Diabetic Rats after Repeated Administration of Gadolinium-Based MRI Contrast Agents on Neurobiology and NLRP3 Inflammasome Activation

BACKGROUND

The neurotoxic potential of gadolinium (Gd)-based contrast agents (GBCAs) retention in the brains of patients with type 2 diabetes mellitus (T2DM) is unclear.

PURPOSE

To determine the deposition and clearance of GBCAs in T2DM rats and the mechanism by which Gd enhances nucleotide-binding oligomerization domain-3 (NLRP3) inflammasome activation.

STUDY TYPE

Cross-sectional, prospective.

ANIMAL MODEL

104 T2DM male Wistar rats.

FIELD STRENGTH/SEQUENCE

9.4-T, T1-weighted fast spin echo sequence.

ASSESSMENT

T2DM (male Wistar rats, n = 52) and control group (healthy, male Wistar rats, n = 52) rats received saline, gadodiamide, Gd-diethylenetriaminepentaacetic acid, and gadoterate meglumine for four consecutive days per week for 7 weeks. The distribution and clearance of Gd in the certain brain were assessed by MRI (T1 signal intensity and relaxation rate R1, on the last day of each week), inductively coupled plasma mass-spectroscopy, ultraperformance liquid chromatography mass spectrometry, and transmission electron microscopy. Behavioral tests, histopathological features, and the effects of GBCAs on neuroinflammation were also analyzed.

STATISTICAL TESTS

One-way analysis of variance, bonferroni method, and unpaired t-test. A P-value <0.05 was considered statistically significant.

RESULTS

The movement distance and appearance time in the open field test of the T2DM rats in the gadodiamide group were significantly shorter than in the other groups. Furthermore, the expression of NLRP3, Pro-Caspase-1, interleukin-1β (IL-1β), and apoptosis-associated speck-like protein containing a CARD protein in neurons was significantly higher in the gadodiamide group than in the saline group, as shown by Western blot. Gadodiamide also induced differentiation of microglia into M1 type, decreased the neuronal mitochondrial membrane potential, and significantly increased neuronal apoptosis from flow cytometry.

DATA CONCLUSION

T2DM may affect both the deposition and clearance of GBCAs in the brain. Informed by the T2DM model, gadodiamide could mediate the neuroinflammatory response by NLRP3 inflammasome activation.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 1.

Novel Approach for Pancreas Transcriptomics Reveals the Cellular Landscape in Homeostasis and Acute Pancreatitis

BACKGROUND & AIMS

Acinar cells produce digestive enzymes that impede transcriptomic characterization of the exocrine pancreas. Thus, single-cell RNA-sequencing studies of the pancreas underrepresent acinar cells relative to histological expectations, and a robust approach to capture pancreatic cell responses in disease states is needed. We sought to innovate a method that overcomes these challenges to accelerate study of the pancreas in health and disease.

METHODS

We leverage FixNCut, a single-cell RNA-sequencing approach in which tissue is reversibly fixed with dithiobis(succinimidyl propionate) before dissociation and single-cell preparation. We apply FixNCut to an established mouse model of acute pancreatitis, validate findings using GeoMx whole transcriptome atlas profiling, and integrate our data with prior studies to compare our method in both mouse and human pancreas datasets.

RESULTS

FixNCut achieves unprecedented definition of challenging pancreatic cells, including acinar and immune populations in homeostasis and acute pancreatitis, and identifies changes in all major cell types during injury and recovery. We define the acinar transcriptome during homeostasis and acinar-to-ductal metaplasia and establish a unique gene set to measure deviation from normal acinar identity. We characterize pancreatic immune cells, and analysis of T-cell subsets reveals a polarization of the homeostatic pancreas toward type-2 immunity. We report immune responses during acute pancreatitis and recovery, including early neutrophil infiltration, expansion of dendritic cell subsets, and a substantial shift in the transcriptome of macrophages due to both resident macrophage activation and monocyte infiltration.

CONCLUSIONS

FixNCut preserves pancreatic transcriptomes to uncover novel cell states during homeostasis and following pancreatitis, establishing a broadly applicable approach and reference atlas for study of pancreas biology and disease.

Lessons learned from phase 3 trials of immunotherapy for glioblastoma: Time for longitudinal sampling?

Glioblastoma (GBM)'s median overall survival is almost 21 months. Six phase 3 immunotherapy clinical trials have recently been published, yet 5/6 did not meet approval by regulatory bodies. For the sixth, approval is uncertain. Trial failures result from multiple factors, ranging from intrinsic tumor biology to clinical trial design. Understanding the clinical and basic science of these 6 trials is compelled by other immunotherapies reaching the point of advanced phase 3 clinical trial testing. We need to understand more of the science in human GBMs in early trials: the "window of opportunity" design may not be best to understand complex changes brought about by immunotherapeutic perturbations of the GBM microenvironment. The convergence of increased safety of image-guided biopsies with "multi-omics" of small cell numbers now permits longitudinal sampling of tumor and biofluids to dissect the complex temporal changes in the GBM microenvironment as a function of the immunotherapy.

Hafnium, Titanium, and Zirconium Intercalation in 2D Layered Nanomaterials

Altering the physical and chemical properties of a layered material through intercalation has emerged as a unique strategy toward tunable applications. In this work, we demonstrate a wet chemical method to intercalate titanium, hafnium, and zirconium into 2D layered nanomaterials. The metals are intercalated using bis-tetrahydrofuran metal halide complexes. Metal intercalation is demonstrated in nanomaterials of Bi2Se3, Si2Te3, MoO3, and GeS. This strategy intercalates, on average, 3 atm % or less of Hf, Ti, and Zr that share charge with the host nanomaterial. This methodology is used to chemochromically alter MoO3 from transparent white to dark blue.

Chronic metabolic stress drives developmental programs and loss of tissue functions in non-transformed liver that mirror tumor states and stratify survival

Under chronic stress, cells must balance competing demands between cellular survival and tissue function. In metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD/NASH), hepatocytes cooperate with structural and immune cells to perform crucial metabolic, synthetic, and detoxification functions despite nutrient imbalances. While prior work has emphasized stress-induced drivers of cell death, the dynamic adaptations of surviving cells and their functional repercussions remain unclear. Namely, we do not know which pathways and programs define cellular responses, what regulatory factors mediate (mal)adaptations, and how this aberrant activity connects to tissue-scale dysfunction and long-term disease outcomes. Here, by applying longitudinal single-cell multi -omics to a mouse model of chronic metabolic stress and extending to human cohorts, we show that stress drives survival-linked tradeoffs and metabolic rewiring, manifesting as shifts towards development-associated states in non-transformed hepatocytes with accompanying decreases in their professional functionality. Diet-induced adaptations occur significantly prior to tumorigenesis but parallel tumorigenesis-induced phenotypes and predict worsened human cancer survival. Through the development of a multi -omic computational gene regulatory inference framework and human in vitro and mouse in vivo genetic perturbations, we validate transcriptional (RELB, SOX4) and metabolic (HMGCS2) mediators that co-regulate and couple the balance between developmental state and hepatocyte functional identity programming. Our work defines cellular features of liver adaptation to chronic stress as well as their links to long-term disease outcomes and cancer hallmarks, unifying diverse axes of cellular dysfunction around core causal mechanisms.

Clinical trial links oncolytic immunoactivation to survival in glioblastoma

Immunotherapy failures can result from the highly suppressive tumour microenvironment that characterizes aggressive forms of cancer such as recurrent glioblastoma (rGBM)1,2. Here we report the results of a first-in-human phase I trial in 41 patients with rGBM who were injected with CAN-3110-an oncolytic herpes virus (oHSV)3. In contrast to other clinical oHSVs, CAN-3110 retains the viral neurovirulence ICP34.5 gene transcribed by a nestin promoter; nestin is overexpressed in GBM and other invasive tumours, but not in the adult brain or healthy differentiated tissue4. These modifications confer CAN-3110 with preferential tumour replication. No dose-limiting toxicities were encountered. Positive HSV1 serology was significantly associated with both improved survival and clearance of CAN-3110 from injected tumours. Survival after treatment, particularly in individuals seropositive for HSV1, was significantly associated with (1) changes in tumour/PBMC T cell counts and clonal diversity, (2) peripheral expansion/contraction of specific T cell clonotypes; and (3) tumour transcriptomic signatures of immune activation. These results provide human validation that intralesional oHSV treatment enhances anticancer immune responses even in immunosuppressive tumour microenvironments, particularly in individuals with cognate serology to the injected virus. This provides a biological rationale for use of this oncolytic modality in cancers that are otherwise unresponsive to immunotherapy (ClinicalTrials.gov: NCT03152318 ).

Impact of Free Hospital-Provided Rideshare Service on Radiation Therapy Completion Rates: A Matched Cohort Analysis

PURPOSE/OBJECTIVE(S)

Radiation therapy (RT) is generally given in consecutive daily sessions over multiple weeks. This poses challenges for patients who face barriers such as limited access to public or private transportation, limited financial resources, lack of social support, and long distances to healthcare facilities. Delayed or incomplete RT increases risk for worse clinical outcomes. The potential of rideshare service, which uses a private vehicle for hire arranged through a phone-based application or website, to facilitate timely RT is understudied.

MATERIALS/METHODS

Retrospective data was collected on patients who received RT at a single institution from 2017-2022. Patient demographic and treatment characteristics were compared between those who did and did not utilize free hospital-provided rideshare service. RT completion rates were analyzed for a 1:1 matched non-rideshare cohort using optimal matching with the scaled Euclidean distance metric, to balance age, sex, race, performance status, number of fractions prescribed, Area Deprivation Index (ADI), distance to treatment center, year of diagnosis, treatment site, intent, and modality. ADI is a validated composite measure of community-level socioeconomic deprivation.

RESULTS

Of 2,906 patients who underwent RT, 58 utilized free hospital-provided rideshare service. Rideshare utilizers had a lower median age (60 vs 66, p = .02), and were more likely to identify as Black or African American (60 vs 22%, p<.0001) compared to non-rideshare utilizers. Rideshare utilizers also had higher ADI scores (median 9 vs 5, p<.0001), indicating higher socioeconomic disadvantage, and travelled shorter distances for treatment (median 5.0 vs 14.7 miles, p<.0001). More rideshare utilizers underwent RT for curative intent (79 vs 50%, p<.0001), concordant with a higher number of fractions prescribed (median 28 vs 5, p<.0001) as well as longer treatment course duration (median 39 vs 13 days, p<.0001). The most common treatment sites were head and neck (31%) and breast / chest wall (22%) for rideshare utilizers, and pelvis (27%) and brain (21%) for non-rideshare utilizers (p<.0001). Volumetric modulated arc therapy followed by 3D conformal were the most common treatment modalities in both groups. The matched cohort analysis revealed that RT completion rates were significantly higher for rideshare vs non-rideshare utilizers at 96 vs 81% (p = .01) overall, and 98 vs 78% (p = .01) for patients undergoing treatment with curative intent.

CONCLUSION

Even after adjustment for socioeconomic, clinical, and treatment characteristics, utilization of free hospital-provided rideshare service was associated with improved RT completion rates. These findings are notable as the majority of rideshare utilizers come from socioeconomically marginalized communities, and would otherwise be expected to face significant barriers to RT completion.

Evaluation of the drug disposition of RO7049389 with in vitro data and human mass balance supported by physiologically based pharmacokinetic modelling

AIMS

RO7049389 (linvencorvir) is a developmental oral treatment for chronic hepatitis B virus infection. The aim of this work was to conduct mass balance (MB) and absolute bioavailability (BA) analyses in healthy volunteers, alongside in vitro evaluations of the metabolism of RO7049389 and a major circulating active metabolite M5 in human hepatocytes, and physiologically based pharmacokinetic (PBPK) modelling to refine the underlying drug disposition paradigm.

METHODS

Participants in the clinical study (MB: Caucasian, male, n = 6; BA: Caucasian and Asian, male and female, n = 16, 8 in each ethnic groups) received oral [14 C] or unlabelled RO7049389 (600/1000 mg) followed by 100 μg intravenous [13 C]RO7049389. Metabolic pathways with fractions metabolized-obtained from the in vitro incubation results of 10 μM [14 C]RO7049389 and 1 μM M5 with (long-term cocultured) human hepatocytes in the absence and presence of the cytochrome P450 3A4 (CYP3A4) inhibitor itraconazole-were used to complement the PBPK models, alongside the clinical MB and BA data.

RESULTS

The model performance in predicting the pharmacokinetic profiles of RO7049389 and M5 aligned with clinical observations in Caucasians and was also successfully applied to Asians. Accordingly, the drug disposition pathways for RO7049389 were postulated with newly characterized estimates of the fractions: biliary excretion by P-glycoprotein (~41%), direct glucuronidation via uridine 5'-diphosphoglucuronosyltransferase 1A3 (~11%), hexose conjugation (~6%), oxidation by CYP3A4 (~28%) and other oxidation reactions (~9%).

CONCLUSION

These results support the ongoing clinical development program for RO7049389 and highlight the broader value of PBPK and MB analyses in drug development.

Sphingomonas caeni sp. nov., a phenolic acid-degrading bacterium isolated from activated sludge

A Gram-stain-negative, rod-shaped, polar flagellated or stalked and non-spore-forming bacterium, designated LB-2^T, was isolated from activated sludge. Growth was observed at 20-30 °C (optimum 28 °C), pH 6.0-8.0 (optimum pH 7.0) and salinity of 0-0.5% (w/v; optimum 0.5%). Phylogenetic analysis based on the 16S rRNA gene indicated that strain LB-2^T belongs to the genus Sphingomonas and showed the highest sequence similarity (96.7%) and less than 96.7% similarities to other type strains. The genome size of strain LB-2^T was 4.10 Mb, with 66.8 mol% G + C content. The average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) values between strains LB-2^T and S. canadensis FWC47^T were 77.8% and 21%, respectively. The predominant cellular fatty acids were summed feature 8 (C_18:1ω7c and/or C_18 : 1ω6c) and C_16:0. The major polar lipids were aminolipid, glycolipid, sphingoglycolipid, phosphatidylcholine, phosphatidylglycerol, four unidentified lipids, glycophospholipid, phosphatidylethanolamine and diphosphatidylglycerol. The predominant respiratory quinone was Q-10 and the major polyamine was sym-homospermidine. On the basis of phenotypic, genotypic and phylogenetic evidences, strain LB-2^T represents a novel species in the genus Sphingomonas, for which the name Sphingomonas caeni sp. nov. is proposed. The type strain is LB-2^T (GDMCC 1.3630^T = NBRC 115,102^T).

TLR7 agonist RO7020531 versus placebo in healthy volunteers and patients with chronic hepatitis B virus infection: a randomised, observer-blind, placebo-controlled, phase 1 trial

BACKGROUND

Toll-like receptor 7 (TLR7) agonists augment immune activity and have potential for the treatment of chronic hepatitis B virus (HBV) infection. We aimed to assess the safety and tolerability of RO7020531 (also called RG7854), a prodrug of the TLR7 agonist RO7011785, in healthy volunteers and patients with chronic HBV infection.

METHODS

This randomised, observer-blind, placebo-controlled, phase 1 study was done in two parts. Part 1 was done at one site in New Zealand and part 2 was done at 12 sites in Bulgaria, Hong Kong, Italy, New Zealand, the Netherlands, Taiwan, Thailand, and the UK. In part 1, healthy volunteers were randomly assigned (4:1) within one of eight dose cohorts (3 mg, 10 mg, 20 mg, 40 mg, 60 mg, 100 mg, 140 mg, or 170 mg) to receive a single RO7020531 dose or placebo or randomly assigned (4:1) within one of three dose cohorts (100 mg, 140 mg, or 170 mg) to receive either RO7020531 or placebo every other day for 13 days. In part 2, nucleoside or nucleotide analogue-suppressed patients with chronic HBV infection were randomly assigned (4:1) within cohorts 1-3 (150 mg, 150 mg, or 170 mg) to receive either RO7020531 or placebo and treatment-naive patients with chronic HBV infection were randomly assigned (3:1) in cohort 4 to receive either 150 mg of RO7020531 or placebo. Patients were treated every other day for 6 weeks. Study medication was administered orally to participants after they had fasted. Study participants and investigational staff were masked to treatment allocation. The primary outcome was the safety and tolerability of RO7020531, as measured by the incidence and severity of adverse events and the incidence of laboratory, vital sign, and electrocardiogram abnormalities, and was analysed in all participants who received at least one dose of the study medication. This trial is registered with ClinicalTrials.gov, NCT02956850, and the study is complete.

FINDINGS

Between Dec 12, 2016, and March 21, 2021, 340 healthy volunteers were screened in part 1, of whom 80 were randomly assigned in the single ascending dose study (eight assigned RO7020531 in each cohort and 16 assigned placebo) and 30 were randomly assigned in the multiple ascending dose study (eight assigned RO7020531 in each cohort and six assigned placebo), and 110 patients were screened in part 2, of whom 30 were randomly assigned in cohorts 1-3 (16 assigned RO7020531 150 mg, eight assigned RO7020531 170 mg, and six assigned placebo) and 20 were randomly assigned in cohort 4 (15 assigned RO7020531 and five assigned placebo). All randomly assigned participants received at least one dose of a study drug and were included in the safety analysis. All tested doses of RO7020531 were safe and had acceptable tolerability in healthy volunteers and patients. The most frequent treatment-related adverse events among the total study population were headache (15 [9%] of 160 participants), influenza-like illness (seven [4%] of 160 participants), and pyrexia (ten [6%] of 160 participants). Most adverse events were mild and transient. There were no severe or serious adverse events in healthy volunteers. In the patient cohorts, there was one severe adverse event (influenza-like illness with 170 mg of RO7020531) and one serious adverse event (moderate influenza-like illness with a 3-day hospitalisation in a treatment-naive patient receiving RO7020531). There were no treatment-related deaths.

INTERPRETATION

Due to acceptable safety and tolerability, RO7020531 should continue to be developed for the treatment of patients with chronic HBV infection.

FUNDING

F Hoffmann-La Roche.

Hepatic Events and Viral Kinetics in Hepatocellular Carcinoma Patients Treated with Atezolizumab plus Bevacizumab

Introduction

In the Phase 3 IMbrave150 trial (NCT03434379), atezolizumab + bevacizumab demonstrated a clinically meaningful survival benefit over sorafenib in patients with unresectable hepatocellular carcinoma (HCC), including those with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. We used IMbrave150 data to investigate the safety and risk of viral reactivation or flare in infected patients treated with atezolizumab + bevacizumab or sorafenib.

Methods

Patients with unresectable HCC not previously treated with systemic therapy were randomized 2:1 to atezolizumab + bevacizumab or sorafenib. In this exploratory analysis, safety was continually evaluated, including for hepatic adverse events. Patients were monitored for HBV and HCV reactivation and flare at screening, the beginning of Cycles 5 and 9, and at treatment discontinuation.

Results

Of 501 enrolled patients, 485 were included in the safety population; 329 (68%) received atezolizumab + bevacizumab, and 156 (32%) received sorafenib. Overall, 150 (31%) and 58 (12%) patients had HBV and HCV infections, respectively. The safety profiles of atezolizumab + bevacizumab and sorafenib were consistent across patients, regardless of viral infection. Overall, hepatic serious adverse events occurred in 11% of patients receiving atezolizumab + bevacizumab and 8% receiving sorafenib. HBV or HCV reactivation occurred in 2% or 16% of atezolizumab + bevacizumab-treated patients, respectively, versus 7% or 14% with sorafenib. There were no instances of hepatitis flare with atezolizumab + bevacizumab.

Conclusions

Atezolizumab + bevacizumab had a similar hepatic safety profile in patients with and without HBV or HCV infection. Viral reactivation rates were similar between arms. Overall, these data support the use of atezolizumab + bevacizumab in patients with HCC and HBV or HCV infection without any special precaution.

Quinolinic acid catabolism is initiated by a novel four-component hydroxylase QuiA in Alcaligenes faecalis JQ191

Quinolinic acid (QA) is an essential nitrogen-containing aromatic heterocyclic compounds in organisms and it also acts as an important intermediate in chemical industry, which has strong neurotoxicity and cytotoxicity. The wide range of sources and applications caused the release and accumulation of QA in the environment which might poses a hazard to ecosystems and human health. However, few research on the degradation of QA by microorganisms and toxicity of QA and its metabolites were reported. Alcaligenes faecalis JQ191 could degrade QA but the genetic foundation of QA degradation has not been studied. In this study, the gene cluster quiA1A2A3A4 was identified from A. faecalis JQ191, which was responsible for the initial catabolism step of QA. The quiA1A2A3A4 gene cluster encodes a novel cytoplasmic four-component hydroxylase QuiA. The ¹H nuclear magnetic resonance indicated that QuiA catalyzed QA to 6-hydroxyquinolinic acid (6HQA) and the H₂¹⁸O-labeling analysis confirmed that the hydroxyl group incorporating into 6HQA was derived from water. Toxicity tests showed that the QA could approximately inhibit 20%-80% growth of Chlorella ellipsoidea, and 6HQA could relieve at least 50% QA growth inhibition of Chlorella ellipsoidea, indicating that the 6-hydroxylation of QA by QuiA is a detoxification process. This research provides new insights into the metabolism of QA by microorganism and potential application in the bioremediation of toxic pyridine derivatives-contaminated environments.

OC-052 A CHANGE IN PRESENTATION OF PARAOESOPHAGEAL HIATUS HERNIA REQUIRING SURGICAL INTERVENTION IN A DISTRICT GENERAL HOSPITAL IN THE NORTHERN REGION OF THE UNITED KINGDOM

Aim

The incidence of paraoesphageal hiatus hernia (PEH) has changed over the last several years. This study aims to ascertain the difference in the presentation of PEH requiring operative intervention at our unit because of the COVID-19 pandemic

Material & Methods

We conducted a retrospective review of procedures performed by a single surgeon for PEH in a district general hospital. We compared cases from 2016 to March 2020 and during the initial period of the COVID-19 pandemic in 2020.

Results

39 consecutive cases were identified undergoing PEH related procedures. The median age was 66 (IQR 26), with slight female predominance (M:F ratio of 5:6). 28 cases (71.8%) were performed as elective cases.

After the 2020 March lockdown, there were 10 cases of PEH repair performed with 78% performed as emergency procedures, compared to 30 cases in the preceding 5 years and 10% performed as emergency cases. Chi-square test to examine the association between COVID-19 pandemic and emergency procedure, X2(1, N=39)=14.199, p=0.000164.

Pre-COVID19 the types of procedures included 76.7% were fundoplication with suture crural closure, 10% were fundoplication with mesh repair, 3.3% biological mesh repair, 3.3% with suture closure of the crural and 6.7% had suture gastropexy. During the COVID-19 period, 44.4% were gastropexy, 33.3% were gastrostomy tube insertion and 22.2% fundoplication performed.

Conclusion

We have seen significantly more emergency PEH related procedures performed and using a variety of procedures. This leads to the consideration of whether current emergency general surgery training can equip trainees for future independent practice.

Isolated functional tricuspid regurgitation, how define patient at-risk for event?

Introduction

Functional tricuspid regurgitation (TR) is a turning point in cardiac diseases. Symptoms typically appear late, and the optimal timing for proposing a valve repair remains a challenge. We sought to analyse the characteristics of right heart remodelling in patients with significant functional TR to identify the parameters that could be used in an easily achievable and fair prognostic model predicting clinical events.

Methods

We designed a prospective observational French multicentre study including 160 patients with significant functional TR (effective regurgitant orifice area &gt;30mm2) and LVEF &gt;40%. Clinical, echocardiographic, and ECG data were collected at baseline, and at the 1- and 2-year follow-up. The primary outcome was all-cause death or hospitalization for heart failure.

Results

At 2 years, 56 patients (35%) achieved the primary outcome. The subset with events showed more advanced right heart remodelling at baseline, but similar TR severity. Right atrial volume index (RAVI) and the TAPSE/sPAP ratio, reflecting right-ventricle-pulmonary artery coupling, were 73 mL/m2 and 0.40 versus 64.7 mL/m2 and 0.50 in the event vs event-free group, respectively (both p&lt;0.05). None among all the clinical and imaging parameters tested had a significant group × time interaction. In multivariable analysis, the model including TAPSE/sPAP ratio &gt;0.4 (OR=0.41, 95%CL 0.2 to 0.82) and RAVI &gt;60 mL/m2 (OR=2.13, 95%CL 0.96 to 4.75) permitted the fairest and most parsimonious prognostic evaluation.

Conclusion

RAVI and TAPSE/sPAP are relevant for predicting the risk for event at 2-year follow-up in patient with an isolated functional TR.

Funding Acknowledgement

Type of funding sources: None.

Use of covered stents to treat complex cerebrovascular diseases: Expert consensus

The treatment of complex cerebrovascular diseases (CCVDs) at the skull base, such as complex intracranial aneurysms, carotid-cavernous sinus fistulas, and intracranial artery traumatic injuries, is a difficult clinical problem despite advances in endovascular and surgical therapies. Covered stents or stent graft insertion is a new concept for endovascular treatment that focuses on arterial wall defect reconstruction, differing from endovascular lesion embolization or flow diverter therapies. In recent years, covered stents specifically designed for cerebrovascular treatment have been applied in the clinical setting, allowing thousands of patients with CCVDs to undergo intraluminal reconstruction treatment and achieving positive results, even in the era of flow diverters. Since there is no unified reference standard for the application of covered stents for treating CCVDs, it is necessary to further standardize and guide the clinical application of this technique. Thus, we organized authoritative experts in the field of neurointervention in China to write an expert consensus, which aims to summarize the results of covered stent insertion in the treatment of CCVDs and propose suitable standards for its application in the clinical setting. Based on the contents of this consensus, clinicians can use individualized intraluminal reconstruction treatment techniques for patients with CCVDs.

Cloning of a novel tetrahydrofolate-dependent dicamba demethylase gene from dicamba-degrading consortium and characterization of the gene product

Dicamba, an important hormone-type systemic herbicide, is widely used to control more than 200 kinds of broadleaf weeds in agriculture. Due to its broad-spectrum, high efficiency and effectively killing glyphosate-resistant weeds, dicamba is considered as an excellent target herbicide for the engineering of herbicide-resistant crops. In this study, an efficient dicamba-degrading microbial consortium was enriched from soil collected from the outfall of a pesticide factory. The enriched consortium could almost completely degrade 500 mg/L of dicamba within 12 h of incubation. A novel tetrahydrofolate (THF)-dependent dicamba demethylase gene, named dmt06, was cloned from the total DNA of the enriched consortium. Dmt06 shared the highest identity (72.3%) with dicamba demethylase Dmt50 from Rhizorhabdus dicambivorans Ndbn-20. Dmt06 was expressed in Escherichia coli BL21 and purified to homogeneity using Co2+-charged nitrilotriacetic acid affinity chromatography. The purified Dmt06 catalyzed the transfer of methyl from dicamba to THF, generating the herbicidally inactive metabolite 3,6-dichlorosalicylate (3,6-DCSA) and 5-methyl-THF. The optimum pH and temperature for Dmt06 were detected to be 7.4 and 35°C, respectively. Under the optimal condition, the specific activity of Dmt06 reached 165 nmol/min/mg toward dicamba, which was much higher than that of Dmt and Dmt50. In conclusion, this study cloned a novel gene, dmt06, encoding an efficient THF-dependent dicamba demethylase, which was a good candidate for dicamba-resistant transgenic engineering.

POS1569-PARE TESTING A NEW APPROACH TO IDENTIFY AND ASSESS PATIENT-VALUED TREATMENT GOALS IN RHEUMATOID ARTHRITIS (RA): A PATIENT-ENGAGED HEALTHCARE VALUATION STRATEGY

Background

Common approaches to valuing health technologies often fail to capture outcomes that matter to patients and families. The treatment goals of people living with rheumatoid arthritis (RA) include common trial endpoints but also include other facets of disease impact. Identifying a feasible and rigorous approach to inclusion of the patient perspective is needed as trialists increasingly seek to incorporate patient-important outcomes in trial design and as varied patient-centered value assessment frameworks emerge. No standard approach is available to systemically identify and quantify patient-important outcomes, nor to include those outcomes in deliberative decision-making. We developed the Patient-Engaged Healthcare Valuation strategy, using principles of goal attainment scaling to frame survey-based goal collection directly from adults.

Objectives

To develop and test a goal-based method for collecting RA patient input for use in clinical trials and value assessment and evaluating the feasibility of this approach in people with RA.

Methods

Patient goals and domains were identified from (1) a literature review (2010-2020) of patient outcomes, goals, and preferences in RA, and (2) discussions with patients and clinicians during two meetings with a steering committee (SC) consisting of clinicians, outcomes researchers, patients/advocates, and health economists. These goals informed the development of a draft survey. Adults with RA were recruited from online patient networks to rate goal importance and suggest additional goals. SC members reviewed the survey findings and assessed feasibility of scaling up goal collection for HTA.

Results

Of 135 articles identified, 17 were retained. An inductive and iterative approach was used to identify and thematically group the final set of 36 goals into 4 domains. The draft survey was cognitively debriefed with 4 adults with RA. The first survey was administered to 20 participants; results informed item revisions and additions for the second round of data collection (n=27).

The 47 respondents were mostly White (87%), college-educated (72%) women (93%) living with RA for an average of 15 years; 75% rated their RA as moderate to severe. Free-text goals added in round 1 include: 1) finding specialists who listen to patient input on symptoms; 2) addressing loneliness or isolation; and 3) finding support from or helping others with RA. All Symptom and Life Impact goals were rated as Important or Very Important by ≥85% of participants; endorsement for Management and Treatment goals was somewhat more variable, with ≥85% endorsing these as Somewhat to Very Important. Results suggested that domains match key goals. Steering committee ratings supported the feasibility of this method.

Conclusion

Goals relevant for RA treatment evaluation can be efficiently identified and rated for importance by patients. Patient-important goals can be incorporated into deliberative healthcare valuation using this method to permit “crowd-sourced” input from people living with RA and to capture heterogeneous patient perspectives in healthcare valuation.

Table 1.

Top Goals based on rating as “Very Important” by >70% of subjects, from set of 36. “My goals for living with RA are to…”

GoalsNot ImportantSomewhat ImportantImportantVery ImportantSymptom Managementimprove the quality of my life with RA0% (0)0% (0)23% (11)77% (36)manage my RA pain0% (0)2% (1)11% (5)87% (41)reduce how my RA pain interferes with my life0% (0)9% (4)17% (8)74% (35)Life Impactreduce the ways in which RA interferes with my life0% (0)2% (1)21% (10)77% (36)be independent in my daily functioning0% (0)4% (1)15% (4)81% (22)Managing my RAfeel like I can manage my RA0% (0)2% (1)26% (12)72% (34)Treatment Featuresunderstand my RA treatment options0% (0)4% (2)21% (10)74% (35)have the information I need to make treatment decisions0% (0)0% (0)19% (9)81% (38)know what to expect with my RA treatment0% (0)2% (1)23% (11)74% (35)find treatments that are effective0% (0)0% (0)6% (3)94% (44)

Acknowledgements

I have no acknowledgements to declare.

Disclosure of Interests

None declared

Combined Multi-Atlas and Multi-Layer Perception for Alzheimer's Disease Classification

Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disease. To distinguish the stage of the disease, AD classification technology challenge has been proposed in Pattern Recognition and Computer Vision 2021 (PRCV 2021) which provides the gray volume and average cortical thickness data extracted in multiple atlases from magnetic resonance imaging (MRI). Traditional methods either train with convolutional neural network (CNN) by MRI data to adapt the spatial features of images or train with recurrent neural network (RNN) by temporal features to predict the next stage. However, the morphological features from the challenge have been extracted into discrete values. We present a multi-atlases multi-layer perceptron (MAMLP) approach to deal with the relationship between morphological features and the stage of the disease. The model consists of multiple multi-layer perceptron (MLP) modules, and morphological features extracted from different atlases will be classified by different MLP modules. The final vote of all classification results obtains the predicted disease stage. Firstly, to preserve the diversity of brain features, the most representative atlases are chosen from groups of similar atlases, and one atlas is selected in each group. Secondly, each atlas is fed into one MLP to fetch the score of the classification. Thirdly, to obtain more stable results, scores from different atlases are combined to vote the result of the classification. Based on this approach, we rank 10th among 373 teams in the challenge. The results of the experiment indicate as follows: (1) Group selection of atlas reduces the number of features required without reducing the accuracy of the model; (2) The MLP architecture achieves better performance than CNN and RNN networks in morphological features; and (3) Compared with other networks, the combination of multiple MLP networks has faster convergence of about 40% and makes the classification more stable.

Diagnosis of Amnesic Mild Cognitive Impairment Using MGS-WBC and VGBN-LM Algorithms

Computer-aided diagnosis (CAD) has undergone rapid development with the advent of advanced neuroimaging and machine learning methods. Nevertheless, how to extract discriminative features from the limited and high-dimensional data is not ideal, especially for amnesic mild cognitive impairment (aMCI) data based on resting-state functional magnetic resonance imaging (rs-fMRI). Furthermore, a robust and reliable system for aMCI detection is conducive to timely detecting and screening subjects at a high risk of Alzheimer's disease (AD). In this scenario, we first develop the mask generation strategy based on within-class and between-class criterion (MGS-WBC), which primarily aims at reducing data redundancy and excavating multiscale features of the brain. Concurrently, vector generation for brain networks based on Laplacian matrix (VGBN-LM) is presented to obtain the global features of the functional network. Finally, all multiscale features are fused to further improve the diagnostic performance of aMCI. Typical classifiers for small data learning, such as naive Bayesian (NB), linear discriminant analysis (LDA), logistic regression (LR), and support vector machines (SVMs), are adopted to evaluate the diagnostic performance of aMCI. This study helps to reveal discriminative neuroimaging features, and outperforms the state-of-the-art methods, providing new insights for the intelligent construction of CAD system of aMCI.

Radiomics Can Distinguish Pediatric Supratentorial Embryonal Tumors, High-Grade Gliomas, and Ependymomas

BACKGROUND AND PURPOSE

Pediatric supratentorial tumors such as embryonal tumors, high-grade gliomas, and ependymomas are difficult to distinguish by histopathology and imaging because of overlapping features. We applied machine learning to uncover MR imaging-based radiomics phenotypes that can differentiate these tumor types.

MATERIALS AND METHODS

Our retrospective cohort of 231 patients from 7 participating institutions had 50 embryonal tumors, 127 high-grade gliomas, and 54 ependymomas. For each tumor volume, we extracted 900 Image Biomarker Standardization Initiative-based PyRadiomics features from T2-weighted and gadolinium-enhanced T1-weighted images. A reduced feature set was obtained by sparse regression analysis and was used as input for 6 candidate classifier models. Training and test sets were randomly allocated from the total cohort in a 75:25 ratio.

RESULTS

The final classifier model for embryonal tumor-versus-high-grade gliomas identified 23 features with an area under the curve of 0.98; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.85, 0.91, 0.79, 0.94, and 0.89, respectively. The classifier for embryonal tumor-versus-ependymomas identified 4 features with an area under the curve of 0.82; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.93, 0.69, 0.76, 0.90, and 0.81, respectively. The classifier for high-grade gliomas-versus-ependymomas identified 35 features with an area under the curve of 0.96; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.82, 0.94, 0.82, 0.94, and 0.91, respectively.

CONCLUSIONS

In this multi-institutional study, we identified distinct radiomic phenotypes that distinguish pediatric supratentorial tumors, high-grade gliomas, and ependymomas with high accuracy. Incorporation of this technique in diagnostic algorithms can improve diagnosis, risk stratification, and treatment planning.

Transforming Growth Factor-α Acts in Hypothalamic Paraventricular Nucleus to Upregulate ERK1/2 Signaling and Expression of Sympathoexcitatory Mediators in Heart Failure Rats

Activation of epidermal growth factor receptor (EGFR) tyrosine kinase is associated with increased extracellular signal-regulated kinase (ERK) 1/2 signaling in the hypothalamic paraventricular nucleus (PVN), which contributes to the sympathetic excitation in heart failure (HF). Transforming growth factor (TGF)-α is a major endogenous ligand for EGFR. The present study sought to determine whether TGF-α increases in the PVN in HF and promotes the activation of EGFR to increase ERK1/2 activity. Male rats received bilateral PVN microinjections of an EGFR siRNA or a scrambled siRNA followed by an intracerebroventricular (ICV) injection of TGF-α or vehicle one week later. In rats pretreated with the scrambled siRNA, ICV TGF-α increased phosphorylated (p-) EGFR and upregulated the expression of p-ERK1/2 and mRNA levels of proinflammatory cytokines (PICs) and renin-angiotensin system (RAS) components in the PVN, when compared with the untreated age-matched control rats. These responses to ICV TGF-α were significantly attenuated in rats pretreated with the EGFR siRNA. Furthermore, bilateral PVN microinjection of a TGF-α siRNA in HF rats significantly decreased the elevated levels of TGF-α, p-EGFR, p-ERK1/2 and the mRNA expression of PICs and RAS components in the PVN, compared with the HF rats treated with a scrambled siRNA. The TGF-α siRNA-treated HF rats also exhibited lower plasma norepinephrine levels and improved peripheral manifestations of HF. These data suggest that TGF-α expression is upregulated in the PVN in HF and induces the activation of EGFR-mediated ERK1/2 signaling to augment the inflammation and RAS activity that drives sympathetic excitation in HF.

Right heart interplay with secondary tricuspid regurgitation. How can we predict clinical events?

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

TRAP

Introduction. Secondary Tricuspid Regurgitation (TR) is a turning point in cardiac diseases. Symptoms occurred too late according to the right heart reverse remodelling capabilities. The ideal timing for proposing a valve repair remains a challenge. We sought to analyse characteristics of patients with significant secondary TR, seeking for changes in parameters over time that could be related to the risk of clinical event.

Material and method. We designed a prospective observational French multicentre study of 160 patients with significant secondary TR (effective regurgitant orifice area &gt; 30 mm²) and LVEF &gt; 40%; we collected clinical, echocardiographic, and EKG data at baseline, 1- and 2-year follow-up. All echocardiographies were centrally analyzed. The primary outcome was death or hospitalization for heart failure

Results. At 2-year 95 patients (59.3%) presented the primary outcome. They had significant morphological and functional alteration of the right heart parameters. Right Atrial Volume Index (RAVI) and right ventricular free wall Strain were respectively 73mL/m² and -19.8% versus 64.7mL/m² and 22.3% in the event-free group. None of them had significant group*time interaction. In the multivariable analysis, TAPSE/sPAP ratio &gt; 0.4 (OR = 0.41 95%CL 0.2 to 0.82) associated to RAVI &gt; 60mL/m² (OR = 2.13 95%CL 0.96 to 4.75) were the two independent parameters that enable the fairest and parsimonious evaluation.

Conclusion. We demonstrated that short analysis using RAVI and TAPSE/sPAP almost reached us to an easier patient assessment by limiting the number of involved parameters. These parameters are now to be for defining the best timing and response to interventions. Abstract Figure. LAVI and TAPSE/sPAP according to events

Dynamics of Donor-Derived Cell-Free DNA at the Early Phase After Pediatric Kidney Transplantation: A Prospective Cohort Study

Background: Donor-derived cell-free DNA (ddcfDNA) has been suggested as an indicator of allograft injury in adult and pediatric kidney transplantation (KTx). However, the dynamics of ddcfDNA in pediatric KTx have not been investigated. In addition, it has not been demonstrated whether donor-recipient (D/R) size mismatch affect ddcfDNA level.

Methods: Pediatric KTx recipients with a single donor kidney were enrolled and followed up for 1 year. ddcfDNA, calculated as a fraction (%) in the recipient plasma, was examined longitudinally within 3 months post-transplant. D/R size mismatch degree was described as D/R height ratio. The 33rd percentile of D/R height ratio (0.70) was used as the cut-off to divide the patients into low donor-recipient height ratio group (<0.70) and high donor-recipient height ratio group (≥0.70). The dynamics of ddcfDNA were analyzed and the impact factors were explored. Stable ddcfDNA was defined as the first lowest ddcfDNA. ddcfDNA flare-up was defined as a remarkable elevation by a proportion of >30% from stable value with a peak value >1% during elevation.

Results: Twenty-one clinically stable recipients were enrolled. The median D/R height ratio was 0.83 (0.62–0.88). It took a median of 8 days for ddcfDNA to drop from day 1 and reach a stable value of 0.67% (0.46–0.73%). Nevertheless, 61.5% patients presented ddcfDNA>1% at day 30. Besides, 81.0% (17/21) of patients experienced elevated ddcfDNA and 47.6% (10/21) met the standard of ddcfDNA flare-up. Donor-recipient height ratio was an independent risk factor for ddcfDNA flare-up (odds ratio = 0.469 per 0.1, 95% CI 0.237–0.925, p = 0.029) and low donor-recipient height ratio (<0.70) was found to increase the risk of flare-up occurrence (odds ratio = 15.00, 95% CI 1.342–167.638, p = 0.028).

Conclusions: ddcfDNA rebounds in many stable pediatric KTx recipients without rejection. This may be induced by significant D/R size mismatch and may affect its diagnostic performance at the early phase after pediatric KTx in children.

Panobinostat reverses HepaCAM gene expression and suppresses proliferation by increasing histone acetylation in prostate cancer

Increased expression of histone deacetylases (HDACs) affiliated to the epigenetic regulation is common aberration in prostate cancer (PCa). We have confirmed that hepatocyte cell adhesion molecule (hepaCAM), acting as a tumor suppressor gene, is rarely expressed in PCa previously, However, the mechanisms of which is still unknown. The level of histone acetylation reportedly may involve anti-oncogene transcription and expression. In this study, we investigated the effect of panobinostat, the broad-spectrum histone deacetylases inhibitor, on PCa LNCaP and DU145 cell growth, and observed re-expression of hepaCAM when treated with panobinostat. We demonstrated that intranuclear acetylation of lys9 of histone H3 (Ac-H3K9) were increased, while that of both mRNA and protein of HDAC1, HDAC3, and HDAC4 were decreased when the treating concentration of panobinostat increased. We confirmed the relationship between histone acetylation and the expression of hepaCAM and AR in prostate cancer tissues. We also confirmed that panobinostat could overcome the resistance for androgen deprivation therapy (ADT). Further, we combined panobinostat with Ad-hepaCAM, which resulted in significantly increased antitumor activity and significant attenuation of the proliferation-associated genes CCND1 and PCNA compared to each single treatment. In conclusion, panobinostat may enhance the acetylation of lys9 of histone 3 and reverse the hepaCAM expression through its inhibitory effect on HDACs activity in PCa LNCaP and DU145 cells; Ad-hepaCAM combined with panobinostat may synergistically inhibit the growth of LNCaP and DU145 cells, via a potential mechanism associated with the down-regulation of the expression of CCND1 and PCNA. These findings suggest that this therapeutic strategy should be further developed in clinical trials.

Intelligent Electromagnetic Sensors for Non-Invasive Trojan Detection

Rapid growth of sensors and the Internet of Things is transforming society, the economy and the quality of life. Many devices at the extreme edge collect and transmit sensitive information wirelessly for remote computing. The device behavior can be monitored through side-channel emissions, including power consumption and electromagnetic (EM) emissions. This study presents a holistic self-testing approach incorporating nanoscale EM sensing devices and an energy-efficient learning module to detect security threats and malicious attacks directly at the front-end sensors. The built-in threat detection approach using the intelligent EM sensors distributed on the power lines is developed to detect abnormal data activities without degrading the performance while achieving good energy efficiency. The minimal usage of energy and space can allow the energy-constrained wireless devices to have an on-chip detection system to predict malicious attacks rapidly in the front line.

MiR-646 regulates proliferation and migration of laryngeal carcinoma through the PI3K/AKT pathway via targeting GPX1

Laryngeal cancer is a common type of head and neck malignancy. microRNA is implicated in the development and progression of various tumours. The present study aimed to explore the potential roles and mechanisms of miR-646 in laryngeal carcinoma cells. We detected the expression of miR-646 and observed that miR-646 was reduced in laryngeal cell lines. Subsequently, the proliferation, migration and invasion of TU212 and TU686 cells were evaluated using CCK-8 assays, cell proliferation ELISA BrdU and transwell assays after transfection with miR-646 mimic. Overexpression of miR-646 attenuated the proliferative and invasive abilities of TU212 and TU686 cells. Dual luciferase reporter assay confirmed that glutathione peroxidase 1 (GPX1) is a direct target of miR-646. Interestingly, restoration of GPX1 promoted cell proliferation and migration, and reversed the biological activities of miR-646 in cell proliferation and migration. It is worth noting that miR-646 overexpression blocked the activation of PI3K/AKT pathway, and this was partly abrogated by GPX1. 740Y-P, a PI3K agonist abolished the effects of miR-646 on cell proliferation and invasion. Taken together, miR-646 prohibited the proliferation and invasion of laryngeal carcinoma cells through the PI3K/AKT pathway via targeting GPX1.

Accelerated bioremediation of a complexly contaminated river sediment through ZVI-electrode combined stimulation

Complexly contaminated river sediment caused by reducible and oxidizable organic pollutants is a growing global concern due to the adverse influence on ecosystem safety and planetary health. How to strengthen indigenous microbial metabolic activity to enhance biodegradation and mineralization efficiency of refractory composite pollutants is critical but poorly understood in environmental biotechnology. Here, a synergetic biostimulation coupling electrode with zero-valent iron (ZVI) was investigated for the bioremediation of river sediments contaminated by 2,4,6-tribromophenol (TBP, reducible pollutant) and hydrocarbons (oxidizable pollutants). The bioremediation efficiency of ZVI based biostimulation coupling electrode against TBP debromination and hydrocarbons degradation were 1.1-3 times higher than the electrode used solely, which was attributed to the shape of distinctive microbial communities and the enrichment of potential dehalogenators (like Desulfovibrio, Desulfomicrobium etc.). The sediment microbial communities were significantly positively correlated with the enhanced degradation efficiencies of TBP and hydrocarbons (P < 0.05). Moreover, the coupled system predominately increased positive microbial interactions in the ecological networks. The possible mutual relationship between microbes i.e., Thiobacillus (iron-oxidizing bacteria) and Desulfovibrio (dehalogenator) as well as Pseudomonas (electroactive bacteria) and Clostridium (hydrocarbons degraders) were revealed. This study proposed a promising approach for efficient bioremediation of complexly contaminated river sediments.

Label-Free Ratiometric Upconversion Nanoprobe for Spatiotemporal pH Mapping in Living Cells

Sensing and imaging pH inside living cells are of paramount importance for better penetrating cellular functions and disease diagnostics. Herein, we engineered an original pH sensor by a simple one-step self-assembly of poly(ethylene glycol) (PEG)ylated phospholipid (DSPE-PEG) and a phenol red small molecule on the surface of upconversion nanoparticles (UCNPs) to form a phospholipid monolayer for sensing and imaging the change of intracellular pH. The sensor showed excellent reversibility and rapid response to the pH variations. Furthermore, this pH sensing system could measure spatial and temporal pH changes during endocytosis and interrogate the pH fluctuations inside cells under external stimuli. Our experimental results revealed that the pH sensor was able to map spatial and temporal pH fluctuations inside living cells, showing its potential application in diagnostics and pH-related study of cell biology.

Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost

Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45-64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71-9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790-1142/100,000 admissions, while the US 2010 census standardized rates were 380-552/100,000 from 2005-2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations' overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005-2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.

Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature

Brain metastases (BMs) are the most common intracranial malignancy with poor prognosis. Patients with intracranial tumors are at greater risk for thrombotic complications and intracranial hemorrhage. Rivaroxaban is a potent oral anticoagulant with the high selectivity of direct factor Xa inhibition. The incidence and severity of rivaroxaban-triggered intratumoral hemorrhage (ITH) in patients with BMs remain unknown. A 57-year-old woman was diagnosed with multiple lung, bone, and BMs from unknown primary cancer origin, and refused any invasive procedures to confirm tumor pathology. However, this patient had a relatively favorable outcome after treating with cabozantinib, an inhibitor of multiple tyrosine kinases. The patient survived over 2 years and developed deep vein thrombosis of right lower limb. Oral rivaroxaban was prescribed, and the multifocal catastrophic ITH was encountered after 1 week. The last head computed tomography imaging revealed a rare but typical image of diffuse hemorrhagic metastases. Hemorrhagic-prone BMs, therapeutic rivaroxaban, and cabozantinib treatment increase risks to develop ITH. In this case rivaroxaban was the trigger to this terminal event. This case is a miserable lesson and keeps reminding us to stay vigilant in clinical practice even when there is a potential benefit for anticoagulation in such population.