Transcatheter Aortic Valve Replacement and Coronary Protection Guided by Deep Learning and 3-Dimensional Printing

OBJECTIVE

In this case report, the auxiliary role of deep learning and 3-dimensional printing technology in the perioperative period was discussed to guide transcatheter aortic valve replacement and coronary stent implantation simultaneously.

CASE PRESENTATION

A 68-year-old man had shortness of breath and chest tightness, accompanied by paroxysmal nocturnal dyspnea, 2 weeks before presenting at our hospital. Echocardiography results obtained in the outpatient department showed severe aortic stenosis combined with regurgitation and pleural effusion. The patient was first treated with closed thoracic drainage. After 800 mL of pleural effusion was collected, the patient's symptoms were relieved and he was admitted to the hospital. Preoperative transthoracic echocardiography showed severe bicuspid aortic valve stenosis combined with calcification and aortic regurgitation (mean pressure gradient, 42 mmHg). Preoperative computed tomography results showed a type I bicuspid aortic valve with severe eccentric calcification. The leaflet could be seen from the left coronary artery plane, which indicated an extremely high possibility of coronary obstruction. After preoperative imaging assessment, deep learning and 3-dimensional printing technology were used for evaluation and simulation. Guided transcatheter aortic valve replacement and a coronary stent implant were completed successfully. Postoperative digital subtraction angiography showed that the bioprosthesis and the chimney coronary stent were in ideal positions. Transesophageal echocardiography showed normal morphology without paravalvular regurgitation.

CONCLUSION

The perioperative guidance of deep learning and 3-dimensional printing are of great help for surgical strategy formulation in patients with severe bicuspid aortic valve stenosis with calcification and high-risk coronary obstruction.

Magnetic Particle Imaging: From Tracer Design to Biomedical Applications in Vasculature Abnormality

Magnetic particle imaging (MPI) is an emerging non-invasive tomographic technique based on the response of magnetic nanoparticles (MNPs) to oscillating drive fields at the center of a static magnetic gradient. In contrast to magnetic resonance imaging (MRI), which is driven by uniform magnetic fields and projects the anatomic information of the subjects, MPI directly tracks and quantifies MNPs in vivo without background signals. Moreover, it does not require radioactive tracers and has no limitations on imaging depth. This article first introduces the basic principles of MPI and important features of MNPs for imaging sensitivity, spatial resolution, and targeted biodistribution. The latest research aiming to optimize the performance of MPI tracers is reviewed based on their material composition, physical properties, and surface modifications. While the unique advantages of MPI have led to a series of promising biomedical applications, recent development of MPI in investigating vascular abnormalities in cardiovascular and cerebrovascular systems, and cancer are also discussed. Finally, recent progress and challenges in the clinical translation of MPI are discussed to provide possible directions for future research and development.

Transcatheter tricuspid valve replacement for functional tricuspid regurgitation after left-sided valve surgery: A single-center experience

BACKGROUND

Functional tricuspid regurgitation (FTR) following left-sided valve surgery (LSVS) is of clinical significance due to its high recurrence and mortality rates. Transcatheter therapy presents a potential solution to address this issue.

AIMS

The study aimed to assess the safety and efficacy of transcatheter tricuspid valve replacement using the Lux-Valve system in a single center for patients with FTR after LSVS.

METHODS

From June 2020 to April 2023, 20 patients with symptomatic severe FTR after LSVS were referred to our center. A multidisciplinary cardiac team evaluated these patients for suitability for transcatheter tricuspid valve replacement with Lux-Valve systems. Primary efficacy and safety endpoints were immediate postoperative tricuspid regurgitation severity ≤ moderate and major adverse events during follow-up.

RESULTS

Twenty patients (average age 65.7 ± 7.4 years; 65.0% women) successfully underwent Lux-Valve system implantation after LSVS. All patients achieved ≤ moderate tricuspid regurgitation immediately after the procedure. Only one patient (5.0%) experienced a procedure-related major adverse event, leading to in-hospital mortality due to pulmonary infection. At the 6-month follow-up, 17 patients (89.5%) improved to New York Heart Association functional class I to II (p < 0.001). The overall Kansas City Cardiomyopathy Questionnaire score significantly improved (35.9 ± 6.7 points to 58.9 ± 5.8 points, p < 0.001).

CONCLUSION

The Lux-Valve system was found to be safe and effective for treating FTR after LSVS. It resulted in positive early outcomes, including a significant reduction in FTR, improved functional status, and enhanced quality of life, especially in high-risk patients.

[Quantitative analysis of risk assessment indicators for re-introduction of imported malaria in China]

OBJECTIVE

To quantitatively analyze the risk indicators of re-introduction of imported malaria in China and their weighting coefficients, so as to investigate the difference in the contribution of risk indicators included in the current risk assessment framework for re-introduction of imported malaria in China to the risk assessment of re-introduction of imported malaria.

METHODS

Publications pertaining to the risk assessment framework for re-introduction of imported malaria in China that reported the risk indicators and their weighting coefficients were retrieved in PubMed, Web of Science, CNKI, Wanfang Data, and VIP with terms of "malaria", "re-introduction/re-transmission/re-establishment", "risk assessment/risk evaluation/risk prediction" from the inception of the database through 3 August 2023, and literature search was performed in Google Scholar to ensure the comprehensiveness of the retrieval. Basic characteristics of included studies were extracted using pre-designed information extraction forms by two investigators, and data pertaining to risk indicators of re-introduction of imported malaria were cross-checked by these two investigators. The risk indicators included in the risk assessment framework for re-introduction of imported malaria in China and their weighting coefficients were visualized with the Nightingale's rose diagrams using the software R 4.2.1, and the importance of risk indictors was evaluated with the frequency of risk indicators included in the risk assessment framework and the ranking of weighting coefficients of risk indicators. In addition, the capability of risk indicators screened by different weighting methods was compared by calculating the ratio of the maximum to the minimum of the weighting coefficients of the risk indicators screened by different weighting methods.

RESULTS

A total of 2 138 publications were retrieved, and following removal of duplications and screening, a total of 8 publications were included in the final analysis. In these 8 studies, 8 risk assessment frameworks for re-introduction of imported malaria in China and 52 risk indicators of re-introduction of imported malaria were reported, in which number of imported malaria cases (n = 8) and species of malaria vectors were more frequently included in the risk assessment frameworks (n = 8), followed by species of imported malaria parasites (n = 6) and population density of local malaria vectors (n = 6), and species of local malaria vectors (n = 6), number of imported malaria cases (n = 5) and species of imported malaria parasites had the three highest weighting coefficients (n = 4). The weighting methods included expert scoring method, combination of expert scoring method and analytic hierarchy process, and combination of expert scoring method and entropy weight method in these 8 studies, and the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by the expert scoring method were 1.143 to 2.241, while the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by combination of the expert scoring method and analytic hierarchy process were 34.970 to 162.000.

CONCLUSIONS

Number of imported malaria cases, species of imported malaria parasites, species of local malaria vectors and population density of local malaria vectors are core indicators in the current risk assessment framework for re-introduction of imported malaria in China. Combination of the expert scoring method and analytic hierarchy process is superior to the expert scoring method alone for weighting the risk indicators.

Individual perceptions of community efficacy for non-communicable disease management in twelve communities in China: cross-sectional and longitudinal analyses

OBJECTIVES

This objective of this study was to use empirical data to assess cross-sectional variation singular and changes over time in community efficacy for non-communicable diseases (NCDs) management (COEN) and to examine individual factors associated with changes in COEN.

STUDY DESIGN

This was a longitudinal observational study.

METHODS

Participants with hypertension and diabetes were randomly selected from 12 communities from three cities in eastern China, and a baseline survey and a 1-year follow-up were conducted. The COEN scale has five dimensions: community physical environment (CPE), behavioral risk factors (BRF), mental health and social relationships (MHSR), community health management (CHM), and community organisations and activities (COA). Mixed-effects models were used to investigate the change in COEN over time and the association between individual factors and changes in COEN.

RESULTS

COEN scores showed significant variation singular among the 12 communities (P < 0.001) at the baseline. In the mixed-effects model, CPE (β coefficient: 1.62, P < 0.001), BRF (0.90, P < 0.001), MHSR (0.86, P < 0.001), CHM (0.46, P < 0.001), and total scores (β = 3.57, P < 0.001) increased significantly over time. The changes in COEN were associated with individual characteristics (e.g., older, men, more educated).

CONCLUSIONS

Cross-sectional variations and changes over time in COEN demonstrated the utility of a sensitive instrument. Factors such as age, gender, marriage, education level, and employment may affect the financial and social resources assignment for NCD management. Our findings suggest that further high-quality studies are needed to better evaluate the effect of community empowerment on the prevention and control of NCDs.

A precise prognostic signature in CTNNB1-mutant hepatocellular carcinoma: Prognosis prediction and precision treatment exploration

Background

CTNNB1 mutates in most hepatocellular carcinoma (HCC) which is the most familiar form of liver cancer with high heterogeneity. It is critical to create a specific prognostication methodology and to investigate additional treatment options for CTNNB1-mutant HCCs.

Methods

A total of 926 samples in five independent cohorts were enrolled in this study, including 127 CTNNB1-mutant samples and 75 estimated CTNNB1-mutant samples. The prognostic signature was constructed by LASSO-Cox regression and evaluated by bioinformatics analyses. The selection of possible drug targets and agents was produced based on the expression profiles and drug sensitivity data of cancer cell lines in two databases.

Results

A prognostic signature based on 15 genes categorized the CTNNB1-mutant HCCs into two groups with different risks. Compared to low-risk patients, high-risk patients had significantly inferior prognoses. ROC curve and multivariate analysis also indicated the superior performance of our signature on the prognosis estimation, particularly in CTNNB1-mutant HCCs. Besides, the nomogram was constructed according to the prognostic signature with excellent predictive performance confirmed by the calibration curve. Subsequently, we suggested that AT-7519 and PHA-793887 might be potential drug agents for high-risk patients.

Conclusion

We established a 15-gene prognostic model, particularly in HCCs with CTNNB1 mutations with good predictive efficiency. Besides, we explored the potential drug targets and agents for patients with high risk. Our findings offered a fresh idea for personalized prognosis management in HCCs with CTNNB1 mutations and threw new insight for precise treatment in HCCs as well.

Design of a 0.15-2 GHz high-resolution vector-sum broadband phase shifter with controlled programmable attenuators for stochastic cooling system

In this paper, a new 0.15-2 GHz broadband phase shifter with 9-bit phase resolution is presented. This broadband digital adjustable phase shifter is implemented by utilizing the signal vector summation technology. The phase shifter consists of one 90° hybrid coupler, two digital attenuators, two 180° hybrid couplers, two microwave switches, and one combiner. By adjusting the attenuation value of the two digital attenuators, the device creates a minimum 0.7° stepped phase shift. In addition, by switching the two microwave switches, a 360° range of phase shift is achieved while almost keeping the amplitude of the phase shifter constant. The measurement results show that the proposed phase shifter achieves a phase resolution of 0.7° while exhibiting an average insertion loss of 9 ± 2 dB and phase unbalance within ±10°. The calculated RMS phase error of the broadband phase shifter is below 5° from 0.15 to 2 GHz.

Unlocking the potential of platinum drugs: organelle-targeted small-molecule platinum complexes for improved anticancer performance

Platinum-based drugs have revolutionized cancer chemotherapy; however, their therapeutic efficacy has been limited by severe side effects and drug resistance. Recently, approaches that target specific organelles in cancer cells have emerged as attractive alternatives to overcome these challenges. Many studies have validated these strategies and highlighted that organelle-targeted platinum complexes demonstrate increased anticancer activity, the ability to overcome drug resistance, novel molecular mechanisms, or even lower toxicity. This review provides a brief summary of various organelle-targeting strategies that promote the accumulation of platinum complexes in certain intracellular areas, such as the nucleus, mitochondria, endoplasmic reticulum (ER), and lysosomes. Moreover, the mechanisms through which these strategies improve anticancer performance, overcome drug resistance, and alter the action mode of conventional platinum drugs are discussed. By providing an extensive account of platinum complexes targeting different organelles, this review aims to assist researchers in understanding the design principles, identifying potential targets, and fostering innovative ideas for the development of platinum complexes.

Measurement and optimization of the beam coupling impedance of a novel 3D-printed titanium alloy cage inside the thin-wall vacuum chamber

Dipole magnet vacuum chambers are among the most critical and costly components of rapid-cycling accelerator facilities. Alternative approaches to traditional ceramic chambers have been explored for the implementation of fast-ramping dipole-magnet vacuum chambers, including thin-wall metallic beam pipe chambers strengthened with transverse ribs and ceramic rings inside thin-walled chambers. Here, we report a novel 3D-printed titanium alloy cage inside the thin-wall vacuum chamber, which is designed for high-intensity heavy ion accelerator facility (HIAF) to reduce manufacturing difficulty and cost, shorten the production cycle, and improve the quality. Comprehensive studies were undertaken to characterize the impedance of the 3D-printed titanium alloy cage inside the thin-wall vacuum chamber. The beam-coupling impedance and eddy currents of the new thin-wall vacuum chamber were studied mostly numerically. Strategies for further reducing the beam-coupling impedance were explored. In addition, impedance bench measurements using the "half wavelength" resonant method were conducted to identify the longitudinal and transverse impedances of the 3D-printed titanium alloy cage inside the thin-wall vacuum chamber prototype experimentally. The simulated and measured results for the impedance were consistent. Furthermore, a campaign for resonance-check measurements on the 3D-printed titanium alloy ring loaded inside a thin-wall vacuum chamber prototype was launched. This novel thin-wall vacuum chamber structure is now entering the fabrication stage and will soon be ready for installation in the Booster Ring (BRing).

Silencing of keratin 15 impairs viability and mobility while facilitating the doxorubicin chemosensitivity by inactivating the β‑catenin pathway in liver cancer

Keratin 15 (KRT15) regulates the invasion as well as the stemness and is associated with tumor size and metastasis of several gastrointestinal cancers apart from liver cancer. The present study aimed to explore the effect of KRT15 knockdown on liver cancer malignant behaviors and its interaction with the β-catenin pathway. Small interfering (si)-KRT15 and si-negative control (NC) were transfected into liver cancer cell lines, followed by the addition or not of CHIR-99021 (a β-catenin agonist). Cell viability, invasion, apoptosis, and the half maximal inhibitory concentration (IC50) value of doxorubicin (Dox) were then assessed. The present study illustrated that KRT15 gene and protein expression levels were upregulated in most liver cancer cell lines (Huh7, PLC, Hep3B and HepG2) compared to the normal liver cell line THLE-2. si-KRT15 reduced cell viability and invasive cell count while promoting the apoptosis rate in Huh7 and HepG2 cells. In addition, si-KRT15 also reduced the IC50 value of Dox. Furthermore, si-KRT15 inactivated the β-catenin pathway as reflected by β-catenin, cyclin D1 and c-Myc expression levels in Huh7 and HepG2 cells. Subsequently, CHIR-99021 treatment increased the cell viability and invasive cell count while reducing the apoptosis rate in Huh7 and HepG2 cells. Concurrently, the IC50 value of Dox was also increased. Notably, CHIR-99021 treatment attenuated the effect of si-KRT15 on mediating the aforementioned Huh7 and HepG2 cell malignant behaviors and Dox chemosensitivity. In conclusion, KRT15 knockdown suppressed viability and mobility but facilitated Dox chemosensitivity via inactivating the β-catenin pathway in liver cancer, suggesting its potential as a target for liver cancer treatment.

A marine coating: Self-healing, stable release of Cu2+, anti-biofouling

We developed a marine coating consisting of Cu-MOF-74, multi-walled carbon nanotube containing carboxyl groups (MWCNT-COOH) and self-healing polymers, which simultaneously possesses self-healing and anti-biofouling properties. Cu-MOF-74 can stably release Cu2+ by virtue of the coordination dissociative mechanism. Studies have proved that MWCNT can inhibit the growth of bacteria, so adding the MWCNT can help to reduce the amount of the copper ions and ensure the antibacterial effect of the coating. In addition, the cross-linked network and abundant -COOH provided by the polymers and MWCNT-COOH further prevent the loss of copper ions. Moreover, the coating we prepared has good performance of self-healing at room temperature or slightly heated because the polymers possess abundant non-covalent hydrogen bonds. Finally, the coating not only has superior antibacterial property, but also effectively prevents the adhesion of macrofouling organism. Therefore, the coating has a longer service life and its environmental friendliness has also been improved.

Stochastic cooling notch filter developments for the high-precision spectrometer ring in the high intensity heavy-ion accelerator facility project

Stochastic cooling of the high-precision spectrometer ring (SRing) at the High Intensity Heavy-Ion Accelerator Facility (HIAF) project in China, which is used mainly for experiments with radioactive fragment beams, is applied to speed up the cooling process of a stored ion beam. In this article, a new coaxial-type notch filter with an amplitude equalizer in the long branch and an optical-type notch filter with phase-stabilized optical fiber are discussed and evaluated for the SRing stochastic cooling system. Both prototypes of coaxial and optical notch filters are fabricated and tested. The minimum notch depth of coaxial and optical notch filters reaches to 26 and 40 dB, respectively. The performance of both coaxial notch filter and optical fiber notch filter is presented in this work. These developments will be used not only for the longitudinal stochastic cooling system but also have potential for the beam feedback system.

Effect of different PD-1 inhibitor combination therapies for unresectable intrahepatic cholangiocarcinoma

BACKGROUND

Immune checkpoint inhibitor (ICI) combination therapy offers a new option for treatment of unresectable intrahepatic cholangiocarcinoma (uICC).

AIM

To compare the effect of different anti-PD-1 combination therapies as the first-line treatments for uICC.

METHODS

This study included 318 patients who received chemotherapy alone (Chemo), anti-PD-1 plus chemotherapy (ICI-chemo), anti-PD-1 plus targeted therapy (ICI-target) or anti-PD-1 plus targeted therapy and chemotherapy (ICI-target-chemo) as first line for uICC from 22 centres in China. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR) and safety.

RESULTS

Patients with ICI-chemo (median PFS [mPFS], 6.3 months; HR: 0.61, 95% CI: 0.42-0.88; p = 0.008; median OS [mOS], 10.7 months; HR: 0.61, 95% CI: 0.39-0.94; p = 0.026), ICI-target (7.2 months; HR: 0.54, 95% CI: 0.36-0.80; p = 0.002; 15.8 months; HR: 0.54, 95% CI: 0.35-0.84; p = 0.006) or ICI-target-chemo (6.9 months; HR: 0.65, 95% CI: 0.47-0.90; p = 0.009; 14.4 months; HR: 0.47, 95% CI: 0.31-0.70; p < 0.001) achieved better clinical outcomes than those with Chemo (3.8 months; 9.3 months). ICI-target was not inferior to ICI-chemo in survival outcomes (HR for PFS: 0.88, 95% CI: 0.55-1.42; p = 0.614; HR for OS: 0.89, 95% CI: 0.51-1.55; p = 0.680). ICI-target-chemo yielded similar prognoses as ICI-chemo (HR for PFS: 1.07, 95% CI: 0.70-1.62; p = 0.764; HR for OS: 0.77, 95% CI: 0.45-1.31; p = 0.328) and ICI-target (HR for PFS: 1.20, 95% CI: 0.77-1.88; p = 0.413; HR for OS: 0.86, 95% CI: 0.51-1.47; p = 0.583) but resulted in more adverse events (p < 0.001; p = 0.010). Multivariable and propensity score analyses supported these findings.

CONCLUSIONS

Among patients with uICC, ICI-chemo or ICI-target provided more survival benefits than Chemo while achieving comparable prognoses and fewer adverse events than ICI-target-chemo.

Self-Enhanced Antibacterial and Antifouling Behavior of Three-Dimensional Porous Cu2O Nanoparticles Functionalized by an Organic-Inorganic Hybrid Matrix

Cu2O is currently an important protective material for domestic engineering and equipment used to exploit marine resources. Cu+ is considered to have more effective antibacterial and antifouling activities than Cu2+. However, disproportionation of Cu+ in the natural environment leads to its reduced bioavailability and weakened reactivity. Novel and functionalized Cu2O composites could enable efficient and environmentally friendly applications of Cu+. To this end, a series of three-dimensional porous Cu2O nanoparticles (3DNP-Cu2O) functionalized by organic (redox gel, R-Gel)-inorganic (reduced graphene oxide, rGO) hybrids─3DNP-Cu2O/rGOx@R-Gel─at room temperature by immobilization-reduction method was prepared and applied for protection against marine biofouling. 3DNP-Cu2O/rGO1.76@R-Gel includes rGO and R-Gel shape 3D porous Cu2O nanoparticles with diameters ∼177 nm and strong dispersion and antioxidant stability. Compared with commercial Cu2O (Cu2O-0), 3DNP-Cu2O/rGO1.76@R-Gel exhibited an ∼50% higher bactericidal rate, ∼96.22% higher water content, and ∼75% lower adhesion of mussels and barnacles. Moreover, 3DNP-Cu2O/rGOx@R-Gel maintains the same excellent, stable, and long-lasting bactericidal performance as Cu2O-0@R-Gel while reducing the average copper ion release concentration by ∼56 to 76%. This was also confirmed by X-ray diffraction, X-ray photoelectric spectroscopy (XPS), atomic absorption spectroscopy, and antifouling tests. In addition, XPS tests of rGO-Cu2+ and R-Gel-Cu2+, photocurrent tests of 3DNP-Cu2O/rGO1.76@R-Gel, and energy-dispersive spectrometry pictures of bacteria confirm that R-Gel and rGO act as electron donors and transfer substrates driving the reduction of Cu2+ (Cu2+ → Cu+) and the diffusion of Cu+. Thus, a self-growing antibacterial and antifouling system of 3DNP-Cu2O/rGO1.76@R-Gel was achieved. The mechanism of accelerated bacterial inactivation and resistance to mussel and barnacle adhesion by 3DNP-Cu2O/rGO1.76@R-Gel was interpreted. It is shown that rGO and R-Gel are important players in the antibacterial and antifouling system of 3DNP-Cu2O/rGO1.76@R-Gel.

Temperature-Derived Purification of Gold Nano-Bipyramids for Colorimetric Detection of Tannic Acid

Gold nanostructures have attracted broad attention. Among various nanostructures, gold nanobipyramids have shown great potential in sensing, biomedicine, environmental protection, chemical catalysis, and optics due to their unique physical and optical properties and ease of chemical functionalization. Compared with other plasmonic nanostructures, gold nanobipyramids possess narrow optical resonances, stronger plasmonic local field enhancement, and size- and shape-dependent surface plasmon resonance. However, the synthesis and purification of homogeneous gold nanobipyramids are very challenging. The gold nanobipyramids synthesized via the commonly used seed-mediated growth method have low yields and are often coproduced with spherical nanoparticles. In this study, we reported a temperature-derived purification method for the isolation of gold bipyramids. In the presence of salt, by altering the temperature of the solution, large gold bipyramids can be separated from small spherical nanoparticles. As a result, a yield of as high as 97% gold nanobipyramids can be achieved through a single round of purification, and correspondingly, the ratio between the longitudinal surface plasmon resonance (LSPR) and transverse SPR intensity significantly increases to as high as 6.7. The purified gold nanobipyramids can be used as a colorimetric probe in the detection of tannic acid with a detection limit of 0.86 μM and a linear detection range from 1.25 to 37.5 μM.

[Risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on the machine learning]

OBJECTIVE

To create risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on machine learning algorithms, so as to provide insights into early identification of imported malaria cases in Jiangsu Province.

METHODS

Case investigation, first symptoms and time of initial diagnosis of imported malaria patients in Jiangsu Province in 2019 were captured from Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention. The risk predictive models of healthcare-seeking delay among imported malaria patients were created with the back propagation (BP) neural network model, logistic regression model, random forest model and Bayesian model using thirteen factors as independent variables, including occupation, species of malaria parasite, main clinical manifestations, presence of complications, severity of disease, age, duration of residing abroad, frequency of malaria parasite infections abroad, incubation period, level of institution at initial diagnosis, country of origin, number of individuals travelling with patients and way to go abroad, and time of healthcare-seeking delay as a dependent variable. Logistic regression model was visualized using a nomogram, and the nomogram was evaluated using calibration curves. In addition, the efficiency of the four models for prediction of risk of healthcare-seeking delay among imported malaria patients was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). The importance of each characteristic was quantified and attributed by using SHAP to examine the positive and negative effects of the value of each characteristic on the predictive efficiency.

RESULTS

A total of 244 imported malaria patients were enrolled, including 100 cases (40.98%) with the duration from onset of first symptoms to time of initial diagnosis that exceeded 24 hours. Logistic regression analysis identified a history of malaria parasite infection [odds ratio (OR) = 3.075, 95% confidential interval (CI): (1.597, 5.923)], long incubation period [OR = 1.010, 95% CI: (1.001, 1.018)] and seeking healthcare in provincial or municipal medical facilities [OR = 12.550, 95% CI: (1.158, 135.963)] as risk factors for delay in seeking healthcare among imported malaria cases. BP neural network modeling showed that duration of residing abroad, incubation period and age posed great impacts on delay in healthcare-seek among imported malaria patients. Random forest modeling showed that the top five factors with the greatest impact on healthcare-seeking delay included main clinical manifestations, the way to go abroad, incubation period, duration of residing abroad and age among imported malaria patients, and Bayesian modeling revealed that the top five factors affecting healthcare-seeking delay among imported malaria patients included level of institutions at initial diagnosis, age, country of origin, history of malaria parasite infection and individuals travelling with imported malaria patients. ROC curve analysis showed higher overall performance of the BP neural network model and the logistic regression model for prediction of the risk of healthcare-seeking delay among imported malaria patients (Z = 2.700 to 4.641, all P values < 0.01), with no statistically significant difference in the AUC among four models (Z = 1.209, P > 0.05). The sensitivity (71.00%) and Youden index (43.92%) of the logistic regression model was higher than those of the BP neural network (63.00% and 36.61%, respectively), and the specificity of the BP neural network model (73.61%) was higher than that of the logistic regression model (72.92%).

CONCLUSIONS

Imported malaria cases with long duration of residing abroad, a history of malaria parasite infection, long incubation period, advanced age and seeking healthcare in provincial or municipal medical institutions have a high likelihood of delay in healthcare-seeking in Jiangsu Province. The models created based on the logistic regression and BP neural network show a high efficiency for prediction of the risk of healthcare-seeking among imported malaria patients in Jiangsu Province, which may provide insights into health management of imported malaria patients.

An ultrasound-activatable platinum prodrug for sono-sensitized chemotherapy

Despite the great success achieved by photoactivated chemotherapy, eradicating deep tumors using external sources with high tissue penetration depth remains a challenge. Here, we present cyaninplatin, a paradigm of Pt(IV) anticancer prodrug that can be activated by ultrasound in a precise and spatiotemporally controllable manner. Upon sono-activation, mitochondria-accumulated cyaninplatin exhibits strengthened mitochondrial DNA damage and cell killing efficiency, and the prodrug overcomes drug resistance as a consequence of combined effects from released Pt(II) chemotherapeutics, the depletion of intracellular reductants, and the burst of reactive oxygen species, which gives rise to a therapeutic approach, namely sono-sensitized chemotherapy (SSCT). Guided by high-resolution ultrasound, optical, and photoacoustic imaging modalities, cyaninplatin realizes the overall theranostics of tumors in vivo with superior efficacy and biosafety. This work highlights the practical utility of ultrasound to precisely activate Pt(IV) anticancer prodrugs for the eradication of deep tumor lesions and broadens the biomedical uses of Pt coordination complexes.

Near-infrared-activated anticancer platinum(IV) complexes directly photooxidize biomolecules in an oxygen-independent manner

Conventional light-driven cancer therapeutics require oxygen and visible light to indirectly damage biomolecules, limiting their efficacy in deep, hypoxic tumours. Here we report the use of near-infrared-activated small-molecule Pt(IV) photooxidants to directly oxidize intracellular biomolecules in an oxygen-independent manner, achieving controllable and effective elimination of cancer stem cells. These Pt(IV) complexes accumulate in the endoplasmic reticulum and show low toxicity in the dark. Upon irradiation, the resultant metal-enhanced photooxidation effect causes them to robustly photooxidize survival-related biomolecules, induce intense oxidative stress, disrupt intracellular pH (pHi) homeostasis and initiate nonclassical necrosis. In vivo experiments confirm that the lead photooxidant can effectively inhibit tumour growth, suppress metastasis and activate the immune system. Our study validates the concept of metal-enhanced photooxidation and the subsequent chemotherapeutic applications, supporting the development of such localized photooxidants to directly damage intracellular biomolecules and decrease pHi as a strategy for effective metal-based drugs.

[Acetylcorynoline inhibits microglia activation by regulating EGFR/MAPK signaling to promote functional recovery of injured mouse spinal cord]

OBJECTIVE

To investigate the effect of acetylcorynoline (Ace) for promoting functional recovery of injured spinal cord in rats and explore the underlying mechanism.

METHODS

Rat models of spinal cord injury (SCI) were treated with intraperitoneal injection of different concentrations of Ace, with the sham-operated rats as the control group. After the treatment, the changes in motor function of the rats and the area of spinal cord injury were assessed with BBB score and HE staining, and the changes in pro-inflammatory cytokine levels and microglial activation were determined using PCR, ELISA and immunofluorescence staining. In a lipopolysaccharide (LPS)-treated BV2 cell model, the effects of different concentrations of Ace or DMSO on microglial activation and inflammatory cytokine production were observed. Network pharmacology analysis was performed to predict the target protein and signaling mechanism that mediated the inhibitory effect of Ace on microglia activation, and AutoDock software was used for molecular docking between Ace and the target protein. A signaling pathway blocker (Osimertinib) was used to verify the signaling mechanism in rat models of SCI and LPS-treated BV2 cell model.

RESULTS

In rat models of SCI, Ace treatment significantly increased the BBB score, reduced the area of spinal cord injury, and lowered the number of activated microglia cells and the levels of pro-inflammatory cytokines (P < 0.05). The cell experiments showed that Ace treatment significantly lower the level of cell activation and the production of inflammatory cytokines in LPS-treated BV2 cells (P < 0.05). Network pharmacology analysis suggested that EGFR was the main target of Ace, and they bound to each other via hydrogen bonds as shown by molecular docking. Western blotting confirmed that Ace inhibited the activation of the EGFR/MAPK signaling pathway in injured mouse spinal cord tissue and in LPS-treated BV2 cells, and its inhibitory effect was comparable to that of Osimertinib.

CONCLUSION

In rat models of SCI, treatment with Ace can inhibit microglia-mediated inflammatory response by regulating the EGFR/MAPK pathway, thus promoting tissue repair and motor function recovery.

Bivariate joint analysis of injury severity of drivers in truck-car crashes accommodating multilayer unobserved heterogeneity

Truck-involved crashes, especially truck-car crashes, are associated with serious and even fatal injuries, thus necessitating an in-depth analysis. Prior research focused solely on examining the injury severity of truck drivers or developed separate performance models for truck and car drivers. However, the severity of injuries to both drivers in the same truck-car crash may be interrelated, and influencing factors of injury severities sustained by the two parties may differ. To address these concerns, a random parameter bivariate probit model with heterogeneity in means (RPBPHM) is applied to examine factors affecting the injury severity of both drivers in the same truck-car crash and how these factors change over the years. Using truck-car crash data from 2017 to 2019 in the UK, the dependent variable is defined as slight injury and serious injury or fatality. Factors such as driver, vehicle, road, and environmental characteristics are statistically analyzed in this study. According to the findings, the RPBPHM model demonstrated a remarkable statistical fit, and a positive correlation was observed between the two drivers' injury severity in truck-car crashes. More importantly, the effects of the explanatory factors showing relatively temporal stability vary across different types of vehicle crashes. For example, car driver improper actions and lane changing by trucks, have a significant interactive effect on the severity of injuries sustained by drivers involved collisions between trucks and cars. Male truck drivers, young truck drivers, older truck drivers, and truck drivers' improper actions, elevate the estimated odds of only truck drivers; while older car and unsignalized crossing increase the possibility of injury severity of only car drivers. Finally, due to shared unobserved crash-specific factors, the 30-mph speed limit, dark no lights, and head-on collision, significantly affect the severity of injuries sustained by drivers involved in collisions between trucks and cars. The modeling approach provides a novel framework for jointly analyzing truck-involved crash injury severities. The findings will help policymakers take the necessary actions to reduce truck-car crashes by implementing appropriate and accurate safety countermeasures.

A benchmark study of convolutional neural networks in fully automatic segmentation of aortic root

Recent clinical studies have suggested that introducing 3D patient-specific aortic root models into the pre-operative assessment procedure of transcatheter aortic valve replacement (TAVR) would reduce the incident rate of peri-operative complications. Tradition manual segmentation is labor-intensive and low-efficient, which cannot meet the clinical demands of processing large data volumes. Recent developments in machine learning provided a viable way for accurate and efficient medical image segmentation for 3D patient-specific models automatically. This study quantitively evaluated the auto segmentation quality and efficiency of the four popular segmentation-dedicated three-dimensional (3D) convolutional neural network (CNN) architectures, including 3D UNet, VNet, 3D Res-UNet and SegResNet. All the CNNs were implemented in PyTorch platform, and low-dose CTA image sets of 98 anonymized patients were retrospectively selected from the database for training and testing of the CNNs. The results showed that despite all four 3D CNNs having similar recall, Dice similarity coefficient (DSC), and Jaccard index on the segmentation of the aortic root, the Hausdorff distance (HD) of the segmentation results from 3D Res-UNet is 8.56 ± 2.28, which is only 9.8% higher than that of VNet, but 25.5% and 86.4% lower than that of 3D UNet and SegResNet, respectively. In addition, 3D Res-UNet and VNet also performed better in the 3D deviation location of interest analysis focusing on the aortic valve and the bottom of the aortic root. Although 3D Res-UNet and VNet are evenly matched in the aspect of classical segmentation quality evaluation metrics and 3D deviation location of interest analysis, 3D Res-UNet is the most efficient CNN architecture with an average segmentation time of 0.10 ± 0.04 s, which is 91.2%, 95.3% and 64.3% faster than 3D UNet, VNet and SegResNet, respectively. The results from this study suggested that 3D Res-UNet is a suitable candidate for accurate and fast automatic aortic root segmentation for pre-operative assessment of TAVR.

[Regular assessment is an effective approach to maintaining the capacity of prevention of re-establishment from imported malaria in China]

After achieving malaria elimination, preventing re-establishment from imported malaria and consolidating malaria elimination achievements are top priorities of the national malaria control program in China. Due to the long-term existence of overseas imported malaria cases and incomplete eradication of local epidemic conditions, there are multiple challenges for prevention of re-establishment from imported malaria in China. Hereby, we propose that regular assessment is an effective approach to maintaining the capability of prevention of re-establishment from imported malaria, and describe the purpose, significance, management and implementation of the capability assessment for prevention of re-establishment from imported malaria, so as to provide insights into the formulation and adjustment of malaria control strategies during the post-elimination phase.

Beyond mere DNA damage: Recent progress in platinum(IV) anticancer complexes containing multi-functional axial ligands

The clinical application of Pt-based anticancer drugs has inspired the development of novel chemotherapeutic metallodrugs with improved efficacies. Pt(IV) prodrugs are one of the most promising successors of Pt(II) drugs and have displayed great anticancer performance. In particular, judicious modification of axial ligands endows Pt(IV) complexes with unique properties that enable them to overcome the limitations of conventional Pt(II) drugs. Herein, we summarize recent developments in Pt(IV) anticancer complexes, with a focus on their axial functionalization with other anticancer agents, immunotherapeutic agents, photosensitive ligands, peptides, and theranostic agents. We hope that this concise view of recently reported Pt(IV) coordination complexes will help researchers to design next-generation multi-functional anticancer agents based on a comprehensive Pt(IV) platform.

Prognostic value of combined pre- and postoperative albumin-to-alkaline phosphatase ratio for patients with hepatocellular carcinoma undergoing trans-catheter chemoembolisation

AIM

To reveal the prognostic value of the postoperative and dynamic albumin-to-alkaline phosphatase ratio (AAPR) in hepatocellular carcinoma (HCC) patients undergoing trans-catheter chemoembolisation (TACE).

MATERIALS AND METHODS

In total, 545 HCC patients undergoing initial TACE were enrolled into the study. The receiver operating characteristic (ROC) curve was plotted to determine the best cut-off for AAPR. Univariate and multivariate Cox regression analyses were used to confirm the independent prognostic effect of AAPR on overall survival (OS). The predictive performance of AAPR was assessed by ROC curves, concordance index (C-index), and Akaike information criterion (AIC), and was compared to existing liver function assessment systems.

RESULTS

The optimal cut-off value for the AAPR was 0.26. Elevated AAPR (>0.26) was associated with a low risk of death after adjustment whether before (HR: 0.53; 95% CI: 0.4-0.69) or after (HR: 0.64; 95% CI: 0.43-0.95) TACE treatment. The combined pre- and postoperative AAPR showed much better performance in ROC curve (1-, 3-, and 5-year AUCs: 0.69, 0.71, 0.69), C-index (0.65; 95% CI: 0.59-0.72) and AIC analyses than pre-AAPR and post-AAPR alone or liver function assessment systems.

CONCLUSION

This study demonstrated both preoperative and postoperative AAPR were independent prognostic factors for HCC patients undergoing TACE. In addition, the combined pre- and post-AAPR showed better predictive performance than pre-AAPR and post-AAPR alone or liver function assessment systems.

Identification of significant gene expression changes in multiple perturbation experiments using knockoffs

Large-scale multiple perturbation experiments have the potential to reveal a more detailed understanding of the molecular pathways that respond to genetic and environmental changes. A key question in these studies is which gene expression changes are important for the response to the perturbation. This problem is challenging because (i) the functional form of the nonlinear relationship between gene expression and the perturbation is unknown and (ii) identification of the most important genes is a high-dimensional variable selection problem. To deal with these challenges, we present here a method based on the model-X knockoffs framework and Deep Neural Networks to identify significant gene expression changes in multiple perturbation experiments. This approach makes no assumptions on the functional form of the dependence between the responses and the perturbations and it enjoys finite sample false discovery rate control for the selected set of important gene expression responses. We apply this approach to the Library of Integrated Network-Based Cellular Signature data sets which is a National Institutes of Health Common Fund program that catalogs how human cells globally respond to chemical, genetic and disease perturbations. We identified important genes whose expression is directly modulated in response to perturbation with anthracycline, vorinostat, trichostatin-a, geldanamycin and sirolimus. We compare the set of important genes that respond to these small molecules to identify co-responsive pathways. Identification of which genes respond to specific perturbation stressors can provide better understanding of the underlying mechanisms of disease and advance the identification of new drug targets.

Multitargeted Platinum(IV) Anticancer Complexes Bearing Pyridinyl Ligands as Axial Leaving Groups

Although multitargeted Pt(IV) anticancer prodrugs have shown significant activities in reducing drug resistance, the types of bioactive ligands and drugs that can be conjugated to the Pt center, remain limited to O-donors. Herein, we report the synthesis of Pt(IV) complexes bearing axial pyridines via ligand exchange reactions. Unexpectedly, the axial pyridines are quickly released after reduction, indicating their potential to be utilized as axial leaving groups. We further expand our synthetic approach to obtaining two multitargeted Pt(IV) prodrugs containing bioactive pyridinyl ligands: a PARP inhibitor and an EGFR tyrosine kinase inhibitor; these conjugates exhibit great potential for overcoming drug resistance, and the latter conjugate inhibits the growth of Pt-resistant tumor in vivo. This research adds to the array of synthetic methods for accessing Pt(IV) prodrugs and significantly increases the types of bioactive axial ligands that can be conjugated to a Pt(IV) center.

The RITA-T (Rapid Interactive Screening Test for Autism in Toddlers) Community Model to Improve Access and Early Identification of Autism in Young Children

Objective: To evaluate improved identification and the generalization of the RITA-T (Rapid interactive Screening Test for Autism in Toddlers) model through partnerships with Primary Care (PC), Early Intervention (EI), and Autism Diagnosticians. Methods: Over 3 years (2018-2021), 15 EI and 9 PC (MD and NP) centers participated in this project. We trained providers on the RITA-T and established screening models. We reviewed charts of all toddlers referred through this model and compared wait times, and diagnoses, to those evaluated through regular referral in a tertiary-based autism clinic. We also examined the RITA-T psychometrics. Results: 377 toddlers met our inclusion criteria. Wait time for diagnosis was an average of 2.8 months and led to further collaboration between community providers. RITA-T cut-off scores stayed consistent. Providers reported improved confidence and easy integration of this model. Conclusions: This model is generalizable and improves the Early Identification of ASD.

Deep learning-based recognition and segmentation of intracranial aneurysms under small sample size

The manual identification and segmentation of intracranial aneurysms (IAs) involved in the 3D reconstruction procedure are labor-intensive and prone to human errors. To meet the demands for routine clinical management and large cohort studies of IAs, fast and accurate patient-specific IA reconstruction becomes a research Frontier. In this study, a deep-learning-based framework for IA identification and segmentation was developed, and the impacts of image pre-processing and convolutional neural network (CNN) architectures on the framework's performance were investigated. Three-dimensional (3D) segmentation-dedicated architectures, including 3D UNet, VNet, and 3D Res-UNet were evaluated. The dataset used in this study included 101 sets of anonymized cranial computed tomography angiography (CTA) images with 140 IA cases. After the labeling and image pre-processing, a training set and test set containing 112 and 28 IA lesions were used to train and evaluate the convolutional neural network mentioned above. The performances of three convolutional neural networks were compared in terms of training performance, segmentation performance, and segmentation efficiency using multiple quantitative metrics. All the convolutional neural networks showed a non-zero voxel-wise recall (V-Recall) at the case level. Among them, 3D UNet exhibited a better overall segmentation performance under the relatively small sample size. The automatic segmentation results based on 3D UNet reached an average V-Recall of 0.797 ± 0.140 (3.5% and 17.3% higher than that of VNet and 3D Res-UNet), as well as an average dice similarity coefficient (DSC) of 0.818 ± 0.100, which was 4.1%, and 11.7% higher than VNet and 3D Res-UNet. Moreover, the average Hausdorff distance (HD) of the 3D UNet was 3.323 ± 3.212 voxels, which was 8.3% and 17.3% lower than that of VNet and 3D Res-UNet. The three-dimensional deviation analysis results also showed that the segmentations of 3D UNet had the smallest deviation with a max distance of +1.4760/-2.3854 mm, an average distance of 0.3480 mm, a standard deviation (STD) of 0.5978 mm, a root mean square (RMS) of 0.7269 mm. In addition, the average segmentation time (AST) of the 3D UNet was 0.053s, equal to that of 3D Res-UNet and 8.62% shorter than VNet. The results from this study suggested that the proposed deep learning framework integrated with 3D UNet can provide fast and accurate IA identification and segmentation.

Blood Components as Carriers for Small-Molecule Platinum Anticancer Drugs

The efficacy of platinum drugs is limited by severe side effects, drug resistance, and poor pharmacokinetic properties. Utilizing long-lasting blood components as drug carriers is a promising strategy to improve the circulation half-lives and tumor accumulation of platinum drugs. Non-immunogenic blood cells such as erythrocytes and blood proteins such as albumins, which have long lifespans, are suitable for the delivery of platinum drugs. In this concept, we briefly summarize the strategies of applying blood components as promising carriers to deliver small-molecule platinum drugs for cancer treatment. Examples of platinum drugs that are encapsulated, non-covalently attached, and covalently bound to erythrocytes and plasma proteins such as albumin and apoferritin are introduced. The potential methods to increase the stability of platinum-based thiol-maleimide conjugates involved in these delivery systems are also discussed. This concept may enlighten researchers with more ideas on the future development of novel platinum drugs that have excellent pharmacokinetic properties and antitumor performance in vivo.

[Surveillance of Aedes populations in Jiangsu Province in 2020]

OBJECTIVE

To investigate the seasonal Aedes population fluctuation and the resistance of Aedes populations to common insecticides in Jiangsu Province in 2020, so as to provide insights into vector-borne infectious diseases control.

METHODS

One village was randomly sampled from each of Xinbei District of Changzhou City and Zhangjiagang County of Suzhou City in southern Jiangsu Province, Hai'an County of Nantong City and Yandu District of Yancheng City in Central Jiangsu Province, and Suining County of Xuzhou City and Sihong County of Suqian City in northern Jiangsu Province during the period between May and October, 2020. A small ponding container was sampled, and larval Aedes mosquitoes were collected using straws once each in early and late stages of each month. All larvae were bred in laboratory to adults for population identification. In addition, larval breeding were observed in all small ponding containers in and out of 30 households that were randomly sampled from six surveillance sites, and the larval mosquito density was estimated using Breteau index. Larval A. albopictus mosquitoes were sampled around Cuiyuan New Village in Jintan District of Changzhou City, and bred in laboratory to the first offspring generation, and the susceptibility of adult female mosquitoes to deltamethrin, lambda-cyhalothrin, malathion, and propoxur was tested using the filter-paper bioassay recommended by WHO.

RESULTS

A total of 1 165 larval Aedes mosquitoes were captured from small ponding containers in six surveillance sites of Jiangsu Province in 2020, and all were identified as A. albopictus following eclosion. The largest number of Aedes larvae captured was found in July. A total of 1 152 households were investigated in six surveillance sites, and the mean Breteau indexes were 9.58, 13.20, 13.71, 13.20, 12.18 and 5.58 from May to October, respectively, while a high Aedes transmission risk was seen in Xinbei District of Changzhou City, with a higher Breteau index than in Suining (H = 23.667, P_adjusted = 0.001) and Sihong (H = 22.500, P_adjusted = 0.003) counties. The field-captured A. albopictus from Cuiyuan New Village in Jintan District of Changzhou City remained sensitive to malathion, but was resistant to propoxur, and developed high-level resistance to deltamethrin and lambda-cyhalothrin.

CONCLUSIONS

A. albopictus was present in southern, central and northern Jiangsu Province in 2020, and the larval density peaked in July. A. albopictus captured from Cuiyuan New Village in Jintan District of Changzhou City has developed high-level resistance to pyrethroid pesticides.

Extracellular vesicles derived from mesenchymal stem cells confer protection against intervertebral disc degeneration through a microRNA-217-dependent mechanism

OBJECTIVE

Extracellular vesicles released by mesenchymal stem cells (MSC-EVs) can be applied to alleviate intervertebral disc degeneration (IVDD) by curbing apoptosis of nucleus pulposus cells (NPCs). The current study aims to evaluate the effect of MSC-EVs on NPC apoptosis and IVDD and the related regulatory mechanisms involving microRNA (miR)-217.

METHOD

Expression of miR-217 was examined in tumor necrosis factor-α (TNF-α)-induced NPCs and MSC-EVs, followed by identification in the relationship between miR-217, enhancer of zeste homolog 2 (EZH2) and forkhead box O-3 (FOXO3). After isolation of EVs from MSCs and subsequent co-culture with NPCs, we assessed effects of miR-217 on NPC viability, autophagy, senescence and apoptosis along with extracellular matrix (ECM) degradation. Further in vivo experiments were conducted in rat models of IVDD to substantiate the effect of miR-217 on IVDD.

RESULTS

Poor miR-217 expression was found in TNF-α-induced NPCs, while high miR-217 expression was identified in MSC-EVs (P < 0.05). MSC-EVs transferred miR-217 to NPCs and increased its expression, thus attenuating NPC apoptosis and ECM degradation (elevated collagen II and aggrecan but reduced MMP13 and ADAMTS5) (P < 0.05). miR-217 targeted EZH2, and EZH2 bound to the FOXO3 promoter and consequently downregulated its expression. FOXO3 restrained NPC apoptosis and ECM degradation by stimulating cell autophagy (P < 0.05). Furthermore, in vivo experimental results confirmed the suppressive role of miR-217 shuttled by MSC-EVs in IVDD.

CONCLUSION

Overall, the delivery of miR-217 may be a novel mechanism underlying the effect of MSC-EVs on NPC apoptosis and ECM degradation following IVDD.

Melanoma in women of childbearing age and in pregnancy in California, 1994-2015: a population-based cohort study

BACKGROUND

Melanoma is one of the most common malignancies during pregnancy. There is debate regarding the impact of pregnancy on the prognosis of melanoma. Recent large population-based studies from the United States are lacking.

OBJECTIVES

To determine the characteristics and survival of women with pregnancy-associated melanoma.

METHODS

This population-based, retrospective cohort study used California Cancer Registry data linked with state-wide hospitalization and ambulatory surgery data to identify 15-44-year-old female patients diagnosed with melanoma in 1994-2015, including pregnant patients. Multivariable logistic regression compared demographic and clinical characteristics between pregnant and non-pregnant women with melanoma. Multivariable cox proportional hazards regression models assessed melanoma-specific and overall survival.

RESULTS

We identified 13 108 patients, of which 1406 were pregnant. Pregnancy-associated melanoma was more frequent in Hispanic compared to non-Hispanic White women. Melanoma occurring post-partum was associated with greater tumour thickness (2.01-4.00 vs. 0.01-1.00 mm, odds ratio 1.75, 95% confidence interval: 1.03-2.98). There were otherwise no significant differences between pregnant and non-pregnant women. Worse survival was associated with Asian, Black and Native American race/ethnicity (vs. non-Hispanic White), lower neighbourhood socio-economic status, public insurance, tumour site, greater tumour thickness and lymph node involvement, but not pregnancy.

CONCLUSIONS

Melanoma occurring post-partum was associated with greater tumour thickness, but pregnancy status did not affect survival after melanoma. Race/ethnicity, socio-economic status and health insurance impacted survival, emphasizing the importance of reducing health disparities.

Optimization of a Novel Mandelamide-Derived Pyrrolopyrimidine Series of PERK Inhibitors

The protein kinase R (PKR)-like endoplasmic reticulum kinase (PERK) is one of three endoplasmic reticulum (ER) transmembrane sensors of the unfolded protein response (UPR) responsible for regulating protein synthesis and alleviating ER stress. PERK has been implicated in tumorigenesis, cancer cell survival as well metabolic diseases such as diabetes. The structure-based design and optimization of a novel mandelamide-derived pyrrolopyrimidine series of PERK inhibitors as described herein, resulted in the identification of compound 26, a potent, selective, and orally bioavailable compound suitable for interrogating PERK pathway biology in vitro and in vivo, with pharmacokinetics suitable for once-a-day oral dosing in mice.

Changes in rate and socioeconomic inequality of cervical cancer screening in northeastern China from 2013 to 2018

Objective

Cervical cancer, the fourth leading cancer diagnosed in women, has brought great attention to cervical cancer screening to eliminate cervical cancer. In this study, we analyzed two waves of provincially representative data from northeastern China's National Health Services Survey (NHSS) in 2013 and 2018, to investigate the temporal changes and socioeconomic inequalities in the cervical cancer screening rate in northeastern China.

Methods

Data from two waves (2013 and 2018) of the NHSS deployed in Jilin Province were analyzed. We included women aged 15-64 years old and considered the occurrence of any cervical screening in the past 12 months to measure the cervical cancer screening rate in correlation with the annual per-capita household income, educational attainment, health insurance, and other socioeconomic characteristics.

Results

A total of 11,616 women aged 15-64 years were eligible for inclusion. Among all participants, 7,069 participants (61.11%) were from rural areas. The rate of cervical cancer screening increased from 2013 to 2018 [odds ratio (OR): 1.06; 95% confidence interval (CI): 1.04-1.09, p < 0.001]. In total, the cervical cancer screening rate was higher among participants who lived in urban areas than rural areas (OR: 1.20; 95% CI: 1.03-1.39, p = 0.020). The rate was also higher among those with the highest household income per capita (OR: 1.30; 95% CI: 1.07-1.56, p = 0.007), with higher educational attainment (p < 0.001), and with health insurance (p < 0.05), respectively. The rate of cervical cancer screening was also significantly associated with parity (OR: 1.62; 95% CI: 1.23-2.41, p = 0.001) and marital status (OR: 1.45; 95% CI: 1.15-1.81, p = 0.001) but not ethnicity (OR: 1.41; 95% CI: 0.95-1.36, p = 0.164).

Conclusion

Cervical cancer screening coverage improved from 2013 to 2018 in northeastern China but remains far below the target 70% screening rate proposed by the World Health Organization. Although rural-urban inequality disappeared over time, other socioeconomic inequalities remained.

Combination of TACE and Lenvatinib as a promising option for downstaging to surgery of initially unresectable intrahepatic cholangiocarcinoma

BACKGROUND

Conversion therapy has been widely applied in various cancer types including intrahepatic cholangiocarcinoma (ICC). The aim of this retrospective study was to evaluate the efficacy and safety of transarterial chemoembolization combined with lenvatinib (TACE-L) as a novel conversion therapy in patients with initially unresectable ICC.

METHODS

Enrolled in this retrospective study were patients with unresectable ICC who received TACE-L between January 2015 and May 2018. The patients were evaluated every 2 months for possible secondary resection.

RESULTS

Of the 44 eligible patients, 28 (63.6%) were successfully downstaged to receive surgical resection and the other 16 patients were included into the unsuccessfully downstaged group. The overall adverse events during TACE-L were moderate, including 12 patients (27.3%) with Grade 3 or 4 toxicities. Of the 28 downregulated patients, 23 (82.1%) achieved an R0 resection, and 6 (21.4%) had Clavien-Dindo grade ≥ 3 complications, including one postoperative death. Kaplan-Meier curves showed that the successfully downstaged patients had better overall survival (OS) than the unsuccessfully downstaged patients (P = 0.006). Multivariable analysis identified successful TACE-L conversion therapy as a significantly favorable prognostic factor for OS.

CONCLUSIONS

TACE-L proves to be a safe and efficacious conversion therapy modality that allows for secondary resectability in patients with initially unresectable ICC.

Lower thermal conductivity of body centered cubic carbon (C14): a comparative study with diamond

In recent years, the material preparation technology has ushered into a stage of rapid development, increasingly more carbon materials are found to display superior properties, making them suitable for designing nano-scale devices. Within the applications of electronic devices, a considerable amount of consumed energy has to be converted into heat; thus the efficiency of heat transport inside these devices can largely determine their overall performance. Decent elucidations of the heat transport mechanisms within low-dimensional materials will be helpful to achieve thermal management control of the related devices and furthermore, to improve their conversion efficiency. It is well understood that the heat transport within these kinds of materials is largely associated with their structural features. In this study, we focused on a novel material, body centered cubic carbon (C14), which is composed of sp³ hybridized carbon atoms. Such a novel material displays superior electronic properties; however, its thermal properties remain to be investigated. In order to systematically evaluate the practical applicability of this novel material, first-principles calculations were employed to systematically solve its structure; furthermore, its thermal conductivity, phonon dispersion spectrum, phonon properties, Grüneisen parameters, scattering phase space and mechanical properties were all described in detail. We found that C14 performs well in heat transport; and via systematical comparison with another allotrope, diamond, its transport mechanism was further summarized. We hope the physical insights provided by this study could serve as theoretical support for nano-scale device design.

Application of cardiovascular 3-dimensional printing in Transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) has been performed for nearly 20 years, with reliable safety and efficacy in moderate- to high-risk patients with aortic stenosis or regurgitation, with the advantage of less trauma and better prognosis than traditional open surgery. However, because surgeons have not been able to obtain a full view of the aortic root, 3-dimensional printing has been used to reconstruct the aortic root so that they could clearly and intuitively understand the specific anatomical structure. In addition, the 3D printed model has been used for the in vitro simulation of the planned procedures to predict the potential complications of TAVR, the goal being to provide guidance to reasonably plan the procedure to achieve the best outcome. Postprocedural 3D printing can be used to understand the depth, shape, and distribution of the stent. Cardiovascular 3D printing has achieved remarkable results in TAVR and has a great potential.

Fluid-structure interaction simulation of calcified aortic valve stenosis

Calcified aortic valve stenosis (CAVS) is caused by calcium buildup and tissue thickening that impede the blood flow from left ventricle (LV) to aorta. In recent years, CAVS has become one of the most common cardiovascular diseases. Therefore, it is necessary to study the mechanics of aortic valve (AV) caused by calcification. In this paper, based on a previous idealized AV model, the hybrid immersed boundary/finite element method (IB/FE) is used to study AV dynamics and hemodynamic performance under normal and calcified conditions. The computational CAVS model is realized by dividing the AV leaflets into a calcified region and a healthy region, and each is described by a specific constitutive equation. Our results show that calcification can significantly affect AV dynamics. For example, the elasticity and mobility of the leaflets decrease due to calcification, leading to a smaller opening area with a high forward jet flow across the valve. The calcified valve also experiences an increase in local stress and strain. The increased loading due to AV stenosis further leads to a significant increase in left ventricular energy loss and transvalvular pressure gradients. The model predicted hemodynamic parameters are in general consistent with the risk classification of AV stenosis in the clinic. Therefore, mathematical models of AV with calcification have the potential to deepen our understanding of AV stenosis-induced ventricular dysfunction and facilitate the development of computational engineering-assisted medical diagnosis in AV related diseases.

Detection of Early Ischemic Changes with Virtual Noncontrast Dual-Energy CT in Acute Ischemic Stroke: A Noninferiority Analysis

BACKGROUND AND PURPOSE

Dual-energy virtual NCCT has the potential to replace conventional NCCT to detect early ischemic changes in acute ischemic stroke. In this study, we evaluated whether virtual NCCT is noninferior compared with standard linearly blended NCCT, a surrogate of conventional NCCT, regarding the detection of early ischemic changes with ASPECTS.

MATERIALS AND METHODS

Adult patients who presented with suspected acute ischemic stroke and who underwent dual-energy NCCT and CTA and brain MR imaging within 48 hours were included. Standard linearly blended images were reconstructed to match a conventional NCCT. Virtual NCCT images were reconstructed from CTA. ASPECTS was evaluated on conventional NCCT, virtual NCCT, and DWI, which served as the reference standard. Agreement between CT assessments and the reference standard was evaluated with the Lin concordance correlation coefficient. Noninferiority was assessed with bootstrapped estimates of the differences in ASPECTS between conventional and virtual NCCT with 95% CIs.

RESULTS

Of the 193 included patients, 100 patients (52%) had ischemia on DWI. Compared with the reference standard, the ASPECTS concordance correlation coefficient for conventional and virtual NCCT was 0.23 (95% CI, 0.15-0.32) and 0.44 (95% CI, 0.33-0.53), respectively. The difference in the concordance correlation coefficient between virtual and conventional NCCT was 0.20 (95% CI, 0.01-0.39) and did not cross the prespecified noninferiority margin of -0.10.

CONCLUSIONS

Dual-energy virtual NCCT is noninferior compared with conventional NCCT for the detection of early ischemic changes with ASPECTS.