Development and Validation of a Predictive Model for Acute Kidney Injury in Sepsis Patients Based on Recursive Partition Analysis

BACKGROUND

Sepsis-associated acute kidney injury (SA-AKI) is a critical condition with significant clinical implications, yet there is a need for a predictive model that can reliably assess the risk of its development. This study is undertaken to bridge a gap in healthcare by creating a predictive model for SA-AKI with the goal of empowering healthcare providers with a tool that can revolutionize patient care and ultimately lead to improved outcomes.

METHODS

A cohort of 615 patients afflicted with sepsis, who were admitted to the intensive care unit, underwent random stratification into 2 groups: a training set (n = 435) and a validation set (n = 180). Subsequently, a multivariate logistic regression model, imbued with nonzero coefficients via LASSO regression, was meticulously devised for the prognostication of SA-AKI. This model was thoughtfully rendered in the form of a nomogram. The salience of individual risk factors was assessed and ranked employing Shapley Additive Interpretation (SHAP). Recursive partition analysis was performed to stratify the risk of patients with sepsis.

RESULTS

Among the panoply of clinical variables examined, hypertension, diabetes mellitus, C-reactive protein, procalcitonin (PCT), activated partial thromboplastin time, and platelet count emerged as robust and independent determinants of SA-AKI. The receiver operating characteristic curve analysis for SA-AKI risk discrimination in both the training set and validation set yielded an area under the curve estimates of 0.843 (95% CI: 0.805 to 0.882) and 0.834 (95% CI: 0.775 to 0.893), respectively. Notably, PCT exhibited the most conspicuous influence on the model's predictive capacity. Furthermore, statistically significant disparities were observed in the incidence of SA-AKI and the 28-day survival rate across high-risk, medium-risk, and low-risk cohorts (P < .05).

CONCLUSION

The composite predictive model, amalgamating the quintet of SA-AKI predictors, holds significant promise in facilitating the identification of high-risk patient subsets.

Sensing of mitochondrial DNA by ZBP1 promotes RIPK3-mediated necroptosis and ferroptosis in response to diquat poisoning

Diquat (DQ) poisoning is a severe medical condition associated with life-threatening implications and multiorgan dysfunction. Despite its clinical significance, the precise underlying mechanism remains inadequately understood. This study elucidates that DQ induces instability in the mitochondrial genome of endothelial cells, resulting in the accumulation of Z-form DNA. This process activates Z-DNA binding protein 1 (ZBP1), which then interacts with receptor-interacting protein kinase 3 (RIPK3), ultimately leading to RIPK3-dependent necroptotic and ferroptotic signaling cascades. Specific deletion of either Zbp1 or Ripk3 in endothelial cells simultaneously inhibits both necroptosis and ferroptosis. This dual inhibition significantly reduces organ damage and lowers mortality rate. Notably, our investigation reveals that RIPK3 has a dual role. It not only phosphorylates MLKL to induce necroptosis but also phosphorylates FSP1 to inhibit its enzymatic activity, promoting ferroptosis. The study further shows that deletion of mixed lineage kinase domain-like (Mlkl) and the augmentation of ferroptosis suppressor protein 1 (FSP1)-dependent non-canonical vitamin K cycling can provide partial protection against DQ-induced organ damage. Combining Mlkl deletion with vitamin K treatment demonstrates a heightened efficacy in ameliorating multiorgan damage and lethality induced by DQ. Taken together, this study identifies ZBP1 as a crucial sensor for DQ-induced mitochondrial Z-form DNA, initiating RIPK3-dependent necroptosis and ferroptosis. These findings suggest that targeting the ZBP1/RIPK3-dependent necroptotic and ferroptotic pathways could be a promising approach for drug interventions aimed at mitigating the adverse consequences of DQ poisoning.

Caspase-11/GSDMD contributes to the progression of hyperuricemic nephropathy by promoting NETs formation

Hyperuricemia is an independent risk factor for chronic kidney disease (CKD) and promotes renal fibrosis, but the underlying mechanism remains largely unknown. Unresolved inflammation is strongly associated with renal fibrosis and is a well-known significant contributor to the progression of CKD, including hyperuricemia nephropathy. In the current study, we elucidated the impact of Caspase-11/Gasdermin D (GSDMD)-dependent neutrophil extracellular traps (NETs) on progressive hyperuricemic nephropathy. We found that the Caspase-11/GSDMD signaling were markedly activated in the kidneys of hyperuricemic nephropathy. Deletion of Gsdmd or Caspase-11 protects against the progression of hyperuricemic nephropathy by reducing kidney inflammation, proinflammatory and profibrogenic factors expression, NETs generation, α-smooth muscle actin expression, and fibrosis. Furthermore, specific deletion of Gsdmd or Caspase-11 in hematopoietic cells showed a protective effect on renal fibrosis in hyperuricemic nephropathy. Additionally, in vitro studies unveiled the capability of uric acid in inducing Caspase-11/GSDMD-dependent NETs formation, consequently enhancing α-smooth muscle actin production in macrophages. In summary, this study demonstrated the contributory role of Caspase-11/GSDMD in the progression of hyperuricemic nephropathy by promoting NETs formation, which may shed new light on the therapeutic approach to treating and reversing hyperuricemic nephropathy.

Morphological and physiological response of amphibious Rotala rotundifolia from emergent to submerged form

Rotala rotundifolia is an amphibious aquatic plant that can live in submerged and emergent forms. It is superior in nitrogen and phosphorus removal. To elucidate its adaptation strategies from emergent to submerged conditions, phenotypic and physiological responses of R. rotundifolia were investigated during three months of submergence, at water levels of 0 cm (CK), 50 cm (W50), and 90 cm (W90). Results showed that submergence stress reduced the relative growth rate of plant height, fresh weight, and biomass accumulation, leading to root degradation and a significant decline in the root-shoot ratio. The amounts of soluble protein (SP), soluble sugar (SS), and starch in the aerial leaves of W50 and W90 decreased during the early stages of submergence compared to CK, whereas the total chlorophyll and proline contents, and activities of superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) increased. The contents of endogenous hormones, including abscisic acid (ABA), gibberellin (GA), and indole-3-acetic acid (IAA), decreased during the change in leaf shape; the decline in ABA was more obvious. The leaf primordium generated transition leaves and submerged leaves to resolve the "carbon starvation" of plants. The maximum values of non-structural carbohydrates (NSC) in the leaves of W50 and W90 occurred at day 30, reaching 14.0 mg g- 1and 10.5 mg g- 1, respectively. The contents of SP and starch, activities of SOD and CAT of the roots in submerged treatments increased, while SS and proline content decreased at day 7. These results demonstrated that developing heterophyllous leaves, increasing chlorophyll content, and regulating plant carbon allocation and consumption were important mechanisms of R. rotundifolia to adapt to underwater habitats.

Construction of prediction model for fetal growth restriction during first trimester in an Asian population

OBJECTIVE

To construct a prediction model for fetal growth restriction (FGR) during the first trimester of pregnancy and evaluate its screening performance.

METHODS

This was a prospective cohort study of singleton pregnancies that underwent routine ultrasound screening at 11 to 13 + 6 weeks at the Affiliated Suzhou Hospital of Nanjing Medical University between January 2019 and April 2022. Basic clinical information, ultrasound indicators and serum biomarkers of pregnant women were collected. Fetal weight assessment was based on the fetal growth curve for the Southern Chinese population. FGR was diagnosed according to Delphi consensus criteria. Least absolute shrinkage and selection operator (lasso) regression was used to select variables for inclusion in the model. Discrimination, calibration and clinical effectiveness of the model were evaluated in training and validation cohorts.

RESULTS

A total of 1188 pregnant women were included, of whom 108 had FGR. Lasso regression identified seven predictive features, including history of maternal hypertension, maternal smoking or passive smoking, gravidity, uterine artery pulsatility index, ductus venosus pulsatility index and multiples of the median values of placental growth factor and soluble fms-like tyrosine kinase-1. The nomogram prediction model constructed from these seven variables accurately predicted FGR, and the area under the receiver-operating-characteristics curve in the validation cohort was 0.82 (95% CI, 0.74-0.90). The calibration curve and Hosmer-Lemeshow test demonstrated good calibration, and the clinical decision curve and clinical impact curve supported its practical value in a clinical setting.

CONCLUSION

The multi-index prediction model for FGR has good predictive value during the first trimester. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A novel magnetic Ti-MOF/chitosan composite for efficient adsorption of Pb(II) from aqueous solutions: Synthesis and investigation

In this investigation, a composite material comprising Ti-MOF and chitosan, denoted as BD-MOF(Ti)@CS/Fe3O4, was successfully designed for the efficient adsorption of Pb(II) from aqueous solutions. A comprehensive array of characterization techniques, including SEM, XRD, BET, FT-IR, and XPS, were meticulously employed to scrutinize the structural attributes and morphological features of the Pb(II) adsorbent. Notably, the material exhibits adaptability to a broad pH range, with adsorption efficiency reaching 99 % between pH 3 and 6. Kinetic studies reveal that the adsorption process of Pb(II) by BD-MOF(Ti)@CS/Fe3O4 adheres closely to a pseudo-second-order kinetic model. Impressively, within a short duration of 40 min, the adsorption efficiency can reach 85 %. Furthermore, the adsorption isotherm aligns with the Hill isotherm model, signifying cooperative adsorption. This observation underscores the synergistic interplay among the functional groups on the surface of BD-MOF(Ti)@CS/Fe3O4 in capturing Pb(II). As per the Hill model, the theoretical maximum capacity was an impressive 944.9 mg/g. Thermodynamic assessments suggested that the adsorption process was spontaneous, entropy increasing and exothermic. Even in the presence of various interfering ions, BD-MOF(Ti)@CS/Fe3O4 exhibited robust adsorption performance, thereby affirming its utility in complex environments. Moreover, the material demonstrates noteworthy reusability, sustaining effective Pb(II) removal across five consecutive cycles in aqueous solutions.

Synthetic of functionalized magnetic titanium-based metal-organic frameworks to efficiently remove Hg(Ⅱ) from wastewater

The rapid development of process technology has led to rapid daily industrial production, which also produced a large amount of waste liquid. At the same time, the existing treatment technology cannot keep up with the demand, resulting in the malicious destruction of the environment by wastewater, especially mercury-containing wastewater was very harmful. Effective means of removing mercury ions need to be found. With magnetic ferric oxide as the core and titanium-based metal-organic frameworks as the shell, a new type of magnetic adsorbent (BTA-MIL-125(Ti)@Fe3O4) was synthesized. Materials were tested by multiple characterization methods and multiple sets of experiments. At optimal pH 6, the removal rate in 100 ppm Hg(Ⅱ) was as high as 95.8%. The theoretical adsorption capacity was 615 mg/L. Isothermal experiments, kinetic experiments and thermodynamic experiments have respectively verified that the material was a kind of adsorption material with self-emission heat based on chemical action and synergistic adsorption with Hill model. By simulating the immunity of a variety of ions (Cu, Zn, Mg, Ni, Cd), the material itself also exhibited a very high affinity for Hg(Ⅱ). The results of five high-cycle stable adsorption proved the repeatable stability of the material itself. Various characterization methods have also shown that nitrogen and sulfur-containing groups chelated with Hg(Ⅱ). All of the above was enough to show that the BTA-MIL-125(Ti)@Fe3O4 was a magnetic adsorption material with excellent performance and great prospects.

Recyclable adsorption removal and fluorescent monitoring of hexavalent chromium by electrospun nanofibers membrane derived from Tb3+ coordinating polyarylene ether amidoxime

Emerging technologies or advanced materials which can simultaneously adsorb and detect highly toxic Cr(VI) are urgently in demand for environmental remediation. Herein, we have designed and synthesized a functional polyarylene ether with aromatic main chain and pendent carboxyl groups along with amidoxime group that can be coordinated with different metal ions. Thanks to its versatile activation of the lanthanide ions' inherent fluorescence and good processability, the fluorescent nanofiber membranes with competitive Cr(VI) adsorption and detection performance have been fabricated via one-step electrospinning of mixed solution containing synthesized polymer and terbium salt. More specifically, the optimized nanofiber membrane exhibits a maximal Cr(VI) adsorption of 278.2 mg/g and specific detection for hexavalent chromium down to 11.76 nM. More importantly, the prepared fluorescent nanofiber membranes can be easily re-generated and re-used for both Cr(VI) adsorption and detection for five times. Given the unique advantages of easy fabrication, competitive dual functionalities as well as good reusability of electrospun fluorescent nanofiber membranes, the present work basically opens up new insight in the design of multifunctional recyclable material for the remediation of heavy metal pollution.

[The impact of the highest mediastinal lymph node metastasis on postoperative recurrence and survival in non-small cell lung cancer patients]

Objective: To examine whether the highest mediastinal lymph node (HMLN) metastasis had an influence on postoperative recurrence and survival among non-small cell lung cancer (NSCLC) patients with pN2 lymph node metastasis. Methods: A total of 261 patients who underwent radical resection of lung cancer and systematic lymph node dissection in the Department of Thoracic Surgery of Peking University First Hospital from January 2007 to December 2016 were retrospectively analyzed. There were 180 males and 81 females, aged (61.5±9.4) years (range: 31 to 83 years). There were 128 cases of HMLN-positive and 133 cases of HMLN-negative. They were pathologically confirmed N2 stage NSCLC and postoperative recurrence and survival were followed up. The Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival (OS) curves according to whether HMLN metastasize or not. The Cox proportional hazards regression model was used for the prognostic analysis. Results: The median DFS and the median OS of the whole group were 28 months and 44 months, respectively. The median DFS in HMLN-positive and HMLN-negative patients was 19 months and 33 months, respectively (P=0.005). The median OS of HMLN-positive and HMLN-negative group was 37 months and 49 months, respectively (P=0.005). Multivariate analysis showed that pneumonectomy and visceral pleural invasion were independent risk factors for both postoperative OS (HR=1.85, 95%CI: 1.25 to 2.72, P=0.002; HR=1.82, 95%CI: 1.30 to 2.56, P=0.007) and DFS (HR=1.61, 95%CI: 1.10 to 2.35, P=0.014; HR=1.77, 95%CI: 1.27 to 2.46,P=0.001). HMLN metastasis and lymphovascular invasion were independent risk factors for only postoperative DFS (HR=1.39, 95%CI: 1.03 to 1.87, P=0.030; HR=1.40, 95%CI: 0.99 to 1.81, P=0.042). Conclusions: For patients of pN2 stage NSCLC, both postoperative recurrence and long-term survival were significantly worse in the HMLN metastatic group. In addition, pneumonectomy and visceral pleural invasion were unfavorable factors that affected both recurrence and overall survival. HMLN metastasis and lymphovascular invasion could shorten the postoperative time for DFS.

Selective adsorption of mercury ion from water by a novel functionalized magnetic Ti based metal-organic framework composite

In the context of industrialization and severe wastewater pollution, mercury ions pose a major threat due to their high toxicity. However, traditional adsorbents and common metal-organic framework (MOF) materials have limited effectiveness. This study focuses on combining magnetic materials with functionalized titanium-based MOF composite (SNN-MIL-125(Ti)@Fe3O4) to improve mercury ion adsorption. Through comprehensive characterization and analysis, the adsorption performance and mechanism of the material were studied. The optimal adsorption of the material was achieved at pH 5, exhibiting a pseudo-second-order adsorption model and the Hill theoretical capacity of 668.98 mg/g. Hill and Tempkin models confirmed the presence of chemical and physical adsorption sites on the material surface. Thermodynamic experiments showed a spontaneous endothermic process. Despite the presence of interfering ions, the material exhibited high selectivity for mercury ions. After four cycles, adsorption performance decreased by only 8%, indicating excellent reusability. Nitrogen- and sulfur-containing functional groups played a key role in mercury ion adsorption. In conclusion, SNN-MIL-125(Ti)@Fe3O4, as a magnetic MOF adsorption material, showed potential for effective remediation of mercury-contaminated wastewater. This study contributes to the development of efficient adsorption materials and enhances the understanding of their mechanism.

Estimate of soil heavy metal in a mining region using PCC-SVM-RFECV-AdaBoost combined with reflectance spectroscopy

Soil contamination with heavy metals is a relatively serious issue in China. Traditional soil heavy metal survey methods cannot meet the demand for rapid and real-time large-scale area soil heavy metal surveys. We chose a typical mining area in Henan Province as the study area, collected 124 soil samples in the field and obtained their soil hyperspectral data indoors using a spectrometer. After different spectral transformations of the soil spectral curves, Pearson correlation coefficients (PCC) between them and the heavy metals Cd, Cr, Cu, and Ni were calculated, and after correlation evaluation, the best spectral transformations for each heavy metal were determined and preselected characteristic wavebands were obtained. Then the support vector machine recursive feature elimination cross-validation (SVM-RFECV) is used to select among the preselected feature wavebands to obtain the final modeled wavebands, and the Adaptive Boosting (AdaBoost), Gradient Boosting Decision Tree (GBDT), Random Forest (RF), and Partial Least Squares (PLS) methods were used to establish the inversion model. The results showed that the PCC-SVM-RFECV can effectively select characteristic wavebands with high contribution to modeling from high-dimensional data. Spectral transformations methods can improve the correlation of spectra with heavy metals. The location and quantity of characteristic wavebands for the four heavy metals were different. The accuracy of AdaBoost was significantly better than that of GBDT, RF, and PLS (i.e., Ni: [Formula: see text]). This study can provide a technical reference for the use of hyperspectral inversion models for large-scale monitoring of soil heavy metal content.

[A method for sensitivity analysis of deviation factor for geometric correction of cone-beam CT system]

OBJECTIVE

To propose a sensitivity test method for geometric correction position deviation of cone-beam CT systems.

METHODS

We proposed the definition of center deviation and its derivation. We analyzed the influence of the variation of the three-dimensional spatial center of the steel ball point, the projection center and the size of the steel ball point on the deviation of geometric parameters and the reconstructed image results by calculating the geometric correction parameters based on the Noo analytical method using the FDK reconstruction algorithm for image reconstruction.

RESULTS

The radius of the steel ball point was within 3 mm. The deviation of the center of the calibration parameter was within the order of magnitude and negligible. A 10% Gaussian perturbation of a single pixel in the 3D spatial coordinates of the steel ball point produced a deviation of about 3 pixel sizes, while the same Gaussian perturbation of the 2D projection coordinates of the steel ball point produced a deviation of about 2 pixel sizes.

CONCLUSION

The geometric correction is more sensitive to the deviation generated by the three-dimensional spatial coordinates of the steel ball point with limited sensitivity to the deviation generated by the two-dimensional projection coordinates of the steel ball point. The deviation sensitivity of a small diameter steel ball point can be ignored.

Study on Extraction, Physicochemical Properties, and Bacterio-Static Activity of Polysaccharides from Phellinus linteus

We optimized an ultrasound-assisted extraction process of Phellinus linteus mycelium polysaccharides (PLPs) and studied their monosaccharide composition and bacteriostatic properties. Based on a single-factor experiment, a three-factor, three-level Box-Behnken design was used to optimize the ultrasound-assisted extraction process of PLP, using the yield of PLP as the index. The chemical composition and monosaccharide composition of PLP were determined by chemical analysis and HPLC analysis, respectively. Microscopic morphological analysis of the surface of PLP was performed via swept-surface electron microscopy. The bacteriostatic properties of PLP were determined using the spectrophotometric turbidimetric method. The results showed that the best extraction process of PLP with ultrasonic assistance achieved a result of 1:42 g/mL. In this method, the ultrasonic temperature was 60 °C, ultrasonic extraction was performed for 20 min, and the yield of PLP was 12.98%. The monosaccharide composition of PLP mainly contains glucose (Glc), mannose (Man), galactose (Gal), and glucuronic acid (GlcA). The intracellular polysaccharide of Phellinus igniarius Mycelia (PIP) is an irregular spherical accumulation, the surface is rough and not smooth, and the extracellular polysaccharide (PEP) is a crumbly accumulation. PIP has a stronger inhibitory ability for S. aureus and E. coli and a slightly weaker inhibitory effect for B. subtilis; the inhibitory effect of PEP on S. aureus, E. coli, and B. subtilis is slightly inferior to that of PIP.

[Prediction of 1p/19q codeletion status in diffuse lower-grade glioma using multimodal MRI radiomics]

OBJECTIVE

To develop a noninvasive method for prediction of 1p/19q codeletion in diffuse lower-grade glioma (DLGG) based on multimodal magnetic resonance imaging (MRI) radiomics.

METHODS

We collected MRI data from 104 patients with pathologically confirmed DLGG between October, 2015 and September, 2022. A total of 535 radiomics features were extracted from T₂WI, T₁WI, FLAIR, CE-T₁WI and DWI, including 70 morphological features, 90 first order features, and 375 texture features. We constructed logistic regression (LR), logistic regression least absolute shrinkage and selection operator (LRlasso), support vector machine (SVM) and Linear Discriminant Analysis (LDA) radiomics models and compared their predictive performance after 10-fold cross validation. The MRI images were reviewed by two radiologists independently for predicting the 1p/19q status. Receiver operating characteristic curves were used to evaluate classification performance of the radiomics models and the radiologists.

RESULTS

The 4 radiomics models (LR, LRlasso, SVM and LDA) achieved similar area under the curve (AUC) in the validation dataset (0.833, 0.819, 0.824 and 0.819, respectively; P>0.1), and their predictive performance was all superior to that of resident physicians of radiology (AUC=0.645, P=0.011, 0.022, 0.016, 0.030, respectively) and similar to that of attending physicians of radiology (AUC=0.838, P>0.05).

CONCLUSION

Multiparametric MRI radiomics models show good performance for noninvasive prediction of 1p/19q codeletion status in patients with in diffuse lower-grade glioma.

Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU

BACKGROUND

Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited.

OBJECTIVE

To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization.

DESIGN, SETTING AND PARTICIPANTS

CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI).

EXPOSURES

The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions.

MAIN OUTCOMES AND MEASURES

The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition).

RESULTS

Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29).

CONCLUSIONS AND RELEVANCE

In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.

[A region-level contrastive learning-based deep model for glomerular ultrastructure segmentation on electron microscope images]

OBJECTIVE

We propose a novel region- level self-supervised contrastive learning method USRegCon (ultrastructural region contrast) based on the semantic similarity of ultrastructures to improve the performance of the model for glomerular ultrastructure segmentation on electron microscope images.

METHODS

USRegCon used a large amount of unlabeled data for pre- training of the model in 3 steps: (1) The model encoded and decoded the ultrastructural information in the image and adaptively divided the image into multiple regions based on the semantic similarity of the ultrastructures; (2) Based on the divided regions, the first-order grayscale region representations and deep semantic region representations of each region were extracted by region pooling operation; (3) For the first-order grayscale region representations, a grayscale loss function was proposed to minimize the grayscale difference within regions and maximize the difference between regions. For deep semantic region representations, a semantic loss function was introduced to maximize the similarity of positive region pairs and the difference of negative region pairs in the representation space. These two loss functions were jointly used for pre-training of the model.

RESULTS

In the segmentation task for 3 ultrastructures of the glomerular filtration barrier based on the private dataset GlomEM, USRegCon achieved promising segmentation results for basement membrane, endothelial cells, and podocytes, with Dice coefficients of (85.69 ± 0.13)%, (74.59 ± 0.13)%, and (78.57 ± 0.16)%, respectively, demonstrating a good performance of the model superior to many existing image-level, pixel-level, and region-level self-supervised contrastive learning methods and close to the fully- supervised pre-training method based on the large- scale labeled dataset ImageNet.

CONCLUSION

USRegCon facilitates the model to learn beneficial region representations from large amounts of unlabeled data to overcome the scarcity of labeled data and improves the deep model performance for glomerular ultrastructure recognition and boundary segmentation.

Efficacy and toxicity profile of first-line treatment for extensive-stage small cell lung cancer: A Bayesian network meta-analysis

BACKGROUND

The efficacy and toxicity profiles for extensive-stage small cell lung cancer (ES-SCLC) are unclear. We aimed to address this gap through a Bayesian network meta-analysis.

METHODS

We performed network analysis from randomized controlled trials comparing these treatments: PD-(L)1 inhibitor, CTLA-4 inhibitor, CXCR inhibitor, PARP inhibitor, CDK inhibitor, chemotherapy, and their combinations. Pooled estimations of progression-free survival, overall survival, objective response rate, and toxicity (systematic and specific) were conducted within the Bayesian framework.

RESULTS

Twenty-five trials involving 9 strategies were included. In terms of progression-free survival and overall survival, PD-(L)1 inhibitor combined with cisplatin/carboplatin (P) and etoposide (E) shown the acknowledged superiority than other treatments. The addition of CTLA-4 inhibitor (ipilimumab) to EP had the highest response rate among these regimens, and the combination of chemotherapy (irinotecan) and cisplatin/carboplatin had the greatest probability of performing considerable systematic security. The secondary endpoint was specific adverse events, including vomiting, fatigue, thrombocytopenia, constipation, and decreased appetite; hence we depicted the specific toxicity profile of each regimen. In addition, we identified the differences between PD-1 inhibitors and PD-L1 inhibitors in prolonging overall survival time for the central nervous system (CNS)/liver metastases patients.

CONCLUSIONS

EP combined with PD-(L)1 inhibitor followed by CTLA-4 inhibitors or anti-angiogenesis was the considerable treatment with considerable efficacy and safety for ES-SCLC. Each treatment has a unique specific toxicity profile, which needs more attention.

Propagation thresholds in a diffusive epidemic model with latency and vaccination

This paper studies the propagation thresholds in a diffusive epidemic model with latency and vaccination. When the initial condition satisfies proper exponential decaying behavior, we present the spatial expansion feature of the infected. Different leftward and rightward spreading speeds are obtained with respect to different decaying initial values. Moreover, the convergence in the sense of compact open topology is also studied when the spreading speeds are finite. Finally, we show that the minimal spreading speed is the minimal wave speed of traveling wave solutions, which also presents the precisely asymptotic behavior of traveling wave solutions for the infected branch at the disease-free side. Here, the asymptotic behavior plays an important role that distinguishes the minimal spreading speed from all possible spreading speeds. From the definition of possible spreading speeds, we may find some factors affecting the spatial expansion ability, which includes that the vaccination could decrease the spatial expansion ability of the disease.

Propagation dynamics in an SIRS model with general incidence functions

This paper studies the initial value problems and traveling wave solutions in an SIRS model with general incidence functions. Linearizing the infected equation at the disease free steady state, we can define a threshold if the corresponding basic reproduction ratio in kinetic system is larger than the unit. When the initial condition for the infected is compactly supported, we prove that the threshold is the spreading speed for three unknown functions. At the same time, this threshold is the minimal wave speed for traveling wave solutions modeling the disease spreading process. If the corresponding basic reproduction ratio in kinetic system is smaller than the unit, then we confirm the extinction of the infected and the nonexistence of nonconstant traveling waves.

The effect of the 2-UPS/RR ankle rehabilitation robot with coupling biomechanical model on muscle behaviors

With the popularization of biomechanical simulation technology, aiming at the rehabilitation of ankle joint injury, we imported simplified model of proposed 2-UPS/RR (two identical unconstraint kinematic branches with a universal-prismatic-spherical (UPS) structure and two rotating pair (R)) ankle rehabilitation robot into AnyBody Modeling System. Therefore, a human-machine model was established using the HILL-type muscle model and muscle recruitment criteria. This paper investigated the effects of rehabilitation trajectories on biomechanical response during rehabilitation. Additionally, three main lower limb muscles (soleus, peroneal brevis, and extensor digitorum longus) were examined under different rehabilitation trajectories (plantar dorsiflexion, varus or valgus, and compound movement) in the present study. Based on the biomechanical response of lower limbs, the results showed that different muscles had different sensitivities to the change of rehabilitation trajectories. The correlation coefficient between joint force and plantar dorsiflexion angle reached 0.99 (P < 0.01), indicating that the change of joint force was mainly dominated by plantar dorsiflexion/plantar flexion, but also affected by varus or valgus. Safe rehabilitation training can be achieved by controlling the designed 2-UPS/RR rehabilitation robot. The behavior of muscle force and joint force under different rehabilitation trajectories can meet the needs of rehabilitation and treatment of joint diseases, and provide more reasonable suggestions for early rehabilitation.

A shallow constructed wetland combining porous filter material and Rotala rotundifolia for advanced treatment of municipal sewage at low HRT

Water scarcity is a worldwide problem. Recycled municipal wastewater is considered a useful alternative to the conventional types of water resources. In this study, a shallow constructed wetland (SCW) with porous filter material and Rotala rotundifolia was used for advanced municipal sewage treatment. The wetland without plant was set as the control (SCW-C). The pollutant removal performance of the system at different hydraulic retention times (HRTs) was investigated. The diversity of the microbial community was analyzed, and the fate of nutrients, mainly N and P, in the system was discussed. Results showed that SCW was efficient in pollutant removal. Effluent concentrations of chemical oxygen demand (COD), total phosphorus (TP), and ammonium nitrogen (NH₄⁺-N) were 15.0-23.6, 0.19-0.28, and 0.83-1.16 mg/L, separately, with average removal efficiencies of 61.2%, 46.3%, and 88.1% at HRT 18 h, which met the requirements of type [Formula: see text] water set by the environmental quality standards for surface water in China. The richness and evenness of the bacterial community were significantly higher in the plant-rooted SCW. They increased along with the system. The dominant genera in the system were phosphate-solubilizing bacteria, nitrifying bacteria, and denitrifying bacteria. The P in the influent mainly flowed to the substrate and plant. At the same time, most N was removed by nitrification and denitrification. These findings suggested that the SCW could remove pollutants from the municipal sewage effluent and meet the standard requirement at low HRT.

User experience with a parenting chatbot micro intervention

Background

The use of chatbots to address mental health conditions have become increasingly popular in recent years. However, few studies aimed to teach parenting skills through chatbots, and there are no reports on parental user experience. Aim: This study aimed to assess the user experience of a parenting chatbot micro intervention to teach how to praise children in a Spanish-speaking country.

Methods

A sample of 89 parents were assigned to the chatbot micro intervention as part of a randomized controlled trial study. Completion rates, engagement, satisfaction, net promoter score, and acceptability were analyzed.

Results

66.3% of the participants completed the intervention. Participants exchanged an average of 49.8 messages (SD = 1.53), provided an average satisfaction score of 4.19 (SD = .79), and reported that they would recommend the chatbot to other parents (net promoter score = 4.63/5; SD = .66). Acceptability level was high (ease of use = 4.66 [SD = .73]; comfortability = 4.76 [SD = .46]; lack of technical problems = 4.69 [SD = .59]; interactivity = 4.51 [SD = .77]; usefulness for everyday life = 4.75 [SD = .54]).

Conclusions

Overall, users completed the intervention at a high rate, engaged with the chatbot, were satisfied, would recommend it to others, and reported a high level of acceptability. Chatbots have the potential to teach parenting skills however research on the efficacy of parenting chatbot interventions is needed.

BALANCE TRAINING AND PHYSICAL ABILITY OF BASKETBALL PLAYERS

ABSTRACT Introduction Balance in gait is a fundamental factor for rhythmic changes on the court, and physical fitness is a basic requirement for competitiveness in basketball. Objective Analyze the effects of balance training on the gait and physical fitness of basketball players. Methods Thirty basketball athletes were selected and randomly divided into a control and experimental group. A balance training program including balls was added to the experimental group, while the control group followed only the traditional training program. The experiment lasted 8 weeks, with the interventions applied 3 times a week. Finally, relevant data collected before and after the experiment were statistically analyzed and discussed. Results The experimental and the control groups showed a statistical gain in balance, with a greater change interval in the experimental group, demonstrating the effect of dynamic balance training in improving basketball-related physical indices. Conclusion There are some deficiencies in the traditional basketball training program that can be compensated with the addition of the balance training program presented in this article, fully improving the skills of basketball players. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Rare Case of Distant Cutaneous Metastasis of Urothelial Carcinoma

Introduction/Objective

Cutaneous metastasis of urothelial carcinoma is extremely rare with poor prognosis. Many cutaneous metastases present in locoregional areas such as abdomen, groin, genitalia or thigh. Only very few cases present with distant cutaneous metastases. We report a rare case of urothelial carcinoma presenting with a cutaneous metastasis to the right neck.

Methods/Case Report

A 71-year-old male with a history of prostate cancer in 2009 presented with hematuria with clots, urinary retention and dysuria. The patient was also noted to have right submandibular ulcerative mass measuring 2.6 cm. Cystoscopy revealed a nodular tumor in the right lateral trigone area and transurethral resections of bladder tumor revealed high-grade papillary urothelial carcinoma, invasive into muscularis propria with lymphovascular invasion. Skin punch biopsy of the right submandibular mass was obtained revealing an infiltrative nodular proliferation of sheets of atypical epithelioid cells with readily identifiable mitoses in at least the dermis without an epidermal connection. Immunostains show the lesional cells are positive for CK5/6, EMA, Ber-EP4 (weak), p40, and GATA3 with variable positivity for p16, consistent with metastatic urothelial carcinoma. The patient received 4 cycles of cisplatin-gemcitabine chemotherapy with good partial response, continued with avelumab for maintenance therapy and is alive up to 6 months.

Results (if a Case Study enter NA)

NA.

Conclusion

Most cutaneous metastases of urothelial carcinoma occur in the local region and have poor prognosis with patients dying within several weeks without treatment. It is important for pathologists to be aware of cutaneous metastatic urothelial carcinoma in more distant sites.

Evaluation of Clinical and Safety Outcomes of Neoadjuvant Immunotherapy Combined With Chemotherapy for Patients With Resectable Esophageal Cancer: A Systematic Review and Meta-analysis

IMPORTANCE

A considerable number of clinical trials of neoadjuvant immunotherapy for patients with resectable esophageal cancer are emerging. However, systematic evaluations of these studies are lacking.

OBJECTIVE

To provide state-of-the-art evidence and normative theoretical support for neoadjuvant immunotherapy for locally advanced resectable esophageal cancer.

DATA SOURCES

PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for relevant original articles and conference proceedings that were published in English through April 1, 2022.

STUDY SELECTION

Published phase 2 or 3 clinical trials that included patients with resectable stage I to IV esophageal cancer who received immune checkpoint inhibitors (ICIs) before surgery as monotherapy or in combination with other therapies.

DATA EXTRACTION AND SYNTHESIS

The Preferred Reporting Items for Systematic Reviews and Meta-analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines for meta-analysis were followed to extract data. A random-effects model was adopted if the heterogeneity was significant (I2 statistic >50%); otherwise, the common-effects model was used. Data analyses were conducted from April 2 to 8, 2022.

MAIN OUTCOMES AND MEASURES

Pathological complete response (pCR) rate and major pathological response (MPR) rate were considered to be the primary outcomes calculated for the clinical outcomes of neoadjuvant immunotherapy. Incidence of treatment-related severe adverse events was set as the major measure for the safety outcome. The rate of R0 surgical resection was summarized. Subgroup analyses were conducted according to histologic subtype and ICI types.

RESULTS

A total of 27 clinical trials with 815 patients were included. Pooled rates were 31.4% (95% CI, 27.6%-35.3%) for pCR and 48.9% (95% CI, 42.0-55.9%) for MCR in patients with esophageal cancer. In terms of safety, the pooled incidence of treatment-related severe adverse events was 26.9% (95% CI, 16.7%-38.3%). Most patients achieved R0 surgical resection (98.6%; 95% CI, 97.1%-99.6%). Regarding histologic subtypes, the pooled pCR rates were 32.4% (95% CI, 28.2%-36.8%) in esophageal squamous cell carcinoma and 25.2% (95% CI, 16.3%-35.1%) in esophageal adenocarcinoma. The pooled MPR rate was 49.4% (95% CI, 42.1%-56.7%) in esophageal squamous cell carcinoma.

CONCLUSIONS AND RELEVANCE

This study found that neoadjuvant immunotherapy with chemotherapy had promising clinical and safety outcomes for patients with resectable esophageal cancer. Randomized clinical trials with long-term follow-up are warranted to validate the findings and benefits of ICIs.

Atrial fibrillation in patients with Graves disease: incidence, risk factors and outcomes

Background

Graves' disease (GD) is associated with atrial fibrillation (AF) with a prevalence ranging between 16% and 60%, but its risk factors are not well-defined. We aimed to describe the incidence, risk factors and outcomes of GD-related AF.

Methods

Patients diagnosed with GD between 2009 and 2019 were included retrospectively. We defined GD-related AF as AF diagnosed within 30 days before or any time after diagnosis of GD. Late onset AF was defined as GD-related AF diagnosed more than 90 days after GD diagnosis. Observed AF events were compared to the expected events in the general population utilizing published data of age and sex-specific rates of AF.

Results

Of 1371 patients with GD, AF occurred in 139 (10.1%) patients. Late onset AF occurred in 32 (23%), of which 50% had attained euthyroidism. The observed incidence of AF was higher in GD than that expected in the general population (p&lt;0.001), Figure 1. When comparing the incidence of only late AF to that in the general population, late AF still happened more frequently in GD although not achieving statistical significance (p=0.06), Figure 1. Independent risk factors were age [HR 1.05 (1.03–1.06) per year], overt hyperthyroidism [HR 2.71 (1.35–5.44)], and male gender [HR 2.42 (1.57–3.71)] for early AF and age [HR 1.06 (1.02–1.09) per year], BMI [1.07 (1.01–1.12) per unit], COPD [3.33 (1.08–10.27)), heart failure [HR 4.19 (1.39–17.42)], and treatment with thionamide [vs. radioiodine ablation HR 2.94 (1.38–6.27)] for late AF. AF was associated with higher rates of mortality [HR 16.32 (4.66–56.58)], acute coronary syndrome/stable angina events [HR 3.89 (1.23–12.31)], and cardiac hospitalizations [HR 15.39 (8.17–29.00)] when adjusted to age, sex, and previous AF.

Conclusion

AF occurred in 10.1% of GD patients. Late onset AF is an important entity comprising a quarter of GD-related AF cases and requires surveillance even after restoring euthyroidism. Risk factors for AF in GD are similar to those in general population, although overt hyperthyroidism conferred the highest risk, especially for early AF. Treatment with thionamide was associated with late AF.

Funding Acknowledgement

Type of funding sources: None.

Predictive mutation signature of immunotherapy benefits in NSCLC based on machine learning algorithms

Background

Developing prediction tools for immunotherapy approaches is a clinically important and rapidly emerging field. The routinely used prediction biomarker is inaccurate and may not adequately utilize large amounts of medical data. Machine learning is a promising way to predict the benefit of immunotherapy from individual data by individuating the most important features from genomic data and clinical characteristics.

Methods

Machine learning was applied to identify a list of candidate genes that may predict immunotherapy benefits using data from the published cohort of 853 patients with NSCLC. We used XGBoost to capture nonlinear relations among many mutation genes and ICI benefits. The value of the derived machine learning-based mutation signature (ML-signature) on immunotherapy efficacy was evaluated and compared with the tumor mutational burden (TMB) and other clinical characteristics. The predictive power of ML-signature was also evaluated in independent cohorts of patients with NSCLC treated with ICI.

Results

We constructed the ML-signature based on 429 (training/validation = 8/2) patients who received immunotherapy and extracted 88 eligible predictive genes. Additionally, we conducted internal and external validation with the utility of the OAK+POPLAR dataset and independent cohorts, respectively. This ML-signature showed the enrichment in immune-related signaling pathways and compared to TMB, ML-signature was equipped with favorable predictive value and stratification.

Conclusion

Previous studies proposed no predictive difference between original TMB and modified TMB, and original TMB contains some genes with no predictive value. To demonstrate that fewer genetic tests are sufficient to predict immunotherapy efficacy, we used machine learning to screen out gene panels, which are used to calculate TMB. Therefore, we obtained the 88-gene panel, which showed the favorable prediction performance and stratification effect compared to the original TMB.

Bioinformatics analysis of potential pathogenesis and risk genes of immunoinflammation-promoted renal injury in severe COVID-19

Renal injury secondary to COVID-19 is an important factor for the poor prognosis of COVID-19 patients. The pathogenesis of renal injury caused by aberrant immune inflammatory of COVID-19 remains unclear. In this study, a total of 166 samples from 4 peripheral blood transcriptomic datasets of COVID-19 patients were integrated. By using the weighted gene co-expression network (WGCNA) algorithm, we identified key genes for mild, moderate, and severe COVID-19. Subsequently, taking these genes as input genes, we performed Short Time-series Expression Miner (STEM) analysis in a time consecutive ischemia-reperfusion injury (IRI) -kidney dataset to identify genes associated with renal injury in COVID-19. The results showed that only in severe COVID-19 there exist a small group of genes associated with the progression of renal injury. Gene enrichment analysis revealed that these genes are involved in extensive immune inflammation and cell death-related pathways. A further protein-protein interaction (PPI) network analysis screened 15 PPI-hub genes: ALOX5, CD38, GSF3R, LGR, RPR1, HCK, ITGAX, LYN, MAPK3, NCF4, SELP, SPI1, WAS, TLR2 and TLR4. Single-cell sequencing analysis indicated that PPI-hub genes were mainly distributed in neutrophils, macrophages, and dendritic cells. Intercellular ligand-receptor analysis characterized the activated ligand-receptors between these immune cells and parenchyma cells in depth. And KEGG enrichment analysis revealed that viral protein interaction with cytokine and cytokine receptor, necroptosis, and Toll-like receptor signaling pathway may be potentially essential for immune cell infiltration leading to COVID-19 renal injury. Finally, we validated the expression pattern of PPI-hub genes in an independent data set by random forest. In addition, we found that the high expression of these genes was correlated with a low glomerular filtration rate. Including them as risk genes in lasso regression, we constructed a Nomogram model for predicting severe COVID-19. In conclusion, our study explores the pathogenesis of renal injury promoted by immunoinflammatory in severe COVID-19 and extends the clinical utility of its key genes.

P-676 Comparison of hCG triggering versus hCG in combination with a GnRH agonist: a prospective randomized controlled trial

Study question

Does co-administration of GnRH agonist and Human chorionic gonadotropin(dual trigger) in PGT cycles improve the number of usable blastocysts per patient compared to hCG alone?

Summary answer

Using the dual trigger has no effect on the number of usable blastocysts undergoing the GnRH-ant protocol for PGT compared to triggering with hCG alone.

What is known already

HCG is used at the end of controlled ovarian hyperstimulation as a surrogate LH surge to induce final oocyte maturation. Recently, based on retrospective studies, the co-administration of GnRH agonist and hCG for final oocyte maturation (dual trigger) has been suggested to improve IVF outcome and pregnancy rates.

Study design, size, duration

A prospective, randomized, open-label controlled clinical trial (ChiCTR-ICR-2000031342), enrolled patients attending our university affiliated Infertility and IVF center (the Reproductive and Genetic Hospital of CITIC-Xiangya, China) between August 2020 and June 2021. This sample size achieves with a power of 80%, at a significance level(α) of 0.05. A sample size of 160 patients, 80 randomized to each group, was chosen to allow for those 10% dropped out.

Participants/materials, setting, methods

The inclusion criteria for participating were: women age 20–35years, AMH≥1.2ng/ml and /or AFC ≥5, Couples with PGT-SR preimplantation genetic testing for chromosomal structural rearrangements (patients with abnormal chromosomal structure only in male or female), undergoing one of their first PGT cycle attempts. Patients fulfilled the criteria on the trigger day were randomly assigned to receive hCG or the dual trigger for final oocyte maturation. The primary outcome was the number of usable blastocysts per patient.

Main results and the role of chance

160 patients were included in the study. The age (29.1 years versus 29.4 years), BMI (22.1 kg/m2 versus 21.9 kg/m2) and the AMH (5.3 ng/ml versus 5.3 ng/ml) were comparable between the two groups. Based on PP analysis, there were no statistical difference in the number of eggs retrieved (17.1 versus 15.9), the MII oocytes (13.3 versus 12.5), the number of usable blastocysts per patient (5.0 versus 4.6) and top-quality blastocysts per patient (3.4 versus 3.2) between the two groups.

Limitations, reasons for caution

None

Wider implications of the findings

The enhanced response observed with the dual trigger might lead to better IVF outcomes were it used more widely.

Trial registration number

ChiCTR-ICR-2000031342

P-524 Bi-allelic CFAP61 variants cause male infertility in humans and mice with severe oligoasthenoteratozoospermia

Study question

Are mutations in cilia and flagella-associated protein 61 (CFAP61) associated with human male infertility?

Summary answer

Bi-allelic variants ([NM_015585.4: c.1654C&gt;T (p.R552C) and c.2911G&gt;A (p.D971N), c.144-2A&gt;G and c.1666G&gt;A (p.G556R)] in CFAP61 were identified as contributory genetics factor in severe oligoasthenoteratozoospermia (OAT).

What is known already

Cfap61 knockout mice were infertile due to multiple morphological abnormalities of the sperm flagella (MMAF). However, so far there is no direct evidence that mutations of CFAP61 cause OAT and male infertility.

Study design, size, duration

Variant screening was performed by whole-exome sequencing (WES) from 325 infertile patients with OAT and 392 fertile individuals. A knockout mouse model was generate to confirm the candidate disease-causing gene, intracytoplasmic sperm injection (ICSI) was used to evaluate the efficiency of clinical treatment.

Participants/materials, setting, methods

A total 325 OAT-affected patients and 392 men with normal fertility were recruited from China. WES was performed, followed by Sanger sequencing validation. In silico bioinformatics predictions and in vitro functional analyses were performed to evaluate the impacts of candidate disease-causing variants. Hematoxylin and eosin (H&E) staining, electron microscopy, and immunofluorescence assays were performed to evaluate the sperm morphology. Two OAT-affected men with CFAP61 variants were treated by ICSI, and pregnancy outcomes were followed.

Main results and the role of chance

We identified bi-allelic CFAP61 variants [NM_015585.4: c.1654C&gt;T (p.R552C) and c.2911G&gt;A (p.D971N), c.144-2A&gt;G and c.1666G&gt;A (p.G556R)] in two (0.62%) of the 325 OAT-affected men. In silico bioinformatics analysis predicted that all four variants were deleterious, and in vitro functional analysis confirmed the deleterious effects of the mutants. Notably, H&E staining and electron microscopy analyses of the spermatozoa revealed multiple morphological abnormalities of sperm flagella, the absence of central pair microtubules, and mitochondrial sheath malformation in sperm flagella from man with CFAP61 variants. Further immunofluorescence assays revealed markedly reduced CFAP61 staining in the sperm flagella. In addition, Cfap61-deficient mice showed the OAT phenotype, suggesting that loss of function of CFAP61 was the cause of OAT. Two individuals accepted ICSI therapy using their own ejaculated sperm, and one of them succeeded in fathering a healthy baby.

Limitations, reasons for caution

Limitations include the lack of in vivo data from the one of patients, and the exact molecular mechanism should be further investigated.

Wider implications of the findings

Our findings indicate that CFAP61 is essential for spermatogenesis and that bi-allelic CFAP61 variants lead to OAT and male infertility in humans and mice. In addition, our results show that ICSI treatment can be recommended for CFAP61-related OAT.

Trial registration number

not applicable

P-060 Bubble-shaped Acrosome: Novel phenotype of Teratozoospermia Caused by Mutation in Actin-like 7A

Study question

What’s the etiology of severe teratozoospermia characteristic as bubble-shaped acrosome (BSA)?

Summary answer

Severe teratozoospermia characterized as BSA caused by mutation (c.1024G&gt;A) in actin-like 7A (ACTL7A).

What is known already

Teratozoospermia is a common cause of male infertility, defined by having a proportion of morphologically normal sperm at less than 4%. It exhibits aberrant sperm phenotypes in the head, neck, midpiece, and endpiece of sperm. Teratozoospermia with ephalic abnormalities are among the most severe and characteristic sperm defects. Some genetic factors are reported to be associated with ephalic abnormalities such as globozoospermia and macrozoospermia. However, other phenotypes and the causative genes of ephalic abnormalities, especially in acrosomal structure, and were largely unknown.

Study design, size, duration

Severe teratozoospermia were recruited from the Reproductive and Genetic Hospital of CITIC-Xiangya from Jan 2019 to Dec 2021.

Participants/materials, setting, methods

Whole-exome sequencing analysis was used to analyze the genetic factor of man. An Actl7a-mutated mouse model was generated by CRISPER-Cas9. Transmission electron microscopy was used to detect the abnormality of ultrastructure during acrosome biogenesis. Immunostaining was used to analyze the localization of ACTL7A and PLCζ. Immunoprecipitation followed by liquid chromatography-mass spectrometry (LC-MS) was used to select the differentially expressed proteins. ICSI with calcium ionophore exposure was performed in couple with ACTL7A mutation.

Main results and the role of chance

We found a man with severe teratozoospermia characterized as BSA carrying a mutation (c.1024G&gt;A) in ACTL7A. Homozygous Actl7a-mutated male mice were sterile, and all of sperm showed acrosomal abnormalities. During acrosomal biogenesis, it detected the acrosome detach from the nuclear in Actl7a-mutated mice. Furthermore, mutant ACTL7A failed to attach to the acroplaxome and was discharged by cytoplasmic droplets, which led to the absence of ACTL7A in mature sperm. The mutant sperm failed to activate the oocyte, and PLCζ discharge accompanied by ACTL7A was observed, leading to total fertilization failure (TFF). Immunoprecipitation followed by LC-MS showed that several differentially expressed proteins participate in acrosome assembly and actin filament organization. Furthermore, assisted oocyte activation by calcium ionophore exposure successfully overcame TFF in a couple with an ACTL7A mutation.

Limitations, reasons for caution

More cases are needed to demonstrate the relationship between mutation and phenotype.

Wider implications of the findings

Our study defined a novel phenotype of the acrosomal abnormality characterized as BSA and revealed the underlying mechanism of mutation in ACTL7A and provided a genetic marker and a therapeutic option for male infertility.

Trial registration number

Not Applicable

Pregnancy outcome after in-vitro fertilization/intracytoplasmic sperm injection in women with congenital uterus didelphys

OBJECTIVE

To investigate the pregnancy and obstetric outcomes of patients with congenital uterus didelphys who achieved clinical pregnancy after in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

METHODS

This was a retrospective matched-cohort study of 83 infertile patients with uterus didelphys who underwent IVF/ICSI and achieved clinical pregnancy from January 2005 to December 2018 at our center. For each patient in the study group, three control patients with normal uterine morphology who underwent IVF/ICSI in 2018 were selected randomly. Patients in the two groups were matched for number of gestational sacs, maternal age, infertility type, cause of infertility, fertilization method, endometrial thickness 1 day before embryo transfer and number of embryos transferred. The classification of congenital uterine anomalies was based on the American Fertility Society system (1988). The pregnancy and obstetric outcomes of the didelphic and control groups were compared separately for singleton and twin pregnancies, and for all pregnancies combined.

RESULTS

In singleton pregnancies, women with uterus didelphys had increased risk of preterm birth (odds ratio (OR), 4.68; rate difference (RD), 0.14; P < 0.001), Cesarean section (OR, 2.80; RD, 0.17; P = 0.016) and birth weight < 2500 g (OR, 4.06; RD, 0.10; P = 0.017) compared to women with normal uterine morphology. In twin pregnancies, the presence of uterus didelphys was associated with increased risk of preterm delivery (OR, 4.79; RD, 0.37; P = 0.006), perinatal mortality (OR, 3.16; RD, 0.19; P = 0.043) and birth weight < 2500 g (OR, 9.57; RD, 0.35; P = 0.001).

CONCLUSIONS

The presence of uterus didelphys was associated with significantly increased risk of some adverse pregnancy outcomes compared to pregnancies with normal uterine morphology in women who underwent IVF/ICSI. A twin pregnancy in women with uterus didelphys was associated with worse perinatal outcome. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Characterizing warm atmospheric boundary layer over land by combining Raman and Doppler lidar measurements

PBL plays a critical role in the atmosphere by transferring heat, moisture, and momentum. The warm PBL has a distinct diurnal cycle including daytime convective mixing layer (ML) and nighttime residual layer developments. Thus, for PBL characterization and process study, simultaneous determinations of PBL height (PBLH) and ML height (MLH) are necessary. Here, new approaches are developed to provide reliable PBLH and MLH to characterize warm PBL evolution. The approaches use Raman lidar (RL) water vapor mixing ratio (WVMR) and Doppler lidar (DL) vertical velocity measurements at the Southern Great Plains (SGP) atmospheric observatory, which was established by the Atmospheric Radiation Measurement (ARM) user facility. Compared with widely used lidar aerosol measurements for PBLH, WVMR is a better trace for PBL vertical mixing. For PBLH, the approach classifies PBL water vapor structures into a few general patterns, then uses a slope method and dynamic threshold method to determine PBLH. For MLH, wavelet analysis is used to re-construct 2-D variance from DL vertical wind velocity measurements according to the turbulence eddy size to minimize the impacts of gravity wave and eddy size on variance calculations; then, a dynamic threshold method is used to determine MLH. Remotely-sensed PBLHs and MLHs are compared with radiosonde measurements based on the Richardson number method. Good agreements between them confirm that the proposed new algorithms are reliable for PBLH and MLH characterization. The algorithms are applied to warm seasons' RL and ML measurements at the SGP site for five years to study warm season PBL structure and processes. The weekly composited diurnal evolutions of PBLHs and MLHs in warm climate were provided to illustrate diurnal and seasonal PBL evolutions. This reliable PBLH and MLH dataset will be valuable for PBL process study, model evolution, and PBL parameterization improvement.

Pulmonary artery pulsatility index by echocardiography predicts mortality in patients with pulmonary hypertension

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary hypertension (PH) is a progressive pulmonary vascular disorder with an elevated mortality risk due to right ventricular failure. Pulmonary arterial pulsatility index (PAPi) based on invasively acquired parameters has emerged as a potentially valuable hemodynamic risk predictor. Whether non-invasively derived PAPi (PA pulse pressure/ RA pressure) is valuable is unclear.

Purpose

To assess whether PAPi measured non-invasively by transthoracic echocardiography acts as a prognostic hemodynamic biomarker of patient risk.

Methods

Consecutive patients undergoing transthoracic echocardiography for known or suspected PH over a one year period were included. PA systolic and diastolic pressure were estimated in standard fashion from peak tricuspid and end-pulmonary regurgitant Doppler profiles. Right atrial pressure was estimated based on 2D & Doppler assessment of the inferior vena cava  hepatic vein. In those patients with PH (mean PA pressure &gt; 20 mm Hg), PAPi was divided into 3 groups based on prior publications with invasive data as &lt;1.5, 1.5 to 3 and &gt;3. Mortality was assessed over 5 years.

Results

Of 1,045 patients enrolled 64% had PH. Patients with the lowest PAPi (table) had higher NT-proBNP levels, larger right ventricles, worse right heart systolic function (cardiac output, TAPSE, systolic annular velocity, free wall systolic strain) and greater degrees of tricuspid regurgitation (Table). In patients with PH, PAPi was inversely associated with death (figure, p &lt; 0.0001) with each group of PAPi correlating with incrementally worse survival. Patients with a PAPi of &lt;1.5 had worst right heart size and dysfunction on echo (table) and worst survival (figure).

Conclusions

In patients with PH, low PAPi derived non-invasively by transthoracic echocardiography is associated with markers of right heart failure, right ventricular dysfunction and worse survival. PAPi could be incorporated into the conventional echo parameters reported in patients with known or suspected PH and maybe a useful predictor of outcome. Abstract Table  Abstract Figure

Arsenic (As) contamination in sediments from coastal areas of China

Arsenic (As) from various anthropogenic sources has accumulated in estuarine and coastal sediments of China in the past decade, but we know little about the overall situation of As pollution at a national scale. Here, we analysed the spatial-temporal distribution characteristics, source, fate, and potential risks of As from 11 provincial-level regions across coastal China based on reviewed data extracted from previous studies published in the past 20 years. The anthropogenic contribution to As load was evident in 8 out of 11 provinces, especially in developed areas such as Tianjin, Zhejiang, and Guangdong. The weighted mean concentration of As in coastal sediments was 9.75 mg kg^-1, which was close to national agricultural land (10.7 mg kg^-1) and mixed land (12.1 mg kg^-1) soil values, and this indicated the likely terrestrial influences and homogenization of As distribution at the interface between land and sea. The accumulation has decreased significantly since 2005, which might be due to continuously reduced emissions from farming and animal husbandry and household consumption in the catchment of coastal areas. The geoaccumulation index indicated that the proportions of unpolluted, unpolluted to moderately polluted, and moderately polluted cases were 48%, 28%, and 8%, respectively. This study provides a comprehensive and quantitative review on As contamination in coastal sediments on a national scale. The results could be used in coastal sediment quality assessment and decision-making by authorities to meet the regulatory requirements linked to coastal environmental protection and management.

Traveling wave solutions in predator–prey models with competition

This paper studies the minimal wave speed of traveling wave solutions in predator–prey models, in which there are several groups of predators that compete among different groups. We investigate the existence and nonexistence of traveling wave solutions modeling the invasion of predators and coexistence of these species. When the positive solution of the corresponding kinetic system converges to the unique positive steady state, a threshold that is the minimal wave speed of traveling wave solutions is obtained. To finish the proof, we construct contracting rectangles and upper–lower solutions and apply the asymptotic spreading theory of scalar equations. Moreover, multiple propagation thresholds in the corresponding initial value problem are presented by numerical examples, and one threshold may be the minimal wave speed of traveling wave solutions.