TMF inhibits extracellular matrix degradation by regulating the C/EBPβ/ADAMTS5 signaling pathway in osteoarthritis

Osteoarthritis (OA) is a chronic joint disease, characterized by degenerative destruction of articular cartilage. Chondrocytes, the unique cell type in cartilage, mediate the metabolism of extracellular matrix (ECM), which is mainly constituted by aggrecan and type II collagen. A disintegrin and metalloproteinase with thrombospondin 5 (ADAMTS5) is an aggrecanase responsible for the degradation of aggrecan in OA cartilage. CCAAT/enhancer binding protein β (C/EBPβ), a transcription factor in the C/EBP family, has been reported to mediate the expression of ADAMTS5. Our previous study showed that 5,7,3',4'-tetramethoxyflavone (TMF) could activate the Sirt1/FOXO3a signaling in OA chondrocytes. However, whether TMF protected against ECM degradation by down-regulating C/EBPβ expression was unknown. In this study, we found that aggrecan expression was down-regulated, and ADAMTS5 expression was up-regulated. Knockdown of C/EBPβ could up-regulate aggrecan expression and down-regulate ADAMTS5 expression in IL-1β-treated C28/I2 cells. TMF could compromise the effects of C/EBPβ on OA chondrocytes by activating the Sirt1/FOXO3a signaling. Conclusively, TMF exhibited protective activity against ECM degradation by mediating the Sirt1/FOXO3a/C/EBPβ pathway in OA chondrocytes.

Cardiac MRI feature-tracking-derived torsion mechanics in systolic and diastolic dysfunction in systemic light-chain cardiac amyloidosis

AIM

To describe the myocardial torsion mechanics in cardiac amyloidosis (CA), and evaluate the correlations between left ventricle (LV) torsion mechanics and conventional parameters using cardiac magnetic resonance imaging feature tracking (CMR-FT).

MATERIALS AND METHODS

One hundred and thirty-nine patients with light-chain CA (AL-CA) were divided into three groups: group 1 with preserved systolic function (LV ejection fraction [LVEF] ≥50%, n=55), group 2 with mildly reduced systolic function (40% ≤ LVEF <50%, n=51), and group 3 with reduced systolic function (LVEF <40%, n=33), and compared with age- and gender-matched healthy controls (n=26). All patients underwent cine imaging and late gadolinium-enhancement (LGE). Cine images were analysed offline using CMR-FT to estimate torsion parameters.

RESULTS

Global torsion, base-mid torsion, and peak diastolic torsion rate (diasTR) were significantly impaired in patients with preserved systolic function (p<0.05 for all), whereas mid-apex torsion and peak systolic torsion rate (sysTR) were preserved (p>0.05 for both) compared with healthy controls. In patients with mildly reduced systolic function, global torsion and base-mid torsion were lower compared to those with preserved systolic function (p<0.05 for both), while mid-apex torsion, sysTR, and diasTR were preserved (p>0.05 for all). In patients with reduced systolic function, only sysTR was significantly worse compared with mildly reduced systolic function (p<0.05). At multivariable analysis, right ventricle (RV) end-systolic volume RVESV index and NYHA class were independently related to global torsion, whereas LVEF was independently related to sysTR. RV ejection fraction (RVEF) was independently related to diasTR. LV global torsion performed well (AUC 0.71; 95% confidence interval [CI]: 0.61, 0.77) in discriminating transmural from non-transmural LGE in AL-CA patients.

CONCLUSION

LV torsion mechanics derived by CMR-FT could help to monitor LV systolic and diastolic function in AL-CA patients and function as a new imaging marker for LV dysfunction and LGE transmurality.

A Real-World Disproportionality Analysis of Drug-Induced Immune Hemolytic Anemia in the FDA Adverse Event Reporting System

BACKGROUND

Drug-induced immune hemolytic anemia (DIIHA) is a rare but potentially life-threatening pharmacogenic hematological adverse effect. Updating the risk of DIIHA among the currently available drugs based on spontaneously reported adverse event data is of great significance.

OBJECTIVE

This study aimed to identify the top 50 drugs associated with immune hemolytic anemia in adults as well as common drugs that could cause immune hemolytic anemia in children based on the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database.

METHODS

We extracted adverse events (AE) in the FAERS database from Q1 2004 to Q3 2022 using Open vigil2.1. We use the high-level term "anaemias haemolytic immune" according to the Medical Dictionary for Regulatory Activities (MedDRA) Dictionary (version 24.0). The reported correlation between drugs and DIIHA risk was identified by reported odds ratio (ROR) and proportional reporting ratio (PRR).

RESULTS

There were 10500309 AEs in FAERS from 2004Q1 to 2022Q3, of which 2326 (0.02%) were DIIHA cases. The incidence of DIIHA is comparable between males and females. The most common drugs associated with DIIHA in adults and children are summarized according to the number of AE reports. The top 3 categories in terms of quantity of drugs are antineoplastic agents, immunosuppressants, and antibiotics for systemic use. The top 5 drugs in terms of ROR and PRR are alemtuzumab, daclizumab, fludarabine, busulfan, and bendamustine in adults, with entecavir, treosulfan, vinorelbine, pegademase, and alemtuzumab for children.

CONCLUSIONS

Our study identified the most common drugs that could induce DIIHA in adults and children, as well as the respective ROR and PRR value to discover new drug signals. This study provides references to clinicians for the management of rare DIIHA.

A pharmacovigilance study of adverse event profiles and haemorrhagic safety of bevacizumab based on the FAERS database

BACKGROUND

Bevacizumab is used for the treatment of advanced malignant tumors; it acts by inhibiting angiogenesis. This study aimed to examine adverse events (AEs) of bevacizumab, especially hemorrhage, using the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

RESEARCH DESIGN AND METHODS

The reporting odds ratio (ROR) and proportional reporting ratio (PRR) were used to analyze the AEs of bevacizumab using FAERS registration data from January 2004 to September 2022. Clinical information regarding hemorrhagic signals was further analyzed.

RESULTS

The number of bevacizumab-associated AE reports was 96,477. Our study found that 892 significant preferred terms (PTs) were spread throughout 25 organ systems. The system organ classes (SOCs) focus on general disorders, administration site conditions, blood and lymphatic system disorders, injury, poisoning, and procedural complications. A total of 2,847 bevacizumab-related hemorrhage cases were reported, and 37 hemorrhagic signals were identified. Hemorrhagic signals were focused on SOC levels in vascular, gastrointestinal, and nervous system disorders. Colorectal, lung, and breast cancers are the three most common malignancies associated with BV-induced hemorrhage.

CONCLUSION

The AE report from the present study confirms the majority of label information for bevacizumab, while also identifying new AEs. In addition, this was a large descriptive study of bevacizumab-induced hemorrhage.

C/EBPβ: The structure, regulation, and its roles in inflammation-related diseases

Inflammation, a mechanism of the human body, has been implicated in many diseases. Inflammatory responses include the release of inflammatory mediators by activating various signaling pathways. CCAAT/enhancer binding protein β (C/EBPβ), a transcription factor in the C/EBP family, contains the leucine zipper (bZIP) domain. The expression of C/EBPβ is mediated at the transcriptional and post-translational levels, such as phosphorylation, acetylation, methylation, and SUMOylation. C/EBPβ has been involved in inflammatory responses by mediating several signaling pathways, such as MAPK/NF-κB and IL-6/JAK/STAT3 pathways. C/EBPβ plays an important role in the pathological development of inflammation-related diseases, such as osteoarthritis, pneumonia, hepatitis, inflammatory bowel diseases, and rheumatoid arthritis. Here, we comprehensively discuss the structure and biological effects of C/EBPβ and its role in inflammatory diseases.

Advances in the roles of ATF4 in osteoporosis

Osteoporosis (OP) is characterized by reduced bone mass, decreased strength, and enhanced bone fragility fracture risk. Activating transcription factor 4 (ATF4) plays a role in cell differentiation, proliferation, apoptosis, redox balance, amino acid uptake, and glycolipid metabolism. ATF4 induces the differentiation of bone marrow mesenchymal stem cells (BM-MSCs) into osteoblasts, increases osteoblast activity, and inhibits osteoclast formation, promoting bone formation and remodeling. In addition, ATF4 mediates the energy metabolism in osteoblasts and promotes angiogenesis. ATF4 is also involved in the mediation of adipogenesis. ATF4 can selectively accumulate in osteoblasts. ATF4 can directly interact with RUNT-related transcription factor 2 (RUNX2) and up-regulate the expression of osteocalcin (OCN) and osterix (Osx). Several upstream factors, such as Wnt/β-catenin and BMP2/Smad signaling pathways, have been involved in ATF4-mediated osteoblast differentiation. ATF4 promotes osteoclastogenesis by mediating the receptor activator of nuclear factor κ-B (NF-κB) ligand (RANKL) signaling. Several agents, such as parathyroid (PTH), melatonin, and natural compounds, have been reported to regulate ATF4 expression and mediate bone metabolism. In this review, we comprehensively discuss the biological activities of ATF4 in maintaining bone homeostasis and inhibiting OP development. ATF4 has become a therapeutic target for OP treatment.

[Notch signaling pathway inhibitor DAPT improves alcohol-induced neuronal differentiation impairment in zebrafish]

OBJECTIVE

To explore the role of the Notch signaling pathway in regulating neuronal differentiation and sensorimotor ability in a zebrafish model of fetal alcohol spectrum disorder.

METHODS

Zebrafish embryos treated with DMSO or 50 μmol/L DAPT (a Notch signaling pathway inhibitor) were examined for mortality rate, hatching rate, malformation rate, and body length at 15 days post fertilization (dpf). The mRNA expression levels of sox2, neurogenin1 and huc in the treated zebrafish embryos were detected using in situ hybridization and qRT-PCR, and their behavioral responses to strong light and vibration stimulation were observed. The zebrafish embryos were then exposed to DMSO, 1.5% ethanol, DAPT, or both ethanol and DAPT, and the changes in mRNA expression levels of sox2, neurogenin1, huc, and the Notch signaling pathway genes as well as behavioral responses were evaluated.

RESULTS

Exposure to 50 μmol/L DAPT significantly increased the mortality rate of 1 dpf zebrafish embryos (P < 0.01), decreased the hatching rate of 2 dpf embryos (P < 0.01), increased the malformation rate of 3 dpf embryos (P < 0.001), and reduced the body length of 15 dpf embryos (P < 0.05). DAPT treatment significantly downregulated sox2 mRNA expression (P < 0.01) and increased neurogenin1 (P < 0.05) and huc (P < 0.01) mRNA expressions in zebrafish embryos. The zebrafish with DAPT treatment exhibited significantly shortened movement distance (P < 0.001) and lowered movement speed (P < 0.05) in response to all the stimulation conditions. Compared with treatment with 1.5% ethanol alone, which obviously upregulated notch1a, her8a and NICD mRNA expressions in zebrafish embryos (P < 0.05), the combined treatment with ethanol and DAPT significantly increased neurogenin1 and huc mRNA expression, decreased sox2 mRNA expression (P < 0.01), and increased the moving distance and moving speed of zebrafish embryos in response to strong light stimulation (P < 0.05).

CONCLUSION

Ethanol exposure causes upregulation of the Notch signaling pathway and impairs neuronal differentiation and sensorimotor ability of zebrafish embryos, and these detrimental effects can be lessened by inhibiting the Notch signaling pathway.

Detection of haemodynamic obstruction in hypertrophic cardiomyopathy using the sub-aortic complex: a cardiac MRI and Doppler study

AIM

To investigate the "sub-aortic complex (SAC)", a new cardiac magnetic resonance imaging (CMRI)-derived parameter, for the evaluation of left ventricular (LV) outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy (HCM), compared with conventional CMRI parameters and Doppler echocardiography.

MATERIALS AND METHODS

A total of 157 consecutive patients with HCM were recruited retrospectively. The patients were divided into two groups, 87 with LVOT obstruction and 70 without obstruction. The SAC was defined as a specific anatomical SAC affecting the LVOT, which were measured on the LV three-chamber steady-state free precession (SSFP) cine image at the end-systolic phase. The relations between the existence and severity of obstruction and SAC index (SACi) were evaluated using Pearson's correlation coefficient, receiver operating characteristic (ROC) curves, and logistic regression.

RESULTS

The SACs were significantly different between the obstructive and non-obstructive groups. The ROC curves indicated that the SACi was able to discriminate obstructive and non-obstructive patients with the best predictive accuracy (AUC = 0.949, p<0.001). The SACi was an independent predictor of LVOT obstruction and there was a significant negative correlation between resting LVOT pressure gradient and SACi (r=0.72 p<0.001). In the subgroup of patients with or without severe basal septal hypertrophy, the SACi was still able to predict LVOT obstruction with excellent diagnostic accuracy (AUC = 0.944 and 0.948, p<0.001, respectively).

CONCLUSION

The SAC is a reliable and straightforward CMRI marker for assessing LVOT obstruction. It is more effective than CMRI two-dimensional flow in diagnosing the severity of obstruction in patients with HCM.

Biodegradable Nanofibrillated Cellulose/Poly-(butylene adipate-co-terephthalate) Composite Film with Enhanced Barrier Properties for Food Packaging

Biodegradable composites consisting of Poly-(butylene adipate-co-terephthalate) (PBAT), thermoplastic starch, hydrophobically modified nanofibrillated cellulose (HMNC), and green surfactant (sucrose fatty acid ester) were prepared via the melt-mixing and film-blowing process (PBAT-HMNC). The composites were characterized using the Fourier transform infrared spectroscope (FT-IR), scanning electron microscope (SEM), and thermogravimetric analyzer (TGA). The mechanical and barrier properties were systematically studied. The results indicated that PBAT-HMNC composites exhibited excellent mechanical and barrier properties. The tensile strength reached the maximum value (over 13 MPa) when the HMNC content was 0.6% and the thermal decomposition temperature decreased by 1 to 2 °C. The lowest values of the water vapor transmission rate (WVTR) and the oxygen transmission rate (OTR) were obtained from the composite with 0.6 wt% HMNC, prepared via the film-bowing process with the values of 389 g/(m2·day) and 782 cc/(m2·day), which decreased by 51.3% and 42.1%, respectively. The Agaricus mushrooms still had a commodity value after 11 days of preservation using the film with 0.6 wt% HMNC. PBAT-HMNC composites have been proven to be promising nanocomposite materials for packaging.

Multilamellar spherical micelles of alkali lignin: dissipative particle dynamics simulations

CONTEXT

Lignin has an immense potential for the production of lignin-based functional materials. In this work, effect of 2-chloro-ethyltrimethyl ammonium chloride (AC)-grafted alkali lignin (AL) on the morphologies in water was investigated by dissipative particle dynamics (DPD) simulations. The results showed that AL molecules formed spherical micelles, but the corresponding phenylpropane units of AL were randomly distributed in spherical micelles. However, AC-grafted modification of phenolic hydroxyl groups in AL led to the formation of multilamellar spherical micelles. The formation of multilamellar spherical micelles of AL mainly went through four stages: small clusters, larger aggregates with a core-shell structure, trilaminar, and multilamellar spherical micelles. AL molecules resulted in dimethomorph molecules being randomly distributed in the spherical micelle, while the dimethomorph molecules were perfectly entrapped into the spherical micelles of AC-grafted AL. Various molecular weights of AL had no effect on the formation and size of multilamellar spherical micelles. With increasing the content of AC-grafted AL, small clusters, multilamellar spherical micelles, tube-like, and lamellar aggregates were observed successively. This work highlights the potential of lignin to prepare monodispersed lignin-based functional colloidal spheres.

METHODS

Coarse-grained beads were performed energy minimization, geometric optimization, NPT ensemble (298 K and 1.0 bar), and NVT ensemble (298 K) calculations. DPD simulations were carried out at 300,000 steps in a 30×30×30 Rc³ cubic box with Materials Studio 7.0 program.

Outstanding Bio-Tribological Performance Induced by the Synergistic Effect of 2D Diamond Nanosheet Coating and Silk Fibroin

Due to their excellent biocompatibility, outstanding mechanical properties, high strength-to-weight ratio, and good corrosion resistance, titanium (Ti) alloys are extensively used as implant materials in artificial joints. However, Ti alloys suffer from poor wear resistance, resulting in a considerably short lifetime. In this study, we demonstrate that the chemical self-assembly of novel two-dimensional (2D) diamond nanosheet coatings on Ti alloys combined with natural silk fibroin used as a novel lubricating fluid synergistically results in excellent friction and wear performance. Linear-reciprocating sliding tests verify that the coefficient of friction and the wear rate of the diamond nanosheet coating under silk fibroin lubrication are reduced by 54 and 98%, respectively, compared to those of the uncoated Ti alloy under water lubrication. The lubricating mechanism of the newly designed system was revealed by a detailed analysis of the involved microstructural and chemical changes. The outstanding tribological behavior was attributed to the establishment of artificial joint lubrication induced by the cross binding between the diamond nanosheets and silk fibroin. Additionally, excellent biocompatibility of the lubricating system was verified by cell viability, which altogether paves the way for the application of diamond coatings in artificial Ti joint implants.

[Soluble egg antigen of Schistosoma japonicum induces macrophage apoptosis in mice]

OBJECTIVE

To investigate the dynamic changes of macrophage numbers and apoptosis during Schistosoma japonicum infection, and to investigate the possible mechanisms of macrophage apoptosis induced by S. japonicum soluble egg antigen (SEA).

METHODS

C57BL/6 mice at ages of 6~8 weeks were randomly divided into 4 groups, including three experimental groups and a normal control group. Each mouse in the experimental groups was infected with (12 ± 1) cercariae of S. japonicum via the abdominal skin, and all mice in an experimental group were sacrificed 3, 5, 8 weeks post-infection, respectively, while mice in the control group were not infected with S. japonicum cercariae and sacrificed on the day of S. japonicum infection in the experimental group. Mouse liver specimens and peritoneal exudation cells were sampled in each group, and the dynamic changes of macrophage numbers and apoptosis were detected. Mouse peritoneal macrophages were isolated, purified and treated with S. japonicum SEA, PBS and ovalbumin (OVA) in vitro, and the macrophage apoptosis was detected using flow cytometry. The mRNA and protein expression of BCL-2 protein family members were determined in macrophages using real-time quantitative PCR (qP-CR) and Western blotting assays, and the activation of caspase 3 was determined using flow cytometry and Western blotting. In addition, macrophages were in vitro treated with S. japonicum SEA in presence of a caspase inhibitor, H₂O₂ or N-acetyl-L-cysteine, and the apoptosis of macrophages was detected using flow cytometry.

RESULTS

The total macrophage numbers continued to increase in mouse liver [(0.873 ± 0.106) × 106, (2.737 ± 0.460) × 10⁶ and (3.107 ± 0.367) × 10⁶ cells, respectively; F = 81.900, P < 0.01] and peritoneal specimens [(5.282 ± 1.136) × 105, (7.500 ± 1.200) × 10⁵ and (12.800 ± 0.800) × 10⁵ cells, respectively; F = 55.720, P < 0.01] 3, 5 and 8 weeks post-infection with S. japonicum, and the numbers of apoptotic macrophages also continued to increase in mouse liver [(0.092 ± 0.018) × 10⁶, (0.186 ± 0.025) × 10⁶ and (0.173 ± 0.0270) × 10⁶ cells; F = 57.780, P < 0.01] and peritoneal specimens [(0.335 ± 0.022) × 10⁵, (0.771 ± 0.099) × 10⁵ and (1.094 ± 0.051) × 10⁵ cells; F = 49.460, P < 0.01] 3, 5 and 8 weeks post-infection with S. japonicum. The apoptotic rate of SEA-treated macrophages [(24.330 ± 0.784)%] was significantly higher than that of PBS-[(18.500 ± 1.077)%] and OVA-treated macrophages [(18.900 ± 1.350)%] (both P values < 0.01). There were no significant differences in the mRNA or protein expression of Bcl-2 [Bcl - 2 mRNA expression: (1.662 ± 0.943) vs. (1.000 ± 0.000), t = 1.215, P > 0.05; BCL protein expression: (0.068 ± 0.004) vs. (0.070 ± 0.005), t = 0.699, P > 0.05], Bax [Bax mRNA expression: (0.711 ± 0.200) vs. (1.000 ± 0.000), t = 2.507, P > 0.05; BAX protein expression: (0.089 ± 0.005) vs. (0.097 ± 0.003), t = 2.232, P > 0.05] and Bak [Bak mRNA expression: (1.255 ± 0.049) vs. (1.00 ± 0.00), t = 0.897, P > 0.05; BAK protein expression: (0.439 ± 0.048) vs. (0.571 ± 0.091), t = 2.231, P > 0.05] between in SEA- and PBS-treated macrophages. S. japonicum SEA induced macrophage apoptosis in the presence of a caspase inhibitor (F = 0.411, P > 0.05); however, SEA failed to induce macrophage apoptosis in the presence of H₂O₂ or NAC (F = 11.880 and 9.897, both P values < 0.05).

CONCLUSIONS

S. japonicum SEA may induce macrophage apoptosis through promoting reactive oxygen species expression during S. japonicum infections in mice.

Development and validation of an individualized nomogram for predicting the high-volume (> 5) central lymph node metastasis in papillary thyroid microcarcinoma

PURPOSE

Papillary thyroid microcarcinoma (PTMC) frequently presents a favorable clinical outcome, while aggressive invasiveness can also be found in some of this population. Identifying the risk clinical factors of high-volume (> 5) central lymph node metastasis (CLNM) in PTMC patients could help oncologists make a better-individualized clinical decision.

METHODS

We retrospectively reviewed the clinical characteristics of adult patients with PTC in the Surveillance, Epidemiology, and End Results (SEER) database between Jan 2010 and Dec 2015 and in one medical center affiliated to Chongqing Medical University between Jan 2018 and Oct 2020. Univariate and multivariate logistic regression analyses were used to determine the risk factors for high volume of CLNM in PTMC patients.

RESULTS

The male gender (OR = 2.02, 95% CI 1.46-2.81), larger tumor size (> 5 mm, OR = 1.64, 95% CI 1.13-2.38), multifocality (OR = 1.87, 95% CI 1.40-2.51), and extrathyroidal invasion (OR = 3.67; 95% CI 2.64-5.10) were independent risk factors in promoting high-volume of CLNM in PTMC patients. By contrast, elderly age (≥ 55 years) at diagnosis (OR = 0.57, 95% CI 0.40-0.81) and PTMC-follicular variate (OR = 0.60, 95% CI 0.42-0.87) were determined as the protective factors. Based on these indicators, a nomogram was further constructed with a good concordance index (C-index) of 0.702, supported by an external validating cohort with a promising C-index of 0.811.

CONCLUSION

A nomogram was successfully established and validated with six clinical indicators. This model could help surgeons to make a better-individualized clinical decision on the management of PTMC patients, especially in terms of whether prophylactic central lymph node dissection and postoperative radiotherapy should be warranted.

Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma

PURPOSE

Patients with papillary thyroid carcinoma (PTC) frequently present a relatively poor prognosis when they coexist with cervical lymph node metastasis (LNM). Moreover, it remains controversial whether prophylactic lymph node dissection (LND) should be performed for patients without clinically lymph node metastasis. Thus, we hereby develop a nomogram for predicting the cervical LNM (including central and lateral LNM) in patients with PTC.

METHODS

We retrospectively reviewed the clinical characteristics of adult patients with PTC in the surveillance, epidemiology, and end results (SEER) database between 2010 and 2015 and in our Department of Breast and Thyroid Surgery in the Second Affiliated Hospital of Chongqing Medical University between 2019 and 2020.

RESULT

A total of 21,972 patients in the SEER database and 747 patients in our department who met the inclusion criteria were enrolled in this study. Ultimately, six clinical features including age, gender, race, extrathyroidal invasion, multifocality, and tumor size were identified to be associated with cervical LNM in patients with PTC, which were screened to develop a nomogram. This model had satisfied discrimination with a concordance index (C-index) of 0.733, supported by both internal and external validation with a C-index of 0.731 and 0.716, respectively. A decision curve analysis was subsequently made to evaluate the feasibility of this nomogram for predicting cervical LNM. Besides, a positive correlation between nomogram score and the average number of lymph node metastases was observed in all groups.

CONCLUSION

This visualized multipopulational-based nomogram model was successfully established. We determined that various clinical characteristics were significantly associated with cervical LNM, which would be better helping clinicians make individualized clinical decisions for PTC patients.

POS0664 A MULTICENTER RANDOMIZED STUDY IN RHEUMATOID ARTHRITIS TO COMPARE IGURATIMOD, METHOTREXATE, OR COMBINATION: 52 WEEK EFFICACY AND SAFETY RESULTS OF THE SMILE TRIAL

Background:

Iguratimod (IGU) has demonstrated efficacy and safety for active rheumatoid arthritis (RA) patients in double-blind clinical trials in China and Japan as a new disease-modifying anti-rheumatic drug (DMARD). There are no studies evaluating the radiographic progression of structural joint damage of IGU for the treatment of RA using the mTSS as the primary endpoint.

Objectives:

Our study was to evaluate the efficacy and safety of IGU monotherapy and IGU combined methotrexate (MTX) compared with MTX monotherapy, including the inhibitory effects of joint destruction.

Methods:

This randomized, double-blind, parallel-controlled, multicenter study in patients with active RA who have not previously used MTX and biological DMARDs (bDMARDs) (ClinicalTrials.gov Identifier NCT01548001) was carried out in China. Patients were randomized 1:1:1 to receive IGU 25 mg twice a day (bid), MTX 10mg once a week(qw) for the first 4 weeks and 15 mg once a week(qw) for week 5 to 52, or IGU combined MTX (IGU+MTX) for 52 weeks. The primary endpoints were to assess and compare American College of Rheumatology 20% (ACR20) response and the change of modified total Sharp scoring (mTSS) score over 52 weeks (Intention-to-treat, ITT analysis). The non-inferiority test was used to analyze the difference of ACR20 response at 52 weeks between the IGU monotherapy and the MTX monotherapy arms, and the non-inferiority limit value was 10%. The difference test was used for the comparison between the IGU+MTX and MTX monotherapy arms. Two-way ANOVA was used to analyze the difference of the changes of mTSS score of each arm compared with baseline value (0 week).

Results:

A total of 895 patients were randomized to IGU 25mg bid (n =297), MTX 10-15mg qw(n=293), and IGU+MTX (n=305). Baseline characteristics were comparable between the arms (Table 1).

Table 1.

Demographic and Other Baseline Characteristics (SAS)

IGUMTXIGU+MTXNumber of Subjects297293305Age, mean (SD) years46.87(10.67)47.63(10.70)48.37(10.69)Female/male, %77.44/22.5679.18/20.8278.03/21.97Duration of RA, mean(SD) years11.67±7.1611.60±7.9811.67±7.27CRP, mean(SD) mg/L222.32±35.4720.67±26.6119.74±31.38Tender joint count, mean (SD)14.59±9.1614.83±9.3014.93±9.88Swollen joint count, mean (SD)9.81±6.639.73±7.209.51±6.22DAS28-CRP, mean (SD)5.084±0.9945.102±0.9795.103±0.956HAQ score, mean (SD)15.82±11.2515.24±10.9316.06±10.92

SAS: Safety Analysis Set; CRP: C-reactive protein;

DAS28: disease activity score; HAQ: Health Assessment Questionnaire

The study met its primary endpoints. More concretely, IGU monotherapy and IGU+MTX were found to be superior to MTX at week 52 with a higher ACR20 response of 77.44%(230/297, P=0.0019) and 77.05%(235/305, P=0.0028) versus 65.87%(193/293) (fig 1). As shown in fig 1, the structural remission (ΔmTSS≤0.5) was statistically significant for IGU monotherapy (57.4%, P=0.0308) but not for IGU+MTX arm (55%) versus MTX monotherapy (47.8%).

Overall incidence of the adverse events (AEs) leading to study discontinuation were reported in 13.8% (41/297) in IGU monotherapy arm, 11.26% (33/293) in MTX monotherapy arm and 11.51% (35/305) patients in IGU+MTX arm. The incidence of adverse drug reactions (ADR) leading to study discontinuation were 11.45% (34/297), 8.53% (25/293) and 9.21% (28/305), respectively. There was no one death and no significant difference in all the safety indicators among the three arms.

Conclusion:

Iguratimod alone or in combination with MTX demonstrated superior efficacy with acceptable safety compared to MTX for patients with active RA who have not previously used MTX bDMARDs.

Disclosure of Interests:

None declared

Peripheral blood T-cell receptor repertoire as a predictor of clinical outcomes in gastrointestinal cancer patients treated with PD-1 inhibitor

BACKGROUND

Identifying valid biomarkers for patient selection impressively promotes the success of anti-PD-1 therapy. However, the unmet need for biomarkers in gastrointestinal (GI) cancers remains significant. We aimed to explore the predictive value of the circulating T-cell receptor (TCR) repertoire for clinical outcomes in GI cancers who received anti-PD-1 therapy.

METHODS

137 pre- and 79 post-treated peripheral blood samples were included. The TCR repertoire was evaluated by sequencing of complementarity-determining region 3 (CDR3) in the TRB gene. The Shannon index was used to measure the diversity of the TCR repertoire, and Morisita's overlap index was used to determine TCR repertoire similarities between pre- and post-treated samples.

RESULTS

Among all enrolled patients, 76 received anti-PD-1 monotherapy and 61 received anti-PD-1 combination therapy. In the anti-PD-1 monotherapy cohort, patients with higher baseline TCR diversity exhibited a significantly higher disease control rate (77.8% vs. 47.2%; hazard ratio [HR] 3.92; 95% confidence interval [CI] 1.14-13.48; P = 0.030) and a longer progression-free survival (PFS) (median: 6.47 months vs. 2.77 months; HR 2.10; 95% CI 1.16-3.79; P = 0.014) and overall survival (OS) (median: NA vs. 8.97 months; HR 3.53; 95% CI 1.49-8.38; P = 0.004) than those with lower diversity. Moreover, patients with a higher TCR repertoire similarity still showed a superior PFS (4.43 months vs. 1.84 months; HR 13.98; 95% CI 4.37-44.68; P < 0.001) and OS (13.40 months vs. 6.12 months; HR 2.93; 95% CI 1.22-7.03; P = 0.016) even in the cohort with lower baseline diversity. However, neither biomarker showed predictive value in the anti-PD-1 combination therapy cohort. Interestingly, the combination of TCR diversity and PD-L1 expression can facilitate patient stratification in a pooled cohort.

CONCLUSION

The circulating TCR repertoire can serve as a predictor of clinical outcomes in anti-PD-1 therapy in GI cancers.

[Role of cardiac magnetic resonance imaging in myocarditis patients with biopsy negative: a retrospective case series study]

Objective: To analyze the cardiac magnetic resonance (CMR) imaging feature of clinically diagnosed myocarditis patients with negative endocardial biopsy (EMB) results, and to further demonstrate the diagnostic value of CMR in these patients. Methods: This was a retrospective case series study. Fourteen patients, who were clinically diagnosed as myocarditis according to 2013 European Society of Cardiology (ESC) clinical diagnostic criteria for myocarditis, but with negative EMB results, were enrolled. All patients underwent CMR examinations. The morphological, functional and histological changes of the heart were assessed based on black blood sequence, cine sequence, T2W-STIR sequence and contrast agent late gadolinium enhancement,(LGE). Results: There were 10 males and 4 females in this cohort, the age was (25.6±13.2) years. The interval between symptom onset and CMR was 21 (13, 60) days, and the interval between symptom onset and EMB was 19 (9, 40) days. There were 13 patients with abnormal CMR results including myocardial oedema, fibrosis, decreased ejection fraction, pericardial effusion or increased cardiac chamber dimension. Nine out of 14 patients had CMR morphological and/or functional abnormalities, including 1 case of left atrium enlargement, 1 case of left ventricle enlargement, 3 cases of right ventricle enlargement, 4 cases of increased left ventricular end diastolic volume index. Left ventricular ejection fraction was<50% in three cases, right ventricular ejection fraction was<40% in 5 cases, and pericardial effusion depth>3 mm was detected in 3 cases. Of the 14 patients, 11 had histological changes, of which 6 had T2 ratio≥2. Among the 10 patients (10/14) with positive LGE, the most common patterns were subepicardial LGE of the lateral wall and/or midwall LGE of the septum (n=9); 2 cases showed extensively subendocardial LGE of the left ventricular wall. No LGE involved in the right ventricular wall in the whole cohort. Conclusion: CMR plays a complementary role in the diagnosis of myocarditis in clinically diagnosed myocarditis patients with negative EMB findings.

Association between TP53 polymorphisms and chronic lymphocytic leukemia

OBJECTIVE

The aim of this study was to explore the association between TP53 gene polymorphisms (rs8068934 A>G and rs218698 C>T) and chronic lymphocytic leukemia (CLL).

PATIENTS AND METHODS

CLL patients who received treatment in our hospital were enrolled in this study as the disease group. Meanwhile, healthy subjects were taken as the control group. Peripheral blood samples were collected to detect TP53 gene polymorphisms at rs8068934 and rs218698, and the haplotype analysis was performed. The expression of TP53 was detected via reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Furthermore, the survival conditions were analyzed.

RESULTS

The allele distribution at rs8068934 (p=0.046) and rs218698 (p=0.028) of TP53 gene was different between control group and disease group. A allele frequency at rs8068934 and T allele frequency at rs218698 were significantly higher in disease group (p<0.05). The genotype distribution at rs218698 of TP53 gene in disease group was also different from that in control group (p=0.038). The results demonstrated that CC genotype frequency in disease group was significantly lower than that in control group (p<0.05). Besides, the distribution of dominant model at rs8068934 (p=0.042) and recessive model at rs218698 (p=0.033) in disease group exhibited remarkable differences from control group, in which AA+AG frequency (dominant model) at rs8068934 and CC+CT frequency (recessive model) at rs218698 in disease group were significantly higher. Meanwhile, the distribution of AT (p=0.029) and GC (p=0.007) haplotypes at rs8068934 and rs218698 in disease group was evidently different from that in control group. The results indicated that disease group showed significantly higher frequency of AT haplotype and lower frequency of GC haplotype (p<0.05). Moreover, TP53 gene polymorphisms at rs8068934 were significantly associated with the levels of white blood cells (WBC) (p=0.000) and platelets (PLT) (p=0.035). Patients with GG genotype had significantly higher level of WBC, while those with AG genotype showed significantly lower level of PLT (p<0.05). TP53 gene polymorphisms at rs218698 were associated with the level of red blood cells (RBC) (p=0.000). Patients with CT genotype had a remarkably lower level of RBC (p<0.05). There were significant correlations of TP53 gene polymorphisms at rs8068934 (p=0.000) and rs218698 (p=0.000) with the expression of TP53. The expression of TP53 was lower in people with AA genotype at rs8068934 but higher in people with TT genotype at rs218698 (p<0.05). Furthermore, TP53 gene polymorphisms at rs8068934 (p=0.000) and rs218698 (p=0.000) were markedly associated with patients' survival.

CONCLUSIONS

TP53 polymorphisms are significantly correlated with the occurrence and progression of CLL.

Efficacy of recombinant N- and C-terminal derivative of EmIMP1 against E. maxima infection in chickens

1. Immune mapped protein-1 (IMP1) of E. maxima has been identified as a vaccine antigen candidate for E. maxima infection. 2. In the current study, the N- and C-terminal derivative of EmIMP1 were expressed in E. coli and administered to chickens. The antibody response, cell-mediated immune (CMI) response and the protective efficacy of the protein vaccines against E. maxima challenge were evaluated. 3. The results showed that C-terminal derivative of EmIMP1 vaccination could increase weight gain, reduce enteric lesions, and decrease faecal oocysts shedding. Moreover, the C-terminal derivative of EmIMP1 caused reasonable improvement in serum antibodies and the numbers of IFN-γ producing peripheral blood mononuclear cells (PBMC), as compared to the control group. 4. This study demonstrated that the C-terminal derivative of EmIMP1 could be used as a potent immunogenic candidate in the development of subunit vaccines against E. maxima infection.

Improving the Performance of Feather Keratin/Polyvinyl Alcohol/Tris(hydroxymethyl)Aminomethane Nanocomposite Films by Incorporating Graphene Oxide or Graphene

In this study, feather keratin/polyvinyl alcohol/tris(hydroxymethyl)aminomethane (FK/PVA/Tris) bionanocomposite films containing graphene oxide (GO) (0.5, 1, 2, and 3 wt%) or graphene (0.5, 1, 2, and 3 wt%) were prepared using a solvent casting method. The scanning electron microscopy results indicated that the dispersion of GO throughout the film matrix was better than that of graphene. The successful formation of new hydrogen bonds between the film matrix and GO was confirmed through the use of Fourier-transform infrared spectroscopy. The tensile strength, elastic modulus, and initial degradation temperature of the films increased, whereas the total soluble mass, water vapor permeability, oxygen permeability, and light transmittance decreased following GO or graphene incorporation. In summary, nanoblending is an effective method to promote the application of FK/PVA/Tris-based blend films in the packaging field.

Electrospun Silver Nanoparticles-Embedded Feather Keratin/Poly(vinyl alcohol)/Poly(ethylene oxide) Antibacterial Composite Nanofibers

Feathers, which contain >90% keratin, are valuable natural protein resources. The aim of this study is to prepare antimicrobial feather keratin (FK)-based nanofibers by incorporating silver nanoparticles (AgNPs). A series of AgNPs-embedded feather keratin/poly(vinyl alcohol)/poly(ethylene oxide) (FK/PVA/PEO) composite nanofibers with varying amounts of AgNPs content were fabricated by electrospinning. Their morphology, crystallinity, thermal stability, tensile property, and antibacterial activity were systematically investigated. The average diameters of composite nanofibers gradually decreased with increases in the amount of AgNPs. The crystallinity, thermal stability, and antibacterial activity of FK/PVA/PEO nanofibers were enhanced by embedding AgNPs. When embedded with 1.2% AgNPs, both the tensile strength and elongation-at-break reached the highest level. This work has the potential to expand the application of FK-based nanofibers in the biomaterial field.

Preparation and Characterization of Edible Dialdehyde Carboxymethyl Cellulose Crosslinked Feather Keratin Films for Food Packaging

The development of edible films based on the natural biopolymer feather keratin (FK) from poultry feathers is of great interest to food packaging. Edible dialdehyde carboxymethyl cellulose (DCMC) crosslinked FK films plasticized with glycerol were prepared by a casting method. The effect of DCMC crosslinking on the microstructure, light transmission, aggregate structure, tensile properties, water resistance and water vapor barrier were investigated. The results indicated the formation of both covalent and hydrogen bonding between FK and DCMC to form amorphous FK/DCMC films with good UV-barrier properties and transmittance. However, with increasing DCMC content, a decrease in tensile strength of the FK films indicated that plasticization, induced by hydrophilic properties of the DCMC, partly offset the crosslinking effect. Reduction in the moisture content, solubility and water vapor permeability indicated that DCMC crosslinking slightly reduced the moisture sensitivity of the FK films. Thus, DCMC crosslinking increased the potential viability of the FK films for food packaging applications, offering a value-added product.

Plasticization of Cottonseed Protein/Polyvinyl Alcohol Blend Films

The use of waste plant protein obtained from underutilized and non-food-producing plants may be a promising strategy in the development of bioactive packaging. A series of blend films were prepared by casting from cottonseed protein (CP) and poly(vinyl alcohol) (PVA) and modified with different plasticizers. The morphology, structure, and crystallinity of each of the blend films were characterized by scanning electron microscopy, Fourier transform infrared spectroscopy, and X-ray diffraction. CP and PVA were found to be compatible in the appropriate ratios, and the CP/PVA blend films were partially crystalline. We compared the effects that four plasticizers, i.e., glycerol, triethanolamine (TEA), ethylene glycol, and polyethylene glycol, had on the performance of the CP/PVA blend films. Plasticizers altered the degree of interaction between CP and PVA, which changed the secondary structure of the CP but had little effect on the crystallinity of CP/PVA blend films. Among the different plasticizers tested, TEA was the most efficient at improving the elongation at the break, tensile strength, and oxygen barrier properties of the CP/PVA blend films. Such CP/PVA blend films plasticized using TEA can, therefore, be considered emerging and promising plastics for potential applications in food packaging and flower planting applications.

Identification of urinary hsa_circ _0137439 as potential biomarker and tumor regulator of bladder cancer

Cell-free circular RNAs (circRNAs) stably and abundantly exist in body fluids. In this study we aimed to investigate the potential of urinary cell-free circRNAs as a novel class of noninvasive disease biomarkers for diagnosis of bladder cancer. Differentially expressed circRNAs from 10 normal and 10 bladder cancer urine samples were firstly detected by microarray. Hsa_circ_0137439 was then screened and validated in 30 normal and 116 bladder cancer samples. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of hsa_circ_0137439. The Kaplan-Meier method was used to evaluate the significance of hsa_circ_0137439 in the prognosis of bladder cancer. We found that hsa_circ_0137439 was significantly upregulated in bladder cancer samples. Moreover, increased expression of hsa_circ_0137439 was correlated with higher tumor stage, higher tumor grade, higher lymph node status, and history of muscle-invasive bladder cancer (MIBC). Also, urinary cell-free hsa_circ_0137439 could not only differentiate bladder cancer from normal controls but also distinguish MIBC from non-muscle-invasive bladder cancer (NMIBC). Additionally, hsa_circ_0137439 in urine supernatant could serve as an independent prognostic predicator of recurrence-free survival and overall survival for patients with bladder cancer. Cell assays showed that hsa_circ_0137439 knockdown contributed to the inhibition of cell proliferation and migration via hsa_circ_0137439/miR-142-5p/ MTDH axis. In conclusion, urinary cell-free hsa_circ_0137439 could be a promising biomarker for tumor diagnosis and prognostic assessment of bladder cancer patients.

Preparation of Anisotropic Aerogels with Pristine Graphene by Heat Flow and Study of Their Effects on Heat Transfer in Paraffin

In this study, anisotropic graphene/graphene oxide (GO) aerogels (AGAs) were obtained by freeze-drying after direct participation of pristine graphene in the self-assembly of anisotropic gel by the heat flow method. After vacuum microwave treatment, the physical, chemical and structural characteristics of the AGAs were investigated. The results show that AGAs, in which the internal graphene sheets are parallel to the heat flow direction, are successfully prepared. After microwave treatment, the amount of oxygen and nitrogen reduces significantly and the sp2 domain increases. However, at the same time, many fragments and holes are generated in the graphene sheets. The effects of AGAs on the phase transition of paraffin is studied, and the results show that the melting enthalpy, solidification enthalpy and initial melting temperature of AGA/paraffin composites decreases as the GO content in the AGAs increases, whereas the melting range, solidifying range and subcooling degree increases. The highest axial thermal conductivity of the AGA/paraffin composite is 1.45 W/(mK), and the thermal conductivity enhancement efficiency is 884% (AGA content was 0.53 vol %). Compared with previously investigated, similar AGA/paraffin composites, the aerogels fabricated in this study have the obvious advantages of a simple fabrication process, a low cost and a high thermal conductivity enhancement efficiency. These aerogels possess the potential for application in phase-change energy storage (PES), thermal energy management and other fields.

The application of PRP combined with TCP in repairing avascular necrosis of the femoral head after femoral neck fracture in rabbit

OBJECTIVE

In view of the high occurrence of avascular necrosis of the femoral head (ANFH) after femoral neck fracture and the difficulties in the treatment, our work aimed to explore the effects of platelet-rich plasma (PRP) combined with tri-calcium phosphate (TCP) on the repair of ANFH after femoral neck fracture and to provide reference for clinical treatment.

MATERIALS AND METHODS

Thirty New Zealand white rabbits were randomly divided into control group, TCP group, and PRP+TCP group. The rabbit ANFH model was established and femoral head tissues were collected. HE staining was used for histological observation. Image analysis and statistical analysis were used to calculate the New Bone Area fraction (NBA %). The levels of bone morphogenetic protein (BMP)-7, transforming growth factor (TGF)-β1, basic fibroblast growth factor (bFGF), interleukin (IL)-6 and tumor necrosis factor (TNF)-a in serum were detected by Enzyme-Linked ImmunoSorbent Assay (ELISA).

RESULTS

The new bone area of TCP group was significantly lower than that of PRP+TCP group (p<0.05). Compared with the control group, the levels of BMP-7, TGF-β1 and bFGF were significantly increased in both TCP and PRP+TCP groups (p<0.05), and the increase in PRP+TCP group was higher than that in TCP group. TCP and PRP+TCP can both significantly reduce the content of IL-6 and TNF-a (p<0.05); however, higher decrease was found in PRP+TCP group compared with the TCP group at 8 weeks after injection.

CONCLUSIONS

PRP combined with TCP, which can promote new bone formation and inhibit inflammatory response, showed higher efficiency in repairing ANFH than internal fixation alone.

[Cardiovascular magnetic resonance imaging characteristics and influence factors of aortic insufficiency patients with myocardial fibrosis]

Objective: To investigate the cardiovascular magnetic resonance (CMR) imaging characteristics and influence factors of aortic insufficiency (AI) patients with myocardial fibrosis. Method: This retrospective study included 59 AI patients who received CMR and transthoracic echocardiography (TTE) examinations from June 2011 to February 2015. AI patients were divided into 2 groups: bicuspid aortic valve (BAV) group (n=30) and non-BAV group (n=29). Patients were also divided into late gadolinium enhancement (LGE) group (n=27) and non-LGE group (n=32). The baseline clinical characteristics were collected through electronic medical records. Hemodynamic parameters such as grade of AI, cardiac functional parameters and LGE mass fraction (LGE%) were measured by CMR post-processing analysis. Kappa test was used to assess the consistency of AI severity between CMR and TTE, and the multivariate logistic regression analysis was performed to evaluate influence factors of myocardial fibrosis in AI patients. Results: (1) 56 (94.9%) patients were male, and the mean age was (44.2±11.0) years old. There was no significant difference in age and gender, hypertension, hyperlipidemia, alcoholic consumption between BAV and non-BAV group (all P>0.05). There were a higher proportion of smoking history (P=0.008), a lower body mass index (BMI) (P=0.020) in the LGE group than in the non-LGE group. (2) The accuracy of CMR in diagnosis of BAV was 96.7% (29/30) compared to the gold standard. In the BAV group, 20 patients (66.7%) were with fusion of left and right cusp (L-R), 5 patients (16.7%) were with fusion of right and noncoronary cusp (R-N), 5 patients (16.7%) were with fusion of left and noncoronary cusp (L-N); patients with BAV had larger left ventricular end diastolic volume index (LVEDVi), left ventricular end systolic volume index (LVESVi), higher proportion of LGE and lower left ventricular ejection fraction (LVEF) than those in non-BAV group (all P<0.05). There were 19 patients with BAV in the LGE group, the cases of L-R, R-N, L-N were 10 (52.6%), 5 (26.3%), and 4 (21.1%), respectively. In the non-LGE group, patients with BAV of L-R, R-N, L-N were 10 (90.9%), 0, and 1 (9.1%), respectively. Patients with LGE had lower body surface area (BSA), LVEF and larger LVEDVi, LVESVi, left ventricular mass index (LVMi) and higher proportion of BAV compared patients without LGE. In addition, the proportion of moderate and severe AI patients was significantly higher in BAV group than in non-BAV group (P=0.009). (3) The consistency of CMR and TTE in evaluating the severity of AI patients: the agreement between TTE and CMR regarding AI severity was satisfactory (kappa value was 0.624, 95%CI 0.402-0.831, P<0.001). (4) The linear regression analysis demonstrated a negative correlation between LVEF and LGE% in BAV and non-BAV group (P<0.001). The multivariate logistic regression analysis showed that the presence of BAV was an independent risk factor of left ventricucar fibrosis (OR=5.050, 95%CI 1.220-20.908, P=0.025) after adjustment for LVEF, hypertension, LVEDVi and LVMi. Conclusion: Multi-parametric CMR provides a satisfactory noninvasive tool for estimation of myocardial fibrosis and ventricular remodeling in patients with AI, and BAV is an independent risk factor for myocardial fibrosis in patients with AI.

[Clinical and cardiac magnetic resonance features of apical hypertrophic cardiomyopathy patients complicating with left ventricular apical aneurysm]

Objective: To evaluate the clinical and cardiac magnetic resonance (CMR) features of apical hypertrophic cardiomyopathy (ApHCM) patients complicating with left ventricular apical aneurysm (LVAA). Methods: CMR confirmed 25 ApHCM patients complicating with LVAA from January 2010 to December 2017 in Fuwai hospital were included in this study, and the baseline clinical data and CMR characteristics were retrospectively analyzed. There were 14 pure ApHCM (hypertrophy limited at the apical segments) complicating with LVAA patients and 11 mixed ApHCM (predominantly apical hypertrophy along with thickening of contiguous non-apical left ventricular region) with LVAA patients. Results: In this patient cohort,age of 84% (21/25) patients ranged between 20-70 years old, and 68% (17/25) were male. There were 68% (17/25) patients with complaint of chest distress symptom, 56% (14/25) with complaint of chest pain, 32% (8/25) with complaint of palpitation,16% (4/25) with complaint of dyspnea, and 12% (3/25) presented as syncope. ST-T segment changes of electrocardiogram were observed in all patients, and giant negative T waves were detected in 80% patients (20/25). The rate of missed diagnosis by echocardiography for detecting ApHCM and LVAA was 16% (4/25) and 68% (17/25), respectively. CMR showed discrete thin-walled dyskinetic or akinetic segment of the most distal portion of the left ventricular chamber in ApHCM patients with LVAA. Transmural late gadolinium enhancement of the aneurysmal rim was detected in 76% (19/25) patients, and the maximum transverse dimension of aneurysm was bigger in patients with transmural late gadolinium enhancement than in patients without transmural late gadolinium enhancement ((22.0±10.8)mm vs. (11.7±4.0) mm, P=0.033). Conclusion: ApHCM with LVAA patients have distinct cardiac clinical features, and CMR is the most useful tool for the accurate and objective evaluation of this disease.

Control of graphene aerogel self-assembly in strongly acidic solution via solution polarity tuning

In view of their advantages (plasticity, low density, adjustable pore size, high porosity of >99.9%), three-dimensional graphene aerogels (GAs) are widely used for energy storage and adsorption separation, which has inspired the development and optimization of the corresponding synthetic techniques. In particular, self-assembly in the liquid phase features the benefits of tunability and sustainability and is viewed as a promising strategy of GA synthesis. During hydrothermal GA preparation, hydrophilic graphene oxide (GO) gradually turns lipophilic upon reduction, and the resulting phase transition separation and polarity change induce self-assembly into an aerogel. However, the effect of solution polarity on the structure or state of dispersed GO nanosheets, which affects the final property-determining process of automatic assembly, is still unclear. Herein, we prepared a series of GAs by hydrothermal reduction of unwashed GO with vitamin C in liquid-phase systems of different polarity and investigated the effects of polarity on the self-assembly process and aerogel properties using a range of instrumental techniques. The results showed that GO reduction is slowed down in weakly polar systems and further demonstrated that the shape of partially reduced graphene oxide (rGO) flakes depends on solution polarity. Flaky, layered, and stacked rGO particles obtained in strongly polar media self-assembled into anisotropic gully aerogels that were brittle and almost completely inelastic. Conversely, in weakly polar media, the prepared rGO sheets were twisted, which increased the number of contact points and modes between sheets and resulted in self-assembly into uniform-pore-structure honeycomb aerogels that showed good elasticity and could be repeatedly compressed.

Improving Thermal, Mechanical, and Barrier Properties of Feather Keratin/Polyvinyl Alcohol/Tris(hydroxymethyl)aminomethane Nanocomposite Films by Incorporating Sodium Montmorillonite and TiO₂

In this study, feather keratin/polyvinyl alcohol/tris(hydroxymethyl)aminomethane (FK/PVA/Tris) bionanocomposite films containing two types of nanoparticles, namely one-dimensional sodium montmorillonite (MMT) clay platelets (0.5, 1, 3, and 5 wt%) and three-dimensional TiO₂ nanospheres (0.5, 1, 3, and 5 wt%), are prepared using solvent casting method. X-ray diffraction studies confirm the completely exfoliated structure of FK/PVA/Tris/MMT nanocomposites. The successful formation of new hydrogen bonds between the hydroxyl groups of the film matrix and the nanofillers is confirmed by Fourier transform infrared spectroscopy. The tensile strength, elongation at break, and initial degradation temperature of the films are enhanced after MMT and TiO₂ incorporation. The water vapor permeability, oxygen permeability, and light transmittance decrease with increase in TiO₂ and MMT contents. In summary, nanoblending is an effective method to promote the application of FK/PVA/Tris blend films in the packaging field.

Synthesis of Structurally Precise Polysiloxanes via the Piers⁻Rubinsztajn Reaction

Silicone materials are widely used, from daily life to the military industry. With the advancement of science and technology and the increasing demands of industry, the requirement for high-performance precise structural silicone materials has increased. Therefore, the most important aspect in this field is finding a breakthrough in the synthetic methods. In this review, the latest research developments in controllable morphological structure and composite structure optimized synthesis of silicone materials using the Piers⁻Rubinsztajn (PR) reaction are summarized. The advantages of the PR reaction compared with traditional synthetic routes to silicone materials are presented. The highly controllable spatial structure of silicone materials and the structural combination of biomass or inorganic materials with silicone materials results in an improvement in performance or function. The morphological control of more complex silicone materials and the synthesis of non-traditional silicone materials with composite structures through the PR reaction will be the main research directions for the development of silicone materials in the future.

Improving the Water Resistance and Mechanical Properties of Feather Keratin/Polyvinyl Alcohol/Tris(Hydroxymethyl)Aminomethane Blend Films by Cross-Linking with Transglutaminase, CaCl₂, and Genipin

The high moisture sensitivity of feather keratin/polyvinyl alcohol/tris(hydroxymethyl)aminomethane (FK/PVA/Tris) blend films hinders their application in the packaging field. Thus, in order to improve the water resistance and mechanical properties of such blend films, we attempted cross-linking the blend film with cross-linking agents such as transglutaminase (TG), CaCl₂, and genipin. Obvious differences in the morphology of the blended films were observed by scanning electron microscopy before and after cross-linking, indicating that cross-linking can inhibit the phase separation of the blend film. Conformational changes in the blend films after cross-linking were detected by Fourier transform infrared spectroscopy. Importantly, from examination of the total soluble mass, contact angle measurements, and water vapor permeability tests, it was apparent that cross-linking greatly improved the water resistance of the blend films, in addition to enhancing the mechanical properties (i.e., tensile strength and elongation at break). However, cross-linking was also found to reduce the oxygen barrier properties of the blend films. Therefore, cross-linking appears to be an effective method for promoting the application of FK/PVA/Tris blend films in the packaging field.

Preparation and Physicochemical Properties of Blend Films of Feather Keratin and Poly(vinyl alcohol) Compatibilized by Tris(hydroxymethyl)aminomethane

Blend films of feather keratin (FK) and synthetic poly(vinyl alcohol) (PVA) that were compatibilized by tris(hydroxymethyl)aminomethane (Tris) were successfully prepared by a solution-casting method. The scanning electron microscopy (SEM) results showed that a phase separation occurred in the FK/PVA/Tris blended system. Analysis by Fourier transform infrared spectroscopy indicated that the main interactions between the three components were hydrogen bonds. In addition, X-ray diffraction analysis showed that the FK/PVA/Tris blend films were partially crystalline. The barrier properties, mechanical properties, and contact angles of the FK/PVA/Tris films were investigated to determine the effects of the PVA and Tris concentrations. More specifically, upon increasing the PVA content, the elongation at break, the hydrophilicity, and the oxygen barrier properties were enhanced. However, at a constant PVA content, an increase in the Tris content caused the oxygen permeability and the contact angle to decrease, while the tensile strength, elongation at break, and oxygen barrier properties were enhanced. These results indicated that the mechanical properties and gas resistance of the FK/PVA/Tris blend films could be successfully improved using the method described herein, confirming that this route provided a convenient and promising means to prepare FK plastics for practical applications.

Vapor-Assisted Crosslinking of a FK/PVA/PEO Nanofiber Membrane

Herein, we demonstrate a three-component FK/PVA/PEO nanofiber membrane by electrospinning and vapor-assisted crosslinking. We have used feather-derived-keratin (FK), poly (vinyl alcohol) (PVA), and poly (ethylene oxide) (PEO) as membrane components and citric acid/glyoxal as the crosslinker. The structural, thermal, hydrophobicity, and mechanical properties of the as-prepared and crosslinked FK/PVA/PEO nanofiber membranes have been systematically investigated. The results suggest that the nanofiber membrane’s vapor-assisted crosslinking by citric acid has shown better performances than that of glyoxal used as a crosslinker. These results exhibit that non-toxic citric acid can be used as a crosslinking agent to modify the performance of keratin-based membranes. This study opens up further avenues for post-synthesis modification of polymeric membranes for a wide range of applications.

Myocardial late gadolinium enhancement: a head-to-head comparison of motion-corrected balanced steady-state free precession with segmented turbo fast low angle shot

AIM

To evaluate the image quality and diagnostic agreement with a head-to-head comparison of late gadolinium enhancement (LGE) images acquired by the motion-corrected (MOCO) balanced steady-state free precession (bSSFP) phase sensitivity inversion recovery (PSIR) and conventional segmented fast low angle shot (FLASH) PSIR methods^15,16 in a patient cohort with a wide spectrum of cardiovascular disease.

MATERIALS AND METHODS

In 59 consecutive patients, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs) of the normal myocardium (NM), LGE, and blood pool (BP) were pair-wise compared between the two different sequences. A further semi-qualitative score system (graded 1 -4) was used to compare the overall image quality (OIQ). The diagnostic agreement of the two techniques were evaluated by both transmural severity and absolutely quantitative size of LGE.

RESULTS

The SNRs of the NM, LGE, and BP of MOCO bSSFP were 4.8±3.4, 53.6±35.6 and 43.2±29.3, compared with 3.9±3.6 (p=0.126), 27.7±18.5 (p<0.001) and 24.3±13.4 (p<0.001) of FLASH LGE, respectively. The CNRs of LGE to NM, LGE to BP, and BP to NM were 48.3±33.1 versus 23.8±16.7 (p<0.001), 6.5±21.6 versus 3.8±10.8 (p<0.001), and 38.3±27.2 versus 20.3±10.7 (p=0.448), respectively. The OIQ of MOCO bSSFP was higher than that of segmented FLASH (median 4 versus median 3, p<0.001). For quantification of LGE size, there is good agreement and high correlation (r=0.992, p<0.001) between the two methods.

CONCLUSIONS

MOCO bSSFP is a feasible, robust sequence for LGE imaging, especially for patients with arrhythmia and those incapable of breath-holding due to severe heart failure.

Volatile organic compounds emitted by filamentous fungi isolated from flooded homes after Hurricane Sandy show toxicity in a Drosophila bioassay

Superstorm Sandy provided an opportunity to study filamentous fungi (molds) associated with winter storm damage. We collected 36 morphologically distinct fungal isolates from flooded buildings. By combining traditional morphological and cultural characters with an analysis of ITS sequences (the fungal DNA barcode), we identified 24 fungal species that belong to eight genera: Penicillium (11 species), Fusarium (four species), Aspergillus (three species), Trichoderma (two species), and one species each of Metarhizium, Mucor, Pestalotiopsis, and Umbelopsis. Then, we used a Drosophila larval assay to assess possible toxicity of volatile organic compounds (VOCs) emitted by these molds. When cultured in a shared atmosphere with growing cultures of molds isolated after Hurricane Sandy, larval toxicity ranged from 15 to 80%. VOCs from Aspergillus niger 129B were the most toxic yielding 80% mortality to Drosophila after 12 days. The VOCs from Trichoderma longibrachiatum 117, Mucor racemosus 138a, and Metarhizium anisopliae 124 were relatively non-toxigenic. A preliminary analysis of VOCs was conducted using solid-phase microextraction-gas chromatography-mass spectrometry from two of the most toxic, two of the least toxic, and two species of intermediate toxicity. The more toxic molds produced higher concentrations of 1-octen-3-ol, 3-octanone, 3-octanol, 2-octen-1-ol, and 2-nonanone; while the less toxic molds produced more 3-methyl-1-butanol and 2-methyl-1-propanol, or an overall lower amount of volatiles. Our data support the hypothesis that at certain concentrations, some VOCs emitted by indoor molds are toxigenic.

Fabrication and characterization of electrospun feather keratin/poly(vinyl alcohol) composite nanofibers

We have fabricated random and aligned feather keratin (FK)/PVA composite nanofibers through an electrospinning process. The morphology, molecular interactions, crystallization behavior, and tensile properties of the nanofibers were investigated.

Effect of selective serotonin reuptake inhibitors on expression of 5-HT1AR and neurotransmitters in rats with vascular dementia

5-hydroxytryptamine receptor 1A (5-HT1AR) is closely associated with cognitive functions. Selective serotonin reuptake inhibitors (SSRIs) can protect individuals from brain damage following ischemia/hypoxia. To investigate the function of SSRIs in vascular dementia (VD), we established a rat model of VD, and observed the effect of SSRIs on the expression of 5-HT1AR mRNA and neurotransmitters. Male SD rats (6 months) were randomly assigned into sham, model, and SSRI groups (N = 30). VD was achieved by permanent ligation of the bilateral common carotid artery. Escitalopram, a highly selective 5-HT reabsorption inhibitor, was ip injected into the rats for three consecutive weeks. The Morris water-maze was used to test learning and memory. H&E staining for neuronal injury was conducted on cortical and hippocampal tissues. HPLC was used to determine the levels of dopamine (DA), 5-HT, and norepinephrine (NE). RT-PCR was used to determine expression of 5-HT1AR mRNA. As compared to control rats, model animals demonstrated elongated escape latency, lower platform crossing times, and significant injuries to hippocampal CA1 neurons. This was accompanied by reductions in DA, 5-HT, and NE levels in hippocampal tissues, as well as reduced cortical 5-HT and decreased 5-HT1AR mRNA expression (P < 0.05). Escitalopram treatments reduced escape latency, elevated platform crossing times, improved CA1 neuronal damage, increased DA and 5-HT levels in hippocampal and cortical neurons, as well as elevated expression of 5-HT1AR mRNA (P < 0.05). Therefore, SSRIs may improve cognitive dysfunction of VD rats, possibly by stimulating expression of neurotransmitters and protecting neurons.