P4HA2 activates mTOR via hydroxylation and targeting P4HA2-mTOR inhibits lung adenocarcinoma cell growth

Mammalian target of rapamycin (mTOR) kinase functions as a central regulator of cell growth and metabolism, and its complexes mTORC1 and mTORC2 phosphorylate distinct substrates. Dysregulation of mTOR signaling is commonly implicated in human diseases, including cancer. Despite three decades of active research in mTOR, much remains to be determined. Here, we demonstrate that prolyl 4-hydroxylase alpha-2 (P4HA2) binds directly to mTOR and hydroxylates one highly conserved proline 2341 (P2341) within a kinase domain of mTOR, thereby activating mTOR kinase and downstream effector proteins (e.g. S6K and AKT). Moreover, the hydroxylation of P2341 strengthens mTOR stability and allows mTOR to accurately recognize its substrates such as S6K and AKT. The growth of lung adenocarcinoma cells overexpressing mTORP2341A is significantly reduced when compared with that of cells overexpressing mTORWT. Interestingly, in vivo cell growth assays show that targeting P4HA2-mTOR significantly suppresses lung adenocarcinoma cell growth. In summary, our study reveals an undiscovered hydroxylation-regulatory mechanism by which P4HA2 directly activates mTOR kinase, providing insights for therapeutically targeting mTOR kinase-driven cancers.

[A case of nontuberculous mycobacterium presenting as a mass and atelectasis with mediastinal and hilar lymph node enlargement]

With the development of testing technology, the diagnosis of nontuberculous mycobacterium (NTM) lung disease has gradually increased in recent years. Because the clinical characteristics of NTM are not typical, and its imaging manifestations are diverse and nonspecific, missed diagnosis and misdiagnosis are common. Etiological investigation is necessary for diagnosis. Conventional etiological investigations are very limited for the diagnosis of NTM. We reported a case of NTM lung disease presenting with a mass and atelectasis with mediastinal and hilar lymph node enlargement that resembled malignant tumors. The literature on this condition was reviewed to improve the clinician's understanding and broaden clinical thinking.

[Analysis of 9 patients with adolescence-onset methylenetetrahydrofolate reductase deficiency]

Objective: To explore the diagnosis and treatment of adolescence-onset methylenetetrahydrofolate reductase (MTHFR) deficiency. Methods: This was a retrospective case study. Nine patients with adolescence-onset MTHFR deficiency were diagnosed at Peking University First Hospital from January 2016 to December 2022, and followed up for more than 1 year. Their general information, clinical manifestations, laboratory tests, cranial images, MTHFR gene variants, diagnosis, treatment, and outcome were analyzed retrospectively. Results: The 9 patients came from 8 families. They had symptoms at age of 8.0 years to 17.0 years and diagnosed at 9.0 years to 17.5 years. Eight were male and 1 was female. Two patients were brothers, the elder brother developed abnormal gait at 17.0 years; and the younger brother was then diagnosed at 15.0 years of age and treated at the asymptomatic stage, who was 18.0 years old with normal condition during this study. The main manifestations of the 8 symptomatic patients included progressive dyskinesia and spastic paralysis of the lower limbs, with or without intellectual decline, cognitive impairment and behavioral abnormalities. Totally, 15 variants of MTHFR gene were identified in the 9 patients, including 8 novel variants. Five patients had brain image abnormalities. Increased plasma total homocysteine level (65-221 μmol/L) was found in all patients, and decreased to 20-70 μmol/L after treatment with betaine and calcium folinate. Besides, the 8 symptomatic patients had their behavior and cognitive problems significantly improved, with a legacy of lower limb motor disorders. Conclusions: Late-onset MTHFR deficiency can occur in adolescence. The diagnosis is usually delayed because of non-specific clinical symptoms. The test of blood total homocysteine could be used as a selective screening test. Eight novel varients of MTHFR gene were identified. Timely treatment can improve clinical condition significantly, and pre-symptomatic treatment may prevent brain damage.

Bioinspired Binickel Catalyst for Carbon Dioxide Reduction: The Importance of Metal-ligand Cooperation

Catalyst design for the efficient CO2 reduction reaction (CO2RR) remains a crucial challenge for the conversion of CO2 to fuels. Natural Ni-Fe carbon monoxide dehydrogenase (NiFe-CODH) achieves reversible conversion of CO2 and CO at nearly thermodynamic equilibrium potential, which provides a template for developing CO2RR catalysts. However, compared with the natural enzyme, most biomimetic synthetic Ni-Fe complexes exhibit negligible CO2RR catalytic activities, which emphasizes the significance of effective bimetallic cooperation for CO2 activation. Enlightened by bimetallic synergy, we herein report a dinickel complex, NiIINiII(bphpp)(AcO)2 (where NiNi(bphpp) is derived from H2bphpp = 2,9-bis(5-tert-butyl-2-hydroxy-3-pyridylphenyl)-1,10-phenanthroline) for electrocatalytic reduction of CO2 to CO, which exhibits a remarkable reactivity approximately 5 times higher than that of the mononuclear Ni catalyst. Electrochemical and computational studies have revealed that the redox-active phenanthroline moiety effectively modulates the electron injection and transfer akin to the [Fe3S4] cluster in NiFe-CODH, and the secondary Ni site facilitates the C-O bond activation and cleavage through electron mediation and Lewis acid characteristics. Our work underscores the significant role of bimetallic cooperation in CO2 reduction catalysis and provides valuable guidance for the rational design of CO2RR catalysts.

Pivotal Role of Geometry Regulation on O-O Bond Formation Mechanism of Bimetallic Water Oxidation Catalysts

In this study, we highlight the impact of catalyst geometry on the formation of O-O bonds in Cu2 and Fe2 catalysts. A series of Cu2 complexes with diverse linkers are designed as electrocatalysts for water oxidation. Interestingly, the catalytic performance of these Cu2 complexes is enhanced as their molecular skeletons become more rigid, which contrasts with the behavior observed in our previous investigation with Fe2 analogs. Moreover, mechanistic studies reveal that the reactivity of the bridging O atom results in distinct pathways for O-O bond formation in Cu2 and Fe2 catalysts. In Cu2 systems, the coupling takes place between a terminal CuIII -OH and a bridging μ-O⋅ radical. Whereas in Fe2 systems, it involves the coupling of two terminal Fe-oxo entities. Furthermore, an in-depth structure-activity analysis uncovers the spatial geometric prerequisites for the coupling of the terminal OH with the bridging μ-O⋅ radical, ultimately leading to the O-O bond formation. Overall, this study emphasizes the critical role of precisely adjusting the spatial geometry of catalysts to align with the O-O bonding pathway.

[The value of quantitative flow ratio in the hemodynamic evaluation of myocardial bridge]

Objective: To explore the application value of quantitative flow ratio (QFR) in the hemodynamic evaluation of myocardial bridge and to preliminarily evaluate the correlation and related influencing factors between deformation quantitative flow ratio (D-QFR) and QFR. Methods: This is a cross-sectional study. Patients with CAG-confirmed simple myocardial bridge of the middle anterior descending coronary artery from June 2012 to June 2022 at the Air Force Medical Center were retrospectively included in this study. Systolic stenosis of mural coronary arteries (MCA) and myocardial bridge length were measured using quantitative coronary angiography. The patients were divided into mild stenosis group (<50% systolic stenosis) and moderate-to-severe stenosis group (≥50% systolic stenosis) according to the Nobel grading criteria. At different time periods (systolic and diastolic), the QFR values were measured at 3 locations (1 to 2 cm before the MCA entrance, the middle segment of the MCA, and 1 to 2 cm after the MCA exit), denoted as QFRa, QFRb, and QFRc, respectively, and the D-QFR values, incorporating vessel deformation information, were recorded. The MCA distal QFR≤0.8 in either stage was defined as an abnormal QFR value. QFR values were compared between the two groups at different locations and within each group. Factors associated with abnormal QFR values were analysed using multifactorial logistic regression. Spearman rank correlation analysis was used to examine the correlation between D-QFR values and systolic and diastolic QFR values.Multiple linear regression was used to analyse the factors associated with D-QFR. Results: A total of 83 patients were enrolled, including 58 males, aged (57.1±13.1) years. There were 48 cases in the mild stenosis group and 35 cases in the moderate-to-severe stenosis group, and the differences in systolic and diastolic QFRb and QFRc values between the two groups were statistically significant (all P<0.05). Within-group comparisons showed the values of QFRb and QFRc in the systolic phase were lower than those in the diastolic phase; QFRb and QFRc were both lower than QFRa during the same period (all P<0.05). Multifactorial logistic regression analysis showed that MCA systolic stenosis (OR=1.225, 95%CI 1.093-1.372, P<0.001) was an influential factor for abnormal QFR. D-QFR values were positively correlated with both systolic and diastolic QFR values (correlation coefficients were 0.849 and 0.675, respectively, both P<0.01). Multiple linear regression analysis showed that D-QFR values were negatively correlated with age (β=-0.208, P=0.029), systolic stenosis (β=-0.500, P<0.001), and myocardial bridge length (β=-0.211, P=0.036). Conclusions: The QFR values in middle and distal of myocardial bridge decrease. The systolic stenosis rate of myocardial bridge is an important factor affecting QFR value. D-QFR is positively correlated with both systolic and diastolic QFR values. Age, myocardial bridge systolic stenosis rate and length are factors influencing the D-QFR values.

Effect of prehabilitation on postoperative outcomes in the frail older people: A systematic review and meta-analysis

OBJECTIVE

The study investigates the impact of preoperative rehabilitation on the surgical prognosis of frail older patients.

METHOD

The effect sizes of all studies retrieved and included by the nine databases were analyzed and expressed as RR and WMD.

RESULTS

8 studies with 902 participants met the criteria for inclusion. A significant reduction in total complications (RR = 0.84, 95 % CI = 0.73 to 0.97, P = 0.021) and the 6MWT after surgery (WMD = 74.76, 95 % CI = 44.75 to 104.77, P = 0.000) was observed in the prehabilitation group. But it had no differences in mortality(RR = 1.89, 95 % CI = 0.75 to 4.72, P = 0.176), readmission rates(RR = 1.04, 95 % CI = 0.56 to 1.91, P = 0.906) and LOS(WMD = -0.24, 95 % CI = -1.00 to 0.52, P = 0.540).

CONCLUSIONS

Prehabilitation had positive effect on postoperative complications and functional recovery in frail older patients.

[Standardized diagnosis results of suspected local anesthetics allergy]

To review and investigate the diagnosis results of local anesthetics (LA) allergy and improve the understanding of LA allergy in clinician. From March 2017 to February 2022, a total of 24 patients were investigated in Allergy Center of West China Hospital,Sichuan University on suspicion of LA allergy. Clinical data and results of skin tests and drug provocation tests (DPT) with the suspected drugs were retrospectively evaluated. The value of standardized diagnostic protocol in the LA allergy were analyzed. The results showed that 24 patients (3 men/21 women) were included with age range from 20 to 74 years. Three cases (12.5%) were positive in previous LA skin tests and proved to be tolerated through standardized tests. Twenty-one patients were initially diagnosed as "LA allergy" because of adverse reactions after previous use of LA, including 20 cases of immediate-type reaction and 1 case of delayed-type reaction. Three cases were considered LA allergy through standardized diagnosis approaches, including skin tests and DPT. One patient was diagnosed with anaphylaxis caused by chlorhexidine. Of the remaining 17 patients, 7 were considered as psychosomatic reactions (29.1%), 3 of sympathetic nervous system conditions (12.5%), 1 of spontaneous urticaria (4.2%), 2 of vasovagal syncope (8.3%), drug side effects (8.3%), skin irritation (8.3%), respectively. In conclusion, true allergic reactions to LA are rare. Through standardized skin tests and DPT, allergy can be ruled out in the vast majority of patients who complain of "LA allergy". For patients who are highly suspected of LA inducing anaphylaxis, other local anesthetics that can be used as safe alternatives should be determined by diagnostic tests according to future needs.

Redox-Active Ligand Assisted Multielectron Catalysis: A Case of Electrocatalyzed CO2-to-CO Conversion

The selective reduction of carbon dioxide remains a significant challenge due to the complex multielectron/proton transfer process, which results in a high kinetic barrier and the production of diverse products. Inspired by the electrostatic and H-bonding interactions observed in the second sphere of the [NiFe]-CODH enzyme, researchers have extensively explored these interactions to regulate proton transfer, stabilize intermediates, and ultimately improve the performance of catalytic CO2 reduction. In this work, a series of cobalt(II) tetraphenylporphyrins with varying numbers of redox-active nitro groups were synthesized and evaluated as CO2 reduction electrocatalysts. Analyses of the redox properties of these complexes revealed a consistent relationship between the number of nitro groups and the corresponding accepted electron number of the ligand at -1.59 V vs. Fc+/0. Among the catalysts tested, TNPPCo with four nitro groups exhibited the most efficient catalytic activity with a turnover frequency of 4.9 × 104 s-1 and a catalytic onset potential 820 mV more positive than that of the parent TPPCo. Furthermore, the turnover frequencies of the catalysts increased with a higher number of nitro groups. These results demonstrate the promising design strategy of incorporating multielectron redox-active ligands into CO2 reduction catalysts to enhance catalytic performance.

Selective Four-Electron Reduction of Oxygen by a Nonheme Heterobimetallic CuFe Complex

We report herein the first nonheme CuFe oxygen reduction catalyst ([CuII (bpbp)(μ-OAc)2 FeIII ]2+ , CuFe-OAc), which serves as a functional model of cytochrome c oxidase and can catalyze oxygen reduction to water with a turnover frequency of 2.4×103  s-1 and selectivity of 96.0 % in the presence of Et3 NH+ . This performance significantly outcompetes its homobimetallic analogues (2.7 s-1 of CuCu-OAc with %H2 O2 selectivity of 98.9 %, and inactive of FeFe-OAc) under the same conditions. Structure-activity relationship studies, in combination with density functional theory calculation, show that the CuFe center efficiently mediates O-O bond cleavage via a CuII (μ-η1  : η2 -O2 )FeIII peroxo intermediate in which the peroxo ligand possesses distinctive coordinating and electronic character. Our work sheds light on the nature of Cu/Fe heterobimetallic cooperation in oxygen reduction catalysis and demonstrates the potential of this synergistic effect in the design of nonheme oxygen reduction catalysts.

Predicting Breast Cancer Subtypes Using Magnetic Resonance Imaging Based Radiomics With Automatic Segmentation

OBJECTIVE

The aim of the study is to demonstrate whether radiomics based on an automatic segmentation method is feasible for predicting molecular subtypes.

METHODS

This retrospective study included 516 patients with confirmed breast cancer. An automatic segmentation-3-dimensional UNet-based Convolutional Neural Networks, trained on our in-house data set-was applied to segment the regions of interest. A set of 1316 radiomics features per region of interest was extracted. Eighteen cross-combination radiomics methods-with 6 feature selection methods and 3 classifiers-were used for model selection. Model classification performance was assessed using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity.

RESULTS

The average dice similarity coefficient value of the automatic segmentation was 0.89. The radiomics models were predictive of 4 molecular subtypes with the best average: AUC = 0.8623, accuracy = 0.6596, sensitivity = 0.6383, and specificity = 0.8775. For luminal versus nonluminal subtypes, AUC = 0.8788 (95% confidence interval [CI], 0.8505-0.9071), accuracy = 0.7756, sensitivity = 0.7973, and specificity = 0.7466. For human epidermal growth factor receptor 2 (HER2)-enriched versus non-HER2-enriched subtypes, AUC = 0.8676 (95% CI, 0.8370-0.8982), accuracy = 0.7737, sensitivity = 0.8859, and specificity = 0.7283. For triple-negative breast cancer versus non-triple-negative breast cancer subtypes, AUC = 0.9335 (95% CI, 0.9027-0.9643), accuracy = 0.9110, sensitivity = 0.4444, and specificity = 0.9865.

CONCLUSIONS

Radiomics based on automatic segmentation of magnetic resonance imaging can predict breast cancer of 4 molecular subtypes noninvasively and is potentially applicable in large samples.

[The value of aspirin challenge tests in the diagnosis of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease]

Objective: To investigate the value of aspirin challenge tests in the diagnosis of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD). Methods: Fifty patients (22 males and 28 females; aged 16-61 years) who were diagnosed with chronic rhinosinusitis with nasal polyps (CRSwNP) with/without asthma, and underwent NERD standardized diagnosis in the Allergy Centre of West China Hospital, Sichuan University from December 2021 to November 2022 were included in the study. The first step was asking about the history of exacerbation respiratory symptoms after intake of any non-steroidal anti-inflammatory drug, including aspirin; the second step was performing intranasal aspirin challenge (IAC); and the third step was performing oral aspirin challenge (OAC). The diagnosis of NERD was made if any of the above steps was positive, and the subsequent steps were not performed, otherwise the diagnosis was made to OAC. If OAC was negative, the diagnosis was non-NERD. All patients completed the sino-nasal outcome test 22 (SNOT 22) score, Lund-Kennedy score by nasal endoscopic, allergen skin prick test, blood routine and serum total IgE test. SPSS version 20.0 was used for statistical analysis. Results: The diagnosis of NRED was confirmed in 27 patients (27/50, 54%). Seven (7/50, 14%) of them were diagnosed by clinical history and 20 (20/50, 40%) were diagnosed by aspirin challenge tests, of which 17 (17/20, 85%) were positive to IAC and 3 (3/20, 15%) to OAC. Of the 43 patients who underwent IAC testing, only 2 (2/43, 5%) developed asthma attacks during challenge. Comparing the clinical characteristics of patients in NERD and non-NERD group, there were significant differences between the two groups in gender (P=0.001), hyposmia (P=0.003), history of repeated CRSwNP surgeries (P=0.028), comorbid asthma (P=0.013), SNOT-22 score (P=0.004) and the percentage of peripheral blood eosinophil (P=0.043). Conclusions: Patients may be underdiagnosed if the diagnosis of NERD is made only by medical history, and it is necessary to carry out aspirin challenge tests. IAC is an important means to diagnose NERD with high accuracy and good safety. However, If IAC is negative, further OAC is required.

[Prognostic value of perioperative change of neutrophil elastase and myeloperoxidase in coronary circulation on perioperative myocardial injury and clinical outcome of patients underwent surgical valve replacement]

Objective: To investigate the clinical value of observing perioperative changes of myeloperoxidase (MPO) and neutrophil elastase (NE) in coronary artery circulation in patients underwent valve replacement surgery. Methods: This perspective cohort study was performed in patients who underwent valvular surgery in Nanjing Drum Tower Hospital and Fuwai Hospital from June 2021 to June 2022. Patients were divided into perioperative myocardial injury group and age-, sex- and type of cardiac procedure-matched non-perioperative myocardial injury control group in the ratio of 1∶1. Perioperative myocardial injury was defined as cardiac troponin T (cTnT)>0.8 μg/L on the first postoperative day (POD), and the cTnT level on the second POD increased by more than 10% compared with the cTnT level on the first POD. During the operation, blood samples were collected from the coronary sinus before clamping ascending aorta, and within 5 minutes after de-clamping ascending aorta. Then, the levels of MPO and NE on coronary sinus were continuously measured. The death, severe ventricular arrhythmia, pneumonia, re-intubation, repeat cardiac surgery, extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT), mechanical ventilation time and the duration of intensive care unit (ICU) were recorded. The levels of MPO and NE and the incidence of clinical outcomes were compared between the myocardial injury group and the control group. The independent risk factors of myocardial injury were analyzed by multivariate logistic regression. Results: A total of 130 patients were enrolled, aged (60.6±7.6) years old, with 59 males (45.4%). There were 65 patients in the myocardial injury group and 65 patients in the control group. During hospitalization, there was no death, ECMO, IABP and CRRT cases in both groups. Compared with the control group, the incidence of severe ventricular arrhythmia (13.8%(9/65) vs. 3.1%(2/65), P=0.03), pneumonia (20.0%(13/65) vs. 3.1%(2/65), P=0.03), re-intubation (6.2%(4/65) vs. 0, P=0.04) was significantly higher in myocardial injury group. The mechanical ventilation time (16.8(10.7, 101.7) h vs. 7.5(4.7, 15.1) h, P<0.01), and the duration of ICU (3.7(2.7, 18.9) vs. 2.7(1.8, 6.9)d, P<0.01) were significantly longer in myocardial injury group compared with the control group. There was no significant difference in the levels of MPO and NE in coronary sinus blood between the two groups before aortic clamping (all P>0.05). However, MPO ((551.3±124.2) μg/L vs. (447.2±135.9) μg/L, P<0.01) and NE ((417.0±83.1)μg/L vs. (341.0±68.3)μg/L, P<0.01) after 5 min aortic de-clamping were significantly higher in myocardial injury group than in the control group. Multivariate logistic regression analysis showed that the levels of NE (OR=1.02, 95%CI: 1.01-1.02, P<0.01), MPO (OR=1.00, 95%CI: 1.00-1.01, P=0.02) and mechanical ventilation time (OR=1.03, 95%CI: 1.01-1.06, P=0.02) were independent risk factors of myocardial injury in patients after surgical valvular replacement. Conclusion: Perioperative myocardial injury is related poor clinical outcomes, perioperative NE and MPO in coronary artery circulation are independent risk factors of perioperative myocardial injury in patients undergoing valve replacement surgery.

New two-stage pH combined with dissolved oxygen control strategy for cyclic β-1,2 glucans synthesis

On the basis of a novel two-stage pH combined with dissolved oxygen (DO) control strategy in fed-batch fermentation, this research addresses the influence of pH on cyclic β-1,2-glucans (CβGs) biosynthesis and melanin accumulation during the production of CβGs by Rhizobium radiobacter ATCC 13,333. Under these optimal fermentation conditions, the maximum cell concentration and CβGs concentration in a 7-L stirred-tank fermenter were 7.94 g L^-1 and 3.12 g L^-1, which were the maximum production reported for R. radiobacter. The melanin concentration of the fermentation broth was maintained at a low level, which was beneficial to the subsequent separation and purification of the CβGs. In addition, a neutral extracellular oligosaccharide (COGs-1) purified by the two-stage pH combined with DO control strategy fermentation medium was structurally characterized. Structural analyses indicated that COGs-1 was a family of unbranched cyclic oligosaccharides composed of only β-1,2-linked D-glucopyranose residues with degree of polymerization between 17 and 23, namely CβGs. This research provides a reliable source of CβGs and structural basis for further studies of biological activity and function. KEY POINTS: • A two-stage pH combined with DO control strategy was proposed for CβGs production and melanin biosynthesis by Rhizobium radiobacter. • The final extracellular CβGs production reached 3.12 g L^-1, which was the highest achieved by Rhizobium radiobacter. • The existence of CβGs could be detected by TLC quickly and accurately.

[Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF)]

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

Association of cognitive function and hypoperfusion in Moyamoya disease patients without stroke

The influence of hypoperfusion on cognition in patients with Moyamoya disease (MMD) is unclear. This study investigated cognitive function changes in MMD patients without stroke and illustrated the relationship between cognitive impairment and hypoperfusion. We prospectively performed a structured battery of seven neurocognitive tests on 115 adult MMD patients without stroke and 82 healthy controls. Hemodynamic assessment was performed using dynamic susceptibility contrast-enhanced MRI. The best subset regression (BSR) strategy was used to identify risk factors. Global cognition (MoCA), speed of information processing (TMT-A), executive function (TMT-B), visuospatial function (CDT), and verbal memory (CAVLT) were significantly poorer in MMD patients without stroke than in healthy controls. The TMT-B score significantly correlated with cerebral blood flow (CBF) in the bilateral lateral frontal lobes, centrum semiovale, and temporal lobes. The TMT-A and CAVLT scores significantly correlated with CBF in the left centrum semiovale (L-CSO) and temporal lobes. According to the BSR results, age, education, white matter lesions, and hypoperfusion of the L-CSO were risk factors for cognitive impairment. Hypoperfusion leads to multiple cognitive impairments in MMD patients without stroke. The perfusion of particular areas may help evaluate the cognitive function of MMD patients and guide therapeutic strategies.

Heterobimetallic NiFe Cooperative Molecular Water Oxidation Catalyst

We reported herein the development of heterobimetallic NiFe molecular platform to understand NiFe synergistic effect in water oxidation catalysis. Compared to homonuclear bimetallic compounds (NiNi and FeFe), NiFe complex possesses more remarkable catalytic water oxidation performance. Mechanistic studies suggest that this remarkable difference is attributed to the fact that NiFe synergy can effectively promote O-O bond formation. The generated Ni^III (μ-O)Fe^IV =O is the key intermediate and O-O bond was formed via intramolecular oxyl-oxo coupling between bridged O radical and terminal Fe^IV =O moiety.

Co-training based virtual sample generation for solving the small sample size problem in process industry

With the development of industrialization, the production scale and complexity of process industries are getting larger and larger. But, limited by the small amounts of samples and the uneven sample distribution in the process industry, it is difficult to establish accurate and efficient data-driven soft sensor models to predict some variables. To further develop the application of soft sensor models, generating new virtual samples based on the original sample distribution to extend the sample set is an ideal approach to solve this problem. In this paper, a novel virtual sample generation method based on the co-training of two K-Nearest Neighbor (KNN) models is proposed. First, according to the sparse parameter, sparse regions in each dimension of the feature space are identified. Second, the input features of virtual samples are generated in these sparse regions by performing interpolation operations. Third, the outputs of virtual samples are predicted by double KNN regressors based on co-training. The qualified virtual samples are screened and the model is updated using these virtual samples to improve the prediction accuracy of the double KNN models. To verify the effectiveness and superiority of the proposed virtual sample generation method based on the co-training (CTVSG), case studies are conducted using two standard functions and a Purified Terephthalic Acid (PTA) industrial dataset, where the effectiveness of CTVSG is confirmed.

Application of immersion B-scan ultrasonography in diagnosis of complex retinal detachment, persistent hyperplastic primary vitreous and intraocular tumors

AIM

To evaluate the diagnostic value of panoramic immersion B-scan ultrasonography (Pano-immersion B-scan, PIB) in complex retinal detachment (RD), persistent hyperplastic primary vitreous (PHPV) and intraocular tumors.

METHODS

The clinical data of 44 patients collected from May 2012 to December 2019 in Chinese PLA General Hospital was retrospectively studied. All of these patients underwent PIB of the eye, because it was difficult to diagnose by routine ocular fundus examination, conventional ultrasound or/and ultrasonic biomicroscope (UBM) due to opacity of refractive media, pupillary occlusion, large involvement or special location of the lesion. The imaging features of difficult cases in PIB were analyzed. The diagnosis accuracy rating of PIB were evaluated and contrasted with conventional ultrasound or UBM by the standard of intraoperative diagnosis or/and pathological results.

RESULTS

According to intraoperative diagnosis or pathological results as gold standard, among the 44 cases, there were 19 cases missed diagnosis, misdiagnosed or difficult-to-diagnose by conventional ultrasound or UBM, including 4 cases of long-standing RD difficult to diagnose, 4 cases misdiagnosed, and 11 cases incompletely observed or miss diagnosed. The diagnostic accuracy rate of PIB and conventional ultrasound or UBM were 100% (44/44) and 56.82% (25/44), and the sensitivity of them were 100% and 56.82%. All the patients underwent PIB and were diagnosed as RD (15 cases), retinal and choroidal detachment (4 cases), subchoroidal hematocele (1 case), vitreous opacity and/or organic membrane formation (4 cases), PHPV (12 cases), iris and/or ciliary body tumors (3 cases), and choroidal tumors (6 cases). According to the intraoperative diagnosis or pathological results, the diagnostic coincidence rate of PIB was 100%, which was significantly higher than conventional ultrasound and UBM.

CONCLUSION

PIB can help to accurately diagnose complex RD, PHPV, and intraocular masses with special location or/and excessive size. It has important diagnostic value for patients with equivocal findings at conventional ultrasound examination.

Computed tomography-based COVID-19 triage through a deep neural network using mask-weighted global average pooling

Background

There is an urgent need to find an effective and accurate method for triaging coronavirus disease 2019 (COVID-19) patients from millions or billions of people. Therefore, this study aimed to develop a novel deep-learning approach for COVID-19 triage based on chest computed tomography (CT) images, including normal, pneumonia, and COVID-19 cases.

Methods

A total of 2,809 chest CT scans (1,105 COVID-19, 854 normal, and 850 non-3COVID-19 pneumonia cases) were acquired for this study and classified into the training set (n = 2,329) and test set (n = 480). A U-net-based convolutional neural network was used for lung segmentation, and a mask-weighted global average pooling (GAP) method was proposed for the deep neural network to improve the performance of COVID-19 classification between COVID-19 and normal or common pneumonia cases.

Results

The results for lung segmentation reached a dice value of 96.5% on 30 independent CT scans. The performance of the mask-weighted GAP method achieved the COVID-19 triage with a sensitivity of 96.5% and specificity of 87.8% using the testing dataset. The mask-weighted GAP method demonstrated 0.9% and 2% improvements in sensitivity and specificity, respectively, compared with the normal GAP. In addition, fusion images between the CT images and the highlighted area from the deep learning model using the Grad-CAM method, indicating the lesion region detected using the deep learning method, were drawn and could also be confirmed by radiologists.

Conclusions

This study proposed a mask-weighted GAP-based deep learning method and obtained promising results for COVID-19 triage based on chest CT images. Furthermore, it can be considered a convenient tool to assist doctors in diagnosing COVID-19.

RGS6 suppresses TGF-β-induced epithelial-mesenchymal transition in non-small cell lung cancers via a novel mechanism dependent on its interaction with SMAD4

Regulator of G-protein signaling 6 (RGS6) is a newly discovered tumor suppressor that has been shown to be protective in development of various cancers such as breast cancer and bladder cancer. But the mechanisms underlying these tumor-suppressing functions of RGS6 are not fully understood. Here, we discover a novel function of RGS6 in suppressing TGF-β-induced epithelial-mesenchymal transition (EMT) of non-small cell lung cancer (NSCLC) cells and in vivo NSCLC metastasis. Using both bioinformatics and experimental tools, we showed that RGS6 was downregulated in lung cancer tissues compared to noncancerous counterparts, and low expression of RGS6 was associated with poor survival of lung cancer patients. Overexpression of RGS6 suppressed TGF-β-induced EMT in vitro and TGF-β-promoted metastasis in vivo, by impairing gene expression of downstream effectors induced by the canonical TGF-β-SMAD signaling. The ability of RGS6 to suppress TGF-β-SMAD-mediated gene expression relied on its binding to SMAD4 to prevent complex formation between SMAD4 and SMAD2/3, but independent of its regulation of the G-protein signaling. Interaction between RGS6 and SMAD4 caused less nuclear entry of p-SMAD3 and SMAD4, resulting in inefficient SMAD3-mediated gene expression. Taken together, our findings reveal a novel and noncanonical role of RGS6 in regulation of TGF-β-induced EMT and metastasis of NSCLC and identify RGS6 as a prognostic marker and a potential novel target for NSCLC therapy.

[Clinical study of heparin anticoagulation scheme during plasma adsorption therapy for liver failure]

Objective: To investigate the reasonable dosage of heparin anticoagulation scheme during plasma adsorption (PA) therapy for liver failure. Methods: Patients with liver failure treated with PA therapy were retrospectively collected and divided according to the anticoagulation scheme into the first-dose heparin anticoagulation group and the first-dose plus maintenance heparin anticoagulation group. Clinical data and laboratory test results were compared before and after treatment between the two groups. Paired t-tests were used for comparison within the normally distributed groups. An independent two-sample t-test was used for inter group comparison. Wilcoxon rank-sum test was used for measurement data that did not conform to a normal distribution. Fisher's exact test was used to compare the count data between groups. Results: There were 138 cases with liver failure treated with PA therapy from October 2017 to September 2020. Among them, 83 and 55 cases were in the first-dose heparin anticoagulation and first-dose plus maintenance heparin anticoagulation group, respectively. Age, gender, and laboratory data before treatment were comparable between the two groups. PA treatment was successfully completed in both groups of patient, and there was no statistically significant difference in the determination of coagulation level with plasma separators (Z=-0.15, P=0.216). There were different degrees of bleeding complications in both groups. In the first-dose heparin anticoagulation group, there were two cases (2.4%) of central venous catheter bleeding and one case (1.2%) of epistaxis. In the first-dose plus maintenance heparin anticoagulation group, there were five cases (9.1%) of central venous catheter bleeding, two cases (3.6%) of skin bleeding, one case (1.8%) of epistaxis, and one case (1.8%) of upper gastrointestinal bleeding. The incidence of bleeding complications was lower in the first-dose of heparin anticoagulation than first-dose plus maintenance heparin anticoagulation group, and the difference was statistically significant (P<0.001). The activated partial thromboplastin time of the two groups was prolonged after therapy withdrawal than with therapy, and the difference was statistically significant (first-dose heparin anticoagulation group: t=3.850, P=0.022; first-dose plus maintenance heparin anticoagulation group: t=6.733, P=0.007). The activated partial thromboplastin time was prolonged in patients with first-dose plus maintenance heparin anticoagulation than first-dose heparin anticoagulation group, and the difference was statistically significant (P=0.025). The total bilirubin of the two groups before and after PA was significantly changed (the first-dose heparin anticoagulation group: Z=-2.455, P=0.017; the first-dose plus maintenance heparin anticoagulation group: Z=-2.307, P=0.024), and there was no statistically significant difference between the two groups (P=0.412). There was no statistically significant difference in platelet changes before and after PA therapy between the two groups (the first dose of heparin anticoagulation group: Z=-0.529, P=0.480; the first-dose plus maintenance heparin anticoagulation group: Z=-0.276, P=0.362). Conclusion: Anticoagulation scheme without maintenance medication is feasible with prothrombin activity before ≤20-40%, activated partial thromboplastin time of ≤87 s (2 times the upper normal value), platelet count before treatment (excluding contraindications to heparin) ≥50×10⁹/L, and the first dose of heparin administration of 0.2 mg/kg during PA therapy in patients with liver failure.

[Clinical effects of matrix acupuncture on cervical spondylotic radiculopathy with nuchal ligament calcification]

OBJECTIVE

To observe the effects of matrix acupuncture on the neck disability index (NDI) score, clinical efficacy, and the calcification size of the nuchal ligament in patients of cervical spondylotic radiculopathy with nuchal ligament calcification.

METHODS

A total of 120 cases were randomly divided into a matrix acupuncture group and a routine acupuncture group, with 60 cases in each group. In the matrix acupuncture group, Ashi-point, bilateral Tianzhu (BL10), bilateral Fengchi (GB20), bilateral Dazhu (BL11), bilateral Jianzhongshu (SI15), and Jianjing (GB21), Tianzong (SI11), Quchi (LI11), Shousanli (LI10), Waiguan (TE5), and Hegu (LI4) at the affected side were selected. In the routine acupuncture group, C3-C7 Jiaji points at the neck and Jianjing (GB21), Tianzong (SI11), Quchi (LI11), Shousanli (LI10), Waiguan (TE5), Hegu (LI4), and Ashi-point at the affected side were selected. The patients in the two groups were treated 30 min once, six days a week, for a total of four weeks. The NDI scores, clinical efficacies, and calcification sizes of nuchal ligament were compared between the two groups every wee-kend.

RESULTS

After four weeks of treatment, the NDI scores and calcification volumes of nuchal ligament decreased in both groups (P<0.05). Compared with the routine acupuncture group, the matrix acupuncture group showed decreased NDI scores and reduced calcification volumes of nuchal ligament at the 1^st, 2^nd, 3^rd, and 4^th weeks of treatment (P<0.05). The cure and marked effective rate in the matrix acupuncture group at the 2^nd, 3^rd, and 4^th weeks of treatment were superior to those of the routine acupuncture group (P<0.05).

CONCLUSION

The matrix acupuncture group and the routine acupuncture group are effective in reducing the NDI score and calcification size of nuchal ligament in patients of cervical spondylotic radiculopathy with nuchal ligament calcification. However, matrix acupuncture has obvious advantages over routine acupuncture.

[Analysis of curative effects of chemoembolization with drug-loaded microspheres of different particle sizes for the treatment of hepatocellular carcinoma]

Objective: To compare and analyze the clinical curative effect and safety of chemoembolization with drug-loaded microspheres of different particle sizes (D-TACE) for the treatment of hepatocellular carcinoma. Methods: Clinical data of 281 cases with hepatocellular carcinoma treated with drug-loaded microspheres-transarterial chemoembolization (TACE) were retrospectively analyzed. According to the different particle sizes of drug-loaded microspheres, they were divided into 100~300 µm (small particle size) and 300~500 µm (large particle size) group. Tumor response rate and complication conditions at 1, 3, and 6 months after chemoembolization were compared. The overall survival time of the two groups were analyzed. Quantitative data conformed to normal distribution and homogeneity of variance were compared using t-test, while other with Wilcoxon signed rank-sum test. Qualitative data were compared using χ² test. Kaplan-Meier method was used for survival analysis, and the differences in survival were analyzed using Log-rank test. P＜0.05 was considered as statistically significant. Survival curves and histograms were drawn using GraphPad Prism9.1 software. Results: The complete remission rates at 1, 3 and 6 months after surgery in the small and large particle size groups were 31.25%, 30.15%, and 42.45% and 18.25%, 15.79% and 24.74%, respectively, and the differences were statistically significant between groups (P_{1 month}=0.012, P_{3 month}=0.009, P_{6 month}=0.008, P＜0.05). The objective remission rates at 1, 3 and 6 months after surgery in the small and large particle size groups were 88.19%, 76.99%, and 70.75% and 81.02%, 72.81% and 53.60%, respectively. Six months after surgery, the small particle size group (objective response rate = 70.75%) was significantly higher than the large particle size group (objective response rate=53.6%, P=0.012). The disease control rates of the small particle size group were 95.14%, 83.33%, and 74.53%, while large particle size group were 91.24%, 81.58%, and 64.95%, respectively, with no statistically significant difference between the two groups. However, the incidence of postoperative biliary tumors (6.20%) was significantly higher in the small-size than large-size group (0.70%), and the difference was statistically significant (P＜0.05, P=0.03). There were no statistically significant differences between other adverse events such as post-embolization syndrome, liver abscess, and myelosuppression. The median survival time of the small and large particle size groups was 31.8 months and 20.5 months, respectively, but the difference was not statistically significant (P=0.182). Conclusions: In the treatment of hepatocellular carcinoma with D-TACE, the short-term curative effect of the small particle size group was better than large particle size group, but the incidence of biliary tumors was high, and D-TACE of different particle sizes had no significant effect on long-term survival.

RNA demethylase ALKBH5 inhibits TGF-β-induced EMT by regulating TGF-β/SMAD signaling in non-small cell lung cancer

AlkB homolog 5 (ALKBH5) has been revealed as a key RNA N⁶ -methyladenosine (m⁶ A) demethylase that is implicated in development and diseases. However, the function of ALKBH5 in TGF-β-induced epithelial-mesenchymal transition (EMT) and tumor metastasis of non-small-cell lung cancer (NSCLC) remains unknown. Here, we firstly show that ALKBH5 expression is significantly reduced in metastatic NSCLC. ALKBH5 overexpression inhibits TGF-β-induced EMT and invasion of NSCLC cells, whereas ALKBH5 knockdown promotes the corresponding phenotypes. ALKBH5 overexpression suppresses TGF-β-stimulated NSCLC cell metastasis in vivo. ALKBH5 overexpression decreases the expression and mRNA stability of TGFβR2 and SMAD3 but increases those of SMAD6, while ALKBH5 knockdown causes the opposite results. Importantly, ALKBH5 overexpression or knockdown leads respectively to an attenuated or augmented phosphorylation of SMAD3, an indispensable downstream effector that activates TGF-β/SMAD signaling. Moreover, m⁶ A-binding proteins YTHDF1/3 promotes TGFβR2 and SMAD3 expression, and YTHDF2 inhibits SMAD6 expression. YTHDF1/2/3 facilitates TGF-β-stimulated EMT and invasion of NSCLC cells. Mechanistically, ALKBH5 affects TGFβR2, SMAD3 and SMAD6 expression and mRNA stability by erasing m⁶ A modification in NSCLC cells. ALKBH5 weakens YTHDF1/3-mediated TGFβR2 and SMAD3 mRNA stabilization, and abolishes YTHDF2-mediated SMAD6 mRNA degradation, supporting the notion that ALKBH5 inhibits TGF-β-induced EMT and invasion of NSCLC cells via YTHD1/2/3-mediated mechanism. Taken together, our findings highlight an important role of ALKBH5 in regulating TGF-β/SMAD signaling, and establish a mechanistic interaction of ALKBH5 with TGFβR2/SMAD3/SMAD6 for controlling TGF-β-induced EMT in NSCLCs.

[Association of thrombocytopenia with mortality after surgery in patients with Standford type A aortic dissection]

Objective: To evaluate the association of thromboytopenia with mortality of Standford type A aortic dissection after cardiopulmonary bypass surgery. Methods: Total of 498 patients with Standford type A aortic dissection after surgery in Fuwai Hospital of the Chinese Academy of Medical Sciences from May 2017 to December 2018 were collected retrospectively. There were 350 males and 148 females, with a mean age of (51.7±12.0) years. The patients were divided into thrombocytopenia group (platelet count<75×10¹⁵/L, n=178) and normal platelet group (platelet count≥75×10¹⁵/L, n=320) according to the lowest platelet count within 72 hours after surgery. The perioperative in-hospital mortality and related complications were calculated by univariate and multivariate logistic regression analysis. The primary endpoint was in-hospital mortality, and the secondary endpoints included secondary thoracotomy, pneumonia, postoperative continuous renal replacement therapy, paraplegia, heart failure, length of hospital stay and intensive care unit (ICU) stay time. Results: The morbidity of thrombocytopenia after Standford type A aortic dissection surgery was 35.7% (178/498). Univariate logistic regression analysis showed that postoperative thrombocytopenia was significantly associated with in-hospital mortality and 7 secondary endpoints (P<0.05). Multivariate logistic regression analysis showed thrombocytopenia after aortic dissection surgery was significantly associated with increased postoperative mortality (OR=12.57, 95%CI: 2.26-69.93, P=0.004), secondary thoracotomy (OR=6.21, 95%CI: 1.31-29.46, P=0.022), continuous renal replacement therapy (OR=7.51, 95%CI: 2.53-22.34, P<0.001), paraplegia (OR=23.99, 95%CI: 1.47-392.21, P=0.026), heart failure (OR=4.71, 95%CI: 1.19-18.62, P=0.027) and longer ICU stay time (OR=1.86, 95%CI: 1.11-3.12, P=0.019). Conclusions: Thrombocytopenia after Standford type A aortic dissection after cardiopulmonary bypass surgery (the lowest platelet count within 72 hours) is strongly associated with postoperative in-hospital mortality. Trying to avoid the factors related to thrombocytopenia can prevent more complications at the same time.

Heterogeneity and prognosis of programmed cell death-ligand 1 expression in the circulating tumor cells of non-small cell lung cancer

Due to tumor heterogeneity, the consistency of programmed cell death-ligand 1 (PD-L1) expression between circulating tumor cells (CTCs) and tissue is controversial. This study aimed to establish a method for detecting CTC PD-L1 expression and exploring the impact of the same on the prognosis of lung cancer. In 32 patients with non-small cell lung cancer, lung cancer cells in the blood were enriched using CD326 immunomagnetic beads. Goat anti-mouse polyclonal CD326 antibody stained the epithelial lung cancer cells and anti-PD-L1 antibody was used to detect the expression of CTC PD-L1. The DAKO Link 48 automatic staining device detected the expression in lung cancer tissue. The consistency of PD-L1 expression was analyzed in lung cancer tissue and CTCs. The effect of plasma interferon gamma, tumor necrosis factor alpha, and interleukin-2 on PD-L1 expression and prognosis was analyzed. The number of CTCs detected in patients was 1-36, with a median of 2. There was no significant difference in PD-L1 expression fractions between CTCs and paired tumor tissue (p>0.05). The correlation coefficient was 0.20. Regardless of lung cancer tissue or CTCs, there was no statistically significant difference in the blood cytokine levels between the two groups with positive or negative PD-L1 expression (p>0.05). There was no correlation between CTCs and PD-L1 in 23 untreated patients. The expression of PD-L1 in CTCs and lung cancer tissue is heterogeneous and unaffected by the peripheral cytokines' levels. PD-L1 expression has no correlation between CTCs and tissues and is not related to prognosis.

Iron-Catalyzed Water Oxidation: O-O Bond Formation via Intramolecular Oxo-Oxo Interaction

Herein, we report the importance of structure regulation on the O-O bond formation process in binuclear iron catalysts. Three complexes, [Fe₂ (μ-O)(OH₂ )₂ (TPA)₂ ]⁴⁺ (1), [Fe₂ (μ-O)(OH₂ )₂ (6-HPA)]⁴⁺ (2) and [Fe₂ (μ-O)(OH₂ )₂ (BPMAN)]⁴⁺ (3), have been designed as electrocatalysts for water oxidation in 0.1 M NaHCO₃ solution (pH 8.4). We found that 1 and 2 are molecular catalysts and that O-O bond formation proceeds via oxo-oxo coupling rather than by the water nucleophilic attack (WNA) pathway. In contrast, complex 3 displays negligible catalytic activity. DFT calculations suggested that the anti to syn isomerization of the two high-valent Fe=O moieties in these catalysts takes place via the axial rotation of one Fe=O unit around the Fe-O-Fe center. This is followed by the O-O bond formation via an oxo-oxo coupling pathway at the Fe^IV Fe^IV state or via oxo-oxyl coupling pathway at the Fe^IV Fe^V state. Importantly, the rigid BPMAN ligand in complex 3 limits the anti to syn isomerization and axial rotation of the Fe=O moiety, which accounts for the negligible catalytic activity.

Quaking 5 suppresses TGF-β-induced EMT and cell invasion in lung adenocarcinoma

Quaking (QKI) proteins belong to the signal transduction and activation of RNA (STAR) family of RNA-binding proteins that have multiple functions in RNA biology. Here, we show that QKI-5 is dramatically decreased in metastatic lung adenocarcinoma (LUAD). QKI-5 overexpression inhibits TGF-β-induced epithelial-mesenchymal transition (EMT) and invasion, whereas QKI-5 knockdown has the opposite effect. QKI-5 overexpression and silencing suppresses and promotes TGF-β-stimulated metastasis in vivo, respectively. QKI-5 inhibits TGF-β-induced EMT and invasion in a TGFβR1-dependent manner. KLF6 knockdown increases TGFβR1 expression and promotes TGF-β-induced EMT, which is partly abrogated by QKI-5 overexpression. Mechanistically, QKI-5 directly interacts with the TGFβR1 3' UTR and causes post-transcriptional degradation of TGFβR1 mRNA, thereby inhibiting TGF-β-induced SMAD3 phosphorylation and TGF-β/SMAD signaling. QKI-5 is positively regulated by KLF6 at the transcriptional level. In LUAD tissues, KLF6 is lowly expressed and positively correlated with QKI-5 expression, while TGFβR1 expression is up-regulated and inversely correlated with QKI-5 expression. We reveal a novel mechanism by which KLF6 transcriptionally regulates QKI-5 and suggest that targeting the KLF6/QKI-5/TGFβR1 axis is a promising targeting strategy for metastatic LUAD.

[Corrigendum] Ski prevents TGF‑β‑induced EMT and cell invasion by repressing SMAD‑dependent signaling in non‑small cell lung cancer

Following the publication of the above paper, an interested reader drew to our attention apparent anomalies associated with Figs. 2, 3 and 4; essentially, these three figures contained panels exhibiting overlapping data, such that data purportedly relating to different experiments were apparently drawn from the same original sources. [Specifically, the Ski, +TGF‑β1 data panel in Fig. 2B, the Mock, +TGF‑β1 data panel in Fig. 3A, and the +TGF‑β1, +SIS3 data panel in Fig. 4B in the original figures were chosen incorrectly.] Upon investigating this matter with the authors, the authors have realized that they made errors in the compilation of the affected figures. The errors were made inadvertently, and the authors have been able to identify the correct data for each of the figures concerned. The corrected versions of these figures are shown opposite and on the next page. Note that these errors did not affect the overall conclusions reported in the study. The authors are grateful to the Editor of Oncology Reports for allowing them the opportunity to publish this Corrigendum; furthermore, the authors apologize for any inconvenience caused to the readership of the Journal. [the original article was published in Oncology Reports 34: 87-94, 2015; DOI: 10.3892/or.2015.3961].

[Acupuncture technique of Jingou Diaoyu combined with speech rehabilitation training for post-stroke motor aphasia]

OBJECTIVE

To compare the clinical efficacy of the acupuncture technique of Jingou Diaoyu combined with speech rehabilitation training and speech rehabilitation training alone for post-stroke motor aphasia.

METHODS

A total of 70 patients with post-stroke motor aphasia were randomly divided into an observation group and a control group, 35 cases in each group. The patients in the control group were treated with basic treatment and speech rehabilitation training; on the basis of the control group, the patients in the observation group were treated with the acupuncture technique of Jingou Diaoyu at Yamen (GV 15), Jinjin (EX-HN 12), Yuye (EX-HN 13), and Hegu (LI 4) etc., once a day, 6 days per week, for a total of 4 weeks. The speech function score, aphasia grade, daily life speech ability score of the two groups before and after treatment were observed, and the clinical efficacy was evaluated.

RESULTS

The total effective rate was 94.3% (33/35) in the observation group, which was superior to 80.0% (28/35) in the control group (P<0.05). In addition to listening comprehension, each score of speech function in the two groups was significantly increased after treatment (P<0.05), and the increasing in the observation group was greater than that in the control group (P<0.05). After treatment, the aphasia grade of the two groups were improved (P<0.05), and the aphasia grade in the observation group was significantly better than that in the control group (P<0.05). After treatment, the scores of daily life speech ability in the two groups were significantly improved (P<0.05), and the increasing in the observation group was greater than that in the control group (P<0.05).

CONCLUSION

The acupuncture technique of Jingou Diaoyu combined with speech rehabilitation training could improve the speech function of patients with post-stroke motor aphasia, and its curative effect is superior to the speech rehabilitation training alone.

The significance of Siglec-15 expression in resectable non-small cell lung cancer

Siglec-15 (S15) is another important mechanism of tumor immune escape besides the PD-L1/PD-1 pathway and represents a new kind of immune checkpoint inhibitor. However, the associations of tumor Siglec-15 expression with clinicopathological characteristics and outcomes of non-small cell lung cancer (NSCLC), and tumor-infiltrating lymphocytes (TILs) in a tumor microenvironment (TME) have so far been unclear. A total of 324 NSCLC surgical samples on tumor microarray were used in this study for investigating the association of S15 expression with clinicopathological characteristics and overall survival (OS) as well as correlation with TILs using multiplex immunofluorescence staining and PD-L1. Results showed that the expression of S15 in adenocarcinoma was significantly higher than that in squamous cell carcinoma. S15 expression was positively correlated with CD8+ T cell density in the stroma. The expression rate of PD-L1 in lung squamous cell carcinoma was higher than that in lung adenocarcinoma. S15 expression was not associated with the prognosis of early NSCLC. The pathological mechanism of the co-expression of S15 and PD-L1 in resectable NSCLC remains to be further studied.

[Implications of EET in renal ischemia/reperfusion by regulating NLRP3 expression and pyroptosis]

Objective: To investigate the mechanism of epoxyeicosatrienoic acids (EET) on renal ischemia/reperfusion (I/R). Methods: Thirty 10-week male C57BL6 mice were randomly divided into five groups: sham goup, I/R group, I/R with EET group, I/R with toll-like receptor 4 (TLR4) inhibitor (TAK242) group, I/R with EET and TAK242 group. Blood urea nitrogen (BUN) and serum creatinine (Scr) as well as renal pathological changes were observed 24 h after reperfusion. The protein expression of NOD-like receptor pyrin domain containing 3 (NLRP3), cysteinyl aspartate specific proteinase 1 (caspase-1), interleukin-1β (IL-1β), TLR4 and myeloid differentiation factor 88 (MyD88) were evaluated using Western blot. Results: Severe renal tubular epithelial cell injury and decreased renal function [BUN:(10.37±0.53) vs (6.70±0.82)mmol/L, t=9.17, P<0.001; Scr: (83.67±3.88) vs (32.50±3.51)μmol/L, t=23.96, P<0.001] occurred in I/R group. Compared to the sham group, the relative expression of NLRP3 (1.54±0.10 vs 0.71±0.05, t=13.14, P<0.001), caspase-1 (2.35±0.05 vs 0.62±0.02, t=73.77, P<0.001), IL-1β (3.11±0.11 vs 1.26±0.05, t=35.97, P<0.001), TLR4 (1.58±0.03 vs 0.39±0.01, t=86.00, P<0.001), MyD88 (0.94±0.02 vs 0.26±0.01, t=72.61, P<0.001) were significantly increased. Mice pretreated with EET analog featured lower kidney damage and diminished levels of above proteins than I/R group (all P<0.001). Besides, the co-administration of TAK242 and EET analog could even markedly reduced the expression levels of each proteins than those in I/R group and I/R with EET group (all P<0.001). Conclusion: EET exerts a protective effect on attenuating renal I/R injury possibly through inhibiting TLR4 pathway to regulate the activation of NLRP3-induced pyroptosis.

[Diagnosis and treatment value of bedside pulmonary ultrasound for atelectasis in patients after cardiac surgery]

Objective: To investigate the value of bedside pulmonary ultrasound in the diagnosis and treatment of atelectasis in patients after cardiac surgery. Methods: A total of 45 patients developed respiratory failure within 1 week after cardiovascular surgery from April 2017 to April 2018 were enrolled in this study. Among them, 27 were male and 18 were female, mean age was (47±5) years. The postoperative pulmonary ultrasound and chest CT findings were collected, and the consistency, efficacy evaluation, timeliness and safety value of pulmonary ultrasound and chest CT diagnosis were compared. The consistency of the two diagnostic methods was checked based on the Kappa consistency test. Results: A total of 87 foci of atelectasis were diagnosed in 45 patients, including 29 foci of complete atelectasis and 58 foci of incomplete atelectasis. Thoracic CT examination confirmed 44 cases of atelectasis (positive rate 97.8%), and 42 cases (93.3%) were found with atelectasis with ultrasound test. The two methods were consistent in the diagnosis of atelectasis (Kappa value was 0.741, P<0.05). In the evaluation of the atelectasis, the results of the two examination methods were completely consistent, and the pulmonary ultrasound couldcheck the lung recruitment in real time. Ultrasound examination after lung recruitment showed that the total ventilation score of 42 patients decreased significantly when compared with that before treatment ((18.3±3.6) vs (26.6±3.8), t=10.229, P<0.05). There was no significant difference in the safety between the two examination methods. The time the bedside pulmonary ultrasound used was significantly shorter than that in the chest CT. Conclusions: The accuracy of bedside pulmonary ultrasound in assessing atelectasis after cardiovascular surgery is consistent with chest CT, it brings dynamic monitoring of lung status and assessment of lung recruitment by changes in lung ventilation scores. The inspection takes a short time and is worth promoting.

[The dosimetry comparison study between 3D print template and free-hand guided of precision (125)I seeds implantation on superficial metastatic carcinoma]

Objective: To compare the dose difference of (125)I seeds implantation on superficial metastatic carcinoma between 3D print template guided operation and traditional implantation. To investigate the accuracy of seeds implantation according preplan guided by 3D print template. Methods: A total of 21 cases of patient with 27 lesions underwent (125)I seeds implantation from January 2015 to May 2018 in Hebei General Hospital were analyzed retrospectively. In which, ten lesions underwent seeds implantation guided by 3D print template (template group) and 17 lesions underwent free-hand traditional implantation (traditional group). All patients had been fixed as the position of operation and then performed CT scan. After preplan was designed, the 3D templates were printed in template group. Postplan was performed after the operation.The dose volume histogram, D90 was calculated. The D90 pre and post operation were collected and compared in each group. The difference of D90 and the percentage difference of D90 between pre and post operation were calculated by the formula D90d=D90post-D90pre, D90d%=(D90post-D90pre)/D90pre×100%, and compared the difference between two groups. Results: The mean D90 pre and post operation in template group were (92±26) and (93±27) Gy respectively, t=-0.749, P=0.473. The mean D90 pre and post operation in traditional group were (104±29) and (104±26) Gy respectively, t=-0.139, P=0.891. The difference of D90 in two groups were (3.1±2.4) and (10.0±8.7) Gy, Z=-2.5, P=0.012. The percentage difference of D90 in two groups were 3.1%±1.9% and 9.5%±7.9%, Compared with the traditional group, the template group had smaller fluctuations, and the difference was statistically significant (Z=-2.7, P=0.006) (all P<0.05). Conclusions: The dose parameters of 3D template guided seeds implantation between postplan and preplan are nearly consistent.3D template has good repeatability, which provides a theoretical basis for the popularization of 3D printing technology.

P4664N-terminal pro-B-type natriuretic peptide and its relationship with cardiac function and prognosis in elderly patients with valvular heart disease

Background

N-terminal pro-B-type natriuretic peptide (NT-proBNP) may provide incremental prognostic value in valvular heart disease (VHD). We aimed to elaborate its value in elder VHD patients and relationship with ventricular function and prognosis.

Methods

From China elDerly Valvular heart Disease (China-DVD) cohort study, elder VHD patients (age ≥60 years) with concomitant echocardiography and NT-proBNP measurements at baseline were included. Patients were followed every six months. The primary endpoint was 1-year all-cause mortality regardless of valvular intervention.

Results

In total, 6025 patients were included in the study (mean age of 71.08±7.61 years, 52.6% male, 78.6% NYHA class > I). The overall median NT-proBNP was 268.92 pmol/L (interquartile range [IQR]: 89.94 to 828.70 pmol/L). Among various VHD, the highest NT-proBNP levels were detected in patients with multivalvular heart disease (379.96 pmol/L [IQR: 146.07 to 1188.53 pmol/L]) and mitral regurgitation (294.88 pmol/L [IQR: 98.44 to 917.75 pmol/L), and the lowest levels were observed in patients with aortic regurgitation (112.04 pmol/L [IQR: 31.92 to 408.04 pmol/L). NT-pro BNP levels correlated with age (r=0.131, p<0.0001). Noteworthily, no significant difference was found between men and women. In general, NT-proBNP correlated with left ventricular ejection fraction (LVEF, r=−0.438, p<0.001), left ventricular end-diastolic dimension (LVEDD, r=0.16, p<0.001) and left atrial dimension (LA, r=0.081, p<0.001). All those correlations were stronger in aortic valve disease than mitral valve disease. Diagnostic ability of NT-proBNP to differentiate severe VHD was limited and varied among different VHD (AUC: 0.62 [0.54, 0.69] in AS, 0.61 [0.53, 0.69] in MS, 0.58 [0.53, 0.63] in AR, 0.49 [0.47, 0.53] in MR). Spline curves revealed a strong association between NT-proBNP and mortality. In the overall population, after adjustment of propensity score accounting for age, sex, coronary heart disease, diabetes, cardiomyopathy, symptoms, severity, LVEF, and valvular intervention, NT-proBNP was a powerful, independent, and incremental predictor of mortality (log transformation, HR: 1.38; [95% CI: 1.30 to 1.46], p<0.001). Moreover, we dichotomized NT-proBNP in severe and nonsevere using median values in various VHD. Except for MS, other VHDs all incurred excess mortality with severe NT-proBNP, especially in aortic stenosis (HR: 17.21; [95% CI: 4.08 to 72.60], p<0.001) and aortic regurgitation (HR: 5.10; [95% CI: 2.13 to 12.22], p<0.001).

Conclusion

Levels of NT-proBNP significantly differ by diagnosis in VHD patients and correlate with echocardiographic parameters to varying degrees, reflecting different hemodynamic changes. In patients with VHD other than single mitral stenosis, NT-proBNP is a powerful, independent, and incremental predictor of mortality. Thus, measurement of NT-proBNP should be considered in the VHD population for further risk stratification.

Acknowledgement/Funding

Key Projects in the National Science & Technology Pillar Program during the 12th five-year Plan

P2744Age distribution of valvular heart disease in China: from a national multicenter prospective cohort study

Background

Valvular heart disease (VHD) has been caught in two important cross-currents in recent decades: aging demography and the rise of multimodality imaging and transcatheter valve therapy. In this setting, we aim to identify the distribution, characteristics, and management of Chinese VHD patients according to age.

Methods

China Valvular Heart Disease Cohort Study (China-VHD) was conducted from March to September 2019 in 46 centers over China. It included prospectively 12331 adults with native moderate or severe VHD, of which we described the distribution, management, and in-hospital events according to age (18–44, 45–54, 55–64, 65–74, ≥75). Multivariate Logistic regression was employed to investigate the impact of age on in-hospital events composed of in-hospital mortality, acute heart failure, and stoke.

Results

In Chinese VHD population, overall percentage peaked in 55–64 year olds. The frequency of multivalvular heart disease (MVHD) saw an increasing trend with age (p for trend <0.001). Of single valvular heart disease, mitral regurgitation (MR) was the most frequent left-sided VHD followed by aortic regurgitation (AR), aortic stenosis (AS), and mitral stenosis (MS). AS frequency significantly grew with age (p for trend = 0.02) while AR peaked in 18–44 year olds and fluctuated at a lower level in the older population. In contrast, mitral valve disease (MS, MR, and mixed mitral valve disease) was most frequent in 45–54 year olds and dropped with age (p for trend all <0.001). Noteworthily, all aortic valve disease was notably frequent in men whereas mitral valve disease and MVHD more common in women. Similar to developed countries, degenerative etiology rose steeply while rheumatic and congenital origin fell with age. Regarding management, surgical valve replacement rate was similar in age groups lower than 75 years old with increasing frequency of concomitant CABG. No matter aortic or mitral, the percentage of bio-prosthesis rocketed after 65 years (aortic: 74.7%, mitral: 70.6%). In multivariate logistic regression, covariables included age, sex, BMI, hypertension, diabetes, coronary heart disease, aortic disease, cardiomyopathy, COPD, NYHA class and valvular intervention. Compared to patients younger than 45, in-hospital events significantly higher in patients over 75 only (OR: 1.69 [95% CI: 1.07–2.66], p<0.02). Moreover, women showed a lower risk of in-hospital events (OR: 0.78 [95% CI: 0.63–0.96], p<0.01).

Age distribution of VHD

Conclusion

Age plays a crucial role in valvular heart disease, best illustrated in AS. Unlike the western world, AR and MR are more frequent than AS but show a slightly decreasing trend with age. As expected, degenerative etiology is becoming more prevalent whereas rheumatism decreases. Age over 75 and male are associated with growing in-hospital events. Degenerative VHD thus present an important public-health burden.

Acknowledgement/Funding

Innovation project of Chinese academy of medical science

Comparison of size-resolved hygroscopic growth factors of urban aerosol by different methods in Tianjin during a haze episode

Size-resolved hygroscopic growth factors of urban aerosol during a haze episode were measured using a Humidified Tandem Differential Mobility Analyzer (HTDMA) (g_m(RH)). These factors were also derived from size-resolved particulate chemical composition combined with the κ-Köhler theory (g_κ(RH)) and the thermodynamic model ISORROPIA-II running in forward mode (g_iso-f(RH)) and reverse mode (g_iso-r(RH)), respectively. In terms of agreement among these hygroscopic growth factors, g_κ(RH) matched g_m(RH) best, followed by g_iso-r(RH). In contrast, g_iso-f(RH) demonstrated a poorer agreement with g_m(RH). The good consistency among g_m(RH), g_κ(RH), and g_iso-r(RH) was because they only focus on the physical hygroscopic process, whereas g_iso-f(RH) contains not only the direct influence of relative humidity (RH) on particle size but also the influence of gaseous precursor on the particle chemical composition, which indirectly affects the hygroscopicity of the particles. In this sense, size-resolved g_κ(RH) and g_iso-r(RH) in a wide size range are more adequate to investigate the impact of RH on light scattering and aerosol radiative forcing. At RH = 80%, g_κ(RH) for accumulation mode particles was 1.30-1.45 on polluted days and higher than that on clean days (1.2-1.3). Whereas on both polluted and clean days, g_κ(RH) of ultrafine and coarse mode particles were generally lower than 1.25. The strong hygroscopicity of accumulation mode particles observed on polluted days can deteriorate visibility due to their high extinction efficiency.

Exploring the Potential of Mesoporous Silica as a Carrier for Puerarin: Characterization, Physical Stability, and In Vivo Pharmacokinetics

The aim of this study was to evaluate the use of a novel porous silica carrier, AEROPERL^® 300 Pharma (AP), to improve the in vitro release and oral bioavailability of puerarin (PUE) in solid dispersions (SDs). PUE-AP SD formulations with different ratios of drug to silica (RDS) were prepared by the solvent method. The scanning electron microscopy (SEM) results indicated that the dispersion of PUE improved as the concentration of AP was increased. The differential scanning calorimetry (DSC) and X-ray diffraction (XRD) results revealed that PUE mostly existed in an amorphous state in the SDs. The rate of drug dissolution from the SDs was significantly higher than that from the PUE powder (p < 0.05). The in vitro drug release percentage from the PUE-AP SDs increased as the RDS was reduced. The oral bioavailability of PUE from the SDs improved when using AP, as indicated by AUC_(0-∞), which was 2.05 and 2.01 times greater than that of the PUE (API) and PVP K30 SDs, respectively (p < 0.05). The drug content, in vitro release profiles, and the amorphous state of PUE in the PUE-AP SDs showed no significant changes after being stored at room temperature for 6 months or under accelerated conditions (40 ± 2°C, 75 ± 5% relative humidity) for 3 months. AP has a high pore volume, large specific surface area, excellent flowability, and hydrophilic properties, making it capable of improving the dissolution and bioavailability of poorly water-soluble drugs.

[Small splint external fixation combined with 3D printing brace for the treatment of Colles fractures]

OBJECTIVE

To explore the short-term clinical efficacy of manipulation reduction-combined with small splint and 3D printing wrist brace external fixation of wrist brace for Colles fracture and the advantages of using the brace.

METHODS

A total of 60 patients with Colles fractures who were treated in Zhongshan Hospital of Traditional Chinese Medicine from February to December 2017 were selected. Patients were randomly divided into 2 groups according to the order of treatment, with 30 patients in the control group, including 13 males and 17 females, aged from 16 to 66 years, with a mean of (49.46±12.63) years; the time from injury to consultation ranged from 3 to 18 h, averaged (6.86±3.15) h. In the experimental group, there were 30 cases, 12 males and 18 females, ranging in age from 14 to 68 years old, with a mean of (46.73±14.40) years old; the time from injury to consultation ranged from 3 to 19 h, averaged(7.06±3.45)h. All the patients in the experimental group and the control group were treated with the same doctor's manipulation to reduce the fracture. The small splints were applied for external fixation after the satisfactory reduction shown in the X-ray. After 1 week of fracture treatment, the small splints were removed from the patients in the experimental group and the 3D printing braces were replaced to maintain fixation until the fracture healed. In the control group, small splints were maintained until the fracture healed. Wrist joint X-ray films were taken before and after reduction and 4 weeks after reduction to observe the palmar inclination angle, ulnar deviation angle, radius height and compare; VAS score and swelling degree score were recorded before and after reduction for 1 and 2 weeks; Cooney and PRWE score of wrist joint were compared after 6 to 8 weeks of reduction.

RESULTS

The VAS score of 2 weeks after reduction was 2.40±0.49 in the experimental group and 2.43±0.50 in the control group. There was no statistical difference in the VAS score between the two groups before and after reduction(P=0.364). The swelling degree of 2 weeks after reduction was 0.50±0.50 in the experimental group and 0.53±0.50 in the control group. There was no statistical difference in the swelling degree between the two groups before and after reduction(P=0.746). The Cooney and PRWE scores of the experimental group were better than those of the control group 6 to 8 weeks after reduction (P<0.05), and the anatomical characteristics of palmar inclination, ulnar deviation and radial shortening of the experimental group were better than those of the control group(P<0.05).

CONCLUSIONS

3D printing braces are light and breathable, comfortable and beautiful, and convenient for dressing. The combination of small splint sequentially applied to Colles fracture has a definite clinical effect, which enriches the means of external fixation treatment. It is believed that with the deepening of clinical research, the design and materials of 3D printing braces as well as their application in future medical treatment will be further developed.

[Magnetic resonance imaging findings of hypovascular clear cell renal cell carcinoma]

Objective: To analyze MRI findings of hypovascular clear cell renal cell carcinoma. Methods: The clinical data and MRI findings of patients with hypovascular clear cell RCC confirmed by pathology from February 2016 to March 2017 were retrospectively analyzed in General Hospital of Chinese People's Liberation Army. According to the diameter of the lesions, they were divided into two groups of diameter ≤4 cm and group of diameter > 4 cm. The data was analyzed by using χ(2) to compare clinical data and tumor imaging characteristics between the two groups. Results: Thirty-four patients had 34 hypovascular lesions.The solid part of the tumor showed a slightly hypo- and isointense in 31 lesions, and high signal in 3 lesions; T(1)WI showed slightly lower and equal signal in 29 lesions and high signal in 5 lesions; DWI showed equal low signal in 10 lesions, 24 tumors were mainly high signal; 33 lesions showed pseudo-capsule; tumor hemorrhage in 12 lesions, necrosis in 9 lesions and cystic change in 22 lesions, lipid component in 4 lesions. There were 19 lesions with diameter ≤ 4 cm and 15 lesions with diameter > 4 cm. The surgical methods and bleeding in the lesion were statistically different between the two groups (P<0.05). Conclusion: The MRI findings of hypovascular clear cell RCC are low signal on T(2)WI, high signal on DWI mainly, less lipid. Laparoscopic radical resection was more suitable for lesions with diameter >4 cm and these lesions were more likely to bleed within the tumor.

[Clinicopathological characteristics and differential diagnosis of interdigitating dendritic cell sarcoma]

Objective: To analyze the clinicopathological features and differential diagnosis of interdigitating dendritic cell sarcoma (IDCS). Methods: The clinical pathological features of 7 IDCS were analyzed. Among them, the follow-up results of 6 cases were available. Results: Among the 7 IDCS patients, 4 cases were male and 3 were female. The age of the patients ranged from 26 to 69 years.Three cases were originated from lymph nodes and 4 cases were originated from skin, stomach, adrenal gland and mesentery, respectively. Microscopically, the tumor cells presented as fascicular and storiform proliferation and infiltrated by lymphocytes. The tumor cells were short-spindle or ovoid, with indistinct border of cytoplasm. The immunohistochemistry results showed that tumor cells were S-100, Vim, CD68 and CD163 positive, and AE1/AE3, EMA, CD117, CD34, Desmin, SMA, CD1α, CD21, CD23, CD35, HMB45, Melan-A, MelanPan and ALK negative.The BRAF mutation and clonal rearrangement of T and B cells were not detected. Among the follow-up period of 7 IDCS patients, 3 occurred disease progressions. Conclusions: IDCS is extremely rare with unique pathological features, and its lesion is not limited to the lymph node. The IDCS patients with extensive lesions may have worse prognose. The differential diagnosis of IDCS includes other histiocytic and dendritic cell neoplasms, malignant melanoma and soft tissue neoplasms.