[Introduction to the 9th edition of TNM classification for lung cancer]

Lung cancer is the second commonly diagnosed cancer and remained the leading cause of cancer-related death, with an estimated 1.8 million deaths in 2020. The identification of driver gene mutation and administration of corresponding tyrosine kinase inhibitor have improved overall survival and quality of life in advanced lung cancer patients. Check point inhibitor has revolutionized treatment strategy of driver gene negative advanced NSCLC patients. TNM staging system is the most widely used classification method, providing an international common language during academic communication and important tool for predicting prognosis and subsequent treatment decision making. Accumulating knowledge about prognostic factors in lung cancer promotes the update of TNM classification. In the World Conference on Lung Cancer (WCLC) held in Singapore, September, 2023, International Association for Study of Lung Cancer (IASLC) released the forthcoming 9th edition of TNM classification for lung cancer, which is supposed to be adopted at January, 2024. The manuscript discussed the history, data resource and limitation of the TNM staging system.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

[Patient-reported outcomes of locally advanced gastric cancer undergoing robotic versus laparoscopic gastrectomy: a randomized controlled study]

Objective: To compare the patient-reported outcomes and short-term clinical outcomes between robotic-assisted and laparoscopic-assisted radical gastrectomy for locally advanced gastric cancer. Methods: This single-center prospective randomized controlled trial was conducted in the Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University from October 2020 to August 2022. Patients with locally advanced gastric cancer who were to undergo radical gastrectomy were selected and randomly divided into two groups according to 1∶1, and received robotic surgery and laparoscopic surgery, respectively. Patient-reported outcomes and short-term clinical outcomes (including postoperative complications, surgical quality and postoperative short-term recovery) were compared between the two groups by t test, Mann-Whitney U test, repeated ANOVA, generalized estimating equation, χ2 test and Fisher's exact test. Results: A total of 237 patients were enrolled for modified intention-to-treat analysis (120 patients in the robotic group, 117 patients in the laparoscopic group). There were 180 males and 59 females, aged (63.0±10.2) years (range: 30 to 85 years). The incidence of postoperative complications was similar between the robotic group and laparoscopic group (16.7% (20/120) vs. 15.4% (18/117), χ2=0.072, P=0.788). The robotic group had higher patient-reported outcomes scores in general health status, emotional, and social domains compared to the laparoscopic group, differences in time effect, intervention effect, and interaction effect were statistically significant (general health status: χ2 value were 275.68, 3.91, 6.38, P value were <0.01, 0.048, 0.041; emotional: χ2 value were 77.79, 6.04, 6.15, P value were <0.01, 0.014, 0.046; social: χ2 value were 148.00, 7.57, 5.98, P value were <0.01, 0.006, 0.048). However, the financial burden of the robotic group was higher, the differences in time effect, intervention effect and interaction effect were statistically significant (χ2 value were 156.24, 4.08, 36.56, P value were<0.01, 0.043,<0.01). Conclusion: Compared to the laparoscopic group, the robotic group could more effectively relieve postoperative negative emotions and improve recovery of social function in patients.

Strong and Ultra-tough Ionic Hydrogel Based on Hyperbranched Macro-Cross-linker: Influence of Topological Structure on Properties

The application of hydrogels often suffers from their inherent limitation of poor mechanical properties. Here, a carboxyl-functionalized and acryloyl-terminated hyperbranched polycaprolactone (PCL) was synthesized and used as a macro-cross-linker to fabricate a super strong and ultra-tough ionic hydrogel. The terminal acryloyl groups of hyperbranched PCL are chemically incorporated into the network to form covalent cross-links, which contribute to robust networks. Meanwhile, the hydrophobic domains formed by the spontaneous aggregation of PCL chains and coordination bonds between Fe3+ and COO- groups serve as dynamic non-covalent cross-links, which enhance the energy dissipation ability. Especially, the influence of the hyperbranched topological structure of PCL on hydrogel properties has been well investigated, exhibiting superior strengthening and toughening effects compared to the linear one. Moreover, the hyperbranched PCL cross-linker also endowed the ionic hydrogel with higher sensitivity than the linear one when used as a strain sensor. As a result, this well-designed ionic hydrogel possesses high mechanical strength, superior toughness, and well ionic conductivity, exhibiting potential applications in the field of flexible strain sensors.

Silver@Prussian Blue Core-Satellite Nanostructures as Multimetal Ions Switch for Potent Zero-Background SERS Bioimaging-Guided Chronic Wound Healing

Metal-organic framework-based metal ion therapy has attracted increasing attention to promote the cascade wound-healing process. However, multimetal ion synergistic administration and accurately controlled ion release are still the challenges. Herein, an aptamer-functionalized silver@cupriferous Prussian blue (ACPA) is established as a metal-based theranostic nanoagent for a chronic nonhealing diabetic wound treatment. Prussian blue offers a programmable nanoplatform to formulate metal ion prescriptions, achieving cooperative wound healing. Silver, copper, and iron ions are released from ACPA controlled by the near-infrared-triggered mild hyperthermia and then synergistically participate in antipathogen, cell migration, and revascularization. ACPA also demonstrates a unique core-satellite nanostructure which enables it with improved surface-enhanced Raman scattering (SERS) capability as potent bacteria-targeted Raman-silent nanoprobe to monitor the residual bacteria during wound healing with nearly zero background. The theranostic feature of ACPA allows high-performance SERS imaging-guided chronic wound healing in infectious diabetic skin and keratitis.

[Clinical diagnosis and treatment of multiple pulmonary nodules]

CT screening has markedly reduced the lung cancer mortality in high-risk population and increased the detection of early-stage pulmonary neoplasms, including multiple pulmonary nodules, especially those with a ground-glass appearance on CT. Multiple primary lung cancer (MPLC) constitutes a specific subtype of lung cancer with indolent biological behaviors, which is predominantly early-stage adenocarcinoma. Although MPLC progresses slowly with rare lymphatic metastasis, existence of synchronous lesions and distributed location of these nodules still pose difficulty for the management of such patients. One single operation is usually insufficient to eradicate all neoplastic lesions, whereas repeated surgical procedures bring about another dilemma: whether clinical benefits of surgical treatment outweigh loss of pulmonary function following multiple operations. Therefore, despite the anxiety for treatment among MPLC patients, whether and how to treat the patient should be assessed meticulously. Currently there is a heated discussion upon the timing of clinical intervention, operation mode and the application of local therapy in MPLC. Based on clinical experience of our multiple disciplinary team, we have summarized and commented on the evaluation, surgical treatment, non-surgical local treatment, targeted therapy and immunotherapy of MPLC in this article to provide further insight into this field.

Label-Free Surface-Enhanced Raman Scattering Bioanalysis Based on Au@Carbon Dot Nanoprobes

Surface-enhanced Raman scattering (SERS) technology has attracted more and more attention in the biomedical field due to its ability to provide molecular fingerprint information of biological samples, as well as its potential in single-cell analysis. This work aims to establish a simple strategy for label-free SERS bioanalysis based on Au@carbon dot nanoprobes (Au@CDs). Here, polyphenol-derived CDs are utilized as the reductant to rapidly synthesize core-shell Au@CD nanostructures, which allows powerful SERS performance even when the concentration of methylene blue (MB) is as low as 10^-9 M, due to the cooperative Raman enhancement mechanism. For bioanalysis, Au@CDs can serve as a unique SERS nanosensor to identify the cellular components of biosamples (e.g., cancer cells and bacteria). The molecular fingerprints from different species can be further distinguished after combination with the principal component analysis. In addition, Au@CDs also enable label-free SERS imaging to analyze intracellular composition profiles. This strategy offers a feasible, label-free SERS bioanalysis, opening up a new prospect for nanodiagnosis.

A novel alternative strategy for monitoring and insight into liver fibrosis progression: The combination of surface-enhanced Raman spectroscopy (SERS) and gut microbiota

Nowadays, the studies on the interaction and relationship between the intestinal microorganisms and liver diseases are increasing. However, it is still a huge challenge for the in-depth investigation and dynamic monitoring of such a complex network. Herein, a significant discovery was made. A strong association between gut microbial structural and functional genomics and SERS spectra of hepatocytes were revealed. Based on the study of gut microbes and SERS spectra, complementary information could be provided for the mechanism analysis of related diseases. Liver fibrosis, a chronic liver disease that lack specific cure was thus comprehensive studied. Liver targeting gold nanoparticle dimers were prepared as the SERS tags, and abundant SERS peak signals were acquired. Meanwhile, the gut microbiomes were also comparative studied. The changes of carbohydrates and lipids in liver cells were observed at the early stages of liver fibrosis, and TLR4 (toll-like receptors 4) was activated to elicit immune responses. Then again, oxidative stress, endotoxin and serum inflammatory factors were the major observations at the late stages. The SERS signals and the microbiome analysis were well confirmed and complemented each other, which suggested that the detection strategy could be another valuable method for the "gut-liver axis" study.

First-in-human, phase I study of AK109, an anti-VEGFR2 antibody in patients with advanced or metastatic solid tumors

BACKGROUND

Vascular endothelial growth factor receptor 2 (VEGFR2) plays a key role in antiangiogenesis which has been an essential strategy for cancer treatment. We report the first-in-human study of AK109, a novel anti-VEGFR2 monoclonal antibody, to characterize the safety profile and pharmacokinetics/pharmacodynamics (PK/PD) properties, and explore the preliminary antitumor efficacy in patients with solid tumors.

PATIENTS AND METHODS

This was a multicenter, open-label, phase I study, including dose escalation and dose expansion (NCT04547205). Patients with advanced cancers were treated 2 and 3 weekly with escalating doses of AK109. A 3 + 3 design was used to determine the maximum tolerated dose. Blood was sampled for PK/PD analysis. The primary endpoint was safety and recommended phase II dose (RP2D).

RESULTS

A total of 40 patients were enrolled. No dose-limiting toxicity was observed. However, 38 patients reported treatment-related adverse events (TRAEs); grade ≥3 TRAEs occurred in 10 patients. The most common TRAEs were proteinuria (n = 24, 60%), hypertension (n = 13, 32.5%), increased aspartate transaminase (n = 11, 27.5%), thrombopenia (n = 10, 25%), and anemia (n = 10, 25%). A total of 28 patients (70%) reported adverse events of special interest (AESIs). The most common AESIs were proteinuria (60%), hypertension (32.5%), and hemorrhage (32.5%), mainly including gum bleeding and urethrorrhagia. AK109 exhibited an approximately linear PK exposure with dose escalation at 2-12 mg/kg. PD analyses showed rapid target engagement. Among the 40 patients, 4 achieved partial response and 21 achieved stable disease with an objective response rate of 10% and a disease control rate of 62.5%. Based on the safety profile, the PK/PD profile, and preliminary antitumor activities, 12 mg/kg Q2W and 15 mg/kg Q3W were selected as RP2D.

CONCLUSIONS

AK109 showed manageable safety profile and promising antitumor activity, supporting further clinical development in a large population.

miR-199-3p suppresses cellular migration and viability and promotes progesterone production in goose ovarian follicles before selection through regulating ITGB8 and other ECM-related genes

1. The extracellular matrix (ECM) constitutes the basal lamina and the area between follicular cells. Remodelling the ECM is believed to be a key event in follicular development, especially during selection, and plays an important role in cell migration, survival, and steroidogenesis. miR-199-3p is differentially expressed in the goose granulosa layer during follicular selection and is reported to play a primary role in inhibiting cell migration and invasion. Nevertheless, the effect of miR-199-3p on ovarian follicles and its role in follicular cellular migration is not understood.2. In this study, qRT-PCR assays revealed that miR-199-3p was differentially expressed in the granulosa layer from goose ovarian follicles before and after follicular selection. Additionally, miR-199-3p overexpression in cultured granulosa cells (GCs) from goose pre-hierarchical follicles significantly suppressed cell viability and migration. It elevated the concentration of progesterone and the expression of key progesterone production genes. Furthermore, miR-199-3p overexpression in the GCs of goose pre-hierarchical follicles inhibited the expression of ECM-related genes (ITGB8, MMP9 and MMP15) yet promoted the expression of another two ECM-related genes (COL4A1 and LAMA1). Finally, dual-fluorescence reporter experiments on 293T cells established the direct targeting of ECM gene ITGB8 by miR-199-3p.3. In conclusion, miR-199-3p may participate in granulosa cell migration, viability, and steroidogenesis in goose ovarian follicles before selection by modulating ITGB8 and other ECM-related genes.

A UV-induced self-reinforced hydrogel based on in situ hydrophobic aggregation of strained 1,2-dithiolane rings

A novel responsive hydrogel exhibiting self-reinforcement and self-healing capacity was developed based on the hydrophobic aggregation of strained 1,2-dithiolane rings. Oligomerization of 1,2-dithiolane within hydrophobic domains under UV irradiation not only reinforced the hydrogel but also maintained its dynamic cross-linked nature by converting the intraring dynamic S-S bond to an outer one.

Clinical efficacy of targeted therapy, immunotherapy combined with hepatic artery infusion chemotherapy (FOLFOX), and lipiodol embolization in the treatment of unresectable hepatocarcinoma

To evaluate the clinical efficacy of targeted therapy and immunotherapy combined with hepatic arterial infusion chemotherapy (HAIC) of FOLFOX and lipiodol embolization in the treatment of unresectable hepatocellular carcinoma. Patients included in the study were those who received targeted therapy and immunotherapy combined with HAIC of FOLFOX and lipiodol embolization in Zhongshan People's Hospital from December 2020 to June 2021 for unresectable hepatocellular carcinoma. Evaluation indicators included objective response rate (ORR), median progression-free survival (mPFS), median duration of response (mDOR), 1-year overall survival rate (OS), surgical conversion rate, and adverse events. Treatment response was assessed using Response Evaluation Criteria in Solid Tumors (mRECIST and RECIST v1.1). A total of 35 patients were included in this study, 30 of whom completed treatment evaluation. According to mRECIST evaluation criteria, the objective response rate (ORR) was 83.3% (25/30); the complete response (CR) was 60% (18/30); the partial response (PR) was 23.3% (7/30), and stable disease (SD) was 16.7% (5/30). The mDOR was 10.3 months (95% Cl: 8.27-NE), and the mPFS was 13.2 months (95% CI: 10.3-NE); the surgical conversion rate was 30.0% (9/30). The 1-year OS was 96.7%. There were no serious surgical complications and grade 4 or 5 adverse events of targeted therapy, immunotherapy and HAIC. Some patients had grade 3 adverse reactions in gastrointestinal toxicity or hepatotoxicity, and the adverse reactions were improved after corresponding symptomatic treatment. We concluded that HAIC of FOLFOX and lipiodol embolization combined with targeted therapy and immunotherapy had a significant curative effect in the treatment of unresectable hepatocellular carcinoma, with no serious adverse reactions and a high rate of surgical conversion rate.

[Research progress of the role of iris characteristics in angle closure]

Glaucoma is a kind of optic nerve degenerative disease characterized by both depressed atrophy of optic nerve and visual field defect. In Asia, the number of patients with primary Angle closure glaucoma (PACG) is increasing year by year, posing serious impact on the life quality of patients. Angle closure is the pathogenic basis of PACG. Early identification of the risk factors for Angle closure and control on its progression are crucial to the prognosis of PACG. With the continuous in-depth study of the iris in recent years, it has been found that the changes in iris volume are also important dynamic risk factor for PACG. This paper summarizes the latest research results of both domestic and overseas, describes and summarizes the histology, biological characteristics, surface features, vascular configuration and genomics of the iris, and further analyzes the role of iris characteristics in angle closure in details, in order to provide a reference for the clinical diagnosis and research work.

[Effect of autologous hematopoietic stem cell transplantation on minimal residual disease in patients with multiple myeloma]

Objective: To evaluate the effect of autologous hematopoietic stem cell transplantation (ASCT) on minimal residual disease (MRD) in patients with multiple myeloma (MM). Method: From August 2018 to August 2021, 92 patients newly diagnosed with MM who had received either the bortezomib combined with cyclophosphamide and dexamethasone (VCD) or the bortezomib, lenalidomide and dexamethasone (VRD) induction regimens followed by sequential ASCT were assessed for overall survival (OS) and the MRD negative rate. The differences in efficacy at 100 days after transplantation were assessed according to factors, including age, risk stratification, target organ damage, and pre-transplant regimen, etc. Results: Among the 92 patients, there were 45 males and 47 females, with a median age of 57.3 (35-67) years. Fifty-seven patients received the VCD regimen, and 35 received VRD as induction regimen. Forty-three patients received busulphan combined with cyclophosphamide and etoposide (BCV), and 49 patients received high-dose melphan (HDM) regimen as pre-transplantation treatment. After transplantation, the total complete remission (CR) rate of 92 patients increased from 23.9% (22/92) to 58.7% (54/92), and the MRD negative rate increased from 4.4% (4/92) to 33.7% (31/92), and the differences were statistically significant (all P<0.05). After transplantation, the MRD negative rates of patients with PR, VGPR and ≥CR before transplantation were 17.6% (6/34), 33.3% (12/36) and 59.1% (13/22), respectively (P=0.006). The CR rates of patients with or without plasmacytoma at initial diagnosis were 36.4% (4/11) and 65.4% (53/81), respectively (P=0.029), and the MRD negative rates were 18.2% (2/11) and 39.5% (32/81), respectively (P=0.037), and the differences were statistically significant. The MRD negative rates in high-risk patients and standard-risk group were 30.5% (12/28) and 42.9% (18/59), respectively (P=0.258). For patients who achieved efficacy above VGPR before transplantation, the MRD negative rates after transplantation in VCD-induced group and VRD group were 29% (9/31) and 59.3% (16/27), respectively (P=0.033), and in BCV group and HDM group were 24% (6/25) and 57.6% (19/33), respectively (P=0.016), the differences between the groups were both statistically significant. Conclusion: ASCT can overcome the adverse factors such as high-risk cytogenetic abnormalities, and significantly improve the CR rate and MRD negative rate of MM patients. However, the benefit for patients with plasmacytoma at initial diagnosis is not as good as that of patients without.

Microfiber-directed reversible assembly of Au nanoparticles for SERS detection of pollutants

Surface-enhanced Raman scattering (SERS) spectroscopy has attracted tremendous interest as a highly sensitive label-free tool to detect pollutants in aqueous environments. However, the high cost and poor reusability of conventional SERS substrates restrict their further applications in rapid and reproducible pollutant detection. Here, we report a reliable optical manipulation method to achieve rapid photothermal self-assembly of Au nanoparticles (AuNPs) in water within 30 s by a tapered optical fiber, which is utilized for highly sensitive SERS substrate preparation. The results show that the SERS substrate achieves low detection limits of 10^-9 mol/L with an enhancement factor (EF) of 10⁶ for chemical pollutants solutions, including thiram, pyrene, and rhodamine 6G. The SERS enhancement effect based on assembled AuNPs was more than 20 times that based on a gold colloid solution. As a result, the smart reversible assembly of AuNPs exhibits switchable plasmonic coupling for tuning SERS activity, which is promising for the application of SERS-based sensors and environmental pollutant detection.

PERK signaling activation restores nucleus pulposus degeneration by activating autophagy under hypoxia environment

OBJECTIVES

Intervertebral disc (IVD) degeneration is an important disease with no efficient biological therapy identified. Autophagy, a wildly known therapeutic target for human disease, has been demonstrated to be activated under hypoxia, with underlying mechanism remains elusive. Thus, this study aims to specify the role of autophagy in IVD degeneration, the regulating mechanism of hypoxia-inducing autophagy, and the therapeutic value of autophagy for IVD degeneration.

METHODS

RNA-seq was used to screen the primary pathway affected in NP cells under hypoxia, the specific link between hypoxia and autophagy were investigated using ChIP-seq and dual luciferase reporter assay. Conditional ATG7 knockout mice (ATG7^-/-) were constructed for assessing the effect of autophagy on IVD degeneration, and puncture induced mice model of IVD degeneration were used for intradiscal injection to evaluate the therapeutic value of autophagy.

RESULTS

We demonstrated that hypoxia induces autophagy by transcriptional activation of autophagic gene LC3B and ATG7, which is controlled by PERK signaling. Then, we observed that inhibiting autophagy or PERK signaling leads to impaired NP cell viability and function, furthermore, using ATG7 knockout (ATG7^-/-) mice, we identified the protective role of autophagy in IVD. Furthermore, we found that intradiscal injection of PERK signaling agonist, CCT020312, significantly restores the degeneration level of needle punctured mice IVD.

CONCLUSION

We showed that the activation of PERK signaling upon hypoxia serves as a vital mechanism to induce autophagy and identified the therapeutic value of PERK signaling agonist for IVD degeneration treatment.

Mussel-inspired hydrogels for fast fabrication of flexible SERS tape for point-of-care testing of β-blockers

SERS-chemometric strategy for POCT.

Facile synthesis of Au@palladium oxide nano-sunflowers for ultrasensitive surface-enhanced Raman scattering analysis

Metal-semiconductor nanocomposites have gain more and more attention as novel surface-enhanced Raman scattering (SERS) substrates due to the coupling Raman enhancement mechanism between the nanocomponents. Herein, Au@palladium oxide (Au@PdOx) nanohybrids...

Safety and efficacy of dendritic cell-based immunotherapy (DCVAC/LuCa) combined with carboplatin/pemetrexed for patients with advanced non-squamous non-small-cell lung cancer without oncogenic drivers

Background

Our prospective, open-label, single-arm phase II study investigated the safety and efficacy of DCVAC/LuCa (dendritic cell vaccines for lung cancer) combined with standard carboplatin/pemetrexed in advanced non-squamous (nsq) non-small-cell lung cancer (NSCLC).

Patients and methods

Eligible patients had stage IV nsq NSCLC without oncogenic drivers and had not received prior systemic cancer therapy. Treatment consisted of carboplatin/pemetrexed for up to 6 cycles followed by 21 cycles of pemetrexed maintenance or until progression or intolerance. Non-progression patients after two cycles of chemotherapy started to receive DCVAC/LuCa subcutaneously (s.c.) on day 15 of cycle 3, and thereafter q3w (day 15 of chemotherapy cycles) for up to 15 doses. Dosing of DCVAC/LuCa s.c. varied among patients depending on the baseline number of leucocytes but remained constant for each single patient. Safety was assessed by adverse events (AEs), treatment-related adverse events (TRAEs), serious adverse events (SAEs), and adverse events of special interest (AESIs). Efficacy was measured by overall survival (OS), progression-free survival (PFS), time to progression (TTP), and objective response rate (ORR).

Results

Sixty-one patients were enrolled. In the safety population (n = 60), eight patients (13.33%) had grade 3 or greater TRAEs, and six patients (10.0%) showed SAEs which were not related to leukapheresis or DC vaccination. Six grade 1 AEs were considered to be related to leukapheresis. No AESIs or DCVAC/LuCa-induced AEs were observed. The 2-year survival rate in the modified intention-to-treat population (n = 44) was 52.57%. Median OS was not reached. Median PFS was 8.0 months, median TTP was 10.2 months, and the ORR was 31.82%.

Conclusion

In treatment-naïve stage IV nsq NSCLC patients without oncogenic drivers, the combination of carboplatin/pemetrexed and DCVAC/LuCa was well tolerated and showed promising efficacy. Therefore, a study to prove our immunotherapeutic concept in a randomized phase III trial is planned.

•

We investigated the safety and efficacy of DCVAC/LuCa combined with standard carboplatin/pemetrexed in nsq NSCLC.

•

The combination therapy showed a favorable tolerability profile in a selected Chinese population.

•

The 2-year survival rate in the modified intention-to-treat population (n = 44) was 52.57%.

Photothermal microfluidic-assisted self-cleaning effect for a highly reusable SERS sensor

The synergistic integration of optofluidic and surface enhanced Raman scattering (SERS) sensing is a new analytical technique that provides a number of unique characteristics for enhancing the sensing performance and simplifying the design of microsystems. Here, we propose a reusable optofluidic SERS sensor by integrating Au nanoisland substrate (AuNIS)-coated fiber into a microfluidic chip. Through both systematic experimental and theoretical analysis, the sensor enables efficient self-cleaning based on its optical-to-heat-hydrodynamic energy conversion property. Besides, the sensor exhibits the instrument detection limit down to 10^-13mol/L and enhancement factor of 10⁶ for Rhodamine 6G. Our optofluidic SERS sensor with such a photothermal microfluidic-assisted self-cleaning method has the advantages of portability, simple operation, and high cleaning efficiency, which will provide a new, to the best of our knowledge, concept and approach for cost-effective and reusable sensors.

[Surface modification of titanium implant with hBMP-2/hIGF-1 for promoting biocompatibility and osteogenesis]

OBJECTIVE

To prepare the human bone morphogenetic protein-2(hBMP-2)/human insulin-like growth factor-1(hIGF-1)coating titanium(Ti)and assess its performance as a dental implant material.

METHODS

hBMP-2 and hIGF-1 were coated to the smooth surface of a Ti plate, and its efficacy for promoting bone formation and bone integration was compared with a pristine Ti plate.The surface characteristics of the metal samples were evaluated using scanning electron microscope (SEM) and by contact angle measurement.MG63 cells were seeded on the surface of the Ti plates, and MTT assay and alizarin red staining was used to examine the cell proliferation and formation of calcified nodules, respectively.Alkaline phosphatase (ALP)secretion of the cells was examined with ELISA, and cellular expressions of osteocalcin and osteopontin were detected with Western blotting for assessing osteogenesis.

RESULTS

SEM examination showed that the surface of Ti with hBMP-2 and hIGF-1 coating presented with a radial pattern resembling snowflakes.The contact angles of non-coated Ti, hBMP-2-coated Ti, hIGF-1-coated, and hBMP-2/-hIGF-1-coated Ti samples were 83.2°, 54°, 56° and 54°, respectively.Compared with the non-coated Ti plate, the surface-modified Ti samples showed a significantly smaller contact angle (P=0.032, 0.029, and 0.028), indicating a good hydrophilicity of the samples.MTT assay showed that MG63 cells grew well on the surface of the coated Ti plates.The hBMP-2/IGF-1 coating significantly induced cellular secretion of ALP(P=0.021, 0.014)and obviously promoted osteogenesis of MG63 cells (P < 0.05).Western blotting results showed that hBMP-2/IGF-1 coating significantly enhanced the expressions of osteocalcin and osteopontin in the seeded cells (P < 0.05).

CONCLUSION

hBMP-2 and hIGF-1 coating of Ti material can promote osteogenesis of the cells seeded on its surface to improve the performance of such Ti material as dental implants.

Vortices-interaction-induced microstreaming for the pump-free separation of particles

Microfluidic techniques have emerged as promising strategies for a wide variety of synthetic or biological sorting. Unfortunately, there is still a lack of sorting with automatic and handy operation. In contrast to passively generated vortices, the thermocapillary vortices produced by temperature gradient have the advantages of flexible manipulation, stable strength, and simple integration. In this Letter, we present a device used for the pump-free separation of particles through vortices interaction without external fluidic control systems required for the majority of existing devices. Specifically, the device induces a different flow type upon the actuation of optical power, and the flow functions, such as simultaneous pumping and sorting, agree with stimulation results very well. More importantly, our developed sorting device can achieve separations by means of tunable cutoff diameter size. Therefore, this versatile device can be utilized to sort complex samples with the advantages of portability, user-friendly control, and automation.

SERS diagnosis of liver fibrosis in the early stage based on gold nanostar liver targeting tags

In order to realize the accurate and early diagnosis of liver fibrosis, a long slow pathological process which may lead to cirrhosis or even liver cancer, liver targeting tags made up of gold nanostars and glycyrrhetinic acid are reported in this paper. Gold nanostars (GNSs) and GNS liver targeting tags (GLTTs) were injected into model mice with stage S1 liver fibrosis and normal mice via the tail vein respectively, then the SERS spectra were collected. GLTTs had a better detection effect on liver tissue than unmodified GNSs (12.85 times), and better detection reproducibility as well. Moreover, according to the MTT and survival analysis experiments, GLTTs also had better biocompatibility. Hence, the changes of 10 SERS signals and other substances in the early stage of liver fibrosis were analyzed at the molecular level, and the SERS characteristic peaks that could be used for the diagnosis of early liver fibrosis were screened out. Revealed by the experimental results, the GLTTs designed and prepared were applicable to the efficient SERS detection of early liver fibrosis in mice, and the strategy we have proposed might be a potential approach for the early diagnosis of this disease in clinics.

AB0564 RHEUMATOLOGISTS’ VIEWS AND EXPERIENCES IN MANAGING PsA PATIENTS BASED ON TREATING TO TARGET STRATEGY: A CROSS-SECTIONAL STUDY IN CHINA

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with progressive, erosive destruction associated with functional impairment. Principles of treat-to-target (T2T) have been widely used in rheumatoid arthritis, which has powerfully improved patient outcomes. In 2017, the concept of T2T has proposed to apply in PsA patients. However, the awareness and implementation of evidence-based T2T treatment guidelines varies across different geographical regions of China, hospital grades, professional status and specialities.

Objectives:

The study aimed to investigate Rheumatologists’ views and experiences in managing PsA patients with T2T strategy in china.

Methods:

A cross-sectional questionnaire survey of Rheumatologists in China from 5 August to 15 August 2020 was conducted for this study. Rheumatologists were contacted by WeChat (a Chinese cell/web app) and asked to complete a web-based questionnaire anonymously. The electronic questionnaire was sent out by the internet platform of WenJuanXing via WeChat (https://www.wjx.cn/). The questionnaire was designed to collect: (a) demographic information; (b) patient management in clinical practice for Rheumatologists; (c) familiarity and application of T2T strategy in Rheumatologists. P values ≤0.05 were considered significant.

Results:

(1) A total of 823 rheumatologists (69.87% female, 30.13% male) provided valid answers to the questionnaire. 71.09% of the participants major in Modern Western Medicine, 28.91% major in traditional chinese medicine. A total of 75.94% worked in Grade-A Tertiary Hospital. A total of 52.73% had more than 10 years of work experience and 63.55% had High-level title. (2) More than half of the patients were followed up by 69% Rheumatologists in their daily practice. The proportion of follow-up patients increased powerfully in the group of Rheumatologists who major in Modern Western Medicine (P=0.014), work in Grade-A Tertiary Hospital (P<0.001), have more than 10 years of work experience (P<0.001) and High-level title (P<0.001). (3) 36.45% Rheumatologist thought the frequency for patient disease activity assessment was every 1 month and 53.1% was every 3 months. And 41.7% Rheumatologist prefer to use PASDAS for disease activity criteria, and only 3.6% choose MDA. (4) A total of 62.43% thought they were familiar with T2T strategy, and 83.6% Rheumatologists applied T2T strategy in clinical practice. Among 135 Rheumatologists who did not apply T2T strategy, 62.2% of Rheumatologists thought that the main barrier to T2T application was that they did not fully understand the strategy. The frequency of application of T2T strategy in clinical practice was significantly different between Rheumatologists who major in Modern Western Medicine (60.75%) and traditional chinese medicine (22.84%) (P=0.023).

Conclusion:

In china, the management of PsA patients need to be standardized to improve patient outcomes. And the promotion of T2T strategy in PsA need to be further strengthened.

References:

[1]Smolen JS, Schöls M, Braun J,et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018 Jan;77(1):3-17.

[2]Tucker LJ, Ye W, Coates LC. Novel Concepts in Psoriatic Arthritis Management: Can We Treat to Target? Curr Rheumatol Rep. 2018 Sep 18;20(11):71.

[3]Coates LC, Helliwell PS. Treating to target in psoriatic arthritis: how to implement in clinical practice. Ann Rheum Dis. 2016;75(4):640-643.

Figure 1

A. Rheumatologist priority of frequency for patient follow-up in different disease status. B. Rheumatologist priority of frequency for patient disease activity assessment in clinical practice. C. Rheumatologist priority of disease activity criteria for PsA patients.

Disclosure of Interests:

None declared.

AB0372 TOCILIZUMAB WAS EFFECTIVE IN REFRACTORY ARTERIAL INVOLVEMENT OF BEHCET’S DISEASE: A REAL-LIFE SINGLE- CENTER EXPERIENCE IN CHINA

Background:

Behcet’s disease (BD) is a chronic and relapsing vasculitis, in which major vessel involvement is a main cause of mortality and morbidity. The therapeutic arsenal is mainly composed of classical immunosuppressants. However, when faced with resistance to these drugs, no alternative therapeutic strategy is currently recommended.

Objectives:

To assess the efficacy and safety of interleukin 6 receptor inhibitor tocilizumab (TCZ) in refractory arterial involvement of BD in a real-life observational setting.

Methods:

10 patients were enrolled in our center between 2014 and 2019. All patients met the international criteria for BD and had severe arterial involvement evaluated by echocardiography, angio-Computerized Tomography scan and vascular Doppler. The diagnosis of refractory arterio-BD was based on objective vascular symptoms not explained by any other known disease and non-response to conventional immunosuppressants combined with glucocorticoids therapy. All patients underwent TCZ infusions at 8mg/kg every 4 weeks. Concomitant therapy with immunosuppressants and glucocorticoids was continued. Clinical and imaging findings were assessed before and after TCZ therapy. All adverse events were recorded during follow-up.

Results:

All the patients were males, with a mean age of 44.3±10.5 years in this study. The mean age at presentation of arterial involvement was 40.8±9.2 years old. The patterns of arterial involvement were aneurysm (n=9), stenosis (n=3) and aortic valve lesion (n=2). After a mean follow-up of 26.8±7.2 months, TCZ yielded rapid and maintained clinical improvement in 9 patients, with complete remission in 6 of them and partial response in 3 of them. Discontinuation of TCZ treatment due to relapse occurred in one case as the enlargement of abdominal aortic aneurysm. The mean glucocorticoid dosage was tapered from 54.5±20.6mg/d to 8.3±3.6mg/d (p<0.001). And the use of immunosuppressants was tapered in 4 (40.0%) patients. As for serological improvement, the median ESR and CRP levels decreased from 50 (2-82) mm/h and 32.9 (2.1-62.3) mg/dL to 4 (1-10) mm/h (p<0.001) and 2.9 (0.2-12.1) mg/dL (p<0.001), respectively. Radiologic improvement of artery lesion was demonstrated in 4(40%) patients. None of the patients had serious adverse events during follow-up.

Conclusion:

TCZ was a safe and effective therapeutic option for refractory arterial involvement of BD, with a favorable steroid-sparing effect.

References:

[1]G Hatemi, R Christensen, D Bang, et al. 2018 update of the EULAR recommendations for the management of Behçet’s syndrome. Ann Rheum Dis. 2018;77(6):808-818.

[2]Y Ozguler, P Leccese, R Christensen, et al. Management of major organ involvement of Behcet’s syndrome: a systematic review for update of the EULAR recommendations. Rheumatology (Oxford). 2018;57(12):2200-2212.

[3]M Akiyama, Y Kaneko, T Takeuchi. Effectiveness of tocilizumab in Behcet’s disease: A systematic literature review. Semin Arthritis Rheum. 2020;50(4):797-804.

Table 1.

Tocilizumab therapy in ten cases of refractory arterio-BD

PatientAge, yearDisease duration, monthsClinical features*Arterial lesionsPrevious therapyResponse at week 24134228O, G, P, S, IStenosis of CA/ SMA/RA/SCA, aortic valve prolapsePred/CYC/MMFCR22024O, SDissecting aneurysm of AA (Debakey I)Pred/MMFPR367276O, G, P, S, Athoracoabdominal aortic aneurysmPred/CYC/TACCR46775O, S, UStenosis of LAD/LCX/RCAPred /CYCCR55080O, G, AAbdominal and coronary aortic aneurysmsPred /CYCRelapse64826O, GAortic insufficiencyPred /CYCPR726147O, P, S, VIliac artery aneurysmPred /MMFCR849466O, S, VThoracoabdominal and coronary aortic aneurysmsPred /CYC/AZACR927181O, P, SPseudoaneurysm of CCAPred /CYCPR10Male/55354O, P, SAbdominal aneurysm, stenosis of LAD/LCX/RCAPred /CYC/AZACR

*O: oral ulcer; G: genital ulcer; P: pathergy test; S: skin lesions; I: intestinal ulcer; A: arthritis; U: uveitis; V: venous thrombosis

Figure 1.

Changes from baseline in BSAS, BDCAF, ESR, CRP and steroid daily dose at 24 weeks

Disclosure of Interests:

None declared

Deposition of resistant bacteria and resistome through FMT in germ-free piglets

Faecal microbiota transplantation (FMT) has received considerable attention in recent years due to its remarkable efficacy in restoring a normal gut microbiome. Here, we established the groups of post-FMT recipient piglets using germ-free piglets during early life to characterize the colonization of gut microbiota composition and the enrichment of resistance gene acquisition. By metagenomic analysis, we identified 115 bacterial phyla and 2111 bacterial genera that were acquired by the FMT recipients. We found that early-life microbial colonization and the spread of resistomes in recipient piglets were age dependent. A total of 425, 425 and 358 AR genes primarily belonging to 114, 114 and 102 different types were detected in the donors, post-FMT recipients in the FMT-3D group and post-FMT recipients in the FMT-15D group respectively. Genes that encoded tetracycline, macrolide and chloramphenicol resistance proteins were the most dominant AR genes, and the results corresponded with the exposure of antibiotic consumption at farm. Bacteroides, Escherichia, Clostridium, Parabacteroides, Treponema, Lactobacillus and Enterococcus were significantly correlated with the distribution of AR genes. More importantly, the relative abundance of AR genes was positively correlated with the levels of mobile genetic elements. Our results indicate that early-life microbial colonization can persistently shape the gut microbiota and antibiotic resistome.

[Epidemiology and the risk factors of myopia among children and youths in Yunnan province]

Objective: The purpose of the study was to describe the prevalence of myopia and to explore the associated factors of myopia among Han and Yi students aged 5-16 years in Yunnan province, China. Methods: A total of 5 971 Han and Yi students were included in the data analysis from the Yunnan eye study which was conducted from March to August, 2014. Information regarding demographic factors, socioeconomic status and lifestyle-related exposures were collected by per-designed questionnaires. The ophthalmic examinations including distance visual acuity, anterior segment examination, cycloplegic auto-refraction, and ocular motility examination were conducted. Logistic regression models were fitted to estimate the risk factors for myopia. Results: The age of 5 971 subjects was (10.68±2.24)years old, and the total prevalence of myopia and high myopia was 48.05% and 0.59%. Myopia prevalence was found to be higher in Han students compared with Yi ethnicity (50.20% vs. 47.10%,P=0.029). In multivariate analysis, the occurrence of myopia was associated with age (OR=1.28, 95%CI: 1.25-1.31), girls (OR=1.32, 95%CI: 1.18-1.48), increasing reading and writing time per day (OR=1.13, 95%CI: 1.07-1.20), having self-reported myopia among friend(s) (OR=1.15, 95%CI: 1.02-1.29), having myopic father (OR=1.38, 95%CI: 1.06-1.79), having myopic mother (OR=1.43, 95%CI: 1.12-1.83) and higher educated mother (OR=1.24, 95%CI: 1.03-1.51). Conclusions: We observed a high prevalence of myopia among Mangshi students. The presence of myopia was associated with increasing age, girls, increasing reading and writing time per day, having self-reported myopia among friend(s), having myopic father, having myopic and high educated mother.