A Simulation-Based Approach for Strategic Evaluation of Resource Allocation for Improving Spatial Access to Radiation Oncology

PURPOSE/OBJECTIVE(S)

Access to radiation therapy is essential to oncologic care. Prior studies have examined geographic distribution of radiation oncologists and centers but with methodologies that fail to account for patient movement across artificially constructed boundaries. This analysis utilizes an approach agnostic to geographic boundaries as well as a mathematical metric to assess the equality of access to care and quantify the impact additional resource allocation would have on a geographic area.

MATERIALS/METHODS

Government databases were utilized to collect information on supply of radiation oncologists and population over 65 years old as a surrogate for demand. Addresses were geocoded to create coordinates for spatial analysis. US Census Centers of Population files were used to assign population data to spatial coordinates. Isochrone lines for driving time around population centers were generated using an internet road maps programming interface. Enhanced two-step floating catchment area (E2SFCA) analysis was performed with catchment area defined as a 120-minute drive from the population centers. A distance decay factor was applied. Spatial access ratios (SPARs), defined as the ratio of a given county's access to care against the mean across all counties, were calculated for each of the 3143 US counties, where a value <1 represents underserved and >1 represents overserved areas. A Gini coefficient was calculated to create a value representing spatial access equality (SPAE) for the current geographic distribution of supply and demand across the US. The incremental impact on SPAE was determined by iteratively simulating the addition of a single radiation oncologist in each of the 3143 US counties, and subsequently used to quantifiably rank areas by magnitude and direction of impact.

RESULTS

Olmsted County, MN and the surrounding counties represent 8 of the 10 most overserved in the US (SPAR: 4.03 - 5.84). There are 1713 underserved counties with SPARs <1 and 130 counties with a SPAR of 0. Thomas County, KS would have greatest benefit on SPAE from the addition of a single radiation oncologist as it would introduce access to numerous neighboring underserved counties. Conversely, introduction of a single radiation oncologist negatively impacted SPAE in 173 of the previously underserved counties by shifting SPAR to overserved without significant positive effect on neighboring counties due to having a small population and isolated location.

CONCLUSION

E2SFCA and SPAE provide a method for evaluating spatial access and a mathematical framework for assessing areas with the greatest potential benefit from new resource allocation. In some instances, resource allocation to a previously underserved area paradoxically has a negative impact on equal access to care. Better solutions such as travel/lodging programs and appropriate hypofractionation would do more to improve issues of access inequality for these areas.

Prostate Cancer in New York City: Impact of Neighborhood Level Social Determinants of Care

PURPOSE/OBJECTIVE(S)

Social determinants of health may impact stage and aggressiveness of cancer presentation. As neighborhoods may influence adjacent neighborhoods across often porous and arbitrary borders, an analysis that measures the spatial impact of these social determinants provides a more holistic evaluation than an analysis that treats each neighborhood as independent and unrelated units. In this paper, we study the impact of sociodemographic and environmental characteristics of neighborhoods on cancer presentation in New York City, using both patient-level analysis and spatial autoregression on the New York State Public Access Cancer Epidemiology Data (NYSPACED) and the NYC Open neighborhood-level dataset.

MATERIALS/METHODS

Two outcomes of interest were chosen: Presentation with high grade prostate cancer and presentation with distant disease. We performed logistic regression on individual patient level analysis. We created generalized cross sectional autoregressive spatial regression models to assess direct and indirect (via adjacent neighborhoods) impact of neighborhood level independent variables. We analyzed the following neighborhood level variables: 1) Percent population that was Black, 2) Percent population living in poverty, 3) Percent population obese based on self-reported height and weight, 4) Percent who report being current smokers, 5) Percent who report eating one or more servings of fruits and/or vegetables in the last day, and 6) annual average micrograms of fine particulate matter per cubic meter of air.

RESULTS

We identified 95,749 patients diagnosed with prostate adenocarcinoma in New York City from 2001-2018. With reported Black race as the referent value, White patients were less likely to present with high grade disease (OR 0.92 [95% CI 0.89-0.95]). Similarly, self-identified White patients were also less likely to present with distant disease (vs. Black, OR 0.76 [95% CI 0.72-0.81]). Spatial autoregression models revealed no neighborhood level variables associated with direct or indirect impacts on presentation with high grade disease. However, there were several variables initially associated with distant disease presentation, including race, poverty, obesity, fruit and vegetable consumption, and air pollution. However, only neighborhood poverty and obesity levels continued to have significant direct impact on presentation with distant disease when included in the regression model with percent Black residents.

CONCLUSION

In conclusion, we discovered a strong association between Race and poverty with the likelihood of presenting with advanced prostate cancer, at both the individual and neighborhood levels. Geographically targeted outreach to improve prostate cancer screening and access to care should be focused on Black men and neighborhoods with high levels of poverty.

The Impact of Travel Time on Trimodal Therapy Compared to Cystectomy for Bladder Cancer

PURPOSE/OBJECTIVE(S)

Neoadjuvant chemotherapy followed by radical cystectomy (RC) and Transurethral Resection of Bladder Tumor (TURBT) followed by concurrent chemoradiation therapy (trimodal therapy, TMT) are both evidence-based approaches to the management of muscle-invasive bladder cancer, and no randomized evidence conclusively supports the use of one treatment over another. Literature suggests that increasing distance to radiation therapy (RT) facilities reduces the likelihood that patients will receive RT, though this has not been evaluated in bladder cancer. We hypothesize that greater travel time between a patient's home and their closest RT facility is associated with a lower likelihood of undergoing TMT.

MATERIALS/METHODS

Clinical data and the locations of patient residences and surgical facilities performing RC were obtained from the California Cancer Registry. RT facility locations were compiled from state regulatory databases and dosimetric accrediting bodies. Travel time was identified using the Google Distance Matrix API. California patients diagnosed with T2-4N0 bladder cancer in 2018-2019 who underwent TMT (> = 55Gy) or RC were included in this analysis. Chi-square tests, Kruskal-Wallis tests, and univariate and multivariate logistic regressions were performed to assess factors associated with an increased likelihood of receipt of TMT, and to compare travel times for patients receiving TMT vs RC.

RESULTS

A total of 536 patients met inclusion criteria, and 27.1% underwent TMT. Patients receiving TMT were more likely to be older, White, male, and live further from their nearest RT facility. After adjusting for age, sex, and race/ethnicity, patients undergoing TMT were more likely than RC patients to live more than 30 minutes away from the nearest RT facility (OR 1.53, p = 0.21, ref<15 minutes). On multivariate analysis, patients receiving TMT were less likely than surgical patients to live 30-60 minutes or >60 minutes from their treatment facility ((OR 0.5, p-value<0.01, and OR 0.23, p-value <.001), ref: <30 minutes). Only 26.2% of patients who received TMT were treated at their nearest RT facility, while 13.3% of patients undergoing RC were treated at their nearest surgical facility.

CONCLUSION

In a modern cohort of bladder cancer patients in California, about a quarter of T2-4N0 patients are undergoing bladder preservation. Patients undergoing TMT lived further from their nearest RT facility than patients undergoing surgery. Surgical patients were more likely to live >30 minutes from their treating facility than TMT patients. A minority of patients underwent treatment at the facility nearest to them, regardless of treatment modality chosen. Taken together, this suggests that proximity to the nearest RT facility may not be associated with a higher likelihood of undergoing TMT. Examination of actual treatment facilities (as opposed to the closest facility) shows that patients are traveling further for surgical care than TMT.

Selected-Lesion SRS as a Novel Strategy in Treatment of Patients with Multiple Brain Metastases

PURPOSE/OBJECTIVE(S)

With the increasing use of intracranial SRS (SRS) for treatment of patients with >10-15 brain metastases treatment; debate remains in the literature about how these patients should be treated. While many advocate for treatment of all lesions with either SRS or whole brain radiation therapy (WBRT), several groups are considering selected-lesion SRS (SL-SRS) where only a subset of intracranial lesions are treated. However, the current practice patterns of SL-SRS are not known.

MATERIALS/METHODS

A survey of 19 questions was created using open-ended and multiple-choice style questions on SL-SRS practices and indications. The survey was distributed to providers in the US and internationally who perform SRS frequently. Ten out of 50 institutions provided responses reflecting the practices of 16 providers. Descriptive statistics was used to compare answers to each question when applicable including percentages and ranges.

RESULTS

SL-SRS was performed at 8/10 institutions, (5 out of 6 US institutions and 3 out of 4 international institutions). Only 2 institutions had established clinical indications for SL-SRS (one in the US and one internationally) and one additional US institution reported clinical trials that require SL-SRS to study efficacy of CNS penetrating targeted therapies. One program reported research protocols for untreated brain metastases that would take priority over SL-SRS (program outside the US). Size of the lesion was cited as the most important factor (90%) when deciding to treat any single lesion. Next, lesion location and focal signs/symptoms were both considered moderately important. 80% ranked distance from prior SRS as the least important factor. Perilesional edema was also less important at most programs (90%). Lesion location and presence of symptoms were also considered important. There were several factors that would encourage providers to consider SL-SRS in a patient. Prior WBRT; progressing systemic disease and CNS-penetrating drug option available; and progressing systemic disease and immunotherapy option available were the most common responses. Most respondents cited "specific request by medical oncology" as well as "cooperative studies in this topic" as factors that might push them towards SL-SRS. Several institutions specified factors beyond the listed options. One institution reported that for patients with >20 lesions, they treated the largest lesions with SRS then follow with WBRT, termed the "pre-WBRT boost." Progression of untreated lesions was the most common reason why providers would bring back patients for additional treatment.

CONCLUSION

The responses to this survey demonstrate that patients with >15-20 intracranial lesions, prior WBRT, and worsening systemic disease with CNS penetrating systemic therapies available are being considered for SL-SRS.

FORMULA-509: A Multicenter Randomized Trial of Post-Operative Salvage Radiotherapy (SRT) and 6 Months of GnRH Agonist with Either Bicalutamide or Abiraterone Acetate/Prednisone (AAP) and Apalutamide (Apa) Post-Radical Prostatectomy (RP)

PURPOSE/OBJECTIVE(S)

FORMULA-509 was designed to evaluate whether adding six months of AAP and Apa to a GnRH Agonist could improve outcomes compared to six months of bicalutamide plus GnRH Agonist for patients with unfavorable features receiving SRT for a detectable PSA post-RP.

MATERIALS/METHODS

FORMULA-509 is an investigator-initiated, multi-center, open-label, randomized trial. Patients had PSA ≥0.1 post-RP and one or more unfavorable features (Gleason 8-10, PSA >0.5, pT3/T4, pN1 or radiographic N1, PSA doubling time <10 months, negative margins, persistent PSA, gross local/regional disease, or Decipher High Risk). All patients received SRT plus 6 months of GnRH agonist and randomization was to concurrent bicalutamide 50 mg or AAP 1000 mg/5 mg + Apa 240 mg QD. Radiation to pelvic nodes was required for pN1 and optional for pN0. The primary endpoint was PSA progression-free survival (PFS) and secondary endpoint was metastasis-free survival (MFS) determined by conventional imaging. The study was powered to detect a HR of 0.50 for PFS and a HR of 0.30 for MFS, each with 80% power and one-sided type I error of 0.05. Stratification was by PSA at study entry (>0.5 vs.≤0.5) and pN0 vs pN1. Analyses within these subgroups were pre-planned and utilized two-sided p-values.

RESULTS

Three hundred forty-five participants (332 evaluable) from 9 sites were randomized from 11/24/2017 to 3/25/2020 (172 bicalutamide, 173 AAP/Apa). Median follow-up was 34 (6-53) months; 29% were pN1 and 31% had PSA >0.5 ng/mL. The HR for PFS was 0.71 (90% CI 0.49-1.03), stratified one-sided log-rank p = 0.06 (3-year PFS was 68.5% bicalutamide vs 74.9% AAP/Apa). The HR for MFS was 0.57 (90% CI 0.33-1.01), stratified one-sided log rank p = 0.05 (3-year MFS was 87.2% bicalutamide vs 90.6% AAP/Apa). In a pre-planned analysis by stratification factors, AAP/Apa was significantly superior for patients with PSA >0.5 for PFS [HR 0.50, (95% CI 0.27-0.95), p = 0.03 (2-sided); 3-year PFS 46.8% bicalutamide vs. 67.2% AAP/Apa] and for MFS [HR 0.32 (95% CI 0.13-0.84), p = 0.02 (2-sided); 3-year MFS 66.1% bicalutamide vs. 84.3% AAP/Apa.] No statistically significant benefit was detected in pre-planned analyses of stratification subgroups defined by PSA≤0.5, pN0, or pN1. Adverse events were consistent with the known safety profiles of the agents being studied, with more rash and hypertension in the AAP/Apa arm.

CONCLUSION

Although this primary analysis did not meet the pre-specified threshold for statistical significance, it does strongly suggest that the addition of AAP/Apa instead of bicalutamide to SRT+6 months of GnRH Agonist may improve PFS and MFS, particularly in the subgroup of patients with PSA>0.5 where a pre-planned subgroup analysis by stratification factors observed a statistically significant benefit for both PFS and MFS. (NCT03141671).

MGMT Promoter Methylation Predicts Survival in 1p19q-Codeleted Gliomas after Chemotherapy

PURPOSE/OBJECTIVE(S)

MGMT promoter methylation (mMGMT) is predictive of response to alkylating chemotherapy in glioblastomas and used to guide treatment decisions. However, the role of MGMT promoter status in low-grade and anaplastic gliomas remains unclear due to molecular heterogeneity and the lack of sufficiently large datasets. We recently found that MGMT promoter methylation predicts progression-free survival in 1p19q-codeleted gliomas after alkylating chemotherapy in a meta-analysis of three prospective cohorts. There were not enough deaths to determine the effect on overall survival. Here, we query a large national database to determine the association between MGMT promoter methylation and overall survival in patients with 1p19q-codeleted gliomas.

MATERIALS/METHODS

We identified all patients with newly diagnosed gliomas in the National Cancer Database (NCDB) from 2010-2016 with 1p19q-codeletion and information on MGMT promoter methylation status. The cohort was stratified based on receipt of chemotherapy. Multivariable Cox proportional hazards regression modeling was used to assess the effect of MGMT promoter methylation status on overall survival after adjusting for age, sex, race, co-morbidity, grade, extent of resection, chemotherapy, and radiotherapy.

RESULTS

We identified 530 eligible patients, 373 (70.4%) of whom received chemotherapy in their initial course of treatment. The MGMT promoter was methylated in 400 (75.5%) patients. For all patients, unmethylated MGMT (uMGMT) was associated with poorer survival compared to mMGMT (75% survival time [75%ST] 45 months vs. not reached, P = .003, adjusted hazard ratio [aHR] 2.36 [95% confidence interval (95% CI) 1.53-3.62]). uMGMT was associated with poorer survival in patients who received chemotherapy (75%ST 22 vs. 66 months, P<.001, aHR 2.55 [95% CI 1.60-4.06]) but not in patients who did not receive chemotherapy (75%ST 110 months vs. not reached, P = 0.7, HR 1.24 [95% CI 0.40-3.81]).

CONCLUSION

To our knowledge, this is the first study to demonstrate an association between overall survival and MGMT promoter status in 1p19q-codeleted gliomas. MGMT promoter status should be used as a stratification factor in future clinical trials of 1p19q-codeleted gliomas that use overall survival as an endpoint.

[Electromyographic signals and the starting threshold voltage of orbicularis oris muscle in healthy rhesus monkeys]

Objective: To investigate the characteristics of electromyography (EMG) signals and the starting threshold voltages of the orbicularis oris muscles (OOM) in healthy rhesus monkeys under different muscle movement conditions. Methods: The EMG signals and the starting threshold voltages at different time points in 4 healthy rhesus monkeys were acquired and recorded with EMG device and evoked potentiometer. The voltage amplitude variation of EMG signals was analyzed, and the voltage amplitude range of EMG signals at the beginning of OOM contraction was established. The data were statistically analyzed by one-way ANOVA. Results: The EMG of OOM in healthy monkeys in the quiet, natural and continuous mouth-closed state was linear and relatively stable, and the absolute value fluctuated between 15 and 50 μV. The EMG waveform increased rapidly during the natural lip contraction movement, and its amplitude fluctuated greatly, with the highest absolute value of the peak value reaching hundreds of microvolts. The amplitude of EMG induced by continuous mouth closure was more than thousands of microvolts. There was no significant difference in EMG amplitudes of OOM in the healthy rhesus monkey under quiet and continuous lip closure at different time points (P>0.05). There was no significant difference in threshold voltages in the state of natural lip contraction of bilateral OOM at different time points (average range: 57.17-57.47 μV) in the healthy rhesus monkeys (P>0.05). There was no significant difference in threshold voltages of OOM induced by bilateral OOM at different time points(average range: 55.38-55.99 μV) in the healthy rhesus monkeys(P>0.05). There were significant differences in the absolute values of EMG amplitudes of OOM between the three lip movement modes: (30.67±8.72) μV in quiet and natural continuous lip closure (475.12±54.72) μV in natural lip contraction, and (921.22±312.79) μV in the induced persistent lip closure, with t values of -8.48, -9.35 and -5.01 respectively, all P<0.001. Conclusions: The EMG signals of OOM show different characteristics under different muscle movement conditions, which can be used as a basis for computer to judge and recognize the movement conditions of OOM. The upper limits of the EMG threshold voltage values of OOM under different motion states are 55-60 μV.

Repeated Administration of Cisplatin Transforms Kidney Fibroblasts through G2/M Arrest and Cellular Senescence

Cisplatin is a potent chemotherapeutic used for the treatment of many types of cancer, but it has nephrotoxic side effects leading to acute kidney injury and subsequently chronic kidney disease (CKD). Previous work has focused on acute kidney tubular injury induced by cisplatin, whereas the chronic sequelae post-injury has not been well-explored. In the present study, we established a kidney fibroblast model of CKD induced by repeated administration of cisplatin (RAC) as a clinically relevant model. In NRK-49F rat kidney fibroblasts, RAC upregulated α-smooth muscle actin (α-SMA) and fibronectin proteins, suggesting that RAC induces kidney fibroblast-to-myofibroblast transformation. RAC also enhanced cell size, including the cell attachment surface area, nuclear area, and cell volume. Furthermore, RAC induced p21 expression and senescence-associated β-galactosidase activity, suggesting that kidney fibroblasts exposed to RAC develop a senescent phenotype. Inhibition of p21 reduced cellular senescence, hypertrophy, and myofibroblast transformation induced by RAC. Intriguingly, after RAC, kidney fibroblasts were arrested at the G2/M phase. Repeated treatment with paclitaxel as an inducer of G2/M arrest upregulated p21, α-SMA, and fibronectin in the kidney fibroblasts. Taken together, these data suggest that RAC transforms kidney fibroblasts into myofibroblasts through G2/M arrest and cellular senescence.

[Epidemiological characteristics of imported COVID-19 cases in Tianjin]

Objective: To understand the epidemiological characteristics of imported COVID-19 cases in Tianjin, and provide references for risk assessment and control of imported COVID-19 cases. Methods: The information of imported COVID-19 cases were obtained from National Notifiable Disease Report System of China CDC. The data of imported COVID-19 cases reported from Tianjin airport and epidemiological surveys by CDCs at all levels from March 15, 2020 to August 31, 2021 were collected and analyzed by using software Excel 2010, SPSS 25.0 and R. Results: From March 15, 2020 to August 31, 2021, a total of 606 imported cases of COVID-19 were reported in Tianjin, in which 552 cases were finally included in the analysis. The male to female ratio of the cases was 1.8∶1, the age of the cases ranged from 3 to 77 years, and the cases were mainly reported in age group 20-39 years (59.8%). The areas where the imported case sojourned within 14 days included Europe (242 cases, 43.8%), Africa (139 cases, 25.2%), Americas (85 cases, 15.4%) and Asia (86 cases, 15.6%). The proportion of confirmed cases in autumn and winter was relatively high. During the study period, the proportion of infected persons found in custom entry quarantine decreased, and the proportion of persons with personal health declaration and under medical isolation observation increased. The interval between entry and diagnosis of infected persons tended to increase. Conclusion: The proportion of imported COVID-19 cases detected on the first day of entry at Tianjin airport decreased, and the interval to detect the infected persons trended to increase, to which close attention must be paid.

Inhibitory Effect of Bovine Adipose-Derived Mesenchymal Stem Cells on Lipopolysaccharide Induced Inflammation of Endometrial Epithelial Cells in Dairy Cows

Endometritis is a disease that affects reproductive health in dairy cows and causes serious economic damage to the dairy industry world-wide. Although in recent years, the application of mesenchymal stem cell (MSC) therapy for the treatment of inflammatory diseases has attracted much attention, there are few reports of the use of MSCs in dairy cows. In the present study, our objective was to explore the inhibitory effects of bovine adipose-derived mesenchymal stem cells (bAD-MSCs) on lipopolysaccharide (LPS) induced inflammation in bovine endometrial epithelial cells (bEECs) along with the potential underlying molecular mechanisms. We characterized isolated bAD-MSCs using cell surface marker staining and adipogenic/osteogenic differentiation, and analyzed them using immunofluorescence, flow cytometry (surface marker staining), and adipogenic and osteogenic differentiation. Furthermore, to understand the anti-inflammatory effects of bAD-MSCs on LPS induced bEEC inflammation, we used a bAD-MSC/bEEC co-culture system. The results showed that bAD-MSC treatments could significantly decrease LPS induced bEEC apoptosis and pro-inflammatory cytokine expression levels, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Furthermore, our results showed that bAD-MSC treatments could also significantly downregulate LPS induced p38, IkB-a, and JAK1 phosphorylation and Bax protein expression levels, which are closely related to inflammatory progress and cellular apoptosis in bEECs. Our findings demonstrate that bAD-MSCs play an inhibitory role in LPS induced bEEC inflammation and provide new insights for the clinical therapy of endometritis in dairy cows.

The compound 2-benzylthio-5,8-dimethoxynaphthalene-1,4-dione leads to apoptotic cell death by increasing the cellular reactive oxygen species levels in Ras-mutated liver cancer cells

The aim of the present study was to verify the pro-apoptotic anticancer potential of several 5,8-dimethoxy-1,4-phthoquinone (DMNQ) derivatives in Ras-mediated tumorigenesis. MTT assays were used to detect cellular viability and flow cytometry was performed to assess intracellular reactive oxygen species (ROS) levels and apoptosis. The expression levels of proteins were detected via western blotting. Among the 12 newly synthesized DMNQ derivatives, 2-benzylthio-5,8-dimethoxynaphthalene-1,4-dione (BZNQ; component #1) significantly reduced cell viability both in mouse NIH3T3 embryonic fibroblasts cells (NC) and H-Ras^G12V transfected mouse NIH3T3 embryonic fibroblasts cells (NR). Moreover, BZNQ resulted in increased cytotoxic sensitivity in Ras-mutant transfected cells. Furthermore, the reactive oxygen species (ROS) levels in H-Ras^G12V transfected HepG2 liver cancer cells (HR) were significantly higher compared with the levels in HepG2 liver cancer cells (HC) following BZNQ treatment, which further resulted in increased cellular apoptosis. Eliminating cellular ROS using an ROS scavenger N-acetyl-L-cysteine markedly reversed BZNQ-induced cellular ROS accumulation and cell apoptosis in HC and HR cells. Western blotting results revealed that BZNQ significantly downregulated H-Ras protein expression and inhibited the Ras-mediated downstream signaling pathways such as protein kinase B, extracellular signal-related kinase and glycogen synthase kinase phosphorylation and β-catenin protein expression. These results indicated that the novel DMNQ derivative BZNQ may be a therapeutic drug for Ras-mediated liver tumorigenesis. The results of the current study suggest that BZNQ exerts its effect by downregulating H-Ras protein expression and Ras-mediated signaling pathways.

[microRNA-16-5p targeted tetraspanin 15 gene to inhibit the proliferation, migration and invasion of osteosarcoma cell through phospoinositide 3-kinase/protein kinase B signaling pathway]

Objective: To study the effects of miR-16-5p on proliferation, migration and invasion of osteosarcoma cells and its mechanism. Methods: Quantitative polymerase chain reaction (qPCR) and Western blotting were used to detect the mRNA and protein expression of miR-16-5p and TSPAN15 in human normal osteoblasts hFOB 1.19 and osteosarcoma cells MG63, Saos2 and HOS. The miR-16-5p or si-TSPAN15 was transfected into MG63 cells to observe its role in cell proliferation, migration and invasion. Cell proliferation was measured with MTT assay, cell migration and invasion were examined by Transwell, and the protein expression of CyclinD1, matrix metalloproteinase 2 (MMP-2), MMP-9, tetraspanin 15 (TSPAN15), phospha-tidylinositol3-kinase(p-PI3K) and phospha-protein kinase B(p-AKT) were determined by using Western blotting. The starbase website prediction combined with dual luciferase gene reporter assay was performed to analyze the targeting relationship between miR-16-5p and TSPAN15. miR-16-5p and pcDNA-TSPAN1 were co-transfected to assess the effect of high expression of TSPAN15 on overexpression of miR-16-5p-induced proliferation, migration and invasion of MG63 cells. Data comparison between the two groups was performed by using t test. Results: Compared with hFOB 1.19 cells (1.00±0.12), the expression of miR-16-5p was significantly decreased in MG63, Saos2 and HOS cells (0.32±0.05, 0.40±0.04, 0.45±0.06, respectively)(F=156.204, P<0.05), and TSPAN15 mRNA and protein levels were greatly increased (F=71.718, 110.350, both P<0.05). Overexpression of miR-16-5p obviously reduced the expression of CyclinD1, MMP-2, MMP-9 protein, cell viability, cell migration and invasion (F=150.136,117.228, 154.971, 89.479, 98.373, 130.880, all P<0.05) in MG63 cells. Knockdown of TSPAN15 greatly reduced CyclinD1, MMP-2, MMP-9 protein levels, cell survival rate, cell migration, and invasion number (F=93.206, 107.030, 109.326, 115.625, 146.113, 139.300, all P<0.05). Overexpression of miR-16-5p markedly decreased the expression of p-PI3K and p-AKT protein in MG63 cells (F=156.755, 181.419, both P<0.05). miR-16-5p targeted to regulate the expression of TSPAN15. High expression of TSPAN15 partially reversed the inhibitory effect of miR-16-5p on TSPAN15, CyclinD1, MMP-2, MMP-9, p-PI3K, p-AKT protein expression, cell viability, cell migration number and invasion number in MG63 cells. Conclusion: miR-16-5p inhibits the proliferation, migration and invasion of osteosarcoma cells by targeting the TSPAN15 gene and regulating the PI3K/AKT signaling pathway.

Novel tunable graphene-encoded metasurfaces on an uneven substrate for beam-steering in far-field at the terahertz frequencies

In this paper, we present a novel tunable graphene coding metasurface structure using a circular graphene patch on an uneven substrate. By changing the Fermi level of graphene or the thickness of the substrate, we can achieve obvious phase variation. Firstly, we put forward two construction methods of 1-bit coding metasurface based on this mechanism. The first method is to change the thickness of the substrate when the Fermi levels of the two-unit cells are the same, so that the two-unit cells exhibit different digital states of '0' and '1'. Furthermore, we change the working frequency band in real-time by switching the Fermi level from 0.05 eV to 0.85 eV. The second method is to change the Fermi level of graphene on the two-unit cells when the physical structure is fixed, so that the two-unit cells exhibit different digital states of '0' and '1'. In this case, we can achieve the regulation of the direction and number of far-field reflected waves in the frequency range of 2.65 THz ∼ 2.85THz. Then, to obtain a single beam of reflected waves deviating from the normal direction, we create a 2-bit method in combination with two 1-bit construction methods. At 1.9 THz, the four-cell structures have a phase difference of approximately 90° and the same reflection coefficient. We also set several coding modes to analyse the control of the reflected wave on the 2-bit coding metasurface. Finally, we realized the real-time regulation of the reflected wave in eight directions from 0° to 360° by controlling the Fermi level of the graphene. Therefore, this article proposes a potentially effective approach to the design of functional devices for beam splitting and beam deflection.

[Study on the method of microelectrodes implantation of artificial facial nerve prosthesis in closed mouth of orbicularis oris muscle in monkeys with facial nerve paralysis]

Objective: To explore the optimal method of microelectrode implantation that can produce efficient mouth closure with microelectrode for orbicularis oris muscle (OOM) in rhesus monkeys with unilateral peripheral facial paralysis (UPFP) in order to provide basis for the research and development of artificial facial nerve prosthesis (AFNP). Methods: Right lateral peripheral facial paralysis model on four healthy rhesus monkeys (two males and two femles, aged 5-6 years, weighed 2.0-3.0 kg) were prepared. AFNP electric stimulation was used to induce closed-mouth reaction of the affected OOM with a one-way rectangular pulse, 50 Hz frequency and 0.2 ms pulse width in vitro. Around the affected lateral OOM, four stimulus electrodes implantation positions were selected at the upper lip (position A), the lower lip (position B), the connection with the corner of the mouth to the ipsilateral tragus (position C), and the horizontal line of the mouth angle (position D). According to the different implantation positions of three stimulation electrodes on the stimulation side of AFNP and the results of our previous study, six groups of microelectrode implantation methods were designed. In Group A, two microelectrodes were implanted at position A and one microelectrode was implanted at position B; in Group B, one microelectrode was implanted at position A, B and C respectively; in Group C, one microelectrode was implanted at position A and two microelectrodes were implanted at position B; in Group D, one microelectrode was implanted at position A, B and D respectively; in Group E, one microelectrode was implanted at position A, C and D respectively; in Group F, one microelectrode was implanted at position B, C and D respectively. The minimum stimulating current (threshold current) required for effective mouth closure were recorded. The threshold and peak current values were compared using one-way ANOVA and LSD-t multiple comparisons. Results: The microelectrodes of the AFNP stimulating side in Group E and F failed to induce a smooth mouth closure. The microelectrodes in A, B, C and D group induced smooth mouth closure. The threshold current value of OOM contraction on affected side in the Group A, B, C, and D were (1.35±0.05), (1.02±0.04), (1.40±0.04) and (1.10±0.02) mA, respectively (F=295.302, P<0.001), with the lowest value in Group B and there was significant difference between the current value in Group B and those in the other groups (all P<0.05). The peak current value of OOM contraction on affected side in the four groups were (3.95±0.02), (2.95±0.03), (3.99±0.05) and (3.51±0.01) mA, respectively (F=1 014.985, P<0.001). Group B showed the best lip-closure morphology observed with naked eyes. Conclusions: When three output microelectrode of the AFNP stimulated side are separately imbedded into the upper lip, the lower lip and the connection with the corner of the mouth to the ipsilateral tragus, AFNP can sufficiently induce closed-mouth reaction. These positions are suitable as priority options microelectrodes implantation positions for the microelectrodes of the AFNP stimulated side.

Is exclusion of leukocytes from platelet-rich plasma (PRP) a better choice for early intervertebral disc regeneration?

Background

Platelet-rich plasma (PRP) is becoming a promising strategy to treat early intervertebral disc degeneration (IDD) in clinics. Pure PRP without leukocytes (P-PRP) may decrease the catabolic and inflammatory changes in the early degenerated intervertebral discs. The aim of this study was to investigate the effects of P-PRP on nucleus pulposus-derived stem cells (NPSCs) isolated from early degenerated intervertebral discs in vitro.

Methods

NPSCs isolated from early degenerated discs of rabbits were treated with P-PRP or leukocyte-platelet-rich PRP (L-PRP) in vitro, followed by measuring cell proliferation, stem cell marker expression, inflammatory gene expression, and anabolic and catabolic protein expression by immunostaining, quantitative real-time polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay.

Results

Cell proliferation was induced by P-PRP in a dose-dependent manner with maximum proliferation at 10% P-PRP dose. P-PRP induced differentiation of NPSCs into active nucleus pulposus cells. P-PRP mainly increased the expression of anabolic genes and relative proteins, aggrecan (AGC), collagen types II (Col II), while L-PRP predominantly increased the expression of catabolic and inflammatory genes, matrix metalloproteinase-1 (MMP-1), MMP-13, interleukin-1 beta (IL-1β), IL-6, tumor necrosis factor alpha (TNF-α), and protein production of IL-1β and TNF-α.

Conclusions

Leukocytes in PRP activate inflammatory and catabolic effects on NPSCs from early degenerated intervertebral discs. Hence, P-PRP may be a more suitable therapeutic strategy for early IDD.

Racial disparities in prostate cancer outcome among prostate-specific antigen screening eligible populations in the United States

Background

In 2012, the United States Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA) screening, despite evidence that Black men are at a higher risk of prostate cancer-specific mortality (PCSM). We evaluated whether Black men of potentially screening-eligible age (55-69 years) are at a disproportionally high risk of poor outcomes.

Patients and methods

The SEER database was used to study 390 259 men diagnosed with prostate cancer in the United States between 2004 and 2011. Multivariable logistic regression modeled the association between Black race and stage of presentation, while Fine-Gray competing risks regression modeled the association between Black race and PCSM, both as a function of screening eligibility (age 55-69 years versus not).

Results

Black men were more likely to present with metastatic disease (adjusted odds ratio [AOR] 1.65; 1.58-1.72; P < 0.001) and were at a higher risk of PCSM (adjusted hazard ratio [AHR] 1.36; 1.27-1.46; P < 0.001) compared to non-Black men. There were significant interactions between race and PSA-screening eligibility such that Black patients experienced more disproportionate rates of metastatic disease (AOR 1.76; 1.65-1.87 versus 1.55; 1.47-1.65; Pinteraction < 0.001) and PCSM (AHR 1.53; 1.37-1.70 versus 1.25; 1.14-1.37; Pinteraction = 0.01) in the potentially PSA-screening eligible group than in the group not eligible for screening.

Conclusions

Racial disparities in prostate cancer outcome among Black men are significantly worse in PSA-screening eligible populations. These results raise the possibility that Black men could be disproportionately impacted by recommendations to end PSA screening in the United States and suggest that Black race should be included in the updated USPSTF PSA screening guidelines.

[Proliferation and differentiation of endogenous neural stem cells in subventricular zone in rats after traumatic craniocerebral injury]

OBJECTIVE

To observe the time course of proliferation and differentiation of neural stem cells (NSCs) in the subventricular zone (SVZ) of rats following traumatic craniocerebral injury (TBI).

METHODS

Forty-eight SD rats were randomized into 3 groups, namely the control group without any treatment, the sham-operated group with scalp incision and preparation of a cranial window, and TBI group with craniocerebral injury induced by Feeney's method. With nestin and BrdU as two cell markers, NSE as the neuron-specific marker and GFAP as the glial cell marker, immunofluorescence assay with double labeled antibodies was performed to examine the proliferation and differentiation of endogenous NSCs in the SVZ at different time points after TBI.

RESULTS

s The numbers of cells positive for nestin/NSE, nestin/GFAP, BrdU/NSE, and BrdU/GFAP in the SVZ of the rats increased significantly after TBI. The positive cells began to increase at 1 day after TBI, reached the peak level at day 3 and became normal at day 14, showing significant differences between the time points of measurement following TBI and from the cell numbers in the control group measured at the same time points. The cells positive for nestin/ GFAP showed the most distinct increase in the SVZ of the rats with TBI.

CONCLUSION

TBI results in mobilization of the NSCs in the SVZ on the injured side to cause the proliferation and differentiation of the endogenous NSCs. The SVZ is one of the most important germinal centers of NSC proliferation and differentiation.

Non-monotonic changes in critical solidification rates for stability of liquid-solid interfaces with static magnetic fields

We report the magnetic field dependence of the critical solidification rate for the stability of liquid-solid interfaces. For a certain temperature gradient, the critical solidification rate first increases, then decreases, and subsequently increases with increasing magnetic field. The effect of the magnetic field on the critical solidification rate is more pronounced at low than at high temperature gradients. The numerical simulations show that the magnetic-field dependent changes of convection velocity and contour at the interface agree with the experimental results. The convection velocity first increases, then decreases, and finally increases again with increasing the magnetic field intensity. The variation of the convection contour at the interface first decreases, then increases slightly, and finally increases remarkably with increasing the magnetic field intensity. Thermoelectromagnetic convection (TEMC) plays the role of micro-stirring the melt and is responsible for the increase of interface stability within the initially increasing range of magnetic field intensity. The weak and significant extents of the magneto-hydrodynamic damping (MHD)-dependent solute build-up at the interface front result, respectively, in the gradual decrease and increase of interfacial stability with increasing the magnetic field intensity. The variation of the liquid-side concentration at the liquid-solid interface with the magnetic field supports the proposed mechanism.

Blue vitiligo following intralesional injection of psoralen combined with ultraviolet B radiation therapy

A 23-year-old Chinese man presented with a 16-month history of white patches on his abdomen and neck. He had previously received an intralesional injection of psoralen along with narrowband psoralen ultraviolet B radiation (PUVB) therapy. Blue macules had appeared in and around the injection sites 1 week later. Dermoscopy revealed blue spots and reticular telangiectasia within the white patches. Histological examination revealed an absence of epidermal melanocytes and pigment in the basal layer, as well as deposition of melanophages between collagen bundles or surrounding blood vessels and appendages in the middle and lower parts of the dermis. A diagnosis of blue vitiligo was made. The blue colour faded gradually over time. Our case provides direct evidence to support the previous surmise that PUVB can contribute to blue vitiligo. To our knowledge, this is only the fourth reported case of blue vitiligo in the English literature.

Genetic diversity of the Chinese traditional herb Blumea balsamifera (Asteraceae) based on AFLP markers

Blumea balsamifera is a commercially important medicinal herb in China and other parts of Asia. It is used to produce borneol. This plant grows in the wild, but resources have diminished greatly in recent years. We examined the genetic diversity of this species to help develop conservation strategies; 35 plants from five provinces were analyzed using AFLPs. Eight AFLP primer combinations generated 1367 fragments, giving a mean of 172 fragments per primer combination. Polymorphism in the germplasm analysis was found for 1360 (99.48%) of the fragments, of which 264 (19.27%) fragments were unique (accession specific) and 423 (25.33%) of the fragments were rare (present in less than 10% of the accessions). The polymorphic fragments were used to group the accessions in a UPGMA phenogram. Most grouping was geographical. In general, accessions coming from Guizhou and Guangxi showed higher diversities as these accessions were scattered in different groups. The genetic distance estimated by Jaccard similarity coefficient index showed low variability among genotypes (coefficient value ranged from 0.60 to 0.95). More attention should be given to the study and conservation of the biodiversity of this economically important genus.

Treatment of Intracerebral Glioblastomas with G422 Tumour Cell Vaccine in a Mouse Model

The aim of this study was to develop a tumour vaccine with the ability to induce and expand higher affinity cytotoxic T lymphocytes and stimulate an effective antitumour immune response. The hypothesis tested was that G422 glioblastoma cells modified with B7-1 and interferon (IFN)-γ genes could serve as a tumour vaccine. It was found that therapeutic subcutaneous immunizations with this tumour vaccine significantly induced a cytotoxic T-cell response and prolonged the survival of female Kuming mice with intracerebral G422 tumour isografts. The data collectively suggested that G422 glioblastoma cells genetically modified with B7-1 and IFN-γ genes could serve as a tumour vaccine.

[Immune modulatory and therapeutical effect of shenqi tablet accessory therapy in treating recurrent genital herpes]

OBJECTIVE

To observe the immune modulatory and therapeutical effect of Shenqi tablet (SQT) in treating recurrent genital herpes.

METHODS

Sixty-three patients were randomly divided into two groups, the SQT group (34 cases) and the control group (29 cases). The immunologic function of patients was determined before and after treatment and the recurrence rate of two groups was compared.

RESULTS

In the SQT group after treatment, CD3, CD4 and CD4/CD8 ratio raised, CD8 percent lowered, serum interleukin 2 (SIL-2) and RBC-C3b raised and serum SIL-2 receptor lowered (all P < 0.05), while in the control group, the above-mentioned parameters were not changed significantly. Follow-up conducted 6 months after treatment showed that the recurrence rate in the SQT group was 26.5% (9 cases), which was lower than that in the control group (72.4%, 21 cases) significantly (P < 0.01).

CONCLUSION

SQT has immune modulatory effect in patients with recurrent genital herpes, it could reduce the recurrence rate.

[An autopsy study of 7 sudden death cases due to acute hemorrhagic enteritis]

7 sudden death cases due to acute hemorrhagic enteritis were analyzed to investigate the age, sex, clinical symptoms, medical diagnosis and anatomic results. The results showed that, because the pathological changes were not typical and clinical symptoms were varid, It was easy to come to erroneous diagnosis and cause medical disputes.