Effects of reprogrammed splenic CD8+ T-cells in vitro and in mice with spontaneous metastatic Lewis lung carcinoma

BACKGROUND

Metastatic disease is a major and difficult-to-treat complication of lung cancer. Considering insufficient effectiveness of existing therapies and taking into account the current problem of lung cancer chemoresistance, it is necessary to continue the development of new treatments.

METHODS

Previously, we have demonstrated the antitumor effects of reprogrammed CD8+ T-cells (rCD8+ T-cells) from the spleen in mice with orthotopic lung carcinoma. Reprogramming was conducted by inhibiting the MAPK/ERK signalling pathway through MEKi and the immune checkpoint PD-1/PD-L1. Concurrently, CD8+ T-cells were trained in Lewis lung carcinoma (LLC) cells. We suggested that rCD8+ T-cells isolated from the spleen might impede the development of metastatic disease.

RESULTS

The present study has indicated that the reprogramming procedure enhances the survival and cytotoxicity of splenic CD8+ T-cells in LLC culture. In an LLC model of spontaneous metastasis, splenic rCD8 + T-cell therapy augmented the numbers of CD8+ T-cells and CD4+ T-cells in the lungs of mice. These changes can account for the partial reduction of tumors in the lungs and the mitigation of metastatic activity.

CONCLUSIONS

Our proposed reprogramming method enhances the antitumor activity of CD8+ T-cells isolated from the spleen and could be valuable in formulating an approach to treating metastatic disease in patients with lung cancer.

Gastro-esophageal diagnostic workup before bariatric surgery or endoscopic treatment for obesity: position statement of the International Society of Diseases of the Esophagus

Obesity is a chronic and multifactorial condition characterized by abnormal weight gain due to excessive adipose tissue accumulation that represents a growing worldwide challenge for public health. In addition, obese patients have an increased risk of hiatal hernia, esophageal, and gastric dysfunction, as well as gastroesophageal reflux disease, which has a prevalence over 40% in those seeking endoscopic or surgical intervention. Surgery has been demonstrated to be the most effective treatment for severe obesity in terms of long-term weight loss, comorbidities, and quality of life improvements and overall mortality decrease. The recent emergence of bariatric endoscopic techniques promises less invasive, more cost-effective, and reproducible approaches to the treatment of obesity. With the endorsement of the International Society for Diseases of the Esophagus, we started a Delphi process to develop consensus statements on the most appropriate diagnostic workup to preoperatively assess gastroesophageal function before bariatric surgical or endoscopic interventions. The Consensus Working Group comprised 11 international experts from five countries. The group consisted of gastroenterologists and surgeons with a large expertise with regard to gastroesophageal reflux disease, bariatric surgery and endoscopy, and physiology. Ten statements were selected, on the basis of the agreement level and clinical relevance, which represent an evidence and experience-based consensus of the International Society for Diseases of the Esophagus.

Resilience and Vulnerability to Stress-Induced Anhedonia: Unveiling Brain Gene Expression and Mitochondrial Dynamics in a Mouse Chronic Stress Depression Model

The role of altered brain mitochondrial regulation in psychiatric pathologies, including Major Depressive Disorder (MDD), has attracted increasing attention. Aberrant mitochondrial functions were suggested to underlie distinct inter-individual vulnerability to stress-related MDD syndrome. In this context, insulin receptor sensitizers (IRSs) that regulate brain metabolism have become a focus of recent research, as their use in pre-clinical studies can help to elucidate the role of mitochondrial dynamics in this disorder and contribute to the development of new antidepressant treatment. Here, following 2-week chronic mild stress (CMS) using predation, social defeat, and restraint, MDD-related behaviour and brain molecular markers have been investigated along with the hippocampus-dependent performance and emotionality in mice that received the IRS dicholine succinate (DS). In a sucrose test, mice were studied for the key feature of MDD, a decreased sensitivity to reward, called anhedonia. Based on this test, animals were assigned to anhedonic and resilient-to-stress-induced-anhedonia groups, using a previously established criterion of a decrease in sucrose preference below 65%. Such assignment was based on the fact that none of control, non-stressed animals displayed sucrose preference that would be smaller than this value. DS-treated stressed mice displayed ameliorated behaviours in a battery of assays: sucrose preference, coat state, the Y-maze, the marble test, tail suspension, and nest building. CMS-vulnerable mice exhibited overexpression of the inflammatory markers Il-1β, tnf, and Cox-1, as well as 5-htt and 5-ht2a-R, in various brain regions. The alterations in hippocampal gene expression were the closest to clinical findings and were studied further. DS-treated, stressed mice showed normalised hippocampal expression of the plasticity markers Camk4, Camk2, Pka, Adcy1, Creb-ar, Nmda-2r-ar, and Nmda-2r-s. DS-treated and non-treated stressed mice who were resilient or vulnerable to anhedonia were compared for hippocampal mitochondrial pathway regulation using Illumina profiling. Resilient mice revealed overexpression of the mitochondrial complexes NADH dehydrogenase, succinate dehydrogenase, cytochrome bc1, cytochrome c oxidase, F-type and V-type ATPases, and inorganic pyrophosphatase, which were decreased in anhedonic mice. DS partially normalised the expression of both ATPases. We conclude that hippocampal reduction in ATP synthesis is associated with anhedonia and pro-inflammatory brain changes that are ameliorated by DS.

Scanning Probe Microscopy Techniques for Studying the Cell Glycocalyx

The glycocalyx is a brush-like layer that covers the surfaces of the membranes of most cell types. It consists of a mixture of carbohydrates, mainly glycoproteins and proteoglycans. Due to its structure and sensitivity to environmental conditions, it represents a complicated object to investigate. Here, we review studies of the glycocalyx conducted using scanning probe microscopy approaches. This includes imaging techniques as well as the measurement of nanomechanical properties. The nanomechanics of the glycocalyx is particularly important since it is widely present on the surfaces of mechanosensitive cells such as endothelial cells. An overview of problems with the interpretation of indirect data via the use of analytical models is presented. Special insight is given into changes in glycocalyx properties during pathological processes. The biological background and alternative research methods are briefly covered.

Mid-IR lasing in HgCdTe multiple quantum well edge-emitting ridges

Thin HgCdTe/CdHgTe quantum wells (QWs) grown on alternative GaAs (013) substrates have been recently proposed as a material for coherent emitters in the mid-IR region. In this work, we develop a technological process for the fabrication of ridge microresonators in waveguide heterostructures with multiple HgCdTe QWs via photolithography and ion etching. We process two samples with different ridge heights and analyze their emission spectra measured under optical excitation. The width of the emission spectra dropped by an order of magnitude compared to the nonprocessed as-grown structure, allowing one to conclude that lasing at 9.2-7.1 µm takes place within the 8-120 K temperature range. However, both samples demonstrated faster temperature quenching of lasing than that of the single-pass stimulated emission from the nonprocessed structure, as well as a drop in the carrier lifetimes. These figures of merit are likely to be compromised not by the Q factor of the cavities, but due to defects induced during the etching process. Finally, the implications for HgCdTe-based lasers for the 3-5 µm transparency window and longer wavelengths (beyond 20 µm) are discussed.

Maternal Chronic Ultrasound Stress Provokes Immune Activation and Behavioral Deficits in the Offspring: A Mouse Model of Neurodevelopmental Pathology

Neurodevelopmental disorders stemming from maternal immune activation can significantly affect a child's life. A major limitation in pre-clinical studies is the scarcity of valid animal models that accurately mimic these challenges. Among the available models, administration of lipopolysaccharide (LPS) to pregnant females is a widely used paradigm. Previous studies have reported that a model of 'emotional stress', involving chronic exposure of rodents to ultrasonic frequencies, induces neuroinflammation, aberrant neuroplasticity, and behavioral deficits. In this study, we explored whether this model is a suitable paradigm for maternal stress and promotes neurodevelopmental abnormalities in the offspring of stressed females. Pregnant dams were exposed to ultrasound stress for 21 days. A separate group was injected with LPS on embryonic days E11.5 and E12.5 to mimic prenatal infection. The behavior of the dams and their female offspring was assessed using the sucrose test, open field test, and elevated plus maze. Additionally, the three-chamber sociability test and Barnes maze were used in the offspring groups. ELISA and qPCR were used to examine pro-inflammatory changes in the blood and hippocampus of adult females. Ultrasound-exposed adult females developed a depressive-like syndrome, hippocampal overexpression of GSK-3β, IL-1β, and IL-6 and increased serum concentrations of IL-1β, IL-6, IL-17, RANTES, and TNFα. The female offspring also displayed depressive-like behavior, as well as cognitive deficits. These abnormalities were comparable to the behavioral changes induced by LPS. The ultrasound stress model can be a promising animal paradigm of neurodevelopmental pathology associated with prenatal 'emotional stress'.

Testing entanglement of annihilation photons

We present a new experimental study of the quantum entanglement of photon pairs produced in positron-electron annihilation at rest. Each annihilation photon has an energy that is five orders of magnitude higher than the energy of photons in optical experiments. It provides a unique opportunity for controlled Compton pre-scattering of initial photons before the polarization measurements. The experimental setup includes a system of Compton polarimeters to measure the angular correlations of annihilation photons in initial and thus prepared pre-scattered states. For the first time, a direct comparison of the polarization correlations of initial and pre-scattered annihilation photons has been carried out. The angular distributions of scattered in polarimeters photons turned out to be the same for both types of events. Moreover, the correlation function in the Bell's inequality is also the same for both states. We discuss the implications of our results for quantum measurement theory and for the quantum-entangled positron emission tomography.

World's First Experience of the Low-dose radionuclide inhalation therapy in the treatment of COVID-19-associated viral pneumonia: phase 1/2 clinical trial

OBJECTIVE

Previously, the 99mTc inhalation was used for pneumonia treatment that decreases inflammation and disease severity. We aimed to investigate the safety and effectiveness of carbon nanoparticles labeled with Technetium isotope (99mTc) in a form of ultradispersed aerosol in combination with standard COVID-19 therapy. The study was a randomized phase 1 and phase 2 clinical trial of low-dose radionuclide inhalation therapy for patients with COVID-19 related pneumonia.

METHOD

We enrolled 47 patients with confirmed COVID-19 infection and early laboratory signs of cytokine storm and randomized them into the Treatment and Control groups. We analyzed blood parameters reflecting the COVID-19 severity and inflammatory response.

RESULTS

Low-dose 99mTc-labeled inhalation showed a minimal accumulation of radionuclide in lungs in healthy volunteers. We observed no significant differences between the groups before treatment in WBC-count, D-dimer, CRP, Ferritin or LDH levels. We found that Ferritin and LDH levels significantly raised after the 7th day follow-up only in the Control group (p<0.0001 and p=0.0005, respectively), while mean values of the same indicators did not change in patients in the Treatment group after the radionuclide treatment. D-dimer values also lowered in the radionuclide treated group, however, this effect was not statistically significant. Furthermore, we evaluated a significant decrease in CD19+ cell counts in patients of the radionuclide-treated group.

CONCLUSION

Inhaled low-dose radionuclide therapy of 99mTc aerosol affects the major prognostic indicators of COVID-19-related pneumonia restraining inflammatory response. Overall, we identified no evidence of major adverse events in the group receiving radionuclide.

A 178-clinical-center experiment of integrating AI solutions for lung pathology diagnosis

In 2020, an experiment testing AI solutions for lung X-ray analysis on a multi-hospital network was conducted. The multi-hospital network linked 178 Moscow state healthcare centers, where all chest X-rays from the network were redirected to a research facility, analyzed with AI, and returned to the centers. The experiment was formulated as a public competition with monetary awards for participating industrial and research teams. The task was to perform the binary detection of abnormalities from chest X-rays. For the objective real-life evaluation, no training X-rays were provided to the participants. This paper presents one of the top-performing AI frameworks from this experiment. First, the framework used two EfficientNets, histograms of gradients, Haar feature ensembles, and local binary patterns to recognize whether an input image represents an acceptable lung X-ray sample, meaning the X-ray is not grayscale inverted, is a frontal chest X-ray, and completely captures both lung fields. Second, the framework extracted the region with lung fields and then passed them to a multi-head DenseNet, where the heads recognized the patient's gender, age and the potential presence of abnormalities, and generated the heatmap with the abnormality regions highlighted. During one month of the experiment from 11.23.2020 to 12.25.2020, 17,888 cases have been analyzed by the framework with 11,902 cases having radiological reports with the reference diagnoses that were unequivocally parsed by the experiment organizers. The performance measured in terms of the area under receiving operator curve (AUC) was 0.77. The AUC for individual diseases ranged from 0.55 for herniation to 0.90 for pneumothorax.

Interpretable vertebral fracture quantification via anchor-free landmarks localization

Vertebral body compression fractures are early signs of osteoporosis. Though these fractures are visible on Computed Tomography (CT) images, they are frequently missed by radiologists in clinical settings. Prior research on automatic methods of vertebral fracture classification proves its reliable quality; however, existing methods provide hard-to-interpret outputs and sometimes fail to process cases with severe abnormalities such as highly pathological vertebrae or scoliosis. We propose a new two-step algorithm to localize the vertebral column in 3D CT images and then detect individual vertebrae and quantify fractures in 2D simultaneously. We train neural networks for both steps using a simple 6-keypoints based annotation scheme, which corresponds precisely to the current clinical recommendation. Our algorithm has no exclusion criteria, processes 3D CT in 2 seconds on a single GPU, and provides an interpretable and verifiable output. The method approaches expert-level performance and demonstrates state-of-the-art results in vertebrae 3D localization (the average error is 1mm), vertebrae 2D detection (precision and recall are 0.99), and fracture identification (ROC AUC at the patient level is up to 0.96). Our anchor-free vertebra detection network shows excellent generalizability on a new domain by achieving ROC AUC 0.95, sensitivity 0.85, specificity 0.9 on a challenging VerSe dataset with many unseen vertebra types.

Helicobacter pylori infection prevalence in ambulatory settings in 2017-2019 in RUSSIA: The data of real-world national multicenter trial

BACKGROUND

The recent data on the prevalence of Helicobacter pylori (H. pylori) infection in Russia are limited. The aim of the study was to compare Helicobacter pylori infection prevalence in ambulatory settings in Russia in 2017 and 2019 years.

MATERIALS AND METHODS

Subjects visiting primary care centers were invited to take part in the study. H. pylori status was assessed by ¹³ C-urea breath test (UBT). Data on subjects' demography, previous treatment exposure, and place of residence were collected in all federal districts of Russia in 2017 and in 2019 calendar years and processed centrally.

RESULTS

The data of 19,875 subjects were available for analysis. The prevalence of H. pylori infection assessed by positive UBT in treatment-naive subjects was highest in the Southern (54.9%) and the North Caucasian (45.1%) federal districts. A significant difference (p < 0.05) in H. pylori prevalence between two testing periods was found only in a half of federal districts: the Central (46.2% in 2017 vs. 36.2% in 2019), the Northwestern (38.6% vs. 35.5% accordingly), the Volga (40.6% vs. 33.0%, accordingly), and the Ural (40.4% vs. 32.7%, accordingly). The lowest prevalence of H. pylori infection was revealed in the age group <18 years old (20.2%), while the highest in the age group of 41-50 years old (43.9%). In 2017, the prevalence of H. pylori was significantly (p < 0.05) higher than in 2019 in all age groups but younger than 18 and older than 70 y.o., where similar rates were found during both study periods.

CONCLUSIONS

The prevalence of H. pylori according to ¹³ C-UBT testing of primary care visitors in Russia is lower than expected (38.8%). The highest prevalence of H. pylori infection found in the Southern and the North Caucasian federal districts of Russia and in the age group of 41-50 years old. This study was registered at clinicaltrials.gov (NCT04892238).

Local inflammatory response to gastroesophageal reflux: Association of gene expression of inflammatory cytokines with esophageal multichannel intraluminal impedance-pH data

BACKGROUND

Gene expression of inflammatory cytokines may take part in the pathophysiology of different forms of gastroesophageal reflux disease (GERD).

AIM

To explore gene expression of inflammatory cytokines in esophageal mucosa in patients with erosive esophagitis (EE) and non-erosive forms of GERD (NERD) and its association with data of esophageal multichannel intraluminal impedance-pH (MII-pH) measurements.

METHODS

This was a single-center prospective study. Esophageal mucosa samples were taken from the lower part of the esophagus during endoscopy. Expression of interleukin (IL)-1β, IL-10, IL-18, tumor necrosis factor α (TNFA), toll-like receptor 4 (TLR4), GATA binding protein 3 (GATA3), differentiation cluster 68 (CD68) and β-2 microglobulin genes in esophageal mucosa was assessed with ImmunoQuantex assays. MII-pH measurements were performed on all the participants. Diagnosis of GERD was confirmed by the results of the MII-pH data. Based on the endoscopy, patients were allocated to the groups of EE and NERD. The control group consisted of non-symptomatic subjects with normal endoscopy and MII-pH results. We used nonparametric statistics to compare the differences between the groups. Association of expression of the mentioned genes with the results of the MII-pH data was assessed with Spearman’s rank method.

RESULTS

Data from 60 patients with GERD and 10 subjects of the control group were available for the analysis. Higher expression of IL-18 (5.89 ± 0.4 vs 5.28 ± 1.1, P = 0.04) and GATA3 (2.92 ± 0.86 vs 2.23 ± 0.96, P = 0.03) was found in the EE group compared to NERD. Expression of IL-1β, IL-18, TNFA, and TLR4 was lower (P < 0.05) in the control group compared to EE and NERD. Esophageal acid exposure correlated with the expression of IL-1β (Spearman’s rank r = 0.29), IL-18 (r = 0.31), TNFA (r = 0.35), GATA3 (r = 0.34), TLR4 (r = 0.29), and CD68 (r = 0.37). Mean esophageal рН correlated inversely with the expression of IL-18, TNFA, GATA3, TLR4, and CD68. No association of gene expression with the number of gastroesophageal refluxes was found.

CONCLUSION

In patients with EE, local expression of IL-18 and GATA3 was higher compared to subjects with NERD. Esophageal acid exposure correlated directly with expression of IL-1β, IL-18, TNFA, TLR4, CD68, and β-2 microglobulin genes. Inverse correlation was revealed between expression of IL-18, TNFA, GATA3, TLR4, and CD68 and mean esophageal pH.

Previous hepatitis B viral infection–an underestimated cause of pancreatic cancer

BACKGROUND

The etiology of pancreatic cancer remains unclear. This limits the possibility of prevention and effective treatment. Hepatitis B virus (HBV) is responsible for the development of different types of cancer, but its role in pancreatic cancer is still being discussed.

AIM

To assess the prevalence of previous HBV infection and to identify viral biomarkers in patients with pancreatic ductal adenocarcinoma (PDAC) to support the role of the virus in etiology of this cancer.

METHODS

The data of 130 hepatitis B surface antigen-negative subjects were available for the final analysis, including 60 patients with PDAC confirmed by cytology or histology and 70 sex- and age-matched controls. All the participants were tested for HBV biomarkers in blood [antibody to hepatitis B core antigen (anti-HBc), antibody to hepatitis B surface antigen (anti-HBs) and HBV DNA], and for those with PDAC, biomarkers in resected pancreatic tissues were tested (HBV DNA, HBV pregenomic RNA and covalently closed circular DNA). We performed immunohistochemistry staining of pancreatic tissues for hepatitis B virus X antigen and Ki-67 protein. Non-parametric statistics were used for the analysis.

RESULTS

Anti-HBc was detected in 18/60 (30%) patients with PDAC and in 9/70 (13%) participants in the control group (P = 0.029). Accordingly, the odds of PDAC in anti-HBc-positive subjects were higher compared to those with no previous HBV infection (odds ratio: 2.905, 95% confidence interval: 1.191-7.084, standard error 0.455). HBV DNA was detected in 8 cases of PDAC and in 6 of them in the pancreatic tumor tissue samples only (all patients were anti-HBc positive). Blood HBV DNA was negative in all subjects of the control group with positive results of the serum anti-HBc test. Among 9 patients with PDAC, 5 revealed signs of replicative competence of the virus (covalently closed circular DNA with or without pregenomic RNA) in the pancreatic tumor tissue samples. Hepatitis B virus X antigen expression and active cell proliferation was revealed by immunohistochemistry in 4 patients with PDAC in the pancreatic tumor tissue samples.

CONCLUSION

We found significantly higher risks of PDAC in anti-HBc-positive patients. Detection of viral replication and hepatitis B virus X protein expression in the tumor tissue prove involvement of HBV infection in pancreatic cancer development.

Hepatitis B virus markers in hepatitis B surface antigen negative patients with pancreatic cancer: Two case reports

BACKGROUND

Hepatitis B virus (HBV) is a known carcinogen that may be involved in pancreatic cancer development. Detection of HBV biomarkers [especially expression of HBV regulatory X protein (HBx)] within the tumor tissue may provide direct support for this. However, there is still a lack of such reports, particularly in non-endemic regions for HBV infection. Here we present two cases of patients with pancreatic ductal adenocarcinoma, without a history of viral hepatitis, in whom the markers of HBV infection were detected in blood and in the resected pancreatic tissue.

CASE SUMMARY

The results of examination of two patients with pancreatic cancer, who gave informed consent for participation and publication, were the source for this study. Besides standards of care, special examination to reveal occult HBV infection was performed. This included blood tests for HBsAg, anti-HBc, anti-HBs, HBV DNA, and pancreatic tissue examinations with polymerase chain reaction for HBV DNA, pregenomic HBV RNA (pgRNA HBV), and covalently closed circular DNA HBV (cccDNA) and immunohistochemistry staining for HBxAg and Ki-67. Both subjects were operated on due to pancreatic ductal adenocarcinoma and serum HBsAg was not detected. However, in both of them anti-HBc antibodies were detected in blood, although HBV DNA was not found. Examination of the resected pancreatic tissue gave positive results for HBV DNA, expression of HBx, and active cellular proliferation by Ki-67 index in both cases. However, HBV pgRNA and cccDNA were detected only in case 1.

CONCLUSION

These cases may reflect potential involvement of HBV infection in the development of pancreatic cancer.

New Specialized Food Product

Objectives

Aim of the study was to assess efficacy of new specialized food product “SPP2” in patients with non-alcoholic steatohepatitis (NASH).

Methods

New specialized food product (SPP2) was developed based on literature data on the efficacy of biologically active compounds in pathogenesis of NASH. It contains: protein, fat, ω-3 PUFAs, carbohydrates, soluble fibre, coenzime Q10, L-carnitine, α-lipoic acid, vitamins (A, B1, B2, B6, PP, B12, D3, C, K), phospholipids. Patients with NASH (per EASL guidelines), were invited to participate in the study and were randomized either to receive iso-caloric diet (based on the data of indirect caloriemetry) alone (ICD) or iso-caloric diet and SPP2 (SPP2). Repeated examinations of body composition with bioimpedance and blood tests were performed at baseline (BL) and after 14 days (EOT) of treatment. The patients were advised to follow usual physical activity during the study. Non-parametric statistics was used to compare BL and EOT characteristics in the groups.

Results

The data of examination of 25 subjects were available. The ICD (n = 8) and SPP2 (n = 17) groups did not differ by demographic and baseline characteristics. The use of SPP2 allowed to achieve better control of weight in SPP2 group (mean ± SD): 117.5 ± 30.1 kg/m2 at BL vs 114.9 ± 28.8 kg/m2 at EOT, P &lt; 0.01) than in ICD (106.7 ± 22.1 at BL vs 104.0 ± 16.8 kg/m2 at EOT, P = 0.07). In SPP2 group significant decrease of cholesterol (5.3 ± 1.3 mmol/L at BL vs 4.6 ± 1.3 mmol/L, P = 0.003), low density lipoproteids (3.7 ± 1.0 mmol/L at BL vs 3.3 ± 1.0 at EOT, P = 0.009), and HOMA-IR (6.1 ± 3.2 vs 3.2 ± 1.5, P = 0.04) was achieved, while in ICD these parameters remained unchanged. While ALT and AST decreased in both groups, significant decrease in alkaline phosphatase and gamma-GT was found only in SPP2 group.

Conclusions

New specialized food product “SPP2” in combination with iso-caloric diet lead to greater decrease of weight, than iso-caloric diet alone. It helps to achieve faster improvement of blood lipid profile and insulin resistance.

Funding Sources

Ministry of Science and Higher Education of Russia, research grant FGMF-2022–0005.

Efficacy of Newly Developed Kombucha-Based Specialized Food Product for Treatment of Constipation-Predominant Irritable Bowel Syndrome

Objectives

Aim: to assess the efficacy of kombucha-based specialized food product, enriched with inulin in patients with constipation-predominant irritable bowel syndrome.

Methods

The study (NCT05164861) was approved by LEC and enrolled subjects with constipation-predominant irritable bowel syndrome (according to ROME IV). The subjects were randomized to receive either 220 ml of a non-alcoholic drink, based on pasteurized kombucha (KG), enriched with inulin (1.15 g/100ml) or 220 ml water (control group, CG), for 10 days. Except study product, subjects were advised to follow their usual diet. Standard examination included evaluation of stool frequency (bowel movements per day), stool form (with the Bristol stool scale) and evaluation of concomitant symptoms (abdominal pain/discomfort, abdominal fullness, bloating, and feeling of incomplete bowel emptying) with the use of 5-point Likert scale before (BL) and 10 days after the start of intervention (EOT).

Results

The complete data of 40 subjects were available for the analysis. Significant increase of stool frequency was found at the EOT compared to BL in KG (n = 20), Mean ± SD: 0.60 ± 0.31 to 0.85 ± 0.19 times/day; p = 0.004, while there was no change in CG (n = 20): 0.63 ± 0.33 vs 0.72 ± 0.28, p > 0.05. Mean values of stool scale form increased in KG (2.95 ± 1.15 to 4.4 ± 0.97; p = 0.001), while remained unchanged in CG (2.94 ± 1.2 vs 3.4 ± 1.2, p = 0.6). Mean values of the Bristol stool scale in KG and CG differed significantly at EOT (p = 0.018). Significant decrease in mean values of incomplete bowel emptying feeling was found in KG (1.88 ± 0.78 at BL vs 1.41 ± 0.56 points at EOT, p = 0.015), but not in the control group. There was no difference in patient's reports for other symptoms between KG and CG.

Conclusions

New specialized kombucha-based drink enriched with inulin is well-tolerated and increases stool frequency and consistency in patients with constipation-predominant irritable bowel syndrome.

Funding Sources

Russian Science Foundation (research grant # 19-76-30,014).

New Specialized Kombucha-Based Non-alcoholic Pasteurized Beverage Shows Favorable Profile of Short-Term Safety and Tolerability in Patients With Constipation

Objectives

Kombucha is a globally known beverage, perceived as “healthy”. It may be a basis for the development of new specialized beverages to increase dietary fiber consumption. However, safety and tolerability of the kombucha-based beverages is poorly studied yet. Aim: to assess short-term safety and tolerability of new kombucha-based pasteurized specialized non-alcoholic beverage, enriched with inulin.

Methods

This study (NCT05164861) enrolled subjects with constipation-predominant irritable bowel syndrome (per ROME IV). The subjects were randomized to receive either 220 ml of the non-alcoholic kombucha-based pasteurized beverage (KG), enriched with inulin (1.15 g/100ml) or 220 ml water (control group, CG), for 10 days. Except study product, subjects were advised to follow their usual diet. Organoleptic evaluation of the beverage; assessment of symptoms (abdominal pain/discomfort, abdominal fullness, bloating, heartburn) with the use of 5-point Likert scale; blood chemistry and hematology were performed before (BL) and on the 10th day of study (EOT). Patients were asked to report any adverse events during the study period.

Results

There were 20 subjects in KG and 20 in CG groups. New specialized food product was well-tolerated, no SAE occurred during the study. No exacerbation of the pre-existing symptoms was observed in KG, including abdominal pain/discomfort (1.28 ± 0.56 vs 1.25 ± 0.56; p > 0.05), abdominal fullness (1.53 ± 0.69 vs 1.22 ± 0.47; p > 0.05), bloating (1.60 ± 0.64 vs 1.37 ± 0.60; p > 0.05), and heartburn (1.28 ± 0.62 vs 1.25 ± 0.52; p > 0.05) during the study. The rate of AEs was low (5%) and did not differ compared to CG. Mean integrative score of organoleptic evaluation of the beverage was good (91.0 ± 13.7%) with non-significant increase at EOT (94.2 ± 6.5%). No laboratory AE were observed.

Conclusions

This study suggest that new specialized kombucha-based drink enriched with inulin is well-tolerated, and has favorable safety profile.

Funding Sources

Russian Science Foundation (research grant # 19-76-30,014).

Clinical Safety and Tolerability of New Specialized Food Product

Objectives

The use of specialized food products may increase efficacy of treatment in patients with non-alcoholic steatohepatitis (NASH). The aim of the study was to assess clinical safety and tolerability of newly developed specialized food product “SPP2” in patients with non-alcoholic steatohepatitis.

Methods

New specialized food product (SPP2) was developed based on literature data on the efficacy of active biological compounds on pathogenesis of NASH. It contains: protein, fat, ω-3 PUFAs, carbohydrates, soluble fibre, Coenzime Q10, L-carnitine, α-lipoic acid, vitamins (A, B1, B2, B6, PP, B12, D3, C, K), phospholipids. The test batch of the product passed laboratory control for biological and toxicological safety. The study was approved by LEC and registered (NCT04308980). Patients with NASH (per EASL), were invited to participate and were randomized to receive iso-caloric diet alone (ICD) or iso-caloric diet and SPP2 (SPP2). Energy value of the diet was amended by calorie content of SPP2. The patients were advised to follow usual physical activity and report any adverse events (AE) occurred during the study. Organoleptic assessment with the use of 5-point Likert scale and repeated blood tests on chemistry and hematology were performed at baseline (BL) and after 14 days (EOT) of treatment. Non-parametric statistics was used for the analysis

Results

One subject was lost to follow-up in ICD group and one postponed the use of SPP2 due to the not related to safety reasons. The data of 25 subjects were available for the final analysis. The ICD (n = 8) and SPP2 (n = 17) groups did not differ by demographic and baseline characteristics. Adherence to diet was 88% in ICD and 92% in SPP2 groups, p = 0.7. Compliance with SPP was 97%. No serious adverse events occurred during the study. Organoleptic assessment of SPP2 initially: appearance (Mean ± SD) 3.9 ± 0.83 points; color 4.0 ± 0.5; aroma 3.6 ± 0.9; texture 3.7 ± 0.8; taste 3.9 ± 0.7; resulting in a mean score 3.9 ± 0.4 point at BL. No dissatisfaction revealed at EOT: the mean organoleptic score was 4.2 ± 0.7 points (P = 0.07). No laboratory AEs occurred.

Conclusions

New specialized food product “SPP2” in combination with iso-calorie diet is safe and well-tolerated by patients with NASH.

Funding Sources

Ministry of Science and Higher Education of Russia, FGMF-2022–0005.

Changes in software as a medical device based on artificial intelligence technologies

Purpose

to develop a procedure for registering changes, notifying users about changes made, unifying software as a medical device based on artificial intelligence technologies (SaMD-AI) changes, as well as requirements for testing and inspections—quality control before and after making changes.

Methods

The main types of changes, divided into two groups—major and minor. Major changes imply a subsequent change of a SaMD-AI version to improve efficiency and safety, to change the functionality, and to ensure the processing of new data types. Minor changes imply those that SaMD-AI developers can make due to errors in the program code. Three types of SaMD-AI testings are proposed to use: functional testing, calibration testing or control, and technical testing.

Results

The presented approaches for validation SaMD-AI changes were introduced. The unified requirements for the request for changes and forms of their submission made this procedure understandable for SaMD-AI developers, and also adjusted the workload for the Experiment experts who checked all the changes made to SaMD-AI.

Conclusion

This article discusses the need to control changes in the module of SaMD-AI, as innovative products influencing medical decision making. It justifies the need to control a module operation of SaMD-AI after making changes. To streamline and optimize the necessary and sufficient control procedures, a systematization of possible changes in SaMD-AI and testing methods was carried out.

Facilitating standardized COVID-19 suspicion prediction based on computed tomography radiomics in a multi-demographic setting

Objective

To develop an automatic COVID-19 Reporting and Data System (CO-RADS)–based classification in a multi-demographic setting.

Methods

This multi-institutional review boards–approved retrospective study included 2720 chest CT scans (mean age, 58 years [range 18–100 years]) from Italian and Russian patients. Three board-certified radiologists from three countries assessed randomly selected subcohorts from each population and provided CO-RADS–based annotations. CT radiomic features were extracted from the selected subcohorts after preprocessing steps like lung lobe segmentation and automatic noise reduction. We compared three machine learning models, logistic regression (LR), multilayer perceptron (MLP), and random forest (RF) for the automated CO-RADS classification. Model evaluation was carried out in two scenarios, first, training on a mixed multi-demographic subcohort and testing on an independent hold-out dataset. In the second scenario, training was done on a single demography and externally validated on the other demography.

Results

The overall inter-observer agreement for the CO-RADS scoring between the radiologists was substantial (k = 0.80). Irrespective of the type of validation test scenario, suspected COVID-19 CT scans were identified with an accuracy of 84%. SHapley Additive exPlanations (SHAP) interpretation showed that the “wavelet_(LH)_GLCM_Imc1” feature had a positive impact on COVID prediction both with and without noise reduction. The application of noise reduction improved the overall performance between the classifiers for all types.

Conclusion

Using an automated model based on the COVID-19 Reporting and Data System (CO-RADS), we achieved clinically acceptable performance in a multi-demographic setting. This approach can serve as a standardized tool for automated COVID-19 assessment.

Keypoints

• Automatic CO-RADS scoring of large-scale multi-demographic chest CTs with mean AUC of 0.93 ± 0.04.

• Validation procedure resembles TRIPOD 2b and 3 categories, enhancing the quality of experimental design to test the cross-dataset domain shift between institutions aiding clinical integration.

• Identification of COVID-19 pneumonia in the presence of community-acquired pneumonia and other comorbidities with an AUC of 0.92.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-022-08730-6.

Genetic coupling of life-history and aerobic performance in Atlantic salmon

A better understanding of the genetic and phenotypic architecture underlying life-history variation is a longstanding aim in biology. Theories suggest energy metabolism determines life-history variation by modulating resource acquisition and allocation trade-offs, but the genetic underpinnings of the relationship and its dependence on ecological conditions have rarely been demonstrated. The strong genetic determination of age-at-maturity by two unlinked genomic regions (vgll3 and six6) makes Atlantic salmon (Salmo salar) an ideal model to address these questions. Using more than 250 juveniles in common garden conditions, we quantified the covariation between metabolic phenotypes-standard and maximum metabolic rates (SMR and MMR), and aerobic scope (AS)-and the life-history genomic regions, and tested if food availability modulates the relationships. We found that the early maturation genotype in vgll3 was associated with higher MMR and consequently AS. Additionally, MMR exhibited physiological epistasis; it was decreased when late maturation genotypes co-occurred in both genomic regions. Contrary to our expectation, the life-history genotypes had no effects on SMR. Furthermore, food availability had no effect on the genetic covariation, suggesting a lack of genotype-by-environment interactions. Our results provide insights on the key organismal processes that link energy use at the juvenile stage to age-at-maturity, indicating potential mechanisms by which metabolism and life-history can coevolve.

Spiperone Stimulates Regeneration in Pulmonary Endothelium Damaged by Cigarette Smoke and Lipopolysaccharide

Background

Endothelial dysfunction and destruction of the pulmonary microcirculation are important pathogenic factors in chronic obstructive pulmonary disease (COPD). In COPD, bronchial obstruction is associated with endothelial dysfunction. Thus, new pharmacological treatment options aimed at restoring the pulmonary endothelium represent a clinical need in COPD therapy. Notch1 has been shown to protect cells against apoptosis, inflammation, and oxidative stress caused by cigarette smoke extract (CSE). Therefore, drug which effect on Notch1 may be a potential therapeutic target for COPD in the future.

Methods

In this study, we assessed the potential of spiperone to mediate regeneration of pulmonary endothelium in model of pulmonary emphysema induced by a CSE and lipopolysaccharide (LPS) in female C57BL/6 mice.

Results

Spiperone increased the number of capillaries as well as the expression of the CD31 in the alveolar tissue compared to the controls. Moreover, application of spiperone prevented alveolar wall destruction (DI), and reduced the area of emphysema. Lastly, we demonstrated that spiperone positively influenced mobilization and migration of endothelial progenitor cells (EPC, CD45⁻CD34⁺CD31⁺), CD309⁺-endothelial cells, and angiogenesis precursors (CD45⁻CD117⁺CD309⁺) into the lung. Spiperone administration significantly reduced the number Notch1 positive CD309⁺-endothelial cells and Notch1+ EPCs.

Conclusion

Overall, our results suggest that spiperone mediates endothelial regeneration in an animal model of COPD. Thus, it could represent a novel therapeutic approach for treatment of emphysema associated with COPD.

Ipidacrine (Axamon), A Reversible Cholinesterase Inhibitor, Improves Erectile Function in Male Rats With Diabetes Mellitus-Induced Erectile Dysfunction

Background

Management of diabetes mellitus-induced erectile dysfunction (DMED) is challenging because of its insufficient responses to phosphodiesterase type 5 inhibitors.

Aim

To compare the effects of ipidacrine, a reversible cholinesterase inhibitor, and sildenafil on DMED in a rat model of streptozotocin (STZ)-induced diabetes.

Methods

Erectile dysfunction (ED) caused by STZ-induced diabetes mellitus was modeled in adult male Wistar rats, which were randomized to 4 groups: untreated diabetic rats, sildenafil (5 mg/kg), ipidacrine (3.6 mg/kg) and ipidacrine (6.7 mg/kg). The test drug (ipidacrine), comparator (sildenafil) or control substance (1% starch solution) were administered orally for 5 days or 14 days. Erectile function was assessed by the change in the maximum intracavernous pressure (ICPmax) following cavernous nerve electrical stimulation. The mean arterial pressure (MAP) was recorded, and the ICPmax/MAP ratio was calculated. Sexual behavior, cholinesterase activity and blood testosterone level tests assessed.

Main Outcome Measure

The quantitative value of ICPmax/MAP 14 days after the start of administration of the test drug and the comparison drug.

Results

Animals with STZ-induced diabetes mellitus showed a significant decrease in ICPmax and ICPmax/MAP ratio compared to the intact control group. When ipidacrine was administered to rats with DMED for 14 days, an increase in these indicators was noted. It was proved that ipidacrine at a dose of 6.7 mg/kg has noninferiority compared to sildenafil on the DMED model. Significant increase in ICPmax compared to STZ-control after electrostimulation of the cavernous nerve was recorded following administration of ipidacrine at a dose of 6.7 mg/kg (P < .05) and sildenafil at a dose 5 mg/kg (P < .05). Neither the test drug, nor the comparator were associated with increase in testosterone levels in blood; as well both drugs did not promote activation of sexual behavior.

Clinical Implications

Ipidacrine may be considered as an effective therapy for DMED but needs to be verified in human investigations.

Strengths & Limitations

The role of ipidacrine, was firstly demonstrated in rats with DMED. However, the results were obtained in animal experiments, and will be further tested in the study of receptor interactions and the determination of cellular targets.

Conclusion

This is the first study to show that administration of ipidacrine, the reversible cholinesterase inhibitor, improved erectile function in diabetic rats and these results may be beneficial in further studies using ipidacrine for treatment of DMED, particularly in non-responders to PDE5 inhibitors.

Bykov V, Gushchina E, Morozov S, et al. Ipidacrine (Axamon), A Reversible Cholinesterase Inhibitor, Improves Erectile Function in Male Rats With Diabetes Mellitus-Induced Erectile Dysfunction. Sex Med 2022;10:100477.

Standard metabolic rate does not associate with age-at-maturity genotype in juvenile Atlantic salmon

Atlantic salmon (Salmo salar) is a species with diverse life-history strategies, to which the timing of maturation contributes considerably. Recently, the genome region including the gene vgll3 has gained attention as a locus with a large effect on Atlantic salmon maturation timing, and recent studies on the vgll3 locus in salmon have indicated that its effect might be mediated through body condition and accumulation of adipose tissue. However, the cellular and physiological pathways leading from vgll3 genotype to phenotype are still unknown. Standard metabolic rate is a potentially important trait for resource acquisition and assimilation and we hypothesized that this trait, being a proxy for the maintenance energy expenditure of an individual, could be an important link in the pathway from vgll3 genotype to maturation timing phenotype. As a first step to studying links between vgll3 and the metabolic phenotype of Atlantic salmon, we measured the standard metabolic rate of 150 first-year Atlantic salmon juveniles of both sexes, originating from 14 different families with either late-maturing or early-maturing vgll3 genotypes. No significant difference in mass-adjusted standard metabolic rate was detected between individuals with different vgll3 genotypes, indicating that juvenile salmon of different vgll3 genotypes have similar maintenance energy requirements in the experimental conditions used and that the effects of vgll3 on body condition and maturation are not strongly related to maintenance energy expenditure in either sex at this life stage.

May Previous Hepatitis B Virus Infection Be Involved in Etiology and Pathogenesis of Autoimmune Liver Diseases?

INTRODUCTION

Viral infections, especially with hepatotropic viruses, may trigger autoimmune liver diseases (AILDs) and deteriorate their course. However, association of previous hepatitis B virus (HBV) infection (presence of anti-HBc with or without anti-HBs or HBV DNA in serum) with AILDs is poorly studied so far. The aim of the study was to assess the prevalence of previous hepatitis B virus infection markers and its clinical significance in patients with autoimmune liver diseases.

METHODS

The study was based on the data obtained from 234 consecutive HBsAg-negative patients with AILDs [81 with autoimmune hepatitis (AIH), 122 with primary biliary cholangitis (PBC) and 31 with primary sclerosing cholangitis (PSC)] and 131 subjects of the control group without liver diseases. Blood samples of the enrolled patients were tested for anti-HBc and HBV DNA. Samples of liver tissue were examined by standard morphologic protocol and, in anti-HBc positive subjects, for HBV DNA. We assessed estimated risks of AILDs according to anti-HBc positivity and association of anti-HBc positivity with stage of liver fibrosis.

RESULTS

Anti-HBc was detected in 14.5% participants in the control group vs 26.1% (p = 0.016) in patients with AILDs (including 27.1% subjects with PBC (p = 0.021 vs control group), in 29% of PSC and 23.5% in AIH. HBV DNA was detected in three patients with PBC and in one with AIH. Positive anti-HBc test result was associated with higher risk of AILDs-odds ratio (OR) = 2.078 [95% confidence interval (CI) 1.179-3.665], especially in PBC: OR (95% CI) 2.186 (1.165-4.101). Odds of advanced stage of liver fibrosis (F3-F4 by METAVIR) in anti-HBc-positive subjects with PBC were also higher compared to those who had no previous HBV infection: OR (95% CI) 2.614 (1.153-5.926).

CONCLUSIONS

Significant proportions of patients with AILDs are anti-HBc positive, and some of them have OBI. Among patients with AILDs, anti-HBc-positivity is most widespread in the PBC group and in subjects with advanced stage of liver fibrosis. Our data may support the idea of an important role of previous HBV infection in the etiology and pathogenesis of AILDs (namely PBC).

Potential of Stem Cells and CART as a Potential Polytherapy for Small Cell Lung Cancer

Despite the increasing urgency of the problem of treating small cell lung cancer (SCLC), information on the causes of its development is fragmentary. There is no complete understanding of the features of antitumor immunity and the role of the microenvironment in the development of SCLC resistance. This impedes the development of new methods for the diagnosis and treatment of SCLC. Lung cancer and chronic obstructive pulmonary disease (COPD) have common pathogenetic factors. COPD is a risk factor for lung cancer including SCLC. Therefore, the search for effective approaches to prevention, diagnosis, and treatment of SCLC in patients with COPD is an urgent task. This review provides information on the etiology and pathogenesis of SCLC, analyses the effectiveness of current treatment options, and critically evaluates the potential of chimeric antigen receptor T cells therapy (CART therapy) in SCLC. Moreover, we discuss potential links between lung cancer and COPD and the role of endothelium in the development of COPD. Finally, we propose a new approach for increasing the efficacy of CART therapy in SCLC.

Symmetry of diffraction patterns of two-dimensional crystal structures

Conventionally, theoretical considerations in electron microscopy employ the weak phase approximation (WPA), which is only valid for weak scattering atomic elements (C, B, N) but not for transition metal dichalcogenide (TMD) materials. This leads to many exciting phenomena being overlooked. The present theoretical study goes beyond the weak phase approximation and thus the obtained results can be applied for two-dimensional (2D) crystals made of weakly as well of strongly scattering atoms, including the TMD materials. We show that the symmetry of an electron diffraction pattern, characterized by the Friedel's pairs, is governed by the symmetry of the exit wave distribution. For an infinite periodic crystal, the exit wave is an infinite and periodic 2D distribution which can be assigned an exit wave unit cell. The latter is determined by both the chemical composition of the crystallographic unit cell and the distance between the atomic layers. For 2D crystals of identical atoms, such as graphene, the exit wave unit cell is symmetrical and, thus, a symmetrical diffraction pattern is expected. For TMD materials, the exit wave unit cell is not symmetrical and a non-symmetrical diffraction pattern is expected for both monolayer and bilayer. Conventionally asymmetry in diffraction patterns has been explained by presence of dynamical (multiple) scattering effects. Our study shows that the asymmetry of a diffraction pattern can be explained solely by the asymmetry of the exit wave unit cell. The exit wave unit cell can be asymmetrical even in kinematic (single) scattering model. Therefore, conclusions about dynamical (multiple) scattering effects in 2D materials cannot be made based solely on asymmetry of a diffraction pattern. We also show that for hexagonally arranged atoms the second-order diffraction peaks show perfectly symmetrical intensities independently on the symmetry of the exit wave unit cell distribution.

The Course of the Angular Artery in the Midface: Implications for Surgical and Minimally Invasive Procedures

BACKGROUND

Previous anatomic studies have provided valuable information on the 2-dimensional course of the angular segment of the facial artery in the midface and its arterial connections. The third dimension (ie, the depth of the artery) is less well characterized.

OBJECTIVES

The objective of the present study was to describe the 3-dimensional pathway of the angular segment of the facial artery and its relationship to the muscles of facial expression.

METHODS

The bilateral location and the depth of the midfacial segment of the facial artery was measured utilizing multi-planar computed tomographic image analyses obtained from contrast agent-enhanced cranial computed tomographic scans of 156 Caucasians aged a of 45.19 ± 18.7 years and with a mean body mass index of 25.05 ± 4.9 kg/m2.

RESULTS

At the nasal ala, the mean depth of the main arterial trunk was 13.7 ± 3.7 mm (range, 2.7-25.0 mm), whereas at the medial canthus it was 1.02 ± 0.62 mm (range, 1.0-3.0 mm). This was reflected by the arteries' relationship to the midfacial muscles: at the nasal ala superficial to levator anguli oris in 62.0% but deep to the levator labii superioris alaeque nasi in 53.6%; at the medial canthus superficial to the levator labii superioris alaeque nasi in 83.1% and superficial to the orbicularis oculi in 82.7%.

CONCLUSIONS

The results presented herein confirm the high variability in the course of the angular segment of the facial artery. Various arterial pathways have been identified providing evidence that, in the midface, there is no guaranteed safe location for minimally invasive procedures.

Dietary Patterns in Patients With Different Forms of Non-alcoholic Fatty Liver Disease

Objectives

The aim of the study was to compare food patterns in patients with simple steatosis (SS) and non-alcoholic steatohepatitis (NASH).

Methods

Prospective study was approved by LEC and enrolled subjects with confirmed non-alcoholic fatty liver disease (SS or NASH group). Nutrilogic software (Nutrilogic, Russia) was used for diet assessment. Dietary patterns were assessed according to the Healthy Eating Index (HEI): amounts of the major groups of foods and food products (grains, fruits, vegetables, dairy products, meats, fats and confectioneries) consumption were compared to the levels described in the HEI, and individual deviation rates were obtained. Nonparametric statistics (Mann-Whitney U test) was used to compare deviation rates found in subjects of SS and NASH groups.

Results

Subjects in NASH group (n = 22) were younger (Mean ± SD: 48.6 ± 13.4 y.o.) than those in SS group (n = 156; 56.5 ± 12.3 y.o., P = 0.008). Main macronutrients consumption did not differ between the groups. Although dietary patterns of major groups of foods consumption did not differ between SS and NASH groups, analysis of the foods subgroups revealed dissimilarity in the structure of vegetables and fats consumption. Patients with NASH consumed larger amounts of potatoes (0.14 ± 0.08 vs 0.11 ± 0.15, P = 0.006), and lower – of onions (0.02 ± 0.03 vs 0.07 ± 0.1, P = 0.006); they also consumed lower amounts of dairy butter (0.14 ± 0.44 vs 0.15 ± 0.21, P = 0.009) compared to subjects with simple steatosis. No other difference in the structure of vegetables (beans, root crops, leafy and other vegetables), fats (animal fats, vegetable oils, margarines) and other major groups of foods consumption was revealed.

Conclusions

Dietary patterns of patients with non-alcoholic steatohepatitis and simple steatosis differ. The obtained results may help in diet modification in patients with NAFLD in case of confirmation in larger multicenter trials.

Funding Sources

Russian Science Foundation, grant #1976-30014.

Number of Gastroesophageal Refluxes Detected With Oesophageal pH-Impedance Study Correlates With Dietary Patterns

Objectives

To evaluate association of number of gastroesophageal refluxes detected with oesophageal pH-impedance study with dietary patterns

Methods

Subjects referred to oesophageal pH-impedance examination were invited to participate in the study, approved by LEC. In case of agreement, they were asked to provide data of their usual nutrition based on food frequency questionnaire (Nutrilogic, Russia). Diet was assessed in accordance with healthy eating index, for the following main groups of products: grains, fruits, vegetables, dairy products, meats, fats and confectioneries. The results are shown as a quotient of dividing the actual values by the recommended. Spearman rank R was used to analyse correlation between number of gastroesophageal refluxes (GER) detected with oesophageal pH-impedance examination and dietary patterns assessment.

Results

Data of 40 consecutive patients (12 of them with confirmed gastroesophageal reflux disease, 28 females, age (Mean ± SD): 52.2 ± 12.9 y.o.) served as the source for the study. Mean energy value of the ration was 2302 ± 1391 kcal/day. Dietary patterns for main food groups was as follows: grains 1.4 ± 0.7, vegetables 1.1 ± 0.7, fruits 0.8 ± 0.9, dairy products 0.6 ± 0.6, meats 1.7 ± 1.0, fats 0.6 ± 0.8, confectionaries 0.3 ± 0.5. Mean number of GERs was 43.8 ± 24.4, acid GERs - 26.2 ± 20.5 per day. Direct medium-strength correlation was found between pattern of dairy products consumption and total number of GERs (Spearman R = 0.47, P &lt; 0.05), weak-acid GERs (R = 0.49, P &lt; 0.05), non-acid GERs (R = 0.62, P &lt; 0.05). Pattern of confectionaries consumption was associated with high (that reached proximal oesophagus, ∼17 cm above LES) GERs: R = 0.47, P &lt; 0.05.

Conclusions

This preliminary results may serve as a basis for further research in larger comparative trials and may be considered when diet modification is planned for patients with GERD.

Funding Sources

Russian Science Foundation research grant #19–76-30014.

Nutrients Consumption Affect the Number of Gastroesophageal Refluxes and Oesophageal Acidity in Children

Objectives

To evaluate the correlation between types and number of gastroesophageal refluxes and nutrients consumption in children and adolescents.

Methods

The study was approved by IEC. The data of examination of 219 children (7–17 y.o.), 147 with GERD and 72 controls served as a source for the study. The amount and types of GER were determined using 24-hours esophageal pH-impedansometry (Ohmega, MMS, The Netherlands). Food frequency questionnaire was used to evaluate level of nutrients consumption. To make possible comparison of data obtained in different age and sex groups of children, direct levels of nutrients consumption were converted to a percentage deviation from the recommended daily allowance rates. Spearman rank correlation analysis was performed with the use of Statistica 10 (StatSoft Inc., USA) to reveal association between usual nutrition and number of gastroesophageal reflux episodes, their acidity and duration in children.

Results

Statistically significant (p &lt; .05) correlation of Acid exposure time was found with amounts of PUFA (Spearman R = −0.334), ω-3 (R = −0.33), ω-6 (R = −0.3); retinols (R = −0.34), niacin (R = −0.28) and ascorbic acid (R = −0.37) consumption. The number of acid refluxes correlated with energy values of the ration (R = 0.269), amount of total protein (R = 0.279), total fat (R = 0.272), total carbohydrates (R = 0.152), and added sugar (R = 0.157) consumption. The number of weak-acid refluxes was not correlated with any of the parameters of actual nutrition. We found significant correlation between the number of non-acid refluxes and amount of PUFAs (R = 0.19), ω-6 (R = 0.151), ω-3 (R = 0.19); sodium (R = 0.158), phosphorus (R = 0.166), vitamin B1 (R = 0.17), niacin (R = 0.19), and ascorbic acid (0.23).

Conclusions

We found that types and number of gastroesophageal refluxes, as well as acidification of the lower part of oesophagus may be associated with diet in children. Our results may mean that different nutrients have different impact on esophageal motility in children. The results may have practical outcome for planning non-pharmacological intervention in children with GERD

Funding Sources

Ministry of Science and Hiigher Education of Russia, research project #0529–2019-0055.

New Specialized Food Product “SPP1” in Combination With Iso-Calorie Diet Shows Better Efficacy Than the Diet Alone in Treatment of Non-alcoholic Steatohepatitis

Objectives

The aim of the study was to assess efficacy and safety of newly developed specialized food product “SPP1” in patients with NASH.

Methods

New specialized food product for clinical use (SPP1) consisted of (% of the RDAs): protein 8%; fat 7% (including ω-3 PUFA 40%); soluble dietary fiber 160%; phospholipids 25%; alpha-lipoic acid 33%; betaine 10%; minerals 13%–44%; vitamins (A, E, D3, K1, C, B1, B2, B6, B12, PP, Folic acid, Pantothenic acid, Biotin) 24%–140%. The study (NCT04308980) was approved by LEC and enrolled patients with diagnosis of NASH. Subjects were randomized to the following groups: those received iso-calorie diet (according to REE, by indirect calorimetry (Quarck RMR, Italy) alone (ICD) and iso-calorie diet + SPP1 (2 portions of SPP1 a day, 14 days)(ICD + SPP1 group). Safety was assessed based on clinical and laboratory data. Repeated measurements (baseline vs those on the 15th day of the study) of body composition (InBody, South Korea), and blood chemistry were compared. Non-parametric statistics (StatSoft, USA) was used for the analysis.

Results

The results of complex examination of 20 subjects (12 in ICD + SPP1 and 8 in ICD group) served as a source for the study. Initially, groups did not differ by age, sex, and BMI. The product was well tolerated. In contrast to ICD group, those in ICD + SPP1 group demonstrated greater decrease of weight: BMI initially (BMI0), Mean ± SD: 38.7 ± 5.4 kg/m2 vs BMI at the end-point (BMIEOT) 37.7 ± 5.1 kg/m2, P = 0.003 in ICD + SPP1 group, whereas in the ICD group BMI0 38.9 ± 7.2 kg/m2 vs BMIEOT 37.9 ± 7.3 kg/m2, P = 0.08. These results were reached predominantly by a decrease of the weight of fat: body fat weight (BFW)0 50.2 ± 10.7 kg vs BFWEOT 48.5 ± 10.8 kg, P = 0.002 in ICD + SPP1 group, whereas BFW0 48.9 ± 11.4 kg vs BFWEOT 46.8 ± 11.6 kg, P = 0.07 in ICD group. ALT and AST levels decreased in both groups, but in neither of them was statistically significant.

Conclusions

The new specialized food product “SPP1” is safe, and well tolerated by patients with NASH. In combination with iso-calorie diet, it may increase efficacy of weight loss, predominantly by fat.

Funding Sources

Ministry of Science and Higher Education, #0529–2019-0055.

A phantom study to optimise the automatic tube current modulation for chest CT in COVID-19

On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic. The expert organisations recommend more cautious use of thoracic computed tomography (CT), opting for low-dose protocols. We aimed at determining a threshold value of automatic tube current modulation noise index below which there is a chance to miss an onset of ground-glass opacities (GGO) in COVID-19. A team of radiologists and medical physicists performed 25 phantom CT studies using different automatic tube current modulation settings (^SUREExposure3D technology). We then conducted a retrospective evaluation of the chest CT images from 22 patients with COVID-19 and calculated the density difference between the GGO and unaffected tissue. Finally, the results were matched to the phantom study results to determine the minimum noise index threshold value. The minimum density difference at the onset of COVID-19 was 252 HU (p < 0.001). This was found to correspond to the ^SUREExposure 3D noise index of 36. We established the noise index threshold of 36 for the Canon scanner without iterative reconstructions, allowing for a decrease in the dose-length product by 80%. The proposed protocol needs to be validated in a prospective study.

International survey on residency programs in radiology: similarities and differences among 17 countries

OBJECTIVE

With the initiative of the ACR International Economics Committee, a multinational survey was conducted to evaluate radiology residency programs around the world.

METHODS

A 31-question survey was developed. It included: economic issues, program size and length, resident's activities during daytime and call, academic aspects including syllabus and examinations. Data was tabulated using the forementioned thematic framework and was qualitatively analyzed.

RESULTS

Responses were received from all 17 countries that were invited to participate (France, Netherlands, Israel, UK, Russia, USA, Japan, India, Germany, Canada, Turkey, Croatia, Serbia, Italy, Ireland, Hungary, and Greece). Residency length varied between 2 and 5 years. The certificate of residency completion is provided by a local hospital [4/17 (23%)], University [6/17 (36%)], National Board [6/17 (36%)], and Ministry of Health [1/17 (6%)]. There was variability among the number of residency programs and residents per program ranging from 15 to 300 programs per nation with a 1-700 residents in each one respectively. Salaries varied significantly and ranged from 8000 to 75,000 USD equivalent. Exams are an integral part of training in all surveyed countries. Length of call varied between 5 and 26 h and the number of monthly calls ranged from 3 to 6. The future of radiology was judged as growing in [12/17 (70%)] countries and stagnant in [5/17 (30%)] countries.

DISCUSSION

Radiology residency programs worldwide have many similarities. The differences are in the structure of the residency programs. Stagnation and uncertainties need to be addressed to ensure the continued development of the next generation of radiologists.

SUMMARY STATEMENT

There are many similarities in the academic aims and approach to education and training of radiology residency programs worldwide. The differences are in the structure of the residency programs and payments to individual residents.

Three-Dimensional Description of the Angular Artery in the Nasolabial Fold

BACKGROUND

Due to its arterial vasculature, the nasolabial sulcus is one of the most challenging facial regions to treat when trying to ameliorate the signs of facial aging.

OBJECTIVES

The aim of the present study was to provide data on the 3-dimensional course of the angular artery within the nasolabial sulcus in relation to age, gender, and body mass index to increase safety during minimally invasive treatments.

METHODS

Thee hundred nasolabial sulci from 75 males and 75 females of Russian Caucasian ethnic background (mean [standard deviation] age, 45.7 [18.7] years; mean body mass index, 25.14 [4.9] kg/m2) were analyzed. Bilateral multiplanar measurements were based on contrast-enhanced computed tomography cranial scans.

RESULTS

Up to 3 arteries could be identified within the nasolabial sulcus: ~90% contained 1 arterial trunk, ~9% had 2 trunks, and ~1% had 3 trunks; females had more arteries than men. The artery is located at mean depths of 21.6 mm at the oral commissure and 8.9 mm at the nasal ala. The angular artery was lateral to the nasolabial sulcus in 100% of cases; the smallest distance between the artery and the nasolabial sulcus was at the oral commissure (11.91 [7.9] mm) and the greatest was at the nasal ala (13.73 [3.9] mm).

CONCLUSIONS

In contrast to current concepts, the angular artery is not located strictly subdermal to the nasolabial sulcus but at a variable depth, and in 100% of the investigated cases lateral to the nasolabial sulcus. With increasing age, the depth and lateral distance between arteries and sulci reduces significantly, underscoring the need for special caution when injecting this site.

Increased Oxidative Stress in the Prefrontal Cortex as a Shared Feature of Depressive- and PTSD-Like Syndromes: Effects of a Standardized Herbal Antioxidant

Major depression (MD) and posttraumatic stress disorder (PTSD) share common brain mechanisms and treatment strategies. Nowadays, the dramatically developing COVID-19 situation unavoidably results in stress, psychological trauma, and high incidence of MD and PTSD. Hence, the importance of the development of new treatments for these disorders cannot be overstated. Herbal medicine appears to be an effective and safe treatment with fewer side effects than classic pharmaca and that is affordable in low-income countries. Currently, oxidative stress and neuroinflammation attract increasing attention as important mechanisms of MD and PTSD. We investigated the effects of a standardized herbal cocktail (SHC), an extract of clove, bell pepper, basil, pomegranate, nettle, and other plants, that was designed as an antioxidant treatment in mouse models of MD and PTSD. In the MD model of “emotional” ultrasound stress (US), mice were subjected to ultrasound frequencies of 16–20 kHz, mimicking rodent sounds of anxiety/despair and “neutral” frequencies of 25–45 kHz, for three weeks and concomitantly treated with SHC. US-exposed mice showed elevated concentrations of oxidative stress markers malondialdehyde and protein carbonyl, increased gene and protein expression of pro-inflammatory cytokines interleukin (IL)-1β and IL-6 and other molecular changes in the prefrontal cortex as well as weight loss, helplessness, anxiety-like behavior, and neophobia that were ameliorated by the SHC treatment. In the PTSD model of the modified forced swim test (modFST), in which a 2-day swim is followed by an additional swim on day 5, mice were pretreated with SHC for 16 days. Increases in the floating behavior and oxidative stress markers malondialdehyde and protein carbonyl in the prefrontal cortex of modFST-mice were prevented by the administration of SHC. Chromatography mass spectrometry revealed bioactive constituents of SHC, including D-ribofuranose, beta-D-lactose, malic, glyceric, and citric acids that can modulate oxidative stress, immunity, and gut and microbiome functions and, thus, are likely to be active antistress elements underlying the beneficial effects of SHC. Significant correlations of malondialdehyde concentration in the prefrontal cortex with altered measures of behavioral despair and anxiety-like behavior suggest that the accumulation of oxidative stress markers are a common biological feature of MD and PTSD that can be equally effectively targeted therapeutically with antioxidant therapy, such as the SHC investigated here.

CT-Based COVID-19 triage: Deep multitask learning improves joint identification and severity quantification

The current COVID-19 pandemic overloads healthcare systems, including radiology departments. Though several deep learning approaches were developed to assist in CT analysis, nobody considered study triage directly as a computer science problem. We describe two basic setups: Identification of COVID-19 to prioritize studies of potentially infected patients to isolate them as early as possible; Severity quantification to highlight patients with severe COVID-19, thus direct them to a hospital or provide emergency medical care. We formalize these tasks as binary classification and estimation of affected lung percentage. Though similar problems were well-studied separately, we show that existing methods could provide reasonable quality only for one of these setups. We employ a multitask approach to consolidate both triage approaches and propose a convolutional neural network to leverage all available labels within a single model. In contrast with the related multitask approaches, we show the benefit from applying the classification layers to the most spatially detailed feature map at the upper part of U-Net instead of the less detailed latent representation at the bottom. We train our model on approximately 1500 publicly available CT studies and test it on the holdout dataset that consists of 123 chest CT studies of patients drawn from the same healthcare system, specifically 32 COVID-19 and 30 bacterial pneumonia cases, 30 cases with cancerous nodules, and 31 healthy controls. The proposed multitask model outperforms the other approaches and achieves ROC AUC scores of 0.87±0.01 vs. bacterial pneumonia, 0.93±0.01 vs. cancerous nodules, and 0.97±0.01 vs. healthy controls in Identification of COVID-19, and achieves 0.97±0.01 Spearman Correlation in Severity quantification. We have released our code and shared the annotated lesions masks for 32 CT images of patients with COVID-19 from the test dataset.

Differences in Temporal Volume between Males and Females and the Influence of Age and BMI: A Cross-Sectional CT-Imaging Study

BACKGROUND

 The temple has been identified as one of the most compelling facial regions in which to seek aesthetic improvement-both locally and in the entire face-when injecting soft tissue fillers.

OBJECTIVE

 The objective of this study is to identify influences of age, gender, and body mass index (BMI) on temporal parameters to better understand clinical observations and to identify optimal treatment strategies for treating temporal hollowing.

METHODS

 The sample consisted of 28 male and 30 female individuals with a median age of 53 (34) years and a median BMI of 27.00 (6.94) kg/m². The surface area of temporal skin, the surface area of temporal bones, and the temporal soft tissue volume were measured utilizing postprocessed computed tomography (CT) images via the Hausdorff minimal distance algorithm. Differences between the investigated participants related to age, BMI, and gender were calculated.

RESULTS

 Median skin surface area was greater in males compared with females 5,100.5 (708) mm² versus 4,208.5 (893) mm² (p < 0.001) as was the median bone surface area 5,329 (690) mm² versus 4,477 (888) mm² (p < 0.001). Males had on average 11.04 mL greater temporal soft tissue volume compared with age and BMI-matched females with p < 0.001. Comparing the volume between premenopausal versus postmenopausal females, the median temporal soft tissue volume was 46.63 mL (11.94) versus 40.32 mL (5.69) (p = 0.014).

CONCLUSION

 The results of this cross-sectional CT imaging study confirmed previous clinical and anatomical observations and added numerical evidence to those observations for a better clinical integration of the data.

Reduction of N2 to Ammonia by Phosphate Molten Salt and Li Electrode: Proof of Concept Using Quantum Mechanics

Electrochemical routes provide an attractive alternative to the Haber-Bosch process for cheaper and more efficient ammonia (NH₃) synthesis from N₂ while avoiding the onerous environmental impact of the Haber-Bosch process. We prototype a strategy based on a eutectic mixture of phosphate molten salt. Using quantum-mechanics (QM)-based reactive molecular dynamics, we demonstrate that lithium nitride (Li₃N) produced from the reduction of nitrogen gas (N₂) by a lithium electrode can react with the phosphate molten salt to form ammonia. We extract reaction kinetics of the various steps from QM to identify conditions with favorable reaction rates for N₂ reduction by a porous lithium electrode to form Li₃N followed by protonation from phosphate molten salt (Li₂HPO₄-LiH₂PO₄ mixture) to selectively form NH₃.

Accelerating 3D Medical Image Segmentation by Adaptive Small-Scale Target Localization

The prevailing approach for three-dimensional (3D) medical image segmentation is to use convolutional networks. Recently, deep learning methods have achieved human-level performance in several important applied problems, such as volumetry for lung-cancer diagnosis or delineation for radiation therapy planning. However, state-of-the-art architectures, such as U-Net and DeepMedic, are computationally heavy and require workstations accelerated with graphics processing units for fast inference. However, scarce research has been conducted concerning enabling fast central processing unit computations for such networks. Our paper fills this gap. We propose a new segmentation method with a human-like technique to segment a 3D study. First, we analyze the image at a small scale to identify areas of interest and then process only relevant feature-map patches. Our method not only reduces the inference time from 10 min to 15 s but also preserves state-of-the-art segmentation quality, as we illustrate in the set of experiments with two large datasets.

An International Survey of Quality and Safety Programs in Radiology

PURPOSE

The aim of this study was to determine the status of radiology quality improvement programs in a variety of selected nations worldwide.

METHODS

A survey was developed by select members of the International Economics Committee of the American College of Radiology on quality programs and was distributed to committee members. Members responded on behalf of their country. The 51-question survey asked about 12 different quality initiatives which were grouped into 4 themes: departments, users, equipment, and outcomes. Respondents reported whether a designated type of quality initiative was used in their country and answered subsequent questions further characterizing it.

RESULTS

The response rate was 100% and represented Australia, Canada, China, England, France, Germany, India, Israel, Japan, the Netherlands, Russia, and the United States. The most frequently reported quality initiatives were imaging appropriateness (91.7%) and disease registries (91.7%), followed by key performance indicators (83.3%) and morbidity and mortality rounds (83.3%). Peer review, equipment accreditation, radiation dose monitoring, and structured reporting were reported by 75.0% of respondents, followed by 58.3% of respondents for quality audits and critical incident reporting. The least frequently reported initiatives included Lean/Kaizen exercises and physician performance assessments, implemented by 25.0% of respondents.

CONCLUSION

There is considerable diversity in the quality programs used throughout the world, despite some influence by national and international organizations, from whom further guidance could increase uniformity and optimize patient care in radiology.

Directed, Elliptic, and Higher Order Flow Harmonics of Protons, Deuterons, and Tritons in Au+Au Collisions at sqrt[s_{NN}]=2.4 GeV

Flow coefficients v_{n} of the orders n=1-6 are measured with the High-Acceptance DiElectron Spectrometer (HADES) at GSI for protons, deuterons, and tritons as a function of centrality, transverse momentum, and rapidity in Au+Au collisions at sqrt[s_{NN}]=2.4  GeV. Combining the information from the flow coefficients of all orders allows us to construct for the first time, at collision energies of a few GeV, a multidifferential picture of the angular emission pattern of these particles. It reflects the complicated interplay between the effect of the central fireball pressure on the emission of particles and their subsequent interaction with spectator matter. The high precision information on higher order flow coefficients is a major step forward in constraining the equation of state of dense baryonic matter.

Antifibrotic and Regenerative Effects of Treamid in Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease characterized by interstitial fibrosis and progressive respiratory failure. Pirfenidone and nintedanib slow down but do not stop the progression of IPF. Thus, new compounds with high antifibrotic activity and simultaneously regenerative activity are an unmet clinical need. Recently, we showed that Treamid can help restoring the pancreas and testicular tissue in mice with metabolic disorders. We hypothesized that Treamid may be effective in antifibrotic therapy and regeneration of damaged lung tissue in pulmonary fibrosis. In this study, experiments were performed on male C57BL/6 mice with bleomycin-induced pulmonary fibrosis. We applied histological and immunohistochemical methods, ELISA, and assessed the expression of markers of endothelial and epithelial cells in primary cultures of CD31⁺ and CD326⁺ lung cells. Finally, we evaluated esterase activity and apoptosis of lung cells in vitro. Our data indicate that Treamid exhibits antifibrotic activity in mice with pulmonary fibrosis and has a positive effect on capillaries of the lungs. Treamid also increases the number of endothelial progenitor cells in the lungs of animals with pulmonary fibrosis. Lastly, Treamid increases esterase activity and decreases apoptosis of CD31⁺ lung cells in vitro. Based on these findings, we suggest that Treamid may represent a promising compound for the development of new antifibrotic agents, which are capable of stimulating regeneration of lung endothelium in IPF patients.

Exploring time like tranistions in pp, πp and AA reactions with HADES

Radiative transition of an excited baryon to a nucleon with emission of a virtual massive photon converting to dielectron pair (Dalitz decays) provides important information about baryon-photon coupling at low q2 in timelike region. A prominent enhancement in the respective electromagnetic transition Form Factors (etFF) at q2 near vector mesons ρ/ω poles has been predicted by various calculations reflecting strong baryon-vector meson couplings. The understanding of these couplings is also of primary importance for the interpretation of the emissivity of QCD matter studied in heavy ion collisions via dilepton emission. Dedicated measurements of baryon Dalitz decays in proton-proton and pion-proton scattering with HADES detector at GSI/FAIR are presented and discussed. The relevance of these studies for the interpretation of results obtained from heavy ion reactions is elucidated on the example of the HADES results.