Isolated non-immune mediated second-degree atrioventricular block in fetus: natural history and predictive factors for spontaneous recovery

OBJECTIVES

To uncover the clinical course of fetal isolated non-immune mediated second-degree AVB and determine the factors associated with the spontaneous recovery for fetal non-immune second-degree atrioventricular block (AVB).

METHODS

A total of 20 fetuses with isolated, non-immune mediated second-degree AVB were prospectively recruited between 2014 and 2022. These fetuses were divided into the spontaneous recovery group (n=12) and the non-spontaneous recovery group (n=8). Maternal and fetal basic characteristics, intrauterine and postnatal outcomes were compared between groups.

RESULTS

Twelve fetuses restored 1:1 atrioventricular conduction in utero and did not recur during the postnatal follow-up period. The residual eight fetuses maintained as second-degree AVB and six of them were aborted due to parental request in utero. Of the two live children with second-degree AVB, one of them progressed to complete AVB at the latest follow up at the age of 34 months, but without any symptoms, heart enlargement or dysfunction. The residual one progressed to complete AVB and was finally diagnosed with type 2 long-QT syndrome. Fetuses in the spontaneous recovery group presented with earlier gestational age at diagnosis (20.0[17.0-26.0] vs. 24.5[18.0-35.0] weeks, p=0.004) and higher atrial rate (147[130-160] vs 138.00[125.00-149.00] bpm, p=0.006) in comparison with the non-spontaneous recovery group. A cut-off value of 22.5 weeks of gestational age and 144 bpm of atrial rate at diagnosis could predict the failure of spontaneous recovery, with sensitivities of 87.5%, 75%, and specificities of 92.0%, 87.5%, respectively.

CONCLUSIONS

The outcome of fetal non-immune second-degree AVB was favorable. Earlier gestational age at diagnosis and higher atrial rate were related to spontaneous reversion for isolated non-immune-mediated second-degree AVB. However, prenatal gene test should be performed for those with persistent AVB to exclude the heritable disorders including LQTS. These findings may provide important references for clinical management and prenatal counseling. This article is protected by copyright. All rights reserved.

[Short-term substitution of calcineurin inhibitors (CNI) with recombinant humanized anti-CD25 monoclonal antibody (Basiliximab) as aGVHD prophylaxis in CNI intolerant patients after allogeneic hematopoietic stem cell transplantation]

Objectives: To investigate the efficacy of short-term substitution of recombinant humanized anti-CD25 monoclonal antibody (Basiliximab) as acute GVHD (aGVHD) prophylaxis in calcineurin inhibitors (CNI) intolerant patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: This study included 17 patients with refractory malignant hematological disorders who underwent salvage allo-HSCT at the Bone Marrow Transplantation Department of Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital from August 2021 to August 2022 and were treated with Baliximab to prevent aGVHD due to severe adverse reactions to CNI. There were seven men and ten women, with a median age of 43 years (18-67). Following the discontinuation of CNI, Basiliximab was administered at a dose of 1 mg/kg once weekly until CNI or mTOR inhibitors were resumed. Results: Basiliximab was started at an average of 5 (1-32) days after HSCT. The median duration of substitution was 20 (7-120) days. All had neutrophil engraftment within a median of 12 (10-17) days. Thirteen patients had platelet engraftment after a median of 13 (11-20) days. Four patients did not develop stable platelet engraftment. Eight patients (47.1% ) developed Grade Ⅱ-Ⅳ aGVHD, while four (23.6% ) developed Grade Ⅲ/Ⅳ aGVHD. Only one patient died from aGVHD. Before the end of the followup period, seven of 17 patients died. The longest followup period of the survivors was 347 days, and the median survival rate was not met. The overall survival (OS) rate at six months was 62.6%. Among the 17 patients, 13 (76.4% ) experienced cytomegalovirus reactivation, 7 (41.2% ) experienced EB virus activation, and no cytomegalovirus disease was observed. Conclusions: When CNI intolerance occurs during allo-HSCT, short-term replacement with Baliximab can be used as an alternative to prevent aGVHD.

A Cholecystokinin Analogue Ameliorates Cognitive Deficits and Regulates Mitochondrial Dynamics via the AMPK/Drp1 Pathway in APP/PS1 Mice

BACKGROUND

There are no drugs on the market that can reverse or slow Alzheimer's disease (AD) progression. A protease-resistant Cholecystokinin (CCK) analogue used in this study is based on the basic structure of CCK, which further increases the stability of the peptide fragment and prolongs its half-life in vivo. We observed a neuroprotective effect of CCK-8L in APPswe/PS1dE9 (APP/PS1) AD mice. However, its corresponding mechanisms still need to be elucidated.

OBJECTIVE

This study examined CCK-8L's neuroprotective effects in enhancing cognitive impairment by regulating mitochondrial dynamics through AMPK/Drp1 pathway in the APP/PS1 AD mice.

METHODS

Behavioural tests are applied to assess competence in cognitive functions. Transmission electron microscopy (TEM) was performed to observe the ultrastructure of mitochondria of hippocampal neurons, Immunofluorescent staining was employed to assay for Aβ1-42, APP, Adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) and dynamin-related protein1 (Drp1). CRISPR/Cas9 was utilized for targeted knockout of the CCKB receptor (CCKBR) in the mouse APP/PS1 hippocampal CA1 region. A model of lentiviral vector-mediated overexpression of APP in N2a cells was constructed.

RESULTS

In vivo, experiments revealed that CCK analogue and liraglutide significantly alleviated cognitive deficits in APP/PS1 mice, reduced Aβ1-42 expression, and ameliorated l damage, which is associated with CCKBR activation in the hippocampal CA1 region of mice. In vitro tests showed that CCK inhibited mitochondrial fission and promoted fusion through AMPK/Drp1 pathway.

CONCLUSIONS

CCK analogue ameliorates cognitive deficits and regulates mitochondrial dynamics by activating the CCKB receptor and the AMPK/Drp1 pathway in AD mice.

Enhanced plasmonic photocatalytic performance of C doped TiN nanocrystals through ultrathin carbon layers

Carbon-doped TiN nanoparticles on an ultrathin carbon layer, were successfully used for photocatalytic dye degradation synthesised by a simple calcination process. The resulting catalyst exhibited remarkable plasmonic photocatalytic performance under visible light irradiation. In comparison with benchmark rutile TiO2 and g-C3N4/TiO2 heterostructure catalysts, the first-order reaction rate constant of the developed catalyst improved approximately 34.2 and 6.5 times, respectively. The doping concentration of carbon and the crystal size of TiN nanoparticles, predominantly influenced by the amount of urea and calcination temperature, were identified as crucial factors governing the plasmonic photocatalytic activity. Density functional theory (DFT) calculations indicated that the introduction of carbon-sp bands into the TiN band structure promoted interband excitation of electrons and facilitated the generation of hotter holes, thereby enhancing the degradation of dyes and ultimately contributing to the superior photocatalytic activity observed.

Hypofractionated Radiotherapy with Prolonged Inter-Fraction Interval (Hypo-Slow RT) to Facilitate Immune Priming of Tumor

PURPOSE/OBJECTIVE(S)

Daily fractionated radiotherapy may pose constant stress for immune activation. A mouse model was built to explore whether hypofractionated radiotherapy with prolonged inter-fraction interval (Hypo-Slow Radiotherapy, HSRT) may enable better immune-priming of tumor than daily radiotherapy.

MATERIALS/METHODS

A subcutaneous MC38 murine colon cancer mouse model was irradiated at different radiation regimens. The impact of inter-fraction interval and dose per fraction on tumor control, immune mobilization, and synergistic effect with anti-PD-1 immunotherapy was explored. Immune activation was assessed by analyzing CD4+ and CD8+ T cells from peripheral blood, and intratumoral CD4+ and CD8+ T cells by flow cytometry; both were sampled three days after the completion of scheduled irradiation.

RESULTS

In a fixed dose per fraction experiment, the 6×5Gy QOD and 6×5Gy QD irradiation schemes resulted in identical tumor control, while the 6×5Gy BIW scheme led to tumor progression; moreover, both QOD and BIW regimens showed ability to activate immune response whereas QD regimen did not. In a fixed biological equivalent dose (BED) experiment, the comparison of different regimens with increased dose per fraction and prolonged inter-fraction interval showed that 12×3Gy QD regimen, HSRT regimens, including 6×5Gy QOD, 4×7Gy BIW, and 2×11Gy QW, led to identical tumor control. Importantly, all HSRT regimens showed significant mobilization of host immunity whereas 12×3Gy QD did not. Both peripheral and intratumor CD4+ and CD8+ cell increase with increased inter-fraction interval and dose per fraction. Finally, all HSRT regimens combined with anti-PD-1 immunotherapy showed enhanced tumor growth delay than any single treatment while 12×3Gy QD regimen did not.

CONCLUSION

This pre-clinical model demonstrated that conventional daily fractionated radiotherapy is not beneficial for host immune activation against tumor. Preliminary results suggested that prolonged inter-fraction interval with increased dose per fraction may be an optional strategy to balance the tumor control and immune activation.

[Impact of immunosuppression intensified conditioning regimen for patients with strong positive pre-transplantation donor-specific anti-HLA antibodies (DSAs) undergoing haploidentical hematopoietic stem cell transplantation]

Objective: To explore the efficacy of immunosuppression intensified conditioning regimen in patients who have strongly positive donor-specific Anti-HLA antibodies (DSAs) and received a haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: Clinical data of 10 patients with strongly positive pretransplant DSAs (defined as MFI ≥10000) were retrospectively analyzed in this study. All of them received a haplo-HSCT in the Hematology Department of Shanghai Zhaxin Traditional Chinese & Western Medicine Hospital. Results: ① Of all ten patients, three were males, and seven were females, with a median age of 53.5 (36-64) years. Of the 10 patients, three were diagnosed with acute myeloid leukemia, two were myelodysplastic syndromes (MDS), two were chronic myelomonocytic leukemia (CMML), two were in an accelerated phase of chronic myeloid leukemia (CML-AP), and one was primary myelofibrosis (PMF). ② Conditioning regimen consisted of fludarabine (Flu) /busulfan (Bu) combined with whole-body irradiation (TBI) /cyclophosphamide (Cy). ③ On the seventh day after transplantation, the median pretransplant DSA level was MFI 15 999 (10 210-23 417) and 10 787 (0-22 720). ④ Eight patients acquired hematopoietic reconstitution; the median time of neutrophil engraftment was 14 (10-16) days; and 18 (14-20) days for platelet engraftment. After a median follow-up of 12.5 (1.5-27) months, primary graft failure was found in one patient and another with poor graft function. Seven patients remained in a disease remission state, and all were DSA-negative. Conclusions: An intensified immunosuppression conditioning regimen can efficiently decrease the level of donor-specific anti-HLA antibodies (DSAs), leading to good short-term efficacy.

Ncor1 Deficiency Promotes Osteoclastogenesis and Exacerbates Periodontitis

Nuclear receptor corepressor 1 (Ncor1) has been reported to regulate different transcription factors in different biological processes, including metabolism, inflammation, and circadian rhythms. However, the role of Ncor1 in periodontitis has not been elucidated. The aims of the present study were to investigate the role of Ncor1 in experimental periodontitis and to explore the underlying mechanisms through an experimental periodontitis model in myeloid cell-specific Ncor1-deficient mice. Myeloid cell-specific Ncor1 knockout (MNKO) mice were generated, and experimental periodontitis induced by ligation using 5-0 silk sutures was established. Ncor1 flox/flox mice were used as littermate controls (LC). Histological staining and micro-computed tomography scanning were used to evaluate osteoclastogenesis and alveolar bone resorption. Flow cytometry was conducted to observe the effect of Ncor1 on myeloid cells. RNA sequencing was used to explore the differentially targeted genes in osteoclastogenesis in the absence of Ncor1. Coimmunoprecipitation (Co-IP), chromatin immunoprecipitation (ChIP) experiments, and dual luciferase assays were performed to explore the relationship between NCoR1 and the targeted gene. Alveolar bone resorption in the MNKO mice was significantly greater than that in the LC mice after periodontitis induction and osteoclastogenesis in vitro. The percentage of CD11b+ cells, particularly CD11b+ Ly6G+ neutrophils, was substantially higher in gingival tissues in the MNKO mice than in the LC mice. Results of RNA sequencing demonstrated that CCAAT enhancer binding protein α (Cebpα) was one of the most differentially expressed genes between the MNKO and LC groups. Mechanistically, Co-IP assays, ChIP experiments, and dual luciferase assays revealed that NCOR1 interacted with peroxisome proliferator-activated receptor gamma (PPARγ) and cooperated with HDAC3 to control the transcription of Cebpα. In conclusion, Ncor1 deficiency promoted osteoclast and neutrophil formation in mice with experimental periodontitis. It regulated the transcription of Cebpα via PPARγ to promote osteoclast differentiation.

Ectopic thymic carcinoma of the parotid gland

Ectopic thymic carcinoma (ETC) of the parotid gland is a rare entity. This report describes the case of a 52-year-old man with a painless mass in the right parotid gland. Magnetic resonance imaging (MRI) showed a biphasic mass consisting of a central segment and a peripheral segment. The patient underwent a superficial parotidectomy, and point-to-point correspondence sampling for analysis based on MRI findings was performed. The pathological finding was ETC, and there was an excellent association between MRI characteristics and histopathological findings. Subsequently, the patient underwent postoperative radiation therapy. At the 9-month follow-up, he had recovered well without facial paralysis, and there was no evidence of recurrence or metastasis. This report describes the clinical, radiological, and pathological features of the ETC.

[Association between inflammation activity of left atrial epicardial adipose tissue measured by 18F-FDG PET/CT and atrial fibrillation]

Objective: To explore the association between inflammation activity of left atrial epicardial adipose tissue (LA-EAT) measured by ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and atrial fibrillation (AF). Methods: A total of 78 patients with AF, who underwent ¹⁸F-FDG PET/CT in the Nuclear Medicine Department of the Third Affiliated Hospital of Soochow University due to abnormally elevated levels of tumor indicators or malignant tumors from March 2018 to December 2019, were enrolled in this retrospective study. According to the examination date of PET/CT and basic characteristics of AF patients (gender, age), a 1∶1 propensity score matching was used to enroll a non-AF control group (78 patients). The maximum standard uptake value of left atrial epicardial tissue (LA-EAT FDG SUV_max) and total EAT volume (V-EAT) were measured by ¹⁸F-FDG PET/CT. Left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) were obtained by echocardiography. Blood lipids and biomarkers of inflammation were measured. The differences of clinical data and EAT-related indicators were compared between the AF group and control group. Logistic multivariate regression analysis was used to determine the related factors of AF. Then the receiver operating characteristic (ROC) curve was used to determine the cutoff value of LA-EAT FDG SUV_max on the diagnosis of AF. Univariate and multivariate logistic regression analysis were used to analyze the relationship between the increase of LA-EAT FDG SUV_max and AF. Results: The age was (66.9±10.2) years and there were 55 males (70.5%) in the AF group. The age was (66.9±8.0) years, and there were 52 males (66.7%) in the control group (both P>0.05). The LAD ((44.2±5.8) mm vs. (35.4±4.4) mm), V-EAT ((122.1±42.0) cm³ vs. (91.6±34.5) cm³), and LA-EAT FDG SUV_max ((1.6±0.3) vs. (1.4±0.2)) values were significantly higher, while LVEF ((60.1±4.7)% vs. (63.9±2.9)%) was lower in the AF group than in the control group (P all<0.001). Multivariate logistic regression analysis showed that LAD (OR=1.340, 95%CI 1.195-1.502), V-EAT (OR=1.016, 95%CI 1.001-1.031), and LA-EAT FDG SUV_max (OR=1.375, 95%CI 1.095-1.723) were positively correlated with AF, LVEF (OR=0.781, 95%CI 0.659-0.926) was negatively correlated with AF(P all<0.05). The area under the ROC curve of LA-EAT FDG SUV_max for diagnosis of AF was 0.680 (95%CI 0.597-0.764, P<0.001), and the best cut-off value was 1.415 with a sensitivity of 65.4% and specificity of 61.5%. After adjusting for high-density lipoprotein cholesterol, LVEF, LAD and V-EAT, LA-EAT FDG SUV_max≥1.415 was independently associated with AF (OR=2.982, 95%CI 1.122-7.926, P=0.010). Conclusions: The inflammatory activity of LA-EAT measured by ¹⁸F-FDG PET/CT is an independent risk factor of AF, and the increased inflammatory activity of LA-EAT is positively correlated with AF.

Increased Agrobacterium-mediated transformation of Saccharomyces cerevisiae after deletion of the yeast ADA2 gene

Agrobacterium tumefaciens is the causative agent of crown gall disease and is widely used as a vector to create transgenic plants. Under laboratory conditions, the yeast Saccharomyces cerevisiae and other yeasts and fungi can also be transformed, and Agrobacterium-mediated transformation (AMT) is now considered the method of choice for genetic transformation of many fungi. Unlike plants, in S. cerevisiae, T-DNA is integrated preferentially by homologous recombination and integration by non-homologous recombination is very inefficient. Here we report that upon deletion of ADA2, encoding a component of the ADA and SAGA transcriptional adaptor/histone acetyltransferase complexes, the efficiency of AMT significantly increased regardless of whether integration of T-DNA was mediated by homologous or non-homologous recombination. This correlates with an increase in double-strand DNA breaks, the putative entry sites for T-DNA, in the genome of the ada2Δ deletion mutant, as visualized by the number of Rad52-GFP foci. Our observations may be useful to enhance the transformation of species that are difficult to transform.

[Vascular endothelial growth factor promotes cancer stemness of triple-negative breast cancer via MAPK/ERK pathway]

OBJECTIVE

To investigate the role of vascular endothelial growth factor (VEGF) in regulating triple-negative breast cancer (TNBC) stem cells and the possible pathways involved in this regulatory mechanism.

METHODS

The Oncomine database, UALCAN database and Human Protein Atlas (HPA) database were used to analyze the expression of VEGF in breast cancer and its association with the molecular subtypes and prognosis of breast cancer. Sphere formation assay was carried out to examine the effects of hVEGF₁₆₅ on sphere formation ability of TNBC MDA-MB-231 cell line; Western blotting and RT-qPCR were performed to detect the expression of the tumor stem cell markers including CD44, c-Myc, Nanog, and ALDH1 and the activation of the related pathways.

RESULTS

Data from the online databases all showed a significant increase of VEGF expression in breast cancer tissues than in the adjacent tissues (P < 0.0001), and its expression level was associated with the molecular subtypes of breast cancer. Specifically, the expression of VEGF was markedly higher in TNBC than in other subtypes of breast cancer. Survival analysis showed that breast cancer patients with a high VEGF expression had a significantly shortened overall survival (P < 0.0001). In the cell experiments, the sphere formation ability of MDA-MB-231 cells was significantly enhanced after treatment with hVEGF₁₆₅ (P=0.0029). Compared with the monolayer cells, MDA-MB-231 spheres showed significantly increased expressions of VEGF, NRP-1, CD44, Nanog and c-Myc. Treatment with hVEGF₁₆₅ resulted in significant time-dependent up-regulation of the expressions of CD44, c-Myc, Nanog and ALDH1 and down-regulation of CD24 expression in the cells. The results of Western blotting demonstrated that treatment with hVEGF₁₆₅ caused significant activation of the ERK/MAPK pathway in MDA-MB-231 cells.

CONCLUSION

VEGF promotes cancer stemness of triple-negative breast cancer possibly through the ERK/MAPK pathway.

Impact of age and menopausal stage on serum anti-Müllerian hormone levels in middle-aged women

OBJECTIVE

This study aimed to evaluate the association between age, menopausal stage and serum anti-Müllerian hormone (AMH) levels in middle-aged women.

METHODS

In this cross-sectional study, the serum AMH levels of 288 healthy women aged 40-55 years (divided into age groups: 40-44, 45-49 and 50-55 years) were evaluated. Stages of Reproductive Aging Workshop + 10 criteria were used to categorize these women into menopausal stages: late reproductive, menopausal transition and early postmenopausal stages. The impact of age, menopausal stage and hormone replacement therapy on serum AMH levels was analyzed using multi-factor analysis of variance. Effects of body mass index, smoking status and oral contraceptive use were simultaneously considered.

RESULTS

The median AMH level was 0.140 ng/ml. Log-AMH levels varied according to age group (variance = 20.113, F = 88.538, p < 0.001) and menopausal stage (variance = 5.543, F = 24.501, p < 0.001). An exponential model defined as AMH = 227,421.757 × e^{(-0.301 × age)} was fit to describe the decline in AMH level with age. The 5th-95th percentiles of the AMH levels ranged from less than 0.020 to 3.150, less than 0.020 to 1.944 and less than 0.020 to 0.030 ng/ml in the aforementioned menopausal stages, respectively.

CONCLUSION

Age and menopausal stage were associated with AMH levels; age had a greater impact on AMH than menopausal stage in middle-aged women.

Regional target loads of atmospheric nitrogen and sulfur deposition for the protection of stream and watershed soil resources of the Adirondack Mountains, USA

Acidic deposition contributes to a range of environmental impacts across forested landscapes, including acidification of soil and drainage water, toxic aluminum mobilization, depletion of available soil nutrient cations, and impacts to forest and aquatic species health and biodiversity. In response to decreasing levels of acidic deposition, soils and drainage waters in some regions of North America have become gradually less acidic. Thresholds of atmospheric deposition at which adverse ecological effects are manifested are called critical loads (CLs) and/or target loads (TLs). Target loads are developed based on approaches that account for spatial and temporal aspects of acidification and recovery. Exceedance represents the extent to which current or projected future levels of acidic deposition exceed the level expected to cause ecological harm. We report TLs of sulfur (S) and nitrogen (N) deposition and the potential for ecosystem recovery of watershed soils and streams in the Adirondack region of New York State, resources that have been less thoroughly investigated than lakes. Regional TLs were calculated by statistical extrapolation of hindcast and forecast simulations of 25 watersheds using the process-based model PnET-BGC coupled with empirical observations of stream hydrology and established sensitivity of sugar maple (Acer saccharum) to soil base saturation and brook trout (Salvelinus fontinalis) to stream acid neutralizing capacity (ANC). Historical impacts and the expected recovery timeline of regional soil and stream chemistry and fish community condition within the Adirondack Park were evaluated. Analysis suggests that many low-order Adirondack streams and associated watershed soils have low TLs (<40 meq/m²/yr of N + S deposition) to achieve specified benchmarks for recovery of soil base saturation or stream ANC. Acid-sensitive headwater and low-order streams and watershed soils in the region are expected to experience continued adverse effects from N and S deposition well into the future even under aggressive emissions reductions. Watershed soils and streams in the western Adirondack Park are particularly vulnerable to acidic deposition and currently in exceedance of TLs. The methods used for linking statistical and process-based models to consider chemical and biological response under varying flow conditions at the regional scale in this study can be applied to other areas of concern.

A triple-classification radiomics model for the differentiation of pleomorphic adenoma, Warthin tumour, and malignant salivary gland tumours on the basis of diffusion-weighted imaging

AIM

To develop and validate a triple-classification radiomics model for the preoperative differentiation of pleomorphic adenoma (PA), Warthin tumour (WT), and malignant salivary gland tumour (MSGT) based on diffusion-weighted imaging (DWI).

MATERIALS AND METHODS

Data from 217 patients with histopathologically confirmed salivary gland tumours (100 PAs, 68 WTs, and 49 MSGTs) from January 2015 to March 2019 were analysed retrospectively and divided into a training set (n=173), and a validation set (n=44). A total of 396 radiomic features were extracted from the DWI of all patients. Analysis of variance (ANOVA) and least absolute shrinkage and selection operator (LASSO) regression were used to select radiomic features, which were then constructed using three classification models, namely, logistic regression method (LR), support vector machine (SVM), and K-nearest neighbor (KNN). The diagnostic performance of the radiomics model was quantified by the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) of the training and validation data sets.

RESULTS

The 20 most valuable features were investigated based on the LASSO regression. LR and SVM methods exhibited better diagnostic ability than KNN for multiclass classification. LR and SVM had the best performance and yielded the AUC values of 0.857 and 0.824, respectively, in the training data set and the AUC values of 0.932 and 0.912, respectively, in the validation data set of MSGT diagnosis.

CONCLUSION

DWI-based triple-classification radiomics model has predictive value in distinguishing PA, WT, and MSGT, which can be used for preoperative auxiliary diagnosis in clinical practice.

A preliminary study: proteomic analysis of exosomes derived from thyroid-stimulating hormone-stimulated HepG2 cells

BACKGROUND

Thyroid-stimulating hormone (TSH) plays an important role in the regulation of lipid metabolism. However, little is known about the role that exosomes play in the process of TSH-induced lipotoxicity in non-alcoholic fatty liver disease (NAFLD). As a preliminary step, the present study set out to investigate alterations in protein expression in exosomes derived from TSH-stimulated HepG2 cells.

METHODS

HepG2 cells were treated with TSH, exosomes were collected, and proteins were identified by mass spectrometry (MS). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway analysis were performed to analyze the identified proteins.

RESULTS

TSH treatment significantly increased exosomal production and changed the exosomal proteomic profile in HepG2 cells. Among the 1728 proteins, 140 identified proteins were upregulated and seven proteins were downregulated. GO analysis and KEGG analysis revealed that these proteins were involved in multiple processes including metabolism, apoptosis, and inflammation.

CONCLUSION

Our preliminary study demonstrated that exosomes derived from TSH-stimulated hepatocytes were increased and showed a specific altered spectrum of proteins, many of which were involved in metabolism, signal transduction, apoptosis, and inflammation. This study offers new insights into the pathogenesis of TSH-induced lipotoxicity in NAFLD.

Prevalence and cardiovascular risk factors of asymptomatic intracranial arterial stenosis: the Kongcun Town Study in Shandong, China

BACKGROUND AND PURPOSE

This study was to investigate the prevalence and cardiovascular risk factors (CRFs) of asymptomatic intracranial atherosclerotic stenosis (aICAS) amongst middle-aged and older adults living in rural communities in China.

METHODS

This population-based study included 2019 subjects (aged ≥40 years, 52.3% women) who were free of stroke and living in rural communities in China. From October 2017 to May 2018, data on demographics, CRFs and health conditions were collected through face-to-face interviews, physical examination and laboratory tests. Asymptomatic ICAS was detected through a two-phase procedure: a screening phase with transcranial Doppler ultrasound, followed by a diagnostic phase with magnetic resonance angiography examination. Multivariable logistic regression models were used to analyse CRFs associated with aICAS.

RESULTS

Of the 2019 participants, aICAS was detected in 153 persons. The overall prevalence of aICAS was 7.6%, and the prevalence of moderate-to-severe aICAS was 5.0%. The multi-adjusted odds ratio (95% confidence interval) of aICAS associated with CRFs was 2.40 (1.56-3.69) for hypertension, 1.91 (1.32-2.76) for high hypersensitive C-reactive protein, 1.68 (1.14-2.49) for diabetes and 1.61 (1.08-2.41) for overweight or obesity. When these four CRFs were aggregated, compared with participants without any of these factors, the multi-adjusted odds ratios (95% confidence interval) of aICAS for persons concurrently having one, two and three or more of these factors were 1.14 (0.52-2.48), 2.91 (1.42-5.99) and 5.51 (2.64-11.50), respectively (P for linear trend <0.001).

CONCLUSIONS

Asymptomatic ICAS is common amongst rural-dwelling middle-aged and older Chinese people. Hypertension, diabetes, overweight or obesity and high hypersensitive C-reactive protein, especially when coexisting, are strongly associated with aICAS.

Reconstruction of mandibular defects using vascularized fibular osteomyocutaneous flap combined with nonvascularized fibular flap

Background

The height of single-layer fibular flap is not long enough to return to the ideal height of the mandible. While the double-layer vascularized fibular osteomyocutaneous flap(VFF) is more complicated in shaping and fixation, along with a longer operation time. The aim of this study was to investigate the clinical effect of VFF combined with nonvascularized fibular flap(NVFF) in the reconstruction of mandibular defect.

Material and Methods

From September 2016 to June 2018, 15 patients with benign mandibular tumors underwent reconstruction with VFF and NVFF. SimPlant Pro ™ software (version 11.04) was used to simulate reconstruction of the mandible preoperatively.

Results

All patients were followed up for 8-23 month, with an average of 11.7 months. 15 VFFs survived well. Among the 15 NVFFs, one was almost completely absorbed, two with partial absorption, and the remaining survived regardless of the small amount of absorption. The postoperative absorption of the whole fibula was 7.53±6.362%, a favorable facial contour and speech function were attained.

Conclusions

The VFF combined with NVFF to reconstruct the mandibular defect can restore the vertical height of the mandible and achieve satisfactory clinical results.

Key words:Vascularized fibular osteomyocutaneous flap(VFF), Nonvascularized fibular flap(NVFF), Mandibular defect.

[Application of direct antiviral drugs in special patients with HCV infection]

Patients with HCV infection can develop decompensated cirrhosis, hepatocellular carcinoma (HCC), even liver failure. As a result, efficient antiviral treatment is very essential to prevent HCV-related disease progression. Newly developed direct-acting antiviral agents (DAAs) have shown safety profile, favorable tolerability, and relatively short duration, which provide an opportunity to expand the number of patients who can be treated for HCV infection. There is a need for further clinical observation and summaries for DAAs in a real world. In the era of DAAs, special patients with HCV infection still get lots of attention from doctors. This review aims at the application of DAAs in patients with HCV infection, combined with chronic kidney diseases, hepatocellular carcinoma, HBV/HCV co-infection, HIV/HCV co-infection, post liver transplantation, pregnancy, children, lymphoma and retreatment.

Abstract P5-17-06: Immune modulation with humanized anti-EGFR antibody panitumumab in an immunocompetent mouse model for inflammatory breast cancer

Background: Inflammatory breast cancer (IBC) is the most lethal and aggressive form of breast cancer and there are no approved targeted therapies specifically for IBC. Targeting the epidermal growth factor receptor (EGFR) pathway is a promising therapeutic target for patients with triple-negative IBC (TN-IBC) with a reported pathological complete response rate of 42% (JAMA Oncology, 2018). The tumor microenvironment (TME) is a critical contributor to the aggressiveness of IBC. Delineating cross-talk between EGFR-targeted therapies and TME components, which define IBC, could inform more efficient combination regimens and novel clinical trial designs for IBC. However, such studies have not been conducted due to the lack of a syngeneic IBC mouse model. Here we report the establishment of an IBC immunocompetent mouse model and the effects of panitumumab (PmAb) on IBC tumor growth and the TME.

Methods: TN-IBC cell lines, SUM149 or FC-IBC-02, were mixed with 50% Matrigel and inoculated into mammary fat pads of hu-NSG-SGM3 mice engrafted with hematopoietic stem cells (The Jackson Laboratory). SUM149 tumor growth in hu-NSG-SGM3 mice treated with either IgG2 (isotype control, 4 mg/kg) or PmAb (1 mg/kg and 4 mg/kg) was measured. The percentages of TME components, including human CD4+ T, CD8+ T, regulatory T (Tregs), and natural killer (NK) cells, and M1 or M2 macrophages, in the peripheral blood and tumor tissues treated with IgG2 and PmAb for 7 weeks were measured by flow cytometry.

Results: Hu-NSG-SGM3 mice supported the growth of TN-IBC SUM149 and FC-IBC-02 xenografts. These humanized mouse models were named SUM149-huSGM3 and FC-IBC-02-huSGM3, respectively. Analysis of the blood cells showed that SUM149-huSGM3 mice display human CD4+ T, CD8+ T, Tregs, M1 and M2 macrophages. T cell infiltration and M1 and M2 macrophages were also detected in SUM149-huSGM3 tumors. NK cells were not detected in both peripheral blood and tumors. PmAb treated SUM149-huSGM3 mice had significantly reduced SUM149 tumor growth, compared with mice that received the IgG2 control. PmAb treatment increased the percentage of CD8+ T cells and reduced the percentage of Tregs in peripheral blood. A similar analysis of tumor infiltrating lymphocytes isolated from each group showed an increase in percent CD8+ T cells in mice treated with PmAb. There were no significant changes of M1 or M2 macrophages following PmAb treatment. These results suggest that the increase in percentage of CD8+ T cells in peripheral blood and IBC tumors, and the decrease in percentage of Tregs in peripheral blood may contribute to the therapeutic efficacy of PmAb.

Conclusion: We established the first immunocompetent mouse model to study the TME and immune response in IBC, which provides the premise for conducting a diversity of novel preclinical therapeutic studies. The mechanism of how immune responses of TN-IBC xenografts mediates the therapeutic efficacy of PmAb in IBC tumors needs to be further investigated. Our study also suggests that combination therapy with immune checkpoint inhibitors may potentiate the efficacy of anti-EGFR therapy in IBC. The therapeutic efficacy of PmAb and anti-PD-L1 combination in SUM149 humanized mice is in progress.

Citation Format: Wang X, Shao S, Pearson T, Cheng Y, Reuben JM, Tripathy D, Ueno NT. Immune modulation with humanized anti-EGFR antibody panitumumab in an immunocompetent mouse model for inflammatory breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-17-06.

[Clinical analysis of chronic tonsillitis in 12 HIV/AIDS patients]

Objective:To explore the clinical characteristics and efficacy of chronic tonsillitis in HIV/AIDS patients.Method:Clinical features and effects were retrospectively analyzed in 12 HIV/AIDS cases with chronic tonsillitisin.Result:All subjects were men with an average age of（26.4±8.7）years; the common clinical symptoms included sore throat(12/12),fever(7/12),snoring(6/10); tosils in these patients were most frequently found in Ⅲ grade enlargement (9/12); 11 patients who were performed tonsillectomy,were satisfied with having chosen tonsillectomy with a mean score of（9.5±0.8）,sore throat episodes and snoring were disengaged after operation in 10 cases,sore throat episodes was significantly improved from 12/year to 2/year in 1 case.Conclusion:Chronic tonsillitis in HIV/AIDS patients occurred more in young and middle-aged men with typical clinical manifestations of sore throat,fever and snoring. Under strict indication,tonsillectomy is an effective treatment for chronic tonsillitis in HIV/AIDS patients.

An observational analysis of insulinoma from a single institution

BACKGROUND

Insulinoma is the commonest functioning pancreatic neuroendocrine tumor causing hyperinsulinemic hypoglycemia.

AIM

This study is aimed to evaluate the clinical features, preoperative laboratory and imaging diagnosis and pathologic findings of insulinoma.

METHODS

Data of the patients from 2001 to 2016 diagnosed as insulinoma in Tongji Hospital, China were retrospectively extracted and analyzed.

RESULTS

A total of 40 patients were diagnosed as insulinoma with a male/female ratio of 0.68:1. The median onset age was 46.5 years. Nearly all the included patients presented neurological symptoms and 60% presented autonomic symptoms. More than 95% of the patients met the functional European Neuroendocrine Tumor Society criteria including glucose, insulin and C-peptide levels. The preoperative detection rates of ultrasonography, enhanced computed tomography, magnetic resonance imaging, and endoscopic ultrasonography were 60.50%, 84.95%, 80% and 83.3% respectively. The joint imaging examinations can markedly increase the detection rate. The mean tumor size was 1.89 ± 0.72 cm. Ki-67 index by histopathological diagnosis were all less than 20%. The positive rates of insulin, synaptophysin and chromogranin A were close to 100%.

CONCLUSION

Laboratory tests of glucose, insulin and C-peptide are reliable for preoperative diagnosis. Combination of the imaging examinations can improve the diagnosis.

[Outcomes of reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation for 10 patients with myelofibrosis]

Objective: To evaluate the efficacy of reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation (RIC-allo-HSCT) for patients with myelofibrosis (MF). Methods: The clinical data of 10 patients with myelofibrosis (MF) who underwent RIC-allo-HSCT. Results: Of all 10 patients, 6 were male and 4 women, with a median age of 28.5 (22-54). Using fludarabine/busulfan plus total body irradiation (FB+TBI) pretreatment scheme based. Hematopoiesis reconstitution was achieved in 9 patients (90%). The median time of neutrophil and platelet engraftment was 13.5 (10-22) day and 16.5 (13-40) day, respectively. Acute GVHD occurred in 4 cases while chronic GVHD in 5 cases. The prospective OS for 3 years was (90.0±8.5)% after a median follow-up time of 17 months. Transplant related mortality was 1 case. Conclusion: RIC-HSCT with FB+TBI is a feasible and effective alternative for MF patients.

[Study on pharyngeal wall floppiness of patients with obstructive sleep apnea-hypopnea syndrome attributable to non-structural factors]

Objective: Acoustic pharyngealmetry technology is utilized to evaluate the change and clinical significance of obstructive sleep apnea-hypopnea syndrome (OSAHS) patients caused by non-upper airway structural factor and normal individuals' PWF(pharyngeal wall floppiness). Methods: Acoustic pharyngealmetry instrument of Ecconvision was utilized to examine 102 OSAHS patients and 50 normal individuals, separately recorded their volume of pharyngeal cavity in sit or supine position, calculated PWF in sit or supine position, and SPSS 12.0 of tware was used to analyze data. Results: PWF was 0.14±0.09 in sit position and PWF was 0.21±0.10, (t=5.96, t=9.63, P<0.001)in supine position of OSAHS group, which were all significantly higher than those of control group. PWFs in supine position of OSAHS group and control group were evidently higher than PWF(t=-11.91, P<0.001; t=-2.32, P=0.025) in sit position. ΔPWF(PWF_supine-PWF_sit)was 0.063±0.054 in OSAHS group which was significantly greater than in control(F=41.173, P<0.01). PWF in sit position and supine position were all positively related with age(r=0.714, r=0.735, P<0.001)while irrelevant with BMI(P>0.05). Conclusions: PWF can be utilized to be an index to reflect the physiological feature of upper airway. PWF can more precisely reflect upper airway collapsibility of OSAHS patients on the condition of PWF in supine position. Pharyngeal wall floppiness quantified as a high PWF index is a non-structure vital factor of OSAHS patients and plays a role of guiding us to make personal treatment plans for OSAHS patients.

Abstract PD6-01: Analysis of breast cancer in young women in the department of defense (DOD) database

Background: Women under the age of 40 account for approximately 7% percent of breast cancer patients. Breast tumors from young women are often ER-negative, occur in African-American patients, and have other indicators of high risk: yet, multivariate analyses demonstrated that young age is an independent predictor of poor outcome. Due to the unique nature of the patient population served by DOD, a disproportionate number of breast cancer cases in young women are seen. We compare the characteristics, treatment, and outcomes of young patients diagnosed with breast cancer with those of older patients.

Methods: The databases of the Military Health System Repository and the DOD Central Registration were used to identify female breast cancer patients treated at DOD facilities between 1998 and 2007. Information on demographics, breast cancer stage at diagnosis, definitive surgical treatments, systemic treatment, recurrence rate and overall survival was analyzed by age groups at the time of diagnosis (less than 40 years old, 40 to 49 years, and 50 years or older) using X2 testing with significance defined as p&lt; 0.05.

Results: We identified 10,066 women who were diagnosed with invasive breast cancer at DOD facilities between 1998 and 2007, of which 11.3% (1139) were less than 40 years old at diagnosis. 53% of this young cohort were white, 25% were African-American and 8% were Hispanic (14% undisclosed). The percentage of breast cancer among African-American women in the young cohort was higher than in the older cohorts (19.3% in 40-49yo and 10.6% in ≥50yo). High-grade tumors were significantly more frequent in the younger cohort when compared to the older group (49.5% vs 34.7% and 25.2%, p&lt;0.001). &lt;40yo most commonly presented with Stage II disease (45.3%) at diagnosis, while older groups were mostly diagnosed with Stage I disease (41.6% and 52.4%). The most common subtype of breast cancer across ages was ER+ disease, however, &lt;40yo group had proportionally less ER+ (49% vs 61% and 67.3%, P&lt;0.001). There was a higher rate of bilateral mastectomies among the young women (18.4% vs 9.1% and 5.0%, p&lt;0.0001). Independently of the stage of disease, chemotherapy was given significantly more frequently to &lt;40y (90.43%) and 40-49yo (81.44%) than ≥50yo (53.71%). The 10-year overall survival of younger women was similar to the ≥50yo cohort, despite intensive treatment.

Discussion: This study is one of the largest retrospective studies of women under 40 years old with breast cancer. Younger women with invasive breast cancer had more aggressive tumors presenting at higher stages. In this group with good access to healthcare, younger women still had a similar overall survival rate to older women despite receiving more aggressive treatment and potentially having fewer comorbidities than the older group.

Citation Format: Zimmer AS, Gatti-Mays M, Soltani S, Lipkowitz S, Steeg PS, Zhu K, Perkins JG, Hu H, Shao S, Brown D, Shriver CD. Analysis of breast cancer in young women in the department of defense (DOD) database [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD6-01.

Characterizing the boundary lateral to the shear direction of deformation twins in magnesium

The three-dimensional nature of twins, especially the atomic structures and motion mechanisms of the boundary lateral to the shear direction of the twin, has never been characterized at the atomic level, because such boundary is, in principle, crystallographically unobservable. We thus refer to it here as the dark side of the twin. Here, using high-resolution transmission electron microscopy and atomistic simulations, we characterize the dark side of deformation twins in magnesium. It is found that the dark side is serrated and comprised of coherent twin boundaries and semi-coherent twist prismatic–prismatic boundaries that control twin growth. The conclusions of this work apply to the same twin mode in other hexagonal close-packed materials, and the conceptual ideas discussed here should hold for all twin modes in crystalline materials.

Twin propagation involves three-dimensional normal, forward and lateral motion of twin interfaces with respect to the twinning shear direction. Here, the authors combine electron microscopy and atomistic simulations to study the until now unknown lateral structure of tensile deformation twins in magnesium.

High-Cholesterol Diet Disrupts the Levels of Hormones Derived from Anterior Pituitary Basophilic Cells

Emerging evidence shows that elevated cholesterol levels are detrimental to health. However, it is unclear whether there is an association between cholesterol and the pituitary. We investigated the effects of a high-cholesterol diet on pituitary hormones using in vivo animal studies and an epidemiological study. In the animal experiments, rats were fed a high-cholesterol or control diet for 28 weeks. In rats fed the high-cholesterol diet, serum levels of thyroid-stimulating hormone (TSH; also known as thyrotrophin), luteinising hormone (LH) and follicle-stimulating hormone (FSH) produced by the basophilic cells of the anterior pituitary were elevated in a time-dependent manner. Among these hormones, TSH was the first to undergo a significant change, whereas adrenocorticotrophic hormone (ACTH), another hormone produced by basophilic cells, was not changed significantly. As the duration of cholesterol feeding increased, cholesterol deposition increased gradually in the pituitary. Histologically, basophilic cells, and especially thyrotrophs and gonadotrophs, showed an obvious increase in cell area, as well as a potential increase in their proportion of total pituitary cells. Expression of the β-subunit of TSH, FSH and LH, which controls hormone specificity and activity, exhibited a corresponding increase. In the epidemiological study, we found a similar elevation of serum TSH, LH and FSH and a decrease in ACTH in patients with hypercholesterolaemia. Significant positive correlations existed between serum total cholesterol and TSH, FSH or LH, even after adjusting for confounding factors. Taken together, the results of the present study suggest that the high-cholesterol diet affected the levels of hormones derived from anterior pituitary basophilic cells. This phenomenon might contribute to the pituitary functional disturbances described in hypercholesterolaemia.

Live-cell and super-resolution imaging reveal that the distribution of wall-associated protein A is correlated with the cell chain integrity of Streptococcus mutans

Streptococcus mutans is a primary pathogen responsible for dental caries. It has an outstanding ability to form biofilm, which is vital for virulence. Previous studies have shown that knockout of Wall-associated protein A (WapA) affects cell chain and biofilm formation of S. mutans. As a surface protein, the distribution of WapA remains unknown, but it is important to understand the mechanism underlying the function of WapA. This study applied the fluorescence protein mCherry as a reporter gene to characterize the dynamic distribution of WapA in S. mutans via time-lapse and super-resolution fluorescence imaging. The results revealed interesting subcellular distribution patterns of WapA in single, dividing and long chains of S. mutans cells. It appears at the middle of the cell and moves to the poles as the cell grows and divides. In a cell chain, after each round of cell division, such dynamic relocation results in WapA distribution at the previous cell division sites, resulting in a pattern where WapA is located at the boundary of two adjacent cell pairs. This WapA distribution pattern corresponds to the breaking segmentation of wapA deletion cell chains. The dynamic relocation of WapA through the cell cycle increases our understanding of the mechanism of WapA in maintaining cell chain integrity and biofilm formation.

Experimental Quantification of Resolved Shear Stresses for Dislocation Motion in TiN

Experimental quantification of the critical resolved shear stress (CRSS) at the level of unit dislocation glide is still a challenge. By using in situ nanoindentation in a high-resolution transmission electron microscope and strain analysis of the acquired structural images, the CRSS for the motion of individual dislocations on {110}⟨011⟩ slip system and glide dislocation re-emission from a tilt grain boundary in TiN are quantified. This work offers an approach to measure the local stresses associated with dislocation motion in high-strength materials.

Damage-tolerant nanotwinned metals with nanovoids under radiation environments

Material performance in extreme radiation environments is central to the design of future nuclear reactors. Radiation induces significant damage in the form of dislocation loops and voids in irradiated materials, and continuous radiation often leads to void growth and subsequent void swelling in metals with low stacking fault energy. Here we show that by using in situ heavy ion irradiation in a transmission electron microscope, pre-introduced nanovoids in nanotwinned Cu efficiently absorb radiation-induced defects accompanied by gradual elimination of nanovoids, enhancing radiation tolerance of Cu. In situ studies and atomistic simulations reveal that such remarkable self-healing capability stems from high density of coherent and incoherent twin boundaries that rapidly capture and transport point defects and dislocation loops to nanovoids, which act as storage bins for interstitial loops. This study describes a counterintuitive yet significant concept: deliberate introduction of nanovoids in conjunction with nanotwins enables unprecedented damage tolerance in metallic materials.

In vivo targeted delivery of CD40 shRNA to mouse intestinal dendritic cells by oral administration of recombinant Sacchromyces cerevisiae

Short hairpin RNA (shRNA)-mediated gene regulation is a commonly used technique for gene manipulation. An efficient and safe delivery system is indispensable when shRNA is delivered into living organisms for gene therapy. Previous studies have proved that DNA and protein can be delivered into dendritic cells (DCs) by non-pathogenic Saccharomyces cerevisiae without being degraded. CD40 is closely related to apoptosis of tumor cells and some immune mechanisms. In this study, we demonstrated that recombinant yeast S. cerevisiae efficiently delivered the shRNA of immune-associated gene (CD40) into mouse intestinal DCs via oral administration. Western blot analysis of isolated intestinal DCs indicated that the inhibition of CD40 gene expression reached up to 56-91%. The secretion of cytokines such as interleukin-2 (IL-2), IL-6, IL-10, IL-12, tumor necrosis factor-α and interferon-γ in intestinal DCs had varying degrees of changes. In conclusion, we found that orally administered recombinant yeast can be used as an efficient shRNA delivery system for intestinal DC-specific gene silencing and immunomodulation in vivo.

Single crystalline nanostructures of topological crystalline insulator SnTe with distinct facets and morphologies

Topological crystalline insulators (TCIs) are a new class of topological materials that possess unique metallic surface states protected by crystalline mirror symmetry. Their topological surface properties are expected to strongly depend on the surface orientation. By combining density functional theory (DFT) calculations and synthesis experiments, we demonstrate the controlled growth of single crystalline nanostructures of the prototypical TCI SnTe with distinct facets and morphologies. Our calculations suggest that the excess energy of the {111} surfaces can be either higher or lower than that of the {100} surfaces, depending on the stoichiometry, while the {110} is always higher than the {100}. In our synthesis experiment, we qualitatively controlled the stoichiometry by tailoring the growth temperature and obtained two types of single crystalline nanowires: smooth nanowires dominated by {100} facets at high temperatures and zigzag nanowires composed of both {100} and {111} surfaces at low temperatures. Notably, there is no {110} facet in our nanostructures, strongly supporting the DFT calculations. Our device fabrication and electrical characterizations suggest that both types of nanowires are suitable for transport studies of topological surface states.