Two birds with one stone: A universal design and application of signal-on labeled fluorescent/electrochemical dual-signal mode biosensor for the detection of tetracycline residues in tap water, milk and chicken

An ingenious and universal design of fluorescent/electrochemical dual-signal mode sensing platform was constructed for the sensitive, selective and accurate detection of tetracycline (TET). Apt-functionalized nano-magnetic beads (Fe3O4-Apt) as capture probe, Apt-complementary short-chain functionalized fluorescent MOF loaded with methylene blue (MB) (cDNA-MOF-MB) as dual-signal tag were prepared. The sensing platform (Fe3O4-Apt/cDNA-MOF-MB) was formed based on the base complementary pairing of Apt and cDNA. With the help of Apt for target recognition, together with magnetic separation technology, a dual-signal mode biosensor was constructed. The dual-signal mode biosensor exhibited a wide linear concentration range from 1.00 × 10-9 g/mL to 1.00 × 10-4 g/mL with a low limit of detection (LOD) of 1.69 × 10-10 g/mL (fluorescence mode assay) and 1.15 × 10-10 g/mL (electrochemical mode assay). The proposed biosensor had been successfully applied to the determination of TET content in real samples with satisfactory recoveries (94.99-101.30%).

Sophora tonkinensis: response and adaptation of physiological characteristics, functional traits, and secondary metabolites to drought stress

The medicinal plant Sophora tonkinensis is a characteristic Chinese shrub of karst areas. The arid climate in karst areas produces high-quality S. tonkinensis; however, the mechanisms of drought tolerance are not clear, which restricts sustainable plantings of S. tonkinensis. This study involved a 20-day drought stress experiment with potted S. tonkinensis and threee soil water regimes: control (CK), mild drought (MDT), and severe drought (SDT). Plant morphology, biomass, physiological indicators, alkaloid content, and other changes under drought stress were monitored. The content of soluble sugars and proteins, and activity of antioxidant enzymes in leaves and roots were higher under drought than CK, indicating that S. tonkinensis is tolerant to osmotic stress in early drought stages. Content of matrine and oxymatrine increased gradually with increasing drought duration in the short term. The epidermis of S. tonkinensis leaves have characteristics of desert plants, including upper epidermal waxy layer, lower epidermal villi, and relatively sunken stomata, suggesting that S. tonkinensis has strong drought tolerance. In conclusion, drought stress changed the cell structure of S. tonkinensis, induced antioxidant enzyme activity and increased its resistance to drought.

Terminal Residue and Dietary Risk Assessment of Atrazine and Isoxaflutole in Corn Using High-Performance Liquid Chromatography-Tandem Mass Spectrometry

Isoxaflutole and atrazine are representative pesticides for weed control in corn fields. Formulations containing these two pesticides have been registered in China, and their residues may threaten food safety and human health. In this study, a method for simultaneous determination of isoxaflutole, atrazine, and their metabolites in fresh corn, corn kernels, and corn straw was established based on modified QuEChERS pre-treatment and high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The linearity of seven compounds was good (R2 ≥ 0.9912), and the matrix effect was 48.5-77.1%. At four spiked levels of 0.01, 0.02, 0.05, and 0.5 mg kg-1, all compounds' average recovery was 76% to 116%, with relative standard deviation (RSD) less than 18.9%. Field experiments were conducted in Liaoning, Heilongjiang, Inner Mongolia, Shanxi, Beijing, and Yunnan provinces to study the terminal residues. The terminal residues of all compounds were below the LOQ (0.01 mg kg-1) in fresh corn and corn kernels, and atrazine residues in corn straw ranged from <0.05 mg kg-1 to 0.17 mg kg-1. Finally, a dietary risk assessment was conducted based on residues from field trials, food consumption, and acceptable daily intake (ADI). For all populations, the chronic dietary risk probability (RQc) of atrazine was between 0.0185% and 0.0739%, while that of isoxaflutole was 0.0074-0.0296%, much lower than 100%. The results may provide scientific guidance for using isoxaflutole and atrazine in corn field ecosystems.

Measuring the Residual Levels of Fenpyroximate and Its Z-Isomer in Citrus Using Ultra-High-Performance Liquid Chromatography-Tandem Mass Spectrometry and Assessing the Related Dietary Intake Risks

Fenpyroximate is an efficient, broad-spectrum phenoxypyrazole acaricide which is used for controlling various mites. In this study, we measured the levels of terminal fenpyroximate residues in citrus fruits, and estimated the dietary intake risks posed by fenpyroximate. To this end, a QuEChERS analytical method was used in combination with ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) to determine the residual levels of fenpyroximate and its Z-isomer (Z-fenpyroximate) in citrus fruits collected from 12 fields under good agricultural practices (GAPs). The average recoveries of fenpyroximate in whole fruits and citrus flesh were 104-110% and 92-109%, respectively, with corresponding RSDs of 1-4% and 1-3%. The average recoveries of Z-fenpyroximate were 104-113% and 90-91%, respectively, with RSDs of 1-2% in both cases. Each limit of quantification (LOQ) was 0.01 mg kg-1. Fifteen days after application with 56 mg kg-1, the terminal residues of fenpyroximate in whole fruits and citrus flesh were <0.010-0.18 mg kg-1 and <0.010-0.063 mg kg-1, respectively; the corresponding values for total fenpyroximate (the sum of fenpyroximate and Z-fenpyroximate) were <0.020-0.19 and <0.020-0.053 mg kg-1. The levels of terminal fenpyroximate residues in citrus fruit were less than the maximum residue limits (MRLs) specified in all the existing international standards. In addition, the risk quotients RQc and RQa were both less than 100%, indicating that the long-term and short-term dietary intake risks posed to Chinese consumers by fenpyroximate in citrus fruit are both acceptable after a 15-day harvest interval.

Partial Stereotactic Ablative Radiotherapy in Bulky Urinary Tract Malignancy: An Update Clinical Outcomes and Dosimetric Analysis

PURPOSE/OBJECTIVE(S)

Patients with bulky urinary tract malignancy have poor prognosis. Stereotactic ablative radiotherapy (SABR) needs careful consideration in abdominopelvic bulky tumors because of dose constraints on the OARs. We reported updated clinical outcomes to evaluate the safety and efficacy of partial stereotactic ablative radiotherapy(P-SABR) in bulky urinary tract malignancy. The study also aims to investigate the feasibility of P-SABR in dose and biologic effective dose (BED) escalation inside the tumors with equivalent toxicity.

MATERIALS/METHODS

A total of 26 patients with urinary tract malignancy underwent P-SABR radiotherapy from January 2013 to September 2018 were retrospectively analyzed in this study. All the patients were in inoperable locally advanced or metastatic stage with tumor diameter > 4.0 cm. The P-SABR plan consisted of the SABR for gross tumor volume boost (GTVb) and following conventionally fractionated radiotherapy for planning target volume (PTV). The first SABR plan to GTVb was delivered in 15-32Gy/3-5f. The second conventionally fractionated radiotherapy plan to PTV was delivered in 40.0-58.08Gy/15-26f. The total P-SABR plan met the OARs constraints. Local control and overall survival were estimated. Acute and late toxicity were evaluated according to RTOG criteria. Paired conventionally fractionated radiotherapy (CFRT) plans were re-designed for all patients, with the same OARs dose constraints and total dose of PTV margin. Dosimetric and BED parameters were compared in P-SABR and paired CFRT plans.

RESULTS

Median age of the patients was 66.5 years (range, 46-90 years). The tumor treated by P-SABR had a median diameter of 8.4 cm (4.1-19.5 cm) and a median volume of 99.2 cc (23.9-631.8 cc). Median follow-up time was 19.1 months. The local control at 1 and 2 years were 83.2%, 77.3%, respectively. The overall survival at 1 and 2 years were 72.2% ,45.5%, respectively. 6 cases have no local recurrence after 36 months. 4 cases remained alive after 60 months. Local symptoms improved in 15/16 cases after P-SABR. Multivariate analysis showed tumor diameter (≥8cm vs. <8cm) was the independent factor affecting local control and overall survival (P=0.033, P=0.016). No patient was observed radiotherapy directly induced ≥grade 3 toxicity. Compared with the paired CFRT plans, the P-SABR plans had no significant difference in most OAR dose parameters, except for the small intestine/colon V15, V45 with an increase of 14.6 cc, 3.4 cc. However, P-SABR plans increased the dose of PTV Dmean, Dmax by 8.7Gy, 14.4Gy (P < 0.001), respectively. In addition, the dose and BED of GTVb had a significant escalation of 15.8Gy and 30.2Gy (P<0.001) respectively in P-SABR plans.

CONCLUSION

We had reported P-SABR is well-tolerated in bulky urinary tract malignancy in previous study. Updated outcomes showed P-SABR may have long-term local control in these people. Compared with traditional CFRT plans, P-SABR plans escalated the dose and BED inside bulky tumors with equivalent toxicity.

Adaptive Ultra-Hypofractionated Whole-Pelvic Radiotherapy in High-Risk and Very High-Risk Prostate Cancer on 1.5-1.5 MR Linac: The Estimated Delivered Dose and Early Toxicity Results

PURPOSE/OBJECTIVE(S)

To study the feasibility and safety for patients with high-risk (HR) and very high-risk (VHR) prostate cancer treated with adaptive ultra-hypofractionated whole-pelvic radiotherapy (UHF-WPRT) on 1.5 magnetic resonance (MR)-Linac.

MATERIALS/METHODS

Sevenpatients with clinical stage T3a-4N0-1M0-1c consecutively treated with UHF-WPRT on a 1.5-T MR-Linac were recruited prospectively in a phase II trial (NCT05183074, ChiCTR2000033382). A 36.25 Gy dose in five fractions was delivered every other day with a boost of 40 Gy to the whole prostate, as well as 25 Gy to whole pelvic nodal area with a concomitant boost of 35 Gy to metastatic regional nodes. To estimate the delivered dose, we collected data by 3D-MR for the following stages: pre-MR, position verification-MR (PV-MR) in the Adapt-To-Shape (ATS) workflow, and 3D-MR during the beam-on phase (Bn-MR) and at the end of RT (post-MR). The target and organ-at-risk contours in the PV-MR, Bn-MR, and post-MR stages were projected from the pre-MR data by deformable image registration and manually adapted by the physician, followed by dose recalculation for the ATS plan. The cumulative acute genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated as per NCI-CTCAE 5.0 criteria. The primary endpoints were acute ≥grade 3 genitourinary (GU) and gastrointestinal (GI) toxicities during the first 3 months.

RESULTS

Overall, 133 MR scans were collected (35 pre-MR, 35 PV-MR, 31 Bn-MR and 32 post-MR scans). With a median on-couch time of 61 minutes, the mean prostate and pelvic planning target volume (PTV)-V95% of all scans was 96.98 ± 3.06% and 96.44 ± 2.85%, respectively. The corresponding mean prostate clinical target volume (CTV)-V100% was 99.89 ± 0.32%, 98.71 ± 1.90%, 97.77 ± 2.89%, and 98.56 ± 1.72%, and the mean pelvic CTV-V100% was 97.57% ± 3.70%, 96.54 ± 3.80%, 95.43 ± 4.31%, and 94.39 ± 4.47% on pre-MR, PV-MR, Bn-MR and post-MR scans, respectively. For the 4 patients with positive nodes, the mean V100% of metastatic regional nodes was 99.89 ± 0.81%. The median V29 Gy change in the rectal wall was -1% (-18%-20%). The V29 Gy of the rectal wall increased by >15% was observed in one scan. A slight increase in the high dose of bladder wall was noted due to gradual bladder growth during the workflow. With median follow-up time of 7.3 (4.6-12.2) months, all patients were followed-up for more than 3 months. No patient was observed with acute CTCAE grade 2 or more severe GU or GI toxicities (0%).

CONCLUSION

UHF-RT to prostate and pelvic with ATS workflow is well tolerated by patients with HR and VHR prostate cancer, with only mild GU and GI toxicities. The 3D-MR-based dosimetry analysis demonstrated clinically acceptable estimated dose coverage of target volumes during the beam-on period.

Simultaneous Determination of 54 Pesticides in Proso Millet Using QuEChERS with Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

To assess the potential risks posed to the environment and human health, analyzing pesticide residues in proso millet is important. This paper aimed to develop a modified QuEChERS method with liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the analysis of 54 pesticide residues in proso millet. Parameters including the mobile phase of the instrument, the acidity of the extraction solvent, and the type of absorbents were optimized to provide satisfactory performance. The method was validated concerning linearity, limit of quantification (LOQ), matrix effect, accuracy, and precision. In detail, the linearity of the matrix-matched calibration curve was acceptable with correlation coefficients (R2) higher than 0.99. The mean recovery was in the range of 86% to 114% with relative standard deviations (RSDs) ≤ 20% (n = 5). The LOQ was determined to be 0.25-10 μg/kg. The developed method was feasible for the determination of multiple pesticide residues in proso millet.

Dissipation, Processing Factors and Dietary Exposure Assessment of Myclobutanil in Tomato

Myclobutanil residue poses a potential threat to consumers' health. This work aims to investigate the degradation behavior, residue levels, processing factors (PFs) and dietary risk of myclobutanil in tomato. Myclobutanil was analyzed using a modified quick, easy, cheap, effective, rugged, safe (QuEChERS) method combined with ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS), and average recoveries ranged from 82% to 102% with relative standard deviations RSDs ≤ 9.1%. After spraying myclobutanil miscible oil under field conditions, the initial concentration of myclobutanil was 0.055 mg/kg, and its dissipation followed the first-order kinetics equation with a half-life of 2.88 days. Myclobutanil was mainly present in the tomato skin, and its concentration was about four times that in the whole tomato. The initial concentration of myclobutanil in raw tomato was 0.100 mg/kg. After washing, peeling, homogenization, simmering and canning, the residual level of myclobutanil decreased to 0.067 mg/kg, 0.023 mg/kg, 0.013 mg/kg, 0.044 mg/kg and 0.041 mg/kg, respectively. Although the procedure of simmering led to an increase in myclobutanil concentration, the PFs were all less than 1 in the whole process, showing that the processing procedure significantly decreased the residual level of myclobutanil canned tomato paste in comparison with the raw agricultural commodity. Washing, peeling, and homogenization played critical roles in reducing pesticide residues. The residues of myclobutanil during the processing of tomato pose low dietary exposure risks to consumers in China, which were acceptable. However, the acute and chronic risk quotient for children revealed that it was necessary to monitor the dietary exposure of pesticide residues for children closely.

Bevacizumab biosimilar candidate TAB008 compared to Avastin® in patients with locally advanced, metastatic EGFR wild-type non-squamous non-small cell lung cancer: a randomized, double-blind, multicenter study

BACKGROUND

Bevacizumab (Avastin®) is a monoclonal antibody targeting the vascular endothelial growth factor (VEGF). Used alone or in combination with chemotherapy and/or immunotherapy, Avastin® has shown promising efficacy in many cancers. This study compared the efficacy and safety of TAB008 with Avastin® sourced from the EU (bevacizumab-EU), in patients with non-squamous non-small cell lung cancer (nsNSCLC).

METHOD

In this randomized, double-blind, multicenter, phase III similarity study, treatment naïve for metastatic lung cancer., EGFR wild-type, locally advanced, metastatic, or recurrent non-squamous, non-small cell, lung cancer (nsNSCLC) patients were enrolled and randomized (1:1) into TAB008 or Avastin® groups. Patients received TAB008 or Avastin® 15 mg/kg intravenously plus paclitaxel/carboplatin for 4-6 cycles followed by TAB008 or Avastin® 7.5 mg/kg until disease progression, unacceptable toxicity or death. The primary endpoint compared the objective response rate (ORR) within 6 cycles as read by an independent radiological review committee (IRRC). Secondary endpoints compared disease control rate (DCR) Within 6 cycles, duration of response (DoR), progression-free survival (PFS), a year overall survival rate (OSR), overall survival (OS), safety, immunogenicity, and steady-state pharmacokinetics.

RESULTS

A total of 549 nsNSCLC patients were enrolled (277 in TAB008 group and 272 in Avastin® group). In the full analysis set, ORRs were 55.957% for TAB008 and 55.720% for Avastin®, and the ORR ratio was 1 (90% CI 0.89-1.14), well within the predefined equivalence margin of 0.75-1.33. No significant differences were found in DCR within 6 cycles (95.703% vs 95.367%, p = 0.8536), DoR (8.17 vs 7.3 months, p = 0.3526), PFS (9.10 vs. 7.97 months, p = 0.9457), 1 year overall survival rate (66.2% vs 68%, p = 0.6793), or OS (20.4 vs 17.6 months, p = 0.6549). Serious adverse events (SAEs) occurred in 37.55% (104/277) of patients in the TAB008 group and 34.32% (93/271) in the Avastin® group. Anti-drug antibodies were reported in 3 of 277 (1.08%) TAB008 patients, and 5 of 271 (1.85%) Avastin® patients, neutralizing antibody (Nab) was positive in 1 patient on Avastin®, which became negative upon follow-up. The steady-state trough concentrations (Cssmin) were 106.13 μg/mL in TAB008 group and 96.03 μg/mL in Avastin® groups, with the treatment group ratio of LS geometric means fully contained within the bioequivalence limits of 80.00-125.00% (90% CI was 101.74-120.05%).

CONCLUSIONS

TAB008 is similar to Avastin® in terms of efficacy, safety, and pharmacokinetic parameters, with comparable immunogenicity.

TRIAL REGISTRATION

ClinicalTrials.gov number; NCT05427305.

Magnetic deep eutectic solvent-based dispersive liquid-liquid microextraction for determination of strobilurin fungicides in water, juice, and vinegar by high-performance liquid chromatography

In this study, a magnetic deep eutectic solvent coupled with dispersive liquid-liquid microextraction using high-performance liquid chromatography (MDES-DLLME-HPLC) was developed to detect strobilurin fungicides. The green hydrophobic MDES synthesized by methyltrioctylammonium chloride, ferric chloride, and heptanoic acid was used as an extraction solvent, which was dispersed by vortex and separated by an external magnetic field. The use of toxic solvents was avoided, and the separation time was reduced. The best experimental results were obtained through single factor and response surface optimization. The method had a good linear relationship with R² > 0.996. The limit of detection (LOD) ranged from 0.001 to 0.002 mg L^-1. The extraction recoveries were 81.9-108.9%. The proposed method was rapid and green, and it has been successfully applied to detection of strobilurin fungicides in water, juice, and vinegar.

Radical Scavenging Capability and Mechanism of Three Isoflavonoids Extracted from Radix Astragali: A Theoretical Study

As a valuable traditional Chinese herbal medicine, Radix Astragali has attracted much attention due to its extensive pharmacological activities. In this study, density functional theory (DFT) was used thermodynamically and kinetically in detail to predict the antioxidant activity and reaction mechanisms involved in the free radical scavenging reactions of three representative isoflavonoids (formononetin, calycosin, and calycosin-7-glucoside) extracted from Radix Astragali. Three main mechanisms, including hydrogen atom transfer (HAT), proton transfer after electron transfer (SET-PT), and sequential proton loss electron transfer (SPLET) were examined by calculating the thermodynamic parameters. It was found that HAT is the predominant mechanism in the gas phase, while SPLET is supported in the solvent environment. The isoflavonoids' order of antioxidant activity was estimated as: calycosin > calycosin-7-glucoside > formononetin. For the calycosin compound, the result revealed the feasibility of double HAT mechanisms, which involve the formation of stable benzodioxazole with significantly reduced energy in the second H⁺/e^- reaction. In addition, the potential energy profiles and kinetic calculations show that the reaction of ^•OH into the 3'-OH site of calycosin has a lower energy barrier (7.2 kcal/mol) and higher rate constant (4.55 × 10⁹ M^-1 s^-1) compared with other reactions in the gas phase.

The Residue and Dietary Risk Assessment of Spirotetramat and Its Four Metabolites in Cabbage Using Ultra-High-Performance Liquid Chromatography-Tandem Mass Spectrometry

Spirotetramat is a potential tetronic acid pesticide for controlling various pests with piercing-sucking mouthparts. To clarify its dietary risk on cabbage, we established an ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method and then investigated the residual levels of spirotetramat and its four metabolites in cabbage collected from field experiments under good agricultural practices (GAPs). The average recoveries of spirotetramat and its metabolites in cabbage were 74~110%, while the relative standard deviation (RSD) was 1~6%, and the limit of quantitation (LOQ) was 0.01 mg kg^-1. The terminal residue of spirotetramat was in the range of <0.05~0.33 mg kg^-1, the chronic dietary risk (RQ_c) was 17.56%, and the acute dietary risk (RQ_a) was 0.025~0.049%, which means an acceptable dietary intake risk. This study provides data to guide on the use of spirotetramat and to establish the maximum residue limits (MRLs) of spirotetramat on cabbage.

Deep eutectic solvent-based adhesive tape extraction combined with enzyme inhibition assay for the determination and distinction of dithiocarbamate pesticides in food samples

A simple, green extraction method of dithiocarbamate (DTC) pesticides in food samples was developed using adhesive tapes and a green deep eutectic solvent (DES). A rapid and convenient determination and distinction method of DTC pesticides was established using tyrosinase inhibition assay. First, DTC pesticides were extracted by pasting and peeling off the adhesive tape, then eluted by the DES synthesized from xylitol and ethylene glycol. Second, determination of DTC pesticides was conducted by inhibiting the activity of tyrosinase which can catalyze the oxidation of catechol. Less colored products were generated in the reaction system (tyrosinase, catechol, and 4-aminoantipyrine), leading to weak absorbance. In addition, different DTC pesticides (ziram, propineb, zineb, mancozeb, thiram, metiram, and ferbam) were successfully distinguished by sensor arrays (tyrosinase, phenolic compounds, and 4-aminoantipyrine) through principal component analysis. The limit of detection was found to be 0.2 μg kg^-1, and the limit of quantification was 0.6 μg kg^-1. The recoveries ranging from 89.4% to 103.8% were obtained in vegetable, fruit, and cereal, with a relative standard deviation of less than 4.2%. The method is simple, rapid, and convenient and shows good application prospects in the determination of pesticides in a variety of food samples.

A universal design of turn-on fluorescent aptasensor based on luminescent MOFs: Application for the detection of bisphenol A in water, milk and chicken samples

A universal design of turn-on fluorescent aptasensor based on aptamer functionalized gold nanoparticles (AuNPs) and luminescent metal-organic frameworks (LMOFs) complex (AuNPs-Apt/NH₂-MIL-125(Ti)) was realized for bisphenol A (BPA) detection. LMOF NH₂-MIL-125(Ti) was prepared using facial hydrothermal method. BPA aptamer functionalized AuNPs were prepared and adsorbed on the surface of NH₂-MIL-125(Ti) to obtain platform of the fluorescent aptasensor. The fabrication process, sensing performance and applicability of the proposed aptasensor were characterized and investigated carefully. Linear detection range of the constructed aptasensor was from 1 × 10^-9 mol L^-1 to 1 × 10^-4 mol L^-1 with good selectivity, repeatability, stability and reproducibility under optimal experimental conditions. Meanwhile, the fluorescent aptasensor was successfully utilized for BPA detection in real samples with the recoveries of 95.80%-103.12%. The proposed aptasensor based on AuNPs-Apt/NH₂-MIL-125(Ti) holds significant potential for BPA detection in environmental and food samples, promoting the construction and application of LMOFs-based aptasensor.

MOF/COF heterostructure hybrid composite-based molecularly imprinted photoelectrochemical sensing platform for determination of dibutyl phthalate: A further expansion for MOF/COF application

A novel metal-organic framework (MOF)/covalent-organic framework (COF) heterostructure hybrid composite (NH₂-UiO-66/TpPa-1-COF) with excellent photoactivity was developed, which further acted as the photoelectrochemical sensitized layer of a molecularly imprinted photoelectrochemical (MIP-PEC) sensor for extremely sensitive and selective determination of dibutyl phthalate (DBP). The NH₂-UiO-66/TpPa-1-COF was synthesized using a simple one-step solvothermal method, which showed improved photocurrent response owing to heterojunction formation, favorable energy-band configuration and strong light absorption capacity. To improve the sensing performance, molecularly imprinted polymer (MIP) was developed by sol-gel polymerization method as the recognition component of PEC sensor. The specific binding of imprinting sites towards DBP could block the electron transfer, causing decreased photocurrent response of the MIP-PEC sensor. The MIP-PEC sensor showed a wide detection range from 0.1 nmol L^-1 to 100 μmol L^-1 with a limit of detection of 3.0 × 10^-11 mol L^-1 under optimal conditions. Meanwhile, the proposed MIP-PEC sensor showed good stability, selectivity, reproducibility, and applicability in real samples. This is the first attempt to apply MOF/COF heterostructure hybrid composite for MIP-PEC sensor construction, providing new insight into the potential applications of microporous crystalline framework heterostructure hybrid composite in the sensing field.

Incidence of adverse cardiovascular events associated with immune checkpoint inhibitors and risk factors for left ventricular dysfunction: A single-center prospective clinical study

Background

The incidence of immune checkpoint inhibitors (ICI)-related adverse cardiovascular events (ACEs) may be underestimated, and there are few reports on the incidence and risk factors of ICI-induced left ventricular dysfunction (LVD).

Objectives

This study aimed to investigate the incidence of ACEs caused by ICI, in particular to analyze the incidence and risk factors of LV systolic and diastolic dysfunction.

Materials and methods

A prospective clinical study was performed on patients who received ICI in our hospital from November 2020 to October 2021. They received regular cardiovascular examinations, including echocardiography, ECG, cTnT, and NT-proBNP, etc. The incidence of various ACEs was counted, and the risk factors of LVD were analyzed.

Results

A total of 106 cancer patients treated with ICI were recruited. During the follow-up, 41 patients (38.68%) developed various ECG abnormalities, 39 patients (36.79%) developed LVDD, 9 patients (8.49%) developed CTRCD, and 2 patients (1.89%) developed new pericardial effusion. The patients with elevated cTnT, CK-MB, and NT-proBNP were 10 (9.43%), 8 (7.55%), and 8 (7.5%), respectively. Thirteen of the 52 patients with LVD had hypertension, while 4 of the 54 patients without LVD had hypertension (OR = 4.17, 95% CI: 1.26-13.78; P = 0.019). The baseline LVEF and LVFS of patients with LVD were 61.54 ± 4.15% and 33.78 ± 2.73%, while those of the control group were 64.16 ± 3.68% and 34.95 ± 2.84, respectively (P = 0.003 and P = 0.048). Compared with patients without LVD, patients with LVD had lower e' (6.99 ± 1.33 cm/s vs. 7.64 ± 1.39 cm/s, P = 0.029) and higher E to e' ratio (11.89 ± 3.15 cm/s vs. 10.43 ± 2.52, P = 0.024). Multiple regression analysis showed that a history of hypertension (HR = 26.52, 95% CI: 2.479-283.667, P = 0.007) and lower baseline e' (HR = 0.04, 95% CI: 0.003-0.709, P = 0.028) were risk factors for developing LVD.

Conclusion

Patients treated with ICI may develop multiple ACEs, including acute myocarditis, pericarditis, ECG abnormalities, and elevated cardiac biomarkers. ICI may lead to a high incidence of LVD, and echocardiography is helpful for early detection of LVD. Patients with hypertension or poor LV systolic or diastolic function at baseline were predictors of LVD after ICI treatment.

Establishing Clinically Meaningful Change on Outcome Assessments Frequently Used in Trials of Mild Cognitive Impairment Due to Alzheimer's Disease

BACKGROUND

Consensus is lacking on what constitutes a meaningful score change for individual patients on clinical outcome assessments (COAs) that are commonly used in clinical trials of Alzheimer's disease. Such thresholds are one important approach to help contextualize trial results and demonstrate meaningful treatment benefit.

OBJECTIVES

To estimate meaningful within-patient change thresholds for the Clinical Dementia Rating Scale - Sum of Boxes (CDR-SB), Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog), and the Mini-Mental State Examination (MMSE) among participants with mild cognitive impairment (MCI).

DESIGN

Retrospective anchor- and distribution-based analyses of data from the ADC-008 (NCT00000173) study were used to estimate thresholds for meaningful within-patient change on the target measures.

SETTING

Analyses were conducted using data from ADC-008 a Phase III, multicenter, randomized, double-blind, placebo-controlled, parallel-group study among participants with the amnestic subtype of MCI, which was conducted by the Alzheimer's Disease Cooperative Study (ADCS) between March 1999 and January 2004 in the United States and Canada.

PARTICIPANTS

Analyses were based on 769 eligible participants who completed the baseline assessment from 69 ADCS sites in the United States and Canada.

MEASUREMENTS

The target outcome measures for this analysis included the CDR-SB, the ADAS-Cog, and the MMSE. The anchor measures for this analysis included the Global Deterioration Scale and the MCI-Clinical Global Impression of Change.

RESULTS

Focusing on the 12-month time point, within-patient increases of 1-2.5 points in the CDR-SB and increases of 2-5 points on the 11-item ADAS-Cog and 13-item ADAS-Cog, on average, reflect minimal-to-moderate levels of deterioration, respectively.

CONCLUSIONS

These thresholds may be useful to aid the interpretation of Alzheimer's disease clinical trial data by illustrating meaningful within-patient progression over the course of a clinical trial via supplementary progressor analyses, which may in turn be informative for treatment decisions. Estimates generated via these methods are specifically intended to evaluate within-patient change and are not intended to assess the magnitude and meaningfulness of differences between group-level changes over time.

Obeticholic acid and 5β-cholanic acid 3 exhibit anti-tumor effects on liver cancer through CXCL16/CXCR6 pathway

Hepatocellular carcinoma (HCC) is the most common type of liver malignancy with a high incidence and mortality rate. Previous in vitro and in vivo studies have confirmed that liver sinusoidal endothelial cells (LSEC) secrete CXCL16, which acts as a messenger to increase the hepatic accumulation of CXCR6⁺ natural killer T (NKT) cells and exert potent antitumor effects. However, evidence for this process in humans is lacking and its clinical significance is still unclear. In this study, by dissecting the human HCC single-cell RNA-seq data, we verified this process through cellphoneDB. NKT cells in patients with high expression of CXCL16 exhibited a higher activation state and produced more interferon-γ (IFN-γ) compared with those with low expression. We next investigated the signaling pathways between activated (CD69 high) and unactivated NKT cells (CD69 low) using NKT cell-developmental trajectories and functional enrichment analyses. In vivo experiments, we found that farnesoid X receptor agonist (obeticholic acid) combined with the takeda G protein coupled receptor 5 antagonist (5β-cholanic acid 3) exhibited significant tumor suppressive effects in the orthotopic liver tumor model and this result may be related to the CXCL16/CXCR6 axis. In conclusion, our study provides the basis and potential strategies for HCC immunotherapy based on NKT cells.

Effect of FXR agonist GW4064 in the treatment of hilar cholangiocarcinoma in rats

The study objective was to observe the treatment effect of the farnesoid X receptor (FXR) agonist GW4064 in a rat model of hilar cholangiocarcinoma to explore a new therapeutic target for gene therapy for hilar cholangiocarcinoma. Eighty male Wistar rats were randomly divided into four groups (treatment group, model group, control group and sham operation group, 20 rats in each group). The four groups were fed a standard diet. The treatment group and the model group were injected with a suspension of cholangiocarcinoma QBC939 cells into the hilar bile duct with a microsyringe, the control group was injected with normal saline, and the sham operation group was not injected with anything. A modified tail suspension test (TST) was used to evaluate the vitality of the rats. At 4 weeks, one rat in the treatment group and model group was euthanized, and the changes in the hilar bile duct were recorded. The procedure was repeated at 6 weeks. After 6 weeks, hilar cholangiocarcinoma occurred in the treatment group and model group. Then, the treatment group was injected with GW4064 intraperitoneally at a dose of 50 mg/kg/day. One week after injection, the rats in the four groups were euthanized. Pathological examination confirmed that tumours had formed, and hilar bile duct tissues were taken from the four groups. FXR, Bsep, Ntcp and NF-κB expression in the hilar bile duct was detected by real-time polymerase chain reaction (RT-PCR) and immunohistochemistry. After three weeks, the rats in the treatment group and model group ate less, and their weight was significantly reduced. Six weeks later, hilar cholangiocarcinoma was detected in the treatment group and model group. After treatment with GW4064, the ratios of FXR/GAPDH mRNA, Bsep/GAPDH mRNA, Ntcp/GAPDH mRNA and NF-κBp65/GAPDH mRNA were significantly different among the four groups. Under a light microscope, FXR protein reacted with anti-FXR antibody, Bsep protein reacted with anti-Bsep antibody, Ntcp protein reacted with anti-Ntcp antibody and NF-κBp65 protein reacted with anti-NF-κBp65 antibody, and they showed granular expression. Every pathological section included 4,800 cells, and there were different numbers of positive cells in each group. FXR expression in the hilar cholangiocarcinoma of rats was significantly lower than that in normal hilar bile duct tissues. GW4064 increased the expression of FXR in tumour tissues. These findings suggest that FXR may be a new therapeutic target and that GW4064 may be helpful in the treatment of hilar cholangiocarcinoma.

A novel metal-organic frameworks composite-based label-free point-of-care quartz crystal microbalance aptasensing platform for tetracycline detection

A novel label-free point-of-care quartz crystal microbalance (QCM) aptasensing platform based on metal-organic frameworks (MOFs) and gold nanoparticles (AuNPs) was fabricated for tetracycline (TC) detection. MOFs (HKUST-1) and AuNPs were modified onto the sensing interface of QCM sensor to enhance the sensing performance of the QCM aptasensor. TC aptamer with sulfhydryl group was fixed through Au-S bond. The recognition performance of the aptasensor was predicted and verified by the computer simulation. At the optimal conditions, the frequency change of the sensor was adopted for quantitative detection of TC. The prepared QCM aptasensor exhibited a wide linear range from 1 × 10^-10 g mL^-1 to 1 × 10^-5 g mL^-1 with low limit of detection (0.8 × 10^-11 g mL^-1). High sensitivity, good selectivity, acceptable recoveries (87.6-91.4%) in real samples were obtained. For the first time, MOFs were utilized in the construction of QCM aptasensing platform, providing a promising application way of MOFs in the QCM sensing.

[Mid-term efficacy of China Net Childhood Lymphoma-mature B-cell lymphoma 2017 regimen in the treatment of pediatric Burkitt lymphoma]

Objective: To analyze the clinical characteristics of children with Burkitt lymphoma (BL) and to summarize the mid-term efficacy of China Net Childhood Lymphoma-mature B-cell lymphoma 2017 (CNCL-B-NHL-2017) regimen. Methods: Clinical features of 436 BL patients who were ≤18 years old and treated with the CNCL-B-NHL-2017 regimen from May 2017 to April 2021 were analyzed retrospectively. Clinical characteristics of patients at disease onset were analyzed and the therapeutic effects of patients with different clinical stages and risk groups were compared. Survival analysis was performed by Kaplan-Meier method, and Cox regression was used to identify the prognostic factors. Results: Among 436 patients, there were 368 (84.4%) males and 68 (15.6%) females, the age of disease onset was 6.0 (4.0, 9.0) years old. According to the St. Jude staging system, there were 4 patients (0.9%) with stage Ⅰ, 30 patients (6.9%) with stage Ⅱ, 217 patients (49.8%) with stage Ⅲ, and 185 patients (42.4%) with stage Ⅳ. All patients were stratified into following risk groups: group A (n=1, 0.2%), group B1 (n=46, 10.6%), group B2 (n=19, 4.4%), group C1 (n=285, 65.4%), group C2 (n=85, 19.5%). Sixty-three patients (14.4%) were treated with chemotherapy only and 373 patients (85.6%) were treated with chemotherapy combined with rituximab. Twenty-one patients (4.8%) suffered from progressive disease, 3 patients (0.7%) relapsed, and 13 patients (3.0%) died of treatment-related complications. The follow-up time of all patients was 24.0 (13.0, 35.0) months, the 2-year event free survival (EFS) rate of all patients was (90.9±1.4) %. The 2-year EFS rates of group A, B1, B2, C1 and C2 were 100.0%, 100.0%, (94.7±5.1) %, (90.7±1.7) % and (85.9±4.0) %, respectively. The 2-year EFS rates was higher in group A, B1, and B2 than those in group C1 (χ²=4.16, P=0.041) and group C2 (χ²=7.21, P=0.007). The 2-year EFS rates of the patients treated with chemotherapy alone and those treated with chemotherapy combined with rituximab were (79.3±5.1)% and (92.9±1.4)% (χ²=14.23, P<0.001) respectively. Multivariate analysis showed that stage Ⅳ (including leukemia stage), serum lactate dehydrogenase (LDH)>4-fold normal value, and with residual tumor in the mid-term evaluation were risk factors for poor prognosis (HR=1.38,1.23,8.52,95%CI 1.05-1.82,1.05-1.43,3.96-18.30). Conclusions: The CNCL-B-NHL-2017 regimen show significant effect in the treatment of pediatric BL. The combination of rituximab improve the efficacy further.

Portable and on-site electrochemical sensor based on surface molecularly imprinted magnetic covalent organic framework for the rapid detection of tetracycline in food

In this study, for the first time, surface molecularly imprinted magnetic covalent organic frameworks (Fe₃O₄@COFs@MIPs) were combined with disposable screen-printed electrode (SPE) to construct a portable and on-site electrochemical sensor for the rapid detection of tetracycline (TC). The Fe₃O₄@COFs@MIPs, which was prepared by layer-by-layer modification method, had good magnetism and excellent adsorption ability. With the help of disposable SPE, equipped with a magnet, the electrode modification process was simplified and the detection efficiency was improved. Under optimal conditions, the fabricated electrochemical sensor exhibited linearity ranging from 1 × 10^-10 to 1 × 10^-4 g mL^-1. It had good selectivity, excellent reproducibility, desirable stability and remarkable applicability. The fabricated sensor was successfully applied to detect TC in real samples with satisfactory recoveries (96.15-106.20%). The detection strategy separated the recognition and adsorption process from the electrochemical detection process, providing a design idea for the application of COFs in the construction of high-efficiency molecularly imprinted electrochemical sensors.

Significant Succession of Intestinal Bacterial Community and Function During the Initial 72 Hours of Acute Pancreatitis in Rats

Acute pancreatitis (AP) is followed by structural and functional changes in the intestine, resulting from microbiome dysbiosis. However, it remains unclear how gut microbiome changes within the initial 72h of onset. In this study, severe acute pancreatitis (SAP), mild acute pancreatitis (MAP), and sham operation (SO) were replicated in rat models. 16S ribosomal RNA gene sequencing was used to explore the gut bacteria community. The predicted Cluster of Orthologous Genes (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic pathways were associated with the 16S rRNA profiles. Compared to the SO group, significant community succession was found during the initial 72h in AP group. At 72 h after AP induction, the Firmicutes/Bacteroidetes (F/B) ratios were significantly different, with the highest ratio in SAP group and the lowest in MAP group. Lactobacillus was the most abundant genus, but it nearly disappeared in SAP rats at 72 h. Clostridiaceae 1 and Clostridium sensu stricto 1 were significantly enriched in AP group. Bacteroidales S24-7 and Bacteroidales S24-7 group norank were enriched in MAP group, while Collinsella, Morganella, and Blautia were enriched in SAP group. Lactobacillus was significantly correlated with nine COGs. Nine COGs showed significant differences between AP group and SO group. Moreover, four COGs showed significant differences between the MAP and SAP groups. KEGG Level_3 pathways propanoate metabolism (Ko00640) in AP group was significantly higher than that in SO group. The aspartate‒ammonia ligase and four KEGG orthology terms of the AP group were lower than that in the SO group, respectively. All these results suggest that the intestinal bacterial community structure and function was changed during the initial 72h in AP rats. The intestinal F/B ratio and the relative abundance of Lactobacillus could be potential markers for early diagnosis of MAP and SAP. The genus Clostridium sensu stricto 1 was the most enriched genus in AP, and may be an important marker for AP.

Short-term/long-term prognosis with or without beta-blockers in patients without heart failure and with preserved ejection fraction after acute myocardial infarction: a multicenter retrospective cohort study

Background

The role of beta-blockers in acute myocardial infarction patients without heart failure and with preserved left ventricular ejection fraction (LVEF ≥ 50%) is unknown. Our study aimed to retrospectively analyze the associations of beta-blockers on such patients.

Methods

This is a multicenter, retrospective study. After screening 5,332 acute myocardial infarction patients, a total of 2519 patients without heart failure and with LVEF ≥ 50% were included. The patients were divided into two groups: the prescribed (n = 2049) and unprescribed (n = 470) beta-blockers group. The propensity score inverse probability treatment weighting was used to control confounding factors. We analyzed the associations between beta-blockers and outcomes in the short-term (1-year) and long-term (median, 3.61 years).

Results

The primary outcome was all-cause mortality. The secondary outcomes were all-cause rehospitalization, cardiac death, recurrent myocardial infarction, new-onset heart failure rehospitalization. This study shows no statistically significant association between discharged with beta-blockers and all-cause mortality, either in the short-term [IPTW Adjusted, HR 1.02; 95%CI 0.43–2.40; P = 0.966] or long-term [IPTW Adjusted, HR 1.17; 95%CI 0.70–1.94; P = 0.547]. Discharged with beta-blockers was significantly associated with a reduced risk of short-term recurrent myocardial infarction [IPTW Adjusted, HR 0.44; 95%CI 0.20–0.97; P = 0.043], but there was no long-term relationship [IPTW Adjusted, HR 1.11; 95%CI 0.61–2.03; P = 0.735]. Other outcomes, such as new-onset heart failure rehospitalization and all-cause rehospitalization, were not observed with meaningful differences in either the short- or long-term. The results of sensitivity analysis were consistent with this.

Conclusions

Beta-blockers might be associated with a reduced risk of recurrent myocardial infarction in patients without heart failure and with preserved left ventricular ejection fraction after acute myocardial infarction, in the short term. Beta-blockers might not be related to all-cause mortality in those patients, either in the short-term or long-term.

Clinical trial registration Influence of Beta-blockers on Prognosis in Patients with Acute Myocardial Infarction Complicated with Normal Ejection Fraction, NCT04485988, Registered on 24/07/2020. Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02631-8.

The duration of beta-blocker therapy and outcomes in patients without heart failure or left ventricular systolic dysfunction after acute myocardial infarction: A multicenter prospective cohort study

Background

The duration of beta‐blocker therapy in patients without heart failure (HF) or left ventricular systolic dysfunction after acute myocardial infarction (AMI) is unclear.

Hypothesis

Continuous beta‐blocker therapy is associated with an improved prognosis.

Methods

This is a prospective, multicenter, cohort study. One thousand four hundred and eighty‐three patients eventually met the inclusion criteria. The study groups included the continuous beta‐blocker therapy group (lasted ≥6 months) and the discontinuous beta‐blocker therapy group (consisting of the no‐beta‐blocker therapy group and the beta‐blocker therapy <6 months group). The inverse probability treatment weighting was used to control confounding factors. The study tried to learn the role of continuous beta‐blocker therapy on outcomes. The median duration of follow‐up was 13.0 months. The primary outcomes were cardiac death and major adverse cardiovascular events (MACE). The secondary outcomes were all‐cause death, stroke, unstable angina, rehospitalization for HF, and recurrent myocardial infarction (MI).

Results

Compared with discontinuous beta‐blocker therapy, continuous beta‐blocker therapy was associated with a reduced risk of unstable angina, recurrent MI, and MACE (hazard ratio [HR]: 0.51; 95% CI: 0.32–0.82; p = 0.006); but this association was not available for cardiac death (HR: 0.57; 95% CI: 0.24–1.36; p = 0.206). When compared to the subgroups of no‐beta‐blocker therapy and beta‐blocker therapy <6 months, respectively, continuous beta‐blocker therapy was still observed to be associated with a reduced risk of unstable angina, recurrent MI, and MACE.

Conclusions

Continuous beta‐blocker therapy was associated with a reduced risk of unstable angina or recurrent MI or MACE in patients without HF or left ventricular systolic dysfunction after AMI.

[Analysis of experience in diagnosis and treatment of fetal goiter in patients with Graves' disease complicated with pregnancy]

This article reported the clinical diagnosis and treatment experience of two cases of fetal goiter in Graves' disease (GD) complicated with pregnancy. Two GD patients took antithyroid drugs regularly during pregnancy and their thyroid functions were well controlled, but the levels of thyrotropin receptor antibody (TRAb) of the two cases were still above the upper limit in the second and third trimester. Two fetuses had fetal goiter in the middle and late stages of pregnancy. After continuously controlling maternal thyroid function and closely monitoring fetal ultrasound, there was no aggravation of the fetal goiter, and the delivery went smoothly. One case had neonatal hyperthyroidism. It is suggested that although the thyroid function was well controlled during pregnancy in patients with GD, the high level of serum TRAb still needs to be alert to the occurrence of fetal goiter, and fetal ultrasound is the most direct non-invasive monitoring method.

Impact of Brachial-Ankle Pulse Wave Velocity on Myocardial Work by Non-invasive Left Ventricular Pressure-Strain in Non-hypertensive and Hypertensive Patients With Preserved Left Ventricular Ejection Fraction

Objective

Data regarding the influence of arterial stiffness on myocardial work (MW) has been scarce. This study was performed to investigate the association between brachial-ankle pulse wave velocity (baPWV) and MW by non-invasive left ventricular pressure–strain in a population of non-hypertensive and hypertensive individuals.

Methods

Two hundred and eight participants (104 hypertensive and 104 non-hypertensive individuals) were prospectively enrolled into the study. All participants underwent conventional echocardiography, as well as 2D speckle-tracking echocardiography to assess MW by non-invasive left ventricular pressure–strain and global longitudinal strain (GLS). baPWV measurements were made at the same day as the echocardiography. Then, participants were categorized according to baPWV tertiles. Correlation between baPWV and MW were analyzed. Predicting ability of baPWV for abnormal WM was analyzed using receiver operating characteristic (ROC) curve.

Results

The median baPWV from the low to high tertile groups were 1286.5 (1197.5–1343.5), 1490.0 (1444.5–1544.0), and 1803.8(1708.3–1972.0) cm/s, respectively. In simple linear regression analysis, baPWV had a significant positive association with global work index (GWI), global constructed work (GCW), and global wasted work (GWW), and a negative association with global work efficiency (GWE). The association remained significant after adjusting for major confounding factors in multiple linear regression analysis. The areas under the ROC curve of baPWV for predicting abnormal GWI, GCW, GWW, and GWE were 0.653, 0.666, 0.725, and 0.688, respectively (all p < 0.05).

Conclusions

BaPWV is significantly associated with all four components of MW using non-invasive left ventricular pressure-strain method in a mixed population of non-hypertensive and hypertensive individuals.

Prognostic value of cardiac magnetic resonance in patients with aortic stenosis: A systematic review and meta-analysis

BACKGROUND

The timing of surgery for aortic stenosis (AS) is imperfect, and the management of moderate AS and asymptomatic severe AS is still challenging. Myocardial fibrosis (MF) is the main pathological basis of cardiac decompensation in patients with AS and can be detected by cardiovascular magnetic resonance (CMR). The aim of this study was to evaluate the prognostic value of MF measured by CMR in patients with AS, which can provide a reference for the timing of aortic valve replacement (AVR).

METHODS

We searched Medline, Embase, and Web of Science to include all studies that investigated the prognostic value of CMR in patients with AS. The search deadline is March 31, 2021. The pooled relative risk (RR) or hazard ratio (HR) and 95% confidence intervals (CI) of the biomarkers including late gadolinium enhancement (LGE), Native T1 or extracellular volume (ECV) were calculated to evaluate the prognostic value.

RESULTS

13 studies and 2,430 patients with AS were included in this study, the mean or medium follow-up duration for each study was ranged from 6 to 67.2 months. Meta-analysis showed the presence of LGE was associated with an increased risk for all-cause mortality (pooled RR: 2.14, 95% CI: 1.67-2.74, P < 0.001), cardiac mortality (pooled RR: 3.50, 95% CI: 2.32-5.30, P < 0.001), and major adverse cardiovascular events (MACEs) (pooled RR: 1.649, 95% CI: 1.23-2.22, P = 0.001). Native T1 was significantly associated with MACEs (pooled RR: 2.23, 95% CI: 1.00-4.95; P = 0.049), and higher ECV was associated with a higher risk of cardiovascular events (pooled HR: 1.69, 95% CI: 1.11-2.58; P = 0.014).

CONCLUSION

The use of CMR to detect MF has a good prognostic value in patients with AS. LGE, Native T1 and ECV measured by CMR can contribute to risk stratification of AS, thereby helping to optimize the timing of AVR.

[Analysis on prevalence and epidemic risk of animal plague in different ecological plague foci in Inner Mongolia Autonomous Region]

The risk of plague epidemics and relapse of various types of plague foci persists in Inner Mongolia Autonomous Region. For Marmota sibirica plague foci, the animal plague has not been found but antibody has been detected positive. Nowadays, Marmota sibirica has been increasing in population and distribution in China. In bordering countries Mongolia and Russia, the animal plague has been continuously prevalent. For Spermophilus dauricus plague foci, the animal plague has been taken place now and then. Compared to the above foci, the animal plague is most prevalent in Meriones unguiculatus plague foci and frequently spread to humans. Due to higher strain virulence and historical disaster in Marmota sibirica plague foci and Spermophilus dauricus plague foci, plague prevention and control should be strengthened on these foci. In addition to routine surveillance, epidemic dynamics need to be further monitored in these two foci, in order to prevent their relapse and spread to humans.

Pembrolizumab versus chemotherapy for patients with esophageal squamous cell carcinoma enrolled in the randomized KEYNOTE-181 trial in Asia

BACKGROUND

In the randomized phase III KEYNOTE-181 study, pembrolizumab prolonged overall survival (OS) compared with chemotherapy as second-line therapy in patients with advanced esophageal cancer and programmed death-ligand 1 (PD-L1) combined positive score (CPS) ≥10. We report a post hoc subgroup analysis of patients with esophageal squamous cell carcinoma (ESCC) enrolled in KEYNOTE-181 in Asia, including patients from the KEYNOTE-181 China extension study.

PATIENTS AND METHODS

Three hundred and forty Asian patients with advanced/metastatic ESCC were enrolled in KEYNOTE-181, including the China cohort. Patients were randomly assigned 1 : 1 to receive pembrolizumab 200 mg every 3 weeks for ≤2 years or investigator's choice of paclitaxel, docetaxel, or irinotecan. OS, progression-free survival, response, and safety were analyzed without formal comparisons. OS was evaluated based on PD-L1 CPS expression level.

RESULTS

In Asian patients with ESCC, median OS was 10.0 months with pembrolizumab and 6.5 months with chemotherapy [hazard ratio (HR), 0.63; 95% CI 0.50-0.80; nominal P < 0.0001]. Median progression-free survival was 2.3 months with pembrolizumab and 3.1 months with chemotherapy (HR, 0.79; 95% CI 0.63-0.99; nominal P = 0.020). Objective response rate was 17.1% with pembrolizumab and 7.1% with chemotherapy; median duration of response was 10.5 months and 7.7 months, respectively. In patients with PD-L1 CPS <1 tumors (pembrolizumab versus chemotherapy), the HR was 0.99 (95% CI 0.56-1.72); the HR (95% CI) for death was better for patients with PD-L1 CPS cut-offs >1 [CPS ≥1, 0.57 (0.44-0.75); CPS ≥5, 0.56 (0.41-0.76); CPS ≥10, 0.53 (0.37-0.75)]. Treatment-related adverse events were reported in 71.8% of patients in the pembrolizumab group and 89.8% in the chemotherapy group; grade 3-5 events were reported in 20.0% and 44.6%, respectively.

CONCLUSIONS

Pembrolizumab monotherapy demonstrated promising efficacy in Asian patients with ESCC, with fewer treatment-related adverse events than chemotherapy. PD-L1 CPS ≥1 is an appropriate cut-off and a predictive marker of pembrolizumab efficacy in Asian patients with ESCC.

Real-world cardiovascular toxicity of immune checkpoint inhibitors in cancer patients: a retrospective controlled cohort study

Over the past decade, immune checkpoint inhibitors (ICI) have dramatically improved the prognosis of many cancer patients, but many immune-related adverse cardiovascular events (ACEs) have been observed. We aimed to investigate the occurrence of ACEs in the real world after receiving ICI and provide clinical reference for how to evaluate it. The study retrospectively included 204 patients who received ICI from October 2019 to November 2020 and 205 patients who only received traditional chemotherapy. The mean duration of follow-up for ICI group was 4.88 months, and the control group was 4.79 months. Patients in the control group did not develop myocarditis, only 2 cases of new-onset pericardial effusion occurred. In contrast, among ICI group, there were 3 cases of ICI-associated myocarditis, accounting for 1.47% (3/204), 6 cases of pericardial effusion. The incidence of new-onset ECG abnormalities in the ICI group was significantly higher than that of the control group (38/180 VS 16/178, HR 2.71, 95% CI: 1.449-5.067, P=0.001). In the ICI group, after receiving ICI treatment, cardiac biomarkers including average cardiac troponin T and N terminal pro B type natriuretic peptide increased significantly, peak in about 1 month, and then gradually decreasing. After the third or fourth month, the cardiac biomarkers gradually increased again. In conclusion, ICI may lead to various ACEs, and its incidence is higher than that of patients who only receive traditional chemotherapy. The changing trend of cardiac biomarkers reflects that ICI may cause acute and chronic myocardial damage. Regularly performing ECG, echocardiogram and cardiac biomarker examinations are helpful for early detection of ACEs caused by ICI and providing timely treatment.

Worst Itch Numerical Rating Scale for Prurigo Nodularis: A Psychometric Evaluation

BACKGROUND

Study TR03 evaluated the safety and efficacy of nalbuphine ER for prurigo nodularis (PN) (NCT02174419).

OBJECTIVE

We conducted supplementary analyses to assess the psychometric properties of the Worst Itch Numeric Rating Scale (WI-NRS), the TR03 primary endpoint.

METHODS

Study TR03 was a double-blind, placebo-controlled, phase 2 trial in PN patients with documented scores ≥5 on the WI-NRS (0 [no itch]-10 [worst itch imaginable]) on ≥5 of 7 days before baseline. Using TR03 data, the WI-NRS's psychometric properties, including reliability, validity, and ability to detect change, were evaluated. A responder threshold was estimated to facilitate interpretation of WI-NRS score changes.

RESULTS

Among 62 treated patients, improvements in mean [SD] (median) WI-NRS scores were observed between baseline (8.2 [1.21] (8.1)) and Week 10 (5.8 [2.43] (6.0)). The WI-NRS had an intraclass correlation coefficient of 0.96 (95% confidence interval, 0.93-0.98) in 42 patients who had stable Itch verbal rating scale (VRS) scores from Week 9-10, supporting strong test-retest reliability. Construct validity was supported, with strong correlations at Week 10 with Average Itch NRS (r=0.87) and Itch VRS single-day/weekly mean scores (r=0.81/0.89) and moderate correlations with ItchyQoL^TM total/domain scores (r=0.41-0.43). The WI-NRS discriminated between predefined severity subgroups based on the Itch VRS and detected changes in itching severity (effect-size estimate: -2.05; standardized response mean: -1.21). An anchor-based threshold based on a two-category improvement in the single-day Itch VRS suggests a responder threshold of ≥3.8 points (~40% improvement).

CONCLUSIONS

The WI-NRS demonstrates good measurement properties, supporting its use in evaluating treatment change in PN.

A Retrospective Observational Study of the Association Between Plasma Levels of Interleukin 8 in 42 Patients with Sepsis-Induced Myocardial Dysfunction at a Single Center Between 2017 and 2020

Background

This retrospective, observational study from a single center aimed to evaluate the association between complement (C)3 and C4, lymphocytes markers CD4 and CD8, and the interleukins IL-1β, IL-2R, IL-6, IL-10, and IL-8 in patients with sepsis-induced myocardial dysfunction (SIMD) and a reduced left ventricular ejection fraction (LVEF) of < 50%.

Material/Methods

Patients with sepsis from July 2017 to December 2020 were divided into a SIMD group (42 patients) and NO-SIMD group (214 patients). Diagnostic criteria of sepsis were based on SEPSIS 3.0 guidelines. SIMD was defined as LVEF <50% by echocardiography and global ejection fraction <25% by transpulmonary thermodilution during hospitalization. The lymphocyte markers and interleukins were detected by flow fluorescence immunomicrobead assay, and C3 and C4 were detected by enzyme-linked immunosorbent assay.

Results

Plasma levels of IL-8 in the SIMD group were significantly higher than those in the NO-SIMD group, 133.90 (80.20, 402.79) vs 46.35 (16.80, 125.00) pg/mL (P<0.001). Logistic regression showed that N terminal pro B type natriuretic peptide (NT-proBNP; 95%CI 1.000–1.000, P<0.001) and IL-8 (95%CI 1.000–1.002, P=0.019) were independent risk factors for SIMD. Receiver operating characteristic curve analysis showed NT-proBNP, IL-8, and cardiac troponin T (cTnT) had different predictive values for SIMD: AUC_NT-proBNP (0.810) >AUC_IL-8 (0.748) >AUC_cTnT (0.710). The cut-off value of IL-8 was 67.55 pg/mL; using this cut-off value, IL-8 predicted SIMD in sepsis with a sensitivity of 83.3% and specificity of 59.3%.

Conclusions

Increased plasma levels of IL-8 were significantly associated with cardiac dysfunction in patients with SIMD.

Effects of Genetic Background and Altitude on Sugars, Malic Acid and Ascorbic Acid in Fruits of Wild and Cultivated Apples (Malus sp.)

Soluble sugars, malic acid, and ascorbic acid in 17 apple cultivars (Malus domestica Borkh.) and three wild forms (M. pumila 'Saiwaihong', M. prunifolia (Willd.) Borkh. and M. micromalus Makino) from three major apple cultivation regions in China were quantified using gas chromatography equipped with flame ionization detector (GC-FID). Fructose was the most abundant sugar, followed by sucrose, glucose, and sorbitol. Wild apples contain more sorbitol and less sucrose and were significantly more acidic than cultivated fruits. The total sugar content varied from 110 to 160 mg/g fresh fruits, total acid content from 2 to 6 mg/g, with a strong influence of genetic background and growth location. Overall, 'Gala', 'Xiali', 'Liuyuehong', 'Lihong', 'Starking Delicious', and 'Starkrimson' were characterized by higher sugar/acid ratio indicating sweeter taste compared to other cultivars. The wild apples had the highest content of ascorbic acid (0.6-0.96 mg/g). Compared to other cultivars, 'Zhongqiuwang', 'Qinguan', and 'Nagafu No. 2' were richer in ascorbic acid. The ascorbic acid content in the commercial cultivars was highly dependent on growth location. The content of malic acid and sucrose positively correlated to altitude, and that of glucose negatively. Malic acid positively correlated with ascorbic acid and sucrose, glucose content with ascorbic acid.