Deep learning-based facial analysis for predicting difficult videolaryngoscopy: a feasibility study

While videolaryngoscopy has resulted in better overall success rates of tracheal intubation, airway assessment is still an important prerequisite for safe airway management. This study aimed to create an artificial intelligence model to identify difficult videolaryngoscopy using a neural network. Baseline characteristics, medical history, bedside examination and seven facial images were included as predictor variables. ResNet-18 was introduced to recognise images and extract features. Different machine learning algorithms were utilised to develop predictive models. A videolaryngoscopy view of Cormack-Lehane grade of 1 or 2 was classified as 'non-difficult', while grade 3 or 4 was classified as 'difficult'. A total of 5849 patients were included, of whom 5335 had non-difficult and 514 had difficult videolaryngoscopy. The facial model (only including facial images) using the Light Gradient Boosting Machine algorithm showed the highest area under the curve (95%CI) of 0.779 (0.733-0.825) with a sensitivity (95%CI) of 0.757 (0.650-0.845) and specificity (95%CI) of 0.721 (0.626-0.794) in the test set. Compared with bedside examination and multivariate scores (El-Ganzouri and Wilson), the facial model had significantly higher predictive performance (p < 0.001). Artificial intelligence-based facial analysis is a feasible technique for predicting difficulty during videolaryngoscopy, and the model developed using neural networks has higher predictive performance than traditional methods.

Loss of feedback regulation between FAM3B and androgen receptor driving prostate cancer progression

BACKGROUND

Although the fusion of the transmembrane serine protease 2 gene (TMPRSS2) with the erythroblast transformation-specific-related gene (ERG), or TMPRSS2-ERG, occurs frequently in prostate cancer, its impact on clinical outcomes remains controversial. Roughly half of TMPRSS2-ERG fusions occur through intrachromosomal deletion of interstitial genes and the remainder via insertional chromosomal rearrangements. Because prostate cancers with deletion-derived TMPRSS2-ERG fusions are more aggressive than those with insertional fusions, we investigated the impact of interstitial gene loss on prostate cancer progression.

METHODS

We conducted an unbiased analysis of transcriptome data from large collections of prostate cancer samples and employed diverse in vitro and in vivo models combined with genetic approaches to characterize the interstitial gene loss that imposes the most important impact on clinical outcome.

RESULTS

This analysis identified FAM3B as the top-ranked interstitial gene whose loss is associated with a poor prognosis. The association between FAM3B loss and poor clinical outcome extended to fusion-negative prostate cancers where FAM3B downregulation occurred through epigenetic imprinting. Importantly, FAM3B loss drives disease progression in prostate cancer. FAM3B acts as an intermediator of a self-governing androgen receptor feedback loop. Specifically, androgen receptor upregulates FAM3B expression by binding to an intronic enhancer to induce an enhancer RNA and facilitate enhancer-promoter looping. FAM3B, in turn, attenuates androgen receptor signaling.

CONCLUSION

Loss of FAM3B in prostate cancer, whether through the TMPRSS2-ERG translocation or epigenetic imprinting, causes an exit from this autoregulatory loop to unleash androgen receptor activity and prostate cancer progression. These findings establish FAM3B loss as a new driver of prostate cancer progression and support the utility of FAM3B loss as a biomarker to better define aggressive prostate cancer.

Erratum: Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande [Phys. Rev. Lett. 130, 031802 (2023)]

This corrects the article DOI: 10.1103/PhysRevLett.130.031802.

Local Cost-Effectiveness of Nasopharyngeal Carcinoma Screening Strategies in Southern China: Secondary Analysis of the PRO-NPC-001 Cluster-Randomized Trial

PURPOSE/OBJECTIVE(S)

Population-based screening for endemic nasopharyngeal carcinoma (NPC) detects most cases at an early stage. In a cluster-randomized trial conducted in Guangdong, a combination of Epstein-Barr Virus (EBV) anti-VCA/EBNA1 IgA serology and endoscopy reduced NPC mortality. We conducted a secondary analysis of this trial in conjunction with local incidence and cost data, hypothesizing that screening would be cost-effective in this region.

MATERIALS/METHODS

We estimated population-level NPC mortality reduction, resource utilization, and cost-effectiveness of 12 unique screening strategies in six populations in Guangdong/Guangxi using a previously-validated time-inhomogeneous decision-analytic cohort model. These 12 strategies evaluated combinations of serology, nasopharyngeal swab PCR (NP PCR), endoscopy, and head/neck MRI. Incidence data, screening costs, and healthcare costs were obtained from local cancer registries, laboratories conducting ELISA/PCR, and the Guangdong provincial healthcare system. We evaluated variable screening ages, sexes, intervals, and durations to identify optimal screening approaches from the perspective of the healthcare system in southern China. An incremental cost-effectiveness ratio (ICER) willingness-to-pay threshold of 1.50 times the per-capita GDP was considered cost-effective in southern China.

RESULTS

For the base strategy screening 50-year-old men and women using only serology and endoscopy, the average cost per screened subject for a single round of screening over a five-year cycle was ¥175.69. The addition of MRI improved sensitivity (76% vs. 62%) and approximately doubled screening costs. Triage with NP PCR was cost-neutral when used in conjunction with MRI and reduced endoscopy/MRI utilization by 37% with a 3-4% reduction in screening sensitivity. Among 50-year-old men and women, screening was cost-effective in all populations provided that medium-risk subjects were not referred for endoscopy/MRI (ICER/GDP 0.62-0.83). The use of NP PCR without MRI (ICER/GDP 0.83) was dominated by the base strategy (ICER/GDP 0.62) due to higher costs and NPC mortality. After a single five-year screening cycle, screening reduced population NPC mortality by 14% with serology + endoscopy and 21% with serology + endoscopy + MRI. Introduction of MRI with or without NP PCR could be cost-effective in all populations. For MRI-based strategies, the most efficient use of resources was deferral of endoscopy unless MRI was abnormal (ICER/GDP 0.67). Overall, the best-performing strategies balanced NPC mortality, screening costs, and MRI utilization.

CONCLUSION

EBV serology-based screening for endemic NPC is likely to be cost-effective among adult men and women in Guangdong and Guangxi. Referring medium-risk subjects for endoscopy/MRI should be avoided, and NP PCR should be used to triage individuals for MRI rather than endoscopy. These data may aid the design of population-based screening programs in this region.

Measurements of neutrino oscillation parameters from the T2K experiment using 3.6×1021 protons on target

The T2K experiment presents new measurements of neutrino oscillation parameters using 19.7 ( 16.3 ) × 10 20 protons on target (POT) in (anti-)neutrino mode at the far detector (FD). Compared to the previous analysis, an additional 4.7 × 10 20 POT neutrino data was collected at the FD. Significant improvements were made to the analysis methodology, with the near-detector analysis introducing new selections and using more than double the data. Additionally, this is the first T2K oscillation analysis to use NA61/SHINE data on a replica of the T2K target to tune the neutrino flux model, and the neutrino interaction model was improved to include new nuclear effects and calculations. Frequentist and Bayesian analyses are presented, including results on sin 2 θ 13 and the impact of priors on the δ CP measurement. Both analyses prefer the normal mass ordering and upper octant of sin 2 θ 23 with a nearly maximally CP-violating phase. Assuming the normal ordering and using the constraint on sin 2 θ 13 from reactors, sin 2 θ 23 = 0 . 561 - 0.032 + 0.021 using Feldman-Cousins corrected intervals, and Δ m 32 2 = 2 . 494 - 0.058 + 0.041 × 10 - 3 eV 2 using constant Δ χ 2 intervals. The CP-violating phase is constrained to δ CP = - 1 . 97 - 0.70 + 0.97 using Feldman-Cousins corrected intervals, and δ CP = 0 , π is excluded at more than 90% confidence level. A Jarlskog invariant of zero is excluded at more than 2 σ credible level using a flat prior in δ CP , and just below 2 σ using a flat prior in sin δ CP . When the external constraint on sin 2 θ 13 is removed, sin 2 θ 13 = 28 . 0 - 6.5 + 2.8 × 10 - 3 , in agreement with measurements from reactor experiments. These results are consistent with previous T2K analyses.

Investigating potential immune mechanisms of trilaciclib administered prior to chemotherapy in patients with metastatic triple-negative breast cancer

PURPOSE

In a phase II trial in patients with metastatic triple-negative breast cancer (mTNBC; NCT02978716), administering trilaciclib prior to gemcitabine plus carboplatin (GCb) enhanced T-cell activation and improved overall survival versus GCb alone. The survival benefit was more pronounced in patients with higher immune-related gene expression. We assessed immune cell subsets and used molecular profiling to further elucidate effects on antitumor immunity.

METHODS

Patients with mTNBC and ≤ 2 prior chemotherapy regimens for locally recurrent TNBC or mTNBC were randomized 1:1:1 to GCb on days 1 and 8, trilaciclib prior to GCb on days 1 and 8, or trilaciclib alone on days 1 and 8, and prior to GCb on days 2 and 9. Gene expression, immune cell populations, and Tumor Inflammation Signature (TIS) scores were assessed in baseline tumor samples, with flow cytometric analysis and intracellular and surface cytokine staining used to assess immune cell populations and function.

RESULTS

After two cycles, the trilaciclib plus GCb group (n = 68) had fewer total T cells and significantly fewer CD8+ T cells and myeloid-derived suppressor cells compared with baseline, with enhanced T-cell effector function versus GCb alone. No significant differences were observed in patients who received GCb alone (n = 34). Of 58 patients in the trilaciclib plus GCb group with antitumor response data, 27 had an objective response. RNA sequencing revealed a trend toward higher baseline TIS scores among responders versus non‑responders.

CONCLUSION

The results suggest that administering trilaciclib prior to GCb may modulate the composition and response of immune cell subsets to TNBC.

[Endoscopic ultrasonographic features of submucosal lesions of upper digestive tract suspected gastrointestinal stromal tumors and their correlation with progression and pathological risk grade of the lesions]

Objective: To investigate the endoscopic ultrasonographic (EUS) characteristics of submucosal lesions of upper digestive tract suspected gastrointestinal stromal tumors (GIST) and their correlation with biological behaviors and pathological risk grade of the tumors. Methods: Retrospective cohort study. The EUS findings, follow-up review, surgical treatment and pathological data of patients with suspected GIST at the Gastrointestinal Endoscopy Center of Peking University People's Hospital from January 2013 to April 2021 were collected. All samples were divided into follow-up group and treatment group based on the pathological condition and the patient's treatment intention. According to whether or not the tumor was enlarged in EUS, the follow-up group was divided into non-enlarged group and enlarged group. Paired T-test was used to compare the lesion size before and after follow-up, and logistic regression was used to analyze the risk factors of tumor enlargement. According to the treatment methods, the treatment group was further divided into endoscopic treatment group and surgical treatment group. According to the pathological results and risk grade, the treatment group was further divided into the low-risk group and the medium-risk group. The risk factors of pathological malignant risk were analyzed by logistic regression, and the tumor diameter of patients with moderate or above pathological risk was predicted by receiver operation characteristic (ROC) curve. The relationship between the findings of EUS and the progression and pathological risk of GIST were also explored. Results: Seventy-three cases including 23 males and 50 females, with an age of 58 (30-88) years, were included in the follow-up group, with a mean lesion diameter of (1.21±0.49) cm before follow-up, median follow-up interval of 33.8 months, and a lesion diameter of (1.18±0.49) cm after follow-up. There was no significant difference (all P>0.05) in lesion diameter between before and after follow-up. There was no significant difference (all P>0.05) between tumor enlargement group (18 cases, 24.7%) and non-enlargement group (55 cases, 75.3%). One hundred and thirty-eight cases, including 52 males and 86 females, with an age of 60 (19-84) years, were enrolled in the treatment group, with a mean EUS estimated diameter of (2.55±1.35) cm and pathological diameters of (3.43±2.42) cm. Ninety-five (68.8%) of these cases were pathologically confirmed as GIST while 43 cases were diagnosed as other tumor types, including 37 benign tumors and 6 malignant tumors. In multifactorial logistic regression analysis, only the increase of tumor diameter [OR (95%CI): 1.800 (1.172-2.766), P=0.007] was a risk factor for pathological intermediate or higher risk. The optimal tumor diameter for predicting pathological intermediate or higher risk using ROC curve analysis was 2.75 cm, with a sensitivity 71.4%, specificity 79.0%, Youden index 0.5 and area under ROC curve 0.807 (95%CI: 0.703-0.909). Conclusions: EUS is essential for assessing the risk of progression and malignancy of submucosal lesions of upper digestive tract suspected GIST. For lesions of small diameter, the interval of follow-up shall be relatively extended while the indication of treatment could be partially waived.

[LINC00926 promotes pyroptosis of hypoxia-induced human umbilical vein vascular endothelial cells by recruiting ELAVL1]

OBJECTIVE

To investigate the regulatory role of the long non-coding RNA LINC00926 in pyroptosis of hypoxia-induced human umbilical vein vascular endothelial cells (HUVECs) and explore the molecular mechanism.

METHODS

HUVECs were transfected with a LINC00926-overexpressing plasmid (OE-LINC00926), a siRNA targeting ELAVL1, or both, followed by exposure to hypoxia (5% O2) or normoxia. The expression of LINC00926 and ELAVL1 in hypoxia-treated HUVECs was detected using real-time quantitative PCR (RT-qPCR) and Western blotting. Cell proliferation was detected using Cell Counting Kit-8 (CCK-8), and the levels of IL-1β in the cell cultures was determined with ELISA. The protein expression levels of pyroptosis-related proteins (caspase-1, cleaved caspase-1 and NLRP3) in the treated cells were analyzed using Western blotting, and the binding between LINC00926 and ELAVL1 was verified with RNA immunoprecipitation (RIP) assay.

RESULTS

Exposure to hypoxia obviously up-regulated the mRNA expression of LINC00926 and the protein expression of ELAVL1 in HUVECs, but did not affect the mRNA expression of ELAVL1. LINC00926 overexpression in the cells significantly inhibited cell proliferation, increased IL-1β level and enhanced the expressions of pyroptosis-related proteins (all P < 0.05). LINC00926 overexpression further up-regulated the protein expression of ELAVL1 in hypoxia-exposed HUVECs. The results of RIP assay confirmed the binding between LINC00926 and ELAVL1. ELAVL1 knockdown significantly decreased IL-1β level and the expressions of pyroptosis-related proteins in hypoxia-exposed HUVECs (P < 0.05), while LINC00926 overexpression partially reversed the effects of ELAVL1 knockdown.

CONCLUSION

LINC00926 promotes pyroptosis of hypoxia-induced HUVECs by recruiting ELAVL1.

[Prediction of microvascular invasion in hepatocellular carcinoma with magnetic resonance imaging using models combining deep attention mechanism with clinical features]

OBJECTIVE

To investigate the consistency and diagnostic performance of magnetic resonance imaging (MRI) for detecting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) and the validity of deep learning attention mechanisms and clinical features for MVI grade prediction.

METHODS

This retrospective study was conducted among 158 patients with HCC treated in Shunde Hospital Affiliated to Southern Medical University between January, 2017 and February, 2020. The imaging data and clinical data of the patients were collected to establish single sequence deep learning models and fusion models based on the EfficientNetB0 and attention modules. The imaging data included conventional MRI sequences (T₁WI, T₂WI, and DWI), enhanced MRI sequences (AP, PP, EP, and HBP) and synthesized MRI sequences (T1mapping-pre and T1mapping-20 min), and the high-risk areas of MVI were visualized using deep learning visualization techniques.

RESULTS

The fusion model based on T1mapping-20min sequence and clinical features outperformed other fusion models with an accuracy of 0.8376, a sensitivity of 0.8378, a specificity of 0.8702, and an AUC of 0.8501 for detecting MVI. The deep fusion models were also capable of displaying the high-risk areas of MVI.

CONCLUSION

The fusion models based on multiple MRI sequences can effectively detect MVI in patients with HCC, demonstrating the validity of deep learning algorithm that combines attention mechanism and clinical features for MVI grade prediction.

Abstract 703: Transient G1 cell cycle arrest with trilaciclib enhances the generation of polyfunctional CD4+ and CD8+ T cells

When administered prior to chemotherapy, intravenous trilaciclib transiently arrests cyclin-dependent kinase 4/6-dependent cells in the G1 phase of the cell cycle, which has been shown to augment antitumor immunity. In an open-label, phase 2 trial in patients with metastatic triple-negative breast cancer (NCT02978716), administering trilaciclib prior to gemcitabine plus carboplatin improved overall survival, potentially through protection and direct activation of immune function. To determine the impact of trilaciclib on effector T-cell function, we conducted in vitro studies to assess the kinetics of cytotoxic function and generation of polyfunctional T cells.

Peripheral blood mononuclear cells (PBMCs) or naïve CD4+ and CD8+ T cells were purified from 6 healthy human donors and activated with CD2/3/28 beads. On days 0, 1, and 3 post activation, 100 nM trilaciclib was added to the cells. To visualize phenotypic and functional changes, T cells that had been activated for 3, 7, or 14 days with or without trilaciclib were restimulated with phorbol myristate acetate (PMA) and ionomycin. Dimension-reduction analysis of flow cytometric data was used to identify polyfunctional subpopulations of CD4+ and CD8+ T cells. T-cell clusters with polyfunctional profiles were identified based on the coproduction of IFNγ, TNFα, and IL-2 cytokines. Subsets of polyfunctional clusters were defined according to other immune phenotypic profiles, including T-cell exhaustion (PD-1 and LAG-3), degranulation (granzyme B), proliferation (Ki-67), and transcription factors (TOX, TCF-1, and T-bet).

For both CD4+ and CD8+ T cells, 3 polyfunctional subpopulations were identified based on differential expression of granzyme B, PD-1, and TOX. When CD4+ and CD8+ T cells were activated in the presence of trilaciclib and restimulated with PMA and ionomycin, there was an increase in the frequency of polyfunctional T-cell subsets producing granzyme B. This was compensated by a decrease in granzyme Blow polyfunctional cells, which was associated with increased PD-1high and TOXhigh expression. Clustering analysis of trilaciclib-treated PBMCs also revealed a reduction in proliferating CD8+ T cells with undetectable effector cytokine function based on a decrease in the frequency of CD8+ T cells expressing TOXhigh and Ki-67high.

Transient G1 cell cycle arrest in T cells may limit T-cell hyperactivation, which has been shown to induce immunopathological responses. The increased generation of polyfunctional CD8+ T cells is associated with enhanced effector T-cell responses and memory T-cell differentiation. In combination with previous data showing increased differentiation of naïve T cells into memory T cells upon exposure to trilaciclib, these data support a beneficial role for trilaciclib in enhancing antitumor T-cell responses.

Citation Format: Sarah Ahn, Subing Cao, Melissa A. Russo, John S. Yi. Transient G1 cell cycle arrest with trilaciclib enhances the generation of polyfunctional CD4+ and CD8+ T cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 703.

Abstract 6674: Single-dose trilaciclib monotherapy potentiates antitumor immunity in the neoadjuvant setting of triple-negative breast cancer by modulating the composition and effector function of peripheral immune cells

Intravenous administration of trilaciclib transiently arrests cyclin-dependent kinase 4/6-dependent cells in the G1 phase of the cell cycle during chemotherapy exposure. In an open-label, phase 2 study in patients with metastatic triple-negative breast cancer (TNBC; NCT02978716), administering trilaciclib prior to gemcitabine plus carboplatin improved overall survival and resulted in enriched T-cell diversity and decreased clonality in peripheral blood compared with administering chemotherapy alone. This phase 2, single-arm, neoadjuvant study (NCT05112536) aims to determine the immune mechanism of action of trilaciclib and its role in modulating antitumor immune responses in patients with TNBC.

Previously untreated patients with early-stage TNBC (N = 24) received single-dose trilaciclib monotherapy during the lead-in phase. After 7 days, patients received systemic therapy with 4 cycles of dose-dense doxorubicin plus cyclophosphamide and 12 weekly cycles of paclitaxel, with trilaciclib administered prior to the first dose of systemic therapy per cycle. Pembrolizumab from cycle 1 and/or carboplatin from cycle 5 was permitted per investigator discretion. Patients underwent curative surgery 3-5 weeks after the last dose of systemic therapy. Peripheral blood samples were collected at baseline, 7 (±1) days post trilaciclib monotherapy prior to chemotherapy, and pre dose on cycle 2, day 1. Peripheral blood mononuclear cells (PBMCs) were isolated from blood samples and cryopreserved for immune profiling via cytometry by time-of-flight (CyTOF), and for functional analysis via intracellular cytokine staining (ICS) and dimensionality reduction.

A preliminary analysis of PBMCs from 7 patients showed a decrease in peripheral myeloid-derived suppressor cells (MDSCs), monocytes, and classical dendritic cells following single-dose trilaciclib monotherapy. There were nominal changes to the frequency of peripheral CD4+ and CD8+ T cells. In 4/7 patients, trilaciclib monotherapy resulted in increased proportions of activated and polyfunctional CD4+ and CD8+ T cells producing IFNγ, TNFα, and IL-2 cytokines. Furthermore, trilaciclib enhanced the frequency of CD8+ T cells producing granzyme B and perforin.

The decrease in MDSCs and increase in functional T cells following trilaciclib monotherapy supports findings from an immune analysis of data from the phase 2 study of trilaciclib in patients with metastatic TNBC. Overall, these data suggest that the transient G1 arrest of peripheral immune cells by single-dose trilaciclib monotherapy favorably modulates immune responses by promoting the generation of polyfunctional T cells and limiting the number of MDSCs in circulation. Enrollment was completed in August 2022. The complete dataset from all 24 patients will be presented.

Citation Format: Sarah Ahn, Subing Cao, Amanda Jacobson, Melissa A. Russo, John S. Yi. Single-dose trilaciclib monotherapy potentiates antitumor immunity in the neoadjuvant setting of triple-negative breast cancer by modulating the composition and effector function of peripheral immune cells. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6674.

Abstract P3-06-03: Trilaciclib induces immune changes within the tumor microenvironment in early-stage triple-negative breast cancer

Background: In early-stage triple-negative breast cancer (TNBC), there is accumulating evidence of a correlation between tumor-infiltrating lymphocytes in tumor tissue and favorable clinical outcomes, with a high CD8+/regulatory T-cell (Treg) ratio after neoadjuvant chemotherapy being predictive of overall survival and associated with pathologic complete response (Ladoire S, et al. Br J Cancer. 2011; Park YH, et al. Nat Commun. 2020). Trilaciclib is a transient inhibitor of cyclin-dependent kinase 4/6 that is administered intravenously prior to chemotherapy. In preclinical studies, trilaciclib has been shown to have immune-enhancing effects by differentially arresting CD8+ T-cell and Treg subsets, which is followed by the faster recovery of CD8+ T cells than Tregs in the tumor microenvironment. Methods: This phase 2, single-arm, open-label study aims to evaluate neoadjuvant, single-dose trilaciclib followed by trilaciclib plus dose-dense anthracycline/cyclophosphamide and taxane in patients with early-stage TNBC (NCT05112536). Patients with previously untreated, non-metastatic, confirmed TNBC and a primary tumor ≥ 1.5 cm of any nodal status receive a single dose of trilaciclib 240 mg/m2 during the lead-in phase, followed by 4 cycles of doxorubicin 60 mg/m2 plus cyclophosphamide 600 mg/m2, and 12 weekly cycles of paclitaxel 80 mg/m2. Trilaciclib 240 mg/m2 is administered prior to the first chemotherapy dose of each cycle. Pembrolizumab 400 mg every 6 weeks starting on day 1, cycle 1, and/or carboplatin AUC 1.5 every week starting on day 1, cycle 5, is allowed per investigator discretion. Tumor biopsies and peripheral blood samples are collected prior to any treatment, 7 days ± 1 day post administration of trilaciclib, and during surgery, with an additional blood sample collection on day 1, cycle 2. The primary objective is to evaluate the immune-based mechanism of action of trilaciclib after a single dose of trilaciclib, as measured by changes in the CD8+/Treg ratio in tumor tissue. Pathologic complete response, safety and tolerability, and additional exploratory immune biomarker endpoints will also be assessed. Results: As of June 3, 2022, 9 patients with early-stage TNBC had been enrolled and 8 patients had received the trilaciclib lead-in dose and initiated doxorubicin/cyclophosphamide. Patients had a median age of 53.0 years, and all had stage II tumors at diagnosis, with 7 having ductal carcinoma. The median number of chemotherapy cycles received was 3 (range 1–6), and all 8 patients received pembrolizumab. Seven patients continue study treatment; 1 patient discontinued due to disease progression. Five patients had an adverse event (AE) related to any study treatment, including 4 patients with ≥ 1 trilaciclib-related AE. There were no grade ≥ 3 treatment-related AEs or serious AEs. On-treatment, post-trilaciclib monotherapy biopsies were available for 4 patients. Following neoadjuvant trilaciclib treatment, the median density of stromal CD8+ T cells increased from 103.1/mm2 at baseline to 229.8/mm2 at day 7. The median CD8+/Treg ratio increased in 2 patients from 1.85 at baseline to 1.90 at day 7. Conclusions: Preliminary analysis of on-treatment tumor biopsies from 4 patients suggests that a single dose of trilaciclib may modulate the immune cell composition in the tumor microenvironment to support antitumor immune responses. The increase in CD8+ T cells following 7-day neoadjuvant treatment with trilaciclib supports previous data suggesting a role in T-cell infiltration. The complete dataset from all patients (estimated enrollment: N ≈ 24) and additional biomarker analyses will be presented.

Citation Format: Michael Danso, Joyce O’Shaughnessy, Lisa S. Wang, Kailash Mosalpuria, Sara Hurvitz, Shom Goel, Sarah Ahn, Subing Cao, John S. Yi, Taofik Oyekunle, Amanda Jacobson, Andrew Beelen, Jeremy Force. Trilaciclib induces immune changes within the tumor microenvironment in early-stage triple-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-06-03.

Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande

We report a search for cosmic-ray boosted dark matter with protons using the 0.37  megaton×years data collected at Super-Kamiokande experiment during the 1996-2018 period (SKI-IV phase). We searched for an excess of proton recoils above the atmospheric neutrino background from the vicinity of the Galactic Center. No such excess is observed, and limits are calculated for two reference models of dark matter with either a constant interaction cross section or through a scalar mediator. This is the first experimental search for boosted dark matter with hadrons using directional information. The results present the most stringent limits on cosmic-ray boosted dark matter and exclude the dark matter-nucleon elastic scattering cross section between 10^{-33}cm^{2} and 10^{-27}cm^{2} for dark matter mass from 1  MeV/c^{2} to 300  MeV/c^{2}.

Clinical study on the treatment of thoracolumbar fractures with single plane screw percutaneous internal fixation

OBJECTIVE

The aim of the study was to investigate the clinical effect of single plane screw percutaneous internal fixation in the treatment of simple thoracolumbar fractures.

PATIENTS AND METHODS

The subjects of this study were 84 patients with simple thoracolumbar fractures treated in our hospital from January 2018 to December 2020. The patients were grouped by different treatment methods (42 cases in each group). The single plane group was treated by percutaneous single plane screw internal fixation and the universal group was treated with percutaneous universal screw. The surgery completion status and the incidence of complications were recorded. The visual analogue scale (VAS) and the Oswestry Disability Index (ODI) of the two groups were recorded before the surgery, 3 days after the surgery, and 7 days after the surgery. The anterior edge height ratio of the fractured vertebra and the kyphotic Cobb angle were marked before the surgery, immediately after the operation, and at the last follow-up.

RESULTS

Difference between groups in surgery time, blood loss and hospital stay was not statistically significant (p>0.05); the single plane group had a substantially lower incidence of complications than the universal group (p<0.05). At the last follow-up, the single plane group had greatly higher anterior edge height ratio of the injured vertebra than the universal group, while kyphotic Cobb angle was greatly higher in the universal group (p<0.05).

CONCLUSIONS

Both single plane screw and universal screw percutaneous internal fixation were feasible for the treatment of simple thoracolumbar fractures, but single plane screw showed better vertebral height recovery and kyphosis correction effect, which could reduce postoperative correction loss.

Extracellular vesicles derived from mesenchymal stem cells confer protection against intervertebral disc degeneration through a microRNA-217-dependent mechanism

OBJECTIVE

Extracellular vesicles released by mesenchymal stem cells (MSC-EVs) can be applied to alleviate intervertebral disc degeneration (IVDD) by curbing apoptosis of nucleus pulposus cells (NPCs). The current study aims to evaluate the effect of MSC-EVs on NPC apoptosis and IVDD and the related regulatory mechanisms involving microRNA (miR)-217.

METHOD

Expression of miR-217 was examined in tumor necrosis factor-α (TNF-α)-induced NPCs and MSC-EVs, followed by identification in the relationship between miR-217, enhancer of zeste homolog 2 (EZH2) and forkhead box O-3 (FOXO3). After isolation of EVs from MSCs and subsequent co-culture with NPCs, we assessed effects of miR-217 on NPC viability, autophagy, senescence and apoptosis along with extracellular matrix (ECM) degradation. Further in vivo experiments were conducted in rat models of IVDD to substantiate the effect of miR-217 on IVDD.

RESULTS

Poor miR-217 expression was found in TNF-α-induced NPCs, while high miR-217 expression was identified in MSC-EVs (P < 0.05). MSC-EVs transferred miR-217 to NPCs and increased its expression, thus attenuating NPC apoptosis and ECM degradation (elevated collagen II and aggrecan but reduced MMP13 and ADAMTS5) (P < 0.05). miR-217 targeted EZH2, and EZH2 bound to the FOXO3 promoter and consequently downregulated its expression. FOXO3 restrained NPC apoptosis and ECM degradation by stimulating cell autophagy (P < 0.05). Furthermore, in vivo experimental results confirmed the suppressive role of miR-217 shuttled by MSC-EVs in IVDD.

CONCLUSION

Overall, the delivery of miR-217 may be a novel mechanism underlying the effect of MSC-EVs on NPC apoptosis and ECM degradation following IVDD.

[Mucinous nevus]

Mucinous nevus is an exceptional entity and presents as flesh-colored to brownish papules or plaques, coalescing to form a pigmentary or verrucous lesion with either a blaschkoid, linear, grouped or zosteriform disposition. It usually appears at birth or during early childhood, but late onset has also been described. Mucinous nevus does not require additional work-up as no internal pathologies have been described. Abstention of any therapeutic intervention is usually preferred.

Arbuscular mycorrhizal fungi: Effects on secondary metabolite accumulation of traditional Chinese medicines

Traditional Chinese medicine (TCM) has played a pivotal role in maintaining the health of people, and the intrinsic quality of TCM is directly related to the clinical efficacy. The medicinal ingredients of TCM are derived from the secondary metabolites of plant metabolism and are also the result of the coordination of various physiological activities in plants. Arbuscular mycorrhizal fungi (AMF) are among the most ubiquitous plant mutualists that enhance the growth and yield of plants by facilitating the uptake of nutrients and water. Symbiosis of AMF with higher plants promotes growth and helps in the accumulation of secondary metabolites. However, there is still no systematic analysis and summation of their roles in the application of TCM, biosynthesis and accumulation of active substances of herbs, as well as the mechanisms. AMF directly or indirectly affect the accumulation of secondary metabolites of TCM, which is the focus of this review. First, in this review, the effects of AMF symbiosis on the content of different secondary metabolites in TCM, such as phenolic acids, flavonoids, alkaloids and terpenoids, are summarized. Moreover, the mechanism of AMF regulating the synthesis of secondary metabolites was also considered, in combination with the establishment of mycorrhizal symbionts, response mechanisms of plant hormones, nutritional elements and expression of key enzyme their activities. Finally, combined with the current application prospects for AMF in TCM, future in-depth research is planned, thus providing a reference for improving the quality of TCM. In this manuscript, we review the research status of AMF in promoting the accumulation of secondary metabolites in TCM to provide new ideas and methods for improving the quality of TCM.

OP0076 L-ARGININE REPROGRAMS OSTEOCLAST PURINE METABOLISM AMELIORATING BONE LOSS IN RHEUMATOID ARTHRITIS

Background

Bone erosion is a clinical feature of rheumatoid arthritis related to disease severity and poor functional prognosis. Excessive osteoclast differentiation and insufficient osteoblast function are the main reasons for the erosive process in RA. Our previous investigation indicated that L-arginine supplementation not only diminished arthritic inflammation in the serum-induced arthritis (K/BxN) model but also decreased inflammatory joints osteoclast numbers (1).

Objectives

In the present study, we aim to investigate the metabolic action of L-arginine supplementation in RA, especially on periarticular bone erosion and systemic bone loss. We plan to depict the metabolic features of TNFα induced inflammatory osteoclasts after in vitro L-arginine supplementation.

Methods

Three murine arthritis models (serum-induced arthritis (K/BxN) model, collagen-induced arthritis model, and hTNFtg mice model) were analysed in this study. L-arginine was supplemented within the drinking water after the onset of arthritis. Bone parameters for axial skeleton (spine) and peripheral skeleton (tibia) from the respective group were quantified by μCT. HE and TRAP staining were performed to address further the erosion area and osteoclast numbers in periarticular sites. In vitro osteoclast differentiation was conducted with or without L-arginine treatment, in the presence or not of TNFα activation. Seahorse and SCENITH analyses were adopted to delineate the metabolic features. JC-1 staining and transmission electron microscopy (TEM) were used to depict the mitochondria metabolism. RNA-seq and mass spectrometry (MS) were performed to investigate the underlying molecular mechanism.

Results

Inflammation was diminished in all three arthritis models after L-arginine supplementation with a significant reduction in arthritic score. Moreover, an amelioration of periarticular bone erosion, systemic bone loss, and decreased osteoclast numbers in periarticular sites were observed in arthritic mice after L-arginine treatment. L-arginine also inhibited osteoclastogenesis in vitro, particularly under TNFα activation. Seahorse and SCENITH analyses indicated TNFα promoted glycolysis while blocking mitochondria-driven oxidative phosphorylations (OXPHOS) in pre-osteoclasts. Meanwhile, JC-1 staining and TEM images also showed that TNFα decreased mitochondria membrane potential and prompted damage of mitochondria. Surprisingly, L-arginine rescued the TNFα inhibition of OXPHOS while promoting ATP production.

RNA-seq and MS data confirmed the boost of OXPHOS after L-arginine treatment under TNFα activation. To interfere with OXPHOS, L-arginine inhibited cJun thus altered arginase-1 and arginase-2 expression. Moreover, the increased ATP in L-arginine treated cells facilitated purine metabolism, especially the production of inosine and hypoxanthine, contributing to the inhibition of osteoclastogenesis. Increasing Adenosine deaminase (ADA) is essential for the production of inosine and hypoxanthine due to the decreased inhibitory regulation of the transcription factor c-Jun.

Conclusion

These data strongly demonstrated that L-arginine ameliorates bone erosion in RA through metabolic reprogramming and perturbation of purine metabolism in osteoclasts. L-arginine might therefore benefit RA therapy by reducing joint inflammation and also ameliorating bone destruction.

References

[1]Hannemann, Nicole, et al. “Transcription factor Fra-1 targets arginase-1 to enhance macrophage-mediated inflammation in arthritis.” The Journal of clinical investigation 129.7 (2019): 2669-2684.

Disclosure of Interests

Shan Cao: None declared, Rui Song: None declared, Xianyi Meng: None declared, Katerina Kachler: None declared, Maximilian Fuchs: None declared, Xinyu Meng: None declared, Yixuan Li: None declared, Verena Taudte: None declared, Meik Kunz: None declared, Ursula Schloetzer-Schrehardt: None declared, Ulrike Schleicher: None declared, Xiaoxiang Chen Speakers bureau: AbbVie, Roche and Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Aline Bozec: None declared.

POS0409 INTESTINAL HIF1α EXPRESSION PROTECTS AGAINST EPITHELIAL CELL DEATH IN ARTHRITIS

Background

While a so-called gut-joint axis is supported by many clinical observations, the current knowledge on such axis is mostly confined to descriptive and correlative data, e.g. showing the microbiota changes are associated with arthritis. In contrast, mechanistic data on how molecular changes in the intestinal epithelium influence the development of arthritis are scarce.

Objectives

To investigate, whether the mucosal barrier in the intestine dependent of the epithelial cell survival maintenance, influences the development of arthritis.

Methods

Intestinal hypoxia inducible factor (HIF)-1α expression was assessed before, at onset and during experimental arthritis and human rheumatoid arthritis (RA). Intestinal epithelial cell-specific HIF1α conditional knock-out mice were generated (HIF1αΔIEC) and subjected to collagen-induced arthritis (CIA). Clinical and histological courses of arthritis were recorded, and T and B cell subsets were analyzed in the gut and secondary lymphatic organs, and intestinal epithelial cells were subjected to molecular mRNA sequencing in HIF1αΔIEC and littermate control mice. Furthermore, pharmacologic HIF1α stabilization by PHD inhibitor was used for the treatment of arthritis.

Results

Intestinal HIF1α expression peaked at onset and remained high in experimental arthritis and RA. Conditionally deletion of HIF1α in gut epithelial cells strongly exacerbate arthritis and was associated with increased gut epithelial cell death, intestinal and lymphatic Th1 and Th17 activation. Mechanistically, HIF1α inhibits the transcription of necroptotic and apoptotic markers, which leads to a defect in the intestinal barrier integrity. Furthermore, treatment with HIF1α stabilization reinforced the gut epithelial cell survival and inhibited arthritis.

Conclusion

These findings show that the HIF1α regulating epithelial cells survival is critical for the breakdown of the intestinal barrier function in arthritis highlighting the functional link between intestinal homeostasis and arthritis.

Disclosure of Interests

None declared.

POS1002 DIAGNOSTIC DELAY AND ITS ASSOCIATED FACTORS IN CHINESE AXIAL SPONDYLOARTHRITIS: A RETROSPECTIVE STUDY

Background

Few data on the prolonged diagnosis and its associated factors in Chinese axial spondyloarthritis (axSpA) is available.

Objectives

To delineate the landscape of diagnostic delay in Chinese axSpA, investigate its associated factors and explore its potential impact on medication modalities.

Methods

A total of 1,295 patients fulfilling the ASAS classification criteria were obtained. Demographic and clinical data were collected through predesigned questionnaires and available medical records. Logistic regression analyses in univariate and multivariable model were performed, using the median of diagnostic delay as cut-off point for group classification. Differences between early and late diagnosed group were subsequently compared by the Pearson chi-square test or Mann-Whitney U test.

Results

The median (IQR) diagnostic delay in Chinese axSpA was 3.0 (1.0~7.0) years and 24.8% of them reported a history of misdiagnosis. Older age at onset (OR=0.97, P<0.001) and higher education attainment (P=0.001) were correlated with early diagnosis of axSpA, whereas coming from less developed areas (P=0.002), a history of peripheral arthritis at the time of diagnosis (OR=1.58, P=0.002) and history of misdiagnosis (OR=1.98, P<0.001) increased the risk of diagnostic delay. Medication modalities were similar between two groups, but the proportion with no medication ever and percentage without regular medication in recent 3 months were higher in the late diagnosed group than early group (26.5% vs. 20.7%, P=0.02; 34.7% vs. 28.6%, P=0.02).

Conclusion

Our findings depicted a detailed spectrum of diagnostic delay in Chinese axSpA, verified five associated factors and pinpointed a remarkable treatment delay even after diagnosis, especially in late diagnosis group.

References

[1]Masson Behar V, Dougados M, Etcheto A, Kreis S, Fabre S, Hudry C, et al. Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients. Joint bone spine. 2017;84(4):467-71.

Figure 1.

Cumulative distribution of age at onset and age at diagnosis in Chinese axSpA

(A) the entire group. (B) stratified by early and late diagnosed group. (C) stratified by education level (college, middle school, secondary school). (D) stratified by history of peripheral arthritis when diagnosed. (E) stratified by history of misdiagnoses when diagnosed. (F) stratified by native place, as statistical significance was found between eastern coastal and western China, only these two groups were presented.

Disclosure of Interests

None declared

[MicroRNA-132 promotes atherosclerosis by inducing mitochondrial oxidative stressmediated ferroptosis]

OBJECTIVE

To explore the expression of microRNA-132 (miR-132) and its potential role in the development of atherosclerosis (AS).

METHODS

Thirty AS samples and 30 samples of normal peripheral vessels were collected from atherosclerotic patients undergoing peripheral angiostomy in our hospital for detecting the expression level of miR-132 using RT-qPCR. The expression of miR-132 in human umbilical vein endothelial cells (HUVEC) was up-regulated by liposome transfection, and intracellular reactive oxygen species (ROS), localization relationship between ROS and mitochondria, functional changes of mitochondrial reactive oxygen superoxide species (mtROS), mitochondrial membrane potential (MMP) and opening of mitochondrial permeability transition pore (mPTP) were analyzed by flow cytometry and laser confocal microscopy. The activity of mitochondrial redox respiratory chain complex (type I, II, III, IV and V) in HUVECs was detected using ELISA, and the expression levels of key iron death proteins were detected with Western blotting.

RESULTS

RT-qPCR results showed that miR-132 was significantly up-regulated in atherosclerotic plaques compared with normal vascular samples (P < 0.001). Compared with control HUVECs, HUVECs overexpressing miR-132 showed a significantly increased level of intracellular ROS (P < 0.001), and most of ROS was colocalized with mitochondria. HUVECs overexpressing miR-132 also showed significantly decreased MMP (P < 0.001) and obviously increased mtROS (P < 0.001) and opening of mPTP (P < 0.001), which led to mitochondrial REDOX respiratory chain stress disorder. The key iron death protein GPX4 was significantly down-regulated and the oxidized protein NOX4 was significantly increased in miR-132-overexpressing HUVECs (P < 0.001).

CONCLUSION

MiR-132 promotes atherosclerosis by inducing mitochondrial oxidative stress-mediated ferroptosis, which may serve as a promising therapeutic target for AS.

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

Background

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

Patients and methods

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

Results

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

Conclusion

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

•

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

•

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

•

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

339 Immune profiling to investigate improved survival in patients with metastatic triple-negative breast cancer receiving trilaciclib prior to chemotherapy

Background

Trilaciclib is an intravenous cyclin-dependent kinase 4/6 inhibitor approved to reduce the incidence of chemotherapy-induced myelosuppression in patients with extensive-stage small cell lung cancer (myeloprotection). In a randomized, open-label phase 2 trial in patients with metastatic triple-negative breast cancer (mTNBC), adding trilaciclib prior to gemcitabine/carboplatin (GCb) increased overall survival in both PD-L1–positive and –negative populations versus GCb alone.1 2 We investigated potential immune mechanisms of anti-tumor efficacy among patients who received trilaciclib plus GCb.

Methods

Peripheral blood was collected prior to and on treatment for flow cytometric analysis, and total RNA isolated from diagnostic tumor biopsies for sequencing. Differential gene expression analysis between responders and non-responders was based on negative binomial distribution and related pathways identified by Kyoto Encyclopedia of Genes and Genomes pathway analysis. Tumor inflammation signatures and deconvolution-based approaches were used to assess the tumor immune microenvironment. PD-L1 expression was considered positive if ≥1% of the total tumor area contained PD-L1–labelled immune cells (Ventana SP142 assay). Patients were defined as responders (confirmed complete or partial response) or non-responders (stable or progressive disease) according to RECIST criteria.

Results

Of 68 patients who received trilaciclib prior to GCb, tumor response status and RNA sequencing data were available for 51 patients, comprising 24 responders and 27 non-responders. Tumors from responders had 253 differentially expressed genes compared with non-responders. Analysis of immune gene signatures revealed a higher T-cell exhaustion score at baseline among responders versus non-responders (P=0.044).Among patients with PD-L1–positive tumors, responders had a greater peripheral immune response at baseline compared with non-responders, including more T cells (P=0.037; particularly memory CD8 T cells [P=0.042]), and a trend toward fewer myeloid-derived suppressor cells (MDSCs). Additionally, tumors from responders had more dendritic cells (P=0.044) and a trend toward enriched tumor inflammation signatures compared with non-responders.By contrast, among patients with PD-L1–negative tumors, responders had similar peripheral immune populations at baseline compared with PD-L1–negative non-responders, but fewer MDSCs (P=0.016), and a trend toward increased T-cell numbers after two cycles of trilaciclib plus GCb.Responders with both PD-L1–positive and –negative tumors had increased numbers of naïve CD8 T cells after two treatment cycles compared with non-responders.

Conclusions

The data suggest that adding trilaciclib prior to GCb enhances antitumor efficacy by modulating the composition of immune cell subsets. The impact of trilaciclib on changes to the tumor-infiltrating immune response is being further investigated in a phase 3 trial in patients with mTNBC (NCT04799249).

Acknowledgements

Flow cytometry and RNA sequencing analyses were performed by Covance, Inc., and Q2 Laboratory Solutions, respectively.

Trial Registration

www.clinicaltrials.govNCT02978716

References

Tan AR, Wright GS, Thummala AR, Danso MA, Popovic L, Pluard TJ, Han HS, Vojnović Ž, Vasev N, Ma L, Richards DA, Wilks ST, Milenković D, Yang Z, Antal JM, Morris SR, O’Shaughnessy J. Trilaciclib plus chemotherapy versus chemotherapy alone in patients with metastatic triple-negative breast cancer: a multicentre, randomised, open-label, phase 2 trial. Lancet Oncol 2019;20(11):1587–1601.

O’Shaughnessy J, Wright GS, Thummala AR, Danso MA, Popovic L, Pluard TJ, Han HS, Vojnović Ž, Vasev N, Ma L, Richards DA, Wilks ST, Milenković D, Xiao J, Sorrentino JA, Horton J, Tan AR. Abstract PD1-06: trilaciclib improves overall survival when given with gemcitabine/carboplatin in patients with metastatic triple-negative breast cancer: final analysis of a randomized phase 2 trial. Cancer Res 2021;81(4 Supplement):PD1-06.

Ethics Approval

The study protocol and all associated amendments and study-related materials were approved by the institutional review board or independent ethics committee of each investigational site.

Is simple reaction time or choice reaction time an indicator of all-cause mortality or CVD mortality?

OBJECTIVES

Simple reaction time (SRT) and choice reaction time (CRT) have been shown to be good indicators for quantitatively assessing the level of human cognitive impairment, but these parameters have also been linked to the risk of human death. This study aimed to quantitatively assess the independent predictive value of SRT or CRT for all-cause mortality or cardiovascular disease (CVD) mortality by conducting a meta-analysis of prospective studies.

STUDY DESIGN

The study design of this study is a prospective cohort study.

METHODS

We conducted a meta-analysis by combining hazard ratios (HRs) and 95% confidence intervals (95% CIs) of SRT or CRT with all-cause mortality or CVD mortality in healthy community residents aged 18 and over. Heterogeneity was evaluated by using Q statistics and Cochrane's I² statistics.

RESULTS

A total of seven prospective studies that examined all-cause mortality and CVD mortality were included. The pooled HR of all-cause mortality in SRT was 1.099 (1.065-1.134, I² = 11.9%), and an increased risk of CVD mortality was associated with lower SRT (HR = 1.186, 95% CI = 1.137-1.236; I² = 52.4%). Similarly, the pooled HR of all-cause mortality in CRT was 1.140 (95% CI = 1.085-1.197, I² = 33.7%). However, lower CRT was not statistically associated with an increased risk of CVD mortality.

CONCLUSION

SRT may be a predictor of all-cause-mortality and CVD mortality, and CRT is significantly associated with an increased risk of all-cause mortality.

Smoking and incidence of insomnia: a systematic review and meta-analysis of cohort studies

OBJECTIVE

This study investigated the impact of smoking on the incidence of insomnia.

STUDY DESIGN

Systematic review and meta-analysis of cohort studies.

METHODS

PubMed, EMBASE, Web of Science, Cochrane Library, and OVID were searched through March 2020. Cohort studies reporting the effect of smoking on the incidence of insomnia were included. We quantitatively analyzed the basic framework and study characteristics and then pooled estimate effects with 95% confidence intervals (CIs) of outcomes of each included study using fixed-effects meta-analyses.

RESULTS

This systematic review included six cohort studies involving 12,445 participants. Quantitatively summarized results suggested that smoking could significantly increase the incidence of insomnia (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.13). Regular smoking was significantly associated with the incidence of insomnia (OR = 1.07, 95% CI: 1.01, 1.13). As for occasional smokers and ex-smokers, the pooled analysis did not indicate a significant association (occasional smoker: OR = 2.09, 95% CI: 0.44, 9.95; ex-smoker; OR = 1.02, 95% CI: 0.67, 1.54). Subgroup analysis by age, gender ratio, and region showed a statistically significant relationship between smoking and the incidence of insomnia in specific groups.

CONCLUSIONS

Integrated longitudinal observational evidence identified smoking as a significant risk factor of insomnia. Considering the limited amount of available studies, more high-quality and prospective cohort studies of large sample sizes are needed to explore details of this association.

Single-cell ATAC and RNA sequencing reveal pre-existing and persistent cells associated with prostate cancer relapse

Prostate cancer is heterogeneous and patients would benefit from methods that stratify those who are likely to respond to systemic therapy. Here, we employ single-cell assays for transposase-accessible chromatin (ATAC) and RNA sequencing in models of early treatment response and resistance to enzalutamide. In doing so, we identify pre-existing and treatment-persistent cell subpopulations that possess regenerative potential when subjected to treatment. We find distinct chromatin landscapes associated with enzalutamide treatment and resistance that are linked to alternative transcriptional programs. Transcriptional profiles characteristic of persistent cells are able to stratify the treatment response of patients. Ultimately, we show that defining changes in chromatin and gene expression in single-cell populations from pre-clinical models can reveal as yet unrecognized molecular predictors of treatment response. This suggests that the application of single-cell methods with high analytical resolution in pre-clinical models may powerfully inform clinical decision-making.

Characterization of serum adiponectin and leptin in healthy perinatal dairy cows or cows with ketosis, and their effectson ketosis involved indices

We investigated changes in concentrations of ADP (adiponectin), LEP (leptin), BHBA (beta-hydroxybutyric acid), NEFA (non-esterified fatty acid), Glucose (Glu) and INS (insulin) in serum of healthy perinatal dairy cows and cows with ketosis. Twenty-one healthy cows and seventeen cows with ketosis from a herd of a total 60 Holstein cows (near dry period i.e. 56 days antepartum) were selected. Blood was collected through the tail vein every 7 days, from 56 day antepartum to 56 day postpartum. Serum ADP, LEP, BHBA, NEFA, Glu, and INS concentrations were determined, and ketosis was diagnosed through serum BHBA (≥1.2 mmol/L). We showed the concentration of serum adipokines and energy balancing indices were stable during antepar- tum period. However, ADP concentration increased while LEP decreased, and there were a significant increase in cows with ketosis compared to that of in healthy cows. Serum BHBA and NEFA concentrations increased significantly at first, and then gradually decreased in both healthy cows and cows with ketosis. However, cows with ketosis showed higher concentrations of BHBA and NEFA which restored later. The serum concentration of Glu in both healthy dairy cows and cows with ketosis showed a decreasing trend. INS concentration in healthy cows was decreased while it was increased in cows with ketosis. The results reflect the extent of hypo- glycemia and lipid mobilization postpartum, suggest IR exists in cows with ketosis while serum ADP and LEP might play roles in the development of ketosis.

Phenomenological Constraints on the Transport Properties of QCD Matter with Data-Driven Model Averaging

Using combined data from the Relativistic Heavy Ion and Large Hadron Colliders, we constrain the shear and bulk viscosities of quark-gluon plasma (QGP) at temperatures of ∼150-350  MeV. We use Bayesian inference to translate experimental and theoretical uncertainties into probabilistic constraints for the viscosities. With Bayesian model averaging we propagate an estimate of the model uncertainty generated by the transition from hydrodynamics to hadron transport in the plasma's final evolution stage, providing the most reliable phenomenological constraints to date on the QGP viscosities.

[The correlation between the severity of uncovertebral joints degeneration and heterotopic ossification after single-level artificial cervical disc replacement]

Objective: To investigate the correlation between the severity of uncovertebral joints degeneration and heterotopic ossification (HO) after single-level artificial cervical disc replacement (ACDR). Methods: From January 2005 to January 2016, 70 patients who had undergone single-level ACDR in Peking University Third Hospital and had at least 5 years follow-up were included in this study. There were 35 males and 35 females with an average age of (42±8) years (range, 25-62 years). Cervical spine A-P X-rays were taken to assess the degeneration of uncovertebral joints and lateral X-rays were taken to assess the degeneration of intervertebral space. Cervical spine lateral and the flexion-extension X-rays at 5 years follow up were taken to assess HO. Degeneration of uncovertebral joints were evaluated by the classification system set-up in Peking University Third Hospital. Kellgren&Lawrence grading system was used to evaluate the degeneration of intervertebral space. HO was evaluated by the McAfee grading standards. The data were collected before surgery and at 5-years follow-up, then the correlation between degeneration of uncovertebral joints, degeneration of intervertebral space and HO was analyzed with Spearman non-parametric test. Results: The average follow-up time of 70 patients was (62.7±4.8) years (range, 52-74 months). There was a significant positive correlation between preoperative uncovertebral joints degeneration and HO after ACDR (r=0.585, P<0.01). There was a significant positive correlation between preoperative intervertebral space degeneration and HO (r=0.557, P<0.01). There was a significant positive correlation between preoperative intervertebral space degeneration and preoperative uncovertebral joints degeneration (r=0.727, P<0.01). Conclusion: There is a significant positive correlation between preoperative uncovertebral joints degeneration and HO after ACDR.