Fluoroscopically calibrated 3D-printed patient-specific instruments improve the accuracy of osteotomy during bone tumor resection adjacent to joints

BACKGROUND

Inadequate surface matching, variation in the guide design, and soft tissue on the skeletal surface may make it difficult to accurately place the 3D-printed patient-specific instrument (PSI) exactly to the designated site, leading to decreased accuracy, or even errors. Consequently, we developed a novel 3D-printed PSI with fluoroscopy-guided positioning markers to enhance the accuracy of osteotomies in joint-preserving surgery. The current study was to compare whether the fluoroscopically calibrated PSI (FCPSI) can achieve better accuracy compared with freehand resection and conventional PSI (CPSI) resection.

METHODS

Simulated joint-preserving surgery was conducted using nine synthetic left knee bone models. Osteotomies adjacent to the knee joint were designed to evaluate the accuracy at the epiphysis side. The experiment was divided into three groups: free-hand, conventional PSI (CPSI), and fluoroscopically Calibrated PSI (FCPSI). Post-resection CT scans were quantitatively analyzed. Analysis of variance (ANOVA) was used.

RESULT

FCPSI improved the resection accuracy significantly. The mean location accuracy is 2.66 mm for FCPSI compared to 6.36 mm (P < 0.001) for freehand resection and 4.58 mm (P = 0.012) for CPSI. The mean average distance is 1.27 mm compared to 2.99 mm (p < 0.001) and 2.11 mm (p = 0.049). The mean absolute angle is 2.16° compared to 8.50° (p < 0.001) and 5.54° (p = 0.021). The mean depth angle is 1.41° compared to 8.10° (p < 0.001) and 5.32° (p = 0.012). However, there were no significant differences in the front angle compared to the freehand resection group (P = 0.055) and CPSI (P = 0.599) group. The location accuracy observed with FCPSI was maintained at 4 mm, while CPSI and freehand resection exhibited a maximum deviation of 8 mm.

CONCLUSION

The fluoroscopically calibrated 3D-printed patient-specific instruments improve the accuracy of osteotomy during bone tumor resection adjacent to joint joints compared to conventional PSI and freehand resection. In conclusion, this novel 3D-printed PSI offers significant accuracy improvement in joint preserving surgery with a minimal increase in time and design costs.

Role of Rain in the Spore Dispersal of Fungal Pathogens Associated with Grapevine Trunk Diseases

Grapevine trunk diseases are caused by a complex of fungi that belong to different taxa, which produce different spore types and have different spore dispersal mechanisms. It is commonly accepted that rainfall plays a key role in spore dispersal, but there is conflicting information in the literature on the relationship between rain and spore trapping in aerobiology studies. We conducted a systematic literature review, extracted quantitative data from published papers, and used the pooled data for Bayesian analysis of the effect of rain on spore trapping. We selected 17 papers covering 95 studies and 8,778 trapping periods, concerning a total of 26 fungal taxa causing Botryosphaeria dieback (BD), Esca complex (EC), and Eutypa dieback (ED). Results confirmed the role of rain in the spore dispersal of these fungi but revealed differences among the different fungi. Rain was a good predictor of spore trapping for ED (AUROC = 0.820) and BD (0.766) but not for the ascomycetes involved in EC (0.569) and not for the only basidiomycetes, Fomitiporella viticola, studied as for spore discharge (AUROC not significant). Prediction of spore trapping was more accurate for negative prognosis than for positive prognosis; a rain cutoff of ≥0.2 mm provided an overall accuracy of ≥0.61 for correct prognoses. Spores trapped in rainless periods accounted for only <10% of the total spores. Our analysis had some drawbacks, which were mainly caused by knowledge gaps and limited data availability; these drawbacks are discussed to facilitate further research.

Direct contact between tumor cells and platelets initiates a FAK-dependent F3/TGF-β positive feedback loop that promotes tumor progression and EMT in osteosarcoma

Platelets have received growing attention for their roles in hematogenous tumor metastasis. However, the tumor-platelet interaction in osteosarcoma (OS) remains poorly understood. Here, using platelet-specific focal adhesion kinase (FAK)-deficient mice, we uncover a FAK-dependent F3/TGF-β positive feedback loop in OS. Disruption of the feedback loop by inhibition of F3, TGF-β, or FAK significantly suppresses OS progression. We demonstrate that OS F3 initiated the feedback loop by increasing platelet TGF-β secretion, and platelet-derived TGF-β promoted OS F3 expression in turn and modulated OS EMT process. Immunofluorescence results indicate platelet infiltration in OS niche and we verified it was mediated by platelet FAK. In addition, platelet FAK was proved to mediate platelet adhesion to OS cells, which was vital for the initiation of F3/TGF-β feedback loop. Collectively, these findings provide a rationale for novel therapeutic strategies targeting tumor-platelet interplay in metastatic OS.

Exploring the molecular mechanisms and shared gene signatures between celiac disease and ulcerative colitis based on bulk RNA and single-cell sequencing: Experimental verification

Many immune-mediated diseases have the common genetic basis, as an autoimmune disorder, celiac disease (CeD) primarily affects the small intestine, and is caused by the ingestion of gluten in genetically susceptible individuals. As for ulcerative colitis (UC), which most likely involves a complex interplay between some components of the commensal microbiota and other environmental factors in its origin. These two autoimmune diseases share a specific target organ, the bowel. The etiology and immunopathogenesis of both conditions characterized by chronic intestinal inflammation, ulcerative colitis and celiac disease, are not completely understood. Both are complex diseases with genetics and the environmental factors contributing to dysregulation of innate and adaptive immune responses, leading to chronic inflammation and disease. This study is designed to further clarify the relationship between UC and CeD. The GEO database was used to download gene expression profiles for CeD (GSE112102) and UC (GSE75214). The GSEA KEGG pathway analysis revealed that immune-related pathways were significantly associated with both diseases. Further, we screened 187 shared differentially expressed genes (DEGs) of the two diseases. Gene Ontology (GO) and WikiPathways were carried out to perform the biological process and pathway enrichment analysis. Subsequently, based on the DEGs, the least absolute shrinkage and selection operator (LASSO) analysis was performed to screen for the diagnostic biomarkers of the diseases. Moreover, single-cell RNA-sequencing (RNA-seq) data from five colonic propria with UC showed that REG4 expression was present in Goblet cell, Enteroendocrine cell, and Epithelial. Finally, our work identified REG4 is the shared gene of UC and CeD via external data validation, cellular experiments, and immunohistochemistry. In conclusion, our study elucidated that abnormal immune response could be the common pathogenesis of UC and CeD, and REG4 might be a key potential biomarker and therapeutic target for the comorbidity of these two diseases.

Temporal Dynamics and Dispersal Patterns of the Primary Inoculum of Coniella diplodiella, the Causal Agent of Grape White Rot

Grape white rot can cause considerable yield losses in viticulture areas worldwide and is principally caused by Coniella diplodiella. The fungus overwinters in berry mummies on the soil surface or on the trellis and produces pycnidia and conidia that serve as primary inoculum. However, little is known about the temporal dynamics and dispersal pattern of C. diplodiella conidia. In this study, we investigated the production and dispersal of C. diplodiella conidia from a primary inoculum source, namely, affected mummified berries that overwintered in two vineyards in northern Italy in 2021 and 2022. Conidia of C. diplodiella were repeatedly produced in berry mummies from the budburst of vines to harvesting, with approximately 50 and 75% of the total conidia in a season being produced before fruit set and véraison, respectively. The production dynamics of C. diplodiella conidia over time were described by a Weibull equation in which the thermal time is the independent variable, with a concordance correlation coefficient of ≥0.964. A rainfall cutoff of ≥0.2 mm provided an overall accuracy of ≥0.86 in predicting conidial dispersal through rain splashes from berry mummies on the soil surface, with the number of dispersed conidia increasing with the amount of rainfall. The dispersal of conidia from mummies on the trellis by washing with rain required at least 6.1 mm of rain. The proposed mathematical equations and rain cutoffs can be used to predict periods with a high dispersal risk of C. diplodiella.

Two-step osteotomy/discectomy through cannulated screw (TOCS) technique for en bloc resection of spine tumor: surgical technique and preliminary results

PURPOSE

We have developed a novel technique for osteotomy/discectomy during en bloc resection of spine tumors named two-step osteotomy/discectomy through cannulated screw (TOCS). This study aims at describing the procedure of TOCS technique and assessing its efficiency and safety.

METHODS

We retrospectively reviewed fourteen patients who underwent en bloc resection for spine tumors using TOCS technique in our center between August 2018 and September 2022. The technique was based on a specially designed "slotted" cannulated screw which was a cannulated screw with a longitudinal slot to provide the accessibility of T-saw. During osteotomy/discectomy, the "slotted" cannulated screw was inserted obliquely along the plane between the dura and the posterior wall of spine in light of the planned osteotomy/discectomy plane under routine fluoroscopic imaging guidance. The T-saw was introduced through the screw, and the osteotomy/discectomy was performed sequentially in two steps under the guidance of the screw by turning the slot away and toward the dura. The intra-/perioperative complication, neurological function (determined by Frankel grading), surgical margin (determined by a pathologist using AJCC R system), follow-up details were documented.

RESULTS

The mean duration of surgery was 599.3 (360-890) min with a mean volume of intra-operative hemorrhage of 2021.4 (800-5000) mL. The intra-/perioperative complications were found in four patients (28.6%). R0 and R1 resections were achieved in nine and five patients, respectively. There was no R2 resection. After a mean follow-up period of 30.6 (10-67) months, all patients were alive except one patient died ten months after surgery due to unrelated cause. No recurrence and implant failure were found. Thirteen patients (92.9%) exhibited completely normal neurological function same as their preoperative neurological status.

CONCLUSION

Using TOCS technique can facilitate a precise, complete and safe osteotomy/discectomy procedure during en bloc resection for spine tumor without the aid of intra-operative navigation.

Glucose oxidase and ruthenium nanorods-embedded self-healing polyvinyl alcohol/polyethylene imine hydrogel for simultaneous photothermal/photodynamic/starvation therapy and skin reconstruction

Tumor recurrence and wound healing represent significant burdens for tumor patients after the surgical removal of melanomas. Wound dressings with wound healing and anticancer therapeutic abilities could help to solve these issues. Thus, a hybrid hydrogel made of polyvinyl alcohol (PVA) and polyethylene imine (PEI) was prepared by cross-linking imine bond and boronic acid bond. This hydrogel was loaded with ruthenium nanorods (Ru NRs) and glucose oxidase (GOx) and named as nanocomposite hydrogel (Ru/GOx@Hydrogel), exhibiting remarkable photothermal/photodynamic/starvation antitumor therapy and wound repair abilities. Ru NRs are bifunctional phototherapeutic agents that simultaneously exhibit intrinsic photothermal and photodynamic functions. Three-dimensional composite hydrogel loaded with GOx can also consume glucose in the presence of O2 during tumor starvation therapy. Near-infrared (NIR) light-triggered hyperthermia can not only promote the consumption of glucose, but also facilitate the ablation of residual cancer cells. The antitumor effect of the Ru/GOx@Hydrogel resulted in significant improvements, compared to those observed with either phototherapy or starvation therapy alone. Additionally, the postoperative wound was substantially healed after treatment with Ru/GOx@Hydrogel and NIR irradiation. Therefore, the Ru/GOx@Hydrogel can be used as a multi-stimulus-responsive nanoplatform that could facilitate on-demand controlled drug release, and be used as a promising postoperative adjuvant in combination therapy.

Facile Preparation of Polyacrylonitrile-Based Activated Carbon Fiber Felts for Effective Adsorption of Dipropyl Sulfide

Activated carbon fibers (ACFs) derived from various polymeric fibers with the characteristics of a high specific surface area, developed pore structure, and good flexibility are promising for the new generation of chemical protection clothing. In this paper, a polyacrylonitrile-based ACF felt was prepared via the process of liquid phase pre-oxidation, along with a one-step carbonization and chemical activation method. The obtained ACF felt exhibited a large specific surface area of 2219.48 m2/g and pore volume of 1.168 cm3/g, as well as abundant polar groups on the surface. Owing to the developed pore structure and elaborated surface chemical property, the ACF felt possessed an intriguing adsorption performance for a chemical warfare agent simulant dipropyl sulfide (DPS), with the highest adsorption capacity being 202.38 mg/g. The effects of the initial concentration of DPS and temperature on the adsorption performance of ACF felt were investigated. Meanwhile, a plausible adsorption mechanism was proposed based on the kinetic analysis and fitting of different adsorption isotherm models. The results demonstrated that the adsorption process of DPS onto ACF felt could be well fitted with a pseudo-second-order equation, indicating a synergistic effect of chemical adsorption and physical adsorption. We anticipate that this work could be helpful to the design and development of advanced ACF felts for the application of breathable chemical protection clothing.

Tetrastigma hemsleyanum suppresses neuroinflammation in febrile seizures rats via regulating PKC-δ/caspase-1 signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Tetrastigma hemsleyanum Diels et Gilg (T. hemsleyanum, Sanyeqing) has been used in the prevention and treatment of repetitive Febrile seizures (FS) over the centuries in China.

AIM OF THE STUDY

T. hemsleyanum exerts wide pharmacological action, which has been widely used for treating various diseases, including infantile febrile seizure. However, the systematic study on this herb's material basis and the functional mechanism is lacking. This study intended to systematically elucidate the mechanism of T. hemsleyanum against febrile seizures.

MATERIALS AND METHODS

The efficacy of T. hemsleyanum was estimated by using a hot bath as a model of FS, the onset and duration of seizure, morphological structure changes of hippocampal neurons as well as magnetoencephalography were applied to evaluate the effects. Meanwhile, the bioactive components of T. hemsleyanum responsible for the therapeutic effect of T. hemsleyanum on FS were identified by UPLC-MS/MS. Then we systematically elucidated the mechanism of T. hemsleyanum based on metabonomics, transcriptomics, network pharmacological and experimental validation.

RESULTS

In a hyperthermia-induced FS model of rats, T. hemsleyanum significantly increased the seizure latency and decreased seizure duration, alleviating the abnormal delta and gamma band activity during epileptic discharge. Furthermore, ten chemical components of ethanol extracts from T. hemsleyanum were identified by UPLC-MS/MS, including quercetin, kaempferol, and procyanidin B1 and so on, which was consistent with the network pharmacology prediction. The serum metabolomics indicated that T. hemsleyanum mainly acts on inflammation regulation and neuroprotection by the glycerophospholipid metabolism pathway. Ninety-two potential targets of T. hemsleyanum on FS were identified by network pharmacology, and TNF, IL-6, and IL-1β were considered the pivotal targets. In the hippocampus transcriptomics, 17 KEGG pathways were identified after T. hemsleyanum treatment compared with the FS model group, among which 15 pathways overlapped with those identified by network pharmacology, and the PKC-δ/caspase-1 signaling pathway was a critical node. Finally, in vivo experiments also verified T. hemsleyanum inhibited the activation of microglia and resulted in a significant reduction in the level of PKCδ, NLRC4, caspase-1, IL-1β, IL-6 and TNF-α in hippocampus of FS rats.

CONCLUSIONS

Our study suggested that the therapeutic effect of T. hemsleyanum on FS might be regulated by inhibiting the neuroinflammation, thus exerting an anticonvulsant effect in vivo, and the mechanism might be related to regulating the PKC-δ/caspase-1 signaling pathway.

Temperature-dependent sporulation of the fungus Coniella diplodiella, the causal agent of grape white rot

White rot, caused by the fungus Coniella diplodiella, can severely reduce grapevine yields worldwide. Currently, white rot control mainly relies on fungicides applied on a calendar basis or following hailstorms that favor disease outbreak; however, the control achieved with this strategy is often inconsistent or otherwise unsatisfactory. Realizing more rational control requires an improved understanding of white rot epidemiology. Toward this end, we conducted experiments with grapevine berries of two Vitis vinifera cultivars (either injured or not before artificial inoculation with a conidia suspension of C. diplodiella) to determine the effect of temperature on the length of latency (i.e., the time between infection and onset of mature pycnidia on berries) and the production of pycnidia and conidia. Sporulation occurred between 10°C and 35°C, with the optimum detected at 20°C. The latency period was shorter at 25-35°C than at lower temperatures; the shortest latency period was 120 h at 30°C on injured berries. Affected berries produced abundant conidia at 15-30℃ (the optimum was 20℃) for more than two months following inoculation. Mathematical equations were developed that fit the data, with strong associations with temperature for latency period (R2 = 0.831) and for the production dynamics of secondary conidia (R2 = 0.918). These equations may contribute to the development of a risk algorithm to predict infection periods, which can inform risk-based rather than calendar-based disease control strategies.

Distinctive biochemistry profiles associated with hyperuricemia between Tibetans and Hans in China

Purpose

We sought to identify distinct risk factors for hyperuricemia in native Tibetan and immigrant Han populations in Tibet, China.

Methods

Three cohorts of male participants aged between 20 and 40 years were enrolled in this study. Biochemical parameters including serum uric acid (UA), fasting plasma glucose, insulin, lactate dehydrogenase (LDH), thyroxin, blood cell count, aminotransferase, and lipid profiles were analyzed. The association of risk factors with UA levels was evaluated using a multivariable line regression model. The effect of UA level on the biochemical parameters between the Hans and Tibetans was evaluated by two-way ANOVA.

Results

The prevalence of hyperuricemia (≥420 μmol/L) was 24.8% (62/250) in the Hans, similar to 23.8% (29/136) in the Tibetans. In the regression analysis, the risk factors that were significantly associated with UA in Hans did not apply to Tibetans. Tibetans had higher fasting insulin (P<0.05) and LDH (P<0.01) levels, in contrast with lower levels of triglycerides (P<0.05), total cholesterol (P<0.01), and low-density lipoprotein-cholesterol (P<0.01) than Hans in normal UA populations. Biochemistry analysis revealed lower albumin levels (P<0.001) and higher levels of all aminotransaminase and especially alkaline phosphatase (P<0.01) in Tibetans than in Hans in both populations. Compared with Hans, Tibetans had lower serum levels of urea, creatinine, and electrolytes in the normal UA population, which were further exacerbated in the high UA population. Tibetans had comparable white blood cell counts as Hans in both normal and high UA populations. In contrast, the red blood cell count and hemoglobin concentration were much lower in Tibetans than in Hans under high UA conditions.

Conclusions

The distinctive biochemistry between Tibetans and Hans may underlie the different etiologies of hyperuricemia in Tibet, China.

Population pharmacokinetic and exposure-response analyses of pemigatinib in patients with advanced solid tumors including cholangiocarcinoma

Pemigatinib is a selective, potent, oral inhibitor of fibroblast growth factor receptor (FGFR)1-3 with efficacy in patients with previously treated, advanced/metastatic cholangiocarcinoma (CCA) with FGFR2 alterations. A previously developed population pharmacokinetic (PK) model of pemigatinib was refined using an updated dataset with 467 participants from seven clinical studies, including patients with CCA. Updated PK model parameters were used to evaluate the association between pemigatinib exposure and efficacy and safety. Pemigatinib PK was adequately described by a two-compartment model with linear elimination and sequential zero- and first-order absorption. The final model successfully minimized, had a successful covariance step, and showed unbiased goodness-of-fit. Estimated first-order absorption rate constant and apparent clearance were 3.7/h and 10.7 L/h, respectively. Sex, baseline body weight, and concomitant use of phosphate binders, proton pump inhibitors, or histamine-2 antagonists significantly impacted PK parameters; however, the impact of covariates on PK exposure was not clinically significant. Steady-state pemigatinib exposure and mean change from baseline in serum phosphate concentration were associated with objective response rate in a bell-shaped relationship and were significantly associated with increased hyperphosphatemia. Pemigatinib exposure was associated with treatment-emergent adverse events, such as decreased appetite, nausea, and stomatitis, although the relationships were shallow. Overall, analyses indicate that 13.5 mg pemigatinib once daily in 21-day cycles (2 weeks on, 1 week off) offers a favorable benefit-risk profile in patients with advanced/metastatic or surgically unresectable CCA and is the optimal dose for clinical development.

Seasonal periodicity of the airborne spores of fungi causing grapevine trunk diseases: an analysis of 247 studies published worldwide

Grapevine trunk diseases (GTDs) are among the most devastating grapevine diseases globally. GTDs are caused by multiple fungi from various taxa, which release spores into the vineyard and infect wood tissue, mainly through wounds caused by viticultural operations. The timing of operations to avoid infection is critical concerning the periodicity of GTD spores in vineyards, and many studies have been conducted in different grape-growing areas worldwide. However, these studies provide conflicting and fragmented information. To synthesize current knowledge, we performed a systematic literature review, extracted quantitative data from published papers, and used these data to identify trends and knowledge gaps to be addressed in future studies. Our database included 26 papers covering 247 studies and 3,529 spore sampling records concerning a total of 29 fungal taxa responsible for Botryosphaeria dieback (BD), Esca complex (EC), and Eutypa dieback (ED). We found a clear seasonality in the presence and abundance of BD spores, with a peak from fall to spring, more in the northern than in the southern hemisphere, but not for EC and ED. Spores of these fungi were present throughout the growing season in both hemispheres, possibly due to higher variability in spore types, sporulation conditions, and spore release mechanisms in EC and ED fungi compared to BD. Our analysis has limitations due to knowledge gaps and data availability for some fungi (e.g., Basidiomycetes, causing EC). These limitations are discussed to facilitate further research.

Serum Exosomes-Based Biomarker circ_0008928 Regulates Cisplatin Sensitivity, Tumor Progression, and Glycolysis Metabolism by miR-488/HK2 Axis in Cisplatin-Resistant Nonsmall Cell Lung Carcinoma

Background: Nonsmall cell lung carcinoma (NSCLC) is a major cause of cancer-related death worldwide. The resistance of NSCLC to chemical drugs, such as cisplatin (CDDP), poses a heavy burden for NSCLC therapy. Herein, the effects of circular_0008928 (circ_0008928) on the CDDP sensitivity and biological behavior of CDDP-resistant NSCLC cells and underlying mechanism are revealed. Materials and Methods: The expression of circ_0008928 and microRNA-488 (miR-488) was detected by quantitative real-time polymerase chain reaction. The expression of hexokinase 2 (HK2) protein and exosome-specific proteins was determined by Western blot. The half-maximal inhibitory concentration (IC50) value of CDDP was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cell proliferation and migratory and invasive abilities were illustrated by cell counting kit-8 and transwell assays. Cell glycolysis metabolism was illustrated by extracellular acidification rate assay, glucose kit and lactate kit assays and Western blot analysis. The binding sites between miR-488 and circ_0008928 or HK2 were predicted by starbase or microT-CDS online database, and identified by dual-luciferase reporter and RNA immunoprecipitation assays. Results: Circ_0008928 expression and HK2 protein expression were significantly upregulated, while miR-488 expression was obviously downregulated in NSCLC cells and CDDP-resistant NSCLC cells. Circ_0008928 expression was increased in serum exosomes of CDDP-resistant NSCLC patients compared with CDDP-sensitive NSCLC patients. In addition, circ_0008928 silencing improved CDDP sensitivity and attenuated CDDP-induced cell proliferation, migration, invasion, and glycolysis metabolism. Circ_0008928 was a sponge of miR-488, and miR-488 bound to HK2 in CDDP-resistant NSCLC cells. Furthermore, both miR-488 inhibitor and HK2 overexpression attenuated circ_0008928 absence-mediated impacts on CDDP sensitivity and tumor process in CDDP-resistant NSCLC. Conclusions: Circ_0008928 knockdown improved CDDP sensitivity and hindered cell proliferation, migration, invasion, and glycolysis metabolism by miR-488/HK2 axis in CDDP-resistant NSCLC. This finding provides a new mechanism for studying CDDP-resistant therapy in NSCLC.

The role of tumor immune microenvironment in chordoma: promising immunotherapy strategies

Chordoma is a rare malignant bone tumor with limited therapeutic options, which is resistant to conventional chemotherapy and radiotherapy, and targeted therapy is also shown with little efficacy. The long-standing delay in researching its mechanisms of occurrence and development has resulted in the dilemma of no effective treatment targets and no available drugs in clinical practice. In recent years, the role of the tumor immune microenvironment in driving tumor growth has become a hot and challenging topic in the field of cancer research. Immunotherapy has shown promising results in the treatment of various tumors. However, the study of the immune microenvironment of chordoma is still in its infancy. In this review, we aim to present a comprehensive reveal of previous exploration on the chordoma immune microenvironment and propose promising immunotherapy strategies for chordoma based on these characteristics.

Facile and efficient preparation of amino bearing metal-organic frameworks-coated cotton fibers for solid-phase extraction of non-steroidal anti-inflammatory drugs in human plasma

The determination of blood concentration of non-steroidal anti-inflammatory drugs (NSAIDs) is highly desired in clinical practice. In this work, three amino bearing metal-organic frameworks (amino-MOFs) coated cotton fibers were prepared using a facile cysteine-triggered in situ growth strategy and proposed as in-tip solid-phase microextraction (in-SPME) adsorbents for efficient extraction of non-steroidal anti-inflammatory drugs from human plasma. The self-made adsorbents exhibited satisfactory extraction performance toward three NSAIDs including diclofenac sodium, ketoprofen and flurbiprofen. Under the optimized conditions, the established method exhibited satisfactory enrichment performance, low limits of detection and excellent extraction efficiency. Good reproducibility, wide linear range, excellent linearity and satisfactory sensitivity were obtained in the experiment. The method was also used for the enrichment and determination of NSAIDs in human plasma samples. Good recoveries were obtained, ranging from 66.5% to 98.9% with relative standard deviations less than 6.62%. The good performance of amino-MOFs was due to the synergistic effects arising from grafted charged amino groups within ordered pores of suitable size, leading to strong affinity towards guest molecules. Electrostatic interaction, hydrogen bond and π-π interaction played a vital role in the extraction of NSAIDs. This report indicated the potential of amino-MOFs as efficient adsorbents for the determination of NSAIDs from human plasma.

Optimal treatment strategy for recurrent hepatocellular carcinoma based on recurrence time and tumor size: A propensity score matching study

BACKGROUND

Recurrent hepatocellular carcinoma (RHCC) is commonly treated with transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) or repeated hepatectomy(RH), but the optimal treatment strategy is still controversial. This study aimed to compare the efficacy and safety of TACE-MWA and RH in RHCC patients after initial radical hepatectomy.

METHODS

A total of 210 RHCC patients were included between June 2014 and January 2021, with 126 patients in the TACE-MWA group and 84 patients in the RH group. The primary endpoints were median repeat recurrence-free survival (rRFS) and overall survival (OS), and the secondary endpoint was complications. Propensity-score matching (PSM) was conducted to minimize bias. Subgroup analysis based on recurrence patterns (recurrence time and tumor size) was performed, and prognostic factors were studied.

RESULTS

Before PSM, the RH group had better median OS (37.0 vs 26.0 months, P<0.001) and rRFS (15.0 vs 14.0 months, P = 0.003). After PSM, the RH group also had a better median OS (33.5 vs 29.0 months, P = 0.038), but there was no significant difference in median rRFS between the two groups (14.0 vs 13.0 months, P = 0.099). Subgroup analysis showed that when RHCC diameter>5 cm, RH had a better median OS (33.5 vs 25.0 months, P = 0.013) and rRFS (14.0 vs 10.9 months, P = 0.030). When the RHCC diameter was≤5 cm, there was no significant difference in the median OS (37.0 vs 31.0 months, P = 0.338) and rRFS (15.0 vs 17.0 months, P = 0.758) between the two groups. When RHCC relapses in the early stage (≤2 years), there is no significant difference in the median OS (26.0 vs 26.0 months, P = 0.310) and rRFS (12.0 vs 10.5 months, P = 0.089) between the two groups. When RHCC relapses in the late stage (>2 years), the RH group has better median OS (41.0 vs 33.0 months, P<0.001) and rRFS (30.0 vs 20.0 months, P = 0.010).

CONCLUSION

Individualized therapy is necessary for RHCC. TACE -MWA may be a good choice for RHCC with early recurrence or tumor diameter ≤5 cm. However, RH should be the first choice for RHCC with late recurrence or tumor diameter>5 cm.

99mTc-MDP bone scintigraphy-based growth evaluation and prediction of epiphysis around the knee: a study of paediatric limb salvage for malignant bone tumours

AIM

To investigate the feasibility of bone scintigraphy in the assessment and prediction of bone growth potential after limb-salvage surgery in children with bone tumours.

MATERIALS AND METHODS

Fifty-five skeletally immature patients with primary bone malignancies in distal femur was enrolled. Thirty-two patients received epiphysis minimally invasive endoprosthesis (EMIE) reconstruction, seven received hemiarthroplasty, and 16 received adult-type rotation-hinged endoprosthesis (ATRHE) reconstruction. All enrolled patients underwent radiographic examination at regular intervals and followed-up for >12 months. The actual limb length discrepancy (LLDa) of the tibia was measured on the radiography image. The expected LLD of tibia (LLDp) was calculated according to multiplier method. The uptake ratio of the ipsilateral epiphysis to the contralateral epiphysis (Ri/c) was calculated at bone scintigraphy. The Ri/c value was accommodated in the formula of multiplier method for a modification. The difference and correlation between the modified expected LLD (LLDm), LLDp and LLDa were analysed.

RESULTS

The growth potential of ipsilateral epiphysis was reserved in all patients who underwent hemiarthroplasty and one fourth of EMIE reconstruction. The Ri/c values in the hemiarthroplasty endoprosthesis group were significantly higher than the EMIE and ATRHE groups. There was no significant difference in Ri/c values between the EMIE and ATRHE group. Data from the 26 patients who reached bone maturation showed that there was a significant difference between LLDp and LLDa. LLDm showed a higher correlation with LLDa than LLDp.

CONCLUSION

Bone scintigraphy is helpful to evaluate the growth potential of epiphysis after surgery. The multiplier method modified by Ri/c value improves prediction accuracy of bone growth.

A single-center retrospective study of the COCO technique in the treatment of chronic internal carotid artery occlusion

OBJECTIVE

To introduce a novel endovascular recanalization method and to investigate its success rate, periprocedural complications, and early outcomes in patients with chronic internal carotid artery occlusion (CICAO). As this novel technique was designed to treat CICAO with a full coaxial system, we named it the COCO technique.

METHODS

Data from consecutive patients with symptomatic CICAO who underwent endovascular recanalization in our institution were retrospectively reviewed. The COCO technique allows extracranial angioplasty and stenting with occasional intracranial angioplasty and stenting as needed to be performed in a coaxial fashion. Patients' demographic and clinical information, morphologic characteristics, procedural results, complications, and follow-up outcomes were recorded.

RESULTS

Forty-nine patients were enrolled in this study. The technical success rate was 89.8% (44/49). Four patients experienced intraoperative complications, two patients had a slight subarachnoid hemorrhage, and two patients had asymptomatic dissection. Distal embolization or carotid-cavernous arteriovenous fistula was not detected. In addition, three patients developed hemorrhagic complications and three developed postoperative ischemic complications. All these patients improved after conservative treatment and subsequent rehabilitation. During the median 6 (3-6) months of follow-up, one patient died of severe pneumonia and two patients experienced recurrent ischemic events. In patients with successful recanalization, modified Rankin Scale scores were lower at the 3-month follow-up than at baseline (1 (0-2) vs 2 (1-2), P=0.04). Restenosis was observed in six (15.8%) patients.

CONCLUSIONS

Our study showed that the COCO technique is effective and safe for endovascular recanalization in patients with CICAO and has low periprocedural complications and favorable functional outcomes.

Integrated analysis of single-cell and bulk RNA sequencing data reveals an immunostimulatory microenvironment in tumor thrombus of osteosarcoma

Tumor thrombus of bone sarcomas represents a unique reservoir for various types of cancer and immune cells, however, the investigation of tumor thrombus at a single-cell level is very limited. And it is still an open question to identify the thrombus-specific tumor microenvironment that is associated with the tumor-adaptive immune response. Here, by analyzing bulk tissue and single-cell level transcriptome from the paired thrombus and primary tumor samples of osteosarcoma (OS) patients, we define the immunostimulatory microenvironment in tumor thrombus of OS with a higher proportion of tumor-associated macrophages with M1-like states (TAM-M1) and TAM-M1 with high expression of CCL4. OS tumor thrombus is found to have upregulated IFN-γ and TGF-β signalings that are related to immune surveillance of circulating tumor cells in blood circulation. Further multiplexed immunofluorescence staining of the CD3/CD4/CD8A/CD68/CCL4 markers validates the immune-activated state in the tumor thrombus samples. Our study first reports the transcriptome differences at a single-cell level between tumor thrombus and primary tumor in sarcoma.

Temperature-Dependent Growth and Spore Germination of Fungi Causing Grapevine Trunk Diseases: Quantitative Analysis of Literature Data

Grapevine trunk diseases (GTDs) are serious threats in all viticultural areas of the world, and their management is always complex and usually inadequate. Fragmented and inconsistent information on the epidemiology and environmental requirements of the causal fungi is among the reasons for poor disease control. Therefore, we conducted a quantitative analysis of literature data to determine the effects of temperature on mycelial growth and the effects of temperature and moisture duration on spore germination. Using the collected information, we then developed mathematical equations describing the response of mycelial growth to temperature, and the response of spore germination to temperature and moisture for the different species and disease syndromes. We considered 27 articles (selected from a total of 207 articles found through a systematic literature search) and 116 cases; these involved 43 fungal species belonging to three disease syndromes. The mycelial growth of the fungi causing Botryosphaeria dieback (BD) and the esca complex (EC) responded similarly to temperature, and preferred higher temperatures than those causing Eutypa dieback (ED) (with optimal temperature of 25.3, 26.5, and 23.3°C, respectively). At any temperature, the minimal duration of the moist period required for 50% spore germination was shorter for BD (3.0 h) than for EC (17.2 h) or ED (15.5 h). Mathematical equations were developed accounting for temperature-moisture relationships of GTD fungi, which showed concordance correlation coefficients ≥0.888; such equations should be useful for reducing the risk of infection.

Indocyanine green fluorescence imaging may detect tumour residuals during surgery for bone and soft-tissue tumours

The aim of this study was to determine the rate of indocyanine green (ICG) staining of bone and soft-tissue tumours, as well as the stability and accuracy of ICG fluorescence imaging in detecting tumour residuals during surgery for bone and soft-tissue tumours. ICG fluorescence imaging was performed during surgery in 34 patients with bone and soft-tissue tumours. ICG was administered intravenously at a dose of 2 mg/kg over a period of 60 minutes on the day prior to surgery. The tumour stain rate and signal-to-background ratio of each tumour were post hoc analyzed. After tumour resection, the tumour bed was scanned to locate sites with fluorescence residuals, which were subsequently inspected and biopsied. The overall tumour stain rate was 88% (30/34 patients), and specific stain rates included 90% for osteosarcomas and 92% for giant cell tumours. For malignant tumours, the overall stain rate was 94%, while it was 82% for benign tumours. The ICG tumour stain was not influenced by different pathologies, such as malignant versus benign pathology, the reception (or lack thereof) of neoadjuvant chemotherapies, the length of time between drug administration and surgery, the number of doses of denosumab for patients with giant cell tumours, or the tumour response to neoadjuvant chemotherapy. The overall accuracy rate of successfully predicting tumour residuals using fluorescence was 49% (23/47 pieces of tissue). The accuracy rate after en bloc resection was significantly lower than that after piecemeal resection (16% vs 71%; p < 0.001). A high percentage of bone and soft-tissue tumours can be stained by ICG and the tumour staining with ICG was stable. This approach can be used in both benign and malignant tumours, regardless of whether neoadjuvant chemotherapy is adopted. The technique is also useful to detect tumour residuals in the wound, especially in patients undergoing piecemeal resection.

Effects of Temperature and Moisture Duration on Spore Germination of Four Fungi that Cause Grapevine Trunk Diseases

Grapevine trunk diseases (GTDs) are serious threats worldwide and are difficult to control, in part because the environmental requirements for epidemiological processes of the causal fungi are poorly understood. Therefore, we investigated the effects of temperature and moisture duration on spore germination of four fungi associated with two GTDs (esca complex and Eutypa dieback): Phaeomoniella chlamydospora, Phaeoacremonium minimum, Cadophora luteo-olivacea, and Eutypa lata. Conidia of Phaeomoniella chlamydospora, Phaeoacremonium minimum, and C. luteo-olivacea were similar: conidia of these fungi germinated profusely (>90%) between 20 and 30°C; Phaeomoniella chlamydospora and Phaeoacremonium minimum tended to germinate at higher temperatures (up to 40°C for P. minimum), and C. luteo-olivacea at lower temperatures (as low as 5°C). E. lata ascospores germinated between 10 and 30°C. The required duration of moist periods for germination was shortest for C. luteo-olivacea (about 6 h), followed by P. minimum and E. lata (about 12 h) and Phaeomoniella chlamydospora (about 24 h). Further research on the environmental requirements of GTD fungi may increase our ability to predict infection periods and, thereby, improve disease control.

FIGHT-102: A phase 1 study of pemigatinib in Japanese patients with advanced malignancies

BACKGROUND

FIGHT-102 was a phase 1, dose-escalation, dose-expansion study of pemigatinib in Japanese patients with advanced solid tumors. Here, we report safety, tolerability, and preliminary efficacy of pemigatinib from FIGHT-102.

METHODS

Patients (≥20 years old) self-administered oral pemigatinib 9, 13.5, or 18 mg QD on intermittent dosing (Part 1) or 13.5 mg QD intermittent or continuous dosing (Part 2). A dosing cycle was 21 days (2 weeks on/1 week off or 21 continuous days). Primary endpoint was safety. Secondary endpoints were pharmacokinetics, pharmacodynamics, and preliminary efficacy.

RESULTS

Forty-four patients (Part 1, n = 14; Part 2, n = 30) were enrolled; most common tumors, cholangiocarcinoma, n = 8; esophageal, n = 6; 26 patients had confirmed FGF/FGFR alterations (Part 1, n = 3; Part 2, n = 23); 70.5% had ≥3 prior systemic therapies. Maximum tolerated dose was not identified. The recommended phase 2 dosage was determined to be 13.5 mg QD. Most common treatment-emergent adverse events (TEAEs) were hyperphosphatemia (81.8%), dysgeusia (45.5%), stomatitis (43.2%), and alopecia (38.6%); most frequent Grade ≥3 TEAEs were anemia and decreased appetite (9.1% each). In Part 1, no patient achieved partial response (PR) or complete response, and 7 (50.0%) patients had stable disease (SD). In Part 2, 5 (16.7%) patients achieved PR (one each with cholangiocarcinoma, gall bladder cancer, breast cancer, urothelial tract/bladder cancer, and sweat gland carcinoma) and 6 (20%) had SD. Median duration of response was 9.56 months (95% CI: 4.17, 14.95).

CONCLUSIONS

Pemigatinib demonstrated manageable adverse events, consistent pharmacokinetics and pharmacodynamics profiles, and preliminary efficacy in Japanese patients with advanced solid tumors.

Development of a model for Colletotrichum diseases with calibration for phylogenetic clades on different host plants

Fungi in the genus Colletotrichum cause serious pre- and post-harvest losses to several agricultural crops worldwide. Through a systematic literature review, we retrieved the published information on Colletotrichum anthracnose diseases on different host plants and developed a mechanistic model incorporating the main stages of the pathogen's life cycle and the effect of weather. The model predicts anthracnose progress during the growing season on the aerial organs of different crops, and was parameterized for seven Colletotrichum clades (acutatum, dematium, destructivum, gloeosporioides, graminicola, and orbiculare) and the singleton species, C. coccodes. The model was evaluated for the anthracnose diseases caused by fungi belonging to five clades on six hosts by using data from 17 epidemics that occurred in Italy, the USA, Canada, and Japan. A comparison of observed versus predicted data showed a concordance correlation coefficient of 0.928 and an average distance between real data and the fitted line of 0.044. After further validation, the model could be used to support decision-making for crop protection.

H4-methylation regulators mediated epitranscriptome patterns and tumor microenvironment infiltration characterization in hepatocellular carcinoma

Epigenetic modifications are involved in the remodeling of the tumor microenvironment (TME) and the regulation of immune response. Nonetheless, the role of histone H4 methylation (H4M) modification in the TME and immune regulation of hepatocellular carcinoma (HCC) is unknown. As a result, the purpose of this research is to discover H4M-mediated modification patterns and their effects on TME and immunologic characteristics in HCC. A total of 2305 samples were enrolled from 13 different cohorts. With the help of consensus clustering analysis, three distinct H4M modification patterns were identified. The cell-infiltrating characteristics of TME under these three patterns were highly consistent with their enriched biological processes and clinical outcome. The H4Mscore was then created using principal component analysis algorithm to quantify the H4M modification pattern of each individual tumor and was systematically correlated with representative tumor characteristics. We found that analyzing H4M modification patterns within individual tumors could predict TME infiltration, homologous recombination deficiency (HRD), intratumor heterogeneity, proliferation activity, mRNA stemness index, and prognosis. The group with a low H4Mscore had an inflamed TME phenotype and a better immunotherapy response, as well as a better survival outcome. The prognostic value of H4Mscore was validated in three internal cohorts and five external cohorts, respectively. In external immunotherapy cohorts, the low H4Mscore was also linked to an enhanced response to anti-PD-1/L1 and anti-CTLA4 immunotherapy and a better prognosis. This study revealed that H4M modification played an important role in forming TME diversity and complexity. Evaluating the H4M modification pattern of individual tumors could help us learn more about TME and develop more effective immunotherapy strategies.

Deep Learning-Empowered Digital Twin Using Acoustic Signal for Welding Quality Inspection

Weld site inspection is a research area of interest in the manufacturing industry. In this study, a digital twin system for welding robots to examine various weld flaws that might happen during welding using the acoustics of the weld site is presented. Additionally, a wavelet filtering technique is implemented to remove the acoustic signal originating from machine noise. Then, an SeCNN-LSTM model is applied to recognize and categorize weld acoustic signals according to the traits of strong acoustic signal time sequences. The model verification accuracy was found to be 91%. In addition, using numerous indicators, the model was compared with seven other models, namely, CNN-SVM, CNN-LSTM, CNN-GRU, BiLSTM, GRU, CNN-BiLSTM, and LSTM. A deep learning model, and acoustic signal filtering and preprocessing techniques are integrated into the proposed digital twin system. The goal of this work was to propose a systematic on-site weld flaw detection approach encompassing data processing, system modeling, and identification methods. In addition, our proposed method could serve as a resource for pertinent research.

First-in-Human Study of INCB062079, a Fibroblast Growth Factor Receptor 4 Inhibitor, in Patients with Advanced Solid Tumors

INTRODUCTION

Fibroblast growth factor receptor (FGFR)-4/FGF19 pathway dysregulation is implicated in hepatobiliary and other solid tumors. INCB062079, an oral, selective, FGFR4 inhibitor, inhibits growth in FGF19/FGFR4-driven liver cancer models.

METHODS

This was a two-part, phase I study (NCT03144661) in previously treated patients with advanced solid tumors. The primary objective was to determine safety, tolerability, and maximum tolerated dose (MTD), while secondary objectives included pharmacokinetics, pharmacodynamics (plasma FGF19; bile acid salts/7α-hydroxy-4-cholesten-3-one [C4] levels), and preliminary efficacy. In Part 1, patients received INCB062079 starting at 10 mg once daily, with 3 + 3 dose escalation. Part 2 (dose expansion) was not conducted because of study termination.

RESULTS

Twenty-three patients were treated (hepatobiliary, n = 11; ovarian, n = 9; other, n = 3). Among six patients receiving 15 mg twice daily, two patients had dose-limiting toxicities (DLTs; grade 3 diarrhea, grade 3 transaminitis). Both had high pretreatment C4 concentrations, prompting a protocol amendment requiring pretreatment C4 concentrations < 40.9 ng/mL and concomitant prophylactic bile acid sequestrant treatment. No additional DLTs were reported at 10 and 15 mg twice daily; higher doses were not assessed. The most common toxicity was diarrhea (60.9%). INCB062079 exposure was dose-proportional; FGF19 and bile acid/C4 concentrations increased with exposure. One partial response was achieved (15 mg twice daily; ovarian cancer; FGF/FGFR status unknown; duration of response, 7.5 months); two patients had stable disease.

CONCLUSIONS

With C4 cut-off and prophylactic bile acid sequestrant implementation, INCB062079 demonstrated a manageable safety profile and evidence of target inhibition. In view of the rarity of FGF19/FGFR4 alterations and slow patient accrual, the study was terminated before establishing an MTD.

The role of tumor-platelet interplay and micro tumor thrombi during hematogenous tumor metastasis

BACKGROUND

In addition to their pivotal roles in coagulation and thrombosis, platelets are crucial in tumor progression, with plenty of clinical and experimental data demonstrating that the interplay of platelets and tumor cells is essential for hematogenous tumor metastasis. After detach from primary sites, tumor cells intravasate into the blood circulation becoming circulating tumor cells and induce platelet activation, aggregation and encasement around tumor cells to form micro tumor thrombi, which create a permissive tumor microenvironment for metastasis. Platelets in micro tumor thrombi protect tumor cells from immune surveillance and anoikis (detachment-triggered apoptosis) through various pathways, which are significant for tumor cell survival in the bloodstream. Moreover, platelets can facilitate tumor metastasis by expediting epithelial-mesenchymal transition (EMT), adhesion to the endothelium, angiogenesis, tumor proliferation processes and platelet-derived microvesicle (PMV) formation.

CONCLUSIONS

Here, we provide a synopsis of the current understanding of the formation of micro tumor thrombi and the role of micro tumor thrombi in tumor hematogenous metastasis based on the tumor-platelet interplay. We also highlight potential therapeutic strategies targeting platelets for tumor treatment, including cancer-associated platelet-targeted nanomedicines.

Effect of Different Doses of Butorphanol on Postoperative Shivering in Elderly Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

Purpose

This study was designed to investigate the effects of different doses of butorphanol on postoperative shivering and quality of recovery in elderly patients.

Patients and Methods

A total of 147 elderly patients (aged 60 or older) scheduled for elective transurethral resection of the prostate were enrolled in the current study. Patients were randomly and evenly assigned into four groups: Group C (0.9% normal saline), Group B1 (butorphanol 0.01 mg/kg), Group B2 (butorphanol 0.02 mg/kg) and Group B3 (butorphanol 0.03 mg/kg). All drugs were diluted to 5mL and injected intravenously slowly 5 min before induction of anesthesia. The primary outcome measure was the incidence of postoperative shivering in the post-anesthesia care unit. Quality of Recovery-40 (QoR-40) scores were assessed on postoperative day (POD) 1, 2 and 3. Perioperative core and skin temperature, extubation time and adverse events were also recorded.

Results

Patients among the four groups had comparable baseline characteristics. Compared with Group C, the incidence of shivering was significantly lower in Group B2 and B3 (P = 0.006 and P = 0.005, respectively). The QoR-40 scores on POD1 were significantly higher in all butorphanol groups than that in Group C (P < 0.0083). In Group B2 and B3, patients experienced lower pain intensity (P < 0.001). In addition, the incidence of catheter-related bladder discomfort (CRBD) was lower in all butorphanol groups than in Group C (P < 0.0083).

Conclusion

Butorphanol 0.02 or 0.03 mg/kg could effectively prevent the occurrence of postoperative shivering in elderly patients scheduled for transurethral resection of the prostate, provided effective postoperative recovery and postoperative analgesia.

Denosumab in pediatric bone disorders and the role of RANKL blockade: a narrative review

Background and Objective

Denosumab is a valuable and safe therapy for skeletal disorders in adults and has received regulatory approval to treat osteoporosis and bone metastases. However, denosumab is not licensed for pediatric use due to a lack of high-quality prospective research on children. This study aimed to describe and discuss the benefits and disadvantages of denosumab in treating bone diseases in children and to summarize the current understanding of the role of denosumab therapy in children.

Methods

A narrative review was conducted using the literature retrieved from the PubMed, Embase, and Cochrane Library databases.

Key Content and Findings

In children with type 6 osteogenesis imperfecta (OI), juvenile Paget disease (JPD), and secondary osteoporosis who show poor response to bisphosphonate, the use of denosumab has been reported to improve osteoporosis and increase bone mineral density (BMD). Moreover, for those with relapse, progressive and refractory aneurysmal bone cyst (ABC), fibrous dysplasia (FD), giant cell tumor of bone (GCTB), and central giant cell granuloma (CGCG) lesions, denosumab can improve pain symptoms, control disease progression, and reduce serious adverse events. Although there have been sporadic reports of adverse events such as hypocalcemia during medication and rebound hypercalcemia after discontinuation, early prevention, monitoring, and timely intervention can prevent children from experiencing severe adverse events.

Conclusions

The published data indicate that denosumab has efficacy in alleviating disease in multiple refractory bone lesions in children.

Gut microbiota and transcriptome profiling revealed the protective effect of aqueous extract of Tetrastigma hemsleyanum leaves on ulcerative colitis in mice

Tetrastigma hemsleyanum, a traditional Chinese medicinal plant, possesses various biological activities, including anti-inflammatory and immunomodulatory functions. The purpose of this study was to determine the alleviating effect of the water extract of Tetrastigma hemsleyanum leaves (THLW) on ulcerative colitis (UC) and its relationship with gut microbiota. The administration of THLW significantly decreased the severity of dextran sulfate sodium (DSS)-induced intestinal damage, as demonstrated by the stabilization of body weight and colon length, and decreased disease activity index (DAI) and histological scores. THLW also decreased NF-κB protein expression in colon tissues and reduced the serum levels of IL-6, IL-1β, and TNF-α. Further co-housing experiment confirmed that the anti-UC effect of THLW was possibly by regulating the structure and composition of gut microbiota, including increasing the abundance of Oscillospiraceae, Prevotellaceae and Corynebacterium. Additionally, the expression of genes related to inflammation and immunity was also regulated by THLW treatment as evidenced by transcriptome analysis. These results suggested that the protective effect of THLW on DSS-induced colitis was mediated by alleviating inflammation and modulating the microbiota composition. This work proved the potent protective effects of THLW treatment on colitis and may have potential for UC relief.

Design, synthesis, and biological activity of novel pomalidomide linked with diphenylcarbamide derivatives

Based on 2-(2,6-dioxopiperidin-3-yl)-4-fluoroisoindoline-1,3-dione as a raw material, a series of novel pomalidomide linked with diphenylcarbamide derivatives were synthesized through several step reactions of substitution, click reaction, and addition reaction. The structures of these compounds were confirmed by 1H NMR, 13C NMR, and MS. We discovered that some of the compounds are capable of suppressing indoleamine pyrrole-2,3-dioxygenase-1 activities in in vitro experiments, in which the inhibitory activity of 5b reached the level of benefits.

Molecular mechanisms and promising role of dihydromyricetin in cardiovascular diseases

Vine tea, a Chinese herbal medicine, is widely used in traditional Asian medicine to treat common health problems. Dihydromyricetin (DMY) is the main functional flavonoid compound extracted from vine tea. In recent years, preclinical studies have focused on the potential beneficial effects of dihydromyricetin, including glucose metabolism regulation, lipid metabolism regulation, neuroprotection, and anti-tumor effects. In addition, DMY may play a role in cardiovascular disease by resisting oxidative stress and participating in the regulation of inflammation. This review is the first review that summaries the applications of dihydromyricetin in cardiovascular diseases, including atherosclerosis, myocardial infarction, myocardial hypertrophy, and diabetic cardiomyopathy. We also clarified the underlying mechanisms and signaling pathways involved in the above process. The aim of this review is to provide a better understanding and quick overview for future researches of dihydromyricetin in the field of cardiovascular diseases, and more detailed and robust researches are needed for evaluation and reference.

A risk score for the prognosis prediction of the muscle-invasive bladder cancer patients who received gemcitabine plus cisplatin chemotherapy

To develop an individualized gene-based risk score to predict the prognosis of muscle-invasive bladder cancer (MIBC) patients who received GC regimens. We downloaded transcriptome profiling data and clinical information from the Cancer Genome Atlas (TCGA) database. We identified 1854 survival-associated genes and then constructed the risk score based on six special genes selected from the survival-associated genes. We divided patients into high-risk and low-risk groups according to the median risk score. High-risk patients have significantly poorer overall survival than low-risk patients (log-rank test chi-square = 38.08, p = 7e-10, C-index = 0.785, se = 0.032). The risk score was evaluated by Kaplan-Meier survival curve, time-dependent ROC curves, and C-index. Multivariate Cox regression and nomogram suggested that the risk score was an independent prognostic indicator. Gene set enrichment analysis indicated that the survival-associated genes were significantly enriched in immune-related terms. Among six special genes, CHPF2, TRAV26-2, and BTF3P12 were found to be immune-related genes. In conclusion, our risk score provided an indicator to predict the prognosis of MIBC patients who received GC regimens and potential immunotherapeutic targets for MIBC.

Novel axial compressive endoprosthesis ACE can enhance metaphyseal fixation and facilitate osseointegration: A biomechanical study

Background: Metaphyseal fixation for endoprosthetic reconstruction after bone tumor resection is difficult due to the short residual bone length and reverse funnel shape of the metaphysis. In the current study, 3D-printed axial compressive endoprosthesis (ACE) with a short stem and intramedullary axial compressive mechanism is proposed to improve metaphyseal fixation. The rationales of ACE are that 1) intramedullary axial compress enhances the stability of endoprosthesis and facilitates bone ingrowth at the osteotomy site; 2) 3D printed porous metallic surface at osteotomy surface and stem allows bone ingrowth to achieve osseointegration.

Methods: A biomechanical study was performed to explore the initial stability using Sawbones. A diaphysis and metaphyseal segmental defect were created and four fixation structures were simulated: 1) ACE; 2) ACE + lateral plate; 3) stem prosthesis + unilateral plate; 4) stem prosthesis + bilateral plates. Bending and torsional stiffness were determined with a material testing machine. The relationship between the torque of the compression nut and the axial compression force of the bone-implant surface was measured using a round gasket load sensor.

Results: ACE + lateral plate was the stiffest in the bending test (sagittal 324.3 ± 110.8 N/mm, coronal 307.7 ± 8.7 N/mm). ACE + lateral plate and stem prosthesis + bilateral plates had the highest torsional stiffness (10.9 ± 1.3 Nm/° and 10.7 ± 0.2 Nm/° respectively). The bending stiffness of ACE was equivalent to stem prosthesis + bilateral plates (sagittal 196 ± 10 N/mm vs. 200 ± 7 N/mm, coronal 197 ± 14 N/mm vs. 209 ± 3 N/mm), but the torsional stiffness of ACE was inferior to stem prosthesis + bilateral plates (6.1 ± 1.3 Nm/° vs. 10.7 ± 0.2 Nm/°). Stem prosthesis + unilateral plate was the least stiff both in bending and torsion. The relationship between torque (T/Nm) and axial pressure (F/N) was F = 233.5T.

Conclusion: The axial compressive design of ACE enhances primary stability and facilitates osseointegration, which provides an alternative option of metaphyseal fixation for endoprosthetic reconstruction.

Do hypokyphotic adolescent idiopathic scoliosis patients treated with Ponte osteotomy obtain a better clinical efficacy? A preliminary retrospective study

Study design

A retrospective case–control study.

Objective

To evaluate whether Ponte osteotomy improves thoracic kyphosis and to determine its clinical efficacy in hypokyphotic adolescent idiopathic scoliosis (AIS).

Methods

Eighty consecutive Lenke type 1 AIS patients with hypokyphotic curves who underwent posterior spinal fusion by one spine surgeon at a single institution were recruited. According to whether Ponte osteotomy was performed, the patients were divided into two groups. The preoperative, immediate, one-year postoperative, and two-year postoperative radiographs were analyzed. The demographic characteristics, surgical information, radiographic parameters, Scoliosis Research Societye-22 (SRS-22) questionnaire, and complications were compared.

Results

The sagittal alignment and coronal alignment were both improved in the Ponte group and the control group postoperatively. There was no significant difference in the preoperative parameters between the two groups, except the TL/L, CB, and LL. Significant differences were found in the MT (15.18° ± 2.84° vs. 20.33° ± 3.75°, P < 0.001) and TK (24.23° ± 2.71° vs. 19.93° ± 2.38°, P < 0.001) at the two-year follow-up. The Ponte group had a longer operation time and more intraoperative blood loss. No significant difference was observed between the groups in the SRS-22 scores at the final follow-up.

Conclusions

Ponte osteotomy could obtain better coronal correction and sagittal contour restoration in AIS patients with hypokyphosis. However, Ponte osteotomies might lead to more intraoperative blood loss and longer operation time. Moreover, no discrepancy was found in the postoperative health-related quality of life of the included patients. Therefore, we considered that the Ponte osteotomy may be an alternative method to restore the desired thoracic kyphosis, which needs further study.

Information on disease resistance patterns of grape varieties may improve disease management

Resistance to downy mildew (DM) and powdery mildew (PM) contributes to sustainable vineyard management by reducing the diseases and the need for fungicide applications. Resistant varieties vary in their degree of resistance to DM and PM, and in their susceptibility to other diseases. As a consequence, fungicide use may differ among varieties depending on their "resistance patterns" (i.e., the resistance level of a variety toward all of the diseases in the vineyard). The resistance patterns of 16 grapevine varieties to DM, PM, black rot (BR), and gray mold (GM) were evaluated over a 4-year period under field conditions. Disease severity was assessed on leaves and bunches, and the AUDPC (Area Under Disease Progress Curve) was calculated to represent the epidemic progress. GM was found only on bunches and only at very low levels, irrespective of the year or variety, and was therefore excluded from further analyses. The varieties were then grouped into four resistance patterns: i) low resistance to DM and PM, intermediate resistance to BR; ii) high resistance to DM, intermediate resistance to PM, low resistance to BR; iii) intermediate resistance to DM and BR, low resistance to PM; and iv) high resistance to DM, PM, and BR. AUDPC values on leaves were positively correlated with AUDPC values on bunches for susceptible varieties but not for resistant ones, with the exception of PM. Therefore, bioassays with leaves can be used to predict the resistance of bunches to DM and BR for susceptible varieties but not for resistant ones. These results may facilitate both strategic and tactical decisions for the sustainable management of grapevine diseases.

Multiomics analyses and machine learning of nuclear receptor coactivator 6 reveal its essential role in hepatocellular carcinoma

Nuclear receptor coactivator 6 (NCOA6), a coactivator of numerous nuclear receptors and transcription factors, regulates multiple critical cellular functions. Nuclear receptor coactivator 6 is dysregulated in various cancers, including hepatocellular carcinoma (HCC); however, its role remains largely unknown. Here we reported that NCOA6 was highly expressed in HCC compared to the adjacent liver tissue, and NCOA6 overexpression was significantly correlated with poor HCC prognosis. Experiments revealed that the knockdown of NCOA6 damaged the proliferation, migration, and invasion of HCC cells. Multiomics and immune infiltration analyses showed a close relationship between NCOA6 expression, multiple cancer-related malignant pathways, and the immunosuppressive microenvironment. Finally, we established an effective NCOA6-related microRNA (miRNA) signature to distinguish HCC from hepatitis\liver cirrhosis patients. To the best of our knowledge, this study is the first to provide a comprehensive analysis of NCOA6 expression in HCC. We found that NCOA6 plays an important role in HCC development and has a potential mechanism of action. Establishing an NCOA6-related miRNA signature will help develop novel diagnostic strategies for HCC patients.

[Retracted] microRNA‑205 acts as a tumor suppressor and directly targets YAP1 in glioma

Following the publication of this paper, it was drawn to the Editors' attention by a concerned reader that certain of the data shown for the cell migration and invasion assays in Fig. 2C were strikingly similar to data appearing in different form in other articles by different authors. Owing to the fact that the contentious data in the above article had already been published elsewhere, or were already under consideration for publication, prior to its submission to Molecular Medicine Reports, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [Molecular Medicine Reports 16: 1431‑1438, 2017; DOI: 10.3892/mmr.2017.6748].

Factors Influencing Nonunion and Fracture Following Biological Intercalary Reconstruction for Lower-Extremity Bone Tumors: A Systematic Review and Pooled Analysis

OBJECTIVES

To determine nonunion rate, fracture rate, and their risk factors following biological intercalary reconstruction for lower extremity bone tumors.

METHODS

A systematic review and pooled analysis were conducted. PubMed, Embase, and Wiley Cochrane Library were searched from inception up to June 01, 2020. Studies concerning biological intercalary reconstruction after resection of lower extremity bone tumors were included. Overall nonunion and fracture rates were calculated. For studies reporting patient outcomes individually with precise graft characteristics and fixation methods, the individual data were extracted. Patients with demographical and clinical characteristics, including age, sex, tumor location, graft characteristics, and fixation method, were pooled for a multivariate analysis. For each factor of interest, odds ratio (OR), 95% confidence interval (95% CI), and p-value from logistic regression were reported.

RESULTS

A total of 2776 articles were identified from the initial literature search and 76 studies (2052 patients) were included. Sixty-nine studies were case series and seven were comparative studies. The overall nonunion rate was 19% (382/2052; range: 0%-53%), and the overall fracture rate was 17% (344/2052; range: 0%-75%). Thirty of the 76 studies (362 patients) reported patients' characteristics individually and were thus included in the pooled multivariate analysis. Intramedullary nail fixation was associated with a significantly higher nonunion rate compared to plate fixation (OR = 2.2, 95% CI: 1.23-4.10, p = 0.009). Reconstruction with a vascularized fibula graft had a statistically non-significant lower nonunion rate than reconstruction without the graft (OR = 0.6, 95% CI: 0.34-1.07, p = 0.086). Devitalized autografts had a lower fracture risk than allografts (OR = 0.3, 95% CI: 0.14-0.64, p = 0.002), and males tended to have higher fracture risk than females (OR = 2.1, 95% CI: 1.00-4.44, p = 0.049).

CONCLUSIONS

Reconstruction with intramedullary nail fixation is related to an elevated risk of nonunion. Allografts and males have a higher fracture risk than devitalized autografts and females, respectively. Further high-quality comparative analyses with large sample sizes and adequate follow-up duration are needed to validate these findings.

Biodistribution, degradability and clearance of 2D materials for their biomedical applications

Two-dimensional (2D) materials have evolved to be a class of rapidly advancing chemical entities in the biomedical field. Nevertheless, potential side effects and safety concerns severely limit their clinical translation. After administration, 2D materials cross multiple biological barriers and are distributed throughout the body. Only the portion that accumulates at the diseased sites exerts a therapeutic effect, whereas those distributed elsewhere may cause damage to healthy tissues and interference to normal physiological function of various organs. To achieve maximum therapeutic efficacy and minimum adverse effects simultaneously, the delivery of 2D materials must be targeted at diseased sites to reach therapeutic concentrations, and the materials must possess sufficient degradation and clearance rates to avoid long-term toxicity. Therefore, it is essential to understand the biodistribution and destiny of 2D materials in vivo. In this review, first, we provide a comprehensive picture of the strategies that are currently adopted for regulating the in vivo fate of 2D materials, including modulations of their size, surface properties, composition, and external stimuli. Second, we systematically review the biodistribution, degradation, and metabolism of several newly emerged 2D materials. Finally, we also discuss the development opportunities of 2D materials in the biomedical field and the challenges to be addressed.

Plate configuration for biological reconstructions of femoral intercalary defect - a finite element evaluation

BACKGROUND AND OBJECTIVE

Biological reconstruction was commonly used for femoral intercalary defect. The initial stability by plate fixation was believed to have an effect on bone union and implant failure. Our study was proposed to explore relationship of plate configuration and initial stability for femoral intercalary reconstruction using allo-/autograft.

METHODS

Femoral intercalary defect models were established with four different plate configurations: (1) Single lateral bridging plate, SLP (2) Lateral bridging plate + Orthogonal adjuvant plate, LP+OAP (3) Lateral bridging plate + Medial adjuvant plate, LP+MAP (4) Lateral bridging plate + Medial bridging plate, LP+MP. A diaphysis defect of 12 cm was simulated, and the removed native femoral bone was used as a structural allograft with the osteotomy gap of 2 mm. Models were analyzed by finite element simulations under an axial compression of 2000N and an axial moment of 10 Nm, respectively.

RESULTS

Axial load: (1) The peak von Mises stress of SLP, LP+OAP, LP+MAP, LP+MP were 993.50 MPa, 335.63 MPa, 240.03 MPa, 281.73 MPa, respectively and LP+MAP was the lowest (p < 0.01); (2) The mean displacement of SLP, LP+OAP, LP+MAP, LP+MP was 0.765, 0.130, 0.121, 0.235 mm, respectively. LP+MAP showed the best stability while SLP had a crash in the medial proximal gap; (3) The LP+MAP configuration had the most uniform stress distribution and the lowest maximum von Mises stress of 79.7 MPa within plates. Axial torsional load: (1) The peak von Mises stress of SLP, LP+OAP, LP+MAP, LP+MP were 431.66Mpa, 120.73 MPa, 72.31 MPa, 109.86 MPa, respectively; (2) The rotation angle of SLP, LP+OAP, LP+MAP, LP+MP was 4.30°, 1.35°, 1.20°, 1.57°, respectively. All of LP+OAP, LP+MAP and LP+MP showed an optimal torsional stability.

CONCLUSIONS

For femoral intercalary reconstruction using allo-/autograft fixed by plates, LP+MAP and LP+MP configurations showed superior stability in terms of axial compression and torsion load by FE simulation. A better stability was believed to be associated with higher union rate and lower hardware failure rate.

A Scoring System for Predicting Neoadjuvant Chemotherapy Response in Primary High-Grade Bone Sarcomas: A Multicenter Study

Objective

Currently, there is a lack of good clinical tools for evaluating the effect of chemotherapy preoperatively on primary high‐grade bone sarcomas. Our goal was to investigate the predictive value of the clinical findings and establish a scoring system to predict chemotherapy response.

Methods

We conducted a retrospective multicenter cohort study and reviewed 322 patients with primary high‐grade bone sarcomas. Patients who routinely received neoadjuvant chemotherapy and underwent primary tumor resection with an assessment of tumor necrosis rate (TNR) were enrolled in this study. The medical records of patients were collected from November 1, 2011, to March 1, 2018, at Peking University People's Hospital (PKUPH) and Peking University Shougang Hospital (PKUSH). The mean age of the patients was 16.2 years (range 3–52 years), of whom 65.5% were male. The clinical data collected before and after neoadjuvant chemotherapy included the degree of pain, laboratory inspection, X‐ray, CT, contrast‐enhanced magnetic resonance (MR), and positron emission tomography‐computed tomography (PET‐CT). Several machine learning models, including logistic regression, decision trees, support vector machines, and neural networks, were used to classify the chemotherapy responses. Area under the curve (AUC) of the scoring system to predict chemotherapy response is the primary outcome measure.

Results

For patients without events, a minimum follow‐up of 24 months was achieved. The median follow‐up time was 43.3 months, and it ranged from 24 to 84 months. The 5 years progression‐free survival (PFS) of the included patients was 54.1%. The 5 years PFS rate was 39.7% for poor responders and 74.9% for good responders. Features such as longest diameter reduction ratio (up to three points), clear bone boundary formation (up to two points), tumor necrosis measured by magnetic resonance (up to two points), maximum standard uptake value (SUV_max) decrease (up to three points), and significant alkaline phosphatase decrease (up to 1 point) were identified as significant predictors of good histological response and constituted the scoring system. A score ≥4 predicts a good response to chemotherapy. The scoring system based on the above factors performed well, achieving an AUC of 0.893. For nonmeasurable lesions (classified by the revised Response Evaluation Criteria in Solid Tumors [RECIST 1.1]), the AUC was 0.901.

Conclusion

We first devised a well‐performing comprehensive scoring system to predict the response to neoadjuvant chemotherapy in primary high‐grade bone sarcomas.

Temperature requirements of Colletotrichum spp. belonging to different clades

The fungal genus Colletotrichum includes plant pathogens that cause substantial economic damage to horticultural, ornamental, and fruit tree crops worldwide. Here, we conducted a systematic literature review to retrieve and analyze the metadata on the influence of temperature on four biological processes: (i) mycelial growth, (ii) conidial germination, (iii) infection by conidia, and (iv) sporulation. The literature review considered 118 papers (selected from a total of 1,641 papers found with the literature search), 19 Colletotrichum species belonging to eight clades (acutatum, graminicola, destructivum, coccodes, dematium, gloeosporioides, and orbiculare), and 27 host plants (alfalfa, almond, apple, azalea, banana, barley, bathurst burr, blueberry, celery, chilli, coffee, corn, cotton, cowpea, grape, guava, jointvetch, lentil, lupin, olive, onion, snap bean, spinach, strawberry, tomato, watermelon, and white bean). We used the metadata to develop temperature-dependent equations representing the effect of temperature on the biological processes for the different clades and species. Inter- and intra-clades similarities and differences are analyzed and discussed. A multi-factor cluster analysis identified four groups of clades with similar temperature dependencies. The results should facilitate further research on the biology and epidemiology of Colletotrichum species and should also contribute to the development of models for the management of anthracnose diseases.

Subgaleal Effusion and Brain Midline Shift After Cranioplasty: A Retrospective Study Between Polyetheretherketone Cranioplasty and Titanium Cranioplasty After Decompressive Craniectomy

Cranioplasty with polyetheretherketone (PEEK) has recently shown better cerebral protection performance, improved brain function, and aesthetic contour compared with titanium mesh. However, whether patients undergoing PEEK cranioplasty tend to develop subgaleal effusions remains elusive. This retrospective study included patients who underwent cranioplasty with PEEK implants or titanium mesh after decompressive craniectomy between July 2017 and July 2020. Patient information, including general information, location, size of the defect, subgaleal depth, and brain midline shift was collected and statistically analyzed. There were 130 cases of cranioplasty, including 35 with PEEK implants and 95 with a titanium mesh. Patients who underwent cranioplasty with a PEEK implant had a higher subgaleal effusion rate than those who underwent cranioplasty with titanium mesh (85.71% vs. 53.68%, P < 0.001), while a midline shift >5 mm was more frequently observed in the PEEK group than in the titanium group (20% vs. 6.3%, P = 0.021). The PEEK material was the only factor associated with subgaleal effusion after cranioplasty (OR 5.589, P = 0.002). Logistic regression analysis further showed that age was a protective factor against midline shift in the PEEK cranioplasty group (OR 0.837, P = 0.029). Patients who underwent cranioplasty with PEEK implants were more likely to develop severe subgaleal effusion and significant brain midline shifts than those with titanium mesh implants.

Outcomes of Semiknee Replacement in Skeletally Immature Bone Sarcoma Patients

INTRODUCTION

 A semiknee mega endoprosthesis (SKMEP) was used to replace the resected distal femur or proximal tibia in skeletally immature bone sarcoma patients. This study investigated the surgical technique, endoprosthesis survival rate, functional outcome, complications, and approaches to resolve limb-length discrepancy (LLD) following this procedure.

PATIENTS AND METHODS

 In total, 15 girls and 16 boys with a mean age of 9.1 years (range, 4-12) and 8.9 years (range, 5-13), respectively, were included in this study. The mean length of the resected distal femur (15 cases) and proximal tibia (16) was 145.0 and 122.8 mm, respectively. Altogether, 19 custom-made SKMEPs and 12 modular units were used to reconstruct the bone and joint defects.

RESULTS

 The average follow-up was 82.8 months (range, 4-225 months). Five patients died of disease. Seven SKMEPs were revised to total knee endoprosthesis after a mean of 40.3 months. Nineteen patients retained the original SKMEP, and the mean LLD was 4.3 cm (range, 0-10 cm). One case each of Henderson type 1B, type 2A, type 2B, and type 5B failures was observed. Knee subluxation occurred in two cases. Although a slight laxity of the knee was identified on physical examination, the average Musculoskeletal Tumor Society 93(MSTS93) functional score was 84.5% (range, 57-97%). The estimated implant survival was 70.5% at 5 years.

CONCLUSION

 This was the largest retrospective study reporting the application of SKMEP in bone sarcoma patients. For selected skeletally immature bone sarcoma patients, SKMEP is an option with satisfactory functional outcomes and survival rates. However, heightening pads or shoes to compensate the LLD were indispensable before subsequent LLD was adjusted by further operation(s).

Case Report: Recombinant Human Endostatin Plus Chemotherapy for Epidermal Growth Factor Receptor-Negative Miliary Lung Adenocarcinoma

Except for the traditional chemotherapy, few treatments strategy about miliary intrapulmonary carcinomatosis (MIPC) have been reported in the existing literature. In this report, we primarily discussed the possible etiology and the potentially effective treatment options for a patient with MIPC who benefited from combined treatment. A nonsmoking woman was diagnosed with MIPC at an advanced stage. Gene detection showed an EGFR negative status. She accepted first-line chemotherapy with pemetrexed and cisplatin, and the tumor progressed. Next, PD-1 inhibitors plus pemetrexed and cisplatin were administered, and the tumor remained uncontrolled. After two cycles of recombinant human endostatin plus second-line chemotherapy, the numerous pulmonary nodules had all nearly completely disappeared, while an accentuated decrease in the primary tumor volume was observed. Moreover, biochemical markers, including the patient’s tumor markers, also trended toward normal. This report describes the first case of a MIPC patient who significantly responded to antiangiogenic therapy combined with chemotherapy. Anti-angiogenic therapy may be a possible strategy for the EGFR-negative lung adenocarcinoma population.

Evaluation of drug–drug interaction potential for pemigatinib using physiologically based pharmacokinetic modeling

Pemigatinib is a potent inhibitor of fibroblast growth factor receptor being developed for oncology indications. It is primarily metabolized by cytochrome P450 (CYP) 3A4, and the ratio of estimated concentration over concentration required for 50% inhibition ratio for pemigatinib as an inhibitor of P‐glycoprotein (P‐gp), organic cation transporter‐2 (OCT2), and multidrug and toxin extrusion protein‐1 (MATE1) exceeds the cutoff values established in regulatory guidance. A Simcyp minimal physiologically based pharmacokinetic (PBPK) with advanced dissolution, absorption, and metabolism absorption model for pemigatinib was developed and validated using observed clinical pharmacokinetic (PK) data and itraconazole/rifampin drug–drug interaction (DDI) data. The model accurately predicted itraconazole DDI (approximate 90% area under the plasma drug concentration–time curve [AUC] and approximate 20% maximum plasma drug concentration [C_max] increase). The model underpredicted rifampin induction by 100% (approximate 6.7‐fold decrease in AUC and approximate 2.6‐fold decrease in C_max in the DDI study), presumably reflecting non‐CYP3A4 mechanisms being impacted. The verified PBPK model was then used to predict the effect of other CYP3A4 inhibitors/inducers on pemigatinib PK and pemigatinib as an inhibitor of P‐gp or OCT2/MATE1 substrates. The worst‐case scenario DDI simulation for pemigatinib as an inhibitor of P‐gp or OCT2/MATE1 substrates showed only a modest DDI effect. The recommendation based on this simulation and clinical data is to reduce pemigatinib dose for coadministration with strong and moderate CYP3A4 inhibitors. No dose adjustment is required for weak CYP3A4 inhibitors. The coadministration of strong and moderate CYP3A4 inducers with pemigatinib should be avoided. PBPK modeling suggested no dose adjustment with P‐gp or OCT2/MATE1 substrates.

Combination of mulberry leaf active components possessed synergetic effect on SD rats with diabetic nephropathy by mediating metabolism, Wnt/β-catenin and TGF-β/Smads signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Mulberry leaf has attracted much attention due to its excellent curative effect on diabetes and its complications, whether the combination of its effective components have protective and synergistic effect on diabetic nephropathy (DN) in vivo remain unclear.

AIM OF THE STUDY

The aim of this study was to investigate the protective and synergistic effect of the combination (MAF_1:1 and MAF_1:5) of mulberry leaf alkaloids (MA) and flavonoids extract (MF) on DN.

MATERIALS AND METHODS

A step by step method consisted of network pharmacological prediction, animal in vivo validation and metabolic mechanism research was used to construct the multi-component-target-pathway network of mulberry leaf against DN. Firstly, the potential components and mechanism of mulberry leaf against DN was explored by network pharmacology analysis. Secondly, DN animal model was established to validate the anti-DN activity of these potential compounds. Thirdly, the metabolomics of serum and urine samples from animal experiments was analyzed to explore the anti-DN mechanism of these potential compounds.

RESULTS

The results of network pharmacology demonstrated that a total of 7 compounds detected in MA and MF exhibited anti-DN activity, their mechanism were strongly in connection with metabolic pathways, arachidonic acid metabolism, sphingolipid signaling pathway, etc. The results of animal experiment indicated that MAF_1:1 and MAF_1:5 significantly relieved metabolic disorders through regulating Wnt/β-catenin and TGF-β/Smads signaling pathway, just like MF or MA alone. Metabolomics suggested they could regulate 16 serum and 7 urine endogenous metabolites through arachidonic acid metabolism, phenylalanine metabolism and sphingolipid metabolism, thus alleviated DN. Significantly, MAF_1:1 and MAF_1:5 might possess synergistic effect considering their therapeutic effects on DN rats were superior to the single use of MA or MF.

CONCLUSIONS

MAF_1:1 and MAF_1:5 possessed protective and synergistic effect on DN rats through multi-target and multi-pathways. These findings were of great scientific significance and application value to reveal the advantage of mulberry leaf in preventing and treating DN.