CircDiaph3 aggravates H/R-induced cardiomyocyte apoptosis and inflammation through miR-338-3p/SRSF1 axis

Acute myocardial infarction (AMI) is one of the most prevalent cardiovascular diseases, accounting for a high incidence rate and high mortality worldwide. Hypoxia/reoxygenation (H/R)-induced myocardial cell injury is the main cause of AMI. Several studies have shown that circular RNA contributes significantly to the pathogenesis of AMI. Here, we established an AMI mouse model to investigate the effect of circDiaph3 in cardiac function and explore the functional role of circDiaph3 in H/R-induced cardiomyocyte injury and its molecular mechanism. Bioinformatics tool and RT-qPCR techniques were applied to detect circDiaph3 expression in human patient samples, heart tissues of AMI mice, and H/R-induced H9C2 cells. CCK-8 was used to examine cell viability, while annexin-V/PI staining was used to assess cell apoptosis. Myocardial reactive oxygen species (ROS) levels were detected by immunofluorescence. Western blot was used to detect the protein expression of anti-apoptotic Bcl-2 while pro-apoptotic Bax and cleaved-Caspase-3. Furthermore, ELISA was used to detect inflammatory cytokines production. While bioinformatics tool and RNA pull-down assay were used to verify the interaction between circDiaph3 and miR-338-3p. We found that circDiaph3 expression was high in AMI patients and mice, as well as in H/R-treated H9C2 cells. CircDiaph3 silencing ameliorated apoptosis and inflammatory response of cardiomyocytes in vivo. Moreover, the knockdown of cirDiaph3 mitigated H/R-induced apoptosis and the release of inflammatory mediators like IL-1β, IL-6, and TNF-α in H9C2 cells. Mechanistically, circDiaph3 induced cell apoptosis and inflammatory responses in H/R-treated H9C2 cells by sponging miR-338-3p. Overexpressing miR-338-3p in H/R-treated cells prominently reversed circDiaph3-induced effects. Notably, miR-338-3p inhibited SRSF1 expression in H/R-treated H9C2 cells. While overexpressing SRSF1 abrogated miR-338-3p-mediated alleviation of apoptosis and inflammation after H/R treatment. To summarize, circDiaph3 aggravates H/R-induced cardiomyocyte apoptosis and inflammation through the miR-338-3p/SRSF1 axis. These findings suggest that the circDiaph3/miR-338-3pp/SRSF1 axis could be a potential therapeutic target for treating H/R-induced myocardial injury.

[Epidemiological and clinical features of newly reported advanced schistosomiasis cases in Sichuan Province from 2011 to 2022]

OBJECTIVE

To analyze the epidemiological characteristics of newly reported advanced schistosomiasis cases in Sichuan Province, so as to provide the evidence for analyzing the causes and formulating targeted control measures of newly reported advanced schistosomiasis cases.

METHODS

Individual case investigation forms for advanced schistosomiasis cases were collected from the Sichuan Provincial Epidemic Annual Report System from 2011 to 2022, and patients' demographics, previous medical history and liver parenchymal grading were retrieved. All advanced schistosomiasis cases' medical records were reviewed, and the subtypes of schistosomiasis-endemic villages where the cases' household registration were, floating population, survival and death and time of death were collected.

RESULTS

A total of 321 newly reported advanced schistosomiasis cases were found in Sichuan Province from 2011 to 2022, with a male to female ratio of 0.99 to 1. There were 274 cases at ages of over 50 years (85.4%), with the highest proportion seen at ages of 60 to 69 years (87 cases, 27.1%), and splenomegaly was the most common type (180 cases, 56.1%), with no dwarfism type detected. The highest number of cases was reported in 2011 (78 cases), followed by in 2022 (74 cases), and the highest number of cases were reported in Meishan City (199 cases, 62.0%), Dongpo District (131 cases, 40.8%), and hilly subtype areas (136 cases, 42.4%). As of the end of 2022, there were 111 deaths due to advanced schistosomiasis, with the highest number of deaths seen in 2018 (25 deaths), and the highest mortality was seen among patients with the ascites type (41.2%). There were 47 (37.3%), 40 (59.5%) and 4 (23.5%) cases with grade III liver parenchyma among patients with splenomegaly, ascites, and colonic proliferation types, respectively, and there was a significant difference in the grading of III liver parenchyma among three types of patients (H = 12.092, P < 0.05), with more severe liver parenchyma injuries seen among patients with the ascites type than among those with splenomegaly and colonic proliferation type (Z = 24.262 and 44.738, both Padjusted values < 0.05).

CONCLUSIONS

There have been newly reported advanced schistosomiasis cases in Sichuan Province during recent years, and patients with the ascites type should be given a high priority among advanced schistosomiasis cases in Sichuan Province. Intensified clue surveys are needed for early identification and treatment of advanced schistosomiasis cases, so as to increase the survival rate and improve the quality of life.

Computed tomography radiomics identification of T1-2 and T3-4 stages of esophageal squamous cell carcinoma: two-dimensional or three-dimensional?

BACKGROUND

To evaluate two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) radiomics analysis for the T stage of esophageal squamous cell carcinoma (ESCC).

METHODS

398 patients with pathologically confirmed ESCC were divided into training and testing sets. All patients underwent chest CT scans preoperatively. For each tumor, based on CT images, a 2D region of interest (ROI) was outlined on the largest cross-sectional area, and a 3D ROI was outlined layer by layer on each section of the tumor. The radiomics platform was used for feature extraction. For feature selection, stepwise logistic regression was used. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of the 2D radiomics model versus the 3D radiomics model. The differences were compared using the DeLong test. The value of the clinical utility of the two radiomics models was evaluated.

RESULTS

1595 radiomics features were extracted. After screening, two radiomics models were constructed. In the training set, the difference between the area under the curve (AUC) of the 2D radiomics model (AUC = 0.831) and the 3D radiomics model (AUC = 0.830) was not statistically significant (p = 0.973). In the testing set, the difference between the AUC of the 2D radiomics model (AUC = 0.807) and the 3D radiomics model (AUC = 0.797) was also not statistically significant (p = 0.748). A 2D model was equally useful as a 3D model in clinical situations.

CONCLUSION

The performance of 2D radiomics model is comparable to that of 3D radiomics model in distinguishing between the T1-2 and T3-4 stages of ESCC. In addition, 2D radiomics model may be a more feasible option due to the shorter time required for segmenting the ROI.

Prevalence and influencing factors of depressive and anxiety symptoms among hospital-based healthcare workers during the surge period of the COVID-19 pandemic in the Chinese mainland: a multicenter cross-sectional study

BACKGROUND

From November 2022 to February 2023, the Chinese mainland experienced a surge in COVID-19 infection and hospitalization, and the hospital-based healthcare workers (HCWs) might suffer serious psychological crisis during this period. This study aims to assess the depressive and anxiety symptoms among HCWs during the surge of COVID-19 pandemic and to provide possible reference on protecting mental health of HCWs in future infectious disease outbreaks.

METHODS

A multicenter cross-sectional study was carried out among hospital-based HCWs in the Chinese mainland from 5 January to 9 February 2023. The PHQ-9 (nine-item Patient Health Questionnaire) and GAD-7 (seven-item Generalized Anxiety Disorder Questionnaire) were used to measure depressive and anxiety symptoms. Ordinal logistic regression analysis was performed to identify influencing factors.

RESULTS

A total of 6522 hospital-based HCWs in the Chinse mainland were included in this survey. The prevalence of depressive symptoms among the HCWs was 70.75%, and anxiety symptoms was 47.87%. The HCWs who perceived higher risk of COVID-19 infection and those who had higher work intensity were more likely to experience depressive and anxiety symptoms. Additionally, higher levels of mindfulness, resilience and perceived social support were negatively associated with depressive and anxiety symptoms.

CONCLUSION

This study revealed that a high proportion of HCWs in the Chinese mainland suffered from mental health disturbances during the surge of the COVID-19 pandemic. Resilience, mindfulness and perceived social support are important protective factors of HCWs' mental health. Tailored interventions, such as mindfulness practice, should be implemented to alleviate psychological symptoms of HCWs during the COVID-19 pandemic or other similar events in the future.

Quercetin protects cadmium-induced renal injuries in mice by inhibiting cell pyroptosis

The toxic heavy metal cadmium (Cd) has a significant impact on kidney health. Documents manifested that non-toxic flavonoid quercetin can reduce Cd-induced kidney damage by reducing oxidative stress and inhibiting apoptosis, while the effect of quercetin on Cd-induced renal cell pyroptosis has not been elucidated. In this study, we established a model of Cd poisoning treated with quercetin both in vitro and in vivo. Results revealed that quercetin effectively reversed the decrease in Cd-induced cell viability. Furthermore, Cd increased blood urea nitrogen while reducing GPX and SOD levels, caused histopathological injuries in kidney with a significantly elevated cell pyroptosis characterized by enhanced levels of proteins representing assembly (NLRP3) and activation (pro IL-1β, cleaved IL-1β, and IL-18) of NLRP3 inflammasome as well as pyroptosis executor (pro caspase-1, cleaved caspase-1). However, quercetin administration alleviated kidney injuries above by decreasing cell pyroptosis. Overall, it suggests that kidney cells are susceptible to pyroptotic cell death due to Cd exposure; while quercetin exhibits protective effects through cell pyroptosis inhibition.

Simulating ozone degradation of deoxynivalenol and its bio-safety assessment by mouse model

Deoxynivalenol (DON), a trichothecene mycotoxin, is one of the most prevalent mycotoxins globally, primarily produced by Fusarium species. DON exposure could cause a range of symptoms, including nausea, vomiting, gastroenteritis, growth retardation, immunosuppression, and intestinal flora disorders in both humans and animals. Recently, ozone degradation technology has been applied for DON control. However, the safety of the contaminated grain after degradation was often ignored. Therefore, the implementation technology for assessing the safety of DON-contaminated grain degradation is of great significance for food safety. In this study, based on previous degradation result of DON, we further studied and assessed the toxicity of corn contaminated with ozone-degrading DON by animal experiments in mice. We simulated feed made from corn contaminated with DON produced by inoculated Fusarium graminearum, which was treated with an ozone aqueous solution. DON treated by ozone could effectively increase the expression of total protein in mice and improve the immune system efficacy. Meanwhile, compared with DON directly-exposed mice, the corn with degrading DON could effectively maintain the level of liver and kidney immune function, and improved growth performance, enterohepatic circulation, and energy metabolism. Our study indicated that the toxicity of fed corn contaminated with degrading-DON decreased significantly after ozone degradation, resulting in a much lower toxicity compared to the DON group, or nontoxicity to some extent. Therefore, we hope that this mouse model could be used as a promising approach for assessing the risk of fungal toxins on metabolism, immunity, and intestinal health.

Multivariable model of postoperative delirium in cardiac surgery patients: proteomic and demographic contributions

Background

Delirium following cardiac surgery is common, morbid, and costly, but may be prevented with risk stratification and targeted intervention. Preoperative protein signatures may identify patients at increased risk for worse postoperative outcomes, including delirium. In this study, we aimed to identify plasma protein biomarkers and develop a predictive model for postoperative delirium in older patients undergoing cardiac surgery, while also uncovering possible pathophysiological mechanisms.

Methods

SOMAscan analysis of 1,305 proteins in the plasma from 57 older adults undergoing cardiac surgery requiring cardiopulmonary bypass was conducted to define delirium-specific protein signatures at baseline (PREOP) and postoperative day 2 (POD2). Selected proteins were validated in 115 patients using the ELLA multiplex immunoassay platform. Proteins were combined with clinical and demographic variables to build multivariable models that estimate the risk of postoperative delirium and bring light to the underlying pathophysiology.

Results

A total of 115 and 85 proteins from SOMAscan analyses were found altered in delirious patients at PREOP and POD2, respectively (p<0.05). Using four criteria including associations with surgery, delirium, and biological plausibility, 12 biomarker candidates (Tukey's fold change (|tFC|)>1.4, Benjamini-Hochberg (BH)-p<0.01) were selected for ELLA multiplex validation. Eight proteins were significantly altered at PREOP, and seven proteins at POD2 (p<0.05), in patients who developed postoperative delirium compared to non-delirious patients. Statistical analyses of model fit resulted in the selection of a combination of age, sex, and three proteins (angiopoietin-2 (ANGPT2); C-C motif chemokine 5 (CCL5); and metalloproteinase inhibitor 1 (TIMP1); AUC=0.829) as the best performing predictive model for delirium at PREOP. The delirium-associated proteins identified as biomarker candidates are involved with inflammation, glial dysfunction, vascularization, and hemostasis, highlighting the multifactorial pathophysiology of delirium.

Conclusion

Our study proposes a model of postoperative delirium that includes a combination of older age, female sex, and altered levels of three proteins. Our results support the identification of patients at higher risk of developing postoperative delirium after cardiac surgery and provide insights on the underlying pathophysiology. ClinicalTrials.gov ( NCT02546765 ).

Overall Survival Prediction in Stereotactic Radiosurgery Patients with Glioblastoma Via a Deep-Learning Approach

PURPOSE/OBJECTIVE(S)

Accurate and automated early survival prediction is critical for glioblastoma (GBM) patients as their poor prognosis requires timely treatment decision-making. We have developed a deep learning (DL)-based GBM overall survival (OS) prediction model based on a multi-institutional public dataset using only pre-operative basic structural multi-parametric magnetic resonance images (MRIs). The purpose of this study is to evaluate this DL-based OS prediction model with an institutional stereotactic radiosurgery (SRS) clinical trial dataset.

MATERIALS/METHODS

The task of this study is to classify GBM patients into 3 OS classes: long-survivors (>15 months), mid-survivors (between 10 and 15 months) and short-survivors (< 10 months). The proposed OS prediction model is an ensemble of a ResNet-based classifier and a K-NN classifier. The ResNet-based classifier is trained in a Siamese fashion to explore inter-class differences. During testing, training sample features are implemented with a K-NN classifier to ensemble with the ResNet-based classifier. A public dataset from Medical Image Computing and Computer Assisted Intervention (MICCAI) Brain Tumor Segmentation (BraTS) challenge 2020 (235 patients) were used for model establishing and initial validation. Then the validated model was evaluated on 19 GBM patients from an institutional SRS clinical trial. Each data entry consists of pre-operative basic structural multi-parametric MRIs and survival days, as well as patient ages for BraTS data and basic clinical characteristics for institutional data. GBM sub-regions, including contrast-enhancing tumor, peri-tumoral edema, and necrotic/non-enhancing tumor core, were segmented in the multi-parametric MRIs by an in-house DL model for both datasets. The OS prediction model was trained on 90% of the segmented BraTS data and validated on the rest 10%, then further evaluated on the institutional data. The model performance was assessed by prediction accuracy (ACC) and the area under the curve (AUC).

RESULTS

For this 3-class OS classification task, our DL-based prediction model achieved an ACC of 65.22% and an AUC of 0.81 on the BraTS dataset compared with the top-ranked result from the BraTS challenge 2020 (Rank 1st: ACC 61.7%), and an ACC of 52.63% and an AUC of 0.69 on the institutional dataset. Further analysis of the institutional dataset found that the predicted OS class had a statistically significant correlation with treatment volume (p = 0.012) and age (p = 0.006), which matches the analysis that the patients' ground truth OS class is statistical significantly correlated with treatment volume (p = 0.045).

CONCLUSION

Our DL-based OS prediction model for GBM using basic structural multi-parametric pre-operative MRIs has demonstrated promising performance in both public and institutional dataset with minimal manual processing requirements. This OS prediction model can be potentially applied to assist timely clinical decision-making.

Cardiac Sparing with Volumetric Modulated Arc Therapy Enabled Total Body Irradiation (CS VMAT-TBI)

PURPOSE/OBJECTIVE(S)

Volumetric modulated arc therapy (VMAT) enabled total body irradiation (TBI) has replaced conventional TBI in our institution given the improved treatment accuracy, patient comfort, and dose modulation ability. The risk of cardiovascular disease is several folds higher among transplant patients who receive TBI, likely related to dose to the heart. We hypothesize that a cardiac-sparing (CS) VMAT-TBI technique is feasible and can meaningfully reduce dose to the heart while still adequately covering nearby lymphatic tissue.

MATERIALS/METHODS

VMAT-TBI is delivered via multi-isocentric external beams in a frame-based setup. Heart is contoured as per published guidelines. A lymph node contour, which includes tonsils, neck nodal stations, mediastinal, abdominal, retroperitoneal, and pelvic nodes is created. Coverage of the lymph node contour is prioritized over organ-sparing during inverse optimization; with a goal of V90% greater than 99.5% and mean dose less than 800 cGy for the lymph nodes and heart, respectively. An IRB-approved retrospective review was performed with mean heart dose collected for all patients treated with CS VMAT-TBI and compared to a representative cohort of five patients treated with VMAT-TBI without cardiac sparing.

RESULTS

Thirty-one patients were treated with CS VMAT-TBI between 2020-2022 with a median follow up time of 11.5 months. Mean heart dose was 796 ± 71 cGy in the CS VMAT-TBI compared to 1247 ± 29 cGy in the VMAT-TBI group without cardiac sparing (p < 0.001). Of those treated with CS VMAT-TBI, three patients relapsed; one relapse occurred in bone marrow only, one relapse occurred in bone marrow and cervical, thoracic, and intra-abdominal lymphoid tissues, and one patient was simulated but never received induction therapy due to overt progression. 100-day relapse-free survival and overall survival were 82.5% and 86.2%, respectively. Median survival time has not been met.

CONCLUSION

Cardiac sparing is feasible in VMAT-TBI and is associated with significant decrease in mean heart dose of ∼450 cGy. This is estimated to confer a 33.3% decreased absolute risk for lifetime major coronary events compared to patients treated with VMAT-TBI without cardiac sparing. Although limited by short follow-up time, there does not appear to be a significant risk for early relapse despite de-escalating cardiac tissue, likely due to prioritizing coverage of lymph nodes. Prospective clinical studies are needed to further validate cardiac and other organ at risk sparing VMAT-TBI techniques.

An Online AI-Powered Interactive Histological Image Annotation Platform for Analyzing Intestinal Regenerating Crypts in Post-Irradiated Mice

PURPOSE/OBJECTIVE(S)

The goal of this project is to build an online AI-powered interactive annotation platform to accurately and efficiently annotate intestinal regenerating crypts in histological images of mice after abdominal irradiation.

MATERIALS/METHODS

The proposed platform is developed by the seamless integration of a front-end web client and a back-end server. Such client/server design allows the users to access the platform without software installation on local computers. Our front-end client is developed with SvelteJS + WebGL technology stack, allowing access from any common web browsers and enabling user interaction, such as image importing/visualization, interactive crypt annotating, and annotation saving/deleting. The back-end server is responsible for executing the tasks requested from the web client, for instance, image pre-processing, AI-based crypts automatic identification, and database management. The image preprocessing is designed to extract a single cross section image using morphological operations because multiple hematoxylin and eosin (H&E) stained jejunum cross sections from post-irradiated mice are scanned within one slide. The auto-crypt identification is powered by a trained and validated AI engine U-Net, classifying image grid tiles into two groups with and without regenerating crypts. The database is implemented with the self-contained SQLite to support recording and indexing the annotated grid tiles with regenerating crypts. The workflow for crypt analysis on this interactive platform has 5 steps: 1) manually import a whole H&E slide image; 2) auto-preprocess the slide by extracting single cross-section images; 3) auto-identify regenerating crypts with an AI engine; 4) interactively annotate (add, delete, modify) auto-identified crypt markers; 5) save and/or output the annotation to the database or the local drive.

RESULTS

The performance of the developed interactive crypt analysis platform was evaluated in aspects of accuracy and efficiency. The AI-powered crypt auto-identification accuracy was assessed by computing the mean absolute error (MAE) on crypt number per cross section between manual and auto annotation using a testing dataset containing 80 cross sections. It achieved an MAE of 3.5±4.8 crypts per cross section, and 81.25% of the cross sections have no more than 5 crypts difference. The efficiency was assessed under two conditions with the server on the cloud and a local computer. It took about 2-3 minutes to finish the entire workflow on the cloud, while 1-2 minutes on the local by saving ∼1 minute on image uploading.

CONCLUSION

The developed web client/server platform enables online automatic identification and interactive annotation of mice crypts in minutes. It is a convenient tool that allows accurate and efficient crypt analysis and can be extended for other histologic image analyses.

Green Tea Derivative (-)-Epigallocatechin-3-Gallate (EGCG) for Prevention of Acute Radiation-Induced Intestinal Injury: A Prospective Phase II Clinical Study in Pelvic Cancer Patients

PURPOSE/OBJECTIVE(S)

Radiation-induced intestinal injury (RIII) remains the most common dose-limiting toxicity following radiotherapy (RT) for pelvic malignancies. However, few efficient and safe methods for the prevention of RIII are available in the clinical practice. Our previous study proved that the green tea polyphenol (-)-epigallocatechin-3-gallate (EGCG) efficiently attenuates radiation-induced intestinal injury (RIII) in animal level. Therefore, this prospective phase II clinical study (ChiCTR2100053703) evaluated the efficacy of EGCG in the prevention of RIII.

MATERIALS/METHODS

Cervical or endometrial cancer patients who received adjuvant or radical RT in our department were enrolled, 400mg EGCG was taken daily, and RIII was evaluated weekly according to the RTOG criteria.

RESULTS

Between February 2022 to January 2023, 37 patients were enrolled (30 were cervical cancer and the other 7 were endometrial cancer), and were followed-up regularly. Among them, the majority patients (75.7%, 28 patients) developed grade 0 or 1 RIII, for which no medical intervention was required. Meanwhile, the occurrence of grade 2 RIII was 24.3% (9 patients), which was significantly lower than that in the historical controls (usually 60% to 80%). Besides that, no patients developed grade 3 or worse RIII.

CONCLUSION

In this phase II clinical trial, compared to historical controls, the prophylactic use of EGCG significantly reduced the incidence and severity of RIII in patients receiving pelvic RT. Therefore, EGCG has the potential to become a novel medical countermeasure for the prevention of RIII for pelvic cancer patients.

Multi-Institutional Phase II Trial Using Dose Escalated Five Fraction Stereotactic Partial Breast Irradiation (S-PBI) with GammaPodTM for Early-Stage Breast Cancer

PURPOSE/OBJECTIVE(S)

We report on our early experience of a multi-institutional phase II study of dose escalated five fraction stereotactic partial breast irradiation (S-PBI) for early-stage breast cancer after partial mastectomy using the GammaPodTM stereotactic radiation system.

MATERIALS/METHODS

Patient eligibility included DCIS or invasive epithelial histologies, AJCC clinical stage 0, I, or II with tumor size < 3 cm, and negative margins. Prior safety of Phase I dose escalation has been reported. Dose was 40 Gy delivered in 5 fractions to the CTV, and minimum dose 30 Gy in 5 fractions to the PTV. CTV margin was 1 cm and PTV margin 3 mm. For PTV cavities larger than 100cc, dose was reduced to 35Gy in 5 fractions to the CTV and 30 Gy in 5 fractions to the PTV. Primary endpoint of the study is to determine the 3-year patient global cosmesis score (4-point scale excellent, good, fair, or poor) and adverse cosmesis using a dose escalated approach with smaller PTV margins than conventional methods. Both patients and physicians completed baseline and subsequent cosmesis outcome questionnaires. Treatment related toxicity was graded using the NCI version 4.0 and RTOG/EORTC late radiation scale.

RESULTS

From 3/2019-10/2021, 74 patients were treated respectively. Of these, 38 were treated to 40Gy and 36 were treated to 35 Gy. Median follow up (f/u) was 24 months (mo), range (r) 3-39mo. Median age was 63 years (r 43-77). Histology included 28 DCIS, and 46 invasive carcinomas. 45/46 invasive tumors were ER+. 60/74 (81%) patients received endocrine therapy, and 7/74 patient received chemotherapy. There were 221 acute grade 1 toxicities, and 28 Grade 2 toxicities. No grade 3 or higher acute toxicities were reported (< 90 days). The most common Grade 2 toxicities were radiation dermatitis (10), breast pain (8), blister (4), skin infection (2), nipple discharge (2), and fatigue (2). In the late period, there were 54 Grade 1 late toxicities, 4 Grade 2 late toxicities, and no Grade 3 or higher late toxicities. Grade 2 toxicities included fibrosis (2), and pain (2). Two patients developed grade 1 asymptomatic nonpalpable fat necrosis both diagnosed at 12 months after radiation treatments. The most common grade 1 late toxicities were breast pain (14), hyperpigmentation (8), fibrosis (10), and fatigue (5). Physicians scored cosmesis excellent or good 70/73 (95.8%), 58/60 (96.7%), 36/36 (100%),17/17(100%) respectively at baseline, 12 months, 24 months, and 36months post SBRT, while patients scored the same periods 62/71 (83.7%), 53/59 (89.8%), 33/36 (91.6%), 17/18 (94.4%). There have been no reports of disease recurrences.

CONCLUSION

Results at 24-month median follow-up, of our dose escalated stereotactic partial breast 5 fraction regimen, has low acute and late toxicity, while maintaining high proportion of excellent/good cosmetic outcomes. Continued analysis of all cohorts is in progress.

CLINICAL TRIALS

gov identifier is NCT03581136.

Deep Learning-Based Pipeline for Automatic Identification of Intestinal Regenerating Crypts in Mouse Histological Images

PURPOSE/OBJECTIVE(S)

A classical approach for evaluating normal tissue radiation response is to count the number of intestinal regenerating crypts in mouse histological images acquired after abdominal radiation. However, manual counting is time-consuming and subject to inter-observer variations. The goal of this study is to build a deep learning-based pipeline for automatically identifying intestinal regenerating crypts to facilitate high-throughput studies.

MATERIALS/METHODS

Sixty-six healthy C57BL/6 female mice underwent 16 MeV whole abdominal electron irradiation. The small bowel was collected from each mouse 4 days post-irradiation, and 9 jejunal cross-sections from each were processed together in a single slide. The slides were stained with hematoxylin and eosin (H&E) and subsequently scanned (x20), providing one electronic histological image per mouse. Regenerating crypts, consisting of more than 10 basophilic crypt epithelial cells, were manually identified using point annotations in histological images. The pipeline was built to take the input of the image containing 9 cross sections and automatically identify the regenerating crypts on each cross section. It mainly consists of two components, cross section segmentation using intensity thresholding and morphological operations and crypt identification using a UNet. The dataset was randomly split into 46, 10, and 10 slide images for UNet training, validation, and testing. Each slide image was split into grid tiles with a voxel size of 200 × 200, and 40 × 40 square masks were placed with centers at manual point annotations on tiles with regenerating crypts. 5203/5198 tiles (w/wo crypt mask) were extracted to train UNet by minimizing dice loss. The mask probability map generated by the UNet was post-processed to identify the crypt position. Postprocessing hyperparameters were tuned using the validation dataset. The model accuracy was evaluated using the testing dataset by computing the mean absolute error (MAE) of the crypt number averaged across all cross sections.

RESULTS

The number of regenerating crypts on testing cross sections ranges from 1 to 63. The testing cross-section-wise MAE achieved by the platform is 3.5±4.8 crypts. 81.25% of testing cross sections have absolute number differences less than or equal to 5 crypts.

CONCLUSION

Our established deep learning-based pipeline can accurately count the number of regenerating crypts in mouse intestinal histological images. We have integrated it into an online platform that enables automatic crypt identification and allows users to interactively modify auto-identified crypt annotations. The acquired annotations from the platform will be used to finetune the deep learning model to achieve better identification performance.

Equivalent Dose Estimation in FLASH Irradiation with a Deep Learning Approach

PURPOSE/OBJECTIVE(S)

Ultra-high dose rate (FLASH) irradiation has been reported to provide decreased normal tissue toxicity without compromising tumor control compared with conventional (CONV) irradiation. However, a comprehensive understanding of the FLASH biological effect requires precise quantification of radiobiology. The study is to explore whether deep learning (DL) can tackle the task. As a proof of concept, we investigate a DL model for estimating FLASH dose to its equivalent CONV dose.

MATERIALS/METHODS

Healthy C57Bl/6 female mice underwent FLASH (200Gy/s; n = 43) or CONV (0.12Gy/s; n = 41) whole abdominal irradiation using ∼16 MeV electron beams with a dose escalation scheme of 5 groups (n = 8 or 9) at 1Gy increments: 12-16Gy FLASH, 11-15Gy CONV. 4 days post-irradiation, 9 jejunum cross-sections per mouse were H&E stained for histological analysis. Each cross-section image was processed to remove lumen background and oversampled into multiple large-scale and small-scale patches along jejunal circumference. In CONV dataset, we randomly selected the data of 32 mice (80%) for model training and the rest (20%) for model validation. A ResNet101-based DL model, pre-trained with an unsupervised contrastive learning scheme, was retrained with only CONV training set to estimate corresponding CONV dose. For comparison, a crypt counting (CC) approach was implemented by manually counting the number of regenerating crypts on each cross-section image. An exponential function of dose vs crypt number was fitted with the CONV training set and used for dose estimation on the testing set. Mean squared error (MSE) was used to assess the accuracy of DL and CC approaches in estimating dose levels in CONV irradiation. The validated DL model was applied to the FLASH set to project FLASH dose into corresponding CONV dose that results in equivalent biological response.

RESULTS

The CONV dose estimated by DL and CC approaches and DL-estimated FLASH equivalent dose were summarized in Table 1. The DL model achieved an MSE of 0.21 Gy2 on CONV testing set compared with 0.32 Gy2 of the CC approach. FLASH equivalent dose estimated by DL model for 12, 13, 14, 15 and 16Gy were 12.16±0.40, 12.53±0.32, 12.72±0.24, 12.85±0.20 and 13.04±0.27 Sv, respectively.

CONCLUSION

Our proposed DL model can accurately estimate the CONV dose based on histological images. The DL predictions of FLASH dataset demonstrate that FLASH may reduce normal tissue toxicity with a lower equivalent dose, especially at high irradiated dose levels. Our study indicates that deep learning can be potentially used to assess the equivalent dose of FLASH irradiation to normal tissue.

Assessment of Cardiac Radiation Dose in the Co-60 Prone Based Stereotactic Partial Breast Irradiation (CP-sPBI) Using the Distance from the Heart to the Planning Treatment Volume as a Surrogate Marker

PURPOSE/OBJECTIVE(S)

Irradiation of the breast has shown to provide sharp dose gradients using Co-60 prone based stereotactic partial breast irradiation (CP-sPBI), a contemporary device for stereotactic radiotherapy for breast cancer (BC) for accelerated partial breast irradiation (APBI). In addition, the precise setup of CP-sPBI permits a small planning treatment volume (PTV) margin of 3 mm creating a greater distance from PTV to organs at risk. However, to date the factors that influence dose gradients and subsequent cardiac doses of ionizing radiation using CP-sPBI have not been well-studied. Here we evaluate distance of the heart to the lumpectomy PTV cavity and how this effects cardiac dose.

MATERIALS/METHODS

A retrospective database of 113 consecutive patients treated by CP-sPBI for APBI from March 2019 to February 2023 who were treated with 30 Gy in 5 fractions were queried for analysis. The minimum distance from the heart to the PTV (hP) was measured in either the axial or sagittal view. A group of 28 patient cases were randomly selected to achieve an even distribution of 28 cases with hP < 2.75 cm and hP ≥ 2.75 cm to compare cardiac toxicities based on hP. Descriptive analyses were performed to evaluate various cardiac dosimetric parameters based on laterality of BC and hP, using the student's t test.

RESULTS

The mean (range) hP was 4.58 cm (0.80-12.23) for all cases. The subgroup analyses of 28 patient cases with cardiac parameters showed the heart mean (range) dose of 1.20 Gy (0.01-2.11). The mean and max heart dose to the left-sided BC were similar to those to the right-sided BC (mean dose: 1.20 vs. 1.19 Gy; P = 0.97 and max dose: 10.47 vs. 5.66 Gy; P = 0.06). An inverse correlation between hP and mean heart dose was shown with the correlation coefficient of -0.81. Using a cutoff of 2.75 cm hP, the differences between hP < 2.75 and hP ≥ 2.75 cm for all cardiac dosimetric evaluations were all statistically significant, including mean (1.67 vs. 0.79 Gy; p<0.01) and maximal heart dose (14.48 vs. 4.11 Gy; p<0.01) CONCLUSION: CP-sPBI treatment delivery system was able to achieve acceptable clinically relevant heart dosimetric parameters when delivering 5 fraction APBI with a mean heart dose of 1.20 Gy for all locations of PTV cavity volume in the breast. Due to CP-sPBIs excellent dose fall-off characteristics, APBI using CP-SPBI showed clinically acceptable cardiac dosimetric parameters, particularly for PTVs located > 2.75 cm from the heart.

Financial Toxicity and Patient Experience Outcomes on a Multi-Institutional Phase I Single Fraction Stereotactic Partial Breast Irradiation Protocol for Early-Stage Breast Cancer

PURPOSE/OBJECTIVE(S)

Given the demonstrated financial toxicity (FT) of radiation treatment on breast cancer patients shown in both conventional and our recent 5 fraction stereotactic APBI (S-PBI) study, we assessed the FT, as well as patient-reported utility, quality-of-life and patient experience measures, on patients treated in our phase I single fraction S-PBI trial.

MATERIALS/METHODS

A phase I single fraction dose escalation trial of S-PBI for early-stage breast cancer was conducted. Women with in-situ or stage I-II (AJCC 6) invasive breast cancer following breast conserving surgery were treated with S-PBI in 1 fraction to a total dose of 22.5, 26.5 or 30 Gy (Clinical trials.gov ID NCT02685332). At one month follow-up, patients were asked to complete our novel "Patient Perspective Cost and Convenience of Care Questionnaire". Patients also completed the EQ-5D-5L, including the visual analogue scale of overall health (VAS), at enrollment, 6, 12-, 24-, 36-, and 48-month follow-up.

RESULTS

Of 29 patients enrolled and treated, questionnaire data was available for all patients. Our trial encompassed a wide range of annual household incomes, education, and employment status. Overall, 44.8% (n = 13/29) of patients reported that radiation treatment presented a financial burden. Interestingly, no demographic information, such as patient race, marital status, education, household income, or employment during treatment predicted perceived FT. Patients reporting FT trended towards younger age (median 64 vs 70.5) and having a cancer related co-pay similar to our 5 fraction S-PBI FT trial; however, due to the small size of this study, this did not reach significance (p = 0.24 and 0.10, respectively). VAS and utility scores were calculated per the EQ-5D-5L and remained unchanged from baseline through 4-year follow-up. Likewise, there was no difference in the utility or VAS between patients who reported FT and those who did not. Interestingly, while patient reported cosmesis was similar for all patients at enrollment, patients who reported FT noted significantly worse cosmesis scores (fair/poor vs good/excellent) at 6 month and 2-year follow-ups (p = 0.01 and 0.04, respectively). Finally, patients were surveyed on treatment related disruption to their daily activities and enjoyment of life. The median values were 0 (scale 0-10, with 0 being no disruption) regardless of perceived FT. Patients were also uniformly satisfied with treatment time with a median score of 10 (scale 0-10, 10 being most satisfied).

CONCLUSION

Here, we show that despite using SPBI in a single fraction, nearly half of the patients treated still reported FT of treatment. Importantly, single fraction S-PBI has no negative impact on patient VAS or utility scores, and all patients were uniformly satisfied with treatment time without significant disruption to their life.

Predicting Neurocognitive Decline in Multiple Brain Metastases Patients Undergoing Distributed Stereotactic Radiosurgery

PURPOSE/OBJECTIVE(S)

Stereotactic radiosurgery (SRS) is the standard of care for treating a limited number (<3) of brain metastasis (BMs), which offers reduced neurotoxicity compared to whole brain radiotherapy (WBRT). Contemporary advancements in SRS made it possible to also commonly treat multiple (>4) BMs (mBMs). Emphasizing the value of preserving quality of life (QoL) after SRS, there is an urgent need for a systematic study of potential neurocognitive decline in patients receiving SRS treatment for mBMs. The purpose of this study is to use routine MRIs to predict neurocognitive decline for patients treated with distributed SRS, allowing for timely and effective treatment strategy design.

MATERIALS/METHODS

This study uses data from an institutional phase I/II clinical trial to determine the neurocognitive decline in patients with (>6) mBMs treated with distributed SRS. In the first 12 months post-SRS, participants are followed and evaluated with routine MRIs and the Hopkins Verbal Learning Test-Revised (HVLT-R) at 2 to 3-month intervals. Changes in HVLT-Delayed Recall scores between two visits are used to define neurocognitive decline. For each visit, an in-house deep learning model segments 66 cortical and 55 subcortical brain regions of interest (ROIs) from the T1 structural MRI and extracts 253 ROI features, including the surface area and thickness of cortical ROIs, and the volume of all ROIS. The difference in ROI features between two visits, together with other clinical factors (e.g., prescription, number of BMs, etc.), is considered as one sample. The study included 22 subjects with 91 visits, resulting in 171 samples with neurocognitive decline labels. The entire sample set is split into 10 folds on patient level for cross validation. In each fold, feature engineering is conducted to remove redundancy and to select the most-important features. The top 20% most frequently selected features are applied with Support Vector Machine to predict the neurocognitive decline label of each sample.

RESULTS

As a preliminary result, the proposed method achieves an accuracy of 76%, with an area under the curve (AUC) of 0.75, sensitivity of 0.65 and specificity of 0.83 for predicting neurocognitive decline in mBMs SRS patients using only routine T1 MRIs. The volume of lateral occipital complex, the thickness of inferior parietal lobe and postcentral gyrus, and the surface area of lateral orbitofrontal cortex and pars triangularis are identified as the 5 most important features for this task.

CONCLUSION

Our method shows promising findings for post-SRS neurocognitive decline prediction solely based on routine baseline and follow-up MRIs. In addition, it can identify critical brain ROIs associated with the post-SRS cognitive function. This method has the potential to assist treatment planning strategy to help preserve patients' QoL.

A Comprehensive Deep Learning Framework for Automatic Target Volumes Segmentation in Post-Operative Stereotactic Partial Breast Irradiation (S-PBI)

PURPOSE/OBJECTIVE(S)

In S-PBI, accurate delineation of post-surgical tumor bed volume (TBV) and clinical target volume (CTV) are crucial tasks to achieve effective radiotherapy outcomes. However, manual contouring is labor intensive, time consuming, and largely relies on the experience of clinicians. We aimed to propose a deep learning (DL) approach which mimics physicians' contouring practice to accurately segment target volumes in post-operative breast CT images.

MATERIALS/METHODS

Our approach incorporated domain knowledge into a 3D U-Net based DL model for breast target volumes (TBV and CTV) delineation. Our TBV segmentation approach was inspired by the marker-guidance procedure in manual delineation, where the visual clues provided by the markers assist physicians in defining TBV. For this purpose, a distance-transformation coupled with a Gaussian filter was adopted to convert markers' locations on the CT images to saliency maps. Subsequently, the CT images and the corresponding saliency maps formed a two-channel input for the segmentation model. For CTV segmentation, TBV was incorporated as an input in addition to the CT images, guiding the model to encode the location-related image features. The architecture allowed the network to emulate the oncologist's manual delineation where CTV is derived from TBV via a margin expansion, followed by correcting the extensions for anatomical barriers of tumor invasion (e.g., skin, chest wall). We retrospectively collected 175 prone CT images from 35 post-operative breast cancer patients who received 5-fraction partial breast irradiation (PBI) regimen on a Co-60 prone based S-PBI unit. The 35 patients were randomly split into 25, 5, and 5 for model training, validation, and testing respectively.

RESULTS

We evaluated the performance of the developed DL model on the testing dataset by comparing the predicted volumes with the manually delineated contours (ground truth) using Dice similarity coefficient (DSC), 95th percentile Hausdorff distance (HD95), and average symmetric surface distance (ASD). For TBV segmentation, our model achieved mean (standard deviation) of 0.76 (±2.7), 6.76 (±1.83) mm, and 1.9 (±0.66) mm for DSC, HD95, and ASD respectively. For CTV segmentation, our model achieved 0.94 (±0.02), 2.46 (±0.5) mm, and 0.53 (±0.14) mm for DSC, HD95, and ASD respectively. The proposed auto-segmentation approach generated TBV and CTV masks in ∼11 seconds per CT volume, implying significantly improved efficiency compared to manual contouring.

CONCLUSION

We developed a comprehensive DL framework mimicking clinical contouring practice for auto-segmentation of target volumes in S-PBI. The results demonstrated high levels of agreement between the predicted contours and physicians' manual contours. The approach is promising for improving the efficiency and accuracy of the on-line treatment planning workflow, such as adaptive based S-PBI.

Prospective Clinical Adoption of Artificial Intelligence for Organ Contouring in Head and Neck Radiation Treatment Planning

PURPOSE/OBJECTIVE(S)

Patients that undergo head and neck (H&N) radiation therapy (RT) require laborious delineation of organs-at-risk (OARs) on computed tomography (CT) scans in a treatment planning system (TPS) to minimize radiation to normal tissue. This task can be completed rapidly and accurately with recently developed artificial intelligence-based semantic segmentation models. The current study aims to deploy and evaluate a strategy for improving clinical practice with this technology.

MATERIALS/METHODS

Deep learning models were trained and tested with CT scans and OAR contours from previous H&N RT cases at our clinic. Two medical physicists vetted the models and selected a 2.5D U-Net for further implementation. The model was embedded in a dedicated server at the hospital, programmed to read H&N CT scans staged for import into the TPS, generate auto-contours, and write them into a TPS-compatible format made available alongside the scan. In the pilot implementation, the auto-contouring service was utilized for more than 60 cases, prospectively. The auto-contours were quantitatively evaluated against the treatment-approved contours to determine how much modification was performed by the clinical team.

RESULTS

The 2.5D U-Net selected for clinical integration segments 21 OARs in less than 3 minutes per scan. Across all the prospective cases, the mean Dice score and mean 95th percentile Hausdorff distance (mm) between the auto-contour and treatment-approved contour for each of the 21 OARs were as follows, respectively: brainstem (0.93, 1.94), optic chiasm (0.70, 2.96), left cochlea (0.69, 2.37), right cochlea (0.68, 2.44), esophagus (0.88, 2.46), left globe (0.93, 1.50), right globe (0.93, 1.63), glottis (0.91, 2.13), larynx (0.93, 2.76), mandible (0.90, 4.86), left optic nerve (0.78, 1.64), right optic nerve (0.82, 1.65), oral cavity (0.86, 8.46), left parotid gland (0.91, 2.78), right parotid gland (0.91, 2.39), pharynx (0.85, 2.39), spinal cord (0.87, 2.27), left submandibular gland (0.85, 3.46), right submandibular gland (0.83, 3.69), left temporal lobe (0.94, 2.20), and right temporal lobe (0.95, 2.09). The auto-contours for the optic chiasm, optic nerves, cochleas, and submandibular glands differed substantially from the final contours, a finding corroborated by the clinical team; the rest were clinically acceptable with minor or no edits necessary.

CONCLUSION

The proposed strategy provides a sophisticated starting point for treatment planning that has garnered overall favorable feedback from the participating radiation oncologists and dosimetrists. Consequently, the technique is being extended to other treatment sites.

Magnetic resonance imaging findings of pulmonary sclerosing pneumocytoma: a case report and literature review

Background

Pulmonary sclerosing pneumocytoma (PSP) is a rare lung tumor that is mostly isolated and commonly reported among middle-aged East Asian women. Recently, Immunohistochemistry (IHC) analysis has suggested that PSP is of primitive epithelial origin, most likely derived from type II alveolar air cells. Patients with PSP are generally asymptomatic and usually detected for other unrelated reasons during routine imaging. Several studies have already investigated the computed tomography (CT) features of PSP and their correlation with pathology. Magnetic resonance imaging (MRI) is a radiation-free imaging technique with important diagnostic value for specific pulmonary nodules. However, very few case reports or studies focus on the MRI findings of PSP.

Case report

We reported a case of an asymptomatic 56-year-old female with a solitary, well-defined soft-tissue mass in the lower lobe of the left lung. The mass showed iso-to-high signal intensity (SI) than muscle on T1-weighted image (T1WI) and T2-weighted image (T2WI) and a much higher SI on fat-suppressed T2WI, diffusion-weighted image, and apparent diffusion coefficient image. Contrast-enhanced fat-suppressed T1WI revealed noticeable inhomogeneous progressive enhancement throughout the mass. The mass revealed early enhancement without a significant peak, followed by a plateau pattern on dynamic contrast-enhanced MRI images. The patient underwent left basal segmentectomy via thoracoscopic surgery. Histopathology and IHC results of the surgical specimen confirmed that it was a PSP. We concluded that the MRI findings of PSP might adequately reflect the different components within the tumor and aid clinicians in preoperative diagnosis and assessment. To the best of our knowledge, this is the most comprehensive case report on the MRI findings of PSP.

Conclusion

The MRI findings of PSP correspond to its histopathological features. Here, we present a case of PSP with the most comprehensive MRI findings, emphasizing the importance of multiple-sequence MRI in diagnosing PSP.

[Efficacy of non-surgical comprehensive treatment for locally advanced hypopharyngeal carcinoma with cervical esophagus invasion]

Objective: To analyze the treatment effects and side effects of non-surgical comprehensive treatment for locally advanced hypopharyngeal carcinoma invading cervical esophagus. Methods: A retrospective analysis was performed on sixty-six patients with locally advanced hypopharyngeal carcinoma invade the esophagus. These patients were treated in the Department of Otolaryngology, Head and Neck Surgery of Chinese People's Liberation Army General Hospital between January 2011 and May 2022, including sixty-five males and one female, aged 43-71 years. Treatment regimen consisted of induction chemotherapy and concurrent chemoradiothrapy and epidermal growth factor receptor (EGFR)-targeted therapy, three of these cases were treated with programmed cell death 1 (PD-1) immunotherapy. The Kaplan-Meier method was used for survival analysis. Side effects were evaluated with the established CTCAE (Common Terminology Criteria for Adverse Events) 5.0 criteria. The factors affecting prognosis were analyzed by Cox multivariate regression analysis. Results: Sixty-four (97.0%, 64/66) patients completed the radiotherapy and chemotherapy plan. The most common grade three side effects were radioactive oropharyngeal mucositis (89.1%, 57/64) and leukopenia (23.4%, 15/64). Five (7.8%, 5/64) patients showed grade three hoarseness; two patients (3.1%, 2/64) suffered from grade three swallowing dysfunction and required feeding tube and intravenous nutrition; the remaining patients(89.1%) retained good vocal and swallowing functions. The overall survival (OS) of all patients was 81.5% after one year, 54.0% after three years, and 39.9% after five years; the progression-free survival (PFS) was 78.3% after one year, 54.9% after three years, and 42.6% after five years; local control rate (LCR) was 80.9% after one year, 62.5% after three years, and 52.0% after five years. T4a patients showed better OS, PFS and LCR than T4b patients, with statistically significant differences (χ2=8.10, 8.27, and 6.64, respectively, all P<0.05). Cox multivariate regression analysis showed that lymph node metastasis was an independent factor affecting prognosis (χ2=10.21, P<0.05). Conclusion: Non-surgical comprehensive treatment can provide with another option of radical treatment for locally advanced hypopharyngeal carcinoma with cervical esophagus invasion, offering the patients higher rate of larynx and esophageal preservation with tolerable side effects.

The prevalence of coagulase-negative staphylococcus associated with bovine mastitis in China and its antimicrobial resistance rate: a meta-analysis

To contribute to the treatment decision and optimize coagulase-negative staphylococcus (CNS) control programs, we conducted a meta-analysis to investigate the epidemiology and antimicrobial resistance rates of coagulase-negative staphylococcus associated with bovine mastitis in China. Three databases (PubMed, Google scholar and China National Knowledge Infrastructure database) were utilized to obtain relevant publications. A total of 18 publications were included in our research, and 3 of them included antimicrobial resistant (AMR) test. The pooled prevalence of coagulase-negative staphylococcus was 17.28%. Subgroup analysis revealed that the prevalence was higher in South China than in North China, was higher in 2011-2020 than in 2000-2010 and was higher in clinical bovine mastitis cases than in subclinical cases. The pooled AMR were most resistant to β-lactams, followed by tetracyclines, quinolones, nitrofurans, lincosamides, sulfonamides, amphenicol and aminoglycosides. The pooled AMR rate of coagulase-negative staphylococcus was lower in 2011-2020 than in 2000-2010. Although the prevalence of CNS showed an increasing trend over 20 years, the AMR rate showed a decreasing trend, and the clinical type of mastitis was the most frequent and the prevalence was highest in South China. Finally, CNS was most resistant to β-lactams amongst the eight groups of antimicrobial agents.

Evidence for Band Renormalizations in Strong-Coupling Superconducting Alkali-Fulleride Films

There has been a long-standing debate about the mechanism of the unusual superconductivity in alkali-intercalated fullerides. In this Letter, using high-resolution angle-resolved photoemission spectroscopy, we systematically investigate the electronic structures of superconducting K_{3}C_{60} thin films. We observe a dispersive energy band crossing the Fermi level with the occupied bandwidth of about 130 meV. The measured band structure shows prominent quasiparticle kinks and a replica band involving the Jahn-Teller active phonon modes, which reflects strong electron-phonon coupling in the system. The electron-phonon coupling constant is estimated to be about 1.2, which dominates the quasiparticle mass renormalization. Moreover, we observe an isotropic nodeless superconducting gap beyond the mean-field estimation (2Δ/k_{B}T_{c}≈5). Both the large electron-phonon coupling constant and large reduced superconducting gap suggest a strong-coupling superconductivity in K_{3}C_{60}, while the electronic correlation effect is suggested by the observation of a waterfall-like band dispersion and the small bandwidth compared with the effective Coulomb interaction. Our results not only directly visualize the crucial band structure but also provide important insights into the mechanism of the unusual superconductivity of fulleride compounds.

Imaging diagnosis of intravenous leiomyomatosis: an institutional experience

AIM

To review and summarise the clinical and imaging characteristics of intravenous leiomyomatosis (IVL), a rare smooth muscle tumour originating from the uterus.

MATERIALS AND METHODS

Twenty-seven patients with a histopathological diagnosis of IVL who underwent surgery were reviewed retrospectively. All patients underwent pelvic ultrasonography, inferior vena cava (IVC) ultrasonography, and echocardiography before surgery. Computed tomography (CT) with contrast enhancement was performed in patients with extrapelvic IVL. Some patients underwent pelvic magnetic resonance imaging (MRI).

RESULTS

Mean age was 44.81 years. Clinical symptoms were non-specific. IVL was intrapelvic in seven patients and extrapelvic in 20. Preoperative pelvic ultrasonography missed the diagnosis in 85.7% of patients with intrapelvic IVL. Pelvic MRI was useful to evaluate the parauterine vessels. Incidence of cardiac involvement was 59.26%. Echocardiography showed a highly mobile sessile mass in the right atrium with moderate-to-low echogenicity that originates from the IVC. Ninety per cent of extrapelvic lesions showed unilateral growth. The most common growth pattern was via the right uterine vein-internal iliac vein-IVC pathway.

CONCLUSION

The clinical symptoms of IVL are non-specific. For patients with intrapelvic IVL, early diagnosis is difficult. Pelvic ultrasound should focus on the parauterine vessels, the iliac and ovarian veins should be explored carefully. MRI has obvious advantages in evaluating parauterine vessel involvement, which is helpful for early diagnosis. For patients with extrapelvic IVL, CT should be performed before surgery as part of a comprehensive evaluation. IVC ultrasonography and echocardiography are recommended when IVL is highly suspected.

[Efficacy and safety of various doses of hybutimibe monotherapy or in combination with atorvastatin for primary hypercholesterolemia: a multicenter, randomized, double-blind, double-dummy, parallel-controlled phase Ⅲ clinical trial]

Objective: To evaluate the efficacy and safety of hybutimibe monotherapy or in combination with atorvastatin in the treatment of primary hypercholesterolemia. Methods: This was a multicenter, randomized, double-blind, double-dummy, parallel-controlled phase Ⅲ clinical trial of patients with untreated primary hypercholesterolemia from 41 centers in China between August 2015 and April 2019. Patients were randomly assigned, at a ratio of 1∶1∶1∶1∶1∶1, to the atorvastatin 10 mg group (group A), hybutimibe 20 mg group (group B), hybutimibe 20 mg plus atorvastatin 10 mg group (group C), hybutimibe 10 mg group (group D), hybutimibe 10 mg plus atorvastatin 10 mg group (group E), and placebo group (group F). After a dietary run-in period for at least 4 weeks, all patients were administered orally once a day according to their groups. The treatment period was 12 weeks after the first dose of the study drug, and efficacy and safety were evaluated at weeks 2, 4, 8, and 12. After the treatment period, patients voluntarily entered the long-term safety evaluation period and continued the assigned treatment (those in group F were randomly assigned to group B or D), with 40 weeks' observation. The primary endpoint was the percent change in low density lipoprotein cholesterol (LDL-C) from baseline at week 12. Secondary endpoints included the percent changes in high density lipoprotein cholesterol (HDL-C), triglyceride (TG), apolipoprotein B (Apo B) at week 12 and changes of the four above-mentioned lipid indicators at weeks 18, 24, 38, and 52. Safety was evaluated during the whole treatment period. Results: Totally, 727 patients were included in the treatment period with a mean age of (55.0±9.3) years old, including 253 males. No statistical differences were observed among the groups in demographics, comorbidities, and baseline blood lipid levels. At week 12, the percent changes in LDL-C were significantly different among groups A to F (all P<0.01). Compared to atorvastatin alone, hybutimibe combined with atorvastatin could further improve LDL-C, TG, and Apo B (all P<0.05). Furthermore, there was no significant difference in percent changes in LDL-C at week 12 between group C and group E (P=0.991 7). During the long-term evaluation period, there were intergroup statistical differences in changes of LDL-C, TG and Apo B at 18, 24, 38, and 52 weeks from baseline among the statins group (group A), hybutimibe group (groups B, D, and F), and combination group (groups C and E) (all P<0.01), with the best effect observed in the combination group. The incidence of adverse events was 64.2% in the statins group, 61.7% in the hybutimibe group, and 71.0% in the combination group during the long-term evaluation period. No treatment-related serious adverse events or adverse events leading to death occurred during the 52-week study period. Conclusions: Hybutimibe combined with atorvastatin showed confirmatory efficacy in patients with untreated primary hypercholesterolemia, which could further enhance the efficacy on the basis of atorvastatin monotherapy, with a good overall safety profile.

Development of a laser-based angle-resolved-photoemission spectrometer with sub-micrometer spatial resolution and high-efficiency spin detection

Angle-resolved photoemission spectroscopy with sub-micrometer spatial resolution (μ-ARPES), has become a powerful tool for studying quantum materials. To achieve sub-micrometer or even nanometer-scale spatial resolution, it is important to focus the incident light beam (usually from synchrotron radiation) using x-ray optics, such as the zone plate or ellipsoidal capillary mirrors. Recently, we developed a laser-based μ-ARPES with spin-resolution (LMS-ARPES). The 177 nm laser beam is achieved by frequency-doubling a 355 nm beam using a KBBF crystal and subsequently focused using an optical lens with a focal length of about 16 mm. By characterizing the focused spot size using different methods and performing spatial-scanning photoemission measurement, we confirm the sub-micron spatial resolution of the system. Compared with the μ-ARPES facilities based on the synchrotron radiation, our LMS-ARPES system is not only more economical and convenient, but also with higher photon flux (>5 × 10¹³ photons/s), thus enabling the high-resolution and high-statistics measurements. Moreover, the system is equipped with a two-dimensional spin detector based on exchange scattering at a surface-passivated iron film grown on a W(100) substrate. We investigate the spin structure of the prototype topological insulator Bi₂Se₃ and reveal a high spin-polarization rate, confirming its spin-momentum locking property. This lab-based LMS-ARPES will be a powerful research tool for studying the local fine electronic structures of different condensed matter systems, including topological quantum materials, mesoscopic materials and structures, and phase-separated materials.

Association of non-alcoholic fatty liver disease with total testosterone in non-overweight/obese men with type 2 diabetes mellitus

PURPOSE

Non-alcoholic fatty liver disease (NAFLD) is considered as both a vital risk factor and a consequence of type 2 diabetes mellitus (T2DM). Low total testosterone (TT) is common in men with T2DM, contributing to increased risks of metabolic diseases. This study aimed to investigate the association between TT levels and the prevalence of NAFLD in men with T2DM.

METHODS

In this cross-sectional study, 1005 men with T2DM were enrolled in National Metabolic Management Center (MMC) of First Affiliated Hospital of Wenzhou Medical University between January 2017 and August 2021. NAFLD was diagnosed using ultrasound as described by the Chinese Liver Disease Association. Overweight/obesity was defined as body mass index (BMI) ≥ 25 kg/m² according to WHO BMI classifications.

RESULTS

Individuals without NAFLD had higher serum TT levels than those with NAFLD. After adjustments for potential confounding factors, the top tertile was significantly associated with lower prevalence of NAFLD compared with the bottom tertile of TT level [odds ratio (OR) 0.303, 95% confidence interval (CI) 0.281-0.713; P < 0.001]. The association between TT with NAFLD in individuals with normal weight (OR 0.175, 95% CI 0.098-0.315; P < 0.001) was stronger than in individuals with overweight/obesity (OR 0.509, 95% CI 0.267-0.971; P = 0.040). There was a significant interaction of TT with overweight/obesity (P for interaction = 0.018 for NAFLD).

CONCLUSION

Higher serum TT was significantly associated with a lower prevalence of NAFLD in men with T2DM. We found that the relationship of TT and NAFLD was stronger in individuals with non-overweight/obesity.

Study on the pathogenicity, immunogenicity, endogenous development and drug sensitivity of Eimeria kongi

Following the discovery of Eimeria kongi, we investigated the pathogenicity, immunogenicity, endogenous development and drug sensitivity of this coccidian. Coccidia-free rabbits were inoculated with 1 × 10² to 5 × 10⁴ sporulated oocysts of E. kongi before challenge 14 days post inoculation. E. kongi was moderately pathogenic and induced good immunity against re-infection. All inoculated doses results in reduced food intake and body weight gain, and an inoculation oocyst dose of 1 × 10³ or higher caused various degrees of diarrhea. Except for one death of the highest dose group, all rabbits recovered 12 days post inoculation. An inoculation dose of 1 × 10³ or 1 × 10⁴ oocysts conferred the most effective protection from re-infection, which reduced oocyst output by approximately 99% and maintained body weight gain. Four generations of schizogony were observed, and the endogenous development mainly occurred in the jejunum and ileum of rabbits. E. kongi was most sensitive to sulfachloropyrazine sodium, followed by decoquinate; it is resistant to diclazuril. Both decoquinate and sulfachloropyrazine sodium may be effective in the control of E. kongi infection.

Association between Iodized Salt Intake and Cognitive Function in Older Adults in China

OBJECTIVES

To investigate the association between iodized salt intake and cognitive function in older adults.

DESIGN

A cross-sectional study.

SETTINGS

Individuals from the Zhejiang Major Public Health Surveillance Program (ZPHS).

PARTICIPANTS

Data of 10,217 participants (including 4,680 coastal residents and 5,537 inland residents) aged ≥ 60 years were analyzed.

MEASUREMENTS

Salt intake was evaluated using a questionnaire, and participants were stratified into the following three groups: iodized salt, non-iodized salt, and mixed salt. Cognitive function was assessed through the Mini-Mental State Examination and defined using education-specific cut-off points. Logistic regression models controlling for an extensive range of potential confounders were generated to examine the association between salt intake and cognitive function among all participants.

RESULTS

Data from 10,217 participants with a 16.1% prevalence of cognitive impairment were analyzed. Compared with non-iodized salt intake, consumption of iodized salt was inversely associated with cognitive impairment (odds ratio [OR], 0.410; 95% confidence interval [CI], 0.351-0.480; P < 0.001) in all participants after multivariable adjustment. An association between iodized salt intake and cognitive impairment was observed in coastal (OR, 0.441; 95% CI, 0.340-0.572; P < 0.001) and inland residents (OR, 0.569; 95% CI, 0.439-0.738; P < 0.001). Despite the insufficient sample size, the results for individuals consuming mixed salt suggested an inverse association between mixed salt intake and cognitive impairment among coastal residents (OR, 0.598; 95% CI, 0.405-0.885; P = 0.010) after multivariable adjustment.

CONCLUSION

Our results indicate that iodized salt intake may reduce the risk of cognitive impairment in older adults living in coastal or inland areas, and the protective effect of iodized salt intake is greater in coastal areas than in inland areas.

The prevalence of bovine mastitis-associated Staphylococcus aureus in China and its antimicrobial resistance rate: A meta-analysis

In this study, to optimize the Staphylococcus aureus control program, a meta-analysis was conducted to investigate the epidemiology and antimicrobial resistance (AMR) profile of S. aureus-associated bovine mastitis in China from 2000 to 2020. A total of 33 publications from PubMed, Google Scholar, and China National Knowledge Infrastructure (CNKI) database were included in our research, among which nine publications included the AMR test. The pooled prevalence of S. aureus was 36.23%, and subgroup analysis revealed that the prevalence dropped from 2000-2010 to 2011-2020, which shows that China is on the right track. The pooled AMR rate indicate isolates were most resistant to β-lactams (50.68%), followed by quinolones (36.23%), macrolides (34.08%), sulfonamides (32.25%), tetracyclines (27.83%), aminoglycosides (26.44%), lincosamides (23.39%), and amphenicol (10.33%). Both the pooled prevalence and AMR of S. aureus in China are higher than those in Western countries, such as Germany, Belgium, Ireland, and the United States-countries with a long animal husbandry history and good management. Thus, there is still room to improve the treatment of S. aureus-associated bovine mastitis in China.

Novel MSH6 mutation predicted metastasis in eyelid and periocular squamous cell carcinoma

BACKGROUND

Our previous research revealed the relative local aggressiveness of eyelid and periocular squamous cell carcinoma (EPSCC), but its distinct genetic characteristics involved remain unknown.

OBJECTIVES

We conducted this study based on next-generation sequencing to identify the genetic distinctiveness of EPSCC and damaging mutations for possible etiology and poor prognosis.

METHODS

We performed sequencing using a 556-gene panel (smartonco) in 48 EPSCCs. Cox hazards model was applied to explore mutated genes that increase risk of metastasis and death. Pathogenesis of the mutations was predicted by sequence alignment algorithms.

RESULTS

The most commonly mutated genes were KMT2C (N=17, 35%), LRP1B (N=14, 29%), KMT2D (N=12, 25%), PTCH1(N=10, 21%) and TP53(N=10, 21%). DNA mismatch repair (MMR) genes (42%) like MSH6(19%) and MLH3(12%) were among the most frequently mutated genes. Cell cycle regulators including TP53(21%) and CDKN2A (10%) were less frequently mutated than in other squamous cell carcinomas (SCCs). Ultra violet exposure, MMR deficiency and aging were the main etiology. Of note, KMT2C has a deleterious mutation hotspot. Patients burdened with MSH6 mutation has a higher risk of overall metastasis (P=0.045, HR=5.165) and nodal metastasis (P=0.022, HR=14.038). Moreover, a hotspot mutation MSH6^E52A brought an even higher risk of nodal metastasis (P=0.011, HR=18.745).

CONCLUSIONS

EPSCCs displayed a unique mutation profile from cutaneous SCCs and mucosal SCCs. We have identified novel damaging mutations in epigenetic regulators like KMT2C boosted early onset of EPSCCs in addition to UVR, aging or MMR deficiency. And malfunction of MMR genes worsened prognosis.

The Prevalence of Klebsiella spp. Associated With Bovine Mastitis in China and Its Antimicrobial Resistance Rate: A Meta-Analysis

Understanding distribution of bovine mastitis pathogen Klebsiella spp. can contribute to the treatment decision and the control within programs of bovine mastitis, we conducted a meta-analysis to investigate the epidemiology and antimicrobial resistance rates of Klebsiella spp. associated with bovine mastitis in China. Three databases, namely, PubMed, Google scholar, and China National Knowledge Infrastructure database, were utilized to obtain relevant publications. According to PRISMA reporting standards, a total of 38 publications were included in the research, among them, 7 papers included an AMR test. The pooled prevalence of Klebsiella spp. was 5.41% (95% CI: 3.87–7.50%). Subgroup analysis revealed that the prevalence was higher in South China (8.55%, 95% CI: 3.57–19.09%) than in North China (4.22%, 95% CI: 2.46–7.14%), in 2010–2020 (7.45%, 95% CI: 5.29–110.40%) than in 2000–2010 (3.14%, 95% CI: 1.90–15.14%), and in the clinical bovine mastitis cases (7.49%, 95% CI: 3.71–14.54%) than in the subclinical cases (4.03%, 95% CI: 1.55–10.08%). The pooled AMR rate revealed that Klebsiella spp. were most resistant to sulfonamides (45.07%, 95% CI: 27.72–63.71%), followed by tetracyclines (36.18%, 95% CI: 23.36–51.34%), aminoglycosides (27.47%, 95% CI: 17.16–40.92%), β-lactams (27.35%, 95% CI: 16.90–41.05%), amphenicol (26.82%, 95% CI: 14.17–44.87%), lincosamides (21.24%, 95% CI: 7.65–46.75%), macrolides (20.98%, 95% CI: 7.20–47.58%), polypeptides (15.51%, 95% CI: 6.46–32.78%), and quinolones (7.8%, 95% CI: 3.25–17.56%). The climate difference between South and North China and the natural pathogenicity of Klebsiella spp. may be the primary reasons for its distribution, and the prevalence of Klebsiella spp. indicated that the genus is an increasing hazard to the dairy industry. The prevalence of AMR in China is commonly higher than in the European countries and Canada, this is a very important concern for strategy programs to control bovine mastitis caused by Klebsiella spp. in China.

Can lymphovascular invasion be predicted by contrast-enhanced CT imaging features in patients with esophageal squamous cell carcinoma? A preliminary retrospective study

Background

To investigate the value of contrast-enhanced CT (CECT)-derived imaging features in predicting lymphovascular invasion (LVI) status in esophageal squamous cell carcinoma (ESCC) patients.

Methods

One hundred and ninety-seven patients with postoperative pathologically confirmed esophageal squamous cell carcinoma treated in our hospital between January 2017 and January 2019 were enrolled in our study, including fifty-nine patients with LVI and one hundred and thirty-eight patients without LVI. The CECT-derived imaging features of all patients were analyzed. The CECT-derived imaging features were divided into quantitative features and qualitative features. The quantitative features consisted of the CT attenuation value of the tumor (CTV_Tumor), the CT attenuation value of the normal esophageal wall (CTV_Normal), the CT attenuation value ratio of the tumor-to-normal esophageal wall (TNR), the CT attenuation value difference between the tumor and normal esophageal wall (ΔTN), the maximum thickness of the tumor measured by CECT (Thickness), the maximum length of the tumor measured by CECT (Length), and the gross tumor volume measured by CECT (GTV). The qualitative features consisted of an enhancement pattern, tumor margin, enlarged blood supply or drainage vessels to the tumor (EVFDT), and tumor necrosis. For the clinicopathological characteristics and CECT-derived imaging feature analysis, the chi-squared test was used for categorical variables, the Mann–Whitney U test was used for continuous variables with a nonnormal distribution, and the independent sample t-test was used for the continuous variables with a normal distribution. The trend test was used for ordinal variables. The association between LVI status and CECT-derived imaging features was analyzed by univariable logistic analysis, followed by multivariable logistic regression and receiver operating characteristic (ROC) curve analysis.

Results

The CTV_Tumor, TNR, ΔTN, Thickness, Length, and GTV in the group with LVI were higher than those in the group without LVI (P < 0.05). A higher proportion of patients with heterogeneous enhancement pattern, irregular tumor margin, EVFDT, and tumor necrosis were present in the group with LVI (P < 0.05). As revealed by the univariable logistic analysis, the CECT-derived imaging features, including CTV_Tumor, TNR, ΔTN and enhancement pattern, Thickness, Length, GTV, tumor margin, EVFDT, and tumor necrosis were associated with LVI status (P < 0.05). Only the TNR (OR 8.655; 95% CI 2.125–37.776), Thickness (OR 6.531; 95% CI 2.410–20.608), and tumor margin (OR 4.384; 95% CI 2.004–9.717) were independent risk factors for LVI in the multivariable logistic regression analysis. The ROC curve analysis incorporating the above three CECT-derived imaging features showed that the area under the curve obtained by the multivariable logistic regression model was 0.820 (95% CI 0.754–0.885).

Conclusion

The CECT-derived imaging features, including TNR, Thickness, tumor margin, and their combination, can be used as predictors of LVI status for patients with ESCC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12880-022-00804-7.

Discrepant effects of monovalent cations on membrane fouling induced by colloidal polymer: Evaluation and mechanism investigation

Understanding how ionic conditions affect membrane fouling induced by anionic polyacrylamide (APAM) is important for achieving long-term and stable operation of a polymer flooding produced wastewater (PFPW) membrane separation process. However, there is lack of studies on the effects of monovalent cations (Na⁺ and K⁺) on APAM-based membrane fouling. In this work, the effects of Na⁺ and K⁺ on filtration efficiency, flux decline behavior, fouling resistance, and cleaning efficiency were studied through a series of microfiltration tests. Moreover, the influencing mechanism of membrane fouling was further comprehensively revealed from the aspects of the extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory, the hydration force, and the microstructure characterizations. The XDLVO theory agreed well with membrane fouling behavior at various ionic strengths. The increase in ionic strength (0-10,000 mg/L) of Na⁺ and K⁺ exacerbated the reduction of relative flux (J/J₀) and the accumulation of fouling resistance, as well as made the porous APAM-induced fouling layer denser and more compact, boosting removal efficiency. Furthermore, K⁺ had a stronger aggravating effect on membrane fouling than Na⁺. Specifically, the final value of J/J₀ for APAM+K⁺ (0.08) was lower than that for APAM + Na⁺ (0.12), and the fouling resistance for APAM+K⁺ (12.25 × 10¹¹ m^-1) was higher than that for APAM + Na⁺ (12.01 × 10¹¹ m^-1) at an ionic strength of 10,000 mg/L, which was owing to the larger hydration force caused by Na⁺ with a smaller ionic radius. This research offers practical guidance for the PFPW membrane filtering process.

The prevalence, molecular characterization and antimicrobial resistance profiling of Streptococcus agalactiae isolated from clinical mastitis cases on large dairy farms in China

This research communication aims to characterize the prevalence, molecular characterization and antimicrobial resistance profiling of Streptococcus agalactiae isolated from clinical mastitis in China. A total of 140 Strep. agalactiae isolates were identified from 12 out of 201 farms in 6 provinces, overall herd prevalence was 18.6% and the MLST analysis showed clonal complexes (CC) 103 and CC 67 were present in these herds with CC 103 predominant, accounting for 97.9%. Isolates were mostly sensitive to the tested antimicrobials: penicillin, ceftiofur, amoxi/clav, cefquinome, and vancomycin (100%), followed by cefalexin (97.9%), oxacillin (96.4%), enrofloxacin (95.7%), erythromycin (89.3%), and clindamycin (88.6%). Only 19.3 and 0.7% of isolates were sensitive to tetracycline and daptomycin, respectively, and sequence type (ST) 103 was most resistant to antimicrobials. In conclusion, CC 103 was the predominant subgroup of bovine mastitis Strep. agalactiae in China, and most antimicrobials apart from tetracycline and daptomycin were effective.

Morphological classification and measurement of the glenoid cavity using three-dimensional reconstruction in a Chinese population

BACKGROUND

The purpose of this study was to examine the various shapes and record the morphometric data of the glenoid cavity in a Chinese population.

MATERIALS AND METHODS

A total of 501 scapulae, 247 left and 254 right, were analyzed. We classified the shape of the glenoid cavity as type Ⅰ (pear-shaped), type Ⅱ (oval-shaped), type Ⅲ (teardrop-shaped), type Ⅳ (calabash-shaped) or type Ⅴ (inverted comma-shaped). Four defined parameters, the superior-inferior glenoid diameter (AB), upper anterior-posterior glenoid diameter (CD), lower anterior-posterior glenoid diameter (EF) and glenoid index (GI), were measured, and five shapes were classified via three-dimensional reconstruction.

RESULTS

The mean AB, CD, EF and GI values of the glenoid were 3.51±0.41 cm, 1.95±0.28 cm, 2.60±0.34 cm, and 1.35±0.12 cm, respectively. The AB value of type Ⅱ glenoid cavities was significantly smaller than that of type Ⅰ and Ⅲ glenoid cavities (P<0.05), but the GI value of type Ⅱ glenoid cavities was larger than that of type Ⅲ cavities (P<0.05). The CD value showed a difference between type Ⅰ and type Ⅲ glenoid cavities (P<0.05). For the EF parameter, the values of type Ⅲ glenoid cavities were significantly larger than those of type Ⅰ and Ⅱ glenoid cavities (P<0.05).

CONCLUSIONS

Measuring and observing the variety of shapes and sizes of the glenoid cavity in Chinese people is conducive to for better understand its morphological features. This information can also guide surgeons in the design and selection of suitable prostheses for total shoulder arthroplasty in the Chinese population in order to reduce postoperative complications.

Autophagy Promotes α-Amanitin-Induced Apoptosis of Hepa1-6 Liver Cells

It is estimated that 90% of deaths from food poisoning in China can be attributed to Amanita poisoning, whose main toxin is α-amanitin. Studies showed that apoptosis plays a critical role in liver injuries induced by α-amanitin. Although the relationship between autophagy and apoptosis in different liver models has been addressed many times, whether autophagy plays a pro or con effect on α-amanitin-induced apoptosis has not been clarified. Therefore, this study was conducted to explore the effect of autophagy in α-amanitin-induced apoptosis in Hepa1-6 liver cells. A 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay was applied to determine cell viability, a 2',7'-dichlorofluorescin diacetate probe was used to monitor reactive oxygen species (ROS) levels, a flow cytometer and dansylcadaverine (MDC) staining were used to observe α-amanitin-induced apoptosis and autophagy, respectively, and apoptosis and autophagy proteins were assessed by western blotting. The results showed that α-amanitin suppressed cell viability in a time- and concentration-dependent manner. Moreover, the release of ROS was increased with increasing α-amanitin amount. Cell apoptosis and autophagy were noticed and characterized by the increased apoptosis rate and autophagic vesicles under a fluorescence microscope as well as upregulation of Bax/Bcl-2, cleaved caspase-3, and LC3-II/I and downregulation of p62. Further, the autophagy activator rapamycin (Rap) and the inhibitor 3-methylademine (3-MA) were introduced, which showed that the apoptosis rate and the ratio of Bax/Bcl-2 as well as the protein expression level of cleaved caspase-3 increased significantly with the pretreatment of Rap and decreased remarkably with the pretreatment of 3-MA. Moreover, cell viability was found to decrease further with the promotion of autophagy. Notably, the ROS level was attenuated after autophagy was elevated. In conclusion, autophagy could promote α-amanitin-induced Hepa1-6 cell apoptosis, and the process is unassociated with ROS levels. This research provides a theoretical basis for the study of the toxicological mechanism of α-amanitin-induced liver injuries.

Biological Characteristics and Pathogenicity of Helcococcus ovis Isolated From Clinical Bovine Mastitis in a Chinese Dairy Herd

Helcococcus ovis (H. ovis) was first reported in ovine subclinical mastitis milk and post-mortem examination organs in Spain and the United Kingdom in 1999; subsequently, it appeared in cattle, horse, goat, and human. However, isolation and characterization of the pathogen from clinical bovine mastitis is unknown. The objective of this study was to identify the pathogen in clinical bovine mastitis. A total of four strains were isolated from bovine mastitis milk samples from a Chinese dairy farm, and they were identified as H. ovis by microscopic examination and 16S rRNA gene sequencing. Phylogenetic tree was constructed using 16S rRNA gene, and the isolates were closely related to other China strains and strains from Japan. The growth speed of the H. ovis isolated was relatively slower than Streptococcus agalactiae, and the phenotypic characteristics were similar to H. ovis CCUG37441 and CCUG39041 except to lactose. The isolates were sensitive to most of the common used antimicrobials. The H. ovis isolates could lead to mild murine mastitis alone and induce severe mastitis when co-infected with Trueperella pyogenes in the murine mammary infection model constructed.

[Retrospective analysis on 77 cases of T4b hypopharyngeal carcinoma treated by non-surgical treatments]

Objective: To analyze the effectiveness, safety and factors influencing the clinical prognosis of patients with hypopharyngeal carcinoma in T4b by nonsurgical treatments. Methods: The clinical data of 77 patients with T4b hypopharyngeal cancer treated in the College of Otolaryngology Head and Neck Surgery of the Chinese People's Liberation Army General Hospital from January 2010 to June 2021 were analyzed retrospectively. All were males, aged(57.0±8.0)years old. Patients were treated with induction chemotherapy plus concurrent chemoradiotherapy. Kaplan Meier survival analysis was used to compare the effects of different factors on prognosis. Adverse reactions during treatments and the causes of death were analyzed. Results: 98.7% of 77 patients with T4b hypopharyngeal cancer completed the chemotherapy plan and 94.8% completed the radiotherapy plan. The most common adverse reactions were grade 2 radiation oral mucositis (50/77, 64.9%) and grade 2 leukopenia (50/77, 64.9%). The incidence of grade 3 severe hoarseness was 7.8% (6/77), one patient (1.3%) underwent gastrostomy due to dysphagia, and pronunciation and swallowing function were effectively preserved in other patients. The overall survival rate was 71.9% at 1 year, 45.6% at 3 years and 29.7% at 5 years. The location of tumor, the presence of liquefaction necrosis in tumor, the use of molecular targeted drugs and the approach of radiotherapy were independent factors,each of which that affected the prognosis of T4b patients with advanced hypopharyngeal cancer [HR (95%CI) were 1.867(1.085-3.213), 3.018 (1.437-6.335), 0.372 (0.181-0.764) and 2.158 (1.015-4.588), respectively, P<0.05]. The two leading causes of death with high incidence were disease recurrence (12/32, 37.5%) and cervical large vessel rupture and hemorrhage (11/32, 34.4%). Conclusions: Non-surgical comprehensive treatment offers a high laryngeal preservation rate in patients with T4b hypopharyngeal cancer. The location of tumor, the liquefaction necrosis within tumor, the use of molecular targeted drugs, and the approach of radiotherapy are independent prognostic factors.

Eggs Consumption in Relation to Lower Risk of Cognitive Impairment in Elderly: Findings from a 6-Year Cohort Study

OBJECTIVES

To evaluate the longitudinal association of eggs consumption with cognitive function in Chinese elderly.

DESIGN

Prospective cohort study.

PARTICIPANTS

9028 participants aged ≥60 years from Zhejiang Ageing and Health Cohort Study without cognitive impairment at baseline survey.

MEASUREMENTS

Cognitive function was assessed through the Mini-Mental State Examination (MMSE) at baseline and three waves of follow-up (2015, 2016, and 2019-2020). Data on eggs consumption was collected in the diet habits section within the questionnaire at baseline. Log-binomial regression models with the Generalized Estimating Equations, controlled for an extensive range of potential confounders, were used to evaluate the association and estimate relative risks (RRs).

RESULTS

After 6 years of follow-up, 3266 (36.18%) participants were indicated as cognitive impairment by MMSE at least once. Compared with non-consumers or less-than-weekly consumers, participants consuming 0.1-2.9 eggs/week and 3.0-5.9 eggs/week had 18% (RR=0.82, 95%CI 0.76-0.89) and 9% (RR=0.91, 95%CI 0.84-0.99) lower risks of cognitive impairment respectively, whereas no association was found in those consuming ≥6.0 eggs/week (P=0.32). Moreover, infrequent lower-quantity consumption (1-2 days/week and 0.1-1.9 eggs/day), infrequent higher-quantity consumption (1-2 days/week and ≥2.0 eggs/day), and frequent lower-quantity consumption (≥3 days/week and 0.1-1.9 eggs/day) were associated with better cognitive performance, whereas null association was found among frequent higher-quantity consumers (≥3 days/week and ≥2.0 eggs/day). The sensitivity analyses yielded consistent results to the main analysis.

CONCLUSION

Limited eggs consumption is prospectively related to a lower risk of cognitive impairment in Chinese elderly.

Knockdown of long noncoding RNA MIAT attenuates cigarette smoke-induced airway remodeling by downregulating miR-29c-3p-HIF3A axis

Chronic obstructive pulmonary disease (COPD) is a global public health issue and is defined as persistent airflow limitation. COPD is a major cause of morbidity and mortality worldwide. Long noncoding RNAs are involved in the course of pulmonary diseases. Here, we revealed that a long noncoding RNA called myocardial-infarction-associated transcript (MIAT) is upregulated in lung tissues of cigarette smoke (CS)-exposed mice. Knockdown of MIAT attenuated CS or CS-extract-induced inflammatory processes, epithelial-mesenchymal transition (EMT), and collagen deposition. Moreover, according to bioinformatic analyses and luciferase reporter assays, MIAT binds to microRNA-29c-3p (miR-29c-3p) and upregulates hypoxia-inducible factor 3 alpha (HIF3A), a target gene of miR-29c-3p. When the MIAT-specific short hairpin RNA and an miR-29c-3p inhibitor were cotransfected into cells, the inhibitor reversed the effects of MIAT knockdown on cell proliferation, apoptosis, inflammation, EMT, and collagen deposition. Overall, these results indicate that MIAT participates in CS-induced EMT and airway remodeling in COPD by upregulating miR-29c-3p-HIF3A axis output, thereby offering a novel promising biomarker for the assessment of COPD exacerbation induced by CS exposure.

Prediction of Potentially Suitable Distributions of Codonopsis pilosula in China Based on an Optimized MaxEnt Model

Species distribution models are widely used in conservation biology and invasive biology. MaxEnt models are the most widely used models among the existing modeling tools. In the MaxEnt modeling process, the default parameters are used most often to build the model. However, these models tend to be overfit. Aiming at this problem, this study uses an optimized MaxEnt model to analyze the impact of past, present and future climate on the distributions of Codonopsis pilosula, an economic species, to provide a theoretical basis for its introduction and cultivation. Based on 264 distribution records and eight environmental variables, the potential distribution areas of C. pilosula in the last interglacial, middle Holocene and current periods and 2050 and 2070 were simulated. Combined with the percentage contribution, permutation importance, and jackknife test, the environmental factors affecting the suitable distribution area of this species were discussed. The results show that the parameters of the optimal model are: the regularization multiplier is 1.5, and the feature combination is LQHP (linear, quadratic, hinge, product). The main temperature factors affecting the distribution of C. pilosula are the annual mean temperature, mean diurnal range, and isothermality. The main precipitation factors are the precipitation seasonality, precipitation in the wettest quarter, and precipitation in the driest quarter, among which the annual average temperature contributes the most to the distribution area of this species. With climate warming, the suitable area of C. pilosula exhibits a northward expansion trend. It is estimated that in 2070, the suitable area of this species will expand to its maximum, reaching 2.5108 million square kilometers. The highly suitable areas of C. pilosula are mainly in Sichuan, Gansu, Shaanxi, Shanxi, and Henan Provinces. Our findings can be used to provide theoretical support related to avoiding the blind introduction of C. pilosula.