Relationships among anxiety, depression, and health-related quality of life in adult epilepsy: A network analysis

OBJECTIVE

Comorbid depression and anxiety in patients with epilepsy (PWE) are common and frequently under-treated, thus, causing poor health-related quality of life (HRQoL). However, little is known regarding the interconnections between anxious/depressive symptoms and the dimensions of HRQoL. Therefore, we conducted a network analysis to explore these relationships in detail among Chinese adult PWE.

METHODS

A cohort of adult PWE was consecutively recruited from the First Affiliated Hospital of Chongqing Medical University. HRQoL, depression, and anxiety were measured with Quality of Life in Epilepsy Inventory-31, Neurological Disorders Depression Inventory for Epilepsy, and Generalized Anxiety Disorder 7-Item Scale, respectively. A regularized partial correlation network was constructed to investigate the interconnections between symptoms of anxiety/depression and the dimensions of HRQoL. We calculated expected influence (EI) and bridge expected influence (BEI) values to identify the most influential nodes.

RESULTS

A total of 396 PWE were enrolled in this study, 78.1% of whom had focal onset epilepsy. The prevalence of anxiety and depression was 30.3% and 28.8%, respectively. The symptoms "frustrated" and "uncontrollable worry" had the highest EI values, whereas "emotional well-being", "seizure worry", "difficulty finding pleasure", and "nervousness or anxiety" had the highest BEI values.

CONCLUSION

This study provides new insights into the relationships among anxiety, depression, and HRQoL. Critical central symptoms and bridge symptoms identified in the network might help to quickly identify PWE comorbid anxiety and depression in busy outpatient settings, thereby enabling early intervention and enhancing quality of life.

Combined brain topological metrics with machine learning to distinguish essential tremor and tremor-dominant Parkinson's disease

BACKGROUND

Essential tremor (ET) and Parkinson's disease (PD) are the two most prevalent movement disorders, sharing several overlapping tremor clinical features. Although growing evidence pointed out that changes in similar brain network nodes are associated with these two diseases, the brain network topological properties are still not very clear.

OBJECTIVE

The combination of graph theory analysis with machine learning (ML) algorithms provides a promising way to reveal the topological pathogenesis in ET and tremor-dominant PD (tPD).

METHODS

Topological metrics were extracted from Resting-state functional images of 86 ET patients, 86 tPD patients, and 86 age- and sex-matched healthy controls (HCs). Three steps were conducted to feature dimensionality reduction and four frequently used classifiers were adopted to discriminate ET, tPD, and HCs.

RESULTS

A support vector machine classifier achieved the best classification performance of four classifiers for discriminating ET, tPD, and HCs with 89.0% mean accuracy (mACC) and was used for binary classification. Particularly, the binary classification performances among ET vs. tPD, ET vs. HCs, and tPD vs. HCs were with 94.2% mACC, 86.0% mACC, and 86.3% mACC, respectively. The most power discriminative features were mainly located in the default, frontal-parietal, cingulo-opercular, sensorimotor, and cerebellum networks. Correlation analysis results showed that 2 topological features negatively and 1 positively correlated with clinical characteristics.

CONCLUSIONS

These results demonstrated that combining topological metrics with ML algorithms could not only achieve high classification accuracy for discrimination ET, tPD, and HCs but also help to reveal the potential brain topological network pathogenesis in ET and tPD.

FLASH radiotherapy for the treatment of symptomatic bone metastases in the thorax (FAST-02): protocol for a prospective study of a novel radiotherapy approach

BACKGROUND

FLASH therapy is a treatment technique in which radiation is delivered at ultra-high dose rates (≥ 40 Gy/s). The first-in-human FAST-01 clinical trial demonstrated the clinical feasibility of proton FLASH in the treatment of extremity bone metastases. The objectives of this investigation are to assess the toxicities of treatment and pain relief in study participants with painful thoracic bone metastases treated with FLASH radiotherapy, as well as workflow metrics in a clinical setting.

METHODS

This single-arm clinical trial is being conducted under an FDA investigational device exemption (IDE) approved for 10 patients with 1-3 painful bone metastases in the thorax, excluding bone metastases in the spine. Treatment will be 8 Gy in a single fraction administered at ≥ 40 Gy/s on a FLASH-enabled proton therapy system delivering a single transmission proton beam. Primary study endpoints are efficacy (pain relief) and safety. Patient questionnaires evaluating pain flare at the treatment site will be completed for 10 consecutive days post-RT. Pain response and adverse events (AEs) will be evaluated on the day of treatment and on day 7, day 15, months 1, 2, 3, 6, 9, and 12, and every 6 months thereafter. The outcomes for clinical workflow feasibility are the occurrence of any device issues as well as time on the treatment table.

DISCUSSION

This prospective clinical trial will provide clinical data for evaluating the efficacy and safety of proton FLASH for palliation of bony metastases in the thorax. Positive findings will support the further exploration of FLASH radiation for other clinical indications including patient populations treated with curative intent.

REGISTRATION

ClinicalTrials.gov NCT05524064.

Identification of bidirectional causal links between gut microbiota and narcolepsy type 1 using Mendelian randomization

STUDY OBJECTIVES

Narcolepsy type 1 (NT1), characterized by cataplexy and orexin deficiency, is a rare and frequently debilitating neurological disorder. It has been noted to have connections with the gut microbiota, yet the exact causal relationships remain unclear.

METHODS

We conducted a comprehensive bidirectional Mendelian randomization (MR) study to rigorously investigate the causal links between the gut microbiota and NT1, utilizing genetic datasets from the MiBioGen consortium and FinnGen consortium, respectively. The inverse-variance weighted (IVW) method was employed to obtain the primary MR estimates, supplemented by several alternative methods as well as sensitivity analyses including Cochran's Q, MR-Egger, MR pleiotropy residual sum and outlier, leave-one-out, and genetic colocalization.

RESULTS

Our findings indicated that an increased relative abundance of five genera including Blautia (p = 4.47E-5), Collinsella (p = 0.036), Gordonibacter (p = 0.047), Hungatella (p = 0.015), and Lachnospiraceae UCG010 (p = 0.027) may be associated with a decreased risk of NT1. Conversely, an increased relative abundance of class Betaproteobacteria (p = 0.032), genus Alloprevotella (p = 0.009), and genus Ruminiclostridium6 (p = 0.029) may potentially heighten the risk of NT1. The onset of NT1 may lead to a decrease in the relative abundance of genus Eubacterium eligens group (p = 0.022), while a increase in the family Family XI (p = 0.009), genus Hungatella (p = 0.005), genus Prevotella (p = 0.013), and unknown genus id.2001 (p = 0.019). These findings remained robust under all sensitivity analyses.

CONCLUSIONS

Our results offer robust evidence for the bidirectional causal links between particular gut microbial taxa and NT1, underscoring the significance of the microbiota-gut-brain axis in the pathological process of NT1.

Genetic causal association between physical activities and epilepsy: A Mendelian randomization study

BACKGROUND

Despite numerous investigations into the relationship between physical activities (PA) and epilepsy, the causal effects remain contentious. Thus, we conducted a two-sample Mendelian randomization (MR) study to assess the potential causality.

METHODS

Single-nucleotide polymorphisms (SNPs) predisposed to self-reported moderate and vigorous physical activities (MPA and VPA) and overall acceleration average (OAA) calculated through wrist-worn accelerometers were selected as exposure instrumental variables. Five subtypes of epilepsy, including all epilepsy, focal epilepsy and generalized epilepsy (with or without each other), focal epilepsy-strict definition and generalized epilepsy-strict definition (without overlap), were chosen as the outcomes. The MR study utilized the inverse-variance weighted (IVW) method as the primary analytical tool, supplemented by MR-Egger, simple mode, weighted mode, and weighted median methods. Cochran's Q and MR-Egger intercept tests were employed to assess heterogeneity and pleiotropy, while MR pleiotropy residual sum and outlier and leave-one-out analyses were conducted to identify potential SNP outliers.

RESULTS

The study indicated that OAA was genetically linked to a decreased risk of both focal epilepsy (OR = 0.812, 95% CI: 0.687-0.960, p = .015, IVW) and focal epilepsy-strict definition (OR = 0.732, 95% CI: 0.596-0.900, p = .003, IVW; OR = 0.749, 95% CI: 0.573-0.979, p = .035, Weighted median). Genetically predicted MPA and VPA did not exhibit a causal association with all epilepsy or its subtypes (p>.05). No evidence of heterogeneity, pleiotropy, or SNP outlier was observed.

CONCLUSIONS

Our findings suggested that PA with accelerometer monitoring may potentially reduce the risk of focal epilepsy, while there is no evidence supporting causal association between self-reported MPA or VPA and either focal or generalized epilepsy.

Rhizopus microsporus and Mucor racemosus coinfection following COVID-19 detected by metagenomics next-generation sequencing: A case of disseminated mucormycosis

Mucormycosis is an invasive opportunistic fungal infection, which may be lethal and mostly affects patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. is the most common cause of mucormycosis, followed by genera such as Mucor and Lichtheimia. Here we report a patient with severe COVID-19 infection who developed nasal pain, facial swelling, prominent black eschar on the nasal root. CT scan revealed pansinusitis along the maxillary, ethmoidal, and sphenoid sinuses. Mixed mold infection with Rhizopus microsporus and Mucor racemosus was detected by blood metagenomics next-generation sequencing (mNGS) and later nasal mucosa histological investigation confirmed mucormycosis. Severe COVID-19 infection led to the patient's thrombocytopenia and leukopenia. Later disseminated mucormycosis aggravated the infection and sepsis eventually resulted in death. It is the first case report of mucormycosis in which R. microsporus and M. racemosus as the etiologic agents were found simultaneously in one patient. COVID-19 infection combined with disseminated mucormycosisis can be fatal and mNGS is a fast, sensitive and accurate diagnostic method for fungi detection.

Body mass index's effect on CRSwNP extends to pathological endotype and recurrence

BACKGROUND

Elevated body mass index (BMI) has been recognized as an important contributor to corticosteroid insensitivity in chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to delineate the effects of elevated BMI on immunological endotype and recurrence in CRSwNP individuals.

METHODOLOGY

A total of 325 patients with CRSwNP undergoing FESS were recruited and stratified by BMI. H&E staining was employed for histological evaluation. Characteristics of inflammatory patterns were identified by immunohistochemical staining. The predictive factors for recurrence were determined and evaluated by multivariable logistic regression analysis and the receiver operating characteristic (ROC) curves across all subjects and by weight group.

RESULTS

In all patients with CRSwNP, 26.15% subjects were classified as overweight/obese group across BMI categories and exhibited a higher symptom burden. The upregulated eosinophil/neutrophil-dominant cellular endotype and amplified type 2/ type 3 coexisting inflammation was present in overweight/obese compared to underweight/normal weight controls. Additionally, a higher recurrent proportion was shown in overweight/obese patients than that in underweight/normal weight cohorts. Multivariable logistic regression analysis identified BMI as an independent predictor for recurrence. The predictive capacity of each conventional parameter (tissue eosinophil and CLCs count, and blood eosinophil percentage) alone or in combination was poor in overweight/obese subjects.

CONCLUSIONS

Overweight/obese CRSwNP stands for a unique phenotype and endotype. Conventional parameters predicting recurrence are compromised in overweight/obese CRSwNP, and there is an urgent need for novel biomarkers that predict recurrence for these patients.

Investigating the Respiratory and Energy Metabolism Mechanisms behind ε-Poly-L-lysine Chitosan Coating's Improved Preservation Effectiveness on Tremella fuciformis

Freshly harvested Tremella fuciformis contains high water content with an unprotected outer surface and exhibits high respiration rates, which renders it prone to moisture and nutrient loss, leading to decay during storage. Our research utilized ε-poly-L-lysine (ε-PL) and chitosan as a composite coating preservative on fresh T. fuciformis. The findings revealed that the ε-PL + chitosan composite coating preservative effectively delayed the development of diseases and reduced weight loss during storage compared to the control group. Furthermore, this treatment significantly decreased the respiration rate of T. fuciformis and the activity of respiratory metabolism-related enzymes, such as alternative oxidase (AOX), cytochrome c oxidase (CCO), succinic dehydrogenase (SDH), 6-phosphogluconate dehydrogenase, and glucose-6-phosphate dehydrogenase (6-PGDH and G-6-PDH). Additionally, the composite coating preservative also delayed the depletion of ATP and ADP and maintained higher levels of the energy charge while preserving low levels of AMP. It also sustained heightened activities of Mg2+-ATPase, Ca2+-ATPase, and H+-ATPase enzymes. These results demonstrate that utilizing the ε-PL + chitosan composite coating preservative can serve as a sufficiently safe and efficient method for prolonging the shelf life of post-harvest fresh T. fuciformis.

Universal and Scalable Weakly-Supervised Domain Adaptation

Domain adaptation leverages labeled data from a source domain to learn an accurate classifier for an unlabeled target domain. Since the data collected in practical applications usually contain noise, the weakly-supervised domain adaptation algorithm has attracted widespread attention from researchers that tolerates the source domain with label noises or/and features noises. Several weakly-supervised domain adaptation methods have been proposed to mitigate the difficulty of obtaining the high-quality source domains that are highly related to the target domain. However, these methods assume to obtain the accurate noise rate in advance to reduce the negative transfer caused by noises in source domain, which limits the application of these methods in the real world where the noise rate is unknown. Meanwhile, since source data usually comes from multiple domains, the naive application of single-source domain adaptation algorithms may lead to sub-optimal results. We hence propose a universal and scalable weakly-supervised domain adaptation method called PDCAS to ease restraints of such assumptions and make it more general. Specifically, PDCAS includes two stages: progressive distillation and domain alignment. In progressive distillation stage, we iteratively distill out potentially clean samples whose annotated labels are highly consistent with the prediction of model and correct labels for noisy source samples. This process is non-supervision by exploiting intrinsic similarity to measure and extract initial corrected samples. In domain alignment stage, we consider Class-Aligned Sampling which balances the samples for both source and target domains along with the global feature distributions to alleviate the shift of label distributions. Finally, we apply PDCAS in multi-source noisy scenario and propose a novel multi-source weakly-supervised domain adaptation method called MSPDCAS, which shows the scalability of our framework. Extensive experiments on Office-31 and Office-Home datasets demonstrate the effectiveness and robustness of our method compared to state-of-the-art methods.

Multiarmed Aromatic Ammonium Salts Boost the Efficiency and Stability of Inverted Organic Solar Cells

Inverted organic solar cells (OSCs) have attracted much attention because of their outstanding stability, with zinc oxide (ZnO) being commonly used as the electron transport layer (ETL). However, both surface defects and the photocatalytic effect of ZnO could lead to serious photodegradation of acceptor materials. This, in turn, hampers the improvement of the efficiency and stability in OSCs. Herein, we developed a multiarmed aromatic ammonium salt, namely, benzene-1,3,5-triyltrimethanaminium bromide (PhTMABr), for modifying ZnO. This compound possesses mild weak acidity aimed at removing the residual amines present within ZnO film. In addition, the PhTMABr could also passivate surface defects of ZnO through multiple hydrogen-bonding interactions between its terminal amino groups and the oxygen anion of ZnO, leading to a better interface contact, which effectively enhances charge transport. As a result, an efficiency of 18.75% was achieved based on the modified ETL compared to the bare ZnO (PCE = 17.34%). The devices utilizing the modified ZnO retained 87% and 90% of their initial PCE after thermal stress aging at 65 °C for 1500 h and continuous 1-sun illumination with maximum power point (MPP) tracking for 1780 h, respectively. Importantly, the extrapolated T80 lifetime with MPP tracking exceeds 10 000 h. The new class of materials employed in this work to modify the ZnO ETL should pave the way for enhancing the efficiency and stability of OSCs, potentially advancing their commercialization process.

Ubiquitin-specific protease 38 promotes inflammatory atrial fibrillation induced by pressure overload

AIMS

Atrial structural and electrical remodelling is a major reason for the initiation and perpetuation of atrial fibrillation (AF). Ubiquitin-specific protease 38 (USP38) is a deubiquitinating enzyme, but its function in the heart remains unknown. The aim of this study was to investigate the effect of USP38 in pressure overload-induced AF.

METHODS AND RESULTS

Cardiac-specific knockout USP38 and cardiac-specific transgenic USP38 mice and their corresponding control mice were used in this study. After 4 weeks with or without aortic banding (AB) surgery, atrial echocardiography, atrial histology, electrophysiological study, and molecular analysis were assessed. Ubiquitin-specific protease 38 knockout mice showed a remarkable improvement in vulnerability to AF, atrial weight and diameter, atrial fibrosis, and calcium-handling protein expression after AB surgery. Conversely, USP38 overexpression further increased susceptibility to AF by exacerbating atrial structural and electrical remodelling. Mechanistically, USP38 interacted with and deubiquitinated nuclear factor-kappa B (NF-κB), and USP38 overexpression increased the level of p-NF-κB in vivo and in vitro, accompanied by the upregulation of NOD-like receptor protein 3 (NLRP3) and inflammatory cytokines, suggesting that USP38 contributes to adverse effects by driving NF-κB/NLRP3-mediated inflammatory responses.

CONCLUSION

Overall, our study indicates that USP38 promotes pressure overload-induced AF through targeting NF-κB/NLRP3-mediated inflammatory responses.

Evidence for genetic causal relationships between gut microbiome, metabolites, and myasthenia gravis: a bidirectional Mendelian randomization study

Background

Myasthenia gravis (MG) is an autoimmune disease observed to have connections with gut microbiome. We aimed to systematically assess the causal relationships between gut microbiome, gut microbiome-derived metabolites, and MG using Mendelian randomization (MR) approach.

Methods

Summary-level genetic datasets from large-scale genome-wide association studies regarding 196 gut microbial taxa from the MiBioGen consortium (n=18,340), 72 derived metabolites from the TwinsUK and KORA studies (n=7,824), and antiacetylcholine receptor (AChR) antibody-positive MG (case=1,873, control=36,370) were employed for MR causal estimates. The inverse-variance weighted (IVW) method was utilized as the main analysis with MR-Egger, maximum likelihood, simple mode, and weighted median as complements. The tests of Cochran's Q, MR-Egger intercept, Steiger, MR-PRESSO and leave-one-out were implemented for sensitivity analyses.

Results

The forward MR estimates of IVW revealed significant causal associations of the abundance of phylum Actinobacteria, class Gammaproteobacteria, family Defluviitaleac, family Family XIII, and family Peptococcaceae with a reduced risk of MG. Conversely, the abundance of phylum Lentisphaerae, order Mollicutes RF9, order Victivallales, and genus Faecalibacterium was causally associated with an increased risk of MG. The reversed MR analysis proved negative causal correlations between the MG and the abundance of family Peptostreptococcaceae, genus Romboutsia, and genus Subdoligranulum. Regarding the derived metabolites, the IVW estimates revealed that elevated levels of beta-hydroxyisovalerate and methionine were causally associated with a decreased risk of MG, while increased levels of choline and kynurenine were linked to an increased risk of MG. Furthermore, genetically predicted MG was associated with a decreased level of cholesterol. The results obtained from complementary MR methods were similar. These findings remained robust in all sensitivity analyses.

Conclusion

Our MR findings support the causal effects of specific gut microbiome taxa and derived metabolites on AChR antibody-positive MG, and vice versa, yielding novel insights into prevention and therapy targets of MG. Future studies may be warranted for validation and pursuing the precise mechanisms.

Structural Characterization and Anti-Inflammatory Activity of Polysaccharides from Tremella fuciformis on Monosodium Urate-Stimulated RAW264.7 Macrophages

The structural characteristics and anti-inflammatory activity of Tremella fuciformis polysaccharides (TFPs) were investigated. The study showed that TFPs were mainly composed of mannose, rhamnose, glucuronic acid, glucose, galactose, xylose, and fucose. TFPs significantly inhibited monosodium urate (MSU)-induced inflammation of RAW264.7 cells, as well as the secretion levels of TNF-α, IL-1β, and IL-18 cytokines. The concentrations of malondialdehyde and reactive oxygen species in RAW264.7 macrophages were reduced, but superoxide dismutase activity was increased. RNA-Seq technology was applied to explore the mechanisms of TFPs ameliorating MSU-induced inflammation of RAW264.7 macrophages. Results revealed that TFPs significantly reduce MSU-stimulated inflammatory damage in RAW 264.7 cells by inhibiting signaling pathways like the hypoxia inducible factor-1 (HIF-1) signaling pathway and erythroblastic oncogene B (ErbB) signaling pathway. This study provides a foundation for TFPs to be developed as novel anti-inflammatory drugs.

Grey Correlation Analysis of Drying Characteristics and Quality of Hypsizygus marmoreus (Crab-Flavoured Mushroom) By-Products

The physical properties and nutritional quality of H. marmoreus by-products (HMB) dried by different methods were comprehensively evaluated by a rigorous statistical method of grey correlation analysis. The results indicated that different drying methods had significant impacts on the characteristics of HMB. Heat pump drying (HPD) was conducive to the preservation of protein and reducing sugar, and hot air drying (HAD) maintained a high content of total flavonoids. The highest fat, polysaccharide, and total phenolic contents were obtained by heated vacuum freeze-drying (H-VFD) treatment. The unheated vacuum freeze-drying (UH-VFD) treatment achieved bright colour, lacunose texture profile, and looser organization structure. The grey correlation analysis showed that UH-VFD and H-VFD had higher-weighted correlation degrees than HPD and HAD. HMB had many higher nutritional components than commodity specifications, especially protein, fat, polyphenols, and amino acids, and had potential applications in the food industry as functional foods and nutraceutical agents.

Efficacy of Postoperative Radiotherapy for Patients with New N2 Descriptors of Subclassification in Completely Resected Non-Small Cell Lung Cancer: A Real-World Study

PURPOSE/OBJECTIVE(S)

Patients with N2 non-small cell lung cancer (NSCLC) were heterogeneous groups and required further stratification. The International Society for the Study of Lung Cancer (IASLC) added new descriptors of three sub-stages for stage N2 NSCLC: N2 at a single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). This study aimed to investigate the efficacy of postoperative radiotherapy (PORT) for patients with these N2 descriptors.

MATERIALS/METHODS

Patients with histologically confirmed NSCLC after complete resection and divided into PORT group and non-PORT group. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) of baseline characteristics between the PORT and non-PORT groups was used for validation.

RESULTS

Totally 1832 patients were enrolled, including 308 N2a1 patients, 682 N2a2 patients, and 842 N2b patients. The median follow-up time was 50.1 months. The survival outcomes of the PORT and non-PORT groups before PSM were shown in Table 1. For patients with N2a1, PORT could not improve the DFS (median DFS of the PORT group and the non-PORT group: not reached vs. 46.8 months, P = 0.41), OS (P = 0.85), or LRFS (P = 0.32), which were consistent with the multivariate analysis and data after the PSM. For patients with N2a2, PORT significantly improved the DFS (median DFS 29.7 vs. 22.2 months, P = 0.02), OS (P = 0.03), and LRFS (P = 0.01). The multivariate analysis and data after the PSM confirmed the benefits in DFS and LRFS, but no benefit was observed in OS (multivariate analysis: HR 0.79, P = 0.18; median OS after PSM: 103.7 vs. 63.1 months, P = 0.34). For patients with N2b, PORT could not improve the DFS (median DFS 20.6 vs. 21.2 months, P = 0.39) but significantly improved the OS (P<0.001) and LRFS (P<0.001). However, the multivariate analysis showed that PORT significantly improved DFS (HR 0.81, P = 0.03), consistent with the data after the PSM (median DFS 20.6 and 17.6 months, P = 0.04).

CONCLUSION

PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.

Chemoradiotherapy Combined with Nab-Paclitaxel plus Cisplatin in Patients with Locally Advanced Borderline Resectable or Unresectable Esophageal Squamous Cell Carcinoma: A Phase I/II Study

PURPOSE/OBJECTIVE(S)

To evaluate the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-PTX) plus cisplatin as the regimen of conversional chemoradiotherapy (cCRT) in locally advanced borderline resectable or unresectable esophageal squamous cell carcinoma (ESCC).

MATERIALS/METHODS

Patients with locally advanced ESCC (cT3-4, Nany, M0-1, M1 was limited to lymph node metastasis in the supraclavicular area) were enrolled. All the patients received the cCRT of nab-PTX plus cisplatin. After the cCRT, those resectable patients received esophagectomy; those unresectable patients continued to receive the definitive chemoradiotherapy (dCRT). The locoregional control (LRC), overall survival (OS), progression-free survival (PFS), distant metastasis free survival (DMFS), pathological complete response (pCR), R0 resection rate and adverse events (AEs) were calculated.

RESULTS

A total of 45 patients with ESCC treated from October 2019 to May 2021 were finally included. The median follow-up time was 30.3 months. The LRC, OS, EFS, DMFS at 1and 2 years were 81.5%, 86.6%, 64.3%, 73.2% and 72.4%, 68.8%, 44.8%, 52.7% respectively. 21 patients (46.7%) received conversional chemoradiotherapy plus surgery (cCRT+S). The pCR rate and R0 resection rate were 47.6% and 84.0%. The LRC rate at 1 and 2 years were 95.0%, 87.1% in cCRT+S patients and 69.3%, 58.7% in dCRT patients respectively (HR, 5.14; 95% CI, 1.10-23.94; P = 0.021). The OS rate at 1 and 2 years were 95.2% and 84.2% in resectable patients compared to 78.8% and 54.4% in unresectable patients (HR, 3.41; 95% CI, 1.10-10.61; P = 0.024). The toxicities during chemoradiotherapy were tolerated, the most common grade 3-4 toxicities were radiation esophagitis (15.6%).

CONCLUSION

Nab-PTX plus cisplatin were effective and safe as the regimen of conversional chemoradiotherapy of ESCC. The patients receiving conversional chemoradiotherapy plus surgery (cCRT+S) were prone to have a better survival.

Clinical Outcomes with Thoracic Radiotherapy for Extensive-Stage Small-Cell Lung Cancer in the Era of Immunotherapy: A Retrospective Analysis

PURPOSE/OBJECTIVE(S)

Chemo-immunotherapy has shown significant benefits for extensive-stage small-cell lung cancer (ES-SCLC), which prolonged overall survival (OS) of nearly 2-4.5 months compared with platinum-based chemotherapy alone. However, thoracic radiotherapy (TRT), was not allowed to be used in previous trials. This retrospective study aimed to evaluate the safety and efficiency of TRT for ES-SCLC patients in the era of Immunotherapy.

MATERIALS/METHODS

We retrospectively reviewed ES-SCLC patients treated with chemo-immunotherapy between 2017 and 2021 in our center. Patients who accepted consolidative or salvage TRT were included. The overall survival, progression-free survival (PFS), local progression-free survival (LPFS), and distant progression free-survival (DPFS) were calculated using the Kaplan-Meier method. Toxicity was recorded based on CTCAE 5.0 scale.

RESULTS

We finally enrolled 30 patients in our study. The median follow-up time was 26.0 months (95% confidence interval, 18.2-33.8 months). 26(86.7%) patients have undergone first-line chemotherapy and immunotherapy, while 4(13.3%) have undergone immunotherapy as a second-line agent. 23(76.6%) patients achieved CR/PR/SD to initial systematic therapy. All patients were treated with TRT with a median dose of 51 Gy (24-60.2 Gy). The median interval between TRT and immunotherapy was 35 days. Median OS was 26 months (95% confidence interval, 17.8-34.2 months) and median PFS was 8 months (95% confidence interval, 5.3-10.7 months). 2-year OS, PFS, and DPFS were 51.4%, 21.4%, and 27.4%, respectively. 18 months LPFS was 59.6%. There was no ≥ G3 radiation-related adverse event except 2(6.7%) G3 esophagitis. G1-2 pneumonitis was reported in 8(26.7%) patients.

CONCLUSION

TRT is well-tolerated and effective for selected ES-SCLC patients in the modern era of immunotherapy. Prospective trials are still needed to further evaluate the combination of TRT and immunotherapy for patients with ES-SCLC.

Temperature-responsive module of OfAP1 and OfLFY regulates floral transition and floral organ identity in Osmanthus fragrans

The MADS-box transcription factor APETELA1 (AP1) is crucially important for reproductive developmental processes. The function of AP1 and the classic LFY-AP1 interaction in woody plants are not widely known. Here, the OfAP1-a gene from the continuously flowering plant Osmanthus fragrans 'Sijigui' was characterized, and its roles in regulating flowering time, petal number robustness and floral organ identity were determined using overexpression in Arabidopsis thaliana and Nicotiana tabacum. The expression of OfAP1-a was significantly induced by low ambient temperature and was upregulated with the floral transition process. Ectopic expression OfAP1-a revealed its classic function in flowering and flower ABC models. The expression of OfAP1-a is inhibited by LEAFY (OfLFY) through direct promoter binding, as confirmed by yeast one-hybrid and dual luciferase assays. Arabidopsis plants overexpressing OfAP1-a exhibited accelerated flowering and altered floral organ identities. Moreover, OfAP1-a-overexpressing plants displayed variable petal numbers. Likewise, the overexpression of OfLFY in Arabidopsis and Nicotiana altered petal number robustness and inflorescence architecture, partially by regulating native AP1 in transformed plants. Furthermore, we performed RNA-seq analysis of transgenic Nicotiana plants. DEGs were identified by transcriptome analysis, and we found that the expression of several floral homeotic genes was altered in both OfAP1-a and OfLFY-overexpressing transgenic lines. Our results suggest that OfAP1-a may play important roles during floral transition and development in response to ambient temperature. OfAP1-a functions as a petal number modulator and may directly activate a subset of flowers to regulate floral organ formation. OfAP1-a and OfLFY mutually regulate the expression of each other and coregulate genes that might be involved in these phenotypes related to flowering. The results provide valuable data for understanding the function of the LFY-AP1 module in the reproductive process and shaping floral structures in woody plants.

Genome-wide identification and analysis of MIKC-type MADS-box genes expression in Chimonanthus salicifolius

BACKGROUND

MIKC type MADS-box transcription factors are one of the largest gene families and play a pivotal role in flowering time and flower development. Chimonanthus salicifolius belongs to the family Calycanthaceae and has a unique flowering time and flowering morphology compared to other Chimonanthus species, but the research on MIKC type MADS-box gene family of C. salicifolius has not been reported.

OBJECTIVE

Identification, comprehensive bioinformatic analysis, the expression pattern of MIKC-type MADS-box gene family from different tissues of C. salicifolius.

METHODS

Genome-wide investigation and expression pattern under different tissues of the MIKC-type MADS-box gene family in C. salicifolius, and their phylogenetic relationships, evolutionary characteristics, gene structure, motif distribution, promoter cis-acting element were performed.

RESULTS

A total of 29 MIKC-type MADS-box genes were identified from the whole genome sequencing. Interspecies synteny analysis revealed more significant collinearity between C. salicifolius and the magnoliids species compared to eudicots and monocots. MIKC-type MADS-box genes from the same subfamily share similar distribution patterns, gene structure, and expression patterns. Compared with Arabidopsis thaliana, Nymphaea colorata, and Chimonanthus praecox, the FLC genes were absent in C. salicifolius, while the AGL6 subfamily was expanded in C. salicifolius. The selectively expanded promoter (AGL6) and lack of repressor (FLC) genes may explain the earlier flowering in C. salicifolius. The loss of the AP3 homologous gene in C. salicifolius is probably the primary cause of the morphological distinction between C. salicifolius and C. praecox. The csAGL6a gene is specifically expressed in the flowering process and indicates the potential function of promoting flowering.

CONCLUSION

This study offers a genome-wide identification and expression profiling of the MIKC-types MADS-box genes in the C. salicifolius, and establishes the foundation for screening flowering development genes and understanding the potential function of the MIKC-types MADS-box genes in the C. salicifolius.

Using histogram analysis of the intrinsic brain activity mapping to identify essential tremor

Background

Essential tremor (ET) is one of the most common movement disorders. Histogram analysis based on brain intrinsic activity imaging is a promising way to identify ET patients from healthy controls (HCs) and further explore the spontaneous brain activity change mechanisms and build the potential diagnostic biomarker in ET patients.

Methods

The histogram features based on the Resting-state functional magnetic resonance imaging (Rs-fMRI) data were extracted from 133 ET patients and 135 well-matched HCs as the input features. Then, a two-sample t-test, the mutual information, and the least absolute shrinkage and selection operator methods were applied to reduce the feature dimensionality. Support vector machine (SVM), logistic regression (LR), random forest (RF), and k-nearest neighbor (KNN) were used to differentiate ET and HCs, and classification performance of the established models was evaluated by the mean area under the curve (AUC). Moreover, correlation analysis was carried out between the selected histogram features and clinical tremor characteristics.

Results

Each classifier achieved a good classification performance in training and testing sets. The mean accuracy and area under the curve (AUC) of SVM, LR, RF, and KNN in the testing set were 92.62%, 0.948; 92.01%, 0.942; 93.88%, 0.941; and 92.27%, 0.939, respectively. The most power-discriminative features were mainly located in the cerebello-thalamo-motor and non-motor cortical pathways. Correlation analysis showed that there were two histogram features negatively and one positively correlated with tremor severity.

Conclusion

Our findings demonstrated that the histogram analysis of the amplitude of low-frequency fluctuation (ALFF) images with multiple machine learning algorithms could identify ET patients from HCs and help to understand the spontaneous brain activity pathogenesis mechanisms in ET patients.

Analysis of Metabolic Components of JUNCAO Wine Based on GC-QTOF-MS

JUNCAO wine fermentation metabolites are closely related to the final quality of the product. Currently, there are no studies of dynamic metabolite changes during fermentation of JUNCAO wine. Here, we used gas chromatography quadrupole time-of-flight mass spectrometry (GC-QTOF-MS) metabolomics and multivariate statistical analysis to explore the relationship between metabolites and fermentation time. A total of 189 metabolites were annotated throughout the fermentation process. The principal component analysis (PCA) revealed a clear separation between the samples in the early and late stages of fermentation. A total of 60 metabolites were annotated as differential during the fermentation (variable importance in the projection, VIP > 1, and p < 0.05), including 21 organic acids, 10 amino acids, 15 sugars and sugar alcohols, and 14 other metabolites. Pathway analysis showed that the most commonly influenced pathways (impact value > 0.1 and p < 0.05) were tricarboxylic acid cycle, alanine, aspartic acid and glutamic acid metabolism, pyrimidine metabolism, and other 10 metabolic pathways. Moreover, integrated metabolic pathways are generated to understand the conversion and accumulation of differential metabolites. Overall, these results provide a comprehensive overview of metabolite changes during fermentation of JUNCAO wine.

The evidence framework of traditional Chinese medicine injection (Aidi injection) in controlling malignant pleural effusion: A clustered systematic review and meta-analysis

INTRODUCTION

Aidi injection (Aidi), a traditional Chinese medicine injection, is often practiced to control malignant pleural effusion (MPE).

OBJECTIVES

We performed a registered systematic review and meta-analysis (PROSPERO: CRD42022337611) to clarify the clinical role of Aidi in MPE, reveal optimal combinations of Aidi and chemical agents, their indications, therapeutic route and usage, and demonstrate their clinical effectiveness and safety.

METHODOLOGY

All randomized controlled trials (RCTs) about Aidi in controlling MPE were collected from Chinese and English databases (up to October 2022). We clustered them into multiple homogenous regimens, evaluated the risk-of-bias at outcome level using a RoB 2, extracted and pooled the data using meta-analysis or descriptive analysis, and finally summarized their evidence quality.

RESULTS

All 56 studies were clustered into intrapleural administration with Aidi alone or plus chemical agents, and intravenous administration with Aidi for MPE. Intrapleural administration with Aidi alone displayed similar clinical responses on Cisplatin (DDP) alone. Only administration with Aidi plus DDP significantly improved complete response and quality of life, and displayed a low pleurodesis failure, disease progression, hematotoxicity, gastrointestinal and hepatorenal toxicity. For patients with moderate to massive effusion, Karnofsky Performance Status score ≥ 50 or anticipated survival time ≥3 months, Aidi (50 ml to 80 ml each time, one time each week and three to eight times) plus DDP (20 to 30 mg, 40 to 50 mg, or 60 to 80 mg each time) significantly improved clinical responses. Most results had moderate to low quality.

CONCLUSIONS

Current evidences indicate that Aidi, a pleurodesis agent, plays an interesting clinical role in controlling MPE. Aidi plus DDP perfusion is a most commonly used regimen, which shows a significant improvement in clinical responses. These findings also provide an indication and possible optimal usage for rational drug use.

Identification of essential tremor based on resting-state functional connectivity

Currently, machine-learning algorithms have been considered the most promising approach to reach a clinical diagnosis at the individual level. This study aimed to investigate whether the whole-brain resting-state functional connectivity (RSFC) metrics combined with machine-learning algorithms could be used to identify essential tremor (ET) patients from healthy controls (HCs) and further revealed ET-related brain network pathogenesis to establish the potential diagnostic biomarkers. The RSFC metrics obtained from 127 ET patients and 120 HCs were used as input features, then the Mann-Whitney U test and the least absolute shrinkage and selection operator (LASSO) methods were applied to reduce feature dimensionality. Four machine-learning algorithms were adopted to identify ET from HCs. The accuracy, sensitivity, specificity and the area under the curve (AUC) were used to evaluate the classification performances. The support vector machine, gradient boosting decision tree, random forest and Gaussian naïve Bayes algorithms could achieve good classification performances with accuracy at 82.8%, 79.4%, 78.9% and 72.4%, respectively. The most discriminative features were primarily located in the cerebello-thalamo-motor and non-motor circuits. Correlation analysis showed that two RSFC features were positively correlated with tremor frequency and four RSFC features were negatively correlated with tremor severity. The present study demonstrated that combining the RSFC matrices with multiple machine-learning algorithms could not only achieve high classification accuracy for discriminating ET patients from HCs but also help us to reveal the potential brain network pathogenesis in ET.

Imaging diagnosis for anterior talofibular ligament injury: a systemic review with meta-analysis

A definite diagnosis of ankle ligament injury is crucial, and many imaging examinations can be used. This review systematically analyzed the effectiveness of various examination methods in the diagnosis of anterior talofibular ligament (ATFL) injuries. Three English databases (PubMed, Embase, and Cochrane Library) and three Chinese databases (CNKI, VIP Database, and Wanfang Database) were searched and relevant studies were summarized. A total of 25 randomized controlled trials met the selection criteria, including six, 16, and three studies recruiting patients with acute, chronic, and both acute and chronic ATFL injuries, respectively. A total of 1409 participants were included. The pooled sensitivity rates of acute ATFL injuries were 82.1% (77.1%-86.5%) by magnetic resonance imaging (MRI) and 88.6% (82.0%-93.5%) by ultrasonography (US). The pooled sensitivity rates of chronic ATFL injuries were 86.3% (82.5%-89.5%) by MRI, 98.7% (95.3%-99.8%) by US, 74.4% (63.6%-83.4%) by stress radiography, and 100% (87.7%-100.0%) for MR arthrography. The pooled specificity rates of acute ATFL injuries were 37.8% (29.1%-47.2%) by MRI and 90.3% (80.1%-96.4%) by US. The pooled specificity rates of chronic ATFL injuries were 86.8% (81.3%-91.2%) by MRI, 94.0% (85.4%-98.3%) for US, 89.4% (76.9%- 96.5%) by stress radiography and 100% (54.1%-100.0%) by MR arthrography. In conclusion, US may be a valuable imaging technique with high sensitivity for diagnosing chronic lateral ankle ligament injuries.

Prognosis and clinical features analysis of EMT-related signature and tumor Immune microenvironment in glioma

Background

As the most common primary malignant intracranial tumor, glioblastoma has a poor prognosis with limited treatment options. It has a high propensity for recurrence, invasion, and poor immune prognosis due to the complex tumor microenvironment.

Methods

Six groups of samples from four datasets were included in this study. We used consensus ClusterPlus to establish two subgroups by the EMT-related gene. The difference in clinicopathological features, genomic characteristics, immune infiltration, treatment response and prognoses were evaluated by multiple algorithms. By using LASSO regression, multi-factor Cox analysis, stepAIC method, a prognostic risk model was constructed based on the final screened genes.

Results

The consensusClusterPlus analyses revealed two subtypes of glioblastoma (C1 and C2), which were characterized by different EMT-related gene expression patterns. C2 subtype with the worse prognosis had the more malignant clinical and pathology manifestations, higher Immune infiltration and tumor-associated molecular pathways scores, and poorer response to treatment. Additionally, our EMT-related genes risk prediction model can provide valuable support for clinical evaluations of glioma.

Conclusions

The assessment system and prediction model displayed good performance in independent prognostic risk assessment and individual patient treatment response prediction. This can help with clinical treatment decisions and the development of effective treatments.

The Joint Effect of Body Mass Index and Serum Lipid Levels on Incident Dementia among Community-Dwelling Older Adults

OBJECTIVES

This study aimed to explore the joint effect of body mass index (BMI) and serum lipids levels on incident dementia.

METHODS

We prospectively followed up with 1,627 dementia-free community residents aged ≥60 for 5.7 years on average. At baseline, weight, and height were measured, and total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were detected in serum. Demographic characteristics were collected through questionnaires. Dementia was based on consensus diagnosis of neurologists and neuropsychologists using DSM-IV criteria. Additive Cox proportional model was used to assess the exposure-response relationship between BMI and serum lipid levels and dementia risk. Interactions and further classifications of BMI and serum lipid levels were further presented by bivariate surface models and decision-tree models.

RESULTS

The joint effects of TC with BMI, TG with BMI, and LDL-C with BMI on the risk of incident dementia shared a similar pattern, different from their independent exposure-response curves. The joint effect of HDL-C with BMI showed an S-surface but without statistical significance. Participants with TC<5.4 mmol/L and BMI<21 kg/m2 (Hazard Ratio(HR) 1.93, 95% Confidence Interval (CI) 1.05-3.53), TC<5.4 mmol/L and BMI≥21 kg/m2 (HR 1.73, 95% CI 1.09-2.72), and TC≥5.4 mmol/L and BMI<21 kg/m2 (HR 4.02, 95% CI 2.10-7.71) were identified to have the increased risk of incident dementia compared to those with TC≥5.4 mmol/L and BMI≥21 kg/m2. Participants with TG<1.7 mmol/L and BMI<21 kg/m2 had an increased risk of incident dementia compared to those with TG≥1.7 mmol/L and BMI≥21 kg/m2 (HR 1.98, 95%CI 1.17-3.3). Participants with LDL-C≥3.3 mmol/L and BMI<21 kg/m2 were identified to have an increased risk of incident dementia compared to those with LDL-C≥3.3 mmol/L and BMI≥21 kg/m2 (HR 3.33, 95%CI 1.64-6.78).

CONCLUSIONS

Our study showed that low BMI combined with low or high levels of serum lipids may increase the risk of dementia among older adults. This finding suggests the potential impacts of these two metabolic indexes on the risk of dementia.

A WRKY Transcription Factor PmWRKY57 from Prunus mume Improves Cold Tolerance in Arabidopsis thaliana

Prunus mume, a woody perennial tree, is valued for its ornamental traits and has been cultivated for a long history. Low temperature is the main environmental factor restricting the distribution and affecting the growth of P. mume. In plants, some WRKY transcription factors have been reported to participate in regulating cold tolerance. However, there were few researches about functional characterization of WRKYs involving in P. mume cold response. Here, a cold-induced WRKY gene named as PmWRKY57 was cloned from a P. mume cultivar 'Guhong Zhusha.' PmWRKY57 protein harboring a WRKY domain and a C2H2 zinc finger motif belongs to Group IIc of WRKY family. The PmWRKY57 protein was located to the nucleus and has transcriptional activation activity. PmWRKY57-overexpresing Arabidopsis thaliana lines showed improved cold tolerance, compared to wild-type plants. Under cold treatment, the leaves of transgenic lines contained significantly lower malondialdehyde content, and higher levels of superoxide dismutase activity, peroxidase activity, and proline content than wild-type plants. Furthermore, the expression levels of cold-response genes such as AtCOR6.6, AtCOR47, AtKIN1, and AtRCI2A were up-regulated in leaves of transgenic A. thaliana compared to those in wild-type plants. This study characterized the function of PmWRKY57 in improving cold tolerance of plants.

Gut Microbiota Dysbiosis Induced by a High-Fat Diet Increases Susceptibility to Atrial Fibrillation

BACKGROUND

Obesity is a significant risk factor for atrial fibrillation (AF), and the gut microbiota is closely related to obesity-induced diseases. However, whether the gut microbiota is involved in regulating obesity-induced AF has not been studied. This study investigated whether gut microbiota dysbiosis affects obesity-related AF.

METHODS

Fecal microbes derived from normal diet (ND)-fed and high-fat diet (HD)-fed mice were transplanted into those fed normally. Morphologic, biochemical, functional, histologic, electrophysiological studies, molecular analysis, 16S rRNA gene amplicon sequencing, and RNA-sequencing were performed.

RESULTS

Transplantation of the HD gut microbes in ND-maintained (THD) mice led to a significant increase in the susceptibility to AF. Gut microbiota analysis showed a significant increase in Desulfovibrionaceae, which generated metabolic endotoxemia in THD mice. Transplantation with HD microbes also resulted in significantly increased levels of circulating lipopolysaccharide (LPS), significant disruption in the histologic architecture of the intestinal tissue, and significantly increased proinflammatory cytokines in the left atrium, indicating that atrial inflammation likely contributed to AF susceptibility. RNA-sequencing showed that the THD group had enhanced activation of ferroptosis and TLR4/NF-κB/NLRP3 inflammasome signalling pathway. Inhibiting the ferroptosis or NLRP3 inflammasome signalling pathway significantly improved atrial fibrosis and reduced susceptibility to obesity-related gut dysbiosis-induced AF.

CONCLUSIONS

This study provides evidence showing an original causal role of gut microbiota dysbiosis in the pathogenesis of obesity-related AF, which showed elevated LPS and dysregulation of atrial pathologic remodelling by activating ferroptosis and the TLR4/NF-κB/NLRP3 inflammasome signalling pathway.

Dapagliflozin reduces pulmonary vascular damage and susceptibility to atrial fibrillation in right heart disease

AIMS

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have made considerable progress in the field of heart failure, but their application in arrhythmia remains to be in-depth. Right heart disease (RHD) often leads to right heart dysfunction and is associated with atrial fibrillation (AF). Here, we explored the possible electrophysiologic effect of dapagliflozin (a type of SGLT2is) in the development of AF in rats with RHD.

METHODS AND RESULTS

Rats in the experimental group were intraperitoneally injected with a single dose of 60 mg/kg monocrotaline (MCT group, n = 32) on the first day of the experiment, whereas rats in the control group were injected with vehicle (CTL group, n = 32). Rats in the treatment subgroup were treated with dapagliflozin solution orally (MCT + DAPA and CTL + DAPA groups) for a total of 4 weeks, whereas rats in the rest of subgroups were given sterile drinking water. After 4 weeks, echocardiography demonstrated that MCT group rats developed obvious pulmonary arterial hypertension and right heart dysfunction. In addition, there were also obvious inflammatory infiltration, fibrosis, and muscularization in right atrial and pulmonary arteries. The P-wave duration (17.00 ± 0.53 ms, vs. 14.43 ± 0.57 ms in CTL; 14.00 ± 0.65 ms in CTL + DAPA; 14.57 ± 0.65 ms in MCT + DAPA; P < 0.05), RR interval (171.60 ± 1.48 ms, vs. 163.10 ± 1.10 ms in CTL; 163.30 ± 1.19 ms in CTL + DAPA; 163.10 ± 1.50 ms in MCT + DAPA; P < 0.05), Tpeak-Tend interval (65.93 ± 2.55 ms, vs. 49.55 ± 1.71 ms in CTL; 48.27 ± 3.08 ms in CTL + DAPA; P < 0.05), and corrected QT interval (200.90 ± 2.40 ms, vs. 160.00 ± 0.82 ms in CTL; 160.40 ± 1.36 ms in CTL + DAPA; 176.6 ± 1.57 ms in MCT + DAPA; P < 0.01) were significantly prolonged in the MCT group after 4 weeks, whereas P-wave amplitude (0.07 ± 0.0011 mV, vs. 0.14 ± 0.0009 mV in CTL; 0.14 ± 0.0011 mV in CTL + DAPA; 0.08 ± 0.0047 mV in MCT + DAPA; P < 0.05) and T-wave amplitude (0.04 ± 0.002 mV, vs. 0.13 ± 0.003 mV in CTL; 0.13 ± 0.003 mV in CTL + DAPA; P < 0.01) were decreased, and atrial 90% action potential duration (47.50 ± 0.93 ms, vs. 59.13 ± 2.1 ms in CTL; 59.75 ± 1.13 ms in CTL + DAPA; 60.63 ± 1.07 ms in MCT + DAPA; P < 0.01) and effective refractory periods (41.14 ± 0.88 ms, vs. 62.86 ± 0.99 ms in CTL; 63.14 ± 0.67 ms in CTL + DAPA; 54.86 ± 0.70 ms in MCT + DAPA; P < 0.01) were shortened. Importantly, the inducibility rate (80%, vs. 0% in CTL; 10% in CTL + DAPA; 40% in MCT + DAPA; P < 0.05) and duration of AF (30.85 ± 22.90 s, vs. 0 ± 0 s in CTL; 0.24 ± 0.76 s in CTL + DAPA; 5.08 ± 7.92 s in MCT + DAPA; P < 0.05) were significantly increased, whereas the expression levels of cardiac ion channels and calcium-handling proteins such as potassium/calcium channels and calmodulin were decreased. Mechanistically, 'NACHT, LRR, and PYD domain-containing protein 3' inflammasome-related pathway was significantly activated in the MCT group. Nevertheless, in the MCT + DAPA group, the above abnormalities were significantly improved.

CONCLUSIONS

Dapagliflozin reduces pulmonary vascular damage and right heart dysfunction, as well as the susceptibility to AF in RHD rats.

Combined brain network topological metrics with machine learning algorithms to identify essential tremor

BACKGROUND AND OBJECTIVE

Essential tremor (ET) is a common movement syndrome, and the pathogenesis mechanisms, especially the brain network topological changes in ET are still unclear. The combination of graph theory (GT) analysis with machine learning (ML) algorithms provides a promising way to identify ET from healthy controls (HCs) at the individual level, and further help to reveal the topological pathogenesis in ET.

METHODS

Resting-state functional magnetic resonance imaging (fMRI) data were obtained from 101 ET and 105 HCs. The topological properties were analyzed by using GT analysis, and the topological metrics under every single threshold and the area under the curve (AUC) of all thresholds were used as features. Then a Mann-Whitney U-test and least absolute shrinkage and selection operator (LASSO) were conducted to feature dimensionality reduction. Four ML algorithms were adopted to identify ET from HCs. The mean accuracy, mean balanced accuracy, mean sensitivity, mean specificity, and mean AUC were used to evaluate the classification performance. In addition, correlation analysis was carried out between selected topological features and clinical tremor characteristics.

RESULTS

All classifiers achieved good classification performance. The mean accuracy of Support vector machine (SVM), logistic regression (LR), random forest (RF), and naïve bayes (NB) was 84.65, 85.03, 84.85, and 76.31%, respectively. LR classifier achieved the best classification performance with 85.03% mean accuracy, 83.97% sensitivity, and an AUC of 0.924. Correlation analysis results showed that 2 topological features negatively and 1 positively correlated with tremor severity.

CONCLUSION

These results demonstrated that combining topological metrics with ML algorithms could not only achieve high classification accuracy for discrimination ET from HCs but also help us to reveal the potential topological pathogenesis of ET.

Integrated Transcriptome and Metabolome Analysis of Color Change and Low-Temperature Response during Flowering of Prunus mume

In China, Prunus mume is a famous flowering tree that has been cultivated for 3000 years. P. mume grows in tropical and subtropical regions, and most varieties lack cold resistance; thus, it is necessary to study the low-temperature response mechanism of P. mume to expand the scope of its cultivation. We used the integrated transcriptomic and metabolomic analysis of a cold-resistant variety of P. mume 'Meiren', to identify key genes and metabolites associated with low temperatures during flowering. The 'Meiren' cultivar responded in a timely manner to temperature by way of a low-temperature signal transduction pathway. After experiencing low temperatures, the petals fade and wilt, resulting in low ornamental value. At the same time, in the cold response pathway, the activities of related transcription factors up- or downregulate genes and metabolites related to low temperature-induced proteins, osmotic regulators, protective enzyme systems, and biosynthesis and metabolism of sugars and acids. Our findings promote research on the adaptation of P. mume to low temperatures during wintering and early flowering for domestication and breeding.

Anp32e promotes renal interstitial fibrosis by upregulating the expression of fibrosis-related proteins

Acidic nuclear phosphoprotein 32 family member e (Anp32e) has been reported to contribute to early mammalian development and cancer metastasis. However, the pathophysiological role of Anp32e in renal interstitial fibrosis (RIF) is poorly understood. Here, we demonstrated that Anp32e was highly expressed in the region of RIF in patients with IgA nephropathy, unilateral ureteral obstruction (UUO) mouse kidneys, and Boston University mouse proximal tubular (BUMPT) cells when treated with TGF-β1; this upregulation was positively correlated with the total fibrotic area of the kidneys. The overexpression of Anp32e enhanced the TGF-β1-induced production of fibrosis-related proteins (fibronectin (Fn) and collagen type I (Col-I)) in BUMPT cells whereas the knockdown of Anp32e suppressed the deposition of these fibrosis-related proteins in UUO mice and TGF-β1-stimulated BUMPT cells. In particular, Anp32e overexpression alone induced the deposition of Fn and Col-I in both mouse kidneys and BUMPT cells without TGF-β1 stimulation. Furthermore, we revealed that the overexpression of Anp32e induced the expression of TGF-β1 and p-Smad3 while TGF-β1 inhibitor SB431542 reversed the Anp32e-induced upregulation of Fn and Col-I in BUMPT cells without TGF-β1 stimulation. Collectively, our data demonstrate that Anp32e promotes the deposition of fibrosis-related proteins by regulating the TGF-β1/Smad3 pathway.

Effect of Shenling Baizhu powder on immunity to diarrheal disease: A systematic review and meta-analysis

Background: Diarrhea is one of the leading causes of death worldwide and is associated with immune dysfunction. The modulatory effects of Shenling Baizhu powder (SLBZS) on immune function in diarrheal disease have been validated in various animal models. However, the results of these studies have not been systematically evaluated. This study aimed to evaluate the preclinical data on SLBZS for the treatment of diarrhea from an immunological perspective.

Methods: PubMed, Embase, Cochrane Library, CNKI, Wanfang Database, VIP, and Chinese Medicine Database were searched for all animal trials on SLBZS for the treatment of diarrhea published up to April 2022. Standardized mean differences (SMD) were used as effect sizes in the meta-analysis of continuous variables, including immune organs, immune cells, and immune cytokines. Subgroup analysis was performed according to animal species and disease models. The GRADE was used to assess the quality of evidence.

Results: A total of 26 studies were included. Meta-analysis showed that compared to those in the model group, SLBZS significantly increased body weight [SMD = 1.54, 95% confidence interval (CI) (1.06, 2.02)], spleen mass [SMD = 1.42, 95% CI (0.98, 1.87)], thymus mass [SMD = 1.11, 95% CI (0.69, 1.53)], macrophage phagocytic capacity (SMD = 1.07, 95% CI [0.59, 1.54]), sIgA [SMD = 1.04, 95% CI (0.33, 1.74)], RBC-C3b-RR [SMD = 1.16, 95% CI (0.65, 1.67)], IL-2 [SMD = 1.52, 95% CI (0.89, 2.14)] and decreased diarrhea scores [SMD = −1.40, 95% CI (−2.03, −0.87)], RBC-IC-RR [SMD = −1.40, 95% CI (−1.94, −0.87)], and IL-8 [SMD = −2.80, 95% CI (−3.54, −2.07)]. Subgroup analysis showed that SLBZS regulated TNF-α, IL-1β, and IL-10 in rats and mice, and improved IL-6 and IL-10 in different diseases, with differences between subgroups (p < 0.05). Owing to heterogeneity, the reliability of the results remains to be verified. The quality of evidence was “very low”.

Conclusion: SLBZS improve diarrhea symptoms by enhancing immune function. It has curative effects with differences between different species and diseases, however, because the reporting in the original studies was too unclear to be assessed, the analysis was inconclusive. For higher quality evidences, future research should pay attention to the scientific rigor of the experimental design and the completeness of the reported results.

Modular regulation of floral traits by a PRE1 homolog in Mimulus verbenaceus: implications for the role of pleiotropy in floral integration

Floral traits often show correlated variation within and among species. For species with fused petals, strong correlations among corolla tube, stamen, and pistil length are particularly prevalent, and these three traits are considered an intra-floral functional module. Pleiotropy has long been implicated in such modular integration of floral traits, but empirical evidence based on actual gene function is scarce. We tested the role of pleiotropy in the expression of intra-floral modularity in the monkeyflower species Mimulus verbenaceus by transgenic manipulation of a homolog of Arabidopsis PRE1. Downregulation of MvPRE1 by RNA interference resulted in simultaneous decreases in the lengths of corolla tube, petal lobe, stamen, and pistil, but little change in calyx and leaf lengths or organ width. Overexpression of MvPRE1 caused increased corolla tube and stamen lengths, with little effect on other floral traits. Our results suggest that genes like MvPRE1 can indeed regulate multiple floral traits in a functional module but meanwhile have little effect on other modules, and that pleiotropic effects of these genes may have played an important role in the evolution of floral integration and intra-floral modularity.

AB0392 EFFICACY AND SAFETY OF UPADACITINIB IN A CHINESE SUBGROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS AND INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

Background

Upadacitinib (UPA) was effective in global Phase 3 trials in rheumatoid arthritis (RA) patients (pts) with inadequate response (IR) to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

Objectives

To assess the efficacy and safety of UPA in csDMARD-IR pts with RA in Chinese subgroup from a Phase 3, randomized, double-blind, placebo (PBO)-controlled study (NCT02955212) 1.

Methods

Pts were randomized to 12 weeks of blinded treatment with UPA 15 mg once daily (QD) or PBO, in combination with csDMARDs. Primary and secondary endpoints were analyzed in a Chinese subgroup, including American College of Rheumatology criteria (ACR) responses, remission and low disease activity measures. Safety was analyzed for pts who received ≥1 dose of study drug.

Results

228 Chinese pts (67.5% of overall trial population) were randomized and took at least one dose of study drug. Baseline characteristics were generally balanced between UPA and PBO. 46% and 35.1% used methotrexate (MTX) alone as concomitant csDMARD in UPA and PBO group, respectively. 38.9% in UPA and 43.0% in PBO group used concomitant csDMARDs other than MTX and 15.0% and 21.9% respectively used a combination. At week 12, more Chinese pts receiving UPA achieved the primary endpoint of ACR20 compared with PBO (71.9% vs 31.6%, nominal p<0.001). UPA also showed greater improvements in all secondary endpoints vs PBO at Week 12 (Table 1), including ACR50 and ACR70, mean change in Disease Activity Score in 28 joints using C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), Short-Form 36-item Health Survey-Physical Component Summary (SF-36 PCS), as well as proportion of pts achieving low disease activity based on DAS28-CRP ≤3.2 and Clinical Disease Activity Index (CDAI) ≤10, and clinical remission based on DAS28-CRP <2.6. Onset of response was rapid with more pts receiving UPA achieving ACR20 by Week 1 versus PBO (25.4% vs 5.3%, nominal p<0.001). Through Week 12 treatment-emergent adverse events (TEAEs) occurred in 57.9% of pts on UPA and 49.1% on PBO. The rate of pts with serious AEs (SAEs) was numerically higher with UPA than with PBO (6.1% vs 4.4%). TEAEs reported in ≥ 3% of subjects and with a higher rate on UPA vs. PBO were: upper respiratory tract infection, alanine aminotransferase increased, aspartate aminotransferase increased, hypertension, diarrhea, and leukopenia. Overall safety was consistent with the trial population1 and similar with the reported safety profile of the global clinical program2.

Table 1.

Summary of Efficacy Endpoint Results at Week 12 in Chinese Subgroup

Endpoint aUPA 15mg (N=114)PBO (N=114)Primary endpointACR20, %71.9***31.6Secondary endpointsΔ DAS28-CRP-2.42***-0.75Δ HAQ-DI-0.55***-0.11Δ SF-36 PCS7.63 b***2.94 cDAS28-CRP ≤3.2, %46.5***9.6DAS28-CRP <2.6, %28.1***1.8CDAI ≤10, %33.3***7.0ACR50, %39.5***7.0ACR70, %16.7***2.6ACR20 at Week 1, %25.4***5.3

***Nominal p<0.001 vs PBO

aNon-responder imputation for binary endpoints; ANCOVA with multiple imputation for DAS28(CRP) and HAQ-DI; mixed model repeated measures for other continuous endpoints. Δ: mean change from baseline

bN=106

cN=104

Conclusion

UPA demonstrated clinical and functional improvement in Chinese csDMARD-IR RA pts. The safety of UPA was comparable with the overall study population and with the safety seen in the global Phase 3 program.

References

[1]Zeng X, Zhao D, Radominski SC, et al. Int J Rheum Dis. 2021;24:1530–1539.

[2]Cohen SB, van Vollenhoven RF, Winthrop KL, et al. Ann Rheum Dis 2021;80:304–311.

Acknowledgements

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship.

Disclosure of Interests

Xiaofeng Zeng: None declared, Yi Liu: None declared, Jiankang Hu: None declared, Jingyang Li: None declared, Yongfu Wang: None declared, Dongbao Zhao: None declared, Lijun Wu: None declared, Zhengyu Xiao: None declared, ZHIJUN LI: None declared, Jian Xu: None declared, Sebastian Meerwein Shareholder of: may own AbbVie stock or options, Employee of: AbbVie employee, Yunxia Xie Shareholder of: may own AbbVie stock or options, Employee of: AbbVie employee, Peiwen Liang Employee of: AbbVie

Intrapleural Perfusion With Staphylococcal Enterotoxin C for Malignant Pleural Effusion: A Clustered Systematic Review and Meta-Analysis

Introduction

The staphylococcal enterotoxin C (SEC), a commercially available bio-product from Staphylococcus aureus (S. aureus), has been widely used to control MPE.

Objectives

We designed and performed a new systematic review (SR) and meta-analysis to clarify the perfusion protocols with SEC, determine their clinical effectiveness and safety, and reveal the indication and optimum usage for achieving the desired responses.

Methodology

All randomized controlled trials (RCTs) about SEC for MPE were collected from electronic databases (from inception until July 2021), and clustered into multiple logical topics. After evaluating their methodological quality, we pooled the data from each topic using the meta-analysis or descriptive analysis, and summarized the evidence quality using the grading of recommendation assessment, development, and evaluation (GRADE) approach.

Results

All 114 studies were clustered into SEC perfusion alone or plus chemical agents. The SEC alone showed a better complete response (CR), a lower pleurodesis failure, and adverse drug reactions (ADRs), and a higher fever than cisplatin (DDP) alone. The SEC and chemical agents developed 10 perfusion protocols. Among them, only SEC and DDP perfusion showed a better CR, a lower failure, disease progression and ADRs, and a higher fever than DDP alone. The SEC (100–200 ng per time, one time a week for one to four times) with DDP (30–40 mg, or 50–60 mg each time) significantly improved clinical responses for patients with moderate to large volume, Karnofsky performance status (KPS) scores ≥40, ≥50, or ≥60, and anticipated survival time (AST) ≥2 or 3 months. Most results were moderate to low quality.

Conclusion

Current pieces of evidence indicate that super-antigen SEC is a pleurodesis agent, which provides an attractive alternative to existing palliative modalities for patients with MPE. Among 10 protocols, the SEC and DDP perfusion is a most commonly used, which shows a significant improvement in clinical responses with low ADRs. These findings also provide a possible indication and optimal usage for SEC and DDP perfusion.

Combined Intrinsic Local Functional Connectivity With Multivariate Pattern Analysis to Identify Depressed Essential Tremor

Background

Although depression is one of the most common neuropsychiatric symptoms in essential tremor (ET), the diagnosis biomarker and intrinsic brain activity remain unclear. We aimed to combine multivariate pattern analysis (MVPA) with local brain functional connectivity to identify depressed ET.

Methods

Based on individual voxel-level local brain functional connectivity (regional homogeneity, ReHo) mapping from 41 depressed ET, 43 non-depressed ET, and 45 healthy controls (HCs), the binary support vector machine (BSVM) and multiclass Gaussian Process Classification (MGPC) algorithms were used to identify depressed ET patients from non-depressed ET and HCs, the accuracy and permutations test were used to assess the classification performance.

Results

The MGPC algorithm was able to classify the three groups (depressed ET, non-depressed ET, and HCs) with a total accuracy of 84.5%. The BSVM algorithm achieved a better classification performance with total accuracy of 90.7, 88.64, and 90.48% for depressed ET vs. HCs, non-depressed ET vs. HCs, and depressed ET vs. non-depressed ET, and the sensitivity for them at 80.49, 76.64, and 80.49%, respectively. The significant discriminative features of depressed ET vs. HCs were primarily located in the cerebellar-motor-prefrontal gyrus-anterior cingulate cortex pathway, and for depressed ET vs. non-depressed ET located in the cerebellar-prefrontal gyrus-anterior cingulate cortex circuits. The partial correlation showed that the ReHo values in the bilateral middle prefrontal gyrus (positive) and the bilateral cerebellum XI (negative) were significantly correlated with clinical depression severity.

Conclusion

Our findings suggested that combined individual ReHo maps with MVPA not only could be used to identify depressed ET but also help to reveal the intrinsic brain activity changes and further act as the potential diagnosis biomarker in depressed ET patients.

A Risk Model Based on Immune-Related Genes Predicts Prognosis and Characterizes the Immune Landscape in Esophageal Cancer

Aberrant immune gene expression has been shown to have close correlations with the occurrence and progression of esophageal cancer (EC). We aimed to generate a prognostic signature based on immune-related genes (IRGs) capable of predicting prognosis, immune checkpoint gene (ICG) expressions, and half-inhibitory concentration (IC₅₀) for chemotherapy agents for EC patients. Transcriptome, clinical, and mutation data on tumorous and paratumorous tissues from EC patients were collected from The Cancer Genome Atlas (TCGA) database. Then, we performed differential analysis to identify IRGs differentially expressed in EC. Their biofunctions and related pathways were explored using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. These gene expression profiling data were merged with survival information and subjected to univariate Cox regression to select prognostic genes, which were then included in a Lasso-Cox model for signature generation (risk score calculation). Patients were divided into the high- and low-risk groups using the median risk score as a cutoff. The accuracy of the signature in overall survival prediction was assessed, so were its performances in predicting ICG expressions and IC₅₀ for chemotherapy and targeted therapy agents and immune cell landscape characterization. Fifteen prognostic IRGs were identified, seven of which were optimal for risk score calculation. As expected, high-risk patients had worse overall survival than low-risk individuals. Significant differences were found in tumor staging, immune cell infiltration degree, frequency of tumor mutations, tumor mutation burden (TMB), and immune checkpoint gene expressions between high- vs. low-risk patients. Further, high-risk patients exhibited high predicted IC₅₀ for paclitaxel, cisplatin, doxorubicin, and erlotinib compared to low-risk patients. The seven-IRG-based signature can independently and accurately predict overall survival and tumor progression, characterize the tumor immune microenvironment (TIME) and estimate ICG expressions and IC₅₀ for antitumor therapies. It shows the potential of guiding personalized treatment for EC patients.

A Real-World Comparative Effectiveness Analysis of Thromboprophylactic Use of Enoxaparin Versus Unfractionated Heparin in Abdominal Surgery Patients in a Large U.S. Hospital Database

Introduction: Little is known about outcomes associated with enoxaparin versus unfractionated heparin (UFH) for venous thromboembolism (VTE) prophylaxis in abdominal surgery patients in U.S. clinical practice. The purpose of this study was to compare VTE, all-cause mortality, PE-related in-hospital mortality, and hospital costs during abdominal surgery hospitalization and the 90 days post-discharge between patients who received enoxaparin versus UFH prophylaxis. Materials and Methods: Using the Premier Healthcare Database, abdominal surgery patients who received at least 1 day of VTE prophylaxis with enoxaparin or UFH were identified between January 1, 2010 and September 30, 2016. Clinical outcomes were assessed using multivariable logistic regression models and cost outcomes were assessed using generalized linear models. Results: Of 363,669 patients identified, 59% received enoxaparin and 41% UFH. In adjusted analyses, there were statistically significant lower odds of VTE (OR 0.80; 95% CI 0.65-0.97), all-cause mortality (OR 0.67; 95% CI 0.60-0.75), and major bleeding (OR 0.88; 95% CI 0.82-0.94) during the hospitalization for enoxaparin versus UFH, but no differences during the 90-days post-discharge or for PE-related mortality. There was a statistically significant lower total hospital cost with enoxaparin versus UFH during index hospitalization ($8,913 vs $9,017, P < .0001), but not post-discharge ($3,342 vs $3,368, P = .42). Unadjusted rates of heparin-induced thrombocytopenia (index:0.1% vs 0.3%; post-discharge: 0.02% vs 0.06%) were reported for enoxaparin and UFH, respectively. Conclusion: In contemporary U.S. hospital practice, statistically significant lower odds of VTE, all-cause mortality and major bleeding with enoxaparin versus UFH prophylaxis were found during abdominal surgery hospitalizations.

Protective effects of Dapagliflozin on the vulnerability of ventricular arrhythmia in rats with pulmonary artery hypertension induced by monocrotaline

Monocrotaline (MCT)-induced pulmonary artery hypertension (PAH) has been reported to cause right heart failure (RHF). Moreover, Right heart diseases have been determined to cause ventricular arrhythmia (VA). So we can conclude that MCT-induced PAH increases the incidence of VA. In addition, Previous studies have determined the benefits of Dapagliflozin (DA) on the cardiac system, but the responses of MCT-induced RHF to DA are not fully reported. So the present study sought to evaluate the effects of DA on the MCT-induced PAH. A dose intraperitoneal injection of MCT (60 mg/kg) was carried out to induce a rat model with PAH. DA (60 mg/l) was administered for 4 weeks following MCT injection. Echocardiography, body weight, blood pressure, blood glucose, electrophysiological study, and Western blot were performed. Four weeks after the MCT injection, MCT-treated rats decreased body weight, blood glucose and blood pressure. In addition, MCT caused the formation of PAH and RHF. Moreover, MCT-induced PAH rats increased the incidence of VA, prolonged action potential duration (APD), and shortened effective refractory period (ERP). Additionally, PAH rats significantly prevented the activated expressions of Ion channel proteins such as potassium channel (Kv1.5, Kv2.1, Kv4.2, Kv4.3) and L-type Ca channel (Cav1.2). As we expected, these changes above in PAH rats were reversed when DA was administered. Mechanistically, DA significantly reduced the levels of toll-like receptor (TLR4), the nuclear factor kappa B (NF-κB) in MCT-treated rats. In conclusion, these findings determine that DA reduces the vulnerability of VA in PAH rats through the TLR4/NF-κB signaling pathway.