The global burden of lymphoma: estimates from the Global Burden of Disease 2019 study

OBJECTIVES

The aim of this study was to describe the global trends in the burden of lymphoma from 1990 to 2019.

STUDY DESIGN

The data used in this study were from the Global Burden of Disease 2019 study.

METHODS

This study described the age-standardised rates of incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of lymphoma (non-Hodgkin and Hodgkin's lymphoma, NHL and HL, respectively) annually from 1990 to 2019, stratified by sociodemographic index (SDI) and 21 world regions. The estimated annual percentage changes in these indexes were calculated.

RESULTS

In 2019, the age-standardised rates of HL per 100,000 population were lower than those of NHL in terms of incidence (1.1 vs 6.7 per 100,000 person-years, respectively) and prevalence (0.3 vs 5.7 per 100,000 person-years, respectively) but not mortality (21.6 vs 3.2 per 100,000 person-years, respectively). From 1999 to 2019, the global incidence of HL decreased and the incidence of NHL increased, and the prevalence of both HL and NHL increased, but the mortality rates decreased. When stratified by SDI, the incidence of HL decreased in all but middle-SDI regions, the mortality rate of HL decreased in all regions, and both the incidence and mortality rate of NHL increased in all but high-SDI regions. The prevalence of HL and NHL increased in all SDI regions, especially in middle-SDI regions. YLLs and DALYs of HL in all SDI regions and those of NHL in high-SDI regions decreased. YLDs slightly increased in middle- to high-SDI regions.

CONCLUSIONS

Lymphoma remains a major public health issue, and better prevention, precise identification, and promising treatments are vitally important.

Identification and Characterization of CD8+ CD27+ CXCR3- T Cell Dysregulation and Progression-Associated Biomarkers in Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE) etiopathogenesis highlights the contributions of overproduction of CD4+ T cells and loss of immune tolerance. However, the involvement of CD8+ T cells in SLE pathology and disease progression remains unclear. Here, the comprehensive immune cell dysregulation in total 263 clinical peripheral blood samples composed of active SLE (aSLE), remission SLE (rSLE) and healthy controls (HCs) is investigated via mass cytometry, flow cytometry and single-cell RNA sequencing. This is observed that CD8+ CD27+ CXCR3- T cells are increased in rSLE compare to aSLE. Meanwhile, the effector function of CD8+ CD27+ CXCR3- T cells are overactive in aSLE compare to HCs and rSLE, and are positively associated with clinical SLE activity. In addition, the response of peripheral blood mononuclear cells (PBMCs) is monitored to interleukin-2 stimulation in aSLE and rSLE to construct dynamic network biomarker (DNB) model. It is demonstrated that DNB score-related parameters can faithfully predict the remission of aSLE and the flares of rSLE. The abundance and functional dysregulation of CD8+ CD27+ CXCR3- T cells can be potential biomarkers for SLE prognosis and concomitant diagnosis. The DNB score with accurate prediction to SLE disease progression can provide clinical treatment suggestions especially for drug dosage determination.

Deliberate foreign body ingestion in patients with underlying mental illness: A retrospective multicentre study

OBJECTIVE

Deliberate foreign body ingestion (DFBI) is characterised by recurrent presentations among patients with mental health conditions, intellectual disabilities and in prisoners. We aimed to profile the characteristics and evaluate the care of such patients in this study.

METHODS

Adult patients with an endoscopic record of attempted foreign body retrieval between January 2013 and September 2020 were identified at three Australian hospitals. Those with a documented mental health diagnosis were included and their standard medical records reviewed. Presentation history, demographics, comorbidities and endoscopic findings were recorded and described.

RESULTS

A total of 166 admissions were accounted for by 35 patients, 2/3 of which had borderline personality disorder (BPD). Repetitive presentations occurred in more than half of the cohort. There was an increased trend of hospital admissions throughout the years. At least half of the cohort had a documented mental health review during their admission. An average of 3.3 (2.9) foreign bodies were ingested per single episode. Endoscopic intervention was performed in 76.5% of incidents. The combined Length of stay for all patients was 680 days.

CONCLUSION

Deliberate foreign body ingestion in mental health patients is a common, recurring and challenging problem that is increasing in frequency and requires collaborative research to further guide holistic management.

Sex Specific Global Burden of Osteoporosis in 204 Countries and Territories, from 1990 to 2030: An Age-Period-Cohort Modeling Study

BACKGROUND

Osteoporosis is a highly prevalent disease with distinct sex pattern. We aimed to estimate the sex specific incidence, prevalence, and disability-adjusted life (DALYs) years of osteoporosis between 1990 and 2019, with additional predictions from 2020 to 2034.

METHODS

We collected osteoporosis disease burden data from the Global Burden of Disease study covering the years 1990 through 2019 in 204 countries and territories. The data included information on the number of incident cases of osteoporosis, DALYs, age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR) and age-standardized DALYs rates. Additionally, we performed an age-period-cohort analysis to forecast the burden of osteoporosis.

RESULTS

The global number of incidence cases of osteoporosis, in 2019, reached 41.5 million cases. From 1990 to 2019, the low-middle socio-demographic index (SDI) region had the highest estimated annual percentage change in the world. Compared to males, female's ASIR and ASPR were all about 1.5 times higher than males for the same years in the same SDI regions. The projected global total number of incidence cases for osteoporosis between 2030 and 2034 is estimated to reach 263.2 million (154.4 million for females and 108.8 for males). Additionally, the burden in terms of DALYs is predicted to be 128.7 million (with 78.4 million for females and 50.3 million for males).

CONCLUSION

The global burden of osteoporosis is still increasing, mainly observed in high SDI countries. Females bear a burden 1.5 times higher than males in terms of incidence and DALYs. Steps should be taken to reduce the osteoporosis burden, especially in high SDI countries.

Watchman device migration and embolization: a report from the NCDR LAAO registry

Background

Incomplete anchoring of the Watchman left atrial appendage closure (LAAO) device can result in substantial device migration or device embolization requiring percutaneous or surgical retrieval.

Purpose

To report rates and characteristics of in-hospital and post-discharge Watchman device migration and embolization events in the United States.

Methods

We performed a retrospective analysis of Watchman procedures (January 2016 through March 2021) reported to the National Cardiovascular Data Registry LAAO Registry. We excluded patients with prior LAAO interventions, no device released, and missing device information. In-hospital events were assessed among all patients and post-discharge events were assessed among patients with 45-day follow-up.

Results

Of 120,278 Watchman procedures, device migration or embolization occurred in 0.07% of patients (n=84) during the index hospitalization and surgery was performed in 39 patients. The in-hospital mortality rate was 14% among patients with device migration or embolization and 20.5% among patients who underwent surgery. In-hospital migration or embolization was more common: at hospitals with a lower median annual procedure volume (24 vs. 41 procedures, p<0.0001), with first-generation Watchman versus next-generation Watchman FLX devices (0.08% vs. 0.04%, p=0.0048), with larger LAA ostia (median 23 mm vs. 21 mm, p=0.004), and with a smaller difference between device and LAA ostial size (median difference 4 mm vs. 5 mm, p=0.04). There were no differences by age, sex, hospital type, hospital size, or teaching versus non-teaching status. Of 98,147 patients with 45-day follow-up, device migration or embolization after discharge occurred in 0.06% (n=54) patients and cardiac surgery was performed in 7.4% (n=4) of cases. The 45-day mortality rate was 3.7% (n=2) among patients with post-discharge device migration or embolization. Post-discharge migration or embolization was more common among men (79.7% of events but 58.9% of all procedures, p=0.0019), taller patients (177.9 cm vs. 172 cm, p=0.0005), and those with greater body mass (99.9 kg vs. 85.5 kg, p=0.0055); in contrast to in-hospital events, there were no differences in hospital volume, device characteristics, or LAA characteristics.

Conclusions

Watchman device migration or embolization is rare but associated with high mortality (Figure 1) and frequently requires surgical retrieval. A substantial proportion of all device migration or embolization cases occur after discharge and different patient and procedure characteristics are associated with in-hospital versus post-discharge cases. Given the morbidity and mortality associated with device migration or embolization, risk mitigation strategies and on-site cardiac surgical back-up are of paramount importance.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health

A Hashing-Based Framework for Enhancing Cluster Delineation of High-Dimensional Single-Cell Profiles

Although many methods have been developed to explore the function of cells by clustering high-dimensional (HD) single-cell omics data, the inconspicuously differential expressions of biomarkers of proteins or genes across all cells disturb the cell cluster delineation and downstream analysis. Here, we introduce a hashing-based framework to improve the delineation of cell clusters, which is based on the hypothesis that one variable with no significant differences can be decomposed into more diversely latent variables to distinguish cells. By projecting the original data into a sparse HD space, fly and densefly hashing preprocessing retain the local structure of data, and improve the cluster delineation of existing clustering methods, such as PhenoGraph. Moreover, the analyses on mass cytometry dataset show that our hashing-based framework manages to unveil new hidden heterogeneities in cell clusters. The proposed framework promotes the utilization of cell biomarkers and enriches the biological findings by introducing more latent variables.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43657-022-00056-z.

Autoantibodies in COVID-19 correlate with antiviral humoral responses and distinct immune signatures

BACKGROUND

Several autoimmune features occur during coronavirus disease 2019 (COVID-19), with possible implications for disease course, immunity, and autoimmune pathology. In this study, we longitudinally screened for clinically relevant systemic autoantibodies to assess their prevalence, temporal trajectory, and association with immunity, comorbidities, and severity of COVID-19.

METHODS

We performed highly sensitive indirect immunofluorescence assays to detect antinuclear antibodies (ANA) and antineutrophil cytoplasmic antibodies (ANCA), along with serum proteomics and virome-wide serological profiling in a multicentric cohort of 175 COVID-19 patients followed up to 1 year after infection, eleven vaccinated individuals, and 41 unexposed controls.

RESULTS

Compared with healthy controls, similar prevalence and patterns of ANA were present in patients during acute COVID-19 and recovery. However, the paired analysis revealed a subgroup of patients with transient presence of certain ANA patterns during acute COVID-19. Furthermore, patients with severe COVID-19 exhibited a high prevalence of ANCA during acute disease. These autoantibodies were quantitatively associated with higher SARS-CoV-2-specific antibody titers in COVID-19 patients and in vaccinated individuals, thus linking autoantibody production to increased antigen-specific humoral responses. Notably, the qualitative breadth of antibodies cross-reactive with other coronaviruses was comparable in ANA-positive and ANA-negative individuals during acute COVID-19. In autoantibody-positive patients, multiparametric characterization demonstrated an inflammatory signature during acute COVID-19 and alterations of the B-cell compartment after recovery.

CONCLUSION

Highly sensitive indirect immunofluorescence assays revealed transient autoantibody production during acute SARS-CoV-2 infection, while the presence of autoantibodies in COVID-19 patients correlated with increased antiviral humoral immune responses and inflammatory immune signatures.

P-329 Endometrioma impairs oocyte development by extensive premature activation of primordial follicles in an experimental endometrioma mouse model

Study question

What are the pathological mechanisms of endometrioma-associated poor ovarian function?

Summary answer

Endometrioma prematurely activated primordial follicles and subsequently impaired ovarian functions through disrupting folliculogenesis and deteriorating oocyte quality.

What is known already

Endometrioma is the most common subtype of endometriosis, of which the endometriotic lesions implant in the ovary. Women with endometrioma are usually coupled with disrupted folliculogenesis, hampered ovulation, impaired oocyte quality and undesired infertility, presenting with reduced ovarian reserve, low oocyte retrieval rates and poor fertility outcomes. However the underlying mechanisms of the disrupted folliculogenesis, hampered ovulation and impaired oocyte quality in endometrioma-associated infertility are still unclear.

Study design, size, duration

An experimental mouse model of endometrioma (OMA) was established to study the effects of endometriosis in ovary on the development and functions of follicles. Four to eight mice were included in experimental and sham control groups each. Ovaries were collected 4 weeks after transplantation of endometrial fragments. Follicle counts and specific developmental markers were used to evaluate the development and functions of follicles. Oocyte quality was studied by meiotic competence, cortical distributions and ATP synthesis.

Participants/materials, setting, methods

Minced endometrial tissues from donor mice were inserted into ovarian bursa in recipient mice. Ovarian follicles in different stages were examined and counted manually with Periodic acid-Schiff staining. Protein expressions of FOXO3, AMH and FSHR were detected by immunohistochemistry to characterise the developing primordial, primary/secondary and antral follicles, respectively. Oocytes were collected from oviduct after superovulation and stained with a-tubulin, LCA-FITC to assess maturity.

Main results and the role of chance

Successful establishment of endometriotic lesions in ovarian tissues was confirmed morphologically and histologically with a success rate of 83.33% in recipient mice. In the OMA ovaries, absolute counts of the follicles in each developmental stage showed significant reduction when compared with sham controls. Percentage of primordial follicles was significantly reduced, but percentage of advanced-staged follicles was significantly increased. Expression of FOXO3 in primordial follicles, AMH in developing follicles (primary, secondary) and FSHR in antral follicles were all significantly decreased in OMA group. Oocytes isolated from OMA ovaries had lower number and size than controls. Large proportion of the oocytes had significantly higher abnormal spindle rates, indicating mitotic disruption. Moreover, a large proportion of the oocytes also had impaired cortical granule migration, indicating affected organelle organization.

Limitations, reasons for caution

Studies based on this animal model may not reflect the exact situation in human. Moreover, success rate of the OMA model cannot reach 100%. Other factors contributing to the endometrioma-associated infertility still undetermined in the OMA models.

Wider implications of the findings

The results demonstrated that endometrioma remarkably deteriorated follicular development, and subsequently impaired oocyte quality by premature activation primordial follicles. The underlying deteriorating effects and mechanism might help to develop novel therapeutic targets to improve fertility outcomes in women with endometrioma.

Trial registration number

N/A

First-in-human (FIH) phase I study of the highly selective phosphoinositide 3-kinase inhibitor delta (PI3Kδ) inhibitor IOA-244 in patients with advanced cancer: Safety, activity, pharmacokinetic (PK), and pharmacodynamic (PD) results

3107

Background: T regulatory (Tregs) cells contribute to immune suppression in cancer. The highly selective inhibitor of PI3Kδ, IOA-244, blocks the activity of Tregs among other things, thus reprograms the anti-tumor immune response. Methods: IOA-244 was investigated in a two-part FIH study. Part A explored the continuous daily dosing of IOA-244 at 10, 20, 40 and 80 mg. Part B consists of expansion cohorts of specific tumor indications, including pre-treated uveal melanoma patients (pts). Primary objective: safety of the anticipated biologically effective dose (BED), or the recommended phase 2 dose (RP2D). Secondary objectives: PK; PD (e.g., inhibition of CD63 expression on basophils, changes in immune cell subsets in peripheral blood); RECIST 1.1.-based responses; PFS and OS. Exploratory studies: changes in circulating immune cells by Cytometry by Time of Flight (CyTOF); response assessments by radiomics Results: Part A Solid Tumor (completed): Sixteen pts were treated in 4 cohorts each with 4 pts. Pts characteristics: uveal melanoma (9/16; 56%), cutaneous melanoma (5/16; 31%) and pleural mesothelioma (2/16; 13%). Four pts had at least one serious TEAE, none considered related to IOA-244. There was no treatment-emergent adverse events (TEAE) leading to study drug discontinuation, immune related toxicity or Dose Limiting Toxicity. CTCAE v5 Grade 1 and 2 were observed, including 2 cases of transient diarrhoea and 2 of AST/ALT elevation. Part A (Completed) – Subgroup Uveal Melanoma Pts (progressed ≥1 line prior therapy): 9 pts treated (3/9 pts ongoing). Mean time on treatment: 7.7 mo (range: 1.8-16.0 mo with 3 pts ongoing). ORR (RECIST 1.1): CR+PR: 0/9 (0%); SD: 6/9 (67%). Median OS: 5.4 mo - not determined (% alive at 1 year: 44% with 3 pts ongoing). CT images from 7/9 patients were assessed for changes in their metastatic lesions by radiomics (baseline and Week 8). Based on 147 matched lesions, 19% had complete responses and 16% had new lesions. In the liver, non-progressive disease was observed in 61% of all lesions, including 42% with either complete response or volume reduction of more than 30%. Using CyTOF, circulating Tregs were reduced while CD8 and NK cells were increased. Part B Uveal Melanoma Expansion Cohort (ongoing): 7 patients (7/7 pts ongoing); mean time on treatment 3.7 mo. ORR (RECIST 1.1): SD in 4/7 pts (57%). Part A Follicular Lymphoma Cohort (ongoing): At 20 mg: 4/4 pts. No DLT. At 80 mg: recruiting. Conclusions: In addition to being well tolerated, IOA-244 at the 80 mg dose shows reduction in peripheral blood Tregs and anti-tumor responses based on radiomics. Therefore, RECIST 1.1.-derived SD may underestimate anti-tumor activity of IOA-244 in treatment-resistant uveal melanoma. Additional patients will be treated to further refine this radiomics-based observation. Clinical trial information: NCT04328844.

Menopausal hormone therapy: what are the problems in the perception of Chinese physicians?

OBJECTIVE

This study aimed to investigate Chinese physicians' perception and attitudes toward menopausal hormone therapy (MHT).

METHODS

This nationwide online survey was conducted in China. Physicians registered in the WeChat groups of the Gynecological Endocrinology Committee of China's Maternal and Child Health Care Association received a message invitation to complete this anonymous online survey from April 2020 to July 2020. Physicians' knowledge of and attitudes toward MHT were surveyed.

RESULTS

In total, 4672 questionnaires were submitted; only completed questionnaires could be submitted. The message was sent to 6021 doctors, so the response rate was 77.6%. Overall, 77.9-92.9% of physicians knew the common indications and contraindications to MHT. Additionally, 90.6%, 85.4%, 80.7% and 37.5% of physicians thought that MHT would increase the risk of venous thrombosis, breast cancer, endometrial cancer and weight gain, respectively. In total, 58.1% of the physicians mistakenly believed that a sex hormone test was one of the necessary examinations to reassess MHT prescription during follow-up visits. We found that 68.5% of physicians would consider using MHT themselves or recommend MHT to their partners in the future, and 11.4% were currently using MHT.

CONCLUSIONS

Most Chinese physicians have basic knowledge of MHT. Their misunderstandings about MHT mainly centered on the risks of endometrial cancer, weight gain and the necessary examinations during follow-up visits. These misunderstandings need to be clarified in future professional training programs.

Function and Characterization of an Alanine Dehydrogenase Homolog From Nocardia seriolae

Fish nocardiosis is a chronic, systemic, granulomatous disease in aquaculture. Nocardia seriolae has been reported to be one of the main pathogenic bacteria of fish nocardiosis. There are few studies on the associated virulence factors and pathogenesis of N. seriolae. Alanine dehydrogenase (ALD), which may be a secreted protein, was discovered by analysis using bioinformatics methods throughout the whole genomic sequence of N. seriolae. Nevertheless, the roles of ALD and its homologs in the pathogenesis of N. seriolae are not demonstrated. In this study, the function of N. seriolae ALD (NsALD) was preliminarily investigated by gene cloning, host cell subcellular localization, secreted protein identification, and cell apoptosis detection. Identification of the extracellular products of N. seriolae via mass spectrometry (MS) analysis revealed that NsALD is a secreted protein. In addition, subcellular localization of NsALD-GFP recombinant protein in fathead minnow (FHM) cells showed that the strong green fluorescence co-localized with the mitochondria. Moreover, apoptosis assays demonstrated that the overexpression of NsALD induces apoptosis in FHM cells. This study may lay the foundation for further exploration of the function of NsALD and facilitate further understanding of the pathogenic mechanism and the associated virulence factors of N. seriolae.

P–316 A rat model of endometrioma to study endometriosis-related infertility

Study question

Underlying mechanisms and specific treatment for endometriosis-related infertility are still unclear and lacking. Is there any animal model suitable for the study?

Summary answer

Endometium ligation to ovary fat pad in rats is a more appropriate and successful but less detrimental model of endometrioma for infertility pathology and outcomes.

What is known already

Nonhuman primates (NHP) have been the most representative animal model for endometriosis since they menstruate in a cyclic pattern and develop endometriosis spontaneously as in human. However, the incidence of spontaneous endometriosis in NHP is low and due to ethical concerns and high cost, the application of NHP for endometriosis study is restricted. Rodents (i.e. rats, mice, rabbits) have been used to analyze the pathophysiology of endometriosis. Because rodents do not develop endometriosis spontaneously, it has to be induced surgically. Ovarian endometriosis is the most common type, but previous experimental models were mostly either subcutaneous, peritoneal wall or mesenteric endometriosis.

Study design, size, duration

An animal study to compare different methods of endometrium transplantation to the ovary as potential animal model of endometrioma to study the endometriosis-related infertility. Compared with NHP and other rodents, rats were chosen due to easy access, low cost, good ovary size, short estrus and reproductive cycle and similar endocrine pattern to human beings. For each transplantation method, at least 5 animals were included and followed up in different time points for comparisons.

Participants/materials, setting, methods

To establish ovarian endometriosis or endometrioma model, uterine tissues were collected from donor rats and then transplanted to recipient rats by either adhesion to ovary, ligation to ovary fat pad, or injection underneath tunica albuginea. Vasculature and histology of engrafts, follicle count and morphology of ovary, receptivity markers of endometrium, immune response and inflammatory cytokines of peritoneal cavity and hormonal changes were assessed after 4 days of transplantation. Implantation rates after conception will be examined.

Main results and the role of chance

Compared with other transplantation methods, only ligation of endometrium fragments to ovary fat pad resulted in endometrioma-like lesion in the ovaries. Compare with sham control ovaries, formation of new vessels from surrounding ovarian vessels to the endometriotic engraft assessed by Cellvizio LAB in vivo imaging was identified, indicating active angiogenesis. Morphology and histology of endometriotic cyst were confirmed in the lesion by H&E staining, suggesting functional endometrium. Stroma markers CD140b, CD106 lkand epithelium markers keratin 17/19 and EpCam were found in the ovary cortex, implying integration of endometrium tissue to the ovarian tissues. Decreased AMH expression and antral follicle count in the ovaries suggested defective follicle development. Reduced receptivity markers HOXA10, LIF and ανβ3 integrin expression in uterine endometrium and implantation rate after nature mating or embryo transfer indicated potential impaired endometrial receptivity. Peripheral and peritoneal levels of COX2 and IL–8 were elevated, suggesting inflammatory response. However, estrogen and progesterone levels were not significant different from baseline and other transplantation methods.

Limitations, reasons for caution

This was an animal model, it might not totally reflect the exact pathological changes of endometrioma in human. Current method was a single and short-term transplantation model, monthly endometrial cells engraftment and slow growing lesions without sufficient estrogen supply might limit the establishment of endometrium-like lesions. Further testings are needed.

Wider implications of the findings: Establishment of animal models for endometrioma is vital important to investigate the pathophysiology, underlying mechanism and potential therapy targets for endometriosis-related infertility. Currently such model is still lacking. An appropriate, adequate and effective but less detrimental model of endometrioma can accelerate the scientific research and clinical application in near future.

Trial registration number

N/A

Bifidobacteria-mediated immune system imprinting early in life

Immune-microbe interactions early in life influence the risk of allergies, asthma, and other inflammatory diseases. Breastfeeding guides healthier immune-microbe relationships by providing nutrients to specialized microbes that in turn benefit the host's immune system. Such bacteria have co-evolved with humans but are now increasingly rare in modern societies. Here we show that a lack of bifidobacteria, and in particular depletion of genes required for human milk oligosaccharide (HMO) utilization from the metagenome, is associated with systemic inflammation and immune dysregulation early in life. In breastfed infants given Bifidobacterium infantis EVC001, which expresses all HMO-utilization genes, intestinal T helper 2 (Th2) and Th17 cytokines were silenced and interferon β (IFNβ) was induced. Fecal water from EVC001-supplemented infants contains abundant indolelactate and B. infantis-derived indole-3-lactic acid (ILA) upregulated immunoregulatory galectin-1 in Th2 and Th17 cells during polarization, providing a functional link between beneficial microbes and immunoregulation during the first months of life.

[Amiodarone promotes heat-induced apoptosis, inflammation and oxidative stress in mouse HL1 atrial myocytes]

OBJECTIVE

To investigate the injury types of atrial myocytes induced by heat exposure and the effect of amiodarone on heat-induced injuries in atrial myocytes.

OBJECTIVE

The optimal temperature for heat exposure and optimal concentration of amiodarone were determined by measuring the cell viability exposed to different temperatures and different concentrations of amiodarone. Heat exposure of HL1 atrial myocytes was conducted using a water bath, and the effect of amiodarone on cell viability was assessed with MTS method; cell apoptosis was detected using flow cytometry, and the levels of IL-1β, IL-6, TNF-α, SOD and MDA were detected with enzyme-linked immunosorbent assay (ELISA).

OBJECTIVE

Compared with the blank control cells, the cells exposed to a temperature of 52 ℃ showed a significantly decreased survival rate and a lowered SOD activity (P < 0.001) with increased IL-1β and MDA levels (P < 0.01) and markedly increased apoptosis rate and IL-6 level (P < 0.001). Compared with the heat exposure group, amiodarone resulted in significantly decreased survival rate of the atrial myocytes (P < 0.01), obviously decreased SOD activity (P < 0.05), and increased cell apoptosis rate (P < 0.05) and IL-1β, IL-6, MDA and TNF-α levels (P < 0.01 or 0.001).

OBJECTIVE

Heat exposure induces apoptosis, inflammation and oxidative stress in mouse HL1 atrial myocytes, and amiodarone can enhance the effects of heat exposure to aggravate the cell injuries.

Peripheral blood T-cell receptor repertoire as a predictor of clinical outcomes in gastrointestinal cancer patients treated with PD-1 inhibitor

BACKGROUND

Identifying valid biomarkers for patient selection impressively promotes the success of anti-PD-1 therapy. However, the unmet need for biomarkers in gastrointestinal (GI) cancers remains significant. We aimed to explore the predictive value of the circulating T-cell receptor (TCR) repertoire for clinical outcomes in GI cancers who received anti-PD-1 therapy.

METHODS

137 pre- and 79 post-treated peripheral blood samples were included. The TCR repertoire was evaluated by sequencing of complementarity-determining region 3 (CDR3) in the TRB gene. The Shannon index was used to measure the diversity of the TCR repertoire, and Morisita's overlap index was used to determine TCR repertoire similarities between pre- and post-treated samples.

RESULTS

Among all enrolled patients, 76 received anti-PD-1 monotherapy and 61 received anti-PD-1 combination therapy. In the anti-PD-1 monotherapy cohort, patients with higher baseline TCR diversity exhibited a significantly higher disease control rate (77.8% vs. 47.2%; hazard ratio [HR] 3.92; 95% confidence interval [CI] 1.14-13.48; P = 0.030) and a longer progression-free survival (PFS) (median: 6.47 months vs. 2.77 months; HR 2.10; 95% CI 1.16-3.79; P = 0.014) and overall survival (OS) (median: NA vs. 8.97 months; HR 3.53; 95% CI 1.49-8.38; P = 0.004) than those with lower diversity. Moreover, patients with a higher TCR repertoire similarity still showed a superior PFS (4.43 months vs. 1.84 months; HR 13.98; 95% CI 4.37-44.68; P < 0.001) and OS (13.40 months vs. 6.12 months; HR 2.93; 95% CI 1.22-7.03; P = 0.016) even in the cohort with lower baseline diversity. However, neither biomarker showed predictive value in the anti-PD-1 combination therapy cohort. Interestingly, the combination of TCR diversity and PD-L1 expression can facilitate patient stratification in a pooled cohort.

CONCLUSION

The circulating TCR repertoire can serve as a predictor of clinical outcomes in anti-PD-1 therapy in GI cancers.

High-resolution MRI of the vessel wall helps to distinguish moyamoya disease from atherosclerotic moyamoya syndrome

AIM

To evaluate the value of high-resolution magnetic resonance imaging of the vessel wall (VWI) for differentiating moyamoya disease (MMD) from atherosclerotic moyamoya syndrome (AS-MMS).

MATERIALS AND METHODS

Twenty-one patients with MMD or AS-MMS were assessed retrospectively by two independent raters regarding and magnetic resonance angiography (MRA) stage grading score; collateral development in the lateral fissure and basal ganglia on MRA; and pattern of the thickening of the arterial wall; presence, degree, and pattern of enhancement; presence and distribution of deep tiny flow voids (DTFVs) and collateral development in the lateral fissure and basal ganglia on VWI. After univariate analysis between the two groups, logistic regression models based on imaging findings of MRA or VWI were implemented respectively, and receiver operating characteristic (ROC) curves were generated to compare the discriminatory power of the two imaging methods for diagnosis of MMD. Interrater agreement was analysed using an unweighted Cohen's κ or interclass correlation coefficient (ICC).

RESULTS

MMD manifested as more concentric thickening, more homogeneous enhancement, higher presence of DTFV, smaller outer-wall boundary area of stenosis or occlusion, and smaller remodelling index on VWI. After Bonferroni-Holm correction for multiple comparisons, for AS-MMS, collaterals in both the lateral fissure and basal ganglia were not usually present on either MRA or VWI. The diagnostic performance of the multivariate logistic regression model based on VWI with an accuracy of 87.1% for classification was higher than MRA. Interrater agreement was moderate or substantial for all the imaging findings.

CONCLUSIONS

VWI might be a useful and feasible method for differentiating MMD from AS-MMS and a prospective tool for guiding first-line treatment.

Spatial and temporal organization of jejunal microbiota in goats during animal development process

AIMS

This research aimed to investigate the temporal bacterial colonization relating to non-rumination, transition and rumination phases, together with the spatial organization of microbial community in the jejunal mucosa and digesta of goats.

METHODS AND RESULTS

This study explored the colonization programme of the jejunal microbiota by employing 16S rRNA amplicon sequencing. The colonization pattern of jejunal bacterial community exhibited an age- and gut region-dependent progression during animal development process. Approximately 268 bacterial signatures contributed to the discrimination between gut regions, with Lactobacillus, Ruminococcus, Eubacterium and Clostridium_sensu_stricto were enriched in the jejunal digesta, and Bacteroides and unclassified bacteria were enriched in the jejunal mucosa. Intriguingly, a shift from Lactobacillus to Butyrivibrio, Eubacterium and Ruminococcus after d 20 was observed for jejunal digesta. In mucosa, Bifidobacterium, Corynebacterium, Faecalibacterium and Roseburia increased with age (P < 0·05) while Arcobacter, Bacteroides and Porphyromonas peaked at d 10.

CONCLUSIONS

The jejunal bacterial community was settled after solid starter provision, which may mark the potential boundary of a timeframe for intervention in goats. The spatial heterogeneity highlighted the complicacy of ecological niches during manipulation of gut microbiota.

SIGNIFICANCE AND IMPACT OF THE STUDY

The present study extended the understanding of microbial programming and niche specific in the jejunum among different life stages and the basal cognition of persistent enhancement of nutrient utilization and decline of enteric diseases in ruminants.

[Clinical application of the gasless unilateral axillary approach in endoscopic thyroid surgery]

Objective: To investigate the efficacy, safety and advantages of gasless unilateral axillary approach (GUAA) in endoscopic thyroid surgery. Methods: A total of 334 patients who underwent the GUAA endoscopic thyroid surgery (GUAA group) or conventional open thyroid surgery (OS group) in the Department of Head and Neck Surgery of Zhejiang Cancer Hospital from January 2017 to June 2018 were retrospectively analyzed. There were 45 males and 289 females, aged from 12 to 72 years old, of whom 139 patients were assigned to GUAA group and 195 patients to OS group. Pathological results included papillary thyroid carcinoma (282 cases), nodular goiter (41 cases) and thyroid adenoma (11 cases). Surgical exploration development curve of GUAA group was drawn and was divided into two parts: the technical exploration stage and the technical stable stage. Surgical efficiency, incidences of complications, and incision satisfaction were compared between GUAA group in technical stable stage and OS group. SPSS 25.0 software was adopted for statistical analysis. Results: The mean age in GUAA group was younger than that in OS group, with a significant difference [(35.3±9.5) years vs. (48.1±10.6) years, t=11.31, P<0.01]. The cases in the endoscope group were divided into technical exploration stage for 51 cases and technical stable stage for 88 cases according to the exploration and development curve. In unilateral radical thyroidectomy and unilateral thyroid lobectomy, the mean operation time [(90.6±18.6) min and (93.5±22.0) min] and postoperative drainage volumes [(121.5±87.6) ml and (155.5±69.1) ml] of GUAA group in the stable stage were more than those of OS group [(61.6±15.6) min and (46.5±8.4) min] and [(93.2±42.3) ml and (78.9±48.7) ml]. The difference was statistically significant (t=12.28, 7.23, 3.35 and 3.05 respectively, all P<0.05), but there were no significant differences in surgical bleeding volumes between two groups [(12.7±6.8) ml vs. (13.5±7.7) ml, t=0.74, P>0.05 and (16.3±14.1) ml vs. (11.9±5.1) ml, t=1.05, P>0.05]. Compared with OS group, GUAA group had the lower incidence of anterior cervical discomfort during swallowing (2.3% vs. 29.2%, P<0.01) and the higher incision satisfaction score (1.1±0.5 vs. 2.8±0.7, t=21.12, P<0.01), however, GUAA group had the higher incidence of supraclavicular (or infraclavicular) numbness after surgery (5.7% vs. 0, P<0.01). And there was no significant difference in the incidences of temporary recurrent laryngeal nerve injury, bleeding, hematoma, infection, lymphatic leakage or chylous leakage after surgery between two groups (P>0.05). Conclusion: GUAA endoscopic thyroid surgery is a safe method with high cosmetic satisfaction.

Grape-seed polyphenols inhibit AAA in mice via regulation of macrophage polarization

AIM

Abdominal aortic aneurysm (AAA) is characterized by macrophage polarization, and at present, no drug therapy is available. Although grape-seed polyphenols (GSP) showed an anti-AAA effect, the role of GSP in the phenotype shift in macrophages remains unknown.

METHOD

The main phenolic compounds in GSP were determined by LC-MS. Male C57BL/6 mice were divided into four equal groups, namely sham group, CaPO4 group, CaPO4+GSP low-dose group, and CaPO4+GSP high-dose group. GSP was administered intragastrically after CaPO4 application. Molecular expressions were histologically evaluated and analyzed by various staining assays and FACS.

RESULTS

GSP administration inhibited CaPO4-induced AAA formation, which correlated with a decrease in macrophage infiltration and retainment of vascular smooth muscle layer as compared to those in the CaPO4 group. FACS assay showed that the GSP administration dose-dependently decreased the CD54 expression (low-dose group: 11.4 ± 2.1 % and high-dose group: 4.8 ± 1.4 % vs 23.2 ± 3.6 %; p < 0.05 and p < 0.01, respectively) and increased the CD206 expression of F4/80-positive cells in GSP-administered groups as compared with that in CaPO4-injured aortas in the CaPO4 group (low-dose group: 22.4 ± 3.3 % and high-dose group: 26.7 ± 4.2 % vs 8.1 ± 1.3 %; p < 0.05 and p < 0.01, respectively).

CONCLUSIONS

GSP could be a pharmacologically potent agent in the treatment of AAA (Tab. 1, Fig. 3,Ref. 20). Text in PDF www.elis.sk Keywords: grape-seed polyphenols, abdominal aortic aneurysm, macrophage, inflammatory, polarization.

The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4-6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology. We apply systems-level analyses of blood immune cells, cytokines, and autoantibodies in healthy children, children with Kawasaki disease enrolled prior to COVID-19, children infected with SARS-CoV-2, and children presenting with MIS-C. We find that the inflammatory response in MIS-C differs from the cytokine storm of severe acute COVID-19, shares several features with Kawasaki disease, but also differs from this condition with respect to T cell subsets, interleukin (IL)-17A, and biomarkers associated with arterial damage. Finally, autoantibody profiling suggests multiple autoantibodies that could be involved in the pathogenesis of MIS-C.

Systems-Level Immunomonitoring from Acute to Recovery Phase of Severe COVID-19

Severe disease of SARS-CoV-2 is characterized by vigorous inflammatory responses in the lung, often with a sudden onset after 5–7 days of stable disease. Efforts to modulate this hyperinflammation and the associated acute respiratory distress syndrome rely on the unraveling of the immune cell interactions and cytokines that drive such responses. Given that every patient is captured at different stages of infection, longitudinal monitoring of the immune response is critical and systems-level analyses are required to capture cellular interactions. Here, we report on a systems-level blood immunomonitoring study of 37 adult patients diagnosed with COVID-19 and followed with up to 14 blood samples from acute to recovery phases of the disease. We describe an IFNγ-eosinophil axis activated before lung hyperinflammation and changes in cell-cell co-regulation during different stages of the disease. We also map an immune trajectory during recovery that is shared among patients with severe COVID-19.

Immunomonitoring from acute to recovery phase COVID-19

An IFNγ-eosinophil axis precedes lung hyperinflammation

Basophils modulate SARS-CoV-2 IgG responses

A shared trajectory of immunological recovery in COVID-19

[Predictive analysis of distant metastasis after primary treatment of papillary thyroid cancer in patients under 18 years old]

Objective: To investigate the distant metastasis after primary treatment of papillary thyroid cancer (PTC) in children and adolescents. Methods: A retrospective analysis of 180 cases (54 boys and 126 girls, with an age range of 6-18 years) with PTC treated at the Chinese Medical Academy Cancer Hospital and Zhejiang Cancer Hospital from January 1, 2001 to December 31, 2014 was performed. Patients' clinical and pathological data were collected. The follow-up results were statistically analyzed. The distant metastasis rate during the follow-up period was analyzed by the Kaplan-Meier method. Log-Rank test was used for univariate analysis and Cox regression model was established in multivariate analysis. Results: Twenty-four cases (13.3%) had distant metastases during following-up with a median of 92 months. The Log-Rank test showed that the younger age ≤15 years old (χ(2)=11.803, P=0.001), the larger tumor diameter >20 mm (χ(2)=5.776, P=0.016), multifocal (χ(2)=11.205, P=0.001), bilateral tumor distribution (χ(2)=19.804, P=0.001), invaded capsule (χ(2)=10.808, P=0.001), and bilateral lymph nodes metastasis (χ(2)=6.278, P=0.012) were risk factors for distant metastasis after initial treatment. The Cox regression analysis showed that age ≤15 years (hazard ratio [95% confidence interval]: 4.08[1.504-11.111], P=0.006) and bilateral tumor distribution (hazard ratio [95% confidence interval]: 4.77[1.903-11.966], P=0.001) were independent risk factors for distant metastasis after initial treatment. The risk factors for local recurrence and distant metastasis were similar, but the local recurrence could not be a significant predictor for distant metastasis. It was indicated that distant metastasis rate was lower in patients with total thyroidectomy in multifocal lesions groups (χ(2)=5.891, P=0.015). Conclusions: Age, tumor size, invaded capsule, bilateral lymph nodes metastasis, multifocal and bilateral lesions are factors for predicting distant metastasis after primary treatment of PTC in children and adolescents. Total thyroidectomy is recommended for patients with multifocal and bilateral lesions.

Expression and distribution of HIF-1α, HIF-2α, VEGF, VEGFR-2 and HIMF in the kidneys of Tibetan sheep, plain sheep and goat

BACKGROUND

The objective of this study was to detect the expression and distribution characteristics of five proteins (the hypoxia-inducible factor 1alpha [HIF-1a], HIF-2a, vascular endothelial growth factor [VEGF], VEGF-2 receptor [VEGFR-2] and hypoxia-induced mitogenic factor [HIMF]) in kidney of Tibetan sheep, plain sheep and goat. The results will provide the basic information for the comparative study of sheep breeds living at different altitudes.

MATERIALS AND METHODS

The kidney tissues were collected from healthy adult Tibetan sheep, plain sheep and goats and made into paraffin sections. Histological characteristics were assessed by haematoxylin and eosin staining. Expressions of HIF-1a, HIF-2a, VEGF, VEGFR-2 and HIMF proteins were measured by immunohistochemical staining.

RESULTS

Immunohistochemistry results showed that the positive expression signals of HIF-1a, HIF-2a, VEGF and VEGFR-2 were detected in epithelial cells of renal tubules and collecting tubules, renal corpuscles in the kidneys of the three sheep breeds. Positive expression signals of HIMF were detected in epithelial cells of proximal tubules and distal tubules in Tibetan sheep and epithelial cells of distal tubules in goat. Immunostaining intensity of HIF-1a, HIF-2a, VEGF and VEGFR-2 proteins in Tibetan sheep was significantly higher than that in both plain sheep and goat (p < 0.05). Immunostaining intensity of HIMF in Tibetan sheep was higher than goat (p < 0.05). Positive expression signals of HIMF were not detected in plain sheep.

CONCLUSIONS

The expression and distribution characteristics of HIF-1a, HIF-2a, VEGF, VEGFR-2 and HIMF in the studied kidney tissues suggested that these proteins may be related to the physiological regulation of Tibetan sheep kidney in hypoxia environment, and therefore might be important regulating proteins for Tibetan sheep to adapt to high altitude hypoxia environment.

Regularized calibrated estimation of propensity scores with model misspecification and high-dimensional data

Propensity scores are widely used with inverse probability weighting to estimate treatment effects in observational studies. We study calibrated estimation as an alternative to maximum likelihood estimation for fitting logistic propensity score models. We show that, with possible model misspecification, minimizing the expected calibration loss underlying the calibrated estimators involves reducing both the expected likelihood loss and a measure of relative errors between the limiting and true propensity scores, which governs the mean squared errors of inverse probability weighted estimators. Furthermore, we derive a regularized calibrated estimator by minimizing the calibration loss with a lasso penalty. We develop a Fisher scoring descent algorithm for computing the proposed estimator and provide a high-dimensional analysis of the resulting inverse probability weighted estimators, leveraging the control of relative errors of propensity scores for calibrated estimation. We present a simulation study and an empirical application to demonstrate the advantages of the proposed methods over maximum likelihood and its regularization. The methods are implemented in the R package RCAL.

Dynamic role of single-celled fungi in ruminal microbial ecology and activities

In ruminants, high fermentation capacity is necessary to develop more efficient ruminant production systems. Greater level of production depends on the ability of the microbial ecosystem to convert organic matter into precursors of milk and meat. This has led to increased interest by animal nutritionists, biochemists and microbiologists in evaluating different strategies to manipulate the rumen biota to improve animal performance, production efficiency and animal health. One of such strategies is the use of natural feed additives such as single-celled fungi yeast. The main objectives of using yeasts as natural additives in ruminant diets include; (i) to prevent rumen microflora disorders, (ii) to improve and sustain higher production of milk and meat, (iii) to reduce rumen acidosis and bloat which adversely affect animal health and performance, (iv) to decrease the risk of ruminant-associated human pathogens and (v) to reduce the excretion of nitrogenous-based compounds, carbon dioxide and methane. Yeast, a natural feed additive, has the potential to enhance feed degradation by increasing the concentration of volatile fatty acids during fermentation processes. In addition, microbial growth in the rumen is enhanced in the presence of yeast leading to the delivery of a greater amount of microbial protein to the duodenum and high nitrogen retention. Single-celled fungi yeast has demonstrated its ability to increase fibre digestibility and lower faecal output of organic matter due to improved digestion of organic matter, which subsequently improves animal productivity. Yeast also has the ability to alter the fermentation process in the rumen in a way that reduces methane formation. Furthermore, yeast inclusion in ruminant diets has been reported to decrease toxins absorption such as mycotoxins and promote epithelial cell integrity. This review article provides information on the impact of single-celled fungi yeast as a feed supplement on ruminal microbiota and its function to improve the health and productive longevity of ruminants.

Identification of downstream target genes regulated by CX43 in hepatocellular carcinoma

The aim of study was to identify the downstream target genes of CX43 by Human Transcriptome Array. Therefore, a gene microarray was generated which consists of CX43-overexpressed hepatocellular carcinoma (HCC) cells transfected with the constructed plasmid and negative controls to identify candidate genes. Integrated bioinformatic analysis was used to clarify biological functions of the identified genes, including Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, protein-protein interaction network, and survival analysis. The candidate genes were further validated by qRT-PCR in liver cancer tissues and CX43-silenced HCC cells. We have found the mRNA and protein levels of CX43 significantly upregulated in HCC cells transfected with CX43 constructed plasmid. We identified 928 differentially expressed genes including 394 upregulated and 534 downregulated genes, enriched in the cancer related functions and pathways by GO and KEGG pathway analysis. The protein-protein interaction network revealed 9 hub genes in this study. Statistical analysis indicated that upregulation of RALA and SRC was associated with poor prognosis in liver cancer. The differential expression of 2 candidate genes were further validated in HCC cells and tissues. In conclusion, protein-coding genes RALA and SRC could be target genes of CX43 and therapeutic targets for hepatocellular carcinoma.

Immunocyte Profiling Using Single-Cell Mass Cytometry Reveals EpCAM+ CD4+ T Cells Abnormal in Colon Cancer

Colon cancer (CC) is one of the leading causes of cancer related mortality. Research over past decades have profoundly enhanced our understanding of immunotherapy, a major clinical accomplishment, and its potential role toward treating CC. However, studies investigating the expression of these immune checkpoints, such as epithelial cell adhesion molecule (EpCAM), programmed death-1 (PD-1), and programmed death-ligand 1 (PD-L1), by peripheral blood mononuclear cells (PBMCs) is lacking. Here, high-dimensional mass cytometry (CyTOF) is used to investigate immune alterations and promising immunotherapeutic targets expression by PBMCs of CC patients. Results reveal that expression of EpCAM and PD-L1 on CD4⁺ T cells significantly increased in patients with CC, compared with age- and sex- matching healthy controls and patients with colonic polyps. These differences are also validated in an independent patient cohort using flow cytometry. Further analysis revealed that EpCAM⁺ CD4⁺ T cells are PD-L1⁺ CCR5⁺ CCR6⁺. Immunofluorescence staining results demonstrate that the increase of EpCAM⁺ CD4⁺ T cells is also observed in tumor tissues, rather than para-cancerous tissues. To ascertain the functional disorders of the identified cell subset, phosphorylated signaling protein levels are assessed using imaging mass cytometry. Increases in pp38 MAPK and pMAPKAPK2 are observable, indicating abnormal activation of pp38 MAPK-pMAPKAPK2 signaling pathway. Results in this study indicate that EpCAM⁺ CD4⁺ T cells may play a role in CC development. Detailed knowledge on the functionality of EpCAM⁺ CD4⁺ T cells is of high translational relevance.

[Correlation between the changes of innate lymphoid cells in peripheral blood of systemic lupus erythematosus and its clinical significance]

Objective: To explore the function and role of innate lymphoid cells in the pathogenesis of systemic lupus erythematosus (SLE) at different disease activity levels. Methods: From Nov 2017 to May 2018, 40 patients with SLE and 15 age-matched healthy non-immune-related diseases controls were enrolled from Anhui provincial hospital. According to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K, the patients were divided into active group (n=20) and remission group (n=20). The frequency of ILCs, B cells, CD4+T and CD8+T cells from peripheral blood mononuclear cells (PBMCs) was detected by flow cytometry. The subsets of ILCs in each group were compared with the subsets of B cells and T cell respectively. The levels of IL-4, IL-33 and IFN-γ in each group were tested by ELISA. Result: Compared with the control group, ILC1 percentage was significantly increased in SLE active group [(22.33%±2.52%) vs (14.56%±1.28%), P=0.018 1]; ILC2 percentage was decreased significantly in both remission group [(19.67%±1.83%) vs (42.48%±3.46%), P<0.000 1] and active group [(8.67%±0.83%) vs (19.67%±1.83%), P<0.000 1]; ILC3 percentage was decreased significantly in active group [(5.72%±1.08%) vs (14.35%±2.40%), P=0.001 3]. SLEDAI score was negatively correlated with the percentage of ILC2 (P=0.023 9) in all patients. The percentage of ILCs in the remission group (P=0.046 2) and activity group (P=0.003 7) were both increased significantly. Moreover, the percentage of ILC2 in active group was negatively correlated with CD4+T cells (P=0.030 8), and the serum IgG was negatively correlated with ILC2% in all patients (P=0.013 8). Compared with control group or remission group, the levels of IFN-γ (F=10.91, P=0.000 1) and IL-4 (F=6.046, P=0.004 7) in active group were remarkable higher. However, IL-33 was significantly reduced in active group (F=6.645, P=0.002 7). The percentage of ILC2 (r=0.154 3, P=0.028 8) and ILC3 (r=0.313 6, P=0.001 1) in all patients with SLE were positively correlated with the level of IL-4. Conclusion: The percentage of ILCs is related to disease activity, and ILCs play a "double-edged" role in the pathogenesis of SLE. Its function and mechanism are worth further exploration.

A Mass-Ratiometry-Based CD45 Barcoding Method for Mass Cytometry Detection

Mass cytometry (CyTOF) is a critical cell profiling tool in acquiring multiparameter proteome data at the single-cell level. A major challenge in CyTOF analysis is sample-to-sample variance arising from the pipetting process, staining variation, and instrument sensitivity. To reduce such variations, cell barcoding strategies that enable the combination of individual samples prior to antibody staining and data acquisition on CyTOF are often utilized. The most prevalent barcoding strategy is based on a binary scheme that cross-examines the existence or nonexistence of certain mass signals; however, it is limited by low barcoding efficiency and high cost, especially for large sample size. Herein, we present a novel barcoding method for CyTOF application based on mass ratiometry. Different mass tags with specific fixed ratios are used to label CD45 antibody to achieve sample barcoding. The presented method exponentially increases the number of possible barcoded samples with the same amount of mass tags compared with conventional methods. It also reduces the overall time for the labeling process to 40 min and avoids the need for expensive commercial barcoding buffer reagents. Moreover, unlike the conventional barcoding process, this strategy does not pre-permeabilize cells before the barcoding procedure, which offers additional benefits in preserving surface biomarker signals.

Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings

BACKGROUND AND PURPOSE

Previous studies have shown perfusion abnormalities in the thalamus and upper brain stem in patients with epilepsy with impaired consciousness. We hypothesized that these areas associated with consciousness will also show metabolic abnormalities. However, metabolic abnormalities in those areas correlated with consciousness has not been characterized with multiple-voxel ¹H-MRS. In this study, we investigated the metabolic alterations in these brain regions and assessed the correlation between seizure features and metabolic alterations.

MATERIALS AND METHODS

Fifty-seven patients with epilepsy and 24 control subjects underwent routine MR imaging and 3D multiple-voxel ¹H-MRS. Patients were divided into 3 subgroups: focal impaired awareness seizures (n = 18), primary generalized tonic-clonic seizures (n = 19), and secondary generalized tonic-clonic seizures (n = 20). The measured metabolite alterations in NAA/Cr, NAA/(Cr + Cho), and Cho/Cr ratios in brain regions associated with the consciousness network were compared between the patient and control groups. ROIs were placed in the bilateral inferior frontal gyrus, supramarginal gyrus, cingulate gyrus, precuneus, thalamus, and upper brain stem. Correlations between clinical parameters (epilepsy duration and seizure frequency) and metabolite alterations were analyzed.

RESULTS

Significantly lower NAA/Cr and NAA/(Cho + Cr) ratios (P < .05 and < .01, respectively) were observed in the bilateral thalamus and upper brain stem in all experimental groups, and significantly high Cho/Cr ratios (P < .05) were observed in the right thalamus in the focal impaired awareness seizures group. There were no significant differences in metabolite ratios among the 3 patient groups (P > .05). The secondary generalized tonic-clonic seizures group showed a negative correlation between the duration of epilepsy and the NAA/(Cr + Cho) ratio in the bilateral thalamus (P < .05).

CONCLUSIONS

Metabolic alterations were observed in the brain stem and thalamus in patients with epilepsy with impaired consciousness.

A Successful Case of Liver Transplantation in an Adult With Congenital Hepatic Arteriovenous Fistulae Associated Cardiac Dilatation and Heart Failure

Congenital hepatic arteriovenous fistulae (CHAVF) are direct communications between the hepatic artery and portal vein or hepatic vein. Clinical symptoms of CHAVF depend mainly on the location, duration, and blood flow volume of the fistulae, which are manifested by portal hypertension, hepatic fibrosis, cardiac enlargement, and eventually heart failure. Here we report a female patient aged 54 who was first admitted to our hospital due to recurrent chest tightness and palpitations in March 2014. Metoprolol tartrate and diltiazem hydrochloride were prescribed to control the symptom since nothing unusual was found in coronary angiography and abdominal ultrasound. Until April 2015, the patient's syndrome relapsed and abdominal computed tomography angiography and digital subtraction angiography revealed diffuse arteriovenous fistulae between the branches of hepatic artery and vein. Subsequently, 3 attempts at hepatic arterial embolization were performed; however, her abdominal pain aggravated and her heart discomfort could not be relieved eventually. Therefore, orthotopic liver transplantation as the salvage treatment was performed using a hepatic graft from a 19-year-old cardiac-death donor performed on January 1, 2017. Upon operation, the enlarged right hepatic artery whose diameter was approximately 1.5 cm in this recipient. And we also demonstrated a novel manner that the graft's celiac artery patch was anastomosed to the recipient's proper hepatic artery and gastroduodenal artery patch, which could reduce the blood flow successfully. The patient recovered uneventfully and was discharged home on the postoperatively 15th day. Since her liver transplantation, she has not complained of cardiac discomfort and abdominal pain, and her heart size has returned to normal on echocardiography. The hepatic artery peak velocity reduced to normal and the heart shadow also recovered. Nevertheless, for complex and diffuse intrahepatic vascular fistulae after failed hepatic artery embolization, liver transplantation should be strongly considered as the definitive treatment of choice.

[Clinical characteristics and outcomes of patients with lung cancer, gastrointestinal cancer and urologic cancer with venous thromboembolism]

Objective: To compare the clinical characteristics and outcomes of patients with lung cancer, gastrointestinal (GI) cancer and urologic cancer with venous thromboembolism (VTE). Methods: From January 2003 to January 2013, 192 lung cancer, GI cancer and urologic cancer patients with VTE were retrospectively evaluated for the clinical characteristics and outcomes. Results: Among 192 patients, 82 cases of lung cancer, 78 cases of GI cancer, 32 cases of urologic cancer were involved. The Eastern Cooperative oncology Group Performance Status score of GI cancer group was significantly higher than those of the lung cancer and urologic cancer groups[(2.4±1.1) vs (2.0±1.4), (1.8±1.0), both P<0.05]. The proportion of smoking patients in lung cancer group was significantly higher than that in GI cancer and urologic cancer groups (79.3% vs 30.8%, 53.1%, both P<0.05), while the proportion of operation was significantly lower than that in the latter two groups (35.4% vs 53.8%, 68.8%, both P<0.05). Pathological types of cancer were mostly adenocarcinoma, and the proportion of adenocarcinoma in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (76.9%, 73.8% vs 37.9%, both P<0.001). The proportion of moderately and/or poorly differentiated histodifferentiation in the first two groups was significantly higher than that of urologic cancer group (90.0%, 95.7% vs 40.0%, both P<0.001). The proportion of patients with TNM stage Ⅲ-Ⅳ in lung cancer group was significantly higher than that of the urological cancer group (87.0% vs 64.3%, P<0.05). The incidence of VTE in lung cancer group was significantly higher than those of GI cancer and urologic cancer groups within 6 months after tumor diagnosis, chemotherapy and operation (79.3% vs 60.3%, 46.9%; 76.5% vs 48.6%, 36.4%; 92.3% vs 57.9%, 59.1%; all P<0.05). The case fatality rate within one year in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (51.2%, 52.6% vs 18.8%, both P<0.01). The median survival time of the lung cancer and GI cancer groups was significantly shorter than that of the urological cancer group (P=0.001, 0.010, respectively). Conclusions: Adenocarcinoma, advanced cancer, and poor histodifferentiation are risk factors of VTE in cancer patients. Most events of VTE occur within 6 months after a diagnosis of cancer. The prognosis of lung cancer and GI cancer complicated with VTE is worse than that of urologic cancer with VTE.