Long-Term Intake of Proton-Pump Inhibitors Could Be Associated with an Increased Incidence of Liver Cancer in Women

BACKGROUND

Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs in gastroenterology. Although PPIs are mostly well tolerated, long-term PPI intake has been linked with diabetes mellitus, osteoporosis and infectious disease. In the present study, we evaluated a potential association between PPI intake and a subsequent diagnosis of liver cancer in a large real-world cohort of outpatients in Germany.

METHODS

A total of 1766 patients with liver cancer, as well as 8830 propensity-score-matched controls, were identified from the Disease Analyzer database (IQVIA). The outcome of the study was the association between PPI use and a subsequent diagnosis of liver cancer, which was evaluated using multivariable logistic regression analyses.

RESULTS

Overall, 42.9% of the liver cancer patients and 39.0% of the controls received at least one PPI prescription before the index date. PPI prescriptions at any time before the index date were associated with an increased risk of subsequent liver cancer (OR: 1.18; 95% CI: 1.06-1.31). The positive association was observed in all age groups, as well as in women and men, but only in women (OR: 1.30; 95% 1.09-1.55) did it reach the predefined level of significance (p < 0.01). When considering the duration of PPI therapy, only PPI therapy for at least two years was significantly associated with an increased risk of liver cancer (OR: 1.28; 95% 1.09-1.50). In an analysis stratified by age and sex, this association was strongest in the age group < 60 years (OR: 1.99; 95% 1.21-3.26).

CONCLUSIONS

Our data suggest that long-term PPI intake in women as well as in patients < 60 years might be associated with an increased risk of liver cancer. These findings support current efforts to reduce the inappropriate use of PPIs in routine clinical practice and to link PPI prescribing to a clear medical indication.

Harnessing the supremacy of MEG3 LncRNA to defeat gastrointestinal malignancies

Evidence suggests that long non-coding RNAs (lncRNAs) play a pivotal role in the carcinogenesis and progression of various human malignancies including gastrointestinal malignancies. This comprehensive review reports the functions and mechanisms of the lncRNA maternally expressed gene 3 (MEG3) involved in gastrointestinal malignancies. It summarizes its roles in mediating the regulation of cellular proliferation, apoptosis, migration, invasiveness, epithelial-to-mesenchymal transition, and drug resistance in several gastrointestinal cancers such as colorectal cancer, gall bladder cancer, pancreatic cancer, gastric cancer, esophageal cancer, cholangiocarcinoma, gastrointestinal stromal tumors and most importantly, hepatocellular carcinoma. In addition, the authors briefly highlight its implicated mechanistic role and interactions with different non-coding RNAs and oncogenic signaling cascades. This review presents the rationale for developing non coding RNA-based anticancer therapy via harnessing the power of MEG3 in gastrointestinal malignancies.

Transplant oncology - Current indications and strategies to advance the field

Liver transplantation (LT) was originally described by Starzl as a promising strategy to treat primary malignancies of the liver. Confronted with high recurrence rates, indications drifted towards non-oncologic liver diseases with LT finally evolving from a high-risk surgery to an almost routine surgical procedure. Continuously improving outcomes following LT and evolving oncological treatment strategies have driven renewed interest in transplant oncology. This is not only reflected by constant refinements to the criteria for LT in patients with HCC, but especially by efforts to expand indications to other primary and secondary liver malignancies. With new patient-centred oncological treatments on the rise and new technologies to expand the donor pool, the field has the chance to come full circle. In this review, we focus on the concept of transplant oncology, current indications, as well as technical and ethical aspects in the context of donor organs as precious resources.

Recent Updates on the Therapeutic Prospects of Reversion-Inducing Cysteine-Rich Protein with Kazal Motifs (RECK) in Liver Injuries

The reversion-inducing cysteine-rich protein with Kazal motifs (RECK), a membrane-anchored glycoprotein, negatively regulates various membrane proteins involved in the tissue governing extracellular matrix (ECM) remodeling such as metalloproteases (MMPs) and the sheddases ADAM10 and ADAM17. The significance of the present review is to summarize the current understanding of the pathophysiological role of RECK, a newly discovered signaling pathway associated with different liver injuries. Specifically, this review analyzes published data on the downregulation of RECK expression in hepatic ischemia/reperfusion (I/R) injury, liver-related cancers, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), as well as in the progression of nonalcoholic fatty liver disease (NAFLD) to non-alcoholic steatohepatitis (NASH). In addition, this review discusses the regulation of RECK by inducers, such as FXR agonists. The RECK protein has also been suggested as a potential diagnostic and prognostic marker for liver injury or as a biomarker with predictive value for drug treatment efficacy.

Atezolizumab and bevacizumab for non-resectable or metastatic combined hepatocellular-cholangiocarcinoma: A multicentric retrospective study

BACKGROUNDS

The efficacy of atezolizumab/bevacizumab has never been reported in patients with metastatic/unresectable combined hepatocellular-cholangiocarcinoma (cHCC-CCA).

PATIENTS AND METHODS

We retrospectively included patients with a histological diagnosis of unresectable/metastatic cHCC-CCA and treated with atezolizumab/bevacizumab (2020-2022) in 7 centers. Clinical and radiological features were collected at the beginning of atezolizumab/bevacizumab. We reported the radiological response using RECIST criteria, overall survival (OS) and progression-free survival (PFS).

RESULTS

Sixteen patients with cHCC-CCA were included and were predominantly male (75%) with advanced fibrosis/cirrhosis (69%). Nine patients received atezolizumab/bevacizumab as a first-line systemic treatment, 5 as a second line, 1 as a third line and 1 as a fifth line. Severe digestive bleeding occurred in 2 patients. Among the 9 patients treated in the first line, 4 experienced radiological progression, 3 partial response and 1 had stable disease. Patients treated with atezolizumab/bevacizumab in the first line had a median OS of 13 months and a median PFS of 3 months. Among the 7 patients receiving atezolizumab/bevacizumab as a second line or more, 4 patients harbored a stable disease, 2 a partial response, and 1 a progressive disease.

CONCLUSIONS

The combination of atezolizumab and bevacizumab showed signs of anti-tumor efficacy in patients with unresectable/metastatic cHCC-CCA.

Putative Local Adaptive SNPs in the Genus Avicennia

The genus Avicennia with eight species grow in intertidal zones of tropical and temperate regions, ranging in distribution from West Asia, to Australia, and Latin America. These mangroves have several medicinal applications for mankind. Many genetic and phylogenetic studies have been carried out on mangroves, but none is concerned with geographical adaptation of SNPs. We therefore, used ITS sequences of about 120 Avicennia taxa growing in different parts of the world and undertook computational analyses to identify discriminating SNPs among these species and to study their association with geographical variables. A combination of multivariate and Bayesian approaches such as CCA, RDA, and LFMM were conducted to identify the SNPs with potential adaptation to geographical and ecological variables. Manhattan plot revealed that many of these SNPs are significantly associated with these variables. The genetic changes accompanied by local and geographical adaptation were illustrated by skyline plot. These genetic changes occurred not under a molecular clock model of evolution and probably under a positive selection pressure imposed in different geographical regions in which these plants grow.

Culturable bacterial flora of juveniles of Pelophylax ridibundus (Pallas, 1771) and influence of abiotic factors on diversity

This study aims to determine the bacterial flora on the skin surface of the juvenile forms of Pelophylax ridibundus inhabiting three different altitudes and examine potential correlations between bacterial diversity, ecological location, and factors. It was attempted to characterize thirty-two bacteria isolated from the Melet River, Sülük Lake, and Çambaşı Pond through combined biochemical and molecular methods. Canonical correspondence analysis showed that the most important ecological factors for microorganisms to settle on frog skin were determined as water conductivity and dissolved oxygen amount. The most frequently isolated bacteria belonged to the genera Erwinia and Pseudomonas. Altitude positively affected Exiguobacterium. This first report of skin cultivable bacteria from P. ridibundus juvenile forms natural population improves our knowledge of amphibian skin bacterial flora. This study contributes to a better understanding of their ecology and how this species has survived in an environment modulated by altitude.

IgG4-related cholangitis - a mimicker of fibrosing and malignant cholangiopathies

IgG4-related cholangitis (IRC) is the major hepatobiliary manifestation of IgG4-related disease (IgG4-RD), a systemic fibroinflammatory disorder. The pathogenesis of IgG4-RD and IRC is currently viewed as multifactorial, as there is evidence of a genetic predisposition while environmental factors, such as blue-collar work, are major risk factors. Various autoantigens have been described in IgG4-RD, including annexin A11 and laminin 511-E8, proteins which may exert a partially protective function in cholangiocytes by enhancing secretion and barrier function, respectively. For the other recently described autoantigens, galectin-3 and prohibitin 1, a distinct role in cholangiocytes appears less apparent. In relation to these autoantigens, oligoclonal expansions of IgG4+ plasmablasts are present in patients with IRC and disappear upon successful treatment. More recently, specific T-cell subtypes including regulatory T cells, follicular T helper 2 cells, peripheral T helper cells and cytotoxic CD8+ and CD4+ SLAMF7+ T cells have been implicated in the pathogenesis of IgG4-RD. The clinical presentation of IRC often mimics other biliary diseases such as primary sclerosing cholangitis or cholangiocarcinoma, which may lead to inappropriate medical and potentially invalidating surgical interventions. As specific biomarkers are lacking, diagnosis is made according to the HISORt criteria comprising histopathology, imaging, serology, other organ manifestations and response to therapy. Treatment of IRC aims to prevent or alleviate organ damage and to improve symptoms and consists of (i) remission induction, (ii) remission maintenance and (iii) long-term management. Glucocorticosteroids are highly effective for remission induction, after which immunomodulators can be introduced for maintenance of remission as glucocorticosteroid-sparing alternatives. Increased insight into the pathogenesis of IRC will lead to improved diagnosis and novel therapeutic strategies in the future.

METTL3 promotes choriocarcinoma progression by activating the miR-935/GJA1 pathway in an m6A-dependent manner

The emerging role of microRNA-935 (miR-935) in modulating cancer progression has been recognized. However, its role in regulating choriocarcinoma (CCA) development and progression remains unknown. The present work aims to reveal the effect of miR-935 on CCA cell tumor properties and the related mechanism. The RNA expression of methyltransferase 3, N6-adenosine-methyltransferase complex catalytic subunit (METTL3), miR-935, and gap junction protein alpha 1 (GJA1) was detected by quantitative real-time polymerase chain reaction. Protein expression of GJA1, Ki67, and METTL3 was measured by western blotting and immunohistochemistry assays. CCK-8 and colony formation were used to analyze cell proliferation. Transwell assays were performed to assess cell migration and invasion. Angiogenesis was investigated by tube formation assay. Xenograft mouse model assay was used to determine miR-935-mediated effect on tumor formation in vivo. The luciferase reporter assay and RNA pull-down assay were used to verify the relationship between miR-935 and GJA1. MeRIP assay was used to analyze the m6A methylation of pri-miR-935. MiR-935 expression was significantly upregulated in CCA tissues and cells when compared with control groups. MiR-935 overexpression promoted CCA cell proliferation, migration, invasion, and tube formation and tumor tumorigenesis in vitro and in vivo, but miR-935 knockdown showed the opposite effects. In addition, miR-935 targeted GJA1 and mediated CCA cell tumor properties by negatively regulating GJA1 expression. METTL3 promoted miR-935 maturation by inducing m6A methylation of pri-miR-935, and its overexpression contributed to CCA cell tumor properties through the regulation of miR-935. METTL3 promoted choriocarcinoma progression by m6A-dependently activating the miR-935/GJA1 pathway.

An Improved Canonical Correlation Analysis for EEG Inter-Band Correlation Extraction

(1) Background: Emotion recognition based on EEG signals is a rapidly growing and promising research field in affective computing. However, traditional methods have focused on single-channel features that reflect time-domain or frequency-domain information of the EEG, as well as bi-channel features that reveal channel-wise relationships across brain regions. Despite these efforts, the mechanism of mutual interactions between EEG rhythms under different emotional expressions remains largely unexplored. Currently, the primary form of information interaction between EEG rhythms is phase-amplitude coupling (PAC), which results in computational complexity and high computational cost. (2) Methods: To address this issue, we proposed a method of extracting inter-bands correlation (IBC) features via canonical correlation analysis (CCA) based on differential entropy (DE) features. This approach eliminates the need for surrogate testing and reduces computational complexity. (3) Results: Our experiments verified the effectiveness of IBC features through several tests, demonstrating that the more correlated features between EEG frequency bands contribute more to emotion classification accuracy. We then fused IBC features and traditional DE features at the decision level, which significantly improved the accuracy of emotion recognition on the SEED dataset and the local CUMULATE dataset compared to using a single feature alone. (4) Conclusions: These findings suggest that IBC features are a promising approach to promoting emotion recognition accuracy. By exploring the mutual interactions between EEG rhythms under different emotional expressions, our method can provide valuable insights into the underlying mechanisms of emotion processing and improve the performance of emotion recognition systems.

Late cervical and vaginal clear cell adenocarcinoma in women exposed in utero to diethylstilbestrol: Evaluation and screening

OBJECTIVES

We aimed to evaluate the risk of cervical and vaginal clear cell adenocarcinoma (CCA) in women, aged 50 years or more, exposed in utero to diethylstilbestrol (DES) and contribute to a reevaluation of the recommendations for cervical and vaginal cancer and pre-cancer screening for these women.

METHODS

We carried out a retrospective review for patients received in a cancer institute. Two cohorts were consecutively studied, the first from 1970 to 2003 and the second from 2004 to 2021, and then linked.

RESULTS

During the first period, we observed 61 CCA cases, with a mean age at diagnosis of 23 years (7-42), 36 (59%) following DES exposure in utero. During the second period, we found 27 cases, with one case of DES exposure (4%) for a women diagnosed at the age of 40 years. The mean age of the second cohort was 38 years (14-79). For the seven women aged 50 years or more at the time of CCA diagnosis, DES exposure was excluded for five and considered unlikely for the other two.

CONCLUSION

In total, 88 cases of cervical or vaginal CCA were observed over a period of 51 years in a cancer center. The 37 cases associated with DES exposure represented approximatively one third of the CCA related to DES expected in France. DES exposure was improbable for the seven cases of CCA for women aged 50 years or more. These results do not support the hypothesis of late cervical or vaginal CCA in women exposed to DES in utero and indicate the need for larger multicentric studies. For the present, we propose specific screening for women exposed to DES in utero in terms of : 1) methods: association of cytology and hrHPV testing, with cervical and vaginal sampling, 2) timing : annual, or without exceeding a three-year interval, continuing after 65 years of age and after hysterectomy.

Spectrum-Enhanced TRCA (SE-TRCA): A novel approach for direction detection in SSVEP-based BCI

The Steady State Visual Evoked Potential (SSVEP) is a widely used component in BCIs due to its high noise resistance and low equipment requirements. Recently, a novel SSVEP-based paradigm has been introduced for direction detection, in which, unlike the common SSVEP paradigms that use several frequency stimuli, only one flickering stimulus is used and it makes direction detection very challenging. So far, only the CCA method has been used for direction detection using SSVEP component analysis. Since Canonical Correlation Analysis (CCA) has some limitations, a Task-Related Component Analysis (TRCA) based method has been introduced for feature extraction to improve the direction detection performance. Although these methods have been proven efficient, they do not utilize the latent frequency information in the EEG signal. Therefore, the performance of direction detection using SSVEP component analysis is still suboptimal. For further improvement, the TRCA-based algorithm is enhanced by incorporating frequency information and introducing Spectrum-Enhanced TRCA (SE-TRCA). SE-TRCA method can utilize frequency information in conjunction with spatial information by concatenating the EEG signal and its shifted version. Accordingly, the obtained spatio-spectral filters perform as a Finite Impulse Response (FIR) filter. To evaluate the proposed SE-TRCA method, two different sorts of datasets (1) a hybrid BCI dataset (including SSVEP component for direction detection) and (2) a pure benchmark SSVEP dataset (including SSVEP component for frequency detection) have been used. Our experiments showed that the accuracy of direction detection using the proposed SE-TRCA and TRCA approaches compared to CCA-based approach have been increased by 23.35% and 28.24%, respectively. Furthermore, the accuracy of character recognition obtained from integrating P300 and SSVEP components in CCA, TRCA, and SETRCA approaches are 54.01%, 56.02%, and 58.56%, on the hybrid dataset, respectively. The evaluation of the SE-TRCA method on the benchmark SSVEP dataset demonstrates that the SE-TRCA method outperforms both CCA and TRCA, particularly regarding frequency detection accuracy. In this specific dataset, the SE-TRCA method achieved an impressive frequency detection accuracy of 98.19% for a 3-s signal, surpassing the accuracies of TRCA and CCA, which were 97.91% and 90.47%, respectively. These results demonstrated that the TRCA-based approach is more efficient than the CCA approach to extracting spatial filters. Moreover, SE-TRCA, extracting both Spectral and spatial information from the EEG signal, can capture more discriminative features from the SSVEP component and increase the accuracy of classification. The results of this study emphasize the effectiveness of the proposed SE-TRCA approach across different SSVEP paradigms and tasks. These findings provide strong evidence for the method's ability to generalize well in SSVEP analysis.

Infectious Agents Induce Wnt/β-Catenin Pathway Deregulation in Primary Liver Cancers

Interaction between infectious agents and liver tissue, as well as repeated and extreme biological events beyond adaptive capacities, may result in pathological conditions predisposing people to development of primary liver cancers (PLCs). In adults, PLCs mainly comprise hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). Various infectious agents in the hepatic microenvironment can destabilize normal liver cell functions by modulating the Wnt/β-catenin pathway components. Among them, hepatotropic viruses B, C, and D are involved in Wnt/β-catenin signaling dysregulation. Other microbial agents, including oncogenic viruses such as Epstein-Barr virus (EBV) and human papilloma virus (HPV), bacteria, e.g., Mycoplasma hyorhinis and Salmonella Typhi, the protozoan parasite Toxoplasma gondii, the fungus Aspergillus flavus, and liver flukes such as Clonorchissinensis or Opisthorchis viverrini, may induce malignant transformation in hepatocytes or in target cells of the biliary tract through aberrant Wnt signaling activation. This review focuses on new insights into infectious agents implicated in the deregulation of Wnt signaling and PLC development. Since the Wnt/β-catenin pathway is a driver of cancer following viral and bacterial infections, molecules inhibiting the complex axis of Wnt signaling could represent novel therapeutic approaches in PLC treatment.

An international multicentre evaluation of treatment strategies for combined hepatocellular-cholangiocarcinoma✰

Background & Aims

Management of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is not well-defined. Therefore, we evaluated the management of cHCC-CCA using an online hospital-wide multicentre survey sent to expert centres.

Methods

A survey was sent to members of the European Network for the Study of Cholangiocarcinoma (ENS-CCA) and the International Cholangiocarcinoma Research Network (ICRN), in July 2021. To capture the respondents' contemporary decision-making process, a hypothetical case study with different tumour size and number combinations was embedded.

Results

Of 155 surveys obtained, 87 (56%) were completed in full and included for analysis. Respondents represented Europe (68%), North America (20%), Asia (11%), and South America (1%) and included surgeons (46%), oncologists (29%), and hepatologists/gastroenterologists (25%). Two-thirds of the respondents included at least one new patient with cHCC-CCA per year. Liver resection was reported as the most likely treatment for a single cHCC-CCA lesion of 2.0-6.0 cm (range: 73-93%) and for two lesions, one up to 6 cm and a second well-defined lesion of 2.0 cm (range: 60-66%). Nonetheless, marked interdisciplinary differences were noted. Surgeons mainly adhered to resection if technically feasible, whereas up to half of the hepatologists/gastroenterologists and oncologists switched to alternative treatment options with increasing tumour burden. Fifty-one (59%) clinicians considered liver transplantation as an option for patients with cHCC-CCA, with the Milan criteria defining the upper limit of inclusion. Overall, well-defined cHCC-CCA treatment policies were lacking and management was most often dependent on local expertise.

Conclusions

Liver resection is considered the first-line treatment of cHCC-CCA, with many clinicians supporting liver transplantation within limits. Marked interdisciplinary differences were reported, depending on local expertise. These findings stress the need for a well-defined multicentre prospective trial comparing treatments, including liver transplantation, to optimise the therapeutic management of cHCC-CCA.

Impact and implications

Because the treatment of combined hepatocellular-cholangiocarcinoma (cHCC-CCA), a rare form of liver cancer, is currently not well-defined, we evaluated the contemporary treatment of this rare tumour type through an online survey sent to expert centres around the world. Based on the responses from 87 clinicians (46% surgeons, 29% oncologists, 25% hepatologists/gastroenterologists), representing four continents and 25 different countries, we found that liver resection is considered the first-line treatment of cHCC-CCA, with many clinicians supporting liver transplantation within limits. Nonetheless, marked differences in treatment decisions were reported among the different specialties (surgeon vs. oncologist vs. hepatologist/gastroenterologist), highlighting the urgent need for a standardisation of therapeutic strategies for patients with cHCC-CCA.

Calcyclin-binding protein contributes to cholangiocarcinoma progression by inhibiting ubiquitination of MCM2

Background

Cholangiocarcinoma (CCA) represents the epithelial cell cancer with high aggressiveness whose five-year survival rate is poor with standard treatment. Calcyclin-binding protein (CACYBP) shows aberrant expression within several malignant tumors, but the role of CACYBP in CCA remains unknown.

Methods

Immunohistochemical (IHC) analysis was used to identify CACYBP overexpression in clinical samples of CCA patients. Moreover, its correlation with clinical outcome was revealed. Furthermore, CACYBP's effect on CCA cell growth and invasion was investigated in vitro and in vivo using loss-of-function experiments.

Results

CACYBP showed up-regulation in CCA, which predicts the dismal prognostic outcome. CACYBP had an important effect on in-vitro and in-vivo cancer cell proliferation and migration. Additionally, knockdown of CACYBP weakened protein stability by promoting ubiquitination of MCM2. Accordingly, MCM2 up-regulation partly reversed CACYBP deficiency's inhibition against cancer cell viability and invasion. Thus, MCM2 might drive CCA development by Wnt/β-catenin pathway.

Conclusions

CACYBP exerted a tumor-promoting role in CCA by suppressing ubiquitination of MCM2 and activating Wnt/β-catenin pathway, hence revealing that it may be the possible therapeutic target for CCA treatment.

Impact of Aberrant β-Catenin Pathway on Cholangiocarcinoma Heterogeneity

The poor prognosis of most cases of advanced cholangiocarcinoma (CCA) constitutes a severe problem in modern oncology, which is aggravated by the fact that the incidence of this liver cancer is increasing worldwide and is often diagnosed late, when surgical removal is not feasible. The difficulty of dealing with this deadly tumor is augmented by the heterogeneity of CCA subtypes and the complexity of mechanisms involved in enhanced proliferation, apoptosis avoidance, chemoresistance, invasiveness, and metastasis that characterize CCA. Among the regulatory processes implicated in developing these malignant traits, the Wnt/β-catenin pathway plays a pivotal role. Alteration of β-catenin expression and subcellular localization has been associated with worse outcomes in some CCA subtypes. This heterogeneity, which also affects cellular and in vivo models commonly used to study CCA biology and anticancer drug development, must be taken into account for CCA investigation to more accurately extrapolate basic laboratory research to the clinical situation. A better understanding of the altered Wnt/β-catenin pathway in relationship with the heterogeneous forms of CCA is mandatory for developing novel diagnostic tools and therapeutic strategies for patients suffering from this lethal disease.

Feasibility study of combining wall shear stress and elastography to assess the vascular status of carotid artery

INTRODUCTION

At present, early detection of the potential risk of atherosclerosis and prevention is of great significance to reduce the occurrence of stroke.

AIM

This study aims to explore the value of combining the wall shear stress measured by ultrasound vector flow imaging technique and sound touch elastography of common carotid artery in normal adults using the Mindray Resona 7 ultrasound system.

METHODS

Forty volunteers (mean age 39.5 y, 23 females, 17 males) were divided into four groups according to their age. All volunteers underwent ultrasound carotid artery examination, and the values of wall shear stress and elasticity on the posterior wall of the common carotid artery were measured using advanced imaging functions, vector flow imaging technique, and sound touch elastography.

RESULTS

Different cut-off values of wall shear stress were used to investigate the significance between two groups with corresponding sound touch elastography values. It can be seen that the statistical difference could be found when the mean wall shear stress was larger than 1.5 Pa approximately (statistical significance was defined when P < 0.05), and the sound touch elastography value was positively correlated with the wall shear stress value.

CONCLUSION

This study reveals that the combination of wall shear stress and sound touch elastography is an effective and feasible method for assessing carotid artery health. When the mean wall shear stress value is over 1.5 Pa, the corresponding sound touch elastography value increases significantly. The risk of atherosclerosis increases with the stiffness of blood vessel walls.

Long Noncoding RNA H19: A Novel Oncogene in Liver Cancer

Liver cancer is the second leading cause of cancer-related death globally, with limited treatment options. Recent studies have demonstrated the critical role of long noncoding RNAs (lncRNAs) in the pathogenesis of liver cancers. Of note, mounting evidence has shown that lncRNA H19, an endogenous noncoding single-stranded RNA, functions as an oncogene in the development and progression of liver cancer, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), the two most prevalent primary liver tumors in adults. H19 can affect many critical biological processes, including the cell proliferation, apoptosis, invasion, and metastasis of liver cancer by its function on epigenetic modification, H19/miR-675 axis, miRNAs sponge, drug resistance, and its regulation of downstream pathways. In this review, we will focus on the most relevant molecular mechanisms of action and regulation of H19 in the development and pathophysiology of HCC and CCA. This review aims to provide valuable perspectives and translational applications of H19 as a potential diagnostic marker and therapeutic target for liver cancer disease.

Studies on phytoremediation of chromated copper arsenate (CCA) using Acacia plant species (Fabaceae)

Soils contaminated with elevated levels of toxic heavy metals affect the soil quality. Phytoremediation is one of the constructive methods used in the mitigation of toxic metals from the soil. A pot experiment was performed by application of eight different concentrations of CCA viz 250, 500, 750, 1,000, 1,250, 1,500, 2,000, and 2,500 mg kg-1 soil to evaluate the efficiency of Acacia mangium and Acacia auriculiformis in phytoremediation of CCA compounds. Results showed that the shoot and root length, height, collar diameter, and biomass of the seedlings were significantly reduced with increase in CCA concentrations. The roots of the seedlings accumulated 1.5- to 2.0-fold higher amounts of CCA than in stem and leaves. The amount of Cr, Cu, and As found in the roots of A. mangium and A. auriculiformis at 2,500 mg CCA were 10.01 and 10.13, 8.51 and 8.84 mg, and 0.18 and 0.33 mg g-1, respectively. Similarly, the amount of Cr, Cu, and As found in stem and leaves were 4.33 and 7.84, 3.51 and 6.62, and 0.10 and 0.11 mg g-1, respectively. The quantity of Cr, Cu, and As found in stem and leaves were 5.95 and 9.00, 4.86 and 7.18, and 0.09 and 0.14 mg g-1, respectively. Overall, the present study advocates potential use of A. mangium and A. auriculiformis in phytoremediation of Cr, Cu, and As contaminated soils.

High Level of Serum Coiled-coil Domain Containing 25 (CCDC25) as a Diagnostic Marker for Cholangiocarcinoma But Not for Other Cancers

BACKGROUND/AIM

Recently, we reported that coiled-coil domain containing 25 (CCDC25) protein is elevated in the sera of patients with cholangiocarcinoma (CCA) and is suggested to be a diagnostic biomarker for CCA. This study aimed to examine whether serum CCDC25 level can be a unique biomarker for CCA. Bioinformatic analyses using Human Protein Atlas (HPA) database and Gene Expression Profiling Interactive Analysis 2 (GEPIA2) indicated that CCDC25 protein and mRNA are expressed not only in CCA but also in other cancers, such as colorectal cancer (CRC), breast cancer (BC), and hepatocellular carcinoma (HCC), all of which are the top 5 cancers highly prevalent in Thailand.

MATERIALS AND METHODS

Using a quantitative dot blot assay, serum CCDC25 levels were measured for 30 healthy controls (HC), 34 CRC, 42 BC, 43 HCC, and 83 CCA.

RESULTS

The serum CCDC25 levels of CCA patients (0.193±0.039 ng/μl) were significantly higher than those of CRC (0.019±0.006 ng/μl), BC (0.036±0.015 ng/μl), HCC (0.035±0.016 ng/μl), and higher than those of HC (0.012±0.003 ng/μl). The serum CCDC25 level can discriminate CCA from the HC, CRC, BC, and HCC with a sensitivity of 100, 99, 94, and 94%, respectively, and specificity of 100, 100, 98, and 95%, respectively.

CONCLUSION

CCDC25 is a candidate diagnostic biomarker for CCA.

Efficient Low-Frequency SSVEP Detection with Wearable EEG Using Normalized Canonical Correlation Analysis

Recent studies show that the integrity of core perceptual and cognitive functions may be tested in a short time with Steady-State Visual Evoked Potentials (SSVEP) with low stimulation frequencies, between 1 and 10 Hz. Wearable EEG systems provide unique opportunities to test these brain functions on diverse populations in out-of-the-lab conditions. However, they also pose significant challenges as the number of EEG channels is typically limited, and the recording conditions might induce high noise levels, particularly for low frequencies. Here we tested the performance of Normalized Canonical Correlation Analysis (NCCA), a frequency-normalized version of CCA, to quantify SSVEP from wearable EEG data with stimulation frequencies ranging from 1 to 10 Hz. We validated NCCA on data collected with an 8-channel wearable wireless EEG system based on BioWolf, a compact, ultra-light, ultra-low-power recording platform. The results show that NCCA correctly and rapidly detects SSVEP at the stimulation frequency within a few cycles of stimulation, even at the lowest frequency (4 s recordings are sufficient for a stimulation frequency of 1 Hz), outperforming a state-of-the-art normalized power spectral measure. Importantly, no preliminary artifact correction or channel selection was required. Potential applications of these results to research and clinical studies are discussed.

FGFR Inhibitors in Cholangiocarcinoma-A Novel Yet Primary Approach: Where Do We Stand Now and Where to Head Next in Targeting This Axis?

Cholangiocarcinomas (CCAs) are rare but aggressive tumours with poor diagnosis and limited treatment options. Molecular targeted therapies became a promising proposal for patients after progression under first-line chemical treatment. In light of an escalating prevalence of CCA, it is crucial to fully comprehend its pathophysiology, aetiology, and possible targets in therapy. Such knowledge would play a pivotal role in searching for new therapeutic approaches concerning diseases' symptoms and their underlying causes. Growing evidence showed that fibroblast growth factor/fibroblast growth factor receptor (FGF/FGFR) pathway dysregulation is involved in a variety of processes during embryonic development and homeostasis as well as tumorigenesis. CCA is known for its close correlation with the FGF/FGFR pathway and targeting this axis has been proposed in treatment guidelines. Bearing in mind the significance of molecular targeted therapies in different neoplasms, it seems most reasonable to move towards intensive research and testing on these in the case of CCA. However, there is still a need for more data covering this topic. Although positive results of many pre-clinical and clinical studies are discussed in this review, many difficulties lie ahead. Furthermore, this review presents up-to-date literature regarding the outcomes of the latest clinical data and discussion over future directions of FGFR-directed therapies in patients with CCA.

Canonical Correlation Analysis and Partial Least Squares for Identifying Brain-Behavior Associations: A Tutorial and a Comparative Study

Canonical correlation analysis (CCA) and partial least squares (PLS) are powerful multivariate methods for capturing associations across 2 modalities of data (e.g., brain and behavior). However, when the sample size is similar to or smaller than the number of variables in the data, standard CCA and PLS models may overfit, i.e., find spurious associations that generalize poorly to new data. Dimensionality reduction and regularized extensions of CCA and PLS have been proposed to address this problem, yet most studies using these approaches have some limitations. This work gives a theoretical and practical introduction into the most common CCA/PLS models and their regularized variants. We examine the limitations of standard CCA and PLS when the sample size is similar to or smaller than the number of variables. We discuss how dimensionality reduction and regularization techniques address this problem and explain their main advantages and disadvantages. We highlight crucial aspects of the CCA/PLS analysis framework, including optimizing the hyperparameters of the model and testing the identified associations for statistical significance. We apply the described CCA/PLS models to simulated data and real data from the Human Connectome Project and Alzheimer's Disease Neuroimaging Initiative (both of n > 500). We use both low- and high-dimensionality versions of these data (i.e., ratios between sample size and variables in the range of ∼1-10 and ∼0.1-0.01, respectively) to demonstrate the impact of data dimensionality on the models. Finally, we summarize the key lessons of the tutorial.

Clear Cell Acanthoma with Malignant Cytologic Features: A Case Report and Review of the Literature

Clear cell acanthoma (CCA) is classically considered a benign epidermal tumor, although rare case reports have described CCA with malignant features. Here, we present a case of a patient with a biopsy proven CCA that regrew post-biopsy and was subsequently completely excised. Histologic examination of the tumor in the excision specimen revealed malignant cytologic features that were not present in the initial biopsy. A review of the literature identified five additional cases of CCA with similar malignant cytologic features. On analysis, common histopathologic characteristics included cellular pleomorphism, increased nuclear-to-cytoplasmic ratio, prominent nucleoli, and atypical mitotic figures. We support the designation of atypical clear cell acanthoma for these entities with features of both CCA and significant cytologic atypia. As none of these cases exhibited clinically aggressive behavior, further study is warranted.

Current Trends in Inpatient Care and In-Hospital Mortality of Cholangiocarcinoma in Germany: A Systematic Analysis between 2010 and 2019

Background: Cholangiocarcinoma (CCA) is a rare malignant disease of the biliary tract with an increasing incidence and a high mortality worldwide. Systematic data on epidemiological trends, treatment strategies, and in-hospital mortality of CCA in Germany are largely missing. However, the evaluation and careful interpretation of these data could help to further improve the treatment strategies and outcome of CCA patients in the future. Methods: Standardized hospital discharge data from the German Federal Statistical Office were used to evaluate epidemiological and clinical trends as well as the in-hospital mortality of CCA in Germany between 2010 and 2019. Results: A total of 154,515 hospitalized CCA cases were included into the analyses. The number of cases significantly increased over time (p < 0.001), with intrahepatic CCA (62.5%) being the most prevalent tumor localization. Overall, in-hospital mortality was 11.4% and remained unchanged over time. In-hospital mortality was significantly associated with patients’ age and tumor localization. The presence of clinical complications such as (sub)acute liver failure, acute respiratory distress syndrome (ARDS), or acute renal failure significantly increased in-hospital mortality up to 77.6%. In-hospital mortality was significantly lower among patients treated at high annual case volume centers. Finally, treatment strategies for CCA significantly changed over time and showed decisive differences with respect to the hospitals’ annual case volume. Conclusions: Our data provide a systematic overview on hospitalized CCA patients in Germany. We identified relevant clinical and epidemiological risk factors associated with an increased in-hospital mortality that could help to further improve framework conditions for the management of CCA patients in the future.

Advances of cancer-associated fibroblasts in liver cancer

Liver cancer is one of the most common malignant tumors worldwide, it is ranked sixth in incidence and fourth in mortality. According to the distinct origin of malignant tumor cells, liver cancer is mainly divided into hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). Since most cases are diagnosed at an advanced stage, the prognosis of liver cancer is poor. Tumor growth depends on the dynamic interaction of various cellular components in the tumor microenvironment (TME). As the most abundant components of tumor stroma, cancer-associated fibroblasts (CAFs) have been involved in the progression of liver cancer. The interplay between CAFs and tumor cells, immune cells, or vascular endothelial cells in the TME through direct cell-to-cell contact or indirect paracrine interaction, affects the initiation and development of tumors. Additionally, CAFs are not a homogeneous cell population in liver cancer. Recently, single-cell sequencing technology has been used to help better understand the diversity of CAFs in liver cancer. In this review, we mainly update the knowledge of CAFs both in HCC and CCA, including their cell origins, chemoresistance, tumor stemness induction, tumor immune microenvironment formation, and the role of tumor cells on CAFs. Understanding the context-dependent role of different CAFs subsets provides new strategies for precise liver cancer treatment.

Diffusion-weighted imaging as an imaging biomarker for assessing survival of patients with intrahepatic mass-forming cholangiocarcinoma

BACKGROUND

Mass-forming cholangiocarcinoma is the most common form of intrahepatic cholangiocarcinoma and is associated with a worse prognosis. This study aimed to assess the role of diffusion-weighted imaging and other imaging features as prognostic markers to predict the survival of patients with intrahepatic mass-forming cholangiocarcinoma (IMCC).

MATERIALS AND METHODS

The study included patients with pathologically proven IMCC from January 2011 to January 2018. Two radiologists retrospectively reviewed various imaging findings and manually estimated the area of diffusion restriction. Patients were grouped according to their restriction area into (group 1) restriction ≥ 1/3 of the tumor and (group 2) restriction < 1/3 of the tumor. Statistical analysis was performed to assess the relationship between various imaging features and patients' survival.

RESULTS

Seventy-three patients were included in the study. IMCC patients with tumor size ≥ 5 cm had increased intrahepatic- and peritoneal metastases (p = 039 and p = 0.001 for reader 1 and p = 0.048 and p = 0.057 for reader 2). There was no significant relationship between the diffusion restriction area and tumor size, enhancement pattern, vascular involvement, lymph node metastasis, peritoneal- and distant metastasis. The number of deaths was significantly higher in patients with group 2 restriction (63.6% for group 1 vs. 96.6% for group 2; p = 0.001 for reader 1)(68.2% for group 1 vs. 89.7%% for group 2; p = 0.030 for reader 2). Patients with group 2 restriction had shorter 1- and 3-year survival rates and lower median survival time. Multivariable survival analysis showed two independent prognostic factors relating to poor survival outcomes: peritoneal metastasis (p = 0.04 for reader 1 and p = 0.041 for reader 2) and diffusion restriction < 1/3 (p = 0.011 for reader 1 and p = 0.042 for reader 2). Lymph node metastasis and intrahepatic metastasis were associated with shorter survival in the univariate analysis. However, these factors were non-significant in the multivariate analysis.

CONCLUSION

Restriction diffusion of less than 1/3 and peritoneal metastasis were associated with shorter overall survival of IMCC patients. Other features that might correlate with the outcome are suspicious lymph nodes and multifocal lesions.

Selective Internal Radiotherapy Changes the Immune Profiles of Extracellular Vesicles and Their Immune Origin in Patients with Inoperable Cholangiocarcinoma

The incidence of cholangiocellular carcinoma (CCA) is rising worldwide. As there are no specific early symptoms or specific markers of CCA, it is often diagnosed in later inoperable stages. Accumulating evidence underlines the importance of radiation therapy in the induction of antitumor immunity. The surface protein composition on extracellular vesicles (EVs) relates to originating cells and thus may play a role in vesicle function. We assessed immune profiles of EVs and their immune origin in patients with inoperable CCA prior and after selective internal radiotherapy (SIRT). A total of 47 CCA patients receiving SIRT and 12 healthy volunteers (HV) were included. Blood was withdrawn before therapy (pre T) and after T. EVs were purified from plasma by cluster of differentiation (CD)9-, CD63-, and CD81-immunobead isolation. To detect differently abundant surface markers, dynamic range and EVs input quality were assessed. A total of 37 EVs surface markers were measured by flow cytometry and correlated either with the administered activity dose (MBq) or with the interval until death (month). EVs phenotyping identified lymphocytes, B cells, NK cells, platelets, endothelial cells, leukocyte activation, B cell activation, T and B cell adhesion markers, stem/progenitor cells, and antigen-presenting cells (APC) as EVs-parenteral cells. CD4 and CD8 significantly declined, while other markers significantly increased in CCA patients pre T vs. HV. Platelets-deriving EVs significantly decreased, normalizing to levels of HV but still significantly increasing vs. HV post SIRT. B cells-deriving EVs significantly increased pre T vs. HV, positively correlating with administered activity dose. MHCII and CD40 EVs significantly increased pre SIRT and negatively correlated with administered activity dose, while EVs from antigen presenting cells and CD49e pre SIRT positively correlated with survival time after therapy. Increased levels of CD24 and CD44 in cancer pre T were significantly decreased post T. Among the heterogeneity of EVs that was demonstrated, in particular, B cells-deriving, MHCII, and CD40 positive or APC-deriving EVs need to be further studied for their diagnostic or prognostic relevance in clinical scenarios.

Bone Mineral Density Is a Predictor of Mortality in Female Patients with Cholangiocellular Carcinoma Undergoing Palliative Treatment

Background: Cholangiocellular adenocarcinoma (CCA) is a rare and aggressive malignancy originating from the bile ducts. Its general prognosis is poor as therapeutic options are limited. Many patients present with advanced stages of disease, and palliative chemotherapy remains the only treatment option. Prognostic markers to assess the outcome of chemotherapeutic treatment in CCA are limited. We therefore evaluated bone mineral density (BMD) as a prognostic tool in patients with advanced CCA. Patients and Methods: We included 75 patients with advanced CCA that were treated at our academic tumor center. Prior to treatment, bone mineral density was analyzed at the first lumbar vertebra using routine CT scans in the venous phase and the local PACS (IntelliSpace PACS, Philips, Amsterdam, The Netherlands). Results: BMD was not significantly different between male and female patients but decreased with age. Patients with BMD above 167 HU have a significantly improved overall survival (474 days vs. 254 days; log-rank X²(1) = 6.090; p = 0.014). The prognostic value of BMD was confirmed using univariate (HR 2.313 (95%CI: 1.170–4.575); p = 0.016) and multivariate (HR 4.143 (95%CI: 1.197–14.343); p = 0.025) Cox regression analyses. Subgroup analysis revealed that the prognostic value of BMD was only present in female patients and not in male patients, suggesting sex-specific differences. Conclusions: Our data suggest that BMD is a valuable, easily accessible, and independent prognostic marker for overall survival in patients with advanced CCA. Furthermore, subgroup analysis showed the sex specificity of this marker, which demonstrated relevance only in female patients.

Prediction of Angiopoietin-like Protein 4-related Signaling Pathways in Cholangiocarcinoma Cells

BACKGROUND/AIM

Angiopoietin-like protein 4 (ANGPTL4) is a multifunctional signaling protein implicated in carbohydrate metabolism, inflammation, cancer growth and progression, anoikis resistance, angiogenesis, and metastasis. However, signaling pathways of ANGPTL4 in cholangiocarcinoma (CCA) remain unknown. The aim of this study was to explore ANGPTL4-related signaling proteins and pathways associated with CCA biology.

MATERIALS AND METHODS

ANGPTL4 of CCA cells was silenced by small interfering RNA (siRNA) with scramble control and ANGPTL4-related signaling proteins were investigated using mass spectrometry, bioinformatics tools and molecular docking.

RESULTS

Among the 321 differentially expressed proteins, 151 were down-regulated. Among them, bioinformatic analyses revealed that ANGPTL4 interacts with DNA-dependent protein kinase catalytic subunit (PRKDC) and 60S ribosomal protein L21 (RPL21) via AKT serine/threonine kinase 1 (AKT1), mechanistic target of rapamycin kinase (MTOR) and ribosomal protein L5 (RPL5). Online database analysis showed that mRNA and protein expression levels of ANGPTL4-related signaling proteins were significantly higher in CCA than in normal tissues. Moreover, a high mRNA expression level was associated with high tumor grade (p<0.0001) and lymph node metastasis (p<0.0001).

CONCLUSION

The signaling pathway of ANGPTL4 in CCA progression might be regulated by PRKDC and RPL21. Furthermore, high expression of ANGPTL4-related signaling proteins has potential to be used in clinical prognosis.

Composition and environmental interpretation of the weed communities in the main planting base of jujube (Ziziphus jujuba Mill. cv. 'LingwuChangzao'), Ningxia province of China

Background

Ziziphus jujuba Mill. cv. 'LingwuChangzao' is a traditional jujube cultivar in northwest China. It is of great significance to explore the weed community composition and environmental characterization for the ecological control and comprehensive management of weeds in jujube orchards. In this article, a total of 37 species were recorded in 40 sample plots (1 m × 1 m). Moreover, fourteen environmental indicators to characterize the spatial locations, climate and soil nutrient characteristics of the plant communities were adopted.

Methodology

Through the two-way indicator species analysis (TWINSPAN) quantity classification and canonical correspondence analysis (CCA) ranking methods, the types of weed communities in the main planting base of jujube 'LingwuChangzao' and the main environmental factors affecting the change and distribution of weed types were analyzed.

Results

The weed communities within the study area were divided into 15 types by the TWINSPAN classification. There were significant differences in soil factors to the species diversity indices of the weed communities, the diversity of weed communities was negatively correlated with available potassium, whereas positively correlated with soil water content. The CCA results showed that community structure and spatial distribution of weed communities were affected by soil water content, total potassium, soil organic carbon, total phosphorus, total nitrogen. Our results can be used as a reference for orchard weed management and provide a theoretical basis for weed invasion control and creating a higher biodiversity in arable land under the background of environmental change.

Timeline of FDA-Approved Targeted Therapy for Cholangiocarcinoma

Simple Summary

Cholangiocarcinoma constitutes around 3% of gastrointestinal cancers, and mortality from this cancer has been rising in the recent decades. Many cases of cholangiocarcinoma are unfortunately discovered in their advanced stages which cannot be treated with surgical resection alone. Targeted therapy is a type of medical treatment that has garnered significant interest due to its ability to specifically target cancer cells while sparing normal healthy cells. A few targeted therapies have just recently been approved by the United States FDA for the treatment of cholangiocarcinoma specifically. This manuscript seeks to explore the timeline of targeted therapies with either FDA approval or FDA breakthrough therapy designation. The official approval of these therapies marks a new age for the treatment of cholangiocarcinoma and brings new options for clinicians across the nation for this unfortunate disease.

Abstract

Cholangiocarcinoma (CCA) represents approximately 3% of gastrointestinal malignancies worldwide and constitutes around 10–15% of all primary liver cancers, being only second to hepatocellular carcinoma. Mortality from CCA has been on the rise in recent decades, and in the United States alone there has been a 36% increase in CCA from 1999 to 2014, with over 7000 CCA mortalities since 2013. Targeted therapies, which have been gaining interest due to their greater specificity toward cancer cells, have only recently started gaining FDA approval for the treatment of CCA. In this manuscript, we will go through the timeline of current FDA-approved targeted therapies as well as those that have gained FDA breakthrough therapy designation.

Recent Trends and In-Hospital Mortality of Transarterial Chemoembolization (TACE) in Germany: A Systematic Analysis of Hospital Discharge Data between 2010 and 2019

(1) Background: Transarterial chemoembolization (TACE) is a minimally invasive procedure, characterized by the selective occlusion of tumor-feeding hepatic arteries, via injection of an embolizing agent and an anticancer drug. It represents a standard of care for intermediate-stage hepatocellular carcinoma (HCC), and it is also increasingly performed in cholangiocarcinoma (CCA), as well as in liver metastases. Apart from the original method, based on intra-arterial infusion of a liquid drug followed by embolization, newer particle-based TACE procedures have been introduced recently. As yet, comprehensive data on current trends of TACE, as well as its in-hospital mortality in Germany, which could help to further improve outcome following TACE, are missing. (2) Methods: Based on standardized hospital discharge data, provided by the German Federal Statistical Office from 2010 to 2019, we aimed at systematically evaluating current clinical developments and in-hospital mortality related to TACE in Germany. (3) Results: A total of 49,595 individual cases undergoing TACE were identified within the observation period. The overall in-hospital mortality was 1.00% and significantly higher in females compared to males (1.12 vs. 0.93%; p < 0.001). We identified several post-interventional complications, such as liver failure (51.49%), sepsis (33.87%), renal failure (23.9%), and liver abscess (15.87%), which were associated with a significantly increased in-hospital mortality. Moreover, in-hospital mortality significantly differed between the underlying indications for TACE (HCC: 0.83%, liver metastases: 1.22%, and CCA: 1.40%), as well as between different embolization agents (liquid embolization: 0.80%, loaded microspheres: 0.92%, spherical particles: 1.54%, and non-spherical particles: 2.84%), for which we observed large geographic differences in their frequency of use. Finally, in-hospital mortality was significantly increased in centers with a low annual TACE case volume (<15 TACE/year: 2.08% vs. >275 TACE/year: 0.45%). (4) Conclusion: Our data provide a systematic overview of indications and embolization methods for TACE in Germany. We identified a variety of factors, such as post-interventional complications, the embolization method used, and the hospitals’ annual case volume, which are associated with an increased in-hospital mortality following TACE. These data might help to further reduce the mortality of this routinely performed local-ablative procedure in the future.

Serum Angiopoietin-Like Protein 4: A Potential Prognostic Biomarker for Prediction of Vascular Invasion and Lymph Node Metastasis in Cholangiocarcinoma Patients

Cholangiocarcinoma (CCA) is a tumor arising from cholangiocytes lining the bile ducts. Vascular invasion and lymph node metastasis are important prognostic factors for disease staging as well as clinical therapeutic decisions for CCA patients. In the present study, we applied CCA sera proteomic analysis to identify a potential biomarker for prognosis of CCA patients. Then, using bioinformatics tools, we identified angiopoietin-like protein 4 (ANGPTL4) which expressed highest signal intensity among candidate proteins in proteomic analysis of CCA sera. Expression of ANGPTL4 in CCA tissues was determined using immunohistochemistry. The results showed that ANGPTL4 was stained at higher level in CCA cells when compared with normal cholangiocytes. The high expression of ANGPTL4 was associated with lymph node metastasis and advanced tumor stage (p = 0.013 and p = 0.031, respectively). Furthermore, serum ANGPTL4 levels in CCA and healthy control (HC) were analyzed using a dot blot assay. And it was found that ANGPTL4 level was significantly higher in CCA than HC group (p < 0.0001). ROC curve analysis revealed that serum ANGPTL4 level was effectively distinguished CCA from healthy patients (cutoff = 0.2697 arbitrary unit (AU), 80.0% sensitivity, 72.7% specificity, AUC = 0.825, p < 0.0001). Serum ANGPTL4 level was associated with vascular invasion and lymph node metastasis (p = 0.0004 and p = 0.006), so that it differentiated CCA with vascular invasion from CCA without vascular invasion (cutoff = 0.5526 AU, 64.9% sensitivity, 92.9% specificity, AUC = 0.751, p = 0.006) and it corresponded to CCA with/without lymph node metastasis (cutoff = 0.5399 AU, 71.4% sensitivity, 70.8% specificity, AUC = 0.691, p = 0.01) by ROC analysis. Serum ANGPTL4 levels showed superior predictive efficiency compared with CA 19-9 and CEA for vascular invasion and lymph node metastasis. In addition, serum ANGPTL4 level was an independent predictive indicator by multivariate regression analysis. In conclusion, serum ANGPTL4 could be a novel prognostic biomarker for prediction of vascular invasion and lymph node metastasis of CCA patients.

Combination of linear and nonlinear multivariate approaches effectively uncover responses of phytoplankton communities to environmental changes at regional scale

The response of a community to environmental changes is either linear or non-linear, so that they can be investigated approximately by linear or nonlinear models. At community level, redundancy analysis (RDA) and canonical correspondence analysis (CCA), and Mantel test and Generalized Dissimilarity Modelling (GDM) are two pairs of fundamental multivariate approaches. Thus, it is necessary to determine how they are used for a given group of communities or a metacommunity. In the present study, we explored the applications of the two pairs of commonly used multivariate methods for the analysis of tropical phytoplankton communities. Phytoplankton were collected from 60 tropical reservoirs in southern China at two distinct regions and two hydrological seasons. Because of a short environmental gradient, response of phytoplankton communities to the environmental gradients was first explored with linear models: distance-based redundancy analysis (db-RDA) and Mantel test. Then, CCA and GDM were further applied to recognize the nonlinear relationship between phytoplankton community variation and environmental changes, and to detect the significant environmental and/or spatial variables. Our results strongly suggest that the combination of db-RDA and GDM provides a highly effective tool to uncover the linearity and nonlinearity in community responses and the important associated environmental and spatial variables, which were significantly different between flooding and dry seasons.

A computational framework for post-TAVR cardiac conduction abnormality (CCA) risk assessment in patient-specific anatomy

BACKGROUND

Cardiac conduction abnormality (CCA)- one of the major persistent complications associated with transcatheter aortic valve replacement (TAVR) may lead to permanent pacemaker implantation. Localized stresses exerted by the device frame on the membranous septum (MS) which lies between the aortic annulus and the bundle of His, may disturb the cardiac conduction and cause the resultant CCA. We hypothesize that the area-weighted average maximum principal logarithmic strain (AMPLS) in the MS region can predict the risk of CCA following TAVR.

METHODS

Rigorous finite element-based modeling analysis was conducted in two patients (Balloon expandable TAVR recipients) to assess post-TAVR CCA risk. Following the procedure one of the patients required permanent pacemaker (PPM) implantation while the other did not (control case). Patient-specific aortic root was modeled, MS was identified from the CT image, and the TAVR deployment was simulated. Mechanical factors in the MS region such as logarithmic strain, contact force, contact pressure, contact pressure index (CPI) and their time history during the TAVR deployment; and anatomical factors such as MS length, implantation depth, were analyzed.

RESULTS

Maximum AMPLS (0.47 and 0.37, respectively), contact force (0.92 N and 0.72 N, respectively), and CPI (3.99 and 2.86, respectively) in the MS region were significantly elevated in the PPM patient as compared to control patient.

CONCLUSION

Elevated stresses generated by TAVR devices during deployment appear to correlate with CCA risk, with AMPLS in the MS region emerging as a strong predictor that could be used for preprocedural planning in order to minimize CCA risk.

Understanding coralline algal responses to ocean acidification: Meta-analysis and synthesis

Ocean acidification (OA) is a major threat to the persistence of biogenic reefs throughout the world's ocean. Coralline algae are comprised of high magnesium calcite and have long been considered one of the most susceptible taxa to the negative impacts of OA. We summarize these impacts and explore the causes of variability in coralline algal responses using a review/qualitative assessment of all relevant literature, meta-analysis, quantitative assessment of critical responses, and a discussion of physiological mechanisms and directions for future research. We find that most coralline algae experienced reduced abundance, calcification rates, recruitment rates, and declines in pH within the site of calcification in laboratory experiments simulating OA or at naturally elevated CO₂ sites. There were no other consistent physiological responses of coralline algae to simulated OA (e.g., photo-physiology, mineralogy, and survival). Calcification/growth was the most frequently measured parameters in coralline algal OA research, and our meta-analyses revealed greater declines in seawater pH were associated with significant decreases in calcification in adults and similar but nonsignificant trends for juveniles. Adults from the family Mesophyllumaceae also tended to be more robust to OA, though there was insufficient data to test similar trends for juveniles. OA was the dominant driver in the majority of laboratory experiments where other local or global drivers were assessed. The interaction between OA and any other single driver was often additive, though factors that changed pH at the surface of coralline algae (light, water motion, epiphytes) acted antagonistically or synergistically with OA more than any other drivers. With advances in experimental design and methodological techniques, we now understand that the physiology of coralline algal calcification largely dictates their responses to OA. However, significant challenges still remain, including improving the geographic and life-history spread of research effort and a need for holistic assessments of physiology.

A mutual information criterion with applications to canonical correlation analysis and graphical models

This paper derives a criterion for deciding conditional independence that is consistent with small-sample corrections of Akaike's information criterion but is easier to apply to such problems as selecting variables in canonical correlation analysis and selecting graphical models. The criterion reduces to mutual information when the assumed distribution equals the true distribution; hence, it is called mutual information criterion (MIC). Although small-sample Kullback-Leibler criteria for these selection problems have been proposed previously, some of which are not widely known, MIC is strikingly more direct to derive and apply.

Sarcopenia Predicts Cancer Mortality in Male but Not in Female Patients Undergoing Surgery for Cholangiocellular Carcinoma

Simple Summary

Cholangiocellular adenocarcinoma is the second most common primary liver tumor. If resectable, this is the therapeutic method of choice. Unfortunately, there are insufficient prognostic markers to determine which patients benefit most from surgery and which do not. The general condition of the patient, especially their muscle mass and quality, has become more and more the focus of recent research as a possible marker for therapeutic outcome. In our study we investigated how the preoperative muscle mass of patients with cholangiocellular adenocarcinoma affects postoperative overall survival. We showed that patients with a higher preoperative muscle mass had a significantly longer survival than patients with reduced muscle mass. Furthermore, we were able to show that this is particularly relevant in men and that in women preoperative muscle mass plays a significantly less important role in postoperative survival than in men.

Abstract

Introduction: Surgery represents the only curative treatment option for patients with cholangiocarcinoma. However, complete tumor resection requires extensive surgery in many patients, and it is still debated which patients represent the ideal candidates for such therapy in terms of overall survival. Sarcopenia has been associated with an adverse outcome for various malignancies, but its role in the context of patients undergoing tumor resection for cholangiocellular adenocarcinoma (CCA) is only poorly understood. Here, we evaluated the role of sarcopenia in the outcome of CCA patients undergoing radical tumor resection. Methods: Pre-operative CT scans were used to assess the skeletal muscle index (L3SMI) as well as the psoas muscle index (L3PMI) in n = 76 patients receiving curative intended surgery for CCA. L3SMI and L3PMI were correlated with clinical and laboratory markers. Results: Patients with a skeletal muscle index or psoas muscle index above an established ideal cut-off (54.26 and 1.685 cm²/m²) showed a significantly better overall survival in Kaplan–Meier Curve analyses (L3SMI: 1814 days (95% CI: 520–3108) vs. 467 days (95% CI: 225–709) days; log rank X²(1) = 7.18, p = 0.007; L3PMI: 608 days (95% CI: 297–919) vs. 87 days (95% CI: 33–141), log rank X²(1) = 18.71; p < 0.001). Notably, these findings, especially for L3PMI, were confirmed in univariate (L3SMI: HR 0.962 (0.936–0.989); p = 0.006; L3PMI: HR 0.529 (0.366–0.766); p ≤ 0.001) and multivariate Cox regression analyses. Further analyses revealed that the prognostic value of both L3SMI and L3PMI was restricted to male patients, while in female patients survival was independent of the individual muscle mass. Conclusion: Measurement of muscle mass from preoperative CT scans represents an easily obtainable tool to estimate patient prognosis following curative surgery. The prognostic value was restricted to male patients, while in female patients these parameters did not reflect the patient outcome.

Encoder-Decoder Architecture for Ultrasound IMC Segmentation and cIMT Measurement

Cardiovascular diseases (CVDs) have shown a huge impact on the number of deaths in the world. Thus, common carotid artery (CCA) segmentation and intima-media thickness (IMT) measurements have been significantly implemented to perform early diagnosis of CVDs by analyzing IMT features. Using computer vision algorithms on CCA images is not widely used for this type of diagnosis, due to the complexity and the lack of dataset to do it. The advancement of deep learning techniques has made accurate early diagnosis from images possible. In this paper, a deep-learning-based approach is proposed to apply semantic segmentation for intima-media complex (IMC) and to calculate the cIMT measurement. In order to overcome the lack of large-scale datasets, an encoder-decoder-based model is proposed using multi-image inputs that can help achieve good learning for the model using different features. The obtained results were evaluated using different image segmentation metrics which demonstrate the effectiveness of the proposed architecture. In addition, IMT thickness is computed, and the experiment showed that the proposed model is robust and fully automated compared to the state-of-the-art work.

Influence of socioeconomic development on river water quality: a case study of two river basins in China

Social and economic development processes require large amounts of natural resources and in some cases seriously deteriorate river water quality. Since the reform and expansion era began, China has vigorously pursued socioeconomic development but neglected environmental protection. However, in recent years, improvements in environmental awareness and the implementation of environmental protection measures have led to a balanced relationship between economic development and the environment. In this study, the Yangtze River Basin and the Yellow River Basin were selected as research areas. We used a combination of canonical correlation analysis (CCA) and a distance-based influence assessment method to quantitatively assess the influence of socioeconomic development on river water quality. The results revealed a strong correlation between socioeconomic development and river water quality. The degree of influence of socioeconomic development on water quality varied not only temporally but also spatially due to differences in socioeconomic development and hydrometeorology in the two basins in North and South China. The average degree of influence in the Yangtze River Basin was between 0.22 and 0.27, and that in the Yellow River Basin was between 0.2 and 0.36. Moreover, the degree of influence in the Yangtze River Basin in the wet season was greater than that in the dry season, whereas the opposite pattern was observed in the Yellow River Basin. The degree of influence in both basins gradually declined after 2011, indicating that the coupling and coordination between socioeconomic development and environmental protection have continuously improved and that the water quality has gradually improved. By analysing the influences of various socioeconomic indicators on water quality, we found that the main factors that influence water quality are per capita GDP and urbanization rate in the Yangtze River Basin and urbanization rate in the Yellow River Basin. The results provide a basis for future sustainable development in the Yangtze River Basin and the Yellow River Basin.

Sarcopenia and Myosteatosis as Prognostic Markers in Patients with Advanced Cholangiocarcinoma Undergoing Palliative Treatment

BACKGROUND

Cholangiocarcinoma (CCA) represents the second most common primary liver cancer and is characterized by a very poor outcome, but reliable prognostic markers are largely missing. Sarcopenia, the progressive loss of muscle mass and strength, as well as myosteatosis have been associated with an unfavorable outcome in several clinical conditions, including cancer. Here, we evaluated the prognostic relevance of sarcopenia and myosteatosis using routine abdominal CT (computed tomography) scans in advanced stage CCA patients undergoing palliative treatment.

METHODS

Routine abdominal CT scans were used to assess the skeletal muscle and the psoas muscle index (L3SMI/L3PMI) at the level of the third lumbar vertebra as radiological indices for sarcopenia as well as the mean skeletal muscle attenuation (MMA) as a surrogate for myosteatosis. Results were correlated with clinical data and outcomes.

RESULTS

Using a calculated optimal cut-off value of 71.95 mm²/cm, CCA patients with an L3SMI value below this cut-off showed a significantly reduced median overall survival (OS) of only 250 days compared to 450 days in patients with a higher L3SMI. Moreover, the median OS of CCA patients with an L3PMI above 6345 mm²/cm was 552 days compared to 252 days in patients with a lower L3PMI. Finally, CCA patients with an MMA above 30.51 Hounsfield Units survived significantly longer (median OS: 430 days) compared to patients with an MMA value below this ideal cut-off (median OS: 215 days). The prognostic relevance of L3SMI, L3PMI, and MMA was confirmed in uni- and multivariate Cox regression analyses.

CONCLUSION

Routine abdominal CT scans represent a unique opportunity to evaluate sarcopenia as well as myosteatosis in advanced CCA patients. We identified the L3SMI/L3PMI as well as the MMA as negative prognostic factors in CCA patients undergoing palliative therapy, arguing that the "opportunistic" evaluation of these parameters might yield important clinical information in daily routine.

A Fast Approach to Removing Muscle Artifacts for EEG with Signal Serialization Based Ensemble Empirical Mode Decomposition

An electroencephalogram (EEG) is an electrophysiological signal reflecting the functional state of the brain. As the control signal of the brain–computer interface (BCI), EEG may build a bridge between humans and computers to improve the life quality for patients with movement disorders. The collected EEG signals are extremely susceptible to the contamination of electromyography (EMG) artifacts, affecting their original characteristics. Therefore, EEG denoising is an essential preprocessing step in any BCI system. Previous studies have confirmed that the combination of ensemble empirical mode decomposition (EEMD) and canonical correlation analysis (CCA) can effectively suppress EMG artifacts. However, the time-consuming iterative process of EEMD may limit the application of the EEMD-CCA method in real-time monitoring of BCI. Compared with the existing EEMD, the recently proposed signal serialization based EEMD (sEEMD) is a good choice to provide effective signal analysis and fast mode decomposition. In this study, an EMG denoising method based on sEEMD and CCA is discussed. All of the analyses are carried out on semi-simulated data. The results show that, in terms of frequency and amplitude, the intrinsic mode functions (IMFs) decomposed by sEEMD are consistent with the IMFs obtained by EEMD. There is no significant difference in the ability to separate EMG artifacts from EEG signals between the sEEMD-CCA method and the EEMD-CCA method (p > 0.05). Even in the case of heavy contamination (signal-to-noise ratio is less than 2 dB), the relative root mean squared error is about 0.3, and the average correlation coefficient remains above 0.9. The running speed of the sEEMD-CCA method to remove EMG artifacts is significantly improved in comparison with that of EEMD-CCA method (p < 0.05). The running time of the sEEMD-CCA method for three lengths of semi-simulated data is shortened by more than 50%. This indicates that sEEMD-CCA is a promising tool for EMG artifact removal in real-time BCI systems.

The relationship between zooplankton community and environmental factors of Ghrib Dam in Algeria

The effect of environmental factors on zooplankton diversity, abundance, and distribution in the Ghrib Dam water body was investigated for 2 years from June 2013 to May 2015. A total of 61 species of zooplankton were recorded, including 45 rotifers, 13 cladocerans, and 3 copepods. The zooplankton abundance fluctuated between 4 and 3363 ind.L^-1, and its Shannon-Wiener index of zooplankton diversity in Ghrib Dam varied from H' = 1.15 to 3.77 during the 2-year study period. The highest diversity index was recorded at sampling site S1 in January 2015, due to the increase of specific richness (Ni = 27, D_mg = 5.75). Canonical correspondence analysis (CCA) was used to determine the influence of environmental factors in structuring the zooplankton species for each group. The results of CCA revealed that the most significant environmental factors influencing zooplankton community were water temperature (WT), dissolved oxygen (DO), phosphorus (PO₄^-), and NO₃^- (p < 0.05, Monte Carlo permutation test). Meanwhile, the appearance of Hexarthra sp., Collotheca pelagica, and Diaphanosoma brachyurum indicated a rise in WT. The existence of Filinia longiseta, Keratella quadrata, and Cyclops strenuus correlated with a rising of DO. Brachionus urceolaris, Filinia passa, Keratella tecta, Notholca acuminata, and Polyarthra dolichoptera positively coexisted in an increased PO₄^-. Daphnia longispina and Oxyurella tenuicaudis were positively associated with high concentration of NO₃^-.

A Culture-Centered Approach to Experiences of the Coronavirus Pandemic Lockdown Among Internal Migrants in India

India's coronavirus lockdown forced low-wage migrant workers to return from the city to the home towns and villages from which they came. Pre-pandemic living and working conditions were already stressful and difficult for these migrants. The lockdown became an additional burden, since it shut down sources of income with no assurance about when, or if, work and earning to support families could be resumed. This article draws on the lens of the Culture-Centered Approach (CCA) to understand how workers engaged with and navigated these difficult times. A total of 54 migrant workers locked-down at home across the Indian states of Bihar, Uttar Pradesh, and West Bengal were interviewed for this qualitative study. Financial worries were found to be endemic, with rising debt a major source of stress, and educational qualifications becoming an obstacle to earning. Returning migrants were suspected of bringing the virus from the city, and so stigmatized in their home towns and villages. However, the pandemic lockdown also showed some unexpected healthful consequences. It provided these marginalized, and always busy workers the time and space to stop working for a while, to stay home, eat home food, and take walks in the comparatively green and clean spaces of their home environments. In this, the pandemic lockdown may be seen to have enabled a measure of agency and health in the lives of these workers, an oasis albeit temporary, and ultimately subject to the demands of the globalized cities of India.

'Too many mice make no lining for their nest' - Reasons and effects of parallel governmental structures for disaster risk reduction and climate change adaptation in Southern Africa

Many African countries face escalating challenges of increasing disaster risk and anticipated impacts of climate change. Although disaster risk reduction (DRR) and climate change adaptation (CCA) are tightly linked and comprising virtually identical practices in vulnerable countries in Southern Africa, research has identified parallel governance structures across the region. This study applied comparative case study research, based on 27 semi-structured interviews, to investigate the reasons for and effects of such parallel structures for DRR and CCA in Botswana, Mozambique, the Seychelles, Tanzania and Zambia. It revealed overwhelmingly negative effects in terms of unclear mandates and leadership, uncoordinated efforts, duplication of efforts, suboptimal use of resources and competition over resources and control. The study identified both external reasons for the parallel structures, in terms of global or international initiatives or incentives, and internal reasons, with regard to the history and quality of the governance structures. Although the identified negative effects are common to a range of complex nexuses, there is a clear distinction with the DRR-CCA nexus comprising virtually indistinguishable practices in Southern Africa. There is, as such, no practical reason for keeping them apart. The parallel structures for DRR and CCA are instead the result of pervasive institutionalisation across the region, driven by coercive, mimetic and normative pressures coming from both within and abroad. Although much point to the difficulties of changing the studied institutional arrangements, these parallel structures for DRR and CCA must be addressed if the populations in Southern Africa are to enjoy safety and sustainable development.

Neurophysiological Indices of Audiovisual Speech Processing Reveal a Hierarchy of Multisensory Integration Effects

Seeing a speaker's face benefits speech comprehension, especially in challenging listening conditions. This perceptual benefit is thought to stem from the neural integration of visual and auditory speech at multiple stages of processing, whereby movement of a speaker's face provides temporal cues to auditory cortex, and articulatory information from the speaker's mouth can aid recognizing specific linguistic units (e.g., phonemes, syllables). However, it remains unclear how the integration of these cues varies as a function of listening conditions. Here, we sought to provide insight on these questions by examining EEG responses in humans (males and females) to natural audiovisual (AV), audio, and visual speech in quiet and in noise. We represented our speech stimuli in terms of their spectrograms and their phonetic features and then quantified the strength of the encoding of those features in the EEG using canonical correlation analysis (CCA). The encoding of both spectrotemporal and phonetic features was shown to be more robust in AV speech responses than what would have been expected from the summation of the audio and visual speech responses, suggesting that multisensory integration occurs at both spectrotemporal and phonetic stages of speech processing. We also found evidence to suggest that the integration effects may change with listening conditions; however, this was an exploratory analysis and future work will be required to examine this effect using a within-subject design. These findings demonstrate that integration of audio and visual speech occurs at multiple stages along the speech processing hierarchy.SIGNIFICANCE STATEMENT During conversation, visual cues impact our perception of speech. Integration of auditory and visual speech is thought to occur at multiple stages of speech processing and vary flexibly depending on the listening conditions. Here, we examine audiovisual (AV) integration at two stages of speech processing using the speech spectrogram and a phonetic representation, and test how AV integration adapts to degraded listening conditions. We find significant integration at both of these stages regardless of listening conditions. These findings reveal neural indices of multisensory interactions at different stages of processing and provide support for the multistage integration framework.

High Levels of Serum IgG for Opisthorchis viverrini and CD44 Expression Predict Worse Prognosis for Cholangiocarcinoma Patients after Curative Resection

Background

Opisthorchis viverrini (OV)-associated cholangiocarcinoma (CCA) has a high immune response with chronic inflammation and oxidative stress. CD44 and Nestin, two cancer stem cell (CSC) markers, play major roles in cancer cell survival. Effects of immune response and expression CSC markers on survival of patients with CCA remain unclear.

Objective

To investigate the effects of level of OV IgG together with CSC marker expression and also the combination of these markers on survival of CCA patients after curative resection.

Methods

All serum specimens from CCA patients who underwent curative surgery from 2005 to 2015 were examined for IgG for OV antigen by ELISA. Tissue specimens were studied for CD44 and Nestin expression. Survival analysis by Cox proportional hazard model was used for estimating hazard ratio (HR) with a 95% confidence interval (CI).

Results

In this study, 122 (69.3%) of 176 were positive for OV IgG, and 35 (19.9%) were considered to have high-positive OV IgG. CD44s positive expression was found in 54 (40%), CD44v6 high expression in 96 (69.6%), CD44v8-10 high expression in 87 (63.5%) and Nestin high expression in 21 (16.1%). Multivariate survival analysis found that high-positive OV IgG and late stage tumor were independent prognostic factors with the adjusted HR of 2.24 (95% CI 1.27–3.93) and 2.78 (95% CI 1.46–5.29), respectively. Subgroup analysis in early and late stage CCA showed that a combined positive OV IgG and CD44s expression with the high expression of CD44v8-10 had the significantly poorest prognosis with HR of 3.75 (95% CI 1.61–8.72) and HR of 1.76 (95% CI 1.02–3.03), respectively.

Conclusion

A high level of OV IgG as well as a high level of CSC markers resulted in an aggressive CCA. OV IgG level together with CSC markers can be used as the prognostic markers for CCA patients’ survival. The study of the CD44 pathway is promising for adjuvant treatment.

Analysis of transcriptome in the relationship between expression of PRC1 protein and prognosis of patients with cholangiocarcinoma

OBJECTIVE

To investigate whether protein regulator of cytokinesis 1 (PRC1), which is involved in the regulation of human carcinogenesis, contributes to poor prognosis in patients with cholangiocarcinoma (CCA).

METHODS

Data and tissues from patients with CCA were retrospectively studied. Immunohistochemical staining and western blotting were used to evaluate and contrast the PRC1 expression profile at the protein level in CCA tumour and pericarcinomatous tissues from the same study population. Relationships between clinical characteristics and patient survival were observed using univariate and multivariate analyses. Correlations between PRC1 expression and clinical characteristics were analysed by logistic regression.

RESULTS

A total of 45 patients were included. PRC1 expression was found to be upregulated in CCA cancer tissues versus pericarcinomatous tissues. Overexpression of PRC1 was shown to be related to tumour differentiation, tumour node metastasis staging and lymph node metastasis, and was also revealed to be an independent marker of poor CCA prognosis.

CONCLUSIONS

The present results suggest that PRC1 may be a prognostic and therapeutic biomarker for patients with CCA.

Auditory stimulus-response modeling with a match-mismatch task

Objective.An auditory stimulus can be related to the brain response that it evokes by a stimulus-response model fit to the data. This offers insight into perceptual processes within the brain and is also of potential use for devices such as brain computer interfaces (BCIs). The quality of the model can be quantified by measuring the fit with a regression problem, or by applying it to a classification task and measuring its performance.Approach.Here we focus on amatch-mismatch(MM) task that entails deciding whether a segment of brain signal matches, via a model, the auditory stimulus that evoked it.Main results. Using these metrics, we describe a range of models of increasing complexity that we compare to methods in the literature, showing state-of-the-art performance. We document in detail one particular implementation, calibrated on a publicly-available database, that can serve as a robust reference to evaluate future developments.Significance.The MM task allows stimulus-response models to be evaluated in the limit of very high model accuracy, making it an attractive alternative to the more commonly used task of auditory attention detection. The MM task does not require class labels, so it is immune to mislabeling, and it is applicable to data recorded in listening scenarios with only one sound source, thus it is cheap to obtain large quantities of training and testing data. Performance metrics from this task, associated with regression accuracy, provide complementary insights into the relation between stimulus and response, as well as information about discriminatory power directly applicable to BCI applications.