Involvement of CircRNAs in regulating The "New Generation of Cancer Hallmarks": A Special Depiction on Hepatocellular Carcinoma

The concept of 'Hallmarks of Cancer' is an approach of reducing the enormous complexity of cancer to a set of guiding principles. As the underlying mechanism of cancer are portrayed, we find that we gain insight and additional aspects of the disease arise. The understanding of the tumor microenvironment (TME) brought a new dimension and led to the discovery of novel hallmarks such as senescent cells, non-mutational epigenetic reprogramming, polymorphic microbiomes and unlocked phenotypic plasticity. Circular RNAs (circRNAs) are single-stranded, covalently closed RNA molecules that are ubiquitous across all species. Recent studies on the circRNAs have highlighted their crucial function in regulating the formation of human malignancies through a range of biological processes. The primary goal of this review is to clarify the role of circRNAs in the most common form of liver cancer, hepatocellular carcinoma (HCC). This review also addressed the topic of how circRNAs affect HCC hallmarks, including the new generation hallmarks. Finally, the enormous applications that these rapidly expanding ncRNA molecules serve in the functional and molecular development of effective HCC diagnostic biomarkers and therapeutic targets.

Multi-wavelength interference phase imaging for automatic breast cancer detection and delineation using diffuse reflection imaging

Millions of women globally are impacted by the major health problem of breast cancer (BC). Early detection of BC is critical for successful treatment and improved survival rates. In this study, we provide a progressive approach for BC detection using multi-wavelength interference (MWI) phase imaging based on diffuse reflection hyperspectral (HS) imaging. The proposed findings are based on the measurement of the interference pattern between the blue (446.6 nm) and red (632 nm) wavelengths. We consider implementing a comprehensive image processing and categorization method based on the use of Fast Fourier (FF) transform analysis pertaining to a change in the refractive index between tumor and normal tissue. We observed that cancer growth affects tissue organization dramatically, as seen by persistently increased refractive index variance in tumors compared normal areas. Both malignant and normal tissue had different depth data collected from it that was analyzed. To enhance the categorization of ex-vivo BC tissue, we developed and validated a training classifier algorithm specifically designed for categorizing HS cube data. Following the application of signal normalization with the FF transform algorithm, our methodology achieved a high level of performance with a specificity (Spec) of 94% and a sensitivity (Sen) of 90.9% for the 632 nm acquired image categorization, based on preliminary findings from breast specimens under investigation. Notably, we successfully leveraged unstained tissue samples to create 3D phase-resolved images that effectively highlight the distinctions in diffuse reflectance features between cancerous and healthy tissue. Preliminary data revealed that our imaging method might be able to assist specialists in safely excising malignant areas and assessing the tumor bed following resection automatically at different depths. This preliminary investigation might result in an effective "in-vivo" disease description utilizing optical technology using a typical RGB camera with wavelength-specific operation with our quantitative phase MWI imaging methodology.

Novel molecular laser-induced photoluminscence signature with hyperspectral imaging for instant and remote detection of trace explosive materials

Instant detection of explosive material is highly appreciated for counterterrorism activity and homeland security. Nitro group (high energy rich bond) is responsible for explosive characteristics. Nitro group includes intense competition between two highly electronegative atoms. Nitro group is frequently encountered in all explosive materials. This function group includes delocalized π bond; that could secure intense photoluminescence (fluorescence and phosphorescence) signature. In this study, the main classes of explosive materials including nitro-compounds (i.e. TNT), nitramines (i.e. RDX), and nitric esters (i.e. PETN) were stimulated with green laser source of 532 nm and 5 mW power. The photoluminescence signature of each tested material was captured via hyperspectral camera. The tested explosives demonstrated characteristic fluorescence signature at 571, 587, and 613 nm for RDX, PETN, and TNT respectively. Furthermore, TNT demonstrated characteristic phosphorescence signature at 975 nm. The customized laser induced photoluminescence technique offered facile detection of trace explosive material via clustering approach based on K-m clustering (k = 8); this technique was able to detect RDX, PETN and TNT traces on the finger nail via processed hyperspectral images at 581 nm, 797 nm and 953 nm, respectively. This study shaded the light on novel customized photoluminescence technique for facile detection and identification of trace explosive materials.

Understanding patient views and acceptability of predictive software in osteoporosis identification

INTRODUCTION

Research into patient and public views on predictive software and its use in healthcare is relatively new. This study aimed to understand older adults' acceptability of an opportunistic bone density assessment for osteoporosis diagnosis (IBEX BH), views on its integration into healthcare, and views on predictive software and AI in healthcare.

METHODS

Focus groups were conducted with participants aged over 50 years, based in South West England. Data were analysed using thematic analysis. Analysis was informed by the theoretical framework of acceptability.

RESULTS

Two focus groups were undertaken with a total of 14 participants. Overall, the participants were generally positive about the IBEX BH software, and predictive software's in general stating 'it sounds like a brilliant idea'. Although participants did not understand the intricacies of the software, they did not feel they needed to. Concerns about IBEX BH focussed more on the clinical indications of the software (e.g. more scans or medications), with participants expressing less trust in results if they indicated medication. Questions were also raised about how and who would receive the results of this software. Individual choice was evident in these discussions, however most indicated the preferences for spoken communication 'But I would expect that these results would be given by a human to another human.'

CONCLUSIONS

Focus group participants were generally accepting of the use of predictive software in healthcare.

IMPLICATIONS FOR PRACTICE

Thought and care needs to be taken when integrating predictive software into practice. Focusses on empowering patients, providing information on processes and results are key.

Delineation and detection of breast cancer using novel label-free fluorescence

BACKGROUND

Accurate diagnosis of breast cancer (BC) plays a crucial role in clinical pathology analysis and ensuring precise surgical margins to prevent recurrence.

METHODS

Laser-induced fluorescence (LIF) technology offers high sensitivity to tissue biochemistry, making it a potential tool for noninvasive BC identification. In this study, we utilized hyperspectral (HS) imaging data of stimulated BC specimens to detect malignancies based on altered fluorescence characteristics compared to normal tissue. Initially, we employed a HS camera and broadband spectrum light to assess the absorbance of BC samples. Notably, significant absorbance differences were observed in the 440-460 nm wavelength range. Subsequently, we developed a specialized LIF system for BC detection, utilizing a low-power blue laser source at 450 nm wavelength for ten BC samples.

RESULTS

Our findings revealed that the fluorescence distribution of breast specimens, which carries molecular-scale structural information, serves as an effective marker for identifying breast tumors. Specifically, the emission at 561 nm exhibited the greatest variation in fluorescence signal intensity for both tumor and normal tissue, serving as an optical predictive biomarker. To enhance BC identification, we propose an advanced image classification technique that combines image segmentation using contour mapping and K-means clustering (K-mc, K = 8) for HS emission image data analysis.

CONCLUSIONS

This exploratory work presents a potential avenue for improving "in-vivo" disease characterization using optical technology, specifically our LIF technique combined with the advanced K-mc approach, facilitating early tumor diagnosis in BC.

Progressive plasticity during colorectal cancer metastasis

Metastasis is the principal cause of cancer death, yet we lack an understanding of metastatic cell states, their relationship to primary tumor states, and the mechanisms by which they transition. In a cohort of biospecimen trios from same-patient normal colon, primary and metastatic colorectal cancer, we show that while primary tumors largely adopt LGR5 + intestinal stem-like states, metastases display progressive plasticity. Loss of intestinal cell states is accompanied by reprogramming into a highly conserved fetal progenitor state, followed by non-canonical differentiation into divergent squamous and neuroendocrine-like states, which is exacerbated by chemotherapy and associated with poor patient survival. Using matched patient-derived organoids, we demonstrate that metastatic cancer cells exhibit greater cell-autonomous multilineage differentiation potential in response to microenvironment cues than their intestinal lineage-restricted primary tumor counterparts. We identify PROX1 as a stabilizer of intestinal lineage in the fetal progenitor state, whose downregulation licenses non-canonical reprogramming.

Instant identification of dental white spot using K-means algorithm via laser-induced fluorescence and associated hyperspectral imaging

Dental caries (DC) is a chronic illness that affects 2 billion individuals worldwide, with 520 million of those suffering from it in their primary teeth. It is apparent that early DC detection and subsequent minimally invasive therapy are crucial clinical requirements. The first reversible clinical indication of demineralization is dental white spot (DWS) lesions. However, diagnosing DWS poses extreme challenges for practitioners. In this investigation, a customized laser-induced fluorescence system with a hyperspectral imaging (HI) camera and a non-ionization laser light supply was created for DWS localization and early DC detection. A UV laser diode source with a wavelength of 395 nm was used for light stimulation for the 10 test samples of teeth. The emitted signature of the main tooth components, including dentin, DWS, enamel, and DC, was recorded. An attempt was made to increase the system's sensitivity to the fluorescent signal by applying a logarithmic scale to the spectral signature. Moreover, further discrimination may be achieved by signal strength. We identified that the fluorescent signal's peak intensity at 771 nm works best for discriminating DWS from normal areas, or DC. For characterizing dentin, the re-emitted frequency at 500 nm has the maximum intensity. Next, we presented our imaging grouping strategy that combines visual enhancement through a moving average, MA, filtering and segmenting an image using K-means clustering (K-mc) (K = 8) for instant and precise DWS grouping for the constructed HI images at (500 nm and 771 nm). Despite the tiny structure and its DWS white appearance, our approach could successfully demarcate the DWS on the tested teeth. Dental examiners might benefit from our simple, non-invasive, non-ionizing optical diagnosis approach to help them make their first assessments and experience accurate and exact delineation of the DWS to obtain immediate and higher rates of early-stage DC detection.

Emerging Technology for Intraoperative Margin and Assisting in Post-Surgery tissue diagnostic for Future Breast-Conserving

INTRODUCTION

Tissue-preserving surgery is utilized progressively in cancer therapy, where a clear surgical margin is critical to avoid cancer recurrence, specifically in breast cancer (BC) surgery. The Intraoperative pathologic approaches that rely on tissue segmenting and staining have been recognized as the ground truth for BC diagnosis. Nevertheless, these methods are constrained by its complication and timewasting for tissue preparation.

OBJECTIVE

We present a non-invasive optical imaging system incorporating a hyperspectral (HS) camera to discriminate between cancerous and non-cancerous tissues in ex-vivo breast specimens, which could be an intraoperative diagnostic technique to aid surgeons during surgery and later a valuable tool to assist pathologists.

METHODS

We have established a hyperspectral Imaging (HSI) system comprising a push-broom HS camera at wavelength 380∼1050 nm with source light 390∼980 nm. We have measured the investigated samples' diffuse reflectance (R_d), fixed on slides from 30 distinct patients incorporating mutually normal and ductal carcinoma tissue. The samples were divided into two groups, stained tissues during the surgery (control group) and unstained samples (test group), both captured with the HSI system in the visible and near-infrared (VIS-NIR) range. Then, to address the problem of the spectral nonuniformity of the illumination device and the influence of the dark current, the radiance data were normalized to yield the radiance of the specimen and neutralize the intensity effect to focus on the spectral reflectance shift for each tissue. The selection of the threshold window from the measured R_d is carried out by exploiting the statistical analysis by calculating each region's mean and standard deviation. Afterward, we selected the optimum spectral images from the HS data cube to apply a custom K-means algorithm and contour delineation to identify the regular districts from the BC regions.

RESULTS

We noticed that the measured spectral R_d for the malignant tissues of the investigated case studies versus the reference source light varies regarding the cancer stage, as sometimes the R_d is higher for the tumor or vice versa for the normal tissue. Later, from the analysis of the whole samples, we found that the most appropriate wavelength for the BC tissues was 447 nm, which was highly reflected versus the normal tissue. However, the most convenient one for the normal tissue was at 545 nm with high reflection versus the BC tissue. Finally, we implement a moving average filter for noise reduction and a custom K-means clustering algorithm on the selected two spectral images (447, 551 nm) to identify the various regions and effectively-identified spectral tissue variations with a sensitivity of 98.95%, and specificity of 98.44%. A pathologist later confirmed these outcomes as the ground truth for the tissue sample investigations.

CONCLUSIONS

The proposed system could help the surgeon and the pathologist identify the cancerous tissue margins from the non-cancerous tissue with a non-invasive, rapid, and minimum time method achieving high sensitivity up to 98.95%.

[Role of optical coherence tomography in unilateral amblyopia]

PURPOSE

To compare the macular and papillary parameters on optical coherence tomography (OCT) between the amblyopic eye and the healthy eye in subjects with unilateral strabismic or anisometropic amblyopia.

PATIENTS AND METHODS

This is a cross-sectional and comparative study carried out over two years, from April 1, 2019, to March 31, 2021. We included patients aged over 5years, followed for unilateral amblyopia, free of any neurological and/or ocular pathology. The evaluation of the macular and papillary parameters in the amblyopic and healthy eyes was performed with Swept-Source Optical Coherence Tomography (OCT-SS). The parameters were compared according to age group and type of amblyopia.

RESULTS

We collected 50 patients, 29 children, and 21 adults, with a mean age of 19.8years. Amblyopia was secondary to anisometropia in 40 patients and strabismus in 10 patients. Analysis of macular tomographic parameters found no significant difference between amblyopic eyes and healthy eyes for mean macular thickness (P=0.86), central macular thickness (P=0.86), or mean macular volume (P=0.54). The mean retinal peripapillary fiber thickness (RNFL) was 107.48μm in the amblyopic eye and 103.8μm in the healthy eye, with a statistically significant difference (P<0.001). This significant thickening of the RNFL in amblyopic eyes was present in adults (P<0.001), children (P<0.001), anisometropic (P<0.001), and strabismic amblyopia (P=0.024). Analysis of the other optic nerve head parameters revealed no significant difference between amblyopic eyes and healthy eyes in terms of optic disc surface area (P=0.89), neuro-retinal annulus surface area (P=0.47), vertical (P=0.98) or horizontal (P=0.74) cup to disc ratio.

CONCLUSION

Amblyopia is accompanied by thickening of the peripapillary retinal fibers without macular repercussions. However, larger prospective studies are needed to confirm these results.

Quantitative phase analysis and hyperspectral imaging for the automatic identification of veins and blood perfusion maps

INTRODUCTION

Medical workers commonly physically identify subcutaneous veins to locate a suitable vesselto implant a catheter for drug administration or blood sample. The general rule of thumb is to locate a big, clean vein that will allow the medication to readily pass within the intended blood vessel. Peripheral problematic venous access happens when a patient's veins are difficult to palpate because of factors like dark skin tone, edema or excess tissue. The ability to see how the vasculature changes to support the therapeutic methods without damaging the surrounding tissue is another challenge.

MATERIALS AND METHODS

Hyperspectral imaging (HI) is a developing technique with several potential uses in medicine. Using its spectroscopic data, veins and arterioles could be noninvasively detected and discriminated. It is frequently important to use quantitative phase analysis for vein localization. To assess hyperspectral image data for the detection of both veins and peripheral arteries, we suggest using an advanced image processing and classification algorithm based on the phase information related to the index of refraction change and associated scattering. We show that this need may be satisfied using quantitative phase imaging of forearm skin tissue at different depths.

RESULTS

To demonstrate the variations in the diffuse reflectance characteristics between skin surface and veins, phase resolved pictures were successfully produced for twelve volunteers using our imaging methodology. We found that the skin surface details are completely apparent at the unique wavelength of 441 nm. The 500-nm wavelength was the most efficient for grouping peripheral arteries and illuminating the blood perfusion maps. Using our HI experimental setup and our phase imaging procedure on the 600 nm and 650 nm visible spectral pictures, we were able to properly describe the vein map. This spectral area may be utilized as a vein locator marker which could approximately reach till 3 mm depth under skin surface.

CONCLUSIONS

Initial findings suggested that our imaging technique would be able to assist medical examiners in safely assessing the veins and arteriole's locations automatically without exposing the skin to infrared radiation. Meanwhile, our pilot research in this work to determine the best spectral wavelengths for localizing veins and mapping blood perfusion using our phase analysis imaging strategy with the HI camera. By substituting the HI camera with a custom conventional RGB camera that only functions at specific wavelengths during the discovering of blood perfusion locations or prior to intravenous catheterization, a distinctive and efficient system for precise identification may be developed to serve in the field of the vascular therapeutic methods.

335 Early Initiation of Biochemical Venous Thromboembolism Prophylaxis Following Traumatic Spleen Injury Is Safe and Effectively Reduce VTE Events

Aim

This study examines the safety and timing initiating VTE prophylaxis post traumatic splenic injuries (TSI).

Method

Patients with TSI were identified from prospectively maintained Trauma Audit and Research Network (TARN) database from 2015–2020 in a single tertiary trauma centre. Clinical and radio-logical information were collected retrospectively. TSI were graded using American Association for the Surgery of Trauma (AAST) splenic injury scale. Chemical venous thromboprophylaxis initiation were categorised as not given, &lt;48h and &gt;48h following the injury.

Results

In total 102 patient were included out of 136 patients identified with TSI. 34 patients were excluded for lack of electronic data, palliative decision, or fatal condition on arrival. 12 patients out of 102 required operative management (OM) and 90 patients NOM. VTE prophylaxis was not given for 31 (30.4%). Medical reasons for this include severe brain injury and early discharge before 48 hours. VTE prophylaxis was initiated for 37 (36.3%) patients within 48 hours, and for 34 patients (33.3%) after 48 hours of admission. Seven patients developed thromboembolic events, majority of which (6/7) received VTE prophylaxis after 48 hours. Importantly, none of the patients who received VTE prophylaxis had rebleeding.

Conclusions

This study showed that early initiation of chemical VTE prophylaxis (&lt;48h) is safe, resulted in lower incidence of DVTs/PEs without increasing the risk of bleeding. Results from this study supports recommendation from other studies 1 to initiate chemical VTE prophylaxis after TSI as early as 24h post injury with no other contra-indications.

5 Cervical Spine Pedicle Screw Accuracy in Open Fluoroscopic, Navigated and Template Guided Systems- a Systematic Review

Aim

Pedicle screws provide excellent fixation for a wide range of indications; their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, largely due to the smaller pedicle sizes and proximity to neurovascular structures in the neck. Recent years have seen the development of technology to improve accuracy and thereby safety in cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer assisted systems and physical templates with screw guides. We have performed a systematic review into the accuracy rates of the various systems.

Method

PubMed and Cochrane Library databases were searched; keywords "pedicle screw cervical spine" were searched; 9 valid papers involving 1427 screws were found.

Results

Accuracy rates were 80.6% for fluoroscopy, 91.4% for navigation methods, and 96.7% for templates.

Conclusions

Superior results for templates are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires prolonged pre-operative planning to create the bespoke template, and the development of an infrastructure to allow for their rapid production and delivery is needed before they become more widely available.

Two broad methods of navigation currently exist: intraoperative CT scanning providing real-time 3D navigation and preoperative CT registration in relation to a fixed reference with intraoperative computer assistance. At present, these methods are more commonly used, due to their proven improved accuracy rates over fluoroscopy, availability in emergencies and alongside minimally invasive techniques.

Despite their novelty and limitations, templates provide promising accuracy scores, although practical considerations may inhibit their proliferation.

Saccharomyces cerevisiae OS303 expression of an alkaline protease from a newly isolated Bacillus subtilis D9

The aim of this study was to produce high yield of a local bacterial alkaline protease in the yeast system because the scientific involvement of microorganisms in enzyme production is still not given enough attention in Saudi Arabia. Soil samples were collected from the rhizosphere of some desert plants in Saudi Arabia. Ninety-three alkaline protease producing bacterial isolates were recovered on skimmed-milk agar at pH 9.4 and 45°C for 48 hr. Isolate D9 obtained from the rhizosphere of Heliotropium digynum at Dhahran City was the most potent isolate in respect to enzyme productivity (184.6 U/ml). The full gene of alkaline protease was amplified and showed the expected size (1300 bp). Restriction enzymes analysis also verified the integrity of the PCR product. The sequence of the protease gene revealed an open reading frame of 1329 nt correspond to the full length of the protease gene of isolate D9 encoding a 443 aa protein. After ligation of the amplified gene by the TA cloning method, digestion with appropriate restriction enzymes confirmed the integrity of the cloned gene. The insert was prepared by two PCRs that were conducted with a pair of primers specifically designed for this purpose. The digested and purified cloning vector pRS426/GAL1p-207-Glu-MS was ligated with the insert then transformed into various strains of Saccharomyces cerevisiae via the electroporation method. Maximum protease expression was done by recombinant OS303 in galactose containing media (145.5 U/ml) with an approximately 2-fold increase when compared with the wild OS303 strain., this may be due to ability to activate gal operon.

963 Management of Acute Gallstone-Related Complications at Great Western Hospital (GWH): Re-Audit

Aim

Gallstone related disease accounts for a third of the admissions to the Surgical Department. In June 2019, a clinical audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted time frame, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented.

Method

A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission, only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed.

Results

Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary relate re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year.

Conclusions

This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.

1-trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl) urea (TPPU), a soluble epoxide hydrolase inhibitor, lowers L-NAME-induced hypertension through suppression of angiotensin-converting enzyme in rats

OBJECTIVE

This study evaluated the efficacy of the soluble epoxide hydrolase (sEH) inhibitor, TPPU on chronic NG-Nitro L-arginine methyl ester (L-NAME)-induced hypertension in rats and its effects on plasma Angiotensin II (Ang II), cardiac Angiotensin-converting enzyme (ACE) and Angiotensin II receptor type 1 (AT1R) expressions.

MATERIALS AND METHODS

Forty Sprague Dawley rats were divided into 5 groups. Two groups served as control and received orally either vehicle or TPPU (3 mg/kg) for five weeks. The other three groups were given L-NAME (50 mg/kg/day) in drinking water for five weeks. Two weeks after the L-NAME treatment, animals received orally either saline or TPPU (3 mg/kg/day) or lisinopril (10 mg/kg/day) daily for 3 weeks. Blood pressure (BP) was measured weekly. At the end of the experiment, plasma Ang II, cardiac ACE and AT1R protein and gene expressions were determined.

RESULTS

L-NAME caused a significant increase in BP of the animals. TPPU and lisinopril resulted in normalization of L-NAME-induced hypertension. They also caused a significant reduction in Ang II and ACE protein and gene expressions compared to L-NAME and vehicle-treated animals.

CONCLUSIONS

This study demonstrates that TPPU effectively lowers L-NAME-induced hypertension in rats. The mechanism of its antihypertensive effect is likely mediated by the suppression of ACE gene and protein expression, leading to a lower Ang II level.

Cholinergic nerve regulation of heart regeneration

Background

Cardiac nerves regulate many important physiological functions of the heart such as heart rate and contractility. The emerging role of cardiac nerves during tissue homeostasis and regeneration is beginning to be appreciated. We discovered that neonatal mice are capable of regenerating their hearts following injury within a brief period after birth by proliferation of the pre-existing cardiomyocytes. Furthermore, we have demonstrated that cholinergic nerves play an important role in guiding the neonatal heart regenerative response. However, the adult mammalian heart, including the human heart, is incapable of regeneration following injury. Thus, there is great excitement about understanding the evolutionarily conserved mechanisms of endogenous cardiac regeneration, so that we can explore potential avenues to reawaken this process in adult humans.

Purpose

Our overarching goal is to define the mechanisms by which cholinergic nerves regulate heart regeneration following ischemic injury by using the neonatal mouse heart regeneration model. These studies will uncover novel pathways by which cholinergic signaling promotes cardiomyocyte proliferation and heart regeneration, which holds significant therapeutic potential for treatment of adult heart disease.

Methods

In this project, we employed genetically engineered mouse models of the critical receptors for cholinergic signaling in the heart to define the mechanisms of cholinergic nerve regulation of heart regeneration. First, we generated a cardiomyocyte-specific deletion of the muscarinic receptor (M2), the most predominant muscarinic receptor subtype present in the heart. In addition, we utilized the α7 nicotinic receptor (Chrna7) knockout mice to study the role of Chrna7 in endogenous immune cells, which is the main mediator of the cholinergic anti-inflammatory pathway. These mouse models will address how cholinergic nerves regulate heart regeneration via the M2 muscarinic receptor signaling and the inflammatory response following injury.

Results

Our results demonstrate that inhibition of two different cholinergic receptors (muscarinic and nicotinic) results in a reduction in cardiomyocyte proliferation and inhibition of the neonatal cardiac regenerative response following injury. More importantly, we demonstrate that cholinergic signaling mediates the cardiac regenerative response mainly through suppression of pro-inflammatory cytokines via the cholinergic anti-inflammatory pathway.

Conclusions

Cholinergic nerve signaling plays an important role in mounting a robust cardiac regenerative response following injury. These results have significant therapeutic potential, which will forge new paradigms with respect to the role of cardiac nerves during mammalian cardiac regeneration and reveal potential mechanisms regarding the benefits of nerve stimulation following cardiac injury in humans.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): American Heart Association, Wisconsin Partnership Program

Uterine exteriorization versus intraperitoneal repair: effect on intraoperative nausea and vomiting during repeat cesarean delivery - A randomized clinical trial

OBJECTIVE

The current study aims to compare the rate of intraoperative nausea and vomiting after repeat cesarean delivery (CD) under two different approaches: by intraperitoneal incision repair or by uterus exteriorization for incision reapair.

MATERIALS AND METHODS

We conducted a single-blinded randomized clinical trial (NCT03009994) at a tertiary University Hospital between the 1st of September 2016 and the 31st of December 2017. The study included pregnant women at term of gestation (>37 weeks) scheduled for repeat CD under spinal anesthesia. Women were assigned to either uterine exteriorization for incision repair (Group I) or intraperitoneal incision repair (Group II). The primary assessed was the rate of nausea and vomiting during CD.

RESULTS

The study included 1028 women in the final analysis. The rate of intraoperative nausea and vomiting was significantly lower in the intraperitoneal repair group compared to the exteriorization group (24% versus 38.7%, p= 0.001). Likewise, occurrence of uterine atony and the need for additional uterotonics were significantly lower in the intraperitoneal repair group (p= 0.001 and 0.02 respectively). Postoperatively, the rate of nausea and vomiting (12.6 % versus 21 %; P=0.001), and the time to the first recognized bowel movement (12.3 hours versus 14.1 hours; P=0.003) were significantly lower in the intraperitoneal repair group compared to the exteriorization group.

CONCLUSIONS

Intraperitoneal repair of the uterine incision during repeat CD is beneficial compared to exteriorization. Improvements in the rate of intra- and postoperative nausea, vomiting, uterine atony and time to the first recognized bowel movement were observed in patients operated with this technique.

Clinical genomics expands the morbid genome of intellectual disability and offers a high diagnostic yield

Intellectual disability (ID) is a measurable phenotypic consequence of genetic and environmental factors. In this study, we prospectively assessed the diagnostic yield of genomic tools (molecular karyotyping, multi-gene panel and exome sequencing) in a cohort of 337 ID subjects as a first-tier test and compared it with a standard clinical evaluation performed in parallel. Standard clinical evaluation suggested a diagnosis in 16% of cases (54/337) but only 70% of these (38/54) were subsequently confirmed. On the other hand, the genomic approach revealed a likely diagnosis in 58% (n=196). These included copy number variants in 14% (n=54, 15% are novel), and point mutations revealed by multi-gene panel and exome sequencing in the remaining 43% (1% were found to have Fragile-X). The identified point mutations were mostly recessive (n=117, 81%), consistent with the high consanguinity of the study cohort, but also X-linked (n=8, 6%) and de novo dominant (n=19, 13%). When applied directly on all cases with negative molecular karyotyping, the diagnostic yield of exome sequencing was 60% (77/129). Exome sequencing also identified likely pathogenic variants in three novel candidate genes (DENND5A, NEMF and DNHD1) each of which harbored independent homozygous mutations in patients with overlapping phenotypes. In addition, exome sequencing revealed de novo and recessive variants in 32 genes (MAMDC2, TUBAL3, CPNE6, KLHL24, USP2, PIP5K1A, UBE4A, TP53TG5, ATOH1, C16ORF90, SLC39A14, TRERF1, RGL1, CDH11, SYDE2, HIRA, FEZF2, PROCA1, PIANP, PLK2, QRFPR, AP3B2, NUDT2, UFC1, BTN3A2, TADA1, ARFGEF3, FAM160B1, ZMYM5, SLC45A1, ARHGAP33 and CAPS2), which we highlight as potential candidates on the basis of several lines of evidence, and one of these genes (SLC39A14) was biallelically inactivated in a potentially treatable form of hypermanganesemia and neurodegeneration. Finally, likely causal variants in previously published candidate genes were identified (ASTN1, HELZ, THOC6, WDR45B, ADRA2B and CLIP1), thus supporting their involvement in ID pathogenesis. Our results expand the morbid genome of ID and support the adoption of genomics as a first-tier test for individuals with ID.

Cation distribution dependent magnetic properties in CoCr2−xFexO4 (x = 0.1 to 0.5): EXAFS, Mössbauer and magnetic measurements

Evolution of structure and rich magnetic transitions such as paramagnetic to ferrimagnetic phase transition at Curie temperature (T_C), spiral ordering temperature (T_S) and lock-in temperature (T_L) have been discussed in CoCr₂O₄ spinel multiferroic after substituting Fe.

Pre-overloading to Extend Fatigue Life of Cast Clasps

Permanent deformation in bending is associated with the development of residual stresses. The objective of this study was to characterize those residual stresses and test whether they can be manipulated to extend the fatigue lives of cast clasps. Simulations with validated non-linear finite element models were used to characterize the residual stresses in clasps cast from Ti-6Al-7Nb, Co-Cr, and Type IV gold alloys. In addition, two groups of as-cast and pre-overloaded (subjected to a load that produced 20 μm of permanent deformation) Ti-6Al-7Nb clasps (10 specimens each) were subjected to cyclic 0.5-mm deflections at 5 Hz until fatigue. Pre-overloaded specimens demonstrated significantly longer fatigue lives (32,200 ± 17,300 cycles) than did those tested in the as-cast condition (17,900 ± 7600 cycles), consistent with the maximum tensile stress values revealed by finite element analysis.

[Incidence and causes of visual impairment in the district of Mahdia, in east Tunisia: Retrospective study of 1487 cases]

OBJECTIVE

To study socio-demographic characteristics and main causes related to visual impairment (VI) as a function of age bracket and to analyze their trends over time in the district of Mahdia.

METHOD

A retrospective review was performed on 1487 cases of visual impairment registered with the social authorities in Mahdia, between 1980 and 2013. The social, demographic, vision exam findings and causes were ascertained and analyzed in an SPSS database. Incidence rates of VI and blindness due to various causes were calculated based on the demographic data from the NSI to estimate the time trends using the general linear regression model and Spearman correlation.

RESULTS

Analyses included 1487 participants with a median age of 47 years, 40.6% of cases were aged under 45 years. Children accounted for 11.1% (165 patients), while age was between 16 and 45 years in 29.5% (439 patients), between 46 and 65 years in 31.5% (469 patients) and greater than 65 years in 27.8% (414 patients). The sex-ratio (M/F) was 1.78. Socially, 51% came from rural areas, 62% were illiterate, and 84% were unemployed. We observed blindness in 70% of participants and low vision in 30%. In children, the causes were dominated by congenital cataract and congenital glaucoma, each present in 31 children (18.8%). Between 16 and 45 years, glaucoma and hereditary dystrophies of the retina were found in 62 and 61 patients respectively (14% each). For age between 46 and 65 years, trachoma was responsible for 19.8% of cases of VI, glaucoma in 15.8% and cataract in 15.1%. Beyond 65 years, glaucoma accounted for 30.7% of the causes of VI and cataract 27.8% of cases. Trend analysis shows a significant increase in the incidence rate of visual impairment with an average of 12% per year (P=0.001). The mean age increased by 46% (P=0.003). Trachoma increased by 118% (P<0.0001) between 1980 and 1990, then declined by 42% (P=0.0013) between 1991 and 2013. Incidence of VI significantly increased by 4% for cataract (P=0.001), 23% (P=0.001) for glaucoma and 20% (P=0.02) for diabetic retinopathy, while VI related to refractive errors and AMD showed no significant change.

CONCLUSION

Advanced age, lower educational and socio-economic status were associated with bilateral VI. Age related eye problems are the main causes of VI, and their incidence is tending to increase. Public health policies and procedures should be targeted to risk related populations and age-related diseases in order to control the incidence of visual impairment and avoid its consequences.

Differences Regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint

OBJECTIVES

The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet.

METHODS

An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA.

RESULTS

Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication.

CONCLUSIONS

There are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient.