[The relationship between differentially expressed thyroid cancer genes and clinical characteristics in metastatic children and adolescents]

Objective: To investigate the relationship between genes and clinical characteristics in children and adolescents with metastatic differentiated thyroid cancer (caDTC). Methods: A cross sectional study. A total of 67 caDTC patients with lymph node metastasis or distant metastasis in Peking Union Medical College Hospital from December 2020 to December 2022 were included, according to the inclusion and exclusion criteria. Then the differences in clinicopathologic features and iodine intake were compared among different genomes, and the age subgroups divided by the age of 12 were further analyzed. Results: Among the 67 cases of caDTC, the diagnosed age [M(Q1, Q3)]was 13.2 (9.7, 16.9) years old, with 23 males and 44 females. There were 68.7% (46/67) of patients have distant metastasis (M1 stage). Pathogenic or potentially pathogenic gene variants were detected in 68.7% (46/67) of the patients, with RET or NTRK fusion (RET/NTRK) being the most common [43.3%(29/67)], BRAF V600E mutation followed [19.4%(13/67)].There was only 1 caDTC with NRAS Q61R mutation. The patients were divided into RET/NTRK fusion group (n=29), BRAF mutation group (n=12), other mutation group (n=4), and non-mutation group (n=21) (1 patient was not included in the gene mutation subgroup comparison due to the presence of NRAS Q61R mutation and BRAF V600E mutation). The comparison of gene feature groups showed that compared to the BRAF mutation group, caDTC with RET/NTRK fusion tended to have a lower age at diagnosis [12.6(9.3, 15.9) vs 17.2(15.5, 18.1) years old, P<0.001], the proportion of mutation load≥2 was higher (10.4% vs 8.3%, P=0.027), with statistically significant difference. Among 46 M1 stage patients, 71.7% (33/46) had initial iodine intake, and 30.4% (14/46) developed radioiodine-refractory (RAIR). In age group comparison, the<12 year old group had a higher proportion of male patients (51.9% vs 22.5%, P=0.013) and a lower incidence of BRAF V600E mutations (0 vs 32.5%, P<0.001) compared to the≥12 year old group, and the differences were statistically significant. Conclusions: The incidence of RET/NTRK fusion ranks first in metastatic caDTC, featured with younger age at diagnosis and higher rate of distant metastasis. Although most metastatic lesions initially consume iodine, they are prone to RAIR. Attention should be paid to the potential role of RET/NTRK fusion in the invasion and iodine resistance of young caDTC patients.

Ca2LaTaO6:Bi3+/Mn4+ Phosphors with High Brightness Far-Red Emitting and Luminescence Enhancement for Plant Growth LED Lights and Temperature Sensor

Herein, Bi3+/Mn4+ doped Ca2LaTaO6 phosphors with a double-perovskite structure were successfully synthesized with solid-state reaction at high temperature. The photoluminescence (PL) performances were investigated in detail. The blue radiation (∼465 nm) from the Bi3+ ion and the red radiation (∼686 nm) originating from the Mn4+ ion were obtained under 313 nm excitation. Especially, the pathway of energy transfer (Bi3+ → Mn4+) contributes to enhance the red emission intensity (Mn4+: ∼686 nm) in Ca2LaTaO6:Bi3+/Mn4+ system. The PL mechanism of Ca2LaTaO6:Bi3+/Mn4+ was analyzed through luminescence lifetimes and PL spectra. Moreover, the emitting bands of Ca2LaTaO6:Bi3+/Mn4+ were primarily matched with the absorbing bands of carotenoids and phytochrome PFR on behalf of plant growth, so the phosphors were suitable for the design of a plant growth light under near-ultraviolet to blue excitation. At last, the optical temperature dependent performances of the Ca2LaTaO6:Bi3+/Mn4+ were analyzed with luminescence intensity ratio technology. The sample has presented excellent temperature measuring relative sensitivity (SR = 2.106% K-1). The results illustrated that the Ca2LaTaO6:Bi3+/Mn4+ phosphor also can be used to develop an optical temperature sensor.

Age effect on the shared etiology of glycemic traits and serum lipids: evidence from a Chinese twin study

PURPOSE

Diabetes and dyslipidemia are among the most common chronic diseases with increasing global disease burdens, and they frequently occur together. The study aimed to investigate differences in the heritability of glycemic traits and serum lipid indicators and differences in overlapping genetic and environmental influences between them across age groups.

METHODS

This study included 1189 twin pairs from the Chinese National Twin Registry and divided them into three groups: aged ≤ 40, 41-50, and > 50 years old. Univariate and bivariate structural equation models (SEMs) were conducted on glycemic indicators and serum lipid indicators, including blood glucose (GLU), glycated hemoglobin A1c (HbA1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), in the total sample and three age groups.

RESULTS

All phenotypes showed moderate to high heritability (0.37-0.64). The heritability of HbA1c demonstrated a downward trend with age (HbA1c: 0.50-0.79), while others remained relatively stable (GLU: 0.55-0.62, TC: 0.58-0.66, TG: 0.50-0.63, LDL-C: 0.24-0.58, HDL-C: 0.31-0.57). The bivariate SEMs demonstrated that GLU and HbA1c were correlated with each serum lipid indicator (0.10-0.17), except HDL-C. Except for HbA1c and LDL-C, as well as HbA1c and HDL-C, differences in genetic correlations underlying glycemic traits and serum lipids between age groups were observed, with the youngest group showing a significantly higher genetic correlation than the oldest group.

CONCLUSION

Across the whole adulthood, genetic influences were consistently important for GLU, TC, TG, LDL-C and HDL-C, and age may affect the shared genetic influences between glycemic traits and serum lipids. Further studies are needed to elucidate the role of age in the interactions of genes related to glycemic traits and serum lipids.

Enhanced TRPC3 transcription through AT1R/PKA/CREB signaling contributes to mitochondrial dysfunction in renal tubular epithelial cells in D-galactose-induced accelerated aging mice

Aging-associated renal dysfunction promotes the pathogenesis of chronic kidney disease. Mitochondrial dysfunction in renal tubular epithelial cells is a hallmark of senescence and leads to accelerated progression of renal disorders. Dysregulated calcium profiles in mitochondria contribute to aging-associated disorders, but the detailed mechanism of this process is not clear. In this study, modulation of the sirtuin 1/angiotensin II type 1 receptor (Sirt1/AT1R) pathway partially attenuated renal glomerular sclerosis, tubular atrophy, and interstitial fibrosis in D-galactose (D-gal)-induced accelerated aging mice. Moreover, modulation of the Sirt1/AT1R pathway improved mitochondrial dysfunction induced by D-gal treatment. Transient receptor potential channel, subtype C, member 3 (TRPC3) upregulation mediated dysregulated cellular and mitochondrial calcium homeostasis during aging. Furthermore, knockdown or knockout (KO) of Trpc3 in mice ameliorated D-gal-induced mitochondrial reactive oxygen species production, membrane potential deterioration, and energy metabolism disorder. Mechanistically, activation of the AT1R/PKA pathway promoted CREB phosphorylation and nucleation of CRE2 binding to the Trpc3 promoter (-1659 to -1648 bp) to enhance transcription. Trpc3 KO significantly improved the renal disorder and cell senescence in D-gal-induced mice. Taken together, these results indicate that TRPC3 upregulation mediates age-related renal disorder and is associated with mitochondrial calcium overload and dysfunction. TRPC3 is a promising therapeutic target for aging-associated renal disorders.

The biological age model for evaluating the degree of aging in centenarians

BACKGROUND

Biological age (BA) has been used to assess individuals' aging conditions. However, few studies have evaluated BA models' applicability in centenarians.

METHODS

Important organ function examinations were performed in 1798 cases of the longevity population (80∼115 years old) in Hainan, China. Eighty indicators were selected that responded to nutritional status, cardiovascular function, liver and kidney function, bone metabolic function, endocrine system, hematological system, and immune system. BA models were constructed using multiple linear regression (MLR), principal component analysis (PCA), Klemera and Doubal method (KDM), random forest (RF), support vector machine (SVM), extreme gradient boosting (XGBoost), and light gradient boosting machine (lightGBM) methods. A tenfold crossover validated the efficacy of models.

RESULTS

A total of 1398 participants were enrolled, of whom centenarians accounted for 49.21%. Seven aging markers were obtained, including estimated glomerular filtration rate, albumin, pulse pressure, calf circumference, body surface area, fructosamine, and complement 4. Eight BA models were successfully constructed, namely MLR, PCA, KDM1, KDM2, RF, SVM, XGBoost and lightGBM, which had the worst R2 of 0.45 and the best R2 of 0.92. The best R2 for cross-validation was KDM2 (0.89), followed by PCA (0.62).

CONCLUSION

In this study, we successfully applied eight methods, including traditional methods and machine learning, to construct models of biological age, and the performance varied among the models.

Association of clinical characteristics and vaccines with risk of persistently viral clearance in patients infected with SARS-CoV-2 Omicron variant in Shanghai, China

Importance

The global COVID-19 pandemic does not appear to end in the near future. Currently, limited data are available on the risk factors for delayed viral clearance in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection.

Objective

This study aimed to investigate the association of clinical characteristics and vaccination with prolonged viral clearance.

Methods

This retrospective cohort included 16,985 patients who had contracted the SARS-CoV-2 Omicron variant between April 5 and May 30, 2022, in Shanghai, China, and had mild or no symptoms. The patients were admitted to the quarantine venue at the Shanghai New International Expo Center.

Results

Of the 16,985 participants, the occurrence of viral clearance was ≤8 and > 8 days in 11,009 (64.8 %) and 5976 (35.2 %) participants, respectively. Risk factors related to patients who remained persistently polymerase chain reaction (PCR)-positive were sex (Male, odds ratio [OR] 1.221, p < 0.001), older age (35-49, OR 1.389, p < 0.001; 50-64, OR 1.659, p < 0.001; ≥65, OR 2.139, p < 0.001), presence of symptoms (OR 1.093, p = 0.030), number of vaccinations (two doses, OR 0.753, p < 0.001; three doses, OR 0.797, p < 0.001; four doses, OR 0.543, p < 0.001), and cycle threshold (Ct) value for ORF1ab gene at diagnosis (25-35, OR 0.235, p < 0.001; >35, OR 0.079, p < 0.001). The lower rates of increase in Ct values were observed in the later viral shedding group than in the early viral shedding group for ORF1ab (β = -0.791, p < 0.001) and N genes (β = -0.825, p < 0.001).

Conclusion

Prolonged SARS-CoV-2 RNA detection and higher viral concentrations were associated with factors such as male sex, older age, symptomatic status, and fewer doses of vaccination in patients admitted to Shanghai Makeshift Hospital between April 5 and May 30, 2022.

[Current major public health challenges]

After COVID-19 pandemic, there are still many public health challenges in the world. The double burden of communicable and non-communicable diseases is still heavy in many countries. Mental health and injury are crucial public health problems which are often neglected. Environmental health and food and drug safety are closely related to human health, to which further management and intervention are needed. These problems have different impacts on people at different life stages, resulting in health problems throughout the life course. The current status of public health is far from the requirements set by the Sustainable Development Goals of United Nations or the initiative of "Healthy China 2030". It is necessary for governments and related departments of all countries to consider public health in all policy development to tackle the major challenge to public health.

Red cell distribution in critically ill patients with chronic obstructive pulmonary disease

BACKGROUND

Red blood cell distribution width (RDW) is associated with increased mortality risk in patients with chronic obstructive pulmonary disease (COPD). However, limited data are available for critically ill patients with COPD.

METHODS

Data from the Medical Information Mart for Intensive Care III V1.4 database were analyzed in this retrospective cohort research. The International Classification of Diseases codes were used to identify critically ill patients with COPD. The first value of RDW was extracted within the first 24 h after intensive care unit admission. The endpoint was 28-day all-cause mortality. Multivariable logistic regression analysis was performed to examine the relationship between RDW and 28-day mortality. Age, sex, ethnicity, anemia status, comorbidities, clinical therapy, and disease severity score were considered for subgroup analysis.

RESULTS

A total of 2,344 patients were included with mean (standard deviation) age of 72.3 (11.3) years, in which 1,739 (53.6%) patients were men. The increase in RDW was correlated with an increased risk of 28-day mortality in the multivariate logistic regression model (odds ratio [OR] 1.15; 95% confidence interval [CI] 1.09-1.21). In comparison with the low-RDW group, the middle and high-RDW groups tended to have higher risks of 28-day all-cause mortality (OR [95% CI] 1.03 [0.78-1.34]; OR [95% CI] 1.70 [1.29-2.22]; P trend < 0.0001). Subgroup analyses show no evidence of effect modifications on the correlation of RDW and 28-day all-cause mortality.

CONCLUSION

An increase in RDW was associated with an increased risk of 28-day all-cause mortality in critically ill patients with COPD. Further studies are required to investigate this association.

Fecobionics in proctology: review and perspectives

Fecobionics is a novel integrated technology for assessment of anorectal function. It is a defecatory test with simultaneous measurements of pressures, orientation, and device angle (a proxy of the anorectal angle). Furthermore, the latest Fecobionics prototypes measure diameters (shape) using impedance planimetry during evacuation of the device. The simultaneous measurement of multiple variables in the integrated test allows new metrics to be developed including more advanced novel defecation indices, enabling mechanistic insight in the defecation process at an unprecedented level in patients with anorectal disorders including patients suffering from obstructed defecation, fecal incontinence, and low anterior resection syndrome. The device has the consistency and shape of a normal stool (type 3-4 on the Bristol Stool Form Scale). Fecobionics has been validated on the bench and in animal studies and used in clinical trials to study defecation phenotypes in normal human subjects and patients with obstructed defecation, fecal incontinence, and low anterior resection syndrome after rectal cancer surgery. Subtypes have been defined, especially of patients with obstructed defecation. Furthermore, Fecobionics has been used to monitor biofeedback therapy in patients with fecal incontinence to predict the outcome of the therapy (responder versus non-responder). Most Fecobionics studies showed a closer correlation to symptoms as compared to current technologies for anorectal assessment. The present article outlines previous and ongoing work, and perspectives for future studies in proctology, including in physiological assessment of function, diagnostics, monitoring of therapy, and as a tool for biofeedback therapy.

Elucidation of the mechanisms and molecular targets of KeChuanLiuWei-Mixture for treatment of severe asthma based on network pharmacology

KeChuanLiuWei-Mixture (KCLW) is widely used as a Chinese medicine prescription to treat severe asthma. However, the underlying therapeutic mechanism of KCLW remains unclear. In this study, a network pharmacology method was used to identify the chemical constituents of KCLW by the TCMSP database and ultra-performance liquid chromatography coupled with time-of-flight mass spectrometry. Differential expression identification, protein-protein interaction (PPI) network and functional enrichment analysis were used to screen key targets of KCLW for severe asthma. Our results confirmed that quercetin, luteolin, kaempferol, and wogonin are the most critical active ingredients in KCLW. Moreover, the 16 relevant severe asthma-related targets of KCLW were obtained by overlapping the PPI networks of the KCLW putative targets and severe asthma-related genes, among which the most important targets were IL-6, NOS2, VEGFA, CXCL2, and PLAT. Functionally, the 16-targets and their interacting differentially expressed genes were primarily related to biological functions and pathways related to immunity and inflammation, such as inflammatory response, T cell differentiation, Nrf2/HO-1 signaling pathway, TGF-β/Smad signaling pathway, and NF-κB signaling pathway. KCLW inhibited inflammation in PDGF-BB-induced airway smooth muscle cells. In summary, this study demonstrates the active substance and potential therapeutic mechanism of KCLW in severe asthma, and offers a clinical direction for KCLW against severe asthma.

A Phase 0 Study Assessing the Intracranial Activity of a Metabolic Radiosensitizer in Patients with Glioblastoma

PURPOSE/OBJECTIVE(S)

Efforts to overcome treatment resistance in glioblastoma (GBM) have been unsuccessful due to tumor heterogeneity and poor intracranial drug penetration. Targeting altered metabolism is a promising approach to improve GBM therapy despite this heterogeneity. Mycophenolate mofetil (MMF) is an inhibitor of purine synthesis that sensitizes GBM to radiation and temozolomide (TMZ) in vitro and in vivo, but its ability to cross the blood brain barrier and inhibit GBM metabolism in patients is unknown. NCT04477200 is a phase 0/1 dose escalation study of MMF combined with radiation and temozolomide in GBM. Here we report the phase 0 results of this study assessing the intracranial activity of MMF.

MATERIALS/METHODS

Purine (GTP and IMP) and mycophenolic acid (MPA, the active metabolite of MMF) concentrations were determined using mass spectrometry in flash-frozen tumor (enhancing and non-enhancing) and normal cortex obtained from 8 patients with recurrent GBM who received MMF (500, 1000, 1500 and 2000 mg BID, N = 2 patients each dose level) for 1 week prior to re-resection and 5 control patients who did not receive MMF prior to re-resection. Plasma MPA concentration was similarly quantified to calculate the enhancing tumor, non-enhancing tumor and normal cortex to plasma MPA ratios.

RESULTS

Patients who received MMF had a mean MPA concentration of 2.2 ± 0.7 µM in the enhancing tumor samples, 1.2 ± 0.5 µM in the non-enhancing tumor samples and 1.3 ± 0.5 µM in normal cortex. MPA concentration was negligible in control patients. This corresponded to tissue/plasma MPA ratios of 0.31, 0.17 and 0.10 for enhancing tumor, non-enhancing tumor and normal cortex, respectively. The GTP/IMP ratio was decreased by 75% in enhancing tumor in MMF-treated patients compared to untreated controls (p = 0.009), indicating effective target engagement and inhibition of purine synthesis. The GTP/IMP ratio was also decreased in cortex and non-enhancing tumor, though a paucity of control samples prevented statistical analysis.

CONCLUSION

Twice daily MMF treatment yields intracranial drug concentrations above 1 µM and lowers the GTP/IMP ratio in GBMs, consistent with target engagement. As we have previously observed radiosensitization in vitro with MPA concentrations of 1 µM, these data suggest that MMF may achieve adequate CNS penetration for therapeutic benefit. The Phase 1 component of this study to determine the dose limiting toxicity and maximally tolerated dose of MMF when combined with reirradiation in recurrent GBM and radiation and TMZ in newly diagnosed GBM is ongoing.

Reyanning Mixture on Asymptomatic or Mild SARS-CoV-2 Infection in Children and Adolescents: A Randomized Controlled Trial

OBJECTIVE

To assess the effect and safety of Reyanning Mixture (RYN) in treating asymptomatic or mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents.

METHODS

This is a prospective, open-label, randomized controlled trial. Patients aged 1-17 years and diagnosed with asymptomatic or mild coronavirus disease-2019 (COVID-19) were assigned to an intervention group (RYN plus standard care) and a control group (standard care) according to a randomization list. The primary outcomes were SARS-CoV-2 negative conversion time. Secondary outcomes included negative conversion rate on days 3 and 7, hospital length of stay, symptom relief rate, new-onset symptoms of asymptomatic infected patients, and progressive disease rate. The cycle threshold (Ct) values of ORF1ab or N genes were also tested.

RESULTS

A total of 214 patients in the intervention group and 217 in the control group were analyzed. The SARS-CoV-2 negative conversion time was significantly shortened in the intervention group [5 days (interquartile range (IQR): 5-6) vs. 7 days (IQR: 6-7), P<0.01]. By days 3 and 7, the negative conversion rates were significantly higher in the intervention group (day 3: 32.7% vs. 21.2%, P=0.007; day 7: 75.2% vs. 60.8%, P=0.001). Ct values significantly increase on day 2 [ORF1ab gene: 35.62 (IQR: 29.17-45.00) vs. 34.22 (IQR: 28.41-39.41), P=0.03; N gene: 34.97 (IQR: 28.50-45.00) vs. 33.51 (IQR: 27.70-38.25), P=0.024] and day 3 [ORF1ab gene: 38.00 (IQR: 32.72-45.00) vs. 35.81 (IQR: 29.96-45.00), P=0.003; N gene: 37.16 (IQR: 32.01-45.00) vs. 35.26 (IQR: 29.09-45.00), P=0.01]. No significant difference was found in hospital length of stay between the two groups (P>0.05). Symptoms of cough were significantly improved (82.2% vs. 70.0%, P=0.02) and wheezing was significantly reduced (0.7% vs. 12.9%, P<0.01) in the intervention group compared with the control group. During the trial, no disease progression or serious adverse events were reported.

CONCLUSION

Adding RYN to standard care may be a safe and effective treatment for children with asymptomatic and mild SARS-CoV-2 infection. (Registration No. ChiCTR2200060292).

A Method for Detecting LDoS Attacks in SDWSN Based on Compressed Hilbert-Huang Transform and Convolutional Neural Networks

Currently, Low-Rate Denial of Service (LDoS) attacks are one of the main threats faced by Software-Defined Wireless Sensor Networks (SDWSNs). This type of attack uses a lot of low-rate requests to occupy network resources and hard to detect. An efficient detection method has been proposed for LDoS attacks with the features of small signals. The non-smooth small signals generated by LDoS attacks are analyzed employing the time-frequency analysis method based on Hilbert-Huang Transform (HHT). In this paper, redundant and similar Intrinsic Mode Functions (IMFs) are removed from standard HHT to save computational resources and to eliminate modal mixing. The compressed HHT transformed one-dimensional dataflow features into two-dimensional temporal-spectral features, which are further input into a Convolutional Neural Network (CNN) to detect LDoS attacks. To evaluate the detection performance of the method, various LDoS attacks are simulated in the Network Simulator-3 (NS-3) experimental environment. The experimental results show that the method has 99.8% detection accuracy for complex and diverse LDoS attacks.

MPP7 is a potential prognostic marker and is associated with cancer metabolism and immune infiltration in clear cell renal cell carcinoma: a bioinformatics analysis based on the TCGA database

Background

Metastasis is a major negative prognostic marker in clear cell renal cell carcinoma (ccRCC). Membrane palmitoylated proteins (MPPs) are a class of cell polarity-associated proteins that function in both cell-cell junction and adhesion. However, the relationship between MPP7 and the prognosis of ccRCC remains elusive. In this study, we aimed to investigate the associations between MPP7 expression with clinical prognosis of ccRCC using bioinformatics analyses.

Methods

The messenger RNA (mRNA) and protein expression patterns of MPP7 in different cancer types were examined using The Cancer Genome Atlas (TCGA) and Human Protein Atlas (HPA) databases, with key clinical characteristics (TNM and pathological stages, pathological grade, survival status) included. A nomogram model using MPP7 expressions and other clinical factors was built to predict the survival probability. The Kaplan-Meier plotter and Cox regression were employed to investigate the clinical significance and prognostic value of MPP7 in ccRCC. MPP7 expression-associated signaling pathways with were analyzed by the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) tools. The Tumor Immune Estimation Resource (TIMER) database was used to investigate the correlation between MPP7 and the infiltration patterns of immune cells.

Results

By analyzing TCGA-kidney renal clear cell carcinoma (TCGA-KIRC) and HPA databases, we found that MPP7 was differentially expressed in tumor tissues and adjacent normal tissues (P<0.001). The MPP7 expression patterns were associated with pathological stage (P<0.001), histological grade (P<0.01), and survival status (P<0.001). Using nomogram model, Cox regression and survival analysis, it showed that MPP7 expressions combined with key clinical factors could accurately predict the clinical prognosis. The promoter methylation patterns of MPP7 were correlated with the clinical factors of ccRCC patients. Furthermore, the KEGG and GO analyses demonstrated that MPP7 is associated with mitochondrial oxidative metabolism. MPP7 expression was associated with multiple types of immune cells and correlated with the enrichment of these cells.

Conclusions

MPP7 is a critical gene links with ccRCC prognosis and is associated with tumor immune status and metabolism. MPP7 could become a potential biomarker and important therapeutic target for ccRCC patients.

Application of combined anterior and posterior approaches for the treatment of cervical tuberculosis with anterior cervical abscess formation and kyphosis using a Jackson operating table: a case report and literature review

BACKGROUND

There have been insufficient reports to date regarding the treatment of cervical spinal tuberculosis, and the optimal surgical approaches to treating this condition have yet to be established.

CASE REPORT

This report describes the treatment of a case of tuberculosis associated with a large abscess and pronounced kyphosis through the use of a combined anterior and posterior approach with the aid of the Jackson operating table. This patient did not exhibit any sensorimotor abnormalities of the upper extremities, lower extremities, or trunk, and presented with symmetrical bilateral hyperreflexia of the knee tendons, while being negative for Hoffmann's sign and Babinski's sign. Laboratory test results revealed an erythrocyte sedimentation rate (ESR) of 42.0 mm/h and a C-reactive protein (CRP) of 47.09 mg/L. Acid-fast staining was negative, and spine magnetic resonance imaging revealed the destruction of the C3-C4 vertebral body and a posterior convex deformity of the cervical spine. The patient reported a visual analog pain score (VAS) of 6, and exhibited an Oswestry disability index (ODI) score of 65. Jackson table-assisted anterior and posterior cervical resection decompression was performed to treat this patient, and at 3 months post-surgery the patient's VAS and ODI scores were respectively reduced to 2 and 17. Computed tomography analyses of the cervical spine at this follow-up time point revealed good structural fusion of the autologous iliac bone graft with internal fixation and improvement of the originally observed cervical kyphosis.

CONCLUSIONS

This case suggests that Jackson table-assisted anterior-posterior lesion removal and bone graft fusion can safely and effectively treat cervical tuberculosis with a large anterior cervical abscess combined with cervical kyphosis, providing a foundation for future efforts to treat spinal tuberculosis.

Efficacy of Lianhua Qingwen for children with SARS-CoV-2 Omicron infection: A propensity score-matched retrospective cohort study

BACKGROUND

Lianhua Qingwen Granules or Capsules (LHQW) has accumulated much research evidence in the fight against the coronavirus disease 2019 (COVID-19) epidemic. However, there are still few data on its efficacy and safety in children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

PURPOSE

To evaluate the efficacy and safety of LHQW in children with SARS-CoV-2 Omicron infection.

METHODS

We conducted a single-center, propensity-score matched retrospective cohort study of children with SARS-CoV-2 Omicron infection in Shanghai New International Expo Center mobile cabin hospital between April 1st and June 1st, 2022. Eligible patients received either LHQW granules/capsules plus supportive care (LHQW group) or supportive care alone (control group). The primary outcome was the negative conversion time of nucleic acid. Secondary outcomes included the negative conversion rate of nucleic acid, the length of hospital stay, clinical disease progression, and cycle threshold [Ct] values for SARS-CoV-2 open reading frame [ORF1ab] or nucleocapsid [N] genes.

RESULTS

Overall, 2808 patients were enrolled, and 346 patients in each group were included in the analysis. Among the propensity-score matched groups, LHQW treatment was associated with an accelerated negative conversion time of nucleic acid (median: 5 d vs. 6 d, Hazard ratio: 1.25, 95% CI: 1.08 - 1.46, Log-rank p < 0.001), a higher negative conversion rate of nucleic acid (Day 2 - 6: 2.9% vs. 0.6%, p = 0.036; 29.8% vs. 5.5%, p < 0.001; 42.5% vs. 24.3%, p < 0.001; 51.4% vs. 31.5%, p < 0.001; 63.3% vs. 55.2%, p = 0.030), shorter hospital stay (median: 10 d vs. 11 d, Hazard ratio: 1.50, 95% CI: 1.29 - 1.74, Log-rank p < 0.001), and lower rates of asymptomatic infection progressing to mild (37.9% vs. 46.5%, p = 0.021).

CONCLUSION

Our study suggested that LHQW treatment was associated with faster clinical recovery in children with SARS-CoV-2 Omicron infection.

Applications of Graphene in Five Senses, Nervous System, and Artificial Muscles

Graphene remains of great interest in biomedical applications because of biocompatibility. Diseases relating to human senses interfere with life satisfaction and happiness. Therefore, the restoration by artificial organs or sensory devices may bring a bright future by the recovery of senses in patients. In this review, we update the most recent progress in graphene based sensors for mimicking human senses such as artificial retina for image sensors, artificial eardrums, gas sensors, chemical sensors, and tactile sensors. The brain-like processors are discussed based on conventional transistors as well as memristor related neuromorphic computing. The brain-machine interface is introduced for providing a single pathway. Besides, the artificial muscles based on graphene are summarized in the means of actuators in order to react to the physical world. Future opportunities remain for elevating the performances of human-like sensors and their clinical applications.

IGF2BP2 promotes pancreatic carcinoma progression by enhancing the stability of B3GNT6 mRNA via m6A methylation

BACKGROUND

Pancreatic carcinoma (PC) is a highly lethal cancer with an increasing mortality rate, its five-year survival rate is only approximately 4%. N6-methyladenosine (m6A) modification is the most common posttranscriptional modification of RNA, it could affect tumor formation by regulating m6A modifications in the mRNA of key oncogenes or tumor suppressor genes. However, its role in PC remains unclear.

METHODS

We combined bioinformatic analysis with in vitro and in vivo experiments to investigate the expression profile of methylation modulators and identify key m6A regulators in the progression of PC. Further study focused on exploring the target genes binding to the regulators through RIP and immunofluorescence staining experiment.

RESULTS

TCGA and Gene Expression Omnibus (GEO) analyses revealed an overall increasing trend in the expression of m6A regulators in PC, and consensus clustering analysis of m6A modification showed that the expression of regulators was negatively correlated with the survival rate. LASSO-Cox regression analysis revealed that IGF2BP2, METTL3, ALKBH5 and KIAA1429 were associated with hazard ratios (HR), but only IGF2BP2 was sufficiently appropriate for the m6A survival prognosis model. The IHC and WB results verified high protein expression of IGF2BP2 in PC, and IGF2BP2 knockdown inhibited the proliferation and migration of PC cells. We predicted and verified B3GNT6 was observably regulated by IGF2BP2 via RIP assays. In addition, IF staining confirmed the co-expression of IGF2BP2 and B3GNT6. The tumor-promoting effect of IGF2BP2 and its co-expression with B3GNT6 were verified in an animal model.

CONCLUSIONS

Elevated m6A levels promote PC progression. IGF2BP2 is a credible marker and modulates B3GNT6 mRNA stability, indicating that IGF2BP2 is a potential prognostic marker and therapeutic target in PC progression.

Efficacy and safety of Reyanning mixture in patients infected with SARS-CoV-2 Omicron variant: A prospective, open-label, randomized controlled trial

BACKGROUND

A wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant rapidly resulted in a steep increase in the infected population and an overloaded healthcare system. Effective medications for Omicron are currently limited. The previous observational study supports the efficacy and safety of Reyanning (RYN) mixture in the treatment of coronavirus disease 2019 (COVID-19).

PURPOSE

To evaluate the efficacy of RYN in asymptomatic and mildly infected patients with SARS-CoV-2 infection.

STUDY DESIGN AND METHODS

This study was a prospective, open-label, randomized controlled trial. We consecutively recruited 2830 patients from Shanghai New International Expo Center mobile cabin hospital and randomized them in a 1:1 ratio to receive RYN plus standard care or receive standard care alone. The primary outcomes were the negative conversion of nucleic acid. Secondary outcomes included the hospital duration, new-onset symptoms, proportion of disease progression, and the viral load measured by the cycle threshold (Ct) value.

RESULTS

A total of 1393 patients in the intervention group and 1407 patients in the control group completed the study. The negative conversion time of nucleic acid was significantly shortened in the intervention group (median: 6 d vs. 7 d, Hazard ratio: 0.768, 95CI %: 0.713-0.828, p < 0.0001). The negative conversion rate of nucleic acid was significantly higher in the intervention group (Day 3: 32.4% vs. 18.3%; Day7: 65.3% vs. 55.2%, p < 0.001). The hospitalization duration was significantly shortened in the intervention group (median: 8 d vs. 9 d, Hazard ratio: 0.759, 95% CI: 0.704-0.818, p < 0.0001). The proportion of new-onset fever (2.4% vs. 4.1%, p = 0.012), coughing (12.2% vs. 14.8%, p = 0.046), and expectoration (6.0% vs. 8.0%, p = 0.032) in the intervention group was significantly lower. RYN treatment increased Ct values and reduced the viral load. No disease progression and serious adverse events were reported during the study.

CONCLUSION

RYN is a safe and effective treatment that can accelerate virus clearance and promote disease recovery in asymptomatic and mild Omicron infections.

[Epidemiological characteristics and the establishment and evaluation of a risk prediction model for nosocomial infection in burn patients]

Objective: To find the epidemiological characteristics of nosocomial infection in burn patients, to establish a risk prediction model for nosocomial infection in burn patients based on the screened independent risk factors of the infection, and to analyze its predictive value. Methods: A retrospective case series study was conducted. From May 2016 to December 2019, 3 475 burn patients who were admitted to the Department of Burns of Affiliated Hospital of Jiangnan University met the inclusion criteria, including 2 290 males and 1 185 females, aged from 1 to 94 years. The incidence of nosocomial infection, the detection site and specific composition of pathogenic bacteria were counted. The patients were randomly divided into training group (2 434 cases) and verification group (1 041 cases) in R 4.1.3 statistic software with a ratio of about 7∶3. Factors including gender, age, total burn area, combination of full-thickness burn/inhalation injury/shock/diabetes on admission, admission to intensive care unit (ICU), status of central venous catheterization/endotracheal intubation/urethral catheter indwelling/surgery, nosocomial infection status, days of antibiotic use, and days of hospital stay of patients were compared between the two groups. According to the occurrence of nosocomial infection, the patients were divided into nosocomial infection group (102 cases) and non-nosocomial infection group (3 373 cases), and in addition to the aforementioned data, non-nosocomial infection related data, the season of admission and types of antibiotics used were compared between the two groups. The above-mentioned data were statistically analyzed with one-way analysis of independent sample t test, chi-square test, and Mann-Whitney U test, and the indicators with statistically significant differences between nosocomial infection group and non-nosocomial infection group were included as variables in multivariate logistic regression analysis to screen independent risk factors for the development of nosocomial infection in 3 475 burn patients. On the basis of independent risk factors and important clinical characteristics, a nomogram prediction model was constructed for the risk of developing nosocomial infection of burn patients in training group. In both training group and verification group, receiver operating characteristic (ROC) curves for prediction of nosocomial infection by the prediction model were plotted, and the area under the ROC curve was calculated; calibration curves were plotted to evaluate the conformity between the predicted results of the prediction model and the actual situation; clinical decision curves were plotted to evaluate the clinical utility of the prediction model. Results: The incidence of nosocomial infection of patients included in this study was 2.94% (102/3 475); pathogens were detected from 212 specimens, mainly wound (78 cases, accounting for 36.79%) and blood (64 cases, accounting for 30.19%) specimens; 250 strains of pathogenic bacteria were detected, mainly gram-negative bacteria (153 strains, accounting for 61.20%). All clinical characteristics of patients between training group and verification group were similar (P>0.05). There were statistically significant differences between patients in nosocomial infection group and non-nosocomial infection group in the aspects of age, total burn area, days of antibiotic use, antibiotic use type, days of hospital stay, combination of full-thickness burn, combination of inhalation injury, combination of shock, ICU admission status, central venous catheterization status, endotracheal intubation status, urethral catheter indwelling status, surgery status (with Z values of 4.41, 14.95, 15.70, 650.32, and 13.73, χ2 values of 151.09, 508.30, 771.20, 955.79, 522.67, 967.40, 732.11, and 225.35, respectively, P<0.01). ICU admission, endotracheal intubation, urethral catheter indwelling, and days of hospital stay were independent risk factors for developing nosocomial infection by 3 475 burn patients (with odds ratios of 5.99, 3.39, 9.32, and 6.21, 95% confidence intervals of 2.25-15.99, 1.56-7.39, 2.77-31.31, and 2.48-15.92, respectively, P<0.01). In training group and verification group, the area under ROC curves of the nosocomial infection prediction model based on independent risk factors, total burn area, and central vein catheterization were both 0.97 (with both 95% confidence intervals being 0.95-0.99); the calibration curve analysis showed that the prediction results of the prediction model were in good agreement with the actual situation; the clinical decision curve analysis showed that the prediction model had good clinical utility. Conclusions: The nosocomial infection in burn patients is mainly caused by gram-negative bacteria, with wound as the main infection site, and the independent risk factors including ICU admission, endotracheal intubation, urethral catheter indwelling, and days of hospital stay. Based on independent risk factors and important clinical features, the risk prediction model for nosocomial infection has a good ability to predict nosocomial infection in burn patients.

Clinical predictors and RT-PCR profile of prolonged viral shedding in patients with SARS-CoV-2 Omicron variant in Shanghai: A retrospective observational study

Objective

To evaluate determinants of prolonged viral RNA shedding in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection.

Materials and methods

Hospitalized patients tested SARS-CoV-2 positive by nasopharyngeal real-time reverse transcriptase-polymerase chain reaction (RT-PCR) were included in the single-center, retrospective study. Patients were divided into 2 groups according to the timing of viral clearance (≤ 8 days, "early clearance" and ≥15 days, "late clearance").

Results

4,084 patients were included in the study (1,023 late clearance, 3,061 early clearance), with median age of 50 years and a higher proportion (61.4%) of male. Univariate analyses showed that comorbidities (including hypertension, diabetes, and coronary heart disease), receiving vaccine, the number of vaccinations, cycle threshold (Ct) open reading frame 1ab (ORF 1ab), and nucleocapsid protein (N) gene values on admission were associated with late viral clearance. In the multivariable analysis, the number of vaccinations (P = 0.010) and Ct ORF 1ab gene (P < 0.001) values on admission were significantly associated with late viral clearance. Generalized Estimating Equations (GEE) analysis showed that the Ct value of ORF 1ab gene and N gene remained unchanged within 3 days, and showed progressively higher values with increasing days during late viral RNA clearance.

Conclusion

The number of vaccinations and Ct values of ORF 1ab gene were independently associated with a prolonged SARS-CoV-2 RNA shedding.

PANK1 associates with cancer metabolism and immune infiltration in clear cell renal cell carcinoma: a retrospective prognostic study based on the TCGA database

Background

Identify key biomarkers to improve the clinical prognosis of patients with advanced and metastatic clear cell renal cell carcinoma (ccRCC) remains an important research topic. Recently, ccRCC has been regarded as a metabolic disease. Pantothenate kinase-1 (PANK1) has been shown to play an important regulatory role in global metabolism and associates with the pathogenesis of hepatocellular carcinoma. Therefore, we aimed to investigate the role of PANK1 in the prognosis of ccRCC and in metabolism and immunity.

Methods

PANK1 messenger ribonucleic acid (RNA) expression patterns in ccRCC using The Cancer Genome Atlas (TCGA) database. The clinical prognostic significance of PANK1 in ccRCC and a Cox regression was performed to evaluate the clinical factors associated with prognosis with confounding factors adjusted. The signaling pathways related to PANK1 expression were identified by Gene Ontology (GO) investigation and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. The Tumor Immune Estimation Resource database was used to analyze the correlation between PANK1 and tumor-infiltrating immune cells.

Results

A total of 539 ccRCC patients and corresponding clinical samples and data from TCGA were included in this analysis. Significant differences were observed in PANK1 expression levels between tumor tissues and adjacent normal tissues in both TCGA-Kidney Renal Clear Cell Carcinoma cohort (4.40 vs. 2.94, P<0.001). PANK1 expression was found to be correlated with pathological stage, histological grade, age, sex, and clinical prognosis. Specifically, the low expression of PANK1 was found to be closely related to poor overall survival (OS), disease-specific survival (DSS), and the progression-free survival (PFS) in ccRCC patients. The receiver operating characteristic curve suggested that PANK1 could be a potential prognostic biomarker (area under the curve =0.880), and that the promoter methylation levels of PANK1 were correlated with clinical factors. Further, PANK1 expression was found to be associated with multiple immune cell types and correlated with the enrichment of these cells. Finally, we further investigated the role of PANK1 in tumor growth and mitochondrial metabolism using ccRCC cells.

Conclusions

PANK1 correlates with ccRCC prognosis, tumor immune status and metabolism using the TCGA data. PANK1 might be a prognostic marker of clinical prognosis for ccRCC patients.

[Analysis of clinical characteristics and prognosis of 4 264 patients with asymptomatic and mild novel coronavirus infections in Shanghai]

OBJECTIVE

To analyze the clinical characteristics and prognosis of patients infected with novel coronavirus Omicron variant in Shanghai, as to provide a reference for epidemic prevention, clinical diagnosis, and treatment.

METHODS

Altogether 4 264 novel coronavirus Omicron variant-infected patients with positive results of nucleic acid admitted to Shanghai New International Expo Center N3 Mobile Cabin Hospital from April 2 to May 7, 2022, were included. The demographic and baseline clinical characteristics, treatment strategy, prognosis, and different factors affecting the length of hospital stay were analyzed.

RESULTS

A total of 4 264 novel coronavirus variant Omicron-infected cases were collected, including 3 111 cases (73.0%) asymptomatic infections and 1 153 cases (27.0%) mild infections. The overall median age was 45 (33, 55) years old with a range from 2 years old to 81 years old. The male to female ratio was 1.37:1. Altogether 3 305 cases (77.5%) had been vaccinated, of which 3 166 cases completed more than 2 doses. The upper respiratory tract symptoms such as cough and expectoration were the most common clinical manifestations of these infected patients. During the course of the disease, patients with asymptomatic infection were mainly treated with traditional Chinese medicine (TCM, 55.1%) and clinical observation (36.8%), and those with mild infection were mainly treated with TCM (42.2%) or integrated Chinese and Western medicine (30.4%). All patients were cured and discharged. The overall median length of hospital stay and the negative conversion time of nucleic acid were 9 (6, 10) days and 8 (5, 9) days, respectively. Compared with the asymptomatic infected patients, the hospitalization duration and the nucleic acid negative conversion time of the mildly infected patients were slightly longer [days: 10 (8, 11) vs. 9 (5, 10); 8 (6, 10) vs. 7 (4, 9), both P < 0.001]. Multiple linear regression analysis showed that the increasing age and mild infection were associated with longer hospitalization duration, and the treatment of TCM or integrated Chinese and Western medicine was associated with shortened length of hospital stay (all P < 0.05).

CONCLUSIONS

The current novel coronavirus Omicron variant epidemic in Shanghai mainly caused asymptomatic and mild infections. The young and middle-aged population had a relatively high infection rate. The upper respiratory tract symptoms such as cough and expectoration were the most common clinical symptoms. Elderly and confirmed patients had prolonged hospitalization duration, while for patients receiving TCM treatment, the hospitalization duration was shortened.

The Status of Iodine Nutrition after Removing Iodized Salt in High Water Iodine Regions: a Cross-sectional Study in China

Currently, the removal of iodized salt is carried out in high water iodine regions. The present situation of iodine nutrition and the prevalence of thyroid diseases in such regions have not been clearly elucidated. This study aimed to figure out these problems to help render effective measures for cases of abnormal iodine nutrition status. A cross-sectional study was carried out in four areas of Jining and Heze, Shandong Province, China, with different water iodine concentrations (WIC). In total, 1344 adults were enrolled in this study, and data related to their iodine nutrition, thyroid function, and thyroid ultrasonography were collected. Subjects were grouped according to WIC, urine iodine concentration (UIC), serum iodine concentration (SIC), and combined UIC and SIC for analysis. Iodine levels were in excess in the 100 μg/L ≤ WIC < 300 μg/L and WIC ≥ 300 μg/L areas. Compared with the control WIC group (10-100 μg/L), the WIC ≥ 300 μg/L group had a higher prevalence of thyroid autoimmunity (TAI, 21.25% vs. 13.19%, P <0.05), subclinical hypothyroidism (SH, 20.20% vs. 11.96%, P < 0.05), thyroid nodules (TN, 31.75% vs. 18.71%, P < 0.05), and thyroid dysfunction (23.62% vs. 12.26%, P < 0.05). Compared with the UIC control group (100-300 μg/L), high UIC group (≥ 800 μg/L) had a higher prevalence of TN (33.75% vs. 21.14%, P < 0.05) and thyroid dysfunction (25% vs. 14.47%, P < 0.05). Next, compared with the control SIC group (50-110 μg/L), high SIC group (≥ 110 μg/L) had a higher prevalence of TAI (33.80% vs. 14.47%, P < 0.05), SH (23.94% vs. 14.30%, P < 0.05), and thyroid dysfunction (33.80% vs. 15.29%, P < 0.05). Finally, subjects with the highest UIC and the highest SIC also had a higher prevalence of TAI (25.92% vs. 10.97%, P < 0.05), SH (23.45% vs. 10.97%, P < 0.05), TN (34.56% vs. 15.85%, P < 0.05), and thyroid dysfunction (27.16% vs. 13.41%, P < 0.05) than subjects with middle iodine levels. The iodine nutrition of subjects in the WIC ≥ 300 μg/L areas was still in excess after removing iodized salt from their diets. High levels of iodine also increased the prevalence of TAI, SH, TN, and thyroid dysfunction in those areas. Simply removing iodized salt may not be sufficient for high water iodine regions.

Deep learning based classification of left ventricular function from two-dimensional echocardiographic images

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Philips Healthcare

Background. Echocardiographic quantification of left ventricular function (LVF) is mainly based on ejection fraction (EF) measurements, which relies on either manual or automated identification of endocardial boundaries followed by calculation of model-based end-systolic and end-diastolic LV volumes. Recent developments in artificial intelligence resulted in computer algorithms that allow fully automated detection of endocardial boundaries and measurement of LV volumes and EF. However, this methodology is prone to errors and inter-measurement variability. We hypothesized that a fully automated deep learning algorithm could be developed, which would accurately classify LVF while avoiding volume and EF measurements. This study was designed to test the accuracy of this approach.

Methods. Deep learning algorithm was developed (Philips Research) based on convolutional neural network (CNN) that uses as input dynamic sequences of apical 2- and 4-chamber echocardiographic views obtained without ultrasound enhancing agents. We used for CNN development a database of clinical DICOM studies: a training set of 14,427 studies with normal LV function and 6,135 abnormal, and a validation set of 2,898 normal and 1,081 abnormal studies, based on Philips IntelliSpace Cardiovascular (ISCV) codes found (defined by cardiologists) in the patients’ reports. The CNN was trained to automatically classify LVF into 3 categories: (1) normal, (2) mildly-to-moderately or moderately reduced, and (3) moderately-to-severely or severely reduced. In the validation set, the automated classifications were compared to those in the patients’ reports as a reference standard. Accuracy of the automated classification was tested using contingency tables, from which sensitivity, specificity, and negative and positive predictive values (NPV, PPV) and overall accuracy were calculated for each category of LVF. Additionally, the area under ROC curve (AUC) was calculated to assess the diagnostic accuracy of the automated classification for each LVF category.

Results.  Automated classification of LVF showed high levels of diagnostic accuracy in identifying cases with LVF in all 3 categories, reflected by high AUC values: (1) 0.94, (2) 0.87 and (3) 0.97 (Figure), and overall accuracy of 0.84 (Table). 

Conclusions. Deep learning algorithm based on CNN allowed accurate automated classification of LVF, when tested on ∼4,000 clinical studies and compared to ISCV codes found in the patients’ reports. This novel fully-automated methodology may become a useful aid in the interpretation of echocardiographic images by providing the reader with a preliminary assessment of LVF. Abstract Figure.

TREATMENT OF SECONDARY LOWER LIMB LYMPHEDEMA AFTER GYNECOLOGIC CANCER WITH COMPLEX DECONGESTIVE THERAPY

Secondary lower extremity lymphedema is a common complication of treatment for gynecological cancers. Conservative therapy plays an important role in the treatment of patients with secondary lower extremity lymphedema; in particular, complex decongestive therapy (CDT) has been recognized as an effective nonoperative technique for these patients. But CDT therapy for secondary lower extremity lymphedema remains a problem in China because this technique and its effectiveness have not achieved widespread use and popularity. Our goal was to assess effects of CDT in patients with secondary lower limb lymphedema after treatment for gynecological cancers. The retrospective study consisted of 60 patients who were treated with 20 sessions of CDT. Assessments included objective changes in limb circumference, degree of LE, imaging features, and incidence of erysipelas before and after CDT treatment. We found that CDT can effectively improve lymph stasis and promote backflow, and decrease circumference, interstitial fluid content, and incidence of erysipelas of lymphedematous lower limb. Our results demonstrate that CDT is an effective treatment method for patients with secondary lower limb lymphedema following treatment for gynecologic cancers. This technique should be more widely utilized and popularized in China to improve the quality of life of millions of patients with secondary lower limb lymphedema.

New developments in defecatory studies based on biomechatronics

Introduction

Defecation is a complex process that is difficult to study and analyze directly. In anorectal disease conditions, the defecation process may be disturbed, resulting in symptoms including fecal incontinence and constipation. Current state-of-the-art technology measures various aspects of anorectal function but detailed analysis is impossible because they are stand-alone tests rather than an integrated multi-dimensional test.

Objectives

The need for physiologically-relevant and easy-to-use diagnostic tests for identifying underlying mechanisms is substantial. We aimed to advance the field with integrated technology for anorectal function assessment.

Methods

We developed a simulated stool named Fecobionics that integrates several tests to assess defecation pressures, dimensions, shape, orientation and bending during evacuation. A novelty is that pressures are measured in axial direction, i.e. in the direction of the trajectory. Using this novel tool, we present new analytical methods to calculate physiologically relevant parameters during expulsion in normal human subjects.

Results

Data are reported from 28 human subjects with progressively more advanced versions of Fecobionics. A new concept utilizes the rear-front pressure (preload-afterload) diagram for computation of novel defecation indices. Fecobionics obtained physiological data that cannot be obtained with current state-of-the-art technologies.

Conclusion

Fecobionics measures well known parameters such as expulsion time and pressures as well as new metrics including defecation indices. The study suggests that Fecobionics is effective in evaluation of key defecatory parameters and well positioned as an integrated technology for assessment of anorectal function and dysfunction.

hsa_circ_0003410 promotes hepatocellular carcinoma progression by increasing the ratio of M2/M1 macrophages through the miR-139-3p/CCL5 axis

Noncoding RNAs have been verified to regulate the infiltration of macrophages to accelerate tumor biological progression, however the regulation of macrophages by circular RNAs in hepatocellular carcinoma (HCC) remains unresolved. Using high‐throughput RNA sequencing, we demonstrated that hsa_circ_0003410 was clearly upregulated in HCC. 5‐Ethynyl‐2′‐deoxyuridine and transwell assays showed that hsa_circ_0003410 facilitated the proliferation and migration of HCC cells in vitro. We knocked down the expression of hsa_circ_0003410 in HepG2 cells and performed next‐generation sequencing to determine possible target genes of hsa_circ_0003410. Kyoto Encyclopedia of Genes and Genomes analysis revealed that different genes were mainly enriched in immune‐related pathways. Mechanistically, we identified CCL5 as the target gene of hsa_circ_0003410. RNA‐FISH showed the co‐expression of hsa_circ_0003410 and CCL5. Western blot and ELISA also verified that hsa_circ_0003410 could upregulate the expression of CCL5 protein. Flow cytometry and immunofluorescence assays indicated that CCL5 activated and recruited M2 macrophages and increased the ratio of M2/M1 macrophages to promote the progression of HCC. Animal experiments in vitro also confirmed our results. Taken together, our experiments revealed that noncoding RNAs play a critical role in the HCC microenvironment and can be considered as markers for the diagnosis and prognosis of HCC.

Role of miR-27a in the regulation of cellular function via the inhibition of MAP2K4 in patients with asthma

Asthma is a respiratory disease with a clinically high incidence, and repeated attacks of asthma severely affect the quality of life and even pose a threat to health, leading to severe burdens on families and even the society. A thorough understanding of the pathogenesis of asthma is essential for the prevention and treatment of asthma. This study aimed to examine the effect of the microRNA miR-27a on asthma and its relationship with mitogen activated protein kinase 4 (MAP2K4). Patients with asthma admitted to our hospital from August 2016 to August 2018 and healthy participants in the same period were included in this prospective analysis. The mRNA expression levels of miR-27a and MAP2K4 in peripheral blood were determined. Airway smooth muscle cells (ASMCs) were used to study the effects of miR-27a and MAP2K4 on cell biological behavior. The relationship between miR-27a and MAP2K4 was verified using dual-luciferase reporter assay. miR-27a expression was increased and MAP2K4 mRNA expression was decreased in asthma (P < 0.05). Increasing miR-27a expression and inhibiting MAP2K4 expression could enhance the activity of ASMCs, whereas inhibiting miR-27a expression and increasing MAP2K4 expression had the opposite effect (P < 0.05). Dual-luciferase reporter assay results showed that the fluorescence activity of MAP2K4-wild type was inhibited by increased miR-27a expression (P < 0.05). miR-27a promotes the proliferation and invasion of ASMCs by targeting MAP2K4 and is involved in the occurrence of asthma.

Metagenomic and metabolomic profiling reveals the correlation between the microbiota and flavor compounds and nutrients in fermented sausages

Understanding the interrelationships between the differentially abundant microorganisms and metabolites of traditional "Fuet" fermented sausages (FSs) and inoculated fermented sausages (IFSs) can help us identify key species that are missing from commercial starter cultures to reproduce the flavor compounds and nutrients of traditional Fuet FSs. IFSs, inoculated with P. pentosaceus, P. acidilactici, S. xylosus, S. carnosus (SBM-52) or P. pentosaceus, and S. xylosus (THM-17), were deficient in reproducing the volatilome profile (in particular esters, methyl aldehydes, and methyl ketones) of traditional Fuet FSs because of the lack of diverse Staphylococci (S. carnosus, S. xylosus, S. equorum, and S. saprophyticus). Moreover, the combination of Pediococcus and Staphylococcus were positively associated with amino acid, fatty acid, l-anserine, and l-carnosine levels. Pyridoxal and indolelactic acid levels were significantly increased in IFSs with the addition of P. acidilactici and S. carnosus, which were positively associated with vitamin B₆ and tryptophan metabolic pathways.

Circular RNA hsa_circ_0001306 Functions as a Competing Endogenous RNA to Regulate FBXW7 Expression by Sponging miR-527 in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most common types of cancer worldwide. Circular RNAs (circRNAs) have been reported to regulate many types of cancers, including HCC. The purpose of this study was to investigate the potential roles of hsa_circ_0001306 in HCC. Firstly, the downregulation of hsa_circ_0001306 was identified by high‑throughput RNA sequencing and further verified by qRT-PCR. Secondly, we evaluated the effects of hsa_circ_0001306 on HCC cell proliferation, invasion, cell cycle. Finally, we used an animal model to validate the in vitro experimental results. The expression of hsa_circ_0001306 was closely related to tumor size. Knockdown of hsa_circ_0001306 could downregulate F-box and WD repeat domain containing 7(FBXW7), a target of miR-527, thereby promoting HCC cell proliferation and invasion. Furthermore, hsa_circ_0001306 siRNA increased the multiplication rate of HCC tumors. Mechanistic studies indicated that hsa_circ_0001306 acts as a ceRNA for miR-527, which resulted in the reduction of its endogenous target, FBXW7. Hsa_circ_001306 is significantly downregulated in HCC, and the hsa_circ_0001306/miR-527/FBXW7 axis plays an important role in HCC progression.

Optimization of the electron beam dump for a GeV-class laser electron accelerator

The advances of laser-driven electron acceleration offer the promise of great reductions in the size of high-energy electron accelerator facilities. Accordingly, it is desirable to design compact radiation shielding for such facilities. A key component of radiation shielding is the high-energy electron beam dump. In an effort to optimize the electron beam dump design, different material combinations have been simulated with the FLUKA Monte Carlo code in the range of 1-40 GeV. The studied beam dump configurations consist of alternating layers of high-Z material (lead or iron) and low-Z material (high-density concrete or borated polyethylene) in either three-layer or five-layer structures. The designs of various beam dump configuration have been compared and it has been found that the iron and concrete stacking in a three-layer structure with a thick iron layer results in the lowest dose at 1, 10, and 40 GeV. The performance of the beam dump exhibits a strong dependence on the selected materials, the stacking method, the beam dump thickness, as well as the electron energy. This parametric study provides general insights that can be used for compact shielding design of future electron accelerator facilities.

[Early infantile epileptic encephalopathy caused by PACS2 gene variation: three cases report and literature review]

Objective: To explore the clinical features of three early-onset infantile epileptic encephalopathy (EIEE) patients with variations in phosphofurin acidic cluster sorting protein 2 (PACS2) gene and to review related literature. Methods: The clinical data and genetic features of three early infantile epileptic encephalopathy 66 (EIEE66) patients with a PACS2 gene variant diagnosed by the Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2019 to January 2020 were retrospectively analyzed. A literature search with "PACS2 gene" "PACS2" "epileptic encephalopathy, early infantile, 66" and"early infantile epileptic encephalopathy 66" as key words was conducted at PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform (up to July 2020). Case reports of patients with PACS2 gene variants and related clinical data were chosen and reviewed. Results: Case 1, a girl aged 2 years and 2 months was hospitalized because of repetitive seizures within more than two years and 6 convulsions within 2 days due to fever. The seizures occurred at the age of 7 days, characterized by focal seizures and generalized tonic-clonic seizures. Sometimes, the frequency of seizures increased with high fever. Regular treatment had not been implemented in the early stage, later seizures were controlled by valproic acid treatment. Case 2, a female 5 months of age, was admitted due to recurrent convulsions in nearly five months. Focal seizures occured at the age of 5 days. And the brain magnetic resonance imaging (MRI) confirmed abnormal cerebellar hemispheres and cerebellar vermis, as well as cerebellar dysplasia. Several antiepileptic drugs and ketogenic diet were ineffective in the early months, and later seizures were controlled with the treatment with levetiracetam and valproic acid. Case 3, a five-month-old girl, was admitted because of recurrent convulsions for nearly five months. At the age of 3 days, she had tonic seizures, and showed good response to levetiracetam and valproic acid. All the three cases were accompanied by development delay and dysmorphic facial appearance, and got seizure-free with the treatment with valproic acid. All copy-number variant analysis and trio whole exome sequencing revealed a recurrent heterozygous missense variant (c.625G>A) in PACS2 gene. No related reports were found in Chinese journals, while 4 reports were found in English literature, describing 17 patients in total. With these 3 patients included, 20 cases had only two missense PACS2 gene variants, in whom 19 cases carried the variant c. 625G>A (p.Glu209Lys) and 1 case carried the variant c. 631G>A (p.Glu211Lys). Epilepsy was the first reported symptom in all patients, and 17 cases had seizures during the first week of life. Out of the various seizure types observed, focal seizures were the predominant types (13 cases), whereas tonic, clonic, tonic-clonic seizures and non-motor seizures (such as facial flushing) were also reported. Almost all patients showed facial dysmorphism and developmental delay to different degrees. Total of 16 patients had abnormal brain MRI recordings, and 13 cases had cerebellar hypoplasia. More specifically, 7 cases showed inferior vermian hypoplasia, and 3 cases showed hypothalamic fusion anomaly. The treatment was mainly aimed to control the symptoms. And the recommended effective treatment for epilepsy has not been reported yet. Conclusions: PACS2-related early infantile epileptic encephalopathy is an autosomal dominant disease, characterized by seizure onset within the first week of life in most cases, dysmorphic facial appearance, and various degrees of developmental retardation. Treatment with valproic acid showed good effect.

Novel bionics developments in gastroenterology: fecobionics assessment of lower GI tract function

Biomechatronics (bionics) is an applied science that is interdisciplinary between biology and engineering (mechanical, electrical and electronics engineering). Biomechatronics covers a wide area and is probably best known in development of prosthetic limbs, vision aids, robotics and neuroscience. Although the gastrointestinal tract is difficult to study, it is particularly suited for a bionics approach as demonstrated by recent developments. Ingestible capsules that travel the tract and record physiological variables have been used in the clinic. Other examples include sacral nerve stimulators that seek to restore normal anorectal function. Recently, we developed a simulated stool termed fecobionics. It has the shape of normal stool and records a variety of parameters including pressures, bending (anorectal angle) and shape changes during colonic transit and defecation, i.e. it integrates several current tests. Fecobionics has been used to study defecation patterns in large animals as well as in humans (normal subjects and patient groups including patients with symptoms of obstructed defecation and fecal incontinence). Recently, it was applied in a canine colon model where it revealed patterns consistent with shallow waves originating from slow waves generated by the interstitial cells of Cajal. Furthermore, novel analysis such as the rear-front pressure (preload-afterload) diagram and quantification of defecation indices have been developed that enable mechanistic insight. This paper reviews the fecobionics technology and outlines perspectives for future applications.

Genome-wide analysis in 756,646 individuals provides first genetic evidence that ACE2 expression influences COVID-19 risk and yields genetic risk scores predictive of severe disease

SARS-CoV-2 enters host cells by binding angiotensin-converting enzyme 2 (ACE2). Through a genome-wide association study, we show that a rare variant (MAF = 0.3%, odds ratio 0.60, P=4.5×10^-13) that down-regulates ACE2 expression reduces risk of COVID-19 disease, providing human genetics support for the hypothesis that ACE2 levels influence COVID-19 risk. Further, we show that common genetic variants define a risk score that predicts severe disease among COVID-19 cases.

A multiscale modelling approach to elucidate the mechanism of the oxygen evolution reaction at the hematite-water interface

Photoelectrochemical (PEC) splitting of water to make hydrogen is a promising clean-energy technology. The oxygen evolution reaction (OER) largely determines the energy efficiency in PEC water-splitting. Hematite, which is a cheap and sustainable semiconductor material with excellent chemical properties, a favourable band gap (2.1 eV) and composed of earth abundant elements is a suitable model photoanode material for studying OER. To understand the design of energy efficient anodes, it is highly desirable to have mechanistic insight into OER at an atomistic level which can be directly connected to experimentally measured quantities. We present a multiscale computational model of OER which connects the thermodynamics and kinetics of elementary charge transfer reactions in OER to kinetics of OER at laboratory length and time scales. We couple density functional theory (DFT) and DFT based molecular dynamics (DFT-MD) simulations with solvent effects at an atomistic level with kinetic Monte Carlo (kMC) simulations at a coarse-grained level in our multiscale model. The time and applied bias potential dependent surface coverage, which are experimentally not known, and the O₂ evolution rate during OER at the hematite-water interface are calculated by the multiscale model. Furthermore, the multiscale model demonstrates the effect of explicitly modelling the interaction of water with the electrode surface via direct adsorption.

Expression of nuclear factor erythroid-2-related factor 2, broad complex-tramtrack-bric a brac and Cap'n'collar homology 1 and γ-glutamic acid cysteine synthase in peripheral blood of patients with chronic obstructive pulmonary disease and its clinical significance

The purpose of the present study was to explore the relationship between nuclear factor erythroid 2-related factor 2 (Nrf2)/BTB-CNC allogeneic 1 (Bach1)/γ-glutamic acid cysteine synthase (γ-GCS) and chronic obstructive pulmonary disease (COPD). The expression of Nrf2, Bach1, γ-GCS mRNA and protein in the peripheral blood mononuclear cells (PBMCs) of 80 COPD patients and 40 healthy volunteers were studied. Then, the correlation between Nrf2, Bach1, γ-GCS and lung function, inflammation and oxidative stress indicators was analyzed. Compared with healthy controls, Nrf2, Bach1 mRNA and protein levels were significantly increased in the PBMCs of COPD patients, while γ-GCS mRNA and protein levels were significantly decreased. Nrf2 and Bach1 protein levels in the nucleus were significantly elevated in acute exacerbation COPD patients compared with patients with a stable stage of COPD, while γ-GCS mRNA levels were significantly reduced. In addition, it was found that Nrf2 nuclear protein levels were significantly reduced in COPD patients compared with the control group, while Bach1 nuclear protein levels were significantly increased. Correlation analysis in COPD group demonstrated that γ-GCS mRNA was positively correlated with Nrf2 nuclear protein level, but negatively correlated with Bach1 nuclear protein level. Further analysis demonstrated that γ-GCS mRNA and Nrf2 protein in the nucleus was positively correlated with forced expiratory volume in one second (FEV₁)/forced vital capacity (FVC)% and FEV₁% predicted, and Bach1 protein in the nucleus was negatively correlated with FEV₁/FVC% and FEV₁% predicted. Additionally, the expression levels of Nrf2, Bach1 and γ-GCS were also associated with smoking. The expression of Nrf2, Bach1 and γ-GCS in peripheral blood mononuclear cells of patients with COPD was dysregulated and related to lung function, which provides a new basis for exploring further the pathogenesis of COPD.

Long non-coding RNA MIR4435-2HG recruits miR-802 from FLOT2 to promote melanoma progression

OBJECTIVE

The regulatory mechanism of lncRNA MIR4435-2HG has been extensively investigated in human cancers other than melanoma. This study aims to elucidate the role of lncRNA MIR4435-2HG in melanoma.

MATERIAL AND METHODS

The mRNA expression was detected by RT-qPCR. MTT assay, Transwell assay and Dual-Luciferase reporter assay were used to investigate the regulatory mechanism of lncRNA MIR4435-2HG.

RESULTS

Upregulation of lncRNA MIR4435-2HG was identified in melanoma and promoted melanoma cell proliferation, migration and invasion. In addition, lncRNA MIR4435-2HG serves as the ceRNA of miR-802. MiR-802 inhibited melanoma progression by downregulating lncRNA MIR4435-2HG. Besides, miR-802 directly targets FLOT2. And knockdown of FLOT2 restrained the progression of melanoma by downregulating lncRNA MIR4435-2HG and upregulating miR-802.

CONCLUSIONS

LncRNA MIR4435-2HG promotes cell proliferation, migration and invasion in melanoma by sponging miR-802 and upregulating FLOT2.