CHOROIDAL AND RETINAL ABNORMALITIES IN CUSHING SYNDROME: Correlation with the Cortisol Level

PURPOSE

To investigate the structure and blood flow of the retina and choroid in Cushing syndrome and their relationship with cortisol levels.

METHODS

A consecutive series of patients with Cushing syndrome with adrenocortical carcinoma were included in this study. Cortisol levels gradually returned to normal after adrenalectomy. Optical coherence tomography and optical coherence tomography angiography were used to assess patients with Cushing syndrome before and after the surgery for retina and choroid. Correlation analysis was performed between cortisol level and fundus changes.

RESULTS

Compared with normal cortisol levels, patients with Cushing syndrome had significantly lower central macular thickness with increased cortisol level (220.82 ± 16.59 µ m and 223.68 ± 15.78 µ m, P = 0.019). However, the central choroidal thickness was higher with increased cortisol level (255.18 ± 105.89 µ m and 205.94 ± 87.04 µ m, P < 0.001). The choriocapillaris flow area was higher with increased cortisol level (2.05 ± 0.14 mm 2 and 2.00 ± 0.13 mm 2 , P = 0.02). The change of choriocapillaris flow area was correlated with the score of Huaxi Emotional-distress Index and 24-hour urine-free cortisol (24h-UFC).

CONCLUSION

The increased cortisol level was correlated with lesser central macular thickness and thicker central choroidal thickness. The decrease of choriocapillaris flow area was correlated with 24h-UFC, indicating the effect of increased cortisol level on choroidal vessels.

Dual-responsive nanocarriers for efficient cytosolic protein delivery and CRISPR-Cas9 gene therapy of inflammatory skin disorders

Developing protein drugs that can target intracellular sites remains a challenge due to their inadequate membrane permeability. Efficient carriers for cytosolic protein delivery are required for protein-based drugs, cancer vaccines, and CRISPR-Cas9 gene therapies. Here, we report a screening process to identify highly efficient materials for cytosolic protein delivery from a library of dual-functionalized polymers bearing both boronate and lipoic acid moieties. Both ligands were found to be crucial for protein binding, endosomal escape, and intracellular protein release. Polymers with higher grafting ratios exhibit remarkable efficacies in cytosolic protein delivery including enzymes, monoclonal antibodies, and Cas9 ribonucleoprotein while preserving their activity. Optimal polymer successfully delivered Cas9 ribonucleoprotein targeting NLRP3 to disrupt NLRP3 inflammasomes in vivo and ameliorate inflammation in a mouse model of psoriasis. Our study presents a promising option for the discovery of highly efficient materials tailored for cytosolic delivery of specific proteins and complexes such as Cas9 ribonucleoprotein.

On-Chip Fabrication-Tolerant Exceptional Points Based on Dual-Scatterer Engineering

The intriguing and anomalous optical characteristics of exceptional points (EPs) in optical resonators have attracted significant attention. While EP-related phenomena have been observed by perturbing resonators with off-chip components, implementing EPs fully on-chip remains challenging due to their extreme susceptibility to fabrication errors. In this Letter, we propose a succinct and compact approach to reach EP in an on-chip integrated silicon microring resonator by manipulating the evolution of backscatterings with two nanocylinders of disparate diameters. The theoretical analysis unveils that the fabrication constraints could be significantly relieved by increasing the difference in diameters of the nanocylinders. The evolution from non-EP to EP is traced experimentally through the step-by-step tuning of the angular and radial positions of nanocylinders. The proposed method opens a pathway toward the on-chip high-density integration of non-Hermitian devices.

Intelligently Quantifying the Entire Irregular Dental Structure

Quantitative analysis of irregular anatomical structures is crucial in oral medicine, but clinicians often typically measure only several representative indicators within the structure as references. Deep learning semantic segmentation offers the potential for entire quantitative analysis. However, challenges persist, including segmentation difficulties due to unclear boundaries and acquiring measurement landmarks for clinical needs in entire quantitative analysis. Taking the palatal alveolar bone as an example, we proposed an artificial intelligence measurement tool for the entire quantitative analysis of irregular dental structures. To expand the applicability, we have included lightweight networks with fewer parameters and lower computational demands. Our approach finally used the lightweight model LU-Net, addressing segmentation challenges caused by unclear boundaries through a compensation module. Additional enamel segmentation was conducted to establish a measurement coordinate system. Ultimately, we presented the entire quantitative information within the structure in a manner that meets clinical needs. The tool achieved excellent segmentation results, manifested by high Dice coefficients (0.934 and 0.949), intersection over union (0.888 and 0.907), and area under the curve (0.943 and 0.949) for palatal alveolar bone and enamel in the test set. In subsequent measurements, the tool visualizes the quantitative information within the target structure by scatter plots. When comparing the measurements against representative indicators, the tool's measurement results show no statistically significant difference from the ground truth, with small mean absolute error, root mean squared error, and errors interval. Bland-Altman plots and intraclass correlation coefficients indicate the satisfactory agreement compared with manual measurements. We proposed a novel intelligent approach to address the entire quantitative analysis of irregular image structures in the clinical setting. This contributes to enabling clinicians to swiftly and comprehensively grasp structural features, facilitating the design of more personalized treatment plans for different patients, enhancing clinical efficiency and treatment success rates in turn.

[Preliminary application of recombinase -aided amplification in detection of Clonorchis sinensis metacercariae in freshwater fish]

OBJECTIVE

To evaluate the performance of recombinase-aided amplification (RAA) assay in detection of Clonorchis sinensis metacercariae in freshwater fish samples, so as to provide insights into standardization and field application of this assay.

METHODS

Wild freshwater fish samples were collected in the rivers of administrative villages where C. sinensis-infected residents lived in Jiangyan District, Xinghua County and Taixing County of Taizhou City, Jiangsu Province from June to September 2022. Genomic DNA was extracted from six freshwater fish specimens (5 g each) containing 0, 1, 2, 4, 8 and 16 C. sinensis metacercariae for fluorescent RAA assay, and the diagnostic sensitivity was evaluated. Fluorescent RAA assay was performed with genomic DNA from C. sinensis, Metorchis orientalis, Haplorchis pumilio and Centrocestus formosanus metacercariae as templates to evaluate its cross-reactions. In addition, the detection of fluorescent RAA assay and direct compression method for C. sinensis metacercariae was compared in field-collected freshwater fish samples.

RESULTS

Positive amplification was found in fresh-water fish specimens containing different numbers of C. sinensis metacercariae, and fluorescent RAA assay was effective to detect one C. sinensis metacercaria in 5 g freshwater fish specimens within 20 min. Fluorescent RAA assay tested negative for DNA from M. orientalis, H. pumilio and C. formosanus metacercariae. Fluorescent RAA assay and direct compression method showed 5.36% (93/1 735) and 2.88% (50/1 735) detection rates for C. sinensis metacercariae in 1 735 field-collected freshwater fish samples, with a statistically significant difference seen (χ2 = 478.150, P < 0.001). There was a significant difference in the detection of C. sinensis metacercariae in different species of freshwater fish by both the direct compression method (χ2 = 11.20, P < 0.05) and fluorescent RAA assay (χ2 = 20.26, P < 0.001), and the detection of C. sinensis metacercariae was higher in Pseudorasbora parva than in other fish species by both the direct compression method and fluorescent RAA assay (both P values < 0.05).

CONCLUSIONS

Fluorescent RAA assay has a high sensitivity for detection of C. sinensis metacercariae in freshwater fish samples, and has no cross-reactions with M. orientalis, H. pumilio or C. formosanus metacercariae. Fluorescent RAA assay shows a higher accuracy for detection of C. sinensis infections in field-collected freshwater fish than the direct compression method.

[Clinical characteristics of children with SARS-CoV-2 Omicron variant infection in Kunming]

Objective: To investigate the clinical characteristics of hospitalized children infected with the Omicron variant in Kunming after the withdrawal of non-pharmaceutical interventions (NPI) and analyze the risk factors of severe cases. Methods: Clinical data was retrospectively collected from 1 145 children with SARS-CoV-2 Omicron infection who were hospitalized in six tertiary grade A hospitals in Kunming from December 10th, 2022 to January 9th, 2023. According to clinical severity, these patients were divided into the general and severe SARS-CoV-2 groups, and their clinical and laboratory data were compared. Between-group comparison was performed using t-test, chi-square test and Mann-Whitney U test. Spearman correlation test and multivariate Logistic regression analysis were used to determine the risk factors of severe illness. Results: A total of 1 145 hospitalized patients were included, of whom 677 were male and 468 female. The age of these patients at visit was 1.7 (0.5, 4.1) years. Specifically, there were 758 patients (66.2%) aged ≤3 years at visit and 387 patients (33.8%) aged >3 years. Of these children, 89 cases (7.8%) had underline diseases and the remaining 1 056 cases (92.2%) had no combined diseases. Additionally, of all the patients, 319 cases (27.9%) were vaccinated with one or two doses of SARS-CoV-2 vaccine, 748 cases (65.3%) had acute upper respiratory tract infection (AURTI), and six cases died (0.5%). A total of 1 051 cases (91.8%) were grouped into general SARS-CoV-2 group and 94 cases (8.2%) were grouped into severe SARS-CoV-2 group. Compared with the general cases, the severe cases showed a lower rate of SARS-CoV-2 vaccination and younger median age, lower lymphocyte count, as well as proportions of CD8+T lymphocyte (36 cases (38.3%) vs. 283 cases (26.9%), 0.5 (2.6, 8.0) vs. 1.6 (0.5, 3.9) years, 1.3 (1.0, 2.7) ×109 vs. 2.7 (1.3,4.4)×109/L, 0.17 (0.12, 0.24) vs. 0.21 (0.15, 0.16), respectively, χ2=4.88, Z=-2.21,-5.03,-2.53, all P<0.05). On the other hand, the length of hospital stay, proportion of underline diseases, ALT, AST, creatine kinase isoenzyme, and troponin T were higher in the severe group compared to those in the general group ((11.6±5.9) vs. (5.3±1.8) d, 41 cases (43.6%) vs. 48 cases (4.6%), 67 (26,120) vs. 20 (15, 32) U/L, 51 (33, 123) vs. 44 (34, 58) U/L、56.9 (23.0, 219.3) vs. 3.6 (1.9, 17.9) U/L, 12.0 (4.9, 56.5) vs. 3.0 (3.0, 7.0) ×10-3 pg/L,respectively, t=-20.43, χ2=183.52, Z=-9.14,-3.12,-6.38,-3.81, all P<0.05). Multivariate regression analysis indicated that increased leukocyte count (OR=1.88, 95%CI 1.18-2.97, P<0.01), CRP (OR=1.18, 95%CI 1.06-1.31, P<0.01), ferritin (OR=1.01, 95%CI 1.00-1.00, P<0.01), interleukin (IL)-6 (OR=1.05, 95%CI 1.01-1.08, P=0.012), D-dimer (OR=2.56, 95%CI 1.44-4.56, P<0.01) and decreased CD4+T lymphocyte (OR=0.84, 95%CI 0.73-0.98, P=0.030) were independently associated with the risk of severe SARS-CoV-2 in hospitalized children with Omicron infection. Conclusions: After the withdrawal of NPI, the pediatric inpatients with Omicron infection in Kunming were predominantly children younger than 3 years of age, and mainly manifested as AURTI with relatively low rate of severe SARS-CoV-2 infection and mortality. Elevated leukocyte counts, CRP, ferritin, IL-6, D-dimer, and decreased CD4+T lymphocytes are significant risk factors for developing severe SARS-CoV-2 infection.

Dosimetric Validation of 3D-Printed Bolus at Different Printing Infill Percentage in VMAT Plan

PURPOSE/OBJECTIVE(S)

The 3D printed bolus technology is rapidly evolving in external beam radiotherapy and printing parameters can have a significant impact on absorbed dose. In this study, a novel 3D printed bolus was designed to evaluate the time and material cost effects, dosimetry differences, and surface dose modulation capabilities in the volumetric-modulated arc therapy (VMAT) plan at different print filling percentages.

MATERIALS/METHODS

A hollow-type bolus, the middle 2.36 mm of 5 mm thickness infilled with different ratio, was designed and printed with polylactic acid (PLA). The ratio of printed material was defined by the infill percentage parameter ranging from 10% to 90%. For each bolus, two treatment plans were designed with AAA algorithm, considering the real computed tomography (CT) scan of the 3D printed bolus and modeling the 3D printed bolus as a virtual bolus structure. Percentage depth dose (PDD) profiles were calculated to build up the mapping equivalent CT value in treatment plan system (TPS). Measurement dose was performed by radiographic films. The PDD profiles were then compared between measured and calculated. A simulation VMAT treatment plan with planning target volume (PTV) close to the body surface was designed on a water-equivalent phantom, and the modulation capabilities of epidermal dose under different filling percentage was compared.

RESULTS

Compared with 100% percent infill 3D printed bolus, The maximum printing time could be reduced by 47.8% and material consumption could be reduced by 42.5%. The surface dose at single field irradiation can reach 69.6% to 85.8% of the maximum dose in different filling boluses. The PDD measurement and mapping equivalent CT calculation deviation was less than 3% when the infill percentage of the middle region is greater than 30%. The dose distribution of the VMAT plan is satisfying for infill percentages greater than 30%.

CONCLUSION

Using the 3D printing technology is possible to modulate the amount of shift of the build-up region by tuning the infill percentage of the 3D printed bolus. Patients could undergo CT simulation without bolus. Appropriate bolus could be selected according to the location of the PTV region and dose requirement.

An Immune-Related Gene Prognostic Prediction Risk Model for Neoadjuvant Chemoradiotherapy in Rectal Cancer Using Artificial Intelligence

PURPOSE/OBJECTIVE(S)

To develop and validate an immune-related gene prognostic model (IRGPM) that can predict disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC) who received neoadjuvant chemoradiotherapy and to clarify the immune characteristics of patients with different prognostic risks.

MATERIALS/METHODS

In this study, we obtained transcriptomic and clinical data from the Gene Expression Omnibus (GEO) database and rectal cancer database of West China Hospital. Genes in the RNA immune-oncology panel were extracted. Elastic net was used to identify the immune-related genes that significantly affected the DFS of patients. A prognostic risk model (IRGPM) for rectal cancer was constructed with the random forest method. The prognostic risk score was calculated by the model, and the patients were divided into high- and low-risk groups according to the median risk score. Immune characteristics were analyzed and compared between the high- and low-risk groups.

RESULTS

A total of 407 LARC samples were used in this study. A 20-gene signature was identified by elastic net and was found to be significantly correlated with DFS. The IRGPM was constructed on the basis of the 20 immune-related genes. Kaplan‒Meier survival analysis showed poorer 5-year DFS in the high-risk group than in the low-risk group, and the receiver operating characteristic (ROC) curve suggested good model prediction (areas under the curve (AUCs) of 0.87, 0.94, 0.95 at 1, 3, and 5 years, respectively). The model was validated in the GSE190826 cohort (AUCs of 0.79, 0.64, and 0.63 at 1, 3, and 5 years, respectively) and the cohort from our institution (AUCs of 0.64, 0.66, and 0. 64 at 1, 3, and 5 years, respectively). The differentially expressed genes between the high- and low-risk groups were enriched in cytokine‒cytokine receptor interactions. The patients in the low-risk group had higher immune scores than the patients in the high-risk group. Subsequently, we found that activated B cells, activated CD8 T cells, central memory CD8 T cells, macrophages, T follicular helper cells and type 2 helper cells were more abundant in the low-risk group. Moreover, we compared the expression of immune checkpoints and found that the low-risk group had a higher PDCD1 expression level.

CONCLUSION

The IRGPM, which was constructed based on the random forest and elastic net methods, is a promising method to distinguish DFS in LARC patients treated with a standard strategy. The low-risk group identified by IRGPM was characterized by the activation of adaptive immunity in tumor microenvironment.

First Demonstration of the Commissioning of a New Multi-Modality Radiotherapy Platform

PURPOSE/OBJECTIVE(S)

A new multi-modality radiotherapy platform was developed and introduced into clinical application, which has received US FDA 510k(K210921) and National Medical Products Administration (NMPA) clearance in China (20223050973). This study, for the first time, presents the technological characteristics and commissioning results of the new platform.

MATERIALS/METHODS

The platform consists of 3 modules: linear accelerator, rotating gamma system, and a kV imaging system within an O-ring gantry. The O-ring gantry can rotate continuously achieved by using a slip ring. The Linac delivers a 6 MV FFF photon beam with a variable dose rate of 50 to 1400 MU/min. The delivery techniques include 3D-CRT, IMRT, and VMAT. The rotating gamma system utilizes 18 Co-60 sources with a reference dose rate of 350 cGy/min. The image-guided techniques consist of kV-kV pairs and kV-CBCT. The X-ray intensity-modulated radiotherapy and γ-ray stereotactic radiotherapy can be delivered on the same platform. The acceptance test and commissioning were performed following the vendor's customer acceptance tests (CAT) and several AAPM Task Group reports/guidelines. Regarding the Linac, all applicable validation tests recommended by the MPPG 5.a (basic photon beam model validation, IMRT/VMAT validation, E2E tests, and patient-specific QA) were performed. For the rotating gamma system, the absorbed doses were measured using a PTW31014 and PTW60016. EBT3 films were employed to measure the relative output factors (ROFs). The E2E tests were performed using a PTW31014 and EBT3 films. The coincidence between the imaging isocenter and the Linac/gamma treatment isocenter was investigated using EBT3 films. The image quality was evaluated regarding the contrast-to-noise ratio (CNR), spatial resolution, and uniformity.

RESULTS

All tests included in the CAT met the vendor's specifications. All MPPG 5.a tests complied with the tolerances. The confidence limits for IMRT/VMAT validation were achieved according to TG-119. The point dose differences were below 1.68% and gamma pass rates (3%/2 mm) were above 95.9% for the Linac E2E tests. All plans of patient-specific QA had point dose differences below 1.79% and gamma pass rates (3%/2 mm) above 96.1% suggested by TG-218. For the rotating gamma system, the differences between the calculated and measured absorbed doses were below 1.86%. The ROFs calculated by the TPS were independently confirmed within 2% using EBT3 films. The point dose differences were below 2.57% and gamma pass rates (2%/1 mm) were above 95.3% for the E2E tests. The coincidence between the imaging isocenter and the Linac/gamma treatment isocenter was within 0.5 mm. The image quality fully complied with the vendor's specifications regarding the CNR, spatial resolution, and uniformity.

CONCLUSION

This is the first report about the commissioning of a new multi-modality radiotherapy platform. The platform has been successfully commissioned and exhibits good performance in mechanical and dosimetry accuracy.

The Association Between Lipid Profile and Subfoveal Choroidal Thickness in Chinese Patients with Proliferative Diabetic Retinopathy Secondary to Type 2 Diabetes

Introduction

Extensive studies have studied the factors associated with subfoveal choroidal thickness (SFCT). However, studies of the association between lipid profile and SFCT in patients with proliferative diabetic retinopathy (PDR) in type 2 diabetes remain limited. Thus, we aimed to investigate the relationship between lipid profile and SFCT in patients with PDR.

Materials and Methods

This was a retrospective cross-sectional study. The included participants were inpatients who underwent vitrectomy for PDR with type 2 diabetes and contralateral eyes of PDR patients meeting the criteria. Multivariate linear regression analysis was used to determine the independent association between lipid profile and SFCT.

Results

A total of 131 participants with PDR were enrolled in the final analysis. The average age of the participants was 55.76 ± 9.88 years, and the average SFCT was 276.10 ± 92.92 μm. Multivariate linear regression model results showed that in the fully adjusted model, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) had a negative association with SFCT (β = -16.51, 95% CI: -29.57, -3.46; P = 0.0148; β = -42.65, 95% CI: -82.60, -2.70; P = 0.0390; β = -17.89, 95% CI: -33.24, -2.54; P = 0.0245, respectively), while triglyceride was not significantly associated with SFCT (β = 5.23, 95% CI: -18.57, 29.02; P = 0.6678). Furthermore, the results of stratified analysis showed that except for triglyceride, the trends of total cholesterol, HDL-C, LDL-C, and SFCT were consistent among different stratifications in participants.

Conclusion

The cholesterol profile had a significant negative association with SFCT in Chinese PDR patients, but triglyceride was not significantly associated with SFCT. This suggests that these systemic imbalances contribute to choroidal changes, and often coexist in diabetic patients.

Optical noise characteristics of injection-locked epitaxial quantum dot lasers on silicon

This work theoretically investigates the relative intensity noise (RIN) and spectral linewidth characteristics of epitaxial quantum dot (QD) lasers on silicon subject to optical injection. The results show that the RIN of QD lasers can be reduced by optical injection, hence a reduction of 10 dB is achieved which leads to a RIN as low as -167.5 dB/Hz in the stable injection-locked area. Furthermore, the spectral linewidth of the QD laser can be greatly improved through the optical injection locked scheme. It is reduced from 556.5 kHz to 9 kHz with injection ratio of -60 dB and can be further reduced down to 1.5 Hz with injection ratio of 0 dB. This work provides an effective method for designing low intensity noise and ultra-narrow linewidth QD laser sources for photonics integrated circuits on silicon.

Multiple and spectrally robust photonic magic angles in reconfigurable α-MoO3 trilayers

The emergence of a topological transition of the polaritonic dispersion in twisted bilayers of anisotropic van der Waals materials at a given twist angle-the photonic magic angle-results in the diffractionless propagation of polaritons with deep-subwavelength resolution. This type of propagation, generally referred to as canalization, holds promise for the control of light at the nanoscale. However, the existence of a single photonic magic angle hinders such control since the canalization direction in twisted bilayers is unique and fixed for each incident frequency. Here we overcome this limitation by demonstrating multiple spectrally robust photonic magic angles in reconfigurable twisted α-phase molybdenum trioxide (α-MoO₃) trilayers. We show that canalization of polaritons can be programmed at will along any desired in-plane direction in a single device with broad spectral ranges. These findings open the door for nanophotonics applications where on-demand control is crucial, such as thermal management, nanoimaging or entanglement of quantum emitters.

Study on the value of the prenatal-postnatal integrated management model in the screening, diagnosis, and treatment of fetal heart malformations

OBJECTIVE

With the development and widespread use of fetal ultrasound and magnetic resonance technology in recent years, approximately 75% of fetuses are diagnosed prenatally with congenital structural malformations, a serious birth defect that endangers the life and health of the newborn. In this study, we aimed to study and analyze the value of the prenatal-postnatal integrated management model in the screening, diagnosis and treatment of fetal heart malformations.

PATIENTS AND METHODS

All pregnant women who were to undergo delivery in our hospital between January 2018 and December 2021 were recruited as the first subjects in this study, and after excluding those who refused to participate in the study, a total of 3,238 cases were finally included as subjects of this study. All pregnant women were screened for fetal heart malformations using the prenatal-postnatal integrated management model. Maternal files were established for all cases of heart malformations, grading the fetuses according to their heart disease grade, observing and recording their deliveries, treatment results and follow-ups.

RESULTS

After screening for heart malformations using the prenatal-postnatal integrated management model, 33 cases of heart malformations were identified, including 5 cases of Grade I (all delivered), 6 cases of Grade II (all delivered), 10 cases of Grade III (1 induced), and 12 cases of Grade IV (1 induced); 2 cases of ventricular septal defect healed spontaneously after delivery, and 18 infants were treated accordingly. The results of the later follow-up showed that 10 children had normalized their heart structure, 7 cases had slight alterations in the heart valves, and 1 case died.

CONCLUSIONS

The prenatal-postnatal integrated management model is a multidisciplinary cooperation model with certain clinical value in the screening, diagnosis and treatment of fetal heart malformations, which is beneficial to comprehensively improve the ability of hospital physicians in the grading management of heart malformations, detecting fetal heart malformations early and predicting fetal changes after birth. It further reduces the incidence of serious birth defects, conforms to the development trend of the diagnosis and treatment of congenital heart diseases, enables to reduce child mortality with timely treatment, effectively improves the surgical prognosis of critical and complex congenital heart diseases, with a promising application prospect.

[Expert consensus on late stage of critical care management]

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

Twist-tunable polaritonic nanoresonators in a van der Waals crystal

Optical nanoresonators are key building blocks in various nanotechnological applications (e.g., spectroscopy) due to their ability to effectively confine light at the nanoscale. Recently, nanoresonators based on phonon polaritons (PhPs)-light coupled to lattice vibrations-in polar crystals (e.g., SiC, or h-BN) have attracted much attention due to their strong field confinement, high quality factors, and their potential to enhance the photonic density of states at mid-infrared (mid-IR) frequencies, where numerous molecular vibrations reside. Here, we introduce a new class of mid-IR nanoresonators that not only exhibit the extraordinary properties previously reported, but also incorporate a new degree of freedom: twist tuning, i.e., the possibility of controlling their spectral response by simply rotating the constituent material. To achieve this result, we place a pristine slab of the van der Waals (vdW) α-MoO3 crystal, which supports in-plane hyperbolic PhPs, on an array of metallic ribbons. This sample design based on electromagnetic engineering, not only allows the definition of α-MoO3 nanoresonators with low losses (quality factors, Q, up to 200), but also enables a broad spectral tuning of the polaritonic resonances (up to 32 cm-1, i.e., up to ~6 times their full width at half maximum, FWHM ~5 cm-1) by a simple in-plane rotation of the same slab (from 0 to 45°). These results open the door to the development of tunable and low-loss IR nanotechnologies, fundamental requirements for their implementation in molecular sensing, emission or photodetection applications.

Efficient intracellular and in vivo delivery of toxin proteins by a ROS-responsive polymer for cancer therapy

Rational design of efficient cytosolic protein delivery carriers holds enormous promise for biotherapeutics development. Several delivery systems have been developed during the past decades, while tailoring the balance between extracellular protein binding and intracellular cargo release is still challenging. In this study, we synthesized a series of oxygen-sensitive reactive polymers, rich in boron, by radical polymerization and post-modification for cytosolic protein delivery in vitro and in vivo. The introduction of boronate building blocks into the polymer scaffold significantly enhanced its protein binding affinity, and the polymer/protein complexes with high stability were obtained by tailoring the molecular ratios between the boronate ligands and the amine groups. The lead material screened from the polymer library exhibited efficient protein delivery efficacy that can release cargo proteins in cytosol in a reactive oxygen species responsive manner, which enables intracellular delivery of proteins with maintained bioactivity. In addition, the polymer-based nanoformulations efficiently delivered saporin, a toxin protein, into osteosarcoma cells and tumor tissues, and exhibited high therapeutic efficacy in an osteosarcoma mouse model. The synthesized polymer in this study can be developed as a promising nanocarrier for cytosolic delivery of protein therapeutics to treat a variety of diseases.

Association between the site of clear corneal Phakic intraocular lens implantation incisions and the inflow of ocular surface fluid into the anterior chamber

Background

Posterior chamber phakic intraocular implantable collamer lens (ICL) implantation is an effective surgical option for the management of myopia. Over the past few years, the number of ICL surgeries has significantly increased. Postoperative inflammation and endophthalmitis are among the most serious complications after successful ICL surgery. Sometimes, when the blepharospasm is removed at the end of surgery, a small amount of the ocular surface fluid will flow into the anterior chamber, which can lead to an increased risk of infection and inflammation. However, little attention has been paid to this phenomenon.

Purpose

We conducted a retrospective study to compare the incidence of extraocular fluid inflow into the eye through the clear corneal incision (CCI) at two different positions (superior and temporal sides).

Methods

A total of 116 patients with myopia underwent superior CCI ICL implantation (n = 58) or temporal CCI ICL implantation (n = 58) at our hospital from October to December 2021. The incidence of conjunctival sac fluid entering the anterior chamber after eyelid fixative was removed was compared in both groups.

Results

Both groups were well matched in all parameters. Ocular surface fluid inflow into the anterior chamber was significantly higher in the superior CCI group (25/58, 47.1%) than in the temporal CCI group (1/58, 1.7%) (p < 0.05).

Conclusion

In the patients with ICL implantation, the temporal CCI was better than the superior CCI in avoiding the ocular surface fluid inflow into the anterior chamber, and the potential risk of infection and inflammation was lower.

[Developmental and epileptic encephalopathy 85 caused by SMC1A gene truncating variation: 4 cases report and literature review]

Objective: To summarize the clinical phenotype of patients with developmental and epileptic encephalopathy 85 caused by SMC1A gene truncating variation. Methods: The clinical data of 4 patients with epileptic encephalopathy caused by SMC1A gene truncating variation from August 2016 to June 2020 were analyzed retrospectively. Related literatures up to October 2021 with the key words "SMC1A" "Developmental and epileptic encephalopathy 85" "SMC1A, epilepsy" and "SMC1A, truncating" in PubMed, CNKI, and Wanfang databases were searched. Relevant literature was summarized and reviewed. Results: These 4 patients were all female. The onset age of seizure were all in the infantile period. They were admitted to the hospital at 3, 2, 11 and 18 months respectively. Focal seizures occurred in all 4 patients, while 1 of them experienced infantile spasm. The characteristic of cluster was observed in all of them with an interval of 14 days to 5.0 months. The seizures were all refractory to different kinds of anti-seizure medications. All 4 patients had severe developmental retardation with microcephaly (head circumference<-2 s). The interictal electroencephalogram (EEG) was characterized by diffuse slow wave. The 4 SMC1A gene variants were p.Gly655fs, p.Glu811fs, p.Arg412fs and p.Ile143fs, all of which were de novo frameshift variation after parental validation. There were another 17 cases with SMC1A gene truncating variation reported in 6 English articles and 1 Chinese article. Among these 21 patients, who were all female, the onset of seizures occurred between 0.5 and 18.0 months of age. Seventeen cases (81%) had the characteristics of cluster attacks, and the intervals of attack cycles were different. Seizure types included generalized tonic-clonic seizure (12 cases (57%)), focal seizure (11 cases(52%)), myoclonic(4 cases(19%)), spasm (4 cases(19%)), atypical absence (3 cases(14%)), tonic seizure (2 cases (10%)), and atonia (1 case(5%)). In addition, 4 cases (19%) had status epilepsy. All patients had moderate to severe mental retardation. Microcephaly was found in all patients. Among 18 cases,EEG in 8 cases had diffuse slow wave background. Brain magnetic resonance imaging (MRI) was normal in 13 cases (62%). Other MRI changes included cerebellar atrophy (3 cases), thin corpus callosum (3 cases), and lateral ventricular enlargement (2 cases). Twenty patients did not respond well to antiepileptic drugs. Conclusions: The clinical phenotypes of patients with epilepsy encephalopathy 85 caused by SMC1A gene truncating variation are characterized by female, early-onset, clustering of seizures, development delay and microcephaly. Diffuse slow waves are shown in interictal EEG in partial. Response to treatment and prognosis are poor.

[Rapid determination of 30 volatile organic compounds in workplace air by gas chromatography]

Objective: To establish a method for rapid detection of DB-WAX capillary column and determination of the workplace air in 30 kinds of volatile organic pollutants. Methods: In August 2020, N-pentane, n-hexane, methylcyclohexane, octane, Acetone, ethyl acetate, butanone, benzene, 3-pentanone, trichloroethylene, tetrachloroethylene, toluene, butyl acetate, 2-hexanone, Isoamyl acetate, ethylbenzene, p-xylene, m-xylene, amyl acetate, o-xylene, chlorobenzene, styrene, cyclohexanone, P-chlorotoluene, bromobenzene, M-dichlorobenzene, p-dichlorobenzene, O-dichlorobenzene, o-Chlorotoluene, 1, 2 , 4-trichlorobenzene of 30 kinds of substances in air were collected by activated carbon tube. After analysis by carbon disulfide, the analytical solution was analyzed by DB-WAX column and determined by FID detector. Results: The above 30 kinds of volatile organic pollutants had good separation effect, the correlation coefficient of the standard curve was above 0.999, the relative standard deviation was 0.1%-3.2%, the desorption efficiency was 77.0%-117.1% , the lower limit of quantitation was 0.33-5.33 μg/ml, and the lowest quantitation concentration was 0.22-3.55 mg/m(3), the recoveries ranged was 95.4%-104.9%. Conclusion: The method can effectively separate and accurately determine 30 volatile organic compounds in these workplaces, and the method is simple and quick.

Properties and Distribution of Seed Banks in a Black Locust (Robinia pseudoacacia) Plantation in Central China

We aimed to compare the properties of seed banks in different types of Robinia pseudoacacia stands and different substratum layers. We established four Black locust plots (each 50 × 50 m) that included two second-generation stands and two third-generation stands. Spatial coordinates, diameter at breast height, and the heights of all trees were measured in the four plots. In each plot, we set a total of 259 points using the regular grid design method. At these points, we sampled the seed banks in the litter and soil (0-5 cm) layers. The coordinates of the 259 points were recorded. After the samples had been collected and screened, a germination trial was performed using the collected seeds from the different layers and stands. We used variogram and kriging interpolation geostatistical methods to analyze the distribution of the seed banks. A kernel density estimation map was generated to examine the relationship between the seed bank and trees in each stand. The results showed that seed bank density was high in the four stands (4005-7325 seeds.m-2), and was higher in the third-generation stands (6085 and 7325 seeds.m-2) than in the second-generation stands (4005 and 5659 seeds.m-2). The seed bank density in the litter layer (3225 seeds.m-2) exceeded that in the soil layer (2164 seeds.m-2). The spatial pattern of the seed banks varied among different stands and was positively correlated with the distribution of trees in each stand. Furthermore, we found that spatial autocorrelation in the seed banks occurred at a variety of scales. Seeds in the litter layer were significantly more active than those in the soil layer; the germination rate varied from 6.67% to 28.89%. The findings of this study suggest that the Robinia pseudoacacia plantation in the Luoning area may exhibit potential for regeneration from seeds, and this will be the focus of our future studies.

Therapeutic Management of Ocular Ischemia in Takayasu's Arteritis: A Case-Based Systematic Review

Background

Takayasu’s arteritis (TA) is a rare, chronic granulomatous large-vessel vasculitis that can lead to ocular ischemia. Ocular outcomes after therapeutic management in TA remain largely unknown. We herein conduct a case-based systematic review to address the current treatment options in this particular cohort.

Methods

PubMed, Medline, and EMBASE databases were searched pertaining to ocular outcomes after systemic treatment in TA. Studies reporting ocular examinations before and after treatment in TA patients with ocular ischemia were included. Clinical characteristics, therapies, ocular outcomes, and complications were recorded.

Results

A 29-year-old woman with newly diagnosed TA showed dramatic regression of Takayasu’s retinopathy (TR) following balloon angioplasty. Optical coherence tomography angiography (OCTA) was used as a novel strategy for subsequent follow-up. A total of 117 eyes of 66 patients with a median age of 27 years were included for systematic review. TR was the most common ocular manifestation. Oral steroids were prescribed in nearly all patients (n = 65), followed by the use of methotrexate and antiplatelet therapy. Of the patients, 65.8% and 34.2% underwent open surgery and endovascular procedure, respectively. The median follow-up period was 12 weeks (interquartile range 8–33.5). Surgical therapy showed better ocular improvement (including visual and imaging responses) in both acute and chronic vision loss, along with fewer complications than medical therapy alone. In the surgical group, the visual prognosis was significantly better in patients with initial visual acuity better than 20/200 (p = 0.03) and those who underwent surgery before stage III TR (p = 0.01). Ocular outcomes were equivalent in the two surgical approaches.

Conclusion

Clinicians should be familiar with ophthalmic manifestations of this potentially treatable complication in TA. Compared with medical therapy alone, surgical intervention might be a better choice for both acute and chronic vision loss. Surgery is best recommended before the onset of irreversible ischemia to the globe. A combined regimen (oral steroids, immunosuppressants, and antiplatelet drugs) might be effective for those with surgical contradictions or reluctance to an invasive procedure. Physicians should be aware of the importance of ocular examinations, including OCTA, during the diagnosis and follow-up in TA.

[Performance evaluation and validation of automated digital image analysis in peripheral blood cells morphology examination]

Objective: To verify and evaluate the performance of automated digital image(DIA) for peripheral blood cell morphology examination. Methods: Three hundred and seventy-nine routine peripheral blood smears and 18 plasmodium positive peripheral blood smears were collected. Blood smears were made and stained by Wright -Giemsa method.White blood cell (WBC) differentiation of blood smears were pre-classified by DIA (DIA direct classification), re-classified (manually reviewed after DIA classification), and artificially classified under microscope. the inter-assay and intra-assay coefficients of variation (CV) of DIA were respectively calculated for repeatability verification. Taking the artificial microscopy as the gold standard, the sensitivity、specificity and accuracy of DIA were calculated. The DIA ability of peripheral blood blast cell morphological count, platelet (PLT) morphological count and morphological examination of plasmodium were also verified. Results: Except for eosinophils and basophils, the inter-assay and intra-assay CV of WBC classification by DIA in normal samples were < 10%. The CV of WBC classification in abnormal samples increased with the decrease of cell percentage. The sensitivity, specificity and accuracy of DIA pre-classification were 90.5%, 99.2%, 98.2%. Through pre-classification and re-classification by DIA,the results of the blood smears which triggered blast cell alarm had a good correlation with manual classification(r=0.812, 0.983, both P<0.01). The PLT morphological count by DIA had high correlation with hematology analyzer (r=0.946, P<0.01). The deviation absolute value of two methods of PLT count was < 15%, while in PLT aggregation or giant thrombocytosis samples,the deviation absolute value of PLT count by two methods was > 15%. After image acquisition by DIA, 17 plasmodium trophozoites were detected in 18 plasmodium-positive peripheral blood smears, and the images were clear. Conclusions: The DIA system has good repeatability, high sensitivity, specificity and accuracy in peripheral blood WBC classification. Its pre-classification and re-classification results have high correlation with the manual classification results.

[Identification of traditional Chinese drugs containing active ingredients for treating myocardial infarction and analysis of their therapeutic mechanisms by network pharmacology and molecular docking]

OBJECTIVE

To identify traditional Chinese drugs that contain active ingredients for treatment of myocardial infarction (MI) and explore their therapeutic mechanisms using network pharmacology and molecular docking technology.

METHODS

The TCMSP database was used for screening the traditional Chinese drugs containing active ingredients for treating MI, and the related targets of MI and the candidate drugs were obtained from Genecards, OMIM, PharmGkb and PharmMapper databases. The common target network of the drug targets and disease targets was established using Venny2.1.0 software. GO and KEGG signal pathway enrichment analysis of the common targets was performed, and the protein-protein interaction (PPI) network was constructed for the targets. The targets in the PPI network were analyzed to identify the key targets, for which GO and KEGG pathway enrichment analyses were performed. Molecular docking was performed for the candidate ingredients and the key targets, and a total score ≥6 was used as the criteria for screening the therapeutic ingredients and their docking binding with key targets was verified. A human umbilical vein endothelial cell (HUVEC) model of oxygen-glucose deprivation (OGD) was used to validate the candidate ingredients and the key therapeutic targets for MI by Western blotting.

RESULTS

Our analysis identified Salvia miltiorrhiza and Dalbergiae odoriferae as the candidate drugs rich in active ingredients for treatment of MI. These ingredients involved 16 key therapeutic targets for MI, which participated in such biological processes as inflammatory response, angiogenesis, energy metabolism and oxidative stress and the pathways including HIF-1, VEGF, and TNF pathways. Sclareol and PTGS2 in Salvia miltiorrhiza and formononetin and KDR in Dalbergiae odoriferae all had high docking total scores. Western blotting showed that at medium and high doses, sclareol significantly inhibited PTGS2 expression and formononetin promoted KDR expressions in the cell models in a dose-dependent manner (P < 0.05).

CONCLUSION

Both Salvia miltiorrhiza and Dalbergiae odoriferae have good therapeutic effects on MI. Sclareol in Salvia miltiorrhiza and formononetin in Dalbergiae odoriferae regulate the expressions of KDR and PTGS2, respectively, to modulate the inflammatory response, angiogenesis, oxidative stress and energy metabolism and thus produce myocardial protective effects.

Comparative Efficacy of Pharmacotherapy for Macular Edema Secondary to Retinal Vein Occlusion: A Network Meta-analysis

Purpose: This network meta-analysis was conducted to obtain the relative effectiveness of different pharmacotherapy of macular edema secondary to retinal vein occlusion (RVO) by summarizing all available evidences.

Methods: PubMed, Embase, and Cochrane Library databases were searched for all relevant randomized controlled trials. The outcomes were estimated through a network meta-analysis, including the mean change in best-corrected visual acuity (BCVA) from baseline, the proportion of patients who gained ≥15 letters in BCVA from baseline, the mean change in central retinal thickness (CRT).

Results: We identified 15 randomized controlled trials (RCTs) involving 3,431 patients with RVO in our study. Different therapeutic regimens were compared including three anti-vascular endothelial growth factor (VEGF) agents (ranibizumab, bevacizumab, and aflibercept), ranibizumab with laser, dexamethasone intravitreal implant, and laser. For branch RVO, ranibizumab 0.5 mg monthly [weighted mean difference (WMD) = 11, 95% confidence intervals (CrI) 3.6 to 19], ranibizumab 0.5 mg 3 + pro re nata (WMD = 9.4, 95% CrI 0.43–18) is most effective in terms of changes of BCVA and 15 letters or more of BCVA improvement. For central RVO, three anti-VEGF regimens can improve visual acuity and there is no significant difference of efficacy among ranibizumab, bevacizumab and aflibercept (p > 0.05). Ranibizumab 0.5 mg monthly could achieve additional efficacy in CRT reduction in eyes with branch RVO or central RVO (WMD = -130, 95% CrI -400 to 140 or WMD = -280, 95% CrI -590 to 16)). Dexamethasone intravitreal implant (WMD = 1.7, 95% CrI -4.2 to 7.1 or WMD = 0.38, 95% CrI -9.8 to 8.8)) did not show a significant improvement in visual acuity at the end of 6 months follow-up in eyes with branch RVO or central RVO.

Conclusion: In summary, this network meta-analysis demonstrated several anti-VEGF agents had equivalent effects on mean visual acuity changes and anatomical recovery in 6 months in eyes with branch or central RVO. Only one injection of dexamethasone intravitreal implant in 6 months could not maintain the visual benefit. Patients and clinicians could choose pharmacotherapies with further consideration toward personal factors.

Pyroptosis: A New Insight Into Eye Disease Therapy

Pyroptosis is a lytic form of programmed cell death mediated by gasdermins (GSDMs) with pore-forming activity in response to certain exogenous and endogenous stimuli. The inflammasomes are intracellular multiprotein complexes consisting of pattern recognition receptors, an adaptor protein ASC (apoptosis speck-like protein), and caspase-1 and cause autocatalytic activation of caspase-1, which cleaves gasdermin D (GSDMD), inducing pyroptosis accompanied by cytokine release. In recent years, the pathogenic roles of inflammasomes and pyroptosis in multiple eye diseases, including keratitis, dry eyes, cataracts, glaucoma, uveitis, age-related macular degeneration, and diabetic retinopathy, have been continuously confirmed. Inhibiting inflammasome activation and abnormal pyroptosis in eyes generally attenuates inflammation and benefits prognosis. Therefore, insight into the pathogenesis underlying pyroptosis and inflammasome development in various types of eye diseases may provide new therapeutic strategies for ocular disorders. Inhibitors of pyroptosis, such as NLRP3, caspase-1, and GSDMD inhibitors, have been proven to be effective in many eye diseases. The purpose of this article is to illuminate the mechanism underlying inflammasome activation and pyroptosis and emphasize its crucial role in various ocular disorders. In addition, we review the application of pyroptosis modulators in eye diseases.

Chondrocyte Adipogenic Differentiation in Softening Osteoarthritic Cartilage

A chondrocyte-to-osteoblast lineage continuum exists in the growth plate. Adipogenic differentiation of chondrocytes in vivo should be investigated. Here, unilateral anterior crossbite (UAC), which can induce osteoarthritic lesions in the temporomandibular joint (TMJ), was applied to 6-wk-old C57BL/6 mice. Matrix loss in TMJ cartilage was obvious, as demonstrated by safranin O staining, and the condylar cartilage elastic modulus values, detected by using atomic force microscopy (AFM), were reduced, indicating cartilage softening that might be linked with loss of the highly charged proteoglycan. By crossing the Rosa26/tdTomato (TdT) mice with Sox9;Cre^ERT2 mice or with Col10;Cre^ERT2 mice, we obtained the Sox9-TdT and Col10-TdT strains, respectively, in which the Sox9- or Col10-expressing cells, accordingly, were labeled by TdT. A few TdT-labeled cells in both strains expressed AdipoQ or DMP-1. The Sox9-TdT⁺AdipoQ⁺ cells were primarily located in the deep zone cartilage and then in the whole cartilage. Col10-TdT⁺AdipoQ⁺ cells, Sox9-TdT⁺DMP-1⁺ cells, and Col10-TdT⁺DMP-1⁺ cells were located in the deep zone region. UAC promoted AdipoQ and DMP-1 expression in cartilage. The percentages of Sox9-TdT⁺AdipoQ⁺ and Col10-TdT⁺AdipoQ⁺ cells to Sox9-TdT⁺ and Col10-TdT⁺ cells, respectively, were increased (both P < 0.05), implying that more chondrocytes were undergoing adipogenic differentiation in the UAC group, the cartilage of which was softened. The percentages of Sox9-TdT⁺DMP-1⁺ and Col10-TdT⁺DMP-1⁺ cells to Sox9-TdT⁺ cells and Col10-TdT⁺ cells, respectively, were increased (both P < 0.05), consistent with our report that UAC enhanced deep zone cartilage calcification, causing stiffening of the deep zone cartilage. Our present data demonstrated that TMJ chondrocyte descendants can become adipogenic in vivo in addition to becoming osteogenic. This potential was promoted in osteoarthritic cartilage, in which deep zone cartilage calcification-associated cartilage stiffening and proteoglycan loss-associated cartilage softening were both stimulated.

New insights into human functional ultrasound imaging

Ultrasound imaging is a vital tool for exploring in vivo the placental function which is essential to understand pathological phenomena such as preeclampsia or intrauterine growth restriction. As technology advances including ready availability of three-dimensional (3D) probes and novel software, new markers of placental function become possible. The objective of this review was to provide an overview of the new ultrasound markers of placental function with a focus on the potential clinical application of three-dimensional power Doppler (3DPD). A broad-free text literature search was undertaken based on human placental studies and sixty full-text studies were included in this review. Three-dimensional power Doppler is a promising technique to predict preeclampsia in the first trimester. However, the influence of external factors such as body mass index, parameter standardisation and machine settings still need to be addressed. Contrast-enhanced ultrasound is currently reserved for research, because the required injected contrast mediums are not currently approved for use in pregnancy, although the safety data is reassuring.

Outcomes and phenotypic expression of rare variants in hypertrophic cardiomyopathy genes in over 200,000 adults

Background

Hypertrophic cardiomyopathy (HCM) is caused by rare variants in sarcomere-encoding genes, but little is known about the clinical significance of these variants in the general population.

Purpose

To determine the population prevalence of HCM-associated sarcomeric variants, characterise their phenotypic manifestations, estimate penetrance, and identify associations between sarcomeric variants and clinical outcomes, we performed an observational study of 218,813 adults in the UK Biobank (UKBB), of whom 200,584 have whole exome sequencing (WES).

Methods

We carried out an integrated analysis of WES and cardiac magnetic resonance (CMR) imaging in UK Biobank participants stratified by sarcomere-encoding variant status. Computer vision techniques were used to automatically segment the four chambers of the heart (Figure 1). Cardiac motion analysis was used to derive strain and strain rates. Regional analysis of left ventricular wall thickness was performed using three-dimensional modelling of these segmentations.

Results

Median age at recruitment was 58 (IQR 50–63 years), and participants were followed up for a median of 10.8 years (IQR 9.9–11.6 years) with a total of 19,507 primary clinical events reported.

The prevalence of rare variants (allele frequency &lt;0.ehab724.17314) in HCM-associated sarcomere-encoding genes in 200,584 participants was 2.9% (n=5,727; 1 in 35), and the prevalence of pathogenic or likely pathogenic variants (SARC-P/LP) was 0.24% (n=474, 1 in 423).

SARC-P/LP variants were associated with increased risk of death or major adverse cardiac events (MACE) compared to controls (HR 1.68, 95% CI 1.37–2.06, p&lt;0.001), mainly due to heart failure endpoints (Figure 2: cumulative hazard curves with zoomed plots for lifetime risk of A) death and MACE or B) heart failure, stratified by genotype; genotype negative (SARC-NEG), carriers of indeterminate sarcomeric variants (SARC-IND) or SARC-P/LP; C) Forest plot of comparative lifetime risk of clinical endpoints by genotype).

While males had a higher overall risk of adverse outcomes, the incremental genetic risk from SARC-P/LP mutations was greater in females (HR for females: 2.18 CI 1.65–2.89, p&lt;0.001; HR for males: 1.42 CI 1.05–1.9, p=0.02).

In 21,322 participants with CMR, SARC-P/LP were associated with asymmetric increase in left ventricular maximum wall thickness (10.9±2.7 vs 9.4±1.6 mm, p&lt;0.001) but hypertrophy (≥13mm) was only present in 16% (n=7/43, 95% CI 7–31%). Other rare sarcomere-encoding variants had a weak effect on wall thickness (9.5±1.7 vs 9.4±1.6 mm, p=0.002) with no combined excess cardiovascular risk.

Conclusions

In the general population, SARC-P/LP variants have low aggregate penetrance for overt HCM but are associated with increased risk of adverse cardiovascular outcomes and a sub-clinical cardiomyopathic phenotype. Although absolute event rates are low, identification of these variants may enhance risk stratification beyond familial disease.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was supported by the Medical Research Council, UK (MC-A651-53301); National Institute for Health Research (NIHR) Imperial College Biomedical Research Centre; NIHR Royal Brompton Cardiovascular Biomedical Research Unit; British Heart Foundation (NH/17/1/32725, RG/19/6/34387, RE/18/4/34215).

[Epidemiological characteristics of adenovirus infection in hospitalized children with acute respiratory tract infection in Kunming during 2019]

Objective: To investigate the epidemiology and clinical characteristics of adenovirus (ADV)-caused acute respiratory tract infection among hospitalized children in Kunming, China. Methods: Clinical and laboratory data were collected from 467 children with adenovirus infection who were hospitalized from January 1, 2019 to December 31, 2019 in 6 grade A class Ⅲ hospitals in Kunming area. The basic characteristics, epidemiology, mixed infection and adenovirus genotypes of the patients were retrospectively analyzed. The patients diagnosed with adenovirus pneumonia (AP) were divided into two groups, severe AP (SAP) group and general AP(GAP) group according to the severity of illness. Mann-Whitney U test or χ² test was used for comparison between groups, while multivariate regression was applied to analyze the risk factors of SAP. Results: Among 15 635 hospitalized children with respiratory tract infection, 467 cases were adenovirus positive, with a detection rate of 2.99%. Of the 467 patients with adenovirus infection, 284 were male and 183 female, the age was 2.4 (1.1,3.9) years, including 44 cases (9.4%) < 0.5 years, 59 cases (12.6%) of 0.5 to<1.0 years, 176 cases (37.7%) of 1.0 to <3.0 years, 150 cases (32.1%) of 3.0 to <7.0 years, and 38 cases (8.1%) of 7.0 to 14.0 years. Adenovirus infection was common in autumn and winter, and the high incidence months were October to December, which accounted for 51.6% (241/467) of the whole year cases. Co-infection was detected in 226 cases (48.4%) out of 467 patients, in which one pathogen co-infection was the most frequent form (172 cases, 76.1%). Of the 262 pathogen detected 108 (41.2%) were Mycoplasma pneumoniae. In 144 of ADV-positve cases (30.8%) were taken geno-typing was done by PCR amplification, the results showed that 74 cases (51.4%) were ADV 3, 7 subtypes and 65 cases (45.1%) of ADV 1, 2,6 subtypes. Of the 467 cases of ADV infection, 320 (68.5%) were diagnosed with pneumonia, 82 (17.6%) with upper respiratory tract infection and pharyngeal tonsillitis, and 65 (13.9%) with bronchitis, laryngeal bronchitis, and asthmatic bronchitis. Among the 320 patients with AP, 56 cases were severe and 264 cases were general. Two cases (3.6%) in severe group died. Compared with the GAP group, the age was young [17 (11,42) months vs. 24 (14,44) months, Z=2.222, P=0.026], the fever duration was long [8 (5,14) days vs. 6 (3,9) days, Z=3.380, P<0.01], and the proportions of preterm birth and having underlying diseases were high [respectively 19.6% (11/56) vs. 6.1% (16/264), 26.8% (15/56) vs. 10.2% (27/264), χ²=8.965,11.109, P<0.05] in SAP group. Referring to laboratory markers, white blood cell count, C-reactive protein, creatine kinase-MB and lactate dehydrogenase were significantly increased in SAP group as compared to GAP group(all P<0.05). Multivariate Logistic regression analysis showed that preterm birth (OR=3.284, 95%CI 1.079-9.993, P=0.036), underlying disease (OR=3.284, 95%CI 1.079-9.993, P=0.036), fever duration ≥10 d (OR=2.523,95%CI 1.195-5.328, P=0.015) and C-reactive protein ≥50 mg/L (OR=3.156, 95%CI 1.324-7.524, P=0.010) were positively correlated with the risk of SAP. Conclusions: The incidence of adenovirus infection among hospitalized children in Kunming was lower than the national level, and no outbreak occurred in 2019. Subtype 3 and 7 of ADV are the predominant strains for infection, which usually occurs in autumn and winter and mainly causes pneumonia. Premature birth, underlining diseases, long fever duration and markedly increased C-reactive protein are the risk factors for developing into severe pneumonia. This paper presents the prevalence and clinical characteristics of adenovirus infection in children at high altitude area.

Mineral deposition intervention through reduction of phosphorus intake suppresses osteoarthritic lesions in temporomandibular joint

OBJECTIVE

To explore the suppressing impact of low phosphorus intake on osteoarthritic temporomandibular joint and the possible mechanisms of nuclear acid injury in the insulted chondrocytes.

DESIGN

Chondrocytes were loaded with fluid flow shear stress (FFSS) with or without low phosphorus medium. Seventy-two mice (sampled at 3-, 7- and 11-wk, n = 6) and forty-eight rats (sampled at 12-wks for different testing purpose, n = 6) were applied with unilateral anterior crossbite (UAC) with or without low phosphorus diet. In the FFSS model, the Ca and P content, molecules related to nucleic acid degradation and the mineral-producing responses in chondrocytes were detected. The effect of culture dish stiffness on chondrocytes osteogenic differentiation was measured. In the UAC model, the content of Ca and P in serum were tested. The condylar cartilage ossification and stiffness were detected using micro-CT, scanning electron microscope and atomic force microscope.

RESULTS

FFSS induced nucleic acid degradation, Pi accumulation and mineral-producing responses in the cultured chondrocytes, all were alleviated by low P medium. Stiffer dish bottoms promoted the osteogenic differentiation of the cultured chondrocytes. UAC stimulated cartilage degeneration and chondrocytes nucleic acid damage, increased PARP 1 and serum P content, and enhanced ossification and stiffening of the cartilage, all were suppressed by low phosphorus diet (all, P < 0.05).

CONCLUSION

Nucleic acid damage takes a role in phosphorus production in osteoarthritic cartilage, contributing to the enhanced mineralization and stiffness of the cartilage that in turn promotes cartilage degradation, which can be alleviated by low phosphorus intake.

Pachychoroid Spectrum Disease: Underlying Pathology, Classification, and Phenotypes

PURPOSE

Pachychoroid spectrum disease encompasses a set of macular disorders secondary to an abnormally thick choroid. However, the pathological process underlying pachychoroid spectrum disease and its overlap with age-related macular degeneration (AMD) remain unclear. This review aimed to understand the underlying pathology, classification, and phenotypes of pachychoroid spectrum disease.

METHODS

This comprehensive literature review was performed based on a search of peer-reviewed published papers relevant to the current knowledge of pachychoroid disease spectrum.

RESULTS

Pachychoroid is primarily a bilateral phenomenon; the main pathological lesions include choriocapillaris attenuation and abnormally dilated pachyvessels. Chronic central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV) show similar morphological changes and angiogenic cytokine levels. The subretinal fluid in PNV may not accurately indicate PNV activity. Besides, types 1 and 2 of choroidal neovascularization (CNV) may be involved in primary pachychoroidal disease. Both choroidal arteriosclerosis and higher hydrostatic pressure contribute to hyalinized choroidal arteries and aneurysmal dilatations, resulting in PNV progression to polypoidal choroidal vasculopathy (PCV). Thus, pachychoroid-related type 2 CNV and chronic CSC could be considered as PNV (IIIc) and as a precursor of PNV (IIIa), respectively. Tangled PCV on optical coherence tomography angiography that fails to develop aneurysms should be classified as a subtype of PNV or a forme fruste of PCV.

CONCLUSIONS

Multiple disorders of the pachychoroid spectrum are considered as a continuous disease process, ultimately stimulated by choroidal malfunction. PCV overlaps both AMD and pachychoroid disease, especially for thin-choroid and bilateral types. The terminology and classification of pachychoroid spectrum disease should be used cautiously.

Uncovering recent progress in nanostructured light-emitters for information and communication technologies

Semiconductor nanostructures with low dimensionality like quantum dots and quantum dashes are one of the best attractive and heuristic solutions for achieving high performance photonic devices. When one or more spatial dimensions of the nanocrystal approach the de Broglie wavelength, nanoscale size effects create a spatial quantization of carriers leading to a complete discretization of energy levels along with additional quantum phenomena like entangled-photon generation or squeezed states of light among others. This article reviews our recent findings and prospects on nanostructure based light emitters where active region is made with quantum-dot and quantum-dash nanostructures. Many applications ranging from silicon-based integrated technologies to quantum information systems rely on the utilization of such laser sources. Here, we link the material and fundamental properties with the device physics. For this purpose, spectral linewidth, polarization anisotropy, optical nonlinearities as well as microwave, dynamic and nonlinear properties are closely examined. The paper focuses on photonic devices grown on native substrates (InP and GaAs) as well as those heterogeneously and epitaxially grown on silicon substrate. This research pipelines the most exciting recent innovation developed around light emitters using nanostructures as gain media and highlights the importance of nanotechnologies on industry and society especially for shaping the future information and communication society.

Circular RNA ZNF292 affects proliferation and apoptosis of hepatocellular carcinoma cells by regulating Wnt/β-catenin pathway

OBJECTIVE

The purpose of this study was to explore the function of circular ribonucleic acid (circRNA) zinc finger protein 292 (ZNF292) in hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

The expression of circRNA ZNF292 in Huh-7 cells was knocked down by small interfering RNAs (siRNAs), and the effect of circRNA ZNF292 knockdown on the proliferation of Huh-7 cells was analyzed by Cell Counting Kit-8 (CCK-8) assay and colony formation assay. Then, flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) were adopted to analyze the impacts of circRNA ZNF292 knockdown on the cycle distribution and apoptosis of Huh-7 cells. Besides, the influences of circRNA ZNF292 knockdown on Wnt/β-catenin signaling pathway and its downstream molecules were detected via quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Western blotting.

RESULTS

Compared with those in siRNA-normal control (NC) group, the proliferation of Huh-7 cells was significantly inhibited and their cloning ability was remarkably weakened (p<0.05), the proportion of cells in S phase was decreased while that in G1 phase was increased (p<0.05), the apoptosis rate of Huh-7 cells was higher and the number of apoptosis was larger in siRNA-2# knockdown group (p<0.05). Besides, in Huh-7 cells with circRNA ZNF292 knockdown, the expressions of Axin, β-catenin, phosphorylated signal transducer and activator of transcription 3 (p-STAT3), p-STAT5, Cyclin A and Cyclin-dependent kinase 2 (CDK2) were down-regulated, while the expressions of STAT3 and STAT5 did not change remarkably.

CONCLUSIONS

Knock downing circRNA ZNF292 leads to cell cycle arrest in G1 phase, thus suppressing cell proliferation and promoting cell apoptosis. The regulatory mechanism of circRNA ZNF292 may involve the regulation of cell cycle and related genes.

Cardiometabolic index: a new tool for screening the metabolically obese normal weight phenotype

PURPOSE

People with the metabolically obese normal weight (MONW) phenotype are considered as an extremely high-risk group for unfavorable health consequences, but they are frequently undetected due to deceptive body mass index (BMI) and complex assessment. This study aimed to explore the clinical usefulness of cardiometabolic index (CMI) in identifying MONW individuals.

METHODS

This cross-sectional study involved a total of 47,683 normal-weight subjects aged ≥ 18 years. Participants underwent anthropometrics, routine biochemical tests, and questionnaires for a full evaluation of the metabolic profile. The odds ratio (OR) of CMI and MONW phenotype was determined by the Logistic regression models and the diagnostic accuracy of CMI was evaluated by the receiver operating characteristic (ROC) curve analysis.

RESULTS

The prevalence of MONW phenotype was 11.0%. After multivariate adjustment, the ORs for MONW in the highest compared with the lowest quartile of CMI was 71.20 (95% CI 55.19-91.86), and 1-SD increment of CMI brought a 54% additional risk. In ROC analysis, compared with BMI and waist circumference, CMI showed superior performance for identifying MONW individuals with an AUC of 0.853 (95% CI 0.847-0.860) in men and 0.912 (95% CI 0.906-0.918) in women, respectively. Moreover, CMI exhibited the highest diagnostic accuracy in younger age groups (aged 18-34 for men; aged 18-34 and 35-44 for women), in which AUCs surpassed 0.9 in both sexes.

CONCLUSIONS

CMI could be served as a valuable indicator to identify MONW phenotype of Chinese adults, particularly for young people.

Fundus changes of Parry-Romberg syndrome: A report of three cases and literature review

PURPOSE

To report three cases of Parry-Romberg syndrome (PRS) with progressive hemifacial atrophy and similar fundus changes.

METHODS

Retrospective case series of three patients who presented to the ophthalmology department with blurred vision in one eye. All of them underwent three-dimensional reconstruction of head computed tomography (CT), related physical examinations, and also monthly ocular examinations of both eyes, including the slit-lamp microscope, fundus autofluorescence, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). We also reviewed the current literature about the fundus change in PRS from inception to March 2020 via PubMed.

RESULTS

Coats-like fundus and exudative retinal detachment were found in all three eyes of three patients during the follow-up. No systematic changes were found except for hemifacial atrophy. The final diagnoses of these three patients were PRS.

CONCLUSION

Only a subset of PRS patients have concomitant ocular changes, but it still should be noticed that the diagnosis of PRS should be considered if adults presented with Coats-like retinopathy and hemifacial atrophy.

Effect modification of the association between diurnal temperature range and hospitalisations for ischaemic stroke by temperature in Hefei, China

OBJECTIVES

Diurnal temperature range (DTR) is an important indicator of global climate change. Many epidemiological studies have reported the associations between high DTR and human health. This study investigated the association between DTR and hospitalisations for ischaemic stroke in Hefei, China.

STUDY DESIGN

This is an ecological study.

METHODS

Data of daily hospital admissions for ischaemic stroke and meteorological variables from 1 January 2009 to 31 December 2017 were collected in Hefei, China. A generalised additive model combined with distributed lag non-linear model was used to quantify the effects of DTR on ischaemic stroke. The interactive effect between DTR and temperature was explored with a non-parametric bivariate response surface model.

RESULTS

High DTR was associated with hospitalisations for ischaemic stroke. The adverse effect of extremely high DTR (99th percentile [17.1 °C]) occurred after 8 days (relative risk [RR] = 1.021, 95% confidence interval [CI] = 1.002, 1.041) and the maximum effect appeared after 12 days (RR = 1.029, 95% CI = 1.011, 1.046). The overall trend of the effect of DTR on ischaemic stroke was decreasing. In addition, there was a significant interactive effect of high DTR and low temperature on ischaemic stroke.

CONCLUSIONS

This study suggests that the impact of high DTR should be considered when formulating targeted measures to prevent ischaemic stroke, especially for those days with high DTR and low mean temperature.

Enabling propagation of anisotropic polaritons along forbidden directions via a topological transition

Polaritons with directional in-plane propagation and ultralow losses in van der Waals (vdW) crystals promise unprecedented manipulation of light at the nanoscale. However, these polaritons present a crucial limitation: their directional propagation is intrinsically determined by the crystal structure of the host material, imposing forbidden directions of propagation. Here, we demonstrate that directional polaritons (in-plane hyperbolic phonon polaritons) in a vdW crystal (α-phase molybdenum trioxide) can be directed along forbidden directions by inducing an optical topological transition, which emerges when the slab is placed on a substrate with a given negative permittivity (4H-silicon carbide). By visualizing the transition in real space, we observe exotic polaritonic states between mutually orthogonal hyperbolic regimes, which unveil the topological origin of the transition: a gap opening in the dispersion. This work provides insights into optical topological transitions in vdW crystals, which introduce a route to direct light at the nanoscale.

Retinal pigment epithelium aperture in acute central serous chorioretinopathy: Another novel possible pathological mechanism

PURPOSE

To present retinal pigment epithelium (RPE) aperture related to an avascular pigment epithelium detachment (PED) secondary to acute central serous chorioretinopathy (CSC).

METHODS

Case report.

RESULTS

A 47-year-old man diagnosed as acute CSC presented with RPE aperture in the superonasal area of the macula in his left eye during follow-up. At 2-week follow-up, his decimal best-corrected visual acuity (BCVA) was improved from 0.08 to 0.6 and subretinal fluid was partially absorbed. However, the near-infrared reflectance demonstrated a round mild hyperreflective lesion on the superonasal area of the macula. On spectral-domain optical coherence tomography (SD-OCT), RPE band of the round lesion discontinued but RPE fractured edges without shrinkage and curling. Fundus autofluorescence (FAF) showed RPE aperture appeared as round hypoautofluorescence and hyperautofluorescence outlined its borderline. OCT angiography demonstrated that no evidence of neovascularization within the sub-RPE space. En Face OCT confirmed that the RPE aperture developed at the edge of the PED lesion. At 8-month follow-up, his decimal BCVA was improved to 1.0 and SD-OCT demonstrated spontaneous resolution of subretinal fluid and restoration of RPE structure, with complete flattening of PED. However, FAF revealed hypoautofluorescence mingled with slight hyperautofluorescence within the lesion.

CONCLUSIONS

To the best of our knowledge, this is the first report of an RPE aperture secondary to acute CSC. Our case indicated another novel possible pathological mechanism that in the relatively healthy RPE, increased hydrostatic pressure simply itself could contribute to RPE aperture.

Tailoring a dissonance-based body image intervention for adult women in a proof of concept trial: The Women's Body Initiative

Although historically conceptualized as problems of youth, recent research indicates that women of all ages experience body dissatisfaction and eating disorder (ED) pathology. Despite this, existing body image interventions predominantly target youth. The Body Project (BP) has extensive support for reducing ED risk factors in younger women and girls. The current proof-of-concept study investigated the feasibility, acceptability, and estimates of intervention effect sizes of a modified BP for adult women, the Women's Body Initiative (WBI). Conducted in the Southwestern United States, adult women (N = 13) aged 29-70 (M = 49.1) participated in 4, 1-h weekly sessions, completing measures at baseline, post-intervention, and 3-month follow-up. Participants rated the program as highly feasible and acceptable. Within-subjects effects sizes were medium to large for primary outcomes (body dissatisfaction, ED pathology) and secondary outcomes (psychosocial impairment, negative affect, quality of life, nutritious food consumption, and sleep) through 3-months. Results suggest preliminary feasibility and acceptability of WBI for adult women, and support proceeding with a larger trial to investigate intervention efficacy.