Evaluating the Effects of Bone Marrow Sparing Radiotherapy on Acute Hematologic Toxicity for Patients with Locoregionally Advanced Cervical Cancer: A Prospective Phase II Randomized Controlled Trial

PURPOSE/OBJECTIVE(S)

Bone marrow sparing intensity modulated radiotherapy (BMS-IMRT) can reduce the incidence of acute hematologic toxicity (HT) for locoregionally advanced cervical cancer (LACC) patients receiving concurrent chemoradiotherapy (CCRT), but the norm has been controversial. The purpose of the study was to evaluate the effects of bone marrow (BM) V40 <25% on decreasing the incidence of acute HT in a prospective clinical trial.

MATERIALS/METHODS

A total of 242 LACC patients were recruited from May 2021 to May 2022, who were evenly randomized into BMS-IMRT group and standard IMRT group according to a computer-generated random number list. All patients received pelvic irradiation with concurrent cisplatin (40 mg/m2 weekly), followed by brachytherapy. For patients in BMS-IMRT group, the outer contour of pelvic bone, lumbar spine and left and right femur heads were additionally delineated as a surrogate for BM, and V40 <25% was prescribed. Blood counts were tested weekly, of which nadirs during external beam radiotherapy (EBRT) were graded to assess acute HT as primary observation index. Second observation index were dosimetric parameters of EBRT plan from the dose volume histograms (DVHs). Binary logistic regression model and receiver operating characteristic (ROC) curve were used for predictive value analysis.

RESULTS

Baseline demographic, disease and treatment characteristics were all balanced between BMS-IMRT group and standard IMRT group. BMS-IMRT was associated with a lower incidence of grade ≥2 and grade ≥3 acute HT, leukopenia and neutropenia (72.70% vs 90.90%, P <0.001*; 16.50% vs 65.30%, P <0.001*; 66.10% vs 85.10%, P = 0.001*; 13.20% vs 54.50%, P <0.001*; 37.20% vs 66.10%, P <0.001*; 10.70% vs 43.80%, P <0.001*). Plan target volume (PTV) for all patients satisfied the clinical requirement of V(100%) ≥95%, and conformity and homogeneity were both comparable between 2 groups. BMS also decreased dose delivered to the organs at risk (OARs) including rectum, bladder and left and right femur head. Univariate and multivariate analyses showed that BM V40 was an independent risk factor for grade ≥3 acute HT (odds ratio [OR] = 2.734, 95% confidence interval [CI] = 1.959-3.815, P <0.001*). Cutoff value was 25.036% and area under the curve (AUC) was 0.786. The nomogram was constructed, which was rigorously evaluated and internally cross-validated, showing good predictive performance.

CONCLUSION

BM V40 <25% can reduce the risks of acute HT for LACC patients receiving CCRT while the dose delivery of target volume and other normal tissues were not compromised. With great practicality and applicability, BM V40 <25% is a promising strategy, making BMS-IMRT widespread especially in the area where application of image guided radiotherapy (IGRT) such as 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET)/CT is not popularized. Chinese clinical trial registry (ChiCTR2200066485).

Comparison of the chronic and multigenerational toxicity of racemic glufosinate and l-glufosinate to Caenorhabditis elegans at environmental concentrations

Glufosinate-ammonium, the second largest transgene crop resistant herbicide, is classified as a mobile persistent pollutant by the U.S. Environmental Protection Agencybecause of its slow decomposition and easy mobile transfer in a water environment. The chronic and multigeneration toxicity of this compound to environmental organisms are alarming. In this study, racemic glufosinate-ammonium and the effective isomer, l-glufosinate-ammonium, were used as the test agents. The developmental, neurotoxic and reproductive toxicities of Caenorhabditis elegans to their parents and progeny were studied by continuous exposure in water at concentrations of 0.1, 1, 10 and 100 μg/L. The causes of toxicity differences were analysed from oxidative stress and transcription levels. Through oxidative stress of C. elegans, racemic glufosinate-ammonium and l-glufosinate-ammonium both mediated the developmental toxicity (shortened developmental cycle, reduced body length and width, promoted ageingand decreased longevity), neurotoxicity (inhibited head swinging, body bending frequency and acetylcholinesterase [AchE] activity) and reproductive toxicity (significant reductions in the number of eggs and offspring in vivo and induced apoptosis of gonadal cells). These phenomena caused oxidative damage (protein and membrane lipid peroxidation) and further induced apoptosis. The changes in various indicators caused by racemic glufosinate-ammonium exposure were more significant than those caused by l-glufosinate-ammonium exposure, and the reproduction-related indicators were more significant than the developmental and neurological indicators. A continuous accumulation of toxicity was observed after multiple generations of continuous exposure. These research results provide a data reference for the ecotoxicological evaluation and risk assessment of glufosinate-ammonium and contribute to the revision and improvement of the related environmental policies of glufosinate-ammonium.

[Clinicopathological characteristics and differential diagnosis of 6 cases of congenital granular cell tumor]

To provide references for the diagnosis and treatment of congenital granular cell tumor (CGCT), by comprehensive analysis of the clinical data, histopathological and immunohistochemical results. Patients with CGCT were involede, from March 2015 to November 2020, at the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Zhengzhou University. A total of 6 children, aged 3-16 days, 1 male and 5 female, 5 maxillary and 1 mandibular, with maximum tumor diameter of 6-70 mm, were included. The lesions of CGCT were single and connected to the alveolar ridge by a pedicle. The surface of the tumor was covered with a vascular network, and two cases had ulcers on the surface of the tumor. All 6 cases had the tumor removed surgically and there was no recurrence or metastasis in the follow-up visit. Although CGCT is rare, it is a benign tumor and generally does not recur or metastasize after surgery, and has a good prognosis. The prenatal imaging, clinical manifestations after delivery, pathological characteristics and immunohistochemical analyses may provide reference for early diagnosis and treatment of CGCT.

[Spatiotemporal Distribution of Ammonia Emissions from Poultry Farming in the Yangtze River Delta Based on Online Monitoring Derived Local Emission Factors]

In order to obtain the ammonia emission level and space-time distribution characteristics of the poultry production industry in the Yangtze River Delta, an online high-resolution monitoring system was used to continuously monitor the atmospheric ammonia concentration in the breeding house and compost shed in a typical large-scale layer farm. By obtaining the ammonia emission level and emission factor during each growth stage, we established the localized ammonia emission inventory for the poultry production industry in the Yangtze River Delta. The results showed that the average daily ρ(NH₃) in the breeding house and compost shed for spring, summer, autumn, and winter were (1.85±0.38), (4.58±0.33), (3.87±0.12), and (2.83±0.47) mg·m^-3 and (2.04±0.50), (4.04±1.04), (2.51±0.67), and (1.55±0.16) mg·m^-3 respectively. Ammonia emissions showed a significant daily hourly change trend. The highest hourly ammonia concentration in the layer house appeared from 13:00-14:00 in the afternoon, and the minimum appeared from 01:00-03:00 in the morning. The highest hourly ammonia concentration in the compost shed occurred between 16:00-19:00 in summer and autumn, whereas the diurnal changes in spring and winter were not significant. Hourly changes in ammonia emissions during the day were mainly affected by daily temperature, poultry activities, and manure management. Ammonia concentrations at different growth stages of laying hens showed significant differences. ρ (NH₃) from young chickens, laying hens, and pre-eliminated chickens were (1.85±0.38), (2.83±0.47), and (1.61±0.32) mg·m^-3, respectively. The ammonia emission rate from laying hens reached 1.53 times and 1.65 times that of young chickens and pre-eliminated chickens, respectively. Metabolism levels and feed intake at different growth stages were the main reasons for the differences in ammonia emissions. Ammonia emission factors for the layer house and compost shed in spring, summer, autumn, and winter were (0.13±0.02), (0.54±0.01), (0.39±0.01), and (0.17±0.01) g·(bird·d)^-1 and (0.07±0.01), (0.17±0.02), (0.08±0.01), and (0.04±0.01) g·(bird·d)^-1, respectively. Annual ammonia emission factors reached (0.11±0.06) kg·(bird·a)^-1 and (0.03±0.02) kg·(bird·a)^-1, respectively. Our results suggest that ambient temperature, ventilation mode, chicken house type, and manure removal frequency were the main influencing factors of ammonia emissions from poultry production. The uncertainty ranges of the ammonia emission coefficients reached±122%,±79%, and±74%, and±56%, respectively. Great uncertainties were generated when empirical emission factors were used for emission inventory establishment. Based on the results of online monitoring, model simulation, and literature analysis, we established an ammonia emission inventory for the poultry production industry within the Yangtze River Delta region by adopting the emission factors of (0.16±0.08) kg·(bird·a)^-1. In 2019, the total ammonia emission from poultry production was (108.81±54.41) kt. In terms of spatial distribution, ammonia emission intensities in the northern regions were significantly higher than those in the southern parts. The ammonia emission intensities during summer were 3.38-3.56 times higher than those in spring and winter.

[Emission Characteristics, Transformation Mechanism, and Reduction Potential of Ammonia Emissions from a Crop Rotation System in Yangtze River Delta]

To study the characteristics and reduction potential of the ammonia emissions of a crop rotation system in the Yangtze River Delta, we monitored and compared the ammonia fluxes from two rotation systems:a conventional rice/winter wheat rotation system and a rice-shrimp cultivation/Chinese milk vetch rotation system. This study was conducted through closing chamber methods to investigate the influencing factors and transformation mechanism of ammonium emissions between the two studied cultivation patterns. Additionally, we established the temporal-spatial emission inventory by sorting out the local ammonia emission factors of farmland in the Yangtze River Delta in the last ten years. The emission reduction effects under different ammonia emission reduction paths were also obtained. The results showed that, the cumulative amount of ammonia emissions throughout the whole monitoring year for the conventional rice/winter wheat rotation system (CR-W) and the rice-shrimp cultivation/Chinese milk vetch rotation system (RS-C) were 65.95 and 20.31 kg·hm^-2, respectively, whereas the ammonia loss rates of CR-W and RS-C were 10.86% and 9.20%, respectively. Field surface water NH₄⁺-N, field surface water pH, and topsoil NH₄⁺-N were the major internal factors of ammonia emissions from paddy fields, whereas topsoil NH₄⁺-N and atmospheric temperature had an important impact on ammonia emissions in the wheat season. The ammonia flux/field NH₄⁺-N ratio (ARN) of field surface water under the CR and RS modes in the rice season reached 0.35±0.27 and 0.14±0.19, respectively, which was 10-25 times that of topsoil in the wheat season, such that the ammonia emission flux in the rice season was significantly higher than that in the wheat season. Under the conditions of high field water pH (8.0-9.0), atmospheric temperature (>28℃), and wind speed (>5.0 m·s^-1), the ammonia flux/field NH₄⁺-N ratios (ARN) were around 1.6-4.6 times that under low pH, temperature, and wind speed conditions, indicating that those three factors were the main factors affecting the conversion of NH₄⁺-N from farmland to atmospheric NH₃. Fertilization types also had significant effects on ARN; under different conditions, the ARN of urea was 1.5-5.5 times that of organic fertilizer. In 2019, the ammonia emission flux of rice and wheat under a conventional planting pattern in the Yangtze River Delta were (49.2±17.6) kg·hm^-2 and (16.0±13.5) kg·hm^-2, respectively, whereas the ammonia loss rates of rice and wheat were (20.1±5.7)% and (5.9±3.6)%, respectively. The ammonia emission loss rate of the former was about three times that of the latter. The ammonia emission inventory built by local factors shows that the total ammonia emissions of the farmland rotation system in the Yangtze River Delta reached (400.3±206.4) kt in 2019, which was mainly concentrated in the central and northern regions of Anhui province and Jiangsu province, and the ammonia emission intensity reached (1.33±1.39) t·km^-2. The selection of different emission factors had a relatively large impact on the change range of the inventory results, reaching the standard of -51.6%~51.6%. Through combing and analyzing the six main paths of ammonia emission reduction in farmland, it was found that nitrogen fertilizer synergism was the best way to reduce ammonia emissions, with the efficiency of (30.9±51.4)%; however, the grain yield increase rate was (-4.2±17.4)%, with great uncertainty. The ammonia emission reduction effect of adding soil additives was relatively poor (-5.4±45.1)%; however, the grain yield increase rate was the highest among those of the six emission reduction paths, reaching (6.8±23.9)%. The ammonia emission reduction effect and grain yield increase rate of the ecological planting and breeding mode were (22.3±15.1)% and (5.6±3.8)%, respectively, which had the advantages of reducing ammonia emissions and increasing crop yield.

Xanthotoxin induced photoactivated toxicity, oxidative stress and cellular apoptosis in Caenorhabditis elegans under ultraviolet A

Xanthotoxin (XAT) is widely present in many kinds of plants. Caenorhabditis elegans, a typical model organism, was used to study the effects of XAT on C. elegans developmental toxicity, neurotoxicity, reproductive toxicity induced under ultraviolet A (UVA), oxidative stress and apoptosis in C. elegans. The results showed that after XAT exposure treatment, the hatchability of C. elegans decreased significantly as the concentration increased; the body length and width increased markedly, the external morphology was swollen; the brood sizes had been decreased; and the frequencies of head thrashes and body bend decreased significantly. At 80 and 100 mg/L, XAT reduced the activities of mitochondrial complex enzymes I and III, resulting in the excessive production of ROS, and inhibited SOD and CAT so that the ROS could not be eliminated over time. ROS accumulation in the bodies further caused the contents of MDA, protein carbonyl and lipofuscin to increase significantly, the mitochondrial membrane potential to be severely damaged, apoptosis to occur, and the apoptosis genes ced-3 and ced-4 to be significantly upregulated. Thus, XAT showed photoactivated toxicity to C. elegans under UVA, which will help people to make full and rational use of plants containing XAT.

Greater efficacy of a combination of conservative therapies for thumb base OA in individuals with lower radial subluxation - a pre-planned subgroup analysis of the COMBO trial

OBJECTIVE

To investigate heterogeneous effects of a combination of conservative therapies compared with an education comparator for thumb base (TB) osteoarthritis (OA) according to clinically relevant characteristics.

METHODS

Pre-planned subgroup analysis of the COMBO trial (n = 204) which compared a combination of education on self-management and ergonomic principles, a prefabricated neoprene splint, hand exercises, and diclofenac sodium gel, with education alone for radiographic and symptomatic TB OA. Primary outcomes were change in pain (visual analogue scale [VAS], 0-100 mm) and hand function (Functional Index for Hand Osteoarthritis questionnaire, 0-30) from baseline to week-6. Other outcomes were grip and tip-pinch strength and patient's global assessment (PGA) (VAS, 0-100 mm). Possible treatment effect modifiers were the presence of interphalangeal joint pain, erosive hand OA, radiographic thumb carpometacarpal joint subluxation (higher vs equal or lower than the sample mean), and baseline radiographic OA severity (Kellgren Lawrence grade). Linear regression models were fitted, adding interaction terms for each subgroup of interest.

RESULTS

The treatment effects of the combined intervention at 6 weeks were greater in participants with lower joint subluxation compared with those with greater subluxation (pain -11.6 [95%CI -22.2, -9.9] and 2.6 [-5.5, 10.7], respectively, difference between the subluxation groups 14.2 units (95% CI 2.3, 26.1), p-value 0.02; and PGA -14.0 [-22.4, -5.5] and 1.5 [-6.2, 9.3), respectively, difference between the subluxation groups 15.5 units (95% CI 4.2, 26.8), p-value 0.03). There was no statistically significant heterogeneity for the other subgroups.

CONCLUSION

A combination of conservative therapies may provide greater benefits over 6 weeks in individuals with lower joint subluxation, although the clinical relevance is uncertain given the wide confidence intervals. Treatment strategies may need to be customized for those with greater joint subluxation.

TRIAL REGISTRATION NUMBER

ACTRN 12616000353493.

[Assessment of the quality of life of mandibular ameloblastoma patients after reconstruction with double-barrel fibula flap]

Objective: To analyse the quality of life of patients receiving repair of bone defect with folded fibula flap after removal of mandibular ameloblastoma. Methods: The case data of 39 patients with ameloblastoma admitted to the First Affiliated Hospital of Zhengzhou University from August 2013 to April 2016 were retrospectively analysed, including 21 males and 18 females, from 18 to 58 years old. 3D printing and digital technology were used in flap preparation before surgery in all patients. The folded fibular flaps were used to repair mandibular defects and the implants were placed between 6-9 months after surgery. The short form-36 health survey questionnaire (SF-36) and the university of Washington quality of life questionnaire (UW-QOL) were applied to evaluate the quality of life of patients before surgery and at 6 months and 24 months after surgery. The higher the score, the better the condition. SPSS 20.0 was adopted for statistical analysis. Results: The SF-36 survey showed that the mean score of body role before surgery (72.4±11.7) was significantly higher than that at 6 months after surgery (39.6±11.1, t=23.580, P<0.05) or that at 24 months after surgery (59.8±6.4, t=8.358, P<0.001). Compared with the preoperative mean scores of Physical Pain (73.0±11.0), General Health (73.4±10.4) and Health Changes (79.2±3.9) before surgery, the mean scores Physical Pain (53.1±7.7), General Health (53.5±7.5) and Health Changes (63.9±11.7) at 6 months after surgery were decreased significantly respectively (t=13.068, 13.756 and 10.880, respectively, all P<0.05), but the mean scores Physical Pain (78.8±14.0), General Health (80.9±12.6) and Health Changes (84.4±4.6) at 24 months after surgery were increased significantly respectively (t=-2.904, -4.027 and -7.586, respectively, all P<0.05), with significant differences in the mean scores of Physical Pain, General Health and Health Changes between 6 and 24 months after surgery (t=-14.241, -16.490, -14.294, respectively, all P<0.001). The UW-QOL survey showed that the mean scores of chewing, language and taste functions decreased at 6 months after surgery (53.1±6.7, 53.0±7.7 and 62.2±9.9, respectively), but improved at 24 months after surgery (67.9±3.9, 63.9±2.9 and 68.4±11.1, respectively), with statistically significant difference (t=-16.765, -11.675 and 2.498, respectively, all P<0.001). Conclusion: The application of folded fibula flaps to repair bone defects after sugery of mandibular ameloblastoma can better meet the needs of language and chewing functions and improve the quality of life of patients.

[Research of prognostic immunophenotypes in 163 patients of diffuse large B-cell lymphoma]

目的

筛选并分析与弥漫大B细胞淋巴瘤（DLBCL）预后相关的免疫表型，探究其预后价值。

方法

选取天津医科大学肿瘤医院2011年1月至2016年12月收治的163例DLBCL患者，免疫组织化学染色检测DLBCL常见免疫表型，COX模型探索独立于国际预后指数（IPI）影响总生存（OS）与无进展生存（PFS）的免疫表型，并分析其两两联合表达对预后的影响。

结果

多因素分析显示BCL6阴性（PFS：HR＝1.652，95％ CI 1.030～2.649，P＝0.037）、P53阳性（OS：HR＝1.842，95％ CI 1.008～3.367，P＝0.047）、BCL2强阳性（OS：HR＝2.102，95％CI 1.249～3.537，P＝0.005；PFS：HR＝2.126，95％ CI 1.312～3.443，P＝0.002）是DLBCL中独立于IPI的预后不良因素。亚组分析显示，在年龄≤60岁组患者中BCL6阴性（PFS：HR＝2.042，95％CI 1.021～4.081，P＝0.043）、P53阳性（OS：HR＝3.069，95％ CI 1.244～7.569，P＝0.015）和BCL2强阳性（OS：HR＝2.433，95％ CI 1.165～5.082，P＝0.018；PFS：HR＝3.209，95％CI 1.606～6.410，P＝0.001）对预后影响显著；在IPI 0～2分亚组患者中，BCL6阴性（OS：HR＝2.467，95％CI 1.322～4.604，P＝0.005；PFS：HR＝2.248，95％CI 1.275～3.965，P＝0.005）和BCL2强阳性（PFS：HR＝2.045，95％CI 1.119～3.735，P＝0.020）对预后影响显著。BCL6和BCL2强阳性的联合表达与DLBCL的预后相关（P＝0.005和P<0.001），BCL6阳性/BCL2非强阳性（86例）预后最好［3年OS率（71.6±4.9）％，3年PFS率（67.0±5.1）％］，BCL6阴性/BCL2强阳性（10例）预后最差［3年OS率（20.0±12.6）％，3年PFS率（10.0±9.5）％］；BCL6、P53的联合表达与DLBCL的预后差异无统计学意义（P＝0.061和P＝0.089），但生存曲线显示BCL6阳性/P53阴性的病例（98例）预后较好［3年OS率（70.6±4.7）％，3年PFS率（64.6±4.9）％］；BCL2强阳性、P53的联合表达与DLBCL的预后显著相关（P<0.001和P<0.001），BCL2强阳性/P53阳性的病例（5例）预后最差（3年OS率和PFS率均为0）；无论BCL6与P53表达如何，BCL2强阳性的病例预后均比非强阳性病例差。

结论

BCL6阴性、P53阳性、BCL2强阳性三种免疫表型单独及联合表达对DLBCL尤其是年龄≤60岁和IPI 0～2分患者的预后预测具有一定价值。

[Clinicopathological features of intravascular peripheral T-cell lymphoma]

Objective: To summarize the clinical and pathological features of intravascular NK and T cell lymphoma for better understanding of such disease to reduce misdiagnosis and miss-diagnosis. Methods: Clinical and pathological features were analyzed retrospectively in one case of intravascular peripheral T-cell lymphoma, not otherwise specified (IVPTCL, NOS) , with literatures review. Results: The case presented in this study was a 66-year-old man. PET/CT scan showed multiple lymph nodes enlargement throughout the body. Normal lymph node structure could not be observed by tissue biopsy, while lymph follicles were partially disrupted. High-power light microscope revealed a large number of blood vessels with diffuse proliferation and dilation, where atypical lymphoid cell mass was restricted in the lumen and partially infiltrated the large blood vessel wall. These tumor cells were medium to large with moderate cytoplasm. The nucleus was irregular, single or multiple nucleoli could be seen, chromatin was condensed, some were empty and bright, and mitotic figures could be seen. Immunohistochemical staining showed that the neoplastic cells were positive for expression of CD3, CD43, CD8, GrB, TIA-1 and perforin. EBER in situ hybridization result was negative. Polymerase chain reaction test identified a clonal gene rearrangement of T-cell receptor γ. The patient was treated with CHOP in combination with chidamide, but died of infection and cardiopulmonary failure within 2 months. 56 cases of intravascular NK/T cell lymphoma with definite classification were collected from relevant literatures, including 47 cases with nasal type of extranodal NK/T cell lymphoma (27 were male and 20 were female) , 8 cases with anaplastic large cell lymphoma (3 males and 5 females) , and only one case with de nova IVPTCL, NOS in brain. We report the second case of IVPTCL,NOS, and notably originated from lymph node for the first time. Conclusions: Intravascular NK/T cell lymphoma is a highly aggressive disease with no effective treatment at present. Involvement of Lymph node has rarely been reported, and further studies on more cases are necessary.

[Application of the posteromedial thigh flap for oral and maxillofacial defect reconstruction]

To explore the feasibility of using the posteromedial thigh flap as an alternative source for oral and maxillofacial reconstruction. During January 2019 to January 2020, twenty-three patients underwent oral and maxillofacial tumor ablation and defect reconstruction with 23 posteromedial thigh flaps were enrolled in the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University. Thirteen of the patients were male and ten were female, with age of (54.5±9.7) years (33-72 years). The numbers and types of perforators, the dimension of flap and the vascular pedicle length were measured. The outcomes of flaps and donor-site complication were recorded. The patients' satisfaction with donor-site cosmesis were evaluated by the visual analogue scale (VAS). More than one sizable perforators was found in each case and the median number of perforators was 2 (range, 1 to 4), and all of the perforators were musculocutaneous. The pedicle length was (9.8±1.5) cm (range, 7.3 to 13.4 cm). The diameters of artery and the larger vein were 2.0 mm (range, 1.5 to 2.5 mm) and 2.0 mm (range, 1.5 to 3.0 mm), respectively. The dimension of the flaps ranged from 8 cm×6 cm to 12 cm×8 cm, and the donor sites were all closed primarily. All of the flaps were clinically survived, only one patient experienced partial wound dehiscence of donor site 14 days postoperatively and no donor site infection or permanent muscular weakness was reported. The VAS scores of the patients' satisfaction with donor-site cosmesis were all more than 8. The perforators of the posteromedial thigh flap is consistent and the donor-site scar is well concealed, which make the posteromedial thigh flap an excellent option for oral and maxillofacial reconstruction.

[Application of neuroendoscopy combined with fluorescence angiography in anterior circulation aneurysm clipping]

Objective: To explore the value of neuroendoscopy combined with fluorescence angiography in anterior circulation aneurysm clipping. Methods: A total of 15 patients with anterior circulation aneurysm from Department of Neurosurgery, Zhongnan Hospital of Wuhan University between October 2018 and January 2019 were enrolled. Neuroendoscopy combined with indocyanine green fluorescence angiography (ICGA) was used to determine the shape of the aneurysm, the specific location of the aneurysm neck and its relationship with the aneurysm-bearing artery during anterior circulation aneurysm clipping. Meanwhile, Neuroendoscopy combined with ICGA can be employed to observe whether there was stenosis and incomplete clamping of the aneurysm-bearing artery after clipping the aneurysm, and whether there was misclamping of the perforating branches hidden under the posterior wall of the aneurysm. Results: The success rate of aneurysm clipping in 15 cases was 15/15. After aneurysm clipping, ICGA and neuroendoscopy were performed. The residual aneurysm neck was detected in 3 cases, and the position of aneurysm clip was adjusted or aneurysm clips were added. In one case, the anterior choroidal aneurysm was found to be mistakenly clipped. After adjusting the aneurysm clip, ICGA and neuroendoscopy showed that the anterior choroidal artery was normal. In another case, the A1 segment aneurysm was clipped. ICGA and neuroendoscopy found that the perforating branch blood vessels were mistakenly clipped. After the adjustment of the aneurysm clip, the blood vessels recovered their patency. There were no surgical-related deaths, disability and coma cases in the study. Conclusions: During aneurysm clipping, neuroendoscopy combined with ICGA can reduce cerebral vasospasm, decrease the misclipping rate of perforation of blood vessels, and avoid residual neck of aneurysm, stenosis or occlusion of aneurysm-bearing artery by using neuroendoscopy to observe whether misclipping of the perforating branch vessels exist and whether the aneurysm is clipped. Therefore, it can reduce postoperative complications.

[Analysis of incidence and risk factors of neonatal ventilator associated pneumonia in a hospital in Hunan Province, 2016-2018]

Objective: To investigate the incidence and risk factors of ventilator-associated pneumonia (VAP) in neonatal intensive care unit (NICU), and to provide evidence for the prevention and control of VAP. Methods: A total of 1 872 neonates, who were admitted into NICU of Hunan Provincial Maternal and Child Health Hospital and subjected to mechanical ventilation from October 2016 to June 2018, were enrolled in the study. The neonates who met the diagnostic criteria of VAP were selected as the case group, and those who were treated with ventilator for 48 hours at the same time were regarded as the control group. Multivariate logistic regression model was used to analyze the related factors of VAP. Results: Of the 1 872 neonates who underwent the mechanical ventilation, the VAP occurred in 160 cases with the incidence rate of 8.5% (160 cases). The 227 specimens were collected. Gram-positive bacteria (n=116, 51.1%) were the main pathogens. The main pathogens were Staphylococcus epidermidis, Enterococcus faecalis, Acinetobacter baumannii. By Chi-square test, birth weight, birth age, Apgar score, duration of ventilator, and whether newborn mothers with pregnancy hypertension were influencing factors. The result of logistic regression analysis showed that compared with no pregnancy included hypertension, the first aid measure at birth was initial resuscitation, and the MV time ≤ 5 days, the risk factors of ventilator-associated pneumonia in neonates included: their mothers with hypertensive disorders complicating pregnancy, using of tracheal intubation and ventilator time more than 5 days. Conclusion: The incidence of VAP in neonates receiving continuous MV therapy in neonatal intensive care unit is higher. Gram-positive bacteria are the main pathogens. VAP in neonates is related to whether newborn mothers with pregnancy hypertension, MV duration and tracheal intubation.

Association of weather factors with the risk of pain exacerbations in people with hip osteoarthritis

Objectives: Our objective was to evaluate the association of weather factors with the risk of pain exacerbations in people with symptomatic hip osteoarthritis (OA). Method: Eligible participants with symptomatic hip OA were instructed to log on to the study website and complete questionnaires every 10 days and additionally whenever they considered they were experiencing a pain exacerbation (case period) during the 90 day follow-up. Pain exacerbation was defined as an increase of two points in pain intensity on an 11-point numeric rating scale (0-10) during the follow-up compared with baseline. Each case period was anchored to four control periods within a 35 day interval using a time-stratified approach. Weather data were obtained for both periods from the publicly available meteorological database of the Australian Bureau of Meteorology. We examined the association of weather factors across 72 h before the index date with the risk of pain exacerbation, using conditional logistic regression. Results: Among 252 participants recruited, 129 participants had at least one episode of pain exacerbation and were included in the analysis. A significant dose-response relationship was found between average daily temperature variation in the prior 72 h and risk of pain exacerbations (p = 0.04 for linear trend). There was no significant association between maximum daily temperature, minimum daily temperature, relative humidity, precipitation, or barometric pressure and hip pain exacerbations. Conclusion: The overall results suggest that only daily temperature variation among different weather factors was associated with hip pain exacerbations in people with symptomatic hip OA.

A REPORT OF RADIATION RISKS DURING AND AFTER PROCESSING MINERAL PLACER FROM SOUTHEAST AFRICA

Recently, high levels of radioactivity were found in products from Chinese mineral processing industries that handle mineral placer from Southeast Africa. The findings led to public panic. The aim of this work is to provide radiological data for the government, workers and the public. In this work, activity concentrations of 238U,232Th,226Ra and40 K in raw ore from Southeast Africa were analysed in the laboratory. Products like monazite and building material were analysed. High concentrations of 238U,232 Th and 226Ra in products were found to be at a level of 104  Bq/kg. Around the South China Mineral Processing Industry, radioactivity in soil and groundwater was analysed. Absorbed dose rates in air and indoor radon concentrations at workplaces were monitored. Annual effective dose to workers and the public was calculated and found to exceed Chinese dose criterion. This report might be an alert for mining and mineral processing in Southeast Africa.

[Prognostic evaluation of P53 and BCL2 proteins in MYC/BCL2 double expression DLBCL]

Objective: To investigate the strong expression (S+) of P53 and BCL2 proteins in MYC/BCL2 double-expression DLBCL (DEL) and whether they can be used for the prognostic evaluation and stratified diagnosis of DELs. Methods: Tissue microarray were made by filed FFPE blocks of 174 DLBCL cases. The translocation of MYC, BCL2 and BCL6 genes were detected by FISH, and the proteins were detected by IHC. Data of clinicopathologic features and follow up of patients were collected and OS (overall survival) and PFS (progression free survival) were analyzed by statistics. Results: Eight double-hit lymphomas (DHLs) were identified in all cases, and 45 DELs were selected from 166 remaining cases, which have no significant difference in OS and PFS compared with non-DEL cases (P=0.668 and P=0.790) . Of 42 DEL-cases with follow up data, 24 cases with P53+ or/and BCL2 (S+) are significantly shorter OS and PFS than others (P=0.003 and P=0.000) , in which the cases with P53+/BCL2 (S+) co-expression were the worst prognosis, and P53/BCL2 co-weaker positive DEL cases even have superior OS and PFS than those non-DELs. Although statistics showed that the cases of P53+ or/and BCL2 (S+) have a lower OS and PFS in total cases (P=0.063 and P=0.024) , it is not the case when the DEL-cases take out from total cases, that is the cases with P53+ or/and BCL2 (S+) are as similar OS and PFS as others in non-DEL group (P=0.590 and P=0.550) . Conclusion: The strong expression of P53 and BCL2 proteins can be used as indicators of stratified diagnosis and poor prognosis of DEL.

Collective topo-epitaxy in the self-assembly of a 3D quantum dot superlattice

Epitaxially fused colloidal quantum dot (QD) superlattices (epi-SLs) may enable a new class of semiconductors that combine the size-tunable photophysics of QDs with bulk-like electronic performance, but progress is hindered by a poor understanding of epi-SL formation and surface chemistry. Here we use X-ray scattering and correlative electron imaging and diffraction of individual SL grains to determine the formation mechanism of three-dimensional PbSe QD epi-SL films. We show that the epi-SL forms from a rhombohedrally distorted body centred cubic parent SL via a phase transition in which the QDs translate with minimal rotation (~10°) and epitaxially fuse across their {100} facets in three dimensions. This collective epitaxial transformation is atomically topotactic across the 10³-10⁵ QDs in each SL grain. Infilling the epi-SLs with alumina by atomic layer deposition greatly changes their electrical properties without affecting the superlattice structure. Our work establishes the formation mechanism of three-dimensional QD epi-SLs and illustrates the critical importance of surface chemistry to charge transport in these materials.

Shortwave infrared fluorescence in vivo imaging of nerves for minimizing the risk of intraoperative nerve injury

Here, we present a novel nerve specific imaging agent for preventing intraoperative nerve injuries based on SWIR QD-based in vivo imaging, which not only provides real-time and long-time SWIR images to intraoperatively identify nerves but can also markedly minimize the risk of iatrogenic nerve injuries during surgeries.

[Accumulation of Cd in Different Crops and Screening of Low-Cd Accumulation Cultivars]

Pot-culture experiments were carried out in Shanghai to screen crop varieties with low bioaccumulation properties with respect to cadmium (Cd). Eight common crops, such as green pepper, cucumber, cowpea, spinach, cauliflower, tomatoes, rice, and wheat, were planted in contaminated soil with different Cd concentrations of 0.23, 0.6, 1.2, 1.8, 2.4, and 3.0 mg·kg^-1 to investigate the effects on biomass, Cd accumulation characteristics, and edible risk safety. The results indicated that:① With the increase in soil Cd content, the aboveground biomass of crops increased firstly and then decreased. The different crop types had different tolerance to Cd, with green pepper showed the strongest tolerance and spinach and tomato showed the least tolerance. ② The bioaccumulation factor of Cd in the edible parts of eight crops ranged in order of wheat > spinach > rice > green pepper > cauliflower > tomato > cucumber > cowpea. ③ Total Cd content in soil was significantly correlated with Cd content in the crops (P<0.05), and the order of the correlation coefficients was spinach > wheat > tomato > cucumber > green pepper > rice > cauliflower > cowpea. ④ The risk threshold value of Cd in soil based on the edible safety of different crops ranged in order of cowpea > cucumber > cauliflower > green pepper > tomato > rice > spinach > wheat. Cucumber, cowpea, and cauliflower were selected as the low-Cd-accumulating varieties according to their tolerance to soil Cd, bioaccumulation capacity, and edible risk threshold values.

An improved method for studying whole sections of late developing wheat grain

Whole sections are important for investigation in situ of the development of cell morphology and accumulation of storage substance in cereal kernels. We developed an improved, simple method to obtain good quality whole histological sections of wheat grains during mid- and late-stage (28 and 35 days post anthesis) grain filling. The wheat grains were fixed and dehydrated, cleared in chloroform for 3 days and infiltrated in paraffin at 55° C for 3 - 5 days. The infiltrated grains then were embedded in paraffin wax, softened using diethyl pyrocarbonate (DEPC) water before sectioning. After these treatments, the wheat grains can be sectioned easily at 10 - 25 μm while retaining the cellular structure and antigenicity. The cell structure, cell distribution, autofluorescence, starch accumulation and localization in situ of bam1, one of the genes encoding β-amylase transcripts in the sections of the late developing wheat grain were observed readily.

Heavy metals accumulation in soil after 4 years of continuous land application of swine manure: A field-scale monitoring and modeling estimation

Land application of animal manure has been encouraged widely in China. This presents a risk of heavy metals (HMs) accumulation in the soil due to their high contents in the feeds and additives. A 4-year field-scale study was conducted to monitor and estimate HMs accumulation in the soil with land application of swine manure. The results show a clear tendency for As, Hg, Cr, Cu, Zn and Mn to increase gradually with the application duration, yielding an average annual increase of 0.57, 0.011, 6.20, 5.64, 22.58, and 23.45 mg kg^-1, respectively, at the annual application rate of about 250 t ha^-1 of swine manure. The estimation from the mass balance modeling indicates the environmental risk of Cd, Cu and Zn will exceed the threshold levels for agricultural soils in China in the next 10-50 years. Determination of a suitable application rate of animal manure would be the first consideration for mitigating the environmental risk of HMs currently.

[Assessment of the quality of life of mandible defect after reconstruction with fibula flap]

Objective: To evaluate the quality of life (QOL) of patients who underwent resection of mandible and reconstruction by fibula flap. Methods: A total of seventy six patients who underwent resection of mandible and reconstruction by fibula flap admitted to The First Affiliated Hospital of Zhengzhou University from January 2013 to August 2016 were prospectively analyzed. In the preoperative and postoperative 3 month, 12 months, the QOL of these patients were assessed by using the 14-item oral health impact profile questionnaires (OHIP), The University of Washington quality of life (UW-QOL) and the European organization for research and treatment of cancer quality of life questionnaire head and neck module (EORTC-QLQ-H&N). Results: The OHIP-14 questionnaire showed the highest score of the three months after surgery was mental discomfort (73.0±11.9) and psychological disorder (72.1±11.9), and it was difficult to be relieved over time. In the 12 months after surgery, the lowest scores were physiological pain (35.0±8.6) and disability (37.5±10.2), and 87% (66/76) patients thought that the flap repair worked well. The UW-QOL questionnaire showed that the scores of the patients' chewing, taste and salivary were significantly reduced by 3 months after the operation, and they were still unable to recover to preoperative level 12 months after surgery. The EORTC-QLQ-H&N35 questionnaire showed that swallowing, language, and diet scored higher in the three months after surgery, but could be restored to preoperative levels 12 months after surgery. The score was higher in 12 months after the operation than before surgery and was related to radiotherapy in some patients. Conclusions: Using fibula flap to repair the mandible defect can restore the patient's jaw function and improve the quality of life of the patients.

Changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children

Aims

The aim of this study was to investigate the changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children.

Patients and Methods

A total of 23 patients with a mean age of 9.6 years (7 to 11) were included All had bilateral recurrent patellar dislocation associated with femoral trochlear dysplasia. The knee with traumatic dislocation at the time of presentation or that had dislocated most frequently was treated with medial patellar retinacular plasty (Group S). The contralateral knee served as a control and was treated conservatively (Group C). All patients were treated between October 2008 and August 2013. The mean follow-up was 48.7 months (43 to 56). Axial CT scans were undertaken in all patients to assess the trochlear morphological characteristics on a particular axial image which was established at the point with the greatest epicondylar width based on measurements preoperatively and at the final follow-up.

Results

Preoperatively, there were no statistically significant differences between the trochlear morphology in the two groups (sulcus angle, p 0.852; trochlear groove depth, p 0.885; lateral trochlear inclination, p 0.676; lateral-to-medial facet ratio, p 0.468; lateral condylar height, p 0.899; medial condylar height, p 0.816). Many radiological parameters of trochlear morphology were significantly different between the two groups at the final follow-up, including well-known parameters, such as the mean sulcus angle (Group S, 146.27° (sd 7.18); Group C, 160.61° (sd 9.29); p < 0.001), the mean trochlear groove depth (Group S, 6.25 mm (sd 0.41); Group C, 3.48 mm (sd 0.65); p < 0.001) and the mean lateral trochlear inclination (Group S, 20.99° (sd 3.87); Group C, 12.18° (sd 1.85); p < 0.001). Lesser known parameters such as the ratio of the lateral to medial trochlear length (Group S, 1.46 (sd 0.19); Group C, 2.14 (sd 0.42); p < 0.001), which is a measurement of facet asymmetry, and the lateral and medial condylar height were also significantly different between the two groups (p < 0.001).

Conclusion

The femoral trochlear morphology can be improved by early (before epiphyseal closure) surgical correction in children with recurrent patellar dislocation associated with femoral trochlear dysplasia. Cite this article: Bone Joint J 2018;100-B:811–21.

Abdominal pain as a result of intermittent hydronephrosis

OBJECTIVE

We report a minority of cases presented with abdominal pain due to intermittent hydronephrosis, to improve the recognition of this condition.

PATIENTS AND METHODS

We retrospectively studied 1152 children complained of abdominal pain in our center from January 2010 to December 2015. Also, we analyzed the clinical presentation, treatment experience, examination results, and image features in detail.

RESULTS

14 patients received a diagnosis of intermittent hydronephrosis including 11 boys and 3 girls. 9 patients were affected on the left kidney and other 5 on the right side. All children presented recurrent abdominal pain, and the ultrasound images varied during different stages. All patients had been misdiagnosed and delayed treatment.

CONCLUSIONS

Abdominal pain caused by intermittent hydronephrosis is easily misdiagnosed; all preschool children with a history of recurrent abdominal pain should be suspected of this condition.

[Assessment of the quality of life of tongue base cancer patients after reconstruction with anterolateral thigh perforator flap]

Objective: To evaluate the quality of life (QOL) of patients who underwent resection of tongue base cancer and reconstruction by anterolateral thigh perforator free flap(ALTFF). Methods: A total of 77 patients with tongue cancer who underwent glossectomy and reconstruction by ALTFF were retrospectively analyzed in this work. At intervals of 3-month before operation, as well as both 3-month and 12-month post-operation, the QOL of these patients was assessed by using the 14-item Oral Health Impact Profile questionnaires(OHIP-14) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module(EORTC-QLQ-H&N35). Results: The OHIP-14 questionnaire showed the physiological pain can be significantly alleviated at 3 months postoperatively. The highest score were psychological discomfort and psychological disorders at 3 months postoperatively. Functional limitations cannot be restored to preoperative level at 12 months postoperatively, although lower than that in 3 months postoperatively(40.6±10.3 vs 39.2±10.6, t=-0.812, P=0.948). The EORTC-QLQ-H & N35 survey showed that swallowing, language and diet were higher at 3 months postoperatively, and improved significantly at 12 months postoperatively. Teeth and mouth opening was lower before and after surgery, and no significant difference was observed. Conclusion: The use of ALTFF to repair tongue base cancer, can restore the patient's appearance, language and chewing function of the basic needs and improve the quality of life of patients.

[Implant restoration on folded fibular graft for the repair of mandibular defect]

Objective: To discuss the key points of implant restoration on folded fibular graft for mandibular defect. Methods: Fifteen patients with mandibular ameloblastoma were treated by segmental resection of the mandible.The mandibular defect was reconstructed with vascularized folded fibular graft. Implant restoration on the graft was conduced 6-9 months after operation.The results were evaluated. Results: All patients had no tenderness in the temporomandibular joint region. The mouth opening reached 3.1-3.9 cm and the occlusion relationship was good. There was no obvious abnormality in masticatory and swallowing function. After 12-48 months of follow-up, the implants were all survived. Conclusions: The application of folded fibula for both mandible defect repair and postoperative implant restoration could achieve satisfactory results in restoration of the facial appearance and physiological function of oral cavity.

Abnormal WNT5A Signaling Causes Mandibular Hypoplasia in Robinow Syndrome

The study of rare genetic diseases provides valuable insights into human gene function. Here, we investigate dominant Robinow syndrome (RS), which affects the WNT5A signaling pathway. Autosomal dominant RS is caused by missense mutations in WNT5A or nonsense mutations in the adaptor protein DVL1 or DVL3. The recessive form of the disease is caused by loss-of-function mutations in the receptor ROR2. RS is characterized by hypertelorism, midface, and mandibular hypoplasia. Here, we focus on the missense mutations in WNT5A, since the impact on function is difficult to predict from in silico analysis. We used chicken embryo to express wild-type or 2 mutant versions of human WNT5A in the mandible and then examined the morphologic, cellular, and molecular effects. The 3 experimental viruses—wt WNT5A, WNT5AC83S, or WNT5AC182R—all caused shortening of the mandible on the injected side as compared with GFP controls. Although the phenotypes initially appeared similar, we uncovered specific disruption of chondrocyte polarity and shape, inhibition of cell migration, differences in target gene expression, and absence of JNK signaling only in the presence of mutant viruses. In addition, the missense mutations do not appear to block receptor binding, since in paracrine experiments, the mutant protein inhibits cell migration. In this study, we ruled out a straightforward gain or loss of function caused by the WNT5A missense mutations. Instead, the mutations are likely redirecting WNT signaling away from JNK-PCP toward other noncanonical pathways. We conclude that in RS, WNT5A missense mutations have dominant neomorphic effects that interfere with the function of the wild-type protein.

Expression of profilin-1 in endothelial cells of rats with acute myocardial infarction

OBJECTIVE

To analyze the expression of profilin-1 in endothelial cells of rats with acute myocardial infarction.

MATERIALS AND METHODS

Twenty adult male Wistar rats were randomly divided into the myocardial infarction (model) group (n=10) and sham-operation (control) group (n=10). The expression of profilin-1 and phosphorylated extracellular signal kinase (pERK1/2) in aortic endothelial cells, indexes of endothelial injury [levels of endothelial microparticles (EMPs) and nitric oxide (NO)], indexes of myocardial injury [cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB)], and mRNA levels of myocardial apoptotic factors (P53, Fas, Bax, and Bcl-2) in rats between the two groups were compared.

RESULTS

The expression of profilin-1 and pERK1/2 in aortic endothelial cells of rats in the model group was higher than in the control group (p<0.05), the levels of EMPs were increased, and NO levels were lower (p<0.05); cTnT and CK-MB in myocardial tissue, and mRNA of pro-apoptotic factors (P53, Fas, and Bax) were increased, whereas Bcl-2 mRNA was decreased (p<0.05). The protein expression of profilin-1 and pERK1 was positively correlated with the levels of cTnT, CK-MB, EMP, P53, Fas, and Bax, and negatively correlated with the levels of NO and Bcl-2 (p<0.05).

CONCLUSIONS

The high expression of profilin-1 is an important mechanism of acute myocardial infarction, and is expected to become a new target for the treatment of myocardial infarction.

[Comparison of free anterolateral thigh perforator flaps versus free forearm flap for reconstruction in elderly patients undergoing glossectomy]

Objective: To evaluate the quality of life (QOL) in elderly patients with tongue cancer who underwent immediate free flap reconstruction surgery. In addition, the efficacy of the anterolateral thigh perforator free flap (ALTFF) and the radial free forearm flap (RFFF) for reconstruction was compared in patients with glossectomy. Methods: Ninty-eight patients undergoing complete or partial glossectomy and reconstruction with free flaps were grouped according to flap type. Oral functions were assessed using The University of Washington Quality of Life (UW-QOL), and the 14-item Oral Health Impact Profile questionnaires (OHIP-14) at 6 and 12 months after reconstructive surgery. Results: Eighty-six of 98 questionnaires (88%) were returned. There was significant difference between the 2 groups in the style of resection (P<0.05). For all oral function domains, the score improved progressively after the operation (6 and 12 months after the procedure). The UW-QOL questionnaire showed a significant difference between the 6 months postoperatively (ALTFF: 290.0 ± 7.8, RFFF: 236.6 ± 24.2) and 12 months postoperatively (ALTFF: 302.0±21.1, RFFF: 331.1±20.4) (P<0.05). The OHIP-14 questionnaire showed a total score of ALTFF (422.0± 15.2) which was significantly less than RFFF (434.0±38.7) at 6 months postoperatively (P<0.05). There were no meaningful differences between the 2 flap types for all oral function domains at 12 months. Conclusions: Using the RFFF or ALTFF for reconstruction of tongue defects after cancer resection influences oral function. There was no significant difference in quality of life between the two flaps at 12 months postoperatively.

Active Site Mapping of an Aspartic Protease by Multiple Fragment Crystal Structures: Versatile Warheads To Address a Catalytic Dyad

Crystallography is frequently used as follow-up method to validate hits identified by biophysical screening cascades. The capacity of crystallography to directly screen fragment libraries is often underestimated, due to its supposed low-throughput and need for high-quality crystals. We applied crystallographic fragment screening to map the protein-binding site of the aspartic protease endothiapepsin by individual soaking experiments. Here, we report on 41 fragments binding to the catalytic dyad and adjacent specificity pockets. The analysis identifies already known warheads but also reveals hydrazide, pyrazole, or carboxylic acid fragments as novel functional groups binding to the dyad. A remarkable swapping of the S1 and S1' pocket between structurally related fragments is explained by either steric demand, required displacement of a well-bound water molecule, or changes of trigonal-planar to tetrahedral geometry of an oxygen functional group in a side chain. Some warheads simultaneously occupying both S1 and S1' are promising starting points for fragment-growing strategies.

Experimental Active-Site Mapping by Fragments: Hot Spots Remote from the Catalytic Center of Endothiapepsin

Successful optimization of a given lead scaffold requires thorough binding-site mapping of the target protein particular in regions remote from the catalytic center where high conservation across protein families is given. We screened a 361-entry fragment library for binding to the aspartic protease endothiapepsin by crystallography. This enzyme is frequently used as a surrogate for the design of renin and β-secretase inhibitors. A hit rate of 20% was achieved, providing 71 crystal structures. Here, we discuss 45 binding poses of fragments accommodated in pockets remote from the catalytic dyad. Three major hot spots are discovered in remote binding areas: Asp81, Asp119, and Phe291. Compared to the dyad binders, bulkier fragments occupy these regions. Many of the discovered fragments suggest an optimization concept on how to grow them into larger ligands occupying adjacent binding pockets that will possibly endow them with the desired selectivity for one given member of a protein family.

High-Throughput Crystallography: Reliable and Efficient Identification of Fragment Hits

Today the identification of lead structures for drug development often starts from small fragment-like molecules raising the chances to find compounds that successfully pass clinical trials. At the heart of the screening for fragments binding to a specific target, crystallography delivers structural information essential for subsequent drug design. While it is common to search for bound ligands in electron densities calculated directly after an initial refinement cycle, we raise the important question whether this strategy is viable for fragments characterized by low affinities. Here, we describe and provide a collection of high-quality diffraction data obtained from 364 protein crystals treated with diverse fragments. Subsequent data analysis showed that ∼25% of all hits would have been missed without further refining the resulting structures. To enable fast and reliable hit identification, we have designed an automated refinement pipeline that will inspire the development of optimized tools facilitating the successful application of fragment-based methods.

Identification and differential expression of microRNAs in the ovaries of pigs (Sus scrofa) with high and low litter sizes

Litter size affects profitability in the swine industry. Mammalian ovaries play important roles during reproduction, including ovulation and hormone secretion, which are tightly regulated by specific microRNAs (miRNAs). In this study, we investigated the effects of specific miRNAs on porcine litter size. We compared the ovarian miRNAs of Yorkshire pigs with high (YH) and low (YL) litter sizes using Solexa sequencing technology. We identified 327 and 320 miRNAs in the ovaries of YH and YL pigs respectively. A total of 297 miRNAs were co-expressed; 30 and 23 miRNAs respectively were specifically expressed in the two libraries. A total of 83 novel miRNAs were predicted; 37 specific miRNAs were obtained, of which 21 miRNAs were upregulated and 16 miRNAs were downregulated in YH compared with YL. Additionally, 19 628 and 19 250 target genes were predicted in the two libraries respectively. The results revealed that specific miRNAs (i.e., miR-224, miR-99a, let-7c, miR-181c, miR-214 and miR-21) may affect porcine litter size. The results of this study will help in gaining understanding of the role of miRNAs in porcine litter size regulation.

Six Biophysical Screening Methods Miss a Large Proportion of Crystallographically Discovered Fragment Hits: A Case Study

Fragment-based lead discovery (FBLD) has become a pillar in drug development. Typical applications of this method comprise at least two biophysical screens as prefilter and a follow-up crystallographic experiment on a subset of fragments. Clearly, structural information is pivotal in FBLD, but a key question is whether such a screening cascade strategy will retrieve the majority of fragment-bound structures. We therefore set out to screen 361 fragments for binding to endothiapepsin, a representative of the challenging group of aspartic proteases, employing six screening techniques and crystallography in parallel. Crystallography resulted in the very high number of 71 structures. Yet alarmingly, 44% of these hits were not detected by any biophysical screening approach. Moreover, any screening cascade, building on the results from two or more screening methods, would have failed to predict at least 73% of these hits. We thus conclude that, at least in the present case, the frequently applied biophysical prescreening filters deteriorate the number of possible X-ray hits while only the immediate use of crystallography enables exhaustive retrieval of a maximum of fragment structures, which represent a rich source guiding hit-to-lead-to-drug evolution.

High-speed ultrashort pulse fiber ring laser using charcoal nanoparticles

A mode-locked erbium-doped fiber ring laser that is easy to set up is proposed and experimentally demonstrated to generate a high-repetition-rate optical pulse train with an ultrashort pulse width. The laser combines a rational harmonic mode-locking technique and charcoal nanoparticles as saturable absorbers. Compared to a solely active mode-locking scheme, the scheme with charcoal nanoparticles can remove the supermodes and narrow the pulse width by a factor of 0.57 at a repetition rate of 20 GHz. Numerical simulation of the laser performance is also provided, which shows good agreement with the experimental results.

Recurrent activating mutations of CD28 in peripheral T-cell lymphomas

Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of mature T-cell neoplasms with a poor prognosis. Recently, mutations in TET2 and other epigenetic modifiers as well as RHOA have been identified in these diseases, particularly in angioimmunoblastic T-cell lymphoma (AITL). CD28 is the major co-stimulatory receptor in T cells which, upon binding ligand, induces sustained T-cell proliferation and cytokine production when combined with T-cell receptor stimulation. We have identified recurrent mutations in CD28 in PTCLs. Two residues-D124 and T195-were recurrently mutated in 11.3% of cases of AITL and in one case of PTCL, not otherwise specified (PTCL-NOS). Surface plasmon resonance analysis of mutations at these residues with predicted differential partner interactions showed increased affinity for ligand CD86 (residue D124) and increased affinity for intracellular adaptor proteins GRB2 and GADS/GRAP2 (residue T195). Molecular modeling studies on each of these mutations suggested how these mutants result in increased affinities. We found increased transcription of the CD28-responsive genes CD226 and TNFA in cells expressing the T195P mutant in response to CD3 and CD86 co-stimulation and increased downstream activation of NF-κB by both D124V and T195P mutants, suggesting a potential therapeutic target in CD28-mutated PTCLs.

Functional and association studies of the cholesteryl ester transfer protein (CETP) gene in a Wannan Black pig model

Some polymorphisms of the human CETP gene are causally and significantly associated with serum lipids levels; however, the information regarding this gene in pigs is sparse. To evaluate the effects of CETP on blood lipid traits and fat deposition in pig, porcine CETP tissue expression patterns were observed by quantitative real-time polymerase chain reaction (qPCR) first. High expression was detected in liver, spleen, gluteus medius (GM) muscle and backfat. A de novo polymorphism (AF333037:g.795C>T) in the intron 1 region of porcine CETP was identified. This polymorphism was further genotyped by direct sequencing of the PCR products of 390 Wannan Black pigs, a Chinese native breed population. Association analyses at 45 and 300 days of age revealed highly significant associations between CETP genotypes and serum lipid traits. Furthermore, this polymorphism was proved to be associated with differences in liver CETP mRNA levels: pigs at 300 days of age with the TT genotype had higher levels than did those with other genotypes (P = 0.021). Additionally, analysis at 300 days of age showed that GM CETP mRNA expression correlated positively with serum lipids levels as well as with carcass backfat thickness and intramuscular fat content in GM. These results indicate that CETP is involved in serum, adipose and muscle lipid metabolism in pigs. The mechanisms underlying such relationships and their functional implications are worthy of further research.

Dexamethasone therapy for preventing delayed encephalopathy after carbon monoxide poisoning

We investigated dexamethasone therapy for preventing delayed encephalopathy after carbon monoxide (CO) poisoning. Eighty healthy male rats were exposed to CO and randomly divided into four groups: hyperbaric oxygen treatment (H), treatment (D), combined hyperbaric and dexamethasone treatment (C), and a control (M) group in which the rats inhaled CO to coma in the hyperbaric oxygen chamber, then were removed without further treatment. Twelve rats were put into the hyperbaric oxygen chamber and treated with air for 60 min (N) group. An eight arm maze was used to evaluate cognitive and memory abilities of these mice. Serum myelin basic protein (MBP) levels were evaluated using ELISA, and magnetic resonance imaging was used to observe brain demyelination and morbidity associated with delayed encephalopathy. A sample of the hippocampus from each group was examined by light microscopy. Cognitive and memory functions decreased in the control group M. Three days after CO poisoning, the serum MBP level of each group increased significantly. On Day 10 after CO poisoning, the MBP levels in groups C and D decreased significantly, but returned to normal on Day 18. MBP levels in the M and H groups were elevated at all time points. Brain MRIs showed significant differences among C, D, H and control M groups. Hematoxylin & eosin staining of the hippocampus showed greater damage in the control M and H groups. Early dexamethasone treatment may be useful for preventing delayed encephalopathy after CO poisoning and may reduce serum MBP levels.