Blocking OLFM4/galectin-3 axis in placental polymorphonuclear myeloid-derived suppressor cells triggers intestinal inflammation in newborns

Fetal growth restriction (FGR) is a major cause of premature and low-weight births, which increases the risk of necrotizing enterocolitis (NEC); however, the association remains unclear. We report a close correlation between placental polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs) and NEC. Newborns with previous FGR exhibited intestinal inflammation and more severe NEC symptoms than healthy newborns. Placental PMN-MDSCs are vital regulators of fetal development and neonatal gut inflammation. Placental single-cell transcriptomics revealed that PMN-MDSCs populations and olfactomedin-4 gene (Olfm4) expression levels were significantly increased in PMN-MDSCs in later pregnancy compared to those in early pregnancy and non-pregnant females. Female mice lacking Olfm4 in myeloid cells mated with wild-type males showed FGR during pregnancy, with a decreased placental PMN-MDSCs population and expression of growth-promoting factors (GPFs) from placental PMN-MDSCs. Galectin-3 (Gal-3) stimulated the OLFM4-mediated secretion of GPFs by placental PMN-MDSCs. Moreover, GPF regulation via OLFM4 in placental PMN-MDSCs was mediated via hypoxia inducible factor-1α (HIF-1α). Notably, the offspring of mothers lacking Olfm4 exhibited intestinal inflammation and were susceptible to NEC. Additionally, OLFM4 expression decreased in placental PMN-MDSCs from pregnancies with FGR and was negatively correlated with neonatal morbidity. These results revealed that placental PMN-MDSCs contributed to fetal development and ameliorate newborn intestinal inflammation.

A cooperative control method and application for series multivariable coupled system

Series multivariable coupled system is a typical controlled object in process control industry. The interaction of various state variables between multiple inputs and outputs in the system forms a complex series multivariable coupled structure. This coupled structure makes the control of a controlled object in the system affect the controlled object in the upper and lower control loop. As a result, it is difficult to control one or more control loops in the system without changing the state of other links in the system. In this paper, a cooperative control method for series multivariable coupled system is proposed. A decoupling controller is designed to remove the coupling effect caused by the interaction between stages, and the system is decoupled into several independent control loops. Differential leading PI (proportional-integral) error compensation method is introduced to ensure the following performance of the controller without static error. The proposed cooperative control method satisfies the Lyapunov stability, and has been successfully applied in the simulation experiment of cascade pumping station system of Beijing East-to-West water transfer project. The proposed method reduces the difficulty to controlling the water level of forebay of each pumping station and ensures the efficient operation of the cascade pumping station system.

An overview on recent advances of reversible fluorescent probes and their biological applications

Due to the simplicity and low detection limit, fluorescent probes are widely used in both analytical sensing and optical imaging. Compared to conventional fluorescent probes, reversibility endows the reversible fluorescent probe outstanding advantages and special properties, making reversible fluorescent probes with capable of quantitative, repetitive or circulatory. Reversible fluorescent probes can also monitor the concentration dynamics of target analytes in real time, such as metal ions, proteins and enzymes, as well as intracellular redox processes, which have been widely applied in various fields. This review summarized the types and excellent properties of reversible fluorescent probes designed and developed in recent years. It also summarized the applications of reversible fluorescent probe in fluorescence imaging, biological testing, monitoring redox cycles, and proposed the remaining challenges and future development directions of the reversible fluorescent probe. This review provided comprehensive overview of reversible fluorescent probe, which may provide valuable references for the design and fabrication of the reversible fluorescent probe.

Exceptionally high proton conductivity in Eu2O3 by proton-coupled electron transfer mechanism

Proton conductors are typically developed by doping to introduce structural defects such as oxygen vacancies to facilitate ionic transport through structural bulk conduction mechanism. In this study, we present a novel electrochemical proton injection method via an in situ fuel cell process, demonstrating proton conduction in europium oxide (Eu2O3) through a surficial conduction mechanism for the first time. By tuning Eu2O3 into a protonated form, H-Eu2O3, we achieved an exceptionally high proton conductivity of 0.16 S cm-1. Distribution of relaxation time (DRT) analysis was employed to investigate the proton transport behavior and reveal the significant contribution of surface proton transport to the overall conductivity of Eu2O3. Remarkably, H-Eu2O3 exhibited a low activation energy for ionic transport, comparable to the best ceramic electrolytes available. The proton-coupled electron transfer (PCET) mechanism describes this novel surficial proton conduction mechanism. These findings provide new possibilities for developing advanced proton conductors with improved performance.

Synthetic Biology Pathway to Nucleoside Triphosphates for Expanded Genetic Alphabets

One horizon in synthetic biology seeks alternative forms of DNA that store, transcribe, and support the evolution of biological information. Here, hydrogen bond donor and acceptor groups are rearranged within a Watson-Crick geometry to get 12 nucleotides that form 6 independently replicating pairs. Such artificially expanded genetic information systems (AEGIS) support Darwinian evolution in vitro. To move AEGIS into living cells, metabolic pathways are next required to make AEGIS triphosphates economically from their nucleosides, eliminating the need to feed these expensive compounds in growth media. We report that "polyphosphate kinases" can be recruited for such pathways, working with natural diphosphate kinases and engineered nucleoside kinases. This pathway in vitro makes AEGIS triphosphates, including third-generation triphosphates having improved ability to survive in living bacterial cells. In α-32P-labeled forms, produced here for the first time, they were used to study DNA polymerases, finding cases where third-generation AEGIS triphosphates perform better with natural enzymes than second-generation AEGIS triphosphates.

METTL3-dependent m6A methylation facilitates uterine receptivity and female fertility via balancing estrogen and progesterone signaling

Infertility is a worldwide reproductive health problem and there are still many unknown etiologies of infertility. In recent years, increasing evidence emerged and confirmed that epigenetic regulation played a leading role in reproduction. However, the function of m⁶A modification in infertility remains unknown. Here we report that METTL3-dependent m⁶A methylation plays an essential role in female fertility via balancing the estrogen and progesterone signaling. Analysis of GEO datasets reveal a significant downregulation of METTL3 expression in the uterus of infertile women with endometriosis or recurrent implantation failure. Conditional deletion of Mettl3 in female reproductive tract by using a Pgr-Cre driver results in infertility due to compromised uterine endometrium receptivity and decidualization. m⁶A-seq analysis of the uterus identifies the 3'UTR of several estrogen-responsive genes with METTL3-dependent m⁶A modification, like Elf3 and Celsr2, whose mRNAs become more stable upon Mettl3 depletion. However, the decreased expression levels of PR and its target genes, including Myc, in the endometrium of Mettl3 cKO mice indicate a deficiency in progesterone responsiveness. In vitro, Myc overexpression could partially compensate for uterine decidualization failure caused by Mettl3 deficiency. Collectively, this study reveals the role of METTL3-dependent m⁶A modification in female fertility and provides insight into the pathology of infertility and pregnancy management.

mTORC1 signaling pathway integrates estrogen and growth factor to coordinate vaginal epithelial cells proliferation and differentiation

The mouse vaginal epithelium cyclically exhibits cell proliferation and differentiation in response to estrogen. Estrogen acts as an activator of mTOR signaling but its role in vaginal epithelial homeostasis is unknown. We analyzed reproductive tract-specific Rptor or Rictor conditional knockout mice to reveal the role of mTOR signaling in estrogen-dependent vaginal epithelial cell proliferation and differentiation. Loss of Rptor but not Rictor in the vagina resulted in an aberrant proliferation of epithelial cells and failure of keratinized differentiation. As gene expression analysis indicated, several estrogen-mediated genes, including Pgr and Ereg (EGF-like growth factor) were not induced by estrogen in Rptor cKO mouse vagina. Moreover, supplementation of EREG could activate the proliferation and survival of vaginal epithelial cells through YAP1 in the absence of Rptor. Thus, mTORC1 signaling integrates estrogen and growth factor signaling to mediate vaginal epithelial cell proliferation and differentiation, providing new insights into vaginal atrophy treatment for post-menopausal women.

The kinase PDK1 regulates regulatory T cell survival via controlling redox homeostasis

Rationale: Regulatory T cells (Treg cells) play an important role in maintaining peripheral tolerance by suppressing over-activation of effector T cells. The kinase PDK1 plays a pivotal role in conventional T cell development. However, whether PDK1 signaling affects the homeostasis and function of Treg cells remains elusive. Methods: In order to evaluate the role of PDK1 in Treg cells from a genetic perspective, mice carrying the floxed PDK1 allele were crossbred with Foxp3Cre mice to efficiently deleted PDK1 in Foxp3+ Treg cells. Flow cytometry was used to detect the immune cell homeostasis of WT and PDK1fl/flFoxp3Cre mice. RNA-seq was used to assess the differences in transcriptional expression profile of WT and PDK1-deficient Treg cells. The metabolic profiles of WT and PDK1-deficient Treg cells were tested using the Glycolysis Stress Test and Mito Stress Test Kits by the Seahorse XFe96 Analyser. Results: PDK1 was essential for the establishment and maintenance of Treg cell homeostasis and function. Disruption of PDK1 in Treg cells led to a spontaneous fatal systemic autoimmune disorder and multi-tissue inflammatory damage, accompanied by a reduction in the number and function of Treg cells. The deletion of PDK1 in Treg cells destroyed the iron ion balance through regulating MEK-ERK signaling and CD71 expression, resulting in excessive production of intracellular ROS, which did not depend on the down-regulation of mTORC1 signaling. Inhibition of excessive ROS, activated MEK-Erk signaling or overload Fe2+ could partially rescue the survival of PDK1-deficient Treg cells. Conclusion: Our results defined a key finding on the mechanism by which PDK1 regulates Treg cell survival via controlling redox homeostasis.

Exosome-Depleted Excretory-Secretory Products of the Fourth-Stage Larval Angiostrongylus cantonensis Promotes Alternative Activation of Macrophages Through Metabolic Reprogramming by the PI3K-Akt Pathway

Angiostrongylus cantonensis (AC), which parasitizes in the brain of the non-permissive host, such as mouse and human, is an etiologic agent of eosinophilic meningitis. Excretory-secretory (ES) products play an important role in the interaction between parasites and hosts’ immune responses. Inflammatory macrophages are responsible for eosinophilic meningitis induced by AC, and the soluble antigens of Angiostrongylus cantonensis fourth stage larva (AC L4), a mimic of dead AC L4, aggravate eosinophilic meningitis in AC-infected mice model via promoting alternative activation of macrophages. In this study, we investigated the key molecules in the ES products of AC L4 on macrophages and observed the relationship between metabolic reprogramming and the PI3K-Akt pathway. First, a co-culture system of macrophage and AC L4 was established to define the role of AC L4 ES products on macrophage polarization. Then, AC L4 exosome and exosome-depleted excretory-secretory products (exofree) were separated from AC L4 ES products using differential centrifugation, and their distinct roles on macrophage polarization were confirmed using qPCR and ELISA experiments. Moreover, AC L4 exofree induced alternative activation of macrophages, which is partially associated with metabolic reprogramming by the PI3K-Akt pathway. Next, lectin blot and deglycosylation assay were done, suggesting the key role of N-linked glycoproteins in exofree. Then, glycoproteomic analysis of exofree and RNA-seq analysis of exofree-treated macrophage were performed. Bi-layer PPI network analysis based on these results identified macrophage-related protein Hexa as a key molecule in inducing alternative activation of macrophages. Our results indicate a great value for research of helminth-derived immunoregulatory molecules, which might contribute to drug development for immune-related diseases.

Survival Outcome with Routine Clinical Use of 82Rb PET/CT Myocardial Blood Flow (MBF) Quantification

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): NIHR Biomedical Research Centre, University College London Hospitals

Background

The prognostic value of 82Rb PET/CT derived myocardial blood flow (MBF) is increasingly recognised in both general and specific cardiovascular populations.

Purpose

This study investigates the prognostic potential of MBF in a large cohort of patients undergoing routine 82Rb PET/CT examination.

Methods

1148 consecutive patients (687 males, mean age 64 +/- 12 years) whom had been referred for 82Rb PET/CT examination in a single centre were included in this study.  All patients completed a stress 82Rb PET/CT with adenosine infusion, paired with a rest study.  Dynamic PET acquisitions were performed in both. Cardiovascular risk factors were documented as per clinical routine. Images were checked for quality and analysed using a proprietary software by an experienced operator to derive MBF parameters.  Overall survival was recorded following the study.

Results

Median follow-up period was 71 +/- 28 months.  Mean survival was 121 (95% CI: 118-124) months. On univariate analysis, global myocardial flow reserve <1.77 was associated with a higher all-cause mortality (p < 0.001). Other parameters including higher age (> =76 years), lower BMI (<21), qualitative abnormality on the myocardial perfusion scan (MPS), low hyperaemic ejection fraction on the gated studies (stress < 37 and rest < 34). Patients being on cardiac glycosides and diuretics were also significant predictor of poor prognosis (p < 0.001) on univariate analysis, presumably reflecting underlying arrhythmia and heart failure. A multivariate Cox regression analysis (step-wise Forward Wald), comprising of the above significant univariate markers, highlighted global myocardial flow reserve (HR: 2.6, 95%CI: 1.8-3.6, p < 0.001), age (HR: 2.8, 95%CI: 2.0-3.9, p < 0.001),, BMI (HR: 2.7, 95%CI: 1.7-4.1, p < 0.001),, ejection fraction (stress - HR: 3.3, 95%CI: 2.3-4.8, p < 0.001), MPS (HR: 1.5, 95%CI: 1.1-2.1, p = 0.024), and patients on diuretics (HR: 1.8, 95%CI: 1.2-2.5, p = 0.003) were independent predictors of overall survival (overall model: p < 0.001)

Discussion

We show that high volume routinely derived MBF in patients undergoing 82Rb PET/CT is a strong predictor of mortality and independent of other risk factors. This has important clinical implication for measuring not only interventional treatment but also measuring the effect of lifestyle and medical strategies.

Comprehensive mechanical & metabolic imaging of abdominal aortic aneurysm with 4D flow/ FDG PET on an integrated PETMRI: a feasibility study

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): NIHR Biomedical Research Centre, University College London Hospitals.

Background

A number of non-invasive imaging derived parameters have been implicated in the development and progression of abdominal aortic aneurysm, although the mechanism, and relationships of many of these are yet to be precisely determined.  Mechanical parameters can now be studied using 4D phase contrast magnetic resonance (PCMR), and inflammatory cellular activity can be detected with FDG PET.

Purpose

It may be postulated that inflammation of the aortic wall may be the intermediary at the tissue level linking mechanical wall shear stress (WSS) to aneurysm progression. It may be feasible to study 4D PCMR and FDG PET at the same patient visit on a PETMRI platform, with the potential to enhance temporal and spatial co-registration and improving the understanding of any relationship between these two parameters.  Our study aims to assess feasibility of studying these on an integrated PETMRI system.

Methods

7 patients with known aortic aneurysm were recruited in a vascular ultrasound screening follow up clinic.  During a single visit following 6 hours fasting, all patients underwent FDG injection and 60 minutes uptake period.  With quiet breathing, list mode PET acquisition and concurrent 4D PCMR was acquired using stacks of spiral acquisition, with ECG trace information for retrospective gating.  Images from the 4D PCMR and FDG PET were assessed qualitatively for image quality and visual matching.

Results

All 7 patients completed the study.  Overall image quality was adequate to good.  There is qualitatively a good concordance with impression of positive correlation between wall shear stress and inflammatory signal (see attached image).

Conclusion

We have demonstrated feasibility of combined assessment of mechanical and metabolic imaging parameters using an integrated PETMRI system.  Initial findings show there to be a broad concordance of wall shear stress and inflammatory signal in the abdominal aneurysm.

Novel double injection technique for sentinel lymph node biopsy in oral cancer

The development of new lymphatic tracers and the advancement of hybrid tracers, such as indocyanine green (ICG)-Nanocoll (GE Healthcare), represent an exciting step in the future of sentinel lymph node biopsy (SLNB). These tracers aim to improve our ability to detect sentinel lymph nodes by enhancing their localisation. The aim of this study was to assess the performance of a novel dual tracer, double injection technique of ICG-'cold'-Nanocoll and radiolabelled Nanocoll, in SLNB for early-stage oral cancer. A double injection technique was performed first using ^99mTc-Nancoll prior to sentinel node imaging followed by ICG-'cold'-Nanocoll injection in theatre. Analysis involved examination of the number, labelling, and location of the nodes harvested, sentinel node status, survival analysis, false negative rate, and complications associated with use of the technique. ICG 'cold' Nanocoll results showed concordance of fluorescence and radioactivity detection in 74 nodes in 24 patients. Most importantly, all nodes found positive for metastasis (6 nodes) were discovered to be both 'hot' and fluorescent; 74 nodes removed were both 'hot' and fluorescent, eight fluorescent only and six 'hot' only. Our results indicate that two sets of tracer injections given at two different time points will flow to the same sentinel nodes. This double labelling increased our confidence that the retrieved node was a sentinel node.

[Hepatic echinococcus granulosus: a clinicopathological analysis of thirteen cases]

Objective: To investigate the clinicopathologic characteristics of hepatic echinococcus granulosus (HEG). Methods: Thirteen cases of HEG were collected from Linzhi People's Hospital between January 2017 to October 2020, and their clinicopathologic features, ultrasound classification, immunophenotype and histochemical data were analyzed, retrospectively and the relevant literature was reviewed. Results: Thirteen patients (5 male patients, 8 female patients) were included in this cohort, and the mean age was 40 years. The most common clinical presentation was mild abdominal distention and pain (9/13). Based on WHO-IWGE ultrasound standardized classification, these cases were classified into 5 types, including type CL (1 case), type CE1 (2 cases), type CE2 (4 cases), type CE3 (3 cases) and type CE4 (3 cases). Gross examination revealed a solitary cyst localized in the liver, varying from 2.7 to 13.5 cm in diameter, and most of them(10/13)were more than 10 cm. Histopathologically, these cysts possessed a thin inner germinal layer and outer adventitial layer, and a central cavity filled with a clear"hydatid"fluid. The germinal layer was continuous and generated brood capsules and protoscoleces. The laminated membranes were clearly demonstrated by elastic fiber and Gomori's stains. Inside the"mother"cyst, there were a varying number of"daughter"vesicles of variable sizes. The inflammatory reaction around the cyst consisted of eosinophils, mononuclear cells immediately next to the cyst layer and sometimes formed granuloma and giant cells resembling the Langhan's type giant cells. The lymphoid cells were positive for CD20 and CD3. The CD68 immunohistochemistry clearly demonstrated epithelioid cells of granuloma in two cases. Moreover, immunohistochemistry revealed plasma cells were locally positive for CD38, IgG and IgG4, but not meeting the criteria for IgG4 related lesion. Conclusions: Hepatic echinococcus granulosus is a zoonotic parasitic disease prevalent in pastoral areas such as Tibet. It is important to understand its clinical features, ultrasound characteristics and histological morphology.

Spontaneous mainstream anammox in a full-scale wastewater treatment plant with hybrid sludge retention time in a temperate zone of China

Spontaneous anammox bacteria enrichment at mainstream conditions was reported in a full-scale Wastewater Treatment Plant (WWTP) in a temperate zone of China. The mainstream anammox was observed after WWTP process retrofit, which constructed a hybrid sludge retention time (SRT) system by providing moving carriers in the anaerobic/anoxic tank and was initially designed to enhance the denitrification process in a conventional anaerobic/anoxic/oxic process. The hybrid SRT system achieved 86.0 ± 4.6% total nitrogen (TN) removal via combined mainstream anammox and conventional denitrification. Autotrophic denitrification via mainstream anammox was confirmed by various shreds of evidence including high-throughput sequencing, specific anammox activity test, and ¹⁵ N isotopic tracing. Long-term anammox bacteria existence in the biofilm of the carrier in anoxic zones was detected in a much higher relative abundance compared with other spots. The contribution of anammox activity to TN removal was estimated at around 20%-30%. The reasons leading to spontaneous anammox enrichment were mainly attributed to the carriers for slow-growing bacteria growth and dissolved oxygen gradient in the anoxic tank (caused by intermittent aeration) for nitrite production. The insights of this full-scale case study provide important perspectives for future mainstream anammox application, and also the design of an energy-neutral WWTP process. PRACTITIONER POINTS: Spontaneous mainstream anammox in a full-scale WWTP after its retrofit in a temperate zone of China was reported. Anammox bacteria enrichment and long-term stability on moving carriers at mainstream conditions was achieved by modified hybrid SRT system. The hybrid SRT system achieve stable nitrogen removal even in cold winter and high BOD/N situation by combining mainstream anammox with conventional denitrification. Long term full-scale operation demonstrated excellent nitrogen removal with about 20%-30% contribution of mainstream anammox. This full-scale case study provided perspectives for future optimizing mainstream anammox application, and also energy-neutral WWTP process design.

Unilateral axillary adenopathy following COVID-19 vaccination: a multimodality pictorial illustration and review of current guidelines

We present a multimodality pictorial review of axillary lymphadenopathy in patients recently vaccinated against COVID-19. As the mass vaccination programme continues to be rolled out worldwide in an effort to combat the pandemic, it is important that radiologists consider recent COVID-19 vaccination in the differential diagnosis of unilateral axillary lymphadenopathy and are aware of typical appearances across all imaging methods. We review current guidelines on the management of unilateral axillary lymphadenopathy in the context of recent COVID-19 vaccination.

Distributions of serum thyroid-stimulating hormone in 2020 thyroid disease-free adults from areas with different iodine levels: a cross-sectional survey in China

PURPOSE

The aim of the present study was to describe the distributions of serum thyroid- stimulating hormone (TSH) levels in thyroid disease-free adults from areas with different iodine levels in China. Meanwhile, we aimed to evaluate the influence of age and gender on the distribution of TSH, assess the relationship between concentrations of TSH and free thyroxine (FT₄), and analyze the factors that may affect TSH levels.

METHODS

2020 adults were included from April 2016 to June 2019. Urinary iodine concentration, serum iodine concentration, serum TSH, FT₄, free triiodothyronine, thyroid peroxidase antibodies and thyroglobulin antibodies were measured, and thyroid ultrasonography was performed.

RESULTS

The median of TSH in iodine-fortification areas (IFA), iodine-adequate areas (IAA), iodine-excessive areas (IEA) were 2.32, 2.11 and 2.34 mIU/L, respectively. Serum TSH concentrations were significantly higher in IFA and IEA than that in IAA (p = 0.005 and < 0.0001). The TSH values of most adults were distributed within the range of 1.01-3.00 mIU/L with the same trend in three groups. In our study, TSH levels did not change with age, and the TSH level of females was higher than that of males (p < 0.0001). There was a negative correlation between FT₄ and TSH in IAA (r = - 0.160, p < 0.0001) and IEA (r = - 0.177, p < 0.0001), but there was no correlation between FT₄ and TSH in IFA (r = - 0.046, p = 0.370). BMI, smoking status, education levels, and marital status were associated with TSH.

CONCLUSION

Our study provides a basis for establishing the reference intervals of TSH in different iodine level areas.

Can deep learning identify normal coronary flow reserve from rubidium myocardial PET perfusion?

Funding Acknowledgements

Type of funding sources: None.

Background

Impaired vasodilator function is an early manifestation of coronary artery disease (CAD) and may precede angiographic stenosis.  Rest and stress myocardial blood flow (MBF) are calculated from dynamic imaging during rest/stress Rubidium (Rb) myocardial PET perfusion.  Coronary flow reserve (CFR) equals stress divided by rest MBF.  CFR is an independent predictor of cardiac mortality in patients with known or suspected CAD.  We evaluated the prediction of CFR from analysis of stress/rest PET images by deep learning (DL) as compared with standard calculation of CFR using supervised learning applied methodology using within a commercial DL training platform.

Methods

1036 patients (625 male, 411 female, mean age: 64.3 years old) were studied. Patients underwent Stress/rest Rb PET perfusion, and CFR calculated using MBF software by an expert user. Abnormal CFR was defined as &lt;2.0. The left ventricle myocardium was segmented using standard software.

DL was trained using polar distribution of normalized PET uptake at stress and rest, processed stress and rest images were cropped, the stress images were then subtracted from the rest images. DL was trained using 935 subtracted images and tested using the remaining 101 images. DL was trained with supervision to classify images. The image shows examples of subtracted  abnormal cases (1a & 1b).

Results

Using our supervised training methodology, the commercial MBF software platform reported 465 cases as abnormal, with 48 of these were included in the DL test set. The DL platform produced abnormal output classifiers for all the whole test set. DL accurately detected over 70% of abnormal cases.

The commercial MBF software reported 571 cases as normal; with 50 of these contributing to the DL test set. DL was accurate in 48.0% of normal cases. Statistical results are shown in the table.

Conclusion

We have shown the proof of concept that DL algorithms trained with supervision can detect abnormal CFR. Our work shows that further work is needed to develop supervised learning methodology in order to improve accuracy for clinical use.

Statistical Results Statistic Value Sensitivity 63.16% Specificity 56.67% + Predictive Value 48.00% - Predictive Value 70.83% Accuracy 59.18% Abstract Figure.

Paediatric Molecular Radiotherapy: Challenges and Opportunities

The common contemporary indications for paediatric molecular radiotherapy (pMRT) are differentiated thyroid cancer and neuroblastoma. It may also have value in neuroendocrine cancers, and it is being investigated in clinical trials for other diseases. pMRT is the prototypical biomarker-driven, precision therapy, with a unique mode of delivery and mechanism of action. It is safe and well tolerated, compared with other treatments. However, its full potential has not yet been achieved, and its wider use faces a number of challenges and obstacles. Paradoxically, the success of radioactive iodine as a curative treatment for metastatic thyroid cancer has led to a 'one size fits all' approach and limited academic enquiry into optimisation of the conventional treatment regimen, until very recently. Second, the specialised requirements for the delivery of pMRT are available in only a very limited number of centres. This limited capacity and geographical coverage results in reduced accessibility. With few enthusiastic advocates for this treatment modality, investment in research to improve treatments and broaden indications from both industry and national and charitable research funders has historically been suboptimal. Nonetheless, there is now an increasing interest in the opportunities offered by pMRT. Increased research funding has been allocated, and technical developments that will permit innovative approaches in pMRT are available for exploration. A new portfolio of clinical trials is being assembled. These studies should help to move at least some paediatric treatments from simply palliative use into potentially curative protocols. Therapeutic strategies require modification and optimisation to achieve this. The delivery should be personalised and tailored appropriately, with a comprehensive evaluation of tumour and organ-at-risk dosimetry, in alignment with the external beam model of radiotherapy. This article gives an overview of the current status of pMRT, indicating the barriers to progress and identifying ways in which these may be overcome.

Control over π-π stacking of heteroheptacene-based nonfullerene acceptors for 16% efficiency polymer solar cells

Nonfullerene acceptors are being investigated for use in polymer solar cells (PSCs), with their advantages of extending the absorption range, reducing the energy loss and therefore enhancing the power conversion efficiency (PCE). However, to further boost the PCE, mobilities of these nonfullerene acceptors should be improved. For nonfullerene acceptors, the π-π stacking distance between cofacially stacked molecules significantly affects their mobility. Here, we demonstrate a strategy to increase the mobility of heteroheptacene-based nonfullerene acceptors by reducing their π-π stacking distances via control over the bulkiness of lateral side chains. Incorporation of 2-butyloctyl substituents into the nonfullerene acceptor (M36) leads to an increased mobility with a reduced π-π stacking distance of 3.45 Å. Consequently, M36 affords an enhanced PCE of 16%, which is the highest among all acceptor-donor-acceptor-type nonfullerene acceptors to date. This strategy of control over the bulkiness of side chains on nonfullerene acceptors should aid the development of more efficient PSCs.