Clinical Evidence for Treatment of Distal Tibiofibular Syndesmosis Injury: A Systematic Review of Clinical Studies

No consensus had been reached about the optimal treatment for syndesmotic fixation. We performed a review of randomized controlled trials (RCTs) to assist in clarifying many of the controversies that were debated for years despite new technology and options. PubMed, Embase, and the Cochrane Library were searched through specific terms and limits. Only RCTs were selected for final inclusion. Study screening and data extraction were performed independently by 2 reviewers. Thirteen RCTs, including 828 cases, met the inclusion criteria and are summarized in this review. Pooled results demonstrated that dynamic fixation had better functional outcomes as well as lower rates of malreduction and complications compared with syndesmotic screw fixation. Both absorbable screw and tricortical screw fixation showed similar results to quadricortical metallic screws. Therefore, dynamic fixation is recommended for the treatment of syndesmosis injuries.

The introduction of benzimidazole and ether moieties into poly(p-phenylene terephthalamide): effects on its microstructure, interactions and properties

Co-poly(p-phenylene terephthalamide) (co-PPTA) fibers containing 4,4′-oxidianiline (4,4′-ODA) and 2-(4-aminophenyl)-5-aminobenzimidazole (BIA) in terephthaloyl chloride (TPC) and p-phenylene diamine (p-PDA) were prepared via a wet spinning method, followed by water washing and drawing at a high temperature. With the addition of a new acid-binding agent, imidazole, the solution prepared by low-temperature polycondensation had suitable viscosity for spinning. Herein, the properties of six co-PPTA fibers with different contents of BIA and 4,4′-ODA segments were studied. The mechanical properties of the co-PPTA fibers were improved with the addition of BIA and ODA; they reached the optimum tensile strength of 2.45 GPa at a p-PDA/ODA/BIA molar ratio of 2/4/4, which showed a higher degree of orientation and the highest crystallinity, and the strength further increased on increasing the thermal drawing ratio. X-ray diffraction indicated that the fibers exhibited highly ordered structures, while two-dimensional wide angle X-ray diffraction showed that molecular packing regions with highly oriented structures were formed. In addition, the co-PPTA fibers exhibited excellent thermal stability when the 5% weight loss temperature was above 492 °C under nitrogen, and glass transition occurred at about 290 °C.

Co-poly(p-phenylene terephthalamide) fibers containing 4,4′-oxidianiline and 2-(4-aminophenyl)-5-aminobenzimidazole in terephthaloyl chloride and p-phenylene diamine were prepared via a wet spinning method, followed by water washing and drawing at high temperature.

Broadband nonlinear absorption properties of two-dimensional hexagonal tellurene nanosheets

Two dimensional (2D) Group-VI Te, tellurene, was successfully exfoliated using a liquid phase exfoliation (LPE) method. The prepared tellurene nanosheets possessed a thickness of 4.3-4.6 nm and the lateral dimension ranged from hundreds of nanometers to several microns. The broadband nonlinear absorption properties were explored for the first time (as we know) using a z-scan method with the laser photon energy in the range of 0.73-2.76 eV, corresponding to the near-infrared-visible waveband. Tellurene nanosheets exhibited excellent broadband saturated absorption and optical limiting behaviors. The low saturable intensity and the large modulation depth for saturated absorption with low energy photon excitation highlight the superiority of the infrared band as a saturable absorber. In addition, with large energy excitation, tellurene manifested an apparent two photon absorption behavior in the visible band, thus it can be used as an optical limiting material. By adopting the mode-locking technique, this high-quality saturable absorber can be applied in all-solid-state or fiber lasers to generate ultra-short and ultra-high peak power laser pulses. Meanwhile, tellurene as an optical limiting material can protect the sensitive optical devices and human eyes. So, our work not only demonstrates that tellurene is a promising broadband nonlinear optical material, but also implies its application prospects in optics.

Characteristics and prognosis of pelvic Ewing sarcoma: a SEER population-based study

Background

The pelvis is one of the primary sites of Ewing sarcoma (ES) and is associated with poorer prognoses than the extremities. Due to the rarity of this disease and limited data available, the prognostic factors of pelvic ES remain controversial. Thus, this study aimed to identify independent prognostic factors, and develop a nomogram for predicting survival rates in patients with pelvic ES.

Methods

Using data provided by the Surveillance, Epidemiology, and End Results (SEER) database, variables including age, sex, race, tumor size, tumor stage, surgery, and radiotherapy were analyzed using the Kaplan–Meier method and Cox proportional hazards regression. Based on the results of multivariate analyses, a nomogram was built to predict the overall survival (OS) of patients with pelvic ES. The performance of the nomogram was evaluated by the concordance index (C-index).

Results

A total of 267 cases diagnosed between 2004 and 2016 were included in the study. Univariate and multivariate analyses showed that patients who were younger, white, had a localized tumor stage, or underwent surgery were associated with improved prognoses, while no significant differences were observed in OS based on sex, tumor size, or radiotherapy. A nomogram was developed and the C-index was 0.728, indicating adequate performance for survival prediction.

Conclusions

Age, race, tumor stage, and surgery were identified as independent prognostic factors for the OS of pelvic ES. The nomogram developed in this study can individually predict 3- and 5-year OS in patients with pelvic ES.

TGLI1 transcription factor mediates breast cancer brain metastasis via activating metastasis-initiating cancer stem cells and astrocytes in the tumor microenvironment

Mechanisms for breast cancer metastasis remain unclear. Whether truncated glioma-associated oncogene homolog 1 (TGLI1), a transcription factor known to promote angiogenesis, migration and invasion, plays any role in metastasis of any tumor type has never been investigated. In this study, results of two mouse models of breast cancer metastasis showed that ectopic expression of TGLI1, but not GLI1, promoted preferential metastasis to the brain. Conversely, selective TGLI1 knockdown using antisense oligonucleotides led to decreased breast cancer brain metastasis (BCBM) in vivo. Immunohistochemical staining showed that TGLI1, but not GLI1, was increased in lymph node metastases compared to matched primary tumors, and that TGLI1 was expressed at higher levels in BCBM specimens compared to primary tumors. TGLI1 activation is associated with a shortened time to develop BCBM and enriched in HER2-enriched and triple-negative breast cancers. Radioresistant BCBM cell lines and specimens expressed higher levels of TGLI1, but not GLI1, than radiosensitive counterparts. Since cancer stem cells (CSCs) are radioresistant and metastasis-initiating cells, we examined TGLI1 for its involvement in breast CSCs and found TGLI1 to transcriptionally activate stemness genes CD44, Nanog, Sox2, and OCT4 leading to CSC renewal, and TGLI1 outcompetes with GLI1 for binding to target promoters. We next examined whether astrocyte-priming underlies TGLI1-mediated brain tropism and found that TGLI1-positive CSCs strongly activated and interacted with astrocytes in vitro and in vivo. These findings demonstrate, for the first time, that TGLI1 mediates breast cancer metastasis to the brain, in part, through promoting metastasis-initiating CSCs and activating astrocytes in BCBM microenvironment.

BSCI-02. tGLI1 IS A NOVEL, ACTIONABLE TARGET FOR THE TREATMENT OF BREAST CANCER BRAIN METASTASES

Despite improvements in early detection and intervention, breast cancer remains the second leading cause of cancer-related death in women and the second most common cancer to metastasize to the brain. Current standard of care options for breast cancer brain metastases (BCBM) include stereotactic radiosurgery, whole-brain radiotherapy, and surgical resection. Local and distant recurrences are common leading to significant morbidity; effective FDA-approved drugs for these patients remain a significant unmet need. Our laboratory discovered an alternative splice variant of glioma-associated oncogene homolog 1 (GLI1), termed truncated GLI1 (tGLI1) that is a tumor-specific gain-of-function transcription factor preferentially expressed in most BCBM samples and recurrent gliomas. Recent results established that tGLI1 promotes breast cancer stem cells (BrCSCs) and is associated with preferential metastasis to the brain and radioresistance, justifying tGLI1 as an ideal therapeutic target for BCBM patients. To identify tGLI1-targeting agents, we screened 1,520 compounds across three commercial drug libraries and found ketoconazole, an FDA-approved azole antifungal and component of previously studied anti-neoplastic regimens, selectively killed tGLI1-expressing breast cancer cells with heightened efficacy against the CSC subpopulation in vitro. tGLI1 knockdown abolished the ability of ketoconazole to target BrCSCs, indicating that ketoconazole effect is dependent on tGLI1. Intracardiac mouse studies showed ketoconazole selectively inhibited circulating tGLI1-positive breast cancer cells from developing into brain metastases and suppressed the progression of existing brain metastases. Mass spectrometry demonstrated ketoconazole effectively penetrated the blood-brain barrier (BBB) and blood-tumor barrier (BTB). Mechanistic studies suggest that ketoconazole-dependent cell kill is, in part, mediated through disruption of the tGLI1-STAT3 interaction. Collectively, our preclinical results demonstrate that ketoconazole is an effective inhibitor of BrCSCs and brain metastasis of tGLI1-positive breast cancer. Based on these promising preclinical data, we opened a window-of-opportunity study in patients with BCBM and recurrent gliomas to determine if ketoconazole treatment alters tGLI1 signaling in humans (NCT03796273).

BSCI-13. TUMOR-SPECIFIC tGLI1 TRANSCRIPTION FACTOR MEDIATES BREAST CANCER BRAIN METASTASIS VIA ACTIVATING METASTASIS-INITIATING CANCER STEM CELLS AND ASTROCYTES IN THE TUMOR MICROENVIRONMENT

Breast cancer is the second leading cause of brain metastases in women; patients with breast cancer brain metastasis (BCBM) survive only 6–18 months after diagnosis. Mechanisms for BCBM remain unclear, which contributes to ineffective treatments and dismal prognosis. Truncated glioma-associated oncogene homolog 1 (tGLI1) belongs to the GLI1 family of zinc-finger transcription factors and functions as a tumor-specific gain-of-function mediator of tumor invasion and angiogenesis. Whether tGLI1 plays any role in metastasis of any tumor type remains unknown. Using an experimental metastasis mouse model, via intracardiac implantation, we showed that ectopic expression of tGLI1, but not GLI1, promoted preferential metastasis to brain. Conversely, selective tGLI1 knockdown using tGLI1-specific antisense oligonucleotides led to decreased brain metastasis of intracardially inoculated breast cancer cells. Furthermore, intracranial implantation mouse study revealed tGLI1 enhanced intracranial colonization and growth of breast cancer cells. Immunohistochemical staining of patient samples showed that tGLI1, but not GLI1, was increased in lymph node metastases compared to matched primary tumors, and that tGLI1 was expressed at higher levels in BCBM specimens compared to primary tumors. Whether tGLI1 plays any role in radioresistance is unknown; we found radioresistant BCBM cell lines and patient specimens expressed higher levels of tGLI1 than radiosensitive counterparts, and that tGLI1 promotes radioresistance. Since cancer stem cells (CSCs) are highly metastatic and radioresistant, we examined whether tGLI1 promotes BCBM and radioresistance through activating CSCs. Results showed that tGLI1 transcriptionally activates stemness genes CD44, Nanog, Sox2, and OCT4, leading to stem cell activation. Furthermore, we observed that tGLI1-positive CSCs strongly activated and interacted with astrocytes, the most abundant brain tumor microenvironmental cells known to promote tumor growth, in vitro and in vivo. Collectively, our findings establish a novel role of that tGLI1 plays in promoting breast cancer preferential metastasis to brain, radioresistance, and astrocytes in the metastatic niche.

Multimorphological top-hat-based multiscale target classification algorithm for real-time image processing

The traditional top-hat method is a commonly used method that quickly separates targets from a background. It is used for its fast processing speed and wide range of applications on programmable hardware. However, in some important fields such as microfluidic control, medicine, aerospace, and optical measurement, the observed targets are often spotted with different sizes. The formation mechanism of multiscale spots varies from each other so that they can not be successfully extracted and classified by the traditional top-hat method. To ensure the integrity of targets with a specific size and suppressed noise, the imaging mechanism of different types of spots are studied, and an improved top-hat method with a gray-scale value-based transform is proposed. Compared with the traditional top-hat method, the proposed algorithm is more effective in completely removing unwanted spots. The calculated results of the simulated and real images verify the effectiveness of the double top-hat method in extracting targets with a specific size. Additionally, the resolution of this method is up to the parameter k, which has been discussed in this paper. Furthermore, a multi-top-hat algorithm is presented to distinguish spots of different sizes, and it could be used for real-time multiscale target detection and tracking, as well as real-time multiscale target detection and tracking.

Investigation and development of maize fused network analysis with multi-omics

Maize is a critically important staple crop in the whole world, which has contributed to both economic security and food in planting areas. The main target for researchers and breeding is the improvement of maize quality and yield. The use of computational biology methods combined with multi-omics for selecting biomolecules of interest for maize breeding has been receiving more attention. Moreover, the rapid growth of high-throughput sequencing data provides the opportunity to explore biomolecules of interest at the molecular level in maize. Furthermore, we constructed weighted networks for each of the omics and then integrated them into a final fused weighted network based on a nonlinear combination method. We also analyzed the final fused network and mined the orphan nodes, some of which were shown to be transcription factors that played a key role in maize development. This study could help to improve maize production via insights at the multi-omics level and provide a new perspective for maize researchers. All related data have been released at http://lab.malab.cn/∼jj/maize.htm.

Abstract 434: Breast cancer bone metastasis mediated by the exosomal miR-19a and secreted IBSP

Bone metastasis (BM) is the one of the most predominant complications in breast cancer (BC) patients. It causes considerable symptoms termed skeletal-related events due to osteoclast-mediated bone resorption. Current treatments targeting BM are proven to reduce the symptoms, but not to extend the patients’ survival. Thus, there is an urgent need to develop early predictive markers and preventive or curative therapies for BCBM. Recently, circulating miRNAs have been found to hold great potential for diagnostic and prognostic purposes. Due to the low stability of cell-free RNA in plasma, these circulating miRNAs exist mostly in a form of membrane-wrapped extracellular vesicles (EVs) and they play important roles in cancer progression. In this study, we aim to identify EVs-derived miRNA from serum of BC patients as biomarkers for diagnosis and prognosis of BCBM. We performed miRNA microarray of EVs from BC cell lines (231 and MCF7), as well as their bone metastatic variants (231BoM-1833 and MCF7BoM2d). Using bioinformatics analysis of circulating miRNA in a cohort of BC patients and real-time PCR measurement for blood-derived EVs from BC patients, we found that extracellular miR-19a is up-regulated in BCBM patients. Kaplan-Meier survival analysis indicates that miR-19a is positively correlated with metastases. Interestingly, miR-19a was also found to be highly enriched in exosomes compared to microvesicles and apoptotic bodies. To study the role of miR-19a in BCBM, we applied the CRISPR/Cas9 technology to knockout the miR-19a in 231BoM-1833 and MCF7-BoM2d cells. The knockout of miR-19a didn’t alter the proliferation or migration of BC cells. However, it significantly decreased BM in our xenograft mouse models. We also found that the knockout of miR-19a decreased osteolytic lesions in the tumor-bearing bones. We treated osteoclast cells with miR-19a-enriched exosomes or miR-19a-knockout exosomes followed by tartrate-resistant acid phosphatase assay and bone resorption assay. Our results indicated that miR19a-enriched exosomes significantly promoted osteoclast differentiation and activity. In addition to exosomal miR-19a, we also identified IBSP as another necessary factor involved in the BCBM. IBSP is over-expressed in ER+ BC patients with BM, and is negatively correlated with bone metastasis-free survival of ER+ patients. We found IBSP functions as a chemoattractant to create an OC precursor enriched microenvironment to facilitate the delivery of exosomal miR-19a to OC in a concentration-dependent manner. Our animal experiment suggests that both exosomal miR-19a and secreted IBSP are necessary for ER+ BC cells to colonize in the bone microenvironment. In this study, we identified exosome-derived miR-19a and IBSP as important mediators of cell-cell communication between breast cancer and osteoclast cells, which warrants further investigation on both as novel biomarkers and therapeutic targets of BCBM.

Citation Format: Kerui Wu, Jiamei Feng, Fei Xing, Sambad Sharma, Yin Liu, Shih-Ying Wu, Abhishek Tyagi, Ravi Singh, Kounosuke Watabe. Breast cancer bone metastasis mediated by the exosomal miR-19a and secreted IBSP [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 434.

Abstract 1512: Nicotine promotes brain metastasis of lung cancer by inducing M1/M2 conversion and suppressing the innate immune response of microglia

Approximately 50% of patients with metastatic lung cancer develop brain metastasis which is almost always fatal, and the median survival time of these patients is only a few months. Smoking is the major risk factor for lung cancer, and tobacco smoke contains a toxic mix of more than 7,000 chemical. Among those chemicals, nicotine has been shown to promote cancer progression and metastasis. However, the exact mechanism by which nicotine derives this process remain poorly understood. The communications between neoplastic cells and microglia, especially M2 type pro-tumor microglia, profoundly affect the brain metastasis progression. Therefore, we hypothesize that nicotine skews microglial polarization to M2 phenotype which promotes brain metastasis of lung cancer. We found that the brain metastasis-free survival rate was significantly decreased in current smokers compared to non-smokers. Abundant CD206+ M2 microglia were observed in brain metastatic lesions in such patients. Consistent with these results, when we transplanted the H2030 brain metastasis of lung cancer cell line (H2030BrM) into nude mice by intra-cardiac injection followed by with or without nicotine treatment, the brain metastasis-free survival was decreased in nicotine treatment group. The number of CD206+cells were also increased in the mouse brain after nicotine treatment. To test the effect of nicotine-driven microglia on tumor progression, H2030BrM cells were treated with conditioned medium (CM) generated from human microglia that were treated with or without nicotine. We found that the CM significantly increased the population of ESA+/CD44+ cancer stem cells and promoted their sphere forming abilities. The expression of SOX2 and Nanog were up-regulated when the H2030BrM cells were cultured with the CM of nicotine-treated microglia. Blocking nicotine-driven M2 microglial polarization by a STAT3 inhibitor suppressed the M2 polarization, resulting in inhibition of tumor growth. To examine the mechanism by which nicotine suppresses anti-tumor function of microglia, we measured the expression of “do not eat me” signal, SIRP on microglia and CD47 on tumor cells. H2030BrM and human microglial cells were treated with nicotine. We found that the mRNA and protein expression of SIRP were up-regulated on human microglia, while the expression of CD47 on H2030BrM were elevated by nicotine treatment. We used FACS to detect the phagocytic ability of microglial by co-culturing H2030BrM with microglial cells. We found that the anti-tumor phagocytic activities of microglia cells were significantly decreased upon nicotine treatment. In conclusion, our results suggest that nicotine promotes lung cancer brain metastasis by enhancing both tumor progression and stemness by skewing microglial polarization and inhibiting its anti-tumor phagocytic ability.

Citation Format: Shih-Ying Wu, Fei Xing, Sambad Sharma, Abhishek Tyagi, Kerui Wu, Yin Liu, Dan Zhao, Ravindra Deshpande, Yusuke Shiozawa, Kounosuke Watabe. Nicotine promotes brain metastasis of lung cancer by inducing M1/M2 conversion and suppressing the innate immune response of microglia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1512.

Abstract 3689: Tumor-specific gain-of-function tGLI1 transcription factor is a novel mediator of breast cancer stem cells and a novel transcriptional activator of cancer stemness genes

Breast cancer is the second leading cause of cancer-related mortality in women; metastasis to distant organs results in 90% of deaths for these patients. Cancer stem cells (CSCs) are considered the drivers of metastasis. Despite our current knowledge of breast CSCs, there still remains a significant challenge in managing patients with the metastatic breast cancer, underscoring the need for identifying novel regulators of breast CSCs. The hedgehog pathway is an important mediator of stem cells; however, the effect of truncated glioma-associated oncogene homolog 1 (tGLI1), a nuclear effector of the hedgehog pathway and a gain-of-function GLI1 transcription factor, on breast CSCs has never been investigated. Herein, we investigated whether tGLI1 is implicated in breast CSCs by evaluating tGLI1 expression levels in cells grown as monolayer versus mammospheres, as a representation of the stem cell population, and found tGLI1 to be induced in mammosphere culture. Overexpression of tGLI1 promoted mammosphere-forming ability of breast cancer cells, as well as, increased the breast CSC population defined by CD44high/CD24low expression. Further, tGLI1 overexpression transformed normal mammary epithelial cells resulting in increased mammosphere formation and enhanced anchorage-independent growth of immortalized human mammary epithelial HMLE cells. Functional and biochemical assays further showed that tGLI1 promotes breast CSC self-renewal by transcriptional activation of stemness genes including a novel tGLI1 target gene, OCT4, a recently reported tGLI1 target gene (CD44), and known GLI1 target genes (Nanog and SOX2). Bioinformatic analysis of breast cancer patient datasets revealed that activated tGLI1 is associated with shortened time to develop metastasis to the lung, bone, and brain. Furthermore, tGLI1 activation is enriched in HER2-enriched and triple-negative breast cancers, the subtypes with the highest propensity to metastasize, compared to luminal subtypes. Gene Set Enrichment Analysis showed that high tGLI1 activation is enriched in breast cancer with high gene signatures of breast CSCs, radioresistance, and metastasis. We further validated these results by immunohistochemical staining of paired primary breast tumors with lymph node metastases and found that that expression of tGLI1, but not GLI1, was increased in lymph node metastases and that tGLI1 was expressed at higher levels (84-91%) of lymph node-positive metastatic HER2-enriched and triple-negative breast tumors. Lastly, tGLI1 knockdown resulted in decreased mammosphere formation of breast cancer cells and decreased expression of stemness genes, OCT4, CD44, and Nanog. Taken together, these findings establish a novel role that tGLI1 plays in mediating breast CSCs and implicate tGLI1 in facilitating breast cancer metastasis.

Citation Format: Sherona R. Sirkisoon, Richard L. Carpenter, Tadas Rimkus, Daniel Doheny, Dongqin Zhu, Noah R. Aguayo, Marlyn Anguelov, Austin Arrigo, Fei Xing, Michael Chan, Jimmy Ruiz, Linda J. Metheny-Barlow, Roy Strowd, Jiayuh Lin, Boris C. Pasche, Waldemar Debinski, Kounosuke Watabe, Hui-Wen Lo. Tumor-specific gain-of-function tGLI1 transcription factor is a novel mediator of breast cancer stem cells and a novel transcriptional activator of cancer stemness genes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3689.

Investigating Maize Yield-Related Genes in Multiple Omics Interaction Network Data

Zea mays (maize) is the highest yielding food crop globally, feeding large numbers of people across the planet. It is thus especially important to explore the key genes that affect maize production with prior knowledge. Merging multiple datasets of different types can improve the accuracy of candidate genes prediction results, so we constructed interaction networks using gene, mRNA, protein, and expression profile datasets. A network propagation schedule was used considering combined scores obtained by integrating both network scores and significance scores for each candidate gene based on the guilt-by-association principle. An SVM model was used to optimize the weighted parameters to achieve more reliable results, according to the accuracy of label classification. We found that integrating multiple omics data with more data types improves the reliability of the results. We investigated the GO terms particularly associated with the top 100 candidate genes and the known genes, and analyzed the roles that these genes play in determining the phenotype of maize. We hope that the candidate genes identified here will provide a biological perspective and contribute to maize breeding research.

CMOS imager non-uniformity response correction-based high-accuracy spot target localization

High-accuracy spot target detection based on a complementary metal-oxide semiconductor (CMOS) image sensor, such as astronomy magnitude, medicine, and astronomy photometrics, needs accurate pixel response. Because pixels have different silicon structures and read outputting, each pixel has non-uniformity response with specific illumination. The flat-field correction of a CMOS image sensor is crucial before image processing. In this work, a flat-field model and correction method based on spot scale areas of CMOS image sensor pixel response are proposed. Compared with traditional full-plane calibration, this method aims at spot areas to fit most selected normal pixels' mean response curve with different light intensities and exposure times, which can guarantee spot imaging areas with higher accurate pixel response. Finally, the accuracy of this flat-field correction method is evaluated by the influence on spot target extraction accuracy. The experimental results indicate that using this flat-field correction method can decrease the non-uniform variance from 7.34 (LSB/10 bit) to 1.91 (LSB/10 bit) (improved by 74.1%) and reduce the noise effect on spot extraction accuracy, which improves it from 0.3453 pixel to 0.0116 pixel (1σ). The proposed approach solves the problem of non-uniform pixel response and improves imaging SNR for high-accuracy spot target localization.

Ultrasensitive Optical Detection of Water Pressure in Microfluidics Using Smart Reduced Graphene Oxide Glass

Despite recent progresses in the field of microfluidics, the effect of liquid pressure on the detection accuracy has been rarely studied. Here, we perform a quantitative analysis of such effect, by utilizing the sensitive optical responses of graphene to the refractive index (RI) change of its surrounding environment. We utilize a reflection coupling configuration by combining the total internal reflection (TIR) and ultrasonic waves. The high-performance graphene is processed on common glasses by using the solution-processable oxidation-reduction method. We find that the RI change of water caused by a pressure as small as 500 Pa generated by the liquid level change in the microfluidics can be measured directly. The detection accuracy and response time limits are approximately 280 Pa and 100 ns, respectively. The Maxwell's boundary conditions, Fresnel's law, and Pascal's law are used in theoretical analyses. This work highlights the importance of liquid pressure in microfluidics and provides guidance in designing and accurate detection of microfluidic devices.

Ca2+ and CACNA1H mediate targeted suppression of breast cancer brain metastasis by AM RF EMF

BACKGROUND

Brain metastases are a major cause of death in patients with metastatic breast cancer. While surgical resection and radiation therapy are effective treatment modalities, the majority of patients will succumb from disease progression. We have developed a novel therapy for brain metastases that delivers athermal radiofrequency electromagnetic fields that are amplitude-modulated at breast cancer specific frequencies (BCF).

METHODS

27.12 MHz amplitude-modulated BCF were administered to a patient with a breast cancer brain metastasis by placing a spoon-shaped antenna on the anterior part of the tongue for three one-hour treatments every day. In preclinical models, a BCF dose, equivalent to that delivered to the patient's brain, was administered to animals implanted with either brain metastasis patient derived xenografts (PDXs) or brain-tropic cell lines. We also examined the efficacy of combining radiation therapy with BCF treatment. Additionally, the mechanistic underpinnings associated with cancer inhibition was identified using an agnostic approach.

FINDINGS

Animal studies demonstrated a significant decrease in growth and metastases of brain-tropic cell lines. Moreover, BCF treatment of PDXs established from patients with brain metastases showed strong suppression of their growth ability. Importantly, BCF treatment led to significant and durable regression of brain metastasis of a patient with triple negative breast cancer. The tumour inhibitory effect was mediated by Ca²⁺ influx in cancer cells through CACNA1H T-type voltage-gated calcium channels, which, acting as the cellular antenna for BCF, activated CAMKII/p38 MAPK signalling and inhibited cancer stem cells through suppression of β-catenin/HMGA2 signalling. Furthermore, BCF treatment downregulated exosomal miR-1246 level, which in turn decreased angiogenesis in brain environment. Therefore, targeted growth inhibition of breast cancer metastases was achieved through CACNA1H.

INTERPRETATION

We demonstrate that BCF, as a single agent or in combination with radiation, is a novel treatment approach to the treatment of brain metastases. This paradigm shifting modality warrants further clinical trials for this unmet medical need.

Graphene Optical Biosensors

Graphene shows great potential in biosensing owing to its extraordinary optical, electrical and physical properties. In particular, graphene possesses unique optical properties, such as broadband and tunable absorption, and strong polarization-dependent effects. This lays a foundation for building graphene-based optical sensors. This paper selectively reviews recent advances in graphene-based optical sensors and biosensors. Graphene-based optical biosensors can be used for single cell detection, cell line, and anticancer drug detection, protein and antigen-antibody detection. These new high-performance graphene-based optical sensors are able to detect surface structural changes and biomolecular interactions. In all these cases, the optical biosensors perform well with ultra-fast detection, high sensitivities, unmarked, and are able to respond in real time. The future of the field of graphene applications is also discussed.

Three-Dimensional Co-Culture of Peripheral Blood-Derived Mesenchymal Stem Cells and Endothelial Progenitor Cells for Bone Regeneration

Engraftment of tissue-engineered bone plays a pivotal role in the treatment of large bone defects. However, promoting thorough vascularization in the central area of tissue-engineered constructs remains a great challenge for clinical application. Here, we developed a three-dimensional (3D) co-culture system using biphasic calcium phosphate bioceramic (BCPB) scaffold seeded with rabbit peripheral blood-derived mesenchymal stem cells (PB-MSCs) and endothelial progenitor cells (EPCs) to improve new bone formation and vascularization for long bone segmental defects. In vitro studies, we identified morphology and characterization of PB-MSCs and EPCs. We also created a co-culture system of PB-MSCs and EPCs, and assessed the CD31 expression, gene expression of VEGF, PDGF and ALP, and tube formation ability of the co-culture system. Moreover, the biocompatibility of the BCPB was assessed and secretion levels of ALP, OC, PDGF and VEGF by co-cultured PB-MSC and EPCs in the 3D co-culture system were determined (ELISA). In vivo studies were performed to assess the ability of the cell-scaffold construct to repair a rabbit large bone defect model by X-ray examination, gross observation, and histological staining. With the extension of incubation time, both osteogenic- and vascular-related genes were up-regulated when EPCs co-cultured with PB-MSCs. In addition, BCPB is biocompatible and the expression levels of osteogenic- and vascular-related markers were also up-regulated in the 3D co-culture system. Seeding of PB-MSCs and EPCs within a modified BCPB and subsequently implanted gave rise to new bone and promoted vascularization in the rabbit model. These findings suggest that our vascularized tissue-engineered bone may be a potential alternative in the treatment of large bone defects.

Postoperative analgesia for pediatric craniotomy patients: a randomized controlled trial

Background

Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery.

Methods

Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia. The formulas used were as follows: Control group included normal saline 100 ml, with a background infusion of 2 ml/h, bolus 0.5 ml; Fentanyl group was used with a background infusion of 0.1–0.2 μg/k·h, bolus 0.1–0.2 μg/kg; Morphine group was used with a background infusion of 10–20 μg/kg·h, bolus 10–20 μg/kg; while Tramadol group was used with a background infusion of 100–400 μg/kg·h, bolus 100–200 μg/kg. Postoperative pain scores and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups.

Results

In comparison of all groups with each other, lower pain scores were shown at 1 h and 8 h after surgery in Morphine group versus Tramadol, Fentanyl and Control groups (P < 0.05). Both Tramadol and Fentanyl groups showed lower pain scores in comparison to Control group (P < 0.05). Nausea and vomiting were observed more in Tramadol group in comparison to all other groups during the 48 h of PCIA usage after operation (P = 0.020). Much more rescue medicines including ibuprofen and morphine were used in Control group (CI = 0.000–0.019). Changes in consciousness and respiratory depression were not observed in study groups. Moderate-to-severe pain was observed in a total of 56 (17.5%) of the study population. Multiple regression analysis for identifying risk factors for moderate-to-severe pain revealed that, younger children (OR = 1.161, 1.027–1.312, P = 0.017), occipital craniotomy (OR = 0.374, 0.155–0.905, P = 0.029), and morphine treatment (OR = 0.077, 0.021–0.281, P < 0.001) are the relevant factors.

Conclusions

Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations.

Trial registration

Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn/index.aspx.

Electronic supplementary material

The online version of this article (10.1186/s12871-019-0722-x) contains supplementary material, which is available to authorized users.

Effect of Ti on Microstructure and Properties of Tungsten Heavy Alloy Joint Brazed by CuAgTi Filler Metal

In this paper, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and X-ray diffractometer (XRD) were used to comprehensively analyze the microstructure and brazing performance of a CuAgTi filler metal with braze tungsten heavy alloys. The association of microstructure, wettability and shear strength of brazing joints was also investigated. With the addition of Ti, the Ti₃Cu₄ phase appeared in the microstructure of filler metal. Ti is active element that promotes the reaction of filler with tungsten. Therefore, the Ti element is enriched around tungsten and forms a Ti₂Cu layer at the interface, leaving a Cu-rich/Ti-poor area on the side. Remaining Ti and Cu elements form the acicular Ti₃Cu₄ structure at the center of the brazing zone. The wettability of filler metal is improved, and the spreading area is increased from 120.3 mm² to 320.9 mm² with the addition of 10 wt.% Ti. The shear strength of joint reaches the highest level at a Ti content of 2.5 wt.%, the highest shear strength is 245.6 MPa at room temperature and 142.2 MPa at 400 °C.

Identification of CD37, cystatin A, and IL-23A gene expression in association with brain metastasis: analysis of a prospective trial

PURPOSE/OBJECTIVES

We aimed to assess the predictive value of a lung cancer gene panel for the development of brain metastases.

MATERIALS/METHODS

Between 2011 and 2015, 102 patients with lung cancer were prospectively enrolled in a clinical trial in which a diagnostic fine-needle aspirate was obtained. Gene expression was conducted on all samples that rendered a diagnosis of non-small cell lung cancer (NSCLC). Subsequent retrospective analysis of brain metastases-related outcomes was performed by reviewing patient electronic medical records. A competing risk multivariable regression was performed to estimate the adjusted hazard ratio for the development of brain metastases and non-brain metastases from NSCLC.

RESULTS

A total of 49 of 102 patients had died by the last follow-up. Median time of follow-up was 13 months (range 0.23-67 months). A total of 17 patients developed brain metastases. Median survival time after diagnosis of brain metastases was 3.58 months (95% confidence interval (CI) 2.17, not available). A total of 30 patients developed metastases without any evidence of brain metastases until the time of death or last follow-up. Competing risk analysis identified three genes that were downregulated differentially in the patients with brain metastases versus non-brain metastatic disease: CD37 (0.017), cystatin A (0.022), and IL-23A (0.027). Other factors associated with brain metastases include: stage T ( P ⩽ 8.3e^-6) and stage N ( P= 6.8e^-4).

CONCLUSIONS

We have identified three genes, CD37, cystatin A, and IL-23A, for which downregulation of gene expression was associated with a greater propensity for developing brain metastases. Validation of these biomarkers could have implications on surveillance patterns in patients with brain metastases from NSCLC.