Exploration of 68Ga-labelled prostate-specific membrane antigen-11 PET/CT parameters for identifying PBRM1 status in primary clear cell renal cell carcinoma

AIM

To investigate the predictive value of ⁶⁸Ga-labelled prostate-specific membrane antigen-11 (⁶⁸Ga-PSMA-11) integrated positron-emission tomography (PET)/computed tomography (CT) in PBRM1-deficient clear cell renal cell carcinoma (ccRCC).

MATERIALS AND METHODS

A total of 41 patients with ccRCC, were enrolled retrospectively and underwent ⁶⁸Ga-PSMA-11 PET/CT preoperatively. Radiological parameters, including CT attenuation value and maximum standard uptake value (SUVmax), were derived. Immunohistochemical and multiple immunofluorescences staining were performed to evaluate the PBRM1 status and immune response. The predictive value of imaging factors was analysed using a receiver operator characteristic curve analysis. Univariate and multivariate logistic regression analyses were used to investigate the relationship between clinical and radiological variables and PBRM1 status.

RESULTS

A total of 41 patients were included in this study, with 14 patients having PBRM1-deficient status. The tumour diameter on imaging and SUVmax differed significantly in patients with different PBRM1 expression statuses and no difference in CT attenuation was identified. Univariate and multivariate logistic regression analyses showed SUVmax was an obvious predictor for identification of PBRM1-deficient tumours. In addition, PBRM1-deficient tumours tended to be accompanied by greater cytotoxic T-cell infiltration, although most of them were in an exhausted state.

CONCLUSIONS

⁶⁸Ga-PSMA-11 PET/CT could be used to discriminate invasive PBRM1-deficient ccRCC.

Blind identification of active landslides in urban areas: a new set of comprehensive criteria

More than 70% of catastrophic landslides were previously unknown and brought tremendous losses to human life and property in urban regions; therefore, there is an urgent need for early identification of active landslides to eliminate landslide risk at the early stage. However, early identification of landslides has always been a worldwide challenge due to high concealment, steep topography, inaccessible location, and sudden onset. This work suggests a new set of comprehensive criteria for the early identification of landslides by integrating surface deformation, geological, topographic, geomorphological, and disaster-failure features. This set of criteria is universally applicable with no use of the prior knowledge of landslide locations (blind identification) and is successfully validated by a field survey. This work selects the Xuecheng region, a hard-hit area of landslides, as the study area and employs multisource data (seismic, geological, topographic, meteorological, SAR, and optical remote sensing data) and time-series InSAR technology to identify active landslides and reveal their deformation rules. Some new viewpoints are suggested. (1) The new comprehensive criteria synthesize the surface deformation, disaster-controlling, and disaster-inducing characteristics and achieve relatively high accuracy by field validation. (2) Forty-seven active landslides are identified in Xuecheng with no use of the prior knowledge of landslides. The soft rocks or soft-hard interbeddings, tectonic movement, fluvial undercutting and eroding, precipitation, earthquakes, and human engineering activity control or induce the development of these active landslides. (3) Two giant landslides that significantly threaten human lives and properties and exhibit different movement modes are selected to highlight the deformation rules of active landslides under the coupled action of poor lithologic condition, tectonic movement, river erosion, precipitation, and human engineering activity. The suggested new criteria can be applied to other landslide hard-hit urban regions and contribute to the timely and effective prevention and control of catastrophic landslides, reduction of enormous disaster losses, and rational management of the environment.

[Clinical study on application of 3D Slicer software assisted domestic frameless stereotactic robot in biopsy of intracranial lesions]

Objective: To examine the application value of 3D Slicer software assisted domestic frameless stereotactic robot in biopsy of intracranial lesions. Methods: A retrospective analysis was performed on 80 patients who admitted consecutively and underwent intracerebral lesions biopsy with the domestic frameless stereotactic robot at Department of Neurosurgery, Aerospace Central Hospital from January 2019 to December 2021. There were 36 males and 44 females, with a mean age of (38.5±18.0) years (range: 6 to 71 years). Before surgery only enhanced T1-weighted three-dimensional magnetization prepared gradient echo sequences and diffusion tensor imaging scans were performed. Self-reconstruction of intracranial lesions, cerebral cortex and blood vessels was carried out using 3D Slicer software system after the DICOM format imaging data of 80 patients were collected. These imaging data were merged to the workstation of the domestic frameless stereotactic robot for preoperative surgical planning and the surgical puncture path was designed to avoid blood vessels in the brain functional area, cerebral cortex and sulcus. Results: All frameless stereotactic biopsy were successfully performed. Postoperative pathological diagnosis included 50 cases of diffuse astrocytic and oligodendroglioma, 15 cases of lymphoma, 5 cases of metastatic tumors, 5 cases of inflammatory demyelinating disease, 2 cases of inflammatory granuloma, 1 case of hemangioma, 1 case of acute lymphoblastic leukemia intracranial invasion and 1 case of seminoma. The positive diagnosis rate was 100% (80/80). Postoperative imaging confirmed that the puncture path and target were accurately implemented according to the preoperative planning, and the target error was (1.32±0.44) mm (range: 0.55 to 1.99 mm). One case of puncture-related bleeding occurred at the target after surgery and improved after treatment. Conclusion: The three-dimensional multimodal images reconstructed by the 3D Slicer software before operation could help the surgeons make the preoperative planning and reduce the risk of stereotactic brain biopsy.

Efficacy and safety of hypoglycemic agents on gestational diabetes mellitus in women: A Bayesian network analysis of randomized controlled trials

Objective

To compare the efficacy and safety of metformin, glyburide, and insulin for GDM, we conducted a subgroup analysis of outcomes for women with GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.

Methods

We searched the NCBI, Embase, and Web of Science databases from inception to March 2022. Randomized controlled trials (RCTs) that compared the outcomes of hypoglycemic agents in women with GDM were included. Bayesian network analysis was employed.

Results

A total of 29 RCTs were included. Metformin was estimated to lead to a slight improvement in total gestational weight gain (WMD - 1.24 kg, 95% CI -2.38, -0.09), a risk of unmet treatment target in the sensitivity analysis (OR 34.50, 95% CI 1.18-791.37) than insulin. The estimated effect of metformin showed improvements in birth weight than insulin (WMD - 102.58 g, 95% CI -180.45 to -25.49) and glyburide (WMD - 137.84 g, 95% CI -255.31 to -25.45), for hypoglycemia within 1 h of birth than insulin (OR 0.65, 95% CI 0.47 to 0.84). The improvement in the estimated effect of metformin for hypoglycemia within 1 h of birth still existed when compared with glyburide (OR 0.41, 95% CI 0.26 to 0.66), whether in the IADPSG group (OR 0.33, 95% CI 0.12 to 0.92) or not (OR 0.43, 95% CI 0.20 to 0.98).

Conclusion

Metformin is beneficial for GDM women to control total GWG compared with insulin, regulate fetal birth weight more than insulin and glyburide, and increase the risk of unmet treatment targets compared with insulin. Compared to metformin, glyburide is associated with neonatal hypoglycemia.

IgA nephropathy with acute kidney disease: Characteristics, prognosis, and causes

BACKGROUND

The clinical manifestations and prognosis of IgA nephropathy (IgAN) are diverse. Some patients may present with kidney dysfunction lasting shorter than 3 months and meet the acute kidney disease (AKD) criteria. This study aimed to investigate the clinicopathological features, causes and prognosis of newly diagnosed cases of IgAN with AKD.

METHODS

1320 IgAN patients diagnosed via kidney biopsy between January 2012 and June 2018 were included in this retrospective study, with a median follow-up period of 35 months. We analyzed the clinicopathological, etiological variables, as well as short-term and long-term prognosis. The main outcome was a composite event of 40% decline in eGFR, kidney failure or death.

RESULTS

Incidence of AKD was 8.8% in the newly diagnosed IgAN patients, and was found to be an independent risk factor affecting the short-term (HR, 7.1; 95% CI, 2.3-22.2; P = 0.001) and long-term (HR, 1.8; 95% CI, 1.2-2.6; P = 0.006) prognosis, respectively. The most common cause of AKD was malignant hypertension-related AKD (MHT-AKD; 24.1%), followed by hematuria-related AKD (H-AKD; 12.9%), nephrotoxic-drug-exposure-related AKD (NTDE-AKD; 12.1%) and crescents-related AKD (C-AKD; 11.2%). The patients in AKD group had more severe clinicopathological characteristics and poor short-term and long-term prognosis than non-AKD group. In subgroup analysis, the MHT-AKD had the worst 5 years survival rate, followed by NTDE-AKD and C-AKD, whereas H-AKD had the best survival rate.

CONCLUSIONS

AKD is not rare among IgAN patients, and is an independent risk factor for short-term and long-term prognosis. IgAN patients with AKD resulting from different causes have different prognosis.

Development and Validation of Risk Prediction Models for Gestational Diabetes Mellitus Using Four Different Methods

Gestational diabetes mellitus (GDM), a common perinatal disease, is related to increased risks of maternal and neonatal adverse perinatal outcomes. We aimed to establish GDM risk prediction models that can be widely used in the first trimester using four different methods, including a score-scaled model derived from a meta-analysis using 42 studies, a logistic regression model, and two machine learning models (decision tree and random forest algorithms). The score-scaled model (seven variables) was established via a meta-analysis and a stratified cohort of 1075 Chinese pregnant women from the Northwest Women's and Children's Hospital (NWCH) and showed an area under the curve (AUC) of 0.772. The logistic regression model (seven variables) was established and validated using the above cohort and showed AUCs of 0.799 and 0.834 for the training and validation sets, respectively. Another two models were established using the decision tree (DT) and random forest (RF) algorithms and showed corresponding AUCs of 0.825 and 0.823 for the training set, and 0.816 and 0.827 for the validation set. The validation of the developed models suggested good performance in a cohort derived from another period. The score-scaled GDM prediction model, the logistic regression GDM prediction model, and the two machine learning GDM prediction models could be employed to identify pregnant women with a high risk of GDM using common clinical indicators, and interventions can be sought promptly.

[The relationship between peripheral blood mitochondrial DNA copy number and incident risk of liver cancer: a case-cohort study]

Objective: To investigate the association between peripheral blood mitochondrial DNA copy number (mtDNAcn) and incident risk of liver cancer. Methods: At the baseline of Dongfeng-Tongji (DFTJ) cohort, 27 009 retirees were recruited from Dongfeng Motor Corporation in 2008. After excluding people without baseline DNA, with current malignant tumor and loss of follow-up, 1 173 participants were randomly selected into a sub-cohort by age-and gender-stratified sampling method at a proportion of 5% among all retirees. A total of 154 incident liver cancer cases identified from the cohort before December 31, 2018 (4 cases had been selected into the sub-cohort) were selected to form the case cohort of liver cancer. For the above 1 323 participants, their baseline levels of mtDNAcn in peripheral blood cells were measured by using quantitative real-time PCR method. The restricted cubic spline analysis was used to fit the shape of the association between baseline mtDNAcn and incident risk of liver cancer. The weighted Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95%CI. Results: In this case-cohort study, the median follow-up time was 10.3 years. The restricted cubic spline analysis indicated that the relationship between peripheral blood mtDNAcn and incident risk of liver cancer followed a U-shaped pattern (P_non-linear<0.05). All case-cohort population were divided into four subgroups by sex-specific quartiles of mtDNAcn levels among sub-cohort participants, when compared to participants in the Q₂ subgroup of mtDNAcn, those in the Q₁ subgroup (HR=2.00,95%CI:1.08-3.70) and Q₄ subgroup (HR=4.11,95%CI:2.32-7.26) both had a significantly elevated risk of liver cancer, while those in the Q₃ subgroup (HR=1.05,95%CI:0.54-2.05) had not. There were no significant multiply interaction effects of aging, gender, tobacco smoking, alcohol drinking and history of chronic hepatitis on the above association (P_interaction>0.05). Conclusion: Both extremely low and high baseline level of mtDNAcn in peripheral blood cells are associated with an increased risk of incident liver cancer, but the underlying mechanisms need to be further clarified.

Activation of PI3K/Akt prevents hypoxia/reoxygenation-induced GnRH decline via FOXO3a

Recent studies have suggested that the hypothalamus has an important role in aging by regulating nuclear factor-κB (NF-κB)-directed gonadotropin-releasing hormone (GnRH) decline. Moreover, our previous study has shown that ischemia-reperfusion (IR) injury activates NF-κB to reduce hypothalamic GnRH release, thus suggesting that IR injury may facilitate hypothalamic programming of system aging. In this study, we further examined the role of phosphoinositide 3-kinase (PI3K)/Protein kinase B (Akt) pathway, a critical intracellular signal pathway involved in the repair process after IR, in hypoxia-reoxygenation (HR)-associated GnRH decline in vitro. We used GT1-7 cells and primarily-cultured mouse GnRH neurons as cell models for investigation. Our data revealed that the activation of the PI3K/Akt/Forkhead box protein O3a (FOXO3a) pathway protects GnRH neurons from HR-induced GnRH decline by preventing HR-induced gnrh1 gene inhibition and NF-κB activation. Our results further the understanding of the regulatory mechanisms of HR-associated hypothalamic GnRH decline.

Handwritten New Tai Lue Character Recognition Using Convolutional Prior Features and Deep Variationally Sparse Gaussian Process Modeling

New Tai Lue is widely used in Southwest China and Southeast Asia. Hence, it is important to study related handwritten character recognition. Considering the many similar characters in handwritten New Tai Lue, this paper proposes an offline handwritten New Tai Lue character recognition method based on convolutional prior features and deep variationally sparse Gaussian process (DVSGP) modeling. An offline handwritten database is constructed, a convolutional neural network is trained to extract the convolutional features of New Tai Lue character images as prior features, and a DVSGP model is built. The extracted features are input into the DVSGP model to construct a recognition model. The experimental results show that the accuracy of the model is 97.67% and that the precision, recall, and F1-score are 0.9769, 0.9767, and 0.9767, respectively, which are better than those of other methods. The proposed method also achieves high accuracy on the MNIST recognition task, verifying its universal applicability.

Radiotherapy-induced abscopal effect on the metastatic carcinoma of unknown primary origin: a case report and literature review

OBJECTIVE

Abscopal effect of radiotherapy refers to a clinical phenomenon that is characterized by the eradication of distant metastatic tumors following localized irradiation. Reports on the abscopal effect following pure radiotherapy have been relatively rare.

CASE REPORT

Herein, we reported a 70-year-old male patient, who has been subjected to swelling and pain in the left neck. Computed tomography examination presented a metastatic lymph node of the left cervical and an intra-abdominal mass which was located in hepatogastric space, upward of the pancreatic head. Histopathology of the left cervical lymph node further ensured a poorly-moderately differentiated form of squamous cell carcinoma. But the primary origin was not defined. This patient received radiotherapy on the metastatic lymph nodes of the left cervical (dose: 60 Gray in 30 fractions) only. After treatment, the pain in the left neck dramatically improved and the swelling of the radiation exposure site diminished gradually. Computed tomography examination also confirmed that the abdominal mass was significantly reduced.

CONCLUSIONS

The abscopal effect, in this case, may help us to get a better understanding of the impact of radiotherapy.

P-016 Effects of the different partial deletions in the AZFc locus of Y-chromosome on the ICSI outcome of severe oligospermia patients

Study question

To investigate the effects of different partial deletions in AZFc locus of Y-chromosome on the clinical outcome of severe oligospermia patients by intracytoplasmic single sperm injection (ICSI)

Summary answer

B2/b3 and b2/b4 deletion in the AZFc locus of Y chromosome have no significant effect on pregnancy outcome in patients with severe oligospermia undergoing ICSI.

What is known already

Thanks to the development of high-throughput sequencing for Y chromosome microdeletion, AZFc deletions can be accurately divided into b2/b4, gr/gr, b2/b3 and b1/b3 types. However, there is no relevant research on the effect of different partial deletion types of AZFc on the outcome of assisted reproduction.

Study design, size, duration

According to whether carrying AZFc microdeletions or not, the patients were divided into AZFc-deletion group and control group. And AZFc-deletion group was divided into 3 subgroups by the types of partial deletion.

Participants/materials, setting, methods

A retrospective analysis was conducted on the patients undergoing high-throughput sequencing for Y chromosome microdeletion screening and ICSI treatment in our hospital from December 2017 to February 2019.

Main results and the role of chance

The AZFc b2/b3 deletion group had no significant difference in D3 availability, high-quality embryo rate, blastocyst formation rate, implantation rate, clinical pregnancy rate and live birth rate, and the control group (P &gt; 0.05). The rate of high-quality embryos in patients with the b2/b4 deletion was lower than that of the control group (23.2% vs. 34.3%, P = 0.004), but there was no statistical difference in other indicators.

Limitations, reasons for caution

In this study, we included only patients who underwent ICSI with ejaculate sperm for analysis, but not patients who had successfully obtained sperm through surgery.

Wider implications of the findings

This study helps clinicians provide more detailed and comprehensive infertility risk answers during consultations with such patients to reduce the mental stress of patients.

Trial registration number

not applicable

Molecular Typing of Gastric Cancer Based on Invasion-Related Genes and Prognosis-Related Features

Background

This study aimed to construct a prognostic stratification system for gastric cancer (GC) using tumour invasion-related genes to more accurately predict the clinical prognosis of GC.

Methodology

Tumour invasion-related genes were downloaded from CancerSEA, and their expression data in the TCGA-STAD dataset were used to cluster samples via non-negative matrix factorisation (NMF). Differentially expressed genes (DEGs) between subtypes were identified using the limma package. KEGG pathway and GO functional enrichment analyses were conducted using the WebGestaltR package (v0.4.2). The immune scores of molecular subtypes were evaluated using the R package ESTIMATE, MCPcounter and the ssGSEA function of the GSVA package. Univariate, multivariate and lasso regression analyses of DEGs were performed using the coxph function of the survival package and the glmnet package to construct a RiskScore model. The robustness of the model was validated using internal and external datasets, and a nomogram was constructed based on the model.

Results

Based on 97 tumour invasion-related genes, 353 GC samples from TCGA were categorised into two subtypes, thereby indicating the presence of inter-subtype differences in prognosis. A total of 569 DEGs were identified between the two subtypes; of which, four genes were selected to construct the risk model. This four-gene signature was robust and exhibited stable predictive performance in different platform datasets (GSE26942 and GSE66229), indicating that the established model performed better than other existing models.

Conclusion

A prognostic stratification system based on a four-gene signature was developed with a desirable area under the curve in the training and independent validation sets. Therefore, the use of this system as a molecular diagnostic test is recommended to assess the prognostic risk of patients with GC.

[The relationship between triglyceride glucose index and risk of cardiovascular disease among Kazakh and Uygur population in Xinjiang: a retrospective cohort analysis]

Objective: To analyze whether triglyceride-glucose (TyG) index is associated with increased risk of cardiovascular diseases (CVD) and the value of TyG index in predicting CVD risk among Kazakh and Uighur population of Xinjiang. Methods: In this study, 5 375 Kazakh and Uygur people of Xinyuan county and Jiashi county were selected as the research objects. Subjects were divided into four groups based on the quartile of the TyG index level. Cox regression model was used to analyze the association between TyG index with the risk of CVD. The dose-response relationship between TyG index and CVD risk was described by restricted cubic splines. The area under the receiver operating characteristic curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to estimate the value of TyG index for predicting CVD. Mediating effect analysis was conducted to analyze the mediating effect of TyG index in the association between body mass index and CVD. Results: The age of subjects was 41.06（30.11，53.00）years old, with 46.30%（2 489/5 375）was male. After multivariate adjustment, there was an increasing trend between the risk of CVD and the higher TyG index P_trend<0.001, compared with subjects of TyG index in Q₁, the HR (95%CI) of Q₂, Q₃, and Q₄ groups was 1.53, 1.23 and 1.73, respectively. Restricted cubic splines showed that TyG index was the linearly associated with the risk of CVD. TyG index could improve the prediction ability of Framingham model for the risk of CVD (NRI=0.106,P=0.010; IDI=0.003,P=0.030). The mediating effect analysis showed that in the relationship between body mass index and CVD, the TyG index had a mediating effect (P<0.001), and the ratio of mediating effect was 12.69%. Conclusion: TyG index is an independent predictor of CVD risk among kazakh and Uygur population in Xinjiang and has a good predictive value for the risk of CVD.