Prevalence and Factors Associated with BRCA1/2 Gene Mutation in Chinese Populations with Breast Cancer

Objective

We aimed to evaluate the prevalence of BRCA1 and BRCA2 mutations in Chinese populations with breast cancer. Factors associated with BRCA1 and BRCA2 mutations are also evaluated.

Methods

This was a cross-sectional study, and patients with breast cancer were included. Data on clinical characteristics, information of breast cancer, and BRCA1 and BRCA2 mutations were extracted. Patients were divided into the carrier and noncarrier groups.

Results

A total of 368 patients were included. Compared to the noncarrier group (n = 240), patients in the carrier group (n = 128) were younger and more likely to have breast cancer at age <40 years. Of the overall 128 patients in the carrier groups, 58 had BRCA1 mutation and 70 had BRCA2 mutation. Among patients with early onset breast cancer, there was no difference in the prevalence of BRCA1 and BRCA2 (20.7% vs 17.1%, P = 0.35). While among patients with a family history of breast/ovarian cancer, BRCA2 mutation was more prevalent than BRCA1 mutation (54.3% vs 44.8%, P = 0.01); and among patients with triple-negative breast cancer, BRCA1 mutation was more prevalent than BRCA2 mutation (34.5% vs 28.6%, P = 0.04). After adjusting for covariates, factors associated with BRCA1 mutation included breast cancer diagnosed <40 years, tumor size >2 cm, and lymph node metastasis; and after adjusting for covariates, factors associated with BRCA2 mutation included age, tumor size >2 cm, and triple-negative breast cancer.

Conclusion

The prevalence of BRCA1 and BRCA2 mutations varied according to three specific subgroups. Factors associated with BRCA1 and BRCA2 mutations were differential.

Deformation of Copper Nanowire under Coupled Tension–Torsion Loading

Metallic nanowires (NWs) are essential building blocks for flexible electronics, and experience different deformation modes due to external mechanical loading. Using atomistic simulations, this work investigated the deformation behavior of copper nanowire under coupled tension–torsion loading. A transition in both yielding pattern and dislocation pattern were observed with varying torsion/tension strain ratios. Specifically, increasing the torsion/tension strain ratio (with larger torsional strain) triggered the nucleation of different partial dislocations in the slip system. At low torsion/tension strain ratios, plastic deformation of the nanowire was dominated by stacking faults with trailing partial dislocations pinned at the surface, shifting to two partial dislocations with stacking faults as the strain ratio increases. More interestingly, the NW under tension-dominated loading exhibited a stacking fault structure after yielding, whereas torsion-dominated loading resulted in a three-dimensional dislocation network within the structure. This work thus suggests that the deformation behavior of the NW varies depending on the coupled mechanical loading, which could be beneficial for various engineering applications.

LncRNA ABHD11-AS1 promotes tumor progression in papillary thyroid carcinoma by regulating EPS15L1/EGFR signaling pathway

OBJECTIVES

lncRNA ABHD11 antisense RNA 1 (ABHD11-AS1) acts as an oncogene involved in papillary thyroid carcinoma (PTC) occurrence and progression. ABHD11-AS1 exerts biologic functions by some miRNAs and proteins to regulate multiple targets. Identification of novel mechanism of ABHD11-AS1 could be helpful in therapeutic targeting for PTC treatment.

METHODS

Differentially expressed lncRNAs were selected from TCGA database. qRT-PCR analysis was applied to examine the expression of ABHD11-AS1 in PTC cell lines and tissues. The relationship of ABHD11-AS1 expression and clinicopathological features was analyzed by Kaplan-Meier analysis. Two PTC cell lines (TPC-1 and KTC-1) were transfected with pcDNA 3.1, pcDNA3.1-ABHD11-AS1, si-NC and si-ABHD11-AS1, respectively, to verify the ABHD11-AS1 oncogene-regulating capacity to promote tumor progression. The cell metastasis and proliferation had been evaluated both in vitro and in vivo.

RESULTS

High expression of ABHD11-AS1 was found in PTC tissues (P < 0.01), which was significantly correlated with lymph node metastasis (P < 0.05). ABHD11-AS1 overexpression noticeably promoted cell proliferation, migration, and invasion capabilities, which were obviously decreased upon ABHD11-AS1 knockdown. ABHD11-AS1 positively regulated EGFR/EPS15L1 pathway, as EGFR, EPS15L1, STAT3, and p-STAT3 were activated.

CONCLUSION

ABHD11-AS1 promotes tumor progression in PTC by regulating EPS15L1/EGFR pathway.

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

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

Quantification of chronic aortic regurgitation using left and right ventricular stroke volumes obtained from two new automated three-dimensional transthoracic echocardiographic software: feasibility and accuracy

The present study aimed to evaluate the feasibility and accuracy of chronic aortic regurgitation (CAR) quantification using left and right ventricular stroke volumes (LVSV and RVSV, respectively) obtained from two new automated three-dimensional transthoracic echocardiographic software-Dynamic HeartModel (DHM) and 3D Auto RV. Patients (n=116) with more than mild isolated CAR were included and divided into two groups: central (n=53) and eccentric CAR (n=63) groups. LVSV and RVSV were automatically measured by DHM and 3D Auto RV. Next, aortic regurgitant volume (ARVol) was calculated three ways: as the difference between LVSV and RVSV, by the two-dimensional proximal isovelocity surface area (PISA) method, and using effective regurgitant orifice area derived from real-time three-dimensional echocardiography (RT3DE) multiplied by CAR velocity time integral (the reference standard). DHM plus 3D Auto RV correlated well with RT3DE in ARVol measurement in both groups (central, r = 0.90; eccentric, r = 0.96), with no significant difference based on consistency analysis. In the eccentric group, PISA led to an obvious underestimation (mean difference= - 4.20 ml, P < 0.05). The kappa agreement between DHM plus 3D Auto RV and RT3DE in grading CAR severity in both groups was good (central, k = 0.89; eccentric, k = 0.86), but that between PISA and RT3DE in the eccentric CAR group was suboptimal (k = 0.74). This study indicates that ARVol quantification using DHM plus 3D Auto RV is feasible and reproducible in patients with more than mild isolated CAR. This new method has great correlation and agreement with RT3DE in ARVol measurement, with evident advantages over PISA in eccentric CAR.

Cingulate circuits are associated with escalation of heroin use and naloxone-induced increases in heroin self-administration

Opioid use disorder (OUD) is defined as a compulsion to seek and take opioids, loss of control over intake and the development of a negative emotional state when access to opioids is denied. Using functional magnetic resonance imaging (fMRI) data in a rat model of OUD, we demonstrate that the escalation of heroin self-administration (SA) and the increased heroin SA following an injection of an opioid receptor antagonist (naloxone) are associated with changes in distinct brain circuits, centered on the cingulate cortex (Cg). Here, SA escalation score was negatively associated with changes in resting state functional connectivity (rsFC) between the Cg and the dorsal striatum. Conversely, increased heroin SA following naloxone injection, was associated with increased connectivity between the Cg and the extended amygdala and hypothalamus. Naloxone-induced increased SA was also positively associated with changes in the amplitude of low frequency fluctuations within the Cg, a measure of spontaneous neuronal activity. Characterizing the distinct brain circuit and behavior changes associated with different facets of addiction increases our understanding of OUD and may provide insight into addiction prevention and treatment.

Biosynthesis of Novel Naphthoquinone Derivatives in the Commonly-used Chassis Cells Saccharomyces cerevisiae and Escherichia coli

Naphthoquinones harboring 1,4-naphthoquinone pharmacophore are considered as privileged structures in medicinal chemistry. In pharmaceutical industry and fundamental research, polyketide naphthoquinones were widely produced by heterologous expression of polyketide synthases in microbial chassis cells, such as Saccharomyces cerevisiae and Escherichia coli. Nevertheless, these cell factories still remain, to a great degree, black boxes that often exceed engineers’ expectations. In this work, the biotransformation of juglone or 1,4-naphthoquinone was conducted to generate novel derivatives and it was revealed that these two naphthoquinones can indeed be modified by the chassis cells. Seventeen derivatives, including 6 novel compounds, were isolated and their structural characterizations indicated the attachment of certain metabolites of chassis cells to naphthoquinones. Some of these biosynthesized derivatives were reported as potent antimicrobial agents with reduced cytotoxic activities. Additionally, molecular docking as simple and quick in silico approach was performed to screen the biosynthesized compounds for their potential antiviral activity. It was found that compound 11 and 17 showed the most promising binding affinities against Nsp9 of SARS-CoV-2, demonstrating their potential antiviral activities. Overall, this work provides a new approach to generate novel molecules in the commonly used chassis cells, which would expand the chemical diversity for the drug development pipeline. It also reveals a novel insight into the potential of the catalytic power of the most widely used chassis cells.

Stage of colorectal cancer diagnosis for immigrants: a population-based retrospective cohort study in Ontario, Canada

BACKGROUND

Colorectal cancer (CRC) is the second most common cause of cancer death in Canada. Immigrants in Ontario, Canada's most populous province, are known to have lower rates of CRC screening, but differences in stage of CRC diagnosis are not known.

METHODS

We utilized linked administrative databases to compare early (stage I-II) versus late (stage III-IV) stage of CRC diagnosis for immigrants versus long-term residents among patients diagnosed in Ontario between 2012 and 2017 (n = 37,717) and examined the association of immigration-related, sociodemographic, and healthcare-related factors with stage.

RESULTS

Almost 45% of those with CRC were diagnosed at a late stage. Immigrants were slightly more likely to be diagnosed at a late stage than their long-term resident counterparts [Adjusted relative risks (ARRs) 1.06 (95% CI 1.02-1.10)], but after adjusting for age and sex, this difference was no longer significant. In fully adjusted models, we observed a higher likelihood of late-stage diagnosis for people with the fewest co-morbidities (ARR 0.86 [95% CI 0.83-0.89]) and those with no visits to primary care (versus a high level of continuity of care) [ARR 1.07 (95% CI 1.03-1.12)].

CONCLUSION

Immigrants were not more likely to have a late-stage CRC diagnosis after adjusting for relevant factors, but access to primary care and healthcare contact was significantly associated with diagnostic stage.

IMPACT

Attachment to a primary care provider who provides regular preventive care may play a role in more favorable stage at diagnosis for CRC and thus should be a healthcare system priority.

[Analysis of M2 macrophage infiltration and its clinical significance in 44 patients with multiple primary cancers of the head and neck]

Objective: To investigate and analyze the characteristics of M2 macrophage infiltration and the clinical significance in patients with multiple primary cancers (MPCs) of head and neck in order to explore its role in the diagnosis and prognosis for patients with MPCs. Methods: RNA-seq data were downloaded from the Genomic Data Commons data portal (TCGA) and the R software v4.0.3 was used to statistically analyze the differences. A retrospective analysis was conducted by screening the clinical data of 44 patients (17 males and 27 females) with MPCs in head and neck from July 1998 to February 2016 in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. Clinical data from a batch of 41 patients (28 males and 13 females) with gingival cancer and without MPCs from August 2013 to December 2015 were collected and analyzed. The number of CD163 positive cells and the expression patterns in immunohistochemically panoramic slices were observed under high magnification. Chi-square test and Spearman correlation analysis were used to compare the difference and correlation between the CD163 positive counts and/or depths of invasion and the number of incidences. The descriptive statistics on the clinical features was performed by SPSS 25.0. Results: TCGA database analysis showed that the infiltration of macrophage in patients with squamous cell carcinoma of head and neck (HNSCC) was increased compared to the para-cancer sites. A total of 142 tissue samples from 44 patients with MPCs were selected in the present single-center retrospective research. The number of CD163-positive cells in MPCs patients [90.9% (40/44)] was significantly increased compared to single gingival cancer patients [61.0%(25/41)] (r=0.353, P=0.001), which was related to the number of occurrence (r=0.368, P=0.001). The ratio of the CD163 counts in primary tumor to the depths of invasion was positively correlated with the number of onsets (r=0.331, P=0.03). In terms of clinical features, the 44 patients with MPCs were mainly female, non-smoking, no alcohol addiction, no systemic history, Tis-T2 stage and N0 stage squamous cell carcinoma. The number of incidences ranged from two to eight. The incidence of cancer relative to synchronous cancer increased with the increased occurrence of MPCs. The primary cancer mainly occurred in tongue, gingiva and buccal sites, while the proportion of onset sites in gingiva, buccal and palate areas increased with the increased occurrence. Conclusions: M2 type macrophage counts and/or ratio to depth of infiltration were associated with the occurrence of MPCs, which could be used as a clinical indicator to distinguish single and MPCs in HNSCC. For early stage of HNSCC, patients with clinical characters of women, non-smoking, no alcohol addiction, no systemic medical history and sites of tongue, gingiva, and buccal should be paid more attention on their follow-up plan. The findings in the present study was also helpful to explore new treatment methods for the patients with MPCs.

Beclin1 controls caspase-4 inflammsome activation and pyroptosis in mouse myocardial reperfusion-induced microvascular injury

BACKGROUND

Myocardial reperfusion injury is often accompanied by cell death and inflammatory reactions. Recently, pyroptosis is gradually recognized as pivotal role in cardiovascular disease. However, little is known about the regulatory role of beclin1 in the control of caspase-4 activation and pyroptosis. The present study confirmed whether beclin1 regulates caspase-4 mediated pyroptosis and thereby protects Human Cardiac microvascular endothelial cells (HCMECs) against injury.

METHODS

TTC and Evan's blue dye, western blot, immunofluorescence and immunohistochemistry staining were performed in wild mice and transgenic mice with overexpression of beclin 1(BECN1-Tg). CMECs were transfected with a beclin1 lentivirus. The cell cytotoxicity was analyzed by LDH-Cytotoxicity Assay Kit. The protein levels of autophagy protein (Beclin1, p62 and LC3II/LC3I) and caspase-4/GSDMD pathway were determined by western blot. Autophagic vacuoles in cells were monitored with RFP-GFP-LC3 using fluorescence microscope.

RESULTS

I/R caused caspase-4 activity and gasdermin D expression increase in vivo and in vitro. Overexpression of beclin1 in heart tissue and CMECs suppressed the caspase-4 activity and decreased the levels of gasdermin D; meanwhile beclin1 overexpression also reduced IL-1β levels, promoted autophagy (p62 expression was inhibited while LC3II expression was increased) in the heart and CMECs. Interestingly, beclin1 overexpression increased animal survival and attenuated myocardial infarct size (45 ± 6.13 vs 22 ± 4.37), no-reflow area (39 ± 5.22 vs 16 ± 2.54) post-myocardial ischemia reperfusion.

CONCLUSIONS

Induction of beclin-1 signaling can be a potential therapeutic target in myocardial reperfusion-induced microvascular injury. Video Abstract.

[Current status of CD34+cell enumeration assay in clinical laboratories and its improvement]

Objective: To investigate the current status and problems of CD34⁺ cell enumeration in clinical laboratories and provide suggestions for the development of quality improvement programs. Methods: A total of 101 laboratories participating in the national external quality assessment program of CD34⁺cell enumeration were surveyed. Questionnaires and quality assessment materials were distributed to collect information on assay methodology and testing results. Quality control requirements for CD34⁺cell enumeration were determined according to the international guidelines, and the compliance of the surveyed laboratories was analyzed. Testing results were analyzed in groups and compared with the College of American Pathologists (CAP) quality assessment data. Results: A total of 97 laboratories returned the questionnaires and 99 laboratories returned the results of quality assessment materials. The questionnaire data showed high compliance rates of quality control requirements such as gating protocols, pipetting methods, and the number of cells acquired (92.8%, 83.9%, and 82.5% respectively). However, these laboratories had relatively low compliance rates such as the use of whole blood quality control materials for internal quality control, selection of erythrocyte lysing reagents, sample processing method, whether to report absolute count results, and quality control of equipment (5.2 %, 28.9%, 39.2%, 46.4%, and 55.7%, respectively). Testing results demonstrated that the coefficient of variation (CV) of percent counts was similar to the CAP quality assessment data, but the CV of absolute counts was greater than the CAP quality assessment data. Conclusions: Clinical laboratories have poor compliance with some quality control requirements and the variability of absolute count results between different laboratories is not satisfactory. Therefore, it is recommended that clinical laboratories should strengthen the training related to the quality control of CD34⁺cell enumeration, especially the absolute counting.

Association of total cholesterol and atherosclerotic cardiovascular disease in patients with follicular thyroid cancer: A real-world study from Chinese populations

ABSTRACT

The association between serum total cholesterol (TC) level and incident atherosclerotic cardiovascular disease (ASCVD) in patients with follicular thyroid cancer postthyroidectomy is unknown.This was a retrospective study and patients (n = 384) were divided into low and high TC groups according to the median TC level. Incidence of composite ASCVD (myocardial infarction, ischemic stroke, and cardiovascular death) was compared between these 2 groups and factors contributing to the association of TC and ASCVD were evaluated.Patients in the high TC group were older and more likely to have diabetes and have higher C-reactive protein level. After thyroidectomy, serum levels of free triiodothyronine and free thyroxine were lower while thyroid-stimulating hormone level was higher in the high TC group. 31.6% and 39.7% of patients developed hypothyroidism in the low and high TC groups (P < .05) postthyroidectomy. The incidence rate of composite ASCVD was higher in the high TC versus low TC groups, with incidence rate ratio of 1.69 (95% confidence interval [CI]: 1.07-2.69), which was mainly driven by a higher incidence rate of myocardial infarction in the high TC group (incidence rate ratio: 2.11 and 95% CI: 1.10-4.20). In unadjusted model, higher TC was associated with 73% higher risk of composite ASCVD. After adjustment for hypothyroidism, the association of higher TC and composite ASCVD was attenuated into insignificance, with hazard ratio of 0.92 and 95% CI: 0.81 to 1.34.Increased TC level was associated with composite ASCVD, which might be attributed to hypothyroidism postthyroidectomy. The use of levothyroxine might help to prevent hypercholestemia and reduce the incidence of ASCVD.

Effect of xylanase and live yeast supplementation on growth performance, nutrient digestibility, and gut microbiome diversity of pigs

Effect of xylanase (Xyl) and live yeast (LY) supplementation on gut microbiome composition, growth performance, and nutrient digestibility of weanling pigs was determined. A total of 180 weanling pigs were assigned to five treatments from weaning to market. Treatments were designated based on whether Xyl, LY, or their combination were fed in the first 2 wk postweaning or thereafter until finishing at day 141 postweaning. Treatments were (days 1–15; days 15–141): control–control, control–Xyl, Xyl–Xyl, LY–Xyl, Xyl + LY–Xyl. Xylanase was added at 16 000 BXU·kg−1 and LY at 1 kg·t−1. Pigs fed with LY and LY + Xyl from days 0–15 had greater body weight and average daily gain at day 15 compared with control (P < 0.05). Glucose transporter 2 mRNA was higher in LY and LY + Xyl groups on day 15 compared with control (P < 0.05). Xylanase supplementation from week 2 postweaning increased apparent total tract nutrient digestibility of gross energy, nitrogen, and phosphorus on day 43. Live yeast with or without Xyl improved growth performance in the first 2 wk after weaning; Xyl + LY–Xyl and control–Xyl groups had improved overall feed efficiency. In conclusion, LY and Xyl supplementation improved performance of weanling pigs in the first 2 wk after weaning with no effects on long-term growth performance.

The Physicochemical Characteristic of Activated Carbon Based on Sludge and Preparation Method

To understand the features and best preparation of sludge activated carbon (SAC), and the pore structure, component, adsorption characteristics, and the yield rate of SAC, many tests have been carried out. The study illustrated that the pore structure was mostly mesopore and amorphous pore such as the ink bottle hole. In terms of different preparations to obtain SAC, the yield of SAC in sample No.1 achieved 88.09%. Using the preparation of ZnCl2 as an activator, the iodine adsorption value was significantly higher than other preparations. However, the content of quartz in sample No.1 achieved a maximum of 52.51%. Charcoal was detected in all samples except sample nos 9-12. The adsorption capacity of Cu(II) and Cd(II) reached a maximum of 600.02 mg.kg-1 and 383.2 mg.kg-1. The results showed an optimum preparation condition, which was by using the ZnCl2 as an activator, 2:1 as the impregnated ratio, 40% concentration in activator and at 400ºC reaction temperature could create rich pore structure and charcoal inside.

Gamma-Ray Observation of the Cygnus Region in the 100-TeV Energy Region

We report observations of gamma-ray emissions with energies in the 100-TeV energy region from the Cygnus region in our Galaxy. Two sources are significantly detected in the directions of the Cygnus OB1 and OB2 associations. Based on their positional coincidences, we associate one with a pulsar PSR J2032+4127 and the other mainly with a pulsar wind nebula PWN G75.2+0.1, with the pulsar moving away from its original birthplace situated around the centroid of the observed gamma-ray emission. This work would stimulate further studies of particle acceleration mechanisms at these gamma-ray sources.

The Role of Four-Dimensional Automatic Right Ventricular Quantification Technology to Determine RV Function and Hemodynamics in Patients With Pulmonary Hypertension Compared With Right Heart Catheterization

Background: Four-dimensional automatic right ventricular quantification technology (4D auto-RVQ) is a new method that can simultaneously measure right ventricular (RV) structure and strain. The role of 4D auto-RVQ in determining RV function and hemodynamics is not clear. The role of 4D auto-RVQ in determining RV function and hemodynamics is not clear. We assessed the 4D auto-RVQ to measure right heart structure, function, and hemodynamics in patients with pulmonary hypertension (PHTN) correlated with right heart catheterization (RHC).

Methods: We enrolled a prospective cohort of 103 patients with PHTN and 25 healthy controls between September 2017 and December 2018. All patients with PHTN underwent echocardiography and RHC. Patients were included if they underwent two-dimensional (2D) and 4D auto-RVQ echocardiographic sequences on the same day as RHC. We analyzed RV functional indices using 2D and 4D auto-RVQ analyses. We divided patients with PHTN into three groups according to echocardiographic image quality as follows: high (n = 24), average (n = 48), and poor (n = 4). Hemodynamic parameters were measured using RHC, including mean right atrial pressure, mean pulmonary arterial pressure, RV cardiac index (RV-CI), and pulmonary vascular resistance.

Results: There were significant differences in most 2D and 4D auto-RVQ parameters between patients with PHTN and healthy controls. Interobserver variability showed significant agreement with 4D auto-RVQ for most measurements except for 4D end-diastolic volume. Indices measured by auto 4D-RVQ in the high-quality image group had a good correlation with RHC but not in the average- and poor-quality image group. Mid-RV diameter showed the best predictive power for the right RV-CI [area under the curve (AUC) 0.935; 95% confidence interval (CI), 0.714–0.997; p < 0.001]. RV end-systolic volume >121.50 mL had a 71.43% sensitivity and a 100% specificity to predict right RV-CI (AUC, 0.890; 95% CI, 0.654–0.986; p < 0.001).

Conclusions: 4D auto-RVQ may be used to estimate RV function and some hemodynamic changes compared with RHC in PHTN patients with high image quality. Furthermore, a large sample of the study is needed to evaluate RV function by 4D auto-RVQ in PHTN patients with average image quality.

High interstudy repeatability of automatic deep learnt biventricular CMR measurements

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Wellcome Trust (UK), NIHR (UK)

Introduction

Cardiac magnetic resonance (CMR) measurements have significant diagnostic and prognostic value. Accurate and repeatable measurements are essential to assess disease severity, evaluate therapy response and monitor disease progression. Deep learning approaches have shown promise for automatic left ventricular (LV) segmentation on CMR, however fully automatic right ventricular (RV) segmentation remains challenging. We aimed to develop a biventricular automatic contouring model and evaluate the interstudy repeatability of the model in a prospectively recruited cohort.

Methods

A deep learning CMR contouring model was developed in a retrospective multi-vendor (Siemens and General Electric), multi-pathology cohort of patients, predominantly with heart failure, pulmonary hypertension and lung diseases (n = 400, ASPIRE registry). Biventricular segmentations were made on all CMR studies across cardiac phases. To test the accuracy of the automatic segmentation, 30 ASPIRE CMRs were segmented independently by two CMR experts. Each segmentation was compared to the automatic contouring with agreement assessed using the Dice similarity coefficient (DSC). 

A prospective validation cohort of 46 subjects (10 healthy volunteers and 36 patients with pulmonary hypertension) were recruited to assess interstudy agreement of automatic and manual CMR assessments. Two CMR studies were performed during separate sessions on the same day. Interstudy repeatability was assessed using intraclass correlation coefficient (ICC) and Bland-Altman plots. 

Results

DSC showed high agreement (figure 1) comparing automatic and expert CMR readers, with minimal bias towards either CMR expert. The scan-scan repeatability CMR measurements were higher for all automatic RV measurements (ICC 0.89 to 0.98) compared to manual RV measurements (0.78 to 0.98). LV automatic and manual measurements were similarly repeatable (figure 2). Bland-Altman plots showed strong agreement with small mean differences between the scan-scan measurements (figure 2).

Conclusion

Fully automatic biventricular short-axis segmentations are comparable with expert manual segmentations, and have shown excellent interstudy repeatability.

Fully automated CMR derived stroke volume correlates with right heart catheter measurements in patients with suspected pulmonary hypertension

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Welcome Trust (UK), NIHR (UK)

Introduction

Cardiac magnetic resonance (CMR) assessment plays a significant role in the diagnosis, prognosis and monitoring of patients with pulmonary hypertension (PH). We developed a deep learning model to automatically generate biventricular contours and validated its result in a prospective cohort of patients with suspected PH who underwent right heart catheterization (RHC).

Methods

A deep learning CMR contouring model was developed in a retrospective multi-vendor (Siemens and General Electric), multi-pathology cohort of patients, predominantly with heart failure, lung disease and PH (n = 400, ASPIRE registry). Biventricular segmentations were made on all CMR studies across cardiac phases. A prospective validation cohort of 102 suspected PH patients was recruited and they had RHC within 24 hours  of the CMR. To test the accuracy of the automatic segmentation, the RHC-thermodilution and CMR-derived measures of stroke volume (SV) were compared for manual and automated measurements. 

Results

The mean and standard deviation for the derived SV was 59 ml ± 21 measured by RHC and 75 ml ± 25 for automated and 79 ml ± 26 for manual CMR measurements. Automatic and manual CMR measurement correlated strongly with RHC derived SV; 0.73, 95% CI [0.62, 0.81] and 0.78, 95% CI [0.69, 0.85], respectively (figure 1).  The agreement between automatic and manual SV was high; interclass correlation coefficient (ICC) = 0.88, 95% CI [0.83, 0.92] and Bland-Altman plots showed a narrow spread of mean differences between manual and automatic measurements (figure 2).

Conclusion

In a prospective cohort, fully automatic CMR assessments corresponded accurately to invasive hemodynamics performed within 24 hours of a CMR study.

Oxidized low-density lipoprotein stimulates dendritic cells maturation via LOX-1-mediated MAPK/NF-κB pathway

Dendritic cells (DCs) play a crucial role as central orchestrators of immune system response in atherosclerosis initiation and progression. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is involved in the immune maturation of DCs, but the underlying mechanisms remain unclear. We isolated mouse bone marrow progenitors and stimulated them with granulocyte-macrophage colony-stimulating factor and interleukin (IL)-4 to induce immature DCs. We then treated DCs with oxidized low-density lipoprotein (oxLDL) to induce maturation. LOX-1 siRNA was used to investigate the modulation of LOX-1 on the development of DCs and the underlying signal pathways. CD11c-positive DCs were successfully derived from mouse bone marrow progenitors. OxLDL promoted the expressions of DCs maturation markers and pro-inflammatory cytokines. OxLDL also upregulated LOX-1 expression and activated MAPK/NF-κB pathways. LOX-1 siRNA could attenuate the expression of MAPK/NF-κB pathways and inflammatory cytokines. In conclusion, oxLDL induced the maturation of DCs via LOX-1-mediated MAPK/NF-κB pathway, which contributed to the initiation and progression of atherosclerosis.