Selenium Vacancies and Synergistic Effect of Near- and Far-Field-Enabled Ultrasensitive Surface-Enhanced Raman-Scattering-Active Substrates for Malaria Detection

Defect engineering with the active control of defect states brings remarkable enhancement on surface-enhanced Raman scattering (SERS) by magnifying semiconductor-molecule interaction. Such light-trapping architectures can increase the light path length, which promotes photon-analytes interactions and further improves the SERS sensitivity. However, by far the reported semiconductor SERS-active substrates based on these strategies are often nonuniform and commonly in the form of isolated laminates or random clusters, which limit their reliability and stability for practical applications. Herein, we develop self-grown single-crystalline "V-shape" SnSe_2-x (SnSe_1.5, SnSe_1.75, SnSe₂) nanoflake arrays (SnSe_2-x NFAs) with controlled selenium vacancies over large-area (10 cm × 10 cm) for ultrahigh-sensitivity SERS. First-principles density functional theory (DFT) is used to calculate the band gap and the electronic density of states (DOS). Based on the Herzberg-Teller theory regarding the vibronic coupling, the results of theoretical calculation reveal that the downshift of band edge and high DOS of SnSe_1.75 can effectively enhance the vibronic coupling within the SnSe_1.75-R6G system, which in turn enhances the photoinduced charge transfer resonance and contributes to the SERS activity with a remarkable enhancement factor of 1.68 × 10⁷. Furthermore, we propose and demonstrate ultrasensitive (10^-15 M for R6G), uniform, and reliable SERS substrates by forming SnSe_1.75 NFAs/Au heterostructures via a facile Au evaporation process. We attribute the superior performance of our SnSe_1.75 NFAs/Au heterostructures to the following reasons: (1) selenium vacancies and (2) synergistic effect of the near and far fields. In addition, we successfully build a detection platform to achieve rapid (∼15 min for the whole process), antibody-free, in situ, and reliable early malaria detection (100% detection rate for 10 samples with 160 points) in whole blood, and molecular hemozoin (<100/mL) can be detected. Our approach not only provides an efficient technique to obtain large-area, uniform, and reliable SERS-active substrates but also offers a substantial impact on addressing practical issues in many application scenarios such as the detection of insect-borne infectious diseases.

[Efficacy and safety of venetoclax combined with azacitidine versus CAG regimen combined with decitabine in elderly patients with relapsed acute myeloid leukemia]

Objective: To compare the efficacy and safety of venetoclax (VEN) combined with azacitidine (AZA) versus CAG regimen combined with decitabine (DAC) in elderly patients with relapsed acute myeloid leukemia (AML). Methods: From January 2018 to August 2020, the clinical data of forty-five elderly patients with relapse AML at the First Affiliated Hospital of Soochow University were retrospectively analyzed, including 31 males and 14 females. The median age was 66 (60-80) years old. Eighteen patients were administrated with VEN and AZA, while the other 27 were in CAG with DAC. The complete remission (CR) rate, partial remission (PR) rate, total remission rate (ORR), adverse events and overall survival (OS) were compared between the two groups. Results: At the end of the treatment, the ORR in VEN with AZA group was 77.8% (14/18); including 11 CR and 3 PR. In CAG with DAC group, the ORR was 37.0% (10/27); including 8 CR and 2 PR (P=0.007). Subgroup analysis suggested that VEN with AZA had a higher ORR in patients stratified as intermediate and poor-risk (P=0.013) or with DNA methylation mutations (P=0.007). Main adverse events in both groups were bone marrow suppression, infections, nausea and vomiting, anorexia and fatigue. Grade Ⅲ-Ⅳ cytopenia developed in lower incidence of VEN with AZA group, such as leukopenia (66.7% vs. 100%, P=0.002), anemia (50.0% vs. 92.6%, P=0.002), thrombocytopenia (72.2% vs. 96.3%, P=0.031) and neutropenia (61.1% vs. 92.6%, P=0.014). In addition, less grade Ⅲ-Ⅳ infections occurred in VEN with AZA group (66.7% vs. 33.3%, P=0.028), as well as grade Ⅲ-Ⅳ gastrointestinal events (40.7% vs. 11.1%, P=0.032), grade Ⅲ-Ⅳ fatigue (55.6% vs.11.1%, P=0.003) compared with CAG with DAC group. The 1-year OS in VEN with AZA group versus CAG with DAC group was 42.9% and 31.6% respectively (P=0.150). Conclusion: VEN combined with AZA proves favorable efficacy and tolerablity in elderly patients with relapsed AML.

[Comparison of alignment and position of prosthesis between portable accelerometer-based navigation device and conventional instrumentation in total knee arthroplasty with valgus deformity]

Objective: To explore the differences of alignment and position of prosthesis between portable accelerometer-based navigation device (PAD) and conventional instrumentation (CI) in total knee arthroplasty (TKA) with valgus deformity. Methods: Patients with knee osteoarthritis and valgus deformity who underwent primary TKA in Peking University Third Hospital from January 2017 to December 2020 were enrolled in this retrospective study and were divided into PAD group and CI group according to the surgical instruments. Five male patients and 44 female patients were included with a mean age of (67.2±7.0) years. The differences in preoperative general data, preoperative and postoperative alignment between the two groups were studied. Results: A total of 49 patients (25 patients in the PAD group and 24 in the CI group) were enrolled in this study. There were no statistically significant differences in gender, age, height, weight, body mass index, surgical side, preoperative hip-knee-ankle (HKA) angle, preoperative HKA angle deviation, Keblish classification and Ranawat classification between the two groups (all P>0.05). There was no significant difference in the accuracy of postoperative HKA angle (2.0°±1.4° vs 3.0°±2.2°, P=0.082), coronal femoral component angle (CFCA) (1.5°±1.2° vs 2.1°±1.6°, P=0.144) and coronal tibial component angle (CTCA) (1.2°±0.8° vs 1.3°±1.0°, P=0.695) between the two groups; but the standard deviation of the above-mentioned three indices in PAD group were all smaller than those in CI group. The rate of outliers of postoperative HKA angle of the PAD group was smaller than that in the CI group (P<0.05), but there was no significant difference in the rate of outliers of CFCA and CTCA between the two groups (both P>0.05). Conclusion: TKA assisted by PAD can provide good alignment and prosthesis position in patients with valgus deformity, and it is superior to TKA with CI in terms of precision and rate of outliers of postoperative overall alignment of lower extremity.

[Effect of the acetabular cup positioning and leg length restoration after total hip arthroplasty using robotic-assisted surgery system]

Objective: To assess the improvement of the robotic-assisted total hip arthroplasty (rTHA) regarding the acetabular cup positioning and the leg length restoration. Methods: Clinical data of 246 patients undergoing primary unilateral THA from September 2019 to June 2021 in Peking University Third Hospital were retrospectively reviewed, including patients treated with rTHA (n=113) and conventional THA (cTHA) (n=133). Thirty-seven male patients along with 76 females were enrolled into the rTHA group with a mean age of (62±9) years. In comparison, the average age of cTHA group was (60±12) years with 59 males and 74 females. The postoperative inclination and anteversion of the acetabular cup and the rate of acetabular cup within the Lewinnek and Callanan "safe zone" were documented and analyzed. For the patient with normal or surgically restored contralateral hip, the leg length discrepancy was also measured and compared between the two groups. Results: The overall mean postoperative inclination and anteversion was 39.0°±5.5° and 14.1°±5.1°, respectively. No statistically significant difference was found between the rTHA and cTHA group regarding postoperative inclination (39.3°±2.9° vs 38.7°±7.0°, P=0.383) and anteversion (13.4°±4.3° vs 14.7°±5.6°, P=0.054). In rTHA group, 97.3%(110/113) of the cups were implanted within the Lewinnek"safe zone"(75.9%(101/133) in cTHA group) and 94.7%(107/113) were within the Callanan"safe zone"(66.2%(88/133) in cTHA group), and those were both higher in rTHA group (both P<0.01). There was no significant difference in postoperative leg length discrepancy between the two groups (P=0.445). Meanwhile, 29(23.0%) cases of cTHA group had leg length discrepancy more than 5 mm, and it was 9.7%(9/93) in rTHA group. Conclusion: It indicated the benefit of rTHA in acetabular cup positioning as well as the leg length restoration.

[Robotic assisted artificial hip and knee arthroplasty is an inevitable trend in the future]

Artificial joint arthroplasty, such as total hip and total knee arthroplasty, is one of the most successful procedures in orthopedics. The quality of life of these patients can be improved significantly through relieving pain, correcting the deformity and improving joint function. Although hip and knee arthroplasty currently are routine surgeries for patients with late stage joint diseases, post-operative complications like leg length discrepancy, dislocation or instability, limp and uncertain reason pain are still common. The position of the implants plays important roles in all these complications. Robotic assisted joint arthroplasty can not only provide 3D pre-operative visual planning, but also can assist to fulfill the pre-operation plan perfectly. But the current joint arthroplasty robots cannot carry out automatic personalized pre-operation planning, and also have the shortcomings of low efficiency and high cost etc. However, based on their current performance and with the help of artificial intelligence and better algorithm, we believe that joint arthroplasty will be more and more precisive, intelligent and minimally invasive, which is an inevitable trend in the development of joint surgery.

[Comparison of alignment between computer assisted surgery and personal specific instrumentation in total knee arthroplasty]

Objective: To explore the differences of alignment and operative time between computer assisted surgery (CAS) and personal specific instrumentation (PSI) in total knee arthroplasty (TKA). Methods: Patients with knee osteoarthritis who underwent unilateral primary TKA in Peking University Third Hospital from June 2019 to April 2021 were enrolled in this prospective study and were randomly divided into CAS group and PSI group with random number table. The differences in preoperative general data, operative time, preoperative and postoperative alignment between the two groups were studied. Results: A total of 80 patients were enrolled in this study, including 40 patients in the CAS group with an average age of (68±6) years (male/female, 6/34 cases) and 40 patients in the PSI group with an average age of (69±6) years (male/female, 5/35 cases). There was no significant differences in gender, age, height, weight, body mass index, surgical side, preoperative hip-knee-ankle (HKA) angle, and preoperative HKA angle deviation between the two groups (all P>0.05). The accuracy of sagittal femoral component angle (sFCA) (1.7°±1.2° vs 2.5°±1.4°, P<0.05) and sagittal tibial component angle (sTCA) (1.2°±0.9° vs 2.3°±1.8°, P<0.01) of the CAS group were both smaller than those in the PSI group, but there was no significant difference in the accuracy of postoperative HKA angle, mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibia angle (mMPTA) between the two groups (all P>0.05). The precision of postoperative HKA angle and sTCA of the CAS group were both smaller than those in the PSI group (2.0°±1.0° vs 2.6°±1.7°, 1.2°±0.9° vs 2.3°±1.8°, both P<0.01), but there was no significant differences in the precision of mLDFA, mMPTA and sFCA between the two groups (all P>0.05). The rate of outliers of postoperative HKA angle (10.0% vs 27.5%, P<0.05), sFCA(5.0% vs 20.0%, P<0.05) and sTCA (2.5% vs 22.5%, P<0.01) of the CAS group were all smaller than those in the PSI group, but there was no significant difference in the rate of outliers of mLDFA and mMPTA between the two groups (both P>0.05). CAS group had significantly longer surgical time than the PSI group ((81±12) min vs (52±8) min, P<0.01). Conclusions: CAS is better than PSI in overall coronal alignment and sagittal position of the prosthesis after TKA. However, CAS requires a longer operation time.

Negative associations of morning serum cortisol levels with obesity: the Henan rural cohort study

AIMS

To evaluate the associations of morning serum cortisol levels with obesity defined by different indices in Chinese rural populations.

MATERIALS AND METHODS

A cross-sectional study was performed including 6198 participants (2566 males and 3632 females). Serum cortisol was collected in morning and quantified by liquid chromatography-tandem mass spectrometry. Obesity was defined by body mass index (BMI), body fat percentage (BFP), waist-to-height ratio (WHtR), waist circumference (WC), visceral fat index (VFI) and waist-to-hip ratio (WHR). Both multivariable liner regression, logistic regression and restrictive cubic splines models were used to estimate the gender-specific relationships between cortisol levels and obesity defined by different indices, respectively.

RESULTS

After adjusting for potential confounders, serum cortisol was negatively associated with different obesity measures, except obese females defined by BFP (for instance, overall obesity defined by BMI, Quartile 4 vs. Quartile 1, odds ratio (OR) = 0.25, 95% confidence interval (CI):0.15, 0.41 in males, and OR = 0.58, 95% CI: 0.42,0.80 in females, central obesity defined by WC, OR = 0.52, 95% CI:0.39,0.69 in males and OR = 0.63, 95% CI:0.51,0.77 in females). Similarly, restrictive cubic splines showed the nonlinear relationship between high levels of cortisol and different obesity indices. Furthermore, ROC curve analysis indicated that cortisol could improve the discrimination of model with common biomarkers.

CONCLUSION

Morning serum cortisol were negatively related to obesity defined by different indices in Chinese rural populations. In addition, cortisol could be as a biomarker for prediction of obesity in males.

Real-world effectiveness and rheumatologist satisfaction with secukinumab in the treatment of patients with axial spondyloarthritis

OBJECTIVES

To assess the effectiveness of secukinumab in patients with axSpA treated in routine clinical settings in 5 European countries.

METHODS

Retrospective analysis of a cross-sectional survey to assess real-world effectiveness of secukinumab in the management of axSpA and rheumatologist satisfaction with treatment in France, Germany, Italy, Spain and the UK from March to December 2018. Outcomes collected included patient demographics, clinical characteristics and rheumatologist- and patient-reported satisfaction with secukinumab treatment.

RESULTS

Five hundred thirty-five patients receiving secukinumab for more than 4 months were assessed, 359 of whom were diagnosed with AS and 178 with nr-axSpA. Rheumatologist assessment of disease status at treatment initiation indicated that 39 (7.3%) had stable/improving disease. Secukinumab treatment for 4 months or longer resulted in 515 (95.9%) patients judged as stable/improving. Treatment was associated with benefits from initiation to assessment in terms of BASDAI (6.2 vs 2.8), 44-joint count score (9.7 vs 6.6), rheumatologist global VAS score (56.9 vs 23.0) and patient global VAS scores (64.4 vs 25.5). These benefits for key clinical outcomes were sustained for periods of 12 months or longer. Patient-reported outcomes on health status using EQ-5D, global functioning using the ASAS health index and overall work impairment via WPAI were sustained over the treatment period, while patient and rheumatologist satisfaction with secukinumab treatment remained very high at 80.2 and 91.2%, respectively.

CONCLUSION

Consistent benefits across multiple clinical and patient-reported outcomes were seen with secukinumab treatment in patients with AS and nr-axSpA treated in routine clinical settings across five European countries. Key Points • In routine clinical settings across five European countries, secukinumab treatment resulted in improvements in a wide range of clinical outcomes including physician-reported disease severity, disease status, pain, BASDAI, 44-joint count score and global VAS scores. • Key clinical and patient reported outcomes were sustained for a 12-month period or longer with secukinumab treatment. • Rheumatologist- and patient-reported treatment satisfaction was high with secukinumab.

[SHOX2 promotes migration, invasion and stemness of bladder cancer cells in vitro]

OBJECTIVE

To explore the role of human short stature homeobox 2 (SHOX2) in regulating the migration, invasion and stemness of human bladder cancer cells.

METHODS

We analyzed SHOX2 gene expression in bladder cancer and adjacent tissues based on TCGA database. Univariate survival analysis of SHOX2 gene expression in TCGA-BLCA data was performed using GEPIA. The probable function of SHOX2 was predicted using GSEA. Human bladder cancer T24 cell models of SHOX2 knockdown or overexpression were assessed for changes in migration and invasion abilities using wound healing assay and Transwell assay, and their cancer stem cell-like characteristics were evaluated using tumorsphere formation assay and colony formation assay. Western blotting was used to detect the expressions of epithelial mesenchymal transition (EMT) markers Ecadherin and vimentin and the TGF-β signaling network component TβR-I in the cells.

RESULTS

SHOX2 expression was significantly higher in bladder cancer tissues than in the adjacent tissues (P < 0.05), especially in paired tissue specimens (P < 0.01), and was negatively correlated with the overall survival of the patients (P < 0.05). SHOX2 gene expression was correlated positively with EMT-related (P < 0.05) and stemness-related gene signatures (P < 0.01). In T24 cells, SHOX2 knockdown significantly suppressed cell migration and invasion, which was significantly enhanced by SHOX2 overexpression (P < 0.01). The cancer stem cell-like characteristics of T24 cells was repressed by SHOX2 knockdown but significantly enhanced by SHOX2 overexpression (P < 0.01). SHOX2 knockdown induced morphological changes of the cells into epithelioid cells, whereas SHOX2 overexpression induced a mesenchymal morphology of the cells. SHOX2 knockdown increased E-cadherin expression and decreased vimentin and TβR-I expression, while SHOX2 overexpression increased the expressions of vimentin and TβR-I in the cells.

CONCLUSION

SHOX2 promotes the migration, invasion and stemness of human bladder cancer cells possibly by regulating EMT via the TGF-β signaling pathway.

Research on sleeve gastrectomy for the treatment of rats with type 2 diabetes mellitus and the regulation of ghrelin and intestinal lesions

OBJECTIVE

To explore the effect of sleeve gastrectomy on type 2 diabetes mellitus (T2DM) in regulating ghrelin and intestinal lesions.

MATERIALS AND METHODS

Specific pathogen free (SPF) Wistar rats were injected with streptozotocin (STZ) after giving a high-sugar and high-fat diet, to establish a T2DM rat model. The rats were randomly divided into a sleeve gastric excision group, a non-surgical group and a fake surgical group, with 10 rats in each group. The weight, blood glucose, glucose tolerance and ghrelin hormone of rats were compared. The feces of rats in each group at the 8th week after surgery were collected, to extract the total bacterial deoxyribonucleic acid (DNA). The bacterial 16S universal primer was used to expand the 16SrRNA V46 conserved region. The total Polymerase Chain Reaction (PCR) products were sequenced by PE101-bp to classify the gene and genera.

RESULTS

The weight of the rats after sleeve gastrectomy significantly decreased (p <0.05). The area under the blood glucose curve and the area under the insulin curve were significantly smaller than those in the non-surgical group and the fake surgical group (p <0.05). Compared with the sleeve gastric excision group, the abundance of Phylum Firmicutes was higher, that of Bacteroidetes was lower. Compared with the sleeve gastric excision group, there were more genera in the fake surgical group and the non-surgical group. The genera with higher abundance in the three groups were Lactobacillus and Bacteroidetes. Compared with the sleeve gastric excision group, the fake surgical group and the non-surgical group had higher abundance of Phylum Firmicutes (p <0.05) and lower abundance of Bacteroidetes (p <0.05).

CONCLUSIONS

To sum up, sleeve gastrectomy can reduce the weight of rats in T2DM rat model, lower blood glucose levels of rats in the model and improve insulin resistance levels. The related mechanism may be related to the upregulation of ghrelin and intestinal flora.

Evolution of AITR family genes in cotton and their functions in abiotic stress tolerance

Abiotic stresses are major environmental factors inhibiting plant growth and development. AITRs (ABA-induced transcription repressors) are a novel family of transcription factors regulating ABA (abscisic acid) signalling and plant responses to abiotic stresses in Arabidopsis. However, the composition and evolution history of AITRs and their roles in the cotton genus are largely unknown. A total of 12 putative AITRs genes were identified in cultivated tetraploid cotton, Gossypium hirsutum. Phylogenetic analysis of GhAITRs in these tetraploid cottons and their closely related species implicate ancient genome-wide duplication occurring after speciation of Gossypium, and Theobroma could generate duplicates of GhAITRs. Duplicated GhAITRs were stably inherited following diploid speciation and further allotetraploidy in Gossypium. Homologous GhAITRs shared common expression patterns in response to ABA, drought and salinity treatments, and drought tolerance induced in transgenic Arabidopsis plants expressing GhAITR-A1. Together, our findings reveal that duplicates in the GhAITRs gene family were achieved by whole genome duplication rather than three individual duplication events, and that GhAITRs function as transcription repressors and are involved in the regulation of plant responses to ABA and drought stress. These results provide insights towards the improvement of abiotic stress tolerance in cotton using GhAITRs.

Long Noncoding RNA Maternally Expressed Gene 3 Targets miR-30b and Regulates the AKT Serine/Threonine Kinase 1/Phosphoinositide 3-Kinase Signaling Pathway of H2O2-Induced Proliferation, Apoptosis, and Oxidative Stress in Retinal Ganglion Cells

Oxidative stress is an important factor affecting retinal ganglion cell (RGC) apoptosis. RGC apoptosis is the main pathophysiological feature of visual impairment as a result of glaucoma. Recently, it has been found that long noncoding RNA (lncRNA) and microRNAs are involved in RGC apoptosis. Here, the function of lncRNA maternally expressed gene 3 (MEG3) and miR-30b in H2 O2-induced RGC proliferation, apoptosis, and oxidative stress was investigated. The expression levels of MEG3 and miR-30b were detected by RT-PCR; the effects of MEG3 and miR-30b on the proliferation and apoptosis of RGCs were observed by flow cytometry; the levels of apoptosis-related proteins and AKT/PI3K signal pathway proteins were detected by protein immunoassay; and the regulation of miR-34a by pvt1 was verified by in vivo and in vitro experiments. The expression of MEG3 and miR-30b increased and decreased significantly in RGCs treated by H2O2. MEG3 expression decreased, apoptosis level-related proteins decreased, the apoptosis rate reduced, and the activity of MDA and SOD decreased. When the expression of miR-34a was inhibited, the proliferation rate of RGCs increased, the apoptosis rate decreased, and the level of apoptosis-related proteins decreased, which reversed MEG3’s effect on RGC apoptosis and proliferation. Furthermore, pvt1 could bind the miR-30b promoter and regulate it with in vitro expression and in vivo expression. Besides, we found that miR-30b can regulate the AKT/PI3K signaling pathway and participate in cell apoptosis and hyperplasia in stress response. LncRNA MEG3 targets miR-30b and regulates the AKT/PI3K signaling pathway on H2 O2-induced cell apoptosis, hyperplasia, and oxidative stress of RGCs.

Imaging Simulation of Charged Nanowires in TEM with Large Defocus Distance

In transmission electron microscope (TEM), both the amplitude and phase of electron beam change when electrons traverse a specimen. The amplitude is easily obtained by the square root of the intensity of a TEM image, while the phase affects defocused images. In order to obtain the phase map and verify the theoretical model of the interaction between electron beam and specimen, a lot of simulations have been performed by researchers. In this work, we have simulated defocus images of a SiC nanowire in TEM with the method of electron optics. Mean inner potential and charge distribution on the nanowire have been considered in the simulation. Besides, due to electron scattering coherence loss of the electron beam has been introduced. A dynamic process with Bayesian optimization was used in the simulation. With the infocus image as input and by adjusting fitting parameters the defocus image is determined with a reasonable charge distribution. The calculated defocus images are in a good agreement with the experimental ones. Here, we present a complete solution and verification method for solving nanoscale charge distribution in TEM.

[Clinical analysis of liver chemistries in children and adolescent with 2019-nCoV infection]

Objective: To describe the clinical features of liver involvement in children and adolescent with 2019-nCoV infection. Methods: The clinical data of 77 hospitalized cases admitted to the Children's Hospital of Fudan University were collected from January 19 to November 28, 2020. The characteristics and risk factors of abnormal liver chemistries in children with laboratory-confirmed 2019-nCoV infection were analyzed. Results: Of the 77 cases, 44 were male (57.1%) and 33 were female (42.9%), with a median age of 10 years. 27(35.1%) were asymptomatic, 28(36.4%) had mild illness, 22(28.6%)had non-severe pneumonia. Hydroxychloroquine was used in 7 cases. Of the 75 children without underlying diseases, alanine aminotransferase was elevated in 1 case (1.5%, during hydroxychloroquine therapy), aspartate aminotransferase was elevated in 7 cases (10.3%), alkaline phosphatase was elevated in 7 cases (28%), and total bilirubin, direct bilirubin, albumin, international normalized ratio were in normal range. There was no statistical difference between the pneumonia group and the non-pneumonia group in term of liver chemistries (P > 0.05), same as between the elevated erythrocyte sedimentation rate group and the normal group. There was no aggravation of liver injury in the child with biliary atresia. The child with epilepsy showed no abnormal liver chemistries after infection. Conclusion: Children with 2019-nCoV infection had mild clinical symptoms with few cases of liver injury. The abnormal liver chemistries in children with COVID-19 infection may be related to the underlying disease and the use of antiviral drugs.

Nanotechnology for catalysis and solar energy conversion

This roadmap on Nanotechnology for Catalysis and Solar Energy Conversion focuses on the application of nanotechnology in addressing the current challenges of energy conversion: 'high efficiency, stability, safety, and the potential for low-cost/scalable manufacturing' to quote from the contributed article by Nathan Lewis. This roadmap focuses on solar-to-fuel conversion, solar water splitting, solar photovoltaics and bio-catalysis. It includes dye-sensitized solar cells (DSSCs), perovskite solar cells, and organic photovoltaics. Smart engineering of colloidal quantum materials and nanostructured electrodes will improve solar-to-fuel conversion efficiency, as described in the articles by Waiskopf and Banin and Meyer. Semiconductor nanoparticles will also improve solar energy conversion efficiency, as discussed by Boschloo et al in their article on DSSCs. Perovskite solar cells have advanced rapidly in recent years, including new ideas on 2D and 3D hybrid halide perovskites, as described by Spanopoulos et al 'Next generation' solar cells using multiple exciton generation (MEG) from hot carriers, described in the article by Nozik and Beard, could lead to remarkable improvement in photovoltaic efficiency by using quantization effects in semiconductor nanostructures (quantum dots, wires or wells). These challenges will not be met without simultaneous improvement in nanoscale characterization methods. Terahertz spectroscopy, discussed in the article by Milot et al is one example of a method that is overcoming the difficulties associated with nanoscale materials characterization by avoiding electrical contacts to nanoparticles, allowing characterization during device operation, and enabling characterization of a single nanoparticle. Besides experimental advances, computational science is also meeting the challenges of nanomaterials synthesis. The article by Kohlstedt and Schatz discusses the computational frameworks being used to predict structure-property relationships in materials and devices, including machine learning methods, with an emphasis on organic photovoltaics. The contribution by Megarity and Armstrong presents the 'electrochemical leaf' for improvements in electrochemistry and beyond. In addition, biohybrid approaches can take advantage of efficient and specific enzyme catalysts. These articles present the nanoscience and technology at the forefront of renewable energy development that will have significant benefits to society.

NORAD regulates proliferation and apoptosis in cardiomyocytes under high-glucose treatment through miRNA-150-5p/ZEB1 axis

OBJECTIVE

The purpose of this study was to uncover the potential role of non-coding RNA activated by DNA damage (lncRNA NORAD) in the disease progression of diabetic cardiomyopathy (DCM) and the underlying mechanism.

MATERIALS AND METHODS

Cell viability, 5-Ethynyl-2'-deoxyuridine (EdU)-positive ratio and apoptotic rate in human cardiomyocyte cell line AC16 undergoing treatment of normal-level (NG) or high-level glucose (HG) were assessed at first. NORAD level in HG-induced AC16 cells at different time points was detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Subsequently, cell viability, EdU-positive ratio, and apoptotic rate in HG-induced AC16 cells overexpressing NORAD were evaluated. Next, subcellular distribution of NORAD was examined, and Dual-Luciferase reporter gene assay was performed to clarify the interaction among NORAD, miRNA-150-5p, and ZEB1. At last, rescue experiments were conducted to clarify the role of NORAD/miRNA-150-5p/ZEB1 axis in influencing the proliferation and apoptosis in HG-induced AC16 cells.

RESULTS

Results revealed that HG treatment suppressed the proliferative ability and stimulated apoptosis in AC16 cells. Besides, NORAD was time-dependently downregulated in HG-induced AC16 cells, and it was mainly distributed in cytoplasm. In addition, the overexpression of NORAD enhanced proliferative ability, attenuated apoptosis, and increased Bcl-2/Bax ratio in HG-induced AC16 cells. Finally, NORAD/miRNA-150-5p/ZEB1 axis was verified to protect the malignant progression of DCM.

CONCLUSIONS

NORAD is upregulated under high-level glucose treatment. Overexpression of NORAD protects DCM development via miRNA-150-5p/ZEB1 axis.

[Blood loss in total knee arthroplasty using computer-assisted navigation or 3D-printed patient-specific instruments]

Objective: To compare the perioperative blood loss in patients undergoing a total knee arthroplasty (TKA) across three different techniques: computer-assisted navigation surgery (CAS), patient specific instrumentation (PSI) and conventional instrumentation (CI). Methods: Ninety consecutive patients with severe knee osteoarthritis who underwent unilateral primary TKA in Peking University Third Hospital Orthopedics Department from January 2018 to December 2018 were enrolled in this prospective study. The patients were randomly divided into three groups (30 case in each group): CAS-TKA group, PSI-TKA group and CI-TKA group. The study measured intraoperative blood loss, total blood loss, hidden blood loss, decreases of hemoglobin and hematocrit, and the post-TKA blood transfusions in the three groups. One-way ANOVA was used to detect the differences among the cohorts, and LSD was used for the post-hoc test. Results: The overall intraoperative blood loss of all patients was 6 ml (5~8 ml). The mean total blood loss and hidden blood loss in CAS-TKA group, PSI-TKA group and CI-TKA group was (1 147.0±301.8) and (1 140.1±301.9)ml, (1 044.3±454.1) and (1 038.5±454.0)ml, (1 154.0±483.6) and (1 145.3±482.7)ml, respectively; there was no significant differences among the three groups (F=0.639, 0.616, both P>0.05). There were no patients who received allogeneic blood transfusion. There were no significant differences in decrease of hemoglobin and hematocrit among the three groups neither (both P>0.05). Conclusions: Compared with conventional TKA, CAS and PSI does not increase the total blood loss of TKA. However, they both demonstrate a potential benefit in reducing blood loss of TKA.

[Application of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy]

Objective: To investigate the effects of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy. Methods: From December 2019 to April 2020, 60 patients receiving single-port video-assisted pulmonary lobectomy at Ningbo Medical Center Lihuili Hospital were selected. The patients were randomly and equally divided into control group and paravertebral block group using a random number table. Patients of paravertebral block group were injected into the thoracic 4-5 intercostal, paravertebral 1 cm using 0.375% ropivacaine (20 ml) with thoracoscopy-guided at the end of surgery, while patients of control group were given patient controlled intravenous analgesia (PCIA). Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of postoperative adverse reactions, additional dose and times of pethidine, the time to resume eating, the rate of postoperative active cough, the first time to get out of bed after surgery and postoperative hospital stay of two groups' patients were recorded. t test and chisquare test were used for statistical analysis. Results: The VAS score of paravertebral block group were lower than those of control group at all time points (all P<0.05). The Ramsay sedation scale of paravertebral block group were higher than those of control group at all time points (all P<0.05). The additional dose and times of pethidine of paravertebral block group were (8.2±2.3) mg and (0.2±0.1) time, which were lower than (87.8±15.3) mg and (1.8±0.3) time of control group, the differences were statistically significant (t=28.91, 34.37, all P<0.05). Incidence of nausea, vomiting and pruritus of paravertebral block group were 10.0%, 6.7% and 0, which were lower than 40.0%, 30.0% and 13.3% of control group, the differences were statistically significant (χ(2)=7.20, 5.45, 4.29, all P<0.05). The rate of postoperative active cough of paravertebral block group was 33.3%, which was higher than 10.0% of control group, the difference was statistically significant (χ(2)=4.81, P<0.05). The time to resume eating, the first time to get out of bed after surgery and postoperative hospital stay were (6.5±0.4) h, (20.9±3.1) h and (4.6±1.0) d, which were lower than (8.5±0.7) h, (28.6±4.8) h and (6.1±1.3) d of control group, the differences were statistically significant (t=13.47, 7.39, 4.19, all P<0.05). Conclusion: Thoracic paravertebral block under thoracoscopy-guided can effectively reduce the postoperative pain of single-port thoracoscopic lobectomy, with fewer adverse reactions, and is beneficial to postoperative recovery.

Impacts of extreme summers on European ecosystems: a comparative analysis of 2003, 2010 and 2018

In Europe, three widespread extreme summer drought and heat (DH) events have occurred in 2003, 2010 and 2018. These events were comparable in magnitude but varied in their geographical distribution and biomes affected. In this study, we perform a comparative analysis of the impact of the DH events on ecosystem CO₂ fluxes over Europe based on an ensemble of 11 dynamic global vegetation models (DGVMs), and the observation-based FLUXCOM product. We find that all DH events were associated with decreases in net ecosystem productivity (NEP), but the gross summer flux anomalies differ between DGVMs and FLUXCOM. At the annual scale, FLUXCOM and DGVMs indicate close to neutral or above-average land CO₂ uptake in DH2003 and DH2018, due to increased productivity in spring and reduced respiration in autumn and winter compensating for less photosynthetic uptake in summer. Most DGVMs estimate lower gross primary production (GPP) sensitivity to soil moisture during extreme summers than FLUXCOM. Finally, we show that the different impacts of the DH events at continental-scale GPP are in part related to differences in vegetation composition of the regions affected and to regional compensating or offsetting effects from climate anomalies beyond the DH centres. This article is part of the theme issue 'Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale'.

The Ca2+ -regulated protein kinase CIPK1 integrates plant responses to phosphate deficiency in Arabidopsis thaliana

Phosphate (Pi) deficiency severely restricts plant growth and development, as Pi is an essential macronutrient. Calcium (Ca²⁺ ) is a ubiquitous second messenger in plants; calcineurin B-like proteins (CBL) and CBL-interacting protein kinases (CIPK) are signalling pathways that act as an important Ca²⁺ signalling network which integrates plants to fine tune the response to stress; however, whether CIPK are involved in Pi deficiency stress remains largely unknown. In this study, we carried out a reverse genetic strategy to screen T-DNA insertion mutants of CIPK isoforms under Pi deficiency in Arabidopsis thaliana. Then Pi content, transcription of phosphate starvation-induced (PSI) genes, acid phosphatase activity and hydrogen peroxide were determined in the wild-type (WT) and cipk1 mutant, respectively. The phenotype of CIPK1 complementation lines was analysed. The cipk1 mutant had a more sensitive phenotype, with lower root elongation and root length, and decreased Pi content compared with the WT under Pi deficiency. Moreover, CIPK1 mutation caused phosphate starvation-induced (PSI) genes to be significantly induced under Pi deficiency. Histological staining demonstrated that the cipk1 mutant had increased acid phosphatase activity and hydrogen peroxide concentration under Pi deficiency. By using the yeast two-hybrid system, we further demonstrated the interaction between CIPK1 and the WRKY transcription factors, WRKY6 and WRKY42. Overall, we demonstrate that CIPK1 is involved in the Pi deficiency signalling pathway in A. thaliana, revealing the important role of Ca²⁺ in the Pi nutrition signalling pathway, and potentially providing a theoretical foundation for molecular breeding of crops with better Pi utilization efficiency.

A comparative meta-analysis of the efficacy of statin-ezetimibe co-therapy versus statin monotherapy in reducing cardiovascular and cerebrovascular adverse events in patients with type 2 diabetes mellitus

OBJECTIVE

This study evaluates the efficacy of statin-ezetimibe co-therapy compared to statin monotherapy in reducing cardiovascular and/or cerebrovascular disease (CVD) prevalence in diabetes and non-diabetes patients.

PATIENTS AND METHODS

Literature search was conducted in electronic databases and study selection was based on pre-determined eligibility criteria. Random-effects metanalyses were performed to examine the risk of CVD incidence between statin-ezetimibe co-therapy and statin monotherapy and subgroups were performed to examine the significance of differences between diabetic and non-diabetic individuals. A pooled analysis of hazard ratios of statin-ezetimibe combination versus statin monotherapy in the prevalence of CVD reported by the individual studies was also performed.

RESULTS

8 studies (136893 individuals; 80790 diabetics, 85555 non-diabetics; age 63.5 years [95% confidence interval (CI) 61.2, 65.8]; 61.5% [95% CI 55.2, 67.8] males) were included. Follow-up duration was 45 months [95% CI 27.5, 62.5]. Risk of CVD prevalence was significantly less with ezetimibe-statin than with statin alone in both diabetes (RR 0.69 [95% CI 0.67, 0.73]; p<0.00001) and in non-diabetes (RR 0.68 [95% CI 0.52, 0.90]; p=0.006) subjects (subgroup difference: chi2=0.00; p=0.97). Risk of prevalence of stroke was significantly less with ezetimibe-statin than with statin monotherapy in diabetes (RR 0.74 [95% CI 0.56, 0.98]; p=0.03) but non-significantly less in non-diabetes patients (RR 0.74 [95% CI 0.39, 1.41]; p=0.39) and this sub-group difference was also not statistically significant (chi2=0.00; p=0.99).

CONCLUSIONS

Statin-ezetimibe co-therapy is found more efficacious than statin monotherapy in reducing the incidence of CVD with no significant difference between diabetic and non-diabetic individuals.

AB0755 REAL WORLD EFFECTIVENESS OF SECUKINUMAB IN PSORIATIC ARTHRITIS: FINDINGS FROM A RECENT CROSS SECTIONAL SURVEY OF RHEUMATOLOGISTS AND PATIENTS IN EUROPE

Background:

Secukinumab has demonstrated significant and sustained reduction of disease activity and improvement in physical functioning and quality of life in PsA pts in RCTs.1

Objectives:

This study assessed effectiveness of secukinumab in PsA in a real-world setting.

Methods:

This was a cross-sectional survey of rheumatologists, dermatologists and pts in France, Germany, Italy, Spain, and UK. Data were collected online from June-Dec 2018 via physician-completed patient record forms. Pts receiving any treatment for PsA were included in survey (n=1675). Pts receiving secukinumab >4 months were included in this analysis. Pts reported quality of life, work, and disability measures at their current consultation. Physicians reported patient demographic and disease characteristics, concomitant and previous treatments, and time since diagnosis. Physicians also reported overall, skin and joint disease severity, pain (1-10 scale), BSA psoriasis involvement, global VAS score, PASI score, SJC, and TJC for 2 time points: initiation of treatment and at the time of data collection (current consultation). Data were analysed descriptively. The data analysed here is representative of pts that are currently receiving secukinumab and does not assess pts that have discontinued treatment.

Results:

572 PsA pts were receiving secukinumab >4 months at their current consultation. Patient mean age was 47.9 yrs, with 43% female, 59% working full time, and a mean BMI of 26.6. On average, pts were diagnosed with PsA 5.6 years before the current consultation, had received secukinumab for 11.0 months, and for 59% of pts secukinumab was their 1st advanced therapy (bDMARDs or tsDMARDs), 24% their 2nd and 16% their 3rd or more. 25% of pts were also receiving a csDMARD concurrently. Pts reported a mean EQ5D utility score of 0.83, mean WPAI overall work impairment of 24.3%, mean HAQ-DI score as 0.6, and mean PsAID12 score as 2.6 at current consultation. Proportion of pts with moderate and severe overall disease severity, and skin and joint severity decreased at current consultation vs at the initiation treatment (Table 1). Between initiation of treatment and current consultation, pts achieved a significant reduction in disease activity scores, pain score, global VAS scores, BSA, PASI score as well as a greater proportion of pts achieving a BSA < 3%, a PASI score < 3 (Table 2).

Conclusion:

This multinational study demonstrated secukinumab effectiveness in routine care in PsA pts, with significant improvements across all outcomes.

References:

[1]Mease et al. RMD Open. 2018; 4(2): e000723

Table 1.

Disease severity at initiation of secukinumab and at current consultation

At initiation of secukinumab (n=572)At current consultation (n=572)Overall disease severity, n (%)Mild32 (5.6)432 (75.5)Moderate316 (55.2)131 (22.9)Severe218 (38.1)9 (1.6)Don’t know6 (1.0)-Skin severity, n (%)Mild93 (16.3)478 (83.6)Moderate287 (51.2)82 (14.3)Severe154 (26.9)12 (2.1)Don’t know38 (6.6-Joint severity, n (%)Mild50 (8.7)444 (77.6)Moderate329 (57.5)118 (20.6)Severe181 (31.6)10 (1.7)Don’t know12 (2.1)-Table 2.

Physician reported outcomes at initiation of secukinumab and at current consultation, mean (SD)

At initiation of secukinumab (n=572)At current consultation (n=572)BSAa19.2 (15.3)4.6 (8.7)BSA < 3%, n (%)28 (8.2)213 (62.5)PASI score (0-72)a17.2 (11.5)4.2 (8)PASI score < 3, n (%)11 (7.1)99 (64.3)DAS28 scorea5.2 (1.5)*2.8 (1.3)TJC (0-68)a12.1 (9.9)2.5 (3.6)SJC (0-66)a10.0 (9.5)2.9 (7.5)Pain score (1-10)6.3 (2.0)2.6 (1.6)Physician global VAS score (1-100)a59.4 (24.2)23.3 (22.2)Patient global VAS score (1-100)a56.7 (30.4)23.4 (18.3)

1.aCalculated on available data.

Disclosure of Interests:

Philip G Conaghan Consultant of: AbbVie, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, GSK, Novartis, Pfizer, Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer, Elizabeth Holdsworth Employee of: Adelphi Real World, Haijun Tian Shareholder of: Novartis Pharmaceutical Corporation, Employee of: Novartis Pharmaceutical Corporation, Nicola Booth Consultant of: Janssen, Papa Anthony: None declared, Niraj Modi Employee of: Novartis Healthcare Pvt Ltd, Dorothy Keininger Shareholder of: Novartis Pharma AG, Employee of: Novartis Pharma AG, Uta Kiltz Grant/research support from: AbbVie, Amgen, Biogen, Novartis, Pfizer, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer, Roche, UCB

AB1289-HPR PERCEPTION OF THE VALUE OF DRUGS ON DIFFERENT MANIFESTATIONS OF PSORIATIC ARTHRITIS BASED ON A MULTI-STAGE EXPERT OPINION SURVEY

Background:

Patients with psoriatic arthritis (PsA) present with heterogeneous clinical phenotypes, which includes different clinical manifestations such as peripheral arthritis, axial disease, dactylitis, enthesitis, and skin and nail psoriasis. Many drugs for treatment of PsA are available for individualised treatment strategies but robust evidence is available for peripheral arthritis only as primary endpoint of RCTs.

Objectives:

To evaluate perception of German physicians on the value of current PsA treatments on different clinical PsA manifestations.

Methods:

In a face-to-face meeting, 8 German physicians (dermatology, rheumatology), specialised in PsA research/patient care, proposed initial scores for the effect size of current PsA drugs on different PsA manifestations based on knowledge of study data and personal experience in use of the drugs. The ability to achieve a consensus of the proposed efficacy scores was explored by applying an online survey among a cohort of PsA experienced physicians. Finally, a second online survey evaluated how a larger group of physicians personally estimate the drug effect sizes on different PsA manifestations.

Results:

Table 1 summarises the efficacy scores proposed by the initial expert group. In the first online survey 25 treating physicians were invited to participate, 14 (56%) of whom completed the survey. An agreement rate of over 65% of the participants was archived for 49 (68%) of the 72 proposed efficacy scores (Table 1). The consensus was especially high for the group of biological disease-modifying antirheumatic drugs (bDMARDs), except for etanercept and abatacept. However, the second survey (16 (39%) participants out of 41 invited physicians) revealed that the experience with the treatment using abatacept was low (4 / 16 (25%)) or non-existing (3 /16 (18.8%)) and several manifestations could not be estimated (Figure 1). Distribution of answers were broad for etanercept in general and for particular drug-manifestation combinations (e.g. effect of ustekinumab on axial disease).

Table 1.

Efficacy scores proposed by a PsA expert group and consensus achieved by an online survey among PsA treating physicians Efficacy scores for different drugs and manifestations range from 0 (no effect) to 5 (maximal effect). Green fields indicate, that at least 65% of the survey participants agreed on the proposed efficacy score.

Peripheral arthritisAxial diseaseEnthesitisDactylitisSkin diseaseNail diseaseMethotrexat2.50012.51.5Sulfasalazin100000Leflunomid2.500111Apremilast3132.533Etanercept4443.533.5Infliximab444444Adalimumab444444.5Golimumab444433Certolizumab pegol444444Ustekinumab3.52.54.534.54Secukinumab444454.5Abatacept3.50001.50Figure 1.

Results from an online survey among physicians querying their perception of efficacies of PsA drugs on different manifestations. Therapeutic effectiveness is estimated by the participants on a scale from 0 (no effect) to 5 (maximal effectiveness); NA = no answer. The size of the dots relates to the number of answers given. Red stars indicate the scores proposed by the initial expert group.

Conclusion:

Many treatments are available to be used in PsA. The usage of treatment classes seems to depend on experience level and mode of action. Higher agreement on efficacy in specific diseases manifestation was achieved in the class of biologics whereas the opinion on efficacy of csDMARDs in general is divergent. Strategies are needed to guide physicians with lower level of experience in the use of specific drugs to achieve an optimised patient care level using personalized treatment strategies.

Disclosure of Interests:

Timm Oberwahrenbrock Grant/research support from: BMS, Hannah Tian: None declared, Diamant Thaçi Grant/research support from: Janssen Research & Development, LLC, Klaus Krueger Consultant of: Celgene, Jürgen Wollenhaupt Consultant of: Celgene, Michaela Köhm Grant/research support from: Pfizer, Janssen, BMS, LEO, Consultant of: BMS, Pfizer, Speakers bureau: Pfizer, BMS, Janssen, Novartis, Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai

Direct and seasonal legacy effects of the 2018 heat wave and drought on European ecosystem productivity

In summer 2018, central and northern Europe were stricken by extreme drought and heat (DH2018). The DH2018 differed from previous events in being preceded by extreme spring warming and brightening, but moderate rainfall deficits, yet registering the fastest transition between wet winter conditions and extreme summer drought. Using 11 vegetation models, we show that spring conditions promoted increased vegetation growth, which, in turn, contributed to fast soil moisture depletion, amplifying the summer drought. We find regional asymmetries in summer ecosystem carbon fluxes: increased (reduced) sink in the northern (southern) areas affected by drought. These asymmetries can be explained by distinct legacy effects of spring growth and of water-use efficiency dynamics mediated by vegetation composition, rather than by distinct ecosystem responses to summer heat/drought. The asymmetries in carbon and water exchanges during spring and summer 2018 suggest that future land-management strategies could influence patterns of summer heat waves and droughts under long-term warming.