Effects of the PARP Inhibitor Niraparib on the Radiosensitivity of Human Lung and Cervical Cancer Cells

PURPOSE/OBJECTIVE(S)

DNA damage repair (DDR) initiated after DNA damage may lead to a decreased radiosensitivity of tumor cells or even radiation resistance. Previous studies indicate that PARP inhibitors block the repair of DNA single-strand breaks (SSBs), and unrepaired SSBs may continuously accumulate and form double-strand breaks (DSBs) that promotes tumor cell death. Studies have also shown that PARP inhibitors act synergistically with RT to inhibit DDR. In this study, we aim to investigate the effect of Niraparib, a clinically approved PARP inhibitor on the radiosensitivity of human lung and cervical cancer cells, and preliminarily explore the underlying mechanism.

MATERIALS/METHODS

The human lung cancer cell line A549 and human cervical cancer cell line Siha were both treated with niraparib (for 1h), or X-ray (4Gy), or Niraparib (for 1h) combined with X-ray (4Gy). The effect was examined via measurements of cell proliferation by the cell counting kit-8 assay, and cell viability was detected by clone formation assays. Cell apoptosis and cell cycle distribution were investigated by flow cytometry.

RESULTS

In human lung and cervical cancer cell lines, Niraparib combined with radiation therapy significantly inhibited cell proliferation. The proportion of apoptotic cells in cell lines treated with Niraparib plus radiation (the combination group) was significantly higher compared with control, radiation-only, and Niraparib-only groups. Additionally, the proportion of A549 cells in the G2/M phase was significantly increased in the combination group compared with the radiation-only group.

CONCLUSION

The results support that PARP inhibitor Niraparib increases the radiosensitivity of tumor cells, promotes their apoptosis, and induces cell cycle redistribution. The possible mechanism is associated with the inhibition of radiation-induced DNA damage repair.

Financial Toxicity and Out-of-Pocket Costs for Patients with Head and Neck Cancer: An Australian Perspective

PURPOSE/OBJECTIVE(S)

Financial toxicity is under-investigated for patients with head and neck cancer (HNC). The aim of this study was to quantify and describe the financial toxicity and out-of-pocket costs for patients with HNC in regional Australia and to consider its relationship with quality of life.

MATERIALS/METHODS

A cross-sectional survey was administered to patients with mucosal HNC who were disease free and 1-3 years after completion of radiotherapy at a regional tertiary hospital in Australia. The survey included questions on socio-demographics, out-of-pocket expenses, and health-related quality of life (HRQoL) measured with the FACT-H&N. Financial toxicity was evaluated using the Financial Index of Toxicity (FIT) survey, which scores financial toxicity on a scale of 0-100 (higher score indicating higher financial toxicity). The relationship between high financial toxicity scores (top quartile) and HRQoL was explored.

RESULTS

Of 57 total patients, 41 (72%) reported out-of-pocket expenses at a median of AU$1,796 (interquartile range AU$2,700) and a maximum of AU$25,050. The overall median FIT score was 13.9 (interquartile range 19.5) and patients with high financial toxicity (n = 14) reported poorer HRQoL (76.5 vs 114.5, p < 0.001). Patients who were not married had a higher financial toxicity score (23.1 vs 11.1, p = 0.01). Similarly, those participants with lower levels of education had higher financial toxicity (19.3 vs 11.1, p = 0.06). Participants with private health insurance were found to have lower rates of financial toxicity (8.3 vs 17.6, p = 0.01). Medications (41%, median AU$400), dietary supplements (41%, median AU$600), travel (36%, median AU$525) and dental (29%, AU$388) were the most common out-of-pocket expenses. Only nineteen patients (33%) reported that a member of their treating team had asked if they have any financial concerns. Participants living in rural locations (> 100km from the hospital) had higher out-of-pocket expenses (AU$2655 vs AU$730, p = 0.01).

CONCLUSION

Financial toxicity is a significant issue for a significant proportion of patients with head and neck cancer which was associated with a reduced HRQoL. All clinicians should consider asking patients with HNC about financial concerns and be aware of what financial support is available in their region. Interventions are required to reduce the burden of financial toxicity for patients with HNC.

Using MRI Radiomics to Predict the Efficacy of Immunotherapy for Brain Metastasis in Patients with Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

Immune-checkpoint inhibitors (ICIs) combined with chemotherapy has been widely used in the first-line treatment of small cell lung cancer (SCLC) patients. However, the efficacy of ICIs for patients with brain metastases (BMs) of SCLC is limited. There are no effective factors to predict the efficacy. We developed and validate a model to predict intracranial efficacy for ICIs in patients with BMs from SCLC by using MRI radiomics.

MATERIALS/METHODS

In this study, we collected 101 SCLC patients with BMs treated with ICIs. They clinical characteristics and pre-treatment Magnetic Resonance Imaging (MRI) were collected. Seventy cases collected from our hospital as training cohort and 31 cases collected from another hospital as an independent validation cohort. Brain metastatic lesions were contoured on ITK-SNAP software and 3748 radiomic features capturing both intra- and peritumoral texture patterns were extracted. The primary endpoint of this study was intracranial overall response rate (ORR). Intraclass correlation coefficient (ICC) and random forest (RF) model were used to select radiomic features. The top 10 selected radiomic features were adopted to build prognostic models by using logistic regression. Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) was chosen as the metric to assess model performances. We also performed a nomogram based on a multivariate logistic regression model includes radiomic and clinical features to predict ICIs intracranial efficacy.

RESULTS

The clinical characteristics including number of treatment lines and concurrent brain radiotherapy, ten intratumoral signatures and one peritumoral signatures were found significantly associated with ICIs intracranial efficacy. Predictors contained in the individualized prediction nomogram included the radiomics signature, and clinical features. The model showed favorable discrimination with a C-index of 0.861[95% CI: 0.779-0.943] and AUC of 0.861[95% CI: 0.778- 0.944] in training cohort and with a C-index of 0.812[95% CI: 0.647-0.978] and AUC of 0.812[95% CI:0.646-0.979] in the test cohort.

CONCLUSION

Radiomic features from pre-treatment MRI images were predictive for intracranial efficacy in SCLC patients with BMs. Pre-treatment radiomics may allow early prediction of benefit and expedite more aggressive treatment for high-risk patients and it has to be further explored as predictor of outcome in a larger series of patients.

The Baseline Serum Lipid Levels and Outcomes of NSCLC Patients Receiving Immunotherapy Combined or Non-Combined with Radiotherapy: A Single Center Retrospective Study

PURPOSE/OBJECTIVE(S)

In recent years, many studies have shown that lipids and lipid-like substances are key regulatory factors in tumor development and play an important role in immune regulation. However, it remains unclear whether serum lipids influence the outcome of immunotherapy. Therefore, determining the serum lipid levels of the immune treatment-beneficiary population may be valuable. The aim of this study is to evaluate the prognostic value of baseline serum lipid levels in non-small cell lung cancer (NSCLC) patients receiving immunotherapy.

MATERIALS/METHODS

We retrospectively included 294 patients with stage III-IV NSCLC who received immunotherapy continuously from December 2018 to November 2021 at our hospital, collecting their pre-treatment lipid levels, such as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Of these, 160 receiving immunotherapy without combined radiotherapy (ICIs-nRT) and 134 combined with radiotherapy (iRT). The endpoint was the correlation between pre-treatment serum lipid levels and overall survival (OS), as well as progression-free survival (PFS). The X-tile tool was used to determine the optimal cut-off value of the indicators. The Kaplan-Meier survival curves were used to calculate OS and PFS and log rank tests were used for comparison. And the Cox proportional hazard model were used for univariate and multivariate analysis.

RESULTS

In all 294 patients, low TG, low TC, and low HDL-C predicted poor OS (P<0.001) and poor PFS (P<0.05). Low LDL-C was associated with poor OS (P = 0.0001). Among 160 patients receiving ICIs-nRT and 134 iRT patients, low levels of TG (P = 0.0134, 0.0024), TC (P = 0.0003, 0.0023), HDL-C (P = 0.0004, 0.0043), and LDL-C (P = 0.0003, 0.0419) were associated with worse OS compared to high levels of them. In the ICIs-nRT patients, low HDL-C predicted poor PFS (P = 0.0011). In 134 iRT patients, low levels of TG (P = 0.0017), TC (P = 0.0028), and LDL-C (P = 0.0330) were poor prognostic factors for PFS. In the univariate and multivariate analysis with OS in all patients, TG and HDL-C were independent risk factors, while TG was an independent risk factor in the analysis with PFS. In ICIs-nRT patients, HDL-C was an independent prognostic factor for patients' OS and PFS. In iRT patients, both TG and HDL-C were prognostic risk factors for OS.

CONCLUSION

These data confirm that higher serum lipid levels are associated with better outcomes in patients with NSCLC undergoing immunotherapy. Serum lipids may identify tumors that are more likely to respond to immunotherapy. Radiation therapy may affect lipid metabolism within the body to enhance the efficacy of immunotherapy.

Single-Cell Dissection of Concurrent Chemoradiotherapy-Induced Immunosenescence in Cervical Cancer

PURPOSE/OBJECTIVE(S)

Immunosenescence could attenuate effective anti-tumor immune response, but it's role in the tumor microenvironment following concurrent chemoradiotherapy (CCRT) in cervical cancer (CC) remains largely unknown. We aimed to investigate CCRT induced immunosenescence and its clinical implications in CC at single-cell resolution.

MATERIALS/METHODS

A total of 11326 cells from single-cell RNA sequencing data derived from five post-CCRT CC tumor samples were analyzed by bioinformatics for immunosenescence. Functional enrichment analysis including Gene Ontology (GO) and Gene Set Variation analysis was performed to identify and assess the molecular heterogeneity of cell subclusters. Kaplan-Meier survival analysis was performed in the bulk RNA-sequencing data included 253 patients with CC obtained from the The Cancer Genome Atlas.

RESULTS

We identified senescent and non-senescent cell clusters in tumor-associated macrophages (TAMs), CD8+ T cells and NK cells after CCRT based on the senescence-related genes expression. GO analysis showed that antigen processing and presentation pathways were enriched in the non-senescent TAMs, while the response to hypoxia and oxidative stress were enriched in the senescent TAMs, which repressed the anti-tumor immunity. We further found that the abundance of senescent TAMs was associated with shorter overall survival (OS) of patients with CC (P<0.001). Moreover, compared to senescent CD8+ T, non-senescent CD8+ T exhibited higher cytotoxicity and exhausted signature scores, and increased enrichment of T cell proliferation, differentiation and activation pathways. In addition, the high proportion of non-senescent NK cell was also associated with better OS of CC patients (P = 0.008).

CONCLUSION

We revealed the potential immune suppressive characteristics of CCRT induced senescent immune cells at single-cell resolution, which provides promising therapeutic targets for CC patients.

Enhancing Immune-Mediated Radiotherapy Efficacy in Murine Models of Head and Neck Cancer through Peroxisome Proliferator-Activated Receptor Modulation

PURPOSE/OBJECTIVE(S)

The tumor microenvironment (TME) in HPV-unrelated head and neck cancer (HNC) is considered to be immunologically "cold," and immunometabolic adaptations to radiotherapy (RT) can exacerbate these conditions and lead to radioresistance. Peroxisome proliferator-activated receptor-α (PPARα) agonism may improve the immune response to RT by reducing glucose scarcity through upregulation of fatty acid utilization in cancer cells. Our clinical trial data shows that high serum oleic acid (OA), a PPAR ligand, correlates with response to radioimmunotherapy.

MATERIALS/METHODS

Orthotopic buccal tumor implantations of MOC2 and LY2 HNC cell lines were performed in C57BL/6 and BALB/c mice, respectively. Mice were placed on a high OA diet (38% kcal from OA) 3 weeks prior to tumor implantation. Control diet consisted of 1% kcal from OA. In vitro RT was performed to characterize the metabolic effects on the cancer cell lines. For in vivo studies, tumors were irradiated upon reaching 100 mm^3 with three 8 Gy fractions, given every 4-5 days. The PPARα agonist fenofibrate (FF, 100mg/kg/day) was given via oral gavage or intraperitoneal injection starting 5 days after RT. Tumor volume and overall survival were measured as objective outcomes, and flow cytometry was used to characterize the immune landscape of the tumor, blood, and lymph nodes. Mass spectrometry was employed for bulk proteomics and metabolomics on serum samples, and stable isotope labeling was performed on CD8 T cells from treated mice ex vivo. Extracellular flux analyses were performed on tumor cells and CD8 T cells to determine metabolic phenotypic changes.

RESULTS

In vitro cytotoxicity was met for MOC2 and LY2 cancer cells in 100 uM FF and OA in comparison to solvent (p<0.01). Extracellular flux analyses show that RT upregulates the glycolytic phenotype of MOC2 and LY2 cancer cells; and that FF and/or OA decrease the glycolytic capacity of the cancer cells. Ex vivo extracellular flux analyses showed increased glycolytic capacity of CD8 T cells in mice treated with FF in comparison to RT alone. RT in combination with FF significantly improved tumor volume response in comparison to RT alone (mean 99.4 vs 182.7 mm^3, p = 0.001) and was comparable to combination radioimmunotherapy (with anti-PDL1 therapy; mean 99.4 vs. 132.3 mm^3). Unexpectedly, OA negated this improvement in efficacy in both MOC2 and LY2 tumor models; mice on the high OA diet had significantly higher average body weight (p<0.01). Significant changes in adaptive immune response were observed within the TME with the addition of FF. This was mirrored by changes in serum metabolomics.

CONCLUSION

PPARα agonism improved the efficacy of RT in murine HNC models and could be considered in future translational clinical trial design.

Analyzing the Predictive Effects of PD-L1 Expression, Early Changes of bTMB and Circulated CD8+T Cells during Treatment for Responses of RT Combined with ICI in NSCLC

PURPOSE/OBJECTIVE(S)

The beneficial role of immunotherapy and the clinical relevance of current biomarkers remain inconclusive; thus, appropriate strategies and reliable predictors need further definition. A rational combination of biomarkers is needed. Here, we estimated potential predictive factors for responses of radiotherapy (RT) combined with immune checkpoint inhibitor (ICI) in a phase II trial to determine the efficacy and safety of combination of moderate hypofractionated RT with ICI in patients with oligometastatic NSCLC (NCT03557411).

MATERIALS/METHODS

Pretreatment tumor tissue samples and longitudinal blood were collected for immune and tumor biomarker analysis. We examined pre-treatment (pre-ICI) PD-L1 expression in tumor cells. Circulating tumor cell (CTC), PD-L1+CTC, blood tumor mutation burden (bTMB), CD8+T cells, CD4+T cells, NK cells, B cells in circulation were acquired pre-ICI and 1 month after ICI starting (1-mth). In addition, early changes of CTC (CTC), PD-L1+CTC (PD-L1+CTC), bTMB (bTMB), CD8+T cells (CD8+T cells), CD4+T cells (CD4+T cells), NK cells (NK cells), B cells (B cells) were also analyzed to estimate the predictive effects for treatment.

RESULTS

High pre-ICI bTMB and increased CD8+T cells at 1 month was associated with better PFS (p = 0.016; p = 0.006). Interaction analyses revealed that each combination of two markers in the 5 markers including PD-L1, pre-ICI bTMB, 1-mth bTMB, 1-mth CD8+T cells and CD8+T cells was significantly associated with PFS, except for CTC, PD-L1+CTC, CD4+T cells, NK cells and B cells in circulation due to low power. Unsupervised cluster analysis based on these markers revealed three sub-cohorts. Cohort-1 was overrepresented by patients with progressive disease (81%) of whom were negative for 3-4 of the 5 biomarkers. Cohort-3 was overrepresented by patients with partial response (70%) of whom were positive for 3-4 of the 5 biomarkers. Survival analyses of the 3 cohorts indicated a significant association with PFS (p = 0.017).

CONCLUSION

This study suggests that a combination of PD-L1 expression, early changes of bTMB and circulated CD8+T cells as a better predictive biomarker for response to RT combined with ICI. Consequently, refinement of this set of biomarkers and validation in a larger set of patients is warranted.

The Predictive Value of Changes in Basal Myocardial F-18 Fluorodeoxyglucose Uptake for Cardiotoxicity in Locally Advanced Esophageal Cancer Patients Receiving Definitive Radiotherapy

PURPOSE/OBJECTIVE(S)

To investigate the predictive value of changes in myocardial 18F-FDG uptake for major adverse cardiac events (MACEs) in locally advanced esophageal cancer patients receiving definitive radiotherapy.

MATERIALS/METHODS

Between August 2012 and January 2018, 400 patients with stage II-III esophageal cancer receiving definitive radiotherapy at two institutions were divided into the training (n = 240) and external validation cohorts (n = 160). All patients underwent FDG-PET imaging within 1 week before treatment and 3 months after treatment. Myocardium delineation was performed by Carimas software (version 2.10) based on the AHA 17-segment model. When contouring the left ventricle, the myocardium was automatically divided into basal (segments 1-6), middle (segments 7-12), and apical (segments 13-16) regions, and the mean dose and FDG uptake parameters of each region were obtained by Carimas. Our primary endpoint was MACEs. Patient clinicopathologic factors, dosimetric parameters for the whole heart and cardiac substructures, and myocardial changes within the three regions on 18F-FDG PET were utilized to seek the best predictive models for cardiotoxicity. To avoid multicollinearity between dose-volume histogram (DVH) parameters, we selected the variables with the lowest Akaike Information Criterion (AIC) value from the DVH parameters of the same cardiac structure for the actual modeling procedure. Competing risk analysis and Cox regressions analysis were performed. The predictive performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) and Brier score.

RESULTS

At a median follow-up interval of 78 months, 28 patients (11.7%) developed MACEs. The basal region of the myocardium received the highest radiation dose, followed by the middle and the apex region. The basal myocardial SUVmax and SUVmean significantly increased after radiotherapy while the apical and middle myocardial SUVmax and SUVmean not significantly increased. In univariate analysis, age, pre-existing cardiac disease, changes in pre- and post-treatment basal myocardial SUVmax and SUVmean (∆SUVmax and ∆SUVmean), and dosimetric parameters for MHD, mean LCX, mean LAD, and mean LV dose were associated with an increased hazard of MACEs. Multivariate analysis showed that basal ∆SUVmean retained significance after adjusting for age, pre-existing cardiac disease, and dosimetric parameters for whole heart and cardiac substructures. The AUCs and Brier scores demonstrated favorable predictive accuracies of the model's integrating variables with significant difference in multivariate analysis when predicting MACEs in the training and validation cohorts.

CONCLUSION

∆SUVmean was an independent indicator of MACE in locally advanced esophageal cancer patients receiving definitive radiotherapy. Changes in basal myocardial FDG uptake is a promising biomaker for predicting radiation-induced cardiotoxicity.

Using CT Radiomics and Machine Learning to Distinguish Radiotherapy vs. Immune Checkpoint Inhibitor-Induced Pneumonitis in Non-Small Cell Lung Cancer Patients

PURPOSE/OBJECTIVE(S)

Both radiotherapy (RT) and immune checkpoint inhibitors (ICIs) may induce pneumonitis which is difficult to distinguish clinically. We tested the utility of computed tomography (CT) in identifying the cause of pneumonitis in patients with non-small cell lung cancer (NSCLC) who received RT, ICIs and RT combined with ICIs (RT+ICIs).

MATERIALS/METHODS

In this study, we analyzed the clinical characteristics and CT morphology of 130 NSCLC patients who developed pneumonitis after receipt of ICIs only (n = 50), thoracic RT only (n = 50) (ICIs only + RT only, the training cohort, n = 100), and RT+ICIs (the test cohort, n = 30). CT radiomics features were extracted using 3D-Slicer software and selected using LASSO regression for training a random forest (RF) classifier and a linear discriminant analysis (LDA) classifier to discern pneumonitis etiology. Patients who received RT or ICIs only were defined as the training cohort since the cause of their pneumonitis was readily identifiable. Patients who received RT+ICIs were defined as the test cohort and the cause of their pneumonitis were determined by clinicians as the ground truth.

RESULTS

In the study, the median time from the initiation of treatment to pneumonitis was 1.9 months in RT+ICIs patients, which was shorter than 2.5 months in RT only and 2.7 months in ICIs only patients. In addition, the patients in RT+ICIs group have more high grade (grade 3-4) pneumonitis compared to patients in ICIs only or RT only group (p<0.05). Pneumonitis after the combined therapy was not a simple superposition mode of RP and CIP, resulting in the distinct characteristics of both RT and ICIs-related pneumonitis. (1) Some cases resembled RP with sharp borders in the ipsilateral lung and others resembled the bilateral distribution of typical CIP, while some patients exhibit an intermediate morphology; (2) Some pneumonitis occurred in the areas of low and medium doses of radiation rather than the high-dose radiation areas similar to RP; (3) Some pneumonitis was initially limited to the ipsilateral lung that had received radiation and then developed in bilateral lungs. The RF classifier showed favorable discrimination between CIP and RP with an area under the receiver operating curve (AUC) of 0.859 (95% CI: 0.7884-0.9292) in the training cohort and 0.851 (95% CI: 0.6998-1) in the test cohort. The simplified LDA classifier consisting of 7 LASSO-selected features achieved an AUC of 0.881 (95% CI: 0.815-0.947) in the training cohort and 0.842 (95% CI: 0.686-0.997) in the test cohort.

CONCLUSION

RT and ICIs-related pneumonitis exhibit distinct clinical characteristics and morphologic features on CT. CT radiomics-based classifiers could provide a noninvasive method to identify the predominant etiology in NSCLC patients who developed pneumonitis after thoracic RT and ICIs.

Efficacy of Nimotuzumab plus Concurrent Chemo-Radiotherapy for Unresectable Esophageal Cancer: A Real-World Study

PURPOSE/OBJECTIVE(S)

The esophageal cancer ranked 7th in the morbidity of malignant cancer and the 6th contributed to carcinoma deaths. Most patients are diagnosed of advanced stage at first visiting. The 5-year survival rate of unresectable esophageal cancer is about 20% after the standard treatment of concurrent chemo-radiotherapy. Nimotuzumab, a humanized anti-EGFR antibody, has shown good efficacy and low toxicity in epithelial tumors. This two-center, real-world study evaluated the efficacy and safety of nimotuzumab combined with concurrent chemoradiotherapy in unresectable esophageal squamous cell carcinoma (ESCC).

MATERIALS/METHODS

Totally 503 eligible unresectable ESCC patients from Jan 2014 to Dec 2020 were included. 1:2 nearest neighbor propensity score matching (PSM) was performed to match the Nimo group (nimotuzumab plus concurrent chemo-radiotherapy) and CRT group (concurrent chemo-radiotherapy), and the covariates included age, gender, tumor location, lesion length, TNM stage, clinical stage, and radiotherapy dose. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR).

RESULTS

A total of 61 patients were in Nimo group which received nimotuzumab (200 mg/w, 4-6 weeks) combined with concurrent chemo-radiotherapy (chemotherapy: S-1/FP/TP/DP for 2-4 cycles; radiotherapy: 2DRT,3D-CRT or IMRT, 50-70 Gy in 25-35 fractions) and 107 patients in CRT group only received concurrent chemo-radiotherapy. The baseline characteristics were well balanced between the two groups. The efficacy of Nimo group was better than that of CRT group. The ORR was 85.2% vs. 71.0%, (P=0.037), the DCR was 98.4% vs. 91.6%, (P>0.05). The median PFS was 28.07 months vs. 19.54 months, and the 1-, 3- and 5-year PFS rates were 78.2% vs. 72.9%, 37.5% vs. 28.3%, and 29.1% vs. 21.3%, respectively (HR: 0.6860, 95% CI: 0.4902-0.9600, P=0.034). The median OS was 34.93 months vs. 24.30 months and the 1-, 3- and 5-year OS rates were 88.5% vs. 81.3%, 46.8% vs. 35.2% and 37.4% vs. 28.0%, respectively (HR: 0.6701, 95% CI: 0.4792-0.9372, P=0.024). The adverse events including radiation esophagitis, radiation pneumonitis, bone marrow suppression, nausea, vomiting, and rash were no significantly different between the two groups (P>0.05).

CONCLUSION

Nimotuzumab combined with concurrent chemo-radiotherapy improved the ORR, and prolonged PFS and OS in unresectable ESCC patients with a good tolerance.

The Updated Landscape of Tumor Microenvironment and Pre-Metastasis Niches for Radiotherapy Resistant Tumors

PURPOSE/OBJECTIVE(S)

In the current clinical work, hypo-fractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) are considered to be completely different treatments. However, the difference between the HFRT and CFRT in reprogramming the tumor immune microenvironment (TIME) is still inconclusive. Our previous work found that compared with HFRT, CFRT is more inclined to trigger immunosuppressive phenotype, but the underlying mechanism is still unclear. Based on this, we use single-cell mRNA sequencing to describe the landscape of TIME with HFRT and CFRT, and find the key targets or pathways to combine with radiotherapy.

MATERIALS/METHODS

By simulating the in vivo radiotherapy strategy, we built recurrent murine cell lines mimicking CFRT and HFRT recurrent tumors (CFRT_R and HFRT_R tumors) with small animal radiation research platform (SARRP).

RESULTS

Based on this unique model, we found that CFRT_R tumors can promote local relapse and lung metastasis significantly compared to HFRT_R tumors. Results of single-cell mRNA sequencing and FCAS also indicate that CFRT_R tumors possess more macrophages in the tumor site and neutrophils in the metastatic site. By using quantitative proteomics of secreted proteins, we prove that CFRT_R tumors secret more Ccl2, S100a11 and Slpi. Mechanically, CFRT_R tumors influence the polarization of M2 TAMs leading to tumor growth through secretion of Ccl2 and S100a11. Meanwhile, CFRT_R tumors also augment the infiltration of neutrophils in the lung through Slpi altering the lung immune landscape to support metastasis. ChIP and EMSA results also reveal that RelB is the core transcription factor of Ccl2, S100a11 and Slpi. Furthermore, local relapse and lung metastasis can be reversed by targeting non-canonical NF-kB pathway.

CONCLUSION

The effect of CFRT_R and HFRT_R tumors in reprogramming TIME is different, CFRT_R tumors can trigger immunosuppressive phenotype compared to HFRT_R tumors by possessing more M2 TAMs in the tumor site and neutrophils in the metastatic site. The killing function of tumor infiltrated T cells can be inhibited by accumulated M2 TAMs, and abundant neutrophils in lungs contribute to the formation of the pre-metastatic niche. Targeting non-canonical NF-kB pathway can reverse local relapse and lung metastasis in CFRT_R tumors by suppressing Ccl2, S100a11 and Slpi secretion. In short, our study not only deepens the understanding of the immune landscape of CFRT and HFRT recurrence tumors, but also provides a novel therapy of CFRT recurrence patients.

Expression of FOXO3 in the skin follicles of goose embryos during embryonic development

1. The Forkhead box O3 (FOXO3) transcription factor is a crucial regulator in controlling cell metabolism, proliferation, apoptosis, migration and response to oxidative stress. However, FOXO3 has not previously been studied much in the embryonic skin follicles of geese.2. This study used Zhedong white geese (Anser cygnoides), Jilin white geese (Anser cygnoides) and Hungarian white geese (Anser anser). The feather follicle structure in the dorsal skin during embryonic stages was examined with haematoxylin and eosin (HE) and Pollak staining. The FOXO3 protein content in the embryonic dorsal skin from feather follicles was detected using western blotting and quantitative real-time PCR.3. The mRNA expression level of FOXO3 in the dorsal skin of Jilin white geese was highly expressed on embryonic day 23 (E23; P < 0.01), while mRNA expression of FOXO3 was highly expressed in the feather follicle of Hungarian white geese at E28 (P < 0.01). The expression of FOXO3 protein mainly concentrated in the early embryonic phase among these goose breeds (P < 0.05). This suggested that FOXO3 plays a crucial role in the development and growth of embryonic dorsal skin of feather follicles. The location of the FOXO3 protein was determined using the IHC technique, which further verified the effect of FOXO3 in the dorsal skin for feather follicles during embryogenesis.4. The study demonstrated the differential expression and localisation of the FOXO3 gene among different goose species. It was speculated that the gene could potentially improve goose feather follicle development and feather-related traits and provide a basis for further understanding of FOXO3 function in the dorsal tissue of goose embryos.

Verification and Mechanism Exploration of CDK4 Alterations on Influencing Radiotherapy Sensitivity in Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

In this study, we aimed to explore the changes of functional phenotype before and after radiotherapy through vitro and vivo experiments. The potential pathway was preliminarily clarified.

MATERIALS/METHODS

Firstly, the relationships between the prognosis and the expression of CDK4 protein in SCLC patients treated with definitive chemoradiotherapy were explored. Then the stable overexpressed/knockdown CDK4 and negative control transfecting SCLC cell lines were established to monitor the changes of cell proliferation, migration, invasion, apoptosis and cell cycle after increasing radiation doses according to a cell counting kit assay, transwell cell migration and invasion assay, apoptosis cell cycle assay and BALB/c mouse model of subcutaneously transplanted tumor. The potential signal pathways were confirmed via KEGG pathway enrichment analysis and western blot.

RESULTS

Compared with patients with lower CDK4 protein expression, prognosis of those with high CDK4 protein expression was decreased significantly (p < 0.05). The cell activity, migration and invasion ability of overexpression/knockdown CDK4 and negative control group were all decreased with increasing radiation doses, but the activity, migration and invasion ability of cells with overexpression CDK4 was stronger after same dose X-ray irradiation (p<0.01). For group with knockdown CDK4, it showed lower cell activity, migration and invasion than negative control group. After X-ray irradiation, the apoptotic ratio of all groups increased. And cells with overexpressed CDK4 displayed significantly reduced apoptosis, less G0/G1 phase cells, and improved M phase cells than the control group. In addition, compared with negative control group, gross tumor volume of overexpression CDK4 group decreased much smaller after X-ray irradiation. H1339 cells with overexpression CDK4 and negative control group were sequenced by transcriptomic sequencing before and after radiotherapy. Taken together, differential genes were consistently enriched in MAPK pathway. Western blot showed that, compared with the negative control group, overexpression CDK4 group of H1339 and SW1271 cells after radiotherapy all showed significant changes on pERK proteins in the ERK pathway increased significantly (P<0.001).

CONCLUSION

In this study, the overexpression/knockdown CDK4 and negative control group were successfully constructed in H1339 and SW1271 cells, revealing the radiotherapy resistance of CDK4 alterations in vitro and in vivo experiment. And CDK4 alterations was shown to promote radiotherapy resistance through phosphorylation of MAPK/ERK signaling pathway in SCLC.

PARP Inhibitor Plus Radiotherapy Reshapes IDH1 Mutation Tumor Immune Suppression Microenvironment Potentiating the Efficiency of Immune Checkpoint Inhibitor

PURPOSE/OBJECTIVE(S)

Isocitrate dehydrogenase 1 (IDH1) mutations confer gain-of-function activity by converting α-ketoglutarate (α-KG) to the oncometabolite D-2-hydroxyglutarate (D-2HG). IDH mutant tumors have fewer tumor-infiltrating CD8+ T cells and reduced PD-L1 expression compared with their wild type (WT) counterparts. In addition, 2-HG can directly inhibit the killing and proliferative functions of CD8+ T lymphocytes, and suggesting that 2-HG promotes an immunosuppressive TME. Several studies have shown that 2-HG can inhibit homologous recombination (HR) and weaken the DNA damage response (DDR), making them more sensitive to poly (ADP-ribose) polymerase (PARP) inhibitors and radiotherapy (RT). At the same time, RT and PARP inhibition (PARPi) have been considered to be a new direction to stimulate antitumor immunity. Therefore, our study intends to use RT + PARPi to reverse the immunosuppressive microenvironment caused by IDH1 mutations, thereby promoting the therapeutic effect of immune checkpoint inhibitors.

MATERIALS/METHODS

We compared the immune responses of clinical tissue samples and TCGA data from either IDH1mut or IDH1WT low-grade gliomas. We then established IDH1mut-overexpressing MC38 and GL261 cell lines to determine the antitumor effect of RT + PARPi. Apoptosis and immunogenic death markers were detected by flow cytometry, western blot (WB) and ELISA in these cell lines. Tumor growth and mouse survival curves were observed in both an MC38 subcutaneous and GL261 orthotopic tumor model. Changes in the composition of the immune microenvironment were assessed using flow cytometry. The mechanisms underpinning these compositional shifts were then further interrogated using various techniques, including WB, immunofluorescence, qRT-PCR, CRISPR/Cas9, and CD8+ T cell migration experiments.

RESULTS

We observed that CD8+ T cell infiltration and expression of the chemokines CXCL10 and CCL5 of CD8+ T cells in IDH1mut tumors were significantly downregulated by immunohistochemistry and TCGA analysis. Gene enrichment analysis using the TCGA database found that IDH1 mutations downregulated interferon (IFN)-related signaling pathways. RT + PARPi induces more DNA damage and actives the CGAS-STING pathway compared with monotherapy, leading to more expression of IFN-β, CXCL10 and CCL5 at mRNA and protein level. In the MC38 subcutaneous tumor model, we found that RT + PARPi increased the infiltration of CD8+ T cells while enhancing the killing function of CD8+ T cells. We observed these same effects in the GL261 orthoma model, as well as increased proliferation function of CD8+ T cells. In addition, RT + PARPi increased the expression of PD-L1 and enhanced the therapeutic effect of immune checkpoint inhibitors.

CONCLUSION

RT + PARPi reshapes the IDH1mut tumor immune suppression microenvironment, thereby potentiating the antitumor effect and efficiency of immune checkpoint inhibitor.

A Dosimetric Study Indicates the Spinal Cord Irradiation Contributes to Acute Hematologic Toxicities in Non-Small Cell Lung Cancer Patients Receiving Radiotherapy Combined with Immunotherapy

PURPOSE/OBJECTIVE(S)

To assess the radiation therapy (RT) dose to radiation-associated hematologic toxicities (HTs) in patients with non-small cell lung cancer (NSCLC) after RT combined with immunotherapy.

MATERIALS/METHODS

Cases of NSCLC treated with RT combined with immunotherapy at Shandong Cancer Hospital in China were identified. The mean dose and the volume of the spinal cord receiving at least 5 to 40 Gy (V5-V40) were retrospectively recorded. Logistic regression was used to estimate associations between grade ≥3 HT (HT3+) and dosimetric/clinical parameters. Receiver operating characteristic analysis was used to determine dosimetric cut-points.

RESULTS

Ninety-nine patients were analyzed. The majority were male (n = 78, 78.8%) and received chemotherapy (n = 83, 83.9%). All patients received either anti-PD-1 immune checkpoint (n = 89, 89.9%) or anti-PD-L1 immune checkpoint (n = 10, 10.1%) therapy. The rate of HT3+ was 24.2% (n = 24). Spinal cord mean dose, V5 to V40 and BMI parameters associated with HT3+ were included in the multivariate analysis. On multivariate analysis, increasing mean spinal cord dose (per Gy) was associated with higher odds of developing HT3+ (odds ratio 1.053, 95% confidence interval 1.002-1.105, P = .041), as were increasing spinal cord V5 to V20 (As show in the Table below). The optimal cut-points identified were V5 = 52.5%, V10 = 47.5%, V20 = 39.4%, and mean dose = 23.3 Gy. Patients with values above these cut-points had an approximately 2-fold increased risk of HT3+.

CONCLUSION

We found that mean spinal cord dose and low-dose parameters (V5-V20) were associated with HT3+ in NSCLC patients after RT and immunotherapy. The mean dose of the spinal cord should be kept lower than 23.3 Gy for these patients. These data suggested that efforts to spare doses to the spinal cord might reduce rates of severe HT.

Predicting Radiation Esophagitis using 18F-FAPI-04 PET/CT in Patients with LA-ESCC Treated with Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

This prospective study examined whether 18F-FAPI-04 PET/CT can predict the development and severity of radiation esophagitis (RE) in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) treated with concurrent chemoradiotherapy.

MATERIALS/METHODS

From June 2021 to March 2022, images were prospectively collected from LA-ESCC patients who underwent 18F-FAPI-04 PET/CT examinations before and during radiotherapy. The development of RE was evaluated weekly according to Radiation Therapy Oncology Group criterion. The target-to-background ratio in blood (TBRblood) was analyzed at each time point and correlated with the onset and severity of RE. Factors that predicted RE were identified by multivariate logistic analyses.

RESULTS

Thirty patients (median age, 66.5 years [interquartile range: 56¨C71 years]; 22 men) were evaluated. Significantly higher TBRblood (during radiotherapy, mean: 3.06 vs 7.11, P = 0.003) and change in TBRblood compared with pre-RT (ΔTBRblood, mean: 0.67 vs 4.81, P = 0.002) were observed in patients with RE than patients without RE. Those with grade 3 RE had a significantly higher TBRblood (during radiotherapy, mean: 4.55 vs 9.66, P = 0.003) and ΔTBRblood (mean: 2.16 vs 7.50, P = 0.003) compared with those with RE

CONCLUSION

The ΔTBRblood on 18F-FAPI-04 PET/CT may be effective at identifying patients at risk for the development of RE, especially grade 3 RE.

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Observation of New Ω_{c}^{0} States Decaying to the Ξ_{c}^{+}K^{-} Final State

Two new excited states, Ω_{c}(3185)^{0} and Ω_{c}(3327)^{0}, are observed in the Ξ_{c}^{+}K^{-} invariant-mass spectrum using proton-proton collision data collected by the LHCb experiment, corresponding to an integrated luminosity of 9  fb^{-1}. Five previously observed excited Ω_{c}^{0} states are confirmed, namely Ω_{c}(3000)^{0}, Ω_{c}(3050)^{0}, Ω_{c}(3065)^{0}, Ω_{c}(3090)^{0}, and Ω_{c}(3119)^{0}. The masses and widths of these seven states are measured with the highest precision to date.

Evidence of a J/ψK_{S}^{0} Structure in B^{0}→J/ψϕK_{S}^{0} Decays

An amplitude analysis of B^{0}→J/ψϕK_{S}^{0} decays is performed using proton-proton collision data, corresponding to an integrated luminosity of 9  fb^{-1}, collected with the LHCb detector at center-of-mass energies of 7, 8, and 13 TeV. Evidence with a significance of 4.0 standard deviations of a structure in the J/ψK_{S}^{0} system, named T_{ψs1}^{θ}(4000)^{0}, is seen, with its mass and width measured to be 3991_{-10}^{+12} _{-17}^{+9}  MeV/c^{2} and 105_{-25}^{+29} _{-23}^{+17}  MeV, respectively, where the first uncertainty is statistical and the second systematic. The T_{ψs1}^{θ}(4000)^{0} state is likely to be the isospin partner of the T_{ψs1}^{θ}(4000)^{+} state, previously observed in the J/ψK^{+} system of the B^{+}→J/ψϕK^{+} decay. When isospin symmetry for the charged and neutral T_{ψs1}^{θ}(4000) states is assumed, the signal significance increases to 5.4 standard deviations.

[Impact of different diagnostic criteria for assessing mild micro-hepatic encephalopathy in liver cirrhosis: an analysis based on a prospective, multicenter, real-world study]

Objective: To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test. Methods: This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ (2) test. A kappa test was used to compare the consistency between groups. Results: After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea (Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences (P < 0.001). Conclusion: The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Measurement of the Ratios of Branching Fractions R(D^{*}) and R(D^{0})

The ratios of branching fractions R(D^{*})≡B(B[over ¯]→D^{*}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]→D^{*}μ^{-}ν[over ¯]_{μ}) and R(D^{0})≡B(B^{-}→D^{0}τ^{-}ν[over ¯]_{τ})/B(B^{-}→D^{0}μ^{-}ν[over ¯]_{μ}) are measured, assuming isospin symmetry, using a sample of proton-proton collision data corresponding to 3.0  fb^{-1} of integrated luminosity recorded by the LHCb experiment during 2011 and 2012. The tau lepton is identified in the decay mode τ^{-}→μ^{-}ν_{τ}ν[over ¯]_{μ}. The measured values are R(D^{*})=0.281±0.018±0.024 and R(D^{0})=0.441±0.060±0.066, where the first uncertainty is statistical and the second is systematic. The correlation between these measurements is ρ=-0.43. The results are consistent with the current average of these quantities and are at a combined 1.9 standard deviations from the predictions based on lepton flavor universality in the standard model.

Measurement of the Prompt D^{0} Nuclear Modification Factor in p-Pb Collisions at sqrt[s_{NN}]=8.16 TeV

The production of prompt D^{0} mesons in proton-lead collisions in both the forward and backward rapidity regions at a center-of-mass energy per nucleon pair of sqrt[s_{NN}]=8.16  TeV is measured by the LHCb experiment. The nuclear modification factor of prompt D^{0} mesons is determined as a function of the transverse momentum p_{T}, and the rapidity in the nucleon-nucleon center-of-mass frame y^{*}. In the forward rapidity region, significantly suppressed production with respect to pp collisions is measured, which provides significant constraints on models of nuclear parton distributions and hadron production down to the very low Bjorken-x region of ∼10^{-5}. In the backward rapidity region, a suppression with a significance of 2.0-3.8 standard deviations compared to parton distribution functions in a nuclear environment expectations is found in the kinematic region of p_{T}>6  GeV/c and -3.25 Collapse

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Measurement of the Time-Integrated CP Asymmetry in D^{0}→K^{-}K^{+} Decays

The time-integrated CP asymmetry in the Cabibbo-suppressed decay D^{0}→K^{-}K^{+} is measured using proton-proton collision data, corresponding to an integrated luminosity of 5.7  fb^{-1} collected at a center-of-mass energy of 13 TeV with the LHCb detector. The D^{0} mesons are required to originate from promptly produced D^{*+}→D^{0}π^{+} decays, and the charge of the companion pion is used to determine the flavor of the charm meson at production. The time-integrated CP asymmetry is measured to be A_{CP}(K^{-}K^{+})=[6.8±5.4±1.6]×10^{-4} where the first uncertainty is statistical and the second systematic. The direct CP asymmetries in D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} decays, a_{K^{-}K^{+}}^{d} and a_{π^{-}π^{+}}^{d}, are derived by combining A_{CP}(K^{-}K^{+}) with the time-integrated CP asymmetry difference, ΔA_{CP}=A_{CP}(K^{-}K^{+})-A_{CP}(π^{-}π^{+}), and other inputs, giving a_{K^{-}K^{+}}^{d}=(7.7±5.7)×10^{-4},a_{π^{-}π^{+}}^{d}=(23.2±6.1)×10^{-4},with a correlation coefficient corresponding to ρ=0.88. The compatibility of these results with CP symmetry is 1.4 and 3.8 standard deviations for D^{0}→K^{-}K^{+} and D^{0}→π^{-}π^{+} decays, respectively. This is the first evidence for direct CP violation in a specific D^{0} decay.

Phenotypic and genetic dissection of the contents of important metallic elements in hybrid rice grown in cadmium-contaminated paddy fields

Rice (Oryza sativa L.) is a staple food that feeds over half of the world's population, and the contents of metallic elements in rice grain play important roles in human nutrition. In this study, the contents of important metallic elements were determined by ICP-OES, and included cadmium (Cd), zinc (Zn), manganese (Mn), copper (Cu), iron (Fe), nickel (Ni), calcium (Ca), and magnesium (Mg) in brown rice, in the first node from the top (Node 1), in the second node from the top (Node 2), and in roots of 55 hybrids and their parental lines. The heritability of metallic element contents (MECs), the general combining ability (GCA) for MEC, and the correlation between MECs in different organs/tissues of hybrids were also analyzed. The results indicated that: (1) there was a positive correlation between the contents of Cd and Zn in nodes and roots, but a negative correlation between the contents of Cd and Zn in brown rice of the hybrids(2) the GCA for MECs can be used to evaluate the ability of the parental lines to improve the metal contents in brown rice of the hybrids(3) the contents of Cd, Zn, Ca, and Mg in brown rice were mainly affected by additive genetic effects(4) the restorer lines R2292 and R2265 can be used to cultivate hybrids with high Zn and low Cd contents in the brown rice.

Measurement of the Branching Fractions B(B^{0}→pp[over ¯]pp[over ¯]) and B(B_{s}^{0}→pp[over ¯]pp[over ¯])

Searches for the rare hadronic decays B^{0}→pp[over ¯]pp[over ¯] and B_{s}^{0}→pp[over ¯]pp[over ¯] are performed using proton-proton collision data recorded by the LHCb experiment and corresponding to an integrated luminosity of 9  fb^{-1}. Significances of 9.3σ and 4.0σ, including statistical and systematic uncertainties, are obtained for the B^{0}→pp[over ¯]pp[over ¯] and B_{s}^{0}→pp[over ¯]pp[over ¯] signals, respectively. The branching fractions are measured relative to the topologically similar normalization decays B^{0}→J/ψ(→pp[over ¯])K^{*0}(→K^{+}π^{-}) and B_{s}^{0}→J/ψ(→pp[over ¯])⁢ϕ(→K^{+}K^{-}). The branching fractions are measured to be B(B^{0}→pp[over ¯]pp[over ¯])=(2.2±0.4±0.1±0.1)×10^{-8} and B(B_{s}^{0}→pp[over ¯]pp[over ¯])=(2.3±1.0±0.2±0.1)×10^{-8}. In these measurements, the first uncertainty is statistical, the second is systematic, and the third one is due to the external branching fraction of the normalization channel.

[Application of intraoperative endoscopic in laparoscopic gastric cancer surgery]

The application of intraoperative endoscopic in laparoscopic gastric cancer surgery can compensate for the limitations of a single laparoscopic mode that only relies only on serous vision, and work as the Chinese saying "four ounces can move a thousand pounds". Intraoperative endoscopy not only effectively helps to accurately locate the tumor boundary in real-time and achieve precise resection, but also enables real time and interactive inspection of the quality of esophagojejunal anastomosis, reduces postoperative complications such as anastomotic leakage and bleeding, and accelerates postoperative recovery. However, most centers in China do not emphasize the application of intraoperative endoscopy in laparoscopic gastric cancer surgery due to the lack of a good cooperation mechanism between the gastrointestinal surgery team and the digestive endoscopy team. Therefore, based on clinical practice experience, the author briefly discusses the application of intraoperative endoscopic in routine laparoscopic gastric cancer surgery, including pre-examination preparation operator position, endoscopic techniques, postoperative management, etc., covering application scenarios such as early tumor localization, confirmation of upper esophageal margin confirmation, anastomotic examination, biopsy of primary lesion specimens in neoadjuvant/conversion treatment cases. We hope that it will help gastroenterologists to better apply intraoperative endoscopy in laparoscopic gastric cancer surgery, and assist in precise resection and safe anastomosis of the operation.

Observation of a Resonant Structure near the D_{s}^{+}D_{s}^{-} Threshold in the B^{+}→D_{s}^{+}D_{s}^{-}K^{+} Decay

An amplitude analysis of the B^{+}→D_{s}^{+}D_{s}^{-}K^{+} decay is carried out to study for the first time its intermediate resonant contributions, using proton-proton collision data collected with the LHCb detector at center-of-mass energies of 7, 8, and 13 TeV. A near-threshold peaking structure, referred to as X(3960), is observed in the D_{s}^{+}D_{s}^{-} invariant-mass spectrum with significance greater than 12 standard deviations. The mass, width, and the quantum numbers of the structure are measured to be 3956±5±10  MeV, 43±13±8  MeV, and J^{PC}=0^{++}, respectively, where the first uncertainties are statistical and the second systematic. The properties of the new structure are consistent with recent theoretical predictions for a state composed of cc[over ¯]ss[over ¯] quarks. Evidence for an additional structure is found around 4140 MeV in the D_{s}^{+}D_{s}^{-} invariant mass, which might be caused either by a new resonance with the 0^{++} assignment or by a J/ψϕ↔D_{s}^{+}D_{s}^{-} coupled-channel effect.

Evidence for Modification of b Quark Hadronization in High-Multiplicity pp Collisions at sqrt[s]=13 TeV

The production rate of B_{s}^{0} mesons relative to B^{0} mesons is measured by the LHCb experiment in pp collisions at a center-of-mass energy sqrt[s]=13  TeV over the forward rapidity interval 2 Collapse

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Test of Lepton Universality in b→sℓ^{+}ℓ^{-} Decays

The first simultaneous test of muon-electron universality using B^{+}→K^{+}ℓ^{+}ℓ^{-} and B^{0}→K^{*0}ℓ^{+}ℓ^{-} decays is performed, in two ranges of the dilepton invariant-mass squared, q^{2}. The analysis uses beauty mesons produced in proton-proton collisions collected with the LHCb detector between 2011 and 2018, corresponding to an integrated luminosity of 9  fb^{-1}. Each of the four lepton universality measurements reported is either the first in the given q^{2} interval or supersedes previous LHCb measurements. The results are compatible with the predictions of the Standard Model.

First Observation of a Doubly Charged Tetraquark and Its Neutral Partner

A combined amplitude analysis is performed for the decays B^{0}→D[over ¯]^{0}D_{s}^{+}π^{-} and B^{+}→D^{-}D_{s}^{+}π^{+}, which are related by isospin symmetry. The analysis is based on data collected by the LHCb detector in proton-proton collisions at center-of-mass energies of 7, 8, and 13 TeV. The full data sample corresponds to an integrated luminosity of 9  fb^{-1}. Two new resonant states with masses of 2.908±0.011±0.020  GeV and widths of 0.136±0.023±0.013  GeV are observed, which decay to D_{s}^{+}π^{+} and D_{s}^{+}π^{-} respectively. The former state indicates the first observation of a doubly charged open-charm tetraquark state with minimal quark content [cs[over ¯]ud[over ¯]], and the latter state is a neutral tetraquark composed of [cs[over ¯]u[over ¯]d] quarks. Both states are found to have spin-parity of 0^{+}, and their resonant parameters are consistent with each other, which suggests that they belong to an isospin triplet.

Search for Rare Decays of D^{0} Mesons into Two Muons

A search for the very rare D^{0}→μ^{+}μ^{-} decay is performed using data collected by the LHCb experiment in proton-proton collisions at sqrt[s]=7, 8, and 13 TeV, corresponding to an integrated luminosity of 9  fb^{-1}. The search is optimized for D^{0} mesons from D^{*+}→D^{0}π^{+} decays but is also sensitive to D^{0} mesons from other sources. No evidence for an excess of events over the expected background is observed. An upper limit on the branching fraction of this decay is set at B(D^{0}→μ^{+}μ^{-})<3.1×10^{-9} at a 90% C.L. This represents the world's most stringent limit, constraining models of physics beyond the standard model.

Nuclear Modification Factor of Neutral Pions in the Forward and Backward Regions in p-Pb Collisions

The nuclear modification factor of neutral pions is measured in proton-lead collisions collected at a center-of-mass energy per nucleon of 8.16 TeV with the LHCb detector. The π^{0} production cross section is measured differentially in transverse momentum (p_{T}) for 1.5 Collapse

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[Impact of the depth of remission by induction chemotherapy on the prognosis of limited stage small cell lung cancer]

Objective: To evaluate the effect of depth of remission of induction chemotherapy on the overall prognosis of limited stage small cell lung cancer (L-SCLC). Methods: The study was a retrospective, L-SCLC patients who contained complete imaging data and underwent consecutive standardized treatments at the Department of Thoracic Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University between January 2013 and June 2021 were included. To delineate the volume of tumor before and after induction chemotherapy and to calculate the depth of remission caused by the induced chemotherapy. The time receiver operating characteristic (timeROC) method was used to determine the optimal predictors for prognosis, multi-factor analysis using Cox risk proportional model. Results: A total of 104 patients were included in this study. The median PFS and OS of this cohort were 13.7 months and 20.9 months, respectively. It was observed by timeROC analysis that residual tumor volume after induction chemotherapy had the optimal predictive value of PFS at 1 year (AUC=0.86, 95% CI: 0.78~0.94) and OS at 2 years (AUC=0.76, 95% CI: 0.65~0.87). Multivariate analysis showed residual tumor volume after induction chemotherapy was the independent prognostic factor to PFS (HR=1.006, 95% CI: 1.003~1.009, P<0.01) and OS (HR=1.009, 95% CI: 1.005~1.012, P<0.001). For those whose residual tumor volume remitted to less than 10 cm(3) after induction chemotherapy, the favorable long-term outcomes could be achieved, regardless of their initial tumor load. Conclusion: The depth of remission of induction chemotherapy could be a promising prognostic predictor to the L-SCLC and provide the individualized treatment guidance.

Observation of a J/ψΛ Resonance Consistent with a Strange Pentaquark Candidate in B^{-}→J/ψΛp[over ¯] Decays

An amplitude analysis of B^{-}→J/ψΛp[over ¯] decays is performed using 4400 signal candidates selected on a data sample of pp collisions recorded at center-of-mass energies of 7, 8, and 13 TeV with the LHCb detector, corresponding to an integrated luminosity of 9  fb^{-1}. A narrow resonance in the J/ψΛ system, consistent with a pentaquark candidate with strangeness, is observed with high significance. The mass and the width of this new state are measured to be 4338.2±0.7±0.4  MeV and 7.0±1.2±1.3  MeV, where the first uncertainty is statistical and the second systematic. The spin is determined to be 1/2 and negative parity is preferred. Because of the small Q-value of the reaction, the most precise single measurement of the B^{-} mass to date, 5279.44±0.05±0.07  MeV, is obtained.

[Sinogram interpolation combined with unsupervised image-to-image translation network for CT metal artifact correction]

OBJECTIVE

To propose a framework that combines sinogram interpolation with unsupervised image-to-image translation (UNIT) network to correct metal artifacts in CT images.

METHODS

The initially corrected CT image and the prior image without artifacts, which were considered as different elements in two different domains, were input into the image transformation network to obtain the corrected image. Verification experiments were carried out to assess the effectiveness of the proposed method using the simulation data, and PSNR and SSIM were calculated for quantitative evaluation of the performance of the method.

RESULTS

The experiment using the simulation data showed that the proposed method achieved better results for improving image quality as compared with other methods, and the corrected images preserved more details and structures. Compared with ADN algorithm, the proposed algorithm improved the PSNR and SSIM by 2.4449 and 0.0023 when the metal was small, by 5.9942 and 8.8388 for images with large metals, and by 8.8388 and 0.0130 when both small and large metals were present, respectively.

CONCLUSION

The proposed method for metal artifact correction can effectively remove metal artifacts, improve image quality, and preserve more details and structures on CT images.

ICARUS at the Fermilab Short-Baseline Neutrino program: initial operation

The ICARUS collaboration employed the 760-ton T600 detector in a successful 3-year physics run at the underground LNGS laboratory, performing a sensitive search for LSND-like anomalous ν e appearance in the CERN Neutrino to Gran Sasso beam, which contributed to the constraints on the allowed neutrino oscillation parameters to a narrow region around 1 eV2 . After a significant overhaul at CERN, the T600 detector has been installed at Fermilab. In 2020 the cryogenic commissioning began with detector cool down, liquid argon filling and recirculation. ICARUS then started its operations collecting the first neutrino events from the booster neutrino beam (BNB) and the Neutrinos at the Main Injector (NuMI) beam off-axis, which were used to test the ICARUS event selection, reconstruction and analysis algorithms. ICARUS successfully completed its commissioning phase in June 2022. The first goal of the ICARUS data taking will be a study to either confirm or refute the claim by Neutrino-4 short-baseline reactor experiment. ICARUS will also perform measurement of neutrino cross sections with the NuMI beam and several Beyond Standard Model searches. After the first year of operations, ICARUS will search for evidence of sterile neutrinos jointly with the Short-Baseline Near Detector, within the Short-Baseline Neutrino program. In this paper, the main activities carried out during the overhauling and installation phases are highlighted. Preliminary technical results from the ICARUS commissioning data with the BNB and NuMI beams are presented both in terms of performance of all ICARUS subsystems and of capability to select and reconstruct neutrino events.

Porous carbon tubes from recycling waste COVID-19 masks for optimization of 8 mol% Y2O3-doped tetragonal zirconia polycrystalline nanopowder

Disposable polypropylene medical masks are widely used to protect people from injury caused by COVID-19 worldwide. However, disposable medical masks are non-biodegradable materials, and the accumulation of waste masks can pollute the environment and waste resources without a reasonable recycling method. The aims of this study are to transform waste masks into carbon materials and to use them as a dispersant in preparing high-quality 8 mol% Y₂O₃-doped tetragonal zirconia nanopowders. The waste masks were carbonized to get a carbon source in the first step, then KOH was used to etch the carbon source creating a micropores structure in the carbon material after the carbon-bed heat treatment method. The resulting carbon material is a porous tube structure with a high specific surface area (1220.34 m²/g) and adsorption capacity. The as-obtained porous carbon tubes were applied as a dispersant to produce 8 mol% Y₂O₃-doped tetragonal zirconia nanopowders, and the resulting nanopowders owned well-dispersed and had the smallest particle size than that prepared by activated carbon as a dispersant. Besides, the sintered 8 mol% Y₂O₃-doped tetragonal zirconia ceramic possessed high density, which resulted in higher ionic conductivity. These findings suggest that waste face masks can be recycled to prepare high-added-value carbon materials and provide a green and low-cost method to reuse polypropylene waste materials.

Donor selection for fecal bacterial transplantation and its combined effects with inulin on early growth and ileal development in chicks

AIMS

To select the best donor and investigate its combined effects with inulin on growth performance, and ileal health of chicks.

METHODS AND RESULTS

The chicks (Hy-line Brown) were treated with fecal microbiota suspension from different breeder hens to select the best donor. Treatment with fecal microbiota transplantation (FMT) alone or in combination with inulin found that it improved gut microbiome in chicks. The organ indexes were increased on 7d, especially the bursa of fabricius index (P < 0.05). On 14d, immune performance, ileal morphology, and barrier were improved, simultaneously, the concentration of short-chain fatty acids was also increased. In addition, for the expression of ileal barrier-related genes, Anaerofustis and Clostridium were positively correlated with them (P < 0.05), Blautia, Prevotella, Veillonella, and Weissella were the opposite (P < 0.05), and RFN20 showed a positive correlation with gut morphology (P < 0.05).

CONCLUSION

Combination of homologous FMT and inulin promoted early growth and intestinal health of chicks.

SLC7A11-associated ferroptosis in acute injury diseases: mechanisms and strategies

Ferroptosis is a kind of iron-dependent renewal programmed death. Its main mechanism is to catalyze the unsaturated fatty acids highly expressed on the cell membrane under the effect of divalent iron, to produce lipid peroxidation, thus inducing cell death. SLC7A11 is a known iron death-related factor. It has been proved that iron death is involved in the occurrence and development of acute diseases, but the specific mechanism is unknown. The purpose of this review is to highlight the regulatory properties of SLC7A11 and gain a deeper understanding of its role in ferroptosis-related acute injury diseases. This is a narrative review. PubMed was used as the main source to randomly implement literature search strategy to index Scopus articles. No specific terms are used. Studies have shown that SLC7A11 may affect the sensitivity of cells to iron ptosis by regulating it at the transcriptional or post-transcriptional level, which is related to the pathology of many acute injury diseases, such as acute lung injury (ALI), acute kidney injury (AKI), acute liver injury, myocardial ischemia-reperfusion injury, and acute cerebral hemorrhage. In order to clarify this point, more and more researchers turn their attention to the study of the specific mechanism between SLC7A11 and ferroptosis-related acute injury diseases. In summary, this review summarized some specific mechanisms by which ferroptosis could be controlled by SLC7A11 and clarified the underlying mechanisms of a series of diseases caused by SLC7A11-associated ferroptosis. It also provided more scientific justification for the clinical application of targeting ferroptosis in preventing and treating various diseases.

Effect of pneumatic leg compression on post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy: a double-blind randomised controlled trial

Post-induction hypotension is common and associated with postoperative complications. We hypothesised that pneumatic leg compression reduces post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy. In this double-blind randomised study, patients were allocated randomly to the pneumatic leg compression group (n = 50) or control (n = 50). In the intervention group, pneumatic leg compression was initiated before induction of anaesthesia. In the control group, pneumatic leg compression was initiated 20 min after anaesthesia induction. The primary outcome was the incidence of post-induction hypotension in these groups. Post-induction hypotension was defined as systolic blood pressure < 90 mmHg during the first 20 min after induction. Haemodynamic variables and area under the curve of post-induction systolic blood pressure over time were assessed. Complications associated with pneumatic leg compression were recorded, including: peripheral neuropathy; compartment syndrome; extensive bullae beneath the leg sleeves; and pulmonary thromboembolism. The incidence of post-induction hypotension decreased in the pneumatic leg compression group compared with that in the control group; 5 (10%) vs. 29 (58%), respectively, p < 0.001. In the pneumatic leg compression group, the lowest systolic, diastolic and mean blood pressures 20 min after induction of anaesthesia were significantly greater than the control group. Pneumatic leg compression resulted in an increased area under the curve of systolic blood pressure in the first 20 min after induction, p = 0.001. There were no pneumatic leg compression-related complications. Pneumatic leg compression reduced post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy, suggesting that it is an effective and safe intervention to prevent post-induction hypotension among elderly patients undergoing general anaesthesia.

Cadmium exposure and risk of breast cancer: A meta-analysis

BACKGROUND

Cadmium is a heavy metal with carcinogenic properties, highly prevalent in industrialized areas worldwide. Prior reviews evaluating whether cadmium influences breast cancer have been inconclusive and not reflected several recent studies.

OBJECTIVE

To evaluate the association between cadmium exposure and female breast cancer incidence, with an emphasis on separately estimating dietary vs. airborne vs. biomarker measures of cadmium and studies published until October 2022.

METHODS

We evaluated risk of bias using set criteria and excluded one study judged to have high risk based on self-report of breast cancer and insufficient adjustment. We conducted a random effects meta-analysis of epidemiological studies, including subgroups by exposure route and by menopausal status.

RESULTS

A total of 17 studies were eligible for our meta-analysis. Only 2 studies addressed airborne cadmium directly. Breast cancer risk was elevated in women exposed to higher levels of cadmium across all studies - pooled odds ratio: 1.13 (95% confidence interval: 1.00, 1.28), with notable heterogeneity between studies (I² = 77%). When examining separately by exposure route, dietary cadmium was not linked with an elevated risk - (OR: 1.05; 95%CI: 0.91, 1.21; I² = 69%), consistent with prior reviews, but biomarker-based studies showed an elevated but non-significant pooled measure (OR: 1.37; 95%CI: 0.96, 1.94; I² = 84%). We did not observe any clear patterns of different risk by menopausal status.

CONCLUSION

Findings from our meta-analysis suggest that exposure to higher cadmium increases the risk of breast cancer in women, but with remaining questions about whether non-dietary exposure may be more risky or whether residual confounding by constituents of tobacco smoke may be at play.

Base MRI Imaging Characteristics of Meningioma Patients to Discuss the WHO Classification of Brain Invasion Otherwise Benign Meningiomas

PURPOSE

Compared and analyzed the MRI imaging features of brain invasion otherwise benign (BIOB) meningiomas and WHO grade 1, grade 2 meningiomas, discussed the WHO grading of BIOB from the perspective of imaging.

MATERIALS AND METHODS

A retrospective analysis was performed on 675 meningiomas patients who carried on MRI examination from January 2006 to February 2022. Setting the 2022 Central nervous system (CNS) WHO Guidelines as the gold standard for pathological diagnosis. Statistical analysis of age, gender, and MRI features of meningiomas in relation to WHO grade and brain invasion.

RESULTS

Among 675 cases meningiomas, 543 (80.4%) were WHO grade 1, 123 (18.2%) were WHO grade 2, and 9 (1.3%) were WHO grade 3. There were 108 cases meningiomas with brain invasion (BI) (16.0%) and 567 cases without BI (84.0%). Among BI cases, 67 cases were BIOB. Compared the MRI features between BIOB and WHO grade 1 meningiomas, multivariate analysis demonstrated that the most strongly factors associated with distinguish them were enhancement degree, peritumoral edema, tumor-brain interface, fingerlike protrusion, mushroom sign, and bone invasion (AUC: 0.925 (0.901∼0.945), sensitivity: 0.925, specificity: 0.801). Compared the MRI features between BIOB and WHO grade 2 meningiomas, multivariate analysis demonstrated that the most strongly factors associated with distinguish them were enhancement degree and the tumor-brain interface (AUC: 0.779 (0.686∼0.841), sensitivity: 0.746, specificity: 0.732), their efficacy was slightly weaker.

CONCLUSIONS

BIOB is more similar to WHO grade 2 meningiomas in clinical and imaging features than WHO grade 1, so we think that it may be reasonable to classify BIOB as WHO Grade 2 meningiomas in the guidelines.

Effect of food additives on key bacterial taxa and the mucosa-associated microbiota in Crohn's disease. The ENIGMA study

Food additives have been linked to the pro-inflammatory microbial dysbiosis associated with Crohn's disease (CD) but the underlying ecological dynamics are unknown. Here, we examine how selection of food additives affects the growth of multiple strains of a key beneficial bacterium (Faecalibacterium prausnitzii), axenic clinical isolates of proinflammatory bacteria from CD patients (Proteus, Morganella, and Klebsiella spp.), and the consortia of mucosa-associated microbiota recovered from multiple Crohn's disease patients. Bacterial growth of the axenic isolates was evaluated using a habitat-simulating medium supplemented with either sodium sulfite, aluminum silicate, carrageenan, carboxymethylcellulose, polysorbate 80, saccharin, sucralose, or aspartame, intended to approximate concentrations found in food. The microbial consortia recovered from post-operative CD patient mucosal biopsy samples were challenged with either carboxymethylcellulose and/or polysorbate 80, and the bacterial communities compared to unchallenged consortia by 16S rRNA gene amplicon profiling. Growth of all F. prausnitzii strains was arrested when either sodium sulfite or polysorbate 80 was added to cultures at baseline or mid-exponential phase of growth, and the inhibitory effects on the Gram-negative bacteria by sodium sulfite were conditional on oxygen availability. The effects from polysorbate 80, saccharin, carrageenan, and/or carboxymethylcellulose on these bacteria were strain-specific. In addition to their direct effects on bacterial growth, polysorbate 80 and/or carboxymethylcellulose can drive profound changes in the CD mucosa-associated microbiota via niche expansion of Proteus and/or Veillonellaceae - both implicated in early Crohn's disease recurrence. These studies on the interaction of food additives with the enteric microbiota provide a basis for dietary management in Crohn's disease.

Global Prevalence and Factors Associated with Frailty among Community-Dwelling Older Adults with Hypertension: A Systematic Review and Meta-Analysis

BACKGROUND

Frailty may increase the risk of adverse outcomes and the presence of comorbidities in hypertension. Understanding the prevalence of frailty in older adults with hypertension is of great importance, whereas estimates of the prevalence of frailty in this population vary greatly.

OBJECTIVES

A systematic review and meta-analysis was conducted to estimate the pooled prevalence of frailty and prefrailty among community-dwelling older adults with hypertension, and to examine the risk factors associated with (pre)frailty in this population.

METHODS

PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL were searched from the inception to May 10, 2023. Investigators assessed eligibility, extracted data, and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. Sensitivity analysis was undertaken by the leave-one-out method and by removing studies with moderate/high risk of bias. The Mantel-Haenszel or inverse variance method was used to estimate risk factors of frailty.

RESULTS

A total of 14 studies met the inclusion criteria, involving 185,249 participants. The pooled prevalence in older adults with hypertension was 23% (95% CI 0.09-0.36) for frailty and 46% (95% CI 0.38-0.54) for prefrailty. The pooled prevalence of frailty was greater in studies with a higher proportion of females (24%, 95% CI 0.05-0.50), using multidimensional tools to define frailty (30%, 95% CI 0.10-0.51) and conducted in Western Pacific (27%, 95% CI 0.17-0.39). Age, female sex, depression, and previous hospitalizations were risk factors of frailty among older adults with hypertension.

CONCLUSION

Frailty and prefrailty are prevalent in community-dwelling older adults with hypertension, and limited risk factors are identified. This implicates the importance of frailty assessment integrated into the routine primary care for older adults with hypertension in community settings as well as the understanding of potential factors.

High Dietary Zinc Intake Is Associated with Shorter Leukocyte Telomere Length, Mediated by Tumor Necrosis Factor-α: A Study of China Adults

OBJECTIVES

Diet can influence peripheral leukocyte telomere length (LTL), and various micronutrients have been reported to correlate with it. Zinc is known for its antioxidant properties and immunomodulatory effects. However, there are few epidemiological investigations on the relationship between dietary zinc intake and LTL. This study analyzed the association between dietary zinc and LTL and the potential role of inflammation and oxidative stress among them.

DESIGN

Cross-sectional and community-based study.

SETTING AND PARTICIPANTS

599 participants from rural communities in the Changping suburb of Beijing, China, were recruited.

MEASUREMENTS

Serum lipid profile, glycosylated hemoglobin (HbA1c), oxidative stress marker, and inflammatory cytokines levels were measured. Detailed dietary data were obtained using a 24 h food recall. LTL was assessed using a real-time PCR assay. Spearman analysis, restricted cubic splines (RCS), and general linear regression models were used to determine the association between dietary zinc intake and LTL. Simple regulatory models were also applied to analyze the role of inflammation and oxidative stress among them.

RESULTS

A total of 482 subjects were ultimately included in this analysis. Spearman analysis showed that dietary zinc intake and zinc intake under energy density were negatively correlated with LTL (r=-0.142 and -0.126, all P <0.05) and positively correlated with tumor necrosis factor-α (TNF-α) (r=0.138 and 0.202, all P <0.05) while only dietary zinc without energy adjustment had a positive correlation with superoxide dismutase (SOD). RCS (P for non-linearity=0.933) and multiple linear regression (B=-0.084, P=0.009) indicated a negative linear association between dietary zinc and LTL. The adjustment of TNF-α rather than SOD could abolish the relationship. The mediation model suggested that the unfavorable effect of dietary zinc on LTL was mediated by TNF-α.

CONCLUSIONS

High dietary zinc may correlate with telomere attrition, and TNF-α can act as a mediator in this relationship. In the future, more extensive cohort studies are needed to further explore the relationship between dietary zinc and cellular aging and the specific mechanisms.