Norovirus outbreaks in hospitals in China: a systematic review

BACKGROUND

Norovirus outbreaks in hospitals can potentially impair patient care and result in significant financial expenses. There is currently limited information on hospital norovirus outbreaks in the Chinese mainland.

AIM

To systematically review the published literature to describe the characteristics of norovirus outbreaks in Chinese mainland hospitals to facilitate prompt identification and control of outbreaks.

METHODS

A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis standards. Databases including PubMed, Web of Science, and Chinese Journals Online databases (China National Knowledge Infrastructure (CNKI), Chinese Wan Fang digital database (WANFANG) were searched from inception to July 18th, 2022.

FINDINGS

A total of 41 norovirus Chinese hospital outbreaks occurring before July 18th, 2022 were reported in 32 articles. Most reported outbreaks were from Shanghai and Beijing, and occurred in December and January. Cases were mainly adults. The male:female ratio was 1.22:1. The majority of cases in norovirus outbreaks were hospitalized patients (56.82%); medical staff were affected in 15 outbreaks. Norovirus outbreaks occurred in both private and public hospitals, and in secondary and tertiary care centres, and occurred mainly in internal medicine and geriatric departments. Person-to-person transmission was the primary transmission mode and GII was more prevalent.

CONCLUSION

Norovirus outbreaks in hospitals can affect both patients and healthcare workers, sometimes causing serious financial losses. In order to have a more complete understanding of the disease burden caused by norovirus outbreaks, surveillance needs to be established in hospitals.

[Neurobehavioral effects of explosion exposure on acute and chronic traumatic brain injury in rats]

Objective: To explore the effect of nerve injury in rats by neurobehavioral experiments, in order to provide a model and idea for further clarification of the traumatic brain injury mechanism under explosion exposure. Methods: From May 2021 to August 2022, 160 SPF male rats were randomly divided into four groups, including control group, 60 kPa group (low intensity group), 90 kPa group (medium intensity group) and 120 kPa group (high intensity group). The blast induced traumatic brain injury (bTBI) model of rats was established by using the shock tube platform to simulate the shock wave parameters of the explosion overpressure of 60 kPa, 90 kPa and 120 kPa. Acute observation was carried out after 24 h and 7 d of explosive exposure, and chronic recovery observation was carried out after 28 d and 90 d. The time effect of shock wave brain injury in different situations was discussed by open field, light dark test, active avoidance test. Finally, the results of brain injury in rats were detected by pathological tissue staining. Results: After 24 h explosion exposure, compared with the control group, the rest time of rats in low and high intensity groups increased, the total movement distance decreased, and the number of visits to the camera obscura decreased, with statistical significance (P<0.05). After 7 days of exposure, compared with the control group, the rest time of rats in high intensity group increased, and the number of visits to the obscura decreased, with statistical significance (P<0.05). After 28 and 90 days of exposure, compared with the control group, there were no significant differences in rest time, total exercise distance and times of visiting the camera obscura in all intensity groups (P>0.05). After 24 h of explosive exposure, compared with the control group, the cell morphology of rats in each intensity group was normal, and no inflammatory cell infiltration was observed. Conclusion: In the acute phase (24 h) of blast exposure, rats have no desire to explore the outside world, and shock wave exposure may damage the neurological function of rats.

[Incidence and related factors of antiviral drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019]

Objective: To analyze the incidence and related factors of drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019. Methods: From April 2017 to April 2019, face-to-face questionnaires and blood sample testing were conducted in all health care institutions providing maternal and perinatal care and midwifery-assisted services in 7 prevention of mother-to-child transmissi project areas in Xinjiang, Yunnan and Guangxi provinces/autonomous regions. Information was collected during the perinatal period and viral load, CD4+T lymphocytes and drug resistance genes were detected at the same time. The multivariate logistic regression model was used to analyze the relationship between different factors and drug resistance in HIV-infected pregnant and postpartum women. Results: A total of 655 HIV-infected pregnant and postpartum women were included in this study. The incidence of drug resistance was 3.4% (22/655), all of whom were cross-drug resistant. The rate of low, moderate and high drug resistance was 2.1% (14/655), 1.2% (8/655) and 0.8% (5/655), respectively. The drug resistance rate in the people who had previously used antiviral drugs was 1.9% (8/418), and the drug resistance rate in the people who had not used drugs was 5.9% (14/237). The NNRTI drug resistance accounted for 2.8% (18/655) and the NRTI drug resistance rate was 2.5% (16/655). The multivariate logistic regression model showed that the risk of HIV resistance was lower in pregnant women who had previously used antiviral drugs (OR=0.32, 95%CI: 0.11-0.76). Conclusion: Strengthening the management of antiviral drug use and focusing on pregnant and postpartum women who have not previously used antiviral drugs can help reduce the occurrence of drug-resistant mutations. Personalized antiviral therapy should be considered to achieve viral inhibition effects in clinical practice.

[Study on formulation and revision of detection methods of "Standards for indoor air quality (GB/T 18883-2022)" in China]

The formulation and revision of the detection methods of indoor air quality standards is an important, rigorous and delicate endeavor. This paper introduced the formulation and revision of the detection methods of the standards for indoor air quality (GB/T 18883-2022), focusing on the revision process, revision principles, main adjustments and technical points of some key indicators to facilitate users to better understand and apply the detection methods in standards for indoor air quality (GB/T 18883-2022).

[Study on formulation and revision of standard limit for formaldehyde in the "Standards for indoor air quality（GB/T 18883-2022）" in China]

Formaldehyde, as an important pollutant in indoor air, has always been of great concern. In the newly issued "Standards for indoor air quality (GB/T 18883-2022)", the standard limit of formaldehyde has been restricted to 0.08 mg/m3. In order to better promote the implementation and application of this new standard, this study reviewed and interpreted the relevant technical content for determining the standard limit, including the indoor concentration and human exposure levels of formaldehyde, the health effects of formaldehyde, and the derivation of safety reference values. It also proposed prospect for the future development and revision of quality standards for formaldehyde in indoor air.

[The role of intravoxel incoherent motion diffusion-weighted imaging in distinguishing diabetic nephropathy from non-diabetic renal disease in diabetic patients]

Objective: To investigate the intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus (T2DM). Methods: A diagnostic test. In this prospective study, patients with T2DM who underwent both IVIM-DWI and renal biopsy at the First Medical Center of Chinese PLA General Hospital between October 2017 and September 2021 were consecutively enrolled. IVIM-DWI parameters including perfusion fraction (f), pure diffusion coefficient (D), and pseudo-diffusion coefficient (D*) were measured in the renal cortex, medulla, and parenchyma. Patients were divided into the DN group and NDRD group based on the renal biopsy results. IVIM-DWI parameters, clinical information, and diabetes-related biochemical indicators between the two groups were compared using Student's t-test or Mann-Whitney U test. The correlation of IVIM-DWI parameters with diabetic nephropathy histological scores were analyzed using Spearman's correlation analyzes. The diagnostic efficiency of IVIM-DWI parameters for distinguishing between DN and NDRD were assessed using the receiver operating characteristic (ROC) curves. Results: A total of 27 DN patients and 23 NDRD patients were included in this study. The DN group comprised 19 male and 8 female patients, with an average age of 52±9 years. The NDRD group comprised 16 male and 7 female patients, with an average age of 49±10 years. The DN group had a higher D* value in the renal cortex and a lower f value in the renal medulla than the NDRD group (9.84×10-3 mm2/s vs. 7.35×10-3 mm2/s, Z=-3.65; 41.01% vs. 46.74%, Z=-2.29; all P<0.05). The renal medulla D* value was negatively correlated with DN grades, interstitial lesion score, and interstitial fibrosis and tubular atrophy (IFTA) score (r=-0.571, -0.409, -0.409; all P<0.05) while the renal cortex f value was positively correlated with vascular sclerosis score (r=0.413, P=0.032). The renal cortex D* value had the highest area under the curve (AUC) for discriminating between the DN and NDRD groups (AUC=0.802, sensitivity 91.3%, specificity 55.6%). Conclusion: IVIM-derived renal cortex D* value can be used non-invasively to differentiate DN from NDRD in patients with T2DM that can potentially facilitate individualized treatment planning for diabetic patients.

[The 503rd case: monoclonal IgM immunoglobulinemia, severe anemia with recurrent fever]

A 42-year-old woman was diagnosed with Waldenström macroglobulinemia (WM) with fatigue, anemia, and monoclonal IgM immunoglobulinemia 6 years prior. She experienced persistent severe anemia with only transient remission after initial chemotherapy and after multiple chemotherapy regimens and immunosuppressive therapies, which were accompanied by recurrent high fever with severe complications including urinary infection, sepsis and shock, rectal perforation, and severe obstructive jaundice. The anemia was diagnosed as warm autoimmune hemolytic anemia and aplastic crisis with inflammation anemia. She received ibrutinib 140 mg once a day, and her hemoglobin levels returned to normal. WM remained stable in very good partial remission with no infection.

[Application of single anterior teeth defect with computer-aided design and computer-aided manufacturing polymethyl methacrylate single-retainer resin-bonded fixed dental prosthesis in children]

Objective: To explore the clinical effect of computer-aided design and computer-aided manufacturing (CAD/CAM) polymethyl methacrylate (PMMA) single-retainer resin-bonded fixed dental prosthesis (RBFDP) for single anterior teeth defect. Methods: A total of 14 children between 10-14 years old (male 8, female 6) who visited the Department of Pediatric Dentistry, School of Stomatology, The Fourth Military Medical University from March to December 2022 with single anterior teeth loss were enrolled in this study. The intraoral scanner was used to obtain their digital impressions, and then the data were imported into CAD software. The single-retainer RBFDP was designed by the CAD software and was manufactured by milling equipment using CAD/CAM PMMA disk. The prosthesis was then tried-in and bonded to the abutment teeth with resin cement and evaluated in a 12 month follow-up observation. The marginal discoloration, marginal adaptation, color match, secondary caries, the occurrence of fractures and loose of abutment tooth were examined on the basis of the modified United States Public Health Services evaluation system. The evaluation was divided into three scores, in which score A indicated ideal restoration effect, score B means that the restoration effect was acceptable (evaluation of restoration integrity, loose of abutment teeth and secondary caries excluded), and score C indicates that the restoration effect is not good. Results: All the 14 CAD/CAM PMMA single-retainer RBFDP had good marginal adaptation and color match with no marginal discoloration, no secondary caries, no fracture of restorations and no abnormal loose of the abutment teeth. All of the six criteria achieved score A evaluation after a three month follow-up observation. One restoration was classified as score B for fracture after a six month follow-up observation, while two restoration were classified as score B for marginal discoloration after 12 month follow-up observation. Conclusions: The CAD/CAM PMMA single-retainer RBFDP was clinically effective in restoration of single anterior teeth defect in children.

Measurement of the top quark mass using a profile likelihood approach with the lepton + jets final states in proton-proton collisions at s=13TeV

The mass of the top quark is measured in 36.3fb - 1 of LHC proton-proton collision data collected with the CMS detector at s = 13 Te V . The measurement uses a sample of top quark pair candidate events containing one isolated electron or muon and at least four jets in the final state. For each event, the mass is reconstructed from a kinematic fit of the decay products to a top quark pair hypothesis. A profile likelihood method is applied using up to four observables per event to extract the top quark mass. The top quark mass is measured to be 171.77 ± 0.37 Ge V . This approach significantly improves the precision over previous measurements.

[Selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle]

Objective: To explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle. Methods: The retrospective observational research method was used. From January 2017 to December 2022, 16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command, including 11 cases of unilateral defect and 5 cases of bilateral defect. All patients were male, aged from 25 to 75 years. After thorough debridement, the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm. Before operation, the color Doppler ultrasound, computed tomography angiography, or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network. Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible, and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm. The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh. The flap repair of wounds in various areas of the ankle and foot was recorded. The postoperative survivals of the flaps and skin grafts were observed after surgery. The postoperative appearance of flaps and walking function of patients were followed up. At the last follow-up, the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System. Results: Two wounds in toe area were repaired with reverse dorsal pedis flaps, 3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps, 2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps, 2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps, 1 wound in toe area was combined with proper plantar digital artery flap, 1 dorsal pedis wound and 1 lateral malleolus wound were repaired with lateral supramalleolar perforator flaps, and 1 lateral malleolus wound and 1 dorsal pedis wound were repaired with sural neurovascular flap. One flap had venous reflux disorder after surgery and survived after treatment, while the other flaps and skin grafts survived completely after surgery. During the follow-up of 6 to 24 months after operation, the appearance of the flaps was good, and the walking function of patients was normal. At the last follow-up, the functional score of foot and ankle was 76 to 95, which was evaluated as excellent in 11 cases and good in 5 cases. Conclusions: According to the condition of high-voltage electric burn in foot and ankle, early and thorough debridement, preoperative imaging examination to evaluate blood vessels of the affected limb, and selection of pedicled axial flap with reliable blood supply are good methods for wound repair and related functional reconstruction of high-voltage electric burn in foot and ankle.

A US-based national surveillance study for the susceptibility and epidemiology of Clostridioides difficile isolates with special reference to ridinilazole: 2020-2021

We have previously reported on the susceptibility and epidemiology of Clostridioides difficile isolates from six geographically dispersed medical centers in the United States. This current survey was conducted with isolates collected in 2020-2021 from six geographically dispersed medical centers in the United States, with specific attention to susceptibility to ridinilazole as well as nine comparators. C. difficile isolates or stools from patients with C. difficile antibiotic-associated diarrhea were collected and referred to a central laboratory. After species confirmation of 300 isolates at the central laboratory, antibiotic susceptibilities were determined by the agar dilution method [M11-A9, Clinical and Laboratory Standards Institute (CLSI)] against the 10 agents. Ribotyping was performed by PCR capillary gel electrophoresis on all isolates. Ridinilazole had a minimum inhibitory concentration (MIC) 90 of 0.25 mcg/mL, and no isolate had an MIC greater than 0.5 mcg/mL. In comparison, fidaxomicin had an MIC 90 of 0.5 mcg/mL. The vancomycin MIC 90 was 2 mcg/mL with a 0.7% resistance rate [both CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria]. The metronidazole MIC 90 was 1 mcg/mL, with none resistant by CLSI criteria, and a 0.3% resistance rate by EUCAST criteria. Among the 50 different ribotypes isolated in the survey, the most common ribotype was 014-020 (14.0%) followed by 106 (10.3%), 027 (10%), 002 (8%), and 078-126 (4.3%). Ridinilazole maintained activity against all ribotypes and all strains resistant to any other agent tested. Ridinilazole showed excellent in vitro activity against C. difficile isolates collected between 2020 and 2021 in the United States, independent of ribotype.

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Cox PT, Erbacher R, Haza G, Jensen F, Kukral O, Mocellin G, Mulhearn M, Pellett D, Regnery B, Yao Y, Zhang F, Bachtis M, Cousins R, Datta A, Hauser J, Ignatenko M, Iqbal M, Lam T, Manca E, Nash WA, Saltzberg D, Stone B, Valuev V, Clare R, Gary JW, Gordon M, Hanson G, Long OR, Manganelli N, Si W, Wimpenny S, Branson JG, Cittolin S, Cooperstein S, Diaz D, Duarte J, Gerosa R, Giannini L, Guiang J, Kansal R, Krutelyov V, Lee R, Letts J, Masciovecchio M, Mokhtar F, Pieri M, Quinnan M, Sathia Narayanan BV, Sharma V, Tadel M, Vourliotis E, Würthwein F, Xiang Y, Yagil A, Campagnari C, Citron M, Collura G, Dorsett A, Incandela J, Kilpatrick M, Kim J, Li AJ, Masterson P, Mei H, Oshiro M, Richman J, Sarica U, Schmitz R, Setti F, Sheplock J, Siddireddy P, Stuart D, Wang S, Bornheim A, Cerri O, Dutta I, Latorre A, Lawhorn JM, Mao J, Newman HB, Nguyen TQ, Spiropulu M, Vlimant JR, Wang C, Xie S, Zhu RY, Alison J, An S, Andrews MB, Bryant P, Dutta V, Ferguson T, Harilal A, Liu C, Mudholkar T, Murthy S, Paulini M, Roberts A, Sanchez A, Terrill W, Cumalat JP, Ford WT, Hassani A, Karathanasis G, MacDonald E, Marini F, Perloff A, Savard C, Schonbeck N, Stenson K, Ulmer KA, Wagner SR, Zipper N, Alexander J, Bright-Thonney S, Chen X, Cranshaw DJ, Fan J, Fan X, Gadkari D, Hogan S, Monroy J, Patterson JR, Reichert J, Reid M, Ryd A, Thom J, Wittich P, Zou R, Albrow M, Alyari M, Apollinari G, Apresyan A, Bauerdick LAT, Berry D, Berryhill J, Bhat PC, Burkett K, Butler JN, Canepa A, Cerati GB, Cheung HWK, Chlebana F, Di Petrillo KF, Dickinson J, Elvira VD, Feng Y, Freeman J, Gandrakota A, Gecse Z, Gray L, Green D, Grünendahl S, Guerrero D, Gutsche O, Harris RM, Heller R, Herwig TC, Hirschauer J, Horyn L, Jayatilaka B, Jindariani S, Johnson M, Joshi U, Klijnsma T, Klima B, Kwok KHM, Lammel S, Lincoln D, Lipton R, Liu T, Madrid C, Maeshima K, Mantilla C, Mason D, McBride P, Merkel P, Mrenna S, Nahn S, Ngadiuba J, Noonan D, Norberg S, Papadimitriou V, Pastika N, Pedro K, Pena C, Ravera F, Hall AR, Ristori L, Sexton-Kennedy E, Smith N, Soha A, Spiegel L, Strait J, Taylor L, Tkaczyk S, Tran NV, Uplegger L, Vaandering EW, Zoi I, Avery P, Bourilkov D, Cadamuro L, Chang P, Cherepanov V, Field RD, Koenig E, Kolosova M, Konigsberg J, Korytov A, Kuznetsova E, Lo KH, Matchev K, Menendez N, Mitselmakher G, Muthirakalayil Madhu A, Rawal N, Rosenzweig D, Rosenzweig S, Shi K, Wang J, Wu Z, Adams T, Askew A, Bower N, Habibullah R, Hagopian V, Kolberg T, Martinez G, Prosper H, Viazlo O, Wulansatiti M, Yohay R, Zhang J, Baarmand MM, Butalla S, Elkafrawy T, Hohlmann M, Kumar Verma R, Rahmani M, Yumiceva F, Adams MR, Cavanaugh R, Dittmer S, Evdokimov O, Gerber CE, Hofman DJ, Lemos DS, Merrit AH, Mills C, Oh G, Roy T, Rudrabhatla S, Tonjes MB, Varelas N, Wang X, Ye Z, Yoo J, Alhusseini M, Dilsiz K, Emediato L, Karaman G, Köseyan OK, Merlo JP, Mestvirishvili A, Nachtman J, Neogi O, Ogul H, Onel Y, Penzo A, Snyder C, Tiras E, Amram O, Blumenfeld B, Corcodilos L, Davis J, Gritsan AV, Kyriacou S, 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Strobbe N, Wadud MA, Cremaldi LM, Bloom K, Bryson M, Claes DR, Fangmeier C, Finco L, Golf F, Joo C, Kamalieddin R, Kravchenko I, Reed I, Siado JE, Snow GR, Tabb W, Wightman A, Yan F, Zecchinelli AG, Agarwal G, Bandyopadhyay H, Hay L, Iashvili I, Kharchilava A, McLean C, Morris M, Nguyen D, Pekkanen J, Rappoccio S, Williams A, Alverson G, Barberis E, Haddad Y, Han Y, Krishna A, Li J, Lidrych J, Madigan G, Marzocchi B, Morse DM, Nguyen V, Orimoto T, Parker A, Skinnari L, Tishelman-Charny A, Wamorkar T, Wang B, Wisecarver A, Wood D, Bhattacharya S, Bueghly J, Chen Z, Gilbert A, Hahn KA, Liu Y, Odell N, Schmitt MH, Velasco M, Band R, Bucci R, Cremonesi M, Das A, Goldouzian R, Hildreth M, Hurtado Anampa K, Jessop C, Lannon K, Lawrence J, Loukas N, Lutton L, Mariano J, Marinelli N, Mcalister I, McCauley T, Mcgrady C, Mohrman K, Moore C, Musienko Y, Ruchti R, Townsend A, Wayne M, Yockey H, Zarucki M, Zygala L, Bylsma B, Carrigan M, Durkin LS, Hill C, Joyce M, Lesauvage A, Nunez Ornelas M, Wei 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Bunichev V, Chadeeva M, Chekhovsky V, Danilov M, Dermenev A, Dimova T, Dremin I, Dubinin M, Dudko L, Epshteyn V, Ershov A, Gavrilov G, Gavrilov V, Gninenko S, Golovtcov V, Golubev N, Golutvin I, Gorbunov I, Ivanov Y, Kachanov V, Kardapoltsev L, Karjavine V, Karneyeu A, Kim V, Kirakosyan M, Kirpichnikov D, Kirsanov M, Klyukhin V, Kodolova O, Konstantinov D, Korenkov V, Kozyrev A, Krasnikov N, Lanev A, Levchenko P, Litomin A, Lychkovskaya N, Makarenko V, Malakhov A, Matveev V, Murzin V, Nikitenko A, Obraztsov S, Oskin A, Ovtin I, Palichik V, Perelygin V, Perfilov M, Petrushanko S, Popov V, Radchenko O, Rusinov V, Savina M, Savrin V, Shalaev V, Shmatov S, Shulha S, Skovpen Y, Slabospitskii S, Smirnov V, Sosnov D, Sulimov V, Tcherniaev E, Terkulov A, Teryaev O, Tlisova I, Toropin A, Uvarov L, Uzunian A, Vorobyev A, Voytishin N, Yuldashev BS, Zarubin A, Zhizhin I, Zhokin A. A search for decays of the Higgs boson to invisible particles in events with a top-antitop quark pair or a vector boson in proton-proton collisions at s=13TeV

A search for decays to invisible particles of Higgs bosons produced in association with a top-antitop quark pair or a vector boson, which both decay to a fully hadronic final state, has been performed using proton-proton collision data collected at s = 13 Te V by the CMS experiment at the LHC, corresponding to an integrated luminosity of 138fb - 1 . The 95% confidence level upper limit set on the branching fraction of the 125Ge V Higgs boson to invisible particles, B ( H → inv ) , is 0.54 (0.39 expected), assuming standard model production cross sections. The results of this analysis are combined with previous B ( H → inv ) searches carried out at s = 7 , 8, and 13Te V in complementary production modes. The combined upper limit at 95% confidence level on B ( H → inv ) is 0.15 (0.08 expected).

Observation of τ Lepton Pair Production in Ultraperipheral Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

We present an observation of photon-photon production of τ lepton pairs in ultraperipheral lead-lead collisions. The measurement is based on a data sample with an integrated luminosity of 404  μb^{-1} collected by the CMS experiment at a center-of-mass energy per nucleon pair of sqrt[s_{NN}]=5.02  TeV. The γγ→τ^{+}τ^{-} process is observed for τ^{+}τ^{-} events with a muon and three charged hadrons in the final state. The measured fiducial cross section is σ(γγ→τ^{+}τ^{-})=4.8±0.6(stat)±0.5(syst)  μb, where the second (third) term corresponds to the statistical (systematic) uncertainty in σ(γγ→τ^{+}τ^{-}) in agreement with leading-order QED predictions. Using σ(γγ→τ^{+}τ^{-}), we estimate a model-dependent value of the anomalous magnetic moment of the τ lepton of a_{τ}=0.001_{-0.089}^{+0.055}.

[A case of left pulmonary artery sling combined with congenital tracheal stenosis in an adult]

Pulmonary artery sling in adults is a rare congenital vascular malformation usually accompanied by tracheal and bronchial stenosis. Due to its high mortality risk and relatively poor prognosis, it has rarely been reported in adults. We reported a middle-aged patient who presented with shortness of breath, predominantly after activity, since childhood. He was diagnosed with "tracheal stenosis" in another hospital and received symptomatic treatment. The diagnosis of left pulmonary artery sling with congenital tracheal stenosis was confirmed by multi-slice spiral CT (MSCT), airway examination with flexible bronchoscope and 3D image post-processing system. Data from this case and the related literatures have been summarized and analyzed. This will help clinicians to improve their level of diagnosis and treatment.

[The implementation and management of disease risk reduction claims in the European Union and the United States]

The improvement of food labeling can improve consumers' health awareness, reduce the burden of chronic diseases on the health and economy, and promote the development of the healthy food industry. Disease Risk Reduction Claim has been developed in European Union and the U.S. for over 20 years, with mature management methods and experience, but it is still lacking in China. Learning and drawing on the international management experience of food disease risk reduction claims can assist China to establish food disease risk reduction claims and improve the food health claims and labeling system.

Endoscopic Ultrasonography-Derived Maximum Tumor Thickness and Tumor Shrinkage Rate as Independent Prognostic Factors in Locally Advanced Esophageal Squamous Cell Carcinoma after Neoadjuvant Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

Neoadjuvant chemoradiotherapy (NCRT) is increasingly used in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). Endoscopic ultrasonography (EUS)-derived maximum tumor thickness (MTT) before and after standard NCRT for LA-ESCC indicates treatment response. However, the accuracy of predicting long-term survival remains uncertain. This study aimed to investigate the association between EUS-derived MTT pre- and post-NCRT and tumor shrinkage rate as well as long-term survival in patients with LA-ESCC receiving NCRT.

MATERIALS/METHODS

We retrospectively enrolled patients with LA-ESCC who underwent EUS examination pre- and post-NCRT from 2017 to 2021. MTT was measured using EUS. Tumor shrinkage rate was the ratio of the difference between pre- and post-MTT to pre-MTT. The most fitted cut-off value defining the EUS response was determined by the receiver operating characteristic curve. Univariate and multivariate Cox regression analyses and Kaplan-Meier (KM) curves were used to calculate overall survival (OS) and progression-free survival (PFS). Data from another center were also used for external validation testing.

RESULTS

The median follow-up period was 30.6 months.230 patients with LA-ESCC who underwent EUS pre- or post-NCRT were enrolled. Of the patients, 178 completed the first EUS pre-NCRT and obtained pre-MTT, 200 completed the re-examined EUS post-NCRT and obtained post-MTT, and 148 completed both EUS and achieved tumor shrinkage. In the whole group the 1-year and 3-year OS rates were 93.9% and 67.9%, and PFS rates were 77.7% and 54.1%, respectively. Thinner post-MTT (≤8.8 mm) and EUS-responders (tumor shrinkage rate≥52%) were independently associated with better OS. The result of EUS-respond was an independent prognostic factor could be confirmed in the external validation group. Among LA-ESCC patients with initial ultrasonic T2-3 staging and T4 staging, no statistically differences were observed between the responder and non-responder groups (P = 0.082; P = 0.190).

CONCLUSION

EUS-derived MTT and tumor shrinkage post-NCRT are independent prognostic factors for long-term survival and may be an alternative method for evaluating tumor response in patients with LA-ESCC after NCRT. Initial tumor infiltration beyond esophageal adventitial layer on ultrasound effect could not, however, predict the long-term prognosis.

Comparison of Pathologic Response and Survival Outcomes between Neoadjuvant Immunochemotherapy (nICT) and Neoadjuvant Chemoradiotherapy (nCRT) in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

PURPOSE/OBJECTIVE(S)

The neoadjuvant immunochemotherapy (nICT) is a novel treatment, which is likely to be safer for locally advanced, surgically resectable Esophageal squamous cell carcinoma (ESCC) that comparing with the traditional neoadjuvant therapy. However, the efficacy of nICT was controversial and the survival benefit remain unknown.

MATERIALS/METHODS

This study included 313 patients with locally advanced ESCC who underwent surgery following neoadjuvant therapy at Sichuan Cancer Hospital from June 2017 and September 2021. The patients were divided into nICT group and neoadjuvant chemoradiotherapy (nCRT) group according to the neoadjuvant strategy. A 1:2 propensity score matching (PSM) was used to balance potential bias across several covariates between two groups with a caliper 0.05.

RESULTS

Among the 146 patients after PSM, the baseline factors were comparable between two groups. Compared with the nCRT group, the nICT group shown a lower pathologic complete response(pCR) rate (11.54% vs 35.11%; P = 0.0039) and lymph nodes uninvolved rate (ypN0: 44.23% vs 62.77%; P = 0.0154), but a higher perineural invasion (32.69% vs 12.77%; P = 0.0075) and angioinvasion rate (40.38% vs 10.64%; P = 0.0001). However, the 2-year OS and DFS rates were similar between the nICT group and the nCRT group in overall study cohort, and these data were confirmed in the matched samples (2-year OS, 78.2% vs 77.2% [p = 0.95]; DFS, 56.9% vs 58.0% [p = 0.69]).

CONCLUSION

Our preliminary findings indicate that, for individuals with locally advanced ESCC, nICT followed by surgery appears to be less effective in pathologic outcomes, while having a comparable survival rate to nRCT. These results imply a complicated and possibly multifaceted link between the kind of neoadjuvant therapy, the pathologic outcomes, and the final survival.

High Dose Hyperfractionated Thoracic Radiotherapy vs. Standard Dose for Limited Stage Small-Cell Lung Cancer: A Multicenter, Open-Label Randomized, Phase 3 Trial

PURPOSE/OBJECTIVE(S)

Limited stage small-cell lung cancer (LS-SCLC) is associated with poor prognosis. We aimed to assess the efficacy and safety of high-dose, hyperfractionated thoracic radiotherapy of 54 Gy in 30 fractions compared with standard dose (45 Gy in 30 fractions) as a first-line treatment for LS-SCLC.

MATERIALS/METHODS

The study was an open-label, randomized, phase 3 trial, done at 16 public hospitals in China. Key inclusion criteria were patients aged 18-70 years, with previously histologically or cytologically confirmed LS-SCLC, previously untreated or received 1-2 courses of intravenous cisplatin (75 mg/m²of body-surface area, on day 1 or divided into two days of each cycle) or carboplatin (area under the curve of 5 mg/mL per min, day 1 of each cycle)and intravenous etoposide (100 mg/m²of body-surface area, on days 1-3 of each cycle), and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.Eligible patients were randomly assigned (1:1) to receive volumetric-modulated arc radiotherapy (VMAT) of 45 Gy in 30 fractions or the simultaneous integrated boost VMAT (SIB-VMAT) of 54 Gy in 30 fractions to the primary lung tumor and lymph node metastases starting 0-42 days after the first chemotherapy course. Both groups of patients received thoracic radiotherapy twice per day and 10 fractions per week. Prophylactic cranial radiation (PCI, 25 Gy in 10 fractions) was implemented to patients with responsive disease. The primary endpoint was overall survival. Safety was analyzed in the as-treated population.

RESULTS

Between June 30, 2017, and April 6, 2021, 224 eligible patients were enrolled and randomly assigned to 54 Gy (n = 108) or 45 Gy (n = 116). Median follow-up for the primary analysis was 45 months (IQR 41-48). Median overall survival was significantly improved in the 54 Gy group (62.4 months) compared with the 45 Gy group (43.1 months; p = 0.001). Median progression-free survival was significantly improved in the 54 Gy group (30.5 months) compared with the 45 Gy group (16.7 months; p = 0.044). The most common grade 3-4 adverse events were neutropenia (30 [28%] of 108 patients in the 54 Gy group vs 27 [23%] of 116 patients in the 45 Gy group), neutropenic infections (6 [6%] vs 2 [2%]), thrombocytopenia (13 [12%] vs 12 [10%]), anemia (6 [6%] vs 4 [3%]), and esophagitis (1 [1%] vs 3 [3%]). Treatment-related serious adverse events occurred in 9 [8%] patients in the 54 Gy group and 16 [14%] patients in the 45 Gy group. There were one treatment-related deaths in 54 Gy group (myocardial infarction).

CONCLUSION

Compared with standard thoracic radiotherapy dose of 45 Gy, the high dose of 54 Gy improved overall survival and progression-free survival without increasing toxicities in patients with LS-SCLC, supporting twice-daily hyperfractionated thoracic radiotherapy of 54 Gy with concurrent chemotherapy is an alternative treatment option for LS-SCLC. This study is complete and registered with ClinicalTrials.gov, NCT03214003.

Radical Chemoradiotherapy vs. Radical Surgery plus Adjuvant Chemotherapy or Chemoradiotherapy in Locally Advanced Primary Small Cell Carcinoma of the Esophagus: A Multicenter Retrospective Study in China

PURPOSE/OBJECTIVE(S)

The purpose was to compare the treatment outcomes of radical chemoradiotherapy versus radical surgery plus adjuvant chemotherapy or chemoradiotherapy in locally advanced primary small cell carcinoma of the esophagus (LA-PSCCE). The hypothesis was that radical chemoradiotherapy had better overall survival (OS) than radical surgery plus adjuvant chemotherapy or chemoradiotherapy.

MATERIALS/METHODS

This large-scale multicenter retrospective study in China enrolled patients with newly diagnosed LA-PSCCE (T3-4N0M0 or TanyN+M0, AJCC 8th edition) from 2008 to 2021. According to different curative treatment approaches, patients were divided into two groups: radical chemoradiotherapy (group: CRT), and radical surgery following adjuvant chemotherapy or chemoradiotherapy (group: S + CT/CRT). The propensity score match (PSM) was applied to reduce the effect of confounding biases in clinicopathological characteristics (age, gender, KPS, tumor location, tumor length, and cTNM stage). Univariate Cox-regression analysis and Kaplan-Meier curve were calculated for OS. Statistical results were summarized as hazard ratio (HR), 95% confidence interval (CI) and P value. A two-sided P < 0.05 was regarded to be statistically significant.

RESULTS

A total of 291 patients with a median follow-up of 4.3 years were retrospectively enrolled. After PSM analysis, 94 and 94 patients were eventually included in group CRT and S + CT/CRT, respectively. Group CRT demonstrated a significantly superior survival than group S + CT/CRT (HR, 0.63; 95% CI, 0.43-0.91; P = 0.01), with a 3-year OS of 49.5% and 27.8% (P = 0.02), respectively. In secondary analysis, patients treated with radical chemoradiotherapy consistently showed significant survival benefit than those with radical surgery plus adjuvant chemoradiotherapy (HR, 0.4; 95% CI, 0.21-0.79; P = 0.008).

CONCLUSION

For patients with newly diagnosed LA-PSCCE, radical chemoradiotherapy should be a preferred recommendation in real-world clinical practice.

The Predictive Value of Circulating Exosomal PD-L1 in Cervical Cancer Immunotherapy

PURPOSE/OBJECTIVE(S)

Programmed death ligand 1 (PD-L1) expression was wildly used as a predictor of immune Check-Point Inhibitors (ICIs) efficiency. However, emerging results showed that PD-L1 was of great heterogeneity in sampling time and site. Recently, some studies found that exosomal PD-L1(ExoPD-L1) was related to ICIs response. In this study, we aimed to explore the predictive value of ExoPD-L1 in ICIs treatment of cervical cancer (CC) for the first time.

MATERIALS/METHODS

A total of 40 primarily diagnosed CC patients who accepted radical radiotherapy (RT) from March 2021 to October 2022 were included. The consecutive tumor sample were collected before and during RT. Another 37 advanced CC patients who accepted ICIs combination therapy from June 2020 to October 2022 were enrolled in this study. Blood samples were collected from each participant before and during treatment. Exosomes were derived by differential centrifugation, which was further identified by Western blot (WB) (CD9/TSG101/Calnexin), transmission electron microscope analysis and nanoparticle tracking analysis. ExoPD-L1 detection was conducted by enzyme-linked immuno-sorbent assay (ELISA). The knockout of PD-L1 was conducted via CRISPR/Cas9 assay and the overexpress of PD-L1 was conducted by lentiviral transfection. CD8+ T cells were extracted from murine spleen by CD8+ T Cell Isolation Kit. Immune cells and cytokines markers were detected by multicolor flow cytometry.

RESULTS

The consecutive detection of PD-L1 showed a dynamic change during RT. Compared with the level before RT, PD-L1 expression elevated in most patients (87.5%, 35/40) after RT. And the responders (n = 18) had elevated ExoPD-L1 level at the first two circles in the ICIs combination therapy (P<0.001). Whereas the level of pre-treatment ExoPD-L1 couldn't stratified clinical responders and non-responders (P = 0.181). The median follow-up time was 14.13 months. The mPFS in increased group vs. decreased group: not reach vs.11.02 months (P = 0.025, HR: 0.218, 0.052-0.913). Continuous blood sampling of mice models also found that effective therapeutic intervention could increase ExoPD-L1 in the early stage. The combination of exosome inhibitor GW4869 and anti-PD-1 further inhibited tumor growth. Mice were injected with external ExoPD-L1OE and ExoPD-L1KO. The results showed that ExoPD-L1OE suppressed body immunity and promoted tumor growth. The results of flow cytometry showed that ExoPD-L1OE inhibited CD8+ T cells from releasing interferon-and granzyme B. And ExoPD-L1OE also suppressed the CD8+ T cells proliferation in murine spleen. The coculture of CD8+ T cells and exosomes in vitro also confirmed the above conclusion.

CONCLUSION

Compared with unstable and impressionable tumoral PD-L1, ExoPD-L1 seems to be better predictor for the efficacy of immunotherapy in CC, which was with easy accessibility and continuation. Exosome PD-L1 played an immunosuppressive role by inhibiting the proliferation and functional factor release of CD8+ T cell.

A Machine Learning Method to Predict Pathological Complete Response of Esophageal Cancer after Neoadjuvant Chemoradiotherapy with Clinicohematological Markers and MR Radiomics: A Multi-Center Study

PURPOSE/OBJECTIVE(S)

Nearly 30% of patients with local advanced esophageal cancer achieved pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT), who may benefit from organ-preservation strategy under accurate prediction of pCR. We aimed to develop and validate machine learning models based on clinicohematological markers and MR radiomics to accurately predict pCR of esophageal cancer after nCRT.

MATERIALS/METHODS

In this multi-center study, eligible patients with esophageal cancer who received baseline MR scan (T2-weighted image) and nCRT plus surgery were enrolled between September 2014 and September 2022 at institution 1 (training set) and between December 2017 and August 2021 at institution 2 (testing set). Pre-nCRT and post-nCRT blood test results were collected to calculate hematological markers. Models were constructed by machine learning based on clinicohematological markers and MR radiomics to predict pCR. Area under the curve (AUC) and cut-off analysis were used to evaluate model performances.

RESULTS

Totally 154 patients (81 in the training set and 73 in the testing set) were enrolled. The combined model integrating pre-nCRT monocyte-to-lymphocyte ratio and 6 radiomics features achieved AUC of 0.800 (95% CI 0.671-0.918) in the testing set, with sensitivity of 79.2% (95% CI 62.5%-95.8%), specificity of 83.7% (95% CI 73.5%-93.9%), positive predictive value of 76.0% (95% CI 62.5%-90.0%), and negative predictive value of 89.6% (95% CI 82.0%-95.8%).

CONCLUSION

A machine learning model based on clinicohematological markers and MR radiomics to predict pCR after nCRT for patients with esophageal cancer was developed and validated, providing a novel tool for personalized treatment. It is necessary to further validate in more large datasets.

Develop a Deep Radiomics Model for Predicting the Response to Neoadjuvant Chemoradiotherapy (nCRT) in Patients with Locally Advanced Esophageal Cancer Using Three-Stage Longitudinal CT Images

PURPOSE/OBJECTIVE(S)

To develop a deep radiomics model for predicting the response to neoadjuvant chemoradiotherapy (nCRT) of patients with locally advanced esophageal cancer using three stage longitudinal CT images.

MATERIALS/METHODS

In this study, 189 patients were used to train our model, 80 patients were used to test the performance of the trained model. All patients enrolled in this study underwent nCRT followed by esophagectomy, and all patients underwent three stage longitudinal CT scans (before nCRT, after nCRT and before esophagectomy). The number of radiomics features for each CT images was 2153, the number of longitudinal radiomic features for each patient was 6459. Then, we used the least absolute shrinkage and selection operator regression for feature importance analysis. After this, the selected features of each stage were feed to the disentangled representation network to explore the relationship between the dynamic changes of tumors before and after nCRT and the pathological complete response (pCR). In addition, in order to further evaluate the effect of the time interval between nCRT and esophagectomy on the response to nCRT, we conducted subgroup analysis on different time frames. The performance of our model was evaluated by area under curve (AUC), accuracy, sensitivity and specificity.

RESULTS

Compared with only using single-stage CT images (the AUC of only using before nCRT CT images, after nCRT CT images, before esophagectomy CT images were 73.27%, 74.21%, and 74.95%, respectively), effectively exploring the dynamic changes of the tumor can achieve better performance in predicting the response to nCRT in the testing cohort (the AUC was 84.29%, 95% CI, 81.14%-87.44%). In addition, the performance of our proposed method outperforms any combinations of two stage CT images (the AUC using the CT images of before nCRT and after nCRT was 77.92%, the AUC using the CT images of before nCRT and before esophagectomy was 79.31%, the AUC using the CT images of after nCRT and before esophagectomy was 80.01%). Finally, the results showed that exploring the dynamic changes of the tumor using the three-stage CT images outperformed using single-stage CT images and any combinations of two-stage CT images in predicting the response to nCRT. The study also found that the time interval between nCRT and esophagectomy had some influence on the accuracy of pCR prediction, with the prediction accuracy tending to increase from 1 to 6 weeks and stabilizing after 6 weeks.

CONCLUSION

By exploring the dynamic changes of tumors, the designed disentangled representation network can effectively predict the response to nCRT of patients with esophageal cancer. In addition, the time interval between nCRT and esophagectomy also has a certain impact on the response to nCRT.

Effects of energy restriction during growing phase on the productive performance of Hyline Brown laying hens aged 6 to 72 wk

The aim of this study was to assess the effects of energy-restricted feeding during growing phase on the productive performance of Hyline Brown laying hens aged 6 to 72 wk. A total of 720 six-week-old layer chicks were allocated equally to 3 groups with 6 replicates of 40 pullets each, and were fed 1 of 3 diets that were nutritionally similar except for the apparent metabolizable energy corrected for nitrogen (AMEn) content. At the age of 6 to 17 wk, the pullets in the control group were given diet with 2,850 kcal/kg AMEn, and were fed ad libitum. The levels of AMEn in diet of pullets in the experimental groups were 90% (2,565 [2,850 × 90%] kcal/kg) and 80% (2,280 [2,850 × 80%] kcal/kg) of that in control group, and the daily amount of feed was restricted to the absolute quantity of the diet consumed by pullets in control group. At the age of 18 to 72 wk, all the hens were fed with the same diets ad libitum. As energy restriction increased in the growing phase, body weight (BW) dropped at the ages of 12 and 15 to 23 wk (at 23 wk: P = 0.001; at other ages: P < 0.001), but it showed no significant difference at 24 wk (P = 0.071). At 20 wk, restricting energy induced a delay in the development of sexual organs, including the ovary stroma, oviduct, and small yellow follicle (P < 0.05), as well as a delay in sexual maturity (P < 0.05). Consequently, the laying rate in the first and second periods dropped linearly (P = 0.046, 0.030, and 0.038, P < 0.001, respectively). The coefficient of variation (CV) in the BW at 19, 20, and 21 wk (P = 0.040, 0.023, and 0.042, respectively), the CV of age at first egg (P < 0.001), and CV of individual egg number at age 18 to 72 wk (P < 0.001) decreased linearly. There was a linear increase in the laying rate of hens in the later periods (at age 32-72 wk, P < 0.05), as well as in the average total egg number per hen and average laying rate at the age of 18 to 72 wk (P = 0.006). The average egg mass also showed a linear increase with increasing levels of energy restriction (P < 0.001). In summary, although appropriate energy restriction during growing phase delayed sexual maturity and sexual organ development in early-laying Hyline Brown pullets, it improved uniformity of BW, age at first egg laying, and individual egg number, and increased egg number per hen, laying rate, average egg mass, and number of settable eggs from 18 to 72 wk of age.

Changes and Relationship in Nutrition Impact Symptoms, Malnutrition during Esophageal Cancer Treatment

PURPOSE/OBJECTIVE(S)

The aim of this study was to assess the changes and relationship between nutritional impact symptoms (NIS) and malnutrition incidence during radiotherapy in patients with esophageal cancer.

MATERIALS/METHODS

A prospective observational study recruited hospitalized patients with esophageal cancer who received radiotherapy or did not receive chemotherapy. 283 patients with esophageal carcinoma were followed up before and during the fourth week of radiotherapy. Nutritional parameters were collected during radiotherapy.

RESULTS

According to the patient 's assessment of NIS and subjective global assessment (PG-SGA), at the mid-term of radiotherapy, the proportion of patients with NIS≥3 increased from 20.8% to 61.13%. Inappetence (37.1%) and abdominal distension (28.6%) were the most common nutritional symptoms. Severe malnutrition increased from 39% to 58.1%.NIS (odds ratio (OR) 30.93, 95% CI 15.92, 60.10, p <0.001) and weight loss of ≥5% (odds ratio (OR) 24.1, 95% CI 11.98, 48.47, p <0.001) were independently associated with severe malnutrition during radiotherapy.

CONCLUSION

Strengthen the nutritional support therapy during mid-radiotherapy for esophageal cancer patient, and NIS can directly predict malnutrition.PG-SGA and NIS can be used for nutritional monitoring in esophageal cancer patients.

Hsa_circ_0003928 regulates the progression of diabetic nephropathy through miR-136-5p/PAQR3 axis

BACKGROUND

Diabetic nephropathy (DN) is one of the complications of diabetes and has a high mortality, but its specific pathogenesis is not clear. In recent years, researches on the mechanism of circRNAs in DN have been proved a lot, whereas the functional mechanism of circ_0003928 in DN remains open and it must be investigated to value its important role in DN prevention.

METHODS

HK-2 cells were treated with high glucose (HG), normal glucose (NG) or Mannitol. Cell counting kit-8 (CCK8) and 5-ethynyl-2'-deoxyuridine (EdU) assays were performed to detect cell proliferation. Enzyme-linked immunosorbent assay (ELISA) was applied to analyze malondialdehyde (MDA) and superoxide dismutase 1 (SOD) levels. Flow cytometry and western blot were preformed to measure cell apoptosis. Real-time quantitative PCR (RT-qPCR) was used to test the levels of circ_0003928, miR-136-5p and progestin and adipoQ receptor family member 3 (PAQR3) mRNA. Western blot was executed to detect Bcl2 associated X (Bax), B cell leukemia/lymphoma 2 (Bcl2), smooth muscle (αSMA), apolipoprotein (C-IV) and PAQR3 levels. Luciferase reporter assay and RNA pull-down assay were used to analyze the target relationship between miR-136-5p and circ_0003928 or PAQR3.

RESULTS

Circ_0003928 and PAQR3 expression were up-regulated, whereas miR-136-5p was decreased in DN serum and HG-induced HK-2 cells. Circ_0003928 knockdown promoted cell proliferation, and inhibit cell apoptosis, oxidative stress, and fibrosis in HK-2 cells under HG condition. MiR-136-5p silencing overturned the protective effects of si-circ_0003928 on HG-induced HK-2 cells. MiR-136-5p was targeted by circ_0003928 and directly targeted PAQR3. Overexpression of PAQR3 counteracted the inhibitory functions of circ_0003928 knockdown or miR-136-5p overexpression on HG-induced HK-2 cell injury.

CONCLUSION

Circ_0003928 acted as a sponge of miR-136-5p to up-regulating PAQR3 expression, and then regulate the proliferation, oxidative stress, fibrosis and apoptosis in HG-induced HK-2 cells.

Tumor-Myeloid Cell Crosstalk Pathways Associated with Abscopal Responses in Breast Cancer

PURPOSE/OBJECTIVE(S)

To identify predictive biomarkers for combined radiotherapy (RT) and immune checkpoint inhibitor (ICI) therapy, which can induce systemic anti-tumor immune responses (i.e., "abscopal" responses) in breast cancer.

MATERIALS/METHODS

Four Trp53-/- Balb/c breast cancer syngeneic allograft models with low tumor mutational burden and resistance to dual ICI (anti-PD1 and anti-CTLA4, BioXcell) were used. Two lines exhibited abscopal responses to RT (8Gyx3) plus ICI combination therapy (i.e., "abscopal models"), whereas the other two did not (i.e., "non-abscopal models"). We performed spatial transcriptomics analysis (GeoMx whole transcriptome assay) of pan-cytokeratin positive (panCK+) tumor and tumor-adjacent CD45+ immune cell segments in orthotopically implanted tumors 10 days after initiating treatment with IgG control, RT alone, ICI alone, or RT/ICI combination (N>5 per group). Genes selectively induced by RT/ICI in panCK+ and CD45+ segments in abscopal models and were not induced in non-abscopal models were identified using two-tailed t-tests and FDR correction for multiple testing (FDR<5%). In vitro analyses of RT-induced secreted inflammatory signaling were conducted by exposing supernatant from irradiated (8Gy) tumor cells to a RAW264.7 macrophage cell line expressing an interferon-inducible luciferase reporter construct, followed by luciferase signal quantification (Invivogen).

RESULTS

Hierarchical clustering of immune-related genes in CD45+ immune segments from breast cancer models with abscopal responses to RT/ICI revealed global differences in tumor-adjacent immune profiles at baseline and after RT/ICI treatment. Abscopal responsive breast cancer models at baseline showed an enrichment of myeloid cell subtypes expressing complement protein C1q, Ccl8, and Csf1r in tumor-adjacent CD45+ immune cells, and CD8+ T cells expressing Ccl5. 10 days after treatment with RT/ICI, tumor-adjacent CD45+ immune cells in abscopal models were enriched in Cxcl10, Irf7, and FcgRIV, whereas these genes were not induced in non-abscopal models. CyTOF analyses confirmed the induction of inflamed professional antigen presenting cells (CD11c+CD80+IA/IE+) by RT/ICI in abscopal models. Within panCK+ tumor segments, RT/ICI in abscopal models selectively induced Isg15 and Zbp1, both of which are involved in secreted inflammatory signaling. Consistently, RT-induced secreted inflammatory signaling from tumor cells to macrophages evaluated in vitro was significantly greater in abscopal models compared to non-abscopal models.

CONCLUSION

Breast cancer models with abscopal responses to RT/ICI show increased Isg15- and Zbp1-dependent secreted inflammatory crosstalk that activates Cxcl10 and Irf7 expression in tumor-adjacent myeloid cells, which warrants further investigation as a potential predictive biomarker for combined RT/ICI therapy in breast cancer.

Deep Learning for Automatic Prediction of Lymph Node Station Metastasis in Esophageal Cancer Patients from Contrast-Enhanced CT

PURPOSE/OBJECTIVE(S)

The diagnosis of lymph node (LN) metastasis in computed tomography (CT) is an essential yet challenging task in esophageal cancer staging and treatment planning. Although criteria (e.g., RECIST, morphological/texture features) are proposed to predict LN metastasis, the diagnostic accuracy remains low with sensitivity <50% and specificity <75%, as reported in previous studies. Deep learning (DL) has the potential to address this issue by learning from large-scale labeled data. However, due to the practical surgery procedure in lymph node dissection, it is difficult to pair the metastasis of individual LN reported in the pathology report to the LN instance found in the CT image. Hence, in this study, we first use pathology reports to determine the LNS metastasis, then develop a multiple instance deep learning (MIDL) model to predict lymph node station (LNS) metastasis.

MATERIALS/METHODS

We collected 1200 esophageal cancer patients with preoperative contrast-enhanced CT before surgery. A recently developed automatic mediastinal LNS segmentation model was first applied to segment LNS of 1 to 8 based on the IASLC protocol. For each LNS, the local CT region of interest (ROI) was cropped to generate a station-wise CT patch, where the LNS was labeled as metastatic if at least one metastatic LN was indicated in the pathology report. Using the station-wise CT patch and LNS label, we train a 3D MIDL model, MobileNetV3, to predict LNS metastasis. To better provide the LN position priors in MIDL, LN instances (with a short axis >4mm) were also segmented using an automatic LN detection algorithm and were added to the MIDL model as an auxiliary input. Five-fold cross-validation was conducted to evaluate the MIDL performance.

RESULTS

The MIDL model's performance is summarized in Table 1. The MIDL model incorporating an additional LN instance mask demonstrated a superior overall AUC of 0.7539, surpassing the model without the LN mask input by 2.93%. The specificity was evaluated at a threshold resulting in a recall of 0.7, and the best model outperformed the CT input model in terms of specificity by 2.11%. This highlights the value of including the LN position prior to the MIDL model. Notably, when a threshold was set to result in a specificity of 75%, the best MIDL model demonstrated a significantly higher recall compared to the previously reported clinical diagnostic recall (39.7% vs. 63.21%).

CONCLUSION

We developed a MIDL classification model to predict LNS metastasis using CT scans of 1200 patients. Our findings suggest that the MIDL model can substantially improve LNS metastasis prediction and has the potential to play an essential role in cancer staging, treatment planning, and prognostic analysis.

Measurement of the Dependence of the Hadron Production Fraction Ratios f_{s}/f_{u} and f_{d}/f_{u} on B Meson Kinematic Variables in Proton-Proton Collisions at sqrt[s]=13 TeV

The dependence of the ratio between the B_{s}^{0} and B^{+} hadron production fractions, f_{s}/f_{u}, on the transverse momentum (p_{T}) and rapidity of the B mesons is studied using the decay channels B_{s}^{0}→J/ψϕ and B^{+}→J/ψK^{+}. The analysis uses a data sample of proton-proton collisions at a center-of-mass energy of 13 TeV, collected by the CMS experiment in 2018 and corresponding to an integrated luminosity of 61.6  fb^{-1}. The f_{s}/f_{u} ratio is observed to depend on the B p_{T} and to be consistent with becoming asymptotically constant at large p_{T}. No rapidity dependence is observed. The ratio of the B^{0} to B^{+} meson production fractions, f_{d}/f_{u}, is also measured, for the first time in proton-proton collisions, using the B^{0}→J/ψK^{*0} decay channel. The result is found to be within 1 standard deviation of unity and independent of p_{T} and rapidity, as expected from isospin invariance.

[Investigation and analysis of occupational hazard factors in different industries in Tongliao City]

Objective: To investigate the occupational hazard factors of different industries in Tongliao City, and to provide scientific basis for the prevention and control of occupational disease in Tongliao City. Methods: In July 2021, the detection data of coal dust, silica dust, cement dust, benzene, noise and other occupational hazard factors, as well as the occupational health examination data of workers in various positions of 104 enterprises in different industries in Tongliao City were cllected and anylazed. χ(2) test was used to analyze the results of chest radiography of workers in different age groups. Results: A total of 104 enterprises were investigated, and the median time-weighted average concentration (C(TWA)) of coal dust, silic a dust, cement dust and benzene in contact with test posts were 0.94, 0.30, 0.70 and 0.95 mg/m(3), respectively. The median 8 h equivalent sound level (L(EX, 8 h)) of noise was 74.1 dB (A) . The over standard rates of silica dust, cement dust and noise contact positions were 10.83% (16/240) , 7.14% (2/28) and 0.48% (3/628) , respectively. The differences of chest X-ray examination of coal dust and silica dust workers in different working ages were statistically significant (χ(2)=218.50, 531.80, P<0.001) . The difference of hearing threshold of noise workers with different working age was statistically significant (χ(2)=1290.00, P<0.001) . The rates of leukopenia and neutropenia were 41.90% (44/105) and 20.95% (22/105) in benzene exposed workers. The positive rate of brucella exposure workers was 1.33% (1/75) for tiger red plate agglutination test and 3.23% (3/93) for tube agglutination test. Conclusion: Silica dust, cement dust and noise exceed the standard in some posts and places in the Tongliao City, and some workers are infected with Brucella. In the future, we can focus on monitoring noise-generating posts, strengthen supervision and implement prevention and control measures to reduce the incidence of occupational diseases.

Thermophysical properties and atomic structure of liquid Zr-Nb alloys investigated by electrostatic levitation and molecular dynamics simulation

The investigation of the thermophysical properties of liquid Zr-Nb alloys holds great significance for theoretical research and technical application in liquid physics. However, the high temperatures involved make their experimental measurement challenging. In this study, the densities of liquid Zr-xwt.% Nb (x= 1.0, 2.5, 6.0) alloys were examined by electrostatic levitation and molecular dynamics calculation. Remarkably, the alloys achieved maximum undercooling of 335 K, 311 K and 326 K, respectively. Correspondingly, the densities are 6.20, 6.22 and 6.26 g·cm-3at the liquidus temperatures (TL), respectively. The corresponding temperature coefficients are 2.61 × 10-4, 2.75 × 10-4and 2.84 × 10-4g·cm-3·K-1, respectively. Notably, the experimental density results align well with the simulated results. Moreover, the molar volume (Vm), thermal expansion coefficient (α) and diffusion coefficient (D) were derived based on the experimental data and simulations. The thermal expansion coefficients reduce linearly with decreasing temperature. The analysis of the pair distribution function, coordination number (CN) and the radial distribution function reveals the temperature-dependent evolution of the atomic structure. TheCNtotalandCNZr-Zrinitially increase and then decrease with decreasing temperature, while the change trends forCNZr-NbandCNNb-Nbvaried among the three alloys. The radial distribution function of three liquid alloys reveals that the atomic number density increases as the temperature drops. Additionally, the total diffusion coefficients decrease with the reduction of temperature and the rise of Nb content from 1.0 wt.% Nb to 6.0 wt.% Nb.

[Knowledge, attitude and practice about first aid and influencing factors in key populations in Beijing: a large cross-sectional study]

Objective: To investigate the status of knowledge, attitude and practice about first aid and influencing factors in key population, those who have frequent contacts with people and might be "first aid" promoter in general population of Beijing, and provide evidences for the promotion of first aid. Methods: This study was a cross-sectional survey based on the "Emergency Rescue Capacity Training Project". Using cluster sampling, we recruited 9 591 participants after the training in Beijing for survey with a self-designed questionnaire from October 2021 to March 2022. Results: In 9 591 participants, 98.58% knew the emergency call number, while only 32.00% knew how to identify sunstroke. The awareness rate of the definition of first aid and legal disclaimer were lower (63.61%, 75.91%). People's willingness to give first aid to others, including relative, acquaintance, stranger and vagrant, were different (χ2=822.82, P<0.001). People were more likely to give first aid to relative, acquaintance and stranger compared with vagrant (P<0.05). With the increase of psychological distance, the willingness to give first aid decreased (Z=-26.57, P<0.001). According to the results of Logistic regression analysis, older age, higher annual family income and higher awareness of first aid related knowledge were contributing factors for giving first aid. In 1 529 people who met emergency, only 66 people (4.32%)did not give any first aid. Conclusions: The key population in Beijing has high awareness of first aid related knowledge and positive attitude of first aid after training. A high proportion of people performed first aid to others. Age, annual family income and awareness of first aid related knowledge were contributing factors for giving first aid.

Search for Exotic Higgs Boson Decays H→AA→4γ with Events Containing Two Merged Diphotons in Proton-Proton Collisions at sqrt[s]=13 TeV

We present the first direct search for exotic Higgs boson decays H→AA, A→γγ in events with two photonlike objects. The hypothetical particle A is a low-mass spin-0 particle decaying promptly to a merged diphoton reconstructed as a single photonlike object. We analyze the data collected by the CMS experiment at sqrt[s]=13  TeV corresponding to an integrated luminosity of 136  fb^{-1}. No excess above the estimated background is found. We set upper limits on the branching fraction B(H→AA→4γ) of (0.9-3.3)×10^{-3} at 95% confidence level for masses of A in the range 0.1-1.2 GeV.

Observation of Same-Sign WW Production from Double Parton Scattering in Proton-Proton Collisions at sqrt[s]=13 TeV

The first observation of the production of W^{±}W^{±} bosons from double parton scattering processes using same-sign electron-muon and dimuon events in proton-proton collisions is reported. The data sample corresponds to an integrated luminosity of 138  fb^{-1} recorded at a center-of-mass energy of 13 TeV using the CMS detector at the CERN LHC. Multivariate discriminants are used to distinguish the signal process from the main backgrounds. A binned maximum likelihood fit is performed to extract the signal cross section. The measured cross section for production of same-sign W bosons decaying leptonically is 80.7±11.2(stat) _{-8.6}^{+9.5}(syst)±12.1(model)  fb, whereas the measured fiducial cross section is 6.28±0.81(stat)±0.69(syst)±0.37(model)  fb. The observed significance of the signal is 6.2 standard deviations above the background-only hypothesis.

Observation of the Rare Decay of the η Meson to Four Muons

A search for the rare η→μ^{+}μ^{-}μ^{+}μ^{-} double-Dalitz decay is performed using a sample of proton-proton collisions, collected by the CMS experiment at the CERN LHC with high-rate muon triggers during 2017 and 2018 and corresponding to an integrated luminosity of 101  fb^{-1}. A signal having a statistical significance well in excess of 5 standard deviations is observed. Using the η→μ^{+}μ^{-} decay as normalization, the branching fraction B(η→μ^{+}μ^{-}μ^{+}μ^{-})=[5.0±0.8(stat)±0.7(syst)±0.7(B_{2μ})]×10^{-9} is measured, where the last term is the uncertainty in the normalization channel branching fraction. This work achieves an improved precision of over 5 orders of magnitude compared to previous results, leading to the first measurement of this branching fraction, which is found to agree with theoretical predictions.

[Evaluation of the efficacy of GnRH-a pretreatment before total hysterectomy for adenomyosis patients: a propensity score matching analysis]

Objective: To evaluate the efficacy of gonadotropin-releasing hormone agonist (GnRH-a) pretreatment before total hysterectomy for adenomyosis patients with uterine volume ≥12 gestational weeks and moderate or severe anemia. Methods: From January 2018 to March 2023, 689 patients who underwent total hysterectomy for adenomyosis in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. According to the preoperative medication, they were divided into study group (127 cases) and control group (562 cases). Patients in the study group underwent GnRH-a pretreatment for 3 cycles before surgery, and the control group received operation directly. SPSS 26.0 software was used to perform 1∶1 matching for the two groups of patients through the propensity score matching method. Matching variables included age, body mass index, gravidity, parity, history of pelvic and abdominal surgery, menstrual cycle, menstrual period, dysmenorrhea score, initial diagnosis of cancer antigen 125 (CA125), uterine volume and hemoglobin value. The dysmenorrhea score, uterine volume, hemoglobin value and CA125 level before and after GnRH-a pretreatment in the study group were compared. And the duration of operation, intraoperative blood loss, postoperative white blood cell count, perioperative blood transfusion cases, postoperative disease rate, duration of hospitalization, total hospitalization cost between the two groups were compared. Results: With propensity score matching, 119 patients in the study group and 119 patients in the control group were finally enrolled in this study. In the study group, before and after the treatment with GnRH-a, the dysmenorrhea score (7.4±1.7 vs 5.6±1.8), uterine volume [(362±160) vs (233±126) cm3], hemoglobin value [(74.1±10.7) vs (102.5±13.5) g/L], and CA125 level [(104±76) vs (64±51) kU/L] were statistically different (all P<0.05). There were statistical differences of operation time [(86±18) vs (116±31) minutes], intraoperative blood loss [(24±9) vs (43±22) ml], white blood cell count after 1 day of operation [(9.80±0.10)×109/L vs (9.90±0.10)×109/L], number of perioperative blood transfusion case [5.9% (7/119) vs 61.3% (73/119)], postoperative disease rate [5.0% (6/119) vs 16.0% (19/119)], hospitalization duration [(7.1±1.6) vs (7.9±1.6) days], and total hospitalization cost [(35 323±5 275) vs (37 159±5 640) yuan] between the study group and the control group (all P<0.05). Conclusion: The pretreatment of using GnRH-a before total hysterectomy for adenomyosis patients with uterine volume ≥12 gestational weeks and moderate or severe anemia is not only conducive to improving dysmenorrhea, signs of anemia, reducing uterine volume, but also conducive to the implementation of surgery, reducing intraoperative and postoperative complications, and reducing hospital costs.

The core role of macrophages in hepatocellular carcinoma: the definition of molecular subtypes and the prognostic risk system

Background: In patients with hepatocellular carcinoma (HCC), the tumor microenvironment (TME) is resistant to immunotherapy because of its specificity. It is meaningful to explore the role of macrophage, which is one of the most abundant immune cells in the TME, in cellular communication and its effect on the prognosis and immunotherapy of HCC. Methods: Dimensionality reduction and clustering of the single-cell RNA-seq data from the GSE149614 dataset were carried out to identify the cellular composition of HCC. CellChat was used to analyze the communication between different cells. The specifically highly expressed genes of macrophages were extracted for univariate Cox regression analysis to obtain prognostic genes for HCC cluster analysis, and the risk system of macrophage-specifically highly expressed genes was developed by random forest analysis and multivariate Cox regression analysis. Prognosis, TME infiltration, potential responses to immunotherapy, and antineoplastic drugs were compared among molecular subtypes and between risk groups. Results: We found that HCC included nine identifiable cell types, of which macrophages had the highest communication intensity with each of the other eight cell types. Of the 179 specifically highly expressed genes of macrophage, 56 were significantly correlated with the prognosis of HCC, which classified HCC into three subtypes, which were reproducible and produced different survival outcomes, TME infiltration, and immunotherapy responses among the subtypes. In the integration of four macrophage-specifically highly expressed genes for the development of a risk system, the risk score was significantly involved in higher immune cell infiltration, poor prognosis, immunotherapy response rate, and sensitivity of six drugs. Conclusion: In this study, through single-cell RNA-seq data, we identified nine cell types, among which macrophage had the highest communication intensity with the rest of the cell types. Based on specifically highly expressed genes of macrophage, we successfully divided HCC patients into three clusters with distinct prognosis, TME, and therapeutic response. Additionally, a risk system was constructed, which provided a potential reference index for the prognostic target and preclinical individualized treatment of HCC.

Measurements of jet multiplicity and jet transverse momentum in multijet events in proton-proton collisions at s=13TeV

Multijet events at large transverse momentum (p T ) are measured at s = 13 Te V using data recorded with the CMS detector at the LHC, corresponding to an integrated luminosity of 36.3 fb - 1 . The multiplicity of jets with p T > 50 Ge V that are produced in association with a high-p T dijet system is measured in various ranges of the p T of the jet with the highest transverse momentum and as a function of the azimuthal angle difference Δ ϕ 1 , 2 between the two highest p T jets in the dijet system. The differential production cross sections are measured as a function of the transverse momenta of the four highest p T jets. The measurements are compared with leading and next-to-leading order matrix element calculations supplemented with simulations of parton shower, hadronization, and multiparton interactions. In addition, the measurements are compared with next-to-leading order matrix element calculations combined with transverse-momentum dependent parton densities and transverse-momentum dependent parton shower.

[Effects of tibial second toe free flap bridged with blood flow and nerve in the treatment of severe flexion contracture of the proximal interphalangeal joint]

Objective: To investigate the effects of tibial second toe free flap bridged with blood flow and nerve in the treatment of severe flexion contracture of the proximal interphalangeal joint. Methods: A retrospective observational study was conducted. From March 2013 to October 2019, 9 patients with severe flexion contracture (type Ⅲ) of the proximal interphalangeal joint after trauma operation, conforming to the inclusion criteria, were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 5 males and 4 females, aged from 17 to 62 years. After the contracture tissue affecting the extension of the proximal interphalangeal joint was cut off, and the scar tissue was resected, the size of the volar wound near the proximal interphalangeal joint in extended position was 2.0 cm×1.0 cm-2.5 cm×1.5 cm, with the length of proper digital artery and nerve defect being 1.0-1.5 cm. A free flap of the same size as the wound was cut from the tibial side of the second toe and transplanted to repair the wound, and the defective proper digital artery and nerve was repaired by bridging with the tibial proper plantar digital artery and nerve of about 1.5 cm in length. The full-thickness skin graft was taken from the proximal tibial side of the lower leg to repair the wound at flap donor site. The wound at skin graft donor site was sutured directly. The survival of flap and skin graft was observed after operation. The patients were followed up, and at the last follow-up, the recovery of the affected finger and the second toe, including the donor and recipient areas were observed, the two-point discrimination distances of the flap repaired site and the pulp of the affected finger were observed and measured at the same time, the blood flow patency of bridged vessel of the affected finger was examined by Allen test, and the function of the proximal interphalangeal joint of the affected finger was evaluated according to Chinese Medical Association's standard for the range of motion of proximal interphalangeal joint. Results: The flaps and skin grafts survived smoothly after operation. The follow-up after operation lasted for 5 to 22 months, with a mean of 10 months. At the last follow-up, the flap repaired site had good shape, good color and texture, with the two-point discrimination distance being 9-12 mm, and the two-point discrimination distance of the pulp of the affected finger was 6-10 mm; the Allen test results of the affected fingers were all negative (i.e., the bridged vessels had good blood flow patency), with no recurrence of flexion contracture, and the function of the proximal interphalangeal joint was evaluated as excellent; the skin graft area of the second toe was not ruptured but was a little pigmented, and the flexion and extension activities of toe were good. Conclusions: The tibial second toe free flap bridged with blood flow and nerve has reliable therapeutic effect in the treatment of severe flexion contracture of the proximal interphalangeal joint, and the color and texture of the flap repaired area are good. Bridging to repair the severely contracted proper digital artery and nerve is beneficial to improve the blood supply of the finger body and rebuild the sensation.

Azimuthal correlations in Z +jets events in proton-proton collisions at s=13TeV

The production of Z bosons associated with jets is measured in pp collisions at s = 13 Te V with data recorded with the CMS experiment at the LHC corresponding to an integrated luminosity of 36.3fb - 1 . The multiplicity of jets with transverse momentum p T > 30 Ge V is measured for different regions of the Z boson's p T ( Z ) , from lower than 10Ge V to higher than 100Ge V . The azimuthal correlation Δ ϕ between the Z boson and the leading jet, as well as the correlations between the two leading jets are measured in three regions of p T ( Z ) . The measurements are compared with several predictions at leading and next-to-leading orders, interfaced with parton showers. Predictions based on transverse-momentum dependent parton distributions and corresponding parton showers give a good description of the measurement in the regions where multiple parton interactions and higher jet multiplicities are not important. The effects of multiple parton interactions are shown to be important to correctly describe the measured spectra in the low p T ( Z ) regions.

Search for Higgs Boson Decay to a Charm Quark-Antiquark Pair in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for the standard model Higgs boson decaying to a charm quark-antiquark pair, H→cc[over ¯], produced in association with a leptonically decaying V (W or Z) boson is presented. The search is performed with proton-proton collisions at sqrt[s]=13  TeV collected by the CMS experiment, corresponding to an integrated luminosity of 138  fb^{-1}. Novel charm jet identification and analysis methods using machine learning techniques are employed. The analysis is validated by searching for Z→cc[over ¯] in VZ events, leading to its first observation at a hadron collider with a significance of 5.7 standard deviations. The observed (expected) upper limit on σ(VH)B(H→cc[over ¯]) is 0.94 (0.50_{-0.15}^{+0.22})pb at 95% confidence level (C.L.), corresponding to 14 (7.6_{-2.3}^{+3.4}) times the standard model prediction. For the Higgs-charm Yukawa coupling modifier, κ_{c}, the observed (expected) 95% C.L. interval is 1.1<|κ_{c}|<5.5 (|κ_{c}|<3.4), the most stringent constraint to date.

Azimuthal Correlations within Exclusive Dijets with Large Momentum Transfer in Photon-Lead Collisions

The structure of nucleons is multidimensional and depends on the transverse momenta, spatial geometry, and polarization of the constituent partons. Such a structure can be studied using high-energy photons produced in ultraperipheral heavy-ion collisions. The first measurement of the azimuthal angular correlations of exclusively produced events with two jets in photon-lead interactions at large momentum transfer is presented, a process that is considered to be sensitive to the underlying nuclear gluon polarization. This study uses a data sample of ultraperipheral lead-lead collisions at sqrt[s_{NN}]=5.02  TeV, corresponding to an integrated luminosity of 0.38  nb^{-1}, collected with the CMS experiment at the LHC. The measured second harmonic of the correlation between the sum and difference of the two jet transverse momentum vectors is found to be positive, and rising, as the dijet transverse momentum increases. A well-tuned model that has been successful at describing a wide range of proton scattering data from the HERA experiments fails to describe the observed correlations, suggesting the presence of gluon polarization effects.

Shortening replacement by emulsion and foam template hydroxypropyl methylcellulose (HPMC)-based oleogels in puff pastry dough. Rheological and texture properties

Shortening plays an essential function in the formulation of sweet laminated bakery products, but has a potential health risk due to their high percentage of saturated fatty acids. In this paper, the feasibility of hydroxypropyl methylcellulose (HPMC) oleogels prepared with emulsion template (ET) and foam template (FT) approaches as fat sources in a puff pastry dough was investigated. Spreadability and thermal properties of control shortening, 100% ET and FT oleogels and shortening/oleogel (50/50) blends were measured. The different systems were applied as the fat source in a puff pastry dough, and their effect on rheological and texture properties was investigated. Results showed that partial replacement of shortening with oleogels could significantly decrease the firmness values (from 115 to 26 N) (P < 0.05) and increased the spreadability of shortening. The methodology to prepare the oleogel (FT or ET) also significantly affected the texture parameters. FT blends had the highest spreadability with significantly lower firmness values and area under the curve. Thermal values showed that both oleogels could slightly increase the melting point of shortening from 47 to 50 °C. The replacement of shortening with oleogel decreases the viscoelasticity of puff pastry dough and increases its thermal stability but does not significantly change dough viscoelasticity in the shortening/oleogel mixture. These results indicated that both oleogels have promising potential to replace shortening in puff pastry dough formulations, but the ET oleogel showed a more similar behavior to the control shortening than the FT oleogel.

99mTc-MDP bone scintigraphy-based growth evaluation and prediction of epiphysis around the knee: a study of paediatric limb salvage for malignant bone tumours

AIM

To investigate the feasibility of bone scintigraphy in the assessment and prediction of bone growth potential after limb-salvage surgery in children with bone tumours.

MATERIALS AND METHODS

Fifty-five skeletally immature patients with primary bone malignancies in distal femur was enrolled. Thirty-two patients received epiphysis minimally invasive endoprosthesis (EMIE) reconstruction, seven received hemiarthroplasty, and 16 received adult-type rotation-hinged endoprosthesis (ATRHE) reconstruction. All enrolled patients underwent radiographic examination at regular intervals and followed-up for >12 months. The actual limb length discrepancy (LLDa) of the tibia was measured on the radiography image. The expected LLD of tibia (LLDp) was calculated according to multiplier method. The uptake ratio of the ipsilateral epiphysis to the contralateral epiphysis (Ri/c) was calculated at bone scintigraphy. The Ri/c value was accommodated in the formula of multiplier method for a modification. The difference and correlation between the modified expected LLD (LLDm), LLDp and LLDa were analysed.

RESULTS

The growth potential of ipsilateral epiphysis was reserved in all patients who underwent hemiarthroplasty and one fourth of EMIE reconstruction. The Ri/c values in the hemiarthroplasty endoprosthesis group were significantly higher than the EMIE and ATRHE groups. There was no significant difference in Ri/c values between the EMIE and ATRHE group. Data from the 26 patients who reached bone maturation showed that there was a significant difference between LLDp and LLDa. LLDm showed a higher correlation with LLDa than LLDp.

CONCLUSION

Bone scintigraphy is helpful to evaluate the growth potential of epiphysis after surgery. The multiplier method modified by Ri/c value improves prediction accuracy of bone growth.

Search for Nonresonant Pair Production of Highly Energetic Higgs Bosons Decaying to Bottom Quarks

A search for nonresonant Higgs boson (H) pair production via gluon and vector boson (V) fusion is performed in the four-bottom-quark final state, using proton-proton collision data at 13 TeV corresponding to 138  fb^{-1} collected by the CMS experiment at the LHC. The analysis targets Lorentz-boosted H pairs identified using a graph neural network. It constrains the strengths relative to the standard model of the H self-coupling and the quartic VVHH couplings, κ_{2V}, excluding κ_{2V}=0 for the first time, with a significance of 6.3 standard deviations when other H couplings are fixed to their standard model values.

Search for Higgs Boson and Observation of Z Boson through Their Decay into a Charm Quark-Antiquark Pair in Boosted Topologies in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for the standard model (SM) Higgs boson (H) produced with transverse momentum (p_{T}) greater than 450 GeV and decaying to a charm quark-antiquark (cc[over ¯]) pair is presented. The search is performed using proton-proton collision data collected at sqrt[s]=13  TeV by the CMS experiment at the LHC, corresponding to an integrated luminosity of 138  fb^{-1}. Boosted H→cc[over ¯] decay products are reconstructed as a single large-radius jet and identified using a deep neural network charm tagging technique. The method is validated by measuring the Z→cc[over ¯] decay process, which is observed in association with jets at high p_{T} for the first time with a signal strength of 1.00_{-0.14}^{+0.17}(syst)±0.08(theo)±0.06(stat), defined as the ratio of the observed process rate to the SM expectation. The observed (expected) upper limit on σ(H)B(H→cc[over ¯]) is set at 47 (39) times the SM prediction at 95% confidence level.

Measurements of the Higgs boson production cross section and couplings in the W boson pair decay channel in proton-proton collisions at s=13TeV

Production cross sections of the standard model Higgs boson decaying to a pair of W bosons are measured in proton-proton collisions at a center-of-mass energy of 13Te V . The analysis targets Higgs bosons produced via gluon fusion, vector boson fusion, and in association with a W or Z boson. Candidate events are required to have at least two charged leptons and moderate missing transverse momentum, targeting events with at least one leptonically decaying W boson originating from the Higgs boson. Results are presented in the form of inclusive and differential cross sections in the simplified template cross section framework, as well as couplings of the Higgs boson to vector bosons and fermions. The data set collected by the CMS detector during 2016-2018 is used, corresponding to an integrated luminosity of 138fb - 1 . The signal strength modifier μ , defined as the ratio of the observed production rate in a given decay channel to the standard model expectation, is measured to be μ = 0 . 95 - 0.09 + 0.10 . All results are found to be compatible with the standard model within the uncertainties.

[Comparison of the effects and safety of dydrogesterone and medroxyprogesterone acetate on endometrial hyperplasia without atypia: a randomized controlled non-inferior phase Ⅲ clinical study]

Objective: To compare the effects and safety of dydrogesterone (DG) and medroxyprogesterone acetate (MPA) on the treatment in patients with endometrial hyperplasia without atypia (EH). Methods: This was a single-center, open-label, prospective non-inferior randomized controlled phase Ⅲ trial. From February 2019 to November 2021, patients with EH admitted to the Obstetrics and Gynecology Hospital of Fudan University were recruited. Enrolled patients were stratified according to the pathological types of simple hyperplasia (SH) or complex hyperplasia (CH), and were randomised to receive MPA or DG. Untill May 14, 2022, the median follow-up time after complete response (CR) was 9.3 months (1.1-17.2 months). The primary endpoint was the 6-month CR rate (6m-CR rate). The secondary endpoints included the 3-month CR rate (3m-CR rate), adverse events rate, recurrence rate, and pregnancy rate in one year after CR. Results: (1) A total of 292 patients with EH were enrolled in the study with the median age of 39 years (31-45 years). A total of 135 SH patients were randomly assigned to MPA group (n=67) and DG group (n=68), and 157 CH patients were randomly assigned to MPA group (n=79) and DG group (n=78). (2) Among 292 patients, 205 patients enrolled into the primary endpoint analysis, including 92 SH patients and 113 CH patients, with 100 patients in MPA group and 105 in DG group, respectively. The 6m-CR rate of MPA group and DG group were 90.0% (90/100) and 88.6% (93/105) respectively, and there were no statistical significance (χ²=0.11, P=0.741), with the rate difference (RD) was -1.4% (95%CI:-9.9%-7.0%). Stratified by the pathology types, the 6m-CR rate of SH patients was 93.5% (86/92), and MPA group and DG group were respectively 91.1% (41/45) and 95.7% (45/47); and the 6m-CR rate of CH patients was 85.8% (97/113), and MPA group and DG group were 89.1% (49/55) and 82.8% (48/58) respectively. The 6m-CR rates of the two treatments had no statistical significance either (all P>0.05). A total of 194 EH patients enrolled into the secondary endpoint analysis, including 88 SH patients and 106 CH patients, and 96 patients in MPA group and 98 in DG group, respectively. The 3m-CR rate of SH patients were 87.5% (77/88), while the 3m-CR rates of MPA group and DG group were 90.7% (39/43) and 84.4% (38/45), respectively; the 3m-CR rate of CH patients was 66.0% (70/106), and MPA group and DG group had the same 3m-CR rate of 66.0% (35/53). No statistical significance was found between the two treatments both in SH and CH patients (all P>0.05). (3) The incidence of adverse events between MPA group and DG group had no statistical significance (P>0.05). (4) A total of 93 SH patients achieved CR, and the cumulative recurrence rate in one year after CR were 5.9% and 0 in MPA group and DG group, respectively. While 112 CH patients achieved CR, and the cumulative recurrence rate in one year after CR were 8.8% and 6.5% in MPA group and DG group, respectively. There were no statistical significance between two treatment groups (all P>0.05). Among the 93 SH patients, 10 patients had family planning but no pregnancy happened during the follow-up period. Among the 112 CH patients, 21 were actively preparing for pregnancy, and the pregnancy rate and live-birth rate in one year after CR in MPA group were 7/9 and 2/7, while in DG group were respectively 4/12 and 2/4, and there were no statistical significance in pregnancy rate and live-birth rate between the two treatment groups (all P>0.05). Conclusions: Compared with MPA, DG is of good efficacy and safety in treating EH. DG is a favorable alternative treatment for EH patients.

[LRG1 inhibits hepatic macrophage activation by enhancing TGF-β1 signaling to alleviate MAFLD in mice]

OBJECTIVE

To explore the effect of leucine-rich α-2-glycoprotein (LRG1) derived from hepatocytes on activation of hepatic M1 Kupffer cells.

METHODS

A metabolic dysfunction-associated fatty liver disease (MAFLD) model was established in BALB/c mice by high-fat diet (HFD) feeding for 16 weeks. Oleic acid was used to induce steatosis in primary cultures of mouse hepatocytes. The mRNA and protein expressions of LRG1 in mouse liver tissues and hepatocytes were detected by real-time PCR and Western blotting. Primary hepatic macrophages were stimulated with the conditioned medium (CM) from steatotic hepatocyte along with LRG1 or transforming growth factor-β1 (TGF-β1), or both for 24 h, and the expression levels of inducible nitric oxide synthase (iNOS) was detected with Western botting, and the mRNA expressions of iNOS, chemokine ligand 1 (CXCL-1) and interleukin-1β (IL-1β) were measured by RT-PCR. The MAFLD mice were injected with LRG1 (n=6), TGF-β1 (n=6), or both (n=6) through the caudal vein, and the live tissues were collected for HE staining and immumohistochemical detection of F4/80 expression; the mRNA expressions of iNOS, CXCL-1 and IL-1β in liver tissues were detected using RT-PCR.

RESULTS

The mRNA and protein expression levels of LRG1 were significantly downregulated in the liver tissues of MAFLD mice and steatotic hepatocytes (P < 0.05). Treatment of the hepatic macrophages with CM from steatosis hepatocytes significantly enhanced the mRNA expression levels of iNOS, CXCL-1 and IL-1β, and these changes were significantly inhibited by the combined treatment with TGF-β1 and LRG1 (P < 0.05). In MAFLD mice, injections with either LRG1 or TGF-β1 alone reduced hepatic lipid deposition and intrahepatic macrophage infiltration, and these effects were significantly enhanced by their combined treatment, which also more strongly inhibited the mRNA expression levels of iNOS, CXCL-1 and IL-1β (P < 0.05).

CONCLUSION

LRG1 inhibits hepatic macrophage infiltration by enhancing TGF-β1 signaling to alleviate fatty liver inflammation in MAFLD mice.