ALK-R3HDM1 and EML4-ALK fusion as a mechanism of acquired resistance to gefitinib: A case report and literature review

We report a case with a novel ALK-R3HDM1 and EML4-ALK dual fusion that might be a delicate mechanism for the acquired resistance of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI). A patient with EGFR L858R lung adenocarcinoma developed disease progression after 72.7 months of gefitinib therapy; rebiopsy was done, and next-generation sequencing showed the disappearance of the previous EGFR mutations. In addition, two new ALK fusions emerged, indicating that the emergence of dual ALK rearrangement may be the underlying mechanism of gefitinib resistance. The patient exhibits an excellent response to second-line alectinib treatment with a significant clinical benefit and a high quality of life. Finally, we summarized previous studies in which ALK fusion is a required resistance mechanism to EGFR-TKI.

Glycosylation Analysis of Feline Small Intestine Following Toxoplasma gondii Infection

Simple Summary

Toxoplasma gondii has a serious impact on public health and the economic development of animal husbandry. Glycosylation, especially N-glycosylation, the pattern modification of proteins, is closely related to the biological functions of proteins, and our study used it to analyze glycosylation alterations in the small intestine of cats infected with T. gondii. The results of the present study showed that 56 glycosylated peptides were upregulated and 37 glycosylated peptides were downregulated. Additionally, we also identified eight N-glycosylated proteins of T. gondii including eight N-glycopeptides and eight N-glycosylation sites. Moreover, the protein eEF2 and its corresponding peptide sequence were identified, with GO terms (i.e., cellular process and metabolic process, cell and cell part, and catalytic activity) that were significantly enriched in the T. gondii MAPK pathway. In addition, the Clusters of Orthologous Groups of proteins (COG) function prediction results showed that posttranslational modification, protein turnover, and chaperones (11%) had the highest enrichment for T. gondii. The host proteins ICAM-1 and PPT1 and the endoplasmic reticulum stress pathway may play an important role in the glycosylation of T. gondii-infected hosts. Our study may provide a new target for T. gondii detection to prevent the spread of T. gondii oocysts in the future.

Abstract

Toxoplasma gondii (T. gondii) is responsible for severe human and livestock diseases, huge economic losses, and adversely affects the health of the public and the development of animal husbandry. Glycosylation is a common posttranslational modification of proteins in eukaryotes, and N-glycosylation is closely related to the biological functions of proteins. However, glycosylation alterations in the feline small intestine following T. gondii infection have not been reported. In this study, the experimental group was intragastrically challenged with 600 brain cysts of the Prugniuad (Pru) strain that were collected from infected mice. The cats’ intestinal epithelial tissues were harvested at 10 days post-infection and then sent for protein glycosylation analysis. High-performance liquid chromatography coupled to tandem mass spectrometry was used to analyze the glycosylation alterations in the small intestine of cats infected with T. gondii. The results of the present study showed that 56 glycosylated peptides were upregulated and 37 glycosylated peptides were downregulated in the feline small intestine infected by T. gondii. Additionally, we also identified eight N-glycosylated proteins of T. gondii including eight N-glycopeptides and eight N-glycosylation sites. The protein A0A086JND6_TOXGO (eEF2) and its corresponding peptide sequence were identified in T. gondii infection. Some special GO terms (i.e., cellular process and metabolic process, cell and cell part, and catalytic activity) were significantly enriched, and the Clusters of Orthologous Groups of proteins (COG) function prediction results showed that posttranslational modification, protein turnover, and chaperones (11%) had the highest enrichment for T. gondii. Interestingly, eEF2, a protein of T. gondii, is also involved in the significantly enriched T. gondii MAPK pathway. The host proteins ICAM-1 and PPT1 and the endoplasmic reticulum stress pathway may play an important role in the glycosylation of Toxoplasma-infected hosts. This is the first report showing that T. gondii oocysts can undergo N-glycosylation in the definitive host and that eEF2 is involved, which may provide a new target for T. gondii detection to prevent the spread of T. gondii oocysts in the future.

Clinical characteristics and prognosis of patient with leptospirosis: A multicenter retrospective analysis in south of China

Purpose

Leptospirosis is a zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. However, there is currently no consensual definition or diagnostic criteria for severe and different forms of leptospirosis. Therefore, more insight on clinical manifestations, risk factors, and outcomes of leptospirosis is warranted. The identification of leptospirosis with distinct clinical manifestations and prognosis in our population.

Methods

Multiple correspondence analysis and hierarchical classification on principal components were presented to identify different clinical types of leptospirosis. The outcomes were clinical phenotypes, laboratory and imaging findings, and prognosis.

Results

The 95 enrolled patients had median values of 54.0 years (39.0-65.0) for age, 9.0 (7.0-14.0) for total hospital stay lengths, of whom 86.3% was male and 40.0% was transferred to ICU. Three clinical types were distinguished: mild leptospirosis (n=43, 45.3%) with less organ dysfunction and shorter hospital stays; respiratory leptospirosis (n=28, 29.5%) with hemoptysis, and respiratory and circulatory failure; and hepato-renal leptospirosis (n=24, 25.3%) with worst liver and kidney dysfunction. Total hospital mortality was 15.8% and was associated with dyspnea and high levels of neutrophil counts.

Conclusions

The identification of leptospirosis with distinct clinical manifestations and prognosis in our population may assist clinicians to distinguish leptospirosis-like disease. Moreover, dyspnea and neutrophil count were found to be independent risk factors for severe leptospirosis progression.

[Improving China's public health emergency response based on One Health theory]

With the progress of globalization and the improvement of transportation, a public health emergency can spread across country's boundary in a short period of time from its original place to other areas or regions, posing public health threatens. Public health emergencies not only affect human-animal/plant-environmental health, but also have long-term implications for social development, so the public health emergency response has gone beyond general public health and requires an integrated and comprehensive One Health approach. This paper analyzes the problems and shortcomings of China's current public health emergency response system in a view of One Health and put forward the recommendations based on One Health concept on integrality, collaboration, development and sustainability of public health emergency response. These recommendations can be used as reference to further optimize the response system of public health emergencies in China.

[Current situation and prospect of primary prevention of cancer in China]

Cancer is a major public health issue that seriously endangers the public health and social development of China. Future initiatives for cancer prevention and control should continue to adhere to the principle of prioritizing prevention, and comprehensively implement related prevention activities nationwide. This is critical to reducing cancer burden in Chinese residents, especially in the low- and middle-income populations and those living in areas that are less economically developed. In the past several decades, the international community has significantly reduced the incidence of related cancers through primary prevention measures such as tobacco control, improved occupational hygiene, and vaccination. China has also implemented a series of exploratory primary prevention measures among high-risk groups of cancer in specific areas including Xuanwei, Qidong, and Linxian, and achieved encouraging results. However, due to the low level of systematic awareness of cancer risk factors and the lack of awareness and ability of self-health management in Chinese residents, it is urgent to develop novel research tools and methods to further reveal the causes of cancer, and establish innovative mechanisms and systems of primary prevention of cancer at population and individual levels. Based on current status of the transformation of cancer spectrum and the development of digital intelligence, it would be beneficial to establish a smart digital system for primary cancer prevention service that can cover the entire population, integrating authoritative popular science education on primary prevention of cancer, individualized cancer risk assessment, and personalized health management assistant. This will improve primary cancer prevention among the Chinese general population and can help the sustainable development of cancer prevention and control in China.

[A retrospective controlled study of TACE-HAIC-targeted-immune quadruple therapy for intermediate and advanced-stage hepatocellular carcinoma]

Objective: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE)-hepatic arterial infusion chemotherapy (HAIC)-targeted-immune quadruple therapy in patients with intermediate and advanced-stage hepatocellular carcinoma (HCC). Methods: 101 patients with intermediate and advanced stage HCC were enrolled according to the inclusion and exclusion criteria, and then they were divided into a combination group and a control group. Patients in the combination group was treated with TACE-HAIC-targeted-immune quadruple therapy, while the control group was only treated with TACE therapy. The overall survival (OS), progression-free survival (PFS), and treatment-related adverse reactions were statistically analyzed in the two groups of patients. Statistical analysis was carried out by t-test, χ² test, rank sum test, Kaplan-Meier curve, log-rank test, Cox regression (or proportional hazards model) analysis according to different data. Results: The tumor objective response rate and disease control rate as evaluated by mRECIST 1.1 criteria in the combination group were 80% and 94%, respectively, which were significantly higher than those in the control group, 41.2% (P<0.001) and 74.5% (P=0.007). The OS and PFS of the combination group were 15.6 months [95%CI 11.3-NA ] and 8.8 months [95%CI 6.9-12.0], respectively, which were significantly better than the control group at 6.1 months [95%CI 5.3-6.6] (P<0.001) and 3.2 months [95%CI 3.0-3.6] (P<0.001). Gastric ulcer incidence was significantly higher in the combination group (9/50, 18%) than that in the control group (2/51, 3.9%) (P=0.023). Conclusion TACE-HAIC-targeted-immune quadruple therapy is a more effective treatment mode for intermediate and advanced-stage HCC than TACE alone, and attention should be paid to the monitoring of target immune-related adverse reactions.

Semen parameters and sex hormones as affected by SARS-CoV-2 infection: A systematic review

Background

Impaired semen quality and reproductive hormone levels were observed in patients during and after recovery from coronavirus disease 2019 (COVID-19), which raised concerns about negative effects on male fertility. Therefore, this study systematically reviews available data on semen parameters and sex hormones in patients with COVID-19.

Methods

Systematic search was performed on PubMed and Google Scholar until July 18th, 2022. We identified relevant articles that discussed the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on male fertility.

Results

A total number of 1,684 articles were identified by using a suitable keyword search strategy. After screening, 26 articles were considered eligible for inclusion in this study. These articles included a total of 1,960 controls and 2,106 patients. When all studies were considered, the results showed that the semen parameters and sex hormone levels of patients infected with SARS-CoV-2 exhibited some significant differences compared with controls. Fortunately, these differences gradually disappear as patients recover from COVID-19.

Conclusion

While present data show the negative effects of SARS-CoV-2 infection on male fertility, this does not appear to be long-term. Semen quality and hormone levels will gradually increase to normal as patients recover.

OpenKBP-Opt: an international and reproducible evaluation of 76 knowledge-based planning pipelines

Objective.To establish an open framework for developing plan optimization models for knowledge-based planning (KBP).Approach.Our framework includes radiotherapy treatment data (i.e. reference plans) for 100 patients with head-and-neck cancer who were treated with intensity-modulated radiotherapy. That data also includes high-quality dose predictions from 19 KBP models that were developed by different research groups using out-of-sample data during the OpenKBP Grand Challenge. The dose predictions were input to four fluence-based dose mimicking models to form 76 unique KBP pipelines that generated 7600 plans (76 pipelines × 100 patients). The predictions and KBP-generated plans were compared to the reference plans via: the dose score, which is the average mean absolute voxel-by-voxel difference in dose; the deviation in dose-volume histogram (DVH) points; and the frequency of clinical planning criteria satisfaction. We also performed a theoretical investigation to justify our dose mimicking models.Main results.The range in rank order correlation of the dose score between predictions and their KBP pipelines was 0.50-0.62, which indicates that the quality of the predictions was generally positively correlated with the quality of the plans. Additionally, compared to the input predictions, the KBP-generated plans performed significantly better (P< 0.05; one-sided Wilcoxon test) on 18 of 23 DVH points. Similarly, each optimization model generated plans that satisfied a higher percentage of criteria than the reference plans, which satisfied 3.5% more criteria than the set of all dose predictions. Lastly, our theoretical investigation demonstrated that the dose mimicking models generated plans that are also optimal for an inverse planning model.Significance.This was the largest international effort to date for evaluating the combination of KBP prediction and optimization models. We found that the best performing models significantly outperformed the reference dose and dose predictions. In the interest of reproducibility, our data and code is freely available.

Measuring aerosols in the operating theatre and beyond using a real-time sensor network

The ability to measure and track aerosols in the vicinity of patients with suspected or confirmed COVID-19 is highly desirable. At present, there is no way to measure and track, in real time, the sizes, dispersion and dilution/disappearance of aerosols that are generated by airway manipulations such as mask ventilation; tracheal intubation; bronchoscopy; dental and gastro-intestinal endoscopy procedures; or by vigorous breathing, coughing or exercise. We deployed low-cost photoelectric sensors in five operating theatres between surgical cases. We measured and analysed dilution and exfiltration of aerosols we generated to evaluate air handling and dispersion under real-world conditions. These data were used to develop a model of aerosol persistence. We found significant variation between different operating theatres. Equipment placement near air vents affects air flows, impacting aerosol movement and elimination patterns. Despite these impediments, air exchange in operating theatres is robust and prolonged fallow time before theatre turnover may not be necessary. Significant concentrations of aerosols are not seen in adjoining areas outside of the operating theatre. These models and dispersion rates can predict aerosol persistence in operating theatres and other clinical areas and potentially facilitate quantification of risk, with obvious and far-reaching implications for designing, evaluating and confirming air handling in non-medical environments.

First Measurement of the Z→μ^{+}μ^{-} Angular Coefficients in the Forward Region of pp Collisions at sqrt[s]=13 TeV

The first study of the angular distribution of μ^{+}μ^{-} pairs produced in the forward rapidity region via the Drell-Yan reaction pp→γ^{*}/Z+X→ℓ^{+}ℓ^{-}+X is presented, using data collected with the LHCb detector at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 5.1  fb^{-1}. The coefficients of the five leading terms in the angular distribution are determined as a function of the dimuon transverse momentum and rapidity. The results are compared to various theoretical predictions of the Z-boson production mechanism and can also be used to probe transverse-momentum-dependent parton distributions within the proton.

[China guideline for the screening, early detection and early treatment of gastric cancer (2022, Beijing)]

Gastric cancer (GC) is a major digestive tract malignancy in China, which seriously threatens the health of Chinese population. A large number of researches have demons-trated that screening, early detection and early treatment are effective in reducing the incidence and mortality of GC. The development of the guideline for GC screening, early detection and early treatment in line with epidemic characteristics of GC in China will greatly promote the homogeneity and standardization, and improve the effect of GC screening. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated and convened a working group comprising multidisciplinary experts. Following the World Health Organization Handbook for Guideline Development, this guideline combined the most up-to-date evidence of GC screening, China's national conditions, and practical experience in cancer screening. This guideline provided evidence-based recommendations with respect to the screening population, technology and procedure management, aiming to improve the effect of GC screening and provide scientific evidence for the GC prevention and control in China.

Dynamic Instance Domain Adaptation

Most existing studies on unsupervised domain adaptation (UDA) assume that each domain's training samples come with domain labels (e.g., painting, photo). Samples from each domain are assumed to follow the same distribution and the domain labels are exploited to learn domain-invariant features via feature alignment. However, such an assumption often does not hold true-there often exist numerous finer-grained domains (e.g., dozens of modern painting styles have been developed, each differing dramatically from those of the classic styles). Therefore, forcing feature distribution alignment across each artificially-defined and coarse-grained domain can be ineffective. In this paper, we address both single-source and multi-source UDA from a completely different perspective, which is to view each instance as a fine domain. Feature alignment across domains is thus redundant. Instead, we propose to perform dynamic instance domain adaptation (DIDA). Concretely, a dynamic neural network with adaptive convolutional kernels is developed to generate instance-adaptive residuals to adapt domain-agnostic deep features to each individual instance. This enables a shared classifier to be applied to both source and target domain data without relying on any domain annotation. Further, instead of imposing intricate feature alignment losses, we adopt a simple semi-supervised learning paradigm using only a cross-entropy loss for both labeled source and pseudo labeled target data. Our model, dubbed DIDA-Net, achieves state-of-the-art performance on several commonly used single-source and multi-source UDA datasets including Digits, Office-Home, DomainNet, Digit-Five, and PACS.

[Analysis of the characteristics of HIV-1 molecular transmission network among people aged 50 years and above in Pengzhou city of Sichuan province]

Objective: To describe the characteristics of molecular transmission network of newly diagnosed HIV-1 infected patients, analyze their risk factors related to network access and provide a scientific basis for precise prevention of HIV infection. Methods: For 340 blood samples collected from confirmed HIV-1 infection cases aged ≥50 years in Pengzhou city of Sichuan province from April 2019 to August 2021, nested PCR amplification was used to amplify, clean up and splice clips the pol gene region. The phylogenetic tree was constructed by multi-sequence comparison to distinguish subtypes, and the pairwise genetic distance was calculated. When the genetic distance threshold was 0.90%, the number of clusters was the largest (41), and the molecular transmission network was constructed.The χ² test and logistic regression analysis were performed.The software SPSS 19.0 was used for statistical analysis. Results: A total of 340 samples were successfully amplified (97.06%, 330/340) in 330 samples. 6 HIV-1 subtypes identified, including:CRF01_AE(56.67%,187/330), CRF07_BC(27.88%,92/330), B(11.21%,37/330), CRF08_BC(3.33%,11/330), CRF55_01B(0.61%,2/330) and C(0.30%,1/330).The network entry rate was 58.79% (194/330).The results of logistic regression analysis of the risk factors of HIV-1 molecular transmission network in the research subjects showed that compared with illiteracy, junior high school (OR=0.35, 95%CI:0.13-0.97) and high school/technical secondary school (OR=0.14, 95%CI: 0.02-0.97) had lower possibility of network entry. Compared with farmers, unknown occupations (OR=0.40,95%CI: 0.17-0.95) are less likely to enter the network .Compared with CRF01_AE, CRF07_BC (OR=0.20, 95%CI: 0.11-0.35) and CRF08_BC subtype (OR=0.09, 95%CI: 0.02-0.45) were less likely to enter the network. Conclusions: The sources of AIDS transmission among middle-aged and elderly people of rural areas are diversified in Pengzhou city of Sichuan province. AIDS intervention should focus on middle-aged and elderly farmers with low educational level, and strengthen detection and traceability investigation.

[Current situation on drug resistance and influencing factors of multidrug-resistance in newly treated pulmonary tuberculosis patients in Gansu province]

Objective: In order to provide the precise prevention and control strategy of drug resistance TB in Gansu province, we analyzed the status and risk factors of new drug resistance pulmonary tuberculosis patients. Methods: New pulmonary tuberculosis patients were enrolled from 30 tuberculosis-specialized medical institutions (drug resistance monitoring stations) in Gansu province between first September 2014 to 31^th August 2017, and filled in the survey questionnaire. The isolated Mycobacterium tuberculosis (MTB) strains were implemented 10 drugs drug- susceptibility tes, including isoniazid (INH), rifampicin (RFP), ethambutol (EMB), streptomycin (Sm), kanamycin (Km), amikacin (Am), ofloxacin (Ofx), capreomycin (Cm), propithio-iso-nicotinamide (Pto).The risk factors were analyzed by logistic regression model. Results: One patient was corresponding one clinical isolates among 1 815 patients. The rate (95%CI) of total drug-resistance, single drugresistance, multiple drug- resistance, multidrug-resistance and extensively drug-resistant were 25.45% (23.45%-27.46%), 11.40% (9.94%-12.87%),6.23% (5.11%-7.34%), 7.82% (6.59%-9.06%) and 0.28% (0.03%-0.52%) respectively. Among 142 multidrug-resistant TB patients, the farmers, young adults aged 20-59 and low-income group were 90.85%, 62.68% and 31.69%, respectively. The results of univariate and multivariate analysis showed that the male, non-Han, treatment less than 1 month group and treatment less than 1 month and withdrawal less than 2 month group were risk factors of new multidrug-resistant pulmonary TB. Conclusions: Compared with the Chinese national baseline level of TB resistance, the total drug resistance rate of new TB patients in Gansu province was low, but the multidrug-resistance rate was high. The health assistance for rural low-income TB patients was still an important strategy to prevent and control multidrug-resistant in Gansu province. And measures must implement to stop irregular treatment and poor compliance, as the risk factors of multidrug-resistance in new PTB patients.

Cloning and functional analysis of a trypsin-like serine protease from Pinctada fucata martensii

Trypsin-like serine proteases (TLSs) play various roles in dietary protein digestion, hemolymph coagulation, antimicrobial peptide synthesis, and, in particular, the rapid immune pathways activated in response to pathogen detection. The cultured pearl industry, of which Pinctada fucata martensii is one of the most important species, is plagued by disease, thus leading to large economic losses. Herein, the molecular mechanisms underlying the innate immune response of P.f. martensii were explored. First, immune effector molecules from the P.f. martensii genome were screened and a TLS-like gene encoding a protein with a trypsin domain, herein designated as PmTLS, was identified. A multi-sequence alignment indicated a low sequence homology between PmTLS and other mollusk TLS-like proteins. Furthermore, a neighbor-joining phylogenetic analysis indicated that PmTLS has the closest genetic relationship to a Crassostrea gigas TLS. Additionally, real-time quantitative PCR (qPCR) analysis showed that PmTLS mRNA is constitutively expressed in all of the 6 examined P.f. martensii tissues, with significantly higher expression noted in hemocytes relative to the other tissues examined (p < 0.05). P.f. martensii samples were then challenged with various pathogen-associated molecular patterns (PAMPs), including lipopolysaccharide, peptidoglycan, and polyinosinic acid. In the challenge groups, PmTLS was significantly upregulated in hemocytes at 48 h post-challenge when compared to the unchallenged controls. Furthermore, treatment with recombinant PmTLS (rPmTLS) also significantly inhibited the growth of most of the examined gram-negative bacteria tested in vitro (p < 0.05), but it had little effect on the growth of the examined gram-positive bacteria. When examining morphological changes via transmission electron microscopy, rPmTLS treated bacteria exhibited morphological changes such as plasma wall separation. Thus, rPmTLS appears to play a bactericidal role by destroying bacterial cell membranes or cell walls, which subsequently leads to a release of the cellular contents and cell death. The findings presented herein have enabled further characterization of the immune defense mechanisms in P.f. martensii and may lead to improved disease control methods for the pearl cultivation industry.

[China guideline for the screening, early detection and early treatment of esophageal cancer (2022, Beijing)]

Esophageal cancer (EC) is a major digestive tract malignancy in China, which seriously threatens the health of Chinese population. A large number of researches have demonstrated that screening and early detection are effective in reducing the incidence and mortality of EC. The development of the guideline for EC screening and early detection in line with epidemic characteristics of EC in China will greatly promote the homogeneity and standardization, and improve the effect of EC screening. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated and convened a working group comprising multidisciplinary experts. Following the World Health Organization Handbook for Guideline Development, this guideline combined the most up-to-date evidence of EC screening, China's national conditions, and practical experience in cancer screening. This guideline provided evidence-based recommendations with respect to the screening population, technology and procedure management, aiming to improve the effect of EC screening and provide scientific evidence for the EC prevention and control in China.

Study of the doubly charmed tetraquark [Formula: see text]

Quantum chromodynamics, the theory of the strong force, describes interactions of coloured quarks and gluons and the formation of hadronic matter. Conventional hadronic matter consists of baryons and mesons made of three quarks and quark-antiquark pairs, respectively. Particles with an alternative quark content are known as exotic states. Here a study is reported of an exotic narrow state in the D0D0π+ mass spectrum just below the D*+D0 mass threshold produced in proton-proton collisions collected with the LHCb detector at the Large Hadron Collider. The state is consistent with the ground isoscalar [Formula: see text] tetraquark with a quark content of [Formula: see text] and spin-parity quantum numbers JP = 1+. Study of the DD mass spectra disfavours interpretation of the resonance as the isovector state. The decay structure via intermediate off-shell D*+ mesons is consistent with the observed D0π+ mass distribution. To analyse the mass of the resonance and its coupling to the D*D system, a dedicated model is developed under the assumption of an isoscalar axial-vector [Formula: see text] state decaying to the D*D channel. Using this model, resonance parameters including the pole position, scattering length, effective range and compositeness are determined to reveal important information about the nature of the [Formula: see text] state. In addition, an unexpected dependence of the production rate on track multiplicity is observed.

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

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

Angular Analysis of D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} Decays and Search for CP Violation

The first full angular analysis and an updated measurement of the decay-rate CP asymmetry of the D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} decays are reported. The analysis uses proton-proton collision data collected with the LHCb detector at center-of-mass energies of 7, 8, and 13 TeV. The dataset corresponds to an integrated luminosity of 9  fb^{-1}. The full set of CP -averaged angular observables and their CP asymmetries are measured as a function of the dimuon invariant mass. The results are consistent with expectations from the standard model and with CP symmetry.

Robotic distal pancreatectomy, a novel standard of care? First benchmark values for surgical outcomes from 14 international expert centers

Objective

Robotic distal pancreatectomy (DP) is emerging as the preferred treatment for body and tail tumors of the pancreas. To enable conclusive comparisons with the standard open or laparoscopic approaches and robotic surgery among centers, novel benchmark outcome values are urgently needed. Therefore, the aim of this study was to identify benchmark values from expert centers beyond the learning curve.

Methods

This multicenter study analyzed outcomes from consecutive patients undergoing robotic DP for resectable malignant or benign lesions from 14 international expert centers. After the learning curve, defined as the first 10 cases of robotic DP, all consecutive patients were included from the start of the program up to June 2020 with a minimum follow-up of 1 year. Benchmark patients were those without significant comorbidities including obesity (BMI &gt;35 kg/m2) cardiac disease, chronic pulmonary disease.

Benchmark cutoff values were derived from the 75th or the 25th percentile of the median values of all benchmark centers.

Results

After reaching the learning curve, 289 (47%) of a total of 614 consecutive patients qualified as benchmark cases. The proportion of benchmark patients varied between 24%-64% per center. Benchmark cut-offs showed a low 6 month- postoperative mortality (&lt;0.6%), but high overall morbidity (&lt;58.3%). Benchmark cutoffs for operative time (&lt;300 min), conversion rate (&lt;3%), clinically relevant pancreatic fistulas (&lt;26.9%), CCI at 90-days (&lt;14.8), hospital stay (&lt;7 days) and readmission rate (&lt;22.9%). Benchmark cut-offs for complications remained unchanged after 3 months follow-up. For ductal adenocarcinoma benchmark cutoffs for number of lymph nodes were &gt; 19 with an R0 resection rate of &gt; 85%, and an overall survival of &gt;86% and &gt;52% after 1- and 5-years, respectively. Centers with a low cohort of benchmark patients (more difficult cases) had less clinically relevant pancreatic fistula (9% vs. 23%) and less overall complications (32% vs. 48%).

Conclusion

This benchmark analysis sets novel reference values for robotic DP, indicating favorable outcomes as compared to laparoscopic and open DP. These references values may serve for quality control of surgery in centers embarking in robotic DP, and include the procedure in the standard of care.

Extranodal NK/T-cell lymphoma: a case report of renal insufficiency during PD1 inhibitor treatment

BACKGROUND

Extranodal NK/T-cell lymphoma (ENKTL) is a subtype of non-Hodgkin's lymphoma that accounts for approximately 3-8% of all malignant lymphomas. So far, ENKTL has no standard treatment guidelines, and the current treatment methods pose adverse effects. The combination of programmed death receptors (PD-1) and programmed death receptors' ligands (PD-L1) downregulates effector T cells; hence, it may be an effective treatment for NK/T-cell lymphoma. Here, we report a patient diagnosed with ENKTL whose health was significantly improved after PD-1 immunotherapy. At the same time, the patient suffered from related renal toxic side effects. Immunotherapy is an emerging treatment method for tumors, and the early diagnosis and identification of its side effects are vital for the diagnosis and treatment of tumors.

CASE REPORT

Laboratory tests, pathological examinations, and the patient's history were performed to estimate the severity and the cause of renal insufficiency. The patient with ENKTL developed transient renal damage during immunotherapy. During the next treatment and examination, renal insufficiency was irrelevant to PD-1 inhibitors and avoided unnecessary drug withdrawal.

CONCLUSIONS

In the present case report, we discuss a patient who developed a severe transient renal impairment during immunotherapy and review published studies regarding immunotherapy and its renal-related side effects. We also outline how to critically distinguish whether a patient's kidney injury is anti-PD-1 treatment. We also provide insights to oncologists to develop an effective follow-up treatment plan for early detection and management of any anti-PD-1 treatment side effects.

FAT1 mutations in colorectal cancer patients are associated with the therapeutic benefit of immunotherapy

e15523

Background: Immunotherapy is one of the main treatment modalities for advanced colorectal cancer. Although microsatellite instability (MSI) is widely applied as an effective immune efficacy prediction biomarker in clinical practice, the majority of the colorectal patients are microsatellite stable (MSS). This study is designed to identify new biomarkers for immune efficacy in colorectal cancer. Methods: Targeted sequencing with a 425 gene panel was performed with the tumor tissues from a total of 161 colorectal cancer (CRC) patients (discovery cohort) for mutation analysis. The association between FAT1 mutations and immunotherapy markers MSI and TMB was investigated using an external database of 727 CRC patients from cBioportal (validation cohort). Results: The discovery cohort consisted of 95(59%) males and 66(41%) females with a median age of 59 years old. There were 2(1.2%) stage II, 5(3.1%) stage III, 24(14.9%) stage IV, and 130(80.8%) unknown stage patients. The majority of the discovery cohort was MSS (154, 95.7%), which was similar to the validation cohort (518, 71.2%). FAT1 mutations were present around similar ratios in both discovery cohort (12.4%) and validation cohort (11.6%). In both cohorts, the co-occurrence analysis revealed that MSI events were often co-occurred with FAT1 mutations and patients with FAT1 mutations had a higher mutational load compared to the FAT1 wild-type patients. Analysis with survival data from the validation cohort showed that OS was significantly higher in patients with FAT1-mutated tumors than in ones with FAT1 wild-type. Compared to the FAT1 wild-type tumors, the higher infiltration rate of immune cell identified in the colorectal tumors with FAT1 mutation may also explain the good immune efficacy of patients with FAT1 mutation. Conclusions: Colorectal cancer patients with FAT1 mutations may benefit from immunotherapy. The increased immunogenicity in patients with FAT1 mutations may be due to increased immune cell infiltration.

Topological analysis of hepatocellular carcinoma tumour microenvironment based on imaging mass cytometry reveals cellular neighbourhood regulated reversely by macrophages with different ontogeny

OBJECTIVE

Hepatocellular carcinoma (HCC) tumour microenvironment (TME) is highly complex with diverse cellular components organising into various functional units, cellular neighbourhoods (CNs). And we wanted to define CN of HCC while preserving the TME architecture, based on which, potential targets for novel immunotherapy could be identified.

DESIGN

A highly multiplexed imaging mass cytometry (IMC) panel was designed to simultaneously quantify 36 biomarkers of tissues from 134 patients with HCC and 7 healthy donors to generate 562 highly multiplexed histology images at single-cell resolution. Different function units were defined by topological analysis of TME. CN relevant to the patients' prognosis was identified as specific target for HCC therapy. Transgenic mouse models were used to validate the novel immunotherapy target for HCC.

RESULTS

Three major types of intratumour areas with distinct distribution patterns of tumorous, stromal and immune cells were identified. 22 cellular metaclusters and 16 CN were defined. CN composed of various types of cells formed regional function units and the regional immunity was regulated reversely by resident Kupffer cells and infiltrating macrophages with protumour and antitumour function, respectively. Depletion of Kupffer cells in mouse liver largely enhances the T cell response, reduces liver tumour growth and sensitises the tumour response to antiprogrammed cell death protein-1 treatment.

CONCLUSION

Our findings reveal for the first time the various topological function units of HCC TME, which also presents the largest depository of pathological landscape for HCC. This work highlights the potential of Kupffer cell-specific targeting rather than overall myeloid cell blocking as a novel immunotherapy for HCC treatment.

Fermented soybean meal increases nutrient digestibility via the improvement of intestinal function, anti-oxidative capacity and immune function of weaned pigs

The nutritional components of fermented soybean meal (FSBM) vary because of the complex process of microbial fermentation. The objective of this study was to investigate the nutritional value of FSBM from two sources and explore the mode of actions of FSBM on the improvement of nutrient digestibility with the measurements of digestive enzymes and serum biomarkers. Eight weaned barrows (initial BW: 14.12 ± 0.24 kg) equipped with T-cannula in the distal ileum were allotted to a duplicated 4 × 4 Latin-square design with four experimental diets and four periods. Four experimental diets included a soybean meal control diet, two FSBM diets, and a nitrogen-free diet. The two sources of FSBM increased the contents of CP, amino acid and lactic acid, while decreased the levels of anti-nutritional factors, including glycinin, β-conglycinin and trypsin inhibitors. Compared to soybean meal control diet, both FSBM diets significantly increased the apparent and standardised ileal digestibility of CP and amino acids (P < 0.05), increased the activities of lipase, maltase and invertase in digesta (P < 0.05), increased total antioxidant capacity, activities of glutathione peroxidase and superoxide dismutase, the levels of interleukin-4, IgA, IgG and IgM in serum (P < 0.05), while decreased the levels of diamine oxidase, malondialdehyde, interleukin-6, and interleukin-2 in serum (P < 0.05). Additionally, the standardised ileal digestibility of amino acids were highly correlated with the aforementioned digestive enzymes and health-related serum biomarkers. In summary, FSBM diets showed an improved nutritional value evidenced by the higher nutrient digestibility, which may be partially derived from its beneficial effects on intestinal integrity, anti-oxidative capacity and immune function.

Efficacy and Safety of Reirradiation with Stereotactic Body Radiation Therapy for Locally Recurrent Pancreatic Adenocarcinoma

AIMS

The purpose of this study was to report on outcomes of a cohort of patients who were treated with reirradiation with stereotactic body radiation therapy (SBRT) for locally recurrent pancreatic adenocarcinoma.

MATERIALS AND METHODS

Patients treated with SBRT reirradiation for locally recurrent pancreatic adenocarcinoma from December 2009 to April 2020 were included in the study. Descriptive statistics were used to record patient demographics, tumour and treatment characteristics. Kaplan-Meier analysis was used to evaluate overall survival, local progression-free survival (LPFS), distant metastasis-free survival and progression-free survival (PFS).

RESULTS

In total, 27 patients were included in the study. The median follow-up time from local recurrence was 19.7 months (range 4.2-43.1 months). Most patients received five-fraction SBRT (26/27, 96%). The median overall survival after local recurrence treatment was 18.3 months (range 3.0-42.6 months), with 6-month, 1-year and 2-year overall survival rates of 88.5%, 73.1% and 33.6%. The median LPFS after local recurrence treatment was 16.2 months (range 2.3-33.6 months), with 6-month, 1-year and 2-year LPFS rates of 95.8%, 62.9% and 27.2%. Peri-SBRT chemotherapy improved LPFS (median 17.5 versus 8.5 months; P = 0.010) and overall survival (median 19.3 versus 5.5 months; P = 0.049). Tumours ≤ 3 cm in the greatest dimension showed better local control (median LPFS 19.2 versus 10.2 months; P = 0.130). There was one case (4%) of acute grade 3 pain and one case (4%) of late grade 3 gastrointestinal toxicity.

CONCLUSIONS

Reirradiation with five-fraction SBRT is safe, but local control remains suboptimal. Patients with smaller tumours experienced improved outcomes, as did patients whose treatment plan included the administration of peri-SBRT chemotherapy.

[Contrastive study on MRI signs of intestinal and pancreatobiliary-type periampullary carcinoma]

Objective: The magnetic resonance imaging (MRI) features of intestinal-type periampullary carcinoma (IPAC) and pancreatobiliary-type periampullary carcinoma (PPAC) were compared and analyzed to discuss the optimal diagnosis scheme. Method: Preoperative MRI images of 59 patients (32 males, 27 females, aged 37-80 years) diagnosed with periampullary carcinoma (PAC) confirmed by surgery and pathology in Nanjing Drum Tower Hospital from January 2017 to July 2020 were retrospectively analyzed. The patients were divided into 21 cases in the IPAC group (11 males, 10 females) and 38 cases in the PPAC group (21 males, 17 females) according to histopathological results. The conventional MRI plain scan signs included in the analysis include lesion morphology, the largest diameter of the lesion, lesion location, duodenal papilla morphology, plain scan lesion signal (with the normal pancreatic signal as reference), diffusion weighted imaging (DWI) signal. Magnetic resonance cholangiopancreatography (MRCP) image signs include the dilatation of common bile duct and main pancreatic duct and quantitative analysis of their diameter, the presence of a round filling defect in the distal end of the common bile duct, the morphology of common bile duct stenosis, the dilatation of lateral branches around the obstructed pancreatic duct, the ductal sign, the distance from the end of the obstructed common bile duct to the duodenal papilla, the distance from the end of the obstructed pancreatic duct to the duodenal papilla, and the angle of the pancreaticobiliary duct. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of single meaningful factors. The MRI features of PAC were summarized according to the significant single factor indicators and were classified into 5 image types. And the diagnostic efficacy of the classification criteria for pathological subtypes of PAC was evaluated by the ROC curve. The DeLong test was used to compare the area under the ROC curve (AUC) of multiple diagnostic methods. Results: In univariate analysis, there were statistically significant differences between IPAC and PPAC in lesion location, duodenal papilla morphology, the circular filling defect in the distal end of the common bile duct, the distance from the obstructed pancreatic duct to the duodenal papilla, the angle of the pancreaticobiliary duct, and lesion signal characteristics on plain T2WI fat suppressant images (all P<0.05). Among the 5 types of MRI images, IPAC is mostly manifested as duodenal papillary nodules(15/21,71.4%), while PPAC is more manifested as pancreatic mass type(18/38,47.4%), thickened common bile duct wall type(9/38,23.7%) or ampullary mass type(9/38,23.7%). Both IPAC(2/21,9.5%) and PPAC(0,0) rarely showed the nodular type of common bile duct lumen. In the DeLong test of the significant univariate index(lesion location, duodenal papilla morphology, the circular filling defect in the distal end of the common bile duct, the distance from obstructed pancreatic duct to duodenal papilla, the angle of the pancreaticobiliary duct, and lesion signal characteristics on plain T2WI fat suppressant images) and the 5 classification of MRI images, the AUC of the 5 classifications of MRI images was 0.932(95%CI:0.867-0.997), which was higher than that of any of the significant univariate indexes (all P<0.05). In addition, the 5 classifications of MRI images have the same high diagnostic power as the logistic regression analysis model(P>0.05). Conclusions: The 5 classification of MRI images can improve the accuracy of differential diagnosis of IPAC and PPAC before surgery, and the diagnostic efficiency is better than any single factor meaningful index and comparable to that of the logistic regression analysis model.

Tests of Lepton Universality Using B^{0}→K_{S}^{0}ℓ^{+}ℓ^{-} and B^{+}→K^{*+}ℓ^{+}ℓ^{-} Decays

Tests of lepton universality in B^{0}→K_{S}^{0}ℓ^{+}ℓ^{-} and B^{+}→K^{*+}ℓ^{+}ℓ^{-} decays where ℓ is either an electron or a muon are presented. The differential branching fractions of B^{0}→K_{S}^{0}e^{+}e^{-} and B^{+}→K^{*+}e^{+}e^{-} decays are measured in intervals of the dilepton invariant mass squared. The measurements are performed using proton-proton collision data recorded by the LHCb experiment, corresponding to an integrated luminosity of 9  fb^{-1} . The results are consistent with the standard model and previous tests of lepton universality in related decay modes. The first observation of B^{0}→K_{S}^{0}e^{+}e^{-} and B^{+}→K^{*+}e^{+}e^{-} decays is reported.

Observation of the Decay Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ}

The first observation of the semileptonic b-baryon decay Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ}, with a significance of 6.1σ, is reported using a data sample corresponding to 3  fb^{-1} of integrated luminosity, collected by the LHCb experiment at center-of-mass energies of 7 and 8 TeV at the LHC. The τ^{-} lepton is reconstructed in the hadronic decay to three charged pions. The ratio K=B(Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ})/B(Λ_{b}^{0}→Λ_{c}^{+}π^{-}π^{+}π^{-}) is measured to be 2.46±0.27±0.40, where the first uncertainty is statistical and the second systematic. The branching fraction B(Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ})=(1.50±0.16±0.25±0.23)% is obtained, where the third uncertainty is from the external branching fraction of the normalization channel Λ_{b}^{0}→Λ_{c}^{+}π^{-}π^{+}π^{-}. The ratio of semileptonic branching fractions R(Λ_{c}^{+})≡B(Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ})/B(Λ_{b}^{0}→Λ_{c}^{+}μ^{-}ν[over ¯]_{μ}) is derived to be 0.242±0.026±0.040±0.059, where the external branching fraction uncertainty from the channel Λ_{b}^{0}→Λ_{c}^{+}μ^{-}ν[over ¯]_{μ} contributes to the last term. This result is in agreement with the standard model prediction.

Trabecular bone score in people with cystic fibrosis

People with cystic fibrosis (CF) are at increased risk of fractures. Our study found that low trabecular bone score (TBS) (a measure of bone strength) may help identify people with CF at risk of fractures especially when combined with bone density measured by DXA, age, hemoglobin A1c, and transplant status.

INTRODUCTION

People with cystic fibrosis (CF) are at increased risk of fractures. This study aims to evaluate the association of trabecular bone score (TBS) with fractures in CF.

METHODS

A cross-sectional study of adults with CF who completed bone density between 2009 and 2019. TBS was applied to lumbar spine studies.

RESULTS

A total of 202 people with CF were included. A history of fracture was present in 36 (17.8%) subjects. Patients with history of fractures had higher hemoglobin A1c (A1C) (7.8 ± 2.7% vs. 6.7 ± 1.7%, p = 0.024), lower femoral neck (FN) Z/T-score (- 1.05 ± 1.08 vs. - 0.44 ± 1.08, p = 0.012), and lower TBS (1.36 ± 0.13 vs. 1.40 ± 0.11, p = 0.05) compared to those without. Lung transplant recipients had a higher prevalence of fractures (50% vs. 14.1%, p < 0.001). The odds ratio (95%CI) of having a fracture for subjects with TBS (≤ 1.2 vs. > 1.2) stratified by FN Z/T-score (≤ - 2.0 or >  - 2.0) was 3.88 (0.92, 16.35), p = 0.07. ROC analysis showed TBS was significantly associated with fractures (p < 0.05); however, FN BMD was superior. A model combining FN BMD, age, A1c, transplant, and TBS improved ROC compared to FN BMD + age (0.837 vs. 0.779, p = 0.031).

CONCLUSIONS

TBS ≤ 1.2 may identify people with CF at high risk of fractures. A model combining FN BMD, age, A1c, transplant, and TBS was significantly associated with fractures compared to FN BMD + age. Future studies are needed to evaluate the prediction of fractures in people with CF using clinical and bone parameters.

Observation of Two New Excited Ξ_{b}^{0} States Decaying to Λ_{b}^{0}K^{-}π^{+}

Two narrow resonant states are observed in the Λ_{b}^{0}K^{-}π^{+} mass spectrum using a data sample of proton-proton collisions at a center-of-mass energy of 13 TeV, collected by the LHCb experiment and corresponding to an integrated luminosity of 6  fb^{-1}. The minimal quark content of the Λ_{b}^{0}K^{-}π^{+} system indicates that these are excited Ξ_{b}^{0} baryons. The masses of the Ξ_{b}(6327)^{0} and Ξ_{b}(6333)^{0} states are m[Ξ_{b}(6327)^{0}]=6327.28_{-0.21}^{+0.23}±0.12±0.24 and m[Ξ_{b}(6333)^{0}]=6332.69_{-0.18}^{+0.17}±0.03±0.22  MeV, respectively, with a mass splitting of Δm=5.41_{-0.27}^{+0.26}±0.12  MeV, where the uncertainties are statistical, systematic, and due to the Λ_{b}^{0} mass measurement. The measured natural widths of these states are consistent with zero, with upper limits of Γ[Ξ_{b}(6327)^{0}]<2.20(2.56) and Γ[Ξ_{b}(6333)^{0}]<1.60(1.92)  MeV at a 90% (95%) credibility level. The significance of the two-peak hypothesis is larger than nine (five) Gaussian standard deviations compared to the no-peak (one-peak) hypothesis. The masses, widths, and resonant structure of the new states are in good agreement with the expectations for a doublet of 1D Ξ_{b}^{0} resonances.

Measurement of the Nuclear Modification Factor and Prompt Charged Particle Production in p-Pb and pp Collisions at sqrt[s_{NN}]=5 TeV

The production of prompt charged particles in proton-lead collisions and in proton-proton collisions at the nucleon-nucleon center-of-mass energy sqrt[s_{NN}]=5  TeV is studied at LHCb as a function of pseudorapidity (η) and transverse momentum (p_{T}) with respect to the proton beam direction. The nuclear modification factor for charged particles is determined as a function of η between -4.8<η<-2.5 (backward region) and 2.0<η<4.8 (forward region), and p_{T} between 0.2<p_{T}<8.0  GeV/c. The results show a suppression of charged particle production in proton-lead collisions relative to proton-proton collisions in the forward region and an enhancement in the backward region for p_{T} larger than 1.5  GeV/c. This measurement constrains nuclear PDFs and saturation models at previously unexplored values of the parton momentum fraction down to 10^{-6}.