Application of deep learning to auto-delineation of target volumes and organs at risk in radiotherapy

The technological advancement heralded the arrival of precision radiotherapy (RT), thereby increasing the therapeutic ratio and decreasing the side effects from treatment. Contour of target volumes (TV) and organs at risk (OARs) in RT is a complicated process. In recent years, automatic contouring of TV and OARs has rapidly developed due to the advances in deep learning (DL). This technology has the potential to save time and to reduce intra- or inter-observer variability. In this paper, the authors provide an overview of RT, introduce the concept of DL, summarize the data characteristics of the included literature, summarize the possible challenges for DL in the future, and discuss the possible research directions.

J-shaped relationship between admission diastolic blood pressure and 2-year cardiovascular mortality in elderly patients with acute coronary syndrome

Objective

To investigate the relationship between admission diastolic blood pressure (DBP) and subsequent cardiovascular and all-cause mortality in elderly patients with acute coronary syndrome (ACS).

Methods

This is a retrospective observational study. Consecutive patients ≥65 years of age admitted for ACS at a 2,300-bed tertiary hospital from December 2012 to July 2019 were included. The association between admission DBP and cardiovascular and all-cause mortality during hospitalization and over the follow-up period among this population were analyzed using multivariate COX regression model. Results were presented according to DBP quartiles: Q1, less than 67 mm Hg; Q2, from 67 to 72 mm Hg; Q3, from 73 to 80 mm Hg; and Q4, above 80 mm Hg.

Results

A total of 6 785 patients were included in this cohort study. Mean (SD) patient age was 74.0 (6.5) years, and 47.6% were women. Mean (SD) follow-up time was 2.54 (1.82) years. A non-linear relation was observed between DBP at admission and cardiovascular and all-cause mortality during hospitalization and over the follow-up period using restricted cubic splines. After adjustment for potential confounders, patients in Q3 or Q2 had lower risk for 2-year cardiovascular death by Cox proportional hazard model compared with patients in Q4 (hazard ratio [HR] 0.66; 95% confidence interval [CI], 0.48–0.90, P=0.010, for Q3 vs Q4; and HR 0.72; 95% CI, 0.53–0.99, P=0.041, for Q2vs Q4), while patients in Q1 had similar risk for cardiovascular death with that of patients in Q4. Meanwhile, when compared with patients in Q1, patients in Q3 had lower risk for 2-year cardiovascular death (HR, 0.72; 95% CI, 0.53–0.97, P=0.033). However, lower or higher admission DBP was not an independent predictor of 2-year all-cause mortality in this population.

Conclusion

Among patients aged ≥65 years admitted for ACS, there is a J-curve relationship between supine admission DBP and risk for 2-year cardiovascular death, with a nadir at 73–80 mm Hg.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support Study population and selectionAdjusted multivariate COX regression

A generalized l 2,p-norm regression based feature selection algorithm

Feature selection is an important data dimension reduction method, and it has been used widely in applications involving high-dimensional data such as genetic data analysis and image processing. In order to achieve robust feature selection, the latest works apply the l 2 , 1 or l 2 , p -norm of matrix to the loss function and regularization terms in regression, and have achieved encouraging results. However, these existing works rigidly set the matrix norms used in the loss function and the regularization terms to the same l 2 , 1 or l 2 , p -norm, which limit their applications. In addition, the algorithms for solutions they present either have high computational complexity and are not suitable for large data sets, or cannot provide satisfying performance due to the approximate calculation. To address these problems, we present a generalized l 2 , p -norm regression based feature selection ( l 2 , p -RFS) method based on a new optimization criterion. The criterion extends the optimization criterion of ( l 2 , p -RFS) when the loss function and the regularization terms in regression use different matrix norms. We cast the new optimization criterion in a regression framework without regularization. In this framework, the new optimization criterion can be solved using an iterative re-weighted least squares (IRLS) procedure in which the least squares problem can be solved efficiently by using the least square QR decomposition (LSQR) algorithm. We have conducted extensive experiments to evaluate the proposed algorithm on various well-known data sets of both gene expression and image data sets, and compare it with other related feature selection methods.

Three Novel Structural Variations at MHC and IL12B Predisposing to Psoriasis

BACKGROUND

Structural variations (SVs, defined as DNA variants ≥50 bp) have been associated with various complex human diseases. However, research to screen the whole genome for SVs predisposing to psoriasis is still lacking.

OBJECTIVES

This study aimed to investigate the association of SVs and psoriasis.

METHODS

We performed a genome-wide screen on SVs using an imputation method on 5 independent cohorts with 45,386 subjects from the Chinese Han population. Fine mapping analysis, genetic interaction analysis and RNA expression analysis were conducted to explore the mechanism of SVs.

RESULTS

We obtained 4,535 SVs in total and identified 2 novel deletions (esv3608550, OR=2.73, P<2.00×10^-308 ; esv3608542, OR=0.47, P=7.40×10^-28 ) at 6q21.33 (MHC), 1 novel Alu element insertion (esv3607339, OR=1.22, P=1.18×10^-35 ) at 5q33.3 (IL12B), and confirmed 1 previously reported deletion (esv3587563, OR=1.30, P=9.52×10^-60 ) at 1q21.2 (LCE) for psoriasis. Fine mapping analysis including SNPs and small Insertions/Deletions (InDels) revealed that esv3608550 and esv3608542 were independently associated with psoriasis, and a novel independent SNP (rs9378188, OR=1.65, P=3.46×10^-38 ) was identified at 6q21.33. By genetic interaction analysis and RNA expression analysis, we speculate that the association of 2 deletions at 6q21.33 with psoriasis might relate to their influence on the expression of HLA-C.

CONCLUSIONS

Our study constructed the most comprehensive SV map for psoriasis thus far and enriched the genetic architecture and pathogenesis of psoriasis as well as highlighted the nonnegligible impact of SVs on complex diseases.

Air pollution in China: health information seeking and protective behaviors

Haze has become one of the most life-threatening problems in China. Chinese people become more dependent on receiving health information from social media, especially WeChat, which shapes their health perceptions and behaviors. Despite the prevalence of health information-seeking behavior (HISB) on WeChat, the predicting factors and consequences of Chinese people's haze HISB using WeChat remain unclear. To fill this gap, a hypothesized model was proposed under the risk perception attitude framework and tested with a longitudinal web-based survey of Chinese people residing in Mainland China, to understand the antecedents and behavioral outcomes of HISB on WeChat. The results from the structural equation modeling showed that perceived risk significantly predicted haze HISB on WeChat, which predicted the intention of wearing PM2.5 mask but not reducing outdoor exercises. The efficacy beliefs of both protective behaviors were not significant predictor of haze HISB. Theoretical and practical implications were discussed.

Accuracy of Bolton's Analysis among Different Malocclusion Patients Plaster Models and Digital Models Obtained by Ex Vivo Scanning with iTero Scanner in Chinese Han Population

Aim

This investigation aimed to compare the accuracy of Bolton's analysis on plaster models of various malocclusion groups by utilizing digital calipers and iTero scanner.

Materials and Methods

The data consisted maxillary and mandibular plaster study casts of 61 patients (Class I-20, Class II-20, Class III-21) there were 31 males and 30 females. iTero®element scanner was utilized to scan the models and Bolton's analysis was performed on digital models. Also, the Digital caliper was utilized to perform the Manual measurements. Mesiodistal tooth widths, Anterior and Overall Bolton ratio was measured utilizing OrthoCAD™ software on digital models and plaster models with digital calipers. Statistical analysis was performed utilizing One-way ANOVA and independent T-test.

Results

Results revealed anterior and overall Bolton ratios showed significant differences (P < 0.05) for the measurements performed utilizing digital models. Anterior ratio for (Group 1) iTero measurements depicted the statistical significant value (P < 0.03) and overall ratio for (Group 2) digital caliper measurements depicted the statistical significant value (P < 0.02).

Conclusion

With the introduction of intra-oral laser scanners it has become more convenient for the practitioner to perform the intra-oral digital scanning and carry out the model analysis digitally and iTero scanner can also be utilized extra-orally to perform the scanning and model analysis. Our study concludes that intra-oral laser scanner like iTero is more convenient for an orthodontist, and can be utilized for extra-oral scanning of orthodontic dental models as the measurements obtained on digital models was as accurate as the conventional method.

[PI3K/Akt signaling pathway mediates the protective effect of endomorphin-1 postconditioning against myocardial ischemia-reperfusion injury in rats]

OBJECTIVE

To investigate the role of PI3K/Akt signaling pathway in mediating the protective effect of endomorphin-1 against myocardial ischemia-reperfusion (IR) injury.

OBJECTIVE

Fifty SD male rats were randomly divided into sham operation group, myocardial IR group, endomorphin-1 post-treatment group (EM50 group), endomorphin-1+wortmannin (a PI3K/Akt signaling pathway inhibitor) treatment group (EM50+Wort group), and wortmannin treatment group (Wort group). Rat models of myocardial IR injury were established by ligation of the left anterior descending coronary artery for 30 min followed by reperfusion for 120 min. The heart rate and mean arterial pressure were monitored during the experiment. Plasma levels of LDH, CK-MB, cTnI, IL-6, TNF-α, SOD and MDA were measured after reperfusion. The mRNA expression of Bax and Bcl-2 was detected using RT-PCR, and the expression of apoptosis-related protein cleaved caspase-3, phosphorylated Akt protein and total Akt protein in myocardial tissue was detected using Western blotting.

OBJECTIVE

Myocardial IR injury significantly decreased heart rate and blood pressure of the rats in comparison with the sham operation (P < 0.05). Compared with those in the IR group, the rats in EM50 group showed significantly increased heart rate and blood pressure (P < 0.05) with decreased plasma LDH, CK-MB, cTnI, IL-6, TNF-α and MDA levels (P < 0.05), increased SOD activity (P < 0.05), increased expression of p-Akt protein and Bcl-2 mRNA (P < 0.05), and decreased expression of Bax mRNA and cleaved caspase-3 protein (P < 0.05). In EM50+Wort group, the heart rate and blood pressure were significantly lowered (P < 0.05), plasma LDH, CK-MB, cTnI, IL-6, TNF-α and MDA levels increased (P < 0.05), SOD activity decreased (P < 0.05), the expression of p-Akt protein and Bcl-2 mRNA was reduced (P < 0.05), and the expression of Bax mRNA and cleaved caspase-3 protein increased (P < 0.05) as compared with those in EM50 group.

OBJECTIVE

EM-1 postconditioning can regulate cardiac myocyte apoptosis and reduce myocardial IR injury in rats. The PI3K/Akt signaling pathway may play a role in mediating the myocardial protective effects of EM-1 postconditioning.

Peta-electron volt gamma-ray emission from the Crab Nebula

The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar's rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10^-4 to 1.1 peta-electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta-electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron's size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta-electron volt electrons, 2.5 × 10³⁶ ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta-electron volt protons to the production of the highest-energy gamma rays.

Saliva and Serum Protein Adsorption on Chemically Modified Silica Surfaces

Biomaterials, once inserted in the oral cavity, become immediately covered by a layer of adsorbed proteins that consists mostly of salivary proteins but also of plasma proteins if the biomaterial is placed close to the gingival margin or if it becomes implanted into tissue and bone. It is often this protein layer, rather than the pristine biomaterial surface, that is subsequently encountered by colonizing bacteria or attaching tissue cells. Thus, to study this important initial protein adsorption from human saliva and serum and how it might be influenced through chemical modification of the biomaterial surface, we have measured the amount of protein adsorbed and analyzed the composition of the adsorbed protein layer using gel electrophoresis and western blotting. Here, we have developed an in vitro model system based on silica surfaces, chemically modified with 7 silane-based self-assembled monolayers that span a broad range of physicochemical properties, from hydrophilic to hydrophobic surfaces (water contact angles from 15° to 115°), low to high surface free energy (12 to 57 mN/m), and negative to positive surface charge (zeta potentials from –120 to +40 mV at physiologic pH). We found that the chemical surface functionalities exerted a substantial effect on the total amounts of proteins adsorbed; however, no linear correlation of the adsorbed amounts with the physicochemical surface parameters was observed. Only the adsorption behavior of a few singular protein components, from which physicochemical data are available, seems to follow physicochemical expectations. Examples are albumin in serum and lysozyme in saliva; in both, adsorption was favored on countercharged surfaces. We conclude from these findings that in complex biofluids such as saliva and serum, adsorption behavior is dominated by the overall protein-binding capacity of the surface rather than by specific physicochemical interactions of single protein entities with the surface.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Extended Very-High-Energy Gamma-Ray Emission Surrounding PSR J0622+3749 Observed by LHAASO-KM2A

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E>25  TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160  TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.

Ultrahigh-energy photons up to 1.4 petaelectronvolts from 12 γ-ray Galactic sources

The extension of the cosmic-ray spectrum beyond 1 petaelectronvolt (PeV; 10¹⁵ electronvolts) indicates the existence of the so-called PeVatrons-cosmic-ray factories that accelerate particles to PeV energies. We need to locate and identify such objects to find the origin of Galactic cosmic rays¹. The principal signature of both electron and proton PeVatrons is ultrahigh-energy (exceeding 100 TeV) γ radiation. Evidence of the presence of a proton PeVatron has been found in the Galactic Centre, according to the detection of a hard-spectrum radiation extending to 0.04 PeV (ref. ²). Although γ-rays with energies slightly higher than 0.1 PeV have been reported from a few objects in the Galactic plane^3-6, unbiased identification and in-depth exploration of PeVatrons requires detection of γ-rays with energies well above 0.1 PeV. Here we report the detection of more than 530 photons at energies above 100 teraelectronvolts and up to 1.4 PeV from 12 ultrahigh-energy γ-ray sources with a statistical significance greater than seven standard deviations. Despite having several potential counterparts in their proximity, including pulsar wind nebulae, supernova remnants and star-forming regions, the PeVatrons responsible for the ultrahigh-energy γ-rays have not yet been firmly localized and identified (except for the Crab Nebula), leaving open the origin of these extreme accelerators.

Genotype characterization and delayed loss of ambulation by glucocorticoids in a large cohort of patients with Duchenne muscular dystrophy

Background

Duchenne muscular dystrophy (DMD) is the most common genetic muscle disease in human. We aimed to describe the genotype distribution in a large cohort of Chinese DMD patients and their delayed loss of ambulation by glucocorticoid (GC) treatments. This is to facilitate protocol designs and outcome measures for the emerging DMD clinical trials.

Results

A total of 1163 patients with DMD were recruited and genotyped. Genotype variations were categorized as large deletions, large duplications, and small mutations. Large deletions were further analyzed for those amenable to exon-skipping therapies. Participants aged 5 years or older were grouped into GC-treated and GC-naïve groups. Clinical progression among different genotypes and their responses to GC treatments were measured by age at loss of ambulation (LOA). Among the mutation genotypes, large deletions, large duplications, and small mutations accounted for 68.79%, 7.14%, and 24.07%, respectively. The mean age at diagnosis was 4.59 years; the median ages at LOA for the GC-naïve, prednisone/prednisolone-treated, and deflazacort-treated groups were 10.23, 12.02, and 13.95 years, respectively. The “deletion amenable to skipping exon 44” subgroup and the nonsense-mutation subgroup had older ages at LOA than the “other deletions” subgroup. Subgroups were further analyzed by both genotypes and GC status. All genotypes showed significant beneficial responses to GC treatment. Deletions amenable to skipping exon 44 showed a lower hazard ratio (0.155). The mean age at death was 18.57 years in this DMD group.

Conclusion

Genotype variation influences clinical progression in certain DMD groups. Beneficial responses to GC treatment were observed among all DMD genotypes. Compared with other genotypes, deletions amenable to skipping exon 44 had a lower hazard ratio, which may indicate a stronger protective effect of GC treatments on this subgroup. These data are valuable for designing future clinical trials, as clinical outcomes may be influenced by the genotypes.

Investigation on potential biomarkers of hyperprogressive disease (HPD) triggered by immune checkpoint inhibitors (ICIs)

PURPOSE

This project aimed to survey the clinical characteristics and survivals of hyperprogressive disease (HPD) mediated by immune checkpoint inhibitors (ICIs) in an attempt to explore the potential predictors.

METHODS

After searching PubMed, MEDLINE, Google Scholar and Cochrane Library databases, 12 studies incorporating 1766 individuals were enrolled. The data were analyzed with Review manager 5.3 software.

RESULTS

The results revealed HPD correlated with previous metastatic sites > 2 (OR = 1.86, 95% CI 1.33-2.59, P = 0.0003), liver metastasis (OR = 3.35, 95% CI 2.09-5.35, P < 0.00001), Royal Marsden Hospital (RMH) score ≥ 2 (OR = 2.80, 95% CI 1.85-4.23, P < 0.00001), higher ECOG PS (OR = 1.60, 95% CI 1.13-2.27, P = 0.008) and LDH > upper limits of normal (ULN) (OR = 2.32, 95% CI 1.51-3.58, P = 0.0001). Instead, HPD was unrelated to gender, age, smoking status, PD-L1 expression, therapy, neutrophil-to-lymphocyte ratio, the histology, the status of EGFR, ALK and KRAS in non-small cell lung cancer and HER-2 expression in advanced gastric cancer. Moreover, HPD was evidently correlated with a shorter OS (HR = 2.92, 95% CI 1.79-4.76, P < 0.0001) and PFS (HR = 3.62, 95% CI 2.79-4.68, P < 0.00001). The same phenomena existed in stratified studies based on study regions and tumor types.

CONCLUSIONS

This study demonstrated that HPD was related to the number of prior metastatic sites > 2, liver metastasis, RMH score ≥ 2, higher ECOG PS score and LDH > ULN. Moreover, HPD was correlated with a poor OS and PFS in patients following ICI therapy.

How Social Media Exposure to Health Information Influences Chinese People's Health Protective Behavior during Air Pollution: A Theory of Planned Behavior Perspective

Haze has become one of the most life-threatening problems in China and affects over one billion Chinese people's health. Chinese people have become more dependent on receiving health information from social media, especially Weibo and WeChat, which shapes their health perceptions and behaviors. To investigate how Chinese people's exposure to health information on social media influenced their health protective behaviors in response to haze, particularly wearing a PM2.5 anti-haze mask, we conducted a longitudinal web-based survey of mainland Chinese. The results from the structural equation modeling showed that (a) attitude and descriptive norm positively mediated the relationships between using Weibo for health information and behavioral intention while descriptive norm negatively mediated the relationship between using WeChat for health information and intention, and that (b) attitude, descriptive norm, and injunctive norm significantly predicted behavioral intention and wearing mask, but perceived behavior control did not. Theoretical and practical implications are discussed.

Clinical Efficacy and Safety of Acupressure on Low Back Pain: A Systematic Review and Meta-Analysis

OBJECTIVES

To evaluate the effectiveness and safety of acupressure on low back pain (LBP).

METHODS

We searched 7 electronic databases and 2 trial registries through December 28, 2020. Randomized controlled trials (RCTs) of acupressure on LBP were considered for meta-analysis with Revman 5.3 and Stata 15.0 software. Methodological quality was evaluated using the Cochrane Collaboration's tool. Trial sequential analysis (TSA) was used to quantify the statistical reliability. HETRED analysis and GRADE were used to determine the heterogeneity and quality of the results, respectively.

RESULTS

Twenty-three RCTs representing 2400 participants were included. Acupressure was superior to tuina massage on response rate (RR 1.25; 95% CI, 1.16 to 1.35; P < 0.00001) and in the standardized mean difference (SMD) for pain reduction [SMD -1.92; 95% CI, -3.09 to -0.76; P=0.001]. Likewise, acupressure was superior to physical therapy [SMD, -0.88; 95% CI, -1.10 to -0.65; P < 0.00001] and to usual care [SMD, -0.32; 95% CI, -0.61 to -0.02; P=0.04] in pain reduction. The Oswestry Disability Index was significantly improved by acupressure compared with usual care [SMD, -0.55; 95% CI, -0.84 to -0.25; P=0.0003]. The combination of acupressure with either manual acupuncture or electro-acupuncture showed significant improvements over the adjuvant therapies alone in response rate [RR 1.19; 95% CI, 1.13 to 1.26; P < 0.00001], pain reduction, and the Japanese Orthopedic Association score (JOA). However, each study displayed substantial heterogeneity. Through subgroup sensitivity analysis and -HETRED analysis, the heterogeneity of acupressure compared with manual acupuncture decreased while the results maintained significance with respect to pain reduction [SMD -0.9; 95% CI, -1.21 to -0.6; P < 0.00001] and JOA [SMD, 0.66; 95% CI, 0.33 to 0.98; P < 0.00001]. Similar results were obtained comparing acupressure with electro-acupuncture with respect to pain [SMD, -1.07; 95% CI, -1.33 to -0.81; P < 0.00001] and JOA [SMD, 0.89; 95% CI, 0.51 to 1.27, P < 0.00001]. TSA demonstrated the effectiveness of acupressure as a standalone or as a combinative treatment (with manual acupuncture or electro-acupuncture) for LBP.

CONCLUSION

Acupressure is an effective treatment for LBP. However, GRADE assessments downgraded the evidence in the trials, indicating that additional investigations are needed to confirm these observations.

An overview on the veracity of intraoral digital scanning system and utilization of iTero scanner for analyzing orthodontic study models both In-Vivo and Ex-Vivo

In the domain of orthodontics, plaster models are contemplated as one of the important tools for diagnosis and treatment planning. In Dentistry, technological advancement has developed in the section of diagnostic devices, for example, the utilization of a 3D intraoral scanner, which can convert plaster models into digital models. With in-office utilization of this system, orthodontists can more meticulously and precisely construct custom braces, clear aligners, and orthodontic appliances. The digital data can be stored as a stereolithography file; it eliminates the disadvantages encountered with the storage of plaster models like breakage, space required, and distortion of the plaster models. ITero®element is the intraoral laser scanner (ILS) which utilizes parallel confocal scanning technology which maximizes the accuracy of the scan. By utilizing the iTero scanner, the dental measurement can be performed in OrthoCADTM software which is highly accurate. The objective of the contemporary study is to review the literature of studies on in-vivo and ex-vivo scanning with the iTero system.

Uric Acid Variability and All-Cause Mortality: A Prospective Cohort Study in Northern China

OBJECTIVES

Uric acid(UA) is related with cardiovascular disease, but the association of UA variability with all-cause mortality is rarely known. This study aimed to investigate the relationship between UA variability and all-cause mortality in Kailuan cohort study in northern China.

DESIGN

Cohort study.

SETTING

Kailuan community hospitals in Tangshan, Hebei province, Northern China.

PARTICIPANTS

A total of 55717 participants from Kailuan Study were enrolled, and our study followed up biennially from 2006 to 2010.

MEASUREMENTS

Clinical records of the participants enrolled were analyzed. UA variation independent of mean (UAVIM) values were calculated and all the participants were quartile grouped into four groups as: Q1(UAVIM<0.68), Q2(0.68≤UAVIM<1.10), Q3(1.10≤UAVIM<1.67) and Q4(UAVIM≥1.67). The endpoint event was all-cause death. Cox regression model was performed to evaluate the hazard ratios(HRs) of all-cause mortality based on UAVIM groups.

RESULTS

During a median follow-up of 6.83 years, 2926 deaths occurred. The accumulated mortality rates were 4.6%, 4.8%, 5.4% and 6.1% in group Q1, Q2, Q3 and Q4 respectively. When adjusted potential confounders, the highest risk for all-cause mortality was in group Q4 and the adjusted HRs and 95% confidence intervals(CIs) of group Q2-Q4 for all-cause death were 1.044(0.937, 1.164), 1.182(1.064, 1.314) and 1.353(1.220, 1.501) compared with group Q1, respectively. Further analysis showed that the risk for all-cause death increased as UAVIM value increased. Sensitive analysis still showed the similar results when excluding participants with hyperuricemia or severe chronic kidney diseases. Sub-group analysis by age, gender, BMI or hypertension history also indicated analogous results.

CONCLUSION

Elevated UAVIM was related with increased all-cause mortality and UAVIM was an independent risk factor for all-cause mortality in the community cohort study.

Validation of superior reference genes for qRT-PCR and Western blot analyses in marine Emiliania huxleyi-virus model system

AIMS

To search for a set of reference genes for reliable gene expression analysis in the globally important marine coccolithophore Emiliania huxleyi-virus model system.

METHODS AND RESULTS

Fifteen housekeeping genes (CDKA, CYP15, EFG3, POLAI, RPL30, RPL13, SAMS, COX1, GPB1-2, HSP90, TUA, TUB, UBA1, CAM3 and GAPDH) were evaluated for their stability as potential reference genes for qRT-PCR using ΔCt, geNorm, NormFinder, Bestkeeper and RefFinder software. CDKA, TUA and TUB genes were tested as loading controls for Western blot in the same sample panel. Additionally, target genes associated with cell apoptosis, that is metacaspase genes, were applied to validate the selection of reference genes. The analysis results demonstrated that putative housekeeping genes exhibited significant variations in both mRNA and protein content during virus infection. After a comprehensive analysis with all the algorithms, CDKA and GAPDH were recommended as the most stable reference genes for E huxleyi virus (EhV) infection treatments. For Western blot, significant variation was seen for TUA and TUB, whereas CDKA was stably expressed, consistent with the results of qRT-PCR.

CONCLUSIONS

CDKA and GAPDH are the best choice for gene and protein expression analysis than the other candidate reference genes under EhV infection conditions.

SIGNIFICANCE AND IMPACT OF THE STUDY

The stable internal control genes identified in this work will help to improve the accuracy and reliability of gene expression analysis and gain insight into complex E. huxleyi-EhV interaction regulatory networks.

Correção de fratura Salter-Harris tipo I em porquinho-da-índia (Cavia porcellus) ˗ relato de caso

RESUMO Um filhote de porquinho-da-índia (Cavia porcellus) foi recebido para atendimento após histórico de ataque por cão. Na avaliação física, observou-se edema, dor e crepitação em membro pélvico direito, sugestivo de fratura. Na avaliação radiográfica, confirmou-se fratura Salter-Harris tipo I em epífise distal da tíbia. A resolução cirúrgica escolhida foi a associação de pino transarticular e coaptação externa com tala de Altman. O paciente teve acompanhamento radiográfico semanal e obteve alta médica no 35o dia de pós-cirúrgico, quando se observou consolidação com completo remodelamento ósseo.

Effect of Liposome-Encapsulated Zoledronic Acid on Microenvironment of Hepatocellular Carcinoma May Depend on the Ratio Between M1 and M2 Polarized Macrophages

We studied the effect of zoledronic acid encapsulated into liposomes (L-ZOL) on tumorassociated macrophages in the stroma of hepatocellular carcinoma xenograft. Liposomes were prepared from 1,2-dipalmitoyl-sn-glycero-3-phosphocholine, 1,2-dipalmitoyl-snglycero-3-phospho-sn-1-glycerol, and 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[carboxy(polyethylene glycol)-2000] using thin film method and loaded with zoledronic acid. It was shown that L-ZOL promoted apoptosis of RAW264.7 cells, eliminate much more protumoral M2 macrophages than antitumoral M1 macrophages in the tumor xenograft, and did not significantly reduce the size of xenograft in 6 days. Thus, the effect of treatment depends on the ratio between antitumoral M1 and protumoral M2 polarized macrophages in the tumor.

MicroRNA-489 promotes cardiomyocyte apoptosis induced by myocardial ischemia-reperfusion injury through inhibiting SPIN1

OBJECTIVE

To investigate whether microRNA-489 could promote cardiomyocyte apoptosis through targeting inhibition of SPIN1, thus participating in the development of myocardial ischemia-reperfusion injury.

MATERIALS AND METHODS

MicroRNA-489 expression in H9c2 cells induced with hypoxia/reoxygenation (H/R) was determined by quantitative real-time polymerase chain reaction (qRT-PCR). With microRNA-489 overexpression in H/R H9c2 cells, activities of lactate dehydrogenase (LDH), methane dicarboxylic aldehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) were detected using relative commercial kits, respectively. The regulatory effect of microRNA-489 on the proliferation and apoptosis of H/R H9c2 cells was assessed through cell counting kit-8 (CCK-8) assay and flow cytometry (FCM), respectively. Through conducting a dual-luciferase reporter gene assay, we evaluated the binding condition between microRNA-489 and SPIN1. Protein expressions of apoptotic genes in H/R H9c2 cells with microRNA-489 overexpression were determined by Western blot. Finally, the regulatory role of microRNA-489 in PI3K/AKT pathway was detected through Western blot.

RESULTS

QRT-PCR data showed that microRNA-489 was highly expressed in H/R H9c2 cells than those in normoxic control. Overexpression of microRNA-489 in H/R H9c2 cells increased the activities of LDH, MDA and GSH-PX, while decreased the activities of SOD. MicroRNA-489 overexpression markedly inhibited the proliferative rate but accelerated apoptosis of H/R H9c2 cells. Western blot results indicated that protein expressions of pro-apoptotic genes Bax and cytochrome C upregulated, whereas anti-apoptotic gene Bcl-2 downregulated after overexpression of microRNA-489 in H/R H9c2 cells. We confirmed that microRNA-489 could target to SPIN1 and inhibit its expression. After overexpression of microRNA-489 in H/R H9c2 cells, PI3K/AKT pathway was inhibited, which was further reversed by PI3K/AKT pathway agonist SC79. Besides, SC79 treatment also reversed the regulatory effect of overexpressed microRNA-489 on cellular behaviors of H/R H9c2 cells.

CONCLUSIONS

MicroRNA-489 inhibits the proliferation and accelerates apoptosis of cardiomyocytes after MIRI by targeting inhibition of SPIN1 via inactivating PI3K/AKT pathway. MicroRNA-489 may be a potential therapeutic target for MIRI.

Down-regulation of miR-155 promotes apoptosis of nasopharyngeal carcinoma CNE-1 cells by targeting PI3K/AKT-FOXO3a signaling

OBJECTIVE

Nasopharyngeal carcinoma is one of the common malignant tumors of the ear, nose, and throat in China. Cell apoptosis is expected to be closely related to prognosis. In recent years, with the development of non-coding RNA function research, it is proposed that miRNA plays an important role in the pathogenesis of nasopharyngeal carcinoma. This study aimed to investigate the role of miR-155 in the apoptosis of nasopharyngeal carcinoma cells.

PATIENTS AND METHODS

Cell transfection was performed to knockdown or overexpress the level of miR-155 or knockdown of the level of FOXO3a. The expression of the related protein was detected by immunoblotting. The Real Time quantitative-PCR was used to detect miR-155 expression. Cell proliferation was assessed by MTT assay. The changes of cell apoptosis were observed by flow cytometry using AV-PI staining and TUNEL staining.

RESULTS

The miR-155 inhibitor and mimics were successfully capable of knocking down or overexpressing miR-155 levels. After knocking down miR-155 level, cell proliferation was significantly attenuated, and apoptosis was significantly increased compared with the sham group (p < 0.05). After overexpression of miR-155, opposite results were observed. In addition, in the cells with the knockdown of miR-155 level, further knockdown of FOXO3a level significantly reduced the inhibitory effect of miR-155 on cell apoptosis compared with the control group (p < 0.05).

CONCLUSIONS

In nasopharyngeal carcinoma CNE-1 cell line, miR-155 can inhibit the proliferation and promote apoptosis of nasopharyngeal carcinoma cells by targeting PI3K/AKT-FOXO3a signaling. MiR-155 may be a novel target for the treatment of nasopharyngeal carcinoma.

Modeling Commodity Flow in the Context of Invasive Species Spread: Study of Tuta absoluta in Nepal

Trade and transport of goods is widely accepted as a primary pathway for the introduction and dispersal of invasive species. However, understanding commodity flows remains a challenge owing to its complex nature, unavailability of quality data, and lack of systematic modeling methods. A robust network-based approach is proposed to model seasonal flow of agricultural produce and examine its role in pest spread. It is applied to study the spread of Tuta absoluta, a devastating pest of tomato in Nepal. Further, the long-term establishment potential of the pest and its economic impact on the country are assessed. Our analysis indicates that regional trade plays an important role in the spread of T. absoluta. The economic impact of this invasion could range from USD 17-25 million. The proposed approach is generic and particularly suited for data-poor scenarios.

[Application of Endo-GIA stapler in laparoscopic radicalcystectomy]

Objective: To explore the application of Endo-GIA stapler in laparoscopic radical cystectomy, especially in the treatment of lateral bladder ligament, and to evaluate its clinical feasibility and practicability. Methods: A retrospective analysis of clinical data about 38 cases of laparoscopic radical cystectomy (LRC) treated in the Department of Urology, Chaoyang Hospital of Beijing and Cancer Hospital, Chinese Academy of Medical Sciences from July 2017 to June 2019 were conducted. The patients were divided into Endo-GIA stopler group(18 cases) and non-Endo-GIA stopler group (20 cases) according to whether Endo-GIA stapler were used. The basic clinical data, operation time of bladder lateral ligament, operation time of bladder lateral wall, operation time of bladder resection, amount of bleeding during operation, pathological data after operation and related indicators of recovery after operation were compared between the two groups. Results: All 38 patients underwent radical cystectomy (RC) successfully under 3-D laparoscopy without conversion to open surgery. The operation time of bladder lateral ligament in Endo-GIA stapler group was significantly shorter than that in non-Endo-GIA stapler group [(3.25±0.75) min vs (9.20±2.95) min, P=0.042]; the operation time of bladder lateral wall in Endo-GIA stapler group was significantly shorter than that in non-Endo-GIA stapler group [(8.06±1.66) min vs (14.30±3.37) min, P=0.016]. The operation time of cystectomy in the Endo-GIA stapler group was significantly shorter than that in the non-Endo-GIA stapler group [(47.06±4.70) min vs (61.60±14.91) min,P=0.003]. The amount of bleeding in the Endo-GIA stapler group was significantly shorter than that in the non-Endo-GIA stapler group [(37.77±21.30) ml vs (114.50±39.80) ml, P=0.015]. The time of drainage tube removal in Endo-GIA group was significantly shorter than that in the non-Endo-GIA group [(5.83±1.54) d vs (7.30±3.00) d, P=0.002]. The length of post-hospitalization in Endo-GIA group was significantly shorter than that in the non-Endo-GIA group [(7.67±1.78) d vs (9.60±3.25) d,P=0.036]. However, there was no significant difference in other basic clinical data, post-operative pathology and post-operative recovery related indicators. Conclusions: Laparoscopic radical cystectomy using Endo-GIA stapler device is safe and feasible. It is easy to operate, shorten the operation time significantly, and reduce the amount of bleeding. To a certain extent, it is conducive to the recovery of patients after operation to some extent, and worthy of clinical application.

Nanographene oxides carrying antisense walR RNA regulates the Enterococcus faecalis biofilm formation and its susceptibility to chlorhexidine

Enterococcus faecalis is the dominant pathogen for persistent periapical periodontitis. The chlorhexidine (CHX) is used as conversional irrigation agents during endodontic root canal therapy. It was reported that the antisense walR RNA (ASwalR) suppressed the biofilm organization. The aim of this study was to investigate the antimicrobial effects of novel graphene oxide (GO)-polyethylenimine (PEI)-based antisense walR (ASwalR) on the inhibition of E. faecalis biofilm and its susceptibility to chlorhexidine. The recombinant ASwalR plasmids were modified with a gene encoding enhanced green fluorescent protein (ASwalR-eGFP) as a reporter gene so that the transformation efficiency could be evaluated by the fluorescence intensity. The GO-PEI-based ASwalR vector transformation strategy was developed to be transformed into E. faecalis and to over-produce ASwalR in biofilms. Colony forming units (CFU) and confocal laser scanning microscopy were used to investigate whether the antibacterial properties of antisense walR interference strategy sensitize E. faecalis biofilm to the CHX. The results indicated that overexpression of ASwalR by GO-PEI-based transformation strategy could inhibit biofilm formation, decrease the EPS synthesis and increase the susceptibility of E. faecalis biofilms to CHX. Our reports demonstrated that antisense walR RNA will be a supplementary strategy in treating E. faecalis with irrigation agents.