RUNX1 as a Potential Target for Combined Radioimmunotherapy of Lung Adenocarcinoma

PURPOSE/OBJECTIVE(S)

Radioimmunotherapy for non-small cell lung cancer has good clinical application prospects. The role and mechanism of RUNX1 in DNA damage repair were explored for its potential role in lung adenocarcinoma radioimmunotherapy.

MATERIALS/METHODS

To study the effect of RUNX1 expression level on the expression of DNA damage repair system related factors and radiation sensitivity of lung adenocarcinoma cells. As an important nuclear transcription factor, RUNX1 was explored whether directly regulating the expression of Nrf2, Rad51, BRCA1, and verifying their respective DNA binding sites in the promoter region through relevant databases. To observe the effect of RUNX1 knockout and overexpression on the expression level of PD-L1 in tumor cells at the cell level; The effect of RUNX1 expression level on the sorting and presentation of PD-L1 cells was investigated by the method of nucleocytoplasmic separation. According to literature reports, CMTM6 and ALIX play a key role in the process of PD-L1 cell sorting and presentation, and explore whether RUNX1 plays a role through this factor. The effect of phosphorylation level of different splicing bodies of RUNX1 (RUNX1a/b/c) on the expression level and DNA damage repair system related factors on tumor radiosensitivity were also explored.

RESULTS

According to TCGA database, RUNX1 is highly expressed and phosphorylated in lung adenocarcinoma. Through gene comparison with the database, it was found that RUNX1 binding sites existed in the promoter region of several factors related to this study, including ALIX, Nrf2, BRCA1, RAD51, ATM, H2AX, etc. After being activated by MAPKp38 phosphorylation, RUNX1a can positively regulate Nrf2 signal pathway. The expression of RUNX1 and p-RUNX1 is time-dependent on ionizing radiation. At the same time, it was found that the expression of RUNX1 and p-RUNX1 was dose-dependent on ionizing radiation, and the expression trend of Nrf2 signal pathway related factors was consistent with RUNX1. RUNX1 regulates the expression of PD-L1, BRCA1, ALIX and Nrf2. Bioinformatics analysis and flow cytometry data show that RUNX1 has inhibitory effect on tumor microenvironment of lung adenocarcinoma.

CONCLUSION

RUNX1 regulates DNA damage repair system and has inhibitory effect on tumor immunity. Inhibiting the expression of RUNX1 in lung adenocarcinoma cells can enhance the effect of radioimmunotherapy.

Proposals for the Delineation of Neck Clinical Target Volume Specific to Oral Squamous Cell Cancer Based on Lymph Node Distribution

PURPOSE/OBJECTIVE(S)

To establish the regional lymph node (LN) distribution probability map and draw the neck clinical target volume specific to oral squamous cell cancer (OSCC).

MATERIALS/METHODS

A total of 293 patients with pathologically proven OSCC were enrolled from Jan 2014 to Jun 2022. The patients were divided into two groups according to the ≤1 cm or>1 cm of minimal distance from the lesion's edge to the midline of body. The center point of the LNs with a minimal axial diameter of ≥10 mm was marked on a single treatment planning computed tomography scan. The neck LN levels I to X were based on 2013 updated international consensus guidelines. LN distribution probability maps were established. The relationships between the LN distribution and consensus guidelines were analyzed to propose modifications for clinical target volume boundaries specific to OSCC.

RESULTS

A total of 1033 LNs were marked. Compared with the >1 cm group, The ≤1 cm group has following feature tendencies: strong addiction to smoking and drinking, predilection for tongue and oral floor cancer, larger primary lesion with mainly infiltrative growth pattern, more frequent extra-nodal extension with mainly contralateral LNs. For the ≤1cm group, the distribution probability of LNs was: ipsilateral II (42.67%), ipsilateral Ib (17.35%), contralateral II (11.18%), ipsilateral III (8.74%), contralateral Ib (7.46%), Ia (6.43%). The other group was: ipsilateral Ib (43.14%), ipsilateral II (37.64%), contralateral Ib (4.31%), ipsilateral III (3.92%), contralateral II (3.53%), Ia (0.78%). Accordingly, the proposals for the delineation of neck clinical target volume were: 1. the inferior boundary of level Ia extends until the level of the thyroid cartilage plate; 2. the upper boundary of level Ib descends to the level of the mandibular angle, and the inner posterior boundary only includes the lateral and posterior margin of the submandibular gland within 5mm; 3. the upper boundary of level II changes to the transverse process of the second cervical vertebra, and the posterior boundary retracts to the posterior edge of the levator scapula. 4. the anterior inner border of level IVa contains only the internal jugular arteriovenous sheath.

CONCLUSION

This is the first description of LN topographic spread patterns for OSCC. Optimization of CTV delineation is helpful to improve the treatment outcome and reduce adverse events.

Proton Based Stereotactic Radiotherapy for Skull Base Patients: Dosimetric Comparison to 4 Modern Radiation Treatment Modalities

PURPOSE/OBJECTIVE(S)

Re-irradiation with ablative doses to a smaller target volume and strict critical structure constraint is a challenge for modern radiation planning and delivery systems. Several advanced radiation treatment techniques can be used for fractionated stereotactic ablative radiosurgery (FSRS) in select patients with unresectable recurrent head and neck tumors. In this study, in order to better understand the dosimetry advantage of each technique, we compare the stereotactic treatment plans of our new small spot size Hitachi proton treatment unit to those of CyberKnife stereotactic radiosurgery (CK), Gamma Knife radiosurgery (GK), volumetric modulated arc therapy (VMAT), and MR Linac radiotherapy (MRL).

MATERIALS/METHODS

Ten FSRS skull base patients treated at our institution using VMAT (n = 5) or GK (n = 5) techniques. Intensity-modulated proton therapy (IMPT) plans were created in Raystation using Monte Carlo dose calculation algorithm. VMAT, CK, GK and MRL plans were generated in RayStation, Accuray Precision, Leksell Gamma Plan, and Monaco treatment planning systems, separately. Planning goals were to achieve the best target coverage of prescribed dose without compromising the critical organs at risk dose volume constraints of the clinical treatment plans. Plans were compared based on percent CTV coverage, Paddick conformity index (PCI), gradient index (GI, V50/V100), dose homogeneity index (HI, (D2-D98)/D50), low dose bath volume (LDBV, ratio of total volume irradiated between 20% and 50% prescription dose and the target volume), beam-on-time (BOT), and mean/maximum doses to brainstems.

RESULTS

The median target volume was 15.5 cm3 (range 1.0 - 36.23 cm3). The prescription was 45 Gy in 5 fractions for VMAT patients, and 21 - 27 Gy in 3 fractions for GK patients. The comparison of the treatment plans of these 5 delivery modalities was shown in table. All techniques achieved comparable CTV coverage. GI was superior for GK plans and outstanding in CK and IMPT plans. IMPT plans were also outstanding in regard to BOT and PCI. Significantly improved HI, LDBV and brainstem mean doses were achieved in IMPT plans. For adjacent brainstem and other OARs, maximum doses were comparable among all techniques.

CONCLUSION

In these five advanced radiation therapy modalities, proton therapy SBRT showed dosimetric advantage over other modalities to spare nearby OARs without sacrifice of target coverage. Further studies are needed to utilize this clinical benefit and investigate plan robustness.

A Multiomics Analysis of the Close Connection between Intratumoral Microbiota and Immune Cell Infiltration in Colorectal Cancer

PURPOSE/OBJECTIVE(S)

The colorectal intratumoral microbiome and its association with the expression of the tumor genome and immune cell infiltration remain poorly characterized. Our study aims to investigate the relationship between intratumoral microbiota with tumor immune infiltration, patient prognosis, and potential downstream signaling pathways.

MATERIALS/METHODS

We collected biopsy samples of tumor tissue and paracancerous tissue from 92 patients with colorectal cancer, and acquired microbiota profiling in these samples using 16s rRNA sequencing. Meanwhile, the immune markers including CD8, FOXP3, CD163, PD-1 and PD-L1 were stained by immunohistochemistry (IHC) to identify the immune infiltration in tumors. Furthermore, we used The Cancer Genome Atlas and The Cancer Microbiome Atlas databases to conduct multiomics analysis on tumor flora and patient survival, tumor gene expression profile and potential downstream pathways.

RESULTS

There was a significant difference in α-diversity (p = 0.00051) and β-diversity (p = 0.004) between tumor and paracancerous tissues. The β-diversity of intratumoral bacterial differed by colorectal cancer tumor stage (early vs. late stage, p = 0.049) and location (left vs. right colon, p = 0.04). Stage-related flora cluster (Porphyromonas, Lachnoclostridium, Bacteroides, Aggregatibacter, and Hungatella) were identified and found to be associated with poor prognosis in colorectal cancer patients (HR = 1.79, p = 0.015). By IHC staining, we found that expression of PD-1 and FOXP3 was significantly reduced at low abundance of stage-related bacterial cluster (p<0.05). Among of them, Hungatella was negatively associated with CD8+T cell infiltration (p<0.05) in tumor. Besides, tumor-location related flora cluster (Bacteroides and Blautia) were identified and found to be associated with good prognosis in colorectal cancer patients (HR = 0.52, p = 0.011). Expression of CD163 was decreased at high abundance of location-related bacterial cluster (p<0.05). Among of them, Blautia was negatively correlated with tumor-associated macrophage infiltration(p<0.05). Furthermore, we found that the stage-related flora cluster was positively connected with the pathway of bile acid metabolism, whereas the location-dependent cluster was negatively correlated with this pathway.

CONCLUSION

We found specific intratumoral bacterial clusters that were related to tumor stage and location, and the clusters were strongly associated with tumor immune infiltration and patient prognosis. Our findings may provide new viewpoint for future research between intratumoral microbiota, metabolism pathway and tumor microenvironment.

IKBKE Promotes Radioresistance of Glioblastoma through AKT/FOXO3a Pathway

PURPOSE/OBJECTIVE(S)

Glioblastoma is an intracranial highly malignant primary tumor, and postoperative radiotherapy is a common treatment of glioblastoma. While radiotherapy resistance of glioblastoma is an important reason for treatment failure. IKBKE is overexpressed in gliomas, but its role in radiotherapy is unknown. This study confirmed that IKBKE can directly phosphorylate AKT protein to regulate FOXO3a, thus promoting the radioresistance of glioblastoma, and proposed a new therapeutic strategy to enhance the efficacy of radiotherapy.

MATERIALS/METHODS

We used flow cytometry, tunel staining, plate cloning, a cell counting kit and WB to confirm the effects of IKBKE and FOXO3a on radioresistance of glioblastoma, and immunofluorescence and WB were used to detect the expression of γ-H2AX. Subcutaneous tumor formation in mice and immunohistochemical staining was performed. IP combined with mass spectrometry, immunofluorescence, endogenous and exogenous IP were used to confirm the interaction between IKBKE and AKT. Point mutation, IP and WB were used to confirm the phosphorylation site of AKT. IP and some small molecule inhibitors were used to confirm the relationship between IKBKE, AKT and PI3K. The effect of IKBKE on FOXO3a was confirmed by WB and qPCR. The protein relationship among IKBKE, FOXO3a and 14-3-3 was confirmed by CHX, MG132, ubiquitin test, immunofluorescence and IP. The above experiments were carried out to verify the effect of Amlexanox, an IKBKE inhibitor, on glioblastoma. And its pharmacokinetics in the brain was determined by LC-MS to provide a theoretical basis for further clinical use.

RESULTS

It was found that IKBKE could increase the radioresistance of glioblastoma in vitro and in vivo. IKBKE could directly phosphorylate AKT, and its phosphorylation sites were Ser473 and Thr308. We also certified that IKBKE activated AKT independent of PI3K. IKBKE inhibited the expression of FOXO3a on protein level, promoted its ubiquitin degradation, enhanced its interaction with 14-3-3, and inhibited its transportation into the nucleus. FOXO3a can increase the radiosensitivity of glioblastoma. Amlexanox, an IKBKE inhibitor, can inhibit the radiosensitivity of glioblastoma and partially pass through the blood-brain barrier to enhance the radiosensitivity of intracranial tumors.

CONCLUSION

IKBKE can activate AKT independent of PI3K by directly phosphorylating AKT Ser473 and Thr308, thus increasing the phosphorylation of FOXO3a. Phosphorylated FOXO3a promoted its ubiquitin degradation, and inhibited its transportation into the nucleus, causing radioresistance in glioblastoma. IKBKE inhibitor Amlexanox can pass through the blood-brain barrier and increase the radiosensitivity of intracranial tumor cells.

Perturbation of Gut Microbiota Modulated the Abscopal Effects of Immunoradiotherapy in Rectal Cancer

PURPOSE/OBJECTIVE(S)

The abscopal effect-the regression of malignancies outside the irradiation zone-can be increased by combining radiotherapy (RT) with immunotherapy. In this study, we aimed to investigate whether the gut microbiota affected the abscopal effect following immunoradiotherapy (iRT) in rectal cancer.

MATERIALS/METHODS

Bilateral MC38 subcutaneous tumors (primary and abscopal tumor) were established in C57/B6 mice with or without oral antibiotic treatment (preadministration of vancomycin, streptomycin, and ampicillin 14 days before therapy). Mice with or without antibiotic therapy were then randomized into eight groups to receive one of four treatments: (1) RT to the primary tumor + anti-PD-1 therapy (iRT), (2) RT to the primary tumor (RT), (3) anti-PD-1 therapy (anti-PD-1), and (4) no treatment. Flow cytometry was used to determine the composition and function of immune cells in the primary and abscopal tumors as well as in the spleen. 16S rRNA sequencing was used to assess the gut microbiome alteration following antibiotic intervention. Multiple bioinformatics were then explored to investigate the impact of specific flora that related to abscopal antitumor effect.

RESULTS

We found that radiation on primary tumors exhibited cytotoxic effect in nonirradiated (abscopal) tumors (p=0.0057, RT vs. untreated group; p=0.0037, iRT vs. anti-PD-1 group). In contrast, abscopal tumors were resistant to the anticancer effects of RT when antibiotics were given (p=0.5374, RT + antibiotics vs. untreated group + antibiotics; p=0.42, iRT + antibiotics vs. anti-PD-1 + antibiotics group). Comparing the RT+antibiotics group to the RT group, we discovered that the number of CD8+CD44+ T cells decreased significantly in both abscopal tumors (p<0.001) and spleens (p=0.0061). In anti-PD-1-treated groups, antibiotics significantly reduced the number of CD8+GranzymeB+ T cells in primary tumors (p=0.0061) and CD4+CD25+ T cells in spleens (p<0.001). In iRT-treated groups, the antibiotic reduced the fraction of CD4+INF-γ+ cells in abscopal tumors (p=0.0134), and increased the number of CD4+PD-1+ T cells in spleens (p<0.001). Moreover, we found that both α- and β-diversity decreased significantly in the gut microbiota after antibiotic treatment (p=0.0079 and p<0.001, respectively). The abundance of g_Alistipes, g_Lactobacillus, g_Lachnospiraceae and g__Lactobacillus fell dramatically in the presence of antibiotics. In addition, functional analyses of Picrust2 and KEGG revealed that antibiotic therapy had the most profound impact on the D-Alanine metabolism pathway (p<0.001).

CONCLUSION

We found that the alteration of the gut microbiome by antibiotics significantly affects the local and systemic antitumoral effect of iRT, our results may provide new insight on how gut modification converts the local anticancer effects of RT into a systemic response that targets metastatic tumors.

Focused Ultrasound for Blood-Brain Barrier Opening and Delivery of Anti-PD1 in Diffuse Midline Gliomas

PURPOSE/OBJECTIVE(S)

Diffuse midline glioma with H3K27 mutation is a fatal pediatric brain tumor, most commonly arising in the brainstem. This tumor remains universally fatal, despite a multitude of clinical trials, with a median overall survival of only 9-12 months. While immune-checkpoint inhibitors (ICIs) have transformed the treatment landscape of multiple solid tumors, delivery past the blood brain barrier (BBB) remains challenging. Programmed cell death protein 1 (PD1) is an immune checkpoint protein expressed on the surface of activated T cells; interaction with its ligand, PDL1, is tumor-protective, dampening T cell response. Recent phase I clinical trials have shown that ICIs targeting proteins along the PD1/PDL1 axis are well tolerated in patients with DMG; however, efficacy remains low. The blood-brain barrier (BBB) poses a major challenge to the efficacious delivery of therapeutic agents with large molecular size, such as anti-PD1. We hypothesize that BBB opening (BBBO) using focused ultrasound (FUS), a form of non-ionizing acoustic radiation, can enhance delivery and efficacy of anti-PD1 for treatment of DMG.

MATERIALS/METHODS

We established a syngeneic mouse DMG model with intracranial injection of cell line 4423 (PDGFB+, H3.3K27M, p53-/-). Magnetic resonance imaging (MRI) was utilized to evaluate BBBO and tumor progression. We measured delivery of anti-PD1 after BBBO using Western Blot and 3D in vivo optical fluorescent imaging/CT (OI/CT) of Cy7 labeled anti-PD1.

RESULTS

We demonstrate that delivery of anti-PD1 can be enhanced over 3.5-fold after reversible BBBO with FUS and concurrent microbubble administration. OI/CT revealed enhanced real-time antibody distribution peritumorally. Furthermore, we demonstrate that combined treatment of FUS and anti-PD1 led to benefit in local control of tumor growth using volumetric analysis of MRI. Preliminary survival studies suggest a positive trend for overall survival.

CONCLUSION

Our results support that FUS-mediated BBBO can increase treatment efficacy of anti-PD1 in a DMG murine model, due to improved targeted delivery to the tumoral region after systemic antibody administration. We consider these findings strong rationale for further investigation of the therapeutic effects of combinatorial treatment using FUS-mediated BBBO and ICIs for the treatment of DMG.

Linking the Mechanics of Chewing to Biology of the Junctional Epithelium

The capacity of a tissue to continuously alter its phenotype lies at the heart of how an animal is able to quickly adapt to changes in environmental stimuli. Within tissues, differentiated cells are rigid and play a limited role in adapting to new environments; however, differentiated cells are replenished by stem cells that are defined by their phenotypic plasticity. Here we demonstrate that a Wnt-responsive stem cell niche in the junctional epithelium is responsible for the capability of this tissue to quickly adapt to changes in the physical consistency of a diet. Mechanical input from chewing is required to both establish and maintain this niche. Since the junctional epithelium directly attaches to the tooth surface via hemidesmosomes, a soft diet requires minimal mastication, and consequently, lower distortional strains are produced in the tissue. This reduced strain state is accompanied by reduced mitotic activity in both stem cells and their progeny, leading to tissue atrophy. The atrophied junctional epithelium exhibits suboptimal barrier functions, allowing the ingression of bacteria into the underlying connective tissues, which in turn trigger inflammation and mild alveolar bone loss. These data link the mechanics of chewing to the biology of tooth-supporting tissues, revealing how a stem cell niche is responsible for the remarkable adaptability of the junctional epithelium to different diets.

Establishing a Chinese older hip fracture registry for older patients: a Delphi study to define the focus and key variables for this registry

A national hip fracture registry does not yet exist in China. This is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. Thousands of Chinese hospitals will build on this and improve the quality of management for older hip fracture patients. The rapidly ageing population of China already experiences over half a million hip fractures every year. Many countries have developed national hip fracture registries to improve the quality of hip fracture management, but such a registry does not exist in China. The study is aimed at determining the core variables of a national hip fracture registry for older hip fracture patients in China. A rapid literature review was conducted to develop a preliminary pool of variables from existing global hip fracture registries. Two rounds of an e-Delphi survey were conducted with experts. The e-Delphi survey used a Likert 5-point scale and boundary value analysis to filter the preliminary pool of variables. The list of core variables was finalised following an online consensus meeting with the experts. Thirty-one experts participated. Most of the experts have senior titles and have worked in a corresponding area for more than 15 years. The response rate of the e-Delphi was 100% for both rounds. The preliminary pool of 89 variables was established after reviewing 13 national hip fracture registries. With two rounds of the e-Delphi and the expert consensus meeting, 86 core variables were recommended for inclusion in the registry. This study is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. The further development of a registry to routinely collect data from thousands of hospitals will build on this work and improve the quality of management for older hip fracture patients in China.

A Comparative Population-Based Study of Tracheal and Lung Adenoid Cystic Carcinoma

PURPOSE/OBJECTIVE(S)

Thoracic adenoid cystic carcinoma (ACC) is very rare, and its clinicopathological characteristics, treatment and prognosis have not been fully elucidated. Previous studies did not differentiate between tracheal and lung lesions.

MATERIALS/METHODS

We identified tracheal ACC (TACC) and lung and bronchus ACC (LACC) patients from our cancer center (from 2005 to 2022) and the Surveillance, Epidemiology, and End Results (SEER) database (from 2000 to 2009). Incidence was calculated and trends were quantified. Significant prognostic factors for overall survival (OS) were reviewed and analyzed by using Cox proportional hazards regression. Then, two nomograms predicting OS of TACC and LACC were constructed based on the SEER database and validated externally by using the separate cohort.

RESULTS

There was an upward trend from 2000 to 2019 for LACC while a downward trend from 2000 to 2009 was shown for TACC. Totally, 55 TACC and 25 LACC were included in our cohort, 121 TACC and 162 LACC included in the SEER cohort. There were larger tumor sizes, more lymph nodes and distant metastases for LACC patients than TACC patients. The proportion of patients receiving radiotherapy were higher for TACC than LACC. More patients with TACC received surgery and perioperative radiotherapy than those with LACC. Patients with LACC had significantly worse OS than patients with TACC (SEER cohort: 93.7 mons vs. 127.0 mons, p = 0.001, our cohort: 72.2 months vs. 130.8months, p = 0.061). Age, lymph node metastasis, distant metastasis and radiation and/or surgery were identified as independent prognostic factors for OS of TACC. Laterality, distant metastasis and surgery were identified for LACC. The discrimination of the nomogram revealed good prognostic accuracy and clinical applicability as indicated by C-index values of 0.753 and 0.833 for the training cohort and the external validation cohort for TACC, and 0.739 and 0.786 for LACC.

CONCLUSION

TACC and LACC are different in incidence, clinical features, prognosis. Compared with LACC, radiotherapy combined with surgery is more important for TACC. Two nomograms were established for TACC and LACC respectively to help physicians make more individualized survival predictions and clinical decisions.

18F-AlF-NOTA-FAPI-04 PET/CT can Predict Treatment Response and Survival in Patients with Inoperable Pancreatic Adenocarcinoma

PURPOSE/OBJECTIVE(S)

We investigated whether uptake of 18F-AlF-NOTA-FAPI-04 on positron emission tomography/computed tomography (PET/CT) could predict treatment response and survival in patients with pancreatic adenocarcinoma (PAAD).

MATERIALS/METHODS

We prospectively evaluated 47 patients with histopathologically confirmed primary PAAD and pretreatment 18F-FAPI PET/CT scans to determine uptake of fibroblast activation protein (FAP) and compare the findings with those from blood tests and immunohistochemically stained tumor specimens. Cox regression and Kaplan-Meier methods were used to assess relationships between disease progression and potential predictors. Receiver operating characteristic (ROC) curve analysis was used to define the optimal cutoff points for distinguishing patients according to good response vs poor response per RECIST v. 1.1.

RESULTS

The FAPI PET variables maximum and mean standardized uptake values (SUVmax, SUVmean); metabolic tumor volume (MTV); and total lesion FAP expression (TLF) were positively correlated with cancer-associated fibroblast (CAF) markers (FAP, α-smooth muscle actin, vimentin, S100A4, and platelet-derived growth factor receptor α/β, all P<0.05). MTV and Log2TLF were associated with survival in patients with inoperable PAAD (all P<0.05). Analyses controlling for sex, age, cTNM, and performance status showed that MTV and Log2TLF were associated with overall survival (MTV hazard ratio [HR] = 1.016, P = 0.016 and Log2TLF HR = 4.093, P = 0.003). ROC cutoff analysis indicated that elevated MTV and TLF were associated with poorer survival. Greater changes from before to after chemotherapy in SUVmax, MTV, and TLF were associated with good treatment response (all P<0.05). ΔMTV, ΔTLF and ΔSUVmax had larger areas under the curve than ΔCA19-9 for predicting treatment response. Kaplan-Meier analysis showed that the extent of change in MTV and TLF from before to after treatment predicted progression-free survival, with cutoff values (based on medians) of -4.95 for ΔMTV (HR = 8.09, P = 0.013) and -77.83 for ΔTLF (HR = 4.62, P = 0.012).

CONCLUSION

Higher baseline MTV on 18F-FAPI-04 PET/CT scans was associated with poorer survival in patients with inoperable PAAD. ΔMTV was more sensitive for predicting response than ΔCA19-9. These results are clinically meaningful for identifying patients with PAAD who are at high risk of disease progression.

CDC73 Impairment of MAPK1 Ubiquitination and Activation of the mTOR Signaling Pathway

PURPOSE/OBJECTIVE(S)

CDC73 has been reported to be upregulated in breast cancer. This study aimed to illuminate the underlying mechanism by which CDC73 mediates breast cancer.

MATERIALS/METHODS

Here, a breast cancer tissue microarray and three breast cancer cell lines MDA-MB-231, BT-549 as well as MCF-7 were employed. Using RNAi method, we knocked down CDC73 and MAPK1 in breast cancer cells. CDC73 overexpression plasmids (LV-013) were generated through pMD2.G and pSPAX2 vectors. Cell events related to tumor development were analyzed through Celigo cell counting assay, a cell counting kit, wound healing assay, Transwell assay and flow cytometry analysis. The exploration on the underlying mechanism was based on PrimeView human gene expression array. Xenograft tumor models were constructed to visualize the effects of CDC73/MAPK2 on breast cancer progression.

RESULTS

CDC73 was abundantly expressed in breast cancer tissues and cell lines, and the expression of CDC73 was related to poor prognosis of patients. In breast cancer, CDC73 could promote the proliferation and migration of tumor cells, while disrupting apoptosis. Also, we found that CBL, an E3 ubiquitin ligase, could interact with CDC73 and promote MAPK1 ubiquitination and degradation of this protein. In addition, silencing MAPK1 led to a suppression of breast cancer cell growth in vitro and in vivo, and even abolished the promoting effects of CDC73 overexpression. We also found that mTOR pathway played a role in CDC73-mediated breast cancer. mTOR pathway inhibitor reversed cell phenotypes induced by CDC73 overexpression.

CONCLUSION

CDC73 promoted MAPK1 ubiquitination and degradation so that affected MAPK1 level and subsequently led to breast cancer progression, providing a novel therapeutic strategy to combat cancer.

Hybrid Immuno-RT for Bulky Tumors: Standard Fractionation with Partial Tumor SBRT

PURPOSE/OBJECTIVE(S)

Bulky tumors remain challenging to be treated. Stereotactic body radiation therapy (SBRT) is effective against radioresistant tumor cells and can induce immunogenic cell death (ICD) that leads to T-cell-mediated antitumor effects. Low-dose radiation (LDRT) can inflame the tumor microenvironment (TME) by recruiting T cells. We designed a novel radiotherapy technique (RT, ERT) whose dose distribution map resembles the "eclipse" by concurrently delivering LDRT to the whole tumor, meanwhile SBRT to only a part of the same tumor. This study examined the safety and efficacy of ERT to bulky lesions with PD-1 inhibitors in mice and patients.

MATERIALS/METHODS

In mice with CT26 colon or LLC1 lung bulky tumors (400 - 500 cm3), the whole tumor was irradiated by LDRT (2 Gy x 3), meanwhile the tumor center was irradiated by SBRT (10 Gy x 3); αPD-1 was given weekly. The dependence of therapeutic effects on CD8+ T cells was determined using depleting antibodies. Frequencies of CD8+ T cells and M1 macrophages (Mφ) were determined by flow cytometry. Multiplex Immunohistochemistry (mIHC) was applied to analyze the number and the location of CD8+ T cells and their subpopulations, as well as the phospho-eIF2α level (the ICD marker) of tumor cells in TME. Patients with advanced lung or liver bulky tumors who failed standard treatment or with oncologic emergencies were treated. Kaplan-Meier method was applied to estimate patients' progression-free survival (PFS) and overall survival (OS).

RESULTS

ERT/αPD-1 is superior to SBRT/αPD-1 or LDRT/αPD-1 in controlling bulky tumors in both mouse models in a CD8+ T-cell dependent manner. In the CT26 model, ERT/αPD-1 resulted in complete tumor regression in 3/11 mice and induced more CD8+ T cells and M1 Mφ in TME compared to other groups. mIHC analysis showed that ERT/αPD-1 induced higher bulk, stem-like (TCF1+ TIM3- PD-1+), and more differentiated (TCF1- TIM3+ PD-1+) CD8+ T cells infiltration into the tumor center and periphery compared to other groups. Compared to untreated or LDRT-treated tumor centers, tumor centers irradiated with ERT or SBRT showed elevated phospho-eIF2α accompanied by higher dendritic cell infiltration. In total, 39 advanced cancer patients were treated with ERT/αPD-1 or plus chemotherapy. Radiation-induced pneumonitis occurred in 1 of 26 patients receiving thoracic ERT. There were two cases of grade III toxicity associated with PD-1 inhibitors. No toxicity above grade III was observed. The objective response rate was 38.5%. The median PFS was 5.6 months and median OS was not reached at a median follow-up of 11.7 months.

CONCLUSION

ERT/αPD-1 showed superior efficacy in controlling bulky tumor in two mouse models. The hybrid immuno-RT (ERT) combing PD-1 inhibitors was safe and effective in patients with bulky tumors. Further clinical trials in combination with bioimaging to identify the optimal SBRT target region for the bulky tumor are warranted.

[Predictive value of plasma exosomal miR-124-3p for the risk of chronic cerebral hypoperfusion]

Objective: To investigate the predictive value of plasma exosomal microRNA (miR)-124-3p in the risk of chronic cerebral hypoperfusion (CCH). Methods: A case-control study. Thirty patients who were diagnosed with CCH (CCH group) based on cranial artery spin labeling (ASL) in the neurology outpatient clinic of Sichuan Provincial People's Hospital from March 2022 to June 2022 and 30 healthy volunteers (control group) were included. Age, gender, smoking history, alcohol consumption history, diabetes history, hypertension, hyperlipidemia history, uric acid, fasting blood glucose, homocysteine and plasma exosomal miR-124-3p expression level were compared between the two groups. Comparisons of categorical variables were analyzed by either χ2 test or Fisher's exact test. If the data of continuous variables followed a normal distribution, they were expressed as mean±standard deviation (SD) and compared by t-test for two independent samples; otherwise, the data were expressed as M(Q1, Q3), and analyzed by Mann-Whitney U test for comparison between two groups. The correlation between cerebral blood flow and exosomal miR-124-3p levels was analyzed by Pearson's correlation. Binary multifactorial logistic regression analysis was used to determine the risk factors associated with CCH, and corresponding odds ratios (OR) and 95% confidence intervals (CI) were calculated. P<0.05 was considered significant. Results: There was no significant difference in age (64±8 vs. 60±8 years old), gender (33.3% vs. 30.0%), history of smoking (20.0% vs. 3.3%), alcohol consumption (20.0% vs. 6.7%), diabetes mellitus (13.3% vs. 13.3%), hypertension (53.3% vs. 30.0%), history of hyperlipidemia (46.7% vs. 36.7%), uric acid (288±60 vs.319±67 μmol/L), and fasting glucose [4.99(4.63, 5.91) vs. 5.28(5.09, 6.05) mmol/L] and homocysteine [11.35(10.18, 13.08) vs.11.00(9.78, 13.03) μmol/L] between the CCH and control groups (P>0.05). Plasma exosomal miR-124-3p expression was significantly higher in the CCH group than in the control group [13.08 (8.59, 21.55) vs. 2.85 (1.44, 5.10), respectively; U=169.50, P<0.001]. Pearson's correlation test showed that the level of exosomal miR-124-3p was negatively correlated with cerebral blood flow in the hypoperfused region in patients with CCH (r=-0.932, P<0.001). Multi-factor logistic regression analysis showed that plasma exosomal miR-124-3p was independently associated with the risk of CCH (OR=1.169,95%CI 1.063-1.286,P=0.001). Conclusions: The expression of plasma exosomal miR-124-3p is negatively correlated with cerebral blood flow in areas of low perfusion and is an independent risk factor for CCH. Plasma exosomal miR-124-3p may thus serve as a valid biomarker for CCH risk prediction.

An Effective Dose Rate Optimization Algorithm for Efficient Conventional-Dose-Rate Proton Therapy and Ultra-High-Dose-Rate FLASH Proton Therapy

PURPOSE/OBJECTIVE(S)

The treatment delivery with high dose rate is desirable for efficient conventional-dose-rate proton therapy (IMPT and proton ARC) and essential for achieving biological sparing effect to normal tissues for ultra-high-dose-rate FLASH proton therapy. The minimum-monitor-unit (MMU) problem is mathematically fundamental to these high-dose-rate proton therapy problems, since the dose rate is proportionally associated with the MMU threshold. However, the MMU problem is nonconvex and larger MMU threshold that leads to higher dose rate makes the nonconvex problem more difficult to solve, for which the conventional optimization methods (e.g., alternating direction method of multipliers (ADMM) or proximal gradient descent (PGD) usually cannot satisfactorily solve. This work will develop an effective dose rate optimization algorithm for the MMU problem.

MATERIALS/METHODS

The new method is based on orthogonal matching pursuit (OMP), and consists of two essential components. First, the iterative convex relaxation method is used to determine the active sets for dose-volume planning constraints and decouple the MMU constraint from the rest. Second, a modified OMP optimization algorithm is used to handle the MMU constraint: the non-zero spots are greedily selected via OMP to form the solution set to be optimized, and then a convex constrained subproblem is formed and can be conveniently solved to optimize the spot weights restricted to this solution set via OMP. During this iterative process, the new non-zero spots localized via OMP will be adaptively added to or removed from the optimization objective.

RESULTS

The new method via OMP is validated in comparison with conventional methods (ADMM and PGD) and a recently proposed new method (called stochastic coordinate descent (SCD) method) for high-dose-rate IMPT, ARC, and FLASH problems of large MMU thresholds, and the results suggest that OMP substantially improved the plan quality from PGD, ADMM and SCD in terms of both target dose conformality (e.g., quantified by max target dose and conformity index) and normal tissue sparing (e.g., mean and max dose). A brain case is provided in the table: compared to PGD/ADMM/SCD, OMP improved the conformity index from 0.42/0.52/0.33 to 0.65 for IMPT and 0.46/0.60/0.61 to 0.83 for ARC.

CONCLUSION

A new dose rate optimization algorithm via OMP is developed to solve the MMU problem with large MMU thresholds, and validated using examples of IMPT, ARC, and FLASH with substantially improved plan quality from conventional methods (ADMM and PGD) and a recently proposed new method SCD.

Retrospective study of preservation and transection of the round ligament of uterus during laparoscopic transabdominal preperitoneal inguinal hernia repair in adult women

PURPOSE

The processing of the round ligament of uterus in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia in women has contended. This study aimed to explore whether there is any difference in the surgical outcome and postoperative complications between the two processing modalities, preservation, and transection of the round ligament of uterus, in adult female inguinal hernia patients undergoing TAPP.

METHODS

Retrospective analysis of 84 female patients (117 sides) who underwent TAPP in XXX Hospital from July 2013 to August 2022. Patient characteristics and technical details of the surgical procedure were collected and divided into two groups according to whether the round ligament of uterus was severed intraoperatively or not. There were 52 cases (77 sides) in the group with preservation of the round ligament of uterus and 32 cases (40 sides) in the group with transection of the round ligament of uterus, comparing the general condition, surgical condition, and the occurrence of postoperative related complications between the 2 groups.

RESULTS

The operative time for unilateral primary inguinal hernia was (129.2 ± 35.1) and (89.5 ± 42.6) minutes in the preservation and transection groups, respectively. There were no statistical differences between the two groups in terms of age, length of hospital stay, ASA, BMI, history of lower abdominal surgery, type and side of hernia, intraoperative bleeding, and time to surgery for primary bilateral hernia (P > 0.05). In addition, there was likewise no statistical difference in the occurrence of postoperative Clavien-Dindo classification, VAS, seroma, mesh infection, labia majora edema, chronic pain or abnormal sensation in the inguinal region, and hernia recurrence in the two groups as well (P > 0.05).

CONCLUSION

There is no evidence that the transection of the round ligament of the uterus during TAPP has an impact on postoperative complications in patients. However, given the important role of the uterine round ligament in the surgical management of patients with uterine prolapse and the high incidence of uterine prolapse in older women, hernia surgeons should also be aware of the need to protect the round ligament of uterus in older women.

[Clinical characteristics and prognosis of patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia arising from malignant tumors]

Objective: To investigate the clinical characteristics, cytogenetics, molecular biology, treatment, and prognosis of patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia (t-MDS/AML) secondary to malignancies. Methods: The clinical data of 86 patients with t-MDS/AML in West China Hospital of Sichuan University between January 2010 and April 2023 were retrospectively analyzed. The clinical characteristics, primary tumor types, and tumor-related therapies were analyzed. Results: The study enrolled a total of 86 patients with t-MDS/AML, including 67 patients with t-AML, including 1 patient with M(0), 6 with M(1), 27 with M(2), 9 with M(3), 12 with M(4), 10 with M(5), 1 with M(6), and 1 with M(7). Sixty-two patients could be genetically stratified, with a median overall survival (OS) of 36 (95% CI 22-52) months for 20 (29.9%) patients in the low-risk group and 6 (95% CI 3-9) months for 10 (14.9%) in the intermediate-risk group. The median OS time was 8 (95% CI 1-15) months in 32 (47.8%) patients in the high-risk group. For patients with non-acute promyelocytic leukemia (APL) and AML, the median OS of the low-risk group was 27 (95% CI 18-36) months, which was significantly longer than that of the non-low-risk group (χ(2)=5.534, P=0.019). All 9 APL cases were treated according to the initial treatment, and the median OS was not reached, and the 1-, 2-, and 3-year OS rates were 100.0%, (75.0±6.2) %, and (75.0±6.2) % respectively. Of the 58 patients with non-APL t-AML (89.7%), 52 received chemotherapy, and 16 achieved complete remission (30.8%) after the first induction chemotherapy. The 1-, 2-, and 3-year OS rates of the non-APL t-AML group were (42.0 ± 6.6) %, (22.9±5.7) %, and (13.4±4.7) %, respectively. The median OS of patients who achieved remission was 24 (95% CI 18-30) months, and the median OS of those who did not achieve remission was 6 (95% CI 3-9) months (χ(2)=10.170, P=0.001). Bone marrow CR was achieved in 7 (53.8%) of 13 patients treated with vineclar-containing chemotherapy, with a median OS of 12 (95% CI 9-15) months, which was not significantly different from that of vineclar-containing chemotherapy (χ(2)=0.600, P=0.437). In 19 patients with t-MDS, the 1-, 2-, and 3-year OS rates were (46.8±11.6) %, (17.5±9.1) %, and (11.7±9.1) % with a median OS of 12 (95% CI 7-17) months, which was not significantly different from that in t-AML (χ(2)=0.232, P=0.630) . Conclusions: Breast cancer, bowel cancer, and other primary tumors are common in patients with t-MDS/AML, which have a higher risk of adverse genetics. Patients with APL had a high induction remission rate and a good long-term prognosis, whereas patients without APL had a low remission rate and a poor long-term prognosis.

Measurement of the Lifetime and Λ Separation Energy of _{Λ}^{3}H

The most precise measurements to date of the _{Λ}^{3}H lifetime τ and Λ separation energy B_{Λ} are obtained using the data sample of Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV collected by ALICE at the LHC. The _{Λ}^{3}H is reconstructed via its charged two-body mesonic decay channel (_{Λ}^{3}H→^{3}He+π^{-} and the charge-conjugate process). The measured values τ=[253±11(stat)±6(syst)]  ps and B_{Λ}=[102±63(stat)±67(syst)]  keV are compatible with predictions from effective field theories and confirm that the _{Λ}^{3}H structure is consistent with a weakly bound system.

Scaphoid, lunate and capitate kinematics in the normal and ligament deficient wrist: A bi-plane X-ray fluoroscopy study

The ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional translations and rotations of the scaphoid, lunate and capitate in the normal and ligament deficient wrist during planar and oblique wrist motions remain poorly understood. This study employed a computer-controlled simulator to replicate physiological wrist motion by dynamic muscle force application, while carpal kinematics were simultaneously measured using bi-plane x-ray fluoroscopy. The aim was to quantify carpal kinematics in the native wrist and after sequential sectioning of the scapholunate interosseous ligament (SLIL) and secondary scapholunate ligament structures. Seven fresh-frozen cadaveric wrist specimens were harvested, and cycles of flexion-extension, radial-ulnar deviation and dart-thrower's motion were simulated. The results showed significant rotational and translational changes to these carpal bones in all stages of disruptions to the supporting ligaments (p < 0.05). Specifically, following the disruption of the dorsal SLIL (Stage II), the scaphoid became significantly more flexed, ulnarly deviated, and pronated relative to the radius, whereas the lunate became more extended, supinated and volarly translated (p < 0.05). Sectioning of the dorsal intercarpal (DIC), dorsal radiocarpal (DRC), and scaphotrapeziotrapezoid (STT) ligaments (Stage IV) caused the scaphoid to collapse further into flexion, ulnar deviation, and pronation. These findings highlight the importance of all the ligamentous attachments that relate to the stability of the scapholunate joint, but more importantly, the dorsal SLIL in maintaining scapholunate stability, and the preservation of the attachments of the DIC and DRC ligaments during dorsal surgical approaches. The findings will be useful in diagnosing wrist pathology and in surgical planning.

Burden and trends of iodine deficiency in Asia from 1990 to 2019

OBJECTIVES

Understanding iodine deficiency (ID) burdens and trends in Asia can help guide effective intervention strategies. This study aims to report the incidence, prevalence, and disability-adjusted life years (DALYs) of ID in 48 Asian countries during the period 1990-2019.

STUDY DESIGN

Data on ID were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 and estimated by age, sex, geographical region, and sociodemographic index (SDI).

METHODS

The estimated annual percentage change (EAPC) was calculated to evaluate the changing trend of age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (ASDR) related to ID during the period 1990-2019.

RESULTS

In Asia, there were 126,983,965.8 cases with 5,466,213.1 new incidence and 1,765,995.5 DALYs of ID in 2019. Between 1999 and 2019, the EAPC in ASIR, ASPR and ASDR were -0.6 (95% confidence interval [CI], -0.8 to -0.4), -0.9 (95% CI, -1.2 to -0.7), and -1.6 (95% CI, -1.8 to -1.5), respectively. Malaysia charted the largest decrease in ASIR, ASPR, and ASDR (82.4%, 85.3%, and 80.9% separately), whereas the Philippines and Pakistan were the only two countries that witnessed an increase in ASIR and ASPR. ID burdens were more pronounced in women, countries located to the south of the Himalayas, and low-middle SDI regions.

CONCLUSIONS

The incidence, prevalence, and DALYs of ID in Asia substantially decreased from 1990 to 2019. Women and low-middle SDI countries have relatively high ID burdens. Governments need to pay constant attention to the implementation and monitoring of universal salt iodization.

[Short-term prognostic predictive value of the neutrophil/lymphocyte ratio combined with prognostic nutritional index in hepatitis B virus-related acute-on-chronic liver failure]

Objective: To explore the prognostic predictive value of neutrophil/lymphocyte ratio (NLR) combined with prognostic nutritional index (PNI) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: Clinical data from 149 HBV-ACLF patients admitted to the infectious diseases Department of the General Hospital of Ningxia Medical University were retrospectively analyzed. Demographic data of the enrolled patients and the initial clinical-related data after admission were collected. Patients were divided into survival (93 cases) and death groups (56 cases) according to their prognostic condition 90 days after discharge. Demographic and clinical differences were compared between the two groups data. Receiver operating characteristic (ROC) curves were plotted to determine the optimal cutoff values for NLR and PNI in predicting the 90-day mortality rate of HBV-ACLF patients. The COX regression model was used to conduct univariate and multivariate analyses to investigate the correlation between NLR and PNI and the prognosis of HBV-ACLF patients. Kaplan-Meier survival analysis was used to explore the effects of NLR and PNI on the survival of HBV-ACLF patients. Results: The death group NLR was higher than that of the survival group, while the PNI was lower than that of the survival group, with a statistically significant difference. The area under the receiver operating characteristic curve (0.842, 95% CI: 0.779-0.906) showed patients with adverse prognosis assessed by NLR combined with PNI had a superior prognosis than that of the Model for End-Stage Liver Disease (MELD) and its combined serum sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores. COX regression analysis showed that NLR≥3.03 and MELD score were independent risk factors affecting the prognosis of HBV-ACLF patients. PNI > 36.13 was a protective factor for evaluating the prognosis of HBV-ACLF patients. Conclusion: NLR combined with PNI can enhance the prognostic predictive value of HBV-ACLF.

Strong Constraints on Jet Quenching in Centrality-Dependent p+Pb Collisions at 5.02 TeV from ATLAS

Jet quenching is the process of color-charged partons losing energy via interactions with quark-gluon plasma droplets created in heavy-ion collisions. The collective expansion of such droplets is well described by viscous hydrodynamics. Similar evidence of collectivity is consistently observed in smaller collision systems, including pp and p+Pb collisions. In contrast, while jet quenching is observed in Pb+Pb collisions, no evidence has been found in these small systems to date, raising fundamental questions about the nature of the system created in these collisions. The ATLAS experiment at the Large Hadron Collider has measured the yield of charged hadrons correlated with reconstructed jets in 0.36  nb^{-1} of p+Pb and 3.6  pb^{-1} of pp collisions at 5.02 TeV. The yields of charged hadrons with p_{T}^{ch}>0.5  GeV near and opposite in azimuth to jets with p_{T}^{jet}>30 or 60 GeV, and the ratios of these yields between p+Pb and pp collisions, I_{pPb}, are reported. The collision centrality of p+Pb events is categorized by the energy deposited by forward neutrons from the struck nucleus. The I_{pPb} values are consistent with unity within a few percent for hadrons with p_{T}^{ch}>4  GeV at all centralities. These data provide new, strong constraints that preclude almost any parton energy loss in central p+Pb collisions.

Search for Heavy Neutral Leptons in Decays of W Bosons Using a Dilepton Displaced Vertex in sqrt[s]=13 TeV pp Collisions with the ATLAS Detector

A search for a long-lived, heavy neutral lepton (N) in 139  fb^{-1} of sqrt[s]=13  TeV pp collision data collected by the ATLAS detector at the Large Hadron Collider is reported. The N is produced via W→Nμ or W→Ne and decays into two charged leptons and a neutrino, forming a displaced vertex. The N mass is used to discriminate between signal and background. No signal is observed, and limits are set on the squared mixing parameters of the N with the left-handed neutrino states for the N mass range 3  GeV Collapse

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Test of CP Invariance in Higgs Boson Vector-Boson-Fusion Production Using the H→γγ Channel with the ATLAS Detector

A test of CP invariance in Higgs boson production via vector-boson fusion has been performed in the H→γγ channel using 139  fb^{-1} of proton-proton collision data at sqrt[s]=13  TeV collected by the ATLAS detector at the LHC. The optimal observable method is used to probe the CP structure of interactions between the Higgs boson and electroweak gauge bosons, as described by an effective field theory. No sign of CP violation is observed in the data. Constraints are set on the parameters describing the strength of the CP-odd component in the coupling between the Higgs boson and the electroweak gauge bosons in two effective field theory bases: d[over ˜] in the HISZ basis and c_{HW[over ˜]} in the Warsaw basis. The results presented are the most stringent constraints on CP violation in the coupling between Higgs and weak bosons. The 95% C.L. constraint on d[over ˜] is derived for the first time and the 95% C.L. constraint on c_{HW[over ˜]} has been improved by a factor of 5 compared to the previous measurement.

[The prevalence of insufficient physical activity and the influencing factors among Chinese adults in 2018]

Objective: To understand the prevalence of insufficient physical activity among adults aged ≥18 years in China and to explore the influencing factors. Methods: The China Chronic Disease and Risk Factor Surveillance was conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method was used to select permanent residents aged ≥18 years. A questionnaire including Global Physical Activity Questionnaire was used to collect information about the participants' demographic characteristics and physical activity through face-to-face interview. A total of 183 769 participants completed the survey. After complex data weighting, the prevalence of insufficient physical activity, occupation, transportation, and leisure-time physical activity time was analyzed. Multivariate logistic regression models were used to analyze the influencing factors related to insufficient physical activity. Results: The prevalence of insufficient physical activity among adults aged ≥18 years was 22.3% (95%CI: 20.9%-23.7%) in China in 2018, with males [24.4% (95%CI: 23.0%-25.8%)] significantly higher than females [20.2% (95%CI: 18.6%-21.8%)]. Adults aged 70 years and above [28.4% (95%CI: 26.9%-29.9%)] were significantly higher than adults in other age groups, followed by adults aged 18-29 years [26.4% (95%CI: 24.4%- 28.3%)] and 30-39 years [23.4% (95%CI: 21.5%-25.3%)], and tended to increase with increasing education and total sedentary behavior time (P<0.001). The weekly occupation, transportation, and leisure-time physical activity time appeared 958.6 (95%CI: 911.4-1 005.8) minutes, 234.5 (95%CI: 224.7- 244.2) minutes, and 88.6 (95%CI: 83.5-93.7) minutes, respectively. Multivariate logistic regression analysis showed that males, adults living in rural areas or northern China, ≥70 years, with junior high school education, an annual household income per capita <6 000 yuan and institutional/clerical/ technical occupation and longer total sedentary behavior time were related to a higher prevalence of insufficient physical activity. Conclusions: In China, over one-fifth of the adults had lower physical activity levels. Adults who are male, young adults, more educated, institutional/clerical/technical occupation, and with more extended total sedentary behavior are the populations that need to be focused on to promote physical activity-related health.

A Phase I Study to Evaluate the Safety, Tolerability, and Pharmacokinetics of Novel Intravenous Formulation of Meloxicam (QP001) in Healthy Chinese Subjects

BACKGROUND

Meloxicam is a selective cyclooxygenase-2 inhibitor used for pain relief, but its poor solubility limits its clinical applications. QP001 is a novel intravenous formulation of meloxicam developed with PEG and pH regulator to improve its solubility. This study aimed to evaluate the safety, tolerability, and pharmacokinetics of QP001 in Chinese healthy subjects.

METHODS

The trial consisted of three parts. Part I was a two-period crossover study to evaluate bioavailability, in which 10 healthy were either intravenously infused with 15mg QP001 (test) or orally given 15mg MobicⓇ (reference). Part II was a single-arm design to assess the pharmacokinetic (PK) characteristics after 30 mg single- and multiple-dose QP001 in 10 subjects. In part III, we investigated the PKs and tolerability of QP001 at a high dose (60 mg) in another 10 subjects. The PK parameters and treatment-emergent adverse events (TEAEs) were evaluated.

RESULTS

A total of 30 subjects were enrolled in the study. QP001 was well tolerated and safe without significant TEAEs in all three study parts. The PK characteristics of QP001 were linear following a single-dose range of 15-60 mg (Cmax and AUC0-t were 5.82-17.66 μg/mL and 58.08-251.17 μg∙h/mL, respectively). After five consecutive daily 30 mg doses, the accumulation index was around 1.98, which indicated a minimal accumulation of QP001. Compared to the tablet dosage form, the relative bioavailability of QP001 reached 116.85%. Additionally, the PK profile of QP001 showed no gender difference.

CONCLUSION

QP001 was well tolerated in healthy Chinese subjects after single ascending doses up to 60 mg and multiple-dose of 30 mg. Based on the PK and safety results, QP001 is a promising once-daily intravenous COX-2 inhibitor candidate for managing pain.

TRIAL REGISTRATION

The trial is registered at chinadrugtrials.org.cn (ChiCTR2100047884).

Measurement of the J/ψ Polarization with Respect to the Event Plane in Pb-Pb Collisions at the LHC

We study the polarization of inclusive J/ψ produced in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV at the LHC in the dimuon channel, via the measurement of the angular distribution of its decay products. We perform the study in the rapidity region 2.5 Collapse

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First Measurement of Antideuteron Number Fluctuations at Energies Available at the Large Hadron Collider

The first measurement of event-by-event antideuteron number fluctuations in high energy heavy-ion collisions is presented. The measurements are carried out at midrapidity (|η|<0.8) as a function of collision centrality in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV using the ALICE detector. A significant negative correlation between the produced antiprotons and antideuterons is observed in all collision centralities. The results are compared with a state-of-the-art coalescence calculation. While it describes the ratio of higher order cumulants of the antideuteron multiplicity distribution, it fails to describe quantitatively the magnitude of the correlation between antiproton and antideuteron production. On the other hand, thermal-statistical model calculations describe all the measured observables within uncertainties only for correlation volumes that are different with respect to those describing proton yields and a similar measurement of net-proton number fluctuations.

Enhanced Deuteron Coalescence Probability in Jets

The transverse-momentum (p_{T}) spectra and coalescence parameters B_{2} of (anti)deuterons are measured in p-p collisions at sqrt[s]=13  TeV for the first time in and out of jets. In this measurement, the direction of the leading particle with the highest p_{T} in the event (p_{T}^{lead}>5  GeV/c) is used as an approximation for the jet axis. The event is consequently divided into three azimuthal regions, and the jet signal is obtained as the difference between the toward region, that contains jet fragmentation products in addition to the underlying event (UE), and the transverse region, which is dominated by the UE. The coalescence parameter in the jet is found to be approximately a factor of 10 larger than that in the underlying event. This experimental observation is consistent with the coalescence picture and can be attributed to the smaller average phase-space distance between nucleons in the jet cone as compared with the underlying event. The results presented in this Letter are compared to predictions from a simple nucleon coalescence model, where the phase-space distributions of nucleons are generated using pythia8 with the Monash 2013 tuning, and to predictions from a deuteron production model based on ordinary nuclear reactions with parametrized energy-dependent cross sections tuned on data. The latter model is implemented in pythia8.3. Both models reproduce the observed large difference between in-jet and out-of-jet coalescence parameters, although the almost flat trend of the B_{2}^{Jet} is not reproduced by the models, which instead give a decreasing trend.

[Analysis of therapeutic mechanism of Liushen Wan against colitis-associated colorectal cancer based on network pharmacology and validation in mice]

OBJECTIVE

To explore the therapeutic mechanism of Liushen Wan (LSW) against colitis-associated colorectal cancer (CAC) by network pharmacology.

METHODS

TCMSP, BATMAN-TCM, CNKI, PubMed, Genecards, OMIM, and TTD databases were used to obtain the related targets of LSW and CAC. The common targets of LSW and CAC were obtained using Venny online website. The PPI network was constructed using Cytoscape 3.8.2 to screen the core targets of LSW in the treatment of CAC. GO and KEGG enrichment analysis were conducted using DAVID database. The therapeutic effect of LSW on CAC was evaluated in a C57BL/6J mouse model of AOM/DSS-induced CAC by observing the changes in body weight, disease activity index, colon length, and size and number of the tumor. HE staining and RT-qPCR were used to analyze the effect of LSW on inflammatory mediators. Immunohistochemistry and TUNEL staining were used to evaluate the effect of LSW on the proliferation and apoptosis of AOM/DSS-treated colon tumor cells. Immunohistochemistry and Western blotting were used to detect the effects of LSW on the expression of TLR4 proteins in CAC mice.

RESULTS

Network pharmacology analysis identified 69 common targets of LSW and CAC, and 33 hub targets were screened in the PPI network. KEGG pathway enrichment analysis suggested that the effect of LSW on CAC was mediated by the Toll-like receptor signaling pathway. In the mouse model of AOM/DSS-induced CAC, LSW significantly inhibited colitis-associated tumorigenesis, reduced tumor number and tumor load (P < 0.05), obviously improved histopathological changes in the colon, downregulated the mRNA levels of proinflammatory cytokines, and inhibited the proliferation (P < 0.01) and promoted apoptosis of colon tumor cells (P < 0.001). LSW also significantly decreased TLR4 protein expression in the colon tissue (P < 0.05).

CONCLUSION

LSW can inhibit CAC in mice possibly by regulating the expression of TLR4 to reduce intestinal inflammation, inhibit colon tumor cell proliferation and promote their apoptosis.

[Diffusion tensor field estimation based on 3D U-Net and diffusion tensor imaging model constraint]

OBJECTIVE

To propose a diffusion tensor field estimation network based on 3D U-Net and diffusion tensor imaging (DTI) model constraint (3D DTI-Unet) to accurately estimate DTI quantification parameters from a small number of diffusion-weighted (DW) images with a low signal-to-noise ratio.

METHODS

The input of 3D DTI-Unet was noisy diffusion magnetic resonance imaging (dMRI) data containing one non-DW image and 6 DW images with different diffusion coding directions. The noise-reduced non-DW image and accurate diffusion tensor field were predicted through 3D U-Net. The dMRI data were reconstructed using the DTI model and compared with the true value of dMRI data to optimize the network and ensure the consistency of the dMRI data with the physical model of the diffusion tensor field. We compared 3D DTI-Unet with two DW image denoising algorithms (MP-PCA and GL-HOSVD) to verify the effect of the proposed method.

RESULTS

The proposed method was better than MP-PCA and GL-HOSVD in terms of quantitative results and visual evaluation of DW images, diffusion tensor field and DTI quantification parameters.

CONCLUSION

The proposed method can obtain accurate DTI quantification parameters from one non-DW image and 6 DW images to reduce image acquisition time and improve the reliability of quantitative diagnosis.

Final Measurement of the ^{235}U Antineutrino Energy Spectrum with the PROSPECT-I Detector at HFIR

This Letter reports one of the most precise measurements to date of the antineutrino spectrum from a purely ^{235}U-fueled reactor, made with the final dataset from the PROSPECT-I detector at the High Flux Isotope Reactor. By extracting information from previously unused detector segments, this analysis effectively doubles the statistics of the previous PROSPECT measurement. The reconstructed energy spectrum is unfolded into antineutrino energy and compared with both the Huber-Mueller model and a spectrum from a commercial reactor burning multiple fuel isotopes. A local excess over the model is observed in the 5-7 MeV energy region. Comparison of the PROSPECT results with those from commercial reactors provides new constraints on the origin of this excess, disfavoring at 2.0 and 3.7 standard deviations the hypotheses that antineutrinos from ^{235}U are solely responsible and noncontributors to the excess observed at commercial reactors, respectively.

[Cardiovascular health status of Chinese adults based on "Life's Essential 8" score]

Objective: To assess the cardiovascular health status of adults in China by using the "Life's Essential 8" score, and provide reference for the development and improvement of cardiovascular disease prevention and control policies and measures. Methods: Chronic Disease and Nutrition Surveillance was conducted in 298 counties/districts in 2015 in 31 provinces (autonomous regions, municipalities) across China, multi-stage stratified cluster random sampling was used to select 45 households in each village or neighborhood, and 20 households were further selected to conduct dietary surveys. In this study, a total of 70 093 adults aged ≥20 years who completed the dietary survey and had complete information were included, their cardiovascular health status were assessed by using the "Life's Essential 8" score, a cardiovascular health scoring standard released by the American Heart Association in 2022. All results were adjusted using complex design-based sampling weights to achieve a better estimate of the population. Results: In 2015, the overall cardiovascular health score of Chinese adults aged ≥20 years was 73.3±12.6, the score was significantly higher in women (77.9±11.6) than in men (68.7±11.8), and higher in urban area (74.5±12.8) than in rural area (71.9±12.2), the differences were significant (P<0.001). It was estimated that about 0.25% (95%CI: 0.16%-0.33%) of adults in China had cardiovascular health score of 100, and 33.0% (95%CI: 31.6%-34.3%), 63.2% (95%CI: 62.1%-64.3%), and 3.9% (95%CI: 3.5%-4.2%) of adults had high, moderate and low cardiovascular health scores, respectively. The proportion of those with high cardiovascular health scores was relatively low in men, those with low education level, those with low income, those living in rural areas, and those living in southwest China (P<0.001). Of the eight factors, diet had the lowest mean score (46.0, 95%CI: 44.7-47.3), followed by blood pressure (59.4, 95%CI: 58.2-60.6) and tobacco exposure (61.4, 95%CI: 60.6-62.2). Conclusions: The cardiovascular health status of two-thirds of adult population in China needs to be improved. Diet, tobacco exposure, and blood pressure are the factors affecting the cardiovascular health of Chinese population, to which close attention needs to be paid, and men, rural residents, and those with lower socioeconomic status are key groups in cardiovascular health promotion.

[Analysis on trend of health examination rate and influencing factors in adults in China, 2010-2018]

Objective: To understand the health examination rate and its changing trend in adults in China from 2010 to 2018, identify the main factors affecting the health examination rate and provide data support for decision making of health intervention. Methods: Data from China Chronic Disease and Risk Factor Surveillance in 2010, 2013, 2015 and 2018 were used. After complex weighting of the data, the rates of health examination, its changing trends and reasons for receiving health examination in adults were analyzed. Average annual percent change (AAPC) was used to describe the changing trend. Anderson model was used as the analysis framework. Multivariate logistic regression model was used to identify the influencing factors for the health examination rate. Results: From 2010 to 2018, the health examination rate in adults increased from 28.2% (95%CI: 24.8%-31.6%) to 41.0% (95%CI: 38.9%-43.1%, P for trend <0.001), the AAPC was 5.47%, the annual average increase was more obvious in those with lower education level and lower income level and in those living in rural area and in western China. In 2018, people received health examination mainly due to providing without charge by community (36.7%) and working unit (28.5%). The results of multivariate analysis showed that being women, age ≥45 years, education level of junior high school or above, living in urban areas, medical insurance, annual income ≥24 000 RMB, suffering from multiple chronic diseases, non-smoking, drinking, adequate physical activity were positive factors for receiving health examination. Conclusion: The rate of health examination in adults increased in China during 2010-2018, and the main reason for receiving health examination is free of charge.

[The prospect and challenge of liquid biopsy in the diagnosis and treatment of chest malignancy]

In recent years, the incidence of chest malignant tumors in China has increased year by year, which has seriously threatened the health problems of people. Among them, early screening and intervention of patients with chest malignancies is the key to cancer prevention. Early detection, early diagnosis, and early treatment as the "three early prevention" of clinical practice are conducive to improve the survival rate of tumor patients. As a non-invasive and real-time reflection of tumor status, liquid biopsy has gradually received attention in clinical diagnosis and treatment. Circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) and exosomes as liquid biopsy "Three carriages" are not only widely used in the diagnosis, monitoring and prognostic evaluation of chest malignancies, but also face many unknown challenges. In this article, the application of liquid biopsy in chest malignancies in recent years is elaborated in detail, which provides a reference for the formulation of clinical tumor prevention and diagnosis and treatment strategies.

[Efficacy and outcomes of shunt surgery for secondary hydrocephalus]

Records of secondary hydrocephalus patients undergoing shunt surgery in the Department of Neurosurgery of Peking Union Medical College Hospital from September 2012 to April 2022 and their clinical characteristics and outcomes were retrospectively reviewed and analyzed. Among 121 patients who received first time shunt placement, the most common causes of secondary hydrocephalus were brain hemorrhage (55, 45.5%) and trauma (35, 28.9%). Cognition decline (106, 87.6%), abnormal gait (50, 41.3%) and incontinence (40, 33.1%) were the most prevalent manifestations. Postoperative central nervous system infection (4, 3.3%), shunt obstruction (3, 2.5%) and subdural hematoma/effusion (4, 3.3%) were the most frequent neurological complications. Overall incidence of postoperative complications was 9% (11 cases) in the current cohort. And 50.5% (54/107) of the patients receiving shunting achieved a Glasgow outcome scale (GOS) score of at least 4. Shunt surgery is preferred for secondary hydrocephalus, especially for secondary normal pressure hydrocephalus. Moreover, it is recommended to complete cranioplasty in staged operation or one-stage operation for the patients with decompressive craniectomy.

[Current status and prospects of neoadjuvant therapy for resectable pancreatic cancer]

Pancreatic cancer is a highly malignant tumor. About 75% of patients with pancreatic cancer who underwent radical surgical resection will still experience postoperative recurrence. Neoadjuvant therapy could improve outcomes in patients with borderline resectable pancreatic cancer,has become a consensus;however it is still controversial in resectable pancreatic cancer. Limited high-quality randomized controlled trial studies support the routine initiation of neoadjuvant therapy in resectable pancreatic cancer. With the development of new technologies, such as next-generation sequencing, liquid biopsy, imaging omics, and organoids, patients are expected to benefit from the precision screening of potential candidates for neoadjuvant therapy and individualized treatment strategy.

CLDN6 Suppresses Migration and Invasion of MCF-7 and SKBR-3 Breast Cancer Cells by Blocking the SMAD/Snail/MMP-2/9 Axis

The study examined the mechanisms of action of signal protein claudin 6 (CLDN6) on migration and invasion of breast cancer cell lines MCF-7 and SKBR-3. To this end, the signal proteins SMAD were blocked with their inhibitor SB431542, the genes CLDN6 and SNAIL were knocked down with short hairpin RNAs, and MMP2 and MMP9 were inhibited with TIMP-1. Expressions of MMP2 and MMP9 mRNAs were evaluated by reverse transcription PCR, Expressions of MMP-2, MMP-9, E-cadherin, N-cadherin, and vimentin were examined by Western blotting. Migration and invasion were analyzed by scratch test and Matrigel invasion assay. SB431542 inhibited expression of MMP2 and MMP9 in both cell lines. Single use of SB431542 inhibited expression of MMP-2/MMP-9 and corresponding mRNAs, but subsequent silencing of CLDN6 gene reversed this effect. TIMP-1 reversed down-regulation of E-cadherin, upregulation of N-cadherin and vimentin, facilitation of migration and invasion evoked by CLDN6 knocking down. Silencing of SNAIL gene inhibited migration and invasion, upregulated the expression of E-cadherin, and down-regulated expression of MMP2, MMP 9, N-cadherin, and vimentin. Thus, CLDN6 suppresses the epithelial-mesenchymal transition, migration, and invasion via blocking SMAD/Snail/MMP-2/9 signaling pathway in MCF-7 and SKBR-3 cancer cell lines.

[Early identification and influencing factors of post-traumatic stress disorder in high-stress rescue workers]

Objective: To explore the risk intensity and related influencing factors of post-traumatic stress disorder (PTSD) among high-stress rescue workers, and to provide effective tools for the risk assessment of PTSD in military rescue workers. Method: From June to August 2022, cluster sampling was used to select the high-stress rescue personnel of an Army department as the survey subjects. The acute Stress reaction (ASD) scale and PTSD checklist were used to evaluate the risk of PTSD in military rescue personnel. Multivariate logistic regression were used to analyze the influencing factors of PTSD. Results: The age of 4 460 subjects was (24.38±4.072) years old, including 4 396 males (98.6%). The positive rate of initial screening for ASD was 2.85% (127/4 460). The positive rate of PTSD was 0.67% (30/4 460). Multivariate logistic regression model analysis showed that female, older age, recent trauma exposure history, passive smoking and alcohol consumption were at higher risk of ASD, the values of OR (95%CI) were 4.183 (1.819-9.618), 6.278 (1.363-28.912), 3.094 (1.500-6.379), 2.059 (1.298-3.267) and 2.607 (1.614-4.211), respectively; Lower education level was associated with lower risk of ASD, OR (95%CI) was 0.593 (0.359-0.978); People who are older, thinner, have a history of mental illness, and drink alcohol were at higher risk for PTSD, the values of OR (95%CI) were 20.144 (2.459-165.043), 10.287 (2.218-47.700), 91.104 (8.592-965.980) and 2.866 (1.144-7.180), respectively. Conclusion: Gender, age, education level, passive smoking, alcohol consumption, past history of mental illness and body mass index may be related to the potential risk of PTSD in rescue workers,passive smoking, alcohol consumption, and weight controlling should be focused on to reduce potential risks of PTSD.

[Role of gut microbiota in perioperative neurocognitive disorders after cardiopulmonary bypass surgery in rats with humanized gut flora]

OBJECTIVE

To investigate whether gut microbiota disturbance after cardiopulmonary bypass (CPB) contributes to the development of perioperative neurocognitive disorders (PND).

METHODS

Fecal samples were collected from healthy individuals and patients with PND after CPB to prepare suspensions of fecal bacteria, which were transplanted into the colorectum of two groups of pseudo-germ-free adult male SD rats (group NP and group P, respectively), with the rats without transplantation as the control group (n=10). The feces of the rats were collected for macrogenomic sequencing analysis, and serum levels of IL-1β, IL-6 and TNF-α were measured with ELISA. The expression levels of GFAP and p-Tau protein in the hippocampus of the rats were detected using Western blotting, and the cognitive function changes of the rats were assessed with Morris water maze test.

RESULTS

In all the 3 groups, macrogenomic sequencing analysis showed clustering and clear partitions of the gut microbiota after the transplantation. The relative abundances of Klebsiella in the control group (P < 0.005), Akkermansia in group P (P < 0.005) and Bacteroides in group NP (P < 0.005) were significantly increased after the transplantation. Compared with those in the control group, the rats in group NP and group P showed significantly decreased serum levels of IL-1β, IL-6 and TNF-α and lowered expression levels of GFAP and p-Tau proteins (all P < 0.05). Escape platform crossings and swimming duration in the interest quadrant increased significantly in group NP (P < 0.05), but the increase was not statistically significant in group N. Compared with those in group P, the rats in group NP had significantly lower serum levels of IL-1β, IL-6 and TNF-α and protein expressions of GFAP and p-Tau (all P < 0.05) with better performance in water maze test (P < 0.05).

CONCLUSION

In patients receiving CPB, disturbances in gut mirobiota contributes to the development of PND possibly in relation with inflammatory response.

[Pachymic acid protects against Crohn's disease-like intestinal barrier injury and colitis in miceby suppressingintestinal epithelial cell apoptosis via inhibiting PI3K/AKT signaling]

OBJECTIVE

To investigate the effect of pachymic acid (PA) against TNBS-induced Crohn's disease (CD)-like colitis in mice and explore the possible mechanism.

METHODS

Twenty-four C57BL/6J mice were randomized equally into control group, TNBS-induced colitis model group and PA treatment group. PA treatment was administered via intraperitoneal injection at the daily dose of 5 mg/kg for 7 days, and the mice in the control and model groups were treated with saline. After the treatments, the mice were euthanized for examination of the disease activity index (DAI) of colitis, body weight changes, colon length, intestinal inflammation, intestinal barrier function and apoptosis of intestinal epithelial cells, and the expressions of TNF-α, IL-6 and IL-1β in the colonic mucosa were detected using ELISA. The possible treatment targets of PA in CD were predicted by network pharmacology. String platform and Cytoscape 3.7.2 software were used to construct the protein-protein interaction (PPI) network. David database was used to analyze the GO function and KEGG pathway; The phosphorylation of PI3K/AKT in the colonic mucosal was detected with Western blotting.

RESULTS

PA significantly alleviated colitis in TNBS-treated mice as shown by improvements in the DAI, body weight loss, colon length, and histological inflammation score and lowered levels of TNF-α, IL-6 and IL-1β. PA treatment also significantly improved FITC-dextran permeability, serum I-FABP level and colonic transepithelial electrical resistance, and inhibited apoptosis of the intestinal epithelial cells in TNBS-treated mice. A total of 248 intersection targets were identified between PA and CD, and the core targets included EGFR, HRAS, SRC, MMP9, STAT3, AKT1, CASP3, ALB, HSP90AA1 and HIF1A. GO and KEGG analysis showed that PA negatively regulated apoptosis in close relation with PI3K/AKT signaling. Molecular docking showed that PA had a strong binding ability with AKT1, ALB, EGFR, HSP90AA1, SRC and STAT3. In TNBS-treated mice, PA significantly decreased p-PI3K and p-AKT expressions in the colonic mucosa.

CONCLUSION

PA ameliorates TNBS-induced intestinal barrier injury in mice by antagonizing apoptosis of intestinal epithelial cells possibly by inhibiting PI3K/AKT signaling.

Remodelling and dysfunction of the sinus node in pulmonary arterial hypertension

Patients with pulmonary arterial hypertension (PAH) have a high burden of arrhythmias, including arrhythmias arising from sinus node dysfunction, and the aim of this study was to investigate the effects of PAH on the sinus node. In the rat, PAH was induced by an injection of monocrotaline. Three weeks after injection, there was a decrease of the intrinsic heart rate (heart rate in the absence of autonomic tone) as well as the normal heart rate, evidence of sinus node dysfunction. In the sinus node of PAH rats, there was a significant downregulation of many ion channels and Ca²⁺-handling genes that could explain the dysfunction: HCN1 and HCN4 (responsible for pacemaker current, I_f), Cav1.2, Cav1.3 and Cav3.1 (responsible for L- and T-type Ca²⁺ currents, I_Ca,L and I_Ca,T), NCX1 (responsible for Na⁺-Ca²⁺ exchanger) and SERCA2 and RYR2 (Ca²⁺-handling molecules). In the sinus node of PAH rats, there was also a significant upregulation of many fibrosis genes that could also help explain the dysfunction: vimentin, collagen type 1, elastin, fibronectin and transforming growth factor β1. In summary, in PAH, there is a remodelling of ion channel, Ca²⁺-handling and fibrosis genes in the sinus node that is likely to be responsible for the sinus node dysfunction. This article is part of the theme issue 'The heartbeat: its molecular basis and physiological mechanisms'.

Measurements of the Elliptic and Triangular Azimuthal Anisotropies in Central ^{3}He+Au, d+Au and p+Au Collisions at sqrt[s_{NN}]=200 GeV

The elliptic (v_{2}) and triangular (v_{3}) azimuthal anisotropy coefficients in central ^{3}He+Au, d+Au, and p+Au collisions at sqrt[s_{NN}]=200  GeV are measured as a function of transverse momentum (p_{T}) at midrapidity (|η|<0.9), via the azimuthal angular correlation between two particles both at |η|<0.9. While the v_{2}(p_{T}) values depend on the colliding systems, the v_{3}(p_{T}) values are system independent within the uncertainties, suggesting an influence on eccentricity from subnucleonic fluctuations in these small-sized systems. These results also provide stringent constraints for the hydrodynamic modeling of these systems.

[A case of Oliver-McFarlane syndrome caused by PNPLA6 gene mutation]

Oliver-McFarlane syndrome is a rare genetic disorder characterized by long eyelashes, choroidoretinal atrophy, and multiple pituitary hormone deficiencies. The patient in this case is a 29-year-old female who has suffered from night blindness, low vision, and long eyelashes since childhood. Through genetic sequencing, she was diagnosed with compound heterozygous variaton in the PNPLA6 gene, indicating Oliver-McFarlane syndrome based on her comprehensive clinical presentation.

A hybrid approach for low-carbon transportation system analysis: integrating CRITIC-DEMATEL and deep learning features

As supply chains, logistics, and transportation activities continue to play a significant role in China's economic and social developments, concerns around energy consumption and carbon emissions are becoming increasingly prevalent. In light of sustainable development goals and the trend toward sustainable or green transportation, there is a need to minimize the environmental impact of these activities. To address this need, the government of China has made efforts to promote low-carbon transportation systems. This study aims to assess the development of low-carbon transportation systems in a case study in China using a hybrid approach based on the Criteria Importance Through Intercriteria Correlation (CRITIC), Decision-Making Trial and Evaluation Laboratory (DEMATEL) and deep learning features. The proposed method provides an accurate quantitative assessment of low-carbon transportation development levels, identifies the key influencing factors, and sorts out the inner connection among the factors. The CRITIC weight matrix is used to obtain the weight ratio, reducing the subjective color of the DEMATEL method. The weighting results are then corrected using an artificial neural network to make the weighting more accurate and objective. To validate our hybrid method, a numerical example in China is applied, and sensitivity analysis is conducted to show the impact of our main parameters and analyze the efficiency of our hybrid method. Overall, the proposed approach offers a novel method for assessing low-carbon transportation development and identifying key factors in China. The results of this study can be used to inform policy and decision-making to promote sustainable transportation systems in China and beyond.

A tera-electron volt afterglow from a narrow jet in an extremely bright gamma-ray burst

Some gamma-ray bursts (GRBs) have a tera-electron volt (TeV) afterglow, but the early onset of this has not been observed. We report observations with the Large High Altitude Air Shower Observatory of the bright GRB 221009A, which serendipitously occurred within the instrument field of view. More than 64,000 photons >0.2 TeV were detected within the first 3000 seconds. The TeV flux began several minutes after the GRB trigger, then rose to a peak about 10 seconds later. This was followed by a decay phase, which became more rapid ~650 seconds after the peak. We interpret the emission using a model of a relativistic jet with half-opening angle ~0.8°. This is consistent with the core of a structured jet and could explain the high isotropic energy of this GRB.