Theoretical studies of the g factors and local structures of the Ni3+ centers in Na2 Zn(SO4 )2 ·4H2 O and K2 Zn(SO4 )2 ·6H2 O crystals

The local structures and the g factors g_i (i = x, y, z) for Ni³⁺ centers in Na₂ Zn(SO₄ )₂ ·4H₂ O (DPPH) and K₂ Zn(SO₄ )₂ ·6H₂ O (PHZS) crystals are theoretically studied by using the perturbation formulas of the g factors for a 3d⁷ ion with low spin (S = 1/2) in orthorhombically compressed octahedra. In these formulas, the contributions to g factors from both the spin-orbit coupling interactions of the central ion and ligands are taken into account, and the required crystal-field parameters are estimated from the superposition model and the local geometry of the systems. Based on the calculations, the Ni-O bonds are found to suffer the axial compression δz (or Δz) of about 0.111 Å (or 0.036 Å) along the z-axis for Ni³⁺ centers in DPPH (or PHZS) crystals. Meanwhile, the Ni-O bonds may experience additional planar bond length variation δx (≈0.015 Å) along x- and y-axes for the orthorhombic Ni³⁺ center in DPPH. The theoretical g factors agree well with the experimental data. The obtained local structural parameters for both Ni³⁺ centers are discussed.

Differentiated cancer cell-originated lactate promotes the self-renewal of cancer stem cells in patient-derived colorectal cancer organoids

Tumors harbor diverse compartments of cells with distinct metabolic properties and phenotypes, but the mechanism by which metabolic commensalism among distinct subsets of cancer cells affects tumor progression remains unclear. Colorectal cancer (CRC) has been reported to consist of cancer stem cells (CSCs) and differentiated cancer cells (non-CSCs). In the present study, organoid models were employed to show that CSCs and non-CSCs in CRC were characterized by distinct metabolic phenotypes. Treatment with either non-CSC-derived conditioned medium or exogenous lactate enhanced organoid-forming and tumor-initiating capacity of CSCs. In tumor regeneration assays with co-implanted CSCs and non-CSCs, the tumor-initiating activity was reduced when either monocarboxylate transporter (MCT)4 in non-CSCs or MCT1 in CSCs was silenced or inhibited. Mechanistically, oxiadative phosphorylation-derived reactive oxygen species in CSCs activated AKT-Wnt/β-catenin signaling, which could be induced by lactate from non-CSCs. Overall, these results suggest that CSCs and non-CSCs possess distinct metabolic profiles and, unexpectedly, non-CSC-originated lactate promotes self-renewal of CSCs and thus contributes to CRC progression. Our findings establish a rationale for developing novel therapies targeting the metabolic commensalism between different cell populations in CRC.

[Efficacy of thymectomy in patients with non-thymoma myasthenia gravis]

Objective: To compare the efficacy between thymectomy plus prednisone and prednisone alone in patients with non-thymoma myasthenia gravis (MG). Methods: Thirty generalized MG patients without thymoma who underwent thymectomy were collected as the operation group, and thirty-nine patients without thymectomy who were treated with prednisone alone were matched as the control group. The start point was the enrollment time and the endpoint event was the "clinical remission" (including complete stabilization remission, drug remission, and poor performance). The survival curve was used to analyze the difference of endpoint event time between the two groups. Besides, a 12-month follow-up study was conducted to compare relevant clinical indicators between the two groups. Results: There was no significant difference in the occurrence time of endpoint events between the two groups (P=0.614). After 6-month follow-up, no significant differences were found in clinical remission rate, the dosage of pyridostigmine bromide and prednisone, the peak dosage of prednisone, the use of other immunosuppressive medications and the rate of hospitalization for exacerbation of disease between the two groups (all P>0.05). After 12-month follow-up, the dosage of prednisone and pyridostigmine in the operation group was significantly lower than that in the control group (5(0,10)mg/d vs 7.5(5,10)mg/d and 30(0,105)mg/d vs 90(15,180)mg/d; P=0.038, 0.032). Conclusion: In patients with mild to moderate non-thymoma generalized MG, thymectomy does not achieve faster remission, but it does reduce the long-term dosage of prednisone and bromopyrazine.

Device Postannealing Enabling over 12% Efficient Solution-Processed Cu2 ZnSnS4 Solar Cells with Cd2+ Substitution

Kesterite Cu₂ ZnSnS₄ is a promising photovoltaic material containing low-cost, earth-abundant, and stable semiconductor elements. However, the highest power conversion efficiency of thin-film solar cells based on Cu₂ ZnSnS₄ is only about 11% due to low open-circuit voltage and fill factor mainly caused by antisite defects and unfavorable heterojunction interface. In this work, a postannealing procedure is proposed to complete a Cd-alloyed Cu₂ ZnSnS₄ device. The postannealing to complete the device significantly enhances the performance of the indium tin oxide and promotes the moderate interdiffusion of elements between the layers in the device. As a result of the diffusion of Cu, Zn, In, and Sn, the interfacial electron and hole densities are improved, leading to the achievement of a suitable band alignment for carrier transport. The postannealing also reduces the interface traps and deep-level defects, contributing to decreased nonradiative recombination. Therefore, the open-circuit voltage and fill factor are both improved, and an efficiency over 12% for pure sulfide-based kesterite thin-film solar cells is obtained.

Autophagic degradation of PML promotes susceptibility to HSV-1 by stress-induced corticosterone

Rationale: Herpes simplex virus type 1 (HSV-1) is a neurotropic virus that can cause a variety of clinical syndromes including mucocutaneous disease and HSV-1 encephalitis (HSE). Here, we characterize the molecular mechanisms underlying the susceptibility to HSV-1 under stressful conditions.

Methods: Restraint stress and corticosterone (CORT, a primary stress hormone) were respectively used to establish HSV-1 susceptible model in vivo and in vitro. Viral titers were determined by plaque assay. Western blotting, immunofluorescence, transmission electron microscopy (TEM), qRT-PCR, H&E staining, IHC staining and flow cytometry were employed to evaluate virus-related protein expressions and detect the activation of autophagy. Loss- and gain-function assays, co-immunoprecipitation (co-IP) technique and autophagy agonist/antagonist treatments were applied in mechanistic experiments.

Results: Restraint stress increased the susceptibility of mouse brain to HSV-1. Similarly, CORT treatment enhanced the susceptibility of neural cells to HSV-1. Furthermore, PML protein level in HSV-1 infected brain tissues and neural cells was remarkably decreased by stress treatment in vivo or CORT treatment in vitro, while its transcriptional level was not affected. Notably, a striking decline in protein expressions of ICP27 and gB was observed in PML-overexpressing cells, which was reversed by CORT treatment. By contrast, protein expression of gB was increased by knockdown with si-PML in virus-infected SH-SY5Y cells. We further discovered that CORT-driven PML degradation was dependent on the activation of autophagy in a ULK1-independent manner, rather than proteasome pathway. Bafilomycin A1 (BaF1) attenuated the augmentation effect of CORT on HSV-1 infection. The expressions of viral proteins were reduced in LC3-depleted cells, and the degradation of PML by CORT-induced autophagy was prevented in cells with LC3 knockdown by RNAi. Interestingly, PML was revealed to interact with the autophagic cargo receptor P62 and the autophagic effector protein LC3. Additionally, CORT failed to increase gB protein level when PML was silenced, providing direct evidence linking autophagic degradation of PML and CORT-induced virus susceptibility.

Conclusion: Our results revealed that restraint stress/CORT increased HSV-1 susceptibility by delivering PML into autolysosomes for degradation. The results obtained from in vitro and in vivo models not only demonstrated the adverse effects of stress on HSV-1 infection, but also systematically investigated the underlying molecular mechanisms. These discoveries broaden our understanding of the interplay between host and viruses, and a comprehensive understanding of the role of autophagy in viral infection will provide information for future development of innovative drugs against viral infection.

Self-Limiting Shell Formation in Cu@Ag Core-Shell Nanocrystals during Galvanic Replacement

The understanding of synthetic pathways of bimetallic nanocrystals remains limited due to the complex energy landscapes and dynamics involved. In this work, we investigate the formation of self-limiting Cu@Ag core-shell nanoparticles starting from Cu nanocrystals followed by galvanic replacement with Ag ions. Bulk quantification with atomic emission spectroscopy and spatially resolved elemental mapping with electron microscopy reveal distinct nucleation regimes that produce nanoparticles with a tunable Ag shell thickness, but only up to a certain limiting thickness. We develop a quantitative transport model that explains this observed self-limiting structure as arising from the balance between entropy-driven interdiffusion and a positive mixing enthalpy. The proposed model depends only on the intrinsic physical properties of the system such as diffusivity and mixing energy and directly yields a high level of agreement with the elemental mapping profiles without requiring additional fit parameters.

PRL3 enhances T-cell acute lymphoblastic leukemia growth through suppressing T-cell signaling pathways and apoptosis

T cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy of thymocytes and is largely driven by the NOTCH/MYC pathway. Yet, additional oncogenic drivers are required for transformation. Here, we identify protein tyrosine phosphatase type 4 A3 (PRL3) as a collaborating oncogenic driver in T-ALL. PRL3 is expressed in a large fraction of primary human T-ALLs and is commonly co-amplified with MYC. PRL3 also synergized with MYC to initiate early-onset ALL in transgenic zebrafish and was required for human T-ALL growth and maintenance. Mass spectrometry phosphoproteomic analysis and mechanistic studies uncovered that PRL3 suppresses downstream T cell phosphorylation signaling pathways, including those modulated by VAV1, and subsequently suppresses apoptosis in leukemia cells. Taken together, our studies have identified new roles for PRL3 as a collaborating oncogenic driver in human T-ALL and suggest that therapeutic targeting of the PRL3 phosphatase will likely be a useful treatment strategy for T-ALL.

Association study of SNCA gene polymorphisms with schizophrenia in a Chinese North Han population

OBJECTIVE

Previous studies suggested that the alpha-synapse protein (SNCA) gene and its coding product α-synuclein (α-Syn) may play a role in the pathogenesis of neurodegenerative diseases. The mutation of SNCA can influence the formation of nerve fibers and the function of dopaminergic neurons, and that may be related to addictive behavior, such as alcohol dependence. SNCA may overlap with the pathogenesis of schizophrenia and Parkinson's disease or alcohol dependence associated with the dopamine pathway. The aim was to determine the association between three SNCA SNPs (rs3822086C/T, rs11931074G/T, and rs356219A/G) and schizophrenia in a Chinese North Han population.

PATIENTS AND METHODS

A total of 878 subjects, with or without schizophrenia, were included in our study. DNA purification, Polymerase Chain Reaction (PCR) amplification, and subsequent restriction fragment length polymorphism (RFLP) analysis were manipulated to determine genotypes.

RESULTS

Between the schizophrenia group and healthy group, neither the genotype nor allele frequencies of rs3822086C/T, rs11931074G/T, or rs356219A/G differed significantly in either the total sample or the subgroups. In the haplotype analysis, the ATT and GTT haplotype frequencies differed significantly between the patients and controls in the total sample (χ2=6.052, p=0.0139; χ2=4.508, p=0.0337). In the female subgroup, the ATT haplotype frequency differed significantly between the patients and controls (χ2=4.219, p=0.04).

CONCLUSIONS

There was no association between SNCA polymorphisms and schizophrenia in the North Han Chinese population, and the ATT haplotype may be a susceptibility factor for schizophrenia.

Quasi-Vertically-Orientated Antimony Sulfide Inorganic Thin-Film Solar Cells Achieved by Vapor Transport Deposition

The one-dimensional photovoltaic absorber material Sb₂S₃ requires crystal orientation engineering to enable efficient carrier transport. In this work, we adopted the vapor transport deposition (VTD) method to fabricate vertically aligned Sb₂S₃ on a CdS buffer layer. Our work shows that such a preferential vertical orientation arises from the sulfur deficit of the CdS surface, which creates a beneficial bonding environment between exposed Cd²⁺ dangling bonds and S atoms in the Sb₂S₃ molecules. The CdS/VTD-Sb₂S₃ interface recombination is suppressed by such properly aligned ribbons at the interface. Compared to typical [120]-oriented Sb₂S₃ films deposited on CdS by the rapid thermal evaporation (RTE) method, the VTD-Sb₂S₃ thin film is highly [211]- and [121]-oriented and the performance of the solar cell is increased considerably. Without using any hole transportation layer, a conversion efficiency of 4.73% is achieved with device structure of indium tin oxide (ITO)/CdS/Sb₂S₃/Au. This work provides a potential way to obtain vertically aligned thin films on different buffer layers.

Size-dependent influence of NOx on the growth rates of organic aerosol particles

Atmospheric new-particle formation (NPF) affects climate by contributing to a large fraction of the cloud condensation nuclei (CCN). Highly oxygenated organic molecules (HOMs) drive the early particle growth and therefore substantially influence the survival of newly formed particles to CCN. Nitrogen oxide (NOx) is known to suppress the NPF driven by HOMs, but the underlying mechanism remains largely unclear. Here, we examine the response of particle growth to the changes of HOM formation caused by NOx. We show that NOx suppresses particle growth in general, but the suppression is rather nonuniform and size dependent, which can be quantitatively explained by the shifted HOM volatility after adding NOx. By illustrating how NOx affects the early growth of new particles, a critical step of CCN formation, our results help provide a refined assessment of the potential climatic effects caused by the diverse changes of NOx level in forest regions around the globe.

Rapid and visual detection of 2019 novel coronavirus (SARS-CoV-2) by a reverse transcription loop-mediated isothermal amplification assay

OBJECTIVE

To evaluate a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and compare it with RT-PCR.

METHODS

We designed primers specific to the orf1ab and S genes of SARS-CoV-2. Total viral RNA was extracted using the QIAamp Viral RNA Mini Kit. We optimized the RT-LAMP assay, and evaluated it for its sensitivity and specificity of detection using real-time turbidity monitoring and visual observation.

RESULTS

The primer sets orf1ab-4 and S-123 amplified the genes in the shortest times, the mean (±SD) times were 18 ± 1.32 min and 20 ± 1.80 min, respectively, and 63°C was the optimum reaction temperature. The sensitivities were 2 × 10¹ copies and 2 × 10² copies per reaction with primer sets orf1ab-4 and S-123, respectively. This assay showed no cross-reactivity with 60 other respiratory pathogens. To describe the availability of this method in clinical diagnosis, we collected 130 specimens from patients with clinically suspected SARS-CoV-2 infection. Among them, 58 were confirmed to be positive and 72 were negative by RT-LAMP. The sensitivity was 100% (95% CI 92.3%-100%), specificity 100% (95% CI 93.7%-100%). This assay detected SARS-CoV-2 in a mean (±SD) time of 26.28 ± 4.48 min and the results can be identified with visual observation.

CONCLUSION

These results demonstrate that we developed a rapid, simple, specific and sensitive RT-LAMP assay for SARS-CoV-2 detection among clinical samples. It will be a powerful tool for SARS-CoV-2 identification, and for monitoring suspected patients, close contacts and high-risk groups.

CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone

This study compares the results of computed tomography X-ray absorptiometry (CTXA) hip volumetric BMD (vBMD) analyses of cortical and trabecular bone with and without partial volume correction. For cortical bone in some circumstances, corrected cortical volumes were negative and corrected vBMD was very high. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.

PURPOSE

Previous studies have reported concerns about the reliability of CTXA hip cortical vBMD measurements generated using partial volume (PV) correction (the "default" analysis, with cortical PV correction). To date, no studies have examined the results of the alternative ("new") analysis (with trabecular PV correction). This study presents in vivo and phantom data comparing the corrected and uncorrected data for cortical and trabecular bone respectively.

METHODS

We used the commercial QCTPro CTXA software to analyze CT scans of 129 elderly Chinese men and women and an anthropomorphic European Proximal Femur phantom (EPFP) and accessed data for two alternative scan analyses using the database dump utility. The CTXA software gives the user two methods of performing the PV correction: (1) a default analysis in which only cortical bone results are corrected; (2) a new analysis in which only trabecular bone results are corrected. Both methods are based on a numerical recalculation of vBMD values without any change in volume of interest (VOI) placement.

RESULT

In vivo, the results of the two analyses for integral bone were the same while cortical and trabecular results were different. PV correction of cortical bone led to a decrease of cortical volume for all four VOIs: total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter (IT) volumes were reduced on average by 7.8 cm³, 0.9 cm³, 2.5 cm³, and 4.3 cm³ respectively. For TR, where cortex was thinnest, average corrected cortical volume was negative (- 0.4± 1.3 cm³). Corrected cortical vBMD values were much larger than uncorrected ones for TH, FN, and IT. Scatter plots of corrected cortical vBMD against cortical bone thickness showed that elevated results correlated with thinner cortices. When trabecular bone was corrected for the PV effect, trabecular volumes of TH, FN, TR, and IT were reduced on average by 7.9 cm³, 0.8 cm³, 2.6 cm³, and 4.4 cm³ respectively, while vBMD measurements were increased correspondingly. The trabecular volume and vBMD measurements of the two datasets both had highly positive correlations. For the EPFP, the PV-corrected FN data deviated from the nominal phantom value, but was closer for the TR and IT VOIs. Both corrected and uncorrected data overestimated trabecular vBMD, with the corrected results showing greater deviation from nominal values.

CONCLUSION

The default and new CTXA analyses for volumetric data generate different results, both for cortical and trabecular bone. For cortical bone, the uncorrected results are subject to partial volume effects but the correction method of the default analysis overcorrects the effect leading to in part unreasonable results for cortical bone volume and BMD. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.

Remobilization mechanism and release characteristics of phosphorus in saline sediments from the Pearl River Estuary (PRE), South China, based on high-resolution measurements

The internal loading of phosphorus (P) is commonly considered an essential factor contributing to eutrophication in freshwater bodies. However, investigation of the lability and remobilization characteristics of P in estuarine saline sediments has been limited. In this study, a sequential chemical extraction procedure and high-resolution measurement using the diffusive gradients in thin film (DGT) technique were employed to explore the lability, potential remobilization mechanism and release characteristics of sediment P in the Pearl River Estuary (PRE), South China. The P accumulated significantly in sediments along the west coast of the PRE due to the combined effects of terrestrial P inputs and specific hydrological conditions. The geochemical fractions of sediment P followed the order of organic P (Org-P) (mean: 58.6%) > iron-bound P (Fe-P) (23.4%) > calcium-bound P (Ca-P) (17.4%) > loosely bound P (LS-P) (0.63%). Synchronous vertical variations in DGT-labile Fe and P in the upper and middle parts of the sediment profiles confirmed that Fe-coupled P mobilization occurred in saline sediments. In contrast, sulfate reduction in bottom sediments supposed to decouple the Fe-P cycling relationship. Additionally, the formation of an "iron curtain" (Fe oxyhydroxides) in the oxic surface sediments efficiently prevented upward diffusion of P, leading to relatively low effluxes of P (0.098-6.59 ng cm^-2 d^-1) across the sediment-water interface.

Anastomosis for distal gastrectomy in Chinese patients: uncut roux-Y or roux-Y?

Background

An appropriate method of anastomosis is crucial for gastric cancer patients who require gastrojejunal anastomosis. Surgeons have proposed different types of modified gastrojejunostomies in the last two decades. We focused on two types of standard anastomosis, i.e., Uncut Roux-Y and Roux-Y gastrojejunostomies, and compared the differences in immediate postoperative complications between the two types.

Methods

This is a retrospective study on 236 gastric cancer patients who underwent curative distal gastrectomy with gastrojejunal Roux-Y or Uncut Roux-Y anastomosis for six consecutive years. Immediate postoperative complications were compared between the two groups. The authors discussed the causes of the significant complications and their management.

Results

There was no difference in demographics between the two groups (92 Roux-y Versus 144 Uncut Roux-y). The overall complication rate was 20.8% with 1.4% anastomotic leakage in the Uncut Roux-Y group versus 33.7% with 7.6% anastomotic failures in the Roux-Y group (p < 0.05). More abdominal infections occurred in the Roux-Y anastomosis group compared with the Uncut Roux-Y anastomosis group (p < 0.05). Duration of postoperative stay was significantly longer in patients with Roux-y anastomosis group (p < 0.05).

Conclusions

Considering the surgical simplicity and postoperative complications, the Uncut Roux-Y is a better choice for anastomosis in patients with gastric cancer undergoing gastrojejunostomy. A well-designed large cohort in a multi-centre randomized controlled trial is necessary to support these findings and compare other aspects.

miR-128-3p contributes to mitochondrial dysfunction and induces apoptosis in glioma cells via targeting pyruvate dehydrogenase kinase 1

Glioma, like most cancers, possesses a unique bioenergetic state of aerobic glycolysis known as the Warburg effect, which is a dominant phenotype of most tumor cells. Glioma tumors exhibit high glycolytic metabolism with increased lactate production. Data derived from the gene expression profiling interactive analysis (GEPIA) database show that pyruvate dehydrogenase kinase 1 (PDK1) is significantly highly expressed in glioma tissues compared with corresponding normal tissues. PDK1 is a key enzyme in the transition of glycolysis to tricarboxylic acid cycle, via inactivating PDH and converting oxidative phosphorylation to Warburg effect, resulting in increment of lactate production. Silencing of PDK1 expression resulted in reduced lactate and ATP, accumulation of ROS, mitochondrial damage, decreased cell growth, and increased cell apoptosis. Aberrant expression of miR-128 has been observed in many human malignancies. Mechanistically, we discover that overexpressed miR-128-3p disturbs the Warburg effect in glioma cells via reducing PDK1. Our experiments confirmed that the miR-128-3p/PDK1 axis played a pivotal role in cancer cell metabolism and growth. Collectively, these findings suggest that therapeutic strategies to modulate the Warburg effect, such as targeting of PDK1, might act as a potential therapeutic target for glioma treatment.

Bone mineral density gains with a second 12-month course of romosozumab therapy following placebo or denosumab

Romosozumab is a therapy that stimulates bone formation and reduces bone resorption. In this study of postmenopausal women with low BMD, a second course of romosozumab following a period off treatment or on denosumab increased or maintained BMD, respectively, and was well tolerated, providing insight into treatment sequence options.

INTRODUCTION

In patients with high fracture risk, therapies that stimulate bone formation provide rapid BMD gains; currently available agents, parathyroid hormone receptor agonists, are limited to a 2-year lifetime exposure and generally used for a single treatment course. However, for long-term osteoporosis management, a second treatment course may be appropriate. Romosozumab, a therapy with the dual effect of increasing bone formation and decreasing bone resorption, reduces fracture risk within 12 months. Here, we report efficacy and safety of a second romosozumab course.

METHODS

In this phase 2, dose-finding study, postmenopausal women with low bone mass (T-score ≤ - 2.0 and ≥ - 3.5) received romosozumab or placebo (month 0-24) followed by placebo or denosumab (month 24-36); participants then received a year of romosozumab (month 36-48).

RESULTS

Of 167 participants who entered the month 36-48 period, 35 had been initially randomized to romosozumab 210 mg monthly. In participants who received romosozumab 210 mg monthly followed by placebo, a second romosozumab course (n = 19) increased BMD by amounts similar to their initial treatment (month 0-12) at the lumbar spine (12.4%; 12.0%, respectively) and total hip (6.0%; 5.5%, respectively). Following denosumab, a second romosozumab course (n = 16) increased BMD at the lumbar spine (2.3%) and maintained BMD at the total hip. Safety profiles were similar between first and second romosozumab courses.

CONCLUSIONS

After 12 months off-treatment, a second romosozumab course again led to rapid and large BMD gains. Following denosumab, BMD gains with romosozumab were smaller than with initial treatment. No new safety findings were observed during the second course.

4284The combined use of radiofrequency-ablation and balloon-dilation (CURB) in the creation of a stable inter-atrial communication: first-in-man use for patients with severe pulmonary arterial hypertension

Background

Recent preclinical research has suggested that combined use of radiofrequency-ablation and balloon-dilation (CURB) had the potential to create a stable inter-atrial communication. However, the related clinical data is still absent.

Purpose

This study describes the first-in-man use of CURB in the patients with severe pulmonary arterial hypertension (PAH).

Methods

Under the guidance of fluoroscopy and intra-cardiac echocardiography, CURB was attempted in 3 patients with severe PAH (age: 35.0±12.1 years, one idiopathic PAH and two PAH related to repaired congenital heart disease). With the aid of 3D location system, fossae ovalis was ablated with radiofrequency. Then the graded balloon-dilation was performed after transseptal puncture, and radiofrequency-ablation was repeated around the rim of fenestration created with balloon-dilation. The exercise capacity and fenestration-size were followed up.

Results

CURB was performed successfully in all 3 patients, and pulmonary vascular resistance was 30.3±10.9 Wood units. The fenestration size was 5.0±1.0 mm (range: 4–6 mm), and systemic arterial oxygen saturation decreased by 4.7±0.6% (range: 4–5%). World Health Organization functional class increased by 1.6±0.5 (P<0.001) and cardiac index increased by 0.58±0.34 L/min/m2 (P<0.001). In addition, exercise capacity improved significantly (+63.7 meters, P<0.001). Follow-up (6.0±1.0 months; range: 5–7 months) showed that all fenestrations were stable (P=0.808), and no complication occurred.

Figure 1. The combined use of radiofrequency-ablation and balloon-dilation (CURB) was performed in the patient with severe PAH. Left figures showed the procedure of CURB. Middle figures showed the created fenestration with MSCT, and the morphology and size of fenestration was provided in the right-inferior panel. In addition, the sizes of right atrium and ventricle were alleviated with increase of left atrium. Right figures indicated that the fenestration-size was stable during follow-up (one week, one month and six months, respectively).

Conclusions

In patients with severe PAH, CURB is feasible and effective to create a stable inter-atrial communication. Further research was required to evaluate the long-term result of this novel approach.

ClinicalTrials.gov ID: NCT03554330.

Acknowledgement/Funding

National Natural Science Foundation of China (81670283) and Beijing Natural Science Foundation (7162160)

Nonlinear heart rate variability biomarkers for gastric cancer severity: A pilot study

Identifying prognostic factors by affordable tools is crucial for guiding gastric cancer (GC) treatments especially at earlier stages for timing interventions. The autonomic function that is clinically assessed by heart rate variability (HRV) is involved in tumorigenesis. This pilot study was aimed to examine whether nonlinear indices of HRV can be biomarkers of GC severity. Sixty-one newly-diagnosed GC patients were enrolled. Presurgical serum fibrinogen (FIB), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA199) were examined. Resting electrocardiogram (ECG) of 5-min was collected prior to surgical treatments to enable the HRV analysis. Twelve nonlinear HRV indices covering the irregularity, complexity, asymmetry, and temporal correlation of heartbeat fluctuations were obtained. Increased short-range temporal correlations, decreased asymmetry, and increased irregularity of heartbeat fluctuations were associated with higher FIB level. Increased irregularity and decreased complexity were also associated with higher CEA level. These associations were independent of age, sex, BMI, alcohol consumption, history of diabetes, left ventricular ejection fraction, and anemia. The results support the hypothesis that perturbations in nonlinear dynamical patterns of HRV predict increased GC severity. Replication in larger samples as well as the examination of longitudinal associations of HRV nonlinear features with cancer prognosis/survival are warranted.