Noninvasive localization of cardiac arrhythmias using electromechanical wave imaging

Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. The 12-lead electrocardiogram (ECG) is the current noninvasive clinical tool used to diagnose and localize cardiac arrhythmias. However, it has limited accuracy and is subject to operator bias. Here, we present electromechanical wave imaging (EWI), a high-frame rate ultrasound technique that can noninvasively map with high accuracy the electromechanical activation of atrial and ventricular arrhythmias in adult patients. This study evaluates the accuracy of EWI for localization of various arrhythmias in all four chambers of the heart before catheter ablation. Fifty-five patients with an accessory pathway (AP) with Wolff-Parkinson-White (WPW) syndrome, premature ventricular complexes (PVCs), atrial tachycardia (AT), or atrial flutter (AFL) underwent transthoracic EWI and 12-lead ECG. Three-dimensional (3D) rendered EWI isochrones and 12-lead ECG predictions by six electrophysiologists were applied to a standardized segmented cardiac model and subsequently compared to the region of successful ablation on 3D electroanatomical maps generated by invasive catheter mapping. There was significant interobserver variability among 12-lead ECG reads by expert electrophysiologists. EWI correctly predicted 96% of arrhythmia locations as compared with 71% for 12-lead ECG analyses [unadjusted for arrhythmia type: odds ratio (OR), 11.8; 95% confidence interval (CI), 2.2 to 63.2; P = 0.004; adjusted for arrhythmia type: OR, 12.1; 95% CI, 2.3 to 63.2; P = 0.003]. This double-blinded clinical study demonstrates that EWI can localize atrial and ventricular arrhythmias including WPW, PVC, AT, and AFL. EWI when used with ECG may allow for improved treatment for patients with arrhythmias.

[Relationship between insulin resistance, serum VCAM-1, FGF19, IGF-1 and colorectal polyps]

Objective: To explore the relationship between insulin resistance, glucose and lipid metabolism related molecules and colorectal polyps. Methods: A total of 262 healthy people who underwent colonoscopy in Shandong cancer hospital from June 2019 to September 2020 were selected. The levels of serum vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 19 (FGF19), insulin like growth factor (IGF-1), fasting blood glucose and fasting blood insulin were detected by enzyme-linked immunosorbent assay (ELISA). Insulin resistance index (HOMA-IR) was calculated, and the influencing factors of occurrence, pathological type, size and number of polyps were analyzed. Results: Among 262 cases, 116 cases were polyp free, 113 cases were adenomatous polyp and 33 cases were inflammatory polyp. HOMA-IR, VCAM-1 and FGF19 in polyp group were 2.904±1.754, (334.415±139.573) ng/ml and (135.865±98.470) pg/ml, respectively, which were higher than 2.369±1.306, (302.480±99.946) ng/ml and(110.694±76.044) ng/ml in non-polyp group, respectively (P<0.05). Multivariate Logistic regression analysis showed that the gender (OR=4.269, 95%CI: 1.963-9.405) and FGF19 (77.0-131.4 pg/ml: OR=2.385, 95%CI: 1.155-4.926) were independent factors of colorectal polyps. The gender (OR=3.799, 95%CI: 1.650-8.748) and FGF19 (77.0-131.4 pg/ml: OR=2.290, 95%CI: 1.072-4.891) were independent factors of colorectal adenomatous polyps. The gender(OR=6.725, 95%CI: 1.853-24.410) and fasting plasma glucose (≥6.5 mmol/L: OR=0.047, 95%CI: 0.009-0.245) were independent factors of colorectal inflammatory polyps. The gender (OR=3.539, 95% CI: 1.293-9.689) was an independent factor for the occurrence of single polyp. The gender (OR=5.063, 95% CI: 2.048-12.515), FGF19 (77.0-131.4 pg/ml: OR=2.502, 95%CI: 1.102-5.681), fasting plasma glucose (≥6.5 mmol/L: OR=0.282, 95%CI: 0.095-0.839) were independent factors of multiple polyps. The gender (OR=3.416, 95% CI: 1.134-10.289) and fasting insulin (≥9.4 μU/ml: OR=9.480, 95% CI: 1.485-60.521) were independent risk factors for colorectal polyps<0.5 cm. The gender (OR=3.151, 95%CI: 1.244-7.984) and fasting plasma glucose (≥6.5 mmol/L: OR=0.310, 95%CI: 0.102-0.941) were independent risk factors for colorectal polyps with the size of 0.5-0.9 cm. The gender (OR=22.649, 95%CI: 4.154-123.485), age (55 to 64 years old: OR=4.473, 95%CI: 1.070-18.704; ≥65 years old: OR=5.815, 95%CI: 1.300-26.009), BMI (≥28 kg/m(2): OR=5.310, 95%CI: 1.224-23.032) and FGF19 (77.0-131.4 pg/ml: OR=7.474, 95%CI: 1.903-29.351) were independent factors for colorectal polyps with size ≥ 1.0 cm. Gender stratification analysis showed that FGF19 was an independent factor for the occurrence of male polyps (77.0-131.4 pg/ml: OR=6.109, 95%CI: 1.688-22.104) and adenomas (77.0-131.4 pg/ml: OR=6.401, 95%CI: 1.717-23.864). The age (55 to 64 years old: OR=3.783, 95%CI: 1.052-13.611) and VCAM-1 (≥352.8 ng/ml: OR=4.341, 95%CI: 1.142-16.493) were independent risk factors of female polyps. The age (55 to 64 years old: OR=5.743, 95%CI: 1.205-27.362, ≥65 years old: OR=6.885, 95%CI: 1.143-41.467), VCAM-1 (≥352.8 ng/ml: OR=6.313, 95%CI: 1.415-28.159) and IGF-1 (≥7.6 ng/ml: OR=5.621, 95%CI: 1.069-29.543) were independent factors of female adenoma. Conclusions: The occurrences of colorectal polyps and adenomatous polyps are related to insulin resistance and glucose and lipid metabolism. Serum FGF19 is an independent influencing factor for the occurrence of colorectal polyps and adenomatous polyps, and is a potential serological diagnostic marker and therapeutic target for colorectal polyps and adenomatous polyps.

Assisted reproductive technology service availability, efficacy and safety in mainland China: 2016

STUDY QUESTION

What is the current status of assisted reproductive technology (ART) service availability, efficacy and safety in mainland China?

SUMMARY ANSWER

In this first national report on ART status in mainland China, data on treatment numbers, outcomes and complications in 2016 are provided and analyzed, respectively.

WHAT IS KNOWN ALREADY

National ART Service Provision Surveys are conducted in mainland China regularly. Data were analyzed, and this manuscript was written by team members from the National Center for Women and Children's Health, China CDC and the Department of Women and Children Health, National Health Commission of the People's Republic of China.

STUDY DESIGN, SIZE AND DURATION

A cross-sectional nationwide survey was completed in 2018, in which data regarding ART treatments, performed from 1st January to 31st December2016 in 445 ART clinics located in 31 provinces of mainland China, were collected.

PARTICIPANTS/MATERIALS, SETTING AND METHODS

There were in total 451 licensed ART clinics (including artificial insemination clinics) in mainland China in 2016, of which 445 submitted service data. A total of 906 840 cycles were provided by 323 in vitro fertilization (IVF) clinics, involving 375 770 conventional IVF cycles, 154 948 intracytoplasmic sperm injection (ICSI) cycles, 367 146 frozen embryo transfer (FET) thawing cycles and 8976 preimplantation genetic diagnosis (PGD) treatment cycles. A total of 161 376 artificial (i.e. intrauterine) insemination (AI) cycles were reported by 443 clinics, with 126 872 cycles using the husband's semen (AIH) and 34 504 using donor semen (AID).

MAIN RESULTS AND THE ROLE OF CHANCE

In total, 98.7% of the licensed clinics, contributing to 100% of the ART services (including AID and AIH cycles), were included in this report. (Six clinics provided institutional information only and were excluded.) There were 906 840 in vitro fertilization cycles performed in mainland China with a population of over 1.3 billion inhabitants, with cycles per million inhabitants (C/M) increasing from 360 in 2013 to 657 in 2016, nationwide (range among provinces: 45-3676). After treatment with conventional IVF, the clinical pregnancy rate (PR) per oocyte retrieval cycle was 23.2%, the delivery rate (DR) per oocyte retrieval cycle was 18.7% and the proportion of twin delivery among the total deliveries was 27.9%. For ICSI cycles, the PR, DR and TDR were 20.5%, 16.7% and 27.2%, respectively. For FET per thawing cycles, the PR, DR and TDR were 48.2%, 37.6% and 24.2%. For PGD per diagnosis cycles, the PR, DR and TDR were 38.1%, 29.7% and 4.2%. For AIH cycles, the PR and DR were 13.3% and 10.5%; for AID cycles, the PR and DR were 24.3% and 21.1%, respectively. The total number of live infants born in mainland China in 2016, was 18.46 million, and the number of infants born through ART conducted in 2016 was 311 309, which accounted for 1.69% of the total. The reported rate of birth defects was about 87/10 000. The incidence of moderate to severe ovarian hyper-stimulation syndrome (OHSS) was 11.5 per 1000 oocyte retrieval cycles, and other complications were much more rare.

LIMITATIONS AND REASONS FOR CAUTION

This report is based on the summary data of ART services provided. The success rates were not calculated by age stratification. A low rate of birth defects was reported, which might be confounded by variations in birth follow-up methods, statistical timing and record taking.

WIDER IMPLICATIONS OF THE FINDINGS

ART service availability has improved significantly in recent years in mainland China. Because China is a vast country, significant imbalances in ART service provision do exist; however, the main efficacy and safety indicators were close to those of western countries.

TRIAL REGISTRATION NUMBER

N/A.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the National Key R&D Program of China (2016YFC1000307-2). There are no competing interests.

Observation of a Near-Threshold Structure in the K^{+} Recoil-Mass Spectra in e^{+}e^{-}→K^{+}(D_{s}^{-}D^{*0}+D_{s}^{*-}D^{0})

We report a study of the processes of e^{+}e^{-}→K^{+}D_{s}^{-}D^{*0} and K^{+}D_{s}^{*-}D^{0} based on e^{+}e^{-} annihilation samples collected with the BESIII detector operating at BEPCII at five center-of-mass energies ranging from 4.628 to 4.698 GeV with a total integrated luminosity of 3.7  fb^{-1}. An excess of events over the known contributions of the conventional charmed mesons is observed near the D_{s}^{-}D^{*0} and D_{s}^{*-}D^{0} mass thresholds in the K^{+} recoil-mass spectrum for events collected at sqrt[s]=4.681  GeV. The structure matches a mass-dependent-width Breit-Wigner line shape, whose pole mass and width are determined as (3982.5_{-2.6}^{+1.8}±2.1)  MeV/c^{2} and (12.8_{-4.4}^{+5.3}±3.0)  MeV, respectively. The first uncertainties are statistical and the second are systematic. The significance of the resonance hypothesis is estimated to be 5.3  σ over the contributions only from the conventional charmed mesons. This is the first candidate for a charged hidden-charm tetraquark with strangeness, decaying into D_{s}^{-}D^{*0} and D_{s}^{*-}D^{0}. However, the properties of the excess need further exploration with more statistics.

Cardiac Resynchronization Therapy Response Assessment with Electromechanical Activation Mapping within 24 Hours of Device Implantation: A Pilot Study

BACKGROUND

Cardiac resynchronization therapy (CRT) response assessment relies on the QRS complex narrowing criterion. Yet one third of patients do not improve despite narrowed QRS after implantation. Electromechanical wave imaging (EWI) is a quantitative echocardiography-based technique capable of noninvasively mapping cardiac electromechanical activation in three dimensions. The aim of this exploratory study was to investigate the EWI technique, sensitive to ventricular dyssynchrony, for informing CRT response on the day of implantation.

METHODS

Forty-four patients with heart failure with left bundle branch block or right ventricular (RV) paced rhythm and decreased left ventricular ejection fraction (LVEF; mean, 25.3 ± 9.6%) underwent EWI without and with CRT within 24 hours of device implantation. Of those, 16 were also scanned while in left ventricular (LV) pacing. Improvement in LVEF at 3-, 6-, or 9-month follow-up defined (1) super-responders (ΔLVEF ≥ 20%), (2) responders (10% ≤ ΔLVEF < 20%), and (3) nonresponders (ΔLVEF ≤ 5%). Three-dimensionally rendered electromechanical maps were obtained under RV, LV, and biventricular CRT pacing conditions. Mean RV free wall and LV lateral wall activation times were computed. The percentage of resynchronized myocardium was measured by quantifying the percentage of the left ventricle activated within 120 msec of QRS onset. Correlations between percentage of resynchronized myocardium and type of CRT response were assessed.

RESULTS

LV lateral wall activation time was significantly different (P ≤ .05) among all three pacing conditions in the 16 patients: LV lateral wall activation time with CRT in biventricular pacing (73.1 ± 17.6 msec) was lower compared with LV pacing (89.5 ± 21.5 msec) and RV pacing (120.3 ± 17.8 msec). Retrospective analysis showed that the percentage of resynchronized myocardium with CRT was a reliable response predictor within 24 hours of implantation for significantly (P ≤ .05) identifying super-responders (n = 7; 97.7 ± 1.9%) from nonresponders (n = 17; 89.9 ± 9.9%).

CONCLUSION

Electromechanical activation mapping constitutes a valuable three-dimensional visualization tool within 24 hours of implantation and could potentially aid in the timely assessment of CRT response rates, including during implantation for adjustment of lead placement and pacing outcomes.

Model-Independent Determination of the Spin of the Ω^{-} and Its Polarization Alignment in ψ(3686)→Ω^{-}Ω[over ¯]^{+}

We present an analysis of the process ψ(3686)→Ω^{-}Ω[over ¯]^{+} (Ω^{-}→K^{-}Λ, Ω[over ¯]^{+}→K^{+}Λ[over ¯], Λ→pπ^{-}, Λ[over ¯]→p[over ¯]π^{+}) based on a dataset of 448×10^{6}  ψ(3686) decays collected with the BESIII detector at the BEPCII electron-positron collider. The helicity amplitudes for the process ψ(3686)→Ω^{-}Ω[over ¯]^{+} and the decay parameters of the subsequent decay Ω^{-}→K^{-}Λ (Ω[over ¯]^{+}→K^{+}Λ[over ¯]) are measured for the first time by a fit to the angular distribution of the complete decay chain, and the spin of the Ω^{-} is determined to be 3/2 for the first time since its discovery more than 50 years ago.

Improved Performance of All-Solid-State Flexible Supercapacitor Based on the Stress-Compensation Effect

This work presents a facile strategy to develop a flexible polyaniline (PANI)-based supercapacitor (SC) with both high energy density and good capacitance retention. An electrode with a symmetrical sandwich-structured configuration (PANI/flexible porous support/PANI) is used as both working and counter electrodes for this supercapacitor. For a conventional electrode with PANI depositing on single side of the support (PANI/flexible support), the flexible support bends severely during the PANI electrodeposition process, which results in poor PANI deposition. On the contrary, for the symmetrical sandwich-structured electrode, due to the stress-compensation effect induced by this configuration, the support bending is significantly suppressed and thus PANI films with a good uniformity are realized. Moreover, the stress-compensation effect involved in the symmetrical sandwichstructured electrode can also effectively balance the stress caused by PANI expansion/shrinkage during its electrochemical charge/discharge operation, thus improving the mechanical stability. The symmetrical sandwich-structured electrode has larger PANI mass loading, better PANI morphologies and stronger mechanical stability than those of the conventional electrode. Consequently, the SC constructed by the symmetrical sandwich-structured electrode displays better electrochemical performance in terms of its larger specific areal capacitance (369.2 mF·cm^-2 at a current density of 0.25 mA·cm^-2), higher energy density (0.031 mWh·cm^-2 at a power density of 1.21 mW·cm^-2) and better cycling retention (93.2% of the retained capacity over 6000 cycles) than the SC constructed by the conventional electrode.

[In vitro study of non-thermal atmospheric plasma influencing the surface properties of dentin]

Objective: To study the influence of non-thermal atmospheric pressure plasma (NTAPP) on dentine surface temperature, wettability and morphology of collagen fibrils under different treatment condition. Methods: Helium was used as the operating gas at the flow rate of 3, 4, 5 L/min respectively. The plasma jet was operated at various input power of 8, 9, 10, 11 W. Thermal accumulation on human dentine surface (6 specimens per group, acquired from Department of Stomatology, The First Affiliated Hospital of Xi'an Medical University and Department of Stomatology, The Second Affiliated Hospital of Xi'an Medical University) of each group was measured continuously at 5 s intervals for 60 s by infrared thermography. Mean values were calculated and temperature curves were drawn. Dentine surface contact angles were measured after NTAPP treatment for 5, 10, 15, 20 s with gas flow rate and input power described above. The micro structure of the collagen fibrils of the negative control group (without NTAPP treatment) and NTAPP treatment groups (5 L/min gas flow rate, input power of 8, 9, 10, 11 W and treating time for 5, 10, 15, 20 s) was observed by field emission scanning electron microscopy (FE-SEM). All data were analyzed by SPSS 18.0. Results: Input power, gas flow and treatment time all showed significant influences on dentine surface temperature and wettability (P<0.01). Dentine temperature rose along with time. The greater input power was, the higher dentine temperature was. The greater gas flow rate was, the faster the temperature rose. Dentine surface temperature reached the highest point of (35.10±0.24) ℃ with NTAPP treatment for 60 s, at input power of 11 W and flow rate of 5 L/min. The contact angles of each experimental group decreased with time, and significant differences were found in the contact angles between the experimental groups and the negative control group (75.57°±1.45°). The contact angles showed a decreasing trend as the input power and the gas flow rate increased. The contact angles reached the lowest point of 13.19°±2.01° with NTAPP treatment for 20 s, at input power of 10 W and flow rate of 5 L/min. The FE-SEM results showed that, along with the increase of input power and extension of time, the demineralized collagen fibrils were destroyed in varying degrees. The collagen fibrils were curled, fractured, fused, and even disappeared. Conclusions: NTAPP could significantly increase the surface temperature, modify dentine wettability and alter the micro structure, which was significantly influenced by input power, gas flow rate and treating time.

[Effect of fluid resuscitation guided by pulse contour cardiac output monitoring technology on organ function in extremely severe burn patients]

Objective: To investigate the effect of fluid resuscitation guided by pulse contour cardiac output (PiCCO) monitoring technology on the organ function in extremely severe burn patients. Methods: From May 2015 to March 2019, 52 patients with extremely severe burn hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, meeting the inclusion criteria, were recruited to conduct a prospectively randomized control study. The patients were divided into PiCCO monitoring rehydration group (25 cases, 17 males and 8 females) and traditional rehydration group (27 cases, 20 males and 7 females) according to the random number table, with the ages of (47±9) and (49±8) years respectively. After admission, all the patients were rehydrated according to the rehydration formula of the Third Military Medical University during shock stage. In traditional rehydration group, fluid resuscitation of the patients was performed by monitoring the traditional shock indicators such as urine volume and central venous pressure, while PiCCO monitoring was performed in patients in PiCCO monitoring rehydration group, and the global end-diastolic volume index combined with the other relevant indicators of PiCCO monitoring were used to guide rehydration on the basis of the monitoring indicators of traditional rehydration group. The rehydration coefficients and urine volumes per kilogram of body weight per hour during the first and second 24 h post injury were compared between the two groups, which were compared with the corresponding rehydration scheme value of the Third Military Medical University (hereinafter referred to as the scheme value) at the same time. The total rehydration volumes within post injury hour (PIH) 8 and during the first and second 24 h post injury, the urine volumes per hour during the first and second 24 h post injury, and the levels of creatinine, urea nitrogen, lactate clearance rate, procalcitonin, creatine kinase isoenzyme (CK-MB) in blood and mean arterial pressure (MAP) on post injury day (PID) 1, 2, and 3 were measured. The incidence of complications, the application case number of mechanical ventilation, and the mechanical ventilation time within PID 28 were analyzed. Data were statistically analyzed with analysis of variance for repeated measurement, t test, Bonferroni correction, Mann-Whitney U test, chi-square test, and Fisher's exact probability method test. Results: During the second 24 h post injury, the rehydration coefficient of patients in traditional rehydration group was significantly higher than the scheme value (t=5.120, P<0.01). During the first and second 24 h post injury, the rehydration coefficients of patients in PiCCO monitoring rehydration group were significantly higher than the scheme values (t=3.655, 10.894, P<0.01) and those in traditional rehydration group (t=3.172, 2.363, P<0.05 or P<0.01). Within PIH 8, the total rehydration volumes of patients between the two groups were similar. During the first and second 24 h post injury, the total rehydration volumes of patients in PiCCO monitoring rehydration group were significantly higher than those in traditional rehydration group (t=4.428, 3.665, P<0.01). During the first and second 24 h post injury, the urine volumes per kilogram of body weight per hour of patients in traditional rehydration group were significantly higher than the schema values (t=4.293, 6.362, P<0.01), and the urine volumes per kilogram body weight per hour of patients in PiCCO monitoring rehydration group were significantly higher than the schema values (t=6.461, 8.234, P<0.01). The urine volumes per kilogram of body weight per hour and urine volumes per hour of patients in PiCCO monitoring rehydration group during the second 24 h post injury were significantly higher than those in traditional rehydration group (t=2.849, 3.644, P<0.05 or P<0.01). The creatinine levels of patients between the two groups on PID 1, 2, and 3 were similar. The urea nitrogen levels of patients in PiCCO monitoring rehydration group on PID 1, 2, and 3 were (6.8±1.5), (5.6±1.4), (4.4±1.4) mmol/L respectively, which were significantly lower than (8.6±1.8), (6.6±1.5), (5.5±1.4) mmol/L in traditional rehydration group (t=3.817, 2.511, 2.903, P<0.05 or P<0.01). The lactate clearance rates of patients in PiCCO monitoring rehydration group on PID 1, 2, and 3 were significantly higher than those in traditional rehydration group (t=2.516, 4.540, 3.130, P<0.05 or P<0.01). The procalcitonin levels of patients in PiCCO monitoring rehydration group on PID 2 and 3 were significantly lower than those in traditional rehydration group (Z=-2.491, -2.903, P<0.05). The CK-MB level of patients in PiCCO monitoring rehydration group on PID 3 was (35±10) U/L, which was significantly lower than (51±16) U/L in traditional rehydration group (t=4.556, P<0.01). The MAP levels of patients between the two groups on PID 1, 2, and 3 were similar. Within PID 28, the incidence of complications of patients in traditional rehydration group was significantly higher than that in PiCCO monitoring rehydration group (χ(2)=4.995, P<0.05), and the application case number of mechanical ventilation and the mechanical ventilation time of patients between the two groups were similar. Conclusions: The use of PiCCO monitoring technology to guide the early fluid resuscitation of extremely severe burn patients is beneficial for accurate determination of the fluid volume required by the patients and reduction of organ injury caused by improper rehydration.

Observation of the Doubly Cabibbo-Suppressed Decay D^{+}→K^{+}π^{+}π^{-}π^{0} and Evidence for D^{+}→K^{+}ω

Using 2.93  fb^{-1} of e^{+}e^{-} collision data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, the first observation of the doubly Cabibbo-suppressed decay D^{+}→K^{+}π^{+}π^{-}π^{0} is reported. After removing decays that contain narrow intermediate resonances, including D^{+}→K^{+}η, D^{+}→K^{+}ω, and D^{+}→K^{+}ϕ, the branching fraction of the decay D^{+}→K^{+}π^{+}π^{-}π^{0} is measured to be (1.13±0.08_{stat}±0.03_{syst})×10^{-3}. The ratio of branching fractions of D^{+}→K^{+}π^{+}π^{-}π^{0} over D^{+}→K^{-}π^{+}π^{+}π^{0} is found to be (1.81±0.15)%, which corresponds to (6.28±0.52)tan^{4}θ_{C}, where θ_{C} is the Cabibbo mixing angle. This ratio is significantly larger than the corresponding ratios for other doubly Cabibbo-suppressed decays. The asymmetry of the branching fractions of charge-conjugated decays D^{±}→K^{±}π^{±}π^{∓}π^{0} is also determined, and no evidence for CP violation is found. In addition, the first evidence for the D^{+}→K^{+}ω decay, with a statistical significance of 3.3σ, is presented and the branching fraction is measured to be B(D^{+}→K^{+}ω)=(5.7_{-2.1}^{+2.5}_{stat}±0.2_{syst})×10^{-5}.

Immune checkpoint inhibitor associated reactivation of primary membranous nephropathy responsive to rituximab

The same mechanisms that mediate antitumor immunity from checkpoint inhibitors (CPIs) can also lead to unintended targeting of normal tissues, characterized as immune-related adverse events (irAEs). Those with pre-existing autoimmune disease are believed to be particularly vulnerable for exacerbating underlying autoimmunity or inducing severe irAEs. We report the first case of CPI-associated reactivation of primary membranous nephropathy (MN) in a patient with pleural mesothelioma responding to immunotherapy. Due to its specificity in targeting B-lymphocytes, rituximab was used to treat primary MN with the expectation that this would not interfere with the benefits gained from T cell-mediated antitumor immunity. Rituximab was effective in treating CPI-associated reactivation of MN, and the patient was successfully rechallenged with nivolumab and maintained stable kidney function and sustained clinical antitumor effect. While exacerbation of pre-existing autoimmune diseases from CPIs is common, therapy for autoimmune reactivation can be rationally directed by an understanding of the immunosuppressive mechanism with goals of cancer treatment.

[Risk factors and clinical features of hospital-associated venous thromboembolism]

Objective: To investigate the clinical features and risk factors of hospital-associated venous thromboembolism (VTE). Methods: The study enrolled acute VTE patients admitted into China-Japan Friendship Hospital from January 1, 2017 to December 31, 2017. The hospital-associated VTE (HA-VTE) group and the community-associated VTE (CA-VTE) group were classified according to whether the VTE occurred during hospitalization or within a 90-day period of admission to hospital (including inpatient with at least two days of hospital stay or a surgical procedure under general or regional anaesthesia). Differences in clinical features, risk factors, and mortality rate were compared between the two groups. Results: A total of 437 patients with acute VTE were analyzed in the study. Among them, 266 patients were HA-VTE, 171 patients were CA-VTE. Patients in the CA-VTE group were more likely to have varicose veins, sedentary, long-distance travel, and patients in the HA-VTE group were more complicated with recent surgery (<1 month), bed rest, active malignant tumor, acute infections, acute cerebral infarction, fracture, central venous catheter (P<0.05). The CA-VTE group had more clinical symptoms such as lower extremity pain, dyspnea, chest pain and chest tightness (P<0.05). HA-VTE patients had less clinical symptoms but were more severe than the CA-VTE patients, with more sudden deaths (0 vs 3.4%, P=0.035). Among HA-VTE patients, 92.8% experienced VTE during hospitalization or within 1 month of the preceding hospital encounter, with a 13-day median time to VTE. The all-cause mortality rate was higher for HA-VTE group than CA-VTE group (8.3% vs 1.2%, P<0.001), and the in-hospital VTE was more common compared to VTE diagnosed post-discharge (12.2% vs 3.4%, P<0.001). Conclusions: More than half events of VTE are related to recent hospitalizations. HA-VTE has different risk factors from CA-VTE, combined with fewer clinical symptoms but higher all-cause mortality rate. More attention about VTE should be paid to hospitalized patients to reduce the incidence of HA-VTE events.

Σ^{+} and Σ[over ¯]^{-} Polarization in the J/ψ and ψ(3686) Decays

From 1310.6×10^{6}  J/ψ and 448.1×10^{6}  ψ(3686) events collected with the BESIII experiment, we report the first observation of Σ^{+} and Σ[over ¯]^{-} spin polarization in e^{+}e^{-}→J/ψ[ψ(3686)]→Σ^{+}Σ[over ¯]^{-} decays. The relative phases of the form factors ΔΦ have been measured to be (-15.5±0.7±0.5)° and (21.7±4.0±0.8)° with J/ψ and ψ(3686) data, respectively. The nonzero value of ΔΦ allows for a direct and simultaneous measurement of the decay asymmetry parameters of Σ^{+}→pπ^{0}(α_{0}=-0.998±0.037±0.009) and Σ[over ¯]^{-}→p[over ¯]π^{0}(α[over ¯]_{0}=0.990±0.037±0.011), the latter value being determined for the first time. The average decay asymmetry, (α_{0}-α[over ¯]_{0})/2, is calculated to be -0.994±0.004±0.002. The CP asymmetry A_{CP,Σ}=(α_{0}+α[over ¯]_{0})/(α_{0}-α[over ¯]_{0})=-0.004±0.037±0.010 is extracted for the first time, and is found to be consistent with CP conservation.

[Experience in the treatment of burn patients combined with inhalation injury during the epidemic of coronavirus disease 2019]

Objective: To introduce the experience in treating burn patients with inhalation injury during the epidemic of coronavirus disease 2019 (COVID-19). Methods: Six burn patients combined with inhalation injury were hospitalized in Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from February 1 to March 1 in 2020 during the high-incidence period of COVID-19, including 4 males and 2 females, aged 21-63 years, admitted at 2-4 hours after burns, with total burn areas of 1%-20% total body surface area (TBSA) and full-thickness burn areas of 1%-12% TBSA. Among them, 1 case had severe inhalation injury, 2 cases had mild inhalation injury, and 3 cases had moderate inhalation injury. The body temperatures of the patients were normal at the time of admission, with no fever or cough in the past 2 weeks. At admission, chest CT of one patient showed double lower lobes and left upper lobes had multiple slices and slightly high-density shadow of nodules. Chest CT of two patients showed thickening of bilateral lung texture, and the chest CT of remaining patients were normal. After admission, 6 patients were given routine treatment, the medical staffs paid attention to the protection and screened for COVID-19 according to the diagnosis and treatment plan of COVID-19. On post injury day (PID) 1, 3, 6, and 9, vein blood of patients were collected for determination of white blood cell (WBC) count, neutrophil, lymphocyte absolute value, and level of procalcitonin (PCT). Nucleic acid of novel coronavirus was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction on PID 3 and 6. The temperatures of patients were recorded after admission. The results of chest CT within one week after injury and the prognosis of the patients were recorded. Measurement data distributed normally were expressed as x±s, and measurement data distributed abnormally were expressed as M(P(25), P(75)). Results: (1) On PID 1, 3, 6, and 9, WBC counts of patients were respectively (19.8±3.8)×10(9)/L, (17.2±3.4)×10(9)/L, (13.3±3.1)×10(9)/L, and (11.1±1.6)×10(9)/L, neutrophils of patients were respectively 0.919±0.019, 0.899±0.011, 0.855±0.034, and 0.811±0.035, absolute values of lymphocytes of patients were respectively (0.65±0.18)×10(9)/L, (0.65±0.24)×10(9)/L, (0.91±0.34)×10(9)/L, and (1.23±0.42)×10(9)/L, and PCT values of patients were respectively 0.49 (0.36, 1.64), 0.39 (0.26, 0.73), 0.28 (0.18, 0.33), and 0.12 (0.11, 0.20) ng/mL. The values of WBC and neutrophils of patients were higher than the normal value, showing a downward trend. The absolute values of lymphocyte of patients returned to the normal value from PID 6. The PCT values of patients were higher than the normal value. (2) Nucleic acid test results of novel coronavirus of 6 patients were negative on PID 3 and 6. The temperatures of 6 patients ranged from 36.5 to 38.6 ℃. The typical imaging features of COVID-19 were not found in 6 patients within 1 week after injury by chest CT. After treatment for 14-32 days, 6 patients were cured and discharged. Conclusions: During COVID-19 pandemic, burn patients combined with inhalation injury should be treated under condition of good protection for doctors and nurses. Meanwhile, virus should be actively screened to reduce the risk of COVID-19 infection among doctors and patients.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Study of Open-Charm Decays and Radiative Transitions of the X(3872)

The processes X(3872)→D^{*0}D[over ¯]^{0}+c.c.,γJ/ψ,γψ(2S), and γD^{+}D^{-} are searched for in a 9.0  fb^{-1} data sample collected at center-of-mass energies between 4.178 and 4.278 GeV with the BESIII detector. We observe X(3872)→D^{*0}D^{0}[over ¯]+c.c. and find evidence for X(3872)→γJ/ψ with statistical significances of 7.4σ and 3.5σ, respectively. No evident signals for X(3872)→γψ(2S) and γD^{+}D^{-} are found, and the upper limit on the relative branching ratio R_{γψ}≡{B[X(3872)→γψ(2S)]}/{B[X(3872)→γJ/ψ]}<0.59 is set at 90% confidence level. Measurements of branching ratios relative to decay X(3872)→π^{+}π^{-}J/ψ are also reported for decays X(3872)→D^{*0}D^{0}[over ¯]+c.c.,γψ(2S),γJ/ψ, and γD^{+}D^{-}, as well as the non-D^{*0}D^{0}[over ¯] three-body decays π^{0}D^{0}D^{0}[over ¯] and γD^{0}D^{0}[over ¯].

Measurements of Absolute Branching Fractions of Fourteen Exclusive Hadronic D Decays to η

Using 2.93  fb^{-1} of e^{+}e^{-} collision data taken at a center-of-mass energy of 3.773 GeV with the BESIII detector, we report the first measurements of the absolute branching fractions of 14 hadronic D^{0(+)} decays to exclusive final states with an η, e.g., D^{0}→K^{-}π^{+}η, K_{S}^{0}π^{0}η, K^{+}K^{-}η, K_{S}^{0}K_{S}^{0}η, K^{-}π^{+}π^{0}η, K_{S}^{0}π^{+}π^{-}η, K_{S}^{0}π^{0}π^{0}η, and π^{+}π^{-}π^{0}η; D^{+}→K_{S}^{0}π^{+}η, K_{S}^{0}K^{+}η, K^{-}π^{+}π^{+}η, K_{S}^{0}π^{+}π^{0}η, π^{+}π^{+}π^{-}η, and π^{+}π^{0}π^{0}η. Among these decays, the D^{0}→K^{-}π^{+}η and D^{+}→K_{S}^{0}π^{+}η decays have the largest branching fractions, which are B(D^{0}→K^{-}π^{+}η)=(1.853±0.025_{stat}±0.031_{syst})% and B(D^{+}→K_{S}^{0}π^{+}η)=(1.309±0.037_{stat}±0.031_{syst})%, respectively. The charge-parity asymmetries for the six decays with highest event yields are determined, and no statistically significant charge-parity violation is found.

Determination of Strong-Phase Parameters in D→K_{S,L}^{0}π^{+}π^{-}

We report the most precise measurements to date of the strong-phase parameters between D^{0} and D[over ¯]^{0} decays to K_{S,L}^{0}π^{+}π^{-} using a sample of 2.93  fb^{-1} of e^{+}e^{-} annihilation data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector at the BEPCII collider. Our results provide the key inputs for a binned model-independent determination of the Cabibbo-Kobayashi-Maskawa angle γ/ϕ_{3} with B decays. Using our results, the decay model sensitivity to the γ/ϕ_{3} measurement is expected to be between 0.7° and 1.2°, approximately a factor of three smaller than that achievable with previous measurements, based on the studies of the simulated data. The improved precision of this work ensures that measurements of γ/ϕ_{3} will not be limited by knowledge of strong phases for the next decade. Furthermore, our results provide critical input for other flavor-physics investigations, including charm mixing, other measurements of CP violation, and the measurement of strong-phase parameters for other D-decay modes.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

Chest Pain Resolution with His-bundle Pacing in a Patient with Left Bundle Branch Block-related Nonischemic Left Ventricular Dysfunction

Chest pain in patients with left bundle branch block (LBBB) and normal coronaries has been reported previously in the literature. Prior cases of intermittent LBBB and "chest pain syndrome" are known of, but the causes of and treatment options for such remain unclear. A mechanism of myocardial dyssynchrony has been proposed as a possible cause of the pain, but this has not yet widely been investigated. The application of His-bundle pacing techniques to promote normal activation of the conduction system may be a treatment option. The function of cardiac implantable electronic devices can be followed via remote monitoring (RM), a vital tool in this unique patient population. The present report introduces the case of a 51-year-old female to highlight this under-recognized syndrome, including the pacing technologies used for treatment and the crucial role of RM follow-up in such affected individuals.

Mucosal inflammation predicts response to systemic steroids in immune checkpoint inhibitor colitis

BACKGROUND

Immune-related colitis is a common, often serious complication of immune checkpoint inhibition (ICI). Although endoscopy is not strictly recommended for any grade of diarrhea/colitis, emerging evidence suggests that endoscopic evaluation may have important therapeutic implications. In this retrospective study, we sought to comprehensively characterize the clinical and histologic features of ICI-induced colitis with a specific focus on evaluating the prognostic role of endoscopy.

METHODS

Data were collected from the medical records of 130 patients with confirmed ICI-induced colitis. In a subset of patients (n=44) with endoscopic and pathologic data, endoscopic data were scored using the Mayo Endoscopic Score (MES) with scores ranging from 0 (no inflammation) to 3 (colonic ulceration). The impact of infliximab on antitumor outcomes was evaluated using progression-free survival (PFS) and overall survival (OS).

RESULTS

We identified 130 patients with ICI-induced colitis across two institutions. All patients were treated with corticosteroids. Additional and/or alternative immunosuppression was employed in 59 cases, with 52 patients (42%) requiring at least one infusion of infliximab 5 mg/kg. Endoscopic assessment with biopsy was performed in 123 cases of suspected colitis (95%), with 44 cases available for MES tabulation. Presence of ulceration (MES 3) was associated with use of infliximab (p=0.008) and MES was significantly higher in patients who received infliximab compared with those who did not (p=0.003) with a median score of 2.5; conversely, those with an MES of zero rarely required secondary immunosuppression. Notably, symptoms of colitis based on Common Terminology Criteria for Adverse Events grade had no association with endoscopic findings based on MES classification. After adjustment for baseline patient and disease characteristics, there was no significant difference in steroid duration or cancer-related outcomes in patients treated with infliximab.

CONCLUSIONS

In our study, we demonstrate the association of endoscopic features, specifically the MES, with immunosuppressive needs. Importantly, we also show that MES was not related to severity of patient symptoms. The data suggest that endoscopic features can guide clinical decision-making better than patient symptoms, both identifying high-risk patients who will require infliximab and those who are likely to respond to initial corticosteroids.