High-throughput quantitation of amino acids and acylcarnitine in cerebrospinal fluid: identification of PCNSL biomarkers and potential metabolic messengers

Background: Due to the poor prognosis and rising occurrence, there is a crucial need to improve the diagnosis of Primary Central Nervous System Lymphoma (PCNSL), which is a rare type of non-Hodgkin's lymphoma. This study utilized targeted metabolomics of cerebrospinal fluid (CSF) to identify biomarker panels for the improved diagnosis or differential diagnosis of primary central nervous system lymphoma (PCNSL). Methods: In this study, a cohort of 68 individuals, including patients with primary central nervous system lymphoma (PCNSL), non-malignant disease controls, and patients with other brain tumors, was recruited. Their cerebrospinal fluid samples were analyzed using the Ultra-high performance liquid chromatography - tandem mass spectrometer (UHPLC-MS/MS) technique for targeted metabolomics analysis. Multivariate statistical analysis and logistic regression modeling were employed to identify biomarkers for both diagnosis (Dx) and differential diagnosis (Diff) purposes. The Dx and Diff models were further validated using a separate cohort of 34 subjects through logistic regression modeling. Results: A targeted analysis of 45 metabolites was conducted using UHPLC-MS/MS on cerebrospinal fluid (CSF) samples from a cohort of 68 individuals, including PCNSL patients, non-malignant disease controls, and patients with other brain tumors. Five metabolic features were identified as biomarkers for PCNSL diagnosis, while nine metabolic features were found to be biomarkers for differential diagnosis. Logistic regression modeling was employed to validate the Dx and Diff models using an independent cohort of 34 subjects. The logistic model demonstrated excellent performance, with an AUC of 0.83 for PCNSL vs. non-malignant disease controls and 0.86 for PCNSL vs. other brain tumor patients. Conclusion: Our study has successfully developed two logistic regression models utilizing metabolic markers in cerebrospinal fluid (CSF) for the diagnosis and differential diagnosis of PCNSL. These models provide valuable insights and hold promise for the future development of a non-invasive and reliable diagnostic tool for PCNSL.

[Correlation between pulmonary quantitative CT measurement indicators and respiratory symptoms in patients with chronic obstructive pulmonary disease in stable stage]

Objective: To explore the correlation between pulmonary quantitative CT measurement indicators and respiratory symptoms in patients with stable chronic obstructive pulmonary disease (COPD). Methods: A total of 186 patients with COPD in stable stage who visited in the outpatient department of Beijing Hospital from March 2021 to February 2022 were prospectively included. Demographic data, respiratory symptoms and lung function were collected. The original DICOM data of high-resolution CT (HRCT) were processed using the FACT medical imaging information system and the pulmonary emphysema index pixel index-950 (PI-950) and the airway wall thickness (4-6 T) and the percentage of airway area (4-6 WA%) of the 4-6 generation bronchi which represent the segmental and subsegmental bronchi were measured automatically. According to the modified British medical research council dyspnea scale (mMRC, 0-1 point for low score group, 2-4 points for high score group), chronic obstructive pulmonary disease assessment test (CAT, score<10 points for low score group,≥10 points for high score group), cough, expectoration and wheezing (asymptomatic group and symptomatic group), they were divided into two groups as dependent variables. The relationship between imaging parameters and the above symptoms was evaluated using a logistic regression model. Results: The study ultimately included 186 patients who met the inclusion criteria, including 162 males and 24 females, aged (68.9±9.3) years old. There were 83 patients in the high mMRC group, 120 patients in the high CAT group, 146 patients in the cough group, 154 patients in the expectoration group, and 65 patients in the wheezing group. The age and emphysema parameter PI-950 in the high score group of mMRC were higher than those in the low score group, while the percentage of the forced expiratory volume in 1 second (FEV1) predicted value (FEV1 pred) after medication, the percentage of carbon monoxide diffusion volume (DLCO) predicted value (DLCO pred), and the percentage of the maximum midexpiratory flow (MMEF) predicted value (MMEF pred) after medication were lower than those in the low score group (all P<0.05). The age of the high CAT group was higher than that of the low score group, while FEV1 pred and MMEF pred after medication were lower than those of the low score group (all P<0.05). The proportion of males, patients with smoking history, and smoking index in the cough group were higher than those in the non cough group, while the 4 WA% was lower than that in the non cough group (all P<0.05). The proportion of males, patients with smoking history, smoking index, and PI-950 in the expectoration group were higher than those in the non expectoration group, while FEV1 pred after medication and 4 WA% were lower than those in the non expectoration group (all P<0.05). The 5 WA% and 6 WA% of the wheezing group were higher than those of the non wheezing group, while MMEF pred after medication was lower than that of the non wheezing group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for demographic characteristics, smoking, combined diseases, lung function and other confounding factors, for every 10% increase in PI-950, the likelihood of developing more severe dyspnea for the patients (high score group according to mMRC) increased by 67.3% (OR=1.673, 95%CI: 1.052-2.658); Every 10% increase in 6WA% increased the likelihood of wheezing by 3.189 times (OR=4.189, 95%CI: 1.070-16.395). No correlation was found between various imaging indicators and cough, expectoration, and CAT scores (P>0.05). Conclusion: Quantitative CT measurement indicators in stable COPD patients can explain the presence and severity of respiratory symptoms, the pulmonary emphysema indicator is associated with dyspnea, and the percentage of proximal airway wall area is associated with wheezing.

[Radiation-associated sarcomas of bone and soft tissue: a clinicopathological analysis of 46 cases]

Objective: To investigate the clinical, imaging, histological, and molecular features and the differential diagnosis of radiation-associated sarcomas of bone and soft tissue. Methods: Forty-six cases of radiation-associated sarcomas of the bone and soft tissue in Beijing Jishuitan Hospital from January 2010 to January 2022 were retrospectively analyzed; and the imaging, histological features and immunophenotype were examined. Results: There were 33 females and 13 males, aged from 18 to 74 years, with a mean of 52 years. The most common site of radiation-associated sarcomas were the limbs and spine (15 cases), followed by the chest (9 cases). The primary diseases included epithelial tumors (15 breast cancer, 6 cervical cancer, and 5 bowel cancer), hematolymphoid tumors, bone and soft tissue tumors and infectious lesions. The latent period of radiation-associated sarcomas ranged from 2-22 years, with an average of 11.6 years. Histopathologically, the morphology was divergent from the primary tumor. The most common malignant tumor type was undifferentiated sarcoma (22 cases), followed by osteosarcoma (16 cases). The immunophenotype of radiation-related sarcoma was almost the same as the corresponding soft tissue sarcoma. Conclusions: Radiation-induced sarcoma has a wide range of primary tumor types and its imaging, morphology and immunohistochemical features are similar to those of the primary sarcoma of bone and soft tissue. Clinical correlation is often recommended for the differential diagnosis.

[Antifungal susceptibility of clinically isolated invasive Candida tropicalis in East China from 2017 to 2021]

Objective: To explore the epidemiological characteristics of sample distribution and antifungal susceptibilities of clinically invasive C. tropicalis isolates from 2017 to 2021 in East China. Methods: Using a retrospective analysis, the East China Invasive Fungal Infection Group (ECIFIG) collected C. tropicalis clinically isolated from 32 hospitals in East China between January 2017 and December 2021. The identification results of the strains were reviewed using mass spectrometry by the central laboratory of the Shanghai East Hospital. The minimum inhibitory concentrations (MICs) of the strains against fluconazole (FLU), voriconazole (VOR), itraconazole (ITR), Posaconazole (POS), isavuconazole (ISA), anidulafungin (ANI), caspofungin (CAS), micafungin (MICA) and 5-fluorocytosine (FCT) were tested by the ThermoFisher CMC1JHY colorimetric microdilution method. The MIC of amphotericin B (AMB) was tested by the broth microdilution method. The MIC results were analyzed based on the clinical breakpoints and epidemiological cutoff values (ECV) published by the Clinical and Laboratory Standards Institute (CLSI) M27 Ed3 and M57 Ed4 documents. Data analysis was conducted using the Kruskal-Wallis test and paired t-test. Results: In total, 305 C. tropicalis isolates were collected. There were 38.0% (116/305) strains isolated from blood, 11.5% (35/305) ascites, 8.9% (27/305) catheter and 8.9% (27/305) drainage fluid. The resistance rate of C. tropicalis to FLU was 32.5%, to VOR was 28.5%, and the cross-resistance rate to FLU and VOR was 28.5%. The wild-type proportions for ITR and POS were 79.3% and 29.2% respectively. There was no significant difference in resistance rates, MIC50, and MIC90 of FLU and VOR, or in the wild-type rates of ITR and POS over five years. More than 95.0% of the isolates were susceptible to echinocandins. However, one strain was identified as being multi-drug resistant. In azole antifungals, voriconazole, itraconazole, posaconazole, and isavuconazole have similar GM MIC values. The GM MIC of fluconazole is significantly higher than that of itraconazole (t=9.95, P<0.05), posaconazole (t=9.99, P<0.05), and voriconazole (t=10.01, P<0.05), Meanwhile, among echinocandins, the GM MIC of ANI was comparable to that of CAS (t=1.17, P>0.05), both of which were significantly higher than MICA (t=11.56, P<0.05; t=4.15, P<0.05). Conclusion: The clinical isolates of C. tropicalis in East China from 2017 to 2021 were relatively susceptible to echinocandins. However, there was consistently high resistance to fluconazole and voriconazole. More intensive efforts should be made on the monitoring of drug resistance in C. tropicalis.

Up-Regulation of TCF21 Expression Reverses the Malignant Phenotype of Cancer-Associated Fibroblasts in Esophageal Squamous Cell Carcinoma

PURPOSE/OBJECTIVE(S)

Cancer-associated fibroblasts (CAFs), as one major component of tumor microenvironment (TME), are closely associated with tumor initiation and progression. Our previous studies have discovered that CAFs induced the resistance of esophageal squamous cell carcinoma (ESCC) cells to a variety of chemotherapeutic drugs such as cisplatin and paclitaxel. Furthermore, CAFs attenuated ionizing irradiation (IR)-induced cancer cells death by regulating DNA damage response. CAFs themselves are highly resistant to death stimuli due to enhanced antioxidant potential and DNA repair capacity. How to inhibit the malignant phenotype of CAFs is critically important for the radical treatment of ESCC.

MATERIALS/METHODS

By RNA-sequencing and DNA methylation analysis, the transcriptome and epigenome of CAFs and matched normal fibroblasts (NFs) have been integratively analyzed. By transfection of TCF21 cDNA plasmid, the expression of TCF21 in CAFs has been up-regulated. Using a cell counting kit and migration and invasion assay, the effect of TCF21 on the growth and migration and invasive ability of CAFs has been detected. Using immunofluorescence and flow cytometry (FCM) analysis and western blotting, the effect of TCF21 on the DNA damage repair and apoptotic death of CAFs following IR has been detected.

RESULTS

TCF21 is one of the top ten down-regulated genes in CAFs compared with NFs due to promoter methylation. Up-regulation of TCF21 expression inhibited the growth rate and migration and invasive ability of CAFs. The expression of α-SMA, as an indicator of CAFs activation, was down-regulated in CAFs which were transfected with TCF21 cDNA. Furthermore, when TCF21 cDNA was transfected into CAFs, IR-induced DNA damage was increased while DNA repair was inhibited in CAFs, suggesting that TCF21 was involved in DNA damage response of CAFs following IR. FCM analysis showed that up-regulation of TCF21 expression promoted IR-induced apoptotic death of CAFs.

CONCLUSION

TCF21 is a determinant of the malignant phenotype of CAFs in ESCC. Up-regulation of TCF21 expression is a promising approach of inhibiting the growth, migration and invasion, activation and radioresistance of CAFs in ESCC.

Development and Validation of CT-Based Dose-Volume-Radiomics Nomogram for Radiation Induced Hypothyroidism in Nasopharyngeal Carcinoma

PURPOSE/OBJECTIVE(S)

Several studies reported hypothyroidism occurred in 40-50% of patients who were treated with neck irradiation. Post-radiation hypothyroidism impairs quality of life, increases the risk of cardiac complications, and requires lifelong thyroxine replacement in affected patients. At present, radiation dose-volume constraints of thyroid gland are used to predict thyroid function outcomes in patients with nasopharyngeal carcinoma (NPC). However, it is limited by (a) inferior predictive power, (b) a lack of analyzing individualized thyroid characteristics as a categoriad to predict radiation induced hypothyroidism (RIHT). In this study, we firstly developed and validated CT-based dose-volume-radiomics nomogram to predict RIHT in patients with NPC.

MATERIALS/METHODS

A total of 451 NPC patients who underwent definitive radiotherapy were randomly assigned into the training (n = 338) and validation set (n = 113) in a 3:1 ratio. Dose-volume parameters, including the thyroid volume, mean dose (Dmean), percentage of the volume that received xGy of radiation (Vx), and the absolute volume that was spared from xGy of radiation (Vsx), were collected from radiotherapy planning databases. We defined primary hypothyroidism as an elevated TSH serum level (> 4.94 mIU/L) in combination with a normal or low serum FT4 level, regardless of symptoms. 1316 CT radiomic features were extracted and selected to construct the radiomics signature (RS). A CT-based nomogram was established by integrating clinical factors, dose-volume parameters and radiomics signature in training set and was tested in validation set.

RESULTS

With a median follow-up period of 68 months, 301 (66.7%) patients developed RIHT. Compared with other dose-volume parameters including thyroid volume, V30, V50, Dmean, Vs45, Vs50, the thyroid volume spared from 60Gy (Vs60) had best power to predict RIHT. The radiomics signature constructed by 8 selected radiomic features showed better prognostic performance than Vs60 for predicting RIHT in training set (RIHT vs. Vs60, C-index: 0.69 vs. 0.58) and internal validation set (C-index: 0.65 vs. 0.55). Patients were stratified into high- and low-risk groups by median radiomic signature. Patients in high-risk group had higher rate of RIHT than patients in low-risk group (training set:61% vs.39%, P<0.05; validation set: 73% vs.32%, P<0.05). The nomogram established by integrating radiomics signature with Vs60 showed optimal prognostic performance with C-index of 0.71 in training, 0.66 in validation set. Calibration curves showed good agreement.

CONCLUSION

CT-based dose-volume-radiomics nomogram provided an excellent prognostic tool for predict incidence rate of RITH in patients with NPC received definitive radiotherapy.

High Dose Hyperfractionated Thoracic Radiotherapy vs. Standard Dose for Limited Stage Small-Cell Lung Cancer: A Multicenter, Open-Label Randomized, Phase 3 Trial

PURPOSE/OBJECTIVE(S)

Limited stage small-cell lung cancer (LS-SCLC) is associated with poor prognosis. We aimed to assess the efficacy and safety of high-dose, hyperfractionated thoracic radiotherapy of 54 Gy in 30 fractions compared with standard dose (45 Gy in 30 fractions) as a first-line treatment for LS-SCLC.

MATERIALS/METHODS

The study was an open-label, randomized, phase 3 trial, done at 16 public hospitals in China. Key inclusion criteria were patients aged 18-70 years, with previously histologically or cytologically confirmed LS-SCLC, previously untreated or received 1-2 courses of intravenous cisplatin (75 mg/m²of body-surface area, on day 1 or divided into two days of each cycle) or carboplatin (area under the curve of 5 mg/mL per min, day 1 of each cycle)and intravenous etoposide (100 mg/m²of body-surface area, on days 1-3 of each cycle), and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.Eligible patients were randomly assigned (1:1) to receive volumetric-modulated arc radiotherapy (VMAT) of 45 Gy in 30 fractions or the simultaneous integrated boost VMAT (SIB-VMAT) of 54 Gy in 30 fractions to the primary lung tumor and lymph node metastases starting 0-42 days after the first chemotherapy course. Both groups of patients received thoracic radiotherapy twice per day and 10 fractions per week. Prophylactic cranial radiation (PCI, 25 Gy in 10 fractions) was implemented to patients with responsive disease. The primary endpoint was overall survival. Safety was analyzed in the as-treated population.

RESULTS

Between June 30, 2017, and April 6, 2021, 224 eligible patients were enrolled and randomly assigned to 54 Gy (n = 108) or 45 Gy (n = 116). Median follow-up for the primary analysis was 45 months (IQR 41-48). Median overall survival was significantly improved in the 54 Gy group (62.4 months) compared with the 45 Gy group (43.1 months; p = 0.001). Median progression-free survival was significantly improved in the 54 Gy group (30.5 months) compared with the 45 Gy group (16.7 months; p = 0.044). The most common grade 3-4 adverse events were neutropenia (30 [28%] of 108 patients in the 54 Gy group vs 27 [23%] of 116 patients in the 45 Gy group), neutropenic infections (6 [6%] vs 2 [2%]), thrombocytopenia (13 [12%] vs 12 [10%]), anemia (6 [6%] vs 4 [3%]), and esophagitis (1 [1%] vs 3 [3%]). Treatment-related serious adverse events occurred in 9 [8%] patients in the 54 Gy group and 16 [14%] patients in the 45 Gy group. There were one treatment-related deaths in 54 Gy group (myocardial infarction).

CONCLUSION

Compared with standard thoracic radiotherapy dose of 45 Gy, the high dose of 54 Gy improved overall survival and progression-free survival without increasing toxicities in patients with LS-SCLC, supporting twice-daily hyperfractionated thoracic radiotherapy of 54 Gy with concurrent chemotherapy is an alternative treatment option for LS-SCLC. This study is complete and registered with ClinicalTrials.gov, NCT03214003.

Hyperthermia Enhances the Radiosensitivity of Pancreatic Cancer Cells by Inhibiting Wnt2B Signaling

PURPOSE/OBJECTIVE(S)

Pancreatic cancer (PC) is a highly lethal human malignance. Due to unobvious symptoms at early stage, most of the patients with PC are diagnosed at late stages and lose the chance of surgical resection. Furthermore, PC patients are resistant to chemoradiotherapy and therefore show a dismal survival. Hyperthermia is commonly used as a sensitizer of chemotherapy or radiotherapy for the clinical treatment of human cancers. Our study aimed to investigate whether hyperthermia can improve the radiosensitivity of PC cells and uncover the involved mechanisms.

MATERIALS/METHODS

PC cells BxPC3, CFPAC-1 and PANC1 were heated to 43 ℃ 1 h before exposure to ionizing irradiation (IR). The radiosensitivity of PC cells were detected in vitro by colony formation assay, immunofluence analysis and western blotting. The mechanisms studies have been conducted using qRT-PCR analysis, cDNA/siRNA transfection and comet assay.

RESULTS

Hyperthermia significantly enhanced the radiosensitivity of PC cells by decreasing their colony formation and increasing DNA damage following IR. By qRT-PCR analysis of Wnt genes expressions, we found Wnt2B was significantly down-regulated in PC-3 cells which were treated with the combination of hyperthermia and IR compared with hyperthermia or IR alone. Functional assays showed that the expression level of Wnt2B was inversely associated with the radiosensitivity of PC-3 cells. Furthermore, we found hyperthermia inhibited the expression of DNA repair proteins such as p-BRCA1 and p-MRE11 in PC cells following IR CONCLUSION: Hyperthermia can significantly enhance the radiosensitivity of PC cells in a Wnt2B signaling-dependent manner.

Impact of shift work on dementia: a systematic review and dose-response meta-analysis

OBJECTIVES

Although shift work has been reported as having a link to dementia, evidence remains inconsistent, and a comprehensive dose-response meta-analysis of the association is still lacking. We therefore conducted this meta-analysis to explore the association between shift work and the risk of dementia.

STUDY DESIGN

Systematic review and dose-response meta-analysis.

METHODS

PubMed, Embase, and Web of Science databases were systematically searched. Fixed or random-effects models were used to estimate the summary relative risks (RRs) and 95% confidence intervals (95% CIs). Generalized least squares regression was used to estimate dose-response associations, and restricted cubic splines were used to examine possible linear or non-linear associations.

RESULTS

Five articles (10 studies) with 72,999 participants and 23,067 cases were eventually included in the meta-analysis. The summary RRs and 95% CIs of dementia risk with shift work and night shift work versus daytime work were 1.13 (95% CI: 1.05-1.21, I2 = 46.70%) and 1.13 (95% CI: 1.03-1.24, I2 = 9.20%), respectively. The risk of dementia increased by 1% (RR = 1.01, 95% CI: 1.01-1.02, I2 = 41.3%) with each 1-year increase in the duration of shift work. We found a non-linear dose-response association between the duration of shift work and the risk of dementia (Pnon-linearity = 0.006). Though the shape of the curve was steeper with the duration of shift work <7 years, the increase was more gradual after 7 years.

CONCLUSION

Our findings suggest that shift work may be a risk factor for future dementia and that controlling the length of shift work is a feasible measure that may contribute to prevent dementia.

Preserving Structural Consistency in the Generation of Synthetic CT in Pelvic MR-Only Radiation Treatment Planning

PURPOSE/OBJECTIVE(S)

MR-based synthetic CT (sCT) generation is necessary for MR-only radiotherapy to assist in radiation dose calculation, owing to no electronic density information in MR images. This study investigated the feasibility of synthesizing CT images from magnetic resonance (MR) images using generation antagonism networks (GANs) for MR radiotherapy of rectal cancer. Meanwhile, the transformer module and the contrast learning loss were introduced to improve the sCT.

MATERIALS/METHODS

The data set used in this study was the T2-weighted MR and CT image data of 108 patients with rectal cancer. Three-fold cross-validation was performed on all data sets. The transformer module was introduced into the plain CycleGAN, and the improved Patch Noise Contrastive Estimation (PatchNCE) loss was used as the loss function. The improved PatchNCE loss maintained the structural consistency of the MR and the synthetic CT by ensuring the consistency of the distribution of image patches on the MR-sCT image pair. The 2.5D images were taken as the input of our model, which refers to taking two consecutive adjacent layers in a specific layer. The CT-to-sCT image similarity was evaluated by metrics of mean absolute error (MAE), peak signal-to-noise ratio (PSNR), and Structure Similarity Index Measure (SSIM). The sCT dosimetric accuracy was verified against CT-based dose distributions for the photon plan. Relative dose differences in the planning target volume and organs at risk were computed.

RESULTS

The evaluation indicators of sCT images generated by our model were superior to the plain CycleGAN in the results of the three-fold cross-validation. MAE, PSNR and SSIM of our model were 42.850HU, 26.486 and 0.988, respectively, which were superior to 47.129HU, 25.167 and 0.978 of the plain CycleGAN. In addition, sCT generated by our model exhibited good continuity in the axial direction compared with plain CycleGAN. Furthermore, most of the relative differences in the DVH indicators were less than 1%.

CONCLUSION

The accuracy of sCT can be effectively improved by introducing a transformer module and comparative learning loss function. Moreover, all dosimetric differences were within clinically acceptable criteria for photon radiotherapy, demonstrating the feasibility of the MRI-only workflow for patients with rectal cancer.

Engineered extracellular vesicles in female reproductive disorders

Biologically active and nanoscale extracellular vesicles (EVs) participate in a variety of cellular physiological and pathological processes in a cell-free manner. Unlike cells, EVs not only do not cause acute immune rejection, but are much smaller and have a low risk of tumorigenicity or embolization. Because of their unique advantages, EVs show promise in applications in the diagnosis and treatment of reproductive disorders. As research broadens, engineering strategies for EVs have been developed, and engineering strategies for EVs have substantially improved their application potential while circumventing the defects of natural EVs, driving EVs toward clinical applications. In this paper, we will review the engineering strategies of EVs, as well as their regulatory effects and mechanisms on reproductive disorders (including premature ovarian insufficiency (POI), polycystic ovarian syndrome (PCOS), recurrent spontaneous abortion (RSA), intrauterine adhesion (IUA), and endometriosis (EMS)) and their application prospects. This work provides new ideas for the treatment of female reproductive disorders by engineering EVs.

Small Samples and Low-Cost Auto-Segmentation Method for Pelvic Organ-at-Risk Segmentation in Magnetic Resonance Images Using Deep-Learning

PURPOSE/OBJECTIVE(S)

In radiotherapy, magnetic resonance (MR) imaging has higher contrast of soft tissue, and no radiation compared with computed tomography (CT) scanning. Due to the high-cost of manual annotation, the deep-learning based automatic organ-at-risk (OAR) and target delineation algorithms are in high-demand, but the collecting of large amounts of high-quality annotated datasets remains difficulty. In this paper, we proposed a low-cost OAR segmentation method with semi-supervised annotation using small annotation samples of pelvic MR images.

MATERIALS/METHODS

This study consisted of 94 patients diagnosed with rectal cancer from April 2018 to March 2021 at Peking University People's Hospital. We used 17 slices of MR images with annotation and 78 slices without annotation to train a deep-learning based segmentation model. The bladder, femoral heads, rectum and small intestine were selected as OAR. Semi-supervised method and ensemble learning were used for generating training set using small sample with annotation. Post-processing algorithm was used to correct the self-annotation data. Two of 14 annotation samples were set as test set. As for un-labeled images, 40 of them were set as semi-supervised annotation train set, the rest were test set. Besides, both 2D and 3D auto-segmentation networks were evaluated.

RESULTS

The dice of bladder, femoral head left and right, rectum and small intestine between segmentation results and reference masks is 0.947, 0.983, 0.981, 0.900, 0.845 only using self-annotation and post-processing method of 2D segmentation model. And the dice of corresponding OAR is 0.871, 0.975, 0.975, 0.783, 0.724 using 3D segmentation network, 0.885,0.982, 0.982, 0.882, 0,814 using 2D segmentation network with supervised method (nnUNet). The 2D model outperformed 3D model with better segmentation performance, shorter inference time and fewer parameters.

CONCLUSION

The results proved that we can train a multi-OAR segmentation model only using small annotation samples and other unlabeled samples. Ensemble learning and post-processing methods are necessary for semi-supervised data annotation. For anisotropy data, 2D model shows better performance than 3D models.

Dietary cholecalciferol and 25-hydroxycholecalciferol supplementation interact to modulate reproductive performance, egg quality, serum antioxidant capacity, intestinal morphology and tibia quality of breeder geese

1. A study was conducted to evaluate the effects of dietary cholecalciferol (vitamin D3) and 25-hydroxycholecalciferol (25-OH-D3) supplementation on the reproductive performance, egg quality, eggshell ultrastructure, serum hormone level and antioxidant capacity, intestinal morphology and tibia quality of breeder geese during the laying period.2. The trial was designed as a 3 × 3 factorial arrangement with three levels (300, 400 and 500 IU/kg) of vitamin D3 supplementation and three levels (25, 50 and 75 μg/kg) of 25-OH-D3 supplementation in a 10-wk feeding trial.3. The results showed that the combined supplementation of 400 IU/kg vitamin D3 and 50 μg/kg 25-OH-D3 had a better feed conversion ratio and a higher egg laying rate than the other groups. Vitamin D3 supplementation significantly increased the rate of qualified eggs for hatching, eggshell strength and thickness, serum testosterone and progesterone levels, serum total superoxide dismutase and glutathione peroxidase activities, tibia ash content and bone mineral density (P < 0.05). Dietary 25-OH-D3 supplementation significantly increased serum glutathione peroxidase activity and duodenal villus height and villus height-to-crypt-depth ratio (P < 0.05). The geese receiving 500 IU/kg vitamin D3 and 75 µg/kg 25-OH-D3 had the highest tibia calcium and phosphorous content among all groups (P < 0.05).4. Feeding 400 IU/kg vitamin D3 plus 50 µg/kg 25-OH-D3 gave optimal effects on feed conversion ratio and egg laying rate. This combination could be a nutritional strategy for increasing the laying rate, eggshell quality, serum hormone levels and serum antioxidant function regardless of 25-OH-D3 supplementation. Supplementation of 50 μg/kg 25-OH-D3 could be a recommended dose for improving the serum antioxidant capacity and intestinal morphology regardless of vitamin D3 supplementation.

Treatment Response Prediction Using a Combination of Hematological Biomarkers and CT Deep Learning Radiomics in Locally Advanced Esophageal Squamous Cell Carcinoma

PURPOSE/OBJECTIVE(S)

To assess the complementary value of hematological biomarkers to deep learning-radiomic models for assessing esophageal squamous cell carcinoma (ESCC) pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT), which will help to provide a reference for the following clinical study of esophageal preservation.

MATERIALS/METHODS

A total of 157 patients with ESCC were enrolled and divided into a training cohort (n = 111) and a validation cohort (n = 47). Computed tomography (CT) was performed for all patients 2 weeks before and 6 weeks after nCRT. In addition, clinicopathological factors and hematological parameters before nCRT were collected. Deep learning and handcrafted radiomic features were extracted from segmented regions of interest (ROIs) from pretreatment (ROI1) and posttreatment (ROI2) CT, which represented the features of the pre- and posttreatment tumors, respectively. The minimum redundancy maximum relevance (mRMR) and least absolute shrinkage and selection operator (LASSO) algorithms were used for feature selection, and logistic regression (LR) was used as the classifier. The deep learning radiomic nomogram (DLRN) was then developed based on the rad-scores and independent clinicopathological risk factors. The model was assessed using area under the receiver operating characteristic (ROC) curve analysis, calibration curve analysis and decision curve analysis and verified with both 10-fold cross-validation and internal validation using bootstrap resampling with 1000 replicates.

RESULTS

Rad-scores were constructed with 8 features, which were finally selected as the most predictive features from ROI 1 and ROI 2. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), albumin and rad-scores were incorporated into the DLRN, which achieved good prediction performance, with areas under the ROC curve of 0.888 (95% CI, 0.824-0.951, p <0.05) for the training cohort and 0.873 (95% CI, 0.772-0.974, p <0.05) for the validation cohort. On the training set, the DLRN achieved an AUC of 0.882 in 10-fold cross-validation, and after internal validation, the area under the ROC curve still reached 0.884. The DLRN performed significantly better than the clinical model and radiomics models (p<0.05). IDI and continuous NRI showed significant improvement for the DLRN when incorporating radiomics features and hematological parameters (IDI = 0.3399, P <0.001; continuous NRI = 1.141, P <0.001; categorical NRI = 0.3836, P <0.001). Calibration curves (p > 0.05) and DCA demonstrated that the DLRN was useful for pCR prediction and produced a greater net benefit than the clinical model and radiomics models.

CONCLUSION

Incorporation of radiomics features and hematological parameters into the DLRN improved pCR prediction after nCRT in ESCC. Enhanced pCR predictability may improve patient selection before surgery, providing clinical application value for the use of active surveillance.

Neointima abating and endothelium preserving - An adventitia-localized nanoformulation to inhibit the epigenetic writer DOT1L

Open vascular reconstructions such as bypass are common treatments for cardiovascular disease. Unfortunately, neointimal hyperplasia (IH) follows, leading to treatment failure for which there is no approved therapy. Here we combined the strengths of tailoring nanoplatforms for open vascular reconstructions and targeting new epigenetic mechanisms. We produced adhesive nanoparticles (ahNP) that could be pen-brushed and immobilized on the adventitia to sustainably release pinometostat, an inhibitor drug selective to the epigenetic writer DOT1L that catalyzes histone-3 lysine-79 dimethylation (H3K79me2). This treatment not only reduced IH by 76.8% in injured arteries mimicking open reconstructions in obese Zucker rats with human-like diseases but also avoided the shortcoming of endothelial impairment in IH management. In mechanistic studies, chromatin immunoprecipitation (ChIP) sequencing revealed co-enrichment of the histone mark H3K27ac(acetyl) and its reader BRD4 at the gene of aurora kinase B (AURKB), where H3K79me2 was also enriched as indicated by ChIP-qPCR. Accordingly, DOT1L co-immunoprecipitated with H3K27ac. Furthermore, the known IH driver BRD4 governed the expression of DOT1L which controlled AURKB's protein level, revealing a BRD4- > DOT1L- > AURKB axis. Consistently, AURKB-selective inhibition reduced IH. Thus, this study presents a prototype nanoformulation suited for open vascular reconstructions, and the new insights into chromatin modulators may aid future translational advances.

Efficacy and Safety of Multifraction Stereotactic Radiation Therapy with Volumetric Modulated Arc Therapy Technique for Multiple Brain Metastases

PURPOSE/OBJECTIVE(S)

Multifraction stereotactic radiotherapy (MF-SRT) with volumetric modulated arc therapy (VMAT) is the standard treatment option for patients with multiple brain metastases. VMAT has superior physical accessibility and economic accessibility compared with advanced radiotherapy technologies such as Tomo or Proton radiotherapy. However, existing studies has mainly focused on comparing the dosimetric parameters between distinct radiotherapy techniques. Moreover, single fraction stereotactic radiosurgery is preferentially recommended for treatment of brain metastases with maximum diameter <2cm compared with MF-SRT. There is a lack of clinical results of its efficacy and subgroup analyses according to diameter. Thus, we first report the detailed analysis of clinical results of SRT using VMAT for brain metastases.

MATERIALS/METHODS

This study is a retrospective analysis of SRT for multiple brain metastasis using VMAT. The clinical efficacy of VMAT was evaluated by local control (LC) in 6-months, 1-year, and 2-year.

RESULTS

A total of 63 patients with 214 brain metastases were enrolled. The most common fractionation schemes were 40 Gy/8F and 48 Gy/12F. In all, LC rates at 6-month, 1-year, and 2-year were 95.5%, 90.6%, and 76.8%, respectively. Using univariate and multivariate analyses according to stratification factors including maximum diameter, GTV volume, dose per fraction, fractions, inner structure, and BED (α/β = 10), we found that no factors were associated with 6-month LC, 1-year LC, and 2-year LC. 1-year LC rates for maximum diameter ≥1 and <2, ≥2 and <3, and ≥3 cm were 89.2%, 90.7%, and 95.7%, respectively. The 1-year LC rates for tumors with GTV <3, ≥3 and <5, ≥5 and <10, and ≥10 cc were 87.0%, 91.7%, 94.7%, and 96.6%, respectively. Interestingly, 1year-LC in GTV ≥3 cc tends to higher than those in GTV <3 cc, but there was no significant difference (94.4% vs 87%, P = 0.162). Brain radionecrosis (RN) was the most significant toxicity occurring in 10 (4.7%) out of the 214 treated brain metastases. Among 6 patients with RN, 4 (66.7%) had been treated with tyrosine kinase inhibitors.

CONCLUSION

The use of MF-SRT with VMAT for multiple brain metastases showed a comparable clinical efficacy to other techniques described in the literature. And the LC rate for maximum diameter <2cm treated with MF-SRT VMAT was comparable to single fraction stereotactic radiosurgery as previously reported. The treatment-related toxicity was acceptable.

Predicting Radiation Esophagitis using 18F-FAPI-04 PET/CT in Patients with LA-ESCC Treated with Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

This prospective study examined whether 18F-FAPI-04 PET/CT can predict the development and severity of radiation esophagitis (RE) in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) treated with concurrent chemoradiotherapy.

MATERIALS/METHODS

From June 2021 to March 2022, images were prospectively collected from LA-ESCC patients who underwent 18F-FAPI-04 PET/CT examinations before and during radiotherapy. The development of RE was evaluated weekly according to Radiation Therapy Oncology Group criterion. The target-to-background ratio in blood (TBRblood) was analyzed at each time point and correlated with the onset and severity of RE. Factors that predicted RE were identified by multivariate logistic analyses.

RESULTS

Thirty patients (median age, 66.5 years [interquartile range: 56¨C71 years]; 22 men) were evaluated. Significantly higher TBRblood (during radiotherapy, mean: 3.06 vs 7.11, P = 0.003) and change in TBRblood compared with pre-RT (ΔTBRblood, mean: 0.67 vs 4.81, P = 0.002) were observed in patients with RE than patients without RE. Those with grade 3 RE had a significantly higher TBRblood (during radiotherapy, mean: 4.55 vs 9.66, P = 0.003) and ΔTBRblood (mean: 2.16 vs 7.50, P = 0.003) compared with those with RE

CONCLUSION

The ΔTBRblood on 18F-FAPI-04 PET/CT may be effective at identifying patients at risk for the development of RE, especially grade 3 RE.

Collapse

Key Words Collapse

MESH Headings Collapse

Grants Collapse

[Effects of microRNA-106b on migration and invasion of human malignant pleural mesothelioma cell NCI-H2452]

Objective: To investigate the inhibitory effect of microRNA-106b in the process of migration and invasion of human malignant pleural mesothelioma cell NCI-H2452. Methods: In April 2017, the expression level of miRNA-106b in malignant pleural mesothelioma cells (NCI-H2452, MSTO-211H, NCI-H2052) and normal mesothelial cells MeT-5A was detected and analyzed. Using NCI-H2452 cells as a model, the NCI-H2452 cell model with miRNA-106b overexpression was established by transfecting miRNA-106b mimics. The expression level of miRNA-106b in the cells was detected by real-time fluorescent quantitative PCR. The effect of miRNA-106b on the migration and invasion ability of NCI-H2452 cells was analyzed. The gene expression data of malignant mesothelioma and the downstream target gene data of miRNA-106b in public databases were analyzed to screen the downstream target genes of miRNA-106b in mesothelioma cells that affect cell migration and invasion ability, and to verify the expression of this gene in NCI-H2452 cells with miRNA-106b overexpression. Results: The expression of miRNA-106b in three MPM cells was decreased compared with MeT-5A cells (P<0.001) . The expression level of miRNA-106b was significantly increased after transfection of miRNA-106b mimics (P<0.001) . The scratch migration levels of the experimental group were 28.45%±4.37%, 38.12%±4.82% and 50.06%±8.92% at 24h, 31h and 48h, respectively. Compared with the control group, the migration level decreased by 37.48%±2.65%, 49.21%±3.45% and 68.14%±3.81% (P<0.01) . The number of cell migration and invasion decreased in the experimental group compared with the control group (P<0.001) . Public databases were used to screen and analyze the possibility that TCF21 gene, as a downstream target gene, could affect the migration and invasion ability of MPM cells. The expression level of TCF21 gene was increased after transfection of miRNA-106b mimics in NCI-H2452 cells (P=0.009) . Conclusion: MiRNA-106b can inhibit the migration and invasion of NCI-H2452 cells and increase the expression of TCF21 gene.

[Investigation and analysis of occupational hazard factors in different industries in Tongliao City]

Objective: To investigate the occupational hazard factors of different industries in Tongliao City, and to provide scientific basis for the prevention and control of occupational disease in Tongliao City. Methods: In July 2021, the detection data of coal dust, silica dust, cement dust, benzene, noise and other occupational hazard factors, as well as the occupational health examination data of workers in various positions of 104 enterprises in different industries in Tongliao City were cllected and anylazed. χ(2) test was used to analyze the results of chest radiography of workers in different age groups. Results: A total of 104 enterprises were investigated, and the median time-weighted average concentration (C(TWA)) of coal dust, silic a dust, cement dust and benzene in contact with test posts were 0.94, 0.30, 0.70 and 0.95 mg/m(3), respectively. The median 8 h equivalent sound level (L(EX, 8 h)) of noise was 74.1 dB (A) . The over standard rates of silica dust, cement dust and noise contact positions were 10.83% (16/240) , 7.14% (2/28) and 0.48% (3/628) , respectively. The differences of chest X-ray examination of coal dust and silica dust workers in different working ages were statistically significant (χ(2)=218.50, 531.80, P<0.001) . The difference of hearing threshold of noise workers with different working age was statistically significant (χ(2)=1290.00, P<0.001) . The rates of leukopenia and neutropenia were 41.90% (44/105) and 20.95% (22/105) in benzene exposed workers. The positive rate of brucella exposure workers was 1.33% (1/75) for tiger red plate agglutination test and 3.23% (3/93) for tube agglutination test. Conclusion: Silica dust, cement dust and noise exceed the standard in some posts and places in the Tongliao City, and some workers are infected with Brucella. In the future, we can focus on monitoring noise-generating posts, strengthen supervision and implement prevention and control measures to reduce the incidence of occupational diseases.

[Investigation on cognition, diagnosis and treatment status of chest tightness variant asthma among Chinese pediatricians]

Objective: To evaluate the awareness, diagnosis and treatment of chest tightness variant asthma (CTVA) among pediatricians in China. Methods: The survey was conducted by convenient sampling method. Pediatricians with professional title of attending physician and above from different grades hospitals in 30 provinces were invited to conduct online questionnaire surveys through WeChat, pediatricians scan QR codes to complete electronic questionnaires in the mini program from January 16th to February 4th, 2021. The contents of questionnaire included the awareness, diagnosis and treatment of CTVA, and comparing the differences between pediatricians in secondary hospitals and tertiary hospitals. Results: A total of 1 529 pediatricians participated in the survey, and 1 484 (97.06%) pediatricians completed the questionnaire and included in the analysis, including 420 males (28.30%). The awareness rate of CTVA among pediatricians was 77.83 % (1 155/1 484). Pediatricians in tertiary hospitals had higher rates of awareness of CTVA than pediatricians in secondary hospitals [81.86% (898/1 097) vs 66.41% (257/387), P<0.001] and had better execution of the guidelines [89.15% (978/1 097) vs 79.59% (308/387), P<0.001]. A total of 93.06 % (1 381/1 484) of pediatricians' first-line treatment included inhaled corticosteroids (ICS) for CTVA. Among them, a higher proportion of pediatricians in tertiary hospitals used ICS included regimens for first-line treatment of CTVA compared with pediatricians in secondary hospitals [94.90% (1 041/1 097) vs 87.86% (340/387), P<0.001]. The reported well control rate of CTVA was 32.08% (476/1 484), which was significantly lower in secondary hospitals than that in tertiary hospitals [17.31% (67/387) vs 37.28% (409/1 097), P<0.001]. Conclusion: Most pediatricians are well aware of CTVA, among which there is a certain gap in clinical practice between pediatricians in secondary hospitals and tertiary hospitals in terms of understanding, diagnosis, and treatment of CTVA.

A methylation- and immune-related lncRNA signature to predict ovarian cancer outcome and uncover mechanisms of chemoresistance

Tumor-associated lncRNAs regulated by epigenetic modification switches mediate immune escape and chemoresistance in ovarian cancer (OC). However, the underlying mechanisms and concrete targets have not been systematically elucidated. Here, we discovered that methylation modifications played a significant role in regulating immune cell infiltration and sensitizing OC to chemotherapy by modulating immune-related lncRNAs (irlncRNAs), which represent tumor immune status. Through deep analysis of the TCGA database, a prognostic risk model incorporating four methylation-related lncRNAs (mrlncRNAs) and irlncRNAs was constructed. Twenty-one mrlncRNA/irlncRNA pairs were identified that were significantly related to the overall survival (OS) of OC patients. Subsequently, we selected four lncRNAs to construct a risk signature predictive of OS and indicative of OC immune infiltration, and verified the robustness of the risk signature in an internal validation set. The risk score was an independent prognostic factor for OC prognosis, which was demonstrated via multifactorial Cox regression analysis and nomogram. Moreover, risk scores were negatively related to the expression of CD274, CTLA4, ICOS, LAG3, PDCD1, and PDCD1LG2 and negatively correlated with CD8+, CD4+, and Treg tumor-infiltrating immune cells. In addition, a high-risk score was associated with a higher IC50 value for cisplatin, which was associated with a significantly worse clinical outcome. Next, a competing endogenous RNA (ceRNA) network and a signaling pathway controlling the infiltration of CD8+ T cells were explored based on the lncRNA model, which suggested a potential therapeutic target for immunotherapy. Overall, this study constructed a prognostic model by pairing mrlncRNAs and irlncRNAs and revealed the critical role of the FTO/RP5-991G20.1/hsa-miR-1976/MEIS1 signaling pathway in regulating immune function and enhancing anticancer therapy.

[A control study of steroid withdrawal protection strategy after kidney transplantation in children]

Objective: To study the influence of steroid withdrawal protection strategy on height growth in pediatric patients after kidney transplantation. Methods: The prospective cohort study enrolled 40 stage 5 chronic kidney disease children receiving kidney transplantation from July 2017 to September 2022 at Guangzhou Women and Children's Medical Center. Based on the primary preoperative disease, patients with immune abnormality-associated glomerular diseases or unknown causes were assigned to the steroid maintenance group, in which patients received steroid tapering within 3 months after surgery to a maintenance dose of 2.5 to 5.0 mg/d. While patients with hereditary kidney disease or congenital urinary malformations were assigned to the steroid withdrawal group, in which patients had steroids tapered off within 3 months. The characteristics of height catch-up growth and clinical data were compared between the 2 groups at baseline, 6, 12, 18 and 24 months after kidney transplantation. T-test, repeated measurement of variance analysis, Mann-Whitney U test, and Fisher exact test were used for the comparison between the 2 groups. Results: Among the 40 children, 17 were males, 23 were females, 25 were in the steroid withdraw group ((7.8±2.8) years old when receiving kidney transplantation) and 15 cases were in the steroid maintenance group ((7.6±3.5) years old when receiving kidney transplantation). The study population was followed up for (26±12) months. The total dose per unit body weight of steroids in the steroid withdrawal group was lower than that in the steroid maintenance group ((0.13±0.06) vs. (0.36±0.19) mg/(kg·d), t=5.83, P<0.001). The height catch-up rate (ΔHtSDS) in the first year after kidney transplantation in the steroid withdraw and steroid maintenance groups was 1.0 (0.7, 1.4) and 0.4 (0.1, 1.0), respectively; in the second year, the ΔHtSDS in the steroid withdraw group was significantly higher than that in the steroid maintenance group (1.1 (0.2, 1.7) vs. 0.3 (0, 0.8), U=28.00, P=0.039). The HtSDS in the steroid withdrawal group at the five follow-up time points was -2.5±0.8, -2.0±0.8, -1.5±0.8, -1.3±0.9 and -0.5±0.3, respectively, while in the steroid maintenance was -2.4±1.3, -2.2±1.1, -2.0±1.0, -1.8±1.0 and -1.6±1.0, respectively. There were statistically significant differences in HtSDS at different follow-up time points in both 2 groups (F=19.81, P<0.01), but no statistical differences in overall impact between the 2 groups (F=1.13, P=0.204). The steroid treatment was interaction with the increase of follow-up time (F=3.62, P=0.009). At the 24th month after transplantation, the HtSDS in the steroid withdrawal group was significantly higher than that in the steroid maintenance group (P=0.047). Six patients in the steroid withdrawal group experienced antibody-mediated immune rejection (AMR), while 3 did in the steroid maintenance group. Moreover, there was no significant difference in AMR between the two groups (χ2=0.06, P=0.814). Conclusion: The steroid withdrawal protection strategy favors the height catch-up growth in pediatric patients after kidney transplantation and does not increase the risk of postoperative antibody-mediated immune rejection.