The efficacy of trans-esophageal echocardiography in treatment of nonvalvular atrial fibrillation with left atrial appendage occlusion

The article "The efficacy of trans-esophageal echocardiography in treatment of nonvalvular atrial fibrillation with left atrial appendage occlusion" by Y. Song, S.-C. Qin, X. Fu, Z.-M. Jiang, K. Chen, X.-L. Wang, R.-F. Zhang, Y. Liuang, R.-F. Zhang, Y. Liu, published in Eur Rev Med Pharmacol Sci 2018; 22 (16): 5335-5338 has been withdrawn.

Investigation of the predisposing factor of pemphigus and its clinical subtype through a genome-wide association and next generation sequence analysis

BACKGROUND

Pemphigus is an autoimmune blistering disease with pemphigus vulgaris (PV) and foliaceus (PF) as the two major histological subtypes. Associations with HLA molecules have been suggested, but specific HLA risk variants as well as non-HLA risk variants remain to be discovered.

METHODS

We performed a two-stage genome-wide association study in the Chinese Han population through a genome-wide discovery analysis and follow-up validation analysis in a total number of 210 PV, 159 PF and 2493 healthy controls. HLA imputation as well as high coverage next generation sequencing based HLA genotyping was employed to investigate the association of classical HLA alleles and amino acid change.

RESULTS

We have discovered independent novel associations with PF at rs2178077 on 12q24.33, located next to RAN (P_PF = 1.57 × 10^-9 ) and rs3888722 within the MHC region (P = 6.73 × 10^-9 ). For the HLA variants, we confirmed independent genome-wide level risk associations in HLA-DQB1 and HLA-DRB1, with DQB1*05:03 to be the strongest association with PV (P = 8.59 × 10^-68 , OR = 31.16) and PF (P = 4.84 × 10^-17 , OR = 5.64). In addition, DRB1*14 was demonstrated to be a second independent variants (P = 4.2 × 10^-63 , OR = 35.47) for PV, while DRB1*04:06 was demonstrated to be the second independent signal (P = 7.44 × 10^-13 , OR = 5.58) for PF.

CONCLUSIONS

These findings advance our understanding of the genetic basis of pemphigus susceptibility and may offer opportunities for risk prediction and preventive treatment for pemphigus, in particular for PV.

The efficacy of trans-esophageal echocardiography in treatment of nonvalvular atrial fibrillation with left atrial appendage occlusion

OBJECTIVE

To investigate the efficacy of transesophageal echocardiography (TEE) in the treatment of nonvalvular atrial fibrillation with left atrial appendage (LAA) occlusion.

PATIENTS AND METHODS

Forty-nine patients with nonvalvular atrial fibrillation were selected from January 2015 to December 2015 to serve as control group, and 49 patients with nonvalvular atrial fibrillation were selected from January 2016 to December 2016 to serve as observation group. Patients in both groups were treated with LAA occlusion. After surgery, patients in control group received 2D-transesophageal echocardiography (2D-TEE), while patients in observation group received 3D-TEE. LAA diameter, maximum depth, postoperative parameters, and postoperative complications were compared between two groups.

RESULTS

The maximum LAA diameter can be measured from different angles in control group, and maximum depth cannot be measured in control group. No significant differences in maximum LAA diameter and maximum depth were found between two groups from different angles (p<0.05). No significant difference in left ventricular end diastolic diameter (LVEDd), left atrial diameter (LA-d), left ventricular ejection fraction (LVEF), mitral regurgitation volume (MV Reg V), E peak and pulmonary vein diastolic flow velocity (PVd) were found between those two groups (p<0.05). The overall occurrence of postoperative complications in observation group and control group were 0.00% and 12.24%, respectively, significant difference was found between those two groups (p<0.05).

CONCLUSIONS

Compared with 2D-TEE, the application of 3D-TEE in treatment of nonvalvular atrial fibrillation with left atrial appendage occlusion is more conducive to the selection of the size of the reservoir, and can reduce the occurrence of postoperative complications.

Flavin monooxygenase 3, the host hepatic enzyme in the metaorganismal trimethylamine N-oxide-generating pathway, modulates platelet responsiveness and thrombosis risk

Essentials Microbe-dependent production of trimethylamine N-oxide (TMAO) contributes to thrombosis risk. The impact of host flavin monooxygenase 3 (FMO3) modulation on platelet function is unknown. Genetic manipulation of FMO3 in mice alters systemic TMAO levels and thrombosis potential. Genetic manipulation of FMO3 is associated with alteration of gut microbial community structure.

SUMMARY

Background Gut microbes play a critical role in the production of trimethylamine N-oxide (TMAO), an atherogenic metabolite that impacts platelet responsiveness and thrombosis potential. Involving both microbe and host enzymatic machinery, TMAO generation utilizes a metaorganismal pathway, beginning with ingestion of trimethylamine (TMA)-containing dietary nutrients such as choline, phosphatidylcholine and carnitine, which are abundant in a Western diet. Gut microbial TMA lyases use these nutrients as substrates to produce TMA, which upon delivery to the liver via the portal circulation, is converted into TMAO by host hepatic flavin monooxygenases (FMOs). Gut microbial production of TMA is rate limiting in the metaorganismal TMAO pathway because hepatic FMO activity is typically in excess. Objectives FMO3 is the major FMO responsible for host generation of TMAO; however, a role for FMO3 in altering platelet responsiveness and thrombosis potential in vivo has not yet been explored. Methods The impact of FMO3 suppression (antisense oligonucleotide-targeting) and overexpression (as transgene) on plasma TMAO levels, platelet responsiveness and thrombosis potential was examined using a murine FeCl3 -induced carotid artery injury model. Cecal microbial composition was examined using 16S analyses. Results Modulation of FMO3 directly impacts systemic TMAO levels, platelet responsiveness and rate of thrombus formation in vivo. Microbial composition analyses reveal taxa whose proportions are associated with both plasma TMAO levels and in vivo thrombosis potential. Conclusions The present studies demonstrate that host hepatic FMO3, the terminal step in the metaorganismal TMAO pathway, participates in diet-dependent and gut microbiota-dependent changes in both platelet responsiveness and thrombosis potential in vivo.

Analysis on Fourier characteristics of wavelength-scanned optical spectrum of low-finesse Fabry-Pérot acoustic sensor

In this work, we investigate the Fourier characteristics of wavelength-scanned optical spectrum of low-finesse Fabry-Pérot (FP) acoustic sensor both theoretically and experimentally. The wavelength scanning will transform the time-domain acoustic signal into phase modulation loaded on the FP sensor spectrum distributed along wavelength. Therefore the interference spectrum can be regarded as carrier signal in the wavelength domain. From this perspective, it is intelligible that the phase modulation loaded on the spectrum (carrier signal) will introduce sidebands in Fourier domain. The spatial frequency and phase of sideband components contain unique information of both acoustic signal and the corresponding sensor. These conclusions are experimentally proved by single sensor head as well as two parallel sensors. The Fourier characteristics of sideband components can be utilized to recognize and distinguish acoustic signals received by different sensors, indicating that it has potential applications in multiplexed FP sensor array and source localization, and so forth.

Discovery of 4 exonic and 1 intergenic novel susceptibility loci for leprosy

Seven new risk coding variants have been identified through an exome-wide association study (EWAS), which studied the contributions of protein-coding variants to leprosy susceptibility. But some potential susceptibility loci were not studied in the previous EWAS study because of the project consideration. Seventeen unstudied potential susceptibility loci of the previous EWAS were validated in 3169 cases and 9814 controls in this study. Four disease-associated exonic loci were identified: rs671 in ALDH2 (P = 2.0 × 10^-20 , odds ratio [OR] = 1.35), rs13259978 in SLC7A2 (P = 1.74 × 10^-8 , OR = 1.28), rs925368 in GIT2 (P = 9.18 × 10^-17 , OR = 1.44), and rs75680863 in TCN2 (P = 8.37 × 10^-21 , OR = 0.74). Potentially implicating ZFP36L1 as a new susceptibility gene, 1 intergenic single nucleotide polymorphism (SNP), rs1465788 (P = 7.81 × 10^-6 , OR = 0.88), was also suggested to be associated with leprosy. A luciferase reporter assay showed that the rs1465788 risk allele notably decreased the transcription activity of the flanking sequence. These findings suggest the possible involvement of lipid metabolism, NF-κB homeostasis and macrophage antimicrobial pathways in leprosy pathogenesis.

Proposal of a novel CHF correlation for PWR under low pressure conditions based on stepwise regression method

Constrained by limited experimental data, development of CHF correlation for PWR fuel assemblies under transient and accidental conditions at low pressure levels (2–10 MPa) is a typical statistical problem with small sample amounts, but simultaneously has requirements of high prediction accuracy. In this study, stepwise regression method was used to develop a new CHF correlation for application in PWR under low pressure conditions. First, several essential thermal-hydraulic parameters which might influence CHF were selected based on consensus characteristics of DNB phenomenon. With stepwise regression, the form and coefficients of the proposed CHF correlation were optimized in a dynamic manner. Compared to currently available CHF correlations, represented by the Westinghouse W-3 correlation, the CHF correlation obtained by stepwise regression has a much simpler form and matches also well with the experimental data.

Spatial self-organization resolves conflicts between individuality and collective migration

Collective behavior can spontaneously emerge when individuals follow common rules of interaction. However, the behavior of each individual differs due to existing genetic and non-genetic variation within the population. It remains unclear how this individuality is managed to achieve collective behavior. We quantify individuality in bands of clonal Escherichia coli cells that migrate collectively along a channel by following a self-generated gradient of attractant. We discover that despite substantial differences in individual chemotactic abilities, the cells are able to migrate as a coherent group by spontaneously sorting themselves within the moving band. This sorting mechanism ensures that differences between individual chemotactic abilities are compensated by differences in the local steepness of the traveling gradient each individual must navigate, and determines the minimum performance required to travel with the band. By resolving conflicts between individuality and collective migration, this mechanism enables populations to maintain advantageous diversity while on the move.

How bacteria migrate collectively despite individual phenotypic variation is not understood. Here, the authors show that cells spontaneously sort themselves within moving bands such that variations in individual tumble bias, a determinant of gradient climbing speed, are compensated by the local gradient steepness experienced by individuals.

Copy Number Variations with Isolated Fetal Ventriculomegaly

BACKGROUND

Copy Number Variations (CNVs) are an important genetic cause of a number of neurodevelopmental disorders (NDs). However, the association between CNVs and the development and prognosis of fetal isolated mild ventriculomegaly (IMV) is unclear.

OBJECTIVES

To investigate possible associations between CNVs and the development of fetal IMV.

METHODS

This retrospective study recruited 154 subjects with ultrasound-confirmed fetal IMV and 190 subjects in a control cohort who underwent a high-risk prenatal serum screening program. The exclusion criteria included fetus G-banding chromosomal abnormality or positive fetus TORCH infection. DNA samples from all 344 fetuses were examined by an SNP-array. Developmental outcomes were assessed during postnatal follow-up.

RESULTS

Fourteen pathogenic CNVs (pCNVs) were identified in 13 out of 154 IMV fetuses. Three pCNVs were found in 3 out of 190 subjects in the prenatal screening high-risk cohort, with a significant difference (P value=0.016, X2 test). Notably, the 14 pCNVs detected in the IMV cohort were all associated with neurodevelopmental disorders (NDs), including autism, intellectual disability. Among the 13 IMV fetuses carrying pCNVs, five subjects were found in the postnatal follow-up to manifest NDs, including two with autism and three with mild neurodevelopmental delay. The other 8 subjects consisted of three normal infants younger than 12-months old, two lost in the follow-up, and three with the termination of pregnancy. Out of 141 IMV subjects without detectable pCNVs, 123 subjects showed normal development, 16 were lost in the follow-up, 2 subjects terminated the pregnancy due to fetal hydrocephalus or congenital heart disease in the late fetus development.

CONCLUSIONS

This study suggests an association between pCNVs and fetal IMV. pCNVs may be involved in the pathological process of fetal IMV and postnatal NDs. Identifying specific genomic alterations may provide an insight into pathogenetic mechanism and aid better diagnosis and prognosis of neurodevelopmental outcomes in fetal IMV.

Appropriate dose of Lactobacillus buchneri supplement improves intestinal microbiota and prevents diarrhoea in weaning Rex rabbits

This study examined the effects on intestinal microbiota and diarrhoea of Lactobacillus buchneri supplementation to the diet of weaning Rex rabbits. To this end, rabbits were treated with L. buchneri at two different doses (LC: 104 cfu/g diet and HC: 105 cfu/g diet) for 4 weeks. PCR-DGGE was used to determine the diversity of the intestinal microbiota, while real-time PCR permitted the detection of individual bacterial species. ELISA and real-time PCR allowed the identification of numerous cytokines in the intestinal tissues. Zonula occludens-1, polymeric immunoglobulin receptor and immunoglobulin A genes were examined to evaluate intestinal barriers. Results showed that the biodiversity of the intestinal microbiota of weaning Rex rabbits improved in the whole tract of the treated groups. The abundance of most detected bacterial species was highly increased in the duodenum, jejunum and ileum after L. buchneri administration. The species abundance in the HC group was more increased than in the LC group when compared to the control. Although the abundance of Enterobacteriaceae exhibited a different pattern, Escherichia coli was inhibited in all treatment groups. Toll-like receptor (TLR)2 and TLR4 genes were down-regulated in all intestinal tissues as the microbiota changed. In the LC group, the secretion of the inflammatory cytokine tumour necrosis factor-α was reduced, the gene expression of the anti-inflammatory cytokine interleukin (IL)-4 was up-regulated and the expression of intestinal-barrier-related genes was enhanced. Conversely, IL-4 expression was increased and the expression of other tested genes did not change in the HC group. The beneficial effects of LC were greater than those of HC or the control in terms of improving the daily weight gain and survival rate of weaning Rex rabbits and reducing their diarrhoea rate. Therefore, 104 cfu/g L. buchneri treatment improved the microbiota of weaning Rex rabbits and prevented diarrhoea in these animals.

Abstract P4-04-03: Hyperactive FOXA1 activates super-enhancer-engaged HIF2α/EPAS1 to promote endocrine-resistant metastatic ER-positive breast cancer

Background: We have recently reported that acquired endocrine resistance (Endo-R) in multiple ER+ breast cancer (BC) Endo-R cell models is driven by high levels of FOXA1 (High-FOXA1), via gene amplification and/or overexpression (OE), leading to coordinated reprogramming of the FOXA1 genomic binding (cistrome) and transcriptome. Forced FOXA1 OE in parental (P) cells induced similar transcriptional reprogramming leading to Endo-R and metastasis. Recent clinical data showing enrichment of FOXA1 amplification in ER+ metastases further support the clinical importance of our findings. However, the molecular components and the mechanism of High-FOXA1-induced transcriptional reprogramming in Endo-R and metastasis are unknown.

Methods: High-FOXA1-containing MCF7 tamoxifen-resistant (TamR) and P/FOXA1-OE cells were used in this study. An integrative multi-OMICS approach was employed to analyze transcriptome (RNA-seq), FOXA1 cistrome, and histone H3K27 acetylation (ac) (ChIP-seq). Intersection of High-FOXA1-induced transcriptome and distinct FOXA1 cistrome-predicted genes defined a High-FOXA1 core gene signature (CGS). Gene Set Enrichment Analysis (GSEA) and Gene Ontology (GO) were used for functional annotation. Cell growth and migration/invasion were measured by a bright-field automated cell counter and Transwell insert system. Altered gene expression was measured by RT-qPCR. High-FOXA1 signaling inhibition included gene knockdown (siRNA) or pharmacologic blockade (the EPAS1 inhibitor PT2385). The predictive role of EPAS1 and the associated gene signature were analyzed using publicly available BC datasets.

Results: FOXA1 OE reprogrammed the FOXA1 cistrome in P cells to resemble that of the TamR cells. The FOXA1 cistrome was significantly correlated with the deposition of H3K27ac in TamR vs. P cells (P&lt;2.2e-16). Similarly, the differentially expressed genes in TamR vs. P cells were enriched for FOXA1 binding at enhancers demarcated by H3K27ac (P=8e-125). The FOXA1-CGS was linked to multiple metastasis-related GO terms including “hypoxia response”, enriched for the cancer secretome gene set (P=4.1e-16), and highly represented in the Endo-R transcriptome across our multiple cell models (MCF7, 600MPE, and CAMA1) (P&lt;0.01). Integrative analysis of H3K27ac-defined super-enhancers (SEs) and altered cistrome/transcriptome upon High-FOXA1 nominated EPAS1, a hypoxia-inducible transcription factor (TF), as a top candidate of SE-activated TFs amplifying High-FOXA1 signaling. EPAS1 blockade markedly repressed the secretome genes (e.g., IL8 and S100P) and cell migration and invasion in TamR cells. Primary ER+ tumors (TCGA) with high EPAS1 are enriched for a cancer secretome gene set (P=3e-4). High EPAS1 predicts poor distant metastasis-free survival in ER+ BC treated with endocrine therapy (P=.034).

Conclusions: High-FOXA1 induces transcriptional reprogramming by coordinating histone enhancer marks to activate EPAS1 via an SE mechanism, which in turn mediates transcriptional reprogramming, partly via inducing a pro-metastatic secretome, to promote Endo-R and metastasis. Targeting the High-FOXA1/EPAS1 axis to block transcriptional reprogramming may offer a new therapeutic strategy to prevent and treat Endo-R metastatic ER+ BC.

Citation Format: Fu X, Pereira R, De Angelis C, Veeraraghavan J, Shea MJ, Nanda S, Feng Q, Jeselsohn R, O'Malley BW, Brown M, Osborne CK, Schiff R. Hyperactive FOXA1 activates super-enhancer-engaged HIF2α/EPAS1 to promote endocrine-resistant metastatic ER-positive breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-04-03.

Abstract P4-03-05: AP-1 as a potential mediator of resistance to the cyclin-dependent kinase (CDK) 4/6-inhibitor palbociclib in ER-positive endocrine-resistant breast cancer

Background: The CDK4/6-inhibitor palbociclib (Palbo) in combination with endocrine therapy (ET) substantially improves progression-free survival compared to ET alone. However, almost all initial responders eventually develop resistance and relapse. Delineating the early adaptive signaling and the mechanisms underlying resistance to CDK4/6 inhibition is therefore crucial to identify new biomarkers and therapeutic targets to enhance the efficacy of Palbo and improve patient outcome.

Materials and Methods: MCF7 parental (P) cells and derivative lines made resistant (R) to tamoxifen (TamR), estrogen deprivation (EDR), or fulvestrant (FulR) were used. The MCF7P line and its endocrine-R (EndoR) derivatives were exposed to increasing concentrations of Palbo to generate acquired Palbo-R (PDR) models. The proteomic/signaling profiles of P and EndoR cells upon short-term Palbo treatment and as PDR develops were determined using reverse-phase protein arrays (RPPA). Transcriptional activity of the activator protein-1 (AP-1) transcription factor (TF) was measured by luciferase reporter assay. Global AP-1 blockade was achieved using a pINDUCER system to express doxycycline (Dox)-inducible dominant-negative (DN) c-Jun that lacks the transcriptional activation domain. Cell growth and colony formation were assessed using methylene blue staining and clonogenic assays, respectively. Levels of phosphorylated (p)-RB and CDK2 were assessed by Western Blot.

Results: In P and all EndoR cell models, Palbo inhibited cell growth and colony formation in a dose-dependent manner, though the inhibitory effect was greater in the EndoR cells compared to P cells [IC50 value of P cells &gt;3 times that of EndoR lines (p&lt;0.001); clonogenic % inhibition at 100nM = 54 in P and &gt;85 in EndoR lines (p&lt;0.001)]. Across the P and all EndoR models, short-term Palbo treatment resulted in increased levels of several membrane and intracellular signaling molecules, TFs, and enzymes. Among these, the AP-1 TF components c-Jun and p-c-Jun showed the highest increase across all models, with the utmost change observed in the TamR model (Fold-change = 4.4, 4.0 for total and p-c-Jun, respectively). Since we also observed that acquired resistance to Palbo in the TamR model was associated with higher AP-1 transcriptional activity and increased total and p-c-Fos levels, we assessed the efficacy of combining Palbo with AP-1 blockade in the TamR model. In two independent TamR clones ectopically expressing inducible DN-c-Jun, AP-1 blockade (+Dox) in combination with Palbo was highly effective in inhibiting cell growth and reducing p-RB and CDK2 levels compared to single agent treatments. In addition, in both the TamR/DN-c-Jun-expressing clones, the combination of Palbo, AP-1 blockade, and fulvestrant resulted in cell death and a significantly greater cell growth inhibition compared to any dual or mono treatments.

Conclusion: Our results suggest activation of AP-1 as a potential mechanism of resistance to Palbo in ER+ EndoR models. Transcriptomic profiling of the Palbo-sensitive and R cells, currently underway, will provide an in-depth understanding of the role of AP-1 as well as other key targets and associated molecular mechanisms in Palbo resistance.

Citation Format: De Angelis C, Nardone A, Cataldo ML, Veeraraghavan J, Fu X, Giuliano M, Malorni L, Jeselsohn R, Osborne KC, Schiff R. AP-1 as a potential mediator of resistance to the cyclin-dependent kinase (CDK) 4/6-inhibitor palbociclib in ER-positive endocrine-resistant breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-03-05.

Enhanced Cardiac S100A1 Expression Improves Recovery from Global Ischemia-Reperfusion Injury

Gene-targeted therapy with the inotropic Ca2 + -sensor protein S100A1 rescues contractile function in post-ischemic heart failure and is being developed towards clinical trials. Its proven beneficial effect on cardiac metabolism and mitochondrial function suggests a cardioprotective effect of S100A1 in myocardial ischemia-reperfusion injury (IRI). Fivefold cardiomyocyte-specific S100A1 overexpressing, isolated rat hearts perfused in working mode were subjected to 28 min ischemia (37 °C) followed by 60 min reperfusion. S100A1 overexpressing hearts showed superior hemodynamic recover: Left ventricular pressure recovered to 57 ± 7.3% of baseline compared to 51 ± 4.6% in control (p = 0.025), this effect mirrored in LV work and dP/dt(max). Troponin T and lactate dehydrogenase was decreased in the S100A1 group, as well as FoxO pro-apoptotic transcription factor, indicating less tissue necrosis, whereas phosphocreatine content was higher after reperfusion. This is the first report of a cardioprotective effect of S100A1 overexpression in a global IRI model.

Enhanced diabetic wound healing by electrospun core–sheath fibers loaded with dimethyloxalylglycine

DMOG-loaded nanofibrous wound dressings enhanced diabetic wound healing by stabilizing HIF-1α.

[Research Progress of Sudden Cardiac Death in Forensic Medicine]

Sudden death （SD） is a special kind of death owing to disease, which severely threatening the lives of community population. As the most common type of SD, sudden cardiac death （SCD） has always been a crucial content of identification and research in forensic pathology. This article reviews the research progress from the aspects of epidemiology, morphology, molecular pathology and virtual anatomy of SCD in forensic medicine, so as to provide a reference for the morphological identification, determination of cause of death, and integrated control of this kind of SD.

Insights into the epidemic characteristics and evolutionary history of the novel porcine circovirus type 3 in southern China

Porcine circovirus type 3 (PCV3) is a newly identified circovirus from swine in the USA, China and Poland. This novel circovirus has been associated with porcine dermatitis and nephropathy syndrome (PDNS), reproductive failure and multisystemic inflammation; moreover, PCV3 poses a potential threat to the swine industry. In this retrospective study, a phylogenetic analysis was conducted to address the epidemiology and evolutionary dynamics of this novel circovirus. The total positive sample rate of PCV3 was 26.7% (76/285) and has increased gradually over the past 3 years. Of these PCV3-positive samples, 22.3% (17/76) were coinfected with PCV2. PCV3 can be detected in multiple sample types with different positive rates, and the positive rate is highest among stillborn. We also divide PCV3 into three clades (PCV3a, PCV3b and PCV3c) based on two amino acid mutations (A24V and R27K) on the cap protein in this study. In addition, the origin of PCV3 was approximately 1966 and may have originated from a bat-associated circovirus. Our results suggested that PCV3 is widely distributed in southern China and has been circulating in swine herds for nearly half a century. PCV3 has evolved into different clades caused by mutations in cap proteins; thus, further research on PCV3 epidemiology should be conducted.