Large Tumor Size is an Indicator for the Timely Administration of Adjuvant Radiotherapy in Luminal Breast Cancer with Positive Lymph Node

Purpose

The optimum timing of adjuvant radiotherapy for breast cancer patients who had undergone surgery remains unclear. The present study aimed to identify the clinical factors which could assist the selecting of time interval (TI) between surgery and adjuvant radiotherapy in luminal breast cancer with lymph node metastasis.

Patients and Methods

This retrospective study included 1054 luminal breast cancer patients with lymph node metastasis, diagnosed between May 2004 and December 2014, and treated with surgery followed by adjuvant therapy. Overall survival (OS) and disease-free survival (DFS) were compared between patients in the short and long TI groups. Multivariate analysis was performed to examine clinical factors associated with DFS. Subgroups analysis was further performed based on the significant predictors of DFS to explore the association of TI and tumor prognosis.

Results

For the whole group of patients, there was no difference in OS and DFS between patients with long and short TI. Multivariate analysis showed that age, N stage and tumor size were significant predictors of DFS. Subgroup analysis demonstrated that neither age nor N stage were informative in TI selection; in contrast, in patients with large tumors, a short TI was associated with better DFS than a long TI. In patients with small tumors, there was no significant association between TI and tumor prognosis. In the multivariable analysis, TI was independent predictor of DFS and local recurrence-free survival in patients with large tumors.

Conclusion

Large tumor size is an indicator for the timely administration of adjuvant radiotherapy in luminal breast cancer with positive lymph node.

[Effects of hnRNP E1 on expression of early genes E2, E6 of HPV16 and biological function in cervical cancer cells]

Objective: To explore the effects of hnRNP E1 on the expression of early genes E2, E6 of HPV16 and the biological function in cervical cancer SiHa cell lines. Methods: The cell experiments in vitro were carried out in cervical cancer cell lines SiHa. The expression levels of E2, E6 mRNA and protein of HPV16 were detected by Real-time PCR and Western blot, respectively, before and after up-regulating hnRNP E1. Meanwhile, the cell proliferation, cycle and apoptosis were evaluated by CCK-8 and flow cytometry. Data analyses were performed using SPSS 22.0 and Graphpad Prism 7.0 software. Results: Compared with the blank and the blank plasmid group, the cells activity and proliferation decreased at 24, 48 and 72 h after up-regulating hnRNP E1 (P<0.05), while the percentage of cells in G0/G1 phase increased and the percentage in S and G2/M phase and proliferation index decreased (P<0.05). Moreover, the late apoptotic rate and the total apoptotic rate increased (P<0.05). The expression levels of E6 mRNA and protein of HPV16 in hnRNP E1 up-regulated group were significantly lower than that in both blank group and blank plasmid group, the differences were significant (P<0.05), showing the tendency of cells proliferation index decrease and total apoptotic rate increase with decreased HPV16 E6 expression. There were no significant differences in the expression of E2 mRNA of HPV16 among the three groups (P=0.427), and no E2 protein of HPV16 was detected. Conclusions: hnRNP E1 could inhibit the transcription and translation of E6 oncogene of HPV16 and further inhibit the proliferation and promote apoptosis of cervical cancer cells, suggesting that hnRNP E1 might be a potential target marker to prevent cervical lesions. But no association between hnRNP E1 and HPV16 E2 was found in SiHa cells.

Elongated axial length and myopia-related fundus changes associated with the Arg130Cys mutation in the LIM2 gene in four Chinese families with congenital cataracts

Background

Congenital cataract (CC) is a congenital abnormality characterized by lens opacity present at birth and is associated with highly heterogeneous clinical manifestations. Lens-specific integral membrane protein (LIM2) gene expression is localized to tight junctional domains of different lens fiber membranes. To date, only four mutations in LIM2 have been reported to be associated with congenital or presenile cataracts. Due to the rarity of variants detected in the gene, there is limited progress in understanding the correlation between the genotype and phenotype of patients with mutations in LIM2.

Methods

A total of four Chinese families with CCs were recruited for this study, including three families inheriting in an autosomal dominant (AD) pattern and one sporadic case. Genomic DNA was extracted from the leukocytes of peripheral blood collected from all available patients. Whole-exome sequencing (WES) was performed on all probands and at least one of their parents. Bioinformatics analysis was performed to evaluate the pathogenicity of the candidate variants. Exon 4 of LIM2 was amplified by polymerase chain reaction and directly sequenced. All patients underwent full ocular examinations. This was an observational study to explore the genotype-phenotype relationships in the four families with a common candidate variant.

Results

Various ocular phenotypes were detected in these families, mainly including CCs, elongated axial length, and myopia-related fundus changes. The LIM2 gene mutation, p.Arg130Cys, was detected in all patients. This was further confirmed by Sanger sequencing. The proportion of probands with this mutation in our CCs database was 3.1% (4/130), which indicated that this mutation appears to be a frequent cause of cataracts in the Han Chinese population. This variation has been reported by other investigators before and was correlated with isolated cataracts.

Conclusions

This is the first study that reports various ocular phenotypes associated with the p.Arg130Cys mutation in the LIM2 gene, which indicated the phenotypic heterogeneity of this gene. LIM2 might not only function as an integral membrane protein in lens fiber cells but also be associated with the axial development of the eyeball. Functional studies of the LIM2 gene are important and should receive more attention.

Effect of Composite Nanoparticle CeO₂ on Myocardial Ischemic Re-Infusion of Cardio Myocyte Apoptosis in Mouse

The myocardial I/R damage is very complicated. Apoptosis is considered to its a critical mechanism. During the cardiac muscle I/R process, oxygen-free radicals play a pivotal role. Arrhythmias, as well as enlargement of the area of myocardial infarction after cardiac muscle I/R process, are caused by adequate blast generated O^2- ion free radicals. During the ischemia-reperfusion process, a large amount of O^2- ion free radicals destroyed the cell structure, and it undergoes lipid peroxidation with unsaturated fatty acids that contain a large number of phospholipids in the cell membrane, causing membrane proteins such as ion channels and enzymes on the cell membrane. The activity of cell is reduced, which affects the function of cell membrane and organelle membrane, destroys its integrity and reduces fluidity.We observed the effects of cerium dioxide nanoparticles on glutathione peroxidase as well as superoxide dismutase, also propionate in myocardial tissue of I/R injury in the mouse. Its effects of malondialdehyde and apoptosis were explored to see its protective effect and to provide more preventive measures for ischemia-reperfusion injury.

[Relations of human papillomavirus infection, vaginal micro-environmental disorder with cervical lesion]

Objective: To study the relations of human papillomavirus (HPV) infection, vaginal micro-environmental disorder with cervical lesion. Methods: A total of 1 019 women including 623 with normal cervical (NC), 303 with low-grade cervical lesion (CIN Ⅰ) and 93 with high-grade cervical lesion (CIN Ⅱ/Ⅲ) were enrolled in this study from the communities in Shanxi province, China. Case-control method was adopted, with NC as the control group and CIN as the case group. Related information was collected including demographic characteristics and relevant factors related to cervical lesions. HPV genotypes were detected by flow-through hybridization technology. Vaginal pH was detected by the pH test paper. Vaginal H(2)O(2) was detected by the combined detection kit of aerobic vaginitis and bacterial vaginosis. Vaginal cleanliness was detected by smear method. Results: Data from the unconditional logistic regression analysis showed that HPV infection (CINⅠ: aOR=1.39, 95%CI: 1.01-1.90; CINⅡ/Ⅲ: aOR=11.74, 95%CI: 6.96-19.80), H(2)O(2) (CINⅠ: aOR=2.09, 95%CI: 1.47-2.98; CINⅡ/Ⅲ: aOR=4.12, 95%CI: 2.01-8.43), cleanliness (CIN Ⅱ/Ⅲ: aOR=2.62, 95%CI: 1.65-4.14), and composite indicators (CINⅠ: aOR=1.67, 95%CI: 1.24-2.25; CINⅡ/Ⅲ: aOR=4.24, 95%CI: 2.30-7.81) all had increased the risk of cervical lesion and the trend on the severity (P<0.001) of cervical lesions. Additionally, we observed a synergic effect between HPV infection and vaginal micro-environmental composite indicator in CINⅡ/Ⅲ. With or without HPV infection, the ORs value of CINⅠ caused by vaginal micro-environment disorder remained close. Conclusions: Results from our study revealed that vaginal micro-environmental composite indicator could increase the risk for cervical lesion, in particular with the high-grade ones which all posed stronger risks when combined with HPV infection. However, the role of vaginal micro-environment disorder in the occurrence of CIN Ⅰ should not be ignored.

Interleukin-1β Suppresses Gastrin via Primary Cilia and Induces Antral Hyperplasia

BACKGROUND & AIMS

Helicobacter pylori infection in humans typically begins with colonization of the gastric antrum. The initial Th1 response occasionally coincides with an increase in gastrin secretion. Subsequently, the gastritis segues to chronic atrophic gastritis, metaplasia, dysplasia and distal gastric cancer. Despite these well characterized clinical events, the link between inflammatory cytokines and non-cardia gastric cancer remains difficult to study in mouse models. Prior studies have demonstrated that overexpression of the Hedgehog (HH) effector GLI2 induces loss of gastrin (atrophy) and antral hyperplasia. To determine the link between specific cytokines, HH signaling and pre-neoplastic changes in the gastric antrum.

METHODS

Mouse lines were created to conditionally direct IL1β or IFN-γ to the antrum using the Gastrin-CreERT2 and Tet activator. Primary cilia, which transduces HH signaling, on G cells were disrupted by deleting the ciliary motor protein KIF3a. Phenotypic changes were assessed by histology and western blots. A subclone of GLUTag enteroendocrine cells selected for gastrin expression and the presence of primary cilia was treated with recombinant SHH, IL1β or IFN-γ with or without kif3a siRNA.

RESULTS

IFN-γ increased gastrin and induced antral hyperplasia. However, antral expression of IL1β suppressed tissue and serum gastrin, while also inducing antral hyperplasia. IFN-γ treatment of GLUTAg cells suppressed GLI2 and induced gastrin, without affecting cilia length. By contrast, IL1β treatment doubled primary cilia length, induced GLI2 and suppressed gastrin gene expression. Knocking down kif3a in GLUTAg cells mitigated SHH or IL1β suppression of gastrin.

CONCLUSIONS

Overexpression of IL1β in the antrum was sufficient to induce antral hyperplasia coincident with suppression of gastrin via primary cilia. ORCID: #0000-0002-6559-8184.

Baicalin attenuates endometritis in a rabbit model induced by infection with Escherichia coli and Staphylococcus aureus via NF-κB and JNK signaling pathways

In this study, a rabbit endometritis model was developed to study cow endometritis. In addition, the protective effects of baicalin (a flavonoid) against endometritis were investigated. Clinical symptoms, differential leukocyte counting, uterine secretion smear microscopy and chemical examination, urine testing, and signs of necropsy showed abnormal changes and inflammatory responses in the uterus of rabbits. Histopathological results revealed visible inflammatory exudates and blood spots between intercellular spaces which confirmed that the rabbit endometritis model was successfully developed. Most importantly, these inflammatory signs were partially attenuated with baicalin treatment. The data revealed that the increased body temperature and leukocyte cells, pus, and the detachment of epithelial cells were alleviated with baicalin administration in a dose-dependent manner. Histopathological tissue changes such as inflammatory cells infiltrates, hyperemia, hemorrhages, and shedding of epithelial cells were partially attenuated with baicalin treatment. In addition, the mRNA expression of inflammation-related genes (iNOS, IL-1β, TNF-α, IL-10, IL-4, and IL-6) was significantly altered in RAW264.7 cells after LPS treatment. Further, the phosphorylated protein expression of JNK, p65, and IκBα were significantly reduced with LPS treatment. Intriguingly, baicalin pretreatment reversed the alteration in mRNA expression of inflammation-related genes and significantly reduced the phosphorylation of JNK, p65, and IκBα. In summary, our results suggest that baicalin has protective effects on bacterial-induced endometritis in rabbits that involve the suppression of NF-κB and JNK signaling pathways and pro-inflammatory cytokines.

Sterol sulfate alleviates atherosclerosis via mediating hepatic cholesterol metabolism in ApoE-/- mice

Compared with terrestrial organisms, the sterols in sea cucumber exhibit a sulfate group at the C-3 position. Our previous study demonstrated that dietary sterol sulfate was superior to phytosterol in alleviating metabolic syndrome by ameliorating inflammation and mediating cholesterol metabolism in high-fat-high-fructose diet mice, which indicated its potential anti-atherosclerosis bioactivity. In the present study, administration with sea cucumber-derived sterol sulfate (SCS) significantly decreased the cholesterol level in oleic acid/palmitic acid-treated HepG2 cells, while no significant changes were observed in the triacylglycerol level. RNA-seq analysis showed that the metabolic changes were mostly attributed to the steroid biosynthesis pathway. ApoE-/- mice were used as an atherosclerosis model to further investigate the regulation of SCS on cholesterol metabolism. The results showed that SCS supplementation dramatically reduced atherosclerotic lesions by 45% and serum low-density lipoprotein cholesterol levels by 59% compared with the model group. Dietary SCS inhibited hepatic cholesterol synthesis via downregulating SREBP-2 and HMGCR. Meanwhile, SCS administration increased cholesterol uptake via enhancing the expression of Vldlr and Ldlr. Noticeably, SCS supplementation altered bile acid profiles in the liver, serum, gallbladder and feces, which might cause the activation of FXR in the liver. These findings provided new evidence about the high bioactivity of sterols with the sulfate group on atherosclerosis.

Neck Circumference Is Associated With Hyperuricemia in Women With Polycystic Ovary Syndrome

OBJECTIVE

To evaluate the association between neck circumference (NC) and hyperuricemia in women with polycystic ovary syndrome (PCOS).

METHODS

This is a cross-sectional study that recruited 601 women with PCOS from January 2018 to January 2021. PCOS was diagnosed according to the Rotterdam definition. Hyperuricemia was defined as serum uric acid level of at least 357 μmol/L.

RESULTS

PCOS females with hyperuricemia had significantly greater values of NC, body mass index (BMI), waist circumference (WC) and hip circumference (HC). NC was positively associated with serum uric acid levels, with a standardized regression coefficient of 0.34 after adjusting for confounding factors. Furthermore, logistic regression analysis showed that NC was significantly associated with an increased risk of hyperuricemia, with an adjusted odds ratio of 1.36. The associations between NC and serum uric acid levels were more considerable in those with medium/high BMI (BMI ≥ 21.63 kg/m²), all ranges of WC or medium/high HC (HC ≥ 90 cm). The optimal cut-off point of NC in predicting hyperuricemia was 32.0 cm (Youden index = 0.48), with the sensitivity and negative predictive value of 84.81% and 92.08%, respectively.

CONCLUSIONS

NC was positively correlated with serum uric acid levels and the prevalence of hyperuricemia in women with PCOS. Therefore, we suggest NC as a simple, novel, and reliable anthropometric measure to be used in the routine clinical assessment of women with PCOS to screen those at high risk of hyperuricemia.

Risk Factors for Subacute Thyroiditis Recurrence: A Systematic Review and Meta-Analysis of Cohort Studies

BACKGROUND

Subacute thyroiditis (SAT) is a self-limited inflammatory thyroid disease with recurring episodes. However, the results regarding the recurrence rate and risk factors for SAT are inconsistent. This meta-analysis aimed to summarize the evidence of the recurrence rate and the risk factors for SAT.

METHODS

The present study involved the performance of a systematic literature search of all English studies published in PubMed, Embase, Web of Science, and The Cochrane Library from inception to August 20, 2021. Cohort studies that reported the SAT recurrence rate and risk factors for recurrence were included. Two independent investigators extracted relevant information. Fixed- and random-effects models were used to pool effect sizes based on study heterogeneity.

RESULTS

Eighteen cohort studies were identified. The pooled findings showed that the recurrence rate was 12.0% (95% CI: 8.2%, 17.1%). The risk of recurrence in the glucocorticoids group was higher than that in the NSAIDs group (RR = 1.84, 95% CI: 1.04, 3.24). However, there was no significant difference in age or sex between the recurrence group and the non-recurrence group. Findings from one or two cohort studies also indicated that the copresence of HLA-B*18:01 and -B*35, the number of days required to taper prednisolone (PSL) to 5 mg/day, the duration of disease before treatment less than 30 days, the sialic acid level, or the TSH level at the termination of treatment and further extension of the hypoechoic area and increase in thyroid volume were related to the recurrence of SAT.

CONCLUSION

Recurrence was common in SAT patients. The present study indicated that glucocorticoid treatment was associated with a higher recurrence rate of SAT than NSAIDs treatment. The clinical implications of this association should be interpreted with caution, and further clinical trials on the long-term effects of different treatment strategies are needed.

Comparing the Performance of Different Instruments for Diagnosing Frailty and Predicting Adverse Outcomes among Elderly Patients with Gastric Cancer

OBJECTIVES

To examine the diagnostic performance of the Tilburg Frailty Indicator (TFI), 11-factor modified frailty index (mFI-11), and 5-factor modified frailty index (mFI-5) for frailty defined by Frailty Phenotype (FP), as well as to compare the predictive ability of TFI, mFI-11, and mFI-5 for adverse outcomes in hospital among elderly patients undergoing gastric cancer surgery.

DESIGN

A prospective cohort study.

SETTING

Hospitalization setting, Nanjing, China.

PARTICIPANTS

We recruited 259 elderly patients undergoing gastric cancer surgery from a tertiary hospital.

MEASUREMENTS

Frailty was assessed by the FP, TFI, mFI-11, and mFI-5 before surgery, respectively. The receiver operating characteristic (ROC) curves were plotted to compared the diagnostic performance of TFI, mFI-11, and mFI-5 using FP as the reference. ROC curves were used to examine the performance of TFI, mFI-11, and mFI-5 in predicting adverse outcomes. The area under the curve (AUC)>0.70 was regarded as an indicator of good performance.

RESULTS

The prevalence of frailty ranged from 8.5% (mFI-11) to 45.9% (TFI). The AUCs of TFI (AUC: 0.764, p<0.001) was significantly greater than that of mFI-11 (AUC: 0.600, p=0.033) and mFI-5 (AUC: 0.600, p=0.0311) in the detection of frailty defined by FP, with quite different sensitivity and specificity at their original cutoffs. TFI and mFI-11 both had statistically significant but similarly inadequate predictive accuracy for adverse outcomes in hospital, including total complications (AUCs: 0.618; 0.621), PLOS (AUCs: 0.593; 0.639), increased hospital costs (AUCs: 0.594; 0.624), and hypoproteinemia (AUCs: 0.573; 0.600). For the mFI-5, only the predictive ability for hypoproteinemia was statistically significant, with poor accuracy (AUC: 0.592, p<0.0055).

CONCLUSION

The TFI performed slightly better than mFI-11 and mFI-5 in our study. Moreover, future studies are needed to further determine an optimal frailty instrument with great diagnostic and predictive accuracy.

A Middle Eocene lowland humid subtropical "Shangri-La" ecosystem in central Tibet

Tibet's ancient topography and its role in climatic and biotic evolution remain speculative due to a paucity of quantitative surface-height measurements through time and space, and sparse fossil records. However, newly discovered fossils from a present elevation of ∼4,850 m in central Tibet improve substantially our knowledge of the ancient Tibetan environment. The 70 plant fossil taxa so far recovered include the first occurrences of several modern Asian lineages and represent a Middle Eocene (∼47 Mya) humid subtropical ecosystem. The fossils not only record the diverse composition of the ancient Tibetan biota, but also allow us to constrain the Middle Eocene land surface height in central Tibet to ∼1,500 ± 900 m, and quantify the prevailing thermal and hydrological regime. This "Shangri-La"-like ecosystem experienced monsoon seasonality with a mean annual temperature of ∼19 °C, and frosts were rare. It contained few Gondwanan taxa, yet was compositionally similar to contemporaneous floras in both North America and Europe. Our discovery quantifies a key part of Tibetan Paleogene topography and climate, and highlights the importance of Tibet in regard to the origin of modern Asian plant species and the evolution of global biodiversity.

Exploring the Relationship Between Psychiatric Traits and the Risk of Mouth Ulcers Using Bi-Directional Mendelian Randomization

Background

Although the association between mouth ulcers and psychiatric traits has been reported by observational studies, their causal relationship remains unclear. Mendelian randomization (MR), powered by large-scale genome-wide association studies (GWAS), provides an opportunity to clarify the causality between mouth ulcers and psychiatric traits.

Methods

We collected summary statistics of mouth ulcers (sample size n = 461,106) and 10 psychiatric traits from the largest publicly available GWAS on Europeans, including anxiety disorder (n = 83,566), attention deficit/hyperactivity disorder (n = 53,293), autism spectrum disorder (n = 46,350), bipolar disorder (n = 51,710), insomnia (n = 1,331,010), major depressive disorder (n = 480,359), mood instability (n = 363,705), neuroticism (n = 168,105), schizophrenia (n = 105,318), and subjective wellbeing (n = 388,538). We applied three two-sample bi-directional MR analysis methods, namely the Inverse Variance Weighted (IVW) method, the MR pleiotropy residual sum and outlier (MR-PRESSO) method, and the weighted median method, to assess the causal relationship between each psychiatric trait and mouth ulcers.

Results

We found significant effects of autism spectrum disorder, insomnia, major depressive disorder, and subjective wellbeing on mouth ulcers, with the corresponding odds ratio (OR) from the IVW method being 1.160 [95% confidence interval (CI): 1.066–1.261, P = 5.39 × 10^–4], 1.092 (1.062–1.122, P = 3.37 × 10^–10), 1.234 (1.134–1.342, P = 1.03 × 10^–6), and 0.703 (0.571–0.865, P = 8.97 × 10^–4), respectively. We also observed suggestive evidence for mood instability to cause mouth ulcers [IVW, OR = 1.662 (1.059–2.609), P = 0.027]. These results were robust to weak instrument bias and heterogeneity. We found no evidence on causal effects between other psychiatric traits and mouth ulcers, in either direction.

Conclusion

Our findings suggest a protective effect of subjective wellbeing and risk effects of autism spectrum disorder, insomnia, major depressive disorder, and mood instability on mouth ulcers. These results clarify the causal relationship between psychiatric traits and the development of mouth ulcers.

Brachytherapy-based radiotherapy is associated with improved survival for newly diagnosed metastatic cervical cancer

PURPOSE

The purpose of this study was to explore the value of brachytherapy (BT) in metastatic cervical cancer, as it has not been well evaluated before.

METHODS AND MATERIALS

We analyzed 2391 patients with Stage IVB cervical cancer from 2004 to 2015 by using data from the Surveillance, Epidemiology, and End Results registry. The parameters were analyzed by Kaplan-Meier and Cox proportional hazards regression models to evaluate cancer-specific survival (CSS) and overall survival.

RESULTS

In general, both univariate and multivariate analysis showed that age, histologic type, tumor size, and chemotherapy were associated with CSS and overall survival (p < 0.05). Further subgroup analysis showed BT alone or BT combined with external beam radiotherapy improved CSS despite the tumor size. In addition, chemotherapy and chemoradiotherapy prolonged CSS compared with external beam radiotherapy alone or no chemotherapy or radiotherapy independently of tumor size (p < 0.05).

CONCLUSIONS

For newly diagnosed metastatic cervical cancers, BT with or without external beam radiotherapy is associated with improved survival. As an aggressive option, chemoradiotherapy is also a potential treatment strategy.

Thermally Triggered, Cell-Specific Enzymatic Glyco-Editing: In Situ Regulation of Lectin Recognition and Immune Response on Target Cells

In situ glyco-editing on the cell surface can endow cellular glycoforms with new structures and properties; however, the lack of cell specificity and dependence on cells' endogenous functions plague the revelation of cellular glycan recognition properties and hamper the application of glyco-editing in complicated authentic biosystems. Herein, we develop a thermally triggered, cell-specific glyco-editing method for regulation of lectin recognition on target live cells in both single- and cocultured settings. The method relies on the aptamer-mediated anchoring of microgel-encapsulated neuraminidase on target cells and subsequent thermally triggered enzyme release for localized sialic acid (Sia) trimming. This temperature-based enzyme accessibility modulation strategy exempts genetic or metabolic engineering operations and, thus for the first time, enables tumor-specific desialylation on complicated tissue slices. The proposed method also provides an unprecedented opportunity to potentiate the innate immune response of natural killer cells toward target tumor cells through thermally triggered cell-specific desialylation, which paves the way for in vivo glycoimmune-checkpoint-targeted cancer therapeutic intervention.

Coverage determinants of breast cancer screening in Flanders: an evaluation of the past decade

Background

Breast cancer (BC) is the most common cancer in women in the developed world. In order to find developing cancers in an early stage, BC screening is commonly used. In Flanders, screening is performed in and outside an organized breast cancer screening program (BCSP). However, the determinants of BC screening coverage for both screening strategies are yet unknown.

Objective

To assess the determinants of BC screening coverage in Flanders.

Methods

Reimbursement data were used to attribute a screening status to each woman in the target population for the years 2008–2016. Yearly coverage data were categorized as screening inside or outside BCSP or no screening. Data were clustered by municipality level. A generalized linear equation model was used to assess the determinants of screening type.

Results

Over all years and municipalities, the median screening coverage rate inside and outside BCSP was 48.40% (IQR: 41.50–54.40%) and 14.10% (IQR: 9.80–19.80%) respectively. A higher coverage rate outside BSCP was statistically significantly (P < 0.001) associated with more crowded households (OR: 3.797, 95% CI: 3.199–4.508), younger age, higher population densities (OR: 2.528, 95% CI: 2.455–2.606), a lower proportion of unemployed job seekers (OR: 0.641, 95% CI: 0.624–0.658) and lower use of dental care (OR: 0.969, 95% CI: 0.967–0.972).

Conclusion

Coverage rate of BC screening is not optimal in Flanders. Women with low SES that are characterized by younger age, living in a high population density area, living in crowded households, or having low dental care are less likely to be screened for BC in Flanders. If screened, they are more likely to be screened outside the BCSP.

Modelling the initial epidemic trends of COVID-19 in Italy, Spain, Germany, and France

The Coronavirus Disease 2019 (COVID-19) has fast spread to over 200 countries and regions worldwide since its outbreak, while in March, Europe became the emerging epicentre. In this study, we aimed to model the epidemic trends and estimate the essential epidemic features of COVID-19 in Italy, Spain, Germany, and France at the initial stage. The numbers of daily confirmed cases and total confirmed cases were extracted from the Coronavirus disease (COVID-19) situation reports of WHO. We applied an extended Susceptible-Exposed-Infectious-Removed (SEIR) model to fit the epidemic trend and estimated corresponding epidemic features. The transmission rate estimates were 1.67 (95% credible interval (CrI), 1.64-1.71), 2.83 (2.72-2.85), 1.91 (1.84-1.98), and 1.89 (1.82-1.96) for Italy, Spain, Germany, and France, corresponding to the basic reproduction numbers (R0) 3.44 (3.35-3.54), 6.25 (5.97-6.55), 4.03 (3.84-4.23), and 4.00 (3.82-4.19), respectively. We found Spain had the lowest ascertainment rate of 0.22 (0.19-0.25), followed by France, Germany, and Italy of 0.45 (0.40-0.50), 0.46 (0.40-0.52), and 0.59 (0.55-0.64). The peaks of daily new confirmed cases would reach on April 16, April 5, April 21, and April 19 for Italy, Spain, Germany, and France if no action was taken by the authorities. Given the high transmissibility and high covertness of COVID-19, strict countermeasures, such as national lockdown and social distancing, were essential to be implemented to reduce the spread of the disease.

Prevalence and risk factors of myopic maculopathy: a cross-sectional study in Han and Uygur adults in Xinjiang, China

OBJECTIVES

To estimate the prevalence, ethnic differences and associated risk factors of myopic maculopathy in Han and Uygur adults in Xinjiang, China.

DESIGN AND SETTING

A cross-sectional study with multistage, stratified cluster sampling method was conducted in Xinjiang, China.

PARTICIPANTS

A total of 4023 Han and Uygur participants aged 40 years and older were eligible for the study.

OUTCOME MEASURES

The association between myopic maculopathy and its risk factors was screened using the generalised estimating equation (GEE) model. We also investigated whether ethnic differences exist between Han and Uygur populations affected by myopic maculopathy. Myopic maculopathy was defined in accordance with International Photographic Classification and Grading System for Myopic Maculopathy.

RESULTS

A total of 3044 subjects (5946 eyes) were included in our study (1736 Han and 1308 Uygur individuals). The participants consisted of 1256 (41.3%) men and 1788 (58.7%) women. The average age was 52.2±9.4 years, and the mean spherical equivalent (SE) was -0.18±2.31 dioptre (D). Myopic maculopathy was detected in 198 eyes of 138 participants. The age-adjusted prevalence of myopic maculopathy reached 5.8% (95% CI 4.8 to 6.8). In the GEE model, myopic maculopathy was significantly associated with old age (per year; OR: 1.16; 95% CI 1.13 to 1.19; p<0.001) and myopic SE (per -1 D; OR: 1.48; 95% CI 1.40 to 1.56; p<0.001). No ethnic differences were detected between Han (98, 5.7%) and Uygur population (40, 3.1%) in terms of the prevalence of myopic maculopathy (OR=0.89; 95% CI 0.53 to 1.48; p=0.64). Neither urbanisation (p=0.38) nor the level of education (p=0.92) was associated with myopic maculopathy.

CONCLUSIONS

A high age-adjusted prevalence of myopic maculopathy was observed in Han and Uygur populations in Xinjiang, China. Old age and high degree of myopic refraction were independent risk factors for myopic maculopathy. No ethnic differences were detected in Han and Uygur populations affected by myopic maculopathy.

Visceral Adiposity and High Intramuscular Fat Deposition Independently Predict Critical Illness in Patients with SARS-CoV-2

OBJECTIVE

This study aimed to assess the association between adipose tissue distribution and severity of clinical course in patients with severe acute respiratory syndrome coronavirus 2.

METHODS

For this retrospective study, 143 hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) who underwent an unenhanced abdominal computed tomography (CT) scan between January 1, 2020, and March 30, 2020, were included. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with the severity of COVID-19 infection.

RESULTS

There were 45 patients who were identified as critically ill. High visceral to subcutaneous adipose tissue area ratio (called visceral adiposity) (odds ratio: 2.47; 95% CI: 1.05-5.98, P = 0.040) and low mean attenuation of skeletal muscle (called high intramuscular fat [IMF] deposition) (odds ratio: 11.90; 95% CI: 4.50-36.14; P < 0.001) were independent risk factors for critical illness. Furthermore, visceral adiposity or high IMF deposition increased the risk of mechanical ventilation (P = 0.013, P < 0.001, respectively). High IMF deposition increased the risk of death (P = 0.012).

CONCLUSIONS

COVID-19 patients with visceral adiposity or high IMF deposition have higher risk for critical illness. Therefore, patients with abdominal obesity should be monitored more carefully when hospitalized.

Schistosomiasis with Duodenal Involvement Presenting as Irritable Bowel Syndrome in a 9-Year-Old Patient

Introduction/Objective

Schistosomiasis is extremely rare in the United States. Most patients diagnosed in the US have an international travel history or recently immigrated from endemic areas. We report a case of a 9-year-old boy who presented with a three-month history of daily abdominal pain, decreased appetite, weight loss, and microcytic anemia. The patient had alternating symptoms of constipation and diarrhea mimicking Irritable Bowel Syndrome (IBS).

Methods

CT scans showed distal sigmoid colon with wall thickening and hyperenhancement. Stool Helicobacter pylori antigen test was positive and hemoglobin levels were low (11 g/dL). The blood eosinophil count was initially within the normal range but was significantly elevated three months later (2,115 cells/µL).

Esophagogastroduodenoscopy and colonoscopy were performed, which showed patchy areas of erythema and punctate bleeding within the descending and sigmoid colon.

Results

Gastrointestinal tract biopsies revealed focal, prominent eosinophilic infiltrates in the lamina propria. There were multifocal granulomas and fibrosis surrounding Schistosoma ova in the lamina propria and submucosa of duodenum, cecum, colon, and rectum. Acid-fast stain highlights the shell and spine of the ova. A retrospective chart review revealed that the patient had traveled to Yemen one month before the onset of symptoms. Schistosomiasis is among the top differentials for marked, sustained eosinophilia, especially with relevant travel history. Distortions caused by processing and sectioning can make speciation difficult on tissue sections. Acid-fast staining of the shell would favor S. mansoni over S. intercalatum; however, the S. intercalatum-S. hematobium hybrid also has an acid fast–positive shell. The duodenum is an uncommon location to find Schistosoma ova, which are usually found in the rectum and sigmoid colon.

Conclusion

The symptoms of gastrointestinal schistosomiasis may mimic IBS, and eosinophilia may initially be not evident as in this case. However, a high degree of suspicion is required in diagnosing schistosomiasis in patients from endemic areas.

Identification of Lupus Podocytopathy with Coexistent Glomerular Diseases – A Case Report

Introduction/Objective

Lupus podocytopathy (LP), featured by nephrotic syndrome, is a unique subtype of lupus nephritis that mimics minimal change disease or primary focal segmental glomerulosclerosis (FSGS) on renal biopsy with diffuse podocyte foot process effacement and no capillary-loop immune deposits. LP usually presents on a background of ISN/RPS class I or class II lupus nephritis, and very rarely may present without immune deposits.

Diagnosis of LP, when confounded by other glomerular diseases associated with nephrotic syndrome, can be very challenging and requires thorough clinical and pathology correlations.

Methods

Here we report a case of LP in a patient with nephrotic syndrome and multiple comorbidities affecting kidneys. A 24-year-old female with type-I diabetes, psoriasis, and intermittent arthritis/rash of unknown etiology, presented with abrupt onset of nephrotic proteinuria attributed to recent low dose prednisone therapy, and renal insufficiency. A renal biopsy showed nodular glomerulosclerosis and FSGS. No immune deposits were identified by immunofluorescence or electron microscopy. Ultrastructurally there was also diffuse glomerular basement membrane thickening and over 90% podocyte foot process effacement. With no established systemic lupus erythematosus (SLE), the case was initially diagnosed as diabetic nephropathy with coexistent FSGS as the etiologies for nephrotic proteinuria, and the patient was put on ACEI and diuretics. However, massive proteinuria persisted, and the patient also developed pancytopenia. Serology concurrent with the biopsy came out later showing positive autoantibodies against dsDNA, Smith, and Histone. With continued worsening of creatinine, a renal biopsy was repeated revealing essentially similar findings to the first biopsy.

Results

Integrating the serology results and clinical presentation, SLE was favored. The pathology findings were re- evaluated and considered to be most consistent with LP and coexistent diabetic nephropathy, with FSGS either a component of LP or an independent lesion secondary to diabetes or hypertension. The patient was started with high dose prednisone at 60 mg/day. One month later, her proteinuria, serum creatinine, pancytopenia, skin rash, and arthritis were all significantly improved.

Conclusion

LP can be easily masked by coexistent glomerular diseases. Sufficient awareness of the entity is necessary for the appropriate diagnosis and treatment.

A Rare Case Of Kikuchi-Fujimoto Disease Displaying Chromosomal Abnormality

Introduction/Objective

Histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease (KFD), is a rare and benign self-limiting process primarily affecting 20~35-year-old Asian women with spontaneous remission after weeks to months of illness. Although the involvement of T cell-mediated immune response, infections, and HLA class II gene have been proposed as possible etiologies, the detailed pathogenesis has not been elucidated. Very few literatures exhibited KFD displaying chromosomal abnormality such as t(2:16).

Methods

Here, we report a rare case of KFD with novel karyotype abnormalities in a 24-year-old African American male. It presented as painless cervical lymphadenopathy for one month without fever, night sweats, or weight loss. An excisional biopsy of the lymph node (LN) was performed.

Results

Tissue culture for bacteria and flow cytometry of the LN were negative. Histopathology revealed numerous pale circumscribed foci composed of lymphocytes, histiocytes, plasmacytoid dendritic cells, and abundant karyorrhectic debris in the background of coagulative necrosis. No neutrophils or hematoxylin bodies are seen.

Immunohistochemical studies showed CD3+/CD4+ T lymphocytes, CD68+ histiocytes, and CD123+ plasmacytoid dendritic cells. Abnormal karyotype was observed as: 46, XY, del(6) (q?16q?22).

Conclusion

We present this case to demonstrate that 1. Although KFD is most prevalent in young Asian females, it may occur in both genders and other ethnical groups and perhaps represents an underdiagnosed process. 2. KFD can mimic a variety of diseases such as rheumatologic, infectious, and hematologic malignancies; a thorough workup including serology, culture, and flow cytometry is needed to exclude serious diseases such as systemic lupus erythematosus and malignancy to render an early diagnosis which may avoid unnecessary diagnostic and therapeutic interventions. 3. Cytogenic abnormalities, although observed in many malignancies, should not be used as a sole determinant of malignancy, and the interpretation needs to be in a relevant clinical and histopathological context in a multidisciplinary setting to avoid misdiagnosis and inappropriate treatment.

Pathogenic mutations reveal a role of RECQ4 in mitochondrial RNA:DNA hybrid formation and resolution

The synthesis of mitochondrial DNA (mtDNA) is a complex process that involves the formation and resolution of unusual nucleic acid structures, such as RNA:DNA hybrids. However, little is known about the enzymes that regulate these processes. RECQ4 is a DNA replication factor important for mtDNA maintenance, and here, we unveil a role of human RECQ4 in regulating the formation and resolution of mitochondrial RNA:DNA hybrids. Mitochondrial membrane protein p32 can block mtDNA synthesis by restricting RECQ4 mitochondrial localization via protein–protein interaction. We found that the interaction with p32 was disrupted not only by the previously reported cancer-associated RECQ4 mutation, del(A420-A463), but also by a clinical mutation of the adjacent residue, P466L. Surprisingly, although P466L mutant was present in the mitochondria at greater levels, unlike del(A420-A463) mutant, it failed to enhance mtDNA synthesis due to the accumulation of RNA:DNA hybrids throughout the mtDNA. Biochemical analysis revealed that P466L mutation enhanced RECQ4 annealing activity to generate RNA:DNA hybrids at the same time reduced its unwinding activity to resolve this structure. Hence, P466L mutation led to a reduced efficiency in completing mtDNA synthesis due to unresolved RNA:DNA hybrids across mtDNA.

MiR-652-3p promotes bladder cancer migration and invasion by targeting KCNN3

OBJECTIVE

Increasing evidence indicated that microRNAs (miRNAs) are crucial regulators for cancer development. Bladder cancer (BCa) is a major threat to human health. The aim of this study was to analyze the roles of miR-652-3p in BCa, and to explore the associated mechanisms.

MATERIALS AND METHODS

MiR-652-3p expression in BCa cell lines was explored using Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) method. MiR-652-3p expression level in BCa tissues was explored at StarBase. Cell Counting Kit-8 (CCK-8) assay, wound-healing assay, and transwell invasion assay were conducted to investigate the biological roles of miR-652-3p. The underlying mechanisms of miR-652-3p in NSCLC were investigated using luciferase activity reporter assay and rescue experiments.

RESULTS

We showed that miR-652-3p expression level was upregulated in both BCa tissues and cell lines. The knockdown of miR-652-3p significantly inhibited BCa cell proliferation, migration, and invasion in vitro. Moreover, we showed that potassium intermediate/small conductance calcium-activated channel, subfamily N, member 3 (KCNN3) was a functional target for miR-652-3p. Besides, the expression of KCNN3 in BCa tissues was negatively correlated with miR-652-3p.

CONCLUSIONS

Collectively, these results showed that miR-652-3p could promote BCa cell proliferation, migration, and invasion via directly regulating KCNN3, which may provide a novel therapeutic target for BCa treatment.

MiR130b from Schlafen4+ MDSCs stimulates epithelial proliferation and correlates with preneoplastic changes prior to gastric cancer

The myeloid differentiation factor Schlafen4 (Slfn4) marks a subset of myeloid-derived suppressor cells (MDSCs) in the stomach during Helicobacter-induced spasmolytic polypeptide-expressing metaplasia (SPEM).

OBJECTIVE

To identify the gene products expressed by Slfn4⁺-MDSCs and to determine how they promote SPEM.

DESIGN

We performed transcriptome analyses for both coding genes (mRNA by RNA-Seq) and non-coding genes (microRNAs using NanoString nCounter) using flow-sorted SLFN4⁺ and SLFN4^- cells from Helicobacter-infected mice exhibiting metaplasia at 6 months postinfection. Thioglycollate-elicited myeloid cells from the peritoneum were cultured and treated with IFNα to induce the T cell suppressor phenotype, expression of MIR130b and SLFN4. MIR130b expression in human gastric tissue including gastric cancer and patient sera was determined by qPCR and in situ hybridisation. Knockdown of MiR130b in vivo in Helicobacter-infected mice was performed using Invivofectamine. Organoids from primary gastric cancers were used to generate xenografts. ChIP assay and Western blots were performed to demonstrate NFκb p65 activation by MIR130b.

RESULTS

MicroRNA analysis identified an increase in MiR130b in gastric SLFN4⁺ cells. Moreover, MIR130b colocalised with SLFN12L, a human homologue of SLFN4, in gastric cancers. MiR130b was required for the T-cell suppressor phenotype exhibited by the SLFN4⁺ cells and promoted Helicobacter-induced metaplasia. Treating gastric organoids with the MIR130b mimic induced epithelial cell proliferation and promoted xenograft tumour growth.

CONCLUSION

Taken together, MiR130b plays an essential role in MDSC function and supports metaplastic transformation.

Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

BACKGROUND

Perioperative neurocognitive disorders (PND) is a common postoperative complication including postoperative delirium (POD), postoperative cognitive decline (POCD) or delayed neurocognitive recovery. It is still controversial whether the use of intraoperative cerebral function monitoring can decrease the incidence of PND. The purpose of this study was to evaluate the effects of different cerebral function monitoring (electroencephalography (EEG) and regional cerebral oxygen saturation (rSO2) monitoring) on PND based on the data from randomized controlled trials (RCTs).

METHODS

The electronic databases of Ovid MEDLINE, PubMed, EMBASE, Cochrane Library database were systematically searched using the indicated keywords from their inception to April 2020. The odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were employed to analyze the data. Heterogeneity across analyzed studies was assessed with chi-square test and I2 test.

RESULTS

Twenty two RCTs with 6356 patients were included in the final analysis. Data from 12 studies including 4976 patients were analyzed to assess the association between the EEG-guided anesthesia and PND. The results showed that EEG-guided anesthesia could reduce the incidence of POD in patients undergoing non-cardiac surgery (OR: 0.73; 95% CI: 0.57-0.95; P = 0.02), but had no effect on patients undergoing cardiac surgery (OR: 0.44; 95% CI: 0.05-3.54; P = 0.44). The use of intraoperative EEG monitoring reduced the incidence of POCD up to 3 months after the surgery (OR: 0.69; 95% CI: 0.49-0.96; P = 0.03), but the incidence of early POCD remained unaffected (OR: 0.61; 95% CI: 0.35-1.07; P = 0.09). The remaining 10 studies compared the effect of rSO2 monitoring to routine care in a total of 1380 participants on the incidence of PND. The results indicated that intraoperative monitoring of rSO2 could reduce the incidence of POCD (OR 0.53, 95% CI 0.39-0.73; P < 0.0001), whereas no significant difference was found regarding the incidence of POD (OR: 0.74; 95% CI: 0.48-1.14; P = 0.17).

CONCLUSIONS

The findings in the present study indicated that intraoperative use of EEG or/and rSO2 monitor could decrease the risk of PND.

TRIAL REGISTRATION

PROSPREO registration number: CRD42019130512 .

Identifying Risk Factors for Regional Recurrence in Early-Stage Breast Cancer with pT1-2 and Negative Sentinel Lymph Node Biopsy

Background

Due to the low rate of regional recurrence (RR) in early-stage breast cancer with pT1-2 and negative sentinel lymph node biopsy (SLNB), no regional therapy is suggested for them. However, whether there is a subset of patients who were with high risk of regional failure and may benefit from regional treatment is still unknown. The current study was designed to identify the patients with high risk of RR, thereby providing clues for enhanced regional therapy.

Methods

We analyzed a total of 1124 breast cancer patients with pT1-2N0 from May 2004 to Dec 2014. All the patients were treated with breast-conservation surgery (BCS) and adjuvant whole-breast radiotherapy. The regional recurrence-free survival (RRFS), local regional recurrence-free survival (LRRFS), disease-free survival (DFS) and overall survival (OS) were assessed by using the Kaplan–Meier method. Cox proportional hazards regression was performed to detect factors in predicting the RRFS.

Results

In multivariable analysis, both T stage and molecular type were significant predictors of RRFS. Patients with T2 stage had a lower RRFS than those with T1stage. Triple-negative patients were more likely to suffer regional failure than the patients with other molecular types. The two predictors were then employed to divide all the patients into three groups based on the risk level of RR. Patients with both T2 and triple-negative molecular type had the lower RRFS, LRRFS, DFS and OS than the patients with one or no risk factor.

Conclusion

For early-stage breast cancer patients with negative SLNB, those who were with both T2 stage and triple-negative molecular type had a high rate of RR and enhance regional therapy may be needed for them.

Gross Chromosomal Rearrangements in Kluyveromyces marxianus Revealed by Illumina and Oxford Nanopore Sequencing

Kluyveromyces marxianus (K. marxianus) is an increasingly popular industrially relevant yeast. It is known to possess a highly efficient non-homologous end joining (NHEJ) pathway that promotes random integration of non-homologous DNA fragments into its genome. The nature of the integration events was traditionally analyzed by Southern blot hybridization. However, the precise DNA sequence at the insertion sites were not fully explored. We transformed a PCR product of the Saccharomyces cerevisiae URA3 gene (ScURA3) into an uracil auxotroph K. marxianus otherwise wildtype strain and picked 24 stable Ura+ transformants for sequencing analysis. We took advantage of rapid advances in DNA sequencing technologies and developed a method using a combination of Illumina MiSeq and Oxford Nanopore sequencing. This approach enables us to uncover the gross chromosomal rearrangements (GCRs) that are associated with the ScURA3 random integration. Moreover, it will shine a light on understanding DNA repair mechanisms in eukaryotes, which could potentially provide insights for cancer research.

Sea cucumbers-derived sterol sulfate alleviates insulin resistance and inflammation in high-fat-high-fructose diet-induced obese mice

Sea cucumbers are widely consumed in traditional medicine and food. Sea cucumbers-derived sulfated sterol exhibits a sulfate group at C-3 position, which is different from phytosterol with a hydroxyl group. However, the effect of sterol sulfate on metabolic syndrome remains unknown. The purpose of the present study is to investigate the alleviation of sterol sulfate on high-fat-high-fructose diet (HFFD)-induced insulin resistance and inflammation. After 2 weeks feeding with HFFD, male C57BL/6J mice were continuously fed with HFFD plus 0.4 % (w/w) sterol sulfate or phytosterol for 6 weeks. The OGTT was carried out at 7 weeks. At the end of the experimental period, the changes of glycogen, circulating glucose, insulin, pro-inflammatory cytokine and adiponectin were measured. H&E staining was used to observe the morphological changes in adipose tissue. Furthermore, the underlying molecular mechanisms were investigated. Dietary sterol sulfate was superior to phytosterol in reducing body weight gain, adipocyte hypertrophy, and levels of circulating glucose and insulin, as well as increasing the glycogen content of tissues. Furthermore, sterol sulfate ameliorated insulin resistance mainly due to the inhibition of gluconeogenesis, the promotion of glycogen synthesis and GLUT4 translocation by activating PI3K/Akt signaling pathway. Additionally, sterol sulfate effectively attenuated inflammation by increasing serum adiponectin and reducing pro-inflammatory cytokine release. Sterol sulfate exhibited a more significant effect than phytosterol in alleviating HFFD -induced insulin resistance and inflammation, which might be closely related to the sulfate group. The results might provide insights into the prevention and alleviation of metabolic syndrome.

Rapid drift of the Tethyan Himalaya terrane before two-stage India-Asia collision

The India-Asia collision is an outstanding smoking gun in the study of continental collision dynamics. How and when the continental collision occurred remains a long-standing controversy. Here we present two new paleomagnetic data sets from rocks deposited on the distal part of the Indian passive margin, which indicate that the Tethyan Himalaya terrane was situated at a paleolatitude of ∼19.4°S at ∼75 Ma and moved rapidly northward to reach a paleolatitude of ∼13.7°N at ∼61 Ma. This implies that the Tethyan Himalaya terrane rifted from India after ∼75 Ma, generating the North India Sea. We document a new two-stage continental collision, first at ∼61 Ma between the Lhasa and Tethyan Himalaya terranes, and subsequently at ∼53−48 Ma between the Tethyan Himalaya terrane and India, diachronously closing the North India Sea from west to east. Our scenario matches the history of India-Asia convergence rates and reconciles multiple lines of geologic evidence for the collision.

Erratum: Evolution of π^{0} Suppression in Au+Au Collisions from sqrt[s_{NN}]=39 to 200 GeV [Phys. Rev. Lett. 109, 152301 (2012)]

This corrects the article DOI: 10.1103/PhysRevLett.109.152301.

Sarcomatoid Carcinoma in the Head and Neck: A Population-Based Analysis of Outcome and Survival

Objectives

To characterize sarcomatoid cell carcinoma (SaC) in head and neck, explore the value of radiotherapy (RT) and chemotherapy, and build a nomogram to predict the prognosis.

Study Design

Retrospective cohort study.

Methods

In total, 559 patients diagnosed with head and neck SaC from 2004 to 2015 were included from the Surveillance, Epidemiology, and End Results program. All the cases were divided into training (N = 313) and validation (N = 246) cohorts according to the year of diagnosis. The cases were analyzed on the age, site, sex, race, T stage, N stage, M stage, surgery, RT, and chemotherapy. Cancer‐specific survival (CSS) and overall survival (OS) were compared among disease‐related categories. The parameters significantly correlated with CSS were used to construct a nomogram.

Results

The multivariate analysis showed that age, T stage, N stage, and M stage were significantly correlated with CSS and OS. Overall, RT was correlated with improved CSS for Stage T3–4 and Stage N1–3. The subgroup analysis showed that RT was correlated with CSS in the Stage N1–3 patients after surgery while chemotherapy indicated an improved survival for Stage T3–4 and N1–3 patients without surgery. The prognostic nomogram was constructed and had a powerful discriminatory ability with the C‐index of CSS: 0.711.

Conclusion

Late‐stage head and neck SaC patients unfit for surgery need comprehensive treatment based on chemotherapy, and patients with node metastasis require adjuvant RT after surgery. Generally, RT might improve the survival of late‐stage patients. A reliable and powerful nomogram was established that can provide an individual prediction of CSS for head and neck SaC.

Level of Evidence

3 Laryngoscope, 131:E489–E499, 2021

Potential Difference Driving Electron Transfer via Defective Carbon Nanotubes toward Selective Oxidation of Organic Micropollutants

Nanocarbon-based persulfate oxidation emerges as a promising technology for the elimination of organic micropollutants (OMPs). However, the nature of the active site and its working mechanism remain elusive, impeding developments of high-performance oxidative technology for water treatment practice. Here, we report that defect-rich carbon nanotubes (CNTs) exhibit a superior activity in the activation of peroxymonosulfate (PMS) for OMP oxidation. Quantitative structure-activity relationship studies combined with theoretical calculations unveil that the double-vacancy defect on CNTs may be the intrinsic active site, which works as a conductive bridge to facilitate the potential difference-dominated electron transfer from the highest occupied molecular orbital of OMPs to the lowest unoccupied molecular orbital of PMS. Based on this unique mechanism, the established CNTs@PMS oxidative system achieves outstanding selectivity and realizes the target-oriented elimination of specific OMPs in a complicated aquatic environment. This work sheds new light on the mechanism of carbocatalysis for selective oxidation and develops an innovative technology toward remediation of practical wastewater.

Using off-target data from whole-exome sequencing to improve genotyping accuracy, association analysis and polygenic risk prediction

Whole-exome sequencing (WES) has been widely used to study the role of protein-coding variants in genetic diseases. Non-coding regions, typically covered by sparse off-target data, are often discarded by conventional WES analyses. Here, we develop a genotype calling pipeline named WEScall to analyse both target and off-target data. We leverage linkage disequilibrium shared within study samples and from an external reference panel to improve genotyping accuracy. In an application to WES of 2527 Chinese and Malays, WEScall can reduce the genotype discordance rate from 0.26% (SE= 6.4 × 10-6) to 0.08% (SE = 3.6 × 10-6) across 1.1 million single nucleotide polymorphisms (SNPs) in the deeply sequenced target regions. Furthermore, we obtain genotypes at 0.70% (SE = 3.0 × 10-6) discordance rate across 5.2 million off-target SNPs, which had ~1.2× mean sequencing depth. Using this dataset, we perform genome-wide association studies of 10 metabolic traits. Despite of our small sample size, we identify 10 loci at genome-wide significance (P < 5 × 10-8), including eight well-established loci. The two novel loci, both associated with glycated haemoglobin levels, are GPATCH8-SLC4A1 (rs369762319, P = 2.56 × 10-12) and ROR2 (rs1201042, P = 3.24 × 10-8). Finally, using summary statistics from UK Biobank and Biobank Japan, we show that polygenic risk prediction can be significantly improved for six out of nine traits by incorporating off-target data (P < 0.01). These results demonstrate WEScall as a useful tool to facilitate WES studies with decent amounts of off-target data.

Comprehensive plasma and tissue profiling reveals systemic metabolic alterations in cardiac hypertrophy and failure

AIMS

Heart failure is characterized by structural and metabolic cardiac remodelling. The aim of the present study is to expand our understanding of the complex metabolic alterations in the transition from pathological hypertrophy to heart failure and exploit the results from a translational perspective.

METHODS AND RESULTS

Mice were subjected to transverse aortic constriction (TAC) or sham surgery and sacrificed 2 weeks, 4 weeks, or 6 weeks after the procedure. Samples from plasma, liver, skeletal muscle, and heart were collected and analysed using metabolomics. Cardiac samples were also analysed by transcriptional profiling. Progressive alterations of key cardiac metabolic pathways and gene expression patterns indicated impaired mitochondrial function and a metabolic switch during transition to heart failure. Similar to the heart, liver, and skeletal muscle revealed significant metabolic alterations such as depletion of essential fatty acids and glycerolipids in late stages of heart failure. Circulating metabolites, particularly fatty acids, reflected cardiac metabolic defects, and deteriorating heart function. For example, inverse correlation was found between plasma and the heart levels of triacylglycerol (C18:1, C18:2, C18:3), and sphingomyelin (d18:1, C23:0) already at an early stage of heart failure. Interestingly, combining metabolic and transcriptional data from cardiac tissue revealed that decreased carnitine shuttling and transportation preceded mitochondrial dysfunction. We, thus, studied the therapeutic potential of OCTN2 (Organic Cation/Carnitine Transporter 2), an important factor for carnitine transportation. Cardiac overexpression of OCTN2 using an adeno-associated viral vector significantly improved ejection fraction and reduced interstitial fibrosis in mice subjected to TAC.

CONCLUSION

Comprehensive plasma and tissue profiling reveals systemic metabolic alterations in heart failure, which can be used for identification of novel biomarkers and potential therapeutic targets.

Early diagnosis and appropriate respiratory support for Mycoplasma pneumoniae pneumonia associated acute respiratory distress syndrome in young and adult patients: a case series from two centers

BACKGROUND

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community acquired pneumonia (CAP). Establishing an early diagnosis of M. pneumoniae pneumonia in patients with acute respiratory distress syndrome (ARDS) may have important therapeutic implications.

METHODS

We describe diagnosis and management of M. pneumoniae pneumonia induced ARDS in a case series of adults and youth hospitalized with radiographically confirmed CAP prospectively enrolled in an observational cohort study in two university teaching hospitals, from November 2017 to October 2019.

RESULTS

In all 10 patients, early and rapid diagnosis for severe M. pneumoniae pneumonia with ARDS was achieved with polymerase chain reaction (PCR) or metagenomic next-generation sequencing (mNGS) testing of samples from the lower respiratory tract or pleural effusion. The average PaO₂/FiO₂ of all patients was 180 mmHg. Of the 10 cases, 4 cases had moderate ARDS (100 mmHg ≤ PaO₂/FiO₂ < 200 mmHg) and 3 cases had severe ARDS (PaO₂/FiO₂ < 100 mmHg). High flow nasal cannula (HFNC) was applied in all patients, though only two patients were sufficiently supported with HFNC. Invasive mechanical ventilation (IMV) was required in 5 patients. High resistance (median 15 L/cmH₂O/s) and low compliance (median 38 ml/cmH₂O) was observed in 4 cases. In these 4 cases, recruitment maneuvers (RM) were applied, with 1 patient demonstrating no response to RM. Prone positioning were applied in 4 cases. Two cases needed ECMO support with median support duration of 5.5 days. No patient in our case series received corticosteroid therapy. All patients were survived and were discharged from hospital.

CONCLUSIONS

Early and rapid diagnosis of severe M. pneumoniae pneumonia with ARDS can be achieved with PCR/mNGS tests in samples from the lower respiratory tract or pleural effusion. In our case series, half of M. pneumoniae pneumonia induced ARDS cases were adequately supported with HFNC or NIV, while half of cases required intubation. RM and prone position were effective in 30% of intubated cases, and 20% needed ECMO support. When early anti-mycoplasmal antibiotics were given together with sufficient respiratory support, the survival rate was high with no need for corticosteroid use.

Eicosapentaenoic Acid-Enriched Phosphoethanolamine Plasmalogens Alleviated Atherosclerosis by Remodeling Gut Microbiota to Regulate Bile Acid Metabolism in LDLR-/- Mice

Eicosapentaenoic acid (EPA)-enriched phosphoethanolamine plasmalogens (EPA-PlsEtns) might be retained in the intestine rich in gut microbiota for a long time after treatment. It reminded us that EPA-PlsEtns might affect intestinal microbiota composition and its metabolites, which have been identified as a contributing factor in the development of cardiovascular diseases. In the present study, EPA-PlsEtn administration for 8 weeks significantly reduced the atherosclerotic lesion area in low-density lipoprotein receptor deficient (LDLR^-/-) mice. Notably, the serum total cholesterol and low-density lipoprotein cholesterol levels were significantly reduced by 33.6 and 38.2%, respectively, by EPA-PlsEtns instead of EPA in the form of ethyl ester (EPA-EE) treatment compared with the model group. EPA-PlsEtn administration also increased total neutral sterol and bile acids in feces by 92 and 39%, respectively, rather than EPA-EE. Mechanistically, EPA-PlsEtns might affect the abundance of gut microbiota contributing to the alteration of bile acid profiles, which might further accelerate bile acid synthesis via increasing cholesterol 7 α-hydroxylase expression induced by the inhibition of farnesoid X receptor activation.

High temperature rise dominated cracking mechanisms in ultra-ductile and tough titanium alloy

Extensive use of titanium alloys is partly hindered by a lack of ductility, strain hardening, and fracture toughness. Recently, several β-metastable titanium alloys were designed to simultaneously activate both transformation-induced plasticity and twinning-induced plasticity effects, resulting in significant improvements to their strain hardening capacity and resistance to plastic localization. Here, we report an ultra-large fracture resistance in a Ti-12Mo alloy (wt.%), that results from a high resistance to damage nucleation, with an unexpected fracture phenomenology under quasi-static loading. Necking develops at a large uniform true strain of 0.3 while fracture initiates at a true fracture strain of 1.0 by intense through-thickness shear within a thin localized shear band. Transmission electron microscopy reveals that dynamic recrystallization occurs in this band, while local partial melting is observed on the fracture surface. Shear band temperatures of 1250–2450 °C are estimated by the fusible coating method. The reported high ductility combined to the unconventional fracture process opens alternative avenues toward Ti alloys toughening.

Specific titanium alloys combine transformation-induced plasticity and twinning-induced plasticity for improved work hardening. Here, the authors show that these alloys also have an ultra-large fracture resistance and an unexpected fracture mechanism via dynamic recrystallization and local melting in a deformation band.

Proximity Enzymatic Glyco-Remodeling Enables Direct and Highly Efficient Lipid Raft Imaging on Live Cells

Lipid rafts, highly ordered cell membrane domains mainly composed of cholesterol, sphingolipids, and protein receptors, serve as important functional platforms for regulation of lipid/protein interactions. The major predicament in lipid raft study is the lack of direct and robust visualization tools for in situ tracking raft components. To solve this issue, we herein report a proximity enzymatic glyco-remodeling strategy for direct and highly efficient lipid raft labeling and imaging on live cells. Through cofunctionalization of raft-specific recognition motif and glycan-remodeling enzyme on gold nanoparticles, the fabricated nanoprobe can be specifically guided to the raft domains to perform catalytic remodeling on neighboring glycans. Taking advantage of the abundant glycoconjugates enriched in lipid rafts, this elaborate design achieves the translation of one raft-recognition event to multiple raft-confined labeling operations, thus, significantly increasing the labeling efficiency and imaging sensitivity. The direct covalent labeling also enables in situ and long-term tracking of raft components in live cells. The method possesses broad applicability and potential expansibility, thus, will greatly facilitate the investigations on the complex composition, organization, and dynamics of lipid rafts.

Evaluating the adsorptivity of organo-functionalized silica nanoparticles towards heavy metals: Quantitative comparison and mechanistic insight

Organo-functionalized SiO₂ nanoparticles are regarded as promising adsorbents for capture of heavy metals. However, actual adsorptivity of a specific functional group onto SiO₂ surface is unclear, thus extending a debate on which type of organic group possesses a better affinity toward heavy metals. Herein, surface functionalization of SiO₂ with different groups (i.e., -EDTA (ethylenediamine triacetic acid), -COOH, -SO₃H, -SH and -NH₂) were achieved by a facile silylating reaction. Batch experiments indicated that adsorption capacity of SiO₂ was remarkably improved by surface functionalization. Quantitative analysis manifested that one mole of EDTA grafted onto SiO₂ surface can adsorb 1.51 mol of Pb(II) ions, which was 7.7, 17.1, 28.4 and 50.2-fold larger than those of COOH-, SO₃H-, SH- and NH₂-functionalized SiO₂, respectively. This is first time to evaluate adsorptivity of functionalized SiO₂ on the basis of per effective functional group, which may repair deficiency of conventional assessment method that calculated on the basis of per unit mass. Further, adsorption mechanism of these functionalized SiO₂ were identified and uncovered by experimental and theoretical studies. This work not only develops an efficient adsorbent for heavy metal remediation but also provides a valuable insight for evaluation and design of novel SiO₂-based materials.