[Analysis of HIV transmission hotspots and characteristics of cross-regional transmission in Guangxi Zhuang Autonomous Region based on molecular network]

Objective: To analyze HIV transmission hotspots and characteristics of cross-regional transmission in Guangxi Zhuang autonomous region (Guangxi) based on the molecular network analysis, and provide evidence for optimization of precise AIDS prevention and control strategies. Methods: A total of 5 996 HIV pol sequences sampled from Guangxi between 1997 and 2020 were analyzed together with 165 534 published HIV pol sequences sampled from other regions. HIV-TRACE was used to construct molecular network in a pairwise genetic distance threshold of 0.5%. Results: The proportion of HIV sequences entering the molecular network of HIV transmission hotspots in Guangxi was 31.5% (1 886/5 996). In the molecular network of HIV cross-regional transmission, the links within Guangxi accounted for 51.6% (2 613/5 062), the links between Guangxi and other provinces in China accounted for 48.0% (2 430/5 062), and the links between Guangxi and other countries accounted for 0.4% (19/5 062). The main regions which had cross-regional linked with Guangxi were Guangdong (49.5%, 1 212/2 449), Beijing (17.5%, 430/2 449), Shanghai (6.9%, 168/2 449), Sichuan (5.7%, 140/2 449), Yunnan (4.2%, 102/2 449), Shaanxi (3.8%, 93/2 449), Zhejiang (2.8%, 69/2 449), Hainan (2.0%, 49/2 449), Anhui (1.5%, 37/2 449), Jiangsu (1.3%, 33/2 449), and other regions (each one <1.0%), respectively. The risk factors of entering the molecular network of HIV transmission hotspots in Guangxi included being aged ≥50 years (compared with being aged 25-49 years, aOR=1.68,95%CI:1.46-1.95), males (compared with females, aOR=1.21,95%CI:1.05-1.40), being single (compared with being married, aOR=1.18,95%CI:1.00-1.39), having education level of high school or above (compared with having education level of junior high school or below, aOR=1.21,95%CI:1.04-1.42), acquired HIV through homosexual intercourse (compared with acquired with HIV through heterosexual intercourse, aOR=1.77, 95%CI:1.48-2.12). The risk factors of cross-regional transmission included males (compared with females, aOR=1.74,95%CI:1.13-2.75), having education level of high school or above (compared with having education level of junior high school or below, aOR=1.96,95%CI:1.43-2.69), being freelancer/unemployed/retired (compared with being farmers, aOR=1.50,95%CI:1.07-2.11), acquired HIV through homosexual intercourse (compared with acquired with HIV through heterosexual intercourse, aOR=3.28,95%CI:2.30-4.72). Conclusion: There are HIV transmission hotspots in Guangxi. Guangxi and other provinces in China form a complex cross-regional transmission network. Future studies should carry out social network surveys in high-risk populations inferred from the molecular network analysis for the timely identification of hidden transmission chains and reduction of the second-generation transmission of HIV.

Genomic testing for copy number and single nucleotide variants in spermatogenic failure

PURPOSE

To identify clinically significant genomic copy number (CNV) and single nucleotide variants (SNV) in males with unexplained spermatogenic failure (SPGF).

MATERIALS AND METHODS

Peripheral blood DNA from 97/102 study participants diagnosed with oligozoospermia, severe oligozoospermia, or non-obstructive azoospermia (NOA) was analyzed for CNVs via array comparative genomic hybridization (aCGH) and SNVs using whole-exome sequencing (WES).

RESULTS

Of the 2544 CNVs identified in individuals with SPGF, > 90% were small, ranging from 0.6 to 75 kb. Thirty, clinically relevant genomic aberrations, were detected in 28 patients (~ 29%). These included likely diagnostic CNVs in 3/41 NOA patients (~ 7%): 1 hemizygous, intragenic TEX11 deletion, 1 hemizygous DDX53 full gene deletion, and 1 homozygous, intragenic STK11 deletion. High-level mosaicism for X chromosome disomy (~ 10% 46,XY and ~ 90% 47,XXY) was also identified in 3 of 41 NOA patients who previously tested normal with conventional karyotyping. The remaining 24 CNVs detected were heterozygous, autosomal recessive carrier variants. Follow-up WES analysis confirmed 8 of 27 (30%) CNVs (X chromosome disomy excluded). WES analysis additionally identified 13 significant SNVs and/or indels in 9 patients (~ 9%) including X-linked AR, KAL1, and NR0B1 variants.

CONCLUSION

Using a combined genome-wide aCGH/WES approach, we identified pathogenic and likely pathogenic SNVs and CNVs in 15 patients (15%) with unexplained SPGF. This value equals the detection rate of conventional testing for aneuploidies and is considerably higher than the prevalence of Y chromosome microdeletions. Our results underscore the importance of comprehensive genomic analysis in emerging diagnostic testing of complex conditions like male infertility.

Development and characterization of a novel active and intelligent film based on pectin and betacyanins from peel waste of pitaya (Hylocereus undatus)

In the present study, peel waste of pitaya (Hylocereus spp.) was used to develop a novel active and functional film. The film was developed with a combination of the white-fleshed pitaya peel pectin (WPPP) as a biopolymer and white-fleshed pitaya peel betacyanins (WPPB) as an active constituent, respectively. Furthermore, montmorillonite (MMT), a cheap and environmental-friendly silicate material, was introduced into film matrix as a filler to reduce the moisture sensitivity of the film. The effect of the incorporation of WPPB on the properties of WPPP/MMT films was investigated. The colorimetric response of WPPP/MMT/WPPB to pH and ammonia was examined, respectively. Moreover, WPPP/MMT/WPPB-2 was employed to monitor the freshness of shrimp. The color of the film changed from redness to reddish-brown, and further to brownness, echoing the shrimp turned from fresh to spoiled. Therefore, WPPP/MMT/WPPB-2 composite films showed promise for the applications in monitoring the freshness of shrimp.

[Variables associated with hematological remission and survival in patients with acute myeloid leukemia after induction failure and relapse]

Objective: This study aimed to explore variables associated with remission rate and survival in patients with acute myeloid leukemia (AML) after induction failure and relapse. Methods: Data of 373 consecutive patients with AML were analyzed after induction failure and relapse. Binary logistics and the Cox model regression were used to identify variables associated with remission rate and outcomes. Results: In patients with AML after induction failure and relapse, the total CR+CRi rates were 50.6% and 40.3%, respectively; among those who achieved CR/CRi, the 3-year RFS rates were 34.4% and 30.4%, respectively, and the 3-year overall survival rates were 40.1% and 31.6%, respectively. In the multivariate analyses, using CLAG or FLAG regimen as a re-induction chemotherapy regimen, age <39 years and SWOG low-risk were significantly associated with higher remission rates in patients with induction failure. Male, secondary AML, SWOG high-risk, the interval from the first remission to relapse within 12 months, and bone marrow blasts ≥20% at the time of relapse were significantly associated with lower remission rates in relapsed patients. Transplantation was significantly associated with prolonged relapse-free survival and overall survival in patients achieving hematologic remission; the SWOG low-risk group was significantly associated with longer overall survival in those with induction failure; and achieving CR (not CRi) or having female gender was associated with longer RFS or overall survival in relapsed patients. Conclusion: Reinduction chemotherapy regimen, age, gender, SWOG risk, secondary AML, the interval from the first remission to relapse, and bone marrow blast percentage at the time of relapse were significantly associated with remission rates in the patients with AML after induction failure and relapse. Transplantation, SWOG low-risk, achieving CR, or female gender were associated with longer survivals in those achieving remission.

Radiomics based on pretreatment MRI for predicting distant metastasis of nasopharyngeal carcinoma: A preliminary study

Objective

To explore the feasibility of predicting distant metastasis (DM) of nasopharyngeal carcinoma (NPC) patients based on MRI radiomics model.

Methods

A total of 146 patients with NPC pathologically confirmed, who did not exhibit DM before treatment, were retrospectively reviewed and followed up for at least one year to analyze the DM risk of the disease. The MRI images of these patients including T2WI and CE-T1WI sequences were extracted. The cases were randomly divided into training group (n=116) and validation group (n=30). The images were filtered before radiomics feature extraction. The least absolute shrinkage and selection operator (LASSO) regression was used to develop the dimension of texture parameters and the logistic regression was used to construct the prediction model. The ROC curve and calibration curve were used to evaluate the predictive performance of the model, and the area under curve (AUC), accuracy, sensitivity, and specificity were calculated.

Results

72 patients had DM and 74 patients had no DM. The AUC, accuracy, sensitivity and specificity of the model were 0. 80 (95% CI: 0.72~0. 88), 75.0%, 76.8%, 73.3%. and0.70 (95% CI: 0.51~0.90), 66.7%, 72.7%, 63.2% in training group and validation group, respectively.

Conclusion

The radiomics model based on logistic regression algorithm has application potential for evaluating the DM risk of patients with NPC.

A combined predictive model based on radiomics features and clinical factors for disease progression in early-stage non-small cell lung cancer treated with stereotactic ablative radiotherapy

Purpose

To accurately assess disease progression after Stereotactic Ablative Radiotherapy (SABR) of early-stage Non-Small Cell Lung Cancer (NSCLC), a combined predictive model based on pre-treatment CT radiomics features and clinical factors was established.

Methods

This study retrospectively analyzed the data of 96 patients with early-stage NSCLC treated with SABR. Clinical factors included general information (e.g. gender, age, KPS, Charlson score, lung function, smoking status), pre-treatment lesion status (e.g. diameter, location, pathological type, T stage), radiation parameters (biological effective dose, BED), the type of peritumoral radiation-induced lung injury (RILI). Independent risk factors were screened by logistic regression analysis. Radiomics features were extracted from pre-treatment CT. The minimum Redundancy Maximum Relevance (mRMR) and the Least Absolute Shrinkage and Selection Operator (LASSO) were adopted for the dimensionality reduction and feature selection. According to the weight coefficient of the features, the Radscore was calculated, and the radiomics model was constructed. Multiple logistic regression analysis was applied to establish the combined model based on radiomics features and clinical factors. Receiver Operating Characteristic (ROC) curve, DeLong test, Hosmer-Lemeshow test, and Decision Curve Analysis (DCA) were used to evaluate the model’s diagnostic efficiency and clinical practicability.

Results

With the median follow-up of 59.1 months, 29 patients developed progression and 67 remained good controlled within two years. Among the clinical factors, the type of peritumoral RILI was the only independent risk factor for progression (P< 0.05). Eleven features were selected from 1781 features to construct a radiomics model. For predicting disease progression after SABR, the Area Under the Curve (AUC) of training and validation cohorts in the radiomics model was 0.88 (95%CI 0.80-0.96) and 0.80 (95%CI 0.62-0.98), and AUC of training and validation cohorts in the combined model were 0.88 (95%CI 0.81-0.96) and 0.81 (95%CI 0.62-0.99). Both the radiomics and the combined models have good prediction efficiency in the training and validation cohorts. Still, DeLong test shows that there is no difference between them.

Conclusions

Compared with the clinical model, the radiomics model and the combined model can better predict the disease progression of early-stage NSCLC after SABR, which might contribute to individualized follow-up plans and treatment strategies.

[Effectiveness investigation on left bundle branch area pacing in 10 infants and toddlers]

Objective: To explore the feasibility, safety and effectiveness of left bundle branch area pacing (LBBAP) in children aged ≤3 years. Methods: A total of 10 children aged ≤3 years who were diagnosed with brady arrhythmia in the First Hospital of Tsinghua University from September 2020 to September 2021 were retrospectively analyzed. All the children met the indication of permanent pacemaker implantation and underwent LBBAP successfully. The intraoperative data (pacing parameters, electrocardiogram and radiographic imaging), cardiac ultrasound data and clinical data during regular postoperative follow-up were recorded. The preoperative and postoperative data were compared using matched samples t test. Results: Ten children (aged (1.6±0.7) years with weight of (10.3±2.5) kg) underwent LBBAP successfully. The QRS wave duration on the postoperative electrocardiogram was (100±9) ms, and the percentage of ventricular pacing was (97±7)%. The postoperative follow-up period was 6 (6, 12) months. At 1 week after operation, the left ventricular end-diastolic diameter Z scores in these children reduced significantly compared with those before operation (1.3±0.6 vs. 3.6±1.1, t=9.37, P<0.001). During the follow-up period, cardiac function was normal and the last left ventricular ejection fraction was (66±4)% in all children. At the last follow-up, the pacing threshold of the 10 children was smaller than 1.0 V and was acceptable. Compared with the intraoperative baseline values, the pacing threshold was slightly higher ((0.8±0.1) vs. (0.5±0.1) V, t=-5.27, P=0.001). However, no significant difference was found regarding sensing threshold ((16±5) vs. (14±4) mV, t=-0.83, P=0.426) and impedance ((584±88) vs. (652±86) Ω, t=2.26, P=0.050). During follow-up, no electrode related complications were recorded. Conclusions: LBBAP is safe and effective for infants and toddlers. Narrow QRS pacing with stable pacing parameters and normal cardiac function could be achieved postoperatively.

[Effectiveness, safety and cost of urinary follicle stimulating hormone in controlled ovarian stimulation in China: multi-center retrospective cohort study of 102 061 in vitro fertilization cycles]

Objective: To explore the effectiveness, safety and cost between urinary follicle stimulating hormone (uFSH) and recombinant follicle stimulating hormone (rFSH) in controlled ovarian stimulation (COS) in China. Methods: Data were collected from 16 reproductive centers in China covering oocytes collection time from May 1, 2015 to June 30, 2018. Eligible patients were over 18 years old, adopting COS with uFSH (uFSH group) or rFSH (rFSH group) as start gonadotropins (Gn), and using in vitro fertilization (IVF) and (or) intracytoplasmic sperm injection for fertilisation, excluding frozen embryo recovery cycle. Generalised estimating equation was used to address the violation of independency assumption between cycles due to multiple IVF cycles for one person and clustering nature of cycles carried out within one center. Controlling variables included age, body mass index, anti-Müllerian hormone level, cause of infertility, ovulation protocol, type of fertilisation, number of embryos transferred, number of days of Gn use. Results: Totally 102 061 cycles met eligibility criteria and were included in the analyses. In terms of effectiveness, after controlling relevant unbalanced baseline characteristics, compared with rFSH group, the high oocyte retrieval (>15 oocytes was considered high retrieval) rate of uFSH group significantly decreased in gonadotropin-releasing hormone agonist protocol (OR=0.642, P<0.01) and in gonadotropin-releasing hormone antagonist protocol (OR=0.556, P=0.001), but the clinical pregnancy rate per transfer cycle and the live birth rate per transfer cycle significantly increased (OR=1.179, OR=1.169, both P<0.01) in both agonist and antagonist protocols. For safety, multiple analysis result demonstrated that in the agonist protocol, compared with rFSH group, the incidence of moderate to severe ovarian hyperstimulation syndrome of uFSH group significantly decreased (OR=0.644, P=0.002). The differences in ectopic pregnancy rate and multiple pregnancy rate between the uFSH and rFSH groups were not significant (P=0.890, P=0.470) in all patients. In terms of cost, compared with rFSH group, the uFSH group had lower total Gn costs for each patient (P<0.01). Conclusion: For patients who underwent COS, uFSH has better safety, and economic profiles over rFSH in China.

[The efficacy and safety of low-dose chemotherapy combined with tyrosine kinase inhibitors in the treatment of Philadelphia-chromosomal-positive acute lymphoblastic leukemia]

Objective: The study aims to explore the efficacy and safety of low-dose chemotherapy combined with tyrosine kinase inhibitor (TKI) as an induction therapy for Philadelphia-chromosomal-positive acute lymphoblastic leukemia (Ph(+) ALL) . Methods: The data of the consecutive newly diagnosed patients with Ph(+) ALL were reviewed. The efficacy and safety of low-dose chemotherapy and conventional-dose chemotherapy combined with TKI were compared. Results: A total of 217 patients with a median age of 38 (10-69) years old were included in this study. 78 patients were in the low-dose chemotherapy group, and 139 patients were in the conventional-dose chemotherapy group. There were no significant differences in the 4-week complete remission (CR) rate (98.7% vs 97.0%, P=0.766) and overall CR rate (100% vs 100%, P=1.000) between the two groups. Multivariate analyses showed that the chemotherapy intensity was not related to the disease-free survival rate and overall survival rate. However, the lower incidence of infection (P=0.017) , the shorter duration of neutropenia (P=0.001) and PLT<20 × 10(9)/L (P=0.057) , and the lower red blood cell transfusion volume (P=0.002) were more common in the low-dose chemotherapy group than in the conventional-dose chemotherapy group. Conclusions: The low-dose chemotherapy is superior to the conventional-dose chemotherapy combined with TKI as induction therapy in Ph(+) ALL with similar efficacy but is safer.

[Analysis of the characteristic of clinical symptoms and cone-beam CT imaging changes in temporomandibular joint osteoarthritis patients with chewing side preference]

Objective: To investigate the clinical symptoms and cone-beam CT (CBCT) imaging characteristics of temporomandibular joint osteoarthritis (TMJOA) with chewing side preference (CSP). Methods: One hundred patients with TMJOA diagnosed in the Department of Stomatology, General Hospital of the Chinese PLA from January 2018 to December 2020 were enrolled, including 32 males and 68 females, with an median age of 27.5 years (16-71 years). According to the habit of CSP, 100 cases were divided into 71 cases of TMJOA with CSP group and 29 cases of TMJOA without CSP group. The clinical symptoms were observed, including pain, TMJ sounds, limited mouth opening as well as the radiograph imaging changes of condylar bone. When analyzing the radiograph imaging changes of condylar, the cases with bilateral TMJ symptoms were excluded and the remaining cases were divided into symptomatic sides and asymptomatic sides with CSP or without CSP according to the symptoms of the chief complaint. SPSS 25.0 was used to analyze the statistical data. Age data did not conform to normal distribution so that median and quartile spacing were used for description, and Mann-Whitney U test was used for nonparametric test. Qualitative data such as gender, clinical symptoms and condylar lesion types were described by composition ratio and Chi-Square test was performed. Results: There was no statistical significance in age and gender of TMJOA patients in the group with or without CSP (P>0.05). There incidence of pain in CSP group [83.1% (59/71)] was margina uy higher than that in non-CSP group but without statistical difference[65.5% (19/29)] (χ²=3.71, P=0.054). There was also no significant difference in TMJ sounds and limitation of mandibular movement between the two groups(χ²=0.11, P=0.742; χ²=0.48, P=0.489). Among all of joints, the most common types of TMJOA were articular flattening and shortening and erosion. CBCT showed that erosion [65.0% (130/200)], flattening and shortening [73.0% (146/200)], subcortical sclerosis [42.0% (84/200)], osteophyte [30.5% (61/200)] and subcortical cystic [15.5% (31/200)]. According to the different groups of chief complaint sides, intra-group comparisons show that the proportion of erosion in symptomatic sides of CSP group [80.0% (40/50)] was significantly higher than that in asymptomatic sides of CSP group [50.0% (25/50)] (χ²=9.89, P=0.002). Inter-group comparisons show that the proportion of condyle flattening and shortening in symptomatic sides of CSP group [84.0% (42/50)] was significantly higher than that in bilateral joint of non-CSP group (8/15) (χ²=8.81, P=0.032). There was no significant difference in the proportion of subcortical sclerosis, osteophyte and subcortical cystic between the group with or without CSP (P>0.05). Conclusions: TMJOA patients with CSP may be more prone to clinical symptoms of pain and CBCT imaging changes of condyle erosion as well as flattening and shortening. CSP may be a promoting factor for the development of TMJOA.

Encapsulating quercetin in cyclodextrin metal-organic frameworks improved its solubility and bioavailability

BACKGROUND

Quercetin (Que) has many pharmacological activities, such as anticancer, antioxidant, cardiovascular protection, antihypertensive and lipid-lowering activities. However, its poor water solubility greatly limits its application in medicine and food. γ-Cyclodextrin metal-organic frameworks (γ-CD-MOFs) are novel porous carriers for loading functional products. In this study, Que was successfully loaded into γ-CD-MOFs, and the new compound (Que-CD-MOFs) was characterised by X-ray diffraction, infrared spectroscopy, thermogravimetric analysis and scanning electron microscopy.

RESULTS

The apparent solubility of Que-CD-MOFs was enhanced by 100-fold compared with that of pure Que. The free radical scavenging ability of the encapsulated Que was significantly improved. The cytotoxicity of Que-CD-MOFs to HK-2 cells was decreased, and their inhibition on HT-29 tumour cells was maintained, as confirmed by CCK-8 assays. Flow cytometry of HT-29 cells showed that Que-CD-MOFs can inhibit G2 phase cells. Based on molecular modelling, Que molecules were preferentially located inside the cavities of γ-CD pairs in γ-CD-MOFs.

CONCLUSION

γ-CD-MOFs are promising carriers for bioactive agents in food and pharmaceutical applications. © 2021 Society of Chemical Industry.

A novel ETV6-NTRK3 gene fusion in primary renal fibrosarcoma

INTRODUCTION

Primary renal fibrosarcoma is a relatively uncommon tumor in the urinary system of adults, in fact only 6 cases have been reported in the English literature so far worldwide. The etiology of renal fibrosarcoma is incompletely understood. It is still lacking in simple and specific tissue-based biomarkers to assist the diagnosis of renal fibrosarcoma. Among the previously reported cases in the literature, the ETV6-NTRK3 gene fusion could be detected in the congenital (or infantile) fibrosarcoma, and this rearrangement may play a vital role in initiation of congenital fibrosarcoma. However, the ETV6-NTRK3 expression has not been reported in adult-type fibrosarcoma in the literature so far.

CASE PRESENTATION

A 66-year-old male patient admitted to our hospital because of chills, fever, and a right indwelling percutaneous nephrostomy catheter. Compared to normal kidney, the right renal had a thinner cortex and no function. After a week of anti-infective treatment, the patient underwent retroperitoneal laparoscopic right nephrectomy. The postoperative pathological result was fibrosarcoma of the right kidney.

CONCLUSIONS

Aberrant expression of EVT6-NTRK3 may contribute to the development of renal fibrosarcoma.

Algorithms and Hardness for Scaffold Filling to Maximize Increased Duo-Preservations

Scaffold filling is a critical step in DNA assembly. Its basic task is to fill the missing genes (fragments) into an incomplete genome (scaffold) to make it similar to the reference genome. There have been a lot of work under distinct measurements in the literature of genome comparison. For genomes with gene duplications, common string partition reveals the similarity more precisely, since it constructs a one-to-one correspondence between the same segments in the two genomes. In this paper, we adopt duo-preservation as the measurement, which is the complement of common string partition, i.e., the number of duo-preservations added to the number of common strings is exactly the length of a genome. Towards a proper scaffold filling, we just focus on the increased duo-preservations. This problem is called scaffold filling to maximize increased duo-preservations (abbr. SF-MIDP). We show that SF-MIDP is solvable in linear time for a simple version where all the genes of the scaffold are matched in a block-matching, but MAX SNP-complete for the general version, and cannot be approximated within [Formula: see text]. Moreover, we present a basic approximation algorithm of factor 2, by which the optimal solution can be described in a new way, and then, improve the approximation factor to [Formula: see text] via a greedy method.

P-382 Decrease of serum estradiol prior to human chorionic gonadotrophin administration have an impact on live birth in IVF/ICSI cycles

Study question

Whether decrease of serum estradiol prior to human chorionic gonadotrophin administration have an impact on live birth in IVF/ICSI cycles?

Summary answer

The E2 change before the day of hCG administration had significant correlation with live birth. The live birth rate decreased with decreasing serum E2 level.

What is known already

The objective of this study was to assess the effects of a decrease of estradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration on in vitro fertilization /intracytoplasmic sperm injection (IVF/ICSI) outcomes, including cycles with long, antagonist and micro stimulus protocols.

Study design, size, duration

In this retrospective cohort study, 1303 patients who received IVF/ICSI non-donor treatment were identified. Patients were divided into two groups according to live birth and the characteristics of IVF/ICSI cycles were compared between groups, including baseline infertility parameters, ovarian stimulation characteristics and embryo laboratory manipulation parameters.

Participants/materials, setting, methods

In this retrospective cohort study, 1303 patients who received IVF/ICSI non-donor treatment were identified. Patients were divided into two groups according to live birth and the characteristics of IVF/ICSI cycles were compared between groups, including baseline infertility parameters, ovarian stimulation characteristics and embryo laboratory manipulation parameters. The multivariate logistic regression model was performed to adjust potential confounders and assess correlation between E2 dynamics before hCG administration and live birth.

Main results and the role of chance

Our results revealed that patients without live birth had higher age (32.13 ± 4.33 vs. 30.21 ± 3.71, P &lt; 0.001) and pervious miscarriages (0.57 ± 0.95 vs. 0.46 ± 0.83, P = 0.0295), while had lower number of oocytes retrieved (8.95 ± 4.69 vs. 12.36 ± 5.54, P &lt; 0.001), day of hCG E2 (8269.53 ± 4104.22 vs. 9580.71 ± 3534.11, P &lt; 0.001) and endometrium thickness (10.37 ± 3.66 vs. 11.50 ± 3.40, P &lt; 0.001) compared with patients with live birth. Additionally, the multivariate logistic regression analysis displayed significant impact of serum E2 change on the live birth, and the achievement of live birth [OR (95%CI) 0.81 (0.71, 0.92), P = 0.001] decreased with the decreasing level of serum E2 before hCG trigger day. Estradiol stratification analyses displayed the OR and 95% CI for the association between △E2 and live birth among patients with different levels of estradiol decline (&lt;25%, 25%–50%, 50%–75%, &gt;75%). Compared with the &lt;25% decline and 25%–50% decline groups, the ORs of 50%–75% and &gt;75% decline groups were 1.66 (95% CI: 1.12-2.45, P = 0.012) and 2.00 (95% CI: 1.39-2.89, P &lt; 0.001), respectively, after adjusting potential confounders.

Limitations, reasons for caution

There was concealment of randomization and blinding of outcome assessments reducing the risk of selection and measurement bias.

Wider implications of the findings

In summary, the E2 change before the day of hCG administration had significant correlation with live birth, and the live birth decreased with the decreasing level of serum E2 before hCG trigger day. The patients with a greater decline in the E2 level more likely to had poor clinical outcomes.

Trial registration number

Chi CTR1900026088

[Status of HVPG clinical application in China in 2021]

Objective: The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China. Methods: This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems. Results: According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%). Conclusion: Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

On-chip multiple beam splitting assisted by bound states in the continuum

Usually, on-chip beam splitting can be achieved by manipulating the in-plane iso-frequency curves (IFCs) of the structure, where the confinement of light along the out-of-plane direction is governed by total internal reflection. In this Letter, without needing a high-index dielectric background material for total internal reflection, we achieve on-chip beam splitting in a linear-crossing metamaterial (LCMM) mimicked by a two-dimensional photonic crystal (PhC) slab where the vertical confinement is enabled by a bound state in the continuum (BIC) and totally beyond the light cone. Particularly, the light propagating inside the LCMM can be flexibly controlled by the rotation angle of the rectangular silicon pillars in the PhC slab. On-chip triple beam splitting can further be designed by combining two kinds of LCMM with opposite rotation angles. Such light beam splitting beyond the light cone originates from the combined manipulation of the BIC and the spatial dispersion of LCMMs. Our work promotes the development of optical devices in integrated optics, such as on-chip focusing, switching, and (de)multiplexing.

ALPK1 Aggravates TMJOA Cartilage Degradation via NF-κB and ERK1/2 Signaling

Temporomandibular joint osteoarthritis (TMJOA) is a common degenerative joint disease without effective intervention strategies. Previous research implied that alpha-kinase 1 (ALPK1) is involved in the inflammatory responses of gout, a chronic arthritis. Herein, we found the main distribution of ALPK1 in a proliferative layer of condylar cartilage and marrow cavity of subchondral bone, as well as a lining layer of synovial tissues in human temporomandibular joint. Moreover, the expression of ALPK1 was augmented in degraded condylar cartilage of monosodium iodoacetate (MIA)-induced TMJOA mice. After MIA induction, ALPK1 knockout mice exhibited attenuated damage of cartilage and subchondral bone, as well as synovitis, as compared with wide type mice. In contrast, intra-articular administration of recombinant human ALPK1 aggravated the pathology of MIA-induced TMJOA. Furthermore, ex vivo study demonstrated that ALPK1 exacerbated chondrocyte catabolism by upregulating matrix metalloproteinase 13 and cyclooxygenase 2 by activating NF-κB (nuclear factor-kappaB) signaling and suppressed anabolism by downregulating aggrecan by inhibiting ERK1/2 (extracellular signal-regulated kinase 1/2) in articular chondrocytes. Taken together, ALPK1 exacerbates the degradation of condylar cartilage during TMJOA through the NF-κB and ERK1/2 signaling pathway. This study provides a new insight regarding the role of ALPK1 during TMJOA pathology.

Exploring the contribution of mechano-sensing to cardiomyopathy

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Medical Research Council (MR/V009540/1),

Wellcome Trust (201543/B/16/Z)

British Heart Foundation (FS/12/40/29712).

Hypertrophic cardiomyopathy (HCM) is an inherited cardiac condition associated with diastolic dysfunction and sudden cardiac death. Disease genes for HCM are traditionally coding for proteins involved in force generation. More recently, it has emerged that variants in genes coding for proteins involved in biomechanical stress-signalling can also cause HCM.

One such protein is filamin C, with proposed mechano-sensing functions in the heart. Within the protein, the immunoglobulin-like domain 20 (Ig20) may play a crucial role in mediating binding to muscle specific ligands. While the mechano-sensing functions of filamin C have been investigated well in skeletal muscle, the underlying cardiac disease mechanisms are not completely understood.

Aim

This work attempts to provide insights into the role of filamin C in cardiac mechano-sensing and dissect disease pathways leading to HCM in the presence of the FLNC variants in Ig20.

Methods

Using mass spectrometry, we aimed to provide a detailed analysis of the proteome of mice carrying the filamin C variant, using ventricular tissue samples from 14wk old homozygous mice. Samples were subject to molecular biology technical and underwent subcellular fractionation (n = 6 per genotype) and were investigated by label-free mass spectrometry.

Results

Utilising whole genome sequencing, a heterozygous FLNC missense variant in Ig20 was identified in a three-generation family affected by HCM. Mice carrying this variant recapitulate molecular features of HCM in the homozygous setting. Three proteins (FLNC, MYH7, MYOT) were found to be upregulated in the myofilament-enriched fraction. Up-regulations of key proteins were found to relocalise towards load-baring sites.

Conclusion

Our data indicate that changes in filamin C and its binding partners expression and localisation are involved in the pathogenesis of HCM in this mouse model.

Efficacy and safety of camrelizumab combined with FLOT versus FLOT alone as neoadjuvant therapy in patients with resectable locally advanced gastric and gastroesophageal junction adenocarcinoma who received D2 radical gastrectomy: Data update

e16044

Background: Docetaxel-based neoadjuvant chemotherapy has been suggested to be beneficial in patients with locally advanced gastric and gastro-oesophageal junction cancer (GC/GEJC). And immunotherapy also show promising treatment efficacy for advanced GC/GEJC. Here we compared the safety and efficacy of camrelizumab combined with chemotherapy versus chemotherapy alone as the neoadjuvant therapy for patients with resectable locally advanced GC/GEJC. Methods: Eligible patients diagnosed as resectable locally advanced GC/GEJC were randomized to receive neoadjuvant treatment, in arm A, the patients received FLOT alone, in arm B, the patients received FLOT combined with camrelizumab(camrelizumab 200mg intravenously every 3 weeks). Eligible patients underwent gastrectomy with D2 lymph node dissection. The primary end point of this trial was pCR rate and R0 resection rate, and the secondary end points were ORR,PFS, OS and safety profile. Results: From January 15 2020 to January 15 2022, 61 patients were recruited (28 patients in arm A and 33 patients in arm B). 51 patients had completed planned neoadjuvant treatment for 4 cycles (25 pts in the arm A, 26 ptsin the arm B). Four patients in the arm A were failure to complete surgical treatment. This analysis was based on the 47 pts. In the arm A, the median age was 63 years (45-74 years) and a total of 16 males and 4 females, ECOG PS 0 (n = 3), ECOG PS 1 (n = 18). In the arm B, the median age was 63 years (28-72 years) and a total of 20 males and 6 females, ECOG PS 0 (n = 5), ECOG PS 1 (n = 21). The R0 resection rate was high in arm B compared with arm A (26/26,100% vs. 19/21, 90.5%). The same results are also reflected in pCR:arm B compared with arm A (3/26,11.5% vs. 1/21, 4.8%). Tumour regression grade were as follows:TRG0 [arm A 5% (1/21), arm B 15% (4/26)], TRG1 [arm A 10% (2/21), arm B 4% (1/26)], TRG2 [arm A 33% (7/21), arm B 54% (14/26)], TRG3 [arm A 52% (11/21), arm B 27% (7/26)].There was a greater proportion of postoperative stage ypN0 in arm B [arm A 24% (5/21); arm B 46% (12/26)]. Postoperative pathologic staging was as follows: ypT0 [arm A 5% (1/21); armB 15% (4/26)].ypT1 [arm A 14% (3/21); armB 8% (2/26)]. ypT2 [armA 0% (0/21); armB 27% (7/21)]. ypT3 [arm A 57% (12/21); arm B 38% (10/26)]. ypT4 [armA 24% (5/21); armB 12% (3/26)]. Neither serious intraoperative complications nor immune-related adverse events were observed during perioperation. Treatment-related AEs neutropenia and leukopenia were manageable and there was no treatment-related death. Conclusions: Camrelizumab combined with FLOT showed promising efficacy as neoadjuvant treatment for patients with locally advanced gastric or GEJ adenocarcinoma, with low complications and acceptable toxicity. Clinical trial information: ChiCTR2000030610.