[Pathological features and diagnostic significance of lung biopsy in occupational lung diseases]

Objective: To investigate the clinicopathological characteristics of occupational lung diseases, to reduce the missed diagnoses and misdiagnoses of the diseases and to help standardize the diagnosis and treatment of these patients. Methods: A total of 4 813 lung biopsy specimens (including 1 935 consultation cases) collected at the Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, China from January 1st, 2017 to December 31th, 2019 were retrospectively analyzed. Among them, 126 cases of occupational lung diseases were confirmed with clinical-radiological-pathological diagnosis. Special staining, PCR and scanning electron microscopy were also used to rule out the major differential diagnoses. Results: The 126 patients with occupational lung diseases included 102 males and 24 females. All of them had a history of exposure to occupational risk factor(s). Morphologically, 68.3% (86/126) of the cases mainly showed pulmonary fibrotic nodules, dust plaque formation or carbon end deposition in pulmonary parenchyma. 16.7% (21/126) of the cases mainly showed welding smoke particle deposition in the alveolar cavity and lung interstitium while 15.1% (19/126) of the cases showed granulomas with fibrous tissue hyperplasia, alveolar protein deposition or giant cell interstitial pneumonia. The qualitative and semi-quantitative analyses of residual dust components in the lung under scanning electron microscope were helpful for the diagnosis of welder's pneumoconiosis and hard metal lung disease. Conclusions: The morphological characteristics of lung biopsy tissue are important reference basis for the clinicopathological diagnosis and differential diagnosis of occupational lung diseases. Recognizing the characteristic morphology and proper use of auxiliary examination are the key to an accurate diagnosis of occupational lung diseases on biopsy specimens.

Enhancing Caregiver Empowerment Through the Story Mosaic System: Human-Centered Design Approach for Visualizing Older Adult Life Stories

Background

Various older adult care settings have embraced the use of the life story approach to enhance the development of comprehensive care plans. However, organizing life stories and extracting useful information is labor-intensive, primarily due to the repetitive, fragmented, and redundant nature of life stories gathered from everyday communication scenarios. Existing life story systems, while available, do not adequately fulfill the requirements of users, especially in the application of care services.

Objective

The objective of this study is to design, develop, and evaluate a digital system that provides caregivers with the necessary tools to view and manage the life stories of older adults, enabling expedited access to pertinent information effectively and visually.

Methods

This study used a multidisciplinary, user-centered design approach across 4 phases: initial design requirements, prototyping, prototype refinement workshops, and usability testing. During the initial phase, we conducted field research in the Hefei Tianyu Senior Living Service Nursing Home, China, to discover how caregivers currently store and use life stories and their needs, challenges, and obstacles in organizing and retrieving information. Subsequently, we designed a low-fidelity prototype according to the users' requirements. A prototyping workshop involving 6 participants was held to collaboratively design and discuss the prototype's function and interaction. User feedback from the workshops was used to optimize the prototype, leading to the development of the system. We then designed 2 rounds of usability testing with 7 caregivers to evaluate the system's usability and effectiveness.

Results

We identified 3 categories of functionalities that are necessary to include in the design of our initial low-fidelity prototype of life story visualizations: life story input, life story organization, and timeline generation. Subsequently, through the workshops, we identified 3 categories for functional optimization: feedback on user interface and usability, optimization suggestions for existing features, and the request for additional functionalities. Next, we designed a medium-fidelity prototype based on human-centered design. The Story Mosaic system underwent usability testing in the Hefei Tianyu Senior Living Service Nursing Home. Overall, 7 users recorded and organized 1123 life stories of 16 older adults. The usability testing results indicated that the system was accessible and easy to use for caregivers. Based on the feedback from the usability testing, we finalized the high-fidelity prototype.

Conclusions

We designed, developed, and evaluated the Story Mosaic system to support the visual management of older adults' life stories. This system empowers caregivers through digital technology and innovative design, pioneering personal narrative integration in caregiving. This system can expand to include informal caregivers and family members for continued adaptability and empathy.

Low-quality of patient-reported outcome reporting in randomized clinical trials of major depressive disorder-a meta-epidemiological review

Objective

Our goal was to review current peer-reviewed articles in which the BDI (Beck Depression Inventory), PHQ-9 (Patient Health Questionnaire), or QIDS-SR16 (16-Item Quick Inventory of Depressive Symptomatology) was used as the primary or secondary outcome measure and to evaluate the quality of PRO (Patient-Reported Outcome) reporting in RCTs (Randomized Controlled Trials) according to the 2013 PRO-specific CONSORT (Consolidated Standards of Reporting Trials) extension.

Methods

We systematically searched in electronic databases. A study would be included if it included patients diagnosed with major depressive disorder according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases, version 10 (ICD-10) as participants, was a randomized controlled trial, included the BDI, PHQ-9, or QIDS-SR16 as the primary or secondary outcome measure, published between 1990 and 2013, and was in English. Two of the authors evaluated the quality of PRO reporting according to the 2013 CONSORT-PRO. Logistic regression were used to evaluate the association between reporting completeness and trial characteristics.

Results

A total of 116 studies were included. These studies were conducted in 25 countries. Sample sizes ranged from 12 to 750. The CONSORT-PRO was not cited in any one of the included studies. Among the 116 studies, 2 (1.72%) studies introduced the rationale for PRO assessment, 60 (51.72%) studies explicitly stated statistical approaches for dealing with missing data, 87 (75.00%) studies reported PRO outcome data at baseline and at subsequent time points. The mean score of reporting completeness was 66.24%. Significantly higher reporting completeness was found for RCTs published after 2013 (OR, 95%CI: 3.81, 1.32-10.99). Studies with a higher sample size were more completely reported than studies with a lower sample size (OR, 95%CI: 1.01, 1.00-1.02).

Conclusion

The CONSORT-PRO guidance was rarely cited. The quality of PRO reporting in depression studies requires improvement. This result may be meaningful for the promotion of PRO reporting in RCTs.

Molecular Mechanisms of Ferroptosis and Their Involvement in Acute Kidney Injury

Ferroptosis is a novel way of regulating cell death, which occurs in a process that is closely linked to intracellular iron metabolism, lipid metabolism, amino acid metabolism, and multiple signaling pathways. The latest research shows that ferroptosis plays a key role in the pathogenesis of acute kidney injury (AKI). Ferroptosis may be an important target for treating AKI caused by various reasons, such as ischemia-reperfusion injury, rhabdomyolysis syndrome, sepsis, and nephrotoxic drugs. This paper provides a review on the regulatory mechanisms of ferroptosis and its role in AKI, which may help to provide new research ideas for the treatment of AKI and future research.

Mannan-binding lectin ameliorates renal fibrosis by suppressing macrophage-to-myofibroblast transition

Mannan-binding lectin (MBL) is a pattern-recognition molecule that plays a crucial role in innate immunity. MBL deficiency correlates with an increased risk of chronic kidney disease (CKD). However, the molecular mechanisms are not fully defined. Here, we established a CKD model in wild-type (WT) and MBL-deficient (MBL-/-) mice via unilateral ureteral obstruction (UUO). The result showed that MBL deficiency aggravated the pathogenesis of renal fibrosis in CKD mice. Strikingly, the in vivo macrophage depletion investigation revealed that macrophages play an essential role in the MBL-mediated suppression of renal fibrosis. We found that MBL limited the progression of macrophage-to-myofibroblast transition (MMT) in kidney tissues of UUO mice. Further in vitro study showed that MBL-/- macrophages exhibited significantly increased levels of fibrotic-related molecules compared with WT cells upon transforming growth factor beta (TGF-β) stimulation. We demonstrated that MBL inhibited the MMT process by suppressing the production of matrix metalloproteinase 9 (MMP-9) and activation of Akt signaling. In summary, our study revealed an expected role of MBL on macrophage transition during renal fibrosis, thus offering new insight into the potential of MBL as a therapeutic target for CKD.

Pharmacological and Behavioral Interventions for Fatigue in Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

This study aims to evaluate pharmacological and behavioral interventions for the treatment of fatigue in Parkinson's disease (PD) patients.

METHODS

We systematically searched PubMed, PsycINFO, Web of Science, EMBASE, CNKI, Wan fang, and VIP up to July 31, 2022. We used Revman 5.3 software for the meta-analysis. The outcomes included Fatigue Severity Scale (FSS) and Parkinson's Fatigue Scale (PFS). The mean difference (MD) and 95% confidence intervals (CI) were collected or calculated.

RESULTS

Thirteen randomized controlled trials (RCTs) with a total of 1758 patients were included. The meta-analysis showed that current clinical treatments reduced FSS (MD: -1.60, 95% CI: -3.14 to -0.05) and PFS (MD: -0.61, 95% CI: -1.17 to -0.05) in patients with PD. Subgroup meta-analysis showed that: (1) neither pharmacological interventions nor behavioral interventions reduced FSS in PD patients; (2) dopaminergic drugs dose-dependently significantly reduced the PFS in patients with PD; (3) behavioral interventions have an almost significant effect (MD: -6.69, 95% CI: -13.71 to 0.33, P = 0.06, I2 = 74%) on alleviating PFS in PD patients; (4) vestibular rehabilitation training significantly reduced the PFS in patients with PD.

CONCLUSIONS

Current clinical treatments alleviate fatigue in PD patients. Dopaminergic drugs may act a stronger effect than amphetamines. Behavioral interventions, especially vestibular rehabilitation training, may be a promising way for the treatment of fatigue in patients with PD though further evidence is still needed.

The effectiveness of Otago exercise program in older adults with frailty or pre-frailty: A systematic review and meta-analysis

BACKGROUND

Frailty is a well-recognized risk factor for adverse health-related outcomes in aging population. However, little is known about the dynamic changing nature of frailty and the potential for it to be modified within the scope of exercise. Currently, there has not been a systematic review of the impact of Otago exercise program (OEP) implementation specifically for the frail or pre-frail older adults.

OBJECTIVE

To determine the effectiveness of Otago exercise program on the degree of frailty, physical balance ability, mobility, grip strength and health-related quality of life in older adults with frailty or pre-frailty.

METHODS

We conducted literature searching in seven electronic databases, as well as hand-search of reference of included studies from inception to December 2022. Eligible studies included clinical trials of pre-frail or frail elderly receiving OEP interventions reporting on the relevant outcomes. The effect size was evaluated using standardized mean differences (SMDs) and its 95% confidence interval with random effects models. Risk of bias was appraised independently by two authors.

RESULTS

10 trials containing 8 RCTs and 2 non-RCTs studies were included. Five studies were evaluated with some concerns in the evidence quality. The results showed that the OEP intervention could possibly reduce the level of frailty (SMD=-1.14, 95% CI: -1.68∼-0.06, P < 0.01) and improve the mobility (SMD=-2.15, 95% CI: -3.35∼-0.94, P < 0.01) and physical balance ability (SMD=2.59, 95% CI: 1.07-4.11), P = 0.01), and enhance their grip strength (SMD=1.68, 95% CI=0.05∼3.31, P = 0.04). However, no statistically significant effect of OEP on quality of life (SMD=-1.517, 95% CI=-3.18∼0.15, P = 0.07) in frail elderly was found based on the current evidence. The subgroup analysis indicated that participant age, different intervention total duration and per min of each session have varying degrees of impact on frail or pre-frail older people.

CONCLUSIONS

The OEP intervention targeting older adults with frailty or pre-frailty are effective in reducing frailty, improving physical balance ability, mobility, and grip strength with low to moderate certainty. More rigorous and tailored research are still needed in the future to further enrich the evidence in these fields.

Application of the concept of fast-track surgery in pediatric ophthalmic surgery

PURPOSE

To explore the effects of the fast-track surgery (FTS) approach during the perioperative period of ophthalmic surgery in pediatric patients.

METHODS

A bidirectional cohort design was applied in this study. The traditional nursing mode was followed in relation to 40 pediatric patients admitted for ophthalmic surgery in March 2018 (control group), whereas the FTS mode was followed with regard to 40 pediatric patients admitted for ophthalmic surgery in April 2018 (observation group). The effects of the FTS mode were determined by comparing the postoperative pain score, restlessness score, and the incidence of postoperative nausea and vomiting between the two groups.

RESULTS

The pain and restlessness scores of the patients at 4hours after surgery in the observation group were significantly decreased compared with those in the control group (P<0.01). The incidence of postoperative nausea and vomiting in the observation group was also slightly lower than that in the control group (P>0.05).

CONCLUSION

A perioperative FTS-based nursing mode can effectively alleviate the postoperative pain and restlessness of pediatric patients without increasing their stress response.

A novel coiled-coil domain containing-related gene signature for predicting prognosis and treatment effect of breast cancer

PURPOSE

Breast cancer (BRCA) is a prevalent tumor worldwide. The association between the coiled-coil domain-containing (CCDC) protein family and different tumors has been established. However, the prognostic significance of this protein family in breast cancer remains uncertain.

METHODS

Gene expression and clinical data were obtained from the TCGA, METABRIC, and GEO databases. Prognosis genes were identified using univariate Cox and LASSO Cox regression, leading to the establishment of a prognostic signature. Subsequently, the risk model was conducted based on survival and clinical feature analyses, and a nomogram for prognosis prediction was developed. Furthermore, analyses of biological function, immune characteristics, and drug sensitivity were performed. Finally, single-cell sequencing data were utilized to uncover the expression patterns of genes in the risk model.

RESULTS

Five genes were identified and utilized for risk modeling. The model demonstrated excellent prognostic value as indicated by ROC and Kaplan-Meier analysis. The high-risk group exhibited shorter survival time and higher likelihood of recurrence. Functional annotation indicated a correlation between the risk score and immune pathways. Conversely, the low-risk group displayed a greater enrichment in immune pathways and exhibited more active immune microenvironment characteristics. Additionally, drug sensitivity analysis using both public and our sequencing data revealed that the risk model possessed a broad range of predictive values.

CONCLUSIONS

We have developed a gene signature and have verified that patients with low-risk are more likely to have better prognosis and respond positively to therapy. This finding offers a valuable point of reference for BRCA individualized treatment.

RIPTACs: A groundbreaking approach to drug discovery

Regulated induced proximity targeting chimeras (RIPTACs), a new class of heterobifunctional molecules, show promise in specifically targeting and eliminating cancer cells while leaving healthy cells unharmed. As a groundbreaking drug discovery approach, RIPTACs work by forming a stable complex with two proteins, one specifically found in cancer cells (target protein, TP) and the other pan-essential for cell survival (effector protein, EP), selectively disrupting the function of the EP in cancer cells and causing cell death. Interestingly, the TPs need not be linked to disease progression, broadening the spectrum of potential drug targets. This review summarizes the discovery and recent advances of the RIPTAC strategy. Additionally, it discusses the associated opportunities and challenges as well as future perspectives in this field.

Electroacupuncture Ameliorates Hypothalamic‒Pituitary‒Adrenal Axis Dysfunction Induced by Surgical Trauma in Mice Through the Hypothalamic Oxytocin System

Electroacupuncture (EA) can effectively reduce surgical stress reactions and promote postoperative recovery, but the mechanisms remain unclear. The present study aims to examine the effects of EA on the hyperactivity of the hypothalamic‒pituitary‒adrenal (HPA) axis and investigate its potential mechanisms. Male C57BL/6 mice were subjected to partial hepatectomy (HT). The results showed that HT increased the concentrations of corticotrophin-releasing hormone (CRH), corticosterone (CORT), and adrenocorticotropic hormone (ACTH) in the peripheral blood and upregulated the expression of CRH and glucocorticoid receptors (GR) proteins in the hypothalamus. EA treatment significantly inhibited the hyperactivity of the HPA axis by decreasing the concentration of CRH, CORT, and ACTH in peripheral blood and downregulating the expression of CRH and GR in the hypothalamus. Moreover, EA treatment reversed the HT-induced downregulation of oxytocin (OXT) and oxytocin receptor (OXTR) in the hypothalamus. Furthermore, intracerebroventricular injection of the OXTR antagonist atosiban blocked the effects of EA. Thus, our findings implied that EA mitigated surgical stress-induced HPA axis dysfunction by activating the OXT/OXTR signaling pathway.

Clinical and Laboratory Characteristics, Neuroimaging Alternations and Treatment Response of 25 HIV-Negative General Paresis Patients

Purpose

General paresis is a common type of neurosyphilis featuring progressive cognitive deterioration. The lack of a golden standard of diagnosis and its nonspecific clinical manifestations resulted in a high rate of misdiagnoses. This study aims to investigate the clinical, laboratory and radiological presentations of general paresis and enrich its knowledge for timely diagnoses.

Patients and methods

The study collected hospitalized patients admitted for general paresis from September 2002 to November 2022. Their socio-demographical and medical status, clinical presentations, cognitive assessments, laboratory and radiographical manifestations and treatment information were collected retrospectively.

Results

A total of 20 males and 5 females were included. Patients' ages ranged from 30 to 66 years (average 50.3 years). The average and median time for diagnosing general paresis was 14.1 months and 10.0 months respectively. The most frequent initial symptom is memory deterioration (68.0%). Impaired calculative ability and memory deterioration were the most frequent cognitive anomalies, as found in 50% and 45.4% of subjects during examination. The mean and median scores of MoCA was 16.7 and 17 respectively. Serological tests revealed positive TPPA for all patients and a median RPR titer at 1:64 positive. All CSF samples with TPPA and FTA-ABS results reported positivity. The MRI manifestations of general paresis include patchy or speckled hyperintensities (70.8%) and cerebral atrophy (45.8%). The most common lesioned sites in MRI were the ventricular and paraventricular area (50.0%) and temporal lobes (45.8%). For treatment, penicillin-based anti-syphilitic plans were adopted in 17 patients (68.0%).

Conclusion

The clinical features and radiological alternations of general paresis patients often exhibited diverse and nonspecific alternations. However, some specific clinical manifestations and auxiliary examinations can provide meaningful clues for the identification and differential diagnosis of this disease.

A single amino acid substitution in the capsid protein of Zika virus contributes to a neurovirulent phenotype

Increasing evidence shows the African lineage Zika virus (ZIKV) displays a more severe neurovirulence compared to the Asian ZIKV. However, viral determinants and the underlying mechanisms of enhanced virulence phenotype remain largely unknown. Herein, we identify a panel of amino acid substitutions that are unique to the African lineage of ZIKVs compared to the Asian lineage by phylogenetic analysis and sequence alignment. We then utilize reverse genetic technology to generate recombinant ZIKVs incorporating these lineage-specific substitutions based on an infectious cDNA clone of Asian ZIKV. Through in vitro characterization, we discover a mutant virus with a lysine to arginine substitution at position 101 of capsid (C) protein (termed K101R) displays a larger plaque phenotype, and replicates more efficiently in various cell lines. Moreover, K101R replicates more efficiently in mouse brains and induces stronger inflammatory responses than the wild type (WT) virus in neonatal mice. Finally, a combined analysis reveals the K101R substitution promotes the production of mature C protein without affecting its binding to viral RNA. Our study identifies the role of K101R substitution in the C protein in contributing to the enhanced virulent phenotype of the African lineage ZIKV, which expands our understanding of the complexity of ZIKV proteins.

Plastic Evolution Characterization for 304 Stainless Steel by CQN_Chen Model under the Proportional Loading

In this paper, the CQN_Chen function is used to characterize the plastic anisotropic evolution of 304 stainless steel (SS304). The uniaxial tensile tests along different loading directions are conducted to experimentally investigate the anisotropic hardening behavior for SS304. The experimental data indicates that the anisotropy of SS304 is weak. The convexity analysis is carried out by the geometry-inspired numerical convex analysis method for the CQN_Chen yield locus during plastic deformation. The Hill48, SY2009 and CQN functions are used as the comparison to evaluate the accuracy of the CQN_Chen function in characterizing plastic evolution. The predicted values are compared with the experimental data. The comparison demonstrates that the CQN_Chen function can accurately characterize anisotropic hardening behavior under uniaxial tension along distinct loading directions and equibiaxial tension. Simultaneously, the CQN_Chen model has the capacity to adjust the yield surface shape between uniaxial tension and equibiaxial tension. The CQN_Chen model is recommended to characterize plastic evolving behavior under uniaxial tension along different directions and equibiaxial tension.

[Chinese expert guidance on overall application of lenvatinib in hepatocellular carcinoma]

Lenvatinib mesylate is an oral receptor tyrosine kinase inhibitor against targets of vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor α, stem cell growth factor receptor, and rearranged during transfection, et al. Lenvatinib has been approved by the National Medical Products Administration of China on September 4, 2018, for the first-line treatment of patients with unresectable hepatocellular carcinoma who have not received systematic treatment before. Up to February 2023, Lenvatinib has been listed in China for more than 4 years, accumulating a series of post-marketing clinical research evidences. Based on the clinical practice before and after the launch of lenvatinib and referring to the clinical experience of other anti-angiogenesis inhibitors, domestic multidisciplinary experts and scholars adopt the Delphi method to formulate the Chinese Expert Guidance on Overall Application of Lenvatinib in Hepatocellular Carcinoma after repeated discussions and revisions, in order to provide reference for reasonable and effective clinical application of lenvatinib for clinicians.

Artificial Intelligence Aided Lipase Production and Engineering for Enzymatic Performance Improvement

With the development of artificial intelligence (AI), tailoring methods for enzyme engineering have been widely expanded. Additional protocols based on optimized network models have been used to predict and optimize lipase production as well as properties, namely, catalytic activity, stability, and substrate specificity. Here, different network models and algorithms for the prediction and reforming of lipase, focusing on its modification methods and cases based on AI, are reviewed in terms of both their advantages and disadvantages. Different neural networks coupled with various algorithms are usually applied to predict the maximum yield of lipase by optimizing the external cultivations for lipase production, while one part is used to predict the molecule variations affecting the properties of lipase. However, few studies have directly utilized AI to engineer lipase by affecting the structure of the enzyme, and a set of research gaps needs to be explored. Additionally, future perspectives of AI application in enzymes, including lipase engineering, are deduced to help the redesign of enzymes and the reform of new functional biocatalysts. This review provides a new horizon for developing effective and innovative AI tools for lipase production and engineering and facilitating lipase applications in the food industry and biomass conversion.

Novobiocin blocks nucleic acid binding to Polθ and inhibits stimulation of its ATPase activity

Polymerase theta (Polθ) acts in DNA replication and repair, and its inhibition is synthetic lethal in BRCA1 and BRCA2-deficient tumor cells. Novobiocin (NVB) is a first-in-class inhibitor of the Polθ ATPase activity, and it is currently being tested in clinical trials as an anti-cancer drug. Here, we investigated the molecular mechanism of NVB-mediated Polθ inhibition. Using hydrogen deuterium exchange-mass spectrometry (HX-MS), biophysical, biochemical, computational and cellular assays, we found NVB is a non-competitive inhibitor of ATP hydrolysis. NVB sugar group deletion resulted in decreased potency and reduced HX-MS interactions, supporting a specific NVB binding orientation. Collective results revealed that NVB binds to an allosteric site to block DNA binding, both in vitro and in cells. Comparisons of The Cancer Genome Atlas (TCGA) tumors and matched controls implied that POLQ upregulation in tumors stems from its role in replication stress responses to increased cell proliferation: this can now be tested in fifteen tumor types by NVB blocking ssDNA-stimulation of ATPase activity, required for Polθ function at replication forks and DNA damage sites. Structural and functional insights provided in this study suggest a path for developing NVB derivatives with improved potency for Polθ inhibition by targeting ssDNA binding with entropically constrained small molecules.

The prevention and treatment of COVID-19 in patients treated with hemodialysis

Patients treated with hemodialysis are often immunocompromised due to concomitant disease. As a result, this population is at high risk of infection and mortality from COVID-19. In addition to symptomatic treatment, a series of antiviral drugs targeting COVID-19 are now emerging. However, these antivirals are used mainly in mild or moderate patients with high-risk factors for progression to severe disease and are not available as pre- or post-exposure prophylaxis for COVID-19. There is a lack of clinical data on the use of anti-COVID-19 drugs, especially in patients treated with hemodialysis, therefore, vaccination remains the main measure to prevent SARS-CoV-2 infection in these patients. Here, we review the clinical features and prognosis of patients on hemodialysis infected with SARS-CoV-2, the main anti-COVID-19 drugs currently available for clinical use, and the safety and efficacy of anti-COVID-19 drugs or COVID-19 vaccination in patients treated with hemodialysis. This information will provide a reference for the treatment and vaccination of COVID-19 in patients treated with hemodialysis and maximize the health benefits of these patients during the outbreak.

Gas Chromatography-Mass Spectrometry Reveals Stage-Specific Metabolic Signatures of Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a type of chronic rheumatic immune disease, and the crucial point of AS treatment is identifying the correct stage of the disease. However, there is a lack of effective diagnostic methods for AS staging. The primary objective of this study was to perform an untargeted metabolomic approach in AS patients in an effort to reveal metabolic differences between patients in remission and acute stages. Serum samples from 40 controls and 57 AS patients were analyzed via gas chromatography-mass spectrometry (GC-MS). Twenty-four kinds of differential metabolites were identified between the healthy controls and AS patients, mainly involving valine/leucine/isoleucine biosynthesis and degradation, phenylalanine/tyrosine/tryptophan biosynthesis, glutathione metabolism, etc. Furthermore, the levels of fatty acids (linoleate, dodecanoate, hexadecanoate, and octadecanoate), amino acids (serine and pyroglutamate), 2-hydroxybutanoate, glucose, etc., were lower in patients in the acute stage than those in the remission stage, which may be associated with the aggravated inflammatory response and elevated oxidative stress in the acute stage. Multiple stage-specific metabolites were significantly correlated with inflammatory indicators (CRP and ESR). In addition, the combination of serum 2-hydroxybutanoate and hexadecanoate plays a significant role in the diagnosis of AS stages. These metabolomics-based findings provide new perspectives for AS staging, treatment, and pathogenesis studies.

ART and Serum albumin are influencing factors of the 5-year survival rate of people living with HIV undergoing maintenance hemodialysis caused by HIV: A cohort study

Human immunodeficiency virus (HIV) infection is one of the most prominent public health problems worldwide. The 5-year survival rate of people living with HIV undergoing maintenance hemodialysis (MHD) and the factors related to the survival rate have not been widely studied. This study calculated the 5-year survival rate of people living with HIV who were undergoing MHD and determined the risk factors that may affect the 5-year survival rate. All enrolled participants were followed up for more than 5 years from the first round of MHD. The survival rate of them was calculated, the Cox proportional hazards model was used for multivariate analysis, the Kaplan-Meier method was used to draw the survival curve, and the log-rank test was used to compare the survival time of different groups. A total of 121 participants were included in the study. Statistical analysis showed that the overall 5-year survival rate was 19.0%. The 6-, 12-, 24-, and 36-month survival rates were 71.90%, 56.20%, 41.32%, and 30.58%, respectively. Infection was the leading cause of death, accounting for 55.37%. The Cox proportional hazards model revealed that antiretroviral therapy (ART) and the serum albumin level after dialysis were independent protective factors for patient survival. The log-rank test showed that there was a significant difference in survival time between the ART and non-ART groups.

Development of properly-polarized trophoblast stem cell-derived organoids to model early human pregnancy

The development of human trophoblast stem cells (hTSC) and stem cell-derived trophoblast organoids has enabled investigation of placental physiology and disease and early maternal-fetal interactions during a stage of human pregnancy that previously had been severely restricted. A key shortcoming in existing trophoblast organoid methodologies is the non-physiologic position of the syncytiotrophoblast (STB) within the inner portion of the organoid, which neither recapitulates placental villous morphology in vivo nor allows for facile modeling of STB exposure to the endometrium or the contents of the intervillous space. Here we have successfully established properly-polarized human trophoblast stem cell (hTSC)-sourced organoids with STB forming on the surface of the organoid. These organoids can also be induced to give rise to the extravillous trophoblast (EVT) lineage with HLA-G + migratory cells that invade into an extracellular matrix-based hydrogel. Compared to previous hTSC organoid methods, organoids created by this method more closely mimic the architecture of the developing human placenta and provide a novel platform to study normal and abnormal human placental development and to model exposures to pharmaceuticals, pathogens and environmental insults.

Motivation

Human placental organoids have been generated to mimic physiological cell-cell interactions. However, those published models derived from human trophoblast stem cells (hTSCs) or placental villi display a non-physiologic "inside-out" morphology. In vivo , the placental villi have an outer layer of syncytialized cells that are in direct contact with maternal blood, acting as a conduit for gas and nutrient exchange, and an inner layer of progenitor, single cytotrophoblast cells that fuse to create the syncytiotrophoblast layer. Existing "inside-out" models put the cytotrophoblast cells in contact with culture media and substrate, making physiologic interactions between syncytiotrophoblast and other cells/tissues and normal and pathogenic exposures coming from maternal blood difficult to model. The goal of this study was to develop an hTSC-derived 3-D human trophoblast organoid model that positions the syncytiotrophoblast layer on the outside of the multicellular organoid.

Graphical abstract

Targeting XPO1 Combined with Radiotherapy to Enhance Systemic Anti-tumor Effects in Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

The combination of radiation and radiosensitizing chemotherapeutic agents have shown promising anti-tumor effects in NSCLC. Acting as an oncogenic driver, XPO1 is frequently overexpressed and/or mutated in lung cancer. Thus, suppression of XPO1-mediated nuclear export presents a unique therapeutic strategy. We hypothesize that XPO1 inhibition combined with radiotherapy (XRT) may remodel the tumor immune microenvironment (TIME) and reduce radioresistance, thus enhance systemic anti-tumor effects.

MATERIALS/METHODS

Herein, we optimized a small molecule inhibitor, WJ01024, which can bind to XPO1 and antagonize its activity to inhibit nuclear export. In the C57BL/6 mouse subcutaneous tumor model, we evaluated the ability of different treatment regimens containing oral WJ01014 single or combined with XRT (one fractions of 15 Gy) in tumor control and tumor recurrence inhibition. The effects of each treatment regimen on the alterations of immunophenotypes, including the quantification, activation, proliferative capacity, exhaustion marker expression, and memory status, were evaluated by flow cytometry.

RESULTS

In our study, we found that the overexpression of XPO1 was associated with poor prognosis and survival in radioresistant patients with NSCLC. The combination therapy of WJ01024 and XRT resulted in an increase of apoptosis and a decrease of proliferation compared to monotherapy, which was closely correlated with tumor regression and improved survival in the C57BL/6 mouse subcutaneous tumor model. Notably, we found that WJ01024 were shown to enhance the therapeutic effect of XRT by remodeling TIME. Compared with XRT, the addition of WJ01024 increased the infiltration and proliferation of radiation-stimulated CD8+ T cells, which especially promoted the production of interferon-γ and granzyme B. Moreover, the combination therapy also reversed the immunosuppressive effect of radiation on the percentage of Tregs and exhausted T cells in mouse xenografts. Thus, the TIME was significantly improved in combination therapy. Strikingly, mechanistic studies suggested that the activation of cyclic GMP-AMP synthase/stimulator of interferon genes (cGAS/STING) signaling pathway is required to reshape TIME and produce synergistic anti-tumor effect with the combination of WJ01024 and XRT.

CONCLUSION

Our findings suggest that WJ01024 might be a potential synergistic treatment for radiotherapy to control the proliferation of NSCLC cells, promote tumor regression and prolong survival in mouse model of NSCLC by activating cGAS/STING signaling, and this in turn potentiate the immune microenvironment.

Using Longitudinal MRI to Manage Proton Range Uncertainty for Pediatric Proton Craniospinal Irradiation

PURPOSE/OBJECTIVE(S)

Clinical evidence has shown that proton therapy can effectively reduce side effects for pediatric patients undergoing vertebral body-sparing craniospinal irradiation (VBS CSI), compared to conventional photon treatment modalities. However, radiation-induced growth impairment remains challenging for VBS CSI due to proton range uncertainty, compromising vertebral body sparing for growing children. Previous studies have shown that fatty marrow replacement can be observed in vertebral bodies 4-48 weeks after treatment is complete. This study aims to detect and quantify the fatty marrow replacement in vertebral bodies using longitudinal magnetic resonance (MR) to manage proton range uncertainty.

MATERIALS/METHODS

A prospective clinical trial of proton VBS CSI was designed, and ten pediatric patients were enrolled with prescribed doses of 15-36 Gy. The thecal sac and neural foramina were the clinical target volumes, and a Monte Carlo planning system was used to robustly optimize treatment plans with a 3.5% range margin. We analyzed patients' T1/T2 MR images acquired before, during, and after proton treatment to investigate the hematopoietic marrow transformation induced by irradiation. A metric was defined to calculate the ratio of fatty and hematopoietic marrow based on relative MR intensity histograms. We proposed a machine learning method via Gaussian fitting process (ML-GFP) to explore hidden correlations between marrow transition and radiation dose to 2 cm3 of the bone marrow (D2cc). We also leveraged this method to embed uncertainty to support potential proton range management for VBS enhancement.

RESULTS

The results indicated that fatty marrow replacement could be observed during inter-fractional treatment. For instance, an individual patient showed that the fatty marrow generation ratios were 0.54, 0.74, and 0.45, corresponding to 11, 18, and 65 days after the treatment started. Using ML-GFP, the fatty marrow transition was found to be quadratically correlated to treatment fractions, and the maximum transformation ranged from 40 to 50 days. Then marrow regeneration was observed due to the decrease in fatty marrow ratios. The fatty marrow ratios were also positively correlated to the D2cc doses ranging from 10 Gy to 36 Gy. Limited by insufficient low-dose data, the ML-GFP model extrapolated the data to predict the marrow transformation below 10 Gy.

CONCLUSION

We demonstrated the feasibility of using non-invasive longitudinal MR to quantify the fatty marrow transition from inter-fractional treatment. Based on this prospective study, the method can detect early fatty marrow generation in vertebrae caused by proton irradiation due to the conservative range margin used for robust optimization. The proposed method could be used to validate the actual proton range, allowing an accurate range margin to be defined to preserve bone marrow. Future investigation will likely focus on clinical implementation to improve life quality for pediatric CSI patients.

Concurrent Chemoradiotherapy plus Programmed Death-1 (PD-1) Blockade for Locally Advanced Cervical Cancer: Preliminary Results of a Single-Arm, Open-Label, Phase II Trial

PURPOSE/OBJECTIVE(S)

This study aims to assess the anti-tumor activity and safety of concurrent chemoradiotherapy plus PD-1 blockade in patients with locally advanced cervical cancer.

MATERIALS/METHODS

This is a single-arm, open-label, prospective phase II study. The key inclusion criteria were treatment-naive patients aged 18-75 years with stage II A2-IVA (FIGO 2018) locally advanced cervical cancer. All patients were treated with concurrent chemoradiotherapy including 2 cycle cisplatin (75mg/m2, for three days, every 3 weeks[Q3W]), nedaplatin or carboplatin can be selected for patients who can't tolerate cisplatin. After CCRT, patients achieving complete response (CR), partial responses(PR), stable disease(SD) received adjuvant chemotherapy (docetaxel 75 mg/m2 day 1+ cisplatin DDP 25 mg/m2 day 1-3, Q3W) for 2 cycle. PD-1 blockade Sintilimab and Tislelizumab was administered intravenously at 200 mg every 3 weeks up to 1 year or until disease progression, unacceptable toxicity, or withdrawal of consent. The primary endpoint was objective response rate (ORR) assessed by investigators per Response Evaluation Criteria In Solid Tumours (RECIST) version 1.1. Secondary endpoints were the 12, 24-month overall survival (OS) rates, the 12, 24-month disease free survival (DFS) rates and safety.

RESULTS

From February 2020 to June 2022, a total of 15 patients was enrolled. Median age was 57 years (range, 36-74 years). Stage IIA1 was documented in 2 patients, stage IIA2 in two patients, stage IIIA in one patient, stage IIIC1 in eight patients, and stage IVA in two patients. And 66.7% (10/15) of patients had Metastatic lymph node. Four patients received adjuvant chemotherapy. The ORR was 100%, with 4 patients achieving CR and 11 PR. The 12 and 24-month OS rates are 93.3% and 84%, the 12 and 24-month DFS rates are 86% and 75.4%, respectively. Treatment-related adverse events (TRAEs) occurred in 86.7% (13/15) of patients. Grade 3 TRAEs are leukocyte (n = 1), thrombocytopenia (n = 1), hepatitis (n = 1), skin reaction (n = 1). No treatment-related deaths occurred. And IFN-γ was significantly elevated after radiotherapy (p = 0.0073).

CONCLUSION

Concurrent chemoradiotherapy plus PD-1 blockade showed promising antitumor activity and manageable toxicities in patients with locally advanced cervical cancer. Long-term outcomes are still pending to further evaluate their therapeutic effects. (ChiCTR2000032856).

Investigating sleep quality and sleep hygiene awareness among Chinese adults: an association and network analysis study

PURPOSE

The relationships between sleep quality and sleep hygiene awareness in the Chinese population were unclear. We aimed to investigate the associations and related factors between sleep quality and sleep hygiene awareness in adults and to identify the most central domain for sleep quality using network analysis.

METHODS

A cross-sectional survey was conducted from April 22 to May 5, 2020. Adults (18 years old or above) who had access to smartphones were invited to participate in this survey. The Pittsburg Sleep Quality Index (PSQI) and the Sleep Hygiene Awareness and Practice Scale (SHAPS) were used to evaluate the sleep quality and sleep hygiene awareness of the participants. Propensity score matching (PSM) was used as sensitivity analysis to reduce the confounding effects. Multiple logistic regression was performed to evaluate the associations. The R packages "bootnet" and "qgraph" were used to estimate the connection and calculate the network centrality indices between good and poor sleepers.

RESULTS

In total, 939 respondents were included in the analysis. Of them, 48.8% (95% CI: 45.6-52.0%) were identified as poor sleepers. Participants with nervous system diseases, psychiatric diseases, and psychological problems were more likely to have poor sleep quality. The notion that using sleep medication regularly was beneficial to sleep was associated with poor sleep quality. Similarly, the notion that waking up at the same time each day disrupted sleep was also associated with poor sleep quality. The findings were consistent before and after PSM. Subjective sleep quality was the most central domain for sleep quality in good and poor sleepers.

CONCLUSION

Poor sleep quality was positively associated with certain sleep hygiene notions in Chinese adults. Effective measures such as self-relief, sleep hygiene education, and cognitive behavioral treatment may have been needed to improve sleep quality, especially during the COVID-19 outbreak.