[Sternal bone marrow cell morphology evaluation utility for diagnostic categorization in patients with acquired hypocellular bone marrow failure syndromes]

Objective: Diagnostic value assessment of sternal bone marrow cell morphology in patients with acquired hypocellular bone marrow failure syndromes (BMFS) characterized by normal cytogenetics. Methods: A total of 194 eligible patients with an acquired hypocellular BMFS pre-sternum diagnosis in Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College from June 2014 to January 2019 were reviewed. Sternal bone marrow evaluation was performed, and a post-sternum diagnosis was made. Clinical characteristics and overall survival (OS) were then compared among patients with different post-sternum diagnosis. Binary logistic regression was used to develop a predictive scoring system. Results: In 152 patients with pre-sternum AA diagnosis, 29 patients with a pre-sternum idiopathic cytopenia of undetermined significance (ICUS) diagnosis, and 13 patients with a pre-sternum clonal cytopenia of undetermined significance (CCUS) diagnosis, sternal bone marrow evaluation resulted in a change of diagnosis to hypocellular myelodysplastic syndrome (hypo-MDS) in 42.8% (65/152) , 24.1% (7/29) , and 30.8% (4/13) , respectively. Patients with a post-sternum hypo-MDS diagnosis showed a significant difference in OS compared with patients with a post-sternum AA diagnosis (P=0.005) . Patients with ICUS/CCUS showed no difference in OS compared with AA and hypo-MDS (P=0.095 and P=0.480, respectively) . A 4-item predictive scoring system to identify hypocellular BMFS patients that need sternal bone marrow evaluation was developed, including age > 60 years old (OR=6.647, 95% CI 1.954-22.611, P=0.002, 2 points) , neutrophil alkaline phosphatase score ≤ 160 (OR=2.654, 95% CI 1.214-5.804, P=0.014, 1 point) , abnormal erythroid markers evaluated by flow cytometry on iliac bone marrow (OR=6.200, 95% CI 1.165-32.988, P=0.032, 2 points) , and DAT (DNMT3A, ASXL1, TET2) genes mutation (OR=4.809, 95% CI 1.587-14.572, P=0.005, 1 point) . The Akaike information criterin (AIC) was 186.1. Conclusion: Patients with a pre-sternum acquired hypocellular BMFS diagnosis characterized by normal cytogenetics may not reach accurate diagnostic categorization without sternal bone marrow cell morphology evaluation, which could be considered a diagnostic tool for this patient population. A predictive scoring system was developed, and when the total score is ≥ 2 points, sternal bone marrow evaluation should be performed for accurate diagnostic categorization that is critical to optimal patient care.

P63-expressing Prostate Adenocarcinoma: A Case Study of a Rare Subtype

Introduction/Objective

Prostate acinar adenocarcinoma (PCa) is a well-researched,and often diagnosed entity. A combination of architectural and cytologic characteristics are used in accurately identifying these carcinomas. However, the diagnosis can be challenging when the foci are minute or the cancer presents with unusual features. Ancillary studies aid in these scenarios. The loss of basal cells in adenocarcinoma makes markers targeting these cells desirable. PIN4 cocktail immunohistochemical stain, which combines alpha-methylacyl-coA racemase (AMACR), that is overexpressed in prostate carcinoma, with basal markers high molecular weight cytokeratin and p63, is a popular ancillary study to assist diagnosing demanding cases. Herein, we present a rare, challenging subtype of prostate carcinoma expressing p63.

Methods/Case Report

A 66-year-old male, with a past medical history of treated HIV and hyperlipidemia, underwent screening biopsies for a PSA of 7.5 ng/mL. Out of 22 parts, three cores showed modest amounts of atypical infiltrating cells. The architecture comprised of ill-defined glands, individual cells and single files of cells. They possessed high nucleocytoplasmic ratio giving a hint of atrophy, with occasional spindling and prominent nucleoli. To add to the challenge, PIN4 immunostaining showed strong nuclear expression of a basal marker with negative AMACR. Due to unusual morphology and basal marker expression, a consideration of basal cell lesion was entertained. However, subsequent staining revealed negative expression of HMWCK, and positive expressions of NKX3.1 and p40. Overall, with this morphology and immunoprofile we diagnosed our case as prostate carcinoma with aberrant expression of p63.

Results (if a Case Study enter NA)

N/A

Conclusion

Grading these lesions is controversial as they are considered to carry a better prognosis over conventional acinar adenocarcinoma of similar grade. A distinct etiopathology is suspected as molecular tests for ERG and PTEN are without alterations. Further discussion and characterization of these lesions is warranted as they are infrequently encountered and prone to being overlooked due to their similarities to benign basal cells.

Eosinophilic Solid and Cystic Renal Cell Carcinoma with Non-typical Immunophenotype: A Series of Two Cases

Introduction/Objective

Eosinophilic solid and cystic renal cell carcinoma (ESC RCC) is an emerging entity receiving increasing attention. Initially characterized in a large series by Trpkov et al, the distinct features of this tumor are voluminous eosinophilic cytoplasm with granular cytoplasmic stippling, mixed solid and cystic architecture, and CK20 positivity/CK7 negativity.

Methods/Case Report

We present two cases of ESC RCC diagnosed at our institution which exhibit a non-typical immunophenotype. The patients were a 58-year-old female and a 59-year-old male, with a 5.5 cm and 3.5 cm incidental renal mass, respectively. Both underwent uncomplicated partial nephrectomies. The tumors exhibited solid, alveolar, tubular and focally cystic growth patterns and were composed of cells with voluminous granular eosinophilic cytoplasm. Tubules and cysts were lined by single hobnail layer of neoplastic cells. Characteristic cytoplasmic stippling and compact leishmaniasis-like globules were present. The tumor nuclei were enlarged, with irregular nuclear contours and scattered multinucleation. The second case was significant for a diffuse neutrophil infiltration along with foamy macrophages. Immunohistochemically, the tumor cells were positive for PAX8, AMACR, CD10 and vimentin, while being negative for pan-cytokeratin, CD117, CAIX, Melan A, and HMB45. Interestingly, CK20 was only positive in very rare single cells and CK7 was focally positive in both cases. In our differentials, we considered SDH-deficient, low-grade FH-deficient, and MiT family translocation-associated RCC. FISH studies showed that the tumor cells have retained the expression of FH and SDHB, without TFE3 and TFEB alterations. Although our cases demonstrated non- typical CK20/CK7 expressions, based on the morphology with other molecular manifestations, the diagnosis of ESC RCC was rendered.

Results (if a Case Study enter NA)

NA.

Conclusion

ESC RCC poses diagnostic difficulties as many eosinophilic/oncocytic entities are included in the differentials, and the immunoprofile of this entity is variable. It is important to appreciate the characteristic histomorphologic features to increase its recognition as inclusion into the WHO classification system is likely.

A Rare Case of Primary Cardiac T-cell Lymphoma in Immunocompetent Adult

Introduction/Objective

Primary cardiac lymphoma (PCL) is an extranodal lymphoma involving only the heart and/or the pericardium. It is exceedingly rare, accounting for <2% of primary cardiac neoplasms in a surgical series and 0.05% of a >12,000 autopsies’ series, and is often associated with an immunocompromised state. Most PCL are of B- cell lineage with T-cell lymphoma constituting < 10%.

Methods/Case Report

We report a case of unexpected sudden death due to primary cardiac T-cell lymphoma in a 48-year-old immunocompetent man without significant medical history who presented in cardiopulmonary arrest following a two-week history of cold-like symptoms. Autopsy revealed an irregular, discontinuous tan plaque on the epicardial surface that extended over the right and left ventricles, and sectioning revealed that extension of the lesion throughout the subvalvular myocardium of the left ventricular wall, interventricular septum, and medial aspects of the right ventricle. The lesion had irregular areas of necrosis and hemorrhage. No lymphadenopathy or other visceral lesions were identified. Histologically, the myocardium had a regionally necrotic, angiocentric infiltrate of atypical, large, pleomorphic lymphoid cells with large, irregular nuclei, vesicular chromatin, and conspicuous nucleoli. Initial immunohistochemical work-up showed a profile of CD45+/CD20-/CD3+ suggesting a T-cell origin with CD8 predominance (CD4-/CD8+). Further work-up demonstrated a profile as CD2+/CD7+/CD25+/CD30+/EBV(EBER- ISH)+/Ki67(70-80%)/ and ALK-1-/BCL6-/CD5-/CD10-/CD56-, supporting extranodal NK/T-cell lymphoma, extranasal type with a cytotoxic T-cell subtype (perforin+/granzyme B+/TIA-1+/TCR Beta F1+).

Results (if a Case Study enter NA)

NA.

Conclusion

Primary cardiac lymphoma with cytotoxic T-cell subtype is extremely rare and fatal. This case is the third report over the past two decades, to our knowledge, of a primary cardiac T-cell lymphoma leading to acute heart failure and sudden death in an immunocompetent adult.

Diffuse Large B-cell Lymphoma of the Prostate: Case Study of an Uncommonly Encountered Entity

Introduction/Objective

Hematologic neoplasms comprise less than 1% of prostate malignancies, with diffuse large b-cell lymphoma (DLBCL) accounting for 15% of those. Chronic lymphocytic leukemia/small lymphocytic lymphoma is most often seen, comprising 53% of lymphomas at this site, with the remainder consisting of marginal zone, mantle cell, and follicular lymphomas.

Methods/Case Report

Our case involves a 51-year-old African American male presenting to a medium-sized academic medical center with a chief complaint of hematuria with clot retention. Patient did endorse night sweats and chills at this time. Imaging revealed an 11 cm mass involving the prostate and bladder, a 10 cm right adrenal mass, and pelvic lymphadenopathy. A cystoscopy with transurethral resection was performed with tissue histology showing complete effacement of prostatic parenchyma by sheets of medium-sized, mildly irregular, non-cohesive cells with minimal cytoplasm. Tissue morphology appeared highly suspicious for lymphoma, but the rarity of this process along with the possibility of other lesions led to differential diagnoses including small cell carcinoma, poorly differentiated prostatic adenocarcinoma, high-grade urothelial carcinoma, and granulomatous prostatitis. Immunohistochemical staining of neoplastic cells showed CD20+ B cells with a non-germinal center immunophenotype (CD10-) and co-expression of Bcl-2 and c-myc. Subsequent FISH analysis demonstrated a Bcl-6 gene rearrangement without a Bcl-2 or MYC rearrangement. Ki67 was positive in 90% of tumor cells. Rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone was initiated for stage IV DLBCL with prophylactic intrathecal methotrexate. The patient has received 6 cycles of chemotherapy to date with resolution of the prostate and adrenal masses. Bladder involvement is still seen radiographically, but is suspected to be mainly necrotic tissue.

Results (if a Case Study enter NA)

N/A

Conclusion

Less aggressive lymphomas are more common, which makes this presentation additionally unexpected. We employed a wide battery of immunohistochemical stains, including NKX3.1, s100, gata-3, pan-ck, CD68, and chromogranin and synaptophysin, when initially evaluating the neoplastic tissue.

Synovial Sarcoma Isn’t Supposed to To This!

Introduction/Objective

NA.

Methods/Case Report

A 35 year old male construction worker with no significant medical history presented with left posterior knee pain, weakness and numbness. Onset of symptoms coincided with an acute gout attack three months prior. Imaging revealed a 6.3 x 6.4 x 6.2 cm intraarticular, multicystic mass arising from the anterior cruciate ligament and extending posteriorly to displace the popliteal artery and vein. It was heterogenous, partially enhancing and aggressive appearing with associated bone erosion of the femoral condyle. Needle core biopsy showed a biphasic synovial sarcoma (SS), confirmed by SS18 gene rearrangement by fluorescence in situ hybridization. The patient underwent an above the knee amputation. Histologic examination of the resected tumor revealed a heterogenous histology. There were areas characteristic of a biphasic SS, hyperchromatic spindle cells, intermixed epithelial clusters and calcifications, and solid areas of round cells with necrosis and staghorn vessels, consistent with poorly differentiated SS. Additionally, a third histologic appearance with large pleomorphic tumor cells, markedly atypical mitotic figures and what appears to be matrix production was noted. These latter findings are not well described in SS but is suggestive of dedifferentiation. Next generation sequencing was performed, focused on the dedifferentiated appearing area, which confirmed the presence of SS18-SSX1 fusion. Additional findings included PDGFRA amplification and p53 mutation. We present this interesting case in order to demonstrate a previously undescribed variant of synovial sarcoma which could be a potential pitfall, especially had this been the area initially sampled in the biopsy.

Results (if a Case Study enter NA)

NA.

Conclusion

NA.

[Human chorionic gonadotropin-secreting gonadoblastomas in a girl of 45, X Turner syndrome: a case report and literature review]

Objective: To summarize the experience in diagnosis and treatment of 45, X Turner syndrome (TS) with gonadal Y chromosome mosaicism and bilateral gonadoblastoma (Gb) secreting human chorionic gonadotrophin(HCG). Methods: A female patient aged 5 years and 3 months was admitted to the hospital with a complaint of "enlarged breasts for 27 months, and elevated blood β-HCG for 8 months". The clinical data were summarized, and related literature up to March 2022 with the key words"Turner syndrome" "Gonadoblastoma" "Y chromosome" "human chorionic gonadotropin" "precocious" in PubMed, CNKI and Wanfang databases were reviewed. Results: The girl went to the local hospital for 2-month breast development at age of 3 years, and was found with a heart murmur diagnosed with "pulmonary venous malformation and atrial septal defect (secondary foramen type)". Surgical correction was performed. She experienced the progressive breast development, rapid linear growth and markedly advanced skeletal age, which cannot be explained by partial activation in the hypothalamic-pituitary-gonadal axis determined at the age of 3 years and 7 months in local hospital. Then whole-exome sequencing revealed chromosome number abnormality 45, X, which was confirmed by Karyotyping. At the age of 4 years and 6 months, serum β-HCG was found to be elevated (24.9 U/L) with no lesion found at the local hospital. On physical examination, she was found with breast development, pubic hair development and clitoromegaly with elevated serum testosterone (1.96 μg/L) and β-HCG (32.3 U/L). Sex determining region Y(SRY) gene was negative in peripheral blood sample. Thoracic and abdominal CT, head and pelvic magnetic resonance imaging were normal. Exploratory laparotomy confirmed the presence of a left adnexal tumor and a right fibrous streak gonad. During surgery, simultaneous samples of bilateral gonadal and peripheral venous blood were obtained and serum β-HCG, estradiol and testosteron concentrations was higher to lower from left gonadal venous blood, right gonadal venous blood, to peripheral venous blood. Bilateral gonadectomy was performed. Histopathology revealed bilateral gonadoblastomas. SRY was positive in bilateral gonadal tissues. After surgery, serum E₂, testerone and β-HCG returned to normal. So far 4 cases of HCG-secreting gonadoblastoma had been reported worldwide. The phenotypes of the 4 cases were all female, with virilization or amenorrhea, and the preoperative peripheral blood β-HCG concentrations were 74.4, 5.0, 40 456.0, and 42.4 U/L, respectively. Conclusions: There is a high risk of Gb in TS with Y chromosome components. Gb is infrequently presented with breast development, and Gb associated with HCG secretion is rare. Karyotyping should be performed in a phenotypic female with masculinization, and virilization in TS indicates the presence of Y chromosome material with concurrent androgen secreting tumors.

[Prevalence and risk factors of medication non-adherence in children with inflammatory bowel disease]

Objective: To investigate the prevalence and risk factors of medication non-adherence in children with inflammatory bowel disease (IBD). Methods: A cross-sectional study was conducted in Children's Hospital, Zhejiang University School of Medicine from September 2020 to March 2022 and 112 children with IBD were enrolled. Their general information, medication adherence, and parental disease-related knowledge were collected by questionnaires. According to the medication adherence score, the children were divided into the adherence group (score of 6 to 8) and the non-adherence group (score of <6), then the demographic and clinical characteristics of the two groups were compared. Subsequently, a multivariate binary Logistic regression analysis was performed to determine the risk factors of medication non-adherence. Results: Of the 112 children, 76 were males and 36 females, with the age of 12.9 (9.5, 14.0) years. There were 50 (44.6%) in the non-adherence group and 62 (55.4%) in the adherence group. Regarding the demographic and clinical characteristics, the results showed that the dosage frequency and the parental disease related knowledge were associated with medication non-adherence (both P<0.05). Multivariate binary Logistic regression analysis showed that compared with 0-6 years old children, the risk of medication non-adherence was significantly increased in children aged 7-12 years (OR=9.30, 95%CI 1.58-54.87, P=0.014) and 13-18 years (OR=8.26, 95%CI 1.49-45.85, P=0.016); and the risk was also significantly increased in children who took medication twice or more per day (OR=12.88, 95%CI 2.77-59.80, P=0.001) compared with children who took medication once per day. Meanwhile, the parental score of the questionnaire on Crohn's disease and ulcerative colitis related knowledge (OR=0.76, 95%CI 0.66-0.89, P=0.001) was also a significant risk factor. Conclusions: Medication non-adherence is common in children with IBD. Children older than 7 years, a dosage frequency of twice or more per day, and parental poor disease-related knowledge are the independent risk factors for medication non-adherence in children with IBD. Clinicians should pay attention to promoting patients' adherence to improve clinical outcomes.

Efficacy of non-surgical periodontal treatment on patients with coronary artery disease: a meta-analysis of randomized controlled trials

BACKGROUND

Coronary artery disease (CAD) is defined as one of the most common cardiovascular diseases (CVDs). Periodontitis is one of the risk factors for CAD.

MATERIAL AND METHODS

PubMed, Embase and Cochrane Library databases were carefully and thoroughly retrieved until October 2021. On the basis of the inclusion and exclusion criteria, eligible articles were selected strictly to identify randomized controlled trials (RCTs). Using Cochran's Q statistic, Review Manager 5.4 and Stata 16, data were extracted, and a comprehensive analysis was carried out.

RESULTS

Six RCTs of 619 patients were included in this study, including 360 in the intervention group (IG) and 259 in the control group (CG). Meta-analysis showed significant difference for C-reactive protein (CRP) (1.20mg/L, 95% CI: 1.13 to 1.27, p < 0.00001) after non-surgical periodontal therapy (NSPT), but showed no significant difference for interleukin-6 (IL-6) (1.19mg/L, 95% CI: -1.03 to 3.40, p=0.29), flow-mediated dilation (FMD) (-1.64%, 95% CI: -4.95 to 1.67, p=0.33), triacylglycerol (TG) (-0.02mg/dL, 95% CI: -0.31 to 0.27, p=0.90), total cholesterol (TC) (0.04mg/dL, 95% CI: -0.25 to 0.33, p=0.90), low-density lipoprotein cholesterol (LDL-C) (0.00mg/dL, 95% CI: -0.29 to 0.29, p=0.99) and high-density lipoprotein cholesterol (HDL-C) (0.11mg/dL, 95% CI: -0.18 to 0.40, p=0.46).

CONCLUSIONS

The impact of NSPT on the reduction of CRP in patients of CAD with periodontitis is significant. NSPT can be considered as an important preventive strategy for major cardiovascular events in CAD.

Prediction using T2-weighted magnetic resonance imaging-based radiomics of residual uterine myoma regrowth after high-intensity focused ultrasound ablation

OBJECTIVES

To develop and evaluate magnetic resonance imaging (MRI)-based radiomics models for predicting residual myoma regrowth within 1 year after high-intensity focused ultrasound (HIFU) ablation of uterine myomas.

METHODS

A retrospective analysis of residual myoma regrowth within 1 year was performed on 428 myomas in 339 patients who were diagnosed with uterine myoma and treated with HIFU ablation in two hospital centers. In total, 851 radiomics features were extracted from T2-weighted images (T2WI) obtained 1 day after HIFU ablation, and the least absolute shrinkage and selection operator in the training cohort (n = 243) was employed to select radiomics features. Support vector machines were adopted to develop radiomics, clinicoradiological and combined radiomics-clinical models to predict residual myoma regrowth, defined as an increase in residual myoma volume of > 10% between that at day 1 post HIFU and that at follow-up MRI within 1 year. These models were validated in both internal (n = 81) and external (n = 104) test cohorts. The predictive performance and clinical application of these models were assessed using receiver-operating-characteristics-curve analysis, the area under the curve (AUC) and decision-curve analysis.

RESULTS

The AUCs of the T2WI-based radiomics prediction model in the internal and external test cohorts were 0.834 (95% CI, 0.747-0.920) and 0.801 (95% CI, 0.712-0.889), respectively, and those of the clinicoradiological model were 0.888 (95% CI, 0.816-0.960) and 0.912 (95% CI, 0.851-0.973), respectively. The combined model had better predictive performance than either the radiomics or the clinicoradiological model, with AUC values of 0.922 (95% CI, 0.857-0.987) and 0.930 (95% CI, 0.880-0.980) in the internal and external test cohorts, respectively. Decision-curve analysis also indicated that application of the combined model has clinical value, this model achieving more net benefits than the other two models.

CONCLUSION

T2WI-based radiomics features can predict effectively the occurrence of residual myoma regrowth within 1 year after HIFU ablation of uterine myomas, which serves as an accurate and convenient reference for clinical decision-making. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

[Establishment and validation of a predictive model for neurogenic urinary tract injury in children]

Objective: To establish a predictive model for upper urinary tract damage in children with neurogenic bladder and verify its efficacy. Methods: From January 2011 to December 2021, 143 children with NB in the Children's Hospital of Chongqing Medical University and 84 children with NB in the First Affiliated Hospital of Zhengzhou University were selected as the research objects. The former is set as the training set and the latter is set as the validation set, and the general parameters of the two are compared. The independent risk factors of upper urinary tract damage in children with NB were screened out by Lasso regression, and multivariate logistic regression analysis and a nomogram prediction model was established. The models were validated internally and externally on the training set and validation set, respectively, and the area under the receiver operating curve (ROC) was used to verify the accuracy of the model. Results: A total of 227 children with NB were included in this study, including 121 males and 106 females, aged (10.2±3.8) years. There was no significant difference in other parameters except age between the training set and validation set (all P>0.05); Lasso regression and multivariate logistic regression analysis showed that detrusor leakage point pressure (DLPP) ≥ 40 cmH₂O (OR=4.76, 95%CI: 2.01-11.26, 1 cmH₂O=0.098 kPa), overactive bladder (OAB) (OR=3.08, 95%CI: 1.34-7.04), bladder compliance (BC)<20 ml/cm H₂O (OR=3.65, 95%CI: 1.41-9.47), history of previous urinary tract infection (OR=2.73, 95%CI: 1.09-6.81), and abdominal pressure/other voiding patterns (OR=2.86, 95%CI: 1.20-6.82) were risk factors for upper urinary tract damage in children with NB (all P<0.05). The above parameters were used to establish a nomogram model of upper urinary tract damage in children with NB. The internal and external validation results show that the AUC values for the training and validation sets were 0.84 (95%CI: 0.77-0.91) and 0.86 (95%CI: 0.79-0.94), respectively. Conclusion: The prediction model of upper urinary tract damage in children with NB constructed in this study has high discrimination, accuracy and clinical applicability, which can help clinicians identify high-risk patients and make individualized treatment design for these patients.

Ultralight type I transvaginal mesh: an alternative for recurrent severe posterior vaginal prolapse

OBJECTIVE

This study aimed to analyze the medium-term outcomes of ultralight type I mesh for postmenopausal women with recurrent severe posterior vaginal prolapse (PVP).

METHODS

All participants underwent transvaginal ultralight type I mesh repair between April 2016 and April 2021 and were followed until May 2022. Pelvic Organ Prolapse Quantification System (POP-Q) staging, mesh-related complications, Patient Global Impression of Improvement (PGI-I) scale and quality of life questionnaire responses were evaluated. The primary outcome was composite surgical success rate at the last follow-up, composite success being defined as no vaginal bulge symptoms, no POP-Q point at or beyond the hymen and no re-treatment for POP. Secondary outcomes included anatomic outcomes (POP-Q score), symptomatic relief and complications.

RESULTS

The median follow-up was 37.3 months. At the last follow-up, the composite success rate was 75%, and POP-Q scores for the vault and posterior wall and quality of life questionnaire scores were significantly improved (p < 0.01). The subjective satisfaction (PGI-I ≤ 2) rate was 83.3%. There were no mesh-related complications.

CONCLUSIONS

Ultralight mesh can achieve good clinical outcomes and substantially improve the quality of life of patients with severe recurrent PVP in the medium term, and may thus be a viable alternative for treating this condition.

[Research progress of polyetheretherketone and its composites in the field of dental implant]

Polyetheretherketone (PEEK) is a polymer material composed of aromatic rings connected by ether and ketone groups. It has advantages of excellent biocompatibility, stable chemical properties, and appropriate elasticity modulus. Since PEEK are increasingly used in dentistry in recent years, the properties, modification methods, and research advances of them in oral implantology were discussed in this review.

Quenching of Single-Particle Strength in A=15 Nuclei

Absolute cross sections for the addition of s- and d-wave neutrons to ^{14}C and ^{14}N have been determined simultaneously via the (d,p) reaction at 10  MeV/u. The difference between the neutron and proton separation energies, ΔS, is around -20  MeV for the ^{14}C+n system and +8  MeV for ^{14}N+n. The population of the 1s_{1/2} and 0d_{5/2} orbitals for both systems is reduced by a factor of approximately 0.5 compared with the independent single-particle model, or about 0.6 when compared with the shell model. This finding strongly contrasts with results deduced from intermediate-energy knockout reactions between similar nuclei on targets of ^{9}Be and ^{12}C. The simultaneous technique used removes many systematic uncertainties.

Quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF): a systematic review

Introduction

Heart failure with preserved ejection fraction (HFpEF) is associated with significant clinical unmet need as mortality and morbidity rates are high despite current treatments. Patient-reported quality of life (QoL) is an important and clinically relevant endpoint in patients with HF so understanding the impact of HFpEF on QoL is essential.

Purpose

The aim of this systematic review was to identify and summarize data on QoL in HFpEF.

Methods

Systematic searches of Medline, Medline Epub Ahead of Print (In-Process & Other Non-Indexed Citations), Embase, and EBM Reviews were conducted in October 2021. Congress proceedings from the past 3 years and reference lists of included publications were also searched. Publications were screened against eligibility criteria by title/abstract and then by full text. Eligibility criteria included clinical studies of any design reporting baseline QoL in adults with HFpEF published from 2016 onwards.

Results

The electronic database search identified 6,403 articles on HFpEF. After screening, 35 full publications reporting HFpEF and QoL were included. Study designs included observational cohort (n=17), cross-sectional (n=3), and post-hoc analyses of interventional studies (n=15). Tools used to measure QoL included KCCQ (n=17), MLHFQ (n=12), EQ-5D-VAS (n=8), SF-12 (n=2), SF-36 (n=2), and EHFSQ-1 (n=1). Health-state utility values (HSUVs) were captured using EQ-5D in four studies. HSUVs in HFpEF ranged from 0.67–0.74, indicating a substantial QoL burden. Eleven studies using various instruments compared QoL in patients with HFpEF vs non-HFpEF (Table 1). Of these, five reported statistically significantly poorer QOL in HFpEF vs non-HFpEF, one reported statistically significantly poorer QOL in non-HFpEF vs HFpEF and five found no statistically significant difference between HF subtypes. Four studies compared QoL in men vs women with three reporting statistically significantly worse QoL in women. Three studies examined the impact of comorbidities, and all reported statistically significantly poorer QoL in patients with comorbid atrial fibrillation, diabetes, or metabolic syndrome. Two studies examined the effect of age; one reported that, vs elderly patients (age ≥85 years), younger patients (age ≤55 years) with HFpEF had statistically significantly worse QoL despite having fewer comorbidities; in contrast, the second study reported that younger patients (age ≤55 years) had statistically significantly better QoL than elderly patients (age ≥75 years). Two studies reported on hospitalizations, with one reporting no difference in QoL between patients who had previously been hospitalized and those who had not and the other reporting that readmission for HF correlated with QoL.

Conclusions

QoL burden among HFpEF patients is substantial. QoL may be affected by age, comorbidities, gender, and prior hospitalization, and may be associated with poorer outcomes. QoL in HFpEF is generally poorer than in non-HFpEF.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): AstraZeneca

Transcriptomic profiling reveals connection to lung autonomic nervous system dysfunction and inflammation in pulmonary artery hypertension rats

Background

Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by elevated pulmonary artery pressure, right ventricular failure, and premature death. Previous studies showed autonomic nervous system (ANS) such as sympathetic nerve overactivity or impaired parasympathetic activity was implicated in the pathogenesis of PAH. However, PA remodeling and molecular mechanisms involved in ANS in PAH remain unclear.

Purpose

To unravel transcriptional regulation, underlying genes and signaling pathways linking to ANS in PAH.

Methods

Publicly available two RNA sequencing (RNAseq) datasets and one single-cell RNA sequencing (scRNAseq) data of lung from rats with PAH induced by high-dose monocrotaline (MCT) were downloaded and reprocessed. For RNA-seq data, STAR and RSEM were used for read alignment and gene expression qualification. Differential expression genes (DEGs) were identified using DSEseq2, after which enrichment analyses were implemented by clusterProfiler. scRNAseq data were analyzed using Seurat.

Results

Two RNAseq datasets identified a total of 6,046 and 2,172 DEGs respectively, including 2,945 and 1,228 up-regulated and 3,101 and 944 down-regulated. Overlapped DEGs genes among datasets were 1,123 genes. Functional enrichment analysis of downregulated DEGs in one data pointed out many dysregulated pathways related to nerve system, such as nervous system process, neuron projection, integral component of synaptic membrane in MCT-induced PAH rat (Fig. 1a). Both RNAseq datasets supported upregulated DEGs were also involved in pathways related to ANS including humoral immune response and synapse pruning (P&lt;0.001) (Fig. 1a). Intriguingly, all four genes (Trem2, C1qa, C1qb and C1qc) in synapse pruning were progressively upregulated with severe PAH condition (P&lt;0.05) (Fig. 1b, c). And RT-PCR results confirmed the expression level of these four genes were remarkably increased in PAH rats (P&lt;0.0001) (Fig. 1d). These four genes are known marker genes for macrophages from lung and microglial cell from brain. scRNAseq data of lungs demonstrated these four genes were significantly upregulated in alveolar macrophages from MCT-PAH rats (P&lt;0.001) (Fig. 1e). However, the pathogenic mechanisms of these four genes in nerve fibers from lungs underlying PAH have never been studied and would be further explored using histological analysis in this study.

Conclusions

Integrated bioinformatic analysis indicated the association of lung nervous system with PAH. Further, we identified four genes implicated in nervous system, previously reported to link to immune system and provide novel insights into the mechanisms underlying relationship between lung ANS and inflammation in the pathogenesis of PAH. The pathogenetic mechanism of these four genes is being further investigated.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Natural Science Foundation of Chinathe Nature Science Foundation of Hubei Province

Radioactivity concentration measurements in fish and shellfish samples from the west coast of Canada after the Fukushima nuclear accident (2011-2018)

Radioactive contamination of the Pacific Ocean following the Fukushima nuclear accident has raised public concern about seafood safety, particularly in coastal Indigenous communities. To address this, Health Canada and partners have collected and analyzed a total of 621 samples of commonly consumed salmon, ground fish, and shellfish from the Canadian west coast from 2011 to 2018. While the vast majority of the ¹³⁷Cs and ¹³⁴Cs levels were below the Minimum Detectable Concentration (MDC, typically 0.7-1.0 Bq kg^-1 fw for a 6 h counting), further examination of 19 fish samples revealed ¹³⁷Cs concentrations of 0.17-0.53 Bq kg^-1 fw with an average value and uncertainty (k = 1) of 0.29 ± 0.02 Bq kg^-1 fw. Of these, only two samples were found to have trace levels of ¹³⁴Cs likely derived from the Fukushima accident. The global fallout contribution from atmospheric nuclear weapons testing to the observed ¹³⁷Cs in these two samples was determined to be 0.26 ± 0.08 Bq kg^-1 fw (49 ± 14%) and 0.12 ± 0.02 Bq kg^-1 fw (24 ± 4%) for collection years 2015 and 2016, respectively. The annual average level of ¹³⁷Cs in fish and shellfish was also determined by spectral summation for collection years 2014-2018. In fish, ¹³⁷Cs levels determined through spectral summation were relatively constant (0.18-0.25 Bq kg^-1 fw) with an average value and uncertainty of 0.21 ± 0.02 Bq kg^-1 fw. By contrast, 38 shellfish samples (bivalves) were measured and revealed no radiocesium or other anomalies in either tissue or shell. In all, measurements over eight years showed that the radioactivity in fish and shellfish was dominated by natural radionuclides and that the level of anthropogenic radionuclides, as indicated by the radioactive cesium content, remained small. An upper bound for ingested dose from ¹³⁷Cs was determined to be approximately 0.26 μSv per year, far below the worldwide average annual effective dose of 2400 μSv from exposure to natural background radiation. We can therefore conclude that fish, such as salmon, ground fish, and shellfish from the Canadian west coast are of no radiological health concern despite the Fukushima Dai-ichi nuclear accident of 2011.

Logistic regression analysis of risk factors for intra-abdominal hypertension after giant ventral hernia repair: a retrospective cohort study

BACKGROUND

Intra-abdominal hypertension (IAH) is a classical complication after giant ventral hernia surgery and may lead to abdominal compartment syndrome (ACS). Assessment of risk factors and prevention of IAH/ACS are essential for hernia surgeons.

METHODS

We performed a retrospective study including 58 giant ventral hernia patients in our center between Jan 1, 2017, and Mar 1, 2022, we recorded age, gender, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), hypertension, type 2 diabetes mellitus (T2DM), hypoproteinemia, body mass index (BMI), the ratio of hernia sac volume to abdominal cavity volume (HSV/ACV), defect width, tension reduction procedure (TRP), positive fluid balance (PFB) and IAH of these patients and analyzed the data using univariate and multivariate logistic regression to screen the risk factors for IAH after surgery.

RESULTS

The multivariate analysis showed that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for the occurrence of IAH after giant ventral hernia repair (P = 0.025, 0.016, 0.017, respectively). We did not find any correlation between postoperative IAH and the patient's age, gender, COPD, CHD, hypertension, T2DM, BMI, defect width, TRP, and PFB.

CONCLUSION

Identifying risk factors is of great significance for the early identification and prevention of IAH/ACS. We found that HSV/ACV ≥ 25%, hypoproteinemia, and PFB were independent risk factors for IAH after giant ventral hernia repair.

[Association between postpartum depression and concentrations of transforming growth factor-β in human colostrum: a nested cohort study]

OBJECTIVE

To explore the association between postpartum depression (PPD) and transforming growth factor-β (TGF-β) concentrations in human colostrum.

METHODS

Participants were recruited from a maternal and infant cohort established in a tertiary general hospital in Guangdong Province between December, 2020 and September, 2021. In the afternoon of the second postpartum day, the women were evaluated with Edinburgh Postnatal Depression Scale (EPDS) for screening PPD (defined as a score of 10 or higher). The women with PPD were matched at a 1:1 ratio with women without PPD with maternal age difference within 5 years and the same mode of delivery. Colostrum samples were collected in morning on the third postpartum day for measurement of TGF-β concentrations using enzyme-linked immunosorbent assay (ELISA), and the association between EPDS scores and TGF-β concentrations was analyzed in the two groups.

RESULTS

A total of 90 women were included in the final analysis. The mean concentrations of TGF-β1, TGF-β2 and TGF-β3 in the colostrum were 684.03 (321.22-859.25) pg/mL, 5116.50±1747.04 pg/mL and 147.84±48.68 pg/mL in women with PPD, respectively, as compared with 745.67 (596.00-964.22) pg/mL, 4912.40±1516.80 pg/mL, and 168.21±48.15 pg/mL in women without PPD, respectively. Compared with women without PPD, the women with PPD had significantly lower concentrations of TGF-β1 (P=0.026) and TGF-β3 (P=0.049) in the colostrum. Spearman correlation analysis revealed that the EPDS scores were negatively associated with the concentrations of TGF-β1 (r=-0.23, P=0.03) and TGF-β3 (r=-0.25, P=0.02) in the colostrum.

CONCLUSION

PPD is associated with decreased concentrations of TGF-β1 and TGF-β3 in human colostrum, suggesting the need of early PPD screening and interventions during pregnancy and the perinatal period to minimize the impact of PPD on human milk compositions.

[Complications related to axial orientation of implants and their research progress]

The ideal axial orientation of implant is the key to the success of implant denture restoration. According to the restoration-oriented concept of implant, the implant axis direction should be consistent with the long axis direction of the suprastructure. In clinical practice, implant axial deviation leads to related complications, such as implant fracture, periimplant inflammation, and poor esthetic outcome of implant restoration, resulting in implant treatment failure. In this paper, complications related to improper implant axial orientation, their causes and treatment strategies are reviewed.

Comparison of amino acid digestibility and its additivity determined with slaughter or cecectomy method for yellow-feather chicken

The objective of this experiment was to compare the slaughter and cecectomy methods to determine amino acid (AA) digestibility of corn and soybean meal and their additivity in a corn-soybean meal diet. A completely randomized design was adopted to determine endogenous AA losses (EAAL) and AA digestibility in each of corn, soybean meal, and a corn-soybean meal diet using either slaughter or cecectomy methods. Each treatment contained 6 replicates with 3 chickens per replicate. The endogenous loss (EL) of histidine and glycine was lower and the EL of methionine and phenylalanine was greater when determined by slaughter vs. cecectomy (P < 0.05). The EL of arginine, isoleucine, leucine, lysine, methionine, phenylalanine, valine, alanine, aspartic acid, glutamic acid, and serine determined by slaughter were 1.2 to 3.2 times of those from cecectomy. The standard error (SE) of EL of 14 AA (excluding histidine and glycine) obtained by slaughter method was 2.1 to 9.6 times of those by cecectomy method. The apparent and standardized digestibility was not affected by methods for most AA except apparent digestibility of methionine, phenylalanine and glycine, and standardized digestibility of glycine in corn. The apparent and standardized digestibility of most AA except apparent digestibility of glycine and standardized digestibility of lysine, cysteine and glycine were less for slaughter versus cecectomy methods in soybean meal (P < 0.05). Using slaughter method resulted in reduced apparent digestibility of 15 AA (except glycine) and reduced standardized digestibility of 7 AA (arginine, isoleucine, leucine, valine, aspartic acid, glutamic acid, and proline) relative to cecectomy method (P < 0.05), but the standardized digestibility of glycine was greater when determined by slaughter vs. cecectomy methods in corn-soybean meal diet (P < 0.05). The mean value of SE of 16 AA digestibility in slaughter method was 2.9 times of that by cecectomy method. The apparent digestibility of 2 and 9 of 16 AA and the standardized digestibility of 15 and 7 of 16 AA were additive when using slaughter and cecectomy determinations, respectively. In conclusion, compared to the slaughter method, cecectomy method had less SE and EAAL but greater apparent digestibility of methionine and phenylalanine in corn, and the apparent digestibility of 15 AA (except glycine) in soybean meal and corn-soybean meal diet. Additivity in apparent and standardized AA digestibility was more inconsistent when determined with slaughter vs. cecectomy methods. These findings suggest that the cecectomy method is more suitable than the slaughter method to determine the digestibility of AA.

Evidence for Nonlinear Gluon Effects in QCD and Their Mass Number Dependence at STAR

The STAR Collaboration reports measurements of back-to-back azimuthal correlations of di-π^{0}s produced at forward pseudorapidities (2.6<η<4.0) in p+p, p+Al, and p+Au collisions at a center-of-mass energy of 200 GeV. We observe a clear suppression of the correlated yields of back-to-back π^{0} pairs in p+Al and p+Au collisions compared to the p+p data. The observed suppression of back-to-back pairs as a function of transverse momentum suggests nonlinear gluon dynamics arising at high parton densities. The larger suppression found in p+Au relative to p+Al collisions exhibits a dependence of the saturation scale Q_{s}^{2} on the mass number A. A linear scaling of the suppression with A^{1/3} is observed with a slope of -0.09±0.01.

[Analysis on perioperative safety and feasibility of pure single-port laparoscopic distal gastrectomy for gastric cancer]

Objective: To investigate the safety and feasibility of pure single-port laparoscopic distal gastrectomy (SDG) in the radical treatment of gastric cancer. Methods: A retrospective cohort study with propensity score matching (PSM) was conducted. Subjects were included in the study who were diagnosed by imaging examination and pathology as early distal gastric cancer, no distant metastasis, no serious cardiovascular and cerebrovascular diseases and underwent radical gastrectomy. Patients with incomplete clinical data, unplanned second operation and complicated with other tumors were excluded. A retrospective analysis was performed on 15 patients who underwent pure SDG radical gastrectomy for gastric cancer from September 2020 to March 2022, namely the SDG group. Fifty-eight patients undergoing conventional five-port laparoscopic radical gastrectomy for gastric cancer were included as the control group, namely the LDG group. As it was found that there was a statistically significant difference in baseline body mass index (BMI) between the two groups [(20.8±0.8) kg/m² vs. (22.9±0.4) kg/m², t=2.456, P=0.017], one-to-one PSM was conducted between the two groups. Then the basic conditions of the two groups of patients in perioperative period were analyzed and compared. Results: There were 14 patients after PSM in the SDG group and the LDG group respectively. There were no significant differences in intraoperative bleeding, number of lymph nodes dissected, time to the first postoperative feeding and postoperative complications between the SDG group and the LDG group (all P>0.05). Compared with LDG group, the operative time in the SDG group was longer [(163.6±6.3) minutes vs. (133.9±4.4) minutes, t=3.866, P=0.001]. However, in the SDG group, time to the first flatus [(2.6±0.2) days vs. (3.3±0.1) days, t=3.053,P=0.005], time to drainage tube removal [(4.5±0.8) days vs. (6.9±0.2) days, t=2.914, P=0.007)] and postoperative hospital stay [(6.7±0.1) days vs. (9.2±1.0) days, t=2.534,P=0.018)] were significantly shorter, and pain score at the first postoperative day evaluated by NRS (1.86±0.29 vs. 2.86±0.35, t=2.205, P=0.037) was significantly lower as compared to the LDG group. Four patients in SDG group did not receive peritoneal drainage tube placement after surgery, and they all recovered safely. Conclusion: The pure single-port laparoscopic radical gastrectomy for gastric cancer is safe and feasible, and has an advantage over the LDG in postoperative recovery.