Toll-like receptor 4 protects against irradiation-induced hematopoietic injury by promoting granulopoiesis and alleviating marrow adipogenesis

Irradiation induces severe damage in the hematopoietic system, which leads to bone marrow hyperplasia, pancytopenia, and aggravated tissue formation in bone marrow. Studies have shown that Toll-like receptor 4 (TLR4) has a protective effect against irradiation, but the underlying mechanism remains unclear. In this study, we used a TLR4 knockout (TLR4^-/-) mouse irradiation model and found that the white blood cell and platelet counts in the peripheral blood of TLR4^-/- mice recovered slowly after irradiation, with bone marrow hyperplasia and increased mortality. Additionally, we found that the proportion of CD11b⁺Gr1⁺ granulocytes in the peripheral blood and bone marrow of TLR4^-/- mice was lower than that of wild-type mice after irradiation. Further, we found that the expression of NADPH Oxidases (NOXs) in the bone marrow was down-regulated after irradiation of TLR4^-/- mice, and administration of the NOXs inhibitor VAS2870 reduced the proportion of CD11b⁺Gr1⁺ cells in the bone marrow and peripheral blood of wild-type mice after irradiation. Irradiation induced severe marrow adipocytes accumulation in TLR4^-/- mice, TLR4 ligand lipopolysaccharide promoted proliferation and inhibited adipogenic differentiation of mesenchymal stromal cells. In summary, our data suggest that TLR4 promotes myeloid hyperplasia by up-regulating the expression of NOXs after irradiation, prohibits marrow adipogensis and increases the tolerance of mice to irradiation.

Role of 3D Pseudocontinuous Arterial Spin-Labeling Perfusion in the Diagnosis and Follow-Up in Patients with Herpes Simplex Encephalitis

BACKGROUND AND PURPOSE

Early diagnosis and treatment of herpes simplex encephalitis are crucial to reduce morbidity and mortality. Our aim was to investigate the role of 3D pseudocontinuous arterial spin-labeling in herpes simplex encephalitis.

MATERIALS AND METHODS

From 2014 to 2019, seventeen consecutive patients with herpes simplex encephalitis and 15 healthy volunteers were recruited in the study. Conventional MR imaging and 3D pseudocontinuous arterial spin-labeling were performed in all subjects. According to the disease duration, the lesions were classified into 3 groups, including acute, subacute, and chronic stages, respectively. Clinical, neuroradiologic, and follow-up features were studied. The normalized lesion/normal tissue CBF values of lesions at different stages were measured and compared with those in the control group, respectively.

RESULTS

Compared with the control group, herpes simplex encephalitis demonstrated hyperperfusion in 11 acute cases and 6 subacute cases and hypoperfusion in 6 chronic cases. The mean normalized lesion/normal tissue CBF values of the lesions were 2.68 ± 0.54 in the acute stage, 2.42 ± 0.52 in the subacute stage, and 0.87 ± 0.30 in the chronic stage, respectively. The mean normalized lesion/normal tissue CBF values of acute and subacute lesions were significantly higher than those of the control group (1.33 ± 0.08; P < .001, respectively), while the mean normalized lesion/normal tissue CBF values of chronic lesions were lower than those of the control group (P < .05). Gradual perfusion reduction on serial 3D pseudocontinuous arterial spin-labeling was observed in herpes simplex encephalitis after effective therapy.

CONCLUSIONS

Conventional MR imaging remains most helpful in the diagnosis of herpes simplex encephalitis, while 3D pseudocontinuous arterial spin-labeling could be an adjunctive technique by providing dynamic CBF features at different stages in herpes simplex encephalitis.

High-Fat Diet from Weaning until Early Adulthood Impairs T Cell Development in the Thymus

The growing prevalence of childhood obesity has become a serious health problem over the past few decades. Although the immune system is greatly affected by childhood obesity, whether obesity influences the T cell development in the thymus is poorly understood. In this study, we used a high-fat diet (HFD)-induced obesity mice model to study the influence of HFD from weaning on the thymus. C57BL/6 mice (male, 3 weeks old) were fed a HFD or standard diet (lean controls) for 6 weeks. The bodyweight of mice fed with an HFD was 28% higher than that in the control group, while the thymus weight of HFD mice decreased by 15% compared with controls. As expected, thymic triacylglycerol content of the HFD mice increased by 37% compared to the control mice. Importantly, the frequencies of CD4⁺ and CD8⁺ single-positive (SP) thymocytes decreased by 38% and 44%, respectively. The apoptotic analysis revealed that thymic tissue of HFD mice had a higher level of Annexin-V positive thymocytes than control animals. Furthermore, the immunoblotting analysis showed that survival signal pathways in the thymus were impaired in the HFD mice, including the AKT/mTOR and ERK pathways. With the analysis of T-cell receptor excision circles (TREC), we found that HFD-induced obesity decreased recent thymic emigrants in spleen tissue. Our findings indicate that HFD from the weaning period impairs T cell development in the thymus, possibly by induction of apoptosis of thymocytes, involving disruption of survival signal pathways.

Gaseous and particulate pollutants in Lhasa, Tibet during 2013-2017: Spatial variability, temporal variations and implications

In recent decades, most big cities in China have experienced severe air pollution accompanied by rapid economic and social development. Analysis of measurements of air pollutants form a fundamental basis for understanding the characteristics of air pollution and are important references for policy-making. In this study, five-year measurements of air pollutants at 6 sites in Lhasa, a typical high altitude big city in southwestern China, were analyzed from January 2013 to December 2017. Air pollutants at all the 6 sites in Lhasa generally displayed similar patterns of both diurnal and monthly variations, indicating the mixed atmospheric environment and the overall effect of the meteorological conditions in the city. Spatially, the air pollutant concentrations at the 6 sites were generally characterized by high concentrations of SO₂, NO₂, CO, PM₁₀ and PM_2.5 at urban sites and high O₃ concentrations at suburban sites. In comparison with other provincial capital cities in China, Lhasa has low concentrations of air pollutants, except for O₃, and thus, better air quality. Although Lhasa has experienced rapid urbanization and economic development, air pollution conditions have remained rather stable and even decreased slightly in term of particular air pollutants. We suggested that the relatively isolated location, low air pollutant emissions associated with its industrial structure and renewable energy consumption, and effective air pollution control measures, collectively contributed to the synchronous improvement of the economy and air quality in Lhasa. Such "Lhasa pattern" may serve as a positive example for other regional hub cities in China and beyond that experience socioeconomic development and simultaneously seek to improve air quality.

Adaptive regulation of detoxification enzymes in Helicoverpa armigera to different host plants

Cotton plants produce gossypol as a major secondary metabolite to resist insect herbivores and pathogens. Helicoverpa armigera may employ multigene families of detoxification enzymes to deal with this metabolite. So far, the strength of the transcriptional response to gossypol detoxification in the cotton bollworms remains poorly understood. Here, we investigated the genomewide transcriptional changes that occur in cotton bollworm larvae after one generation feeding on various host plants (cotton, corn, soybean and chili) or an artificial diet. Six genes potentially involved in detoxification of xenobiotics were highly upregulated in bollworms fed on cotton, and the expression of five of these differed significantly in insects that fed on gossypol diet compared with the artificial diet. When these six genes were downregulated using RNA interference, downregulation only of CYP4L11, CYP6AB9 and CCE001b led to reduced growth of bollworm larvae feeding on gossypol diets. These data suggest that the three genes are involved in response of H. armigera to gossypol of cotton. Our results proved that H. armigera may have a broad mechanism for gossypol detoxification.

Unusual plastic deformation behavior of nanotwinned Cu/high entropy alloy FeCoCrNi nanolaminates

Compared with coarse-grained FeCoCrNi-based high entropy alloys (HEAs), their nanocrystalline (NC) siblings with ultra-high strength often suffer from notably reduced deformability. Here, to enhance the deformability of these NC HEAs without losing their high strength, we design equal layered nanotwinned (NT) Cu/HEA (HEA = FeCoCrNi) crystalline/crystalline nanolaminates (C/CNLs) with coherent crystalline/crystalline interfaces (CCIs). In contrast to the tenet that in conventional bimetal C/CNLs, the soft/ductile phase plays the dominant major role, we discover that in NT Cu/HEA C/CNLs, the hard HEA phase unusually makes more contribution to the plastic deformation. The underlying reason is that the soft NT Cu layers without dislocation pile-up serve as the dislocation donator and export abundant dislocations that transmit across the coherent CCIs into the hard HEA accepter, and thus trigger their great deformability. The size-dependent hardness was explained based on dislocation-based models considering the stability of extremely small nanotwins with thickness less than ∼10 nm. These findings provide a new pathway to achieve great deformability of strong alloys with high lattice friction stresses in ultra-strong metallic composites: control the size of NT soft phases to suppress dislocation pile-up in conjunction with coherent CCIs to facilitate continuity of dislocation slip.

SAT-047 Disorders in Mice with Subclinical Hypothyroidism

Subclinical hypothyroidism (SCH) is becoming a global health problem because of its increasing prevalence and potential adverse effects, including cardiovascular diseases and nonalcoholic fatty liver disease. However, the association remains controversial. MicroRNAs (miRNAs) have been shown to be implicated in lipid metabolism disorders. But how miRNAs regulate hepatic lipid metabolism in SCH remains unknown. We investigated miRNA alterations and proteome profiles in a SCH mouse model, which were generated with methimazole(MMI) for 16 weeks. The profiles of 17 miRNAs which are critical to hepatic lipid metabolism and proteome were investigated using quantitative PCR and iTRAQ labeling in the livers from SCH (n=9) and control mice (CON, n=7). Putative targets prediction of miRNAs was carried out using Targetscan and miRanda. Compared with the control mice, SCH mice had significantly different expressed 8 miRNAs and 36 proteins in livers. We identified a regulatory module containing 3 miRNAs (miR-34a-5p, miR-24-3p, miR-130a-3p ) and 5 proteins (Thioredoxin (Txn), Aldehyde dehydrogenase (Aldh3a2), Selenium-binding protein 2(Selenbp2), Elongation factor 1-beta( Eef1b) and Prosaposin, isoform CRA-a (Psap)). Integrated analysis of miRNA and proteome highlighted a regulatory module between miRNAs and proteins, which, to some extent, may contribute to a better understanding of hepatic lipid metabolism disorders in SCH mice.

[Emotional and behavioral problems associated with sleep problems in preschool aged children]

Objective: To examine whether sleep problems are related to both emotional and behavioral problems in children aged 3-6 years. Methods: A large cross-sectional study was conducted in Anqing, Wuhu, Tongling and Yangzhou from March to June 2015. A total of 8 900 preschool aged children were included. Sleep problems were obtained by using adapted BISQ completed by the parents or the people who took care of children. Emotional and behavioral problems of the children were accessed by using Strengths and Difficulties Questionnaire (SDQ), and multivariate logistic regression model was used for statistical analyses. Results: The detected rates of emotional symptoms, conduct problems, hyperactivity problems, peer problems, total difficulties and prosocial behavior in preschool aged children were 9.0%, 13.9%, 18.9%, 25.5%, 13.6% and 16.2% respectively. All the detected rates were higher in boys than in girls except the higher rate of emotional symptoms. The proportions of children with high sleep quality, moderate sleep quality and poor or worse sleep quality were 3.9%, 52.9% and 43.2% respectively. After controlling the confounding factors of demographic variables, including gender, age, delivery mode, birth weight, birth height and patent's educational level, multinomial logistic regression analysis showed that the risk of emotional symptoms, conduct problems, hyperactivity problems, peer problems, total difficulties and prosocial behavior in children with longer sleep duration was lower than that in children with shorter sleep duration, the ORs were 0.86 (95%CI: 0.77-0.95), 0.85 (95%CI: 0.78-0.93), 0.85 (95%CI: 0.79-0.92), 0.87(95%CI: 0.81-0.93), 0.83 (95%CI: 0.76-0.91) and 0.82 (95%CI: 0.76-0.89) respectively. Compared with the children with good sleep quality, the risk of emotional symptoms, conduct problems, hyperactivity problems, peer problems, total difficulties and prosocial behavior were higher in children with poor or worse sleep quality, the ORs were 3.26 (95%CI: 2.40-4.42), 2.86 (95%CI: 2.16-3.78), 2.60 (95%CI: 2.00-3.38), 1.96 (95%CI: 1.52-2.54), 4.02 (95%CI: 3.06-5.27) and 2.56 (95%CI: 1.96-3.35) respectively. Conclusion: There was a negative impact of shorter sleep and poor or worse sleep on emotional and behavioral problems of preschool aged children.

Abstract P4-08-33: The significance of Oncotype DX recurrence score in T1-2N1M0 ER positive HER2 negative breast cancer: An analysis combined with the prognostic stage in the updated AJCC 8th edition

Purpose: Oncotype DX recurrence score (Oncotype DX RS) is applied in the prognostic stage in T1-2N0M0 ER+/HER2- breast cancer. But its significance is unclear in cases with T1-2N1M0 ER+/HER2- disease. Our study was to evaluate the prognostic significance of Oncotype DX RS in combination with the prognostic stage in the updated AJCC 8th edition. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was searched to identify invasive ductal breast cancer cases in T1-2N1M0 stage with ER positive HER2 negative status and Oncotype DX RS diagnosed between 2004 and 2012. Patients with unknown histologic grade or PR status, no or unknown surgery performed, or less than 6 months of follow up were excluded. Patients with RS 0-10, 11-25, &gt;25 were categorized into low risk, midrange risk and high risk groups respectively. Comparisons of the distribution of RS groups among prognostic stages were performed using Pearson's chi-square. Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared across RS groups using the log-rank statistic. Cox models were fitted to compare the association between RS groups, prognostic stages and BCSS or OS after adjusting for other characteristics. Results: Altogether 4059 cases were enrolled, which were categorized into prognostic stage IA-IIIA (only 357 cases in stage IIB and 35 cases in stage IIIA). More than 60% cases in prognostic stage IA-IIA had their RS in midrange risk group. There were decreasing proportion of low risk RS group and increasing proportion of high risk RS group with the ascending of prognostic stages (P&lt;0.001). The median follow up was 59 months. There were significant differences in BCSS and OS among RS groups (log-rank P&lt;0.001). In the subgroup analysis, there were also significant differences in BCSS and OS among RS groups in prognostic stages IA-IIA. In the multivariate Cox analysis, the RS group was an independent prognostic factor for BCSS (midrange risk vs. low risk, HR=3.647, 95% CI: 1.124-11.837, P=0.031; high risk vs. low risk, HR=15.372, 95% CI: 4.600-51.374, P&lt;0.001) and OS (midrange risk vs. low risk, HR=1.718, 95% CI: 1.039-2.840, P=0.035; high risk vs. low risk, HR=4.225, 95% CI: 2.462-7.251, P&lt;0.001) along with the prognostic stage. Conclusions: Oncotype DX RS has prognostic significance in T1-2N1M0 ER+/HER2- disease. Further prospective research is warranted.

Citation Format: Chen H, Wang M, Zhang P, Zhang M, Wu K. The significance of Oncotype DX recurrence score in T1-2N1M0 ER positive HER2 negative breast cancer: An analysis combined with the prognostic stage in the updated AJCC 8th edition [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-33.

Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity

Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People's Hospital and divided into experimental (n=89) or control (n=151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate. Only two patients developed transoral salivary fistulas in the experimental group, while in the control group there were 14 (9%). The incidence of fistulas in the experimental group was significantly lower than that in the control group (p=0.035). Regression analysis showed that there was a significant correlation between the groups and the incidence of salivary fistulas (p=0.032). The two-step suture technique is safe, effective, and easy to learn, and could reduce the incidence of postoperative salivary fistulas.

NEAT1 is a potential prognostic biomarker for patients with nasopharyngeal carcinoma

Nuclear paraspeckle assembly transcript 1 (NEAT1) has been found to be dysregulated and associated with clinical progression in various human cancers. The clinical and prognostic value of NEAT1 in nasopharyngeal carcinoma (NPC) was still controversial. The aim of our study was to provide more sufficient evidence that NEAT1 expression is correlated with overall survival in patients with NPC. NEAT1 expression was detected in NPC tissue samples, and the relationship between NEAT1 expression and clinical parameters, including prognosis, was analyzed. The meta-analysis was performed to further assess the prognostic significance of NEAT1 expression in patients with NPC. In our study, we found that the levels of NEAT1 expression were increased in NPC clinical tissue specimens, and associated with advanced M classification and clinical stages. Moreover, the Kaplan-Meier analysis suggested that the levels of NEAT1 expression were negatively associated with the overall survival of patients with NPC. Furthermore, univariate and multivariate Cox regression analyses showed that NEAT1 high-expression was an independent unfavorable prognostic factor in patients with NPC. Finally, we conducted a meta-analysis including 297 patients with NPC from the three studies, and found the pooled HR (95% confidence interval [CI]) was 1.64 (95% CI: 0.68-3.93) for the random effects model and 2.04 (95% CI: 1.42-2.95) for the fixed effect model. In conclusion, NEAT1 is a potential prognostic biomarker for NPC, but more studies are needed to further verify the prognostic value of NEAT1 in patients with NPC.

Abnormal Glucose Metabolism and Insulin Resistance Are Induced via the IRE1α/XBP-1 Pathway in Subclinical Hypothyroidism

Subclinical hypothyroidism (SCH) and diabetes mellitus are closely related and often occur together in individuals. However, the underlying mechanism of this association is still uncertain. In this study we re-analyzed the data of a mature database (NHANES, 1999 ~ 2002) and found that both fasting plasma glucose levels and the proportion of hyperglycemic subjects among SCH patients were higher than that found in euthyroid controls. SCH was also associated with a 2.29-fold increased risk for diabetes. Subsequently, we established an SCH mouse model and subjected it to an oral glucose tolerance test (OGTT) and an insulin tolerance test (ITT). SCH mice exhibited impaired glucose and insulin tolerance. Increased HOMA-IR and decreased ISI indexes, indicating insulin resistance (IR), were also observed in the SCH state. Hepatic ERp29 and Bip, as well as IRE1α and XBP-1s, were induced significantly in SCH mice, suggesting the induction of endoplasmic reticulum (ER) stress, particularly involving the IRE1α/XBP-1s pathway. Interestingly, when we relieved ER stress using 4-phenyl butyric acid, abnormal glucose metabolism, and IR status in SCH mice were improved. Our findings suggest that ER stress, predominantly involving the IRE1α/XBP-1s pathway, may play a pivotal role in abnormal glucose metabolism and IR in SCH that may help develop potential strategies for the prevention and treatment of diabetes.

Bio-orthogonal chemistry-based method for fluorescent labelling of ribosomal RNA in live mammalian cells

A bio-orthogonal chemistry-based approach for fluorescent labelling of ribosomal RNA is described.

Pulmonary hemorrhage in neonatal respiratory distress syndrome: Radiographic evolution, course, complications and long-term clinical outcomes

BACKGROUND

Pulmonary hemorrhage (PH) is occasionally seen in premature infants after surfactant treatment for respiratory distress syndrome (RDS). These infants receive frequent chest radiographs (CXR) during and after hospitalization enabling long-term radiographic-clinical correlation.

OBJECTIVE

To chart the natural evolution of CXR findings of PH in RDS and correlate radiographic patterns to supplemental oxygen requirement.

MATERIALS AND METHODS

Retrospective review of clinical notes for gestational age (GA), birth weight (BW), intraventricular hemorrhage (IVH) and oxygen requirement were performed. CXRs were reviewed at 4 time-points; during PH, 28 days postnatal age, 36 weeks and at farthest available clinical follow-up.

RESULTS

18 infants born (2003-2016), GA (24-30 weeks); BW (482-1590 grams) were included. Mean onset of PH was 1.94 (0-5) days. 9/18 (50%) had IVH. 3 died during PH; all had IVH. During PH, CXR showed whiteout 9/18 (50%); patchy opacities 5/18 (27%); diffuse haziness 1/18 (6%) and no change 3/18 (17%). At 28 days postnatal age, CXR showed fine-interstitial (FI) markings 14/15 (93%) and whiteout 1/15 (7%). At 36 weeks,12/14 (85%) had FI and 2/14 (15%) developed cystic-interstitial changes. At farthest follow-up, FI 3/13 (23%); coarse-interstitial 4/13 (30%); peri-bronchial cuffing 5/13 (38%); normal 1/13 (9%) and the majority had hyperinflation 9/13 (69%). At discharge, 9/14 (64%) required home-oxygen and 5/14 (36%) were on room-air. At farthest follow-up, 6/14 (42%) required home-oxygen and 8/14 (58%) were on room-air.

CONCLUSION

Premature infants that survive PH may later develop chronic lung disease of prematurity with an evolving interstitial pattern on CXR that clears overtime as they outgrow the need for supplemental oxygen.

Probing the size- and constituent-mediated mechanical properties and deformation behavior in crystalline/amorphous nanolaminates

Two kinds of crystalline/amorphous nanolaminates (C/ANLs), i.e., Ag/Cu-Zr and Mo/Cu-Zr, with a wide range of modulation ratios η (thickness ratio of the amorphous layer to the crystalline layer) from 0.1 up to 9.0 were, respectively, prepared using magnetron sputtering. The hardness and the strain rate sensitivity m were measured for comparison through nanoindentation testing. The mechanical properties displayed a strong η-dependence, which was tuned by the crystalline phases. With the increase of η, the hardness increased in the Ag/Cu-Zr nanolaminates while it decreased in the Mo/Cu-Zr ones. However, the two C/ANLs showed similar variations in m that was reduced gradually from positive values at small η to negative values at large η. Microstructural examination demonstrated that the amorphous Cu-Zr layers in both the C/ANLs showed a deformation-induced crystallization (DIC) phenomenon within the nanoindentation deformation zone. The DIC was highly dependent on η and became more intense in the Mo/Cu-Zr than in the Ag/Cu-Zr C/ANLs. The η- and constituent-dependent DIC behaviors were rationalized in light of the stress field applied on the amorphous layers that is sensitive to both the amorphous layer thickness and the crystalline constituents. This DIC-induced negative m in amorphous layers competed with the positive m in crystalline layers, leading to a negative-to-positive change in m on reducing η. The underlying deformation mechanism was revealed to be the cooperation between dislocation activities in the crystalline layers and shear transformation zone motions in the amorphous layers. Furthermore, a modified mechanistic model was utilized to quantitatively describe the η-dependent hardness at different crystalline constituents.

Excessive mitochondrial fragmentation triggered by erlotinib promotes pancreatic cancer PANC-1 cell apoptosis via activating the mROS-HtrA2/Omi pathways

Background

Mitochondrial fragmentation drastically regulates the viability of pancreatic cancer through a poorly understood mechanism. The present study used erlotinib to activate mitochondrial fragmentation and then investigated the downstream events that occurred in response to mitochondrial fragmentation.

Methods

Cell viability and apoptosis were determined via MTT assay, TUNEL staining and ELISA. Mitochondrial fragmentation was measured via an immunofluorescence assay and qPCR. siRNA transfection and pathway blockers were used to perform the loss-of-function assays.

Results

The results of our study demonstrated that erlotinib treatment mediated cell apoptosis in the PANC-1 pancreatic cancer cell line via evoking mitochondrial fragmentation. Mechanistically, erlotinib application increased mitochondrial fission and reduced mitochondrial fusion, triggering mitochondrial fragmentation. Subsequently, mitochondrial fragmentation caused the overproduction of mitochondrial ROS (mROS). Interestingly, excessive mROS induced cardiolipin oxidation and mPTP opening, finally facilitating HtrA2/Omi liberation from the mitochondria into the cytoplasm, where HtrA2/Omi activated caspase-9-dependent cell apoptosis. Notably, neutralization of mROS or knockdown of HtrA2/Omi attenuated erlotinib-mediated mitochondrial fragmentation and favored cancer cell survival.

Conclusions

Together, our results identified the mROS-HtrA2/Omi axis as a novel signaling pathway that is activated by mitochondrial fragmentation and that promotes PANC-1 pancreatic cancer cell mitochondrial apoptosis in the presence of erlotinib.

Electronic supplementary material

The online version of this article (10.1186/s12935-018-0665-1) contains supplementary material, which is available to authorized users.