The association between 2,4-D and serum testosterone levels: NHANES 2013-2014

BACKGROUND

Previous studies have investigated associations between herbicides such as 2,4-Dichlorophenoxyacetic acid (2,4-D) and dyshormonogenesis, specifically low testosterone, in human, rodent, and cell models, but results have been conflicting and inconclusive.

METHODS

Using data from a cross-sectional study of 456 adult men in the 2013-2014 NHANES survey cycle, we examined the relationship between urinary concentrations of 2,4-D and serum testosterone levels.

RESULTS

Multivariable regression models adjusting for potential confounders revealed a significant, negative association between urinary 2,4-D and mean serum testosterone among U.S. adult males (β =  - 11.4 ng/dL, p = 0.02). Multivariable logistic regression models using a cutoff defining abnormally low testosterone (i.e., serum testosterone < 300 ng/dL) revealed no significant associations between 2,4-D and the odds of low testosterone.

CONCLUSION

These findings expand on previous literature implicating a role for 2,4-D in the etiology of low testosterone and dyshormonogenesis. Future studies are warranted to corroborate these findings, determine clinical significance, and to investigate the proposed potential biological mechanisms underlying this association.

Quantitative RNA assessment and long-term stability in the FFPE tumor samples using Digital Spatial Profiler

Background

Long-term storage of tissue slides has been reported to induce reduced biomarker (e.g. proteins and messenger RNA) detection. This study aimed to evaluate the impact of long-term storage time (0, 16, 24 and 36 weeks) and treatment conditions (non-paraffin and paraffin dipping) at 4°C on RNA quality in formalin-fixed and paraffin-embedded (FFPE) tissue sections.

Materials and methods

NanoString GeoMx Digital Spatial Profiling (DSP), a novel platform that allows spatial profiling, was used to profile RNA in human bladder cancer FFPE tissue sections.

Results

We observed excellent consistency of quantitative DSP RNA counts of all targets between two different treatment conditions (R > 0.97, Pearson correlation) at each time point and among all four different storage time points (R > 0.96, Pearson correlation) within each treatment condition. No significant difference was observed in the percentage of target genes with sufficient signal across two different treatment conditions at any time point (0 week, P = 0.96; 16 weeks, P = 0.76; 24 weeks, P = 0.96; 36 weeks, P = 0.76, Kolmogorov–Smirnov test) and across all four different storage time points (P > 0.05, Kolmogorov–Smirnov test) in either treatment condition.

Conclusion

Although both treatment conditions provided similar results in terms of count reproducibility and signal preservation, we recommend paraffin dipping to generate reproducible RNA results and optimize sample storage. Technology behind the NanoString GeoMx DSP platform shows a robust and reproducible RNA signal from multiple targets in the FFPE tissue sections stored at 4°C for at least up to 36 weeks.

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Long-term storage of FFPE sections has been reported to induce reduced antigen detection especially for RNA.

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This study evaluated the impact of storage times and treatment conditions on FFPE sections.

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The GeoMx DSP system, a novel platform that allows spatial RNA profiling, has been utilized.

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Long-term antigenicity preservation of quantitative DSP RNA counts was reported among storage times and treatment conditions.

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This finding is valuable in low resourced settings where routine access to FFPE blocks is challenging.

SMDI: An Index for Measuring Subgingival Microbial Dysbiosis

An intuitive, clinically relevant index of microbial dysbiosis as a summary statistic of subgingival microbiome profiles is needed. Here, we describe a subgingival microbial dysbiosis index (SMDI) based on machine learning analysis of published periodontitis/health 16S microbiome data. The raw sequencing data, split into training and test sets, were quality filtered, taxonomically assigned to the species level, and centered log-ratio transformed. The training data set was subject to random forest analysis to identify discriminating species (DS) between periodontitis and health. DS lists, compiled by various "Gini" importance score cutoffs, were used to compute the SMDI for samples in the training and test data sets as the mean centered log-ratio abundance of periodontitis-associated species subtracted by that of health-associated ones. Diagnostic accuracy was assessed with receiver operating characteristic analysis. An SMDI based on 49 DS provided the highest accuracy with areas under the curve of 0.96 and 0.92 in the training and test data sets, respectively, and ranged from -6 (most normobiotic) to 5 (most dysbiotic) with a value around zero discriminating most of the periodontitis and healthy samples. The top periodontitis-associated DS were Treponema denticola, Mogibacterium timidum, Fretibacterium spp., and Tannerella forsythia, while Actinomyces naeslundii and Streptococcus sanguinis were the top health-associated DS. The index was highly reproducible by hypervariable region. Applying the index to additional test data sets in which nitrate had been used to modulate the microbiome demonstrated that nitrate has dysbiosis-lowering properties in vitro and in vivo. Finally, 3 genera (Treponema, Fretibacterium, and Actinomyces) were identified that could be used for calculation of a simplified SMDI with comparable accuracy. In conclusion, we have developed a nonbiased, reproducible, and easy-to-interpret index that can be used to identify patients/sites at risk of periodontitis, to assess the microbial response to treatment, and, importantly, as a quantitative tool in microbiome modulation studies.

[Proteinuria associated with hookworm infection: a case report]

As a common soil-borne nematode, hookworm is mainly parasitized in the intestine, and the clinical manifestations of hookworm infections mainly include gastrointestinal symptoms and iron-deficiency anemia. In addition, hookworm may be also parasitized in other organs in addition to gastrointestinal system, resulting in development of disorders in other systems. Proteinuria caused by hookworm infections is rare and easy to be misdiagnosed in clinical practices. Hereby, the diagnosis and treatment of a case of proteinuria associated with hookworm infections was reported, in order to increase the understanding of hookworm infection-associated proteinuria among clinicians.

A110 FEASIBILITY OF EUS-GUIDED PORTAL PRESSURE GRADIENT MEASUREMENT WITHOUT DEEP SEDATION: A PATH TO ACCURATE PORTAL PRESSURE DETERMINATION

Aims

Hepatic venous pressure gradient (HVPG) is the gold standard for the diagnosis and staging of portal hypertension. Previous studies have shown that it underestimates pre-sinusoidal portal hypertension. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) can safely measure direct portal vein pressure (PVP) and bridge this diagnostic gap. However, EUS-PPG has so far been performed with patients under deep sedation which can alter HVPG measurement and lead to misclassification of portal hypertension. Ketamine, a conscious sedation agent, has minimal effect on portal hemodynamics. We present our center’s experience with EUS-PPG under ketamine and low dose midazolam.

Methods

We retrospectively reviewed consecutive patients undergoing EUS-PPG with conscious sedation using ketamine and low-dose midazolam (<0.02 mg/kg) at the McGill University Health Centre from February to May 2021. Patients were placed in the left lateral position. Hepatic vein and portal vein were located through EUS via a trans-gastric/hepatic approach. A through the scope 25-gauge needle attached to a manometer was advanced through the liver to measure hepatic vein pressure (HVP) and portal vein pressure (PVP). Three measurements were sampled per vessel and mean pressure differences calculated to obtain PPG. PPG was considered reliable if the differences between the values was no more than 1mmHg.

Results

Three patients underwent EUS-PPG for evaluation of pre-sinusoidal portal hypertension. Cirrhosis was excluded in all patients based on recent liver biopsy or transient elastography. The first patient is a 69-year-old man with splenomegaly and recanalization of the paraumbilical vein on imaging. He received 80 mg of ketamine and no midazolam. HVPG measured was 1 mmHg. EUS-PPG was successful with PPG of 6 mmHg (HVP= 7 mmHg, and PVP= 13 mmHg). The second patient is a 42-year-old woman with previous sleeve gastrectomy and known with portal cavernoma. She received 120 mg of ketamine and 1 mg of midazolam. EUS-PPG was technically difficult due to respiratory movements. The measurement was not considered reliable as differences in PPG were as high as 2mmHg. In this case, PPG was 0mmHg (HVP= 15mmHg, and PVP= 15mmHg). The third patient, a 74-year-old man with hepatic steatosis and splenomegaly received 70 mg of ketamine and 1 mg of midazolam. EUS-PPG was successful (HVP= 3mmHg, PVP= 3mmHg) yielding a PPG 0mmHg. All patients tolerated the procedure well with no procedural or sedation-related complications

Conclusions

Our early experience suggests that EUS-PPG can be successfully and safely performed in patients under conscious sedation with ketamine and low-dose midazolam. This combination may avoid deep sedation with high dose midazolam or propofol which are known to alter accuracy of HVPG.

Measurement of HVP (left) and PVP (right)

Funding Agencies

None

The relationship between serum 25-hydroxyvitamin-D level and sweat function in patients with type 2 diabetes mellitus

AIMS

The objective of this study is to explore the relationship between serum 25-hydroxyvitamin-D(25-(OH)₂D₃) level and sweat function in patients with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study of 1021 patients with T2DM who underwent 25-(OH)₂D₃ level detections and sweat function tests was carried out. These individuals were divided into deficient groups (n = 154 cases), insufficient groups (n = 593 cases) and sufficient groups (n = 274 cases). Spearman correlation analysis and multivariate stepwise linear regression analysis were implemented to determine the association of 25-(OH)2D3 level and sweat function.

RESULTS

The total presence of sweating dysfunction was 38.59%. Patients with a lower level of serum 25-(OH)₂D₃ had more severe sweat secretion impairment (P < 0.05). As the decrease of serum 25-(OH)₂D₃ level, the presence of sweating dysfunction increased (P < 0.05). 25-(OH)₂D₃ level was positively correlated with sweat function parameters, age and duration of T2DM were negatively correlated with sweat function parameter (P < 0.05). Multivariate stepwise linear regression analysis explored a significant association between serum 25-(OH)₂D₃ level with sweat function (P < 0.05).

CONCLUSIONS

Serum 25-(OH)₂D₃ level was positively correlated with sweat function in patients with T2DM.

[Establishment and analysis of prediction model for invasive subsolid pulmonary nodules based on radiomics]

Objective: To evaluate the best radiomic features based prediction model for identifying the histopathological subtypes of invasive adenocarcinoma or noninvasive pulmonary nodules appearing as subsolid nodules. Methods: A total of 352 patients (108 males and 244 females, median age was [M(Q₁,Q₃)]57 (50,65), underwent high-resolution chest CT and appearing as subsolid nodules and further treated by surgical resection whose subsequently pathological results were classified as atypical adenomatous hyperplasia (AAH), carcinoma in situ (AIS), microinvasive carcinoma (MIA), invasive adenocarcinoma (IA), from January 2015 to September 2019, in Radiology Department of Zhongda Hospital Affiliated to Southeast University and Jinling Hospital, Medical School of Nanjing University were retrospectively collected. They were divided into non-invasive group (n=233) and invasive group (n=119) according to pathological findings. According to the ratio of training set: internal test set: external test set, which is about 3∶1∶1,the patients in Zhongda Hospital Affiliated to Southeast University were randomly divided into training set (n=215, non-IA∶IA 155∶60) and internal test set(n=69, non-IA∶IA 52∶17), meanwhile a certain number of patients in Jinling Hospital, Medical School of Nanjing University(n=68, non-IA∶IA 26∶42)were randomly selected as an independent external test set. Particular quantitative parameters of the nodules, radiomic features, morphological characteristics, clinical data, and serum tumor markers were recorded. Radiomic label was constructed using LASSO regression method. The morphological model, CT model and comprehensive model were constructed by binary logistic regression and were verified in test sets, respectively. Results: Shape_MinorAxis(Gradient),Glszm_ZoneEntropy(LBP) were selected as the two most significant features based on training set. Radiomic tag=1.065 75×Shape_MinorAxis(Gradient)+0.030 58×Glszm_ZoneEntropy(LBP). Comparing the prediction performance of all models in each data cohort, the CT model (Ln(P/1-P)=-2.417 11+1.031 60×Radimic tag+1.203 06×Diameter+1.614 21×(Pleural indentation sign = Y) constructed by radiomic label, pleural depression, and quantitative parameters (diameter, average density) was much better than other models and was chosen as the optimal model, with an AUC of CT models in training cohort and test cohort was 0.954 (95%CI: 0.927-0.981), 0.865 (95%CI:0.764-0.966), better than morphological model 0.857 (95%CI:0.796-0.918), 0.818(95%CI: 0.686-0.949) and comprehensive model 0.951(95%CI: 0.921-0.981), 0.856(95%CI: 0.730-0.982), respectively. Conclusion: The integrative CT model has a better prediction efficiency for identifying invasive or noninvasive nodules appearing as subsolid nodules.

Genetically Modified Sugarcane Intercropping Soybean Impact on Rhizosphere Bacterial Communities and Co-occurrence Patterns

Strategies involving genes in the dehydration-responsive element binding (DREB) family, which participates in drought stress regulation, and intercropping with legumes are becoming prominent options in promoting sustainable sugarcane cultivation. An increasing number of studies focusing on root interactions in intercropping systems, particularly involving transgenic crops, are being conducted to better understand and thus, harness beneficial soil microbes to enhance plant growth. We designed experiments to investigate the characteristics of two intercropping patterns, soybean with wild-type (WT) sugarcane and soybean with genetically modified (GM) Ea-DREB2B-overexpressing sugarcane, to assess the response of the rhizosphere microbiota to the different cropping patterns. Bacterial diversity in the rhizosphere microbial community differed between the two intercropping pattens. In addition, the biomass of GM sugarcane that intercropped with soybean was significantly improved compared with WT sugarcane, and the aboveground biomass and root biomass of GM soybean intercropping sugarcane increased by 49.15 and 46.03% compared with monoculture. Furthermore, a beneficial rhizosphere environment for the growth of Actinobacteria was established in the systems intercropped with GM sugarcane. Improving the production mode of crops by genetic modification is a key strategy to improving crop yields and provides new opportunities to further investigate the effects of intercropping on plant roots and soil microbiota. Thus, this study provides a basis for selecting suitable sugarcane-soybean intercropping patterns and a theoretical foundation for a sustainable sugarcane production.

[Advances in clinical application of obstruction catheter in prevention and treatment of intestinal obstruction]

Intestinal obstruction is one of the most common diseases in abdominal surgery, and its prevention and treatment is a clinical difficulty. Although surgical operation can solve the symptoms of obstruction, there are many postoperative complications, and it is easy to develop re-obstruction due to postoperative abdominal adhesion. The internal fixation of small intestine with obstruction catheter provides a new idea for the prevention of postoperative adhesive bowel obstruction. The use of transanal ileus catheter provides the possibility of direct intestinal anastomosis after resection of malignant obstruction in the left hemicolon and can reduce the incidence of postoperative complications. However, sufficient attention should be paid to the related complications, and prevention and treatment should be planned. It is important to note that the use of obstruction catheter is only one of the conservative treatments for bowel obstruction, and it is not a complete replacement of surgery. Surgical treatment should still be considered, if the catheter fails to significantly move, if the obstructive symptoms do not significantly improve 5 days after catheterization.

[Role of hepatic surgery in colorectal cancer multiple liver metastasis]

Colorectal cancer liver metastasis can be categorized as initially resectable and initially unresectable liver metastasis. Patients with initially resectable colorectal cancer liver metastases may benefit from hepatic surgery significantly,while those with initially unresectable metastases also have an opportunity to be treated radically by liver surgery after conversion therapy,so as to have a prolonged survival time. It is crucial to choose the right time and right way of surgical intervention. The timing depends on determination of tumor resectability,controlling of pre-operative systemic therapy and evaluation of liver function after systemic treatment. The selection of right way contains the election between synchronous operation and staged operation, resection margin and using of technologies such as laparoscope and associating liver partition and portal vein ligation for staged hepatectomy. This paper aims to explore the optimal timing for operation and the approaches of surgical method based on the research progress worldwide for prolonging the survival time of patients with colorectal cancer multiple liver metastases.

[Establishment of human colon cancer transplantation tumor model in normal immune mice]

Objective: Establishment of a new model of human primary colon cancer transplantation tumor in normal immune mice and to provide a reliable experimental animal model for studying the pathogenesis of colon cancer under normal immunity. Methods: Human colon cancer cells come from colon cancer patients who underwent surgery in the Affiliated Hospital of Jining Medical College in 2017. The mice in the cell control group were inoculated with phosphate buffered solution (PBS) containing colon cancer cells, the microcarrier control group was inoculated with PBS containing microcarrier 6, and the cell-microcarrier complex group was inoculated with the PBS containing colon cancer cell-microcarrier complex. The cells of each group were inoculated under the skin of the right axilla of mice by subcutaneous injection, and the time, size, tumor formation rate and pathological changes under microscope were recorded. The transplanted tumor tissue was immunohistochemically stained with the EnVisiion two-step method, and the tumor formation rate of the transplanted tumor was judged according to the proportion of positive cells in the visual field. The polymerase chain reaction (PCR) method was used to detect the expression of human-specific Alu sequence in mice tumor tissue. Results: After inoculation with tumor cells, the mice in the cell control group and the microcarrier control group did not die and did not form tumors; the mice in the cell-microcarrier complex group had palpable subcutaneous tumors in the right axillary subcutaneously on the 5th to 7th days after inoculation, and tumor formation rate is 67% (10/15), and the tumor volume can reach about 500 mm(3) 2 to 3 weeks after vaccination. The immunohistochemistry results showed that CK20, CDX-2 and carcinoembryonic antigen were all positively expressed. The PCR results showed that the expression of human-specific Alu sequence can be detected in the transplanted tumor tissue of tumor-bearing mice. Conclusion: Human primary colon cancer cells used microcarrier 6 as a carrier to form tumors in normal immunized mice, and successfully established a new model of human colon cancer transplantation tumor in normal immune mice.

[The analysis of related factors on the unilateral aldosterone secretion in the functional diagnosis of primary aldosteronism and establishment of a predictive model]

Objective: To explore related factors associated with unilateral aldosterone secretion of patients with primary aldosteronism (PA) and construct a predictive model. Methods: The clinical data of patients who were diagnosed as PA in West China Hospital from April 2016 to September 2020 was analyzed retrospectively. According to the results of the adrenal enhancement CT, patients were divided into 3 groups, namely non-nodular group with no bilateral adrenal glands lesions, only with unilateral adrenal hyperplasia or bilateral adrenal hyperplasia, unilateral nodule group with unilateral adrenal nodules and the contralateral adrenal glands with hyperplasia or not, and bilateral nodules group with nodules in both adrenal glands. Regarding the related factors of dominant side of aldosterone secretion, univariate analysis and binary logistic regression were used. Receiver operating characteristic curve and nomogram were used to evaluate the diagnostic performance of regression models. Results: A total of 237 patients with PA were included, of which, 118 males and 119 females, the median age was 39 years, and the body mass index (BMI) was (25.2±3.5) kg/m². There were 157 (66.2%) of 237 patients with typical imaging findings. There were 32 cases in no-nodular group, 183 cases in unilateral nodule group, and 22 cases in bilateral nodules group. Multivariate analysis showed that age (OR=0.876, P<0.001), blood potassium concentration (OR=0.430, P=0.004), and typical imaging findings (OR=2.202, P=0.035) were associated with unilateral aldosterone secretion. As for unilateral nodule group, multivariate analysis showed that age (OR=0.900, P<0.001), plasma aldosteronism concentration (PAC) (OR=1.050, P=0.018), and typical imaging findings (OR=2.637, P=0.025) were associated with unilateral aldosterone secretion. The agreement rate between the dominant side of the adrenal CT and AVS was only 50.2%. Multivariate analysis showed that age (OR=0.954, P=0.001), BMI (OR=0.893, P=0.024) and PAC (OR=1.043, P=0.011) were independently associated with concordance between AVS and CT. The cut-off value of the ROC curve was 0.43; the model sensitivity was 56.3%; the specificity was 86.7% and the area under the ROC curve was 0.742. Conclusions: Age is an important predictor in the diagnosis of PA subtypes. It is recommended to refer to subgroup based on imaging results for clinical decision. For patients with no obvious lesions or bilateral lesions on CT, AVS should be performed as far as possible to confirm the subtypes in diagnosis of PA.