[Comparison of time series and case-crossover analyses in environmental epidemiology]

Time-series and case-crossover are two main study designs in environmental epidemiology. However, due to the differences in design principles and model construction between the two analyses, the results of the two analyses may not be consistent. Herein, we examined the short-term effect of cold spells on cardiovascular mortality in Nanjing using both time series and case-crossover analyses, aiming to provide a basis for the selection of appropriate research design in environmental epidemiology.

Incidence of cardiovascular events in patients treated with immune checkpoint inhibitors

Background

In rare cases, immune checkpoint inhibitors (ICIs) cause immune-mediated myocarditis. However, the true incidence of other major adverse cardiovascular events (MACE) following ICI treatment remains unknown, mainly because late occurring side effects are rarely reported in prospective clinical trials.

Purpose

To identify the incidence and risk factors of MACE in a real-life ICI-treated cancer cohort and to compare the incidence with non-ICI-treated cancer patients and population controls.

Methods

In total, 672 ICI-treated patients were included. The primary endpoint was MACE, a composite of acute coronary syndrome, heart failure, stroke and transient ischemic attack. Secondary outcomes were acute coronary syndrome and heart failure separately. Incidence rates were compared between groups after matching according to age, sex, cardiovascular history and cancer type.

Results

Incidence of MACE was 10.3% during a median time of follow-up of 13 months (IQR 6 to 22). In multivariable analysis, a history of heart failure (hazard ratio (HR): 2.27; 95% confidence interval (CI): 1.03 to 5.04; p=0.043) and valvular heart disease (HR 3.01; 95% CI: 1.05 to 8.66; p=0.041) remained significantly associated with MACE.

Cumulative incidence rates were significantly higher in the matched ICI group (rate at full range of follow-up (rate): 8.51; 95% CI: 6.18 to 11.4) compared with the cancer cohort not exposed to ICI (rate: 5.20; 95% CI: 3.56 to 7.35; p=0.032) and the population controls (rate: 2.55; 95% CI: 2.16 to 2.99; p<0.001) mainly driven by a higher risk of heart failure events (Figure 1).

Conclusions

Cardiovascular events during and after ICI treatment are more common than currently appreciated. Patients at risk are those with a history of cardiovascular disease. Compared with matched cancer and population controls, MACE incidence rates are significantly higher, suggesting a potential harmful effect of ICI treatment besides the underlying risk.

Funding Acknowledgement

Type of funding sources: None.

Lung cancer screening study from a smoking population in Kunming

OBJECTIVE

Yunnan, China, is a central tobacco-producing region with a large smoking population and an increasing incidence of lung cancer in recent years. This study aimed to understand the incidence of lung cancer and the characteristics of lung nodules on low-dose computed tomography (LDCT) scans of the chest in a long-term smoking population in Kunming.

PATIENTS AND METHODS

Long-term smokers in Kunming who were not at risk of evident lung disease symptoms were recruited through recommendation and publicity by the Kunming University of Science and Technology.

RESULTS

Among 375 cases eligible for inclusion,14 cases of lung cancer were detected with a detection rate of 3.73% (95% CI: 2.55%-4.27%), including one case of squamous carcinoma, one case of small cell lung cancer, seven cases of adenocarcinoma of the lung and five cases of early-stage lung cancer (35.71%). In the group of < 6 mm solid nodules and < 5 mm non-solid nodules, no lung cancer was detected in 201 cases; lung cancer was detected in 14 cases in 61 cases, and there was a statistical difference between the two groups (p < 0.05).

CONCLUSIONS

The lung cancer detection rate in long-term smokers was high, with the type predominantly adenocarcinoma and a high incidence of lung nodules, and increased when solid nodules≥6 mm or non-solid nodules ≥ 5 mm were present. It is recommended that screening for lung cancer by LDCT of the chest be introduced in the male smoking population who meet the risk factors and that screening for lung cancer in women should be redefined as a high-risk factor.

A genome-wide association study of folates in sweet corn kernels

Folate is commonly synthesized in natural plants and is an essential water-soluble vitamin of great importance inhuman health. Although the key genes involved in folate biosynthesis and transformation pathways have been identified in plants, the genetic architecture of folate in sweet corn kernels remain largely unclear. In this study, an association panel of 295 inbred lines of sweet corn was constructed. Six folate derivatives were quantified in sweet corn kernels at 20 days after pollination and a total of 95 loci were identified for eight folate traits using a genome-wide association study. A peak GWAS signal revealed that natural variation in ZmFCL, encoding a 5-formyltetrahydrofolate cyclo-ligase, accounted for 30.12% of phenotypic variation in 5-FTHF content. Further analysis revealed that two adjacent SNPs on the second exon resulting in an AA-to-GG in the gene and an Asn-to-Gly change in the protein could be the causative variant influencing 5-FTHF content. Meanwhile, 5-FTHF content was negatively correlated with ZmFCL expression levels in the population. These results extend our knowledge regarding the genetic basis of folate and provide molecular markers for the optimization of folate levels in sweet corn kernels.

The key clock component ZEITLUPE (ZTL) negatively regulates ABA signaling by degradation of CHLH in Arabidopsis

Ubiquitination-mediated protein degradation plays important roles in ABA signal transduction and delivering responses to chloroplast stress signals in plants, but additional E3 ligases of protein ubiquitination remain to be identified to understand the complex signaling network. Here we reported that ZEITLUPE (ZTL), an F-box protein, negatively regulates abscisic acid (ABA) signaling during ABA-inhibited early seedling growth and ABA-induced stomatal closure in Arabidopsis thaliana. Using molecular biology and biochemistry approaches, we demonstrated that ZTL interacts with and ubiquitinates its substrate, CHLH/ABAR (Mg-chelatase H subunit/putative ABA receptor), to modulate CHLH stability via the 26S proteasome pathway. CHLH acts genetically downstream of ZTL in ABA and drought stress signaling. Interestingly, ABA conversely induces ZTL phosphorylation, and high levels of ABA also induce CHLH proteasomal degradation, implying that phosphorylated ZTL protein may enhance the affinity to CHLH, leading to the increased degradation of CHLH after ABA treatment. Taken together, our results revealed a possible mechanism of reciprocal regulation between ABA signaling and the circadian clock, which is thought to be essential for plant fitness and survival.

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.

An intubation method for mono-pulmonary ventilation in patients with difficult airway

OBJECTIVE

This study aimed to compare the clinical effect between thermal softening PVC double-lumen tube (DLT) and single-lumen tube (SLT) guided by laryngoscope and bronchoscopy in patients with difficult airways.

PATIENTS AND METHODS

72 patients with chest surgery in need of mono-pulmonary ventilation, aged 20-70 years old, with ASA rating I-III and Arné scoring ≥ 11, were enrolled. Patients were categorized randomly into two groups with 36 patients in each: the D group (DLT was used) and the S group (SLT was used). Bronchoscopy was used for guiding the intubation and aligning in both groups. Laryngoscope would also be used immediately after failure in two trials of intubation. Intubation resistance, intubation success rate, laryngoscopy assist rate, time for intubation, time for alignment, incidence of catheter dislocation, VAS score for post-operative throat pain, and the damage extent of vocal cord were recorded.

RESULTS

No significant differences were seen between two the groups in terms of intubation resistance, intubation success rate, laryngoscopy assist rate, time for intubation, VAS score for post-operative throat pain, and the damage extent of vocal cord. However, shorter time for alignment and lower incidence of catheter dislocation were observed in the D group than in the S group (both p < 0.05).

CONCLUSIONS

For intubation in patients with difficult airway, the thermal softening DLT was as safe as the SLT, but simpler in alignment and had a lower dislocation incidence. Meanwhile, video laryngoscope could increase the success rate of intubation with either tube.

[TXNDC17 protein overexpression in uterine papillary serous carcinoma is associated with clinicopathological characteristics and prognosis]

Objective: To analyze clinicopathological characteristics of patients with uterine papillary serous carcinoma (UPSC) in China, and investigate roles of TXNDC17 protein in UPSC clinicopathological characteristics and prognosis. Methods: Fifty-five patients with UPSC treated in Women's Hospital School of Medicine Zhejiang University from 2003 to 2016 were analysed retrospectively. Immunohistochemistry (IHC) were performed to TXNDC17 and BECN1 (Beclin 1 protein, a key regulator of autophagy) protein expression respectively. Kaplan-Meier was used to calculate the cumulative survival rate, Log-rank test was performed to compare the difference in cumulative survival rate among patients with different clinicopathological characteristics, and Cox regression model was used to analyze the related between TXNDC17 expression and prognosis of UPSC patients. Results: The median age of the 55 UPSC patients was 63(49, 79) years, 43.6%(24/55) with late stages (stage Ⅲ/Ⅳ), and 32.7 % (18/55) exhibiting more than half of myometrium invasion were enrolled. Notably, 28 (50.9%) patients had TXNDC17 protein overexpression, and associated with BECN1 overexpression(P=0.023). Besides, co-expression of TXNDC17 and BECN1 occurred at an advanced stage and deep myometrial invasion (P=0.013,0.009). The cumulative survival rate of TXNDC17 overexpression(37.4% vs 91.5%),FIGO Ⅲ/Ⅳ stage(44.1% vs 70.1%), deep myometrium invasion(36.1% vs 75.4%) and BECN1 overexpression(0 vs 83.0%)patients was low (P<0.05). The multivariate proportional hazards model revealed that myometrial invasion and TXNDC17 overexpression were associated with prognosis of UPSC patients. Conclusions: This study shows that TXNDC17 overexpression is associate with poor survival in UPSC patients. Co-expression of TXNDC17 and BECN1 shows characteristics of advanced stages and deep myometrial invasion. TXNDC17 may be a potential predictor or target in UPSC therapeutics..

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.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

The Transcription Factor MYB37 Positively Regulates Photosynthetic Inhibition and Oxidative Damage in Arabidopsis Leaves Under Salt Stress

MYB transcription factors (TFs) mediate plant responses and defenses to biotic and abiotic stresses. The effects of overexpression of MYB37, an R2R3 MYB subgroup 14 transcription factors in Arabidopsis thaliana, on chlorophyll content, chlorophyll fluorescence parameters, reactive oxygen species (ROS) metabolism, and the contents of osmotic regulatory substances were studied under 100 mM NaCl stress. Compared with the wild type (Col-0), MYB37 overexpression significantly alleviated the salt stress symptoms in A. thaliana plants. Chlorophyll a (Chl a) and chlorophyll b (Chl b) contents were significantly decreased in OE-1 and OE-2 than in Col-0. Particularly, the Chl a/b ratio was also higher in OE-1 and OE-2 than in Col-0 under NaCl stress. However, MYB37 overexpression alleviated the degradation of chlorophyll, especially Chl a. Salt stress inhibited the activities of PSII and PSI in Arabidopsis leaves, but did not affect the activity of PSII electron donor side oxygen-evolving complex (OEC). MYB37 overexpression increased photosynthesis in Arabidopsis by increasing PSII and PSI activities. MYB37 overexpression also promoted the transfer of electrons from Q _A to Q _B on the PSII receptor side of Arabidopsis under NaCl stress. Additionally, MYB37 overexpression increased Y(II) and Y(NPQ) of Arabidopsis under NaCl stress and decreased Y(NO). These results indicate that MYB37 overexpression increases PSII activity and regulates the proportion of energy dissipation in Arabidopsis leaves under NaCl stress, thus decreasing the proportion of inactivated reaction centers. Salt stress causes excess electrons and energy in the photosynthetic electron transport chain of Arabidopsis leaves, resulting in the release of reactive oxygen species (ROS), such as superoxide anion and hydrogen peroxide, leading to oxidative damage. Nevertheless, MYB37 overexpression reduced accumulation of malondialdehyde in Arabidopsis leaves under NaCl stress and alleviated the degree of membrane lipid peroxidation caused by ROS. Salt stress also enhanced the accumulation of soluble sugar (SS) and proline (Pro) in Arabidopsis leaves, thus reducing salt stress damage to plants. Salt stress also degraded soluble protein (SP). Furthermore, the accumulation of osmoregulation substances SS and Pro in OE-1 and OE-2 was not different from that in Col-0 since MYB37 overexpression in Arabidopsis OE-1, and OE-2 did not significantly affect plants under NaCl stress. However, SP content was significantly higher in OE-1 and OE-2 than in Col-0. These results indicate that MYB37 overexpression can alleviate the degradation of Arabidopsis proteins under NaCl stress, promote plant growth and improve salt tolerance.

[Whether extracorporeal membrane oxygenation can be used in adult patients with sepsis and septic shock?]

Sepsis is a critical medical problem that needs to be solved urgently worldwide. Some patients with sepsis have refractory shock or/and severe respiratory failure, which may require supporting with extracorporeal membrane oxygenation (ECMO). Particularly, it is important to choose the optimal mode and grasp the optimal timing of the initiation in the experienced ECMO center. The choice of mode is mainly based on the patient's condition of oxygenation and hemodynamics. During the management of ECMO support, some issues like blood flow, anticoagulation and therapy of antibiotics should be noted. Thus far, the research of ECMO in adult patients with sepsis and septic shock are mainly retrospective, observational and with small sample size. Further exploration is needed in the future.

Natural variation in the NAC transcription factor NONRIPENING contributes to melon fruit ripening

The NAC transcription factor NONRIPENING (NOR) is a master regulator of climacteric fruit ripening. Melon (Cucumis melo L.) has climacteric and non-climacteric fruit ripening varieties and is an ideal model to study fruit ripening. Two natural CmNAC-NOR variants, the climacteric haplotype CmNAC-NOR^S,N and the non-climacteric haplotype CmNAC-NOR^A,S , have effects on fruit ripening; however, their regulatory mechanisms have not been elucidated. Here, we report that a natural mutation in the transcriptional activation domain of CmNAC-NOR^S,N contributes to climacteric melon fruit ripening. CmNAC-NOR knockout in the climacteric-type melon cultivar "BYJH" completely inhibited fruit ripening, while ripening was delayed by 5-8 d in heterozygous cmnac-nor mutant fruits. CmNAC-NOR directly activated carotenoid, ethylene, and abscisic acid biosynthetic genes to promote fruit coloration and ripening. Furthermore, CmNAC-NOR mediated the transcription of the "CmNAC-NOR-CmNAC73-CmCWINV2" module to enhance flesh sweetness. The transcriptional activation activity of the climacteric haplotype CmNAC-NOR^S,N on these target genes was significantly higher than that of the non-climacteric haplotype CmNAC-NOR^A,S . Moreover, CmNAC-NOR^S,N complementation fully rescued the non-ripening phenotype of the tomato (Solanum lycopersicum) cr-nor mutant, while CmNAC-NOR^A,S did not. Our results provide insight into the molecular mechanism of climacteric and non-climacteric fruit ripening in melon.