A novel cardiac arrest severity score for the early prediction of hypoxic-ischemic brain injury and in-hospital death

Funding Acknowledgements

Type of funding sources: None.

Background

Out-of-hospital cardiac arrest (OHCA) outcomes are unsatisfactory despite postcardiac arrest care. Early prediction of prognoses might help stratify patients and provide tailored therapy.

Purpose

In this study, we derived and validated a novel scoring system to predict hypoxic-ischaemic brain injury (HIBI) and in-hospital death (IHD).

Methods

We retrospectively analysed Korean Hypothermia Network prospective registry data collected from in Korea between 2015 and 2018. Patients without neuroprognostication data were excluded, and the remaining patients were randomly divided into derivation and validation cohorts. HIBI was defined when at least one prognostication predicted a poor outcome. IHD meant all deaths regardless of cause. In the derivation cohort, stepwise multivariate logistic regression was conducted for HIBI and IHD scores, and model performance was assessed. We then classified patients into four categories and analysed associations between the categories and cerebral performance categories (CPCs) at hospital discharge. Finally, we validated our models in the internal validation cohort.

Results

Among 1373 patients, 240 were excluded, and 1133 were randomised into derivation (n=754) and validation cohorts (n=379). In the derivation cohort, 7 and 8 predictors were selected for HIBI (0–8) and IHD scores (0–11), respectively, and the area under the curve (AUC) was 0.85 (95% CI 0.82–0.87) and 0.80 (95% CI 0.77–0.82), respectively. Applying optimum cutoff values of ≥6 points for HIBI and ≥7 points for IHD, patients were classified as follows: HIBI (-)/IHD (-), Category 1 (n=424); HIBI (-)/IHD (+), Category 2 (n=100); HIBI (+)/IHD (-), Category 3 (n=21); and HIBI (+)/IHD (+), Category 4 (n=209). CPCs at discharge were significantly different in each category (p<0.001). In the validation cohort, the model showed moderate discrimination (AUC 0.83, 95% CI 0.79–0.87 for HIBI and AUC 0.77, 95% CI 0.72–0.81 for IHD) with good calibration. Each category of the validation cohort showed a significant difference in discharge outcomes (p<0.001) and a similar trend to the derivation cohort.

Conclusions

We presented a novel approach for assessing illness severity after OHCA. Although external prospective studies are warranted, risk stratification for HIBI and IHD could help provide OHCA patients with appropriate treatment.

Novel serum biomarkers for predicting prognosis in post cardiac arrest patients

Funding Acknowledgements

Type of funding sources: None.

Objective

To determine the clinical feasibility of novel serum biomarkers by comparing them with conventional serum biomarkers in out-of-hospital cardiac arrest (OHCA) patients treated with target temperature management (TTM).

Methods

This study was a prospective observational study conducted on OHCA patients who underwent TTM. We measured serum biomarker Neuron‑Specific Enolase (NSE), S-100B (S100 calcium-binding protein), Tau protein, Glial Fibrillary Acidic Protein (GFAP), Neurofilament Light Chain (NFL), and Ubiquitin C-terminal hydrolase-L1 (UCH-L1) at 0, 24, 48, and 72 hours after return of spontaneous circulation (ROSC). Conventional biomarkers include NSE and S-100B. The primary outcome was good neurologic outcome at 6 months after OHCA.

Results

A total of 100 patients were included in this study from August 2018 to May 2020. Among the included patients, 46 patients had good neurologic outcomes. As for the biomarker's AUC value measured immediately after ROSC, GFAP had the highest value (0.850), and among the values measured 24 hours after ROSC, S100B showed the highest value (0.901). The AUC values of biomarkers measured after 48 hours and 72 hours after ROSC, were the highest in NFL (0.921, 0.946). AUC values measured after 72 hours of ROSC showed higher values in novel biomarkers than in conventional biomarkers.

Conclusion

After 72 hours of ROSC, the Novel biomarkers showed a higher AUC value than the conventional biomarkers. Among them, NFL showed the highest AUC values than other biomarkers at 48 and 72 hours of ROSC.

The Complete Mitochondrial Genome and Gene Arrangement of the Enigmatic Scaphopod Pictodentalium vernedei

The enigmatic scaphopods, or tusk shells, are a small and rare group of molluscs whose phylogenomic position among the Conchifera is undetermined, and the taxonomy within this class also needs revision. Such work is hindered by there only being a very few mitochondrial genomes in this group that are currently available. Here, we present the assembly and annotation of the complete mitochondrial genome from Dentaliida Pictodentalium vernedei, whose mitochondrial genome is 14,519 bp in size, containing 13 protein-coding genes, 22 tRNA genes and two rRNA genes. The nucleotide composition was skewed toward A-T, with a 71.91% proportion of AT content. Due to the mitogenome-based phylogenetic analysis, we defined P. vernedei as a sister to Graptacme eborea in Dentaliida. Although a few re-arrangements occurred, the mitochondrial gene order showed deep conservation within Dentaliida. Yet, such a gene order in Dentaliida largely diverges from Gadilida and other molluscan classes, suggesting that scaphopods have the highest degree of mitogenome arrangement compared to other molluscs.

Transradial versus transfemoral approach for TACE: a retrospective study

OBJECTIVE

Transcatheter arterial chemoembolization (TACE) has been widely applied in the treatment of hepatocellular carcinoma (HCC). Our study aimed to investigate the feasibility and efficacy of transradial access as an alternative to transfemoral access for TACE.

METHODS

Patients undergoing TACE were divided into the radial artery (RA) route group or the femoral artery (FA) route group according to the operation approach, namely, transradial or transfemoral access. We retrospectively analysed the clinical characteristics, technical outcomes, clinical efficacy and incidence of adverse events to compare the two technologies for intervention for HCC.

RESULTS

Transradial access was found to achieve superior technical outcomes and clinical efficacy, as the patients in the RA group had a lower rate of hepatic arterial spasm, a higher partial response rate and a lower progression rate than the patients in the FA group according to the mRECIST evaluations. In contrast, the liver function indices and VAS (visual analogue scale) pain scores were consistent across the two groups. Moreover, patients in the RA group had a shorter length of stay than those in the FA group, despite similar hospitalization expenses. The total adverse events were significantly reduced by transradial access for TACE (72.5% vs. 84.1%, P = 0.027).

CONCLUSION

Our study suggested that transradial access is an effective and feasible alternative to transfemoral access for TACE. Large-scale prospective randomized controlled studies are expected.

Engineering Shewanella oneidensis to efficiently harvest electricity power by co-utilizing glucose and lactate in thin stillage of liquor industry

Thin stillage, rich in glucose and lactate, can seriously pollute water resources when directly discharged into the natural environment. Microbial fuel cells (MFC), as a green and sustainable technology, could utilize exoelectrogens to break down organics in wastewater and harvest electricity. Nevertheless, Shewanella oneidensis MR-1, cannot utilize thin stillage for efficient power generation. Here, to enable S. oneidensis to co-utilize glucose and lactate from thin stillage, an engineered S. oneidensis G₇∆RSL₁ was first created by constructing glucose metabolism pathway, promoting glucose and lactate co-utilization, and enhancing biofilm formation. Then, to enhance biofilm conductivity, we constructed a 3D self-assembled G₇∆RSL₁-rGO/CNT biohybrid with maximum power density of 560.4 mW m^-2 and 373.7 mW m^-2 in artificial and actual thin stillage, respectively, the highest among the reported genetically engineered S. oneidensis with thin stillage as carbon source. This study provides a new strategy to facilitate practical applications of MFC in wastewater remediation and efficient power recovery.

Structural characterization of SARS-CoV-2 dimeric ORF9b reveals potential fold-switching trigger mechanism

The constant emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants indicates the evolution and adaptation of the virus. Enhanced innate immune evasion through increased expression of viral antagonist proteins, including ORF9b, contributes to the improved transmission of the Alpha variant; hence, more attention should be paid to these viral proteins. ORF9b is an accessory protein that suppresses innate immunity via a monomer conformation by binding to Tom70. Here, we solved the dimeric structure of SARS-CoV-2 ORF9b with a long hydrophobic tunnel containing a lipid molecule that is crucial for the dimeric conformation and determined the specific lipid ligands as monoglycerides by conducting a liquid chromatography with tandem mass spectrometry analysis, suggesting an important role in the viral life cycle. Notably, a long intertwined loop accessible for host factor binding was observed in the structure. Eight phosphorylated residues in ORF9b were identified, and residues S50 and S53 were found to contribute to the stabilization of dimeric ORF9b. Additionally, we proposed a model of multifunctional ORF9b with a distinct conformation, suggesting that ORF9b is a fold-switching protein, while both lipids and phosphorylation contribute to the switching. Specifically, the ORF9b monomer interacts with Tom70 to suppress the innate immune response, whereas the ORF9b dimer binds to the membrane involving mature virion assembly. Our results provide a better understanding of the multiple functions of ORF9b.

CoP decorated 2D/2D red phosphorus/B doped g-C3N4 type II heterojunction for boosted pure water splitting activity via the two-electron pathway

CoP decorated 2D/2D red phosphorus/B doped g-C3N4 heterojunction enabled photocatalytic pure water splitting to produce H2 with a two-electron process.

Carboxylic acid-assisted sterically demanding reductive cross-coupling between cycloalkenyl and alkyl bromides

A nickel-catalysed reductive cross-coupling between 2-bromo cycloalkenyl carboxylic acids and alkyl bromides has been developed, affording all-carbon tetrasubstituted cycloalkenes in moderate to excellent yields up to 92%. Mechanistic studies indicated...

A Multicentre Clinical Study of Sarcoma Personalised Treatment Using Patient-Derived Tumour Xenografts

AIMS

Medication for advanced sarcomas has not improved for three decades. Patient-derived tumour xenografts (PDTX) are a promising solution for developing new therapies and real-time personalised medicine because of their highly effective prediction of drug efficacy. However, there is a dearth of PDTX models for sarcomas due to the scarcity and heterogeneity of the disease.

MATERIALS AND METHODS

A multicentre clinical collaborative study (ChiCTR-OOC-17013617) was carried out. Fresh patient tumour tissues via resection or biopsy were used for the PDTX set-up. The standard medical care chosen by the physician was given to the patient, in parallel with testing on multiple regimens. The outcomes of patients' responses and PDTX tests were compared. Comprehensive analyses were carried out to assess the clinical value of PDTX for the treatment of sarcomas. Living tissues from successfully engrafted cases were deposited into a repository.

RESULTS

Forty-two cases, including 36 bone sarcomas and six soft-tissue sarcomas, were enrolled; the overall engraftment rate was 73.8%. Histopathological examination showed a 100% consistency between primary tumours and tumour grafts. The engraftment rate was independent of age, gender and sampling methods, but was associated with subtypes of tumour. The outgrowth time of tumour grafts could be associated with prognosis. Major somatic mutations in tumour grafts occurred primarily in common tumour driver genes. Poor prognosis was associated with the KMT2C mutation. A drug efficacy test showed complete concordance between the PDTX model and patients' responses in 17 regimens.

CONCLUSION

PDTX is an ideal preclinical model for sarcomas because of its faithful preservation of the heterogeneity of the disease, a satisfactory engraftment rate and high accuracy in its prediction of drug efficacy.

Integrated mRNA and miRNA transcriptomic analysis reveals the response of Rapana venosa to the metamorphic inducer (juvenile oysters)

Metamorphosis, as a critical developmental event, controls the population dynamics of most marine invertebrates, especially some carnivorous gastropods that feed on bivalves, whose population dynamics not only affect the maintenance of the ecological balance but also impact the protection of bivalve resources; therefore, the metamorphosis of carnivorous gastropods deserve attention. Here, we investigated the mechanism underlying the response of the carnivorous gastropod Rapana venosa to its metamorphic inducer juvenile oysters through integrated analysis of miRNA and mRNA profiles. According to the results, we speculated that the AMPK signaling pathway may be the critical regulator in the response to juvenile oysters in R. venosa competent larvae. The NF-kB and JAK-STAT signaling pathways that regulated apoptosis were also activated by the metamorphic inducer, which may result in the degeneration of the velum. Additionally, the significant changes in the expression of the SARP-19 precursor gene and protein cibby homolog 1-like gene may indicate that these signaling pathways also regulate growth and development during metamorphosis. This study provides further evidence that juvenile oysters can induce metamorphosis of R. venosa at the transcriptional level, which expands our understanding of the metamorphosis mechanism in carnivorous gastropods.

[Automatic removal algorithm of electrooculographic artifacts in non-invasive brain-computer interface based on independent component analysis]

The non-invasive brain-computer interface (BCI) has gradually become a hot spot of current research, and it has been applied in many fields such as mental disorder detection and physiological monitoring. However, the electroencephalography (EEG) signals required by the non-invasive BCI can be easily contaminated by electrooculographic (EOG) artifacts, which seriously affects the analysis of EEG signals. Therefore, this paper proposed an improved independent component analysis method combined with a frequency filter, which automatically recognizes artifact components based on the correlation coefficient and kurtosis dual threshold. In this method, the frequency difference between EOG and EEG was used to remove the EOG information in the artifact component through frequency filter, so as to retain more EEG information. The experimental results on the public datasets and our laboratory data showed that the method in this paper could effectively improve the effect of EOG artifact removal and improve the loss of EEG information, which is helpful for the promotion of non-invasive BCI.

Multi-dimensional data transmission using inverse-designed silicon photonics and microcombs

The use of optical interconnects has burgeoned as a promising technology that can address the limits of data transfer for future high-performance silicon chips. Recent pushes to enhance optical communication have focused on developing wavelength-division multiplexing technology, and new dimensions of data transfer will be paramount to fulfill the ever-growing need for speed. Here we demonstrate an integrated multi-dimensional communication scheme that combines wavelength- and mode- multiplexing on a silicon photonic circuit. Using foundry-compatible photonic inverse design and spectrally flattened microcombs, we demonstrate a 1.12-Tb/s natively error-free data transmission throughout a silicon nanophotonic waveguide. Furthermore, we implement inverse-designed surface-normal couplers to enable multimode optical transmission between separate silicon chips throughout a multimode-matched fibre. All the inverse-designed devices comply with the process design rules for standard silicon photonic foundries. Our approach is inherently scalable to a multiplicative enhancement over the state of the art silicon photonic transmitters.

Titania-Nanotube-Coated Titanium Substrates Promote Osteogenesis and Suppress Osteoclastogenesis via Integrin ανβ3

The balance of bone turnover mediated by osteoclastogenesis and osteogenesis implants that could suppress osteoclastogenesis and promote osteogenesis is an appropriate treatment strategy for osteoporosis patients. Titanium is one of the most applied materials in implants. In this study, titania nanotubes (Ti-NTs) were produced by anodization at 10, 40, and 60 V. We found that Ti-NTs were nontoxic to bone marrow mesenchymal stem cells (BMSCs). Ti-NTs suppressed osteoclast formation and function in a diameter dependent manner in vitro. Furthermore, Ti-NTs enhanced the activity of osteogenesis, expressions of osteogenesis-related marker genes were increased and β-Catenin pathway was active. Alkaline phosphatase (ALP) activity and matrix mineralization were also promoted in vitro. To explore the possible mechanisms, we performed a series of experiments to indicate the effects of Ti-NTs on cytoskeletal organization and integrin ανβ3 expression of osteoclasts and osteoblasts. The results demonstrated that 90-nm-diameter Ti-NTs could suppress the expression of integrin ανβ3 in osteoclast precursor cells. Interestingly, it revealed an opposite effect on BMSCs. Moreover, 90 nm-diameter Ti-NTs prevented ovariectomy (OVX)-induced bone loss. These findings indicated that Ti-NTs could inhibit osteoclastogenesis and enhance osteogenesis; it was mediated via regulation of integrin ανβ3─90 nm-diameter Ti-NT revealed a good biological ability especially suited for osteoporosis treatment.

High-capacity free-space optical communications using wavelength- and mode-division-multiplexing in the mid-infrared region

Due to its absorption properties in atmosphere, the mid-infrared (mid-IR) region has gained interest for its potential to provide high data capacity in free-space optical (FSO) communications. Here, we experimentally demonstrate wavelength-division-multiplexing (WDM) and mode-division-multiplexing (MDM) in a ~0.5 m mid-IR FSO link. We multiplex three ~3.4 μm wavelengths (3.396 μm, 3.397 μm, and 3.398 μm) on a single polarization, with each wavelength carrying two orbital-angular-momentum (OAM) beams. As each beam carries 50-Gbit/s quadrature-phase-shift-keying data, a total capacity of 300 Gbit/s is achieved. The WDM channels are generated and detected in the near-IR (C-band). They are converted to mid-IR and converted back to C-band through the difference frequency generation nonlinear processes. We estimate that the system penalties at a bit error rate near the forward error correction threshold include the following: (i) the wavelength conversions induce ~2 dB optical signal-to-noise ratio (OSNR) penalty, (ii) WDM induces ~1 dB OSNR penalty, and (iii) MDM induces ~0.5 dB OSNR penalty. These results show the potential of using multiplexing to achieve a ~30X increase in data capacity for a mid-IR FSO link.

Structural basis for a human broadly neutralizing influenza A hemagglutinin stem-specific antibody including H17/18 subtypes

Influenza infection continues are a persistent threat to public health. The identification and characterization of human broadly neutralizing antibodies can facilitate the development of antibody drugs and the design of universal influenza vaccines. Here, we present structural information for the human antibody PN-SIA28's heterosubtypic binding of hemagglutinin (HA) from circulating and emerging potential influenza A viruses (IAVs). Aside from group 1 and 2 conventional IAV HAs, PN-SIA28 also inhibits membrane fusion mediated by bat-origin H17 and H18 HAs. Crystallographic analyses of Fab alone or in complex with H1, H14, and H18 HA proteins reveal that PN-SIA28 binds to a highly conserved epitope in the fusion domain of different HAs, with the same CDRHs but different CDRLs for different HAs tested, distinguishing it from other structurally characterized anti-stem antibodies. The binding characteristics of PN-SIA28 provides information to support the design of increasingly potent engineered antibodies, antiviral drugs, and/or universal influenza vaccines.

Lead Optimization and Avoidance of Metabolic-perturbing Motif Developing Novel Diarylpyrimidines as Potent HIV-1 NNRTIs

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) represent an indispensable part of anti-HIV-1 therapy. To discover novel HIV-1 NNRTIs with increased drug resistance profiles and improved pharmacokinetic (PK) properties, a series of novel diarylpyrimidine derivatives were generated via the cocrystal structure-based drug design strategy. Among them, 36a exhibited outstanding antiviral activity against HIV-1 IIIB and a panel of mutant strains (L100I, K103N, Y181C, Y188L, E138K, F227L + V106A, and RES056), with EC₅₀ ranging from 2.22 to 53.3 nM. Besides, 36a was identified with higher binding affinity (K_D = 2.50 μM) and inhibitory activity (IC₅₀ = 0.03 μM) to HIV-1 RT. Molecular docking and molecular dynamics simulation were performed to rationalize the design and the improved drug resistance of these novel inhibitors. Additionally, 36a·HCl exhibited favorable PK (T_1/2 = 5.12 h, F = 12.1%) and safety properties (LD₅₀ > 2000 mg/kg). All these suggested that 36a·HCl may serve as a novel drug candidate anti-HIV-1 therapy.

Generation of OAM-carrying space-time wave packets with time-dependent beam radii using a coherent combination of multiple LG modes on multiple frequencies

Space-time (ST) wave packets, in which spatial and temporal characteristics are coupled, have gained attention due to their unique propagation characteristics, such as propagation invariance and tunable group velocity in addition to their potential ability to carry orbital angular momentum (OAM). Through experiment and simulation, we explore the generation of OAM-carrying ST wave packets, with the unique property of a time-dependent beam radius at various ranges of propagation distances. To achieve this, we synthesize multiple frequency comb lines, each assigned to a coherent combination of multiple Laguerre-Gaussian (LG_ℓ,p) modes with the same azimuthal index but different radial indices. The time-dependent interference among the spatial modes at the different frequencies leads to the generation of the desired OAM-carrying ST wave packet with dynamically varying radii. The simulation results indicate that the dynamic range of beam radius oscillations increases with the number of modes and frequency lines. The simulated ST wave packet for OAM of orders +1 or +3 has an OAM purity of >95%. In addition, we experimentally generate and measure the OAM-carrying ST wave packets with time-dependent beam radii. In the experiment, several lines of a Kerr frequency comb are spatially modulated with the superposition of multiple LG modes and combined to generate such an ST wave packet. In the experiment, ST wave packets for OAM of orders +1 or +3 have an OAM purity of >64%. In simulation and experiment, OAM purity decreases and beam radius becomes larger over the propagation.

Optimal Thresholds for Fracton Codes and Random Spin Models with Subsystem Symmetry

Fracton models provide examples of novel gapped quantum phases of matter that host intrinsically immobile excitations and therefore lie beyond the conventional notion of topological order. Here, we calculate optimal error thresholds for quantum error correcting codes based on fracton models. By mapping the error-correction process for bit-flip and phase-flip noises into novel statistical models with Ising variables and random multibody couplings, we obtain models that exhibit an unconventional subsystem symmetry instead of a more usual global symmetry. We perform large-scale parallel tempering Monte Carlo simulations to obtain disorder-temperature phase diagrams, which are then used to predict optimal error thresholds for the corresponding fracton code. Remarkably, we found that the X-cube fracton code displays a minimum error threshold (7.5%) that is much higher than 3D topological codes such as the toric code (3.3%), or the color code (1.9%). This result, together with the predicted absence of glass order at the Nishimori line, shows great potential for fracton phases to be used as quantum memory platforms.

MoO2 nanosheets anchored with Co nanoparticles as a bifunctional electrocatalytic platform for overall water splitting

Electrochemical water splitting is one of the potential commercial techniques to produce clean hydrogen energy because of the high efficiency and environmental friendliness. However, development of low-cost bifunctional electrocatalysts that can replace Pt-based catalysts for the hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) is challenging. Herein, Co nanoparticles (NPs) are anchored on MoO₂ nanosheets (Co/MoO₂) by thermal reduction of the CoMoO₄ nanosheet array in Ar/H₂. The uniformly distributed Co NPs improve the electron transfer capability and modulate the surface states of the MoO₂ nanosheets to enhance hydrogen desorption and HER kinetics. Moreover, the Co/MoO₂ composite is beneficial to the interfacial structure and the MoO₂ nanosheets prevent aggregation of Co NPs to improve the intrinsic OER characteristics in the alkaline electrolyte. As a result, the Co/MoO₂ electrocatalyst shows low HER and OER overpotentials of 178 and 318 mV at a current density of 10 mA cm^-2 in 1 M KOH. The electrolytic cell consisting of the bifunctional Co/MoO₂ electrodes shows a small voltage of 1.72 V for a current density of 10 mA cm^-2 in overall water splitting.

Iterative Synthesis of Inulin-Type Fructooligosaccharides Enabled by Stereoselective β-d-Fructofuranosylation

Inulin-type fructooligosaccharides (FOSs) constitute an abundant subgroup of fructans with important biological activities. However, the availability of individual fructooligosaccharides with an accurate structure in high purity and quality remains challenging. We herein report the first iterative synthesis of five inulin-type FOSs with degrees of polymerization ranging from 3 to 7 via highly stereoselective β-(2 → 1)-d-fructofuranosylation on a gram scale. Central to the synthesis is the decisive use of the 1-O-TIPS-6-O-picoloyl-protected fructofuranosyl thioglycoside donor, which assured the excellent β-selective glycosylation by the hydrogen-bond-mediated aglycone delivery (HAD).