An acetylated lysine residue of its low-glucose inhibitory domain controls activity and protein interactions of ChREBP

Carbohydrate response element-binding protein (ChREBP) is a transcription factor activated by glucose metabolites that orchestrates the expression of genes involved in glycolysis, de novo lipogenesis, and ATP homeostasis. Inadequate ChREBP activity impairs the cellular adaptations to glucose exposure and in humans associates with dyslipidemia, fatty liver disease, and type 2 diabetes. ChREBP activity is regulated by cytosolic-nuclear translocation involving its low-glucose inhibitory domain (LID). Whether this domain is targeted by post-translational lysine acetylation is unknown. Here we report a novel LID acetylation site that controls activity and protein interactions of ChREBP. Mutation of this residue increased glucose-induced activity and target gene expression of ChREBP. Mechanistically, mutant ChREBP protein showed more nuclear localization and enhanced genomic binding to a target promoter. Interactions with proteins that exhibit differential binding upon glucose exposure were attenuated by the mutation, demonstrating the importance of the LID in the formation of the protein interactome. Particularly interactions with 14-3-3 proteins, factors that regulate cytosolic/nuclear trafficking of ChREBP, were reduced, whereas interactions with proteins of the nucleosome remodeling deacetylase complex (NuRD) were increased. These molecular insights may shape new therapeutic strategies to target ChREBP activity and counteract metabolic diseases.

RAG suppresses group 2 innate lymphoid cells

Antigen specificity is the central trait distinguishing adaptive from innate immune function. Assembly of antigen-specific T cell and B cell receptors occurs through V(D)J recombination mediated by the Recombinase Activating Gene endonucleases RAG1 and RAG2 (collectively called RAG). In the absence of RAG, mature T and B cells do not develop and thus RAG is critically associated with adaptive immune function. In addition to adaptive T helper 2 (Th2) cells, group 2 innate lymphoid cells (ILC2s) contribute to type 2 immune responses by producing cytokines like Interleukin-5 (IL-5) and IL-13. Although it has been reported that RAG expression modulates the function of innate natural killer (NK) cells, whether other innate immune cells such as ILC2s are affected by RAG remains unclear. We find that in RAG-deficient mice, ILC2 populations expand and produce increased IL-5 and IL-13 at steady state and contribute to increased inflammation in atopic dermatitis (AD)-like disease. Furthermore, we show that RAG modulates ILC2 function in a cell-intrinsic manner independent of the absence or presence of adaptive T and B lymphocytes. Lastly, employing multiomic single cell analyses of RAG1 lineage-traced cells, we identify key transcriptional and epigenomic ILC2 functional programs that are suppressed by a history of RAG expression. Collectively, our data reveal a novel role for RAG in modulating innate type 2 immunity through suppression of ILC2s.

Active Surveillance for Prostate Cancer in Older Men

Prostate cancer is a common disease, affecting 1 in 8 men. The risk of mortality from untreated prostate cancer is limited in the first 5 to 10 years after treatment and as a result, the benefit of treatment is in men with greater than 10 years of life expectancy. When life expectancy is more limited, options for non-curative intervention include active surveillance, de-intensified surveillance, and watchful waiting. In this review, these strategies will be discussed.

PIM kinase inhibition counters resistance to radiotherapy and chemotherapy in human prostate cancer

PURPOSE

PIM kinases are associated with treatment resistance and poor prognosis in prostate cancer through roles in DNA damage response, cellular metabolism, proliferation, and survival. We hypothesized PIM inhibition addresses treatment resistance to radiotherapy and docetaxel in prostate cancer.

METHODS

PIM inhibition in prostate cancer cell lines was examined by phosphorylated H2AX and colony formations assays. In normal and castrated mice with prostate tumor xenografts, tumor growth was monitored with daily oral PIM inhibition +/- fractionated radiotherapy (RT) or docetaxel. Radiotherapy was given 30 Gy in 15 treatments, mimicking clinical conventional daily treatment over 3 weeks in a translational murine model system.

RESULTS

PIM inhibition decreased radiotherapy-induced DNA-damage repair and decreased cell proliferation and survival. In mice, PIM inhibition increased the efficacy of both radiation and docetaxel to reduce tumor size in hormone-dependent and -independent xenografts. Xenografts showed altered gene expression changes, including downregulation of ribosomal pathways and upregulation of cardiomyocyte signaling pathways, due to PIM inhibition as analyzed by RNA-Seq. Immunostaining of multiple proteins, including COX-2 and MDM2, was altered by PIM inhibition.

CONCLUSIONS

PIM inhibition addresses treatment resistance to docetaxel and radiotherapy in multiple prostate cancer models. Our data provide a strong rationale for testing PIM inhibitors in combination with standard therapies for treatment-resistant high-risk localized or metastatic prostate cancer in clinical trials.

The 5-year results of the Stratified Cancer Active Surveillance programme for men with prostate cancer

OBJECTIVES

To report 5-year outcomes from the STRATified CANcer Surveillance (STRATCANS) programme based on progression risks using National Institute for Health and Clinical Excellence (NICE) Cambridge Prognostic Group (CPG) at diagnosis, prostate specific antigen density and magnetic resonance imaging (MRI) visibility.

PATIENTS AND METHODS

Men with CPG1 and CPG2 disease selecting active surveillance (AS) were included into STRATCANS and allocated to one of three increasing follow-up intensities. Outcome measures were: (i) treatment for CPG≥3 progression (main outcome), (ii) any treatment, (iii) conversion to watchful waiting (WW), (iv) patient self-attrition, and (v) mortality.

RESULTS

A total of 297 men (median age 66.0 years) were reviewed. The median (interquartile range, mean) follow-up for men still on AS was 4.9 (2.7-7.6, 5.3) years. In the cohort, 38.0% were CPG2 and 25.0% Grade Group (GG) 2 at AS entry. Overall, 214/297 (72.1%) remained treatment free: 158 (53.1%) were still on AS, 17 (5.7%) died of other causes, and 39 (13.1%) progressed to WW/discharge. Only 10 (3.4%) left AS from anxiety. There were no cancer deaths or metastatic events. In all, 80 men (26.9%) converted to treatment due to biopsy/MRI progression but only 35 (11.7%) of these reached CPG≥3 disease. Treatment for CPG≥3 occurred in 7.6% of CPG1 and 18.5% of CPG2 disease and 9.9% of GG1 and 17.5% of GG2 disease. By STRATCANS tier, treatment for CPG≥3 disease was 4.7% in STRATCANS 1, 12.9% in STRATCANS 2, and 27.4% in STRATCANS 3 (P < 0.001). STRATCANS had an area under the curve (AUC) of 0.74 for predicting CPG≥3 progression out-performing stratification by GG (AUC 0.64), CPG (0.69) and Likert score (0.51) alone or a combination of MRI visibility and GG (0.64). Longitudinal data have allowed further refinement of the STRATCANS schedule.

CONCLUSIONS

The STRATCANS 5-year outcomes demonstrate that a simple risk stratified surveillance using a prognostically meaningful endpoint is safe, durable, has low treatment rates, high patient compliance and appropriately tailors monitoring based on risks of progression. A website and implementation toolkit are now available.

Earthworms attenuate antibiotic resistance genes and mobile genetic elements during vermicomposting of sewage sludge

Sewage sludge is among the richest reservoirs of antibiotic resistance genes (ARGs) that may spread to urban environment. Further investigation is warranted for removal of sludge-borne ARGs in large-scale vermicomposting systems. Under this scenario, there is the necessity to unveil the role of the widely-used earthworm species Eisenia andrei, since the current body of literature mostly focuses on E. fetida. The present study sought to evaluate the changes in sludge-borne ARGs and mobile genetic elements in a pilot-scale vermireactor in the presence of E. andrei in response to both gut- and cast-associated processes (GAPs and CAPs, respectively), by coupling high-throughput quantitative PCR and Illumina sequencing. After gut transit, large decreases in the relative abundances and number of the genes conferring resistance to major antibiotic classes, including some specific genes classified as of potentially high risk to human health, were recorded in the fresh casts. Likewise, genes encoding resistance to heavy metals were about nine-times lower in the egested materials than in the initial sludge. Genes coding for integrases or insertional sequences also exhibited reduced abundance as a result of GAP and CAP processes, suggesting that vermicompost appears to be less prone to horizontal gene transfer than untreated sludge. These findings provide evidence about the capacity of the earthworm E. andrei to diminish the risk of ARG spread during vermicomposting, reinforcing its potential for bioremediation purposes by transforming large quantities of waste into an improved fertiliser. This is crucial to propel vermicomposting technology forward and achieve transition toward net zero-waste process.

Innovative Policy Supports for Integration in Health and Social Care Focused on Culturally and Linguistically Diverse Populations in Australia: A Qualitative Study

The fragmented nature of Australian health and social care systems present a barrier to integrated care. Culturally and linguistically diverse (CALD) communities are recognised as a priority population with unmet health and social needs. This study describes policy supports for programs that promote health and social care integration with a CALD focus, including governance and partnerships; workforce and staffing; funding and payment; and data sharing and use. The research question was 'what innovative policy supports to integrate health and social programs?'. Qualitative interviews of participants involved in the implementation of health and social care programs in the Sydney using the Innovative Policy Supports For Integrated Health And Social Care Programs Framework, were conducted. Twenty-seven participants from 24 health and social programs based in Sydney participated in the study. Six programs serviced CALD communities only. Ten had majority of CALD clients, with the remaining having a mixture of clients. Ten programs had a formal coordinator role. Most programs did not report new approaches to data sharing. Two out of the 6 CALD targeted programs reported data-sharing via teleconference in the context of emergency. These were 2 health programs addressing COVID-19 disparities and the humanitarian needs of refugees, respectively. Only 2 reported a special funding to assist vulnerable families and common emergency department presenters, respectively. This study demonstrated the lack of integration of services in health and social care. Policy development and implementation should consider bringing stakeholders together (informed by CALD groups) to advance the generation of technology for adopting universal standards and the integration of funding to better support health and social care for CALD communities in multicultural Australia.

Short-term outcomes of triplet therapy in metastatic hormone-sensitive prostate cancer in older adults: a retrospective, single-center real-world cohort study

PURPOSE

To evaluate the efficacy and safety of triplet therapy in patients with metastatic hormone-sensitive prostate cancer (mHSPC), focusing on older adults, in a real-world clinical setting.

METHODS

In this retrospective, single-center study, we analyzed data from 21 patients with mHSPC (median age: 71 years) treated with androgen deprivation therapy (ADT), docetaxel, and darolutamide. Relative (≥ 90% reduction from baseline) and absolute (PSA < 0.2 ng/mL) prostate-specific antigen (PSA) response rates over 6 months were assessed, along with adverse event (AE) profiles.

RESULTS

At 6 months, the absolute PSA response rate was 71.4%, while the relative PSA response rate reached 100% by 3 months. Treatment-related toxicity was notable, with AEs observed in 95.2% of the patients, predominantly neutropenia. Patients aged ≥ 80 years had significantly higher treatment interruption rates for both docetaxel and darolutamide compared with those aged ≤ 79 years. Nonetheless, PSA response rates were comparable between the age groups. Neutrophil recovery time was significantly prolonged in patients aged ≥ 80 years compared to those aged ≤ 79 years.

CONCLUSION

Triplet therapy effectively reduces PSA in patients with mHSPC, including older adults. However, the high incidence of severe AEs, particularly in older adults, underscores the need for individualized treatment strategies. Despite these challenges, careful management of toxicities makes this regimen viable in clinical practice. These findings emphasize the importance of real-world data in optimizing therapy for aging populations and may serve as a basis for future prospective studies comparing triplet and doublet therapies across diverse patient cohorts.

Patient data for commercial companies? An ethical framework for sharing patients' data with for-profit companies for research

BACKGROUND

Research using data from medical care promises to advance medical science and improve healthcare. Academia is not the only sector that expects such research to be of great benefit. The research-based health industry is also interested in so-called 'real-world' health data to develop new drugs, medical technologies or data-based health applications. While access to medical data is handled very differently in different countries, and some empirical data suggest people are uncomfortable with the idea of companies accessing health information, this paper aims to advance the ethical debate about secondary use of medical data generated in the public healthcare sector by for-profit companies for medical research (ReuseForPro).

METHODS

We first clarify some basic concepts and our ethical-normative approach, then discuss and ethically evaluate potential claims and interests of relevant stakeholders: patients as data subjects in the public healthcare system, for-profit companies, the public, and physicians and their healthcare institutions. Finally, we address the tensions between legitimate claims of different stakeholders in order to suggest conditions that might ensure ethically sound ReuseForPro.

RESULTS

We conclude that there are good reasons to grant for-profit companies access to medical data if they meet certain conditions: among others they need to respect patients' informational rights and their actions need to be compatible with the public's interest in health benefit from ReuseForPro.

Optimized CUT&RUN protocol for activated primary mouse B cells

ChIP-seq has long been the standard for study of chromatin-protein interactions. However, development of a new technique, CUT&RUN, showed substantial advantages compared to ChIP-seq including higher quality signal while using substantially less sample. While a powerful technique, the original protocol was designed using cell lines and histones as targets. Due to their fragility, this was unsuitable for obtaining high-quality data from activated primary B lymphocytes. To adapt this protocol for B cells, cells were fixed prior to nuclear isolation, and several critical adjustments were introduced to the procedure and reagents. We measured binding of H3K4me3 histone and RNA Polymerase II, detecting robust peaks with as little as 100k nuclei. Additionally, freeze-thaw of B cells prior to processing did not affect results, emphasizing the flexibility of this modified technique. Using the protocol described here will allow one to quantify non-histone proteins bound to DNA from limited numbers of B cells with more efficiency than can be achieved from the current standard, ChIP-seq.

Sphingosylphosphorylcholine induces itch via activation of TRPM3 and TRPA1 in mice

Itch is a prevalent symptom in atopic dermatitis (AD), often leading to a strong urge to scratch. Elevated levels of sphingosylphosphorylcholine (SPC) are found in the stratum corneum of AD patients, and while SPC is known to induce itch, its molecular targets are not well understood. This study aims to identify the signaling pathway of SPC-induced itch under AD conditions. We demonstrate that SPC specifically activates the Transient Receptor Potential Melastatin 3 (TRPM3) channel in sensory neurons. In HEK293T cells expressing TRPM3, SPC treatment caused a significant increase in intracellular calcium, which was inhibited by TRPM3 antagonists. Among various TRP channels tested, TRPM3 exhibited the highest reactivity to SPC, followed by TRPA1. Molecular docking analysis also supported interactions between SPC and both TRPM3 and TRPA1. In an AD mouse model, SPC-induced responses were dependent on TRPM3 and TRPA1, and the expression of these channels increased in dorsal root ganglion neurons. SPC-induced scratching behaviors were significantly reduced by TRPM3 and TRPA1 antagonists, with TRPM3 playing a critical role in spontaneous scratching. This study identifies TRPM3 and TRPA1 as key mediators of SPC-induced itch, providing potential therapeutic targets for treating itch in AD patients.

Obesity promotes urinary tract infection by disrupting urothelial immune defenses

Obesity is a significant public health concern that is associated with numerous health risks. Infections are a major complication of obesity, but the mechanisms responsible for increased infection risk are poorly defined. Here, we use a diet induced obesity mouse model and investigate how obesity impacts urinary tract infection (UTI) susceptibility and bladder immune defenses. Our results show that high-fat diet fed female and male mice exhibit increased susceptibility to uropathogenic E. coli (UPEC) following experimental UTI. Transcriptomic analysis of bladder urothelial cells shows that obesity alters gene expression in a sex-specific manner, with distinct differentially expressed genes in male and female mice, but shared activation of focal adhesion and extracellular matrix signaling. Western blot and immunostaining confirm activation of focal adhesion kinase, a central component of the focal adhesion pathway, in the bladders of obese female and male mice. Mechanistically, experiments using primary human urothelial cells demonstrate that focal adhesion kinase overexpression promotes UPEC invasion. These findings demonstrate that obesity enhances UTI susceptibility by activating focal adhesion kinase and promoting bacterial invasion of the urothelium. Together, they explain how obesity promotes UTI vulnerability and identify modifiable targets for managing obesity-associated UTI.

Significance Statement

Obesity is associated with an increased risk of urinary tract infections (UTIs), but the underlying mechanisms promoting infection susceptibility remain poorly understood. Here, we show that diet-induced obesity drives sex-specific changes in bladder urothelial gene expression, including distinct immune responses in male and female mice. Despite these differences, both sexes exhibit activation of focal adhesion kinase (FAK). FAK overexpression promotes bacterial invasion into human bladder cells. These findings provide a mechanistic explanation for obesity-associated UTI susceptibility and suggest that targeting FAK signaling could offer a therapeutic strategy to prevent UTIs, with implications for personalized interventions in obesity.

Overcoming barriers in the use of artificial intelligence in point of care ultrasound

Point-of-care ultrasound is a portable, low-cost imaging technology focused on answering specific clinical questions in real time. Artificial intelligence amplifies its capabilities by aiding clinicians in the acquisition and interpretation of the images; however, there are growing concerns on its effectiveness and trustworthiness. Here, we address key issues such as population bias, explainability and training of artificial intelligence in this field and propose approaches to ensure clinical effectiveness.

Achieving precision assessment of functional clinical scores for upper extremity using IMU-Based wearable devices and deep learning methods

Stroke is a serious cerebrovascular disease, and rehabilitation following the acute phase is particularly crucial. Not all rehabilitation outcomes are favorable, highlighting the necessity for personalized rehabilitation. Precision assessment is essential for tailored rehabilitation interventions. Wearable inertial measurement units (IMUs) and deep learning approaches have been effectively employed for motor function prediction. This study aims to use machine learning techniques and data collected from IMUs to assess the Fugl-Meyer upper extremity subscale for post-stroke patients with motor dysfunction. IMUs signals from 120 patients were collected during a clinical trial. These signals were fed into a gated recurrent unit network to complete the scoring of individual actions, which were then aggregated to obtain the total score. Simultaneously, on the basis of the internal correlation between the Fugl-Meyer assessment and the Brunnstrom scale, Brunnstrom stage prediction models of the arm and hand were established via the random forest and extremely randomized trees algorithm. The experimental results show that the proposed models can score Fugl-Meyer items with a high accuracy of 92.66%. The R2 between the doctors' score and the model's score is 0.9838. The Brunnstrom stage prediction models can predict high-quality stages, achieving a Spearman correlation coefficient of 0.9709. The application of the proposed method enables precision assessment of patients' upper extremity motor function, thereby facilitating more personalized rehabilitation programs to achieve optimal recovery outcomes. Trial registration: Clinical trial of telerehabilitation training and intelligent evaluation system, ChiCTR2200061310, Registered 20 June 2022-Retrospective registration.

Patient-reported outcome measures (PROMs) used to assess sexual functioning in prostate cancer patients: a systematic review of psychometric properties

BACKGROUND

Prostate cancer (PCa) significantly impacts patients' sexual functioning and quality of life. Patient-reported outcome measures (PROMs) are essential for accurately assessing these issues, yet a comprehensive evaluation of their psychometric properties in PCa patients is lacking.

AIMS

This systematic review aimed to provide a comprehensive evaluation of all generic and specific PROMs used to assess sexual functioning in PCa patients and make recommendations the application of PROMs in this patient group.

METHODS

Six electronic databases were searched from up to May 5, 2024. Studies reporting the development and/or validation of PROMs for PCa patients or generic instruments administered to this population were included. The COSMIN risk of bias checklist was adopted to assess the methodological quality and psychometric properties of included PROMs. Psychometric properties of the PROM in each included study were rated against the criteria for good measurement properties based on the COSMIN guideline.

OUTCOMES

The main outcome was to identify the appropriate PROM that can be adopted and used for assessing sexual functioning in PCa patients in clinical setting.

RESULTS

A total of 10 PROMs were identified across 32 studies, primarily focusing on localized PCa patients after radical prostatectomy. The Expanded Prostate Cancer Index Composite (EPIC-26) was the most frequently evaluated and widely used PROM in clinical practice. EPIC-26 (Spanish, Italian, Chinese versions) and UCLA Prostate Cancer Index (UCLA-PCI) demonstrated better psychometric properties compared to other scales. However, no PROM met all COSMIN standards.

CLINICAL IMPLICATIONS

In a clinical setting, it is crucial to utilize well-validated PROMs with good psychometric properties to effectively identify patients with PCa experiencing sexual difficulties who may require additional support.

STRENGTHS AND LIMITATIONS

We applied strict inclusion criteria related to study design and study population, ensuring the assumption of transitivity and the consistency of the analysis.

CONCLUSION

Although EPIC-26 is a shortened version with strong psychometric properties, it may still be too lengthy for patients with significant health issues. Furthermore, the included PROMs do not address issues related to partner relationships, or the psychological impact of sexual dysfunction in sufficient detail. Future research should aim to develop and validate new PROMs that fill these gaps. These tools should be both psychometrically robust and practical for routine use, enabling real-time monitoring and improved care delivery.

Long-term outcomes of active surveillance for Grade Group 1 prostate cancer and the impact of the use of MRI on overtreatment

OBJECTIVES

To present the long-term outcomes of men with Grade Group (GG) 1 prostate cancer (PCa), included in the Prostate Cancer Research International Active Surveillance (PRIAS) study, and to assess the effect of the inclusion of magnetic resonance imaging (MRI) within the active surveillance (AS) protocol.

PATIENTS AND METHODS

The PRIAS study is a multicentre, prospective, web-based cohort study monitoring patients on AS. In total, 8910 men with GG1 PCa were followed in 169 centres worldwide. The cumulative incidences of definitive treatment, metastasis and PCa-specific mortality (PCSM) were estimated using competing risk analyses. Additionally, multivariable analysis was performed to assess the risk of reclassification, stratified by MRI performed around the time of diagnosis.

RESULTS

The cumulative incidence of definitive treatment 15 years post-diagnosis was 55% (95% confidence interval [CI] 53-57). For metastasis, the 15-year cumulative incidence was 2.7% (95% CI 1.5-4.4). Eight men of died from PCa, resulting in a 15-year cumulative PCSM incidence of 0.23% (95% CI 0.09-0.54). Compared to men with no MRI around the time of diagnosis, those who underwent MRI during the first 18 months of AS were associated with a significantly higher risk of reclassification to ≥GG2, while men with a positive MRI before diagnosis were associated with a higher risk of reclassification to GG2, but not to ≥GG3. Men with GG2 PCa on MRI-targeted rebiopsy who underwent definitive treatment did not show a statistically significant higher risk of 5-year disease recurrence compared to those who had GG1 PCa on last biopsy during AS.

CONCLUSIONS

Our study confirms the safety of AS for GG1 PCa, with low metastasis and PCSM rates over 15 years. Furthermore, the inclusion of MRI in AS prompts increased detection of GG2, leading to increased treatment rates despite similar short-term risks. To minimise overtreatment, expanding eligibility for AS and the uptake of AS in men with favourable GG2 PCa is crucial to address the stage shift resulting from the increased accuracy of MRI.

Antibacterial compounds against non-growing and intracellular bacteria

Slow- and non-growing bacterial populations, along with intracellular pathogens, often evade standard antibacterial treatments and are linked to persistent and recurrent infections. This necessitates the development of therapies specifically targeting nonproliferating bacteria. To identify compounds active against non-growing uropathogenic Escherichia coli (UPEC) we performed a drug-repurposing screen of 6454 approved drugs and drug candidates. Using dilution-regrowth assays, we identified 39 compounds that either kill non-growing UPEC or delay its regrowth post-treatment. The hits include fluoroquinolones, macrolides, rifamycins, biguanide disinfectants, a pleuromutilin, and anti-cancer agents. Twenty-nine of the hits have not previously been recognized as active against non-growing bacteria. The hits were further tested against non-growing Pseudomonas aeruginosa and Staphylococcus aureus. Ten compounds - solithromycin, rifabutin, mitomycin C, and seven fluoroquinolones-have strong bactericidal activity against non-growing P. aeruginosa, killing >4 log10 of bacteria at 2.5 µM. Solithromycin, valnemulin, evofosfamide, and satraplatin are unique in their ability to selectively target non-growing bacteria, exhibiting poor efficacy against growing bacteria. Finally, 31 hit compounds inhibit the growth of intracellular Shigella flexneri in a human enterocyte infection model, indicating their ability to permeate the cytoplasm of host cells. The identified compounds hold potential for treating persistent infections, warranting further comparative studies with current standard-of-care antibiotics.

Specific DNA features of the RNA polymerase I core promoter element targeted by core factor

RNA polymerase I (Pol I) is essential for ribosomal RNA (rRNA) synthesis, driving ribosome biogenesis in eukaryotes. Transcription initiation by Pol I requires core factor (CF) binding to the core element (CE) of the ribosomal DNA (rDNA) promoter. Despite structural conservation across species, significant sequence variability suggests CF recognizes DNA through structural features rather than specific sequences. We investigated CF's DNA binding preferences to elucidate the role of DNA structural properties in CE recognition. Analysis of CE sequences from 35 fungal species revealed conserved structural features, notably a rigid AT-rich patch at positions -22 to -20 and a conserved G base pair at position -24. Competition-based electrophoretic mobility shift assays (EMSA) with single base-pair substitutions showed CF tolerates mutations at many positions but is sensitive to changes in the AT-rich patch. Loss of CF binding correlated with alterations in DNA structural properties such as increased bendability, decreased curvature, widened minor groove width, and altered helix twist. In vitro SELEX experiments identified novel CE sequences preferentially bound by CF, exhibiting increased GC content, higher bendability, and decreased curvature despite lacking sequence conservation. Classification based on bendability profiles revealed CF preferentially binds bendable sequences. In vivo selection assays confirmed these findings, demonstrating consistent CF binding preferences within a cellular context. Our results indicate that CF recognizes and binds to the CE primarily through specific DNA structural features rather than nucleotide sequences. Structural properties like bendability, curvature, and minor groove width are critical determinants of CF binding, facilitating effective Pol I transcription initiation.

Combining Experimental Validation and Network Pharmacology to Reveal the Action Mechanism of Panax Notoginseng-Radix Salviae on Atherosclerosis

Purpose

Few studies have evaluated the mechanisms of the specific efficacy of Panax notoginseng-Radix Salviae couplet medicines (PN-RS) in the treatment of atherosclerosis (AS). This study aims to explore the potential bioactive ingredients and molecular mechanisms of PN-RS in the treatment of AS.

Materials and Methods

C57BL/6J mice were fed a common diet as the control group. ApoE-/- mice were randomly divided into the model, PN-RS treatment (0.75 mgPN+3.75 mgRS/g/day via gavage), and positive drug groups (rosuvastatin, 1.25 mg/kg/day via gavage). After two months of drugs intervention, H&E and Masson staining, the serum lipid concentration and atherosclerotic index were conducted to verify the PN-RS efficacy. Network pharmacology analysis was carried out to identify the pathways and targets of PN-RS. The signaling pathway-related targets and cytokines were tested via enzyme-linked immunosorbent assay (ELISA), Western blotting and real-time polymerase chain reaction (PCR).

Results

Network pharmacology analysis identified the JAK2-STAT3 signaling pathway as a key pathway through which PN-RS exerts its therapeutic effects. Results from animal experiments demonstrated that PN-RS significantly reduced the atherosclerotic lesion area and decreased serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and atherogenic index (AI). Mechanistic studies further revealed that PN-RS inhibited the JAK2-STAT3 signaling pathway and reduced the concentrations of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), and monocyte chemoattractant protein-1 (MCP-1).

Conclusion

These findings suggest that PN-RS could be a promising treatment for atherosclerosis, applicable across diverse populations. Future research should investigate its efficacy in various demographic groups and in combination with other therapies.

Peptidergic Systems and Neuroblastoma

The peptidergic systems are involved in neuroblastoma. Peptides (angiotensin II, neuropeptide Y, neurotensin, substance P) act as oncogenic agents in neuroblastoma, whereas others (adrenomedullin, corticotropin-releasing factor, urocortin, orexin) exert anticancer effects against neuroblastoma. This plethora of peptidergic systems show the functional complexity of the mechanisms regulated by peptides in neuroblastoma. Peptide receptor antagonists act as antineuroblastoma agents since these compounds counteracted neuroblastoma cell growth and migration and the angiogenesis promoted by oncogenic peptides. Other therapeutic approaches (signaling pathway inhibitors, focal adhesion kinase inhibitors, peptide receptor knockdown, acetic acid analogs) that also counteract the beneficial effects mediated by the oncogenic peptides in neuroblastoma are discussed, and future research lines to be developed in neuroblastoma (interactions between oncogenic and anticancer peptides, combination therapy using peptide receptor antagonists and chemotherapy/radiotherapy) are also suggested. Although the data regarding the involvement of the peptidergic systems in neuroblastoma are, in many cases, fragmentary or very scarce for a particular peptidergic system, taken together, they are quite promising with respect to potentiating and developing this research line with the aim of developing new therapeutic strategies to treat neuroblastoma in the future. Peptidergic systems are potential and promising targets for the diagnosis and treatment of neuroblastoma.

Advancing clinical biochemistry: addressing gaps and driving future innovations

Modern healthcare depends fundamentally on clinical biochemistry for disease diagnosis and therapeutic guidance. The discipline encounters operational constraints, including sampling inefficiencies, precision limitations, and expansion difficulties. Recent advancements in established technologies, such as mass spectrometry and the development of high-throughput screening and point-of-care technologies, are revolutionizing the industry. Modern biosensor technology and wearable monitors facilitate continuous health tracking, Artificial Intelligence (AI)/machine learning (ML) applications enhance analytical capabilities, generating predictive insights for individualized treatment protocols. However, concerns regarding algorithmic bias, data privacy, lack of transparency in decision-making ("black box" models), and over-reliance on automated systems pose significant challenges that must be addressed for responsible AI integration. However, significant limitations remain-substantial implementation expenses, system incompatibility issues, and information security vulnerabilities intersect with ethical considerations regarding algorithmic fairness and protected health information. Addressing these challenges demands coordinated efforts between clinicians, scientists, and technical specialists. This review discusses current challenges in clinical biochemistry, explicitly addressing the limitations of reference intervals and barriers to implementing innovative biomarkers in medical settings. The discussion evaluates how advanced technologies and multidisciplinary collaboration can overcome these constraints while identifying research priorities to enhance diagnostic precision and accessibility for better healthcare delivery.

DNA sequence analysis landscape: a comprehensive review of DNA sequence analysis task types, databases, datasets, word embedding methods, and language models

Deoxyribonucleic acid (DNA) serves as fundamental genetic blueprint that governs development, functioning, growth, and reproduction of all living organisms. DNA can be altered through germline and somatic mutations. Germline mutations underlie hereditary conditions, while somatic mutations can be induced by various factors including environmental influences, chemicals, lifestyle choices, and errors in DNA replication and repair mechanisms which can lead to cancer. DNA sequence analysis plays a pivotal role in uncovering the intricate information embedded within an organism's genetic blueprint and understanding the factors that can modify it. This analysis helps in early detection of genetic diseases and the design of targeted therapies. Traditional wet-lab experimental DNA sequence analysis through traditional wet-lab experimental methods is costly, time-consuming, and prone to errors. To accelerate large-scale DNA sequence analysis, researchers are developing AI applications that complement wet-lab experimental methods. These AI approaches can help generate hypotheses, prioritize experiments, and interpret results by identifying patterns in large genomic datasets. Effective integration of AI methods with experimental validation requires scientists to understand both fields. Considering the need of a comprehensive literature that bridges the gap between both fields, contributions of this paper are manifold: It presents diverse range of DNA sequence analysis tasks and AI methodologies. It equips AI researchers with essential biological knowledge of 44 distinct DNA sequence analysis tasks and aligns these tasks with 3 distinct AI-paradigms, namely, classification, regression, and clustering. It streamlines the integration of AI into DNA sequence analysis tasks by consolidating information of 36 diverse biological databases that can be used to develop benchmark datasets for 44 different DNA sequence analysis tasks. To ensure performance comparisons between new and existing AI predictors, it provides insights into 140 benchmark datasets related to 44 distinct DNA sequence analysis tasks. It presents word embeddings and language models applications across 44 distinct DNA sequence analysis tasks. It streamlines the development of new predictors by providing a comprehensive survey of 39 word embeddings and 67 language models based predictive pipeline performance values as well as top performing traditional sequence encoding-based predictors and their performances across 44 DNA sequence analysis tasks.

Personalized risk-adapted models in prostate cancer during active surveillance using MRI-a narrative review

The presence of histologically defined prostate cancer (PCa) is common and rises with age. Nevertheless, histological evidence of PCa does not always lead to clinically evident or life-threatening disease, and we know that PSA-based population screening can find twice the prevalence of PCa than would present via clinical routes. The PROTECT study randomized men diagnosed through PSA screening, to surgery, radiotherapy, or active monitoring. At 15 years, PCa-related deaths ranged from 2.1% in the surgery group to 2.9% in the active monitoring group, while the risk of death from other causes was 22%. Modern PCa diagnosis uses MRI to determine who needs a biopsy and how it is done. Multiparametric MRI can selectively detect PCa of higher grade and volume, which is more likely to be associated with progression, metastases, and death, and hence to benefit from treatment. MRI and MRI-targeted biopsies are recommended prior to enrolment in active surveillance (AS) programs for accurate risk classification. The UCLH AS cohort based on per-cause MRI evaluations has shown baseline Gleason grade and MRI index lesion visibility to be strong predictors of progression to treatment. Serial evaluation with MRI has been codified with the PRECISE recommendations to support MRI-based monitoring during AS. AS recommendations have extended to certain favorable-intermediate risk cancers. The Movember International Consensus Meeting has determined a dynamic risk-stratified AS approach to be the highest-ranked research priority. We review the impact of MRI on AS from patient selection to risk stratification, and the development of MRI-led personalized AS protocols. KEY POINTS: Question Standardized protocols are not able to address the heterogeneity of men on active surveillance for PCa and are burdened by unnecessary examinations. Findings MRI can improve the selection of men for active surveillance, predict time to treatment, and risk-stratify patients at risk of progression. Clinical relevance MRI-led risk-adapted protocols may reduce the burden of active surveillance on patients, improve adherence, and reduce healthcare costs.

Has Active Surveillance for Prostate Cancer Become Safer? Lessons Learned from a Global Clinical Registry

BACKGROUND AND OBJECTIVE

Active surveillance (AS) has evolved into a widely applied treatment strategy for many men around the world with low-risk prostate cancer (or in selected cases intermediate-risk disease). Here, we report on the safety and acceptability of AS, and treatment outcomes for low- and intermediate-risk tumours over time in 14 623 men with follow-up of over 6 yr.

METHODS

Clinical data from 26 999 men on AS from 25 cohorts in 15 countries have been collected in an international database from 2000 onwards.

KEY FINDINGS AND LIMITATIONS

Across our predefined four time periods of 4 yr each (covering the period 2000-2016), there was no significant change in overall survival (OS). However, metastasis-free survival (MFS) rates have improved since the second period and were excellent (>99%). Treatment-free survival rates for earlier periods showed a slightly more rapid shift to radical treatment. Over time, there was a constant proportion of 5% of men for whom anxiety was registered as the reason for treatment alteration. There was, however, also a subset of 10-15% in whom treatment was changed, for which no apparent reason was available. In a subset of men (10-15%), tumour progression was the trigger for treatment. In men who opted for radical treatment, surgery was the most common treatment modality. In those men who underwent radical treatment, 90% were free from biochemical recurrence at 5 yr after treatment.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Our study confirms that AS was a safe management option over the full duration in this large multicentre cohort with long-term follow-up, given the 84.1% OS and 99.4% MFS at 10 yr. The probability of treatment at 10 yr was 20% in men with initial low-risk tumours and 31% in men with intermediate-risk tumours. New diagnostic modalities may improve the acceptability of follow-up using individual risk assessments, while safely broadening the use of AS in higher-risk tumours.

PATIENT SUMMARY

Active surveillance (AS) has evolved into a widely applied treatment strategy for many men with prostate cancer around the world. In this report, we show the long-term safety of following AS for men with low- and intermediate-risk prostate cancer. Our study confirms AS as a safe management option for low- and intermediate-risk prostate cancer. New diagnostic modalities may improve the acceptability of follow-up using individual risk assessments, while safely broadening the use of AS in higher-risk tumours.

Long-term oncological outcomes of active surveillance for low-risk prostate cancer diagnosed during the MRI era

BACKGROUND

Active surveillance (AS) is the recommended approach for managing Grade-Group1 (GG1) prostate cancer (PCa). Incorporating MRI at entry improve patient selection and outcomes.

OBJECTIVE

To evaluate long-term oncological outcomes of patients receiving AS selected with MRI at entry.

MATERIALS AND METHODS

Retrospective analysis of a single-center cohort of patients selected for AS from 2007 to 2022. Inclusion criteria were GG1 PCa with MRI prior to systematic and targeted biopsies. A per-protocol re-biopsy at one year has not been part of the AS inclusion criteria since 2015. Main outcome was cumulative incidence of: biopsy grade reclassification, AS discontinuation, active treatment, post-active treatment biochemical recurrence, metastasis, and mortality. Secondary outcome was the identification of risk factors for AS discontinuation.

RESULTS

Cohort consists of 354 men. Median follow-up is 6.3 years (IQR: 3.2-9.1). Median PSA was 6.3ng/mL (5.0 to 8.5). At 10 years post-diagnosis, the cumulative incidence was 29.6% (95%CI: 23.3-36.2%) for grade reclassification, 40.0% (95%CI: 32.8-47.0%) for AS discontinuation, 36.9% (95% CI: 30.0-43.7) for active treatment, 9.4% (95% CI: 3.7-18.4) for post-active treatment biochemical recurrence and 0.5% for metastatic progression (2 patients). No PCa-related deaths were observed. PI-RADS score, and the number of positive biopsies at inclusion were identified as predictive factors for AS discontinuation.

CONCLUSION

In this cohort of AS patients with MRI at entry, 60% of men remained on AS at 10 years, with less than 1% developing metastatic disease and no PCa-related mortality. These results support AS management with MRI at entry and add to share decision-making with patients.

LEVEL OF EVIDENCE

Level 2.

Prevalence and impact of sarcopenia in patients with inflammatory bowel diseases: A prospective cohort study

BACKGROUND

Inflammatory bowel disease (IBD) patients with sarcopenia are at increased morbidity risk. The aim of this study was to assess the prevalence of sarcopenia in IBD outpatients using both morphological and functional criteria.

METHODS

In this prospective cohort study, all IBD patients admitted to the day hospital unit between March 01 and 31, 2023 were included. Muscle mass and function were evaluated using bioelectrical impedance analysis and handgrip strength measurement, respectively. Probable sarcopenia was defined as reduced handgrip strength (<16-27 kg). Myopenia was defined by a low appendicular muscle mass index (<5.5-7 kg/m²). Sarcopenia was diagnosed based on the coexistence of reduced muscle strength and muscle mass. Disease activity, therapeutic changes, hospitalizations, and IBD-related surgeries were assessed at month 6.

RESULTS

Sixty patients with either Crohn's disease (CD, 52 %) or ulcerative colitis (48 %), with a median age of 37 years (interquartile range [IQR]: 28-54), were included. Fifty-five percent were women. Most patients were in remission (67 %, n = 40). In CD patients, the involvement was ileocolic (48 %), ileal (35 %), or colonic (16 %). A history of IBD-related digestive surgery was noted in 30 % of cases. The median body mass index [BMI] was 24 (IQR: 21-27). The prevalence of sarcopenia, probable sarcopenia, and myopenia was 10 %, 18 %, and 20 %, respectively. Sarcopenic patients were significantly older (59 vs 36 years, p = 0.01), had a longer disease duration (20 vs 8 years, p = 0.003), were more likely to have associated joint inflammation (27 % vs 6 %, p = 0.01) and CD (80 % vs 49 %, p = 0.36). Myopenia was significantly associated with a history of surgery (67 % vs 21 %, p = 0.004) and a lower BMI (21 vs 24, p = 0.001).

CONCLUSION

In this prospective cohort of IBD outpatients, 10 % and 20 % of patients had sarcopenia and myopenia, respectively. Screening for sarcopenia therefore seems essential in this population, including in stable outpatients in remission who do not meet malnutrition criteria and in overweight patients, as according to the literature, sarcopenia is associated with poorer clinical outcomes and increased postoperative complications. Interventional studies are needed to assess the impact of multidisciplinary treatment of sarcopenia on quality of life and disease progression.

De-escalation of Monitoring in Active Surveillance for Prostate Cancer: Results from the GAP3 Consortium

BACKGROUND AND OBJECTIVE

There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring.

METHODS

The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring.

KEY FINDINGS AND LIMITATIONS

Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation.

CONCLUSIONS

Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa.

PATIENT SUMMARY

We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.

Corticosteroid-Dependent Association between Prognostic Peripheral Blood Cell-Free DNA Levels and Neutrophil-Mediated NETosis in Patients with Glioblastoma

PURPOSE

Noninvasive prognostic biomarkers to inform clinical decision-making are an urgent unmet need for the management of patients with glioblastoma (GBM). We previously showed that higher circulating cell-free DNA (ccfDNA) concentration is associated with worse survival in GBM. However, the biology underlying this is unknown.

EXPERIMENTAL DESIGN

We prospectively enrolled 129 patients with treatment-naïve GBM with blood drawn prior to initial resection (baseline) and at the time of the first postradiotherapy MRI. We performed ccfDNA methylation deconvolution to determine cellular sources of ccfDNA. ELISA was performed to detect citrullinated histone 3 (citH3), a marker of neutrophil extracellular traps (NET). Multiplex proteomic analysis was used to measure soluble inflammatory proteins.

RESULTS

We found that neutrophils contributed the highest proportion of prognostic ccfDNA. The percentage of ccfDNA derived from neutrophils was correlated with total [ccfDNA] but only in patients receiving preoperative corticosteroids. At baseline and on therapy, [citH3] was significantly higher in the plasma of patients with GBM receiving corticosteroids compared with corticosteroid-naïve GBM or no-cancer controls. Unsupervised hierarchical clustering of ccfDNA methylation patterns yielded two clusters, with one enriched for patients with the NETosis phenotype and who received corticosteroids. Unsupervised clustering of circulating inflammatory proteins yielded similar results.

CONCLUSIONS

These data suggest neutrophil-mediated NETosis is the dominant source of prognostic ccfDNA in patients with GBM and may be associated with glucocorticoid exposure. If further studies show that pharmacological inhibition of NETosis can mitigate the deleterious effects of corticosteroids, these plasma markers will have important clinical utility as noninvasive correlative biomarkers.

The Innovative Health Initiative public-private partnership: a catalyst for big data-driven health research and innovation

The use of "Big Data" in health research could be a game changer to revolutionize the field and drive innovation. However, the complexity of health data and of the healthcare ecosystem makes big data applications challenging. To overcome these challenges, it is essential that all stakeholders, both data owners and users, feel comfortable with the data use and the results of the analyses. This can only be achieved using a collaborative approach that prioritizes transparency and trust. The European Innovative Health Initiative (IHI) is a prime example of a successful public-private partnership that has achieved this. By fostering a culture of collaboration and trust, the IHI has enabled unprecedented access to large amounts of health data, improved data quality and standards, and created valuable resources and knowledge for progress in areas of unmet public health need. This perspective explores the IHI model and highlights examples from its projects that demonstrate its power as a catalyst for big data-driven health research and innovation. By sharing lessons learned and best practices, we aim to contribute to the development of a robust data-driven evidence base for the translation of research into improved patient care practices and products.

Projected outcomes of reduced-biopsy management of Grade Group 1 prostate cancer: implications for relabeling

BACKGROUND

Implications of relabeling Grade Group 1 prostate cancer as noncancer will depend on the recommended active surveillance strategy. Whether relabeling should prompt deintensifying, prostate-specific antigen (PSA)-based active monitoring approaches is unclear. We investigated outcomes of biopsy-based active surveillance strategies vs PSA-based active monitoring for Grade Group 1 diagnoses under different patient adherence rates.

METHODS

We analyzed longitudinal PSA levels and time to Grade Group 2 or higher reclassification among 850 patients with a diagnosis of Grade Group 1 disease from the Canary Prostate Active Surveillance Study (2008-2013). We then simulated 20 000 patients over 12 years, comparing Grade Group 2 or higher detection under biennial biopsy against 3 PSA-based strategies: (1) PSA (biopsy for PSA change ≥20% per year), (2) PSA plus magnetic resonance imaging (magnetic resonance imaging for PSA change ≥20% per year and biopsy for Prostate Imaging Reporting & Data System ≥3), and (3) predicted risk (biopsy for predicted upgrading risk ≥10%).

RESULTS

Under biennial biopsies and 20% dropout to active treatment, 17% of patients had a 2-year or longer delay in Grade Group 2 or higher detection. The PSA strategy reduced the number of biopsies by 39% but delayed detection in 32% of patients. The PSA plus magnetic resonance imaging strategy reduced the number of biopsies by 52%, with a 34% delay. The predicted risk strategy reduced the number of biopsies by 31%, with only an 8% delay. These findings are robust to biopsy sensitivity and confirmatory biopsy.

CONCLUSIONS

Prostate-specific antigen-based active monitoring could substantially reduce biopsy frequency; however, a precision strategy based on an individual upgrading risk is most likely to minimize delays in detection of disease progression. This strategy may be preferred if active surveillance is deintensified under relabeling, provided patient adherence remains unaffected.

Screening and identification of viruses in termites: behavior-regulating roles of RcBsV and RcBV

BACKGROUND

Termites live underground in a social setting having continuous contact with microorganism. However, there is no comparative study on virus diversity and relative abundance between termites, castes and body parts in termites. To address this gap, pseudergates of Cryptotermes declivis, workers of the Odontotermes formosanus, and workers, soldiers and alates of the Reticulitermes chinensis were used as experimental materials to perform virome sequencing, virus annotations and their relative abundance analysis.

RESULTS

It was found that three termites showed different virome taxonomic compositions, abundances and distributions. Small number of viruses were detected in the head, which indicated that the diversity of the virus in the thorax-abdomen is greater than that in the head. Notable differences in viruses between castes in R. chinensis were observed. Eight candidate viruses from the virome of R. chinensis were cloned and identified. To check the influences of viruses on termite behaviors, RNA interference of R. chinensis betsystermes virus (RcBsV) and R. chinensis bracovirus (RcBV) was successfully performed. The relative abundance of the two targeted viruses were significantly decreased in workers of R. chinensis fed on dsRcBsV and dsRcBV. The duration of aggressive behaviors significantly increased, while altruistic behaviors significantly decreased, suggesting that the reduced relative abundance of RcBsV and RcBV resulted in the disruption of normal social behaviors in termites.

CONCLUSION

These findings enhance our understanding of viral diversity in different termites and castes and its behavioral impacts on termites, which can be used to control termites. © 2024 Society of Chemical Industry.

Irreversible Electroporation for the Focal Treatment of Prostate Cancer: A Systematic Review

PURPOSE

Irreversible electroporation (IRE) is a promising alternative treatment for low-intermediate-risk localized prostate cancer. In this systematic review we aim to evaluate the safety profile and functional and oncological outcomes of this new technique.

MATERIALS AND METHODS

A systematic review of the literature was performed on PubMed, EMBASE, and Scopus up to 24 August 2023. Nineteen studies were analyzed, including 12 prospective studies and 7 retrospective studies. A total of 1,452 patients underwent IRE as the sole primary treatment modality.

RESULTS

The in-field clinically significant prostate cancer rate was reported between 0%-15.6% in the repeat biopsy. The retreatment rate was reported from 8% to 36.6%. The 3 years failure-free survival was presented between 90%-96.8%. The post-operative pad-free rate ranged between 96.7%-100%. Greater heterogeneity exists considering the change in erectile function. The most common reported complications were urinary tract infection and hematuria. Major complications were rare.

CONCLUSIONS

These results underline that IRE achieves favorable oncological control with an excellent safety profile, in the meantime preserving patients' urinary and erectile function.

An overview of utilizing artificial intelligence in localized prostate cancer imaging

INTRODUCTION

Prostate cancer (PCa) is a leading cause of cancer-related deaths among men, and accurate diagnosis is critical for effective management. Multiparametric MRI (mpMRI) has become an essential tool in PCa diagnosis due to its superior spatial resolution which enables detailed anatomical, functional information and its resultant ability to detect clinically significant PCa. However, challenges such as subjective interpretation methods and high inter-reader variability remain. In recent years, artificial intelligence (AI) has emerged as a promising solution to enhance the diagnostic performance of mpMRI by automating key tasks such as prostate segmentation, lesion detection, classification.

AREAS COVERED

This review provides a comprehensive overview of the current AI applications in prostate mpMRI, discussing advancements in automated image analysis and how AI-driven models are developed to improve detection and risk stratification. A literature search was conducted to examine both machine learning and deep learning techniques applied in this field, highlighting key studies and future directions.

EXPERT OPINION

While AI models have shown significant promise, their clinical integration remains limited due to the need for larger, multi-institutional validation studies. As AI continues to evolve, multimodal approaches combining imaging with clinical data are likely to play pivotal role in personalized PCa diagnosis, treatment planning.

Time-lapse tryptic digestion: a proteomic approach to improve sequence coverage of extracellular matrix proteins

The extracellular matrix (ECM) is a complex and dynamic meshwork of proteins providing structural support to cells. It also provides biochemical signals governing cellular processes, including proliferation, adhesion, and migration. Alterations of ECM structure and/or composition have been linked to many pathological processes, including cancer and fibrosis. Over the past decade, mass-spectrometry-based proteomics has become the state-of-the-art method to profile the protein composition of ECMs. However, existing methods do not fully capture the broad dynamic range of protein abundances in the ECM. They also do not permit to achieve the high coverage needed to gain finer biochemical on ECM proteoforms (e.g., isoforms, post-translational modifications) and topographical information critical to better understand ECM protein functions. Here, we present the development of a time-lapsed proteomic pipeline using limited tryptic proteolysis and sequential release of peptides over time. This experimental pipeline was combined with data-independent acquisition mass spectrometry and the assembly of a custom matrisome spectral library to enhance peptide-to-spectrum matching. This pipeline shows superior protein identification, peptide-to-spectrum matching, and significantly increased sequence coverage against standard ECM proteomic pipelines. Exploiting the spatio-temporal resolution of this method, we further demonstrate how time-resolved 3-dimensional peptide mapping can identify protein regions differentially susceptible to trypsin, which may aid in identifying protein-protein interaction sites.

Different fibroblast subtypes propel spatially defined ileal inflammation through TNFR1 signalling in murine ileitis

Crohn's disease (CD) is a persistent inflammatory disorder primarily affecting the terminal ileum. The TnfΔΑRE mice, which spontaneously develop CD-like ileitis due to TNF overexpression, represent a faithful model of the human disease. Here, via single-cell RNA sequencing in TnfΔΑRE mice, we show that murine TNF-dependent ileitis is characterized by cell expansion in tertiary lymphoid organs (TLO), T cell effector reprogramming, and accumulation of activated macrophages in the submucosal granulomas. Within the stromal cell compartment, fibroblast subsets (telocytes, trophocytes, PdgfraloCd81- cells) are less abundant while lymphatic endothelial cells (LEC) and fibroblastic reticular cells (FRC) show relative expansion compared to the wild type. All three fibroblast subsets show strong pro-inflammatory signature. TNFR1 loss or gain of function experiments in specific fibroblast subsets suggest that the TnfΔΑRE-induced ileitis is initiated in the lamina propria via TNF pathway activation in villus-associated fibroblasts (telocytes and PdgfraloCd81- cells), which are responsible for the organization of TLOs. Trophocytes drive disease progression in the submucosal layer, accompanied by the excessive formation of granulomas. These findings provide evidence for spatial regulation of inflammation by fibroblast subsets and underscore the pivotal role of fibroblasts in the inception and advancement of ileitis.

Explainable AI for Symptom-Based Detection of Monkeypox: a machine learning approach

BACKGROUND

Monkeypox, a viral zoonotic disease, is an emerging global health concern, with rising incidence and outbreaks extending beyond its endemic regions in Central and, West Africa and the world. The disease transmits through contact with infected animals and humans, leading to fever, rash, and lymphadenopathy symptoms. Control efforts include surveillance, contact tracing, and vaccination campaigns; however, the increasing number of cases underscores the necessity for a coordinated global response to mitigate its impact. Since monkeypox has become a public health issue, new methods for efficiently identifying cases are required. The control of monkeypox infections depends on early detection and prediction. This study aimed to utilize Symptom-Based Detection of Monkeypox using a machine-learning approach.

METHODS

This research presents a machine learning approach that integrates various Explainable Artificial Intelligence (XAI) to enhance the detection of monkeypox cases based on clinical symptoms, addressing the limitations of image-based diagnostic systems. In this study, we used a publicly available dataset from GitHub containing clinical features about monkeypox disease. The data have been analysed using Random Forest, Bagging, Gradient Boosting, CatBoost, XGBoost, and LGBMClassifier to develop a robust predictive model.

RESULTS

The study shows that machine learning models can accurately diagnose monkeypox based on symptoms like fever, rash, lymphadenopathy and other clinical symptoms. By using XAI techniques for feature importance, the approach not only achieved high accuracy but also provided transparency in decision-making. This integration of explainable Artificial intelligence (AI) enhances trust and allows healthcare professionals to understand predictions, leading to timely interventions and improved public health responses to monkeypox outbreaks. All Machine learning methods have been compared with the evaluation matrix. The best performance was for the LGBMClassifier, with an accuracy of 89.3%. In addition, multiple Explainable Techniques tools were used to help in examining and explaining the output of the LGBMClassifier model.

CONCLUSIONS

Our research shows that combining explainable techniques with AI models greatly enhances the accuracy of case detection and boosts the trust of medical professionals. These models result in directly involving the reader and health care professional in the decision-making process, making informed decisions, and efficiently allocating resources by providing insight into the decision-making process. In addition, this study underscores the potential of AI in public health surveillance, particularly in enhancing responses to emerging infectious diseases such as monkeypox.

Transcriptomic characterisation of acute myeloid leukemia cell lines bearing the same t(9;11) driver mutation reveals different molecular signatures

BACKGROUND

Acute myeloid leukemia (AML) is the most common type of acute leukemia, accounting for 20% of cases in children and adolescents. Genome-wide studies have identified genes that are commonly mutated in AML, including many epigenetic regulators involved in either DNA methylation (DNMT3A, TET2, IDH1/2) or histone post-translational modifications (ASXL1, EZH2, MLL1). Several cell lines derived from AML patients are widely used in cancer research. Whether important differences in these cell lines exist remains poorly characterised.

RESULTS

Here, we used RNA sequencing (RNA-Seq) to contrast the transcriptome of four commonly used AML-derived cell lines: THP-1, NOMO-1, MOLM-13 bearing the common initiating t(9;11) translocation, and MV4.11 bearing the t(4;11) translocation. Gene set enrichment analyses and comparison of key transcription and epigenetic regulator genes revealed important differences in the transcriptome, distinguishing these AML models. Among these, we found striking differences in the expression of clusters of genes located on chromosome 19 encoding Zinc Finger (ZNF) transcriptional repressors. Low expression of many ZNF genes within these clusters is associated with poor survival in AML patients.

CONCLUSION

The present study offers a valuable resource by providing a detailed comparative characterisation of the transcriptome of cell lines within the same AML subtype used as models for leukemia research.

Data collaboration for causal inference from limited medical testing and medication data

Observational studies enable causal inferences when randomized controlled trials (RCTs) are not feasible. However, integrating sensitive medical data across multiple institutions introduces significant privacy challenges. The data collaboration quasi-experiment (DC-QE) framework addresses these concerns by sharing "intermediate representations"-dimensionality-reduced data derived from raw data-instead of the raw data. Although DC-QE can estimate treatment effects, its application to medical data remains unexplored. The aim of this study was to apply the DC-QE framework to medical data from a single institution to simulate distributed data environments under independent and identically distributed (IID) and non-IID conditions. We propose a method for generating intermediate representations within the DC-QE framework. Experimental results show that DC-QE consistently outperformed individual analyses across various accuracy metrics, closely approximating the performance of centralized analysis. The proposed method further improved performance, particularly under non-IID conditions. These outcomes highlight the potential of the DC-QE framework as a robust approach for privacy-preserving causal inferences in healthcare. Broader adoption of this framework and increased use of intermediate representations could grant researchers access to larger, more diverse datasets while safeguarding patient confidentiality. This approach may ultimately aid in identifying previously unrecognized causal relationships, support drug repurposing efforts, and enhance therapeutic interventions for rare diseases.

Adenosine deaminase and deoxyadenosine regulate intracellular immune response in C. elegans

Adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP) are enzymes in the purine salvage pathway, which recycles purines to meet cellular demands. Mutations of these enzymes in humans cause inflammatory and immunodeficiency syndromes, but the mechanisms are not well understood. Prior work in the nematode Caenorhabditis elegans demonstrated that loss of PNP ortholog PNP-1 induced an immune response called the intracellular pathogen response (IPR). Here, we show that loss of the enzyme upstream of PNP-1 called ADAH-1 (ADA homolog) also induces the IPR and promotes resistance against intracellular pathogens. Unlike PNP-1, ADAH-1 is essential for organismal development. Importantly, we find that supplementation of deoxyadenosine, a substrate for ADA, induces the IPR and promotes resistance to intracellular pathogens in C. elegans, a finding we extend to human cells. Thus, mutations in ADA and PNP induce innate immunity through increased deoxyadenosine, a phenomenon that is conserved from C. elegans to humans.

RAG suppresses group 2 innate lymphoid cells

Antigen specificity is the central trait distinguishing adaptive from innate immune function. Assembly of antigen-specific T cell and B cell receptors occurs through V(D)J recombination mediated by the Recombinase Activating Gene endonucleases RAG1 and RAG2 (collectively called RAG). In the absence of RAG, mature T and B cells do not develop and thus RAG is critically associated with adaptive immune function. In addition to adaptive T helper 2 (Th2) cells, group 2 innate lymphoid cells (ILC2s) contribute to type 2 immune responses by producing cytokines like Interleukin-5 (IL-5) and IL-13. Although it has been reported that RAG expression modulates the function of innate natural killer (NK) cells, whether other innate immune cells such as ILC2s are affected by RAG remains unclear. We find that in RAG-deficient mice, ILC2 populations expand and produce increased IL-5 and IL-13 at steady state and contribute to increased inflammation in atopic dermatitis (AD)-like disease. Further, we show that RAG modulates ILC2 function in a cell-intrinsic manner independent of the absence or presence of adaptive T and B lymphocytes. Lastly, employing multiomic single cell analyses of RAG1 lineage-traced cells, we identify key transcriptional and epigenomic ILC2 functional programs that are suppressed by a history of RAG expression. Collectively, our data reveal a novel role for RAG in modulating innate type 2 immunity through suppression of ILC2s.

Targeting PRAME directly or via EZH2 inhibition overcomes retinoid resistance and represents a novel therapy for keratinocyte carcinoma

Retinoids have demonstrated efficacy as preventative/treatment agents for keratinocyte carcinomas (KCs): basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC). However, retinoid resistance mechanisms limit the efficacy of these compounds. A subset of KCs expresses Preferentially Expressed Antigen in Melanoma (PRAME): a retinoid signaling corepressor. PRAME is proposed to repress retinoid signaling by guiding enhancer of zeste homolog 2 (EZH2) to retinoic acid response elements (RARE) in promoters. We investigated the effects of PRAME on KC pathogenesis and retinoid response. High-PRAME expression in tumors was negatively correlated with epidermal differentiation gene signatures. PRAME overexpression downregulated epidermal differentiation gene signatures and impaired differentiation in 3D culture. PRAME overexpression attenuated retinoid-induced RARE activation, growth suppression, and differentiation responses. Conversely, low-PRAME tumors and PRAME-depleted KC cells demonstrated enriched epidermal differentiation gene signatures. PRAME downregulation restored retinoid-induced RARE activation, growth suppression, keratinization in SCC, and cell death signaling in BCC. Furthermore, combined retinoid and EZH2 inhibitor treatment augmented RARE activation and suppressed PRAME-expressing KC cell growth. Hence, PRAME confers retinoid resistance in KC, which may be overcome by EZH2 inhibition.

CD4 T cell dysfunction is associated with bacterial recrudescence during chronic tuberculosis

While most people contain Mycobacterium tuberculosis infection, some individuals develop active disease, usually within two years of infection. Why immunity fails after initially controlling infection is unknown. C57BL/6 mice control Mycobacterium tuberculosis for up to a year but ultimately succumb to disease. We hypothesize that the development of CD4 T cell dysfunction permits bacterial recrudescence. We developed a reductionist model to assess antigen-specific T cells during chronic infection and found evidence of CD4 T cell senescence and exhaustion. In C57BL/6 mice, CD4 T cells upregulate coinhibitory receptors and lose effector cytokine production. Single cell RNAseq shows that only a small number of CD4 T cells in the lungs of chronically infected mice are polyfunctional. While the origin and causal relationship between T-cell dysfunction and recrudescence remains uncertain, we propose T cell dysfunction leads to a feed-forward loop that causes increased bacillary numbers, greater T cell dysfunction, and progressive disease.

Applying machine learning algorithms to explore the impact of combined noise and dust on hearing loss in occupationally exposed populations

This study aimed to explore the combined impacts of occupational noise and dust on hearing and extra-auditory functions and identify associated risk factors via machine learning techniques. Data from 14,145 workers (627 with occupational noise-induced hearing loss (ONIHL)) at Hebei Medical Examination Center (2017-2023) were analyzed. Workers with combined exposure and without specific contraindications or other hearing impairment causes were included. Demographic and clinical data were gathered. Chi-square and Mann-Whitney U tests examined variables, and multivariate logistic regression determined ONIHL risk factors. Machine learning algorithms like Logistic Regression and Random Forest were developed, optimized, and evaluated. Results showed significant differences in gender, exposure, blood pressure, smoking, etc. between ONIHL and non-ONIHL groups. Male gender, combined exposure, diastolic blood pressure elevation, smoking, fasting blood glucose elevation, and age were positive predictors, while systolic blood pressure elevation was negative. The logistic model had the highest predictive ability (ROC = 0.714). Subgroup analysis revealed a significant positive correlation in specific subgroups. In summary, combined exposure increased ONIHL risk and affected health. Machine learning effectively predicted ONIHL, but the study had limitations and needed further research.

Nuclear Argonaute protein NRDE-3 switches small RNA partners during embryogenesis to mediate temporal-specific gene regulatory activity

RNA interference (RNAi) is a conserved pathway that utilizes Argonaute proteins and their associated small RNAs to exert gene regulatory function on complementary transcripts. While the majority of germline-expressed RNAi proteins reside in perinuclear germ granules, it is unknown whether and how RNAi pathways are spatially organized in other cell types. Here, we find that the small RNA biogenesis machinery is spatially and temporally organized during Caenorhabditis elegans embryogenesis. Specifically, the RNAi factor, SIMR-1, forms visible concentrates during mid-embryogenesis that contain an RNA-dependent RNA polymerase, a poly-UG polymerase, and the unloaded nuclear Argonaute protein, NRDE-3. Curiously, coincident with the appearance of the SIMR granules, the small RNAs bound to NRDE-3 switch from predominantly CSR-class 22G-RNAs to ERGO-dependent 22G-RNAs. NRDE-3 binds ERGO-dependent 22G-RNAs in the somatic cells of larvae and adults to silence ERGO-target genes; here we further demonstrate that NRDE-3-bound, CSR-class 22G-RNAs repress transcription in oocytes. Thus, our study defines two separable roles for NRDE-3, targeting germline-expressed genes during oogenesis to promote global transcriptional repression, and switching during embryogenesis to repress recently duplicated genes and retrotransposons in somatic cells, highlighting the plasticity of Argonaute proteins and the need for more precise temporal characterization of Argonaute-small RNA interactions.

The presence of prostate MRI-visible lesions at follow-up biopsy as a risk factor for histopathological upgrading during active surveillance

OBJECTIVE

To prospectively determine the ability of visible lesions on multiparametric MRI (PI-RADS 4-5) and commonly used biomarkers to predict disease upgrading on rebiopsy in men with low-risk prostate cancer (PCa) enrolled in active surveillance (AS).

MATERIALS AND METHODS

For this prospective study, approved by the Institutional Review Board (IRB), we selected consecutive patients with low-risk, low-grade, and localized prostate cancer (PCa) from our active surveillance (AS) program, who were enrolled between March 2014 and December 2020. Patients who had undergone previous prostate surgery, hormonal treatment, had contraindications for mpMRI, or transrectal ultrasound-guided (TRUS) biopsy were excluded from this study. All eligible patients underwent mpMRI at least 3 months after the initial biopsy, followed by MRI-targeted TRUS-guided re-biopsy within 12 months after enrollment. The mpMRI studies were evaluated by an experienced radiologist using the PI-RADS v2 classification. Statistical significance was determined by comparing the results from the MRI with the pathology data from rebiopsy.

RESULTS

There were 240 patients included. Overall upgrading rate was 41.2% (99/240), higher among patients classified as PIRADS 4 or 5 (77%). MRI sensitivity was 77.7% and specificity was 83.6% on re-biopsy. Visible lesion on mpMRI, PSA density and 3 + /12 positive cores at the first biopsy were good predictors of disease upgrade on rebiopsy. On our predictive model, patients with PI-RADS 4 or 5, PSA density > 0.15 ng/mL/cm3, and 3 + /12 positive cores at first biopsy had 92.4% chance of having clinically significant PCa.

CONCLUSION

Patients in AS with PI-RADS 4 or 5 lesions, PSA density > 0.15 ng/mL/cm3 and 3 + /12 positive cores at first biopsy have a high probability of having significant PCa on re-biopsy.

Parental Mental Health Conditions and Infant Health Outcomes Among Military Families

INTRODUCTION

Little is known about the effects of parental mental health burdens during pregnancy on infant health among military families, who are subject to various stressors unique to military life. The present study leveraged infant data from the DoD Birth and Infant Health Research (BIHR) program and self-reported parental survey data from the Millennium Cohort Study (MCS) to examine associations of parental mental health conditions with adverse infant health outcomes.

MATERIALS AND METHODS

Subjects included singleton infants captured in BIHR program data, born between July 2001 and December 2012, to MCS women and men who completed a baseline or follow-up survey from 1 year before pregnancy start through infant birth date. Survey assessment included mental health screenings and behavioral health measures (e.g., smoking and alcohol use). Mental health exposures included post-traumatic stress disorder, major depression, and panic/anxiety disorder and were assessed as "any mental health condition" (yes or no) and "count of mental health conditions" (0, 1, 2, or 3). Infant outcomes included birth defects, low birth weight, and preterm birth and were assessed individually and as a composite measure of "any adverse outcome." Descriptive statistics were calculated for the maternal and the paternal study populations stratified by exposure status. Log-binomial models estimated risk ratios (RRs) and confidence intervals (CIs) for all outcomes.

RESULTS

Among 9489 infants born to MCS women, 1006 (10.6%) were born to women who screened positive for any mental health condition; 571 (6.0%), 268 (2.8%), and 167 (1.8%) were born to women who screened positive for 1, 2, and 3 mental health conditions, respectively. Of the 9377 of these infants included in analyses, 256 (2.7%) had a birth defect, 331 (3.5%) were low birth weight, and 596 (6.4%) were born preterm. Among 19,149 infants born to MCS men, 1433 (7.5%) were born to men who screened positive for any mental health condition; 838 (4.4%), 351 (1.8%), and 244 (1.3%) were born to men who screened positive for 1, 2, and 3 mental health conditions, respectively. Of the 18,983 of these infants included in analyses, 54 (2.8%) had a birth defect, 649 (3.4%) were low birth weight, and 1,359 (7.2%) were born preterm. Infants born to men or women who screened positive for all 3 mental health conditions vs. none exhibited elevated risk estimates for each individual infant outcome, but CIs included the null. Increased risk for any adverse infant outcome, however, was observed for women with all 3 mental health conditions (RR = 1.70, CI, 1.12-2.59), but not men (RR = 1.29, CI, 0.89-1.88).

CONCLUSIONS

Findings suggest an association between parental mental health and adverse infant health outcomes, particularly for maternal mental health. Future research would benefit from larger sample sizes to detect potentially small effects of parental mental health on birth outcomes.

Trusted partners, community priorities, and data protections: requirements for precision medicine research with Alaska Native peoples

Precision medicine holds promise for improving health care by tailoring disease treatment and prevention efforts to the needs of individual patients. It also raises ethical questions related to equitable distribution of the benefits of precision medicine; data management, including the terms of data ownership, sharing, and security; and, the nature and extent of community engagement in and oversight of research. These questions are particularly salient for minoritized communities that have been harmed by unethical research practices and often deprived the full benefit of advances in medical science. Understanding the perspectives of these communities is essential to the design and conduct of ethical and effective precision medicine research. This study explored perspectives on the acceptability, feasibility, value, and benefits and harms of precision medicine research among Alaska Native and American Indian (ANAI) peoples. We conducted four focus groups with ANAI individuals who receive primary care from a Tribal health organization in Anchorage, Alaska. Participants were willing to engage in precision medicine research provided specific requirements were met. Research must be conducted by the Tribal health organization or another trusted partner, community health priorities must drive the research agenda, and researchers must employ robust data protections to guard against loss of data security and maintain control over data use and access. These requirements work collectively to ensure research benefits and respects Tribal sovereignty. These findings could help inform efforts to design and implement precision medicine research programs tailored to concerns of ANAI peoples.

Integrated multiomic analysis identifies TRIP13 as a mediator of alveolar epithelial type II cell dysfunction in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a lethal progressive lung disease urgently needing new therapies. Current treatments only delay disease progression, leaving lung transplant as the sole remaining option. Recent studies support a model whereby IPF arises because alveolar epithelial type II (AT2) cells, which normally mediate distal lung regeneration, acquire airway and/or mesenchymal characteristics, preventing proper repair. Mechanisms driving this abnormal differentiation remain unclear. We performed integrated transcriptomic and epigenomic analysis of purified AT2 cells which revealed genome-wide alterations in IPF lungs. The most prominent epigenetic alteration was activation of an enhancer in thyroid receptor interactor 13 (TRIP13), although TRIP13 was not the most significantly transcriptionally upregulated gene. TRIP13 is broadly implicated in epithelial-mesenchymal plasticity. In cultured human AT2 cells and lung slices, small molecule TRIP13 inhibitor DCZ0415 prevented acquisition of the mesenchymal gene signature characteristic of IPF, suggesting TRIP13 inhibition as a potential therapeutic approach to fibrotic disease.

Incorporation of artificial intelligence into nursing research: A scoping review

BACKGROUND

The integration of artificial intelligence (AI) across different sectors, notably healthcare, is on the rise. However, a thorough exploration of AI's incorporation into nursing research, as well as its advantages and obstacles, is still lacking.

OBJECTIVE

The aim of this scoping review was to map the roles, benefits, challenges, and potentials for the future development and use of AI in the context of nursing research.

METHODS

An exhaustive search was conducted across seven databases: MEDLINE, PsycINFO, SCOPUS, Web of Science, CINAHL, Google Scholar, and ProQuest. Articles were additionally identified through manual examination of reference lists of the articles that were included in the study. The search criteria were restricted to articles published in English between 2010 and 2023. The Joanna Briggs Institute (JBI) approach for scoping reviews and the PRISMA-ScR guidelines guided the processes of source selection, data extraction, and data presentation.

RESULTS

Twenty articles met the inclusion criteria, covering topics from ethical considerations to methodological issues and AI's capabilities in data analysis and predictive modeling.

CONCLUSION

The review identified both the potentials and complexities of integrating AI into nursing research. Ethical and legal considerations warrant a coordinated approach from multiple stakeholders.

IMPLICATION

The findings emphasized AI's potential to revolutionize nursing research, underscoring the need for ethical guidelines, equitable access, and AI literacy training to ensure its responsible and inclusive use.

Human-AI Interaction in the ScreenTrustCAD Trial: Recall Proportion and Positive Predictive Value Related to Screening Mammograms Flagged by AI CAD versus a Human Reader

Background The ScreenTrustCAD trial was a prospective study that evaluated the cancer detection rates for combinations of artificial intelligence (AI) computer-aided detection (CAD) and two radiologists. The results raised concerns about the tendency of radiologists to agree with AI CAD too much (when AI CAD made an erroneous flagging) or too little (when AI CAD made a correct flagging). Purpose To evaluate differences in recall proportion and positive predictive value (PPV) related to which reader flagged the mammogram for consensus discussion: AI CAD and/or radiologists. Materials and Methods Participants were enrolled from April 2021 to June 2022, and each examination was interpreted by three independent readers: two radiologists and AI CAD, after which positive findings were forwarded to the consensus discussion. For each combination of readers flagging an examination, the proportion recalled and the PPV were calculated by dividing the number of pathologic evaluation-verified cancers by the number of positive examinations. Results The study included 54 991 women (median age, 55 years [IQR, 46-65 years]), among whom 5489 were flagged for consensus discussion and 1348 were recalled. For examinations flagged by one reader, the proportion recalled after flagging by one radiologist was larger (14.2% [263 of 1858]) compared with flagging by AI CAD (4.6% [86 of 1886]) (P < .001), whereas the PPV of breast cancer was lower (3.4% [nine of 263] vs 22% [19 of 86]) (P < .001). For examinations flagged by two readers, the proportion recalled after flagging by two radiologists was larger (57.2% [360 of 629]) compared with flagging by AI CAD and one radiologist (38.6% [244 of 632]) (P < .001), whereas the PPV was lower (2.5% [nine of 360] vs 25.0% [61 of 244]) (P < .001). For examinations flagged by all three readers, the proportion recalled was 82.6% (400 of 484) and the PPV was 34.2 (137 of 400). Conclusion A larger proportion of participants were recalled after initial flagging by radiologists compared with those flagged by AI CAD, with a lower proportion of cancer. ClinicalTrials.gov Identifier: NCT04778670 © RSNA, 2025 See also the editorial by Grimm in this issue.