Plant genotype-specific modulation of Clonostachys rosea-mediated biocontrol of septoria tritici blotch disease in wheat

BACKGROUND

Beneficial microorganisms can act as biological control agents (BCAs) directly by targeting pathogens or indirectly by enhancing the plant's defense mechanisms against pathogens. However, efficiencies with which plants benefit from BCAs vary, potentially because of genetic variation in plants for plant-BCA compatibility. The aim of this study was to explore the genetic variation in winter wheat for modulation of Clonostachys rosea-mediated biocontrol of septoria tritici blotch disease caused by the fungal pathogen Zymoseptoria tritici.

RESULTS

In total, 202 winter wheat genotypes, including landraces and old cultivars grown from 1900 onwards in the Scandinavian countries, were tested under greenhouse-controlled conditions. Foliar spray applications of the pathogen and the fungal BCA in two treatments, i.e., Z. tritici (Zt) alone and Z. tritici along with C. rosea (ZtCr) were used to assess the disease progress over time. The absence and presence of C. rosea in Zt and ZtCr, respectively, allowed the dissection of variation for plant disease resistance and biocontrol efficacy. The study showed significant (P < 0.05) phenotypic variation among plant genotypes for disease progression in both Zt and ZtCr treatments. Moreover, the application of C. rosea resulted in a significant (P < 0.05) reduction in disease progression for seven genotypes and increased disease progression for eleven genotypes, indicating a plant genotype-dependent effect on the interaction between wheat, C. rosea and Z. tritici. For the phenotypic variation in disease progress and biocontrol efficacy, a genome-wide association study using a 20K single-nucleotide polymorphism (SNP) marker array was also performed. In total, five distinct SNP markers associated with disease resistance and four SNP markers associated with C. rosea biocontrol efficacy were identified.

CONCLUSIONS

This work serves as a foundation to further characterize the genetic basis of plant-BCA interactions when inoculated with Z. tritici, facilitating opportunities for simultaneous breeding for disease resistance and biocontrol efficacy.

Accuracy of Low-Dose Chest CT-Based Artificial Intelligence Models in Osteoporosis Detection: A Systematic Review and Meta-analysis

The purpose of this study is to systematically review and evaluate the accuracy of low-dose chest CT-based artificial intelligence in osteoporosis screening. A systematic literature search for relevant studies up to 13th December 2024 was performed in the PubMed, Scopus, Web of Science, and Cochrane Library databases. This meta-analysis was conducted in accordance with the PRISMA-DTA statement. Modified QUADAS-2 was used to assess the methodological quality of the studies. Quantification bias metrics were extracted to evaluate the performance of the AI models for vertebrae segmentation and labeling based on low-dose chest CT images. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated. To assess publication bias, Egger test and funnel plot were conducted. Meta-regression and subgroup analysis were performed to explore potential heterogeneity. Eight studies suitable for the analysis were included. The pooled Dice similarity coefficient (DSC) for automatic vertebrae segmentation was 0.92 (95% CI 0.88-0.97). For the diagnosis of abnormal (osteoporosis + osteopenia) or osteoporosis participants, respectively, pooled sensitivities were 0.90 (95% CI 0.88-0.91) and 0.86(95% CI 0.82-0.89); pooled specificities were 0.90 (95% CI 0.88-0.91) and 0.93 (95% CI 0.92-0.94); and summary receiver operating characteristic (SROC) curves were 0.9653 and 0.9676. Meta-regression and subgroup analyses identified potential sources of heterogeneity, including result source (external dataset vs. internal dataset), ROI annotations (one radiologist vs. two radiologists), model developed with or without radiomics, and VBs segmentation output (included lumbar spine vs. only thoracic spine) (P < 0.05). The low-dose chest CT-based AI model shown promise information for identifying patients with osteoporosis or osteopenia who need further evaluation. Further prospective multi-center, multi-dataset studies are still required to assess the complementary role of the AI model in osteoporosis and osteopenia diagnosis through low-dose chest CT images.

The effect of Baduanjin exercise training on balance and fall risk in elderly individuals: A randomized controlled trial

BACKGROUND

While studies have reported the potential effectiveness of Baduanjin exercises and physical activity recommendations in addressing balance disorders and the increased fall risk commonly observed in elderly individuals, it remains unclear which approach yields superior outcomes. This study aimed to compare the effects of Baduanjin exercise training and physical activity recommendations on balance and fall risk in elderly individuals.

METHODS

Sixty elderly individuals were included the study. The participants were randomly divided into experimental (n = 30) and control group (n = 30). A Baduanjin exercise training was given to experimental group and physical activity recommendation was given to control group. Both groups performed the exercises training or physical activity recommendation 5 days a week for 8 weeks. The Berg balance scale and the timed up and go test were used to assess balance and fall risk, respectively. All assessments were repeated before and after the 8-week program for both groups.

RESULTS

There was a significant increase both in the Berg balance scale and the timed up and go test in both groups (P < .05), but the increases in the experimental group were greater than in the control group (P < .05).

CONCLUSION

The results of this study suggest that both Baduanjin exercise training and general physical activity recommendations are effective in enhancing balance and mitigating fall risk among elderly individuals. Nevertheless, Baduanjin exercise training exhibited greater efficacy in achieving these outcomes compared to physical activity recommendations.

Heterogeneous Responses to High-Dose Testosterone in Castration-Resistant Prostate Cancer Tumors with Mixed Rb-Proficient and Rb-Deficient Cells

Androgen deprivation therapy remains a cornerstone in managing prostate cancer. However, its recurrence often leads to the more aggressive castration-resistant prostate cancer (CRPC). Although second-line androgen receptor signaling inhibition treatments such as enzalutamide and abiraterone are available, their effectiveness against CRPC is only transient. High-dose testosterone (Hi-T) has recently emerged as a promising treatment for CRPC, primarily through the suppression of E2F and MYC signaling. However, the roles of Rb family proteins in influencing this therapeutic response remain debated. In this study, we utilized a CRPC patient-derived xenograft model that includes both Rb pathway-proficient and -deficient cell populations based on the positive or negative expression of RB family genes. Single-cell RNA sequencing analysis revealed that Rb-proficient cells displayed a robust response to Hi-T, whereas Rb-deficient cells exhibited significant resistance. Notably, our analysis indicated increased enrichment of the hypoxia signature in the Rb-deficient cell population. Further studies in RB1-silenced CRPC cell lines showed that treatment with a hypoxia-inducible factor-1α inhibitor can restore the sensitivity of Rb-deficient cells to high-dose dihydrotestosterone treatment. In conclusion, our research provides new molecular insights into CRPC tumor cell responses to Hi-T and proposes a new strategy to resensitize Rb-deficient CRPC cells to Hi-T treatment.

Antipseudomonal cephalosporins versus piperacillin/tazobactam or carbapenems for the definitive antibiotic treatment of Pseudomonas aeruginosa bacteraemia: new kids on the ICU block?

BACKGROUND

Pseudomonas aeruginosa bloodstream infections (Pa-BSIs) are still a major cause of mortality in ICUs, posing many treatment uncertainties.

METHODS

This multicentre, retrospective study analysed data from 14 Italian hospitals, including all consecutive adults developing Pa-BSI in ICU during 2021-22 and treated with antibiotics for at least 48 h. The primary aim was to identify predictors of 30 day mortality using Cox regression. Results were adjusted with inverse probability of treatment weighting (IPTW) and for immortal time bias.

RESULTS

Overall, 170 patients were included. High-risk BSI (source: lung, intra-abdominal, CNS) occurred in 118 (69%) patients, and 54 (32%) had septic shock. In 37 (22%), 73 (43%), 12 (7%) and 48 (28%) the definitive backbone therapy was piperacillin/tazobactam, carbapenems, colistin or new antipseudomonal cephalosporins (ceftolozane/tazobactam, n = 20; ceftazidime/avibactam, n = 22; cefiderocol, n = 6), respectively. Moreover, 58 (34%) received a second drug as combination therapy. The incidence of 30 day all-cause mortality was 27.6% (47 patients). By Cox regression, Charlson comorbidity index, neutropenia, septic shock and high-risk BSI were independent predictors of 30 day mortality, while previous colonization by P. aeruginosa, use of antipseudomonal cephalosporins as definitive treatment, and combination therapy were shown to be protective. However, after IPTW adjustment, only the protective effect of antipseudomonal cephalosporins was confirmed (adjusted HR = 0.27, 95% CI = 0.10-0.69), but not for combination therapy. Hence, the treatment effect was calculated: antipseudomonal cephalosporins significantly reduced mortality risk [-17% (95% CI = -4% to -30%)], while combination therapy was beneficial only in the case of septic shock [-66% (95% CI = -44% to -88%].

CONCLUSIONS

In ICU, antipseudomonal cephalosporins may be the preferred target therapy for the treatment of Pa-BSI; in addition, initial combination therapy may be protective in the case of septic shock.

Bioinformatics combined with network pharmacology and experimental validation to identify key biomarkers of hepatocellular carcinoma and corresponding compounds in Radix Astragali and Pueraria Mirifica

The occurrence and death rates of primary hepatocellular carcinoma (HCC) are increasing, and there remains a shortage of effective oral medications with minimal side effects. We aim to identify potential biomarkers and compounds from Radix Astragali (RA) and Pueraria Mirifica (PM) to treat liver cancer and improve prognosis. Differentially expressed genes (DEGs) associated with HCC were identified by bioinformatics analysis of three datasets, GSE112791, GSE101685, and GSE45114. Using public databases to predict the bioactive components and possible targets of RA and PM. Target crossover from Gene Expression Omnibus (GEO) and public databases were used to identify potential biomarkers for HCC. Subsequently, validation and prognostic value analyses were performed using the Gene Expression Profile Interaction Analysis (GEPIA) platform. The Cytoscape software created a network of "compound targets" to pinpoint compounds linked to the biomarkers. Molecular docking techniques were utilized to validate the connection between these compounds and the identified biomarkers. Ultimately, the HepG2 liver cancer cell line was chosen to assess the inhibitory effect of Hederagenin (HDG) and to confirm the expression of ADH1B through Western blot analysis. In this study, four key biomarkers (NR1I2, ADH1B, NQO1, GHR) were identified. Molecular docking showed that these four core targets could form stable conformations with the corresponding compounds. As the drug concentration decreases, the inhibitory effect on HepG2 diminishes, and the survival rate of HepG2 cells significantly declines following the administration of 100 µmol/L HDG. Compared to the control, the expression of ADH1B protein is significantly increased in HepG2 cells treated with 100 µmol/L HDG. The study identified four key biomarkers (ADH1B, GHR, NQO1, NR1I2) that have prognostic ability for HCC. This study provides biomarkers and potential targeted monomeric medicines for treating HCC.

T1 and T2 measurements of the neonatal brain at 7 T

PURPOSE

To determine the expected range of NMR relaxation times (T1 and T2) in the neonatal brain at 7 T.

METHODS

Data were acquired in a total of 40 examinations on infants in natural sleep. The cohort included 34 unique subjects with postmenstrual age range between 33 and 52 weeks and contained a mix of healthy individuals and those with clinical concerns. Single-slice T1 and T2 mapping protocols were used to provide measurements in white matter, cortex, cerebellum, and deep gray matter. Automatic image segmentation of a separate T2-weighted brain volume was used to define regions of interest for analysis.

RESULTS

Linear regression was used to estimate relaxation times at term equivalent age (40 weeks postmenstrual age).T 1 40 wk $$ {T}_1^{40 wk} $$ with 95% confidence intervals was measured to be 2933 [2893, 2972] ms in white matter; 2653 [2604, 2701] ms in cerebellum; and 2486 [2439, 2532] ms in basal ganglia.T 2 40 wk $$ {T}_2^{40 wk} $$ was estimated as 119 [116, 121] ms in white matter, 99 [96, 102] ms in cerebellum, and 90 [89, 92] ms in basal ganglia. Most tissue-relaxation times showed a significant negative correlation with postmenstrual age, with the strongest correlation seen in cerebellum.

CONCLUSIONS

We describe neonatal brain tissue and age-specific T1 and T2 relaxation values at 7 T. The presented values differ substantially from both adult values at 7 T and neonate values measured at lower field strengths, and will be essential for pulse-sequence optimization for neonatal studies.

Unplanned extubation prevention in the neuroscience ICU at a High Reliability Organization

BACKGROUND

Intubated neuroscience ICU patients are at risk for unplanned extubation (premature removal of the endotracheal tube by the patient or during patient care). The incidence of unplanned extubation is an indicator of the quality of ICU care. Unplanned extubation is a risk factor for pneumonia, increased ventilator days, the need for tracheostomy and increased ICU and hospital length-of-stay. After serial unplanned extubations, we introduced a multidisciplinary unit-based practice standard to reduce unplanned extubations as part of a quality improvement initiative in the neuroscience ICU in a large academic medical center at a High Reliability Organization in May 2021. The unit-based practice standard to guide care of intubated neuroscience ICU patients focused on communication, timely escalation of concerns, use of sedation/analgesia targeting RASS ≤ -1, soft wrist restraints (unless specified exclusion criteria met) and continuous observation for patients at high risk of agitation/restlessness. We sought to determine the impact of this initiative on the incidence of unplanned extubations.

METHOD

Unplanned extubations were identified via retrospective audit of prospective incident reports from our Patient Safety Incident registry pre-initiative (June 2020-May 2021) and prospective audit of incident reports post-initiative (July 2021-March 2024). Chart review facilitated collection of data on patient age, sex, diagnosis, intubation day, RASS goal, sedation/analgesia, restraints, constant observation, shift, and reintubation. The total number of intubated patients and ventilator days during these timeframes was identified retrospectively via an electronic medical record report of all patients on ventilators in the neuroscience ICU.

RESULTS

During the pre-initiative audit period, there were 214 intubated patients (968 ventilator days). The audit identified 9 unplanned extubations (0.93/100 ventilator days; 8 males, median age 63-years-old (IQR 47-67)). There were 4 patients who were not ordered for sedation/analgesia or had a RASS goal of 0 and no patients were in nonviolent soft wrist restraints. During the post-initiative audit period, there were 576 intubated patients (2,730 ventilator days). The audit identified 6 unplanned extubations (0.22/100 ventilator days; 6 males, median age 53-years-old (IQR 27-78)). All 6 patients had a RASS goal ≤ -1 and were in nonviolent soft wrist restraints.

CONCLUSION

This quality improvement initiative effectively reduced the incidence of unplanned extubations in our neuroscience ICU.

Ensuring safety in cytotoxic drug preparation: A systematic review of guidelines addressing education for pharmacy professionals

BACKGROUND

Chemotherapy preparation involves the use of specific techniques and equipment, given the need to maintain preparation sterility and its strict prescribed composition, and avoid occupational exposure to cytotoxic agents.

OBJECTIVE

This study aims to identify the most relevant contents for pharmacy professionals' education and training programs and to elucidate the evaluation procedure these professionals should follow when handling cytotoxics.

METHODS

We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in conducting and reporting this systematic review. We conducted a literature search in PubMed, Cochrane, and Literatura Latino-Americana e do Caribe em Ciências da Saúde to identify guidelines on cytotoxic drug preparation published between 2004 and 2024. Inclusion criteria included guidelines written in English, Spanish, or Portuguese that addressed the education, training, and/or evaluation of pharmacy professionals involved in handling cytotoxic drugs. We excluded guidelines developed for other health professionals (e.g. nurses) and guidelines exclusively addressing the manipulation of oral dosage forms. Citation searching was also performed to avoid search biases. Three researchers independently selected 20 guidelines that met the inclusion criteria, out of 3781 unique references identified. Four appraisers assessed the guidelines using the Appraisal of Guidelines for Research and Evaluation-II tool.

RESULTS

Recommendations for training in cytotoxic drug handling generally included preinitiation and periodic assessment. Personal protective equipment and engineering controls use, spill management, and aseptic technique were the most frequently mentioned specific training contents. We have developed a training proposal based on the guidelines, with 4 training levels that address the specific identified content. Each level presents potential competency assessment strategies.

CONCLUSION

Included publications frequently recognized that conducting educational programs before and during the preparation of cytotoxic drugs was important and the combination of theoretical and practical learning seems of the utmost relevance. The development or update of guidelines in this area should prioritize their effective applicability to facilitate their implementation.

Economic Evaluation of Penpulimab Plus Paclitaxel and Carboplatin Combination Therapy as First-Line Treatment for Locally Advanced or Metastatic Squamous Non-small Cell Lung Cancer in China

INTRODUCTION

Penpulimab is a PD-1 monoclonal antibody recommended for treating squamous non-small cell lung cancer (sqNSCLC) in combination with paclitaxel and carboplatin. This study aimed to assess the cost-effectiveness of penpulimab combined with paclitaxel and carboplatin against paclitaxel plus carboplatin as first-line treatment for locally advanced or metastatic sqNSCLC in China.

METHODS

A three-state partitioned survival model was constructed using the efficacy outcomes obtained by digitizing the AK105-302 trial and was extrapolated to the lifetime horizon. Data on direct medical costs and utilities was gathered from the literature and commercial databases from the perspective of the Chinese healthcare system. Outcomes included quality-adjusted life years (QALYs), life years (LYs), and the incremental cost-effectiveness ratio (ICER). Sensitivity analysis and scenario analysis were performed to test the model robustness.

RESULTS

The incremental efficacy of penpulimab plus paclitaxel and carboplatin was 0.821 QALYs and 1.176 LYs with an incremental cost of $20,335 compared with paclitaxel plus carboplatin combination therapy. The ICER was $24,778 per QALY, falling below the threshold of three times the per capita gross domestic product of China, a commonly applied benchmark. The results of the one-way sensitivity analysis demonstrated that the ICER values were primarily influenced by the utility of progression-free state and cost of penpulimab. Probabilistic sensitivity analysis showed that penpulimab plus paclitaxel and carboplatin was cost-effective for 98.3% of the cases. Scenario analysis yielded results similar to those of the base-case analysis.

CONCLUSIONS

Our analysis suggests that penpulimab plus paclitaxel and carboplatin combination therapy is cost-effective for patients with locally advanced or metastatic sqNSCLC in China.

Integrating a multi-omics strategy framework to screen potential targets in cognitive impairment-related epilepsy

Epilepsy is a prevalent neurological disorder that affects over 70 million individuals worldwide and is often associated with cognitive impairments. Despite the widespread impact of epilepsy and cognitive impairments, the genetic basis and causal relationships underlying these conditions remain uncertain, prompting us to conduct a comprehensive investigation into the molecular mechanisms involved. In this study, we utilized statistical data from the third National Health and Nutrition Examination Survey (NHANES III) to evaluate correlation and large-scale pan-phenotype genome-wide association study (GWAS) data to establish genetic correlation and causality. Leveraging multi-omics datasets, we performed a comprehensive post-analysis that included variant prioritization, gene analysis, tissue and cell type enrichment, and pathway annotation. An integrated strategy-multi-trait analysis of GWAS (MTAG), transcriptome-wide association study (TWAS), summary-data-based Mendelian Randomization (SMR), and protein quantitative trait locus (pQTL)-MR-was performed to investigate the shared genetic architecture. Based on multiple orthogonal lines of evidence, we thereby identified 40 single nucleotide polymorphisms (SNPs) and 85 genes common to both conditions. Additionally, we optimized candidate genes such as GNAQ, FADS1, and PTK2 by single-cell expression analysis and molecular pathway mechanisms, thereby highlighting potential shared genetic pathways. These findings elucidate the genetic interplay and co-occurring mechanisms between epilepsy and cognitive impairments, providing crucial insights for future research and therapeutic strategies.

Case 337: Venous Vascular Malformation

HISTORY

A 38-year-old previously healthy male patient presented with left-sided facial pain over the prior 5 weeks. He first noticed the pain while washing and applying pressure to his face. The pain was described as shock-like, sharp and shooting, and radiating along the left cheek and temple. It began as 1-2-second episodes occurring two to three times per day, sometimes spontaneously, progressing in severity and frequency over time. Mild progressive left facial weakness also developed a few weeks after initial symptoms. Physical examination demonstrated reproducible pain in the distribution of the maxillary division of the trigeminal nerve (V2), with normal motor and sensory function. A recent routine dental examination demonstrated healthy teeth and gums, and there was no history of dental procedures or trauma. The rest of the physical and neurologic examinations revealed no abnormalities. The patient was afebrile with normal vital signs. Findings of routine laboratory testing, including complete blood count, metabolic panel with electrolytes, kidney and liver function, and inflammatory markers such as C-reactive protein, were all within normal limits. Following the neurologic and otolaryngologic evaluations, imaging was recommended. The patient was also started on treatment with carbamazepine for trigeminal neuralgia, with modest improvement of symptoms. He initially underwent MRI of the temporal bones at an outside hospital. After subsequent referral to our hospital, follow-up concomitant MRI and CT were performed approximately 3 months after the initial imaging.

SHP2-mediated ROS activation induces chondrocyte paraptosis in osteoarthritis and is attenuated by low-intensity pulsed ultrasound

Background

Paraptosis is a novel form of programmed cell death, generally caused by disrupted proteostasis or alterations of redox homeostasis. However, its impact and underlying mechanisms on the pathology of osteoarthritis (OA) are still unclear. This study aimed to investigate the role and regulatory mechanism of SHP2 in chondrocyte paraptosis and the effects influenced by low-intensity pulsed ultrasound (LIPUS).

Methods

SHP2, a MAPK upstream intermediary, has been identified as one of the critical targets of IL-1β-induced paraptosis in the GEO and GeneCard databases. The expression of SHP2 in chondrocytes was regulated by either siRNA knockdown or plasmid overexpression. Additionally, adeno-associated viruses were injected into the knee joints of rats to explore whether SHP2 plays a role in the development of OA. The impact of LIPUS on paraptosis and OA was examined in IL-1β-induced chondrocytes and a post-traumatic OA model, with SHP2 regulation assessed at both cellular and animal levels.

Results

An increase in cellular reactive oxygen species (ROS) caused by IL-1β halts the growth of chondrocytes and induces paraptosis in the chondrocytes. IL-1β-induced paraptosis, manifested as endoplasmic reticulum (ER)-derived vacuolization, was mediated by ROS-mediated ER stress and MAPK activation. SHP2 facilitates ROS production, thereby exacerbating the chondrocytes paraptosis. SHP2 knockdown and ROS inhibition effectively reduced this process and significantly mitigated inflammation and cartilage degeneration. Furthermore, we discovered that LIPUS delayed OA progression by inhibiting the activation of the MAPK pathway, ER stress, and ER-derived vacuoles in chondrocytes, all of which play critical roles in paraptosis, through the downregulation of SHP2 expression. Results on animals showed that LIPUS inhibited cartilage degeneration and alleviated OA progression.

Conclusion

SHP2 exacerbates IL-1β-induced oxidative stress and the subsequent paraptosis in chondrocytes, promoting OA progression. LIPUS mitigates paraptosis by modulating SHP2, which in turn slows OA progression.

The translational potential of this article

This study indicates that a novel SHP2-mediated cell death mechanism, paraptosis, plays a role in post-traumatic OA progression. LIPUS helps maintain cartilage-subchondral bone unit integrity by targeting SHP2 inhibition. SHP2 emerges as a potential therapeutic target, while LIPUS provides a promising non-invasive approach for treating trauma-related OA.

Heparin-binding protein levels as an emerging key biomarker for accurate diagnosis of bacterial meningitis: A promising yet preliminary evaluation

This systematic review aims to consolidate evidence on the potential of heparin-binding protein (HBP) as an emerging and promising biomarker for diagnosing bacterial meningitis (BM). We conducted a comprehensive search across PubMed, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) databases, with no restrictions on publication date or language. Sixteen studies, encompassing a total of 2,032 participants, were included in the analysis. The results consistently demonstrated that HBP expression levels in both cerebrospinal fluid (CSF) and blood are markedly elevated in cases of BM compared to patients with non-central nervous system (CNS) infections or other types of meningitis, such as viral meningitis. The pooled sensitivity estimate for HBP measured in CSF was 0.94 [95% confidence interval (CI), 0.88-0.97], and the specificity was 0.96 [95%CI, 0.90-0.98]. The diagnostic odds ratio (DOR) was calculated as 327 [95%CI, 96-1,110]. According to Fagan's nomogram, an initial probability of 20% for a positive test result increased to 85% following a positive HBP test, while a negative test reduced the probability to just 2%. The diagnostic performance of CSF HBP surpassed that of procalcitonin in detecting BM. Furthermore, in cases where symptoms of CNS infection are present, HBP levels in blood also demonstrate notable diagnostic accuracy. These findings suggest that HBP holds significant potential as a biomarker for BM. However, further large-scale studies are required to establish optimal HBP thresholds for improved clinical applicability.

The imbalance of follicular helper T cells and follicular regulatory T cells is involved in renal injury in active lupus nephritis

OBJECTIVE

This study is to research the role of follicular helper T (TFH) cells and follicular regulatory T (TFR) cells in the progression of lupus nephritis (LN).

METHODS

A total of 33 active LN patients, 30 stable LN patients, and 30 healthy controls (HC) were included in this study. The frequencies of TFH, TFR, T cell Ig and ITIM domain (TIGIT) + TFR, and CD226 + TFR cells in peripheral blood were measured using flow cytometry. The distribution and proportion of TFH and TFR cells in renal tissue were assessed using a multiplex immunohistochemical.

RESULTS

Active LN had a significantly lower TFR and TFR/TFH ratio in peripheral blood than HC and stable LN. TIGIT + TFR was lower in active LN, while CD226 + TFR was higher. In LN, TFR and TFR/TFH ratio showed a negative correlation with creatinine (CREA), but a positive correlation with endogenous creatinine clearance (Ccr). TFH and TFR mainly infiltrated the renal interstitium or surrounding renal tubules and participated in the formation of ectopic lymphoid-like structures in active LN. In active LN, TFH cells in renal tissue were higher than in control renal tissue. The tissue TFH showed a positive correlation with the activity index, CREA, but a negative correlation with Ccr. The tissue TFR/TFH ratio showed a negative correlation with the activity index, CREA, but a positive correlation with Ccr.

CONCLUSION

In active LN, the proportions of TFR cells in peripheral blood are reduced and function is impaired. In active LN, TFH and TFR imbalances have been observed and are associated with renal injury.

What is the most effective antibiotic monotherapy for severe Pseudomonas aeruginosa infection? A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND OBJECTIVES

Severe infections caused by Pseudomonas aeruginosa are associated with significant morbidity and mortality, particularly in hospitalized and immunocompromised patients. Determining the optimal definitive monotherapy for these infections is critical. The main objective was to compile the evidence of subgroups of patients with Pseudomonas aeruginosa infection from randomized control trials (RCTs) evaluating different definite antipseudomonal monotherapies for severe P. aeruginosa infection.

METHODS

Systematic review and meta-analysis of RCTs that assessed monotherapy with an antipseudomonal drug versus another antipseudomonal for definite treatment, and reported on the subgroup of patients with P. aeruginosa infection. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, LILACS and the reference lists of included trials. Eligibility criteria included RCTs enrolling hospitalized adults (≥18 years) with microbiologically confirmed severe P. aeruginosa infections. Studies were excluded if they included >20% of patients receiving combination therapy or if patients had resistant P. aeruginosa strains at recruitment. Antipseudomonal drugs evaluated included cephalosporins, carbapenems, penicillins, quinolones and aztreonam. The primary outcome was 30-day mortality. Risk of bias was assessed using the Cochrane tool. Results were pooled using fixed-effects and random-effects models as appropriate. Relative risk (RR) and 95% CIs were calculated. Sensitivity analyses and subgroup analyses were performed when data were available.

RESULTS

A total of 76 RCTs and 1681 patients with pseudomonal infection were included. Due to the low number of studies which reported our outcomes of interest, all subgroup analyses were underpowered. No difference in all-cause mortality was found for any direct antibiotic comparison. Higher clinical failure rates of carbapenems versus piperacillin-tazobactam were observed for pneumonia in two RCTs (RR, 2.55; 95% CI, 1.29-5.03; I2 = 0%, n = 2), and higher microbiological failure rates with carbapenems versus other comparators (RR, 1.24; 95% CI, 1.02-1.51; I2 = 0%, n = 23). Patients treated with imipenem were more likely to develop resistance to the study drug versus comparators (RR, 2.33; 95% CI, 1.61-3.38; I2 = 0%, n = 7).

CONCLUSIONS

In this systematic review and meta-analysis of definite antipseudomonal monotherapy for P. aeruginosa infection, we found no evidence of clinical benefit differences among direct antibiotic comparisons, but all subgroup analyses were underpowered to detect significant differences.

Predictive Value of MHR, PLR Combined With NLRP1 for Severity and Long-Term Prognosis in Premature Coronary Artery Disease

OBJECTIVE

To investigate the predictive value of platelet to lymphocyte ratio (PLR), monocyte to high-density lipoprotein ratio (MHR) combined with nucleotide binding oligomeric domain like receptor protein 1 (NLRP1) for the severity of premature coronary heart disease (PCHD) and its 2-year long-term prognosis.

METHOD

A total of 132 patients with PCHD examined in our hospital from February 2020 to January 2022 were retrospectively selected as the research objects. All patients who met the criteria were divided into mild group, moderate group, and severe group according to the severity of PCHD. The patients were followed up for 2 years. Patients were then divided into good prognosis group (without adverse cardiovascular events, n = 96) and poor prognosis group (with adverse cardiovascular events, n = 36). The predictive value was evaluated by ROC curve and multivariate logistic regression analysis.

RESULTS

Compared with the mild group, the levels of MHR, PLR, and NLRP1 in the moderate group and the severe group were significantly increased (p < 0.05). The levels of MHR, PLR, and NLRP1 in the poor prognosis group were higher than the good prognosis group (p < 0.05). The area under the curve (AUC) of MHR, PLR, and NLRP1 alone and in combination for predicting the 2-year long-term prognosis of patients was 0.787, 0.653, 0.869, and 0.926, respectively. Combined markers showed superior predictive accuracy (p < 0.05). After adjusting for confounding factors such as treatment, comorbidities, weight, gender, and smoking, MHR, PLR, and NLRP1 were independent risk factors for severe progression and poor prognosis of PCHD (p < 0.05).

CONCLUSION

MHR, PLR, and NLRP1 were increased in patients with higher severity of PCHD and poor prognosis. The combined detection has certain clinical guiding value for PCHD. However, this study was a single-center retrospective study with a small sample size. Thus, the results need to be further verified.

Dexmedetomidine mitigation of renal ischaemia-reperfusion injury: comprehensive insights from cellular mechanisms to clinical application

Renal ischaemia-reperfusion injury (IRI) is a critical cause of acute kidney injury (AKI) after major surgery, leading to elevated morbidity, mortality, and long-term renal dysfunction. Despite advances in perioperative care, the occurrence of IRI remains high. The renoprotective properties of dexmedetomidine (DEX), a selective α2-adrenergic receptor agonist, have been demonstrated, reducing oxidative stress, inflammation, apoptosis, ferroptosis, cellular senescence, and renal fibrosis while enhancing mitochondrial function and autophagy. From cellular studies to clinical applications, DEX has been effective in mitigating renal IRI, enhancing postoperative renal outcomes, and lowering the incidence of AKI in various surgical settings. This review comprehensively discusses and summarises the renoprotective effects and the underlying mechanisms of DEX, with a focus on its application across various surgical and clinical scenarios. In conclusion, DEX effectively mitigates renal IRI, as evidenced by robust in vitro, in vivo, and clinical studies. It significantly reduces kidney damage and improves surgical outcomes. However, its efficacy is less pronounced in kidney transplantation, suggesting that its renoprotective effects vary depending on the clinical context.

Glutamate stress in the caudal nucleus tractus solitarii (nTS): Impact on respiratory function and synaptic signaling in an Alzheimer's disease model

Respiratory dysfunction is a prevalent comorbidity in Alzheimer's disease (AD), yet its underlying mechanisms are poorly understood. Using the Streptozotocin (STZ) -induced rat model of AD, which replicates respiratory dysfunction and brain pathologies observed in human AD, we analyzed how these impairments relate to central neurological integration within the peripheral chemoreflex. Our focus was on glutamatergic signaling at the synapse between peripheral chemoafferents and second-order neurons in the nucleus tractus solitarii (nTS), a critical brainstem center for respiratory control. Activating the peripheral chemoreflex with potassium cyanide (KCN) increased respiratory frequency. Response magnitudes to repeated KCN injections typically decreased over time, which was exacerbated in the STZ-AD group. Similarly, repeated glutamate nanoinjections into the caudal/commissural nTS caused a pronounced reduction of respiratory frequency responses in STZ-AD. Electrophysiological analysis of nTS neurons within the peripheral chemoreflex revealed increased network activity, enhanced excitatory postsynaptic currents evoked by solitary tract stimulation (TS-EPSCs), and elevated asynchronous glutamate release following high-frequency stimulation (aEPSCs). These data were consistent with molecular evidence for astrogliosis (elevated GFAP expression), reduced astrocytic glutamate uptake (decreased EAAT2 expression), and presynaptic calcium dysregulation (increased TRPV1 expression). Additionally, presynaptic metabotropic glutamate receptors (mGluR3) were downregulated, while postsynaptic ionotropic receptor expression remained unchanged. With high-frequency solitary tract stimulation, STZ-AD rats had greater frequency-dependent TS-EPSC depression than controls, mirroring the diminished respiratory responses to KCN and glutamate nanoinjections. Our findings connect neurophysiological and molecular changes at the first nTS synapse of the peripheral chemoreflex with impaired respiratory responses to hypoxia in the STZ-AD model.

Identification and functional regulation of two alternative splicing isoforms of the Uhrf2 gene in Miichthysmiiuy

Alternative splicing can produce a variety of splicing isoforms to increase protein diversity, participate in the regulation of gene expression and the occurrence and development of diseases, and thus play an important role in innate immunity. Ubiquitin like with PHD and ring finger domains 2 (Uhrf2) protein is associated with cell proliferation, inflammation, tumors, and cancer, and is currently the focus of medical immunology research, but there is little research on alternative splicing of the Uhrf2 gene. In this study, we identified two different splicing isoforms of Uhrf2 in Miichthys miiuy through Sanger sequencing, dual-luciferase reporter gene assay, qRT-PCR, subcellular localization experiments, and named them Uhrf2-α and Uhrf2-β. Subcellular localization experiments found that Uhrf2-α was mainly located in the nucleus, while Uhrf2-β was mainly located in the cytoplasm. Although their localization was different, both could significantly inhibit the activation of IRF3 and NF-κB signaling pathways, and effectively inhibit the levels of inflammatory cytokines. These results indicate that Uhrf2-α and Uhrf2-β play important negative regulatory roles in innate immune responses in fish.

Technical aspects and clinical applications of synthetic MRI: a scoping review

INTRODUCTION

Synthetic magnetic resonance imaging (SyMRI) is a non-invasive, robust MRI technique that generates multiple contrast-weighted images by acquiring a single MRI sequence within a few minutes, along with quantitative maps, automatic brain segmentation, and volumetry. Since its inception, it has undergone technical advancements and has also been tested for feasibility in various organs and pathological conditions. This scoping review comprehensively pinpoints the critical technical aspects and maps the wide range of clinical applications/benefits of SyMRI.

CONTENT

A comprehensive search was conducted across five databases, PubMed, Scopus, Web of Science, Embase, and CINAHL Ultimate, using appropriate keywords related to SyMRI. A total of 99 studies were included after a 2-step screening process. Data related to the technical factors and clinical application was charted.

SUMMARY

SyMRI provides quantitative maps and segmentation techniques comparable to conventional MRI and has demonstrated feasibility and applications across neuroimaging, musculoskeletal, abdominal and breast pathologies spanning the entire human lifespan, from prenatal development to advanced age. Certain drawbacks related to image quality have been encountered that can be overcome with technical advances, especially AI-based algorithms.

OUTLOOK

SyMRI has immense potential for being incorporated into routine imaging for various pathologies due to its added advantage of providing quantitative measurements for more robust diagnostic and prognostic work-up with faster acquisitions and greater post-processing options.

Distinct Mechanisms of Multiple Alpha-Band Activities in Frontal Regions Following an 8-Week Medium- (Yoga) and High-Intensity (Pamela) Exercise Intervention

AIM

Long-term moderate- to high-intensity exercise has been shown to significantly enhance overall health such as the improvement of physiological indicators and brain functions. One key aspect of brain activity is alpha-band activity, which encompasses various sub-oscillations within the alpha frequency band. However, the precise functions of these alpha sub-oscillations following different exercise regimens remain unclear.

METHODS

We recruited 58 healthy college students and divided them into four groups: Pamela (high-intensity interval training, HIIT), yoga (moderate-intensity continuous training, MICT), and their corresponding matched control group (no exercise) for each exercise intervention group. Participants in the exercise intervention groups underwent training for up to 8 weeks (HIIT or MICT). Resting-state EEG data were collected before and after training, both with eyes open and closed.

RESULTS

Following HIIT, the Pamela group experienced a significant reduction in body fat percentage and a notable increase in skeletal muscle mass. In terms of neural activity, the main difference was observed in the mid-frequency alpha range in the frontoparietal region during the eyes-open resting state. Conversely, after 8-week yoga training, participants demonstrated a significant improvement in the duration of maintaining balance and sleep quality, and the main neural difference was reflected in the low- and high-frequency alpha band activities in the bilateral frontotemporal regions during the eyes-closed resting state.

CONCLUSION

This study, for the first time, differentiates the effects of long-term moderate- and high-intensity exercise on neural oscillation during different resting states, which highlights that different sub-frequency bands within the alpha frequency band would represent different exercise-related functions.

Clinical photon-counting CT increases CT number precision and reduces patient size dependence compared to single- and dual-energy CT

OBJECTIVES

To study whether photon-counting computed tomography (PCCT) can improve CT number accuracy and precision and reduce patient size dependence compared to dual-energy CT (DECT) virtual monoenergetic imaging (VMI) and single-energy CT (SECT).

METHODS

Clinical PCCT, DECT, and SECT scanners were used to image a multi-energy quality assurance phantom and tissue-equivalent inserts with/without an outer nested annulus, representing 2 object sizes (18 and 33 cm). CT numbers were converted to linear attenuation coefficients (LAC) and regions of interest applied. Theoretical monoenergetic LAC were calculated from known elemental compositions as a ground truth. Percent differences in mean LAC between phantom sizes, between mean and theoretical LAC, and its coefficient of variation (COV) were calculated.

RESULTS

Mean LAC percent differences between small and larger phantoms were highest in DECT (within -3% to 9%) and SECT (within 1%-5%), particularly at higher calcium and iodine concentrations, while being relatively constant in PCCT over material concentrations and VMI energies (within ±2%). The COV in mean LAC was consistently lower (about 2-5 times) in PCCT relative to DECT and SECT for calcium in the large phantom. With consideration of the theoretical uncertainties of 2%, both PCCT and DECT showed comparable agreement to theoretical LAC.

CONCLUSIONS

PCCT VMI produces CT numbers with less dependence on patient size and increased precision in large object sizes than DECT VMI and SECT.

ADVANCES IN KNOWLEDGE

Clinical PCCT provides less variable CT numbers than DECT and SECT with less sensitivity to the imaged object size.

Deciphering the anti‑influenza potential of Eucommiae Cortex based on bioinformatics analysis: In silico and in vitro experiments

Influenza infections damage the airway and induce the innate immune response that contributes to hyper-inflammation. Eucommiae Cortex (EC) enhances immune function and suppresses inflammation. To determine potential compounds and targets of EC associated with influenza, bioinformatics analyses and experimental verification were employed. The active compounds of EC were retrieved from the Traditional Chinese Medicine Systems Pharmacology database. The intersecting targets of EC and influenza were determined and examined using network pharmacology to analyze the relationship between the compounds and disease targets. The network identified three main compounds (quercetin, genistein and kaempferol) and four main targets (IL6, BCL2, IL1B and TNF). The ligand-target binding affinity was calculated by molecular docking, a computational method used in drug design to predict the interaction between the compound and protein target. The docking results revealed that kaempferol and TNF showed the strongest binding affinity. In vitro experiments confirmed the therapeutic effect of EC in influenza virus-infected Madin-Darby canine kidney cells. Collectively, the present study identified the active compounds and potential targets of EC in influenza and suggested EC as a future influenza treatment.

Truncation-Enhanced Aptamer Binding Affinity and Its Potential as a Sensor for Macrobrachium rosenbergii Nodavirus Detection

White tail disease in Macrobrachium rosenbergii is caused by M. rosenbergii nodavirus (MrNV) infection, resulting in up to 100% mortality in larvae and post-larvae stages, severely impacting aquaculture production. Existing genome-based detection methods for MrNV are costly and time-consuming, highlighting the need for rapid and cost-effective diagnostic tests. This study evaluated the effects of truncating selected aptamer on its binding affinity to the MrNV capsid protein. The previously isolated and identified aptamer through magnetic-capture SELEX and Next Generation Sequencing demonstrated high binding affinity to the MrNV capsid protein. Truncation at the primer overhang was found to improve binding affinity, reducing the dissociation constant from 347 nM to 30.1 nM. The calculated limit of detection for the truncated aptamer decreased from 5.64 nM to 1.7 nM, while the limit of quantification decreased from 17.1 nM to 5.16 nM. These reductions indicate that the truncated aptamer has higher sensitivity compared to the full-length aptamer. In tests with MrNV-infected M. rosenbergii samples, both the enzyme-linked aptamer assay and the gold nanoparticle aptasensor assay showed consistent results when 0.5 μg of total protein lysate was used. This indicates that the prawn protein concentration interferes with the detection of the viral protein. These findings suggest the potential application of the truncated aptamer as a sensor in the development of a practical aptamer-based diagnostic kit. For instance, an aptamer-based lateral flow assay test kit could provide a user-friendly, cost-effective solution that eliminates the need for sophisticated instrumentation for diagnosis or data interpretation, making it ideal for detecting MrNV infection in M. rosenbergii aquaculture.

Piezoelectric dual-network tough hydrogel with on-demand thermal contraction and sonopiezoelectric effect for promoting infected-joint-skin-wound healing via FAK and AKT signaling pathways

The dynamic and whole stage management of infected wound healing throughout the entire repair process, including intelligent on-demand wound closure and the regulation of the transition from bactericidal to reparative phases, remains a major challenge. This study develops sonopiezoelectric-effect-mediated on-demand reactive-oxygen-species release by incorporating piezoelectric barium titanate modified with gold nanoparticles and a thermally responsive dual-network tough hydrogel dressing with a physical network structure based on ureidopyrimidinone-modified gelatin crosslinked by multiple hydrogen bonds, and with a chemical network structure based on N-isopropylacrylamide and methacryloyl gelatin formed via radical polymerization. This hydrogel exhibits temperature-sensitive softening, on-demand thermal contraction performance, high mechanical strength, good tissue adhesion, outstanding piezoelectricity, tunable sonopiezoelectric behavior, regulatable photothermal properties and desirable biocompatibility. The tunable sonopiezoelectric effect enables the hydrogel to eliminate wound bacteria in the short term, and effectively promote human fibroblast proliferation and migration over the long term. The hydrogel dressing actively contracts to close wound edges and further promotes the healing of MRSA-infected skin defects in the neck of mice by promoting fibroblast migration, enhancing collagen deposition and facilitating angiogenesis via up-regulating the FAK and AKT signaling pathways, providing a novel design strategy for developing dressings targeting chronic joint-skin wounds.

Heparin-binding Protein as a Diagnostic and Prognostic Marker of Infections: A Systematic Review and Meta-analysis

Heparin-binding protein (HBP) is a granule protein derived from neutrophils, located in secretory vesicles and neutrophilic granules, also known as cationic antimicrobial protein of 37 kDa (CAP37) or azurocidin. This study evaluates the diagnostic and prognostic value of HBP levels in relation to infection, organ dysfunction, and mortality in adult patients. A systematic review and meta-analysis were conducted by searching PubMed, Web of Science, EMBASE, and the Cochrane Database from their inception through June 2024. Original studies assessing HBP levels' diagnostic and prognostic utility in predicting infection and disease severity in critically ill adult patients were included. The primary outcome was the diagnostic and predictive role of HBP in infection and severity. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to evaluate bias risk. A total of 56 studies involving 11,486 patients were included. Pooled analysis showed HBP had a sensitivity of 0.87 (95% CI, 0.82-0.91), specificity of 0.87 (95% CI, 0.79-0.92), and an AUC of 0.93 (95% CI, 0.91-0.95) for infection diagnosis. For prognostic assessment, sensitivity was 0.77 (95% CI, 0.74-0.80), specificity was 0.72 (95% CI, 0.68-0.76), and AUC was 0.81 (95% CI, 0.78-0.85). HBP outperformed procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) in diagnosing and predicting critical illness. No publication bias was detected. HBP demonstrates high sensitivity and specificity for diagnosing infections in critically ill adult patients. Additionally, it effectively predicts disease progression, including organ dysfunction and mortality, surpassing traditional biomarkers such as PCT, CRP, and WBC. All that cannot be true for subjects with severe neutropenia.

Factors influencing sleep quality in healthcare workers: The mediating role of depression and anxiety symptoms

BackgroundNumerous research has investigated the impact of depression and anxiety symptoms, occupational stress, work hours on sleep quality. Nevertheless, the interrelationships between these variables remain poorly understood.ObjectiveThe objective of this study is to examine the factors that influence sleep quality, to elucidate the relationships between them and to examine the extent to which depressive and anxiety symptoms act as mediators in the aforementioned relationships.MethodsA cross-sectional survey was conducted to obtain information about medical personnel in Chongqing, China. The Depressive Symptom Scale, Anxiety Symptom Scale and Sleep Quality Scale developed by the Chinese Center for Disease Control and Prevention were used to assess the status of depression, anxiety and sleep quality, respectively. Structural equation modeling was employed to investigate the factors that influence sleep quality.ResultsThe detection rate of poor sleep quality among healthcare workers in Chongqing was 57.9%, analyzed by structural equation modeling, the direct effects of anxiety and depressive symptoms on sleep quality were -0.328, -0.221 and fully mediated the relationship between socio-economic status, weekly working hours and occupational tension and sleep quality. Social support, demands and payments had higher effects on sleep quality of -0.167, -0.176 respectively.ConclusionsThe factors affecting sleep quality were identified as weekly working hours, working age, socioeconomic status, and occupational tension. The sub-dimensions of occupational tension that played a decisive role were social support, demands, and payments. The association between the aforementioned variables and sleep quality was fully mediated by depression and anxiety symptoms.

PD-1 inhibitors improve the efficacy of tyrosine kinase inhibitors combined with transcatheter arterial chemoembolization in advanced hepatocellular carcinoma: a meta-analysis and trial sequential analysis

BACKGROUND

This meta-analysis and trial sequential analysis (TSA) aimed to evaluate the efficacy and safety of triple therapy with tyrosine kinase inhibitors (TKIs) combined with transcatheter arterial chemoembolization (TACE) plus programmed death 1 (PD-1) inhibitors (T-T-P) and dual therapy with TKIs combined with TACE (T-T) for the treatment of advanced unresectable hepatocellular carcinoma (uHCC).

METHODS

Literature related to the efficacy of TKIs combined with TACE plus PD-1 inhibitors in uHCC was searched using the Embase, PubMed, and Cocrane libraries. TSA was used to reduce false positive results due to random error.

RESULTS

Seventeen articles were included in this meta-analysis, including 2,561 patients. In the T-T-P group, OS [HR 0.45, 95% confidence interval (CI) 0.39-0.52; p = 0.000], PFS [HR 0.43, 95% CI 0.38 - 0.48; p = 0.000], were significantly prolonged compared to those in the T-T group; ORR (RR 1.59 [95% CI 1.39-1.81]; p = 0.000) and DCR (RR 1.26 [95% CI 1.15-1.37]; p = 0.000) were significantly higher. TSA analysis showed early results without further testing. Prognostic factor analysis demonstrated that portal vein tumor thrombus (PVTT) and extrahepatic metastasis were common independent risk factors for OS and PFS. Regarding grade 3/4 adverse events results showed no statistically significant differences in any of them.

CONCLUSIONS

Compared with T-T treatment group, the T-T-P treatment group exhibited a notable improvement in OS and PFS, particularly in cases of PVTT and extrahepatic metastasis. Furthermore, it can markedly enhance the ORR and DCR in patients with uHCC.

Drug interaction with UDP-Glucuronosyltransferase (UGT) enzymes is a predictor of drug-induced liver injury

BACKGROUND AND AIMS

DILI frequently contributes to the attrition of new drug candidates and is a common cause for the withdrawal of approved drugs from the market. Although some noncytochrome P450 (non-CYP) metabolism enzymes have been implicated in DILI development, their association with DILI outcomes has not been systematically evaluated.

APPROACH AND RESULTS

In this study, we analyzed a large data set comprising 317 drugs and their interactions in vitro with 42 non-CYP enzymes as substrates, inducers, and/or inhibitors retrieved from historical regulatory documents using multivariate logistic regression. We examined how these in vitro drug-enzyme interactions are correlated with the drugs' potential for DILI concern, as classified in the Liver Toxicity Knowledge Base database. Our study revealed that drugs that inhibit non-CYP enzymes are significantly associated with high DILI concern. Particularly, interaction with UDP-glucuronosyltransferases (UGT) enzymes is an important predictor of DILI outcomes. Further analysis indicated that only pure UGT inhibitors and dual substrate inhibitors, but not pure UGT substrates, are significantly associated with high DILI concern.

CONCLUSIONS

Drug interactions with UGT enzymes may independently predict DILI, and their combined use with the rule-of-two model further improves overall predictive performance. These findings could expand the currently available tools for assessing the potential for DILI in humans.

Extracellular vesicles from Lacticaseibacillus paracasei reduce neuroinflammation in hippocampus and restore some cognitive functions in hyperammonemic rats

Cirrhotic patients may show minimal hepatic encephalopathy (MHE) which impairs life quality and span. There is a need of new safe treatments for MHE. Hyperammonemia is a main contributor to MHE. Hyperammonemic rats reproduce the cognitive impairment present in patients with MHE, which is mediated by neuroinflammation and altered glutamatergic neurotransmission in hippocampus. Probiotics induce positive effects in MHE patients, which could be mediated by bacterial extracellular vesicles (EVs). The aims of this work were to evaluate in hyperammonemic rats: 1) if intravenous administration of EVs from L. paracasei improves memory and learning and 2) reduces neuroinflammation in hippocampus and 3) to study the mechanisms involved using an ex vivo approach. It is shown that intravenous injection of EVs from L. paracasei reverses glial activation in hippocampus and cognitive impairment in hyperammonemic rats. Ex vivo studies in hippocampal slices show that hyperammonemia increases TNFα and TNFR1 and S1PR2 membrane expression and activation, leading to increased IL-1β content and activation of IL-1 receptor and of Src. This increases CCL2 and BDNF and TrkB activation. This leads to increased membrane expression of the NR2B subunit of the NMDA receptor and of the GluA2 subunit of AMPA receptors and reduced membrane expression of the GluA1 subunit, leading to cognitive impairment. EVs from L. paracasei reduce neuroinflammation in hyperammonemic rats and restore the function of the TNFα-TNFR1-S1PR2-IL-1β-CCL2-BDNF-TrkB pathway, glutamatergic neurotransmission and cognitive function in rats with hyperammonemia and MHE. This suggests that these EVs could also improve cognitive function in cirrhotic patients with MHE.

A review of molecular interplay between inflammation and cancer: The role of lncRNAs in pathogenesis and therapeutic potential

The inflammatory microenvironment (IME) has been demonstrated to facilitate the initiation and progression of tumors throughout the inflammatory process. Simultaneously, cancer can initiate or intensify the inflammatory response, thereby promoting tumor progression. This review examines the dual role of long non-coding RNAs (lncRNAs) in the interplay between inflammation and cancer. LncRNA modulate inflammation-induced cancer by influencing the activation of signaling pathways (NF-κB, Wnt/β-catenin, mTOR, etc), microRNA (miRNA) sponging, protein interactions, interactions with immune cells, and encoding short peptides. In contrast, lncRNAs also impact cancer-induced inflammatory processes by regulating cytokine expression, mediating tumor-derived extracellular vesicles (EVs), modulating intracellular reactive oxygen species (ROS) levels, and facilitating metabolic reprogramming. Furthermore, the therapeutic potential of lncRNA and the challenges of clinical translation were explicitly discussed as well. Overall, this review aims to provide a comprehensive and systematic resource for future researchers investigating the impact of lncRNAs on inflammation and cancer.

Egg yolk-derived low-density lipoprotein: A potential drug delivery system to eradicate intracellular bacteria

Antibiotics have limited capacities to penetrate and eliminate intracellular bacteria. This study developed a drug delivery system to surmount the cell-membrane barrier and achieve efficient intracellular antibiotic accumulation for intracellular-bacterial eradication. Ceftiofur (CEF) was encapsulated in hen egg-yolk-extracted low-density lipoproteins (heLDLs) to generate CEF-heLDLs. Based on preliminary research, the drug-loading efficiency was approximately 44.48 % ± 2.35 % (encapsulation rate, approximately 99.31 % ± 0.63 %). CEF-heLDLs exhibited smaller particle sizes and higher absolute zeta potentials than heLDLs, indicating improved dispersibility and stability. In-vitro analyses demonstrated receptor-mediated uptake of CEF-heLDL, with lysosome colocalization. In-vivo localization analyses in mice showed multiorgan distribution characteristics. In-vitro and in-vivo antibacterial experiments showed that CEF-heLDLs displayed superior antibacterial effects against intracellular Staphylococcus aureus compared with free CEF, significantly damaging bacterial cell walls and decreasing intracellular-bacterial survival rates (P < 0.001). CEF-heLDLs significantly reduced mortality in methicillin-resistant S. aureus-infected mice (P < 0.001) compared with free CEF and improved bacterial-induced leukocytosis (P < 0.001). The CEF-heLDL synthesized in this study effectively delivers CEF into cells. Compared to free CEF, it has significantly enhanced efficacy in eliminating intracellular S. aureus, offering a promising novel approach for eradication of intracellular bacteria.

IUPHAR review: From gut to brain: The role of gut dysbiosis, bacterial amyloids, and metabolic disease in Alzheimer's disease

Gut microbial dysbiosis, or altered gut microbial communities, in Alzheimer's Disease suggests a pathogenic role for gut inflammation and microbial products in shaping a neuroinflammatory environment. Similarly, metabolic diseases, such as obesity and diabetes, are also associated with an increased risk of Alzheimer's Disease. As the metabolic landscape shifts during gut inflammation, and gut inflammation in turn impacts metabolic processes, we explore how these interconnected pathways may contribute to the progression of Alzheimer's Disease. Additionally, we discuss the role of bacterial amyloids produced by gut microbes, which may exacerbate amyloid aggregation in the brain and contribute to neurodegenerative processes. Furthermore, we highlight potential therapeutic strategies aimed at reducing gut inflammation, improving metabolic health, and decreasing amyloid content as a means to mitigate Alzheimer's Disease progression. These approaches, targeting the gut-brain-metabolic axis, could offer promising avenues for delaying or preventing cognitive decline in affected individuals.

Predictions of PM2.5 using air pollutants and meteorological factors with COVID-19 cases in Malaysia and Indonesia: a comparative study using feature selection and robust regression

The study examines the relationship between air quality, meteorological factors, and COVID-19 cases in Cheras, Kuala Lumpur, and Kelapa Gading, North Jakarta. Analyzing data from 2020 and 2021, the research found notable correlations: COVID-19 cases in Cheras were positively associated with relative humidity (RH) and carbon monoxide (CO) but negatively with ozone (O₃) and RH in different years. In Kelapa Gading, COVID-19 cases were positively correlated with pollutants like sulfur dioxide (SO₂) and CO, while ambient temperature (AT) showed a negative correlation. The enforcement of social restrictions notably reduced air pollution, affecting COVID-19 spread. Predictive models for PM2.5 levels using robust regression techniques showed strong performance in Kuala Lumpur (R² > 0.9) but exhibited overfitting tendencies in Jakarta, suggesting the need for a longer study period for more accurate results.

Quantification of Epigenetic DNA and RNA Modifications by UHPLC-MS/MS Technologies: New Concepts and New Improvements for the Special Collections

Dynamic and reversible DNA and RNA modifications are essential for cell differentiation and development. Aberrant epigenetic modifications are closely associated with the occurrence and progression of diseases, serving as potential markers for cancer diagnosis and prognosis. Ultra-high-performance liquid chromatography coupled with tandem mass spectrometry (UHPLC-MS/MS) offers distinct advantages in the qualitative and quantitative analysis of various modifications due to its sensitivity, specificity, and accuracy. This review provides a comprehensive overview of the current knowledge regarding the liquid chromatography-mass spectrometry (LC-MS) analysis of DNA and RNA modifications, including analytical procedures, advancements, and biological applications, with a focus on tracing the source of (N6-2'-deoxy-adenosine) 6mdA in eukaryotes. Additionally, we examine the integration of UHPLC-MS/MS with other separation techniques to achieve accurate quantification of modifications in specific regions, certain fragments, and free nucleosides.

Association of individual and environmental factors exposure with asthma among children: a cross-sectional study in Northern and Southern cities, China

BACKGROUND

Although previous studies have explored many risk factors associated with childhood asthma worldwide, limited studies have examined whether these risk factors differ in different regions. Our study aims to investigate whether there are differences in the factors influencing childhood asthma in Northern and Southern China and to explore possible reasons for this.

METHODS

A cross-sectional analysis of 12,771 urban children aged 4-14 in China, we first applied a group Least Absolute Shrinkage and Selection Operator (LASSO) to influencing factors associated with childhood asthma, using cross-validation as the criterion. Then, we used logistic regression to calculate further the results. The Area Under the curve value used to evaluate model performance.

RESULTS

In Northern China, risk factors for childhood asthma include boys, previously hospitalized with eczema/dermatitis or asthmatic bronchitis or chronic cough, history of infected with viral, bacterial or mycoplasma, testing positive for allergens, having conjunctivitis or two or more allergy problems, paternal or maternal with asthma or conjunctivitis or eczema/dermatitis, autumn and winter and house decoration less than 1 year before move in; Older than 11 years and the frequency of airing the quilt are protective factor against asthma. In Southern China, risk factors include antibiotic use in neonates, previously hospitalized with asthmatic bronchitis, history of infected with viral, testing positive for allergens, having conjunctivitis, summer or winter, screen time more than 4 h per day and paternal or maternal with rhinitis.

CONCLUSIONS

Our findings suggested that risk or protective factors contributing to childhood asthma differ significantly between Northern and Southern China.

High stent shunt flow increases the incidence of overt-hepatic encephalopathy in cirrhotic patients after transjugular intrahepatic portosystemic shunt

BACKGROUND

The incidence of hepatic encephalopathy (HE) was higher within 1 year after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis. While some findings showed that the shunt flow correlates with HE, it remains unknown whether the stent shunt flow (SSF) is associated with overt-hepatic encephalopathy (OHE). This study, therefore, investigated the association between SSF and OHE after a TIPS.

METHODS

A digital color ultrasonic diagnostic device was used to measure stent flow velocity (SFV). The association between SSF and OHE was then examined using logistic regression and restricted cubic spline models. The predictive value of SSF for OHE was also assessed using receiver operating characteristic curve analysis.

RESULTS

Of the 91 patients, 24 (26.4%) developed OHE after TIPS within 1 year. Patients with OHE post-TIPS had higher SSF than those without [2459 (2203-2490) ml/min vs. 2190 (1968-2363) ml/min; P  = 0.001]. Multiple logistic regression showed interquartile range of SSF was associated positively with the risk of OHE after TIPS [odds ratio, 2.483; 95% confidence interval (CI), 1.407-4.383; P  = 0.002]. The Andersen-Gill model indicated SSF [hazard ratio (HR), 1.002; 95% CI, 1.001-1.004; P  < 0.05] and age (HR, 1.042; 95% CI, 1.012-1.072; P  < 0.01) were independent predictors of OHE after TIPS. SSF had higher predictive power for OHE than age, ammonia levels, Child-Pugh score, and model for end-stage liver disease score.

CONCLUSION

This study suggests high SSF may be associated closely with an increased risk of OHE in patients with cirrhosis following TIPS.

Novel MRI-based Hyper-Fused Radiomics for Predicting Pathologic Complete Response to Neoadjuvant Therapy in Breast Cancer

RATIONALE AND OBJECTIVES

To propose a novel MRI-based hyper-fused radiomic approach to predict pathologic complete response (pCR) to neoadjuvant therapy (NAT) in breast cancer (BC).

MATERIALS AND METHODS

Pretreatment dynamic contrast-enhanced (DCE) MRI and ultra-multi-b-value (UMB) diffusion-weighted imaging (DWI) data were acquired in BC patients who received NAT followed by surgery at two centers. Hyper-fused radiomic features (RFs) and conventional RFs were extracted from DCE-MRI or UMB-DWI. After feature selection, the following models were built using logistic regression and the retained RFs: hyper-fused model, conventional model, and compound model that integrates the hyper-fused and conventional RFs. The output probability of each model was used to generate a radiomic signature. The model's performance was quantified by the area under the receiver-operating characteristic curve (AUC). Multivariable logistic regression was used to identify variables (clinicopathological variables and the generated radiomic signatures) associated with pCR.

RESULTS

The training/external test set (center 1/2) included 547/295 women. The hyper-fused models (AUCs=0.81-0.85) outperformed (p<0.05) the conventional models (AUCs=0.74-0.80) in predicting pCR. The compound models (AUCs=0.88-0.93) outperformed (p<0.05) the hyper-fused models and conventional models for pCR prediction. The hyper-fused radiomic signatures (odds ratios=5.70-12.98; p<0.05) and compound radiomic signatures (odds ratios=1.57-7.71; p<0.05) were independently associated with pCR. These are true for the training and external test sets.

CONCLUSION

The hyper-fused radiomic approach had significantly better performance for predicting pCR to NAT than the conventional radiomic approach, and the hyper-fused RFs provided incremental discrimination of pCR beyond the conventional RFs. The generated hyper-fused radiomic signatures were independent predictors of pCR.

Endocuff-Assisted Colonoscopy for Identifying Sessile Serrated Polyps and Adenomas During Routine Colorectal Cancer Screening: A Retrospective Cohort Study

Background and Aims

Polyps located in less accessible areas of the colon, such as inner curves of flexures, are often difficult to visualize. Colonoscope attachments such as the Endocuff have been developed to improve the visualization of these polyps. We aimed to assess the utility of Endocuff-assisted colonoscopy (EAC) in the detection of tubular adenomas and sessile serrated polyps (SSP) compared to conventional colonoscopy during routine colorectal cancer screening.

Patients and Methods

This retrospective cohort study included patients who underwent colorectal cancer screening with either conventional colonoscopy or EAC between November 2022 and March 2023. The primary outcomes were SSP and tubular adenoma detection rates. Secondary outcomes included total procedure time, cecal intubation time, and ileal intubation rates.

Results

Of the 435 patients included, 189 (43%) underwent EAC, and 246 (57%) underwent conventional colonoscopy. The mean ± standard deviation number of polyps detected was 1.7 ± 2.2, the mean procedure time was 18.7 ± 7.5 min, and the mean cecal intubation time was 4.4 ± 3.3 min, with no significant differences between groups. A smaller proportion of patients in the EAC group had successful ileal intubation (14% vs. 55%; p < 0.01). The tubular adenoma detection rate was similar between EAC and conventional colonoscopy (41% vs. 39%; p = 0.70), but the SSP detection rate was significantly higher with EAC (16% vs. 8.5%; p < 0.01).

Conclusion

EAC may enhance the detection of difficult-to-visualize SSPs during screening colonoscopies without affecting overall procedure time. However, physicians should consider the examination indication when selecting EAC, as ileal intubation may be more challenging.

Predictive value of systemic inflammatory index (SII) for the time to negative nucleic acid conversion in patients with mild COVID-19 by the omicron wave

Objective

Inflammatory indices are pivotal markers in gaging the harm of the COVID-19 trajectory. The definitive impact of inflammatory indices on forecasting the period required for a negative shift in nucleic acid status during the Omicron wave remains ambiguous. This research endeavors to delineate the relationship between the Systemic Inflammatory Index (SII) and the timeline for conversion to negative nucleic acid status in Omicron variant-infected patients, and to scrutinize the prognostic validity of SII for such conversion.

Methods

Adult patients hospitalized at the Shanghai Public Health Clinical Center with mild cases attributed to the Omicron variant were studied from March to December 2022. They were stratified into early-conversion (with mild cases attributed to (>10 days) groups). Analyzing patient information, clinical traits, and laboratory results, we divided patients into two groups. We used logistic regression to find the link between SII and virus test timing and built ROC curves to measure predictive value via AUC.

Results

A total of 2,603 patients were enrolled. Univariate analysis found big differences in pulse rates, respiratory rates, prealbumin levels, HS-CRP levels, IL-6 levels, SII, and PNI (p < 0.05) between the groups. Adjusting for confounders, logistic regression revealed that the highest SII group had a 1.46 greater risk of not clearing a 10-day PCR test than the lowest group (OR = 1.46; 95% CI, 1.173-1.817, p = 0.001). Each one-unit rise in SII raised the risk of 10-day PCR failure by 0.1% (p < 0.0001). The ROC curve showed SII's AUC as 0.603 (95% CI: 0.576-0.630), predicting virus test turn-around with a cut-off of 920.5, 61.9% specificity, and 52.5% sensitivity. Compared to other indicators such as IL-6 and HS-CRP, SII exhibited the highest AUC value and specificity.

Conclusion

In mild cases caused by the Omicron wave, there was a discernible link between the SII and the period leading to a negative nucleic acid test outcome, with higher SII values indicating an increased risk of prolonged conversion time. SII might help guide treatment better than other indicators by predicting disease course.

Uncovering the role of TREM-1 in celiac disease: In silico insights into the recognition of gluten-derived peptides and inflammatory mechanisms

BACKGROUND

Celiac disease (CD) is a chronic enteropathy characterized by a permanent intolerance to gluten. While CD has been associated with heightened T cell responses and the involvement of distinct innate immunity components, the role of the triggering receptor expressed on myeloid cells (TREM) family in this disease remains unclear. Thus, as TREM-1 has already been implicated in other inflammatory bowel diseases, and given its role in the amplification of inflammation, we hypothesized that it might play a role in the pathophysiology of CD.

METHODS AND RESULTS

the STRING tool was used to predict protein-protein interaction networks between TREM-1 and CD signaling pathways. Then, molecular docking and molecular dynamics simulations were conducted to explore potential interactions between TREM-1 and different peptides derived from alpha-gliadin (25-mer, 33-mer and p31-43). Finally, we used transcriptomic data, available from public repositories, to assess TREM1 gene expression, and genes involved in its signaling pathway, in CD patients. Our results found an association between TREM-1 and CD markers, with STRING analysis, and the in silico simulations suggesting that the receptor might recognize the alpha-gliadin peptides, with the TREM-1/p31-43 interaction as the most likely interaction to occur biologically. Furthermore, TREM1 and its signaling pathway were increased in patients with active CD, while in those in clinical remission, the expression levels were similar to healthy controls.

CONCLUSIONS

collectively, our findings suggest that TREM-1 might recognize alpha-gliadin derived peptides, and TREM-1's activation may contribute to the intestinal inflammation observed in CD.

Distinguishing major depressive disorder from bipolar disorder using alpha-band activity in resting-state electroencephalogram

BACKGROUND

Bipolar disorder (BD) and major depressive disorder (MDD) share overlapping depressive symptoms, which pose challenges for achieving rapid and accurate differential diagnosis in clinical practice. This study aims to investigate whether alpha sub-band activity in electroencephalogram (EEG) can serve as a discriminative feature between MDD and BD, thereby improving diagnostic accuracy in mood disorders.

METHODS

This study recruited a total of 103 participants, comprising 37 patients diagnosed with MDD, 36 patients with BD, and 30 healthy controls (HC). All participants were matched in terms of gender and age. EEG data were acquired during both eyes-open and eyes-closed states over a 5-minute duration to examine whether different sub-oscillations in the alpha band can differentiate between MDD and BD.

RESULTS

We found that at the group level, the peak frequency of the HC group was in the low alpha band, the BD group in the medium alpha band, and the MDD group in the high alpha band. Our results indicate that the MDD and BD groups display the most pronounced differences in the high alpha band, irrespective of whether the eyes are open or closed. In contrast, the HC group exhibits some distinctions from the MDD and BD groups in the low alpha band.

CONCLUSIONS

This study provides novel insights into the differential characteristics of alpha sub-band oscillations in MDD from BD as compared to healthy controls. These observations suggest distinct neural signatures for MDD and BD, highlighting the potential value of alpha sub-band analyses in diagnostic classification.

A review on smart dressings with advanced features

Wound care is a multifaceted and collaborative process, and chronic wounds can have significant repercussions on a patient's well-being and impose a financial burden on the healthcare industry. While traditional wound dressings can effectively facilitate healing, their limitations in addressing the intricacies of the wound healing process remain a formidable obstacle. Smart wound dressings have emerged as a promising solution to tackle this challenge, offering numerous advantages over conventional dressings, such as real-time monitoring of wound healing and enhanced wound care management. These advanced medical dressings incorporate microelectronic sensors that can monitor the wound environment and provide timely interventions for accelerated and comprehensive healing. Furthermore, advancements in drug delivery systems have enabled real-time monitoring, targeted therapy, and controlled release of medications. Smart wound dressings exhibit versatility, as they are available in various forms and can be utilised for treating different types of acute or chronic wounds. Ultimately, the development of innovative wound care technologies and treatments plays a vital role in addressing the complexities presented by wounds and enhancing patients' quality of life. This review sheds light on the diverse types of smart dressings and their distinctive features, emphasising their potential in advancing the field of wound care.

Does Aspirin Increase Risk of Bleeding in Patients Undergoing Skin Lesion Excision: A Systematic Review and Meta-Analysis

Background

Aspirin is a commonly prescribed medication, which impairs the action of platelets. This also results in a higher risk of bleeding. Cutaneous lesion excision is frequently performed for diagnosis and treatment of malignancies, as well as for aesthetic or functional benefits. We must balance the risk of bleeding against the risk of discontinuing aspirin. We conducted a systematic review, and meta-analysis, in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to evaluate the evidence of postoperative bleeding risk conferred by continuation of aspirin in cutaneous surgery.

Methods

A systematic search of the literature was performed. Included studies evaluated the incidence of hemorrhage or hematoma in adults undergoing cutaneous surgery. The following participant characteristics were noted: age, sex, surgical site, and type of wound closure performed. A random-effects model was chosen to calculate the effect size-expressed as odds ratio (OR) with a 95% confidence interval-for bleeding of any severity, moderate severity, severe severity, infection, and wound dehiscence (outcomes).

Results

A total of 26,860 procedures were included from 20 studies. A statistically significant increase in odds of bleeding of any severity (16,748 procedures included) OR 1.39 (1.02-1.90) and for bleeding of severe severity (12,311 procedures included) OR 2.46 (1.53-3.95) was identified. Moderate severity bleeding (1629 procedures included) OR 0.92 (0.46-1.81), infection OR 0.60 (0.28-1.28), and wound dehiscence OR 0.92 (0.41-2.06) effect size results did not attain statistical significance.

Conclusions

Our analysis identified a statistically significant increase in postoperative bleeding risk for patients taking aspirin and undergoing cutaneous surgery.

Proportion of patients in phase 2 oncology trials receiving treatments that are ultimately approved

BACKGROUND

Many patients enroll in phase 1 dose expansion cohorts or phase 2 clinical trials (together referred to below as "phase 2") seeking access to novel treatments. Little is known about the extent to which they benefit by enrolling. Herein, we use a novel metric of benefit-therapeutic proportion-to assess the probability that patients in phase 2 trials receive treatment that eventually advances to FDA (Food and Drug Administration) approval for their condition.

METHODS

We randomly sampled 400 trials identified in a search of Clinicaltrials.gov for cancer phase 2 trials initiated between November 1, 2012 and November 1, 2015. We determined whether the drug/dose/indication tested in each trial advanced to FDA approval within 7.5 years. We determined whether the drug/dose/indication presented substantial clinical benefit using the ESMO-MCBS (European Society for Medical Oncology - Magnitude of Clinical Benefit Scale), or whether it received off-label recommendation in NCCN (National Comprehensive Cancer Network) guidelines.

RESULTS

Collectively, trials in our sample enrolled 25 002 patient-participants in 608 specific treatment cohorts. A total of 4045 patients received a treatment that advanced to FDA approval (16.2%; 95% CI = 10.3 to 22.7). The therapeutic proportion increased to 19.4% (95% CI = 14.1 to 25.8) when considering NCCN off-label recommendations and decreased to 9.3% (95% CI = 4.7 to 14.6) for FDA-approved regimens considered being of substantial clinical benefit by ESMO-MCBS. Bootstrap test of mean difference showed no statistical difference in proportions based on drug class, trial phase, or sponsorship.

CONCLUSION

One in 6 patients in phase 2 clinical trials receives treatments that are eventually approved. This represents a higher therapeutic value than phase 1 trials.

Strategically Designed Mitochondria-Targeting AIEgens for Effective Eradication of Primary and Metastatic Tumors via Synergistic Phototherapy and Induced Immunogenic Cell Death

In recent years, photoimmunotherapy has emerged as an innovative modality in antitumor therapy, garnering significant research interest due to its integration of the advantages of both phototherapy and immunotherapy. However, despite extensive efforts to advance photoimmunotherapy, the design strategies for photoimmunotherapy agents remain uncertain, significantly hindering progress in this field. Here, a novel molecular design strategy for developing superb photoimmunotherapy agents that integrates aggregation-induced emission (AIE) activity, mitochondria targeting, high-efficiency reactive oxygen species generation, and high photothermal conversion capabilities into a single molecule is proposed. A comprehensive study demonstrates that the target molecule (TPETTBI) that is strategically designed can exert prominent photodynamic therapy (PDT) and photothermal therapy (PTT) effects, leading to tumor cell death. More importantly, the synergistic action of PDT and PTT can further induce mitochondrial dysfunction and trigger large-scale immunogenic cell death (ICD) to attain a long-lasting effect of antitumor immunity. Therefore, this work provides new insights into the rational design of phototherapy agents for precise and efficient tumor treatment by integrating synergistic PDT, PTT, and ICD-based immunotherapy within a single molecule.