AI's deep dive into complex pediatric inguinal hernia issues: a challenge to traditional guidelines?

OBJECTIVE

This study utilized ChatGPT, an artificial intelligence program based on large language models, to explore controversial issues in pediatric inguinal hernia surgery and compare its responses with the guidelines of the European Association of Pediatric Surgeons (EUPSA).

METHODS

Six contentious issues raised by EUPSA were submitted to ChatGPT 4.0 for analysis, for which two independent responses were generated for each issue. These generated answers were subsequently compared with systematic reviews and guidelines. To ensure content accuracy and reliability, a content analysis was conducted, and expert evaluations were solicited for validation. Content analysis evaluated the consistency or discrepancy between ChatGPT 4.0's responses and the guidelines. An expert scoring method assess the quality, reliability, and applicability of responses. The TF-IDF model tested the stability and consistency of the two responses.

RESULTS

The responses generated by ChatGPT 4.0 were mostly consistent with the guidelines. However, some differences and contradictions were noted. The average quality score was 3.33, reliability score was 2.75, and applicability score was 3.46 (out of 5). The average similarity between the two responses was 0.72 (out of 1), Content analysis and expert ratings yielded consistent conclusions, enhancing the credibility of our research.

CONCLUSION

ChatGPT can provide valuable responses to clinical questions, but it has limitations and requires further improvement. It is recommended to combine ChatGPT with other reliable data sources to improve clinical practice and decision-making.

[A semi-supervised network-based tissue-aware contrast enhancement method for CT images]

OBJECTIVE

To propose a tissue- aware contrast enhancement network (T- ACEnet) for CT image enhancement and validate its accuracy in CT image organ segmentation tasks.

METHODS

The original CT images were mapped to generate low dynamic grayscale images with lung and soft tissue window contrasts, and the supervised sub-network learned to recognize the optimal window width and level setting of the lung and abdominal soft tissues via the lung mask. The self-supervised sub-network then used the extreme value suppression loss function to preserve more organ edge structure information. The images generated by the T-ACEnet were fed into the segmentation network to segment multiple abdominal organs.

RESULTS

The images obtained by T-ACEnet were capable of providing more window setting information in a single image, which allowed the physicians to conduct preliminary screening of the lesions. Compared with the suboptimal methods, T-ACE images achieved improvements by 0.51, 0.26, 0.10, and 14.14 in SSIM, QABF, VIFF, and PSNR metrics, respectively, with a reduced MSE by an order of magnitude. When T-ACE images were used as input for segmentation networks, the organ segmentation accuracy could be effectively improved without changing the model as compared with the original CT images. All the 5 segmentation quantitative indices were improved, with the maximum improvement of 4.16%.

CONCLUSION

The T-ACEnet can perceptually improve the contrast of organ tissues and provide more comprehensive and continuous diagnostic information, and the T-ACE images generated using this method can significantly improve the performance of organ segmentation tasks.

[A semi-supervised material quantitative intelligent imaging algorithm for spectral CT based on prior information perception learning]

OBJECTIVE

To propose a semi-supervised material quantitative intelligent imaging algorithm based on prior information perception learning (SLMD-Net) to improve the quality and precision of spectral CT imaging.

METHODS

The algorithm includes a supervised and a self- supervised submodule. In the supervised submodule, the mapping relationship between low and high signal-to-noise ratio (SNR) data was constructed through mean square error loss function learning based on a small labeled dataset. In the self- supervised sub-module, an image recovery model was utilized to construct the loss function incorporating the prior information from a large unlabeled low SNR basic material image dataset, and the total variation (TV) model was used to to characterize the prior information of the images. The two submodules were combined to form the SLMD-Net method, and pre-clinical simulation data were used to validate the feasibility and effectiveness of the algorithm.

RESULTS

Compared with the traditional model-driven quantitative imaging methods (FBP-DI, PWLS-PCG, and E3DTV), data-driven supervised-learning-based quantitative imaging methods (SUMD-Net and BFCNN), a material quantitative imaging method based on unsupervised learning (UNTV-Net) and semi-supervised learning-based cycle consistent generative adversarial network (Semi-CycleGAN), the proposed SLMD-Net method had better performance in both visual and quantitative assessments. For quantitative imaging of water and bone materials, the SLMD-Net method had the highest PSNR index (31.82 and 29.06), the highest FSIM index (0.95 and 0.90), and the lowest RMSE index (0.03 and 0.02), respectively) and achieved significantly higher image quality scores than the other 7 material decomposition methods (P < 0.05). The material quantitative imaging performance of SLMD-Net was close to that of the supervised network SUMD-Net trained with labeled data with a doubled size.

CONCLUSIONS

A small labeled dataset and a large unlabeled low SNR material image dataset can be fully used to suppress noise amplification and artifacts in basic material decomposition in spectral CT and reduce the dependence on labeled data-driven network, which considers more realistic scenario in clinics.

The novel importance of miR-143 in obesity regulation

Obesity and substantially increased risk of metabolic diseases have become a global epidemic. microRNAs have attracted a great deal of attention as a potential therapeutic target for obesity. MiR-143 has been known to specifically promote adipocyte differentiation by downregulating extracellular signal-regulated kinase 5. Our latest study found that miR-143 knockout is against diet-induced obesity by promoting brown adipose tissue thermogenesis and inhibiting white adipose tissue adipogenesis. Moreover, LPS- or IL-6-induced inhibition of miR-143 expression in brown adipocytes promotes thermogenesis by targeting adenylate cyclase 9. In this review, we will summarize the expression and functions of miR-143 in different tissues, the influence of obesity on miR-143 in various tissues, the important role of adipose-derived miR-143 in the development of obesity, the role of miR-143 in immune cells and thermoregulation and discuss the potential significance and application prospects of miR-143 in obesity management.

Prediction of knee pain improvement over two years for knee osteoarthritis using a dynamic nomogram based on MRI-derived radiomics: a proof-of-concept study

OBJECTIVES

To develop and validate a nomogram to detect improved knee pain in osteoarthritis (OA) by integrating magnetic resonance imaging (MRI) radiomics signature of subchondral bone and clinical characteristics.

METHODS

Participants were selected from the Vitamin D Effects on Osteoarthritis (VIDEO) study. The primary outcome was 20% improvement of knee pain score over 2 years in participants administrated either vitamin D or placebo. Radiomics features of subchondral bone and clinical characteristics from 216 participants were extracted and analyzed. The participants were randomly split into the training and validation cohorts at a ratio of 8:2. Least absolute shrinkage and selection operator (LASSO) regression was used to select features and generate radiomics signatures. The optimal radiomics signature and clinical indicators were fitted into a nomogram using multivariable logistic regression model.

RESULTS

The nomogram showed favorable discrimination performance [AUC_training, 0.79 (95% CI: 0.72-0.79), AUC_validation, 0.83 (95% CI: 0.70-0.96)] as well as a good calibration. Additional contributing value of fusion radiomics signature to the nomogram was statistically significant (NRI, 0.23; IDI, 0.14, P < 0.001 in training cohort and NRI, 0.29; IDI, 0.18, P < 0.05 in validating cohort). Decision curve analysis confirmed the clinical usefulness of nomogram.

CONCLUSION

The radiomics-based nomogram comprising the MR radiomics signature and clinical variables achieves a favorable predictive efficacy and accuracy in differentiating improvement in knee pain among OA patients. This proof-of-concept study provides a promising way to predict clinically meaningful outcomes.

LPS-Induced Inhibition of miR-143 Expression in Brown Adipocytes Promotes Thermogenesis and Fever

Fever is an important part of inflammatory response to infection. Although brown adipose tissue (BAT) thermogenesis is known to be potently influenced by systemic inflammation, the role of BAT during infection-induced fever remains largely unknown. Here, we injected mice with a low dose of LPS and found that low-dose LPS can directly induce thermogenesis of brown adipocytes. It is known that miR-143 is highly expressed in the BAT, and miR-143 knockout mice exhibited stronger thermogenesis under cold exposure. Interestingly, miR-143 was negatively correlated with an LPS-induced increase of TNFα and IL-6 mRNA levels, and the IL-6 pathway may mediate the inhibition of miR-143 expression. Moreover, miR-143 is down-regulated by LPS, and overexpression of miR-143 in brown adipocytes by lentivirus could rescue the enhancement of UCP1 protein expression caused by LPS, hinting miR-143 may be an important regulator of the thermogenesis in brown adipocytes. More importantly, the knockout of miR-143 further enhanced the LPS-induced increase of body temperature and BAT thermogenesis, and this result was further confirmed by in vitro experiments by using primary brown adipocytes. Mechanistically, adenylate cyclase 9 (AC9) is a new target gene of miR-143 and LPS increases BAT thermogenesis by a way of inhibiting miR-143 expression, a negative regulator for AC9. Our study considerably improves our collective understanding of the important function of miR-143 in inflammatory BAT thermogenesis.

miR-143-null Is against Diet-Induced Obesity by Promoting BAT Thermogenesis and Inhibiting WAT Adipogenesis

Excessive energy intake is the main cause of obesity, and stimulation of brown adipose tissue (BAT) thermogenesis has emerged as an attractive tool for anti-obesity. Although miR-143 has been reported to promote white adipocyte differentiation, its role in BAT remains unclear. In our study, we found that during HFD-induced obesity, the expression of miR-143 in BAT was significantly reduced, and the expression of miR-143 in WAT first increased and then decreased. Knockout (KO) of miR-143 with CRISPR/Cas9 did not affect the energy metabolism of normal diet fed mice and brown adipocyte differentiation but inhibited the differentiation of white adipocytes. Importantly, during high fat diet-induced obesity, miR-143KO significantly reduced body weight, and improved energy expenditure, insulin sensitivity, and glucose tolerance. Further exploration showed that miR-143KO reduced the weight of adipose tissue, promoted mitochondrial number and functions, induced thermogenesis and lipolysis of BAT, increased lipolysis, and inhibited lipogenesis of white adipose tissue (WAT). Our study considerably improves our collective understanding of the function of miR-143 in adipose tissue and its potential significance in anti-obesity and provides a new avenue for the management of obesity through the inhibition of miR-143 in BAT and WAT.

[Association analysis between genetic variants of matrix metalloproteinase enzyme 2 gene and the blood pressure of children and adolescents]

Objective: To explore the association between genetic variants of matrix metalloproteinase enzyme 2 (MMP2) gene and the blood pressure of children and adolescents. Methods: This cross-sectional study was performed in 2016 and included 4 155 children and adolescents in the urban area of Guangzhou. Physical examinations (including body height, weight, and blood pressure), questionnaires (including general characteristics, physical exercise, parental educational level, household income, etc.), and blood sampling were performed. Multivariable linear regression models were used to investigate the associations of MMP2 genetic variations (rs243865, rs7201) and the genetic risk score (GRS) level with standardized blood pressure. Mediating effect of standardized body mass index (BMI) was further assessed by process analysis in the association between GRS level and blood pressure, and potential additive interaction between physical activity and GRS level was analyzed using the product term in the regression model. Results: A total of 4 155 primary and secondary schoolchildren were finally included in the analysis, consisting of 1 401 (33.7%) second grade pupils of primary school, 1 422 (34.2%) first grade pupils of middle school, and 1 332 (32.1%) first-grade students of senior high school. After adjusting for age, sex, parental educational level, and family income, as compared to the rs243865 TT genotype, the CC/CT genotype increased diastolic blood pressure (DBP) by 0.461 standard deviations (SD) (β for dominant model=0.461, 95%CI 0.199-0.723). When compared to the rs7201 CC genotype, the AA/AC genotype showed 0.147 SD higher systolic blood pressure (SBP) (β for recessive model=0.147, 95%CI 0.014-0.279) and 0.171 SD increased DBP (β for recessive model=0.171, 95%CI 0.039-0.304). For each increment of GRS level, SBP and DBP increased by 0.151 SD (β for dominant model=0.151, 95%CI 0.029-0.272) and 0.242 SD (β=0.242, 95%CI 0.120-0.363), respectively. The mediating effect of BMI accounted for 28.3% and 12.6% of the total effect of GRS on SBP and DBP, respectively. After controlling BMI, the direct effect of GRS on DBP remained statistically significant (P<0.001). The insufficient moderate-to-vigorous physical activity (<0.5 h/d) showed a significant interaction with GRS on SBP under additive scale (β for interaction=0.518, 95%CI 0.088-0.949, P=0.018). Conclusions: rs243865 and rs7201 variants in MMP2 gene are associated with the elevated blood pressure of children and adolescents. Obesity may yield a mediation role in the associations, while insufficient physical activity may have a positively additive interaction with MMP2 genetic variants.

Time series analysis of rubella incidence in Chongqing, China using SARIMA and BPNN mathematical models

INTRODUCTION

Chongqing is among the areas with the highest rubella incidence rates in China. This study aimed to analyze the temporal distribution characteristics of rubella and establish a forecasting model in Chongqing, which could provide a tool for decision-making in the early warning system for the health sector.

METHODOLOGY

The rubella monthly incidence data from 2004 to 2019 were obtained from the Chongqing Center of Disease and Control. The incidence from 2004 to June 2019 was fitted using the seasonal autoregressive integrated moving average (SARIMA) model and the back-propagation neural network (BPNN) model, and the data from July to December 2019 was used for validation.

RESULTS

A total of 30,083 rubella cases were reported in this study, with a significantly higher average annual incidence before the nationwide introduction of rubella-containing vaccine (RCV). The peak of rubella notification was from April to June annually. Both SARIMA and BPNN models were capable of predicting the expected incidence of rubella. However, the linear SARIMA model fits and predicts better than the nonlinear BPNN model.

CONCLUSIONS

Based on the results, rubella incidence in Chongqing has an obvious seasonal trend, and SARIMA (2,1,1) × (1,1,1) 12 model can predict the incidence of rubella well. The SARIMA model is a feasible tool for producing reliable rubella forecasts in Chongqing.

The prevalence of stroke and related risk factors among residents aged ≥ 40 years in Chongqing, Southwest China

Background

China bears the largest global stroke burden, yet little is known about its rates in Chongqing, southwest China. We aimed to investigate the prevalence and related risk factors for stroke in Chongqing, and to provide evidence for improved formulation of targeted primary preventive measures for stroke.

Methods

In 2015, a cross-sectional study was conducted in Nan’an district, Chongqing. Participants responded to a questionnaire surveying general information and common risk factors for stroke, and related physical examinations were conducted.

Results

Of 25,000 people aged ≥ 40 years who were investigated, 24,859 participants completed the questionnaire and underwent the physical examination. The crude prevalence rate for stroke was 1.71%, and was higher in men than in women (1.9% versus 1.6%). Prevalence rates increased with age (p < 0.001). Multiple logistic regression analysis indicated that too little exercise, hypertension, family history of stroke, and history of transient ischemic attack were stroke risk factors among three groups (men, women, and total participants; all p-values < 0.05). Smoking was a risk factor for men (odds ratio 2.77; 95% Cl 1.46–5.28) and having only attained a primary school or lower education level was a risk factor for women (p < 0.05).

Conclusions

These findings suggest that controlling stroke risk factors for stroke prevention is still crucial. Moreover, this study provides comprehensive resource data for further stroke research in southwest China.

[Time-series analysis on the relationship between ambient PM2.5 and daily outpatient visits due to allergic conjunctivitis among children in Shenzhen]

Objective: To explore the short-term effects of ambient PM_2.5 on the outpatient visits of allergic conjunctivitis among children in Shenzhen. Methods: It was a ecological study. Data on daily visits including date of visit, sex and age from children with allergic conjunctivitis were collected from Shenzhen Eye Hospital and Shenzhen Children's Hospital in 2018. Related data on air pollution (PM_2.5, PM₁₀, SO₂, NO₂, CO and O₃) and meteorology (atmospheric pressure, temperature and relative humidity) were also collected. Pearson correlation analysis was used for normal distribution data and Spearman rank correlation analysis was used for non-normal distribution data. Generalized additive model was used to estimate the impact of PM_2.5 pollution on allergic conjunctivitis outpatients and the lagging effects. Results: In 2018, there were 16 133 allergic conjunctivitis outpatients in the two hospitals. The maximum age was 18 years and the minimum age was 2 months. Males accounted for 49.3%. The daily average concentration of PM_2.5 was 22 (15, 31) μg/m³. Changes of the concentration of PM_2.5 had a positive correlation with the amount of allergic conjunctivitis visits, and the Spearman correlation coefficient was 0.150 (P=0.004). The single pollutant model showed that the strongest effect appeared at 3 days (RR=1.111， 95%CI:1.071-1.152). A 10 μg/m³ increase of PM_2.5 would result in an excessive number of allergic conjunctivitis outpatients as much as 11.112% (95%CI：7.011%-15.212%). In the multiple air pollutants models, after the introduction of NO₂, O₃ and CO, the concentration of PM_2.5 showed an enhanced effect on the number of hospital visits due to allergic conjunctivitis on the same day, and the difference was statistically significant (P<0.05). Conclusion: Changes of the concentration of PM_{2.5 h}ad a positive correlation with daily outpatient visits of allergic conjunctivitis among children in Shenzhen. (Chin J Ophthalmol, 2020, 56: 608-614).

MicroRNA-374b accelerates the development of lung cancer through downregulating PTEN expression via activating PI3K/Akt pathway

OBJECTIVE

To elucidate whether microRNA-374b could participate in the development of lung cancer (LC) through downregulating PTEN (gene of phosphate and tensin homolog deleted on chromosome ten) expression via activating PI3K/Akt pathway.

PATIENTS AND METHODS

Expression levels of microRNA-374b and PTEN in LC tissues and adjacent normal tissues were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Moreover, the expression level of microRNA-374b in LC cell lines was detected as well. The microRNA-374b inhibitor was constructed and transfected to downregulate microRNA-374b expression in A549 and H358 cells. The regulatory effects of microRNA-374b on migratory and proliferative capacities of LC cells were explored by wound healing and cell counting kit-8 (CCK-8) assay, respectively. After co-transfection of microRNA-374b inhibitor and si-PTEN in LC cells, expression levels of PTEN/PI3K/Akt were determined by qRT-PCR and Western blot.

RESULTS

QRT-PCR results showed that microRNA-374b expression was higher, while PTEN expression was lower in LC tissues than adjacent tissues. Identically, microRNA-374b was also highly expressed in LC cell lines. PTEN expression was negatively correlated with microRNA-374b expression in LC. The downregulation of microRNA-374b in A549 and H358 cells inhibited their migratory and proliferative potentials. Subsequently, we verified that microRNA-374b could bind to PTEN through dual-luciferase reporter gene assay. MicroRNA-374b could inhibit PTEN expression and activate the PI3K/Akt pathway. Furthermore, PTEN knockdown enhanced migratory and proliferative abilities of LC cells, which were attenuated by co-transfection of microRNA-374b inhibitor.

CONCLUSIONS

MicroRNA-374b promotes the development of LC by downregulating PTEN expression through activating PI3K/Akt pathway.

1144 Actigraphy-defined Sleep And Neurocognitive Decline In Middle-age Hispanic/Latino Adults

Introduction

Few studies have evaluated objective sleep measures and longitudinal neurocognitive decline, particularly in middle-age or Hispanic/Latino adults. We evaluated prospective associations between actigraphy-defined sleep and 7-year neurocognitive change among Hispanic/Latino adults. We hypothesized that sleep duration would be associated with neurocognitive decline.

Methods

We analyzed data from 1,036 adults 45-64 years of age from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-center prospective cohort study of diverse community-dwelling Hispanic/Latino adults. At Visit 1 (2008-2011), participants underwent neurocognitive assessments, 7-days of actigraphy, home sleep testing, and sleep questionnaires (including the Insomnia Severity Index). Seven years later, participants repeated neurocognitive assessments. The neurocognitive battery included the Six-Item Screener, Brief Spanish-English Verbal Learning Test, phonemic word fluency test, and Digit Symbol Subtest. Survey linear regression was used to evaluate prospective associations between actigraphy-defined or self-reported sleep variables and neurocognitive change. Final models adjusted for objectively-defined variables (age, body-mass index, Field Center, and time between neurocognitive assessments), and self-reported variables (sex, education, Hispanic/Latino background, alcohol consumption, physical activity, heart failure, cerebrovascular events, depression and anxiety symptoms, and antidepressant use).

Results

At Visit 1, the sample was 55% female and mean age was 54.9±2.2 years. The mean sleep duration was 402.6±27.6 minutes, mean sleep-onset latency was 11.3±9.7 minutes, mean number of days with naps of ≥ 15 minutes duration was 1.1±0.7, and mean sleep-time per nap was 51±14.1 minutes. Increased sleep-onset latency was associated with 7-year declines in global neurocognitive function (β=-0.0026, p&lt;0.01), verbal learning (β=-0.0028, p&lt;0.001) and verbal memory (β=-0.036, p&lt;0.05). Increased sleep-time per nap predicted better verbal memory (β=0.0038, p&lt;0.05). In contrast, sleep duration, sleep fragmentation, and self-reported sleep measures were not associated with neurocognitive change.

Conclusion

Among middle-age adults, sleep-onset latency and nap duration were associated with neurocognitive change. These findings may serve as targets for intervention of neurocognitive decline.

Support

This work is supported by the National Institute on Aging: R01AG048642, RF1AG054548, R01AG061022, R21AG056952, and R21HL140437 (AR).

Developing an Indicator System for a Healthy City: Taking an Urban Area as a Pilot

PURPOSE

The Healthy Cities Project is an important strategy for global health. This study aimed to develop a scientific and appropriate indicator system for the evaluation of a Healthy City in Chongqing, China.

METHODS

Data were collected via a review of government documents, focus group discussions, and in-depth interviews. A total of 34 government documents were reviewed to build the indicator database based on our previous studies. The first round of focus group discussions, which involved eight health-related experts, was conducted to form the indicator system framework. In-depth interviews with 15 experts from government departments were conducted to design the improved indicator system. The second round of focus group discussions, which featured four experts, was conducted to obtain the final recommended list of indicators. A thematic framework was used to analyze the detailed interview notes.

RESULTS

The indicator system for the Healthy City consisted of 5 first-level indicators, 21 second-level indicators (e.g., health literacy), 73 third-level indicators (e.g., incidence of myopia), and three characteristic indicators. This indicator system spanned the scope of the environment, society, health services, healthy people, and health behaviors.

CONCLUSION

This indicator system was based on the current status of the construction of the Healthy City in the pilot district. The indicator system could be dynamically adjusted according to the development of the Healthy City in the pilot district. Government departments play an important decision-making role in the development process of this indicator system.

Intravoxel incoherent motion diffusion-weighted imaging assessment of microvascular characteristics in the murine embryonal rhabdomyosarcoma model

Background

Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) can distinguish the false diffusion generated by microvascular blood flow from the true water molecule diffusion.

Purpose

To investigate the correlation between IVIM-DWI parameters and angiogenic markers such as the microvessel density and vascular endothelial growth factor (VEGF) expression in the murine embryonal rhabdomyosarcoma model.

Material and Methods

The murine embryonal rhabdomyosarcoma model was produced by subcutaneously injecting 107 human embryonal rhabdomyosarcoma cells into the right back of nude mice. The apparent diffusion coefficient (ADC), pseudo-diffusion coefficient (D*), true diffusion coefficient (D), and perfusion fraction (f) were obtained from 22 mice models using IVIM-DWI with b-values of 0, 50, 100, 150, 200, 400, 600, 800, 1000, and 1200 s/mm2. The microvessel density and VEGF expression were obtained by histologic examination. We then compared the correlation between IVIM-DWI parameters and microvessel density and VEGF expression.

Results

The average ADC, D*, D, and f values were 1.05 ± 0.27 × 10−3 mm2/s, 6.19 ± 1.78 × 10−3 mm2/s, 0.69 ± 0.09 ×10−3 mm2/s, and 17.68 ± 8.41 (%), respectively. There was moderate positive correlation between D* value and microvessel density and VEGF expression (r = 0.484, P = 0.023; r = 0.511, P = 0.015). However, there was no significant correlation between ADC, D, and f values and microvessel density and VEGF expression.

Conclusion

The D* value from IVIM-DWI may be used to evaluate tumor angiogenesis in the murine embryonal rhabdomyosarcoma model.

Over-expression of both VEGF-C and Twist predicts poor prognosis in human breast cancer

BACKGROUND

Angiogenesis is an indispensable step in the growth and invasiveness of breast cancers involving a series of exquisite molecular steps. Pro-angiogenic factors, including vascular endothelial growth factor (VEGF), have been recognized as pivotal therapeutic targets in the treatment of breast cancer. More recently, a highly conserved transcription factor Twist has been reported to be involved in tumor angiogenesis and metastasis.

METHODS

The expression of VEGF-C and Twist was immunohistochemically determined in tissue samples of primary tumors from 408 patients undergoing curative surgical resection for breast cancer. The correlations of VEGF-C and Twist expressions with clinicopathologic parameters as well as survival outcomes were evaluated.

RESULTS

Of the 408 patients evaluated, approximately 70% had high expression of VEGF-C which was significantly associated with advanced tumor stages (P = 0.019). Similarly, VEGF-C expression was associated with the proliferation index Ki67, N3 lymph node metastasis, and D2-40-positive lymphatic vessel invasion (LVI) in a univariate analysis. Furthermore, patients with high expressions of VEGF-C and Twist (V + T+) had significantly increased lymph node metastasis, higher clinical stage, and worse disease-free survival, DFS (P = 0.001) and overall survival, OS (P = 0.011).

CONCLUSIONS

Our results suggested that co-expression of VEGF-C and Twist was associated with larger tumor size, higher numbers of lymph node involvement, D2-40-positive LVI, higher risk of distant metastasis, and worse DFS or OS in breast cancer patients.

Monitoring the Early Antiproliferative Effect of the Analgesic-Antitumor Peptide, BmK AGAP on Breast Cancer Using Intravoxel Incoherent Motion With a Reduced Distribution of Four b-Values

Background: The present study aimed to investigate the possibility of using intravoxel incoherent motion (IVIM) diffusion magnetic resonance imaging (MRI) to quantitatively assess the early therapeutic effect of the analgesic–antitumor peptide BmK AGAP on breast cancer and also evaluate the medical value of a reduced distribution of four b-values.

Methods: IVIM diffusion MRI using 10 b-values and 4 b-values (0–1,000 s/mm²) was performed at five different time points on BALB/c mice bearing xenograft breast tumors treated with BmK AGAP. Variability in Dslow, Dfast, PF, and ADC derived from the set of 10 b-values and 4 b-values was assessed to evaluate the antitumor effect of BmK AGAP on breast tumor.

Results: The data showed that PF values significantly decreased in rBmK AGAP-treated mice on day 12 (P = 0.044). PF displayed the greatest AUC but with a poor medical value (AUC = 0.65). The data showed no significant difference between IVIM measurements acquired from the two sets of b-values at different time points except in the PF on the day 3. The within-subject coefficients of variation were relatively higher in Dfast and PF. However, except for a case noticed on day 0 in PF measurements, the results indicated no statistically significant difference at various time points in the rBmK AGAP-treated or the untreated group (P < 0.05).

Conclusion: IVIM showed poor medical value in the early evaluation of the antiproliferative effect of rBmK AGAP in breast cancer, suggesting sensitivity in PF. A reduced distribution of four b-values may provide remarkable measurements but with a potential loss of accuracy in the perfusion-related parameter PF.

Appropriate dose of Lactobacillus buchneri supplement improves intestinal microbiota and prevents diarrhoea in weaning Rex rabbits

This study examined the effects on intestinal microbiota and diarrhoea of Lactobacillus buchneri supplementation to the diet of weaning Rex rabbits. To this end, rabbits were treated with L. buchneri at two different doses (LC: 104 cfu/g diet and HC: 105 cfu/g diet) for 4 weeks. PCR-DGGE was used to determine the diversity of the intestinal microbiota, while real-time PCR permitted the detection of individual bacterial species. ELISA and real-time PCR allowed the identification of numerous cytokines in the intestinal tissues. Zonula occludens-1, polymeric immunoglobulin receptor and immunoglobulin A genes were examined to evaluate intestinal barriers. Results showed that the biodiversity of the intestinal microbiota of weaning Rex rabbits improved in the whole tract of the treated groups. The abundance of most detected bacterial species was highly increased in the duodenum, jejunum and ileum after L. buchneri administration. The species abundance in the HC group was more increased than in the LC group when compared to the control. Although the abundance of Enterobacteriaceae exhibited a different pattern, Escherichia coli was inhibited in all treatment groups. Toll-like receptor (TLR)2 and TLR4 genes were down-regulated in all intestinal tissues as the microbiota changed. In the LC group, the secretion of the inflammatory cytokine tumour necrosis factor-α was reduced, the gene expression of the anti-inflammatory cytokine interleukin (IL)-4 was up-regulated and the expression of intestinal-barrier-related genes was enhanced. Conversely, IL-4 expression was increased and the expression of other tested genes did not change in the HC group. The beneficial effects of LC were greater than those of HC or the control in terms of improving the daily weight gain and survival rate of weaning Rex rabbits and reducing their diarrhoea rate. Therefore, 104 cfu/g L. buchneri treatment improved the microbiota of weaning Rex rabbits and prevented diarrhoea in these animals.

Gene expression profiles for a prognostic immunoscore in gastric cancer

Background

Increasing evidence has indicated an association between immune infiltration in gastric cancer and clinical outcome. However, reliable prognostic signatures, based on systematic assessments of the immune landscape inferred from bulk tumour transcriptomes, have not been established. The aim was to develop an immune signature, based on the cellular composition of the immune infiltrate inferred from bulk tumour transcriptomes, to improve the prognostic predictions of gastric cancer.

Methods

Twenty‐two types of immune cell fraction were estimated based on large public gastric cancer cohorts from the Gene Expression Omnibus using CIBERSORT. An immunoscore based on the fraction of immune cell types was then constructed using a least absolute shrinkage and selection operator (LASSO) Cox regression model.

Results

Using the LASSO model, an immunoscore was established consisting of 11 types of immune cell fraction. In the training cohort (490 patients), significant differences were found between high‐ and low‐immunoscore groups in overall survival across and within subpopulations with an identical TNM stage. Multivariable analysis revealed that the immunoscore was an independent prognostic factor (hazard ratio 1·92, 95 per cent c.i. 1·54 to 2·40). The prognostic value of the immunoscore was also confirmed in the validation (210) and entire (700) cohorts.

Conclusion

The proposed immunoscore represents a promising signature for estimating overall survival in patients with gastric cancer.

Immunoscore predicts prognosis

Effects of cryopreservation on ultrastructural morphology of white shrimp (Litopenaeus vannamei) sperm

BACKGROUND

The structural integrity of a spermatozoon is very important for the processes of fertilization and embryo development.

OBJECTIVE

To provide valuable data for developing better cryopreservation techniques for shrimp sperm.

MATERIALS AND METHODS

Using scanning electron microscopy and transmission electron microscopy, we examined the morphological alteration of Litopenaeus vannamei sperm after cryopreservation with different concentrations of dimethylsulfoxide (DMSO).

RESULTS

We found that the damaged post-thaw sperm presented either vesiculated acrosomal contents, wrinkled membranes, perforated membranes, and loss of the acrosomal spike. The seriously damaged sperm showed missing acrosomal spikes, deformed nuclei, burst nuclear membranes, and vacuolated nuclei. In addition, we found that the post-thaw sperm stored with 5% DMSO had the highest viability rate and lowest DNA damage coefficient by eosin-nigrosin staining and comet assay.

CONCLUSION

Our results suggested that cryopreservation has deleterious effects on ultrastructural morphology of L. vannamei sperm, especially on acrosomal spikes and membranes.

Isolation and characterization of novel polymorphic microsatellite loci in large yellow croaker (Larimichthys crocea)

The large yellow croaker (Larimichthys crocea) is one of the largest marine net-cage cultured species in the oceans around China. In the present study, we isolated and characterized 13 polymorphic microsatellite markers from genomic libraries of L. crocea. Loci were screened for 10 wild specimens from 2 sites in southeast of China. All loci were polymorphic. The number of alleles per locus ranged from 2 to 21. The expected heterozygosity ranged from 0.233 to 0.838 and observed heterozygosity ranged from 0.527 to 0.935. Eleven loci were highly informative (polymorphic information content >0.5). Significant deviation from Hardy-Weinberg equilibrium was observed at 3 loci after Bonferroni's correction. The microsatellite loci may be valuable tools for studying the genetic diversity and genetic structure for conservation planning of the fish.

On random-effects meta-analysis

Meta-analysis is widely used to compare and combine the results of multiple independent studies. To account for between-study heterogeneity, investigators often employ random-effects models, under which the effect sizes of interest are assumed to follow a normal distribution. It is common to estimate the mean effect size by a weighted linear combination of study-specific estimators, with the weight for each study being inversely proportional to the sum of the variance of the effect-size estimator and the estimated variance component of the random-effects distribution. Because the estimator of the variance component involved in the weights is random and correlated with study-specific effect-size estimators, the commonly adopted asymptotic normal approximation to the meta-analysis estimator is grossly inaccurate unless the number of studies is large. When individual participant data are available, one can also estimate the mean effect size by maximizing the joint likelihood. We establish the asymptotic properties of the meta-analysis estimator and the joint maximum likelihood estimator when the number of studies is either fixed or increases at a slower rate than the study sizes and we discover a surprising result: the former estimator is always at least as efficient as the latter. We also develop a novel resampling technique that improves the accuracy of statistical inference. We demonstrate the benefits of the proposed inference procedures using simulated and empirical data.

Doubly Robust Learning for Estimating Individualized Treatment with Censored Data

Individualized treatment rules recommend treatments based on individual patient characteristics in order to maximize clinical benefit. When the clinical outcome of interest is survival time, estimation is often complicated by censoring. We develop nonparametric methods for estimating an optimal individualized treatment rule in the presence of censored data. To adjust for censoring, we propose a doubly robust estimator which requires correct specification of either the censoring model or survival model, but not both; the method is shown to be Fisher consistent when either model is correct. Furthermore, we establish the convergence rate of the expected survival under the estimated optimal individualized treatment rule to the expected survival under the optimal individualized treatment rule. We illustrate the proposed methods using simulation study and data from a Phase III clinical trial on non-small cell lung cancer.

A Likelihood-Based Framework for Association Analysis of Allele-Specific Copy Numbers

Copy number variants (CNVs) and single nucleotide polymorphisms (SNPs) co-exist throughout the human genome and jointly contribute to phenotypic variations. Thus, it is desirable to consider both types of variants, as characterized by allele-specific copy numbers (ASCNs), in association studies of complex human diseases. Current SNP genotyping technologies capture the CNV and SNP information simultaneously via fluorescent intensity measurements. The common practice of calling ASCNs from the intensity measurements and then using the ASCN calls in downstream association analysis has important limitations. First, the association tests are prone to false-positive findings when differential measurement errors between cases and controls arise from differences in DNA quality or handling. Second, the uncertainties in the ASCN calls are ignored. We present a general framework for the integrated analysis of CNVs and SNPs, including the analysis of total copy numbers as a special case. Our approach combines the ASCN calling and the association analysis into a single step while allowing for differential measurement errors. We construct likelihood functions that properly account for case-control sampling and measurement errors. We establish the asymptotic properties of the maximum likelihood estimators and develop EM algorithms to implement the corresponding inference procedures. The advantages of the proposed methods over the existing ones are demonstrated through realistic simulation studies and an application to a genome-wide association study of schizophrenia. Extensions to next-generation sequencing data are discussed.

Penalized Q-Learning for Dynamic Treatment Regimens

A dynamic treatment regimen incorporates both accrued information and long-term effects of treatment from specially designed clinical trials. As these trials become more and more popular in conjunction with longitudinal data from clinical studies, the development of statistical inference for optimal dynamic treatment regimens is a high priority. In this paper, we propose a new machine learning framework called penalized Q-learning, under which valid statistical inference is established. We also propose a new statistical procedure: individual selection and corresponding methods for incorporating individual selection within penalized Q-learning. Extensive numerical studies are presented which compare the proposed methods with existing methods, under a variety of scenarios, and demonstrate that the proposed approach is both inferentially and computationally superior. It is illustrated with a depression clinical trial study.

Short-term therapeutic drug monitoring of mycophenolic acid reduces infection: a prospective, single-center cohort study in Chinese living-related kidney transplantation

BACKGROUND

The role of therapeutic drug monitoring (TDM) of mycophenolic acid (MPA) in kidney transplant recipients (KTRs) is not clear. We performed a prospective cohort study to evaluate the efficiency of MPA TDM in the Chinese population.

METHODS

A total of 183 living-related KTRs were studied; 101 KTRs received controlled-dose mycophenolate mofetil (MMF) (the CD group), and 82 patients received fixed-dose MMF (the FD group). MPA exposure was measured at days 3, 7, 14, and 30 in the CD group, and at day 30 in the FD group. The primary endpoint was treatment failure (a composite of acute rejection, graft loss, death, or MMF discontinuation) at 12 months post transplantation.

RESULTS

In the CD group, with a starting MMF dose of 2 g/day, approximately 35% of patients had high MPA levels, which were >60 mg × h/L, and mean MPA levels were 59.17 mg × h/L and 61.38 mg × h/L for the CD and FD groups, respectively (P = 0.588). After adjusting MMF dose, MPA exposures in the CD group at day 30 were lower than those in the FD group at day 30 (54.06 vs. 61.38, P = 0.004). At month 12, the CD group had fewer infections (16.8% vs. 31.7%, P = 0.018) with no difference in treatment failure, acute rejection, diarrhea, or anemia.

CONCLUSIONS

KTRs can benefit from short-term TDM of MPA in reducing infection, without increasing acute rejection.

Long-term outcome of HLA-haploidentical hematopoietic SCT without in vitro T-cell depletion for adult severe aplastic anemia after modified conditioning and supportive therapy

HLA-haploidentical hematopoietic SCT (HSCT) is an option for severe aplastic anemia (SAA) patients. Here, we evaluated the outcomes of 26 adult-SAA patients who received HLA-haploidentical HSCT in five transplant centers in southwestern China. Most of the patients in this study failed prior therapy and were transfused heavily before the transplantation. The patients received fludarabine+cyclophosphamide+antithymocyte globulin as conditioning regimens and then unmanipulated peripheral blood plus marrow transplantation. Micafungin, i.v. Ig and recombinant human TPO were used for post-grafting infection prevention and supportive care. Of 26 patients, 25 achieved engraftment at a median of 13 days (range, 11-19 days) after HSCT. One of 25 patients experienced graft rejection and did not achieve sustained engraftment after second HSCT. Therefore, the final engraftment rate was 92.3%. Three of 25 (12%) patients developed acute GVHD, 10 of 25 (40%) patients developed chronic GVHD (9 with limited whereas the other with extensive). The OS rate was 84.6% and the average follow-up time was 1313.2 (738-2005) days for surviving patients. This encouraging result suggests that HLA-haploidentical HSCT is an effective therapeutic option for adults with acquired SAA if an HLA-identical donor is not available.

Role of monokine induced by interferon-γ in liver injury induced by hepatitis B virus in mice

The chemokine monokine induced by interferon-γ (Mig) is involved in the recruitment of inflammatory cells and liver injury during hepatitis B virus (HBV) infection. HBV protein X contributes to Mig expression in vitro by activation of nuclear factor (NF)-κB; however, the molecular mechanisms by which HBV induces Mig expression in vivo are unknown. In this paper, we established a mouse model for HBV study by tail vein injection of HBV genome-containing adenovirus vectors. Host immune response to the secreted hepatitis B surface antigen and e antigen was detected and serum alanine aminotransferase (ALT) was elevated at different time points. We also demonstrated that peripheral and intrahepatic Mig expression was increased after Ad-HBV infection. This was followed by inflammatory cell migration and formation of inflammatory foci in the liver. In addition, NF-κB p65 subunit translocated from the cytoplasm to the nucleus, and phosphoinositide 3-kinase/Akt, extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) were to some extent phosphorylated after HBV injection. Following tail vein injection of Mig siRNA/in vivo-jetPEI-Gal complex, Mig expression was partially suppressed, inflammatory cell migration was inhibited, serum level of ALT were reduced. In conclusion, through NF-κB activation, HBV induced Mig expression in vivo, which recruited peripheral inflammatory cells to the liver and resulted in liver damage. Phosphorylation of phosphoinositide 3-kinase/Akt, ERK and JNK but not p38 might involved in the molecular mechanisms underlying HBV induced Mig expression in vivo.

Correcting for Population Stratification in Genomewide Association Studies

Genomewide association studies have become the primary tool for discovering the genetic basis of complex human diseases. Such studies are susceptible to the confounding effects of population stratification, in that the combination of allele-frequency heterogeneity with disease-risk heterogeneity among different ancestral subpopulations can induce spurious associations between genetic variants and disease. This article provides a statistically rigorous and computationally feasible solution to this challenging problem of unmeasured confounders. We show that the odds ratio of disease with a genetic variant is identifiable if and only if the genotype is independent of the unknown population substructure conditional on a set of observed ancestry-informative markers in the disease-free population. Under this condition, the odds ratio of interest can be estimated by fitting a semiparametric logistic regression model with an arbitrary function of a propensity score relating the genotype probability to ancestry-informative markers. Approximating the unknown function of the propensity score by B-splines, we derive a consistent and asymptotically normal estimator for the odds ratio of interest with a consistent variance estimator. Simulation studies demonstrate that the proposed inference procedures perform well in realistic settings. An application to the well-known Wellcome Trust Case-Control Study is presented. Supplemental materials are available online.

Effect of myofiber characteristics and thickness of perimysium and endomysium on meat tenderness of chickens

The objective of the present study was to evaluate the role of myofiber characteristics and the thickness of 2 major muscle membranes, perimysium and endomysium, in determining the breast meat tenderness of chickens. Birds from 2 breeds (White Leghorn and a line of broiler) were chosen. Chicks were sexed and wing-banded at hatch and were grown in separate cages in a single house. Sixty broilers and 60 White Leghorns were harvested at 6 wk of age, respectively, whereas another 60 White Leghorns were slaughtered at 18 wk of age. An equal number of males and females was maintained for each group. Body weight, breast muscle weight, pH, drip loss, cooking loss, Warner-Bratzler shear force value (SFV), total energy of shear force, fiber diameter, sarcomere length, myofiber density, and the thickness of endomysium and perimysium of the breast were determined for each bird. At 6 wk of age, histological examination indicated that the size of myofiber and thickness of endomysium and perimysium of broilers were larger than that those of White Leghorns (P < 0.01), whereas the SFV, drip loss, and cooking loss of broilers were smaller (P < 0.01). A comparison between the White Leghorns at 18 wk and the broilers at 6 wk, which were at similar BW but different ages, showed that the breast muscle weight of broilers was larger (P < 0.01) than that of White Leghorns. For breast muscle, the endomysium of broilers at 6 wk was thicker than that of White Leghorns at 18 wk (P < 0.01), whereas the perimysium was thinner (P < 0.01). The SFV, drip loss, and the cooking loss of broilers were smaller than those of White Leghorns at similar BW (P < 0.01). Meat tenderness was negatively correlated with myofiber density (-0.27) and the thickness of endomysium (-0.29) and positively correlated with the thickness of perimysium (0.20). It is suggested that muscle membrane should be considered in evaluating meat tenderness of the chicken.

On the relative efficiency of using summary statistics versus individual-level data in meta-analysis

Meta-analysis is widely used to synthesize the results of multiple studies. Although meta-analysis is traditionally carried out by combining the summary statistics of relevant studies, advances in technologies and communications have made it increasingly feasible to access the original data on individual participants. In the present paper, we investigate the relative efficiency of analyzing original data versus combining summary statistics. We show that, for all commonly used parametric and semiparametric models, there is no asymptotic efficiency gain by analyzing original data if the parameter of main interest has a common value across studies, the nuisance parameters have distinct values among studies, and the summary statistics are based on maximum likelihood. We also assess the relative efficiency of the two methods when the parameter of main interest has different values among studies or when there are common nuisance parameters across studies. We conduct simulation studies to confirm the theoretical results and provide empirical comparisons from a genetic association study.

A general framework for studying genetic effects and gene-environment interactions with missing data

Missing data arise in genetic association studies when genotypes are unknown or when haplotypes are of direct interest. We provide a general likelihood-based framework for making inference on genetic effects and gene-environment interactions with such missing data. We allow genetic and environmental variables to be correlated while leaving the distribution of environmental variables completely unspecified. We consider 3 major study designs-cross-sectional, case-control, and cohort designs-and construct appropriate likelihood functions for all common phenotypes (e.g. case-control status, quantitative traits, and potentially censored ages at onset of disease). The likelihood functions involve both finite- and infinite-dimensional parameters. The maximum likelihood estimators are shown to be consistent, asymptotically normal, and asymptotically efficient. Expectation-Maximization (EM) algorithms are developed to implement the corresponding inference procedures. Extensive simulation studies demonstrate that the proposed inferential and numerical methods perform well in practical settings. Illustration with a genome-wide association study of lung cancer is provided.

Meta-analysis of genome-wide association studies: no efficiency gain in using individual participant data

To identify genetic variants with modest effects on complex human diseases, a growing number of networks or consortia are created for sharing data from multiple genome-wide association studies on the same disease or related disorders. A central question in this enterprise is whether to obtain summary results or individual participant data from relevant studies. We show theoretically and numerically that meta-analysis of summary results is statistically as efficient as joint analysis of individual participant data (provided that both analyses are performed properly under the same modeling assumptions). We illustrate this equivalence with case-control data from the Finland-United States Investigation of NIDDM Genetics (FUSION) study. Collating only summary results will increase the number and representativeness of available studies, simplify data collection and analysis, reduce resource utilization, and accelerate discovery.