Triglyceride to high-density lipoprotein cholesterol ratio associated with long-term adverse clinical outcomes in patients deferred revascularization following fractional flow reserve

BACKGROUND

Guidelines on coronary intermediate lesions strongly recommend deferred revascularization after detecting a normal fractional flow reserve (FFR). Researches about triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) on cardiovascular diseases has also been well conducted. However, the association of TG/HDL-C and long-term adverse clinical outcomes remains unknown for patients deferred revascularization following FFR.

METHODS

This study retrospectively included 374 coronary artery disease (CAD) patients with non-significant coronary lesions diagnosed by coronary angiography (CAG) and FFR. The main outcome measure was the combination of major adverse cardiovascular and cerebrovascular events (MACCEs). All patients were categorized into three subgroups in terms of TG/HDL-C tertiles (T1 < 0.96, 0.96 ≤ T2 < 1.58, T3 ≥ 1.58). Three different Cox regression models were utilized to reveal the association between TG/HDL-C and prevalence of MACCEs.

RESULTS

47 MACCEs were recorded throughout a median monitoring period of 6.6 years. The Kaplan-Meier survival curves showed a higher MACCEs rate occurred in the higher TG/HDL-C group (5.6% vs. 12.9% vs. 19.4%, log-rank P < 0.01). After adjustment, patients in T3 suffered a 2.6-fold risk compared to the T1 group (T3 vs. T1: HR 2.55, 95% CI 1.05-6.21, P = 0.038; T2 vs. T1: HR 1.71, 95% CI 0.65-4.49, P = 0.075; P for trend = 0.001). The restricted cubic spline (RCS) analysis demonstrated that the HR for MACCEs rose as TG/HDL-C increased. Both the receiver operating characteristic (ROC) and time-dependent ROC proved the excellent predictive ability of TG/HDL-C.

CONCLUSION

The study illustrates that TG/HDL-C correlates with the risk of MACCEs in CAD patients deferred revascularization following FFR. TG/HDL-C could serve as a dependable predictor of cardiovascular events over the long term in this population.

Antibody level comparison after porcine epidemic diarrhea vaccination via different immunization routes

Porcine epidemic diarrhea (PED) is a disease extremely harmful to pig health. Intramuscular and Houhai acupoint injections are the main immunization routes to prevent and control PED. This study aimed to evaluate the efficacy of these two routes in pregnant sows based on serum IgG, IgA, and neutralizing antibody levels. PED virus (PEDV) immunoprophylaxis with live-attenuated and inactivated vaccines was administered. The vaccinations for the intramuscular injections elevated IgG and neutralizing antibody levels more than Houhai acupoint injections at most timepoints after immunization. However, the anti-PEDV IgA antibodies induced by vaccination with the two immunization routes did not differ significantly. In conclusion, intramuscular injections are better than Houhai acupoint injections for PEDV vaccination of pregnant sows.

A high level of uric acid is associated with long-term adverse cardiovascular outcomes in patients who received fractional flow reserve with coronary intermediate stenosis

BACKGROUND AND AIMS

The role of fractional flow reserve (FFR) in coronary intermediate lesions is widely recommended by guidelines. The effect of uric acid (UA) on cardiovascular events is also well known. However, the relationship between UA and long-term cardiovascular outcomes in patients who received FFR with intermediate lesions remains unknown.

METHODS AND RESULTS

We retrospectively included 428 patients who underwent both coronary angiography (CAG) and FFR. Participants were stratified into two groups based on the median UA. The primary endpoint was the composite of major adverse cardiovascular and cerebrovascular events (MACCEs), including repeat revascularization, nonfatal stroke, nonfatal myocardial infarction, and all-cause death. A Cox proportional hazards model was utilized to analyze the association between UA and the prevalence of MACCEs. During a median follow-up of 5.8 years, a higher MACCEs rate occurred in the high UA group compared to the low UA group (16.8% vs. 5.1%, p log-rank<0.01). Elevated UA was independently linked to a higher incidence of MACCEs, whether UA was treated as a categorical or continuous variable (hazard ratio [HR] 2.76, 95% confidence interval [CI] 1.27-6.03 or HR 1.01, 95% CI 1.01-1.02). The restricted cubic spline (RCS) analysis illustrated that the HR for MACCEs increased with increasing UA.

CONCLUSION

The present study demonstrates that UA is associated with MACCEs risk and suggests that UA is a reliable predictor of long-term cardiovascular events in coronary intermediate stenosis patients.

Identification of Reduced mTOR T1262 Phosphorylation as a Novel Mechanism and Therapeutic Target of Apoptosis in Senescent Cardiomyocytes: Aging and Cardiomyocyte Apoptosis

The mechanisms through which aging increases heart injury remain partially understood. Protein phosphorylation plays a critical regulatory role in cell survival and death. Using an unbiased phosphoproteomics approach, we aimed to identify the proteins whose phosphorylation could be causatively related to aging-related cardiomyocyte apoptosis and elucidate the underlying mechanisms. Comparative phosphoproteomics was conducted on cardiac tissues obtained from young (8 weeks) and aged (24 months) mice. Our findings revealed that the Mammalian Target of Rapamycin phosphorylation at T1262 (mTORT1262) was reduced in the aging heart. Immunohistochemical and Western blot analyses confirmed these findings in aging myocardia and D-galactose-induced senescent AC16 cardiomyocytes. In hypoxia/reoxygenation cardiomyocytes, mTORT1262 phosphorylation deficiency (mTORT1262A, lentivirus-mediated transfection) inhibited AKT1, suppressed NF-κB, activated FOXO1/3a signaling, and ultimately exacerbated apoptosis. Conversely, mTORT1262 pseudophosphorylation (mTORT1262E) exhibited opposite effects. Through bioinformatics and CO-IP, purinergic receptor P2X4 (P2X4R) was found to be the possible receptor responsible for mTORT1262 phosphorylation. Knockdown of P2X4R increased apoptosis, whereas its overexpression decreased it. In senescent cardiomyocytes, P2X4R expression and mTORT1262 and AKT1S473 phosphorylation were reduced, NF-κB signaling was suppressed, and FOXO1/3a signaling was activated. We demonstrated that P2X4R downregulation and the subsequent reduction of mTORT1262 phosphorylation is a novel mechanism contributing to cardiomyocyte apoptosis in aging hearts. The P2X4R-mTOR-AKT1 signaling pathway represents a potential therapeutic target against accelerated cardiac injury in aging.

[The association between body mass index and in-hospital major adverse cardiovascular and cerebral events in patients with acute coronary syndrome]

Objective: To assess the association between body mass index (BMI) and major adverse cardiovascular and cerebrovascular events (MACCE) among patients with acute coronary syndrome (ACS). Methods: This was a multicenter prospective cohort study, which was based on the Improving Care for Cardiovascular Disease in China (CCC) project. The hospitalized patients with ACS aged between 18 and 80 years, registered in CCC project from November 1, 2014 to December 31, 2019 were included. The included patients were categorized into four groups based on their BMI at the time of admission: underweight (BMI<18.5 kg/m2), normal weight (BMI between 18.5 and 24.9 kg/m2), overweight (BMI between 25.0 and 29.9 kg/m2), and obese (BMI≥30.0 kg/m2). Multivariate logistic regression models was used to analyze the relationship between BMI and the risk of in-hospital MACCE. Results: A total of 71 681 ACS inpatients were included in the study. The age was (63.4±14.7) years, and 26.5% (18 979/71 681) were female. And the incidence of MACCE for the underweight, normal weight, overweight, and obese groups were 14.9% (322/2 154), 9.5% (3 997/41 960), 7.9% (1 908/24 140) and 7.0% (240/3 427), respectively (P<0.001). Multivariate logistic regression analysis showed a higher incidence of MACCE in the underweight group compared to the normal weight group (OR=1.30, 95%CI 1.13-1.49, P<0.001), while the overweight and obese groups exhibited no statistically significant difference in the incidence of MACCE compared to the normal weight group (both P>0.05). Conclusion: ACS patients with BMI below normal have a higher risk of in-hospital MACCE, suggesting that BMI may be an indicator for evaluating short-term prognosis in ACS patients.

Association of D-dimer to albumin ratio with adverse cardiovascular outcomes in ischaemic heart failure patients with diabetes mellitus: a retrospective cohort study

OBJECTIVE

To determine the association of D-dimer to albumin ratio (DAR) with major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in ischaemic heart failure patients with diabetes mellitus.

DESIGN

A retrospective observational cohort study.

SETTING

Single centre in Beijing, China, conducted at one of the largest cardiology centres in China.

PARTICIPANTS

From June 2017 to June 2019, 3707 patients with heart failure and concomitant multiple vessel disease undergoing elective PCI were screened. A total 1021 of patients were enrolled after exclusion and the follow-up period was up to 36 months.

PRIMARY AND SECONDARY OUTCOME MEASURES

The MACE was the primary measured outcome. The secondary outcomes were all-cause mortality, non-fatal myocardial infarction and any revascularisation.

METHODS

These participants were grouped according to DAR tertiles. The cumulative incidence functions, Cox regression, restricted cubic spline and receiver operating characteristic curves were used to determine the association between DAR and outcomes. The subgroup analysis was also performed.

RESULTS

After follow-up, MACE occurred in 404 (39.6%) participants. The cumulative hazards curve manifested significant differences in MACE, all-cause mortality and any revascularisation (log-rank test: all p<0.001). In adjusted models, DAR was an independent risk factor of MACE (tertile 2: HR 1.82, 95% CI 1.37 to 2.42; tertile 3: HR 1.74, 95% CI 1.28 to 2.36) and all-cause mortality (tertile 2: HR 2.04, 95% CI 1.35 to 3.11; tertile 3: HR 1.89, 95% CI 1.20 to 2.98). The optimal cut-off of DAR was 1.2. In the stratified analysis, sex, age, hypertension, hypercholesterolaemia, total revascularisation and any interfered vessel did not affect the independent predictive ability.

CONCLUSION

Higher DAR was independently associated with MACE and all-cause mortality after PCI in ischaemic heart failure patients with diabetes mellitus.

Mild hyperthermia-assisted chitosan hydrogel with photothermal antibacterial property and CAT-like activity for infected wound healing

Infected wounds pose a serious threat to public health and pose a significant challenge and financial burden worldwide. The treatment of infected wounds is now an urgent problem to be solved. Herein, mild hyperthermia-assisted hydrogels composed of carboxymethyl chitosan (CMCs), oxidized dextran (Odex), epigallocatechin gallate (EGCG) and PtNPs@PVP (CAT-like nanoenzymes) were proposed for the repair of infected wounds. The incorporation of PtNPs@PVP nanoenzymes give the hydrogels excellent photothermal property and CAT-like activity. When the temperature is maintained at 42-45 °C under 808 nm near infrared (NIR) exposure, the CMCs/Odex/EGCG/Nanoenzymes (COEN2) hydrogel demonstrated highly enhanced antibacterial ability (95.9 % in vivo), hydrogen peroxide (H2O2) scavenging ratio (85.1 % in vitro) and oxygen supply (20.7 mg/L in vitro). Furthermore, this mild-heat stimulation also promoted angiogenesis in the damaged skin area. Overall, this multifunctional hydrogel with antibacterial, antioxidant, oxygen supply, hemostasis, and angiogenesis capabilities has shown great promise in the repair of infected wounds. This study establishes the paradigm of enhanced infected wound healing by mild hyperthermia-assisted H2O2 scavenging, oxygen supplemental, and photothermal antibacterial hydrogels.

PMN-incorporated multifunctional chitosan hydrogel for postoperative synergistic photothermal melanoma therapy and skin regeneration

Melanoma excision surgery is usually accompanied by neoplasm residual, tissue defect, and bacterial infection, resulting in high tumor recurrence and chronic wound. Nanocomposite hydrogels can satisfy the twin requirements of avoiding tumor recurrence and skin wound healing following skin melanoma surgery due to their photothermal anti-tumor and anti-bacterial activities. In this study, carboxymethyl chitosan, oxidized fucoidan and polyphenol-metal nanoparticle (PMN) of tannic acid capped gold nanoparticles were used to fabricate multifunctional nanocomposite hydrogels through Schiff base reaction. The prepared hydrogel demonstrated outstanding photothermal effect, and the controlled high temperature will rapidly kill melanoma cells as well as bacteria within 10 min. Good injectability, self-healing and adhesion combined with high reactive oxygen species (ROS) scavenging capacity, hemostasis and biocompatibility made this hydrogel platform perfect for the postoperative treatment of melanoma and promoting wound healing. With the assistance of NIR irradiance, hydrogel can inhibit tumor tissue proliferation and promote tumor cell apoptosis, thereby helping to prevent melanoma recurrence after surgical removal of tumors. Simultaneously, the irradiance heat and polyphenol component kill bacteria on the wound surface, eliminate ROS, inhibit inflammatory responses, and promote angiogenesis, collagen deposition, and skin regeneration, all of which help to speed up wound healing.

[A follow-up study on the pain changes trend and effects in patients diagnosed with herpes zoster in Beijing City]

Objective: To understand the changes in pain and its effects in patients with the diagnosis of herpes zoster. Methods: A total of 3 487 patients diagnosed with herpes zoster (HZ) for the first time at the outpatient department of Miyun District Hospital from January 1, 2017, to December 31, 2019, were included in the study. The information of patients was registered and issued with a record card. Patients were required to record the time of pain and rash by themselves. Telephone follow-up was conducted at 21, 90, 180 and 365 days after the onset of rashes, including hospitalization, location of rash and pain, and the time of start and end. The impact of pain on life was evaluated by the Zoster Brief Pain Inventory (ZBPI). Results: The age of 2 999 HZ patients included in the analysis were (53±16) years old, including 1 377 (45.91%) males and 1 903 (63.45%) patients aged 50 years and older. After 21 days of rash, mild, moderate and severe pain accounted for 20.87% (626 cases), 37.98% (1 139 cases) and 33.81% (1 014 cases), respectively. Only 5.07% (152 cases) had no pain or discomfort, and 2.27% (68 cases) had no pain but discomfort. Most of the pain sites were consistent with the rash sites. The chest and back and waist and abdomen were the most common, accounting for 35.58% (1 067 cases) and 29.18% (875 cases), respectively, followed by the limbs and face and neck, accounting for 16.74% (502 cases) and 16.40% (492 cases), respectively. The M (Q1, Q3) of pain days in the HZ patients was 14 (8, 20) days, and the incidence of post-herpetic neuralgia (PHN) was 6.63% (171/2 580) (excluding 419 patients who refused to visit or lost to visit on 90 days after the onset of rash). The pain score of HZ patients within 21 days after the rash was (5.19±2.73) points, and the pain score of PHN patients was (7.61±2.13) points, which was significantly higher than that of non-PHN patients [(5.04±2.69) points] (P<0.001). Daily activities, emotions, walking ability, work, social interaction, sleep and recreation were affected for 21 days after the rash in HZ patients, ranging from 60.79% to 83.83%, with sleep being the most affected (83.83%). The impact scores of pain and life dimensions in PHN patients ranged from 4.59 to 7.61 points on the ZBPI scale, which were higher than those in non-PHN patients (2.49-5.04) (t values ranged from 8.86 to 11.67, all P values <0.001). Conclusion: The proportion of pain in HZ patients after the diagnosis is high, and the pain is more obvious in patients with PHN and HZ patients aged 50 and older, which has a greater impact on their daily lives.

Research status of elderly-care robots and safe human-robot interaction methods

Faced with the increasingly severe global aging population with fewer children, the research, development, and application of elderly-care robots are expected to provide some technical means to solve the problems of elderly care, disability and semi-disability nursing, and rehabilitation. Elderly-care robots involve biomechanics, computer science, automatic control, ethics, and other fields of knowledge, which is one of the most challenging and most concerned research fields of robotics. Unlike other robots, elderly-care robots work for the frail elderly. There is information exchange and energy exchange between people and robots, and the safe human-robot interaction methods are the research core and key technology. The states of the art of elderly-care robots and their various nursing modes and safe interaction methods are introduced and discussed in this paper. To conclude, considering the disparity between current elderly care robots and their anticipated objectives, we offer a comprehensive overview of the critical technologies and research trends that impact and enhance the feasibility and acceptance of elderly care robots. These areas encompass the collaborative assistance of diverse assistive robots, the establishment of a novel smart home care model for elderly individuals using sensor networks, the optimization of robot design for improved flexibility, and the enhancement of robot acceptability.

Monocyte to high-density lipoprotein cholesterol ratio predicts poor outcomes in ischaemic heart failure patients combined with diabetes: a retrospective study

BACKGROUND

The prevalence of ischaemic heart failure (HF) continues to increase. Diabetes mellitus (DM) concomitant with ischaemic HF increases the risk of major adverse cardiovascular events (MACEs). As a promising predictor for cardiovascular diseases, the predictive value of the monocyte to high-density lipoprotein cholesterol ratio (MHR) for MACE in the ischaemic HF with DM cohort has never been investigated before.

OBJECTIVE

We aimed to investigate the MHR as a predictor for MACE in ischaemic HF patients with DM who underwent percutaneous coronary intervention (PCI).

METHODS

This observational study enrolled 1049 patients with ischaemic HF and DM undergoing PCI from June 2017 to June 2019. The baseline data were collected. MACEs, including all-cause mortality, nonfatal myocardial infarction, and any revascularization, were recorded within the 36-month follow-up. The characteristics and incidence of MACE were analysed in four groups stratified by the quartiles of MHR. The hazard ratio for MACE was analysed with Cox regression models. The incidence of MACE in the four groups was evaluated by Kaplan‒Meier survival analysis. Restricted cubic spline analysis was performed to determine the nonlinear correlation between the MHR and MACE.

RESULTS

After the 36-month follow-up, 407 patients (38.8%) experienced MACEs. The incidence of MACE was significantly higher among patients in the upper MHR quartile than among those in the lower MHR quartiles (23.4% vs. 36.0% vs. 41.4% and 54.6%; P < 0.001, respectively), which was consistent with the Kaplan‒Meier survival analyses (P < 0.0001). A multivariate Cox regression model showed that the MHR was an independent risk factor for MACE after variables were adjusted (adjusted HR: 2.11; 95% CI 1.47-3.03; P < 0.001). Its predictive effects on MACE showed no interaction with hypercholesterolemia (P > 0.05).

CONCLUSION

The MHR was a significant and independent predictor of MACEs in ischaemic HF patients with DM undergoing PCI.

Demographics, Medical Comorbidities, and Functional Factors Associated with Radiation Therapy Regimen Length in Older Patients

PURPOSE/OBJECTIVE(S)

To determine demographic, comorbidity, and functional factors associated with radiation therapy (RT) regimen length in older patients.

MATERIALS/METHODS

Using data from the Medicare Current Beneficiary Survey (MCBS), we identified patients who were diagnosed with cancer from 2002-2019 and received RT. The MCBS dataset is comprised of linked patient survey and Medicare claims data. Days of RT were used as a proxy for fractions of RT each patient received. We used treatment guidelines to identify a minimum treatment threshold for each cancer type to differentiate patients with low RT utilization from normal or supra-palliative RT utilization. Statistical analyses of patient demographics, comorbidities, and activities of daily living (ADL) were performed using chi-square and t-tests.

RESULTS

A total of 880 patients were included in this analysis, of whom 669 had high RT utilization. Of the demographic factors considered, age 85+ was associated with longer RT regimen length (p = 0.045), as was being "other" or multi-race, community, or facility treatment setting, and residing in the south (p = 0.013, 0.006, 0.003, 0.038, respectively). Of medical comorbidities, only lung disease was associated with longer RT regime (p = 0.020). Longer RT regimen length was significantly associated with requiring assistance with any ADLs (bathing, dressing, eating, chair, walking, toileting, all with p <0.001).

CONCLUSION

This abstract identifies specific patient demographics, medical comorbidities, and ADL limitations which may be associated with RT regimen length in older patients. Future work should focus on optimizing patients and delivery systems for RT and the relationship between pre- and post-treatment ADLs.

[Application of genetic counseling and preventive surgery in hereditary breast-ovarian cancer syndrome based on a rare family]

Objective: To investigate the genetic, clinical and pathological characteristics of families with hereditary breast-ovarian cancer syndrome (HBOCS) and to explore the implementation of genetic counseling and preventive surgery. Methods: Four siblings with HBOCS in Cancer Hospital/Chinese Academy of Medical Sciences were selected as the study subjects. BRCA gene testing and genetic counseling were performed, family history was traced and family map was drawn. Results: There were 7 cancer patients (Ⅰ 2, Ⅱ 4, Ⅱ 8, Ⅲ 7, Ⅲ 10, Ⅲ 11, Ⅲ 12) in three generations in the family. One patient (Ⅲ 7) had breast cancer and ovarian cancer successively. The first generation (Ⅰ 2) developed cancer at age 60, the second generation (Ⅱ4 and Ⅱ8) developed cancer at 55. The third generation (Ⅲ 7, Ⅲ 10, Ⅲ 11, Ⅲ 12) developed cancer at the age of 42-50 years. Four HBOCS patients were treated in our hospital, and all of them were found to have deleterious BRCA1 mutation. Two had already developed ovarian cancer (Ⅲ 10, Ⅲ 12), while in one case (Ⅲ 11), tubal carcinoma was found during preventive total hysterectomy and pelvic lymph node metastasis was found after the supplementary staging surgery. The other patient without cancer underwent preventive bilateral salpingectomy(Ⅲ 15). Conclusion: The HBOCS family reported in this study is relatively rare, the onset time of tumor was younger generation by generation. It is very important to pay attention to the genetic counseling of ovarian cancer patients and to timely detect the HBOCS families for genetic testing and prophylactic surgery.

Alloying-Induced Synthesis of Amorphous PdZnS Hollow Spheres as Enhanced Oxygen Reduction Catalysts

Amorphous alloys have multiple advantages in electrocatalysis, yet the isotropic nature makes their syntheses a great obstacle in application. In this work, it is shown that the Zn2+ can interfere with the crystallization of Pd-base structures to form amorphous alloy materials. By simply adjusting the Zn2+ content, unique PdZnS amorphous hollow spheres (AHS) with various compositions and degrees of crystallinity can be obtained through a facile one-pot wet chemical method. Owing to both the amorphous nature and hollow morphologies, the PdZnS AHSs possess appealing activities and stabilities as oxygen reduction catalysts. Typically, the Pd20 ZnS10 AHSs exhibit the highest half-wave potential (E1/2 ) of 0.940 V (vs reversible hydrogen electrode), and such E1/2 only negatively shifts 25 mV after 60 000 cycles.

Highly Atherogenic Lipid Particles are Associated with Preeclampsia After Successful Fertility Treatment for Obese Women who have Unexplained Infertility

Atherogenic dyslipidemia-before or during pregnancy-may contribute to preeclampsia and subsequent cardiovascular disease risk. We performed a nested case-control study to further understand dyslipidemia associated with preeclampsia. The cohort consisted of participants in the randomized clinical trial "Improving Reproductive Fitness Through Pretreatment with Lifestyle Modification in Obese Women with Unexplained Infertility" (FIT-PLESE). FIT-PLESE was designed to study the effect of a pre-fertility treatment 16-week randomized lifestyle intervention program (Nutrisystem diet + exercise + orlistat vs. training alone) on improvement in live birth rate among obese women with unexplained infertility. Of the 279 patients in FIT-PLESE, 80 delivered a viable infant. Maternal serum was analyzed across five visits: before and after lifestyle interventions and also at three pregnancy visits (16, 24, and 32 weeks gestation). Apolipoprotein lipids were measured in a blinded fashion using ion mobility. Cases were those who developed preeclampsia. Controls also had a live birth but did not develop preeclampsia. Generalized linear and mixed models with repeated measures were used to compare the mean lipoprotein lipid levels of the two groups across all visits. Complete data were available for 75 pregnancies, and preeclampsia developed in 14.5% of the pregnancies. Cholesterol/high-density lipoprotein (HDL) ratios (p < 0.003), triglycerides (p = 0.012), and triglyceride/HDL ratios, all adjusted for BMI, were worse in patients with preeclampsia (p < 0.001). Subclasses a, b, and c of highly atherogenic, very small, low-density lipoprotein (LDL) particles were higher during pregnancy for the preeclamptic women (p < 0.05). Very small LDL particle subclass d levels were significantly greater only at 24 weeks (p = 0.012). The role of highly atherogenic, very small LDL particle excess in the pathophysiology of preeclampsia awaits further investigation.

Sex matters: the frequently overlooked importance of considering sex in computational models

Personalised medicine and the development of a virtual human or a digital twin comprises visions of the future of medicine. To realise these innovations, an understanding of the biology and physiology of all people are required if we wish to apply these technologies at a population level. Sex differences in health and biology is one aspect that has frequently been overlooked, with young white males being seen as the "average" human being. This has not been helped by the lack of inclusion of female cells and animals in biomedical research and preclinical studies or the historic exclusion, and still low in proportion, of women in clinical trials. However, there are many known differences in health between the sexes across all scales of biology which can manifest in differences in susceptibility to diseases, symptoms in a given disease, and outcomes to a given treatment. Neglecting these important differences in the development of any health technologies could lead to adverse outcomes for both males and females. Here we highlight just some of the sex differences in the cardio-respiratory systems with the goal of raising awareness that these differences exist. We discuss modelling studies that have considered sex differences and touch on how and when to create sex-specific models. Scientific studies should ensure sex differences are included right from the study planning phase and results reported using sex as a biological variable. Computational models must have sex-specific versions to ensure a movement towards personalised medicine is realised.

[Interpretation of Detection and identification standard of hookworm-Hook-worm larvae coproculture techniques (WS/T 791-2021)]

Detection and identification standard of hookworm-Hookworm larvae coproculture techniques (WS/T 791-2021) is the first recommended technical standard for hookworm detection and species identification using the hookworm larvae coproculture technique in China. This standard was issued on November 23, 2021, and had been in effect since May 1, 2022. This article provides a detailed interpretation pertaining to the background, drafting process, main contents, and dos and don'ts for better understanding and application of this standard among professionals working in disease control and prevention institutions and medical institutions.

Application of Flow Cytometry in the Diagnosis of Bovine Epidemic Disease

As science and technology continue to advance, the use of flow cytometry is becoming more widespread. It can provide important information about cells in the body by detecting and analysing them, thereby providing a reliable basis for disease diagnosis. In the diagnosis of bovine epidemic diseases, flow cytometry can be used to detect bovine viral diarrhoea, bovine leukaemia, bovine brucellosis, bovine tuberculosis, and other diseases. This paper describes the structure of a flow cytometer (liquid flow system, optical detection system, data storage and analysis system) and its working principles for rapid quantitative analysis and sorting of single cells or biological particles. Additionally, the research progress of flow cytometry in the diagnosis of bovine epidemic diseases was reviewed in order to provide a reference for future research and application of flow cytometry in the diagnosis of bovine epidemic diseases.

[Clinical value of the MeltPro MTB assays in detection of drug-resistant tuberculosis in paraffin-embedded tissues]

Objective: To evaluate the clinical value of the MeltPro MTB assays in the diagnosis of drug-resistant tuberculosis. Methods: A cross-sectional study design was used to retrospectively collect all 4 551 patients with confirmed tuberculosis between January 2018 and December 2019 at Beijing Chest Hospital, Capital Medical University. Phenotypic drug sensitivity test and GeneXpert MTB/RIF (hereafter referred to as "Xpert") assay were used as gold standards to analyze the accuracy of the probe melting curve method. The clinical value of this technique was also evaluated as a complementary method to conventional assays of drug resistance to increase the detective rate of drug-resistant tuberculosis. Results: By taking the phenotypic drug susceptibility test as the gold standard, the sensitivity of the MeltPro MTB assays to detect resistance to rifampicin, isoniazid, ethambutol and fluoroquinolone was 14/15, 95.7%(22/23), 2/4 and 8/9,respectively; and the specificity was 92.0%(115/125), 93.2%(109/117), 90.4%(123/136) and 93.9%(123/131),respectively; the overall concordance rate was 92.1%(95%CI:89.6%-94.1%),and the Kappa value of the consistency test was 0.63(95%CI:0.55-0.72).By taking the Xpert test results as the reference, the sensitivity of this technology to the detection of rifampicin resistance was 93.6%(44/47), the specificity was100%(310/310), the concordance rate was 99.2%(95%CI:97.6%-99.7%), and the Kappa value of the consistency test was 0.96(95%CI:0.93-0.99). The MeltPro MTB assays had been used in 4 551 confirmed patients; the proportion of patients who obtained effective drug resistance results increased from 83.3% to 87.8%(P<0.01); and detection rate of rifampicin, isoniazid, ethambutol, fluoroquinolone resistance, multidrug and pre-extensive drug resistance cases were increased by 3.2%, 14.7%, 22.2%, 13.7%, 11.2% and 12.5%, respectively. Conclusion: The MeltPro MTB assays show satisfactory accuracy in the diagnosis of drug-resistant tuberculosis. This molecular pathological test is an effective complementary method in improving test positivity of drug-resistant tuberculosis.

Worrying results on resignation intention for ICU physicians in China: a big data report from 34 provinces

OBJECTIVE

The clinical work of ICU doctors is characterized by high intensity and medical risks, which lead to a highly stressful state for a long time and the occurrence of resignation due to long-term burnout. This study analyzes the correlation between the personal life, hospital work, social opinion, and psychological assessment of ICU physicians and their resignation intention.

SUBJECTS AND METHODS

This study is a multicenter questionnaire on the factors influencing resignation intention among ICU physicians. The study was completed through Critical Care E Institute (CCEI) and China Calm Therapy Research Group Academic Organization (CNCSG) by contacting critical care physicians in 3-A hospitals in 34 provinces in China. The questionnaire was in electronic format, and the results were filled in using the WeChat scan code. The survey included 22 indicators which included basic information about physicians (including gender, marriage, children, and income, etc.), hospital work (weekly working hours, on night duty, hospital environment, the evaluation of hospital's emphasis on medical staff, etc.), and SCL-90 psychological assessment.

RESULTS

A total of 1,749 ICU physicians completed the questionnaire. The results showed that 1,208 physicians (69.1%) intended to resign. There were statistical differences between the group's resignation intention and without resignation intention on 13 indicators. These indicators include professional title, night shift every few days, hospital hours/week, income satisfaction, work environment satisfaction, career prospect, and SCL-90 score, etc. (all p<0.05, respectively). The remaining nine indicators were not statistically different between the two groups (all p>0.05, respectively). Logistics analysis showed that working years, hospital hours (h/week), income satisfaction, work environment satisfaction, pride in hospital work, career prospects, and total SCL-90 score were all independent influences on physicians' choice of resignation intention (all p<0.05, respectively). The ROC curves' results showed that all seven indicators' predictive diagnostic value was low, with AUC areas ranging from 0.567 to 0.660. However, the combined diagnostic model of seven indicators has moderate diagnostic value. The AUC area of the model was 0.740 (95% CI: 0.718-0.760), with a sensitivity of 75.99% and specificity of 60.07%.

CONCLUSIONS

Physicians' income, working years, work environment satisfaction, career prospects, and psychological well-being can influence the choice of physicians' resignation intention in Chinese intensive care units. Government administration and hospitals can develop appropriate policies to enhance doctors working in hospital, thus reducing physicians' resignation choices.

A 15-year experience: intraoperative parathyroid hormone assay for the management of primary hyperparathyroidism in a UK endocrine surgical unit

PURPOSE

This study aims to evaluate the outcomes of first-time parathyroidectomy for primary hyperparathyroidism using intraoperative PTH (IOPTH) assay in the light of the UK National Institute for Health and Care Excellence (NICE) guidelines for the management of primary hyperparathyroidism.

METHOD

This is a retrospective cohort analysis of a prospectively maintained database of endocrine surgery in a tertiary centre. Preoperative radiological localisation (concordance and accuracy), intraoperative PTH parameters and adjusted serum calcium at minimum 6-month follow-up were analysed. The accuracy of IOPTH to predict post-operative normocalcaemia and the number needed to treat (NNT) within the cohort when IOPTH was utilised were determined. Differences between groups were evaluated with Chi-squared and Fisher's exact test.

RESULTS

Between January 2004 and September 2018, 849 patients (75.4% women), median age 64 years (IQR 54-72), were analysed. The median preoperative adjusted serum calcium was 2.80mmol/l (IQR 2.78-2.90), and the median preoperative PTH was 14.20pmol/l (IQR 10.70-20.25). The overall first-time cure (normocalcaemia) rate was 96.4%. The sensitivity, specificity, positive predictive value and negative predictive values of IOPTH were 96.8%, 83.2%, 97.6% and 78.8%, respectively, with an accuracy of 95.1%. For patients with concordant scans (48.3%), a targeted approach without IOPTH would have achieved a cure rate of 94.1% compared with 98.0% using IOPTH (p<0.01) CONCLUSION: The use of IOPTH assay significantly improved the rate of normocalcaemia at 6 months. The low NNT to benefit from IOPTH, particularly those patients with a single positive scan, and the inevitable reduction in the potential costs incurred from failure and reoperation justify its utilisation.

Multi-targeted fluorescent probes for detection of Zn(II) and Cu(II) ions based on ESIPT mechanism

With the rapid development of industry, it is pretty critical to detect the heavy metals. Recently, the 2-(2-hydroxyphenyl) benzothiazole derivatives with different numbers of rotatable phenyl m (m = 1,2,3) fluorescent probes HL^m were synthesized. However, the theoretical analysis of the mechanism was still missing. In this work, we have systematically researched the mechanisms of excited state intramolecular proton transfer (ESIPT) and the detection of Cu(II), Zn(II) ions for the hydrogen-bond system HL^m though quantum chemistry methods. By bond parameters and the minimum energy pathways analyses, the proton of this system was probed directly transfer without barrier. Bond parameters, real space function at bond critical point, the frontier molecular orbital, electron spectra and orbital interaction diagram were carried to elucidate response to Cu(II), Zn(II) ions. In addition, comparing the Gibbs free energy variation of the complexation reaction between fluorescent probes and ions, it can be proved that the number of rotatable benzene rings affects the response ability of the probe to target ions.

Development of a laser-based angle-resolved-photoemission spectrometer with sub-micrometer spatial resolution and high-efficiency spin detection

Angle-resolved photoemission spectroscopy with sub-micrometer spatial resolution (μ-ARPES), has become a powerful tool for studying quantum materials. To achieve sub-micrometer or even nanometer-scale spatial resolution, it is important to focus the incident light beam (usually from synchrotron radiation) using x-ray optics, such as the zone plate or ellipsoidal capillary mirrors. Recently, we developed a laser-based μ-ARPES with spin-resolution (LMS-ARPES). The 177 nm laser beam is achieved by frequency-doubling a 355 nm beam using a KBBF crystal and subsequently focused using an optical lens with a focal length of about 16 mm. By characterizing the focused spot size using different methods and performing spatial-scanning photoemission measurement, we confirm the sub-micron spatial resolution of the system. Compared with the μ-ARPES facilities based on the synchrotron radiation, our LMS-ARPES system is not only more economical and convenient, but also with higher photon flux (>5 × 10¹³ photons/s), thus enabling the high-resolution and high-statistics measurements. Moreover, the system is equipped with a two-dimensional spin detector based on exchange scattering at a surface-passivated iron film grown on a W(100) substrate. We investigate the spin structure of the prototype topological insulator Bi₂Se₃ and reveal a high spin-polarization rate, confirming its spin-momentum locking property. This lab-based LMS-ARPES will be a powerful research tool for studying the local fine electronic structures of different condensed matter systems, including topological quantum materials, mesoscopic materials and structures, and phase-separated materials.

Nanocomposite multifunctional hyaluronic acid hydrogel with photothermal antibacterial and antioxidant properties for infected wound healing

Bacterial infection and subsequent reactive oxygen species (ROS) damage are major factors that delay wound healing in infected skin. Recently, photothermal therapy (PTT), as a new antibacterial method, has shown great advantages in the treatment of infected skin wound. Antibacterial and antioxidant hydrogels can reduce bacterial colonization and infection, scavenge ROS, relieve inflammation, and accelerate wound healing. In this study, an enzyme-crosslinked hyaluronic acid-tyramine (HT) hydrogel loaded with antioxidant and photothermal silver nanoparticles (AgNPs), named HTA, was developed as functional wound dressing to promote the infected skin wound healing. Natural antioxidant tannic acids (TA) were used as both reducing and stabilizing agents to facilely synthesize the silver nanoparticles capped with TA (AgNPs@TA). The incorporation of AgNPs@TA significantly enhanced the antioxidant, antibacterial, photothermal antibacterial, adhesive, and hemostatic abilities of the resulted HTA hydrogel. Besides, HTA hydrogel has rapid gelation, well injection and biocompatibility. In vivo results on the Staphylococcus aureus and Escherichia coli co-infected mouse skin wound model showed that HTA_0.4 (containing 0.4 mg/mL AgNPs@TA) hydrogel combined with near infrared ray radiation highly alleviated inflammation, promoted angiogenesis, and accelerated the healing process. Therefore, this nanocomposite hydrogel wound dressing with antibacterial and antioxidant capabilities has great application potential in the treatment of infected skin wounds.

Differences in in-hospital outcomes and healthcare utilization for laparoscopic versus open approach for emergency inguinal hernia repair: a nationwide analysis

PURPOSE

There has been a growing debate of whether laparoscopic or open surgical techniques are superior for inguinal hernia repair. For incarcerated and strangulated inguinal hernias, the laparoscopic approach remains controversial. This study aims to be the first nationwide analysis to compare clinical and healthcare utilization outcomes between laparoscopic and open inguinal hernia repair in an emergency setting.

METHODS

A retrospective analysis of the National Inpatient Sample was performed. All patients who underwent laparoscopic inguinal hernia repair (LIHR) and open inguinal hernia repair (OIHR) between October 2015 and December 2019 were included. The primary outcome was mortality, and secondary outcomes include post-operative complications, ICU admission, length of stay (LOS), and total admission cost. Two approaches were compared using univariate and multivariate logistic and linear regression.

RESULTS

Between the years 2015 and 2019, 17,205 patients were included. Among these, 213 patients underwent LIHR and 16,992 underwent OIHR. No difference was observed between laparoscopic and open repair for mortality (odds ratio [OR] 0.80, 95% CI [0.25, 2.61], p = 0.714). Additionally, there was no significant difference between groups for post-operative ICU admission (OR 1.11, 95% CI [0.74, 1.67], p = 0.614), post-operative complications (OR 1.09, 95% CI [0.76, 1.56], p = 0.647), LOS (mean difference [MD]: -0.02 days, 95% CI [- 0.56, 0.52], p = 0.934), or total admission cost (MD: $3,028.29, 95% CI [$- 110.94, $6167.53], p = 0.059).

CONCLUSION

Laparoscopic inguinal hernia repair is comparable to the open inguinal hernia repair with respect to low rates of morbidity, mortality as well as healthcare resource utilization.

[Low-density lipoprotein cholesterol levels and lipid-lowering treatment status among young and middle-aged ultra-high-risk patients with acute coronary syndrome in China]

Objective: To assess low-density lipoprotein cholesterol (LDL-C) levels and use of lipid-lowering treatment among young and middle-aged ultra-high-risk patients with acute coronary syndrome (ACS) in China. Methods: The study was based on the"Improving Care for Cardiovascular Disease in China (CCC)-ACS"project, a collaborative registry by and Chinese Society of Cardiology (CSC) and the American Heart Association. Hospitalized-patients with ACS were consecutively enrolled from 159 tertiary and 82 secondary hospitals across China, related clinical information was collected. This study included young and middle-aged hospitalized patients (18-59 years) with ACS from November 2014 to December 2019 registered in CCC-ACS project. Ultra-high-risk was defined according to Chinese expert consensus on lipid management of ultra-high-risk atherosclerotic cardiovascular disease (ASCVD) patients of CSC. The mean LDL-C levels at admission, pre-hospital lipid-lowering therapy and proportion of patients with LDL-C target achieved were analyzed. Results: A total of 42 230 patients younger than 60 years with ACS were included in this study. The mean age was (50.4±6.9) years, and 86.8% (36 676/42 230) of the ACS patients were male. Among them, 86.9% (36 687/42 230) met the criteria of ultra-high-risk. The mean level of LDL-C at admission was (2.8±1.0)mmol/L, only 5.3 % (1 948/36 687) patients achieved the targeted goal of LDL-C<1.4 mmol/L. Among the ultra-high-risk ASCVD patients, 17.5% (6 430/36 687) received lipid-lowering drugs before hospitalization, 96.4% (6 198/6 430) of whom received statins monotherapy. Among patients receiving pre-hospital statins, only 9.9% (626/6 323) patients reached an LDL-C<1.4 mmol/L at admission. Conclusions: The majority of young and middle-aged hospitalized patients with ACS are ultra-high-risk patients for ASCVD in China. Pre-hospital lipid-lowering drugs use is lower in these ultra-high-risk ASCVD patients and most patients do not reach the new LDL-C target level at admission.

Identification of a linear epitope in the capsid protein of goose astrovirus with monoclonal antibody

Goose astrovirus (GoAstV) is a novel avastrovirus that typically causes gosling gout and results in 2 to 20% mortality. GoAstV capsid protein is the sole structural protein, which is responsible for viral attachment, assembly, maturation as well as eliciting host antibodies. However, the epitopes within capsid protein have not been well studied. In this study, a monoclonal antibody, named 1D7, was generated against GoAstV capsid protein by hybridoma technology. Western blot results showed that this MAb could react with recombinant capsid protein expressed in E. coli. Also, it recognized the precursor of capsid protein, VP90 and VP70, in GoAstV-infected cells. Besides, excellent specificity of MAb 1D7 was further demonstrated in indirect immunofluorescence assay and immunohistochemical analysis. Epitope mapping results revealed that MAb 1D7 recognized the epitope 33QKVY 36 within Cap protein. Sequence alignment indicated that 33QKVY 36 is a conserved epitope among the isolates of goose astrovirus type 2 (GoAstV-2), suggesting the potential for its use in GoAstV-2 specific diagnostic assay. These findings may provide some insight into a function of the GoAstV capsid protein and further contribute to the development of diagnostic methods for GoAstV infection.

[circ-WHSC1 affects the growth, metastasis and radiotherapy sensitivity of nasopharyngeal carcinoma cells by targeting miR-338-3p/ELAVL1 axis]

Objective: To study the effect of circ-WHSC1 on the growth, metastasis and radiosensitivity of nasopharyngeal carcinoma cells and its molecular mechanism. Methods: Cancerous tissues and adjacent tissues were collected from 23 patients with nasopharyngeal carcinoma, and real-time fluorescent quantitative PCR (RT-qPCR) was used to detect the expression levels of circ-WHSC1, miR-338-3p, and ELAVL1 mRNA. Western blot was used to detect the expression of ELAVL1 protein. Nasopharyngeal carcinoma cells 5-8F and SUNE1 were divided into si-NC group, si-circ-WHSC1 group, pCD5-ciR group, circ-WHSC1 group, anti-miR-NC group, anti-miR-338-3p group, miR-NC group, miR-338-3p group, si-circ-WHSC1+ anti-miR-NC group, si-circ-WHSC1+ anti-miR-338-3p group, miR-338-3p+ pcDNA group, miR-338-3p+ ELAVL1 group. Tetramethylazolium salt colorimetric method (MTT) was used to detect cell viability. Clone formation test was used to detect cell clone formation and cell radiosensitivity. Flow cytometry was used to detect cell apoptosis. Transwell was used to detect cell migration and invasion. Dual luciferase assay was used to detect the targeting relationship between circ-WHSC1 and miR-338-3p, miR-338-3p and ELAVL1. The SUNE1 cells stably transfected with sh-circ-WHSC1 were injected into nude mice and irradiated with radiation, and then the tumor volume and weight of mice were detected. Results: The expressions of circ-WHSC1 (1.57±0.94 vs 3.78±1.18, 1.00±0.10 vs 1.64±0.14/2.00±0.21/2.81±0.26/3.36±0.34) and ELAVL1 (1.28±0.74 vs 3.36±0.77, 1.00±0.08 vs 2.51±0.19/3.27±0.27) in nasopharyngeal carcinoma tissues and cells were increased, and the expression of miR-338-3p (3.13±0.96 vs 1.37±0.98, 1.00±0.08 vs 0.48±0.08/0.38±0.07) was decreased (P<0.05). After knockdown of circ-WHSC1, the activity of nasopharyngeal carcinoma cells was decreased [(100.00±8.00)% vs (51.33±8.62)%, (100.00±10.10)% vs (41.02±7.31)%], the number of clone-forming cells was decreased (101.00±8.54 vs 50.33±8.02, 114.00±14.10 vs 42.33±10.01), the rate of apoptosis was increased [(5.37±1.20)% vs (18.3±1.01)%, (6.5±1.18)% vs (22.43±1.40)%], and the numbers of migration (136.00±13.00 vs 72.33±9.50, 154.00±14.10 vs 62.67±11.50) and invasion (113.67±11.59 vs 60.67±9.07, 124.33±15.57 vs 50.33±9.01) were decreased; after different doses of radiation, the cell survival score was decreased (0.23±0.04 vs 0.06±0.01, 0.32±0.07 vs 0.05±0.02) (P<0.05). Circ-WHSC1 targeted and negatively regulated miR-338-3p. Inhibition of miR-338-3p affected the effect of knockdown of circ-WHSC1 on the proliferation, apoptosis, migration, invasion and radiosensitivity of nasopharyngeal carcinoma cells. MiR-338-3p targeted and negatively regulated ELAVL1; ELAVL1 overexpression affected the effects of miR-338-3p on the proliferation, apoptosis, migration, invasion and radiosensitivity of nasopharyngeal carcinoma cells. After the cells stably transfected with sh-circ-WHSC1 were injected into nude mice, the tumor volume [(884.67±95.63)mm(3) vs (487.33±76.51)mm(3)] and weight [(899.01±88.54)mg vs (558.67±75.04) mg] of the nude mice were reduced; after further irradiation, the tumor volume [(395.00±73.50)mm(3) vs 243.13±42.51)mm(3)] and weight[ (452.33±67.30)mg vs (211.09±57.51)mg] of the nude mice were reduced (P<0.05). Circ-WHSC1 regulated the expression of ELAVL1 by targeting miR-382. Conclusion: Knockdown of circ-WHSC1 can inhibit the growth and metastasis of nasopharyngeal carcinoma cells by targeting miR-338-3p/ELAVL1 axis, and enhances the radiosensitivity of nasopharyngeal carcinoma cells.

Free-Standing Stable Silicon-Based Anode with Exceptional Flexibility Realized by a Multifunctional Structure Design in Multiple Dimensions

Cyclized polyacrylonitrile (cPAN) with decently flexible, elastic, and conductive properties is a promising substrate or binder material for flexible devices. However, it is infeasible to accommodate the large volume expansion and contribute the exceptional rate capability of silicon anodes in lithium-ion batteries only counting on the limited elasticity and conductivity of cPAN. Herein, we report a robust silicon/carbon-cPAN-graphene (SC-CP-G) composite membrane with excellent flexibility based on a multifunctional structure design in multiple dimensions, which can be used as a free-standing integrated anode for lithium ion batteries. In this integrated electrode, silicon nanoparticles are encapsulated in porous carbon with in situ formed confined space, and the silicon/carbon particles are further embedded in cPAN nanofibers, which are inextricably interwoven with a reduced graphene oxide film, forming an interpenetrating network architecture. The unique hierarchical and functional structure design greatly improves the mechanical performance, cycling stability, and capacity accessibility of silicon electrodes, delivering a specific capacity of 1847 mA h g^-1 at 2 A g^-1 and a capacity retention of 87% after 150 cycles.

An automated method for BRISQUE quantification of image quality in echocardiography

Background

Echocardiography (echo) remains the most widely used imaging modality for the assessment, monitoring, and prognostication of the heart. Despite its prevalence, standardisation efforts for echo chamber quantification are ongoing, with challenges owing to subjectivity during acquisition and analysis. Furthermore, the confidence in derived functional indices is often dependent on the quality of the acquired images. However, few studies have investigated the accuracy of echo measurements compared to a reference modality such as cardiac magnetic resonance (CMR) imaging, when stratified by image quality.

Purpose

To develop an objective and automated method to quantify echo image quality, and subsequently to investigate the relationship between image quality and patient demographics, as well as the magnitude of bias in left ventricular (LV) functional indices compared with CMR.

Methods

Transthoracic apical 2D echo (2DE) and 3D echo (3DE) data from 128 participants (72 healthy controls and 56 patients with acquired heart disease) were used to train a BRISQUE (Blind/Referenceless Image Spatial Quality Evaluator) algorithm [1]. Briefly, feature extraction was performed by fitting pixel luminances to a generalised Gaussian distribution (GGD), followed by support vector regression to correlate features (i.e., shape, variance, and mean parameters of the GGD) to quality scores (Fig. 1). Independent BRISQUE models were trained on 580 2DE images (consisting of 2-, 3-, and 4-chamber views) and 128 targeted LV 3DE acquisitions at end-diastole, each assigned a subjective perceived quality score between 1 (poor) and 9 (excellent) by a single observer. LV indices including end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and global longitudinal strain (GLS), were assessed according to standard guidelines. Resultant BRISQUE scores were plotted against patient demographics (age, height, weight) and the measurement bias by comparison to CMR (acquired within 1 hour of echo).

Results

Several linear relationships (where P-value of slope &lt;0.05) were observed between demographics, cardiac indices, and BRISQUE scores. Increasing patient weight (and height in 3DE) were found to be associated with poorer image quality. There was no apparent relationship between image quality and age. Of interest, EF exhibited a relationship with image quality in both 2DE and 3DE (Fig. 2), whereby higher quality images tended to overestimate EF, while lower quality images underestimated EF. For 3DE, image quality dependency was also observed for ESV and GLS biases.

Conclusions

BRISQUE can objectively quantify image quality to produce scores which correlate to those of an expert observer, with potential utility for the standardised quantification of echo image quality. Using this method, it may be possible to predict patient characteristics which adversely impact echo quality, as well as the magnitude of measurement biases for certain functional indices.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council (HRC) of New Zealand; National Heart Foundation (NHF) of New Zealand

Right ventricular quantification using 3D echocardiography: a comparison with CMR

Background

Volumetric and functional right ventricular (RV) indices such as ejection fraction (EF) and global strains are known independent predictors of adverse cardiovascular events. While cardiac magnetic resonance (CMR) imaging remains the reference standard for volume quantification, echocardiography is more accessible and allows for rapid ventricular assessment. Compared to conventional 2D echocardiography, 3D echocardiography (3DE) enables full volume acquisitions and the ability to circumvent geometric assumptions. Given the complexity of RV geometry and sensitivity to image plane positioning, this advantage offers the potential to obtain more accurate diagnostic measurements.

Purpose

Tools for RV analysis in 3DE have been less extensively studied compared to those for the left ventricle (LV). We sought to quantify discrepancies in RV indices derived from 3DE and CMR.

Methods

Transthoracic real-time 3DE and cine CMR imaging were performed in 20 prospectively recruited participants (12 patients with acquired cardiac disease and 8 healthy controls), &lt;1 hour apart. Dynamic 3D biventricular models were constructed semi-automatically from CMR by identifying fiducial landmarks, correcting in-plane breath-hold mis-registrations, and interactively fitting contours to the endocardial and epicardial borders on long- and short-axis slices. For 3DE, right ventricular endocardial models were created by fitting contours on 2D image planes resampled from the 3D volume at end-diastole and end-systole, which were subsequently tracked over one cardiac cycle (Figure 1). RV indices including end-diastolic volume (EDV), end-systolic volume (ESV), EF, global longitudinal strain (GLS), and global circumferential strain (GCS) were calculated from the 3DE- and CMR-derived 3D geometric models and compared. Paired-sample t-tests were performed to identify statistically significant differences (where P&lt;0.05), and intraclass correlation coefficients (ICC) for absolute agreement were computed to assess the reliability for each measurement.

Results

Differences (mean ± SD) in RV indices between 3DE and CMR, with corresponding ICCs are presented in Table 1. Statistically significant differences in RV EDV, ESV, EF, and GLS were observed, with 3DE consistently underestimating volumes and overestimating function when compared to CMR. Although a statistically significant difference in RV GCS was not observed, a low ICC score indicated poor reliability.

Conclusions

Volume underestimation in RV indices between 3DE and CMR were found to be larger than those previously reported for the LV, which is likely due to the increased geometric complexity and surface area to volume ratio for the RV. Moreover, 3DE tends to overestimate RV function in terms of EF and GLS, which may impact treatment pathways if used in a clinical setting. Recognising systematic differences between modalities reinforces the need to further develop 3DE technologies for more accurate RV quantification.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council (HRC) of New Zealand;National Heart Foundation (NHF) of New Zealand

Degradable microneedle patches loaded with antibacterial gelatin nanoparticles to treat staphylococcal infection-induced chronic wounds

Infection-induced chronic wounds cause prolonged pains, a high risk of amputation, and even increased mortality in immunocompromised patients. Here we report an antibacterial microneedle (MN) patch, which features high degradability in biological fluids and gelatinase-responsive release of an antibacterial photothermal peptide AMP-Cypate. We first synthesize gelatin nanoparticles (GNPs) and then conjugate the AMP-Cypate to afford composite AMP-Cypate@GNPs. The proteinaceous nanoparticles can responsively release AMP-Cypate in the presence of gelatinase, an enzyme secreted specifically by Staphylococcus aureus (S. aureus). AMP-Cypate@GNPs were then deposited in the tips of MNs fabricated by PVP and recombinant human type III collagen (Col III) to devise the antibacterial MN/AMP-Cypate@GNP patches. When applied to the infection site, MNs break through the epidermis and the stratum corneum, dissolve in the infected dermis, reach the bacterial colony or biofilm, release AMP-Cypate@GNPs, and exert a gelatinase-responsive photothermal therapy under near-infrared (NIR) irradiation to kill the pathogen S. aureus. In a rat model of staphylococcal infection-induced chronic wounds mimicking the condition of diabetic foot ulcer, the antibacterial MN/AMP-Cypate@GNP patches eradiated the bacterial infection and resulted in complete healing of the wounds, proving its potential application in the treatment of chronic wound infections and diabetic foot ulcers.

Leveraging CMR for 3D echocardiography: an annotated multimodality dataset for AI

Funding Acknowledgements: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council of New Zealand (HRC)

National Heart Foundation of New Zealand (NHF)

Segmentation of the left ventricular myocardium and cavity in 3D echocardiography (3DE) is a critical task for the quantification of systolic function in heart disease. Continuing advances in 3DE have considerably improved image quality, prompting increased clinical uptake in recent years, particularly for volumetric measurements. Nevertheless, analysis of 3DE remains a difficult problem due to inherently complex noise characteristics, anisotropic image resolution, and regions of acoustic dropout.

One of the primary challenges associated with the development of automated methods for 3DE analysis is the requirement of a sufficiently large training dataset. Historically, ground truth annotations have been difficult to obtain due to the high degree of inter- and intra-observer variability associated with manual 3DE segmentation, thus, limiting the scope of AI-based solutions. To address the lack of expert consensus, we instead used labels derived from cardiac magnetic resonance (CMR) images of the same subjects. By spatiotemporally registering CMR labels to corresponding 3DE image data on a per subject basis (Figure 1), we collated 520 annotated 3DE images from a mixed cohort of 130 human subjects (2 independent single-beat acquisitions per subject at end-diastole and end-systole) consisting of healthy controls and patients with acquired cardiac disease. Comprising images acquired across a range of patient demographics, this curated dataset exhibits variation in image quality, 3DE acquisition parameters, as well as left ventricular shape and pose within the 3D image volume.

To demonstrate the utility of such a dataset, nn-UNet, a self-configuring deep learning method for semantic segmentation was employed. An 80/20 split of the dataset was used for training and testing, respectively, and data augmentations were applied in the form of scaling, rotation, and reflection. The trained network was capable of reproducing measurements derived from CMR for end-diastolic volume, end-systolic volume, ejection fraction, and mass, while outperforming an expert human observer in terms of accuracy as well as scan-rescan reproducibility (Table I).

As part of ongoing efforts to improve the accuracy and efficiency of 3DE analysis, we have leveraged the high resolution and signal-to-noise-ratio of CMR (relative to 3DE), to create a novel, publicly available benchmark dataset for developing and evaluating 3DE labelling methods. This approach not only significantly reduces the effects of observer-specific bias and variability in training data arising from conventional manual 3DE analysis methods, but also improves the agreement between cardiac indices derived from 3DE and CMR.

Figure 1. Data annotation workflow Table I. Results

[Analysis on the epidemic characteristics and genetic characteristics of varicella in Beijing from 2019 to 2021]

The reported incidence of varicella in Beijing from 2019 to 2021 were 63.8/100 000, 32.2/100 000 and 38.6/100 000, respectively. There were two VZV epidemics in Beijing each year, one peaked in May and the other in November. However, the first VZV epidemic almost disappeared in 2020. Among the cases involved in the varicella outbreaks in school, the proportion of the students with no history of vaccine immunization, 1 dose of immunization and 2 doses of immunization were 33.12%, 44.79% and 22.08%, respectively. The major body of VZV breakthrough cases was children aged 6-14 years (523/755, 69.27%). The proportion of moderate- or severe-rash were 55.32%, 39.06%, 29.96% in the three groups of cases with no immunization history, 1 dose of immunization and 2 doses of immunization, respectively (P<0.001). A total of 1 089 varicella samples were collected, and 837 (76.86%) were confirmed to be PCR-positive for VZV and were identified as VZV wild strains. 311 VZV strains were sequenced successfully, and 307 strains were clade 2 (98.72%), 1 clade 3 (0.32%) and 3 Clade 5 (0.96%). Compared with the representative strains, the nucleotide similarities of ORF22 fragments were between 99.4% and 100%, and amino acid similarities were between 99.4% and 100%.

Increased cytochrome C threonine 50 phosphorylation in aging heart as a novel defensive signaling against hypoxia/reoxygenation induced apoptosis

Previous studies have shown that aging promotes myocardial apoptosis. However, the detailed mechanisms remain unclear. Our recent studies revealed that aging not only activates apoptosis, but also activates some anti-apoptotic factors. By quantitative phosphoproteomics, here we demonstrated that aging increases cytochrome c (Cytc) phosphorylation at threonine 50 (T50), a post-translational modification with unknown functional impact. With point mutation and lentivirus transfection, cardiomyocytes were divided into four groups: empty vector group, WT (wild type), T50E (as a phosphomimic variant), and T50A (non-phosphorylatable). TUNEL staining and flow cytometry were used to determine the apoptosis ratio in different groups after hypoxic/reoxygenated (H/R) treatment. The results showed that T50-phosphorylated Cytc suppressed myocardial apoptosis induced by H/R. Furthermore, Western Blot and ELISA measurements revealed that Cytc T50 phosphorylation inhibited caspase-9 and caspase-3 activity without altering caspase-8, BCL-2, BCL-XL, and Bax expression. In our study, we demonstrated that aging increases phosphorylation Cytc at T50 and this aging-increasing phosphorylation site can suppress H/R-induced apoptosis.

The impact of employee entrepreneurship on sustainable innovation capability: the effect of value cocreation and role stress

Purpose

Enterprises generally change their organizational structures in an era of uncertainty for flexibility, and accordingly, employee entrepreneurship emerges as employees gain more power and responsibility during this process. This paper aims to explore how employee entrepreneurship impacts enterprises’ sustainable innovation capability. The authors consider the mediating effect of value cocreation and the moderating effect of role stress.

Design/methodology/approach

The authors adopted a questionnaire survey to test the hypothesis, and 356 questionnaires were collected from an online questionnaire platform.

Findings

The results show that employee entrepreneurship has a positive impact on sustainable innovation capability, value cocreation plays a partial mediating role in this relationship between employee entrepreneurship and value cocreation and role stress plays a negative moderating role in the relationship between employee entrepreneurship and value cocreation.

Research limitations/implications

The study makes three main contributions to the literature concerning entrepreneurship and enterprise sustainable innovation capability. First, in relation to the entrepreneurship literature, the authors shift entrepreneurship research from entrepreneurs/leaders to employees in the digital transformation context and specify the connotation of employee entrepreneurship. This shift further enriches and broadens the research boundary of entrepreneurship (Bhide, 2000; Djankov et al., 2006). Second, we add the micro dynamic mechanism of sustainable innovation capability by focusing on the effect of employee entrepreneurship. Employee entrepreneurship positively contributes to enterprise sustainable innovation capability, which is partially mediated by value cocreation, and its impact on value cocreation is moderated by role stress due to the identity change of employees in the digital transformation context. The authors answer calls to clarify the micromechanisms of building enterprise competitive advantage (Terziovski and Sohal, 2020). The research confirms the relationship change between enterprises and consumers in value creation from separation to cooperation (Tu et al., 2020; Costa and Hafto, 2021). Additionally, the authors discuss the dynamic mechanism and factors of value cocreation at the employee level and further verify the positive effect of an active interaction among enterprises, consumers and other value creators (Matarazzo et al., 2021; Heinonen et al., 2013). This approach compensates for the deficiency of previous studies investigating the influence of value cocreation at the level of organization members.

Practical implications

The theoretical analysis and empirical conclusions of this study have important practical implications. First, employee entrepreneurship positively impacts enterprises’ sustainable innovation capabilities. Therefore, enterprises should stimulate their employees’ entrepreneurship to strengthen organizational resilience and adaptability, which are important for enterprises to survive in the changeable age. For example, enterprises can authorize their frontline employees with more resource allocation power and reduce hierarchical control; thus, their employees can address emergencies in a timely manner and catch fleeting market opportunities. Second, since value cocreation is a partial mechanism by which employee entrepreneurship contributes to an enterprise’s sustainable innovation capability, enterprises should help employees improve their capabilities and knowledge for value cocreation. For instance, enterprises should develop decision-making support toolkits, upscale training courses and efficient coordination tools to help employees achieve the necessary skills and knowledge. Only in this way can they qualify to perform an increasing number of autonomous tasks. Finally, employees’ role stress negatively moderates the relationship between employee entrepreneurship and value cocreation. This finding provides a reference for enterprises in position setting, role rule-making, role responsibility-planning, etc. Specifically, enterprises should build a feedback mechanism to manage employees’ role ambiguity, conflict and overload; thus, they can eliminate the potential negative effects on value cocreation and their sustainable innovation capability in a timely manner.

Originality/value

This study expands the boundary and connotation of entrepreneurship in an era of uncertainty, specifies the micromechanism of sustainable innovation capability and provides new insights for enterprises constructing their sustainable innovation capability.

[Anatomical elucidation and histological study of pelvic autonomic nerve-plane based female fresh cadaver]

Objective: To investigate the rationality of nerve-plane sparing radical hysterectomy (NPSRH) for cervical cancer by observing the anatomical and histological characteristics of pelvic autonomic plane based on fresh cadaver. Methods: From October 2015 to September 2020, 14 fresh female cadavers were anatomically and histologically studied in the Laboratory of Anatomy and Embryology Department, Peking Union Medical College, Chinese Academy of Medical Sciences. The median age of the specimens was 79 years (range: 67 to 92 years). Twenty-eight hemi-pelvic specimens were obtained from 14 fresh female cadavers. NPSRH procedures were simulated in 8 hemi-pelvic cavities to prove its feasibility. Detailed dissection was conducted to recognize nerve plane and to observe the distribution of pelvic nerves in 10 hemipelvis. In the other 10 hemipelvis, whole parametrium tissue was taken from the crossing of ureter and the uterine artery to the ureterovesical entrance and be embedded, then continuous section was performed, and was stained by hematoxylin-eosin staining (HE) to observe the relationship of nerves and vessels. Immunohistochemical staining of S100, tyrosine dehydrogenase (TH), and vasoactive intestinal peptide (VIP) were performed to count and distinguish sympathetic and parasympathetic nerves, respectively. Results: (1) The pelvic autonomic nerve-plane was completely preserved in 7 of 8 hemipelvis by simulating NPSRH. (2) After detailed dissection in 10 hemipelvis, it was found that hypogastric nerve, pelvic splanchnic nerve, and their confluence of inferior hypogastric plexus were distributed in a planar statelocating in the ureteral mesentery and its caudal extension. This nerve plane showed a cross relationship with deep uterine vein and its branches. The bladder branches and vesical venous plexus were closely related to the inferior hypogastric plexus. The middle vesical vein and inferior vesical vein were intact in 7 of 10 hemipelvis, and either vesical vein was missing in 3 of them. It was observed that the vesical venous plexus communicated with the deep uterine vein trunk on the medial side of the nerve plane in 6 hemipelvis, while flowed into the deep uterine vein on the lateral side of the nerve plane in 2 hemipelvis, and in the other 2 hemipelvis it directly flowed into the internal iliac vein. (3) It was revealed that autonomic nerves were continuously distributed beneath the ureteral with sagittal plane by HE staining. The average nerve content below the ureteral width was 70.9% of the total in nerve plane by S100 staining. TH and VIP staining showed that the average number of sympathetic fibers was 13.5 and parasympathetic fibers was 8.2, reminding sympathetic predominated. Conclusion: Pelvic autonomic nerves are mainly distributed within the mesangial plane below the ureter, which provides an anatomic justification for NPSRH.

POS0035 GENE REGULATION IN T-CELLS FROM PsA PATIENTS DIFFERS BETWEEN PERIPHERAL BLOOD AND THE INFLAMED JOINTS: IMPLICATIONS FOR THE INTERPRETATION OF GWAS SIGNALS

Background

Genome-wide association studies (GWAS) have identified variants that are associated with complex diseases such as Psoriatic Arthritis (PsA). The majority of these variants do not affect the coding sequence of proteins but rather regulatory elements which are highly cell type and state specific, and can affect distally located genes via chromatin interaction mechanisms.

We and others have previously analysed GWAS loci for multiple conditions (including PsA and Rheumatoid Arthrtitis) in cell lines using functional genomics techniques, providing putative mechanisms to many loci with previously unknown function [1].

However, multiple studies have identified large differences in gene regulatory mechanisms between cell lines and primary cells, which could significantly alter the proposed mechanisms. Differences between between samples from healthy volunteers and patients, in particular from the affected tissue, have although not been exhaustively investigated.

Objectives

To assess the impact of using primary cells derived from PsA patients compared to healthy volunteers in functional genomics studies.

Methods

CD4+ and CD8+ T cells were isolated from peripherial blood from 10 healthy controls and 48 PsA patients and from 6 PsA synovial fluid samples.

We performed RNA-seq and ATAC-seq on these two cell types to analyse the global patterns of gene expression and chromatin activity.

Results

We find subtle differences between PsA patients and healthy controls in cells isolated from blood. RNA-seq analysis identified only a handful of differentially expressed genes whilst ATAC-seq analysis identified only 28 differential loci.

On the other hand, T cells isolated from synovial fluid showed significant differences compared to T cells isolated from patient’s blood. Interestingly, we find that CD4+ T cells show substantially more differentially expressed genes compared to CD8+ T cells (1168 vs 346 Log2FoldChange > 1, FDR < 0.01). Genes overexpressed in synovial CD4+ T cells are more strongly enriched for immune pathways such as cytokine signaling and T cell proliferation compared to synovial CD8+ T cells

We also find that synovial CD4+ T cells highly overexpress MHC class II genes (Figure 1).

Figure 1.

Normalized counts of the alpha chains of MHC class 2 genes in CD4+ and CD8+ T cells purified from blood from healthy subjects and patients and synovial fluid.

Conclusion

This preliminary analysis suggests that T cells isolated from peripherial blood do not seem to differ significantly between PsA patients and healthy controls. In contrast, cells isolated from synovial fluid are highly specialized and activated. Moreover, these cells do not resemble canonically activated T cells which means that this state can not be easily emulated in vitro.

This study indicates the importance of not only studying GWAS loci in relevant primary cells from patients, but also that attention needs to be given to cells isolated from the affected site.

References

[1]Shi C, Ray-Jones H, Ding J, et al (2021) Chromatin Looping Links Target Genes with Genetic Risk Loci for Dermatological Traits. J Invest Dermatol 141:1975–1984. https://doi.org/10.1016/J.JID.2021.01.015

Acknowledgements

This work was funded by the Wellcome Trust (award references 207491/Z/17/Z and 215207/Z/19/Z), the Versus Arthritis (award reference 21754), the NIHR Manchester Biomedical Research Centre, and the Medical Research Council (award reference MR/N00017X/1).

Disclosure of Interests

None declared

AB0392 EFFICACY AND SAFETY OF UPADACITINIB IN A CHINESE SUBGROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS AND INADEQUATE RESPONSE TO CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS

Background

Upadacitinib (UPA) was effective in global Phase 3 trials in rheumatoid arthritis (RA) patients (pts) with inadequate response (IR) to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

Objectives

To assess the efficacy and safety of UPA in csDMARD-IR pts with RA in Chinese subgroup from a Phase 3, randomized, double-blind, placebo (PBO)-controlled study (NCT02955212) 1.

Methods

Pts were randomized to 12 weeks of blinded treatment with UPA 15 mg once daily (QD) or PBO, in combination with csDMARDs. Primary and secondary endpoints were analyzed in a Chinese subgroup, including American College of Rheumatology criteria (ACR) responses, remission and low disease activity measures. Safety was analyzed for pts who received ≥1 dose of study drug.

Results

228 Chinese pts (67.5% of overall trial population) were randomized and took at least one dose of study drug. Baseline characteristics were generally balanced between UPA and PBO. 46% and 35.1% used methotrexate (MTX) alone as concomitant csDMARD in UPA and PBO group, respectively. 38.9% in UPA and 43.0% in PBO group used concomitant csDMARDs other than MTX and 15.0% and 21.9% respectively used a combination. At week 12, more Chinese pts receiving UPA achieved the primary endpoint of ACR20 compared with PBO (71.9% vs 31.6%, nominal p<0.001). UPA also showed greater improvements in all secondary endpoints vs PBO at Week 12 (Table 1), including ACR50 and ACR70, mean change in Disease Activity Score in 28 joints using C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), Short-Form 36-item Health Survey-Physical Component Summary (SF-36 PCS), as well as proportion of pts achieving low disease activity based on DAS28-CRP ≤3.2 and Clinical Disease Activity Index (CDAI) ≤10, and clinical remission based on DAS28-CRP <2.6. Onset of response was rapid with more pts receiving UPA achieving ACR20 by Week 1 versus PBO (25.4% vs 5.3%, nominal p<0.001). Through Week 12 treatment-emergent adverse events (TEAEs) occurred in 57.9% of pts on UPA and 49.1% on PBO. The rate of pts with serious AEs (SAEs) was numerically higher with UPA than with PBO (6.1% vs 4.4%). TEAEs reported in ≥ 3% of subjects and with a higher rate on UPA vs. PBO were: upper respiratory tract infection, alanine aminotransferase increased, aspartate aminotransferase increased, hypertension, diarrhea, and leukopenia. Overall safety was consistent with the trial population1 and similar with the reported safety profile of the global clinical program2.

Table 1.

Summary of Efficacy Endpoint Results at Week 12 in Chinese Subgroup

Endpoint aUPA 15mg (N=114)PBO (N=114)Primary endpointACR20, %71.9***31.6Secondary endpointsΔ DAS28-CRP-2.42***-0.75Δ HAQ-DI-0.55***-0.11Δ SF-36 PCS7.63 b***2.94 cDAS28-CRP ≤3.2, %46.5***9.6DAS28-CRP <2.6, %28.1***1.8CDAI ≤10, %33.3***7.0ACR50, %39.5***7.0ACR70, %16.7***2.6ACR20 at Week 1, %25.4***5.3

***Nominal p<0.001 vs PBO

aNon-responder imputation for binary endpoints; ANCOVA with multiple imputation for DAS28(CRP) and HAQ-DI; mixed model repeated measures for other continuous endpoints. Δ: mean change from baseline

bN=106

cN=104

Conclusion

UPA demonstrated clinical and functional improvement in Chinese csDMARD-IR RA pts. The safety of UPA was comparable with the overall study population and with the safety seen in the global Phase 3 program.

References

[1]Zeng X, Zhao D, Radominski SC, et al. Int J Rheum Dis. 2021;24:1530–1539.

[2]Cohen SB, van Vollenhoven RF, Winthrop KL, et al. Ann Rheum Dis 2021;80:304–311.

Acknowledgements

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship.

Disclosure of Interests

Xiaofeng Zeng: None declared, Yi Liu: None declared, Jiankang Hu: None declared, Jingyang Li: None declared, Yongfu Wang: None declared, Dongbao Zhao: None declared, Lijun Wu: None declared, Zhengyu Xiao: None declared, ZHIJUN LI: None declared, Jian Xu: None declared, Sebastian Meerwein Shareholder of: may own AbbVie stock or options, Employee of: AbbVie employee, Yunxia Xie Shareholder of: may own AbbVie stock or options, Employee of: AbbVie employee, Peiwen Liang Employee of: AbbVie

Stanniocalcin 1 alleviates myocardial ischemia-reperfusion injury through inhibiting inflammation and apoptosis of myocardial cells

OBJECTIVE

Myocardial ischemia-reperfusion injury (MIRI) is the main cause of death from ischemic heart diseases. Stanniocalcin 1 (STC1) has a potential therapeutic effect on MIRI. The purpose of this study is to investigate the effect of STC1 on inflammation and apoptosis of myocardium in MIRI.

MATERIALS AND METHODS

We used rats to make ischemia-reperfusion (I/R) models and determined the efficiency of modeling by 2, 3, 5-triphenyl tetrazolium chloride staining, echocardiography, and lactate dehydrogenase detection. We injected subcutaneously recombinant human STC1 (2.5 μg/kg, 5 μg/kg) into rats daily one week before modeling to detect the effect of STC1 pretreatment on inflammation and apoptosis of rat myocardial cells. In addition, we cultured rat myocardial cell lines (H9c2 cells) to investigate the effect of STC1 on myocardial cells.

RESULTS

The cardiac function and structure of I/R rats were obviously destroyed. After treating rats with STC1, we found that the cardiac function and structure of the rats were significantly improved. In addition, STC1 reduced the expression of inflammatory factors and apoptosis levels in rat myocardium. Stimulation of STC1 also improved the viability of H9c2 cells in vitro.

CONCLUSIONS

Therefore, STC1 can alleviate MIRI by inhibiting inflammation and apoptosis. It indicated that STC1 may have a potential therapeutic effect on MIRI.

[Efficacy and prognostic analysis of 125I brathytherapy combined with chemotherapy for pediatric parameningeal rhabdomyosarcoma]

Objective: To analyze the efficacy and prognostic factors in children with parameningeal rhabdomyosarcoma (PMRMS) treated by ¹²⁵I brachytherapy combined with chemotherapy. Methods: A retrospective analysis of the clinical data of 33 pediatric patients treated with ¹²⁵I brachytherapy combined with chemotherapy in Peking University Stomatological Hospital from July 2013 to October 2018 was carried out to analyze the efficacy and prognostic factors. Results: Among the 33 patients, 19 were males and 14 were females; the median age was 4 years old (1-12 years old). There were 17 cases with embryonic type, 9 cases with alveolar type, and 7 with undifferentiated type; 26 cases with original PMRMS, and 7 cases with recurrent PMRMS. The tumors occurred in subtemporal-mastoid area in 15 patients, while nasopalatine-paranasal area in 6 cases, and parapharyngeal-submandibular area in 12 cases. There were 28 patients in IRS Ⅲ, and 5 patients in IRS Ⅳ. As for the risk level, 28 cases were in the middle-risk group and 5 cases in the high-risk group. The median follow-up time was 52 months. The 1, 3, and 5-year local control rates were 87.9%, 58.6%, and 49.9%, and the 1, 3, and 5-year survival rates were 93.8%, 60.5%, and 47.5%, respectively. The 5-year local control rate and 5-year survival rate of 12 patients with the tumor in the parapharyngeal-submandibular area were 91.7% and 100%, respectively. The 5-year local control rate and 5-year survival rate of the 6 patients with tumor in the nasopalatine-paranasal area were both 83.3%. The 3-year local control rate and 3-year survival rate of the 15 patients with tumor in the subtemporal-mastoid area were 17.5% and 21.4%. The multivariate survival analysis using Cox proportional risk regression model showed that the tumor located in the subtemporal-mastoid area was an independent risk factor affecting the 5-year overall survival rate (HR=38.40, 95%CI: 4.87-302.52, P=0.001). Within 3 months after ¹²⁵I seed implantation, the incidence of acute radiotherapy adverse reactions in all patients was 84.8% (28/33). Twenty-one patients (63.6%) had a grade 1 acute radiotherapy reaction, and 7 cases (21.2%) had a grade 2 acute radiotherapy reaction. No acute radiotherapy adverse reactions of grade 3 or 4 occurred. Three months after ¹²⁵I seed implantation, the adverse reactions were significantly alleviated, and no adverse reactions of grade 3 or above such as skin ulcer or salivary gland fibrosis occurred, and no serious cranio-maxillofacial deformities occurred. Conclusions: ¹²⁵I seed brachytherapy combined with chemotherapy has a definite clinical effect in the treatment of children with parameningeal rhabdomyosarcoma. The prognosis of rhabdomyosarcoma in the parapharyngeal-submandibular area and nasopalatine-paranasal area is better than that in the subtemporal-mastoid area.

[Characteristics of overnight obstructive apnea events in patients with obstructive sleep apnea hypopnea syndrome]

Objective: To compare the overnight variation trends in the duration of obstructive apnea events, and to explore the adaptive capacity to the pathophysiological consequences of periodic sleep disordered-breathing and its underlying mechanism in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: A retrospective analysis were performed of the polysomnographic (PSG) results of 89 snoring patients including 10 non-OSAHS, 15 mild, 29 moderate and 35 severe OSAHS. The total record time was divided into four equal phases, and the variation trends of the mean apnea duration (MAD) and the longest apnea duration (LAD) were compared with the progression of sleep phases in different groups. Correlation analysis was conducted with demographic indicators, pulse oxygen saturation (SpO₂) and sleep related indicators. In addition, the number of apneas-time variability curve was plotted for fitting analysis. Results: In patients with severe OSAHS, both MAD [26.1(20.9, 31.4) s] and LAD [56.5(46.5, 82.0) s] were significantly higher than those of non-OSAHS, mild and moderate OSAHS (P<0.001). In addition, the MAD in the third and fourth quartiles were significantly higher than that in the first quartile [(28.4±9.0) s, (27.3±9.8) s, (22.3±9.9) s, respectively, P=0.046], and the LAD in the third quartile was significantly higher than that in the first quartile [56.5(38.5, 71.0) s, 41.0(28.0, 53.0) s, respectively, P=0.018]. In all subjects, the MAD and LAD in the third and fourth quartiles were significantly higher than those in the first quartile [MAD: 20.3(10.3, 29.2) s, 18.5(11.3, 24.2) s, 12.9(0.0, 21.8) s, respectively, P<0.001; LAD: 28.0(10.3, 50.5) s, 28.0(12.0, 44.5) s, 14.5(0.0, 32.3) s, respectively, P<0.001]. There was no statistical difference in the lowest SpO₂ (LSpO₂), the mean SpO₂ (MSpO₂), and the percent of sleep time oxygen saturation below 90% (T90%) of all subjects in different sleep phases (P>0.05). The LAD was positively correlated with obstructive apnea index (OAI, OR=1.660, P=0.025), but no correlation was observed with other indicators (P>0.05). The MAD increased 0.22 s per episode at the onset of sleep (1-31 apnea events), then dropped to 0.04 s of increase per episode, with a dynamics change of 5.5-fold slower. Conclusions: The MAD and LAD show a gradual prolongation trend with the progression of sleep phases, and the prolongation trend is the most obvious in patients with severe OSAHS, while the dynamic change trend of SpO₂ is not obvious. There may be multiple adaptation mechanisms for recurrent hypoxic episodes, and the adaptation occurr in stages, with a rapid increase in MAD at the onset of sleep, follow by a markedly slower increase. Patients with severe OSAHS express the most complete pattern, suggesting the most severe pathophysiological outcomes.

[Diffuse midline gliomas with H3K27 alteration in children: a clinicopathological analysis of forty-one cases]

Objective: To investigate the clinicopathological features of pediatric diffuse midline glioma with H3K27 alteration and to analyze their relationship with prognosis. Methods: Forty-one cases of childhood diffuse midline glioma with H3K27 alteration were collected at Children's Hospital of Fudan University (39 cases) and Xi'an Children's Hospital (2 cases), from July 2016 to July 2020. The clinical manifestations, imaging data, histopathology, immunohistochemical phenotype and molecular genetics features, tumor size, site and histological grading were evaluated. Results: Among the 41 cases, 21 were males and 20 females, the age of onset was 3-14 years, the average and median age was 7.6 years and 7.0 years, respectively. The tumor sites were brain stem (n=36) and other locations (n=5). The clinical manifestations were dizziness, gait disturbance, and limb weakness, etc. The MRI features were variable. The histology varied from low-grade to high-grade glioma with neuron differentiation. Immunohistochemistry showed that the tumor cells expressed H3K27M, GFAP, and Olig2. Genetic study showed that 76% (16/21) of tumors had H3F3A gene mutation, mostly accompanied by TP53 (62%, 13/21) missense mutation; five tumors (24%, 5/21) had HIST1H3B gene mutation, accompanied by missense mutations in ACVR1 and PI3K pathway-related gene PIK3CA (4/5) and PIK3R1 (1/5) mutations. The prognosis was dismal with only one alive and others died. The average and median overall survival time was 7 months and 4 months, respectively. Cox multivariate regression analysis showed that age, tumor location, radiologically maximum tumor diameter, histologic grading, and surgical methods were not significantly associated with overall survival rate (P>0.05). Conclusions: Pediatric diffuse midline gliomas with H3K27 alteration have unique clinicopathological and genetic characteristics. The prognosis is poor. The tumor location and histopathologic grading are not related to prognosis. New specific drugs and comprehensive treatment are needed to improve the prognosis.