Protective Effects of Lycium ruthenicum Murray against Acute Alcoholic Liver Disease in Mice via the Nrf2/HO-1/NF-κB Signaling Pathway

Acute alcoholic liver disease (ALD) resulting from short-term heavy alcohol consumption has become a global health concern. Moreover, anthocyanins have attracted much attention for their ability to prevent oxidation and inflammation. The present work evaluates the protective effects of Lycium ruthenicum Murray (LRM) against ALD and explores the possible underlying mechanism involved. The total anthocyanin content in LRM was 43.64 ± 9.28 Pt g/100 g dry weight. Mice were orally administered 50, 125, or 375 mg LRM/kg body weight (BW) for 21 days. On days 18-21, mice were orally administered 15 mL of ethanol/kg BW. Markers of liver damage, oxidative stress, and inflammation were examined. Furthermore, the modulatory effect of LRM on Nrf2/HO-1/NF-κB pathway molecules was evaluated through quantitative reverse transcription polymerase chain reaction (RT‒qPCR) and immunohistochemistry analyses. The difference between the groups indicated that LRM improved liver histopathology and the liver index, decreased aspartate transaminase, alanine transaminase, malondialdehyde, reactive oxygen species, IL-6, TNF-α, and IL-1β expression, but elevated superoxide dismutase, catalase, and glutathione-s-transferase levels. Moreover, LRM upregulated Nrf2 and Ho-1 but downregulated Nf-κb and Tnf-α genes at the transcript level. In summary, LRM alleviated ethanol-induced ALD in mice by reducing oxidative damage and associated inflammatory responses. LRM protects against ALD by reducing damage factors and enhancing defense factors, especially via the Nrf2/HO-1/NF-κB pathway. Thus, LRM has application potential in ALD prophylaxis and treatment.

Tracing Photoinduced Hydrogen Migration in Alcohol Dications from Time-Resolved Molecular-Frame Photoelectron Angular Distributions

The recent implementation of attosecond and few-femtosecond X-ray pump/X-ray probe schemes in large-scale free-electron laser facilities has opened the way to visualize fast nuclear dynamics in molecules with unprecedented temporal and spatial resolution. Here, we present the results of theoretical calculations showing how polarization-averaged molecular-frame photoelectron angular distributions (PA-MFPADs) can be used to visualize the dynamics of hydrogen migration in methanol, ethanol, propanol, and isopropyl alcohol dications generated by X-ray irradiation of the corresponding neutral species. We show that changes in the PA-MFPADs with the pump-probe delay as a result of intramolecular photoelectron diffraction carry information on the dynamics of hydrogen migration in real space. Although visualization of this dynamics is more straightforward in the smaller systems, methanol and ethanol, one can still recognize the signature of that motion in propanol and isopropyl alcohol and assign a tentative path to it. A possible pathway for a corresponding experiment requires an angularly resolved detection of photoelectrons in coincidence with molecular fragment ions used to define a molecular frame of reference. Such studies have become, in principle, possible since the first XFELs with sufficiently high repetition rates have emerged. To further support our findings, we provide experimental evidence of H migration in ethanol-OD from ion-ion coincidence measurements performed with synchrotron radiation.

[Diagnosis and treatment understanding of Waldenström macroglobulinemia in China: a cross-sectional study]

Objective: To conduct a nationwide physician survey to better understand clinicians' disease awareness, treatment patterns, and experience of Waldenström macroglobulinemia (WM) in China. Methods: This cross-sectional study was conducted from February 2022 to July 2022 by recruiting clinicians with WM treatment experience from hematology, hematology-oncology, and oncology departments throughout China. Quantitative surveys were designed based on the qualitative interviews. Results: The study included 415 clinicians from 219 hospitals spread across thirty-three cities and twenty-two provinces. As for diagnosis, the laboratory tests prescribed by physicians for suspected WM patients were relatively consistent (92% -99% recommendation for laboratory, 79% -95% recommendation for pathology, 96% recommendation for gene testing, and 63% -83% recommendation for imaging examination). However, from a physician's perspective, there was 22% misdiagnosis occurred in clinical practice. The rate of misdiagnosis was higher in lower-level hospitals than in tertiary grade A hospitals (29% vs 21%, P<0.001). The main reasons for misdiagnosis were that WM was easily confused with other diseases, and physicians lacked the necessary knowledge to make an accurate diagnosis. In terms of gene testing in clinical practice, 96% of participating physicians believed that WM patients would require gene testing for MYD88 and CXCR4 mutations because the results of gene testing would aid in confirming diagnosis and treatment options. In terms of treatment, 55% of physicians thought that the most important goal was to achieve remission, while 54% and 51% of physicians wanted to improve laboratory and/or examination results and extend overall survival time, respectively. Among patients with treatment indications, physicians estimated that approximately 21% of them refused to receive treatment, mainly owing to a lack of affordable care and disease awareness. When selecting the most appropriate treatment regimens, physicians would consider patient affordability (63% ), comorbidity (61% ), and risk level (54% ). Regimens containing Bruton tyrosine kinase inhibitor (BTKi) were most widely recommended for both treatment-naïve and relapsed/refractory patients (94% for all patients, 95% for treatment-naïve patients, and 75% for relapsed/refractory patients), and most physicians recommended Ibrutinib (84% ). For those patients who received treatment, physicians reported that approximately 23% of patients did not comply with the treatment regimen due to a lack of affordability and disease awareness. Furthermore, 66% of physicians believe that in the future, increasing disease awareness and improving diagnosis rates is critical. Conclusions: This study is the first national physician survey of WM conducted in China. It systematically describes the issues that exist in WM diagnosis and treatment in China, such as a high rate of misdiagnosis, limited access to gene testing and new drugs, and poor patient adherence to treatment. Chinese doctors believe that improving doctors' and patients' understanding of WM is one of the most urgent issues that must be addressed right now.

Zanubrutinib-lenalidomide-rituximab (ZR2) in unfit diffuse large B-cell lymphoma: efficient and tolerant

The objective of this study is to examine the effectiveness and safety of zanubrutinib, rituximab, and lenalidomide (ZR2) in unfit patients with diffuse large B-cell lymphoma (DLBCL). Thrombosis or bleeding risk of ZR2 regimen, especially when antiplatelet agents were co-prescribed, was also evaluated. We retrospectively reviewed unfit newly diagnosed (ND) and refractory or relapsed (R/R) patients with DLBCL who were administered with ZR2 regimen in two medical centers between December 2019 and February 2022. Response rates, progression-free survival (PFS), overall survival (OS), bleeding adverse events (AEs), and thrombosis episodes were analyzed. Furthermore, we investigated the effects of zanubrutinib alone or in combination with lenalidomide on platelet functions in vitro and in vivo. A total of 30 unfit patients (13 ND DLBCL and 17 R/R DLBCL patients) who received ZR2 regimen were enrolled in the study (median age: 69.5 years). The ultimate ORRs for the ND DLBCL and R/R DLBCL were 77.0% and 50.1%, respectively. The median follow-up was 16.6 months. The median PFS and OS were not achieved during the follow-up time. Subcutaneous hemorrhage AEs occurred in four cases, three cases suffered severe bleeding events, and thrombosis events were observed in two patients. ZR2 regimen inhibited platelet functions (aggregation, clot retraction, spreading and activation) in vitro and in vivo function testing especially in response to collagen. ZR2 is an efficient treatment option for unfit patients with DLBCL and could be well tolerated. Notably, this regimen inhibited platelet functions. Antiplatelet agents should be used with caution in patients treated with this regimen.

Notch signaling regulates Th17 cells differentiation through PI3K/AKT/mTORC1 pathway and involves in the thyroid injury of autoimmune thyroiditis

PURPOSE

Autoimmune Thyroiditis (AIT) is the most common thyroid disease; however, there were no measures to prevent the progression of the disease. The present study attempts to identify that Notch signaling regulates the differentiation of T helper 17 (Th17) cells by activating downstream Phosphatidylinositol-3 kinase/protein kinase/mechanistic target of rapamycin complex 1 (PI3K/AKT/mTORC1) pathway participating in the thyroid injury of the experimental autoimmune thyroiditis (EAT).

METHODS

In vivo experiments, mice were randomly divided into 4 groups: a control group, an EAT group, and two groups with LY294002 treatment (pTg plus 25 mg/kg or 50 mg/kg LY294002, respectively). The degrees of thyroiditis were evaluated, and the percentage of Th17 cells, expression of interleukin-17A (IL-17A), and the main components of the Notch-PI3K signaling pathway were detected in different groups. In vitro experiments, two different dosages of LY294002 (25 and 50 μM) were used to intervene splenic mononuclear cells (SMCs) from EAT mice to further evaluate the regulatory effect of Notch-PI3K pathway on Th17 cells.

RESULTS

Our data demonstrate that the infiltration of Th17 cells and the expressions of IL-17A, Notch, hairy and split 1 (Hes1), p‑AKT (Ser473), p‑AKT (Thr308), p‑mTOR (Ser2448), S6K1, and S6K2 increased remarkably in EAT mice. After PI3K pathway was blocked, the degrees of thyroiditis were significantly alleviated, and the proportion of Th17 cells, the expression of IL-17A, and the above Notch-PI3K pathway-related molecules decreased in a dose-dependent manner. Additionally, the proportion of Th17 cells was positively correlated with the concentration of serum thyroglobulin antibody (TgAb), IL-17A, and Notch-PI3K pathway-related molecules mRNA levels.

CONCLUSIONS

Notch signal promotes the secretion of IL-17A from Th17 cells by regulating the downstream PI3K/AKT/mTORC1 pathway through Hes-Phosphatase and tensin homolog (PTEN) and participates in thyroid autoimmune damage, and the PI3K pathway inhibitor may play important effects on AIT by affecting Th17 cells differentiation.

Investigation of the Potential Mechanism of Compound Dragon's Blood Capsule against Myocardial IschemiaBased on Network Pharmacology

BACKGROUND

Dragon's blood is widely consumed in China, Vietnam and Laos to promote blood circulation. A Compound Dragon's blood capsule (CDC) is a patented medicine composed of dragon's blood, notoginseng, and borneol. This combination is purported to stabilize coronary heart disease and myocardial ischemia. However, the possible mechanisms and the characterization of its drug targets' relevance at the systemic level remain unclear.

AIM

The present study aims to reveal the potential mechanisms of CDC's anti-myocardial ischemia effect.

MATERIALS AND METHODS

The potential mechanisms were investigated by network pharmacology and qRT-PCR was used to verify the expression levels of key genes of PI3k-Akt pathway.

RESULTS

S1PR2 and AGTR1 were the common targets, which involved 6 biological processes annotated by KEGG and GO analysis. The qRT-PCR results showed a remarkable increase in the expression of Pi3k, Pdk1, Akt, Mdm2, Bcl2, and mTOR. Results also showed a decline in the expression of P53 and Casp3 after CDC intervention.

CONCLUSION

CDC has a significant anti-myocardial ischemia effect through the PI3k/Akt pathway, which demonstrates that CDC is a suitable adjuvant to treat CHD and provides a theoretical basis for its further clinical application.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Glycyrrhetinic Acid Receptor-Mediated Zeolitic Imidazolate Framework-8 Loaded Doxorubicin as a Nanotherapeutic System for Liver Cancer Treatment

In this study, we designed and developed a DOX nanodrug delivery system (PEG-GA@ZIF-8@DOX) using ZIF-8 as the carrier and glycyrrhetinic acid (GA) as the targeting ligand. We confirmed that DOX was loaded and PEG-GA was successfully modified on the surface of the nanoparticles. The in vitro release profile of the system was investigated at pH 5.0 and 7.4. The cellular uptake, in vitro cytotoxicity, and lysosomal escape characteristics were examined using HepG2 cells. We established an H22 tumor-bearing mouse model and evaluated the in vivo antitumor activity. The results showed that the system had a uniform nanomorphology. The drug loading capacity was 11.22 ± 0.87%. In acidic conditions (pH 5.0), the final release rate of DOX was 57.73%, while at pH 7.4, it was 25.12%. GA-mediated targeting facilitated the uptake of DOX by the HepG2 cells. PEG-GA@ZIF-8@DOX could escape from the lysosomes and release the drug in the cytoplasm, thus exerting its antitumor effect. When the in vivo efficacy was analyzed, we found that the tumor inhibition rate of PEG-GA@ZIF-8@DOX was 67.64%; it also alleviated the loss of the body weight of the treated mice. This drug delivery system significantly enhanced the antitumor effect of doxorubicin in vitro and in vivo, while mitigating its toxic side effects.

Increased serum soluble interleukin-2 receptor levels in dermatomyositis are associated with Th17/Treg immune imbalance

Dermatomyositis (DM) represents a multifaceted chronic inflammatory myopathy, primarily manifesting as progressive deterioration of muscular and cutaneous tissues. Despite an incomplete comprehension of DM's etiology and pathogenesis, current evidence implicates the involvement of T lymphocyte infiltration, extensive cytokine release, myositis-specific antibodies, and myositis-associated antibodies in disease development. Serum soluble interleukin-2 receptor (sIL-2R) frequently serves as a marker for T cell activation; however, its role remains elusive. Consequently, this investigation sought to elucidate the association between sIL-2R levels, peripheral blood lymphocyte subset counts, and related cytokines in DM patients, with the aim of uncovering the intricate mechanisms underlying DM and establishing a theoretical foundation for the implementation of precise, targeted, individualized immunomodulatory therapy. In this study, a cohort of 60 dermatomyositis (DM) patients, comprising 32 with inactive DM and 28 with active DM, was enrolled and stratified into inactive and active groups based on the Myositis Disease Activity Visual Analogue Scale (MYOACT). Flow cytometry was employed to quantify the absolute counts of peripheral lymphocyte subsets and CD4+T cell subsets in each group, while a flow cytometry bead array was utilized to measure serum cytokine levels. In a comparative analysis between healthy individuals and patients diagnosed with DM, we observed a marked elevation in serum sIL-2R concentrations (P < 0.001) and T-helper 17 cell/regulatory T cell (Th17/Treg) ratios (P < 0.01) within the latter group. A positive correlation was identified between serum sIL-2R levels and various parameters, including ESR, CRP, VAS, AST, CKMB, LDH, HBDH, PT, APTT, DDi, IL-6, IL-10, and IFN-γlevels (P < 0.05). In contrast, serum sIL-2R levels demonstrated a negative correlation with LY, HGB, ALB, Th17 cell populations, and Th17/Treg cell ratios (P < 0.05). Employing multivariate logistic regression, we identified serum sIL-2R concentrations as an independent risk factor for both disease activity and hepatic involvement in DM patients. Moreover, receiver operating characteristic (ROC) curve analyses revealed that serum sIL-2R levels significantly contributed to the differentiation of disease activity and the detection of liver involvement in DM patients, with areas under the ROC curve (AUC) of 0.757 (95% CI 0.630-0.884, P = 0.001) and 0.826 (95% CI 0.717-0.935, P < 0.001), respectively. This study highlights the potential utility of serum sIL-2R levels as a valuable biomarker for assessing disease activity and liver involvement in dermatomyositis. Elevated serum concentrations of sIL-2R were observed in patients with DM, exhibiting significant associations with Th17 cell populations and Th17/ Treg ratios. These findings indicate that sIL-2R may be implicated in the immunopathogenesis of DM, thereby warranting further investigation to elucidate its role in the disease process.

Data-independent acquisition-based global phosphoproteomics reveal the diverse roles of casein kinase 1 in plant development

Casein kinase 1 (CK1) is serine/threonine protein kinase highly conserved among eukaryotes, and regulates multiple developmental and signaling events through phosphorylation of target proteins. Arabidopsis early flowering 1 (EL1)-like (AELs) are plant-specific CK1s with varied functions, but identification and validation of their substrates is a major bottleneck in elucidating their physiological roles. Here, we conducted a quantitative phosphoproteomic analysis in data-independent acquisition mode to systematically identify CK1 substrates. We extracted proteins from seedlings overexpressing individual AEL genes (AEL1/2/3/4-OE) or lacking AEL function (all ael single mutants and two triple mutants) to identify the high-confidence phosphopeptides with significantly altered abundance compared to wild-type Col-0. Among these, we selected 3985 phosphopeptides with higher abundance in AEL-OE lines or lower abundance in ael mutants compared with Col-0 as AEL-upregulated phosphopeptides, and defined 1032 phosphoproteins. Eight CK1s substrate motifs were enriched among AEL-upregulated phosphopeptides and verified, which allowed us to predict additional candidate substrates and functions of CK1s. We functionally characterized a newly identified substrate C3H17, a CCCH-type zinc finger transcription factor, through biochemical and genetic analyses, revealing a role for AEL-promoted C3H17 protein stability and transactivation activity in regulating embryogenesis. As CK1s are highly conserved across eukaryotes, we searched the rice, mouse, and human protein databases using newly identified CK1 substrate motifs, yielding many more candidate substrates than currently known, largely expanding our understanding of the common and distinct functions exerted by CK1s in Arabidopsis and humans, facilitating future mechanistic studies of CK1-mediated phosphorylation in different species.

The miR167-OsARF12 module regulates rice grain filling and grain size downstream of miR159

Grain weight and quality are always determined by grain filling. Plant microRNAs have drawn attention as key targets for regulation of grain size and yield. However, the mechanisms that underlie grain size regulation remain largely unclear because of the complex networks that control this trait. Our earlier studies demonstrated that suppressed expression of miR167 (STTM/MIM167) substantially increased grain weight. In a field test, the yield increased up to 12.90%-21.94% because of a significantly enhanced grain filling rate. Here, biochemical and genetic analyses revealed the regulatory effects of miR159 on miR167 expression. Further analysis indicated that OsARF12 is the major mediator by which miR167 regulates rice grain filling. Overexpression of OsARF12 produced grain weight and grain filling phenotypes resembling those of STTM/MIM167 plants. Upon in-depth analysis, we found that OsARF12 activates OsCDKF;2 expression by directly binding to the TGTCGG motif in its promoter region. Flow cytometry analysis of young panicles from OsARF12-overexpressing plants and examination of cell number in cdkf;2 mutants verified that OsARF12 positively regulates grain filling and grain size by targeting OsCDKF;2. Moreover, RNA sequencing results suggested that the miR167-OsARF12 module is involved in the cell development process and hormone pathways. OsARF12-overexpressing plants and cdkf;2 mutants exhibited enhanced and reduced sensitivity to exogenous auxin and brassinosteroid (BR) treatment, confirming that targeting of OsCDKF;2 by OsARF12 mediates auxin and BR signaling. Our results reveal that the miR167-OsARF12 module works downstream of miR159 to regulate rice grain filling and grain size via OsCDKF;2 by controlling cell division and mediating auxin and BR signals.

[Status and associated factors of pre-exposure prophylaxis use among men who have sex with men in 24 cities in China]

Objective: To understand the cognition and medication use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China and its associated factors. Method: From August 25 to September 5, 2021, 2 447 MSM were recruited in 24 cities to complete the online questionnaire through a male social interaction platform, Blued 7.5 software. The survey contents included demographic information of the respondents, PrEP awareness and usage, and risk behaviors. Descriptive analysis and multi-level logistic regression were performed for data analysis. SPSS 24.0 and SAS 9.4 software were used for statistical analysis. Results: Among the 2 447 respondents of MSM, 1 712 (69.96%) had heard of PrEP, 437 (17.86%) ever used PrEP, 274 (11.20%) were on PrEP, and 163 (6.66%) had discontinued PrEP; among the 437 cases (whoever used PrEP), more than 61.88% (388/627) adopted emtricitabine/tenofovir disoproxil fumarate regimen, and most of them adopted on-demand regimen. The average PrEP dosage reported in the past year is 1.12 tabletsper person per week. PrEP purchase was primarily via an online channel, and the most concerned factor was the PrEP effectiveness on HIV prevention. The most common reasons for discontinuing PrEP, reported by 163 cases, were the lack of HIV risk perception, the use of a condom to prevent HIV, and the economic burden of PrEP use. The logistic regression analysis showed that PrEP use among MSM in 24 cities was statistically associated with age, monthly income, ever having unprotected anal sex in the past year, used sexual drugs and sexually transmitted disease (STD) diagnosis in the past year. Compared with MSM aged 18-24, the proportion of MSM was relatively lower among those aged 25-44, who discontinued the PrEP (aOR=0.54,95%CI:0.34-0.87) or never used PrEP (aOR=0.62,95%CI:0.44-0.87). The proportion of unprotected anal sex among MSM currently on PrEP use was higher than those who have stopped PrEP and never used PrEP (all P<0.05). Those MSM group, with monthly income higher than 5 000 Yuan, used sexual drugs and STD diagnosis in the past year were more likely to have a higher rate for PrEP usage (all P<0.05). Conclusions: Currently, pre-exposure prophylaxis in the MSM group is primarily obtained via the online channel and adopted in an on-demand mode. Although the PrEP users have reached a certain proportion, it is still necessary to strengthen health education on the PrEP effects and side effects of MSM and to improve the awareness and use rate, especially for young MSM group, which can be combined with the advantages of the internet targeting its needs and use barriers.

Phyllosticta rizhaoensis sp. nov. causing leaf blight of Ophiopogon japonicus in China

Ophiopogon japonicus (Asparagaceae) is a perennial grass species which can be cultivated as an ornamental and medicinal plant. From April 2021 to September 2022, a serious leaf blight disease of O. japonicus was discovered in Rizhao City, Shandong Province, China. The initial disease symptoms were small yellow spots, finally developing as tip blight, often associated with many small, black, semi-immersed pycnidial conidiomata formed in lesions. To obtain isolates of the causal agent for this disease, samples were randomly collected from O. japonicus diseased leaves in Rizhao City. In total 97 Phyllosticta isolates were obtained from samples, and studied using morphological features and multi-locus phylogenetic analyses of a combined dataset using the internal transcribed spacers (ITS), the 28S large subunit of ribosomal RNA (LSU), and partial translation elongation factor 1-alpha (tef), actin (act) and glyceraldehyde-3-phosphate dehydrogenase (gapdh) loci. Phylogenetically, these Phyllosticta isolates formed a clade in the P. concentrica species complex, and clustered with P. pilospora and P. spinarum. Morphologically, isolates in this clade differed from P. pilospora and P. spinarum by the size of conidiogenous cells and conidia, and the absence of an apical conidial appendage. As a result, these isolates were described as a novel species Phyllosticta rizhaoensis. Pathogenicity was confirmed using Koch's postulates, which showed that P. rizhaoensis could induce leaf blight symptoms on O. japonicus in China. Citation: Wang C-B, Wang T-T, Ma C-Y, Xue H, Li Y, Piao C-G, Jiang N (2023). Phyllosticta rizhaoensis sp. nov. causing leaf blight of Ophiopogon japonicus in China. Fungal Systematics and Evolution 11: 43-50. doi: 10.3114/fuse.2023.11.03.

[Analysis of on-demand adherence and related factors in men who have sex with men who access HIV pre-exposure prophylaxis services via the internet]

Objective: To understand the compliancy to on-demand HIV pre-exposure prophylaxis (PrEP) and related factors in men who have sex with men (MSM) accessing to PrEP service through an Internet platform. Methods: A cross-sectional study method was used to recruit survey respondents through the Heer Health platform from July 6 to August 30, 2022, and a questionnaire survey on the current status of medication use was conducted in MSM who use PrEP through the platform and take medication on demand. The MSM's information collected in the survey mainly included socio-demographic characteristics, behavioral characteristics, risk perception characteristics, PrEP awareness and the status of dose taking. Univariate and multivariate logistic regression analyses were used to evaluate factors related with compliancy to PrEP. Results: A total of 330 MSM who met the recruitment criteria were included during the survey period, with a valid response rate of 96.7% (319/330) to the questionnaire survey. The age of the 319 MSM was (32.5±7.3) years. Most of them had education level of junior college or college and above (94.7%, 302/319), most of them were unmarried (90.3%, 288/319), most of them had full-time works (95.9%, 306/319), and 40.8% of them had average monthly income ≥10 000 yuan (130/319). The proportion of the MSM with good compliancy to PrEP was 86.5% (276/319). The results of univariate and multivariate logistic analyses showed that the MSM with good awareness of PrEP had relatively better compliancy to PrEP compared with those with poor awareness of PrEP (aOR=2.43, 95%CI:1.11-5.32). Conclusions: The compliancy to on-demand PrEP was good in MSM who accessed to the services through Internet platform, but there is still a need to strengthen PrEP promotion in MSM for the further improvement of PrEP compliancy and reduction of the risk for HIV infection in this population.

Modified transcrestal sinus floor elevation with concomitant implant placement in edentulous posterior maxillae with residual bone height of 5 mm or less: a non-controlled prospective study

The aim of this study was to describe a modified transcrestal sinus floor elevation (mTSFE) technique and to evaluate its clinical effectiveness and reliability when residual bone height is severely reduced. Forty-three maxillary edentulous patients who met the inclusion criteria were enrolled. All patients underwent the mTSFE technique; 66 dental implants were inserted simultaneously. Patient-reported outcomes were assessed 2 weeks after surgery. Prosthetic crowns were placed 6 months after surgery. Radiographic analyses and clinical analyses were conducted to assess the clinical effectiveness and feasibility of mTSFE during a follow-up period of 2-8 years. The mean vertical bone increase after surgery was 8.09 mm, and it decreased to 6.56 mm at 6 months after surgery. Two cases of membrane perforation occurred during surgery and one implant was lost in the third year after surgery; the survival rate at the implant level was 98.48%. No severe postoperative complication was reported and the subjective feeling of patients was acceptable. This mTSFE technique could simplify the operative procedure and might be helpful to reduce intraoperative trauma, as well as to alleviate postoperative discomfort.

[Yang Shoushan Medical Cases in the Wumen Medical School]

The unique manuscript, Yang Shoushan Medical Cases, is now held by the library of Nanjing University of Chinese Medicine.It is the medical cases collection of Yang Shoushan, a well-known doctor of Suzhou in the late Qing Dynasty.It was found that the number of medical cases and the details of each case recorded in this book were much more than that in his other existing medical writings. It greatly enriches the historical materials for the study of Yang's clinical characteristics and academic thought.Its compiler was Huang Shounan, a physician and calligrapher in Suzhou in the late Qing Dynasty and the early Republic of China.This book was not recorded as a book compiled by Huang Shounan before now. This book was believed to be completed in 1890.

Glucosylglycerol Extends Chronological Lifespan of the Budding Yeast via an Increased Osmolarity Response

Glucosylglycerol (GG) is an osmolyte that protects cells from extreme conditions. It is produced by sucrose phosphorylase, an enzyme that uses sucrose and glycerol as substrate. GG protects tissue integrity in desert plants during harsh conditions and guards cyanobacteria against high salinity (halotolerant). However, no extensive research has been conducted on the lifespan application of this compound on the yeast Saccharomyces cerevisiae. We designed this study to (1) characterize GG's effect on yeast chronological lifespan (CLS) and (2) to determine the mechanisms underlying its lifespan promotion on strain DBY746. The results obtained in our study confirm that GG causes increased longevity when administered at moderate doses (48 mM and 120 mM). In addition, we discovered that GG promotes yeast cell longevity by increasing the osmolarity of the culture medium. The maximum lifespan increased by approximately 15.38% and 34.6%, (i.e., 115.38 and 134.61) respectively, upon administration of GG at 48 mM and 120 mM concentrations. Elucidation of the mechanisms underlying this positive response suggests that GG promotes CLS by activities that modulate reactive oxygen species (ROS) generation, as evident in its increased ROS generation (mitohormesis). An increase in medium osmolarity caused by GG supplementation triggers ROS production and promotes longevity in the yeast (S. cerevisiae). An in-depth study on the potential application of this molecule in aging research is crucial; this will aid in expounding the mechanisms of this geroprotector and its longevity supportive tendencies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12088-023-01055-y.

[Miao Zunyi - his life, writings and students]

Miao Zunyi was an influential physician in the mid-Qing Dynasty. He was self-taught as he read a great amount of prescription books of traditional Chinese medicine. He was proficient in medical theories but flexible in treatment. It was recorded in Draft of Qing History that Miao Zunyi, Ye Tianshi and Xue Shengbai were named as "the three schools of Wuzhong". He began to write books in his later years. He wrote prefaces to Pulse Causes, Syndrome and Treatment (Mai Yin Zheng Zhi) and Wu Yi Hui Jiang. His existing works include Treatise on Febrile Disease (Shang Han Ji Zhu), Wen Re Lang Zhao, Song Xin Notes and Song Xin Medical Cases. Miao's Medical Cases and Song Xin Tang Yi An Jing Yan Chao. He had many remarkable students, such like Huang Tang, Guan Ding, Miao Song, and Shen Nianzu.

A coarse-to-fine and automatic algorithm for breast diagnosis on multi-series MRI images

Introduction

Early breast carcinomas can be effectively diagnosed and controlled. However, it demands extra work and radiologist in China often suffer from overtime working due to too many patients, even experienced ones could make mistakes after overloaded work. To improve the efficiency and reduce the rate of misdiagnosis, automatic breast diagnosis on Magnetic Resonance Imaging (MRI) images is vital yet challenging for breast disease screening and successful treatment planning. There are some obstacles that hinder the development of automatic approaches, such as class-imbalance of samples, hard mimics of lesions, etc. In this paper, we propose a coarse-to-fine algorithm to address those problems of automatic breast diagnosis on multi-series MRI images. The algorithm utilizes deep learning techniques to provide breast segmentation, tumor segmentation and tumor classification functions, thus supporting doctors' decisions in clinical practice.

Methods

In proposed algorithm, a DenseUNet is firstly employed to extract breast-related regions by removing irrelevant parts in the thoracic cavity. Then, by taking advantage of the attention mechanism and the focal loss, a novel network named Attention Dense UNet (ADUNet) is designed for the tumor segmentation. Particularly, the focal loss in ADUNet addresses class-imbalance and model overwhelmed problems. Finally, a customized network is developed for the tumor classification. Besides, while most approaches only consider one or two series, the proposed algorithm takes in account multiple series of MRI images.

Results

Extensive experiments are carried out to evaluate its performance on 435 multi-series MRI volumes from 87 patients collected from Tongji Hospital. In the dataset, all cases are with benign, malignant, or both type of tumors, the category of which covers carcinoma, fibroadenoma, cyst and abscess. The ground truths of tumors are labeled by two radiologists with 3 years of experience on breast MRI reporting by drawing contours of tumor slice by slice. ADUNet is compared with other prevalent deep-learning methods on the tumor segmentation and quantitative results, and achieves the best performance on both Case Dice Score and Global Dice Score by 0.748 and 0.801 respectively. Moreover, the customized classification network outperforms two CNN-M based models and achieves tumor-level and case-level AUC by 0.831 and 0.918 respectively.

Discussion

All data in this paper are collected from the same MRI device, thus it is reasonable to assume that they are from the same domain and independent identically distributed. Whether the proposed algorithm is robust enough in a multi-source case still remains an open question. Each stage of the proposed algorithm is trained separately, which makes each stage more robust and converge faster. Such training strategy considers each stage as a separate task and does not take into account the relationships between tasks.

Coexistent diabetes is associated with the presence of adverse phenotypic features in patients with hypertrophic cardiomyopathy

Background

Type 2 diabetes mellitus (DM) is associated with worsened clinical outcomes in hypertrophic cardiomyopathy (HCM) patients. The reasons for this adverse prognostic association are incompletely understood. Although distinct entities both HCM and DM share common features of impaired myocardial energetics and coronary microvascular function.

Purpose

We sought to test the hypothesis that co-existent diabetes is associated with greater reductions in myocardial energetics and perfusion, and higher scar burden in HCM.

Research design and methods

Seventy-five age- and sex-matched participants with concomitant HCM and DM (HCM-DM, n=20), isolated HCM (n=20), isolated DM (n=20) and healthy volunteers (HV, n=15) underwent 31phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance imaging. The HCM groups were matched for HCM phenotype. The DM groups were matched for diabetes treatment, duration, HbA1c, body mass index and hypertension comorbidity.

Results

ESC sudden cardiac death risk scores were comparable between the HCM groups (HCM: 2.2±1.5%, HCM-DM: 1.9±1.2%; p=NS) and sarcomeric mutations were equally common. HCM-DM had the highest NT-proBNP levels (HV: 42 ng/L [IQR: 35–66], DM: 118 ng/L [IQR: 53–187], HCM: 298 ng/L [IQR: 157–837], HCM-DM: 726 ng/L [IQR: 213–8695]; p&lt;0.0001). Left-ventricular ejection fraction, mass and wall thickness were similar between the HCM groups. HCM-DM displayed a greater degree of fibrosis burden with higher scar percentage, and lower global longitudinal strain compared to the isolated HCM. PCr/ATP was similarly decreased in the HCM-DM and DM (HV: 2.17±0.49, DM: 1.61±0.23, HCM: 1.93±0.38, HCM-DM: 1.54±0.27; p=0.0003). HCM-DM had the lowest stress myocardial blood flow (HV: 2.06±0.42 ml/min/g, DM: 1.78±0.45 ml/min/g, HCM: 1.74±0.44 ml/min/g, HCM-DM: 1.39±0.42 ml/min/g; p=0.004).

Conclusions

We show for the first time that HCM patients with DM comorbidity display greater reductions in myocardial energetics, perfusion, contractile function and higher myocardial scar burden and serum NT-proBNP levels compared to patients with isolated HCM despite similar LV mass and wall thickness and presence of sarcomeric mutations. These adverse phenotypic features may be important components of the adverse clinical manifestation attributable to a combined presence of HCM and DM.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Diabetes UK

Female sex and systolic blood pressure are independently associated with coronary microvascular dysfunction in asymptomatic adults with type 2 diabetes

Introduction

Coronary microvascular dysfunction is frequently reported in people with type 2 diabetes (T2D), is associated with reduced exercise capacity, and is a prognostic marker. Identifying modifiable risk factors associated with microvascular dysfunction may facilitate early intervention to improve outcomes in these patients.

Purpose

To identify independent determinants of myocardial perfusion reserve (MPR) in asymptomatic adults with T2D and no prevalent cardiovascular disease.

Methods

Prospective cross-sectional study. People with and without T2D and no signs, symptoms or evidence of cardiovascular disease underwent comprehensive phenotyping with echocardiography, coronary artery calcium scoring, and multiparametric cardiac MRI including adenosine stress and rest perfusion with automated pixel-wise myocardial blood flow (MBF) mapping. Participants with regional perfusion defects indicating obstructive coronary disease or silent myocardial infarct on late-gadolinium enhancement were excluded from analysis. Univariable and multivariable linear regression was performed to identify independent determinants of MPR.

Results

Two-hundred people with T2D (diabetes duration 11±8 years) were compared with 39 sex- and ethnicity-matched non-diabetic controls (Table 1). People with T2D had higher body mass index (BMI) and ambulatory 24-hour systolic blood pressure (SBP). There was evidence of concentric left ventricular (LV) remodelling (higher LV mass/volume), extracellular matrix expansion (higher ECV fraction), and both systolic and diastolic dysfunction (lower global longitudinal systolic strain and E/A ratio, respectively) in those with T2D. Resting MBF was similar between groups, but stress MBF tended to be lower in T2D compared to controls with significantly reduced MPR in T2Ds (2.87±0.86 vs 3.18±0.82, p=0.043). In univariable analysis, MPR correlated with sex, 24-hour SBP, and E/e' ratio. In a multivariable model adjusting for clinical (age, sex, smoking status, BMI, ambulatory SBP, diabetes duration, HbA1c, low-density lipoprotein, albuminuria) and imaging variables (E/e' ratio, LV mass/volume, global longitudinal strain, myocardial ECV, coronary calcium score) known to affect coronary perfusion, female sex (β=−0.227, p=0.013) and 24-hour SBP (β=−0.275, p=0.001) were the only variables independently associated with MPR.

Conclusion

Female sex is associated with coronary microvascular dysfunction in asymptomatic people with T2D but not LV mass or myocardial extracellular volume. Systolic BP is the only modifiable independent determinant of MPR and may be an early target for intervention to prevent heart failure development in these patients.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) United Kingdom through a Research Professorship award (RP-2017-08-ST2-007).British Heart Foundation through a Clinical Research Training Fellowship award (FS/16/47/32190).

Clinical outcomes and myocardial recovery in energetics, perfusion and contractile function after valve replacement surgery in severe aortic stenosis patients with diabetes comorbidity

Background

Aortic stenosis (AS) and type 2 diabetes mellitus (DM) are increasingly frequent comorbidities in aging populations, and diabetes is associated with increased morbidity and mortality after aortic valve replacement (AVR). Although distinct pathological entities, AS and DM share common features of impaired myocardial energetics and coronary microvascular dysfunction (CMD). The mechanisms for the adverse prognostic association between AS and DM are incompletely understood.

Purpose

Utilising 31phosphorus magnetic resonance spectroscopy (31P-MRS) and CMR, we tested the hypotheses that the collective impact of severe AS and DM on the myocardium aggravates the impairment in energetics, function and perfusion.

Methods

Eighty-eight severe AS patients with (AS-DM) and without DM (Iso-AS) undergoing AVR and 15 healthy volunteers were recruited. Patients with coronary artery disease were excluded. Participants with AS underwent 31P-MRS and comprehensive CMR imaging 1 month prior to and 6 months after AVR.

Results

Demographic, biochemical and CMR/31P-MRS data are shown in Table-1. All groups were matched for age and sex distribution, with AS groups matched for surgical scores and frailty scores. NTproBNP levels were similarly elevated in AS groups. Left ventricular (LV) volumes and ejection fraction (EF) were similar between the groups, with no significant difference in LV mass or wall thickness between the AS groups. The baseline differences in myocardial energetics, stress myocardial blood flow (MBF) and global longitudinal strain (GLS) are shown in the Figure. AS-DM patients showed greater reductions in myocardial energetics (p&lt;0.0001), global stress MBF (p&lt;0.0001) and more significant reductions in GLS (p=0.001) than the Iso-AS patients. At 6 month post AVR both AS groups showed significant improvements in stress MBF and GLS. However, only the Iso-AS patients showed significant improvement in myocardial energetics.

AS patients were followed up for a median of 12 months. Cumulative incidence of the clinical events post AVR (composite of cardiovascular death, stroke, heart failure admission, infective endocarditis) were significantly higher in the AS-DM group than the Iso-AS group (Hazard Ratio: 3.35; 95% CI: 0.97–11.6; p=0.02).

Conclusion

Diabetes was associated with increased morbidity and mortality after AVR. We showed for the first time that the collective impact of T2DM and AS on the myocardium aggravates energetic impairment, CMD and contractile dysfunction. While myocardial recovery following AVR was associated with similar improvements in perfusion and contractile function in severe AS patients with and without T2DM, improvements in energetics were only detected in isolated AS patients. However, despite the significant improvements in contractile function and perfusion following AVR in diabetes patients, these parameters remained lower in the group with diabetes comorbidity compared to isolated AS patients.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Wellcome Trust

Improved diagnostic accuracy for apical hypertrophic cardiomyopathy

Introduction

The diagnosis of apical hypertrophic cardiomyopathy (ApHCM) is contingent on demonstrating apical maximum wall thickness (MWT) of ≥15mm; the same threshold as other HCM subtypes. However, the myocardium naturally tapers towards the apex in healthy individuals, so ≥15mm MWT is proportionately higher in the apex than in naturally thicker basal segments. Using cardiac magnetic resonance (CMR), relative ApHCM has been described (typical ECG features, loss of apical tapering, cavity obliteration but hypertrophy &lt;15mm). Wall thickness measurement using machine learning now exceeds human performance.

Purpose

We aimed to redefine the optimal diagnostic threshold for ApHCM using segment-specific criteria based on a large cohort of healthy control subjects.

Methods

Segmental wall thickness was measured using healthy subjects from the UK Biobank using a clinically validated machine learning algorithm1,2. A normative reference range was established for all 16 segments, conditioned to body surface area (BSA), sex and age. Derived segment-specific wall thickness thresholds were used to define optimal disease thresholds for patients clinically managed with overt (MWT ≥15mm) and relative ApHCM (MWT &lt;15mm, but typical ECG and imaging findings).

Results

4118 UK biobank subjects were used to define normal segmental thicknesses and reference ranges. These were applied to ApHCM (73 overt, 31 relative). There were no apical wall thickness age related differences. The upper limit of the 95% confidence interval corresponded to a combined maximum apical MWT for both males and females of 10.4mm using non-indexed measurement, or 5.6mm/m2 when indexed to BSA. Non-indexed segmental threshold identified 100% of ApHCM patients (true positives), 81% (25 of 31) relative ApHCM and 3% (115 of 4118) of healthy UK biobank subjects (false positives). Indexed segmental thresholds improved the diagnostic potential in relative ApHCM without an increase in false positives (100% of ApHCM patients, 84% (26 of 31) of relative ApHCM patients, and 3% healthy UK biobank (127 of 4118).

Conclusion

We propose new diagnostic criteria for ApHCM using segmental indexed apical wall thickness of &gt;5.6 mm/m2 to better identify inappropriate apical hypertrophy in those whose wall thickness does not meet current criteria for diagnosis.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Body mass index associated differences in cardiac stress energetics in type 2 diabetes

Background

Patients with T2D and heart disease have normal body mass index (BMI), suggesting that diabetes and obesity mediate cardiovascular change by different mechanisms. Changes in cardiac energy metabolism in lean diabetic patients during exercise stress have not been previously reported.

Objectives

We aimed to assess if there are BMI-associated differences in cardiac stress metabolism in patients with T2D.

Methods

Twenty-five overweight T2D patients (O-T2D) and eleven lean T2D patients (LnT2D), age- and ethnicity-matched and with no other comorbidities were studied. Patients were on oral hypoglycaemics only and were free of diabetes complications. Participants underwent rest and dobutamine stress phosphorus magnetic resonance spectroscopy (31P-MRS) and cardiovascular magnetic resonance (CMR) at 3T for the assessment of myocardial phosphocreatine to ATP ratio (PCr/ATP) as a measure of myocardial energetics, biventricular volumes, rest and stress left ventricular (LV) ejection fraction, global longitudinal shortening, and mitral in-flow E/A ratio for assessment of diastolic function and perfusion.

Intravenous Dobutamine was administered at a dose of 10μg/kg/min, increasing at 90 second intervals up to a maximum of 40 μg/kg/min to achieve a target heart rate of 65% of the age-predicted maximal heart rate. Mean rate pressure product (RPP) was recorded at rest and stress. Heart rate was maintained at target for the duration of the 31P-MRS and stress CMR cine, mitral in-flow and perfusion acquisitions.

Results

The cardiac volumes, systolic or diastolic function and LV mass were similar between LnT2D and O-T2D. Although the O-T2D patients had a numerically lower rest and stress PCr/ATP ratio, this did not reach statistical significance. Resting PCr/ATP was reduced in LnT2D and O-T2D patients similarly. However, LnT2D showed a greater reduction in PCr/ATP (stress PCr/ATP LnT2D 1.51±0.2 vs O-T2D 1.41±0.25, p=0.02) despite similar increases in RPP. Stress myocardial blood flow (MBF) was also significantly lower in the O-T2D patients. There were significant correlations of BMI with LV mass (r=0.35, p=0.03); stress LVEF (r=−0.34, p=0.04); stress MBF stress (r=−0.53, p=0.001) and stress E/A (r=0.46, p=0.01) (figure 1).

Conclusions

Despite their better stress perfusion and similar glycaemic control, LnT2D show worse metabolic reserve characterised by more significant decrements in energetics in response to hemodynamic stress compared to overweight patients with T2D. Higher BMI correlates inversely with stress myocardial blood flow and with stress left ventricular ejection fraction. The presence of these subtle alterations in measures of stress metabolism and perfusion might signify a distinct metabolic phenotype of “lean diabetic cardiomyopathy”. Future studies are needed to further delineate alterations in cardiac energy metabolism in lean and overweight/obese type 2 diabetes patients, and their role in the development of cardiac dysfunction.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Wellcome TrustBHF

Gestational diabetes, preeclampsia and the maternal heart

Background

Gestational diabetes mellitus (GDM) and preeclampsia (pE) are both associated with an increased risk of cardiovascular mortality and morbidity, including an increased risk of developing heart failure in later life. Both conditions are increasing in prevalence; GDM affects up to 12% and pE affects 3–5% of pregnancies worldwide. Compromised cardiac energy production is an important contributor to most forms of heart disease. The changes in myocardial energetics in GDM and pE have not been characterised previously.

Purpose

We sought to assess if women with GDM and women with pE in the third trimester of pregnancy exhibit adverse cardiac alterations in myocardial energetics, function or tissue characteristics.

Methods

Thirty-eight healthy pregnant (HP) women, thirty women with GDM and fifteen women with pE were recruited, matched for age and ethnicity. Participants underwent phosphorus magnetic resonance spectroscopy and cardiovascular magnetic resonance for assessment of myocardial energetics (phosphocreatine to ATP ratio (PCr/ATP)), tissue characteristics, biventricular volumes and ejection fractions, left ventricular (LV) mass, global longitudinal strain (GLS) and mitral in-flow E/A ratio.

Results

The biochemical characteristics and multiparametric MR results are given in Table 1.

The women in the GDM and the pE groups had higher body-mass index. There was a stepwise increase in the systolic and diastolic BP from the HP to the GDM to the pE group. There was no difference in NTproBNP concentrations between the groups. The gestational weight gain was higher in women with GDM and pE compared to the HP group.

The women in the GDM and the pE groups showed similar reductions in myocardial PCr/ATP ratios compared to HP group (Figure 1a), accompanied by lower LV end-diastolic volumes and higher LV mass (Figure 1b) and enhanced LV concentricity in both groups (Figure 1c). While LV ejection fractions were similar across the groups, the GLS was reduced in women with GDM and in women with pE (Figure 1d).

Conclusions

We show here for the first time that despite no prior diagnosis of diabetes or hypertension, women with GDM or pE manifest impaired myocardial contractility and higher LV mass, associated with reductions in myocardial energetics. These findings may aid our understanding of the long-term cardiovascular risks associated with these conditions.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Wellcome Trust

Evaluation of cardiac involvement in patients with clinical post-COVID-19 syndrome

Introduction

The underlying pathophysiology of Post-COVID-19 syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus magnetic resonance spectroscopy (31P-MRS) allows non-invasive assessment of the myocardial energetic state.

Purpose

We sought to assess whether Post-COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and tissue characteristics or energetic derangement.

Methods

Prospective case-control study. A total of 20 patients with a clinical diagnosis of Post-COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and ten matching controls underwent 31P-MRS and CMR at 3T at a single time point. (Figure 1) All patients had been symptomatic with acute COVID-19, but none required hospital admission.

Results

Between the Post-COVID-19 syndrome patients and matched contemporary controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes, left ventricular mass), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T1 and extracellular volume [ECV] fraction mapping, late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with Post-COVID-19 syndrome showed subepicardial hyperenhancement on the late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, ECV, T1, T2 mapping or energetics. This patient was excluded from statistical analyses. (Table 1)

Conclusion

In this study, the overwhelming majority of patients with a clinical Post-COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Welcome Trust Clinical Career Development Fellowship (221690/Z/20/Z);NIHR-UKRI COVID-19 Rapid Response Rolling Call (COV0254)ESC Training Grant

Chidamide with PEL regimen (prednisone, etoposide, lenalidomide) for elderly or frail patients with relapsed/refractory diffuse large B-Cell lymphoma -results of a single center, retrospective cohort in China

Treatment for relapsed/refractory Diffuse Large B-Cell Lymphoma (R/R DLBCL) is evolving rapidly due to the emergence of novel drugs, of which histone deacetylase inhibitors (HDACis) are an important example. This study showed efficacy in patients with R/R DLBCL after failure of conventional therapies. We conducted a single-center, retrospective study of 34 frail or elderly R/R DLBCL patients who had been treated off-label with chidamide-containing regimens from 2018 to 2020. X² or Fisher test were used to compare response rate and Kaplan-Meier method was used to perform the survival analyses which compared with log-rank test between different groups. The test standard was p < 0.05. In total, 34 patients with R/R DLBCL received CPEL+/-R for at least 1 cycle were included. Most of them were refractory patients (n = 28,82.4%). The interim objective response rate (ORR) was 73.5% (32.4% complete remission [CR]), and the ultimate ORR was 50.0% (35.3% CR). After a median follow-up of 13.1 months, the median progression-free survival (PFS) was 10.5 months (95%CI 6.4-14.6) and the median overall survival (OS) was 19.3 months (95%CI 11.8-26.9). The 1 year expected PFS and OS rate was 43.0% and 73.7%, respectively. The most common grade 3/4 hematologic adverse events (AEs) were neutropenia (n = 11,32.3%) and anemia (n = 4, 11.8%) 0.23.5% (8/34) of all patients experienced grade 3/4 nonhematologic AEs. No treatment-related deaths were observed. The study showed chidamide-included regimen could be an option for R/R DLBCL patients ineligible for intensive chemotherapies. Current data showed favorable efficiency and moderate safety profile. Further study is warranted for better illustration of efficacy and usage in combination therapies.

Convolutional neural network transformer (CNNT) for free-breathing real-time cine imaging

Funding Acknowledgements

Type of funding sources: None.

Background

Real-time cine imaging does not require breath-holding and is a robust cine imaging technique in the presence of irregular heartbeats. It is a good alternative to the conventional breath-hold retro-gated cine for simplified acquisition and improved patient comfort. Real-time acquisition is achieved with the single-shot BSSFP readout without retro-gating. To maintain good temporal and spatial resolution, higher acceleration (e.g. &gt;4x parallel imaging) is required. As a result, the real-time cine images experience reduced signal-to-noise ratio (SNR), which limits its clinical acceptance.

Purpose

We developed a novel deep learning model architecture, the Convolutional Neural Network Transformer (CNNT), to improve the quality of real-time cine, under 4x, 5x and 6x acceleration.

Method

Convolutional Neural Networks (CNN) are widely used in CMR research to process cardiac images. Cardiac images are often acquired as a time series with strong inter-phase correlation. We combined the CNN with the more recent transformer model to develop a novel CNNT architecture. It takes in the entire 2D+T time series as input and has advantages of CNN for efficient computation and spatial invariance. It further inherits the advantages of attention layer in the transformer and is able to efficiently utilize the temporal correlation within a time series.

A CNNT model is developed to improve the SNR of real-time cine imaging. N=10 patients were scanned at a heart center, with 4x, 5x and 6x acceleration. Typical imaging parameters are: FOV 360×270mm2, flip angle 50°, acquired matrix size 160×90 for R=4 acceleration, 192×108 for R=5 and 6, temporal resolution 40ms for R=4, 42ms for R=5 and 35ms for R=6. The real-time images went through a TGRAPPA reconstruction [1] and the CNNT model. The SNR of TGRAPPA was measured with SNR units [2]. The Monte-Carlo pseudo-replica test was used to measure SNR for the CNNT model. For every cine series, two phases were picked for the end-systole and end-diastole. For every image picked, two region-of-interests were drawn in the myocardium and in the LV blood pool. The CNNT model was deployed inline on the MR scanner using the Gadgetron InlineAI [3].

Results

Figure 1 gives real-time cine images for three accelerations, reconstructed with TGRAPPA and CNNT. The parallel imaging TGRAPPA reconstruction suffers significant SNR loss from elevated g-factor and less acquired data. The deep learning CNNT model recovered SNR even at the very high 6x acceleration, without observed loss of boundary sharpness.

Table 1 lists the SNR measurement results. The TGRAPPA SNR decreased ∼4x from R=4 to R=6 for both the blood and myocardium. For the blood, the CNNT increased the SNR by 170%, 335%, 371% at R=4, 5 and 6. For the myocardium, the SNR increases were 335%, 634% and 828%.

Conclusion

We developed a convolutional neural network transformer model to recover the SNR for real-time cine imaging at higher acceleration.

CNNT DB-LGE: free-breathing dark blood late enhancement imaging using the convolutional neural network transformer speeds acquisition by 50%

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported in part by the Division of Intramural Research of the National Heart, Lung, and Blood Institute, National Institutes of Health (grants Z1A-HL006214-05 and Z1A-HL006242-02).

Background

Dark blood late gadolinium enhancement (DB-LGE) imaging shows superior delineation of myocardial infarction (MI), especially at the sub-endocardial boundary. Our previous study [1] developed a free-breathing DB-LGE with the single shot SSFP readout, phase sensitive inversion recovery (PSIR) reconstruction, and respiratory motion corrected averaging. To compensate the potential signal-to-noise ratio loss, our previous DB-LGE doubled the measurements, thereby increasing the acquisition time.

Purpose

In this study, we developed a deep learning image enhancement model using a novel neural network architecture called the convolutional neural network transformer (CNNT) to improve the image quality of DB-LGE and to reduce the acquisition time by decreasing the number of measurements.

Methods

A novel image enhancement model was developed using a novel network architecture called the Convolutional Neural Network Transformer (CNNT) proposed by us. This architecture is suitable for the 2D+Time CMR acquisition, by exploiting the temporal correlation between images over multiple averages.

The evaluation was first retrospectively conducted on a cohort of 12 patients acquired with the original protocol [1] using the full 16 measurements. For every subject, a complete short-axis stack (typically 12 slices) was acquired to cover the entire left ventricular. The imaging data was reconstructed in three ways. Original: using all acquired 16 measurements. This is our base-line protocol. Original 50%: using only the first 8 measurements. CNNT 50%: using only the first 8 averages, but performing the CNNT deep learning image enhancement before MOCO PSIR reconstruction. Two experienced imaging researchers (PK and MF, &gt;10 years of experience for both) scored all DB-LGE images for the overall quality, diagnostic confidence and delineation of MI/boundaries (5 = excellent, 4 = good, 3 = fair, 2 = poor, and 1 = non-diagnostic). The CNNT DB-LGE was deployed to the MR scanner using the Gadgetron InlineAI [2].

Results

Figure 1 gives examples of DB-LGE with three reconstruction methods. The CNNT image has higher SNR and well delineated MI. The Original images with the longest acquisition have good quality and the Original-50% acquired with 8 measurements are good quality but have reduced SNR. The mean scores for overall image quality, diagnostic confidence and MI delineation of two reviewers were 4.88±0.23, 4.88±0.23, 4.83±0.25 for CNNT and 4.96±0.14, 4.96±0.14, 4.67±0.39 for the original approach. No significant differences were found between the original and the CNNT (P&gt;0.15 for all).

Figure 2 shows an acute MI patient prospectively acquired with the 50% scan time reduction, with and without the CNNT enhancement. The resulting PSIR images well delineate the MVO due to the acute MI, with improved SNR.

Conclusion

A novel CNNT model was proposed and evaluated to speed up the free-breathing MOCO DB LGE by 50% without sacrificing image quality.

Improving the diagnostic accuracy of apical hypertrophic cardiomyopathy using machine learning

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Hughes is supported by the British Heart Foundation (grant number FS/17/82/33222).

Introduction

The imaging criteria for diagnosis of apical hypertrophic cardiomyopathy (ApHCM) is a maximum wall thickness (MWT) ≥15mm. CMR enables detection of subtle phenotypic features (e.g. loss of apical tapering, cavity obliteration) and coupled with characteristic electrocardiogram changes, ApHCM can be diagnosed without overt hypertrophy. However, these patients are not captured by current diagnostic criteria.

Purpose

We sought to use a machine learning tool to quantify wall thickness and identify patients with ‘relative’ ApHCM that do not reach current diagnostic thresholds.

Methods

CMR images from 4118 healthy participants from the UK Biobank were segmented automatically with a clinically validated machine learning algorithm and wall thickness measured at all point in the myocardium by solving a solution to Laplace’s equation. MWT were pooled into 16 AHA segments and indexed to body surface area (BSA). The non-indexed and indexed segmental upper limit of normal was calculated as the mean + 3 standard deviations (the equivalent of 95% confidence interval after correcting for multiple [16] comparisons using the Bonferroni method).

Results

73 overt ApHCM subjects (MWT&gt;15mm) and 31 relative ApHCM subjects underwent CMR scanning. In healthy controls, the non-indexed (and indexed) upper limits were calculated for the apical-anterior 10.2mm (5.2 mm/m2), apical-septal 11.1mm (5.6 mm/m2), apical-inferior 10.5mm (5.3 mm/m2) and apical-lateral 10.1mm (5.2 mm/m2) segments. With a non-indexed cut-off, all (73 of 73) overt ApHCM and 84% (26 of 31) relative ApHCM were classified as having an abnormally thick apex. 3% (127 of 4118) of the healthy UK Biobank cohort were classified as abnormal, as expected. Using an indexed cut-off, all overt ApHCM and 87% (27/31) relative ApHCM were classified as abnormal, and 3% (123 of 4118) of the healthy UK Biobank cohort were misclassified.

Conclusion

We can successfully classify 87% of relative ApHCM patients from a normative reference range derived from a large cohort of healthy patients – a significant improvement on existing methods. We show that the specificity and sensitivity is increased when MWT is indexed to BSA. For practical clinical application, we recommend a cut-off of 10mm or an indexed cut-off of 5mm/m2 in any apical segment to diagnose apical LVH. Overt and relative apical HCM examplesHealthy controls AHA maps (non-indexed)

Speeding up cardiac MR segmentation with semi-supervision: applications in cine imaging

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): This material is based upon work supported by the Google Cloud Research Credits program with the award GCP19980904.

Background

Segmentation is an important postprocessing step in cardiac magnetic resonance (CMR) imaging that enables quantitative assessment of functional parameters. Deep learning can automate the segmentation process, producing accurate contours of cardiac structures while reducing the time required to analyze images and the interobserver variation compared to manual analysis. However, common approaches to training neural networks (NNs) require large amounts of labeled data, which is costly to generate and slows down the development of CMR segmentation NNs for new applications. Semi-supervision is an approach to alleviate this labeling burden by relying on abundant unlabeled data and a smaller amount of labeled data to train NNs.

Purpose

We propose a novel semi-supervised method to train CMR segmentation NNs. We use the proposed method to train NNs to segment the left ventricle in CMR cine images. Ultimately, we aim to show that semi-supervision can drastically reduce the amount of labeled data required to develop machine learning segmentation applications for CMR while maintaining high performance.

Methods

Our dataset consists of 1,208 short-axis cine CMR images and 1,244 long-axis cine CMR images. An expert annotator manually segmented the endocardium on the end-diastolic and end-systolic short-axis and long-axis images and the epicardium on the end-diastolic short-axis images. We split the dataset randomly by patient into 60% training, 20% validation, and 20% testing data. We train semi-supervised segmentation networks using a supervised cross-entropy loss to learn from the labeled training data and a cosine embedding loss in addition to a pseudo-labeling step to learn from the unlabeled training data. To evaluate how performance changes with different amounts of labeled training data, we vary the percent of training data that has labels from &lt;1%-100%. We evaluate the predicted segmentation masks using the Dice coefficient.

Results

Using only 100 labeled image slices, the semi-supervised segmentation NNs achieve a mean Dice coefficient within 1.10% of networks trained with fully labeled training sets, corresponding to &gt;85% reduction in required labeled training data (Table 1). The proposed semi-supervised method improves performance over naïve training by 6.21% for the most limited labeled data setting (i.e., 10 labeled image slices; Figure 1).

Conclusion

We have shown that NNs trained with limited labeled data achieve high performance on left ventricle segmentation in short-axis and long-axis CMR cines. The proposed approach is flexible and broadly applicable to different CMR segmentation tasks, enabling rapid development of segmentation networks for many cardiac structures and applications. Table 1Figure 1

Knockdown of the long non‑coding RNA CACNA1G‑AS1 enhances cytotoxicity and apoptosis of human diffuse large B cell lymphoma by regulating miR‑3160‑5p

Abstract: Long non-coding RNAs (lncRNAs) have been confirmed to be connected with tumor proliferation, apoptosis, metastasis and recurrence. Previous studies have indicated that lncRNA calcium voltage-gated channel subunit α1 G (CACNA1G)-antisense 1 (AS1) can function as a pro-oncogene in several types of cancer. However, the specific role and mechanism of CACNA1G-AS1 have not been fully elucidated in human diffuse large B cell lymphoma (DLBCL). In the present study, CACNA1G-AS1 expression was verified in DLBCL tissues and cells by reverse transcription-quantitative PCR, and the relationship between CACNA1G-AS1 and microRNA (miR)-3160-5p was confirmed using luciferase reporter assays. After CACNA1G-AS1-knockdown and miR-3160-5p-overexpression, MTT, colony formation and flow cytometry assays were conducted to assess the changes in the cytotoxicity and apoptosis of OCI-Ly10 and SUDHL-4 cells. In addition, in vivo experiments were performed to determine the impact of CACNA1G-AS1-knockdown on tumor growth and apoptosis. It was revealed that CACNA1G-AS1 was highly expressed in DLBCL tissues and cells and that expression of CACNA1G-AS1 was associated with the clinical stage of DLBCL. Functionally, CACNA1G-AS1-knockdown was demonstrated to increase cytotoxicity and expedite apoptosis in DLBCL cells in vitro and in vivo. In addition, CACNA1G-AS1 could downregulate miR-3160-5p by targeting binding in DLBCL cells. Overexpression of miR-3160-5p had the same effects on the cytotoxicity and apoptosis of DLBCL cells as CACNA1G-AS1-knockdown. Overall, the present study revealed that CACNA1G-AS1-knockdown and miR-3160-5p-overexpression could prevent DLBCL carcinogenesis, which might provide novel therapeutic targets for DLBCL.

Pharmacological inhibition of eIF2alpha phosphorylation by integrated stress response inhibitor (ISRIB) ameliorates vascular calcification in rats

Vascular calcification (VC) is an independent risk factor for cardiovascular events and all-cause mortality with the absence of current treatment. This study aimed to investigate whether eIF2alpha phosphorylation inhibition could ameliorate VC. VC in rats was induced by administration of vitamin D3 (3×10(5) IU/kg, intramuscularly) plus nicotine (25 mg/kg, intragastrically). ISRIB (0.25 mg/kg·week), an inhibitor of eIF2alpha phosphorylation, ameliorated the elevation of calcium deposition and ALP activity in calcified rat aortas, accompanied by amelioration of increased SBP, PP, and PWV. The decreased protein levels of calponin and SM22alpha, and the increased levels of RUNX2 and BMP2 in calcified aorta were all rescued by ISRIB, while the increased levels of the GRP78, GRP94, and C/EBP homologous proteins in rats with VC were also attenuated. Moreover, ISRIB could prevent the elevation of eIF2alpha phosphorylation and ATF4, and partially inhibit PERK phosphorylation in the calcified aorta. These results suggested that an eIF2alpha phosphorylation inhibitor could ameliorate VC pathogenesis by blocking eIF2alpha/ATF4 signaling, which may provide a new target for VC prevention and treatment.

Rituximab plus cladribine versus R-CHOP in frontline management of marginal zone lymphoma in China: a propensity-score matched multicenter study

Marginal zone lymphoma (MZL) is an uncommon subtype of non-Hodgkin lymphoma (NHL). Combination of rituximab and cladribine (R-2CdA) is a potential option for indolent NHL (iNHL) and mantle cell lymphoma (MCL) patients. The goal of this multicenter retrospective study was to assess the efficacy and safety of R-2CdA in MZL to support consensus-reaching in first-line therapy in advanced-stage patients. We searched electronic medical records databases of eight centers in China. Between November 2014 and December 2019, 183 symptomatic advanced MZL patients (42 treated with R-2CdA and 141 with rituximab plus cyclophosphamide, adriamycin, vincristine, and prednisone [R-CHOP]) were identified. After propensity score matching (PSM) (1:1) to adjust for clinical characteristics, 39 patients from each treatment arm were selected. The overall response rate (ORR) (84.6% vs. 94.9%, P = 0.263) and complete response rate (59.0% vs. 66.7%, P = 0.487) were comparable between two protocols. Neither progression-free survival (PFS), including the 5-year PFS (67.7% vs. 56.1%, P = 0.352), nor overall survival was improved by R-2CdA versus R-CHOP. However, R-2CdA was more tolerable than R-CHOP in MZL patients regarding grade 3/4 hematological adverse events (odds ratio [OR] 0.565, 95% confidence interval [CI] neutropenic fever (OR 0.795, 95% CI 0.678-0.932), and infections (OR 0.800, 95% CI 0.640-1.000). Overall, our study demonstrated that R-2CdA is potentially as effective as but safer than R-CHOP in advanced MZL.

Penpulimab for Relapsed or Refractory Classical Hodgkin Lymphoma: A Multicenter, Single-Arm, Pivotal Phase I/II Trial (AK105-201)

Background

Nearly all anti-PD-1 antibodies are of the IgG4 isotype, and thus possess residual FcR effector functions. Such anti-PD-1 antibodies are also associated with immune tolerance and escape due to instability of the CH3 domain and Fc-Fc interaction. In this trial, we examined the efficacy and safety of penpulimab, a novel IgG1 anti-PD-1 antibody that does not bind to the Fc receptor, in patients with refractory or relapsed classical Hodgkin lymphoma (R/R cHL).

Methods

Adult patients (≥18 years of age) with R/R cHL received 200 mg penpulimab once biweekly until disease progression or unacceptable toxicities for a maximum of 24 months. The primary endpoint was objective response rate (ORR) based on the Independent Radiology Review Committee per Lugano 2014 criteria. Secondary endpoints included progression-free survival (PFS), overall survival (OS), treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs).

Results

A total of 94 patients were enrolled. The median follow-up was 15.8 months. The ORR was 89.4% (95% CI 80.8%, 95.0%) in the full analysis set (85 patients). Forty (47.1%) patients achieved complete remission, 36 (42.4%) patients achieved partial remission. The 12-month PFS rate was 72.1% (95% CI 60.5%, 80.8%) and the 18-month OS rate was 100%. Totally 97.9% (92/94) of patients experienced at least one TRAE. The rate of grade 3 and above TRAEs was 26.6% (25/94). In addition, 51 (54.3%) patients experienced an irAE, and 4 (4.3%) patients developed grade 3 or above irAEs. No irAE-related death occurred.

Conclusions

Penpulimab was effective and safe in patients with R/R cHL.

[Effect of tourniquet on morphology and stiffness of quadriceps in patients receiving total knee arthroplasty: a randomized controlled trial]

Objective: To evaluate tourniquet effect on the morphology and stiffness of quadriceps in patients receiving total knee arthroplasty (TKA). Methods: Total of 80 patients with primary knee osteoarthritis receiving unilateral primary TKA from August 2020 to June 2021 in Peking University Third Hospital were enrolled in this randomized controlled trial. The patients were randomly divided into tourniquet group and non-tourniquet group (40 cases in each group). The study measured and compared postoperative thickness and stiffness of quadriceps, as well as circumference of the affected thigh in two groups. Results: There were 11 males and 29 females in tourniquet group, 9 males and 31 females in non-tourniquet group, with mean age of (69.1±5.1) years and (67.4±5.3) years, respectively. There was no significant difference in demographic information such as gender, age and BMI (all P<0.05). Postoperative thickness of quadriceps, stiffness of quadriceps and circumference［x¯±s or M （Q₁，Q₃）］of the affected thigh in all patients were (2.76±0.69) cm, 25.20 (17.83, 32.90) m/s, 54.00 (51.13, 56.00) cm. These outcomes in tourniquet and non-tourniquet group［x¯±s or M （Q₁，Q₃）］were (2.78±0.76) cm and (2.73±0.61) cm, 24.00 (17.15, 33.13) m/s and 25.20 (18.68, 32.85) m/s, 54.00 (49.75, 55.00) cm and 54.50 (52.13, 57.53) cm, respectively; no significant deference was found in these indexes between the two groups (all P>0.05). Conclusion: Tourniquet has no significant effect on morphology and stiffness of quadriceps in patients undergoing TKA.

[Status of HVPG clinical application in China in 2021]

Objective: The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China. Methods: This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems. Results: According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%). Conclusion: Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Efficacy and Safety of a Pegasparaginase-Based Chemotherapy Regimen vs an L-asparaginase-Based Chemotherapy Regimen for Newly Diagnosed Advanced Extranodal Natural Killer/T-Cell Lymphoma: A Randomized Clinical Trial

Importance

The L-asparaginase-based SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide) chemotherapy regimen has shown higher response rates and survival benefit over an anthracycline-containing regimen. However, the safety profile was not satisfied. A well-tolerated regimen with promising efficacy is lacking.

Objective

To compare the efficacy and safety of the DDGP (dexamethasone, cisplatin, gemcitabine, and pegaspargase) regimen with the SMILE regimen in newly diagnosed advanced-stage (III/IV) extranodal natural killer/T-cell lymphoma (ENKL).

Design, Setting, and Participants

This was an open-label, multicenter, randomized clinical trial that took place across 12 participating hospitals in China from January 2011 to February 2019. Patients were eligible if they were 14 to 70 years old with newly diagnosed ENKL in stages III/IV and had an Eastern Cooperative Oncology Group performance status of 0 to 2. Eligible patients were evenly randomized to either the DDGP or SMILE group.

Interventions

Patients in each group were treated with the assigned regimen every 21 days for 6 cycles.

Main Outcomes and Measures

The primary end point was progression-free survival (PFS), and secondary end points included overall response rate and overall survival (OS). The adverse events between the DDGP and SMILE groups were compared.

Results

Among the 87 randomized patients, 80 received treatment (40 in the DDGP group and 40 in the SMILE group); the median (IQR) age was 43 (12) years, and 51 (64%) were male. The baseline characteristics were similar between the groups. At a median follow-up of 41.5 months, the median PFS was not reached in the DDGP group vs 6.8 months in the SMILE group (HR, 0.42; 95% CI, 0.23-0.77; P = .004), and the median OS was not reached in the DDGP group vs 75.2 months in the SMILE group (HR, 0.41; 95% CI, 0.19-0.89, P = .02). The PFS rate at 3 years and OS rate at 5 years were higher in the DDGP group vs the SMILE group (3-year PFS, 56.6% vs 41.8%; 5-year OS, 74.3% vs 51.7%). The overall response rate was higher in the DDGP group than in the SMILE group (90.0% vs 60.0%; P = .002). Grade 3 and 4 hematologic toxic effects were more frequently reported in the SMILE group vs the DDGP group (leukopenia, 85.0% vs 62.5%; neutropenia, 85.0% vs 65.0%).

Conclusions and Relevance

In this randomized clinical trial, the DDGP regimen showed promising preliminary results for patients with newly diagnosed local advanced ENKL. A confirmation trial based on larger population is warranted.

Trial Registration

ClinicalTrials.gov Identifier: NCT01501149.

POS0549 IMBALANCED Tfr/Tfh IN PERIPHERAL BLOOD OF NEW-ONSET RHEUMATOID ARTHRITIS

Background

Rheumatoid arthritis (RA) is a kind of autoimmune disease characterized with chronic aggressive arthritis, presence of abnormal antibodies and persistent synovitis[1]. However, the pathogenesis of RA remained unclear by now. Several observations have showed that the breakdown of immune tolerance was involved in the development of RA. T follicular regulatory (Tfr) cells and T follicular helper (Tfh) cells, as a new subset of CD4+T cell, can exert an opposite effect in the regulation of humoral immunity[2]. Intensive researches have showed that the imbalance of Tfr/Tfh cell is related to the pathogenesis and development of autoimmune disease. There is still a lack of understanding of the relationship between Tfr/Tfh and RA, which needs further exploration.

Objectives

To detect the expression of Tfh and Tfr cells in thr peripheral blood of patients with new-onset RA and healthy controls, and to explore the role of Tfh and Tfr cells in the pathogenesis and development of RA.

Methods

We enrolled 26 patients with new-onset RA who hospitalized at the Second Hospital of Shanxi Medical University from the June 2021 to the November 2021. And 17 age and gender-matched healthy adults were anticipated as controls. The absolute number of Tfh and Tfr cells in peripheral blood was detected by flow cytometry. Disease activity indicators were collected including erythrocyte sedimentation rate (ESR, mm/h) and Disease Activity Score in 28 joints (DAS28). Then we compared the expression of Tfh and Tfr cells between the patients and healthy controls and conducted the correlation analysis with disease activity.

Results

There was significant decreased level of Tfr cells in the patients with new-onset RA compared with healthy controls (P<0.001) and a lower ratio of Tfr/Tfh in the patients (P<0.01). The reduced Tfr cells and Tfr/Tfh were significant negative correlation with the disease activity indicators including ESR and DAS28 (r=-0.305, P=0.033). There was no statistically significant in the absolute number of Tfh cells between patients and healthy controls, but the level of Tfh cell showed an increasing trend in new-onset RA.

Conclusion

The results we investigated here showed that new-onset RA exhibited an imbalance of Tfr/Tfh, specifically reduced Tfr cells, compared with healthy controls, which were negatively correlated with higher disease activity in RA. It was likely that the imbalance of Tfr/Tfh in peripheral blood played an important role in the development of RA, which may be a target to treat RA.

Table 1.

A summary of data of all enrolled patients with RA and healthy controls

HC(n=17)New-onset RA(n=26)P valueAge(years)51.94±13.0355.88±13.56P=0.35Sex(male/female)4/137/19P=0.81ESR(mm/h) a-54.85±32.71-DAS28 a-5.09±1.56-Tfh cell count(cell/UL)b43.156(23.277,106.638)83.914(38.133,119.662)0.214Tfr cell count(cell/UL)b1.422(0.882,1.893)0.441(0.116,2.888)0.025*Tfr/Tfhb0.030(0.014,0.049)0.011(0.001,0.024)0.001**

a Results are expressed as the mean ± standard error. b Results are expressed as the median(Q1,Q3).

Normally distributed continuous variables were analyzed by the independent-samples Student’s t-test. And nonparametric variables were analyzed by Mann–Whitney U test

Figure 1.

The differences of Tfr and Tfh cells in peripheral blood between the healthy controls and patients with RA. Tfr cells were higher in new-onset RA leading to an imbalance of Tfr/Tfh. Statistical analyses were performed by the Mann-Whitney U test. (*P<0.05, **P<0.01)

Figure 2.

The correlation of disease activity with the level of Tfr cells and Tfr/Tfh. Tfr cells and Tfr/Tfh were negative associated with ESR and DAS28. Statistical analyses were performed by the Spearman correlation analysis.

References

[1]Sparks, J.A. Rheumatoid Arthritis [J]. Ann Intern Med, 2019, 170(1).DOI: 10.7326/AITC201901010.

[2]Deng, J., Y. Wei, V.R. Fonseca, L. Graca, and D. Yu. T follicular helper cells and T follicular regulatory cells in rheumatic diseases [J]. Nat Rev Rheumatol, 2019, 15(8): 475-490.DOI: 10.1038/s41584-019-0254-2.

Disclosure of Interests

None declared.

Significant Reorientation Transition of Magnetic Damping Anisotropy in Co2FeAl Heusler Alloy Films at Low Temperatures

The temperature (T) dependences of magnetization dynamics, especially for magnetic damping anisotropy, have been systematically investigated in well-ordered Co2FeAl films with a biaxial anisotropy. It is found that the damping anisotropy factor Q, defined as the fractional difference of damping between the hard and easy axes, changes from 0.35 to -0.09 as T decreases from 300 to 80 K, performing a distinctive reorientation transition at T ∼ 200 K. Through the thickness-dependent damping measurement results, the damping anisotropy reorientation is verified to originate from the competitions between the intrinsic anisotropic distribution of bulk spin orbit coupling and the interfacial two-magnon scattering. The former governs the effective damping at high temperatures, while the latter with an opposite fourfold symmetry gradually plays a dominant role at reduced temperatures, leading to the transition of the Q value from positive to negative. The clear clarification of damping anisotropy variation as well as the underlying mechanism in this study would be of great importance for designing key spintronic devices with optimized dynamic magnetic properties.

Chidamide plus prednisone, etoposide, and thalidomide for untreated angioimmunoblastic T-cell lymphoma in a Chinese population: A multicenter phase II trial

Angioimmunoblastic T‐cell lymphoma (AITL) is a common type of peripheral T‐cell lymphoma (PTCL) with a poor prognosis, and an effective first‐line therapy is lacking. Chidamide is a selective histone deacetylase inhibitor and has been approved by the China Food and Drug Administration for relapsed or refractory PTCL. We conducted a multicenter phase II clinical trial combining chidamide with prednisone, etoposide, and thalidomide (CPET regimen) for a total of eight cycles in untreated AITL patients in China. The primary objectives were the overall response rate (ORR) and complete remission (CR) rate after eight cycles of the CPET regimen. The secondary endpoints were progression‐free survival (PFS) and safety. Of the 71 enrolled patients, 51 completed the eight cycles of the CPET regimen. The ORR and CR of the 51 patients were 90.2 and 54.9%, respectively. After a median follow‐up of 11.4 months (95% confidence interval [CI], 9.9–17.0), the median PFS of the 51 patients was 42.6 months (95% CI, 27.7—not reached) and the median overall survival (OS) was not reached. The 2‐year PFS rate and OS rate were 66.5 and 82.2%, respectively. Sixty‐eight patients received at least one cycle of CPET regimen and were included as the safety assessment population. The most common grade 3/4 adverse event was neutropenia (n = 22, 32.3%). Twelve patients showed treatment‐related infections and recovered from antibiotic therapy; the other adverse events were mostly mild and reversible. The oral CPET regimen is an effective, tolerable, and economical choice for untreated AITL in a Chinese population. This trial was registered in www.clinicaltrials.gov as NCT03273452.

[The influence of subjective comfort of working environment on occupational stress of railway station workers]

Objective: To explore the influential factors of job stress suffered by workers in railway stations, the level of job stress of were measured and subjective comfort of employees targeting to working environment were reported. Methods: In March 2019, a cluster sampling study was designed to collect the personal characteristics, job characteristics and subjective comfort degree of working environment of 432 employees in Chongqing railway stations. Meanwhile, job stress was assessed using the effort-reward imbalance scale. Chi-square test was used to compare the difference of occupational stress detection rate among different stratified factors such as occupational characteristics. Logistic regression was applied to analyze the influential factors of occupational stress. Results: The detection rate of job stress of workers in the railway stations was 31.02% (134/432) . The detection rate of job stress was higher among the divorced workers in railway stations, those earning less than 5, 000 yuan per month, those with 10-20 years' length of service, those who worked as a conductor and other workers including baggageman, station master on duty and assistant engineer (χ(2)=9.61, 14.76, 23.28, 11.06, P=0.008, 0.002, 0.000, 0.011) . The detection rate of job stress was higher among those whose working environment subjective feelings were uncomfortable, the differences were statistically significant (P<0.001) . The results showed that the occupational stress of the staff in the railway stations was influenced by their subjective feeling of air quality, noise and Space Layout (P<0.05) . The risk factors of occupational stress were air quality, noise and uncomfortable space layout (OR=0.571, 0.068, 0.441, P=0.051, 0.054, 0.007) . Conductor, other (Bellboy, Duty Station Master, assistant engineer) were the risk factors of occupational stress (OR=1.884, 2.703, P=0.065, 0.019) . The employees of station A and station B were the risk factors of occupational stress (OR=4.681, 1.811, P=0.002, 0.067) . Conclusion: The higher detection rate of job stress of workers in the railway stations is correlated with the subjective comfort degree of the working environment of the workers.

LINC01006 and miR-3199 Serve as Novel Markers of Poor Prognosis in Colon Cancer and Regulate Cell Proliferation, Migration and Invasion

Purpose

Colon cancer is the most commonly diagnosed gastrointestinal cancer. This research intended to evaluate the prognostic values of LINC01006 and miR-3199 for colon cancer and their effects on cell physiology.

Patients and Methods

LINC01006 and miR-3199 expression levels were determined by RT-qPCR. Patients’ 5-year cumulative survival rate was analyzed by Kaplan–Meier curves with the Log rank test. Chi-square test and multivariate Cox regression analysis were used to access the clinical significance. CCK-8 assay, transwell assay, and TUNEL assays were used to monitor the change of cell proliferation, invasion, migration, and apoptosis.

Results

The expression level of LINC01006 was increased while miR-3199 was decreased in colon tissues and cells compared to normal ones. This dysregulated expression was correlated with T stage (P = 0.002) and N stage (P = 0.009). High LINC01006 level (HR = 4.048, 95%: 1.502–10.911, P = 0.006) or low miR-3199 level (HR = 3.421, 95% CI: 1.254–9.330, P = 0.016) was outstanding for predicting poor prognosis in patients with colon cancer. Downregulation of LINC01006 reduced cell proliferation, invasion, and migration but induced cell apoptosis (P < 0.05).

Conclusion

LINC01006 knockdown showed anti-proliferative, anti-metastatic, and apoptotic-induced effects on colon cancer cells. This study contributes to research on promising prognostic biomarkers of colon cancer and might give way to further investigation of alternative tumor targets.

Pharmacomicrobiology of Methotrexate in Rheumatoid Arthritis: Gut Microbiome as Predictor of Therapeutic Response

Rheumatoid arthritis (RA) is a disabling autoimmune disease with invasive arthritis as the main manifestation and synovitis as the basic pathological change, which can cause progressive destruction of articular cartilage and bone, ultimately leading to joint deformity and loss of function. Since its introduction in the 1980s and its widespread use in the treatment of RA, low-dose methotrexate (MTX) therapy has dramatically changed the course and outcome of RA treatment. The clinical use of this drug will be more rational with a better understanding of the pharmacology, anti-inflammatory mechanisms of action and adverse reaction about it. At present, the current clinical status of newly diagnosed RA is that MTX is initiated first regardless of the patients’ suitability. But up to 50% of patients could not reach adequate clinical efficacy or have severe adverse events. Prior to drug initiation, a prognostic tool for treatment response is lacking, which is thought to be the most important cause of the situation. A growing body of studies have shown that differences in microbial metagenomes (including bacterial strains, genes, enzymes, proteins and/or metabolites) in the gastrointestinal tract of RA patients may at least partially determine their bioavailability and/or subsequent response to MTX. Based on this, some researchers established a random forest model to predict whether different RA patients (with different gut microbiome) would respond to MTX. Of course, MTX, in turn, alters the gut microbiome in a dose-dependent manner. The interaction between drugs and microorganisms is called pharmacomicrobiology. Then, the concept of precision medicine has been raised. In this view, we summarize the characteristics and anti-inflammatory mechanisms of MTX and highlight the interaction between gut microbiome and MTX aiming to find the optimal treatment for patients according to individual differences and discuss the application and prospect of precision medicine.

STAT3 Promotes Cell Proliferation by Potentiating the CCL4 Transcriptional Activity in Diffuse Large B-Cell Lymphoma

STAT3 is a transcription factor and a candidate therapeutic option for human cancers. However, the underlying mechanism of STAT3 in the pathogenesis of diffuse large B-cell lymphoma (DLBCL) has yet to be established. We studied here whether STAT3 contributes to CCL4 transcription elevation in DLBCL. Our established protein-protein interactions (PPI) network revealed the overexpression of STAT3 and CCL4 in DLBCL. Mechanistically, STAT3 activated CCL4 transcription to induce the Wnt/β-catenin pathway. The prognostic analysis exhibited that the overall survival of patients with high STAT3 and CCL4 were poorer than those with low STAT3 and CCL4 expression. In addition, silencing of STAT3 reverted the malignant phenotype in DLBCL cells. CCL4 overexpression partly weakened the si-STAT3-mediated anti-tumor effects on DLBCL cells. Tumor xenograft models showed that si-STAT3 inhibited tumor growth in vivo and decreased proliferative and mitogenic activities in tumor tissues, findings that were consistent with the in vitro data. Hence, this study provides new evidence that STAT3 and CCL4 may be new prognostic biomarkers and therapeutic targets for treating DLBCL.