Injectable ultrasound-powered bone-adhesive nanocomposite hydrogel for electrically accelerated irregular bone defect healing

The treatment of critical-size bone defects with irregular shapes remains a major challenge in the field of orthopedics. Bone implants with adaptability to complex morphological bone defects, bone-adhesive properties, and potent osteogenic capacity are necessary. Here, a shape-adaptive, highly bone-adhesive, and ultrasound-powered injectable nanocomposite hydrogel is developed via dynamic covalent crosslinking of amine-modified piezoelectric nanoparticles and biopolymer hydrogel networks for electrically accelerated bone healing. Depending on the inorganic-organic interaction between the amino-modified piezoelectric nanoparticles and the bio-adhesive hydrogel network, the bone adhesive strength of the prepared hydrogel exhibited an approximately 3-fold increase. In response to ultrasound radiation, the nanocomposite hydrogel could generate a controllable electrical output (-41.16 to 61.82 mV) to enhance the osteogenic effect in vitro and in vivo significantly. Rat critical-size calvarial defect repair validates accelerated bone healing. In addition, bioinformatics analysis reveals that the ultrasound-responsive nanocomposite hydrogel enhanced the osteogenic differentiation of bone mesenchymal stem cells by increasing calcium ion influx and up-regulating the PI3K/AKT and MEK/ERK signaling pathways. Overall, the present work reveals a novel wireless ultrasound-powered bone-adhesive nanocomposite hydrogel that broadens the therapeutic horizons for irregular bone defects.

Intestinal Translocation of Live Porphyromonas gingivalis Drives Insulin Resistance

Periodontitis has been emphasized as a risk factor of insulin resistance-related systemic diseases. Accumulating evidence has suggested a possible "oral-gut axis" linking oral infection and extraoral diseases, but it remains unclear whether periodontal pathogens can survive the barriers of the digestive tract and how they play their pathogenic roles. The present study established a periodontitis mouse model through oral ligature plus Porphyromonas gingivalis inoculation and demonstrated that periodontitis aggravated diet-induced obesity and insulin resistance, while also causing P. gingivalis enrichment in the intestine. Metabolic labeling strategy validated that P. gingivalis could translocate to the gastrointestinal tract in a viable state. Oral administration of living P. gingivalis elicited insulin resistance, while administration of pasteurized P. gingivalis had no such effect. Combination analysis of metagenome sequencing and nontargeted metabolomics suggested that the tryptophan metabolism pathway, specifically indole and its derivatives, was involved in the pathogenesis of insulin resistance caused by oral administration of living P. gingivalis. Moreover, liquid chromatography-high-resolution mass spectrometry analysis confirmed that the aryl hydrocarbon receptor (AhR) ligands, mainly indole acetic acid, tryptamine, and indole-3-aldehyde, were reduced in diet-induced obese mice with periodontitis, leading to inactivation of AhR signaling. Supplementation with Ficz (6-formylindolo (3,2-b) carbazole), an AhR agonist, alleviated periodontitis-associated insulin resistance, in which the restoration of gut barrier function might play an important role. Collectively, these findings reveal that the oral-gut translocation of viable P. gingivalis works as a fuel linking periodontitis and insulin resistance, in which reduction of AhR ligands and inactivation of AhR signaling are involved. This study provides novel insight into the role of the oral-gut axis in the pathogenesis of periodontitis-associated comorbidities.

Challenges of Treating Lung Cancer Patients at MR-Linac Using MR-Based Synthetic CT Calculation in the Adaptive Workflow

PURPOSE/OBJECTIVE(S)

Magnetic Resonance guided adaptive radiotherapy (MRgART) allows plan adaptation according to the new patient anatomy; the contours of the structures are adjusted based on the patient's daily MRI, and in the adapt to shape (ATS) workflow, the adapted plan is recalculated on the MRI-based synthetic CT (sCT) generated by bulk density assignment. For sites where there is a high electronic density (ED) gradient between the target and surrounding tissues, such as in lung cancer treatments, the assignment of an average ED may not be able to reproduce an accurate dose calculation. This study evaluates the accuracy of the sCT adapted plan calculation for lung cancer patients and assesses whether the assignment of an optimized ED can reduce dosimetric differences should they arise MATERIALS/METHODS: Nine lung cancer patients treated at Unity 1.5 MR-Linac were selected for this retrospective study. The patient's target and organs at risk (OARs) were contoured, and a CT reference plan containing the ED bulk assignment information i.e., the contours to use in the ATS workflow, and their corresponding average ED was generated. To assess the accuracy of the dosimetry of the adapted plan calculated on the sCT, the plan was recalculated on an ideal sCT (sCTref) obtained from the reference CT by forcing the drawn contours to the average ED as defined on the CT reference plan. Targets and OARs dose-volume histogram (DVH) of the CT and sCTref plans and the dose distributions using gamma (γ) analysis with 2%-2mm criteria were compared. In the case of a discrepancy between the DVHs, the average Eds used for the recalculation on the sCTref were adjusted by several attempts to obtain a sCT optimized (sCTopt) for which a superposition of DVHs on CT and sCTopt was achieved.

RESULTS

For 7 of the 9 patients CT and sCTref target DVHs were not comparable, with a mean dosimetric difference of 5.55% (range 2.35%-7.46%) in the target volume receiving the prescription dose (VDpre), while OARs DVH dose differences remained below 1% for the nine patients. The adjustment of the ED of the homolateral lung in the sCTopt, reduced the mean target VDpre dosimetric difference between CT and sCTopt to 0.66% (range 0.17%-1.64%). In addition, the results of the gamma analysis increased from values ranging between 39.5%-70.3% to 88.5%-93.2%, as shown in the Table.

CONCLUSION

Dosimetric errors in the use of the sCT calculation for targets in high ED gradient areas may arise; the use of optimized ED for sCT calculation may be a promising strand to investigate in order to proceed with MR-based sCT plan adaptation for lung cancer treatment.

Study on the Clinical Use of a Respiratory Navigator Combined with Breath-Hold for MRI- Guided Liver SBRT

PURPOSE/OBJECTIVE(S)

Respiratory movement strongly affects the accuracy of stereotactic body radiation therapy (SBRT) of liver malignancies treated without the use of a respiratory gating system. This study investigates the feasibility and advantages of using a respiratory navigator-guided combined with patient breath-hold for liver SBRT in an adaptive magnetic-resonance guided workflow.

MATERIALS/METHODS

Clinical datasets of 10 liver cancer patients treated with 1.5T MR-Linac with respiratory navigator-guided SBRT combined with patient breath-hold were retrospectively analyzed. All patients underwent simulation CT with and without contrast, and 4D-CT and 3D-T2w MRI without contrast. Patients received a prescription dose ranging from 36 to 50 Gy in 5 to 8 fractions and followed the adapt to shape (ATS) workflow including contours adjustment and a subsequent MR-based synthetic CT (sCT) calculation on the online MRI acquired. The reference treatment plan was optimized on the expiratory phase of the 4D-CT, and during the online session the contours and the adapted plans were performed using the 3D-T2w navigator MRI of the patient's end-expiratory signal; 2D-T2w real-time monitoring MRI was also used as support for the contour's definition. The radiation therapist instructed the patients to hold their breath at the end of the breathing cycle for the time of the beam on. A total of 59 fractions were analyzed. For each fraction the dosimetric parameters of the target and normal liver of the adaptive and reference plans were compared; particularly the volume, the conformity index (CI) and gradient index (GI) for the target, and V5, V10 and Dmean for the normal liver. T-student statistical analysis was performed; a p-value less than 0.05 was considered statistically significant.

RESULTS

In the free breathing state, the 3D-T2w navigator MRI images enable a clear visualization of the tumor and its boundaries. The average target CI of the adaptive and reference plans is not significantly different (p = 0.448), while the GI is significantly higher (p = 0.043). Normal liver V10 and Dmean are lower and V5 is slightly increased, but without statistical differences. The mean values and standard deviation of the dosimetric parameters of the reference and adapted plans are shown in the Table below.

CONCLUSION

The use of a respiratory navigator combined with the breath-hold for MRI- guided liver SBRT allows clear visualization of the tumor, ensures the accuracy of the delivered dose and may be considered an alternative when the respiratory gating system is not available during MRgART sessions.

Study on Lattice Radiotherapy Treatments (LRT) for Head and Neck Bulky Tumors

PURPOSE/OBJECTIVE(S)

Lattice radiotherapy (LRT) exploits various effects of radiation, such as the bystander effect and the abscopal effect, and consists on the administration of high dose fraction in small areas with large tumor masses, helping to solve the problem of treating bulky disease, especially if it is located in a critical anatomical area. The optimization of LRT treatment plans is challenging due to the difficulty to generate spots of high dose within the tumor with consequent high gradient. This study compares the plan dosimetry and delivery time of two delivery techniques VMAT and CyberKnife for LRT treatments of bulky head and neck lesions.

MATERIALS/METHODS

Six patients with giant head and neck tumors who received LRT at our institution were included in this study. Target and OARs were contoured following international guidelines; to allow easy identification of the desired high gradient zones, an artificial geometrical lattice structure with spherical vertices was arranged inside the target volume (GTV), and the vertices of the lattice representing the high dose boost volumes (GTVboost) were delineated. The GTVboost and GTV were prescribed to receive 12 Gy and 3 Gy, respectively in a single fraction. Separate VMAT and CyberKnife LRT plans were optimized for each patient with lattice vertex of 0.5 diameter and center-to-center distances of 1.5 cm (LRT1.5) and 3 cm (LRT3). The dose heterogeneity was measured as the peak-to-valley dose ratio (PVDR), with the traditional definition being replaced by the D10/D90 ratio, where D10 and D90 represent the doses covering 10% and 90% of the GTV, respectively. For each plan generated, the treatment delivery time, the monitor units (MU), and the PVDR were assessed. Pre-treatment plan verifications were performed with ArcCheck array and Gafchromics film for VMAT and CyberKnife, respectively, using gamma analysis criteria of 3%-3mm.

RESULTS

The mean PVDR obtained for VMAT LRT plans were 2.0 and 2.6 for LRT1.5 and LRT3, respectively, and 3.2 and 4.7, respectively for CyberKnife LRT plans. For each pre-treatment plan dose verification, the gamma passing rate (GPR) was higher than 95.0 %; CyberKnife delivery time and MU were more than 10 times higher than that of VMAT, nevertheless, VMAT had a lower PVDR. The detailed results are shown in the table below.

CONCLUSION

CyberKnife LRT has a strong ability to place the peak dose within the target, generating a higher peak-to-valley dose ratio, however its use is partially invalidated by the long beam delivery times and the resulting high MU number; the use of the VMAT LRT technique allows clinically adequate dosimetry with acceptable delivery times.

Accelerated Bone Reconstruction by the Yoda1 Bilayer Membrane via Promotion of Osteointegration and Angiogenesis

Guided bone regeneration membranes are widely used to prevent fibroblast penetration and facilitate bone defect repair by osteoblasts. However, the current clinically available collagen membranes lack bone induction and angiogenic capacities, exhibiting limited bone regeneration. The mechanically sensitive channel, Piezo1, which is activated by Yoda1, has been reported to play crucial roles in osteogenesis and angiogenesis. Nevertheless, the application of Yoda1 alone is unsustainable to maintain this activity. Therefore, this study fabricates a Yoda1-loading bilayer membrane using electrospinning technology. Its inner layer in contact with the bone defect is composed of vertically aligned fibers, which regulate the proliferation and differentiation of cells, release Yoda1, and promote bone regeneration. Its outer layer in contact with the soft tissue is dense with oriented fibers by UV cross-linking, mainly preventing fibroblast infiltration and inhibiting the immune response. Furthermore, the loaded Yoda1 affects osteogenesis and angiogenesis via the Piezo1/RhoA/Rho-associated coiled-coil-containing protein kinase 1/Yes1-associated transcriptional regulator signaling pathway. The results reveal that the Yoda1 bilayer membrane is efficient and versatile in accelerating bone regeneration, suggesting its potential as a novel therapeutic agent for various clinical issues.

[Application and challenges of neuroimaging technology in mechanisms and treatment of drug addiction]

Neuroimaging technologies can non-invasively characterize the structure and function of addiction brain, reveal the neural mechanism of addictive behavior, and provide a priori for the potential targets of brain stimulation. Neuroimaging technologies has played an important role in the study of drug addiction diseases, relapse prediction, and therapeutic evaluation of non-invasive brain stimulations, but it also faces many challenges. In this manuscript, we discuss the classification and analysis methods of neuroimaging technologies, its application in addiction and challenges, thus to promote the application of neuroimaging technology in the treatment of drug addiction.

pH-responsive cinnamaldehyde-TiO2 nanotube coating: fabrication and functions in a simulated diabetes condition

Current evidence has suggested that diabetes increases the risk of implanting failure, and therefore, appropriate surface modification of dental implants in patients with diabetes is crucial. TiO₂ nanotube (TNT) has an osteogenic nanotopography, and its osteogenic properties can be further improved by loading appropriate drugs. Cinnamaldehyde (CIN) has been proven to have osteogenic, anti-inflammatory, and anti-bacterial effects. We fabricated a pH-responsive cinnamaldehyde-TiO₂ nanotube coating (TNT-CIN) and hypothesized that this coating will exert osteogenic, anti-inflammatory, and anti-bacterial functions in a simulated diabetes condition. TNT-CIN was constructed by anodic oxidation, hydroxylation, silylation, and Schiff base reaction to bind CIN, and its surface characteristics were determined. Conditions of diabetes and diabetes with a concurrent infection were simulated using 22-mM glucose without and with 1-μg/mL lipopolysaccharide, respectively. The viability and osteogenic differentiation of bone marrow mesenchymal stem cells, polarization and secretion of macrophages, and resistance to Porphyromonas gingivalis and Streptococcus mutans were evaluated. CIN was bound to the TNT surface successfully and released better in low pH condition. TNT-CIN showed better osteogenic and anti-inflammatory effects and superior bacterial resistance than TNT in a simulated diabetes condition. These findings indicated that TNT-CIN is a promising, multifunctional surface coating for patients with diabetes needing dental implants. Graphical abstract.

[Analysis of clinical phenotype and genotype of Chinese children with disorders of sex development]

Objective: To explore the heterogeneity and correlation of clinical phenotypes and genotypes in children with disorders of sex development (DSD). Methods: A retrospective study of 1 235 patients with clinically proposed DSD in 36 pediatric medical institutions across the country from January 2017 to May 2021. After capturing 277 DSD-related candidate genes, second-generation sequencing was performed to analyzed the heterogeneity and correlation combined with clinical phenotypes. Results: Among 1 235 children with clinically proposed DSD, 980 were males and 255 were females of social gender at the time of initial diagnosis with the age ranged from 1 day of age to 17.92 years. A total of 443 children with pathogenic variants were detected through molecular genetic studies, with a positive detection rate of 35.9%. The most common clinical phenotypes were micropenis (455 cases), hypospadias (321 cases), and cryptorchidism (172 cases) and common mutations detected were in SRD5A2 gene (80 cases), AR gene (53 cases) and CYP21A2 gene (44 cases). Among them, the SRD5A2 mutation is the most common in children with simple micropenis and simple hypospadias, while the AMH mutation is the most common in children with simple cryptorchidism. Conclusions: The SRD5A2 mutation is the most common genetic variant in Chinese children with DSD, and micropenis, cryptorchidism, and hypospadias are the most common clinical phenotypes. Molecular diagnosis can provide clues about the biological basis of DSD, and can also guide clinicians to perform specific clinical examinations. Target sequence capture probes and next-generation sequencing technology can provide effective and economical genetic diagnosis for children with DSD.

The safety and efficacy of transarterial chemoembolisation with bleomycin for hepatocellular carcinoma unresponsive to doxorubicin: a prospective single-centre study

AIM

To investigate the safety and efficacy of transarterial chemoembolisation (TACE) with bleomycin for hepatocellular carcinoma (HCC) unresponsive to doxorubicin.

MATERIALS AND METHODS

A randomised controlled trial was undertaken of HCC patients resistant to TACE with doxorubicin to assess the survival benefits of the experimental group (TACE with bleomycin) compared with the control group (TACE with doxorubicin). One hundred and seventy patients were allocated randomly between December 2015 and December 2017, and 80 patients of each group were analysed. The modified response evaluation criteria in solid tumours (mRECIST) was used to evaluated the tumour response every 4-6 weeks. The primary endpoint was median progression-free survival (mPFS) and median overall survival (mOS). Safety was assessed by post-procedure complications.

RESULTS

The study was completed in October 2018. Objective response rate (ORR) of the experimental group was 27.5% (22/80), mPFS and mOS was 5.8 and 8.1 months. ORR of the control group was 7.5% (6/80), mPFS and mOS was 2.9 and 4 months. The ORR were significantly different between two groups (χ² = 0.348, p<0.05). The differences of mPFS and mOS between the two groups were statistically significant (χ² = 2.865, p<0.05 and χ² = 0.926, p<0.05, respectively). There were no significant difference in post-procedure complications (p>0.05) and no major complications occurred.

CONCLUSION

It is suggested that TACE with bleomycin is a safe and effective method for HCC and bleomycin can be a second-line chemotherapeutic agent for the HCC patients unresponsive to TACE with doxorubicin.

Controlling selectivity in N-heterocycle directed borylation of indoles

Electrophilic borylation of indoles with BX₃ (X = Cl or Br) using directing groups installed at N1 can proceed at the C2 or the C7 position. The six membered heterocycle directing groups utilised herein, pyridines and pyrimidine, result in indole C2 borylation being the dominant outcome (in the absence of a C2-substituent). In contrast, C7 borylation was achieved using five membered heterocycle directing groups, such as thiazole and benzoxazole. Calculations on the borylation of indole substituted with a five (thiazole) and a six (pyrimidine) membered heterocycle directing group indicated that borylation proceeds via borenium cations with arenium cation formation having the highest barrier in both cases. The C7 borylated isomer was calculated to be the thermodynamically favoured product with both five and six membered heterocycle directing groups, but for pyrimidine directed indole borylation the C2 product was calculated to be the kinetic product. This is in contrast to thiazole directed indole borylation with BCl₃ where the C7 borylated isomer is the kinetic product too. Thus, heterocycle ring size is a useful way to control C2 vs. C7 selectivity in N-heterocycle directed indole C-H borylation.

Nomogram predicting early neurological improvement in ischaemic stroke patients treated with endovascular thrombectomy

BACKGROUND AND PURPOSE

Early neurological improvement (ENI) after endovascular thrombectomy (EVT) has been associated with favorable outcomes. This study aimed to identify the optimal definition of ENI and develop a nomogram for predicting ENI after EVT in acute ischaemic stroke.

METHODS

Patients with EVT were enrolled from a multicenter registry as the training cohort. The receiver operating characteristic curve was used to estimate the optimal threshold for ENI at 24 h of EVT. Logistic regression analysis was utilized to generate the best-fit nomogram for predicting ENI. The discrimination of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC). An additional 447 patients from two stroke centers were prospectively recruited as the test cohort for validating the nomogram.

RESULTS

A total of 612 patients with EVT were included in the training cohort. The optimal threshold for predicting 3-month favorable outcome (modified Rankin Scale 0-2) was an improvement of the National Institutes of Health Stroke Scale (NIHSS) score by ≥6 points (AUC 0.875; sensitivity 79.5%; specificity 90.7%). Age, blood glucose, recanalization, symptomatic intracranial hemorrhage (sICH) and baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were independently associated with ENI, and were incorporated in the nomogram. The AUC of the nomogram was 0.795 in the training cohort and 0.752 in the test cohort.

CONCLUSIONS

A reduction of NIHSS score ≥6 appeared to be the optimal definition of ENI. The nomogram composed of age, blood glucose, recanalization, sICH and baseline ASPECTS may predict the probability of ENI in ischaemic stroke patients treated with EVT.

Intramolecular (directed) electrophilic C-H borylation

The intramolecular C-H borylation of (hetero)arenes and alkenes using electrophilic boranes is a powerful transition metal free methodology for forming C-B bonds. These C-H borylation reactions are preceded by intermolecular bond (both dative and covalent) formation, with examples proceeding via initial C-B and N-B bond formation dominating this field thus both are discussed in depth herein. Less prevalent intramolecular electrophilic C-H borylation reactions that proceed by intermolecular O-B, S-B and P-B bond formation are also summarised. Mechanistic studies are presented that reveal two mechanisms for C-H borylation, (i) electrophilic aromatic substitution (prevalent with B-X electrophiles); (ii) σ-bond metathesis mediated (prevalent with B-H and B-R electrophiles). To date, intramolecular electrophilic C-H borylation is utilised mainly for accessing boron containing conjugated organic materials, however recent developments, summarized herein alongside early studies, have highlighted the applicability of this methodology for forming synthetically versatile organo-boronate esters and boron containing bioactives. The multitude of synthetic procedures reported for intramolecular electrophilic C-H borylation contain many common features and this enables key requirements for successful C-H borylation and the factors effecting regioselectivity and substrate scope to be identified, discussed and summarized.

[Value of lenvatinib for the treatment of advanced hepatocellular carcinoma]

Objective: To observe the safety and efficacy of lenvatinib for the treatment of medium-advanced hepatocellular carcinoma. Methods: A total of 36 patients with medium-advanced hepatocellular carcinoma from the First Medical Center of the Chinese PLA General Hospital were retrospectively analyzed from January 2018 to May 2019. All patients had shown tumor progression after at least 2 sessions of TACE. The patients were consisted of 30 males and 6 females with age range of 35 to 76 (54±10) years. Patients received orally administered lenvatinib at a dose of 12 mg once daily for patients ≥ 60 kg and 8 mg once daily for patients<60 kg. According to modified RECIST criteria the tumor response, disease control rate, overall survival and progression free survival were evaluated once every 6-8 weeks. The adverse events were recorded. Results: No patient was in complete response, 2 cases (5.7%) in partial response, and 5 cases (14.3%) in stable disease, respectively. Disease control rate was 20.0% (7/35), the overall survival was 11.5 months, and the progression free survival was 5.3 months. The overall incidence of adverse events was 66.7% (24/36). The most frequent adverse events were hypertension, proteinuria, hand-foot skin reaction and abdominal distension. Conclusion: Lenvatinib can extend the overall survival in a percentage of medium-advanced hepatocellular carcinoma patients who were unresectable and refractory to TACE. Although the incidence of adverse events is high, most of them are mild and reversible.

Uric acid level and risk of symptomatic intracranial haemorrhage in ischaemic stroke treated with endovascular treatment

BACKGROUND AND PURPOSE

There are limited data on the association between uric acid (UA) and symptomatic intracranial haemorrhage (SICH) in patients who have undergone mechanical thrombectomy [endovascular treatment (EVT)]. In the present study, we aimed to investigate the role of serum UA level in SICH after EVT in a real-world practice.

METHODS

Patients were selected from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke (ACTUAL) registry. SICH was identified using the Heidelberg Bleeding Classification. Multivariable logistic regression analysis was performed to explore the relationship between serum UA and SICH.

RESULTS

Among 611 enrolled patients, 90 (14.7%) were diagnosed with SICH within 72 h after EVT. Patients with SICH had a significantly higher level of serum UA (median, 341.0 vs. 302.0 μmol/L; P = 0.003) than those without SICH. Univariate logistic regression analysis indicated that patients with UA levels in the fourth quartile, compared with the first quartile, were more likely to have SICH (odds ratio, 2.846; 95% confidence intervals, 1.429-6.003; P = 0.003). The association remained significant after multivariable adjustment for potential confounders. Furthermore, the multiple-adjusted spline regression model showed an inverted U-shaped association between UA and SICH (P = 0.047 for non-linearity).

CONCLUSION

Our study indicated that increased serum UA level was independently associated with SICH after EVT in acute ischaemic stroke.

The synthesis of brominated-boron-doped PAHs by alkyne 1,1-bromoboration: mechanistic and functionalisation studies

The synthesis of a range of brominated-B n -containing (n = 1, 2) polycyclic aromatic hydrocarbons (PAHs) is achieved simply by reacting BBr3 with appropriately substituted alkynes via a bromoboration/electrophilic C-H borylation sequence. The brominated-B n -PAHs were isolated as either the borinic acids or B-mesityl-protected derivatives, with the latter having extremely deep LUMOs for the B2-doped PAHs (with one example having a reduction potential of E 1/2 = -0.96 V versus Fc+/Fc, Fc = ferrocene). Mechanistic studies revealed the reaction sequence proceeds by initial alkyne 1,1-bromoboration. 1,1-Bromoboration also was applied to access a number of unprecedented 1-bromo-2,2-diaryl substituted vinylboronate esters directly from internal alkynes. Bromoboration/C-H borylation installs useful C-Br units onto the B n -PAHs, which were utilised in Negishi coupling reactions, including for the installation of two triarylamine donor (D) groups onto a B2-PAH. The resultant D-A-D molecule has a low optical gap with an absorption onset at 750 nm and emission centered at 810 nm in the solid state.

Dietary Inflammatory Index and Leukoaraiosis in Patients with Ischemic Stroke

OBJECTIVES

Diet may change the chronic levels of systemic inflammation, which in turn influence the development of leukoaraiosis (LA). This study aimed to examine the association between dietary inflammatory index (DII) and LA in patients with ischemic stroke.

METHODS

Patients with first-ever ischemic stroke were enrolled from two centers. A semi-quantitative food frequency questionnaire (FFQ) was used to evaluate diet contents. The DII score of each patient was calculated based on the reported diet contents. Presence and degree of LA were evaluated with a magnetic resonance imaging (MRI) scan. LA was graded according to Fazekas scale.

RESULTS

Of the 497 enrolled patients, 337 (67.8%) were detected with LA. Patients with LA had a higher DII score (0.23 vs -0.88, P < 0.001). Logistic regression analysis detected that patients with highest quartile of DII score had an OR of 3.61 (95% CI: 2.05-6.36, P < 0.001) for LA compared with those with lowest quartile of DII. After adjusting for major confounders, the highest DII quartile remained as an independent predictor for LA (OR = 2.66, 95% CI: 1.41-5.00, P = 0.008).

CONCLUSIONS

A pro-inflammatory diet pattern, as indicated by higher DII values, appears to be associated with a higher risk of LA. This result suggested that dietary-mediated inflammation may involved in the pathogenesis of LA, which warrant further study.

Transarterial embolisation with bleomycin and N-butyl-2-cyanoacrylate -Lipiodol mixture for symptomatic polycystic liver disease: preliminary experience

AIMS

To evaluate the therapeutic effect and safety of transarterial embolisation using a bleomycin-Lipiodol mixture and N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture (BNL) for the treatment of polycystic liver disease (PLD).

MATERIALS AND METHODS

From June 2012 to July 2018, a total of consecutive 14 symptomatic patients (13 women and 1 man; mean age, 49.3±9.9 years) with PLD were referred and underwent transcatheter arterial embolisation (TAE) with BNL.

RESULTS

Technical success was achieved in all cases. PLD-related severe symptoms were improved remarkably in 13 of the treated patients. The mean maximum abdominal circumference decreased significantly from 100.6±9.4 to 94.9±9.1 cm (p<0.01). The total liver volume decreased significantly compared with pre-TAE in 13 patients at 6-12 months after TAE. It decreased from 9,776±2,219 to 8,303±2,009 cm³ (p<0.01). There were no major complications associated with the procedure.

CONCLUSION

TAE with the bleomycin-Lipiodol mixture and NBCA-Lipiodol mixture may be an effective method for treating symptomatic PLD patients, with improvement of symptoms and shrinkage of cyst volume.

[FOXD2-AS1 is corelated with clinicopathological parameter of laryngeal carcinoma and promote cancer cell proliferation]

Objective: To investigate the expression and clinical significance of long non-coding RNA FOXD2-AS1 in laryngeal squamous cell carcinoma and its effect on cancer cell proliferation. Method: Real-time quantitative polymerase chain reaction(RT-qPCR) was used to detect the expression of FOXD2-AS1 in 85 cases of laryngeal carcinoma. One-way ANOVA was used to determine relationships between its expression and clinicopathological parameters of laryngeal carcinoma. The prognostic significance of FOXD2-AS1 in head and neck cancer was explored using bioinformatics technology. SiRNA was used to interfere the expression of FOXD2-AS1 in TU686 laryngeal carcinoma cells. MTT and clonal formation assay were used to investigate the biological effect of FOXD2-AS1. MicroRNA binding to FOXD2-AS1 was investigated using double luciferase assay. Result: The expression of FOXD2-AS1 in laryngeal cancer tissues was significantly higher than that in normal tissues(t=10.012, P<0.05), and was associated with T staging of laryngeal cancer(χ=6.41, P=0.016). There were no relationships between FOXD2-AS1 expression and age, sex, smoking history, primary site of tumor and lymph node metastasis(N staging). Survival analysis of head and neck tumors in the TCGA database using GEPIA showed poor prognosis in patients with high FOXD2-AS1 expression(P=0.048). Suppressing FOXD2-AS1 via siRNA in TU686 cells decreased clonal formation ability(t=8.053, P<0.05) and MTT assay confirmed that interference of FOXD2-AS1 down regulated proliferation activity of TU686 cells(t=9.337, P<0.05). Double luciferase assay showed that FOXD2-AS1 could directly bind to miR-206, thus inhibiting the expression of miR-206. Further MTT assay indicated that inhibiting miR-206 attenuated the suppressing effect of si-FOXD2-AS1 on the proliferation of TU686 cells. Conclusion: FOXD2-AS1 is corelated with clinicopathological parameter of laryngeal squamous cell carcinoma and promotes cancer cell proliferation through targeting miR-206.

[Hyperglycemia caused by mutation of GCK gene in 10 patients analysis of clinical and mutation characteristics]

Objective: To explore the gene mutation characteristics and detailed clinical presentations of hyperglycemia caused by GCK mutations in 10 patients. Methods: The clinical and follow-up data of 10 patients with hyperglycemia caused by mutation of GCK gene were reviewed. The patients were ascertained between January 1, 2014 and August 31, 2018 at the Department of Pediatrics, the First Affiliated Hospital of Zhejiang University and Ningbo Women & Children's Hospital. Clinical data were collected, including age, gender, main complaint, family history, fasting blood glucose, fasting blood insulin, 2-hour blood glucose, 2-hour blood insulin after oral glucose tolerance test, glycosylated hemoglobin, anti-glutamic acid decarboxylase antibody and body mass index. Mutations of GCK gene were detected by Sanger sequencing or high-throughput sequencing of diabetes-related genes in the patients and their family members. Results: There were ten patients, 8 of them were male, 2 were female.The ages at diagnosis varied between 4.7 to 12.3 years. The patients usually did not have obvious clinical symptoms of diabetes mellitus. Most of them were unexpectedly found to have hyperglycemia and with impaired glucose metabolism in three consecutive generations. The fasting blood glucose of patients was 6.8-7.7 mmol/L, 2-hour postprandial blood glucose was 7.8-11.6 mmol/L. Fasting blood insulin was 0.5-8.5 mU/L, glucose tolerance test results showed that 2 h postprondial blood insulin was 1.3-55.4 mU/L. The level of glycosylated hemoglobin was 6.1%-6.8%. Anti-glutamic acid decarboxylase antibody was negative in all patients. The GCK mutations identified in patients and one of their parents were located at exon5 (4 cases), exon9 (2 cases), exon2 (1 case), exon4 (1 case), exon6 (1 case) and exon7 (1 case). Conclusions: Most of the hyperglycemia patients caused by GCK mutations did not have typical clinical symptoms of diabetes. The fasting blood glucose was slightly elevated. Abnormal glucose tolerance test results were found in all 10 patients. Three consecutive generations of family had impaired glucose metabolism. GCK mutations located at exon 5 were common in 10 cases. There was no correlation between type of mutations and plasma glucose levels in domestic and international researches. When fasting glucose was found abnormal in clinic, a complete family history should be taken and the GCK gene should be sequenced to confirm the diagnosis in time.

[Significance of pelvic contrast enhanced MRA prior to prostatic artery embolization]

Objective: To assess the values of pelvic contrast enhanced magnetic resonance angiography (MRA) in detection of prostatic artery prior to prostatic arterial embolization(PAE). Methods: This multicenter, prospective study from 5 hospitals in China consisted of 47 patients (mean age (69±16) years, range 56-83 years) who underwent PAE for benign prostatic hyperplasia (BPH) between January 2016 and April 2018, preprocedural prediction of prostatic arteries were determined using contrast enhanced MRA.CE-MRA findings were compared with subsequent intraprocedural digital subtraction angiography (DSA) or DSA combined with cone-beam computed tomography (CT) to assess the sensitivity and specificity with which contrast enhanced MRA predicted the number and origins of prostatic artery, also to assess the optimal oblique projection of PA. Results: In total, 47 patients (94 pelvic sides) with 97 PAs confirmed by DSA or DSA combined with cone-beam CT at the time of embolization, MR angiography successfully identified 88 PAs and their origins , the sensitivity and specificity was 90.7% (88/97) and 93.6% (88/94), respectively.MR angiography correctly determined the bilateral prostatic artery origins in 36 (76.6%) cases.According to the optimal oblique projection of PAs suggested by MR angiography, the origins and trajectory of PAs of all patients underwent PAE with the same oblique projection (20°-45°ipsilateral anterior oblique direction) were clearly displayed when performed the first arteriography. Conclusion: Pelvic contrast enhanced MR angiography with high sensitivity and specificity in detection the origin, trajectory and number of PAs, and it could provide useful information regarding prostatic arteries before PAE.

[Transarterial chemoembolization with bleomycin treatment for moderate-advenced hepatocellular carcinoma]

Objective: To investigate the safety and efficacy of transarterial chemoembolization (TACE) using bleomycin for the treatment of medium-advanced hepatocellular carcinoma (HCC). Methods: Between December 2015 and December 2017, a total of 160 patients from the Chinese PLA General Hospital with moderate-advanced HCC whose diagnoses were confirmed by pathology or clinical imaging and were in accord with the Barcelona Clinic Liver Cancer (BCLC) staging criteria were prospectively analyzed.All patients had shown persistent viable tumor or tumor progression after at least 2 sessions of TACE.All patients included 135 males and 25 females , age 35-74 (57±8)years, were randomly divided into two groups, the treatment group: TACE procedures consisted of bleomycin+ pirarubicin+ oxaliplatin+ fluorouracil, the control group: pirarubicin+ oxaliplatin+ fluorouracil, and according to modified RECIST criteria the tumor response was evaluated once every 4-6 weeks, survival analysis was performed, overall survival and progression free survival were evaluated.the adverse events were recorded. Results: Response rate of the treatment group was 27.5%(22/80), the median progression free survival(mPFS)was 5.8 months, and the median overall survival (mOS) was 8.1 months.Response rate of the control group was 7.5%(6/80), mPFS of 2.9 months, and mOS of 4 months.The differences in mPFS and in mOS between the two groups were statistically significant (P=0.009, 0.002 respectively), and no serious adverse occurred. Conclusion: It is suggested that transarterial chemoembolization with bleomycin is safe and effective for medium-advenced HCC.

Diagnostic and prognostic implications of serum miR-101 in osteosarcoma

Blood-circulating microRNAs (miRNAs) have been reported to be used as potential biomarkers in various cancers. MiR-101 has been found to act as a tumor suppressor in many tumor types, but little is known for osteosarcoma. The purpose of this study was to investigate miR-101 expression in osteosarcoma patients and assess its correlation with clinical features and prognosis. Serum samples from 152 osteosarcoma patients and 70 healthy controls were detected using quantitative reverse-transcription polymerase chain reaction (qRT-PCR). The data showed that miR-101 expression levels were remarkably underexpressed in serum samples from osteosarcoma patients compared to controls, and the post-treatment serum miR-101 expression was significantly higher than that in the pre-treatment expression. Low serum miR-101 expression was positively associated with advanced clinical stage and distant metastasis. Receiver operating characteristic (ROC) curve analysis showed that serum miR-101 could serve as a useful marker for osteosarcoma diagnosis, with a high sensitivity and specificity. Moreover, patients with high miR-101 expression had longer overall survival and recurrence free survival than those with low miR-101 expression. In addition, both univariate and multivariate analyses showed that serum miR-101 downregulation was associated with shorter overall survival and recurrence free survival. Our present results implicated serum miR-101 might be a useful biomarker for the clinical diagnosis and prognosis of osteosarcoma.

Apical stress distribution under vertical compaction of gutta-percha and occlusal loads in canals with varying apical sizes: a three-dimensional finite element analysis

AIM

To investigate and compare the effects of two apical canal instrumentation protocols on apical stress distribution at the root apex under vertical compaction of gutta-percha and occlusal loads using finite element analysis.

METHODOLOGY

Three finite element analysis models of a mandibular first premolar were reconstructed: an original canal model, a size 35, .04 taper apical canal enlargement model and a Lightspeed size 60 apical canal enlargement model. A 15 N compaction force was applied vertically to the gutta-percha 5 mm from the apex. A 175 N occlusal load in two directions (vertical and 45° to the longitudinal axis of the tooth) was simulated. Stresses in the apical 2 mm of the root were calculated and compared among the three models.

RESULTS

Under vertical compaction, stresses in the apical canal instrumented by Lightspeed size 60 (maximal 3.3 MPa) were higher than that of the size 35, .04 taper model (maximal 1.3 MPa). In the case of the two occlusal forces, the Lightspeed size 60 apical enlargement was associated with the greatest stress distribution in the apical region. The greatest stress and the most obvious stress difference between the models appeared at the tip of the root when occlusal and vertical compaction loads were applied.

CONCLUSIONS

Apical enlargement caused stress distribution changes in the apical region of roots. The larger apical size led to higher stress concentration at the root apex.

Tanshinone IIA ameliorates chronic arthritis in mice by modulating neutrophil activities

Rheumatoid arthritis (RA) is a chronic immune inflammatory disease mediated by the influx of immune cells into the synovial joint space. As Tanshinone IIA (TIIA) has potent anti-oxidant and anti-inflammatory activities, we used the adjuvant-induced arthritis (AA) murine model of RA to investigate the impact of TIIA on RA and immune cell activation. The anti-arthritic activity of TIIA was investigated in an adjuvant-induced arthritis model of RA in mice. Myeloperoxidase and neutrophil elastase expression levels were assessed in ankle joints by immunohistochemistry analysis. Immune cell infiltration was evaluated in air pouch experiments. Proinflammatory cytokines expression levels were determined by quantitative real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays. Neutrophil extracellular traps (NETs) were assessed by immunostaining and confocal microscopy. Treatment with TIIA alleviated cartilage erosion and neutrophil infiltration in the ankle joints of AA mice and reduced proinflammatory cytokine expression levels in sera. TIIA suppressed interleukin-6 and tumour necrosis factor-α expression and release in neutrophils and promoted neutrophil apoptosis. TIIA also inhibited the NET formation of neutrophils. Our findings demonstrated that TIIA can ameliorate RA effectively by targeting neutrophils, indicating that TIIA may act as a potential therapeutic for RA.

HBV-induced ROS accumulation promotes hepatocarcinogenesis through Snail-mediated epigenetic silencing of SOCS3

Interleukin-6 (IL-6) has been demonstrated to be involved in Hepatitis B virus (HBV)-associated hepatocarcinogenesis through activation of the STAT3 pathway. The sustained activation of the IL-6/STAT3 pathway is frequently associated with repression of SOCS3, which is both a target gene and a negative regulator of STAT3. However, the silencing mechanism of SOCS3 in hepatocellular carcinoma (HCC) remains to be elucidated. Here, we showed that the repression of SOCS3 and sustained activation of IL-6/STAT3 pathway in HBV-producing HCC cells were caused by HBV-induced mitochondrial ROS accumulation. Mechanistic studies revealed that ROS-mediated DNA methylation resulted in the silencing of SOCS3. Decreased SOCS3 expression significantly promoted the proliferation of HCC cells and growth of tumor xenografts in mice. Further studies revealed that HBV-induced ROS accumulation upregulated the expression of the transcription factor, Snail, which bound to the E-boxes of SOCS3 promoter and mediated the epigenetic silencing of SOCS3 in association with DNMT1 and HDAC1. In addition, we found that the expression of Snail and SOCS3 were inversely correlated in HBV-associated HCC patients, suggesting that SOCS3 and/or Snail could be used as prognostic markers in HCC pathogenesis. Taken together, our data show that HBV-induced mitochondrial ROS production represses SOCS3 expression through Snail-mediated epigenetic silencing, leading to the sustained activation of IL-6/STAT3 pathway and ultimately contributing to hepatocarcinogenesis.

Invited review: Inflammation during the transition to lactation: New adventures with an old flame

For dairy cattle, the first several weeks of lactation represent the highest-risk period in their lives after their own neonatal period. Although more than 50% of cows during this period are estimated to suffer from at least one subclinical disorder, the complicated admixture of normal adaptations to lactation, infectious challenges, and metabolic disorders has made it difficult to determine which physiological processes are adaptive and which are pathological during this time. Subacute inflammation, a condition that has been well documented in obesity, has been a subject of great interest among dairy cattle physiologists in the past decade. Many studies have now clearly shown that essentially all cows experience some degree of systemic inflammation in the several days after parturition. The magnitude and likely persistence of the inflammatory state varies widely among cows, and several studies have linked the degree of postpartum inflammation to increased disease risk and decreased whole-lactation milk production. In addition to these associations, enhancing postpartum inflammation with repeated subacute administration of cytokines has impaired productivity and markers of health, whereas targeted use of nonsteroidal anti-inflammatory drugs during this window of time has enhanced whole-lactation productivity in several studies. Despite these findings, many questions remain about postpartum inflammation, including which organs are key initiators of this state and what signaling molecules are responsible for systemic and tissue-specific inflammatory states. Continued in vivo work should help clarify the degree to which mild postpartum inflammation is adaptive and whether the targeted use of anti-inflammatory drugs or nutrients can improve the health and productivity of dairy cows.

Latent transforming growth factor-β binding proteins (LTBP-1 and LTBP-2) and gingiva keratinization

OBJECTIVE

Transforming growth factor-beta (TGF-β) proteins are involved in epithelial keratinization. The major function of latent TGF-β binding proteins (LTBPs) is modulating TGF-β activity. However, whether LTBP-1 and LTBP-2 play roles in gingiva keratinization remains unclear.

MATERIALS AND METHODS

Human keratinized gingiva and non-keratinized alveolar mucosa were processed for LTBP-1, LTBP-2, cytokeratin-1 (K1), cytokeratin-4 (K4), and TGF-β immunohistochemical (IHC) staining. Porcine heterotopically transplanted connective tissues and newly grown epithelia were harvested for IHC staining. The expression levels of LTBP-1 and LTBP-2 were compared between differentiated and undifferentiated human normal oral keratinocytes (hNOK). The expression of LTBP-1 and LTBP-2 was knocked down in a cell line (OEC-M1) to evaluate the effects on the expression of K1, K4, and involucrin (INV).

RESULTS

In human and porcine specimens, LTBP-2 expression patterns distinguished keratinized and non-keratinized oral epithelia. Western blotting results showed that K1, LTBP-1, and INV proteins were upregulated in differentiated hNOK. In OEC-M1 cells, LTBP-2 knockdown resulted in upregulated the expression of K1 and INV and downregulated the expression of K4. LTBP-1 knockdown resulted in opposite effects.

CONCLUSION

The expression patterns of LTBP-2 differ in keratinized gingiva and non-keratinized mucosa. LTBP-1 and LTBP-2 are involved in the keratinization of oral epithelium; however, the underlying mechanism remains to be elucidated.

High-grain diets suppress ruminal tissue abundance of angiopoietin-like protein 4 in cattle

Angiopoietin-like protein 4 (ANGPTL4) is expressed in bovine ruminal epithelium, making it possible that dietary components or commensal microbes may influence gastrointestinal ANGPTL4 production via interactions at the mucosal surface. Therefore, we conducted 3 experiments to evaluate the effects of dietary concentrate level and VFA infusions on ANGPTL4 abundance in ruminal tissue. In Exp. 1, we assigned 12 nonlactating Holstein cows to either 8% or 64% concentrate diets; diets were fed 28 d before euthanasia and ruminal tissue collection. Ruminal tissue and plasma ANGPTL4 protein abundance were unaltered by treatment. In Exp. 2, we assigned 8 continental crossbred heifers to either a 45% or 90% concentrate diet; diets were fed for 75 d before euthanasia and ruminal tissue collection. Compared with the 45% concentrate diet, the 90% concentrate diet decreased (P < 0.01) ruminal tissue ANGPTL4 protein abundance. In Exp. 3, we assigned 6 ruminally cannulated lactating Holstein cows to a treatment sequence in replicated 3 × 3 Latin squares and fed a standard lactation diet. Cows were infused with 5 mol/d sodium acetate, sodium propionate, or sodium butyrate for 2 d. Infusions of VFA did not affect (P > 0.10) mRNA or protein abundance of ANGPTL4 in ruminal papillae. Ruminal papillae ANGPTL4 abundance was, however, negatively correlated with (P = 0.01) ruminal VFA concentrations. ANGPTL4 abundance in ruminal tissue decreases in response to very high dietary concentrate and is inversely correlated with ruminal total VFA concentrations.