Palladium (II)-Catalyzed C-H Activation with Bifunctional Ligands: From Curiosity to Industrialization

In 2001, our curiosity to understand the stereochemistry of C-H metalation with Pd prompted our first studies in Pd(II)-catalyzed asymmetric C-H activation (RSC Research appointment: 020 7451 2545, Grant: RG 36873, Dec. 2002). We identified four central challenges: 1. poor reactivity of simple Pd salts with native substrates; 2. few strategies to control site selectivity for remote C-H bonds; 3. the lack of chiral catalysts to achieve enantioselectivity via asymmetric C-H metalation, and 4. low practicality due to limited coupling partner scope and the use of specialized oxidants. These challenges necessitated new strategies in catalyst and reaction development. For reactivity, we developed approaches to enhance substrate-catalyst affinity together with novel bifunctional ligands which participate in and accelerate the C-H cleavage step. For site-selectivity, we introduced the concept of systematically modulating the distance and geometry between a directing template, catalyst, and substrate to selectively access remote C-H bonds. For enantioselectivity, we devised predictable stereomodels for catalyst-controlled enantioselective C-H activation based on the participation of bifunctional ligands. Finally, for practicality, we have developed varied catalytic manifolds for Pd(II) to accommodate diverse coupling partners while employing practical oxidants such as simple peroxides. These advances have culminated in numerous C-H activation reactions, setting the stage for broad industrial applications.

New role of cardiomyocyte Bmal1 in the regulation of sex-specific heart transcriptomes

It has been well established that cardiovascular diseases exhibit significant differences between sexes in both preclinical models and humans. In addition, there is growing recognition that disrupted circadian rhythms can contribute to the onset and progression of cardiovascular diseases. However, little is known about sex differences between the cardiac circadian clock and circadian transcriptomes in mice. Here, we show that the the core clock genes are expressed in common in both sexes but the circadian transcriptome of the mouse heart is very sex-specific. Hearts from female mice expressed significantly more rhythmically expressed genes (REGs) than male hearts and the temporal pattern of REGs was distinctly different between sexes. We next used a cardiomyocyte-specific knock out of the core clock gene, Bmal1, to investigate its role in sex-specific gene expression in the heart. All sex differences in the circadian transcriptomes were significantly diminished with cardiomyocyte-specific loss of Bmal1. Surprisingly, loss of cardiomyocyte Bmal1 also resulted in a roughly 8-fold reduction in the number of all the differentially expressed genes between male and female hearts. We conclude that cardiomyocyte-specific Bmal1, and potentially the core clock mechanism, is vital in conferring sex-specific gene expression in the adult mouse heart.

Autophagy gene expression in skeletal muscle of older individuals is associated with physical performance, muscle volume and mitochondrial function in the study of muscle, mobility and aging (SOMMA)

Autophagy is essential for proteostasis, energetic balance, and cell defense and is a key pathway in aging. Identifying associations between autophagy gene expression patterns in skeletal muscle and physical performance outcomes would further our knowledge of mechanisms related with proteostasis and healthy aging. Muscle biopsies were obtained from participants in the Study of Muscle, Mobility, and Aging (SOMMA). For 575 participants, RNA was sequenced and expression of 281 genes related to autophagy regulation, mitophagy, and mTOR/upstream pathways was determined. Associations between gene expression and outcomes including mitochondrial respiration in muscle fiber bundles (MAX OXPHOS), physical performance (VO2 peak, 400 m walking speed, and leg power), and thigh muscle volume, were determined using negative binomial regression models. For autophagy, key transcriptional regulators including TFE3 and NFKB-related genes (RELA, RELB, and NFKB1) were negatively associated with outcomes. On the contrary, regulators of oxidative metabolism that also promote overall autophagy, mitophagy, and pexophagy (PPARGC1A, PPARA, and EPAS1) were positively associated with multiple outcomes. In line with this, several mitophagy, fusion, and fission-related genes (NIPSNAP2, DNM1L, and OPA1) were also positively associated with outcomes. For mTOR pathway and related genes, expression of WDR59 and WDR24, both subunits of GATOR2 complex (an indirect inhibitor of mTORC1), and PRKAG3, which is a regulatory subunit of AMPK, were negatively correlated with multiple outcomes. Our study identifies autophagy and selective autophagy such as mitophagy gene expression patterns in human skeletal muscle related to physical performance, muscle volume, and mitochondrial function in older persons which may lead to target identification to preserve mobility and independence.

Substrate recognition mechanism of the endoplasmic reticulum-associated ubiquitin ligase Doa10

Doa10 (MARCHF6 in metazoans) is a large polytopic membrane-embedded E3 ubiquitin ligase in the endoplasmic reticulum (ER) that plays an important role in quality control of cytosolic and ER proteins. Although Doa10 is highly conserved across eukaryotes, it is not understood how Doa10 recognizes its substrates. Here, we define the substrate recognition mechanism of Doa10 by structural and functional analyses on Saccharomyces cerevisiae Doa10 and its model substrates. Cryo-EM analysis shows that Doa10 has unusual architecture with a large lipid-filled central cavity, and its conserved middle domain forms an additional water-filled lateral tunnel open to the cytosol. Our biochemical data and molecular dynamics simulations suggest that the entrance of the substrate's degron peptide into the lateral tunnel is required for efficient polyubiquitination. The N- and C-terminal membrane domains of Doa10 seem to form fence-like features to restrict polyubiquitination to those proteins that can access the central cavity and lateral tunnel. Our study reveals how extended hydrophobic sequences at the termini of substrate proteins are recognized by Doa10 as a signal for quality control.

[The analysis of unconventional lymph node metastasis in tongue squamous cell carcinoma]

Objective: To analyze the characteristics of cervical lymph node metastasis in tongue squamous cell carcinoma (TSCC). Methods: A retrospective study was conducted. A total of 329 patients with TSCC who underwent en bloc resection of primary tumor and neck dissection in the Second Xiangya Hospital of Central South University from June 2010 to March 2018 were included. There were 283 males and 46 females, aged from 26 to 80 years. All patients underwent the modified neck dissection. The main difference between the modified neck dissection and the traditional neck dissection lay in the managements of unconventional lymph nodes. The lymphatic adipose tissues adjacent to the superior thyroid artery, the base of facial artery and the branches of external carotid artery were thoroughly dissected. The primary tumor as well as lingual artery, tissues along the lingual artery and lymph nodes in the mouth floor were resected. χ2 test was used for comparison of count data, and linear regression model was used for multivariate analysis. Results: Cervical lymph node metastases were found in 136 patients (41.3%). Among 142 patients (T1-2cN0) with supraomohyoid neck dissection, 22 patients had pathologically occult lymph node metastases (15.5%), with a 5-year overall survival rate of 90.2%, which was similar to the 5-year overall survival rate of 92.1% in 120 patients without lymph node metastasis (χ2=0.156, P=0.693). Multivariate linear regression analysis showed that T stage, clinical stage and unconventional lymph node metastasis were important factors for cervical lymph node metastasis in tongue cancer patients (P<0.05). Unconventional lymph node metastases occurred in 30 patients (9.1%), including the metastases of lymph nodes in the floor of mouth (3.0%), the lingual artery (2.4%), the base of the external maxillary artery (2.1%), the superior thyroid artery (0.9%), and the external carotid artery (0.6%). There were significant differences in the unconventional lymph node metastasis rates between patients with negative and positive conventional lymph node metastases [4.9%(10/203) vs. 15.9%(20/126), χ2=11.242, P=0.001] and also between patients with depth of invasion ≤5 mm, 5 mm 10 mm [3.1%(2/64) vs. 5.7%(6/106) vs. 13.8%(22/159), χ2=7.907, P=0.005]. Conclusion: Supraomohyoid neck dissection can achieve reliable control efficacy in patients with cN0 tongue cancer. All patients with lymph node dissection should undergo unconventional lymph node dissection. Unconventional lymph node dissection is strongly recommended for patients with conventional lymph node metastasis.

Neutron-gamma discrimination with broaden the lower limit of energy threshold using BP neural network

Neutron-gamma discrimination is a tough and significative in experimental neutrons measurements procedure, especially for low-energy neutrons signal discrimination. In this work, based on the Pulse Shape Discrimination (PSD) and Back-Propagation (BP) artificial neural networks, a neutron-gamma discrimination method is developed to broaden the lower limit of energy threshold with the hidden layer of 20 neurons. Compared with neutron-gamma discrimination method based on PSD only, the developed neutron-gamma discrimination method based on the PSD and BP-ANN can discriminate neutron and gamma-ray signals with low energy threshold, which can discriminate signals up to 99.93%. Moreover, this work can reduce the energy threshold from 350 keV to 70 keV, as well as the acquired data utilization increased from 60% to more than 99.9%, which overcome the hardware limitations and distinguish neutron and gamma-ray signals, effectively. The developed neutron-gamma discrimination method and the trained neural network can be directly used to other experimental neutrons measurements.

Functional ultrasound imaging of the human spinal cord

Utilizing the first in-human functional ultrasound imaging (fUSI) of the spinal cord, we demonstrate the integration of spinal functional responses to electrical stimulation. We record and characterize the hemodynamic responses of the spinal cord to a neuromodulatory intervention commonly used for treating pain and increasingly used for the restoration of sensorimotor and autonomic function. We found that the hemodynamic response to stimulation reflects a spatiotemporal modulation of the spinal cord circuitry not previously recognized. Our analytical capability offers a mechanism to assess blood flow changes with a new level of spatial and temporal precision in vivo and demonstrates that fUSI can decode the functional state of spinal networks in a single trial, which is of fundamental importance for developing real-time closed-loop neuromodulation systems. This work is a critical step toward developing a vital technique to study spinal cord function and effects of clinical neuromodulation.

Genome-wide association studies and Mendelian randomization analyses provide insights into the causes of early-onset colorectal cancer

BACKGROUND

The incidence of early-onset colorectal cancer (EOCRC; diagnosed <50 years of age) is rising globally; however, the causes underlying this trend are largely unknown. CRC has strong genetic and environmental determinants, yet common genetic variants and causal modifiable risk factors underlying EOCRC are unknown. We conducted the first EOCRC-specific genome-wide association study (GWAS) and Mendelian randomization (MR) analyses to explore germline genetic and causal modifiable risk factors associated with EOCRC.

PATIENTS AND METHODS

We conducted a GWAS meta-analysis of 6176 EOCRC cases and 65 829 controls from the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO), the Colorectal Transdisciplinary Study (CORECT), the Colon Cancer Family Registry (CCFR), and the UK Biobank. We then used the EOCRC GWAS to investigate 28 modifiable risk factors using two-sample MR.

RESULTS

We found two novel risk loci for EOCRC at 1p34.1 and 4p15.33, which were not previously associated with CRC risk. We identified a deleterious coding variant (rs36053993, G396D) at polyposis-associated DNA repair gene MUTYH (odds ratio 1.80, 95% confidence interval 1.47-2.22) but show that most of the common genetic susceptibility was from noncoding signals enriched in epigenetic markers present in gastrointestinal tract cells. We identified new EOCRC-susceptibility genes, and in addition to pathways such as transforming growth factor (TGF) β, suppressor of Mothers Against Decapentaplegic (SMAD), bone morphogenetic protein (BMP) and phosphatidylinositol kinase (PI3K) signaling, our study highlights a role for insulin signaling and immune/infection-related pathways in EOCRC. In our MR analyses, we found novel evidence of probable causal associations for higher levels of body size and metabolic factors-such as body fat percentage, waist circumference, waist-to-hip ratio, basal metabolic rate, and fasting insulin-higher alcohol drinking, and lower education attainment with increased EOCRC risk.

CONCLUSIONS

Our novel findings indicate inherited susceptibility to EOCRC and suggest modifiable lifestyle and metabolic targets that could also be used to risk-stratify individuals for personalized screening strategies or other interventions.

Comparison of Hyaluronidase-Mediated Degradation Kinetics of Commercially Available Hyaluronic Acid Fillers In Vitro

BACKGROUND

Hyaluronic acid (HA)-based fillers are degradable with hyaluronidase, which allows for better management of adverse effects and reversal of suboptimal treatment outcomes.

OBJECTIVES

To compare the enzymatic degradation kinetics of 16 commercially available HA-based fillers, representing 6 manufacturing technologies.

METHODS

In this nonclinical study, a recently developed in vitro multidose hyaluronidase administration protocol was used to induce degradation of HA-based fillers, which allowed for real-time evaluation of viscoelastic properties at near static conditions. Each filler was exposed to repeated doses of hyaluronidase at intervals of 5 minutes to reach the degradation threshold of G' ≤ 30 Pa.

RESULTS

Noticeable differences in degradation characteristics were observed based on the design and technology of different filler classes. Vycross fillers were the most difficult to degrade and the Cohesive Polydensified Matrix filler was the least difficult to degrade. Preserved Network Technology products demonstrated proportional increases in gel degradation time and enzyme volume required for degradation across the individual RHA products and indication categories. No obvious relationship was observed between gel degradation characteristics and the individual parameters of HA concentration, HA chain length, or the degree of modification of each filler when analyzed separately; however, a general correlation was identified with certain physicochemical properties.

CONCLUSIONS

Manufacturing technology was the most important factor influencing the reversibility of an HA product. An understanding of the differential degradation profiles of commercially available fillers will allow clinicians to select products that offer a higher margin of safety due to their preferential reversibility.

The Interplay between Mycobacterium tuberculosis and Human Microbiome

Tuberculosis (TB), a respiratory disease caused by Mycobacterium tuberculosis (Mtb), is a significant cause of mortality worldwide. The lung, a breeding ground for Mtb, was once thought to be a sterile environment, but has now been found to host its own profile of microbes. These microbes are critical in the development of the host immune system and can produce metabolites that aid in host defense against various pathogens. Mtb infection as well as antibiotics can shift the microbial profile, causing dysbiosis and dampening the host immune response. Additionally, increasing cases of drug resistant TB have impacted the success rates of the traditional therapies of isoniazid, rifampin, pyrazinamide, and ethambutol. Recent years have produced tremendous research into the human microbiome and its role in contributing to or attenuating disease processes. Potential treatments aimed at altering the gut-lung bacterial axis may offer promising results against drug resistant TB and help mitigate the effects of TB.

Substrate recognition mechanism of the endoplasmic reticulum-associated ubiquitin ligase Doa10

Doa10 (MARCH6 in metazoans) is a large polytopic membrane-embedded E3 ubiquitin ligase in the endoplasmic reticulum (ER) that plays an important role in quality control of cytosolic and ER proteins. Although Doa10 is highly conserved across eukaryotes, it is not understood how Doa10 recognizes its substrates. Here, we defined the substrate recognition mechanism of Doa10 by structural and functional analyses on Saccharomyces cerevisiae Doa10 and its well-defined degron Deg1. Cryo-EM analysis shows that Doa10 has unusual architecture with a large lipid-filled central cavity, and its conserved middle domain forms an additional water-filled lateral tunnel open to the cytosol. Our biochemical data and molecular dynamics simulations suggest that the entrance of the substrate's degron peptide into the lateral tunnel is required for efficient polyubiquitination. The N- and C-terminal membrane domains of Doa10 seem to form fence-like features to restrict polyubiquitination to those proteins that can access the central cavity and lateral tunnel.

Cu-mediated enantioselective C-H alkynylation of ferrocenes with chiral BINOL ligands

A wide range of Cu(II)-catalyzed C-H activation reactions have been realized since 2006, however, whether a C-H metalation mechanism similar to Pd(II)-catalyzed C-H activation reaction is operating remains an open question. To address this question and ultimately develop ligand accelerated Cu(II)-catalyzed C-H activation reactions, realizing the enantioselective version and investigating the mechanism is critically important. With a modified chiral BINOL ligand, we report the first example of Cu-mediated enantioselective C-H activation reaction for the construction of planar chiral ferrocenes with high yields and stereoinduction. The key to the success of this reaction is the discovery of a ligand acceleration effect with the BINOL-based diol ligand in the directed Cu-catalyzed C-H alkynylation of ferrocene derivatives bearing an oxazoline-aniline directing group. This transformation is compatible with terminal aryl and alkyl alkynes, which are incompatible with Pd-catalyzed C-H activation reactions. This finding provides an invaluable mechanistic information in determining whether Cu(II) cleaves C-H bonds via CMD pathway in analogous manner to Pd(II) catalysts.

Directed evolution unlocks oxygen reactivity for a nicotine-degrading flavoenzyme

The flavoenzyme nicotine oxidoreductase (NicA2) is a promising injectable treatment to aid in the cessation of smoking, a behavior responsible for one in ten deaths worldwide. NicA2 acts by degrading nicotine in the bloodstream before it reaches the brain. Clinical use of NicA2 is limited by its poor catalytic activity in the absence of its natural electron acceptor CycN. Without CycN, NicA2 is instead oxidized slowly by dioxygen (O2), necessitating unfeasibly large doses in a therapeutic setting. Here, we report a genetic selection strategy that directly links CycN-independent activity of NicA2 to growth of Pseudomonas putida S16. This selection enabled us to evolve NicA2 variants with substantial improvement in their rate of oxidation by O2. The encoded mutations cluster around a putative O2 tunnel, increasing flexibility and accessibility to O2 in this region. These mutations further confer desirable clinical properties. A variant form of NicA2 is tenfold more effective than the wild type at degrading nicotine in the bloodstream of rats.

Resident memory T cell development is associated with AP-1 transcription factor upregulation across anatomical niches

Tissue-resident memory T (T RM ) cells play a central role in immune responses to pathogens across all barrier tissues after infection. However, the underlying mechanisms that drive T RM differentiation and priming for their recall effector function remains unclear. In this study, we leveraged both newly generated and publicly available single-cell RNA-sequencing (scRNAseq) data generated across 10 developmental time points to define features of CD8 T RM across both skin and small-intestine intraepithelial lymphocytes (siIEL). We employed linear modeling to capture temporally-associated gene programs that increase their expression levels in T cell subsets transitioning from an effector to a memory T cell state. In addition to capturing tissue-specific gene programs, we defined a consensus T RM signature of 60 genes across skin and siIEL that can effectively distinguish T RM from circulating T cell populations, providing a more specific T RM signature than what was previously generated by comparing bulk T RM to naïve or non-tissue resident memory populations. This updated T RM signature included the AP-1 transcription factor family members Fos, Fosb and Fosl2 . Moreover, ATACseq analysis detected an enrichment of AP-1-specific motifs at open chromatin sites in mature T RM . CyCIF tissue imaging detected nuclear co-localization of AP-1 members Fosb and Junb in resting CD8 T RM >100 days post-infection. Taken together, these results reveal a critical role of AP-1 transcription factor members in T RM biology and suggests a novel mechanism for rapid reactivation of resting T RM in tissue upon antigen encounter.

Dynamic Effects of Thoracic Irradiation on Immune Status of Organs in and out of Radiation Field in Mice

PURPOSE/OBJECTIVE(S)

Thoracic irradiation involves large blood vessels and hematopoietic tissues which was easily inducing lymphopenia. Lymphocytes are important components of immune response and lymphopenia is associated with poorer survival. However, the dynamic recovery of lymphocyte subsets after thoracic irradiation were rarely reported in the literature. This study focused on dynamic changes of lymphocytes subsets of mice after receiving thoracic irradiation in and out of radiation field.

MATERIALS/METHODS

C57BL/6 male mice aged 6-8 weeks received 2Gy*5fx whole thoracic irradiation and were sacrificed on the 1 day, 7 days, 15 days, 25 days after irradiation. Peripheral blood was harvested for mature lymphocyte subsets (B cells, T cells, CD4+T cells, CD8+T cells, NK cells) detection by performing flow cytometry, while thymus, femur bone marrow and sternal bone marrow for hematopoietic stem cells (Long-term Hematopoietic Stem Cell [LT-HSC], Short-term Hematopoietic Stem Cell [ST-HSC]) and progenitor cells (Multipotent Progenitor [MPP], Common Lymphoid Progenitor [CLP]). Absolute counts method was used in flow cytometry and data analysis were performed by scientific 2-D graphing and statistics software.

RESULTS

We found that the lymphocyte subsets were significantly reduced in peripheral blood of irradiated mice (all p<0.05). The mature lymphocyte subsets returned to normal 2-3 weeks after irradiation. After radiation, thymus weight was significantly decreased (p<0.0001). With the recovery of thymus weight, the number of hematopoietic stem cells returned to the baseline. For the femur bone marrow (out of the radiation field), hematopoietic stem cells and progenitor cells showed a proliferation tendency. MPP significantly increased in the 1day after irradiation (p = 0.0347) and LT-HSC increased in the 8 days (p = 0.0011). However, although ST-HSC and CLP were slightly increased after irradiation, there were no statistically significance. The sternal bone marrow (in the radiation field) reached the lowest value 1day after irradiation (all p<0.0001). Although hematopoietic stem cells and progenitor cells recovered gradually, but still far away from the level of the control group (all p<0.05).

CONCLUSION

The recovery of lymphocytes in the peripheral blood might mainly come from the supplement of bone marrow out of the irradiation field, while bone marrow in the field suffered serious destruction which did slightly help for lymphocytes recovery.

Malignant Epiretinal Membrane After Proton Beam Radiation of Ciliary Body Melanoma

Purpose

To report the development of malignant epiretinal membrane after radiation of ciliary body melanoma.

Case Report

A 65-year-old woman was referred for evaluation of a ciliary body tumor in her right eye. On examination, a pigmented ciliary body tumor, displacing the iris anteriorly, was visible superotemporally and ultrasound biomicroscopy revealed a large solid ciliary body tumor. She was diagnosed with ciliary body melanoma and treated with proton beam radiation. Over the following 29 months, the treated tumor regressed but optical coherence tomography (OCT) showed the development of a dense epiretinal membrane. Enucleation was performed and histopathological examination showed viable melanoma cells in the vitreous cavity with sheet-like growth of viable spindle melanoma cells on the epiretinal surface.

Conclusion

The development of a pigmented epiretinal membrane in eyes with uveal melanoma should raise the possibility of a malignant epiretinal membrane.

Recovery Characteristics of Lymphocyte Subsets after Thoracic Radiotherapy: A Single Center Clinical Study

PURPOSE/OBJECTIVE(S)

Lymphocytes play a critical role in anti-tumor, and are highly sensitive to radiation. However, the dynamic changes of lymphocytes subsets after receiving thoracic radiotherapy have rarely been investigated. This study was to explore the recovery characteristics of each subset, and the role of thymosin α1 after thoracic radiotherapy.

MATERIALS/METHODS

A total of 252 patients receiving chest radiotherapy included in this study. Blood was harvested before, at the end of radiotherapy, 1 month, 4 months, 7 months, 10 months, 13 months, and 19 months after radiotherapy for lymphocyte subsets detection by performing flow cytometry. In addition, a total of 26 patients with thoracic malignancy were treated with thymosin α1 after radiotherapy for one month. The number of lymphocyte subsets at the end of 1 month after radiotherapy were compared with control group. Absolute counts method was used in flow cytometry.

RESULTS

At the end of radiotherapy, nearly all of the subsets decreased significantly (T cell: 65.4%, Tc cell: 64.8%, Th cell: 66.1%, B cell: 88.7%, NK cell: 68.8%), except Treg cell. Tc cells recovered rapidly to baseline level at 1 month. The number of NK cells increased by 1.95 times at 1 month, and recovered to baseline level at 7th month. The number of B cell at 1 month was still 19.2% compared baseline, and recovered slowly to baseline at 7th month. The number of Th cells were nearly no recovery, and were 44.1% compared with baseline even at 19th month. For patients with thymosin α1 injection, all of the lymphocyte subsets had no significant difference compared those without thymosin α1 injection. In addition, younger patients were with better recovery in Th cells (p = 0.011) and B cells (p < 0.001) than elder patients at 1 month.

CONCLUSION

B cell was the most radiosensitive lymphocyte, and Th cell was continuous exhaustion after thoracic radiation. Thymosin α1 had no effect on lymphocyte subpopulation recovery, and new drugs are urgently needed to explore in the future.

Patients With Chronic Foot and Ankle Conditions Experience Significant Improvements in Sleep Quality Following Surgical Intervention

BACKGROUND

Poor sleep quality is associated with metabolic dysregulation and impaired healing. The purpose of the current study was to quantify the prevalence of poor sleep in patients with atraumatic foot and ankle (F&A) conditions and determine whether surgical treatment is associated with sleep quality improvement.

METHODS

Patients scheduled for surgical management of atraumatic F&A conditions were enrolled by 4 fellowship-trained orthopaedic F&A surgeons between May 2018 and April 2019. Patients completed the Pittsburgh Sleep Quality Index (PSQI) pre- and postoperatively. The PSQI ranges from 0 to 21, with a score ≥5 indicative of poor sleep quality. Patients also reported their perception of how their current F&A pain influenced their sleep quality on a scale of 0 to 10, where 0 indicated no influence and 10 indicated a strong influence (pain perception score [PPS]). Patients with known sleep disorders, acute surgical trauma, and infection were excluded.

RESULTS

A total of 115 patients were enrolled. The mean preoperative PSQI and PPS were 8.1 ± 3.6 (range, 2-19) and 3.1 ± 2.7 (range, 0-10), respectively. Overall, 86.1% of patients had poor sleep quality (PSQI score ≥5). Similarly, 64.3% of patients had a PPS ≥1, indicating the belief that F&A pain contributed to sleep disturbance. A minimum of 6 months of follow-up was collected for 72 (62.6%) patients. On average, these 72 patients experienced significant improvements in sleep quality (mean PSQI decreased from 7.8 ± 3.2 to 5.4 ± 3.1, P < .001). Of these patients, 59.7% continued to experience poor sleep quality (PSQI ≥5), and 55.6% perceived that F&A pain contributed to sleep disturbance (PPS ≥1).

CONCLUSION

In this series, 86.1% of patients presenting for management of atraumatic F&A conditions had poor sleep quality at the time of their initial visit, with 64.3% perceiving their F&A conditions to influence their sleep quality. Improvements in sleep quality were observed at 6 months postoperatively, though over half of patients continued to experience poor sleep quality. The location of pathology and procedure performed was not associated with sleep quality.

LEVELS OF EVIDENCE

Level IV: Prospective case series.

No Racial Differences Found in Access to Biologics: A Population-Based Study of Psoriasis Patients in the United States

BACKGROUND

Conflicting evidence exists regarding the role of race in access to biologics for patients with psoriasis.

OBJECTIVE

To compare biologic use among adult and pediatric United States psoriasis patients of different racial backgrounds.

METHODS

Population-based study of US psoriasis patients using the 2003 to 2018 Medical Expenditure Panel Survey (MEPS).

RESULTS

Among 31,525,500 adults and children with psoriasis (weighted), 3,026,578 (9.6%) were on biologics. Among psoriasis patients, 27,464,864 (87.1%) self-identified as white, 2,033,802 (6.5%) self-identified as Black, 1,173,435 (3.7%) self-identified as Asian or Pacific Islander, and 853,399 (2.7%) self-identified as other races. Among those on biologics, 2,778,239 (91.8%) self-identified as white, 84,971 (2.8%) identified as Black, 89,452 (3.0%) self-identified as Asian or Pacific Islander, and 73,917 (2.4%) self-identified as other races. Multivariate logistic regression revealed no significant differences in biologic access between whites and non-whites after adjusting for sociodemographic factors including insurance status (OR for Blacks: 0.347 [0.118, 1.021], P=0.055; OR for Asians: 0.616 [0.240, 1.579], P=0.311; OR for other races: 0.850 [0.216, 3.336], P=0.814.

CONCLUSION

The results of this study suggest that race alone is not independently associated with access to biologics among adult US psoriasis patients. Additional studies are necessary to evaluate factors independently associated with biologics access among adults and children with psoriasis in the US. J Drugs Dermatol. 2023;22(8):835-837. doi:10.36849/JDD.7134 Reddy R, Khan S, Yee D, et al. No racial differences found in access to biologics: a population-based study of psoriasis patients in the United States. .

Automation vs. Innovation: Unexplored Strategies to Improve Virtual Care

While there is a global desire to increase digital health capacity, digital health should transform health services delivery rather than simply automate - or worse - replicate existing practices. Failing to capitalize on this transformative potential misses an opportunity to engage patients and other users to provide a more person-centered experience. However, digital transformation done recklessly can disrupt workflow, alienate users, and jeopardize patient safety, as we have observed with implementation of many digital health tools. This paper uses a telemedicine example to provide insight into how digital health innovation can be a meaningful enabler of health system transformation. Examining different ways to leverage digital health technologies is crucial to best capitalize on their potential.

No causal effects between rosiglitazone and cardiovascular disease or risk factors: a Mendelian randomization study

OBJECTIVE

Although many observational studies have shown an association between rosiglitazone and cardiovascular disease (CVD) or risk factors, controversy remains. We conducted a Mendelian randomized (MR) study to explore whether rosiglitazone is causally related to CVDs and risk factors.

PATIENTS AND METHODS

Single-nucleotide polymorphisms associated with rosiglitazone at genome-wide significance were identified from a genome-wide association study of 337,159 European-ancestry individuals. Four treatments with rosiglitazone-associated single-nucleotide polymorphisms associated with a higher risk of CVDs were used as an instrumental variable (IV). Summary-level data for 7 CVDs and 7 risk factors were obtained from UK Biobank and consortia.

RESULTS

We found no causal effects of rosiglitazone, either on CVDs or risk factors. The results were consistent in sensitivity analyses using Cochran's Q test, MR-PRESSO method, leave-one-out analysis and Mendelian randomization-Egger method (MR-Egger), and no directional pleiotropy was observed. Sensitivity analyses confirmed that rosiglitazone was not significantly associated with CVDs and risk factors.

CONCLUSIONS

The findings from this MR study indicate no causal relationship between rosiglitazone and CVDs or risk factors. Hence, previous observational studies may have been biased.

Lipid peroxidation in diamond supported bilayers

Lipid peroxidation is a process that occurs in cells when they are exposed to oxidative stress. During the process reactive oxygen species attack lipids within the lipid bilayers of cells. Since the products of lipid peroxidation are toxic and carcinogenic, it is important to understand where and how it occurs with nanoscale resolution. The radical intermediates of this process are particularly interesting since they are causing chain reactions damaging large parts of the lipid membranes in cells. However, they are also difficult to measure for the state of the art because they are short lived and reactive. Here, we study the lipid peroxidation of three artificial lipid bilayers on a diamonds substrate that can be used to study lipid peroxidation. In particular, we present a diamond quantum sensing method called T₁-relaxometry that allows for in situ measurements and imaging of radical intermediates of lipid peroxidation in these membranes.

Synthesis of planar chiral ferrocenes via enantioselective remote C-H activation

Planar chiral ferrocenes are widely studied structures in asymmetric catalysis, materials science and medicinal chemistry. Although synthetic methods for 1,2-disubstituted planar chiral ferrocenes are well known, methods for the direct construction of 1,3-disubstituted planar chiral ferrocenes remain elusive. Here we report a modular platform for the construction of planar chirality in 1,3-disubstituted ferrocenes/ruthenocenes via an enantioselective relay remote C-H activation strategy. This method demonstrates a mechanism for remote enantiocontrol via enantiodetermining initial C‒H activation at the C2 position, enabled by a chiral mono-N-protected natural amino-acid ligand, and subsequent relay to the remote C3 position by a bridgehead-substituted norbornene mediator. A wide variety of 1,3-disubstituted planar chiral metallocenes are prepared with high enantioselectivity (96‒99% e.e.). The reaction shows good functional-group tolerance and high step-economy, and aryl iodides/bromides are compatible as coupling partners. The resulting metallocenes can be readily derivatized to yield planar chiral ligands and catalysts for asymmetric catalysis as well as building blocks for other applications.

Formal γ-C-H Functionalization of Cyclobutyl Ketones: Synthesis of cis-1,3-Difunctionalized Cyclobutanes

1,3-Difunctionalized cyclobutanes are an emerging scaffold in medicinal chemistry that can confer beneficial pharmacological properties to small-molecule drug candidates. However, the diastereocontrolled synthesis of these compounds typically requires complicated synthetic routes, indicating a need for novel methods. Here, we report a sequential C-H/C-C functionalization strategy for the stereospecific synthesis of cis-γ-functionalized cyclobutyl ketones from readily available cyclobutyl aryl ketones. Specifically, a bicyclo[1.1.1]pentan-2-ol intermediate is generated from the parent cyclobutyl ketone via an optimized Norrish-Yang procedure. This intermediate then undergoes a ligand-enabled, palladium-catalyzed C-C cleavage/functionalization to produce valuable cis-γ-(hetero)arylated, alkenylated, and alkynylated cyclobutyl aryl ketones, the benzoyl moiety of which can subsequently be converted to a wide range of functional groups including amides and esters.

Differences in accessing dermatology offices, primary care offices, and emergency departments between Hispanics and Non-Hispanic White Patients

How Hispanic patients access dermatologic care for skin diseases is unknown. This study aims to determine if differences exist in accessing the emergency department (ED), primary care, and outpatient dermatologic offices for skin diseases between Hispanic and non-Hispanic White patients. This cross-sectional study used nationally representative data from the Medical Panel Expenditure Survey (MEPS) from 2016-2019. A total of 109,337,668 (weighted) patients with any skin disease diagnosed at an ED, primary care, or dermatology visit were identified. Hispanics comprised 13.0% and non-Hispanic Whites comprised 68.8% of this subpopulation. Overall, 94.1% of Hispanic patients attended a primary care visit for their skin complaint, 5.8% saw a dermatologist, and 0.1% attended an ED visit. Compared to non-Hispanic Whites, Hispanics were more likely to attend a primary care visit (aOR 1.865; 95%CI, 1.640-2.122) and less likely to attend an outpatient dermatology visit (aOR 0.536; 95%CI, 0.471-0.610), after adjusting for insurance status, education, income, sex, age, and comorbidities. Our study suggests that, compared to non-Hispanic Whites, Hispanic patients access primary care more frequently and outpatient dermatologic offices less frequently for their skin conditions. Language barriers, less familiarity with the healthcare system, and lack of adequate health insurance may play roles in this observation.

Analyses of canine cancer mutations and treatment outcomes using real-world clinico-genomics data of 2119 dogs

Spontaneous tumors in canines share significant genetic and histological similarities with human tumors, positioning them as valuable models to guide drug development. However, current translational studies have limited real world evidence as cancer outcomes are dispersed across veterinary clinics and genomic tests are rarely performed on dogs. In this study, we aim to expand the value of canine models by systematically characterizing genetic mutations in tumors and their response to targeted treatments. In total, we collect and analyze survival outcomes for 2119 tumor-bearing dogs and the prognostic effect of genomic alterations in a subset of 1108 dogs. Our analysis identifies prognostic concordance between canines and humans in several key oncogenes, including TP53 and PIK3CA. We also find that several targeted treatments designed for humans are associated with a positive prognosis when used to treat canine tumors with specific genomic alterations, underscoring the value of canine models in advancing drug discovery for personalized oncology.

[Application of anterolateral thigh flap preforming tongue in patients with total glossectomy]

Objective: To investigate the efficacy of anterolateral thigh flap preforming tongue in patients with total glossectomy. Methods: A total of 27 patients with tongue cancer who underwent total glossectomy, neck lymph node dissection and anterolateral thigh flap transfer were collected from January 2019 to April 2021 in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital. All patients were males, the age ranged from 35-73 years. The patients were divided into experimental (14 cases) and control (13 cases) groups, based on whether the tongue was reconstructed. The clinical parameters of two groups were analyzed by independent sample t test or Fisher exact probability method. Results: The success rate of free flap was 100%, of the patients, 2 patients had cervical hematoma and 1 patient had wound infection postoperatively. There was no difference in speech (6.69±3.42 vs. 5.50±3.01, t=0.96, P=0.346) or swallowing (χ²=0.46, P=0.793) function between two groups at 1 month after surgery. However, the speech (24.94±7.43 vs. 18.44±6.30, t=2.48, P=0.020) and swallowing (χ²=6.97, P=0.008) functions in experimental group were significantly better than those in control group. No case was lost to follow-up. All patients were extubated after operation, with average time of 7.2 days in the experimental group and 7.7 days in the control group. The overall survival rate was 71.4% in the experimental group and 61.5% in the control group. Conclusion: The use of anterolateral thigh flap preforming tongue can improve the speech and swallowing functions in patients with total glossectomy and offer a novel method for tongue construction.

Burden of brain and central nervous system cancers in China from 1990 to 2019

OBJECTIVE

Primary central nervous system (CNS) cancer is a predominant source of mortality and morbidity globally. This study aims to analyze the burden and variation trends of CNS cancer in China from 1990 to 2019.

MATERIALS AND METHODS

In this cross-sectional study, we analyzed people of all ages with CNS cancer in China from January 1, 1990, to December 31, 2019. We collected the data including incidence, deaths, and disability-adjusted life-years (DALYs) from the Global Burden of Disease (GBD) study 2019. The age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and DALYs rate were compared by age and sex.

RESULTS

In 2019, there were more than 94 (95% uncertainty intervals [CI]: 73-114) thousand incident cases, 63 (47-76) thousand deaths and 2.0 (1.5-2.5) million DALYs due to CNS cancer in China in 2019. From 1990 to 2019, the absolute number of incident cases, deaths, and DALYs increased by 107.0% (39.0 to 169.0), 67.0% (12.0 to 117.0), and 16.0% (-23.0 to 63.0). The ASIR increased by 28.0% (-16.0 to 64.0). ASDR and age-standardized DALYs rate decreased by -10.0% (-40.0 to 15.0) and -22.0% (-50.0 to 10.0), respectively.

CONCLUSIONS

The overall burden due to CNS cancer in China remains high, as evidenced by the sharp increase in the incident cases, deaths, and DALYs from 1990 to 2019. Elderly patients and neonates show relatively high burden. Sex-specific differences in the incidence of CNS cancer in China are observed.

Systemic Barriers in Receiving Electronically Prescribed Glaucoma Medications

PRCIS

Over a third of electronically prescribed glaucoma medications were not picked up within 1 month of patient request. Feedback-driven protocols may help minimize treatment interruptions attributed to electronic prescribing.

PURPOSE

Glaucoma treatment relies on long-term medication compliance and many socioeconomic factors impact the ability of patients to receive their medications. This study aims to quantify treatment interruptions attributable to electronically prescribed medications and propose interventions to minimize this barrier.

METHODS

This is a cross-sectional study of the electronic prescribing patterns at a tertiary care hospital serving a socioeconomically diverse patient population. Glaucoma medication refill requests received over a 6-week interval were reviewed and patient pharmacies were contacted 1 month after the request date to determine whether the medication was received by the patient. Patients who did not pick up the prescriptions were contacted and consented to participate in a survey to identify the barriers to acquiring the medications.

RESULTS

Refill requests of 198 glaucoma medications met the inclusion criteria and the most common classes were prostaglandin analogs (44%) and alpha-2-agonists (21%). Medications were not obtained within 1 month in 71 (35.9%) cases. Prior authorization requirement was significantly associated with patients not obtaining their medication (odds ratio, 0.07; 95% confidence interval, 0.03-0.45). Patient reported challenges to successful receipt electronically prescribed medications included insurance coverage (32.2%) and pharmacy availability (22.6%).

CONCLUSIONS

Approximately a third of electronically prescribed glaucoma medications were not received by patients within a month of refill request due to the need for prior authorization, insurance coverage, and pharmacy availability. A mechanism to alert providers and to address these barriers to medication access may minimize treatment interruption and disease progression.

Detecting free radicals post viral infections

Free radical generation plays a key role in viral infections. While free radicals have an antimicrobial effect on bacteria or fungi, their interplay with viruses is complicated and varies greatly for different types of viruses as well as different radical species. In some cases, radical generation contributes to the defense against the viruses and thus reduces the viral load. In other cases, radical generation induces mutations or damages the host tissue and can increase the viral load. This has led to antioxidants being used to treat viral infections. Here we discuss the roles that radicals play in virus pathology. Furthermore, we critically review methods that facilitate the detection of free radicals in vivo or in vitro in viral infections.

[Association of nutritional status with clinical outcomes of stroke patients with acute anterior circulation large vessel occlusion after emergency endovascular treatment]

OBJECTIVE

To explore the influence of nutritional status on 90-day functional outcomes of stroke patients with acute large vessel occlusion in the anterior circulation after endovascular treatment (EVT).

METHODS

We retrospectively analyzed the baseline, laboratory, surgical and 90-day follow-up data of patients with stroke resulting from acute large vessel occlusion in the anterior circulation, who underwent emergency endovascular treatment in our hospital from July, 2015 to December, 2020. A favorable outcome was defined as a modified Rankin scale score ≤2 at 90 days. Univariate and multivariate regression analyses were performed to explore the relationship between nutritional status and 90-day functional outcomes of the patients.

RESULTS

A total of 459 patients (mean age of 68.29±11.21 years, including 260 males) were enrolled in this study. According to their prognostic nutritional index (PNI), the patients were divided into normal nutrition group (392 cases, 85.4%), moderate malnutrition group (44 cases, 9.6%), and severe malnutrition group (23 cases, 5.0%). Univariate analysis showed that the patients with good clinical outcomes had a lower proportion of malnutrition with a younger age, a lower rate of diabetes, lower baseline blood pressure, lower baseline NIHSS score, higher baseline ASPECT score, and higher rates of good collateral circulation and complete vascular recanalization. Multivariate analysis showed that in addition to age, diabetes, baseline systolic blood pressure, successful recanalization, baseline ASPECT score, baseline NIHSS score and collateral circulation, a greater PNI was a protective factor for a good 90-day outcome of patients after EVT (moderate vs severe: OR=0.245, 95% CI: 0.066-0.908, P=0.035; normal vs severe: OR=0.185, 95% CI: 0.059-0.581, P=0.004).

CONCLUSION

Nutritional status an important factor affecting the 90-day outcomes after EVT of stroke patients with acute large vessel occlusion in the anterior circulation.

[Association of BMI with acute exacerbation in mild to moderate chronic obstructive pulmonary disease patients in community: a prospective study]

Objective: BMI may play a protective role in reducing the mortality rate of patients with chronic obstructive pulmonary disease (COPD), but its effect on acute exacerbation of COPD remain unclear. Methods: Subjects were selected from the COPD patients registration system established in 2014 in Pudong new district, Shanghai. COPD patients from 8 communities were selected by cluster sampling and follow up was conducted prospectively for 18 months. Basic information and BMI were obtained from baseline survey, and acute exacerbations were collected during follow-up. The association between BMI and risk of acute exacerbation was evaluated by using multiple negative binomial regression. Results: Among 328 community COPD patients, 295 who completed the follow up were included in the analysis, in whom 96.3% (284/295) were mild COPD patients. During the follow-up, 11.1% (33/295) of the patients reported acute exacerbation. The results of multiple negative binomial regression suggested that, the risk for acute exacerbation decreased with the increase of BMI (IRR=0.85, 95%CI:0.73-0.98), overweight patients with BMI ≥25.0 kg/m² (IRR=0.36, 95%CI:0.13-0.91) or moderate BMI (T₂ vs. T₁, IRR=0.31, 95%CI:0.11-0.77) had lower risk for acute exacerbation compared with the patients with normal or low BMI. BMI had a linear correlation with the risk of acute exacerbation. Conclusion: The risk for acute exacerbation in patients with mild or moderate COPD in communities decreased with the increase of BMI, and being overweight might be a protective factor for the acute exacerbation of COPD.

Partial RAG deficiency in humans induces dysregulated peripheral lymphocyte development and humoral tolerance defect with accumulation of T-bet+ B cells

The recombination-activating genes (RAG) 1 and 2 are indispensable for diversifying the primary B cell receptor repertoire and pruning self-reactive clones via receptor editing in the bone marrow; however, the impact of RAG1/RAG2 on peripheral tolerance is unknown. Partial RAG deficiency (pRD) manifesting with late-onset immune dysregulation represents an ‘experiment of nature’ to explore this conundrum. By studying B cell development and subset-specific repertoires in pRD, we demonstrate that reduced RAG activity impinges on peripheral tolerance through the generation of a restricted primary B cell repertoire, persistent antigenic stimulation and an inflammatory milieu with elevated B cell-activating factor. This unique environment gradually provokes profound B cell dysregulation with widespread activation, remarkable extrafollicular maturation and persistence, expansion and somatic diversification of self-reactive clones. Through the model of pRD, we reveal a RAG-dependent ‘domino effect’ that impacts stringency of tolerance and B cell fate in the periphery.

Patients with partial recombination-activating gene (RAG) deficiency (pRD) present variable late-onset autoimmune clinical phenotypes. Walter and colleagues identified a restricted primary B cell antigen receptor repertoire enriched for autoreactivity and clonal persistence in pRD. They described dysregulated B cell maturation with expansion of T-bet⁺ B cells revealing how RAG impacts stringency of tolerance and B cell fate in the periphery.

The enzyme pseudooxynicotine amine oxidase from Pseudomonas putida S16 is not an oxidase, but a dehydrogenase

The soil-dwelling bacterium Pseudomonas putida S16 can survive on nicotine as its sole carbon and nitrogen source. The enzymes nicotine oxidoreductase (NicA2) and pseudooxynicotine amine oxidase (Pnao), both members of the flavin containing amine oxidase family, catalyze the first two steps in the nicotine catabolism pathway. Our laboratory has previously shown that, contrary to other members of its enzyme family, NicA2 is actually a dehydrogenase that uses a cytochrome c protein (CycN) as its electron acceptor. The natural electron acceptor for Pnao is unknown; however, within the P. putida S16 genome, pnao forms an operon with cycN and nicA2, leading us to hypothesize that Pnao may also be a dehydrogenase that uses CycN as its electron acceptor. Here we characterized the kinetic properties of Pnao and show that Pnao is poorly oxidized by O₂, but can be rapidly oxidized by CycN, indicating that Pnao indeed acts as a dehydrogenase that uses CycN as its oxidant. Comparing steady-state kinetics with transient kinetic experiments revealed that product release primarily limits turnover by Pnao. We also resolved the crystal structure of Pnao at 2.60 Å, which shows that Pnao has a similar structural fold as NicA2. Furthermore, rigid-body docking of the structure of CycN with Pnao and NicA2 identified a potential conserved binding site for CycN on these two enzymes. Taken together, our results demonstrate that although Pnao and NicA2 show a high degree of similarity to flavin containing amine oxidases that use dioxygen directly, both enzymes are actually dehydrogenases.

Abstract 635: Concordance between dogs and humans: The use of AI in evaluating clinical cancer genomic datasets

Spontaneous tumors in dogs are highly similar to human cancers histologically, genetically, molecularly and clinically. In this presentation we explore similarities found across species when associating cancer biomarkers and outcomes. Our findings validate concordance across the cancer journeys. This is important to deepen the field of comparative oncology and affirming spontaneous cancer in dogs as an ideal ‘model’ for precision oncology, building upon recent work in tumor biology concordance. Our machine learning analysis prognosis and predictive effect of genomic alterations in 1303 client-owned tumor-bearing dogs identified TP53 and PTPRD as prognostic markers for poor survival in dogs with an overall survival hazard ratio (OS HR) of 1.732, 1.914, respectively (P&lt;0.001 and P=0.023). These results are aligned with non-small cell lung cancer, metastatic breast cancer and pancreatic cancer in people correlated with poor survival when carrying TP53 mutation, and PTPRD also correlated with poor survival in gliomas. Besides that, we also identified ALB1 and PIK3CA prognostic markers for poor survival in canine tumors with an overall survival hazard ratio (OS HR) of 1.707, 1.689, respectively (P=0.01, and P=0.002). This data reaffirms the similarity between canine and human cancers not just in the genomic profiles but also the tumor biology and treatment strategy for both species. Among tumor types, lymphoma and hemangiosarcoma showed the worst survival times (N=32, OS HR=1.929, P=0.002, and N=202, OS HR=1.743, P&lt;0.001). Interestingly, we also identified that dogs with RET mutations respond better to toceranib, a veterinary oral multikinase inhibitor against RET, VEGFR2, PDGFR, FLT3 and c-KIT; this is in concordance with sunitinib a tyrosine kinase inhibitor that target RET used in humans thyroid carcinomas and other tumors carrying RET mutations. To the best of our knowledge, this is the largest canine tumor clinical genomic dataset analysis. Applying real-world evidence and data tools in the FidoCure® dataset, we successfully identified associations between gene mutations and survival associated with response to target therapy treatment. These associations can benefit dogs by enabling better therapeutic recommendations and also benefit human cancer research since canine models recapitulate human disease with intact immune systems and similar tumor genomic profiles, confirmed by the FidoCure® database, accelerating clinical studies of novel treatments that currently have significant barriers to study at scale.

Citation Format: Kevin Wu, Lucas Rodrigues, Gerald Post, Garrett Harvey, Aubrey Miller, Lindsay Lambert, Christina Lopes, Benjamin Lewis, James Zou. Concordance between dogs and humans: The use of AI in evaluating clinical cancer genomic datasets [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 635.