Improvement of sorghum-wheat blended flours by E-beam irradiation: Physicochemical properties, rheological behavior, microstructure, and quality properties

To enhance the processing suitability of blended flours, this study used 4 kGy E-beam irradiated (EBI) sorghum flour in different ratios blended with wheat flour and further verified the improvement mechanism of the processed products under the optimal ratios. The results suggested that the EBI can mitigate the deterioration of the blend flour farinograph properties while enhancing the gas release during dough fermentation. Under the same addition ratio, the irradiated blend flours showed higher expansion height, gas release, cavitation time, and gas retention coefficient than the control flours. Also, irradiated blend flours retained a gluten network at a higher addition rate (20 %). Moreover, the irradiated blend flours were optimized at 10 % as its pasting and thermal properties were improved. Notably, this ameliorating effect promotes a decrease in hardness and chewiness and an increase in cohesion of the bread cores, presenting better textural attributes and delaying the aging rate during storage. The findings are instructive for applying EBI technology in the manufacture and quality improvement of mixed grain breads and open a new research avenue for processing sorghum staple foods.

Associations between preparedness, perceived stress, depression, and quality of life in family caregivers of patients with a temporary enterostomy

PURPOSE

To investigate the preparedness, perceived stress, risk of depression, and quality of life of family caregivers of patients receiving a temporary enterostomy, to provide a reference for improving the long-term care and quality of life of patients receiving a temporary enterostomy.

METHODS

We enrolled 181 family caregivers of patients in a hospital in China from 2021 to 2023. Responses to the General Information Questionnaire, the Chinese Caregiver Preparedness Scale, the Chinese Perceived Stress Scale, the Chinese bilingual version of the Patient Health Questionnaire-2, and the 12-item Short Form Survey were collected online.

RESULTS

Pearson's correlation analysis revealed that family caregivers' risk of depression was negatively correlated with their preparedness, the physical component summary score, and the mental component summary score but was positively correlated with perceived stress. Multiple linear regression analysis identified factors influencing caregiver preparedness.

CONCLUSIONS

These findings help healthcare personnel to identify high-risk individuals among family caregivers of patients receiving a temporary enterostomy. This provides a basis for formulating well-planned, dynamic health education programs that meet patients' needs for disease-related knowledge and care.

Barriers to the completion of bachelor thesis for bachelor nursing students during their internship: A qualitative study from dual student and faculty perspectives

BACKGROUND

Bachelor thesis are among the most important ways of exercising Chinese nursing students' research skills and developing critical thinking. However, there is a mismatch between the expectations and abilities of clinical nursing teachers and nursing students. Exploring the impediments to nursing students' research skills can provide a basis for developing targeted improvements.

OBJECTIVE

To identify barriers to the completion of research projects among nursing undergraduates during their internships from the dual student and instructor perspectives.

DESIGN

Descriptive qualitative design.

SETTING

Affected by the COVID-19 pandemic, we conducted this study at a tertiary hospital in Fuzhou, Fujian Province.

PARTICIPANTS

The study was conducted using a purposive sample of 16 nursing interns and six instructors.

METHODS

Data were collected through semi-structured interviews to provide nursing students and instructors with various perspectives. The collected data were analysed using thematic analysis methods.

RESULTS

This study included 16 students (two male and 14 female; age 21.75 ± 0.66 years), six instructors (age 34.33 ± 1.97 years), which was sufficient to reach data saturation. We identified 126 codes from the interview data and obtained seven subcategories among three categories: a) Lack of scientific research training: lack of clinical instructors' experience, lack of academic training courses, and lack of necessary scientific research resources support; b) Poor communication: excessive workload, poor instructor-student relationship, and lack of communication skills; and c) Lack of support systems: lack of support from other disciplines and negative coping patterns.

CONCLUSIONS

The findings of this study will help nursing interns develop an interest in scientific research throughout their internships. Reducing barriers will also strengthen teacher training programmes, improve the teaching process, promote teacher-student communication, and provide students with necessary social support.

Induction Immunotherapy vs. Consolidation Immunotherapy for Unresectable Stage III NSCLC

PURPOSE/OBJECTIVE(S)

Consolidation immunotherapy after chemoradiotherapy (CRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). However, whether upfront immunotherapy before CRT has similar benefits has not been addressed. This study aimed at exploring the efficacy and safety of induction immunotherapy for unresectable stage III NSCLC through real-world data.

MATERIALS/METHODS

Patients diagnosed with stage III NSCLC who received immunotherapy in combination with sequential (sCRT) or concurrent CRT (cCRT) between November 2018 and December 2021 were retrospectively identified. Patients were divided into induction (Ind), consolidation (Con) and induction plus consolidation (Ind+Con) immunotherapy groups. Progression-free survival (PFS) and overall survival (OS) were assessed from the initiation of treatment and estimated by Kaplan‒Meier method. The potential factors affecting PFS and OS were analyzed by univariate and multivariate Cox regression models.

RESULTS

One hundred and two patients were included, with 52 (51.0%) patients in the Ind group, 35 (34.3%) in the Con group and 15 (14.7%) in the Ind+Con group. Median PFS was 24.0 months vs. 36.0 months vs. 19.0 months in the three groups, and 2-year PFS were 43.0% vs 51.1% vs 44.4% (p = 0.940). Median OS was not reached (NR) vs. 44.0 months vs. NR, with a 2-year OS rate of 80.5% vs. 84.4% vs. 86.2% (p = 0.861). In the cCRT setting, 2-year PFS rates were 56.7% vs. 71.6% vs. 100.0% (p = 0.439), 2-year OS rates were 92.3% vs. 89.3% vs. 100.0% in the three groups (p = 0.827). In multivariate analysis, elder (HR = 0.487, p = 0.037) and cCRT (HR = 0.282, p = 0.001) were the independent factors favoring PFS, while only elder (HR = 0.088, p = 0.021) was the independent factors favoring OS. Adverse events were similar in the three arms. Further analysis found the objective response rate (ORR) and disease control rate (DCR) in the Ind and Ind+Con group after induction immunotherapy were 59.7% and 98.5%, respectively. Only 1 (1.5%) patient developed progression. Subgroup analysis showed no significant difference in PFS (p = 0.520) and OS (p = 0.116) between patients who responded to induction immunotherapy (PR+CR) and those who did not (SD+PD). Patients with <4 cycles of induction immunotherapy exhibited numerically better PFS than those with ≥4 cycles of induction immunotherapy (p = 0.113) and improved OS (p = 0.021).

CONCLUSION

Induction immunotherapy may achieve similar survival benefits to consolidation immunotherapy, and the combination of induction and consolidation immunotherapy with cCRT appears to achieve better outcomes. It seems feasible and safe to upfront immunotherapy before CRT, and further investigations on the combination of induction immunotherapy and CRT are warranted.

Palliative Care as a Component of High Value and Cost-Saving Care During Hospitalization for Metastatic Cancer

PURPOSE/OBJECTIVE(S)

Randomized controlled trials have demonstrated that palliative care can improve both quality of life and survival for outpatients with advanced cancer, but there is limited population-based data on the value of inpatient palliative care. We assessed palliative care as a component of high-value care among a nationally representative sample of inpatients with metastatic cancer. We further identified care, patient, and hospital characteristics significantly associated with high costs.

MATERIALS/METHODS

This study analyzed hospitalizations of patients ≥18 years with a primary diagnosis of metastatic cancer from the National Inpatient Sample (covering 97% of the U.S. population) from 2010-2019. We utilized multivariable mixed-effects logistic regression to assess medical services (receipt of palliative care, invasive medical ventilation [IMV], systemic therapy), patient demographics, and hospital characteristics that were associated with high charges billed to insurance and hospital costs. We utilized generalized linear mixed-effects models to determine cost savings associated with provision of palliative care.

RESULTS

Among 397,691 hospitalizations from 2010 to 2019, the median charge per admission increased by 24.9%, from $44,904 in 2010 to $56,098 in 2019, while the median cost remained stable at $14,300. Receipt of inpatient palliative care was associated with significantly lower charges (Odds Ratio [OR], 0.62; 95% CI, 0.61-0.64; P <.001) and costs (OR, 0.59; 95% CI, 0.58-0.61; P<.001). Factors associated with high charges were receipt of invasive medical ventilation (P<.001) or systemic therapy (P<.001), Hispanic patients (P<.001), and young age (18-49 years, P<.001). For-profit hospitals were more likely to bill high charges (OR, 5.05; 95% CI, 4.78-5.33, P<.001) but less likely to incur high hospital costs (OR, 0.51; 95% CI, 0.48-0.54, P<.001) than public hospitals. In adjusted generalized linear mixed effects regression, palliative care provision was associated with a $1,293 (-13.4%, P<.001) reduction in costs per hospitalization compared to no palliative care, independent of receipt of invasive care and age. Significant interactions were observed between receipt of palliative care and patient age group (-9.6% for 18-49 years; -14.7% for ≥70 years), receipt of IMV (-6.4% for IMV receipt; -14.0% for no IMV), hospital ownership (-19.6% for for-profit; -10.5% for public), and year of hospitalization (-15.4% for 2010; -8.9% for 2019).

CONCLUSION

Inpatient palliative care is associated with reduced hospital costs for patients with metastatic cancer, irrespective of age and receipt of aggressive interventions. Assuming inpatient palliative care receipt increases by 50%, we estimate $4,045,000 in annual national savings. Integration of inpatient palliative care may de-escalate costs incurred through low-value inpatient interventions.

[Prospective randomized controlled trial on 2 940 nm fractional erbium laser combined with fractional micro-plasma radiofrequency in the treatment of facial atrophic acne scars]

Objective: To compare the efficacy and safety of 2 940 nm fractional erbium laser combined with fractional micro-plasma radiofrequency (FMR) therapy and 2 940 nm fractional erbium laser in the treatment of atrophic acne scars. Methods: A prospective randomized controlled research was conducted. A total of 100 atrophic acne scar patients (38 males and 62 females, aged 18-37 years) who were treated in the Scar Laser Clinic of the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from March 2018 to March 2021 and conformed to the inclusion criteria were recruited. The patients were randomly divided into erbium laser+FMR group and erbium laser alone group, with 50 cases in each group. The facial acne scars of patients in erbium laser alone group were treated with 2 940 nm fractional erbium laser, while the facial acne scars of patients in erbium laser+FMR group were treated with erbium laser as above, besides, the scars of U and M types were treated with FMR, once every 3 months for a total of 3 times. Before the first treatment and 3 months after each treatment, the Echelle D'Assessment Clinique des Cicatrices D'Acne (ECCA) was used to score the scar. The occurrence of adverse reaction during the treatment process was observed and recorded, and the incidence was calculated. Three months after the last treatment, the 5-level classification method was used to evaluate the satisfaction of patients with the treatment effect, and the satisfaction rate was calculated. Data were statistically analyzed with independent sample t test and chi-square test. Results: A total of 89 patients completed the study, including 46 patients in erbium laser+FMR group (19 males and 27 females, aged (26±5) years) and 43 patients in erbium laser alone group (15 males and 28 females, aged (27±6) years). The ECCA scores before the first treatment and 3 months after the first treatment of patients were similar between the two groups (P>0.05). The ECCA scores of patients in erbium laser+FMR group at 3 months after the second and third treatment were 72±23 and 61±18, respectively, which were significantly lower than 85±26 and 76±25 in erbium laser alone group (with t values of -2.45 and -3.26, respectively, P<0.05). During the treatment process, the incidence of adverse reaction of patients in erbium laser+FMR group and erbium laser alone group were 23.91% (11/46) and 16.28% (7/43), respectively, and there was no statistically significant difference between the two groups (P>0.05). The satisfaction rate of patients in erbium laser+FMR group was 78.26% (36/46) at 3 months after the last treatment, which was significantly higher than 53.49% (23/43) in erbium laser alone group (χ2=6.10, P<0.05). Conclusions: The 2 940 nm fractional erbium laser combined with FMR is superior to 2 940 nm fractional erbium laser alone in the treatment of facial atrophic acne scars, achieving significantly higher efficacy without significantly increasing the incidence of adverse reaction, and patients are more satisfied with the efficacy. It can be used as a recommended therapy in clinical practice.

Wheat starch particle size distribution regulates the dynamic transition behavior of gluten at different stages of dough mixing

This study investigated the morphology distribution, molecular structure, and aggregative properties variation of gluten protein during dough mixing stage and interpreted the interaction between starch with different sizes and protein. Research results indicated that mixing process induced glutenin macropolymer depolymerization, and promoted the monomeric protein conversion into the polymeric protein. Appropriate mixing (9 min) enhanced the interaction between wheat starch with different particle sizes and gluten protein. Confocal laser scanning microscopy images showed that a moderate increase in B-starch content in the dough system contributed to forming a more continuous, dense, and ordered gluten network. The 50A-50B and 25A-75B doughs mixed for 9 min exhibited a dense gluten network, and the arrangement of A-/B-starch granules and gluten was tight and ordered. The addition of B-starch increased α-helixes, β-turns, and random coil structure. Farinographic properties indicated that 25A-75B composite flour had the highest dough stability time and the lowest degree of softening. The 25A-75B noodle displayed maximum hardness, cohesiveness, chewiness, and tensile strength. The correlation analysis indicated that starch particle size distribution could influence noodle quality by changing the gluten network. The paper can provide theoretical support for regulating dough characteristics by adjusting the starch granule size distribution.

Electropolishing influence on biocompatibility of additively manufactured Ti-Nb-Ta-Zr: in vivo and in vitro

Balling defect of the additively manufactured titanium lattice implants easily leads to muscle tissue rejection, which might cause failure of implantation. Electropolishing is widely used in surface polishing of complex components and has potential to deal with the balling defect. However, a clad layer could be formed on the surface of titanium alloy after electropolishing, which may affect the biocompatibility of the metal implants. To manufacture lattice structured β-type Ti-Ni-Ta-Zr (TNTZ) for bio-medical applications, it is necessary to investigate the impact of electropolishing on material biocompatibility. In this study, animal experiments were conducted to investigate the in vivo biocompatibility of the as-printed TNTZ alloy with or without electropolishing; and proteomics technology was used to elaborate the results. The following conclusions were drawn: (a) a 30% oxalic acid electropolishing treatment was effective in solving balling defects, and ~21 nm amorphous clad layer would be formed on the surface of the material after polishing; (b) the electropolished TNTZ suggested decreased cell cytotoxicity and improved blood biocompatibility as compared to as-printed TNTZ; (c) the amorphous clad layer could make a barrier to prevent Ta and Zr ions from penetrating into the muscle tissue, and could form a good tissue regeneration at the implantation site during 4 weeks, indicating that the electropolished TNTZ has the potential as implants; and (d) the cells attached to the electropolished TNTZ showed higher antioxidant capacity but less proliferation than attached to as-printed TNTZ.

Health disparities among older adults following tropical cyclone exposure in Florida

Tropical cyclones (TCs) pose a significant threat to human health, and research is needed to identify high-risk subpopulations. We investigated whether hospitalization risks from TCs in Florida (FL), United States, varied across individuals and communities. We modeled the associations between all storms in FL from 1999 to 2016 and over 3.5 million Medicare hospitalizations for respiratory (RD) and cardiovascular disease (CVD). We estimated the relative risk (RR), comparing hospitalizations during TC-periods (2 days before to 7 days after) to matched non-TC-periods. We then separately modeled the associations in relation to individual and community characteristics. TCs were associated with elevated risk of RD hospitalizations (RR: 4.37, 95% CI: 3.08, 6.19), but not CVD (RR: 1.04, 95% CI: 0.87, 1.24). There was limited evidence of modification by individual characteristics (age, sex, or Medicaid eligibility); however, risks were elevated in communities with higher poverty or lower homeownership (for CVD hospitalizations) and in denser or more urban communities (for RD hospitalizations). More research is needed to understand the potential mechanisms and causal pathways that might account for the observed differences in the association between tropical cyclones and hospitalizations across communities.

Neural correlates of peer evaluation in irritable adolescents: Linking anticipation to receipt of social feedback

Elevated irritability during adolescence predicts mental health issues in adulthood. Social interactions commonly elicit symptoms of irritability. Prior research has traditionally examined neural activity during the anticipation of, and immediate reaction to, social feedback separately in irritable adolescents. However, studies suggest that irritable adolescents demonstrate altered brain activation when anticipating feedback, and these alterations may have downstream effects on the neural activity when actually presented with feedback. Thus, the goal of this study was to characterize the influence of irritability on the relationship between brain function during anticipation and receipt of social feedback. We leveraged the Virtual School task to mimic social interactions using dynamic stimuli. Parallel region of interest (ROI) analyses tested effects of anticipatory bilateral amygdala (or dorsal anterior cingulate cortex; dACC) activation on the dACC (or bilateral amygdala) activation during receipt of peer feedback. Parallel exploratory whole-brain analyses were conducted to identify the effects of anticipatory bilateral amygdala or dACC activation on other regions during receipt of peer feedback. In ROI analyses, more vs. less irritable adolescents showed distinct relationships between anticipatory bilateral amygdala activation and dACC activation when receiving predictably mean feedback. Across both whole-brain analyses, anticipatory bilateral amygdala and dACC activation were separately associated with activation in socioemotional regions of the brain during subsequent feedback. These relationships were modulated by irritability, and the valence and predictability of the feedback. This suggests that irritable adolescents may engage in altered emotion processing and regulation strategies, depending on the valence and predictability of social feedback.

[Exploration of making removable partial denture by digital technology]

To explore the digital manufacturing process of distal extension removable partial denture. From November 2021 to December 2022, 12 patients (7 males and 5 females) with free-ending situation were selected from the Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University. Three-dimensional model of the relationship between alveolar ridge and jaw position was obtained by intraoral scanning technique. After routine design, manufacturing and try-in of metal framework for removable partial denture, the metal framework was located in the mouth and scanned again to obtain the composite model of dentition, alveolar ridge and metal framework. The free-end modified model is obtained by merging the digital model of free-end alveolar ridge with the virtual model with the metal framework. The three-dimensional model of artificial dentition, and base plate was designed on the free-end modified model, and the resin model were made by digital milling technology. The removable partial denture was made by accurately positioning the artificial dentition and base plate, bonding metal framework with injection resin, grinding and polishing the artificial dentition and resin base. Compared with the design data after clinical trial, the results showed that there was an error of 0.4-1.0 mm and an error of 0.03-0.10 mm in the connection between the resin base of artificial dentition and the connecting rod of the in-place bolt and the connection between artificial dentition and resin base. After denturen delivery, only 2 patients needed grinding adjustment in follow-up visit due to tenderness, and the rest patients did not find any discomfort. The digital fabrication process of removable partial denture used in this study can basically solve the problems of digital fabrication of free-end modified model and assembly of artificial dentition with resin base and metal framework.

Multiscale structure-property relationships of oxidized wheat starch prepared assisted with electron beam irradiation

In this study, two promising eco-friendly modification techniques, electron beam (EB) irradiation and hydrogen peroxide (H₂O₂) oxidation, were used to prepare oxidized wheat starch. Neither irradiation nor oxidation changed starch granule morphology, crystalline pattern, and Fourier transform infrared spectra pattern. Nevertheless, EB irradiation decreased the crystallinity and the absorbance ratios of 1047/1022 cm^-1 (R_1047/1022), but oxidized starch exhibited the opposite results. Both irradiation and oxidation treatments reduced the amylopectin molecular weight (Mw), pasting viscosities, and gelatinization temperatures, while increasing the amylose Mw, solubility and paste clarity. Notably, EB irradiation pretreatment dramatically elevated the carboxyl content of oxidized starch. In addition, irradiated-oxidized starches displayed higher solubility, paste clarity, and lower pasting viscosities than single oxidized starches. The main reason was that EB irradiation preferentially attacks the starch granules, degrades the starch molecules, and depolymerizes the starch chains. Therefore, this green method of irradiation-assisted oxidation of starch is promising and may promote the appropriate application of modified wheat starch.

[A real-world study on the efficacy and safety analysis of paclitaxel liposome in advanced breast cancer]

Objective: To explore the application and efficacy of paclitaxel liposome in the treatment of advanced breast cancer among Chinese population in the real world. Methods: The clinical characteristics of patients with advanced breast cancer who received paclitaxel liposome as salvage treatment from January 1, 2016 to August 31, 2019 in 11 hospitals were collected and retrospectively analyzed. The primary outcome was progression free survival (PFS), and the secondary outcome included objective response rate (ORR) and safety. The survival curve was drawn by Kaplan-Meier analysis and the Cox regression model were used for the multivariate analysis. Results: Among 647 patients with advanced breast cancer who received paclitaxel liposome, the first-line treatment accounted for 43.3% (280/647), the second-line treatment accounted for 27.7% (179/647), and the third-line and above treatment accounted for 29.1% (188/647). The median dose of first-line and second-line treatment was 260 mg per cycle, and 240 mg in third line and above treatment. The median period of paclitaxel liposome alone and combined chemotherapy or targeted therapy is 4 cycles and 6 cycles, respectively. In the whole group, 167 patients (25.8%) were treated with paclitaxel liposome combined with capecitabine±trastuzumab (TX±H), 123 patients (19.0%) were treated with paclitaxel liposome alone (T), and 119 patients (18.4%) were treated with paclitaxel liposome combined with platinum ± trastuzumab (TP±H), 108 patients (16.7%) were treated with paclitaxel liposome combined with trastuzumab ± pertuzumab (TH±P). The median PFS of first-line and second-line patients (5.5 and 5.5 months, respectively) were longer than that of patients treated with third line and above (4.9 months, P<0.05); The ORR of the first line, second line, third line and above patients were 46.7%, 36.8% and 28.2%, respectively. Multivariate analysis showed that event-free survival (EFS) and the number of treatment lines were independent prognostic factors for PFS. The common adverse events were myelosuppression, gastrointestinal reactions, hand foot syndrome and abnormal liver function. Conclusion: Paclitaxel liposomes is widely used and has promising efficacy in multi-subtype advanced breast cancer.

Burn-out, emotional labour and psychological resilience among gastroenterology nurses during COVID-19: a cross-sectional study

OBJECTIVES

To investigate the relationship between burn-out, emotional labour and psychological resilience of gastroenterology nurses during the COVID-19 pandemic and explore the factors associated with these specific variables.

DESIGN

A multicentre cross-sectional study with anonymous self-reporting was conducted from 24 November 2021 to 26 December 2021.

SETTING

The study was conducted in Fujian Province, China.

PARTICIPANTS

The participants were 345 gastroenterology nurses from 7 tertiary hospitals.

PRIMARY AND SECONDARY OUTCOME MEASURES

Burn-out, emotional labour and psychological resilience were the primary outcome measures. Using a convenience sampling method, the data were collected using Questionnaire Star (a tool for questionnaire surveys) via WeChat. The Chinese version of the Maslach Burnout Inventory, the Chinese version of the Emotional Labour Scale and the Chinese version of the Psychological Resilience Scale were used to evaluate burn-out, emotional labour and psychological resilience, respectively.

RESULTS

The total scores for burn-out, emotional labour and psychological resilience in gastroenterology nurses were 53.07±19.63, 38.79±12.22 and 69.97±22.38, respectively, with less use of deep acting and more use of surface acting. Pearson correlation analysis showed that burn-out was positively correlated with two dimensions of emotional labour; surface acting and emotional expression, and negatively correlated with deep acting. There was a negative correlation between emotional labour and all three dimensions of psychological resilience.

CONCLUSIONS

Greater adoption of deep acting by nurses can be promoted by improving their psychological resilience during events such as the COVID-19 pandemic, which can help improve emotional labour, thereby reducing burn-out and decreasing turnover rates. Senior management in hospitals must pay attention to nurses' psychological status. Further interventional studies could be conducted in the future to explore relevant measures.

The role of cadaveric simulation in talus fracture research: A scoping review

BACKGROUND

Talus fractures are rare (<1% of all fractures), and their rarity limits the number of studies available to guide management. In instances such as this, cadaveric studies can play an important role. The purpose of this scoping review was to identify and describe the current body of literature on cadaveric studies of fractures of the talus.

METHODS

Through multiple electronic database searches (Medline, Embase, Scopus) we identified a broad body of cadaveric research into talus fractures, and these were classified into 4 main themes. Study characteristics were summarised along with any descriptive results and conclusions.

RESULTS

The search yielded 484 articles of which 19 met the inclusion criteria. They provide valuable insights into benefits and drawbacks of surgical approaches to the talus, particularly with regard to direct visualisation of anatomic reduction, and risks of neurovascular or tendon compromise. For talar neck fractures it is clear that cannulated screws offer superior fixation over plates, however, are inferior when considering anatomic reduction of the fracture. Direct visualisation of fracture reduction is far superior to intraoperative radiographic assessment, and mal-reduction leads to reduced subtalar joint range of motion, midfoot deformity, and increased joint contact pressures.

CONCLUSIONS

This study provides a summary of the existing literature surrounding the use of cadaver studies in fractures of the talus. We have identified gaps in the literature, particularly surrounding strength of fixation of new locking plate fixation techniques.

[Effect of duodenal stump reinforcement on postoperative complications in patients undergoing laparoscopic radical gastrectomy]

Objective: To evaluate the influence of duodenal stump reinforcing on the short-term complications after laparoscopic radical gastrectomy. Methods: A retrospective cohort study with propensity score matching (PSM) was conducted. Clinical data of 1204 patients with gastric cancer who underwent laparoscopic radical gastrectomy at the First Affiliated Hospital of Army Medical University from April 2009 to December 2018 were collected. The digestive tract reconstruction methods included Billroth II anastomosis, Roux-en-Y anastomosis and un-cut-Roux- en-Y anastomosis. A linear stapler was used to transected the stomach and the duodenum. Among 1204 patients, 838 were males and 366 were females with mean age of (57.0±16.0) years. Duodenal stump was reinforced in 792 cases (reinforcement group) and unreinforced in 412 cases (non-reinforcement group). There were significant differences in resection range and anastomotic methods between the two groups (both P<0.001). The two groups were matched by propensity score according to the ratio of 1∶1, and the reinforcement group was further divided into purse string group and non-purse string group. The primary outcome was short-term postoperative complications (within one month after operation). Complications with Clavien-Dindo grade ≥ III a were defined as severe complications, and the morbidity of complication between the reinforcement group and the non-reinforcement group, as well as between the purse string group and the non-purse string group was compared. Results: After PSM, 411 pairs were included in the reinforcement group and the non-reinforcement group, and there were no significant differences in baseline data between the two groups (all P>0.05). No perioperative death occurred in any patient.The short-term morbidity of postoperative complication was 7.4% (61/822), including 14 cases of anastomotic leakage (23.0%), 11 cases of abdominal hemorrhage (18.0%), 8 cases of duodenal stump leakage (13.1%), 2 cases of incision dehiscence (3.3%), 6 cases of incision infection (9.8%) and 20 cases of abdominal infection (32.8%). Short-term postoperative complications were found in 25 patients (6.1%) and 36 patients (8.8%) in the reinforcement group and the non-reinforcement group, respectively, without significant difference (χ²=2.142, P=0.143). Nineteen patients (2.3%) developed short-term severe complications (Clavien-Dindo grade ≥IIIa), while no significant difference in severe complications was found between the two groups (1.7% vs. 2.9%, χ²=1.347, P=0.246). Sub-group analysis showed that the morbidity of short-term postoperative complication of the purse string group was 2.6% (9/345), which was lower than 24.2% (16/66) of the non-purse string group (χ²=45.388, P<0.001). Conclusion: Conventional reinforcement of duodenal stump does not significantly reduce the incidence of duodenal stump leakage, so it is necessary to choose whether to reinforce the duodenal stump individually, and purse string suture should be the first choice when decided to reinforce.

[Predictive model of curative effect of mite subcutaneous immunotherapy in 5-18 years of age patients with allergic asthma]

Objective: To analyze the factors affecting the efficacy of mite subcutaneous immunotherapy (SCIT) in allergic asthma patients aged 5-18 years, and to find the best predictive model for the curative effect. Methods: The data of 688 patients aged 5-18 years with allergic asthma who completed more than 3 years of mite SCIT from December 2006 to November 2021 in the Department of Respiratory Medicine, Children's Hospital Affiliated to Nanjing Medical University were retrospectively analyzed. Male, results of skin prick test (SPT), age, daily medication score (DMS), visual analogue scale (VAS) score, and enrollment season were defined as independent variables. R language models, including Logistic regression model, random forest model and extreme gradient boosting (XGboost) model, were used to analyze the impact of these independent variables on the outcomes. The receiver operating characteristic curve was applied to compare the predictive ability of the models. Hypothesis testing of the area under curve (AUC) of the 3 models was performed using DeLong test. Results: There were 435 males and 253 females in the 688 patients. There were 349 patients aged 5-<8 years, 240 patients aged 8-<11 years, and 99 patients aged 11-18 years. SPT showed that 429 cases (62.4%) were only allergic to mite, and 259 cases (37.7%) were also allergic to other allergens. According to the efficacy after 3 years of SCIT, 351 cases (51.0%) discontinued the treatment and 337 cases (49.0%) required continued treatment. The DMS was 4 (3, 6) at initiation, 3 (2, 5) at 3 months, 3 (2, 5) at 4 months, 2 (1, 3) at 12 months, and 0 (0, 1) at 3 years of SCIT treatment. The VAS was 3.5 (2.5, 5.2) at initiation, 3.2 (2.2, 4.8) at 3 months, 2.6 (1.4, 4.1) at 4 months, 1.0 (0.6, 1.8) at 12 months, and 0.5 (0, 1.2) at 3 years of treatment. At 3, 4, and 12 months, the rate of decline in DMS was 0 (0, 20%), 16.7% (0, 33.3%), and 50.0% (31.0%, 75.0%), respectively; and the VAS decreased by 7.1% (3.2%,13.8%), 27.6% (16.7%,44.4%), and 70.2% (56.1%, 82.3%), respectively. Regarding the enrollment season, 99 cases were in spring, 230 cases in summer, 171 cases in autumn, and 188 cases in winter. The R language Logistic regression model found that DMS>3 points at 3 months (OR=-3.5, 95%CI:-4.3--2.7, P<0.01), male (OR=-1.7, 95%CI:-2.3--1.0), P<0.01), DMS decline rate>16.7% at 4 months (OR=-1.6, 95%CI:-2.3--0.8, P<0.01) and DMS decline rate>0 at 3 months (OR=-0.7, 95%CI:-1.3--0.2, P<0.05) had higher possibility of drug discontinuation; whereas, the decline rate of DMS at 12 months>50.0% (OR=0.7, 95%CI: 0.1-1.3, P<0.05), VAS at 12 months>1.0 points (OR=0.9, 95%CI: 0.3-1.6, P<0.05), and initial VAS<4.0 points (OR=1.0, 95%CI: 0.4-1.6, P<0.01) had lower possibility of drug discontinuation. Both the random forest model and the XGboost model showed that DMS>3 points at 3 months (mean decrease accuracy=30.9, importance=0.45) had the greatest impact on drug discontinuation. The AUC of the random forest model was the largest at 0.900, with an accuracy of 78.2% and a sensitivity of 84.5%. Logistic regression model had AUC of 0.891, accuracy of 80.0%, and sensitivity of 80.0%; XGboost model had AUC of 0.886, accuracy of 76.9%, and sensitivity of 84.5%. The AUC of the pairwise comparison model by DeLong test found that all three models could be used for the prediction of this data set (all P>0.05). Conclusions: The more drugs used to control the primary disease, and the more careful reduction of the control medicine after starting SCIT treatment, the more favorable it is to stop all drugs after 3 years. The random forest model is the best predictive model for the efficacy of mite SCIT in asthmatic children.

[Effect of progesterone receptor status on efficacy of aromatase inhibitors and survival time in patients with advanced breast cancer]

To investigate the effect of progesterone receptor (PR) on the efficacy of first-line aromatase inhibitor (AI) endocrine therapy and progression-free survival (PFS) in patients with estrogen receptor (ER) positive HER-2 negative advanced breast cancer. The clinical data of 198 patients with advanced breast cancer treated in Henan Cancer Hospital from January 2014 to October 2019 were collected. The Chi-square test was used to compare the difference between the two groups, and the Cox regression model was used to analyze the related prognostic factors. The median progression-free survival time ((PFS)) of PR+and PR- patients were 12.5 months and 9.0 months, respectively, and the difference was statistically significant (P=0.004). The clinical benefit rate (CBR) was 81.1% and 63.1%, respectively, and the difference was not statistically significant (P<0.001). PR is an independent prognostic factor of first-line AI endocrine therapy in ER-positive HER-2-negative patients. PR+type breast cancer has a better response to first-line AI endocrine therapy and longer PFS time than PR- type advanced breast cancer.

MiR-218-5p Affects Subcutaneous Adipogenesis by Targeting ACSL1, A Novel Candidate for Pig Fat Deposition

As a centre enzyme in fatty acid activation, acyl-CoA synthetase long-chain family member 1 (ACSL1) plays an important role in body lipid homeostasis. However, the functions of ACSL1 in the subcutaneous adipogenesis of pigs are largely unknown. In the present study, we found that the expression of ACSL1 significantly increased during the process of porcine preadipocyte differentiation. Moreover, silencing of ACSL1 in preadipocytes decreased levels of triglyceride and adipogenic-related markers, including FABP4, APOE, and FASN (p < 0.01), and simultaneously increased levels of lipolytic-related markers, such as ATGL and HSL (p < 0.05). Conversely, overexpression of ACSL1 in preadipocytes increased levels of triglyceride and FABP4, APOE, and FASN (p < 0.01), and reduced levels of ATGL and HSL (p < 0.05). Luciferase reporter assays revealed that ACSL1 is a target of miR-218-5p, which can reduce the mRNA and protein levels of ACSL1 by directly binding the 3′ untranslated region of ACSL1. Furthermore, miR-218-5p has an inhibition role in porcine preadipocyte differentiation by suppressing ACSL1 expression. Taken together, these data provide insights into the mechanism of the miR-218-5p/ACSL1 axis in regulating subcutaneous fat deposition of pigs.

SESN3 Inhibited SMAD3 to Relieve Its Suppression for MiR-124, Thus Regulating Pre-Adipocyte Adipogenesis

Sestrin-3, together with the other two members Sestrin-1 and Sestrin-2, belongs to the Sestrin family. The Sestrin protein family has been demonstrated to be involved in antioxidative, metabolic homeostasis, and even the development of nonalcoholic steatohepatitis (NASH). However, the adipogenic regulatory role of SESN3 in adipogenesis still needs to be further explored. In this study, we demonstrated SESN3 inhibited porcine pre-adipocyte proliferation, thus suppressing its adipogenesis. Meanwhile, SESN3 has been demonstrated to inhibit Smad3 thus protecting against NASH. Further, for our previous study, we found mmu-miR-124 involved in 3T3-L1 cell adipogenesis regulation. In this study, we also identified that ssc-miR-124 inhibited porcine pre-adipocyte proliferation, thus suppressing its adipogenesis, and the SMAD3 was an inhibitor of ssc-miR-124 by binding to its promoter. Furthermore, the ssc-miR-124 targeted porcine C/EBPα and GR and thus inhibited pre-adipocyte adipogenesis. In conclusion, SESN3 inhibited SMAD3, thus improving ssc-miR124, and then suppressed C/EBPα and GR to regulate pre-adipocytes adipogenesis.

Bone infection: a clinical priority for clinicians, scientists and educators

Bone infection has received increasing attention in recent years as one of the main outstanding clinical problems in orthopaedic-trauma surgery that has not been successfully addressed. In fact, infection may develop across a spectrum of patient types regardless of the level of perioperative management, including antibiotic prophylaxis. Some of the main unknown factors that may be involved, and the main targets for future intervention, include more accurate and less invasive diagnostic options, more thorough and accurate debridement protocols, and more potent and targeted antimicrobials. The underlying biology dominates the clinical management of bone infections, with features such as biofilm formation, osteolysis and vascularisation being particularly influential. Based on the persistence of this problem, an improved understanding of the basic biology is deemed necessary to enable innovation in the field. Furthermore, from the clinical side, better evidence, documentation and outreach will be required to translate these innovations to the patient. This review presents the findings and progress of the AO Trauma Clinical Priority Program on the topic of bone infection.

[Adrenal adenoma presenting as serous chorioretinopathy complicated by exudative retinal detachment: a case report]

The case is presented on a 33-year-old woman with sudden vision loss for more than 20 days without a history of steroid use either locally or systemically. There was a history of connective tissue disease. The fundus fluorescein angiogram and optical coherence tomography showed multiple central serous chorioretinopathy (CSC) complicated by exudative retinal detachment (ERD). Meanwhile, the computed tomography of the adrenal suggested an adrenal adenoma. After complete tumor resection, the visual and anatomical functions of this patient have been significantly improved. Moreover, recurrence of CSC complicated by ERD was not observed during 9 months clinical follow-up after surgery. (Chin J Ophthalmol, 2021, 57: 784-786).

A further survey of the quantitative trait loci affecting swine body size and carcass traits in five related pig populations

Breeding for good meat quality performance while maintaining large body size and desirable carcass traits has been the major challenge for modern swine selective breeding. To address this goal, in the present work we studied five related populations produced by two commercial breeds (Berkshire and Duroc) and two Chinese breeds (Licha black pig and Lulai black pig). A single-trait GWAS performed on 20 body size and carcass traits using a self-developed China Chip-1 porcine SNP50K BeadChip identified 11 genome-wide significant QTL on nine chromosomes and 22 suggestive QTL on 15 chromosomes. For the 11 genome-wide significant QTL, eight were detected in at least two populations, and the rest were population-specific and only mapped in Shanxia black pig. Most of the genome-wide significant QTL were pleiotropic; for example, the QTL around 75.65 Mb on SSC4 was associated with four traits at genome-wide significance level. After screening the genes within 50 kb of the top SNP for each genome-wide significant QTL, NR6A1 and VRTN were chosen as candidate genes for vertebrae number; PLAG1 and BMP2 were identified as candidate genes for body size; and MC4R was the strong candidate gene for body weight. The four genes have been reported as candidates for thoracic vertebrae number, lumbar vertebrae number, carcass length and body weight respectively in previous studies. The effects of VRTN on thoracic vertebrae number, carcass length and body length have been verified in Shanxia black pig. Therefore, the VRTN genotype could be used in gene-assisted selection, and this could accelerate genetic improvement of body size and carcass traits in Shanxia black pig.

Elevated Serum FGG Levels Prognosticate and Promote the Disease Progression in Prostate Cancer

Castration-resistant prostate cancer (CRPC) threatens the health of men in general and no effective therapeutics currently exists for the treatment of CRPC. It is therefore of great importance to find a novel molecule that can be a biomarker and a therapeutic target for CRPC. First, we found that the serum fibrinogen gamma (FGG) levels in patients with CRPC were significantly higher than those with localized prostate cancer (PCa) through iTRAQ proteomics and ELISA experiments. Immunohistochemistry, quantitative real-time polymerase chain reaction and western blot also showed an increase of FGG expression in CRPC tissues and cells. Then we proved the proliferation, invasion and migration ability of CRPC cells were significantly reduced after FGG knockdown. The number of apoptotic cells increased at least sixfold after FGG silencing, and was observed in conjunction with an upregulation of p53, caspase 3, clea-caspase 3, and Bax, and a downregulation of Bcl2 and survivin. FGG knockdown in DU145 cells resulted in smaller xenografts than control cells in a mouse model. and we established that FGG is modulated by IL-6 which was increased in CRPC patients via phosphorylation of STAT3. The data suggests that FGG may be a potential therapeutic target and prognostic marker for CRPC.

Hoxa11 and Hoxa13 facilitate slow-twitch muscle formation in C2C12 cells and indirectly affect the lipid deposition of 3T3-L1 cells

Muscle-fiber type in livestock skeletal muscles influences meat quality, but the underlying mechanisms remain unclear. We previously showed that Homeobox A11 (Hoxa11) and Homeobox A13 (Hoxa13) are differentially expressed in fast- and slow-twitch muscles, but their effects on the formation of muscle-fiber types and intramuscular fat deposition have not been investigated. Here, our results revealed that overexpression of Hoxa11 and Hoxa13 delayed cell-cycle progression in C2C12 myoblasts, reduced their proliferation, and promoted their differentiation into slow-twitch muscle fibers. Knockdown experiments produced the opposite results. The conditioned media of differentiated C2C12 cells with Hoxa11/Hoxa13 overexpression or knockdown were harvested. Staining results showed that adipogenesis of preadipocytes was significantly promoted by Hoxa13 knockdown C2C12 cell culture medium. Changes in lipid accumulation were due to a reduction in lipid decomposition and an increase in triglyceride synthesis; genes related to fatty-acid synthesis were decreased. In conclusion, our study showed that Hoxa11 and Hoxa13 promote slow-twitch muscle formation and indirectly regulate preadipocyte adipogenesis, which may facilitate meat-quality improvement in the future.

Apelin-13/APJ system delays intervertebral disc degeneration by activating the PI3K/AKT signaling pathway

OBJECTIVE

To study the effect of Apelin-13/APJ system on intervertebral disc degeneration and its mechanism.

PATIENTS AND METHODS

This study detected the expression of APJ in human intervertebral disc tissue with varying degrees of degeneration. IL-1β is used to stimulate the degeneration of nucleus pulposus cells. We used recombinant human Apelin-13 and Ala13 to activate and inhibit the APJ receptor, respectively. The inhibitor LY294002 was used to inhibit the PI3K/AKT signaling pathway. We studied the effects of Apelin-13/APJ system on nucleus pulposus cells and its mechanism by Western blot, RT-PCR, and so on.

RESULTS

APJ is lowly expressed in the nucleus pulposus of patients with a high degree of degeneration. IL-1β stimulates the nucleus pulposus cells and reduces the expression of APJ in nucleus pulposus cells. Recombinant human Apelin-13 reduces the degradation of nucleus pulposus extracellular matrix, promotes proliferation, and reduces the levels of apoptosis and inflammation. In addition, the Apelin-13/APJ system increases the expression of PI3K and AKT and activates the PI3K/AKT signaling pathway.

CONCLUSIONS

Apelin-13/APJ system activates PI3K/AKT signaling pathway activity, reduces the degradation of nucleus pulposus extracellular matrix, promotes proliferation, and reduces the level of apoptosis and inflammation, thus delaying the degeneration of the intervertebral disc.

Long noncoding RNA PVT1 promotes metastasis via miR-484 sponging in osteosarcoma cells

OBJECTIVE

Long noncoding RNAs (lncRNAs) are widely involved in various malignancies including osteosarcoma. In the current study, we aimed to illustrate the role of lncRNA plasmacytoma variant translocation 1 (PVT1) in osteosarcoma.

PATIENTS AND METHODS

Expression of PVT1 and microRNA-486 (miR-486) in osteosarcoma tissue specimens and cell lines were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) assays and in situ hybridizations (ISH) assay. Transwell migration/invasion assays were performed to determine the metastatic ability changes in osteosarcoma cells. Kaplan-Meier survival analysis was applied to analyze the overall survival (OS) of patients with osteosarcoma. Luciferase assays were used to evaluate the targeted binding effect between PVT1 and miR-486.

RESULTS

We illustrated that lncRNA plasmacytoma variant translocation 1 (PVT1) was upregulated in osteosarcoma, and it was correlated with poor prognosis of patients with osteosarcoma. Furthermore, we found that PVT1, via constructed loss of function and gain of function assays, promoted osteosarcoma cells migration and invasion. Meanwhile, we demonstrated that microRNA-486 (miR-486) was involved in PVT1-induced migration and invasion. We also uncovered that miR-486 was downregulated in osteosarcoma tissue specimens and cell lines. Functionally, we showed that upregulation of miR-486 reversed the facilitative effect of PVT1 on osteosarcoma cells migration and invasion, and vice versa. Mechanically, we illustrated that PVT1 interacted with miR-486 in a reciprocal suppressed manner. Moreover, we found that miR-486 could target to PVT1 via Luciferase assay. Lastly, we proved that PVT1 promoted osteosarcoma cells migration and invasion through miR-486 sponging.

CONCLUSIONS

We demonstrated that PVT1, functioning as an oncogene, promotes osteosarcoma cells metastasis via miR-486 sponging. PVT1/miR-486 axis might be a novel target in the molecular treatment of osteosarcoma.

Hydroclimate footprint of pan-Asian monsoon water isotope during the last deglaciation

Oxygen isotope speleothem records exhibit coherent variability over the pan-Asian summer monsoon (AM) region. The hydroclimatic representation of these oxygen isotope records for the AM, however, has remained poorly understood. Here, combining an isotope-enabled Earth system model in transient experiments with proxy records, we show that the widespread AM δ18Oc signal during the last deglaciation (20 to 11 thousand years ago) is accompanied by a continental-scale, coherent hydroclimate footprint, with spatially opposite signs in rainfall. This footprint is generated as a dynamically coherent response of the AM system primarily to meltwater forcing and secondarily to insolation forcing and is further reinforced by atmospheric teleconnection. Hence, widespread δ18Op depletion in the AM region is accompanied by a northward migration of the westerly jet and enhanced southwesterly monsoon wind, as well as increased rainfall from South Asia (India) to northern China but decreased rainfall in southeast China.

CircRNA UBAP2 promotes the progression of ovarian cancer by sponging microRNA-144

OBJECTIVE

This study aims to elucidate the regulatory effect of circular RNA UBAP2 (circUBAP2) on the progression of ovarian cancer (OC).

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to detect the expressions of circUBAP2, microRNA-144 and CHD2 in OC tissues and adjacent normal tissues. The correlation between the expression levels of circUBAP2 and microRNA-144 with pathological parameters of OC patients was analyzed. Subcellular distribution of circUBAP2 was detected by chromatin fractionation assay. After overexpression of circUBAP2 in OC cells, changes in proliferative and migratory abilities were evaluated by Cell Counting Kit-8 (CCK-8) and transwell assay, respectively. In addition, the Dual-Luciferase reporter gene assay was used to verify the binding of circUBAP2 and microRNA-144, and the binding of CHD2 to microRNA-144.

RESULTS

QRT-PCR results showed that circUBAP2 was highly expressed in OC tissues, and its expression was negatively correlated with TMN stage and five-year survival of OC patients. CircUBAP2 was mainly distributed in the cytoplasm. Overexpression of circUBAP2 significantly promoted the proliferative and migratory abilities of OC cells. The Dual-Luciferase reporter gene assay demonstrated that circUBAP2 could bind to microRNA-144. Meanwhile, circUBAP2 negatively regulated microRNA-144 expression in OC cells. Besides, the promotive effects of circUBAP2 on the proliferation and migration of OC cells were reversed by microRNA-144 overexpression. MicroRNA-144 was lowly expressed in OC tissues, which was negatively correlated with TNM stage of OC patients. The Dual-Luciferase reporter gene assay confirmed the binding condition between CHD2 and microRNA-144. CHD2 expression was negatively regulated by microRNA-144 in OC cells. Moreover, CHD2 could bind to microRNA-144 and partially inhibited its activity, thereby promoting the proliferative and migratory abilities of OC cells.

CONCLUSIONS

CircUBAP2 promotes the progression of ovarian cancer by adsorbing microRNA-144.

HBP1 deficiency protects against stress-induced premature senescence of nucleus pulposus

OBJECTIVE

Senescence of nucleus pulposus (NP) cells is involved in the pathological process of intervertebral disc degeneration (IVDD). HMG-box transcription factor 1 (HBP1) is a transcriptional inhibitor that prevents proliferation and regulates premature senescence of cells. The aim of this study was to confirm whether HBP1 deficiency could protect stress-induced NP cells premature senescence.

PATIENTS AND METHODS

Firstly, HBP1 protein level in human degenerated intervertebral disc tissues was detected. Then, NP cells were isolated from disc samples and transfected with plasmid to upregulate HBP1expression. H2O2 and interleukin-1b (IL-1b) were used to induce NP cells premature senescence in a different manner. Thereafter, cell viability, proliferation, and apoptosis were measured, and the protein expressions of collagen II, HBP1, and p16, were determined by Western blot or immunofluorescence. Finally, the mRNA levels of aggrecan, collagen I, IL-6, Transforming Growth Factor-α (TNF-α), and matrix metalloproteinase-3 (MMP-3) were determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR).

RESULTS

The data indicated that HBP1 was upregulated in degenerated NP tissues. HBP1 gene overexpression increased p16 expression, affected NP cell proliferation, and caused cell apoptosis. In addition, HBP1 also decreased the collagen II and aggrecan expressions but increased collagen I, IL-6, TNF-α, and MMP-3 levels. Moreover, the silencing of HBP1 markedly reversed the H2O2 and IL-1b induced NP cell senescence by reducing p16 expression, apoptotic cell population, and inflammatory response and by promoting cell proliferation.

CONCLUSIONS

In summary, HBP1 accumulation contributes to the senescence of NP cells, and HBP1 deficiency protects stress-induced NP cells premature senescence.

[CAR T-cell bridging to allo-HSCT for relapsed/refractory B-cell acute lymphoblastic leukemia: the follow-up outcomes]

Objective: This study aims to investigate the efficacy and safety of chimeric antigen receptor (CAR) T-cell bridging allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of recurrent and refractory acute B-lymphocytic leukemia (R/R B-ALL) . Methods: A total of 50 R/R B-ALL patients who underwent CAR T-scell therapy to bridge allo-HSCT in the First Affiliated Hospital of Soochow University from January 2017 to May 2019 were retrospectively analyzed. The overall survival (OS) rate, event-free survival (EFS) rate, cumulative recurrence rate (CIR) , and transplant-related mortality (TRM) of patients with different bone marrow minimal residual disease (MRD) levels were analyzed before and after CAR T-cell infusion and before allo-HSCT. Results: The response rate of CAR T-cell therapy and the incidence rate of severe cytokine release syndrome were 92% and 28% , respectively. During 55 infusions, no treatment-related deaths occurred in any of the patients. The median time of CAR T-cell infusion to allo-HSCT was 54 (26-232) days, the median follow-up time after CAR T-cell infusion was 637 (117-1097) days, and the 1-year OS and EFS rates were (80.0±5.7) % and (60.0±6.9) % . The 1-year CIR and TRM after allo-HSCT were (28.0±0.4) % and (8.0±0.2) % . After CAR T-cell infusion and before allo-HSCT, patients with bone marrow MRD<0.01% had a significantly longer EFS [ (70.0±7.2) % vs (20.0±12.6) % , P<0.001; (66.7±7.5) % vs (36.4±14.5) % , P=0.008]and lower CIR [ (25.0±0.5) % vs (70.0±2.6) % , P<0.001; (23.08±0.47) % vs (45.45±2.60) % , P=0.038]. Conclusion: CAR T-cell therapy bridging allo-HSCT is safe and effective for recurrent and refractory B-ALL.

Additively manufactured biomedical Ti-Nb-Ta-Zr lattices with tunable Young's modulus: Mechanical property, biocompatibility, and proteomics analysis

Some β-Ti alloys, such as Ti-Nb-Ta-Zr (TNTZ) alloys, exhibit a low Young's modulus and excellent biocompatibility. These alloys are promising new generation biomedical implant materials. Selective laser melting (SLM) can further enable customer-specific manufacturing of β-Ti alloys to satisfy the ever-increasing need for enhanced biomedical products. In this study, we quantitatively determined the relationships between porosity, yield strength, and Young's modulus of SLM-prepared TNTZ lattices. The study constitutes a critical step toward understanding the behavior of the lattice and eventually enables tuning the Young's modulus to match that of human bones. Fatigue properties were also investigated on as-printed lattices in terms of the stress limit. The biocompatibility study included a routine evaluation of the relative cell growth rate and a proteomics analysis using a common mouse fibroblast cell line, L929. The results indicated that the as-printed TNTZ samples exhibited evidence of protein proliferation of the L929 cells, particularly P06733, and that those proteins are responsible for biological processes and molecular functions. They in turn may have promoted cell regeneration, cell motility, and protein binding, which at least partially explains the good biocompatibility of the as-printed TNTZ at the protein level. The study highlights the promising applications of additively manufactured TNTZ as a bone-replacing material from mechanical and biocompatibility perspectives.

Identification of a TH 2-high psoriasis cluster based on skin biomarker analysis in a Chinese psoriasis population

BACKGROUND

Psoriasis is an immune-mediated, chronic inflammatory disease with diverse phenotypes. However, its biological diversity has not been well-characterized in Chinese psoriasis population.

OBJECTIVES

To characterize psoriasis biological heterogenicity using gene expression profiles of lesional skin biopsy specimens in a Chinese psoriasis population.

METHODS

Lesional tissues and blood samples from Chinese psoriasis patients (n = 40), atopic dermatitis (AD) patients (n = 25) and age-matched healthy controls (n = 19) were investigated by using real-time PCR array, histological evaluation and flow cytometry. Unsupervised hierarchical clustering was performed using gene expression profiles of patients with psoriasis.

RESULTS

Two distinct psoriasis clusters were identified. Both clusters indicated high T_H 17 activation. One cluster (n = 6 of 40 consecutive psoriasis patients) indicated a strong T_H 2 component in skin lesions, with early onset and low peripheral blood eosinophil level. Significantly higher IL-4, IL-13, IL-25, IL-31 and TSLP gene induction typified this cluster of psoriasis patients, even compared with AD patients. Both psoriasis clusters were characterized by neutrophilic microabscess formation. Histologically, the T_H 2 high psoriasis cluster indicated a low percentage of perivascular eosinophils.

CONCLUSIONS

Two distinct psoriasis clusters were identified. One presented early onset and a low eosinophil level, indicating T_H 17 polarization and a strong T_H 2 component. These results laid the foundation for further demonstrating the pathogenesis of psoriasis in Chinese population.