Identification of potent pan-ephrin receptor kinase inhibitors using DNA-encoded chemistry technology

EPH receptors (EPHs), the largest family of tyrosine kinases, phosphorylate downstream substrates upon binding of ephrin cell surface-associated ligands. In a large cohort of endometriotic lesions from individuals with endometriosis, we found that EPHA2 and EPHA4 expressions are increased in endometriotic lesions relative to normal eutopic endometrium. Because signaling through EPHs is associated with increased cell migration and invasion, we hypothesized that chemical inhibition of EPHA2/4 could have therapeutic value. We screened DNA-encoded chemical libraries (DECL) to rapidly identify EPHA2/4 kinase inhibitors. Hit compound, CDD-2693, exhibited picomolar/nanomolar kinase activity against EPHA2 (Ki: 4.0 nM) and EPHA4 (Ki: 0.81 nM). Kinome profiling revealed that CDD-2693 bound to most EPH family and SRC family kinases. Using NanoBRET target engagement assays, CDD-2693 had nanomolar activity versus EPHA2 (IC50: 461 nM) and EPHA4 (IC50: 40 nM) but was a micromolar inhibitor of SRC, YES, and FGR. Chemical optimization produced CDD-3167, having picomolar biochemical activity toward EPHA2 (Ki: 0.13 nM) and EPHA4 (Ki: 0.38 nM) with excellent cell-based potency EPHA2 (IC50: 8.0 nM) and EPHA4 (IC50: 2.3 nM). Moreover, CDD-3167 maintained superior off-target cellular selectivity. In 12Z endometriotic epithelial cells, CDD-2693 and CDD-3167 significantly decreased EFNA5 (ligand) induced phosphorylation of EPHA2/4, decreased 12Z cell viability, and decreased IL-1β-mediated expression of prostaglandin synthase 2 (PTGS2). CDD-2693 and CDD-3167 decreased expansion of primary endometrial epithelial organoids from patients with endometriosis and decreased Ewing's sarcoma viability. Thus, using DECL, we identified potent pan-EPH inhibitors that show specificity and activity in cellular models of endometriosis and cancer.

CYP3A Mediates an Unusual C(sp2)-C(sp3) Bond Cleavage via Ipso-Addition of Oxygen in Drug Metabolism

Mammalian cytochrome P450 drug-metabolizing enzymes rarely cleave carbon-carbon (C-C) bonds and the mechanisms of such cleavages are largely unknown. We identified two unusual cleavages of non-polar, unstrained C(sp2)-C(sp3) bonds in the FDA-approved tyrosine kinase inhibitor pexidartinib that are mediated by CYP3A4/5, the major human phase I drug metabolizing enzymes. Using a synthetic ketone, we rule out the Baeyer-Villiger oxidation mechanism that is commonly invoked to address P450-mediated C-C bond cleavages. Our studies in 18O2 and H2 18O enriched systems reveal two unusual distinct mechanisms of C-C bond cleavage: one bond is cleaved by CYP3A-mediated ipso-addition of oxygen to a C(sp2) site of N-protected pyridin-2-amines, and the other occurs by a pseudo-retro-aldol reaction after hydroxylation of a C(sp3) site. This is the first report of CYP3A-mediated C-C bond cleavage in drug metabolism via ipso-addition of oxygen mediated mechanism. CYP3A-mediated ipso-addition is also implicated in the regioselective C-C cleavages of several pexidartinib analogs. The regiospecificity of CYP3A-catalyzed oxygen ipso-addition under environmentally friendly conditions may be attractive and inspire biomimetic or P450-engineering methods to address the challenging task of C-C bond cleavages.

[Research status and reflection on animal models of sepsis]

Infectious diseases are the leading cause of death in children. Sepsis is a critical infectious disease that causes death in children globally, with a high morbidity and mortality rate. It poses a serious threat to children's health. Early diagnosis has become the key to treating severe sepsis. The establishment of animal models of sepsis can help people better diagnose sepsis and take interventions to improve the prognosis of sepsis patients. This study reviews the types, advantages and disadvantages of existing animal models of sepsis and proposes the optimization of these models to provide a reference basis for the selection and optimization of experimental models and the promotion of the "reverse transformation" of sepsis into clinical practice.

Cryptanshinone extract of Salvia miltiorrhiza stimulates pediatric acute myeloid leukemia stem cell apoptosis and the anti-inflammatory mechanism via accelerating microRNA-211-5p to supress Janus kinase 2/signal transducer and activator of transcription 3 signaling pathway activation

This study was designed to explore cryptanshinone (CPT) extract of Salvia miltiorrhiza stimulating pediatric acute myeloid leukemia (AML) stem cell (LSC) apoptosis and anti-inflammatory mechanism via accelerating microRNA (miR)-211-5p to restrain Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway activation. Obtaining blood samples from pediatric acute myeloid leukemia patients and healthy volunteers and detecting miR-211-5p and JAK2 were performed. Purchase of the human AML cell line KG1a was conducted, and sorting of KG1a cells was to gain LSC. Test of miR-211-5p and JAK2, the phosphorylation of JAK2/STAT3 was implemented. Pretreatment of LSCs was with CPT. Variation of miR-211-5p and JAK2 in LSCs was via plasmid transfection to explore their actions in cell advancement with apoptosis and inflammation. Identification of the targeting of miR-211-5p with JAK2 was implemented. In results: MiR-211-5p was declined in endometrial cancer, while JAK2 was elevated; CPT was available to boost LSC apoptosis and restrain the inflammation; elevated miR-211-5p or repressive JAK2 was available to strengthen the acceleration of CPT on LSCs apoptosis and the repression of inflammation; MiR-211-5p targeted JAK2; augmented JAK2 was available to turn around the action of elevated miR-211-5p. We conclude that CPT extract of Salvia miltiorrhiza stimulated pediatric LSC apoptosis and restrained the inflammation via accelerating microRNA (miR)-211-5p to suppress JAK2/STAT3 pathway activation.

[Impact of different diagnostic criteria for assessing mild micro-hepatic encephalopathy in liver cirrhosis: an analysis based on a prospective, multicenter, real-world study]

Objective: To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test. Methods: This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ (2) test. A kappa test was used to compare the consistency between groups. Results: After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea (Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences (P < 0.001). Conclusion: The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

[Blood eosinophils and clinical features of pneumoconiosis complicated with chronic obstructive pulmonary disease: A cross-sectional study]

Objective: To analyze the correlation between peripheral blood eosinophil (EOS) level and clinical characteristics of patients with pneumoconiosis complicated with chronic obstructive pulmonary disease (COPD) . Methods: From January 2007 to November 2020, newly diagnosed patients with pneumoconiosis complicated with COPD in Beijing Chaoyang Hospital, were retrospectively analyzed. These patients were stratified into EOS<100 cells/μl group and EOS≥100 cells/μl group, taking 100 cells/μl as the cut-off value. Demographic characteristics, clinical symptoms, lung function and laboratory indexes were compared between the two groups. Results: The median EOS count of patients with pneumoconiosis complicated with COPD was 100 (40, 180) cells/μl. 50.2% (160/319) had blood eosinophil counts ≥100 cells/μl, and 11.0% (35/319) had blood eosinophil counts ≥300 cells/μl. In comparison with EOS<100 cells/μl group, EOS≥100 cells/μl group were older (P=0.035), had higher body mass index (P=0.008), and had lower forced respiratory volume in the first second (P=0.017), had higher the ratio of residual volume to total lung volume (P=0.010), and had lower diffusing capacity of the lung for carbon monoxide (P=0.008). Arterial partial pressure of oxygen was significantly reduced in EOS≥100 cells/μl group (P=0.039). The peripheral blood EOS count was negatively correlated with forced vital capacity, forced breathing volume in the first second, carbon monoxide diffusion, peak expiratory flow, and maximum mid expiratory flow as a percentage of expected values (r(s)=-0.22, -0.18, -0.19, -0.19, -0.19, P=0.000, 0.001, 0.003, 0.008, 0.002), and positively correlated with the ratio of residual air volume to total lung volume (r(s)=0.17, P=0.002) . Conclusion: There was a correlation between blood EOS count and pulmonary function parameters, can proide reference for the diagnosis and treatment of chnoric obstuctive pulmmory disease in clinical practice.

[The incidence of artificial stone-related silicosis among interior decoration workers in different countries]

In this paper, 177 cases of artificial stone-related silicosis in interior decoration workers from Israel, Spain, USA, Italy and Australia were analyzed. Interior decoration workers were from small businesses (or workshops), engaged in kitchen and/or bathroom artificial stone countertops cutting, grinding, polishing and other reprocessing. In the working environment, the content of crystalline silica in artificial stone was more than 70%, and the concentration of silica dust exceeded the relevant standards. Most workplaces used dry cutting without ventilation and dust removal and other dust-proof measures, and most workers did not wear qualified respiratory protective equipment. Taking comprehensive measures such as wet operation, ventilation and dust removal, and individual protection can effectively prevent the occurrence of artificial stone-related silicosis.

[Clinical characteristics and follow-up analysis of 12 patients of acute phosphine poisoning]

Objective: To investigate the clinical characteristics of patients with acute phosphine poisoning, and to follow up and evaluate the prognosis of patients. Methods: In May 2022, 12 patients with phosphine poisoning by respiratory inhalation in Beijing Chao-Yang Hospital of Capital Medical University were analyzed. The patients were treated with symptomatic support therapy. Three months later, patients were re-evaluated the symptoms of poisoning, pulmonary function and magnetic resonance imaging (MRI) of the brain to understand the prognosis of the phosphine poisoning. Results: The main symptoms of 12 patients were respiratory and central nervous system symptoms with hypoxia. The symptoms of poisoning improved after treatment. Follow-up found that the patients had different degrees of residual symptoms. Pulmonary function showed increased airway resistance. Airway challenge test was positive in some patients. MRI of the head of some patients showed small ischemic focus in bilateral frontal lobes. Conclusion: Acute phosphine poisoning may cause persistent damage to the respiratory system and central system, and residual symptoms after 3 months.

[A systematic review of the epidemiology and clinical characteristics of artificial stone-related silicosis and dust protection]

Objective: To investigate the epidemiology, clinical characteristics, on-site dust monitoring and individual protection of the patients with artificial stone-related silicosis. Methods: In March 2022, the literature on artificial stone-related silicosis published from January 1965 to February 2022 was searched in China Journal Full-text Database, Wanfang Database, VIP Database, EMbase and PubMed. Chinese and English search terms include "silica dust""silica dust""silicosis""artificial stone""pneumoconiosis", etc. References were included according to inclusion and exclusion criteria, and data were extracted. The epidemiological characteristics, natural course of disease, workplace dust concentration and individual protection level of patients with artificial stone-related silicosis were analyzed by systematic review. Results: A total of 30 literatures were included, including 7 cohort studies, 14 cross-sectional studies, 3 case-control studies and 6 case reports. A total of 1358 patients with artificial stone-related silicosis were diagnosed from 1997 to 2020, with an average age of 41.5 years old and an average dust exposure time of 11.3 years. Among them, 36.2% (282/778) had progressive mass fibrosis or accelerated progressive silicosis at first diagnosis. Chest imaging showed diffuse small nodule shadow, pulmonary fibrosis, and silico-alveolar proteinosis. Pulmonary function showed restricted or mixed ventilation disorder with or without decreased diffusion volume. The disease progressed rapidly, with progressive mass fibrosis, respiratory failure, and even death. Patients engaged in artificial quartz stone processing, with high concentration of silica including ultra-fine particles, most of which were dry operation, lack of on-site ventilation measures and no effective personal protection. Conclusion: The artificial stone processing workers suffer from artificial stone-related silicosis due to dry cutting, lack of on-site dust removal facilities and personal protective measures, and the disease progresses rapidly, leading to poor prognosis.

[A concise review of diagnosis and evaluation of interstitial lung abnormalities]

Interstitial lung abnormalities (ILAs) refer to the subtle or mild signs of ILAs pulmonary parenchyma on chest HRCT scans, which are not yet sufficient to diagnose a certain interstitial lung disease, may be potentially compatible an early stage of the diseases. The signs of ILAs usually includes ground-glass opacities, reticular abnormakicies, honeycombing, traction bronchiectasis or non-emphysematous cysts. This article reviews the research progreses in the definition and classification, risk factors, prognosis, comorbidities and management of ILAs in combination with domestic and foreign literatures.

[Effect of pirfenidone on paraquat-induced pulmonary fibrosis in rats]

Objective: To construct paraquat (PQ) poisoning rat model and to explore the effect of pirfenidone (PFD) on PQ-induced pulmonary fibrosis. Methods: In April 2017, male 6-8 week-old Wistar rats were selected, and PQ was administered intraperitoneally at one time. PFD was administered by gavage 2 hours after poisoning. The daily gavage doses were 100, 200 and 300 mg/kg, and the rats were divided into physiological saline group, PQ group, PQ+PFD 100 group, PQ+PFD 200 group, PQ+PFD 300 group, with 10 rats in each group at each observation time point. The pathological changes of lung tissue at different time points (the 1st, 3rd, 7th, 14th, 28th, 42nd and 56th days) after poisoning and the effect of PFD intervention with different dose on PQ-induced pulmonary fibrosis were observed. Pathological evaluation of lung tissue was performed by Ashcroft scale method. The PQ+PFD 200 group was selected to further explore the pathological changes of lung tissue, the contents of hydroxyproline and malondialdehyde in lung tissue were determined.And the tumor necrosis factor (TNF) -α, interleukin (IL) -6, transforming growth factor (TGF) -β1, fibroblast growth factor (FGF) -B, platelet-derived growth factor (PDGF) -AB, insulin-like growth factor (IGF) -1 and PQ concentrations in serum and lung tissue were determined. Results: On the 1st to 7th day after PQ exposure, rats developed lung inflammation, which was aggravated on the 7th to 14th day, and pulmonary fibrosis appeared on the 14th to 56th day. Compared with PQ group, the Ashcroft scores of lung fibrosis in PQ+PFD 200 group and PQ+PDF 300 group decreased significantly in 7th and 28th day (P<0.05), while the Ashcroft score of lung fibrosis in PQ+PFD 100 group had no significant difference (P>0.05). After PQ exposure, the content of hydroxyproline in lung tissue increased gradually and reached the peak value on the 28th day. Compared with the PQ group, the contents of hydroxyproline in the PQ+PFD 200 group decreased at the 7th, 14th and 28th day, and the contents of malondialdehyde decreased at the 3rd and 7th day, the differences were statistically significant (P<0.05). The levels of TNF-α, IL-6 in rat serum and lung tissue reached the peak value on the 7th day after PQ exposure, and the levels of TGF-β1, FGF-B and IGF-1 in rat serum and lung tissue reached the peak value on the 14th day after PQ exposure, and the level of PDGF-AB in rat serum and lung tissue reached the peak value on the 28th day after PQ exposure. Compared with PQ group, the level of serum IL-6 in PQ+PFD 200 group decreased significantly on the 7th day, and serum TGF-β1, FGF-B, PDGF-AB and IGF-1 on the 14th and 28th day were decreased significantly (P<0.05). The levels of TNF-α, IL-6 in lung tissue of rats in PQ+PFD 200 group on the 7th day decreased significantly, and the levels of TGF-β1, FGF-B and IGF-1 in lung tissue of rats on the 14th day were significantly decreased, and the level of PDGF-AB in lung tissue of rats on the 28th day were significantly decreased (P<0.05) . Conclusion: PFD partially alleviates the PQ-induced lung inflammation and fibrosis by inhibiting oxidative stress, reducing the levels of pro-inflammatory and pro-fibrotic cytokines in serum and lung tissue, but does not affect the concentrations of PQ in serum and lung tissue.

Concise Syntheses of Microsomal Metabolites of a Potent OXE (Oxoeicosanoid) Receptor Antagonist

5-Oxo-6,8,11,14-eicosatetraenoic acid (5-oxo-ETE) is the most potent eosinophil chemoattractant among lipid mediators, and its actions are mediated by the selective oxoeicosanoid (OXE) receptor. Our group previously developed a highly potent indole-based OXE antagonist, S-C025, with an IC₅₀ value of 120 pM. S-C025 was converted to a number of metabolites in the presence of monkey liver microsomes. Complete chemical syntheses of authentic standards enabled us to identify that the four major metabolites were derived by the oxidation at its benzylic and N-methyl carbon atoms. Herein we report concise syntheses of the four major metabolites of S-C025.

[Bibliometric and hot spot visualization analysis of pneumoconiosis and smoking]

Objective: To analyze the distribution and keywords of Chinese and English literature on pneumoconiosis and smoking, and to explore its characteristics and evolutionary laws. Methods: In November 2020, using PubMed, Web of Science, SinoMed, and CNKI as search databases, literature search was performed using Chinese and English search terms related to pneumoconiosis and smoking. The document management software Note Express 3.5.0 and the bibliometric analysis software VOS viewer 1.6.10 were used to analyze the publication year, number of publications, countries, research institutions and keywords. Results: In the English literature, there were 938 articles about pneumoconiosis and smoking related research, and the literature was first published in 1962. Among them, the United States published the largest number of articles (450 articles), and China published 29 articles, ranking fourth. There were a total of 601 research articles on pneumoconiosis and smoking in Chinese literature. The literature was first published in 1976. The institution that published the most articles was China Medical University (23 articles), followed by Lanzhou University (15 articles). Keyword co-occurrence analysis showed that domestic and foreign literatures were the main research hotspots on occupational exposure, carcinogenicity, risk factors, lung function, and DNA damage of pneumoconiosis and smoking. Conclusion: The research on pneumoconiosis and smoking focuses on carcinogenicity, risk factors, lung function, DNA damage mechanism, etc., providing research hotspots for the prevention and clinical treatment of related diseases.

[Research progress of occupational and environmental exposure and idiopathic pulmonary fibrosis]

Occupational and environmental exposure can directly cause specific lung diseases, and can also induce autoimmune diseases that can lead to various types of interstitial lung diseases. In recent years, it was discovered that certain occupational and environmental exposure was related to the increased risk of Idiopathic pulmonary fibrosis (IPF) disease and progression, including metal and mineral dust, wood dust, organic dust, asbestos dust, silica dust, cigarette smoke and air pollution. IPF is a chronic progressive fibrotic lung disease of unknown etiology, with a characteristic imaging and histologic pattern called usual interstitial pneumonia. This article is a review based on the correlation and mechanism of occupational and environmental exposure in the pathogenesis and disease progression of IPF to improve the understanding of the disease and promote the formulation of treatment plans.

Advancing ASMS with LC-MS/MS for the discovery of novel PDCL2 ligands from DNA-Encoded chemical library selections

BACKGROUND

A safe, effective, and reversible nonhormonal male contraceptive drug is greatly needed for male contraception as well as for circumventing the side effects of female hormonal contraceptives. Phosducin-like 2 (PDCL2) is a testis-specific phosphoprotein in mice and humans. We recently found that male PDCL2 knockout mice are sterile due to globozoospermia caused by impaired sperm head formation, indicating that PDCL2 is a potential target for male contraception. Herein, our study for the first time developed a biophysical assay for PDCL2 allowing us to screen a series of small molecules, to study structure-activity relationships (SAR), and to discover two PDCL2 binders with novel chemical structure.

OBJECTIVE

To identify a PDCL2 ligand for therapeutic male contraception, we performed DNA-encoded chemical library (DECL) screening and off-DNA hit validation using a unique affinity selection mass spectrometry (ASMS) biophysical profiling strategy.

MATERIALS AND METHODS

We employed the screening process of DECL which contain billions of chemically unique DNA-barcoded compounds generated through individual sequences of reactions and different combinations of functionalized building blocks. The structures of the PDCL2 binders are proposed based on the sequencing analysis of the DNA barcode attached to each individual DECL compound. The proposed structure is synthesized through multi-step reactions. To confirm and determine binding affinity between the DECL identified molecules and PDCL2, we developed an ASMS assay that incorporates liquid chromatography with tandem mass spectrometry (LC-MS/MS).

RESULTS

After a screening process of PDCL2 with DECLs containing >440 billion compounds, we identified a series of hits. The selected compounds were synthesized as off-DNA small molecules, characterized by spectroscopy data, and subjected to our ASMS/LC-MS/MS binding assay. By this assay, we discovered two novel compounds that showed good binding affinity for PDCL2, which was further confirmed by thermal shift assay (TSA).

DISCUSSION AND CONCLUSION AND RELEVANCE

With the ASMS/LC-MS/MS assay developed in this paper, we successfully discovered a PDCL2 ligand that warrants further development as a male contraceptive. This article is protected by copyright. All rights reserved.

[Prevalence and risk factors of silicosis complicated with chronic obstructive pulmonary disease]

Objective: To explore the prevalence, clinical characteristics and risk factors of chronic obstructive pulmonary disease (COPD) in silicosis patients. Methods: In May 2021, a cross-sectional study was used to retrospectively include 329 silicosis patients first diagnosed in Beijing Chaoyang Hospital from January 1, 2007 to December 31, 2020. The demographic data, occupational history, chest imaging, pulmonary function and blood routine indicators of silicosis patients with COPD were analyzed, and the risk factors of silicosis with COPD were analyzed by multiple logistic regression. Results: There were 128 patients with silicosis complicated with COPD, and the overall prevalence rate was 38.9% (128/329) . Among them, 73.4% (94/128) were male and 33.6% (43/128) were heavy smokers; 33.6% (43/128) of patients were classified as gold 1, 37.5% (48/128) as gold 2, 25.0% (32/128) as gold 3, and 3.9% (5/128) as gold 4. Diagnostic age (OR=1.04, 95%CI=1.02~1.06, P<0.001) , cumulative smoking (OR=1.03, 95%CI=1.01~1.05, P=0.008) and silicosis stage III (OR=7.06, 95% CI=4.00-12.46, P<0.001) were risk factors for silicosis complicated with COPD. Conclusion: Diagnostic age, cumulative smoking volume and third stage of silicosis are the risk factors of silicosis patients with different degrees of COPD, which should be paid attention to in clinical treatment.

The testis-specific E3 ubiquitin ligase RNF133 is required for fecundity in mice

BACKGROUND

Ubiquitination is a post-translational modification required for a number of physiological functions regulating protein homeostasis, such as protein degradation. The endoplasmic reticulum (ER) quality control system recognizes and degrades proteins no longer needed in the ER through the ubiquitin-proteasome pathway. E2 and E3 enzymes containing a transmembrane domain have been shown to function in ER quality control. The ER transmembrane protein UBE2J1 is a E2 ubiquitin-conjugating enzyme reported to be essential for spermiogenesis at the elongating spermatid stage. Spermatids from Ube2j1 KO male mice are believed to have defects in the dislocation step of ER quality control. However, associated E3 ubiquitin-protein ligases that function during spermatogenesis remain unknown.

RESULTS

We identified four evolutionarily conserved testis-specific E3 ubiquitin-protein ligases [RING finger protein 133 (Rnf133); RING finger protein 148 (Rnf148); RING finger protein 151 (Rnf151); and Zinc finger SWIM-type containing 2 (Zswim2)]. Using the CRISPR/Cas9 system, we generated and analyzed the fertility of mutant mice with null alleles for each of these E3-encoding genes, as well as double and triple knockout (KO) mice. Male fertility, male reproductive organ, and sperm-associated parameters were analyzed in detail. Fecundity remained largely unaffected in Rnf148, Rnf151, and Zswim2 KO males; however, Rnf133 KO males displayed severe subfertility. Additionally, Rnf133 KO sperm exhibited abnormal morphology and reduced motility. Ultrastructural analysis demonstrated that cytoplasmic droplets were retained in Rnf133 KO spermatozoa. Although Rnf133 and Rnf148 encode paralogous genes that are chromosomally linked and encode putative ER transmembrane E3 ubiquitin-protein ligases based on their protein structures, there was limited functional redundancy of these proteins. In addition, we identified UBE2J1 as an E2 ubiquitin-conjugating protein that interacts with RNF133.

CONCLUSIONS

Our studies reveal that RNF133 is a testis-expressed E3 ubiquitin-protein ligase that plays a critical role for sperm function during spermiogenesis. Based on the presence of a transmembrane domain in RNF133 and its interaction with the ER containing E2 protein UBE2J1, we hypothesize that these ubiquitin-regulatory proteins function together in ER quality control during spermatogenesis.

Intravoxel incoherent motion diffusion-weighted imaging as a quantitative tool for evaluating disease activity in patients with axial spondyloarthritis

AIM

To determine the correlations between four quantitative magnetic resonance imaging (MRI) parameters derived from intravoxel incoherent motion diffusion-weighted images (IVIM DWI) and the semi-quantitative Spondyloarthritis Research Consortium of Canada (SPARCC) score of the sacroiliac joint (SIJ) and five clinical activity indices in patients with axial spondyloarthritis (axSpA).

AND METHODS

A total of 75 patients with axSpA and complete clinical activity indices and SIJ MRI were enrolled to this prospective study. Univariable and multivariable linear regression analyses were performed to evaluate correlations between MRI parameters and clinical activity indices after controlling for confounders. All data were further analysed using Pearson's correlation coefficients (r).

RESULTS

Only pure diffusion coefficient (D) and incoherent perfusion related microcirculation (D∗) were found to be independently positively correlated with several clinical activity indices (all p<0.05). Positive correlations were observed between D and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Patient Global Assessment (PGA), extent of influence of pain, with r of 0.605, 0.402, 0.319, and 0.485 (all p<0.0125). D∗ correlated positively with BASDAI, BASFI, and PGA (r=0.436, 0.356, 0.301, respectively; all p<0.0125).

CONCLUSION

D and D∗ derived from IVIM DWI could be associated with some disease activity indices in patients with axSpA; apparent diffusion coefficient (ADC) and SPARCC scores were not correlated with these indices. IVIM DWI may be a useful tool for the quantitative assessment of disease activity in patients with axSpA.

[Risk factors for syncope in children with severe idiopathic pulmonary arterial hypertension]

Objective: To explore the risk factors for syncope in children with severe idiopathic pulmonary arterial hypertension (IPAH). Methods: Forty-four patients (age<18 years) with IPAH admitted to the Department of Pediatric Cardiology, Beijing Anzhen Hospital between May 2011 and October 2021 were retrospectively included. Patients were devided into syncope group and non-syncope group. Clinical manifestation and hemodynamic parameters including echocardiography, blood tests, right heart catheterization and acute pulmonary vascular expansion test were compared between two groups. Comparisons between groups were performed with unpaired Student t test, or Mann-Whitney U test or chi-square test. Logistic regression was used to calculate the odds ratio (OR) for parameters with statistically significant differences between groups and analyze the statistical correlation. Results: Among the 44 patients, 16 were males, the onset age was (7.2±3.9) years. Twenty-four (55%) children presented with 1 to 11 times of episodes of syncope, and 18 cases of whom induced by physical activity. Syncope group had a larger proportion of New York Heart Association (NYHA) heart function class Ⅲ-Ⅳ (67% (16/24) vs. 25% (5/20), χ²=7.59, P=0.006), higher brain natriuretic peptide (BNP) value ((251±39) vs. (61±40) pg/L, t=-2.18, P=0.035), higher pulmonary-to-aorta diameter ratio (1.6±0.4 vs. 1.4±0.2, t=-2.25, P=0.030) and larger pulmonary vascular resistance index ((22±11) vs. (16±7) WU/m², t=-2.13, P=0.039) compared with non-syncope group. The proportion of patent foramen ovale (4% (1/24) vs. 45% (9/20), χ²=10.36, P=0.001), left ventricular ejection fraction (LVEF) ((68±5)% vs. (72±8)%, t=2.23, P=0.031) and the positive rate of acute pulmonary vascular expansion test (8% (2/24) vs. 35% (7/20), χ²=4.77, P=0.029) of syncope group were significantly lower than those of non-syncope group. Multiple Logistic regression analysis showed that NYHA heart function Ⅲ-Ⅳ (OR=6.787, 95%CI 1.445-31.880), pulmonary vascular resistance index (OR=1.247, 95%CI 1.020-1.525) and BNP (OR=1.036, 95%CI 1.007-1.066) were independent risk factors for syncope. The patent foramen ovale (OR=0.010, 95%CI 0.000-0.586) was a protective factor for syncope. Conclusions: NYHA cardiac function grade, pulmonary vascular resistance index and BNP are independent risk factors for syncope. Patent foramen ovale is a protective factor for syncope. Exercise is the main inducement of syncope in children with IPAH.

Brain functional changes in individuals with bulimia nervosa: a protocol for systematic review and meta-analysis

INTRODUCTION

Bulimia nervosa (BN) is a disorder with high health and socioeconomic burdens that typically arises in late adolescence and early adulthood. Previous neuroimaging studies have found functional brain changes in patients with BN. This study aims to review the latest neurobiological evidence from studies of individuals with BN, examine the consistency of these findings and evaluate the food addiction hypothesis of the disease.

METHODS AND ANALYSIS

A systematic search will be performed using the Cochrane Library, PubMed, Embase and Web of Science databases, covering the period from database inception to 30 November 2021. Two researchers will be responsible for study selection, quality assessment and data extraction. The anisotropic effect size version of the signed differential mapping method will be used to conduct a coordinate-based meta-analysis. Publication bias will be examined with the Egger test. The quality of studies will be evaluated using the Newcastle-Ottawa Scale.

ETHICS AND DISSEMINATION

No ethics approval is required for this is a systematic review protocol and does not require the collection of primary data. Findings will be disseminated through peer-reviewed journal or related conferences.

PROSPERO REGISTRATION NUMBER

CRD42022307233.

[Chest high-resolution CT features analysis in predicting the progression of asbestosis]

Objective: To analyze the radiological characteristics of chest high-resolution computed tomography (HRCT) of patients with asbestosis, and to investigate the signs of predicting the disease progression of asbestosis. Methods: A prospective method was used to enroll 68 patients with asbestosis who were regularly followed up from 2013 to 2016. The radiological characteristics of patients with asbestosis were described by the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) , and the differences between patients with and without progression were compared during the observation period. The Cox proportional hazards regression model was used to analyze the chest HRCT radiological signs predicting the progression of asbestosis. Results: The study included 68 patients with asbestosis aged (65.5±7.8) years old, of which 64.7% (44/68) were female, 29.4% (20/68) had a history of smoking. There was no significant difference in age, sex, smoking and asbestos exposure between patients with progressive asbestosis (20.6%, 14/68) and patients without progressive asbestosis (79.4%, 54/68) (P>0.05) . Chest HRCT of patients with asbestosis showed irregular and/or linear opacities, of which 5.9% (4/68) were accompanied by honeycombing. Irregular and/or linear opacities were mainly lower lung preponderant, often accompanied with ground glass opacity and mosaic perfusion. 98.5% (67/68) had pleural abnormalities, of which 39.7% (27/68) had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. The analysis of multivariable Cox proportional hazard regression showed that the risk of the progression of asbestosis was increased with higher irregular and/or linears opacities cores (HR=1.184, 95%CI: 1.012-1.384, P=0.034) and the appearance of honeycombing (HR=6.488, 95%CI: 1.447-29.097, P=0.015) . Conclusion: The irregular and/or linear opacities scores and honeycombing on chest HRCT are independent influencing factors for predicting the disease progression of asbestosis.

[Current trends in research on occupational benzene poisoning: a bibliometric and visual analysis]

Objective: To analyze the research trends of benzene poisoning in recent years, to highlight the relevant research hotspots and prospects through bibliometrics. Methods: In August 2020, used "benzene" methylbenzere as key words, publications were retrieved from the PubMed, the Web of Science Core Collection database, SinoMed and CNKI before August 31, 2020. Describing the publication time, the number of the published research, publication countries, research institutions and journals. VOSviewer 1.6.10 were used to evaluate and co-occurrence analyze the keywords of the researches. Results: There were 510 English literatures about benzene poisoning. 43 countries had published relevant literatures. The United States had the largest number of articles (43.92%, 224/510) in this field, and China ranked second (11.57%, 59/510) . Relevant results had been published in 257 English journals. The most widely published journal was Environmental Health Perspectives (4.90%, 25/510) . There were 536 Chinese literatures. 368 research institutions had published relevant literatures. The first one was Shenzhen Occupational Disease Prevention and Control Hospital (3.36%, 18/536) , followed by the Chinese Center for Disease Control and Prevention (3.17%, 17/536) . A total of 170 journals had published relevant research results. The most frequently published journal is Chinese Journal of Industrial Hygiene and Occupational Diseases (12.13%, 65/536) . Key words co-occurrence analysis indicated that the domestic and foreign literatures paid more attention to occupational exposure, blood toxicity, myelosuppression, genetic polymorphism and so on. Conclusion: Domestic and foreign researches on benzene poisoning are mostly in China and the United States. In recent years, the research has gradually focused on the related mechanism of benzene poisoning, such as blood toxicity, carcinogenicity, genotoxicity and immunotoxicity.

A Highly Convergent Total Synthesis of Norhalichondrin B

A new synthetic strategy for the total synthesis of norhalichondrin B featuring a highly convergent approach and our recently disclosed reverse approach for the synthesis of cyclic ether structural motifs is disclosed. Resulting in the shortest route to norhalichondrin B disclosed thus far, the reported total synthesis was achieved through the synthesis of two almost equally complex fragments whose coupling and short elaboration sequence featured an essential epimerization of the C16 stereocenter occurring concurrently with a simple acid-induced deprotection, a tactic based on a prior study along the synthetic route. This unprecedented strategy within the halichondrin family of natural products could find practical application to the synthesis of other more or less complex natural or designed halichondrin analogues.

[Mini-incision with endoscope-assisted surgery for bilateral congenital second branchial cleft fistula and a pedigree report]

Objective: To investigate the feasibility and efficacy of mini-incision with endoscope-assisted resection for bilateral congenital second branchial cleft fistula, and to report on a rare pedigree. Methods: The clinical data of 5 patients with bilateral congenital second branchial fistula admitted in Fujian Provincial Hospital from April 2007 to December 2018 were retrospectively reviewed, including 2 males and 3 females, aged from 3 to 31 years old. The surgical strateges and clinical experience of single mini-incision with endoscope-assisted fistulectomy were summarized, and a rare pedigree was reported. Results: In five patients, Case 1 to Case 4 were treated with bilateral endoscopic-assisted fistula high ligation with titanium clips and removal through a single small incision under general anesthesia. No obvious complications occurred after the operation. The patients were followed up for 40-164 months with no fistula recurrence. Case 5 gave up surgical resection and was followed up for 24 months with acute infection attack once. Case 2 and Case 4 came from the same family. In this family, 7 out of 31 members of four generations had second branchial cleft fistulas, of which 4 were bilateral and 3 were right. Pedigree analysis was consistent with autosomal dominant inheritance. No deafness, preauricular tag, external and middle ear deformity and kidney malformation were found in the family members. Conclusions: Bilateral congenital second branchial cleft fistula is rare. Surgical resection is the preferred treatment. Mini-incision with endoscopic-assisted fistula high ligation with titanium clip and resection has clear operative field, ideal cosmetic effect and definite curative effect.

Targeting the oxoeicosanoid (OXE) receptor with a selective antagonist inhibits allergen-induced pulmonary inflammation in non-human primates

BACKGROUND AND PURPOSE

The 5-lipoxygenase product 5-oxo-ETE (5-oxo-6,8,11,14-eicosatetraenoic acid) is a potent chemoattractant for eosinophils and neutrophils. However, little is known about its pathophysiological role because of the lack of a rodent ortholog of its OXE receptor. The present study aimed to determine whether the selective OXE receptor antagonist S-Y048 can inhibit allergen-induced pulmonary inflammation in a monkey model of asthma.

EXPERIMENTAL APPROACH

Monkeys sensitized to house dust mite antigen (HDM) were treated with either vehicle or S-Y048 prior to challenge with aerosolized HDM and bronchoalveolar (BAL) fluid was obtained 24 h later. After six weeks, animals that had initially been treated with vehicle received S-Y048 and vice versa for animals initially treated with S-Y048. Eosinophils and neutrophils in BAL and lung tissue samples were evaluated, as well as mucus-containing cells in bronchi.

KEY RESULTS

HDM significantly increased the numbers of eosinophils, neutrophils, and macrophages in BAL fluid 24 h after challenge. These responses were all significantly inhibited by S-Y048, which also reduced the numbers of eosinophils and neutrophils in lung tissue 24 h after challenge with HDM. S-Y048 also significantly reduced the numbers of bronchial epithelial cells staining for mucin and MUC5AC after antigen challenge.

CONCLUSION AND IMPLICATIONS

This study provides the first evidence that 5-oxo-ETE may play an important role in inducing allergen-induced pulmonary inflammation and could also be involved in regulating MUC5AC in goblet cells. OXE receptor antagonists such as S-Y048 may useful therapeutic agents in asthma and other eosinophilic as well as neutrophilic diseases.

Successful use of tofacitinib in epidermolysis bullosa pruriginosa

This case report describes 26-year-old woman who had multiple clusters of pale-pink lichenoid papules since childhood and the accompanying itching was intense. Skin biopsy revealed obvious fissures had formed under the epidermis. The patient was diagnosed with epidermolysis bullosa pruriginosa and was successfully treated with tofacitinib.

[Efficacy of the XEN gel stent on intraocular pressure lowering in glaucoma patients]

Objective: To evaluate the efficacy and safety of the XEN gel implant in the treatment of glaucoma. Methods: It was a retrospective case series study. Eight patients (8 eyes) in the First Affiliated Hospital of Fujian Medical University from January 2020 to September 2020 were included, including six males and two females, aged 29 to 74 years. The patients treated with the XEN gel implanting for glaucoma. After detailed ophthalmic examination, all the patients met the surgical indications for the XEN gel implanting. Preoperative and postoperative intraocular pressure (IOP), anterior segment and fundus examination results, medication, and surgical complications were evaluated. Results: There were seven patients with primary open-angle glaucoma and one patient with glaucomatocyclitic syndrome. Five patients had received anti-glaucoma surgeries, and the remaining three patients had not received surgical treatment. All XEN gel stents were implanted successfully. All patients were followed up for 4 to 12 months. The preoperative maximum IOP ranged from 11 to 44 mmHg (median, 28 mmHg, 1 mmHg=0.133 kPa), and the IOP was 10 to 18 mmHg (median, 13 mmHg) at the last follow-up. Two to 4 types of medication were used for glaucoma preoperatively (median, 3), while 0 to 2 types (median, 0) were used at the last follow-up. During the follow-up, 7 cases were completely successful and only one case failed. Intraoperative hemorrhage occurred in two patients, and after effective treatment, the IOP decreased to below 20 mmHg. One patient was found to have an increased IOP with the XEN luminal obstruction, and the XEN drainage tube was recanalized. The IOP was about 10 mmHg at the last follow-up, and no anti-glaucoma drugs were used, but the surgery was assessed as failure by standard. The remaining patients had no other serious complications. Conclusion: This preliminary study shows that the XEN gel drainage may be a safe and effective treatment for patients with glaucoma. (Chin J Ophthalmol, 2021, 57: 679-684).

Rapid and accurate diagnosis of brain abscess caused by Nocardia asiatica with a combination of Ziehl-Neelsen staining and metagenomics next-generation sequencing

BACKGROUND AND PURPOSE

Early and accurate diagnosis is vital in cerebral nocardiosis, a very rare and infectious disease associated with a high mortality rate. Herein, we report a case that a patient with brain abscess was swiftly diagnosed and successfully treated.

METHODS

We report a case of a 61-year-old woman with a brain abscess caused by Nocardia asiatica, diagnosed by a combination of Ziehl-Neelsen staining and metagenomics next-generation sequencing (mNGS).

RESULTS

A 61-year-old woman with left breast cancer resection, diabetes mellitus and a 7-month discontinuous cough and fever was admitted to our hospital. On the third day of hospitalization, she experienced a sudden loss of consciousness and was diagnosed with a brain abscess and a pathological change in cerebral mass on brain magnetic resonance imaging (MRI). Due to the failure of culturing any microorganisms from the pup, the dissected sample from the patient with Ziehl-Neelsen staining tested positive for acid-fast bacilli and was subjected to mNGS. The pathogen was identified as N. asiatica and the patient was treated accordingly with linezolid and trimethoprim-sulfamethoxazole until complete recovery was confirmed by the follow-up cerebral MRI.

CONCLUSIONS

This is the first case report of a brain abscess caused by N. asiatica being swiftly diagnosed by a combination of Ziehl-Neelsen staining and mNGS. This rapid diagnosis allowed us to successfully treat this rare infection.

A Reverse Approach to the Total Synthesis of Halichondrin B

A new strategy is described for the total synthesis of halichondrin B featuring reversal of the sequential construction of a number of its cyclic ethers from the classical approach by instead forming C-O bonds first followed by C-C bond formation. Employing the Nicholas reaction to generate linear ethers as precursors for the total synthesis of halichondrin B and other members of the halichondrin and eribulin families of compounds, this novel approach provides new opportunities for the development of improved syntheses of these complex and valuable compounds. In this Article, we report the syntheses of defined fragments I, MN, EFG, and A. Fragments I and MN were then coupled and elaborated to advanced intermediate IJKLMN, which was joined with fragment EFG to afford, after appropriate elaboration and macrolactonization, the more advanced polycyclic intermediate EFGHIJKLMN. Elaboration of the latter and coupling with fragment A followed by further functionalization completed the total synthesis of halichondrin B through a short and convergent pathway.

[Asbestos exposure and asbestos-related malignant diseases:an epidemiological review]

Asbestos has high fire resistance, electrical insulation and thermal insulation. It is an important fire prevention, insulation and insulation material. It is widely used in industrial production and daily life. In 1987, the international agency for research on cancer (IARC) has listed asbestos as a class I carcinogen; in 2012, IARC confirmed that all types of asbestos have carcinogenic effect. By 2019, asbestos has been banned in 66 countries and regions around the world. Asbestos exposure increases the risk of human malignant tumor. Lung cancer and mesothelioma are known asbestos induced tumors. Epidemiological studies also support that asbestos exposure is related to the incidence of malignant tumors in reproductive system, digestive system, urinary system, nasopharynx head and neck. We summarized the epidemiological studies of asbestos induced tumors in order to provide reference for further research.

[A case of Hemolytic anemia caused by subacute lead poisoning]

Lead poisoning is characterized by nervous, digestive and blood system damage, such as neurasthenia, abdominal pain, abdominal distension, jaundice, small cell hypochromic anemia and so on. A case of severe hemolytic anemia caused by subacute lead poisoning was treated in Beijing Chaoyang Hospital Affiliated to Capital Medical University. The main symptoms of the patient were abdominal colic, constipation and hemolytic anemia.

[Research progress of silica-associated autoimmune diseases]

Silicosis is caused by long-term exposure to dust containing crystalline silica. However, silica exposure, which may lead to autoimmune dysfunction, is associated with autoimmune diseases such as rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus, idiopathic inflammatory myopathy and anti-central granulocyte cytoplasmic antibody associated vasculitis. With silica exposure autoimmune diseases may exist with or without silicosis. This article reviews recent research on silica-associated autoimmune diseases such as the concept, epidemiology, clinical characteristics and potential mechanisms to improve the understanding of the disease and promote the formulation of diagnostic criteria and treatment plans.

Design, Synthesis, and Biological Evaluation of Tubulysin Analogues, Linker-Drugs, and Antibody-Drug Conjugates, Insights into Structure-Activity Relationships, and Tubulysin-Tubulin Binding Derived from X-ray Crystallographic Analysis

Molecular design, synthesis, and biological evaluation of tubulysin analogues, linker-drugs, and antibody-drug conjugates are described. Among the new discoveries reported is the identification of new potent analogues within the tubulysin family that carry a C11 alkyl ether substituent, rather than the usual ester structural motif at that position, a fact that endows the former with higher plasma stability than that of the latter. Also described herein are X-ray crystallographic analysis studies of two tubulin-tubulysin complexes formed within the α/β interface between two tubulin heterodimers and two highly potent tubulysin analogues, one of which exhibited a different binding mode to the one previously reported for tubulysin M. The X-ray crystallographic analysis-derived new insights into the binding modes of these tubulysin analogues explain their potencies and provide inspiration for further design, synthesis, and biological investigations within this class of antitumor agents. A number of these analogues were conjugated as payloads with appropriate linkers at different sites allowing their attachment onto targeting antibodies for cancer therapies. A number of such antibody-drug conjugates were constructed and tested, both in vivo and in vitro, leading to the identification of at least one promising ADC (Herceptin-LD3), warranting further investigations.

[A concise review of telomere and telomerase-related genetic markers in fibrotic lung diseases]

Fibrotic lung diseases are a heterogeneous group of diffuse parenchymal lung diseases caused by various factors. Pulmonary fibrosis is one of the common pathological changes of advanced fibrotic lung diseases. Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic lung disorder with unknown etiology. IPF mainly affects the elderly that is considered as an aging related disease. Telomeres are specialized structures at the ends of chromosomes. Telomere shortening results in cellular senescence or apoptosis. Telomerase is a ribonucleoprotein complex that maintains telomere length and genome stability. The telomere shortening and mutations in telomere-related genes are associated with incidence and prognosis of pulmonary fibrosis. Here, a concise review of telomere and telomerase-related genomic markers in IPF and other fibrotic lung diseases is written.

[Advances in flavoring-related bronchiolitis obliterans]

Occupational exposure to the diacetyl flavoring may cause bronchiolitis obliterans (BO) in workers. The first case of flavoring-related bronchiolitis obliterans was reported in 2002. Since then, similar cases have been identified among workers in various production industries in some countries and regions. At present, there are no cases reported in China. In order to improve the awareness of the disease and promote the prevention work, this article reviews the research progress of case recognition, risk factors, clinical manifestation and possible pathogenesis.

Performance Assessment on Buffy Coat Examination for Human Granulocytic Anaplasmosis Diagnosis

Introduction/Objective

Anaplasma phagocytophilum is an obligate gram-negative intracellular bacterium that causes human granulocytic anaplasmosis (HGA). The diagnostic tests for HGA include buffy coat examination, culture, PCR, and serology. In our lab, suspected patient will be subjected to buffy coat examination, and the result will be further confirmed with PCR. The aim of the study is to assess the epidemiology of HGA diagnosed at WMC during 06/2014- 08/2019, and as well as the performance accuracy of buffy coat examination as compared to PCR.

Methods

The results of buffy coat examination and in house HGA PCR from 06/2014 to 08/2019 were collected from SoftLAB and SoftMOL, respectively.

Results

A total of 1,057 blood specimens were tested by buffy coat examination from 06/2014-08/2019; among them, 658 specimens were also analyzed by HGA PCR assay (Fig. 1). Positivity for buffy coat examination and PCR was 2.6% and 6.1%, respectively. Overall, using PCR as reference diagnostic method, 42 new HGA cases were identified.

The number of new HGA cases varied among years from 2 to 15, with year of 2017 having the greatest number of total cases (Fig. 2). Further analyzing new HGA cases by months reveal HGA starts in April and ends in December, and peaks at June and July (Fig. 3).

When comparing buffy coat result to PCR, 17 positive buffy coat tests were confirmed positive in PCR test, and 619 negative buffy coat tests were also consistent with negative PCR test result. However, 21 cases which were initially negative in buffy coat examination were positive in PCR tests. On the other hand, 1 positive buffy coat examination case was negative in PCR (table 1). Overall, using PCR as a reference test, the sensitivity and specificity of buffy coat examination are 44.7% and 99.8%, respectively.

Conclusion

Buffy coat examination has high specificity but low sensitivity in detecting HGAcompared to PCR. Low sensitivity is most likely due to variable presence of intracytoplasmic aggregates of HGA in peripheral blood neutrophils and technically incompetency of testing personnel. Overall, it is a good test for laboratory confirmation of clinically suspected HGA cases. We suggest clinicians to add HGA PCR to all the buffy coat examination to avoid missing potential HGA diagnosis. Moreover, more training and competency on testing personnel may improve the sensitivity of buffy coat exam for diagnosis of HGA.

A Comparative Analysis of Immunohistochemical Profile of Primary and Metastatic Endometrial Endometrioid Carcinoma

Introduction/Objective

Beta catenin plays an important role in cancer tumorigenesis and have been found to be associated with metastasis in a variety of tumors. Analyzing TCGA data, we found that 30% of endometrial endometrioid carcinoma cases have beta-catenin mutations. We hypothesize that beta-catenin mutation may be associated with metastasis of endometrial endometrioid carcinoma. ER and PR expression was also compared to determine any changes after metastasis.

Methods

Retrospective institutional review of all endometrial endometrioid carcinoma (192 cases) between 2011 to 2018 was performed, including 149 cases of FIGO grade I, 38 cases of FIGO grade II and 5 cases of FIGO grade III. 19 cases with paired primary and metastatic specimen were identified. Immunohistochemistry staining (IHC) was carried out for ER, PR and beta-catenin.

Results

Median patient age was 56 years. The most common metastatic site was vagina, accounting for 68% of metastasis (14/19), followed by bladder (3/19), lung (2/19) and rectum (1/19). The primary and metastatic carcinoma of all 19 cases exhibit very similar morphology. All of those cases were positive and concordant for ER and PR in primary and metastatic endometrioid carcinoma. On the other hand, nuclear beta-catenin staining caused by mutation was positive in 5 metastatic carcinoma but not in primary carcinoma.

Conclusion

IHC expression of ER and PR remains unchanged between primary and metastatic carcinoma, demonstrating the reliability of ER and PR to confirm the origin of metastatic carcinoma. 26% of the metastatic carcinoma (5/19) exhibit nuclear beta-catenin staining but not in primary carcinoma, suggesting the possible role of beta-catenin in metastasis of endometrial endometrioid carcinoma.

Structural exercise-based intervention for health problems in individuals with autism spectrum disorders: a pilot study

OBJECTIVE

Exercise-based intervention promises to be more effective in a structured framework for individuals with autism spectrum disorders (ASD). The aim of this study was to observe changes in behavior of individuals with ASD by investigating their physical status after the structured exercise-based intervention.

PATIENTS AND METHODS

The exercise intervention integrated an 8-week exercise program that included aerobic, resistive, and neuromuscular exercises. Body composition and the Autism Treatment Evaluation Checklist (ATEC) were evaluated to assess changes after the exercise-based intervention.

RESULTS

After the exercise intervention, the fat mass of individuals with ASD were significantly reduced, and their behavior improved markedly.

CONCLUSIONS

This pilot study demonstrated that individuals with ASD require long-term, structured exercise-based intervention, and that such exercise-based intervention is effective for improving their health.

[Progress in randomized clinical trials of antifibrotic drug nintedanib and pirfenidone]

Pulmonary fibrosis is the terminal manifestation of a variety of interstitial lung diseases. Idiopathic pulmonary fibrosis (IPF) is one of the chronic, progressive, fibrotic lung disease with high incidence and poor prognosis. Nintedanib and pirfenidone are currently marketed anti-pulmonary fibrosis drugs, and their efficacy and safety are recognized in patients with IPF. This article reviews the targets and clinical trials of the two drugs, and provides a basis for the expansion of indications for anti-pulmonary fibrosis drugs.

Linking vein properties to leaf biomechanics across 58 woody species from a subtropical forest

Leaf venations have elements with relatively lower elasticity than other leaf tissue components, which are thought to contribute to leaf biomechanics. A better mechanistic understanding of relationships between vein traits and leaf mechanical properties is essential for ecologically relevant interpretation of leaf structural variations. We investigated 13 major (first to third order) and minor (>third order) vein traits, six leaf mechanical properties and other structural traits across 58 woody species from a subtropical forest to elucidate how vein traits contribute to leaf biomechanics. Across species, vein dry mass density (ρ_v ), total vein dry mass per leaf area (VMA) and minor vein diameter (VD_min ), but not the lower-order vein density (VLA_1•2 ), were positively correlated with leaf force to punch (F_p ) and force to tear (F_t ). Structural equation models showed that ρ_v and VD_min not only contribute to leaf mechanical properties directly (direct pathway), but also had impacts on leaf biomechanics by influencing leaf thickness and leaf dry mass per area (indirect pathway). Our study demonstrated that vein dry mass density and minor vein diameter are the key vein properties for leaf biomechanics. We also suggest that the mechanical characteristics of venations are potential factors influencing leaf mechanical resistance, structure and leaf economics spectrum.

[Risk factors of cirrhosis combined with sarcopenia and their impact on clinical outcomes]

Objective: To study the occurrence of sarcopenia in patients with liver cirrhosis, and to explore their risk factors and impact on clinical outcomes. Methods: 199 hospitalized cases with liver cirrhosis were collected for nutritional risk screening, anthropometric measurement and blood biochemical examination. The body composition analysis was measured based on the skeletal muscle content of the four limbs to calculate the appendicular skeletal muscle mass index (ASMI). Patients were divided into sarcopenia and non-sarcopenia group and the relevant indexes of both groups were compared to screen for factors affecting the occurrence of sarcopenia. During the follow-up of 48 months, the survival and complications of the both groups were compared. Statistical analysis was performed using t-test, χ(2) test and logistic regression analysis in terms of different data. Results: The incidence of sarcopenia in cirrhosis was 36.7%, with the highest prevalence in patients with recurrent hepatic encephalopathy (62.5%), followed by patients with abdominal ascites / pleural effusion (37.6%). The incidence of sarcopenia was significantly higher in those with nutritional risk than in those without nutritional risk (P < 0.05). However, even among those without nutritional risk, 14.8% had combined sarcopenia. The body mass index (BMI), upper arm muscle circumference (AMC), and body cell mass (BCM) of the sarcopenia group were lower than those of the non-sarcopenia group (P < 0.05), and the edema index (ECW/TBW) was higher than the latter (P < 0.05). Multivariate analysis showed that age, gender, BMI, and complications of hepatic encephalopathy were the main influencing factors of cirrhosis combined with sarcopenia (P < 0.05). During the follow-up period, the sarcopenia group had a higher mortality rate than non-sarcopenia goup (P < 0.05), and the incidence of recurrent abdominal ascites/pleural effusion, hepatic encephalopathy, and infection was also significantly elevated (P < 0.05). Conclusion: Sarcopenia is one of the manifestations of malnutrition in patients with liver cirrhosis, which increases the risk of mortality and other complications, and has adverse impact on the clinical outcome. Additionally, older age, male sex, low BMI and recurrent hepatic encephalopathy has higher risk for developing sarcopenia.