[The effect of the ratio of aneurysm sac diameter to patient age on the long-term efficacy of different surgical methods for infrarenal abdominal aortic aneurysm]

Objective: To investigate the effect of the ratio of the maximum diameter of aneurysm sac to age (R) on the long-term efficacy of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with infrarenal abdominal aortic aneurysm (IAAA). Methods: This is a retrospective cohort study.The clinical data of 317 patients with IAAA who underwent surgical repair in the Department of Vascular Surgery,the Third Affiliated Hospital of Sun Yat-Sen University from January 2016 to October 2022 were retrospectively collected.There were 266 males and 51 females,aged (69.7±8.3) years (range:37 to 87 years).The R value of the patient was calculated and the receiver operating characteristic(ROC) curve was used to establish a model to calculate the optimal cut-off value.The propensity score matching method was used to match the baseline data of patients in the EVAR and OSR group by 3∶1 (the caliper value was 0.05),and the patients were stratified according to the cutoff value of R,and the postoperative efficacy and survival of the patients were analyzed.The primary endpoint was the total mortality rate,and the secondary endpoints included the occurrence of postoperative complications and reintervention.Pearson χ2 or Fisher 's exact test was used for categorical variables,and t test was used for continuous variables to compare differences between groups.The survival curves of the two groups were described by Kaplan-Meier method. Results: After propensity score matching,198 cases were in the EVAR group and 66 cases were in the OSR group.The ROC model showed that the best cut-off value of R value was 0.90,and the two groups were divided into two layers:R<0.90 and R≥0.90.Among them,112 patients with R<0.90 (84 cases of EVAR,28 cases of OSR);there were 152 patients with R≥0.90 (114 cases of EVAR and 38 cases of OSR).The follow-up time was (23.6±1.6) months (range:1 to 70 months).In the R≥0.90 stratification,the total mortality (26.3% vs.5.3%,P<0.05),complication rate (44.7% vs.26.3%,P<0.05), and secondary intervention rate (31.6% vs.13.2%,P<0.05) in the EVAR group were higher than those in the OSR group.In the R<0.90 stratification,there was no significant difference in the total mortality rate (13.1% vs.10.7%,P<0.05),complication rate (28.6% vs.35.7%,P>0.05) and secondary intervention rate (14.3% vs.21.4%, P>0.05) between the two groups. Conclusions: When R≥0.90 in IAAA patients,OSR maybe more beneficial to patients in terms of survival rate,postoperative complication rate and secondary intervention rate than EVAR.When R<0.90,there are no significant differences in survival rate,complication rate and secondary intervention rate between the two surgical methods.

Effect of contact precautions on preventing meticillin-resistant Staphylococcus aureus transmission in intensive care units: a review and modelling study of field trials

BACKGROUND

Contact precautions (CPs) have been widely implemented in hospitals, particularly in intensive care units (ICUs), as the standard approach for managing meticillin-resistant Staphylococcus aureus (MRSA). However, the effectiveness of CPs in preventing MRSA transmission remains a subject of debate.

AIM

To assess the effectiveness of CPs in reducing MRSA transmission within ICUs.

METHODS

A comprehensive analysis was conducted using data from 16 sets of parameters collected from 13 field studies investigating the effectiveness of CPs in ICUs, and an epidemiologic model was developed to simulate the dynamics of MRSA incidence in the hospital setting.

FINDINGS

The analysis demonstrated a mean reduction of 20.52% (95% confidence interval -30.52 to 71.60%) in the MRSA transmission rate associated with the implementation of CPs. Furthermore, reducing the time-delay of screening tests and increasing the percentage of patients identified with MRSA through screening at admission were found to contribute to the effectiveness of CPs.

CONCLUSION

Proper implementation of CPs, with a particular emphasis on early identification of MRSA-colonized/infected patients, demonstrated a strong association with reduced MRSA transmission within the hospital setting. However, further research is necessary to investigate the effectiveness and safety of decolonization and other interventions used in conjunction with CPs to mitigate the risk of infection among colonized patients.

[Metagenomic next-generation sequencing for the diagnosis of Pneumocystis jirovecii pneumonia after allogeneic hematopoietic stem cell transplantation]

Objectives: To investigate the value of metagenomic next-generation sequencing (mNGS) in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: The data of 98 patients with suspected pulmonary infection after allo-HSCT who underwent pathogen detection from bronchoalveolar lavage fluid between June 2016 and August 2023 at Nanfang Hospital were analyzed. The diagnostic performance of mNGS, conventional methods, and real-time quantitative polymerase chain reaction (qPCR) for PJP were compared. Results: A total of 12 patients were diagnosed with PJP, including 11 with a proven diagnosis and 1 with a probable diagnosis. Among the patients with a proven diagnosis, 1 was positive by both conventional methods and qPCR, and 10 were positive by qPCR only. Pneumocystis jirovecii was detected by mNGS in all 12 patients. The diagnostic sensitivity of mNGS for PJP was 100%, which was greater than that of conventional methods (8.3%, P=0.001) and similar to that of qPCR (91.6%, P=1.000) . A total of 75% of the patients developed mixed pulmonary infections, and cytomegalovirus and Epstein-Barr virus were the most common pathogens. Mixed infection was detected in eight patients by mNGS and in five patients by qPCR, but not by conventional methods (P=0.008) . Conclusions: mNGS had good sensitivity for diagnosing PJP after allo-HSCT and was advantageous for detecting mixed infectious pathogens; therefore, mNGS might be an effective supplement to regular detection methods and qPCR.

Malnutrition Is Associated with Diabetic Retinopathy in Patients with Type 2 Diabetes

Background

The relationship between malnutrition and diabetic retinopathy (DR) is still unclear. The purpose of this study is to investigate the relationship between malnutrition and DR in type 2 diabetic patients.

Methods

A cross-sectional study was conducted on 612 patients with type 2 diabetes mellitus. Four malnutrition assessment tools: Global Leadership Initiative on Malnutrition (GLIM) criteria, controlling nutritional status (CONUT), nutritional risk index (NRI), and prognostic nutritional index (PNI), were applied to assess the nutritional status of the study population. The association between malnutrition and DR was examined using multivariable logistic regression and ordered logistic regression.

Results

The proportion of malnutrition varied from 10.0% to 34.3% in total patients and from 16.3% to 45.1% in DR patients across the assessment tools. DR patients were more likely to be malnourished than patients without DR. The adjusted odds ratios (aOR) and 95% confidence interval (CI) for DR of malnutrition defined by different tools were 1.86 (1.01-3.14) for GLIM criteria, 1.67 (1.04-2.70) for NRI, and 2.24 (1.07-4.69) for PNI. The aOR and 95% CI for the severity of DR of malnutrition defined by different tools were 1.99 (1.12-3.51) for GLIM criteria, 1.65 (1.06-2.58) for NRI, and 2.51 (1.31-4.79) for PNI.

Conclusions

Malnutrition was common in DR patients, and it was closely linked to the presence and severity of DR. Diabetic patients with DR should undergo nutritional assessment and early treatment of malnutrition to prevent the onset or progression of DR.

Ultrasound Assessment of the Gastrocnemius Muscle as a Potential Tool for Identifying Sarcopenia in Patients with Type 2 Diabetes

Objective

This study aims to examine the clinical significance of ultrasound evaluation of the gastrocnemius muscle (GM) in identifying sarcopenia in patients with type 2 diabetes (T2D).

Methods

One hundred and fifty-three patients with T2D were included in this study. We measured the appendicular skeletal muscle mass index (ASMI), handgrip strength, and 6-meter walking speed. The US-derived muscle thickness (MT), cross-sectional area (CSA), and shear wave ultrasound elastography (SWE) of GM were also measured. We assessed the correlations between clinical indicators and US features. The model for screening sarcopenia was established using stepwise logistic regression. Stepwise linear regression was used to identify a set of variables that jointly estimated ASMI. The model's ability to identify sarcopenia and low muscle mass was assessed by receiver operating characteristic (ROC) curve analysis.

Results

The prevalence of sarcopenia in this study was 24.2%. The CSA, MT and SWE values of the patients with sarcopenia were lower than those of patients without sarcopenia (all p < 0.05). ASMI was positively correlated with CSA (r = 0.56, p < 0.001) and MT (r = 0.39, p < 0.001). Handgrip strength was positively correlated with CSA (r = 0.45, p < 0.001), MT (r = 0.25, p < 0.001), and SWE (r = 0.26, p = 0.002). A diagnostic model for sarcopenia was established with a sensitivity of 81.1%, specificity of 75.0%, and an area under the curve (AUC) of 0.800. The estimated ASMI equation was developed and found to have a positive correlation with actual ASMI (r = 0.70, p < 0.001). It was also effective in diagnosing low muscle mass, with an AUC of 0.787 for males and 0.783 for females.

Conclusion

Ultrasonographic assessment of the gastrocnemius muscle was found to be a useful and convenient method for detecting sarcopenia in patients with T2D.

A Ferroptosis Microneedle Integrated Wireless Implanted Photodynamic Therapy Pellet for Cancer Treatment

PURPOSE/OBJECTIVE(S)

Effective, non-toxic, and targeted induction of lung cancer cell death is urgently needed. The goal of this research is to create a new implantable battery-free therapeutic pellet with integrated drug microneedles that allows for wireless photodynamic therapy (PDT) and targeted release of a ferroptosis inducer (Imidazole ketone erastin, IKE) into tumor tissue.

MATERIALS/METHODS

A wireless power unit, μ-LED illuminant, a flexible control circuit, and an IKE-stored biodegradable microneedle enclosed in polydimethylsiloxane (PDMS) were all built into an integrated therapeutic pellet. Lung cancer cells were used to illustrate the in vitro viability and molecular biological processes of this system. Therapeutic pellet implanted into the LLC xenograft C57BL/6 model. PDT was conducted by 660 nm laser irradiation after injecting a photosensitizer (Chlorin e6, Ce6) and targeted IKE released into the tumor. Systematically analyzing the therapeutic effects on lung cancer and toxic side-effects.

RESULTS

The PDT-IKE group reduced cellular viability by 90% compared to the control group at the cellular level. In mouse model studies, the PDT-IKE group suppressed tumors at 78.8%, three or four times greater than the PDT (26.6%) or IKE (19.2%) group alone. The PDT-IKE group also controlled IKE release more precisely with heated electrodes, reducing nephrotoxicity and improving safety. Moreover, the combination of PDT and IKE can effectively cause ferroptosis in tumor cells, both in vivo and in vitro.

CONCLUSION

A new implantable battery-free therapeutic pellet was designed for wireless PDT with integrated IKE microneedles to induce obvious ferroptosis in lung cancer. The proposed pellet would provide a promising strategy for cancer treatment.

Nurse-led dexmedetomidine sedation for magnetic resonance imaging in children: a 6-year quality improvement project

We aimed to safely introduce dexmedetomidine into a nurse-led sedation service for magnetic resonance imaging in children. Secondary aims were to increase the number of children eligible for sedation and to increase the actual number of children having sedation performed by our nurse sedation team. We analysed 1768 consecutive intravenous and 219 intranasal dexmedetomidine sedation episodes in infants, children and adolescents having magnetic resonance imaging scans between March 2016 and March 2022. The overall sedation success rate was 98.4%, with a 98.9% success rate for intravenous dexmedetomidine and a 95.0% success rate for intranasal dexmedetomidine. The incidence of scan interruption during intravenous and intranasal dexmedetomidine sedation was 8.8% and 21.9%, respectively. We conclude that paediatric sedation with dexmedetomidine for magnetic resonance scanning is safe and successful.

Deep learning for predicting the risk of immune checkpoint inhibitor-related pneumonitis in lung cancer

AIM

To develop and validate a nomogram model that combines computed tomography (CT)-based radiological factors extracted from deep-learning and clinical factors for the early predictions of immune checkpoint inhibitor-related pneumonitis (ICI-P).

MATERIALS AND METHODS

Forty ICI-P patients and 101 patients without ICI-P were divided randomly into the training (n=113) and test (n=28) sets. The convolution neural network (CNN) algorithm was used to extract the CT-based radiological features of predictable ICI-P and calculated the CT score of each patient. A nomogram model to predict the risk of ICI-P was developed by logistic regression.

RESULTS

CT score was calculated from five radiological features extracted by the residual neural network-50-V2 with feature pyramid networks. Four predictors of ICI-P in the nomogram model included a clinical feature (pre-existing lung diseases), two serum markers (absolute lymphocyte count and lactate dehydrogenase), and a CT score. The area under curve of the nomogram model in the training (0.910 versus 0.871 versus 0.778) and test (0.900 versus 0.856 versus 0.869) sets was better than the radiological and clinical models. The nomogram model showed good consistency and better clinical practicability.

CONCLUSION

The nomogram model that combined CT-based radiological factors and clinical factors can be used as a new non-invasive tool for the early prediction of ICI-P in lung cancer patients after immunotherapy with low cost and low manual input.

[Effect of enhanced recovery after surgery on surgical stress response in patients with gastric cancer complicated with type 2 diabetes mellitus]

Objective: To investigate the effect of enhanced recovery after surgery on the stress response of gastric cancer patients complicated with type 2 diabetes mellitus. Methods: We retrospectively analyzed the data of 49 patients with type 2 diabetes who underwent radical gastrectomy for gastric cancer in the Department of gastroenterology of the Affiliated Hospital of Jiangsu University from Jan to Dec 2020. They were randomly divided into experimental group and control group according to different perioperative management measures. The perioperative C-reactive protein (CRP), white blood cell (WBC), interleukin-6(IL-6), insulin resistance (HOMA-IR), blood glucose fluctuation and postoperative recovery were compared between the two groups. Results: A total of 49 patients were enrolled in the study (23 in the experimental group and 26 in the control group). The degree of stress reaction of the experimental group was lighter than that of the control group. The levels of CRP were significantly different on the 5th and 7th day after operation, IL-6 was significantly different on the 1st, 3rd, 5th and 7th day after operation, WBC and HOMA-IR were significantly different on the 1st day postoperatively. And the changes of HOMA-IR and blood glucose in experimental group were more gentle than those in control group. All the differences were statistically significant(P<0.05). In the experimental group, the time of first anal exhaust, indwelling time of drainage tube or nasointestinal tube and the total hospitalization time were significantly shorter than those of the control group(P<0.05). Conclusion: ERAS can reduce the degree of inflammatory stress and the postoperative IR level promote the early recovery of patients with gastric cancer complicated with type 2 diabetes mellitus.

[Association between metabolically healthy obesity and incident risk of stroke in adult aged over 40 from rural Henan province]

Objective: To investigate the association between metabolically healthy obesity and the incident risk of stroke in people aged ≥40 years from rural areas of Henan Province. Methods: During 2007 to 2008, 20 194 residents aged ≥18 years were selected for baseline examination by random cluster sampling and 17 265 participants were followed up during 2013 to 2014. According to the aim of current study, a total of 11 864 eligible subjects were included in this post-hoc analysis. Depending on body mass index and metabolic status, subjects were divided into four groups: metabolically healthy normal weight, metabolically healthy obesity, metabolically abnormal normal weight and metabolically abnormal obesity. Multivariate logistic regression model was used to analyze the relationship between metabolically healthy obesity and the risk of stroke. Results: The median (Q₁, Q₃) age of study participants was 54(46, 61) years, and 4 526 participants were men. During the mean follow-up of 6 years, the cumulative incidence of stroke was 7.16%. The incidence of stroke in metabolically healthy normal weight, metabolically healthy obesity, metabolically abnormal normal weight, and metabolically abnormal obesity were 3.73%, 4.61%, 8.99% and 9.38%, respectively (χ²=117.458, P<0.001). After adjusting possible confounding factors, compared with metabolically healthy normal weight, the risk of stroke was significantly increased in the metabolically healthy obesity group, metabolically abnormal normal weight group and metabolically abnormal obesity group with the odds ratio (OR) and 95% confidence interval (CI) of 1.52(1.10-2.12), 2.11(1.61-2.77) and 2.78(2.18-3.55), respectively. Stratified analysis showed that the risk of stroke was significantly higher in metabolically healthy obesity people aged 40-59 years compared with metabolically healthy normal weight group (OR=2.12, 95%CI: 1.36-3.30). Conclusion: Metabolically healthy obesity, metabolically abnormal normal weight and metabolically abnormal obesity are positively associated with the risk of stroke.

Pseudomonas sp. TCd-1 significantly alters the rhizosphere bacterial community of rice in Cd contaminated paddy field

Cadmium (Cd) pollution of paddy soils is one of the main concerns causing food security and environmental problems. Microbial bioremediation is an effective and eco-friendly measure that uses microbes to reduce Cd accumulation in crops. Additionally, rhizosphere bacterial communities also act essential roles in crop tolerance of heavy metals. However, the effects of inoculations with Cd resistant bacteria on crop rhizosphere bacterial communities under Cd exposure are largely unknown. In this study, we used high-throughput 16S rRNA gene sequencing technologies to explore the community structure and co-occurrence network of the rhizosphere bacterial communities associated with the rice crop under different Cd treatments and the application of Cd-tolerant strain Pseudomonas sp. TCd-1. We found that the strain TCd-1 both significantly reduced the rhizobacterial alpha diversity and changed the beta diversity. PERMANOVA and NMDS analysis showed that Cd stress and TCd-1 strain could act as strong environmental filters resulting in observable differentiation of rhizobacterial community composition among different groups. In addition, RDA results indicated that the rhizosphere pH, root Cd content, catalase (CAT), urease (URE), gibberellic acid (GA3) exert significant association with rhizosphere bacterial assembly. PICRUSt analysis revealed that the TCd-1 strain improved the metabolic capacity of rhizosphere bacteria under Cd stress. Furthermore, co-occurrence network topological features and keystone taxa also varied among different groups. This study could provide necessary insights into developing an efficient bioremediation and safe production of rice crops in Cd contaminated paddy fields with the application of Pseudomonas sp. TCd-1 strain, as well as advance our understanding of the principles of rhizosphere bacterial community assembly under Cd stress.

Pollution monitoring, risk assessment and target remediation of heavy metals in rice from a five-year investigation in Western Fujian region, China

Recently, rice contamination by heavy metals (HMs) has become a severe problem. Taking the Western Fujian region as an example in this study, a total of 1311 rice samples containing eight HMs were collected from 2015 to 2019, then used to explore their pollution characteristics, health risks, and Spatio-temporal variations, finally derive the target remediation areas of the key pollutants. The results showed that average concentrations of all the HMs had not reached the limits of the National Standards of Food Safety, but pollution indexes of As (0.783) and Cu (0.665) were at accumulation level (>0.6), which posed high pollution risks. Furthermore, locations of higher HMs concentrations coincided with those of higher pollution estimation probabilities. The non-carcinogenic risk (4.150, 2.434) and carcinogenic risk (4.96 × 10^-3, 2.92 × 10^-3) for children and adults cannot be negligible, As and Cd were the largest contributors. Children were more susceptible than adults due to the metal concentrations and rice intake rate. The spatio-temporal changes indicated that a decreasing trend in average concentrations of HMs (except Cr), but As (0.37%-0.88%) contents increased in the west and northeast parts, and so did Cd (1.92%-5.11%) in the central region during monitoring. For the target remediation, particular regions in the western and eastern were used as risky areas of As and Cd, respectively. Our results will provide theoretical support for the pollution management of HMs in rice.

The association between serum adropin and carotid atherosclerosis in patients with type 2 diabetes mellitus: a cross‑sectional study

BACKGROUND

Adropin, a newly‑identified energy homeostasis protein, has been implicated in the maintenance of metabolic homeostasis and insulin sensitivity. This study attempts to measure the association between serum adropin and carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM).

METHODS

This cross‑sectional study was performed in 503 hospitalized patients with T2DM.Serum adropin level was measured by a sandwich enzyme-linked immunosorbent assay. The carotid atherosclerosis was assessed by color Doppler sonography. The association between adropin and carotid atherosclerotic plaque was tested by logistic regression model. The effect of adropin on carotid intimal-medial thickness (CIMT) was estimated using linear regression model.

RESULTS

Overall, 280 (55.7%) patients had carotid atherosclerotic plaque. The risk of carotid atherosclerotic plaque decreased with the increment of serum adropin level (adjusted odds ratio [aOR], 0.90; 95%CI: 0.81-0.99) in patients with T2DM. Serum adropin (Standardized β = - 0.006, p = 0.028) was also independently protective factor for CIMT in patients with T2DM.

CONCLUSION

In patients with T2DM, high serum adropin level was correlated with a decreased risk of carotid atherosclerosis in T2DM patients. Low circulating level of adropin may promote carotid atherosclerosis.

Effects of Pseudomonas TCd-1 on rice (Oryza sativa) cadmium uptake, rhizosphere soils enzyme activities and cadmium bioavailability under cadmium contamination

Microbial remediation is a promising technique to reduce Cd accumulation in rice (Oryza sativa). In present study, a set of pot experiments were conducted to evaluate the effects of Cd-tolerate Pseudomonas TCd-1 inoculation on rice Cd uptake, soil enzyme activities and Cd bioavailability in the rhizosphere soils under Cd contaminated conditions. The results showed that at the ripening stage, with the inoculation of TCd-1, Cd contents in root, culm, leaf, hull and brown rice significantly reduced by 60.7%, 47.7%, 50.6%, 58.1% and 47.9%, respectively, and the cadmium bioconcentration factor (BCF) of rice lowered by 66.2% under 5 mg kg-1 Cd treatment. At the meantime, in the rhizosphere soils, pH increased by 0.05, the contents of exchangeable Cd (EX-Cd) and Fe-Mn oxides (OX-Cd) increased by 107.8% and 33.5%, whereas organic matter (OM-Cd) and residual (Res-Cd) decreased by 31.9% and 60.0%, respectively. The activity of acid phosphatase (ACP) increased by 28.3%, catalase (CAT), saccharase (SUC) activity decreased by 28.5% and 26.0%. Similarly, the Cd contents in root, culm, leaf, hull and brown rice reduced by 42.1%, 42.5%, 58.0%, 50.3%, and 68.8%, respectively, and the BCF lowered by 57.1%, under 10 mg kg-1 Cd treatment. Simultaneously, the soil pH increased by 0.06, the activities of CAT, SUC, urease (URE), ACP decreased by 26.4%, 34.6%, 63.8% and 15.3%, respectively. Furthermore, the correlation analysis showed that the inoculation of TCd-1 changed the correlation between rice Cd content and the biomass of roots, leaves, soil pH, CAT, PPO, URE activities, OM-Cd in rhizosphere soils. It suggested that Pseudomonas TCd-1 effectively reduced Cd uptake and Cd accumulation in rice was closely linked to the changes of soil pH, enzyme activities and Cd availability.

Risk assessment and hotspots identification of heavy metals in rice: A case study in Longyan of Fujian province, China

The potential threats of heavy metals in rice have attracted increasing attention worldwide. In this study, we assessed the pollution status and health risk of rice collected from Longyan in Fujian, China. Meanwhile, we explored the spatial pattern and hotspots of those metals. The results showed that the average concentrations of Cd, Hg, As, Pb, Cr, Ni, Cu, and Zn in rice were 0.064, 0.002, 0.464, 0.072, 0.138, 0.106, 10.819, and 23.788 mg kg^-1, respectively. Among them, As and Cu remarkably accumulated with the exceeding ratio of 50.30% and 55.12%, respectively. Furthermore, the values of the target hazard quotient in rice ranked as As > Cu > Zn > Cd > Pd > Ni > Hg > Cr, which As and Cu was greater than 1.0. And the carcinogenic risk values were in the order of As > Cd > Ni > Cr, which all exceeded the tolerance level (1 × 10^-4). Risk assessment indicated that both children and adults were posed the non-carcinogenic and carcinogenic risk from rice intake, and As had the largest contribution rate for them. Comparison found that the spatial patterns of heavy metals distribution were consistent with the hotspots. The hotspots for As and Zn located in the western part (Changting and Wuping), Cd and Cu in the eastern part (Xinluo and Yongding), Cr and Ni were simultaneously found in the northeast (Zhangping), while Hg and Pb were mainly located in the central region (Shanghang). Overall, combining the pollution status, risk assessment, and hotspot distribution in rice, the western region (Changting and Wuping) were identified as priority areas for remediation.

Identification Of Strn-Ntrk2 Rearrangement In A High Grade Sarcoma, With Good Clinical Response To Firstline Larotrectinib Therapy

Casestudy

Gene fusions involving tropomyosin receptor kinase genes, NTRK (NTRK1-3), are important in tumorigenesis. Larotrectinib, a selective NTRK inhibitor, is recently approved to treat NTRK fusion positive solid tumors. We herein report a case of soft tissue sarcoma harboring two STRN-NTRK2 gene fusions, with good clinical response to firstline larotrectinib treatment.

Results

A 35 year-old female presented with pain in the right gluteal region, and a large solid mass without overlying erythema, edema and induration was identified. Initial MRI study showed a heterogenous, vascular and partially necrotic mass (16.5 x 12.9 x 10.4 cm) centered in the right gluteus medius and maximus muscles. A core biopsy of the mass showed a cellular mesenchymal neoplasm with round/ovoid cells, high mitosis (21 per 10 HPFs) and focal staghorn type vessels, reminiscent of solitary fibrous tumor. However, STAT6 immunostaining was negative.

Additional immunostains show no specific lineage. Our in-house NGS fusion panel showed two in-frame STRN- NTRK2 fusions, containing the same 5’ partner sequence (exon 1-3) of STRN, with the 3’ fusion partner starting from either the exon 15 or the exon 16 of NTRK2. Due to the large size and location of the tumor, larotrectinib was initiated as firstline therapy. The patient noticed a quick amelioration of tumor related pain, and a significant shrinkage of the size of tumor following the initial 7-day treatment. On post-treatment day 52, MRI showed the tumor significantly decreased in size to 7.7 x 7.4 x 6.6 cm with satisfactory symptomatic relief.

Conclusion

NTRK2 fusions are relatively rare when compared with NTRK1 and NTRK3, especially in sarcoma. Of note, the only other report in the literature of NRTK2 fusion- positive sarcoma also showed SFT-like morphology, and the patient responded well to larotrectinib as second line therapy.

Identification Of Strn-Ntrk2 Rearrangement In A High Grade Sarcoma, With Good Clinical Response To Firstline Larotrectinib Therapy

Casestudy

Gene fusions involving tropomyosin receptor kinase genes, NTRK (NTRK1-3), are important in tumorigenesis. Larotrectinib, a selective NTRK inhibitor, is recently approved to treat NTRK fusion positive solid tumors. We herein report a case of soft tissue sarcoma harboring two STRN-NTRK2 gene fusions, with good clinical response to firstline larotrectinib treatment.

Results

A 35 year-old female presented with pain in the right gluteal region, and a large solid mass without overlying erythema, edema and induration was identified. Initial MRI study showed a heterogenous, vascular and partially necrotic mass (16.5 x 12.9 x 10.4 cm) centered in the right gluteus medius and maximus muscles. A core biopsy of the mass showed a cellular mesenchymal neoplasm with round/ovoid cells, high mitosis (21 per 10 HPFs) and focal staghorn type vessels, reminiscent of solitary fibrous tumor. However, STAT6 immunostaining was negative.

Additional immunostains show no specific lineage. Our in-house NGS fusion panel showed two in-frame STRNNTRK2 fusions, containing the same 5’ partner sequence (exon 1-3) of STRN, with the 3’ fusion partner starting from either the exon 15 or the exon 16 of NTRK2. Due to the large size and location of the tumor, larotrectinib was initiated as firstline therapy. The patient noticed a quick amelioration of tumor related pain, and a significant shrinkage of the size of tumor following the initial 7-day treatment. On post-treatment day 52, MRI showed the tumor significantly decreased in size to 7.7 x 7.4 x 6.6 cm with satisfactory symptomatic relief.

Conclusion

NTRK2 fusions are relatively rare when compared with NTRK1 and NTRK3, especially in sarcoma. Of note, the only other report in the literature of NRTK2 fusion- positive sarcoma also showed SFT-like morphology, and the patient responded well to larotrectinib as second line therapy.

Identification of differentially expressed genes and signalling pathways in the ovary of higher and lower laying ducks

1. Ovarian transcriptomic profiling between birds showing high egg number (HEN) and birds of low egg number (LEN) in Longyan Shan-ma ducks at 71 weeks of age was carried out using Illumina Hiseq 2500 technology. 2. A total of 343 differentially expressed genes (DEGs, 269 upregulated and 74 downregulated) were identified between HEN and LEN ovaries. These DEGs were enriched in 30 Gene Ontology terms. Pathway functional analysis found that the DEGs were enriched in 10 metabolic pathways (P < 0.05), one of which was regulation of the actin cytoskeleton pathway (Q < 0.05). 3. Three integrin family genes, ITGB2, ITGB5 and ITGA8 were differentially expressed in the RNA-seq and qPCR experiments. 4. The DEGs and signalling pathways identified in ovarian tissue in this study provide new insights into high egg production in Longyan Shan-ma duck.

Responses of glutathione and phytochelatins biosysthesis in a cadmium accumulator of Perilla frutescens (L.) Britt. under cadmium contaminated conditions

Screening new accumulators of heavy metal and identifying their tolerance, enrichment capacity of heavy metals are currently hot issues in phytoremediation research. A series of hydroponic experiments were conducted to analyze the effects of glutathione and phytochelatins in roots, stems, and leaves of Perilla frutescens under cadmium stress. The results showed that the non-protein thiols in roots and stems mainly existed in the form of GSH, PC₂, PC₃, and PC₄ under Cd stress condition, while in leaves they existed in the form of GSH, PC₂, and PC₃. Furthermore, the contents of GSH and PCs positively correlated with Cd, but negatively correlated with root vigor and chlorophyll content under Cd stress conditions. After 21 days of treatments, the contents of Cd in different parts of the plant were 1465.2-3092.9 mg· kg^-1 in the roots, 199.6-478.4 mg·kg^-1 in the stems and 61.3-96.9 mg· kg^-1 in the leaves at 2, 5, 10 mg·L^-1 Cd levels respectively, and the amount of Cd uptakes were up to 3547.7-5701.7 μg·plant^-1. Therefore, P. frutescens performed high capacity in Cd accumulation, and PCs played a key role in Cd tolerance. The application prospect of the plant in phytoremediation Cd polluted soil was also discussed.

Effects of phenolic acids on free radical scavenging and heavy metal bioavailability in kandelia obovata under cadmium and zinc stress

Current mechanism studies in plant heavy metal tolerance do not consider the effects of different phenolic acids on the bioavailability of heavy metals and the comparison with antioxidant enzyme system in the hydroxyl radical scavenging capacity. In present study, by a set of pot culture experiments with adding cadmium (Cd) and zinc (Zn) to the sediments, the effects of different phenolic acids on the toxicity of Cd and Zn in Kandelia obovata and the dominant role in scavenging hydroxyl radicals were evaluated. The results showed that 100 mg kg^-1 Zn treatment promoted the growth of plant under high concentrations of Cd and Zn stress. Under the stress of Cd and Zn, the phenolic acids were mainly metabolized by phenylpropanoid and flavonoid pathways, supplemented by shikimate and monolignol pathways in K. obovata. Eleven phenolic acids with different abilities of scavenging free radicals were detected in the plant, including pyrogallic acid (Gal), coumaric acid (Cou), protocatechuic acid (Pro), chlorogenic acid (Chl), 4-hydroxy benzoic acid (Hyd), caffeic acid (Caf), vanillic acid (Van), ferulic acid (Fer), benzoic acid (Ben), and salicylic acid (Sal). By adding phenolic acids to the sediments, chlorogenic acid (Chl), pyrogallic acid (Gal), cinnamic acid (Cin), and coumaric acid (Cou) behave as more reactive in changing Cd or Zn into residual fractions than the others, and chlorogenic acid (Chl), pyrogallic acid (Gal), ferulic acid (Fer) and caffeic acid (Caf) have higher ability of scavenging hydroxyl radicals than the others. In summary, K. obovata tends to synthesize phenolic acids with strong scavenging ability of free radicals and changing the bioavailability of Cd and Zn under high concentration of Cd and Zn stress. Phenolic acids played a crucial role in the mitigative effect of heavy metal stress via scavenging free radicals and involving in the process of Cd and Zn uptake and tolerance. The results will provide important theoretical basis and method guidance for mangrove wetland conservation.

Multiplexed drug testing of tumor slices using a microfluidic platform

Current methods to assess the drug response of individual human cancers are often inaccurate, costly, or slow. Functional approaches that rapidly and directly assess the response of patient cancer tissue to drugs or small molecules offer a promising way to improve drug testing, and have the potential to identify the best therapy for individual patients. We developed a digitally manufactured microfluidic platform for multiplexed drug testing of intact cancer slice cultures, and demonstrate the use of this platform to evaluate drug responses in slice cultures from human glioma xenografts and patient tumor biopsies. This approach retains much of the tissue microenvironment and can provide results rapidly enough, within days of surgery, to guide the choice of effective initial therapies. Our results establish a useful preclinical platform for cancer drug testing and development with the potential to improve cancer personalized medicine.

Transinguinal preperitoneal repair of giant inguinoscrotal hernias using Kugel mesh

INTRODUCTION

Giant inguinoscrotal hernias are rarely encountered in clinical settings, and their repair is technically challenging. The aim of this study is to evaluate the efficacy of transinguinal preperitoneal repair (TIPP) of giant inguinoscrotal hernias using Kugel mesh.

METHODS

A retrospective analysis was conducted on 9 patients with 11 giant inguinoscrotal hernias who underwent TIPP repair using Kugel mesh between December 2008 and January 2019. Demographics and perioperative and postoperative data were collected, and the operative experience was summarized.

RESULTS

The patients underwent a successful repair procedure with simultaneous omentectomy but without resection of the other abdominal organs. The median operation time was 120min, the median intraoperative blood loss was 75mL and the median defect area was 72 cm². The median duration for diet restoration was 4 days, and the median postoperative hospital stay was 6 days. The drainage tube placed in the preperitoneal space was removed after a median duration of 5 days, and the drainage tube placed in the distal hernia sac was removed after a median duration of 6 days. Three patients suffered from a postoperative increase in intra-abdominal pressure, while one patient deteriorated into abdominal compartment syndrome accompanied by respiratory dysfunction. No haematomas, seromas, incisional or mesh infections, recurrence or chronic pain occurred during the follow-up period.

CONCLUSIONS

TIPP repair using Kugel mesh is a feasible and effective method for giant inguinoscrotal hernias.

Chitinase-like protein YKL-40 regulates human bronchial epithelial cells proliferation, apoptosis, and migration through TGF-β1/Smads pathway

In order to study the effects of chitinase-like protein YKL-40 on proliferation, apoptosis, and migration of human bronchial epithelial cell line (BEAS-2B), and the underlying mechanisms, we cultured BEAS-2B alone or with different concentrations of YKL-40. thiazolyl blue tetrazolium bromide (MTT) assay was used to examine the cell proliferation. Annexin V-fluorescein isothiocyanate isomer (FITC)/propidium iodide staining and scratch assay were performed to test the cell apoptosis and migration. The concentrations of transforming growth factor-β1 (TGF-β1), Smad3, Smad7, alpha-smooth muscle actin (α-SMA), interleukin-4 (IL-4), IL-6, and IL-8 in the cell culture supernatant were detected by enzyme-linked immunosorbent assay. The messenger RNA and protein levels of YKL-40, TGF-β1, Smad3, Smad7, and α-SMA were detected by reverse transcription polymerase chain reaction and Western blot. BEAS-2B cells cultured with different concentrations of YKL-40 showed significantly higher cell proliferation and migration and inflammatory cytokines compared with that of control group, while the cell apoptosis was significantly lower than that of control group (p < 0.05). In addition, BEAS-2B cells cultured with YKL-40 had increased TGF-β1, Smad3, Smad7, and α-SMA levels in the supernatant, compared with that of BEAS-2B cells cultured alone (p < 0.05). Furthermore, LY364947, as TGF-β1/Smads signaling pathway inhibitor, decreased cell proliferation and migration ability and enhanced cell apoptosis of BEAS-2B cells compared with control group (p < 0.05). However, YKL-40 administration reversed the effect of LY364947 on the biological behavior of BEAS-2B cells. YKL-40 could affect the biological behaviors of BEAS-2B cells, which might be related to the TGF-β1/Smads pathway.