Structure of phosphorylated-like RssB, the adaptor delivering σs to the ClpXP proteolytic machinery, reveals an interface switch for activation

In enterobacteria such as Escherichia coli, the general stress response is mediated by σs, the stationary phase dissociable promoter specificity subunit of RNA polymerase. σs is degraded by ClpXP during active growth in a process dependent on the RssB adaptor, which is thought to be stimulated by the phosphorylation of a conserved aspartate in its N-terminal receiver domain. Here we present the crystal structure of full-length RssB bound to a beryllofluoride phosphomimic. Compared to the structure of RssB bound to the IraD anti-adaptor, our new RssB structure with bound beryllofluoride reveals conformational differences and coil-to-helix transitions in the C-terminal region of the RssB receiver domain and in the interdomain segmented helical linker. These are accompanied by masking of the α4-β5-α5 (4-5-5) "signaling" face of the RssB receiver domain by its C-terminal domain. Critically, using hydrogen-deuterium exchange mass spectrometry, we identify σs-binding determinants on the 4-5-5 face, implying that this surface needs to be unmasked to effect an interdomain interface switch and enable full σs engagement and hand-off to ClpXP. In activated receiver domains, the 4-5-5 face is often the locus of intermolecular interactions, but its masking by intramolecular contacts upon phosphorylation is unusual, emphasizing that RssB is a response regulator that undergoes atypical regulation.

G-C3N4 sheet nanoarchitectonics with island-like crystalline/amorphous homojunctions towards efficient H2 and H2O2 evolution

Photocatalystic evolution of H2O2 from water and oxygen has attracted significant attention because of environmentally friendly. The absorption in visible and hydrophilic feature of graphitic carbon nitride (g-C3N4) make it a good candidate. In this paper, a rapid post-treatment at high temperature was developed to obtain g-C3N4 nanosheets with abundant crystalline/amorphous interfaces to form homojunctions, which optimized uniplanar carrier mobility dynamics. The conversion from bulk to two-dimensional g-C3N4 resulted from the breakage of interplanar hydrogen bonds and interlayer Van der Waals force. The unique morphology not only rendered photocatalyst with larger specific surface area but also inhibited the robust volume recombination of charge carriers. The accelerated charge carriers flow at the interface, interplane and interlayer together ameliorated the separation and transfer of electrons and holes. A new-emerged n→π* transition ameliorated the poor light utilization efficiency. Beyond the increased photocatalytic H2 evolution property (779.2 μmol g-1 h-1), optimized sample displayed a H2O2 evolution activity as high as 4877.1 μM g-1 h-1 under visible light illumination, which was ∼5.8 times of that of bulk g-C3N4. Detailed photocatalytic mechanism investigation manifested that the two-step single-electron oxygen reduction process occupied the dominant status in H2O2 evolution. This work proposed a novel strategy for obtaining g-C3N4 homojunctions as a promising bi-functional metal-free catalyst to be applied in clean energy production field.

Impact of fetal growth restriction on pregnancy outcome in women undergoing expectant management for preterm pre-eclampsia

OBJECTIVES

To assess whether coexisting fetal growth restriction (FGR) influences pregnancy latency among women with preterm pre-eclampsia undergoing expectant management. Secondary outcomes assessed were indication for delivery, mode of delivery and rate of serious adverse maternal and perinatal outcomes.

METHODS

We conducted a secondary analysis of the Pre-eclampsia Intervention (PIE) and the Pre-eclampsia Intervention 2 (PI2) trial data. These randomized controlled trials evaluated whether esomeprazole and metformin could prolong gestation of women diagnosed with pre-eclampsia between 26 and 32 weeks of gestation undergoing expectant management. Delivery indications were deteriorating maternal or fetal status, or reaching 34 weeks' gestation. FGR (defined by Delphi consensus) at the time of pre-eclampsia diagnosis was examined as a predictor of outcome. Only placebo data from PI2 were included, as the trial showed that metformin use was associated with prolonged gestation. All outcome data were collected prospectively from diagnosis of pre-eclampsia to 6 weeks after the expected due date.

RESULTS

Of the 202 women included, 92 (45.5%) had FGR at the time of pre-eclampsia diagnosis. Median pregnancy latency was 6.8 days in the FGR group and 15.3 days in the control group (difference 8.5 days; adjusted 0.49-fold change (95% CI, 0.33-0.74); P < 0.001). FGR pregnancies were less likely to reach 34 weeks' gestation (12.0% vs 30.9%; adjusted relative risk (aRR), 0.44 (95% CI, 0.23-0.83)) and more likely to be delivered for suspected fetal compromise (64.1% vs 36.4%; aRR, 1.84 (95% CI, 1.36-2.47)). More women with FGR underwent a prelabor emergency Cesarean section (66.3% vs 43.6%; aRR, 1.56 (95% CI, 1.20-2.03)) and were less likely to have a successful induction of labor (4.3% vs 14.5%; aRR, 0.32 (95% CI, 0.10-1.00)), compared to those without FGR. The rate of maternal complications did not differ significantly between the two groups. FGR was associated with a higher rate of infant death (14.1% vs 4.5%; aRR, 3.26 (95% CI, 1.08-9.81)) and need for intubation and mechanical ventilation (15.2% vs 5.5%; aRR, 2.97 (95% CI, 1.11-7.90)).

CONCLUSION

FGR is commonly present in women with early preterm pre-eclampsia and outcome is poorer. FGR is associated with shorter pregnancy latency, more emergency Cesarean deliveries, fewer successful inductions and increased rates of neonatal morbidity and mortality. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Effects of Robot Animacy and Emotional Expressions on Perspective-Taking Abilities: A Comparative Study across Age Groups

The global population is inevitably aging due to increased life expectancy and declining birth rates, leading to an amplified demand for innovative social and healthcare services. One promising avenue is the introduction of companion robots. These robots are designed to provide physical assistance as well as emotional support and companionship, necessitating effective human-robot interaction (HRI). This study explores the role of cognitive empathy within HRI, focusing on the influence of robot facial animacy and emotional expressions on perspective-taking abilities-a key aspect of cognitive empathy-across different age groups. To this end, a director task involving 60 participants (30 young and 30 older adults) with varying degrees of robot facial animacy (0%, 50%, 100%) and emotional expressions (happy, neutral) was conducted. The results revealed that older adults displayed enhanced perspective-taking with higher animacy faces. Interestingly, while happiness on high-animacy faces improved perspective-taking, the same expression on low-animacy faces reduced it. These findings highlight the importance of considering facial animacy and emotional expressions in designing companion robots for older adults to optimize user engagement and acceptance. The study's implications are pertinent to the design and development of socially effective service robots, particularly for the aging population.

Association between monocyte lymphocyte ratio and abdominal aortic calcification in US adults: A cross-sectional study

BACKGROUND

This study aimed to evaluate the association between Monocyte Lymphocyte Ratio (MLR) and Abdominal Aortic Calcification (AAC) in adults over 40 years of age in the United States.

METHODS

Data were collected from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). AAC was quantified by the Kauppila score system based on dual-energy X-Ray absorptiometry. Severe AAC was defined as a total AAC score > 6. The lymphocyte count and monocyte count can be directly obtained from laboratory data files. Multivariable logistic regression models were used to determine the association between MLR and the AAC score and severe AAC.

RESULTS

A total of 3,045 participants were included in the present study. After adjusting for multiple covariates, MLR was positively associated with higher AAC score (β = 0.21, 95% CI 0.07, 0.34, p = 0.0032) and the odds of severe AAC increased by 14% per 0.1 unit increase in the MLR (OR = 1.14, 95% CI 1.00, 1.31, p = 0.0541). The Odds Ratio (OR) (95% CI) of severe AAC for participants in MLR tertile 3 was 1.88 (1.02, 3.47) compared with those in tertile 1 (p for trend = 0.0341). Subgroup analyses showed that a stronger association was detected in the elderly compared with non-elderly (p for interaction = 0.0346) and diabetes compared with non-diabetes (borderline significant p for interaction = 0.0578).

CONCLUSION

In adults in the United States, MLR was associated with higher AAC scores and a higher probability of severe AAC. MLR may become a promising tool to predict the risk of AAC.

The effects of the prognostic biomarker SAAL1 on cancer growth and its association with the immune microenvironment in lung adenocarcinoma

BACKGROUND

Inhibition of Serum Amyloid A-like 1 (SAAL1) expression could inhibit cancer progression and improve the prognosis of cancer patients. At present, the correlation between SAAL1 and lung adenocarcinoma (LAC) remains unclear. Therefore, this study surveyed the worth and pathway of SAAL1 in LAC progression and immunity.

METHODS

Bioinformatics and immunohistochemistry were used to identify the SAAL1 expression in LAC. The roles of SAAL1 expression in the existence values of LAC patients were explored, and the nomograms were constructed. Clinical values of SAAL1 co-expressed genes were evaluated by COX regression, survival, and Receiver operating characteristic (ROC) analysis. EDU and western blotting methods were used to inquiry the functions and pathways of the SAAL1 in cell growths. The correlation between the SAAL1 level and immune microenvironment was visualized using correlation research.

RESULTS

SAAL1 level was elevated in LAC tissues, and was observed in cancer tissues of dead patients. SAAL1 overexpression had something to do with shorter overall survival, progression-free interval, and disease-specific survival in LAC. The area under the curve of SAAL1 was 0.902 in normal tissues and cancer tissues. Inhibition of SAAL1 expression could inhibit cancer cell proliferation, which may be related to the decreased expression of cyclin D1 and Bcl-2 proteins. In LAC, SAAL1 level had something to do with stromal, immune, and estimate scores, and correlated with macrophages, T cells, Th2 cells, CD8 T cells, NK CD56dim cells, DC, eosinophils, NK CD56bright cells, pDC, iDC, cytotoxic cells, Tgd, aDC cells, B cells, Tcm, and TFH levels. SAAL1 overexpression had something to do with existence values and the immunity in LAC.

CONCLUSIONS

Inhibition of SAAL1 expression could regulate cancer growth via cyclin D1 and Bcl-2. SAAL1 is a promising prognostic biomarker in LAC patients.

A positive feedback loop of heparanase/syndecan1/nerve growth factor regulates cancer pain progression

Background

The purpose of this research was to assess the role of heparanase (HPSE)/syndecan1 (SDC1)/nerve growth factor (NGF) on cancer pain from melanoma.

Methods

The influence of HPSE on the biological function of melanoma cells and cancer pain in a mouse model was evaluated. Immunohistochemical staining was used to analyze HPSE and SDC1. HPSE, NGF, and SDC1 were detected using western blot. Inflammatory factors were detected using ELISA assay.

Results

HPSE promoted melanoma cell viability, proliferation, migration, invasion, and tumor growth, as well as cancer pain, while SST0001 treatment reversed the promoting effect of HPSE. HPSE up-regulated NGF, and NGF feedback promoted HPSE. High expression of NGF reversed the inhibitory effect of HPSE down-regulation on melanoma cell phenotype deterioration, including cell viability, proliferation, migration, and invasion. SST0001 down-regulated SDC1 expression. SDC1 reversed the inhibitory effect of SST0001 on cancer pain.

Conclusions

The results showed that HPSE promoted melanoma development and cancer pain by interacting with NGF/SDC1. It provides new insights to better understand the role of HPSE in melanoma and also provides a new direction for cancer pain treatment.

Downregulation of T-cell cytotoxic marker IL18R1 promotes cancer proliferation and migration and is associated with dismal prognosis and immunity in lung squamous cell carcinoma

Immunotherapy can improve the survival of patients with advanced lung squamous cell carcinoma (LUSC). T cytotoxic cells are one of the main members of the immune microenvironment. Herein, we aimed to identify the roles of T-cell cytotoxic markers interleukin 18 (IL18) receptor 1 (IL18R1) in the LUSC progression using bioinformatics, clinical tissue specimen, and cell experiment. We assessed the association between the IL18R1 expression and immune infiltration and IL18R1-related competing RNA network. The IL18R1 expression was downregulated in the LUSC tissues. The IL18R1 expression downregulation was associated with diagnosis and short overall survival and disease-specific survival, and it was also an independent risk factor for dismal survival time in LUSC. IL18R1-related nomograms predicted the survival time of patients with LUSC. IL18R1 overexpression inhibited the proliferation, migration, and invasion of LUSC cells. The IL18R1 expression was significantly associated with the microenvironment (stromal, immune, and estimate scores), immune cells (such as the T cells, cytotoxic cells, CD8 T cells), and immune cell markers (such as the CD8A, PD-1, and CTLA4) in LUSC. AC091563.1 and RBPMS-AS1 downregulation was positively associated with the IL18R1 expression, negatively associated with the miR-128-3p expression, and associated with short disease-specific survival and progression in LUSC. In conclusion, IL18R1 was significantly downregulated and associated with the prognosis and immune microenvironment. IL18R1 overexpression inhibits the growth and migration of cancer cells in LUSC. Furthermore, AC091563.1 and RBPMS-AS1 might compete with IL18R1 to bind miR-128-3p for participating in LUSC progression. These results showed that IL18R1 is a biomarker for evaluating the prognosis of patients with LUSC.

TRAT1 overexpression delays cancer progression and is associated with immune infiltration in lung adenocarcinoma

The roles and mechanisms of T-cell receptor (TCR)-associated transmembrane adaptor 1 (TRAT1) in lung adenocarcinoma (LAC) have not yet been reported in the relevant literature. Therefore, this study aimed to understand the roles and mechanisms of TRAT1 in LAC using bioinformatics and in vitro experiments. TRAT1 expression levels in LAC samples were analysed using various databases. TRAT1 co-expressed genes were acquired by the correlation analysis of LAC tissues. The functional mechanisms and protein network of TRAT1 co-expressed genes were analysed using bioinformatics analysis. The expression of TRAT1 was activated in LAC cells, and the roles of TRAT1 overexpression in the growth and migration of cancer cells was investigated using flow cytometry, Cell Counting Kit-8 (CCK-8), and migration and invasion assays. The relationship between TRAT1 overexpression, the immune microenvironment, and RNA modification was evaluated using correlation analysis. TRAT1 expression levels were significantly abnormal at multiple mutation sites and were related to the prognosis of LAC. TRAT1 co-expressed genes were involved in cell proliferation, adhesion, and differentiation, and TRAT1 overexpression significantly inhibited cell viability, migration, and invasion and promoted apoptosis of A549 and H1299 cells, which might be related to the TCR, B cell receptor (BCR), MAPK, and other pathways. TRAT1 expression levels were significantly correlated with the ESTIMATE, immune, and stromal scores in the LAC microenvironment. Additionally, TRAT1 expression levels were significantly correlated with the populations of B cells, CD8 T cells, cytotoxic cells, and other immune cells. TRAT1 overexpression was significantly correlated with the expression of immune cell markers (such as PDCD1, CD2, CD3E) and genes involved in RNA modification (such as ALKBH1, ALKBH3, ALKBH5). In conclusions, TRAT1 overexpression inhibited the growth and migration of LAC cells, thereby delaying cancer progression, and was correlated with the LAC microenvironment and RNA modifications.

O-085 School-Age Outcomes Among IVF-Conceived Children: A Causal Inference Analysis Using Linked Population-Wide Data

Study question

To determine the causal effect of in-vitro fertilisation (IVF) on primary school-age childhood developmental and educational outcomes, compared with outcomes following spontaneous conception.

Summary answer

The school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived peers.

What is known already

More than 8 million children have been conceived globally with the assistance of in-vitro fertilization (IVF). Large cohort studies have suggested an increase in the frequency of congenital abnormalities, autism spectrum disorder, developmental-delay and intellectual disability in children conceived via IVF. Educational and cognitive outcomes following IVF conception have not yet been adequately established. Two large Scandinavian studies (Norrman et al 2018 and Wienecke et al 2020) found poorer educational outcomes in children born after IVF-conception.

Study design, size, duration

Causal inference methods (based on the potential outcomes approach) were used to analyse observation data in a way that emulates the results of a target randomised clinical trial. The study cohort comprised state-wide linked maternal and childhood administrative data from Victoria, Australia.

Participants/materials, setting, methods

The study included singleton infants conceived spontaneously or via IVF and born between 2005-2014. The exposure of interest was conception via IVF, with those born after spontaneous conception as the control group. Two separate measures of childhood outcome were examined: The Australian Early Developmental Consensus (AEDC), (age 4-6); and the National Assessment Program – Literacy and Numeracy (NAPLAN) at age 7-9. We combined inverse probability weighting with regression adjustment to estimate population average causal effects.

Main results and the role of chance

The final cohort included 412,713 children across the two outcome cohorts. Linked records were available for 4,697 IVF-conceived cases and 168,503 controls for AEDC outcome data, and 8,976 cases and 333,335 controls for NAPLAN data. The mothers of IVF-conceived children were older, more highly educated mothers, who lived in more socio-economic advantaged areas and were less likely to be from non-English speaking backgrounds. There was no causal effect of IVF-conception on the on the risk of developmental vulnerability at school-entry compared to spontaneously conceived children, as defined by AEDC metrics; with an adjusted risk difference of -0.3% (95% CI -3.7% to 3.1%) and an adjusted risk ratio of 0.97 (95% CI 0.77 to 1.25). At age 7-9 years, there was no causal effect of IVF-conception on the NAPLAN overall z-score, adjusted mean difference of 0.030 (95% CI -0.018 to 0.077) between IVF-conceived and spontaneously conceived children.

Given the use of observational data, there were missing data and inherent differences in the covariate profile of the exposure cohorts. Multiple imputation and doubly robust inverse probability weighting regression adjustment modelling was utilised to allow a causal interpretation of results.

Limitations, reasons for caution

Children who did not attend school due to severe disability were not included, possibly leading to selection bias. It is possible that unmeasured common cause confounders could have led to bias in estimating the average treatment effects.

Wider implications of the findings

This study, in contrast to previous evidence, suggests that conception via IVF does not affect early childhood developmental and educational outcomes. These findings provide important reassurance for current and prospective parents, and clinicians alike.

Trial registration number

Not applicable

Clinical Roles of Risk Model Based on Differentially Expressed Genes in Mesenchymal Stem Cells in Prognosis and Immunity of Non-small Cell Lung Cancer

The tumor microenvironment (TME) plays an important regulatory role in the progression of non-small cell lung cancer (NSCLC). Mesenchymal stem cells (MSCs) in the TME might contribute to the occurrence and development of cancer. This study evaluates the role of differentially expressed genes (DEGs) of MSCs and the development of NSCLC and develops a prognostic risk model to assess the therapeutic responses. The DEGs in MSCs from lung tissues and from normal tissues were analyzed using GEO2R. The functions and mechanisms of the DEGs were analyzed using the Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Additionally, the Cancer Genome Atlas (TCGA) database was used to determine the expression levels of the DEGs of MSCs in the NSCLC tissues. The prognostic factors of NSCLC related to MSCs were screened by survival analysis, meta-analysis, Cox regression analysis, and a prognostic risk model and nomogram was developed. The signaling mechanisms and immune roles that risk model participate in NSCLC development were determined via Gene Set Enrichment Analysis and CIBERSORT analysis. Compared to the normal tissues, 161 DEGs were identified in the MSCs of the lung tissues. These DEGs were associated with mechanisms, such as DNA replication, nuclear division, and homologous recombination. The overexpression of DDIT4, IL6, ITGA11, MME, MSX2, POSTN, and TRPA1 were associated with dismal prognosis of NSCLC patients. A high-risk score based on the prognostic risk model indicated the dismal prognosis of NSCLC patients. The nomogram showed that the age, clinical stage, and risk score affected the prognosis of NSCLC patients. Further, the high-risk model was associated with signaling mechanisms, such as the ECM-receptor interaction pathways, cytokine-cytokine receptor interaction, and MAPK pathways, involved in the progression of NSCLC and was also related to the components of the immune system, such as macrophages M0, T follicular helper cells, regulatory T cells. Therefore, the risk model and nomogram that was constructed on the basis of MSC-related factors such as POSTN, TRPA1, and DDIT4 could facilitate the discovery of target molecules that participate in the progression of NSCLC, which might also serve as new candidate markers for evaluating the prognosis of NSCLC patients.

Influences of Hypothermia on the Cortical Blood Supply by Laser Speckle Imaging

Induced hypothermia has been broadly applied in neurological intensive care unit (NICU). Meanwhile, accidental hypothermia is also a threatening condition in daily life. It is meaningful to investigate the influences of temperature change on the cerebral blood flow (CBF). In the present study, temporal laser speckle image contrast analysis (tLASCA) was implemented to study the relative CBF change in cerebral artery, vein and capillary level under mild (35$\circ$C) and moderate (32$\circ$C) hypothermia. Twelve male Sprague-Dawley rats (300±50g) were anesthetized with sodium pentobarbital and randomly assigned to mild and moderate hypothermia groups (n=9 each). Laser speckle imaging trials were acquired from baseline (37$\circ$C), hypothermia (35$\circ$C or 32$\circ$C) and post-rewarming (37$\circ$C) phases. In the mild group, mean CBF in different vessels all increased throughout the hypothermic and post-rewarming phases. On the contrary, mean CBF reduced by 10% to 20% at 32$\circ$C and returned to ~95% of the baseline level during the post-rewarming session in the moderate group. Besides, in the moderate group, a CBF rebound in vein was found in the post-rewarming phase. Our results suggested that the CBF changed differently between mild and moderate hypothermia, which may worth for further study in clinical. And we demonstrated LSI as a promising method to achieve high spatiotemporal resolution CBF change with minimal invasion.

The burden of heat-related mortality attributable to recent human-induced climate change

Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991-2018. Across all study countries, we find that 37.0% (range 20.5-76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change.

Putative ratios of facial attractiveness in a deep neural network

Empirical evidence has shown that there is an ideal arrangement of facial features (ideal ratios) that can optimize the attractiveness of a person's face. These putative ratios define facial attractiveness in terms of spatial relations and provide important rules for measuring the attractiveness of a face. In this paper, we show that a deep neural network (DNN) model can learn putative ratios from face images based only on categorical annotation when no annotated facial features for attractiveness are explicitly given. To this end, we conducted three experiments. In Experiment 1, we trained a DNN model to recognize the attractiveness (female/male × high/low attractiveness) of face in the images using four category-specific neurons (CSNs). In Experiment 2, face-like images were generated by reversing the DNN model (e.g., deconvolution). These images depict the intuitive attributes encoded in CSNs of the four categories of facial attractiveness and reveal certain consistencies with reported evidence on the putative ratios. In Experiment 3, simulated psychophysical experiments on face images with varying putative ratios reveal changes in the activity of the CSNs that are remarkably similar to those of human judgements reported in a previous study. These results show that the trained DNN model can learn putative ratios as key features for the representation of facial attractiveness. This finding advances our understanding of facial attractiveness via DNN-based perspective approaches.

The importance of overweight in COVID-19: A retrospective analysis in a single center of Wuhan, China

The aim of this study was to evaluate the association between overweight and severity, drug response, and clinical outcomes of novel coronavirus disease 2019 (COVID-19).In this retrospective cohort study, we reviewed medical records of 240 COVID-19 patients admitted to Union Hospital in Wuhan, China, between December 24, 2019, and March 25, 2020. Physical, clinical, laboratory, radiological characteristics, treatment, and outcome data were abstracted. Patients who were obese [body mass index (BMI) ≥28 kg/m], underweight (BMI < 18.5 kg/m), under 18 years old, pregnant, or still in hospital were excluded. Disease severity was classified as moderate or severe pneumonia based on the World Health Organization interim guidance. Overweight was defined as BMI ≥24 kg/m and <28 kg/m. Patients were followed for discharge or death through April 10, 2020. We used logistic regression models to identify risk factors for severe disease, Cox proportional hazard models to explore associations between medications and patient outcomes (discharge or in-hospital death), and Kaplan-Meier survival curves and Cox regression models to evaluate risk factors for in-hospital death.One-half of patients (120, 50.0%) had severe pneumonia, while nearly one-half (114, 47.5%) were overweight. Among patients over 45 years old, overweight patients had significantly lower rates of fatigue, higher rates of headache, and higher median C-reactive protein levels. Patients under 45 years old had higher rates of cough and myalgia and higher proportions of increased alanine aminotransferase and lactic dehydrogenase, as well as more pulmonary lobes involved in the pneumonia revealed by chest computed tomography scans. Overweight patients were at higher risk of developing severe pneumonia. Although weight was not a risk factor for in-hospital death, overweight patients showed different responses to medications compared with normal weight patients. Intravenous interferon-α, intravenous glucocorticoids, and antifungal drugs were associated with reduced mortality in overweight patients. Intravenous immunoglobulin, oseltamivir, and ribavirin were associated with reduced mortality in normal weight patients.Overweight is a worldwide health problem. We found overweight to be related to the COVID-19 severity but not to in-hospital death. Clinicians should be aware that overweight COVID-19 patients require increased attention for different clinical features and treatment response.

Decreased prealbumin level is associated with increased risk for mortality in elderly hospitalized patients with COVID-19

OBJECTIVES

High-risk patients ≥65 y of age with coronavirus disease 2019 (COVID-19) tended to have lower serum prealbumin concentrations. The aim of this study was to investigate the association of prealbumin at baseline on COVID-19-related mortality in elderly patients (≥65 y of age).

METHODS

We non-selectively and consecutively collected participants from Tongji Hospital in Wuhan from January 17 to February 17, 2020. Univariate and multivariate logistic regression models were employed to evaluate the correlation between prealbumin and in-hospital outcomes (in-hospital mortality, admission to the intensive care unit [ICU], and mechanical ventilation) in elderly patients with COVID-19. Linear trend was performed by entering the median value of each category of prealbumin tertile as a continuous variable and was visually confirmed by using generalized additive models. Interaction and stratified analyses were conducted as well.

RESULTS

We included 446 elderly patients with COVID-19 in the final analyses. In-hospital mortality was 14.79%. Of the 446 patients, 15.47% were admitted to the ICU and 21.3% required mechanical ventilation. Compared with patients in the highest tertile, the prealbumin of patients in the lowest tertile had a 19.09-fold higher risk for death [odds ratio (OR), 20.09; 95% confidence interval (CI), 3.62-111.64; P = 0.0006], 25.39-fold higher risk for ICU admission (OR, 26.39; 95% CI, 4.04-172.39; P = 0.0006), and 1.8-fold higher risk for mechanical ventilation (OR, 2.8; 95% CI, 1.15-6.78; P = 0.0227) after adjustment for potential confounders. There was a linear trend correlation between serum prealbumin concentration and risk for in-hospital mortality, ICU admission, and mechanical ventilation in elderly patients with COVID-19 infection.

CONCLUSION

Prealbumin is an independent risk factor of in-hospital mortality for elderly patients with COVID-19. Assessment of prealbumin may help identify high-risk individuals ≥65 y of age with COVID-19.

THU0219 FIRST-INHUMAN STUDY OF SAFETY, PHARMACOKINETICS AND PHARMACODYNAMICS OF IRAK1/4 INHIBITOR R835 IN HEALTHY SUBJECTS

Background:

Toll-Like Receptors (TLR) and Interleukin-1 Receptors (IL-1R) play a critical role in the innate immune response as microbial and tissue damage sensors, providing a bridge between the innate and adaptive immunity. Interleukin receptor associated kinases (IRAK) 1 and 4 are serine/threonine kinases that are essential for signaling downstream of most TLRs and IL-1Rs and the resulting production of pro-inflammatory cytokines. Suppression of TLR and IL-1R signaling through inhibition of IRAK1/4 kinases is a promising therapeutic approach for the treatment of inflammatory and autoimmune diseases. We have identified a potent and selective IRAK1/4 inhibitor (R835) that showed dose-dependent inhibition of lipopolysaccharide (LPS, a TLR4 agonist), and IL-1β induced serum cytokines in mice. R835 prevented disease onset and progression in multiple rodent models of inflammatory diseases, including arthritis and lupus models.

Objectives:

The aim of this FIH study was to characterize the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of R835 after single or multiple dose oral administrations.

Methods:

This study was a randomized, placebo-controlled, double-blind Phase 1 study in healthy subjects in three parts: single ascending doses (20 mg-1920 mg, Part A) with food effect in a separate cohort (480 mg), multiple ascending doses (120 mg and 960 mg, BID, Part B) with a caffeine interaction (960 mg cohort), and an intravenous LPS challenge test at 240 mg oral dose of R835 (Part C).

Results:

Single doses of up to 480 mg R835 in organic solution, single doses of up to 1920 mg R835 as capsule, multiple doses of 120 mg R835 Q12H (organic solution), and 960 mg R835 Q12H (capsule) were safe and well tolerated. All R835 related adverse events (AEs) were mild in intensity and reversible, and mostly associated with the higher doses of R835 in the organic solution. The most common AEs were headache and gastrointestinal disturbance. The PK of R835 was linear and dose proportional in exposure over the dose range studied. A nominal level of accumulation in plasma achieved rapidly upon repeated BID administrations with steady-state essentially attained in 2 days. A high-fat meal with the capsule formulation resulted in slow rate of absorption but had no effect on the extent of absorption. There was no effect of R835 on metabolism of caffeine (P450 CYP1A2 prototype substrate). In the LPS challenge test, R835 profoundly inhibited the acute release of cytokines, including TNF-α, IL-6, IL-8, MIP1α and MIP1β, but had no impact on CRP release.

Conclusion:

R835 was well tolerated after single or multiple dose administrations. The most common AEs were headache and gastrointestinal disturbance. For both of the formulations tested, the PK of R835 was linear and exposure was dose proportional with rapid steady-state attainment following BID administration. There was no drug-drug interaction by use of caffeine as the protype substrate. R835 inhibited the LPS induced release of cytokines in the serum, including TNF-α, IL-6, IL-8, MIP1α and MIP1β, mirroring preclinical data in mice. The desirable PK and safety profile combined with proof of mechanism, as demonstrated by inhibition of cytokine release, support progression of R835 into Phase II clinical development as an agent for the treatment of inflammatory and autoimmune diseases.

Disclosure of Interests: :

Lucy Yan Shareholder of: Amgen, Rigel, Employee of: Amgen, Rigel, Sandra Tong Shareholder of: Rigel, Employee of: Rigel, Anthony Absalom: None declared, Izaak den Daas: None declared, Gary Park Shareholder of: Rigel Pharmaceuticals, Employee of: Rigel Pharmaceuticals, Vanessa Taylor Shareholder of: Rigel Pharmaceuticals, Employee of: Rigel Pharmaceuticals, Donna Chow Shareholder of: Rigel, Employee of: Rigel, Meng Lee Shareholder of: Rigel, Employee of: Rigel, Hanzhe Zheng Shareholder of: Rigel, Employee of: Rigel, Andrew Chow Shareholder of: Rigel, Employee of: Rigel

Impact of climate variability on length of stay in hospital for childhood pneumonia in rural Bangladesh

OBJECTIVES

Pneumonia is a significant contributor to mortality and morbidity in children aged <5 years, and it is also one of the leading causes of hospitalisation for children in this age group. This study assessed the association between climate variability, patient characteristics (i.e. age, sex, weight, parental education, socio-economic status) and length of stay (LOS) in hospital for childhood pneumonia and its economic impact on rural Bangladesh.

STUDY DESIGN

An ecological study design was used.

METHODS

Data on daily hospitalisation for pneumonia in children aged <5 years (including patient characteristics) and daily climate data (temperature and relative humidity) between 1st January 2012 and 31st December 2016 were obtained from the Matlab Hospital (the International Centre for Diarrhoeal Disease Research, Bangladesh) and the Bangladesh Meteorological Department, respectively. A generalised linear model with Poisson link was used to quantify the association between climate factors, patient characteristics and LOS in hospital.

RESULTS

The study showed that average temperature, temperature variation and humidity variation were positively associated with the LOS in hospital for pneumonia. A 1°C rise in average temperature and temperature variation during hospital stay increased the LOS in hospital by 1% (relative risk [RR]: 1.010, 95% confidence interval [CI]: 1.001-1.018) and 9.3% (RR: 1.093, 95% CI: 1.051-1.138), respectively. A 1% increase in humidity variation increased the LOS in hospital for pneumonia by 2.2% (RR: 1.022, 95% CI: 1.004-1.039). In terms of economic impact, for every 1° C temperature variation during the period of hospital stay, there is an addition of 0.81 USD/day/patient as a result of direct costs and 1.8 USD/day/patient for total costs. Annually, this results in an additional 443 USD for direct and 985 USD for total costs.

CONCLUSIONS

Climate variation appears to significantly contribute to the LOS in hospital for childhood pneumonia. These findings may help policymakers to develop effective disease management and prevention strategies.

Predictive factors for disease progression in hospitalized patients with coronavirus disease 2019 in Wuhan, China

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Male gender and comorbidity were the independent risk factors for death in COVID-19 patients.

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Lymphopenia and high CRP were the independent risk factors for poor outcome in COVID-19.

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The risk factors would facilitate early identification of high-risk COVID-19 patients.

Background

A few studies have revealed the clinical characteristics of hospitalized patients with COVID-19. However, predictive factors for the outcomes remain unclear.

Objective

Attempted to determine the predictive factors for the poor outcomes of patients with COVID-19.

Study design

This is a single-center, retrospective study. Clinical, laboratory, and treatment data were collected and analyzed from 111 hospitalized patients with laboratory-confirmed COVID-19 in Union Hospital. The gathered data of discharged and deteriorated patients were compared.

Results

Among these 111 patients, 93 patients were discharged and 18 patients were deteriorated. The lymphocyte count (0.56 G/L [0.47−0.63] vs 1.30 G/L [0.95−1.65]) was lower in the deteriorated group than those in the discharged group. The numbers of pulmonary lobe involved (5.00 [5.00–5.00] vs 4.00 [2.00−5.00]), serum C‐reactive protein (CRP, 79.52 mg/L [61.25−102.98] vs 7.93 mg/L [3.14−22.50]), IL-6 (35.72 pg/mL [9.24−85.19] vs 5.09 pg/mL [3.16−9.72]), and IL-10 (5.35 pg/mL [4.48−7.84] vs 3.97 pg/mL [3.34−4.79]) concentrations in deteriorated patients were elevated compared with discharged patients. Multivariate logistic regression analysis showed that male gender (OR, 24.8 [1.8−342.1]), comorbidity (OR, 52.6 [3.6−776.4]), lymphopenia (OR, 17.3 [1.1−261.8]), and elevated CRP (OR, 96.5 [4.6−2017.6]) were the independent risk factors for the poor prognosis in COVID-19 patients.

Conclusions

This finding would facilitate the early identification of high-risk COVID-19 patients.

Cerebral-placental-uterine ratio as novel predictor of late fetal growth restriction: prospective cohort study

OBJECTIVE

Fetal growth restriction (FGR) is a major risk factor for stillbirth and most commonly arises from uteroplacental insufficiency. Despite clinical examination and third-trimester fetal biometry, cases of FGR often remain undetected antenatally. Placental insufficiency is known to be associated with altered blood flow resistance in maternal, placental and fetal vessels. The aim of this study was to evaluate the performance of individual and combined Doppler blood flow resistance measurements in the prediction of term small-for-gestational age and FGR.

METHODS

This was a prospective study of 347 nulliparous women with a singleton pregnancy at 36 weeks' gestation in which fetal growth and Doppler measurements were obtained. Pulsatility indices (PI) of the uterine arteries (UtA), umbilical artery (UA) and fetal vessels were analyzed, individually and in combination, for prediction of birth weight < 10^th , < 5^th and < 3^rd centiles. Doppler values were converted into centiles or multiples of the median (MoM) for gestational age. The sensitivities, positive and negative predictive values and odds ratios (OR) of the Doppler parameters for these birth weights at ∼ 90% specificity were assessed. Additionally, the correlations between Doppler measurements and other measures of placental insufficiency, namely fetal growth velocity and neonatal body fat measures, were analyzed.

RESULTS

The Doppler combination most strongly associated with placental insufficiency was a newly generated parameter, which we have named the cerebral-placental-uterine ratio (CPUR). CPUR is the cerebroplacental ratio (CPR) (middle cerebral artery PI/UA-PI) divided by mean UtA-PI. CPUR MoM detected FGR better than did mean UtA-PI MoM or CPR MoM alone. At ∼ 90% specificity, low CPUR MoM had sensitivities of 50% for birth weight < 10^th centile, 68% for < 5^th centile and 89% for < 3^rd centile. The respective sensitivities of low CPR MoM were 26%, 37% and 44% and those of high UtA-PI MoM were 34%, 47% and 67%. Low CPUR MoM was associated with birth weight < 10^th centile with an OR of 9.1, < 5^th centile with an OR of 17.3 and < 3^rd centile with an OR of 57.0 (P < 0.0001 for all). CPUR MoM was also correlated most strongly with fetal growth velocity and neonatal body fat measures, as compared with CPR MoM or UtA-PI MoM alone.

CONCLUSIONS

In this cohort, a novel Doppler variable combination, the CPUR (CPR/UtA-PI), had the strongest association with indicators of placental insufficiency. CPUR detected more cases of FGR than did any other Doppler parameter measured. If these results are replicated independently, this new parameter may lead to better identification of fetuses at increased risk of stillbirth that may benefit from obstetric intervention. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Unusual case of extracutaneous pyoderma gangrenosum with myelodysplastic syndrome

Pyoderma gangrenosum (PG) is a rare, noninfectious, inflammatory disease characterized by neutrophilic infiltration and destruction of tissue. Extracutaneous involvement in PG is unusual. Myelodysplastic syndrome (MDS) is the most frequent hematologic disease associated with PG. We present a case diagnosed with MDS-EB-I. He had a large ulcer in his buttocks. Tissue culture and microscopy showed no evidence of fungi, bacteria, or mycobacteria. Histology showed granulation tissue, inflammatory infiltrate, abscess formation, and focal necrotizing vasculitis. Dermatology opinion confirmed PG. The skin lesions responded well to corticosteroid treatment at first, but it relapsed quickly with involvement of skin and lungs. In the meantime, MDS progressed to acute myeloid leukemia. The patient received chemotherapy and immunosuppressive therapy at the same time. After achievement of complete remission (CR), he had allogeneic hematopoietic stem cell transplantation. Two years later, the patient is still in CR status with no sign of PG relapse.

Preventing and mitigating health risks of climate change

Global environmental changes, driven by the consequences of human activities and population growth, are altering our planet in ways that pose current threats to human health, with the magnitude of these threats projected to increase over coming decades if additional, proactive actions are not taken. Global changes, unprecedented in their geospatial and temporal scales, include climate change, marine pollution, ozone layer depletion, soil degradation, and urbanization. Climate change is the best studied. The health risks of a changing climate will become increasingly urgent as climate change affects the quantity and quality of food and water, increases air pollution, alters the distribution of vectors/pathogens and disease transmission dynamics, and reduces eco-physical buffering against extreme weather and climate events. Health systems urgently need to be improved to effectively address these emerging challenges. This paper provides an overview of the health consequences of climate change, and discusses how health risks can be minimized and avoided via mitigation and adaptation pathways.

Deregulation of lncRNA-AC078883.3 and microRNA-19a is involved in the development of chemoresistance to cisplatin via modulating signaling pathway of PTEN/AKT

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide. As a platinum-based chemotherapeutic drug, cisplatin has been used in the NSCLC treatment for over 30 years, and its effects are impaired by drug resistance. This study aimed to investigate the potential role of lncRNA-AC078883.3 in the development of chemoresistance against cisplatin. Real-time PCR, Western blot analysis, Immunohistochemistry (IHC) assay, bioinformatic analysis, and luciferase assay were collaboratively used to establish the lncRNA-AC078883.3/miR-19a/PTEN/AKT pathway. Also, the effect of cisplatin on cell proliferation was observed via an MTT assay. Furthermore, Cox regression and Kaplan-Meier analyses were used to study whether lncRNA-AC078883.3 is involved in the survival of NSCLC. Compared with the Cisplatin-Sensitive group, the Cisplatin-Resistance group exhibited lower levels of lncRNA-AC078883.3 and PTEN and higher levels of miR-19a and p-Akt. The growth rate of A549 and H460 cells and the IC ₅₀ of DPP in the Cisplatin-Resistance group were higher than those in the Cisplatin-S group. miR-19a contains a putative binding site of lncRNA-AC078883.3, which enabled the luciferase activity of wild-type lncRNA-AC078883.3 to be reduced by miR-19a. In addition, by directly targeting PTEN 3'-untranslated region (UTR), miR-19a repressed the luciferase activity of wild-type PTEN 3'-UTR. The median OS of patients with reduced lncRNA-AC078883.3 expression was longer than that of patients with higher lncRNA-AC078883.3 expression. Finally, compared with low lncRNA-AC078883.3-expression patients, the high lncRNA-AC078883.3-expression patients were associated with lower miR-19a expression and higher PTEN expression. Therefore, we suggested for the first time that the low expression of lncRNA-AC078883.3 contributed to the development of chemoresistance against cisplatin.

Structural basis for inhibition of a response regulator of σS stability by a ClpXP antiadaptor

Dorich et al. present the first crystal structure of RssB bound to an antiadaptor, the DNA damage-inducible IraD. The structural data, together with mechanistic studies, suggest that RssB plasticity is critical for regulation of σ^S degradation.

The stationary phase promoter specificity subunit σ^S (RpoS) is delivered to the ClpXP machinery for degradation dependent on the adaptor RssB. This adaptor-specific degradation of σ^S provides a major point for regulation and transcriptional reprogramming during the general stress response. RssB is an atypical response regulator and the only known ClpXP adaptor that is inhibited by multiple but dissimilar antiadaptors (IraD, IraP, and IraM). These are induced by distinct stress signals and bind to RssB in poorly understood manners to achieve stress-specific inhibition of σ^S turnover. Here we present the first crystal structure of RssB bound to an antiadaptor, the DNA damage-inducible IraD. The structure reveals that RssB adopts a compact closed architecture with extensive interactions between its N-terminal and C-terminal domains. The structural data, together with mechanistic studies, suggest that RssB plasticity, conferred by an interdomain glutamate-rich flexible linker, is critical for regulation of σ^S degradation. Structural modulation of interdomain linkers may thus constitute a general strategy for tuning response regulators.

Zoonotic origin and transmission of Middle East respiratory syndrome coronavirus in the UAE

Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, there have been a number of clusters of human-to-human transmission. These cases of human-to-human transmission involve close contact and have occurred primarily in healthcare settings, and they are suspected to result from repeated zoonotic introductions. In this study, we sequenced whole MERS-CoV genomes directly from respiratory samples collected from 23 confirmed MERS cases in the United Arab Emirates (UAE). These samples included cases from three nosocomial and three household clusters. The sequences were analysed for changes and relatedness with regard to the collected epidemiological data and other available MERS-CoV genomic data. Sequence analysis supports the epidemiological data within the clusters, and further, suggests that these clusters emerged independently. To understand how and when these clusters emerged, respiratory samples were taken from dromedary camels, a known host of MERS-CoV, in the same geographic regions as the human clusters. Middle East respiratory syndrome coronavirus genomes from six virus-positive animals were sequenced, and these genomes were nearly identical to those found in human patients from corresponding regions. These data demonstrate a genetic link for each of these clusters to a camel and support the hypothesis that human MERS-CoV diversity results from multiple zoonotic introductions.

The cerebral blood flow response dependency on stimulus pulse width is affected by stimulus current amplitude - a study of activation flow coupling

The coupling of cerebral blood flow (CBF) to neuronal activation, referred to as activation flow coupling (AFC), has been a fundamental brain physiology property. The stimulus-evoked CBF response was usually considered as a surrogate marker for neuronal activity in AFC studies. The selection of appropriate stimulation parameters, e.g., current amplitude and pulse width, is of great importance yet the effect of pulse width changes remained contradictory in previous studies. In this work, we use laser speckle contrast imaging (LSCI) to study the spatiotemporal CBF response to hindpaw somatosensory stimulation of different pulse widths (0.3 ms vs 1 ms) and current amplitudes (3 mA vs 6 mA) in a rodent experiment. The results showed that the change of pulse width significantly affected the CBF peak value at a lower current level (p<;0.05). In addition, the duration for observing significantly different average CBF response, denoted as td, at various pulse widths, was dependent on stimulus current amplitude. At a lower amplitude (3 mA), td was 6.5 s; While at a higher amplitude (6 mA), td was 2.5 s. It was indicated that the changes of pulse width had longer influence on the average CBF response at a lower current amplitude. Our findings may help to understand and explain the inconsistent AFC with different stimulation parameters in fundamental brain physiology.

LncRNA expression profiles in HBV-transformed human hepatocellular carcinoma cells treated with a novel inhibitor of human La protein

We previously identified a novel inhibitor of La protein, H11, which inhibited hepatitis B virus (HBV) replication by inhibiting the interaction between La protein and HBV RNA. However, the other cellular factors involved in this process remain unclear. To investigate the mechanism of H11-mediated inhibition of HBV infection, a lncRNA microarray analysis was performed using H11-treated and untreated stable HBV-expressing human hepatoblastoma HepG2.2.15 cells. The profiles of differentially expressed lncRNAs and mRNAs were generated and analysed using Gene Ontology (GO) and pathway analyses. The microarray data showed that 61 lncRNAs were upregulated, 74 lncRNAs were downregulated, 43 mRNAs were upregulated, and 44 mRNAs were downregulated in H11 treatment group when compared with the control group, and these results were consistent with qRT-PCR expression data. Bioinformatic analysis indicated that the differentially expressed lncRNAs were involved in RNA-mediated post-transcriptional gene silencing, regulation of viral genome replication and Jak-STAT signalling and apoptosis pathways. GO analysis showed that differentially expressed mRNAs were enriched in negative regulation of the Wnt signalling pathway and negative regulation of growth. Pathways analysis indicated that the differentially expressed mRNAs were involved in regulation of nuclear β-catenin signalling and target gene transcription, as direct p53 effectors, and in the peroxisome proliferator-activated receptors signalling and peroxisome pathways. Microarray data and qRT-PCR results indicated that H11 mediates inhibition of HBV replication by regulating the Wnt, β-catenin and PPAR signalling pathways.

Placental-specific sFLT-1: role in pre-eclamptic pathophysiology and its translational possibilities for clinical prediction and diagnosis

Pre-eclampsia is a common obstetric complication globally responsible for a significant burden of maternal and perinatal morbidity and mortality. Central to its pathophysiology is the anti-angiogenic protein, soluble fms-like tyrosine kinase-1 (sFLT-1). sFLT-1 is released from a range of tissues into the circulation, where it antagonizes the activity of vascular endothelial growth factor and placental growth factor leading to endothelial dysfunction. It is this widespread endothelial dysfunction that produces the clinical features of pre-eclampsia including hypertension and proteinuria. There are multiple splice variants of sFLT-1. One, known as sFLT-1 e15a, evolved quite recently and is only present in humans and higher order primates. This sFLT-1 variant is also the main sFLT-1 secreted from the placenta. Recent work has shown that sFLT-1 e15a is significantly elevated in the placenta and circulation of women with pre-eclampsia. It is also biologically active, capable of causing endothelial dysfunction and the end-organ dysfunction seen in pre-eclampsia. Indeed, the over-expression of sFLT-1 e15a in mice recapitulates the pre-eclamptic phenotype in pregnancy. Therefore, here we propose that sFLT-1 e15a may be the sFLT-1 variant primarily responsible for pre-eclampsia, a uniquely human disease. Furthermore, this placental-specific sFLT-1 variant provides promise for use as an accurate biomarker in the prediction or diagnosis of pre-eclampsia.

Characterization of Heart Rate Variability Changes Following Asphyxia in Rats

Objectives: A non-invasive method to monitor the functioning of the autonomous nervous system consists in heart rate variability (HRV) analysis. The aim of this study was to investigate the changes on HRV after an asphyxia experiment in rats, using several linear (time and frequency domain) and nonlinear parameters (approximate entropy, SD1 and SD2 indices derived from Poincare plots).

Methods: The experiments involved the study of HRV changes after cardiac arrest (CA) resulting from 5 min of hypoxia and asphyxia, followed by manual resuscitation and return of spontaneous circulation. 5 min stationary periods of RR intervals were selected for further analysis from 5 rats in following distinct situations: 1) baseline, 2) 30 min after CA, 3) 60 min after CA, 4) 90 min after CA, 5) 120 min after CA, 6) 150 min after CA. The ANS contribution has been delineated based on time and frequency domain analysis.

Results and Conclusions: The results indicate that the recovery process following the asphyxia cardiac arrest reflects the impaired functioning of the autonomic nervous system. Both linear and nonlinear parameters track the different phases of the experiment, with an increased sensitivity displayed by the approximate entropy (ApEn). After 150 min the ApEn RRI parameter recovers to its baseline value. The results forward the ApEn as a more sensitive parameter of the recovery process following the asphyxia.

Hemodynamic response to optogenetic stimulation varied under different stimulus parameters

The coupling between neuronal activity and cerebral blood flow(CBF), known as neurovascular coupling, serves as the basis of functional brain imaging. Optogenetics provides a precise and selective approach to manipulate the activity in cell-specific neurons. It has been used in neuroscience research for comprehensive understanding about the light-evoked neurovascular coupling in rodent neuronal circuits. However, the spatiotemporal CBF response characteristics under different stimulus parameters such as pulse width and frequency remains unclear due to the lack of efficient CBF imaging technology. In this work, we used laser speckle contrast imaging(LSCI) to study the spatiotemporal hemodynamic response to optogenetic stimulation with different pulse widths (5ms, 10ms, 20ms) and frequencies (5Hz, 10Hz, 20Hz) in Channelrhodopsin-2(ChR2) expressing rats. The results showed that the averaged CBF response generally increased along with higher pulse width or frequency. The CBF peak response was significantly higher at 20ms and it took significantly shorter time to reach response peak at 5Hz. Our work adds additional insights in understanding the cell-specific neurovascular coupling mechanism and provides informative reference when applying ChR2 optogenetics in neurological disease research.

White matter integrity correlates with choline level in dorsal anterior cingulate cortex of obsessive compulsive disorder patients: A combined DTI-MRS study

Structural and functional neuroimaging studies have indicated that the cortico-striato -thalamo-cortical (CSTC) circuit contributes to the pathophysiology of obsessive compulsive disorder (OCD). As an essential component of CSTC circuit, the dorsal anterior cingulate cortex (dACC) plays an important role for its advanced function in cognition and emotion control. A comprehensive understanding of the dACC disruption in OCD pathological mechanism is desired. In this study, we performed a combined diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS) study in 15 OCD patients and 15 healthy controls to investigate the association between structural abnormality and metabolic alterations within the dACC area. We found a positive correlation between the dACC fractional anisotropy (FA) value and choline concentration in patients. Moreover, the FA was positively associated with OCD clinical symptom, especially the compulsive behavior, which showed the clinical relevance of dACC white matter integrity in OCD. To our knowledge, the present work is the first combined DTI-MRS study of OCD. Our findings demonstrated the co-occurrence of structural and metabolic changes within dACC in OCD patients. It was suggested that the disrupted white matter integrity might be accompanied with degraded cellular membrane turnover.

Study of functional brain homogeneity in female patients with major depressive disorder

Women are at a twofold higher risk of developing major depressive disorder (MDD) than that of men. However, the investigation of female MDD patients functional brain activity is rare and the detailed mechanism remains unclear. The present work is to explore the altered spontaneous neural activity measured with regional homogeneity (ReHo) in female MDD patients using resting-state functional magnetic resonance imaging (fMRI) technique. Twelve MDD females and twelve matched healthy participants were included in the study. The ReHo analysis method was used to detect regional homogeneity features across the whole brain. Increased ReHo value was found in the left anterior cingulate gyrus (ACC_L) and right fusiform gyrus, and decreased ReHo value in the right putamen, left middle frontal gyrus and left middle occipital gyrus was shown in female MDD patients compared to healthy controls. Also, a significant positive correlation between patients ReHo value and HAMA score (r = 0.59, p = 0.045) was found in the ACC_L. The study of spontaneous neuronal activity alteration using ReHo analysis improves our understanding about the mechanism of female depression.

Increased risk of severe infections in non-small-cell lung cancer patients treated with pemetrexed: a meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Infections related to pemetrexed have been reported in clinical trials. It is not yet clear whether this drug increases infection risk or not. This meta-analysis assessed the overall incidence and risk of severe infections (≥ grade 3) associated with the use of pemetrexed in non-small-cell lung cancer patients.

METHODS

The databases of PubMed, Embase, and the Cochrane Library were searched for relevant studies published up to December 2015. Eligible studies included randomized controlled trials (RCTs) of pemetrexed for non-small-cell lung cancer patients that reported grade 3-5 infection and febrile neutropenia. Summary incidence rates, relative risks (RRs) and 95% confidence intervals (CIs) were calculated by using either random-effects or fixed-effects models, according to the heterogeneity of the included studies.

RESULTS

Seven randomized controlled trials were included, comprising 1848 patients. The incidence of severe infection and febrile neutropenia due to pemetrexed was 5.7% (95% CI: 3.2-8.3%) and 1.3% (95% CI: 0.7-2.0%), respectively. The use of pemetrexed was associated with an increased risk of severe infection (RR 1.61, 95% CI: 1.07-2.44, P = .02) and febrile neutropenia (RR 4.28, 95% CI: 1.08-17.01, P = .04).

CONCLUSION

The use of pemetrexed was associated with an increased risk of developing severe infections and febrile neutropenia in non-small-cell lung cancer patients. Frequent clinical monitoring and management of infections should be emphasized during pemetrexed treatment. More studies are needed to reveal the mechanism of the increased risk of severe infections.

Loss of Par3 promotes lung adenocarcinoma metastasis through 14-3-3ζ protein

Partitioning defective protein 3 (Par3) can activate the Tiam1/Rac pathway to inhibit invasion and metastasis in many cancers; however, the role of Par3 in lung adenocarcinoma remains unknown. Here we show that Par3 is downregulated in lung adenocarcinoma tissues and is associated with higher rates of lymph node metastasis and recurrence. Our functional study demonstrated that knock-down of Par3 promoted lung adenocarcinoma cell growth, cell migration, tumor formation, and metastasis, all of which were effectively inhibited when 14-3-3ζ was silenced. We found that Par3 binded with 14-3-3ζ protein and also showed that Par3 abrogated the binding of 14-3-3ζ to Tiam1, which was responsible for Rac1 activation. Knock-down of 14-3-3ζ inhibited Tiam1/Rac-GTP activation and blocked the invasive behavior of cells lacking Par3. These data suggest that loss of Par3 promotes metastatic behavior in lung adenocarcinoma cells through 14-3-3ζ protein.

Spontaneous neuronal activity in insula predicts symptom severity of unmedicated obsessive compulsive disorder adults

Emerging evidence has suggested that the pathophysiology of obsessive compulsive disorder (OCD) might involve widely distributed large-scale brain systems. The dysfunction within salience network, which is comprised of dorsal anterior cingulated cortex (dACC) and bilateral insular areas, has been proposed to contribute to OCD onset. The mechanism underlying salience network abnormality remains unclear and it is worthwhile to investigate its clinical relevance using functional neuroimaging approaches. In this study, we performed the spontaneous brain activity measurement using resting-state functional magnetic resonance imaging (fMRI) on unmedicated OCD patients (n=23). Specifically, the amplitude of low frequency (0.01-0.08 Hz) fluctuations (ALFF) was calculated for regions in salience network. The voxel-based Pearson's correlative analysis was conducted to explore the relationship beween ALFF measures and symptom severity for OCD patients. The results showed that the spontaneous neuronal activity in insula was significantly correlated to OCD clinical symptoms, especially compulsive behaviors. Our findings consolidated that the salience network played an important role in the pathogenesis of OCD and the intensity of intrinsic brain activity in insula provided a predictive biomarker for OCD symptom severity.

Healing of Deep Wound Infection without Removal of Non-Absorbable Dura Mater (Neuro-Patch®): A Case Report

We report on a female patient who received microvascular decompression due to hemifacial spasm. Neuro-Patch® was used during the operation to repair and replace damaged dura mater. Six days after the operation, the incision wound was found to be infected. Abscesses were present deep in the incision. However, because the artificial dura mater was attached so tightly to the original dura mater, the infection was not able to spread inside the skull. After 3 months of meticulous wound cleaning and drug treatment to promote the growth of granulation tissue, we were able to gradually achieve healing of the infection without having to remove the non-absorbable artificial dura mater. By describing this case and the results of a review of the pertinent literature, we discuss the possibility of recovery of an infection without removal of artificial dura mater.

XBP1 induces MMP-9 expression to promote proliferation and invasion in human esophageal squamous cell carcinoma

X-box binding protein 1 (XBP1) was found to be overexpressed in glioma and breast cancers, suggesting that XBP1 might act as a potent oncogenic protein. However, the clinical significance and biological role of XBP1 in esophageal squamous cell carcinoma (ESCC) remain unknown. In this study, we report that XBP1 is markedly overexpressed in ESCC cell lines and clinical samples. XBP1 overexpression was significantly correlated with ESCC tumor stage, lymph node metastasis and poor outcome. A functional study demonstrated that XBP1 promoted cell growth and cell invasion both in vitro and in vivo. Further study found that the XBP1-mediated invasion and proliferation of cancer cells requires the up-regulation of matrix metalloproteinase-9 (MMP-9). Importantly, a significant correlation between XBP1 and MMP-9 levels was observed in ESCC clinical samples. Our findings demonstrate that XBP1 is an oncogene that plays an important role in the development of ESCC by activating MMP-9 expression.

14-3-3ζ promotes lung cancer cell invasion by increasing the Snail protein expression through atypical protein kinase C (aPKC)/NF-κB signaling

14-3-3ζ has been identified as a putative oncogene in several cancers, including non-small cell lung cancer (NSCLC). However, the mechanisms underlying its functions remain undefined. In this study, we show that overexpression of 14-3-3ζ was frequently detected in lung adenocarcinoma (LuAC) tissues and was significantly associated with lymph node metastasis and poor outcome. Functional studies demonstrated that 14-3-3ζ promoted migration and invasion in A549 cells, both of which were effectively inhibited when 14-3-3ζ was silenced with short hairpin RNA (shRNA). Furthermore, 14-3-3ζ-mediated invasion of cancer cells was found to upregulate Snail through the activation of atypical protein kinase C (aPKC). Activation of aPKCζ mediates this effect by stimulating NF-κB signaling. Our results identify a specific pathway by which 14-3-3ζ induces tumor invasion and provide insight into potential therapeutic approaches to target 14-3-3ζ-associated lung adenocarcinoma.

Colorectal Cancer Screening with Faecal Occult Blood Testing: Community Intention, Knowledge, Beliefs and Behaviour

The objective of this study was to examine the current community intention, knowledge, beliefs and behaviour regarding colorectal cancer (CRC) screening with faecal occult blood testing (FOBT). A cross sectional telephone survey of the general population was conducted in Queensland, Australia. A random sample of 1,136 residents aged 40-80 years were invited to participate in the survey with a response rate of 77.8%. 77.5% (95% confidence interval [95% CI]: 74.0 to 80.7%) of respondents reported that they would participate in CRC screening by FOBT if recommended to do so by doctors or health authorities. Screening intention was significantly associated with interest in further information concerning CRC or CRC screening (odds ratio: 6.7; 95% CI: 3.4 - 13.1), belief that CRC screening is necessary for persons without symptoms (5.0; 95% CI: 1.5 -17.1), and belief that treating bowel cancer in the early stages increases a person's chance of survival (5.1; 95% CI: 2.6 - 9.9). Knowledge of seeking medical advice (2.8; 95% CI: 0.9 - 8.7) and diarrhoea/constipation as a symptom of CRC (1.7; 95% CI: 0.9 - 3.2), self-initiated screening behaviour (1.5; 95% CI: 0.8 -2.9), and medical check a couple of times a year or more (2.4; 95% CI: 0.9 - 6.5) were also marginally significantly associated with screening intention. Community intention to screen for CRC with FOBT may have increased over recent years. Screening intention is associated with community knowledge, attitudes/beliefs and behaviour.