A modified model for predicting mortality after transjugular intrahepatic portosystemic shunt: A multicentre study

BACKGROUND AND AIMS

The transjugular intrahepatic portosystemic shunt has controversial survival benefits; thus, patient screening should be performed preoperatively. In this study, we aimed to develop a model to predict post-transjugular intrahepatic portosystemic shunt mortality to aid clinical decision making.

METHODS

A total of 811 patients undergoing transjugular intrahepatic portosystemic shunt from five hospitals were divided into the training and external validation data sets. A modified prediction model of post-transjugular intrahepatic portosystemic shunt mortality (ModelMT ) was built after performing logistic regression. To verify the improved performance of ModelMT , we compared it with seven previous models, both in discrimination and calibration. Furthermore, patients were stratified into low-, medium-, high- and extremely high-risk subgroups.

RESULTS

ModelMT demonstrated a satisfying predictive efficiency in both discrimination and calibration, with an area under the curve of .875 in the training set and .852 in the validation set. Compared to previous models (ALBI, BILI-PLT, MELD-Na, MOTS, FIPS, MELD, CLIF-C AD), ModelMT showed superior performance in discrimination by statistical difference in the Delong test, net reclassification improvement and integrated discrimination improvement (all p < .050). Similar results were observed in calibration. Low-, medium-, high- and extremely high-risk groups were defined by scores of ≤160, 160-180, 180-200 and >200, respectively. To facilitate future clinical application, we also built an applet for ModelMT .

CONCLUSIONS

We successfully developed a predictive model with improved performance to assist in decision making for transjugular intrahepatic portosystemic shunt according to survival benefits.

Poliovirus receptor (PVR) mediates carboplatin-induced PD-L1 expression in non-small-cell lung cancer cells

Programmed death-ligand-1 (PD-L1) is an immune suppressor that inhibits T cell based immunity. Anti-PD-L1/PD-1 immunotherapy benefits those patients receiving platinum-based combinational chemotherapy. However, the underlying mechanism is still largely unknown. In this study, we found that carboplatin could induce PD-L1 expression in NSCLC H292, A549 and H1299 cells in a dose-dependent manner. mRNA sequencing and the subsequent validation assays found that carboplatin significantly induced PVR expression, which is considered as an immuno-adhesion molecule. Mechanistically, PVR knockdown significantly abrogated carboplatin-induced PD-L1 expression. Functionally, knockdown of PVR significantly reversed the CD3+ T cells proliferation inhibition caused by carboplatin increased PD-L1. Moreover, the carboplatin-induced PVR and subsequent up-regulation of PD-L1 might be mediated via the EGFR, PI3K/AKT, and ERK signaling pathways. Immunohistochemical staining results showed that the PD-L1 expression was positively associated with PVR expression in clinical NSCLC samples. Our study reveals a novel regulatory mechanism of PD-L1 expression, provides evidence that carboplatin inhibits tumor immune response by up-regulating PD-L1 expression and explains the rationale for combining platinum-based chemotherapy with PD-L1/PD-1 inhibitors.

circIFNGR2 regulating ankylosing spondylitis-associated inflammation through macrophage polarization

Macrophages activation is crucial in pathogenesis of rheumatic diseases like ankylosing spondylitis (AS). Circular RNAs (circRNAs)-induced macrophage-associated inflammation participates in many autoimmune diseases but remains elusive in AS. Here, we verified increased expression of circIFNGR2 in peripheral blood mononuclear cells from patients with AS and its expression levels were correlated with the AS severity. In vitro assays revealed that circIFNGR2 enhances macrophage proliferation, and regulates M1/M2 macrophage polarization and NF-κB/Akt pathways. We identified that circIFNGR2 promoted the expression of iNOS/TNFα and M1 polarization, and restrained M2 polarization by sponging miR-939. Additionally, the RNA-binding protein, eIF4A3, was found to enhance the production of circIFNGR2. Interestingly, miR-939 attenuated joint damage in collagen-induced arthritis mice, whereas circIFNGR2 reversed this effect. Our findings highlight the pro-inflammatory roles of eIF4A3-induced circIFNGR2 in AS by modulating macrophage-associated inflammation through miR-939.

[Clinical characteristics of patients referred to cardio-oncology clinic]

To explore characteristics of outpatients in a single cardio-oncology clinic, patients visiting cardio-oncology clinic of Fuwai Hospital CAMS&PUMC (Beijing, China) from January 2020 to December 2021 were analyzed retrospectively. In total, 330 patients were included, the median age (Q₁, Q₃) was 58(46, 66) years, and there were 192 females (58.2%). The purposes for visit included an evaluation and treatment of cardiovascular adverse reactions (n=247, 74.8%), pre-antitumor therapy assessment (n=51, 15.5%), and management of primary or metastatic cardiac tumors (n=32, 9.7%). For patients with cardiovascular adverse reactions, the most common tumor type was breast cancer (n=88, 29.5%), followed by gastrointestinal cancer (n=70, 23.5%), and hematological cancers (n=62, 20.8%). Among them, 236 cases (95.5%) had received antitumor drugs in the past; 38 cases (15.4%) had a history of chest radiotherapy; some cases were complicated with hypertension (n=69, 23.2%) and/or hyperlipidemia (n=69, 23.2%); 42 cases (14.1%) had a history of coronary heart disease; and 16 cases (5.4%) were complicated with atrial fibrillation or flutter. Among 32 patients with cardiac tumors, 11 cases (34.4%) had primary malignant tumors; 6 cases (18.8%) had benign tumors; 2 cases (6.3%) had metastatic tumors; and 13 (40.6%) had unknown pathological types. This study explores the epidemiology of cardio-oncology in China and provides clinical insights for the future development of cardio-oncology. In the future, it is still necessary to study the benefits of cardio-oncology clinics and develop standardized indicators to evaluate their benefits.

[Can periodontitis affect colorectal cancer by altering microbiota balance?]

Emerging evidence suggests that, along with dietary, genetic and environmental factors, gut microbiota plays a role in the progress of colorectal cancer. Dysbiosis of oral flora in patients with periodontitis affects the composition of microbial community in the gut, impairs gut barrier function, and induces a proinflammatory microenvironment, all of which contribute to the progression of colorectal cancer. In view of the influences by microbiota dysbiosis, this article reviews the role of periodontitis in affecting the occurrence and development of colorectal cancer.

Exosomal LncRNA RP5-977B1 as a novel minimally invasive biomarker for diagnosis and prognosis in non-small cell lung cancer

BACKGROUND

Lung cancer is the leading cause of cancer-related deaths in the world. Non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases. For lack of conveniently sensitive and specific biomarkers, the majority of patients are in the late stage at initial diagnosis. Long non-coding RNAs (LncRNAs), a novel type of non-coding RNA, have recently been recognized as critical factors in tumor initiation and progression, but the role of exosomal LncRNAs has not been thoroughly excavated in NSCLC yet.

METHODS

We isolated exosomes from the serum of patients with NSCLC and healthy controls. Exosome RNA deep sequencing was subsequently performed to detect differentially expressed exosomal LncRNAs. qRT-PCR assay was then utilized to validate dysregulated LncRNAs in both testing and multicentric validation cohort. Receiver operating characteristic (ROC) curve was used to detect the diagnostic capability of exosomal biomarkers. Furthermore, Kaplan-Meier analysis was applied to evaluate the prognostic values of these molecules.

RESULTS

On the basis of analysis, we found that novel exosomal LncRNA RP5-977B1 exhibited higher levels in NSCLC than that in the healthy controls. The area under the curve (AUC) value of exosomal RP5-977B1 was 0.8899 and superior to conventional biomarkers CEA and CYFRA21-1 both in testing and multicentric validation cohort. Interestingly, the diagnostic capability of exosomal RP5-977B1 was also validated in early-stage patients with NSCLC. Furthermore, high expression of exosomal RP5-977B1was closely related with worse prognosis in NSCLC (P = 0.036).

CONCLUSIONS

Our results suggested that exosomal RP5-977B1 might serve as a novel "liquid biopsy" diagnostic and prognostic biomarker to monitor NSCLC and improve possible therapy.

Screening for malignant tumor cells in serous effusions with an automatic hematology analyzer using a novel diagnostic algorithm

Background

Due to the high false-positive rate of the high-fluorescence body fluid (HF-BF) cell parameter of the hematology analyzer in BF mode, a novel algorithm based on the Mindray BC-6800 Plus hematology analyzer (BC-6800Plus), with higher diagnostic accuracy compared to that of the traditional HF-BF algorithm, was used to screen for malignant tumor cells in clinical BF samples. In this study, the body fluid mode of BC-6800Plus was applied to investigate the ability of its available parameters and characteristic regional particles in tumor cells screening.

Methods

A total of 220 BF samples (including pleural effusion and ascites) were randomly classified into a training cohort (154 samples) and a validation cohort (66 samples), and detected on the BC-6800Plus in BF mode. Based on the scatter plot analysis of the instrument, a novel gating algorithm, malignant cell algorithm-body fluid (MA-BF), was designed to detect the aggregated cells expressing highest fluorescence (FL) signals and side-scatter (SS) signals than other cells. BF collection and analyses were performed in compliance with the CLSI H56-A guideline. tumor cell-positive samples were defined as greater than or equal to confirIIIb (Papanicolaou class system) by the pathological examination. The diagnostic accuracy of HF-BF and MA-BF were determined by the receiver operating characteristic (ROC) curve analysis.

Results

When the cutoff values of the absolute count (HF-BF#) and relative count (HF-BF%) were set as 0.022×10⁹/L and 3.0%, respectively, the area under curve (AUC), sensitivity, and specificity were 0.76, 0.85 and 0.55 for HF-BF#, and were 0.70, 0.85, and 0.49 for HF-BF%, respectively. The new parameters, the absolute tumor cell count (MA-BF#) and relative count (MA-BF%), were established in the training cohort using the novel algorithm. We confirmed the cutoff values of MA-HF# and MA-HF% in BF were set as 0.006×10⁹/L and 0.2% in the training cohort, respectively. In the validation cohort, the AUC, sensitivity, and specificity were 0.89, 0.93, and 0.78 for MA-BF#, and were 0.89, 0.87 and 0.75 for MA-BF%, respectively.

Conclusions

The MA-BF parameters of the novel algorithm output had better diagnostic accuracy for BF tumor cells than the traditional HF-BF parameters.

Hsa_circ_0000652 Aggravates Inflammation by Activation of Macrophages and Enhancement of OX40/OX40L Interaction in Ankylosing Spondylitis

Circular RNAs (circRNAs) have emerged as important roles in various inflammatory processes of rheumatic diseases. However, their expression profiles and influences in the pathogenesis of ankylosing spondylitis (AS) remain unclear. In this study, we revealed the differential expression profiles of circRNAs in peripheral blood mononuclear cells (PBMCs) in AS by circRNA sequencing. We screened the differentially expressed circRNAs in AS and verified that hsa_circ_0000652 was upregulated and had potential to be a biomarker of progression. Functionally, hsa_circ_0000652 promoted proliferation and cytokine production in macrophages and inhibited apoptosis. Through dual-luciferase assays and RNA pull-down assays, we demonstrated that hsa_circ_0000652 acted as a competing endogenous RNA (ceRNA) by binding with hsa-miR-1179 and regulated OX40L, which is characterized as a co-stimulatory molecule and found to be upregulated in AS patients. As a result, hsa_circ_0000652 aggravated the inflammation in the coculture system containing CD4⁺ T cells and macrophages via OX40/OX40L interaction. Our findings suggest that hsa_circ_0000652 was upregulated in AS patients and may serve as a pro-inflammatory factor in macrophages and a positive regulator of OX40/OX40L by sponging hsa-miR-1179.

Risk stratification by long non-coding RNAs profiling in COVID-19 patients

Coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has become a global pandemic worldwide. Long non‐coding RNAs (lncRNAs) are a subclass of endogenous, non‐protein‐coding RNA, which lacks an open reading frame and is more than 200 nucleotides in length. However, the functions for lncRNAs in COVID‐19 have not been unravelled. The present study aimed at identifying the related lncRNAs based on RNA sequencing of peripheral blood mononuclear cells from patients with SARS‐CoV‐2 infection as well as health individuals. Overall, 17 severe, 12 non‐severe patients and 10 healthy controls were enrolled in this study. Firstly, we reported some altered lncRNAs between severe, non‐severe COVID‐19 patients and healthy controls. Next, we developed a 7‐lncRNA panel with a good differential ability between severe and non‐severe COVID‐19 patients using least absolute shrinkage and selection operator regression. Finally, we observed that COVID‐19 is a heterogeneous disease among which severe COVID‐19 patients have two subtypes with similar risk score and immune score based on lncRNA panel using iCluster algorithm. As the roles of lncRNAs in COVID‐19 have not yet been fully identified and understood, our analysis should provide valuable resource and information for the future studies.

EDTA-K2 Improves the Detection Sensitivity of SARS-CoV-2 IgM and IgG Antibodies by Chelating Colloidal Gold in the Immunochromatographic Assay

OBJECTIVE

The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now rapidly spreading globally. Serological tests are an important method to assist in the diagnosis of COVID-19, used for epidemiological investigations. In this study, we aimed to investigate the impact of different types of vacuum collection tubes on the detection of SARS-CoV-2 IgM and IgG antibodies, using the colloidal gold immunochromatographic assay (GICA).

PATIENTS AND METHODS

A total of 112 patients with COVID-19 and 200 healthy control subjects with no infection were enrolled in this study. Their serum and plasma were collected into four different types of vacuum blood collection tubes. SARS-CoV-2 IgM and IgG specific antibodies in the plasma and serum were then detected by GICA and chemiluminescence assay (CA), respectively. In addition, the particle sizes of different colloidal gold solutions in the presence of different anticoagulants and coagulants were evaluated by both laser diffraction (Malvern) and confocal laser microscope, respectively.

RESULTS

Our results revealed that anticoagulated plasma with EDTA-K2 improved the positive detection rate of SARS-CoV-2 IgM antibodies. Furthermore, our results shown that the detection results by GICA and CA were highly consistent, especially, the results of EDTA-K2 anticoagulated plasma detected by GICA was more consistent with CA results. We confirmed that EDTA-K2 could improve the detection sensitivity of SARS-CoV-2 IgG antibodies by chelating excessive colloidal gold compared with sodium citrate or lithium heparin, these methodologies did not appear to cause false positives. Colloidal gold particles could be chelated and aggregated by EDTA-K2, but not by sodium citrate, lithium heparin and coagulants.

CONCLUSION

GICA is widely used to detect antibodies for the advantages of convenient, fast, low cost, suitable for screening large sample and require minimal equipment. In this study, we found that EDTA-K2 amplified the positive antibody signal by chelating colloidal gold and improved the detection sensitivity of SARS-CoV-2 IgM and IgG antibodies when using the GICA. Therefore, we suggested that EDTA-K2 anticoagulated plasma was more suitable for the detection of SARS-CoV-2 antibodies.

The future of Extracellular Vesicles as Theranostics - an ISEV meeting report

The utilization of extracellular vesicles (EVs) in clinical theranostics has rapidly advanced in the past decade. In November 2018, the International Society for Extracellular Vesicles (ISEV) held a workshop on “EVs in Clinical Theranostic”. Here, we report the conclusions of roundtable discussions on the current advancement in the analysis technologies and we provide some guidelines to researchers in the field to consider the use of EVs in clinical application. The main challenges and the requirements for EV separation and characterization strategies, quality control and clinical investigation were discussed to promote the application of EVs in future clinical studies.

[Analysis of risk factors for lymphoma patients dying of cardiovascular disease]

Objective: To understand and explore the risk factors of the death of lymphoma patients from cardiovascular disease. Methods: The medical records and death information of 1 173 patients with lymphoma were collected, cases that died from cardiovascular disease were screened. A binary logistic regression model was used to analyze the independent risk factors of patients with lymphoma died from cardiovascular disease. Results: Among 1 173 patients with lymphoma, 75 (6.4%) died of cardiovascular disease, including 27 cases of coronary heart disease, 25 cases of stroke, 7 cases of hypertension, 5 cases of sudden cardiac death, 4 cases of pulmonary embolism, 3 cases of heart failure, 4 cases of others. Among the patients who survived for more than 5 years, 16.1% (35/217) died of cardiovascular disease. Among those who survived for more than 10 years, 11.7% (7/60) died of cardiovascular disease. Multivariate Logistic regression analysis showed that the primary site of lymphoma (OR=0.521, P=0.039), stage (stage Ⅱ: OR=2.487, P=0.016; stage Ⅲ: OR=3.233, P=0.002) and cardiovascular toxicity in the course of diagnosis and treatment (OR=3.019, P=0.001) are independent influencing factors for the death of cardiovascular disease in patients with lymphoma. Patients whose primary sites of lymphoma were lymph nodes had lower risk of dying from cardiovascular disease, while the patients with stage Ⅱ to Ⅲ stage and cardiovascular toxicity during diagnosis and treatment had higher risk of dying from cardiovascular disease. Conclusions: Cardiovascular disease is an important factor affecting the survival of patients with lymphoma. With the extension of survival time, the risk of dying from cardiovascular disease increases significantly. The primary site, tumor stage, and cardiovascular toxicity that occur during the diagnosis and treatment may be the independent influencing factors for patients with lymphoma that die from cardiovascular disease.

Facile fluorescent aptasensor using aggregation-induced emission luminogens for exosomal proteins profiling towards liquid biopsy

Surface protein patterns of tumor-derived exosomes could be promising noninvasive diagnostic biomarkers for liquid biopsy. However, a convenient and cost-effective platform for exosomal protein profiling is still lacking. Herein, a facile fluorescent aptasensor is developed to assess exosomal tumor-associated proteins, combining aptamers, aggregation-induced emission luminogens (AIEgens), and graphene oxide (GO) as recognition elements, fluorescent dye, and the quencher, respectively. Specifically, numberous TPE-TAs could bind one aptamer and form aggregates rapidly, resulting in an amplified fluorescence signal. In the absence of tumor-derived exosomes, GO absorbs the TPE-TAs/aptamer complex, allowing fluorescence quenching. When the target exosomes are introduced, the aptamer preferentially binds with its target. Thus the TPE-TAs/aptamer complexes detach from GO surface, followed by the appearance of a "turn-on" fluorescent signal. Under the optimized conditions, the linear range of target exosomes is estimated to be 4.07 × 10⁵ to 1.83 × 10⁷ particles/μL (0.68-30.4 pM) with a detection limit of 3.43 × 10⁵ particles/μL (0.57 pM). This strategy demonstrated great performance in differentiating prostate cancer from healthy individuals (AUC: 0.9790). Furthermore, by profiling three tumor-associated protein markers including epidermal growth factor receptor (EGFR), epithelial cell adhesion molecule (EpCAM), and human epidermal growth factor receptor 2 (HER2) on exosomes in a breast tumor cohort, this sensing platform diagnoses breast tumors with high efficiency (AUC: 0.9845) and exhibits a high sensitivity of 97.37% for distinguishing malignant breast cancers, where the stage I cases were detected with 92.31% sensitivity. Therefore, this aptasensor provides a promising strategy to profile tumor-derived exosomal proteins for early diagnosis in liquid biopsy.

Homogenous Magneto-Fluorescent Nanosensor for Tumor-Derived Exosome Isolation and Analysis

Tumor-derived exosomes carrying unique surface proteins have shown great promise as novel biomarkers for liquid biopsies. However, point-of-care analysis for tumor-derived exosomes in the blood with low-cost and easy processing is still challenging. Herein, we develop an integrated approach, homogenous magneto-fluorescent exosome (hMFEX) nanosensor, for rapid and on-site tumor-derived exosomes analysis. Tumor-derived exosomes are captured immunomagnetically, which further initiates the aptamer-triggered assembly of DNA three-way junctions in homogenous solution containing aggregation-induced emission luminogens and graphene oxide, resulting in an amplified fluorescence signal. By integrating magnetic isolation and enhanced fluorescence measurement, the hMFEX nanosensor detects tumor-derived exosomes in the dynamic range spanning 5 orders of magnitude with high specificity, and the limit of detection is 6.56 × 10⁴ particles/μL. Analyzing tumor-derived exosomes in limited volume plasma from breast cancer patients demonstrates the excellent clinical diagnostic efficacy of the hMFEX nanosensor. This study provides new insights into the point-of-care testing of tumor-derived exosomes for cancer diagnostics.

Heat inactivation of serum interferes with the immunoanalysis of antibodies to SARS-CoV-2

Background

The detection of serum antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is emerging as a new tool for the coronavirus disease 2019 (COVID‐19) diagnosis. Since many coronaviruses are sensitive to heat, heating inactivation of samples at 56°C prior to testing is considered a possible method to reduce the risk of transmission, but the effect of heating on the measurement of SARS‐CoV‐2 antibodies is still unclear.

Methods

By comparing the levels of SARS‐CoV‐2 antibodies before and after heat inactivation of serum at 56°C for 30 minutes using a quantitative fluorescence immunochromatographic assay

Results

We showed that heat inactivation significantly interferes with the levels of antibodies to SARS‐CoV‐2. The IgM levels of all the 34 serum samples (100%) from COVID‐19 patients decreased by an average level of 53.56%. The IgG levels were decreased in 22 of 34 samples (64.71%) by an average level of 49.54%. Similar changes can also be observed in the non–COVID‐19 disease group (n = 9). Of note, 44.12% of the detected IgM levels were dropped below the cutoff value after heating, suggesting heat inactivation can lead to false‐negative results of these samples.

Conclusion

Our results indicate that heat inactivation of serum at 56°C for 30 minutes interferes with the immunoanalysis of antibodies to SARS‐CoV‐2. Heat inactivation prior to immunoanalysis is not recommended, and the possibility of false‐negative results should be considered if the sample was pre‐inactivated by heating.

Compact radio emission indicates a structured jet was produced by a binary neutron star merger

The binary neutron star merger event GW170817 was detected through both electromagnetic radiation and gravitational waves. Its afterglow emission may have been produced by either a narrow relativistic jet or an isotropic outflow. High-spatial-resolution measurements of the source size and displacement can discriminate between these scenarios. We present very-long-baseline interferometry observations, performed 207.4 days after the merger by using a global network of 32 radio telescopes. The apparent source size is constrained to be smaller than 2.5 milli-arc seconds at the 90% confidence level. This excludes the isotropic outflow scenario, which would have produced a larger apparent size, indicating that GW170817 produced a structured relativistic jet. Our rate calculations show that at least 10% of neutron star mergers produce such a jet.

Assessment of oral anticoagulation control at pharmacist-managed clinics: A retrospective cohort study

In chronic kidney disease (CKD) patients, the ratio of warfarin enantiomers is changed and becomes unstable due to a reduction of cytochrome P450 (CYP) 2C9 activity of, which contributes to the development of hemorrhagic complications. The aim of this study was to investigate the influence of interventions by clinical pharmacists in addition to guidance by physicians on time in therapeutic range (TTR) control of warfarin therapy for CKD patients with non-valvular atrial fibrillation (NVAF). This retrospective cohort study included NVAF patients with CKD admitted and discharged from a cardiovascular internal medicine ward between March 2011 and July 2013 in Yokosuka Kyousai Hospital. Participants were classified into two groups according to the instructions by clinical pharmacists and physicians (intervention group) and by physicians only (usual care group). The primary outcome was TTR. Secondary outcomes were major bleeding and minor bleeding. In total, 39 participants (28 males, 11 females; mean age: 72.1 years) were classified into the intervention (n = 16) and usual care (n = 23) groups. TTR in the intervention group was significantly higher than in the usual care group. Major bleeding and minor bleeding were not significantly different between the two groups. The intervention of clinical pharmacists with anticoagulation therapy can lead to a proper use of warfarin prescribed by physicians.

Single-Exosome-Counting Immunoassays for Cancer Diagnostics

Exosomes shed by tumor cells have been recognized as promising biomarkers for cancer diagnostics due to their unique composition and functions. Quantification of low concentrations of specific exosomes present in very small volumes of clinical samples may be used for noninvasive cancer diagnosis and prognosis. We developed an immunosorbent assay for digital qualification of target exosomes using droplet microfluidics. The exosomes were immobilized on magnetic microbeads through sandwich ELISA complexes tagged with an enzymatic reporter that produces a fluorescent signal. The constructed beads were further isolated and encapsulated into a sufficient number of droplets to ensure only a single bead was encapsulated in a droplet. Our droplet-based single-exosome-counting enzyme-linked immunoassay (droplet digital ExoELISA) approach enables absolute counting of cancer-specific exosomes to achieve unprecedented accuracy. We were able to achieve a limit of detection (LOD) down to 10 enzyme-labeled exosome complexes per microliter (∼10^-17 M). We demonstrated the application of the droplet digital ExoELISA platform in quantitative detection of exosomes in plasma samples directly from breast cancer patients. We believe our approach may have the potential for early diagnosis of cancer and accelerate the discovery of cancer exosomal biomarkers for clinical diagnosis.

The association between the increase in pulse pressure and renal function in chronic kidney disease patients with dyslipidemia

In recent years, an association between chronic kidney disease (CKD) and arteriosclerosis has been identified. Pulse pressure (PP) is used as an index of arteriosclerosis. However, there have been few studies of the relationship between PP and renal dysfunction in patients with CKD. Therefore, we examined the association of increased PP on renal function in patients with CKD and dyslipidemia. This study included 104 patients with CKD who were diagnosed with dyslipidemia and commenced on drug treatment. In the present study, patients with PP ≥65 mmHg were included in the High PP group, and patients with PP <65 mmHg were included in the Low PP group. We compared the High PP group with the Low PP group about background patient characteristics, laboratory data and antihypertensive medications and type. Mutiple logistic regression analysis identified estimated glomerular filtration rate (eGFR) as a significant predictor of PP ≥65 mmHg. In addition, values of BUN, Ccr, and eGFR baseline and 12 months later were compared. In the High PP group, compared with baseline, BUN increased significantly and Ccr and eGFR decreased significantly after 12 months later. We consider that PP may be an auxiliary indicator of generalized arterial sclerosis and renal function.

MiR-145 detection in urinary extracellular vesicles increase diagnostic efficiency of prostate cancer based on hydrostatic filtration dialysis method

BACKGROUND

Extracellular vesicles (EVs) can be detected in body fluids and may serve as disease biomarkers. Increasing evidence suggests that circulating miRNAs in serum and urine may be potential non-invasive biomarkers for prostate cancer (PCa). In the present study, we aimed to investigate whether hydrostatic filtration dialysis (HFD) is suitable for urinary EVs (UEVs) isolation and whether such reported PCa-related miRNAs can be detected in UEVs as PCa biomarkers.

METHODS

To analyze EVs miRNAs, we searched for an easy and economic method to enrich EVs from urine samples. We compared the efficiency of HFD method and conventional ultracentrifugation (UC) in isolating UEVs. Subsequently, UEVs were isolated from patients with PCa, patients with benign prostate hyperplasia (BPH) and healthy individuals. Differential expression of four PCa-related miRNAs (miR-572, miR-1290, miR-141, and miR-145) were measured in UEVs and paired serum EVs using SYBR Green-based quantitative reverse transcription-polymerase chain reaction (qRT-PCR).

RESULTS

The overall performance of HFD was similar to UC. In miRNA yield, both HFD and UC can meet the needs of further analysis. The level of miR-145 in UEVs was significantly increased in patients with PCa compared with the patients with BPH (P = 0.018). In addition, significant increase was observed in miR-145 levels when patients with Gleason score ≥8 tumors compared with Gleason score ≤7 (P = 0.020). Receiver-operating characteristic curve (ROC) revealed that miR-145 in UEVs combined with serum PSA could differentiate PCa from BPH better than PSA alone (AUC 0.863 and AUC 0.805, respectively). In serum EVs, four miRNAs were significantly higher in patients with PCa than with BPH.

CONCLUSION

HFD is appropriate for UEVs isolation and miRNA analysis when compared with conventional UC. miR-145 in UEVs is upregulated from PCa patients compared BPH patients and healthy controls. We suggest the potential use of UEVs miR-145 as a biomarker of PCa.

Efficacy of statins for osteoporosis: a systematic review and meta-analysis

Our meta-analysis assessed the efficacy of statins on the risk of fracture, bone mineral density (BMD), and the markers of bone metabolism by collecting data from 33 clinical trials. We found that statin treatment was associated with bone metabolism. And statins seemed to be more effective on male patients with osteoporosis. The efficacy of statins for the treatment of osteoporosis has been controversial in previous studies and meta-analyses. Our meta-analysis was conducted to examine in detail the efficacy of statins on osteoporosis. We searched PubMed, Embase, and the Cochrane Library databases for clinical trials from inception to May 2016. We included studies that described the effect of statins on the risk of fracture, BMD, or bone turnover markers. Moreover, we also conducted subgroup analyses according to the skeleton site, patient gender, and length of follow-up. A total of 33 studies which included 23 observational studies (16 cohort studies and 7 case-control studies) and 10 randomized controlled trials (RCTs) were evaluated. These 33 studies included 314,473 patients in statin group and 1,349,192 patients in control group. Statins decreased the risk of overall fractures (OR = 0.81, 95% CI 0.73-0.89) and hip fractures (OR = 0.75, 95% CI 0.60-0.92). Furthermore, the use of statins was associated with increased BMD at the total hip (standardized mean difference (SMD) = 0.18, 95% CI 0.00-0.36) and lumbar spine (SMD = 0.20, 95% CI 0.07-0.32) and improved the bone formation marker, osteocalcin (OC) (SMD = 0.21, 95% CI 0.00-0.42). However, there was no positive effect on vertebral fractures, upper extremity fractures, BMD at the femoral neck, bone-specific alkaline phosphatase (BALP), and serum C-terminal peptide of type I collagen (S-CTX). Also, compared with male subgroups, the effect on female subgroups was only slightly positive or of no statistical significance. Our meta-analysis indicates that statin treatment may be associated with a decreased risk of overall fractures and hip fractures, an increased BMD at the total hip, BMD at the lumbar spine, and OC. Moreover, our results also show that statin treatment may have a greater effect on male patients than on female patients.

Malignant pleural effusion cell blocks are substitutes for tissue in EML4-ALK rearrangement detection in patients with advanced non-small-cell lung cancer

OBJECTIVE

To evaluate the feasibility of malignant pleural effusions (MPE) as surrogate samples for the detection of echinoderm microtubule-associated protein-like4 (EML4)-anaplastic lymphoma kinase (ALK) and to investigate the prognostic and predictive value of EML4-ALK in MPE of non-small-cell lung cancer (NSCLC).

METHODS

One hundred and nine NSCLC patients were retrospectively analysed. EML4-ALK was identified using paraffin-embedded tumour cells in MPE samples by immunohistochemistry (IHC, Ventana) and confirmed by fluorescence using in situ hybridisation (FISH) and qRT-PCR. The EGFR mutation was determined by MPE, using denaturing high-performance liquid chromatography (DHPLC).

RESULTS

A total of 5 out of 109 (4.58%) patients were identified as EML4-ALK rearrangement in MPE by IHC.; In addition to two metachronous samples, the consistency of MPE and tissue for EML4-ALK detection was 100% (21/21), and the sensitivity and specificity were 100% (2/2) and 100% (19/19), respectively. EML4-ALK rearrangement cases were confirmed by FISH and qRT-PCR; the sensitivity were both 100% (2/2) when compared with tissue, and it was 60% (3/5) and 100% (5/5), respectively, when compared with MPE by IHC. The overall response rate (ORR) was 100% (2/2) for patients with EML4-ALK in MPE. Moreover, the PFS of these patients appeared to be prolonged in chemotherapy (9.27 versus 6.53 and versus 4.67 months, P = 0.122), compared with the EGFR mutation and the EGFR/ALK double negative group, respectively.

CONCLUSION

EML4-ALK rearrangement detection in malignant pleural effusions is a complementary method for EML4-ALK detection. VETANA and qRT-PCR are more appropriate for MPE detection. EML4-ALK rearrangement in pleural effusions has a predictive value for treatment.

Proteomic research on diapause-related proteins in the female ladybird, Coccinella septempunctata L

In the experiments reported here, we used the female ladybird Coccinella septempunctata L. as a model to identify diapause-associated proteins using proteomics technology. Our results indicated that protein expression patterns of diapausing and nondiapausing individuals were highly differentiated. A total of 58 spots showed significant differences in abundance (Ratio > 2 and P < 0.05) according to two-dimensional electrophoresis and GE Image Scanner III analysis. Sixteen protein spots were further investigated using mass spectrometry. Eight proteins were characterized, including chaperones and proteins involved in glucose metabolism, lipid metabolism, and the tricarboxylic acid cycle. Among these proteins, five proteins were upregulated in diapausing female adults, including a chaperone (Symbionin symL), malate dehydrogenase (putative), two proteins linked to lipid metabolism (unknown and conserved hypothetical protein) and phosphoglyceromutase (partial). By contrast, isocitrate dehydrogenase (RH49423p), fumarylacetoacetate hydrolase (AGAP001942-PA), and a putative medium chain acyl-CoA dehydrogenase were downregulated. These results contribute to the understanding of diapause mechanisms of the ladybird C. septempunctata and may suggest methods for improving the application of this natural enemy insect.

NFAT4-dependent miR-324-5p regulates mitochondrial morphology and cardiomyocyte cell death by targeting Mtfr1

Emerging evidence suggest that the abnormal mitochondrial fission participates in pathogenesis of cardiac diseases, including myocardial infarction and heart failure. However, the molecular components regulating mitochondrial network in heart remain largely unidentified. Here we report that NFAT4, miR-324-5p and mitochondrial fission regulator 1 (Mtfr1) function in one signaling axis that regulates mitochondrial morphology and cardiomyocyte cell death. Knocking down Mtfr1 suppresses mitochondrial fission, apoptosis and myocardial infarction. Mtfr1 is a direct target of miR-324-5p, and miR-324-5p attenuates mitochondrial fission, cardiomyocyte apoptosis and myocardial infarction by suppressing Mtfr1 translation. Finally, we show that transcription factor NFAT4 inhibits miR-324-5p expression. Knockdown of NFAT4 suppresses mitochondrial fission and protects cardiomyocyte from apoptosis and myocardial infarction. Our study defines the NFAT4/ miR-324-5p/Mtfr1 axis, which participates in the regulation of mitochondrial fission and cardiomyocyte apoptosis, and suggests potential new treatment avenues for cardiac diseases.

Analysis of factors for poor activated partial thromboplastin time control after dabigatran administration

In this study, we compared patients whose activated partial thromboplastin time (APTT) was prolonged excessively with those whose APTT was controlled within the normal range after dabigatran administration. We analyzed the factors for the APTT prolongation. We divided the patients into two groups: those whose APTTs prolonged to more than 65 s and those whose APTTs were less than 65 s after dabigatran administration. There were 130 patients from March 2011 to July 2013, and we analyzed the background features and laboratory data of these patients. Results showed that there were no significant differences in the patients' background and laboratory data except for the high-density lipoprotein cholesterol (HDL-C) level. However, details of the relationship between the APTT prolongation and the HDL-C level are currently unknown. We hypothesize that the reason for the APTT prolongation is the variability in such parameters as the time of blood drawing, internal time of dabigatran, individual variability, and blood concentration. Therefore, we consider that these parameters need to be carefully evaluated even if APTT does not show prolongation.

Analysis of factors affecting time in therapeutic range control after warfarin administration

The protective efficacy of warfarin for cardiogenic cerebral embolism has been established. However, warfarin is generally administered to only approximately 35% of the atrial fibrillation patients who required warfarin therapy. It has been reported that international normalized ratio (INR) control was carried out appropriately in < 50% of such patients. Therefore, from the viewpoint of prevention of the onset and recurrence of embolism, the maintenance of a stable anticoagulant level is necessary. In warfarin therapy, in addition to INR control, time in therapeutic range (TTR) also markedly affects the efficacy of warfarin therapy. Therefore, we classified patients into two groups on the basis of the cutoff TTR ≥ 65% at which the inhibitory effect of warfarin on stroke has been observed. We aimed to examine the association between INR and TTR with the correction of the therapeutic efficacy of warfarin by analyzing the factors leading to poor TTR control. The most valuable finding of this study is that marked fluctuations of brain natriuretic peptide levels in patients with complication of heart failure was a risk factor for poor TTR control. Identification of the factors leading to the poor TTR control is useful for making the decision to switch to other anticoagulants, such as dabigatran or apixaban, or to continue warfarin by correcting risk factors in atrial fibrillation patients receiving long-term warfarin therapy.

GaLactic and Extragalactic All-sky Murchison Widefield Array survey eXtended (GLEAM-X) I: Survey Description and Initial Data Release

We describe a new low-frequency wideband radio survey of the southern sky. Observations covering 72-231MHz and Declinations south of +30° have been performed with the Murchison Widefield Array "extended" Phase I I configuration over 2018-2020 and will be processed to form data products including continuum and polarisation images and mosaics, multi-frequency catalogues, transient search data, and ionospheric measurements. From a pilot field described in this work, we publish an initial data release covering 1,447 deg² over 4 h≤ RA≤ 13 h, -32.7° ≤ Dec ≤ -20.7°. We process twenty frequency bands sampling 72-231 MHz, with a resolution of 2'-45″, and produce a wideband source-finding image across 170-231MHz with a root-mean-square noise of 1.27 ± 0.15 mJy beam^-1. Source-finding yields 79,124 components, of which 71,320 are fitted spectrally. The catalogue has a completeness of 98% at ~ 50 mJy, and a reliability of 98.2% at 5σ rising to 99.7% at 7σ. A catalogue is available from Vizier; images are made available on the GLEAM-X VO server and SkyView. This is the first in a series of data releases from the GLEAM-X survey.

Exosomes serve as tumour markers for personalized diagnostics owing to their important role in cancer metastasis

Exosomes, membrane vesicles of 40–100 nm in diameter, are derived from endosomes in various cells. The bioactive molecules specifically packed into exosomes can be horizontally transferred into recipient cells changing their biological properties, by which tumour cells continuously modify their surrounding microenvironment and distant target cells favouring cancer metastasis. It has been suspected for a long time that exosomes participate in the whole process of tumour metastasis. Although there is much unknown and many controversies in the role of cancer exosome, the major contribution of tumour-associated exosomes to different steps of cancer metastasis are demonstrated in this review. Mainly because these exosomes are easily accessible and capable of representing their parental cells, exosomes draw much attention as a promising biomarker for tumour screening, diagnosis and prognosis. Currently, researchers have found numerous biomarkers in exosomes with great potential to be utilized in personalized medicine. In this article, we summarize the roles of biomarkers, which are validated by clinical samples. Even though many conundrums remain, such as exosome extraction, large multicentre validation of biomarkers and data interpretation, exosomes are certain to be used in clinical practice in the near future as the field rapidly expands.

E2F1-regulated miR-30b suppresses Cyclophilin D and protects heart from ischemia/reperfusion injury and necrotic cell death

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Cell death is a hallmark characteristic of various cardiac diseases, including myocardial infarction and heart failure. Emerging evidences suggest that necrosis is programmed and is one of the main forms of cell death in the pathological process in cardiac diseases. However, the molecular components regulating programmed necrosis in heart remain largely unidentified. Here we report that miR-30b, Cyclophilin D (CypD) and E2F1 constitute an axis that regulates necrosis. The results show that knockdown of CypD attenuated necrosis in the cellular model and also myocardial infarction in the animal model. miR-30b suppresses the translation of CypD and thus inhibits CypD-mediated necrotic cell death in cardiomyocytes. Cardiac-specific miR-30b transgenic mice exhibit reduced necrosis and myocardial infarct size upon ischemia/reperfusion (I/R) injury. Further, we identify that E2F1 transcriptionally represses miR-30b expression. Knockdown of E2F1 in cardiomyocytes inhibits necrotic cell death, and E2F1 knockout mice show reduced necrosis and myocardial infarct size upon I/R. Our present study identifies a novel signaling pathway composed of E2F1, miR-30b and CypD that regulates myocardial necrosis. This discovery will not only provide de novo regulators in the necrotic process but will also shed new light on the effective therapy of myocardial infarction and heart failure.

Unidirectional spin-wave heat conveyer

When energy is introduced into a region of matter, it heats up and the local temperature increases. This energy spontaneously diffuses away from the heated region. In general, heat should flow from warmer to cooler regions and it is not possible to externally change the direction of heat conduction. Here we show a magnetically controllable heat flow caused by a spin-wave current. The direction of the flow can be switched by applying a magnetic field. When microwave energy is applied to a region of ferrimagnetic Y3Fe5O12, an end of the magnet far from this region is found to be heated in a controlled manner and a negative temperature gradient towards it is formed. This is due to unidirectional energy transfer by the excitation of spin-wave modes without time-reversal symmetry and to the conversion of spin waves into heat. When a Y3Fe5O12 film with low damping coefficients is used, spin waves are observed to emit heat at the sample end up to 10 mm away from the excitation source. The magnetically controlled remote heating we observe is directly applicable to the fabrication of a heat-flow controller.