CTLA-4 haplotype predicts HBsAg and HBcrAg levels and HBeAg seroconversion age in children with chronic HBV infection

Background & Aim

Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) attenuates cytotoxic T lymphocyte (CTL) activation. This study was performed to examine the relationships between CTLA-4 genotypes/haplotypes, hepatitis B surface antigen (HBsAg), and hepatitis B core-related antigen (HBcrAg) levels, and their potential impact on the clinical course of chronic HBV infection.

Methods

We recruited 145 treatment-naïve patients with genotype B or C chronic HBV infection who were initially hepatitis B e-antigen (HBeAg)-positive and had been followed from a mean age of 7.08 years for a total of 4,787 person-years in the study cohort. We also recruited another 69 treatment-naïve adults with genotype B or C chronic HBV infection as a validation cohort. We assessed the CTLA-4 gene single nucleotide polymorphisms rs4553808 (-A1661G)/rs5742909 (-C318T) in both cohorts, and the serum HBsAg and HBcrAg levels in the study cohort.

Results

CTLA-4 promoter haplotypes were associated with HBsAg and HBcrAg levels at 10 and 15 years of age in the study cohort. Patients with the CTLA-4 AA/CC haplotype showed earlier spontaneous HBeAg seroconversion (hazard ratio = 1.58; p = 0.02), and a more rapid annual decline in the serum HBsAg level than other patients (0.09 vs. 0.03 log10 IU/ml/year, p = 0.02). The CTLA-4 AA/CC haplotype was also predictive of HBeAg seroconversion in the validation cohort (p = 0.01).

Conclusions

Chronic HBV-infected patients with a CTLA-4 AA/CC haplotype had lower serum HBsAg and HBcrAg levels in childhood and earlier spontaneous HBeAg seroconversion.

Impact and implications

The role of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) in chronic HBV-infected children has not been studied previously. In a very long-term cohort followed from childhood to adulthood, we showed that CTLA-4 haplotypes are associated with HBV biomarker levels in childhood and are correlated with the clinical course of chronic HBV infection. CTLA-4 pathway may serve as a future target for the development of therapeutic agents against HBV infection.

Correction: Magnetotransport and magnetic properties of Cr-modified Mn2Sb epitaxial thin films

Correction for 'Magnetotransport and magnetic properties of Cr-modified Mn₂Sb epitaxial thin films' by Ting-Wei Chen et al., Phys. Chem. Chem. Phys., 2023, 25, 5785-5794, https://doi.org/10.1039/D2CP05442F.

[Opportunities and prospects for sports medicine in China]

Over the past decades, Chinese sports medicine has made remarkable progress, successfully establishing its status as a discipline and embracing unprecedented development opportunities. In the foreseeable future, "sports for health promotion", in addition to already fast development of "sports injury treatment" and "sports rehabilitation", will become the third vital advancing directions of sports medicine in China. The popularization and application of exercise prescription will become an effective and reliable approach to fulfill sports for health promotion. "Function first, early rehabilitation, return to sports" is the principle of treatment and discipline tenet that will lead the sports injury treatment and rehabilitation to achieve great breakthrough in many fields of sports medicine. With the opportunities and challenges, how to consistently identify and follow the right development path in line with our national circumstances requires the determination, perseverance, courage and wisdom of all Chinese sports medicine practitioners.

The efficacy of a mindfulness-based exercise program in older residents of a long-term care facility in Taiwan

Older people living in long-term care facilities remain largely inactive, and therefore promoting exercise in this population is necessary. This study evaluated the efficacy of a mindfulness-based exercise program in older residents of a long-term care facility in Taiwan. A convenience sample of 72 older residents of a long-term care facility were recruited and assigned to either an experimental group or a control group. The experimental group (n = 36) participated in an 8-week mindfulness-based exercise program, and the control group (n = 36) received routine care. The generalized estimating equation showed significantly larger improvements in a fear of falling, exercise self-efficacy, dynamic balance, and muscle strength in the experimental group than in the control group from baseline to the end of the intervention and 3 months after the end of the intervention. This study provides a reference for how to improve exercise practice in older people living in long-term care facilities.

Magnetotransport and magnetic properties of Cr-modified Mn2Sb epitaxial thin films

High-quality Mn_2-xCr_xSb (x = 0.01, 0.04, and 0.1) epitaxial thin films were grown on SrTiO₃ (STO) (001) single-crystal substrates using molecular beam epitaxy. Magnetotransport and magnetic measurements reveal that the x = 0.01 sample undergoes a quasi-ferrimagnetic (I) [Q-FIM(I)]-to-ferrimagnetic (II) [FIM(II)] spin reorientation (SR) transition and a giant magnetoresistance (MR) associated first-order ferrimagnetic(II)-to-antiferromagnetic (AFM) phase transition upon cooling, resulting in the AFM ground state with a weak in-plane net moment. Upon increasing the doping level from x = 0.01 to 0.1, both the SR transition and the first-order magnetic transition are suppressed. For x = 0.1, the former transition is suppressed, leaving only the Q-FIM(I)-to-AFM transition within the whole temperature region. T_AFM-FIM shows almost similar changes upon the application of either in-plane or out-of-plane magnetic fields. T_AFM-FIM values of the x = 0.01 and 0.04 samples are much higher than those of the Mn_2-xCr_xSb bulk with similar doping levels, which can be understood by the clamping effect from STO substrates. For each thin-film sample, the MR effect is observed near T_AFM-FIM and disappears in the high temperature Q-FIM(I) phase and low temperature AFM phase, indicating that MR is related to the spin-dependent electron scattering during the first-order magnetic phase transition. Based on the magnetotransport and magnetic data, a magnetic phase diagram is established for the Mn_2-xCr_xSb films in the low doping level region.

Spontaneous giant vortices and circular supercurrents in a trapped exciton-polariton condensate

We theoretically study an exciton-polariton condensate trapped in a harmonic potential with an annular pump. With a circular pump, predictions were made for a spontaneous rotating vortex lattice packed by singly quantized vortices. If the circular pump is replaced by an annular pump, singly quantized vortices are absorbed into the central hole and form a multiply quantized vortex. For a sufficiently narrow annular width, all vortices are absorbed into the central hole, ultimately forming a giant vortex with supersonic circular supercurrents flowing around it. Vortex-antivortex pairs can be generated if a defect is present in these supersonic circular supercurrents. We further discover that the motion of the vortex-antivortex pairs depends on the position at which they were generated. We suggest that this property can be used to control whether the velocity of the circular supercurrents is above or below the sound velocity.

Tyrosine 12 of human calcitonin modulates its amyloid formation, membrane binding, and bioactivity

Irreversible aggregation greatly limits the bioavailability and therapeutic activity of peptide-based drugs, so preventing protein or peptide aggregation is a common issue in drug formulation. Human calcitonin (hCT), a peptide hormone secreted by thyroidal parafollicular cells, can regulate blood calcium levels and maintain bone structure. Hence, it can be used as a treatment for metabolic bone diseases, such as osteoporosis and Paget's disease. However, hCT has a relatively high propensity to form amyloid fibrils that hinder its biological function and limit its pharmaceutical potential. In previous studies, we demonstrated, along with other research groups, that modifying specific residues of hCT is sufficient to prevent hCT aggregation. We proceeded to find the key residues that regulate the aggregation of hCT for a better understanding of the mechanism of hCT aggregation. In this work, we used amyloid propensity prediction software and found that Tyr12 may play a key role in regulating hCT aggregation. Thus, we propose three human calcitonin variants (Y12E, Y12P, Y12R) for hCT non-amyloidogenic substituents and examined the aggregation characteristics of variants using multiple biophysical techniques. Y12E showed the best anti-aggregation propensity and can work as inhibitor of hCT aggregation. We also found this residue is crucial for membrane binding and receptor binding. The data presented herein provides an overview of Tyr12 that should be carefully considered in peptide design.

Half-skyrmions with higher topological quantum numbers in homogeneous exciton-polariton condensates

We investigate the topological excitations of half-quantum vortices (HQVs) with higher topological quantum numbers in a homogeneous spinor exciton-polariton condensate pumped by a laser beam and an additional coherent light carrying orbital angular momentum. The spin texture and integrated topological charge can be controlled through the pump. Among these textures, the polaritonic half-skyrmions (or polaritonic merons) can be created with a suitable excitation condition. Moreover, when the pump polarization is in favor of the vortex component of the HQV, there is an inversion of circular polarization (spin flipping) from the center of the HQV towards the edge. The radial flipping position can be manipulated by the pump polarization or power. Finally, we demonstrate that the HQVs can stably exist from the linear stability analysis.

Aromatization as an Impetus to Harness Ketones for Metallaphotoredox-Catalyzed Benzoylation/Benzylation of (Hetero)arenes

Herein we report ketones as feedstock materials in radical cross-coupling reactions under Ni/photoredox dual catalysis. In this approach, simple condensation first converts ketones into prearomatic intermediates that then act as activated radical sources for cross-coupling with aryl halides. Our strategy enables the direct benzylation/benzoylation of (hetero)arenes under mild reaction conditions with high functional group tolerance.

Carbonic Anhydrase XII is a Clinically Significant, Molecular Tumor-Subtype Specific Therapeutic Target in Glioma with the Potential to Combat Invasion of Brain Tumor Cells

Background

The metabolic enzyme carbonic anhydrase 12 (CA12/CAXII) emerges as a promising cancer therapeutic target with drug development projects underway. Previous reports proposed the relevance of CA12 in the context of glioma but are limited in patient data quantity, ignore ethnic diversity of patients or rely on semi-quantitative, thereby out of date, methodology. Moreover, little is known on the association of CA12 to brain tumor stemness or on the effect of anti-CAXII-directed monotherapies on glioma stem cells (GSCs), in particular their response regarding mesenchymal differentiation status.

Methods

We performed in silico analysis on three independent, large-scale patient datasets interrogating state of the art molecular diagnostics alongside clinical outcomes. We analyzed CAXII abundance on a collection of GSCs and functionally tested their response to exposure to CAXII blocking antibody 6A10.

Results

CA12 is highly expressed in glial tumors compared with normal tissue and predicts for poor clinical course of tumor patients. CA12 expression in glioblastoma significantly correlates with clinically established, molecular markers of IDH1^WT DNA, WHO grade IV or absence of 1p/19q chromosome arm co-deletion. Furthermore, tumors with elevated CA12 cluster into the mesenchymal transcription subclass of the disease. CAXII abundance in different GSCs ranges from almost absent to high levels and does not correlate to stem cell marker CD133/AC133 cell surface expression. Moreover, aiming to pharmacologically block CAXII in our cells with antibody 6A10 caused significant functional response only in one of the tested GSCs models, featuring suppression of cell invasion accompanied by reduction of ZEB1 protein and other stem cell markers.

Conclusion

CA12 represents a clinically relevant and molecular brain tumor-subtype specific therapeutic target. Our correlative data from experimental and clinical samples does not support CA12/CAXII to be GSC specific. 6A10 possesses promising potential to impede the invasive capacity of glioma cells and supports the emerging concept that CAXII interacts with cancer EMT programs. However, further mechanistic studies are required to comprehensively assess the therapeutic potential of 6A10 and to identify different resistance mechanisms of GSCs.

Magnetotransport and magnetic properties of the layered noncollinear antiferromagnetic Cr2Se3single crystals

We report on the growth of high-quality stoichiometric layered Cr2Se3single crystals with metallic and noncollinear antiferromagnetic ground state using the chemical vapor transport (CVT) method. The crystals show weak ferromagnetism in the in-plane and out-of-plane directions below the Neél temperature (TN), however, the field-cooled out-of-plane magnetization at 500 Oe and 10 K (∼0.24μB/f.u.) is approximately 15 times larger than that of the in-plane one, indicating strongc-axis easy uniaxial magnetic anisotropy, which is further supported by the in-plane and out-of-plane isothermal anisotropic magnetic hysteresis loops and the angular dependent magnetoresistance (MR). The latter also reveals a decrease of the coercive field of the crystal upon the tilting of the weak ferromagnetic easy axis away from the direction of the magnetic field. Further, the out-of-plane isothermal MR are negative belowTNand show butterfly shapes forT< 10 K and couple with the magnetic hysteresisM(H) loop. These results may help researchers better understand the interplay between the weak ferromagnetism and the magnetotransport properties of 2D itinerant noncollinear antiferromagnetic systems.

Genomic Signature of Mismatch Repair Deficiency in Areca Nut-Related Oral Cancer

Areca nut (AN) chewing contributes to an increase of oral squamous cell carcinoma (OSCC) cases in South and Southeast Asia; however, genomic events underlying the carcinogenesis process of AN-related OSCC remain unclear. Here, we comprehensively describe the genomic and transcriptome alterations of 113 Chinese OSCC patients (89 AN related and 24 AN negative) by whole-exome sequencing and RNA sequencing, and we compared the genomic differences between AN-related and AN-negative samples by integrating sequencing data of 325 OSCC patients from The Cancer Genome Atlas database and 50 from a published Taiwanese study. We identified 11 significantly mutated genes for OSCC, including 4 novel ones (ATG2A, WEE1, DST, and TSC2), of which WEE1 and ATG2A mutated with significantly higher rates in AN-related samples (P = 0.04 and P = 0.003, respectively). Mutational signature analysis revealed that AN-related OSCCs were specially characterized by the genomic signature of mismatch repair deficiency (dMMR), which could also predict the prognosis status of AN-related OSCC. In addition, an elevated PD-L1 expression was also observed in both AN-related patients (P = 3.71 × 10^-11) and those with a high dMMR level (P = 1.99 × 10^-4). Further differential expression analysis and in vitro experiments confirmed the role of dMMR in the development of OSCC induced by AN exposure. Taken together, this study first revealed the molecular profiles and highlighted the role of dMMR in AN-related OSCC among the Chinese population and identified that AN-related OSCC may represent a potential cohort for effective anti-PD-1/L1 immunotherapy.

Construction of hybrid DNAs@CP for the rapid synchronous sensing of multiplex microRNAs based on experimental studies and molecular simulation

A water stable one-dimensional (1D) ladder-shaped coordination polymer (CP) has been synthesized and exhibits a strong affinity to two fluorescein-tagged single-stranded probe DNAs (P-DNAs), giving a sensing platform of P-DNAs@1. Such a hybrid sensing platform is capable of simultaneous detection of breast cancer related microRNA-221 (miRNA-221) and miRNA-222 in a specific and synchronous manner, without observable cross-reactions, as supported by experimental evidences. The interaction mode and the electronic energy between CP 1 with nucleic acid were confirmed by molecular simulation and the universal force field (UFF).

Nonvolatile and Reversible Ferroelectric Control of Electronic Properties of Bi2Te3 Topological Insulator Thin Films Grown on Pb(Mg1/3Nb2/3)O3-PbTiO3 Single Crystals

Single-phase (00 l)-oriented Bi₂Te₃ topological insulator thin films have been deposited on (111)-oriented ferroelectric 0.71Pb(Mg_1/3Nb_2/3)O₃-0.29PbTiO₃ (PMN-PT) single-crystal substrates. Taking advantage of the nonvolatile polarization charges induced by the polarization direction switching of PMN-PT substrates at room temperature, the carrier density, Fermi level, magnetoconductance, conductance channel, phase coherence length, and quantum corrections to the conductance can be in situ modulated in a reversible and nonvolatile manner. Specifically, upon the polarization switching from the positively poled P_r⁺ state (i.e., polarization direction points to the film) to the negatively poled P_r^- (i.e., polarization direction points to the bottom electrode) state, both the electron carrier density and the Fermi wave vector decrease significantly, reflecting a shift of the Fermi level toward the Dirac point. The polarization switching from P_r⁺ to P_r^- also results in significant increase of the conductance channel α from -0.15 to -0.3 and a decrease of the phase coherence length from 200 to 80 nm at T = 2 K as well as a reduction of the electron-electron interaction. All these results demonstrate that electric-voltage control of physical properties using PMN-PT as both substrates and gating materials provides a simple and a straightforward approach to realize reversible and nonvolatile tuning of electronic properties of topological thin films and may be further extended to study carrier density-related quantum transport properties of other quantum matter.

Integration of Oxide Semiconductor Thin Films with Relaxor-Based Ferroelectric Single Crystals with Large Reversible and Nonvolatile Modulation of Electronic Properties

We report the fabrication of 0.71Pb(Mg_1/3Nb_2/3)O₃-0.29PbTiO₃ (PMN-0.29PT)-based ferroelectric field effect transistors (FeFETs) by the epitaxial growth of cobalt-doped tin dioxide (SnO₂) semiconductor thin films on PMN-0.29PT single crystals. Using such FeFETs we realized in situ, reversible, and nonvolatile manipulation of the electron carrier density and achieved a large nonvolatile modulation of the resistance (∼330%) of the SnO₂:Co films through the polarization switching of PMN-0.29PT at 300 K. Particularly, combining the ferroelectric gating with piezoresponse force microscopy, X-ray diffraction, Hall effect, and magnetoresistance (MR), we rigorously disclose that both sign and magnitude of the MR are intrinsically determined by the electron carrier density, which could modify the s-d exchange interaction of the SnO₂:Co films. Furthermore, we realized multilevel resistance states of the SnO₂:Co films by combining the ferroelectric gating with ultraviolet light illumination, demonstrating that the FeFETs have potential applications in multistate resistive memories and electro-optical devices.

Dark gap solitons in exciton-polariton condensates in a periodic potential

We show that dark spatial gap solitons can occur inside the band gap of an exciton-polariton condensate (EPC) in a one-dimensional periodic potential. The energy dispersions of an EPC loaded into a periodic potential show a band-gap structure. Using the effective-mass model of the complex Gross-Pitaevskii equation with pump and dissipation in an EPC in a periodic potential, dark gap solitons are demonstrated near the minimum energy points of the band center and band edge of the first and second bands, respectively. The excitation energies of dark gap solitons are below these minimum points and fall into the band gap. The spatial width of a dark gap soliton becomes smaller as the pump power is increased.

Polariton solitons and nonlinear localized states in a one-dimensional semiconductor microcavity

This paper presents numerical studies of cavity polariton solitons (CPSs) in a resonantly pumped semiconductor microcavity with an imbedded spatial defect. In the bistable regime of the well-known homogeneous polariton condensate, with proper incident wave vector and pump strength, bright and/or dark cavity solitons can be found in the presence of a spatially confined potential. The minimum pump strength required to observe the CPSs or nonlinear localized states in this parametric pump scheme is therefore reported.

Blunt Abdominal Trauma with Left Kidney Dropped into Lower Retroperitoneal Cavity: A Case Report and Literature Review

Blunt abdominal injury with kidney laceration is not unusually seen in high-energy traffic accident. It can present with no symptoms and yet lead to fatal complications. High-grade lacerations of kidney (American Association for the Surgery of Trauma [AAST] grade IV to V) will show up with contrast extravasation and disrupted kidney/pelvicalyceal system morphology in computed tomography (CT). However, it is rare to see kidney dislocation from retroperitoneal space because of the presence of the Gerota's fascia. We present a case of a 16-year-old boy suffering from traffic accident with blunt truncal/abdominal injury. The contrast CT of abdomen revealed that his left kidney was dislocated from the original retroperitoneal space and sagged to the lower retroperitoneal cavity. We performed emergency left nephrectomy. He recovered well and there was no complication noted after the surgical intervention. We also review the literature of kidney laceration regarding diagnosis and treatment. (Hong Kong j.emerg.med. 2016;24:176-179)

Systemic therapies for recurrent or metastatic nasopharyngeal carcinoma: a systematic review

BACKGROUND

The majority of published studies in recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) are single-arm trials. Reliable modelling of progression-free survival (PFS) and overall survival (OS) outcomes, therefore, is difficult. This study aim to analyse existent literature to estimate the relative efficacy of available systemic regimens in RM-NPC, as well as provide estimates of aggregate OS and PFS.

METHODS

We conducted a systematic search of MEDLINE, EMBASE and the Cochrane Library to March 2015. Clinical trials (in English only) investigating cytotoxic and molecularly targeted agents in adult patients with RM-NPC were included. All relevant studies were assessed for quality using Downs and Blacks (DB) checklist (maximum quality score of 27). Aggregate data analysis and Student's t-test were performed for all identified studies (model A). For studies that published analysable Kaplan-Meier curves, survival data were extracted and marginal proportional hazards models were constructed (model B).

RESULTS

A total of 56 studies were identified and included in model A, 26 of which had analysable Kaplan-Meier curves and were included in model B. The 26 studies in model B had significantly higher mean DB scores than the remaining 30 (17.3 vs 13.7, P=0.002). For patients receiving first line chemotherapy, the estimated median OS was 15.7 months by model A (95% CI, 12.3-19.1), and 19.3 months by model B (95% CI, 17.6-21.1). For patients undergoing second line or higher therapies (2nd+), the estimated median OS was 11.5 months by model A (95% CI 10.1-12.9), and 12.5 months by model B (95% CI 11.9-13.4). PFS estimates for patients undergoing first-line chemotherapy by model A was 7.6 months (95% CI, 6.2-9.0), and 8.0 months by model B (95% CI, 7.6-8.8). For patients undergoing therapy in the 2nd+ setting, the estimated PFS by model A was 5.4 months (95% CI, 3.8-7.0), and 5.2 months by model B (95% CI, 4.7-5.6).

CONCLUSIONS

We present the first aggregate estimates of OS and PFS for RM-NPC patients receiving first and second-line or higher treatment settings, which could inform the design of future clinical trials in this disease setting.

Quantum fluctuations and stability of vortex lattices in a nonresonantly pumped exciton-polariton condensate

The dynamics of an exciton-polariton condensate (EPC) subject to harmonic confinement can cause spontaneously formed vortices to arrange into a triangular vortex lattice. The stability of such a spontaneously formed vortex lattice is still unknown. We investigate the quantum fluctuations of vortex lattices in a rapidly rotating EPC with a rotation frequency close to the harmonic trap. In such a large condensate, we find that a vortex lattice with a triangular structure is stable, whereas one with a square structure becomes unstable. This result indicates that a driven-dissipative vortex array with strong quantum fluctuations can occur in an EPC.

Nonequilibrium and nonlinear defect states in microcavity-polariton condensates

The nonequilibrium and nonlinear defect modes (NNDMs), localized by a defect in a nonequilibrium microcavity-polariton condensate (MPC), are studied. There are three analytic solutions of NNDMs in a point defect: the bright NNDM, a bound state with two dark solitons for an attractive potential, and a gray soliton bound by a defect for a repulsive potential. We find that the stable NNDMs in a nonequilibrium MPC are the bright NNDM and gray soliton bound by a defect. The bright NNDM, which has the hyperbolic cotangent form, is a bright localized state existing in a uniform MPC. The bright NNDM is a unique state occurring in a nonequilibrium MPC that has pump-dissipation and repulsive-nonlinearity characters. No such state can exist in an equilibrium system with repulsive nonlinearity.

Stable gray soliton pinned by a defect in a microcavity-polariton condensate

We study the spatially localized dark state, called dark soliton, in a one-dimensional system of the non-resonantly pumped microcavity-polariton condensate (MPC). From the recent work by Xue and Matuszewski [Phys. Rev. Lett. 112, 216401 (2014)], we know that the dark soliton in the pure MPC system is unstable. But we find that a dark soliton pinned by a defect in the impure MPC becomes a gray soliton and can be stabilized by the presence of a defect. Moreover, the stable regime of the gray soliton is given in terms of the defect strength and pump parameter.

A systematic review of immune-related adverse event reporting in clinical trials of immune checkpoint inhibitors

BACKGROUND

There are limited data about the quality of immune-related adverse event (irAE) reporting in immune checkpoint inhibitor (ICI) clinical trial publications.

METHODS

A systematic search of citations from Medline, EMBASE and Cochrane databases identified prospective clinical trials involving ICIs in advanced solid tumors from 2003 to 2013. A 21-point quality score (QS) was adapted from the CONSORT harms extension statement. Linear regression was used to identify factors associated with quality reporting.

RESULTS

After a review of 2628 articles, 50 trial reports were included, with ICIs as either monotherapy (54%) or part of a combination regimen (46%). The mean QS was 11.21 points (range 3.50-17.50 points). The median grade 3/4 AE rate reported was 21% (range 0%-66%) and 29/50 (58%) trials concluded that irAEs were tolerable. Multivariate regression analysis revealed that year of publication (within last 5 years, P = 0.01) and journal impact factor >15 (P = 0.004) were associated with higher QS. Complete reporting of specific characteristics of irAEs including onset, management and reversibility were reported by 14%, 8% and 6% of studies, respectively. The incidence of grade 3/4 adverse events was higher for inhibitors against CTLA-4 compared with other immune checkpoints (P < 0.001).

CONCLUSIONS

The reporting of irAEs is suboptimal. A standardized reporting method of irAEs that accounts for tolerability, management and reversibility is needed and would enable a more precise evaluation of the therapeutic risk benefit ratio of ICIs.

Ad-layers enhance graphene's performance

Graphene's performance as transparent conductor can be significantly enhanced by discontinuous ad-layers on top of a complete graphene sheet by providing highly efficient parallel pathways for carrier transport.

Role of modulation frequency in a hybrid Q-switched Nd:LuVO₄ laser with an acousto-optic modulator and a Cr⁴⁺:YAG saturable absorber

This study presents a hybrid Q-switched Nd:LuVO₄ laser with an acousto-optic modulator (AOM) and a Cr⁴⁺:YAG saturable absorber. The importance of the modulation frequency of the AOM in this dual-loss modulation system is examined with two distinct observations: (1) the periodic-ramp pulse characteristics with the modulation frequency, and (2) the existence of the intrinsic modulation frequency for minimizing the pulsewidth. The shortest pulsewidth and the highest peak power were 10.6 ns and 13.9 kW, respectively, at a pump power of 10 W. Compared with the passively Q-switched laser, which has a pulsewidth of 18.3 ns, the ratio of pulse compression reaches 42%. Finally, numerical simulations based on the rate equations are used to verify the experimental results.

Appropriate liver resection type for patients with the American joint committee on cancer classification T1 and T2 hepatocellular carcinoma

SYNOPSIS

Major liver resection prevents intrahepatic tumor recurrence in T2 hepatocellular carcinoma patients with microvascular invasion or daughter nodules.

BACKGROUND AND OBJECTIVES

There is no consensus on whether major or minor hepatectomy is better for hepatocellular carcinoma (HCC) patients. We investigated the outcomes of liver resection type in resectable HCC patients.

METHODS

Two hundred sixty-three HCC patients with Child-Pugh class A liver function who underwent curative hepatectomy were enrolled. Among them, 186 patients had pathologic stage T1 HCC and 77 had stage T2 HCC. Patients were also classed according to the type of resection (major or minor). Clinicopathologic characteristics and outcomes were compared.

RESULTS

Patients with T1 HCC who underwent major resection had a higher rate of blood transfusion than those who underwent minor resection (P < 0.001). The disease-free survival rate of T2 patients who underwent major resection was better than that of patients who underwent minor resection (P = 0.004). The overall survival rates of T1 and T2 HCC patients did not differ significantly between those with major or minor resection.

CONCLUSIONS

Major liver resection is recommended for T2 HCC patients with adequate remnant liver function because it results in a better disease-free survival rate than does minor resection in these patients. Minor liver resection is suggested for T1 HCC patients, except for those with a tumor sitting close to vessels, because it is associated with a low incidence of blood transfusion and a good survival rate.

Aristolochic acid I induced oxidative DNA damage associated with glutathione depletion and ERK1/2 activation in human cells

Aristolochic acid I (AAI) has been widely found in herbal remedies and linked to the development of nephropathy and urothelial carcinoma in humans. This study elucidated the mechanism of oxidative stress and DNA damage mediated by AAI in human cells. Treatment of human promyelocytic leukemia cells (HL-60) and human renal proximal tubular cells (HK-2) with AAI led to a dose-dependent increase of reactive oxygen species (ROS). AAI also elevated the levels of DNA strand breaks and 8-hydroxy guanosine in HL-60 and HK-2 cells. Antioxidants, including Tiron, N-acetyl-l-cysteine (NAC) and glutathione (GSH), effectively suppressed the AAI-induced ROS and AAI-elicited genotoxicity, indicating that AAI induced the DNA damage through oxidative stress. GSH depletion was also found in AAI-treated cultures and proceeded prior to ROS formation. Exposure of HL-60 cells with AAI activated both ERK1/2 and p38 kinase phosphorylation, while only MEK1/2 inhibitor, U0126, significantly decreased AAI-mediated ROS. Preincubation of cells with thiol-containing compounds (NAC and GSH) inhibited the caspase 3 activity triggered by AAI, but non-thiol Tiron did not show a similar effect. This study demonstrated that AAI treatment results in oxidative stress-related DNA damage through GSH depletion and ERK1/2 activation; AAI-induced apoptosis is associated with GSH loss, but is independent of ROS generation.

Radiofrequency ablation after transarterial embolization as therapy for patients with unresectable hepatocellular carcinoma

PURPOSE

To evaluate the usefulness of transcatheter arterial embolization (TAE) followed by radiofrequency ablation (RFA) as combined treatment for unresectable hepatocellular carcinoma (HCC).

PATIENTS AND METHODS

Thirty-six consecutive patients (cirrhosis, Child-Pugh class A or B) with solitary or oligonodular HCC were treated (41 lesions; mean size, 58.9 mm; range, 30-120 mm). RFA was performed after one TAE treatment. Local efficacy was evaluated with multiphasic computed tomography (CT) performed an average of two months after RFA and once during later follow-up.

RESULTS

The mean follow-up period was 16 months (range, 2-45 months). Technical success (namely, complete tumor devascularization during the arterial phase) was achieved for 59% of lesions at the first CT evaluation and for 46% at the second evaluation. Among prognostic factors included in the analysis, only lesion diameter (< 50 mm versus > or = 50 mm) was statistically significant in terms of predicting local success (Fisher's exact test: 85% versus 43% at first CT, p<0.01; 70% versus 36% during follow-up, p=0.05). There were no major periprocedural complications. Kaplan-Meier analysis showed survival rates of 84% at 12 months and 57% at 24 months.

CONCLUSIONS

Combined therapy--TAE then RFA--for unresectable HCC lesions in patients with cirrhosis produces a relatively high complete local response rate compared with TAE or RFA alone. Our results, considered with those from other case series, may help design prospective, randomized clinical trials to test combination therapy versus single-modality therapy in terms of risks and benefits.

Current and strain-induced spin polarization in InGaN/GaN superlattices

The lateral current-induced spin polarization in InGaN/GaN superlattices (SLs) without an applied magnetic field is reported. The fact that the sign of the nonequilibrium spin changes as the current reverses and is opposite for the two edges provides a clear signature for the spin Hall effect. In addition, it is discovered that the spin Hall effect can be strongly manipulated by the internal strains. A theoretical work has also been developed to understand the observed strain-induced spin polarization. Our result paves an alternative way for the generation of spin polarized current.

Intrapericardial isolation of the inferior vena cava through a transdiaphragmatic pericardial window for tumor resection without sternotomy or thoracotomy

AIMS

The prognosis for patients with advanced tumors invading the inferior vena cava (IVC) is dismal and surgical treatments for these tumors are challenging. A surgical approach that avoids sternotomy and thoracotomy for tumors invading the IVC even to the level of the hepatocaval junction would be extremely helpful.

METHODS

The intrapericardial IVC was isolated via a transdiaphragmatic pericardial window using a transabdominal approach. Hepatectomy was then applied via an anterior approach until the IVC was seen. Total hepatic vascular exclusion was achieved by clamping the portal triad, intrapericardial IVC and infrahepatic IVC. We removed the primary tumor, the liver portion involved and the tumor thrombi, with segmental resection of the IVC. Vascular continuity was reestablished using a 20-mm-diameter polytetrafluoroethylene graft.

RESULTS

Four patients with tumors invading the IVC were treated with this method. All underwent gross en-bloc tumor resections and all survived.

CONCLUSION

This method for the resection of IVC tumors could avoid emboli dislodging from the tumor thrombi, prevent the complications of sternotomy, cardiopulmonary bypass and shorten operative times.

Comparison of clinical staging systems in predicting survival of hepatocellular carcinoma patients receiving major or minor hepatectomy

AIM

To compare the utility of seven commonly used staging systems in the prediction of survival among patients with hepatocellular carcinoma (HCC) undergoing major or minor hepatectomy.

METHODS

All patients were classified by the Okuda, the TNM, the CLIP, the BCLC, the CUPI, the JIS and the MELD classifications to estimate the probabilities of survival. Survival curves were calculated using the Kaplan-Meier method and were examined using log-rank testing. The overall predictive power for patient survival with each staging system was evaluated using linear trend chi(2) tests and from the area under the receiver operating characteristic (ROC) curve.

RESULTS

In our patient cohort, the log-rank test and the linear trend chi(2) test of the CLIP and JIS systems gave better results than did the other staging systems. The discriminatory ability of the CLIP and JIS staging for death, evaluated by ROC curve areas, was also better. In the subgroups of major hepatectomy patients with a non-cirrhotic liver or minor hepatectomy patients with a cirrhotic liver, the CLIP and JIS systems showed similar better performances in these three tests. The discriminatory ability of the CLIP system was the best in major hepatectomy patients with a non-cirrhotic liver while JIS score discriminated best in minor hepatectomy patients with a cirrhotic liver.

CONCLUSION

Among the seven staging systems, the CLIP and JIS systems perform better than do the others. While the CLIP system should be considered to stage major hepatectomy patients, the JIS system could be chosen to stage minor hepatectomy patients.

An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases

AIM

The aim of the present study was to report our experience of totally implantable central venous access devices (TICVAD) implantation using two techniques and attempt to define the better technique.

MATERIALS AND METHODS

From January 1998 to September 2003, 1131 patients were reviewed and divided into two groups with implantation by cephalic vein cut-down (group A) done by general surgeons and subclavian vein puncture with the Seldinger technique (group B) done by vascular surgeons. The operative time, early and late complications of these two groups were compared. Data were analysed by Student's t-test.

RESULTS

The average of operative time was 43 min in group A (35-70 min) and 40 min in group B (35-60 min) (P>0.05). No post-operative pneumothorax, hemothorax and fragmentation occurred in group A; the incidence of peri-operative complication was higher in group B. The overall and early complications of group A were significantly lower than that of group B (P<0.0001).

CONCLUSION

This retrospective study showed that the cephalic vein cut-down approach for TICVAD placement avoided the risks of pneumothorax, hemothorax and catheter fragmentation.

Prediction of the risk of hepatic failure in patients with portal vein invasion hepatoma after hepatic resection

AIM

Hepatic failure can develop after curative hepatectomy in patients with a hepatocellular carcinoma (HCC) invading the portal vein, because of cirrhosis and excessive tissue loss. This study aimed to identify the risk factors for hepatic failure in such patients.

METHOD

Forty patients with an HCC invading the portal vein underwent curative hepatectomy from January 1995 to June 2003. Eight patients developed hepatic failure and died within 3 months. Possible risk factors for this were analysed using univariate and multivariate regression. These included the liver function index, surgical blood loss, tumour pattern, portal hypertension, estimated residual liver volume measured by computed tomography (ERLV(CT)) and estimated residual liver volume using the indocyanine green (ICG) retention rate at 15 min (ERLV(ICG15)).

RESULTS

The ERLV(CT) smaller than the ERLV(ICG15) and presence of portal hypertension were independent risk factors for post-hepatectomy hepatic failure.

CONCLUSION

Having portal vein invasion HCC with portal hypertension or an ERLV(CT) less than an ERLV(ICG15) are significant predictors of post-hepatectomy hepatic failure. These factors are important considerations for patients with portal vein invasion HCC who could undergo curative hepatic resection.

The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity

OBJECTIVE

To evaluate the effect of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity.

METHODS

A total of 126 patients with bilateral knee osteoarthritis and obesity were classified into 3 groups by their stages of osteoarthritis. Each group was divided into subgroups a, b, and c. The subjects in subgroup a received weight reduction treatment, those in subgroup b received weight reduction and electrotherapy modalities, and those in subgroup c received electrotherapy modalities to relieve pain.

RESULTS

Pain reduction, weight reduction, ambulation speed, and changes of Lequesne's index were greater in patients in subgroups a and b than in subgroup c after treatment. Although the last pain scores in subgroup b were less than those in subgroup a, as measured by a visual analog scale (VAS), there was no significant difference between their functional status. Significant pain relief (VAS < 2) and an acceptable functional status (Lequesne's index < 7) were indicated when weight reduction was more than 15% and 12%, respectively, of the initial body weight of the individual.

CONCLUSION

Weight reduction was found to be a practical adjuvant treatment in the rehabilitation of patients with knee osteoarthritis.

Interpretation of skull radiographs for facial fractures by medical staff working in UK emergency departments: a pilot study

OBJECTIVES

This was a pilot study to determine the ability of hospital doctors (1) to assess the technical quality of occipitomental (OM) radiographs and (2) to identify facial fractures.

METHOD

Twenty-two doctors from four UK Accident and Emergency (A&E) departments participated in a two part study: Part A was a postal questionnaire containing questions on demographic data, educational background, selection criteria, assessing radiographs and radiation protection; and Part B was a clinical viewing session to interpret 20 randomized OM radiographs divided into four groups; technically good and poor without fractures, and technically good and poor with fractures.

RESULTS

Study participants ranged from junior house officers to senior consultants. There was considerable variation in educational background and radiographic interpretation instruction at undergraduate and postgraduate level. OM radiographs constituted 10% of all skull radiographs examined per week, yet only 40% of the doctors felt confident when assessing technical quality. The majority of participants had only a limited knowledge of radiation protection legislation. During the viewing session, only 50% of the participants correctly identified those radiographs with fractures and those with technique errors. There was no significant difference between house officers and other grades of staff. A higher level of seniority did not equate with greater interpretative ability. Subjective confidence in assessing film quality did not correlate with the actual film viewing.

CONCLUSION

Only half of the A&E doctors taking part in the study were able to correctly assess film quality and identify facial fractures on OM radiographs. If the pilot sample is representative, then the findings are of considerable concern.

The effect of surgical stress on insulin sensitivity, glucose effectiveness and acute insulin response to glucose load

Hyperglycemia after stress is a very common clinical phenomenon. It is generally hypothesized that the underlying cause is a neuroendocrine-mediated deterioration in glucose metabolism. However, the detailed roles of insulin sensitivity, glucose effectiveness and acute insulin response to glucose load in response to stress have not been well established. Hernioplasty was used as a minor stress model for studying stress-induced hyperglycemia. Eleven healthy young men were enrolled voluntarily in this study. Their mean age was 22.0 +/- 0.9 yr and BMI 23.3 +/- 0.6 kg/m2. Frequently sampled i.v. glucose tolerance tests were performed one day before and one day after the surgery. Insulin sensitivity (SI), glucose effectiveness (EG) and area under acute insulin response (AIR) were calculated from "minimal model" algorithms. We also measured fasting concentrations of human GH, ACTH and F on the days of the test. Compared to the pre-operation data, levels of ACTH and F did not change significantly after the surgery. Only GH levels were marginally significant. On the other hand, the SI (0.75 +/- 0.1, 0.52 +/- 0.9 x 10(-5) min(-1)/pmol, p = 0.04), EG (0.023 +/- 0.03, 0.016 +/- 0.003 min(-1), p = 0.01) and AIR (6738.5 +/- 1111.6, 5130.0 +/- 1047.2 pmol, p = 0.005) were all significantly decreased after surgery. The percentages of decrease were 16.3 +/- 15.5, 32.1 +/- 10.3 and 17.8 +/- 10.3%, respectively. Finally, only the changes of EG positively correlate with the changes of ACTH before and after surgery. No significant changes were noted among other stress hormones and the changes of SI, EG and AIR. In conclusion, hernioplasty results in reduced SI, EG and AIR. Among them, although not statistically significant, the EG showed the most distinct decrease after the surgery, which has not been found in previous literature.

Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients

Patients with end-stage renal disease undergoing regular dialysis are prone to encephalopathy, but the cause is often unclear. Dialysis patients are at risk for thiamine deficiency, which may mimic many uremic complications, including encephalopathy. To determine whether unexplained encephalopathy in regular dialysis patients is associated with thiamine deficiency, we conducted a prospective study that enrolled 30 consecutive dialysis patients with altered mental status admitted to a referred hospital during a 1-year period. A complete history, physical and neurological examinations, laboratory investigations, and computed tomographic scans or magnetic resonance imaging of the brain were obtained for each subject. In 10 of the 30 patients, diagnoses remained obscure after the initial workup. Manifestations included confusion, chorea, acute visual loss, rapidly progressive dementia, myoclonus, convulsions, and coma. Intravenous thiamine was administered to these 10 patients. All 10 patients had thiamine deficiency confirmed by a marked response to thiamine supplementation and/or a low serum thiamine concentration (35.3 +/- 6.0 nmol/L; normal, >50 nmol/L). Nine patients recovered, but one patient failed to respond because of delayed treatment. We conclude that in regular dialysis patients, unexplained encephalopathy can be mainly attributed to thiamine deficiency. This condition is fatal if unrecognized and can be successfully treated with prompt thiamine replacement.

Optical emissions in a sonoluminescing bubble

We study how the mechanism of spontaneous decay of atoms (or molecules) in a sonoluminescing bubble (SLB) can be affected by the high density and high temperature environment resulting from the rapid collapse of the gas bubble immediately prior to light emission. We present a detailed study of the density of states of photons in multiple-layered spheres, which mimic various stages of a SLB. In particular, we found that the spontaneous decay rate could be strongly enhanced in the presence of a thin plasma shell inside the bubble, which was predicted recently in numerical hydrodynamic simulations of a SLB.

Human peritoneal mesothelial cells produce nitric oxide: induction by cytokines

OBJECTIVE

To investigate the induction of nitric oxide synthase type II (iNOS) in human peritoneal mesothelial cells (HPMC) using cytokines and bacterial lipopolysaccharide (LPS).

DESIGN

Confluent monolayers of HPMC were exposed to cytokines [tumor necrosis factor alpha (TNFalpha), interleukin-1 beta (IL-1beta), interferon gamma (IFNgamma)] or LPS, individually or in various double and triple combinations, for 24-72 hours. Concentrations of nitrate and nitrite in the media were quantified using the Griess reaction and used as indirect indices of nitric oxide (NO) production. The expression of iNOS was assessed using reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blot.

RESULTS

Neither single cytokines nor LPS was able to induce iNOS mRNA or NO production. Both double combinations of TNFalpha + IFNgamma and IL-1beta + IFNgamma were able to induce iNOS mRNA expression, but only TNFalpha + IFNgamma induced significant NO production. The triple combination of TNFalpha + IFNgamma + IL-1beta induced even more NO production than TNFalpha + IFNgamma. There was no constitutive NO synthase type III (eNOS) expression in HPMC.

CONCLUSIONS

Certain combinations of cytokines could stimulate cultured HPMC to produce NO, and HPMC might be a source of intraperitoneal NO production during peritonitis.