Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

Research Progress on Plant Responses to Stress Combinations in the Context of Climate Change

In the context of climate change, the frequency and intensity of extreme weather events are increasing, environmental pollution and global warming are exacerbated by anthropogenic activities, and plants will experience a more complex and variable environment of stress combinations. Research on plant responses to stress combinations is crucial for the development and utilization of climate-adaptive plants. Recently, the concept of stress combinations has been expanded from simple to multifactorial stress combinations (MFSCs). Researchers have realized the complexity and necessity of stress combination research and have extensively employed composite gradient methods, multi-omics techniques, and interdisciplinary approaches to integrate laboratory and field experiments. Researchers have studied the response mechanisms of plant reactive oxygen species (ROS), phytohormones, transcription factors (TFs), and other response mechanisms under stress combinations and reached some generalized conclusions. In this article, we focus on the research progress and methodological dynamics of plant responses to stress combinations and propose key scientific questions that are crucial to address, in the context of plant responses to stress assemblages, conserving biodiversity, and ensuring food security. We can enhance the search for universal pathways, identify targets for stress combinations, explore adaptive genetic responses, and leverage high-technology research. This is in pursuit of cultivating plants with greater tolerance to stress combinations and enabling their adaptation to and mitigation of the impacts of climate change.

Sorption behaviour of neptunium in marine and fresh water bottom sediments in Far East area of Russia (Lake Khanka and Amur Bay)

The concentration and sorption behavior of 237Np on the bottom sediments of water bodies in the Far East region of Russia (Lake Khanka and Peter the Great Bay) were studied for the first time. The 237Np concentrations vary from 1.06 × 10-6 to 4.43 × 10-5 mBq g-1 in the bottom sediments of Lake Khanka and from 1.05 × 10-4 to 2.52 × 10-3 mBq g-1 for Amur Bay. The experiment on the adsorption of Np on marine and lake sediment showed that it is sorbed through complexation with silicates (albite, leucite). The Np sorption isotherm on marine sediments is described by the Langmuir equation; the distribution coefficients (Kd) of Np vary from 57 to 588 mL g-1. For lake sediments, the isotherm is described by the Henry equation; the Kd value reaches 935 mL g-1.

Remnant cholesterol is associated with hip BMD and low bone mass in young and middle-aged men: a cross-sectional study

PURPOSE

Remnant cholesterol (RC) is a contributor to cardiovascular diseases, obesity, diabetes, and metabolic syndrome. However, the specific relationship between RC and bone metabolism remains unexplored. Therefore, we aimed to investigate the relationships of RC with hip bone mineral density (BMD) and the risk of low bone mass.

METHODS

Physical examination data was collected from men aged < 60 years as part of the Kailuan Study between 2014 and 2018. The characteristics of the participants were compared between RC quartile groups. A generalized linear regression model was used to evaluate the relationship between RC and hip BMD and a logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for low bone mass. Additional analyses were performed after stratification by body mass index (BMI) (≥ or < 24 kg/m2). Sensitivity analyses were performed by excluding individuals who were taking lipid-lowering therapy or had cancer, cardiovascular diseases, or diabetes.

RESULTS

Data from a total of 7,053 participants were included in the analysis. After adjustment for confounding factors, RC negatively correlated with hip BMD (β =  - 0.0079, 95% CI: - 0.0133, - 0.0025). The risk of low bone mass increased from the lowest to the highest RC quartile, with ORs of 1 (reference), 1.09 (95% CI: (0.82, 1.44), 1.35 (95%CI: 1.02, 1.77), and 1.43 (95% CI: 1.09, 1.89) for Q1, Q2, Q3, and Q4, respectively (P for trend = 0.004) in the fully adjusted model. Compared to RC < 0.80 mmol/l group, the risk of low bone mass increased 39% in RC ≥ 0.80 mmol/l group (P < 0.001). The correlation between RC and hip BMD was stronger in participants with BMI ≥ 24 kg/m2 group (β =  - 0.0159, 95% CI: - 0.0289, - 0.0029). The results of sensitivity analyses were consistent with the main results.

CONCLUSION

We have identified a negative correlation between serum RC and hip BMD, and a higher RC concentration was found to be associated with a greater risk of low bone mass in young and middle-aged men.

The effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid ophthalmopathy

PURPOSE

To evaluate the effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy.

METHODS

This retrospective study enrolled 55 eyes of 33 patients treated in our hospital for restrictive strabismus caused by thyroid-associated ophthalmopathy. We performed muscle recession for the obviously restricted extraocular muscles, with 6 weeks of follow-up. Surgical outcomes were compared between the orbital decompression group (DG, n=15) and non-orbital decompression group (NDG, n=18).

RESULTS

A total of 33 patients with Graves' ophthalmopathy who underwent rectus muscle recession surgery were included. Of these, 15 patients had undergone orbital decompression prior to strabismus surgery, and 18 had not. The two groups did not differ in terms of the preoperative horizontal or vertical ocular deviation, degree of restriction of eye movement, degree of diplopia, or mean number of muscles that underwent surgery (P>0.05). There was no significant difference in the preoperative horizontal or vertical ocular deviation, level of eye movement restriction, degree of diplopia and the success rate of the surgery (P>0.05).

CONCLUSION

Rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy during the quiescent period could improve the ocular deviation and diplopia, and orbital decompression performed before strabismus surgery had no significant effect on surgical technique or outcomes of rectus muscle recession surgery.

[Quality of blood smear examinations for malaria parasites in Chenzhou City after malaria elimination]

OBJECTIVE

To analyze the quality of blood smear examinations for malaria parasites in Chenzhou City, so as to provide insights into sustainable consolidation of malaria elimination achievements.

METHODS

All positive blood smears from fever patients were irregularly sampled from each county (district) of Chenzhou City from 2018 to 2022 and reexamined, and no less than 3% negative blood smears were reexamined. The preparation, dyeing, cleanliness and microscopic examination results of blood smear were reexamined, and the quality of blood smear reexaminations was assessed using a descriptive statistical method.

RESULTS

A total of 13 625 fever patients received blood smear examinations for malaria parasites in Chenzhou City from 2018 to 2022, of which 21 were positive and 13 604 were negative; 687 blood samples were reviewed, and the percentage of negative blood smear reexaminations was 4.90% (666/13 604), with a 63.51% rate of qualified negative blood smears preparation, a 67.87% rate of qualified dyeing and a 76.13% rate of qualified cleanliness, and no missing diagnosis found. There were 21 positive blood smears reexamined, and the proportions of qualified blood smears preparation, dyeing and cleanliness were all 85.71%, with 2 smears mistaking Plasmodium species (9.52%). The percentage of qualified negative blood smears preparation was 51.41% in 2022, which reduced by 31.61% in relative to that (75.17%) in 2019 (χ2 = 9.033, P < 0.05), and the percentage of qualified negative blood smears dyeing was 60.19% in 2022, which reduced by 28.82% in relative to that (84.56%) in 2019 (χ2 = 19.498, P < 0.05), while the percentage of qualified negative blood smears cleanliness was 62.96% in 2022, which reduced by 28.93% in relative to that (88.59%) in 2019 (χ2 = 23.826, P < 0.001). In addition, there were no significant differences in the proportion of qualified negative blood smears preparation (χ2 = 0.260, P > 0.05) or dyeing (χ2 = 1.094, P > 0.05) among the three years, while a significant difference was detected in the percentage of qualified negative blood smears cleanliness (χ2 = 12.175, P < 0.05).

CONCLUSIONS

No missing diagnosis was seen in blood smear examinations for malaria parasites among fever patients in Chenzhou City after malaria elimination; however, there were reductions in proportions of qualified blood smears preparation, dyeing and cleanliness. Quality control of blood smear examinations is recommended to be reinforced in key regions of Chenzhou City.

Measurement of Ultra-High-Energy Diffuse Gamma-Ray Emission of the Galactic Plane from 10 TeV to 1 PeV with LHAASO-KM2A

The diffuse Galactic γ-ray emission, mainly produced via interactions between cosmic rays and the interstellar medium and/or radiation field, is a very important probe of the distribution, propagation, and interaction of cosmic rays in the Milky Way. In this Letter, we report the measurements of diffuse γ rays from the Galactic plane between 10 TeV and 1 PeV energies, with the square kilometer array of the Large High Altitude Air Shower Observatory (LHAASO). Diffuse emissions from the inner (15°10  TeV). The energy spectrum in the inner Galaxy regions can be described by a power-law function with an index of -2.99±0.04, which is different from the curved spectrum as expected from hadronic interactions between locally measured cosmic rays and the line-of-sight integrated gas content. Furthermore, the measured flux is higher by a factor of ∼3 than the prediction. A similar spectrum with an index of -2.99±0.07 is found in the outer Galaxy region, and the absolute flux for 10≲E≲60  TeV is again higher than the prediction for hadronic cosmic ray interactions. The latitude distributions of the diffuse emission are consistent with the gas distribution, while the longitude distributions show clear deviation from the gas distribution. The LHAASO measurements imply that either additional emission sources exist or cosmic ray intensities have spatial variations.

Timing of Postoperative Radiation Therapy for Early-Stage Endometrial Carcinoma: A 20-Year Single-Center Retrospective Cohort Experience in China

PURPOSE/OBJECTIVE(S)

To investigate the appropriate timing of radiotherapy (RT) after hysterectomy for women with early-stage endometrial carcinoma (EC).

MATERIALS/METHODS

Between 1999 and 2020, 1080 patients with I and II endometrial cancer received postoperative RT at our hospital. All patients underwent hysterectomy followed by RT. The optimal cut-off values for the surgery-RT interval (SRI) based on overall survival (OS) were determined using the R software. The disease-free survival (DFS), OS, locoregional recurrence free survival (LRFS), and distant metastasis free survival (DMFS) rates were estimated using the Kaplan-Meier method. Multivariate analyses were performed using Cox proportional hazards regression.

RESULTS

Median follow-up time was 52 months. Median SRI were 46 days. The optimal cut-off value for the surgery-RT interval (SRI) based on overall survival (OS) is 40 days. The group initiated RT within 40 days following surgery has higher OS (P = 0.004), higher LRFS (P = 0.002) and higher DMFS (P = 0.039). An SRI of ≤ 40 days was independently associated with higher OS (HR 0.454, 95% CI:0.261-0.788), higher LRFS (HR 0.487, 95% CI:0.304-0.779), and higher DMFS (HR 0.643, 95% CI:0.421-0.982) than SRI of >40 days. However, SRI had no significant effect on DFS.

CONCLUSION

The surgery-RT interval affects the patients' survival endpoints. Based on this analysis, the timing of the initiation of RT after hysterectomy is crucial for patients with early-stage endometrial carcinoma (EC). The postoperative radiation therapy for endometrial cancer should be initiated within 40 days following surgery.

Risk Stratification of Postoperative Adjuvant Therapy for Endometrial Cancer (POAT-ENDORISK) Based on Bayesian Network Model: A Development and Validation Study

PURPOSE/OBJECTIVE(S)

To establish a Bayesian network (BN) model for postoperative adjuvant treatment of early endometrial carcinoma (EC) patients.

MATERIALS/METHODS

We retrospectively analyzed the data of 1280 early EC patients treated by multiple institutions in China from 1999 to 2017. All patients received primary hysterectomy/bilateral salpingo-oophorectomy and adjuvant radiotherapy. The FIGO 2009 stage of all patients is stage I and stage II EC, and the median age is 57 years old. All patients are grouped according to the ESMO-ESGO-ESTRO risk stratification. The clinicopathologic factors, treatment-related factors, local regional recurrence, distant metastasis and cancer-specific survival rate (CSS) of all patients were reviewed. We divide the original data set into training set and Validation set according to the ratio of 7:3. The training of the Bayesian network model is completed on Netica, and the test of the model effect is finally completed on the test set.

RESULTS

After variable screening, a total of 14 characteristic variables entered the final model. A total of 896 patients were used for the development of BN model, and 384 patients were used for the validation of BN model. The results of the model showed that the factors directly related to CSS were locoregional failure (LRF), radiotherapy mode, distant metastasis (DM). Factors directly related to DM were chemotherapy, LRF, CSS. The factors directly related to LRF were risk stratification, preoperative serum CA125 and preoperative HB. The accuracy, sensibility, specificity, micro-f1, micro-f1, weighted-f1 and AUC of BN model in predicting DM and CSS were better than XGBoost model.

CONCLUSION

In this study, we integrated almost all clinical pathology and treatment information related to postoperative adjuvant treatment of early EC patients and established a BN model for personalized clinical decision-making of postoperative adjuvant treatment of early EC patients. The results showed the complex correlation among the variables, and the overall prediction ability and visualization effect of BN model was significantly better than XGBoost model. Prospective research is needed before clinical implementation.

Comparison of Molecular and Clinicopathologic-Based Classifications and the Transition of Adjuvant Treatment Mode for Early-Stage Endometrial Cancer

PURPOSE/OBJECTIVE(S)

Due to the division in classification strategies based on different molecular and clinicopathologic guidelines, the current emergence of multiple molecular typing methods greatly challenges the traditional classification-guided hierarchical treatment model.

MATERIALS/METHODS

The early-stage ECs who underwent a total hysterectomy and comprehensive molecular analyses were analyzed consecutively between May 2021 and December 2022. All enrolled patients were performed with immunohistochemistry for lymph-vascular space invasion (LVSI), p53, and mismatch repair (MMR) proteins, NGS-panel Sanger sequencing for POLE exonuclease domain, and TP53. The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) classifier and the ESGO/ESTRO/ESP guidelines with and without molecular character were respectively employed to reclassify the enrolled patients. Categorical variables of the risk-group shift were compared by Pearson's χ2 or two-sided Fisher's exact test.

RESULTS

A total of 81 early-stage ECs patients were enrolled. Molecular analyses identified four subgroups across the 81 ECs: 9 (11%) POLE mut, 22 (27.1%) MMRd, 38 (46.9%) NSMP, and 12 (14.8%) p53 abn. Compared with ESGO/ESTRO/ESP 2016 classifier, 26 (32.1%) and 23 (28.4%) patients in ESGO/ESTRO/ESP 2020 cohort with and without molecular classification, respectively, were risk-group downshifted (p>0.05). Ten (12.3%) patients were upshifted in ESGO/ESTRO/ESP 2020 molecular classification comparing to clinical classifier. Remarkably, two patients demonstrated discordance between the ProMisE and TCGA classifiers since the different sequences of classification strategies. On the other hand, 48 of 81 patients received adjuvant radiotherapy, and 12 patients received external beam radiation therapy (EBRT). According to the final molecular test, eight of 12 were classified into low and intermediate risk.

CONCLUSION

The treatment of endometrial cancer is in a period of transition from the clinicopathologic-based model to the era of molecular precision. Discordance between different classifiers and overtreatment remain in clinical practice. Therefore, we should be cautious about using molecular typing to guide adjuvant treatment decisions until it is finally validated in prospective trials.

Dose DIBH Really Reduce the Subclinical Cardiac Acute Injury? Analysis of Clinical Real World from Our Institute

PURPOSE/OBJECTIVE(S)

The study is aim to investigate whether Deep-inspirational breath-hold (DIBH), compared with free breathing (FB), could provide a short-term cardiac benefit in patients with early left breast cancer after breast-conserving surgery combined whole breast radiotherapy.

MATERIALS/METHODS

A total of 78 patients with early stage left breast cancer treated with radiotherapy between 2021-2022 after breast-conserving surgery were enrolled. Among them, 32 cases were treated with DIBH technique and 46 cases were treated with free breathing. Patients with previous cardiac disease such as coronary artery disease were excluded. We performed myocardial enzymes, ECG, and ECHO in all patients within 2 weeks before, during, and 6 months after radiotherapy. The results of the two groups were compared using nonparametric tests and chi-square tests, and P < 0.05 indicated statistical significance. Where subclinical acute cardiac injury was defined as new above-normal myocardial enzymes and/or electrocardiographic ST-T or T-wave changes and/or ECHO abnormalities after the start of radiotherapy.

RESULTS

The median follow-up of patients was 6 months and the mean age of patients was 52.3 years for FB and 44.9 years for DIBH. There were no significant differences in staging, molecular subtype, chemotherapy and endocrine therapy history. The proportion of subclinical acute cardiac injury was smaller in the DIBH group compared to the FB group (DIBH = 31/46 and FB = 28/32, p = 0.042). The most sensitive of the subclinical acute cardiac injury events were detected by myocardial enzymes rising, with cTnI (p = 0.034) and NT-proBNP (p = 0.023) appearing significantly lower in the DIBH patients during radiotherapy. The difference of cTnI between 2 groups at 6 months after radiotherapy became non-significant. In contrast, CK-MB was higher in DIBH compared with FB only 6 months after radiotherapy (p = 0.006). The differences in ECG and ECHO were not significant between the two groups.

CONCLUSION

After breast-conserving surgery combined with radiotherapy for left early breast cancer, DIBH compared to FB reduces the proportion of acute subclinical cardiac injury that occurs with the most sensitive changes in myocardial enzymes. Subsequent studies will explore the relationship between the short-term subclinical injury and irradiated dose, as well as long term cardiac injury.

Lymphocyte Count Kinetics and the Effect of Different Radiotherapy Techniques on Radiation-Induced Lymphopenia in Patients with Breast Cancer Receiving Hypofractionated Postmastectomy Radiotherapy

PURPOSE/OBJECTIVE(S)

Radiation-induced lymphopenia (RIL) is associated with poor prognosis in solid tumors. This study aimed to describe the lymphocyte kinetics in patients with breast cancer receiving hypofractionated postmastectomy radiotherapy (RT) and to investigate the association of different RT techniques with RIL.

MATERIALS/METHODS

We assessed 607 patients who received hypofractionated postmastectomy RT for breast cancer in our prospective clinical database from 8 hospitals. All patients received irradiation to the chest wall and supraclavicular fossa. RT techniques included integrated RT with the photon-based intensity modulated techniques to irradiate all target volumes (integrated RT) and a hybrid approach combining photon irradiation to supraclavicular nodes and electron irradiation to the chest wall (hybrid RT). Peripheral lymphocyte counts (PLC) were tested prior to RT (baseline), weekly during RT, at 1, 2 weeks, 3, 6 months after RT, and then every 6 months. Grade 3+ RIL was defined as PLC nadir during RT of <0.5 ×103/ml. Mean PLC was compared by the t test. Univariate, multivariate, and propensity score matching (PSM) analyses were used to evaluate the effect of different RT techniques on grade 3+ RIL.

RESULTS

During RT, 121 (19.9%) of patients had grade 3+ RIL. The PLC started to recover at 1 week and reached baseline levels 1 year after RT. A greater proportion of the patients treated with the integrated RT (90/269, 33.5%) developed grade 3+ PLC compared with those receiving hybrid RT (31/338, 9.2%, P < 0.001). After conducting PSM, multivariate analyses showed lower baseline PLC (HR = 0.15, P<0.001) and RT technique (the integrated RT vs. hybrid RT, HR = 4.76, P<0.001) were independent risk factors for grade 3+ RIL. The PLC in patients receiving the integrated RT after RT were higher than that in those receiving hybrid RT (p<0.05).

CONCLUSION

RT technique affect the risk of and recovery from RIL, which may impact survival. Choosing appropriate RT technique to minimize RIL might be considered to benefit their outcomes.

Dose-Volume Predictors for Radiation Esophagitis in Breast Cancer Patients Undergoing Hypofractionated Regional Nodal Radiotherapy

PURPOSE/OBJECTIVE(S)

Radiation esophagitis (RE) is often overlooked in breast cancer radiotherapy. This study aimed to assess the incidence and dose-volume predictors of RE in breast cancer patients undergoing hypofractionated regional nodal irradiation (RNI).

MATERIALS/METHODS

Eligible patients were included who received intensity-modulated radiotherapy (RT) at the chest wall, the supraclavicular/infraclavicular fossa, level II axilla, and/or the internal mammary chain after mastectomy. The prescribed dose was 43.5 Gy in 15 fractions. The dose constraint for the esophagus was maximum dose <48 Gy. RE was evaluated weekly during RT and at 1 and 2 weeks, followed by 3 and 6 months after RT, and was graded according to the Common Toxicity Criteria for Adverse Events v3.0. The esophagus was contoured from the lower border level of the cricoid cartilage to the lower margin of the aortic arch. Esophageal total volume, mean dose (Dmean), maximum dose (Dmax), and the relative and absolute volumes receiving at least 5-45 Gy by 5 Gy increments (RV5-RV45 and AV5-AV45) were evaluated. Univariable and multivariable logistics regression analyses were performed to determine risk factors for RE, and receiver operating characteristic curves were obtained to identify the thresholds of esophageal dosimetric parameters.

RESULTS

In total, 298 patients were included between May 8, 2020 and January 5, 2022 (minimum post-RT follow-up: 6 months). A total of 153 (51.3%) patients had left-sided breast cancer and 145 (48.7%) patients received internal mammary nodal irradiation (IMNI). Grade 2 and 3 RE incidence was 40.9% (122/298) and 0.3% (1/298), respectively. No grade 4 or 5 RE was observed. All RE cases resolved within 1 month after RT, and the median duration of RE was 3 weeks (range, 1-5). Based on univariable analyses, tumor laterality (p < .001), IMNI (p = .056) and esophageal Dmean, Dmax, RV10-RV40, and AV10-AV40 were risk factors of ≥grade 2 RE. Esophageal RV10-RV40 and AV35-AV40 were significantly associated with the risk of ≥grade 2 RE after adjusting for tumor laterality and IMNI. Based on multivariable analyses, RV25 and AV35 were optimum dose-volume predictors for ≥grade 2 RE at thresholds 20% for RV25 (35.9% vs. 60.9%, p = .04) and 0.27 mL for AV35 (31.0% vs. 54.6%, p = .04).

CONCLUSION

RE is common in breast cancer patients undergoing hypofractionated RNI. With the same esophageal contouring standard, maintaining the upper esophageal V25 at <20% and V35 at <0.27 mL may decrease the risk of RE and improve the quality of life of patients.

Quality Assurance in a Phase III, Multicenter, Randomized Trial of POstmastectomy radioThErapy in Node posiTive Breast Cancer with or without Internal mAmmary nodaL Irradiation (POTENTIAL): A Planning Dummy Run

PURPOSE/OBJECTIVE(S)

To report the planning dummy run results of the POstmastectomy radioThErapy in Node posiTive breast cancer with or without Internal mAmmary nodaL irradiation (POTENTIAL) trial-a multicenter, randomized, phase 3 trial-to evaluate postmastectomy radiotherapy, with or without internal mammary nodal irradiation, for patients with high-risk breast cancer.

MATERIALS/METHODS

All participating institutions were provided the contours of the dummy run case, and they generated radiotherapy (RT) plans per protocol guidelines. The plans were reviewed and feedback were provided by the quality assurance team, after which the institutions resubmitted revised plans. The information on beams arrangement, skin flash, inhomogeneity corrections, and protocol compliance was assessed both in the primary and final submission.

RESULTS

Theplans from 26 institutions were included in the analysis. A number of major deviations were found in the primary submission, such as less strict constraint on organs at risk (OARs) V5Gy, and no application of chest wall skin flash. The protocol compliance rates of the dose coverage for the planning target volume of the chest wall (PTVcw), PTV of supra/infraclavicular fossa plus axilla levels I, II, III (PTVsc+ax), and PTV of the IMN region (PTVim) were all significantly improved in the final submission compared with those in the primary submission, which were 96.2% vs. 69.2%, 100% vs. 76.9%, and 88.4% vs. 53.8, respectively. For OARs, the protocol compliance rates of heart Dmean, left anterior descending coronary artery V40Gy, ipsilateral lung V5Gy, and stomach V5Gy were significantly improved.

CONCLUSION

All major deviations were corrected and protocol compliance was significantly improved and of high level in the final submission. Moreover, the variations were reduced. Therefore, a planning dummy run was essential to guarantee good RT plan quality and inter-institutional consistency for multicenter trials.

Mismatch Repair Status is an Effective Prognostic Factor for Early-Stage Endometrial Carcinoma

PURPOSE/OBJECTIVE(S)

This study is to evaluate the impact of mismatch repair (MMR) status on prognosis among patients with stage I to II (FIGO 2009) endometrial carcinoma (EC) treated with hysterectomy and adjuvant RT.

MATERIALS/METHODS

Between Oct. 2017 and Dec. 2020, patients with stage I to II (FIGO 2009) EC who had undergone hysterectomy followed by adjuvant RT in our institution were retrospectively reviewed. Clinical characteristics were compared between patients with proficient and deficient mismatch repair (pMMR and dMMR) using Pearson Chi-Square test for categorical variables. Kaplan-Meier method and log-rank test were used to compared overall survival (OS), disease-free survival (DFS), local-regional recurrence free survival (LRFS) and distant metastasis free survival (DMFS). Statistically significant difference was set as p<0.05.

RESULTS

Totally 276 stage I to II EC patients with known MMR status were included in this study. Among them, 211 patients were classified as pMMR while 65 patients were classified as dMMR. When compared to pMMR, patients with dMMR were more likely to have grade 3 and non-endometrioid type(37.8% vs. 20.8%, p = 0.014), lympho-vascular invasion (36.7% vs. 16.3%, p = 0.000), young age (<60) (28.6% vs. 17.2%, p = 0.027), HIR to HR classification(30.9% vs. 16.1%, p = 0.004). Of all the 276 patients, the median follow-up time was 31 months. Two-year DMFS was superior for pMMR compared to dMMR patients (96.3% vs. 95.0%, p = 0.048). Two-year DFS tended to be better for pMMR than dMMR patients with survival curves not crossed over each other (93.0% vs. 86.8%, p = 0.074). Two-year OS (98.9% vs. 98.4%, p = 0.716) and LRFS (96.3% vs. 95.0%, p = 0.815) were not different between pMMR/dMMR patients. For HIR to HR group, we reached the similar conclusion while for LR to IR group, survival statistics were not different between pMMR/dMMR patients. As to failure pattern, dMMR were more likely to have distant failure while local and regional failure were not different between the two groups.

CONCLUSION

For stage I to II EC, patients with dMMR have poorer DMFS and DFS compared to pMMR patients especially in HIR to HR risk classification. The combination of MMR status and other clinical and pathological factors may establish a new prognostic model and form a new risk stratification system.

Postoperative Radiotherapy to Abdominal and Pelvic Lymphatic Drainage Area for Stage III Epithelial Ovarian Cancer: A Sharp Tool to Prolong Disease-Free Survival Time

PURPOSE/OBJECTIVE(S)

For patients with stage III epithelial ovarian cancer, there are limited studies on the effects of postoperative adjuvant radiotherapy (RT) after standard cytoreductive surgery (CRS) and full treatment of first-line adjuvant chemotherapy (CT). The aims of our study were to assess the therapeutic efficacy and toxicity of our special postoperative radiotherapy to abdominal and pelvic lymphatic drainage area for stage III epithelial ovarian cancer patients.

MATERIALS/METHODS

We retrospectively collected patients with stage III epithelial ovarian cancer after CRS and full-course adjuvant chemotherapy. The CT+RT group patients were treated with intensity modulated radiotherapy (IMRT) to abdominal and pelvic lymphatic drainage area (which has been shown to be an alternative to whole abdominal radiotherapy (WART) both on the basis of clinical result and dosimetric verification from our prior study). The CT group data was obtained from the PUMCH's electronic medical record analytical database between 2010 and 2020. A propensity score matching analysis was performed 1:2 between CT+RT group and CT group.

RESULTS

A total of 132 patients with median follow-up of 73.9 months (9.1-137.7 months) were included (44 and 88 for the CT+RT and CT groups, retrospectively). The baseline characteristics of age, histology, level of CA12-5, surgical staging, residual tumor, courses of adjuvant CT, and courses to reduce CA12-5 to normal were all balanced. The median disease-free survival (DFS) time, 5-year overall survival (OS), and local recurrence free survival (LRFS) of CT+RT group and CT group were 100.0 months versus 25.9 months (p = 0.020), 69.2% versus 49.9% (p = 0.002), 85.9% versus 50.5% (p = 0.020), respectively. Distant metastasis was still the primary reason (57.6%), and local failure rate was 42.3%, the local recurrence rate was significantly lower in CT+RT group, compared with CT group (13.6% versus 45.5%, p = 0.016). In terms of toxicity, CT+RT group mainly presented with acute hematological toxicities, with no statistically significant difference with CT group when compared with grade III intestinal adverse effects (3/44 versus 6/88, p = 0.480).

CONCLUSION

This report demonstrates that long-term disease-free survival could be achieved in stage III epithelial ovarian cancer patients treated with IMRT preventive radiation to abdominal and pelvic lymphatic area. Compared with CT group, DFS and OS were significantly prolonged and adverse effects were acceptable.

A tera-electron volt afterglow from a narrow jet in an extremely bright gamma-ray burst

Some gamma-ray bursts (GRBs) have a tera-electron volt (TeV) afterglow, but the early onset of this has not been observed. We report observations with the Large High Altitude Air Shower Observatory of the bright GRB 221009A, which serendipitously occurred within the instrument field of view. More than 64,000 photons >0.2 TeV were detected within the first 3000 seconds. The TeV flux began several minutes after the GRB trigger, then rose to a peak about 10 seconds later. This was followed by a decay phase, which became more rapid ~650 seconds after the peak. We interpret the emission using a model of a relativistic jet with half-opening angle ~0.8°. This is consistent with the core of a structured jet and could explain the high isotropic energy of this GRB.

Effects of Six Consecutive Years of Irrigation and Phosphorus Fertilization on Alfalfa Yield

Alfalfa (Medicago satiua L.) is a major forage legume in semi-arid regions such as North China Plain and is the material foundation for the development of herbivorous animal husbandry. How to improve the yield of alfalfa per unit area from a technical perspective and achieve high-yield cultivation of alfalfa is the focus of research by scientific researchers and producers. To evaluate the effects of irrigation and P fertilization as well as the P residual effect on alfalfa yield, we conducted a six-year (2008-2013) field experiment in loamy sand soil. There were four irrigation levels (W0: 0 mm, W1: 25 mm, W2: 50 mm, W3: 75 mm per time, four times a year) and three P fertilization levels (F0: 0 kg P₂O₅ ha^-1, F1: 52.5 kg P₂O₅ ha^-1, F2: 105 kg P₂O₅ ha^-1 per time, twice a year). The highest dry matter yield (DMY) was obtained in the W2F2 treatment, with an annual mean of 13,961.1 kg ha^-1. During 2009-2013, the DMY of first and second-cut alfalfa increased significantly with increasing irrigation levels, whereas the opposite pattern was observed in fourth-cut alfalfa. Regression analysis revealed that the optimal amount of water supply (sum of seasonal irrigation and rainfall during the growing season) to obtain maximum DMY was between 725 and 755 mm. Increasing P fertilization contributed to significantly higher DMY in each cut of alfalfa during 2010-2013 but not in the first two growing seasons. The mean annual DMY of W0F2, W1F2, W2F2, and W3F2 treatments was 19.7%, 25.6%, 30.7%, and 24.1% higher than that of W0F0 treatment, respectively. When no P fertilizer was applied in F2 plots in 2013, soil availability and total P concentrations, annual alfalfa DMY, and plant nutrient contents did not differ significantly compared with those in fertilized F2 plots. Results of this study suggest that moderate irrigation with lower annual P fertilization is a more environmentally sound management practice while maintaining alfalfa productivity in the semi-arid study area.

Herders' adaptation strategies and animal husbandry development under climate change: A panel data analysis

The frequent occurrence of extreme climate events has become an indisputable fact. However, the role of adaptation to extreme climate change in the development of livestock husbandry is still insufficiently understood. This study empirically analyzed the impact of herders' adaptation strategies to extreme drought on livestock husbandry development and aimed to explore the optimal grassland management path under continuous climate change. A panel dataset of surveyed herders from the Xilingol League, a traditional pastoral area in China, was used. The results indicated that the average frequency of extreme drought in the Xilingol League from 1980 to 2020 was 4.94 months/year, and the occurrence of extreme drought showed a slightly upward trend. The average technical efficiency of livestock husbandry was 0.721, which can still be improved. Hay purchases can effectively promote livestock technical efficiency (p<0.01) and is the main adaptation strategy of herders to extreme drought. Further analysis showed that non-farming and pastoral employment has a positive regulatory effect in the impact of purchased hay on livestock technical efficiency. The results of this study deepen the understanding of effective adaptation to extreme weather events in pastoral areas due to climate change and provide useful information to policymakers engaged in grassland management.

Favorable outcome in advanced pheochromocytoma and paraganglioma after hypofractionated intensity modulated radiotherapy

PURPOSE

The purpose of this study was to review outcomes of patients with advanced/metastatic pheochromocytoma/paraganglioma (PPGL) treated at our institution with Intensity-modulated radiotherapy (IMRT), describe the treatment outcomes, and determine predictors.

METHODS

A retrospective study on patients with advanced/metastatic PPGL who received IMRT at Peking Union Medical College Hospital between 2014 and 2019. A total of 14 patients with 17 lesions were included in this study. Ultra-hypofractionated radiation therapy was used for 7 lesions in 5 patients, while hypofractionated radiation therapy was used for 8 lesions in 7 patients. 2 patients got conventional fractionated radiotherapy. Patients who received external beam radiation therapy were given a median total radiation dose of 74.4/130 Gy (BED10/3) in a median of 13 fractions.

RESULTS

OS at 2 years was 78% for all patients. For lesions evaluated by RECIST response, at least stable disease of the target lesion was achieved in 94% and distant progression in 28.5%, with an average time to progression of 5.2 months. Patients with locally advanced primary tumors or recurred in situ (n = 8) achieved 100% local control, and none of them got recurrence or distant metastasis after radiotherapy at last follow-up (median 29 months). Of patients with catecholamine-related syndromes (n = 12), 91% of symptomatic lesions improved following radiation therapy and a more than 50% decline in catecholamines.

CONCLUSIONS

We have found hypofractionated IMRT effective as an additional therapy for patients with advanced primary tumors or recurrence in situ and not amenable to complete surgical resection.

Recurrent syncope in an 84-year-old man

An 84-year-old man with hypertension and type 2 diabetes presented with recurrent transient loss of consciousness within 2 hours after dinner at home. Physical examination, electrocardiogram, and laboratory studies were unremarkable except hypotension. Blood pressures were measured in different postures and within 2 hours after meal, but neither orthostatic hypotension nor postprandial hypotension was detected. Further, history taking revealed that the patient was tube-fed with a fluid food pump with an inappropriate rapid infusion rate of 1500 mL per minute at home. He was eventually diagnosed as having syncope due to postprandial hypotension, which was caused by the inappropriate way of tube feeding. The family was educated about appropriate way of tube-feeding and the patient did not develop any episode of syncope during a two-year follow-up. This case highlights the importance of careful history taking in the diagnostic evaluation of syncope and the increased risk of syncope due to postprandial hypotension in the elderly.

Patterns and Drivers of Aboveground Insect Diversity along Ecological Transect in Temperate Grazed Steppes of Eastern Eurasian

Insects are important components of biodiversity and play significant roles in the steppe ecosystem. They are abundant, easy to sample, and sensitive to changing conditions, making them useful indicators of environmental changes. This study aims to describe patterns (α and β) of insect diversity across two steppe types (a typical steppe and a desert steppe) along the Eastern Eurasian Steppe Transect (EEST), as well as evaluate the effects of environmental variables in determining these patterns and the influence of plant diversity alterations on these effects. To this end, we collected 5244 individual insects and found an n-shaped diversity distribution along the latitudinal gradient and a significant difference in insect communities across the two steppe types. Further, the Mantel test and path analysis indicate that climate and grazing activities combine to influence insect diversity, and these effects are mediated through plant diversity, strongly supporting the role of bottom-up effects in situations of climatic and grazing pattern changes. Moreover, the contribution of plant diversity varied with steppe types and insect functional groups, with greater effects seen in the typical steppe and herbivorous insects. This indicated the importance of protecting species diversity in steppes through managing plant diversity and assessments of local environmental factors such as grazing intensity and temperature.

Response of Grassland Soil Quality to Shallow Plowing and Nutrient Addition

Due to differences in the soil environment and grassland management measures, the change characteristics of soil microbial entropy and soil comprehensive quality in different types of grassland may vary significantly. In this study, the spatial variation characteristics of grassland soil microbial entropy under shallow plowing and nutrient addition measures were studied using a networking experimental platform established in a temperate meadow steppe, typical steppe, and desert steppe in northern China. The grassland soil quality was comprehensively evaluated to provide a theoretical basis for the scientific and reasonable management of grasslands under global climate change. The results show that in the meadow steppe, shallow plowing and nutrient addition significantly decreased the soil microbial biomass carbon and microbial entropy in the region, resulting in a decrease in the comprehensive score of soil quality. In the typical steppe, due to the influence of shallow tillage measures, the microbial biomass of the grassland soil in the region was higher than that of the control group and its two treatments, and the comprehensive score of soil quality was ranked first among the four treatments. In the desert steppe, the interaction of shallow plowing and nutrient addition significantly increased the soil microbial entropy in the region. Under the nutrient addition measures, the soil microbial entropy of the desert steppe showed a downward trend. In addition, the soil C/N ratio of the desert grassland under nutrient addition measures increased significantly, and the comprehensive score of soil quality ranked first among the four treatments as the microbial entropy decreased significantly.

Constraints on Heavy Decaying Dark Matter from 570 Days of LHAASO Observations

The kilometer square array (KM2A) of the large high altitude air shower observatory (LHAASO) aims at surveying the northern γ-ray sky at energies above 10 TeV with unprecedented sensitivity. γ-ray observations have long been one of the most powerful tools for dark matter searches, as, e.g., high-energy γ rays could be produced by the decays of heavy dark matter particles. In this Letter, we present the first dark matter analysis with LHAASO-KM2A, using the first 340 days of data from 1/2-KM2A and 230 days of data from 3/4-KM2A. Several regions of interest are used to search for a signal and account for the residual cosmic-ray background after γ/hadron separation. We find no excess of dark matter signals, and thus place some of the strongest γ-ray constraints on the lifetime of heavy dark matter particles with mass between 10^{5} and 10^{9}  GeV. Our results with LHAASO are robust, and have important implications for dark matter interpretations of the diffuse astrophysical high-energy neutrino emission.

Ectopic expression of BrIQD35 promotes drought stress tolerance in Nicotiana benthamiana

The plant IQD gene family is responsive to a variety of stresses. In this study, we studied the structural features and functions of the gene BrIQD35 in Chinese cabbage, a member of the IQD gene family. BrIQD35 was cloned and shown to contain an IQ motif. Transient expression of BrIQD35 indicated that it was localized on the plasma membrane and was significantly upregulated under drought and salt stress in Chinese cabbage. To further identify the function of BrIQD35, it was heterologously overexpressed in Nicotiana benthamiana. Although there was no significant difference between BrIQD35-overexpressed and wild-type (WT) plants under salt stress, WT N. benthamiana showed more wilting than the BrIQD35-overexpressed plants under drought stress. Since the IQ motif has been annotated as a CaM binding site, yeast two-hybrid assays were used to explore the interaction between BrIQD35 and CaM. The results indicated that BrIQD35 interacts weakly with CaMb, but not with CaMa, suggesting that BrIQD35 may function through the Ca2+ -CaMb pathway. The findings reveal a novel gene involved in drought tolerance, which is important for plant breeding and quality improvement for Chinese cabbage.

Who are the real high-risk patients with pathological T2N0M0 non-small-cell lung cancer that can benefit from adjuvant chemotherapy?

Background

Methods

Results

Conclusions

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ACT could not improve long-term survival in pT2N0M0 NSCLC in general.

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ACT could only improve OS and DFS in pT2N0M0 NSCLC >4 cm.

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ACT could not improve CSS in any subgroup of pT2N0M0 NSCLC.

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For patients with other high-risk factors, ACT failed to improve long-term survival.

[CXCL5 inhibits tumor immune of lung cancer via modulating PD1/PD-L1 signaling]

Objective: To investigate the role of CXCL5 in tumor immune of lung cancer and to explore the potential molecular mechanisms. Methods: A total of 62 cases of patients with lung cancer admitted in the First Affiliated Hospital of Henan University from May 2018 to December 2019 were recruited as study object. Another 20 cases of patients with pulmonary infectious diseases and 20 cases of healthy control were selected as control. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of CXCL5 in patients with lung cancer, pulmonary infectious diseases and healthy control. Immunohistochemical staining (IHC) was used to detect the expressions of CXCL5 and PD-1/PD-L1 in tumor and paracarcinoma tissues of patients with lung cancer. Pearson correlation analysis was used to evaluate the correlation between CXCL5 and PD-1 in tumor and paracarcinoma tissues of patients with lung cancer. Lewis cells either expressing CXCL5 or vector plasmids were used to establish C57BL/6J mice model of lung cancer, and all mice were then divided into vehicle and PD-1 antibody treatment groups, 10 mice for each group. The mice survival and tumor growth curves were recorded. IHC was used to evaluate the expressions of CXCL5, PD-1 as well as the proportions of CD8(+) T and Treg cells in xenograft tumor tissues. Results: In patients with lung cancer, the serum level of CXCL5 [(351.7±51.5) ng/L] was significant higher than that in patients with pulmonary infectious diseases and healthy control [(124.7±23.4) ng/L, P<0.001]. The expression levels of CXCL5 (0.136±0.034), CXCR2 (0.255±0.050), PD-1 (0.054±0.012) and PD-L1 (0.350±0.084) in tumor were significant higher than those in paracarcinoma normal tissues [(0.074±0.022), (0.112±0.023), (0.041±0.007) and (0.270±0.043) respectively, P<0.001]. CXCL5 was significant positively correlated with PD-1 in tumor tissues of lung cancer (r=0.643, P<0.001), but not correlated with PD-1 in paracarcinoma tissues(r=0.088, P=0.496). The vector control group, CXCL5 overexpression group, vector control + anti-PD-1 antibody treatment group and CXCL5 overexpression + anti-PD-1 antibody treatment group all successfully formed tumors in mice, while CXCL5 overexpression increased the tumor growth significantly (P<0.01), which was abrogated by the treatment of anti-PD-1 antibody. CXCL5 overexpression decreased the mice survival time significantly (P<0.01), this effect was also abrogated by the treatment of anti-PD-1 antibody. The proportion of CD8(+) T cells in CXCL5 overexpression group [(10.40±2.00)%] was significant lower than that in vector control group [(21.20±3.30)%, P=0.002]. The proportion of CD4(+) Foxp3(+) Treg cells in CXCL5 overexpression group [(38.40±3.70)%] was significant higher than that in vector control group [(23.30±2.25)%, P<0.001]. After the treatment of anti-PD-1 antibody, no significant difference were observed for the proportion of CD8(+) T cells [(34.10±5.00)% and (33.40±4.00)% respectively] and Treg cells [(14.70±3.50)% and (14.50±3.30)% respectively] in xenograft tumor tissues between CXCL5 overexpression+ anti-PD-1 antibody treatment group and vector control + anti-PD-1 antibody treatment group (P>0.05). Conclusion: The expressions of CXCL5 and PD-1/PD-L1 are all increased significantly in the tumor tissues of patients with lung cancer, CXCL5 may inhibit tumor immune of lung cancer via modulating PD-1/PD-L1 signaling.

Exploring Lorentz Invariance Violation from Ultrahigh-Energy γ Rays Observed by LHAASO

Recently, the LHAASO Collaboration published the detection of 12 ultrahigh-energy γ-ray sources above 100 TeV, with the highest energy photon reaching 1.4 PeV. The first detection of PeV γ rays from astrophysical sources may provide a very sensitive probe of the effect of the Lorentz invariance violation (LIV), which results in decay of high-energy γ rays in the superluminal scenario and hence a sharp cutoff of the energy spectrum. Two highest energy sources are studied in this work. No signature of the existence of the LIV is found in their energy spectra, and the lower limits on the LIV energy scale are derived. Our results show that the first-order LIV energy scale should be higher than about 10^{5} times the Planck scale M_{Pl} and that the second-order LIV scale is >10^{-3}M_{Pl}. Both limits improve by at least one order of magnitude the previous results.

Changes in bone mineral density in Down syndrome individuals: a systematic review and meta-analysis

Data evaluating changes in bone mineral density (BMD) in Down syndrome (DS) individuals remains controversial. Therefore, we conducted a systematic review and meta-analysis to better understand associations between BMD and DS. A systematic literature search of PubMed, EMBASE, Web of Science, and the Cochrane Library up until 1st January 2021 was conducted. We used the keywords "bone mineral density" and "Down Syndrome." Fifteen studies were included. Overall, our results showed a significant decrease in BMD of total body (TB BMD) [MD =  - 0.18; 95% CI (- 0.23 and - 0.12), P < 0.00001, I2 = 89%], total hip (TH BMD) [MD =  - 0.12; 95% CI (- 0.15 and - 0.10), P < 0.00001, I2 = 0%], lumbar spine (LS BMD) [MD =  - 0.12; 95% CI (- 0.14 and - 0.09), P < 0.00001, I2 = 18%], and femoral neck (FN BMD) [MD =  - 0.08; 95% CI (- 0.10 and - 0.06), P < 0.00001, I2 = 0%] in DS individuals when compared with controls. Moreover, the volumetric BMD of lumbar spine (LS vBMD) [MD =  - 0.01; 95% CI (- 0.02 and - 0.01), P = 0.0004, I2 = 19%] also showed a decreasing tendency while the volumetric BMD of the femoral neck (FN vBMD) [MD = 0.01; 95% CI (0.00 and 0.02), P = 0.02, I2 = 0%] was elevated in DS individuals versus controls. These findings demonstrated that individuals with DS had a decreased total and regional (TH, LS, and FN) BMD when compared with the general population. Additionally, when BMD was adjusted for skeletal volume, LS vBMD was also lower, while FN vBMD was elevated in DS individuals versus controls.

Genetic characterization and clinical characteristics of bovine viral diarrhea viruses in cattle herds of Heilongjiang province, China

BACKGROUND

Heilongjiang province is the main cattle-producing area in China, and molecular epidemiological studies of bovine viral diarrhea viruses (BVDV) in cattle have not been performed in the province.

AIMS

The objective of this research was to determine the genetic and clinical characteristics of BVDV in cattle.

METHODS

Fifty-three BVDV-positive clinical samples were collected from 22 cattle farms in Heilongjiang, and the 5´-untranslated region (5´-UTR) was used to carry out a phylogenetic analysis of the viruses.

RESULTS

The similarity of the 5´-UTR sequences among these BVDVs was 84.2%-100%, and the phylogenetic analysis showed that all viruses belong to the BVDV-1 species, which is classified into five subtypes: BVDV-1b (47.17%, n=25), 1c (15.09%, n=8), 1d (16.98%, n=9), 1 m (3.77%, n=2), and 1o (16.98%, n=9). The statistical results showed that the BVDV-1b subtype had a positive correlation with gastrointestinal disease (P<0.05; 95% CI: 1.19 to 3.34). There were up to three or four BVDV-1 subtypes in some dairy cattle farms, but farms with a single subtype were prevalent (5/10).

CONCLUSION

BVDV-1b is predominant in cattle herds of Heilongjiang province, China, and shows a positive correlation with gastrointestinal disease. BVDV-1o was found for the first time in Chinese cattle, which increased the complex distribution of BVDV-1 subtypes in cattle herds of China.

Utilizing phenotypic characteristics of metastatic brain tumors to improve the probability of detecting circulating tumor DNA from cerebrospinal fluid in non-small-cell lung cancer patients: development and validation of a prediction model in a prospective cohort study

Background

Circulating tumor DNA (ctDNA) in cerebrospinal fluid (CSF) has become a promising surrogate for genomic profiling of central nervous system tumors. However, suboptimal ctDNA detection rates from CSF limit its clinical utility. Thus precise screening of suitable patients is needed to maximize the clinical benefit.

Patients and methods

Between February 2017 and December 2020, 66 newly diagnosed non-small-cell lung cancer (NSCLC) patients with brain parenchymal metastases were prospectively enrolled as a training cohort and 30 additional patients were enrolled as an external validation cohort. CSF samples and matched primary tumor tissues were collected before treatment and subjected to next-generation sequencing (NGS). The imageological characteristics of patients’ brain tumors were evaluated by radiologists using enhanced magnetic resonance imaging images. The clinical and imageological characteristics were evaluated by complete subsets regression, Akaike information criteria, and Bayesian information criteria methods to establish the prediction model. A nomogram was then built for CSF ctDNA detection prediction.

Results

The somatic mutation detection rate of genes covered by our targeted NGS panel was significantly lower in CSF ctDNA (59.09%) than tumor tissue (91.84%). The T_size (diameter of the largest intracranial lesion) and LVD_min (minimum lesion–ventricle distance for all intracranial lesions) were significantly associated with positive CSF ctDNA detection, and thus, were selected to establish the prediction model, which achieved an area under the ROC curve (AUC) of 0.819 and an accuracy of 0.800. The model’s predictive ability was further validated in the independent external cohort (AUC of 0.772, accuracy of 0.767) and by internal cross-validation. The CSF ctDNA detection rate was significantly improved from 58.18% (32/55) to 81.81% (27/33) in patients after model selection (P = 0.022).

Conclusions

This study developed a regression model to predict the probability of detecting CSF ctDNA using the phenotypic characteristics of metastatic brain lesions in NSCLC patients, thus, maximizing the benefits of CSF liquid biopsies.

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Intracranial tumor size and distance to nearest ventricle were significantly correlated with positive CSF ctDNA detection.

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A prediction model incorporating T_size and LVD_min was developed and validated to evaluate the odds of CSF ctDNA positivity.

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The CSF ctDNA detection rate was significantly improved in patients after model selection.

Electrochemical behaviour of uranium at a tripolyphosphate modified ITO electrode

UO₂²⁺ binds to the surface of a tripolyphosphate modified mesoporous indium tin-doped oxide electrode (nanoITO|P₃). Electrochemical studies reveal that nITO|P₃ electrodes catalyze the 2-electron interconversion between UO₂²⁺ and U⁴⁺ with the P₃-ligand assisting in the rate-limiting proton-coupled reduction of U(V) to U(IV), based on the kinetic isotope effect (1.8). Product composition between nITO|P₃(U⁴⁺) and surface adsorbed UO₂ can be controlled by adjusting the proton concentration and/or scan rate in voltammograms. These studies with uranium suggest that nITO|P₃ electrodes are good candidates for redox transformations with other actinides including neptunium, plutonium, and americium.

Characterization and Comparative Analysis of Complete Chloroplast Genomes of Three Species From the Genus Astragalus (Leguminosae)

Astragalus is the largest genus in Leguminosae. Several molecular studies have investigated the potential adulterants of the species within this genus; nonetheless, the evolutionary relationships among these species remain unclear. Herein, we sequenced and annotated the complete chloroplast genomes of three Astragalus species—Astragalus adsurgens, Astragalus mongholicus var. dahuricus, and Astragalus melilotoides using next-generation sequencing technology and plastid genome annotator (PGA) tool. All species belonged to the inverted repeat lacking clade (IRLC) and had similar sequences concerning gene contents and characteristics. Abundant simple sequence repeat (SSR) loci were detected, with single-nucleotide repeats accounting for the highest proportion of SSRs, most of which were A/T homopolymers. Using Astragalus membranaceus var. membranaceus as reference, the divergence was evident in most non-coding regions of the complete chloroplast genomes of these species. Seven genes (atpB, psbD, rpoB, rpoC1, trnV, rrn16, and rrn23) showed high nucleotide variability (Pi), and could be used as DNA barcodes for Astragalus sp. cemA and rpl33 were found undergoing positive selection by the section patterns in the coded protein. Phylogenetic analysis showed that Astragalus is a monophyletic group closely related to the genus Oxytropis within the tribe Galegeae. The newly sequenced chloroplast genomes provide insight into the unresolved evolutionary relationships within Astragalus spp. and are expected to contribute to species identification.

Expression Level and Clinical Significance of Inflammatory Cytokines and Biochemical Markers in Gingival Crevicular Fluid During Different Crown Adhesion Patterns of Dental Implant

Objective

The aim of this study was to investigate the expression level and clinical significance of inflammatory factors and biochemical markers in gingival crevicular fluid during different crown-binding styles in dental implant patients.

Methods

A total of 38 patients with posterior tooth loss and implant repair were recruited and divided into two groups according to the different ways of crown bonding, including 19 prostheses (19 patients) in the adhesive retainer group and 19 prostheses (19 patients) in the modified adhesive retainer group. Moreover, the peri-implant gingival sulcus fluids of each group of patients were collected at 7, 15, 30, 60, and 90 d of post-treatment, and the expression level of each cytokine as well as biochemical marker were analyzed by enzyme-linked adsorption method, respectively.

Results

Compared with the control group, the peri-implant plaque index and gingival bleeding index were decreased in the observation group. In addition, the secretion of peri-implant gingival crevicular fluid in the observation group was significantly higher than that of the control group. The level of IL-6, TNF-α expressions in peri-implant gingival crevicular fluid were gradually decreased with follow-up time, and the rate of decline gets slow at 15 h after operation. The TGFα in peri-implant gingival crevicular fluid in the two groups began to increase at 7 d, reached a peak at about 15 d, then slowly decreased and stabilized after 60 d. While the OCN was gradually increased during the whole detection process, slowly released before 30 d, then increasingly released and maintained at a peak state after 60 d. All the above differences were statistically significant (P < 0.05).

Conclusion

Different crown-binding patterns of implant teeth have a significant effect on the secretion amount of peri-implant gingival crevicular fluid and the expression level of inflammatory cytokines as well as biochemical markers.

Peta-electron volt gamma-ray emission from the Crab Nebula

The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar's rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10^-4 to 1.1 peta-electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta-electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron's size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta-electron volt electrons, 2.5 × 10³⁶ ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta-electron volt protons to the production of the highest-energy gamma rays.

Prevalence of overweight and obesity in children and adolescents with intellectual disabilities in China

BACKGROUND

Overweight and obesity in children and adolescents has become a worldwide epidemic. There are several studies that have concentrated on the prevalence rate of children and adolescents with intellectual disabilities (ID), whereas data on such a population on the mainland of China remain unclear. The purpose of this study was to investigate the prevalence rate of overweight and obesity among school-aged children and adolescents with ID on China's mainland.

METHODS

This study employed a cross-sectional design to examine the body weight status of 1873 children and adolescents (ages 6-18 years old) with ID in 35 special education schools. Body mass index was calculated, and the concepts of overweight and obesity were defined according to the standard of the Working Group for Obesity in China.

RESULTS

Data indicated that 18.2% (95% CI: 16.5%-20.0%) of children and adolescents with ID were overweight and 14.4% (95% CI: 12.8%-16.0%) were obese. Boys with ID were more likely to be overweight than girls with ID (OR = 1.48[95% CI: 1.13-1.94], P < 0.05). Children and adolescents with Down syndrome or autism spectrum disorder had a trend to be classified as overweight (OR = 1.76[95% CI: 1.22-2.54], P < 0.05; OR = 1.57[95% CI: 1.17-2.09], P < 0.05, respectively) or obesity (OR = 1.82[95% CI: 1.23-2.69], P < 0.05; OR = 1.40 [95% CI: 1.02-1.93], P < 0.05, respectively) compared with those with ID without these conditions. Moreover, children and teenagers with ID living in urban areas had a predisposition to be overweight (OR = 2.16[95% CI: 1.14-4.09], P < 0.05) or obese (OR = 3.25[95% CI: 1.41-7.50], P < 0.05) relative to those who lived in rural areas.

CONCLUSION

Results indicated that in China, the prevalence rate of overweight and obesity among school-aged children and adolescents with ID was remarkably high. Therefore, future research should make every effort to focus on reducing and preventing overweight and obesity of this population in China.

Extended Very-High-Energy Gamma-Ray Emission Surrounding PSR J0622+3749 Observed by LHAASO-KM2A

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E>25  TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160  TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.