Gold nanoclusters-based fluorescence resonance energy transfer for rapid and sensitive detection of Pb2

Lead pollution has remained a significant global concern for several decades due to its detrimental effects on the brain, heart, kidneys, lungs, and immune system across all age groups. Addressing the demand for detecting trace amounts of lead in food samples, we have developed a novel biosensor based on fluorescence resonance energy transfer (FRET) from fluorescein R6G to gold nanoclusters (AuNCs-CCY). By utilizing polypeptides as a template, we successfully synthesized AuNCs-CCY with an excitation spectrum that overlaps with the emission spectrum of R6G. Exploiting the fact that Pb2+ induces the aggregation of gold nanoclusters, leading to the separation of R6G from AuNCs-CCY and subsequent fluorescence recovery, we achieved the quantitative detection of Pb2+. Within the concentration range of 0.002-0.20 μM, a linear relationship was observed between the fluorescence enhancement value (F-F0) and Pb2+ concentration, characterized by the linear equation y = 2398.69x + 87.87 (R2 = 0.996). The limit of detection (LOD) for Pb2+ was determined to be 0.00079 μM (3σ/K). The recovery rate ranged from 96 % to 104 %, with a relative standard deviation (RSD) below 10 %. These findings demonstrate the potential application value of our biosensor, which offers a promising approach to address the urgent need for sensitive detection of heavy metal ions, specifically Pb2+, in food samples.

[Interpretation of specification for service of cancer screening for workers]

As the backbone force of China's social and economic construction, the health status of workers is closely related to the nation's productivity and social development. Currently, cancers have become one of the major diseases threatening the health of workers. However, there are still many shortcomings in the cancer screening services for the workers. To standardize cancer screening services for workers, ensure the quality of screening services, and improve the overall screening effectiveness, 19 institutions, including Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences, have jointly formulated the Group Standard "Specification for service of cancer screening for workers (T/CHAA 023-2023)". This standard follows the principles of "legality, scientific rigor, advancement, and feasibility" and combines the frontier scientific advances in cancer screening. It clarifies the relevant requirements for service principles, service design, service delivery, service management, service evaluation, and improving worker cancer screening. Implementing this group standard will help connect the common screening needs of workers, employers, and cancer screening service providers, standardize the screening process, improve screening quality, and ultimately increase the early diagnosis rate and survival rate of cancer patients. Consequently, this group standard will help safeguard workers' health rights and interests, ensure the labor force resources, promote the comprehensive coordinated and sustainable development of society, and contribute to realizing the "Healthy China 2030" strategic policy.

RNA-seq-based comparative transcriptome analysis reveals the role of CsPrx73 in waterlogging-triggered adventitious root formation in cucumber

Abiotic stressors like waterlogging are detrimental to cucumber development and growth. However, comprehension of the highly complex molecular mechanism underlying waterlogging can provide an opportunity to enhance cucumber tolerance under waterlogging stress. We examined the hypocotyl and stage-specific transcriptomes of the waterlogging-tolerant YZ026A and the waterlogging-sensitive YZ106A, which had different adventitious rooting ability under waterlogging. YZ026A performed better under waterlogging stress by altering its antioxidative machinery and demonstrated a greater superoxide ion (O 2-) scavenging ability. KEGG pathway enrichment analysis showed that a high number of differentially expressed genes (DEGs) were enriched in phenylpropanoid biosynthesis. By pairwise comparison and weighted gene co-expression network analysis analysis, 2616 DEGs were obtained which were categorized into 11 gene co-expression modules. Amongst the 11 modules, black was identified as the common module and yielded a novel key regulatory gene, CsPrx73. Transgenic cucumber plants overexpressing CsPrx73 enhance adventitious root (AR) formation under waterlogging conditions and increase reactive oxygen species (ROS) scavenging. Silencing of CsPrx73 expression by virus-induced gene silencing adversely affects AR formation under the waterlogging condition. Our results also indicated that CsERF7-3, a waterlogging-responsive ERF transcription factor, can directly bind to the ATCTA-box motif in the CsPrx73 promoter to initiate its expression. Overexpression of CsERF7-3 enhanced CsPrx73 expression and AR formation. On the contrary, CsERF7-3-silenced plants decreased CsPrx73 expression and rooting ability. In conclusion , our study demonstrates a novel CsERF7-3-CsPrx73 module that allows cucumbers to adapt more efficiently to waterlogging stress by promoting AR production and ROS scavenging.

Terahertz in vivo imaging of human skin: Toward detection of abnormal skin pathologies

Terahertz (THz) imaging has long held promise for skin cancer detection but has been hampered by the lack of practical technological implementation. In this article, we introduce a technique for discriminating several skin pathologies using a coherent THz confocal system based on a THz quantum cascade laser. High resolution in vivo THz images (with diffraction limited to the order of 100 μm) of several different lesion types were acquired and compared against one another using the amplitude and phase values. Our system successfully separated pathologies using a combination of phase and amplitude information and their respective surface textures. The large scan field (50 × 40 mm) of the system allows macroscopic visualization of several skin lesions in a single frame. Utilizing THz imaging for dermatological assessment of skin lesions offers substantial additional diagnostic value for clinicians. THz images contain information complementary to the information contained in the conventional digital images.

Neurosonographic evaluation of corpus callosum-fastigium and tectal length in late-onset small fetuses

Linked article: This Correspondence comments on Lip‐Sosa et al. Click here to view the article.

Hepatitis E virus infection increases the risk of obstetric complications and perinatal adverse outcomes in pregnant women with chronic hepatitis B virus infection

OBJECTIVE

Hepatitis E virus (HEV) infection may occur in pregnant women who had chronic hepatitis B virus (HBV) infection. This study aimed to evaluate whether HEV-HBV co-infection increases the risk of obstetric complications and perinatal adverse outcomes in pregnant women.

PATIENTS AND METHODS

We investigated the clinical data of 3,251 pregnant women with chronic HBV infection. The obstetric complications and perinatal adverse outcomes were compared between patients with HEV-HBV co-infection and patients who had pure chronic HBV infection.

RESULTS

Of the 3,251 pregnant women with chronic HBV infection, 98 patients (3%) had HEV-HBV co-infection. Compared with healthy controls, there is an increased risk of obstetric complications in pregnant women with pure HEV infection [odds ratio (OR)= 3.99, p < 0.001], pure chronic HBV infection (OR = 2.76, p < 0.001), and HEV-HBV co-infection (OR = 5.41,p < 0.001). The rate of obstetric complications and perinatal adverse outcomes is significantly higher in pregnant women with HEV-HBV co-infection compared with those with pure chronic HBV infection or those with pure HEV infection (all p< 0.05). The HEV-HBV co-infection is the most significant risk factor for perinatal adverse outcomes (OR = 15.47, p < 0.001), followed by pure HEV infection (OR = 10.22, p < 0.001), and pure HBV infection (OR = 5.82, p < 0.001).

CONCLUSIONS

HEV infection increases the risk of obstetric complications and perinatal adverse outcomes in pregnant women with chronic HBV infection.

Retrospective analysis of discordant results between histology and other clinical diagnostic tests on helicobacter pylori infection

BACKGROUND

A reliable test is essential for diagnosing Helicobacter pylori (H. pylori) infection, and crucial for managing H. pylori-related diseases. Serving as an excellent method for detecting H. pylori infection, histologic examination is a test that clinicians heavily rely on, especially when complemented with immunohistochemistry (IHC). Additionally, other diagnostic tests for H. pylori, such as the rapid urease test (CLO test) and stool antigen test (SA), are also highly sensitive and specific. Typically, the results of histology and other tests align with each other. However, on rare occasions, discrepancy between histopathology and other H. pylori diagnostic tests occurs.

AIM

To investigate the discordance between histology and other H. pylori tests, the underlying causes, and the impact on clinical management.

METHODS

Pathology reports of gastric biopsies were retrieved spanning August 2013 and July 2018. Reports were included in the study only if there were other H. pylori tests within seven days of the biopsy. These additional tests include CLO test, SA, and H. pylori culture. Concordance between histopathology and other tests was determined based on the consistency of results. In instances where histology results were negative while other tests were positive, the slides were retrieved for re-assessment, and the clinical chart was reviewed.

RESULTS

Of 1396 pathology reports were identified, each accompanied by one additional H. pylori test. The concordance rates in detecting H. pylori infection between biopsy and other tests did not exhibit significant differences based on the number of biopsy fragments. 117 discrepant cases were identified. Only 20 cases (9 with CLO test and 11 with SA) had negative biopsy but positive results in other tests. Four cases initially stained with Warthin-Starry turned out to be positive for H. pylori with subsequent IHC staining. Among the remaining 16 true discrepant cases, 10 patients were on proton pump inhibitors before the biopsy and/or other tests. Most patients underwent treatment, except for two who were untreated, and two patients who were lost to follow-up.

CONCLUSION

There are rare discrepant cases with negative biopsy but positive in SA or CLO test. Various factors may contribute to this inconsistency. Most patients in such cases had undergone treatment.

AI's Role in Improving Social Connection and Oral Health for Older Adults: A Synergistic Approach

KNOWLEDGE TRANSFER STATEMENT

This study explored how artificial intelligence (AI) can revolutionize geriatric care by improving oral health and alleviating social disconnection among isolated older adults. The findings can guide clinicians in integrating AI tools into practices, assist policymakers in developing AI-inclusive health policies, and inform patients about the potential benefits of AI in enhancing their health outcomes and social connection.

Genetic liability between COVID-19 and pre-eclampsia/eclampsia: a Mendelian randomization study

OBJECTIVE

The aim of this study was to investigate the possible causal relationship between COVID-19 and the risk of pre-eclampsia/eclampsia using a Mendelian randomized (MR) design.

METHODS

We estimated their genetic correlations and then performed two-sample Mendelian randomization analyses using pooled statistics from the COVID-19 susceptibility/hospitalization genome-wide association study and the pre-eclampsia/eclampsia datasets. The main analyses were performed using the inverse variance weighting method, supplemented by the weighted median method and the MR-Egger method.

RESULTS

We identified a significant and positive genetic correlation between COVID-19 susceptibility and pre-eclampsia/eclampsia [OR = 1.23 (1.01-1.51), p = 0.043]. Meanwhile, hospitalization of COVID-19 was significantly associated with a higher risk of pre-eclampsia/eclampsia [OR = 1.15 (1.02-1.30), p = 0.024]. Consistently, hospitalization of COVID-19 were nominally associated with higher risk of pre-eclampsia [OR = 1.14, (1.01-1.30), p = 0.040]. The results were robust under all sensitivity analyses.

CONCLUSION

These results suggest that COVID-19 may increase the risk of pre-eclampsia/eclampsia. Future development of preventive or therapeutic interventions should emphasize this to mitigate the complications of COVID-19. [Figure: see text].

A review of recent progress in the application of Raman spectroscopy and SERS detection of microplastics and derivatives

The global environmental concern surrounding microplastic (MP) pollution has raised alarms due to its potential health risks to animals, plants, and humans. Because of the complex structure and composition of microplastics (MPs), the detection methods are limited, resulting in restricted detection accuracy. Surface enhancement of Raman spectroscopy (SERS), a spectral technique, offers several advantages, such as high resolution and low detection limit. It has the potential to be extensively employed for sensitive detection and high-resolution imaging of microplastics. We have summarized the research conducted in recent years on the detection of microplastics using Raman and SERS. Here, we have reviewed qualitative and quantitative analyses of microplastics and their derivatives, as well as the latest progress, challenges, and potential applications.

[Analysis on the current situation and influencing factors of residents' satisfaction with the built environment of China's Hygienic City Initiative]

Objective: To understand the current situation and the main influencing factors of residents' satisfaction with the built environment of China's Hygienic City Initiative. Methods: From the list of China's hygienic cities (excluding county-level cities), 61 cities were randomly selected in equal proportion and the eligible respondents were randomly selected by using the "Questionnaire Star" network platform to carry out the online questionnaire survey. A self-made satisfaction evaluation scale was used to investigate the satisfaction of the included respondents with the urban built environment and search for relevant data on the city level. The two-level multi-factor mixed effect model was constructed to analyze the influencing factors of residents' satisfaction with the built environment of China's Hygienic City Initiative. Results: The age range of 2 465 respondents was mainly between 18 and 40 years old (79.9%), with males being the main group (45.8%). The total score of residents' satisfaction with the built environment of China's hygienic cities was (69.14±13.24) points. Based on four standardized dimensions of sense of gain, the result showed that the satisfaction of urban governance had the highest score (65.08 points), followed by urban environmental sanitation (63.68 points), urban lifestyle (59.97 points) and urban basic function (59.02 points). The analysis results of the two-level multi-factor mixed effect model showed that compared with residents with an annual average concentration of inhalable fine particles in the environment>48 micrograms/cubic meter, residents with an average concentration between 38 and 48 micrograms/cubic meter [β (95%CI): 1.65 (0.08, 3.21)] and≤37 micrograms/cubic meter or less [β (95%CI): 1.98 (0.53, 3.43)] had higher satisfaction. Compared with residents whose proportion of the secondary industry to GDP was≤40.9%, residents in cities with a larger proportion had a lower satisfaction level [residents with a proportion of 40.9%-48.03%, β (95%CI):-2.21 (-3.93, -0.49); residents with a proportion greater than 48.03%, β (95%CI):-2.58 (-4.58, -0.59)]. Compared with residents with a junior high school or lower education level, residents with a higher education level had a lower satisfaction level [β (95%CI):-2.37 (-4.57, -0.17)]. Residents of universities and above [β (95%CI):-3.82 (-6.05, -1.60)], regularly participate in physical exercise [β (95%CI): 5.78 (4.71, 6.84)] and self-rated good health status [β (95%CI): 6.39 (5.33, 7.45)] had a higher satisfaction level. Conclusion: The satisfaction of residents with the built environment of China's hygienic cities is still acceptable. Satisfaction is related to individual characteristics such as residents' cultural level, type of residence, frequent participation in physical exercise, and self-rated good health status, as well as urban-level factors such as green coverage rate in built-up areas, annual average concentration of inhalable fine particles, and the proportion of GDP in the secondary industry.

Objective Boundary Generation for Gross Target Volume and Organs at Risk Using 3D Multi-Modal Medical Images

PURPOSE/OBJECTIVE(S)

Accurate delineation of Gross Target Volume (GTV) and Organs at Risk (OARs) in medical images is an essential but challenging step in radiotherapy. Deep-learning based automated delineation methods, which learn from manual annotations, are currently prevalent in academic research. However, the limited resolution of medical images and the fuzzy boundaries of lesions and organs present a challenge to the precision of manual annotations. By leveraging the complementary information from multi-modal medical images, this study proposed a novel method to generate objective boundaries of GTV and OARs.

MATERIALS/METHODS

We present a novel method of objective boundary generation, inspired by image matting primarily used for 2D RGB natural images, to process 3D grayscale medical images. The proposed method has the following advantages. 1) It allows for flexible input modalities and assigns weights to each modality according to their relative significance when computing information flows in the matting algorithm. 2) It computes 3D spatial information flow among voxels, which has more advantages over its 2D counterpart. 3) It has a closed-form solution that generates deterministic results. To evaluate the characteristics of the generated boundaries, patients with stage I nasopharyngeal carcinoma (NPC) were studied, with CT images and multi-modal MR images (T1, T1C, T2) aligned using deformable registration. Region of Interests (ROIs), i.e., GTV and parotid gland, were used, with a rough trimap marking extremely few foreground voxels, many background voxels, and a large unknown region. The proposed algorithm leverages the connection between each voxel and its nearest neighbors in the feature space, to propagate the opacity information.

RESULTS

We evaluated the results by employing both qualitative and quantitative methods. Using qualitative evaluation, experienced clinicians confirmed that the results were in agreement with the input data, especially for areas where borders were visible in most modalities (e.g., between air and tumor). For more challenging regions, where boundaries were unclear in the images, the results displayed fine-grained opacity transitions indicating the confidence of each voxel belonging to the ROI. When compared to the delineations made by clinicians, we found our results are usually more compact. We define a precision metric that evaluates the ratio of the matted foreground inside clinicians' delineations versus the entire matted foreground. Using a threshold of 0.4, our binarized result scored 0.95 for GTV and 0.92 for parotid gland.

CONCLUSION

The proposed method demonstrated satisfactory results on challenging ROIs. The objective boundaries generated by this method have advantages in many aspects, including improvement of delineation protocols, enhancement of manual annotation consistency, and increase of deep-learning based automated delineation accuracy.

Potential Dosimetric Predictors of Patient-Reported Quality of Life for Head and Neck Cancer Following Chemoradiation IMRT

PURPOSE/OBJECTIVE(S)

This study aims to identify both acute and late patient patient-reported salivary quality of life outcomes in patients with head and neck cancer treated with chemoradiation therapy on a prospective trial.

MATERIALS/METHODS

A cohort of 40 patients with head and neck cancers were included in the study. All patients underwent concurrent chemoradiation therapy using IMRT delivery (1 patient on one Linac, 24 patients on a different Linac, and 15 on a helical delivery machine). All patients were asked to complete the University of Washington Quality of Life (UOW-QOL) questionnaire at baseline, immediately after treatment, as well as at 1 month, 3 months, 6 months, 12 month and 18 months post-treatment. For the salivary quality of life (QOL) outcome scores, the possible responses were scored on a discreet scale of 100, 70, 30, and 0, with 100 as normal and 0 as dysfunctional. Dosimetric endpoints achieved based on the treatment plan, such as maximum/mean/minimum doses, V30 (percent volume receiving 30 Gy dose), and Dy (dose received to y percent volume) were collected for the bilateral salivary glands, bilateral temporomandibular joint and bilateral submandibular glands. The associations between these dosimetric parameters and the corresponding salivary QOL scores at each time point were analyzed. A Wilcoxon test was performed to identify any differences in the dosimetry and salivary QOL scores among the four different responses.

RESULTS

At short-term follow-up including 1- and 6-month, the distribution of the mean dose received by the right parotid was significantly different between the patients that reported a salivary QOL score of 30 and those that reported 100, with p-values of 0.007 for the 1-month comparison and 0.006 for the 6-month comparison. This was also seen for the V30, with p-values of 0.027 for the 1-month comparison and 0.013 for the 6-month comparison. At 3 months, the maximum dose received by the left temporomandibular joint was significantly different between the patients that reported 30 and those that reported 70, with a p-value of 0.038. At 6 months, the average dose distribution of the right submandibular gland received between the patients that reported a score of 30 and 100 was also significantly different, with a p-value of 0.006. At the long-term follow-up time points of 12 and 18 months, no significant differences were found.

CONCLUSION

The significant differences seen in the data suggest that the dosimetry may have effects on patient reported salivary QOL at short-term follow-up but not long-term. This provides a new perspective into how a patient's QOL over a period of time could be affected by the amount of dose to critical organs. These results also serve as the basis for further investigation into the actual delivered dose, which could differ from the planned dose due to daily anatomic changes over the course of head and neck radiotherapy delivery. These daily volumetric and dosimetric changes may guide early adaptive treatment to improve patient-reported QOL outcomes.

A Generalized Deep Learning Method for Synthetic CT Generation

PURPOSE/OBJECTIVE(S)

The application of deep learning to generate synthetic CT (sCT) has been widely studied in radiotherapy. Existing methods generally involve data from two different image modalities, such as CBCT-CT or MRI-CT, the quality of sCT is adversely affected by source image quality. We propose a unique method of synthesizing MRI and CBCT into sCT based on single-modal CT for training, and call it SmGAN.

MATERIALS/METHODS

We used planning CT of a group of 35 head and neck cases to as training data. We then applied two different spatial transformations to the planning CT image to produce the transformed CT1 and CT2. And We used a random style enhancement technique (Shuffle Remap) to modify the image distribution of CT1 which we termed CT1+E. CT1+E was used to simulate the patient's "image of the day" while CT2 to simulate the "planning image". After feeding both CT1+E and CT2 into the generator, we obtained the sCT predicted by the generator. The generator was trained using the Mean Absolute Error (MAE) loss between sCT and CT1. In the actual clinical process, we use the patient's CBCT or MRI instead of CT1+E and the patient's planning CT instead of CT2 as the input of the generator. After processing, we get an sCT that can maintain the spatial position of the image taken on the day, while presenting features similar to the planning CT. The evaluation data we have includes 10 pairs of MRI-Def_CT and 10 pairs of CBCT-Def_CT Head and Neck patients. Def_CT is obtained from the planning CT based on the spatial position deformation of MRI and CBCT. To evaluate the accuracy of sCT based on MRI and CBCT with Def CT, we use a range of metrics, including Hounsfield Unit (HU) difference, peak signal-to-noise ratio (PSNR), structural similarity (SSIM) and gamma pass rate. All results will be benchmarks against the advanced method RegGAN for comparison.

RESULTS

Compared to RegGAN, the results of SmGAN were significantly better. The mean absolute errors within the body were (44.7±216.2 HU vs. 36.7±131.4 HU) and (64.9±123.7 HU vs. 58.2±152.8 HU) for the CBCT-SCT and MRI-SCT, respectively (Table 1). In addition, experimental results show that SmGAN also outperforms RegGAN in dose calculation accuracy. For example, under the 10% threshold, SmGAN's gamma pass rate of 1mm and 1% is 0.926±0.02, compared with gamma rate of 0.896±0.02 for RegGAN.

CONCLUSION

We proposed a generalized deep learning model for synthetic CT generation, based on CBCT or MRI images. The proposed algorithm achieved high accuracy of dosimetric metrics, as well as excellent IMRT QA verification results. Compared to other existing synthetic CT generation methods, the proposed SmGAN required a single-modal image for training, which is considered as a major breakthrough in the industry, and is expected to have wide spread of clinical applications.

An Adaptive Multi-Feature Fusion Network for Predicting Overall Survival of Patients with Head and Neck Cancer

PURPOSE/OBJECTIVE(S)

Accurate prognostic prediction could allow personalized treatment to achieve optimal clinical outcome. We aimed to develop a highly predictive overall survival model, considering the complementary relationships between clinical information, traditional radiomics and deep image information, to further improve the overall prediction accuracy by constructing a richer feature set and adaptive weighting.

MATERIALS/METHODS

A total of 427 patients with Oropharyngeal Cancer (OPC) patients from the TCIA database were included. 341 cases were used for training, 86 cases were used as an independent cohort. Patient characteristics, including TMN, age, gender, HPV status, smoking or drinking status, etc. were considered as potential predictors. Traditional radiomics features of gross tumor volume (GTV) was extracted from planning CT using open-source software. In addition, a two-dimensional convolutional network (2D_CNN) was designed to extract deep image features. An adaptive multi-feature fusion network was developed to predict overall survival of patients based on three types of features. The fusion network integrates an attention mechanism to the channel dimension to obtain proper weighting of each channel in the feature graph through the fully connected network by focusing on effective feature channels and automatic learning according to the loss, thus improving the utilization rate of effective features. The model performance was evaluated using the area-under-ROC-curve (AUC), accuracy, precision, recall, f1-score.

RESULTS

The AUCs of predictive models based on clinical features, traditional radiomics features and deep image features were 0.7, 0.61 and 0.72, respectively. Combining patient characteristics, radiomic features and deep imaging features, the AUCs of the prediction models was significantly improved to 0.85 and 0.86 (with attention mechanisms) for the independent test cohort (Table 1).

CONCLUSION

The proposed adaptive multi-channel network assigned effective weights to the potential predictors, selectively enhanced useful features while suppressed irrelevant features, enabling more accurate feature map weights. We demonstrated the improved predictive value, with a multi-channel fusion network integrated with an attention mechanism, for overall survival of OPC patients.

Quality and Safety Considerations in Image Guided Radiation Therapy: An ASTRO Safety White Paper Update

PURPOSE/OBJECTIVE(S)

This updated report on image guided radiation therapy (IGRT) is based on a consensus-based white paper previously published by the American Society for Radiation Oncology (ASTRO) addressing patient safety. In the past decade, IGRT technology and procedures have progressed significantly and are now more commonly used. The use of IGRT has now extended beyond high-precision treatments, such as stereotactic radiosurgery and stereotactic body radiation therapy, and into routine clinical practice for many treatment techniques and anatomic sites. Therefore, quality and treatment planning and delivery considerations for these techniques are paramount for patient safety.

MATERIALS/METHODS

In 2021, ASTRO convened an interdisciplinary task force to assess the original IGRT white paper and update content where appropriate. Recommendations were created using a consensus-building methodology, and task force members indicated their level of agreement based on a 5-point Likert scale from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters who selected "strongly agree" or "agree" indicated consensus.

RESULTS

The IGRT white paper was published (Pract Radiat Oncol. 2022 Dec) and endorsed by the American Association of Physicists in Medicine (AAPM), American Association of Medical Dosimetrists, and American Society of Radiologic Technologists. Since the first IGRT paper was published by ASTRO in 2013, significant technological advancement has taken place. New and updated considerations in personnel requirements, staffing, education and training, equipment and technological requirements, quality management and assurance, IGRT program management, and safety considerations were reported. A 17-point consensus was reached and recommended in 5 areas surrounding program development, quality assurance, quality management, treatment delivery, and vendor engagement (Table 5, Summary of key recommendations).

CONCLUSION

This IGRT white paper builds on the previous version and uses other guidance documents to primarily focus on processes related to quality and safety. IGRT requires an interdisciplinary team-based approach, staffed by appropriately trained specialists, as well as significant personnel resources, specialized technology, and implementation time. A thorough feasibility analysis of resources is required and should be discussed with all personnel before undertaking new imaging techniques. A comprehensive quality-assurance program must be developed to ensure IGRT is performed safely and effectively. As IGRT technologies continue to improve or emerge, existing practice guidelines should be updated regularly according to the latest AAPM Task Group reports. Patient safety in the application of IGRT is everyone's responsibility, and professional organizations, regulators, vendors, and end-users must demonstrate strong commitments to ensure that the highest levels of safety are achieved.

Early Prediction of Radiation Treatment Response via Longitudinal Analysis of CBCT Radiomic Features for Locally Advanced Rectal Cancer

PURPOSE/OBJECTIVE(S)

Patients respond to the same radiation treatment course differently due to inter- and intra- patient variability in radiosensitivity. Despite widespread use of AI/ML in radiation oncology, there is a lack of monitoring strategies used during treatment courses to evaluate early predictors of treatment response in a systematic fashion. This work advances a straightforward, yet effective, method for the early detection of treatment response through systematically analyzing daily CBCT radiomic features. The goal is to aid clinicians in assessing the treatment efficacy routinely with a view towards optimizing personalized treatment.

MATERIALS/METHODS

We included a cohort of 30 patients diagnosed with locally advanced rectal cancer who underwent neo-adjuvant fractionated radiation treatment (RT) with a prescription dose of 50.4 Gy (28 fractions), followed by total mesorectal excision surgery after completion of ChemoRT. Daily IGRT imaging was acquired prior to each fraction resulting in a total of 840 CBCTs. Patients were divided into responder (14 patients) and non-responder (16 patients) groups based on post-RT pathological response. Mutual information algorithms were utilized to rigorously register daily CBCT images to the planning CT, and longitudinal radiomic features of the target were extracted from the daily CBCTs during the entire treatment course. All longitudinal features for a given patient were standardized with Z-Score normalization, followed by linear fitting using the least square method, resulting in radiomic feature trends (RFT) represented by slope values. Statistical significance was established via a two-sample U test and P-value with a threshold of 0.05. Logistic regression was performed to eliminate RFT with accuracy rates lower than 0.5. The final trending model was developed using random forest. For each patient at fraction N, our investigation involved independent 27 group experiments, where each experiment considered image group from fraction #1 to N, to confirm the effectiveness and stability of the model.

RESULTS

The proposed RFT demonstrated a high level of precision and consistency for post-RT response based on longitudinal CBCT images for LARC patients. The trending model yielded an accuracy of 0.9556, 95% CI (0.94, 0.972) when each daily image was considered, the prediction consistency was 0.964. Given the first 14 experiments (considering group images of fraction #1-15), the prediction accuracy was 0.9357, 95% CI (0.915, 0.956) and the prediction consistency was 0.952.

CONCLUSION

A strategy for monitoring and early prediction of LARC patients' radioresponse was evaluated via longitudinal CBCT assessment. Our trending models demonstrate a significant difference between the responder vs non-responder groups as early as the 15th fraction. Our strategy achieved superior accuracy and consistency to predict post-RT response of LARC patients.

Ceruloplasmin regulating fibrosis in orbital fibroblasts provides a novel therapeutic target for Graves' orbitopathy

PURPOSE

In diagnosing the pathogenesis of Graves' orbitopathy (GO), there is a growing interest in fibrosis generated by orbital fibroblasts (OFs); nevertheless, the involvement of ceruloplasmin (CP) in OFs remains unknown.

METHODS

Differentially expressed genes (DEGs) were identified through bioinformatic analysis. OFs were isolated from orbital tissue and identified with immunofluorescent staining. The levels of DEGs were validated in GO tissue samples and TGF-β-challenged OFs, and CP was selected for the following laboratory investigations. CP overexpression or knockdown was achieved, and cell viability and fibrosis-associated proteins were investigated to assess the cell phenotype and function. Signaling pathways were subsequently investigated to explore the mechanism of CP function in OFs.

RESULTS

CP and cathepsin C (CTSC) are two overlapped DEGs in GSE58331 and GSE105149. OFs were isolated and identified through fibrotic biomarkers. CP and CTSC were downregulated in GO tissue samples and TGF-β-challenged OFs. CP overexpression or knockdown was achieved in OFs by transducing a CP overexpression vector or small interfering RNA against CP (si1-CP or si2-CP) and verified using a qRT-PCR. CP overexpression inhibited cell viability and reduced the levels of α-SMA, vimentin, fibronectin, and collagen I, whereas CP knockdown exerted opposite effects on OFs. CP overexpression inhibited the phosphorylation of Smad3, Erk1/2, p38, JNK, and AKT; conversely, CP knockdown exerted opposite effects on the phosphorylation of factors mentioned above.

CONCLUSION

CP was downregulated in GO and suppressed the expression of fibrosis-associated proteins in both GO and normal OFs. CP might serve as a promising therapeutic agent in the treatment regimens for GO.

A Novel Multi-Objective Based Feature Selection Method for Response Prediction

PURPOSE/OBJECTIVE(S)

Accurate response prediction is essential towards personalized treatment in radiation therapy. Excessive imaging features, extracted from medical images, pose a great challenge in radiomic analyses. Feature selection is an essential step to remove redundant and irrelevant features for model construction.

MATERIALS/METHODS

We proposed a novel multi-objective based radiomic feature selection method (MRMOPSO), where the number of features, sensitivity, and specificity are jointly considered as optimization objectives for feature selection. The MRMOPSO innovated by three aspects: 1) Fisher score initialize the feature population to speed up the convergence; 2) Min-redundancy particle generation operations to reduce the redundancy between radiomic features, a truncation strategy was also introduced; 3) Particle selection operation guided by elitism strategies to improve local search ability of the algorithm. We evaluated the effectiveness of the proposed MRMOPSO method using a cohort of oropharyngeal cancer patients from The Cancer Imaging Archive (TCIA). 357 patients were used for model training and additional 64 patients were used for independent evaluation. The proposed methods were compared with (a) classical feature selection methods, i.e., Lasso, minimal-redundancy-maximal-relevance criterion (mRMR), F-score, and mutual information (MI), (b) single-objective feature selection methods, i.e., genetic algorithm (GA), particle swarm optimization algorithm (PSO) and (c) multi-objective feature selection methods, i.e., multiple objective particle swarm optimization (MOPSO), nondominated sorting genetic algorithm II (NSGA II).

RESULTS

The other feature selection methods yielded AUCs, sensitivity, specificity of (0.48-0.71), (0.49-0.86), (0.33-0.67), respectively. The MRMOPSO achieved significantly highly AUC of 0.84 with smaller number of selected features on the independent dataset (Table 1). Additionally, the MRMOPSO remarkably improved the sensitivity (0.81), specificity (0.81) and achieved an excellent balance between sensitively and specificity.

CONCLUSION

We demonstrated a novel multi-objective based radiomic feature selection method. The proposed algorithm effectively reduced feature dimension, and achieved superior AUC with simultaneous improved sensitivity and specificity, for radiomic response prediction.

Impact of Prophylactic Pelvic Lymph Node Irradiation in De-Novo Oligometastatic Prostate Cancer

PURPOSE/OBJECTIVE(S)

To evaluate the impact of prophylactic pelvic nodal irradiation in de-novo oligometastatic prostate cancer treated with radiotherapy (RT) for both primary tumor and all metastatic lesions.

MATERIALS/METHODS

This was a single-center prospective cohort study. De novo oligometastatic prostate cancer patients with RT for both primary tumor and all metastatic lesions were included. Kaplan-Meier method, log rank test and cox regression were used to calculate OS and PFS. PFS included PSA failure, local or distant failure assessed by imaging.

RESULTS

This study analyzed 202 patients from 10/2011 to 1/2022 with median follow-up of 48 months. A total of 126 (62.4%) patients were treated with pelvic lymph node RT. The dose was 47.5 Gy with 1.9 Gy per fraction. Among them, 66 (32.7%) patients were treated with whole pelvic RT (WPRT), which the upper limit was at the aortic bifurcation. 60 (29.7%) patients were treated with mini-WPRT, which the upper limit was at the lower margin of obturator foramen. The incidence of diarrhea (P = 0.038) and leukocyte reduction (P = 0.040) in the WPRT subgroup during radiotherapy was significantly higher than that in the mini-WPRT and non-pelvic RT subgroup. For the whole cohort, the median OS and PFS were not reached. The subgroup analysis showed that the elective pelvic nodal irradiation could improve PFS (P = 0.042). However, there was no difference of PFS between standard WPRT and mini-WPRT.

CONCLUSION

The study suggests that for de-novo oligometastatic prostate cancer, elective pelvic nodal irradiation may improve PFS. For patients who cannot tolerate WPRT, mini-WPRT may be an alternative option. However, it needs to be verified in the prospective RCT study.

Unsupervised Domain Adaptation of Auto-Segmentation on Multi-Source MRIs

PURPOSE/OBJECTIVE(S)

Deep learning has achieved great success in medical image segmentation. Most existing deep learning (DL) approaches make no adjustments to the model prior to inference. These models can perform well on the data of the same distribution, but their performance usually degrades when applied to the images from different source, i.e., different scanners. To tackle the problem caused by domain shift, we proposed an unsupervised domain adaptation (UDA) method based on entropy minimization and physical consistency constraints.

MATERIALS/METHODS

The proposed method combines feature-level and instance-level domain adaptation techniques to transfer knowledge from the source to the target domain. Specifically, the feature-level adaptation technique uses a graph-based entropy minimization to reduce the discrepancy between the source and target domains. The instance-level adaptation technique employs a novel consistency loss to regularize the physical consistency of the same object, such as volume, length, and centroid, thus improving the segmentation accuracy of the target domain. A collection of 93 abdominal MR images, comprising 45 cases from a 0.35T MRI scanner (TRUFI) and 48 cases from a 1.5T MRI scanner (T2), was utilized to evaluate the effectiveness of the proposed method. The contours of 6 organs-at-risk were delineated by a senior radiation oncologist, serving as the ground truth. Three models, the source model (SRC) trained on the source domain, the target model (TGT) trained on the target domain, and the UDA model adapted from the source domain to the target domain, were compared on the target domain using the Dice Similarity Coefficient (DSC).

RESULTS

In the experiment of 0.35T-to-1.5T, the proposed UDA method outperformed the source model, achieving an average DSC score of 0.82 ± 0.11, compared to 0.58 ± 0.23 (SRC) and 0.85 ± 0.09 (TGT), respectively. In the inverse experiment 1.5T-to-0.35T, the UDA model achieved an average DSC score of 0.79±0.13, compared to DSCs of 0.52 ± 0.25 and 0.81 ± 0.11 for the SRC and TGT respectively. The UDA method yielded a significant improvement of 46%, compared to the SRC. Particularly, OARs (organ at risk) with higher deformability such as the stomach and duodenum achieved a 58% and 63% improvement in performance, respectively.

CONCLUSION

This work presents a compelling approach of UDA for auto-segmentation on multi-source MRIs. Experimental results demonstrate that the UDA effectively improve the segmentation performance of the source model in the target domain, resulting in a more robust segmentation model.

Feature Selection Based on Unsupervised Clustering Mechanism on Multiple-Sequence MRIs for Predicting Neoadjuvant Chemoradiation Response in Locally Advanced Rectal Cancer

PURPOSE/OBJECTIVE(S)

Accurate response prediction allows for personalized cancer management. We developed an unsupervised clustering mechanism to improve effectiveness and efficiency in feature selection operation for accurate patient stratification.

MATERIALS/METHODS

Forty-three locally advanced rectal cancer (LARC) patients underwent neoadjuvant chemoradiation were included, pre-treatment T2 and ADC MRIs were acquired for each patient. An initial feature space consisting of 200 radiomic features extracted from manually delineated GTVs from two sequences of MR images. Additional 960 high-order radiomic features extracted from a 3D convolutional neural network (CNN). To remove redundant and irrelevant features, we developed an unsupervised clustering-based feature selection operation to determine the combination of features with potential best performance. The normal process of feature selection involves searching new feature combinations and training new classifiers for evaluating their performance via an iterative process based on selected feature set, the overall time cost is tremendous. To balance the computational cost and search efficiency, firstly, we proposed an unsupervised clustering analysis metric- Comprehensive Cluster Analysis Index (CCAI) through the K-means algorithm, where the average distances between the sample points and the cluster centroids and so on, to construct a multiple linear regression model. Secondly, we extracted sample points by varying the number of features and feature ratios between radiomic features and 3D-CNN features in the output of feature selection. Thirdly, we optimized the model using the sampling points to calculate the CCAI. Two typical feature combination search algorithms, the random forest recursive feature elimination (RF-RFE) and the differential evolution (DE), were used to perform feature selection with CCAI.

RESULTS

The accuracy, area-under-curve (AUC) and specificity, based on combined 3D-CNN and radiomic features extracted from combined T2 and ADC images, were 0.852, 0.871, and 0.735, respectively. Our experiments illustrated higher predictive power (AUC = 0.846) based on high-order abstract features extracted from the CNN on ADC and T2 images, compared to the traditional radiomic model (AUC = 0.714). Additionally, the predictive models constructed based on radiomics and CNN features extracted from ADC images were more predictable in terms of treatment responses than the radiomic and CNN imaging features extracted from T2 images. The average computational time of DE and RF-RFE were 50.5s and 128.6s in one single computation, the average computational time were 24.2s and 91.3s with CCAI, respectively.

CONCLUSION

We proposed an unsupervised clustering analysis mechanism to improve the effectiveness of feature selection while decreasing its time cost markedly, which highlight the correlation and complementarity between low- and high-level imaging features, achieving better predictive accuracy.

Corrigendum: Analysis of a super-transmission of SARS-CoV-2 omicron variant BA.5.2 in the outdoor night market

[This corrects the article DOI: 10.3389/fpubh.2023.1153303.].

Cucumber abscisic acid 8'-hydroxylase Csyf2 regulates yellow flesh by modulating carotenoid biosynthesis

Cucumber (Cucumis sativus L.) flesh is typically colorless or pale green. Flesh with yellow or orange pigment, determined mainly by carotenoid content and composition, is mostly found in semi-wild Xishuangbanna cucumber, which has a very narrow genetic background. Here, we identified a spontaneous cucumber mutant with yellow flesh (yf-343), which accumulated more β-cryptoxanthin and less lutein than regular cultivated European glasshouse-type cucumbers. Genetic analysis revealed that the yellow flesh phenotype was controlled by a single recessive gene. Through fine mapping and gene sequencing, we identified the candidate gene C. sativus yellow flesh 2 (Csyf2), encoding an abscisic acid (ABA) 8'-hydroxylase. Overexpression and RNAi-silencing of Csyf2 in cucumber hairy roots produced lower and higher ABA contents than in non-transgenic controls, respectively. Further, RNA-seq analysis suggested that genes related to ABA signal transduction were differentially expressed in fruit flesh between yf-343 and its wild type, BY, with white flesh. The carotenoid biosynthesis pathway was specifically enriched in fruit flesh at 30 days after pollination when yf-343 fruit flesh turns yellow. Our findings highlight a promising target for gene editing to increase carotenoid content, expanding our genetic resources for pigmented cucumber flesh breeding for improving the nutritional quality of cucumber.

A review on surfactin: molecular regulation of biosynthesis

Surfactin has many biological activities, such as inhibiting plant diseases, resisting bacteria, fungi, viruses, tumors, mycoplasma, anti-adhesion, etc. It has great application potential in agricultural biological control, clinical medical treatment, environmental treatment and other fields. However, the low yield has been the bottleneck of its popularization and application. It is very important to understand the synthesis route and control strategy of surfactin to improve its yield and purity. In this paper, based on the biosynthetic pathway and regulatory factors of surfactin, its biosynthesis regulation strategy was comprehensively summarized, involving enhancement of endogenous and exogenous precursor supply, modification of the synthesis pathway of lipid chain and peptide chain, improvement of secretion and efflux, and manipulation some global regulatory factors, such as Spo0A, AbrB, ComQXP, phrCSF, etc. to directly or indirectly stimulate surfactin synthesis. And the current production and separation and purification process of surfactin are briefly described. This review also provides a scientific reference for promoting surfactin production and its applications in various fields.

Analysis of a super-transmission of SARS-CoV-2 omicron variant BA.5.2 in the outdoor night market

Introduction

The COVID-19 pandemic continues to ravage the world, and mutations of the SARS-CoV-2 continues. The new strain has become more transmissible. The role of aerosol transmission in the pandemic deserves great attention.

Methods

In this observational study, we collected data from market customers and stallholders who had been exposed to the virus in the Qingkou night market on July 31 and were subsequently infected. We analyzed the possible infection zones of secondary cases and aerosol suspension time in ambient air. We described and analyzed the characteristics of the secondary cases and the transmission routes for customers.

Results

The point source outbreak of COVID-19 in Qingkou night market contained a cluster of 131 secondary cases. In a less-enclosed place like the Qingkou night market, aerosols with BA.5.2 strain released by patients could suspend in ambient air up to 1 h 39 min and still be contagious.

Conclusion

Aerosols with viruses can spread over a relatively long distance and stay in ambient air for a long time in a less enclosed space, but shorter than that under experimental conditions. Therefore, the aerosol suspension time must be considered when identifying and tracing close contact in outbreak investigations.

Metabolomics and Transcription Profiling of Pumpkin Fruit Reveals Enhanced Bioactive Flavonoids and Coumarins in Giant Pumpkin (Cucurbita maxima)

Atlantic giant (AG, Cucurbita maxima) is a type of giant pumpkin in the Cucurbitaceae family and has the world's largest fruit. AG possesses excellent ornamental and economic value due to its well-known large fruit. However, giant pumpkins are usually thrown away after viewing, thus generating a waste of resources. To explore the additional value of giant pumpkins, a metabolome assay was performed between AG and Hubbard (a small fruit pumpkin) fruits. We found that bioactive compounds, especially flavonoids (including 8-prenylnaringenin, tetrahydrocurcumin, galangin, and acacetin) and coumarins (including coumarin, umbelliferone, 4-coumaryl alcohol, and coumaryl acetate), with extensive antioxidant and pharmacological functions, showed higher accumulation in AG fruit than in Hubbard fruits. Comparative transcriptomics of the two pumpkin fruits indicated that the differentially expressed genes (DEGs) encoding PAL, C4H, 4CL, CSE, HCT, CAD, and CCoAOMT were relatively highly expressed, which promoted an increased accumulation of the identified flavonoids and coumarins in giant pumpkins. In addition, the construction of a co-expression network and cis-element analysis of the promoter demonstrated that differentially expressed MYB, bHLH, AP2, and WRKY transcription factors might play vital roles in regulating the expression of DEGs involved in the biosynthesis of several flavonoids and coumarins. Our current results provide new insights into the accumulation of active compounds in giant pumpkins.

Recurrent Primary Peritoneal Psammocarcinoma: A Case Report on a Diagnostic Challenge in Cytology

Psammocarcinoma (PCa) is a rare variant of low-grade papillary serous carcinoma that can arise from the peritoneal as well as ovarian surfaces. When this tumor involves the extra-ovarian peritoneum significantly and the ovarian surface minimally or not at all, it is considered of peritoneal origin. PCa has a recurrent indolent clinical course. It is challenging to diagnose peritoneal PCa, particularly on cytological smears because of the bland cellular features of neoplastic cells. We report a case of recurrent metastatic primary peritoneal PCa in a 71-year-old female of Ashkenazi Jewish ancestry diagnosed on cytology of ascitic and cystic fluid.

[Analysis of the characteristics of viral infections in children with diarrhea in Beijing from 2018 to 2022]

Objective: To explore the characteristics of viral infections in children with diarrhea in Beijing from 2018 to 2022. Methods: Real-time PCR and enzyme-linked immunosorbent assay were used to detect viral nucleic acid of Norovirus (NoV), Sappovirus (SaV), Astrovirus (AstV), Enteric Adenovirus (AdV) or antigen of Rotavirus (RV) in 748 stool samples collected from Beijing Capital Institute of Pediatrics from January 2018 to December 2021. Subsequently, the reverse transcription PCR or PCR method was used to amplify the target gene of the positive samples after the initial screening, followed by sequencing, genotyping and evolution analysis, so as to obtain the characteristics of these viruses. Phylogenetic analysis was performed using Mega 6.0. Results: From 2018 to 2021, the overall detection rate of the above five common viruses was 37.6%(281/748)in children under 5 years old in Beijing. NoV, Enteric AdV and RV were still the top three diarrhea-related viruses, followed by AstV and SaV, accounting for 41.6%, 29.2%, 27.8%, 8.9% and 7.5%, respectively. The detection rate of co-infections with two or three diarrhea-related viruses was 4.7% (35/748). From the perspective of annual distribution, the detection rate of Enteric AdV was the highest in 2021, while NoV was predominant in the other 4 years. From the perspective of genetic characteristics, NoV was predominant by GII.4, and after the first detection of GII.4[P16] in 2020, it occupied the first two gene groups together with GII.4[P31]. Although the predominant RV was G9P[8], the rare epidemic strain G8P[8] was first detected in 2021. The predominant genotypes of Enteric AdV and AstV were Ad41 and HAstV-1. SaV was sporadic spread with a low detection rate. Conclusion: Among the diarrhea-related viruses infected children under 5 years of age in Beijing, the predominant strains of NoV and RV have changed and new sub-genotypes have been detected for the first time, while the predominant strains of AstV and Enteric AdV are relatively stable.

Synthesis of nanoparticles via microfluidic devices and integrated applications

In recent years, nanomaterials have attracted the research intervention of experts in the fields of catalysis, energy, biomedical testing, and biomedicine with their unrivaled optical, chemical, and biological properties. From basic metal and oxide nanoparticles to complex quantum dots and MOFs, the stable preparation of various nanomaterials has always been a struggle for researchers. Microfluidics, as a paradigm of microscale control, is a remarkable platform for online stable synthesis of nanomaterials with efficient mass and heat transfer in microreactors, flexible blending of reactants, and precise control of reaction conditions. We describe the process of microfluidic preparation of nanoparticles in the last 5 years in terms of microfluidic techniques and the methods of microfluidic manipulation of fluids. Then, the ability of microfluidics to prepare different nanomaterials, such as metals, oxides, quantum dots, and biopolymer nanoparticles, is presented. The effective synthesis of some nanomaterials with complex structures and the cases of nanomaterials prepared by microfluidics under extreme conditions (high temperature and pressure), the compatibility of microfluidics as a superior platform for the preparation of nanoparticles is demonstrated. Microfluidics has a potent integration capability to combine nanoparticle synthesis with real-time monitoring and online detection, which significantly improves the quality and production efficiency of nanoparticles, and also provides a high-quality ultra-clean platform for some bioassays.

Changes in the Texture and Flavor of Lotus Root after Different Cooking Methods

The changes in the texture and flavor of lotus root were determined before and after boiling, steaming and frying. Compared to fresh lotus root, all three kinds of cooking decreased the hardness and springiness, and frying significantly enhanced the gumminess, chewiness and cohesiveness. The flavor components, such as flavor amino acids, nucleotides and their taste character in lotus roots, were determined by liquid chromatography and electronic tongue. The amino acids and nucleotide contents of fresh lotus root were 20.9 and 0.07 μg/kg, respectively. The content of flavor substances in lotus roots decreased obviously, and the texture characteristics decreased after boiling and steaming. After deep-frying for 2 min, the free amino acids and nucleotide contents of lotus root were 32.09 and 0.85 μg/kg, respectively, which were the highest in all cooking methods. The contents of volatile flavor components and their smell character in lotus roots were determined by GC-MS and electronic nose. There were 58 kinds of flavor compounds identified in fresh lotus root, mainly alcohols, esters and olefins. The total amount of volatile flavor compounds decreased, and new compounds, such as benzene derivatives, were produced in lotus roots after boiling and steaming. After deep-frying, the content of volatile flavor compounds in lotus root increased significantly, especially the aldehyde volatile flavor compounds. The production of pyran, pyrazine and pyridine volatile flavor compounds made the lotus root flavor unique and delicious. The taste and smell character of lotus roots before and after cooking were effectively separated by an electronic tongue, nose and PCA analysis; the results suggested the boiled lotus root exhibited the most natural and characteristic taste and smell among the four groups.

Diabetes, Edentulism, and Cognitive Decline: A 12-Year Prospective Analysis

Diabetes mellitus (DM) is a recognized risk factor for dementia, and increasing evidence shows that tooth loss is associated with cognitive impairment and dementia. However, the effect of the co-occurrence of DM and edentulism on cognitive decline is understudied. This 12-y cohort study aimed to assess the effect of the co-occurrence of DM and edentulism on cognitive decline and examine whether the effect differs by age group. Data were drawn from the 2006 to 2018 Health and Retirement Study. The study sample included 5,440 older adults aged 65 to 74 y, 3,300 aged 75 to 84 y, and 1,208 aged 85 y or older. Linear mixed-effect regression was employed to model the rates of cognitive decline stratified by age cohorts. Compared with their counterparts with neither DM nor edentulism at baseline, older adults aged 65 to 74 y (β = -1.12; 95% confidence interval [CI], -1.56 to -0.65; P < 0.001) and those aged 75 to 84 y with both conditions (β = -1.35; 95% CI, -2.09 to -0.61; P < 0.001) had a worse cognitive function. For the rate of cognitive decline, compared to those with neither condition from the same age cohort, older adults aged 65 to 74 y with both conditions declined at a higher rate (β = -0.15; 95% CI, -0.20 to -0.10; P < 0.001). Having DM alone led to an accelerated cognitive decline in older adults aged 65 to 74 y (β = -0.09; 95% CI, -0.13 to -0.05; P < 0.001); having edentulism alone led to an accelerated decline in older adults aged 65 to 74 y (β = -0.13; 95% CI, -0.17 to -0.08; P < 0.001) and older adults aged 75 to 84 (β = -0.10; 95% CI, -0.17 to -0.03; P < 0.01). Our study finds the co-occurrence of DM and edentulism led to a worse cognitive function and a faster cognitive decline in older adults aged 65 to 74 y.

Lignin Biosynthesis in Postharvest Water Bamboo (Zizania latifolia) Shoots during Cold Storage Is Regulated by RBOH-Mediated Reactive Oxygen Species Signaling

Lignification is a major cause of senescence in fresh shoots of water bamboo (Zizania latifolia), which is a popular vegetable in southeast Asia; however, its physiological and molecular mechanisms is less understood. In the present study, lignin content and transcriptome change in postharvested water bamboo shoots under cold storage were investigated. We found that lignin significantly accumulated in the epidermis of the shoots with the increase of firmness. In the cold storage shoots, the major up-regulated genes were involved in phenylpropanoid biosynthesis, plant-pathogen interactions, and starch and sucrose metabolism. The lignin biosynthesis genes PAL, 4CL, C4H, CCoAOMT, CCR, F5H, CAD, and POD family were up-regulated during cold storage, while HCT and C3H were down-regulated. The MAPK signaling pathway was also up-regulated and respiratory burst oxidase homologue (RBOH) genes were strongly up-regulated. Therefore, we investigated the RBOH gene family and their expression profile in water bamboo shoots. The results indicated that 10 ZlRBOHs were up-regulated in cold storage shoots. Diphenyleneiodonium chloride (DPI), an inhibitor of RBOH oxidase, significantly inhibited the expression of genes involved in lignin deposition and biosynthesis, while H2O2 enhanced these processes. These results suggest that lignification of water bamboo shoots is regulated by RBOH-mediated ROS signaling.

The role and molecular mechanism of gut microbiota in Graves' orbitopathy

PURPOSE

Graves' orbitopathy (GO) is an autoimmune orbital disorder. Gut microbiota dysfunction plays a vital role in autoimmune diseases, including Graves' disease (GD) and GO. In the present study, we aimed to investigate the change of gut microbiota in GD/GO using mouse model.

METHODS

The murine model of GD/GO was established by the challenge of adenovirus expressing thyroid-stimulating hormone (TSH) receptor (TSHR) (Ad-TSHR). The histological changes of orbital and thyroid tissues were analyzed by hematoxylin and eosin (H&E), Masson staining, and immunohistochemistry (IHC) staining. The fecal samples were collected for 16S rRNA gene sequencing and bioinformatics analysis.

RESULTS

The GD/GO model was established successfully, as manifested as the broadened eyelid, exophthalmia and conjunctive redness, severe inflammatory infiltration among thyroid glands and between extraocular muscle space, hypertrophic extraocular muscles, elevated thyroxine (T4) and decreased TSH, and positive CD34, CD40, collagen I, and α-SMA staining. A total of 222 operational taxonomic units (OUTs) were overlapped between mice in the Ad-NC and Ad-TSHR groups. The microbial composition of the samples in the two groups was mainly Bacteroidia and Clostridia, and the Ad-NC group had a significantly lower content of Bacteroidia and higher content of Clostridia. KEGG orthology analysis results revealed differences in dehydrogenase, aspartic acid, bile acid, chalcone synthase, acetyltransferase, glutamylcyclotransferase, glycogenin, and 1-phosphatidylinositol-4-phosphate 5-kinase between two groups; enzyme commission (EC) analysis results revealed differences in several dehydrogenase, oxidase, thioxy/reductase between two groups; MetaCyc pathways analysis results revealed differences in isoleucine degradation, oxidation of C1 compounds, tricarboxylic acid (TCA) cycle IV, taurine degradation, and biosynthesis of paromamine, heme, colonic acid building blocks, butanediol, lysine/threonine/methionine, and histidine/purine/pyrimidine between two groups.

CONCLUSION

This study induced a mouse model of GD/GO by Ad-TSHR challenge, and gut microbiota characteristics were identified in the GD/GO mice. The Bacteroidia and Clostridia abundance was changed in the GD/GO mice. These findings may lay a solid experimental foundation for developing personalized treatment regimens for GD patients according to the individual gut microbiota. Given the potential impact of regional differences on intestinal microbiota, this study in China may provide a reference for the global overview of the gut-thyroid axis hypothesis.

A case report of type 2M Von Willebrand disease with unique mutations

Von Willebrand disease (vWD) is the most common inherited bleeding disorder. It results from quantitative or qualitative defects of the von Willebrand factor (vWF) protein, and is divided into three types, namely type 1, type 2(2A, 2B, 2M, and 2N), and type 3 vWD. Here we report a case of 55-year-old female who presented with recurrent gastrointestinal bleeding due to angiodysplasia. Her past medical history is significant for vWD (type unknown) with hemoptysis, epistaxis and menorrhagia requiring Humate-P replacement multiple times. She has one sister with mild vWD of unknown type and 4 other siblings with no bleeding history. Coagulation testing shows normal PT and aPTT. Von Willebrand panel shows vWF antigen of 33%, VWF ristocetin cofactor activity of 15%, and Factor VIII of 87%. The ratio (VWF: RCo/VWF: Ag) is low (0.45) and the multimer pattern is normal. This is consistent with type 2M vWD. VWD gene sequencing shows heterozygous variants of c.4241T&gt;G (p.Val1414Gly) and c.5227G&gt;A (p.Val1743Met). Of note, one variant (c.4241T&gt;G/p.Val1414Gly) has been reported in two individuals with type 2A but not in type 2M vWD. This may truly represent different types of vWD caused by same mutation or could be due to variation in testing and/or result interpretation among laboratories. The other variant c.5227G&gt;A(p.Val1743Met) in A3 domain has never been reported with uncertain significance. Further investigation including vWF panel testing and genetic analysis in family members would help characterize those mutations.

One-pot fabrication of Mo1-xWxS2 alloy nanosheets as SERS substrates with highly Raman enhancement effect and long-term stability

A new Mo_1-xW_xS₂ two-dimensional nanosheets were prepared by the one-pot method. After certain Mo atoms in MoS₂ were replaced by W ones in a hydrothermal reduction procedure, Mo_1-xW_xS₂ was formed on the Mo foil. Well enhanced Mo_1-xW_xS₂ nanosheets were prepared when the sodium tungstate concentration got under control. Various characterizations were carried out, which indicate that Mo_1-xW_xS₂ nanosheets with good crystallinity. Compared with MoS₂, the Raman intensity of Rhodamine 6G (10^-6 M) was amplified by 1.7 times with Mo_1-xW_xS₂ nanosheets as the substrate. The characteristic Raman peaks could still be clearly distinguished until the concentration of Rhodamine 6G (R6G), Methylene blue (MB) and Crystal violet (CV) down to 10^-8, 10^-8 and 10^-7 M, respectively. With abundant edge active sites that facilitate charge transfer, Mo_1-xW_xS₂ nanosheets could better enhance SERS signals of target detection molecules and get a good linear relationship exists within the concentration and Raman peak strength. In addition, R6G SERS detection also shows excellent reproducibility and long-term stability of this TMDs SERS substrate.

[Indirubin relieves inflammatory injury of chondrocytes in a mouse model of osteoarthritis]

OBJECTIVE

To investigate the effect of indirubin for relieving joint inflammation and injury in a rat model of osteoarthritis.

METHODS

Articular cartilage chondrocytes were isolated from adult rat knee joint and cultured in the presence of interleukin-1β (IL-1β) and 0.1, 0.5, 1.0, or 2.0 μmol/L indirubin. The cells were transfected with NPAS2 siRNA or a non-specific siRNA, and the cell proliferation and apoptosis were evaluated using tetramethylthiazole blue staining and flow cytometry. The protein expression levels of Bax, Bcl-2, ACAN, COL2A1, MMP-13 and NPAS2 were detected with Western blotting, and the levels of NO, PGE2 and TNF-α in the culture supernatant were determined with ELISA. The mRNA expression levels of NPAS2, ACAN, COL2A1 and MMP-13 were detected using fluorescence quantitative PCR. In a C57BL/6 mouse model of osteoarthritis, the effect of indirubin on BAX, Bcl-2, ACAN and MMP-13 protein expressions in the bone and joint tissues were evaluated with Western blotting.

RESULTS

Treatment with 0.1 μmol/L indirubin produced no significant changes in chondrocyte proliferation, apoptosis, caspase-3 activity, or BAX and Bcl-2 protein expressions. At higher doses (0.5, 1.0 and 2.0 μmol/L), indirubin significantly promoted cell proliferation, increased Bcl-2 protein expression, and lowered cell apoptosis rate, caspase-3 activity and Bax protein expression (P < 0.05). Indirubin treatment at 0.5 μmol/L up-regulated the protein and mRNA expressions of NPAS2, ACAN and COL2A1, and down-regulated the expressions of MMP-13, NO, PGE2 and TNF-α (P < 0.05). Interference of NPAS2 expression significantly attenuated the protective effect of 0.5 μmol/L indirubin against IL-1β-induced chondrocyte injury. The mouse model of osteoarthritis showed obviously increased protein levels of BAX and MMP-13 (P < 0.01) and decreased levels of Bcl-2 (P < 0.05) and ACAN (P < 0.01) in the knee joint, and indirubin treatment of the mouse models significantly inhibited the increase of BAX and MMP-13 protein expressions (P < 0.01) and up-regulated the protein expressions of Bcl-2 and ACAN (P < 0.05).

CONCLUSION

Indirubin has a protective effect on osteoarthritis tissue and alleviates inflammation and damage of osteoarthritis chondrocytes possibly through NPAS2.

Transcriptome analysis of the production enhancement mechanism of antimicrobial lipopeptides of Streptomyces bikiniensis HD-087 by co-culture with Magnaporthe oryzae Guy11

The lipopeptides produced by Streptomyces bikiniensis have a significant inhibitory effect on Magnaporthe oryzae, but the low yield limits its application. In this study, the anti-M. oryzae activity of the broth of S. bikiniensis HD-087 co-cultured with M. oryzae Guy11 mycelium has risen by 41.22% compared with pure culture, and under induction conditions of adding Guy11-inducer (cell-free supernatant of M. oryzae Guy11), the activity of strain HD-087 improved 61.76%. The result proved that the enhancement effect of Guy11 on the antimicrobial activity of HD-087 was mainly related to metabolites but mycelium cells. Under optimum induction conditions, NRPS gene expression levels of HD-087 were significantly increased by induction with Guy11-inducer, the biomass of HD-087 had no significant change, but crude extract of lipopeptide (CEL) production was 107.4% higher than pure culture, and TLC result under acid hydrolysis showed that the induced culture has one component more than pure culture. To clarify the regulation mechanism of improving lipopeptide production of HD-087 with Guy11-inducer, transcriptomic analysis was performed using RNAseq to compare the induced culture and pure culture. In the induced culture, 943 genes were up-regulated, while 590 genes were down-regulated in DEGs (differentially expressed genes). KEGG results showed that the expression of genes related to amino acid synthesis, fatty acid metabolism, TCA cycle and pyruvate metabolism pathway were significantly increased. The increased expression of genes related to these metabolic pathways provided sufficient precursors for lipopeptide synthesis. Accordingly, key enzyme genes responsible for the synthesis of lipopeptides Srf and NRPS was significantly increased. Quorum sensing related genes OppA and MppA were significantly up-regulated, and then ComP was activated and promoted lipopeptide synthesis. These results provided a scientific basis for using M. oryzae to induce the increase of the production of Streptomyces lipopeptides, and also laid a foundation for further exploring the co-culture mechanisms among different genera.

[Progress in clinical diagnosis and treatment of multiple primary lung cancer]

With the application of high-resolution chest imaging system and lung cancer screening program, patients with multiple primary lung cancer (MPLC) are becoming a growing population in clinical practice. However, the diagnostic criteria of MPLC and its differentiation from intrapulmonary metastasis of lung cancer (IM) are still controversial, especially in cases with similar histology. On the basis of reviewing the existing literature, this paper discusses the changes of the diagnostic criteria of MPLC and the differential diagnosis methods of imaging, histology and molecular genetics of MPLC and IM, and briefly introduces the application of multidisciplinary diagnosis, algorithm, predictive model and artificial intelligence in the differential diagnosis of MPLC. In addition, we also discuss the latest progress in the treatment of MPLC. Radical surgery is the main method for the treatment of MPLC. Stereotactic body radiation therapy (SBRT) is safe and feasible for inoperable MPLC patients, and targeted therapy and immunotherapy can also be used in MPLC after appropriate patient selection.

[Soluble egg antigen of Schistosoma japonicum induces macrophage apoptosis in mice]

OBJECTIVE

To investigate the dynamic changes of macrophage numbers and apoptosis during Schistosoma japonicum infection, and to investigate the possible mechanisms of macrophage apoptosis induced by S. japonicum soluble egg antigen (SEA).

METHODS

C57BL/6 mice at ages of 6~8 weeks were randomly divided into 4 groups, including three experimental groups and a normal control group. Each mouse in the experimental groups was infected with (12 ± 1) cercariae of S. japonicum via the abdominal skin, and all mice in an experimental group were sacrificed 3, 5, 8 weeks post-infection, respectively, while mice in the control group were not infected with S. japonicum cercariae and sacrificed on the day of S. japonicum infection in the experimental group. Mouse liver specimens and peritoneal exudation cells were sampled in each group, and the dynamic changes of macrophage numbers and apoptosis were detected. Mouse peritoneal macrophages were isolated, purified and treated with S. japonicum SEA, PBS and ovalbumin (OVA) in vitro, and the macrophage apoptosis was detected using flow cytometry. The mRNA and protein expression of BCL-2 protein family members were determined in macrophages using real-time quantitative PCR (qP-CR) and Western blotting assays, and the activation of caspase 3 was determined using flow cytometry and Western blotting. In addition, macrophages were in vitro treated with S. japonicum SEA in presence of a caspase inhibitor, H₂O₂ or N-acetyl-L-cysteine, and the apoptosis of macrophages was detected using flow cytometry.

RESULTS

The total macrophage numbers continued to increase in mouse liver [(0.873 ± 0.106) × 106, (2.737 ± 0.460) × 10⁶ and (3.107 ± 0.367) × 10⁶ cells, respectively; F = 81.900, P < 0.01] and peritoneal specimens [(5.282 ± 1.136) × 105, (7.500 ± 1.200) × 10⁵ and (12.800 ± 0.800) × 10⁵ cells, respectively; F = 55.720, P < 0.01] 3, 5 and 8 weeks post-infection with S. japonicum, and the numbers of apoptotic macrophages also continued to increase in mouse liver [(0.092 ± 0.018) × 10⁶, (0.186 ± 0.025) × 10⁶ and (0.173 ± 0.0270) × 10⁶ cells; F = 57.780, P < 0.01] and peritoneal specimens [(0.335 ± 0.022) × 10⁵, (0.771 ± 0.099) × 10⁵ and (1.094 ± 0.051) × 10⁵ cells; F = 49.460, P < 0.01] 3, 5 and 8 weeks post-infection with S. japonicum. The apoptotic rate of SEA-treated macrophages [(24.330 ± 0.784)%] was significantly higher than that of PBS-[(18.500 ± 1.077)%] and OVA-treated macrophages [(18.900 ± 1.350)%] (both P values < 0.01). There were no significant differences in the mRNA or protein expression of Bcl-2 [Bcl - 2 mRNA expression: (1.662 ± 0.943) vs. (1.000 ± 0.000), t = 1.215, P > 0.05; BCL protein expression: (0.068 ± 0.004) vs. (0.070 ± 0.005), t = 0.699, P > 0.05], Bax [Bax mRNA expression: (0.711 ± 0.200) vs. (1.000 ± 0.000), t = 2.507, P > 0.05; BAX protein expression: (0.089 ± 0.005) vs. (0.097 ± 0.003), t = 2.232, P > 0.05] and Bak [Bak mRNA expression: (1.255 ± 0.049) vs. (1.00 ± 0.00), t = 0.897, P > 0.05; BAK protein expression: (0.439 ± 0.048) vs. (0.571 ± 0.091), t = 2.231, P > 0.05] between in SEA- and PBS-treated macrophages. S. japonicum SEA induced macrophage apoptosis in the presence of a caspase inhibitor (F = 0.411, P > 0.05); however, SEA failed to induce macrophage apoptosis in the presence of H₂O₂ or NAC (F = 11.880 and 9.897, both P values < 0.05).

CONCLUSIONS

S. japonicum SEA may induce macrophage apoptosis through promoting reactive oxygen species expression during S. japonicum infections in mice.

POS0071 THE EFFICACY OF PIRFENIDONE COMBINED WITH IMMUNOSUPPRESSANT THERAPY IN THE CONNECTIVE TISSUE DISEASE-ASSOCIATED PULMONARY INTERSTITIAL DISEASE, A 24-WEEK PROSPECTIVE CONTROLLED COHORT STUDY

Background

Pulmonary interstitial disease(ILD)is very common in connective tissue disease (CTD). Different subtypes display significant differentiations in prognosis. Pirfenidone (PFD), the targeted anti-fibrosis and anti-inflammatory drug, started to apply in CTD-ILD, while its strategy of combination with immunotherapy, bridging time and service time are worth discussing.

Objectives

To evaluate the efficacy and safety of PFD combined with immunosuppressant (IS) in the treatment of several CTD- ILD.

Methods

111 CTD-ILD patients were involved from Aug 2019 to Dec 2021 (ClinicalTrials.gov Identifier NCT04928586), including systemic sclerosis (SSc, n=30), inflammatory myopathy (IIM, n=51), rheumatoid arthritis (RA, n=17) and other CTDs (such as systemic lupus erythematosus, sjogren’s syndrome, n=13). Patients were treated with relative stable dose of glucocorticoid (GC) and/or IS since screening.After the evaluation of HRCT, pulmonary function (FVC% and DLCo%) and basic disease activity, PFD was added or not and followed up regularly for 24 weeks. The changes of lung function and imaging were recorded in different subgroups.

Results

At baseline, The FVC% in the SSc-PFD (n=14), IIM-PFD (n=25) pts were lower than that of SSc-no-PFD (n=16), IIM-no-PFD (n=26) respectively, that was 81.06 vs 99.63(p = 0.014), 78.23 vs 91.12, (p= 0.010). And IIM-PFD group present a lower baseline DLCo% than IIM-no-PFD pts (64.25 vs 72.82, p =0.034). DLCo% in the other CTDs was lower than SSc, IIM, RA pts (54.58 vs 65.55, 68.71, 66.89, p=0.036), while there were no significant differences in baseline FVC% among these disease.

After 24 weeks of treatment, FVC% in SSc-PFD group was improved by 7.15%, while that was -0.91% in SSc-no-PFD pts (p=0.042). The elevation in FVC% was also significant between the IIM-PFD and IIM-no-PFD control (8.00 vs 1.40, p=0.016). On the other hand, DLCo% of RA-PFD obviously enhanced 7.40%, compared with RA-no-PFD decrease 5.50% from baseline(p=0.002) (Figure 1).

Figure 1.

The changes of FVC% and DLco% in PFD treated CTD-ILD for 24 weeks. (A) FVC% changes in SSc, IIM, RA and other CTD-ILD from baseline.; (B) DLco% changes in SSc, IIM, RA and other CTD-ILD from baseline. * p< 0.05, compared to no PFD treatment group.

When performing subgroup analysis with manifestations in HRCT, the change of FVC% in SSc-PFD pts with usual interstitial pueumonia tendency(SSc-PFD-UIP) was higher than SSc-PFD-non-UIP group (8.05 vs -3.20, p=0.014). However, the non-UIP tendency in IIM-PDF pts displayed superior therapeutic effects than IIM-PDF-UIP pts (10.50 vs 1.00, p=0.005). In addition, DLCo% improved significantly in RA-PDF-non-UIP subgroup, compared with RA-PDF-UIP pts (10.40 vs -4.45, p=0.017).

According to whether the baseline FVC% and DLCo% value was less than 70%, the improvement of FVC% was significantly higher in PFD treatment group than no-PFD pts of SSc and IIM with baseline High-FVC%(6.60 vs 0.10, p=0.047),(6.30 vs 1.10, p= 0.089).In RA-PFD pts, DLCo% showed a significant increase in baseline DLCo% less than 70% subgroup, compared to RA-no-PDF (7.40% vs -6.60%, p=0.011).The basic IS were considerable between PFD andno-PFD pts throughout the study and no differences of GS and IS dosages at baseline and follow up among all subgroups.

Multiple linear regression analysis found that baseline FVC%<70%(HR=4.56,6.81) and prescription of PFD(HR=4.56,4.37) could positively affect the changes of FVC% and DLCo% (all p<0.05).

Conclusion

The response of pulmonary function to PFD were varied in different CTD-ILD subsets. SSc and IIM pts acquired obviously improvement on FVC%, especially with high baseline FVC group. DLco% elevated in RA-PFD, highlight those baseline Low-DLco and No-UIP pts.

Acknowledgements

Funded by ECCM Program of Clinical Research Center of Shandong University (No. 2021SDUCRCB010)

Disclosure of Interests

None declared

Measurement of trace bisphenol A in drinking water with combination of immunochromatographic detection technology and SERS method

Sensitive and selective detection of target analyte is very important in many fields such as commodity inspection and quality monitoring. In this work, based on the principle of competitive immunoassay, surface-enhanced Raman spectroscopy (SERS) was used to establish a rapid and highly sensitive method for the detection of trace amounts of bisphenol A in water. Here, Raman molecule 5,5-dithiobis-2-nitrobenzoic acid and anti-BPA antibody were conjugated with Au (core)@Ag (shell) nanoparticle to serve as SERS nanoprobe. After the SERS nanoprobe is combined with the substance to be tested, it uses the siphon effect to pass through the test line and the charging line on the test strip. And the Raman test was performed on the T line with a Raman spectrometer. The detection limitation was 0.1 pg/mL. Compared with the reported gas chromatography, liquid chromatography, fluorescence analysis, and other detection methods, SERS ICA does not demand complicated sample preparation procedures, and has the advantages of simple detection methods, quick results, High sensitivity, good specificity, and low technical demands for laboratory environment and testers. In addition, Raman spectrometers have gradually developed to be portable, making it easier to meet the needs of on-site rapid and highly sensitive detection, and will show broad prospects for applications in the fields of biomedical diagnosis and food safety monitoring.