Compound sophora decoction alleviates ulcerative colitis by regulating macrophage polarization through cGAS inhibition: network pharmacology and experimental validation

INTRODUCTION

Ulcerative colitis (UC) is a refractory disease with complex pathogenesis, and its pathogenesis is not clear. The present study aimed to investigate the potential target and related mechanism of Compound Sophora Decoction (CSD) in treating UC.

METHODS

A network pharmacology approach predicted the components and targets of CSD to treat UC, and cell and animal experiments confirmed the findings of the approach and a new target for CSD treatment of UC.

RESULTS

A total of 155 potential targets were identified for CSD treatment of UC, with some related to macrophage polarization, such as nitric oxide synthase (NOS2), also known as inducible nitric oxide synthase (iNOS). GO and KEGG enrichment analysis indicated that oxidative stress response and multiple inflammatory signaling pathways such as TNF-α may play a significant role. In vitro experiments revealed that Interferon-stimulated DNA (ISD) interference can cause polarization imbalances in Raw 264.7 and bone marrow-derived macrophages (BMDMs). Flow cytometry demonstrated that polarization of macrophages in the intestine, spleen, and lymph nodes in vivo was also unbalanced after dextran sulfate sodium (DSS) modeling with pathological intestinal injury. Both in vitro and in vivo studies indicated that after inducing inflammation, the levels of macrophage polarization-related markers (iNOS and Arg1) and inflammation-related factors (CCL17, IL10, TNF-α, and CXCL10) changed, accompanied by increased expression of cGAS. However, CSD treatment based on inflammation can inhibit the expression of cGAS protein and mRNA, lower the level of inflammatory factors, promote the expression of anti-inflammatory factors, and regulate macrophage polarization.

CONCLUSION

We concluded that CSD alleviated DSS-induced UC by inhibiting cGAS, thus regulating macrophage polarization.

Deep learning-based automatic scoring models for the disease activity of rheumatoid arthritis based on multimodal ultrasound images

OBJECTIVES

We aimed to investigate the value of deep learning (DL) models based on multimodal ultrasonographic (US) images to quantify RA activity.

METHODS

Static greyscale (SGS), dynamic greyscale (DGS), static power Doppler (SPD) and dynamic power Doppler (DPD) US images were collected and evaluated by two expert radiologists according to the EULAR-OMERACT Synovitis Scoring system. Four DL models were developed based on the ResNet-type structure, evaluated on two separate test cohorts, and finally compared with the performance of 12 radiologists with different levels of experience.

RESULTS

In total, 1244 images were used for the model training, and 152 and 354 for testing (cohort 1 and 2, respectively). The best-performing models for the scores of 0/1/2/3 were the DPD, SGS, DGS and SPD models, respectively (Area Under the receiver operating characteristic Curve [AUC] = 0.87/0.95/0.74/0.95; no significant differences). All the DL models provided results comparable to the experienced radiologists on a per-image basis (intraclass correlation coefficient: 0.239-0.756, P < 0.05). The SPD model performed better than the SGS one on test cohort 1 (score of 0/2/3: AUC = 0.82/0.67/0.95 vs 0.66/0.66/0.75, respectively) and test cohort 2 (score of 0: AUC = 0.89 vs 0.81). The dynamic DL models performed better than the static ones in most of the scoring processes and were more accurate than the most of senior radiologists, especially the DPD model.

CONCLUSION

DL models based on multimodal US images allow a quantitative and objective assessment of RA activity. Dynamic DL models in particular have potential value in assisting radiologists to improve the accuracy of RA US-based grading.

Maternal androgen excess inhibits fetal cardiomyocytes proliferation through RB-mediated cell cycle arrest and induces cardiac hypertrophy in adulthood

PURPOSE

Maternal hyperandrogenism during pregnancy is associated with adverse gestational outcomes and chronic non-communicable diseases in offspring. However, few studies are reported to demonstrate the association between maternal androgen excess and cardiac health in offspring. This study aimed to explore the relation between androgen exposure in utero and cardiac health of offspring in fetal and adult period. Its underlying mechanism is also illustrated in this research.

METHODS

Pregnant mice were injected with dihydrotestosterone (DHT) from gestational day (GD) 16.5 to GD18.5. On GD18.5, fetal heart tissue was collected for metabolite and morphological analysis. The hearts from adult offspring were also collected for morphological and qPCR analysis. H9c2 cells were treated with 75 μM androsterone. Immunofluorescence, flow cytometry, qPCR, and western blot were performed to observe cell proliferation and explore the underlying mechanism.

RESULTS

Intrauterine exposure to excessive androgen led to thinner ventricular wall, decreased number of cardiomyocytes in fetal offspring and caused cardiac hypertrophy, compromised cardiac function in adult offspring. The analysis of steroid hormone metabolites in fetal heart tissue by ultra performance liquid chromatography and tandem mass spectrometry showed that the content of androgen metabolite androsterone was significantly increased. Mechanistically, H9c2 cells treated with androsterone led to a significant decrease in phosphorylated retinoblastoma protein (pRB) and cell cycle-related protein including cyclin-dependent kinase 2 (CDK2), cyclin-dependent kinase 4 (CDK4), and cyclin D1 (CCND1) in cardiomyocytes. This resulted in cell cycle arrest at G1-S phase, which in turn inhibited cardiomyocyte proliferation.

CONCLUSION

Taken together, our results indicate that in utero exposure to DHT, its metabolite androsterone could directly decrease cardiomyocytes proliferation through cell cycle arrest, which has a life-long-lasting effect on cardiac health. Our study highlights the importance of monitoring sex hormones in women during pregnancy and the follow-up of cardiac function in offspring with high risk of intrauterine androgen exposure.

Knowledge-Driven Experimental Discovery of Ce-Based Metal Oxide Composites for Selective Catalytic Reduction of NOx with NH3 through Interpretable Machine Learning

Mining the scientific literature, combined with data-driven methods, may assist in the identification of optimized catalysts. In this paper, we employed interpretable machine learning to discover ternary metal oxides capable of selective catalytic reduction of nitrogen oxides with ammonia (NH3-SCR). Specifically, we devised a machine learning framework utilizing extreme gradient boosting (XGB), identified for its optimal performance, and SHapley Additive exPlanations (SHAP) to evaluate a curated database of 5654 distinct metal oxide composite catalytic systems containing cerium (Ce) element, with records of catalyst composition and preparation and reaction conditions. By virtual screening, this framework precisely pinpointed a CeO2-MoO3-Fe2O3 catalyst with superior NOx conversion, N2 selectivity, and resistance to H2O and SO2, as confirmed by empirical evaluations. Subsequent characterization affirmed its favorable structural, chemical bulk properties and reaction mechanism. Demonstrating the efficacy of combining knowledge-driven techniques with experimental validation and analysis, our strategy charts a course for analogous catalyst discoveries.

Development and validation of a nomogram model based on pretreatment ultrasound and contrast-enhanced ultrasound to predict the efficacy of neoadjuvant chemotherapy in patients with borderline resectable or locally advanced pancreatic cancer

OBJECTIVES

To develop a nomogram using pretreatment ultrasound (US) and contrast-enhanced ultrasound (CEUS) to predict the clinical response of neoadjuvant chemotherapy (NAC) in patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC).

METHODS

A total of 111 patients with pancreatic ductal adenocarcinoma (PDAC) treated with NAC between October 2017 and February 2022 were retrospectively enrolled. The patients were randomly divided (7:3) into training and validation cohorts. The pretreatment US and CEUS features were reviewed. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of clinical response in the training cohort. Then a prediction nomogram model based on the independent predictors was constructed. The area under the curve (AUC), calibration plot, C-index and decision curve analysis (DCA) were used to assess the nomogram's performance, calibration, discrimination and clinical benefit.

RESULTS

The multivariate logistic regression analysis showed that the taller-than-wide shape in the longitudinal plane (odds ratio [OR]:0.20, p = 0.01), time from injection of contrast agent to peak enhancement (OR:3.64; p = 0.05) and Peaktumor/ Peaknormal (OR:1.51; p = 0.03) were independent predictors of clinical response to NAC. The predictive nomogram developed based on the above imaging features showed AUCs were 0.852 and 0.854 in the primary and validation cohorts, respectively. Good calibration was achieved in the training datasets, with C-index of 0.852. DCA verified the clinical usefulness of the nomogram.

CONCLUSIONS

The nomogram based on pretreatment US and CEUS can effectively predict the clinical response of NAC in patients with BRPC and LAPC; it may help guide personalized treatment.

Relationship between uric acid to albumin ratio and in-stent restenosis in patients with coronary artery disease undergoing drug-eluting stenting

BACKGROUND

In-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI) to treat coronary artery disease (CAD) is an urgent issue in clinical practice. Recent studies have highlighted uric acid-albumin ratio (UAR) as a new marker for evaluating inflammation and oxidative stress, capable of predicting cardiovascular ailments. We aimed to examine the correlation between UAR levels and ISR in patients who underwent drug-eluting stent (DES) implantation.

METHODS

We included 503 patients with CAD who underwent initial DES implantation and angiography during the follow-up period. Based on coronary angiographic findings, the patients were categorized into ISR (n = 73) and non-ISR groups (n = 430). Before angiography, laboratory parameters were measured for all enrolled patients. To ascertain the influential factors linked to ISR, multivariate logistic regression analysis was performed. The predictive capability of UAR in determining ISR was assessed using receiver operating characteristic (ROC) curve analysis. Statistical significance was set at P  < 0.05.

RESULTS

Multivariate logistic regression analysis revealed that diabetes mellitus, stent length, UAR, albumin levels, and C-reactive protein levels independently predicted ISR. ROC curve analysis revealed that UAR had an area under the curve of 0.767 (95% CI: 0.709 - 0.826) for predicting ISR and demonstrated that UAR outperformed the individual predictive abilities of uric acid and albumin for ISR.

CONCLUSION

UAR was associated with ISR in patients with CAD undergoing PCI with DES implantation. Moreover, ROC curve analysis demonstrated that UAR exhibited superior predictive accuracy for ISR compared with evaluating uric acid and albumin levels separately.

Evaluation of the diagnostic efficacy of liquid-based cytology obtained via percutaneous ultrasound-guided fine-needle aspiration for pancreatic masses: a large tertiary center's 8-year experience

PURPOSE

There were limited data on the diagnostic efficacy of liquid-based cytology (LBC) for pancreatic tissues acquired by percutaneous ultrasound-guided fine-needle aspiration (US-FNA). This study aimed to evaluate the diagnostic value of LBC acquired via percutaneous US-FNA for pancreatic tumors compared with LBC combined with smear cytology (SC).

METHODS

A retrospective database search (January 2014 and February 2022) was performed for patients who underwent percutaneous US-FNA with both LBC and SC. Clinical and pathological data were collected from 298 patients; eventually, 251 cases met the inclusion criteria. Diagnostic accuracy, sensitivity (SEN), specificity (SPE), positive predictive value (PPV) and negative predictive value (NPV) were compared. Rapid on-site evaluation (ROSE) was not available in all cases.

RESULTS

Based on the pancreaticobiliary cytology guidelines published by the Papanicolaou Society of Cytopathology, 224 (89.2%), 13 (5.2%) and 14 (5.6%) cases were diagnosed as malignant, pre-malignant and benign lesions, respectively. The diagnostic accuracy of the LBC + SC (88.5%) was better than that of LBC (87.3%) but without statistical significance (P = 0.125). The SEN, SPE, PPV and NPV were 87.5%, 85.2%, 98.0% and 45.1%, respectively, in the LBC group and 88.8%, 85.2%, 98.0% and 47.9%, respectively, in the LBC + SC group. According to univariate and multivariate analyses, there were no factors have significant association with the diagnostic sensitivity of LBC.

CONCLUSIONS

LBC obtained via percutaneous US-FNA provides good diagnostic value for pancreatic lesions and there was no significant difference between the diagnostic accuracy of LBC and LBC + SC when ROSE was unavailable.

Relationship between weight-adjusted waist circumference index and prevalence of gallstones in U.S. adults: a study based on the NHANES 2017-2020

Objective

We aimed to assess the association between weight-adjusted waist circumference index (WWI) and gallstone prevalence in US adults.

Methods

We selected individuals from the National Health and Nutrition Examination Survey (NHANES) database from 2017 to 2020 and used logistic regression analyses, subgroup analyses, and dose-response curves to assess the association between WWI and gallbladder stone prevalence and age, sex, and ethnicity.

Results

A total of 7971 participants aged ≥20 years were enrolled in our study; 828 patients had a self-reported history of gallstones. After correcting for confounders, for each unit of WWI after Ln conversion, the prevalence of gallbladder stones increased by 34% (OR=1.34, 95% CI:1.20, 1.50). Dose-response curves showed a positive correlation between WWI and gallbladder stone prevalence.According to the subgroup analysis, the positive association between TyG index and high-frequency HI was more significant in males(OR=1.34, 95% CI:1.07, 1.69), <40 years old(OR=1.42, 95% CI:1.18, 1.71), white people Americans(OR=1.35, 95% CI:1.08, 1.68) and other races(OR= 1.56, 95% CI:1.13, 2.14).

Conclusion

Higher WWI was positively associated with the prevalence of gallbladder stones and was associated with gender, age, and ethnicity. This is noteworthy, although a causal relationship could not be established.

Predicting the Efficacy of Neoadjuvant Chemotherapy for Pancreatic Cancer Using Deep Learning of Contrast-Enhanced Ultrasound Videos

Contrast-enhanced ultrasound (CEUS) is a promising imaging modality in predicting the efficacy of neoadjuvant chemotherapy for pancreatic cancer, a tumor with high mortality. In this study, we proposed a deep-learning-based strategy for analyzing CEUS videos to predict the prognosis of pancreatic cancer neoadjuvant chemotherapy. Pre-trained convolutional neural network (CNN) models were used for binary classification of the chemotherapy as effective or ineffective, with CEUS videos collected before chemotherapy as the model input, and with the efficacy after chemotherapy as the reference standard. We proposed two deep learning models. The first CNN model used videos of ultrasound (US) and CEUS (US+CEUS), while the second CNN model only used videos of selected regions of interest (ROIs) within CEUS (CEUS-ROI). A total of 38 patients with strict restriction of clinical factors were enrolled, with 76 original CEUS videos collected. After data augmentation, 760 and 720 videos were included for the two CNN models, respectively. Seventy-six-fold and 72-fold cross-validations were performed to validate the classification performance of the two CNN models. The areas under the curve were 0.892 and 0.908 for the two models. The accuracy, recall, precision and F1 score were 0.829, 0.759, 0.786, and 0.772 for the first model. Those were 0.864, 0.930, 0.866, and 0.897 for the second model. A total of 38.2% and 40.3% of the original videos could be clearly distinguished by the deep learning models when the naked eye made an inaccurate classification. This study is the first to demonstrate the feasibility and potential of deep learning models based on pre-chemotherapy CEUS videos in predicting the efficacy of neoadjuvant chemotherapy for pancreas cancer.

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Background

Contrast-enhanced ultrasound (CEUS) has proven valuable in diagnosing benign and malignant pancreatic diseases, but its value in evaluating hepatic metastasis remains to be further explored. This study investigated the relationship between CEUS features of pancreatic ductal adenocarcinoma (PDAC) and concomitant or recurrent liver metastases after treatment.

Methods

This retrospective study included 133 participants with PDAC who were diagnosed with pancreatic lesions with CEUS at Peking Union Medical College Hospital from January 2017 to November 2020. According to the CEUS classification methods in our center, all the pancreatic lesions were classified as either with rich or poor blood supply. Additionally, quantitative ultrasonographic parameters were measured in the center and periphery of all pancreatic lesions. CEUS modes and parameters of the different hepatic metastasis groups were compared. The diagnostic performance of CEUS was calculated for diagnosing synchronous and metachronous hepatic metastasis.

Results

The proportions of rich blood supply and poor blood supply were 46% (32/69) and 54% (37/69), respectively, in the no hepatic metastasis group; 42% (14/33) and 58% (19/33), respectively, in the metachronous hepatic metastasis (MHM) group; and 19% (6/31) and 81% (25/31), respectively, in the synchronous hepatic metastasis (SHM) group. The wash-in slope ratio (WIS ratio) between the center of the lesion and around the lesion and peak intensity ratio (PI ratio) between the center of the lesion and around the lesion had higher values in the negative hepatic metastasis group (P<0.05). In predicting synchronous and metachronous hepatic metastasis, the WIS ratio had the best diagnostic performance. The sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) were 81.8%, 95.7%, 91.2%, 90.0%, and 91.7%, respectively, for MHM; and 87.1%, 95.7%, 93.0%, 90.0%, and 94.3%, respectively, for SHM.

Conclusions

CEUS would be helpful in image surveillance for synchronous or metachronous hepatic metastasis of PDAC.

Naringin ameliorates 5-fluorouracil induced cardiotoxicity: An insight into its modulatory impact on oxidative stress, inflammatory and apoptotic parameters

5-fluorouracil (5-FU) is an efficacious fluoropyrimidine antimetabolite anticancer drug, however, its clinical utility is constrained due to side effect toxicity on delicate organs, including the heart. This study thus aimed at exploring the cardioprotective potentials of naringin (NRG) against 5-FU-induced cardiotoxicity in rats. We divided Wistar rats into four experimental groups (n = 6) for the administration of NRG (100 mg/kg bw, orally) and/or 5-FU (150 mg/kg bw, intraperitoneal). NRG was administered for 10 days, while 5-FU was injected on the 8th day only. Serum troponin-I (cTn-I) and creatine kinase (CK) were estimated. Cardiac activities/level of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), reduced glutathione (GSH), malondialdehyde (MDA), interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), inducible nitric oxide synthase (iNOS) and nuclear factor-ĸB (NF-κB) and caspase-3 were determined. 5-FU markedly increased cTn-I, CK, cardiac inflammatory mediators and caspase-3 expressions, whereas antioxidant mediators decreased appreciably when compared to the control groups. Interestingly, the prophylactic administration of NRG prominently inhibited the 5-FU-provoked oxidative stress, pro-inflammation and apoptosis in the heart of rats. Histopathology confirmed the biochemical results of the heart. Therefore, NRG is a potential natural flavonoid for mitigation of 5-FU cardiotoxicity in rats.

Case Report: A report on the countermeasures after the rupture of the scalp venous indwelling needle catheter in 12 cases

As a substitute for a scalp needle, the intravenous indwelling needle is easy to operate and easy to use. it is not only conducive to the rescue of critically ill children, improves nursing efficiency, but also avoids pain caused by repeated venipuncture. However, cases of indwelling needle catheter breaking and remaining in scalp vessels are rarely reported. This study collected 12 cases of scalp vein indwelling needle rupture and retention in scalp vessels in our center from January 2012 to January 2022. It was found that there were 7 males and 5 females, with an average age of 19.17 ± 8.96 months. The average length of the severed end was 15.00 ± 1.54 mm. In 8 cases, the catheter was broken during the haircut, and in 2 cases, the wall structure was damaged and broken after repeated folding of the catheter. In 2 cases, the children did not cooperate during extubation, the head twisted violently and the catheter was broken.5 cases tried to extract it by manipulation and hemostatic forceps, of which 4 cases were successful, and 1 case was successfully removed after the completion of three-dimensional computerized tomography (3D-CT) imaging positioning. The remaining 7 cases were removed by operation, and the success rate of the first operation was 100% in 4 cases who chose 3D-CT. The other 3 cases chose ordinary CT plain scan positioning, the success rate of the first operation was 66.6%, and one child was successfully removed after the second operation after the failure of the operation plus 3D-CT scan positioning. All the children were in stable condition after the operation and were discharged smoothly. When the broken catheter is relatively shallow and the scalp is not completely closed, we could choose the preliminary positioning of B-ultrasound or ordinary CT, and then try to remove it by manual squeezing combined with hemostatic forceps. However B-ultrasound and ordinary CT could not meet the requirements of accurate location, 3D-CT has a very important localization value for surgery, which can improve the success rate and help successfully remove the ruptured catheter.

Nutritional Status as a Risk Factor for New-Onset Atrial Fibrillation in Acute Myocardial Infarction

Purpose

Our study aimed to identify new-onset atrial fibrillation (NOAF) risk factors in acute myocardial infarction (AMI) patients after treatment with percutaneous coronary intervention (PCI) and investigate whether their nutritional status can be a predicting factor of NOAF.

Patients and Methods

We analyzed 662 AMI patients after PCI for NOAF occurrence during follow-up hospitalization and divided them into an NOAF and non-NOAF group. The patients' nutritional status was assessed using the controlling nutritional status (CONUT) score and geriatric nutritional risk index (GNRI). The Kaplan‒Meier analysis was used to assess NOAF-free survival in varying degrees of malnutrition. Cox proportional hazards models were used to identify the risk factors for NOAF.

Results

Eighty-four (12.7%) patients developed NOAF during hospitalization. There was a statistically significant difference in the occurrence of NOAF among different categories of nutritional status. The CONUT score and GNRI classifications were independent predictors of NOAF. NOAF occurrence was associated with older age, higher uric acid levels, higher N-terminal pro-B-type natriuretic peptide levels, greater left atrial size, and worse Killip class upon admission.

Conclusion

The nutritional status can affect NOAF occurrence in AMI patients after PCI. The CONUT score and GNRI are ideal tools for evaluating the nutritional status of AMI patients, with an excellent predictive effect on NOAF.

Berberine plays a cardioprotective role by inhibiting macrophage Wnt5a/β-catenin pathway in the myocardium of mice after myocardial infarction

Myocardial infarction (MI) is one of the diseases with high fatality rate. Berberine (BBR) is a monomer compound with various biological functions. And some studies have confirmed that BBR plays an important role in alleviating cardiomyocyte injury after MI. However, the specific mechanism is unclear. In this study, we induced a model of MI by ligation of the left anterior descending coronary artery and we surprisingly found that BBR significantly improved ventricular remodeling, with a minor inflammatory and oxidative stress injury, and stronger angiogenesis. Moreover, BBR inhibited the secretion of Wnt5a/β-catenin pathway in macrophages after MI, thus promoting the differentiation of macrophages into M2 type. In summary, BBR effectively improved cardiac function of mice after MI, and the potential protective mechanism was associated with the regulation of inflammatory responses and the inhibition of macrophage Wnt5a/β-catenin pathway in the infarcted heart tissues. Importantly, these findings supported BBR as an effective cardioprotective drug after MI.

Case report: Peritumoral hepatic steatosis in a patient with a metastatic somatostatin-producing oligosymptomatic neuroendocrine neoplasm

Neuroendocrine neoplasms (NENs) comprise a heterogeneous collection of tumors derived from various neuroendocrine cells and are divided into functioning NEN and non-functioning NEN. Some NENs present with mild symptoms and can secrete somatostatin. These neoplasms are known as somatostatin-producing oligosymptomatic NENs. In this report, we describe a case of metastatic somatostatin-producing oligosymptomatic NEN with peritumoral hepatic steatosis and review the relevant literature. The patient was a 45-year-old woman who presented with mild steatorrhea and melena. A computed tomography scan revealed an enlarged pancreas protruding into the duodenum. Pathology after total pancreatectomy showed a grade 2 pancreatic NEN with positive somatostatin immunostaining. Enlarging masses on the liver were observed after the operation. Ultrasound examination revealed several lesions in the liver, with inner hypoechoic areas that showed rapid enhancement and fast washout on contrast-enhanced ultrasonography and with outer hyperechoic areas with continuous iso-enhancement. Therefore, the inner hypoechoic areas seen on contrast-enhanced ultrasonography were suspected to be true metastases. A biopsy confirmed this suspicion and indicated that the outer areas were peritumoral liver steatosis. This case highlights the importance of the imaging pattern described in this report for accurate diagnosis of metastatic NEN to avoid incorrect estimation of tumor size or a missed diagnosis on biopsy.

Evaluation of the diagnostic performance of the EFSUMB CEUS Pancreatic Applications guidelines (2017 version): a retrospective single-center analysis of 455 solid pancreatic masses

OBJECTIVES

To explore the diagnostic performance of EFSUMB CEUS Pancreatic Applications guidelines (version 2017) before and after the addition of iso-enhancement and very fast/fast washout as supplementary diagnostic criteria for PDAC.

METHODS

In this retrospective study, patients diagnosed with solid pancreatic lesions from January 2017 to December 2020 were evaluated. Pancreatic ductal adenocarcinoma (PDAC) is reported to show hypo-enhancement in all phases according to the EFSUMB guidelines. First, based on this definition, all lesions were categorized as PDAC and non-PDAC. Then, iso-enhancement and very fast/fast washout were added as supplementary diagnostic criteria, and all lesions were recategorized. The diagnostic performance was assessed in terms of the accuracy (ACC), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV). The reference standard consisted of histologic evaluation or composite imaging and clinical follow-up findings.

RESULTS

A total of 455 nodules in 450 patients (median age, 58.37 years; 250 men) were included. The diagnostic performance using the EFSUMB CEUS guidelines for PDAC had an ACC of 69.5%, SEN of 65.4%, SPE of 84%, PPV of 93.5%, NPV of 40.6%, and ROC of 0.747. After recategorization according to the supplementary diagnostic criteria, the diagnostic performance for PDAC had an ACC of 95.8%, SEN of 99.2%, SPE of 84%, PPV of 95.7%, NPV of 96.6%, and ROC of 0.916.

CONCLUSION

The EFSUMB guidelines and recommendations for pancreatic lesions can effectively identify PDAC via hypo-enhancement on CEUS. However, the diagnostic performance may be further improved by the reclassification of PDAC lesions after adding iso-enhancement and very fast/fast washout mode.

KEY POINTS

• In the EFSUMB guidelines, the only diagnostic criterion for PDAC is hypo-enhancement, to which iso-enhancement and very fast/fast washout mode were added in our research. • Using hypo-enhancement/iso-enhancement with very fast/fast washout patterns as the diagnostic criteria for PDAC for solid pancreatic masses on CEUS has high diagnostic accuracy. • The blood supply pattern of PDAC can provide important information, and CEUS has unique advantages in this respect due to its real-time dynamic attenuation ability.

The diagnostic performance of contrast-enhanced ultrasound versus contrast-enhanced computed tomography for pancreatic carcinoma: a systematic review and meta-analysis

BACKGROUND

Pancreatic carcinoma is a highly fatal disease, and early diagnosis is of vital importance. This meta-analysis aimed to compare the diagnostic performances of contrast-enhanced ultrasonography (CEUS) against contrast-enhanced computed tomography (CECT) for pancreatic carcinoma, using pathological results or alternative imaging modality as the gold standard.

METHODS

A thorough search was conducted in PubMed, EMBASE, Web of Science and Cochrane Library databases. Two investigators selected the studies and extracted the data independently. A bivariate mixed-effects regression model was used to calculate the pooled data. Subgroup analysis and meta-regression were performed to explore the causes of heterogeneity.

RESULTS

A total of 1,227 records were identified, of which 7 articles with 588 patients were assessed for eligibility. The overall sensitivity, specificity of CEUS and CECT with their 95% confidential intervals (95% CI) were 0.91 (0.85-0.94) and 0.88 (0.81-0.92), 0.83 (0.70-0.91) and 0.87 (0.73-0.94), respectively. The area under curve (AUC) of CEUS and CECT were 0.94 and 0.93. Subgroup analysis showed CEUS may be good at diagnosing lesions with diameters less than 2 cm. Tumor features, region and study type were the main causes of heterogeneity.

CONCLUSIONS

CEUS has a satisfying diagnostic performance for pancreatic carcinoma and it has high sensitivity for small pancreatic carcinomas (≤2 cm); besides, it performs well in discriminating pancreatic cancer from chronic pancreatitis. Therefore, CEUS can be a useful supplement to CECT.

Transient receptor potential vanilloid subtype 1: A potential therapeutic target for fibrotic diseases

The transient receptor potential vanilloid subtype 1 (TRPV1), belonging to the TRPV channel family, is a non-selective, calcium-dependent, cation channel implicated in several pathophysiological processes. Collagen, an extracellular matrix component, can accumulate under pathological conditions and may lead to the destruction of tissue structure, organ dysfunction, and organ failure. Increasing evidence indicates that TRPV1 plays a role in the development and occurrence of fibrotic diseases, including myocardial, renal, pancreatic, and corneal fibrosis. However, the mechanism by which TRPV1 regulates fibrosis remains unclear. This review highlights the comprehensive role played by TRPV1 in regulating pro-fibrotic processes, the potential of TRPV1 as a therapeutic target in fibrotic diseases, as well as the different signaling pathways associated with TRPV1 and fibrosis.

Coronary angiography causes Rumpel-Leede symptoms

BACKGROUND

Rumpel Leede sign (RLS) is a clinical presentation observed at the extremities due to pressure applied externally. The appearance ranges from scattered pin-point rashes to an entire arm covered with petechial hemorrhage depending upon the severity. This phenomenon is relatively uncommon in clinical practice.

CASE PRESENTATION

A 64 year old female patient developed a rash in the normal skin area below the compression area on the second day of single catheter coronary angiography. The patient's rash resolved without treatment after 3 days.

CONCLUSIONS

We report a case of hypertension and hyperlipidemia with a petechial rash on the skin under the tourniquet compressed by the radial artery after coronary angiography, which is consistent with the Rumpel-Leede phenomenon. clinicians should be watchful of these symptoms.

AB0182 THE PROFILE OF POOR PROGNOSTIC FACTORS BASED ON EULAR RECOMMENDATIONS IN CHINESE RA PATIENTS: A SINGLE-CENTER OBSERVATIONAL STUDY

Background

Despite the constant updating of rheumatoid arthritis (RA) treatment strategies, whether poor prognostic factors (PPFs) can guide RA treatment is still controversial. There are limited data about the presence of PPFs in Chinese RA patients.

Objectives

To describe the profile of PPFs based on European League Against Rheumatism (EULAR) recommendations in Chinese RA patients, and explore the significance of these factors in adjusting treatment therapy.

Methods

In this real-world study, RA patients were enrolled from 2012 to 2020. The baseline characteristics and prognostic factors based on EULAR recommendations include acute-phase reactant levels, rheumatoid factor (RF), anti-cyclic citrullinate peptide (anti-CCP antibody), swollen joint counts (SJC), early bone erosions, and responses to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) at month 3 or month 6 were collected. Disease activity was assessed by disease activity score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR), DAS28-C-reactive protein (DAS28-CRP), simple disease activity index (SDAI), and clinical disease activity index (CDAI). The association of different factors was represented by a Venn diagram. The number of patients presenting with different combinations of prognostic factors was graphically displayed by UpSetR. Correlation between binary variables was analyzed by the Chi-square test.

Results

1252 registered RA patients were enrolled. 901/1252 (72.0%) patients had elevated ESR or CRP and 1027/1164 (88.2%) patients had positive RF or anti-CCP antibody. 397/1252 (31.7%) patients had ors was graphicas. 166/444 (37.0%) patients had early bone erosions, which usually coexisted with other PPFs. 394 (34.4%) of the 1105 patients who received csDMARD therapy as prescribed had persistent moderate or high disease activity (MDA/HDA). Failure of two or more csDMARDs was found in 245 (22.2%) patients. 99% of RA patients had at least one PPF. Patients with MDA/HDA usually coexisted with other PPF. MDA/HDA was significantly correlated with elevated ESR/CRP or high SJC and is not correlated with positive RF/anti-CCP antibody or early bone erosion.

Conclusion

PPFs are prevalent in RA patients in real-world data. It is inappropriate to guide treatment strategies just based on the presence or absence of PPFs. The categories of PPFs should be simplified and the role of different combinations of PPFs in guiding treatment therapies remains to be explored.

References

[1]Hu, H., et al., Burden of rheumatoid arthritis from a societal perspective: A prevalence-based study on the cost of this illness for patients in China. International journal of rheumatic diseases, 2018. 21(8): p. 1572-1580.

[2]Muñoz-Fernández, S., et al., Use of prognostic factors of rheumatoid arthritis in clinical practice and perception of their predictive capacity before and after exposure to evidence. Rheumatology international, 2018. 38(12): p. 2289-2296.

[3]Koga, T., et al., Prognostic Factors Toward Clinically Relevant Radiographic Progression in Patients With Rheumatoid Arthritis in Clinical Practice: A Japanese Multicenter, Prospective Longitudinal Cohort Study for Achieving a Treat-to-Target Strategy. Medicine, 2016. 95(17): p. e3476.

[4]Smolen, J.S., et al., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the rheumatic diseases, 2020. 79(6): p. 685-699.

[5]Fraenkel, L., et al., 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis care & research, 2021. 73(7): p. 924-939.

Figure 1.

Coexistence of 6 PPFs including positive RF/anti-CCP antibody, elevated ESR/CRP, high SJC, persistent MDA/HDA, failure of two or more csDMARDs, and early bone erosion.

Acknowledgements

This study was based on the contributions of all colleagues in our department during the outpatient visits over the past decade.

Disclosure of Interests

None declared

Transient Receptor Potential Channels, Natriuretic Peptides, and Angiotensin Receptor-Neprilysin Inhibitors in Patients With Heart Failure

Heart failure (HF) remains the leading cause of death, morbidity, and medical expenses worldwide. Treatments for HF with reduced ejection fraction have progressed in recent years; however, acute decompensated heart failure remains difficult to treat. The transient receptor potential (TRP) channel family plays roles in various cardiovascular diseases, responding to neurohormonal and mechanical load stimulation. Thus, TRP channels are promising targets for drug discovery, and many studies have evaluated the roles of TRP channels expressed on pain neurons. The natriuretic peptide (NP) family of proteins regulates blood volume, natriuresis, and vasodilation and can antagonize the renin-angiotensin-aldosterone system and participate in the pathogenesis of major cardiovascular diseases, such as HF, coronary atherosclerotic heart disease, and left ventricular hypertrophy. NPs are degraded by neprilysin, and the blood level of NPs has predictive value in the diagnosis and prognostic stratification of HF. In this review, we discuss the relationships between typical TRP family channels (e.g., transient receptor potential cation channel subfamily V member 1 andTRPV1, transient receptor potential cation channel subfamily C member 6) and the NP system (e.g., atrial NP, B-type NP, and C-type NP) and their respective roles in HF. We also discuss novel drugs introduced for the treatment of HF.

Beneficial Effects of Celastrol on Immune Balance by Modulating Gut Microbiota in Experimental Ulcerative Colitis Mice

Ulcerative colitis (UC) is a chronic inflammatory bowel disease caused by many factors including colonic inflammation and microbiota dysbiosis. Previous studies have indicated that celastrol (CSR) has strong anti-inflammatory and immune-inhibitory effects. Here, we investigated the effects of CSR on colonic inflammation and mucosal immunity in an experimental colitis model, and addressed the mechanism by which CSR exerts the protective effects. We characterized the therapeutic effects and the potential mechanism of CSR on treating UC using histological staining, intestinal permeability assay, cytokine assay, flow cytometry, fecal microbiota transplantation (FMT), 16S rRNA sequencing, untargeted metabolomics, and cell differentiation. CSR administration significantly ameliorated the dextran sodium sulfate (DSS)-induced colitis in mice, which was evidenced by the recovered body weight and colon length as well as the decreased disease activity index (DAI) score and intestinal permeability. Meanwhile, CSR down-regulated the production of pro-inflammatory cytokines and up-regulated the amount of anti-inflammatory mediators at both mRNA and protein levels, and improved the balances of Treg/Th1 and Treg/Th17 to maintain the colonic immune homeostasis. Notably, all the therapeutic effects were exerted in a gut microbiota-dependent manner. Furthermore, CSR treatment increased the gut microbiota diversity and changed the compositions of the gut microbiota and metabolites, which is probably associated with the gut microbiota-mediated protective effects. In conclusion, this study provides the strong evidence that CSR may be a promising therapeutic drug for UC.

Clinical Outcomes Associated With His-Purkinje System Pacing vs. Biventricular Pacing, in Cardiac Resynchronization Therapy: A Meta-Analysis

Aims

His-Purkinje system pacing has recently emerged as an alternative to biventricular pacing (BIVP) in cardiac resynchronization therapy (CRT). The aim of this study was to conduct a meta-analysis comparing the clinical outcomes associated with His-Purkinje system pacing (HPSP) vs. BIVP in patients with heart failure. There is also a comparison of clinical outcomes of His-bundle pacing (HBP) and left bundle branch pacing (LBBP) in the His-Purkinje system.

Methods

We searched the Cochrane Library, Embase, and PubMed, for studies published between January 2010 and October 2021 that compared the clinical outcomes associated with HPSP vs. BIVP and HBP vs. LBBP in HPSP in patients who underwent CRT. The pacing threshold, R-wave amplitudes, QRS duration, New York Heart Association functional (NYHA), left ventricular ejection fraction (LVEF), and LV end-diastolic diameter (LVEDD) of heart failure, at follow-up, were extracted and summarized for meta-analysis.

Results

A total of 18 studies and 1517 patients were included in our analysis. After a follow-up period of 9.3 ± 5.4 months, the HPSP was found to be associated with shorter QRS duration in the CRT population compared to that in the BIVP (SMD, −1.17; 95% CI, −1.56 to −0.78; P &lt; 0.00001; I2 = 74%). No statistical difference was verified between HBP and LBBP on QRS duration (SMD, 0.04; 95% CI, −0.32 to 0.40; P = 0.82; I2 = 84%). In the comparison of HPSP and BIVP, the LBBP subgroup showed improved LVEF (SMD, 0.67; 95% CI, 0.42–0.91; P &lt; 0.00001; I2 = 0%), shorter LVEDD (SMD, 0.59; 95% CI, 0.93–0.26; P = 0.0005; I2 = 0%), and higher New York Heart Association functional class (SMD, −0.65; 95% CI, −0.86 to −0.43; P &lt; 0.00001; I2 = 45%). In terms of pacing threshold and R-wave amplitude clinical outcomes, LBBP has a lower pacing threshold (SMD, 1.25; 95% CI, 1.12–1.39; P &lt; 0.00001; I2 = 47%) and higher R-wave amplitude (MD, −7.88; 95% CI, −8.46 to −7.31; P &lt; 0.00001; I2 = 8%) performance compared to HBP.

Conclusion

Our meta-analysis showed that the HPSP produced higher LVEF, shorter QRS duration, and higher NYHA functional class in the CRT population than the BIVP as observed on follow-up. LBBP has a lower pacing threshold and higher R-wave amplitude. HPSP may be a new and promising alternative to BIVP in the future.

Berberine ameliorates DSS-induced intestinal mucosal barrier dysfunction through microbiota-dependence and Wnt/β-catenin pathway

Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disorder of the colon, and it has become one of the world-recognized medical problems as it is recurrent and refractory. Berberine (BBR) is an effective drug for UC treatment. However, the underlying mechanism and targets remain obscure. In this study, we systematically investigated the therapeutic effect and its mechanism of BBR in ameliorating DSS-induced mouse colitis. Expectedly, the colon inflammation was significantly relieved by BBR, and microbiota depletion by antibiotic cocktail significantly reversed the therapeutic effect. Further studies showed that BBR can regulate the abundance and component of bacteria, reestablish the broken chemical and epithelial barriers. Meanwhile, BBR administration dramatically decreased ILC1 and Th17 cells, and increased Tregs as well as ILC3 in colonic tissue of DSS-induced mice, and it was able to regulate the expression of various immune factors at the mRNA level. Moreover, a proteomic study revealed that Wnt/β-catenin pathway was remarkably enhanced in colonic tissue of BBR-treated mice, and the therapeutic effect of BBR was disappeared after the intervention of Wnt pathway inhibitor FH535. These results substantially revealed that BBR restores DSS-induced colon inflammation in a microbiota-dependent manner, and BBR performs its protective roles in colon by maintaining the structure and function of the intestinal mucosal barrier, regulating the intestinal mucosal immune homeostasis and it works through the Wnt/β-catenin pathway. Importantly, these findings also provided the proof that BBR serves as a potential gut microbiota modulator and mucosal barrier protector for UC prevention and therapy.

Enhancement patterns in the venous phase of contrast-enhanced ultrasounds: diagnostic value for patients with solid pancreatic lesions

Background

To observe and assess the diagnostic value of the venous phase enhancement patterns of contrast-enhanced ultrasounds (CEUS) in patients with solid pancreatic lesions that show iso- to hyperenhancement in the arterial phase of the CEUS.

Methods

Patients who underwent CEUS for pancreatic lesions in the Peking Union Medical College Hospital between April 2017 and August 2019 were identified from the dynamic CEUS imaging database in the hospital. A total of 57 patients with pathologically or clinically diagnosed pancreatic lesions were retrospectively included in this study, and the CEUS images from these patients were evaluated. The enhancement patterns in each phase were analyzed, and each lesion was classified as malignant or benign using a five-point scale of confidence based on morphology, boundary, vascular invasion, blood flow, and enhancement patterns in ultrasound (US) and CEUS images.

Results

Rapid washout in the venous phase of CEUS images was detected in 30 malignant lesions and 4 benign lesions with malignant potential. The specificity for determining malignancy was 77.8%. Continuous isoenhancement with normal pancreatic tissues in the venous phase achieved a high specificity of 95.0% for determining benign lesions. Early hyperenhancement in the arterial phase followed by slow washout in the venous phase showed high specificity of 98.1% for determining metastasis. The diagnostic confidence improved after reviewing CEUS scans (area under the receiver operating characteristic curve was 0.737 for baseline US and 0.910 for CEUS; P=0.056).

Conclusions

Enhancement patterns in the venous phase of CEUS images were beneficial in the differential diagnosis of solid pancreatic lesions with iso- to hyperenhancement in the arterial phase on CEUS.

Correlation Between Enhancement Patterns on Transabdominal Ultrasound and Survival for Pancreatic Ductal Adenocarcinoma

Objective

Investigate the CEUS enhancement patterns of PDAC and analyse correlations between the CEUS enhancement pattern and both the degree of tumour tissue differentiation and overall survival (OS).

Methods

The study included 56 patients with locally advanced PDAC, performed conventional ultrasound and CEUS, and analysed characteristics of the CEUS enhancement patterns. In addition, clinical data, such as serum level of CA19-9, TNM stage were collected, and patients’ survival times were followed up. TICs of dynamic CEUS images were acquired using image processing software to obtain the peak, TP, sharpness, and AUC. Correlations of the CEUS enhancement patterns of PDAC with the degree of differentiation of tumour tissue and OS were quantitatively analysed, as were the correlations of the TIC parameters and CEUS enhancement patterns with OS.

Results

Enhancement in the arterial phase included iso-enhancement (30.3%) and hypo-enhancement (69.6%), and was not significantly correlated with sex, age at disease onset, or lesion size. Also was not significantly correlated with tumour tissue differentiation. Clear survival times were obtained for 50 patients during follow-up, and the median survival time was significantly longer for the patients with iso-enhancement than hypo-enhancement. Among the TIC parameters, peak_tumour, sharpness_tumour, AEsharpness, and REsharpness differed significantly between the group with iso-enhancement and hypo-enhancement (p < 0.05).

Conclusion

The CEUS enhancement patterns of PDAC in the arterial phase include iso-enhancement and hypo-enhancement. Enhancement pattern was not significantly correlated with the degree of differentiation of tumour tissue, but patient survival time differed significantly between the two enhancement patterns, with longer survival for patients with iso-enhancement.

A Retrospective Study of Ultrasonography in the Investigation of Primary Hyperparathyroidism: A New Perspective for Ultrasound Echogenicity Features of Parathyroid Nodules

OBJECTIVE

To identify and understand parathyroid lesions of patients with primary hyperparathyroidism (PHPT) more accurately under ultrasound.

METHODS

This retrospective study involved 423 adult patients with PHPT with a single parathyroid nodule and positive parathyroid ultrasonography between 2018 and 2019. The clinical characteristics of the study patients and histopathologic sections were reviewed.

RESULTS

According to the main grayscale echogenicity features of parathyroid nodules, 423 cases were divided into groups: iso-hyperechogenicity solid (61/423), hypoechogenicity solid (304/423), and mixed-echogenicity cyst-solid (58/423) groups. Comparison among the 3 groups showed that the iso-hyperechogenicity group included more asymptomatic patients with PHPT and fewer patients with severe symptoms like bone fractures (P < .05). The mixed-echogenicity group showed higher median serum parathyroid hormone (PTH) and serum calcium levels and larger lesion sizes (P < .05), and the iso-hyperechogenicity group showed the lowest median serum PTH level. No difference in lesion size was noted between the 2 solid groups, but the median serum PTH level in the hypoechogenicity group was higher than that in the iso-hyperechogenicity group (P < .05). According to histopathology, the hypoechogenic area of the samples may contain more functional components (chief cells), whereas the iso-hyperechogenic area has more nonfunctional components (eg, lipocytes and connective tissues).

CONCLUSION

The PHPT nodules distinguished by ultrasound echogenicity features showed different histopathologic components, reflected by different clinical characteristics of the patients with PHPT.

Body Image Dissatisfaction and Impulse Buying: A Moderated Mediation Model

This study investigated the mediating roles of self-acceptance and self-esteem in the relationship between body image dissatisfaction and impulse buying, and tested the moderating effect of gender on the relationships. A sample of 374 college students and graduate students (33.4% male, 66.6% female) participated in the study. Results revealed that (a) body image dissatisfaction positively associated with impulse buying; (b) self-esteem plays a mediating role between body image dissatisfaction and impulsive buying; (c) a serial indirect pathway (i.e., Body image dissatisfaction → self-acceptance → self-esteem → impulse buying) emerged; (d) the mediation path from self-acceptance to self-esteem was stronger for female than that from male. The results underscore the importance of identifying the mechanisms that moderate the mediated path between body image dissatisfaction and impulse buying among students. These findings point to the potential implications about how to reduce impulse buying through improving body image satisfaction.

A systematic investigation on synergistic electroplating and capacitive removal of Pb2+ from artificial industrial waste water

A capacitive deionization cell designed with symmetric activated carbon electrodes was demonstrated to be able to successfully reduce wastewater Pb²⁺ concentrations to below the 5 ppm statuary limited for discharge into public sewers. The investigation found that the removal efficiency shows a maximum of 98% with an initial Pb²⁺ concentration of 100 ppm under an optimized voltage of 1.3 V. Although the reversibility of the process was poor during the first charge/discharge cycle, in part due to cathodic electrodeposition of lead hydroxycarbonates, this was improved by acidification of the electrolyte and subsequent cycles showed good reversibility. Finally, it was demonstrated that Na⁺ ions, with 50% removal efficiency and 100% reversibility, do not interfere with either the removal rate of Pb²⁺ ions or the reversibility of this process, providing a new angle on desalination applications for the system.

Schematic description of Pb²⁺ removal based on capacitive electrochemical technique.

Two-beam coupling by a hot electron nonlinearity

Transparent conductive oxides such as indium tin oxide (ITO) bear the potential to deliver efficient all-optical functionality due to their record-breaking optical nonlinearity at epsilon near zero (ENZ) wavelengths. All-optical applications generally involve more than one beam, but, to our knowledge, the coherent interaction between beams has not previously been discussed in these materials, which have a hot electron nonlinearity. Here we study the optical nonlinearity at ENZ in ITO and show that spatial and temporal interference has important consequences in a two-beam geometry. Our pump-probe results reveal a polarization-dependent transient that is explained by diffraction of pump light into the probe direction by a temperature grating produced by pump-probe interference. We further show that this effect allows tailoring the nonlinearity by tuning the frequency or chirp. Having fine control over the strong and ultrafast ENZ nonlinearity may enable applications in all-optical neural networks, nanophotonics, and spectroscopy.

Investigation on the Effect of Different Mild Acidic Electrolyte on ZIBs Electrode/Electrolyte Interface and the Performance Improvements With the Optimized Cathode

Zinc ion batteries (ZIBs), as promising alternatives of lithium ion batteries (LIBs), have aroused revived interest in the energy storage field recently. To obtain good performance, the choice of electrolyte plays a vital role. Therefore, in this work, three kinds of aqueous electrolyte have been assessed for interfacial effect and ZIB performance. Through the comparison, ZnSO₄ electrolyte showed advantages on ionic conductivity over both Zn(NO₃)₂ and Zn(CH₃COO)₂ solution, Zn(CH₃COO)₂ exhibited considerable Zn stripping/plating kinetics with ZnSO₄, and there was no characteristic peak pair of Zn dissolution/deposition found in Zn(NO₃)₂. Additionally, a lower charge transfer resistance was proved when the cell with 1 M ZnSO₄ solution. Besides, to further study on cathodic graphite paper, activation and optimization has been conducted, and cells with optimized graphite paper showed an outstanding enhancement.

Carotid artery stiffness in rural adult Chinese: a cross-sectional analysis of the community-based China stroke cohort study

OBJECTIVES

To derive normative carotid artery stiffness data in rural adult Chinese population-based study of ultrasound measurements of carotid elasticity by using quality arterial stiffness (QAS), and to assess the changes of relevant parameters in Chinese adults 40 years of age and older.

DESIGN

A China stroke cohort study (total number: 1586) in the northern countryside were carried out between June 2013 and April 2016, designed to investigate the risk factors of cardiovascular and age-related diseases.

SETTING

The present study was a cross-sectional analysis of an ongoing community-based Shunyi cohort study in China.

PARTICIPANTS

A total of 583 participants (227 men and 356 women; aged 40-80 years) with ultrasound carotid QAS examination were retrieved from the study to analyse.

PRIMARY AND SECONDARY OUTCOME MEASURES

Arterial stiffness parameters included diastolic diameter (Dd), pulse wave velocity (PWV), stiffness indices α and β were calculated by QAS. Other clinical indicators included physical measurements, medical histories and blood biochemical test.

RESULTS

In the entire study sample, mean Dd was 7.93±0.88 mm, mean PWV was 9.4±2.4 m/s, mean α was 7.65±5.13 and mean β was 15.53±10.29. PWV was significant higher in participants with hypertension (9.9 m/s vs 9.2 m/s in those without, p=0.002), and with diabetes (10.3 m/s vs 9.2 m/s in those without, p=0.003). PWV were significantly higher in participants with HbA1c at 5.8%-6.4% versus <5.8%, but no difference was found between subjects with glycohaemoglobin (HbA1c) at 5.8%-6.4% versus >6.4% (p=0.005, p=0.955, respectively). Age increase by every 10 years was associated with Dd increased by 0.27 mm, PWV increased by 1.2 m/s, α increased by 1.34 and β increased by 2.71. Systolic blood pressure (SBP) increase by every 10 mm Hg was associated with Dd increased by 0.15 mm, PWV increased by 0.35 m/s, α increased by 0.13 and β increased by 0.15.

CONCLUSION

Among the participants older than 40 years, stiffness of the carotid artery had differences between hypertension and non-hypertension adults, as well as between diabetes and non-diabetes adults. Stiffness of the carotid artery also have differences between adults with HbA1c at 5.8%-6.4% versus <5.8%. Stiffness of the carotid artery increases with increasing age and increasing SBP at a range from 40 and up.

Elevated Exhaustion Levels of NK and CD8+ T Cells as Indicators for Progression and Prognosis of COVID-19 Disease

Background

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) induced Coronavirus Disease 2019 (COVID-19) has posed a global threat to public health. The immune system is crucial in defending and eliminating the virus and infected cells. However, immune dysregulation may result in the rapid progression of COVID-19. Here, we evaluated the subsets, phenotypic and functional characteristics of natural killer (NK) and T cells in patients with COVID-19 and their associations with disease severity.

Methods

Demographic and clinical data of COVID-19 patients enrolled in Wuhan Union Hospital from February 25 to February 27, 2020, were collected and analyzed. The phenotypic and functional characteristics of NK cells and T cells subsets in circulating blood and serum levels of cytokines were analyzed via flow cytometry. Then the LASSO logistic regression model was employed to predict risk factors for the severity of COVID-19.

Results

The counts and percentages of NK cells, CD4⁺ T cells, CD8⁺ T cells and NKT cells were significantly reduced in patients with severe symptoms. The cytotoxic CD3^-CD56^dimCD16⁺ cell population significantly decreased, while the CD3^-CD56^dimCD16^- part significantly increased in severe COVID-19 patients. More importantly, elevated expression of regulatory molecules, such as CD244 and programmed death-1 (PD-1), on NK cells and T cells, as well as decreased serum cytotoxic effector molecules including perforin and granzyme A, were detected in patients with COVID-19. The serum IL-6, IL-10, and TNF-α were significantly increased in severe patients. Moreover, the CD3^-CD56^dimCD16^- cells were screened out as an influential factor in severe cases by LASSO logistic regression.

Conclusions

The functional exhaustion and other subset alteration of NK and T cells may contribute to the progression and improve the prognosis of COVID-19. Surveillance of lymphocyte subsets may in the future enable early screening for signs of critical illness and understanding the pathogenesis of this disease.

A novel chiral surfactant-type metallomicellar catalyst for asymmetric Michael addition in water

A series of Schiff-based ligands consisting of both tertiary amines and lipophilic groups were designed and synthesized. Using these ligands, a new chiral surfactant-type metallomicellar catalyst was developed in water, and this was identified by SEM/TEM analyses. These metallomicelles can be empolyed in asymmetric Michael addition reactions in water, delivering the corresponding adducts with excellent yields and enantioselectivities.

Obesity is a potential risk factor contributing to clinical manifestations of COVID-19

BACKGROUND

Since December 2019, novel coronavirus (SARS-CoV-2)-induced pneumonia (COVID-19) occurred in Wuhan, and rapidly spread throughout China. COVID-19 patients demonstrated significantly different outcomes in clinic. We aimed to figure out whether obesity is a risk factor influencing the progression and prognosis of COVID-19.

METHODS

95 patients with COVID-19 were divided into obesity group and non-obesity group according to their body mass index (BMI). The demographic data, clinical characteristics, laboratory examination, and chest computed tomography (CT) were collected, analyzed and compared between two groups.

RESULTS

Our data showed that COVID-19 patients with obesity had more underlying diseases and higher mortality rate compared to those without obesity. Furthermore, patients with obesity also demonstrated more severe pathological change in lung and higher blood lymphocytes, triglycerides, IL-6, CRP, cystatin C, alanine aminotransferase (ALT), erythrocyte sedimentation rate (ESR), which may greatly influence disease progression and poor prognosis of COVID-19.

CONCLUSIONS

It suggest that obesity contributes to clinical manifestations and may influence the progression and prognosis of COVID-19 and it is considered as a potential risk factor of the prognosis of COVID-19. Special medical care and appropriate intervention should be performed in obesity patients with COVID-19 during hospitalization and later clinical follow-up, especially for those with additional other comorbidities.

A novel simple scoring model for predicting severity of patients with SARS-CoV-2 infection

An outbreak of pneumonia caused by a novel coronavirus (COVID‐19) began in Wuhan, China in December 2019 and quickly spread throughout the country and world. An efficient and convenient method based on clinical characteristics was needed to evaluate the potential deterioration in patients. We aimed to develop a simple and practical risk scoring system to predict the severity of COVID‐19 patients on admission. We retrospectively investigated the clinical information of confirmed COVID‐19 patients from 10 February 2020 to 29 February 2020 in Wuhan Union Hospital. Predictors of severity were identified by univariate and multivariate logistic regression analysis. A total of 147 patients with confirmed SARS‐CoV‐2 infection were grouped into non‐severe (94 patients) and severe (53 patients) groups. We found that an increased level of white blood cells (WBC), neutrophils, D‐dimer, fibrinogen (FIB), IL‐6, C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), α‐hydroxybutyrate dehydrogenase (HBDH), serum amyloid A (SAA) and a decreased level of lymphocytes were important risk factors associated with severity. Furthermore, three variables were used to formulate a clinical risk scoring system named COVID‐19 index = 3 × D‐dimer (µg/L) + 2 × lgESR (mm/hr) − 4 × lymphocyte (×10⁹/L) + 8. The area under the receiver operating characteristic (ROC) curve was 0.843 (95% CI, 0.771–0.914). We propose an effective scoring system to predict the severity of COVID‐19 patients. This simple prediction model may provide healthcare workers with a practical method and could positively impact decision‐making with regard to deteriorating patients.

Lewis Acid-Catalyzed Enantioselective Friedel-Crafts Alkylation of Pyrrole in Water

Highly enantioselective Friedel-Crafts alkylation of pyrroles with 2-enoyl-pyridine N-oxides in water/chloroform (10:1) was developed under catalysis of Lewis acid. The Friedel-Crafts alkylation products can be obtained in high yields and excellent enantioselectivities. Moreover, several control experiments were carried out to study the reaction mechanism.

Ionic liquid-aided hydrothermal treatment of lignocellulose for the synergistic outputs of carbon dots and enhanced enzymatic hydrolysis

How to propel an efficient exploitation of waste streams is a pivotal tache for the long-range augment of hydrothermal biomass valorization. A facile approach was proposed to simultaneously produce carbon dots (CDs), fermentable sugar, and cellulose enzymatic lignin from agricultural straw with the aid of ionic liquid (IL, 1-aminoethyl-3-methylimidazolium nitrate, [C2NH2MIm][NO3]) catalyzed hydrothermal treatment. The graphite N-doped CDs with bright-blue fluorescence, which was mainly derived from the incorporation of hemicellulose (e.g. xylooligosaccharides), lignin and [C2NH2MIm][NO3], exhibited an average-diameter of 8.14 nm. The exfoliation of amorphous parts and robust fibers was formed to improve cellulose digestibility from 14.7 to 81.6%. The efficient recovery and checkup of lignin pave a way for its potential depolymerization into arenes. This protocol offers a significant benefit for large-scale hydrothermal biorefinery where reduction of process waste is a prime concern, and leads to high-value products (i.e., CDs and lignin) that also fosters the feasibility of bioethanol.

AB0104 CORRELATION OF PLASMA 14-3-3Η LEVELS WITH DISEASE ACTIVITY MEASURES IN METHOTREXATE-NAÏVE RA PATIENTS TREATED WITH UPADACITINIB MONOTHERAPY IN THE SELECT-EARLY PHASE 3 STUDY

Background:

Early diagnosis and treat-to-target strategies in RA improve clinical and radiographic outcomes. 14-3-3η is a soluble diagnostic biomarker that is involved in the pathogenesis of RA (1) including the potent activation of key signalling cascades such as the JAK-STAT pathway and whose initial expression coincides with a transition to synovitis. In undifferentiated arthralgia, 14-3-3η independently predicts the development of RA. In confirmed RA, 14-3-3η levels decrease with treatment response (2) and those changes are associated with clinical and radiographic outcomes, including the prediction of joint damage progression in patients who have achieved clinical remission. Upadacitinib (UPA), an oral JAK1-selective inhibitor, demonstrated significant and clinically meaningful improvements in RA vs. methotrexate (MTX) in the SELECT-EARLY phase 3 study (3).

Objectives:

To determine the impact of treatment with UPA monotherapy 15 mg QD on the levels of plasma 14-3-3η and to explore its relationship with clinical measures in early MTX-naïve RA patients.

Methods:

Patients from the SELECT-EARLY study were randomly selected (UPA n = 100; MTX n = 100) from the pool of patients with available plasma samples. 14-3-3η tests were performed at Augurex according to standard operating procedures. Concentrations (ng/mL) were log-transformed for analysis. Non-parametric correlations between biomarker data and clinical end points were derived using the Spearman method. Changes in 14-3-3η over time were compared using a Repeated Measure Mixed Linear Model. All statistical analyses were conducted in JMP 14.1 (SAS Institute).

Results:

At baseline, 79% of patients were 14-3-3η positive (≥ 0.19 ng/mL) with similar levels in both arms. Baseline levels of 14-3-3η correlated significantly with baseline disease activity measures (CDAI ρ = 0.164, p = 0.042; DASCRP ρ = 0.222, p = 0.004; and SDAI ρ = 0.177, p = 0.028) but not with baseline mTSS (ρ =-0.021, p = 0.787); of note baseline mTSS were relatively low in this subset of early RA patients (median = 2, IQR [0 – 9.5]). Over time, 14-3-3η levels tended to be lower in both the UPA and MTX groups. However, only treatment with UPA for 24 weeks resulted in a significant decrease in circulating 14-3-3η (p = 0.0002) (Figure 1). In addition, at week 24 in the UPA arm, changes in 14-3-3η levels correlated significantly with changes in concurrent disease activity measures (Δ CDAI ρ = 0.264, p = 0.030; Δ DASCRP ρ = 0.267, p = 0.021; and Δ SDAI ρ = 0.267, p = 0.028) but not with change in mTSS (ρ =-0.186, p = 0.111). In contrast to UPA, the relatively small changes in 14-3-3η induced by MTX did not correlate with any clinical measures.

Figure1

Conclusion:

This study demonstrates that treatment with UPA 15 mg QD monotherapy for 24 weeks significantly reduces the levels of circulating 14-3-3η in MTX-naïve RA patients and that these changes correlate with clinical measures of disease activity. Although we were not able to detect a clear relationship between changes in 14-3-3η and rate of structural damage progression, we would like to hypothesize that the superior clinical activity of UPA over MTX on joint damage may be related to the significant reduction in 14-3-3η induced by UPA; this hypothesis should be tested in a larger RA cohort with a larger proportion of joint damage progressors.

References:

[1]Maksymowych WP et al. Arthritis Res Ther. 2014;16(2):R99.

[2]Hirata S et al. Arthritis Res Ther. 2015;17(1):280.

[3]van Vollenhoven R et al. Arthritis Rheumatol.;2018 (Suppl 10; vol.70).

Disclosure of Interests:

Thierry Sornasse Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, Simran Chahal Shareholder of: Augurex Life Science Corp, Employee of: Augurex Life Science Corp, Yuan Gui Shareholder of: Augurex Life Science Corp, Employee of: Augurex Life Science Corp, Neeraja Nagarajan Employee of: Augurex Life Science Corp, Alan Friedman Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, Norma Biln Shareholder of: Augurex Life Science Corp, AbbVie Inc, Employee of: Augurex Life Science Corp

0973 Maternal Depression And Infant Sleep Duration Trajectory In The First 3 Years: A Prospective Cohort Study

Introduction

The study was to investigate trajectories of infant sleep duration and associations with trajectories of maternal depression status during 3 years post-partum.

Methods

Data were from the Child Health Promotion Project in Shanghai (CHPPS). Mothers were recruited at the third trimester of pregnancy and followed up together with the infants until 36 months postpartum. Between 2012 and 2013, 262 women (Mage=29.5, SDage=3.2, range: 22-39 years old) were recruited and were followed from June 2012 to August 2015. Sleep duration of the children was assessed using Brief Infant Sleep Questionnaire (BISQ) at 42 days, 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, and 36 months postpartum. Center for Epidemiological Survey-Depression Scale (CESD), Edinburgh Postnatal Depression Scale (EPDS), and the Profile of Mood States (POMS) were used to measure the mother’s depression status at late pregnancy, 42 days postpartum, and 12-36 months postpartum, respectively. The group-based trajectory models (GBTM) were used to estimate patterns of infant sleep duration development and maternal depression status.

Results

Two trajectories of infant day sleep duration were identified, defined as “initial short sleepers” (54.8%) and “initial long sleepers” (45.2%). Three trajectories of infant night sleep duration were identified, labeled as “increasing” (8.5%), “stable” (61.7%), and “mild declining” (29.8%). Two trajectories infant total sleep duration were identified, defined as “initial short sleepers” (51.5%) and “initial long sleepers” (48.5%). Two trajectories of maternal depression status were identified, labeled as “low” (74.2%) and “high” (25.8%). After controlling for covariates, women who have higher depression status had infants of shorter day sleep duration. There was no significant association with infant night sleep duration.

Conclusion

Our study suggests that maternal postpartum depression is associated with short infant day sleep duration, but not with infant night sleep duration.

Support

Supported by the Chinese National Natural Science Foundation of China (81773443, 81728017, 81602870, 81601162, 81602868)

Synergistic benefits from a lignin-first biorefinery of poplar via coupling acesulfamate ionic liquid followed by mild alkaline extraction

A novel mind-set, termed lignin-first biorefinery, is bewitching to synchronously boost lignin output for entirely lignocellulosic utilization. A lignin-first fractionation, using a food-additive derived ionic liquid (1-ethyl-3-methylimidazolium acesulfamate, emimAce) and mild alkaline pretreatments, was formed for the purposely isolating poplar lignin, whilst delivering a cellulose-rich substrate that can be easily available for enzymatic digestion. The emimAce-driven lignin, alkali-soluble lignin and hemicellulose, and accessible cellulose were sequentially gained. We introduce a lignin-first approach to extract the amorphous fractions, destroy the robust architecture, and reform cellulose-I to II, thereby advancing the cellulose bioconversion from 15.4 to 90.5%. A harvest of 70.7% lignin, 52.1% hemicellulose, and 330.1 mg/g glucose was fulfilled from raw poplar. A structural ''beginning-to-end'' analysis of lignin inferred that emimAce ions are expected to interact with lignin β-aryl-ether due to their aromatic character. It was reasonable to derive benefits from lignin-first technique that can substantially augment the domain of biorefinering.

Carotid atherosclerosis, dilation, and stiffness relate to cerebral small vessel disease

OBJECTIVE

To investigate the association of carotid atherosclerosis, dilation, and stiffness with imaging markers of cerebral small vessel disease (CSVD) in a community-based sample.

METHODS

The study comprised 1,051 participants (age 57.5 ± 9.2 years). Carotid plaques, intima-media thickness (IMT), diastolic diameter, pulse wave velocity, and stiffness index (β) were measured by ultrasound. Imaging markers of CSVD, including lacunes, cerebral microbleeds, dilated PVS, and white matter hyperintensities (WMH) volume, were assessed.

RESULTS

Carotid plaque was associated with the presence of lacunes (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.78-4.33; p < 0.001) and larger WMH volume (natural log transformed, β ± SE, 0.32 ± 0.10; p = 0.002). The increased carotid diameter was associated with the presence of lacunes (OR 1.82, 95% CI 1.22-2.72; p = 0.003), larger WMH volume (β ± SE, 0.37 ± 0.10; p < 0.001), and PVS in the basal ganglia (OR 1.59, 95% CI 1.20-2.11; p = 0.001). Associations of carotid dilation and CSVD were independent of carotid IMT and plaque. Most parenchymal lesions were located in the basal ganglia and deep white matter. Carotid IMT and stiffness were not associated with CSVD.

CONCLUSIONS

Carotid atherosclerosis and dilation are associated with imaging markers of CSVD. The noninvasive carotid assessment would seem to be a rational approach to risk stratification of CSVD.

[The inhibition of 18β-sodium glycyrrhetinic acid on thymic stromal lymphopoietin expression in the nasal mucosa of allergic rhinitis rats]

Objective: To explore the effect of 18β-sodium glycyrrhetinic acid on thymic stromal lymphopoietin (TSLP) in nasal mucosa of allergic rhinitis (AR) rats. Methods: One hundred Wistar rats,half male and half female,were randomly divided into 5 groups by random number table method: control group, AR model group,budesonide group,18β-sodium glycyrrhetinic acid at dose of 20 mg/kg and 40 mg/kg groups, with 20 rats in each group. AR animal models were established by ovalbumin (OVA) sensitization in the other four experimental groups. After successful modeling, budesonide and 18β-sodium glycyrrhetinic acid were given in each group,and the detection time points were 2 weeks and 4 weeks. The distribution of TSLP in rat nasal mucosa was detected by immunohistochemistry,and the expression of TSLP in rat nasal mucosa was determined by Western blot at the protein level. The expression of TSLP-mRNA in rat nasal mucosa was detected and compared by real-time fluorescence quantitative PCR (RT-PCR) at mRNA level. The concentrations of IL-4 and OVA-sIgE in rat serum were measured and compared by ELISA. One-way analysis of variance and the least significant difference method were used for the comparison among groups, LSD t test was used for the comparison between the two groups,and the difference was statistically significant (P<0.05). Results: Immunohistochemistry confirmed existence of TSLP in rat nasal mucosa, especially in epithelial cells,endothelial cells and epithelial cilia. Western blot and RT-PCR suggested that the expression of TSLP and TSLP-mRNA in nasal mucosa of AR model group was significantly higher than that of control group (2 weeks TSLP: 1.795 9±0.131 4 vs 0.990 5±0.164 2, 4 weeks TSLP: 1.809 7±0.253 4 vs 0.870 3±0.124 4; 2 weeks TSLP-mRNA:4.582 9±0.697 7 vs 1.108 7±0.081 1, 4 weeks TSLP-mRNA:4.814 4±0.662 8 vs 1.001 0±0.155 3; all P<0.05). After 2 weeks and 4 weeks of drug intervention,the expression of TSLP and TSLP-mRNA was inhibited in nasal mucosa of budesonide group,18β-sodium sodium glycyrrhetinic acid at dose of 20 mg/kg and 40 mg/kg group,which was significantly different from that of AR model group (2 weeks TSLP: (0.897 8±0.081 8)/(1.072 1±0.113 6)/(1.396 6±0.133 9) vs 1.795 9±0.131 4; 4 weeks TSLP: (1.191 0±0.161 3)/(1.141 0±0.152 3)/(1.200 5±0.189 6) vs 1.809 7±0.253 4; 2 weeks TSLP-mRNA: (1.175 6±0.100 9)/(1.254 4±0.078 2)/(2.037 2±0.559 2) vs 4.582 9±0.697 7; 4 weeks TSLP-mRNA: (1.158 3±0.104 3)/(1.224 0±0.034 0)/(1.275 2±0.099 6) vs 4.814 4±0.662 8; all P<0.05), and not significantly different from control group. With the inhibition of TSLP, the concentrations of IL-4 and OVA-sIgE in rat serum were also decreased. Conclusion: 18β-sodium glycyrrhetinic acid has obvious inhibitory effect on TSLP in nasal mucosa of AR rats, which can control Th2 type immune inflammatory reaction.

[Effects of 18β-sodium glycyrrhetinic acid on TNF-α expression in rats with allergic rhinitis]

Objective:To observe the effect of 18β-sodium glycyrrhetinic acid(18β-SGA) on the expression of TNF-α in nasal mucosa of rats with allergic rhinitis（AR）, and explore the intervention mechanism of 18β-SGA on AR. Method:One hundred and six SPF-level Wistar rats were randomly divided into control group, AR group, budesonide group, 18β-SGA low dose group and high dose group. After the AR rat model was constructed by ovalbumin, the rats were given drug intervention and sacrificed after 2 and 4 weeks of intervention. The nasal mucosa of the rats was taken for immunohistochemical staining, RT-qPCR and Western-blotting to localize and quantify the expression of TNF-α. Result:By immunohistochemistry, Western-blotting and RT-PCR, TNF-α was mainly found in the columnar epithelium, vascular endothelium, glandular and some inflammatory cytoplasm of nasal mucosa. And the expression of TNF-α in the nasal mucosa of AR rats was significantly increased than the normal group at the protein and mRNA levels (P<0.01). After intervention with different doses of 18β-SGA, the expression of TNF-α was significantly decreased (P<0.01), especially after 4 weeks of 18β-SGA low dose group(P<0.01). Conclusion:Different doses of 18β-SGA have therapeutic effects on AR, and its mechanism of action may be related to the inhibition of TNF-α expression.

A case report of cholangiocarcinoma combined with moderately differentiated gastric adenocarcinoma

RATIONALE

Multiple primary carcinoma (MPM) refers to simultaneous or successive occurrence of ≥2 types of primary malignant tumors in a single organ or in different organs of the same individual. It is rarely seen in clinical practice. Among the various types of MPM, hilar cholangiocarcinoma combined with gastric cancer is extremely rare.

PATIENT CONCERNS

The patient was a 61-year-old man who was admitted to our hospital due to upper abdominal discomfort and yellow-stained skin mucosa for 9 days.

DIAGNOSES

Preoperative diagnosis: Considering the typical preoperative painless jaundice as well as his clinical imaging report, the patient received the following preoperative diagnosis: obstructive jaundice, type IV hilar cholangiocarcinoma based on Bismuth-Corlette classification, and no intrahepatic distant metastasis. Intraoperative diagnosis: The results of intraoperative snap freezing and laboratory examination indicated gastric adenocarcinoma. Therefore, the patient received an intraoperative diagnosis of obstructive jaundice, hilar cholangiocarcinoma, and gastric cancer. Postoperative pathological diagnosis: Postoperative pathological examination of the gastric lesion revealed the following results: ulcerative, moderately differentiated gastric adenocarcinoma and intestinal type in the Lauren classification of stomach cancer; moderately differentiated adenocarcinoma of the bile duct.

INTERVENTIONS

Surgical resection operation was carried out and the patient received chemotherapy after operation. But we could not strictly follow the relevant clinical guidelines to perform standardized operations and provide comprehensive treatment because of his economic situation, psychological factors, and the current medical environment in China.

OUTCOMES

The patient did not receive standardized postoperative therapy. Although he lived and worked normally for 8 months after the operation, he died 10 months after surgery.

LESSONS

This report reminds us to pay close attention to the likelihood of MPM and other low-incidence diseases. The physicians and imaging clinicians should explore all clinical possibilities to avoid misdiagnosis of this rare disease and formulate effective treatment plans to maximize the therapeutic benefits for the patient.

Copper-catalyzed enantioselective Mukaiyama aldol reaction of silyl enol ethers with isatins

A highly enantioselective Mukaiyama aldol reaction of silyl enol ethers with isatins catalyzed by chiral copper complexes was developed. A series of chiral 3-substituted 3-hydroxy-2-oxindoles bearing a tetra-substituted center could be obtained exclusively with high yields (up to 95%) and excellent enantioselectivities (up to 99%). In particular, water was essential to improve the diastereoselectivity.

Analysis of the autophagy gene expression profile of pancreatic cancer based on autophagy-related protein microtubule-associated protein 1A/1B-light chain 3

BACKGROUND

Pancreatic cancer is a highly invasive malignant tumor. Expression levels of the autophagy-related protein microtubule-associated protein 1A/1B-light chain 3 (LC3) and perineural invasion (PNI) are closely related to its occurrence and development. Our previous results showed that the high expression of LC3 was positively correlated with PNI in the patients with pancreatic cancer. In this study, we further searched for differential genes involved in autophagy of pancreatic cancer by gene expression profiling and analyzed their biological functions in pancreatic cancer, which provides a theoretical basis for elucidating the pathophysiological mechanism of autophagy in pancreatic cancer and PNI.

AIM

To identify differentially expressed genes involved in pancreatic cancer autophagy and explore the pathogenesis at the molecular level.

METHODS

Two sets of gene expression profiles of pancreatic cancer/normal tissue (GSE16515 and GSE15471) were collected from the Gene Expression Omnibus. Significance analysis of microarrays algorithm was used to screen differentially expressed genes related to pancreatic cancer. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were used to analyze the functional enrichment of the differentially expressed genes. Protein interaction data containing only differentially expressed genes was downloaded from String database and screened. Module mining was carried out by Cytoscape software and ClusterOne plug-in. The interaction relationship between the modules was analyzed and the pivot nodes between the functional modules were determined according to the information of the functional modules and the data of reliable protein interaction network.

RESULTS

Based on the above two data sets of pancreatic tissue total gene expression, 6098 and 12928 differentially expressed genes were obtained by analysis of genes with higher phenotypic correlation. After extracting the intersection of the two differential gene sets, 4870 genes were determined. GO analysis showed that 14 significant functional items including negative regulation of protein ubiquitination were closely related to autophagy. A total of 986 differentially expressed genes were enriched in these functional items. After eliminating the autophagy related genes of human cancer cells which had been defined, 347 differentially expressed genes were obtained. KEGG pathway analysis showed that the pathways hsa04144 and hsa04020 were related to autophagy. In addition, 65 clustering modules were screened after the protein interaction network was constructed based on String database, and module 32 contains the LC3 gene, which interacts with multiple autophagy-related genes. Moreover, ubiquitin C acts as a pivot node in functional modules to connect multiple modules related to pancreatic cancer and autophagy.

CONCLUSION

Three hundred and forty-seven genes associated with autophagy in human pancreatic cancer were concentrated, and a key gene ubiquitin C which is closely related to the occurrence of PNI was determined, suggesting that LC3 may influence the PNI and prognosis of pancreatic cancer through ubiquitin C.