Ratio of 4:1 between ZnGeAs2and MnAs phases in a single composite and its impact on the structure-driven magnetoresistance

A strong influence of the lattice degree of freedom on magnetoresistance (MR) under high pressure underlies the conception of 'structure-driven' magnetoresistance (SDMR). In most magnetic or topological materials, the suppression of MR with increasing pressure is a general trend, while for some magnetic composites the MR enhances and even shows unusual behavior as a consequence of structural transition. Here we investigated the SDMR in the composite material based on the ZnGeAs2semiconductor matrix and MnAs magnetic inclusions in a phase ratio of 4:1. At ambient pressure, its magnetic and transport properties are governed by MnAs inclusions, i.e. it shows a Curie temperatureTC≈ 320 K and metallic-like conductivity. Under high pressure, the low-field room temperature MR undergoes multiple changes in the pressure range up to 7.2 GPa. The structural transition in the ZnGeAs2matrix has been found at ∼6 GPa, slightly lower than in the pure ZnGeAs2(6.2 GPa). The huge SDMR as high as 85% at 6.8 GPa and 2.5 kOe, which contains both positive and negative MR components, is accompanied by a pressure-induced metallic-like-to-semiconductor-like transition and the enhanced ferromagnetic order of MnAs inclusions. This observation offers a competing mechanism between the robust extrinsic ferromagnetism and high-pressure electronic properties of ZnGeAs2.

Review: Mechanism, effectiveness, and the prospects of medicinal plants and their bioactive compounds in lowering ruminants' enteric methane emission

Animal nutritionists continue to investigate new strategies to combat the challenge of methane emissions from ruminants. Medicinal plants (MPs) are known to be beneficial to animal health and exert functional roles in livestock due to their phytogenic compounds with antimicrobial, immunostimulatory, antioxidative, and anti-inflammatory activities. Some MP has been reported to be anti-methanogenic and can effectively lower ruminants' enteric methane emissions. This review overviews trends in MP utilization in ruminants, their bioactivity and their effectiveness in lowering enteric methane production. It highlights the MP regulatory mechanism and the gaps that must be critically addressed to improve its efficacy. MP could reduce enteric methane production by up to 8-50% by regulating the rumen fermentation pathway, directing hydrogen toward propionogenesis, and modifying rumen diversity, structure, and population of the methanogens and protozoa. Yet, factors such as palatability, extraction techniques, and economic implications must be further considered to exploit their potential fully.

Cross-validation approaches for penalized Cox regression

Cross-validation is the most common way of selecting tuning parameters in penalized regression, but its use in penalized Cox regression models has received relatively little attention in the literature. Due to its partial likelihood construction, carrying out cross-validation for Cox models is not straightforward, and there are several potential approaches for implementation. Here, we propose a new approach based on cross-validating the linear predictors of the Cox model and compare it to approaches that have been proposed elsewhere. We show that the proposed approach offers an attractive balance of performance and numerical stability, and illustrate these advantages using simulated data as well as analyzing a high-dimensional study of gene expression and survival in lung cancer patients.

Oral Lipid Nanocrystal Amphotericin B for Cryptococcal Meningitis: A Randomized Clinical Trial

BACKGROUND

Amphotericin B is the gold standard treatment for severe mycoses. A new orally delivered, less-toxic formulation of amphotericin has been developed.

METHODS

In our randomized clinical trial, we tested oral lipid nanocrystal (LNC) amphotericin B (MAT2203, Matinas Biopharma) vs intravenous (IV) amphotericin for human immunodeficiency virus-associated cryptococcal meningitis in 4 sequential cohorts. Two pilot cohorts assessed safety and tolerability (n = 10 each), and 2 cohorts assessed efficacy with/without 2 IV loading doses (n = 40 each). The experimental arm received 1.8 g/d oral LNC amphotericin through 2 weeks with 100 mg/kg/d flucytosine, then 1.2 g/d LNC amphotericin through 6 weeks. The randomized control arm (n = 41) received 7 days of IV amphotericin with flucytosine, then 7 days of fluconazole 1200 mg/d. The primary end point was cerebrospinal fluid (CSF) early fungicidal activity (EFA).

RESULTS

We randomized 80 participants to oral LNC amphotericin + flucytosine with (n = 40) and without (n = 40) 2 IV loading doses and 41 control participants to IV amphotericin + flucytosine. Mean EFA was 0.40 log10 colony-forming units (CFU)/mL/d for all-oral LNC amphotericin, 0.42 log10  Cryptococcus CFU/mL/d for oral LNC amphotericin with IV loading doses, and 0.46 log10 CFU/mL/d for IV amphotericin controls. LNC amphotericin groups achieved 2-week CSF sterility in 63% (44 of 70) vs 68% (23 of 34) of controls. The 18-week survival was 85% (34 of 40) with all-oral LNC amphotericin, 90% (36 of 40) with oral LNC amphotericin given IV loading doses, and 85% (35 of 41) with IV amphotericin.Grade 3-4 laboratory adverse events occurred less frequently in LNC amphotericin groups (41%) than the IV amphotericin group (61%, P = .05), particularly for anemia (21% vs 44%; P = .01) and potassium (5% vs 17%; P = .04).

CONCLUSIONS

This new oral amphotericin B LNC formulation appears promising for cryptococcal meningitis with antifungal activity, similar survival, and less toxicity than IV amphotericin.

CLINICAL TRIALS REGISTRATION

NCT04031833.

[Comparison of the efficiency of different etiological assays for detection of Schistosoma japonicum infections in wild mice]

OBJECTIVE

To compare the efficiency of multiple etiological techniques for detection of Schistosoma japonicum infections in wild mice, so as to provide technical supports to assessment of schistosomiasis transmission risk.

METHODS

Wild mice were captured with baited traps at night in Oncomelania hupensis snail-infested settings in schistosomiasis-endemic foci of Anhui Province from October to November, 2022. S. japonicum infections were detected in wild mice using microscopy of mouse liver tissues, microscopy of mouse mesenteric tissues, microscopy of mouse liver tissue homogenates, miracidial hatching test of mouse liver tissue homogenates, Kato-Katz technique and miracidial hatching test of mouse stool samples alone and in combinations. Identification of S. japonicum eggs or miracidia by any of these six assays was defined as an infection. The sensitivity of six assays alone or in combinations was compared for detection of S. japonicum infections in wild mice.

RESULTS

A total of 1 703 wild mice were captured, with 366 wild mice detected positive for S. japonicum (21.49%). There were significant differences in the prevalence of S. japonicum infections in wild mice by six assays (Q = 529.33, P < 0.001) and in the sensitivity of six assays for detection of S. japonicum infections in wild mice (χ2 = 527.78, P < 0.001). In addition, the combination of microscopy of mouse liver tissues and mesenteric tissues, combination of microscopy of mouse liver tissues and liver tissue homogenates and combination of microscopy of mouse liver tissues, microscopy of mesenteric tissues, microscopy of liver tissue homogenates and Kato-Katz technique showed 86.61%, 87.16% and 97.27% sensitivities for detection of S. japonicum infections in wild mice, respectively.

CONCLUSIONS

Diverse etiological assays show various efficiencies for detection of S. japonicum infections in wild mice. Combination of microscopy of mouse liver tissues and microscopy of mesenteric tissues, and combination of microscopy of mouse liver tissues and microscopy of liver tissue homogenates are potential approaches for field detection of S. japonicum infections in wild mice.

5-Flucytosine Longitudinal Antifungal Susceptibility Testing of Cryptococcus neoformans: A Substudy of the EnACT Trial Testing Oral Amphotericin

Background

The EnACT trial was a phase 2 randomized clinical trial conducted in Uganda, which evaluated a novel orally delivered lipid nanocrystal (LNC) amphotericin B in combination with flucytosine for the treatment of cryptococcal meningitis. When flucytosine (5FC) is used as monotherapy in cryptococcosis, 5FC can induce resistant Cryptococcus mutants. Oral amphotericin B uses a novel drug delivery mechanism, and we assessed whether resistance to 5FC develops during oral LNC-amphotericin B therapy.

Methods

We enrolled Ugandans with HIV diagnosed with cryptococcal meningitis and who were randomized to receive 5FC and either standard intravenous (IV) amphotericin B or oral LNC-amphotericin B. We used broth microdilution to measure the minimum inhibitory concentration (MIC) of the first and last cryptococcal isolates in each participant. Breakpoints are inferred from 5FC in Candida albicans. We measured cerebral spinal fluid (CSF) 5FC concentrations by liquid chromatography and tandem mass spectrometry.

Results

Cryptococcus 5FC MIC50 was 4 µg/mL, and MIC90 was 8 µg/mL. After 2 weeks of therapy, there was no evidence of 5FC resistance developing, defined as a >4-fold change in susceptibility in any Cryptococcus isolate tested. The median CSF 5FC concentration to MIC ratio (interquartile range) was 3.0 (1.7-5.5) µg/mL. There was no association between 5FC/MIC ratio and early fungicidal activity of the quantitative rate of CSF yeast clearance (R2 = 0.004; P = .63).

Conclusions

There is no evidence of baseline resistance to 5FC or incident resistance during combination therapy with oral or IV amphotericin B in Uganda. Oral amphotericin B can safely be used in combination with 5FC.

Achieving Normoglycemia With Tirzepatide: Analysis of SURPASS 1-4 Trials

OBJECTIVE

Tirzepatide is a novel single-molecule glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, which demonstrated unprecedented improvements in glycemic control and body weight reduction, in the SURPASS phase 3 program. In this exploratory analysis, we aimed to characterize tirzepatide-treated participants who achieved HbA1c <5.7% and evaluate changes in clinical markers associated with long-term cardiometabolic health.

RESEARCH DESIGN AND METHODS

Baseline characteristics and change from baseline to week 40 for several efficacy and safety parameters were analyzed according to HbA1c attainment category (<5.7%, 5.7-6.5%, and >6.5%) using descriptive statistics in participants taking ≥75% of treatment doses, without rescue medication, in the SURPASS 1-4 trials (N = 3,229). Logistic regression models with tirzepatide doses adjusted as a covariate were used to obtain odds ratios and assess the impact of patient characteristics achieving an HbA1c <5.7%.

RESULTS

Tirzepatide-treated participants who achieved HbA1c <5.7% were slightly younger, with a shorter duration of diabetes and lower HbA1c value at baseline compared with those who did not achieve HbA1c <5.7%. In addition, they showed greater improvements in HbA1c, body weight, waist circumference, blood pressure, liver enzymes, and lipid parameters without increasing hypoglycemia risk.

CONCLUSIONS

Normoglycemia was unprecedently achieved in a significant proportion of participants in the SURPASS clinical program, without increasing hypoglycemia risk, and was associated with an overall improvement in metabolic health.

Gender equity of authorship in pulmonary medicine over the past decade

BACKGROUND

Gender disparity in authorship broadly persists in medical literature, little is known about female authorship within pulmonary medicine.

METHODS

A bibliometric analysis of publications from 2012 to 2021 in 12 journals with the highest impact in pulmonary medicine was conducted. Only original research and review articles were included. Names of the first and last authors were extracted and their genders were identified using the Gender-API web. Female authorship was described by overall distribution and distribution by country/region/continent and journal. We compared the article citations by gender combinations, evaluated the trend in female authorship, and forecasted when parity for first and last authorship would be reached. We also conducted a systematic review of female authorship in clinical medicine.

RESULTS

14,875 articles were included, and the overall percentage of female first authors was higher than last authors (37.0% vs 22.2%, p<0.001). Asia had the lowest percentage of female first (27.6%) and last (15.2%) authors. The percentages of female first and last authors increased slightly over time, except for a rapid increase in the COVID-19 pandemic periods. Parity was predicted in 2046 for the first authors and 2059 for the last authors. Articles with male authors were cited more than articles with female authors. However, male-male collaborations significantly decreased, whereas female-female collaborations significantly increased.

CONCLUSIONS

Despite the slow improvement in female authorship over the past decade, there is still a substantial gender disparity in female first and last authorship in high-impact medical journals in pulmonary medicine.

Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda

In sub-Saharan Africa, an estimated 25% of people with HIV present with advanced HIV and are at high risk of opportunistic infections. Whereas histoplasmosis has occasionally been seen in Uganda, the understanding of the local risk of acute infection is limited. We sought to determine the prevalence of Histoplasma antigenuria using an enzyme immunoassay (EIA, clarus Histoplasma GM EIA, IMMY; Norman, OK, USA) in a cohort of outpatients with advanced HIV disease in Kampala, Uganda. Among the persons with positive urine Histoplasma antigen tests, we assessed their clinical presentation and outcomes. The EIA was run on stored urine samples as per the manufacturer's instructions. Specimens ≥1 EIA units were considered positive. Among the 388 tested urine samples, 4 (1.2%) were positive for Histoplasma antigen. The histoplasmosis prevalence among participants with a CD4 < 100 cells/mcL was 2.5% (4/158). Three of the four participants with a positive Histoplasma antigen test reported systemic symptoms consistent with histoplasmosis. All four participants had a positive urine lipoarabinomannan test and were treated for tuberculosis. By the four-week follow-up visit, all participants were clinically improved, alive, and in care without antifungal therapy. In advanced HIV, the clinical presentations of tuberculosis and histoplasmosis overlap. The value of histoplasmosis screening and pre-emptive treatment is an area of future research.

[Trends in the prevalence of schistosomiasis in Anhui Province from 2004 to 2020 based on Joinpoint regression analysis]

OBJECTIVE

To investigate the changing trends in the prevalence of schistosomiasis in Anhui Province from 2004 to 2020, so as to provide the evidence for formulating the schistosomiasis elimination strategy in the province.

METHODS

The epidemiological data of schistosomiasis in Anhui Province from 2004 to 2020 were collected, and the trends in the endemic status of schistosomiasis were analyzed using a Joinpoint regression model. The trends in the prevalence of Schistosoma japonicum infections in humans, bovines and Oncomelania hupensis were measured in Anhui Province from 2004 to 2020 using average annual percent change (AAPC), and the correlations among the changing trends in the prevalence of S. japonicum infections in humans, bovines and O. hupensis snail status were evaluated using Pearson correlation analysis.

RESULTS

The prevalence of S.japonicum human infections continued to decline in Anhui Province from 2004 to 2020, with an annual mean decline of 14.8% [AAPC = -14.8%, 95% confidential interval (CI): (-18.9%, -10.5%), P < 0.01]. The prevalence of S. japonicum infections continued to decline in bovines in Anhui Province from 2004 to 2015 [AAPC = -31.3%, 95%CI: (-35.1%, -27.2%), P < 0.01], and was 0 for 5 successive years from 2016 to 2020. During the period from 2004 to 2020, there was an annual mean decline of 0.7% in areas of snail habitats [AAPC = -0.7%, 95%CI: (-1.2%, 0.3%), P < 0.05] and an annual mean decline of 9.2% in the density of living snails [AAPC = -9.2%, 95%CI: (-18.3%, 1.0%), P = 0.08] in Anhui Province from 2004 to 2020, and an annual mean decline of 35.6% was found in the density of S. japonicum-infected snails [AAPC = -35.6%, 95%CI: (-49.2%, -18.3%), P < 0.01] from 2004 to 2012, with no infected snails detected in Anhui Province from 2013 to 2020. There were significant correlations in the prevalence of S. japonicum infections between humans and bovines (r = 0.959, P < 0.01), between the prevalence of S. japonicum human infections and the density of S. japonicum-infected snails (r = 0.823, P < 0.01) and between the prevalence of S. japonicum infections in bovines and the density of S. japonicum-infected snails (r = 0.902, P < 0.01).

CONCLUSIONS

The prevalence of S. japonicum infections appeared a decline in humans, bovines and O. hupensis in Anhui Province from 2004 to 2020, and significant correlations were found among the changing trends in the prevalence of S. japonicum human infections, the prevalence of S. japonicum bovine infections and the density of S. japonicum-infected O. hupensis snails. Because of a minor decline in the area of snail habitats and widespread distribution of O. hupensis, however, there is still a risk of schistosomiasis transmission, and precision control for schistosomiasis remains to be reinforced in Anhui Province.

[Investigation on prevalence of Schistosoma japonicum infections in wild mice in Shitai County, Anhui Province, 2018]

OBJECTIVE

To investigate the prevalence of Schistosoma japonicum infection in wild mice in Shitai County, Anhui Province, so as to provide insights into precise control of the source of S. japonicum infections.

METHODS

Wild mice were captured using the trapping method for three successive nights at snail-infested settings from Jitan Village of Jitan Township, and Shiquan Village and Xibai Village of Dingxiang Township, Shitai County, Anhui Province in June and October, 2018. All trapped wild mice were sacrificed and liver and mesenteric vein specimens were collected for detection of S. japonicum eggs using microscopy, while the fecal samples in mouse intestines were collected for identification of S. japonicum infections using Kato-Katz technique. In addition, the population density of trapped wild mice was estimated and the prevalence of S. japonicum infection was calculated in trapped wild mice.

RESULTS

A total of 376 wild mice were trapped from three villages in Shitai County. The population density of trapped wild mice was 9.1% (376/4 124), and the prevalence of S. japonicum infection was 24.2% (91/376) in trapped wild mice. The highest prevalence of S. japonicum infection was detected in Shiquan Village of Dingxiang Township (30.1%), and the lowest prevalence was seen in Xibai Village of Dingxiang Township; however, there was no significant difference in the prevalence of S. japonicum infection in trapped wild mice among three villages (χ²= 4.111, P > 0.05). In addition, there was no significant difference in the prevalence of S. japonicum infection in wild mice captured between on June (26.8%, 34/127) and October (22.9%, 57/249) (χ² = 0.690, P = 0.406). The trapped wild mice included 6 species, including Rattus norvegicus, Niviventer niviventer, R. losea, Apodemus agrarius, Mus musculus and N. coning, and the two highest prevalence of S. japonicum infection was detected in R. losea (34.9%, 22/63) and R. norvegicus (31.2%, 44/141).

CONCLUSIONS

The prevalence of S. japonicum infections is high in wild mice in Shitai County, and there is a natural focus of schistosomiasis transmission in Shitai County.

Return-to-baseline multiple imputation for missing values in clinical trials

Return-to-baseline is an important method to impute missing values or unobserved potential outcomes when certain hypothetical strategies are used to handle intercurrent events in clinical trials. Current return-to-baseline approaches seen in literature and in practice inflate the variability of the "complete" dataset after imputation and lead to biased mean estimators when the probability of missingness depends on the observed baseline and/or postbaseline intermediate outcomes. In this article, we first provide a set of criteria a return-to-baseline imputation method should satisfy. Under this framework, we propose a novel return-to-baseline imputation method. Simulations show the completed data after the new imputation approach have the proper distribution, and the estimators based on the new imputation method outperform the traditional method in terms of both bias and variance, when missingness depends on the observed values. The new method can be implemented easily with the existing multiple imputation procedures in commonly used statistical packages.

Two-Stage Adaptive Design for Prognostic Biomarker Signatures with a Survival Endpoint

Cancer biomarker discoveries typically involve utilizing patient specimens. In practice, there is often strong desire to preserve high quality biospecimens for studies that are most likely to yield useful information. Previously, we proposed a two-stage adaptive design for binary endpoints which terminates the biomarker study in a futility interim if the model performance is unsatisfactory. In this work, we extend the two-stage design framework to accommodate time-to-event endpoints. The first stage of the procedure involves testing whether the measure of discrimination for survival models (C-index) exceeds a pre-specified threshold. We describe the computation of cross-validated C-index and evaluation of the statistical significance using re-sampling techniques. The second stage involves an independent model validation. Our simulation studies show that under the null hypothesis, the proposed design maintains type I error at the nominal level and has high probabilities of terminating the study early. Under the alternative hypothesis, power of the design is a function of the true event proportion, the sample size, and the targeted improvement in the discriminant measure. We apply the method to design of a prognostic biomarker study in patients with triple-negative breast cancer. Some practical aspects of the proposed method are discussed.

[Clinicopathological features and prognosis of nodal nevi]

Objective: To investigate the clinicopathological characteristics, differential diagnosis and prognosis of nodal nevi (NN). Methods: Eighteen cases of NN diagnosed at Fudan University Shanghai Cancer Center, Shanghai, China from 2009 to 2019 were collected. The clinicopathological characteristics and follow-up data were retrospectively analyzed. Histopathologic evaluation and immunohistochemical studies were carried out. The Vysis Melanoma FISH Probe Kit, combined with 9p21(CDKN2A) and 8q24(MYC) assays were performed in 2 cases. Results: There were 2 males and 16 females in the case series. The age of the patients ranged from 36 to 70 years (average 48.2 years). Fifteen cases located in axillary lymph nodes, 1 in inguinal lymph node, 1 in cervical lymph node, and 1 in external iliac lymph node. NN was found in only one lymph node in each case. Histologically, the nevus cell aggregates were found in capsule of lymph nodes in all cases. Nevus cells grew along the capsule into trabeculae in 8 cases, with 3 of them scattered in parenchyma. In one of these 8 cases, nevus cell aggregates massively occupied the parenchyma of the lymph node. The largest lesions in the 18 NN cases measured from 0.2 to 6.5 mm. All of the NN cases were classified as conventional nevi. The majority of the cases were composed of uniform nevus-like cells and identical to cutaneous pigmented nevi without atypia, necrosis, or mitosis. In the NN case that massively occupied parenchyma, some areas had abundant nevus cells and displayed atypical cytologic features, including increased nucleo-cytoplasmic ratio, small nucleoli, and occasional mitotic figures. Immunohistochemistry was performed in 13 cases. All of them were positive for S-100, SOX10, Melan A, and p16. HMB45 showed weak staining in rare cells of only one case out of 13 cases. Ki-67 labeling index <1% was found in all 13 cases. Additionally, the results of FISH assay were both negative. All patients were followed up for 13 to 129 months (median 31.5 months). Except that one patient died of the salivary gland carcinoma, the other patients all survived without tumor during the follow-up period. Conclusions: NN is a benign melanocytic lesion in lymph node. It is important to distinguish NN from metastatic melanoma when nevus cells occur in parenchyma and subcapsular sinus of lymph nodes, or show some atypical cytologic features. The morphology of bland nevus cells in capsule and trabeculae is a valuable clue. Besides, immunohistochemical profiling and FISH assay are helpful in the differential diagnosis.

[Efficacy analysis of fully endoscopic microvascular decompression in primary trigeminal neuralgia via keyhole approach]

Objective: To explore the efficacy and technical features of fully endoscopic microvascular decompression(MVD) in primary trigeminal neuralgia(PTN) via keyhole approach. Methods: The clinical data of 97 patients with PTN underwent fully endoscopic MVD via keyhole approach in the Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from December 2014 to February 2019 was collected. During fully endoscopic MVD in PTN via keyhole approach, performer use natural clearance without grinding except developed rock bone crest or excessive retraction of the brain tissue, visually and panoramically observe and evaluate the CPA area, accurately identify the responsible vessels, to avoid the omission of responsible vessels or insufficient decompression. And the use of preplaced technology, bridging technology and submersible technology, ensure the efficacy of surgery and reduce the surgical side injuries.Barrow Neurological Institute (BNI) pain score was used to evaluate the efficacy and identify the recurrence. The surgical efficacy was analyzed. Results: The offending vessels were identified under endoscope in 96 cases. Among them, arterial compression was found in 77 cases, venous compression in 6 cases, and both arterial and venous compression in 13 cases. About the pain outcomes, 87 cases had immediate and complete relief of pain, 5 cases had almost relief of pain, 4 cases had partial relief of pain, and still needed medication control, but the dose was lower than that before operation, and 1 case had no obvious relief of pain. About complications, there were 4 cases of temporary facial numbness, 1 case of temporary hearing loss, both of them recovered after symptomatic treatment. There was no cerebral infarction or hemorrhage, intracranial or incision infection. All cases were followed up for 3.0-38.0 months with a median period of(22.4±2.2) months. During the follow-up periods, postoperative recurrence occurred in 3 cases. Conclusion: Fully endoscopic MVD for PTN through keyhole approach, provides panoramic view to avoid omission of offending vessels and reduce complications, seemed to be a safe and effective surgical method.

Patterns of Care and Clinical Outcomes in Patients with Cerebral Sinus Venous Thrombosis

OBJECTIVES

To explore the association between rurality, transfer patterns and level of care with clinical outcomes of CVST patients in a rural Midwestern state.

MATERIALS AND METHODS

CVST patients admitted to the hospitals between 2005 and 2014 were identified by inpatient diagnosis codes from statewide administrative claims dataset. Records were linked across interhospital transfers using probabilistic linkage. Rurality was defined by Rural-Urban Commuting Areas using the 2-category approximation. Driving distances were estimated using GoogleMaps Application Programming Interface. Hospital stroke certification was defined by the Joint Commission. Severity of CVST was estimated by cost of care corrected for inflation and cost-to-charge ratios. Outcome was discharge disposition and total length of stay (LOS). Wilcoxon rank-sum, Chi-square, Fisher's exact tests and linear and logistic regressions were used.

RESULTS

168 CVST patients were identified (79.8% female; median age = 32, IQR = 24.0-45.5). Median LOS was four days (IQR = 2-7) and patients traveled a median of 8.1 miles (IQR = 2.5-28.5) to the first hospital; 42% of patients were transferred to a second hospital, 5% to a third. More than half (58.3%) bypassed the nearest hospital. 86% visit a primary or comprehensive stroke center (CSC) during their acute care. Rurality was not significantly associated with LOS or discharge disposition after adjusting for age, sex and cost of care. Patients in CSC demonstrated greater likelihood of being discharged home compared to at a primary stroke center after adjusting for age and disease severity (p = 0.008).

CONCLUSIONS

While rurality was not significantly associated with LOS or disposition outcome, care at a CSC increases likelihood of being discharge home.

Greater intraprocedural systolic blood pressure and blood pressure variability are associated with contrast-induced neurotoxicity after neurointerventional procedures

BACKGROUND

Contrast-induced neurotoxicity (CIN) is a rare complication of neurointerventional procedures and its understanding remains limited. We evaluated the association of CIN with systemic hemodynamics in patients undergoing neuroendovascular interventions.

METHODS

We conducted a 1:2 matched case-control study from a prospectively collected database of 2510 neurointerventional patients. We defined CIN as new neurological deficits presented ≤24 h post-operation after excluding other possible etiologies. We obtained demographic, clinical and imaging data, and baseline and intraprocedural blood pressures (BP) from medical records. The area between baseline and intraprocedural BP was used to measure sustained variability of BP over time. A generalized linear mixed model and generalized estimating equation were used to analyze the BP difference between groups over time.

RESULTS

We evaluated 11 CIN cases and 22 controls. 2746 and 5837 min of continued BP data were analyzed for cases and controls, respectively. CIN cases had higher measurements and greater variability for: Systolic BP (SBP) [median 125 (IQR:121-147) vs. 114 (IQR:107-124) mmHg], median area above baseline [median 350 (IQR:25-1328) vs. 52 (IQR:0-293) mmHg*minutes] and mean arterial pressure (MAP) [median 85 (IQR:79-98) vs. 80 (IQR:74-89) mmHg]. CIN cases demonstrated a significant mean increase in SBP and MAP of 23.41 mmHg (p < 0.01) and 13.79 mmHg (p < 0.01) when compared to controls, respectively, over the perioperative time.

CONCLUSION

Sustained hypertension and high BP variability may contribute to the pathophysiology of CIN. Acute hypertension can increase blood-brain barrier permeability and potentially allow contrast to leak into the brain parenchyma causing direct toxicity and CIN symptoms.

microRNA-1205 promotes cell growth by targeting APC2 in lung adenocarcinoma

OBJECTIVE

An increasing amount of evidence indicates that microRNAs (miRNAs) can be potential diagnostic and prognostic markers for various cancers. In this study, a novel miRNA, miR-1205, was identified in lung adenocarcinoma (LUAD).

PATIENTS AND METHODS

First, the expression of miR-1205 in tissues was determined and verified to be correlated with the prognosis of patients. Overexpression and knockdown in LUAD cells were chosen to evaluate the effect of miR-1205 on cell growth in vitro. Luciferase assays, Western blot and rescue assays were performed to screen and confirm potential targets of miR-1205.

RESULTS

We demonstrated that miR-1205 was down-regulated in the tissues of LUAD, and that miR-1205 may be a predictor of overall survival of LUAD. The overexpression of miR-1205 promoted cell proliferation and colony formation. Our results indicated that miR-1205 targeted APC2 directly, serving as a vital part in accelerating LUAD cell proliferation.

CONCLUSIONS

We showed that miR-1205 could promote LUAD cell growth by targeting APC2 protein expression and provided further proof of miR-1205 as a potential non-invasive biomarker and therapeutic target for LUAD.

Abstract WMP5: CT Perfusion Profiles of Infarct Growth in Large Vessel Occlusion Acute Stroke Patients Sensitive to Decreases in Blood Pressure

The growth of a final infarct volume largely depends on cerebral perfusion after a large vessel occlusion (LVO) stroke. Decreases of blood pressure (BP) before recanalization are associated with larger infarct and worse functional outcome. It is uncertain whether an intervention to elevate BP improves outcome, particularly if susceptibility to the BP beneficial effect varies by individual factors such as the collateral vessel status. We aim to define the association of BP, infarct growth and perfusion patterns of potential vulnerable patients. We retrospectively studied patients with anterior LVOs who underwent mechanical thrombectomy (MT) at two comprehensive stroke centers. Only patients with TICI score ≥2b and admission CTP and 24 hours MRI were included. Infarct growth was calculated as 620 ADC volume subtracted from CBF <30% in the ischemic hemisphere using the Automatic Rapid Software. Hypoperfusion intensity ratio (HIR) was calculated as the ratio of the Tmax >10s volume to the Tmax >6s volume with a lower value indicating a more favorable ratio. Intra-procedural BP was continuously monitored using a non-invasive cuff or intraarterial catheter. Systolic BP (SBP) and mean arterial pressure (MAP) were averaged at various time points throughout MT. We analyzed 199 patients from 317 MT. A quantile regression with quantile τ = 0.25, 0.5 and 0.75 was fitted to study how Infarct Growth Rate (IGR) is affected by BP change. At 0.25 and 0.5 quantiles, one unit change in MAP did not lead to a significant change for IGR. At the 0.75 quantile (quartile 3), one unit change in MAP resulted in 0.79 unit change in IGR (95% CI: -0.11, 1.69; p= 0.09). Hence, we identified patients whose IGR is above the 0.75 quantile as the vulnerable subgroup. The vulnerable subgroup had significant larger median volumes of Tmax in all sequences when compared to the non-vulnerable subgroup: Tmax10 (67.8cc vs 40.0cc, p= 0.004), Tmax8 (92.9cc vs 62.0cc, p= 0.003), Tmax6 (134cc vs 98.7cc, p =0.003), Tmax4 (228.6cc vs 184.3cc, p= 0.016). The median HIR was also significantly higher (0.4 vs 0.3, p= 0.026) in the BP vulnerable population. Admission perfusion patterns of collaterals evaluated may help to identify the most vulnerable population to increase their infarct growth when facing decrease in BP.

Evolution of surface relief of epitaxial diamond films upon growth resumption by microwave plasma chemical vapor deposition

Homoepitaxial diamond growth may proceed with stops and resumptions to produce thick crystals. We found the resumption procedure to take place in a complex way, via a disturbance of step growth features, followed by the recovery after a certain time.

[The prostate cancer precision screening program: a preliminary report after recruitment of 2 159 men]

Objective: The Chinese Anti-Cancer Association Genitourinary Cancer Committee Prostate Cancer Working Group released Consensus of prostate cancer (PCa) screening in 2017. This program aims to evaluate the methods and significance of prostate cancer precision screening in high risk population. Methods: A total of 2 159 eligible males enrolled from 13 community centers and 3 screening centers received PSA test from April 2017 to August 2018. Prostate-specific antigen (PSA) determination in serum with a cut-off of ≥4.0 ng/ml was the main screening test and indication for biopsy. The interviewer-administered questionnaire covered demographic characteristics and environmental exposure factors. The associations between these factors and prostate cancer risk were determined by multivariable unconditional logistic regression models. Results: Altogether, 271 cases (12.6%) had a confirmed PSA increase ≥ 4.0 μg/L (median 9.1, range 4.0-25.0). Subsequently, 57 subjects (21.0%) out of the 271 PSA-suspicious men underwent prostate biopsy, and 34 (59.6%) were confirmed as prostate cancer. Until now, the overall prostate cancer incidence in the first screening round was1.57%. There were no statistical differences in the distributions of PSA-suspicious and prostate cancer incidence between community centers and screening centers (P=0.578 and 0.735). Age (OR: 2.63; 95%CI: 1.84-3.75, P<0.001) and chronic prostatitis history (OR: 2.02; 95%CI: 1.55-2.63, P<0.001) were significantly associated with PSA level. After adjustment for these factors, older age (OR: 4.04; 95%CI: 1.71-9.59, P=0.002) and statins use (OR: 3.09; 95%CI: 1.25-7.69, P=0.015) were associated with an elevated risk of PCa. Conclusions: It is of substantial significance to screen prostate cancer in high risk population. Both community centers and screening centers methods are effective. Although largely underestimated, the incidence of PCa in the targeted Chinese population is higher than expected. Older men have a high risk of harboring PCa. Our study suggests a decreased risk of PCa in men with statins use. Prostate Cancer Precision Screening is promising to improve prostate cancer survival in China.

MiR-448 downregulates CTTN to inhibit cell proliferation and promote apoptosis in glioma

OBJECTIVE

miRNAs have been confirmed to be related to cell proliferation and apoptosis. In this study, we detected the potential effect of miR-448 on glioma cell proliferation and apoptosis.

MATERIALS AND METHODS

miR-448 and CTTN expression levels were detected in glioma cell lines with quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Cells were transfected with miR-448 mimics and inhibitor by using lipofectamine 2000 respectively. The proliferative ability of transfected cells was detected via methyl thiazolyl tetrazolium (MTT) and cell counting kit-8 (CCK8) assays. Cell apoptosis and cell-cycle were tested using flow cytometry. The regulatory correlation between miR-448 and CTTN was explored by bioinformatics analysis and luciferase reporter assay.

RESULTS

Lower expression of miR-448 and higher level of CTTN were detected in glioma cells. MiR-448 could regulate cell proliferation, cell apoptosis, and cell cycle. CTTN was negatively regulated by miR-448.

CONCLUSIONS

miR-448 downregulates CTTN to inhibit cell proliferation and promote apoptosis in glioma, which indicates a potential therapeutic target of glioma.

[Application of complete endoscopic technique in microvascular decompression related tovertebrobasilar artery compression]

Objective: To study the operative method, special technique and curative effect of complete neuroendoscopic microvascular decompression(MVD) related to vertebrobasilar artery compression. Methods: Thirteen patients with functional cranial nerve disease caused by vertebrobasilar artery as direct or indirect responsible vessel accepted complete endoscopic MVD, including 11 patients with hemifacial spasm and 2 patients with trigeminal neuralgia. The procedure and curative effect of endoscopic surgery were analyzed retrospectively. Results: All procedures of complete neuroendoscopic MVD were successfully completed.Intraoperative observation by endoscope showed that 6 cases were oppressed directly by vertebral artery, 2 cases were oppressed directly by basilar artery, 5 cases were combined oppressed by displaced basilar artery and other vessels (1 case was superior cerebellar artery and 4 cases were anterior inferior cerebellar artery). During the operation, Teflon sheets was placed directly into the compression point in 2 cases, the "Pre-placed" technique was used to place Teflon sheets in 7 cases, and the "Set up bridge" technique was used to place Teflon sheets in 4 cases. Follow-up for 8-38 months,the symptoms disappeared completely in 12 cases and improved in 1 case. No deaths and severe complications occurred, such as postoperative bleeding, cerebellar infarction and intracranial infection. Conclusion: MVD related to vertebrobasilar artery compression can be performed by complete neuroendoscopic technique, which can achieve sufficient decompression effect and curative effect.Flexible use of the special technology of placing Teflon sheets by single-hand under endoscope, such as the "Pre-placed" and "Set up bridge" technique, is an important technical guarantee for the successful completion of endoscopic MVD.

Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis

Background

While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively, the prevalence, natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis (ISBAS) remain unknown.

Methods

We reviewed our prospective institutional database to identify patients with ≥50% symptomatic basilar artery (BA) stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries. Stroke mechanism, collateral circulation, and degree and length of stenosis were analysed. The primary outcome was time from index event to new transient ischaemic attack (TIA), acute ischaemic stroke (AIS) or death. Other outcome variables included modified Rankin Scale (mRS) score on discharge and last follow-up.

Results

Of 6369 patients with AIS/TIA, 91 (1.43%) had ISBAS. Seventy-three (80.2%) patients presented with AIS and 18 (19.8%) with TIA. Twenty-nine (31.9%) were women and the median age was 66.8±13.6 years. The mean follow-up time was 2.7 years. The most common stroke mechanism was artery-to-artery thromboembolism (45.2%), followed by perforator occlusion (28.7%) and flow-dependent/hypoperfusion (15.1%). The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge (78.3±14.3 vs 86.9±14.5, p=0.007). Kaplan-Meier curves showed higher recurrence/death rates in patients with ≥80% stenosis, mid-basilar location and poor collateral circulation. Approximately 13% of patients with ISBAS presented with complete BA occlusion.

Conclusion

ISBAS is an uncommon (1.43%) cause of TIA and AIS. Men in their 60s are mostly affected, and artery-to-artery embolism is the most common stroke mechanism. Mid-basilar location, ≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.

[Chemotherapy combined with androgen-deprivation therapy in high-volume metastatic hormone sensitive prostate cancer: a short-term efficacy and safety analysis]

Objective: To investigate the short-term efficacy and adverse events of chemotherapy combined with androgen-deprivation therapy in high-volume metastatic hormone sensitive prostate cancer. Methods: From March 2015 to August 2017, 55 patients with high-volume metastatic hormone sensitive prostate cancer were enrolled at Department of Urology, Fudan University Shanghai Cancer Center receiving chemotherapy combined with androgen-deprivation therapy. The age was 65(8) years (M(Q(R))) (range: 46 to 79 years). Patients were enrolled in the study for continuous androgen-deprivation therapy (medical or surgical castration), combined with docetaxel 75 mg/m(2) intravenous injection on the first day, repeated every 21 days (6 cycles). Endpoints included overall survival, progression-free survival of prostate cancer, prostate specific antigen (PSA) response rate, and adverse events. Results: The follow-up time was 21.2(11.7) months. The PSA value before chemotherapy was 144.9(415.3) μg/L. The days in patients undergoing androgen deprivation therapy before chemotherapy was 14(23) days. Four patients (7.3%) presented 0 in Eastern Cooperative Oncology Group scoring system and 51 patients(92.7%) presented 1. Thirty-nine patients (70.9%) completed more than 6 cycles of combined chemotherapy, 17 patients (30.9%) showed PSA<0.2 μg/L at 6 months after treatment, and 14 patients (25.5%) showed PSA<0.2 μg/L at 12 months after treatment. Twenty-eight patients (50.9%) had grade 3 to 4 neutropenia and 1 patient (1.8%) developed infectious neutropenia and died. Nausea and vomit occurred in 16 patients (29.1%). Twelve patients (21.8%) underwent dose adjustment due to adverse events in blood system. Conclusions: The short-term effect was confirmed in high-volume metastatic hormone sensitive prostate cancer using chemotherapy combined androgen-deprivation therapy, and the long-term effect remains to be seen. Myelosuppression during chemotherapy requires close attention, and taking timely examination is recommended.

Bacillus licheniformis, a potential probiotic, inhibits obesity by modulating colonic microflora in C57BL/6J mice model

AIMS

This study evaluated the effects of a potential probiotic, Bacillus sp., on the growth, serum and hepatic triglyceride, histological features of liver tissues and colonic microflora in high-fat diet-induced obese mice.

METHODS AND RESULTS

Sixty male C57BL/6J mice were randomly divided into five groups: mice fed a low-fat diet (Cont), mice fed a high-fat diet (Hf), Hf and orally challenged with Bacillus subtilis (Bs), B. licheniformis (Bl) and a mixture of B. subtilis and B. licheniformis (Bls). Gavage feeding was provided at week 9 and the experiment was continued for 8 weeks. Treatment with B. licheniformis and a mixture of Bacillus sp. attenuated body weight gain at the end of study and enhanced glucose tolerance by sensitizing insulin action in the Hf-fed mice. Lower serum and hepatic triglyceride and epididymal fat weight were observed in Bl and Bls groups than that of Hf group. Lesser hepatic fat deposition was observed in the Bl and Bls groups than in the Hf group. High-throughput sequencing showed that Bacillus sp. supplementation dramatically changed the colonic bacterial community in obese mice.

CONCLUSIONS

Bacillus licheniformis reduced body weight and improved glucose tolerance, obesity and insulin resistance in Hf-fed mice by changing colonic microbiota composition.

SIGNIFICANCE AND IMPACT OF THE STUDY

Orally administration of Bacillus licheniformis may reduce body weight and decrease fat deposition by modulating colonic bacterial community in Hf model.

[Efficacy analysis of soft neuroendoscopic techniques in the treatment of chronic subdural hematoma]

Objective: To investigate the efficacy of soft neuroendoscopic techniques in the treatment of chronic subdural hematoma (CSDH). Methods: A retrospective analysis of 201 cases of CSDH diagnosed and treated at Beijing Shijitan Hospital (CMU) from January 2006 to December 2017 was conducted. From January 2006 to December 2010, 126 cases of CSDH were treated with skull drilling and drainage (non-endoscopic group). From January 2011 to December 2017, 75 cases of CSDH were treated with soft neuroendoscopy (endoscopic group). The operation time of the non-endoscopic and endoscopic groups, the hematoma clearance rate on the first day after surgery, the time of the drainage tube, the length of hospital stay, the incidence of complications, mortality and recurrence rate were compared. Results: There were no deaths in both groups. The average operation time of the non-endoscopic group was 43 min, compared with the average operation time of the endoscopy group of 50 min, there was no significant difference (P>0.05). The average hematoma clearance rate on the first day after surgery in the endoscopy group (98.2%) was significantly higher than that in non-endoscopic group (87.3%) (P<0.01). The average time of drainage tube in the endoscopy group (23 h) was significantly shorter than that in the non-endoscopic group (50 h) (P<0.01). On the first postoperative day, the proportion of patients with mRS≤3 in the endoscopic group was significantly higher than that in the non-endoscopic group (P<0.01). At the time of discharge, the proportion of patients with mRS≤3 in the endoscopy group was also significantly higher than that in the non-endoscopic group, P<0.05. There was no significant difference in the average hospital stay between endoscopy group (7 d) and non-endoscopic group (8 d) (P>0.05). The postoperative complication rate in the endoscopy group was significantly lower than that in the non-endoscopic group (P<0.01). During 0.5-8 years of follow-up, the recurrence rate of CSDH in the endoscopic group (5.33%) was significantly lower than that in the non-endoscopic group (15.07%) (P<0.01). Conclusion: The application of visualization features of soft neuroendoscopy in the treatment of CSDH can significantly improve hematoma clearance, shorten the time of drainage tube, reduce postoperative complications and recurrence rate, and improve surgical outcomes.

[Use of prostate health index in diagnosing prostate cancer in Chinese men]

Objective: To investigate the value of prostate health index (PHI) in the diagnosis of prostate cancer in patients with total prostate specific antigen (tPSA) <20 μg/L. Methods: Totally 1 135 patients with tPSA<20 μg/L and prostate biopsy indications at Department of Urology, Fudan University Shanghai Cancer Center from March 2013 to April 2016 were enrolled in this study. They were tested for serum tPSA, free prostate specific antigen and prostate specific antigen isoform 2, from which PHI was calculated. Diagnostic efficacy of PHI and tPSA were evaluated using receiver operating characteristic (ROC) curve analysis. The detection rates of prostate cancer were calculated in different ranges of PHI. Subgroup analysis of 716 patients, who were aged 50 or above with tPSA in the range of 4 to 10 μg/L and digital rectal examination negative, was performed. Results: In the biopsied objects with tPSA<20 μg/L, PHI was significantly higher in prostate cancer patients than that in non-cancer patients (48.4(37.4) vs. 26.5(16.9), U=52 674.00, P=0.000), PHI was also significantly higher in high-grade prostate cancer patients than that of low-grade prostate cancer patients (44.5(30.8) vs. 56.4(42.5), U=23 314.00, P=0.000). The area under the curve (AUC) of PHI for diagnosing prostate cancer was significantly higher than that of tPSA (0.771 vs. 0.627, P=0.000). When PHI was in the range of <27, 27 to <36, 36 to <55 and ≥55, the probability of prostate cancer was 9.4% (95%CI: 7.0% to 12.2%), 16.3% (95%CI: 12.2% to 20.8%), 31.0% (95%CI: 25.9% to 37.3%) and 66.4% (95%CI: 58.9% to 74.2%), respectively. Subgroup analysis showed that the AUC of PHI in diagnosing prostate cancer was significantly higher than that of tPSA (0.764 vs. 0.569, P=0.000). When PHI was in the range of <27, 27 to <36, 36 to <55 and ≥55, the probability of prostate cancer was 8.1% (95%CI: 5.4% to 11.3%), 14.0% (95%CI: 9.1% to 19.9%), 30.8% (95%CI: 23.6% to 38.7%) and 78.8% (95%CI: 66.7% to 88.9%), respectively. Conclusion: PHI is superior to tPSA in the diagnosis of prostate cancer in Chinese men with tPSA<20 μg/L.

MicroRNA-214-3p: A link between autophagy and endothelial cell dysfunction in atherosclerosis

AIM

Endothelial cell injury assumes a fundamental part in the pathogenesis of atherosclerosis, and endothelial cell autophagy has protective effects on the development of atherosclerosis, although the underlying molecular regulation mechanism is indistinct. This study aimed to investigate whether microRNA-214-3p (miR-214-3p) is involved in the endothelial cell autophagy regulation of atherosclerosis.

METHODS

We utilized ApoE^-/- mice provided with a high-fat diet (HFD) as atherosclerosis model. We analysed the level of miR-214-3p and the levels of autophagy-related protein 5 (ATG5) and autophagy-related protein 12 (ATG12) in the purified CD31⁺ endothelial cells from mouse aorta. Bioinformatics analysis and a dual-luciferase reporter assay were performed to confirm the binding target of miR-214-3p. In vitro study, human umbilical vein endothelial cells (HUVECs) were transfected with miR-214-3p mimics/inhibitor and stimulated with 100 μg/mL oxidized low-density lipoprotein (ox-LDL) for 12 hours to initiate a stress-repairing autophagic process.

RESULTS

In mouse models, we identified an inverse correlation between miR-214-3p, ATG5 and ATG12. We observed that in young HUVECs, ox-LDL-initiated autophagy was repressed by miR-214-3p overexpression, as evaluated by autophagic protein analysis, microtubule-associated protein 1 light chain 3B-II (LC3B-II) immunofluorescence assay and transmission electron microscopy (TEM). Also, miR-214-3p promoted ox-LDL accumulation in HUVECs and THP-1 monocyte adhesion. Conversely, in old HUVECs, suppression of miR-214-3p preserved the ability to initiate a protective autophagy reaction to the ox-LDL stimulation.

CONCLUSION

miR-214-3p regulates ox-LDL-initiated autophagy in HUVECs by directly targeting the 3'UTR of ATG5 and may have a suitable role in the pathogenesis of atherosclerosis.

Abstract WP59: A Clot Burden Score Predicts Functional Outcome and Neurological Complications After Cerebral Venous Sinus Thrombosis

Background and purpose: Involvement of deep venous structures is associated with worse outcomes in patients with cerebral venous sinus thrombosis (CVST); however, the impact of clot burden has not been studied. The aim of this study was to assess the value of a novel quantitative clot burden score as an independent predictor of clinical outcomes.

Methods: We retrospectively reviewed all patients admitted to University of Iowa Health Care with CVST between 2004-2014. All patients received standard of care medical management per AHA/ASA recommendations. The degree of the thrombosis was categorized in admission MR venograms as (partial=1 vs. complete occlusion=2). Clot burden scores were computed as the sum of the thrombosis degree in the following vessels: cerebral veins (cortical veins, internal cerebral, vein of Rosenthal, vein of Galen) and cerebral sinuses (superior sagittal, inferior sagittal, straight, torcula, transverse/sigmoid). The primary outcome was modified Rankin Scale (mRS) at discharge. Secondary outcomes included hemorrhage, infarction, and cerebral edema. Multiple regressions were conducted to examine effects of clot burden scores on each of the four outcomes.

Results: 115 patients met inclusion criteria, 76 women, and mean age 42. Thrombosis in cerebral veins area was noted in 58(50%), clot burden score Median=4, IQR=2; while 108(96%) had thrombosis in the cerebral sinuses area, Median=4, IQR=5. Clot burden in cerebral veins (p=.005) but not in cerebral sinuses, was associated with worse discharge mRS, r= .22. This effect remained significant when adjusting for age and gender (p=.002), but not when adjusting for complications including ICH, infarct, edema. Importantly, higher clot burden score in the cerebral veins predicted ICH (OR=1.73, p<.001), infarct size (OR=1.66, p<.001), and edema (OR=1.71, p<.001).

Conclusion: Quantitative clot burden measurement of the cerebral veins conveys additional prediction on outcomes of CVST. Our findings suggest that the worse clinical outcomes associated with clot burden in the cerebral veins may be mediated by ICH, infarct size, and/or edema. The structural differences between the cerebral veins and sinuses may play a role in the variability in clinical outcomes among patients with CVST.

Abstract TMP18: Heparin Resistance is an Independent Predictor of Poor outcome in Cerebral Venous Sinus Thrombosis

Background and purpose: Unfractionated Heparin (UFH) infusion represents the most commonly used therapy in the acute management of cerebral venous sinus thrombosis (CVST). effectiveness of heparin in reaching therapeutic anti-coagulation levels has not been well studied in this population. Identifying subgroup of patients who will not respond to Heparin may prove useful in studying alternative treatments such as the new oral anticoagulants and endovascular therapy. We aimed to evaluate the initial response to heparin infusion measured by partial thromboplastin time (PTT) and it implication in discharge outcome.

Methods: Retrospective review of all consecutive patients at University of Iowa Hospitals and Clinics between 2004-2014 with CVST was conducted. All patients were treated with initial weight based bolus (14units/kg) of UFH followed by infusion. Consecutive PTT values in the first 48hrs of admission were classified as either therapeutic (40-87), supra-therapeutic (>87), or resistant (<40). Then patients were classified as good responders if 80% of PTT values were in the therapeutic range, classified as adequate if 65-79% of PTT values were therapeutic; rest of patients were classified as non-responders. Univariate and multivariate regressions models were performed to assess the association with discharge mRS, the primary outcome.

Results: 115 patients met inclusion criteria (76 women), mean age was 42. Mean PTT was 44.8 (SD=18.6; 95%CI of 41.2-48.5) in the first 48 hours. Patients resistant to Heparin (44%) had significantly worse functional outcomes, mRS [95%CI 2.3-3.6], compared to good [41%, 95%CI 1.2-2.3] and adequate responders to Heparin [15%, 95%CI 0.5-2.3] (p=.003). Mean PTT in the first 48 hours predicted discharge mRS, r=-.28,p<.005 and this effect remained significant when age, sex, altered mental status at admission were controlled, p=.001.

Conclusion: A significant portion of patients that receive heparin do not reach therapeutic levels within the initial days after hospitalization, and this does not appear to be a consequence of disease burden in our population. Specifying clinical features that predict heparin resistance might help to identify patients that benefit from alternative anticoagulation therapies.

Abstract WP47: Quantitative Analysis of Hemorrhage and Infarct Volume for Predicting Outcome in Cerebral Venous Sinus Thrombosis

Background and purpose: Intracerebral hemorrhage (ICH) and venous infarction are known complications that independently predict poor outcome in patients with cerebral venous sinus thrombosis (CVST). We aimed to study the utility of precise quantification of volumes of venous infarction and ICH using digitalized images in refining our prediction of discharge outcome.

Methods: We retrospectively reviewed all patients with CVST admitted to University of Iowa Health Care between 2004-2014. All patients received standard of care management per available AHA/ASA recommendations. Scans were analyzed using Carestream Vue PACS software. Gradient Echo (GRE) MRI sequence was used to calculate ICH volume. When MRI was not available CT was used. Diffusion Weighted Imaging (DWI) MRI sequence was used to calculate infarction volume. Volume scorer was blinded to the clinical outcomes. Univariate and multivariate analyses were conducted. A p value ≤ 0.05 was set as statistically significant.

Results: 115 patients met inclusion criteria, 76 women, mean age 42. A total of 30 (26%) had venous infarction, 34 (30%) had ICH. The median volumes were 8 cc (SD=27) for ICH and 14 cc (SD= 35) for infarction. Both ICH and infarction volumes were significantly higher among those with a poor functional outcome (mRS=3-6) [Mdn=16 cc, SD=32 for ICH; Mdn=33 cc, SD=46 for infarction] than those with good outcome [Mdn=5 cc, SD=7 for ICH; Mdn=7 cc, SD=162 for infarction], p= .029 and p=.027 respectively. The correlation between ICH volume and mRS was r=.43, p=.012 and the corresponding correlation for infarction volume was r=.62, p=.002. Regressions testing the effects of ICH and infarction volumes on discharge mRS showed that both significantly contributed (p<.001 & p=.004 respectively). These effects remained significant when controlling for the effects of age, gender, presence of deep infarct, and altered mental status at presentation (p=.001 and p=.013 respectively).

Conclusion: Quantitative measurement of Infarction and ICH volumes on admission leads to a more accurate prediction of outcome at discharge in CVST patients. Its combination with clinical variables might signify an additional prognostication tool for identification of high risk patients refractory to standard therapy.

Abstract WP63: Global Cerebral Edema is Associated With Worse Outcomes in Patients With Cerebral Venous Sinus Thrombosis

Background and Purpose: Obstruction of venous drainage may lead to venous hypertension, edema, infarction or intracerebral hemorrhage (ICH) in patients with cerebral venous thrombosis (CVST). While the presence of ICH and infarction are associated with worse outcomes, the independent effect of edema remains unknown. We aimed to evaluate the impact of the characteristics of brain edema on functional outcomes as measured by the modified Rankin Scale (mRS) at discharge.

Methods: We retrospectively reviewed all patients who presented to the University of Iowa Health Care with CVST between 2004-2014. All patients received standard of care management per available AHA/ASA recommendations. Edema was categorized as focal vasogenic, focal cytotoxic or global cerebral edema (GCE). Vasogenic edema was described as hyperintensity on FLAIR MRI sequences around the location of venous clot while cytotoxic edema was noted when hyperintensities were visualized around the location of ICH/ venous infarction on FLAIR or DWI respectively. GCE was scored when bilateral finger-like extensions into gray white junction and effacement of gyri/sulci were seen on CT scans as described by Claassen et al. Edema scorer was blinded to outcome measures. Multiple regressions were conducted on mRS outcome to test hypotheses of interest. A p value ≤ 0.05 was set as statistically significant.

Results: 115 patients met inclusion criteria, 76 women, mean age 42. A total of 30(26%) had venous infarction, 34(30%)ICH , 57(50%) had cerebral edema(20% vasogenic, 35% cytotoxic and 32% GCE). The three edema types together explained 22% variance in discharge mRS (p<.001). The effect of GCE remained significant (p=.001) when adjusting for age, presence/absence of ICH and infarct. The 95%CIs for discharge mRS among those with GCE [2.89-4.17] compared to those without GCE [1.44-2.12]. Vasogenic and cytotoxic edema did not contribute significantly to prediction in multivariate analyses.

Conclusions: Characterization of early cerebral edema might contribute to a better prognostication of high risk patients after CVTS. GCE in particular forecast an unfavorable outcome. Further understanding of its pathogenesis may represent a new therapeutic window for refractory patients to standard therapies.

Growth of three-dimensional diamond mosaics by microwave plasma-assisted chemical vapor deposition

Growth of novel 3D diamond mosaic structures by MPCVD was realized, clearing the way for complex diamond shapes.

Rheumatoid arthritis fibroblast-like synoviocytes co-cultured with PBMC increased peripheral CD4+ CXCR5+ ICOS+ T cell numbers

'Circulating' T follicular helper cells (Tfh), characterized by their surface phenotypes CD4⁺ chemokine receptor 5 (CXCR5)⁺ inducible co-stimulatory molecule (ICOS)⁺ , have been identified as the CD4⁺ T cell subset specialized in supporting the activation, expansion and differentiation of B cells. Fibroblast-like synoviocytes (FLS) are critical in promoting inflammation and cartilage destruction in rheumatoid arthritis (RA), and the interaction between FLS and T cells is considered to facilitate FLS activation and T cell recruitment. However, it remains unknown whether RA-FLS co-cultured with activated peripheral blood mononuclear cells (PBMC) has immunoregulatory effects on peripheral Tfh. In the present study, we co-cultured RA-FLS with or without anti-CD3/CD28-stimulated PBMC. The results showed that RA-FLS co-cultured with stimulated PBMC could increase the numbers of CD4⁺ CXCR5⁺ ICOS⁺ T cells of RA PBMC possibly via the production of interleukin (IL)-6, a critical cytokine involved in the differentiation of Tfh cells. We also observed increased reactive oxygen species (ROS) levels in the co-culture system of RA-FLS and PBMC. The percentage of CD4⁺ CXCR5⁺ ICOS⁺ T cells was decreased when ROS production was inhibited by N-acetyl-L-cysteine (NAC), a specific inhibitor which can decrease ROS production. In addition, we showed that the higher levels of tumour necrosis factor (TNF)-α and IL-1β in the co-culture system and the blocking of TNF receptor 2 (TNF-R2) and IL-1β receptor (IL-1βR) both decreased the numbers of CD4⁺ CXCR5⁺ ICOS⁺ T cells. Our study reveals a novel mechanistic insight into how the interaction of RA-FLS and PBMC participates in the RA pathogenesis, and also provides support for the biologicals application for RA.

Prolonged exposure to extracellular lumican restrains pancreatic adenocarcinoma growth

We previously demonstrated that pancreatic stellate cells within pancreatic ductal adenocarcinoma (PDAC) stroma secrete lumican and its presence is associated with prolonged survival of patients with localized PDAC. Here, we observed that extracellular lumican decreases PDAC tumour cell growth in xenograft and syngeneic orthotopic animal models, and induces growth inhibition of low-passage human PDAC cells in a species-specific manner. PDAC cells grown in variant culture conditions and exposed to extracellular lumican display typical characterizations of cancer cell in a quiescent state, such as growth inhibition, apoptosis, G0/G1 arrest and chemoresistance. Importantly, extracellular lumican is associated with diminished ERK1/2 phosphorylation and increased p38 phosphorylation within PDAC cells. We further demonstrated that extracellular lumican physically binds with EGFR to trigger EGFR internalization and downregulation of EGFR and its downstream signal molecule ERK. Lumican enhances casitas B-lineage lymphoma expression, which stabilized the TGFβ Type II receptor sensitizing PDAC cells to TGFβ-mediated activation of p38 and SMAD signals. These provide a mechanism for the shift in signalling and phenotypic changes we observed after prolonged exposure to lumican. Together, our findings demonstrate that stromal lumican restrains PDAC cell growth through mediating cell entry into a quiescent state.

[Effect of home noninvasive positive pressure ventilation on patients with severe stable chronic obstructive pulmonary disease: a meta-analysis]

Objective: To evaluate the effect of home noninvasive positive pressure ventilation (NPPV) on patients with severe stable chronic obstructive pulmonary disease(COPD) by meta-analysis. Methods: The data of this meta-analysis was retrieved from the PubMed, EMBASE, Cochrane library, Wanfang, Weipu and CNKI databases from January 1980 to January 2016. Randomized controlled trials (RCTs) on comparison of the effect of home NPPV in patients with severe stable COPD were enrolled. The enrolled data were divided into different subgroups in terms of the levels of inspiratory positive airway pressure(IPAP), different duration of ventilation per day, and different levels of baseline hypercapnia on change in PaCO(2). Meta-analysis was performed to compare the effect of different subgroups by RevMan 5.3. Results: Ten studies with a total of 789 patients were included. Home NPPV improved 6-minute walk distance (WMD: -45.12, 95%CI: -85.39--4.85, P=0.03) and forced expiratory volume in the first second [standard mean difference(SMD): -0.26, 95%CI: -0.51--0.02, P=0.03]after 1 year of ventilation, but did not improve the mortality, PaCO(2,)PaO(2,)pH, FVC, maximal inspiratory pressure (MIP), FEV(1)/FVC, maximal voluntary ventilation(MVV) total sleep time, sleep efficiency and the proportion of rapid eye movement (REM) sleep. Subgroup analysis showed that home NPPV can significantly reduce the PaCO(2) in patients ventilated with 18 cmH(2)O(1 cmH(2)O=0.098 kPa) and higher IPAP levels than those with lower IPAP levels (SMD: -0.6, 95%CI: -1.09--0.12, P=0.01), and in patients with NPPV for at least 5 h per day and those with lower duration (SMD: -0.45, 95%CI: -0.87--0.02, P=0.04), and in patients with baseline PaCO(2) of at least 55 mmHg (1 mmHg=0.133 kPa) (SMD: -0.69, 95%CI: -1.07--0.31, P=0.00) than those with lower levels. Conclusions: Home NPPV can improve 6MWD and FEV(1) in severe stable COPD patients but does not improve the mortality, gas exchange and sleep efficiency. Patients may gain more benefits when using higher IPAP levels, longer ventilation per day and in those with higher baseline PaCO(2).

Isolation and characterization of white and brown adipocytes in Kunming mice

White adipose tissue and brown adipose tissue play critical roles in controlling energy homeostasis and the development of obesity and diabetes. We isolated mouse white adipocytes from inguinal white fat tissues and brown adipocytes from interscapular brown fat tissues, and employed a variety of approaches, including immunofluorescent staining, quantitative real-time PCR, western blotting analysis, and differentiation assay, to characterize those adipocytes. Both white and brown adipocytes stained positively for CD44 and CD29, and lipid droplets were observed after the induction of adipogenesis. The Asc1 expression level in the white adipocytes was 2.5-fold higher than that in the brown adipocytes (P < 0.05), and the expression of Ucp1 in the white adipocytes was approximately 50% of that in the brown adipocytes (P < 0.05). The expression of α-tubulin in the brown adipocytes was approximately 70% of that in the white adipocytes. The brown adipocytes had a higher Cidea mRNA level (P < 0.05) and a lower Pparγ mRNA level (P < 0.05) than the white adipocytes. The results demonstrate that white and brown adipocytes have different gene expression signatures, and may represent two useful cell models to study the mechanisms involved in obesity.

Extracellular lumican augments cytotoxicity of chemotherapy in pancreatic ductal adenocarcinoma cells via autophagy inhibition

Lumican, an extracellular matrix proteoglycan overexpressed by pancreatic stellate cells (PSCs) and pancreatic ductal adenocarcinoma cells (PDACs), drives the formation of a tumor-specific microenvironment. We recently showed that extracellular lumican inhibits pancreatic cancer cell growth and is associated with prolonged survival after surgery. Here we investigated the role of extracellular lumican in chemotherapy-mediated cancer therapy. Lumican secretion was increased by chemotherapeutic agents in PDAC, and especially in PSCs, and appeared to be linked to the extent of cells' response to chemotherapy-induced growth inhibition. In multiple PDAC models, including cell lines, patient-derived xenografts and lumican knockout mice, lumican significantly increased antitumor effect of chemotherapy. This effect was associated with DNA damage, apoptosis and inhibition of cell viability, glucose consumption, lactate production and vascular endothelial growth factor secretion. In PDAC cells, chemotherapeutic agents triggered autophagosome formation and increased LC3 expression through the reactive oxygen species-mediated AMP-activated kinase (AMPK) signaling pathway. Inhibition of gemcitabine-induced autophagy in cancer cells by treatment with AMPK inhibitor compound C, lysosomal inhibitor chloroquine or autophagy inhibitor 3MA enhanced gemcitabine-induced apoptosis, suggesting that autophagy is a protective cellular response to gemcitabine treatment. Importantly, lumican dramatically decreased AMPK activity, inhibiting chemotherapy-induced autophagy in both in vitro and in vivo PDAC models. Co-treatment of PDAC cells with lumican and gemcitabine increased mitochondrial damage, reactive oxygen species (ROS) production and cytochrome c release, indicating that lumican-induced disruption of mitochondrial function may be the mechanism of sensitization to gemcitabine. Together, our findings demonstrate that extracellular lumican augments cytotoxicity of chemotherapy in PDAC cells through inhibition of chemotherapeutic agent-induced autophagy.

Hepatitis C virus upregulates B-cell receptor signaling: a novel mechanism for HCV-associated B-cell lymphoproliferative disorders

B-cell receptor (BCR) signaling is essential for the development of B cells and has a critical role in B-cell neoplasia. Increasing evidence indicates an association between chronic hepatitis C virus (HCV) infection and B-cell lymphoma, however, the mechanisms by which HCV causes B-cell lymphoproliferative disorder are still unclear. Herein, we demonstrate the expression of HCV viral proteins in B cells of HCV-infected patients and show that HCV upregulates BCR signaling in human primary B cells. HCV nonstructural protein NS3/4A interacts with CHK2 and downregulates its activity, modulating HuR posttranscriptional regulation of a network of target mRNAs associated with B-cell lymphoproliferative disorders. Interestingly, the BCR signaling pathway was found to have the largest number of transcripts with increased association with HuR and was upregulated by NS3/4A. Our study reveals a previously unidentified role of NS3/4A in regulation of host BCR signaling during HCV infection, contributing to a better understanding of the molecular mechanisms underlying HCV-associated B-cell lymphoproliferative disorders.

A novel HLA allele, HLA-DQB1*02:57, was identified by polymerase chain reaction sequence-based typing in a Chinese individual

HLA-DQB1*02:57 has one base substitution at position 260 T>C in exon 2 from HLA-DQB1*02:01:01.

Fabrication of three-dimensional hierarchical nanostructures using template-directed colloidal assembly

Optical effects in template-directed colloidal assembly are explored to fabricate microscale patterns with integrated three-dimensional (3D) nanostructures. This method allows the patterning of periodic nanostructures in arbitrarily designed regions by controlling particle assembly and light illumination. Using both "bottom-up" and "top-down" methods, this approach enables low-cost fabrication of hierarchical devices.