Tet controls axon guidance in early brain development through glutamatergic signaling

Mutations in ten-eleven translocation (TET) proteins are associated with human neurodevelopmental disorders. We find a function of Tet in regulating Drosophila early brain development. The Tet DNA-binding domain (TetAXXC) is required for axon guidance in the mushroom body (MB). Glutamine synthetase 2 (Gs2), a key enzyme in glutamatergic signaling, is significantly down-regulated in the TetAXXC brains. Loss of Gs2 recapitulates the TetAXXC phenotype. Surprisingly, Tet and Gs2 act in the insulin-producing cells (IPCs) to control MB axon guidance, and overexpression of Gs2 in IPCs rescues the defects of TetAXXC. Feeding TetAXXC with metabotropic glutamate receptor antagonist MPEP rescues the phenotype while glutamate enhances it. Mutants in Tet and Drosophila Fmr1, the homolog of human FMR1, have similar defects, and overexpression of Gs2 in IPCs also rescues the Fmr1 phenotype. We provide the first evidence that Tet controls the guidance of developing brain axons by modulating glutamatergic signaling.

Noradrenergic signaling controls Alzheimer's disease pathology via activation of microglial β2 adrenergic receptors

In Alzheimer's disease (AD) pathophysiology, plaque and tangle accumulation trigger an inflammatory response that mounts positive feed-back loops between inflammation and protein aggregation, aggravating neurite damage and neuronal death. One of the earliest brain regions to undergo neurodegeneration is the locus coeruleus (LC), the predominant site of norepinephrine (NE) production in the central nervous system (CNS). In animal models of AD, dampening the impact of noradrenergic signaling pathways, either through administration of beta blockers or pharmacological ablation of the LC, heightened neuroinflammation through increased levels of pro-inflammatory mediators. Since microglia are the resident immune cells of the CNS, it is reasonable to postulate that they are responsible for translating the loss of NE tone into exacerbated disease pathology. Recent findings from our lab demonstrated that noradrenergic signaling inhibits microglia dynamics via β2 adrenergic receptors (β2ARs), suggesting a potential anti-inflammatory role for microglial β2AR signaling. Thus, we hypothesize that microglial β2 adrenergic signaling is progressively impaired during AD progression, which leads to the chronic immune vigilant state of microglia that worsens disease pathology. First, we characterized changes in microglial β2AR signaling as a function of amyloid pathology. We found that LC neurons and their projections degenerate early and progressively in the 5xFAD mouse model of AD; accompanied by mild decrease in the levels of norepinephrine and its metabolite normetanephrine. Interestingly, while 5xFAD microglia, especially plaque-associated microglia, significant downregulated β2AR gene expression early in amyloid pathology, they did not lose their responsiveness to β2AR stimulation. Most importantly, we demonstrated that specific microglial β2AR deletion worsened disease pathology while chronic β2AR stimulation resulted in attenuation of amyloid pathology and associated neuritic damage, suggesting microglial β2AR might be used as potential therapeutic target to modify AD pathology.

Evaluating the potential of ChatGPT-4 in ophthalmology: The good, the bad and the ugly

There is growing interest nowadays for artificial intelligence (AI) in all medical fields. Beyond the direct medical application of AI to medical data, generative AI such as "pre-trained transformer" (GPT) could significantly change the ophthalmology landscape, opening up new avenues for enhancing precision, productivity, and patient outcomes. At present, ChatGPT-4 has been investigated in various ways in ophthalmology for research, medical education, and support for clinical decisions purposes. This article intends to demonstrate the application of ChatGPT-4 within the field of ophthalmology by employing a 'mise en abime' approach. While we explore its potential to enhance the future of ophthalmology care, we will also carefully outline its current limitations and potential risks.

Tet Controls Axon Guidance in Early Brain Development through Glutamatergic Signaling

Mutations in human TET proteins have been found in individuals with neurodevelopmental disorders. Here we report a new function of Tet in regulating Drosophila early brain development. We found that mutation in the Tet DNA-binding domain ( Tet AXXC ) resulted in axon guidance defects in the mushroom body (MB). Tet is required in early brain development during the outgrowth of MB β axons. Transcriptomic study shows that glutamine synthetase 2 (Gs2), a key enzyme in glutamatergic signaling, is significantly downregulated in the Tet AXXC mutant brains. CRISPR/Cas9 mutagenesis or RNAi knockdown of Gs2 recapitulates the Tet AXXC mutant phenotype. Surprisingly, Tet and Gs2 act in the insulin-producing cells (IPCs) to control MB axon guidance, and overexpression of Gs2 in these cells rescues the axon guidance defects of Tet AXXC . Treating Tet AXXC with the metabotropic glutamate receptor antagonist MPEP can rescue while treating with glutamate enhances the phenotype confirming Tet function in regulating glutamatergic signaling. Tet AXXC and the Drosophila homolog of Fragile X Messenger Ribonucleoprotein protein mutant ( Fmr1 3 ) have similar axon guidance defects and reduction in Gs2 mRNA levels. Interestingly, overexpression of Gs2 in the IPCs also rescues the Fmr1 3 phenotype, suggesting functional overlapping of the two genes. Our studies provide the first evidence that Tet can control the guidance of axons in the developing brain by modulating glutamatergic signaling and the function is mediated by its DNA-binding domain.

NOD1 mediates interleukin-18 processing in epithelial cells responding to Helicobacter pylori infection in mice

The interleukin-1 family members, IL-1β and IL-18, are processed into their biologically active forms by multi-protein complexes, known as inflammasomes. Although the inflammasome pathways that mediate IL-1β processing in myeloid cells have been defined, those involved in IL-18 processing, particularly in non-myeloid cells, are still not well understood. Here we report that the host defence molecule NOD1 regulates IL-18 processing in mouse epithelial cells in response to the mucosal pathogen, Helicobacter pylori. Specifically, NOD1 in epithelial cells mediates IL-18 processing and maturation via interactions with caspase-1, instead of the canonical inflammasome pathway involving RIPK2, NF-κB, NLRP3 and ASC. NOD1 activation and IL-18 then help maintain epithelial homoeostasis to mediate protection against pre-neoplastic changes induced by gastric H. pylori infection in vivo. Our findings thus demonstrate a function for NOD1 in epithelial cell production of bioactive IL-18 and protection against H. pylori-induced pathology.

Assessment of the relative benefits of monotherapy and combination therapy approaches to the treatment of hospital-acquired Stenotrophomonas maltophilia pneumonia: a multicenter, observational, real-world study

PURPOSE

Stenotrophomonas maltophilia is a Gram-negative pathogen that most commonly causes hospital-acquired infections that can be extremely challenging to treat, contributing to underrecognized mortality throughout the world. The relative benefits of monotherapy as compared to combination therapy in patients diagnosed with S. maltophilia pneumonia, however, have yet to be established.

METHODS

Data from 307 patients diagnosed with S. maltophilia hospital-acquired pneumonia (HAP) across four Chinese teaching hospitals from 2016 to 2022 were retrospectively analyzed.

RESULTS

Of the analyzed patients, 55.7% (171/307) were administered combination definitive therapy, with a 30-day all-cause mortality rate of 41.0% (126/307). A propensity score weighting analysis revealed that compared with monotherapy, combination definitive therapy was associated with a comparable 30-day mortality risk in the overall patient cohort (OR 1.124, 95% CI 0.707-1.786, P = 0.622), immunocompetent patients (OR 1.349, 95% CI 0.712-2.554, P = 0.359), and patients with APACHE II scores < 15 (OR 2.357, 95% CI 0.820-6.677, P = 0.111), whereas it was associated with a decreased risk of death in immunocompromised patients (OR 0.404, 95% CI .170-0.962, P = 0.041) and individuals with APACHE II scores ≥ 15 (OR 0.494, 95% CI 0.256-0.951, P = 0.035).

CONCLUSION

The present data suggest that when treating S. maltophilia-HAP, immunocompromised patients and individuals with APACHE II scores ≥ 15 may potentially benefit from combination therapy.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

POS0746 MEASUREMENT OF ANTI-SUPRABASIN ANTIBODIES, MULTIPLE CYTOKINES AND CHEMOKINES AS POTENTIAL PREDICTIVE BIOMARKERS FOR NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS

Background

The pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE) is multifactorial and involves diverse cytokines, autoantibodies and immune complexes inducing blood-brain barrier (BBB) dysfunction, neuroendocrine-immune imbalance, vascular occlusion, tissue, and neuronal damage. Several pro-inflammatory cytokines have been implicated in the pathogenesis of NPSLE [1]. Previously we have shown that the titer of anti-suprabasin (SBSN) antibodies in cerebrospinal fluid (CSF) of NPSLE patients was significantly higher than in SLE, MS and NPH groups [2]. However, distinguishing NPSLE from other neuropsychiatric conditions with different etiologies is challenging.

Objectives

This study determined the most critical serum biomarkers for the development of NPSLE as they may have clinical utility prior to the onset of neuropsychiatric symptoms.

Methods

We retrospectively analyzed 35 NPSLE patients, 34 SLE patients, 20 viral meningitis (VM) patients, and 16 relapsing-remitting multiple sclerosis (MS) patients. We measured anti-SBSN antibodies concentrations in serum by using Luciferase immunoprecipitation system (LIPS) assay. The serum concentrations of cytokines/chemokines were measured by using multiplex bead-based assay. All the clinical information and laboratory tests were collected at the time of admission.

Results

The Bayesian posterior mean and 95% HPDI of the cut-off of AI and its PPV and 1-NPV values were 5.26 (3.68;7.17), 0.87, (0.72; 1.0) and 0.44, (0.36; 0.5), respectively (Figure 1).

Figure 1.

Summary of the posterior distribution of the cutoff of AI and its predictive value (1-NPV and PPV). The 95% HPDI is shown as the thick black horizontal line with the boundaries written above the line

Among analyzed biomarkers, VEGF had the highest sparsity-oriented important learning (SOIL) importance, followed by AI, sCD40L, IL-10, GRO, MDC, IL-8, IL-9, TNFα, MIP-1α (Figure 2).

Figure 2.

Top 10 biomarkers having highest SOIL importance in prediction of NPSLE.

Abbreviations

• AI: anti-SBSN antibody index

• PPV: positive predictive

• NPV: negative predictive value

• SOIL: sparsity-oriented important learning

• IL: interleukin

•MIP: macrophage inflammatory protein

• sCD40L: soluble CD40 ligand

• MDC: macrophage-derived chemokine

• VEGF: vascular endothelial growth factor

• MDC: macrophage-derived chemokine

• TNF: Tumor necrosis factor

Conclusion

Our data demonstrated the ranking of serum biomarkers for the prediction of NPSLE. The most essential biomarkers are VEGF, anti-SBSN antibodies, sCD40L, IL-10, GRO, MDC, IL-8, IL-9, TNFα, MIP-1α.

References

[1]Govoni M, Hanly JG: Rheumatology (Oxford), 2020: 59(Suppl5):v52-v62.

[2]Ichinose K, et al: Clinical immunology, 2018; 193:123-130.

Disclosure of Interests

None declared

POS0129 TO CONTRAST OR NOT TO CONTRAST? ON THE ROLE OF CONTRAST ENHANCEMENT IN HAND MRI STUDIES OF PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Currently, clinical indications for application of gadolinium-based contrast agents (GBCA) in magnetic resonance imaging (MRI) are increasingly being questioned1. Rheumatoid arthritis is a disease which is characterised by joint inflammation and due to various existing therapies, early diagnosis and sensitive monitoring is beneficial for assessing disease progression, therapy response and optimizing the individual therapy.

Objectives

This study aimed to evaluate the necessity of contrast enhancement in MRI of the hand in patients with rheumatoid arthritis (RA).

Methods

31 patients with RA (mean age, 50±14 years [range, 18–72 years]) from the German ArthroMark cohort underwent morphologic high-field MRI scans on a clinical 3T scanner. MRI studies were analyzed based on (1) the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS2) and (2) the GBCA-free RAMRIS version, termed RAMRIS Sine-Gadolinium-For-Experts (RAMRIS-SAFE), in which synovitis and tenosynovitis were assessed using the short-tau-inversion-recovery (STIR) sequence instead of the post-contrast T1-weighted sequence.

Results

Correlation between RAMRIS and RAMRIS-SAFE in terms of Spearman’s ρ was almost perfect (ρ=0.976; p<0.001). The synovitis subscores, as based on RAMRIS and RAMRIS-SAFE, were equally strongly correlated (ρ=0.937; p<0.001), while the tenosynovitis subscores were less strongly correlated (ρ=0.380 p=0.035). Inter-rater reliability in terms of Cohen’s κ was high (0.963 ≤ κ ≤ 0.925).

Conclusion

In conclusion, RAMRIS-SAFE as the GBCA-free version of the well-established RAMRIS is a patient-friendly and resource-efficient alternative for assessing disease-related joint changes in RA. As patients with RA are subject to repetitive GBCA applications, non-contrast imaging protocols should be considered.

References

[1]Olchowy, C.; Cebulski, K.; Lasecki, M.; Chaber, R.; Olchowy, A.; Kalwak, K.; Zaleska-Dorobisz, U. The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity - A systematic review. PLoS One 2017, 12, e0171704, doi:10.1371/journal.pone.0171704.

[2]Ostergaard, M.; Peterfy, C.G.; Bird, P.; Gandjbakhch, F.; Glinatsi, D.; Eshed, I.; Haavardsholm, E.A.; Lillegraven, S.; Boyesen, P.; Ejbjerg, B.; et al. The OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging (MRI) Scoring System: Updated Recommendations by the OMERACT MRI in Arthritis Working Group. Journal of Rheumatology 2017, 44, 1706-1712, doi:10.3899/jrheum.161433.

Table 1.

Composition of both scores: RAMRIS-SAFE and RAMRIS

ImagingFeatureAnatomic LocationMRI Sequence:RAMRIS-SAFE(without contrast enhancement)RAMRIS(with contrastenhancement)Erosion•distal radius and distal ulnacoronal T1coronal T1•all carpal bones and metacarpal bases•MCP joints (II-V)Osteitis•distal radius and distal ulnacoronal STIRcoronal STIR•all carpal bones and metacarpal bases•MCP joints (II-V)Synovitis•Distal radio-ulnar jointcoronal STIR,coronal and axial•Radiocarpal jointaxial T1T1 + contrast•Intercarpal and carpometacarpal joints•MCP (II-V) jointsTenosynovitis•flexor tendons at the level of MCP jointscoronal STIR,axial T1coronal and axialT1 + contrastJoint spacenarrowing•all radiocarpal, intercarpal, carpometacarpal, . . and MCP joints (n=17)coronal T1coronal T1

Abbreviations are “RAMRIS” (rheumatoid arthritis MRI scoring system), “RAMRIS-SAFE” (RAMRIS sine gadolinium for experts), “MCP” (metacarpophalangeal), and “STIR” (Short-Tau-Inversion-Recovery).

Figure 1.

Exemplary imaging features (erosion, osteitis, synovitis, tenosynovitis, and joint space narrowing) that are scored semiquantitatively based on RAMRIS, shown in (i) unenhanced MRT T1-weighted sequence (left column), (ii) STIR sequence (middle column), and enhanced T1-weighted postcontrast sequence (right column).

Disclosure of Interests

Gesa Rübsam: None declared, Miriam Frenken: None declared, Alexaner Dieter Mewes: None declared, Karl Ludger Radke: None declared, Lien Le: None declared, Lena Wilms: None declared, Sven Nebelung: None declared, Daniel Abrar: None declared, Philipp Sewerin Speakers bureau: AXIOM Health, AMGEN, AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Chugai Pharma Marketing Ltd./Chugai Europe, Deutscher Psoriasis-Bund, Fresenius Kabi, Gilead Sciences, Hexal Pharma, Janssen-Cilag, Johnson & Johnson, Lilly/Lilly Europe/Lilly Global, medi-login, Mediri GmbH, Novartis Pharma, Onkowissen

GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB Pharma, Consultant of: AXIOM Health, AMGEN, AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Chugai Pharma Marketing Ltd./Chugai Europe, Deutscher

Psoriasis-Bund, Fresenius Kabi, Gilead Sciences, Hexal Pharma, Janssen-Cilag, Johnson & Johnson, Lilly/Lilly Europe/Lilly Global, medilogin, Mediri GmbH, Novartis Pharma, Onkowissen GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Swedish Orphan Biovitrum, UCB, Grant/research support from: Deutsche Forschungsgesellschaft (DFG), Bundesministerium für Bildung und Forschung (BMBF), AMGEN, AbbVie, BMS, Celgene, Chugai, Deutscher Psoriasis-Bund, Janssen-Cilag, Lilly, Novartis, Roche, Rheumazentrum Rhein-Ruhr, UCB Pharma

Using a machine learning algorithm to detect depressed ejection fraction from a single-lead ECG

Background

Multiple studies demonstrate the benefit of intervention for left ventricular ejection fraction (LVEF) below 40%, so the development of a low ejection fraction algorithm to detect LVEF below 40% can aid in early screening of initial asymptomatic Heart Failure with reduced Ejection Fraction (HFrEF).

Objective

To demonstrate the performance of a low ejection fraction algorithm using single-lead ECG data to detect LVEF below 40%.

Methods

We collected 1325 single-lead ECG recordings (15s duration) at various chest positions using an electronic stethoscope from 197 patients. We analyzed these ECG recordings using a deep neural network model trained on individual leads extracted from a 12-lead ECG to discriminate left ventricular ejection fractions (EFs) above or below different thresholds. We compared the model output to ejection fraction measured using echocardiograms.

Results

Across all recordings from all patients, we obtained an AUROC of 0.89, with a sensitivity of 88% and specificity of 74% using a model output threshold of 0.35 (Figure 1). The AUROC of recordings taken at different orientations and stances ranged from 0.85 to 0.92 (Table 1), with a sensitivity of at least 78% and specificity of at least 66% at any orientation.

Conclusion

Using a single lead ECG measured by an electronic stethoscope and a deep neural network model, we were able to detect depressed ejection fraction (≤40%) with a sensitivity of 88% and specificity of 74%. This work demonstrates the utility of a low-cost electronic stethoscope and machine learning for early screening and detection of depressed left ventricular ejection fraction.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Eko Health

Deep Learning Algorithm for Automated Cardiac Murmur Detection via a Digital Stethoscope Platform

Background

Clinicians vary markedly in their ability to detect murmurs during cardiac auscultation and identify the underlying pathological features. Deep learning approaches have shown promise in medicine by transforming collected data into clinically significant information. The objective of this research is to assess the performance of a deep learning algorithm to detect murmurs and clinically significant valvular heart disease using recordings from a commercial digital stethoscope platform.

Methods and Results

Using >34 hours of previously acquired and annotated heart sound recordings, we trained a deep neural network to detect murmurs. To test the algorithm, we enrolled 962 patients in a clinical study and collected recordings at the 4 primary auscultation locations. Ground truth was established using patient echocardiograms and annotations by 3 expert cardiologists. Algorithm performance for detecting murmurs has sensitivity and specificity of 76.3% and 91.4%, respectively. By omitting softer murmurs, those with grade 1 intensity, sensitivity increased to 90.0%. Application of the algorithm at the appropriate anatomic auscultation location detected moderate‐to‐severe or greater aortic stenosis, with sensitivity of 93.2% and specificity of 86.0%, and moderate‐to‐severe or greater mitral regurgitation, with sensitivity of 66.2% and specificity of 94.6%.

Conclusions

The deep learning algorithm’s ability to detect murmurs and clinically significant aortic stenosis and mitral regurgitation is comparable to expert cardiologists based on the annotated subset of our database. The findings suggest that such algorithms would have utility as front‐line clinical support tools to aid clinicians in screening for cardiac murmurs caused by valvular heart disease.

Registration

URL: https://clinicaltrials.gov; Unique Identifier: NCT03458806.

E-cigarette promotes breast carcinoma progression and lung metastasis: Macrophage-tumor cells crosstalk and the role of CCL5 and VCAM-1

Young women represent a target of E-cigarette (E-cig) companies, raising concern for potential connections with breast cancer (BC) that have not yet been elucidated. We hypothesized that E-cig promotes BC development and lung metastasis possibly through BC-monocyte/tumor-associated macrophage (TAM) crosstalk via CCL5 and V-CAM-1 axes. We demonstrated that E-cig promoted the infiltration of circulating monocytes in mammary fat pad (MFP) model. Furthermore, E-cig exposure significantly enhanced BC cell growth in MFP tumor and metastatic lung colonization; immunohistochemical stains illustrated the increase of TAMs infiltration, reduced BC cell apoptosis and increased proliferation index after E-cig exposure. In vitro studies show E-cig vapor condensate (EVC) treatment upregulated protein expressions of CCL5, V-CAM-1, and other pro-tumorigenic factors in BC cells. Mechanistically, co-culture system demonstrated both EVC and macrophages independently stimulated BC cell growth and the migration via CCL5/CCR1/CCR5 axis. During metastasis, E-Cig exposure stimulated BC cell survival via direct interaction with infiltrated macrophages, regulated by VCAM-1 and integrin α₄β1. Our findings, for the first time, showed that E-cig promotes BC growth and metastasis. This study highlights the critical role of TAMs via CCL5 and VCAM-1 pathways in E-cig promoted BC tumor development.

The role of survivin in the progression of pancreatic ductal adenocarcinoma (PDAC) and a novel survivin-targeted therapeutic for PDAC

Treating pancreatic ductal adenocarcinoma (PDAC) remains a major hurdle in the field of oncology. Less than half of patients respond to frontline chemotherapy and the pancreatic tumor microenvironment limits the efficacy of immunotherapeutic approaches. Targeted therapies could serve as effective treatments to enhance the clinical response rate. One potential therapeutic target is survivin, a protein that is normally expressed during embryonic and fetal development and has a critical impact on cell cycle control and apoptosis. In adulthood, survivin is not present in most normal adult cells, but is significantly re-expressed in tumor tissues. In PDAC, elevated survivin expression is correlated with treatment resistance and lower patient survival, although the underlying mechanisms of survivin's action in this type of cancer is poorly understood. Using patient derived xenografts of PDAC and their corresponding primary pancreatic cancer lines (PPCL-46 and PPCL-LM1) possessing increased expression of survivin, we aimed to evaluate the therapeutic response of a novel survivin inhibitor, UFSHR, with respect to survivin expression and the tumorigenic characteristics of PDAC. Cell viability and apoptosis analyses revealed that repressing survivin expression by UFSHR or YM155, a well-known inhibitor of survivin, in PPCLs effectively reduces cell proliferation by inducing apoptosis. Tumor cell migration was also hindered following treatment with YM155 and UFSHR. In addition, both survivin inhibitors, particularly UFSHR, effectively reduced progression of PPCL-46 and PPCL-LM1 tumors, when compared to the untreated cohort. Overall, this study provides solid evidence to support the critical role of survivin in PDAC progression and proposes a novel survivin inhibitor UFSHR that can become an alternative strategy for this type of cancer.

Smectite formation in the presence of sulfuric acid: Implications for acidic smectite formation on early Mars

The excess of orbital detection of smectite deposits compared to carbonate deposits on the martian surface presents an enigma because smectite and carbonate formations are both favored alteration products of basalt under neutral to alkaline conditions. We propose that Mars experienced acidic events caused by sulfuric acid (H2SO4) that permitted phyllosilicate, but inhibited carbonate, formation. To experimentally verify this hypothesis, we report the first synthesis of smectite from Mars-analogue glass-rich basalt simulant (66 wt% glass, 32 wt% olivine, 2 wt% chromite) in the presence of H2SO4 under hydrothermal conditions (~200 °C). Smectites were analyzed by X-ray diffraction, Mossbauer spectroscopy, visible and near-infrared reflectance spectroscopy and electron microprobe to characterize mineralogy and chemical composition. Solution chemistry was determined by Inductively Coupled Plasma Mass Spectrometry. Basalt simulant suspensions in 11-42 mM H2SO4 were acidic with pH ≤ 2 at the beginning of incubation and varied from acidic (pH 1.8) to mildly alkaline (pH 8.4) at the end of incubation. Alteration of glass phase during reaction of the basalt simulant with H2SO4 led to formation of the dioctahedral smectite at final pH ~3 and trioctahedral smectite saponite at final pH ~4 and higher. Anhydrite and hematite formed in the final pH range from 1.8 to 8.4 while natroalunite was detected at pH 1.8. Hematite was precipitated as a result of oxidative dissolution of olivine present in Adirondack basalt simulant. Formation of secondary phases, including smectite, resulted in release of variable amounts of Si, Mg, Na and Ca while solubilization of Al and Fe was low. Comparison of mineralogical and solution chemistry data indicated that the type of smectite (i.e., dioctahedral vs trioctahedral) was likely controlled by Mg leaching from altering basalt and substantial Mg loss created favorable conditions for formation of dioctahedral smectite. We present a model for global-scale smectite formation on Mars via acid-sulfate conditions created by the volcanic outgassing of SO2 in the Noachian and early Hesperian.

[Investigation on epidemic status of clonorchiasis sinensis based on inpatients in Zhongshan City, China]

Objective To understand the prevalence and epidemiological features of clonorchiasis sinensis based on inpatients in Zhongshan City. Methods All of the 23 town hospitals in Zhongshan City were selected as the surveillance hospitals in 2016. Among the inpatients from those hospitals, those lived in the city longer than 6 months were selected as the surveillance subjects. The stool specimens of the subjects were collected and examined by the modified Kato-Katz thick smear method for the eggs of Clonorchis sinensis. The crude infection rates of C. sinensis of the subjects were standardized according to the age and sex compositions of the population in Zhongshan City, 2016. Meanwhile, the infection rates of the subjects from different towns and those combined with related clinical diseases were analyzed. Results A total of 2 667 people were included in the surveillance, among which 219 were tested as positives, with a crude infection rate of 8.21%. For the positives, the male accounted for 81.74% (179/219), and their age ranged from 4 to 89 years with the mean value of (62.20±13.80) years. After standardization by age and sex composition, the infection rate was 3.62% for the whole population, the rates of the male and the female were 5.46% and 1.53%, respectively, and the former was 3.57 times as high as the latter. Both the infection rates of the male and the female rose as the age increasing (χ²_male = 99.91, χ²_female = 16.51, both P < 0.01). The standardized infection rates among the subjects in different towns ranged from 0 to 10.40%, and the rates in the north towns were higher than those in the south towns. The standardized rate was 9.22% for the subjects combined with gallstone, 3.40% for those not combined with gallstone, and the former was 2.71 times as high as that of the latter. Conclusion The people aged 30 years and above, with gallstone or living in towns with high C. sinensis infection rates are the key population for prevention and control of clonorchiasis in Zhongshan City.

Distribution of Salmonella Serovars and Antimicrobial Susceptibility from Poultry and Swine Farms in Central Vietnam

This study was conducted to estimate the prevalence of Salmonella spp. and their antimicrobial susceptibilities on poultry and swine farms, sampled in 2 regions in Central Vietnam. A total of 67 poultry farms and 46 swine farms were sampled in a period of 5 months (from September 2012 to January 2013). Salmonella spp. was prevalent in 46.3% and 71.7% of poultry and swine farms, respectively. Altogether, 99 non-typhoidal Salmonella were isolated and the most common serovars were Salmonella Weltevreden (19%), followed by Salmonella Typhimurium (12%) and Salmonella 4,[5],12:i:- (11%). Overall, 71 of 99 (72%) Salmonella isolates were resistant to at least one of the 14 antimicrobial agents tested. Both in poultry and swine farms, high levels of resistance were observed for ampicillin, chloramphenicol, ciprofloxacin, sulphamethoxazole and tetracycline. The presence of Salmonella isolates from poultry and swine farms which were resistant to different classes of antimicrobials suggests that alternative control measures to antimicrobials should be implemented. Moreover, an effective policy should be promoted to encourage a prudent use of these agents in animal farming in Vietnam.

Dehydrated human amnion/chorion membrane treatment of venous leg ulcers: correlation between 4-week and 24-week outcomes

OBJECTIVE

To evaluate correct correlation between an intermediate rate of wound reduction (40% wound area reduction after 4-weeks treatment) and complete healing at 24 weeks in patients with a venous leg ulcer (VLU).

METHOD

A retrospective follow-up study of patients completing a multicenter randomised controlled trial (RCT) comparing the number of patients achieving at least 40% healing of their VLU within 4-weeks of treatment with either dehydrated human amnion/chorion membrane (dHACM) allograft or multilayer compression only was conducted. Outcomes assessed were rates of complete healing within 24 weeks of enrolment and days to healing. Data were divided into two groups based on status at RCT completion (healed at least 40% yes or no). Correct correlation with status at 4 weeks and complete healing within 24 weeks was determined. Clinical characteristics were also compared for patients with and without correct correlation between 4-week and 24-week status.

RESULTS

We identified 55 patients at 5 study sites. Some 47 without complete healing during the initial study were eligible. As three patients were lost to follow-up we evaluated 44 records. Of these, 20 (45.4%) had reduced wound size of ≥40% and 24 (55%) had <40% reduction during the initial study. Complete healing occurred in 16/20 (80%) of the ≥40% group at a mean of 46 days, p=0.0027 and 8/24 (33.3%) of the <40% group at a mean of 103.6 days, p=0.0023. Overall, correct correlation of status at 4 weeks and ultimate healing status of VLU occurred in 32/44 patients (73%).

CONCLUSION

These results confirm that the intermediate outcome used in our initial study is a viable predictor of ultimate VLU healing.

Otoprotective effects of erythropoietin on Cdh23erl/erl mice

The Cdh23(erl/erl) mice are a novel mouse model for DFNB12 and are characterized by progressive hearing loss. In this study, erythropoietin (EPO) was given to the Cdh23(erl/erl) mice by intraperitoneal injection every other day from P7 for 7 weeks. Phosphate-buffered saline-treated or untreated Cdh23(erl/erl) mice were used as controls. Auditory-evoked brainstem response (ABR) thresholds and distortion product oto-acoustic emission (DPOAE) were measured in the mouse groups at the age of 4, 6 and 8 weeks. The results show that EPO can significantly decrease the ABR thresholds in the Cdh23(erl/erl) mice as compared with those of the untreated mice at stimulus frequencies of click, 8-, 16- and 32-kHz at three time points. Meanwhile, DPOAE amplitudes in the EPO-treated Cdh23(erl/erl) mouse group were significantly higher than those of the untreated groups at f2 frequency of 15383 Hz at the three time points. Furthermore, the mean percentage of outer hair cell loss at middle through basal turns of cochleae was significantly lower in EPO-treated Cdh23(erl/erl) mice than in the untreated mice (P<0.05). This is the first report that EPO acts as an otoprotectant in a DFNB12 mouse model with progressive hearing loss.