TRIM45 facilitates NASH-progressed HCC by promoting fatty acid synthesis via catalyzing FABP5 ubiquitylation

Non-alcoholic steatohepatitis (NASH) is rapidly surpassing viral hepatitis as the primary cause of hepatocellular carcinoma (HCC). However, understanding of NASH-progressed HCC remains poor, which might impede HCC diagnosis and therapy. In this study, we aim to identify shared transcriptional changes between NASH and HCC, of which we focused on E3 ligase TRIM45. We found TRIM45 exacerbates HCC cells proliferation and metastasis in vitro and in vivo. Further transcriptome analysis revealed TRIM45 predominantly affects fatty acid metabolism and oleic acid restored impaired proliferation and metastasis of TRIM45-deficient HCC cells. IP-tandem mass spectrum and FABP5 depriving experiment indicated that TRIM45 enhance fatty acid synthesis depending on FABP5 presence. Interestingly, we found TRIM45 directly added K33-type and K63-type poly-ubiquitin chains to FABP5 NLS domain, which ultimately promoted FABP5 nuclear translocation. Nuclear FABP5 interacted with PPARγ to facilitate downstream lipid synthesis gene expression. We observed TRIM45 accelerated NASH-to-HCC transition and exacerbated both NASH and NASH-HCC with the enhanced fatty acid production in vivo. Moreover, high concentration of fatty acid increased TRIM45 expression. The established mechanism was substantiated by gene expression correlation in TCGA-LIHC. Collectively, our research revealed a common lipid reprograming process in NASH and HCC and identified the cyclical amplification of the TRIM45-FABP5-PPARγ-fatty acid axis. This signaling pathway offers potential therapeutic targets for therapeutic intervention in NASH and NASH-progressed HCC.

Broadening Bandwidth in a Semi-Active Vibration Absorption System Utilizing Stacked Polyvinyl Chloride Gel Actuators

Plasticized polyvinyl chloride (PVC) gel is a new soft and smart material, whose potential in electroactive variable stiffness can be used for vibration control in soft robotic systems. In this paper, a new semi-active vibration absorber is developed by stacking PVC gel actuator units. The absorption bandwidth of a single PVC gel absorber covers the range of three natural frequencies (76.5 Hz, 95 Hz, 124 Hz) of a rectangular steel plate in vibration attenuation. The maximum reduction percentage in acceleration amplitude is 63%. With stacked PVC gel actuator units, the absorption bandwidth can be shifted and obviously broadened.

Analysis of hemorrhage upon ultrasound-guided percutaneous renal biopsy in China: a retrospective study

PURPOSE

Ultrasound-guided percutaneous renal biopsy (PRB) has been considered as a golden standard for CKD diagnosis and is employed to identify potential therapeutic targets since 1950s. Post-biopsy hemorrhage is the most common complication, while severe bleeding complication might cause nephrectomy or death. Therefore, how to reduce the occurrence of complications while ensuring the success of PRB is always a clinical research topic.

METHODS

This study retrospectively collected and established a renal biopsy database of each patient who underwent ultrasound-guided PRB at a tertiary teaching hospital from September 2017 to December 2020 through the Health Information System. All the data were statistically processed by SPSS software.

RESULTS

A total of 1146 patients underwent PRB for various reasons. The overall rate of post-biopsy hemorrhage was 37.70% (432/1146). Of those bleedings, minor bleeding after PRB was found in 337 (29.41%), middle bleeding 84 (7.33%), major bleeding 11 (0.96%). Besides that, there were 96 patients (8.38%) reported their discomfort symptoms. There was no death. Females were at significantly increased risk of hemorrhagic complication than males (OR = 2.017, CI = 1.531-2.658). While the risk for hemorrhagic complication significantly decreased as BMI and platelet before renal biopsy increased (OR = 0.956, CI = 0.924-0.989; OR = 0.998, CI = 0.996-1.000). As the APTT time prolonged, the risk for hemorrhagic complication significantly increased (OR = 1.072, CI = 1.023-1.123). Those patients whose albumin were higher, also had higher risk for hemorrhagic complication than other patients (OR = 1.020, CI = 1.000-1.041). Specifically, postoperative urination within 4 h increased the risk for hemorrhagic complication (OR = 1.741, CI = 1.176-2.576).

CONCLUSION

Our analysis finds that the incidence of post-biopsy bleeding complication is 37.70%, and its risk is associated with female, lower BMI, lower platelet before renal biopsy, prolonged APTT, higher albumin, and postoperative urination within 4 h. The findings highlighted the importance of perioperative management for renal biopsy, including adequate risk assessment, tailored careful observation after PRB. And medical staff should pay more attention to fluid management after ultrasound-guided PRB.

Inhibition of CDK7 mitigates doxorubicin cardiotoxicity and enhances anticancer efficacy

AIMS

The anthracycline family of anticancer agents such as doxorubicin (DOX) can induce apoptotic death of cardiomyocytes and cause cardiotoxicity. We previously reported that DOX-induced apoptosis is accompanied by cardiomyocyte cell cycle-reentry. Cell cycle progression requires cyclin-dependent kinase 7 (CDK7)-mediated activation of downstream cell cycle CDKs. This study aims to determine whether CDK7 can be targeted for cardioprotection during anthracycline chemotherapy.

METHODS AND RESULTS

DOX exposure induced CDK7 activation in mouse heart and isolated cardiomyocytes. Cardiac-specific ablation of Cdk7 attenuated DOX-induced cardiac dysfunction and fibrosis. Treatment with the covalent CDK7 inhibitor THZ1 also protected against DOX-induced cardiomyopathy and apoptosis. DOX treatment induced activation of the proapoptotic CDK2-FOXO1-Bim axis in a CDK7-dependent manner. In response to DOX, endogenous CDK7 directly bound and phosphorylated CDK2 at Thr160 in cardiomyocytes, leading to full CDK2 kinase activation. Importantly, inhibition of CDK7 further suppressed tumor growth when used in combination with DOX in an immunocompetent mouse model of breast cancer.

CONCLUSIONS

Activation of CDK7 is necessary for DOX-induced cardiomyocyte apoptosis and cardiomyopathy. Our findings uncover a novel proapoptotic role for CDK7 in cardiomyocytes. Moreover, this study suggests that inhibition of CDK7 attenuates DOX-induced cardiotoxicity, but augments the anticancer efficacy of DOX. Therefore, combined administration of CDK7 inhibitor and DOX may exhibit diminished cardiotoxicity but superior anticancer activity.

Placental senescence pathophysiology is shared between peripartum cardiomyopathy and preeclampsia in mouse and human

Peripartum cardiomyopathy (PPCM) is an idiopathic form of pregnancy-induced heart failure associated with preeclampsia. Circulating factors in late pregnancy are thought to contribute to both diseases, suggesting a common underlying pathophysiological process. However, what drives this process remains unclear. Using serum proteomics, we identified the senescence-associated secretory phenotype (SASP), a marker of cellular senescence associated with biological aging, as the most highly up-regulated pathway in young women with PPCM or preeclampsia. Placentas from women with preeclampsia displayed multiple markers of amplified senescence and tissue aging, as well as overall increased gene expression of 28 circulating proteins that contributed to SASP pathway enrichment in serum samples from patients with preeclampsia or PPCM. The most highly expressed placental SASP factor, activin A, was associated with cardiac dysfunction or heart failure severity in women with preeclampsia or PPCM. In a murine model of PPCM induced by cardiomyocyte-specific deletion of the gene encoding peroxisome proliferator-activated receptor γ coactivator-1α, inhibiting activin A signaling in the early postpartum period with a monoclonal antibody to the activin type II receptor improved heart function. In addition, attenuating placental senescence with the senolytic compound fisetin in late pregnancy improved cardiac function in these animals. These findings link senescence biology to cardiac dysfunction in pregnancy and help to elucidate the pathogenesis underlying cardiovascular diseases of pregnancy.

Intrinsic and Extrinsic Contributors to the Cardiac Benefits of Exercise

Among its many cardiovascular benefits, exercise training improves heart function and protects the heart against age-related decline, pathological stress, and injury. Here, we focus on cardiac benefits with an emphasis on more recent updates to our understanding. While the cardiomyocyte continues to play a central role as both a target and effector of exercise's benefits, there is a growing recognition of the important roles of other, noncardiomyocyte lineages and pathways, including some that lie outside the heart itself. We review what is known about mediators of exercise's benefits-both those intrinsic to the heart (at the level of cardiomyocytes, fibroblasts, or vascular cells) and those that are systemic (including metabolism, inflammation, the microbiome, and aging)-highlighting what is known about the molecular mechanisms responsible.

Renal damage and old age: risk factors for thrombosis in patients with ANCA-associated vasculitis

INTRODUCTION

Thrombosis in ANCA-associated vasculitis (AAV) was prevalent and has been neglected in Chinese patients. This study tried to describe the clinical characteristics, identify the risk factors, and investigate the causal relationship between AAV and venous thromboembolism (VTE) by two-sample Mendelian randomization (MR) analysis.

METHODS

In this retrospective, observational study, we included all hospitalized AAV patients from Jan 2013 to Apr 2022 in Peking Union Medical College Hospital. We collected their clinical data for multivariate regression analysis to determine the risk factors for thrombosis. The nomogram was constructed by applying these risk factors to predict thrombosis in AAV patients. As for MR analysis, we selected single nucleotide polymorphisms (SNPs) related to AAV from published genome-wide association studies and extracted the outcome data containing deep vein thrombosis (DVT) and pulmonary embolism (PE) from the UK biobank.

RESULTS

1203 primary AAV patients were enrolled, and thrombosis occurred in 11.3%. Multivariate regression suggested that older than 65 years, EGPA, neurological involvement, lung involvement, significantly elevated serum creatinine (> 500µmol/L), and elevated D-dimer were associated with thrombosis in AAV patients. The model demonstrated satisfied discrimination with an AUC of 0.769 (95% CI, 0.726-0.812). MR analysis showed that EGPA could increase the risk of developing DVT and PE (OR = 1.0038, 95%CI = 1.0035-1.0041, P = 0.009).

CONCLUSION

Thrombosis was not rare in Chinese patients with AAV. Renal damage and old age emerged as critical risk factors for thrombosis. EGPA might have a potential causal relationship with DVT and PE.

Sedimentary records of environmental evolution in Dongzhai Port mangrove swamps (South China) over the last hundred years: Insights from corrections of grain-size effects

Mangrove sediments play a vital role in the biogeochemical processes of elements by behaving as both sources and/or sink for nutrients and trace metals. Under the combined impacts of grain-size effects and human activities, it is difficult to accurately assess the sources and degree of pollutants. For this purpose, two cores were collected from a mangrove swamps of Dongzhai Port (South China) and analyzed for temporal distributions of grain size, nutrients, major and trace elements, and 210Pb activities. Due to the significant vertical variation of grain size with depth, linear regression analysis was conducted based on trace metals (i.e., Pb, Cr, Ni, Cu, Cd, Zn) and normalized element Al to reconstruct local environmental background. The results showed that the contents of Cu, Cd, and Zn in the surface layers exhibited significantly increasing trends since the 1980s, with maximum contents of 9.06, 0.16, and 228.66 μg g-1, and their enrichment factors up to 1.52, 1.40, and 1.50, respectively. It should be attributed to shrimp farming and domestic sewage, indicating slight anthropogenic inputs. The evolution process was divided into three stages in Dongzhai Port over the last 100 years: before 1980 AD, 1980-2000 AD, and from 2000 AD to the present, corresponding to the stages of natural deposition, domestic pollution, and aquaculture pollution, respectively.

Organization of microtubule plus-end dynamics by phase separation in mitosis

In eukaryotes, microtubule polymers are essential for cellular plasticity and fate decisions. End-binding (EB) proteins serve as scaffolds for orchestrating microtubule polymer dynamics and are essential for cellular dynamics and chromosome segregation in mitosis. Here, we show that EB1 forms molecular condensates with TIP150 and MCAK through liquid-liquid phase separation to compartmentalize the kinetochore-microtubule plus-end machinery, ensuring accurate kinetochore-microtubule interactions during chromosome segregation in mitosis. Perturbation of EB1-TIP150 polymer formation by a competing peptide prevents phase separation of the EB1-mediated complex and chromosome alignment at the metaphase equator in both cultured cells and Drosophila embryos. Lys220 of EB1 is dynamically acetylated by p300/CBP-associated factor in early mitosis, and persistent acetylation at Lys220 attenuates the phase separation of the EB1-mediated complex, dissolves droplets in vitro, and harnesses accurate chromosome segregation. Our data suggest a novel framework for understanding the organization and regulation of eukaryotic spindle for accurate chromosome segregation in mitosis.

Precise Photodynamic Therapy by Midkine Nanobody-Engineered Nanoparticles Remodels the Microenvironment of Pancreatic Ductal Adenocarcinoma and Potentiates the Immunotherapy

Pancreatic ductal adenocarcinoma (PDAC) is notorious for its resistance against chemotherapy and immunotherapy due to its dense desmoplastic and immunosuppressive tumor microenvironment (TME). Traditional photodynamic therapy (PDT) was also less effective for PDAC owing to poor selectivity, insufficient penetration, and accumulation of photosensitizers in tumor sites. Here, we designed a light-responsive novel nanoplatform targeting the TME of PDAC through tumor-specific midkine nanobodies (Nbs), which could efficiently deliver semiconducting polymeric nanoparticles (NPs) to the TME of PDAC and locally produce abundant reactive oxygen species (ROS) for precise photoimmunotherapy. The synthesized nanocomposite can not only achieve multimodal imaging of PDAC tumors (fluorescence and photoacoustic imaging) but also lead to apoptosis and immunogenic cell death of tumor cells via ROS under light excitation, ultimately preventing tumor progression and remodeling the immunosuppressive TME with increased infiltration of T lymphocytes. Combined with a PD-1 checkpoint blockade, the targeted PDT platform showed the best antitumor performance and markedly extended mice survival. Conclusively, this work integrating Nbs with photodynamic NPs provides a novel strategy to target formidable PDAC to achieve tumor suppression and activate antitumor immunity, creating possibilities for boosting efficacy of immunotherapy for PDAC tumors through the combination with precise local PDT.

Influence of Imbibition Fracturing Fluid on the Original Water and Methane Occurrence in Actual Coalbed Methane Reservoirs Using the Integrated Device of Displacement and Low-Field Nuclear Magnetic Resonance

The original water in the coal rock pores plays a controlling role in the occurrence of gas. Furthermore, during the hydraulic fracturing process, pressurized fracturing fluid with a higher pressure than the original pore pressure in the fractures drives the fracturing fluid to infiltrate into the coal rock pores, thereby altering the occurrence pattern of gas and water in the original pores. However, due to the limitations of the indoor simulation device, a systematic conclusion on the impact of the original pore water and imbibition fracturing fluid on coalbed methane reservoirs has not yet been formed. In this paper, an integrated device combining displacement and low-field nuclear magnetic resonance was employed using underground cylindrical coal rock samples as experimental subjects. Experimental conditions were maintained at a temperature of 30 °C, a confining pressure of 23 MPa, and an approximate reservoir pressure of 15 MPa. The initial water saturation levels were altered to 0, 27.88, and 42.18% to replicate the conditions of a coalbed methane reservoir at a depth of approximately 1200 m. Fracturing fluid with a pressure of 18 MPa was injected into the experimental samples to simulate the impact of the fracturing fluid on the original reservoir during hydraulic fracturing. This allowed for a realistic assessment of the influence of initial water saturation and fracturing fluid absorption on the coalbed methane recovery rate in the reservoir. The experimental results indicate that the imbibition process promotes the desorption of adsorbed gas, and the desorption amount of adsorbed gas increases with the increase in the original water saturation. This will result in an increase in the gas pressure within the pore system. The conditions of this experiment, in comparison to the previous ones, more closely resemble real reservoir conditions. This enables a realistic assessment of how the presence of the original water content and the absorption of the fracturing fluid affect gas occurrence within the reservoir.

Synthesis, biological activity evaluation and mechanism of action of novel bis-isatin derivatives as potential anti-liver cancer agents

A series of bis-isatin conjugates with lysine linker were synthesized with the aim of probing their antiproliferative potential. All the newly synthesized derivatives (0-100 μM) were first screened against liver cancer cell lines(Huh1, H22, Huh7, Hepa1-6, HepG2, Huh6 and 97H) using CCK-8 assay. Results indicated that the derivative 4d exhibited the most potent activity against Huh1 (IC50 = 17.13 µM) and Huh7(IC50 = 8.265 µM). In vivo anti-tumor study showed that compound 4d effectively inhibited tumor growth in Huh1-induced xenograft mouse model; the anti-tumor effect of compound 4d (15 mg/kg) was comparable with sorafenib (20 mg/kg). H&E staining analysis and routine blood test and blood serum biochemistry examination was performed to confirm the safety of compound 4d in xenograft models. The mechanism of action of 4d on tumor growth inhibition was further investigated by RNA-Seq analysis, which indicates a positive regulation of autophagy signaling pathway, which was further confirmed with key biomarker expression of autophagy after 4d treatment. Our results suggest that the bis-isatin conjugate compound 4d is a promising tumor inhibitory agent for some liver cancer.

Construction of 2D sandwich-like Na2V6O16·3H2O@MXene heterostructure for advanced aqueous zinc ion batteries

Aqueous zinc ion batteries (AZIBs) have attained enormous attention in the last few years. The cathode materials of aqueous zinc ion batteries play a vital effect in their electrochemical and battery properties. In this manuscript, Sandwich-like MXene@Na2V6O16·3H2O (NVO@MXene) heterostructure was successfully prepared by the combination and cooperation of the layer lattice structure of Na2V6O16·3H2O and the high conductivity of MXene. When used as the cathode material for AZIBs, NVO@MXene demonstrates preeminent rate capability and excellent reversible capacity of 175 mAh/g after 3000 cycles at 5 A/g with a retention rate of 88.9 % of initial discharge capacity. The outstanding battery performance can be attributed to the MXene layers with high conductivity for accelerating the ion diffusion rate and reducing the agglomeration of Na2V6O16·3H2O nanowires during the (dis)charge process. Meanwhile, the stable layered structure of Na16V6O6·3H2O with wide interlamellar spacing (d = 7.9 Å) is also favorable for the s fast intercalation/deintercalation of Zn2+. Finally, ex-situ X-ray diffraction and X-ray photoelectron spectroscopy were applied to study and reveal the energy storage mechanism of this novel material for aqueous zinc ion batteries.

Sn0.1-Li4Ti5O12/C as a promising cathode material with a large capacity and high rate performance for Mg-Li hybrid batteries

The development prospects of conventional Li-ion batteries are limited by the paucity of Li resources. Mg-Li hybrid batteries (MLIBs) combine the advantages of Li-ion batteries and magnesium batteries. Li+ can migrate rapidly in the cathode materials, and the Mg anode has the advantage of being dendrite-free. In this study, a type of Li4Ti5O12 composite material doped with Sn4+ and a conductive carbon skeleton (Li4Ti4.9Sn0.1O12/C, Sn0.1-LTO/C) was prepared by a simple one-pot sol-gel method. The doped Sn4+ replaces part of Ti4+ in the crystal lattice, which makes Ti3+ require charge compensation, thus improving the ionic conductivity. The intervention of the conductive carbon skeleton further improves the conductivity of the Sn0.1-LTO/C composite material. The performance of Sn0.1-LTO/C as the cathode of MLIBs is explored. The initial discharge capacity was 159.1 mA h g-1 at 0.5 C, and it was maintained at 105 mA h g-1 even after 500 cycles. The excellent electrochemical performance is attributed to a small amount of Sn doping and the involvement of the conductive carbon skeleton, which indicated that the Sn0.1-LTO/C composite material provides great potential application in MLIBs.

Development and Validation of a Dynamic Nomogram for Predicting 3-Month Mortality in Acute Ischemic Stroke Patients with Atrial Fibrillation

Background

Acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) carries a substantial risk of mortality, emphasizing the need for effective risk assessment and timely interventions. This study aimed to develop and validate a practical dynamic nomogram for predicting 3-month mortality in AIS patients with AF.

Methods

AIS patients with AF were enrolled and randomly divided into training and validation cohorts. The nomogram was developed based on independent risk factors identified by multivariate logistic regression analysis. The prediction performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, decision curve analysis (DCA), and Kaplan-Meier survival analysis.

Results

A total of 412 patients with AIS and AF entered final analysis, 288 patients in the training cohort and 124 patients in the validation cohort. The nomogram was developed using age, baseline National Institutes of Health Stroke Scale score, early introduction of novel oral anticoagulants, and pneumonia as independent risk factors. The nomogram exhibited good discrimination both in the training cohort (AUC, 0.851; 95% CI, 0.802-0.899) and the validation cohort (AUC, 0.811; 95% CI, 0.706-0.916). The calibration plots, DCA and Kaplan-Meier survival analysis demonstrated that the nomogram was well calibrated and clinically useful, effectively distinguishing the 3-month survival status of patients with AIS and AF, respectively. The dynamic nomogram can be obtained at the website: https://yanxiaodi.shinyapps.io/3-monthmortality/.

Conclusion

The dynamic nomogram represents the first predictive model for 3-month mortality and may contribute to managing the mortality risk of patients with AIS and AF.

Mass spectrometry analysis of intact protein N-glycosylation signatures of cells and sera in pancreatic adenocarcinomas

Pancreatic cancer is among the most malignant cancers, and thus early intervention is the key to better survival outcomes. However, no methods have been derived that can reliably identify early precursors of development into malignancy. Therefore, it is urgent to discover early molecular changes during pancreatic tumorigenesis. As aberrant glycosylation is closely associated with cancer progression, numerous efforts have been made to mine glycosylation changes as biomarkers for diagnosis; however, detailed glycoproteomic information, especially site-specific N-glycosylation changes in pancreatic cancer with and without drug treatment, needs to be further explored. Herein, we used comprehensive solid-phase chemoenzymatic glycoproteomics to analyze glycans, glycosites, and intact glycopeptides in pancreatic cancer cells and patient sera. The profiling of N-glycans in cancer cells revealed an increase in the secreted glycoproteins from the primary tumor of MIA PaCa-2 cells, whereas human sera, which contain many secreted glycoproteins, had significant changes of glycans at their specific glycosites. These results indicated the potential role for tumor-specific glycosylation as disease biomarkers. We also found that AMG-510, a small molecule inhibitor against Kirsten rat sarcoma viral oncogene homolog (KRAS) G12C mutation, profoundly reduced the glycosylation level in MIA PaCa-2 cells, suggesting that KRAS plays a role in the cellular glycosylation process, and thus glycosylation inhibition contributes to the anti-tumor effect of AMG-510.

Diagnostic Potential of Serum Glycome Analysis in Lung Cancer: A Glycopattern Study

Lung cancer is the leading cause of cancer-related death, with high morbidity and mortality rates due to the lack of reliable methods for diagnosing lung cancer at an early stage. Low-dose computed tomography can help detect abnormal areas in the lungs, but only 16% of cases are diagnosed early. Tests for lung cancer markers are often employed to determine genetic expression or mutations in lung carcinogenesis. Serum glycome analysis is a promising new method for early lung cancer diagnosis as glycopatterns exhibit significant differences in lung cancer patients. In this study, we employed a solid-phase chemoenzymatic method to systematically compare glycopatterns in benign cases, adenocarcinoma before and after surgery, and advanced stages of adenocarcinoma. Our findings indicate that serum high-mannose levels are elevated in both benign cases and adenocarcinoma, while complex N-glycans, including fucose and 2,6-linked sialic acid, are downregulated in the serum. Subsequently, we developed an algorithm that utilizes 16 altered N-glycans, 7 upregulated and 9 downregulated, to generate a score based on their intensity. This score can predict the stages of cancer progression in patients through glycan characterization. This methodology offers a potential means of diagnosing lung cancer through serum glycome analysis.

LIM domain only 7 negatively controls nonalcoholic steatohepatitis in the setting of hyperlipidemia

BACKGROUND AND AIMS

Hyperlipidemia has been extensively recognized as a high-risk factor for NASH; however, clinical susceptibility to NASH is highly heterogeneous. The key controller(s) of NASH susceptibility in patients with hyperlipidemia has not yet been elucidated. Here, we aimed to reveal the key regulators of NASH in patients with hyperlipidemia and to explore its role and underlying mechanisms.

APPROACH AND RESULTS

To identify the predominant suppressors of NASH in the setting of hyperlipidemia, we collected liver biopsy samples from patients with hyperlipidemia, with or without NASH, and performed RNA-sequencing analysis. Notably, decreased Lineage specific Interacting Motif domain only 7 (LMO7) expression robustly correlated with the occurrence and severity of NASH. Although overexpression of LMO7 effectively blocked hepatic lipid accumulation and inflammation, LMO7 deficiency in hepatocytes greatly exacerbated diet-induced NASH progression. Mechanistically, lysine 48 (K48)-linked ubiquitin-mediated proteasomal degradation of tripartite motif-containing 47 (TRIM47) and subsequent inactivation of the c-Jun N-terminal kinase (JNK)/p38 mitogen-activated protein kinase (MAPK) cascade are required for the protective function of LMO7 in NASH.

CONCLUSIONS

These findings provide proof-of-concept evidence supporting LMO7 as a robust suppressor of NASH in the context of hyperlipidemia, indicating that targeting the LMO7-TRIM47 axis is a promising therapeutic strategy for NASH.

Deep-Learning-Based MRI Microbleeds Detection for Cerebral Small Vessel Disease on Quantitative Susceptibility Mapping

BACKGROUND

Cerebral microbleeds (CMB) are indicators of severe cerebral small vessel disease (CSVD) that can be identified through hemosiderin-sensitive sequences in MRI. Specifically, quantitative susceptibility mapping (QSM) and deep learning were applied to detect CMBs in MRI.

PURPOSE

To automatically detect CMB on QSM, we proposed a two-stage deep learning pipeline.

STUDY TYPE

Retrospective.

SUBJECTS

A total number of 1843 CMBs from 393 patients (69 ± 12) with cerebral small vessel disease were included in this study. Seventy-eight subjects (70 ± 13) were used as external testing.

FIELD STRENGTH/SEQUENCE

3 T/QSM.

ASSESSMENT

The proposed pipeline consisted of two stages. In stage I, 2.5D fast radial symmetry transform (FRST) algorithm along with a one-layer convolutional network was used to identify CMB candidate regions in QSM images. In stage II, the V-Net was utilized to reduce false positives. The V-Net was trained using CMB and non CMB labels, which allowed for high-level feature extraction and differentiation between CMBs and CMB mimics like vessels. The location of CMB was assessed according to the microbleeds anatomical rating scale (MARS) system.

STATISTICAL TESTS

The sensitivity and positive predicative value (PPV) were reported to evaluate the performance of the model. The number of false positive per subject was presented.

RESULTS

Our pipeline demonstrated high sensitivities of up to 94.9% at stage I and 93.5% at stage II. The overall sensitivity was 88.9%, and the false positive rate per subject was 2.87. With respect to MARS, sensitivities of above 85% were observed for nine different brain regions.

DATA CONCLUSION

We have presented a deep learning pipeline for detecting CMB in the CSVD cohort, along with a semi-automated MARS scoring system using the proposed method. Our results demonstrated the successful application of deep learning for CMB detection on QSM and outperformed previous handcrafted methods.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY: Stage 2.

Modified separators boost polysulfides adsorption-catalysis in lithium-sulfur batteries from Ni@Co hetero-nanocrystals into CNT-porous carbon dual frameworks

In this manuscript, nickel/cobalt bimetallic nanocrystals confining into three-dimensional interpenetrating dual-carbon conductive structure (NiCo@C/CNTs) were successfully manufactured by annealing its core-shell structure (Ni-ZIF-67@ZIF-8) precursor under the high temperature. The results presented that the bimetallic nickel and cobalt nanocrystals with superior catalytic activity could quickly convert solid Li2S/Li2S2into soluble LiPSs and effectively decrease the energy barrier. While the hierarchical CNT-porous carbon dual frameworks can provide quick electron/ion transport because of their large specific surface area and the exposure of enough active sites. When used as the separator modifier for lithium sulfur batteries, the battery properties were significantly improved with high specific capacity, outstanding rate capability, and long-term cycle stability. Specifically, its initial specific capacity can achieve to 1038.51 mAh g-1 at 0.5C. At the high rate of 3C, it still delivers satisfactory discharge capacity of 555 mAhg-1 and the capacity decay rate is only 0.065% per cycle after 1000 cycles at 1C. Furthermore, even exposed to heavy sulfur loading (3.61 mg/cm2), they still maintain promising cycle stability. Therefore, such kinds of MOFs derivative with powerful chemical immobilization and catalytic conversion for polysulfides provides a novel guidance for the modification separator and the potential application in the field of high-performance Li-S batteries.

Advances in Conductive Hydrogel for Spinal Cord Injury Repair and Regeneration

Spinal cord injury (SCI) treatment represents a major challenge in clinical practice. In recent years, the rapid development of neural tissue engineering technology has provided a new therapeutic approach for spinal cord injury repair. Implanting functionalized electroconductive hydrogels (ECH) in the injury area has been shown to promote axonal regeneration and facilitate the generation of neuronal circuits by reshaping the microenvironment of SCI. ECH not only facilitate intercellular electrical signaling but, when combined with electrical stimulation, enable the transmission of electrical signals to electroactive tissue and activate bioelectric signaling pathways, thereby promoting neural tissue repair. Therefore, the implantation of ECH into damaged tissues can effectively restore physiological functions related to electrical conduction. This article focuses on the dynamic pathophysiological changes in the SCI microenvironment and discusses the mechanisms of electrical stimulation/signal in the process of SCI repair. By examining electrical activity during nerve repair, we provide insights into the mechanisms behind electrical stimulation and signaling during SCI repair. We classify conductive biomaterials, and offer an overview of the current applications and research progress of conductive hydrogels in spinal cord repair and regeneration, aiming to provide a reference for future explorations and developments in spinal cord regeneration strategies.

Identification and targeting of cancer-associated fibroblast signature genes for prognosis and therapy in Cutaneous melanoma

BACKGROUND

Cancer-associated fibroblasts (CAFs) play pivotal roles in tumor invasion and metastasis. However, studies on CAF biomarkers in Cutaneous Melanoma (CM) are still scarce. This study aimed to explore the potential CAF biomarkers in CM, propose the potential therapeutic targets, and provide new insights for targeted therapy of CAFs in CM.

METHODS

We utilized weighted gene co-expression network analysis to identify CAF signature genes in CM, and conducted comprehensive bioinformatics analysis on the CAF risk score established by these genes. Moreover, single-cell sequencing analysis, spatial transcriptome analysis, and cell experiments were utilized for verifying the expression and distribution pattern of signature genes. Furthermore, molecular docking was employed to screen potential target drugs.

RESULTS

FBLN1 and COL5A1, two crucial CAF signature genes, were screened to establish the CAF risk score. Subsequently, a comprehensive bioinformatic analysis of the CAF risk score revealed that high-risk score group was significantly enriched in pathways associated with tumor progression. Besides, CAF risk score was significantly negatively correlated with clinical prognosis, immunotherapy response, and tumor mutational burden in CM patients. In addition, FBLN1 and COL5A1 were further identified as CAF-specific biomarkers in CM by multi-omics analysis and experimental validation. Eventually, based on these two targets, Mifepristone and Dexamethasone were screened as potential anti-CAFs drugs.

CONCLUSION

The findings indicated that FBLN1 and COL5A1 were the CAF signature genes in CM, which were associated with the progression, treatment, and prognosis of CM. The comprehensive exploration of CAF signature genes is expected to provide new insight for clinical CM therapy.

Effects of rTMS combined with rPMS on stroke patients with arm paralysis after contralateral seventh cervical nerve transfer: a case-series

OBJECTIVE

We conducted this study to evaluate the effect of rTMS combined with rPMS on stroke patients with arm paralysis after CSCNTS.

METHODS

A case-series of four stroke patients with arm paralysis, ages ranging from 39 to 51 years, that underwent CSCNTS was conducted. Patients were treated with 10 HZ rTMS on the contralesional primary motor cortex combined with 20 HZ rPMS on groups of elbow and wrist muscles for 15 days.

RESULTS

The muscle tone of elbow flexor muscle (EFM), elbow extensor muscle (EEM), wrist flexor muscle (WFM) and flexor digitorum (FD) reduced immediately after operation followed by increasing gradually. After rehabilitation, the muscle tone of EEM and EFM reduced by 14% and 11%, respectively. There was a 13% and 45% change ratio in WFM and FD. The numeric rating scale (mean = 5.75 ± 1.71) was significantly lower (mean = 3.25 ± 1.90, t = 8.66, p = .00). Grip and pinch strength (mean = 23.65 ± 4.91; mean = 4.9 ± 0.59) were significantly higher (mean = 34.63 ± 5.23, t = -61.07, p = .00; mean = 7.1 ± 0.73, t = -13.91, p = .00).

CONCLUSIONS

The rehabilitation of stroke patients with arm paralysis after CSCNTS is a long, complicated process which includes great change of neuropathic pain, muscle tone, and muscle strength. In order to enhance the neural connection between the contralesional hemisphere and the hemiplegic limb, alleviate postoperative complications, as well as accelerate the rehabilitation process, we can consider to use rTMS combined with rPMS.

Development of a multiple convolutional neural network-facilitated diagnostic screening program for immunofluorescence images of IgA nephropathy and idiopathic membranous nephropathy

Background

Immunoglobulin A nephropathy (IgAN) and idiopathic membranous nephropathy (IMN) are the most common glomerular diseases. Immunofluorescence (IF) tests of renal tissues are crucial for the diagnosis. We developed a multiple convolutional neural network (CNN)-facilitated diagnostic program to assist the IF diagnosis of IgAN and IMN.

Methods

The diagnostic program consisted of four parts: a CNN trained as a glomeruli detection module, an IF intensity comparator, dual-CNN (D-CNN) trained as a deposition appearance and location classifier and a post-processing module. A total of 1573 glomerular IF images from 1009 patients with glomerular diseases were used for the training and validation of the diagnostic program. A total of 1610 images of 426 patients from different hospitals were used as test datasets. The performance of the diagnostic program was compared with nephropathologists.

Results

In >90% of the tested images, the glomerulus location module achieved an intersection over union >0.8. The accuracy of the D-CNN in recognizing irregular granular mesangial deposition and fine granular deposition along the glomerular basement membrane was 96.1% and 93.3%, respectively. As for the diagnostic program, the accuracy, sensitivity and specificity of diagnosing suspected IgAN were 97.6%, 94.4% and 96.0%, respectively. The accuracy, sensitivity and specificity of diagnosing suspected IMN were 91.7%, 88.9% and 95.8%, respectively. The corresponding areas under the curve (AUCs) were 0.983 and 0.935. When tested with images from the outside hospital, the diagnostic program showed stable performance. The AUCs for diagnosing suspected IgAN and IMN were 0.972 and 0.948, respectively. Compared with inexperienced nephropathologists, the program showed better performance.

Conclusion

The proposed diagnostic program could assist the IF diagnosis of IgAN and IMN.

Recent advancement in vascularized tissue-engineered bone based on materials design and modification

Bone is one of the most vascular network-rich tissues in the body and the vascular system is essential for the development, homeostasis, and regeneration of bone. When segmental irreversible damage occurs to the bone, restoring its vascular system by means other than autogenous bone grafts with vascular pedicles is a therapeutic challenge. By pre-generating the vascular network of the scaffold in vivo or in vitro, the pre-vascularization technique enables an abundant blood supply in the scaffold after implantation. However, pre-vascularization techniques are time-consuming, and in vivo pre-vascularization techniques can be damaging to the body. Critical bone deficiencies may be filled quickly with immediate implantation of a supporting bone tissue engineered scaffold. However, bone tissue engineered scaffolds generally lack vascularization, which requires modification of the scaffold to aid in enhancing internal vascularization. In this review, we summarize the relationship between the vascular system and osteogenesis and use it as a basis to further discuss surgical and cytotechnology-based pre-vascularization strategies and to describe the preparation of vascularized bone tissue engineered scaffolds that can be implanted immediately. We anticipate that this study will serve as inspiration for future vascularized bone tissue engineered scaffold construction and will aid in the achievement of clinical vascularized bone.

Conjoint analysis of clinical, imaging, and pathological features of schistosomiasis and colorectal cancer

This study aims to examine and compare clinical, radiological, and pathological data between colorectal cancer (CRC) patients with and without schistosomiasis and uncover distinctive CRC characteristics when accompanied by schistosomiasis. This retrospective study is based on data collected from 341 patients diagnosed with CRC post-surgery and pathology. Of these patients, 101 (Group A) were diagnosed with colorectal cancer co-occurring with schistosomiasis (CRC-S), while 240 patients (Group B) were diagnosed with colorectal cancer without concurrent schistosomiasis (CRC-NS). Both groups were compared and analyzed based on their clinical data, imaging-based TNM staging, lymph node metastasis, nerve invasion, vascular cancer thrombus, and histopathological differentiation. A Chi-squared test revealed a significant difference in gender distribution between the patients with CRC-S (Group A) and CRC-NS (Group B), with a p -value of 0.043 and χ2 = 4.115. Specifically, a higher incidence rate was observed among males in Group A. There was a difference in the overall distribution of TNM staging between the two groups (p = 0.034, χ2 = 6.764). After pairwise comparison, a statistically significant difference was observed in the T3 stage (p <0.05). The proportion of the T3 stage in Group A was significantly higher than that in Group B, indicating certain advantages. There was a difference in postoperative histopathological grading between the two groups (p = 0.005, χ2 = 10.626). After pairwise comparison, a statistically significant difference was observed between the well-differentiated adenocarcinoma and the moderately and poorly differentiated adenocarcinoma (p <0.05), with a higher proportion of welldifferentiated patients in Group A compared to Group B. There was no significant difference in age, lymph node metastasis, nerve invasion, and vascular invasion between the two groups of patients (p > 0.05). Among the 101 patients with CRC-S, 87 (86%) showed linear calcification on CT imaging. Patients with CRC-S are mainly male, with tumor staging mostly in the middle stage, high tumor differentiation, and low malignancy. CT imaging can help identify the presence of lumps and linear calcification indicative of schistosome deposits. MRI can early clarify TNM staging and determine the presence of lymph node metastasis and nerve and vascular invasion.

Targeted delivery of organic small-molecule photothermal materials with engineered extracellular vesicles for imaging-guided tumor photothermal therapy

Imaging-guided photothermal therapy (PTT) for cancers recently gathered increasing focus thanks to its precise diagnosis and potent therapeutic effectiveness. Croconaine (CR) dyes demonstrate potential in expanding utility for near infrared (NIR) dyes in bio-imaging/theranostics. However, reports on CR dyes for PTT are scarce most likely due to the short of the efficacious delivery strategies to achieve specific accumulation in diseased tissues to induce PTT. Extracellular vesicles (EVs) are multifunctional nanoparticle systems that function as safe platform for disease theragnostics, which provide potential benefits in extensive biomedical applications. Here, we developed a novel delivery system for photothermal molecules based on a CR dye that exerts photothermal activity through CDH17 nanobody-engineered EVs. The formed CR@E8-EVs showed strong NIR absorption, excellent photothermal performance, good biological compatibility and superb active tumor-targeting capability. The CR@E8-EVs can not only visualize and feature the tumors through CR intrinsic property as a photoacoustic imaging (PAI) agent, but also effectively retard the tumor growth under laser irradiation to perform PTT. It is expected that the engineered EVs will become a novel delivery vehicle of small organic photothermal agents (SOPTAs) in future clinical PTT applications.

Effects of nanosilica on the properties of brine-base drilling fluid

In the process of drilling oil and gas wells, the shrinkage and falling of wellbore walls are often caused by the expansion of mud shale water. To date, conventional additives have been unable to plug the pore throats of shale rock with nanoscale pores and thus cannot effectively solve the problem of wellbore instability encountered in shale formation drilling. In view of this situation, the idea of using nanosilica to plug the nanopore throat of mud shale is proposed to reduce its permeability and to slow water intrusion. The influences of nanosilica on the properties of brine-base drilling fluid drilling fluid are evaluated by measuring the viscosity, filtration loss and swelling of the drilling fluid. The results of laboratory experiments show that the improvement in drilling fluid properties can only be achieved on the basis of salt resistance; that is, a salt-resistant soil slurry should be used. A concentration of 1-5% nanosilica can improve the viscosity of the drilling fluid by increasing the internal friction between particles. However, nanosilica materials are sensitive to salt concentration. Nanosilica particles can be deposited on the surface of a filter cake to block the pores of the filter paper, and the filtration loss reduction rate can reach 40.2%. Blocking the pores of the clay plays a role in preventing the clay from absorbing water and expanding. The optimal addition amount of silica is 3%, and its salt resistance can reach 16%. Considering the experimental results of filtration loss, swelling amount and cost performance, 3%NP + 4%NaCl + SWM-B is selected as the optimal formula. The results of this study can be applied to effectively improve the phenomenon of wellbore instability during drilling in shale formations, and it has important application value.

Effect of Water on Effective Pore Structures for Medium-Rank Coal: Based on the Prefreezing Nitrogen Adsorption-Desorption Experiment

Water is ubiquitous in coal reservoirs, and its distribution can have a remarkable influence on the effective pore space of methane. This study conducted the combination experiments of moisture equilibrium and prefreezing nitrogen adsorption-desorption to explore the adsorption behavior of water in coal pores and thus to reveal the distribution characteristics of water in pores with different scales as well as the influence of water on pore structures. The results showed that the adsorption mechanism of water vapor undergoes a transition from monolayer to multilayer to condensation with the increase in relative humidity (RH). The occurrence characteristics of adsorbed water in coal pores are controlled by the RH and pore size. When the RH is increased from 0 to 98%, the nitrogen adsorption capacity, specific surface area, and effective pore volume of the samples were all decreased significantly due to the different adsorption modes of water, which is more significant in pores with d < 10 nm. Additionally, the relative pressure corresponding to the branching position of the nitrogen adsorption-desorption curve will be changed with the increase in moisture content. Based on this, it is calculated that the adsorbed water will change the smoothness of the pore wall and the complexity of the pore structure.

Development of a multimodal kidney age prediction based on automatic segmentation CT image in patients with normal renal function

Background

For decades, description of renal function has been of interest to clinicians and researchers. Serum creatinine (Scr) and estimated glomerular filtration rate (eGFR) are familiar but also limited in many circumstances. Meanwhile, the physiological volumes of the kidney cortex and medulla are presumed to change with age and have been proven to change with decreasing kidney function.

Methods

We recruited 182 patients with normal Scr levels between October 2021 and February 2022 in Peking Union Medical College Hospital (PUMCH) with demographic and clinical data. A 3D U-Net architecture is used for both cortex and medullary separation, and volume calculation. In addition, we included patients with the same inclusion criteria but with diabetes (PUMCH-DM test set) and diabetic nephropathy (PUMCH-DN test set) for internal comparison to verify the possible clinical value of "kidney age" (K-AGE).

Results

The PUMCH training set included 146 participants with a mean age of 47.5 ± 7.4 years and mean Scr 63.5 ± 12.3 μmol/L. The PUMCH test set included 36 participants with a mean age of 47.1 ± 7.9 years and mean Scr 66.9 ± 13.0 μmol/L. The multimodal method predicted K-AGE approximately close to the patient's actual physiological age, with 92% prediction within the 95% confidential interval. The mean absolute error increases with disease progression (PUMCH 5.00, PUMCH-DM 6.99, PUMCH-DN 9.32).

Conclusion

We established a machine learning model for predicting the K-AGE, which offered the possibility of evaluating the whole kidney health in normal kidney aging and in disease conditions.

Engineered Extracellular Vesicles for Delivery of an IL-1 Receptor Antagonist Promote Targeted Repair of Retinal Degeneration

Retinal degeneration (RD) is an irreversible blinding disease that seriously affects patients' daily activities and mental health. Targeting hyperactivated microglia and regulating polarization are promising strategies for treating the disease. Mesenchymal stem cell (MSC) transplantation is proven to be an effective treatment due to its immunomodulatory and regenerative properties. However, the low efficiency of cell migration and integration of MSCs remains a major obstacle to clinical use. The goal of this study is to develop a nanodelivery system that targets hyperactivated microglia and inhibits their release of proinflammatory factors, to achieve durable neuroprotection. This approach is to engineer extracellular vesicles (EVs) isolated from MSC, modify them with a cyclic RGD (cRGD) peptide on their surface, and load them with an antagonist of the IL-1 receptor, anakinra. Comparing with non-engineered EVs, it is observed that engineered cRGD-EVs exhibit an increased targeting efficiency against hyperactivated microglia and strongly protected photoreceptors in experimental RD cells and animal models. This study provides a strategy to improve drug delivery to degenerated retinas and offers a promising approach to improve the treatment of RD through targeted modulation of the immune microenvironment via engineered cRGD-EVs.

Protein crotonylation: An emerging regulator in DNA damage response

DNA damage caused by internal or external factors lead to increased genomic instability and various diseases. The DNA damage response (DDR) is a crucial mechanism that maintaining genomic stability through detecting and repairing DNA damage timely. Post-translational modifications (PTMs) play significant roles in regulation of DDR. Among the present PTMs, crotonylation has emerged as a novel identified modification that is involved in a wide range of biological processes including gene expression, spermatogenesis, cell cycle, and the development of diverse diseases. In the past decade, numerous crotonylation sites have been identified in histone and non-histone proteins, leading to a more comprehensive and deep understanding of the function and mechanisms in protein crotonylation. This review provides a comprehensive overview of the regulatory mechanisms of protein crotonylation and the effect of crotonylation in DDR. Furthermore, the effect of protein crotonylation in tumor development and progression is presented, to inspire and explore the novel strategies for tumor therapy.

Dosimetric Quality of Artificial Intelligence Based Organ at Risk Segmentation

PURPOSE/OBJECTIVE(S)

to compare dosimetric parameters between Artificial intelligence (AI) generated organ at risks (OAR) and Radiation Oncologist approved OARs and evaluation of appropriateness unedited AI- OARs in routine clinical plan optimization and evaluation.

MATERIALS/METHODS

The OARs (lung, spinal cord and heart) for twenty SBRT (stereotactic body radiotherapy) lung CT simulation datasets were derived by AI based segmentation algorithms. These AI- OARs were edited by a staff Radiation Oncologist and then subjected to our SBRT peer-review process at our institution. A SBRT plan based on the approved contours was created. Dosimetric parameters for the unedited AI-OARs and edited physician-approved OARs were then compared.

RESULTS

Lung V20 differences between AI- OAR and physician- OAR varied from 0.01% - 0.7% with a mean value of 0.1% difference (p-value 0.004). Spinal cord D0.03cc varied from 0.02 Gy - 0.9 Gy with a mean value of 0.3 Gy difference (p-value 0.002). Heart D0.03cc varied from 0.01 Gy - 4.3 Gy with mean value 0.9 Gy difference (p-value 0.02).

CONCLUSION

Dosimetric parameters for AI-based lung, spinal cord and heart OARs vs physician approved OARs were different, overall, the differences were generally small. These differences are likely on par with inter-observer differences seen between individual radiation oncologists. Unedited OARs have the promise for routine use in plan optimization and evaluation to further improve efficiency.

Clinical Outcomes of Image-Guided Volumetric Modulated Arc Therapy for Total Body Irradiation

PURPOSE/OBJECTIVE(S)

Volumetric modulated arc therapy (VMAT)-based total body irradiation (TBI) with image guidance is a novel technique that is increasing in implementation. Compared to conventional TBI, VMAT-TBI offers favorable dose homogeneity, better organ-at-risk sparing, and enhanced patient comfort. However, whether these dosimetric advantages translate to improved clinical outcomes that justify the increased planning and delivery burden is not well understood. Only a single study of clinical outcomes of VMAT-TBI exists in the literature. We present the largest study to date of clinical outcomes of VMAT-TBI.

MATERIALS/METHODS

In this IRB-approved retrospective single-institution study, all patients treated with VMAT-TBI conditioning for allogeneic stem cell transplant, per the institution's published protocol, were identified. Dosimetric data were abstracted from the radiation oncology treatment planning system. Clinical data were abstracted from the electronic medical record. The primary outcome was six-month overall survival (6M OS) from the last day of TBI by Kaplan-Meier method.

RESULTS

Fifty-five patients (47 adult and 8 pediatric) were treated with VMAT-TBI between June 2020 and December 2022. All patients received conditioning chemotherapy with standard-dose TBI of 12 or 13.2 Gy in 8 twice-daily fractions. The PTV coverage (V95%) mean was 95.3% ± 1.2%. Mean lung dose was 9.5 Gy ± 0.6 for adult patients and 8.4 Gy ± 0.9 for pediatric patients. Mean lung dose rate was 18.0 cGy/min ± 4.4. Mean kidney dose was 5.9 Gy ± 0.6. Mean skin dose measured by MOSFET was 12.7 Gy ± 1.2. Median treatment time was 63 minutes (range: 53-104). Median follow-up was 7.7 months. At most recent follow-up, 78% of patients were alive. 6M OS was 82%. Common acute toxicities were fatigue (90.9% of patients, all grade 1-2), diarrhea (70.9%, all grade 1-2), nausea (76.4%, all grade 1-2), mucositis (60% grade 1-2, 12.7% grade 3, 1.8% grade 4, no grade 5), and xerostomia (54.5%, all grade 1). Mean pretreatment FEV1 was 98.3 percent of predicted (%p) ± 11.9%p and mean posttreatment FEV1 was 94.7%p ± 13.8%p. Mean pretreatment GFR was 101.4mL/min/1.73m² ± 17.4, mean 3-month posttreatment GFR was 92.4 ± 20.0, and mean 6-month posttreatment GFR was 97.5 ± 26.48. One patient experienced grade 2 pneumonitis; there were no other cases of pneumonitis. There were no acute grade 3+ toxicities aside from mucositis. Observed late toxicities were cataracts (7.3%, all grades 1-3) and hypothyroidism (12.7%, all grades 1-2). There were no grade 3+ late toxicities. Mild acute graft-versus-host disease (GVHD) was noted in 27.2% of patients and mild chronic GVHD was noted in 14.5% of patients, with no other cases of GVHD.

CONCLUSION

In the largest series to date, VMAT-TBI had excellent oncologic and toxicity outcomes. A randomized trial of VMAT-TBI versus standard TBI is warranted.

Alternative splicing: a bridge connecting NAFLD and HCC

Non-alcoholic fatty liver disease (NAFLD) is becoming the most important risk factor for hepatocellular carcinoma (HCC). Understanding the progression of benign diseases to HCC is crucial for early prevention and reversal of malignant transformation. Alternative splicing (AS) of RNA plays a role in the pathogenicity, initiation, and transformation of liver disease. We summarize the changes or mutations in the activity of splicing factors in NAFLD and HCC, as well as the impact of AS mediated by epigenetic modifications such as DNA methylation, RNA methylation, histone modification, and protein phosphorylation on liver cell fate. We also summarize therapeutic methods and drugs that are helpful for treating NAFLD, HCC, and the early stages of NAFLD progression to HCC.

The Interplay Effect and Mitigations with Cyclotron and Linac Proton Beam Scanning for Lung SBRT

PURPOSE/OBJECTIVE(S)

To evaluate the impact of different types of pencil beam scanning proton accelerators and spot sizes on interplay effects, mitigations, and plan quality for lung cancer patients treated with SBRT.

MATERIALS/METHODS

Twenty lung cancer patients (ten peripheral and ten central tumors) treated in our institution with photon SBRT were selected to represent varying tumor volumes and respiratory motion amplitudes for this retrospective study. The respiratory motion amplitude ranged from 0.1 to 1.0 cm with compression. For each patient, plans were created using: 1) cyclotron-generated proton beams (CPB) (σ: 2.7-7.0 mm); 2) linear accelerator proton beams (LPB) (σ: 2.9-5.5 mm); and 3) linear accelerator proton minibeams (LPMB) (σ: 0.9-3.9 mm). Plans were robustly optimized on the GTV using each individual 4DCT phase. Single-filed optimization (SFO) plans were the first attempt, and if the plan quality did not meet the dosimetric requirement, multi-field optimization (MFO) was used. MFO plans were created for all patients for comparison. For each patient, all plans were normalized to have the same dose to 99% of the GTV. Interplay effects were evaluated for ten scenarios of treatment delivery starting in ten breathing phases using machine generic time models and a constant breathing period of 4 seconds. Volumetric repainting (VR) was performed 2-6 times for each plan. To assess plan quality in the nominal scenario, we compared the conformity index (CI), R50, and the percentage of lung volume receiving 20 Gy (RBE) (V20Gy). CI is defined as the ratio of the 100% isodose volume to the GTV. R50 is defined as the 50% isodose volume divided by the GTV. Dmax and V18Gy of the proximal bronchial tree (PBT) were evaluated for central tumors.

RESULTS

Twelve of 20 plans can be optimized sufficiently with SFO. In interplay effect evaluation, the mean V100%RX values of the GTV were 99.42±0.6%, 97.52±3.9%, and 94.49±7.3%for CPB, LPB, and LPMB plans respectively. After VR 2/3/5 times, the V100%RX values were improved (on average) by 0.13%/1.84%/4.63% for CPB/LPB/LPMB plans. The delivery time for VR plans was the lowest for LPB plans, while delivery time for LPMB was on average 1 minute longer than CPB plans. VR showed no effect on lung V20Gy, Dmax and V18Gy of the PBT. SFO plans were more robust against the interplay effect compared with MFO plans for LPB and LPMB. Average CIs of 1.88±0.4, 1.79±0.4, and 1.75±0.4; average R50s of 7.99±4.0, 6.68±3.0, and 5.70±2.6; and average lung V20Gy values of 2.81±1.5, 2.26±1.3, and 1.85±1.1 were obtained for CPB, LPB, and LPMB plans, respectively. Dmax and V18Gy of the PBT decreased with decreasing spot sizes.

CONCLUSION

LPMB, with the smallest spot size, produced superior plan quality. In the absence of VR, proton machines with large spot sizes generated more robust plans against interplay effects. VR improved the plan robustness against interplay effects for modalities with small spot sizes and fast energy changes, preserving the low dose sparing aspect of the LPMB, even when motion is included.

Cullin-associated and neddylation-dissociated 1 regulate reprogramming of lipid metabolism through SKP1-Cullin-1-F-boxFBXO11 -mediated heterogeneous nuclear ribonucleoprotein A2/B1 ubiquitination and promote hepatocellular carcinoma

BACKGROUND

Enhanced de novo lipogenesis is essential for hepatocellular carcinoma (HCC). Abnormally high cullin-associated and neddylation-dissociated 1 (CAND1) expression is associated with poor clinical prognosis in HCC. The SKP1-Cullin-1-F-box (SCF) complex consists of the SKP1, Cullin-1 and F-box proteins (FBPs) and performs multiple functions including adipogenesis. SCF complex was modulated by CAND1, but Whether and how the CAND1 promotes HCC by regulating SCF complex and lipogenesis are unknown.

METHODS

HCC samples were used to analyze the correlations between CAND1 expression and clinicopathological characteristics such as survival and prognosis. The in vitro functions of CAND1, FBXO11 and heterogeneous nuclear ribonucleoprotein A2/B1 (hnRNPA2B1) were measured by cell proliferation, colony formation and migration assays. The in vivo functions were tested in multiple mouse liver cancer models including patient-derived xenograft (PDX), cell line-derived xenograft and AKT/NRASV12-induced primary liver cancer models. Injections of adeno-associated virus targeting CAND1 (AAV-shCAND1) were performed to evaluate the therapeutic efficacy of targeting CAND1. RNA-Seq and lipidomic assays followed by serial biochemical experiments including mass spectrometry, immunoprecipitation and GST pull-down were performed to dissect the underlying mechanisms.

RESULTS

CAND1 promoted the expression of lipid synthesis genes by disrupting SCF complex assembly and lipid accumulation. Furthermore, we identified hnRNPA2B1 as a novel F-box protein 11 (FBXO11)-binding partner. FBXO11 directly bound to hnRNPA2B1 and promoted hnRNPA2B1 ubiquitination and subsequent degradation. Our evaluations of the therapeutic efficacy of AAV-shCAND1 injections confirmed that targeting the CAND1-SCFFBXO11 -hnRNPA2B1A signalling axis was therapeutically effective. CAND1 downregulation significantly reduced the tumour burden in a primary mouse liver cancer model and a PDX model.

CONCLUSIONS

Our results highlight that CAND1 is associated with poor prognosis in HCC and regulates lipid metabolic reprogramming by dissociating the SCF complex. Targeting the CAND1-SCFFBXO11 -hnRNPA2B1 axis may be a novel strategy for HCC treatment.

Investigation of the Relationship between Aperture Use for Treating Small and Shallow Brain Lesions in Proton Therapy with Different Spot Size Variations in Three Proton Therapy Systems

PURPOSE/OBJECTIVE(S)

To compare plan quality among standard vs. aperture-based Intensity-Modulated Proton Therapy (IMPT) using cyclotron-generated proton beams (CPB), linear accelerator proton beams (LPB), and linear accelerator proton minibeams (LPMB) for multiple brain metastases.

MATERIALS/METHODS

Fifty-five brain lesions from twenty patients were planned with three different spot size ranges using CPBs (σ: 2.7-7.0 mm) and compared against LPBs (σ: 2.9-5.5 mm), and LPMBs (σ: 0.9-3.9 mm). Apertures with a diameter of 0.3 cm were applied to beams irradiating all tumors < 1 cm3 in volume and any tumor < 2.5 cm depth in the patient and compared against the same patient plans containing no apertures. All plans were optimized with the multi-field optimization (MFO) technique using the Monte Carlo algorithm. Dose coverage to each lesion for each proton plan was set to 99% of the GTV receiving the prescription (Rx) dose for all plans. Robustness with ±2 mm setup uncertainty and ±2% range uncertainty was included in robust evaluation using V100%Rx > 95% of the GTV. Conformity index (CI) and gradient index (GI) were used to analyze the effect of apertures vs. no apertures (standard) for each IMPT plan type. CI was defined as the volume of the 100% isodose line divided by the volume of the GTV + 2 mm expansion to account for robust planning. The Wilcoxon signed rank test was utilized to determine the statistical significance of dosimetric results compared between aperture-based and standard IMPT plans.

RESULTS

When apertures were implemented in the treatment planning for all shallow and small brain lesions, shallow brain tumors showed the most prominent improvement in conformity and gradient index. A 6.7% difference in average conformity was calculated for standard vs. aperture-based plans for LPMBs, followed by a 5.3% improvement for CPBs. Improvement in gradient index for standard vs. aperture-based plans was significant for both shallow and deeper tumors for CPB and LPB plan types, as shown in Table 1 below. CPB and LPB plan gradient indices were statistically significant for comparing aperture-based vs. standard IMPT plans.

CONCLUSION

We successfully quantified plan quality and evaluated results for aperture- vs. standard IMPT plans using CPBs, LPBs, and LPMBs for brain metastases. Plan quality improves the greatest with apertures applied to beams irradiating shallow tumors. Apertures may not be necessary for small, deeper tumors with IMPT.

Using kV Triggered Imaging and Liver Dome Position to Reduce the Dosimetric Error Caused by Breath Hold Variability for Liver Stereotactic Body Radiation Therapy

PURPOSE/OBJECTIVE(S)

In a previous study, we demonstrated that manual gating using kV triggered imaging and liver dome position can reduce targeting errors caused by breath hold variability for liver stereotactic body radiation therapy (SBRT). In this study, we quantified the dosimetric error caused by breath hold variability and investigated the effect of liver dome gating on reducing dosimetric error.

MATERIALS/METHODS

Twenty-five liver SBRT patients treated with deep inspiration breath-hold were included in this IRB approved study. Volumetric modulated arc therapy was used to deliver 30-60 Gy in 1-5 fractions. To verify the breath-hold reproducibility during treatment, a KV triggered image was acquired at the beginning of each breath-hold. The liver dome position was visually compared with the expected upper/lower liver boundaries created by expanding/contracting the liver contour 5mm in the superior-inferior direction. If the liver dome position was within the boundaries, delivery continued; otherwise, beam was held manually and the patient was instructed to take another breath hold until the liver dome position was within boundaries. To calculate delivered dose, for each fraction, the treatment plan was divided into sub-beams, each corresponding to one breath hold using delivery log files. The triggered images were registered to the planning CT to determine the liver position during each breath hold. Dose delivered during each breath hold was calculated by shifting the isocenter of the sub-beam according to the liver position. Breath holds discarded by gating were excluded since no dose was delivered during these breath holds. Delivered fractional doses were compared with planned fractional doses using GTV D99 and liver Dmean. To estimate delivered dose without gating, the first "corrective" breath hold taken after the discarded breath holds was replaced with the prior discarded breath hold and dose calculation was repeated.

RESULTS

Seven hundred eleven triggered images from 91 treatment fractions were analyzed. Without gating, in 11 of the 91 fractions from 7 of the 25 patients, delivered GTV D99 reduced > 0.50 Gy from planned value (range 0.51-1.68 Gy, 3-10% of planned fractional GTV D99). Liver dome gating was able to detect/exclude irreproducible breath holds in 8 of the 11 fractions, increasing the delivered GTV D99 by 0.70 Gy per fraction on average (range 0.21-1.63 Gy). With liver dome gating, delivered fractional GTV D99 was comparable to planned value for all fractions (12.96 +/- 5.19 Gy vs 13.04 +/- 5.18 Gy, p > 0.05). Liver mean dose was not affected by breath hold variability or gating. Fractional liver Dmean was 2.26 +/- 1.19 Gy from plan, 2.27 +/- 1.21 Gy for delivery with gating and 2.27 +/- 1.20 Gy for delivery without gating.

CONCLUSION

Breath hold variability may cause tumor underdose. Liver dome gating using kV triggered imaging reduces dosimetric error and ensures tumor coverage for liver SBRT.

Partial Tongue Sparing without Marginal Failures: The Dosimetric Advantages for Oral Tongue Squamous Cell Carcinoma

PURPOSE/OBJECTIVE(S)

Due to a lack of internal barriers, many radiation oncologists believe whole tongue (WT) irradiation is warranted in the adjuvant setting for oral tongue cancer. Our institutional practice is to include the resection bed and flap with a 5-10 mm margin, attempting to spare unaffected oral tongue. We hypothesize that partial tongue (PT) irradiation, when feasible, results in decreased dose to surrounding normal structures without an increased risk of local recurrence (LR).

MATERIALS/METHODS

Patients with a new diagnosis of squamous cell carcinoma of the oral tongue treated with adjuvant IMRT between 2010 and 2021 were collected from an IRB approved database. PT was defined as <80% of residual tongue in the clinical target volume (CTV). Recurrence was deemed local if in the tongue or floor of mouth, and in field if within the CTV or marginal if outside of CTV. Mean dose to mandible, pharyngeal constrictors, and oral cavity were evaluated. Comparisons between groups were made using parametric one-way ANOVA. Multivariable linear regression was used to predict mean radiation dose. Local control and overall survival were estimated using Kaplan-Meier.

RESULTS

A total of 130 patients are included with median follow up 34.1 months (IQR 13.5-64.6). Radiation dose was 48-72 Gy in 24-36 fractions, most commonly 60-66 Gy in 30-33 fractions (84.6%). All were treated to oral cavity, and neck irradiation included bilateral 96 (72%), unilateral 31 (24%), and none 3 (4%). PT sparing was feasible in 91 (70%) and 39 (30%) required WT. Primary tumor stage in PT included 20 pT1, 50 pT2, 17 pT3, and 4 pT4, and WT included 3 pT1, 8 pT2, 15 pT3, and 13 pT4. 3-year local control for PT and WT was 96% and 87%, respectively. LR occurred in 14 patients overall (10.8%), 6.6% (6) of patients treated with PT and 20.5% (8) treated with WT (p = 0.072). Of the LR for PT, stage was 2 pT1, 3 pT2, and 1 pT3, and all occurred within the radiation field. Of the LR for WT, stage was 1 each of pT1 and pT2, 2 pT3, and 4 pT4. Overall survival was 57%, regional and distant recurrence was each 17.7%. Dosimetric analysis for PT vs WT is described in Table 1, demonstrating lower mean dose when the primary tumor CTV is limited to PT. Unilateral neck irradiation also resulted in a lower mandible [-8.5 Gy (-11.2 - -5.8)], pharyngeal constrictor [-14.3 Gy (-18.1 - -10.5)], and oral cavity [-9.0 Gy (-13.0 - -5.0)] dose (all p<0.001).

CONCLUSION

Limiting the primary tumor CTV to PT for adjuvant radiotherapy resulted in significant sparing of the mandible and pharyngeal constrictors, and a routinely lower oral cavity mean dose of ≥3.5 Gy. There was a low risk of LR when implementing PT, and all LR occurred in field. Given the increased sparing of normal structures, and low risk of LR outside of PT radiation field, sparing a portion of unaffected oral tongue should be considered.

Radio-Immune Response of Spatially Fractionated Radiotherapy for VMAT Lattice Plans

PURPOSE/OBJECTIVE(S)

To evaluate radio-immune response of spatially fractionated radiotherapy (SFRT) for large tumors using VMAT Lattice technique in terms of tumor volume under irradiation and dose fractionation schemes after SFRT.

MATERIALS/METHODS

Eleven patients treated with SFRT from a single institution were retrospectively replanned to deliver 15Gy in single fraction using Lattice technique. High dose regions are defined by multiple spheres with the diameter of 1.25 to 1.5cm and their vertex space of 3.0 to 4.0cm inside of GTV. VMAT plans with multiple arcs were developed for SFRT. Four palliative fractionation regimens of 200cGy x 12 (EQD2 = 24Gy with a/b of 10Gy), 400cGy x 5 (23.3Gy), 600cGy x 3 (24Gy) and 800cGy x2 (24Gy) and four definitive regimens of 200cGy x 24 (EQD2 = 48Gy), 400cGy x 10 (46.7Gy), 600cGy x 6 (48Gy) and 800cGy x 4 (48Gy) were considered for radiotherapy to follow SFRT. Linear quadratic (LQ) model is compared with radio-immune (RI) response model in which the activation of cytotoxic T lymphocytes, tumor immune suppression capability and immunotherapy drugs can be considered. Tumor regrowth time (TRT, time to tumor regrowth to the original volume after treatment) from each model was compared as a measure of benefit achieved from the application of SFRT.

RESULTS

The average volume of GTVs in this study was 776cc (range 58-2944cc). Three different SFRT plans (2D GRID technique with conventional collimator, 2D GRID with step & shoot IMRT, and 3D Lattice) were developed for each patient but only Lattice plans were considered in this study since they produced comparable dose modulation inside the tumor but only Lattice significantly reduced skin and critical organ dose. Radio-immune response model always expects longer TRT than LQ model. For palliative regimens, TRT of RI model is longer than that of LQ model by 14.5±9.9, 15.1±10.6, 17.2±12.4, 17.5±12.8 days for each fractionation scheme. When Lattice plan of 15Gy is delivered before the palliative treatment, the difference becomes 25.9±15.3, 31.5±23.3, 36.7±27.6, 37.5±28.5 days. The benefit of SFRT from RI response is only about 10-20 days. Interestingly, RI response is inversely proportional to tumor volume. When curative dose is considered, the difference of TRT is drastically changed from 25.9±9.8, 460.7±285.8, 1180.8±985.7, 1512.0±1327.5 days to 20.7±4.4, 449.0±411.7, 1725.4±2171.0, 3517.7±4531.7 days. The benefit of SFRT from RI response appears larger for large tumor with hypo-fractionation in definitive regimens.

CONCLUSION

The benefit of SFRT is significant for large tumors with hypo fractionation in the definitive regimens when radio-immune response model is considered which is not apparent in LQ model. Radio-immune response model may help to guide the development of successful treatment scheme large tumor volumes.

Phase II Randomized Trial of Single- vs. Two-Fraction Spine Stereotactic Radiosurgery for the Treatment of Vertebral Metastases

PURPOSE/OBJECTIVE(S)

As systemic therapies improve significantly, more patients with limited metastatic disease are undergoing spine stereotactic radiosurgery (sSRS). High dose (≥24 Gy) single fraction sSRS has been associated with a vertebral compression fracture (VCF) risk of up to 40%. Comparatively, lower dose (16-18 Gy) single fraction sSRS is associated with a fracture risk of 15-20%, with the risk increasing as the dose increases. To mitigate the risk of VCF, while optimizing higher dose delivery, some have advocated utilizing two-fraction sSRS regimen. Therefore, we designed a phase II randomized trial in which we hypothesized that single fraction sSRS is non-inferior to two-fraction sSRS with respect to VCF but offers patients greater convenience.

MATERIALS/METHODS

Inclusion criteria include age ≥18, Karnofsky performance score ≥70, vertebral metastasis from C3 to L5, maximum of three separate sites of metastases, limited paraspinal extension (<5 cm), and no rapid neurological decline. Patients must also be either Recursive Partitioning Analysis Class 1 (KPS >70 AND controlled systemic disease) or Class 2 (KPS >70, uncontrolled systemic disease OR KPS ≤70, age ≥54, no visceral metastases). Exclusion criteria include multiple primary cancers, primary neoplasm of the spine, prior surgery at the site of sSRS, spinal cord compression, bony retropulsion resulting in neurologic deficit, inability to undergo/contraindication to MRI, or diffuse multi-level metastatic spine disease. Our primary hypothesis is that single fraction sSRS (experimental arm - 16-18 Gy) is non-inferior to two fraction sSRS (standard arm - 24 Gy). Furthermore, we hypothesize that both treatment arms will have similar local control, pain control, quality of life and toxicity profiles. The primary endpoint of this trial is the development or progression of VCF at 6 months. Secondary endpoints include local control, pain control, quality of life and toxicity all of which will be assessed at 12 months. For the sample size calculation, we assumed a VCF risk of 17% in the experimental arm and a 7% risk in the standard arm. Based on these calculations, we aim to enroll 130 patients, 65 in each arm. This trial is currently enrolling patients actively, and approximately 30% of expected enrollment has been completed to date. This trial is registered on clinicaltrials.gov: NCT04218617.

RESULTS

Pending full accrual.

CONCLUSION

Pending full accrual.

Knockdown of CircCRIM1 Inhibits HDAC4 to Impede Osteosarcoma Proliferation, Migration, and Invasion and Facilitate Autophagy by Targeting miR-432-5p [Retraction]

[This retracts the article DOI: 10.2147/CMAR.S253130.].

Renal Outcomes in Older Adults with Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis: A New Prediction Model

INTRODUCTION

Older patients with antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) commonly experience renal impairment and poor prognoses. This study aimed to establish a risk-scoring system for predicting composite renal outcomes in older patients with AAV.

METHODS

This retrospective observational study included all patients with AAV hospitalized in a single-center tertiary hospital in China between January 2013 and April 2022. Patients aged ≥65 years were defined as older adults and short-term composite renal outcomes included a ≥25% reduction in estimated glomerular filtration rate (eGFR) (for AKI), renal replacement therapy, provision of renal replacement therapy (long-term dialysis, kidney transplant, or sustained eGFR <15 mL/min/1.73 m), or all-cause mortality. Patients were randomly divided into development and validation cohorts (2:1). Logistic regression analysis was performed in the development cohort to analyze risk factors. The scoring system was established accordingly and further validated in the validation cohort.

RESULTS

1,203 patients were enrolled in the study, among whom the older adult group accounted for 36% with a mean age of 71. The older adult group had a worse prognosis, a higher mortality rate, a higher rate of end-stage renal disease, and worsening renal function. Logistic regression showed that age >75 years, chronic heart disease, and elevated serum creatinine and D-dimer values were risk factors for poor prognosis in patients with AAV. The development and validation cohorts in patients with AAV produced area under the curve values of 0.82 (0.78-0.86) and 0.83 (0.77-0.89), respectively.

CONCLUSION

We established a risk-scoring system based on baseline clinical characteristics to predict composite renal outcomes in patients with AAV. Our results suggest that more attention should be paid to older patients with severe renal impairment and active inflammation.

Evaluation of CT features for differentiating consolidation pattern of pulmonary MALT lymphoma from pneumonic-type lung adenocarcinoma

Purpose

In clinical practice, the consolidation pattern of pulmonary mucosa-associated lymphoid tissue (C-MALT) was often misdiagnosed as pneumonic-type lung adenocarcinoma (P-LADC). However, the mainstay of treatment and prognosis of these two diseases are different. The purpose of this study was to distinguish C-MALT from P-LADC by pre-treatment chest computed tomography (CT) features.

Patients and methods

A total of 31 patients with C-MALT (15 men and 16 women; mean age, 61.1 ± 11.2 years) and 58 patients with P-LADC (34 men and 24 women; mean age, 68.6 ± 7.4 years) confirmed by pathology who underwent contrast-enhanced chest CT were retrospectively enrolled from September 2014 to February 2023. Detailed clinical and CT characteristics of the two groups were evaluated. Logistic regression analysis was used to assess the effectiveness of statistically significant variables in distinguishing C-MALT from P-LADC.

Results

The average age of C-MALT was younger than P-LADC patients (p<0.001). With regard to CT features, bronchiectasis within the consolidation was more common in the C-MALT group than the P-LADC group [83.87% (26 of 31) vs 20.69% (12 of 58), p<0.001]; whereas lymph nodes enlargement [75.86% (44 of 58) vs 9.68% (3 of 31), p<0.001] and pleural effusion [43.10% (25of 58) vs 19.35% (6 of 31), p=0.025] were more frequently observed in the P-LADC group than C-MALT group. The predictors with p<0.05 (age, bronchiectasis, lymph node enlargement, and pleural effusion) were used to construct a logistic regression model in discriminating C-MALT from P-LADC, the area under curve (AUC), positive predictive value (PPV), negative predictive value (NPV), specificity, sensitivity, and accuracy were 0.9555, 86.67%, 91.53%, 83.87%, 93.10%, and 89.89%, respectively.

Conclusion

C-MALT and P-LADC have differential clinical and CT features. An adequate understanding of these different characteristics can contribute to the early accurate diagnosis of C-MALT and provide an appropriate therapeutic strategy.

Cross modality generative learning framework for anatomical transitive Magnetic Resonance Imaging (MRI) from Electrical Impedance Tomography (EIT) image

This paper presents a cross-modality generative learning framework for transitive magnetic resonance imaging (MRI) from electrical impedance tomography (EIT). The proposed framework is aimed at converting low-resolution EIT images to high-resolution wrist MRI images using a cascaded cycle generative adversarial network (CycleGAN) model. This model comprises three main components: the collection of initial EIT from the medical device, the generation of a high-resolution transitive EIT image from the corresponding MRI image for domain adaptation, and the coalescence of two CycleGAN models for cross-modality generation. The initial EIT image was generated at three different frequencies (70 kHz, 140 kHz, and 200 kHz) using a 16-electrode belt. Wrist T1-weighted images were acquired on a 1.5T MRI. A total of 19 normal volunteers were imaged using both EIT and MRI, which resulted in 713 paired EIT and MRI images. The cascaded CycleGAN, end-to-end CycleGAN, and Pix2Pix models were trained and tested on the same cohort. The proposed method achieved the highest accuracy in bone detection, with 0.97 for the proposed cascaded CycleGAN, 0.68 for end-to-end CycleGAN, and 0.70 for the Pix2Pix model. Visual inspection showed that the proposed method reduced bone-related errors in the MRI-style anatomical reference compared with end-to-end CycleGAN and Pix2Pix. Multifrequency EIT inputs reduced the testing normalized root mean squared error of MRI-style anatomical reference from 67.9% ± 12.7% to 61.4% ± 8.8% compared with that of single-frequency EIT. The mean conductivity values of fat and bone from regularized EIT were 0.0435 ± 0.0379 S/m and 0.0183 ± 0.0154 S/m, respectively, when the anatomical prior was employed. These results demonstrate that the proposed framework is able to generate MRI-style anatomical references from EIT images with a good degree of accuracy.

Erratum: A positive feedback loop of CENPU/E2F6/E2F1 facilitates proliferation and metastasis via ubiquitination of E2F6 in hepatocellular carcinoma: Erratum

[This corrects the article DOI: 10.7150/ijbs.69495.].

RBL2 Regulates Cardiac Sensitivity to Anthracycline Chemotherapy

Background

Anthracycline chemotherapies cause heart failure in a subset of cancer patients. We previously reported that the anthracycline doxorubicin (DOX) induces cardiotoxicity through the activation of cyclin-dependent kinase 2 (CDK2).

Objectives

The aim of this study was to determine whether retinoblastoma-like 2 (RBL2/p130), an emerging CDK2 inhibitor, regulates anthracycline sensitivity in the heart.

Methods

Rbl2-/- mice and Rbl2+/+ littermates received DOX (5 mg/kg/wk for 4 weeks intraperitoneally, 20 mg/kg cumulative). Heart function was monitored with echocardiography. The association of RBL2 genetic variants with anthracycline cardiomyopathy was evaluated in the SJLIFE (St. Jude Lifetime Cohort Study) and CPNDS (Canadian Pharmacogenomics Network for Drug Safety) studies.

Results

The loss of endogenous Rbl2 increased basal CDK2 activity in the mouse heart. Mice lacking Rbl2 were more sensitive to DOX-induced cardiotoxicity, as evidenced by rapid deterioration of heart function and loss of heart mass. The disruption of Rbl2 exacerbated DOX-induced mitochondrial damage and cardiomyocyte apoptosis. Mechanistically, Rbl2 deficiency enhanced CDK2-dependent activation of forkhead box O1 (FOXO1), leading to up-regulation of the proapoptotic protein Bim. The inhibition of CDK2 desensitized Rbl2-depleted cardiomyocytes to DOX. In wild-type cardiomyocytes, DOX exposure induced Rbl2 expression in a FOXO1-dependent manner. Importantly, the rs17800727 G allele of the human RBL2 gene was associated with reduced anthracycline cardiotoxicity in childhood cancer survivors.

Conclusions

Rbl2 is an endogenous CDK2 inhibitor in the heart and represses FOXO1-mediated proapoptotic gene expression. The loss of Rbl2 increases sensitivity to DOX-induced cardiotoxicity. Our findings suggest that RBL2 could be used as a biomarker to predict the risk of cardiotoxicity before the initiation of anthracycline-based chemotherapy.

The Safety and Efficacy of Rituximab-Based Regimen in Atypical Membranous Nephropathy: A Single Center Retrospective Cohort Study

Purpose

There are increasing reports of atypical membranous nephropathy (AMN) cases with similar pathological characteristics to secondary membranous nephropathy (SMN) without definite underlying causes. Although rituximab has become a first-line option in treating idiopathic membranous nephropathy (IMN), the efficacy and safety of rituximab-based regimen for AMN is not clear.

Patients and Methods

This is a retrospective, single-center study. AMN patients who received rituximab-based therapy were included. IMN patients treated with rituximab during the same period were selected as the control group matched by gender, sex, baseline urinary protein and albumin levels. Baseline data and follow-up data were collected.

Results

A total of 20 AMN patients and 40 IMN patients were included. The baseline levels of urinary protein were comparable between the two groups [6.77 (IQR 3.34, 11.49) g/24 h vs 6.47 (IQR 3.4, 10.76) g/24 h, P=0.944]. The baseline levels of serum albumin were 26.15±6.71 g/L and 26.8±5.54 g/L (P=0.689) respectively. The cumulative remission rate for rituximab-based treatment at the 12th month was lower in AMN group than IMN group [13 (65%) vs 36 (90%), P=0.045]. In AMN group, non-responders showed a higher level of proteinuria and a worse renal function at baseline than those of responders. There was no significant difference in the overall adverse events or serious adverse events between the two groups.

Conclusion

In our study, AMN patients obtained proteinuria remission in a lower percentage compared with IMN patients. In general, rituximab-based therapy is effective in AMN patients with an acceptable safety profile.