Multi-center Dose Prediction Using Attention-aware Deep learning Algorithm Based on Transformers for Cervical Cancer Radiotherapy

AIMS

Accurate dose delivery is crucial for cervical cancer volumetric modulated arc therapy (VMAT). We aimed to develop a robust deep-learning (DL) algorithm for fast and accurate dose prediction of cervical cancer VMAT in multicenter datasets and then explore the feasibility of the DL algorithm to endometrial cancer VMAT with different prescriptions.

MATERIALS AND METHODS

We proposed the AtTranNet algorithm for three-dimensional dose prediction. A total of 367 cervical patients were enrolled in this study. Three hundred twenty-two cervical patients from 3 centers were randomly divided into 70%, 10%, and 20% as training, validation, and testing sets, respectively. Forty-five cervical patients from another center were selected for external testing. Moreover, 70 patients of endometrial cancer with different prescriptions were further selected to test the model. Prediction precision was evaluated by dosimetric difference, dose map, and dose-volume histogram metrics.

RESULTS

The prediction results were all clinically acceptable. The mean absolute error within the body in internal testing was 0.66 ± 0.63%. The maximum |δD| for planning target volume was observed in D98, which is 1.24 ± 2.73 Gy. The maximum |δD| for organs at risk was observed in Dmean of bladder, which is 4.79 ± 3.14 Gy. The maximum |δV| were observed in V40 of pelvic bones, which is 4.77 ± 4.48%.

CONCLUSION

AtTranNet showed the feasibility and reasonable accuracy in the dose prediction for cervical cancer in multiple centers. The model can also be generalized for endometrial cancer with different prescriptions without any transfer learning.

The application of the modified Snodgrass technique in hypospadias surgery

OBJECTIVE

We aimed to explore the effectiveness of the modified tubularized incised plate urethroplasty (Snodgrass Technique) in hypospadias surgery.

PATIENTS AND METHODS

A study was conducted on 50 pediatric patients with hypospadias treated in our hospital from May 2020 to May 2023. The patients were divided into two groups based on the condition of their urethral plate; 22 patients were included in the study group and 28 patients were included in the control group. The control group underwent the traditional Snodgrass technique, while the study group received the modified Snodgrass technique. The two groups were compared in terms of treatment efficacy, preoperative and postoperative 6-month Hypospadias Objective Scoring Evaluation (HOSE) scores, surgical data, and postoperative complications.

RESULTS

The operation time for the study group was longer than that of the control group, and the intraoperative blood loss was less, but the differences were not statistically significant (p > 0.05). The success rate of surgery in the study group was 95.45% (21/22), compared to 71.43% (20/28) in the control group, showing a statistically significant difference (p < 0.05). The maximum urinary flow rate at 3 and 6 months postoperatively was significantly higher in the study group than in the control group (p < 0.05). The time to maximum flow (TQmax) and post-void residual (PVR) at 3 and 6 months postoperatively were significantly lower in the study group (p < 0.05). A total of 3 patients in the cohort developed urethral fistulas, all between 0.10 cm x 0.10 cm and 0.15 cm x 0.15 cm in size. By instructing the patients to apply pressure to the fistula during urination, all fistulas closed between 3 and 6 months postoperatively. The incidence of postoperative complications was 4.55% in the study group and 28.57% in the control group, a difference that was statistically significant (p < 0.05).

CONCLUSIONS

The modified Snodgrass technique shows significant therapeutic effectiveness in hypospadias surgery, substantially increasing the success rate and reducing postoperative complications in pediatric patients, making it suitable for widespread application.

A Frameshift Variant of GluN2A Identified in an Epilepsy Patient Results in NMDA Receptor Mistargeting

N-methyl-D-aspartate receptors (NMDARs) are crucial for neuronal development and synaptic plasticity. Dysfunction of NMDARs is associated with multiple neurodevelopmental disorders, including epilepsy, autism spectrum disorder, and intellectual disability. Understanding the impact of genetic variants of NMDAR subunits can shed light on the mechanisms of disease. Here, we characterized the functional implications of a de novo mutation of the GluN2A subunit (P1199Rfs*32) resulting in the truncation of the C-terminal domain. The variant was identified in a male patient with epileptic encephalopathy, multiple seizure types, severe aphasia, and neurobehavioral changes. Given the known role of the CTD in NMDAR trafficking, we examined changes in receptor localization and abundance at the postsynaptic membrane using a combination of molecular assays in heterologous cells and rat primary neuronal cultures. We observed that the GluN2A P1199Rfs*32-containing receptors traffic efficiently to the postsynaptic membrane but have increased extra-synaptic expression relative to WT GluN2A-containing NMDARs. Using in silico predictions, we hypothesized that the mutant would lose all PDZ interactions, except for the recycling protein Scribble1. Indeed, we observed impaired binding to the scaffolding protein postsynaptic protein-95 (PSD-95); however, we found the mutant interacts with Scribble1, which facilitates the recycling of both the mutant and the WT GluN2A. Finally, we found that neurons expressing GluN2A P1199Rfs*32 have fewer synapses and decreased spine density, indicating compromised synaptic transmission in these neurons. Overall, our data show that GluN2A P1199Rfs*32 is a loss-of-function variant with altered membrane localization in neurons and provide mechanistic insight into disease etiology.

Temperature dependence of spring carbon uptake in northern high latitudes during the past four decades

In the northern high latitudes, warmer spring temperatures generally lead to earlier leaf onsets, higher vegetation production, and enhanced spring carbon uptake. Yet, whether this positive linkage has diminished under climate change remains debated. Here, we used atmospheric CO2 measurements at Barrow (Alaska) during 1979-2020 to investigate the strength of temperature dependence of spring carbon uptake reflected by two indicators, spring zero-crossing date (SZC) and CO2 drawdown (SCC). We found a fall and rise in the interannual correlation of temperature with SZC and SCC (RSZC-T and RSCC-T ), showing a recent reversal of the previously reported weakening trend of RSZC-T and RSCC-T . We used a terrestrial biosphere model coupled with an atmospheric transport model to reproduce this fall and rise phenomenon and conducted factorial simulations to explore its potential causes. We found that a strong-weak-strong spatial synchrony of spring temperature anomalies per se has contributed to the fall and rise trend in RSZC-T and RSCC-T , despite an overall unbroken temperature control on net ecosystem CO2 fluxes at local scale. Our results provide an alternative explanation for the apparent drop of RSZC-T and RSCC-T during the late 1990s and 2000s, and suggest a continued positive linkage between spring carbon uptake and temperature during the past four decades. We thus caution the interpretation of apparent climate sensitivities of carbon cycle retrieved from spatially aggregated signals.

High-resolution assessment of coal mining methane emissions by satellite in Shanxi, China

Accurate assessment of coal mine methane (CMM) emissions is a prerequisite for defining baselines and assessing the effectiveness of mitigation measures. Such an endeavor is jeopardized, however, by large uncertainties in current CMM estimates. Here, we assimilated atmospheric methane column concentrations observed by the TROPOMI space borne instrument in a high-resolution regional inversion to estimate CMM emissions in Shanxi, a province representing 15% of the global coal production. The emissions are estimated to be 8.5 ± 0.6 and 8.6 ± 0.6 Tg CH4 yr-1 in 2019 and 2020, respectively, close to upper bound of current bottom-up estimates. Data from more than a thousand of individual mines indicate that our estimated emission factors increase significantly with coal mining depth at prefecture level, suggesting that ongoing deeper mining will increase CMM emission intensity. Our results show robustness of estimating CMM emissions utilizing TROPOMI images and highlight potential of monitoring methane leakages and emissions from satellites.

Microbial communities in terrestrial surface soils are not widely limited by carbon

Microbial communities in soils are generally considered to be limited by carbon (C), which could be a crucial control for basic soil functions and responses of microbial heterotrophic metabolism to climate change. However, global soil microbial C limitation (MCL) has rarely been estimated and is poorly understood. Here, we predicted MCL, defined as limited availability of substrate C relative to nitrogen and/or phosphorus to meet microbial metabolic requirements, based on the thresholds of extracellular enzyme activity across 847 sites (2476 observations) representing global natural ecosystems. Results showed that only about 22% of global sites in terrestrial surface soils show relative C limitation in microbial community. This finding challenges the conventional hypothesis of ubiquitous C limitation for soil microbial metabolism. The limited geographic extent of C limitation in our study was mainly attributed to plant litter, rather than soil organic matter that has been processed by microbes, serving as the dominant C source for microbial acquisition. We also identified a significant latitudinal pattern of predicted MCL with larger C limitation at mid- to high latitudes, whereas this limitation was generally absent in the tropics. Moreover, MCL significantly constrained the rates of soil heterotrophic respiration, suggesting a potentially larger relative increase in respiration at mid- to high latitudes than low latitudes, if climate change increases primary productivity that alleviates MCL at higher latitudes. Our study provides the first global estimates of MCL, advancing our understanding of terrestrial C cycling and microbial metabolic feedback under global climate change.

Challenges and opportunities in the global methane cycle

To control the atmospheric methane concentration for Paris Agreement and Global Methane Pledge, it is urgent to elucidate global methane budget, in the context of dangerous high growth rate of atmospheric methane concentration in the past three years (2020-2022). Interdisciplinary research can definitely help answer the open questions about methane budget, as some examples shown in this Special Issue on "Methane emissions, sinks, and mitigation".

The diagnostic accuracy of the IFLIP system for binocular visual function anomalies assessment

OBJECTIVE

This study aimed to evaluate the diagnostic accuracy of the intelligent flipper (IFLIP) system in identifying binocular vision anomalies.

PATIENTS AND METHODS

This study comprised 70 participants aged 18 to 22. Participants underwent comprehensive eye assessments, including measurement of visual acuity, refraction, far and near cover test, stereopsis, and worth four dot test. The manual accommodation amplitude and facility, as well as the IFLIP system test, were also evaluated. The correlation between the indices of the IFLIP and manual accommodation tests was analyzed using multiple regression models, and the diagnostic ability of the IFLIP was characterized using Receiver Operating Curve (ROC) analysis. The significance level was 0.05.

RESULTS

The mean age of the 70 participants was 20.03±0.78 years. The mean manual and IFLIP accommodation facilities were 12.00±3.70 cycle per minute (CPM) and 10.01±2.77 CPM, respectively. No correlation was found between the indices of the IFLIP system and manual accommodative amplitude. However, the regression model showed that the contraction/relaxation ratio of the IFLIP system was positively correlated to the manual accommodation facility, and the average contraction time was negatively correlated with the manual accommodation facility. The ROC analysis proposed a cut-off of 10.15 CPM monocularly for the IFLIP accommodation facility assessment.

CONCLUSIONS

This study indicated that the parameters obtained by the IFLIP system and the manual accommodation facility were comparable, and the IFLIP system had good sensitivity and specificity in the assessment of the accommodation facility, thus may serve as a promising tool for screening and diagnosis of binocular visual function anomalies in clinical and community settings.

Overestimated nitrogen loss from denitrification for natural terrestrial ecosystems in CMIP6 Earth System Models

Denitrification and leaching nitrogen (N) losses are poorly constrained in Earth System Models (ESMs). Here, we produce a global map of natural soil ¹⁵N abundance and quantify soil denitrification N loss for global natural ecosystems using an isotope-benchmarking method. We show an overestimation of denitrification by almost two times in the 13 ESMs of the Sixth Phase Coupled Model Intercomparison Project (CMIP6, 73 ± 31 Tg N yr^-1), compared with our estimate of 38 ± 11 Tg N yr^-1, which is rooted in isotope mass balance. Moreover, we find a negative correlation between the sensitivity of plant production to rising carbon dioxide (CO₂) concentration and denitrification in boreal regions, revealing that overestimated denitrification in ESMs would translate to an exaggeration of N limitation on the responses of plant growth to elevated CO₂. Our study highlights the need of improving the representation of the denitrification in ESMs and better assessing the effects of terrestrial ecosystems on CO₂ mitigation.

Projecting the excess mortality related to diurnal temperature range: A nationwide analysis in China

The projection of excess mortality due to diurnal temperature range (DTR) in future has not been evaluated yet in China. Based on daily cause-specific mortality data from 266 cities in China, this study aimed to examine the association between DTR and mortality, which help project the future mortality burden attributable to DTR by considering the modification effects of altitude and population migration. We first found that every 10 °C increase in the DTR would result in a 3.3 % (95 % confidence interval: 2.6 %-4.1 %) excess risk of non-accidental mortality. The unit risk of DTR-associated cause-specific mortality at moderate or high altitudes was significantly lower than at lower altitudes, especially for cardiovascular disease. Subsequently, DTR-associated excess mortality in 2017 in China was 233,154 deaths (with a population-weighted attributable fraction of 2.9 %). Furthermore, we projected DTR-attributable additional mortality in the future, with the associated mortalities to be 221,860 deaths in 2050-2059 (2050s) and 132,305 deaths in 2090-2099 (2090s), under the SSP1-2.6 scenario. Meanwhile, the regional inequalities were exacerbated by 18 % in 2050s and 13 % in 2090s when considering the modification effects of city altitude. Future population migration would increase excess mortality in most areas in central and southern China, and reduce the disease burden in most areas in eastern, western, and northern China. Our findings underpinned that regional strategies should be adopted to mitigate excess mortality attributable to global climate change.

Multifunctional magnesium-organic framework doped biodegradable bone cement for antibacterial growth, inflammatory regulation and osteogenic differentiation

Degradable bone cement has superior osteoconductivity and plasticity and is commonly used to treat defects greater than the critical-size. Magnesium gallate metal-organic frameworks (MOFs) (Mg-MOF), with antibacterial and anti-inflammatory properties, are doped into a composite cement composed of calcium sulfate, calcium citrate, and dicalcium hydrogen phosphate anhydrous (CS/CC/DCPA). The doping of the Mg-MOF slightly influences the microstructure and curing properties of the composite cement, with the mechanical strength of the cement displaying a significant increase from 27 to 32 MPa. Antibacterial tests reveal that the Mg-MOF bone cement has excellent antibacterial characteristics and can effectively inhibit bacterial growth in 4 h (Staphyloccocus aureus survival rate <10%). Herein, lipopolysaccharide (LPS)-induced macrophage models are used to investigate the anti-inflammatory characteristics of composite cement. The Mg-MOF bone cement can regulate the inflammatory factors and polarization of macrophages (M1 and M2). In addition, the composite cement promotes cell proliferation and osteo-differentiation of mBMSCs, and the activity of alkaline phosphatase and calcium nodules are increased. The bone related transcription factor and specific proteins, such as runt-related transcription factor 2 (Runx2), bone morphogenetic protein 2, osteocalcin (OCN), osteopontin (OPN), and collagen type 1 (COL1), were highly expressed by the Mg-MOF bone cements. Therefore, Mg-MOF doped CS/CC/DCPA bone cement is multifunctional for bone repair, which will promote bone formation and avoid the infection of wounds, and it is suitable for use with non-load-bearing bone defects.

Prediction of knee pain improvement over two years for knee osteoarthritis using a dynamic nomogram based on MRI-derived radiomics: a proof-of-concept study

OBJECTIVES

To develop and validate a nomogram to detect improved knee pain in osteoarthritis (OA) by integrating magnetic resonance imaging (MRI) radiomics signature of subchondral bone and clinical characteristics.

METHODS

Participants were selected from the Vitamin D Effects on Osteoarthritis (VIDEO) study. The primary outcome was 20% improvement of knee pain score over 2 years in participants administrated either vitamin D or placebo. Radiomics features of subchondral bone and clinical characteristics from 216 participants were extracted and analyzed. The participants were randomly split into the training and validation cohorts at a ratio of 8:2. Least absolute shrinkage and selection operator (LASSO) regression was used to select features and generate radiomics signatures. The optimal radiomics signature and clinical indicators were fitted into a nomogram using multivariable logistic regression model.

RESULTS

The nomogram showed favorable discrimination performance [AUC_training, 0.79 (95% CI: 0.72-0.79), AUC_validation, 0.83 (95% CI: 0.70-0.96)] as well as a good calibration. Additional contributing value of fusion radiomics signature to the nomogram was statistically significant (NRI, 0.23; IDI, 0.14, P < 0.001 in training cohort and NRI, 0.29; IDI, 0.18, P < 0.05 in validating cohort). Decision curve analysis confirmed the clinical usefulness of nomogram.

CONCLUSION

The radiomics-based nomogram comprising the MR radiomics signature and clinical variables achieves a favorable predictive efficacy and accuracy in differentiating improvement in knee pain among OA patients. This proof-of-concept study provides a promising way to predict clinically meaningful outcomes.

Quantifying Methane Emissions from Aquaculture Ponds in China

Small ponds are important methane (CH₄) sources. However, current estimates of CH₄ emissions from aquaculture ponds are largely uncertain due to data paucity, especially in China─the largest aquaculture producer in the world. Here, we present a nationwide metadata analysis with a database of 55 field observations to examine total CH₄ emissions from aquaculture ponds in China. We found that the annual CH₄ fluxes from aquaculture ponds are much larger than those from reservoirs and lakes. The total CH₄ emission from aquaculture ponds is 1.60 ± 0.62 Tg CH₄ yr^-1, with an average growth rate of ∼0.03 Tg CH₄ yr^-2 during the period 2008-2019. Compared with global major protein-producing livestocks, aquaculture species have a lower (63%) emission intensity, defined by the amount of CH₄ emitted per unit of animal proteins. Our study highlights the essential contribution of China's aquaculture ponds to national CH₄ emissions and the lower environmental cost of the aquaculture sector for future animal protein production. More field measurements with multi-scale observations are urgently needed to reduce the uncertainty of CH₄ emissions from aquaculture ponds.

Half-millennium evidence suggests that extinction debts of global vertebrates started in the Second Industrial Revolution

Extinction debt describes the time-lagged process of species extinction, which usually requires dozens to hundreds of years to be paid off. However, due to the lack of long-term habitat data, it is indeterminate how strong the signal of extinction debts is at the global scale and when the debts started. Here, by compiling the geographical distributions of 6120 reptiles, 6047 amphibians, and 4278 mammals and correlating them with annual forest cover data from 1500 to 1992, we show that the beginning of the Second Industrial Revolution (the mid-19^th century) was the earliest signal of cumulative extinction debts for global forest-dwelling vertebrate groups. More importantly, the impact of global protected areas on mitigating accumulated vertebrate extinction debt is not as immediate as that of mitigating reduced forest cover but rather suffers from pronounced time-lag effects. As the disequilibrium of vertebrate richness and forested habitat is currently taking place, preventive actions should be taken to promote a well-balanced status among forest restoration, protected areas, and biodiversity conservation to slow the accumulating debts for global forest-dwelling vertebrates.

Regressions underestimate the direct effect of soil moisture on land carbon sink variability

Multiple linear regression (MLR) is widely used to attribute causes of the interannual variability (IAV) of land carbon uptake, yet, parameter estimation in MLR can be problematic if the predictors are strongly inter-correlated. Recently, Humphrey et al., (2021) used MLR method to conclude that the indirect effect of soil moisture (SM) via land-atmosphere coupling, rather than direct effect of SM on photosynthesis and respiration, controls the IAV of NBP. Here we assess the validity of MLR and find that the direct effect of SM on NBP-IAV is greatly underestimated by MLR, which may undermine their main conclusion.

[Analysis of the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 for intrahepatic parenchymal substantial lesions ≤3.0 cm]

Objective: To investigate the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 in high-risk hepatocellular carcinoma (HCC) patients with intrahepatic parenchymal substantial lesions ≤3.0 cm. Methods: A retrospective analysis was conducted in hospitals between September 2014 to April 2020. 131 pathologically confirmed non-HCC cases with lesions ≤3.0 cm in diameter were randomly matched with 131 cases with lesions ≤3.0 cm in diameter and divided into benign (56 cases), other hepatic malignant tumor (OM, 75 cases), and HCC group (131 cases) in a 1:1 ratio. MRI features of the lesions were analyzed and classified according to LI-RADS v2018 criteria (tie-break rule was applied to lesions with both HCC and LR-M features). Taking the pathological results as the gold standard, the sensitivity and specificity of the LI-RADS v2018 classification criteria and the more stringent LR-5 criteria (with three main signs of HCC at the same time) were calculated for HCC, OM or benign lesions diagnosis. Mann -Whitney U test was used to compare the classification results. Results: The number of cases classified as LR-M, LR-1, LR-2, LR-3, LR-4, and LR-5 in HCC group after applying the tie-break rule were 14, 0, 0, 12, 28, and 77, respectively. There were 40, 0, 0, 4, 17, 14 and 8, 5, 1, 26, 13, 3 cases in benign and OM group, respectively. There were 41 (41/77), 4 (4/14) and 1 (1/3) lesion case in the HCC, OM and benign group, respectively, that met the more stringent LR-5 criteria. The sensitivity of LR-4 combined with LR-5 (LR-4/5) criteria, LR-5 criteria and more stringent LR-5 criteria for HCC diagnosis were 80.2% (105/131), 58.8% (77/131) and 31.3% (41/131), respectively, and the specificity were 64.1% (84/131), 87.0% (114/131) and 96.2% (126/131), respectively. The sensitivity and specificity of LR-M were 53.3% (40/75) and 88.2% (165/187), respectively. The sensitivity and specificity using LR-1 combined with LR-2 (LR-1/2) criteria for the diagnosis of benign liver lesions were 10.7% (6/56) and 100% (206/206), respectively. Conclusions: LR-1/2, LR-5, and LR-M criteria have high diagnostic specificity for intrahepatic lesions with a diameter of ≤3.0 cm. Lesions classified as LR-3 are more likely to be benign. The specificity of LR-4/5 criteria is low, while the more stringent LR-5 criteria has a high specificity for HCC diagnosis.

Sarcomatoid Eccrine Porocarcinoma in a Patient with Urothelial Carcinoma

Introduction/Objective

Sarcomatoid porocarcinoma of skin is an exceedingly rare and diagnostically challenging malignancy of the sweat gland. In this report, we describe a rare case of a sarcomatoid eccrine porocarcinoma initially diagnosed to be a squamous cell carcinoma (SCC) in a patient with metastatic urothelial carcinoma (UC).

Methods/Case Report

Our patient is a 60 year old male with stage IV, poorly differentiated UC status post TURBT with residual tumor, and a 4 x 3 x 1 cm, polypoid, ulcerating skin nodule on his right cheek presumptively diagnosed to be an SCC on biopsy at an outside hospital. Given the concern that this cutaneous lesion may be a metastatic UC with squamous differentiation, the skin nodule was re-biopsied at our hospital. On histology, the lesion consisted of sheets of squamoid, polygonal cells in the dermis with pleomorphic nuclei showing irregular contours, prominent nucleoli, coarse chromatin, and frequent mitoses. The tumor was focally connected to the epidermis, which established it as a primary skin neoplasm and not a metastatic lesion. The tumor cells stained diffusely positive for vimentin, AE1/AE3, CK5/6, HMW CK, CK7, p63, and p16, negative for CK20, GATA-3, BerEP4, and Sox10, and showed high Ki67 proliferation index. Within the tumor sheets were poorly formed, focal ductal elements that stained positive for CAM5.2, EMA, CEA, and CK19, and negative for p63. The tumor showed comedo necrosis, epidermal ulceration, and no keratinization. The tumor was diagnosed to be a porocarcinoma given its positive staining for CK7 and p16, presence of focal ductal elements, and epidermal connection, with sarcomatoid features indicated by strong vimentin expression.

Results (if a Case Study enter NA)

NA.

Conclusion

In this report, we described an exceedingly rare, diagnostically challenging case of a sarcomatoid porocarcinoma initially suspected to be a cutaneous SCC or metastatic UC with squamous differentiation. Although the tumor cells morphologically resembled SCC, its positive staining for CK7 and p16, presence of ductal elements, and lack of keratinization, favored a diagnosis of porocarcinoma rather than cutaneous SCC. Its focal connection to the epidermis and lack of GATA-3 expression favored a primary skin neoplasm rather than a metastatic UC. Its sarcomatoid nature was indicated by strong vimentin expression. Sarcomatoid porocarcinoma is diagnostically challenging given its rarity and potential to mimic other cutaneous malignancies such as SCC.

A Scalp Metastatic Follicular Thyroid Carcinoma with a Silent Thyroid History and Normal Thyroid Uptake by PET-CT

Introduction/Objective

Follicular thyroid carcinoma (FTC) accounts for 10%-15% of all primary thyroid cancers. Follicular thyroid cancer is known to metastasize hematogenously, with distant metastasis occurring in 6-20% of cases. Scalp metastasis with an underlying thyroid carcinoma is an exceedingly rare clinical entity; there are less than 15 case reports in the literature. 1-2. Here, we present a case of widely invasive FTC with skull metastases located on the parietal calvarium. The scalp mass was confirmed as follicular thyroid carcinoma via microscopic morphology and positive immunoreactivity for Vimentin, TTF1, thyroglobulin, and PAX8. We present this case not only because of the diagnostic challenge and rare scalp metastasis, but also because of the patient’s unusual “silent” thyroid medical history and no abnormal thyroid uptake by PET-CT.

Methods/Case Report

81-year-old female presenting 2-year history of right parietal scalp mass, which was previously suspected for lipoma with attempted resection in Mexico but interrupted due to severe hemorrhage. No palpable thyroid nodule was noted. PET-CT showed avid lesions of the right breast with nipple retraction, as well as avid suspicious lesions of bilateral lungs, calvarium, xiphoid process, right acetabulum, T spine most c/f widely metastatic cancer, most likely a breast primary; evaluation of the neck demonstrates physiologic FDG-activity in the thyroid. Thyroid studies showed hyperthyroidism: TSH (L) &lt;0.010 uIU/mL; Free T3 (H) 4.7 pg/mL and Free T4 1.00 ng/d. The patient was performed Ultrasound-guided FNA and core biopsy of the large parietal scalp lesion, however, FNA of the cystic component was nondiagnostic (no malignant cells seen).

Results (if a Case Study enter NA)

NA.

Conclusion

Core biopsy of the large parietal mass the tumor cells tend to form follicular or microfollicular architecture with colloid present, but no papillary nuclear features. Rare mitotic figures are seen. IHC stain of tumor cells are positive for AE1/AE3, Cam5.2, CK7, TTF1, thyroglobulin, PAX8, and Vimentin, which show strong evidence for metastatic follicular thyroid carcinoma (FTC) origin. Tumor cells are negative for Napsin-A, P63, Synaptophysin, Ck5/6, Ck20, EMA, WT1, CDX2, GATA3, Mammaglobin, ER, PR, and BRST2, which helps rule out the primary malignancy from lung, breast, neuroendocrine or other adenocarcinomas.

Metastasis of a Primary Sinonasal Alveolar Rhabdomyosarcoma to the Testicle in an Adult Patient

Introduction/Objective

Alveolar rhabdomyosarcoma is an aggressive tumor of skeletal muscle differentiation that predominantly affects adolescents and young adults, and is rare over 45 years of age. It has poor prognosis with metastasis, and most commonly spreads to the lymph nodes, bone marrow, and lungs. In this report, we describe a middle-aged patient with a primary sinonasal alveolar rhabdomyosarcoma which metastasized to the right testicle, an unusual metastatic site reported only a few times in literature.

Methods/Case Report

Our patient is a 53 year old male who presented in 2020 with recurrent epistaxis and bilateral cervical lymphadenopathy over a 2 month period. Maxillofacial CT/MRI imaging revealed a 4-cm sized mass within the left nasal cavity eroding into the ethmoid sinuses. The patient underwent endoscopic sinus surgery of the sinonasal mass, which on histology, appeared as poorly differentiated small round blue cells with numerous mitoses infiltrating as single cells and nests. These cells stained positive for vimentin, myogenin, desmin, and CD56, and negative for AE1/AE3, chromogranin, S-100, CD99, and CD45. The cells showed very high Ki67 proliferation index (70-80%) and tested positive for FOXO1 gene rearrangement, which supported the diagnosis of alveolar rhabdomyosarcoma. The patient completed chemoradiation therapy, and MRI scans over the next 2 years were negative for residual sinonasal tumor. However, the patient returned in 2022 after having undergone a right orchiectomy at an outside hospital for testicular pain, and abdominal CT showed diffuse retroperitoneal lymphadenopathy concerning for metastasis. On histology, the resected testicle showed seminiferous tubules infiltrated and destroyed by sheets of poorly differentiated small round blue cells with fibrous septae separating the nests of tumor cells into alveolar-like spaces with central loss of cohesion. The tumor cells showed the same immunohistochemical staining pattern as the primary sinonasal lesion, thus confirming it to be metastatic alveolar rhabdomyosarcoma.

Results (if a Case Study enter NA)

NA.

Conclusion

It is unusual for alveolar rhabdomyosarcomas to occur in adults over 45 years old, and is even rarer for these tumors to metastasize to the testicle. Metastases also only account for 1% of testicular tumors. Our report documents a very rare case of an alveolar rhabdomyosarcoma in a middle-aged adult which metastasized to the testicle after chemoradiation therapy.

Bioinspired Anti-demineralization Enamel Coating for Orthodontics

White spot lesions and enamel cracks are the 2 most prominent diseases that occur after orthodontic treatment and are caused by enamel demineralization from accumulated bacterial biofilms and/or enamel damage caused by the removal of residual adhesive after bracket debonding. Inspired by the self-assembled amelogenin nanoribbons in enamel, we developed an enamel coating with a self-assembling antimicrobial peptide, D-GL13K, to simultaneously reduce demineralization and residual adhesive. The self-assembled amphiphilic nanoribbons significantly increased the hydrophobicity of the etched enamel, which reduced the permeability of the coated enamel surfaces as desired. The antimicrobial activity of this coating was evaluated against Streptococcus mutans by colony-forming unit counting and live/dead assays. The anti-demineralization effect was demonstrated by the reduced demineralization depth analyzed by optical coherence tomography and the increased Vickers hardness. The coatings did not reduce the shear bond strength but significantly reduced the adhesive remnant index score. This bioinspired enamel coating may provide a new strategy for preventing white spot lesions and enamel cracks after orthodontic treatment.

Validating and optimizing mismatch tolerance of Doppler backscattering measurements with the beam model (invited)

We use the beam model of Doppler backscattering (DBS), which was previously derived from beam tracing and the reciprocity theorem, to shed light on mismatch attenuation. This attenuation of the backscattered signal occurs when the wavevector of the probe beam's electric field is not in the plane perpendicular to the magnetic field. Correcting for this effect is important for determining the amplitude of the actual density fluctuations. Previous preliminary comparisons between the model and Mega-Ampere Spherical Tokamak (MAST) plasmas were promising. In this work, we quantitatively account for this effect on DIII-D, a conventional tokamak. We compare the predicted and measured mismatch attenuation in various DIII-D, MAST, and MAST-U plasmas, showing that the beam model is applicable in a wide variety of situations. Finally, we performed a preliminary parameter sweep and found that the mismatch tolerance can be improved by optimizing the probe beam's width and curvature at launch. This is potentially a design consideration for new DBS systems.

Gridded maps of wetlands dynamics over mid-low latitudes for 1980–2020 based on TOPMODEL

Dynamics of global wetlands are closely linked to biodiversity conservation, hydrology, and greenhouse gas emissions. However, long-term time series of global wetland products are still lacking. Using a diagnostic model based on the TOPography-based hydrological MODEL (TOPMODEL), this study produced an ensemble of 28 gridded maps of monthly global/regional wetland extents (with more reliable estimates at mid-low latitudes) for 1980–2020 at 0.25° × 0.25° spatial resolution, calibrated with a combination of four observation-based wetland data and seven gridded soil moisture reanalysis datasets. The gridded dynamic maps of wetlands capture the spatial distributions, seasonal cycles, and interannual variabilities of observed wetland extent well, and also show a good agreement with independent satellite-based terrestrial water storage estimates over wetland areas. The long temporal coverage extending beyond the era of satellite datasets, the global coverage, and the opportunity to provide real-time updates from ongoing soil moisture data make these products helpful for various applications such as analyzing the wetland-related methane emission.

Measurement(s)	wetland area
Technology Type(s)	computational modeling technique
Factor Type(s)	geographic location • temporal interval
Sample Characteristic - Environment	land
Sample Characteristic - Location	global

Impact of the initial hydrophilic ratio on black carbon aerosols in the Arctic

Black carbon (BC) contributes to patterns of Arctic warming, yet the initial hydrophilic ratio (IHR) of BC emitted from various sources and its impact on Arctic BC remain uncertain. With the use of a tagged tracer method of BC implemented in the global chemistry transport model GEOS-Chem, IHRs were partitioned into 7 BC combustion source categories according to the PKU-BC-v2 emission inventory. The results show that as the IHR increased, the concentration of BC decreased globally. The impact on Arctic BC was mainly reflected in the vertical profile and the burden rather than at the surface. Specifically, the greatest impact of IHR on Arctic BC appeared in summer, with the largest perturbation appearing at an altitude of approximately 600 hPa, reaching 8%. This change in BC vertical profile was mainly caused by the IHR change of wildfire combustion in Russia (44%) and Canada (51%), and the emissions from these two regions were also the two most important contributors to the BC concentration and burden in the middle and lower Arctic atmosphere in summer. In the other three seasons, anthropogenic combustion sources (oil, coal, and biomass) in East Asia, Russia, and Europe accounted for 19-40%, 14-28%, and 7-23%, respectively, of the monthly BC burden. Emissions from Russia were the most important contributor (27-43%) to the monthly BC surface concentration. Due to the large adjustment in IHR from 20% to 70%, biomass burning in Europe was shown to be the dominant contributor causing both burden (39%) and surface concentration (88%) changes in all seasons except summer.

Trade-off between tree planting and wetland conservation in China

Trade-offs between tree planting programs and wetland conservation are unclear. Here, we employ satellite-derived inundation data and a process-based land surface model (ORCHIDEE-Hillslope) to investigate the impacts of tree planting on wetland dynamics in China for 2000–2016 and the potential impacts of near-term tree planting activities for 2017–2035. We find that 160,000–190,000 km² (25.3–25.6%) of historical tree planting over wetland grid cells has resulted in 1,300–1,500 km² (0.3–0.4%) net wetland loss. Compared to moist southern regions, the dry northern and western regions show a much higher sensitivity of wetland reduction to tree planting. With most protected wetlands in China located in the drier northern and western basins, continuing tree planting scenarios are projected to lead to a > 10% wetland loss relative to 2000 across 4–8 out of 38 national wetland nature reserves. Our work shows how spatial optimization can help the balance of tree planting and wetland conservation targets.

Afforestation and reforestation programs aimed at enhancing carbon sequestration may have unintended effects on non-forest ecosystems and biodiversity. Here the authors use remote sensing and land surface modelling to quantify trade-offs between tree planting and wetland conservation in China

Effects of various preservation treatments on diversity and abundance of microbial community in rice product (MiBa) during storage

To determine the most effective preservation method for MiBa (a traditional Chinese rice product), MiBa treated with 75% alcohol, 75% alcohol + inhibitor, ozone treatment; untreated (control); and raw rice were subjected to 16S rRNA gene and ITS three-generation sequencing by High-throughput Sequencing Technology. According to the results the preservation effects of different treatment methods ranked as follows: ozone treatment >75% alcohol treatment >75% alcohol+inhibitor > control. Bacterial composition analysis showed that the bacterial community on the surface of MiBa treated with ozone was dominated by genera Leuconostoc and Serratia. The fungal community consisted mainly of Aspergillus and Alternaria. In summary, ozone treatment proved to be the most effective in inhibiting microbial contamination during the storage of MiBa, effectively extending its shelf life.

Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches

OBJECTIVES

To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC.

METHODS

We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses.

RESULTS

Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool.

CONCLUSIONS

Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.

Regional trends and drivers of the global methane budget

The ongoing development of the Global Carbon Project (GCP) global methane (CH₄ ) budget shows a continuation of increasing CH₄ emissions and CH₄ accumulation in the atmosphere during 2000-2017. Here, we decompose the global budget into 19 regions (18 land and 1 oceanic) and five key source sectors to spatially attribute the observed global trends. A comparison of top-down (TD) (atmospheric and transport model-based) and bottom-up (BU) (inventory- and process model-based) CH₄ emission estimates demonstrates robust temporal trends with CH₄ emissions increasing in 16 of the 19 regions. Five regions-China, Southeast Asia, USA, South Asia, and Brazil-account for >40% of the global total emissions (their anthropogenic and natural sources together totaling >270 Tg CH₄  yr^-1 in 2008-2017). Two of these regions, China and South Asia, emit predominantly anthropogenic emissions (>75%) and together emit more than 25% of global anthropogenic emissions. China and the Middle East show the largest increases in total emission rates over the 2000 to 2017 period with regional emissions increasing by >20%. In contrast, Europe and Korea and Japan show a steady decline in CH₄ emission rates, with total emissions decreasing by ~10% between 2000 and 2017. Coal mining, waste (predominantly solid waste disposal) and livestock (especially enteric fermentation) are dominant drivers of observed emissions increases while declines appear driven by a combination of waste and fossil emission reductions. As such, together these sectors present the greatest risks of further increasing the atmospheric CH₄ burden and the greatest opportunities for greenhouse gas abatement.

Biphasic Sarcomatoid Sweat Gland Carcinoma With Ductal Epithelial And Spindled Myoepithelial Cell Components (Malignant Mixed Tumor Of Skin)

Introduction/Objective

Sweat gland carcinomas are a group of malignant skin adnexal tumors that are difficult to diagnose due to their rarity, wide morphologic variation, and limited literature on diagnosis and classification. These tumors may appear bland and morphologically resemble benign skin adnexal tumors, or may appear poorly differentiated and mimic metastatic carcinoma especially from a breast primary. Biphasic sweat gland carcinomas are an even rarer entity, with only few cases reported in literature, and have been described to consist of a well- differentiated ductal epithelial component and a poorly differentiated, sarcomatoid, spindle cell component.

Methods/Case Report

Our case report describes a 53 year old female referred to our institution for diagnosis of an excised skin lesion of the right upper arm, which had been slowly growing for 8 years. The histology revealed a biphasic malignant neoplasm involving the dermis and subcutis. The tumor consisted of an epithelial cell component with glandular and squamoid morphology and positive for CK5/6, CK7, and CAM5.2, and a spindled myoepithelial cell component with sarcomatoid morphology and positive for S100, vimentin, and p63. Stains for CK20, ER, PR, PAX8, CEA, and TTF1 were negative. The histological and clinical findings favored a primary skin adnexal tumor, rather than a metastatic lesion.

The patient underwent wide local excision of the lesion given that margins of the original excision were indeterminate. The histology of this re-excision demonstrated the same biphasic tumor with ductal epithelial and sarcomatoid myoepithelial cell components positive for the same stains. Although margins were negative in this re-excision, 3-4 months later, the patient developed dyspnea with multiple new pulmonary and hilar masses discovered on imaging, and new-onset headache with a frontal lobe mass discovered on brain imaging. These masses were biopsied/resected, and revealed to be metastases of the original cutaneous tumor positive for the same markers.

Results (if a Case Study enter NA)

NA

Conclusion

This case report describes a rare, diagnostically challenging case of a biphasic sweat gland carcinoma with ductal epithelial and sarcomatoid myoepithelial cell components, which demonstrated aggressive behavior with distant metastasis. These tumors are a clinicopathological quandary given their rarity and the paucity of literature on their characterization.

Skin Involvement by Erdheim-Chester Disease; A Case Report

Introduction/Objective

Erdheim-Chester Disease (ECD) is considered one of the rare forms of non-Langerhans cell histiocytosis. It is caused by infiltration of different organs with lipid-laden histiocytes with foamy cytoplasm. Clinically, it can present as an indolent localized disease or a fatal disease with multi-organ failure.

Methods/Case Report

Here we report a case of fifty year-old female with a history of Erdheim Chester disease involvement of the left parietal lobe presented to the dermatology clinic with purpuric, tender maculopapular rash on bilateral cheeks, trunk, and bilateral upper extremities. Biopsy of the lesion on central chest revealed acute and chronic superficial dermal inflammation and skin crusting. The dermis is also infiltrated by many foamy lipid-laden macrophages. These macrophages stained with CD68 and CD163 and were S-100 and CD1a negative. BRAF V600E mutation was detected. Based on the immunophenotypic characteristics, as well as the molecular testing results and the clinical history of the patient, diagnosis of cutaneous involvement by Erdheim- Chester disease was made.

Results (if a Case Study enter NA)

NA

Conclusion

In summary, despite the fact that skin involvement by Erdheim- Chester disease is rare, it is imperative to consider it in the differential diagnosis of histiocytic diseases affecting the skin and differentiate it from its histologic mimickers. Molecular testing is a helpful tool in the diagnosis of Erdheim-Chester disease. Accurate diagnosis is crucial for guiding treatment plans.

Phageome-based vaccination and human innate immune modulation could be a useful strategy to control human Coronavirus infections

Human Coronavirus (CoV) infections, including SARS-COV, MERS-COV, and SARS-CoV-2, usually cause fatal lower and upper respiratory tract infections due to exacerbated expression of pro-inflammatory cytokines and chemokines. We aim to summarize different aspects, such as CoV immune evasion mechanisms and host innate immune response to these infections, and their role in pathogenesis. We have also elaborated the up-to-date findings on different vaccine development strategies and progress against CoVs in both humans and non-human models. Most importantly, we have described the Phageome-human immune interaction, its therapeutic usage as anti-viral, anti-inflammatory agent, and implications for multiple vaccine development systems. The data suggest that endogenous phages might play a vital role in eliminating the infection and regulating the body's immune system. Considering the innate-immune-induced pathogenesis against CoVs and the therapeutic aptitude of phageome, we propose that the prophylactic administration of phages and phage-based vaccines could be a useful strategy to control the emerging CoV infections.

Large historical carbon emissions from cultivated northern peatlands

When a peatland is drained and cultivated, it behaves as a notable source of CO₂ However, we lack temporally and spatially explicit estimates of carbon losses from cultivated peatlands. Using a process-based land surface model that explicitly includes representation of peatland processes, we estimate that northern peatlands converted to croplands emitted 72 Pg C over 850-2010, with 45% of this source having occurred before 1750. This source surpassed the carbon accumulation by high-latitude undisturbed peatlands (36 to 47 Pg C). Carbon losses from the cultivation of northern peatlands are omitted in previous land-use emission assessments. Adding this ignored historical land-use emission implies an 18% larger terrestrial carbon storage since 1750 to close the historical global carbon budget. We also show that carbon emission per unit area decrease with time since drainage, suggesting that time since drainage should be accounted for in inventories to refine land-use emissions from cultivated peatlands.

A Warm Summer is Unlikely to Stop Transmission of COVID-19 Naturally

The outbreak of coronavirus disease 2019 (COVID-19) showed various transmission rate (R t ) across different regions. The determination of the factors affecting transmission rate is urgent and crucial to combat COVID-19. Here we explored variation of R t between 277 regions across the globe and the associated potential socioeconomic, demographic, and environmental factors. At global scale, the R t started to decrease approximately 2 weeks after policy interventions initiated. This lag from the date of policy interventions initiation to the date when R t started to decrease ranges from 9 to 19 days, largest in Europe and North America. We find that proportion of elderly people or life expectancy can explain ~50% of variation in transmission rate across the 277 regions. The transmission rate at the point of inflection (R I ) increases by 29.4% (25.2-34.0%) for 1% uptick in the proportion of people aged above 65, indicating that elderly people face ~2.5 times higher infection risk than younger people. Air temperature is negatively correlated with transmission rate, which is mainly attributed to collinearities between air temperature and demographic factors. Our model predicted that temperature sensitivity of R I is only -2.7% (-5.2-0%) per degree Celsius after excluding collinearities between air temperature and demographic factors. This low temperature sensitivity of R I suggests that a warm summer is unlikely to impede the spread of COVID-19 naturally.

Case Report: Coexistence of Adenoid Cystic Carcinoma and Adenoid Basal Carcinoma in the Uterine Cervix

Introduction/Objective

Adenoid cystic carcinoma (ACC) and adenoid basal carcinoma (ABC) are very rare tumors, accounting for less than 1% of all cervical adenocarcinomas. ACC is an aggressive neoplasm and has poor prognosis while ABC has a favorable prognosis. Coexistence of ACC or ABC and squamous intraepithelial lesion/invasive squamous cell carcinoma in the uterine cervix has been reported in the literature; however, coexistence of ACC and ABC in the uterine cervix is very rare.

Methods

Case presentation: Here we present a case of coexistence ACC and ABC in a 66-year-old woman who suffered from heavy bloody vaginal discharge for one year with weight fluctuations. The cervical exam and CT scan showed a friable mass at the uterine cervix, measuring up to 5.5 cm, and cervical mass punch biopsy was performed. Histopathological examination of the specimen revealed an intact nonkeratinizing stratified squamous epithelium overlying proliferation of nests punctuated by small round spaces, resembling cribriform pattern in the stroma. The tumor cells were small and basaloid with hyperchromatic nuclei and scant cytoplasm. Palisading of tumor cells at the peripheral of the tumor nests were observed in some areas. Mitotic figures and necrosis were not seen.

Immunohistochemical stains were performed and showed two distinct patterns of ACC and ABC. ACC tumor cells were positive for CD117, focally positive for CAM5.2 and S100, and negative for p63. ABC tumor cells were positive for p63 and EMA and negative for CD117 and S100. Both ACC and ABC components were positive for p16, Sox 10, BCL-2 and vimentin and negative for CK7, p40, CEA and ER. PAS stain showed positive staining in the basement membrane-like material in ACC component. A final pathologic diagnosis of coexistence of ACC and ABC of the uterine cervix were made.

Conclusion

Literature review revealed that this was an exceedingly rare case of coexistence of ACC and ABC in the uterine cervix. It is extremely important to correctly diagnose ACC and ABC as there is very poor prognosis in the former and good prognosis in the latter.

Global terrestrial carbon fluxes of 1999-2019 estimated by upscaling eddy covariance data with a random forest

The terrestrial biosphere is a key player in slowing the accumulation of carbon dioxide in the atmosphere. While quantification of carbon fluxes at global land scale is important for mitigation policy related to climate and carbon, measurements are only available at sites scarcely distributed in the world. This leads to using various methods to upscale site measurements to the whole terrestrial biosphere. This article reports a product obtained by using a Random Forest to upscale terrestrial net ecosystem exchange, gross primary production, and ecosystem respiration from FLUXNET 2015. Our product covers land from −60°S to 80°N with a spatial resolution of 0.1° × 0.1° every 10 days during the period 1999–2019. It was compared with four existing products. A distinguishable feature of our method is using three derived variables of leaf area index to represent plant functional type (PFT) so that measurements from different PFTs can be mixed better by the model. This product can be valuable for the carbon-cycle community to validate terrestrial biosphere models and cross check datasets.

Measurement(s)	ecosystem-wide respiration • gross primary production • net ecosystem exchange • carbon flux • carbon dioxide
Technology Type(s)	Random forest
Factor Type(s)	year of data collection
Sample Characteristic - Environment	terrestrial biome • climate system
Sample Characteristic - Location	Earth (planet)

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.12932882

Genomic and transcriptional heterogeneity of multifocal hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) often presents with multiple nodules within the liver, with limited effective interventions. The high genetic heterogeneity of HCC might be the major cause of treatment failure. We aimed to characterize genomic heterogeneity, infer clonal evolution, investigate RNA expression pattern and explore tumour immune microenvironment profile of multifocal HCC.

PATIENTS AND METHODS

Whole-exome sequencing and RNA sequencing were carried out in 34 tumours and 6 adjacent normal liver tissue samples from 6 multifocal HCC patients. Protein expression of Ki67, AFP, P53, Survivin and CD8 was detected by immunohistochemistry. Fluorescence in situ hybridization was carried out to validate the amplification status of sorafenib-targeted genes.

RESULTS

We deciphered genomic and transcriptional heterogeneity among tumours in each multifocal HCC patient including mutational profiles, copy number alterations, tumour evolutionary trajectory and tumour immune microenvironment profiles. Of note, sorafenib-targeted alterations were identified in the trunk of phylogenetic tree in only one out of the six patients, which may explain the relative low treatment response rate to sorafenib in clinical practice. Moreover, we demonstrated RNA expression patterns and tumour immune microenvironment profiles of all nodules. We found that RNA expression pattern was associated with Edmondson-Steiner grading. Based on the differential expression of 66 reported immune markers, unsupervised hierarchical clustering analysis of 34 nodules identified immune subsets: one low expression cluster with seven nodules and one high expression cluster with 11 nodules. CD8+ T cells were more enriched in nodules of the high expression cluster.

CONCLUSIONS

Our study provided a detailed view of genomic and transcriptional heterogeneity, clonal evolution and immune infiltration of multifocal HCC. The heterogeneity of druggable targets and immune landscape might help interpret the clinical responsiveness to targeted drugs and immunotherapy for multifocal HCC patients.

Causes of slowing-down seasonal CO2 amplitude at Mauna Loa

Changing amplitude of the seasonal cycle of atmospheric CO₂ (SCA) in the northern hemisphere is an emerging carbon cycle property. Mauna Loa (MLO) station (20°N, 156°W), which has the longest continuous northern hemisphere CO₂ record, shows an increasing SCA before the 1980s (p < .01), followed by no significant change thereafter. We analyzed the potential driving factors of SCA slowing-down, with an ensemble of dynamic global vegetation models (DGVMs) coupled with an atmospheric transport model. We found that slowing-down of SCA at MLO is primarily explained by response of net biome productivity (NBP) to climate change, and by changes in atmospheric circulations. Through NBP, climate change increases SCA at MLO before the 1980s and decreases it afterwards. The effect of climate change on the slowing-down of SCA at MLO is mainly exerted by intensified drought stress acting to offset the acceleration driven by CO₂ fertilization. This challenges the view that CO₂ fertilization is the dominant cause of emergent SCA trends at northern sites south of 40°N. The contribution of agricultural intensification on the deceleration of SCA at MLO was elusive according to land-atmosphere CO₂ flux estimated by DGVMs and atmospheric inversions. Our results also show the necessity to adequately account for changing circulation patterns in understanding carbon cycle dynamics observed from atmospheric observations and in using these observations to benchmark DGVMs.

Empirical estimates of regional carbon budgets imply reduced global soil heterotrophic respiration

Resolving regional carbon budgets is critical for informing land-based mitigation policy. For nine regions covering nearly the whole globe, we collected inventory estimates of carbon-stock changes complemented by satellite estimates of biomass changes where inventory data are missing. The net land–atmospheric carbon exchange (NEE) was calculated by taking the sum of the carbon-stock change and lateral carbon fluxes from crop and wood trade, and riverine-carbon export to the ocean. Summing up NEE from all regions, we obtained a global ‘bottom-up’ NEE for net land anthropogenic CO₂ uptake of –2.2 ± 0.6 PgC yr⁻¹ consistent with the independent top-down NEE from the global atmospheric carbon budget during 2000–2009. This estimate is so far the most comprehensive global bottom-up carbon budget accounting, which set up an important milestone for global carbon-cycle studies. By decomposing NEE into component fluxes, we found that global soil heterotrophic respiration amounts to a source of CO₂ of 39 PgC yr⁻¹ with an interquartile of 33–46 PgC yr⁻¹—a much smaller portion of net primary productivity than previously reported.

Arabidopsis nucleoporin CPR5 controls trichome cell death through the core cell cycle regulator CKI

The Arabidopsis trichome is a polyploid epidermal cell resulting from multiple rounds of endocycles. The CYCLIN-DEPENDENT KINASE INHIBITOR (CKI) family proteins are core cell cycle regulators that promote the endocycle. CONSTITUTIVE EXPRESSION OF PR GENES 5 (CPR5) is a plant-specific nucleoporin. It has been found that two Arabidopsis CKI, SIAMESE (SIM) and SIAMESE-RELATED 1 (SMR1), function downstream of CPR5 to activate plant effector-triggered cell death. The sim smr1 double mutants form multicellular and clustered trichomes, while the cpr5 mutants produce dead and branchless trichomes. This study explored roles of the CPR5-CKI signalling pathway in trichome cell cycle transition. To examine the underlying mechanism of how cell cycle transition is regulated in plant trichomes, Trypan blue staining, flow cytometry, scanning electron microscopy (SEM) and nuclear DNA measurement were conducted. The native promoter-driven CKI and GUS fusion reporter showed that both SIM and SMR1 proteins were preferentially expressed in trichomes. The cpr5-induced dead and branchless trichomes were fully suppressed by the sim smr1 double mutant, suggesting that SIM and SMR1 function downstream of CPR5 in trichome development. Flow cytometry analysis showed that as compared to the number of 2C (C = DNA content in a haploid nucleus) cells, the number of 4C cells significantly increased, whereas that of polyploidy cells (8C and 16C) dramatically decreased in the cpr5 mutant. The elevated 4C/2C ratio in the cpr5 mutant is consistent with de-repression of pro-endocycle regulators SIM and SMR1. The polyploidy cells (8C and 16C) may be selectively targeted to cell death, which is therefore attributed to the branchless trichomes in the cpr5 mutant. Nuclear DNA content analysis demonstrated that the nuclear DNA content of trichomes in the cpr5 sim mutant was significantly higher than in the sim mutant, indicating that CPR5 is a negative endocycle regulator in trichomes. This study reveals that the CPR5-CKI signalling pathway controls trichome cell cycle transition and excessive endocycles are required for cell death in plant trichomes.

Global vegetation biomass production efficiency constrained by models and observations

Plants use only a fraction of their photosynthetically derived carbon for biomass production (BP). The biomass production efficiency (BPE), defined as the ratio of BP to photosynthesis, and its variation across and within vegetation types is poorly understood, which hinders our capacity to accurately estimate carbon turnover times and carbon sinks. Here, we present a new global estimation of BPE obtained by combining field measurements from 113 sites with 14 carbon cycle models. Our best estimate of global BPE is 0.41 ± 0.05, excluding cropland. The largest BPE is found in boreal forests (0.48 ± 0.06) and the lowest in tropical forests (0.40 ± 0.04). Carbon cycle models overestimate BPE, although models with carbon-nitrogen interactions tend to be more realistic. Using observation-based estimates of global photosynthesis, we quantify the global BP of non-cropland ecosystems of 41 ± 6 Pg C/year. This flux is less than net primary production as it does not contain carbon allocated to symbionts, used for exudates or volatile carbon compound emissions to the atmosphere. Our study reveals a positive bias of 24 ± 11% in the model-estimated BP (10 of 14 models). When correcting models for this bias while leaving modeled carbon turnover times unchanged, we found that the global ecosystem carbon storage change during the last century is decreased by 67% (or 58 Pg C).

Missed atmospheric organic phosphorus emitted by terrestrial plants, part 2: Experiment of volatile phosphorus

The emission and deposition of global atmospheric phosphorus (P) have long been considered unbalanced, and primary biogenic aerosol particles (PBAP) and phosphine (PH₃) are considered to be the only atmospheric P sources from the ecosystem. In this work, we found and quantified volatile organic phosphorus (VOP) emissions from plants unaccounted for in previous studies. In a greenhouse in which lemons were cultivated, the atmospheric total phosphorus (TP) concentration of particulate matter (PM) was 41.8% higher than that in a greenhouse containing only soil, and the proportion of organic phosphorus (OP) in TP was doubled. ³¹P nuclear magnetic resonance tests (³¹P-NMR) of PM showed that phosphate monoesters were the main components contributed by plants in both the greenhouse and at an outside observation site. Atmospheric gaseous P was directly measured to be 1-2 orders of magnitude lower than P in PM but appeared to double during plant growing seasons relative to other months. Bag-sampling and gas chromatography mass spectrometry (GCMS) tests showed that the gaseous P emitted by plants in the greenhouse was triethyl phosphate. VOP might be an important component of atmospheric P that has been underestimated in previous studies.