Microstructural, Micromechanical Atlas of the Temporomandibular Joint Disc

The temporomandibular joint (TMJ) disc is mainly composed of collagen, with its arrangement responding to efficient stress distribution. However, microstructural and micromechanical transformations of the TMJ disc under resting, functional, and pathological conditions remain unclear. To address this, our study presents a high-resolution microstructural and mechanical atlas of the porcine TMJ disc. First, the naive microstructure and mechanical properties were investigated in porcine TMJ discs (resting and functional conditions). Subsequently, the perforation and tear models (pathological conditions) were compared. Following this, a rabbit model of anterior disc displacement (abnormal stress) was studied. Results show diverse microstructures and mechanical properties at the nanometer to micrometer scale. In the functional state, gradual unfolding of the crimping cycle in secondary and tertiary structures leads to D-cycle prolongation in the primary structure, causing tissue failure. Pathological conditions lead to stress concentration near the injury site due to collagen interfibrillar traffic patterns, resulting in earlier damage manifestation. Additionally, the abnormal stress model shows collagen damage initiating at the primary structure and extending to the superstructure over time. These findings highlight collagen's various roles in different pathophysiological states. Our study offers valuable insights into TMJ disc function and dysfunction, aiding the development of diagnostic and therapeutic strategies for TMJ disorders, as well as providing guidance for the design of structural biomimetic materials.

Prevalence and risk factors of colorectal neoplasia in individuals aged 40-49 years: Findings from screening program in China

BACKGROUND AND AIM

The incidence of colorectal cancer (CRC) in individuals under 50 is increasing worldwide. We conducted an analysis of colonoscopy findings in high-risk individuals under 50 in the CRC screening program in Tianjin, China, to determine the detection rate and risk factors of advanced adenomas (AA), advanced colorectal neoplasia (ACN), colorectal neoplasia (CN).

METHODS

Our study investigated individuals aged 40-49 who underwent CRC screening and completed colonoscopy, 2012-2020, while the 50-54 age group served as a control. We compared the detection rates of AA, ACN, and CN among three age groups using univariate and multivariable logistic regression analyses, and investigated the risk factors associated with AA, ACN, and CN among individuals aged 40-49.

RESULTS

We found a gradual increase in the detection rate of AA, ACN, and CN among individuals aged 40-54. The detection rates for AA (OR 0.58; 95% CI 0.41-0.81), ACN (OR 0.58; 95% CI 0.43-0.77), and CN (OR 0.64; 95% CI 0.56-0.74) were lower in individuals aged 40-44 compared to 45-49. The detection rates of AA (OR 1.08; 95% CI 0.87-1.34) and ACN (OR 1.12; 95% CI 0.93-1.35) in individuals aged 45-49 were comparable with 50-54. Besides, lifestyle factors, BMI, and FIT are not associated with the detection rates of AA, ACN, and CN among individuals aged 40-49.

CONCLUSIONS

Our study reveals screening data in individuals under 50, indicating comparable detection rates of AA and ACN in individuals aged 45-49 and 50-54. These findings provide valuable data support for optimizing the optimal age to initiate screening.

A revisit of drugs and potential therapeutic targets against non-alcoholic fatty liver disease: learning from clinical trials

PURPOSE

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease, with a worldwide prevalence of 25%. Although numerous clinical trials have been conducted over the last few decades, an effective treatment has not been approved yet. Extensive research has accumulated a large amount of data and experience; however, the vast number of clinical trials and new therapeutic targets for NAFLD make it impossible to keep abreast of the relevant information. Therefore, a systematic analysis of the existing trials is necessary.

METHODS

Here, we reviewed clinical trials on NAFLD registered in the mandated federal database, ClinicalTrials.gov, to generate a detailed overview of the trials related to drugs and therapeutic targets for NAFLD treatment. Following screening for pertinence to therapy, a total of 440 entries were identified that included active trials as well as those that have already been completed, suspended, terminated, or withdrawn.

RESULTS

We summarize and systematically analyze the state, drug development pipeline, and discovery of treatment targets for NAFLD. We consider possible factors that may affect clinical outcomes. Furthermore, we discussed these results to explore the mechanisms responsible for clinical outcomes.

CONCLUSION

We summarised the landscape of current clinical trials and suggested the directions for future NAFLD therapy to assist internal medicine specialists in treating the whole clinical spectrum of this highly prevalent liver disease.

Trends in colorectal cancer screening compliance and incidence among 60- to 74-year-olds in China

BACKGROUND

Compliance with colonoscopy among elderly individuals participating in colorectal cancer (CRC) screening programs is unsatisfactory, despite a high detection rate of bowel-related diseases. In this study, our aim was to analyze the impact of risk factors on the trends of compliance and detection rates in colonoscopy among high-risk individuals aged 60-74.

METHODS

A retrospective study was conducted on the high-risk individuals aged 60-74 participating in the 2021 CRC screening program in Tianjin, China. Logistic regression analyses, including both univariate and multivariate analyses, were performed to explore the impact of different risk factors on colonoscopy compliance among the high-risk individuals. Besides, the study investigated the influence of various risk factors on the detection rates of bowel-related diseases among the high-risk individuals who underwent colonoscopy.

RESULTS

A total of 24,064 high-risk individuals were included, and 5478 individuals received a free colonoscopy, with an overall compliance of 22.76%. Among them, the adenoma detection rate was 55.46%. Males and individuals with a positive FIT had high compliance and detection rates for CRC, advanced adenomas (AA), advanced colorectal neoplasia (ACN), and colorectal neoplasm (CN). Individuals aged 70-74 were associated with low compliance but high CRC, ACN, and CN detection rates. Individuals who reported a history of chronic constipation, bloody mucous, and CRC in first-degree relative showed high compliance but no significantwere associated with the detection rates of CRC, AA, and CN.

CONCLUSION

This study reported several risk factors associated with the screening behaviors for CRC. Patterns and trends in CRC, AA, ACN, and CN compliance and detection rates correlate with risk factors.

[Analysis and prediction of disease burden of cirrhosis and other chronic liver diseases due to alcohol use in China from 1990 to 2030]

Objective: To comprehensively understand the disease burden of liver cirrhosis and other chronic liver diseases caused by alcohol use in China from 1990 to 2019, as well as to predict the trends in disease burden from 2020 to 2030. Methods: The analysis utilized data from the Global Burden of Disease study in 2019 (GBD2019). Key indicators such as incidence rate, mortality rate, disability-adjusted life years (DALY), years of life lost due to premature mortality, and years lived with disability were selected to describe the disease burden of alcohol-related liver cirrhosis and other chronic liver diseases in China from 1990 to 2019. The estimated annual percentage change (EAPC) was used to depict the temporal trends in disease burden. Furthermore, a Bayesian age-period-cohort (BAPC) model was constructed using R software to predict the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of alcohol-related liver cirrhosis and other chronic liver diseases in China from 2020 to 2030. Results: From 1990 to 2019, the incidence of alcohol-related liver cirrhosis and other chronic liver diseases in China showed an upward trend, with an EAPC of 0.31% (95%CI: 0.10%-0.52%). However, the DALY declined, with an EAPC of -2.81% (95%CI: -2.92% - -2.70%). The ASMR showed a downward trend, with an EAPC of -2.55% (95%CI: -2.66% - -2.45%). The highest incidence of cirrhosis of liver caused by alcohol and other chronic liver diseases was reported in the age group of 35-49 years, while the ASMR increased gradually with age, with a significant rise after the age of 30. The age-standardized DALY rate peaked between the ages of 55 and 64. The disease burden indicators for males were consistently higher than those for females during the same period. According to the predictions of the BAPC model, from 2020 to 2030, the ASIR for cirrhosis of liver caused by alcohol and other chronic liver diseases in the entire population of China was projected to increase from 3.45/100 000 in 2020 to 3.78/100 000 in 2030, a growth of 9.57%. Conversely, the ASMR was expected to decrease from 1.45/100 000 in 2020 to 1.24/100 000 in 2030, a reduction of 14.48%. Conclusions: The disease burden of cirrhosis of liver caused by alcohol and other chronic liver diseases remained serious in China, especially in men and the middle-aged to elderly population. There is a pressing need to prioritize attention and resources towards these groups. Despite the projected decrease in ASMR, the ASIR continued to rise and is expected to persist in its upward trend until 2030.

Development of terpenoid repellents against Aedes albopictus: a combined study of biological activity evaluation and computational modelling

To explore novel terpenoid repellents, 22 candidate terpenoid derivatives were synthesized and tested for their electroantennogram (EAG) responses and repellent activities against Aedes albopictus. The results from the EAG experiments revealed that 5-(2-hydroxypropan-2-yl)-2-methylcyclohex-2-en-1-yl formate (compound 1) induced distinct EAG responses in female Aedes albopictus. At concentrations of 0.1, 1, 10, 100, and 1000 mg/L, the EAG response values for compound 1 were 179.59, 183.99, 190.38, 193.80, and 196.66 mV, demonstrating comparable or superior effectiveness to DEET. Repellent activity analysis indicated significant repellent activity for compound 1, closest to the positive control DEET. The in silico assessment of the ADMET profile of compound 1 indicates that it successfully passed the ADMET evaluation. Molecular docking studies exhibited favourable binding of compound 1 to the active site of the odorant binding protein (OBP) of Aedes albopictus, involving hydrophobic forces and hydrogen bond interactions with residues in the OBP pocket. The QSAR model highlighted the influential role of hydrogen-bonding receptors, positively charged surface area of weighted atoms, polarity parameters of molecules, and maximum nuclear-nuclear repulsion force of carbon-carbon bonds on the relative EAG response values of the tested compounds. This study holds substantial significance for the advancement of new terpenoid repellents.

Tumor-draining lymph nodes: opportunities, challenges, and future directions in colorectal cancer immunotherapy

Tumor-draining lymph nodes (TDLNs) are potential immunotherapy targets that could expand the population of patients with colorectal cancer (CRC) who may benefit from immunotherapy. Currently, pathological detection of tumor cell infiltration limits the acquisition of immune information related to the resected lymph nodes. Understanding the immune function and metastatic risk of specific stages of lymph nodes can facilitate better discussions on the removal or preservation of lymph nodes, as well as the timing of immunotherapy. This review summarized the contribution of TDLNs to CRC responses to immune checkpoint blockade therapy, local immunotherapy, adoptive cell therapy, and cancer vaccines, and discussed the significance of these findings for the development of diagnostics based on TDLNs and the potential implications for guiding immunotherapy after a definitive diagnosis. Molecular pathology and immune spectrum diagnosis of TDLNs will promote significant advances in the selection of immunotherapy options and predicting treatment efficacy.

[Association between congenital hypothyroidism and in-hospital adverse outcomes in very low birth weight infants]

Objective: To investigate the association between congenital hypothyroidism (CH) and the adverse outcomes during hospitalization in very low birth weight infants (VLBWI). Methods: This prospective, multicenter observational cohort study was conducted based on the data from the Sino-northern Neonatal Network (SNN). Data of 5 818 VLBWI with birth weight <1 500 g and gestational age between 24-<37 weeks that were admitted to the 37 neonatal intensive care units from January 1st, 2019 to December 31st, 2022 were collected and analyzed. Thyroid function was first screened at 7 to 10 days after birth, followed by weekly tests within the first 4 weeks, and retested at 36 weeks of corrected gestational age or before discharge. The VLBWI were assigned to the CH group or non-CH group. Chi-square test, Fisher exact probability method, Wilcoxon rank sum test, univariate and multivariate Logistic regression were used to analyze the relationship between CH and poor prognosis during hospitalization in VLBWI. Results: A total of 5 818 eligible VLBWI were enrolled, with 2 982 (51.3%) males and the gestational age of 30 (29, 31) weeks. The incidence of CH was 5.5% (319 VLBWI). Among the CH group, only 121 VLBWI (37.9%) were diagnosed at the first screening. Univariate Logistic regression analysis showed that CH was associated with increased incidence of extrauterine growth retardation (EUGR) (OR=1.31(1.04-1.64), P<0.05) and retinopathy of prematurity (ROP) of stage Ⅲ and above (OR=1.74(1.11-2.75), P<0.05). However, multivariate Logistic regression analysis showed no significant correlation between CH and EUGR, moderate to severe bronchopulmonary dysplasia, grade Ⅲ to Ⅳ intraventricular hemorrhage, neonatal necrotizing enterocolitis in stage Ⅱ or above, and ROP in stage Ⅲ or above (OR=1.04 (0.81-1.33), 0.79 (0.54-1.15), 1.15 (0.58-2.26), 1.43 (0.81-2.53), 1.12 (0.70-1.80), all P>0.05). Conclusion: There is no significant correlation between CH and in-hospital adverse outcomes, possibly due to timely diagnosis and active replacement therapy.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

A radiomics model based on T2WI and clinical indexes for prediction of lateral lymph node metastasis in rectal cancer

OBJECTIVE

The aim of this study was to explore the clinical value of a radiomics prediction model based on T2-weighted imaging (T2WI) and clinical indexes in predicting lateral lymph node (LLN) metastasis in rectal cancer patients.

METHODS

This was a retrospective analysis of 106 rectal cancer patients who had undergone LLN dissection. The clinical risk factors for LLN metastasis were selected by multivariable logistic regression analysis of the clinical indicators of the patients. The LLN radiomics features were extracted from the pelvic T2WI of the patients. The least absolute shrinkage and selection operator algorithm and backward stepwise regression method were adopted for feature selection. Three LLN metastasis prediction models were established through logistic regression analysis based on the clinical risk factors and radiomics features. Model performance was assessed in terms of discriminability and decision curve analysis in the training, verification and test sets.

RESULTS

The model based on the combined T2WI radiomics features and clinical risk factors demonstrated the highest accuracy, surpassing the models based solely on either T2WI radiomics features or clinical risk factors. Specifically, the model achieved an AUC value of 0.836 in the test set. Decision curve analysis revealed that this model had the greatest clinical utility for the vast majority of the threshold probability range from 0.4 to 1.0.

CONCLUSION

Combining T2WI radiomics features with clinical risk factors holds promise for the noninvasive assessment of the biological characteristics of the LLNs in rectal cancer, potentially aiding in therapeutic decision-making and optimizing patient outcomes.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Diagnostic value of a radiomics model based on CT and MRI for prediction of lateral lymph node metastasis of rectal cancer

This study aimed to develop a radiomics model for predicting lateral lymph node (LLN) metastasis in rectal cancer patients using MR-T2WI and CT images, and assess its clinical value. This prospective study included rectal cancer patients with complete MR-T2WI and portal enhanced CT images who underwent LLN dissection at Tianjin Union Medical Center between June 2017 and November 2022. Primary lesions and LLN were segmented using 3D slicer. Radiomics features were extracted from the region of interest using pyradiomics in Python. Least absolute shrinkage and selection operator algorithm and backward stepwise regression were employed for feature selection. Three LLN metastasis radiomics prediction models were established via multivariable logistic regression analysis. The performance of the model was evaluated using receiver operating characteristic curve analysis, and the area under the curve (AUC), sensitivity, specificity were calculated for the training, validation, and test sets. A nomogram was constructed for visualization, and decision curve analysis (DCA) was performed to evaluate clinical value. We included 94 eligible patients in the analysis. For each patient, we extracted a total of 1344 radiomics features. The CT combined with MR-T2WI model had the highest AUC for all sets compared to CT and MR-T2WI models. AUC values for the CT combined with MR-T2WI model in the training, validation, and test sets were 0.957, 0.901, and 0.936, respectively. DCA revealed high prediction value for the combined MR-T2WI and CT model. A radiomics model based on CT and MR-T2WI data effectively predicted LLN metastasis in rectal cancer patients preoperatively.

Hardware Implementation of Quantum Stabilizers in Superconducting Circuits

Stabilizer operations are at the heart of quantum error correction and are typically implemented in software-controlled entangling gates and measurements of groups of qubits. Alternatively, qubits can be designed so that the Hamiltonian corresponds directly to a stabilizer for protecting quantum information. We demonstrate such a hardware implementation of stabilizers in a superconducting circuit composed of chains of π-periodic Josephson elements. With local on-chip flux and charge biasing, we observe a progressive softening of the energy band dispersion with respect to flux as the number of frustrated plaquette elements is increased, in close agreement with our numerical modeling.

Predicting Prostate VMAT 3D Radiation Doses of Continuously Varying Organ Dose Trade-Offs Using a Conditional Variational Autoencoder

PURPOSE/OBJECTIVE(S)

Predicting 3D radiation doses from planning structures is a promising method of knowledge-based treatment planning. However, most models are designed to predict only one 3D dose distribution per patient, based on historical organ dose trade-offs. To allow customizable plan generation, in this study, we aim to show the feasibility of dose prediction in which the degrees of organ dose trade-off could be explicitly specified. Specifically, the bladder vs. rectum dose trade-off in prostate cancer was investigated.

MATERIALS/METHODS

In an IRB-approved study, we obtained imaging and structure contours for 167 patients with prostate cancer who received definitive radiotherapy. Training data was generated by automatically creating 3 different plans for each patient: while keeping target dose patterns constant, 1 base plan was generated with optimization objectives directly based on the output of a custom RapidPlan model prediction (S = 0), 1 plan with the goal to significantly lower bladder dose relative to the rectum (S = -1), and 1 plan with the goal to significantly lower rectum dose relative to the bladder (S = 1). This process was achieved by adjusting priority values during optimization. S is a scalar indicating the degree of bladder vs. rectum dose trade-off (higher S = higher dose to the bladder relative to the rectum). A conditional variational autoencoder (cVAE) was constructed as the generative model. Training, validation, and testing sets consist of 124, 10, and 33 patients, respectively. During training, the inputs to the model were 3D structure masks with voxel values modified based on S, and the output was the corresponding 3D dose. For model testing, we selected 7 equispaced values of S in the range [-1, +1] for each of the 33 test patients, generated the 3D doses for each S value (normalized to D2% = 110%), and calculated the differences of key dosimetric parameters (for S levels other than 0) compared to the predicted base plan (S = 0). The mean and standard deviations for these differences were reported.

RESULTS

The cVAE model converged after training for 800 epochs. As the value of S increased from -1 to +1, the target coverage remained similar, while the doses to the bladder and rectum increased and decreased, respectively, as expected (Table 1). This pattern was also confirmed by qualitative examination of dose-volume histograms for additional S values.

CONCLUSION

We demonstrated the feasibility of predicting 3D radiation dose distributions for prostate cancer where the degrees of organ dose trade-off could be explicitly specified.

Cost-Effectiveness of Short-Course Radiotherapy Based Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer in China

PURPOSE/OBJECTIVE(S)

The phase III STELLAR (NCT02533271) trial demonstrated that four cycles of chemotherapy after short-course radiotherapy (SCRT-TNT) were not inferior to the standard care of long-course concurrent radiotherapy (LCRT) in patients with locally advanced rectal cancer (LARC). This study assessed the cost-effectiveness of SCRT-TNT versus LCRT in locally advanced rectal cancer in China on the basis of the STELLAR trial.

MATERIALS/METHODS

A Markov model was used to synthesize the healthcare costs and benefits of LARC patients based on results from the STELLAR trial. The model assumes that LARC who meet the inclusion criteria of the STELLAR trial experience four possible states: No Evidence of Disease (NED), locally recurrence, distant metastases, or any death from rectal cancer or other unrelated causes, where local recurrence continues to be classified as resectable and unresectable. The transition status period is 3 month, and 5 years is used to calculate direct medical costs and health benefits. The probabilities of states transition after SCRT-TNT or LCRT were derived from the results of the STELLAR trial and previous published article (Table.1). Costs were evaluated from the Chinese payer's perspective reported in early 2022 US dollars (US$1 = 6.78 Chinese Yuan). Sensitivity analyses were performed for key variables. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefits. Effectiveness was defined as quality-adjusted life-years (QALYs). Willingness-to-pay (WTP) threshold was set at $43500/QALY. Data were collected from October 3, 2020, to September 20, 2021, and analyzed from November 15, 2020, to October 25, 2021.

RESULTS

During the 5-year horizon, for the base case scenario, SCRT-TNT incurred a lower total cost and higher QALYs compared with LCCRT. The total cost was $65767 and QALYs were 1.77 for SCRT-TNT; for LCCRT, the total cost was $72802 and QALYs were 1.64. This resulted in an ICER of -$ 55470.69 per QALY. Therefore, SCRT-TNT was a cost-saving and dominating treatment strategy compared with LCRT. Sensitivity analysis showed that ICERs were most sensitive to the parameters of distant metastases risk after treatment.

CONCLUSION

SCRT-TNT in locally advanced rectal cancer can be a cost-effective alternative to LCRT in China, and should be considered in appropriately selected patients.

Feasibility of Using Zero-Shot Learning in Transformer-Based Natural Language Processing Algorithm for Key Information Extraction from Head and Neck Tumor Board Notes

PURPOSE/OBJECTIVE(S)

Natural language processing (NLP) technology has the potential to automate information aggregation and summarization in oncology. One example is the automation of patient registry creation. In this work, we aim to show (1) the feasibility of using modern NLP algorithms to extract key information from tumor board notes, and (2) the impact of prompt engineering on the quality of the results.

MATERIALS/METHODS

In this IRB-approved study, we obtained the texts of head and neck tumor board notes for 306 unique patients. Five key pieces of information used to create a patient registry were predefined: age, gender, tumor histology, tumor stage, and primary location. The NLP algorithm used was a modified Text-To-Text Transfer Transformer (T5) model that was initially trained on the Colossal Clean Crawled Corpus (C4) dataset and subsequently fine-tuned on the Stanford Question Answering Dataset (SQuAD) to perform the downstream task of extractive question answering. The NLP model and trained weights were obtained from the Hugging Face platform. During inference, the entire body of the tumor board note and a related question were fed as inputs, and the model predicted a sequence of texts in response to the question. Two sets of questions of similar semantic meanings were used. Questions in prompt set #1 included "What is the gender?", "What is the age?", "What is the type of carcinoma in pathological diagnosis?", "What is the stage?", and "Where is the carcinoma located at?". Questions in prompt set #2 include "Is the patient male or female?", "How old is the patient?", "What kind of cancer?", "What is the cancer stage?", and "What is the tumor location?". Each model-predicted response was compared to the ground truth extracted from the tumor board notes. A response was classified as true if it is consistent with the ground truth, otherwise, it was deemed false. The response accuracy for each question was subsequently calculated.

RESULTS

The median number of words in each tumor board note was 448 (range, 219 - 1505). The accuracy of the NLP algorithm for each question from either set is reported in Table 1. Algorithm performance is higher for extracting objective information such as age, gender, and histology. In addition, it was found that questions of similar semantic meanings but with different wording can lead to significantly different results.

CONCLUSION

We demonstrated that a transformer-based extractive question-answering NLP algorithm can be successfully used for extracting information from head and neck tumor board notes with zero-shot learning. Furthermore, our results highlight the significance of prompt engineering for applying NLP for this task. Future work on finetuning these algorithms to oncology-specific texts can potentially enhance algorithm performance for more difficult tasks.

Genetic Variations in TrkB.T1 Isoform and Their Association with Somatic and Psychological Symptoms in Individuals with IBS

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, is often comorbid with somatic pain and psychological disorders. Dysregulated signaling of brain-derived neurotrophic factor (BDNF) and its receptor, tropomyosin-related kinase B (TrkB), has been implicated in somatic-psychological symptoms in individuals with IBS. Thus, we investigated the association of 10 single nucleotide polymorphisms (SNPs) in the regulatory 3' untranslated region (UTR) of NTRK2 (TrkB) kinase domain-deficient truncated isoform (TrkB.T1) and the BDNF Val66Met SNP with somatic and psychological symptoms and quality of life in a U.S. cohort (IBS n=464; healthy controls n=156). We found that the homozygous recessive genotype (G/G) of rs2013566 in individuals with IBS is associated with worsened somatic symptoms, including headache, back pain, joint pain, muscle pain, and somatization as well as diminished sleep quality, energy level and overall quality of life. Validation using U.K. BioBank (UKBB) data confirmed the association of rs2013566 with increased likelihood of headache. Several SNPs (rs1627784, rs1624327, rs1147198) showed significant associations with muscle pain in our U.S. cohort. Notably, these SNPs are predominantly located in H3K4Me1-enriched regions, suggesting their enhancer and/or transcription regulation potential. Together, our findings suggest that genetic variation within the 3'UTR region of the TrkB.T1 isoform may contribute to comorbid conditions in individuals with IBS, resulting in a spectrum of somatic and psychological symptoms that may influence their quality of life. These findings advance our understanding of the genetic interaction between BDNF/TrkB pathways and somatic-psychological symptoms in IBS, highlighting the importance of further exploring this interaction for potential clinical applications.

An Analysis of the Gene Expression Associated with Lymph Node Metastasis in Colorectal Cancer

Objective

This study aimed to explore the genes regulating lymph node metastasis in colorectal cancer (CRC) and to clarify their relationship with tumor immune cell infiltration and patient prognoses.

Methods

The data sets of CRC patients were collected through the Cancer Gene Atlas database; the differentially expressed genes (DEGs) associated with CRC lymph node metastasis were screened; a protein-protein interaction (PPI) network was constructed; the top 20 hub genes were selected; the Gene Ontology functions and the Kyoto Encyclopedia of Genes and Genomes pathways were enriched and analyzed. The Least Absolute Shrinkage and Selection Operator (LASSO) regression method was employed to further screen the characteristic genes associated with CRC lymph node metastasis in 20 hub genes, exploring the correlation between the characteristic genes and immune cell infiltration, conducting a univariate COX analysis on the characteristic genes, obtaining survival-related genes, constructing a risk score formula, conducting a Kaplan-Meier analysis based on the risk score formula, and performing a multivariate COX regression analysis on the clinical factors and risk scores.

Results

A total of 62 DEGs associated with CRC lymph node metastasis were obtained. Among the 20 hub genes identified via PPI, only calcium-activated chloride channel regulator 1 (CLCA1) expression was down-regulated in lymph node metastasis, and the rest were up-regulated. A total of nine characteristic genes associated with CRC lymph node metastasis (KIF1A, TMEM59L, CLCA1, COL9A3, GDF5, TUBB2B, STMN2, FOXN1, and SCN5A) were screened using the LASSO regression method. The nine characteristic genes were significantly related to different kinds of immune cell infiltration, from which three survival-related genes (TMEM59L, CLCA1, and TUBB2B) were screened. A multi-factor COX regression showed that the risk scores obtained from TMEM59L, CLCA1, and TUBB2B were independent prognostic factors. Immunohistochemical validation was performed in tissue samples from patients with rectal and colon cancer.

Conclusion

TMEM59L, CLCA1, and TUBB2B were independent prognostic factors associated with lymphatic metastasis of CRC.

Ultraviolet metasurface-assisted photoacoustic microscopy with great enhancement in DOF for fast histology imaging

Pathology interpretations of tissue rely on the gold standard of histology imaging, potentially hampering timely access to critical information for diagnosis and management of neoplasms because of tedious sample preparations. Slide-free capture of cell nuclei in unprocessed specimens without staining is preferable; however, inevitable irregular surfaces in fresh tissues results in limitations. An ultraviolet metasurface with the ability to generate an ultraviolet optical focus maintaining < 1.1-µm in lateral resolution and ∼290 µm in depth of field (DOF) is proposed for fast, high resolution, label-free photoacoustic histological imaging of unprocessed tissues with uneven surfaces. Microanatomical characteristics of the cell nuclei can be observed, as demonstrated by the mouse brain samples that were cut by hand and a ∼3 × 3-mm2 field of view was imaged in ∼27 min. Therefore, ultraviolet metasurface-assisted photoacoustic microscopy is anticipated to benefit intraoperative pathological assessments and basic scientific research by alleviating laborious tissue preparations.

Mutational spectrum for guiding the decision of adjuvant treatment in patients with resected biliary tract carcinoma

BACKGROUND

Systemic chemotherapy or chemoradiation therapy has proven to be effective in treating advanced biliary tract carcinoma (BTC). However, its efficacy in the adjuvant setting remains controversial. Therefore, this study aimed to determine the prognostic significance of genomic biomarkers in resected BTC and their potential role in stratifying patients for adjuvant treatment.

METHODS

We retrospectively reviewed 113 BTC patients who underwent curative-intent surgery and had available tumor sequencing data. Disease-free survival (DFS) was the primary outcome examined and univariate analysis was used to identify gene mutations with prognostic value. Favorable and unfavoratble gene subsets were distinguished from the selected genes through grouping, respectively. Multivariate Cox regression was used to identify independent prognostic factors of DFS.

RESULTS

Our results indicated that mutations in ACVR1B, AR, CTNNB1, ERBB3, and LRP2 were favorable mutations, while mutations in ARID1A, CDKN2A, FGFR2, NF1, NF2, PBRM1, PIK3CA, and TGFBR1 were unfavorable mutations. In addition to age, sex, and node positive, favorable genes (HR = 0.15, 95% CI = 0.04-0.48, p = 0.001) and unfavorable genes (HR = 2.86, 95% CI = 1.51-5.29, p = 0.001) were identified as independent prognostic factors for DFS. Out of the 113 patients, only 35 received adjuvant treatment whereas the majority (78) did not. For patients with both favorable and unfavorable mutations undetected, adjuvant treatment showed negative effect on DFS (median DFS: S441 vs. 956 days, p = 0.010), but there was no significant difference in DFS among those in other mutational subgroups.

CONCLUSIONS

Genomic testing might be useful in guiding the decisions regarding adjuvant treatment in BTC.

Fibroblast growth factor 3 promotes spontaneous mammary tumorigenesis in Tientsin albino 2 mice via the FGF3/FGFR1/STAT3 pathway

Introduction

Tientsin albino 2 (TA2) mice can develop spontaneous breast cancer (SBC), which is associated with multiple pregnancies and infection with the mouse mammary tumor virus (MMTV). In this study, we sought to elucidate the molecular mechanisms underlying the development of SBC in TA2 mice induced by MMTV.

Methods

The integration site of MMTV in TA2 SBC was identified using whole-genome sequencing. The expression of fibroblast growth factor 3 (FGF3) in SBCs and normal breast tissues was compared. The primary cell line, TA-1106, derived from SBC, was cultured. The proliferation, cell cycle, migration, invasion, and tumorigenicity abilities, as well as the expression of epithelial-mesenchymal transition-related proteins, phosphorylated STAT3, and phosphorylated Akt, were assessed in MA-891cell line from TA2 and TA-1106 cells after FGF3 knockdown. The binding of FGF3 to FGF receptor 1 (FGFR1) was determined by co-immunoprecipitation. Additionally, the relationship between STAT3 and Akt phosphorylation was investigated using a small molecule inhibitor and STAT3 knockdown.

Results

MMTV integrated upstream of the FGF3 gene, and the FGF3 protein was highly expressed in TA2 SBCs. FGF3 knockdown in MA-891 and TA-1106 decreased their proliferation, migration, and invasion abilities, affected the cell cycle and expression of epithelial-mesenchymal transition-related proteins, and inhibited the growth of animal xenografts. FGF3 binds to FGFR1, and either FGF3 or FGFR1 knockdown decreases STAT3 and Akt phosphorylation levels. Inhibition of phosphorylation or expression of STAT3 resulted in decreased Akt phosphorylation levels. Inhibition of Akt phosphorylation also resulted in decreased STAT3 phosphorylation levels. Furthermore, treatment of MA-891 and TA-1106 cells with Wortmannin or Stattic caused FGFR1 upregulation in addition to inhibiting Akt or STAT3 phosphorylation.

Conclusion

The results of this study demonstrate that FGF3 plays a significant role in the development of SBC through the FGF3/FGFR1/STAT3 signaling pathway. There is a reciprocal activation between STAT3 and Akt. Inhibition of STAT3 or Akt phosphorylation promoted the expression of FGFR1. Validating the conclusions obtained in this study in human breast cancer (HBC) may contribute to targeted therapy and it is worth exploring whether the homologous sequences of MMTV in HBC have a similar oncogenic effect.

Laparoscopic versus open surgery for perihilar cholangiocarcinoma: a multicenter propensity score analysis of short- term outcomes

BACKGROUND

Laparoscopic surgery (LS) has been increasingly applied in perihilar cholangiocarcinoma (pCCA). In this study, we intend to compare the short-term outcomes of LS versus open operation (OP) for pCCA in a multicentric practice in China.

METHODS

This real-world analysis included 645 pCCA patients receiving LS and OP at 11 participating centers in China between January 2013 and January 2019. A comparative analysis was performed before and after propensity score matching (PSM) in LS and OP groups, and within Bismuth subgroups. Univariate and multivariate models were performed to identify significant prognostic factors of adverse surgical outcomes and postoperative length of stay (LOS).

RESULTS

Among 645 pCCAs, 256 received LS and 389 received OP. Reduced hepaticojejunostomy (30.89% vs 51.40%, P = 0.006), biliary plasty requirement (19.51% vs 40.16%, P = 0.001), shorter LOS (mean 14.32 vs 17.95 d, P < 0.001), and lower severe complication (CD ≥ III) (12.11% vs. 22.88%, P = 0.006) were observed in the LS group compared with the OP group. Major postoperative complications such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency were similar between LS and OP (P > 0.05 for all). After PSM, the short-term outcomes of two surgical methods were similar, except for shorter LOS in LS compared with OP (mean 15.19 vs 18.48 d, P = 0.0007). A series subgroup analysis demonstrated that LS was safe and had advantages in shorting LOS.

CONCLUSION

Although the complex surgical procedures, LS generally seems to be safe and feasible for experienced surgeons.

TRIAL REGISTRATION

NCT05402618 (date of first registration: 02/06/2022).

Postponing colonoscopy for 6 months in high-risk population increases colorectal cancer detection in China

BACKGROUND AND AIMS

Colonoscopy is an important colorectal cancer (CRC) screening modality; however, not all high-risk groups identified by fecal immunochemical test (FIT) and/or high-risk factor questionnaire (HRFQ) undergo colonoscopy in time. The impact of delays in colonoscopy on CRC detection among high-risk populations remains poorly understood, warranting further clarification.

METHODS

A retrospective study was conducted among CRC high-risk population identified by Tianjin CRC screening program. According to the colonoscopy results after HRFQ and FIT, patients were classified into CRC, advanced adenoma, non-advanced adenoma, and normal groups. The time interval between CRC screening and colonoscopy was investigated and its relationship with colonoscopy results. Logistic regression was performed to explore the risk factors of CRC detection.

RESULTS

Among the high-risk population without a history of CRC or polyps, 49,810 underwent HRFQ, FIT, and colonoscopy, and a time interval of fewer than 6 months was found for 79.56% of patients (n = 39,630). People with positive FIT were more likely to undergo colonoscopy within 6 months, and detection rates of CRC and/or advanced adenoma were positively related to time intervals. Similar results were found in people with a negative FIT but positive HRFQ. A time interval longer than 6 months was a significant predictor of CRC detection in high-risk populations.

CONCLUSION

For high-risk people identified by CRC screening, especially those with a positive FIT, a time interval of 6 months was associated with an increased probability of CRC detection. Our findings emphasize that populations at high risk should undergo colonoscopy at least within 6 months.

Synthesis of a Ni(OH)2@Cu2Se hetero-nanocage by ion exchange for advanced glucose sensing in serum and beverages

Cu₂Se nanosheets were coated on the surface of Ni(OH)₂ nanocages (NCs) by ion exchange driven by selenium incorporation. The resulting Ni(OH)₂@Cu₂Se hollow heterostructures (Ni(OH)₂@Cu₂Se HHSs) showed high electrical conductivity and electrocatalytic activities derived from the synergistic effects of Ni/Cu phases. These structures enhanced glucose adsorption abilities, confirmed by density function theory (DFT) calculations, and the robustness of the integrated nano-electrocatalyst. Remarkably, Ni(OH)₂@Cu₂Se HHSs modified electrodes excited excellent glucose sensing behavior with a wide linear range (0.001-7.5 mM), a sensitivity up to 2420.4 Μa mM^-1 cm², a low limit of detection (LOD, 0.15 μM), and fast response (less 2 s). Furthermore, Ni(OH)₂@Cu₂Se HHSs competently analyzed glucose in serum and beverages with good recoveries ranging from 94.4 to 103.6%. Integrating copper selenide and Ni-based materials as 3D hollow heterostructures expands the selection of electrocatalysts for sensitive glucose detection in food and biological samples.

The Long-Term Outcome of Laparoscopic Resection for Perihilar Cholangiocarcinoma Compared with the Open Approach: A Real-World Multicentric Analysis

OBJECTIVE

The aim of this study was to compare the short- and long-term outcomes of laparoscopic surgery (LS) and open surgery (OP) for perihilar cholangiocarcinoma (PHC) using a large real-world dataset in China.

METHODS

Data of patients with PHC who underwent LS and OP from January 2013 to October 2018, across 10 centers in China, were extracted from medical records. A comparative analysis was performed before and after propensity score matching (PSM) in the LS and OP groups and within the study subgroups. The Cox proportional hazards mixed-effects model was applied to estimate the risk factors for mortality, with center and year of operation as random effects.

RESULTS

A total of 467 patients with PHC were included, of whom 161 underwent LS and 306 underwent OP. Postoperative morbidity, such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency, was similar between the LS and OP groups. The median overall survival (OS) was longer in the LS group than in the OP group (NA vs. 22 months; hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.02-1.39, p = 0.024). Among the matched datasets, OS was comparable between the LS and OP groups (NA vs. 35 months; HR 0.99, 95% CI 0.77-1.26, p = 0.915). The mixed-effect model identified that the surgical method was not associated with long-term outcomes and that LS and OP provided similar oncological outcomes.

CONCLUSIONS

Considering the comparable long-term prognosis and short-term outcomes of LS and OP, LS could be a technically feasible surgical method for PHC patients with all Bismuth-Corlett types of PHC.

Effect of Collagen-Reactive Functional Monomer on Etch-and-Rinse Adhesives

In this study, we evaluated a novel functional monomer (4-formylphenyl acrylate [FA]) that can specifically and covalently bind to the dentin collagen matrix as a potential alternative hydrophobic diluent-like monomer for improving the durability of dentin bonding. Experimental adhesives with different FA contents (0%, 10%, 20%, and 30%) were evaluated as partial substituents for the hydrophilic monomer 2-hydroxyethyl methacrylate, with the commercial adhesive One-Step (Bisco, Inc.) employed as the positive control. Their degree of conversion, viscosity, hydrophobicity, mechanical properties, and water absorption/solubility were measured as the comprehensive characterization. In situ zymographic assays were performed to determine the extent to which FA inhibits the endogenous hydrolytic activity of dentin. Finally, the bonding performances of the novel adhesives were evaluated with microtensile strength tests and scanning electron microscopy. The results showed that the incorporation of FA significantly improved the mobility of experimental adhesives attributable to the dilution property of FA. In contrast to the possible compromised rate of polymerization by hydroxyethyl methacrylate, FA exhibited typical characteristics of favorable copolymerization with polymerizable monomers in adhesives and improved the degree of conversion of experimental adhesives. The rigidity and hydrophobic properties of the phenyl framework of the FA molecule conferred superior mechanical properties and hydrolysis resistance to the novel experimental adhesives. An inhibitory effect on gelatinolytic activities within the hybrid layer was also observed in the in situ zymographic assays, even at a low FA concentration (10%). In conjunction with the significantly improved infiltration found via scanning electron microscopy, the experimental adhesives containing FA possessed significantly better-maintained microtensile strength, even after aging. Thus, the incorporation of this novel monomer endowed the experimental adhesives with multiple enhanced functionalities. These remarkable advantages highlight the suitability of the monomer for further applications in clinical practice.

Prognostic risk analysis related to radioresistance genes in colorectal cancer

Background

Radiotherapy (RT) is one of the most important treatments for patients with colorectal cancer (CRC). Radioresistance is the crucial cause of poor therapeutic outcomes in colorectal cancer. However, the underlying mechanism of radioresistance in colorectal cancer is still poorly defined. Herein we established a radioresistant colorectal cancer cell line and performed transcriptomics analyses to search for the underlying genes that contribute to radioresistance and investigate its association with the prognosis of CRC patients.

Methods

The radioresistant cell line was developed from the parental HCT116 cell by a stepwise increased dose of irradiation. Differential gene analysis was performed using cellular transcriptome data to identify genes associated with radioresistance, from which extracellular matrix (ECM) and cell adhesion-related genes were screened. Survival data from a CRC cohort in the TCGA database were used for further model gene screening and validation. The correlation between the risk score model and tumor microenvironment, clinical phenotype, drug treatment sensitivity, and tumor mutation status were also investigated.

Results

A total of 493 different expression genes were identified from the radioresistant and wild-type cell line, of which 94 genes were associated with ECM and cell adhesion-related genes. The five model genes TNFRSF13C, CD36, ANGPTL4, LAMB3, and SERPINA1 were identified for CRC radioresistance via screening using the best model. A ROC curve indicated that the AUC of the resulting prognostic model (based on the 5-gene risk score and other clinical parameters, including age, sex, and tumor stages) was 0.79, 0.77, and 0.78 at 1, 2, and 3 years, respectively. The calibration curve showed high agreement between the risk score prediction and actual survival probability. The immune microenvironment, drug treatment sensitivity, and tumor mutation status significantly differed between the high- and low-risk groups.

Conclusions

The risk score model built with five radioresistance genes in this study, including TNFRSF13C, CD36, ANGPTL4, LAMB3, and SERPINA1, showed favorable performance in prognosis prediction after radiotherapy for CRC.

Association of Dental Caries with Muscle Mass, Muscle Strength, and Sarcopenia: A Community-Based Study

OBJECTIVES

Changes in the oral cavity can reflect other changes throughout the body. This study aimed to investigate the association of dental caries with muscle mass, muscle strength, and sarcopenia, and also to describe the microbial diversity, composition, and community structure of severe dental caries and sarcopenia.

DESIGN

Cross-sectional study based on a Chinese population aged from 50 to 85 years.

SETTING

Communities from Lanxi City, Zhejiang Province, China.

PARTICIPANTS

A total of 1,442 participants aged from 50 to 85 years from a general community (62.8% women; median age 61.0 [interquartile range: 55.0, 68.0]).

MEASUREMENTS

Dental caries was assessed by the decayed, missing, and filled teeth (DMFT) index. Sarcopenia was defined as the presence of both low muscle mass (assessed by dual-energy X-ray absorptiometry scanning) and low muscle strength (assessed by handgrip strength). Multivariate logistic regression models were used to analyze the association of dental caries with muscle mass, muscle strength, and sarcopenia. Fecal samples underwent 16S rRNA profiling to evaluate the diversity and composition of the gut microbiota in patients with severe dental caries and/or sarcopenia.

RESULTS

In the fully adjusted logistic models, dental caries was positively associated with low muscle strength (DMFT ≥ 7: OR, 1.61; 95% CI, 1.25-2.06), and sarcopenia (DMFT ≥ 7: OR, 1.51; 95% CI, 1.01-2.26), but not low muscle mass. Severe dental caries was positively associated with higher alpha-diversity indices (richness, chao1, and ACE, all p < 0.05) and associated with beta-diversity based on Bray-Curtis distance (p = 0.006). The severe dental caries group and the sarcopenia group overlapped with 11 depleted and 13 enriched genera.

CONCLUSION

Dental caries was positively associated with low muscle strength and sarcopenia but not muscle mass, and this association was more pronounced in male individuals. Significant differences were observed in gut microbiota composition both in severe dental caries and sarcopenia, and there was an overlap of the genera features. Future longitudinal studies are needed to clarify causal relationships.

[Efficacy of dienogest versus gonadotropin-releasing hormone agonist combined with dienogest sequential therapy in the treatment of adenomyosis]

Objective: To investigate the efficacy and safety of dienogest (DNG) alone and gonadotropin-releasing hormone agonist (GnRH-a) combined with DNG sequential treatment to adenomyosis. Methods: The clinical data of 110 patients with adenomyosis attending the First Affiliated Hospital of Nanjing Medical University from December 2019 to March 2022 were retrospectively analyzed, including 40 patients treated with DNG (2 mg/day) alone (DNG group) and 70 patients treated with sequential DNG (2 mg/day) after 3-6 injections of GnRH-a (GnRH-a+DNG group). The clinical data before and after treatment were compared between the two groups. Results: (1) The dysmenorrhea visual analogue scale (VAS) scores, cancer antigen 125 (CA₁₂₅) and cancer antigen 19-9 (CA_19-9) levels at different time periods after treatment were significantly lower than before treatment in both groups (median before treatment: DNG group 70.0 mm, 68.55 kU/L, 22.45 kU/L respectively, GnRH-a+DNG group 80.0 mm, 151.50 kU/L, 20.44 kU/L respectively; all P<0.001). (2) The hemoglobin (Hb) levels of patients in both groups at different time periods after treatment were significantly higher than those before treatment (median: DNG group 102.00 g/L, GnRH-a+DNG group 94.00 g/L; all P<0.001). (3) Treatment with DNG alone did not have a significant effect on uterine volume in patients of DNG group (P>0.05), and uterine volume decreased significantly in the 15th-24th months of GnRH-a+DNG group compared with that before treatment (median: 167.76 vs 227.77 cm³; P<0.05). (4) There were no significant differences in hepatic and renal function and coagulation indexes between the two groups before and after treatment (all P>0.05), and no significant abnormal lesions were observed in breast tissue during the follow-up period. (5) The incidence of amenorrhea of GnRH-a+DNG group was higher than that of DNG group, and the incidences of irregular spotting bleeding and breakthrough hemorrhage were lower than those in DNG group. Conclusions: Whether DNG is used alone or in combination with GnRH-a in sequence, it could significantly relieve dysmenorrhea symptoms, improve the level of Hb, reduce the levels of CA₁₂₅ and CA_19-9 in patients with adenomyosis, with no adverse effects on coagulation and hepatic or renal function. GnRH-a sequential DNG therapy is superior to DNG alone in improving uterine bleeding patterns and controlling the growth of uterine volume in patients with adenomyosis.

[A time-series study on the association of ambient temperature with daily outpatient visits of eczema in Huizhou city]

Objective: To explore the impact of environmental temperature exposure on eczema visits. Methods: Eczema clinic data from January 1, 2016 to December 31, 2019 were collected from the Huizhou Dermatology Hospital, and data on meteorological factors (average daily temperature and relative humidity) for the same period were derived from 86 meteorological stations of the Guangdong Provincial Climate Center. A distributed lag nonlinear model (DLNM) was used to assess the lagged effect of environmental temperature exposure on eczema, and a natural smooth spline function was used to control the nonlinear confounding of humidity. Results: There were 254 053 eczema outpatient visits at the Huizhou Dermatology Hospital within four years, with an average of 173.89 visits per day. The relationship between daily average temperature and the number of visits was non-linear (U shape). The risk of eczema increased by 2.20% (1.19%-3.21%) for every 1 ℃ decrease for the low temperature, and increased by 2.35% (1.24%-3.5%) for every 1 ℃ increase for the high temperature. The effect of high temperature was greater than that of low temperature. In all cases, 1.60% (0.44%-2.68%) of eczema outpatient visits were attributed to low temperature and the attributable number was 4 065 (1 128-6 798), while 6.33% (1.40%-10.87%) of eczema outpatient visits were due to high temperature and the attributable number was 16 082 (3 557-27 616). Conclusion: Both high temperature and low temperature are associated with increased risk of eczema.

P04.01.B High impact of ITGB1 on Pi3K/AKT expression in medulloblastoma

Medulloblastoma, an embryonal tumor of the cerebellum, is one of the most frequent malignant brain tumors. Despite the increasing use of genetic variation in treatment stratification, high-risk patients characterized by light meningeal spread, TP53 mutations, or MYC amplification still have poor survival. Phosphatidylinositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) signaling is one of the most important intracellular pathways, which can be considered as a master regulator for cancer. In tissue samples obtained from medulloblastoma patients, the significant upregulation of PI3K/AKT was associated with a lifting expression level of integrin β1(ITGB1). To understand the underlying mechanism, we investigated the effect of ITGB1 on the PI3K/AKT pathway in medulloblastoma cell lines. Transfection of this ITGB1 reduced proliferation and invasion of several medulloblastoma cell lines and inhibit epithelial-mesenchymal transition. In addition, knocking down ITGB1 expression can significantly inhibit the activation of PI3K/AKT signaling pathway. In conclusion, ITGB1 may selectively activation the pathophysiological effect of aberrant PI3K/AKT expression and serve as a targeted approach for medulloblastoma therapy.

OS10.7.A Activation of the CCR8-ACP5 axis by human microglia/macrophage derived CCL18 promotes glioma growth

Background

Glioblastoma multiforme is a highly malignant primary brain tumor with an average survival of 14 months and very limited therapeutic options. Glioma associated microglia and macrophages (GAMs) foster tumor growth by releasing several cytokines, which have only partly been identified. Here, we studied the chemokine (C-C motif) ligand 18 (CCL18), a chemokine which is only expressed in human, but not rodent GAMs, in a novel ex-vivo brain slice model including transplantation of human induced pluripotent stem cells (iPSC) derived human microglia (iMGL) and human glioma cells in to murine brain slices, which had been depleted of intrinsic murine microglia before.

Material and Methods

After establishing the humanized ex-vivo brain slice model, we performed immunohistochemical analysis (IHC) of growth and invasiveness, qrtPCR on glioma cells isolated by magnetic-activated cell sorting (MACS), functional assays measuring invasiveness, proliferation, migration and colony formation of glioma cells in vitro and in slice experiments. Corresponding studies on tumor growth and invasiveness were performed after treatment with a CCL18 neutralizing antibody, a CCR8 neutralizing antibodies and knockdown of CCR8, ACP5 (Acid Phosphatase 5) and PITPNM3 with small interfering RNA (siRNA) and short hairpin RNA (shRNA). QrtPCR, IHC and Westernblot analysis were performed on primary glioma specimens. We also conducted bioinformatic analyses, based on the TCGA GBM, GLIOVIS and GEPIA databases.

Results

We observed that CCL18 was highly expressed in GAMs, whereas CCR8 was only expressed in glioma cells. We identified the chemokine (C-C motif) receptor 8 (CCR8) as a functional receptor for CCL18 and ACP5 as an important down-stream signaling component in glioma cells. Activation of the CCL18/CCR8/ACP5 signaling pathway in human glioblastoma was associated with enhanced tumor growth and invasiveness.

Conclusion

GAMs derived CCL18 promoted glioma growth by activation of the CCR8/ACP5 axis in human glioma cells and therefore is a potential therapeutic target.

Two-year outcomes of Roux-en-Y gastric bypass vs medical treatment in type 2 diabetes with a body mass index lower than 32.5 kg/m2: a multicenter propensity score-matched analysis

BACKGROUND

Roux-en-Y gastric bypass (RYGB) has been widely reported to be safe and feasible, and has a powerful effect on improving metabolism and weight loss in patients with a high body mass index (BMI). A few studies have focused on the comparison of RYGB with medical treatment in type 2 diabetes (T2D) patients with a lower BMI.

OBJECTIVES

To compare the metabolic effects and safety of RYGB versus medical treatment during a 2 years follow-up in T2D patients with a BMI of 25 to 32.5 kg/m².

METHODS

This retrospective and multicenter cohort study participants were extracted from the T2D patients with a lower BMI (25-32.5 kg/m²) from three bariatric centers between 2009 and 2018. Propensity score matching (PSM) was used to minimize bias, and each patient in the surgical group was matched 1:2 to the patients in the medical group with the closest propensity score. Finally, 71 patients who received RYGB and 142 patients who underwent medical treatment with a 2 years follow-up were enrolled to compare the effects of RYGB and medical treatment. The primary endpoint was achievement of the triple endpoint (the simultaneous achievement of hemoglobin A1c (HbA1c) < 7.0%, fasting low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL (2.6 mmol/L), and systolic blood pressure (SBP) < 130 mmHg at the year-1 visit). Changes in weight, BMI, medication usage, complications, and adverse events were assessed.

RESULTS

In total, 213 patients (mean age of 47.4 ± 9.5 years, 70.4% male, mean BMI of 28.6 ± 2.2 kg/m²) were included in this study. At the end of the first year, 17 patients (23.9%) in the surgical group and 10 (7.0%) in the medical group had achieved the composite triple endpoint (OR 4.64; 95% CI 1.82-11.81; p = 0.001). Additionally, 43 patients (60.6%) in the surgical group and 11 patients (19.7%) in the medical group experienced remission of T2D. However, more complications were observed in the surgical group (36 vs. 22, p < 0.01).

CONCLUSIONS

Among T2D patients with a BMI between 25.0 and 32.5 kg/m², RYGB was more effective than medical treatment in resolving metabolic disorders and also resulted in more complications. The risk for complications should be considered in the clinical decision-making process for T2D patients with a low BMI.

[Prolonged epidural labor analgesia increases risks of epidural analgesia failure for conversion to cesarean section]

OBJECTIVE

To explore the effect of epidural labor analgesia duration on the outcomes of different anesthetic approaches for conversion to cesarean section.

METHODS

We retrospectively collected the clinical data of pregnant women undergoing conversion from epidural labor analgesia to cesarean section at Sichuan Maternal and Child Health Hospital and Jinjiang District Maternal and Child Health Care Hospital between July, 2019 and June, 2020. For cesarean section, the women received epidural anesthesia when the epidural catheter was maintained in correct position with effective analgesia, spinal anesthesia at the discretion of the anesthesiologists, or general anesthesia in cases requiring immediate cesarean section or following failure of epidural anesthesia or spinal anesthesia. Receiver-operating characteristic curve analysis was performed to determine the cutoff value of the analgesia duration using Youden index. The women were divided into two groups according to the cut off value for analyzing the relative risk using cross tabulations.

RESULTS

A total of 820 pregnant women undergoing conversion to cesarean section were enrolled in this analysis, including 615 (75.0%) in epidural anesthesia group, 186 (22.7%) in spinal anesthesia group, and 19 (2.3%) in general anesthesia group; none of the women experienced failure of epidural or spinal anesthesia. The mean anesthesia duration was 8.2±4.7 h in epidural anesthesia, 10.6±5.1 h in spinal anesthesia group, and 6.7 ± 5.2 h in general anesthesia group. Multivariate logistic regression analysis showed that prolongation of analgesia duration by 1 h (OR=1.094, 95% CI: 1.057-1.132, P < 0.001) and an increase of cervical orifice by 1 cm (OR=1.066, 95% CI: 1.011-1.124, P=0.017) were independent risk factors for epidural analgesia failure. The cutoff value of analgesia duration was 9.5 h, and beyond that duration the relative risk of receiving spinal anesthesia was 1.204 (95% CI: 1.103-2.341, P < 0.001).

CONCLUSION

Prolonged epidural labor analgesia increases the risk of failure of epidural analgesia for conversion to epidural anesthesia. In cases with an analgesia duration over 9.5 h, spinal anesthesia is recommended if immediate cesarean section is not required.

Connexin 43 Contributes to the Sensitization of Colorectal Cancer Cells to Photodynamic Therapy through Akt Inhibition

BACKGROUND

Photodynamic therapy could be one approach to treat colorectal cancer, but resistance leads to failure of therapy. Akt activation is a cellular survival response to photodynamic therapy and is also a reason for resistance. Thus, inhibition of Akt is a strategy to decrease resistance. Akt interacts with connexin 43, another protein involved in photodynamic therapy resistance. Connexin 43 is widely expressed in different human tissues and has a complex role in tumor development. However, the mechanism of inhibition of Akt by connexin 43 that sensitizes colorectal cancer cells to photodynamic therapy needs further investigation.

METHODS

In this study, two colorectal cancer cells with low phosphorylated connexin 43 level were used to explore this mechanism. LY294002 was used as an Akt inhibitor, and connexin 43-pCMV3 was transfected into cells to increase connexin 43 expression.

RESULTS

Akt and connexin 43 inhibit each other in both colorectal cancer cell lines. In vitro and in vivo experiments showed that LY294002 and connexin 43 transfection sensitized cells to hematoporphyrin-Photodynamic therapy. LY294002 increased the sensitivity of cells to photodynamic therapy with a pronounced effect in cells with high expression levels of connexin 43.

CONCLUSIONS

Connexin 43 should be considered an important factor in increasing the phototoxicity of photodynamic therapy in colorectal cancer through Akt inhibition.

CO2 fluxes from three different temperate grazed pastures using Eddy covariance measurements

Grasslands cover around 25% of the global ice-free land surface, they are used predominantly for forage and livestock production and are considered to contribute significantly to soil carbon (C) sequestration. Recent investigations into using 'nature-based solutions' to limit warming to <2 °C suggest up to 25% of GHG mitigation might be achieved through changes to grassland management. In this study we evaluate pasture management interventions at the Rothamsted Research North Wyke Farm Platform, under commercial farming conditions, over two years and consider their impacts on net CO₂ exchange. We investigate if our permanent pasture system (PP) is, in the short-term, a net sink for CO₂ and whether reseeding this with deep-rooting, high-sugar grass (HS) or a mix of high-sugar grass and clover (HSC) might increase the net removal of atmospheric CO₂. In general CO₂ fluxes were less variable in 2018 than in 2017 while overall we found that net CO₂ fluxes for the PP treatment changed from a sink in 2017 (-5.40 t CO₂ ha^-1 y^-1) to a source in 2018 (6.17 t CO₂ ha^-1 y^-1), resulting in an overall small source of 0.76 t CO₂ ha^-1 over the two years for this treatment. HS showed a similar trend, changing from a net sink in 2017 (-4.82 t CO₂ ha^-1 y^-1) to a net source in 2018 (3.91 t CO₂ ha^-1 y^-1) whilst the HSC field was a net source in both years (3.92 and 4.10 t CO₂ ha^-1 y^-1, respectively). These results suggested that pasture type has an influence in the atmospheric CO₂ balance and our regression modelling supported this conclusion, with pasture type and time of the year (and their interaction) being significant factors in predicting fluxes.

Colorectal Cancer Screening With High Risk-Factor Questionnaire and Fecal Immunochemical Tests Among 5, 947, 986 Asymptomatic Population: A Population-Based Study

Background

The recent uptrend in colorectal cancer (CRC) incidence in China is causing an increasingly overwhelming social burden. And its occurrence can be effectively reduced by sensitizing CRC screening for early diagnosis and treatment. However, a large number of people in China do not undergo screening due to multiple factors. To address this issue, since 2012, a CRC screening program has been initiated in Tianjin.

Methods

Residents aged 40-74 years were eligible for CRC screening. The first was to complete the high-risk factor questionnaire (HRFQ) and undergo fecal immunochemical test (FIT). Then those with a positive result in any of the two screening methods were recommended for a free colonoscopy.

Results

The detection rate of intestinal diseases increased with age, had a male predominance, and was higher in residents from central urban areas and those with primary school above education level. The sensitivity of predicting CRC after colonoscopy in the high-risk group was 76.02%; the specificity was 25.33%.A significant decrease in the detection rate of intestinal disease, CRC and advanced adenoma was observed from positive FIT, the high-risk group and positive HRFQ, 47.13%, 44.79%, 42.30%; 3.15%, 2.44%, 1.76%; 7.72%, 6.42%, 5.08%, in that order, while no inter-group difference was found for the detection of polyps. In addition, the different combinations of HRFQ and FIT can enroll more high-risk population than FIT or (and) HRFQ only, and thus detect more intestinal diseases (include CRC/AA/Polyp).

Conclusion

The superimposition of different screening method for HRFQ and FIT is an effective strategy for the detection of CRC, AA, and Polyp, compared to HRFQ or FIT alone. However, further improvements in screening and interventions are needed to promote colonoscopy compliance.

Prognosis of Patients Over 60 Years Old With Early Rectal Cancer Undergoing Transanal Endoscopic Microsurgery – A Single-Center Experience

Aim

Transanal endoscopic microsurgery (TEM) is widely performed in early rectal cancer. This technique offers greater organ preservation and decreases the risk of subsequent surgery. However, postoperative local recurrence and distant metastasis remain challenges for patients with high-risk pathological factors. This single-center study reports the prognosis of early rectal cancer patients over 60 years old after TEM.

Methods

The data of the patients over 60 years old who underwent local anal resection were collected retrospectively. Moreover, the 5-year follow-up data were analyzed to determine the 5-year DFS and OS.

Results

47 early rectal cancer patients over 60 years old underwent TEM. There were 27 patients with high-risk factors and 20 patients without high-risk factors. Two patients underwent radical surgery after TEM and ten patients received adjuvant treatment. Local recurrence occurred in 7 patients, of which 4 underwent salvage surgery. The 5-year progression-free survival rate was 75.6%, which was lower in the high-risk patients group (69.6%) than in the non-high-risk patients group (83.3%) (P&gt;0.05). The 5-year OS was 90.2%, but there was no statistically significant difference between the two groups (high-risk patients 87.0%, non-high-risk patients 94.4%). Furthermore, there was no significant difference in DFS and OS between people over and under 70 years old.

Conclusion

Some high-risk factor patients over 60 years old do not have inferior 5-year DFS and OS to the non-high-risk patients. TEM is an option for old patients with high surgical risks. Even if postoperative pathology revealed high-risk factors, timely surgical treatment after local recurrence would be beneficial to improve the 5-year DFS and OS.

Label-free identification of human glioma xenograft of mouse brain with quantitative ultraviolet photoacoustic histology imaging

The ability to unveil molecular specificities of endogenous nonfluorescent chromophores of ultraviolet photoacoustic imaging technology enables label-free histology imaging of tissue specimens. In this work, we exploit ultraviolet photoacoustic microscopy for identifying human glioma xenograft of mouse brain ex vivo. Intrinsically excellent imaging contrast of cell nucleus at ultraviolet photoacoustic illumination along with good spatial resolution allows for discerning the brain glioma of freshly-harvested thick brain slices, which circumvents laborious time-consuming preparations of the tissue specimens including micrometer-thick slicing and H&E staining that are prerequisites in standard histology analysis. The identification of tumor margins and quantitative analysis of tumor areas is implemented, representing good agreement with the standard H&E-stained observations. Quantitative ultraviolet photoacoustic microscopy can access fast pathological assessment to the brain tissues, and thus potentially facilitates intraoperative brain tumor resection to precisely remove all cancerous cells and preserve healthy tissue for maintaining its essential function.