Spatial-temporal trends in leprosy burden and its associations with socioeconomic and physical geographic factors: results from the Global Burden of Disease Study 2019

OBJECTIVES

The purpose of our study was to assess the multiscalar changes in leprosy burden and its associated risk factors over the last three decades.

STUDY DESIGN

We conducted an in-depth examination of leprosy's spatial-temporal trends at multiple geographical scale (global, regional, and national), utilizing information from Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2019).

METHODS

Incidence and the estimated annual percentage change (EAPC) in age-standardized incidence rate (ASIR) of leprosy were determined, with countries categorized based on leprosy incidence changes. We examined socioeconomic and physical geography influences on leprosy incidence via Spearman correlation analysis, using ternary phase diagrams to reveal the synergetic effects on leprosy occurrence.

RESULTS

Globally, incident cases of leprosy decreased by 27.86% from 1990 to 2019, with a reduction in ASIR (EAPC = -2.53), yet trends were not homogeneous across regions. ASIR and EAPC correlated positively with sociodemographic index (SDI), and an ASIR growth appeared in high SDI region (EAPC = 3.07). Leprosy burden was chiefly distributed in Tropical Latin America, Oceania, Central Sub-Saharan Africa, and South Asia. Negative correlations were detected between the incidence of leprosy and factors of SDI, GDP per capita, urban population to total population, and precipitation, whereas the number of refugee population, temperature, and elevation showed opposite positive results.

CONCLUSIONS

Despite a global decline in leprosy over the past three decades, the disparities of disease occurrence at regional and national scales still persisted. Socioeconomic and physical geographic factors posed an obvious influence on the transmission risk of leprosy. The persistence and regional fluctuations of leprosy incidence necessitate the ongoing dynamic and multilayered control strategies worldwide in combating this ancient disease.

Development and calibration of a multi-delay coherence imaging diagnostic on the MAST-U tokamak

The MAST-U Super-X divertor provides the opportunity to study fusion plasma exhaust under novel conditions. However, in order to study these conditions, advanced diagnostics are required. Following the development of the MAST-U Multi-Wavelength Imaging (MWI) diagnostic, we present the installation of a multi-delay coherence imaging spectroscopy (CIS) system within the MAST-U MWI, along with modifications made to the MWI for effective operation. This diagnostic will measure either carbon ion flow velocities and temperatures or electron densities through Dγ emission. We have extended previously developed techniques for wavelength calibration to account for errors due to the misalignment of interferometer components. In addition, we have developed a comprehensive calibration procedure to account for the temperature dependence of the instrument's delays by fitting to a linearly modified version of the delay equation presented by Veiras et al. [Appl. Opt. 49(15), 2769 (2010)]. Together, these procedures reduce the cost and hardware complexity of implementing CIS instruments when compared to those that use in situ or tunable laser calibration systems, as calibrations can be generated to good accuracy using previously measured data.

[Clinical application of split liver transplantation: a single center report of 203 cases]

Objective: To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application. Methods: This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis. Results: The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group (χ2=5.560,P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group (χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion: SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Effects of soyhulls with different particle size on the growth performance, blood indices and gut microbiota of yellow feather broilers

1. The objective of this study was to determine the effects of soyhulls with different particle sizes on the growth performance, blood indices and gut microbiota of yellow feather broilers.2. Total of 240 healthy, one-day-old, yellow feather broilers were randomly divided into four groups, with six pen replicates within each group and ten birds per pen. The control group birds were fed the basal diet (Control). For the treatment groups, 5% soyhulls with different particle sizes were included in the basal diet. The particle size geometric mean diameters (dgw) of the soyhulls in the three treatment groups were 299.69 μm (LowPS), 489.85 μm (MediumPS) and 734.83 μm (HighPS) with geometric standard deviation (Sgw) 1.75 μm, 1.62 μm and 1.67 μm, respectively.3. Results showed that the growth performance variables and organ indices were not different among the four groups. The MediumPS group had increased TG, T-CHO, ALT, HDL-C, and GSH-PX levels and decreased T-AOC levels, whereas LowPS and HighPS groups had increased HDL-C and GSH-PX levels (p < 0.05). Microbial diversity analysis showed that the intestinal microbiota of yellow feather broilers mainly included Firmicutes and Bacteroidetes. Inclusion of 5% soyhulls with different particle size had no effect on alpha diversity indices of caecal microbiota. The HighPS group had significantly higher relative abundance of Firmicutes spp. and lower Bacteroidetes spp. compared with the LowPS and MediumPS group but this was not different from the Control group. The relative abundance of Cyanobacteria spp. was significantly higher in the HighPS group than the other three groups. LEfSe analysis showed that there were more enriched biomarker taxa in the groups with soyhulls than the control group.4. Overall, the inclusion of soyhulls with different particle sizes had limited effects on growth performance, blood indices and caecal microbiota composition of yellow feather broilers.

A meta-analysis of the relationship between milk protein production and absorbed amino acids and digested energy in dairy cattle

Milk protein production is the largest draw on AA supplies for lactating dairy cattle. Prior NRC predictions of milk protein production have been absorbed protein (MP)-based and utilized a first-limiting nutrient concept to integrate the effects of energy and protein, which yielded poor accuracy and precision (root mean squared error (RMSE) > 21%). Using a meta-data set gathered, various alternative equation forms considering MP, absorbed total essential AA (EAA), absorbed individual EAA, and digested energy (DE) supplies as additive drivers of production were evaluated, and all were found to be superior in statistical performance to the first limitation approach (RMSE = 14-15%). Inclusion of DE intake and a quadratic term for MP or absorbed EAA supplies were found to be necessary to achieve intercept estimates (non-productive protein use) that were similar to the factorial estimates of NASEM. The partial linear slope for MP was found to be 0.409, which is consistent with the observed slope bias of -0.34g/g when a slope of 0.67 was used for MP efficiency in a first-limiting nutrient system. Replacement of MP with the supplies of individual absorbed EAA expressed in g/d and a common quadratic across the EAA resulted in unbiased predictions with improved statistical performance as compared with MP-based models. Based on Akaike's Information Criterion (AIC) and biological consistency, the best equations included absorbed His, Ile, Lys, Met, Thr, the non-essential AA, and individual DE intakes from fatty acids, neutral detergent fiber, residual organic matter, and starch. Several also contained a term for absorbed Leu. These equations generally had RMSE of 14.3% and a concordance correlations (CCC) of 0.76. Based on the common quadratic and individual linear terms, milk protein response plateaus were predicted at approximately 320 g/d of absorbed His, Ile, and Lys; 395 g/d of absorbed Thr; 550 g/d of absorbed Met; and 70 g/d of absorbed Leu. Therefore, responses to each except Leu are almost linear throughout the normal in vivo range. De-aggregation of the quadratic term and parsing to individual absorbed EAA resulted in non-biological estimates for several EAA indicating over-parameterization. Expression of the EAA as g/100 g of total absorbed EAA or as ratios of DE intake and using linear and quadratic terms for each EAA resulted in similar statistical performance, but the solutions had identifiability problems and several non-biological parameter estimates. The use of ratios also introduced nonlinearity in the independent variables which violates linear regression assumptions. Further screening of the global model using absorbed EAA expressed as g/d with a common quadratic using an all-models approach, and exhaustive cross-evaluation indicated the parameter estimates for body weight, all 4 DE terms, His, Ile, Lys, Met, and the common quadratic term were stable, while estimates for Leu and Thr were known with less certainty. Use of independent and additive terms and a quadratic expression in the equation results in variable efficiencies of conversion. The additivity also provides partial substitution among the nutrients. Both of these prevent establishment of fixed nutrient requirements in support of milk protein production.

Association of adverse and positive childhood experiences with health-related quality of life in adolescents

OBJECTIVES

To investigate the independent impacts of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) on the health-related quality of life (HRQOL) of Chinese adolescents, and to explore the potential moderating role of PCEs in the association between ACEs and HRQOL.

STUDY DESIGN

This was a cross-sectional study.

METHODS

We surveyed 6982 students aged 11-20 in Guangzhou, China, from November to December 2021. Adolescents self-reported their ACEs, PCEs, and HRQOL by the Childhood Trauma Questionnaire Short Form, the Adverse Childhood Experiences-International Questionnaire, the Benevolent Childhood Experiences Scale, and the Paediatric Quality of Life Inventory Version 4.0, respectively. Multivariable linear regressions were performed to examine the associations between ACEs, PCEs, and HRQOL controlled for adolescents' age, gender, single-child status, boarding school attendance, primary caregivers, as well as parental age and occupational status. Likelihood-ratio tests were further applied to explore the moderating role of PCEs.

RESULTS

In the models that considered both ACEs and PCEs, ACEs were significantly associated with lower HRQOL scores in all dimensions, summary scales, and total scale (β = -13.88, 95% confidence interval [CI]: -14.82, -12.94 for total scale). Conversely, exposure to an above-average number of PCEs was associated with higher HRQOL scores in all measured aspects (β = 7.20, 95%CI: 6.57, 7.84 for total scale). PCEs significantly moderated the association between ACEs and all HRQOL dimensions, summary scales, and total scale, except school functioning.

CONCLUSION

ACEs and PCEs exert independent and opposite impacts on adolescents' HRQOL. PCEs could mitigate the negative impacts of ACEs. Enhancing resilience, like PCEs, may contribute to improving the HRQOL among adolescents who have exposed to ACEs.

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.

Mendelian Randomization Analysis Reveals Causal Factors behind Alzheimer's Disease Risk: Evidence, Opportunities, and Challenges

Alzheimer's disease and its comorbidities pose a heavy disease burden globally, and its treatment remains a major challenge. Identifying the protective and risk factors for Alzheimer's disease, as well as its possible underlying molecular processes, can facilitate the development of interventions that can slow its progression. Observational studies and randomized controlled trials have provided some evidence regarding potential risk factors for Alzheimer's disease; however, the results of these studies vary. Mendelian randomization is a novel epidemiological methodology primarily used to infer causal relationships between exposures and outcomes. Many Mendelian randomization studies have identified potential causal relationships between Alzheimer's disease and certain diseases, lifestyle habits, and biological exposures, thus providing valuable data for further mechanistic studies and the development and implementation of clinical prevention strategies. However, the results and data from Mendelian randomization studies must be interpreted based on comprehensive evidence. Moreover, the existing Mendelian randomization studies on the epidemiology of Alzheimer's disease have some limitations that are worth exploring. Therefore, the aim of this review was to summarize the available evidence on the potential protective and risk factors for Alzheimer's disease by assessing published Mendelian randomization studies on Alzheimer's disease, and to provide new perspectives on the etiology of Alzheimer's disease.

An E-band multi-channel Doppler backscattering system on EAST

An E-band (60-90 GHz) multi-channel Doppler backscattering (DBS) system with X-mode polarization has been installed on the Experimental Advanced Superconducting Tokamak (EAST), which can measure the turbulence at five different radial locations simultaneously. This system can launch 31 fixed microwave frequencies in the range of 60-90 GHz with a 1 GHz interval into the plasma, and five probing signals are selected by employing a reference signal and multiple filters. During experiments, the frequency of the reference signal is tunable in the E-band, and the selected probing signals can be changed as needed without any other adjustments, which can be performed in one shot or between shots. Furthermore, the incident angle can be adjusted from -10° to 20°, and the wavenumber range is 4-25 cm-1 with a wavenumber resolution of Δk/k ≤ 0.35. Ray tracing simulations are employed to calculate the scattering locations and the perpendicular wavenumber. In this article, the hardware design, ray tracing, and initial results obtained from the EAST plasma will be presented.

Spatial and temporal distribution of endotoxins, antibiotic resistance genes and mobile genetic elements in the air of a dairy farm in Germany

Antimicrobial resistance (AMR) is a serious issue that is continuously growing and spreading, leading to a dwindling number of effective treatments for infections that were easily treatable with antibiotics in the past. Animal farms are a major hotspot for AMR, where antimicrobials are often overused, misused, and abused, in addition to overcrowding of animals. In this study, we investigated the risk of AMR transmission from a farm to nearby residential areas by examining the overall occurrence of endotoxins, antibiotic resistance genes (ARGs), and mobile genetic elements (MGEs) in the air of a cattle farm. We assessed various factors, including the season and year, day and nighttime, and different locations within the farm building and its vicinity. The most abundant ARGs detected were tetW, aadA1, and sul2, genes that encode for resistances towards antibiotics commonly used in veterinary medicine. While there was a clear concentration gradient for endotoxin from the middle of the farm building to the outside areas, the abundance of ARGs and MGEs was relatively uniform among all locations within the farm and its vicinity. This suggests that endotoxins preferentially accumulated in the coarse particle fraction, which deposited quickly, as opposed to the ARGs and MGEs, which might concentrate in the fine particle fraction and remain longer in the aerosol phase. The occurrence of the same genes found in the air samples and in the manure indicated that ARGs and MGEs in the air mostly originated from the cows, continuously being released from the manure to the air. Although our atmospheric dispersion model indicated a relatively low risk for nearby residential areas, farm workers might be at greater risk of getting infected with resistant bacteria and experiencing overall respiratory tract issues due to continuous exposure to elevated concentrations of endotoxins, ARGs and MGEs in the air of the farm.

Softening of a flat phonon mode in the kagome ScV6Sn6

Geometrically frustrated kagome lattices are raising as novel platforms to engineer correlated topological electron flat bands that are prominent to electronic instabilities. Here, we demonstrate a phonon softening at the kz = π plane in ScV6Sn6. The low energy longitudinal phonon collapses at ~98 K and q = [Formula: see text] due to the electron-phonon interaction, without the emergence of long-range charge order which sets in at a different propagation vector qCDW = [Formula: see text]. Theoretical calculations corroborate the experimental finding to indicate that the leading instability is located at [Formula: see text] of a rather flat mode. We relate the phonon renormalization to the orbital-resolved susceptibility of the trigonal Sn atoms and explain the approximately flat phonon dispersion. Our data report the first example of the collapse of a kagome bosonic mode and promote the 166 compounds of kagomes as primary candidates to explore correlated flat phonon-topological flat electron physics.

[Development of auxiliary early predicting model for human brucellosis using machine learning algorithm]

Using machine learning algorithms to construct an early prediction model of brucellosis to improve the diagnosis efficiency of Brucellosis. This study was a case-control study. 2 381 brucellosis patients from Beijing Ditan Hospital affiliated to Capital Medical University were retrospectively collected as case group, and healthy people from Beijing Chaoyang Hospital affiliated to Capital Medical University were collected as control group from May 9, 2011 to November 29, 2021. The relevant clinical information and full blood count results of 13 257 data were collected and five algorithms of machine learning were used to construct an early predication model of brucellosis by using machine learning: random forest, Naive Bayes, decision tree, logistic regression and support vector machine;14 074 data (2 143 cases incase group and 11 931 cases in control group) were used to establish the early predication model of brucellosis, and 1 564 (238 cases in case group and 1 326 cases in control group) data were used to test the predication efficiency of the brucellosis model. The results showed that the support vector machine algorithm has the best predication performance by comparing the five machine learning models. The area under receiver curve (AUC) of receiver operating characteristic (ROC) was 0.991, and the accuracy, precision, specificity and Recall were 95.6%, 95.5%, 95.4% and 95.9%, respectively. Based on the SHAP plot, platelet distribution width (PDW) and basophil relative value (BASO%) results were low, and men with high coefficient of variation (R-CV), erythrocyte hemoglobin concentration (MCHC), and platelet volume (MPV) were predicted to be at high risk of brucellosis. Platelet distribution width (PDW) contributed the most to the prediction model, followed by red blood cell distribution width coefficient of variation (R-CV). In conclusion, the establishment of a high-precision early predication method of brucellosis based on machine learning may be of great significance for the early detection and treatment of brucellosis patients.

Effectiveness of Bladder Filling Control during Online MR-Guided Adaptive Radiotherapy for Rectum Cancer

PURPOSE/OBJECTIVE(S)

MR-guided adaptive radiotherapy (MRgART) treatment sessions at MR-Linac are time-consuming and changes in bladder filling during the session can impact the treatment dosimetry. In this work, we present the procedure implemented in the clinical workflow to stabilize bladder filling during the MR based adaptive radiotherapy sessions and evaluate its effectiveness and the resulting dosimetric impact on the adaptive plan.

MATERIALS/METHODS

Twenty-five rectum cancer patients treated at 1.5T MR-Linac with a short course radiotherapy (25 Gy in 5 fractions of 5 Gy each) were included in this retrospective study. Patients were treated with the adapt-to-shape workflow consisting of a plan adaptation based on the MRI acquired in each session and optimized on the corresponding MR-based synthetic CT. Considering the significant interval time between the acquisition of the first daily MRI used for plan adaptation, and the beam delivery, a bladder catheter was used to stabilize the bladder filling; the procedure consists of emptying the bladder and refilling it with a well-known amount of physiological solution before each MRI acquisition. Two MRIs were acquired at each session: the first was used for plan adaptation and the second was acquired while approving the adapted plan, to be rigidly registered with the first to ensure the appropriateness of the isodoses on the ongoing delivery treatment. A total of 125 sessions and 250 MRI images and bladder contours were analyzed; for each fraction, the time interval between the first and second MRI and the corresponding bladder volumes were recorded; the consistency of bladder volumes and shapes along each online session was assessed with the dice similarity index (DSC) and Hausdorff distance (HD); the impact on plan dosimetry was evaluated by comparing target and bladder DVH cut off points of the plan on the two different MRI datasets.

RESULTS

The time interval between the first and second MRI, averaged over the 125 sessions is 39.0 min, range (18.6-75.8) min. The changes in bladder volumes, DSC index, HD, and the differences between the bladder and target DVH cut-off points are shown in the table below. The DSC and HD are comparable to inter-observer variability in manual contour segmentation, with an average DSC of 0.91 and average HD of 2.13 mm; the average differences in bladder and target dosimetry remain under 0.63% and 0.10%, respectively.

CONCLUSION

The use of a procedure in the clinical workflow of MRgART to stabilize the bladder filling throughout the online session may be helpful to guarantee the accuracy of the ongoing delivered treatment.

[Meta-analysis of the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates]

Objective: To systematically evaluate the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates. Methods: Eight databases in either Chinese or English, including PubMed, the Cochrane Library, Embase, Medline, Scopus, CNKI, Wanfang and VIP, were searched to extract the studies on the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates published from the establishment of each database to December 2022. The Meta-analysis was performed using Stata 14.0 statistical software. Results: A total of 9 studies were included in this Meta-analysis, including 6 retrospective cohort studies, 2 prospective cohort studies and 1 randomized controlled trial (RCT) study, involving 9 143 premature infants. The Meta-analysis showed that prenatal steroid exposure increased the risk of late preterm neonatal hypoglycemia (RR=1.55, 95%CI 1.25-1.91, P<0.001). The similar correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates was all found in the following subgroups: North America (RR=1.57, 95%CI 1.37-1.80, P<0.001), enrolling pregnant women with gestational diabetes (RR=1.62, 95%CI 1.26-2.08, P<0.001), A-grade literature quality (RR=1.43, 95%CI 1.14-1.79, P=0.002), criteria for hypoglycemia ≤40 mg/dl (1 mg/dl=0.056 mmol/L, RR=1.49, 95%CI 1.28-1.73, P<0.001), sample size of 501-1 500 (RR=1.69, 95%CI 1.19-2.40, P=0.003) and >1 500 (RR=1.65, 95%CI 1.48-1.83, P<0.001), steroid injection dosage and frequency of 12 mg 2 times (RR=1.66, 95%CI 1.50-1.84, P<0.001), the time interval from antenatal corticosteroid administration to delivery of 24-47 h (RR=1.98, 95%CI 1.26-3.10, P=0.003), unadjusted gestational age (RR=1.78, 95%CI 1.02-3.10,P=0.043) and unadjusted birth weight (RR=1.80, 95%CI 1.22-2.66, P=0.003). Meta-regression results showed that steroid injection frequency and dose were the main sources of high heterogeneity among studies (P=0.030). Conclusion: Prenatal steroid exposure may be a risk factor for hypoglycemia in late preterm neonates.

Systematic evaluation of the safety and therapeutic effects of para-aortic lymphadenectomy for advanced gastric cancer: a systematic review and meta-analysis

OBJECTIVE

At present, there is still no definite conclusion on whether advanced gastric cancer (GC) requires additional para-aortic nodes dissection (PAND). The purpose of this study is to summarize current evidence on the potential benefits of the extended systemic lymphadenectomy (D2+) compared to D2 lymphadenectomy in the treatment of gastric cancer.

MATERIALS AND METHODS

Systematic literature search was performed across PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Database for Chinese Technical Periodicals, and China Biology Medicine disc using the following terms: gastric cancer, para-aortic lymphadenectomy, D2+ lymphadenectomy and D3 lymphadenectomy. RevMan 5.3 software was used for the meta-analysis.

RESULTS

A total of 20 studies involving 5,643 patients were included, consisting of 6 randomized controlled trials (RCT) and 14 non-randomized controlled trials (nRCT). Compared with the D2 group, the operating time in the D2+ group was longer [mean difference (MD)=99.45 min, 95% confidence interval (CI) (48.93, 149.97), p<0.001], with more intra-operative blood loss [MD=262.14 mL, 95% CI (165.21, 359.07), p<0.001]. There were no significant differences in five-year overall survival (OS) [HR=1.09, 95% CI (0.95, 1.25), p=0.22] and post-operative mortality [RR=0.96, 95% CI (0.59, 1.57), p=0.88] between the two groups. The rate of post-operative complications in group D2+ was higher than that in group D2 [RR=1.42, 95% CI (1.11, 1.81), p<0.001].

CONCLUSIONS

Prophylactic D2+ surgery is not recommended, since D2+ surgery is associated with an increased rate of post-operative complications and does not improve the long-term survival rate of patients with advanced gastric cancer. However, D2+ surgery (especially D2+PAND) has certain survival advantages for specific patients, and D2+PAND surgery combined with chemotherapy may potentially improve long-term survival rate.

FoxO1/NLRP3 Inflammasome Promotes Age-Related Alveolar Bone Resorption

Periodontitis is the utmost common chronic oral disease that exhibits intense susceptibility to aging. Aging is characterized by persistent sterile low-grade inflammation, leading to age-related periodontal complications represented by alveolar bone loss. Currently, forkhead transcription factor O1 (FoxO1) is generally believed to have a significant role in body development, senescence, cell viability, and oxidative stress in numerous organs and cells. However, the role of this transcription factor in mediating age-related alveolar bone resorption has not been examined. In this study, FoxO1 deficiency was discovered to have a beneficial correlation with halting the progression of alveolar bone resorption in aged mice. To further investigate the function of FoxO1 in age-related alveolar bone resorption, osteoblastic-specific FoxO1 knockout mice were generated, leading to an amelioration in alveolar bone loss compared to aged-matched wild-type mice, manifested as enhanced osteogenic potential. Mechanistically, we identified enhancement of the NLRP3 inflammasome signaling in FoxO1-deficient osteoblasts in the high dose of reactive oxygen species. Concordant with our study, MCC950, a specific inhibitor of NLRP3 inflammasome, greatly rescued osteoblast differentiation under oxidative stress. Our data shed light on the manifestations of FoxO1 depletion in osteoblasts and propose a possible mechanism for the therapy of age-related alveolar bone loss.

Suvemcitug as second-line treatment of advanced or metastatic solid tumors and with FOLFIRI for pretreated metastatic colorectal cancer: phase Ia/Ib open label, dose-escalation trials

BACKGROUND

Suvemcitug (BD0801), a novel humanized rabbit monoclonal antibody against vascular endothelial growth factor, has demonstrated promising antitumor activities in preclinical studies.

PATIENTS AND METHODS

The phase Ia/b trials investigated the safety and tolerability and antitumor activities of suvemcitug for pretreated advanced solid tumors and in combination with FOLFIRI (leucovorin and fluorouracil plus irinotecan) in second-line treatment of metastatic colorectal cancer using a 3 + 3 dose-escalation design. Patients received escalating doses of suvemcitug (phase Ia: 2, 4, 5, 6, and 7.5 mg/kg; phase Ib: 1, 2, 3, 4, and 5 mg/kg plus FOLFIRI). The primary endpoint was safety and tolerability in both trials.

RESULTS

All patients in the phase Ia trial had at least one adverse event (AE). Dose-limiting toxicities included grade 3 hyperbilirubinemia (one patient), hypertension and proteinuria (one patient), and proteinuria (one patient). The maximum tolerated dose was 5 mg/kg. The most common grade 3 and above AEs were proteinuria (9/25, 36%) and hypertension (8/25, 32%). Forty-eight patients (85.7%) in phase Ib had grade 3 and above AEs, including neutropenia (25/56, 44.6%), reduced leucocyte count (12/56, 21.4%), proteinuria (10/56, 17.9%), and elevated blood pressure (9/56, 16.1%). Only 1 patient in the phase Ia trial showed partial response, [objective response rate 4.0%, 95% confidence interval (CI) 0.1% to 20.4%] whereas 18/53 patients in the phase Ib trial exhibited partial response (objective response rate 34.0%, 95% CI 21.5% to 48.3%). The median progression-free survival was 7.2 months (95% CI 5.1-8.7 months).

CONCLUSIONS

Suvemcitug has an acceptable toxicity profile and exhibits antitumor activities in pretreated patients with advanced solid tumors or metastatic colorectal cancer.

Techno-economic analysis of dynamic, end-to-end optimal pharmaceutical campaign manufacturing using PharmaPy

Increased interest in the pharmaceutical industry to transition from batch to continuouos manufacturing motivates the use of digital frameworks that allow systematic comparison of candidate process configurations. This paper evaluates the technical and economic feasibility of different end-to-end optimal process configurations, viz. batch, hybrid and continuous, for small-scale manufacturing of an active pharmaceutical ingredient. Production campaigns were analyzed for those configurations containing continuous equipment, where significant start-up effects are expected given the relatively short campaign times considered. Hybrid operating mode was found to be the most attractive process configuration at intermediate and large annual production targets, which stems from combining continuous reactors and semi-batch vaporization equipment. Continuous operation was found to be more costly, due to long stabilization times of continuous crystallization, and thermodynamic limitations of flash vaporization. Our work reveals the benefits of systematic digital evaluation of process configurations that operate under feasible conditions and compliant product quality attributes.

[Endoscopic resection of type D trigeminal schwannoma through nasal sinus approach]

Objective: To examine the feasibility and surgical approach of removing type D trigeminal schwannoma through nasal cavity and nasal sinus under endoscope. Methods: Eleven patients with trigeminal schwannoma who were treated in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University from December 2014 to August 2021 were analyzed retrospectively in this study. There were 7 males and 4 females, aged (47.5±13.5) years (range: 12 to 64 years). The neoplasm involved the pterygopalatine fossa, infratemporal fossa, ethmoidal sinus, sphenoid sinus, cavernous sinus, and middle cranial fossa. The size of tumors were between 1.6 cm×2.0 cm×2.0 cm and 5.7 cm×6.0 cm×6.0 cm. Under general anesthesia, the tumors were resected through the transpterygoid approach in 4 cases, through the prelacrimal recess approach in 4 cases, through the extended prelacrimal recess approach in 2 cases, and through the endoscopic medial maxillectomy approach in 1 case. The nasal endoscopy and imaging examination were conducted to detect whether neoplasm recurred or not, and the main clinical symptoms during follow-up. Results: All the surgical procedures were performed under endonasal endoscope, including Gross total resection in 10 patients. The tumor of a 12-year-old patient was not resected completely due to huge tumor size and limited operation space. One patient was accompanied by two other schwannomas located in the occipital region and the ipsilateral parotid gland region originating from the zygomatic branch of the facial nerve, both of which were removed concurrently. After tumor resection, the dura mater of middle cranial fossa was directly exposed in the nasal sinus in 2 cases, including 1 case accompanied by cerebrospinal fluid leakage which was reconstructed by a free mucosal flap obtained from the middle turbinate, the other case was packed by the autologous fat to protect the dura mater. The operation time was (M(IQR)) 180 (160) minutes (range: 120 to 485 minutes). No complications and deaths were observed. No recurrence was observed in the 10 patients with total tumor resection during a 58 (68) months' (range: 10 to 90 months) follow-up. No obvious change was observed in the facial appearance of all patients during the follow-up. Conclusion: Type D trigeminal schwannoma involving pterygopalatine fossa and infratemporal fossa can be removed safely through purely endoscopic endonasal approach by selecting the appropriate approach according to the size and involvement of the tumor.

Antimony release and volatilization from rice paddy soils: Field and microcosm study

The fate of antimony (Sb) in submerged soils and the impact of common agricultural practices (e.g., manuring) on Sb release and volatilization is understudied. We investigated porewater Sb release and volatilization in the field and laboratory for three rice paddy soils. In the field study, the porewater Sb concentration (up to 107.1 μg L^-1) was associated with iron (Fe) at two sites, and with pH, Fe, manganese (Mn), and sulfate (SO₄^2-) at one site. The surface water Sb concentrations (up to 495.3 ± 113.7 μg L^-1) were up to 99 times higher than the regulatory values indicating a potential risk to aquaculture and rice agriculture. For the first time, volatile Sb was detected in rice paddy fields using a validated quantitative method (18.1 ± 5.2 to 217.9 ± 160.7 mg ha^-1 y^-1). We also investigated the influence of two common rice agriculture practices (flooding and manuring) on Sb release and volatilization in a 56-day microcosm experiment using the same soils from the field campaign. Flooding induced an immediate, but temporary, Sb release into the porewater that declined with SO₄^2-, indicating that SO₄^2- reduction may reduce porewater Sb concentrations. A secondary Sb release, corresponding to Fe reduction in the porewater, was observed in some of the microcosms. Our results suggest flooding-induced Sb release into rice paddy porewaters is temporary but relevant. Manuring the soils did not impact the porewater Sb concentration but did enhance Sb volatilization. Volatile Sb (159.6 ± 108.4 to 2237.5 ± 679.7 ng kg^-1 y^-1) was detected in most of the treatments and was correlated with the surface water Sb concentration. Our study indicates that Sb volatilization could be occurring at the soil-water interface or directly in the surface water and highlights that future works should investigate this potentially relevant mechanism.

[Clinical efficacy of split liver transplantation in the treatment of children with biliary atresia]

Objective: To compare the clinical efficacy of split liver transplantation (SLT) and living donor liver transplantation(LDLT) in the treatment of children with biliary atresia. Methods: The clinical data of 64 children with biliary atresia who underwent SLT and 44 children who underwent LDLT from June 2017 to May 2022 at Liver Surgery & Liver Transplantation Center,the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Among the children who received SLT, there were 40 males and 24 females. The median age at transplantation was 8 months (range:4 to 168 months). Among the patients who received LDLT, there were 24 males and 20 females. The age at transplantation ranged from 4 to 24 months,with a median age of 7 months. Sixty-four children with biliary atresia were divided into two groups according to the SLT operation time: 32 cases in the early SLT group(June 2017 to January 2019) and 32 cases in the technically mature SLT group (February 2019 to May 2022). Rank sum test or t test was used to compare the recovery of liver function between the LDLT group and the SLT group,and between the early SLT group and the technically mature SLT group. The incidence of postoperative complications was compared by χ² test or Fisher exact probability method. Kaplan-Meier method and Log-rank test were used for survival analysis. Results: The cold ischemia time(M (IQR)) (218 (65) minutes), intraoperative blood loss(175 (100) ml) and graft-to-recipient body weight ratio (3.0±0.7) in the LDLT group were lower than those in the SLT group(500 (130) minutes, 200 (250) ml, 3.4±0.8) (Z=-8.064,Z=-2.969, t=-2.048, all P<0.05). The cold ischemia time(457(158)minutes) and total hospital stay ((37.4±22.4)days) in the technically mature SLT group were lower than those in the early SLT group(510(60)minutes, (53.0±39.0)days).The differences were statistically significant (Z=-2.132, t=1.934, both P<0.05).The liver function indexes of LDLT group and SLT group showed unimodal changes within 1 week after operation. The peak values of ALT, AST, prothrombin time, activeated partial thromboplasting time, international normalized ratio, fibrinogen and creatinine all appeared at 1 day after operation, and the peak value of prothrombin activity appeared at 3 days after operation. All indicators returned to normal at 7 days after operation. The 1-,2-,and 3-year overall survival rates were 95.5% in LDLT group and 93.5% in the technically mature SLT group, and the difference was not statistically significant. The 1-,2-,and 3-year overall survival rates were 90.2% in the early SLT group and 93.5% in the technically mature SLT group, and there was no significant difference between the two groups(P>0.05). The main complications of the early SLT group were surgery-related complications(28.1%,9/32), and the main complications of the technically mature SLT group were non-surgery-related complications(21.9%,7/32). There were 5 deaths in the SLT group,including 4 in the early SLT group and 1 in the technically mature SLT group. Conclusion: The survival rate of SLT in the treatment of biliary atresia is comparable to that of LDLT.

PSI-18 Effect of Heat Processing Methods on Carbohydrate Subfractions and Degradation in Relation to Carbohydrate Molecular Spectral Profile of Barley Grain Using Advanced Molecular Spectroscopy in Ruminants

To our knowledge, there are few studies on the association between carbohydrate molecular structure spectral profiles of barley grain and ruminant-relevant nutritional characteristics. This study aimed to study associate processing-induced changes in carbohydrate molecular structure with changes in ruminant-relevant carbohydrate nutritional profiles. The heat processing methods included: dry roasting, autoclaving, and microwave irradiation. The ruminant-relevant carbohydrate nutritional profiles were determined which included carbohydrate chemical profiles, carbohydrate subfractions, ruminant-relevant carbohydrate digestion. The molecular structure spectral profiles were determined using vibrational molecular spectroscopy (ATR-FT/IR). The results showed that heat related processing significantly induced carbohydrate molecular spectral profiles. The heat related processing also significantly changed ruminant-relevant nutritional characteristics. There was an association between processing induced carbohydrate molecular structure changes and ruminant-relevant carbohydrate nutritional profiles. The advanced vibrational molecular spectroscopic technique (ATR-FTIR) shows the great potential as a fast analytical tool to predict ruminant-relevant carbohydrate nutritional characteristics.

Whole genome and transcriptome analysis enhances precision cancer treatment options

BACKGROUND

Recent advances are enabling delivery of precision genomic medicine to cancer clinics. While the majority of approaches profile panels of selected genes or hotspot regions, comprehensive data provided by whole genome and transcriptome sequencing and analysis (WGTA) presents an opportunity to align a much larger proportion of patients to therapies.

PATIENTS AND METHODS

Samples from 570 patients with advanced or metastatic cancer of diverse types enrolled in the Personalized OncoGenomics (POG) program underwent WGTA. DNA-based data, including mutations, copy number, and mutation signatures, were combined with RNA-based data, including gene expression and fusions, to generate comprehensive WGTA profiles. A multidisciplinary molecular tumour board used WGTA profiles to identify and prioritize clinically actionable alterations and inform therapy. Patient responses to WGTA-informed therapies were collected.

RESULTS

Clinically actionable targets were identified for 83% of patients, 37% of whom received WGTA-informed treatments. RNA expression data were particularly informative, contributing to 67% of WGTA-informed treatments; 25% of treatments were informed by RNA expression alone. Of a total 248 WGTA-informed treatments, 46% resulted in clinical benefit. RNA expression data were comparable to DNA-based mutation and copy number data in aligning to clinically beneficial treatments. Genome signatures also guided therapeutics including platinum, PARP inhibitors, and immunotherapies. Patients accessed WGTA-informed treatments through clinical trials (19%), off-label use (35%), and as standard therapies (46%) including those which would not otherwise have been the next choice of therapy, demonstrating the utility of genomic information to direct use of chemotherapies as well as targeted therapies.

CONCLUSIONS

Integrating RNA expression and genome data illuminated treatment options that resulted in 46% of treated patients experiencing positive clinical benefit, supporting the use of comprehensive WGTA profiling in clinical cancer care.

CLINICAL TRIAL NUMBER

NCT02155621.

Improved tenderness of beef from bulls supplemented with active dry yeast is related to matrix metalloproteinases and reduced oxidative stress

Supplementing diets with active dry yeast (ADY, Saccharomyces cerevisiae) improves the carcass quality grade of beef cattle and the tenderness of beef. The relevant mechanisms have not been fully elucidated, but may be related to the effect of ADY on oxidative stress and the activity of matrix metalloproteinases (MMPs). To provide further insight into these mechanisms, this study evaluated the influence of ADY supplementation on growth performance, carcass traits, meat quality, concentrations of MMPs in serum (MMP-2, MMP-9 and MMP-13), oxidative stress indices and antioxidant capacity indices in beef cattle. Forty-six crossbred Simmental × Yanbian bulls (∼18 months of age, BW 436 ± 35 kg) participated in a 145-day finishing trial. ADY supplementation significantly improved marbling deposition, intramuscular fat content, and beef tenderness (P < 0.05); altered individual fatty acid proportions in the beef and increased saturated fatty acids while decreasing polyunsaturated fatty acids (P < 0.05); significantly decreased the abundance of reactive oxygen species in serum and meat; significantly increased the level of superoxide dismutase in meat (P < 0.05); tended to increase the level of catalase (P = 0.075) in serum and glutathione reductase (P = 0.066) in meat; and increased the secretion of MMPs. The improvement of beef tenderness following ADY supplementation of finishing bulls is related to the effects of ADY on the secretion of MMPs and the lowering of oxidative stress.

[Pituicytoma: a clinicopathological analysis of twenty-one cases]

Objective: To investigate the clinicopathological features and treatment strategies of pituicytoma. Methods: Twenty-one cases of pituicytoma were collected at the First Affiliated Hospital of Nanjing Medical University and Jinling Hospital, Nanjing, China from 2009 to 2020. The clinical data of 21 pituicytoma patients was retrospectively analyzed, and the relevant literature was reviewed. Results: Twenty-one patients aged 4 to 68 years, including 8 males and 13 females. All patients underwent surgical treatment. Histologically, the tumor was consisted almost entirely of elongate, bipolar spindle cells arranged in a fascicular or storiform pattern. Mitotic figures were rare. Immunohistochemically, tumor cells were diffusely positive for S-100 protein (21/21), vimentin (15/15) and TTF1 (14/14), while they were weakly or focally positive for GFAP (13/16) and EMA (6/12). CKpan was negative in all cases and Ki-67 proliferation index was low (<5%). Among the 18 patients with follow-up, all survived and 2 relapsed after surgery. Conclusions: Pituicytoma is a rare low-grade glioma of the sellar area. It is easily confused with other sellar tumors. Preoperative diagnosis is difficult. It needs to be confirmed by histopathology and immunohistochemistry. Microsurgery is the main treatment method at present.

Automated 3D Fetal Brain Segmentation Using an Optimized Deep Learning Approach

BACKGROUND AND PURPOSE

MR imaging provides critical information about fetal brain growth and development. Currently, morphologic analysis primarily relies on manual segmentation, which is time-intensive and has limited repeatability. This work aimed to develop a deep learning-based automatic fetal brain segmentation method that provides improved accuracy and robustness compared with atlas-based methods.

MATERIALS AND METHODS

A total of 106 fetal MR imaging studies were acquired prospectively from fetuses between 23 and 39 weeks of gestation. We trained a deep learning model on the MR imaging scans of 65 healthy fetuses and compared its performance with a 4D atlas-based segmentation method using the Wilcoxon signed-rank test. The trained model was also evaluated on data from 41 fetuses diagnosed with congenital heart disease.

RESULTS

The proposed method showed high consistency with the manual segmentation, with an average Dice score of 0.897. It also demonstrated significantly improved performance (P < .001) based on the Dice score and 95% Hausdorff distance in all brain regions compared with the atlas-based method. The performance of the proposed method was consistent across gestational ages. The segmentations of the brains of fetuses with high-risk congenital heart disease were also highly consistent with the manual segmentation, though the Dice score was 7% lower than that of healthy fetuses.

CONCLUSIONS

The proposed deep learning method provides an efficient and reliable approach for fetal brain segmentation, which outperformed segmentation based on a 4D atlas and has been used in clinical and research settings.

Experimental Evidence of Intrinsic Current Generation by Turbulence in Stationary Tokamak Plasmas

High-β_{θe} (a ratio of the electron thermal pressure to the poloidal magnetic pressure) steady-state long-pulse plasmas with steep central electron temperature gradient are achieved in the Experimental Advanced Superconducting Tokamak. An intrinsic current is observed to be modulated by turbulence driven by the electron temperature gradient. This turbulent current is generated in the countercurrent direction and can reach a maximum ratio of 25% of the bootstrap current. Gyrokinetic simulations and experimental observations indicate that the turbulence is the electron temperature gradient mode (ETG). The dominant mechanism for the turbulent current generation is due to the divergence of ETG-driven residual flux of current. Good agreement has been found between experiments and theory for the critical value of the electron temperature gradient triggering ETG and for the level of the turbulent current. The maximum values of turbulent current and electron temperature gradient lead to the destabilization of an m/n=1/1 kink mode, which by counteraction reduces the turbulence level (m and n are the poloidal and toroidal mode number, respectively). These observations suggest that the self-regulation system including turbulence, turbulent current, and kink mode is a contributing mechanism for sustaining the steady-state long-pulse high-β_{θe} regime.

Impact of nodular calcification on the outcomes of patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PCI)

Background

Calcified plaque is thought to adversely impact clinical outcomes but the impact of nodular calcification after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear.

Purpose

This study sought to explore the impact of nodular calcification on the outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes.

Methods

Five-hundred culprit plaque with calcification were analysed from 495 ACS patients in whom PCI was performed. Plaques were divided into nodular calcification group (n=238) and non-nodular calcification group (n=262). Calcification is defined as an area with low back-scattering signal and a sharp border. Nodular calcification was defined as a protruding mass with an irregular surface, high backscattering, and signal attenuation on optical coherence tomography (OCT).

Results

Patients with nodular calcification were older (p&lt;0.001) and had lower left ventricular ejection fraction (p=0.006) compared to patients with non-nodular calcification. Lesion length (31 (25.2, 38.5) vs. 29 (22.8, 34.1), p&lt;0.001) was longer in plaques with nodular calcification. A higher prevalence of superficial calcium (p&lt;0.001) was observed in plaques with nodular calcification compared with non-nodular calcification group. Minimum stent area (MSA) (5.0 (3.9, 6.3) vs. 5.4 (4.2, 6.7), p=0.011) and stent expansion (70 (62.7, 81.8) vs. 75 (65.2, 86.6), p=0.004) were significantly smaller in the nodular calcification group than in the non-nodular calcification group. Independent predictors of nodular calcification were age (p&lt;0.001) lesion length (p=0.002) and calcium depth (p&lt;0.001).

Conclusion

This study demonstrated that the presence of nodular calcification is associated with unfavourable outcomes with smaller minimum stent area and higher incidence of stent under expansion in patients with ACS treated with primary PCI.

Funding Acknowledgement

Type of funding sources: None.

Frequency and predictors of thin-cap fibroatheroma progression: a comprehensive and dynamic in-vivo OCT study

Purpose

To assess the evolution of thin-cap fibroatheroma (TCFA) and to explore predictors for its progression by using optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS).

Methods

We enrolled ACS patients with non-culprit TCFA at baseline and corresponding OCT images at follow-up of 9 to 15 months. Clinical, angiographic and OCT data were collected and analyzed according to established methods. TCFA was defined as a lipid plaque with maximum lipid arc &gt;90° and fibrous cap thickness &lt;65μm. Considering the resolution of OCT, the regression of TCFA was defined as an increase of fibrous cap thickness &gt;10μm. Inversely, TCFA progression was defined as a decrease, constant or ≤10μm increase of fibrous cap thickness.

Results

41 patients with 55 non-culprit TCFAs were taken into final analysis. 17 patients (41.5%) had patient-level progression and 22 TCFAs (40.0%) progressed at plaque-level with a median follow-up duration of 371 days. 11 (20.0%) of the 55 TCFAs happened subclinical rupture at follow-up, including 10 with the formation a new layer and 1 without the detection of the new layer. Besides, another patient suffered re-myocardial infarction because of the rupture of TCFA induced acute thrombosis and lumen occlusion during follow-up. The baseline clinical and angiographic characteristics were similar between the two cohorts. The progression group had a significantly higher prevalence of macrophage infiltration and vasa vasorum at baseline than the non-progression group (Figure 1). Multivariate analysis identified macrophage infiltration (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 1.01 to 27.91; p=0.049]) as the independent predictor of TCFA progression. When it came to the evolution of lesion morphology and lipid components, the progression cohort had a higher percent change of lumen stenosis and lipid length (Figure 2).

Conclusions

About 40% of non-culprit TCFAs in ACS patients progressed in fibrous cap thickness at a median interval of 1 year. Macrophage infiltration was the independent predictor of non-culprit TCFA progression. The progression of fibrous cap thickness was usually accompanied with an aggressive evolution of other lesion characteristics.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): the National Key R&D Program of China Baseline OCT characteristicsPercent change of lesion morphology

Comparison of peripheral artery plaque characteristics between ACS patients with plaque rupture and plaque erosion in culprit coronary artery: an OCT and ultrasound study

Background

Recent research has found that the characteristics of peripheral arterial plaque are related to the increased risk of cardiovascular disease, however, the relationship of plaque characteristics between peripheral artery and coronary is still unknown.

Purpose

To assess the correlation between coronary plaque characteristics assessed by optical coherence tomography (OCT) and peripheral artery plaque characteristics assessed by ultrasound.

Methods

150 patients with acute coronary syndrome (ACS) underwent coronary angiography were prospectively enrolled. OCT imaging of culprit vessel were performed during the procedure and ultrasound examination of bilateral carotid, iliofemoral and popliteal arteries was performed during hospitalization after procedure. Panvascular disease was defined as the presence of observable plaques in two or more vascular beds. Patients were divided into plaque rupture (PR) group and plaque erosion (PE) group according to culprit plaque characteristics on OCT.

Results

There were 132 (88%) ACS patients had panvascular disease in which 36 (24%) with generalized atherosclerosis (4 sites) and the prevalence of panvascular atherosclerosis in PR group was significantly higher than in PE group especially in carotid arteries and iliofemoral arteries (Figure 1, Figure 2). Compared to PE group, PR group had higher carotid plaque score (p=0.001) which indicates more plaques and severer atherosclerosis. Moreover, there were larger intima-media thickness (IMT) of iliofemoral arteries (6.9±1.4mm vs. 6.5±1.1mm, p=0.036) and more calcified plaques in PR group.

Conclusions

Panvascular disease is highly prevalent in ACS patients especially in patients with plaque rupture in culprit vessel, in which more than half of the patients had plaques in more than 3 sites of vascular beds. In addition, patients with plaque rupture had thicker iliofemoral IMT and higher panvascular atherosclerosis burden, which indicates that characteristics of coronary plaques are the focal expression of plaques in the whole panvcascular system.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Key R&D Program of China Figure 1. Prevalence of panvascular disease in ACSFigure 2. Comparison of peripheral artery plaques

Prevalence, predictors, and clinical prognosis of macrophage infiltrates in patients with ST-segment elevation myocardial infarction caused by plaque erosion as assessed by OCT

Background

Autopsy series showed that one of most common plaque phenotypes underlying coronary thrombi was plaque erosion. Identification of erosion may permit a less invasive management. Chronic inflammation is a common process in atherosclerosis. The severity of plaque inflammation can be assessed by optical coherence tomography (OCT) defined macrophages density. The impact of macrophage infiltrates (MØI) in ST-segment elevation myocardial infarction (STEMI) patients caused by plaque erosion was still unknown.

Purpose

The aim of this study was to evaluate plaque morphology and clinical prognosis associated with MØI as assessed by optical coherence tomography in STEMI patients caused by plaque erosion.

Methods

From October 2014 to December 2017, 1561 STEMI with OCT imaging before percutaneous coronary intervention were enrolled in this study. Finally, 312 STEMI patients caused by plaque erosion were split into two group according to the presence of MØI in culprit eroded plaques.

Results

163 (52.2%) STEMI patients presented plaque erosion with MØI, whereas 149 (47.8%) patients had no evidence of MØI. MØI were more frequency appeared in older patients (p=0.015). The severity and vulnerability of culprit lesions were higher in patients with MØI characterized by more aggressive and vulnerable features. Patients with MØI had worse long-term prognosis, compared with patient without MØI, mainly driven by a higher rate of target lesion revascularization (p=0.046), especially in STEMI patients presented plaque erosion with intensive antiplatelet therapy (p=0.035).

Conclusions

In the present study, we demonstrated that macrophage infiltrates at the site of erode plaques were associated with severity and vulnerability of culprit lesions. The long-term prognosis in patients with MØI were poorer especially in patients without stent implantation.

Funding Acknowledgement

Type of funding sources: None. Study flow chartPredictors of plaque erosion with MØI

Gender-specific difference of clinical and plaque characteristics in myocardial infarction with non-obstructive artery (MINOCA): insights from optical coherence tomography

Background

To date, sparse data are available with regard to gender differences in coronary plaque morphology and composition as underlying mechanism of MINOCA.

Purpose

To assess the differences in coronary plaque morphology in culprit lesion between women and men with MINOCA using intravascular optical coherence tomography.

Methods

Totally, 7404 consecutives acute myocardial infarction patients who underwent emergency coronary angiography between 2016 and 2019 were screened. MINOCA were identified in 292 patients (mean age: 72.6% male, 54.1% with ST-segment elevation). Optical coherence tomography was performed in 190 patients (men, n=142).

Results

Women with MINOCA were older (62.5±10.6 vs. 54.0±11.5, P&lt;0.001) and more over 55 years (75.3% vs. 43.6%, P&lt;0.001). Although women with MINOCA more frequently presented with NSTEMI (56.8% vs. 41.7%, P=0.025) and prior coronary artery disease (CAD) (33.3% vs. 6.3%, P&lt;0.001), they were less likely smoker (27.2% vs. 58.8%, P&lt;0.001). There was no significant difference in incidence of plaque rupture, erosion and calcified nodule between men and women. However, women were more likely to have thin-cap fibroatheroma (TCFA) (39.6% vs. 22.5%, P=0.025).

Conclusion

Women with MINOCA were older, more frequently presented with NSTEMI and less smoking compared to men. Besides, more TCFA were observed in women.

Funding Acknowledgement

Type of funding sources: None. Clinical and OCT plaque profilesProportion of clinical and OCT profiles

Sulforaphane overcomes T790M-mediated gefitinib resistance in vitro through epithelial-mesenchymal transition

The purpose of the present study was to investigate the effects of sulforaphane (SFN) on gefitinib-resistant cell lines with a T790 mutation (PC-9/AB11). The PC-9 and PC-9/AB11 cells were stained with H&E and visualized with a light microscope. The CCK-8 assay method was used to evaluate the antiproliferative activity of gefitinib and SFN on the cells. Cell cycle arrest and apoptosis were analyzed via flow cytometry. The cytotoxic interaction between the two drugs was evaluated in vitro using the combination index method, and epithelial-mesenchymal transition (EMT)-related proteins and alterations in the signaling pathways were determined by Western blot analysis. Compared to the PC-9 cells, the gefitinib-resistant PC-9/AB11 cells acquired a T790M mutation and had characteristics in accordance with EMT. The combination of gefitinib and SFN induced dose-dependent antiproliferative effects in the PC-9 and PC-9/AB11 cells, while both induced cell cycle arrest and cell apoptosis only in the PC-9/AB11 cells. The synergistic effect in the PC-9/AB11 cells was associated with this drug combination, as it caused an expression change of the epithelial (E-cadherin, claudin-1) and matrix proteins (vimentin, N-cadherin) in the cells, related to the reversal of EMT, as well as an expression change of the epidermal growth factor receptor (EGFR), p-EGFR, p-AKT, and p-ERK proteins. In this study, SFN overcame T790M-mediated gefitinib resistance in vitro through EMT. Thus, a combination of gefitinib and SFN may be a beneficial treatment strategy for lung cancer patients with acquired resistance due to T790M mutation.

PharmaPy: An object-oriented tool for the development of hybrid pharmaceutical flowsheets

Process design and optimization continue to provide computational challenges as the chemical engineering and process optimization communities seek to address more complex and larger scale applications. Software tools for digital design and flowsheet simulation are readily available for traditional chemical processing applications such as in commodity chemicals and hydrocarbon processing; however, tools for pharmaceutical manufacturing are much less well developed. This paper introduces, PharmaPy, a Python-based modelling platform for pharmaceutical manufacturing systems design and optimization. The versatility of the platform is demonstrated in simulation and optimization of both continuous and batch processes. The structure and features of a Python-based modeling platform, PharmaPy are presented. Illustrative examples are shown to highlight key features of the platform and framework.

What is an appropriate caesarean delivery rate for China: a multicentre survey

Objective

To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction.

Design

A multicentre cross‐sectional study.

Setting

A total of 94 hospitals across 23 provinces in China.

Population

A total of 73 977 randomly selected deliveries.

Methods

We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates.

Main outcome measures

CD rates in China.

Results

In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs.

Conclusions

Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD.

Tweetable abstract

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

Linked article This article is commented on by M Varner, p. 148 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16953.