A Deep Learning Pipeline Using Prior Knowledge for Automatic Evaluation of Placenta Accreta Spectrum Disorders With MRI.

BACKGROUND: The diagnosis of prenatal placenta accreta spectrum (PAS) with magnetic resonance imaging (MRI) is highly dependent on radiologists' experience. A deep learning (DL) method using the prior knowledge that PAS-related signs are generally found along the utero-placental borderline (UPB) may help radiologists, especially those with less experience, to mitigate this issue. PURPOSE: To develop a DL tool for antenatal diagnosis of PAS using T2-weighted MR images. STUDY TYPE: Retrospective. SUBJECTS: Five hundred and forty pregnant women with clinically suspected PAS disorders from two institutions, divided into training (409), internal test (103), and external test (28) datasets. FIELD STRENGTH/SEQUENCE: Sagittal T2-weighted fast spin echo sequence at 1.5 T and 3 T. ASSESSMENT: An nnU-Net was trained for placenta segmentation. The UPB straightening approach was used to extract the utero-placental boundary region. The UPB image was then fed into DenseNet-PAS for PAS diagnosis. DenseNet-PP learnt placental position information to improve the PAS diagnosis performance. Three radiologists with 8, 10, and 12 years of experience independently evaluated the images. Two radiologists marked the placenta tissue. Histopathological findings were the reference standard. STATISTICAL TESTS: Area under the curve (AUC) was used to evaluate the classification. Dice coefficient evaluated the segmentation between radiologists and the model performance. The Mann-Whitney U-test or the chi-squared test assessed the significance of differences. Decision curve analysis was used to determine clinical effectiveness. DeLong's test was used to compare AUCs. RESULTS: Of the 540 patients, 170 had PAS disorders confirmed by histopathology. The DL model using UPB images and placental position yielded the highest AUC of 0.860 and 0.897 in internal test and external test cohorts, respectively, significantly exceeding the performance of three radiologists (internal test AUC, 0.737-0.770). DATA CONCLUSION: By extracting the UPB image, this fully automatic DL pipeline achieved high accuracy and may assist radiologists in PAS diagnosis using MRI. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

Retinoic acid released from self-assembling peptide activates cardiomyocyte proliferation and enhances repair of infarcted myocardium.

The limited cardiomyocyte proliferation is insufficient for repair of the myocardium. Therefore, activating cardiomyocyte proliferation might be a reasonable option for myocardial regeneration. Here, we investigated effect of retinoic acid (RA) on inducing adult cardiomyocyte proliferation and assessed efficacy of self-assembling peptide (SAP)-released RA in activating regeneration of the infarcted myocardium. Effect of RA on inducing cardiomyocyte proliferation was examined with the isolated cardiomyocytes. Expression of the cell cycle-associated genes and paracrine factors in the infarcted myocardium was examined at one week after treatment with SAP-carried RA. Cardiomyocyte proliferation, myocardial regeneration and improvement of cardiac function were assessed at four weeks after treatment. In the adult rat myocardium, expression of RA synthetase gene Raldh2 and RA concentration were decreased significantly. After treatment with RA, the proliferated cardiomyocytes were increased. The formulated SAP could sustainedly release RA. After treatment with SAP-carried RA, expression of the pro-proliferative genes in cell cycle and paracrine factors in the infarcted myocardium were up-regulated. Myocardial regeneration was enhanced, and cardiac function was improved significantly. These results demonstrate that RA can induce adult cardiomyocytes to proliferate effectively. The sustained release of RA with SAP is a promise strategy to enhance repair of the infarcted myocardium.

Transportation infrastructure upgrading and green development efficiency: Empirical analysis with double machine learning method.

In order to deal with the environmental problems such as pollution emissions and climate change, sustainable development in the field of transportation has gradually become a hot topic to all sectors of society. In addition, promoting the green and low-carbon transformation of China's transportation is also an important issue in the new era. Thus, it is particularly important to correctly identify the green effect of high-speed rail. However, the traditional causal reasoning model faces several challenges such as 'dimensional curse' and multicollinearity. Based on the panel data of 283 prefecture-level cities in China from 2003 to 2019, this study uses the double machine learning model to explore the impact of transportation infrastructure upgrading on the efficiency of urban green development in China. The research shows that the upgrading of transportation infrastructure can effectively improve the efficiency of urban green development by 4%. Service industry agglomeration and green innovation are verified as two mediating channels. Moreover, the synthetic difference in difference model is employed to evaluate the regional impact of high-speed rail, and finds that the regional impact of transportation policies often exceeds the impact of individual cities. We further apply the conclusions of this paper to the research at the micro enterprise level. Goodman-Bacon decomposition and a variety of robustness tests confirm the validity of our conclusions. The study's comprehensive empirical analysis not only validates the positive effects of transportation upgrades on green development, but also offers novel insights into the underlying mechanisms and policy implications of transportation upgrading.

A Simple High-Flux Switchable VUV Lamp Based on an Electrodeless Fluorescent Lamp for SPI/PAI Mass Spectrometry.

Single-photon ionization (SPI) is a unique soft ionization technique for organic analysis. A convenient high-flux vacuum ultraviolet (VUV) light source is a key precondition for wide application of SPI techniques. In this study, we present a novel VUV lamp by simply modifying an ordinary electrodeless fluorescent lamp. By replacing the glass bulb with a stainless steel bulb and introducing 5% Kr/He (v/v) as the excitation gas, an excellent VUV photon flux over 4.0 × 1014 photons s-1 was obtained. Due to its rapid glow characteristics, the VUV lamp can be switched on and off instantly as required by detection, ensuring the stability and service life of the lamp. To demonstrate the performance of the new lamp, the switchable VUV lamp was coupled with an SPI-mass spectrometer, which could be changed to photoinduced associative ionization (PAI) mode by doping gaseous CH2Cl2 to initiate an associative ionization reaction. Two types of volatile organic compounds sensitive to SPI and PAI, typically benzene series and oxygenated organics, respectively, were selected as samples. The instrument exhibited a high detection sensitivity for the tested compounds. With a measurement time of 11 s, the 3σ limits of detection ranged from 0.33 to 0.75 pptv in SPI mode and from 0.03 to 0.12 pptv in PAI mode. This study provides an extremely simple method to assemble a VUV lamp with many merits, e.g., portability, robustness, durability, low cost, and high flux. The VUV lamp may contribute to the development of SPI-related highly sensitive detection technologies.

Novel MCP-Windowed EUV Light Source and Its Mass Spectrometric Application for Detecting Chlorinated Methanes.

Various vacuum ultraviolet (VUV) lamps are simple and convenient VUV light sources for mass spectrometry and other research fields. However, the strong absorption of high-energy photons by window materials limits the application of an extreme ultraviolet (EUV) light. In this study, a novel high-flux EUV light source is developed using a microchannel plate (MCP) window to transmit 73.6 nm (16.9 eV) EUV light generated via the radio frequency (RF) inductive discharge of neon. The MCP used is a 0.5 mm thick glass plate with a regular array of microtubes (12 µm i.d.). The photon fluxes of the EUV light source with the MCP window (12 mm i.d.) and an aperture (1.8 mm i.d.) are ∼1.31 × 1014 and ∼9.80 × 1012 photons s-1, respectively, while their corresponding leakage flow rates of the discharge gas are 0.062 and 0.046 cm3 atom s-1, according to the contrast experiments. The transmission efficiency of the MCP to the EUV light is 30.2%, with a 1.2% deviation. An EUV photoionization time-of-flight mass spectrometer (EUV-PI-TOFMS) is built to validate the practicality of the MCP-windowed EUV light source further. The detection sensitivities in 30 s measurements for methyl chloride (CH3Cl), methylene chloride (CH2Cl2), trichloromethane (CHCl3), and carbon tetrachloride (CCl4) in synthetic air are 4366, 4120, 5854, and 4095 counts ppbv-1, respectively. The corresponding 3σ limits of detection (LODs) are 42, 34, 24, and 15 pptv. This study develops a new feasible method for efficiently utilizing high-energy EUV light, with many application prospects in scientific research.

Proposal to transfer Bacillus massiliigorillae to the genus Peribacillus as Peribacillus massiliigorillae comb. nov., and Bacillus sinesaloumensis to the genus Ferdinandcohnia as Ferdinandcohnia sinesaloumensis comb. nov.

The present study was carried out to clarify the taxonomic position of Bacillus massiliigorillae and Bacillus sinesaloumensis. The 16S rRNA gene sequences extracted from the Bacillus sinesaloumensis Marseille-P3516T (FTOX00000000) and Bacillus massiliigorillae G2T (CAVL000000000) genomes showed 98.5 and 99.1% similarity with the type strains of Ferdinandcohnia humi and Peribacillus endoradicis, respectively. The amino acid identity (AAI) values of Bacillus sinesaloumensis Marseille-P3516T were higher with Ferdinandcohnia members, while Bacillus massiliigorillae G2T with Peribacillus members. In phylogenomic and phylogenetic trees, Bacillus sinesaloumensis Marseille-P3516T and Bacillus massiliigorillae G2T clade with members of the genera Ferdinandcohnia and Peribacillus, respectively. Based on the above results, we propose to transfer Bacillus massiliigorillae to the genus Peribacillus as Peribacillus massiliigorillae comb. nov., and Bacillus sinesaloumensis to the genus Ferdinandcohnia as Ferdinandcohnia sinesaloumensis comb. nov.

Glucometer-based biosensor for the determination of ractopamine in animal-derived foods using rolling circle amplification.

Screening for persistent organic pollutants (POPs) in food is a complex and challenging process, as POPs can be present in very low levels and can be difficult to detect. Herein, we developed an ultrasensitive biosensor based on a rolling circle amplification (RCA) platform using a glucometer to determine POP. The biosensor was constructed using gold nanoparticle probes modified with antibodies and dozens of primers, magnetic microparticle probes conjugated with haptens, and targets. After competition, RCA reactions are triggered, numerous RCA products hybridize with the ssDNA-invertase, and the target is successfully transformed into glucose. Using ractopamine as a model analyte, this strategy obtained a linear detection range of 0.038-5.00 ng mL-1 and a detection limit of 0.0158 ng mL-1, which was preliminarily verified by screening in real samples. Compared with conventional immunoassays, this biosensor utilizes the high efficiency of RCA and the portable properties of a glucometer, which effectively improves the sensitivity and simplifies the procedures using magnetic separation technology. Moreover, it has been successfully applied to ractopamine determination in animal-derived foods, revealing its potential as a promising tool for POP screening.

A Configurationally Confined Thermally Activated Delayed Fluorescent Two-Coordinate CuI Complex for Efficient Blue Electroluminescence.

Thermally activated delayed fluorescence (TADF) from linear two-coordinate coinage metal complexes is sensitive to the geometric arrangement of the ligands. Herein we realize the tuning of configuration from coplanar to orthogonal gradually by variation of substituents. In a complex with confined twist configuration, its blue emission peaking at 458 nm presents a high ΦPL of 0.74 and a short τTADF of 1.9 µs, which indicates a fast enough kr,TADF of 3.9×105  s-1 and a depressed knr of 1.4×105  s-1 . Such outstanding luminescent properties are attributed to the proper overlap of HOMO and LUMO on CuI d orbitals that guarantees not only small ΔEST but also sufficient transition oscillator strength for fast k r , S 1 ${{k}_{{\rm r},{{\rm S}}_{1}}}$ . Vacuum-deposited blue OLEDs with either doped or host-free emissive layer present external quantum efficiencies over 20 % and 10 %, respectively, demonstrating the practicality of the configurationally confined strategy for efficient linear CuI TADF emitters.

Proposal for transfer Bacillus alkalicola to the genus Evansella as Evansella alkalicola comb. nov.

The taxonomic position of Bacillus alkalicola was evaluated using phylogenetic and genome-based comparisons. In phylogenetic (based on 16S rRNA gene sequence) and phylogenomic (based on concatenation of protein-marker genes) trees, Bacillus alkalicola clade with the members of the genus Evansella. The amino acid identity (AAI) values suggested to reclassify Bacillus alkalicola as a member of the genus Evansella. The average nucleotide identity (ANI) value between Bacillus alkalicola and the members of the genus Evansella was lower than the threshold values for bacterial species delineation. Based on the results, we propose to transfer Bacillus alkalicola to the genus Evansella as Evansella alkalicola comb. nov. The type strain is Zby6T (=CGMCC 1.10368T=JCM 17098T=NBRC 107743T).

Proposal to transfer Bacillus lacisalsi Dong et al. 2021 to the genus Alteribacter as Alteribacter lacisalsi comb. nov.

In the present study, the taxonomic position of Bacillus lacisalsi YSP-3T was evaluated using phylogenetic and genome-based comparison. B. lacisalsi YSP-3T showed the highest 16S rRNA gene sequence similarity to Alteribacter natronophilus M30T (98.4 %), followed by Alteribacter aurantiacus K1-5T (97.5 %) and Alteribacter populi FJAT-45347T (97.2 %). In phylogenetic (based on 16S rRNA gene sequences) and phylogenomic (based on 71 bacterial single-copy genes) trees, B. lacisalsi YSP-3T clustered with the members of the genus Alteribacter. The amino acid identity (AAI) values between B. lacisalsi YSP-3T and the members of the genus Alteribacter were >65 %, which is above the cut-off level (65-95 %) for genus delineation. The average nucleotide identity (ANI) values between B. lacisalsi YSP-3T and the members of the genus Alteribacter were <95 %, which is lower than the threshold value (95-96 %) for bacterial species delineation. The AAI value suggested that B. lacisalsi YSP-3T was a member of the genus Alteribacter while the ANIb value suggested it as a novel species of the genus Alteribacter. Based on the results, we propose to transfer Bacillus lacisalsi to the genus Alteribacter as Alteribacter lacisalsi comb. nov.

Reducing lipofuscin accumulation and cardiomyocytic senescence of aging heart by enhancing autophagy.

Cardiomyocytes are particularly prone to lipofuscin accumulation. In the aging heart, lipofuscin accumulation is augmented. This study examined distribution of lipofuscin and senescent cardiomyocytes and evaluated improvement of lipofuscin accumulation and cardiomyocytic senescence of the aging heart after treatment with rapamycin. The results of Schmorl staining, Sudan black staining and autofluorescence detection showed that there was more lipofuscin in the myocardium of the ventricles especially in the left ventricle. The conductive tissue contained less lipofuscin than the myocardium. In the aged hearts, lipofuscin accumulation and senescent cardiomyocytes were increased, and the level of autophagy was reduced. In double staining of Sudan black B and senescence-associated ß-galactosidase, 10%-20% lipofuscin-loaded cardiomyocytes became senescent. All senescent cardiomyocytes contained lipofuscin deposits. After enhancing autophagy with feed of rapamycin for six months, lipofuscin accumulation and senescence of cardiomyocytes were improved in old rats. Colocalization of autophagic structure and lipofuscin as well as electron micrographs showed that some lipofuscin-loaded lysosomes were sequestrated by autophagic structures. This study suggests that rapamycin-enhanced autopahgy is effective for reducing lipofuscinogenesis and promoting degradation of lipofuscin. Therefore, enhancing autophagy is a novel therapy for alleviating lipofuscin accumulation and myocardial senescence.

Target-Cell-Specific Bioorthogonal and Endogenous ATP Control of Signal Amplification for Intracellular MicroRNA Imaging.

A stringent signal amplification method to profile microRNA (miRNA) expression within a specific cell remains a key challenge in biology. To address this issue, we report a target-cell-specific DNA nanosystem for endogenous adenosine-5'-triphosphate (ATP) bioorthogonal activation of the hybridization chain reaction (HCR) to spatiotemporally controlled signal amplification detection of miRNA in vitro and in vivo. The system consists of ATP aptamer-sealed engineered HCR functional units combined with a cancer cell membrane-encapsulated glutathione (GSH)-responsive metal-organic framework (MOF). Once the nanosystem is specifically and efficiently internalized into a cancer cell through membrane-mediated homing targeting, the MOF structure degrades and releases HCR functional units. The endogenous high expressional ATP recognizes the aptamer, allowing the HCR functional units to adopt its active modality. The activated HCR functional units are then able to spatiotemporally and bioorthogonally image miRNA with high sensitivity in vitro and in vivo.

A bioluminescence reporter mouse strain for in vivo imaging of CD8+ T cell localization and function.

CD8+ T cells play a critical role during adaptive immune response, which often change locations and expand or contract in numbers under different states. In the past, many attempts to develop CD8+T cells that express luciferase in vivo have involved the use of viral transduction, which has drawbacks of hardly tracked via detection of luciferase signal in untouched natural states. Here, we generate a transgenic mouse model via CRISPR-mediated genome editing, C57BL/6-CD8aem(IRES-AkaLuci-2A-EGFP) knock-in mice(CD8a-Aka mice), as a novel tool for non-invasive imaging of CD8+ T cells, which expressed a highly sensitive luciferase-Akaluciferase. Our study offers a convenient and robust tool for understanding fundamental CD8+ T cell biology in experimental applications and preclinical translational studies.

Antiviral Effects of Novel 2-Benzoxyl-Phenylpyridine Derivatives.

Coxsackievirus B3 (CVB3) is the most common cause of acute and chronic viral myocarditis, primarily in children, while human adenovirus infections represent a significant cause of morbidity and mortality worldwide, in people of all ages. A series of novel 2-benzoxyl-phenylpyridine derivatives were evaluated for their potential antiviral activities against CVB3 and adenovirus type 7 (ADV7). Preliminary assays indicated that some of these compounds exhibited excellent antiviral effects on both CVB3 and ADV7 viruses; they could effectively inhibit virus-induced cytopathic effects, reduce viral progeny yields, and had similar or superior antiviral activities compared with the control drug, ribavirin. Further, these compounds targeted the early stages of CVB3 replication in cells, including viral RNA replication and protein synthesis, rather than inactivating the virus directly, inhibiting virus adsorption/entry, or affecting viral release from cells. Our data demonstrate that the tested 2-benzoxyl-phenylpyridine derivatives are effective inhibitors of CVB3 and ADV7, raising the possibility that these compounds might be feasible candidates for anti-viral agents.

Gut microbiota adaptation to high altitude in indigenous animals.

Limited is known about role of gut microbiota in the metabolism of high-altitude-living herbivores, and potential co-evolution between gut microbiome and host genome during high altitude adaptation were not fully understood. Here, DNA from faecal samples was used to investigate the gut microbial compositions and diversity in three host species endemic to the high-altitude Tibetan plateau, the Tibetan antelope (Pantholops hodgsonii, T-antelope, 4300 m) and the Tibetan wild ass (Equus kiang, T-ass, 4300 m), and in the Tibetan sheep (Ovis aries, T-sheep) collected from two different altitudes (T-sheep [k], 4300 m and T-sheep [l] 3000 m). Ordinary sheep (O. aries, sheep) from low altitudes (1800 m) were used for comparison. 16S rRNA gene sequencing revealed that the genera Ruminococcus (22.78%), Oscillospira (20.00%), and Clostridium (10.00%) were common taxa in all high-altitude species (T-antelope, T-ass and T-sheep [k]). Ruminococcaceae, Clostridiales, Clostridia, and Firmicutes showed greater enrichment in the T-antelopes' gut microbiota than in the microbiota of lower-altitude sheep (T-sheep [l] and sheep). The T-antelopes' gut microbiota displayed a higher ratio of Firmicutes to Bacteroidetes than lower-altitude sheep (T-sheep [l] and sheep). A functional capacity analysis of the paired-end metagenomics sequences of the gut metagenomes of high-altitude T-antelopes and T-sheep annotated over 80% of the unique genes to metabolism (especially carbohydrate metabolism pathways) and genetic information processing in the Kyoto Encyclopedia of Genes and Genomes database. The gut metagenome of the T-antelope may have co-evolved with the host genomes (e.g. glycolysis and DNA repair). The higher-altitude herbivores tended to have similar gut microbial compositions, with similar functional capacities, suggesting that their gut microbiota could involved in their high-altitude adaptation.

Enhancement of cardiac lymphangiogenesis by transplantation of CD34+VEGFR-3+ endothelial progenitor cells and sustained release of VEGF-C.

Impairment of cardiac lymphatic vessels leads to cardiac lymphedema. Recent studies have suggested that stimulation of lymphangiogenesis may reduce cardiac lymphedema. However, effects of lymphatic endothelial progenitor cells (LEPCs) on cardiac lymphangiogenesis are poorly understood. Therefore, this study investigated effectiveness of LEPC transplantation and VEGF-C release with self-assembling peptide (SAP) on cardiac lymphangiogenesis after myocardial infarction (MI). CD34+VEGFR-3+ EPCs isolated from rat bone marrow differentiated into lymphatic endothelial cells after VEGF-C induction. VEGF-C also stimulated the cells to incorporate into the lymphatic capillary-like structures. The functionalized SAP could adhere with the cells and released VEGF-C sustainedly. In the condition of hypoxia and serum deprivation or abdominal pouch assay, the SAP hydrogel protected the cells from apoptosis and necrosis. At 4 weeks after intramyocardial transplantation of the cells and VEGF-C loaded with SAP hydrogel in rat MI models, cardiac lymphangiogenesis was increased, cardiac edema and reverse remodeling were reduced, and cardiac function was improved significantly. Delivery with SAP hydrogel favored survival of the engrafted cells. VEGF-C released from the hydrogel promoted differentiation and incorporation of the cells as well as growth of pre-existed lymphatic vessels. Cardiac lymphangiogenesis was beneficial for elimination of the inflammatory cells in the infarcted myocardium. Moreover, angiogenesis and myocardial regeneration were enhanced after reduction of lymphedema. These results demonstrate that the combined delivery of LEPCs and VEGF-C with the functionalized SAP promotes cardiac lymphangiogenesis and repair of the infarcted myocardium effectively. This study represents a novel therapy for relieving myocardial edema in cardiovascular diseases.

Serelaxin inhibits differentiation and fibrotic behaviors of cardiac fibroblasts by suppressing ALK-5/Smad2/3 signaling pathway.

Serelaxin, a recombinant form of human relaxin-2, is currently regarded as a novel drug for treatment of acute heart failure. However, whether therapeutic effects of serelaxin are achieved by inhibiting cardiac fibrosis remains unclear. In this study, we investigate effects of serelaxin on inhibiting cardiac fibrosis. Cardiac fibroblasts (CFs) were isolated from the hearts of adult rats. Effects of serelaxin on differentiation of CFs towards myofibroblasts (MFs) and their fibrotic behaviors after induction with TGF-ß1 were examined. Synthesis and degradation of collagens, secretion of IL-10, and expression of ALK-5 and p-Smad2/3 of TGF-ß1-induced cells were assessed after treatment with serelaxin. Serelaxin inhibited differentiation of TGF-ß1-induced CFs towards MFs, and reduced proliferation and migration of the induced cells. Moreover, serelaxin down-regulated expression of collagen I/III and TIMP-2, and up-regulated expression of MMP-2 and MMP-9 in the cells. After treatment with serelaxin, activity of MMP-2 and MMP-9 and secretion of IL-10 increased, expression of ALK-5 and the level of Smad2/3 phosphorylation was reduced significantly. These results suggest that serelaxin can inhibit differentiation of TGF-ß1-induced CFs towards MFs, reduce production of collagens by suppressing ALK-5/Smad2/3 signaling pathway, and enhance extracellular matrix degradation by increasing MMP-2/TIMP-2 ratio and IL-10 secretion. Serelaxin may be a potential therapeutic drug for inhibiting cardiac fibrosis.

Advancing the predictivity of skin sensitization by applying a novel HMOX1 reporter system.

Reporter cell lines are a particularly useful tool to screen for the skin sensitization potential of chemicals. Current cell models based on Keap1-Nrf2 mimic induction by conducting antioxidant response element-luciferase plasmids. However, plasmid-based reporters may ignore comprehensive aspects of induction, thus affecting the accuracy of hazard identification. Herein, we developed a novel HaCaT-based reporter system, EndoSens, whereby luciferase was specifically inserted into the cassette for heme oxygenase (decycling) 1 (HMOX1, the most consistent marker induced by skin sensitizers) by CRISPR/Cas9. Testing data from 20 coded substances showed an accuracy of 90%, sensitivity of 91.7%, and specificity of 87.5%, which exceeded the OECD requirement. Among the 35 chemicals examined, predictivity was better than reported for the validated KeratinoSens™. These results indicate that the EndoSens assay could advance the predictivity of skin sensitization, thus making it a promising tool for in vitro skin sensitization testing.

Hypoxic preconditioning-induced autophagy enhances survival of engrafted endothelial progenitor cells in ischaemic limb.

Recent clinical studies have suggested that endothelial progenitor cells (EPCs) transplantation provides a modest benefit for treatment of the ischaemic diseases such as limb ischaemia. However, cell-based therapies have been limited by poor survival of the engrafted cells. This investigation was designed to establish optimal hypoxia preconditioning and evaluate effects of hypoxic preconditioning-induced autophagy on survival of the engrafted EPCs. Autophagy of CD34+ VEGFR-2+ EPCs isolated from rat bone marrow increased after treatment with 1% O2 . The number of the apoptotic cells in the hypoxic cells increased significantly after autophagy was inhibited with 3-methyladenine. According to balance of autophagy and apoptosis, treatment with 1% O2 for 2 hrs was determined as optimal preconditioning for EPC transplantation. To examine survival of the hypoxic cells, the cells were implanted into the ischaemic pouch of the abdominal wall in rats. The number of the survived cells was greater in the hypoxic group. After the cells loaded with fibrin were transplanted with intramuscular injection, blood perfusion, arteriogenesis and angiogenesis in the ischaemic hindlimb were analysed with laser Doppler-based perfusion measurement, angiogram and the density of the microvessels in histological sections, respectively. Repair of the ischaemic tissue was improved significantly in the hypoxic preconditioning group. Loading the cells with fibrin has cytoprotective effect on survival of the engrafted cells. These results suggest that activation of autophagy with hypoxic preconditioning is an optimizing strategy for EPC therapy of limb ischaemia.