Comparative efficacy and safety of tenofovir amibufenamide vs tenofovir alafenamide in the initial 48-week treatment of high viral load chronic hepatitis B: A single-centre retrospective study.

BACKGROUND/AIM: Tenofovir amibufenamide (TMF) employs innovative ProTide technology and a methylation strategy to enhance the lipid solubility and plasma stability of the amide bond, providing advantages over tenofovir alafenamide (TAF). Despite promising Phase III clinical trial results demonstrating its antiviral efficacy, real-world data on TMF remains scarce. This study evaluates the antiviral efficacy and safety of TMF compared to TAF as the initial treatment in patients with high viral loads of chronic hepatitis B (CHB). METHODS: We retrospectively collected clinical data from March 1 2022 to June 30 2022 for highly viremic CHB patients who received either TMF (n = 58) or TAF (n = 32) as their initial monotherapy at Beijing YouAn Hospital. To understand the efficacy and safety of TMF over 48 weeks, we compared the virological response rates and HBeAg/HBsAg serological clearance rates between TMF and TAF groups. Also, the changes in serum creatinine, eGFR and serum lipid levels were assessed. RESULTS: Baseline median HBV DNA levels were 7.85 (6.89, 8.36) IgIU/ml for TMF and 7.44 (6.89, 8.03) IgIU/ml for TAF. Median ALT levels were 102.0 (56.0, 210.0) U/L for TMF and 195.0 (73.5, 371.0) U/L for TAF, with HBeAg positivity rates of 70.7% and 75.0%, respectively. At 48 weeks, virological response rates (HBV DNA <10 IU/ml) were 43.5% (20/46) for TMF and 42.9% (12/28) for TAF (p = 1.000). ALT normalization rates were 87.9% for TMF and 90.6% for TAF (p = .969), and HBeAg serological clearance rates were 21.1% and 18.2%, respectively (p = 1.000). No patients achieved HBsAg clearance. Compared with the baseline, LDL-C levels increased, while eGFR decreased, with no significant differences in serum creatinine, triglycerides and total cholesterol levels noted at week 48 for both TMF and TAF groups. CONCLUSION: TMF demonstrates comparable antiviral efficacy to TAF when used as initial therapy in highly viremic CHB patients, with similar impacts on renal function and lipid profiles.

CLigOpt: controllable ligand design through target-specific optimization.

MOTIVATION: A key challenge in deep generative models for molecular design is to navigate random sampling of the vast molecular space, and produce promising molecules that strike a balance across multiple chemical criteria. Fragment-based drug design (FBDD), using fragments as starting points, is an effective way to constrain chemical space and improve generation of biologically active molecules. Furthermore, optimization approaches are often implemented with generative models to search through chemical space, and identify promising samples which satisfy specific properties. Controllable FBDD has promising potential in efficient target-specific ligand design. RESULTS: We propose a controllable FBDD model, CLigOpt, which can generate molecules with desired properties from a given fragment pair. CLigOpt is a variational autoencoder-based model which utilizes co-embeddings of node and edge features to fully mine information from molecular graphs, as well as a multi-objective Controllable Generation Module to generate molecules under property controls. CLigOpt achieves consistently strong performance in generating structurally and chemically valid molecules, as evaluated across six metrics. Applicability is illustrated through ligand candidates for hDHFR and it is shown that the proportion of feasible active molecules from the generated set is increased by 10%. Molecular docking and synthesizability prediction tasks are conducted to prioritize generated molecules to derive potential lead compounds. AVAILABILITY AND IMPLEMENTATION: The source code is available via  https://github.com/yutongLi1997/CLigOpt-Controllable-Ligand-Design-through-Target-Specific-Optimisation.

Clinical profiles and related factors in tuberculosis patients with positive sputum smear mycobacterium tuberculosis tests.

The aim of this study was to explore the related factors linked to the development and infectivity of tuberculosis. This was achieved by comparing the clinical characteristics of patients with pulmonary tuberculosis (TB) who tested positive in smear Mycobacterium tuberculosis tests with this who tested negative in smear mycobacterium tests but positive in sputum Gene Xpert tests. We gathered clinical data of 1612 recently hospitalized patients diagnosed with pulmonary tuberculosis who tested positive either in sputum Gene-Xpert test or sputum smear Mycobacterium tuberculosis tests. The data was collected from January 1, 2018 to August 5, 2023, at Sichuan Provincial People's Hospital. We conducted separately analyzes and comparisons of the clinical characteristics between the two groups of patients, aiming to discussed the related factors influencing the development and infectivity of tuberculosis. In comparison to the GeneXpert positive group, the sputum smear positive group exhibited a higher proportion of elderly patients (aged 75-89) and individuals classified as underweight (BMI < 18.5 kg/m2). Furthermore, this group was more prone to experiencing symptoms such as weight loss, coughing and sputum production, hemoptysis, shortness of breath, and difficulty breathing. Moreover, they are also more likely to develop extrapulmonary tuberculosis, such as tuberculous meningitis, tuberculous pleurisy, and tuberculous peritonitis. These clinical features, when present, not only increase the likelihood of a positive result in sputum smear tests but also suggest a high infectivity of pulmonary tuberculosis. Elderly individuals (aged 75 to 89) who are underweight (BMI < 18.5 kg/m2), display symptom of cough, expectoration, hemoptysis and dyspnea-particularly cough and expectoration-and those with extra pulmonary tuberculosis serve as indicators of highly infectious pulmonary tuberculosis patients. These patients may present with more severe condition, carrying a higher bacteria, and being more prone to bacterial elimination. Identification of these patients is crucial, and prompt actions such as timely and rapid isolation measures, cutting off transmission routes, and early empirical treatment of tuberculosis are essential to control the development of the disease.

Precision mapping of snail habitat in lake and marshland areas: Integrating environmental and textural indicators using Random Forest modeling.

Schistosomiasis japonica continues to pose a significant public health challenge in China, primarily due to the widespread distribution of Oncomelania hupensis, the sole intermediate host of Schistosoma. This study aims to address the constraints of existing remote sensing analyses for identifying snail habitats, which frequently neglect spatial scale and seasonal variations. To this end, we adopt a multi-source data-driven Random Forest approach that integrates bottomland and ground-surface texture data with traditional environmental variables, enhancing the accuracy of snail habitat assessments. We developed four distinct models for the lake and marshland areas of Guichi, China: a baseline model incorporating ground-surface texture, bottomland variables, and environmental variables; Model 1 with only environmental variables; Model 2 adding ground-surface texture and environmental variables; and Model 3 integrating bottomland with environmental variables. The baseline model outperformed the others, achieving a true skill statistic of 0.93, an accuracy of 0.97, a kappa statistic of 0.94, and an area under the curve of 0.99. Our analysis pinpointed critical high-risk snail habitats distributed in a belt-like pattern along major water bodies, near the Yangtze River, QiuPu River, and around Shengjin Lake, Jiuhua River, and Qingtong River. These insights can aid local health authorities in more efficiently allocating limited resources, developing effective snail surveillance and control strategies to combat schistosomiasis. Additionally, this approach can be adapted to localize other endemic hosts with similar ecological characteristics.

Human adipose mesenchymal stem cell-derived exosomes alleviate fibrosis by restraining ferroptosis in keloids.

Background: Keloid is a fibroproliferative disease with unsatisfactory therapeutic effects and a high recurrence rate. exosomes produced by adipose-derived mesenchymal stem cells (ADSC-Exos) have attracted significant interest due to their ability to treat fibrosis. However, the molecular mechanisms of ADSC-Exos in keloids remain inconclusive. Objective: Our study revealed the relationship between ferroptosis and fibrosis in keloids. Subsequently, this study aimed to explore further the anti-fibrotic effect of ADSC-Exos on keloids through ferroptosis and the potential underlying mechanisms. Methods: To investigate the impact of ferroptosis on keloid fibrosis, Erastin and ferrostatin-1 (fer-1) were utilized to treat keloid fibroblast. Keloid keloids treated with Erastin and fer-1 were cocultured with ADSC-Exos to validate the impact of ferroptosis on the effect of ADSC-Exos on keloid anti-ferrotic protein, peroxidase 4 (GPX4) and anti-fibrotic effects in vivo and in vitro by Western blot, as well as variations in iron metabolite expression, malondialdehyde (MDA), liposomal peroxidation (LPO) and glutathione (GSH) were analyzed. The effect of solute carrier family 7-member 11 (SLC7A11) silencing on ADSC-Exo-treated keloid fibroblast was investigated. Results: Iron metabolite dysregulation was validated in keloids. Fibrosis progression is enhanced by Erastin-induced ferroptosis. The anti-fibrotic effects of ADSC-Exos and fer-1 are related to their ability to prevent iron metabolism. ADSC-Exos effectively suppressed keloid fibrosis progression and increased GSH and GPX4 gene expression. Additionally, the use of Erastin limits the effect of ADSC-Exos in keloids. Furthermore, the effect of ADSC-Exos on keloids was associated with SLC7A11-GPX4 signaling pathway. Conclusion: We demonstrated a new potential mechanism by which anti-ferroptosis inhibits the progression of keloid fibrosis and identified an ADSC-Exo-based keloid therapeutic strategy. Resisting the occurrence of ferroptosis and the existence of the SLC7A11-GPX4 signaling pathway might serve as a target for ADSC-Exos.

Quantitative comparison of single-cell RNA sequencing versus single-molecule RNA imaging for quantifying transcriptional noise.

Stochastic fluctuations (noise) in transcription generate substantial cell-to-cell variability. However, how best to quantify genome-wide noise, remains unclear. Here we utilize a small-molecule perturbation (IdU) to amplify noise and assess noise quantification from numerous scRNA-seq algorithms on human and mouse datasets, and then compare to noise quantification from single-molecule RNA FISH (smFISH) for a panel of representative genes. We find that various scRNA-seq analyses report amplified noise, without altered mean-expression levels, for ~90% of genes and that smFISH analysis verifies noise amplification for the vast majority of genes tested. Collectively, the analyses suggest that most scRNA-seq algorithms are appropriate for quantifying noise including a simple normalization approach, although all of these systematically underestimate noise compared to smFISH. From a practical standpoint, this analysis argues that IdU is a globally penetrant noise-enhancer molecule-amplifying noise without altering mean-expression levels-which could enable investigations of the physiological impacts of transcriptional noise.

Community efficacy for non-communicable disease management (COEN): Conceptualization and measurement.

The importance of community-based non-communicable disease (NCD) management has been internationally recognized. However, currently, no instrument is available to evaluate a community's ability to provide NCD management for its residents. This study defined such an ability as "Community Efficacy for NCD Management" (COEN), and aimed to conceptualize, develop and validate a scale to measure COEN. We first conducted literature review, expert interviews, and Delphi panels to conceptualize COEN and select scale items. Then, we conducted two rounds of community surveys and interviews to validate the COEN scale among local residents in three cities in China. We used Cronbach's alpha to test the scale's internal consistency, Kappa test for test-retest reliability, and exploratory factor analysis for structural validity. COEN was conceptualized as "the ability of a community to provide NCD management for its residents, reflected by its natural environment, social relationships, community resources, health services, and resident-engaging activities." The first community research among 345 residents yielded a 38-item COEN scale with high internal consistency (Cronbach's alpha = 0.86) and acceptable test-retest reliability (Kappa value >0.2). The second community research tested a shortened COEN scale among 657 residents, yielding a final COEN scale with 14 items from five factors: community management (n = 3), social relationships (n = 4), resource accessibility (n = 3), community health services (n = 2), and resident engagement (n = 2), with an overall Cronbach's alpha of 0.79. COEN is a meaningful concept in contextualizing and evaluating NCD management anchored in the community, and the COEN scale is a multi-domain reliable tool to quantify COEN, which can be used to guide future related research and practice in public health.

Different viral effectors hijack TCP17, a key transcription factor for host Auxin synthesis, to promote viral infection.

Auxin is an important class of plant hormones that play an important role in plant growth development, biotic stress response, and viruses often suppress host plant auxin levels to promote infection. However, previous research on auxin-mediated disease resistance has focused mainly on signaling pathway, and the molecular mechanisms of how pathogenic proteins manipulate the biosynthetic pathway of auxin remain poorly understood. TCP is a class of plant-specific transcription factors, of which TCP17 is a member that binds to the promoter of YUCCAs, a key rate-limiting enzyme for auxin synthesis, and promotes the expression of YUCCAs, which is involved in auxin synthesis in plants. In this study, we reported that Tomato spotted wilt virus (TSWV) infection suppressed the expression of YUCCAs through its interaction with TCP17. Further studies revealed that the NSs protein encoded by TSWV disrupts the dimerization of TCP17, thereby inhibit its transcriptional activation ability and reducing the auxin content in plants. Consequently, this interference inhibits the auxin response signal and promotes the TSWV infection. Transgenic plants overexpressing TCP17 exhibit resistance against TSWV infection, whereas plants knocking out TCP17 were more susceptible to TSWV infection. Additionally, proteins encoded by other RNA viruses (BSMV, RSV and TBSV) can also interact with TCP17 and interfere with its dimerization. Notably, overexpression of TCP17 enhanced resistance against BSMV. This suggests that TCP17 plays a crucial role in plant defense against different types of plant viruses that use viral proteins to target this key component of auxin synthesis and promote infection.

A solar-driven nanocellulose Janus aerogel with excellent floating stability and dual functions of oil-water separation and photocatalytic degradation of organic pollutants.

Effective and practical cleanup of viscous crude oil spills is extremely important in real harsh marine environments. Herein, we designed a solar-driven, nanocellulose-based Janus aerogel (Janus-A) with excellent floating stability and dual function of oil-water separation and degradation of aqueous organic pollutants. Janus-A, with its amphiprotic nature, was prepared through polypyrrole (PPy) deposition, freeze-drying, octyltrichlorosilane (OTS) impregnation, TiO2 spraying on the bottom surface, and UV irradiation treatment. The photothermal conversion effect of PPy coating raised the surface temperature of aerogel to 75.8 °C within 6 min under one simulated solar irradiation, which greatly reduced the viscosity of the crude oil and increased the absorption capacity of the aerogel to 36.7 g/g. Benefiting from the balance between the buoyancy generated by the hydrophobic part and water absorption of the hydrophilic part, Janus-A showed excellent floating stability under simulated winds and waves. In addition, Janus-A exhibited high degradation efficiency for organic pollutants in water owing to the synergistic photocatalytic properties of TiO2 and PPy. These excellent performances make Janus-A ideal for integrated water-oil separation and water remediation.

A brain cell atlas integrating single-cell transcriptomes across human brain regions.

While single-cell technologies have greatly advanced our comprehension of human brain cell types and functions, studies including large numbers of donors and multiple brain regions are needed to extend our understanding of brain cell heterogeneity. Integrating atlas-level single-cell data presents a chance to reveal rare cell types and cellular heterogeneity across brain regions. Here we present the Brain Cell Atlas, a comprehensive reference atlas of brain cells, by assembling single-cell data from 70 human and 103 mouse studies of the brain throughout major developmental stages across brain regions, covering over 26.3 million cells or nuclei from both healthy and diseased tissues. Using machine-learning based algorithms, the Brain Cell Atlas provides a consensus cell type annotation, and it showcases the identification of putative neural progenitor cells and a cell subpopulation of PCDH9high microglia in the human brain. We demonstrate the gene regulatory difference of PCDH9high microglia between hippocampus and prefrontal cortex and elucidate the cell-cell communication network. The Brain Cell Atlas presents an atlas-level integrative resource for comparing brain cells in different environments and conditions within the Human Cell Atlas.

Patient, family, and community factors associated with medication adherence among people with hypertension or diabetes: A cross-sectional analysis.

Background: While suboptimal medication adherence remains an obstacle to the management of hypertension and diabetes in China, few studies have investigated associated factors with medication adherence on different dimensions simultaneously. Objective: To systematically examine associated patient, family, and community factors with suboptimal medication adherence among people with hypertension and/or type 2 diabetes in China. Methods: The study stratified a random sample of 622 adults aged 45 years or older with hypertension and/or type 2 diabetes from three southeast cities in China in 2019. Trained interviewers used the Morisky Green Levine Medication Adherence Scale, Self-Efficacy to Manage Chronic Disease (SEMCD) Scale, and the Family Adaptability, Partnership, Growth, Affection, and Resolve (APGAR) Scale to assess medication adherence, self-efficacy, and family function, respectively. Participants also reported their perceived satisfaction with community health services (quantity, quality, affordability, and overall acceptance). The study used the multivariable logistic regression to assess the association of patient, family, and community factors with suboptimal medication adherence. Results: Among the participants, 42.9% reported suboptimal medication adherence. In the multivariable logistic regression model, male participants (odds ratio [OR] = 0.55, p = 0.001) had higher medication adherence compared to females. Having a self-efficacy score that was lower than or equal to the sample mean was significantly associated with lower adherence (OR = 1.44, p = 0.039). Participants unsatisfied with the affordability of community health services and medicine had lower adherence (OR = 2.18, p = 0.028) than those neutral or satisfied. There were no significant associations between family function and medication adherence. Conclusions: Sex, self-efficacy, and perceived affordability of community health services were important factors associated with medication adherence. Healthcare professionals are recommended to consider multiple factors and leverage services and resources in community health centers when promoting medication adherence.

Enhancing aqueous zinc-ion energy storage performance with ion-mediating carbon quantum dots-modified separators regulating zinc deposition behavior.

Aqueous zinc-ion batteries (AZIBs) hold promising applications owing to their safety, cost-effectiveness, and competitive capacity. However, issues such as zinc dendritic formation and side reactions severely impede their practical viability. Utilizing carbon quantum dots (CQDs) to modify cheap, tenacious, and highly hydrophilic filter paper (FP) as separator effectively improves the electrochemical performance of zinc ion energy storage systems. The structured arrangement of CQDs redistributes zinc ion transport and induces uniform zinc icon deposition, thereby improving zinc ion reaction kinetics. Moreover, the rich functional groups on the surface of CQDs readily form hydrogen bonds with active H2O, further inhibiting corrosion reactions. With the assistance of CQDs, the FP-CQDs separator maintains high ionic conductivity and a high zinc-ion transference number, ensuring dendrite-free and corrosion-resistant operation with high coulombic efficiency and a prolonged lifespan of 1200 h at 1 mA cm-2. Zn//AC hybrid capacitors incorporating FP-CQDs separator demonstrate superior capacity retention compared to those using FP separator alone, with a high capacity retention after 600 cycles at 1 A/g, while Zn//V2O5 full batteries also exhibit excellent cycling stability. Given these findings, this study presents a new composite separator for advanced aqueous zinc-ion energy storage systems.

Effect of Alleviating Preoperative Anxiety on Gastrointestinal Function Recovery After Laparoscopic High Ligation of the Hernia Sac in Children with Indirect Inguinal Hernia.

Purpose: Anxiety and depression can affect the physiology of the gastrointestinal tract through the brain-gut axis, causing gastrointestinal dysfunction, which is mainly manifested as indigestion, diarrhoea, constipation, or abdominal pain. Preoperative anxiety arises in children due to separation from parents, fear of unfamiliar surroundings and anaesthesia and surgical procedures.To discuss the effect of alleviating preoperative anxiety on postoperative recovery of gastrointestinal function in children with indirect inguinal hernia after laparoscopic high ligation of the hernia sac. Patients and Methods: 90 children with laparoscopic high ligation of the herniated sac in oblique inguinal hernia were randomly divided into control group (Group C) and experimental group (Group M). The Group M was given midazolam oral solution 0.5mg/kg (maximum dose 20mg), and The Group C was given 5% glucose solution with the same dose.Primary outcome was the time to first postoperative defecation and I-FEED scores.The secondary outcomes included mYPAS-SF scores; child sedation scores; child-parent separation scores; parental STAI scores;PHBQ scores;FLACC scores, operative time, and fluid input and surgeon job satisfaction. Results: Compared with Group C, there was a shorter time to first postoperative defecation (P < 0.05), and lower I-FEED scores on postoperative day 1 (P < 0.05). The mYPAS-SF scores, which were significantly different in Group M at T1, T2, and T3 (P < 0.05), parental STAI scores at S1, child sedation scores and child-parent separation scores in T1, and surgeon job satisfaction between the two groups were significantly different (P < 0.05). There were no statistically significant differences in I-FEED scores on days 2 and 3, PHBQ scores, FLACC scores, operative time, and fluid input between the two groups of children (P > 0.05). Conclusion: Preoperative application of midazolam oral solution to relieve preoperative anxiety helps to promote the recovery of postoperative gastrointestinal function in children with indirect inguinal hernia and increases the surgeon job satisfaction.

Readmissions in Sepsis Survivors: Discharge Setting Risks.

BACKGROUND: Sepsis is a complex condition with high morbidity and mortality. Prompt treatment can improve survival, but for survivors the risk of deterioration and readmission remains high. Little is known about the association between discharge setting and readmission among sepsis survivors. OBJECTIVE: To examine 30-day hospital readmission rates in adult sepsis survivors by the type of setting to which patients were discharged. METHODS: The Medical Information Mart for Intensive Care database was used to identify adult sepsis survivors and evaluate 30-day readmission by discharge setting. A χ2 contingency analysis was used with each factor and presence/absence of readmission. The Kruskal-Wallis test was used to compare readmissions across discharge settings. RESULTS: From our sample (N = 7107; mean age 66.5 years; 46.2% women), 23.6% (n = 1674) were readmitted within 30 days and of those readmitted, 30% were readmitted between 1 and 3 times. Discharge setting (P < .001) and age (P = .02) were significantly associated with readmission, but sex, ethnicity, and insurance type were not. High numbers of readmissions were seen in patients discharged to skilled nursing facilities (29.6%), home health care (26.9%), and home (15.0%). Similar high comorbidity burden and acuteness of illness were seen in patients discharged to these settings. CONCLUSIONS: Sepsis survivors discharged to skilled nursing facilities, home health care, and home are at high risk for 30-day readmission. The rates of readmission from home health care and home settings were alarming. Often patients are discharged to inappropriate settings, placing them at risk for residual sepsis and readmission. Future research should focus on appropriate timing of hospital discharge and transition to the most appropriate discharge setting.

A mitochondria-targeted fluorescent sensor for imaging endogenous peroxynitrite changes in acute lung injury.

Acute lung injury (ALI) is a serious pulmonary inflammatory disease resulting from excessive reactive oxygen species (ROS) which could cause the damage of the alveolar epithelial cells and capillary endothelial cells. Peroxynitrite, as one of short-lived reactive oxygen species, is closely related to the process of ALI. Thus, it is important to monitor the fluctuation of peroxynitrite in living system for understanding the process of ALI. Herein, the novel mitochondria-targeted fluorescent probe BHMT was designed to respond to peroxynitrite and pH with distinct fluorescence properties respectively. The absorption spectrum of the probe BHMT exhibited a notable red shift as the pH value declined from 8.8 to 2.6. Upon reaction with peroxynitrite, BHMT had a significant increase of fluorescence intensity (63-fold) with maintaining a detection limit of only 43.7 nM. Furthermore, BHMT could detect the levels of endogenous peroxynitrite and image the intracellular pH in ratiometric channels utilizing cell imaging. In addition, BHMT was successfully applied to revealing the relationship between the peroxynitrite and the extent of ALI. Thus, these results indicated the probe BHMT could be a potential tool for diagnosing the early stage of ALI and revealed the peroxynitrite was likely to be a crucial therapeutic target in ALI treatment.

Computed tomography radiomics study of invasion and instability of lung adenocarcinoma manifesting as ground glass nodule.

Background: Ground-glass nodule (GGN) is the most common manifestation of lung adenocarcinoma on computed tomography (CT). Clinically, the success rate of preoperative diagnosis of GGN by puncture biopsy and other means is still low. The aim of this study is to investigate the clinical and radiomics characteristics of lung adenocarcinoma presenting as GGN on CT images using radiomics analysis methods, establish a radiomics model, and predict the classification of pathological tissue and instability of GGN type lung adenocarcinoma. Methods: This study retrospectively collected 249 patients with 298 GGN lesions who were pathologically confirmed of having lung adenocarcinoma. The images were imported into the Siemens scientific research prototype software to outline the region of interest and extract the radiomics features. Logistic model A (a radiomics model to identify the infiltration of lung adenocarcinoma manifesting as GGNs) was established using features after the dimensionality reduction process. The receiver operating characteristic (ROC) curve of the model on training set and the verification set was drawn, and the area under the curve (AUC) was calculated. Second, a total of 112 lesions were selected from 298 lesions originating from CT images of at least two occasions, and the time between the first CT and the preoperative CT was defined as not less than 90 days. The mass doubling time (MDT) of all lesions was calculated. According to the different MDT diagnostic thresholds instability was predicted. Finally, their AUCs were calculated and compared. Results: There were statistically significant differences in age and lesion location distribution between the "noninvasive" lesion group and the invasive lesion group (P<0.05), but there were no statistically significant differences in sex (P>0.05). Model A had an AUC of 0.89, sensitivity of 0.75, and specificity of 0.86 in the training set and an AUC of 0.87, sensitivity of 0.63, and specificity of 0.90 in the validation set. There was no significant difference statistically in MDT between "noninvasive" lesions and invasive lesions (P>0.05). The AUCs of radiomics models B1, B2 and B3 were 0.89, 0.80, and 0.81, respectively; the sensitivities were 0.71, 0.54, and 0.76, respectively; the specificities were 0.83, 0.77, and 0.60, respectively; and the accuracies were 0.78, 0.65, and 0.69, respectively. Conclusions: There were statistically significant differences in age and location of lesions between the "noninvasive" lesion group and the invasive lesion group. The radiomics model can predict the invasiveness of lung adenocarcinoma manifesting as GGNs. There was no significant difference in MDT between "noninvasive" lesions and invasive lesions. The radiomics model can predict the instability of lung adenocarcinoma manifesting as GGN. When the threshold of MDT was set at 813 days, the model had higher specificity, accuracy, and diagnostic efficiency.

A randomized phase 2b study of subcutaneous PD-L1 antibody ASC22 in virally-suppressed, HBeAg negative chronic hepatitis B patients.

BACKGROUND AIMS: Studies have shown that blocking the PD-1/PD-L1 pathway may lead to a potential cure for HBV infections. ASC22 (Envafolimab) is a humanized, single-domain PD-L1 antibody administered subcutaneously. This study aimed to evaluate the efficacy and safety of ASC22 in virally suppressed chronic hepatitis B (CHB) patients on nucleos(t)ide analogs (NAs). APPROACH AND RESULTS: This randomized, single-blind, phase IIb trial enrolled CHB patients in two cohorts for a 24-week treatment with ASC22 or placebo (PBO) once every 2 weeks and 24-week follow-up. In total, 60, 59, and 30 patients were treated with 1.0, 2.5 mg/kg ASC22 and PBO, respectively. The mean HBsAg changes from baseline at week 24 and 24 week follow-up periods were -0.309 (p<0.001) and -0.272 (p<0.023) log10 IU/mL in the 1.0 mg/kg ASC22 group, -0.231 (p=0.007) and -0.205 (p=0.12) log10 IU/mL in the 2.5 mg/kg ASC22 group, and-0.003 and -0.063 log10 IU/mL in the PBO group, respectively (ITT population). Three out of ten patients with baseline HBsAg levels ≤100 IU/mL in the 1.0 mg/kg group obtained on-treatment HBsAg loss. Most AEs were mild (97.9%). There were no study drug-related serious AEs in the 1.0 mg/kg ASC22 group. CONCLUSIONS: Subcutaneous administration of 1.0 mg/kg ASC22 Q2W for 24 weeks was shown to be safe and well tolerated in virally suppressed CHB patients on NAs and can induce HBsAg decline, especially in patients with HBsAg ≤100 IU/mL.

Alteration of ß-glucan in the emerging fungal pathogen Candida auris leads to immune evasion and increased virulence.

Candida auris is an emerging pathogenic yeast that has been categorized as a global public health threat and a critical priority among fungal pathogens. Despite this, the immune response against C. auris infection is still not well understood. Hosts fight Candida infections through the immune system that recognizes pathogen-associated molecular patterns such as ß-glucan, mannan, and chitin on the fungal cell wall. In this study, levels of ß-glucan and mannan exposures in C. auris grown under different physiologically relevant stimuli were quantified by flow cytometry-based analysis. Lactate, hypoxia, and sublethal concentration of fluconazole trigger a decrease in surface ß-glucan while low pH triggers an increase in ß-glucan. There is no inverse pattern between exposure levels of ß-glucan and mannan in the cell wall architecture among the three clades. To determine the effect of cell wall remodeling on the immune response, a phagocytosis assay was performed, followed by quantification of released cytokines by ELISA. Lactate-induced decrease in ß-glucan leads to reduced uptake of C. auris by PMA-differentiated THP-1 and RAW 264.7 macrophages. Furthermore, reduced production of CCL3/MIP-1⍺ but not TNF-⍺ and IL-10 were observed. An in vivo infection analysis using silkworms reveals that a reduction in ß-glucan triggers an increase in the virulence of C. auris. This study demonstrates that ß-glucan alteration occurs in C. auris and serves as an escape mechanism from immune cells leading to increased virulence.

Diagnostic efficacy of absolute and relative myocardial blood flow of stress dynamic CT myocardial perfusion for detecting myocardial ischemia in patients with hemodynamically significant coronary artery disease.

Introduction: Stress dynamic computed tomography myocardial perfusion imaging (CT-MPI) is an accurate quantitative method for diagnosing myocardial ischemia in coronary artery disease (CAD). However, its clinical application has been limited, partly due to the varied cutoff values for absolute myocardial blood flow (MBFa) and the uncertain value of the relative myocardial blood flow ratio (MBF-ratio). This study aimed to compare the diagnostic efficacy of and investigate the optimal cutoff values for MBFa and the MBF-ratio in CT-MPI for diagnosing myocardial ischemia in patients with hemodynamically significant CAD. Methods: Patients with suspected or known hemodynamically significant CAD who underwent CT-MPI + CT angiography and invasive coronary angiography (ICA)/fractional flow reserve (FFR) between October 2020 and December 2023 were retrospectively evaluated. ICA ≥80% or FFR ≤0.8 were set as the diagnostic standards for functional ischemia. The patients and vessels were categorized into ischemic and non-ischemic groups, and differences in MBFa and the MBF-ratio were compared between the groups. The area under the curve (AUC) and optimal cutoff values were calculated. Diagnostic efficacy parameters, such as sensitivity, specificity, and accuracy, were also compared. In addition, a consistency test was performed. Results: A total of 46 patients (mean age: 65.37 ± 8.25 years; 120 vessels) were evaluated. Hemodynamically significant stenosis was detected in 30/46 patients (48%) and 81/120 vessels (67.5%). The MBFa and MBF-ratio values were significantly lower in the ischemic than in the non-ischemic group; in the per-vessel analysis, the MBFa values were 73 vs. 128 (P < 0.001) and the MBF-ratio values were 0.781 vs. 0.856 (P < 0.001), respectively. The optimal cutoff values for MBFa and the MBF-ratio were 117.71 and 0.67, respectively. MBFa demonstrated a sensitivity, specificity, accuracy, AUC, positive predictive value, negative predictive value, and kappa value of 97.44%, 74.07%, 81.66%, 0.936 [95% confidence interval (CI): 0.876-0.973, P < 0.001], 63.33%, 98.36%, and 0.631 (95% CI: 0.500-0.762), respectively. The corresponding values for the MBF-ratio were 92.31%, 85.19%, 87.5%, 0.962 (95% CI: 0.911-0.989, P < 0.001), 75%, 95.83%, and 0.731 (95% CI: 0.606-0.857, P < 0.001), with no significant difference (P = 0.1225). Conclusion: Both MBFa and the MBF-ratio exhibit excellent diagnostic performance for myocardial ischemia in patients with hemodynamically significant CAD. The MBF-ratio is more robust than MBFa for interpreting CT-MPI findings in clinical practice, which is useful for radiologists and clinicians implementing CT-MPI.

Effect of Urolithin A on the Improvement of Circadian Rhythm Dysregulation in Intestinal Barrier Induced by Inflammation.

Circadian rhythm plays an important role in intestinal homeostasis and intestinal immune function. Circadian rhythm dysregulation was reported to induce intestinal microbiota dysbiosis, intestinal barrier disruption, and trigger intestinal inflammation. However, the relationship between intestinal microbiota metabolites and the circadian rhythm of the intestinal barrier was still unclear. Urolithin A (UA), a kind of intestinal microbial metabolite, was selected in this study. Results showed UA influenced on the expression rhythm of the clock genes BMAL1 and PER2 in intestinal epithelial cells. Furthermore, the study investigated the effects of UA on the expression rhythms of clock genes (BMAL1 and PER2) and tight junctions (OCLN, TJP1, and CLND1), all of which were dysregulated by inflammation. In addition, UA pre-treatment by oral administration to female C57BL/6 mice showed the improvement in the fecal IgA concentrations, tight junction expression (Clnd1 and Clnd4), and clock gene expression (Bmal1 and Per2) in a DSS-induced colitis model induced using DSS treatment. Finally, the Nrf2-SIRT1 signaling pathway was confirmed to be involved in UA's effect on the circadian rhythm of intestinal epithelial cells by antagonist treatment. This study also showed evidence that UA feeding showed an impact on the central clock, which are circadian rhythms in SCN. Therefore, this study highlighted the potential of UA in treating diseases like IBD with sleeping disorders by improving the dysregulated circadian rhythms in both the intestinal barrier and the SCN.