Macrophage depletion damages hematopoiesis partially through inhibition of cell homing and expansion after hematopoietic cell transplantation.

Bone marrow macrophages (Mφ) are essential components of the bone marrow niche that regulate the function of hematopoietic stem cells. Poor graft function and inhibition of hematopoietic production can result from abnormal macrophage function; however, the underlying mechanism is unclear. Clodronate liposomes (Clo-Lip) have been used widely to deplete macrophages and study their functions. Our previous results showed that Clod-Lip-mediated clearance of macrophages plays a vital role in regulating hematopoietic reconstruction after allogeneic hematopoietic cell transplantation (HCT). In this study, using an isogenic hematopoietic stem cell transplantation model, we found that Clod-Lip-mediated clearance of macrophages suppressed hematopoietic reconstruction by inhibiting the homing process of hematopoietic cells. We also demonstrated that macrophage depletion inhibited the direct supportive effect of macrophages on hematopoietic stem and progenitor cells and erythroid differentiation but promoted the production of megakaryocytic progenitors ex vivo. We showed that macrophages increase CD49e expression on hematopoietic stem and progenitor cells (HSPCs). However, CD49e inhibitors did not support the proliferative effect of macrophages on hematopoietic cells. In contrast, macrophage E-selectin/ intercellular cell adhesion molecule-1 (ICAM-1) may be involved in directly regulating HSPCs. In conclusion, macrophage depletion with Clo-Lip partially disrupts bone marrow hematopoiesis after HCT by impeding donor cell homing and macrophage-HSPCs interactions.

A Novel Inflammatory-Nutritional Prognostic Scoring System for Patients with Diffuse Large B Cell Lymphoma.

Purpose: This study aimed to examine the predictive ability of inflammatory and nutritional markers and further establish a novel inflammatory nutritional prognostic scoring (INPS) system. Patients and Methods: We collected clinicopathological and baseline laboratory data of 352 patients with DLBCL between April 2010 and January 2023 at the First affiliated hospital of Ningbo University. Eligible patients were randomly divided into training and validation cohorts (n = 281 and 71, respectively) in an 8:2 ratio. We used the least absolute shrinkage and selection operator (LASSO) Cox regression model to determine the most important factors among the eight inflammatory-nutritional variables. The impact of INPS on OS was evaluated using the Kaplan-Meier curve and the Log rank test. A prognostic nomogram was developed based on the multivariate Cox regression method. Then, we used the concordance index (C-index), calibration plot, and time-dependent receiver operating characteristic (ROC) analysis to evaluate the prognostic performance and predictive accuracy of the nomogram. Results: Seven inflammatory-nutritional biomarkers, including neutrophil-lymphocyte ratio (NLR), prognostic nutritional index (PNI), body mass index (BMI), monocyte-lymphocyte ratio (MLR), prealbumin, C reactive protein, and D-dimer were selected using the LASSO Cox analysis to construct INPS, In the multivariate analysis, IPI-High-intermediate group, IPI-High group, high INPS were independently associated with OS, respectively. The prognostic nomogram for overall survival consisting of the above two indicators showed excellent discrimination. The C-index for the nomogram was 0.94 and 0.95 in the training and validation cohorts. The time-dependent ROC curves showed that the predictive accuracy of the nomogram for OS was better than that of the NCCN-IPI system. Conclusion: The INPS based on seven inflammatory-nutritional indexes was a reliable and convenient predictor of outcomes in DLBCL patients.

XGBoost-based machine learning test improves the accuracy of hemorrhage prediction among geriatric patients with long-term administration of rivaroxaban.

BACKGROUND: Hemorrhage is a potential and serious adverse drug reaction, especially for geriatric patients with long-term administration of rivaroxaban. It is essential to establish an effective model for predicting bleeding events, which could improve the safety of rivaroxaban use in clinical practice. METHODS: The hemorrhage information of 798 geriatric patients (over the age of 70 years) who needed long-term administration of rivaroxaban for anticoagulation therapy was constantly tracked and recorded through a well-established clinical follow-up system. Relying on the 27 collected clinical indicators of these patients, conventional logistic regression analysis, random forest and XGBoost-based machine learning approaches were applied to analyze the hemorrhagic risk factors and establish the corresponding prediction models. Furthermore, the performance of the models was tested and compared by the area under curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS: A total of 112 patients (14.0%) had bleeding adverse events after treatment with rivaroxaban for more than 3 months. Among them, 96 patients had gastrointestinal and intracranial hemorrhage during treatment, which accounted for 83.18% of the total hemorrhagic events. The logistic regression, random forest and XGBoost models were established with AUCs of 0.679, 0.672 and 0.776, respectively. The XGBoost model showed the best predictive performance in terms of discrimination, accuracy and calibration among all the models. CONCLUSION: An XGBoost-based model with good discrimination and accuracy was built to predict the hemorrhage risk of rivaroxaban, which will facilitate individualized treatment for geriatric patients.

Robo4 inhibits gamma radiation-induced permeability of a murine microvascular endothelial cell by regulating the junctions.

BACKGROUND: Hematopoietic stem cell transplantation involves irradiation preconditioning which causes bone marrow endothelial cell dysfunction. While much emphasis is on the reconstitution of hematopoietic stem cells in the bone marrow microenvironment, endothelial cell preservation is indispensable to overcome the preconditioning damages. This study aims to ascertain the role of Roundabout 4 (Robo4) in regulating irradiation-induced damage to the endothelium. METHODS: Microvascular endothelial cells were treated with γ-radiation to establish an endothelial cell injury model. Robo4 expression in the endothelial cells was manipulated employing lentiviral-mediated RNAi and gene overexpression technology before irradiation treatment. The permeability of endothelial cells was measured using qPCR, immunocytochemistry, and immunoblotting to analyze the effect on the expression and distribution of junctional molecules, adherens junctions, tight junctions, and gap junctions. Using Transwell endothelial monolayer staining, FITC-Dextran permeability, and gap junction-mediated intercellular communication (GJIC) assays, we determined the changes in endothelial functions after Robo4 gene manipulation and irradiation. Moreover, we measured the proportion of CD31 expression in endothelial cells by flow cytometry. We analyzed variations between two or multiple groups using Student's t-tests and ANOVA. RESULTS: Ionizing radiation upregulates Robo4 expression but disrupts endothelial junctional molecules. Robo4 deletion causes further degradation of endothelial junctions hence increasing the permeability of the endothelial cell monolayer. Robo4 knockdown in microvascular endothelial cells increases the degradation and delocalization of ZO-1, PECAM-1, occludin, and claudin-5 molecules after irradiation. Conversely, connexin 43 expression increases after silencing Robo4 in endothelial cells to induce permeability but are readily destroyed when exposed to 10 Gy of gamma radiation. Also, Robo4 knockdown enhances Y731-VE-cadherin phosphorylation leading to the depletion and destabilization of VE-cadherin at the endothelial junctions following irradiation. However, Robo4 overexpression mitigates irradiation-induced degradation of tight junctional proteins and stabilizes claudin-5 and ZO-1 distribution. Finally, the enhanced expression of Robo4 ameliorates the irradiation-induced depletion of VE-cadherin and connexin 43, improves the integrity of microvascular endothelial cell junctions, and decreases permeability. CONCLUSION: This study reveals that Robo4 maintains microvascular integrity after radiation preconditioning treatment by regulating endothelial permeability and protecting endothelial functions. Our results also provided a potential mechanism to repair the bone marrow vascular niche after irradiation by modulating Robo4 expression.

Tissue-specific accumulation, bioaccumulation, and depuration of liquid crystal monomers (LCMs) in adult zebrafish (Danio rerio).

This study investigated the properties of bioaccumulation, tissue-specific accumulation, and depuration of liquid crystal monomers (LCMs) in adult zebrafish (Danio rerio) exposed to a mixture of 39 LCMs for 19 days followed by depuration for 12 days. Tissue-specific accumulation of LCMs was examined at the time point of day 19, and we observed that the distribution of LCMs varied among different tissues with the following order of Σ39LCM concentrations, the intestine > brain > gill > liver > muscle. We also observed that the bioaccumulation potential of LCMs varied among LCM groups with different functional groups, and LCMs with the cyan group were prone to accumulate in zebrafish. Among the 39 target LCMs, nine exhibited bioconcentration factors (BCFs) >1000, indicating their great bioaccumulation potential in aquatic environments. The experimental BCFs of 22 LCMs in the present study were lower than the theoretical values predicted by the Estimation Programs Interface (EPI) Suite software developed by U.S. Environmental Protection Agency (USEPA), suggesting that their bioaccumulation potential might be overestimated by theoretical estimation techniques. Another interesting finding was the significant positive correlation relationship in both sexes of zebrafish (p < 0.01, r2 = 0.66 for male; p < 0.01, r2 = 0.41 for female) between logBCFww and logKow values of LCMs. Overall, this study provides fundamental information regarding the bioaccumulation potentials of LCMs, which could be helpful for further investigating the health risks of LCMs in aquatic environments.

Experimental determination of octanol-water partition coefficient (KOW) of 39 liquid crystal monomers (LCMs) by use of the shake-flask method.

Liquid crystal monomers (LCMs) were recently proposed as persistent, bioaccumulative, and toxic substances; however, there is a dearth of information regarding their experimental octanol-water partition coefficients (KOW). In the present study, we determined the experimental KOW values of these 39 LCMs by use of a classic shake-flask method. We observed that experimental KOW values of LCMs largely varied depending on their specific structures, and the Log transformed KOW generally fall in the range of 4.94-7.62. The experimental KOW values were further compared with those predicted by Estimation Programs Interface (EPI) Suite software. Interestingly, we observed that experimental and estimated Log KOW values were generally comparable for LCMs containing two benzene or cyclohexane rings; however, the estimated values gradually deviated from the experimental ones as the number of benzene or cyclohexane rings of LCM structures increased. Based on the experimental Log KOW values of 39 LCMs, we established a quantitative structure activity relationship (QSAR) model for predicting Log KOW values of other LCMs, for which authentic standards are not available. Adjusted square of determination coefficient (R2) of the developed model is 0.810, indicating its goodness-of-fit for estimation of Log KOW values of other substances with similar backbone structures. Overall, our present study provides the first insight on experimental Log KOW values of LCMs, and suggests that LCMs are inclined to accumulative in the fatty tissue of organisms in the aqueous environments.

Non-contact screening system based for COVID-19 on XGBoost and logistic regression.

BACKGROUND: The coronavirus disease (COVID-19) effected a global health crisis in 2019, 2020, and beyond. Currently, methods such as temperature detection, clinical manifestations, and nucleic acid testing are used to comprehensively determine whether patients are infected with the severe acute respiratory syndrome coronavirus 2. However, during the peak period of COVID-19 outbreaks and in underdeveloped regions, medical staff and high-tech detection equipment were limited, resulting in the continued spread of the disease. Thus, a more portable, cost-effective, and automated auxiliary screening method is necessary. OBJECTIVE: We aim to apply a machine learning algorithm and non-contact monitoring system to automatically screen potential COVID-19 patients. METHODS: We used impulse-radio ultra-wideband radar to detect respiration, heart rate, body movement, sleep quality, and various other physiological indicators. We collected 140 radar monitoring data from 23 COVID-19 patients in Wuhan Tongji Hospital and compared them with 144 radar monitoring data from healthy controls. Then, the XGBoost and logistic regression (XGBoost + LR) algorithms were used to classify the data according to patients and healthy subjects. RESULTS: The XGBoost + LR algorithm demonstrated excellent discrimination (precision = 92.5%, recall rate = 96.8%, AUC = 98.0%), outperforming other single machine learning algorithms. Furthermore, the SHAP value indicates that the number of apneas during REM, mean heart rate, and some sleep parameters are important features for classification. CONCLUSION: The XGBoost + LR-based screening system can accurately predict COVID-19 patients and can be applied in hotels, nursing homes, wards, and other crowded locations to effectively help medical staff.

Clodronate-liposomes aggravate irradiation-induced myelosuppression by promoting myeloid differentiation.

PURPOSE: Clodronate-liposomes (Clod-Lip) is an effective candidate drug for treating chronic myelomonocytic leukemia, autoimmune hemolytic anemia and immune thrombocytopenic purpura in mice experiments. But its role in hematopoietic recovery after acute myelosuppression is still unknown. We aim to explore the function and underlining mechanisms of Clod-Lip on hematopoietic reconstitution after sublethal dose irradiation in mice. MATERIALS AND METHODS: Mice at 8-10 weeks received a total-body sublethal dose γ-irradiation (TBI) and injected with Clod-Lip or PBS-Liposomes (PBS-Lip) every 4 days after TBI. The survival rate of each group was recorded. Flow cytometry was used to analyze changes in hematopoietic stem cells and their progenies in bone marrow. ELISA and RT-qPCR were used for the analysis of hematopoietic regulatory factors. Regarding IL-1ß inhibition, 25 mg/kg diacerein or an equal volume of DMSO was intraperitoneally injected into mice every day after TBI. RESULTS: In sublethal dose-irradiated mice, Clod-Lip reduced the survival rate, the total number of bone marrow and hematopoietic stem cells, delayed peripheral blood recovery of red blood cells and platelets. However, it could increase the number of CMP, MEP and myeloid cells, which suggested that Clod-Lip could induce HSC to myeloid differentiation in vivo. We further verified that Clod-Lip may induce myeloid differentiation by bone marrow microenvironmental factor IL-1ß. CONCLUSIONS: In summary, this study suggested that Clod-Lip may aggravate inhibitor effect of hematopoietic function and promote myeloid differentiation in myelosuppression mice model.

PEDF promotes the repair of bone marrow endothelial cell injury and accelerates hematopoietic reconstruction after bone marrow transplantation.

BACKGROUND: Preconditioning before bone marrow transplantation such as irradiation causes vascular endothelial cells damage and promoting the repair of damaged endothelial cells is beneficial for hematopoietic reconstitution. Pigment epithelium-derived factor (PEDF) regulates vascular permeability. However, PEDF's role in the repair of damaged endothelial cells during preconditioning remains unclear. The purpose of our study is to investigate PEDF's effect on preconditioning-induced damage of endothelial cells and hematopoietic reconstitution. METHODS: Damaged endothelial cells induced by irradiation was co-cultured with hematopoietic stem cells (HSC) in the absence or presence of PEDF followed by analysis of HSC number, cell cycle, colony formation and differentiation. In addition, PEDF was injected into mice model of bone marrow transplantation followed by analysis of bone marrow injury, HSC number and peripheral hematopoietic reconstitution as well as the secretion of cytokines (SCF, TGF-ß, IL-6 and TNF-α). Comparisons between two groups were performed by student t-test and multiple groups by one-way or two-way ANOVA. RESULTS: Damaged endothelial cells reduced HSC expansion and colony formation, induced HSC cell cycle arrest and apoptosis and promoted HSC differentiation as well as decreased PEDF expression. Addition of PEDF increased CD144 expression in damaged endothelial cells and inhibited the increase of endothelial permeability, which were abolished after addition of PEDF receptor inhibitor Atglistatin. Additionally, PEDF ameliorated the inhibitory effect of damaged endothelial cells on HSC expansion in vitro. Finally, PEDF accelerated hematopoietic reconstitution after bone marrow transplantation in mice and promoted the secretion of SCF, TGF-ß and IL-6. CONCLUSIONS: PEDF inhibits the increased endothelial permeability induced by irradiation and reverse the inhibitory effect of injured endothelial cells on hematopoietic stem cells and promote hematopoietic reconstruction.

Reference gene selection and validation for mRNA expression analysis by RT-qPCR in murine M1- and M2-polarized macrophage.

Murine bone marrow-derived macrophages (M0) and M1- and M2-polarized macrophages are being widely used as a laboratory model for polarized macrophages related molecular mechanism analysis. Gene expression analysis based on reference gene normalization using RT-qPCR was a powerful way to explore the molecular mechanism. But little is known about reference genes in these cell models. So, the goal of this study was to identify reference genes in these types of macrophages. Candidate reference genes in murine bone marrow-derived and polarized macrophages were selected from microarray data using Limma linear model method and evaluated by determining the stability value using five algorithms: BestKeeper, NormFinder, GeNorm, Delta CT method, and RefFinder. Finally, the selected stable reference genes were validated by testing three important immune and inflammatory genes (NLRP1, IL-1ß, and TNF-α) in the cell lines. Our study has clearly shown that Ubc followed by Eef1a1 and B2m respectively were recognized as the three ideal reference genes for gene expression analysis in murine bone marrow-derived and polarized macrophages. When three reference genes with strong different stability were used for validation, a large variation of a gene expression level of IL-1ß, TNF-α and NLRP1 were obtained which provides clear evidence of the need for careful selection of reference genes for RT-qPCR analysis. Normalization of mRNA expression level with Ubc rather than Actb or Gusb by qPCR in macrophages and polarized macrophages is required to ensure the accuracy of the qPCR analysis.

Online treatment compliance checking for clinical pathways.

Compliance checking for clinical pathways (CPs) is getting increasing attention in health-care organizations due to stricter requirements for cost control and treatment excellence. Many compliance measures have been proposed for treatment behavior inspection in CPs. However, most of them look at aggregated data seen from an external perspective, e.g. length of stay, cost, infection rate, etc., which may provide only a posterior impression of the overall conformance with the established CPs such that in-depth and in near real time checking on the compliance of the essential/critical treatment behaviors of CPs is limited. To provide clinicians real time insights into violations of the established CP specification and support online compliance checking, this article presents a semantic rule-based CP compliance checking system. In detail, we construct a CP ontology (CPO) model to provide a formal grounding of CP compliance checking. Using the proposed CPO, domain treatment constraints are modeled into Semantic Web Rule Language (SWRL) rules to specify the underlying treatment behaviors and their quantified temporal structure in a CP. The established SWRL rules are integrated with the CP workflow such that a series of applicable compliance checking and evaluation can be reminded and recommended during the pathway execution. The proposed approach can, therefore, provides a comprehensive compliance checking service as a paralleling activity to the patient treatment journey of a CP rather than an afterthought. The proposed approach is illustrated with a case study on the unstable angina clinical pathway implemented in the Cardiology Department of a Chinese hospital. The results demonstrate that the approach, as a feasible solution to provide near real time conformance checking of CPs, not only enables clinicians to uncover non-compliant treatment behaviors, but also empowers clinicians with the capability to make informed decisions when dealing with treatment compliance violations in the pathway execution.