G6PD maintains the VSMC synthetic phenotype and accelerates vascular neointimal hyperplasia by inhibiting the VDAC1-Bax-mediated mitochondrial apoptosis pathway.

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) plays an important role in vascular smooth muscle cell (VSMC) phenotypic switching, which is an early pathogenic event in various vascular remodeling diseases (VRDs). However, the underlying mechanism is not fully understood. METHODS: An IP‒LC‒MS/MS assay was conducted to identify new binding partners of G6PD involved in the regulation of VSMC phenotypic switching under platelet-derived growth factor-BB (PDGF-BB) stimulation. Co-IP, GST pull-down, and immunofluorescence colocalization were employed to clarify the interaction between G6PD and voltage-dependent anion-selective channel protein 1 (VDAC1). The molecular mechanisms involved were elucidated by examining the interaction between VDAC1 and apoptosis-related biomarkers, as well as the oligomerization state of VDAC1. RESULTS: The G6PD level was significantly elevated and positively correlated with the synthetic characteristics of VSMCs induced by PDGF-BB. We identified VDAC1 as a novel G6PD-interacting molecule essential for apoptosis. Specifically, the G6PD-NTD region was found to predominantly contribute to this interaction. G6PD promotes VSMC survival and accelerates vascular neointimal hyperplasia by inhibiting VSMC apoptosis. Mechanistically, G6PD interacts with VDAC1 upon stimulation with PDGF-BB. By competing with Bax for VDAC1 binding, G6PD reduces VDAC1 oligomerization and counteracts VDAC1-Bax-mediated apoptosis, thereby accelerating neointimal hyperplasia. CONCLUSION: Our study showed that the G6PD-VDAC1-Bax axis is a vital switch in VSMC apoptosis and is essential for VSMC phenotypic switching and neointimal hyperplasia, providing mechanistic insight into early VRDs.

NIR-driven multifunctional PEC biosensor based on aptamer-modified PDA/MnO2 photoelectrode for bacterial detection and inactivation.

Sensitive detection and effective inactivation of bacteria are essential in preventing foodborne bacterial infection that poses a significant threat to human health. Herein, a near-infrared (NIR)-driven multifunctional photoelectrochemical (PEC) biosensor was constructed for detection and inactivation of S. aureus. Based on the covalent bonding between amine and carboxyl groups, carboxyl-functionalized SA31 aptamer was immobilized on the PDA/MnO2 photoelectrode. In the presence of S. aureus, SA31 aptamer can specifically capture S. aureus, causing the decrease of photocurrent signal owing to steric hindrance effect. Leveraging photocurrent-off signal, there existed a satisfied linear relationship between the photocurrent variation and the logarithm of S. aureus concentration, achieving a wide linear range from 10 to 107 CFU/mL with a low detection limit of 2.0 CFU/mL. Notably, PDA/MnO2 with peroxidase-like activity facilitated the catalytic oxidation of S. aureus with assistance of hydrogen peroxide (H2O2) to cause the inactivation of S. aureus. Desorption of inactivated S. aureus from the photoelectrode led to a recovery of photocurrent signal, enabling a "signal on" switch. Simultaneously, the excellent photothermal performance of the PDA/MnO2 converted light energy into heat energy under the irradiation of NIR light (808 nm, 1.5 W/cm2), triggering the synergistic antibacterial effect against S. aureus (97.36%). This work provides a novel strategy for fabricating the detection and inactivation of bacteria in practical applications.

DFT Insight into a Strain-Release Mechanism in Bicyclo[1.1.0]butanes via Concerted Activation of Central and Lateral C-C Bonds with Rh(III) Catalysis.

Transition-metal-catalyzed, strain-release-driven transformations of "spring-loaded" bicyclo[1.1.0]butanes (BCBs) are considered potent tools in synthetic organic chemistry. Previously proposed strain-release mechanisms involve either the insertion of the central C-C bond of BCBs into a metal-carbon bond, followed by ß-C elimination, or the oxidative addition of the central or lateral C-C bond on the transition metal center, followed by reductive elimination. This study, employing DFT calculations on a Rh(III)-catalyzed model system in a three-component protocol involving oxime ether, BCB ester, and ethyl glyoxylate for constructing diastereoselective quaternary carbon centers, introduces an unusual strain-release mechanism for BCBs. In this mechanism, the catalytic reaction is initiated by the simultaneous cleavage of two C-C bonds (the central and lateral C-C bonds), resulting in the formation of a Rh-carbene intermediate. The new mechanism exhibits a barrier of 21.0 kcal/mol, making it energetically more favorable by 11.1 kcal/mol compared to the previously suggested most favorable pathway. This unusual reaction mode rationalizes experimental observation of the construction of quaternary carbon centers, including the excellent E-selectivity and diastereoselectivity. The newly proposed strain-release mechanism holds promise in advancing our understanding of transition-metal-catalyzed C-C bond activation mechanisms and facilitating the synthesis of transition metal carbene complexes.

Saxagliptin reduces the injury of Alzheimer's disease cell model by down-regulating the expression of miR-483-5p.

This study aimed to investigate the effect of saxagliptin on the injury of Alzheimer's disease (AD) cell model and its possible mechanism. SK-N-SH cells were cultured in vitro and divided into CON group, AD group, AD+L-SAX group, AD+M-SAX group, AD+H-SAX group, AD+anti-miR-NC group, AD+anti-miR-483-5p group, AD+SAX+miR-NC group and AD+SAX+miR-483-5p group. Then the levels of MDA, SOD and GSH-Px in each group were detected by ELISA method; cell apoptosis was detected by flow cytometry; the protein expression levels of Bax and Bcl-2 were detected by Western Blot; the expression level of miR-483-5p was detected by RT-qPCR. Compared with the control group, MDA content, apoptosis rate, and the expression of Bax protein and miR-483-5p increased in the AD group (P<0.05), while the activity of SOD and GSH-Px and the expression of Bcl-2 protein decreased (P<0.05). Compared with the AD group, MDA content, apoptosis rate, and the expression of Bax protein and miR-483-5p decreased in the AD+L-SAX group, AD+M-SAX group and AD+H-SAX group (P<0.05), while the activity of SOD and GSH-Px and the expression of Bcl-2 protein increased (P<0.05). Compared with AD+anti-miR-NC group, MDA content, apoptosis rate, and the expression of Bax protein and miR-483-5p decreased in the AD+anti-miR-483-5p group (P<0.05), while the activity of SOD and GSH-Px and the expression of Bcl-2 protein increased (P<0.05). Compared with AD+SAX+miR-NC group, MDA content, apoptosis rate, and the expression of Bax protein and miR-483-5p increased in the AD+SAX+miR-483-5p group (P<0.05), while the activity of SOD and GSH-Px and the expression of Bcl-2 protein decreased (P<0.05). Saxagliptin may reduce the injury of Alzheimer's disease cell model by down-regulating the expression of miR-483-5p.

Postoperative therapy for local-advanced gastric cancer: A systematic review and meta-analysis.

BACKGROUND: Adjuvant therapy after surgery is effective for the treatment of advanced gastric cancer (GC), but the regimens are not uniform, resulting in imbalanced benefits. OBJECTIVES: To compare the overall survival (OS), relapse-free survival (RFS) and disease-free survival (DFS) of patients with local-advanced GC (LAGC) after surgery plus adjuvant therapy and with surgery alone based on meta-analysis. MATERIAL AND METHODS: Literature search was performed among the articles published in the PubMed, Embase and Cochrane Library databases from January 2000 to December 2018. Study selection was conducted based on the following criteria: randomized clinical trials (RCTs) on surgery plus adjuvant therapy compared to surgery alone; studies compared OS and/or RFS/DFS; and cases medically confirmed with LAGC. Only articles in English were included. RESULTS: A total of 12 datasets from 11 randomized controlled trials (RCTs) involving 4606 patients were included in the meta-analysis. There was a significant improvement in OS of patients who underwent postoperative adjuvant therapy (HR 0.78; 95% CI: 0.72-0.84; p < 0.001). In the subgroup analysis, it showed a higher improvement in OS patients who received adjuvant chemotherapy plus immunotherapy or radiotherapy (HR 0.72; 95% CI: 0.61-0.85; p < 0.001). CONCLUSION: Adjuvant therapy led to survival benefits in patients with LAGC.

Quality assurance in a phase III, multicenter, randomized trial of POstmastectomy radioThErapy in Node posiTive breast cancer with or without Internal mAmmary nodaL irradiation (POTENTIAL): a planning benchmark case.

PURPOSE: To report the planning benchmark case results of the POTENTIAL trial-a multicenter, randomized, phase 3 trial-to evaluate the value of internal mammary nodal (IMN) irradiation for patients with high-risk breast cancer. METHODS: All participating institutions were provided the outlines of one benchmark case, and they generated radiation therapy plans per protocol. The plans were evaluated by a quality assurance team, after which the institutions resubmitted their revised plans. The information on beams arrangement, skin flash, inhomogeneity corrections, and protocol compliance was assessed in the first and final submission. RESULTS: The plans from 26 institutions were analyzed. Some major deviations were found in the first submission. The protocol compliance rates of dose coverage for the planning target volume of chest wall, supraclavicular fossa plus axilla, and IMN region (PTVim) were all significantly improved in the final submission, which were 96.2% vs. 69.2%, 100% vs. 76.9%, and 88.4% vs. 53.8%, respectively. For OARs, the compliance rates of heart Dmean, left anterior descending coronary artery V40Gy, ipsilateral lung V5Gy, and stomach V5Gy were significantly improved. In the first and final submission, the mean values of PTVim V100% were 79.9% vs. 92.7%; the mean values of heart Dmean were 11.5 Gy vs. 9.7 Gy for hypofractionated radiation therapy and 11.5 Gy vs. 11.0 Gy for conventional fractionated radiation therapy, respectively. CONCLUSION: The major deviations were corrected and protocol compliance was significantly improved after revision, which highlighted the importance of planning benchmark case to guarantee the planning quality for multicenter trials.

Exploring the Substrate-Assisted Dehydration of Chorismate Catalyzed by Dehydratase MqnA from QM/MM Calculations: The Role of Pocket Residues and the Hydrolysis Mechanism of N17D Mutant.

MqnA is the first enzyme on the futalosine pathway to menaquinone, which catalyzes the dehydration of chorismate to yield 3-enolpyruvyl-benzoate (3-EPB). MqnA is also the only chorismate dehydratase known so far. In this work, based on the recently determined crystal structures, we constructed the enzyme-substrate complex models and conducted quantum mechanics/molecular mechanics (QM/MM) calculations to elucidate the reaction details of MqnA and the critical roles of pocket residues. The calculation results confirm that the MqnA-catalyzed dehydration of chorismate follows the substrate-assisted E1cb mechanism, in which the enol carboxylate in the side chain of the substrate is responsible for deprotonating the C3 of chorismate. This proton transfer process is much slower than C4-OH departure. Calculations on different mutants reveal that S86 and N17 are important for anchoring the enol carboxylate of the substrate in a favorable conformation to extract the C3-proton. The strong H-bonds formed between the enol carboxylate of chorismate and S86/N17 play a key role in stabilizing the reaction intermediate. Consistent with the experimental observations, our calculations demonstrate that the MqnA N17D mutant also shows hydrolase activity and the typical enzyme-catalyzed hydrolysis mechanism is elucidated. The protonated D17 is responsible for saturating the methylene group of chorismate to start the hydrolysis reaction. The orientation of the carboxyl group of D17 is key in determining MqnA to be a dehydratase or hydrolase.

Tribological Properties Laser-Cladded Spherical WB-Reinforced Co-Based Coatings under Low-Temperature Friction.

Three groups of spherical WB-reinforced Co-based coatings (Co coating, Co + 15%WB coating, Co + 45%WB coating) were fabricated by laser-cladded technology. The microstructure and constituent phase of spherical WB-reinforced Co-based coatings were examined through scanning electron microscopy (SEM) with energy dispersive spectrometry (EDS) and X-ray diffraction (XRD). The low-temperature tribological properties were analyzed by coefficient of friction, 2D and 3D profiles across the wear track, and wear surface morphology, respectively. The results showed that the phases in the WB-reinforced Co-based coatings are mainly γ-Co, carbides Cr23C6 and Cr7C3, WB, and WO3. Under dry sliding friction at -20 °C, the more spherical WB, the lower the friction coefficient. The wear rate of Co + 45%WB coating was as low as 3.567 × 10-4 mm3/N·m-1, indicating the outstanding wear resistance. Abrasive wear was observed on the rough surface of the WB-added coatings. Compared with dry sliding, due to the plastic deformation of micro-convexes and lubrication function in the 3.5 wt.% NaCl solution, the wear tracks on the surfaces of the three tested coatings were shallower, exhibiting distinct elongated plough grooves.

Growth differentiation factor 7 pretreatment enhances the therapeutic capacity of bone marrow-derived mesenchymal stromal cells against cerebral ischemia-reperfusion injury.

Bone marrow-derived mesenchymal stem cells (BMSCs) transplantation is a promising therapeutic strategy for cerebral ischemia/reperfusion (I/R) injury; however, the clinical outcome is barely satisfactory and demands further improvement. The present study aimed to investigate whether preconditioning of BMSCs by recombinant human growth differentiation factor 7 (rhGDF7) could enhance its therapeutic capacity against cerebral I/R injury. Mouse BMSCs and primary neurons were co-cultured and exposed to oxygen glucose deprivation/reperfusion (OGD/R) stimulation. To investigate the role of exosomal microRNA-369-3p (miR-369-3p), inhibitors, RNAi and the miR-369-3p antagomir were used. Meanwhile, mice were intravenously injected with rhGDF7-preconditioned BMSCs and then received cerebral I/R surgery. Markers of inflammation, oxidative stress and neural damage were evaluated. To inhibit AMP-activated protein kinase (AMPK), compound C was used in vivo and in vitro. Compared with cell-free transwell or vehicle-preconditioned BMSCs, rhGDF7-preconditioned BMSCs significantly prevented OGD/R-induced inflammation, oxidative stress and neural damage in vitro. Meanwhile, rhGDF7-preconditioned BMSCs could prevent I/R-induced cerebral inflammation and oxidative stress in vivo. Mechanistically, rhGDF7 preconditioning significantly increased exosomal miR-369-3p expression in BMSCs and then transferred exosomal miR-369-3p to primary neurons, where it bound to phosphodiesterase 4 D (Pde4d) 3'-UTR and downregulated PDE4D expression, thereby preventing I/R-induced inflammation, oxidative stress and neural damage through activating AMPK pathway. Our study identify GDF7 pretreatment as a promising adjuvant reagent to improve the therapeutic potency of BMSCs for cerebral I/R injury and ischemic stroke.

Preparation of Multifunctional Nano-Molybdenum Disulfide and Its Tribological Properties in Water-Based Cutting Fluids.

In order to meet the advanced requirements of the manufacturing industry, the use of water-based cutting fluids (WCFs) in metal processing is gradually increasing. However, their lubrication performance still needs to be improved considerably. Therefore, new multifunctional molybdenum disulfide nanoparticles (m-MoS2 NPs) were developed to improve the lubricating properties of WCFs. M-MoS2 NPs modified with silver nanoparticles were prepared by an in situ surface modification. The morphology and chemical composition of the m-MoS2 NPs were characterized by scanning electron microscopy (SEM), high-resolution transmission electron microscopy (HR-TEM), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS). Furthermore, the dispersion and bactericidal properties of m-MoS2 NPs with different weight percents in WCFs were also studied experimentally. The effect of m-MoS2 NPs concentration on friction properties and their friction mechanism were investigated in this research. The results revealed that the prepared m-MoS2 NPs were all nanoscale particles with a layered structure. The dispersion and bactericidal properties of m-MoS2 NPs in WCFs were better than those of MoS2 NPs. The best dispersion and bactericidal properties were observed with 1 wt % MoS2 NPs, as well as friction reduction and antiwear properties. During friction, the two friction surfaces were in the boundary lubrication state,and the prepared m-MoS2 NPs entered the friction contact zone along with the WCFs. A friction chemical reaction film rich in MoS2 and Ag NPs was formed on the friction surface to fill and repair the worn surface, exerting a good lubrication effect.

[Analysis of Revision Content and Evaluation Attentions on Guidance for Registration of Metallic Bone Plate Internal Fixation System (Revised in 2021)].

This study briefly introduces the revised content of Guidance for Registration of Metallic Bone Plate Internal Fixation System (Revised in 2021) compared to the original guidance, mainly including the principles of dividing registration unit, main performance indicators of standard specification, physical and mechanical performance research, and clinical evaluation. At the same time, in order to provide some references for the registration of metallic bone plate internal fixation system, this study analyzes the main concerns in the review process of these products based on the accumulation of experience combining with the current review requirements.

A phase II study of concurrent involved-field radiotherapy and intrathecal chemotherapy for leptomeningeal metastasis from solid tumors.

BACKGROUND: The role of involved-field radiation therapy (IFRT) and intrathecal chemotherapy (IC) in leptomeningeal metastasis (LM) from solid tumors was gradually underestimated in the era of targeted therapy. This study was aimed to investigate the safety and effectiveness of concurrent IFRT and intrathecal methotrexate (MTX)/cytarabine (Ara-C) for LM, particularly for those who developed LM while receiving targeted therapy. MATERIALS AND METHODS: Enrolled patients were given induction IC first and then concurrent treatment, which consisted of IFRT (40 Gy total; 2 Gy/f) and IC (MTX 15 mg or Ara-C 50 mg, once per week). Primary endpoint was clinical response rate (RR). Secondary endpoints were safety and overall survival (OS). RESULTS: Fifty-three patients received induction intrathecal MTX (n = 27) or Ara-C (n = 26). Forty-two patients completed concurrent therapy. Total RR was 34% (18/53). The improvement rate of neurological symptoms and KPS scores were 72% (38/53) and 66% (35/53) respectively. Adverse events (AEs) rate was 28% (15/53). Eight patients (15%, 8/53) showed grade 3-4 AEs, including myelosuppression (n = 4) and radiculitis (n = 5). Median OS was 6.5 months (95% CI, 5.3-7.7 months). Median survival for 18 patients who had clinical response was 7.9 months (95% CI, 4.4-11.4 months), and 0.8 months (95% CI, 0.08-1.5 months) for 6 patients who had LM progression. The median survival in 22 patients who received prior targeted therapy was 6.3 months (95% CI, 4.5-8.1 months). CONCLUSION: Concurrent IFRT and intrathecal MTX or Ara-C was proved to be a feasible treatment option with an acceptable safety profile for LM from a common tumor entity.

MicroRNA-32-3p facilitates cerebral ischemia/reperfusion injury through inhibiting Cab39/AMPK.

Oxidative stress is a key pathogenic factor of cerebral ischemia/reperfusion (I/R) injury. MicroRNA-32-3p (miR-32-3p) plays critical roles in regulating ischemic diseases; however, its role in oxidative stress and cerebral I/R injury remains elusive. Primary cortical neurons and rats were treated with the agomir, antagomir and matched controls of miR-32-3p, and then received oxygen glucose deprivation/reperfusion (OGD/R) or I/R stimulation. To investigate the involvement of AMP-activated protein kinase (AMPK) and calcium-binding protein 39 (Cab39), a pharmacological inhibitor and small interfering RNA were used in vivo and in vitro. Herein, we found that miR-32-3p was upregulated in OGD/R-treated neurons and I/R-injured brains, and that inhibiting miR-32-3p by the miR-32-3p antagomir dramatically alleviated oxidative stress and neural death in OGD/R-stimulated primary cortical neurons. Conversely, overexpressing miR-32-3p by the miR-32-3p agomir further aggravated OGD/R-induced neural death and oxidative damage in primary cortical neurons. Meanwhile, we observed that the miR-32-3p antagomir prevented, while the miR-32-3p agomir facilitated neural death, oxidative damage and cerebral I/R injury in vivo. Mechanistically, miR-32-3p bound to the 3'-untranslated regions of Cab39, inhibited its protein level and subsequently inactivated AMPK. Conversely, treatment with the miR-32-3p antagomir upregulated Cab39 and activated AMPK, thereby attenuating oxidative damage and cerebral I/R injury. Moreover, inhibiting AMPK or Cab39 dramatically blocked the miR-32-3p antagomir-mediated beneficial effects against cerebral I/R injury in vivo and in vitro. miR-32-3p plays critical roles in neural death and oxidative damage upon I/R stimulation, and it is a novel target to treat cerebral I/R injury.

Targeting the neural stem cells in subventricular zone for the treatment of glioblastoma: an update from preclinical evidence to clinical interventions.

BACKGROUND: Glioblastoma is one of the most common and aggressive adult brain tumors. The conventional treatment strategy, surgery combined with chemoradiotherapy, did not change the fact that the recurrence rate was high and the survival rate was low. Over the years, accumulating evidence has shown that the subventricular zone has an important role in the recurrence and treatment resistance of glioblastoma. The human adult subventricular zone contains neural stem cells and glioma stem cells that are probably a part of reason for therapy resistance and recurrence of glioblastoma. MAIN BODY: Over the years, both bench and bedside evidences strongly support the view that the presence of neural stem cells and glioma stem cells in the subventricular zone may be the crucial factor of recurrence of glioblastoma after conventional therapy. It emphasizes the necessity to explore new therapy strategies with the aim to target subventricular zone to eradicate neural stem cells or glioma stem cells. In this review, we summarize the recent preclinical and clinical advances in targeting neural stem cells in the subventricular zone for glioblastoma treatment, and clarify the prospects and challenges in clinical application. CONCLUSIONS: Although there remain unresolved issues, current advances provide us with a lot of evidence that targeting the neural stem cells and glioma stem cells in subventricular zone may have the potential to solve the dilemma of glioblastoma recurrence and treatment resistance.

Roles of STAT3 in the pathogenesis and treatment of glioblastoma.

Glioblastoma (GBM) is the most malignant of astrocytomas mainly involving the cerebral hemispheres and the cerebral cortex. It is one of the fatal and refractory solid tumors, with a 5-year survival rate of merely 5% among the adults. IL6/JAK/STAT3 is an important signaling pathway involved in the pathogenesis and progression of GBM. The expression of STAT3 in GBM tissues is substantially higher than that of normal brain cells. The abnormal activation of STAT3 renders the tumor microenvironment of GBM immunosuppression. Besides, blocking the STAT3 pathway can effectively inhibit the growth and metastasis of GBM. On this basis, inhibition of STAT3 may be a new therapeutic approach for GBM, and the combination of STAT3 targeted therapy and conventional therapies may improve the current status of GBM treatment. This review summarized the roles of STAT3 in the pathogenesis of GBM and the feasibility of STAT3 for GBM target therapy.

Dose-Volume Predictors for Radiation Esophagitis in Patients With Breast Cancer Undergoing Hypofractionated Regional Nodal Radiation Therapy.

PURPOSE: Our objective was to assess the incidence and dose-volume predictors of radiation esophagitis (RE) in patients with breast cancer undergoing hypofractionated regional nodal irradiation. METHODS AND MATERIALS: Eligible patients who received intensity modulated radiation therapy (RT) at the chest wall, the supraclavicular/infraclavicular fossa, level II axilla, and/or the internal mammary chain after mastectomy were included. The prescribed dose was 43.5 Gy in 15 fractions. RE was evaluated weekly during RT and at 1 and 2 weeks, followed by 3 and 6 months after RT, and was graded according to National Cancer Institute Common Toxicity Criteria for Adverse Events, version 3.0. The esophagus was contoured from the lower border level of the cricoid cartilage to the lower margin of the aortic arch. Esophageal total volume, mean dose, maximum dose, and the relative volumes (RV) and absolute volumes (AV) receiving at least 5 to 45 Gy by 5-Gy increments (RV5-RV45 and AV5-AV45) were evaluated. Univariable and multivariable logistic regression analyses were performed to determine risk factors for RE, and receiver operating characteristic curves were obtained to identify the thresholds of esophageal dosimetric parameters. RESULTS: In total, 298 patients were included between May 8, 2020, and January 5, 2022 (minimum post-RT follow-up: 6 months). Grade 2 and 3 RE incidence was 40.9% (122/298) and 0.3% (1/298), respectively. No grade 4 or 5 RE was observed. Esophageal RV20-RV40 and AV35-AV40 were significantly associated with the risk of grade ≥2 RE after adjusting for tumor laterality and internal mammary nodal irradiation. RV25 and AV35 were optimum dose-volume predictors for grade ≥2 RE at thresholds 20% for RV25 (35.9% vs 60.9%; P = .04) and 0.27 mL for AV35 (31.0% vs 54.6%; P = .04). CONCLUSIONS: RE is common in patients with breast cancer undergoing hypofractionated regional nodal irradiation. Maintaining the upper esophageal V25 at <20% and V35 at <0.27 mL may decrease the risk of RE.

Clinical anatomy teaching: A promising strategy for anatomic education.

Background: Human anatomy is a predominant course that helps medical students enhance their performance in other clinical curricula. However, it is difficult for students to learn the relationship between anatomy and diseases, since the traditional teaching modality of anatomy courses does not contain enough clinical contents. Clinical anatomy education merges clinical diagnosis and treatment into anatomy learning. This study seeks to determine whether systematic clinical anatomy teaching can improve students' performance and interest in anatomy courses. Methods: This study was a retrospective study conducted at West China Medical School, Sichuan University. Medical students of the 8-year program who participated in the course "HUMAN MORPHOLOGY" in the academic years of 2014-2018 did not receive a systematic clinical anatomy course, while those in the academic years of 2018-2022 did. These two groups were involved to analyze their final examination. Then, a questionnaire for students in the academic year of 2021-2022 was conducted to assess their general satisfaction and opinions on the usefulness and learning modalities of clinical anatomy courses. Results: Students who received systematic clinical anatomy lessons performed significantly better than those who were not in the final examinations. The average grades were 73.64 and 79.90 in the 3rd semester of medicine (p < 0.0001) and 75.70 and 82.18 in the 4th semester of medicine (p < 0.0001) before and after 2018, respectively. The response rate of the questionnaire was 77.78%, and most of the students agreed that the clinical anatomy lessons were satisfactory, with 40 out of 71 (56.34%) strongly agreeing and 26 out of 71 (36.62%) agreeing. Conclusion: Clinical anatomy education should be more emphasized and merged into the gross anatomy curriculum owing to the better performance in the final examination and high rate of satisfaction.

Catalytic Mechanism of Pyridoxal 5'-Phosphate-Dependent Aminodeoxychorismate Lyase: A Computational QM/MM Study.

Aminodeoxychorismate lyase (ADCL) is a kind of pyridoxal-5'-phosphate (PLP)-dependent enzyme that catalyzes the conversion of 4-amino-4-deoxychorismate (ADC) to p-aminobenzoate (PABA), which is a key step for the biosynthesis of folate. To illuminate the reaction details at the atomistic level, an enzyme-substrate reactant model has been constructed, and QM/MM calculations have been performed. Our calculation results reveal that the overall catalytic cycle contains 11 elementary steps, which can be described by three stages, including the transamination reaction of PLP, the release of pyruvate and aromatization of ADC, and the recovery to the initial aldimine. During the reaction, a series of intramolecular proton transfer are involved, which are the key for the C-N bond formation and cleavage as well as the aromatization of the ADC ring. In addition to forming the Schiff base with the pocket residue Lys251 and substrate in the internal aldimine and the external aldimine, respectively, the coenzyme PLP also plays a critical role in the intramolecular proton transfer by employing its hydroxyl oxygen anion and phosphate group. These findings may provide useful information for further understanding the catalytic mechanism of other PLP-dependent enzymes.

Efficacy and safety of immune checkpoint inhibitors with or without radiotherapy in metastatic non-small cell lung cancer: A systematic review and meta-analysis.

Background and purpose: Although immune checkpoint inhibitors (ICIs) have become the first-line treatment for metastatic non-small cell lung cancer (mNSCLC), their efficacy is limited. Meanwhile, recent reports suggest that radiotherapy (RT) can activate the systemic antitumor immune response by increasing the release of antigens from tumor tissues. Therefore, in patients with mNSCLC treated with ICIs, investigations were performed to determine whether the addition of RT improved the outcomes. Furthermore, the adverse events rate was evaluated. Methods and materials: Pubmed, Embase, and Cochrane Library were searched using the keywords "radiotherapy," "immune checkpoint inhibitors," and "non-small cell lung cancer" from the date of inception to 2 May 2022. Randomized controlled trials (RCTs) and nonRCTs (NRCTs) comparing the efficacy and safety of RT combined with ICIs versus ICIs alone in metastatic NSCLC were assessed. The primary outcomes were progression-free survival (PFS) and overall survival (OS), and the secondary outcomes were abscopal response rate (ARR), abscopal control rate (ACR), adverse events rate, and pneumonia rate. The analyses were conducted using the Mantel-Haenszel fixed-effects or random-effects model. The I2 statistic was used to determine heterogeneity, whereas funnel plots and Egger's test were used to assess publication bias. Results: In 15 clinical studies, 713 patients received RT combined with ICIs and 1,275 patients received only ICIs. With regard to PFS and OS, the hazard ratios of RT combined with ICIs were 0.79 (0.70, 0.89) and 0.72 (0.63, 0.82), respectively. In terms of ARR and ACR, the odds ratios (ORs) of RT combined with ICIs were 1.94 (1.19, 3.17) and 1.79 (1.08, 2.97), respectively. Subgroup analyses based on study type (RCT/NRCT), RT target (intracranial/extracranial), number of RT sites (single site), previous ICI resistance (yes/no), and sequencing of RT and ICIs (concurrent/post-RT ICIs) revealed that the addition of RT significantly prolonged PFS and OS. However, subgroup analyses based on radiation dose/fractionation indicated that the addition of hypofractionated RT significantly prolonged OS but not PFS. When grouped according to the level of PD-L1 expression, the addition of RT prolonged PFS only in patients who were PD-L1-negative. Furthermore, subgroup analyses of ARR and ACR signified that the combination therapy resulted in better local control of lesions outside the irradiation field in the hypofractionated RT, extracranial RT, and ICI-naïve subgroups. In terms of adverse events, the addition of RT did not significantly increase the adverse events rate but was associated with a higher pneumonia rate [OR values were 1.24 (0.92, 1.67) and 1.76 (1.12, 2.77), respectively]. Conclusion: Meta-analysis of existing data suggests that the addition of RT can significantly prolong PFS and OS in patients with metastatic NSCLC receiving ICIs. In addition to lesions in the irradiation field, RT can improve the local control rate of lesions outside the irradiation field via immune activation. Combination therapy does not increase the overall risk of adverse reactions, except for pneumonia.