Publications by authors named "Yue Dong"

284 Publications

MRI-based radiomics analysis for predicting the EGFR mutation based on thoracic spinal metastases in lung adenocarcinoma patients.

Med Phys 2021 Jul 28. Epub 2021 Jul 28.

Department of Biomedical Engineering, School of Fundamental Sciences, China Medical University, Shenyang, 110122, P.R. China.

Purpose: This study aims to develop and evaluate multi-parametric MRI-based radiomics for preoperative identification of epidermal growth factor receptor (EGFR) mutation, which is important in treatment planning for patients with thoracic spinal metastases from primary lung adenocarcinoma.

Methods: A total of 110 patients were enrolled between Jan. 2016 and Mar. 2019 as a primary cohort. A time-independent validation cohort was conducted containing 52 patients consecutively enrolled from Jul. 2019 to Apr. 2021. The patients were pathologically diagnosed thoracic spinal metastases from primary lung adenocarcinoma, all underwent T1-weighted (T1W), T2-weighted (T2W) and T2-weighted fat-suppressed (T2FS) MRI scans of the thoracic spinal. Handcrafted and deep learning-based features were extracted and selected from each MRI modality, and used to build the radiomics signature. Various machine learning classifiers were developed and compared. A clinical-radiomics nomogram integrating the combined rad signature and the most important clinical factor was constructed with receiver operating characteristic (ROC), calibration and decision curves analysis (DCA) to evaluate the prediction performance.

Results: The combined radiomics signature derived from the joint of three modalities can effectively classify EGFR mutation and EGFR wild-type patients, with an area under the ROC curve (AUC) of 0.886 (95% Confidence Interval [CI]: 0.826 - 0.947, SEN = 0.935, SPE = 0.688) in the training group and 0.803 (95% CI: 0.682 - 0.924, SEN = 0.700, SPE = 0.818) in the time-independent validation group. The nomogram incorporating the combined radiomics signature and smoking status achieved the best prediction performance in the training (AUC = 0.888, 95% CI: 0.849 - 0.958, SEN = 0.839, SPE = 0.792) and time-independent validation (AUC = 0.821, 95% CI: 0.692 - 0.929, SEN = 0.667, SPE = 0.909) cohort. The DCA confirmed potential clinical usefulness of our nomogram.

Conclusion: Our study demonstrated the potential of multi-parametric MRI-based radiomics on preoperatively predicting the EGFR mutation. The proposed nomogram model can be considered as a new biomarker to guide the selection of individual treatment strategies for patients with thoracic spinal metastases from primary lung adenocarcinoma.
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http://dx.doi.org/10.1002/mp.15137DOI Listing
July 2021

DT2VIS: A focus+context answer generation system to facilitate visual exploration of tabular data.

IEEE Comput Graph Appl 2021 Jul 14;PP. Epub 2021 Jul 14.

Visual analysis dialogue system utilizing natural language interface is emerging as a promising data analysis tool. However, previous work mostly focused on accurately understanding the query intent of a user but not on generating answers and inducing explorations. A focus+context answer generation approach, which allows users to obtain insight and contextual information simultaneously, is proposed in this work to address incomplete user query (i.e., input query can not reflect all possible intentions of the user). A query recommendation algorithm, which applies the historical query information of a user to recommend follow-up query, is also designed and implemented to provide in-depth exploration. These ideas are implemented in a system called DT2VIS. Specific cases of utilizing DT2VIS are also provided to analyze data. Finally, results show that DT2VIS could help users easily and efficiently reach their analysis goal in a comparative study.
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http://dx.doi.org/10.1109/MCG.2021.3097326DOI Listing
July 2021

Genetic, clinical and neuroimaging profiles of sporadic and autosomal recessive hereditary spastic paraplegia cases in Chinese.

Neurosci Lett 2021 Jul 10;761:136108. Epub 2021 Jul 10.

Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China. Electronic address:

Spastic paraplegias (SPGs) are a group of clinically and genetically heterogeneous neurodegenerative diseases. Mutations in 78 genes have been identified in autosomal dominant hereditary SPG (AD-HSP) and autosomal recessive hereditary SPG (AR-HSP). Compared to familial HSP, much less is known about the genetic and clinical profiles of sporadic SPGs. In this study, we have screened mutations for 18 sporadic SPGs or AR-HSP patients (mainly Northern Chinese) by whole-exome sequencing. We identified 12 mutations in five genes in 9 (50%) patients, including 9 novel ones: SPG5A/CYP7B1 (c.851C > A; c.122 + 2 T > G), SPG11/KIAA1840 (c.1735 + 3_ 1735 + 6del AAGT); SPG7/SPG7 (c.1454G > A; c.1892_ 1906dup GAGGACGGGCCTCGG); SPG39/PNPLA6 (c.1591G > A; c. 2990C > T); SPG15/ ZFYVE26 (c. 4804C > T; c. 4278 G > A). Among all the mutations, 7 were detected in the SPG5A and SPG11. Age at onset was significantly younger in cases with mutations (15.45 ± 6.78 years) than those without mutations (25.56 ± 10.90 years) (P = 0.03). Except for two cases with the SPG5A mutations, all cases presented with complicated SPGs. Three cases carrying mutations in SPG7, SPG15, SPG39 showed symptoms and signs of ataxia. One case carrying the homozygous c.259 + 2 T > C mutation in CYP7B1 showed serum parameters indicating liver impairment. Magnetic resonance imaging showed significantly thinned corpus callosum in cases with SPG11 and SPG15, but not in those with SPG5A, SPG7 or SPG39. In contrast, cerebellar atrophy was prominent in the SPG7 and SPG39 cases. These findings expand the spectrum of genetic, clinical and imaging features of sporadic SPG and AR-HSP, and have important implications in genetic counselling, molecular mechanisms and precise diagnosis of the disease.
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http://dx.doi.org/10.1016/j.neulet.2021.136108DOI Listing
July 2021

The first complete mitochondrial genome of (Caridea, Acanthephyridae).

Mitochondrial DNA B Resour 2021 Jun 21;6(7):2050-2051. Epub 2021 Jun 21.

MNR Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resources, Qingdao, China.

is a deep-sea shrimp, belonging to Caridea, Acanthephyridae. The whole complete mitochondrial genome of was 17,956 bp in length, with 37 genes, containing 13 protein-coding genes, 22 tRNAs, and 2 rRNAs. The GC content of was 39.43%. The genomic structure and gene arrangement were identical to those of Caridea species. The phylogenetic analysis of 13 protein-coding genes showed a close relationship to the genera .
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http://dx.doi.org/10.1080/23802359.2021.1942259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218848PMC
June 2021

Simultaneous Use of Hypertonic Saline and IV Furosemide for Fluid Overload: A Systematic Review and Meta-Analysis.

Crit Care Med 2021 Jun 24. Epub 2021 Jun 24.

Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN. Division of Intensive Care Unit, Department of Critical Care Medicine, the First Affiliated Hospital of UTSC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Mayo Clinic Library, Evidence-based Practice Center, Mayo Clinic, Rochester, MN. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN. Unidad de Conocimiento y Evidencia, CONEVID, Universidad Peruana Cayetano Heredia, Lima, Peru. Division of Critical Care, Department of Medicine, Mayo Clinic Health System, Mankato, MN.

Objectives: To evaluate the efficacy of the simultaneous hypertonic saline solution and IV furosemide (HSS+Fx) for patients with fluid overload compared with IV furosemide alone (Fx).

Data Sources: Electronic databases (MEDLINE, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, PsycINFO, Scopus, and WOS) were searched from inception to March 2020.

Study Selection: Randomized controlled trials on the use of HSS+Fx in adult patients with fluid overload versus Fx were included.

Data Extraction: Data were collected on all-cause mortality, hospital length of stay, heart failure-related readmission, along with inpatient weight loss, change of daily diuresis, serum creatinine, and 24-hour urine sodium excretion from prior to post intervention. Pooled analysis with random effects models yielded relative risk or mean difference with 95% CIs.

Data Synthesis: Eleven randomized controlled trials comprising 2,987 acute decompensated heart failure patients were included. Meta-analysis demonstrated that HSS+Fx was associated with lower all-cause mortality (relative risk, 0.55; 95% CI, 0.46-0.67; p < 0.05; I2 = 12%) and heart failure-related readmissions (relative risk, 0.50; 95% CI, 0.33-0.76; p < 0.05; I2 = 61%), shorter hospital length of stay (mean difference, -3.28 d; 95% CI, -4.14 to -2.43; p < 0.05; I2 = 93%), increased daily diuresis (mean difference, 583.87 mL; 95% CI, 504.92-662.81; p < 0.05; I2 = 76%), weight loss (mean difference, -1.76 kg; 95% CI, -2.52 to -1.00; p < 0.05; I2 = 57%), serum sodium change (mean difference, 6.89 mEq/L; 95% CI, 4.98-8.79; p < 0.05; I2 = 95%), and higher 24-hour urine sodium excretion (mean difference, 61.10 mEq; 95% CI, 51.47-70.73; p < 0.05; I2 = 95%), along with decreased serum creatinine (mean difference, -0.46 mg/dL; 95% CI, -0.51 to -0.41; p < 0.05; I2 = 89%) when compared with Fx. The Grading of Recommendation, Assessment, Development, and Evaluation certainty of evidence ranged from low to moderate.

Conclusions: Benefits of the HSS+Fx over Fx were observed across all examined outcomes in acute decompensated heart failure patients with fluid overload. There is at least moderate certainty that HSS+Fx is associated with a reduction in mortality in patients with acute decompensated heart failure. Factors associated with a successful HSS+Fx utilization are still unknown. Current evidence cannot be extrapolated to other than fluid overload states in acute decompensated heart failure.
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http://dx.doi.org/10.1097/CCM.0000000000005174DOI Listing
June 2021

Combined dynamic contrast enhanced MRI parameter with clinical factors predict the survival of concurrent chemo-radiotherapy in patients with 2018 FIGO IIICr stage cervical cancer.

Eur J Radiol 2021 Aug 21;141:109787. Epub 2021 May 21.

Department of Radiology, Liaoning Cancer Hospital & Institute, China Medical University, China. Electronic address:

Purpose: Combined clinical prognostic factors and magnetic resonance imaging (MRI) parameters on predicting the prognosis after concurrent chemo-radiotherapy (CCRT)in patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) IIICr stage patients.

Methods: A total of 117 patients with cervical cancer (2018 FIGO stage IIICr) who underwent CCRT were enrolled from Dec.2014 to Jul.2017. 47 patients developed outcome events, including 32 recurrences and 15 deaths. Clinical and MR parameters of primary tumors were analyzed, including apparent diffusion coefficient (ADC) values (ADC, ADC, and ADC) and dynamic contrast-enhanced MRI (DCE-MRI) parameters (K, K, V) were recorded. The short diameters of visible lymph nodes in the MRI and enhanced computed tomography (CT) images were measured. Progression-free survival (PFS) was compared by Kaplan-Meier analysis and independent predictors were identified using cox regression analysis.

Results: The median PFS was 35 months (6-68 month). The 1-year and 3-year PFS rates were was 90.4 %, 74.4 %, respectively. Multivariate analysis showed that 2018 FIGOIIIC2r stage (HR 2.701,95 %CI1.259to. 5.797; p = 0.011), K(HR 0.353;95 %CI 0.189 to 0.659; p = 0.001) and ADC (HR0.423,95 %CI0.229to0.783; p = 0.006) were highly correlated with poor PFS.

Conclusion: In conclusion, we have identified IIIC2r stage, K value and ADC value as the most important factors in evaluating the survival rate and prognosis of patients with stage IIICr cervical cancer. For stage IIIC1r subgroup, K, ADC value and site of positive lymph node >2 were independent prognostic factors.
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http://dx.doi.org/10.1016/j.ejrad.2021.109787DOI Listing
August 2021

Propofol, Ketamine, and Etomidate as Induction Agents for Intubation and Outcomes in Critically Ill Patients: A Retrospective Cohort Study.

Crit Care Explor 2021 May 24;3(5):e0435. Epub 2021 May 24.

Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

Propofol, ketamine, and etomidate are common anesthetic agents for induction of anesthesia in the ICU. The choice between these agents is complex and may not depend solely upon severity of illness.

Objectives: To evaluate the association between the administration of propofol, ketamine, and etomidate and ICU, hospital mortality, and length of stay.

Design Setting And Participants: Retrospective single-center cohort study. ICUs in a tertiary medical center, between January 01, 2012, and December 31, 2017. Critically ill adult patients given a single IV anesthetic for intubation.

Main Outcome And Measures: Primary outcomes were ICU and hospital mortality. Secondary outcomes were ICU- and hospital-free days through 28 days. An inverse probability of treatment weighed approach was used. The propensity score was estimated using a generalized logit model as a function of patient characteristics, admission source, ICU type, readmission status, length of ICU stays prior to intubation, and acute physiology score. Mortality outcomes were assessed with weighted logistic regression and -free days assessed by weighted linear regression with Bonferroni correction for pairwise comparisons.

Results: Of 2,673 patients, 36% received propofol, 30% ketamine and 34% etomidate. Overall ICU and hospital mortality were 19% and 29%, respectively. Patients given ketamine had higher odds of ICU mortality (1.45; [95% CI, 1.07-1.94]; = 0.015) and patients given etomidate had higher odds of ICU mortality (1.87; 1.40-2.49; < 0.001), hospital mortality (1.43; 1.09-1.86; = 0.009), and less ICU-free days (-2.10; -3.21 to -1.00; < 0.001) than those given propofol. Patients given ketamine and etomidate had similar odds of hospital mortality (1.06; 0.80-1.42; = 0.761) and similar hospital-free days (0.30; -0.81 to 1.40; = 0.600).

Conclusions And Relevance: Compared with ketamine and etomidate, propofol was associated with better outcome in critically ill patients undergoing anesthesia for intubation. Even after adjusting for severity of illness prior to intubation, residual confounders cannot be excluded.
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http://dx.doi.org/10.1097/CCE.0000000000000435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148417PMC
May 2021

When aging switches on Alzheimer's.

Aging (Albany NY) 2021 05 20;13(10):13376-13377. Epub 2021 May 20.

Department of Biomedical Engineering, MIND Institute, Center for Neurobiology of Learning and Memory, University of California, Irvine, CA 92697, USA.

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http://dx.doi.org/10.18632/aging.203085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202892PMC
May 2021

Training of Pediatric Critical Care Providers in Developing Countries in Evidence Based Medicine Utilizing Remote Simulation Sessions.

Glob Pediatr Health 2021 23;8:2333794X211007473. Epub 2021 Apr 23.

Mayo Clinic, Rochester, MN, USA.

Remote simulation training provides a unique opportunity to captivate providers despite language, distance, and cultural barriers. Previously we developed a novel electronic decision support and rounding tool, the Checklist for Early Recognition and Treatment of Acute Illness in Pediatrics (CERTAINp). This study was conducted to determine the feasibility and impact of remote simulation training of international PICU providers using CERTAINp. We conducted train-the-trainer sessions in 7 hospitals based in 5 countries (China, Congo, Croatia, India, and Turkey) between 11/2015 and 11/2016. Providers first took part in a base line simulation session to assess their clinical performance. They had structured hands-on training using CERTAINp, which was done remotely using video conference with recording capabilities. Performance in PICU "admission" and "rounding" scenarios was assessed by their adherence to standard of care guidelines using CERTAINp. After this training, the providers were re-evaluated for performance using a validated instrument by 2 independent trained reviewers. A total of 7 hospitals completed both baseline and post simulation sessions. We observed improved critical task (total 14) completion in the admission scenarios where pre training task completion was 8.2 ± 2.6, while after remote training was 11.2 ± 1.8,  = .01. In rounding scenarios, compliance to standard of care guidelines improved overall from 45% to 95% ( < .01). We observed an improvement in compliance for measures determined as best practice guidelines in simulation rounding and overall improvement in critical tasks for simulated admission cases after remote training.
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http://dx.doi.org/10.1177/2333794X211007473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072099PMC
April 2021

Inclusion of Albumin in the Initial Resuscitation of Adult Patients with Medical Sepsis or Septic Shock: A Propensity Score Matched Analysis.

Shock 2021 May 13. Epub 2021 May 13.

Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

Introduction: The impact of albumin resuscitation on sepsis outcomes is debated, particularly in the initial phase of resuscitation. We aimed to investigate the association between albumin use in the initial six hours of resuscitation and subsequent outcomes in adult septic patients.

Methods: This single-center, retrospective, propensity score-matched cohort study included adult patients admitted to intensive care units (ICUs) with sepsis or septic shock from January 1, 2006, to May 4, 2018, at a tertiary referral hospital. We compared two groups based on albumin receipt within the initial six resuscitation hours (albumin group vs. non-albumin group). We performed a 1:2 propensity score matching to assess shock-free time in ICU as the primary outcome.

Results: Of 2,732 patients with medical sepsis, 286 cases in the albumin group were matched with 549 individuals in the non-albumin group. Compared to the non-albumin group, the albumin group required more intravenous fluids and had higher net fluid balance, lower mean arterial pressure, and lower serum base excess level in the initial 6 and 24 hours of resuscitation. Shock-free time, ICU and hospital length of stay, and 28-day mortality were not different between albumin and non-albumin groups (56 vs. 66 hours, P = 0.18; 3.5 vs. 3.7 days, P = 0.61; 9.1 vs. 9.5 days, P = 0.27; 36 vs. 32%, P = 0.25, respectively).

Conclusions: Using albumin during the initial six hours of resuscitation was not associated with benefits in clinical outcomes of patients with medical sepsis.
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http://dx.doi.org/10.1097/SHK.0000000000001810DOI Listing
May 2021

Public health impact of delaying second dose of BNT162b2 or mRNA-1273 covid-19 vaccine: simulation agent based modeling study.

BMJ 2021 05 12;373:n1087. Epub 2021 May 12.

Department of Medicine, Mayo Clinic, Rochester, MN, USA

Objective: To estimate population health outcomes with delayed second dose versus standard schedule of SARS-CoV-2 mRNA vaccination.

Design: Simulation agent based modeling study.

Setting: Simulated population based on real world US county.

Participants: The simulation included 100 000 agents, with a representative distribution of demographics and occupations. Networks of contacts were established to simulate potentially infectious interactions though occupation, household, and random interactions.

Interventions: Simulation of standard covid-19 vaccination versus delayed second dose vaccination prioritizing the first dose. The simulation runs were replicated 10 times. Sensitivity analyses included first dose vaccine efficacy of 50%, 60%, 70%, 80%, and 90% after day 12 post-vaccination; vaccination rate of 0.1%, 0.3%, and 1% of population per day; assuming the vaccine prevents only symptoms but not asymptomatic spread (that is, non-sterilizing vaccine); and an alternative vaccination strategy that implements delayed second dose for people under 65 years of age, but not until all those above this age have been vaccinated.

Main Outcome Measures: Cumulative covid-19 mortality, cumulative SARS-CoV-2 infections, and cumulative hospital admissions due to covid-19 over 180 days.

Results: Over all simulation replications, the median cumulative mortality per 100 000 for standard dosing versus delayed second dose was 226 179, 233 207, and 235 236 for 90%, 80%, and 70% first dose efficacy, respectively. The delayed second dose strategy was optimal for vaccine efficacies at or above 80% and vaccination rates at or below 0.3% of the population per day, under both sterilizing and non-sterilizing vaccine assumptions, resulting in absolute cumulative mortality reductions between 26 and 47 per 100 000. The delayed second dose strategy for people under 65 performed consistently well under all vaccination rates tested.

Conclusions: A delayed second dose vaccination strategy, at least for people aged under 65, could result in reduced cumulative mortality under certain conditions.
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http://dx.doi.org/10.1136/bmj.n1087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114182PMC
May 2021

Allostery of atypical modulators at oligomeric G protein-coupled receptors.

Sci Rep 2021 Apr 29;11(1):9265. Epub 2021 Apr 29.

Departments of Psychiatry and Pharmacology, Hershey Medical Center, Penn State University College of Medicine, Hershey, PA, 17033, USA.

Many G protein-coupled receptors (GPCRs) are therapeutic targets, with most drugs acting at the orthosteric site. Some GPCRs also possess allosteric sites, which have become a focus of drug discovery. In the M muscarinic receptor, allosteric modulators regulate the binding and functional effects of orthosteric ligands through a mix of conformational changes, steric hindrance and electrostatic repulsion transmitted within and between the constituent protomers of an oligomer. Tacrine has been called an atypical modulator because it exhibits positive cooperativity, as revealed by Hill coefficients greater than 1 in its negative allosteric effect on binding and response. Radioligand binding and molecular dynamics simulations were used to probe the mechanism of that modulation in monomers and oligomers of wild-type and mutant M receptors. Tacrine is not atypical at monomers, which indicates that its atypical effects are a property of the receptor in its oligomeric state. These results illustrate that oligomerization of the M receptor has functional consequences.
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http://dx.doi.org/10.1038/s41598-021-88399-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085029PMC
April 2021

[Mechanisms of Penicillin Wastewater Treatment by Coupled Electrocatalytic and Bioelectrochemical Systems].

Huan Jing Ke Xue 2021 May;42(5):2378-2384

State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin 150090, China.

Large amounts of wastewater containing residual antibiotics are produced in antibiotics production, but it is difficult for traditional biological wastewater treatment to efficiently treat this high concentration antibiotic wastewater. Coupled electrocatalytic and bioelectrochemical systems were proposed to treat typical -lactam antibiotics (penicillin) wastewater. The penicillin wastewater was oxidized by a boron-doped diamond (BDD) electrocatalytic electrode and then steadily treated by a bioelectrochemical system (BES). The penicillin removal rate of the electrocatalytic system was 89%, and 79% of the residual penicillin was further removed by the BES. The maximum power density of the BES with pretreated penicillin of (1124±28) mW·m was increased by 473% compared with that of the BES with raw penicillin. The total penicillin removal rate was 98% in the electrocatalytic and bioelectrochemical system. The results of the BES anode biomass and biofacies showed that was the dominant bacterial group on the anode before penicillin addition, and it was the main microorganism in the formation of the anode biofilm. is an electricity-producing bacterium with a power generation function. Penicillin inhibited the biomass of the mixed anode bacteria and the biological activity of Proteus microorganisms, which were the main electricity-producing bacteria, and reduced the biomass of and . This was the main factor affecting the power generation performance and reactor treatment effect. The pretreatment of penicillin wastewater by electrocatalytic degradation can significantly decrease its concentration, efficiently alleviate the inhibition of the BES by penicillin, and improve the biodegradability of wastewater. The coupled electrocatalytic and bioelectrochemical system is a new technology for antibiotic wastewater treatment with a high efficiency and low energy consumption.
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http://dx.doi.org/10.13227/j.hjkx.202007300DOI Listing
May 2021

What Contributes to Diagnostic Error or Delay? A Qualitative Exploration Across Diverse Acute Care Settings in the United States.

J Patient Saf 2021 Jun;17(4):239-248

Kern Center, Mayo Clinic, Rochester, Minnesota.

Objectives: Diagnostic error and delay is a prevalent and impactful problem. This study was part of a mixed-methods approach to understand the organizational, clinician, and patient factors contributing to diagnostic error and delay among acutely ill patients within a health system, as well as recommendations for the development of tailored, targeted, feasible, and effective interventions.

Methods: We did a multisite qualitative study using focus group methodology to explore the perspectives of key clinician stakeholders. We used a conceptual framework that characterized diagnostic error and delay as occurring within 1 of 3 stages of the patient's diagnostic journey-critical information gathering, synthesis of key information, and decision making and communication. We developed our moderator guide based on the sociotechnical frameworks previously described by Holden and Singh for understanding noncognitive factors that lead to diagnostic error and delay. Deidentified focus group transcripts were coded in triplicate and to consensus over a series of meetings. A final coded data set was then uploaded into NVivo software. The data were then analyzed to generate overarching themes and categories.

Results: We recruited a total of 64 participants across 4 sites from emergency departments, hospital floor, and intensive care unit settings into 11 focus groups. Clinicians perceive that diverse organizational, communication and coordination, individual clinician, and patient factors interact to impede the process of making timely and accurate diagnoses.

Conclusions: This study highlights the complex sociotechnical system within which individual clinicians operate and the contributions of systems, processes, and institutional factors to diagnostic error and delay.
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http://dx.doi.org/10.1097/PTS.0000000000000817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195035PMC
June 2021

Speech Perception with Noise Vocoding and Background Noise: An EEG and Behavioral Study.

Authors:
Yue Dong Yan Gai

J Assoc Res Otolaryngol 2021 Jun 13;22(3):349-363. Epub 2021 Apr 13.

Biomedical Engineering, Parks College of Engineering, Aviation and Technology, Saint Louis University, 3507 Lindell Blvd, St Louis, MO, 63103, USA.

This study explored the physiological response of the human brain to degraded speech syllables. The degradation was introduced using noise vocoding and/or background noise. The goal was to identify physiological features of auditory-evoked potentials (AEPs) that may explain speech intelligibility. Ten human subjects with normal hearing participated in syllable-detection tasks, while their AEPs were recorded with 32-channel electroencephalography. Subjects were presented with six syllables in the form of consonant-vowel-consonant or vowel-consonant-vowel. Noise vocoding with 22 or 4 frequency channels was applied to the syllables. When examining the peak heights in the AEPs (P1, N1, and P2), vocoding alone showed no consistent effect. P1 was not consistently reduced by background noise, N1 was sometimes reduced by noise, and P2 was almost always highly reduced. Two other physiological metrics were examined: (1) classification accuracy of the syllables based on AEPs, which indicated whether AEPs were distinguishable for different syllables, and (2) cross-condition correlation of AEPs (r) between the clean and degraded speech, which indicated the brain's ability to extract speech-related features and suppress response to noise. Both metrics decreased with degraded speech quality. We further tested if the two metrics can explain cross-subject variations in their behavioral performance. A significant correlation existed for r, as well as classification based on early AEPs, in the fronto-central areas. Because r indicates similarities between clean and degraded speech, our finding suggests that high speech intelligibility may be a result of the brain's ability to ignore noise in the sound carrier and/or background.
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http://dx.doi.org/10.1007/s10162-021-00787-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110670PMC
June 2021

Simultaneous electricity generation and eutrophic water treatment utilizing iron coagulation cell with nitrification and denitrification biocathodes.

Sci Total Environ 2021 Aug 17;782:146436. Epub 2021 Mar 17.

School of Environment, State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, No 73 Huanghe Road, Nangang District, Harbin 150090, China. Electronic address:

Anthropogenic nutrients released into water induce eutrophication and threaten aquatic life and human health. In this study, an Fe anode coagulation cell with nitrification and denitrification biocathodes was constructed for power generation and algae and nutrient removal. The nitrification and denitrification biocathodes achieved maximum power densities of 6.0 and 6.6 W/m, respectively. The algae (99.2 ± 0.5%), phosphate (97.4 ± 0.6%), and ammonia (23.1 ± 0.2%) were removed by a spontaneous electrocoagulation process in the anode chamber. In the nitrification biocathode chamber, 95.3 ± 1.4% of the ammonia was oxidized within 6 h, and 88.2 ± 2.5% of the nitrate was removed in 10 h in the denitrification biocathode chamber. The microbial community analysis revealed that ammonia removal was attributed to nitrifying bacteria, including Acinetobacter sp., Phycisphaera sp., and Nitrosomonas sp., and the dominant denitrifying bacteria in the denitrifying biocathode chamber were Planococcus sp., Exiguobacterium sp., and Lysinibacillus sp. In this study, the combination of Fe anodes and biocathodes is shown to afford an efficient method for the simultaneous algae and nutrient removal and power generation.
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http://dx.doi.org/10.1016/j.scitotenv.2021.146436DOI Listing
August 2021

Gut Microbial Composition and Diversity in Four Ophiuroid Species: Divergence Between Suspension Feeder and Scavenger and Their Symbiotic Microbes.

Front Microbiol 2021 19;12:645070. Epub 2021 Mar 19.

MNR Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resources, Qingdao, China.

Gut microbiota have important roles in the survival and adaptation of the host. Ophiuroids, as the worldwide dominant benthos, have ecological roles in benthic-pelagic coupling in the sea floor. However, little is known about the composition and diversity of their gut microbiota and its potential functions in benthic ecosystems. In present study, we preformed 16S rRNA sequencing and function analysis in four dominant species (, , , and ) with two feeding types (suspension feeding/herbivores and scavenger/carnivores) from the Yellow Sea, China. Results showed that 56 phyla and 569 genera of microbiota were identified among ophiuroid guts. Multivariate and diversity analyses showed that the ophiuroid gut microbiota were independent and have higher biodiversity to the sediment microbial in the Yellow Sea. Phyla Proteobacteria, Firmicutes, Tenericutes, and Bacteroidetes were the dominant bacteria, with more than 80% abundance among the four ophiuroid species. A comparison among the gut microbial compositions among four ophiuroids showed the similarity of two offshore carnivore ophiuroids ( and ) and variation in the dominant microbiota types of three nearshore ophiuroids (, , and ). The functional analysis revealed the significant differences of the environment-related expression in gut microbiota between nearshore and offshore environments. The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) functional annotation showed the significant divergence of metabolism pathways between two nearshore species, the herbivores and carnivores , such as the Lipid metabolism, Carbohydrate metabolism, and Metabolism of cofactors and vitamins. The homolog search and phylogenetic analysis identified the first gut symbiotic Hepatoplasma in with important roles for the nutrient metabolisms. Overall, our study reported the comprehensive data of ophiuroid gut microbiota, while the functional microbiome provides insight into the physiology and environmental adaptation in ophiuroids.
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http://dx.doi.org/10.3389/fmicb.2021.645070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017295PMC
March 2021

Derivation and Validation of an Automated Search Strategy to Retrospectively Identify Acute Respiratory Distress Patients Per Berlin Definition.

Front Med (Lausanne) 2021 11;8:614380. Epub 2021 Mar 11.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States.

Acute respiratory distress syndrome (ARDS) is common in critically ill patients and linked with serious consequences. A manual chart review for ARDS diagnosis could be laborious and time-consuming. We developed an automated search strategy to retrospectively identify ARDS patients using the Berlin definition to allow for timely and accurate ARDS detection. The automated search strategy was created through sequential steps, with keywords applied to an institutional electronic medical records (EMRs) database. We included all adult patients admitted to the intensive care unit (ICU) at the Mayo Clinic (Rochester, MN) from January 1, 2009 to December 31, 2017. We selected 100 patients at random to be divided into two derivation cohorts and identified 50 patients at random for the validation cohort. The sensitivity and specificity of the automated search strategy were compared with a manual medical record review (gold standard) for data extraction of ARDS patients per Berlin definition. On the first derivation cohort, the automated search strategy achieved a sensitivity of 91.3%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 93.1%. On the second derivation cohort, it reached the sensitivity of 90.9%, specificity of 100%, PPV of 100%, and NPV of 93.3%. The strategy performance in the validation cohort had a sensitivity of 94.4%, specificity of 96.9%, PPV of 94.4%, and NPV of 96.9%. This automated search strategy for ARDS with the Berlin definition is reliable and accurate, and can serve as an efficient alternative to time-consuming manual data review.
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http://dx.doi.org/10.3389/fmed.2021.614380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992243PMC
March 2021

Incidence and Risk of Infection Associated With Fingolimod in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis of 8,448 Patients From 12 Randomized Controlled Trials.

Front Immunol 2021 8;12:611711. Epub 2021 Mar 8.

Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China.

There is a controversy regarding whether fingolimod is associated with an increased risk of infection in patients with multiple sclerosis (MS). We performed a systematic review and meta-analysis of data from randomized controlled trials (RCTs) to determine the risk of infection in these patients. We systematically searched PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov from inception to April 8, 2020, to identify RCTs that reported the occurrence of infection in patients with MS treated with fingolimod. Relative risks (RRs) and 95% confidence intervals (95% CIs) were calculated using the random-effects model. Twelve RCTs including 8,448 patients were eligible. Compared with the control (placebo and other active treatments), fingolimod significantly increased the risk of infection (RR, 1.16; 95% CI, 1.07-1.27; , 81%), regardless of whether the infection was a general infection (RR, 1.14; 95% CI, 1.05-1.25; , 78%), or a serious infection (RR, 1.49; 95% CI, 1.06-2.10; , 0%). Analyses of subgroups found that fingolimod significantly increased the risk of lower respiratory infection (RR, 1.48; 95% CI, 1.19-1.85; , 0%) and herpes virus infection (RR, 1.34; 95% CI, 1.01-1.78; , 9%). There appears to be no dose-dependent increase in the risk of infection associated with fingolimod (0.5 mg: RR, 1.15; 95% CI, 1.07-1.25; , 91%; 1.25 mg: RR, 1.11; 95% CI, 0.97-1.28; , 81%; P = 0.66). Compared with a placebo and other active treatments, fingolimod was associated with a 16% increase in the risk of infection, especially lower respiratory infection and herpes virus infection. The risk of infection associated with fingolimod might not be dose related.
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http://dx.doi.org/10.3389/fimmu.2021.611711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982402PMC
June 2021

Autosomal recessive spastic ataxia of Charlevoix-Saguenay caused by novel mutations in SACS gene: A report of two Chinese families.

Neurosci Lett 2021 05 18;752:135831. Epub 2021 Mar 18.

Department of Neurology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China. Electronic address:

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare hereditary disease characterized by cerebellar ataxia, pyramidal signs in lower limbs, and sensorimotor neuropathy. The disease is caused by bi-allelic mutations of the SACS gene encoding the sacsin protein. Over 200 mutations have been reported worldwide. Here, we report two unrelated Chinese ARSACS patients with novel mutations revealed by whole-exome sequencing (WES). One 36-year-old female patient exhibited classical ARSACS characteristics including cerebellar ataxia, pyramidal tract signs in the lower limbs and sensorimotor neuropathy, while the other 9-year-old male showed cerebellar ataxia and peripheral neuropathy. WES identified a compound heterozygous variant in the SACS gene (c.5692 G > T, p.E1898X; c.12673-12677 del TATCA, p.Y4225D fs*6) in the female patient and another compound heterozygous variant (c.1773C > A, p.S578X; c.8088-8089 in. CA, p.M2697Q fs*43) in the male patient. All of these novel mutations were predicted to be loss-of-function which affect the expression of the two important C-terminal domains (DnaJ and HEPN). These findings add new insights into the mutational and clinical spectrum of ARSACS.
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http://dx.doi.org/10.1016/j.neulet.2021.135831DOI Listing
May 2021

Checklist for Early Recognition and Treatment of Acute Illness and Injury: An Exploratory Multicenter International Quality-Improvement Study in the ICUs With Variable Resources.

Crit Care Med 2021 06;49(6):e598-e612

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.

Objectives: To determine whether the "Checklist for Early Recognition and Treatment of Acute Illness and Injury" decision support tool during ICU admission and rounding is associated with improvements in nonadherence to evidence-based daily care processes and outcomes in variably resourced ICUs.

Design, Settings, Patients: This before-after study was performed in 34 ICUs (15 countries) from 2013 to 2017. Data were collected for 3 months before and 6 months after Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation.

Interventions: Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation using remote simulation training.

Measurements And Main Results: The coprimary outcomes, modified from the original protocol before data analysis, were nonadherence to 10 basic care processes and ICU and hospital length of stay. There were 1,447 patients in the preimplementation phase and 2,809 patients in the postimplementation phase. After adjusting for center effect, Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation was associated with reduced nonadherence to care processes (adjusted incidence rate ratio [95% CI]): deep vein thrombosis prophylaxis (0.74 [0.68-0.81), peptic ulcer prophylaxis (0.46 [0.38-0.57]), spontaneous breathing trial (0.81 [0.76-0.86]), family conferences (0.86 [0.81-0.92]), and daily assessment for the need of central venous catheters (0.85 [0.81-0.90]), urinary catheters (0.84 [0.80-0.88]), antimicrobials (0.66 [0.62-0.71]), and sedation (0.62 [0.57-0.67]). Analyses adjusted for baseline characteristics showed associations of Checklist for Early Recognition and Treatment of Acute Illness and Injury implementation with decreased ICU length of stay (adjusted ratio of geometric means [95% CI]) 0.86 [0.80-0.92]), hospital length of stay (0.92 [0.85-0.97]), and hospital mortality (adjusted odds ratio [95% CI], 0.81 (0.69-0.95).

Conclusions: A quality-improvement intervention with remote simulation training to implement a decision support tool was associated with decreased nonadherence to daily care processes, shorter length of stay, and decreased mortality.
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http://dx.doi.org/10.1097/CCM.0000000000004937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132910PMC
June 2021

Multiparametric MRI-Based Radiomics Approaches for Preoperative Prediction of EGFR Mutation Status in Spinal Bone Metastases in Patients with Lung Adenocarcinoma.

J Magn Reson Imaging 2021 08 27;54(2):497-507. Epub 2021 Feb 27.

Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.

Background: Preoperative prediction of epidermal growth factor receptor (EGFR) mutation status in patients with spinal bone metastases (SBM) from primary lung adenocarcinoma is potentially important for treatment decisions.

Purpose: To develop and validate multiparametric magnetic resonance imaging (MRI)-based radiomics methods for preoperative prediction of EGFR mutation based on MRI of SBM.

Study Type: Retrospective.

Population: A total of 97 preoperative patients with lumbar SBM from lung adenocarcinoma (77 in training set and 20 in validation set).

Field Strength/sequence: T1-weighted, T2-weighted, and T2-weighted fat-suppressed fast spin echo sequences at 3.0 T.

Assessment: Radiomics handcrafted and deep learning-based features were extracted and selected from each MRI sequence. The abilities of the features to predict EGFR mutation status were analyzed and compared. A radiomics nomogram was constructed integrating the selected features.

Statistical Tests: The Mann-Whitney U test and χ test were employed for evaluating associations between clinical characteristics and EGFR mutation status for continuous and discrete variables, respectively. Least absolute shrinkage and selection operator was used for selection of predictive features. Sensitivity (SEN), specificity (SPE), and area under the receiver operating characteristic curve (AUC) were used to evaluate the ability of radiomics models to predict the EGFR mutation. Calibration and decision curve analysis (DCA) were performed to assess and validate nomogram results.

Results: The radiomics signature comprised five handcrafted and one deep learning-based features and achieved good performance for predicting EGFR mutation status, with AUCs of 0.891 (95% confidence interval [CI], 0.820-0.962, SEN = 0.913, SPE = 0.710) in the training group and 0.771 (95% CI, 0.551-0.991, SEN = 0.750, SPE = 0.875) in the validation group. DCA confirmed the potential clinical usefulness of the radiomics models.

Data Conclusion: Multiparametric MRI-based radiomics is potentially clinical valuable for predicting EGFR mutation status in patients with SBM from lung adenocarcinoma.

Level Of Evidence: 3 TECHNICAL EFFICACY: 2.
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http://dx.doi.org/10.1002/jmri.27579DOI Listing
August 2021

Magnetic Microswarm Composed of Porous Nanocatalysts for Targeted Elimination of Biofilm Occlusion.

ACS Nano 2021 03 26;15(3):5056-5067. Epub 2021 Feb 26.

Department of Mechanical and Automation Engineering, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR 999077, China.

Biofilm is difficult to thoroughly cure with conventional antibiotics due to the high mechanical stability and antimicrobial barrier resulting from extracellular polymeric substances. Encouraged by the great potential of magnetic micro-/nanorobots in various fields and their enhanced action in swarm form, we designed a magnetic microswarm consisting of porous FeO mesoparticles (p-FeO MPs) and explored its application in biofilm disruption. Here, the p-FeO MPs microswarm (p-FeO swarm) was generated and actuated by a simple rotating magnetic field, which exhibited the capability of remote actuation, high cargo capacity, and strong localized convections. Notably, the p-FeO swarm could eliminate biofilms with high efficiency due to synergistic effects of chemical and physical processes: (i) generating bactericidal free radicals (•OH) for killing bacteria cells and degrading the biofilm by p-FeO MPs; (ii) physically disrupting the biofilm and promoting •OH penetration deep into biofilms by the swarm motion. As a demonstration of targeted treatment, the p-FeO swarm could be actuated to clear the biofilm along the geometrical route on a 2D surface and sweep away biofilm clogs in a 3D U-shaped tube. This designed microswarm platform holds great potential in treating biofilm occlusions particularly inside the tiny and tortuous cavities of medical and industrial settings.
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http://dx.doi.org/10.1021/acsnano.0c10010DOI Listing
March 2021

Are We Ready for Video Recognition and Computer Vision in the Intensive Care Unit? A Survey.

Appl Clin Inform 2021 01 24;12(1):120-132. Epub 2021 Feb 24.

Department of Anesthesiology and Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, United States.

Objective: Video recording and video recognition (VR) with computer vision have become widely used in many aspects of modern life. Hospitals have employed VR technology for security purposes, however, despite the growing number of studies showing the feasibility of VR software for physiologic monitoring or detection of patient movement, its use in the intensive care unit (ICU) in real-time is sparse and the perception of this novel technology is unknown. The objective of this study is to understand the attitudes of providers, patients, and patient's families toward using VR in the ICU.

Design: A 10-question survey instrument was used and distributed into two groups of participants: clinicians (MDs, advance practice providers, registered nurses), patients and families (adult patients and patients' relatives). Questions were specifically worded and section for free text-comments created to elicit respondents' thoughts and attitudes on potential issues and barriers toward implementation of VR in the ICU.

Setting: The survey was conducted at Mayo Clinic in Minnesota and Florida.

Results: A total of 233 clinicians' and 50 patients' surveys were collected. Both cohorts favored VR under specific circumstances (e.g., invasive intervention and diagnostic manipulation). Acceptable reasons for VR usage according to clinicians were anticipated positive impact on patient safety (70%), and diagnostic suggestions and decision support (51%). A minority of providers was concerned that artificial intelligence (AI) would replace their job (14%) or erode professional skills (28%). The potential use of VR in lawsuits (81% clinicians) and privacy breaches (59% patients) were major areas of concern. Further identified barriers were lack of trust for AI, deterioration of the patient-clinician rapport. Patients agreed with VR unless it does not reduce nursing care or record sensitive scenarios.

Conclusion: The survey provides valuable information on the acceptance of VR cameras in the critical care setting including an overview of real concerns and attitudes toward the use of VR technology in the ICU.
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http://dx.doi.org/10.1055/s-0040-1722614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904385PMC
January 2021

Deuteration of Formyl Groups via a Catalytic Radical H/D Exchange Approach.

ACS Catal 2020 Feb 23;10(3):2226-2230. Epub 2020 Jan 23.

Department of Pharmacology and Toxicology, College of Pharmacy, and BIO5 Institute, University of Arizona, 1703 E. Mabel Street, Tucson, AZ 85721-0207, USA.

H/D exchange at formyl groups represents the straightforward approach to C-1 deuterated aldehydes. This transformation has been recently realized by transition metal and NHC carbene catalysis. Mechanistically, all these processes involve an ionic pathway. Herein we report a distinct photoredox catalytic, visible light mediated neutral radical approach. Selective control of highly reactive acyl radical in the energy barrier surmountable, reversible reaction enables driving the formation of deuterated products when an excess of DO is employed. The power of the H/D exchange process has been demonstrated for not only aromatic aldehydes, but also aliphatic substrates, which have been difficult in transitional metal catalyzed H/D exchange reactions, and for selective late-stage deuterium incorporation into complex structures with uniformly high deuteration level (>90%).
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http://dx.doi.org/10.1021/acscatal.9b05300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899177PMC
February 2020

Knockdown of AURKA sensitizes the efficacy of radiation in human colorectal cancer.

Life Sci 2021 Apr 2;271:119148. Epub 2021 Feb 2.

Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, China. Electronic address:

Aims: Abnormally amplified expression of AURKA (aurora kinase A) is closely related to chemo-resistance in human colorectal cancer, lung cancer and leukemia. However, the biological role of AURKA in response to radio-sensitivity in human colorectal cancer is still unknown. Therefore, we evaluated the radio-sensitize ability of perturbation AURKA in human colorectal cancer.

Main Methods: The knockdown effect of shAURKA was determined by western blot and qRT-PCR, respectively. Cell growth was determined by CCK-8 and clonogenic assay. Cell migration and metastasis was measured by wound healing assay and transwell invasive assay, respectively. Cell cycle and apoptosis was analyzed by flow cytometry. The alteration of down-stream targets was determined by western blot analysis.

Key Findings: We observed that high-level of AURKA expression is associated with poor prognosis in CRC patients receiving radiotherapy. Knockdown of AURKA significantly sensitizes the efficacy of radiation on the proliferation of HCT116 and HT-29 cells. The combination of AURKA inhibition and radiation could effectively suppress the ability of cell migration and metastasis, but also synergistically induce cellular apoptosis and arrest cell cycle at G2/M phase. Further studies demonstrated that knockdown AURKA markedly enhanced the efficacy of radiation through elevated PARP cleavage and induced AURKA-mediated pro-apoptosis factor BIM. Meanwhile, knockdown of AURKA in combination with radiation synergistically suppressed the regulator in blockage of G2/M phase, CDK2.

Significance: Taken together, our results provide the evidence that targeted inhibition of AURKA could be a promising strategy for enhancing the efficacy of radiation for the treatment of human colorectal cancer.
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http://dx.doi.org/10.1016/j.lfs.2021.119148DOI Listing
April 2021
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