BOOST: a phase 3 trial of sorafenib vs. best supportive care in first line treatment of hepatocellular carcinoma in patients with deteriorated liver function

Aim: Only patients with good liver function {[Child-Pugh (CP)] A class} were eligible for trials testing sorafenib as first-line treatment of hepatocellular car...     

Evaluation of the wound healing potentials of two subspecies of Hypericum perforatum on cultured NIH3T3 fibroblasts

For centuries, Hypericum perforatum has been used in folk medicine to treat wounds. In the present study, the wound healing activities of extracts of H. perforatum ssp. perforatum (HPP) and H. perforatum ssp. veronense (HPV) were evaluated by comparing with a titrated extract of Centella asiatica (TECA) on NIH3T3 fibroblasts. The cells were incubated with the extracts. Using microscopical methods by staining cells, mitotic ability, morphological changes and collagen production in the fibroblasts were evaluated as parameters to approach possible wound repair mechanism(s). The wound healing activity caused an increase in the percentage of polygonal fibroblasts and in collagen granule numbers in fibroblasts of HPP and HPV. At 1 µg/mL, HPP caused a greater increase in mitotic cell numbers than HPV. The most increases in polygonal cell numbers were observed with HPV at 1 and 10 µg/mL. The number of collagen granules was increased with 1 µg/mL HPV being higher than HPP. As an indication of cytotoxic effects, round cells in response to HPV and HPP extracts, were found to be increased in concentrations higher than 10–50 µg/mL. The results indicated that the two subspecies of H. perforatum have different wound healing profiles as a result of the fibroblast migration and stimulation of collagen synthesis. Copyright © 2010 John Wiley & Sons, Ltd.     

A lack of an association between COVID-19 vaccination and corneal graft rejection: results of a large multi-country population based study

PurposeThe aim of the study was to present the rates of corneal transplant rejection from 2018 to 2022 at both Moorfields Eye Hospital UK, and Ospedali Privati Forli (OPF) “Villa Igea”, Italy and evaluate the purported association between COVID-19 vaccination and rejection.MethodsWe performed a retrospective review of rejection cases presenting to the two units. Monthly rates were correlated against regional vaccination programme rates. At OPF, conditional Poisson regression model was employed to estimate the incidence risk ratio (IRR) of graft rejection following COVID-19 vaccination risk period compared with the control period.ResultsBetween January 2018 and March 2022, there were 471 (Moorfields), 95 (OPF) episodes of rejection. From the start of vaccination programme in the UK in late January 2021, the median number of graft rejections per month at Moorfields was 6 (range: 5–9), which was not significantly different to post-lockdown, pre-vaccination programme (March 2020–January 2021), p = 0.367. At OPF, the median rates of rejection before and after initiation of the vaccination programme were not significantly different (p = 0.124). No significant increase in incidence rate of rejection in the risk period following COVID-19 vaccination was found (IRR = 0.53, p = 0.71).ConclusionNo notable increase in rates of transplant rejection was noted in year 2021 when COVID-19 vaccination was broadly implemented. The apparent temporal relationship between COVID-19 vaccination and corneal graft rejection highlighted in several case reports may not represent a causative association.Subject terms: Corneal diseases, Risk factors     

Titin activates myosin filaments in skeletal muscle by switching from an extensible spring to a mechanical rectifier

Titin is a molecular spring in parallel with myosin motors in each muscle half-sarcomere, responsible for passive force development at sarcomere length (SL) above the physiological range (>2.7 μm). The role of titin at physiological SL is unclear and is investigated here in single intact muscle cells of the frog (Rana esculenta), by combining half-sarcomere mechanics and synchrotron X-ray diffraction in the presence of 20 μM para-nitro-blebbistatin, which abolishes the activity of myosin motors and maintains them in the resting state even during activation of the cell by electrical stimulation. We show that, during cell activation at physiological SL, titin in the I-band switches from an SL-dependent extensible spring (OFF-state) to an SL-independent rectifier (ON-state) that allows free shortening while resisting stretch with an effective stiffness of ~3 pN nm⁻¹ per half-thick filament. In this way, I-band titin efficiently transmits any load increase to the myosin filament in the A-band. Small-angle X-ray diffraction signals reveal that, with I-band titin ON, the periodic interactions of A-band titin with myosin motors alter their resting disposition in a load-dependent manner, biasing the azimuthal orientation of the motors toward actin. This work sets the stage for future investigations on scaffold and mechanosensing-based signaling functions of titin in health and disease.

Contraction of the striated muscle is powered by the cyclical adenosine triphosphate (ATP)-fueled interactions of the motor protein myosin II, arranged in two bipolar arrays on thick filaments originating at the midpoint of each sarcomere (M-line), with the nearby thin, actin-containing filaments originating at the sarcomere extremities (Z-line, Fig. 1A). In the half-sarcomere, myosin motors are mechanically coupled as parallel force generators and the collective force depends on the number of motors available for actin attachment and thus on the degree of overlap between thick and thin filaments (Fig. 1B, black circles; ref. 1). The half-sarcomere is the basic functional unit in which the emergent properties from the arrays of myosin motors, the interdigitating thin filaments, and a “third” filament made by the cytoskeleton protein titin (Fig. 1C) account for the mechanical performance of muscle and its regulation.Open in a separate windowFig. 1.Structure–function of myofilaments and titin in relation to the length of the sarcomere. (A) Overview of the thick filament (blue), myosin motors (orange), and thin filament (yellow) at SL 2.2 μm (full overlap) and 3.0 μm (partial overlap). (B) Relation between SL and either active force at the plateau of the isometric tetanic contraction (black circles, linear fit to points at SL >2.2 μm, continuous line) or passive force (triangles, fitted with an exponential equation (red dashed line) and with the model (red circles) described in SI Appendix, Supporting Note 1 and Fig. S1). Data from ref. 2. (C) Protein disposition on the thin (yellow) and thick (light blue) filaments in the half-sarcomere at rest at 2.2 μm SL. M-line on the right and Z-line on the left. Inset: Overlap region on an enlarged scale to show with better resolution the ~38 nm axial periodicity of the troponin complex (gray) along the thin filament and the two motor domains (orange) of each myosin molecule tilted back on their tail (blue) in the OFF state (3, 4). The 49 crowns of motors are numbered starting from the M-line; thin filament with tropomyosin (brown) and troponin complex (gray); MyBP-C (green) aligned with myosin triplets from crowns 12 to 30. Titin (magenta) with PEVK segment identified by dark magenta. HBZ, half-bare zone. P-, C-, and D-zones, proximal, MyBP-C containing and distal zones. Only two of the six titin molecules and only one of the three series of MyBP-C molecules per htf are represented for clarity. (D) Straightening of the proximal tandem Ig segment by passive stretch to 3.0 μm SL.Titin is a giant protein (up to 4 MDa) that spans the half-sarcomere (Fig. 1C, magenta), first through the I-band, connecting the Z-line with the tip of the thick filament, and then through the A-band, associated with the thick filament (six molecules per thick filament; refs. 5, 6) up to the M-line at the center of the sarcomere (7–9). The titin I-band region acts as a spring able to transmit the stress also when no myosin motors are attached to actin. In the muscle fiber of the frog, in which there is no contribution from extracellular matrix components (10, 11), titin is responsible for the passive force when the muscle cell is stretched at rest (Fig. 1B, triangles; refs. 12–16). Within the I-band titin, the distal tandem immunoglobulin-like segment forms a stiff end-filament composed of the six titin molecules attaching to the tip of the thick filament (17, 18), while the other two segments account for titin extensibility: the proximal tandem Ig segment (hereinafter called tandem Ig segment) and the unique sequence rich in proline (P), glutamate (E), valine (V), and lysine (K) residues (PEVK segment). Both spring-like segments exhibit variable muscle-type specific lengths (7, 19), which account for the differences in passive force–sarcomere length (SL) relations (20). In situ studies using immunofluorescence and immunoelectron microscopy on skinned fibers and myofibrils from mammalian skeletal muscle demonstrated that the large extensibility of the muscle sarcomere at SL < 2.7 μm is enabled by straightening out of randomly bent elements of the tandem Ig segment. At longer SL, at which the tandem Ig segment approaches its contour length, the passive force increases more steeply, reflecting the PEVK segment stiffness (SI Appendix, Supporting Note 1 and Fig. S1; see refs. 21–25).Titin in the A-band is composed of Ig and fibronectin (Fn) domains each ~4 nm long, with two distinct domain superrepeats: 11 “C-type” superrepeats, each composed of 11 Ig-Fn domains, extending from about layer 3 to 37 of the myosin crowns, and 6 “D-type” superrepeats, each composed of seven Ig-Fn domains, extending from about layer 38 to the filament tip (Fig. 1C; refs. 7, 26–28). The A-band region of titin is made inextensible by its association to the other proteins in the thick filament, myosin, and the Myosin Binding Protein C (MyBP-C), an accessory protein that is bound with its C terminus to the central one-third of the half-thick filament (htf) (C-zone, from layer 12 to 30, Fig. 1C) and extends from the thick filament backbone to establish dynamic interactions with the thin filament (2, 29–31) with its N terminus.I-band titin transmits any pulling force exerted on the extremity of the half-sarcomere to the tip of the thick filament and in this way could play a role in thick filament mechanosensing that switches myosin motors ON (3, 32). Moreover, as an elastic element in parallel with motors, I-band titin could preserve the homogeneity of sarcomeres during contraction, by preventing the lengthening of weak half-sarcomeres. However, titin-dependent passive force typically rises steeply only at SL > 2.6 µm (Fig. 1B; refs. 2, 10, 11, 22, 24, 33), and thus I-band titin stiffness is too low for the above functions at physiological SL, unless it gets much larger during contraction.The mechanical definition of the I-band titin in situ in the active half-sarcomere is hampered by the presence of the in-parallel array of myosin motors with a stiffness that is more than one order of magnitude larger than titin stiffness (34). Here, we use para-nitro-blebbistatin (PNB; ref. 35) to inhibit actin–myosin interaction during tetanic stimulation of a frog muscle cell. In addition, 20 μM PNB suppresses in vitro actin-triggered ATPase activity of frog muscle myosin S1 and heavy meromyosin (HMM) (SI Appendix, Materials and Methods and Fig. S2 A and B) and the mechanical response of the muscle cell to tetanic stimulation (SI Appendix, Fig. S2 C–E), maintaining the motors in the OFF-state conformation, in which they lie tilted back on the surface of the thick filament (Fig. 1C and SI Appendix, Fig. S3) (4, 36). Previous studies noted that blebbistatin does not fully suppress the mechanical response and maintain the motor OFF-state upon Ca²⁺ activation in skinned rabbit psoas fibers (32, 37). This is likely a consequence of either the lower inhibitory power of blebbistatin as compared to PNB (SI Appendix, Fig. S2 A and B) or intrinsic limits of skinned preparations to fully preserve the motor OFF-structure (27, 38).Here, we used sarcomere-level mechanics and small-angle X-ray fiber diffraction to determine the titin-dependent mechanical and structural responses to a stepwise increase in load imposed on the muscle cell under PNB-inhibitory conditions. Length changes in units of nanometer per half-sarcomere (hereinafter referred to as nm) were measured with a striation follower in a population of ~500 sarcomeres. We discovered that upon stimulation at physiological SL, titin in the I-band switches from the OFF-state characterized by large extensibility to the ON-state in which it exhibits rectifying properties, allowing free shortening, while opposing stretching with a viscosity coefficient three orders of magnitude larger that underpins an effective stiffness of 3 pN nm⁻¹. With the I-band titin in the ON-state, the periodic interactions between A-band titin and myosin motors are able to activate the thick filament by perturbing the resting disposition of motors on the surface of the thick filament in a load-dependent manner and biasing them toward the sixfold rotational symmetry of the thin filaments in the myofilament lattice.     

Protection against severe COVID-19 after second booster dose of adapted bivalent (original/Omicron BA.4-5) mRNA vaccine in persons ≥ 60 years,by time since infection,Italy, 12 September to 11 December 2022

Effectiveness against severe COVID-19 of a second booster dose of the bivalent (original/BA.4–5) mRNA vaccine 7–90 days post-administration, relative to a first booster dose of an mRNA vaccine received ≥ 120 days earlier, was ca 60% both in persons ≥ 60 years never infected and in those infected > 6 months before. Relative effectiveness in those infected 4–6 months earlier indicated no significant additional protection (10%; 95% CI: −44 to 44). A second booster vaccination 6 months after the latest infection may be warranted.     

Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients

Background/AimsThe utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation in an international real-world cohort of cACLD patients.MethodscACLD patients were stratified into three categories (CSPH excluded, grey zone, and CSPH). The risks of decompensation across different CSPH categories were estimated using competing risk regression for clustered data, with death and hepatocellular carcinoma as competing events. The performance of “treating definite CSPH” strategy to prevent decompensation using non-selective beta-blocker (NSBB) was compared against other strategies in decision curve analysis.ResultsOne thousand one hundred fifty-nine cACLD patients (36.8% had CSPH) were included; 7.2% experienced decompensation over a median follow-up of 40 months. Non-invasive assessment of CSPH predicts a 5-fold higher risk of liver decompensation in cACLD patients (subdistribution hazard ratio, 5.5; 95% confidence interval, 4.0–7.4). “Probable CSPH” is suboptimal to predict decompensation risk in cACLD patients. CSPH exclusion criteria reliably exclude cACLD patients at risk of decompensation, regardless of etiology. Among the grey zone, the decompensation risk was negligible among viral-related cACLD, but was substantially higher among the non-viral cACLD group. Decision curve analysis showed that “treating definite CSPH” strategy is superior to “treating all varices” or “treating probable CSPH” strategy to prevent decompensation using NSBB.ConclusionsNon-invasive assessment of CSPH may stratify decompensation risk and the need for NSBB in cACLD patients.     

The Role of Nitrogen Fertilization on the Occurrence of Regulated,Modified and Emerging Mycotoxins and Fungal Metabolites in Maize Kernels

The European Food Safety Authority is currently evaluating the risks related to the presence of emerging mycotoxins in food and feeds. The aim of this study was to investigate the role of soil fertility, resulting from different nitrogen fertilization rates, on the contamination of regulated mycotoxins and emerging fungal metabolites in maize grains. The trial was carried out in the 2012–2013 growing seasons as part of a long-term (20-year) experimental platform area in North-West Italy, where five different N rates, ranging from 0 to 400 kg N ha⁻¹, were applied to maize each year. Maize samples were analyzed by means of a dilute-and-shoot multi-mycotoxin LC-MS/MS method, and more than 25 of the most abundant mycotoxins and fungal metabolites were detected. Contamination by fumonisins and other fungal metabolites produced by Fusarium spp. of the section Liseola was observed to have increased in soils that showed a poor fertility status. On the other hand, an overload of nitrogen fertilization was generally associated with higher deoxynivalenol and zearalenone contamination in maize kernels, as well as a higher risk of other fungal metabolites produced by Fusarium spp. sections Discolor and Roseum. A balanced application of N fertilizer, in accordance with maize uptake, generally appears to be the best solution to guarantee an overall lower contamination by regulated mycotoxins and emerging fungal metabolites.     

Diagnostic accuracy of multislice computed tomography coronary angiography is improved at low heart rates

Purpose: Assess the effect of heart rate on diagnostic accuracy for the detection of significant coronary artery stenosis using 16-row multislice computed tomography (MSCT). Material and methods: About 120 patients (105 males; 59±11 years) with suspected coronary artery disease who underwent conventional coronary angiography (CA) and MSCT-CA were retrospectively enrolled for the study. Patients underwent a MSCT-CA (Sensation 16, Siemens, Germany), with the following protocol: collimation 16×0.75 mm, gantry rotation time 420 ms, feed/rotation 3.0 mm, kV 120, mAs 400–500. The protocol for contrast material administration was 100 ml of Iodixanol (Visipaque 320 mg l/ml, Amersham, UK) at 4 ml/s and the delay was defined with a bolus tracking technique. In all patients the mean heart rate (HR) during the scan was used as a criteria to divide the population in two groups of 60 patients each. In one group (Low HR) the 60 patients with lower heart rates, and in the other group (High HR) the patients with higher heart rates. In the two groups diagnostic accuracy (per coronary segment) for the detection of significant stenosis (≥50% lumen reduction) was evaluated in vessels ≥2 mm of diameter using quantitative CA as reference standard. The difference in diagnostic accuracy were compared with a Chi² test and a p<0.05 was considered significant. Results: There was no significant difference between the two groups regarding age, gender, weight, mean intravascular attenuation, and calcium score. Overall 1310 (652 for Low HR and 658 for High HR) segments with 219 (105 for Low HR and 114 for High HR) significant lesions were available for the analysis. The average heart rate was 52±4HU and 63±5HU for Low HR and High HR, respectively (p<0.001). The sensitivity and specificity were 92 and 96% for Low HR and 90 and 92% for High HR (p<0.05). There were 22 vs. 44 false positives, and 8 vs. 12 false negatives in the Low HR and High HR, respectively. Conclusion: Increasing HR significantly deteriorates diagnostic accuracy in MSCT-CA.     

Substances of abuse consumption among patients seeking medical help for uro-andrological purposes:a sociobehavioral survey in the real-life scenario

Substances of abuse(SoA),as well as smoking and alcohol consumption,are well known for their impact on male fertility status,erectile function,and ejaculation.W...