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ROC-325 combination data.

Cathepsin D knockdown studies.

Drug washout experiment.

Growth characteristics and HCQ sensitivity of ATG5 and ATG7 knockdown cells.

Purpose: Although autophagy plays important roles in malignant pathogenesis and drug resistance, there are few clinical agents that disrupt this pathway, and the potential therapeutic benefit of autophagy inhibition remains undetermined. We used medicinal chemistry approaches to generate a series of novel agents that inhibit autophagic degradation.Experimental Design: ROC-325 was selected as a lead compound for further evaluation. Comprehensive in vitro and in vivo studies were conducted to evaluate the selectivity, tolerability, and efficacy of ROC-325 in preclinical models of renal cell carcinoma (RCC) with HCQ serving as a comparator. Markers of autophagy inhibition and cell death were evaluated in tumor specimens.Results: ROC-325 exhibited superior in vitro anticancer effects compared with the existing autophagy inhibitor hydroxychloroquine (HCQ) in 12 different cancer cell lines with diverse genetic backgrounds. Focused studies of the mechanism of action and efficacy of ROC-325 in RCC cells showed that drug treatment induced hallmark characteristics of autophagy inhibition, including accumulation of autophagosomes with undegraded cargo, lysosomal deacidification, p62 stabilization, and disruption of autophagic flux. Subsequent experiments showed that ROC-325 antagonized RCC growth and survival in an ATG5/7-dependent manner, induced apoptosis, and exhibited favorable selectivity. Oral administration of ROC-325 to mice bearing 786-0 RCC xenografts was well tolerated, was significantly more effective at inhibiting tumor progression than HCQ, and inhibited autophagy in vivo.Conclusions: Our findings demonstrate that ROC-325 has superior preclinical anticancer activity compared with HCQ and support the clinical investigation of its safety and preliminary efficacy in patients with RCC and other autophagy-dependent malignancies. Clin Cancer Res; 23(11); 2869–79. ©2016 AACR.

Gene expression data

BackgroundOver-ordering of daily laboratory tests adversely affects patient care through hospital-acquired anaemia, patient discomfort, burden on front-line staff and unnecessary downstream testing. This remains a prevalent issue despite the 2013 Choosing Wisely recommendation to minimise unnecessary daily labs. We conducted a systematic review of the literature to identify interventions targeting unnecessary laboratory testing.MethodsWe systematically searched MEDLINE, EMBASE, Cochrane Central and SCOPUS databases to identify interventions focused on reducing daily complete blood count, complete metabolic panel and basic metabolic panel labs. We defined interventions as ‘effective’ if a statistically significant reduction was attained and ‘highly effective’ if a reduction of ≥25% was attained.ResultsThe search yielded 5646 studies with 41 articles that met inclusion criteria. We grouped interventions into one or more categories: audit and feedback, cost display, education, electronic medical record (EMR) change, and policy change. Most interventions lasted less than a year and used a multipronged approach. All five strategies were effective in most studies with EMR change being the most commonly used independent strategy. EMR change and policy change were the strategies most frequently reported as effective. EMR change was the strategy most frequently reported as highly effective.ConclusionOur analysis identified five categories of interventions targeting daily laboratory testing. All categories were effective in most studies, with EMR change being most frequently highly effective.PROSPERO registration numberCRD42021254076.

Background multimorbidity contributes to a large portion of the disease burden in low- and middle-income countries. However, limited research has been undertaken in China. This study has investigated the prevalence of multimorbidity and the associations of multimorbidity with activities of daily living (ADL), instrumental activities of daily living (IADL) and depression in China. Methods the study participants included 10,055 adults aged 45 years and older from three rounds of the China Health and Retirement Longitudinal Study 2011–2015. Random-effects logistic regression models were used to examine the association of multimorbidity with ADL limitation, IADL limitation and mental disease. Results the prevalence of multimorbidity amongst adults in China aged 45 years and older was 62.1% in 2015. The prevalence of multimorbidity was increased with older age, among women, in a higher socio-economic group and in the most deprived regions. Multimorbidity is associated with an increased likelihood of experiencing ADL limitation (adjusted odds ratio [AOR] = 5.738, 95% confidence intervals (CI) = 5.733, 5.744) and IADL limitation (AOR = 2.590, 95% CI = 2.588, 2.592) and depression (AOR = 3.352, 95% CI = 3.350, 3.354). Rural–urban disparities in functional difficulties and depression were also found amongst patients with multimorbidity. Conclusions the burden of multimorbidity is high in China, particularly amongst the older population. Multimorbidity is associated with higher levels of functional limitations and depression. China healthcare reforms should introduce integrated care models and patient-centred healthcare delivery. The increasing need for reorientation of healthcare resources considering the distribution of multimorbidity and its adverse effect requires more attention from health policymakers in China and other developing countries.

Covalent organic frameworks (COFs) are molecule-based 2D and 3D materials that possess a wide range of mechanical and electronic properties. We have performed a joint experimental and theoretical study of the electronic structure of boroxine-linked COFs grown under ultrahigh vacuum conditions and characterized using scanning tunneling spectroscopy on Au(111) and hBN/Cu(111) substrates. Our results show that a single hBN layer electronically decouples the COF from the metallic substrate, thus suppressing substrate-induced broadening and revealing new features in the COF electronic local density of states (LDOS). The resulting sharpening of LDOS features allows us to experimentally determine the COF band gap, bandwidths, and the electronic hopping amplitude between adjacent COF bridge sites. These experimental parameters are consistent with the results of first-principles theoretical predictions.

Objective To review observational human, murine, and interventional trial studies that have examined the gut microbiome in food allergy, and to provide perspective on future investigations in this field. Data Sources A review of the published literature was performed with PubMed, and clinical studies catalogued at ClinicalTrials.gov were also reviewed. Study Selections The most recent relevant studies, seminal works, and topical clinical trials were selected. Results Gut dysbiosis likely precedes the development of food allergy, and the timing of such dysbiosis is critical. Gut microbiota associated with individual food allergies may be distinct. Murine models support the importance of gut microbiota in shaping immune maturation and tolerance. Gut microbiota may affect food allergy susceptibility by modulating type 2 immunity, influencing immune development and tolerance, regulating basophil populations, and promoting intestinal barrier function. Ongoing and future interventional trials of probiotics, prebiotics, synbiotics, and fecal microbiota transfer will help translate our understanding of the gut microbiome in food allergy to clinical practice. Future work in this area will include deepening of current research foci, as well as expansion of efforts to include the virome, mycobiome, and interactions between the microbiome, host, and environment. Robust and consistent study designs, multidimensional profiling, and systems biology approaches will enable this future work. Conclusion By advancing research on the microbiome in food allergy, we can further our understanding of food allergy and derive new approaches for its prevention and therapy.

Background: Over-ordering of daily labs affects patient safety through hospital-acquired anemia, patient discomfort, frontline staff burden, and unnecessary downstream testing resulting in the delivery of low-value care. Routine ordering of unnecessary tests occurs for many reasons and can additionally increase cost of care. At our center, previous interventions have targeted lab ordering, but have struggled to remain sustainable. Our student-run project, as part of a high value care curriculum, set out to understand current state practice and local culture to inform future high-value care and quality improvement interventions to target over-ordering of daily labs. Methods: We employed mixed methods to assess lab ordering behaviors and attitudes at an urban quaternary academic medical center. Electronic medical record (EMR) data was gathered to assess the number of daily labs (BMP, CMP, and CBC) ordered on a general medicine unit from June–October 2020. We surveyed internal medicine (IM) attendings, residents, physician assistants (PA), nurse practitioners (NP), registered nurses (RN), and patient care associates (PCA) to understand cross-professional beliefs and attitudes about daily lab testing. Results:An average of 2.2 labs were collected per patient day. This was an increase from the 1.3 labs per patient day found in a similar patient population from March 2016 to August 2017 after the last daily lab reduction intervention. A widely distributed survey yielded 127 frontline staff responses: 29 (22.8%) attending physicians, 43 (33.9%) resident physicians and fellows, 12 (9.4%) PAs, 10 (7.9%) NPs, 14 (11.0%) RNs, and 19 (15%) PCAs. Of the 94 ordering providers (MD, DO, PA, NP), 73% thought they were unnecessary. No attending physicians designated daily lab testing as necessary, in contrast to 10% of NPs, 33% of PAs and 25% of residents. Only 29% of ordering providers agreed that daily testing improved patient care and safety; moreover, 89% believe it has potential harms. Of the residents, NP, and PAs, 68% cited worry over attending reaction and 97% cited training/habit as a reason for ordering unnecessary labs. Conclusions: Analysis of prior interventions on unnecessary lab testing has demonstrated a strong need for sustainable interventions to improve patient care and reduce costs. Our multidisciplinary survey highlights a major discrepancy between attendings and other ordering providers on the necessity of daily tests. These results reveal the potential impact of planned PDSA (plan-do-study-act) cycle interventions including planned educational sessions, the initiation of monthly audit and feedback email, and attending-led rounding discussions on necessary labs. Learning Objective #1: To describe the current state of daily labs ordered per patient in the context of prior interventions to reduce lab burden as a means to identify areas of improvement for future quality initiatives. Learning Objective #2: To assess interdisciplinary attitudes on daily laboratory testing to develop a sustainable quality improvement intervention.

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, creates an urgent need for identifying molecular mechanisms that mediate viral entry, propagation, and tissue pathology. Cell membrane bound angiotensin-converting enzyme 2 (ACE2) and associated proteases, transmembrane protease serine 2 (TMPRSS2) and Cathepsin L (CTSL), were previously identified as mediators of SARS-CoV2 cellular entry. Here, we assess the cell type-specific RNA expression of ACE2, TMPRSS2, and CTSL through an integrated analysis of 107 single-cell and single-nucleus RNA-Seq studies, including 22 lung and airways datasets (16 unpublished), and 85 datasets from other diverse organs. Joint expression of ACE2 and the accessory proteases identifies specific subsets of respiratory epithelial cells as putative targets of viral infection in the nasal passages, airways, and alveoli. Cells that co-express ACE2 and proteases are also identified in cells from other organs, some of which have been associated with COVID-19 transmission or pathology, including gut enterocytes, corneal epithelial cells, cardiomyocytes, heart pericytes, olfactory sustentacular cells, and renal epithelial cells. Performing the first meta-analyses of scRNA-seq studies, we analyzed 1,176,683 cells from 282 nasal, airway, and lung parenchyma samples from 164 donors spanning fetal, childhood, adult, and elderly age groups, associate increased levels of ACE2, TMPRSS2, and CTSL in specific cell types with increasing age, male gender, and smoking, all of which are epidemiologically linked to COVID-19 susceptibility and outcomes. Notably, there was a particularly low expression of ACE2 in the few young pediatric samples in the analysis. Further analysis reveals a gene expression program shared by ACE2+TMPRSS2+ cells in nasal, lung and gut tissues, including genes that may mediate viral entry, subtend key immune functions, and mediate epithelial-macrophage cross-talk. Amongst these are IL6, its receptor and co-receptor, IL1R, TNF response pathways, and complement genes. Cell type specificity in the lung and airways and smoking effects were conserved in mice. Our analyses suggest that differences in the cell type-specific expression of mediators of SARS-CoV-2 viral entry may be responsible for aspects of COVID-19 epidemiology and clinical course, and point to putative molecular pathways involved in disease susceptibility and pathogenesis.

Bottom-up graphene nanoribbon (GNR) heterojunctions are nanoscale strips of graphene whose electronic structure abruptly changes across a covalently bonded interface. Their rational design offers opportunities for profound technological advancements enabled by their extraordinary structural and electronic properties. Thus far, the most critical aspect of their synthesis, the control over sequence and position of heterojunctions along the length of a ribbon, has been plagued by randomness in monomer sequences emerging from step-growth copolymerization of distinct monomers. All bottom-up GNR heterojunction structures created so far have exhibited random sequences of heterojunctions and, while useful for fundamental scientific studies, are difficult to incorporate into functional nanodevices as a result. In contrast, we describe a hierarchical fabrication strategy that allows the growth of bottom-up GNRs that preferentially exhibit a single heterojunction interface rather than a random statistical sequence of junctions along the ribbon. Such heterojunctions provide a viable platform that could be directly used in functional GNR-based device applications at the molecular scale. Our hierarchical GNR fabrication strategy is based on differences in the dissociation energies of C-Br and C-I bonds that allow control over the growth sequence of the block copolymers from which GNRs are formed and consequently yields a significantly higher proportion of single-junction GNR heterostructures. Scanning tunneling spectroscopy and density functional theory calculations confirm that hierarchically grown heterojunctions between chevron GNR (cGNR) and binaphthyl-cGNR segments exhibit straddling Type I band alignment in structures that are only one atomic layer thick and 3 nm in width.

The emergence of low-power 32-bit Systems-on-Chip (SoCs), which integrate a 32-bit MCU, radio, and flash, presents an opportunity to re-examine design points and trade-offs at all levels of the system architecture of networked sensors. To this end, we develop a post-SoC/32-bit design point called Hamilton, showing that using integrated components enables a ~$7 core and shifts hardware modularity to design time. We study the interaction between hardware and embedded operating systems, identifying that (1) post-SoC motes provide lower idle current (5.9 μA) than traditional 16-bit motes, (2) 32-bit MCUs are a major energy consumer (e.g., tick increases idle current >50 times), comparable to radios, and (3) thread-based concurrency is viable, requiring only 8.3 μs of context switch time. We design a system architecture, based on a tickless multithreading operating system, with cooperative/adaptive clocking, advanced sensor abstraction, and preemptive packet processing. Its efficient MCU control improves concurrency with ~30% less energy consumption. Together, these developments set the system architecture for networked sensors in a new direction.

In analysing clinical trials designed to show superiority of one treatment compared to another, it is standard to use an intention to treat analytic approach. In active-controlled noninferiority studies, this is not standard, due to concerns that such an analysis will inflate the chance of falsely rejecting the null hypothesis, accepting therapeutic noninferiority when it is not justified. The reasons for using intention to treat (ITT) approaches in superiority studies include a desire to capture all information on study subjects, a need to prevent bias, and assurance that comparative groups are, on average, equivalent in prognostic factors. In this commentary, we argue that these same justifications carry over to noninferiority studies, and that for those and other reasons it should be the preferred analytic approach. We review regulatory guidelines, and propose a number of approaches to minimizing the potential disadvantages of the ITT approach in the noninferiority setting. Clinical Trials 2007; 4: 286—291; http://ctj.sagepub.com

The apicomplexan intraerythrocytic parasite Babesia microti is an emerging human pathogen and the primary cause of human babesiosis, a malaria-like illness endemic in the United States. The pathogen is transmitted to humans by the tick vector, Ixodes scapularis, and by transfusion of blood from asymptomatic B. microti-infected donors. Whereas the nuclear and mitochondrial genomes of this parasite have been sequenced, assembled and annotated, its apicoplast genome remained incomplete, mainly due to its low representation and high A+T content. Here we report the complete sequence and annotation of the apicoplast genome of the B. microti R1 isolate. The genome consists of a 28.7 kb circular molecule encoding primarily functions important for maintenance of the apicoplast DNA, transcription, translation and maturation of organellar proteins. Genome analysis and annotation revealed a unique gene structure and organization of the B. microti apicoplast genome and suggest that all metabolic and non-housekeeping functions in this organelle are nuclear-encoded. B. microti apicoplast functions are significantly different from those of the host, suggesting that they might be useful as targets for development of potent and safe therapies for the treatment of human babesiosis.

Angiotensin-converting enzyme 2 (ACE2) and accessory proteases (TMPRSS2 and CTSL) are needed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cellular entry, and their expression may shed light on viral tropism and impact across the body. We assessed the cell-type-specific expression of ACE2, TMPRSS2 and CTSL across 107 single-cell RNA-sequencing studies from different tissues. ACE2, TMPRSS2 and CTSL are coexpressed in specific subsets of respiratory epithelial cells in the nasal passages, airways and alveoli, and in cells from other organs associated with coronavirus disease 2019 (COVID-19) transmission or pathology. We performed a meta-analysis of 31 lung single-cell RNA-sequencing studies with 1,320,896 cells from 377 nasal, airway and lung parenchyma samples from 228 individuals. This revealed cell-type-specific associations of age, sex and smoking with expression levels of ACE2, TMPRSS2 and CTSL. Expression of entry factors increased with age and in males, including in airway secretory cells and alveolar type 2 cells. Expression programs shared by ACE2+TMPRSS2+ cells in nasal, lung and gut tissues included genes that may mediate viral entry, key immune functions and epithelial-macrophage cross-talk, such as genes involved in the interleukin-6, interleukin-1, tumor necrosis factor and complement pathways. Cell-type-specific expression patterns may contribute to the pathogenesis of COVID-19, and our work highlights putative molecular pathways for therapeutic intervention.