Genomic landscape of lung adenocarcinoma in East Asians

Lung cancer is the world’s leading cause of cancer death and shows strong ancestry disparities. By sequencing and assembling a large genomic and transcriptomic dataset of lung adenocarcinoma (LUAD) in individuals of East Asian ancestry (EAS; n = 305), we found that East Asian LUADs had more stable genomes characterized by fewer mutations and fewer copy number alterations than LUADs from individuals of European ancestry. This difference is much stronger in smokers as compared to nonsmokers. Transcriptomic clustering identified a new EAS-specific LUAD subgroup with a less complex genomic profile and upregulated immune-related genes, allowing the possibility of immunotherapy-based approaches. Integrative analysis across clinical and molecular features showed the importance of molecular phenotypes in patient prognostic stratification. EAS LUADs had better prediction accuracy than those of European ancestry, potentially due to their less complex genomic architecture. This study elucidated a comprehensive genomic landscape of EAS LUADs and highlighted important ancestry differences between the two cohorts

Synthesis and Enhanced Field-Emission of Thin-Walled, Open-Ended, and Well-Aligned N-Doped Carbon Nanotubes

Thin-walled, open-ended, and well-aligned N-doped carbon nanotubes (CNTs) on the quartz slides were synthesized by using acetonitrile as carbon sources. As-obtained products possess large thin-walled index (TWI, defined as the ratio of inner diameter and wall thickness of a CNT). The effect of temperature on the growth of CNTs using acetonitrile as the carbon source was also investigated. It is found that the diameter, the TWI of CNTs increase and the Fe encapsulation in CNTs decreases as the growth temperature rises in the range of 780–860°C. When the growth temperature is kept at 860°C, CNTs with TWI = 6.2 can be obtained. It was found that the filed-emission properties became better as CNT growth temperatures increased from 780 to 860°C. The lowest turn-on and threshold field was 0.27 and 0.49 V/μm, respectively. And the best field-enhancement factors reached 1.09 × 105, which is significantly improved about an order of magnitude compared with previous reports. In this study, about 30 × 50 mm2 free-standing film of thin-walled open-ended well-aligned N-doped carbon nanotubes was also prepared. The free-standing film can be transferred easily to other substrates, which would promote their applications in different fields

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Integrated pharmacokinetic&ndash;pharmacodynamic modeling to evaluate empiric carbapenem therapy in bloodstream infections

Tze-Peng Lim,1,2 Reyna Wang,1 Gang Quan Poh,3 Tse-Hsien Koh,4 Thean-Yen Tan,5 Winnie Lee,1 Jocelyn Qi-Min Teo,1 Yiying Cai,1 Thuan-Tong Tan,6 Pui Lai Rachel Ee,3 Andrea L Kwa1,3,7 1Department of Pharmacy, Singapore General Hospital, Singapore, Singapore; 2SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore; 3Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore; 4Department of Microbiology, Singapore General Hospital, Singapore, Singapore; 5Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore; 6Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore; 7Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore Objectives: Treatment for nosocomial bloodstream infections (BSI) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) is challenging. Rising antimicrobial resistance, especially in extended spectrum beta-lactamase production, inadvertently increases empiric carbapenem consumption. Three antipseudomonal carbapenems (imipenem, meropenem [MER], and doripenem [DOR]) are available commercially against MDR GNB in Singapore. The study aims to determine the most optimal empiric carbapenem dosing regimens (CDR) and evaluate their cost-effectiveness for GNB-BSI in the face of increasing MDR GNB. Methods: Carbapenem minimum inhibitory concentrations (MICs) were generated for non-repeat GNB-BSI obtained in 2013&ndash;2014 from two hospitals. Monte Carlo simulations were used to assess the cumulative fraction of response (CFR) of various CDRs using the percentage of time above MIC for 40% (%T&nbsp;&gt;&nbsp;MIC of 40%) as the pharmacokinetic (PK)&ndash;pharmacodynamic (PD) parameter for efficacy. Carbapenem costs were based on patient antibiotic costs. Antibiotic cost-effectiveness was calculated as total daily drug cost/CFR. Results: A total of 1,140 bloodstream isolates were collected. They comprised 116 Acinetobacter baumannii, 237 Pseudomonas aeruginosa, and 787 Enterobacteriaceae. All CDRs achieved ~40, ~80, and &ge;90% CFRs against A. baumannii, P. aeruginosa, and Enterobacteriaceae, respectively. Against P. aeruginosa, MER 2&nbsp;g every 8&nbsp;h infused over 3&nbsp;h and DOR 1&nbsp;g every 8&nbsp;h infused over 4&nbsp;h achieved CFRs 84 and 81%, respectively. Against Enterobacteriaceae, the cost of MER 2&nbsp;g every 8&nbsp;h infused over 3&nbsp;h was the lowest among the three carbapenems at $0.40/percentage of CFR. Conclusion: This study demonstrates the utility of PK&ndash;PD modeling to formulate the optimal selection of a cost-effective empiric CDR in antibiotics guidelines and formulary inclusion. The findings support the selection of high MER doses of prolonged infusions as empiric coverage for GNB-BSI in our institutions. Keywords: empiric carbapenem regimens, multidrug resistant, Gram-negative bacteria, bloodstream infection

Environmental Sustainable Fleet Planning in B2C e-Commerce Urban Distribution NetworksSmart City

Sustainable distribution is one of the topics concerning the smart city concept. In this chapter we face the problem of delivering a given amount of goods in urban areas arising from e-channel department stores, with the aim of minimizing the overall distribution costs; costs take into account traveling components, loading and other operative aspects, and environmental issues. More precisely, in the present business to consumer distribution problem, we have to determine the fleet of not homogeneous vehicles (trucks, wagons, vans and picks-up) to be used for satisfying the demands of clients coming from e-channels, and their related itineraries, given the traveling limits imposed by the urban government; in particular, we have to respect the maximum route length constraints and use the appropriate vehicles for each kind of street. We propose a mathematical programming model to solve this computationally difficult problem, which is strategic for being able to implement sustainable distribution plans in a smart city context. Preliminary results of test bed cases related to different sized urban distribution networks are reported and analyzed

Beyond fitness tracking: The use of consumer-grade wearable data from normal volunteers in cardiovascular and lipidomics research

The use of consumer-grade wearables for purposes beyond fitness tracking has not been comprehensively explored. We generated and analyzed multidimensional data from 233 normal volunteers, integrating wearable data, lifestyle questionnaires, cardiac imaging, sphingolipid profiling, and multiple clinical-grade cardiovascular and metabolic disease markers. We show that subjects can be stratified into distinct clusters based on daily activity patterns and that these clusters are marked by distinct demographic and behavioral patterns. While resting heart rates (RHRs) performed better than step counts in being associated with cardiovascular and metabolic disease markers, step counts identified relationships between physical activity and cardiac remodeling, suggesting that wearable data may play a role in reducing overdiagnosis of cardiac hypertrophy or dilatation in active individuals. Wearable-derived activity levels can be used to identify known and novel activity-modulated sphingolipids that are in turn associated with insulin sensitivity. Our findings demonstrate the potential for wearables in biomedical research and personalized health