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Background: Patients with chronic kidney disease (CKD) are at high risk of myocardial infarction. Cardiac troponins are the biomarkers of choice for the diagnosis of acute myocardial infarction (AMI) without ST‐segment elevation (NSTE). In patients with CKD, troponin levels are often chronically elevated, which reduces their diagnostic utility when NSTE‐AMI is suspected. The aim of this study was to derive a diagnostic algorithm for serial troponin measurements in patients with CKD and suspected NSTE‐AMI.
Methods and Results: Two cohorts, 1494 patients from a prospective cohort study with high‐sensitivity troponin I (hs‐cTnI) measurements and 7059 cases from a clinical registry with high‐sensitivity troponin T (hs‐cTnT ) measurements, were analyzed. The prospective cohort comprised 280 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m2). The registry data set contained 1581 CKD patients. In both cohorts, CKD patients were more likely to have adjudicated NSTE‐AMI than non‐CKD patients. The specificities of hs‐cTnI and hs‐cTnT to detect NSTE‐AMI were reduced with CKD (0.82 versus 0.91 for hs‐cTnI and 0.26 versus 0.73 for hs‐cTnT) but could be restored by applying optimized cutoffs to either the first or a second measurement after 3 hours. The best diagnostic performance was achieved with an algorithm that incorporates serial measurements and rules in or out AMI in 69% (hs‐cTnI) and 55% (hs‐cTnT) of CKD patients.
Conclusions: The diagnostic performance of high‐sensitivity cardiac troponins in patients with CKD with suspected NSTE‐AMI is improved by use of an algorithm based on admission troponin and dynamic changes in troponin concentration.
As new generations of targeted therapies emerge and tumor genome sequencing discovers increasingly comprehensive mutation repertoires, the functional relationships of mutations to tumor phenotypes remain largely unknown. Here, we measured ex vivo sensitivity of 246 blood cancers to 63 drugs alongside genome, transcriptome, and DNA methylome analysis to understand determinants of drug response. We assembled a primary blood cancer cell encyclopedia data set that revealed disease-specific sensitivities for each cancer. Within chronic lymphocytic leukemia (CLL), responses to 62% of drugs were associated with 2 or more mutations, and linked the B cell receptor (BCR) pathway to trisomy 12, an important driver of CLL. Based on drug responses, the disease could be organized into phenotypic subgroups characterized by exploitable dependencies on BCR, mTOR, or MEK signaling and associated with mutations, gene expression, and DNA methylation. Fourteen percent of CLLs were driven by mTOR signaling in a non–BCR-dependent manner. Multivariate modeling revealed immunoglobulin heavy chain variable gene (IGHV) mutation status and trisomy 12 as the most important modulators of response to kinase inhibitors in CLL. Ex vivo drug responses were associated with outcome. This study overcomes the perception that most mutations do not influence drug response of cancer, and points to an updated approach to understanding tumor biology, with implications for biomarker discovery and cancer care.
Measurement of cross sections for e⁺e⁻ → μ⁺μ⁻ at center-of-mass energies from 3.80 to 4.60 GeV
(2020)
The observed cross sections for 𝑒+𝑒−→𝜇+𝜇− at energies from 3.8 to 4.6 GeV are measured using data samples taken with the BESIII detector operated at the BEPCII collider. We measure the muonic widths and determine the branching fractions of the charmonium states 𝜓(4040), 𝜓(4160), and 𝜓(4415) decaying to 𝜇+𝜇−, as well as making a first determination of the phase of the amplitudes. In addition, we observe evidence for a structure in the dimuon cross section near 4.220 GeV/𝑐2, which we denote as 𝑆(4220). Analyzing a coherent sum of amplitudes yields eight solutions, one of which gives a mass of 𝑀𝑆(4220) = 4216.7±8.9±4.1 MeV/𝑐2, a total width of Γtot S(4220) = 47.2±22.8±10.5 MeV, and a muonic width of Γ𝜇𝜇 𝑆(4220) = 1.53±1.26±0.54 keV, where the first uncertainties are statistical and the second systematic. The eight solutions give the central values of the mass, total width, muonic width to be, respectively, in the range from 4212.8 to 4219.4 MeV/𝑐2, from 36.4 to 49.6 MeV, and from 1.09 to 1.53 keV. The statistical significance of the 𝑆(4220) signal is 3.9𝜎. Correcting the total dimuon cross section for radiative effects yields a statistical significance for this structure of 8.1𝜎.
Using 2.93 fb−1 of 𝑒+𝑒− collision data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, the first observation of the doubly Cabibbo-suppressed decay 𝐷+→𝐾+𝜋+𝜋−𝜋0 is reported. After removing decays that contain narrow intermediate resonances, including 𝐷+→𝐾+𝜂, 𝐷+→𝐾+𝜔, and 𝐷+→𝐾+𝜙, the branching fraction of the decay 𝐷+→𝐾+𝜋+𝜋−𝜋0 is measured to be (1.13±0.08stat±0.03syst)×10−3. The ratio of branching fractions of 𝐷+→𝐾+𝜋+𝜋−𝜋0 over 𝐷+→𝐾−𝜋+𝜋+𝜋0 is found to be (1.81±0.15)%, which corresponds to (6.28±0.52)tan4𝜃𝐶, where 𝜃𝐶 is the Cabibbo mixing angle. This ratio is significantly larger than the corresponding ratios for other doubly Cabibbo-suppressed decays. The asymmetry of the branching fractions of charge-conjugated decays 𝐷±→𝐾±𝜋±𝜋∓𝜋0 is also determined, and no evidence for 𝐶𝑃 violation is found. In addition, the first evidence for the 𝐷+→𝐾+𝜔 decay, with a statistical significance of 3.3𝜎, is presented and the branching fraction is measured to be ℬ(𝐷+→𝐾+𝜔) = (5.7+2.5−2.1stat±0.2syst)×10−5.
Using a sample of 1.31×109 𝐽/𝜓 events collected with the BESIII detector, we perform a study of 𝐽/𝜓→𝛾𝜂𝜂𝜂′ to search for the 𝑋(2370) and 𝜂𝑐 in the 𝜂𝜂𝜂′ invariant mass distribution. No significant signal for the 𝑋(2370) is observed, and we set an upper limit for the product branching fraction of ℬ(𝐽/𝜓→𝛾𝑋(2370)·ℬ(𝑋(2370)→𝜂𝜂𝜂′)<9.2×10−6 at the 90% confidence level. A clear 𝜂𝑐 signal is observed for the first time, yielding a product branching fraction of ℬ(𝐽/𝜓→𝛾𝜂𝑐)·ℬ(𝜂𝑐→𝜂𝜂𝜂′)=(4.86±0.62(stat)±0.45(sys))×10−5.
We report an amplitude analysis and branching fraction measurement of 𝐷+
𝑠→𝐾+𝐾−𝜋+ decay using a data sample of 3.19 fb−1 recorded with BESIII detector at a center-of-mass energy of 4.178 GeV. We perform a model-independent partial wave analysis in the low 𝐾+𝐾− mass region to determine the 𝐾+𝐾− S-wave line shape, followed by an amplitude analysis of our very pure high-statistics sample. With the detection efficiency based on the amplitude analysis results, the absolute branching fraction is measured to be ℬ(𝐷+𝑠→𝐾+𝐾−𝜋+)=(5.47±0.08stat±0.13sys)%.
By analyzing a data sample corresponding to an integrated luminosity of 2.93 fb−1 collected at a center-of-mass energy of 3.773 GeV with By analyzing a data sample corresponding to an integrated luminosity of 2.93 fb−1 collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the 𝐷+→𝜂𝜇+𝜈𝜇 decay to be ℬ𝐷+→𝜂𝜇+𝜈𝜇=(10.4±1.0stat±0.5syst)×10−4. Using the world averaged value of ℬ𝐷+→𝜂𝑒+𝜈𝑒, the ratio of the two branching fractions is determined to be ℬ𝐷+→𝜂𝜇+𝜈𝜇/ℬ𝐷+→𝜂𝑒+𝜈𝑒=0.91±0.13(stat+syst), which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor 𝑓𝜂+(0) and the 𝑐→𝑑 Cabibbo-Kobayashi-Maskawa matrix element |𝑉𝑐𝑑| to be 𝑓𝜂+(0)|𝑉𝑐𝑑|=0.087±0.008stat±0.002syst. Taking the input of |𝑉𝑐𝑑| from the global fit in the standard model, we determine 𝑓𝜂+(0)=0.39±0.04stat±0.01syst. On the other hand, using the value of 𝑓𝜂+(0) calculated in theory, we find |𝑉𝑐𝑑| = 0.242±0.022stat±0.006syst±0.033theory.
We report a measurement of the observed cross sections of e+ e− → J/ψX based on 3.21 fb − 1 of data accumulated at energies from 3.645 to 3.891 GeV with the BESIII detector operated at the BEPCII collider. In analysis of the cross sections, we measured the decay branching fractions of B(ψ(3686) → J/ψX) = (64.4 ± 0.6 ± 1.6)% and B(ψ(3770) → J/ψX) = (0.5 ± 0.2 ± 0.1)% for the first time. The energy-dependent line shape of these cross sections cannot be well described by two Breit-Wigner (BW) amplitudes of the expected decays ψ (3686) → J/ψX and ψ(3770) → J/ψX. Instead, it can be better described with one more BW amplitude of the decay R(3760)→ J/ψX. Under this assumption, we extracted the R (3760) mass M R (3760 ) = 3766.2 ± 3.8 ± 0.4 MeV/c2, total width Γ tot R ( 3760 ) = 22.2 ± 5.9 ± 1.4 MeV, and product of leptonic width and decay branching fraction
ΓeeR(3760) B[R(3760) → J/ψX] = (79.4 ± 85.5 ± 11.7) eV. The significance of the R(3760) is 5.3σ. The first uncertainties of these measured quantities are from fits to the cross sections and second systematic.
We report an amplitude analysis and branching fraction measurement of D+s→K+K−π+ decay using a data sample of 3.19 fb−1 recorded with BESIII detector at a center-of-mass energy of 4.178 GeV.
We perform a model-independent partial wave analysis in the low K+K− mass region to determine the K+K− S-wave lineshape, followed by an amplitude analysis of our very pure high-statistics sample.
The amplitude analysis provides an accurate determination of the detection efficiency allowing us to measure the branching fraction B(D+s→K+K−π+)=(5.47±0.08stat±0.13sys)%.
The processes 𝑒+𝑒−→𝐷+ 𝑠𝐷𝑠1(2460)−+c.c. and 𝑒+𝑒−→𝐷*+ 𝑠𝐷𝑠1(2460)−+c.c. are studied for the first time using data samples collected with the BESIII detector at the BEPCII collider. The Born cross sections of 𝑒+𝑒−→𝐷+ 𝑠𝐷𝑠1(2460)−+c.c. at nine center-of-mass energies between 4.467 GeV and 4.600 GeV and those of 𝑒+𝑒−→𝐷*+ 𝑠𝐷𝑠1(2460)−+c.c. at √𝑠=4.590 GeV and 4.600 GeV are measured. No obvious charmonium or charmoniumlike structure is seen in the measured cross sections.