An analysis of the variations and clinical applications of the lateral circumflex femoral artery

BACKGROUND

Identifying the arterial variation of the lateral circumflex femoral artery (LCFA) is a vital step in planning surgical and radiological approach. The aim of the study was to evaluate the variations and discuss the clinical correlates of the LCFA.

MATERIALS AND METHODS

Fifty eight adult cadavers (male 45, female 13) with 115 usable sides were used to assess and classify the origin and branches of the LCFA. Also its external diameter, distance from mid-inguinal ligament to sites of origin from the profunda femoris artery or femoral arteries.

RESULTS

There were seven types of LCFA variations in this sample. We classified them as types A to G, of which type A was normal, that is, the one showing a single LCFA arising from the profunda femoris artery. Nearly 50.43% of the sample had type B-G variations, each having 13, 10, 23, 4, 4, and 3 cases, accounting for 11.30%, 8.70%, 20.00%, 3.48%, 3.48%, and 2.61%, respectively.

CONCLUSIONS

There are many variant types in the LCFA. To avoid iatrogenic injuries, clinicians must have a sound understanding of the variation types of this important blood vessel.

[Bivariate heritability estimation of resting heart rate and common chronic disease based on extended pedigrees]

OBJECTIVE

To estimate the univariate heritability of resting heart rate and common chronic disease such as hypertension, diabetes, and dyslipidemia based on extended pedigrees in Fujian Tulou area and to explore bivariate heritability to test for the genetic correlation between resting heart rate and other relative phenotypes.

METHODS

The study was conducted in Tulou area of Nanjing County, Fujian Province from August 2015 to December 2017. The participants were residents with Zhang surname and their relatives from Taxia Village, Qujiang Village, and Nanou Village or residents with Chen surname and their relatives from Caoban Village, Tumei Village, and Beiling Village. The baseline survey recruited 1 563 family members from 452 extended pedigrees. The pedigree reconstruction was based on the family information registration and the genealogy booklet. Univariate and bivariate heritability was estimated using variance component models for continuous variables, and susceptibility-threshold model for binary variables.

RESULTS

The pedigree reconstruction identified 1 seven-generation pedigree, 2 five-generation pedigrees, 23 four-generation pedigrees, 186 three-generation pedigrees, and 240 two-generation pedigrees. The mean age of the participants was 57.2 years and the males accounted for 39.4%. The prevalence of hypertension, diabetes, dyslipidemia in this population was 49.2%, 10.0%, and 45.2%, respectively. The univariate heritability estimation of resting heart rate, hypertension, and dyslipidemia was 0.263 (95%CI: 0.120－0.407), 0.404 (95%CI: 0.135－0.673), and 0.799 (95%CI: 0.590－1), respectively. The heritability of systolic blood pressure, diastolic blood pressure, fasting glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol was 0.379, 0.306, 0.393, 0.452, 0.568, 0.852, and 0.387, respectively. In bivariate analysis, there were phenotypic correlations between resting heart rate with hypertension, diabetes, diastolic blood pressure, fasting glucose, and triglyceride. After taking resting heart rate into account, there were strong genetic correlations between resting heart rate with fasting glucose (genetic correlation 0.485, 95%CI: 0.120－1, P<0.05) and diabetes (genetic correlation 0.795, 95%CI: 0.181－0.788, P<0.05).

CONCLUSION

Resting heart rate was a heritable trait and correlated with several common chronic diseases and related traits. There was strong genetic correlation between resting heart rate with fasting glucose and diabetes, suggesting that they may share common genetic risk factors.

Arsenite induces dysfunction of regulatory T cells through acetylation control of the Foxp3 promoter

Arsenic is known to cause damage to the body's immune system by inducing epigenetic changes. However, the molecular mechanism of this damage remains elusive. Here, we report that arsenic disrupts the morphology of lymphocytes, decreases cell viability, and results in abnormal proportions of T lymphocyte subsets. Moreover, our results revealed that arsenic can reduce global acetylation of histone H4 at K16 (H4K16 ac) in lymphocytes via decreasing the level of males absent on the first but upregulates mRNA and protein levels of the forkhead/winged-helix box P3 (Foxp3) gene by increasing the acetylation of histone H4 at K16 (H4K16) at the promoter of Foxp3. Finally, arsenic-induced dysfunction of regulatory T cells (Tregs) could be ameliorated by trichostatin A. Our research indicates that arsenic-induced immunosuppressive effect in human lymphocytes may be related to the acetylation of H4K16 at the promoter of Foxp3 and that histone deacetylase inhibitors may play a role in the prevention and treatment of immune injury caused by arsenic.

Development of a combined immunochromatographic lateral flow assay for accurate and rapid Escherichia coli O157:H7 detection

Escherichia coli O157:H7 is an important pathogenic Bacterium that threatens human health. A convenient, sensitive and specific method for the E. coli O157:H7 detection is necessary. We developed two pairs of monoclonal antibodies through traditional hybridoma technology, one specifically against E. coli O157 antigen and the other specifically against E. coli H7 antigen. Using these two pairs of antibodies, we developed two rapid test kits to specifically detect E. coli O157 antigen and E. coli H7 antigen, respectively. The detection sensitivity for O157 positive E. coli is 1 × 10³ CFU per ml and for H7 positive E. coli is 1 × 10⁴ CFU per ml. Combining these two pairs of antibodies together, we developed a combo test strip that can specifically detect O157: H7, with a detection sensitivity of 1 × 10⁴ CFU per ml, when two detection lines are visible to the naked eye. This is currently the only rapid detection reagent that specifically detects O157: H7 by simultaneously detecting O157 antigen and H7 antigens of E. coli. Our product has advantages of simplicity and precision, and can be a very useful on-site inspection tool for accurate and rapid detection of E. coli O157:H7 infection.

Dynamics and risk indicators of intrasinus elevation height following transalveolar sinus floor elevation with immediate implant placement: a longitudinal cohort study

Successful intrasinus graft consolidation is essential for the treatment outcome of transalveolar sinus floor elevation (SFE). This study was performed to examine the dynamics and risk indicators related to the elevation height after transalveolar SFE with grafting material and simultaneous implant placement. Fifty-two patients with 55 sites undergoing transalveolar SFE with immediate implant placement were enrolled retrospectively. Cone beam computed tomography (CBCT) images were collected and saved in DICOM format, at the following time-points: pre-surgery (T0), immediately post-surgery (T1), and 6 months post-surgery (T2). Voxel-based CBCT superimposition was performed to measure the sinus width, residual alveolar height, implant protrusion length, total elevation height, and apical graft height. The change in total elevation height from T1 to T2 was defined as the study outcome. Clinical and linear variables were analysed using linear regression. From T1 to T2, the total elevation height showed an average reduction of 1.0±1.1mm, while 10.9% sites showed an increased elevation height. Univariate regression analysis showed no significant correlation between tested clinical or linear variables and the study outcome. The results suggest that the change in elevation height was not influenced by the alveolar or sinus dimensions, graft materials, implant diameter, implant protrusion length, or the total elevation height at T1.

THU0076 SONIC HEDGEHOG PROMOTES SYNOVIAL HYPERPLASIA AND BONE DAMAGE THROUGH P38 MAPK SIGNALING IN EXPERIMENTAL ARTHRITIS

Background:

Abnormal activation of sonic hedgehog (SHH) signaling has been found in synovium from patients with rheumatoid arthritis (RA). Inhibition of SHH signaling is reported to attenuate inflammation and cartilage damage in adjuvant-induced arthritis (AIA). Previously we have demonstrated that SHH signaling promoted the tumor-like behavior of fibroblast-like synoviocytes (FLSs) through p38 MAPKin vitro.

Objectives:

In the current study, we aim to further explore the role of SHH-p38 MAPK signaling in regulating synovial hyperplasia and bone erosion in experimental arthritis.

Methods:

Collagen-induced arthritis (CIA) mouse model was induced and the mice were injected with adenovirus associated virus (AAV) overexpressing SHH or treated with small molecule inhibitors GDC-0449. SB203580 was administrated for the inhibition of p38 MAPK. The severity of paw inflammation was graded and serum levels of TNFα, IL-6 were detected. The histological features of arthritis were evaluated by H&E staining. The bone erosion was identified by micro-CT assessment and the number and function of osteoclasts were determined.

Results:

Blockade of SHH by GDC-0449 significantly alleviated the symptoms and decreased the synovial hyperplasia, inflammatory infiltration, cartilage and bone damage in ankles of CIA. The bone erosions in the area of the metatarsophalangeal and ankle joints and production of TNFα, IL-6 were decreased by SHH inhibition. In addition, the administration of GDC-0449 significantly decreased the number of TRAP positive cells and the expression of NFATc1. On the contrary, SHH overexpression led to increased severity of arthritis and pathological changes. We also observed the accelerated bone injury accompanied with increased number and activity of osteoclasts and increased production of serum IL-6 in mice with upregulation of SHH expression. Of note, the administration of p38 MAPK inhibitor reversed the effects of SHH overexpression, with a reduction of joint swelling and histological scores. Inhibition of p38 MAPK prevented the bone erosion and decreased the number of TRAP positive cells and the expression of NFATc1, which were promoted by SHH overexpression.

Conclusion:

The study indicates that SHH promotes the synovial hyperplasia and bone erosion of CIA in a p38 MAPK-dependent manner. SHH-p38 MAPK signaling could be a potential target for the treatment of RA.

Acknowledgments:

This work was supported by grants from the National Natural Science Foundation of China (81571584, 81701609).

Disclosure of Interests:

None declared

MiR-128 promotes the apoptosis of glioma cells via binding to NEK2

OBJECTIVE

The aim of this study was to explore whether miR-128 could promote the apoptosis of glioma cells by targeting NIMA related kinase-2 (NEK2), thus participating in the occurrence and progression of glioma.

PATIENTS AND METHODS

Expression levels of miR-128 and NEK2 in glioma tissues and normal brain tissues were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The relationship between miR-128 expression, tumor size and stage of glioma was analyzed. The effect of miR-128 on the apoptosis of glioma cells was detected by flow cytometry and Western blot, respectively. Dual-luciferase reporter gene assay was applied to verify the binding condition of miR-128 and NEK2. Meanwhile, rescue experiments were conducted to determine whether miR-128 could promote the apoptosis of glioma cells by targeting NEK2.

RESULTS

The expression level of miR-128 in glioma tissues was significantly lower than that of normal brain tissues. However, NEK2 was highly expressed in glioma tissues. MiR-128 expression was correlated to tumor size and malignant level of glioma, whereas not related to age and gender of glioma patients. Meanwhile, overexpression of miR-128 promoted the apoptosis of U87 cells, upregulated protein levels of cleaved Caspase-3 and BCL2-associated X (Bax), and downregulated B-cell lymphoma-2 (Bcl-2). Dual-luciferase reporter gene assay indicated that miR-128 directly bound to NEK2. Further rescue experiments suggested that NEK2 overexpression partially reversed the effect of miR-128 on the apoptosis of glioma cells.

CONCLUSIONS

Downregulated miR-128 inhibited the apoptosis of glioma cells via targeting NEK2.

The Aortic Calcification Index is a risk factor associated with anastomotic leakage after anterior resection of rectal cancer

AIM

Anastomotic leakage (AL) is one of the most feared postoperative complications after anterior resection (AR) of rectal cancer. An adequate blood supply at the anastomotic site is regarded as a prerequisite for healing. We hypothesize that the Aortic Calcification Index (ACI) might reflect the severity of atherosclerosis in patients, and thereby be a risk factor for AL.

METHOD

AL was investigated retrospectively according to the definition of the International Study Group of Rectal Cancer in 423 rectal cancer patients who underwent anterior rectal resection. The ACI was measured by preoperative abdominal CT scan. The cross-section of the aorta was evenly divided into 12 sectors, the number of calcified sectors was counted as the calcification score of each slice. Lasso logistic regression and multivariate regression analysis were used to identify risk factors for AL.

RESULTS

The percentage of AL after AR was 7.8% (33/423); the mortality of patients who sustained a leak was 3.0% (1/33). Patients with a high ACI had a significantly higher percentage of AL than patients with low ACI (11.2% vs 5.6%, P = 0.04). Among patients with AL, a higher ACI was associated with greater severity of AL (the ACI of patients with grade A leakage, grade B leakage and grade C leakage was 0.5% ± 0.2%, 11.5% ± 9.2% and 24.2% ± 21.7%, respectively; P = 0.008). After risk adjustment, multivariate regression analysis showed that a higher ACI was an independent risk factor for AL (OR 2.391, P = 0.04).

CONCLUSION

A high ACI might be an important prognostic factor for AL after AR for rectal cancer. Confirmatory studies are required.

[Renal clear cell carcinoma transferred to infratemporal fossa and pterygopalatine fossa: A case report]

SummaryRenal clear cell carcinoma is prone to distant metastasis, especially in the head and neck, but it is rare to transfer to infratemporal fossa and pterygopalatine fossa. We reported a 62-year-old male patient with complains of numbness and burning sensation on the left side of the face for more than 3 months. Left kidney removal was performed 8 years ago due to renal cancer. Preoperative enhancement CT showed a large blood-rich occupation in the left nasopharyngeal and pterygopalatine with adjacent paranasal sinus and skull base bone destruction. Under the general anesthesia, the anterior lacrimal recess approach was used for tumor resection. Preoperative interventional embolization of the feeding artery, intraoperative pathology, frozen section showed metastasis of renal cell carcinoma, and postoperative immunohistochemical examination, confirmed metastatic renal clear cell carcinoma（infratemporal fossa and pterygopalatine fossa）. The patients were transferred to the oncology department for further radiotherapy and chemotherapy.

Relationship between Blood Acetaldehyde Concentration and Psychomotor Function of Individuals with Different ALDH2 Genotypes after Alcohol Consumption

Abstract

Objective To explore the change rules of blood ethanol and blood acetaldehyde concentration, the impairment of psychomotor functions of different acetaldehyde dehydrogenase （ALDH） 2 genotype individuals after alcohol consumption and the relationship among them. Methods The ALDH2 genotypes in seventy-nine healthy volunteers were obtained by SNaPshot^TM method, then divided into ALDH2*1/*1 （wild type） and ALDH2*1/*2 （mutant type） group. After volunteers consumed 1.0 g/kg of alcohol, blood ethanol concentration and blood acetaldehyde concentration at a series of time points before and after alcohol consumption and psychomotor functions, such as, visual selective response time, auditory simple response time and tracking experiment were detected. Biphasic alcohol response questionnaires were collected. Results After alcohol consumption, ALDH2*1/*2 group's blood ethanol and blood acetaldehyde concentration reached the peak earlier than ALDH2*1/*1 group. Its blood acetaldehyde concentration was higher than that of ALDH2*1/*1 group, 1-6 h after alcohol consumption. The psychomotor functions, such as visual selective response time and auditory simple response time in ALDH2*1/*2 group were more significantly impaired than those in ALDH2*1/*1 group after alcohol consumption. There was no statistical significance between the two groups in excitement or sedation reactions （P>0.05）. Pearson correlation coefficient test showed that blood acetaldehyde concentration was related with psychomotor function. Conclusion There are significant differences between the psychomotor function of ALDH2 wild type and mutant type individuals after alcohol consumption estimated to be related to the difference in blood acetaldehyde concentration after alcohol consumption.

OS10.6 Infigratinib (BGJ398) in patients with recurrent gliomas with fibroblast growth factor receptor (FGFR) alterations: a multicenter phase II study

BACKGROUND

FGFR mutations and translocations occur in approximately 10% of glioblastomas (GBMs). FGFR3-TACC3 fusion has been reported as predictive of response to FGFR tyrosine kinase inhibitor therapy both pre-clinically and clinically. Infigratinib (BGJ398) is a selective small-molecule pan-FGFR kinase inhibitor that has demonstrated anti-tumor activity in several solid tumors with FGFR genetic alterations. Therefore, we conducted a phase II trial to test the efficacy of infigratinib in FGFR-altered recurrent GBM (NCT01975701).

METHODS

This open-label trial accrued adults with recurrent high-grade gliomas following failure of initial therapy that harbored FGFR1-TACC1 or FGFR3-TACC3 fusions; activating mutations in FGFR1, 2 or 3; or FGFR1, 2, 3, or 4 amplification. Oral infigratinib was administered 125 mg on days 1–21 every 28 days. Prophylaxis for hyperphosphatemia, a common toxicity, was recommended. The primary endpoint was the 6-month progression-free survival (6mPFS) rate by RANO (locally assessed, estimated by K-M method), with a goal of >40%.

RESULTS

As of the Sep 2017 data cut-off, 26 patients (16 men, 10 women; median age 55 years, range 20–76 years; 50% with ≥2 prior regimens) were treated, and 24 (92.3%) discontinued for disease progression (n=21) or other reasons (n=3). All patients had FGFR1 or FGFR3 gene alterations, and 4 had >1 gene alteration. The estimated 6mPFS rate was 16% (95% CI 5.0–32.5%); median PFS was 1.7 months (95% CI 1.1–2.8 months); median OS was 6.7 months (95% CI 4.2–11.7 months); ORR was 7.7% (95% CI 1.0–25.1%). The best overall response was: partial response 7.7% (FGFR1 mutation n=1; FGFR3 amplification n=1); stable disease 26.9%; progressive disease 50.0%; missing/unknown 15.3%. The most common (>15%) all-grade treatment-related adverse events (AEs) were hyperphosphatemia, fatigue, diarrhea, hyperlipasemia, and stomatitis. There were no grade 4 treatment-related AEs. Eleven patients (42.3%) had treatment-related AEs requiring dose interruptions or reductions (most commonly hyperphosphatemia).

CONCLUSIONS

Infigratinib induced partial response or stable disease in approximately one-third of patients with recurrent GBM and/or other glioma subtypes harboring FGFR alterations. Most AEs were reversible and manageable. Further potential combinations are being explored in patients with proven FGFR-TACC fusion genes and analysis of biomarker data is ongoing.

[Association of maternal nocturnal sleep throughout pregnancy with the early nocturnal sleep of infants]

Objective: To investigate the association between maternal nocturnal sleep during pregnancy and their infants' nocturnal sleep patterns in early infancy by establishing a birth cohort. Methods: In this prospective study,healthy pregnant women and their infants were recruited in Chongqing Health Center for Women and Children from September 2013 to January 2014. A total of 40 healthy pregnant women and their infants were enrolled, and 34 pairs (85%) completed the whole survey. Actiwatch, wearing on the mother's wrist or infant's ankle,was used to monitor nighttime sleep at home for 7 times in total,with 7 consecutive days for each monitoring course. Pregnant women were monitored at 16, 24, 32 weeks gestational age, and were required to finish Pittsburgh Sleep Quality Index (PSQI) scale at the end of each monitoring. Their infants were initially monitored at 14 days after birth, followed by 1(st), 2(nd), and 3(rd) month after birth,with sleep diary recorded by parents. Pearson correlation analysis and multivariate linear regression were used to investigate the potential correlation between these two sleep patterns. Results: The average nocturnal sleep time was (465±53) min throughout pregnancy, with increased trend in the latency of maternal nighttime sleep onset ((30±15), (34±29), (38±30) min) while decreasing of average sleep efficiency ((85±5)%, (84±8)%, (83±8)%). The longest night sleep duration decreased from (382±74) min in the first trimester to (330±83) min in the third trimester (F=4.932, P<0.05), while awakening time after sleep onset (WASO) correspondingly increased from (27±22) min to (53±25) min (F=12.605, P<0.05). In terms of infants, the latency of nighttime sleep onset decreased from (43±33) min on the 14th day to (20±29) min at 3-month of age (t=3.281, P=0.002), while the longest nighttime sleep duration increased from (20±62) min to (265±140) min (t=3.867, P<0.01); meanwhile, the total nocturnal sleep time and the sleep efficiency increased from (373±126) min and (63±28)% to (431±103) min and (75±16)%, respectively (t=2.362, P=0.024; t=2.418, P=0.039, respectively). After adjusting for maternal age and body mass index (BMI), parental educational level and family income, maternal mood, exposure to tobacco and alcohol during pregnancy, method of delivery, as well as infants' gender, feeding patterns and gestational weeks, the regression analysis showed that the total nocturnal sleep time and the longest nighttime sleep duration during pregnancy were positively correlated with the corresponding parameters of their infants at the age of 3 months (B=0.541, 95%CI 0.168-0.914, t=2.882, P=0.005; B=0.310, 95%CI 0.035-0.586, t=2.240, P=0.027, respectively). Conclusions: The total nocturnal sleep time and the longest nighttime sleep duration during pregnancy are positively correlated with the corresponding parameters of their infants in early infancy. Paying more attention to improve maternal sleep quality may facilitate their infants to establish sleep-wake patterns early.

[A preliminary evaluation and discussion on the value of the medical content of book 'Zhu Bing Ⅰ', a medical bamboo compilation excavated from a Han dynasty tomb in Laoguanshan]

The compilation of medical bamboo slips, which are excavated from a Han dynasty tomb in Laoguanshan(Mount. Laoguan), has two manuscripts: 'Zhu Bing Ⅰ(cases study Ⅰ)'and 'Zhu Bing Ⅱ(cases study Ⅱ)'. 'Zhu Bing Ⅰ'mainly discussed the pathogenic factor "wind" and "wind diseases" . It also analyzed the features of pathogenic factor "wind" . It classified the "wind diseases" into 17 kinds from 4 point views, and documented the symptoms of 17 kinds of "wind disease" . It was first time that its most ideas were documented in traditional Chinese medicine literatures.

The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

BACKGROUND

The aim of the study was to probe the morphological features of the proximal segment (V1) of vertebral artery (VA) in a sample of Chinese cadavers.

MATERIALS AND METHODS

The origin, course and outer diameter at origin of the pre-vertebral part of the VAs were evaluated in 119 adult cadavers.

RESULTS

It was found that 94.12% of the VAs originated from the subclavian arteries, bilaterally. The variant origins were present in 5.88% of the cadavers and all originated directly from the arch of the aorta. All the variations were observed on the left side of male cadavers. The average outer diameters at origin of the normal and variation groups were 4.35 ± 1.00 mm and 4.82 ± ± 1.42 mm, respectively, p = 0.035. In the normal group, but not in the variation group, the average diameter in the males was significantly larger than that in the females (4.50 ± 0.99 mm, 3.92 ± 0.92 mm, respectively, p = 0.000). In addition, only 5 cadavers in the normal group had hypoplastic VAs (4.20%, 4 males, 3 right-sided). Vertebral artery dominance (VAD) was present in 91 (69 males) out of 112 cadavers and more common on the left (n = 48). In addition, 3 cadavers satisfied conditions for coexistence of VAD and vertebral artery hypoplasia. All 7 cadavers in the variation group exhibited VAD, which was more common on the right side (n = 5).

CONCLUSIONS

The morphologic variations and frequencies described above have implications for the early prevention, abnormal anatomy detection, accurate diagnosis, safe surgery and endovascular treatment of cardiovascular and neurological disease.

Effects of neratinib on health-related quality of life in women with HER2-positive early-stage breast cancer: longitudinal analyses from the randomized phase III ExteNET trial

BACKGROUND

We report longitudinal health-related quality-of-life (HRQoL) data from the international, randomized, double-blind, placebo-controlled phase III ExteNET study, which demonstrated an invasive disease-free survival benefit of extended adjuvant therapy with neratinib over placebo in human epidermal growth factor receptor-2-positive early-stage breast cancer.

PATIENTS AND METHODS

Women (N  = 2840) with early-stage HER2-positive breast cancer who had completed trastuzumab-based adjuvant therapy were randomly assigned to neratinib 240  mg/day or placebo for 12  months. HRQoL was an exploratory end point. Patients completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) and EuroQol 5-Dimensions (EQ-5D) questionnaires at baseline and months 1, 3, 6, 9, and 12. Changes from baseline were compared using analysis of covariance with no imputation for missing values. Sensitivity analyses used alternative methods. Changes in HRQoL scores were regarded as clinically meaningful if they exceeded previously reported important differences (IDs).

RESULTS

Of the 2840 patients (intention-to-treat population), 2407 patients were evaluable for FACT-B (neratinib, N  = 1171; placebo, N  = 1236) and 2427 patients for EQ-5D (neratinib, N  = 1186; placebo, N  = 1241). Questionnaire completion rates exceeded 85%. Neratinib was associated with a decrease in global HRQoL scores at month 1 compared with placebo (adjusted mean differences: FACT-B total, -2.9 points; EQ-5D index, -0.02), after which between-group differences diminished at later time-points. Except for the FACT-B physical well-being (PWB) subscale at month 1; all between-group differences were less than reported IDs. The FACT-B breast cancer-specific subscale showed small improvements with neratinib at months 3-9, but all were less than IDs. Sensitivity analyses exploring missing data did not change the results.

CONCLUSIONS

Extended adjuvant neratinib was associated with a transient, reversible decrease in HRQoL during the first month of treatment, possibly linked to treatment-related diarrhea. With the exception of the PWB subscale at month 1, all neratinib-related HRQoL changes did not reach clinically meaningful thresholds. ClinicalTrials.gov: NCT00878709.

[Clinical manifestations and risk factors of poor prognosis of Acinetobacter baumannii intracranial infection]

Objective: To investigate the clinical features and risk factors for poor prognosis in patients with intracranial Acinetobacter baumannii infection. Methods: Retrospective analysis of data of patients who were hospitalized in the First Affiliated Hospital of AnHui Medical University between January 2011 and December 2017, and whose cerebral spinal fluid samples were positive for Acinetobacter baumannii and who were clinically demonstrated as intracranial infection during hospitalization was performed. Risk factors for poor prognosis were analyzed using single factor analysis and logistic regression analysis. Results: A total of 50 patients were included, with poor prognosis rate of 58% (29/50).92% of patients had history of craniotomy or operation of site adjacent to brain.Major type of intracranial infection was purulent meningitis.Fever rate was 100%.Multidrug resistant Acinetobacter baumannii accounted for 89.01%. Sensitivity to meropenem was only 9.09%.Shock, multi-drug resistant bacteria and no intrathecal injection were risk factors for poor prognosis of patient.Multi-factor logistic regression analysis showed "no intrathecal injection" was independent risk factor for poor prognosis of patients with intracranial Acinetobacter baumannii infection. Conclusions: Acinetobacter baumannii that induced intracranial infection is mostly highly drug-resistant bacterium, with high risk of post-infection poor prognosis.Clinically, it is essential to take proper peri-operative measures and early identify occurrence of intracranial infection.Reasonable application of anti-infection drug and external ventricle drainage, especially intrathecal injection of aminoglycosides, can be promoted as a kind of safe and effective means.

[The Occupational and Procreation Health of Road Sweeping Female Sanitation Workers in a District of a City]

Objective: To investigate occupational and procreation health of roadsweeping female sanitation workers in a city district. Methods: Using cross-sectional survey methods, all 303 the road sweeping female sanitation workers of one company were selected and interviewed face to face with questionnaires in june 2017. Data were analysed by SPSS22.0 statistical software. Results: The total prevalence of reproduction tract infection was 21.47%. The prevalence of uterine fibroids was 6.38%, and menstruation abnormal rate was 25.17%. The sanitation worker of menstruation abnormal rate was 31.03%, which were exposed low temperature, automobile exhaust and air contaminant at the same time, or else was 19.61%. There were statistical significance between them. (χ(2)=5.161, P<0.05) The sanitation worker of menstruation abnormal rate was 28.81%, which were not satisfied with women/s rights protection, or else was 11.67%. There were statistical significance between them. (χ(2)=7.435, P<0.01) . Conclusion: Female sanitation workers in the city district were exposed to many occupational hazards. The status of procreation health among road sweeping female sanitation workers in the city district is not optimistic. Occupational health protection and laborers's rights protection should be emphasized to improve health status of female sanitation workers.

[Fujian Tulou Family Cohort Study: study design and characteristics of participants and pedigrees in baseline investigation]

Objective: To describe the study design, the characteristics of participants as well as the pedigrees included in the baseline survey of Fujian Tulou Family Cohort Study. Methods: Fujian Tulou Family Cohort Study was a prospective open cohort study with a biological sample bank. A baseline survey was conducted in Tulou areas of Nanjing county in Fujian province from 2015 to 2018, including questionnaire survey, physical and biochemical indicators examinations, and blood sample collection in adults aged ≥18 years. In addition, family relationship of the participants was also recorded. The pedigree information of the juveniles under 18 years old were also collected. Results: The baseline survey included 2 727 individuals in two clans, of whom 2 373 (87.0%) were adults, and 2 126 participants completed questionnaires, physical examinations and biochemical tests. The average age of the 2 126 participants was (57.9±13.3) years, with 39.4% being males. The current smoking rates in male and female participants were 41.2% and 2.1%, respectively. The corresponding rates of current alcohol consumption were 19.0% and 2.6%. For common chronic diseases, the prevalence rates were 51.3% for hypertension, 9.7% for diabetes and 26.7% for hyperlipemia according to the self-reported disease diagnoses, health examination results and biochemical examination results in class Ⅱ or Ⅲ hospitals. Based on the family relationship information and genealogical data, 710 pedigrees were finally identified, consisting of 5 087 family members. The numbers of five, four, three, and two generations pedigrees were 3, 88, 238 and 381, respectively. The pairs of the first to the fifth degree relatives were 12 039, 2 662, 1 511, 202 and 31, respectively. Conclusion: The establishment of Fujian Tulou Family Cohort provides valuable resources for exploring the genetic risk factors, environmental risk factors and gene-environment interactions contributing to the risk of common chronic diseases.

[Research advance of microRNA in the pathogenesis of chronic rhinosinusitis]

Chronic rhinosinusitis (CRS) is a common disease of otorhinolaryngology head and neck surgery, manifested as nasal-sinus mucosal chronic inflammation. However, the pathogenesis of CRS is not clear. There are studies found that microRNA (miRNA) involved in CRS gene regulation. In this review, we summarize the expression of miRNAs in CRS, with the in-depth study of the role of miRNAs in CRS, and will further elucidate the pathogenesis of CRS.

Free electrons excited SPASER

Surface plasmon amplification by stimulated emission of radiation (SPASER) is discovered and used for realizing lasers at nanometer scale. The conventional gain media that are applied in SPASER are solid materials, such as organic dye or semiconductor, which limits the frequency range of SPASER. The free electrons could be considered as a kind of gain medium for emitting radiation. Here, we investigate theoretically the SPASER, which is excited by free electrons. We also demonstrate the tunable, deep-ultraviolet, and ultracompact laser numerically by having free electrons interact with surface plasmon polariton mode supported on metal surface. The output power density could reach about 30 W/μm² and the wavelength in deep ultraviolet could be widely tuned by varying the electron energy. This work offers a way of realizing integrated free electron laser in the ultraviolet frequency region.

[An analysis of the evaluation results of symptom checklist 90 for occupational females in different industries]

Objective: To evaluate the mental health of occupational females in different industries. Methods: We investigated the psychologic status of Chinese occupational females using symptom checklist 90. And statistical software was applied to analyze results of symptom checklist 90. Results: There were 41, 166 effec-tive questionnaires. The number of positive questionnaires was 14 361, and the positive rate was 34.89%. The positive rate of obsessive-compulsive factor was 24.07%. The positive rate of somatization factor was 16.12%. The positive rate of depression was 15.50%. The median positive item number was 20 (IQR: 34) , and the median split of positive symptoms was 2.11 (IQR: 0.37) . There were differences in the positive rate of SCL-90 scale among different age groups, different regions and different industries, the difference was statistically significant (P<0.05) . The positive rate of SCL-90 for the occupational females was 34.89%. The top three factors of the high-est positive SCL-90 were obsessive-compulsive symptoms, somatization and depression. Conclusion: There were differences in the psychological status of occupational females for different regions, different ages and different occupations.

[Effect of serum growth hormone releasing hormone levels on cognitive function in patients with moderate-severe obstructive sleep apnea-hypopnea syndrome]

Objective: To investigate the effect of GHRH on the cognitive function of OSAHS patients by detecting the serum GHRH levels and assessing their cognitive function in patients with OSAHS. Methods: A total of 70 moderate-severe OSAHS patientsand 32 adults with snoring from October 2013 to May 2017 were enrolled for overnight polysomnography(PSG) and cognitive function assessment. Blood samples were taken at the next morning and serum GHRH levels were measured by ELISA. Results: There was no significant difference between OSAHS group (318.73±186.66)pg/ml and control group (291.48±147.36)pg/ml. Compared with control group, the serum GHRH levels were significantly increased in OSAHS patients without cognitive impairment (370.31±197.33)pg/ml, and evidently decreased in those with cognitive impairment (193.63±70.97)pg/ml (both P<0.05). The cognitive function of OSAHS patients was influenced by serum GHRH levels (OR=0.42, 95%CI: 0.24-0.73), body mass index (OR=2.23, 95%CI: 1.03-4.79), and daily sleepiness score (OR=1.80, 95%CI: 1.04-3.09). Conclusion: Serum GHRH levels in patients with moderate-severe OSAHS may play a protective role in patients' cognitive function.

[Prevalence of reproductive system diseases among female workers in a city and related occupational influencing factors: an analysis of 9944 cases]

Objective: To investigate the prevalence of reproductive system diseases among female workers in a city and related occupational influencing factors. Methods: From June to September, 2016, a cross-sectional survey was used to select 9 944 female workers from six districts of Beijing and then a face-to-face questionnaire survey was performed. Univariate analysis using chi-square test and multivariate logistic regression analysis were used to investigate the risk factors for reproductive system diseases. Results: The age of 9944 female workers ranged from 18 to 65 years (mean 35.53±9.52 years) , and among them, 7 351 (73.92%) were married. The overall prevalence rate of reproductive system diseases among these 9944 female workers during the past three months was 28.29%, and the prevalence rates of hyperplasia of mammary glands, vaginitis, and hysteromyoma were 15.54%, 11.25%, and 6.77%, respectively. After adjustment for age, marital status, education level, and annual family income, the multivariate logistic regression analysis showed that frequent overtime work (odds ratio[OR]=1.119, 95% confidence interval[CI]: 1.070-1.343) , frequent night shifts (OR=1.198, 95%CI: 1.054-1.361) , standing for a long time (OR=1.197, 95%CI: 1.063-1.347) , sitting for a long time (OR=1.327, 95%CI: 1.191-1.479) , heavy workload (OR=1.429, 95%CI: 1.262-1.615) , exposure to lead (OR=1.696, 95%CI: 1.307-2.201) , exposure to mercury (OR=1.452, 95%CI: 1.086-1.940) , and exposure to ionizing radiation (OR=1.679, 95%CI: 1.424-1.980) were associated with reproductive system diseases. Conclusion: The prevalence of reproductive system diseases among female workers in Beijing is not optimistic. Reproductive system diseases are associated with frequent overtime work, frequent night shifts, standing for a long time, sitting for a long time, heavy workload, and exposure to lead, mercury, and ionizing radiation.

[A meta-analysis of Symptom Checklist-90 assessment results in Chinese nurses]

Objective: To investigate the application of Symptom Checklist-90 (SCL-90) in Chinese nurses. Methods: We performed a literature search for articles in Chinese on the mental health of nurses investigated using the SCL-90 that were published from January 2007 to December 2016. A total of 129 articles were included, involving 178 groups of valid samples as well as 36316 subjects in 27 provinces or cities in China. The metafor package of R 3.2.1 software and Excel were used for meta-analysis and data statistics. Results: Heterogeneity was identified for the nine factors included in the literature data (Q test: P<0.05; I(2) test >40%) , so a random effects model was used. For all factors except interpersonal relationship factor, the 95% confidence intervals of the pooled effect sizes did not include 0. For all factors except interpersonal relationship factor (Egger test: P<0.05) , no significant asymmetry or incompleteness appeared in the funnel plots. The fail-safe number of each factor was much larger than 5k+10. The merger scores and mean values of nine factors were higher than the national norm. Conclusion: The SCL-90 is widely used in the study of mental status of Chinese nurses, but the SCL-90 norm for nurses is lacking.

Millimeter-wave system-on-chip advancement for fusion plasma diagnostics

Recent advances in radio-frequency system-on-chip technology have provided mm-wave fusion plasma diagnostics with the capability to overcome major challenges such as space inefficiency, inflexible installation, sensitivity, susceptibility to EMI, and prohibitively high cost of conventional discrete component assemblies as higher imaging resolution and data accuracy are achieved by increasing the number of channels. Nowadays, shrinking transistor gate lengths on fabrication techniques have enabled hundreds of GHz operation, which is suitable for millimeter-wave diagnostics on current and future tokamaks. The Davis Millimeter Wave Research Center (DMRC) has successfully developed V-band (55-75 GHz) transmitter and receiver chips for Microwave Imaging Reflectometer (MIR) instruments. The transmitter can illuminate 8 different frequencies simultaneously within 55-75 GHz. Moreover, the receiver has the capability to amplify the reflected signal (>30 dB) while offering 10-30× reduction in noise temperature compared to current MIR instruments. Plasma diagnostics requires ultra-wideband (more than 20 GHz) operation which is approximately nine times wider bandwidth than the recent commercial impetus for communication systems. Current efforts are underway for gallium-arsenide monolithic microwave integrated circuit receiver chips at W-band (75-110 GHz) and F-band (90-140 GHz) permitting measurements at higher toroidal magnetic fields.

Liquid crystal polymer receiver modules for electron cyclotron emission imaging on the DIII-D tokamak

A new generation of millimeter-wave heterodyne imaging receiver arrays has been developed and demonstrated on the DIII-D electron cyclotron emission imaging (ECEI) system. Improved circuit integration, improved noise performance, and enhanced shielding from out-of-band emission are made possible by using advanced liquid crystal polymer (LCP) substrates and monolithic microwave integrated circuit (MMIC) receiver chips. This array exhibits ∼15 dB additional gain and >30× reduction in noise temperature compared to previous generation ECEI arrays. Each LCP horn-waveguide module houses a 3 × 3 mm GaAs MMIC receiver chip, which consists of a low noise millimeter-wave preamplifier, balanced mixer, and IF amplifier together with a local oscillator multiplier chain driven at ∼12 GHz. A proof-of-principle partial LCP instrument with 5 poloidal channels was installed on DIII-D in 2017, with a full proof-of-principle system (20 poloidal × 8 radial channels) installed and commissioned in early 2018. The enhanced shielding of the LCP modules is seen to greatly reduce the sensitivity of ECEI signals to out-of-band microwave noise which has plagued previous ECEI studies on DIII-D. The LCP ECEI system is expected to be a valuable diagnostic tool for pedestal region measurements, focusing particularly on electron temperature evolution during edge localized mode bursting.

[High resolution diffusion-weighted imaging for characterising nasopharyngeal carcinoma]

Objective: To evaluate the characteristics of high resolution diffusion-weighted imaging(DWI) using readout segmentation of long variable echo trains (RESOLVE ) for nasopharyngeal carcinoma (NPC). Methods: A total of 131 with newly diagnosed NPC patients from the 5th Affiliated Hospital of Sun Yat-sen University were included in this study from October 2013 to April 2016.DWI using RESOLVE technique was performed. The signal intensity (SI(lesion)), and mean(ADC(mean)), maximum(ADC(max)), minimum (ADC(min))ADCs of NPC were calculated. The signal intensity (SI(normal))and ADC (ADC(normal))of normal nasopharyngeal tissue were calculated. These quantitative parameters of NPC and normal nasopharyngeal tissue were compared.Statistical difference of ADC(mean), ADC(max) and ADC(min) between the clinical tumor stages were assessed. Results: On the DWI, all NPCs were clearly shown as high signal intensity relative to the surrounding normal nasopharyngeal structure(F=70.019, P=0.000). The ADC(mean)(F=20.442, P=0.000), ADC(max)(F=35.374, P=0.000), ADC(min)(F=61.534, P=0.000) in the carcinoma were significantly lower compared with that of normal nasopharyngeal structure. There was no statistically significant difference of ADC(mean), ADC(max) and ADC(min) (P>0.05)in different clinical stages of NPC. Conclusion: NPC can be clearly detected by RESOLVE-DWI, but the ADC(mean), ADC(max) and ADC(min) can not be used for differentiating the clinical stage of NPC.

[Data analysis on hepatitis B through pilot surveillance reporting system in Henan province, 2012-2016]

Objective: To standardize the reporting system on hepatitis B in order to improve the quality of monitoring program in Henan province. Methods: A total of 6 sites of Hepatitis B pilot surveillance were selected in Xinzheng of Zhengzhou city, Linzhou of Anyang city, Shanyang district of Jiaozuo city, Shaoling district of Luohe city, Yongcheng of Shangqiu city, Pingqiao district of Xinyang city in Henan province. Subjects under study were those reported hepatitis B cases, from 2012 to 2016. Cases diagnosed in 2011 were chosen as controls. Data on classification of hepatitis B, time that HBsAg became positive and ALT value of the cases were analyzed annually. 5 ml venous blood was collected and anti-HBc IgM confirmed test was made for those suspected acute cases on hepatitis B. Based on the 2016 data from the monitoring system, the incidence of acute hepatitis B in Henan province was estimated. Results: The number of reported hepatitis B cases had declined in 6 sites of Hepatitis B pilot surveillance substantially. A total of 17 436 hepatitis B reported in 2011 but only 2 632 cases were reported in 2016, with a reduction of 84.90%(14 804/17 436) in these six monitoring sites. The number of unclassified hepatitis B cases also dropped sharply. In 2011, 36.87% of the cases were unclassified, but the figure reduced to 0.08% in 2016, from the six sites. The rate on ALT detection also gradually improved. The rate of misdiagnosis on HBV carrier from hepatitis B almost disappeared. From 2013 to 2016, 777 blood samples were collected from six pilot sites. 29.34% (228/777) of the blood samples were tested positive for anti-HBc IgM after confirmed by the hepatitis laboratory of the China Center for Disease Control and Prevention. Conclusions: Since the development of the pilot surveillance program, the quality of reporting system on hepatitis B had been improved, as well as the accuracy of diagnosis. Rate on the accuracy of reporting on hepatitis B and the methods of testing should be improved at the monitoring sites.

[Correlation of Genetic Polymorphism, Alcoholic Beverage Type and Ethanol Metabolism]

OBJECTIVES

To explore the effects of ADH1B and ALDH2 gene polymorphism and type of alcoholic beverage on ethanol metabolism, to provide data support for cases involving the interpretation of ethanol metabolism or back calculation of blood ethanol concentration in forensic practice.

METHODS

A total of 81 volunteers were selected. The genotypes of ADH1B, ADH1C and ALDH2 were obtained by a multiplex SNaPshot genotyping method. Each subject was administered with 1.0 g/kg of alcohol. About 1 mL venous blood was collected before and after the alcohol consumption at 30 min, 45 min, 1 h, 1.5 h, 2 h, 3 h, 4 h, 5 h, 6 h, 7 h and 8 h, respectively. The concentrations of ethanol and acetaldehyde in blood were determined by headspace gas chromatography. The peak times of blood ethanol concentration （T_max）, the peak mass concentrations of ethanol （C_max）, the area under curve （AUC） of ethanol （AUC_ethanol）, AUC_acetaldehyde and ethanol elimination rates （_β） were calculated. In order to eliminate the influence of ADH1C, the ADH1C*1/*1 carriers were grouped based on the genotype of ADH1B and ALDH2. The data of each group were evaluated by one-way analysis of variance and pairwise comparison tests were performed by least significant difference method. The gene interactions were evaluated by two-way analysis of variance. Each parameter of three kinds of alcoholic beverage （white wine, red wine and beer） among groups was analysed by variance analysis with randomized block design.

RESULTS

There were no differences in the value of T_max and C_max between the groups with different ADH1B and ALDH2 genotype. The differences in the values of AUC_ethanol, _β and AUC_acetaldehyde among some groups carrying different ADH1B and ALDH2 genotype had statistical significance, while no significant difference was observed in these parameters when one individual taking same dose of different alcoholic beverage type.

CONCLUSIONS

The ethanol metabolism is associated with the related gene polymorphism, which is barely affected by alcoholic beverage type.

[The impact of weight management and related diuretic medication intervention based on body weight changes on cardiac function and re-hospitalization rate in patients with chronic congestive heart failure]

Objective: To explore the impact of weight management and related medication intervention based on body weight changes on cardiac function among patients with chronic congestive heart failure (CHF). Methods: Using prospective, randomized, controlled study methods, consecutive CHF patients, who hospitalized in our department from June 2014 to June 2016 (n=350), were randomly divided into intervention group (n=175) and control group (n=175). Patients in the intervention group received weight management guidance and the post discharge diuretic drugs regimen was adjusted based on body weight changes. The control group received routine medical care post discharge. Left ventricular ejection fraction (LVEF), B type natriuretic peptide precursor (NT-proBNP), 6 minutes walk distance and NYHA classification at one day before discharge and after 6 months were compared between the two groups respectively. Results: Follow-up visit data were not available from 6 patients in the control and intervention group respectively. NYHA classification, LVEF, NT-proBNP and 6 minutes walk distance were similar between the two groups at one day before discharge (all P>0.05). After 6 months, the LVEF and 6 minutes walk distance were significantly higher while NT-proBNP level was significantly lower in the intervention group compared to the control group (all P<0.01). Meanwhile, the LVEF and 6 minutes walk distance were significantly increased, while NT-proBNP was significantly reduced at 6 months post discharge compared to one day before discharge in the intervention group (all P<0.01). The LVEF was also significantly improved (P=0.035), but the NT-proBNP and 6 minutes walk distance were similar (P were 0.328 and 0.807 respectively) at 6 months after discharge compared to one day before discharge in the control group. The NYHA classification was significantly lower in intervention group and in control group at 6 months after discharge compared to one day before discharge (Z=5.154, P<0.01 and Z=10.497, P<0.01), and the NYHA classification improved more in the intervention group than in control group at 6 months after discharge (Z=9.235, P<0.01). The re-hospitalization rate of CHF patients in intervention group was 11.83% (20/169), which was significantly lower than the control group (33.14% (56/169), χ(2)=21.99, P<0.01). At 6 months follow up, body weight remained unchanged in the intervention group, while body weight tended to be higher in the control group compared to one day before discharge. Conclusion: The weight management and diuretic drug regimen adjudgment intervention based on body weight changes can improve cardiac function and reduced re-hospitalization rate in CHF patients.

MicroRNA-related genetic variants in iron regulatory genes, dietary iron intake, microRNAs and lung cancer risk

Background

Genetic variations in MicroRNA (miRNA) binding sites may alter structural accessibility of miRNA binding sites to modulate risk of cancer. This large-scale integrative multistage study was aimed to evaluate the interplay of genetic variations in miRNA binding sites of iron regulatory pathway, dietary iron intake and lung cancer (LC) risk.

Patients and methods

The interplay of genetic variant, dietary iron intake and LC risk was assessed in large-scale case-control study. Functional characterization of the validated SNP and analysis of target miRNAs were performed.

Results

We found that the miRNA binding site SNP rs1062980 in 3' UTR of Iron-Responsive Element Binding protein 2 gene (IREB2) was associated with a 14% reduced LC risk (P value = 4.9×10 - 9). Comparing to AA genotype, GG genotype was associated with a 27% reduced LC risk. This association was evident in males and ever-smokers but not in females and never-smokers. Higher level of dietary iron intake was significantly associated with 39% reduced LC risk (P value = 2.0×10 - 8). This association was only present in individuals with AG + AA genotypes with a 46% reduced risk (P value = 1.0×10 - 10), but not in GG genotype. The eQTL-analysis showed that rs1062980 significantly alters IREB2 expression level. Rs1062980 is predicted to alter a miR-29 binding site on IREB2 and indeed the expression of miR-29 is inversely correlated with IREB2 expression. Further, we found that higher circulating miR-29a level was significantly associated with 78% increased LC risk.

Conclusion

The miRNA binding site SNP rs1062980 in iron regulatory pathway, which may alter the expression of IREB2 potentially through modulating the binding of miR-29a, together with dietary iron intake may modify risk of LC both individually and jointly. These discoveries reveal novel pathway for understanding lung cancer tumorigenesis and risk stratification.

Abstract P1-13-05: Timing of initiation of neratinib after completion of trastuzumab-based adjuvant therapy in early-stage HER2+ breast cancer: Exploratory analyses from the phase III ExteNET trial

Background: The international, randomized, placebo-controlled phase III ExteNET trial showed that 1 year of neratinib after trastuzumab-based adjuvant therapy significantly improved 2-year invasive disease-free survival (iDFS) in early-stage HER2+ breast cancer (HR 0.67; 95% CI 0.50–0.91; p=0.009) [Chan et al. Lancet Oncol 2016]. The significant iDFS benefit with neratinib was maintained after a median of 5 years' follow-up (HR 0.73; 95% CI 0.57-0.92; p=0.008) [Martin et al. ESMO 2017]. We present exploratory analyses from the ExteNET trial examining the effects of the interval between completion of trastuzumab and randomization to commence neratinib on iDFS.

Methods: Women with early-stage HER2+ breast cancer were randomly assigned to oral neratinib 240 mg/day or placebo for 1 year after standard primary therapy and trastuzumab-based adjuvant therapy. Under the original study protocol, (neo)adjuvant trastuzumab was to be completed ≤24 months before randomization; this was revised to ≤12 months before randomization after the NCCTG-N9831/NSABP B-31 4-year analysis showed that the risk of relapse is greatest during the first 12 months after completing trastuzumab. Disease recurrences were collected prospectively during 1 and 2 years post-randomization, and from medical records during 3–5 years post-randomization. Patients randomized ≤12 months after completion of adjuvant trastuzumab were further separated to look at those who initiated neratinib ≤6 months of completing adjuvant trastuzumab. Primary endpoint: iDFS. HR (95% CI) estimated using Cox proportional-hazards models. Data cut-off: March 1, 2017. Clinicaltrials.gov: NCT00878709.

Results:The intention-to-treat population comprised 2840 patients (neratinib, n=1420; placebo, n=1420). Median time from last trastuzumab dose to randomization was 4.4 and 4.6 months in the neratinib and placebo groups, respectively. 81% of patients were randomized ≤12 months of completing trastuzumab. The effects of the interval between the last dose of trastuzumab and randomization/initiation of neratinib on iDFS after a median follow-up of 5.2 years are shown in the table.

  Estimated 5-year iDFS rate, % P-valueInterval from last dose of trastuzumab to randomizationnNeratinibPlaceboHR (95% CI)a(2-sided)≤6 months164190.085.40.62 (0.46–0.84)0.002≤12 monthsb229789.786.50.70 (0.54–0.90)0.006&gt;12 monthsb54392.392.61.00 (0.51–1.94)0.992a. Neratinib vs placebo; b. Protocol-defined subgroups

Conclusions: In ExteNET, patients who initiated neratinib within 12 months of completing trastuzumab-based adjuvant therapy appeared to derive greater benefit from treatment than those who started neratinib later. Further, exploratory analyses suggest that the magnitude of benefit with neratinib is greater if initiated sooner (i.e. within 6 months of completing trastuzumab). Given the benefits of neratinib overall in those initiating treatment ≤12 months from the end of adjuvant trastuzumab, extended adjuvant treatment with neratinib should be initiated early following completion of trastuzumab.

Citation Format: Ejlertsen B, Chan A, Gnant M, von Minckwitz G, Delaloge S, Buyse M, O'Shaughnessy J, Mansi J, Moy B, Iwata H, Wong A, Ye Y, Means-Powell J, Hui R, Ruiz-Borrego M, Ruiz Simon A, Shen Z-Z, Holmes FA, Lesniewski-Kmak K, Martin M. Timing of initiation of neratinib after completion of trastuzumab-based adjuvant therapy in early-stage HER2+ breast cancer: Exploratory analyses from the phase III ExteNET trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-05.

Genetic variations in cancer-related significantly mutated genes and lung cancer susceptibility

Background

Cancer initiation and development are driven by key mutations in driver genes. Applying high-throughput sequencing technologies and bioinformatic analyses, The Cancer Genome Atlas (TCGA) project has identified panels of somatic mutations that contributed to the etiology of various cancers. However, there are few studies investigating the germline genetic variations in these significantly mutated genes (SMGs) and lung cancer susceptibility.

Patients and methods

We comprehensively evaluated 1655 tagged single nucleotide polymorphisms (SNPs) located in 127 SMGs identified by TCGA, and test their association with lung cancer risk in large-scale case-control study. Functional effect of the validated SNPs, gene mutation frequency and pathways were analyzed.

Results

We found 11 SNPs in 8 genes showed consistent association (P < 0.1) and 8 SNPs significantly associated with lung cancer risk (P < 0.05) in both discovery and validation phases. The most significant association was rs10412613 in PPP2R1A, with the minor G allele associated with a decreased risk of lung cancer [odds ratio = 0.91, 95% confidence interval (CI): 0.87-0.96, P = 2.3 × 10-4]. Cumulative analysis of risk score built as a weight sum of the 11 SNPs showed consistently elevated risk with increasing risk score (P for trend = 9.5 × 10-9). In stratified analyses, the association of PPP2R1A:rs10412613 and lung cancer risk appeared stronger among population of younger age at diagnosis and never smokers. The expression quantitative trait loci analysis indicated that rs10412613, rs10804682, rs635469 and rs6742399 genotypes significantly correlated with the expression of PPP2R1A, ATR, SETBP1 and ERBB4, respectively. From TCGA data, expression of the identified genes was significantly different in lung tumors compared with normal tissues, and the genes' highest mutation frequency was found in lung cancers. Integrative pathway analysis indicated the identified genes were mainly involved in AKT/NF-κB regulatory pathway suggesting the underlying biological processes.

Conclusion

This study revealed novel genetic variants in SMGs associated with lung cancer risk, which might contribute to elucidating the biological network involved in lung cancer development.