P–412 Low serum hCG levels adjusted for the hCG trigger dose in fresh cycles may be associated with a poor clinical pregnancy rate of FET cycles

Study question

Is there any association between serum human chorionic gonadotropin (hCG) levels after trigger at previous fresh cycles and pregnancy outcomes of frozen-thawed embryo transfer (FET) cycles?

Summary answer

Low adjusted serum hCG level after hCG trigger at fresh cycles is negatively associated with clinical pregnancy rates (CPR) of hormone replacement treatment-FET (HRT-FET). What is known already: Literature showed that low serum hCG levels after the same dose of hCG trigger was associated with reduced pregnancy outcomes of the fresh cycles. However, the relationship between hCG levels after trigger at fresh cycles and pregnancy outcomes of FET cycles remains unknown.

Study design, size, duration

This matched retrospective study was conducted at a Reproductive Medicine Center between 2016 and 2018. Subjects performing HRT-FET cycles, whose previous fresh cycles used a bolus of hCG alone or a bolus of GnRHa combined with hCG for trigger were included. A total of 186 HRT-FET cycles with complete data was included for the final analysis.

Participants/materials, setting, methods

The study population was grouped into women with intramuscular injection of hCG prior to secretory transformation (hCG group, n = 93) and a comparison group (control group, n = 93) of women without hCG addition matched for patients’ age and duration of infertility. At the previous fresh cycles, serum hCG levels were measured 12 hours later after hCG trigger (defined as the “hCG+12 h” timepoint), and were adjusted for doses (defined as adjusted hCG levels). Main results and the role of chance: For patients achieving clinical pregnancy, the adjusted hCG level significantly increased (P < 0.05). Meanwhile, the ROC curve also showed a significantly predictive value of adjusted serum hCG levels at the “hCG+12 h” timepoint for CPR in HRT- FET cycles (AUC=0.626, 95%CI: 0.512–0.740) and the optimal hCG threshold proposed by ROC for CPR was 46.31 mIU/mL with sensitivity of 71.4% and specificity of 56.9%. For all patients, the CPR in hCG group was significantly higher than that in control group (61.3% vs. 44.1%). Furthermore, all cycles were then divided into four groups based on the injection of hCG prior to secretory transformation in HRT-FET cycles and this cut-off value of hCG levels at the “hCG+12 h” timepoint. For patients with adjusted hCG levels ≤46.31 mIU/mL, the CPR was significantly improved in hCG group compared with control group (61.1% vs. 29.3%). But for patients with adjusted hCG levels >46.31 mIU/mL, no statistically significant difference was observed between the hCG and control group (61.4% vs. 55.8%).

Limitations, reasons for caution

Although the results achieved statistically significant, the sample size was relatively small, which limits our ability to draw a definitive conclusion. The reason of the small sample size may be that to reduce the risk of OHSS, doctors would give preference to trigger with GnRH agonist in our center.

Wider implications of the findings: Adjusted serum hCG levels might represent a potential factor to guide adequate support in the subsequent HRT-FET cycles. Meanwhile, for patients with low adjusted serum hCG levels, intramuscular hCG injection prior to secretory transformation may be a good compensation way to rescue pregnancy impair in the subsequent HRT-FET cycles.

Trial registration number

N/A.

Bone marrow-derived mesenchymal stem cells inhibit CD8+ T cell immune responses via PD-1/PD-L1 pathway in multiple myeloma

High expression of the inhibitory receptor programmed cell death ligand 1 (PD-L1) on tumor cells and tumor stromal cells have been found to play a key role in tumor immune evasion in several human malignancies. However, the expression of PD-L1 on bone marrow mesenchymal stem cells (BMSCs) and whether the programmed cell death 1 (PD-1)/PD-L1 signal pathway is involved in the BMSCs versus T cell immune response in multiple myeloma (MM) remains poorly defined. In this study, we explored the expression of PD-L1 on BMSCs from newly diagnosed MM (NDMM) patients and the role of PD-1/PD-L1 pathway in BMSC-mediated regulation of CD8⁺ T cells. The data showed that the expression of PD-L1 on BMSCs in NDMM patients was significantly increased compared to that in normal controls (NC) (18·81 ± 1·61 versus 2·78± 0·70%; P < 0·001). Furthermore, the PD-1 expression on CD8⁺ T cells with NDMM patients was significantly higher than that in normal controls (43·22 ± 2·98 versus 20·71 ± 1·08%; P < 0·001). However, there was no significant difference in PD-1 expression of CD4⁺ T cells and natural killer (NK) cells between the NDMM and NC groups. Additionally, the co-culture assays revealed that BMSCs significantly suppressed CD8⁺ T cell function. However, the PD-L1 inhibitor effectively reversed BMSC-mediated suppression in CD8⁺ T cells. We also found that the combination of PD-L1 inhibitor and pomalidomide can further enhance the killing effect of CD8⁺ T cells on MM cells. In summary, our findings demonstrated that BMSCs in patients with MM may induce apoptosis of CD8⁺ T cells through the PD-1/PD-L1 axis and inhibit the release of perforin and granzyme B from CD8⁺ T cells to promote the immune escape of MM.

Lurasidone in adolescents with schizophrenia: Sustained remission and recovery during 2 years of open-label treatment

Introduction

Compared with adult onset, early onset schizophrenia is typically characterized by greater illness severity and less favorable prognosis.

Objectives

To evaluate the proportion of adolescent patients with schizophrenia who achieved sustained remission and recovery during 2 years of treatment with lurasidone.

Methods

Patients aged 13-17 years with a DSM-IV-TR diagnosis of schizophrenia, and a Positive and Negative Symptom Scale (PANSS) total score ≥70 and <120, were randomized to 6 weeks of double-blind (DB), fixed-dose treatment with lurasidone (37 or 74 mg/d) or placebo. Patients who completed 6 weeks of DB treatment were eligible to enroll in a 2-year, open-label (OL), flexible dose extension study of lurasidone (18.5-74 mg/d). Criteria for sustained remission, were the 6-month consensus criteria summarized by Andreasen (Am J Psych 2005;162:441-9). Criteria for sustained recovery consisted of meeting sustained remission criteria with a Children’s Global Assessment Scale (CGAS) score ≥70 for at least 6-months indicating no clinically significant functional impairment.

Results

A total of 271 patients completed the 6-week DB study and entered the extension study, and 186 (68.6%) and 156 (57.6%) completed 52 weeks and 104 weeks of treatment, respectively. During OL treatment with lurasidone, 52.8% met sustained remission criteria, with a Kaplan-Meier (KM) estimate of 64.1 weeks for median time to sustained remission; and 28.8% met sustained recovery criteria, KM estimate of 104.6 weeks for median time to sustained recovery.

Conclusions

For adolescents with schizophrenia, treatment with lurasidone was associated with high rates of sustained remission and sustained recovery over a two-year period.

Disclosure

Employee of Sunovion Pharmaceuticals Inc. The study summarized in this Abstract was supported by funding from Sunovion Pharmaceuticals Inc

Relationship between epidermal growth factor receptor mutations and CT features in patients with lung adenocarcinoma

AIM

The purpose of this study was to investigate the relationship between epidermal growth factor receptor (EGFR) mutation status and computed tomography (CT) features in patients with lung adenocarcinoma.

MATERIALS AND METHODS

A total of 483 patients with lung adenocarcinoma diagnosed between January 2015 and April 2020 were included in this study. All patients underwent a preoperative chest CT, and a total of 31 detailed CT features were quantified. The mutation status of EGFR exon 18-21 was detected by a polymerase chain reaction (PCR)-based amplified refractory mutation system. Student's t and Fisher's exact or chi-square tests were used to compare continuous and categorical variables, respectively. Least absolute shrinkage and selection operator (LASSO) regularisation was used to determine the optimal combination of CT features and clinical characteristics to predict the EGFR mutation status. The model was tested using a validation set consisting of 120 patients.

RESULTS

EGFR mutations were found in 249 (51.6%) of 483 patients with lung adenocarcinoma. Univariate analysis showed that 14 CT features and two clinical characteristics correlated significantly with the EGFR mutation status. Smoking history, long-axis diameter, bubble-like lucency, pleural retraction, thickened bronchovascular bundles, and peripheral emphysema were independent predictors of the EGFR mutation status, according to LASSO regularisation. In the training and verification cohorts, the areas under the curve of the prediction model were 0.766 and 0.745, respectively.

CONCLUSIONS

CT features of patients with lung adenocarcinoma can help predict the EGFR mutation status.

[Study on the state of macrophage infiltration in the progression of non-alcoholic fatty liver disease induced by high-fat diet in mice]

Objective: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease. Macrophages are an important cell-mediated immune response in the pathogenesis of NAFLD. However, the dynamic changes of intrahepatic infiltration during the pathogenesis of NAFLD remains unclear. Therefore, this study intends to investigate the changes and their correlations with morphological indicators, hepatic histopathological index, and intrahepatic macrophage infiltration in the progression of NAFLD induced by high-fat diet in mice. Methods: C57BL/6J mice were fed with 42% high-fat diet, and the morphological data and liver tissue were obtained at 1, 2, 4, 8 and 12 months, respectively. Hepatic histopathological characteristics were evaluated by HE stain. Immunohistochemical staining was used to detect the number of F4/80 positive cells in liver tissue at different stages to evaluate the degree of intrahepatic macrophage infiltration. Results: (1) The body weight, liver weight, and liver weight/body weight of mice fed with high-fat diet had gradually increased. (2) HE staining results showed that mice fed with high-fat diet had mainly developed simple steatosis within 1 to 2 months. In addition, a balloon-like hepatocyte degeneration and intralobular inflammation had begun to appear at 4 months, indicating that non-alcoholic steatohepatitis had started, and can be seen very clearly at 8 to 12 months. (3) Immunohistochemical staining results suggested that in the simple steatosis stage of NAFLD, the intrahepatic macrophage infiltration was not significant. However, after NAFLD activity score > 3, a large amount of infiltration had appeared and cluster-like changes in the later stage. (4) Correlation analysis results indicated that the degree of macrophage infiltration was not related to the mice morphological indicators (body weight, liver weight and liver weight/body weight) and pathological indicators (percentage of hepatic steatotic change, and degree of hepatocyte ballooning and intralobular inflammation), but was significantly related to the NAFLD activity score. Conclusion: High-fat diet can successfully induce NAFLD in mice and progress to the stage of non-alcoholic steatohepatitis. At the same time, high-fat diet can induce macrophage infiltration in liver tissue of mice and the changing trend of infiltration is related to NAFLD activity score.

Preoperative anthropomorphic radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy

BACKGROUND

Postoperative pancreatic fistulae (POPF) are a major contributing factor to pancreatoduodenectomy-associated morbidity. Established risk calculators mostly rely on subjective or intraoperative assessments. We hypothesized that various objective preoperatively determined computed tomography (CT) measurements could predict POPF as well as validated models and allow for more informed operative consent in high-risk patients.

METHODS

Patients undergoing elective pancreatoduodenectomies between January 2013 and April 2018 were identified in a prospective database. Comparative statistical analyses and multivariable logistic regression models were generated to predict POPF development. Model performance was tested with receiver operating characteristics (ROC) curves. Pancreatic neck attenuation (Hounsfield units) was measured in triplicate by pancreatic protocol CT (venous phase, coronal plane) anterior to the portal vein. A pancreatic density index (PDI) was created to adjust for differences in contrast timing by dividing the mean of these measurements by the portal vein attenuation. Total areas of subcutaneous fat and skeletal muscle were calculated at the L3 vertebral level on axial CT. Pancreatic duct (PD) diameter was determined by CT.

RESULTS

In the study period 220 patients had elective pancreatoduodenectomies with 35 (16%) developing a POPF of any grade. Multivariable regression analysis revealed that demographics (age, sex, and race) were not associated with POPF, yet patients resected for pancreatic adenocarcinoma or chronic pancreatitis were less likely to develop a POPF (10 vs. 24%; p = 0.004). ROC curves were created using various combinations of gland texture, body mass index, skeletal muscle index, sarcopenia, PDI, PD diameter, and subcutaneous fat area indexed for height (SFI). A model replacing gland texture with SFI and PDI (AUC 0.844) had similar predictive performance as the established model (p = 0.169).

CONCLUSION

A combination of preoperative objective CT measurements can adequately predict POPF and is comparable to established models relying on subjective intraoperative variables. Validation in a larger dataset would allow for better preoperative stratification of high-risk patients and improve informed consent among this patient population.

[Oncologic outcomes of early stage cervical cancer performed operation by different laparoscopic surgical procedures: analysis of clinical data from mutiple centers]

Objective: To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy. Methods: From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study. Results: There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH （P=0.010）. Stratify analysis， including stage of disease （Ⅰb1 and Ⅱa1）， histologic subtypes （squamous-cell carcinoma, adenocarcinoma）， lymph node metastasis， revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group （98.6% vs 93.6%, P=0.012）. In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% （P=0.007）. ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference （P=0.046）； for adenocarcinoma, the OS at five years were 91.0% and 88.6%， and there was no difference between two groups （P=0.230）. ③ Lymph node metastasis： the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively (P=0.156， P=0.093）. (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group （88.2% vs 75.8%, P=0.074）. Conclusions: The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.

Older adults benefit from more widespread brain network integration during working memory

Neuroimaging evidence suggests that the aging brain relies on a more distributed set of cortical regions than younger adults in order to maintain successful levels of performance during demanding cognitive tasks. However, it remains unclear how task demands give rise to this age-related expansion in cortical networks. To investigate this issue, functional magnetic resonance imaging was used to measure univariate activity, network connectivity, and cognitive performance in younger and older adults during a working memory (WM) task. Here, individuals performed a WM task in which they held letters online while reordering them alphabetically. WM load was titrated to obtain four individualized difficulty levels with different set sizes. Network integration-defined as the ratio of within-versus between-network connectivity-was linked to individual differences in WM capacity. The study yielded three main findings. First, as task difficulty increased, network integration decreased in younger adults, whereas it increased in older adults. Second, age-related increases in network integration were driven by increases in right hemisphere connectivity to both left and right cortical regions, a finding that helps to reconcile existing theories of compensatory recruitment in aging. Lastly, older adults with higher WM capacity demonstrated higher levels of network integration in the most difficult task condition. These results shed light on the mechanisms of age-related network reorganization by demonstrating that changes in network connectivity may act as an adaptive form of compensation, with older adults recruiting a more distributed cortical network as task demands increase.

A Phototheranostic Strategy to Continuously Deliver Singlet Oxygen in the Dark and Hypoxic Tumor Microenvironment

Continuous irradiation during photodynamic therapy (PDT) inevitably induces tumor hypoxia, thereby weakening the PDT effect. In PDT-induced hypoxia, providing singlet oxygen from stored chemical energy may enhance the cell-killing effect and boost the therapeutic effect. Herein, we present a phototheranostic (DPPTPE@PEG-Py NPs) prepared by using a 2-pyridone-based diblock polymer (PEG-Py) to encapsulate a semiconducting, heavy-atom-free pyrrolopyrrolidone-tetraphenylethylene (DPPTPE) with high singlet-oxygen-generation ability both in dichloromethane and water. The PEG-Py can trap the 1 O2 generated from DPPTPE under laser irradiation and form a stable intermediate of endoperoxide, which can then release 1 O2 in the dark, hypoxic tumor microenvironment. Furthermore, fluorescence-imaging-guided phototherapy demonstrates that this phototheranostic could completely inhibit tumor growth with the help of laser irradiation.

The inhibition of the breast cancer by PPARγ agonist pioglitazone through JAK2/STAT3 pathway

Breast cancer, especially triple-negative breast cancer, is one of the deadliest cancers in women. To date, there is a lack of a good therapeutic regimen for it. PPARγ has been reported to be a tumor suppressor and could be activated by many agonists involved in cancer inhibition. Therefore, the expression of PPARγ in breast cancer was analyzed by online software UALCAN whose data were from the TCGA database. The results revealed that the PPARγ expression was reduced in breast cancer tissues. Furthermore, the methylation in the PPARγ promoter was also assayed and the results indicated that the methylation level in the PPARγ promoter in breast cancer tissue was higher than that in normal tissue. In order to verify the methylation in promoter involved in the regulation of gene PPARγ expression, the 5'-Aza and fluorescence assays were performed and the results proved that methylation in promoter participated in gene PPARγ expression regulation. Pioglitazone, a PPARγ agonist, still was not investigated in breast cancer. Therefore, the effects of pioglitazone on breast cancer cells were tested by cell viability, scratch and transwell assays, and results indicated that the pioglitazone has the inhibition effect on the proliferation and migration of breast cancer cells by PPARγ which was correlated with the JAK2/STAT3 pathway. In order to further confirm the inhibition effect of pioglitazone on breast cancer in vivo, the nude mice model was administrated by gavage with pioglitazone. And the results indicated that pioglitazone could inhibit the growth of breast cancer in the PPARγ overexpression group in vivo. In summary, the expression of gene PPARγ was decreased in breast cancer tissues, which was correlated with its methylation in the promoter region. Moreover, pioglitazone could exert its inhibition on breast cancer proliferation and migration by the JAK2/STAT3 pathway.

The Efficacy of Lurasidone on PANSS Subscales in Adolescent Patients with Schizophrenia: Results from a 6-week, Double-blind, Placebo-controlled, Multicenter Study

Introduction

Lurasidone is an atypical antipsychotic that demonstrated efficacy in the treatment of adults with schizophrenia in the dose range of 37–148 mg/day.

Objective/Aims

The objective of this analysis was to evaluate the efficacy of lurasidone in adolescent patients with schizophrenia.

Methods

Adolescents (13–17 years old) diagnosed with schizophrenia were randomly assigned to six weeks of double-blind treatment with lurasidone 37 mg/day, 74 mg/day or placebo. Changes from baseline to week 6 in PANSS total and subscale (positive, negative, general psychopathology, excitability) scores were evaluated using mixed-model repeated-measures analysis.

Results

A total of 326 patients (mean age, 15.4 years) were randomized and received lurasidone 37 mg/day (n = 108), 74 mg/day (n = 106), or placebo (n = 112). The PANSS total score at week 6 demonstrated a placebo-adjusted, least-squares (LS) mean improvement of –8.0 (P < 0.001; effect size [ES], 0.51) for the 37 mg/day group and –7.7 (P < 0.001; ES = 0.48) for the 74 mg/day group. Placebo-adjusted LS mean change for lurasidone 37 mg/day and 74 mg/day, respectively, was –3.2 (P < 0.001; ES = 0.62) and –3.2 (P < 0.001; ES = 0.60) on the PANSS positive subscale, –1.7 (P = 0.011; ES = 0.41) and –1.6 (P = 0.022; ES = 0.35) on the PANSS negative subscale, –2.8 (P = 0.012; ES = 0.38) and –2.8 (P = 0.011; ES = 0.37) on the PANSS general psychopathology subscale, and –1.1 (P = 0.016; ES = 0.36) and –1.8 (P < 0.001; ES = 0.53) on the PANSS excitability subscale.

Conclusions

In adolescent patients with schizophrenia, lurasidone (37 mg/day and 74 mg/day) demonstrated statistically significant efficacy and clinically meaningful improvement across a wide spectrum of symptoms associated with schizophrenia. Sponsored by Sunovion Pharmaceuticals Inc. ClinicalTrials.gov identifier: NCT01911429.

Disclosure of interest

Dr Correll reports being a consultant and/or advisor for Alkermes, Forum Pharmaceuticals Inc., Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, Lundbeck, Medavante, Medscape, Otsuka, Pfizer Inc, ProPhase, Sunovion Pharmaceuticals Inc., Supernus, Takeda, and Teva providing expert testimony for Bristol-Myers Squibb Company, Janssen, and Otsuka serving on a Data Safety Monitoring Board for Lundbeck and Pfizer Inc and receiving grant support from Takeda. Drs Goldman, Cucchiaro, Deng and Loebel are employees of Sunovion Pharmaceuticals Inc.

Clinical characteristics of lip infantile haemangiomas and main risk factors for ulceration: an 8-year retrospective study of 69 Chinese infants

BACKGROUND

Infantile haemangiomas (IHs) involving the lip are of special concern because of the susceptibility of complications, including ulceration, obstruction and disfigurement. The available data for the relationship between their clinical characteristics and ulcerations are limited.

OBJECTIVES

To describe the clinical characteristics of lip IHs and to evaluate the main risk factors for ulceration.

METHODS

A retrospective study was designed that included infants with lip IHs during an 8-year period, the clinical data of participants were collected, and univariable and multivariable logistic models were used to determine the relationships between the clinical characteristics of lip IHs and ulcerations. Location, size and type were investigated as potential independent factors influencing the development of ulceration.

RESULTS

A total of 69 lip IHs were identified including 40 girls and 29 boys. Ulcerations were found in 37 (53.6%) lip IHs. Lip haemangiomas experiencing ulceration had a mean size (SD) of 3.49 (2.82) cm² compared with 1.08 (0.96) cm² for those without ulceration. Twenty-eight (52.8%) of the 53 localized haemangiomas and 9 (56.3%) of the 16 segmental haemangiomas experienced ulcerations. Univariable analyses of all investigated factors revealed significant associations of location and size with increased risk of ulceration, and these significant associations remained after adjusting for sex and age [OR 8.61 (95% CI, 2.24-33.13) and 2.62 (95% CI, 1.46-4.72), respectively]. The duration before ulceration was between 4 and 70 days after the occurrence of lip IHs, with a median of 28 (19.41) days. Most ulcers occurred within 45 days of IH occurrence.

CONCLUSIONS

Ulceration is a common complication of lip IHs at an earlier stage. A swollen with pale or bright crimson appearance of the lip IH surface could be an important signal of subsequent ulceration. Location of the IH on the lower lip and lip IH size are risk factors for the occurrence of ulceration.

An assessment of a hybrid lighting system that employs ultraviolet-A for mitigating healthcare-associated infections in a newborn intensive care unit

Reducing healthcare-associated infections is critically important. A new hybrid lighting system technology, designed to provide both visible white light and disinfecting UV-A (λmax = 366 nm) radiation, was retrofitted into a modern hospital newborn intensive care unit. The UV-A dosing was set to levels calculated to be safe for human occupation (maximum of 10 W m−2 for 8 hours at eye level). Eight-hour exposures at 3 W m−2 on newborn intensive care unit counter surfaces were effective for suppressing selected pathogens identified by the Centers for Disease Control and Prevention as problematic for healthcare facilities. Professional staff accepted the hybrid lighting system, although its implementation in this newborn intensive care unit was not completely satisfactory. An analysis of photodegrading effects suggested that UV-A resistant equipment and furnishing may need to be installed with this technology. The present findings should form the foundation for the next generation of this lighting technology.

Pancreatic sarcomatoid carcinoma: CT, MRI, and 18F-FDG PET/CT features

AIM

To investigate computed tomography (CT), magnetic resonance imaging (MRI), and combined 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (¹⁸F-FDG) positron-emission tomography (PET)/CT features of pancreatic sarcomatoid carcinoma (PSC).

MATERIALS AND METHODS

The hospital database was searched retrospectively for the patients with PSC confirmed at histopathology after surgery. Ten patients who underwent unenhanced and enhanced CT (n=4), unenhanced and enhanced MRI (n=2), ¹⁸F-FDG PET/CT (n=2), and both enhanced CT and ¹⁸F-FDG PET/CT (n=2) were enrolled. Two patients underwent additional delayed PET/CT. The maximum standardised uptake value (SUVmax) was measured on PET/CT images.

RESULTS

Eleven lesions were detected in 10 patients. Solid and cystic components (n=6), intratumoural haemorrhage (n=1), nodular calcification (n=2), main pancreatic duct dilatation resulted from lesion obstruction (n=5) or compression (n=3), cholangiectasis (n=5), vascular and peripheral organ invasion (n=5 and 6, respectively), hepatic and lymphatic metastases (n=4 and 2, respectively) were detected. All five lesions in four patients who underwent PET/CT showed intense FDG uptake on PET/CT with SUVmax (16, range 10.9-21.1). Increase of FDG uptake (SUVmax = 18.9, 20.1, and 27.3, respectively) was revealed on the delayed scan of three lesions in two patients.

CONCLUSIONS

PSCs were more commonly ill-defined solid cystic masses, which caused pancreatic duct obstruction/compression without pancreatic parenchymal atrophy, and these masses on PET/CT showed high FDG uptake on both initial and delayed PET/CT.

Outpatient dermatology consultations for oncology patients with acute dermatologic adverse events impact anticancer therapy interruption: a retrospective study

BACKGROUND

Dermatologic adverse events (dAEs) of anticancer therapies may negatively impact dosing and quality of life. While therapy interruption patterns due to dAEs have been studied in hospitalized cancer patients, similar outcomes in outpatient oncodermatology are lacking.

OBJECTIVES

To analyse the therapy interruption patterns, clinico-histopathologic characteristics and management outcomes of outpatient dermatology consultations for acute dAEs attributed to the most frequently interrupted class of oncologic agents.

METHODS

We performed a retrospective cohort study of all cancer patients who received a same-day outpatient dermatology consultation for acute dAEs at our institution from 1 January to 30 June 2015. Relevant data were abstracted from electronic medical records, including demographics, oncologic history and explicit recommendations by both the referring clinician and consulting dermatologist on anticancer therapy interruption. Consultations with the most frequently interrupted class of oncologic treatment were characterized according to clinico-histopathologic features, dermatologic management and clinical outcomes.

RESULTS

There were 426 same-day outpatient dermatology consultations (median age 59, 60% female, 30% breast cancer), of which 295 (69%) had systemic anticancer therapy administered within 30 days prior. There was weak inter-rater agreement between referring clinicians and consulting dermatologists on interruption of anticancer treatment (n = 150, κ = 0.096; 95% CI -0.02 to 0.21). Seventy-three (25%) consultations involved interruption by the referring clinician, most commonly targeted therapy (24, 33%). Maculopapular rash was commonly observed in 23 consultations with 25 dAEs attributed to targeted agents (48%), and topical corticosteroids were most frequently utilized for management (22, 38%). The majority (83%) of consultations with targeted therapy-induced dAEs responded to dermatologic treatment and 84% resumed oncologic therapy, although three (19%) at a reduced dose. Rash recurred only in two instances (13%).

CONCLUSIONS

A high frequency of positive outcomes in the management of targeted therapy-induced dAEs by outpatient consulting dermatologists and low recurrence of skin toxicity suggests impactful reductions in interruption of anticancer therapy.

High-resolution ion mobility spectrometry-mass spectrometry of isomeric/isobaric ribonucleotide variants

In this report, we explored the benefits of cyclic ion mobility (cIM) mass spectrometry in the analysis of isomeric post-transcriptional modifications of RNA. Standard methyl-cytidine samples were initially utilized to test the ability to correctly distinguish different structures sharing the same elemental composition and thus molecular mass. Analyzed individually, the analytes displayed characteristic arrival times (tD ) determined by the different positions of the modifying methyl groups onto the common cytidine scaffold. Analyzed in mixture, the widths of the respective signals resulted in significant overlap that initially prevented their resolution on the tD scale. The separation of the four isomers was achieved by increasing the number of passes through the cIM device, which enabled to fully differentiate the characteristic ion mobility behaviors associated with very subtle structural variations. The placement of the cIM device between the mass-selective quadrupole and the time-of-flight analyzer allowed us to perform gas-phase activation of each of these ion populations, which had been first isolated according to a common mass-to-charge ratio and then separated on the basis of different ion mobility behaviors. The observed fragmentation patterns confirmed the structures of the various isomers thus substantiating the benefits of complementing unique tD information with specific fragmentation data to reach more stringent analyte identification. These capabilities were further tested by analyzing natural mono-nucleotide mixtures obtained by exonuclease digestion of total RNA extracts. In particular, the combination of cIM separation and post-mobility dissociation allowed us to establish the composition of methyl-cytidine and methyl-adenine components present in the entire transcriptome of HeLa cells. For this reason, we expect that this technique will benefit not only epitranscriptomic studies requiring the determination of identity and expression levels of RNA modifications, but also metabolomics investigations involving the analysis of natural extracts that may possibly contain subsets of isomeric/isobaric species.

A New Global Variance Reduction Technique Based on Geometry and Energy Splitting/Roulette

With the increase of computer resources and the application of global variance reduction (GVR) method, it is a trend to obtain global distribution using the Monte Carlo (MC) method in deep-penetration shielding calculation. GVR technique uses biased source and weight window to decrease the MC calculation tally error for deep-penetration problems. However, excessive splitting of large weight particles out of the source region is time-consuming for problems with significant fluence rate variation. A new GVR technique, which performs space and energy splitting/roulette based on the importance of the phase space, is proposed in this paper to avoid excessive splitting of large weight particles. The improved GVR technique is applied to the H. B. Robinson Unit 2 (HBR-2) benchmark and CAP1400 dose rate distribution calculation. Numerical results show that the new GVR technique shows excellent performance for deep-penetration shielding calculation.

Incidence and mortality of nasopharyngeal carcinoma: interim analysis of a cluster randomized controlled screening trial (PRO-NPC-001) in southern China

BACKGROUND

Previous mass screening studies have shown that IgA antibodies against Epstein-Barr Virus (EBV) can facilitate early detection of nasopharyngeal carcinoma (NPC), but the impact of EBV-antibody screening for NPC-specific mortality remains unknown.

PATIENTS AND METHODS

A prospective, cluster randomized, controlled trial for NPC screening (PRO-NPC-001) was conducted in 3 selected towns of Zhongshan City and 13 selected towns of Sihui City in southern China beginning in 2008. Serum samples of the screening group were tested for two previously selected anti-EBV antibodies. Subjects with serological medium risk were subsequently retested annually for 3 years, and those with serological high risk were referred to otorhinolaryngologists for diagnostic check-up. An interim analysis was carried out to evaluate the primary end points of the NPC-specific mortality and the early diagnostic rate, and the secondary end point of the NPC incidence, through linkage with the database of Zhongshan City.

RESULTS

Among 70 296 total subjects, 29 413 screened participants (41.8% of the total subjects) in the screening group and 50 636 in the control group, 153 (43.3 per 100 000 person-year), 62 (55.3 per 100 000 person-year) and 99 (33.1 per 100 000 person-year) NPC cases were identified. The early diagnostic rates of NPC were significantly higher in the participants (79.0%, P < 0.0001) and the screening group (45.9%, P < 0.0001) compared with the control group (20.6%). Although no differences were found between NPC-specific mortality of the screening group and the control group [relative risk (RR)= 0.82, 95% confidence interval (CI) 0.37-1.79], lower NPC-specific mortality was noticed among participants from the screening group versus the control group (RR = 0.22, 95% CI 0.09-0.49).

CONCLUSION

IgA antibodies against EBV can identify high-risk population and was effective in screening for early asymptomatic NPC. Although the mortality reduction was not significant in the primary end point, we noted encouraging evidence of a mortality reduction in screening participants in this interim analysis.

CLINICAL TRIAL NUMBER

NCT00941538.

[Study on safety of adjuvant radiotherapy concurrent with weekly chemotherapy for stage ⅡB-ⅣA esophageal carcinoma after radical resection]

Objective: To evaluate the tolerability and short-term efficacy of chemo-radiotherapy in 125 patients with stage ⅡB-ⅣA esophageal carcinoma after radical resection. Methods: We retrospectively evaluated the rate of completion, toxicity and survival of patients undergoing adjuvant concurrent chemo-radiotherapy after radical resection of esophageal carcinoma from January 2004 to December 2014 in our institution. The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test. Multivariate prognostic analysis was performed using the Cox proportional hazard model. Results: 122 patients received more than 50 Gy dose (97.6%). A total of 52 patients received more than 5 weeks chemo-radiotherapy (41.6%), while 73 patients underwent only 1-4 weeks (58.4%). The median following up was 48.4 months. 8 patients lost follow up (6.4%). The 1-year and 3-year overall survival rate were 91.6% and 57.0%, respectively, with a median survival time of 64.4 months. The 1-year and 3-year disease free survival rate were 73.2% and 54.3%, respectively, with a median disease free survival time of 59.1 months. The most common acute complications associated with chemo-radiotherapy were myelosuppression, radiation esophagitis and radiation dermatitis, the majority of which were Grade 1-2. Of the 125 patients, there were 59 cases of recurrence, including 23 cases with local regional recurrence, 26 cases with hematogenous metastasis, and 8 cases with mixed recurrence. Univariate analysis showed that the numbers of concurrent chemotherapy was associated with the overall survival (P=0.006). But receiving more than 5 weeks was not the prognostic factor compared to 1 to 4 weeks chemotherapy (P=0.231). Multivariate analysis showed that only the numbers of concurrent chemotherapy was an independent prognostic factor (P=0.010). Conclusions: Postoperative radiotherapy concurrent with weekly chemotherapy could improve the overall survival and decrease the recurrence for stage ⅡB-ⅣA esophageal carcinoma after radical resection. However, the completion rate of chemotherapy was low, so it was necessary to explore reasonable regimens to improve the completion rate and carry out prospective randomized controlled trial.

[The value of the planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of esophageal squamous cell carcinoma]

Objective: The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non-radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors. Methods: We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy (33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single-institution database.The survival rates were calculated by Kaplan-Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model. Results: The median follow-up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease-free survival (DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3-year OS were 75.5%, 57.4%, 27.3% (P<0.001) and 3-year DFS were 72.0%, 44.7%, 17.6% (P<0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3-year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7% of the negative group (both P<0.001). The 3-year OS and DFS of pathologic stage Ⅰ, Ⅱ, ⅢA, ⅢB and Ⅵ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3% (P<0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3% (P<0.001), respectively.The operation-related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS (P<0.05 for all). Conclusions: The planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.

[Effect of CCR1 gene overexpression on the migration of bone marrow - derived mesenchymal stem cells towards hepatocellular carcinoma]

Objective: To evaluate the effect of human CCR1 (hCCR1) gene overexpression on the migration of human bone marrow-derived mesenchymal stem cells (hMSCs) towards hepatocellular carcinoma (HCC), and to examine the application prospects of MSCs as gene delivery vectors in the treatment of HCC. Methods: The hCCR1 gene was subcloned into a lentiviral vector to generate the recombinant plasmid pLV-hCCR1. The pLV-hCCR1 plasmid and two other packaging plasmids were co-transfected into 293T cells using calcium phosphate, and the virus-containing supernatant was collected. hMSCs were then infected with the recombinant lentivirus, and the expression of hCCR1 mRNA and protein was analyzed by RT-PCR and Western blot, respectively. The effect of CCR1 gene overexpression on the in vitro migration of hMSCs was examined using the Transwell migration assay. Orthotopic nude mice models of HCC were established using the MHCC-97H-GFP cell line, and the mice were divided into two groups (n = 8 per group). hMSCs were then intravenously injected via the tail vein into the tumor-bearing nude mice to examine the effect of hCCR1 overexpression on the in vivo migration of hMSCs towards HCC. Unpaired Student's t-test was used for two-group comparisons, and one-way ANOVA was used for multi-group comparisons. Results: Restriction enzyme digestion and DNA sequencing demonstrated that the recombinant plasmid pLV-hCCR1 was constructed successfully. The LV-hCCR1 lentivirus packaged by 293T cells has high infection efficiency in hMSCs, and hCCR1 was overexpressed in hMSCs after LV-hCCR1 infection. Transwell migration assay showed that hCCR1-transfected hMSCs had significantly enhanced migration towards HCC cell line-derived condition medium (CM) compared with the control RFP-hMSCs [(134.8±15.7)/LPF vs (83.5±10.9)/LPF, t = 10.40, P < 0.01]. In vivo migration experiment also demonstrated that there was significantly higher number of hCCR1-hMSCs localized within the MHCC-97H-GFP xenografts than hMSCs-RFP on day 14 following intravenous injection of hMSCs in mice [(86.7±14.1)/HPF vs (54.5±9.6)/HPF, t = -7.32, P < 0.01]. Conclusion: Overexpression of CCR1 gene can significantly enhance the migration capacity of hMSCs towards HCC cells in vitro and in vivo. This study provides evidence for potential clinical application of MSCs as more effective delivery vehicles in cancer gene therapy.