Chinese expert group consensus on diagnosis and clinical management of osteoradionecrosis of the mandible

Osteoradionecrosis of the mandible (MORN) is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of the mandible as the main manifestation. Clinically, MORN-related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorders, refractory orocutaneous fistula, bone exposure, and even pathological fracture. MORN has become a challenging clinical problem for oral and maxillofacial surgeons to deal with, but thus far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Because of the nonexistence of standardized treatment criteria, most clinical treatment against MORN nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the diagnosis and treatment of MORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in MORN from 16 domestic medical colleges and affiliated hospitals to discuss the spectrum of diagnosis and and formulate treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This 'expert consensus statement on diagnosis and clinical management of MORN' is for clinical reference.

Does the Brown classification of maxillectomy defects have prognostic prediction for patients with oral cavity squamous cell carcinoma involving the maxilla?

The aim of this study was to investigate the correlation between the maxillectomy defect, T stage, and prognosis of patients with maxillary squamous cell carcinoma (SCC). The Brown classification system was used to appraise the maxillectomy defects due to maxillary SCC. The clinical data of 137 patients with maxillary SCC during the period 2000-2010 were reviewed; 105 patients were followed up. Preoperative T stage and postoperative maxillectomy class were recorded. The relationship between the maxillectomy defect class and T stage of maxillary SCC was analysed. Correlations between the maxillectomy defect class, local recurrence rate, and survival rate were assessed using IBM SPSS Statistics v19.0. The most common maxillectomy defect class was IIb (54.7%, 75/137). The maxillectomy defect class was significantly associated with the T stage (P < 0.001). Both T stage and the maxillectomy defect class were significantly associated with the survival rate of patients with maxillary SCC (both P< 0.001). In conclusion, the class of the maxillectomy defect was found to be associated with the T stage. Both of these were prognostic factors for patients with maxillary SCC. The class of the maxillectomy defect is suitable for clinical application in predicting the prognosis compared with T stage.

A case of systemic lupus erythematosus with rectal necrosis

Lupus mesenteric vasculitis is one of the most devastating complications of systemic lupus erythematosus (SLE) and may lead to a spectrum of complications, including ulceration, haemorrhage, bowel necrosis, perforation, serositis and ascites. Among such complications, intestinal necrosis and intestinal perforation are the most serious. Rectal necrosis is a rare manifestation of SLE, with only two case reports in the English literature. Here, we report the case of a 59-year-old male patient with SLE complicated by rectal necrosis that was initially misdiagnosed as acne and rectal tumours. After two surgeries and the addition of immunosuppressive therapy, the patient was eventually cured and discharged.

Measurement of ϒ(1S) Elliptic Flow at Forward Rapidity in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The first measurement of the ϒ(1S) elliptic flow coefficient (v_{2}) is performed at forward rapidity (2.5<y<4) in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector at the LHC. The results are obtained with the scalar product method and are reported as a function of transverse momentum (p_{T}) up to 15  GeV/c in the 5%-60% centrality interval. The measured ϒ(1S)v_{2} is consistent with 0 and with the small positive values predicted by transport models within uncertainties. The v_{2} coefficient in 2<p_{T}<15  GeV/c is lower than that of inclusive J/ψ mesons in the same p_{T} interval by 2.6 standard deviations. These results, combined with earlier suppression measurements, are in agreement with a scenario in which the ϒ(1S) production in Pb-Pb collisions at LHC energies is dominated by dissociation limited to the early stage of the collision, whereas in the J/ψ case there is substantial experimental evidence of an additional regeneration component.

Investigations of Anisotropic Flow Using Multiparticle Azimuthal Correlations in pp, p-Pb, Xe-Xe, and Pb-Pb Collisions at the LHC

Measurements of anisotropic flow coefficients (v_{n}) and their cross-correlations using two- and multiparticle cumulant methods are reported in collisions of pp at sqrt[s]=13  TeV, p-Pb at a center-of-mass energy per nucleon pair sqrt[s_{NN}]=5.02  TeV, Xe-Xe at sqrt[s_{NN}]=5.44  TeV, and Pb-Pb at sqrt[s_{NN}]=5.02  TeV recorded with the ALICE detector. The multiplicity dependence of v_{n} is studied in a very wide range from 20 to 3000 particles produced in the midrapidity region |η|<0.8 for the transverse momentum range 0.2<p_{T}<3.0  GeV/c. An ordering of the coefficients v_{2}>v_{3}>v_{4} is found in pp and p-Pb collisions, similar to that seen in large collision systems, while a weak v_{2} multiplicity dependence is observed relative to nucleus-nucleus collisions in the same multiplicity range. Using a novel subevent method, v_{2} measured with four-particle cumulants is found to be compatible with that from six-particle cumulants in pp and p-Pb collisions. The magnitude of the correlation between v_{n}^{2} and v_{m}^{2}, evaluated with the symmetric cumulants SC(m,n) is observed to be positive at all multiplicities for v_{2} and v_{4}, while for v_{2} and v_{3} it is negative and changes sign for multiplicities below 100, which may indicate a different v_{n} fluctuation pattern in this multiplicity range. The observed long-range multiparticle azimuthal correlations in high multiplicity pp and p-Pb collisions can neither be described by pythia 8 nor by impact-parameter-Glasma, music, and ultrarelativistic quantum molecular dynamics model calculations, and hence, provide new insights into the understanding of collective effects in small collision systems.

First Observation of an Attractive Interaction between a Proton and a Cascade Baryon

This Letter presents the first experimental observation of the attractive strong interaction between a proton and a multistrange baryon (hyperon) Ξ^{-}. The result is extracted from two-particle correlations of combined p-Ξ^{-}⊕p[over ¯]-Ξ[over ¯]^{+} pairs measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV at the LHC with ALICE. The measured correlation function is compared with the prediction obtained assuming only an attractive Coulomb interaction and a standard deviation in the range [3.6, 5.3] is found. Since the measured p-Ξ^{-}⊕p[over ¯]-Ξ[over ¯]^{+} correlation is significantly enhanced with respect to the Coulomb prediction, the presence of an additional, strong, attractive interaction is evident. The data are compatible with recent lattice calculations by the HAL-QCD Collaboration, with a standard deviation in the range [1.8, 3.7]. The lattice potential predicts a shallow repulsive Ξ^{-} interaction within pure neutron matter and this implies stiffer equations of state for neutron-rich matter including hyperons. Implications of the strong interaction for the modeling of neutron stars are discussed.

[SIVA1 Regulates the Stability of Single-Stranded DNA-Binding Protein 3 Isoforms]

The assembly of LIM-homeodomain (LIM-HD) transcriptional complex plays important roles in early neuronal development. The stability of LIM-HD is controlled by single-strand binding protein 3 (SSBP3) via a cascade mechanism protecting it from proteasomal degradation. The expression level of SSBP3 has to be precisely regulated. Although a decrease of SSBP3 level is associated with several diseases, the mechanism of SSBP3 downregulation and whether SSBP3 itself is subject to proteasomal degradation remain largely unknown. Two strongly conserved transcripts of the SSBP3 gene, SSBP3a and SSBP3c, were cloned from a human brain cDNA library. By RT-PCR, we show that Ssbp3c is continuously expressed in both embryonic and adult mouse brain, whereas Ssbp3a is restricted to embryonic brain tissue. By co-IP and GST pulldown assays, we identified SIVA1 as a novel SSBP3-binding factor. In a ubiquitination assay, we show that SIVA1 enhances the ubiquitination of SSBP3 and regulates its abundance. Our findings reveal the proteasomal degradation of SSBP3 for the first time and provide a rationale for an SIVAl-SSBP3-dependent mechanism for the disassembly of LIM-HD multiprotein complexes.

[Epidemiological characteristics of imported acute infectious diseases in the border areas of Yunnan province, 2008-2017]

Objective: To understand the epidemiological characteristics of imported acute infectious diseases between 2008 and 2017 in the border areas of Yunnan province. Methods: All the cases occurred between January 2008 and December 2017 and related information was from the Chinese CDC infectious disease report information management system, according to definition of imported cases diagnosed by clinicians. Epidemiological characteristics of the imported cases of related information were gathered. Results: A total of 13 157 imported acute infectious diseases were reported from the border areas of Yunnan province, which accounted for 6.03% (13 157/218 284) of the total number of acute infectious diseases in the same areas from 2008 to 2017. Malaria, dengue fever and hand-foot-mouth disease were accounted for 56.05% (7 374/13 157), 21.82% (2 871/13 157) and 4.62% (608/13 157), of all the case, respectively. The number of imported malaria cases decreased annually. However, dengue fever showed a sharp increase. Peaks of the epidemics appeared as: May for malaria and October for dengue fever. Male patients were accounting for the majority (73.22%, 9 634/13 157), so as the patients with Chinese nationality (54.91%, 7 225/13 157). The age distribution appeared as: 67.12% (8 829/13 157) for the 15-44 year olds and 19.26% (2 535/13 157) were children below 14 years of age. Proportions of occupation appeared as: farmers (45.23%, 5 596/13 157), migrant workers (21.30%, 2 802/13 157) and children living at home (11.12%, 1 463/13 157). Most of the imported cases were coming from Myanmar and appearing in the following three counties: Ruili city, Tengchong city, and Yingjiang of Yunnan province. Cities/counties that with number of imported cases more than 10% of the local reported cases, would include Ruili city, Tengchong city, Zhenkang county and Mangshi of Yunnan province. Conclusions: Imported acute infectious disease was a serious public health problem in Yunnan province, 2008-2017. The main imported acute infectious diseases were malaria, dengue fever and hand-foot-mouth disease. The majority imported cases were accounting for Chinese, male, young adults and farmers. It is also important for immigration workers to carry out surveillance, prevention and control programs on infectious diseases when working in neighboring countries.

[Retrospective cohort study on the correlation between high value of lactic acid and risk of death in 127 patients with extensive burn during shock stage]

Objective: To analyze the relationship between serum lactic acid value and risk of death in patients with extensive burn during shock stage and the related influencing factors. Methods: Clinical data of 127 patients (111 males and 16 females) with extensive burn admitted to Institute of Burn Research of the First Affiliated Hospital of Army Medical University from January 2009 to December 2013 and Department of Plastic Surgery and Burns of the Affiliated Hospital of Southwest Medical University from January 2016 to December 2018, who met the admission criteria, were retrospectively analyzed. The patients aged 21 to 62 years, with total burn area more than 50% total body surface area. All patients were treated with antishock therapy after admission. (1) According to the treatment outcome, the patients were divided into survival group (n=98) and death group (n=29). The gender, age, total burn area, partial-thickness burn area, full-thickness burn area, abbreviated burn severity index (ABSI), admission time after injury, number of patients with inhalation injury, number of patients with acute renal failure, and serum lactic acid values on admission and at post admission hour (PAH) 12, 24, 36, and 48 were recorded. (2) According to the optimal positive cut-off value of serum lactic acid 48 hours after admission, the patients were divided into high lactic acid group and normal lactic acid group. Age, gender, total burn area, indexes at PAH 48 including urea nitrogen, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin, alkaline phosphatase (ALP), albumin, white blood cell count, platelet count, lymphocyte count, prothrombin time (PT), hematocrit value, oxygenation index, respiratory index (RI), the alveolar-arterial oxygen partial pressure difference, mean arterial pressure (MAP) at PAH 48, the average urine volume within 48 hours after admission, the total volume of intravenous fluid infusion within 48 hours after admission, the volume of fluid infusion per kilogram of body mass within the first 24 hours after admission, the volume of fluid infusion per one percent of body surface area per kilogram of body mass within the first 24 hours after admission, the volume of urine per kilogram of body mass per hour within the first 24 hours after admission, and the percentage of hospital death were recorded. Data were processed with t test, chi-square test, and Fisher's exact probability test. Cox regression analysis was used to screen independent risk factors affecting the prognosis of patients. Receiver operating characteristic curve (ROC) of serum lactic acid value at PAH 48 of 127 patients was drawn to predict patients' death and determine the optimal positive cut-off value. Multivariate logistic regression analysis was used to screen independent risk factors causing increase of serum lactic acid. Results: (1) There were significantly statistical differences in total burn area, full-thickness burn area, and ABSI of patients between survival group and death group (t=6.257, 4.476, 5.727, P<0.01), while other indexes between the two groups were close. (2) The serum values of lactic acid of patients in death group on admission and at PAH 12, 24, 36, and 48 were (4.00±0.28), (4.50±0.26), (4.02±0.31), (3.48±0.22), (3.40±0.19) mmol/L, respectively, which were significantly higher than those in survival group [(3.30±0.21), (3.20±0.19), (2.33±0.17), (1.85±0.18), (1.50±0.09) mmol/L, t=14.552, 29.603, 38.133, 40.648, 74.973, P<0.05 or P<0.01]. (3) Cox regression analysis showed that the serum value of lactic acid at PAH 48 was the independent risk factor affecting the prognosis of patients, with risk ratio of 1.853 and 95% confidence interval of 1.342-2.559, P<0.01. (4) The total area under ROC of serum value of lactic acid at PAH 48 to predict death of 127 patients was 0.811, with 95% confidence interval of 0.699-0.924, P<0.01. The optimal positive cut-off value of serum value of lactic acid was 1.75 mmol/L, with sensitivity of 75.0% and specificity of 79.5% for predicting death. (5) There were significantly statistical differences in total burn area, ALT, AST, ALP, PT, total serum bilirubin, total volume of intravenous fluid infusion within 48 hours after admission, volume of fluid infusion per kilogram of body mass within the first 24 hours after admission, and percentage of hospital deaths of patients between high lactic acid group (n=34) and normal lactic acid group (n=93), t=3.592, 6.797, 10.367, 2.089, 2.880, 4.517, 2.984, 4.044, χ(2)=58.498, P<0.05 or P<0.01, while other indexes were close between the two groups. (6) Multivariate logistic regression analysis showed that AST and total serum bilirubin were independent risk factors for increase of serum lactic acid, with odds ratios of 1.021 and 1.064 and 95% confidence intervals of 1.001-1.040 and 1.001-1.132, P<0.05. Conclusions: Serum value of lactic acid at PAH 48 can independently predict the death of patients with extensive burns. Liver injury is an important risk factor causing hyperlacticemia during burn shock stage. Widespread increase of vascular permeability and large amount of fluid resuscitation are the core factors leading to aggravation of abdominal organ injury.

[Effects of glutamine on skeletal muscle membrane repair in severely burned mice and the functional mechanism]

Objective: To observe how glutamine affect the skeletal muscle membrane repair in severely burned mice through promoting the mitsugumin 53 (MG53) dimerization in skeletal muscle and to explore its functional mechanism. Methods: (1) Animal experiments. A total of 179 BALB/c male mice aged 6 to 8 weeks were divided into sham injury group (n=43), burn group (n=73) and burn+ glutamine group (n=63) according to the random number table (the same grouping method below). Mice in sham injury group were sham injured on the back, and mice in burn group and burn+ glutamine group were inflicted with 30% total body surface area full-thickness scald (hereinafter referred to as burn) on the back. Mice in burn+ glutamine group were intragastrically administered with glutamine (1 mg/kg), and the other two groups were given the same amount of amino acid solution once per day for 14 days. On post burn hour 12, 10 mice from burn group were taken for preparation of burn serum, which is used in the following cell experiments. Blood samples were collected from the hearts to prepare serum from 10 mice in sham injury group immediately after burn and from 10 mice in burn group and burn+ glutamine group on post burn day (PBD) 5, 10, and 14, respectively. And then the whole gastrocnemius muscle was harvested after the mice were sacrificed. On PBD 10, the whole flexor brevis digitorum was harvested from 6 mice in the 3 groups respectively after the mice were sacrificed. On PBD 5, 10, and 14, the whole gastrocnemius muscle tissue was harvested from another 9 mice in the 3 groups respectively after the mice were sacrificed. The mass of the whole gastrocnemius muscle of mice was weighed. The total protein content of gastrocnemius muscle of mice was detected by coomassie brilliant blue method. The repair function of myolemma of flexor brevis digitorum of mice was detected by two-photon laser fiber membrane perforating. The serum content of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) of mice was determined with radioimmunoassay. The expressions of MG53 dimer and monomer in gastrocnemius of mice were determined with non-reductive electrophoresis-Western blotting. The protein expressions of endoplasmic reticulum stress sign proteins CCAAT/enhancer binding protein homologous protein (CHOP) and glucose-regulated protein 78 (GRP78) in gastrocnemius of mice were determined with Western blotting. (2) Cell experiments. Mice skeletal muscle precursor cells C2C12 were cultured in vitro, and cells of the second passage were selected for the experiments. The cells were divided into normal control group, burn serum group, and burn serum+ glutamine group, with 3 dishes in each group and 1×10(3) cells in each dish. Cells in normal control group were cultured with 1 mL Dulbecco's modified Eagle medium (DMEM) with fetal bovine serum of volume fraction 10%, cells in burn serum group were cultured with 1 mL DMEM with burn serum of volume fraction 10%, and cells in burn serum+ glutamine group were cultured with 1 mL DMEM with burn serum of volume fraction 10% and 4 μL glutamine with a final molar concentration of 8 mmol/L. After 24 hours of culturing, the repair function of myocyte membrane after differentiation of skeletal muscle precursor cells in mice was detected with the same method before. Another cells were grouped and cultured as before, with 3 wells in each group and 1×10(5) cells in each well. After 24 hours of culturing, the expressions of MG53 dimer and monomer and endoplasmic reticulum stress marker proteins in the cells were detected as before. Data were processed with analysis of variance of factorial design, one-way analysis of variance, least significant difference t test, and Student Newman Keuls test. Results: Animal experiments. (1) Compared with those in sham injury group, the mass and total protein content of gastrocnemius muscle of mice in burn group were significantly decreased on PBD 5, 10, and 14 (P<0.05). Compared with those in burn group, the mass and total protein content of gastrocnemius muscle of mice in burn+ glutamine group were significantly increased on PBD 5, 10, and 14 (P<0.05). (2) Compared with that in sham injury group (0.9±0.4), the fluorescence intensity of FM1-43 in myofiber of mice in burn group (7.8±0.4) was significantly increased on PBD 10 (t=7.75, P<0.05). Compared with that in burn group, the fluorescence intensity of FM1-43 in myofiber of mice in burn+ glutamine group (4.0±0.4) was significantly decreased on PBD 10 (t=-4.31, P<0.05). (3) Compared with that in sham injury group, the serum content of TNF-α and IL-6 of mice in burn group was significantly increased on PBD 5, 10, and 14 (P<0.05). Compared with that in burn group, the serum content of TNF-α and IL-6 of mice in burn+ glutamine group was significantly decreased on PBD 5, 10, and 14 (P<0.05). (4) Compared with 56.97±2.82, 44.89±4.72, 42.46±1.06, 14.26±0.99, 62.36±2.74, and 29.45±0.84 in sham injury group, the expressions of MG53 dimer and monomer in gastrocnemius of mice were significantly decreased in burn group on PBD 5, 10, and 14 (6.16±0.25, 26.09±1.22, 28.86±1.53, 5.63±0.25, 26.74±0.79, 4.41±0.52, P<0.05). Compared with those in burn group, the expression of MG53 dimer of gastrocnemius of mice in burn+ glutamine group was significantly increased on PBD 10 and 14 (36.79±1.44, 43.96±1.62), and the expression of MG53 monomer of gastrocnemius muscle of mice in burn+ glutamine group was significantly increased on PBD 14 (13.16±2.17, P<0.05). Compared with those in sham injury group, the protein expressions of CHOP and GRP78 in gastrocnemius muscle of mice in burn group were significantly elevated on PBD 5, 10, and 14 (P<0.05). Compared with those in burn group, the protein expressions of CHOP and GRP78 in gastrocnemius of mice in burn+ glutamine group were significantly reduced on PBD 5, 10 (P<0.05). Cell experiments. (1) Compared with that in normal control group (1.76±0.25), the fluorescence intensity of FM1-43 in cells in burn serum group (9.46±1.22) was significantly increased after 24 hours of culturing (t=12.28, P<0.05). Compared with that in burn serum group, the fluorescence intensity of FM1-43 in cells in burn serum+ glutamine group (4.71±0.45) was significantly decreased after 24 hours of culturing (t=-7.59, P<0.05). (2) The expressions of MG53 monomer of cells were similar in normal control group, burn serum group, and burn+ glutamine group after 24 hours of culturing (P>0.05). Compared with 58.5±1.8 in normal control group, the expression of MG53 dimer of cells in burn serum group was significantly decreased after 24 hours of culturing (14.1±1.4, P<0.05). Compared with that in burn serum group, the expression of MG53 dimer of cells in burn serum+ glutamine group was significantly increased after 24 hours of culturing (30.9±0.6, P<0.05). Compared with those in normal control group, the protein expressions of CHOP and GRP78 of cells were significantly elevated in burn serum group after 24 hours of culturing (P<0.05). Compared with those in burn serum group, the protein expressions of CHOP and GRP78 of cells were significantly reduced in burn serum+ glutamine group after 24 hours of culturing (P<0.05). Conclusions: Glutamine can promote MG53 dimerization by alleviating endoplasmic reticulum stress in severely burned mice. Thus it can accelerate skeletal muscle membrane repair, reduce the local inflammatory reaction of skeletal muscle and consumption of skeletal muscle.

Large debris dumps in the northern South China Sea

Knowledge of the abundance, source, and fate of marine debris in the deep sea is largely constrained thus far. Here, we report the existence of large deep-sea debris dumps that have not been reported before on the seafloor worldwide. Marine debris remarkably accumulated at ~1700-1800 m in the tributary submarine canyons of the Xisha Trough, northern South China Sea (SCS). Although marine debris in Xisha Trough is patchy, the debris abundance was as high as 36,818 and 51,929 items/km² at locations SY78 and SY82, respectively, which is one order of magnitude higher than that in other submarine canyons. We propose that most of the debris came from fishery and navigation activities, as indicated by the categories of debris collected from the seafloor dumps. Seasonal surface ocean currents of the SCS and geomorphology of submarine canyons possibly influence the movement of the debris from coasts to the deep seafloor.

A polymorphic MYC response element in KBTBD11 influences colorectal cancer risk, especially in interaction with an MYC-regulated SNP rs6983267

Background

MYC is a well-established cancer driver gene regulating the expression of numerous genes, indicating that polymorphisms in MYC response elements could affect tumorigenesis through altering MYC regulation. We performed integrative multistage study to evaluate the effects of variants in MYC response elements and colorectal cancer (CRC) risk.

Patients and methods

We systematically integrated ChIP-Seq, DNase-Seq and transcription factor motif data to screen variants with potential ability to affect the MYC binding affinity. Then, we conducted a two-stage case-control study, totally consisting of 4830 CRC cases and 4759 controls in Chinese population to identify risk polymorphisms and interactions. The effects of risk variants were confirmed by functional assays in CRC LoVo, SW480 and HCT15 cells.

Results

We identified a novel polymorphism rs11777210 in KBTBD11 significantly associated with CRC susceptibility (P = 2.43 × 10-12). Notably, we observed a significant interaction between rs11777210 and MYC nearby rs6983267 (P-multi = 0.003, P-add = 0.005), subjects carrying rs6983267 GG and rs11777210 CC genotypes showing higher susceptibility to CRC (2.83-fold) than those carrying rs6983267 TT and rs11777210 TT genotypes. We further demonstrated that rs6983267 T > G increased MYC expression, and MYC bound to and negatively regulated KBTBD11 expression when the rs11777210 C risk allele was present. KBTBD11 was downregulated in tumor tissues, and KBTBD11 knockdown promoted cell proliferation and inhibited cell apoptosis.

Conclusion

The rs11777210 is a potential predictive biomarker of CRC susceptibility, and KBTBD11 functions as a putative tumor suppressor in tumorigenesis. Our study highlighted the high CRC risk of people carrying rs6983267 G and rs11777210 C alleles, and provided possible biological mechanism of the interaction.

Interleukin-1 receptor antagonist protein (IL-1Ra) and miR-140 overexpression via pNNS-conjugated chitosan-mediated gene transfer enhances the repair of full-thickness cartilage defects in a rabbit model

Objectives

Previously, we reported the improved transfection efficiency of a plasmid DNA-chitosan (pDNA-CS) complex using a phosphorylatable nuclear localization signal-linked nucleic kinase substrate short peptide (pNNS) conjugated to chitosan (pNNS-CS). This study investigated the effects of pNNS-CS-mediated miR-140 and interleukin-1 receptor antagonist protein (IL-1Ra) gene transfection both in rabbit chondrocytes and a cartilage defect model.

Methods

The pBudCE4.1-miR-140, pBudCE4.1-IL-1Ra, and negative control pBudCE4.1 plasmids were constructed and combined with pNNS-CS to form pDNA/pNNS-CS complexes. These complexes were transfected into chondrocytes or injected into the knee joint cavity.

Results

High IL-1Ra and miR-140 expression levels were detected both in vitro and in vivo. In vitro, compared with the pBudCE4.1 group, the transgenic group presented with significantly increased chondrocyte proliferation and glycosaminoglycan (GAG) synthesis, as well as increased collagen type II alpha 1 chain (COL2A1), aggrecan (ACAN), and TIMP metallopeptidase inhibitor 1 (TIMP-1) levels. Nitric oxide (NO) synthesis was reduced, as were a disintegrin and metalloproteinase with thrombospondin type 1 motif 5 (ADAMTS-5) and matrix metalloproteinase (MMP)-13 levels. In vivo, the exogenous genes reduced the synovial fluid GAG and NO concentrations and the ADAMTS-5 and MMP-13 levels in cartilage. In contrast, COL2A1, ACAN, and TIMP-1 levels were increased, and the cartilage Mankin score was decreased in the transgenic group compared with the pBudCE4.1 group. Double gene combination produced greater efficacies than each single gene, both in vitro and in vivo.

Conclusion

This study suggests that pNNS-CS is a good candidate for treating cartilage defects via gene therapy, and that IL-1Ra in combination with miR-140 produces promising biological effects on cartilage defects.

Cite this article: R. Zhao, S. Wang, L. Jia, Q. Li, J. Qiao, X. Peng. Interleukin-1 receptor antagonist protein (IL-1Ra) and miR-140 overexpression via pNNS-conjugated chitosan-mediated gene transfer enhances the repair of full-thickness cartilage defects in a rabbit model. Bone Joint Res 2019;8:165–178. DOI: 10.1302/2046-3758.83.BJR-2018-0222.R1.

Comparison of the subjective satisfaction of the donor site morbidity: Free radial forearm flap versus anterolateral thigh flap for reconstruction in tongue cancer patients

BACKGROUND

The purpose of the study was to compare the differences of the subjective satisfaction of the donor site morbidity between the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) for tongue reconstruction.

MATERIAL AND METHODS

One hundred and nineteen patients underwent FRFF or ALTF reconstruction were retrospectively evaluated by a standardized self-established donor site morbidity questionnaire which included 5 domains, sensibility, movement disabilities, cosmetics, social activities and general impacts on the quality of life.

RESULTS

The Cronbach's coefficient alpha of the questionnaire was 0.707. The exploratory factor analysis revealed that the 5 items of the questionnaire might load onto two distinct subscales. Patients with ALTF had higher scores in the sensibility, cosmetics and the composite score (P < 0.05). No significant differences were found in the movement disabilities, social activities and general impacts on the quality of life between the two groups (P > 0.05).

CONCLUSIONS

ALTF has the advantage of better results of donor site morbidity, such as sensibility and cosmetics, over FRFF.

Azimuthal Anisotropy of Heavy-Flavor Decay Electrons in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

Angular correlations between heavy-flavor decay electrons and charged particles at midrapidity (|η|<0.8) are measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. The analysis is carried out for the 0%-20% (high) and 60%-100% (low) multiplicity ranges. The jet contribution in the correlation distribution from high-multiplicity events is removed by subtracting the distribution from low-multiplicity events. An azimuthal modulation remains after removing the jet contribution, similar to previous observations in two-particle angular correlation measurements for light-flavor hadrons. A Fourier decomposition of the modulation results in a positive second-order coefficient (v_{2}) for heavy-flavor decay electrons in the transverse momentum interval 1.5<p_{T}<4  GeV/c in high-multiplicity events, with a significance larger than 5σ. The results are compared with those of charged particles at midrapidity and those of inclusive muons at forward rapidity. The v_{2} measurement of open heavy-flavor particles at midrapidity in small collision systems could provide crucial information to help interpret the anisotropies observed in such systems.

[Multimodal image fusion technology for diagnosis and treatment of the skull base-infratemporal tumors]

OBJECTIVE

To explore the value of incorporated multimodal image fusion technology with computer-aided design of the skull base-infratemporal tumor treatment.

METHODS

A retrospective study was carried out to enroll seventeen patients with skull base-infratemporal tumors treated at Peking University Hospital of Stomatology from February 2011 to September 2018. Plain CT, enhanced CT and MRI data were imported into the iPlan 3.0 software (BrainLab navigation system), and the image fusion was performed for each patient preoperatively. Then the three-dimensional images of the tumor, vital vessels and craniofacial bones were reconstructed to prepare virtual operation design. We evaluated the application of multimodal image fusion technology that had been incorporated with computer-aided planning during the navigation-guided biopsy or surgery, through the analysis of the biopsy and operation data and regular follow-up postoperatively.

RESULTS

The mean age of 17 patients (7 males and 10 females) was 46 years. Primary tumors occurred in 11 cases, and recurrent tumors in 6 cases. The size of the 17 tumors ranged from 2.9 cm to 9 cm, and the mean size was 4.35 cm. There were 7 cases with skull base bone destruction and/or intracranial extension, and 10 cases with tumors adjacent to the skull base. High-quality multimodal fused images were obtained in all the 17 cases. The spatial-position relationships of the tumors, adjacent craniomaxillofacial bones and vital vessels labeled with different colors were displayed well on the generated fusion images. The multimodal image fusion technology that incorporated with computer-aided three-dimensional reconstruction and then applied in navigation-guided biopsy or surgery showed that, preoperative analysis and virtual operation design functioned with good results, especially in cases with small tumor size, recurrence or illdefined borders in the skull base-infratemporal region. Operation was carried out in 16 cases after preoperative diagnosis and assessment, and 1 case was performed by navigation-guided biopsy only. The proportions of navigation-guided surgery and biopsy were 70.6% (12/17) and 17.6% (3/17) individually. The positive rate of pathologic diagnosis using navigation-guided biopsy was 100% (3/3). All the navigation-guided biopsies or operations were carried out successfully. Complications included 1 case of cerebrospinal fluid leak from a recurred meningioma patient postoperatively, and 1 case of facial paralysis resulting from parotid-gland deep lobe tumor. Most (14/15) tumors got complete removal with safe boundary through intra-operative navigation verification and post-operative imaging confirmation, except for one case of subtotal resection to avoid the injury of cavernous sinus. The pathological results of the tumors could be classified to mesenchymal (10), adenogenous (3), neurogenic (3) or epithelial (1) resources. The follow-up time ranged from 3 to 94 months, with the median follow-up time of 9 months.

CONCLUSION

Taking full advantages of individualized multimodal images, could help analyze the three-dimensional spatial position relationship of tumors, vital vessels and craniofacial bones properly, and then complete the virtual operation design well. The incorporated multimodal image fusion technology with navigation technology may improve the accuracy and safety of core needle biopsy and surgical treatment of skull base-infratemporal tumors.

Allogeneic adipose-derived stem cells suppress mTORC1 pathway in a murine model of systemic lupus erythematosus

OBJECTIVE

The aim of our study was to investigate the efficacy of adipose-derived stem cells (ADSC) transplantation in systemic lupus erythematosus (SLE) and to determine the mechanism of ADSC transplantation.

METHODS

B6.MRL/lpr mice were administered ADSC intravenously every week from age 28 to 31 weeks, while the lupus control group and the normal control received phosphate buffered solution (PBS) on the same schedule.

RESULTS

Compared with the lupus control group, the ADSC treatment group had a significant improvement of histologic abnormalities, serologic abnormalities, and immunologic function. Anti-double-stranded DNA antibodies, spleen/weight ratio, deposits of C3/IgG in the kidney, and serum creatinine and blood urea nitrogen levels were significantly decreased with the transplantation of ADSC. A significant decrease of the Th17/CD4⁺ T cell ratio in the spleen, the serum IL-17 concentration, as well as renal IL-17 expression was observed in the ADSC treatment group. Western blot results also showed that ADSC treatment had a lower expression of protein kinase B (Akt), p-Akt, mTOR, p-mTOR, p70S6K, p-p70S6K, and HIF-1α.

CONCLUSION

ADSC treatment can prevent the development of lupus nephritis and significantly ameliorate already-established disease. ADSC treatment reduced Akt, mTOR, p70S6K, HIF-1α, and that this inhibition can avert IL-17-induced inflammation, suggesting that ADSC may be a promising treatment for SLE.

Are antithrombotic agents necessary for head and neck microvascular surgery?

The aim of this prospective study was to determine the effect of antithrombotic agents in preventing thrombosis after head and neck reconstructive surgery. A randomized clinical trial of referred patients undergoing free flap surgery between February 2015 and July 2017 was conducted. Four hundred and fifty-four patients were randomly assigned to group A (n=153), administered aspirin and low molecular weight dextran; group B (n=150), administered low molecular weight heparin; and group C (n=151), not administered any antithrombotic agent. Patient demographic characteristics, donor site, thrombosis, haematoma, and flap failure were recorded. Coagulation values including platelet count, prothrombin time, and activated partial thromboplastin time were measured during the perioperative period. Repeated-measures ANOVA and the χ² test were used for data comparisons. No significant inter-group differences were observed for postoperative microvascular thrombosis (P=0.536) or flap failure (P=0.615) among the three groups. There were more postoperative haematoma revisions in group B than in groups A and C (P=0.032). It is concluded that postoperative antithrombotic agents neither provide a significant improvement in the free flap success rate nor decrease the risk of thrombosis and may increase the risk of haematoma.

Non-vascularised fibular bone graft after vascular crisis: compensation for the failure of vascularised fibular free flaps

After reconstruction of a segmental mandibular defect with a fibular free flap, a vascular crisis can be detected clinically and a "no-flow" phenomenon found during re-exploration. Traditional methods used to solve this include removal of the failed flap and delayed mandibular reconstruction, or restoration of the defect with a functional reconstruction plate or contralateral fibular free flap. Our aim therefore was to investigate under what circumstances it is feasible to use a non-vascularised fibular bone graft (NVFB) as a free bone graft after the failure of a vascularised fibular free flap. From 1 January 2010-31 December 2014, 10 patients who had NVFB after failure of a fibular free flap were included in the study. All patients were treated at the Peking University School and Hospital of Stomatology. NVFB were preserved successfully without infection in all 10 cases, and follow-up imaging showed that it had incorporated well with the residual mandible, the basic function and facial aesthetics of which were maintained. In conclusion we have identified that by precise selection of patients, detailed preoperative planning, and meticulous postoperative care, NVFB can be used as a "rescue" technique after failure of a fibular free flap, and can successfully restore the segmental mandibular defect and facial contour.

[Comorbidity in oral squamous cell carcinoma patients: an initial research in Beijing area]

Objective: To make a preliminery research of comobidity in oral squamous cell carcinoma (OSCC) patients who resides in Beijing area and investigate whether comorbidity affect the surviving rate independently. Compare the similarities and differences between Chinese and foreign OSCC patients. Methods: The medical records of 313 patients who undertaken operation in Peking University Stomatology School from January 2007 to Delember 2009 were retrospectively reviewed. Adult comorbidity evaluation-27 Chinese edition index was used to estimate the comorbidity severity. COX proportional hazards model was used to analyze whether the TNM stage, comobidity, age and gender affected 5-year survival rate. Results: TNM stage and comorbidity have a significant impact on survival rate, the postoperative survival rate decreased significantly with the increasing level of TNM staging and the complexity of comorbidity disease. In this study, the proportion of patients with none, mild, moderate and severe comorbidity diseases was 24%, 48%, 18% and 10%. The five-year survival rates of patients with moderate and severe comorbidity disease were 50% (29/58) and 13% (4/30) respectively. Conclusions: The comorbidity disease information can help assess the overall health of OSCC patients, and it is recommended to improve the clinical staging and overall evaluation of oral cancer patients with comorbidity disease information.

Diffusional kurtosis imaging in assessing renal function and pathology of IgA nephropathy: a preliminary clinical study

AIM

To evaluate renal fibrosis in immunoglobulin A nephropathy (IgAN) using diffusion kurtosis imaging (DKI).

MATERIALS AND METHODS

Twenty patients with biopsy-proven IgAN were enrolled. DKI was performed on a clinical 3 T magnetic resonance imaging (MRI) system, and region-of-interest measurements were conducted to determine mean kurtosis (K), mean diffusivity (D), and apparent diffusion coefficient (ADC) of the kidney cortex. Renal biopsy specimens were scored based on the severity of renal fibrosis. The associations between the DKI data and clinicopathological parameters were investigated.

RESULTS

Both the K and ADC were not only well correlated with the estimated glomerular filtration rate, but also significantly associated with the pathological scores of fibrosis, including the glomerular sclerosis index (K: r=0.759, p<0.001; ADC: r=-0.636, p=0.003) and the percentage of tubular atrophy and interstitial fibrosis (K: r=0.767, p<0.001; ADC: r=-0.702, p=0.001). Further receiver operating characteristic analysis showed that K demonstrated better diagnostic performance in discriminating severe glomerulosclerosis (area under curve [AUC] 0.970, sensitivity 81.8%, specificity 100%), and ADC displayed better capabilities in identifying severe tubular atrophy/interstitial fibrosis (AUC 0.976, sensitivity 100%, specificity 92.9%).

CONCLUSION

This DKI method can be used to detect renal fibrosis in IgAN in a non-invasive manner and may provide additional information for characterisation and surveillance.

The role of CKIP-1 in osteoporosis development and treatment

Osteoporosis is a systemic skeletal disorder characterized by reduced bone mass and deterioration of bone microarchitecture, which results in increased bone fragility and fracture risk. Casein kinase 2-interacting protein-1 (CKIP-1) is a protein that plays an important role in regulation of bone formation. The effect of CKIP-1 on bone formation is mainly mediated through negative regulation of the bone morphogenetic protein pathway. In addition, CKIP-1 has an important role in the progression of osteoporosis. This review provides a summary of the recent studies on the role of CKIP-1 in osteoporosis development and treatment.

Cite this article: X. Peng, X. Wu, J. Zhang, G. Zhang, G. Li, X. Pan. The role of CKIP-1 in osteoporosis development and treatment. Bone Joint Res 2018;7:173–178. DOI: 10.1302/2046-3758.72.BJR-2017-0172.R1.

[Isolated vertigo as the first symptom of posterior circulation infarction:reporot of 11 cases]

Objective:To analyze the clinical characteristics of patients with cerebellar and brainstem infarction who initially presented with isolated vertigo to avoid misdiagnosing of this disease.Method:Eleven patients with cerebellar and brainstem infarction who initially presented with isolated vertigo treated in our clinic between January 2014 and September 2017 were reviewed and the clinical characteristics and imaging presentation of the patients were evaluated.Result:Vertigo as the first attack was in 5 cases, recurrent attacks was in 6 cases,10 cases were with vascular risk factors except for 1 case, initially diagnosed as vestibular neuritis was 4 cases, Meniere's disease was 1 case, posterior circulartion ischemia was 1 case,and unknown causes was 5 cases; delayed neurological symptoms and signs occurring was 4 cases, but not in other cases; finally determined by brain MRI as acute cerebellar infarction was 5 cases, brainstem infarction was 5 cases, and concurrent cerebellar and brainstem infarction was 1 case. All patients had good prognosis.Conclusion:Isolated vertigo due to posterior circulation infarction is easy to be misdiagnosed as peripheral vertigo.Patients presenting with isolated vertigo, when with vascular risk factors, should receive MRI and DWI examinations. Properly diagnosis and treatment may lead a good prognosis.

CXCR4 antagonist AMD3100 enhances the response of MDA-MB-231 triple-negative breast cancer cells to ionizing radiation

Radiation therapy (RT) is one of the primary modalities for triple-negative breast cancer (TNBC) treatment. However, due to the pro-metastatic potential of radiation and the intrinsic radiation resistance of some tumors, many patients experience RT failure, which leads to cancer relapse and distant metastasis. This preclinical study evaluated the efficacy of the antagonist of the SDF-1 receptor CXCR4, AMD3100, as a radiosensitizer in TNBC models. The combined effect of ionizing radiation and AMD3100 was determined in vitro by surviving fraction, cell cycle distribution, Bax and Bcl-2 expression, and apoptosis assays in a TNBC cell line (MDA-MB-231). For in vivo studies, human xenograft athymic nude mice were used. Treatment of TNBC cells with AMD3100 significantly augmented cellular radiosensitivity. Radiosensitivity was enhanced specifically through increased Bax expression, reduced Bcl-2 expression, prolonged G2-M arrest, and increased apoptosis. Combined treatment with AMD3100 and irradiation also enhanced tumor growth delay, with an enhancement factor ranging from 1.5 to 1.8. These findings support the evaluation of antagonists of the SDF-1 receptor CXCR4, such as AMD3100, as potent radiosensitizers in TNBC.

D-Meson Azimuthal Anisotropy in Midcentral Pb-Pb Collisions at sqrt[s]_{NN}=5.02 TeV

The azimuthal anisotropy coefficient v_{2} of prompt D^{0}, D^{+}, D^{*+}, and D_{s}^{+} mesons was measured in midcentral (30%-50% centrality class) Pb-Pb collisions at a center-of-mass energy per nucleon pair sqrt[s_{NN}]=5.02  TeV, with the ALICE detector at the LHC. The D mesons were reconstructed via their hadronic decays at midrapidity, |y|<0.8, in the transverse momentum interval 1<p_{T}<24  GeV/c. The measured D-meson v_{2} has similar values as that of charged pions. The D_{s}^{+} v_{2}, measured for the first time, is found to be compatible with that of nonstrange D mesons. The measurements are compared with theoretical calculations of charm-quark transport in a hydrodynamically expanding medium and have the potential to constrain medium parameters.

Thymoquinone protects against cerebral small vessel disease: Role of antioxidant and anti-inflammatory activities

Cerebral small vessel disease (CSVD) is a leading cause of progressive decline of cognition and a major risk factor for stroke. Thymoquinone (TQ) is the major biological component of Nigella sativa (N. sativa) and its extracts. We explored the possible protective effect of TQ against CSVD in strokeprone spontaneously hypertensive SHRsp rats. Morris water maze and novel object recognition tests were conducted to evaluate memory and cognitive function. mRNA expression of inflammatory factors were determined and oxidative stress was evaluated. We showed that TQ markedly decreased the level of systolic blood pressure in SHRsp rats. TQ reduced the escape latency time and the time spent in the target quadrant in the Morris water maze test in SHRsp rats. TQ also decreased the time spent with the novel object in SHRsp rats in both short- and long-term memory tests. TQ markedly increased the capacity to distinguish between familiar objects and novel objects in the SHRsp rats in the short- and long-term memory tests. The mRNA expression of IL-1β, IL-6, monocyte chemoattractant protein-1 and cyclooxygenase-2 in the brain of SHRsp rats was remarkably decreased by TQ, indicating the reduction of inflammation. Moreover, TQ increased the activities of superoxide dismutase and catalase, decreased the malondialdehyde level and increased glutathione level in the brain of SHRsp rats, indicating the attenuation of oxidative stress. In summary, we found that TQ could effectively attenuate the blood pressure and the injury of memory and cognition under the condition of CSVD. The anti-inflammatory and antioxidant activities of TQ may be responsible for its protective effect. We demonstrate that TQ is a novel candidate for the treatment of CSVD and its neurological outcome.

Abstract P1-07-31: Integrated transcriptomics analyses identify novel three microRNAs signature to predict poor prognosis and metastasis in breast cancer

Backgrounds: MicroRNA (miRNA) play a crucial role in cancer progression, and altered miRNA expression has been demonstrated to be associated with breast cancer. MiRNA is also known to be stably detectable not only in tissue but peripheral circulation; therefore it could be a feasible and potential biomarker of breast cancer in clinical settings. However, few studies have been reported to identify promising miRNA profiles as predictive biomarker using statistically satisfied large cohorts of breast cancer patients. The aim of this study is to identify miRNA signature that can predict patient survival utilizing integrated and unbiased transcriptomics analyses.

Methods: Integrated and unbiased transcriptomics approach was conducted on genomic and clinicopathological information of 2580 breast cancer patients. We utilized The cancer Genome Atlas (TCGA) to identify miRNA signature that could significantly associated with clinical relevance including prognosis and metastatic information, followed by validation analyses with the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) and Gene Expression Omnibus (GEO)

Results: A novel risk scoring model including three miRNAs signature (miR-19a, miR-93, and miR-106a) was identified using Cox model. This miRNA score was able to extract the patient population with extremely poor prognosis in TCGA (5-yr overall survival rate, 49.2 %, p=0.0005). This result was validated with another three completely independent cohorts with microarray dataset accompanied with sufficient clinical information and miRNA expression (GSE19536, n=96, p=0.0009; GSE22220, n=210, p=0.0003; METABRIC, n=1223, p=0,0023). Interestingly, the subtype stratification with PAM-50 classification using bioinformatics pipeline demonstrated that this miRNA score could predict poor overall or disease-free survival especially in the population with luminal A, B or normal like subtype (p=0.0300 and p=0.0001, respectively). In addition, competing risk analysis for tumor recurrences demonstrated that the risk scoring using three miRNAs signature could be significantly associated with bone metastasis (p=0.0052). Finally, Gene Set Enrichment Analysis (GSEA) identified that high risk score using three miRNAs associated significantly with several critical gene sets related to metastatic formation such as angiogenesis (p &lt;0.0001), epithelial mesenchymal transition (EMT) (p = 0.0155), focal adhesion (p &lt;0.0001), TGF-beta signaling pathway (p = 0.0025), and ECM receptor interaction (p = 0.0068).

Conclusions: We demonstrated a promising miRNAs signature score system for predicting extremely poor prognosis and metastatic potentiality in breast cancer using novel integrated transcriptomics concept.

Citation Format: Takabe K, Kawaguchi T, Yan L, Qi Q, Peng X, Young J, Liu S. Integrated transcriptomics analyses identify novel three microRNAs signature to predict poor prognosis and metastasis in breast cancer [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 P1-07-31.

Abstract P6-06-06: Immunogenomics approach elucidating clinical significance of DNA repair genes and tumor infiltrating immune cells in breast cancer

Backgrounds: Evading the immune system is one of the Hallmarks of Cancer. Indeed, tumor infiltrating immune cells has been shown to play critical roles in suppression of cancer progression. Genetic aberration of DNA repair genes is known to increase immunogenicity in breast cancer. However, the patient survival relevance of tumor infiltrating immune cells in regard to DNA repair genes has not yet elucidated in large cohort of breast cancer patients. We hypothesized that DNA repair gene deficiency is related to increased global genomic instability that leads to increased mutation burden, which recruits infiltrating immune cells to tumor microenvironment that result in better prognosis of breast cancer.

Patients and Methods: Integrated and unbiased transcriptomics approach was conducted on genomic and clinicopathological information of 3614 breast cancer patients. We utilized The cancer Genome Atlas (TCGA) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) to evaluate the association between the aberration of DNA repair genes and tumor infiltrating immune cell composition in breast cancer tumors, as well as its significant clinical relevance, utilizing bioinformatics and biostatistics pipelines.

Results:Low expression level of double-strand break repair genes; BRCA1, PRKDC, and RECQL4,demonstrated significantlybetter prognosis in TCGA cohort (p=0.018, p=0.036, and p=0.0002, respectively). This result was consistent in METABRIC cohort (p=0.021, p=0.00021, and p&lt;0.000001, respectively). Utilizing CIBERSORT system that estimate the fraction of 22 immune cell types, we found that low expression of BRCA1 significantly associated with high levels of CD8 positive cell composition in both cohorts (TCGA, p=4.67E-08; METABRIC, p=0.0038), which implicate that tumor infiltrating lymphocytes are attracted to BRCA1 low expressing tumors. Further, low expression of BRCA1 showed significantly better survival in HER2 positive subtype population, but not in the other populations (TCGA, p=0.027; METABRIC, p=0.13). Finally, significantly poor prognosis was observed in breast cancers low in immune-response markers; PD-1, PD-L1, TIM3, LAG3, and CTLA4, in combination with high expression of BRCA1 (p=0.0016, p=0.0041, p=0.015, p=0.0041, and p=0.0043, respectively), which is in agreement with the dogma that intact DNA repair induce less immune-response that result is worse survival.

Conclusions: We conclude that our immunogenomics approach identify the interplay between DNA repair genes, especially gene expression of BRCA1, and tumor infiltrating immune cells, and it could have significant prognostic relevance in breast cancer.

Citation Format: Takabe K, Kawaguchi T, Yan L, Peng X, Qi Q, Okano M, Young J, Liu S. Immunogenomics approach elucidating clinical significance of DNA repair genes and tumor infiltrating immune cells in breast cancer [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 P6-06-06.