[Efficacy of sequential therapy with telbivudine in treatment of HBeAg-positive chronic hepatitis B patients with partial response to pegylated interferon-α therapy]

Objective: To investigate the efficacy of sequential therapy with telbivudine in the treatment of HBeAg-positive chronic hepatitis B (CHB) patients with partial response after a standard course of interferon therapy. Methods: A retrospective cohort study was performed for 58 HBeAg-positive CHB patients with partial response at the end of interferon therapy (48-60 weeks) from January 2009 to December 2013. According to whether telbivudine was used sequentially or withdrawn at the end of the course of treatment, the patients were divided into telbivudine sequential therapy group and withdrawal group, and the two groups were compared with in terms of biochemical, virological, and serological response rates. The chi-square test, the t-test, and the non-parametric test were used based on data type. Results: A total of 58 patients were enrolled in this study, with 31 in the telbivudine sequential therapy group and 27 in the withdrawal group. At 12 and 24 weeks after interferon therapy ended, the telbivudine sequential therapy group had a significantly higher HBeAg clearance rate than the withdrawal group (22.6%/29.0% vs 0%/3.7%, P < 0.05). At week 48 of follow-up, the telbivudine sequential therapy group had a significantly higher combined response rate than the withdrawal group (22.6% vs 0%, P = 0.015). Among the 31 patients in the telbivudine sequential therapy group, 11 had an increase in creatine kinase during the administration of telbivudine. No patient in either group experienced serious adverse reactions during follow-up, such as muscular soreness, myositis, peripheral neuropathy, renal dysfunction, and liver function decompensation. Conclusion: In HBeAg-positive CHB patients with partial response to interferon therapy, sequential therapy with telbivudine can increase serological HBeAg clearance rate and combined response rate at week 48, and it is safe in HBeAg-positive CHB patients achieving partial response at the end of interferon therapy.

Network meta-analysis of novel and conventional sentinel lymph node biopsy techniques in breast cancer

Background

The aim of this network meta‐analysis was to compare the performance of blue dye alone or in combination with radioisotope (technetium‐99m, Tc) with three novel techniques for sentinel lymph node detection in breast cancer: indocyanine green fluorescence (ICG), superparamagnetic iron oxide (SPIO) nanoparticles and contrast‐enhanced ultrasound imaging (CEUS).

Methods

PubMed, Embase, the Cochrane Library, China Knowledge Research Integrated Database, ClinicalTrials.gov and OpenGrey databases were searched up to 31 November 2017, without language restriction. Studies that compared the detection performance of at least one of the novel methods (ICG, SPIO and CEUS) with that of traditional methods (blue dye and/or radioisotope) were included in network meta‐analysis.

Results

Thirty‐five studies were included. Pooled risk ratios (RRs) for Tc (1·09, 95 per cent c.i. 1·04 to 1·15), ICG (1·12, 1·07 to 1·16) and SPIO (1·09, 1·01 to 1·18) showed statistically better performance in detecting sentinel lymph nodes than blue dye alone. ICG had the lowest false‐negative rate, with a RR of 0·29 (0·16 to 0·54), followed by Tc (RR 0·44, 0·20 to 0·96) and SPIO (RR 0·45, 0·14 to 1·45), with blue dye alone as the reference group.

Conclusion

SPIO or ICG alone are superior to blue dye alone and comparable to the standard dual‐modality technique of blue dye with Tc.

Abstract P3-03-26: Challenging dual modality as the gold standard for sentinel lymph node biopsy in breast cancer: A systematic review and network meta-analysis of novel and conventional techniques

The current gold standard for sentinel lymph node biopsy in breast cancer patients is the dual modality technique (radioisotope and blue dye). Owing to the limitations inherent to the use of radioisotopes, the uptake of this method is limited to approximately 50-60% of breast cancer patients in developed countries. In most centers worldwide with no access to radioisotopes, blue dye is the most commonly employed technique as it is relatively cheap, easy to administer with no radiation exposure risk. However, the use of blue dye is associated with a high false negative rate. We performed a systematic review and network meta-analysis to compare the performance of blue dye and radioisotope against three novel techniques, namely indocyanine green fluorescence (ICG), superparamagnetic iron oxide (SPIO) nanoparticles and contrast enhanced ultrasound (CEUS) using microbubbles. This is the first network meta-analysis synthesizing direct as well as indirect comparisons of performance among different techniques in terms of sentinel lymph node detection and false negative rate, thereby allowing a more robust quantitative analysis. In comparison to a published systematic review on this topic in 2014, the current review had almost double the number of patients and trials included with a total of 35 cohort studies and 4,244 patients. Our systematic review suggested that two of the techniques, indocyanine green fluorescence (ICG) and superparamagnetic iron oxide (SPIO) nanoparticles have consistently performed better than the blue dye technique and similar to gold standard dual modality. Hence, in centres where blue dye was used as a single modality, perhaps ICG and SPIO can offer a viable alternative with improved performance. Future research should focus on the economic evaluations of various techniques as well as to explore the cost-effectiveness and cost-utility of adopting new techniques in the clinical setting.

Table 2Pooled estimates of RR and averages on detection rate and false negative rate from network meta-analysis (RR)ICG1.03 (0.96, 1.11)1.08 (1.00, 1.15)1.03 (0.99, 1.06)1.05 (0.96, 1.14)1.12 (1.07, 1.16)*0.67 (0.21, 2.08)SPIO1.03 (0.95, 1.12)0.99 (0.93, 1.06)1.01 (0.95, 1.07)1.09 (1.01, 1.18)*0.16 (0.52, 0.05)0.24 (0.05, 1.08)CEUS0.96 (0.89, 1.02)0.98 (0.90, 1.06)1.03 (0.98, 1.11)0.64 (0.36, 1.13)0.96 (0.34, 2.75)4.00 (1.17, 13.7)*Tc1.00 (0.91, 1.10)1.09 (1.04, 1.15)*0.56 (0.14, 2.23)0.84 (0.36, 1.93)3.49 (0.67, 18.2)0.87 (0.24, 3.23)Tc/BD1.09 (0.98, 1.16)0.29 (0.16, 0.54)*0.45 (0.14, 1.45)1.85 (0.68, 6.06)0.44 (0.20, 0.96)*0.57 (0.13, 2.51)BDBD: Blue dye; CEUS: Contrast-enhanced ultrasound; ICG: Indocyanine green; SPIO: Superparamagnetic iron oxide; Tc: Technetium-99; Tc/BD: Combined used of Technetium-99 and blue dye Top right panel reported the pooled RRs of detection rate from network meta-analysis, and the technique name below each RR was the reference group; Bottom left panel reported the pooled RRs of false negative rate from network meta-analysis, and the technique name to the right of each RR was the reference group; *: Statistical significant with P value &lt; 0.05

Citation Format: Mok CW, Zheng Q, Shi L, Tan S-M. Challenging dual modality as the gold standard for sentinel lymph node biopsy in breast cancer: A systematic review and network meta-analysis of novel and conventional techniques [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-26.

[New insight of craniofacial and oral findings of the RASopathies]

The RASopathies are a group of syndromes that have in common germline mutations in genes that encode components of the RAS/mitogen-activated protein kinase (MAPK) pathway and have been a focus of study to understand the role of this pathway in development and disease. These syndromes include Noonan syndrome (NS), NS with multiple lentigines (NSML), neu-rofibromatosis type 1 (NF1), Costello syndrome (CS), cardio-facio-cutaneous (CFC) syndrome, neurofibromatosis type 1-like syndrome (NFLS) and capillary malformation-arteriovenous malformation syndrome (CM-AVM). These disorders affect multiple systems, including the craniofacial complex. Although the crani-ofacial features have been well described and can aid in clinical diagnosis, the dental phenotypes have not been analysed in detail for each of the RASopathies. In this review, we summarize the clinical features of the RASopathies, highlighting the reported craniofacial and dental findings.

Computer-aided diagnosis of congenital abnormalities of the kidney and urinary tract in children based on ultrasound imaging data by integrating texture image features and deep transfer learning image features

INTRODUCTION

Anatomic characteristics of kidneys derived from ultrasound images are potential biomarkers of children with congenital abnormalities of the kidney and urinary tract (CAKUT), but current methods are limited by the lack of automated processes that accurately classify diseased and normal kidneys.

OBJECTIVE

The objective of the study was to evaluate the diagnostic performance of deep transfer learning techniques to classify kidneys of normal children and those with CAKUT.

STUDY DESIGN

A transfer learning method was developed to extract features of kidneys from ultrasound images obtained during routine clinical care of 50 children with CAKUT and 50 controls. To classify diseased and normal kidneys, support vector machine classifiers were built on the extracted features using (1) transfer learning imaging features from a pretrained deep learning model, (2) conventional imaging features, and (3) their combination. These classifiers were compared, and their diagnosis performance was measured using area under the receiver operating characteristic curve (AUC), accuracy, specificity, and sensitivity.

RESULTS

The AUC for classifiers built on the combination features were 0.92, 0.88, and 0.92 for discriminating the left, right, and bilateral abnormal kidney scans from controls with classification rates of 84%, 81%, and 87%; specificity of 84%, 74%, and 88%; and sensitivity of 85%, 88%, and 86%, respectively. These classifiers performed better than classifiers built on either the transfer learning features or the conventional features alone (p < 0.001).

DISCUSSION

The present study validated transfer learning techniques for imaging feature extraction of ultrasound images to build classifiers for distinguishing children with CAKUT from controls. The experiments have demonstrated that the classifiers built on the transfer learning features and conventional image features could distinguish abnormal kidney images from controls with AUCs greater than 0.88, indicating that classification of ultrasound kidney scans has a great potential to aid kidney disease diagnosis. A limitation of the present study is the moderate number of patients that contributed data to the transfer learning approach.

CONCLUSIONS

The combination of transfer learning and conventional imaging features yielded the best classification performance for distinguishing children with CAKUT from controls based on ultrasound images of kidneys.

The growing applications of SuFEx click chemistry

SuFEx (Sulfur Fluoride Exchange) is a modular, next generation family of click reactions, geared towards the rapid and reliable assembly of functional molecules.

Snx27 Deletion Promotes Recovery From Spinal Cord Injury by Neuroprotection and Reduces Macrophage/Microglia Proliferation

Sorting nexin 27 (SNX27) is an endosome-associated cargo adaptor that is involved in various pathologies and development of neurological diseases. However, the role of SNX27 in spinal cord injury (SCI) remains unclear. In this study, we found that SNX27 was up-regulated in injured mice spinal cords by western blot and immunofluorescence. A comparative analysis of Basso mouse scale (BMS), footprint test and corticospinal tract (CST) tracing in Snx27 ^+/+ and Snx27 ^+/- mice revealed that haploinsufficiency of SNX27 ameliorated the clinical symptoms of SCI. Based on the results of western blot and immunofluorescence, mechanistically, we found that SNX27 deficiency suppresses apoptotic caspase-3 induced neuronal death. In addition, SNX27 haploinsufficiency lowers the infiltration and activation of macrophage/microglia by suppressing their proliferation at the SCI lesion site. Together, these results suggest that down-regulation of SNX27 is a potential therapy targeting both acute neuronal death and chronic neuroinflammation, and promoting nerve repair after SCI.

Heterogeneous to homogeneous melting transition visualized with ultrafast electron diffraction

The ultrafast laser excitation of matters leads to nonequilibrium states with complex solid-liquid phase-transition dynamics. We used electron diffraction at mega-electron volt energies to visualize the ultrafast melting of gold on the atomic scale length. For energy densities approaching the irreversible melting regime, we first observed heterogeneous melting on time scales of 100 to 1000 picoseconds, transitioning to homogeneous melting that occurs catastrophically within 10 to 20 picoseconds at higher energy densities. We showed evidence for the heterogeneous coexistence of solid and liquid. We determined the ion and electron temperature evolution and found superheated conditions. Our results constrain the electron-ion coupling rate, determine the Debye temperature, and reveal the melting sensitivity to nucleation seeds.

Model research on repairing meniscus injury in rabbits using bone marrow mesenchymal stem cells and silk fibroin meniscus porous scaffold

OBJECTIVE

The purpose of this study is to evaluate the histocompatibility and feasibility of structure and function of bone marrow mesenchymal stem cells (BMSCs) and silk fibroin meniscus porous scaffolds in repairing meniscus injury in rabbits.

MATERIALS AND METHODS

BMSCs were cultured and identified in vitro, silk fibroin meniscus porous scaffolds were prepared and the histocompatibility of porous scaffolds was evaluated via in vitro culture. Silk fibroin-BMSCs porous scaffolds were implanted into the meniscus defect area of New Zealand white rabbits as the experimental group, the blank scaffold group without BMSCs, pure BMSCs group and blank control group were set up with 10 rabbits in each group. Joint capsules were opened for general observation at 6 weeks and 12 weeks after operation. The specimens received the HE staining, alkaline toluidine blue staining, and immunohistochemical staining of Type I and Type II collagen and S100 protein.

RESULTS

In vitro HE staining and SEM observation showed that the scaffolds showed the sponge-like structure with abundant microporous structure on the surface and inside, which had a good histocompatibility with BMSCs. At 6 and 12 weeks after operation in experimental group, meniscus-like tissues were found in the meniscus defect area. HE staining showed the fibrous cartilage-like structure and obvious collagenous fiber structure around arranged in an orderly manner. Alkaline toluidine blue staining showed the cartilage-specific glycosaminoglycan (GAG); Type I and Type II collagen and S100 protein staining were strongly positive. However, the above changes were not seen in other groups.

CONCLUSIONS

BMSCs and silk fibroin meniscus porous scaffolds have a better histocompatibility and feasibility of structure and function in repairing meniscus injury in rabbits.

The long noncoding RNA BC0209135 inhibits the cell invasion through Wnt/β-catenin signaling in colorectal cancer

OBJECTIVE

Previous studies have shown that BC029135, a long noncoding RNA (lncRNA) with high conservation, was decreased with high fold change in colorectal cancer (CRC) by using microarray assay. In the present work, we investigated the functions of BC029135 in CRC, as well as the potential mechanisms underlying the malignant phenotype caused by loss of BC029135.

MATERIALS AND METHODS

Bioinformatics analysis of lncRNA BC029135 was performed to identify the potential function. The cell lines of HCT-116, SW480, SW620, LoVo, SW1116, and HT29 were used in this study. The mRNA expression of BC029135 and β-actinin was measured by Real-Time Polymerase Chain Reaction (RT-PCR). Western blot analysis was used to determine protein expression of β-actinin, MMP-2, cyclin D1, and c-Myc.

RESULTS

Our research showed that the expression of BC029135 in CRC tissues and cell lines was significantly lower than in adjacent normal tissues. In addition, overexpression of lncRNA BC029135 could inhibit the invasion of CRC cells. We also found that lncRNA BC029135 inhibits Wnt/β-catenin signaling in CRC cell lines.

CONCLUSIONS

We suggest that up-regulation of BC029135 suppresses CRC invasion and inactivates Wnt/β-catenin signaling. It will provide new insights for the treatment of colorectal cancer and new clues for clinical treatment.

Inhibition of PKCδ reduces amyloid-β levels and reverses Alzheimer disease phenotypes

β-amyloid protein (Aβ) plays a central role in the pathogenesis of Alzheimer disease (AD). Aβ is generated from sequential cleavage of amyloid precursor protein (APP) by β-site APP-cleaving enzyme 1 (BACE1) and the γ-secretase complex. Although activation of some protein kinase C (PKC) isoforms such as PKCα and ε has been shown to regulate nonamyloidogenic pathways and Aβ degradation, it is unclear whether other PKC isoforms are involved in APP processing/AD pathogenesis. In this study, we report that increased PKCδ levels correlate with BACE1 expression in the AD brain. PKCδ knockdown reduces BACE1 expression, BACE1-mediated APP processing, and Aβ production. Conversely, overexpression of PKCδ increases BACE1 expression and Aβ generation. Importantly, inhibition of PKCδ by rottlerin markedly reduces BACE1 expression, Aβ levels, and neuritic plaque formation and rescues cognitive deficits in an APP Swedish mutations K594N/M595L/presenilin-1 with an exon 9 deletion-transgenic AD mouse model. Our study indicates that PKCδ plays an important role in aggravating AD pathogenesis, and PKCδ may be a potential target in AD therapeutics.

Comparative efficacy of five long-term weight loss drugs: quantitative information for medication guidelines

Quantitative information is scarce in current obesity medication guidelines, and they do not clearly reflect the differences in the efficacy characteristics among various drugs. This study quantitatively assessed the efficacy characteristics of five FDA-approved long-term weight loss drugs. Potentially eligible studies were obtained from public databases. Using the differences in the weight change from baseline between the drug group and the corresponding placebo group as the major indicator of efficacy, a time-effect model was established, and crucial pharmacodynamic parameters, such as the maximal efficacy, drug onset time and rate of body weight regain after the maximal efficacy point, were used to reflect the differences in efficacy among the five drugs. Finally, 50 reports (involving 43,443 participants) were included. After deducting the placebo effects, the maximal efficacies (95% CI) of orlistat (120 mg), lorcaserin, naltrexone-bupropion, phentermine-topiramate (PT, 7.5/46 mg) and liraglutide were -2.94 (-5.82, -1.27), -3.06 (-4.39, -1.71), -6.15 (-9.78, -3.25), -7.45 (-9.76, -3.88) and -5.50 (-10.62, -2.97) kg at weeks 60, 54, 67, 59 and 65 respectively, and their rates of body weight regain were 0.51, 0.48, 0.91, 1.27and 0.43 kg per year respectively. The 1-year dropout rates of orlistat, lorcaserin, naltrexone-bupropion, PT and liraglutide were 29.0, 40.9, 49.1, 34.9 and 24.3% respectively. In addition, a significant dose-effect correlation was observed for orlistat and PT. This study provides valid quantitative information for medication guidelines.