Directional massless Dirac fermions in a layered van der Waals material with one-dimensional long-range order

One or a few layers of van der Waals (vdW) materials are promising for applications in nanoscale electronics. Established properties include high mobility in graphene, a large direct gap in monolayer MoS₂, the quantum spin Hall effect in monolayer WTe₂ and so on. These exciting properties arise from electron quantum confinement in the two-dimensional limit. Here, we use angle-resolved photoemission spectroscopy to reveal directional massless Dirac fermions due to one-dimensional confinement of carriers in the layered vdW material NbSi_0.45Te₂. The one-dimensional directional massless Dirac fermions are protected by non-symmorphic symmetry, and emerge from a stripe-like structural modulation with long-range translational symmetry only along the stripe direction as we show using scanning tunnelling microscopy. Our work not only provides a playground for investigating further the properties of directional massless Dirac fermions, but also introduces a unique component with one-dimensional long-range order for engineering nano-electronic devices based on heterostructures of vdW materials.

Isolation and characterization of Salmonella in pork samples collected from retail and wholesale markets in each season from 2016 to 2018 in Wuhan, China

AIMS

To investigate the prevalence and characteristics of Salmonella in pork on sale in Wuhan, Central China.

METHODS AND RESULTS

A total of 4744 pork samples were collected from retail or wholesale markets in each season from 2016 to 2018. The samples showed an overall Salmonella prevalence of 19·54% (927/4744), among which the samples collected in 2017 (21·67%, 428/1975) possessed a significantly higher prevalence than those collected in 2016 (18·61%, 209/1123) (P = 0·047) or 2018 (17·51%, 290/1656) (P = 0·002), and the samples collected in winter showed the lowest prevalence (15·86%, 177/1116). The Salmonella prevalence was significantly higher among samples from retail markets (25·68%, 283/1102) than wholesale markets (17·68%, 644/3642) (P = 0·000). Antimicrobial resistance of 922 Salmonella strains was tested by determining the minimal inhibitory concentrations using a broth microdilution method. The strains revealed that 98·92% (912/922) were resistant to at least one of the antimicrobial agents, and 80·04% (738/922) were resistant to three or more antimicrobials (MDR). Resistance to sulfamethoxazole/trimethoprim (89·91%), tetracycline (87·20%) and ampicillin (71·69%) was predominant. The proportion of MDR strains in 2017 (93·62%, 396/423) was significantly higher than that in 2016 (63·16%, 132/209) (P = 0·000) or 2018 (69·66%, 202/290) (P = 0·000). No significant difference was observed in the proportions of MDR strains between wholesale markets (76·07%, 213/280) and retail markets (80·53%, 517/642) (P = 0·075). Multi-locus sequence typing for 554 of the isolates revealed 20 different sequence types (STs), among which ST40 (38·27%, 212/554), ST34 (18·41%, 102/554) and ST469 (14·46%, 79/554) were dominant.

CONCLUSIONS

A high risk of Salmonella prevalence and antimicrobial resistance was observed in pork in Wuhan. The risk varies between different sampling years, seasons and market types.

SIGNIFICANCE AND IMPACT OF THE STUDY

Providing baseline data on Salmonella contamination in pork on sale in Central China.

First Observation of the Directed Flow of D^{0} and D^{0}[over ¯] in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

We report the first measurement of rapidity-odd directed flow (v_{1}) for D^{0} and D^{0}[over ¯] mesons at midrapidity (|y|<0.8) in Au+Au collisions at sqrt[s_{NN}]=200  GeV using the STAR detector at the Relativistic Heavy Ion Collider. In 10-80% Au+Au collisions, the slope of the v_{1} rapidity dependence (dv_{1}/dy), averaged over D^{0} and D^{0}[over ¯] mesons, is -0.080±0.017(stat)±0.016(syst) for transverse momentum p_{T} above 1.5  GeV/c. The absolute value of D^{0} meson dv_{1}/dy is about 25 times larger than that for charged kaons, with 3.4σ significance. These data give a unique insight into the initial tilt of the produced matter, and offer constraints on the geometric and transport parameters of the hot QCD medium created in relativistic heavy-ion collisions.

Polarization of Λ (Λ[over ¯]) Hyperons along the Beam Direction in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

The Λ (Λ[over ¯]) hyperon polarization along the beam direction has been measured in Au+Au collisions at sqrt[s_{NN}]=200  GeV, for the first time in heavy-ion collisions. The polarization dependence on the hyperons' emission angle relative to the elliptic flow plane exhibits a second harmonic sine modulation, indicating a quadrupole pattern of the vorticity component along the beam direction, expected due to elliptic flow. The polarization is found to increase in more peripheral collisions, and shows no strong transverse momentum (p_{T}) dependence at p_{T} greater than 1  GeV/c. The magnitude of the signal is about 5 times smaller than those predicted by hydrodynamic and multiphase transport models; the observed phase of the emission angle dependence is also opposite to these model predictions. In contrast, the kinematic vorticity calculations in the blast-wave model tuned to reproduce particle spectra, elliptic flow, and the azimuthal dependence of the Gaussian source radii measured with the Hanbury Brown-Twiss intensity interferometry technique reproduce well the modulation phase measured in the data and capture the centrality and transverse momentum dependence of the polarization signal.

Observation of Excess J/ψ Yield at Very Low Transverse Momenta in Au+Au Collisions at sqrt[s_{NN}]=200 GeV and U+U Collisions at sqrt[s_{NN}]=193 GeV

We report on the first measurements of J/ψ production at very low transverse momentum (p_{T}<0.2  GeV/c) in hadronic Au+Au collisions at sqrt[s_{NN}]=200  GeV and U+U collisions at sqrt[s_{NN}]=193  GeV. Remarkably, the inferred nuclear modification factor of J/ψ at midrapidity in Au+Au (U+U) collisions reaches about 24 (52) for p_{T}<0.05  GeV/c in the 60%-80% collision centrality class. This noteworthy enhancement cannot be explained by hadronic production accompanied by cold and hot medium effects. In addition, the dN/dt distribution of J/ψ for the very low p_{T} range is presented for the first time. The distribution is consistent with that expected from the Au nucleus and shows a hint of interference. Comparison of the measurements to theoretical calculations of coherent production shows that the excess yield can be described reasonably well and reveals a partial disruption of coherent production in semicentral collisions, perhaps due to the violent hadronic interactions. Incorporating theoretical calculations, the results strongly suggest that the dramatic enhancement of J/ψ yield observed at extremely low p_{T} originates from coherent photon-nucleus interactions. In particular, coherently produced J/ψ's in violent hadronic collisions may provide a novel probe of the quark-gluon plasma.

[Targeted therapy for malignant peripheral nerve sheath tumor: translational research and clinical application]

Malignant peripheral nerve sheath tumor (MPNST) is a rare invasive soft tissue sarcoma that originates from peripheral nerve branches and peripheral nerve sheaths. Early radical surgery is an effective treatment for MPNST. Since it is insensitive to radiotherapy and chemotherapy, the disease manifests a rapid progression, poor prognosis and high mortality. In recent years, the translational researches on the driving factors and therapeutic targets of MPNST have been rapidly developed, including the pathways of NF1-Ras, Raf-MEK-ERK, PI3K-AKT-mTOR, Wnt signaling, and abnormal expressions of apoptotic proteins, the general loss of polycomb repressive complex 2 (PRC2), upregulation of the HDAC family, abnormal expressions of receptor tyrosine kinases, expressions of programmed cell death ligand (PD-L1), aurora kinase and various microRNAs.This review summarizes the current translational researches on potential therapeutic targets of MPNST, and the clinical trials which provide helpful information for MPNST targeted therapy.

Benign esophageal schwannoma: A case report and review of literature

Esophageal schwannoma was extremely rare and difficult to differentiate from other submucosal tumors. We present a case of a 55-year-old woman who suffered from dysphagia and retrosternal pain for a month. Endoscopic ultrasonography revealed a submucosal tumor, located 23-25cm from the incisors arising from the esophagus. The patient underwent subtotal esophagectomy. The histopathological finding confirmed the diagnosis of esophageal schwannoma. Her postoperative course was uneventful and free of recurrence 2 years after the operation.

Crystal Structure of the PX Domain of SNX27

SNX27 is a component of the retromer complex essential for the recycling of transmembrane receptors. SNX27 contains the N-terminal Phox (PX) domain that binds inositol 1,3-diphosphate (Ins(1,3)P₂) and is important for the SNX27 localization. Here, we determined the crystal structure of human SNX27 PX domain by X-ray crystallography. We found that the sulfate ion is located in the positively charged lipid-binding pocket of the PX domain, which mimics the phospholipid recognition. In addition, we modelled the SNX27-PX-Ins(1,3)P₂ complex to better understand the mechanism of Ins(1,3)P₂ recognition by the PX domain of SNX27.

Impaired skeletal muscle mitochondrial pyruvate uptake rewires glucose metabolism to drive whole-body leanness

Metabolic cycles are a fundamental element of cellular and organismal function. Among the most critical in higher organisms is the Cori Cycle, the systemic cycling between lactate and glucose. Here, skeletal muscle-specific Mitochondrial Pyruvate Carrier (MPC) deletion in mice diverted pyruvate into circulating lactate. This switch disinhibited muscle fatty acid oxidation and drove Cori Cycling that contributed to increased energy expenditure. Loss of muscle MPC activity led to strikingly decreased adiposity with complete muscle mass and strength retention. Notably, despite decreasing muscle glucose oxidation, muscle MPC disruption increased muscle glucose uptake and whole-body insulin sensitivity. Furthermore, chronic and acute muscle MPC deletion accelerated fat mass loss on a normal diet after high fat diet-induced obesity. Our results illuminate the role of the skeletal muscle MPC as a whole-body carbon flux control point. They highlight the potential utility of modulating muscle pyruvate utilization to ameliorate obesity and type 2 diabetes.

Charge Transfer and Built-in Electric Fields between a Crystalline Oxide and Silicon

We report charge transfer and built-in electric fields across the epitaxial SrNb_{x}Ti_{1-x}O_{3-δ}/Si(001) interface. Electrical transport measurements indicate the formation of a hole gas in the Si and the presence of built-in fields. Hard x-ray photoelectron measurements reveal pronounced asymmetries in core-level spectra that arise from these built-in fields. Theoretical analysis of core-level spectra enables built-in fields and the resulting band bending to be spatially mapped across the heterojunction. The demonstration of tunable charge transfer, built-in fields, and the spatial mapping of the latter, lays the groundwork for the development of electrically coupled, functional heterojunctions.

Relationship between serum homocysteine and different menopausal stage

Objective: This study aimed to investigate the serum level of homocysteine in menopausal women and to explore the association between menopausal status, blood lipids, and homocysteine concentrations.Methods: The study recruited females aged 40-60 years who were not receiving menopausal hormone therapy. The demographic characteristics and menopausal status of the women were collected in the form of questionnaires. The study analyzed the association between hyperhomocysteinemia and variables using binary logistic stepwise regression.Results: Among 366 enrolled subjects, menopausal status was divided into four stages: premenopause stage (n = 135), menopausal transition stage (n = 91), early postmenopause stage (n = 87), and late postmenopause stage (n = 53). The proportion of hyperhomocysteinemia in the premenopausal stage, menopausal transition stage, and postmenopausal stage was 43%, 26.4%, and 45%, respectively (χ² = 8.999, p = 0.011). The mean concentration of homocysteine was 9.75 µmol/l. The level of homocysteine was higher in the postmenopause stage than in the other stages (p = 0.043), and the difference between postmenopause and menopausal transition was statistically significant (p < 0.01). In the binary logic analysis, menopausal transition compared with postmenopause (odds ratio = 2.027, 95% confidence interval = 1.117-3.679, p = 0.005).Conclusions: Serum homocysteine levels are associated with menopausal status. Homocysteine concentrations were progressively higher across menopausal stages. The transformation in the female body across the menopause transition stages may cause elevations in the homocysteine level in postmenopausal women.

Omental herniation through the diaphragmatic defect: Two cases mimicking mediastinal lipomas

Omental herniation through a diaphragmatic defect without involvement of the stomach is rare and has often been misdiagnosed as mediastinal lipoma. We herein report two cases of intrathoracic omental herniation through adiaphragmatic defect in patients that were misdiagnosed as a mediastinal lipoma at presentation. They both underwent successful laparoscopic diaphragmatic hernia repairs with full resolution of their symptoms. Doctors should pay attention to the differential diagnosis between diaphragmatic hernia and mediastinal lipoma when a fatty mass is found in the mediastinum at the magnetic resonance imaging (MRI) or computed tomography (CT) scan.

[The association between Cathepsin S and pulmonary function and CT phenotypes in patients with chronic obstructive pulmonary disease]

Objective: To explore the value of cathepsin S in the bronchoalveolar lavage fluid (BALF) of patients with chronic obstructive pulmonary disease (COPD) in the evaluation of pulmonary function and CT phenotypes. Method: From April 2014 to April 2017, 46 patients with stable COPD were enrolled, and 29 healthy volunteers served as the control group. The patients were divided into 4 subgroups: GOLD Ⅰ(n=12), GOLD Ⅱ(n=6), GOLD Ⅲ(n=14), GOLD Ⅳ(n=14). The levels of cathepsin S and IFN-γ in BALF were determined by enzyme-linked immunosorbent assay (ELISA). The percentage ratio of low attenuation area to total lung area (LAA%), two times the ratio of airway wall thickness to outer diameter(2T/D), and the ratio of wall area to total cross-sectional area (WA) were measured by HRCT. Results: There were significant differences in the levels of cathepsin S in BALF between the groups (F=6.639, P=0.000). BALF cathepsin S levels were as follows: GOLD Ⅳ grou P>GOLD Ⅲ grou P>GOLD Ⅱ grou P>GOLD group Ⅰ >healthy control group (P value were all<0.05); LAA grade 3>LAA grade 2>LAA grade 1>LAA grade 0 (P value were all<0.05). Correlation analysis showed that BALF cathepsin S levels were correlated negatively with FEV(1)/FVC, FEV(1)% predicted, and DLCO% (r value was -0.065、-0.576、-0.392, respectively, P value were all<0.05), and but positively with RV/TLC%, LAA%, 2T/D, WA and IFN-γ(r value was 0.695, 0.497, 0.142, 0.309, 0.148, respectively, P value were all<0.05). Conclusion: The levels of cathepsin S were associated with the degree of airflow limitation and emphysema phenotype in COPD.

Azimuthal Harmonics in Small and Large Collision Systems at RHIC Top Energies

The first (v_{1}^{fluc}), second (v_{2}), and third (v_{3}) harmonic coefficients of the azimuthal particle distribution at midrapidity are extracted for charged hadrons and studied as a function of transverse momentum (p_{T}) and mean charged particle multiplicity density ⟨N_{ch}⟩ in U+U (sqrt[s_{NN}]=193  GeV), Au+Au, Cu+Au, Cu+Cu, d+Au, and p+Au collisions at sqrt[s_{NN}]=200  GeV with the STAR detector. For the same ⟨N_{ch}⟩, the v_{1}^{fluc} and v_{3} coefficients are observed to be independent of the collision system, while v_{2} exhibits such a scaling only when normalized by the initial-state eccentricity (ϵ_{2}). The data also show that ln(v_{2}/ϵ_{2}) scales linearly with ⟨N_{ch}⟩^{-1/3}. These measurements provide insight into initial-geometry fluctuations and the role of viscous hydrodynamic attenuation on v_{n} from small to large collision systems.

Ambulatory activity interacts with common risk factors for osteoarthritis to modify increases in MRI-detected osteophytes

OBJECTIVE

To investigate the longitudinal association between objectively measured ambulatory activity (AA) and knee MRI-detected osteophytes (OPs), and to test whether this relationship was modified by common risk factors for OA including sex, obesity, disease severity and knee injury history.

METHODS

408 community-dwelling adults aged 51-81 years were assessed at baseline and 2.7 years. T1-weighted fat-suppressed MRI was used to evaluate knee OPs at both time points. AA was assessed at baseline by pedometers and categorized as: less active (≤7499 steps per day), moderately active (7500-9999 steps per day) and highly active (≥10,000 steps per day).

RESULTS

Statistically significant interactions were detected between knee OA risk factors and AA on increases in MRI-detected OPs (all P < 0.05). In stratified analyses, being moderately active, compared to being less active, was protective against an increase in MRI-detected OPs (score change of ≥1) in females (relative risk (RR) = 0.42, 95%CI, 0.25-0.70, P < 0.01), those who were obese (RR = 0.50, 95%CI, 0.30-0.83, P < 0.01), those with radiographic OA (ROA) (RR = 0.68, 95%CI, 0.47-0.97, P = 0.02) and those with a history of knee injury (RR = 0.27, 95%CI, 0.08-0.88, P = 0.02) in almost every knee compartment, after adjustment for confounders. No statistically significant associations were found in males, non-obese, non-ROA or non-injury groups.

CONCLUSIONS

Being moderately active is protective against an increase in MRI-detected OPs in females, those with ROA, those who are obese and those with a history of knee injury. These findings suggest that being moderately active is beneficial for individuals who are at higher risk of knee OA.

Inhibition of miR-214-5p attenuates inflammatory chemotaxis and nerve regeneration obstruction after spinal cord injury in rats

OBJECTIVE

To investigate the effect of miR-214-5p on spinal cord injury (SCI) and the possible mechanism in pathophysiological relevance, and to evaluate the therapeutic efficacy of the corresponding inhibitor.

MATERIALS AND METHODS

The SCI model was successfully established in 6-week-old rats. The levels of locomotor function recovery in rats of miR-214-5p inhibitor group and SCI group were detected one month later by Basso-Beattie-Bresnahan (BBB) locomotor rating scale, Western blotting, quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. Rat microglia cells were cultured in vitro. Furthermore, the effect of miR-214-5p and its inhibitor on inflammatory microglia was explored.

RESULTS

Compared with SCI group, rats in miR-214-5p inhibitor group showed a significant retardation of inflammatory diffusion in terms of reduced production of inflammatory factors and chemokines in vivo. MiR-214-5p inhibitor markedly attenuated antioxidant stress, inhibited apoptosis, and increased nerve fibers repair. Compared with lipopolysaccharide (LPS) group, tumor necrosis factor alpha (TNF-α) and interleukin 1 (IL-1) decreased significantly in microglia treated with miR-214-5p inhibitor in vitro. Furthermore, inhibition of miR-214-5p remarkably promoted locomotor function recovery in rats.

CONCLUSIONS

MiR-214-5p inhibitor retarded inflammatory diffusion by inhibiting inflammatory factors and chemokines after SCI. In addition, this might relieve nerve structure destruction, resist oxidative stress and inhibit apoptosis, eventually promoting function recovery.

Abstract PD7-06: Molecular subtypes of invasive lobular breast cancer in the I-SPY2 TRIAL

Background: Invasive lobular carcinoma (ILC) of the breast has distinct histological and molecular variations compared to invasive ductal carcinoma (IDC), including absence of the adhesion protein E-cadherin. Recently, molecular subtypes within ILC have been described, with an analysis from The Cancer Genome Atlas (Ciriello et al) identifying three distinct groups within ILC based on gene expression—reactive-like, immune-related, and proliferative. In this study, we applied this 60-gene classifier to a locally advanced cohort of ILC and mixed ILC/IDC cases from patients screening for the I-SPY 2 neoadjuvant chemotherapy trial.

Methods: The I-SPY 2 TRIAL is open to women with more locally advanced, clinically/molecularly (as assessed by MammaPrint) high risk breast cancer. HR+HER2- MammaPrint Low risk patients ineligible for I-SPY 2 randomization are invited to join a MP Low risk registry. 131 ILC and mixed ILC/IDC tumors from these cohorts (I-SPY 2: n=80; low risk registry: n=51) with pre-treatment Agilent microarrays were available for analysis. We used the Classification to Nearest Centroid technique to assign TCGA subtype to our cohort. We assessed association between TCGA subtype, clinical covariates and response to therapy using a chi-square test. We also evaluated the Euclidean distance between each sample and the three subtype centroids. In an exploratory analysis, we used consensus clustering based on the 1000 most varying genes within the HR+HER2- I-SPY ILC cases to generate new unsupervised groupings, and assessed the concordance with the TCGA reactive-like, immune-related and proliferative subtype assignments.

Results: Of the 131 patients included, most (79%) were HR+HER2-, 11% were HR+HER2+, 2% were HR-HER2+ and 8% were HR-HER2- for a total of 10% HR-. 66 were pure ILC, while 65 were mixed ILC/IDC. Upon applying the TCGA 60-gene classifier, the distribution of ILC subtypes was as follows: 33 (25%) were classified as reactive-like, 50 (38%) were immune-related, and 48 (37%) were proliferative. 64% of triple negative cases were reactive-like; while the HR+HER2- and HER2+ cases were more likely to be in the proliferative or immune-related subtype (p=0.037). Among the 80 I-SPY 2 cases, the overall pathologic complete response rate was low (16%) but equivalent to the overall HR+HER2- I-SPY2 population (16%). This did not differ across the groups defined by the TCGA ILC subtypes (p=0.79).

Interestingly, a subset of cases assigned as reactive-like and immune-related were of similar distance to the proliferative subtype centroid as patients assigned to the proliferative subtype. When we used consensus clustering to identify new subsets within our locally advanced ILC cohort, our unsupervised groupings had only 32% concordance with the TCGA ILC subtype assignments.

Conclusion: The low concordance between our consensus cluster groupings and the TCGA subtype groupings may reflect underlying differences within a locally advanced cohort of ILC cases, like I-SPY, that may not be captured in the 60-gene classifier developed from the overall lower stage TCGA cohort. These findings suggest that considerable molecular heterogeneity exists in lobular cancers, which merits further investigation.

Citation Format: Zhu Z, Yau C, Chien AJ, Haddad T, Esserman LJ, van't Veer L, Mukhtar RA, I-SPY2 Consortium. Molecular subtypes of invasive lobular breast cancer in the I-SPY2 TRIAL [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 PD7-06.

Abstract P3-10-02: Identifying breast cancer molecular phenotypes to predict response in a modern treatment landscape: Lessons from ˜1000 patients across 10 arms of the I-SPY 2 TRIAL

Background: The explosion in new treatment options targeting immune checkpoints, HER signaling, DNA repair deficiency, AKT, and other pathways calls for updated breast cancer subtypes beyond HR and HER2 status to predict which patients will respond to which treatments. Here we leverage the I-SPY 2 TRIAL biomarker program over the past 8 years across 10 treatment arms to elucidate a minimal set of biomarkers that may improve response prediction in a modern treatment context, and to investigate which new patient phenotypes are identified by these response-predictive biomarkers.

Methods: 986 patients were considered in this analysis. Treatments included paclitaxel alone (or with trastuzumab (H) in HER2+) or combined with investigational agents: veliparib/carboplatin (VC); neratinib; MK2206; ganitumab; ganetespib; AMG386; TDM1/pertuzumab (P); H/P; and pembrolizumab (Pembro). 24 prospectively defined, mechanism-of-action and pathway-based expression and phospho-protein signatures/biomarkers assayed from pre-treatment biopsies were previously found to be predictive in a particular agent/arm in pre-specified analysis. Here we evaluate these biomarkers in all patients. We assessed association between each biomarker and response in the population as a whole and within each arm and HR/HER2 subtype using a logistic model. To identify optimal dichotomizing thresholds for select biomarkers, 2-fold cross-validation was repeated 500 times. Our analysis is exploratory and does not adjust for multiplicities.

Results: Our initial set of 24 predictive biomarkers reflects DNA repair deficiency (n=2), immune activation (n=7), ER signaling (n=2), HER2 signaling (n=4), proliferation (n=2), phospho-activation of AKT/mTOR (n=2), and ANG/TIE2 (n=1) pathways, among others. Biomarkers reflecting similar biology are correlated and cluster together. We make use of this correlation structure to reduce the dimensionality of the biomarker set to five predictive signals: proliferation, DNA repair deficiency (DRD), immune-engaged (Immune+), luminal/ER (lum), and HER2-activated. These biomarkers, when dichotomized, identify patient groups with differential predicted sensitivities to I-SPY 2 agents and are present at different proportions within receptor subtypes. For instance, in the HER2- subset, Immune+/DRD+ patients are predicted sensitive to both VC and Pembro, and account for 39% of TN, but only 12% of HR+HER2-. On the other end of the spectrum, only 17% of TN are Immune-/DRD-, compared to the majority (56%) of HR+HER2-. There are also subsets of patients positive for only one marker. For the HER2+ subset, 67% are HER2-activated+, and 25% lum+; of these HER2-activated+ patients are more likely to be Immune+ (44%), vs 23% in lum+. HER2-activated+/Immune+ patients have higher predicted sensitivity to HER2-targeted agents than lum+ or Immune- patients.

In all, these molecular phenotypes predict sensitivity to one or more I-SPY 2 investigational agents for 75% of the ˜ 1000 patients.

Conclusion: Molecular phenotypes reflecting proliferation, immune engagement, HER2-activation, luminal/ER-signaling, and DNA repair deficiency may provide a roadmap to guide treatment prioritization for emerging therapeutics.

Citation Format: Wolf DM, Yau C, Wulfkuhle J, Petricoin E, Campbell M, Brown-Swigart L, Hirst G, Asare S, Zhu Z, Lee EP, Delson A, Pohlmann P, I-SPY 2 TRIAL Consortium, Hylton N, Liu MC, Symmans F, DeMichele A, Yee D, Berry D, Esserman L, van 't Veer L. Identifying breast cancer molecular phenotypes to predict response in a modern treatment landscape: Lessons from ˜1000 patients across 10 arms of the I-SPY 2 TRIAL [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 P3-10-02.

Liver Derived FGF21 Maintains Core Body Temperature During Acute Cold Exposure

Fibroblast Growth Factor 21 (FGF21) elicits an array of metabolic effects. However, the physiological role of FGF21 during thermal challenges is not clear. In this study, we assessed the tissue source of FGF21 and its site of action to regulate core body temperature in response to cold. Using mice lacking FGF21 specifically in the liver (FGF21 LivKO) or adipose tissues (FGF21 AdipoKO), we performed a series of cold exposure studies to examine the tissue specific induction of FGF21 in response to cold. We also examined the physiological site of FGF21 action during cold exposure by impairing FGF21 signaling to adipose tissues or the central nervous system (CNS) using genetic ablation of the FGF21 co-receptor β-klotho in adipose tissues (KLB AdipoKO) or pharmacological blockage of FGF21 signaling. We found that only liver-derived FGF21 enters circulation during acute cold exposure and is critical for thermoregulation. While FGF21 signaling directly to adipose tissues during cold is dispensable for thermoregulation, central FGF21 signaling is necessary for maximal sympathetic drive to brown adipose tissue to maintain thermoregulation during cold. These data demonstrate a previously unrecognized role for FGF21 in the maintenance of body temperature in response to cold.

Associations between serum S100A8/S100A9 and knee symptoms, joint structures and cartilage enzymes in patients with knee osteoarthritis

OBJECTIVE

Animal studies suggest that S100A8/S100A9 may be involved in the pathogenesis of osteoarthritis (OA); however, there has been no clinical study examining the associations between serum S100A8/S100A9 and knee symptoms, joint structures and cartilage degradation enzymes in knee OA patients so far. Therefore, this study was designed to investigate the cross-sectional associations between serum levels of S100A8/S100A9 and the outcomes in patients with knee OA.

DESIGN

A total of 141 subjects with clinical knee OA were included. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was used to assess joint symptoms. Magnetic resonance imaging (MRI) was used to measure knee structural abnormalities including cartilage defects. Knee radiography was used to assess joint space narrowing (JSN), osteophytes and the radiographic severity of OA. Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of S100A8/S100A9, matrix metalloproteinase (MMP)-3, MMP10 and MMP13.

RESULTS

In multivariable analyses, serum S100A8/S100A9 were positively associated with total WOMAC score (β: 0.111 per 10 ng/ml, P = 0.021), WOMAC weight-bearing pain (β: 0.015 per 10 ng/ml, P = 0.043) and WOMAC physical dysfunction (β: 0.091 per 10 ng/ml, P = 0.010), and had positive associations with total cartilage defects and cartilage defects at lateral femoral, lateral tibial and medial femoral sites (ORs: 1.006-1.008 per 10 ng/ml, all P < 0.05) and serum levels of MMP3 (β: 0.002 per 10 ng/ml, P = 0.032) in patients with clinical knee OA.

CONCLUSIONS

Serum levels of S100A8/S100A9 were positively associated with increased knee symptoms, cartilage defects and serum cartilage degradation enzymes in patients with knee OA, suggesting that S100A8/S100A9 may have a role to play in knee OA. Future longitudinal studies are required to confirm these findings.

Determining the motivations of family members to undertake cardiopulmonary resuscitation training through grounded theory

AIMS

To explore the motivation of family members of patients at high risk for sudden cardiac death for undertaking cardiopulmonary resuscitation (CPR) training.

BACKGROUND

Home cardiac arrests are associated with poor outcomes because few family members learn CPR. Little is known about factors that motivate family members to participate in CPR training.

DESIGN

We used grounded theory to establish a theoretical framework to explore the motivational factors for learning CPR among family members.

METHODS

Twelve participant observations and 42 semi-structured interviews with family members of different behaviours towards CPR training were conducted from December 2013 - November 2016. Data were analysed using constant-comparisons, situational analysis, and encoding.

FINDINGS

A motivation-behaviour theoretical framework for learning CPR was constructed. We identified meeting inner needs as the core category to demonstrate motivation. Security motivation and responsibility motivation emerged as main categories, which demonstrate that seeking a sense of security and shouldering family responsibility were important considerations for family members to learn CPR. These two motivations produced high-engagement behaviours of family members to learn CPR.

CONCLUSIONS

The motivations we identified-deriving from a sense of security and family responsibility-are the main reasons family members would learn CPR and, therefore, should be understood by medical professionals. Understanding these motivations may help in the formulation of customized CPR training that further meets the needs of family members. For example, motivational interventions that are integrated with a family-based CPR course can be designed to improve the participation of family members and the sustainability of the course.

Association of serum galectin-3 with risks of death and vascular events in acute ischaemic stroke patients: the role of hyperglycemia

BACKGROUND AND PURPOSE

Whether the association between galectin-3 and stroke outcome is modified by fasting plasma glucose (FPG) is unknown. The aim was to evaluate the prognostic effect of galectin-3 amongst ischaemic stroke patients stratified by FPG.

METHODS

In all, 3082 ischaemic stroke patients were included in this study and serum galectin-3 was tested at baseline. The primary outcome was a composite outcome of death and vascular events, and secondary outcomes were death, stroke recurrence and vascular events within 1 year after stroke.

RESULTS

Increased galectin-3 was significantly associated with the primary outcome, stroke recurrence and vascular events in the patients with hyperglycemia but not in those with normoglycemia (P for interaction < 0.05 for all). The multivariate-adjusted hazard ratios (95% confidence intervals) were 1.72 (1.05-2.84), 2.64 (1.14-6.12) and 2.68 (1.33-5.38) for the primary outcome, stroke recurrence and vascular events, respectively. A linear association between galectin-3 and the primary outcome was observed in hyperglycemic patients (P for linearity = 0.007).

CONCLUSION

Increased galectin-3 was associated with the primary outcome, stroke recurrence and vascular events within 1 year after stroke in the patients with hyperglycemia, suggesting that galectin-3 may be an important prognostic factor for ischaemic stroke patients with hyperglycemia.

A novel method for assessing proximal tibiofibular joint on MR images in patients with knee osteoarthritis

OBJECTIVES

To validate a method to measure the morphological parameters of the proximal tibiofibular joint (PTFJ) in patients with knee osteoarthritis (OA).

METHODS

408 participants were examined in this cross-sectional subject-based study. We calculated the fibular contacting area of PTFJ (S) and its projection areas onto the horizontal plane (load-bearing area, Sτ), the sagittal plane (lateral stress-bolstering area, Sφ) and the coronal plane (posterior stress-bolstering area, Sυ). Joint space narrowing (JSN) and osteophyte was measured using radiographs. Cartilage defects, bone marrow lesions (BMLs) and cartilage volume were evaluated using magnetic resonance imaging (MRI).

RESULTS

The average PTFJ fibular contacting area was 2.4 cm² (SD, ±0.7 cm²). Intra-observer and inter-observer reliabilities of measures of PTFJ morphological parameters were excellent (≥0.90). S, Sτ and Sφ were significantly associated with JSN in the medial tibiofemoral compartment (PR: 1.40, 95% CI 1.10-1.78; PR: 1.65, 95% CI 1.25-2.18 and PR: 0.53, 95% CI 0.29-0.97, respectively). There was a significantly positive association between S, Sτ and medial and/or femoral tibial cartilage defects. S, Sτ and Sυ were significantly and positively associated with medial and/or femoral tibial BMLs (PR: 1.36, 95% CI 1.12-1.64; PR: 1.47, 95% CI 1.17-1.83; and PR: 1.39, 95% CI 1.06-1.82, respectively) after adjustment. S and Sτ were significantly and negatively associated with medial tibial cartilage volume.

CONCLUSIONS

This novel method to assess the morphological parameters of PTFJ in MRI is reproducible. These parameters are associated with knee radiographic and MRI-based OA-related structural abnormalities, suggesting clinical construct validity. Its predictive validity needs to be examined in future longitudinal studies.

[The efficacy of sublingual specific immunotherapy in children with allergic rhinitis]

Objective:To investigate the efficacy of single-allergen sublingual immunotherapy (SLIT) in children with allergic rhinitis and the potential relationship between sensitization status and efficacy and analyze the possible relationships between sensitized state and clinical efficacy. Method:One hundred and thirty children, aged 4-15 years old, with mites-induced respiratory allergic diseases had been arranged into the treatment group (n=70) or control group (n=50) and received SLIT with standardized dermatophagoides farinae extracts and pharmacotherapy for 1 year. Rhinitis and asthma symptoms and medications, visual analogue scale (VAS), skin prick test (SPT) and peak expiratory flows (PEF) were evaluated. After treatment, patients in the poly-sensitized group who completed the study had been analyzed as subgroup 1 (n=33) and subgroup 2 (n=37) according to the number of coexist allergens. Result:The global clinical parameters had been significantly improved after treatment. The treatment and control group rhinitis symptom score, symptomatic medication score and VAS scores were significantly reduced after 52 weeks treatment (all P<0.05). SLIT group dust mite grade skin reactions decreased after 52 weeks treatment (P<0.05). Dust mite skin reactions grade was greater than before treatment in the control group (P>0.05). Between the two groups, SLIT group rhinitis symptom score at 24 weeks, 36 weeks, 52 weeks were lower than the control group, the difference was statistically significant (P<0.05). SLIT group symptomatic medication score and VAS scores at 36 weeks and 52 weeks compared with the control group, the difference was statistically significant (P<0.05). Dust mite SLIT group grade skin reactions grade was lower than the control group at 52 weeks, the difference was statistically significant (P<0.05). In addition to the 36 weeks poly-sensitized group symptoms of allergic rhinitis score was lower than mono-sensitized group (P＜0.05) and at 24 weeks poly-sensitized group VAS score was lower than single allergy group (P<0.05), the comparison between subgroup 1 and subgroup 2 indicated that, there was no significant difference in symptoms scores, SPT, PEF and VAS at each scheduled follow-up visit. Conclusion:This study shows that SLIT can significantly reduce rhinitis symptoms and drug use, and improve the children with allergies. An equivalent efficacy of single-allergen SLIT is found in poly-sensitized and mono-sensitized children. The number of coexist positive allergens has a limited impact on the efficacy from a long-term perspective.

Predicted final spinal height in patients with adolescent idiopathic scoliosis can be achieved by surgery regardless of maturity status

AIMS

The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status.

PATIENTS AND METHODS

The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOS_f) and height of pelvis at follow-up (HOP_f) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOP_f. One-way analysis of variance (ANOVA) was performed for statistical analysis.

RESULTS

Of the 152 patients, there were 32 patients in Group 1, 27 patients in Group 2, 48 patients in Group 3, and 45 patients in Group 4. Significantly greater HOS_f was observed in Group 3 compared with Group 1 (p = 0.03) and in Group 4 compared with Group 2 (p = 0.02), with similar HOP_f (p = 0.75 and p = 0.83, respectively), suggesting that patients who undergo surgery at Risser grade of 0 to 1 have a shorter spinal height at follow-up than those who have surgery at Risser 4 to 5. HOS_f was similar to pHOS in both Group 1 and Group 2 (p = 0.62 and p = 0.45, respectively), indicating that undergoing surgery at Risser 0 to 1 does not necessarily affect final spinal height.

CONCLUSION

This study shows that fusion surgery at Risser 0 may result in growth restriction unlike fusion surgery at Risser 3 to 4. Despite such growth restriction, AIS patients could reach their predicted or 'normal' spinal height after surgery regardless of baseline maturity status due to the longer baseline spinal length in AIS patients and the remaining growth potential at the non-fusion levels. Cite this article: Bone Joint J 2018;100-B:1372-6.