Tenofovir disoproxil fumarate vs adefovir dipivoxil in Chinese patients with chronic hepatitis B after 48 weeks: a randomized controlled trial

Tenofovir disoproxil fumarate (TDF) has demonstrated long-term efficacy and a high barrier to resistance in multiple chronic hepatitis B (CHB) populations outside of China. This study aimed to evaluate the efficacy and safety of TDF compared with adefovir dipivoxil (ADV) in Chinese patients with CHB during 48 weeks of treatment (ClinicalTrial.gov number, NCT01300234). A Phase 3, multicentred, randomized, double-blind, controlled trial compared the efficacy and safety of TDF with ADV in Chinese patients with CHB. The primary endpoint was the proportion of patients with HBV DNA <400 copies/mL in each treatment group at Week 48, using an unpooled Z-test for superiority. Secondary endpoints included viral suppression, serologic response, histological improvement, normalization of alanine aminotransferase (ALT) levels and the emergence of resistance mutations. A total of 509 patients, 202 hepatitis B e antigen (HBeAg)-positive and 307 HBeAg-negative, with HBV DNA ≥10(5) copies/mL received either TDF 300 mg od or ADV 10 mg od. At Week 48, TDF demonstrated superior viral suppression compared with ADV in both HBeAg-positive (76.7% vs 18.2%, P < 0.0001) and HBeAg-negative (96.8% vs 71.2%, P < 0.0001) patients. The majority of patients in both treatment arms achieved ALT normalization (>85%). No resistance to TDF was observed. The frequency of adverse events was comparable between treatment arms (TDF 3.9% vs ADV 4.8%). In this double-blind, randomized, clinical trial, TDF demonstrated superiority over ADV with respect to viral suppression in Chinese patients with CHB at 48 weeks of treatment and without the development of resistance.

Prospective controlled study of the safety and oncological outcomes of ELAPE procure with definitive anatomic landmarks versus conventional APE for lower rectal cancer

BACKGROUND

The use of extra-levator abdominoperineal resection (ELAPE) procedure for lower rectal cancer is controversial. It is unclear whether the ELAPE procedure could improve surgical safety and lead to better oncological outcomes.

METHODS

Sixty-nine lower rectal cancer patients who underwent ELAPE (36 cases) or conventional abdominoperineal resection (APE; 33 cases) between June 2011 and February 2013 were prospectively investigated. Clinicopathological variables including blood loss, intraoperative perforation (IOP) rate, circumferential resection margin (CRM) involvement, lymph node harvest, the postoperative complications, urinary and sexual function, quality of life (QOL), local recurrence rate and survival were recorded and compared.

RESULTS

Blood loss (P = 0.021), perineal wound complication (P = 0.039), IOP rate (P = 0.028), local recurrence (P = 0.034) were significantly less frequent in the ELAPE group. There was greater CRM involvement in the conventional APE group but no statistical difference between the two groups. Urinary function, sexual function and QOL were not significantly different between the two groups. Overall survival and progression-free survival were not significantly different between two groups, even when survival was analyzed according to TNM stage, T stage, N stage, and with or without neoadjuvant chemoradiotherapy. In patients who underwent ELAPE there was no statistical difference in postoperative complications between younger and elderly patients (age ≥60).

CONCLUSIONS

ELAPE procedure with definitive anatomic landmarks demonstrated surgical safety and decreased local recurrence for lower rectal cancer patients including the elderly, but there were no survival improvements in compared to conventional APE procedure.

Differential behavior patterns in cynomolgus monkey Macaca fascicularis in home cage in response to human gaze

BACKGROUND

Non-human primates, when encountering human beings, show wariness and alertness. These behaviors differ when there is direct human gaze vs. when human averts his gaze.

METHODS

We observed cynomolgus monkey in their home cage and studied their behaviors in response to human gaze. Four behaviors were analyzed: opening mouth, staring at observer, agitated activity, and approaching observer.

RESULTS

Three behaviors appeared to be sensitive to human gaze between when the human observer gazed at the monkey and when the human observer looked away. Individual animals also displayed subpatterns of responses to human gaze.

CONCLUSIONS

These results indicate that, even in their home cage, monkeys display a heightened level of awareness when gazed upon by a human observer, suggesting that human gaze may elicit emotional reactions. Further, under the human gaze, distinct behavioral subpatterns were apparent within the monkey cohort in our study, indicative of subgroups within the cohort.

Protein expression and promoter methylation of the candidate biomarker TCF21 in gastric cancer

PURPOSE

Transcription factor 21 (TCF21) has been identified as a candidate tumor suppressor at 6q23-q24 that is epigenetically inactivated in many types of human cancers. This study aimed to determine the expression of TCF21 mRNA and protein in gastric cancer cell lines and tissue specimens and then investigate the prognostic impact of TCF21 expression in gastric cancer and analyze the relationship between TCF21 expression and methylation level.

METHODS

We used real-time PCR and immunohistochemical staining to detect the expression of TCF21 and used methylation-specific-PCR to determine the methylation status of TCF21 in gastric cancer samples and gastric cancer cell lines.

RESULTS

The results showed that TCF21 expression level in gastric cancer samples was significantly lower than in normal adjacent tissue samples. The Kaplan-Meier survival analysis demonstrated that TCF21 was a significant prognosticator of cancer-specific survival (p = 0.001). Furthermore, the methylation level of TCF21 in gastric cancer samples was much higher than the samples in normal adjacent tissue. Treatment with the DNA methyltransferase inhibitor 5-Aza-2'-deoxy-cytidine can upregulate the expression of TCF21 in gastric cancer cells.

CONCLUSIONS

These results suggest that the low expression of TCF21 was an independent prognostic factor for poor survival in patients with gastric cancer. Aberrant methylation was an important reason for the downregulation of TCF21 and may be associated with tumorigenesis in gastric cancer.

Natural CD8+CD122+ T cells are more potent in suppression of allograft rejection than CD4+CD25+ regulatory T cells

Despite extensive studies on CD4+CD25+ regulatory T cells (Tregs), their application in adoptive transfer therapies is still not optimal in immune-competent wild-type (WT) animal models. Therefore, it is compelling to search for more potent Tregs for potential clinical application. Mounting evidence has shown that naturally occurring CD8+CD122+ T cells are also Tregs. However, their suppression in allograft rejection, efficiency in suppression and underlying mechanisms remain unclear. Using a murine allotransplantation model, we reported here that CD8+CD122+ Tregs were actually more potent in suppression of allograft rejection and underwent more rapid homeostatic proliferation than their CD4+CD25+ counterparts. Moreover, they produced more IL-10 and were more potent in suppressing T cell proliferation in vitro. Deficiency in IL-10 in CD4+CD25+ and CD8+CD122+ Tregs resulted in their reduced but equal suppression in vivo and in vitro, suggesting that IL-10 is responsible for more effective suppression by CD8+CD122+ than CD4+CD25+ Tregs. Importantly, transfer of CD8+CD122+ Tregs together with the administration of recombinant IL-15 significantly prolonged allograft survival in WT mice. Thus, for the first time, we demonstrate that naturally arising CD8+CD122+ Tregs not only inhibit allograft rejection but also exert this suppression more potently than their CD4+CD25+ counterparts. This novel finding may have important implications for tolerance induction.

Photodegradation of organic matter in fresh garbage leachate using immobilized nano-sized TiO2 as catalysts

Two immobilized nano-sized TiO2 catalysts, TiO2/activated carbon (TiO2/AC) and TiO2/silica gel (SG) (TiO2/SG), were prepared by the sol-gel method, and their use in the photocatalytic degradation of organic matter in fresh garbage leachate under UV irradiation was investigated. The influences of the catalyst dosage, the initial solution pH, H2O2 addition and the reuse of the catalysts were evaluated. The degradation of organic matter was assessed based on the decrease of the chemical oxygen demand (COD) in the leachate. The results indicated that the degradation of the COD obeyed first-order kinetics in the presence of both photocatalysts. The degradation rate of COD was found to increase with increasing catalyst dosage up to 9 g/L for TiO2/AC and 6 g/L for TiO2/SG, above which the degradation began to attenuate. Furthermore, the degradation rate first increased and then decreased as the solution pH increased from 2 to 14, and the degradation rate increased as the amount of H2O2 increased to 2.93 mM, after which it remained constant. No obvious decrease in the rate of COD degradation was observed during the first four repeated uses of the photocatalysts, indicating that the catalysts could be recovered and reused. Compared with TiO2/AC, TiO2/SG exhibited higher efficiency in photocatalyzing the degradation of COD in garbage leachate.

Cost analysis of adjuvant therapy with XELOX or FOLFOX4 for colon cancer

AIM

XELOX and FOLFOX4 have both been recommended as adjuvant therapy for stage III colon cancer. This study compared the two regimens in terms of monetary costs, assuming equal efficacy of the therapies.

METHOD

A retrospective financial audit was conducted of the medical records of patients treated with XELOX or FOLFOX4. All itemized expenses were classified as direct (chemotherapy, hospitalization, venous access and tests), related to adverse effects due to the adjuvant therapy, or societal (travel and time costs). The cost of supportive care was not included.

RESULTS

XELOX involved less total cost to the patient than FOLFOX4 (a difference of US$2857.68), fewer costs related to adverse effects ($668.97), and less travel ($26.07) and time ($390.93) expenditure per patient.

CONCLUSION

The results indicate that, overall, XELOX is a more affordable option than FOLFOX4 in China.

Mitotic and meiotic behavior of rye chromosomes in wheat - Psathyrostachys huashanica amphiploid x triticale progeny

The dynamics of rye chromosomes during mitosis and meiosis was analyzed in a subset comprising 33 F3 lines from the cross of wheat, Psathyrostachys huashanica amphiploid (AABBDDNsNs) and hexaploid triticale (AABBRR), as visualized by genomic in situ hybridization. The results indicated that 31 of the total lines contained 4-14 rye chromosomes. Twenty-eight combinations had more rye chromosomes than the F1 hybrids, suggesting the occurrence of spontaneous quantitative increment. No P. huashanica chromosomes were detected in all of the combinations tested. Mitotic analysis showed that rye chromosomes progressed normally with the wheat counterparts without loss. However, abnormal meiosis was found in almost all lines. Similar progression between wheat and rye genomes appeared from interphase to metaphase I. It was at anaphase I that many rye univalents lagged behind those of wheat, followed by equational division. This resulted in the formation of chromosomal segments and micronuclei at telophase I or II. Micronuclei could also be generated from the immobilized univalents in the periphery of cells. Synapsis and translocations between wheat and rye genomes, chromosome bridges, and unreduced gametes were detected. Therefore, it is proposed that rye chromosome elimination may involve chromatid lagging, fragmentation and micronucleation, or the immobilization of certain univalents during meiosis instead of mitosis in the relatively advanced generations. This mechanism, together with spontaneous incremental increase of rye chromosome number, permitted the generation of various germplasms for wheat improvement.

Two years efficiency of lamivudine and adefovir dipivoxil combined therapy in chronic hepatitis B patients

BACKGROUND

Lamivudine (LAM) and adefovir (ADV) are widely used in most Asian countries, though monotherapy is associated with the occurrence of resistance.

AIM

To evaluate the efficiency of LAM and ADV combined treatment of chronic hepatitis B patients with compensated cirrhosis.

PATIENTS AND METHODS

206 eligible Chinese patients were randomly assigned in a 1:1 ratio to receive either LAM or ADV for the first 24 weeks. According to virologic response at 24 weeks, the patients either continued to monotherapy or switched to combined therapy for 48 weeks. After 48 weeks, all patients received LAM and ADV combined therapy for 96 weeks.

RESULTS

Serum HBV DNA levels significantly decreased in patients with ADV or LAM monotherapy and continuously reduced after the combined therapy. Serum ALT normalized rate were 88.24% and 81.37% at week 48, and 95.74% and 87.36% at week 96 in ADV and LAM group respectively, comparing to 60.78% and 56.73% in ADV and LAM groups at baseline. The accumulated virological breakthrough rate at week 48 and 96 was significantly higher in LAM group.

CONCLUSIONS

Both combination strategies were resulted in the long term virological, biochemical improvement in Chinese chronic hepatitis B patients with compensated cirrhosis.

Inhibition of hepatitis B virus gene expression by small interfering RNAs targeting cccDNA and X antigen

To test the possible inhibition of hepatitis B virus (HBV) replication and expression by small interfering RNAs (siRNAs) targeting simultaneously covalenthy closed circular DNA (dnacccDNA) and X antigen, corresponding recombinant plasmids were transfected into HepG2.2.15 cells and the levels of cccDNA, HBXAg, HBcAg, and HBeAg were assayed at various times post transfection. As expected, the single siRNAs showed marked inhibitory effects but their combination was even more efficient. These results provide a new insight into the development of a potential anti-HBV strategy of enhancing the efficacy of individual antivirals and overcoming the high mutation rate of HBV.

One Alpha-hydroxycholecalciferol Improves Growth Performance, Tibia Quality, and Meat Color of Broilers Fed Calcium- and Phosphorus-Deficient Diets

An experiment was conducted to evaluate the effects of one alpha-hydroxycholecalciferol (1α-OH D₃) on growth performance, tibia quality, and skin and meat color in broilers fed calcium (Ca)- and phosphorus (P)-deficient corn-soybean meal diets. A total of 288 male Ross broilers, at 21 days of age, were randomly assigned to three treatments with eight cages per treatment. Three levels of 1α-OH D₃ (0, 5, and 10 μg/kg) were added to a basal diet (0.50% Ca, 0.13% non-phytate phosphorus (NPP), and 0.35% total phosphorus (tP)) without vitamin D₃. As a result of this study, the addition of 1α-OH D₃ increased body weight gain (p<0.001), feed intake (p = 0.007), feed efficiency (p<0.001), tibia weight (p = 0.002), length (p<0.001), breaking-strength (p = 0.012), ash (p<0.001), Ca (p<0.001), and P content (p = 0.004). Dietary 1α-OH D₃ enhanced breast meat yellowness (p = 0.015) and the length and weight of the small intestine of the broilers. Moreover, 1α-OH D₃ decreased serum Ca concentration (p = 0.074) and breast meat redness (p = 0.010). These results indicate that the 1α-OH D₃ improves growth, tibia quality, and meat color in broilers fed Ca- and P-deficient corn-soybean meal diets.

Hepatitis B virus suppresses the functional interaction between natural killer cells and plasmacytoid dendritic cells

Natural killer cells (NK) are one of the key players in the eradication and control of viral infections. Infections with the hepatitis B virus (HBV) may lead to persistence in a subgroup of patients, and impaired NK cell functions have been observed in these patients. Crosstalk with other immune cells has been shown to modulate the function of NK cells. We studied the functional crosstalk between NK cells and plasmacytoid dendritic cell (pDC) and its modulation by HBV. Healthy human peripheral blood-derived NK cells and pDC were purified and cocultured in the presence or absence of HepG2.2.15-derived HBV under various in vitro conditions. The functionality of NK cells was assessed by evaluation of activation markers, cytokine production and cytotoxicity of carboxyfluorescein succinimidyl ester-labelled K562 target cells by flow cytometry or immunoassays. Additionally, the crosstalk was examined using NK and pDC from patients with chronic HBV. The activation of NK cells in cocultures with pDC, as demonstrated by CD69, CD25 and HLA-DR, was not affected by the presence of HBV. Similarly, when cocultured with pDC, the cytotoxic potential of NK cells was not influenced by HBV. However, HBV significantly inhibited pDC-induced IFN-γ production by NK cells both in the presence and in the absence of CpG. As HBV did not affect cytokine-induced IFN-γ production by NK cells cultured alone, the suppressive effect of HBV on NK cell function was mediated via interference with pDC-NK cell interaction. In contrast to other viruses, HBV does not activate pDC-NK cell interaction but inhibits pDC-induced NK cell function. In parallel with NK cells of patients with chronic HBV, which show diminished cytokine production with normal cytotoxicity, HBV specifically suppressed pDC-induced IFN-γ production by NK cells without affecting their cytolytic ability. These data demonstrate that HBV modulates pDC-NK cell crosstalk, which may contribute to HBV persistence.