Observation of a_{0}^{0}(980)-f_{0}(980) Mixing

We report the first observation of a_{0}^{0}(980)-f_{0}(980) mixing in the decays of J/ψ→ϕf_{0}(980)→ϕa_{0}^{0}(980)→ϕηπ^{0} and χ_{c1}→a_{0}^{0}(980)π^{0}→f_{0}(980)π^{0}→π^{+}π^{-}π^{0}, using data samples of 1.31×10^{9}  J/ψ events and 4.48×10^{8}  ψ(3686) events accumulated with the BESIII detector. The signals of f_{0}(980)→a_{0}^{0}(980) and a_{0}^{0}(980)→f_{0}(980) mixing are observed at levels of statistical significance of 7.4σ and 5.5σ, respectively. The corresponding branching fractions and mixing intensities are measured and the constraint regions on the coupling constants, g_{a_{0}K^{+}K^{-}} and g_{f_{0}K^{+}K^{-}}, are estimated. The results improve the understanding of the nature of a_{0}^{0}(980) and f_{0}(980).

Abstract 3759: Characterization of INCB081776, a potent and selective dual AXL/MER kinase inhibitor

Tyro-3, Axl, and Mer constitute the TAM family of receptor tyrosine kinases (RTKs), which are amplified, translocated, or over-expressed in numerous types of human cancer. These RTKs play important roles in tumor growth, survival, cell adhesion and migration as well as drug resistance. In addition, it has been shown that both AXL and MER are critical regulators of innate immunity, phagocytosis, and immune-suppressive activity. Therefore targeting both AXL and MER kinases may not only impact the growth, survival and malignant progression of neoplastic cells directly, but also has the potential to restore and enhance host immunity against cancers. INCB081776 is a potent inhibitor of AXL and MER that exhibits selective pharmacological activity and enhanced anti-tumor immune activity. In biochemical assays, INCB081776 potently inhibited the kinase activity of recombinant AXL/MER enzymes and was highly selective against a panel of 192 kinases (IC50 = 0.61±0.31 nM and 3.17±1.97 nM against AXL and MER, respectively). INCB081776 is greater than 30 fold selective against TYRO3. Selectivity against TYRO3 is important as retinal toxicity associated with loss of the Mer gene appears to be modulated by TYRO3 in mice. In cellular assays, INCB081776 effectively blocked auto-phosphorylation of AXL or MER including BAF3 cells transfected with constitutively active AXL or MER, AXL in H1299 tumor cells, or MER kinase in G361 tumor cells, with low nanomolar IC50 values. In addition, INCB081776 inhibited activation of MER kinase in primary human macrophages with low nanomolar IC50 potency. More importantly, in an in vitro functional assay, INCB081776 partially reversed M2 macrophage-mediated suppression of T cell proliferation, and increased IFN-γ in co-cultured macrophages and T cells. In vivo, INCB081776 administration to H1299 tumor-bearing mice dose-dependently inhibited the phosphorylation in tumors. Consistent with the proposed mechanism of action, INCB081776 potently inhibited tumor growth in immunocompetent mice, but not in immunodeficient mice, demonstrating that a functional immune system is important for activity. Treatment was associated with dose-related increases in the percent of tumor-infiltrating effector CD4+ and CD8+ T cells, as well as macrophages with the M1 phenotype. In addition, INCB081776 decreased the percentage of intratumoral M2 macrophages and monocytic myeloid-derived suppressor cell (M-MDSC) immune cell populations. In the 4T1 model, combining INCB081776 with anti-PD-L1 resulted in synergistic anti-tumor effects compared to either single agent. Collectively, these preclinical data support the hypothesis and potential therapeutic utility of INCB081776 as an immunotherapeutic agent capable of enhancing tumor immune surveillance mechanisms in cancer patients as a single agent and when combined with therapies mediating immune PD-L1 checkpoint blockade.

Citation Format: Margaret Favata, Kerri Lasky, Yvonne Lo, Patricia Feldman, Jun Li, Yaoyu Chen, Christina Stevens, Min Ye, Hui Wang, Ke Liu, Richard Wynn, Yanlong Li, Jennifer Harris, Robert Landman, Yu Li, Xiaozhao Wang, Chunhong He, Yun-Long Li, Chu-Biao Xue, Wenqing Yao, Jonathan Rios-Doria, Zhenhai Gao, Maryanne Covington, Xuesong M. Liu, Holly Koblish, Peggy Scherle. Characterization of INCB081776, a potent and selective dual AXL/MER kinase inhibitor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3759.

Precision Study of η^{'}→γπ^{+}π^{-} Decay Dynamics

Using a low background data sample of 9.7×10^{5}  J/ψ→γη^{'}, η^{'}→γπ^{+}π^{-} events, which are 2 orders of magnitude larger than those from the previous experiments, recorded with the BESIII detector at BEPCII, the decay dynamics of η^{'}→γπ^{+}π^{-} are studied with both model-dependent and model-independent approaches. The contributions of ω and the ρ(770)-ω interference are observed for the first time in the decays η^{'}→γπ^{+}π^{-} in both approaches. Additionally, a contribution from the box anomaly or the ρ(1450) resonance is required in the model-dependent approach, while the process specific part of the decay amplitude is determined in the model-independent approach.

Finite slice analysis (FINA) of sliced and velocity mapped images on a Cartesian grid

Although time-sliced imaging yields improved signal-to-noise and resolution compared with unsliced velocity mapped ion images, for finite slice widths as encountered in real experiments there is a loss of resolution and recovered intensities for the slow fragments. Recently, we reported a new approach that permits correction of these effects for an arbitrarily sliced distribution of a 3D charged particle cloud. This finite slice analysis (FinA) method utilizes basis functions that model the out-of-plane contribution of a given velocity component to the image for sequential subtraction in a spherical polar coordinate system. However, the original approach suffers from a slow processing time due to the weighting procedure needed to accurately model the out-of-plane projection of an anisotropic angular distribution. To overcome this issue we present a variant of the method in which the FinA approach is performed in a cylindrical coordinate system (Cartesian in the image plane) rather than a spherical polar coordinate system. Dubbed C-FinA, we show how this method is applied in much the same manner. We compare this variant to the polar FinA method and find that the processing time (of a 510 × 510 pixel image) in its most extreme case improves by a factor of 100. We also show that although the resulting velocity resolution is not quite as high as the polar version, this new approach shows superior resolution for fine structure in the differential cross sections. We demonstrate the method on a range of experimental and synthetic data at different effective slice widths.

[Efficacy of staging surgery in pulmonary atresia with intact ventricular septum]

Objective: To assess the feasibility and efficacy of a staged invasive treatment strategy for the treatment of pulmonary atresia with intact ventricular septum, in the first stage using a catheter-based stent placement, second-stage surgery, and three-stage atrial septal occlusion. Methods: Totally 19 children with pulmonary atresia with intact ventricular septum were enrolled at Department of Cardiovascular Surgery, the Children's Hospital of Zhejiang University School of Medicine from January 2009 to December 2017, including 11 male and 8 female patients. The age was (13.8±7.7) days (ranging from 3 to 35 days). The weight was (3.4±0.5) kg (ranging from 2.8 to 4.1 kg). Among them, there were 13 cases of type Ⅱ and 6 cases of type Ⅲ. Regular follow-up visits for patients with stage Ⅰ arterial duct stenting after 1, 3, and 6 months; and routine follow-ups for 1, 3, and 6 months after stage Ⅱ surgery.The t test was used to compare the oxygen saturation between pre-operation and post-operation. Results: All 19 patients underwent arterial catheterization. The preoperative peripheral oxygen saturation was (64.4±5.3)%, while increased to (86.0±3.0)% after operation (t=16.353, P=0.000). One patient died during follow-up and 2 patients lost follow-up. One patient received stent balloon dilatation due to oxygen saturation decrease.Twelve patients completed the second-stage surgery and 1 case died after surgery. The rest were alive, including 2 cases of double-ventricular correction and 9 cases of semi-ventricular treatment in one room; 2 cases had completed three-stage atrial septal occlusion. Conclusions: Stage Ⅰ arterial duct stent, stage Ⅱ surgery, and stage Ⅲ atrial septal occlusion to treat pulmonary atresia with intact ventricular septum in children is feasible and effective. The method can be used as the important treatment direction for pulmonary atresia with intact ventricular septum.

[Usefulness of the residual SYNTAX score to predict long term outcome in acute coronary syndrome patients underwent percutaneous coronary intervention]

Objective: To quantify the extent and complexity of residual coronary stenosis following PCI by the residual SYNTAX score, and to evaluate its impact on adverse ischemic outcomes in acute coronary syndrome(ACS) patients. Methods: From January 2013 to December 2013, a total of 1 414 consecutive moderate- and high-risk ACS patients who underwent any PCI with multi-vessel coronary artery disease were evaluated.Patients were stratified by rSS quartiles and their outcomes were compared. Results: The rSS was 4.8±6.7. 591 patients (41.8%) had rSS=0(CR), 233 patients (16.5%) had rSS>0 but ≤ 3, 296 patients (20.9%) had rSS>3 but ≤8 and 294 patients (20.8%) had rSS>8.Clinical risk factors were more frequent in patients with incomplete revascularization(IR) compared with complete revascularization(CR). The 2-year rates of all-caused death(1.2% vs 0.4%, 2.0%, 4.4%, P=0.003), cardiac death, revascularization and MACCE were significantly higher in high rSS group, compared to other groups.By multivariable analysis, rSS was a strong independent predictor of ischemic outcomes at 2-year, including all-cause mortality (HR=1.05, 95%CI 1.01-1.09, P=0.019), cardiac death, revascularization and MACCE. Conclusions: The rSS is a strong independent predictor of all-caused death, cardiac death, revascularization and MACCE and has moderated predictive ability for those ischemic outcomes.

[Impact of direct bilirubin on the long-term outcome of patients with acute coronary syndrome post percutaneous coronary intervention]

Objective: To investigate the impact of direct bilirubin on long-term prognosis of acute coronary syndrome (ACS) patients post percutaneous coronary intervention(PCI). Methods: As a prospective and observational cohort study, a total of 6 431 consecutive ACS patients underwent PCI from January to December 2013 in Fuwai hospital were included. Patients were divided into 3 groups according to tertiles values of direct bilirubin as follows: low direct bilirubin group(<2.2 μmol/L, n=2 219), moderate direct bilirubin group(2.2-3.0 μmol/L, n=2 016), and high direct bilirubin group(>3 μmol/L, n=2 196). The clinical characteristics were compared among the 3 groups, and the impact of direct bilirubin on clinical adverse events (main adverse cardiovascular and cerebrovascular events included cardiogenic death, myocardial infarction, revascularization, stroke, and stent thrombosis) were analyzed at 2 years after PCI. Results: (1) Percent of male patients was 66.5%(1 475/2 219), 78.0%(1 572/2 016), and 86.2%(1 892/2 196), body mass index was(25.7±3.1), (26.0±3.3),and (26.0±3.2) kg/m(2), the ratio of the history of old myocardial infarction was 11.9%(264/2 219), 13.0%(263/2 016),and 14.9%(328/2 196), the ratio of the current smoker was 56.3%(1 249/2 219), 59.1%(1 192/2 016),and 60.0%(1 317/2 196) in low, moderate and high direct bilirubin groups respectively, and the differences were statistically significant (P<0.01 or 0.05). (2) Two years after PCI, the all-cause mortality was 0.8%(17/2 219), 1.8%(36/2 016), and 1.5%(33/2 196) (P=0.011),the cardiogenic mortality was 0.5%(12/2 219), 1.3%(26/2 016), and 0.6%(13/2 196) (P=0.010),the ratio of myocardial infarction was 2.2%(49/2 219), 2.4%(49/2 016), and 1.4%(31/2 196)(P=0.044),the ratio of revascularization was 8.8%(195/2 219), 8.3%(168/2 016),and 8.9%(196/2 196)(P=0.783),the ratio of stroke was 1.4%(30/2 219),1.1%(22/2 016), and 1.9%(42/2 196)(P=0.076),the ratio of stent thrombosis was 0.9%(19/2 219), 1.2%(24/2 016),and 0.7%(15/2 196)(P=0.210) in low, moderate and high direct bilirubin groups, respectively. (3) Multivariable Cox regression analysis showed that, patients in moderate direct bilirubin group faced increased the risk of all-cause mortality compared with patients in the low direct bilirubin group (HR=2.23, 95%CI 1.23-4.05, P= 0.009), and the risk of all-cause mortality was similar between high direct bilirubin group and low direct bilirubin group (HR=1.84, 95%CI 0.99-3.38, P= 0.051). There were no statistically significant difference in the risks of main adverse cardiovascular and cerebrovascular events,cardiogenic death, myocardial infarction, revascularization, stroke, and stent thrombosis in moderate and high direct bilirubin groups compared with low direct bilirubin group (all P>0.05). Conclusion: Moderate direct bilirubin level is associated with increased risk of all-cause death at 2 years after PCI compared with low level of direct bilirubin group.

Identification of a 62-kDa major allergen from Artemisia pollen as a putative galactose oxidase

BACKGROUND

Around 20 years ago, a 60- to 70-kDa protein was reported as a major allergen of mugwort (Artemisia vulgaris) pollen. This study was to identify and characterize its molecular properties.

METHODS

Sera from 113 Chinese and 20 Dutch Artemisia-allergic/sensitized subjects (and pools thereof) were used to identify the 60- to 70-kDa allergen. Pollen extracts of seven Artemisia species were compared by immunoblotting. Transcriptomics and proteomics (mass spectrometry) of A. annua pollen were used to identify the putative 60- to 70-kDa Artemisia allergen. Both the natural purified and recombinant allergens were evaluated for IgE reactivity by ImmunoCAP. Fourteen Chinese Artemisia-allergic patients were tested intradermally with purified natural allergen.

RESULTS

Immunoblots revealed two major bands at 12 and 25 kDa, and a weak band at 70 kDa for all seven Artemisia species. Using a combined transcriptomic and proteomic approach, the high molecular mass allergen in A. annua pollen was shown to be a 62-kDa putative galactose oxidase, with a putative N-glycosylation site. More than 94% of Artemisia pollen-allergic patients had IgE response to this allergen. Although recognition of a nonglycosylated recombinant version was only confirmed in a minority (16%) and at much lower IgE levels, this discrepancy cannot be explained simply by reactivity to the carbohydrate moiety on the natural allergen. Intradermal testing with the natural allergen was positive in five of nine sensitized patients.

CONCLUSIONS

The previously reported 60- to 70-kDa allergen of Artemisia pollen is most likely a 62-kDa putative galactose oxidase here designated Art an 7.

Precision Measurement of the e^{+}e^{-}→Λ_{c}^{+}Λ[over ¯]_{c}^{-} Cross Section Near Threshold

The cross section of the e^{+}e^{-}→Λ_{c}^{+}Λ[over ¯]_{c}^{-} process is measured with unprecedented precision using data collected with the BESIII detector at sqrt[s]=4574.5, 4580.0, 4590.0 and 4599.5 MeV. The nonzero cross section near the Λ_{c}^{+}Λ[over ¯]_{c}^{-} production threshold is cleared. At center-of-mass energies sqrt[s]=4574.5 and 4599.5 MeV, the higher statistics data enable us to measure the Λ_{c} polar angle distributions. From these, the Λ_{c} electric over magnetic form-factor ratios (|G_{E}/G_{M}|) are measured for the first time. They are found to be 1.14±0.14±0.07 and 1.23±0.05±0.03, respectively, where the first uncertainties are statistical and the second are systematic.

HPV16 DNA and integration in normal and malignant epithelium: implications for the etiology of laryngeal squamous cell carcinoma

Background

Molecular evidence suggests that human papillomavirus (HPV) has a role in the etiology of oropharyngeal squamous cell carcinoma. However, the role of HPV in laryngeal squamous cell carcinoma (LSCC) is unclear.

Patients and methods

We conducted a case–control study using tumor tissue specimens from 300 LSCC patients and vocal cord polyp specimens from 300 cancer-free controls. HPV genotype, HPV16 viral load and viral integration status, and p16 expression were determined.

Results

The prevalence of HPV (all types) was higher in cases than controls [21 (7.0%) versus 10 (3.3%), adjusted odds ratio (aOR) 2.37, 95% CI 1.08–5.21]. The prevalence of HPV16 was higher in cases than controls [20 (6.7%) versus 8 (2.7%), aOR 2.84, 95% CI 1.21–6.68]. The risk of LSCC associated with HPV16 DNA positivity was even higher in patients aged 55 years or younger (aOR 3.52, 95% CI 1.07–11.54), males (aOR 4.74, 95% CI 1.33–16.90), never-smokers (aOR 5.57, 95% CI 1.41–22.10), and never-drinkers (aOR 3.72, 95% CI 1.09–12.72). HPV DNA was partly or fully integrated in all 20 HPV16-positive cases but was episomal in all 8 HPV16-positive controls; however, the HPV16-positive cases and controls had similar viral loads (P = 0.28). P16 immunostaining was positive in 31 of the 300 cases (10.3%) and negative in all 300 controls.

Conclusion

These results suggest that prior infection with HPV16 may play a role in the etiology of some LSCC. This larger case–control study will offer for the first time the possibility to address in depth the understanding of a tissue-specific role of HPV in laryngeal carcinogenesis. Further studies with larger samples are needed to confirm these findings.

Interpretation of liver stiffness measurement-based approach for the monitoring of hepatitis B patients with antiviral therapy: A 2-year prospective study

Liver biopsy is not routinely performed in treated chronic hepatitis B. Liver stiffness measurement has been validated for noninvasive liver fibrosis assessment in pretreatment chronic hepatitis B but has not been assessed for fibrosis monitoring during antiviral therapy. Liver stiffness was systemically monitored by Fibroscan^® every 6 months in a cohort of patients with hepatitis B receiving antiviral therapy and compared with liver biopsies at baseline and week 104. A total of 534 hepatitis B e antigen-positive treatment-naive patients receiving telbivudine-based therapy with qualified liver stiffness measurement at baseline and week 104 were analyzed, 164 of which had adequate paired liver biopsies. Liver stiffness decreased rapidly (-2.2 kPa/24 weeks) in parallel with alanine aminotransferase (ALT) from 8.6 (2.6-49.5) kPa at baseline to 6.1 (2.2-37.4) kPa at week 24. Interestingly, liver stiffness decreased slowly (-0.3 kPa/24 weeks) but continually from week 24 to week 104 (6.1 vs 5.3 kPa, P < .001) while ALT levels remained stable within the normal range. More importantly, liver stiffness declined significantly irrespective of baseline ALT levels and liver necroinflammation grades. From baseline to week 104, the proportion of patients with no or mild fibrosis (Ishak, 0-2) increased from 74.4% (122/164) to 93.9% (154/164). Multivariate analysis revealed that percentage decline of 52-week liver stiffness from baseline was independently associated with 104-week liver fibrosis regression (odds ratio, 3.742; P = .016). Early decline of 52-week liver stiffness from baseline may reflect the remission of both liver inflammation and fibrosis and was predictive of 104-week fibrosis regression in treated patients with chronic hepatitis B.

Characterization of CD45RO+ memory T lymphocytes in keloid disease

BACKGROUND

Memory T cells, a highly effective subset of T lymphocytes, have been reported to be involved in many inflammatory skin disorders. However, the potential role of memory T cells in keloid disease (KD) remains unclear.

OBJECTIVES

Due to their important role in regulating inflammation, we investigated the characteristics of CD45RO⁺ memory T cells in KD.

METHODS

Primary cutaneous cells were isolated from keloid scars and normal skin by enzymic digestion. Peripheral blood mononuclear cells were isolated from a related blood sample, and flow cytometry was applied to identify the phenotypic and functional abnormalities of memory T cells in KD.

RESULTS

We observed that the majority of T lymphocytes in keloid scars had the memory phenotype, and a greater number of the CD8⁺ memory T cells in keloid scars produced lower levels of tumour necrosis factor (TNF)-α. This abnormal cytokine production was even more distinct in Forkhead box (FOX)P3^-  CD8^- memory T cells, with lower TNF-α production and enhanced interferon-γ production. Furthermore, FOXP3⁺  CD8^- memory T cells in keloid scars were abnormal, including showing reduced CD25 and cytotoxic T-lymphocyte-associated antigen 4 expression and interleukin-10 production. In addition, a significant decrease in the number of CD4⁺  CD25^high  FOXP3⁺ regulatory T cells was identified in patients with multiple keloid scars. We also found that there was significantly increased infiltration of CD103⁺  CD8⁺ memory T cells in keloid scars.

CONCLUSIONS

Our findings preliminarily elucidate the abnormalities of CD45RO⁺ memory T cells in keloid scars and provide early evidence that a disrupted T-cell response contributes to the progression of KD.

CT quantitative parameters to predict the invasiveness of lung pure ground-glass nodules (pGGNs)

AIM

To investigate the value of computed tomography (CT) quantitative parameters in predicting the invasiveness of lung pure ground-glass nodules (pGGNs).

MATERIALS AND METHODS

Chest CT images and pathological findings of 163 pGGNs in 154 consecutive patients were reviewed. According to the clinical management strategies, cases were divided into pre-invasive and MIA groups (atypical adenomatous hyperplasia [AAH], adenocarcinoma in situ [AIS], and minimally invasive adenocarcinoma [MIA]) and invasive group (invasive adenocarcinoma [IAC]). CT quantitative parameters including maximum diameter, largest diameter perpendicular to the maximum diameter, maximum cross-sectional area, volume, mass, and mean attenuation value were measured and compared between two groups. Their diagnostic performances were evaluated using receiver operating characteristic (ROC) and logistic regression analysis.

RESULTS

Significant differences existed for all the CT quantitative parameters in both groups (p<0.01). The values of area under the curve (AUC) were 0.783 of maximum diameter (95% CI: 0.711-0.843), 0.779 of longest diameter perpendicular to maximum diameter (95% CI: 0.707-0.840), 0.796 of largest cross-sectional area (95% CI: 0.726-0.855), 0.781 of volume (95% CI: 0.710-0.842), 0.794 of mass (95% CI: 0.722-0.865) and 0.625 of mean attenuation value (95% CI: 0.546-0.700), respectively. A pairwise-manner comparison showed the AUC of mean attenuation value was the smallest (p<0.01). Logistic regression analysis showed the largest cross-sectional area (OR=2.307, 95% CI: 1.689-3.150) was the independent predictor for IAC with a cut-off value of 2.22 cm².

CONCLUSIONS

CT quantitative parameters could predict the invasiveness of lung pGGNs. The largest cross-sectional area is the most valuable independent predictor and the mean attenuation value is less valuable.

Note: Development of a multichannel magnetic probe array for magnetohydrodynamic activity studies in Sino-United Spherical Tokamak

A 30-channel movable magnetic probe radial array measuring the poloidal magnetic field's time derivative Ḃ_θ has been developed and installed on the Sino-United Spherical Tokamak to investigate the magnetohydrodynamic (MHD) activities in ohmic discharges. The probe array consists of thirty identical commercial chip inductors mounted on a slim printed circuit board and shielded by a customized quartz tube of 14 mm in outer diameter. With the application of instrumentation amplifiers, the system exhibits a good signal to noise ratio and the measured vertical field spatial distribution agrees well with the simulation result. The measured spatial and temporal distribution of Ḃ_θ during the MHD activities exhibits a clear phase reversal layer, which is a direct proof of tearing mode and provides a reliable indication of the magnetic island chain position.

[Outcome of patients with coronary artery disease and left ventricular ejection fraction less than 50% undergoing percutaneous coronary intervention]

Objective: To investigate the in-hospital and long-term outcomes of patients with left ventricular ejection fraction (LVEF) <50% undergoing percutaneous coronary intervention (PCI) . Methods: From January to December 2013, 10 445 consecutive patients who underwent PCI in Fuwai Hospital and the LVEF value was available were prospectively included. The patients were divided into LVEF≥50% group (9 896 cases) and LVEF<50% group (549 cases) . The in-hospital and 2-year clinical outcomes were compared between the 2 groups. The association between LVEF<50% and clinical outcomes was assessed using multivariable Cox regression analysis. Results: (1) Compared with LVEF ≥50% group, LVEF< 50% group had higher rates of in-hospital all-cause death (1.1% (6/549) vs. 0.2% (17/9 896) , P<0.01) , cardiac death (1.1% (6/549) vs. 0.1% (12/9 896) , P<0.01) , in-stent thrombosis (0.7% (4/549) vs. 0.2% (18/9 896) , P<0.01) , myocardial infarction (2.4% (13/549) vs. 1.2% (121/9 896) , P<0.05) ,and major adverse cardiovascular and cerebrovascular events (MACCE) which including death, myocardial infarction, revascularization, in-stent thrombosis, and stroke (3.6% (20/549) vs. 1.4% (137/9 896) , P<0.01) . (2) A total of 10 388 (99.5%) patients completed 2-year follow-up. Compared with LVEF ≥50% group, LVEF<50% group had higher rates of 2-year all-cause death (4.7% (26/549) vs. 1.0% (101/9 896) , P<0.01) , cardiac death (4.0% (22/549) vs. 0.5% (50/9 896) , P<0.01) , in-stent thrombosis (3.1% (17/549) vs. 0.7% (71/9 896) , P<0.001) , myocardial infarction (4.2% (23/549) vs. 1.9% (186/9 896) , P<0.01) ,and MACCE (17.9% (98/549) vs. 11.8% (1 172/9 896) , P<0.01) . There were no significant differences on the rates of 2-year target-vessel revascularization, bleeding and stroke between the two groups. (3) The multivariable Cox regression analysis demonstrated that LVEF< 50% was the independent risk factor of 2-year all-cause death (HR=2.47, 95%CI 1.49-4.08, P<0.01) , cardiac death (HR=3.25, 95%CI 1.79-5.90, P<0.01) , in-stent thrombosis (HR=4.19, 95%CI 2.39-7.34, P<0.01) , myocardial infarction (HR=2.00, 95%CI 1.26-3.16, P<0.01) , and MACCE (HR=1.40, 95%CI 1.13-1.74, P<0.01) . (4) After propensity score matching, all in-hospital outcomes were similar between the two groups, including all-cause death, cardiac death, in-stent thrombosis, myocardial infarction, revascularization, bleeding, stroke, and MACCE (all P>0.05) . After propensity score matching,the multivariable Cox regression analysis demonstrated that LVEF<50% was still an independent risk factor of 2-year all-cause death (HR=3.08, 95%CI 1.37-6.89, P<0.01) , cardiac death (HR= 4.12, 95%CI 1.53-11.07, P<0.01) ,and in-stent thrombosis (HR=3.82, 95%CI 1.27-11.5, P<0.05) . Conclusion: LVEF< 50% is an independent risk factor of 2-year all-cause death, cardiac death, and in-stent thrombosis in patients undergoing PCI, but it does not increase the risk of target-vessel revascularization, bleeding or stroke.

[Efficacy comparison of 3 strategies for real-world stable coronary artery disease patients with three-vessel disease]

Objective: To compare the effectiveness of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical therapy (MT) alone for real-world stable coronary artery disease (SCAD) patients with three-vessel disease (TVD) in mainland China. Methods: A total of 8 943 consecutive cases with TVD hospitalized in our center from April 2004 to February 2011 were screened for this study. In this cohort, 3 435 cases diagnosed as SCAD were analyzed. PCI, CABG, MT alone were performed in 1 313 (38.2%), 1 259 (36.7%) and 863 (25.1%) patients, respectively. Propensity score matching (PSM) analysis using nearest neighbor matching with a 1∶1 ratio was applied, and 758 pairs of CABG and PCI groups, 552 pairs of PCI and MT groups, 639 pairs of CABG and MT groups were selected, respectively. 1- and 2-year clinical outcomes were evaluated among PCI, CABG and MT group. Kaplan-Meier curves and multivariable Cox regression method were used for survival analysis. Results: Significant differences were found at baseline between PCI, CABG and MT group, including age, gender, body mass index, family history of coronary artery disease, hyperlipidemia, diabetes mellitus, previous myocardial infarction, stroke, previous revascularization, peripheral vascular disease, SNYTAX score, left ventricular ejection fraction, hemoglobin, serum creatinine, high-sensitivity C-reactive protein, triglyceride and medication (all P<0.05) . All-cause death rates of 1- and 2-year follow-up of PCI, CABG and MT group were 0.6% (8/1 313), 1.1% (14/1 259), 3.4% (29/863) (P<0.001) and 1.1%(14/1 313), 1.5%(19/1 259), 7.3%(63/863) (P<0.001), respectively. Multivariate Cox regression analysis showed that 1-year MACCE rate (HR=0.51, 95%CI 0.33-0.77, P=0.001) was significantly reduced, due to the significant decrease of myocardial infarction (MI) rate (HR=0.09, 95%CI 0.01-0.76, P=0.027) and repeat revascularization rate (HR=0.21, 95%CI 0.10-0.41, P<0.001) in CABG group compared to PCI group, while all-cause death (HR=1.21, 95%CI 0.48-3.00, P=0.69) and stroke rate (HR=2.31, 95%CI 0.82-6.47, P=0.112) were similar between 2 groups. 2-year outcome showed CABG was associated with higher stroke rate (HR=2.20, 95%CI 1.06-4.55, P=0.034) and lower MI (HR=0.19, 95%CI 0.06-0.59, P=0.004) and repeat revascularization rate (HR=0.22, 95%CI 0.13-0.37, P<0.001), and lower MACCE rate (HR=0.49, 95%CI 0.36-0.68, P<0.001). Compared to MT group, 2-year all-cause death (HR=0.22, 95%CI 0.12-0.42, P<0.001) and MACCE rate (HR=0.63, 95%CI 0.47-0.83, P=0.001) were lower in PCI group, while 2-year all-cause death (HR=0.21, 95%CI 0.13-0.37, P<0.001), MACCE (HR=0.31, 95%CI 0.23-0.42, P<0.001), MI (HR=0.19, 95%CI 0.06-0.60, P=0.004) and repeat revascularization rate (HR=0.24, 95%CI 0.13-0.41, P<0.001) were lower in CABG group. Results of multivariate Cox regression analysis after PSM were consistent with above results. Conclusion: For SCAD patients with TVD, CABG shows better effectiveness by reducing MI and revascularization risk as compared to PCI, even though stroke risk is somehow higher in CABG patients. Patients received MT alone are associated with worse outcomes than those undergoing revascularization strategies.

Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis

AIM

The application of complete mesocolic excision (CME) in colon cancer is controversial. We performed a meta-analysis to compare the safety, quality and effect of CME with non-complete mesocolic excision (NCME) in patients with colon cancer.

METHOD

We searched PubMed, ScienceDirect, the Cochrane Library and Scopus to identify studies comparing CME with NCME in colon cancer. We focused on three study outcome areas: safety (operation time, blood loss, complications, mortality); quality (large bowel length, distance from the tumour to the high vascular tie, area of mesentery, total lymph nodes); and effect (long-term survival).

RESULTS

A total of 8586 patients from 12 studies were included in the meta-analysis. CME was associated with greater intra-operative blood loss [weighted mean difference (WMD) 79.87, 95% CI: 65.88-93.86], more postoperative surgical complications (relative risk 1.23, 95% CI: 1.08-1.40), longer large bowel resection (WMD 47.06, 95% CI: 10.49-83.62), greater distance from the tumour to the high vascular tie (WMD 17.51, 95% CI: 15.16-19.87), larger area of mesentery (WMD 36.09, 95% CI: 18.06-54.13) and more lymph nodes (WMD 6.13, 95% CI: 1.97-10.28) than NCME. CME also had positive effects on 5-year survival [hazard ratio (HR) 0.33, 95% CI: 0.13-0.81], 3-year survival (HR 0.58, 95% CI: 0.39-0.86) and 3-year survival for Stage III disease (HR 0.69, 95% CI: 0.60-0.80) compared with NCME.

CONCLUSION

Limited evidence suggests that CME is a more effective strategy for improving specimen quality and survival but with a higher complication rate.

[Clinical characteristics and prognosis in the patients of stroke after percutaneous coronary intervention]

Objective: To investigate the clinical characteristics and prognosis in patients with stroke after percutaneous coronary intervention (PCI). Methods: From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI including acute coronary syndrome and stable angina pectoris were enrolled.A two years' follow up was conducted among these patients to investigate the clinical characteristics and prognosis of patients with stroke and of those without. A comparison was done between the two groups. Results: One hundred and forty-five patients had stroke (1.4%) during the follow-up period after PCI, including 124 cases with ischemic stroke (1.2%), out of whom 4 (3.2%) patients died; 21 cases with hemorrhagic stroke, out of whom 9 patients (42.9%) died.There was more female, and more patients with risks factors, hypertension, previous myocardial infarction, previous stroke, etc. in the patients with stroke.During the 2-year follow-up, patients with stroke experienced higher incidence of all-cause mortality (9% vs 1.1%, P<0.000 1). There were no significant differences in the incidences of cardiac death, myocardial infarction, revascularization, stent thrombosis and major adverse cardiovascular event rates between the two groups.COX regression analysis showed that stroke after PCI was associated with the increased mortality (HR=8.387, 95%CI: 4.725-14.855, P<0.000 1). Meanwhile, after propensity score matched analyses (129 pairs), the trend was not changed, and stroke was still an independent risk factor of all-cause mortality (HR=6.737, 95%CI: 1.52-29.85, P=0.012). Conclusions: The patients underwent PCI, who had stroke later, had more clinical risk factors, and more serious degree of atherosclerosis.The incidence of stroke is an independent risk factor for all-cause mortality in patients with coronary heart disease after PCI.

Human Adipose-Derived Stem Cells Delay Retinal Degeneration in Royal College of Surgeons Rats Through Anti-Apoptotic and VEGF-Mediated Neuroprotective Effects

Stem cell therapy is a promising therapeutic approach for retinal degeneration (RD). Our study investigated the effects of human adipose derived stem cell (hADSCs) on Royal College of Surgeons (RCS) rats.

METHODS

Green fluorescent protein (GFP)-labeled hADSCs were transplanted subretinally into RCS rats at postnatal (PN) 21 days to explore potential therapeutic effects, while adeno-associated viral vector (AAV2)-vascular endothelial growth factor (VEGF) and siVEGF-hADSCs were used to aid the mechanistic dissections. Visual function was evaluated by Electroretinogram (ERG) recording. Potential transdifferentiations were examined by Immunofluorescence (IF) and gene expressions were analyzed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Apoptotic retinal cells were detected by Terminal Deoxynucleotidyl Transferase dUTP Nick End Labeling (TUNEL) assay and the cytokines secreted by hADSCs were measured by Enzyme-linked Immunosorbent Assay (ELISA).

RESULTS

The visual function of RCS rats began to decrease one week after their eyes opened at PN week 3 and almost lost in PN 5 weeks, accompanied by the loss of retinal outer nuclear layer (ONL). Subretinal transplantation of hADSCs significantly improved the visual function 2 weeks after the transplantation and such therapeutic effect persisted up to 8 weeks after the treatment (PN 11 weeks), with 3-4 rows of photoreceptors remained in the ONL and reduced apoptosis. Consistent with these phenotypic changes, the gene expression of rod photoreceptor markers Rhodopsin (Rho), Crx and Opsin (Opn1) in RCS rats showed obvious decreasing trends over time after PN 3 weeks, but were elevated with hADSC treatment. hADSC transplantation also repressed the expressions of Bax, Bak and Caspase 3, but not the expression of anti-apoptotic genes, including Bcl-2 and Bcl-XL. Finally, substantial VEGF, hepatocyte growth factor (HGF) and pigment epithelium-derived factor (PEDF) secretions from hADSCs were detected, while endogenous Vegf expression level decreased over time in RCS rats. The treatment of AAV2-VEGF showed comparable therapeutic effects as hADSCs but siRNA knockdown of VEGF in hADSCs essentially abolished the therapeutic effects.

CONCLUSIONS

Subretinal transplantation of hADSCs in RCS rats effectively delayed the retinal degeneration, enhanced the retinal cell survival and improved the visual function. Mechanistically this was mainly due to hADSC dependent anti-apoptotic and neuroprotective effects through its secretion of growth and neurotrophic factors including VEGF. Clinical application of hADSCs merits further investigation.