[Application of retroauricular sulcus incision in the operation of benign tumors in the deep lobe of parotid gland]

Objective: To investigate the application of retroauricular groove incision in the resection of benign tumors in the deep lobe of parotid. Methods: From January 2017 to January 2022, 19 patients (11 males and 8 females, age ranged from 17 to 69 years, with a median age of 48) with benign tumor in the deep lobe of parotid gland underwent parotidectomy through retroauricular sulcus incision in Linyi People's Hospital. Among them, 17 cases with tumor diameter≤4.0 cm underwent simple retroauricular groove incision, and 2 cases were dumbbell type with tumor diameter>4.0 cm on the medial side of mandible protruding into the parapharyngeal space, in which the deep lobe and tumor of parotid gland were resected through retroauricular sulcus incision combined with intraoral incision. Results: Tumors were completely removed through retroauricular sulcus incision in 17 cases, and dumbbell type tumors were removed through retroauricular sulcus incision combined with intraoral incision in 2 cases. Postoperative pathological examinations showed pleomorphic adenoma in 13 cases, basal cell adenoma in 4 cases and Warthin's tumor in 2 cases. Temporary mandibular marginal branch paralysis occurred in 2 patients and returned to normal 3 weeks after operation. All incisions healed in Phase I. By following-up of 1-5 years with a median follow-up time of 3.1 years, none of the patients had Frey syndrome, salivary fistula, other complications and tumor recurrence. The patients and their families were satisfied with the postoperative facial appearances. Conclusion: The retroauricular groove approach can not only preserve the function of parotid superficial lobe and facial nerve, but also has less trauma, less tissue defect and hidden scar. As the advantages of less complication, low recurrence rate and good cosmetic effect, the incision is worthy of clinical application.

Integrated Biogeography and Assembly Mechanisms of Microeukaryotic Communities in Coastal Waters Near Shellfish Cultivation

The Lianjiang coast in the East China Sea is a typical subtropical marine ecosystem, and shellfish cultivation occupies almost all of the available tidal flats. Many studies have investigated the effects of shellfish cultivation on benthic organisms and sediments, while the impact of shellfish cultivation on plankton ecosystems is still poorly understood. This study investigated the biogeographical patterns of microeukaryotic communities from Lianjiang coastal waters in four seasons using 18S ribosomal RNA gene amplicon sequencing. Microeukaryotes were mainly comprised of Dinoflagellata, Diatomea, Arthropoda, Ciliophora, Chlorophyta, Protalveolata, Cryptophyceae, and Ochrophyta, and presented significant differences in three habitats (the aquaculture area, confluent area, and offshore area) and four seasons. Similarity percentage analysis revealed that Paracalanus parvus, Heterocapsa rotundata, Bestiolina similis, and five additional key taxa contributed to spatio-temporal differences. Seasonal environmental and spatial factors explained 27.47% of microeukaryotic community variation on average, with 11.11% of the variation shared. Environmental variables, particularly depth, pH, and nitrite concentration, were strongly associated with the microeukaryotic community compositions. The neutral community model further demonstrated that stochastic processes were sufficient in shaping substantial variation in microeukaryotic communities across four seasons, which may reveal the remaining unexplained microeukaryotic community variation. We further divided four seasons into the aquaculture stages and non-aquaculture stages, and speculated that aquaculture activities may increase the dispersal limitation of microeukaryotes in coastal waters, especially for the big bodied-microbes like Arthropoda. The results provide a better understanding of the biogeographical patterns, processes, and mechanisms of microeukaryotic communities near shellfish cultivation.

Alteration in Community Dynamics of Chaetoceros curvisetus and Bacterioplankton Communities in Response to Surfactin Exposure

The use of surfactin is a promising method to mitigate algal blooms. However, little is known about surfactin toxicity to algae and bacterioplankton. Here, we treated Chaetoceros curvisetus, the dominant species of algal blooms in the East China Sea, with 0, 0.5, 1, 2, 3, and 4 mg/L of surfactin for 96 h to investigate temporal variability. Our results showed that low concentrations of surfactin (<2 mg/L) changed the cell morphology of C. curvisetus, and higher concentrations (>3 mg/L) had lethal effects. Meanwhile, we examined the community dynamics of the free-living (FL, 0.22-5 μm) and particle-attached (PA, >5 μm) bacterioplankton of C. curvisetus in response to different surfactin concentrations and cultivation periods. Both PA and FL bacterioplankton were mainly composed of Proteobacteria, Actinobacteria, and Bacteroidetes, while FL bacterioplankton were more diverse than PA bacterioplankton. The variations of FL and PA bacterioplankton were significantly constrained by the surfactin concentration. Surfactin changed the lifestyle of some bacterioplankton from FL to PA, which mainly belonged to abundant bacterioplankton. Furthermore, we identified some surfactin-sensitive species/taxa. Our study will help enhance the ability to predict marine microbial responses under the effect of surfactin, providing a research foundation for this new harmful algal bloom mitigation method.

Safety and Efficacy Analysis of Patients with Extensive-Stage Small Cell Lung Cancer (ES-SCLC) Treated with SHR-1316 Plus Chemotherapy and Sequential Chest Radiotherapy as First-Line Therapy from a Phase II Trial

PURPOSE/OBJECTIVE(S)

CAPSTONE-1, a phase 3 trial, showed that SHR-1316 (PD-L1 antibody) combined with standard first-line chemotherapy could prolong overall survival (OS) in patients (pts) with ES-SCLC. The CREST trial reported consolidative thoracic radiotherapy (TRT) of 30 Gy in 10 fractions provided a 10% 2-year OS benefit and more intensive TRT should be investigated in ES-SCLC. In the era of immunotherapy, the role of TRT also needs further exploration. Therefore, we designed this clinical trial to investigate the efficacy and safety of SHR-1316 plus first-line chemotherapy followed by TRT combined with SHR-1316.

MATERIALS/METHODS

Key inclusion criteria were pts aged 18-75 years, with previously untreated histologically or cytologically confirmed ES-SCLC, and an ECOG performance status of 0-1. Eligible pts would receive 4∼6 cycles of SHR-1316 (20mg/kg, D1, q3w) combined with EP/EC (etoposide, 100mg/m2, D1-5, q3w and cisplatin, 75mg/m², D1-3, q3w or carboplatin, AUC = 5, D1, q3w), followed by SHR-1316 combined with TRT (≥3 Gy*10 f or ≥2 Gy*25 f, involved-field irradiation), and then the maintenance therapy with SHR-1316 until disease progression or intolerable adverse events (AEs). The main endpoints included ORR, PFS and safety.

RESULTS

From October 2020 to January 2023, 33 pts received SHR-1316 and sequential consolidative TRT. Among them, 19 pts received high-dose TRT (>3 Gy*10 f or ≥2 Gy*25 f) and 14 pts received low-dose TRT (≤3 Gy*10 f or<2 Gy*25 f). The median age was 62 (range: 38-73). Most pts were male (28, 84.8%), former smokers (22, 66.7%) with an ECOG performance status 1 (32, 97%). Ten (30.3%) pts were diagnosed with brain metastasis and 10 (30.3%) pts had liver metastasis at baseline. At the data cutoff date, 9 pts remained on treatment, the average number of treatment cycles was 9.2. 33 pts had at least one 1 post-treatment tumor assessment. The confirmed ORR and DCR were 90.9% (30/33) and 100% (33/33) in all pts, were 89.5% (17/19) and 100% (19/19) in high-dose TRT group, and were 92.9% (13/14) and 100% (14/14) in low-dose TRT group. The median PFS was 10.2(CI: 5.8∼14.7) months in all pts, was 7 (CI: 3.8∼10.2) months in high-dose TRT group and 10.4 (CI: 8.4∼12.3) months in low-dose TRT group. AEs occurred in 27 (81.8%) pts and grade 3 or 4 AEs occurred in 20 (60.6%) pts. The most common grade 3 or 4 AEs included neutropenia (15, 45.5%), leukopenia (8, 24.2%), lymphocytopenia (5, 15.2%), pneumonia (3, 9.1%), anemia (3, 9.1%) and thrombocytopenia (2, 6.1%).

CONCLUSION

SHR-1316 plus chemotherapy and sequential TRT as first-line therapy for ES-SCLC showed promising efficacy and acceptable safety. There is no significant difference between high-dose and low-dose TRT groups in terms of safety and efficacy according to current data.

Study on the Dynamic Changes of Myocardial Injury Markers in Radiotherapy for Esophageal Carcinoma and Its Correlation with Cardiac Dosimetry

PURPOSE/OBJECTIVE(S)

It was hypothesized that radiotherapy for esophageal cancer could cause radiation-induced heart damage. To investigate the dynamic changes of myocardial enzyme, high-sensitive troponin T (hs-TnT), N-terminal pro-brain natriuretic peptide precursors (PRO-BNP) and left ventricular ejection fraction (LVEF) during radiotherapy and six months after radiotherapy for middle and lower thoracic squamous cell carcinoma, and to analyze the correlation between these indicators and dose-volume histogram (DVH) parameters of the heart.

MATERIALS/METHODS

A total of 35 patients with thoracic esophageal squamous cell carcinoma who underwent radical concurrent chemoradiotherapy were enrolled in the study. Radiation therapy was performed for up to 6 weeks. All patients received Intensity modulated radiation therapy (IMRT). Total radiation dose was from 50.4Gy to 60 Gy in each patient with a dose of 1.8-2.0 Gy per fraction. Blood samples to determine creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), lactic dehydrogenase (LDH), alpha-hydroxybutyric dehydrogenase (α-HBDH), hs-TnT, PRO-BNP and LVEF were measured before radiotherapy, during (10th -20th fraction), at the end of radiotherapy, 1, 3, 6 months after radiotherapy. The dynamic changes of the above indexes were analyzed. The correlation between the above indexes and the mean heart dose (Dmean), V5-V60 (dose-volume histograms data were recorded in discrete 5Gy dose levels) of the heart in the course of radiotherapy was also analyzed.

RESULTS

The Serum hs-TNT and LVEF show an upward trend during radiotherapy, at the end of radiotherapy and 6 months after radiotherapy for esophageal cancer. The hs-TnT of patients before, during, at the end of radiotherapy and 1, 3, and 6 months after radiotherapy were 7.2pg/ml, 9.1pg/ml, 9.1pg/ml, 9.0pg/ml, 9.4pg/ml, and 8.1pg/ml, respectively (p<0.05). The LVEF were 63.7%, 62.4%, 62.0%, 62.5%, 62.2%, 61.9% respectively (p<0.05). The pro-BNP showed an upward trend during radiotherapy and gradually returned to normal after radiotherapy. The CK and CK-MB showed a downward trend during radiotherapy and 1 month after radiotherapy, and gradually returned to normal 3 months after radiotherapy. Compared with the low dose group (the average dose of heart < 2000cGy), the high dose group (≥2000cGy) had a greater increase in hs-TNT, pro-BNP and LVEF, and a slower recovery time. There was no correlation between the changes of myocardial enzyme, hs-TnT, PRO-BNP, LVEF and the heart mean dose, V5-V60 during radiotherapy (p>0.05).

CONCLUSION

Cardiac injury induced by concurrent chemoradiotherapy for middle and lower thoracic esophageal cancer can lead to the increase of serum hs-TNT and pro-BNP and the increase of LVEF in the early stage of treatment, and this phenomenon is more obvious in the high-dose group. The hs-TnT and PRO-BNP are sensitive parameters to reflect the heart damage in esophageal cancer radiotherapy, which may provide reference for the heart protection during radiotherapy.

Quantitative phosphoproteomics reveals molecular pathway network alterations in human early-stage primary hepatic carcinomas: potential for 3P medical approach

Objective

Hepatic carcinoma is one of the most common types of malignant tumors in the digestive system, and its biological characteristics determine its high rate of metastasis and recurrence after radical resection, leading to a poor prognosis for patients. Increasing evidence demonstrates that phosphoproteins and phosphorylation-mediated molecular pathways influence the occurrence and development of hepatic carcinoma. It is urgent need to develop early-stage biomarkers for improving diagnosis, therapy, medical service, and prognostic assessment. We hypothesize that phosphoproteome and phosphorylation-mediated signaling pathway networks significantly differ in human early-stage primary hepatic carcinomas relative to control liver tissues, which will identify the key differentially phosphorylated proteins and phosphorylation-mediated signaling pathway network alterations in human early-stage primary hepatic carcinoma to innovate predictive diagnosis, prognostic assessment, and personalized medical services and progress beyond the state of the art in the framework of predictive, preventive, and personalized medicine (PPPM).

Methods

Tandem mass tag (TMT)-based quantitative proteomics coupled with TiO2 enrichment of phosphopeptides was used to identify phosphorylation profiling, and bioinformatics was used to analyze the pathways and biological functions of phosphorylation profiling between early-stage hepatic carcinoma tissues and tumor-adjacent normal control tissues. Furthermore, the integrative analysis with transcriptomic data from TCGA database obtained differently expressed genes (DEGs) corresponding to differentially phosphorylated proteins (DPPs) and overall survival (OS)-related DPPs.

Results

A total of 1326 phosphopeptides derived from 858 DPPs in human early-stage primary hepatic carcinoma were identified. KEGG pathway network analysis of 858 DPPs revealed 33 statistically significant signaling pathways, including spliceosome, glycolysis/gluconeogenesis, B-cell receptor signaling pathway, HIF-1 signaling pathway, and fatty acid degradation. Gene Ontology (GO) analysis of 858 DPPs revealed that protein phosphorylation was involved in 57 biological processes, 40 cellular components, and 37 molecular functions. Protein-protein interaction (PPI) network constructed multiple high-combined scores and co-expressed DPPs. Integrative analysis of transcriptomic data and DPP data identified 105 overlapped molecules (DPPs; DEGs) between hepatic carcinoma tissues and control tissues and 125 OS-related DPPs. Overlapping Venn plots showed 14 common molecules among datasets of DPPs, DEGs, and OS-related DDPs, including FTCD, NDRG2, CCT2, PECR, SLC23A2, PNPLA7, ANLN, HNRNPM, HJURP, MCM2, STMN1, TCOF1, TOP2A, and SSRP1. The drug sensitivities of OS-related DPPs were identified, including LMOD1, CAV2, UBE2E2, RAPH1, ANXA5, HDLBP, CUEDC1, APBB1IP, VCL, SRSF10, SLC23A2, EPB41L2, ESR1, PLEKHA4, SAFB2, SMARCAD1, VCAN, PSD4, RDH16, NOP56, MEF2C, BAIAP2L2, NAGS, SRSF2, FHOD3, and STMN1.

Conclusions

Identification and annotation of phosphoproteomes and phosphorylation-mediated signaling pathways in human early-stage primary hepatic carcinoma tissues provided new directions for tumor prevention and treatment, which (i) helps to enrich phosphorylation functional research and develop new biomarkers; (ii) enriches phosphorylation-mediated signaling pathways to gain a deeper understanding of the underlying mechanisms of early-stage primary hepatic carcinoma; and (iii) develops anti-tumor drugs that facilitate targeted phosphorylated sites. We recommend quantitative phosphoproteomics in early-stage primary hepatic carcinoma, which offers great promise for in-depth insight into the molecular mechanism of early-stage primary hepatic carcinoma, the discovery of effective therapeutic targets/drugs, and the construction of reliable phosphorylation-related biomarkers for patient stratification, predictive diagnosis, prognostic assessment, and personalized medical services in the framework of PPPM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-023-00335-3.

Establishment and characterization of an immortalized bovine intestinal epithelial cell line

Primary bovine intestinal epithelial cells (PBIECs) are an important model for studying the molecular and pathogenic mechanisms of diseases affecting the bovine intestine. It is difficult to obtain and grow PBIECs stably, and their short lifespan greatly limits their application. Therefore, the purpose of this study was to create a cell line for exploring the mechanisms of pathogen infection in bovine intestinal epithelial cells in vitro. We isolated and cultured PBIECs and established an immortalized BIEC line by transfecting PBIECs with the pCI-neo-hTERT (human telomerase reverse transcriptase) recombinant plasmid. The immortalized cell line (BIECs-21) retained structure and function similar to that of the PBIECs. The marker proteins characteristic of epithelial cells, cytokeratin 18 (CK18), occludin, zonula occludens protein 1 (ZO-1), E-cadherin and enterokinase, were all positive in the immortalized cell line, and the cell structure, growth rate, karyotype, serum dependence and contact inhibition were normal. The hTERT gene was successfully transferred into BIECs-21 where it remained stable and was highly expressed. The transport of short-chain fatty acids and glucose uptake by the BIECs-21 was consistent with PBIECs, and we showed that they could be infected with the intestinal parasite, Neospora caninum. The immortalized BIECs-21, which have exceeded 80 passages, were structurally and functionally similar to the primary BIECs and thus provide a valuable research tool for investigating the mechanism of pathogen infection of the bovine intestinal epithelium in vitro.

Monoammonium glycyrrhizinate improves antioxidant capacity of calf intestinal epithelial cells exposed to heat stress in vitro

Dairy calves are highly susceptible to the negative effects of heat stress, which can cause organ hypoxia after blood redistribution, damage the intestinal barrier, and trigger intestinal oxidative stress. This study aimed to investigate the antioxidant effects of monoammonium glycyrrhizinate (MAG) on calf small intestinal epithelial cells under heat stress in vitro. Small intestinal epithelial cells were isolated from a 1-day-old healthy calf and purified by differential enzymatic detachment. The purified cells were divided into seven groups. The control group was cultured with DMEM/F-12 at 37℃ for 6 h, and the treatment groups were cultured with 0, 0.1, 0.25, 0.5, 1, or 5 μg/mL MAG at 42℃ for 6 h. Heat stress causes oxidative damage to cells. Adding MAG in the medium can significantly improve cell activity and reduce cellular oxidative stress. Monoammonium glycyrrhizinate significantly increased the total antioxidant capacity (T-AOC) and superoxide dismutase (SOD) activity caused by heat stress, and significantly decreased malondialdehyde (MDA) and nitric oxide (NO) levels. The MAG treatment also reduced lactate dehydrogenase (LDH) release, increased mitochondrial membrane potential (MMP), and decreased apoptosis under heat stress. MAG also upregulated the expression of the antioxidant-related genes, Nrf2 and GSTT1, in heat-stressed intestinal epithelial cells and significantly downregulated the expression of the heat shock response-related proteins, MAPK, HSP70, HSP90, and HSP27. From the above results, we conclude that 0.25 μg/mL MAG improves the capability of the antioxidant system in small intestinal epithelial cells to eliminate reactive oxygen species by activating antioxidant pathways, improving the oxidant/antioxidant balance, lowering excessive heat shock responses, and reducing intestinal oxidative stress.

Case report: Bullous pemphigoid associated with sintilimab therapy for pMMR/MSS colorectal cancer

Immunotherapy has become a very effective treatment for many cancers. It has a unique set of immune system-related adverse effects, collectively known as immune-related adverse events (irAEs). Skin toxicities are the most common irAEs, of which bullous pemphigoid, although rare, is potentially life-threatening and affects patients’ survival. In this article, we report the treatment of bullous pemphigoid caused by programmed cell death protein-1 (PD-1) in a case of proficient mismatch repair (pMMR)/microsatellite stable (MSS) colorectal cancer. No significant adverse effects were observed in the patient after methylprednisone was tapered to 4 mg twice a day. No new skin lesions occurred recently in the patient and the original skin lesions healed. In particular, the patient’s immunotherapy was not stopped and the best outcome was a partial remission of the disease, lasting for more than 8 months.

Simultaneous Confidence Band Approach for Comparison of COVID-19 Case Counts

The outbreak of the novel coronavirus (COVID-19) was declared to be a global emergency in January of 2020, and everyday life throughout the world was disrupted. Among many questions about COVID-19 that remain unanswered, it is of interest for society to identify whether there is any significant difference in daily case counts between males and females. The daily case count sequences are correlated due to the nature of a contagious disease, and contain a nonlinear trend owing to several unexpected events, such as vaccinations and the appearance of the delta variant. It is possible that these unexpected events have changed the dynamical system that generates data. The classic t-test is not appropriate to analyze such correlated data with a nonconstant trend. This study applies a simultaneous confidence band approach in an attempt to overcome these difficulties; that is, a simultaneous confidence band for the trend of an autoregressive moving-average time series is constructed using B-spline estimation. The proposed method is applied to the daily case count data of seniors of both genders (at least 60 years old) in the State of Ohio from April 1, 2020 to March 31, 2022, and the result shows that there is a significant difference at the 95% confidence level between the two gender case counts adjusted for the population sizes.

Microbial food webs share similar biogeographic patterns and driving mechanisms with depths in oligotrophic tropical western Pacific Ocean

Microbial food web (MFW) dominates the energy flow in oligotrophic tropical open ocean pelagic ecosystems. Understanding biogeographic patterns and driving mechanisms of key components of the MFW is one of the central topics in current marine ecology. Investigations were conducted along an 1,100-km horizontal gradient and in the full-water column vertical gradient of the oligotrophic tropical western Pacific Ocean. High-throughput sequencing and association networking methods were used to analyze the community structure and interspecies interactions of MFW. The structure of MFW significantly differed with depths, but not across horizontal gradients. Bacteria and microeukaryotes were interconnected and had more predominantly positive and negative linkages in the aphotic layers. Key components of MFW exhibited similar biogeographic patterns and driving mechanisms. Geographic distance exerted minimal effects on the distribution patterns of the microbial food web, while environmental factors played more important roles, especially for temperature and inorganic nutrients. Stochastic processes were more important in the microbial food webs of the 5-200  m layer than the >500  m layer, and drift explained the majority of stochastic processes. Moreover, only a weak but not significant driving force for North Equatorial Current on the east-west connectivity of the microbial food web was found in the upper layers. This knowledge is a critical fundamental data for future planning of marine protected areas targeting the protection of tuna fishing in the western Pacific Ocean.

A lung adenocarcinoma patient with ROS1 fusion and NBN germline mutation achieves long progression-free survival from sintilimab combined with niraparib after failure of ROS1 inhibitors: a case report

Background

Lung cancer is a malignant tumor with high morbidity and mortality worldwide. At present, the main treatment methods for patients with advanced non-small cell lung cancer (NSCLC) include molecular targeted therapy and immunotherapy. The efficacy rate of immune checkpoint inhibitor (ICI) monotherapy is relatively low. Studies have confirmed that some combination therapies have better anti-tumor efficacy and higher response rates, such as PD-1/PD-L1 inhibitors combined with chemotherapy or targeted therapy. Poly (ADP-ribose) polymerase (PARP) inhibitors have become a new line of cancer therapy in ovarian and breast cancer, but it’s not approved in lung cancer. Some reports show that homologous recombination repair (HRR) gene variants may be potential biomarkers for immunotherapy. However, whether lung cancer with HRR gene variants can be benefit from ICIs combined with PARP inhibitors is unknown.

Case Description

We present a case of a 30-year-old man who was admitted to hospital with several months of cough and the chest computed tomography (CT) scan showed a mass about 2.6 cm × 2.1 cm in the left lung. Then he was diagnosed with lung adenocarcinoma (LUAD). Next generation sequencing (NGS) revealed that he harbors ROS1 fusion and NBN germline mutation. So, he received platinum-based chemotherapy and ROS1 inhibitors, but the disease continued to progress. Ultimately, the patient was switched to sintilimab combined with niraparib and the efficacy was evaluated as stable disease (SD), with a progression-free survival (PFS) of more than 12 months, and the overall survival (OS) is 23 months up to now. During the treatment, the major adverse events (AEs) observed were lymphopenia, nausea, vomiting, and edema. The AEs were tolerable.

Conclusions

This case shows that the combination of small-molecule inhibitors and immunotherapy may improve survival in NSCLC patients with driver genes, and sintilimab combined with niraparib provides a successful clinical case for the treatment of refractory tumors HRR gene mutation, which can be used as a reference for personalized treatment. Of course, more clinical trials are needed to confirm this combination treatment strategy.

Autologous Skin Fibroblast-Based PLGA Nanoparticles for Treating Multiorgan Fibrosis

Fibrotic diseases remain a substantial health burden with few therapeutic approaches. A hallmark of fibrosis is the aberrant activation and accumulation of myofibroblasts, which is caused by excessive profibrotic cytokines. Conventional anticytokine therapies fail to undergo clinical trials, as simply blocking a single or several antifibrotic cytokines cannot abrogate the profibrotic microenvironment. Here, biomimetic nanoparticles based on autologous skin fibroblasts are customized as decoys to neutralize multiple fibroblast-targeted cytokines. By fusing the skin fibroblast membrane onto poly(lactic-co-glycolic) acid cores, these nanoparticles, termed fibroblast membrane-camouflaged nanoparticles (FNPs), are shown to effectively scavenge various profibrotic cytokines, including transforming growth factor-β, interleukin (IL)-11, IL-13, and IL-17, thereby modulating the profibrotic microenvironment. FNPs are sequentially prepared into multiple formulations for different administration routines. As a proof-of-concept, in three independent animal models with various organ fibrosis (lung fibrosis, liver fibrosis, and heart fibrosis), FNPs effectively reduce the accumulation of myofibroblasts, and the formation of fibrotic tissue, concomitantly restoring organ function and indicating that FNPs are a potential broad-spectrum therapy for fibrosis management.

The analysis of CCND1 amplification in Chinese patients with esophageal carcinoma

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Background: The CCND1 gene is considered an oncogene located on human chromosome 11q13.3, Cyclin D1 protein encoded by the CCND1 gene is the critical gatekeeping protein in charge of regulating the transition. Previous studies have reported that CCND1 amplification associated with a negative response to immune checkpoint inhibitors (ICIs) in pancancers, but the association with clinical and molecular characteristics in esophageal carcinoma (ESCA) have not been researched. Herein, we explore CCND1 amplification profiles in Chinese patients with ESCA. Methods: A total of 59 patients of ESCA with paired tumor-normal samples were collected into the study. All samples were detected by DNA based sequencing with a 1021 gene panel. Results: Firstly, the frequency of CCND1 amplification in Chinese ESCA patients was 32.20% (19/59). Then, all the samples were divided into two groups according to whether CCND1 was amplified or not. In the CCND1 amplification group, the top8 co-mutated genes were TP53, FGF4, FGF3, FGF19, MYC, NOTCH1, CDKN2A, CDKN2B. We calculated the clinical and molecular characteristics between the two groups, the results showed there were no difference in gender, age and TNM stage. Meanwhile, the CCND1 amplification group had more somatic mutations (median 19 vs. 11, P = 0.0003), higher TMB value (median 8.64 vs. 5.76, P = 0.0199) and more TMB-H patients (47.37% vs. 17.50%, P = 0.018). Indicating the CCND1 amplification is associated with TMB-H in ESCA. However, previous studies have reported the negative impact of CCND1 amplification on the efficacy of ICIs in pancancer (including ESCA), these results suggesting the efficacy of ICIs in ESCA may be affected by multiple biomarkers, especially for TMB-H patients should be concerned about the high frequency CCND1 amplification, the patients may have a poorer benefit from immunotherapy. Conclusions: The efficacy of ICIs in ESCA may be affected by multiple biomarkers, especially for TMB-H patients should be concerned about the higher frequency of CCND1 amplification, these patients may have a poorer benefit from immunotherapy.[Table: see text]

Safety and Efficacy of Sintilimab and Anlotinib as First Line Treatment for Advanced Hepatocellular Carcinoma (KEEP-G04): A Single-Arm Phase 2 Study

Purpose

Immune checkpoint inhibitors plus antiangiogenic tyrosine kinase inhibitors may offer a first-line treatment for advanced hepatocellular carcinoma (HCC). In this phase 2 trial [registered with clinicaltrials.gov (NCT04052152)], we investigated the safety and efficacy of first-line anti-PD-1 antibody sintilimab plus antiangiogenic TKI anlotinib for advanced HCC.

Methods and Materials

Pathologically-proven advanced HCC patients received sintilimab (200 mg) on day 1 and anlotinib (12 mg) once daily on days 1 to 14 every 3 weeks, with a safety run-in for the first six participants to assess dose-limiting toxicities (DLTs). The primary endpoints were safety and objective response rate (ORR) per RECIST v1.1.

Results

Twenty advanced HCC patients were enrolled. No DLTs occurred in the safety run-in. All patients had treatment-related adverse events (TRAEs). Grade 3 TRAEs occurred in 8 (40.0%) patients, the most common being decreased platelet count (10.0%) and increased γ-glutamyl transferase (10.0%). No grade 4/5 TRAEs occurred. Five (25%) patients developed immune-related AEs. The ORR was 35.0% (95%CI 15.4%-59.2%) per RECIST v1.1 and 55.0% (95%CI 31.5%-76.9%) per modified RECIST. At data cutoff (March 31, 2021), the median progression-free survival was 12.2 months (95%CI, 3.8 to not reached). The median PFS was significantly longer in patients with lower LDH levels (not reached [NR], 95% CI, 8.7 to NR vs. higher LDH levels 5.2 months, 95% CI 3.4 to NR; P=0.020) and a CONUT score ≤2 (NR, 95% CI 5.1 to NR vs. CONUT score >2 6.2 months, 95% CI 1.8 to NR; P=0.020). Furthermore, patients showing tumor response had a significantly higher median proportion of CD16⁺CD56⁺ NK cells than patients who had stable or progressive disease (21.6% vs. 14.6%; P=0.026).

Conclusion

Sintilimab plus anlotinib showed promising clinical activities with manageable toxicity as first-line treatment of advanced HCC.

[Risk assessment of internal mammary lymph node metastasis and choice of irradiation of internal mammary lymphatic drainage area in breast cancer patients with negative internal breast lymph nodes on imaging]

Objective: To explore the independent risk factors of internal mammary lymph nodes (IMN) metastasis and the risk assessment method of IMN metastasis preoperatively in breast cancer patients with negative IMN in imaging examination, and guide the radiotherapy of IMN in patients with different risk stratification of IMN metastasis. Methods: The clinical and pathological data of 301 breast cancer patients who underwent internal mammary sentinel node biopsy(IM-SLNB) and/or IMN dissection in Shandong Cancer Hospital with negative IMN on CT and/or MRI from January 2010 to October 2019 were analyzed retrospectively. The independent risk factors were analyzed by univariate and multivariate logistic regression, and the independent risk factors of IMN metastasis were used to risk stratification. Results: Among the 301 patients, 43 patients had IMN metastasis, and the rate of IMN metastasis was 14.3%. Univariate analysis showed that vascular tumor thrombus, progesterone receptor (PR) expression, T stage and N stage were associated with IMN metastasis. Multivariate logistic regression analysis showed that tumor located in medial quadrant, positive PR and axillary lymph node metastasis were independent risk factors for IMN metastasis. The risk of IMN metastasis was assessed according to the independent risk factors of the patients: low-risk group is including 0 risk factor, medium-risk group is including 1 risk factor, and high-risk group is including 2-3 risk factors. According to this evaluation criteria, 301 patients with breast cancer were divided into low-risk group (with 0 risk factors), medium-risk group (with 1 risk factor) and high-risk group (with 2-3 risk factors). The IMN metastasis rates were 0 (0/34), 4.3% (6/140) and 29.1% (37/127), respectively. Conclusions: The risk stratification of IMN metastasis according to three independent risk factors of IMN metastasis including tumor located in medial quadrant, positive PR and axillary lymph node metastasis in breast cancer patients can guide the radiotherapy of IMN in newly diagnosed breast cancer patients. For N1 patients, radiotherapy of IMN is strongly recommended when the primary tumor is located in the medial quadrant and/or PR positive.

Biodiversity and Biogeography of Abundant and Rare Microbial Assemblages in the Western Subtropical Pacific Ocean

The levels of chlorophyll a and nutrient concentrations in the surface waters of the western subtropical Pacific Ocean are among the lowest globally. In addition, our knowledge of basin-scale diversity and biogeography of microbial communities in this vast extremely oligotrophic environment is still rather limited. Here, high-throughput sequencing was used to examine the biodiversity and biogeography of abundant and rare microbial assemblages throughout the water column from the surface to a depth of 3,000 m across a horizontal distance of 1,100 km in the western Pacific Ocean. Microbial alpha diversity in the 200-m layer was higher than at other depths, with Gammaproteobacteria, Alphaproteobacteria, and Clostridia as the dominant classes in all samples. Distinctly vertical distributions within the microbial communities were revealed, with no difference horizontally. Some microbes exhibited depth stratification. For example, the relative abundances of Cyanobacteria and Alphaproteobacteria decreased with depth, while Nitrososphaeria, Actinobacteria, and Gammaproteobacteria increased with depth in the aphotic layers. Furthermore, we found that environmental (selective process) and spatial (neutral process) factors had different effects on abundant and rare taxa. Geographical distance showed little effect on the dispersal of all and abundant taxa, while statistically significant distance-decay relationships were observed among the rare taxa. Temperature and chlorophyll a were strongly associated with all, abundant, and rare taxa in the photic layers, while total inorganic nitrogen was recognized as the crucial factor in the aphotic layers. Variance partitioning analysis indicated that environmental selection played a relatively important role in shaping all and abundant taxa, while the variation in rare taxa explained by environmental and spatial processes was relatively low, as more than 70% of the variation remained unexplained. This study provides novel knowledge related to microbial community diversity in the western subtropical Pacific Ocean, and the analyzes biogeographical patterns among abundant and rare taxa.

Sintilimab plus anlotinib as first-line therapy in patients (pts) with advanced hepatocellular carcinoma (aHCC)

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Background: The synergic combination of anti-PD-1/PD-L1 and antiangiogenic agents has exhibited as an encourage treatment pattern in aHCC. Multi-targeted antiangiogenic TKIs, such as lenvatinib and sorafenib, are approved for 1st-line treatment of aHCC. Sintilimab, a novel selective anti-PD-1 monoclonal antibody, has demonstrated encouraging clinical activities in aHCC. The trial aims to explore the safety and efficacy of sintilimab plus anlotinib (a TKI against angiogenesis) in aHCC. Methods: This is a single-arm phase 2 study. Eligible Pts with aHCC, BCLC stage C or B (not amenable for surgery and chemoembolization), Child-Pugh scores≤7 and ECOG PS ≤ 1 received 1st-line treatment of sintilimab (200mg, iv, D1) plus anlotinib (12mg, po, QD, D1-14) every 3 wks until disease progression or unacceptable toxicity. Primary endpoints were safety and objective response rate (ORR, per RECIST 1.1), and secondary endpoints included disease control rate (DCR), progression free survival (PFS), duration of response (DOR) and overall survival (OS). Results: As of January 15, 2021, 20 pts were enrolled (males 18 ; median age 56 yrs [range 41-70] ; BCLCB/C: 5/15 ; Child-Pugh A/B7: 19/1 ; HBV infection 20). All pts received at least two cycles of treatments with median cycles 7.5 [range 2-22]. Median follow-up was 12 months [range 3-19]. The most common treatment-related adverse events (TRAEs) were grade 1-2 with thrombocytopenia (45.0%), hand-foot syndrome (40.0%), hypertension (35.0%), increased AST (35.0%), ALT (30.0%), decreased neutrophil count (25.0%), leukopenia (25.0%). 8 pts experienced manageable grade 3 TRAEs, and no grade 4/5. 12 pts required dose reduction of anlotinib (9 pts to 10 mg and 3 to 8 mg). No treatment withdraw caused by TRAEs. ORR was 40.0% (8/20) with 1 CR and 7 PR, 11 pts were SD, and DCR was 95.0% (19/20). Median DoR was not reached. 6m-PFS rate was 66.4% (95%CI: 47.7%-92.5%), immature median PFS was 14.65 months (95%CI: 5.06 -not reached) with 8 events. Conclusions: The combination of sintilimab and anlotinib showed promising clinical activities with manageable toxicity for first line treatment of aHCC. Clinical trial information: NCT04052152. Research Sponsor: Innovent Biologics, Inc., Chia-Tai Tianqing Pharmaceutical Group Co Ltd. Clinical trial information: NCT04052152.

Effects of Glycyrrhiza polysaccharide in diet on growth performance, serum antioxidant capacity, and biochemistry of broilers

In the present study, we analyzed the effects of Glycyrrhiza polysaccharide (GCP) on growth performance, serum antioxidant capacity, and biochemistry of broilers. A total of 600, one-day-old AA broilers randomly divided into 5 treatment groups with 6 replicate pens of 20 birds per cage received dietary supplementation with GCP (0, 200, 500, 1,000, and 1,500 mg/kg) for 42 d. The supplementation of GCP linearly decreased (P < 0.05) feed conversion rate on day 22 to 42. Dietary supplementation with GCP reduced (P < 0.05) serum total cholesterol on day 21 and 42 and linearly improved (P < 0.05) albumin and high-density lipoprotein cholesterol. Dietary supplementation with 1,000 or 1,500 mg/kg GCP significantly increased (P < 0.05) serum total superoxide dismutase (T-SOD) activity on day 21 and 42 and reduced (P < 0.05) serum malondialdehyde content on 21 d. Dietary supplementation with 1,000 or 1,500 mg/kg GCP significantly improved (P < 0.05) interleukin-1β (IL-1β) and interferon-γ (IFN-γ) expressions in liver on day 21 and 42. At the end of the experiment, we randomly selected 20 broilers from 3 treatment groups (0, 1,000, and 1,500 mg/kg), respectively, to perform an lipopolysaccharide (LPS)-induced acute stress experiment. The 60 broilers were divided into 6 treatment groups with 10 birds per cage. The experiment was designed as a 3 × 2 factorial arrangement with GCP (0, 1,000, or 1,500 mg/kg) and LPS (injection of saline or 1 mg/kg body weight) levels as treatments. When the grouping was finished, the broilers were immediately intraperitoneally injected with LPS or normal saline. Six hours after challenged, serum antioxidant and liver immunity were analyzed. The results showed that dietary GCP prevented LPS-induced reductions in T-SOD activity and increases in malonaldehyde content (P < 0.05). Also, dietary GCP supplementation mitigated the LPS-induced increase in IL-1β and IFN-γ in the liver. Supplementation with 1,500 mg/kg GCP showed the most optimal effect in broilers. GCP has the potential to be used as feed additive in broilers.

Camrelizumab plus gemcitabine and oxaliplatin (GEMOX) in patients with advanced biliary tract cancer: a single-arm, open-label, phase II trial

Background

Immune checkpoint inhibitors monotherapy has been studied in patients with advanced biliary tract cancer (BTC). The aim of this study was to assess the efficacy and safety of camrelizumab, plus gemcitabine and oxaliplatin (GEMOX) as first-line treatment in advanced BTC and explored the potential biomarkers associated with response.

Methods

In this single-arm, open-label, phase II study, we enrolled stage IV BTC patients. Participants received camrelizumab (3 mg/kg) plus gemcitabine (800 mg/m²) and oxaliplatin (85 mg/m²). Primary endpoints were 6-month progression-free survival (PFS) rate and safety. Secondary endpoints were objective response rate (ORR), PFS and overall survival (OS). Exploratory endpoints included association between response and tumor mutational burden (TMB), blood TMB, dynamic change of ctDNA and immune microenvironment.

Results

54 patients with advanced BTC were screened, of whom 38 eligible patients were enrolled. One patient withdrew informed consent before first dose treatment. Median follow-up was 11.8 months. The 6-month PFS rate was 50% (95% CI 33 to 65). Twenty (54%) out of 37 patients had an objective response. The median PFS was 6.1 months and median OS was 11.8 months. The most common treatment-related adverse events (TRAEs) were fatigue (27 (73%)) and fever (27 (73%)). The most frequent grade 3 or worse TRAEs were hypokalemia (7 (19%)) and fatigue (6 (16%)). The ORR was 80% in patients with programmed cell death ligand-1 (PD-L1) tumor proportion score (TPS) ≥1% versus 53.8% in PD-L1 TPS <1%. There was no association between response and TMB, blood TMB, immune proportion score or immune cells (p>0.05), except that PFS was associated with blood TMB. Patients with positive post-treatment ctDNA had shorter PFS (p=0.007; HR, 2.83; 95% CI 1.27 to 6.28).

Conclusion

Camrelizumab plus GEMOX showed a promising antitumor activity and acceptable safety profile as first-line treatment in advanced BTC patients. Potential biomarkers are needed to identify patients who might respond to camrelizumab plus GEMOX.

Trial registration number

NCT03486678.

Efficacy and safety of iguratimod on patients with primary Sjögren's syndrome: a randomized, placebo-controlled clinical trial

Objective: To evaluate the clinical efficacy and safety of iguratimod for the treatment of primary Sjögren's syndrome (pSS) and explore its possible mechanism of action.Method: We conducted a randomized, placebo-controlled clinical trial in 66 pSS patients. Patients were randomized in a 2:1 ratio to receive oral iguratimod for 24 weeks or matching placebo. The primary endpoint was the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI). Secondary endpoints included mental discomfort visual analogue scale (VAS) score, patient global assessment (PGA), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), Schirmer's test values, unstimulated whole salivary flow, erythrocyte sedimentation rate (ESR), and immunoglobulin G (IgG). The proportions of B cells in peripheral blood and levels of serum B-cell activating factor (BAFF) were measured at baseline and week 24 in the iguratimod group. All adverse events were recorded during the trial period.Results:ESSPRI improved more in the iguratimod than in the placebo group (p = 0.016). Mental discomfort VAS score, PGA, Schirmer's test, ESR, and IgG also improved more in the iguratimod than in the placebo group (all p < 0.05). Adverse events were reported 13.6% of the iguratimod group. Levels of BAFF and proportions of plasma cells in patients decreased significantly after iguratimod treatment. The proportions of peripheral plasma cells had positive correlations with both serum IgG and BAFF.Conclusion: Iguratimod improved some dryness symptoms and disease activity in pSS patients, and reduced the level of BAFF and percentage of plasma cells over 24 weeks. Iguratimod seems to be an effective and safe treatment for pSS.

Bacterioplankton assembly and interspecies interactions follow trajectories of Gymnodinium-diatom bloom

The underlying mechanisms of bacterioplankton community assembly and interspecies interactions during harmful algal blooms remain largely unclear. Using 16S rRNA gene amplicon sequencing, we analyzed the bacterioplankton communities over the continuous course of saxitoxin-producing Gymnodinium catenatum blooms and two diatom (i.e., Skeletonema costatum and Chaetoceros curvisetus) blooms in an anthropogenically controlled and eutrophic bay, East China Sea. The succession of bacterioplankton communities correlated with changes in the dynamics of algal species. Deterministic versus stochastic bacterioplankton community assemblage processes were quantified, demonstrating that stochastic processes increased when algal blooms happened. The occurrence of algal blooms caused weaker bacterioplankton interspecies interactions and higher degrees of cooperative activities, changed keystone taxa and diminished the stability of bacterial communities. These findings consequently have important implications for our understanding of bacterioplankton community ecology during algal blooms.

Expression and prognostic significance of long noncoding RNA AK001796 in esophageal squamous cell carcinoma

OBJECTIVE

Previous study has reported that long noncoding RNA AK001796 (AK001796) functions as a tumor promoter in esophageal squamous cell carcinoma (ESCC). However, its clinical in ESCC patients remains largely unclear. The purpose of the present study was to evaluate the prognostic value of AK001796 in ESCC patients.

PATIENTS AND METHODS

The expression levels of AK001796 in ESCC tissues and matched normal tissues were detected by RT-PCR. Association between AK001796 levels and clinicopathological factors was also analyzed by chi-square test. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and log-rank test. The predictors for OS and DFS were assessed by univariate analysis and multivariate analysis using Cox's proportional hazards model.

RESULTS

We found that AK001796 was elevated in human ESCC samples compared with the adjacent normal tissues (p<0.01), and the high level of AK001796 expression was significantly correlated with lymph node metastasis (p=0.032) and advanced UICC stage (p=0.016). Interestingly, Kaplan-Meier analysis indicated that patients with high AK001796 expression had a significantly lower OS (p=0.010) and DFS (p=0.001). Moreover, we showed that AK001796 was an independent poor prognostic factor for OS and DFS in ESCC patients through univariate and multivariate analysis.

CONCLUSIONS

Our data provide important evidence that AK001796 may be a useful biomarker of advanced progression and poor prognosis of ESCC.

Succession of bacterioplankton communities over complete Gymnodinium-diatom bloom cycles

Shifts in bacterioplankton communities during algal blooms have been widely investigated, but our understanding of their succession over the continuous course of paralytic shellfish poisoning producing Gymnodinium catenatum blooms and diatom (Skeletonema costatum and Chaetoceros curvisetus) blooms in natural bays is highly understudied. Here, we used high-throughput sequencing of bacterioplankton 16S rRNA genes to investigate the composition and successional patterns of bacterioplankton communities during Gymnodinium-diatom bloom cycles. Changes in community compositional patterns were then evaluated in context of environmental and phytoplankton community variation. Bacterioplankton α-diversity significantly decreased during the emergence of the algal blooms, with Flavobacteriaceae, Rhodobacteraceae, Cryomorphaceae, and Saprospiraceae as the dominant bacterial families in waters during the blooms. Bacterioplankton community compositions could be separated into three successive stages according to bloom dynamics, wherein the succession of bacterioplankton communities was correlated with changes in algal species. Environmental variables, and particularly pH, salinity, and nutrient concentrations (e.g., of nitrite, nitrate, and ammonium) were strongly associated with variation in bacterioplankton community structures. Variance partitioning analysis indicated that phytoplankton effects alone could explain more variance than only environmental effects. Moreover, LEfSe analysis was used to identify special bacterioplankton genera as "biomarkers" for bloom stages, such as Tepidisphaera and Pseudarcicella, whose abundances were significantly associated with different stages of the phytoplankton blooms. The phylotype "biomarkers" that were identified hold significant potential as indicators for phytoplankton bloom successional dynamics. Overall, these results may contribute to the understanding of the ecological processes shaping microbial communities during successive Gymnodinium-diatom blooms.

SHR-1210 combined with GEMOX as first-line treatment in patients with advanced biliary tract cancer

535

Background: This study aimed to evaluate the efficacy and safety of SHR-1210 (a humanized anti-programmed cell death receptor 1 antibody) plus gemcitabine and oxaliplatin (GEMOX) as first line treatment in patients (pts) with biliary tract cancer (BTC). Methods: This was a single-arm, single-center, exploratory trial, which included advanced BTC pts. Pts received SHR-1210 (3mg/kg, total dose ≤200mg, ivd, D1/2W) combined with gemcitabine (800 mg/m2, ivd, D1/2W) and oxaliplatin (85mg/m2, ivd, D2/2W). Combined chemotherapy lasted for no more than 12 cycles. Once chemotherapy intolerance occurred or at end of 12-cycle combined chemotherapy, pts with stable disease or objective response would continue to take SHR-1210 as single agent until disease progression or intolerable toxicity. The primary endpoint was the 6-month progression free survival (PFS) rate. Results: From February 2018 to April 2019, 37 eligible pts were enrolled. The median age was 64 (range 41-74) years, male/female was 70.3/29.7%, and bile duct cancer/gallbladder cancer was 59.5/40.5%. All 37 pts were included in the safety analysis. The overall AE incidence rate was 97.3%. The incidence of grade ≥3 AEs was 73.0%, which mainly included increased GGT (gammaglutamyltransferase, 18.9%), hypokalemia (18.9%), and fatigue (16.2%). Particularly, the incidence of fever is 73.0%, in which 2 pts experienced grade 3/4 fever. Among 36 evaluable pts, 19 pts got partial response (PR, 52.8%), 14 pts stable disease (SD, 38.9%), and 3 pts progressive disease (PD, 8.3%) at best. The primary endpoint 6-month PFS rate was 50.0% (95% CI 32.4-65.4), which indicated that the primary endpoint of the study was reached, and mPFS was 6.2 months (95% CI 4.2-7.1). The 12-month overall survival (OS) rate was 50.5% (95% CI 30.6-67.4), and mOS was 12.1 months (95% CI 8.0-NA). Conclusions: This study has reached the pre-defined primary endpoint with a high response rate. Predictive biomarker analysis was reported in another abstract. Further study is needed to validate the efficacy of this combination. Clinical trial information: NCT03486678.

Biomarker exploration for SHR-1210 plus GEMOX as first-line treatment in advanced biliary tract cancer

536

Background: We conducted a trial to evaluate the efficacy and safety of SHR-1210 (a humanized anti-programmed cell death receptor 1 antibody) plus gemcitabine and oxaliplatin (GEMOX) as in untreated patients (pts) with biliary tract cancer (BTC) (NCT03486678). This study is to explore the predictive biomarkers for efficacy. Methods: Baseline lymphocyte count and lactate dehydrogenase (LDH) level were obtained from routine tests. Gene mutation and tumor mutation burden (TMB) from baseline tissue and blood samples were tested by the next generation sequencing (NGS) with a 425-gene panel. The expressions of PD-L1 and markers for lymphocyte, natural killer cells, and macrophages in baseline tumor tissue samples were analyzed by immunohistochemistry (IHC). Results: The median progression free survival (PFS) and overall survival (OS) in this trial was 6.2m and 12.1m, respectively. Firstly, pts with normal LDH level (≤271 U/L) had a tendency for longer PFS (6.2m vs 5.0m, p = 0.053) and significantly longer OS (p = 12.6m vs 6.8m, p < 0.001) than those with elevated LDH ( > 271 U/L). Low baseline lymphocyte count (≤ 1.1×109/L) was related to worse OS (12.6m vs 6.9m, p < 0.001) and PFS (6.2m vs 3.9m, p = 0.021). Secondly, baseline tissue and ctDNA gene mutations were detected in 33 and 30 pts, respectively. Tissue analysis showed that pts with STK11 (p = 0.0254), CTNNB1 (p < 0.001) and SMARCA4 (p = 0.0181) wild type showed significantly longer PFS than those with mutations. Pts with ARID1A gene wild type showed a tendency for longer PFS (p = 0.0634) and significantly longer OS (p = 0.0149). Gene mutations from baseline ctDNA revealed that pts with wild type SMARCA4, CTNNB1, STK11, and NF1 had longer PFS than those with mutations. Lastly, IHC meant that PD-L1 positivity may be related to longer PFS (TPS > 1%, p = 0.08; IPS > 1%, p = 0.05). Besides, pts with CD68+ HLA-DR+ macrophages > 0.01%, CD68+ HLA-DR- macrophages>2.5%, and CD56bright>1.7% and CD56dim > 0.05 also got PFS benefits (all p < 0.05). TMB (cutoff = 7 muts/mbp) was not associated with PFS. Conclusions: Despite limited sample size, biomarkers from routine blood test, gene mutation and immune microenvironment can be helpful to stratify pts who are sensitive to immunotherapy in advanced BTC. Clinical trial information: NCT03486678.

SNHG 6 promotes the progression of Colon and Rectal adenocarcinoma via miR-101-3p and Wnt/β-catenin signaling pathway

Background

Small nucleolar RNA host gene 6 (SNHG6) regulates diverse biological processes in cancers. Potential function of SNHG6 in human colon and rectal adenocarcinoma (CRC) was evaluated.

Methods

Quantitative real-time polymerase chain reaction, MTT assays, Colony formation assays, Transwell assay, Western Blotting and Luciferase reporter assays were performed to measure the biological functions and potential molecular mechanisms of SNHG6 in CRC.

Results

SNHG6 was over-expressed in CRC, and high expression of s SNHG6 were associated with short survival times. We then identified miR-101-3p as an inhibitory target of SNHG6. Knockdown of SNHG6 significantly decreased miR-101-3p expression. Moreover, silenced SNHG6 obviously inhibited CRC cell growth, weakened cell invasion capacity and blocked the Wnt/β-catenin signaling pathway.

Conclusion

SNHG6 could regulate the progression of CRC via modulating the expression levels of miR-101-3p and the activity of Wnt/β-catenin signaling.

SHR-1210 plus GEMOX as first line treatment in biliary tract cancer: Results from a single-arm exploratory study

4092

Background: SHR1210 is a humanized anti-programmed cell death receptor 1 (PD-1) antibody. We conducted a single arm exploratory study to evaluate the efficacy and safety of SHR-1210 plus gemcitabine and oxaliplatin (GEMOX) as first line treatment in patients (pts) with biliary tract cancer (BTC). Methods: Pts received SHR-1210 (3mg/kg, total dose ≤200mg, ivd, D1/2W) combined with gemcitabine (800 mg/m2, ivd, D1/2W) and oxaliplatin (85mg/m2, ivd, D2/2W). Combined chemotherapy lasted for no more than 8-12 cycles. Once chemotherapy intolerance occurred or at end of 12-cycle combined chemotherapy, pts with stable disease or objective response would continue to take SHR-1210 as single agent until disease progression or intolerable toxicity. Response was assessed every 8 weeks. Results: From February 2018 to Dec 15, 2018, 32 eligible pts were recruited, and 27 pts who had been treated for more than 2 months were included in this analysis. Median age was 64 (range 47-75) years. 16 pts were bile duct cancer, while 11 pts were gallbladder cancer. 26 pts can be evaluated for efficacy. Twelve pts achieved partial response (46.15%), 12 pts stable disease (46.15%), and 2 pts progressive disease. Pts with gallbladder cancer had the trend of higher objective response (63.64% vs 33.33%, p = 0.23) than those with cholangiocarcinoma. 19 pts had tissue sample for next generation sequencing. Gallbladder cancer had the tendency of higher median tumor mutation burden (TMB) than cholangiocarcinoma (8.1mut/Mb vs 5.4mut/Mb, p=0.33). Pts with high TMB(>8.6 mut/Mb, based on geenseeq BTC database) had significantly higher objective response than low TMB (100% vs 26%, p=0.0294). The most common grade ≥3 adverse events were nausea (18.52%),increased GGT (gammaglutamyltransferase,18.52%), hypokalemia(18.52%) and fatigue (18.52%). Conclusions: SHR-1210 plus GEMOX showed promising efficacy with tolerable adverse events for BTC pts. Gallbladder cancer pts seem to benefit more from this treatment. Tumor mutation burden may be a predictive factor for immunotherapy. Clinical trial information: NCT03486678.

Regulatory T cells are an important prognostic factor in breast cancer: a systematic review and meta-analysis

The clinical relevance of regulatory T cell (Treg) infiltration in breast cancer (BC) remains controversial, and no recent meta-analysis has been published on this subject. Our aim was to identify the precise relationship between Tregs and the prognosis and clinic-pathological features of BC. Eligible articles were identified with a MEDLINE database search over a period up to March 2015. Our meta-analysis was performed using STATA software 11.0 and Review Manager 5.3. The correlations between Treg infiltration and clinico-pathological features and BC prognosis were analyzed. Subgroup and sensitivity analyses, as well as meta-regression, were conducted. Eighteen published studies (including 8,562 patients) were eligible. Overall survival (OS) and disease-, recurrence-, and progression-free survival (DFS/RFS/PFS) were correlated with Treg infiltration (OR=2.03 (95% CI, 1.40-2.95; P=0.000) and 1.48 (95% CI, 1.00-2.19; P=0.050), respectively), including 3-, 5-, and 10-year mortality rates. In addition, low Treg infiltration was present in estrogen receptor (ER)-positive tumors (P=0.000), progesterone receptor (PR)-positive tumors (P=0.003), Her2-negative tumors (P=0.000) and histological grade I/II tumors (P=0.001). No publication bias was observed with the exception of OS. Subgroup analysis suggested that the mortality rate of the high Treg infiltration subgroup was increased compared with the low Treg infiltration subgroup among ER-positive patients. Treg infiltration indicated a poorer prognosis for BC and is related to ER, PR, and Her2 status and histological grade. Thus, Treg infiltration could help predict outcomes and guide clinical therapy.

The expressions of YAP1, β-catenin and survivin in colon cancer tissues and their clinical significance

We aimed to evaluate the effects of YAP1, β-catenin, and survivin on the onset and progression of colon cancer, and to explore their correlations. The expressions of YAP1, β-catenin, and survivin in 106 colon cancer tissues and 55 normal colon mucosa tissues were measured by immunohistochemical assay. The correlations between their expressions and clinical and pathological characteristics were analyzed. The expression rates of YAP1, β-catenin, and survivin in colon cancer tissues were significantly higher than those in normal colon mucosa tissues (P<0.001). The expressions of YAP1, β-catenin, and survivin in colon cancer were correlated with neither gender nor age (P>0.05), but with the degree of differentiation, depth of invasion, lymph node metastasis and Duke's stage (P<0.05). Pearson's correlation analysis showed that the expressions of YAP1, β-catenin, and survivin in colon cancer tissues were all positively correlated (P<0.05). The overexpression of YAP1, β-catenin, and survivin played an important role in the onset and progression of colon cancer, providing reference value for prognosis prediction.

[Comparation study of incidental irradiation dose to the internal mammary chain during postmastectomy radiotherapy for patients treated with different irradiation techniques]

Objective: To evaluated the unplanned coverage dose to the internal mammary chain (IMC) in patient treated with postmastectomy radiotherapy (PMRT). Methods: One hundred and thirty eight patients with breast cancer receiving radiotherapy (RT) in our hospital were retrospectively analyzed. Patients were divided into three groups: three-dimensional conformal radiotherapy (3D-CRT) group, forward intensity-modulated radiotherapy (F-IMRT) group and inverse IMRT (I-IMRT) group. The IMC were contoured according to Radiation Therapy Oncology Group (RTOG) consensus, and were not include into the planning target volume (PTV). The incidental irradiation dose to IMC among the three groups and the first three intercostal spaces IMC (ICS-IMC 1-3) were all compared, and explored the relationship between the mean doses (Dmean) of IMC and the OARs (ipsilateral lung and heart). Results: The dose delivered to IMC showed no difference in CRT, F-IMRT and I-IMRT(33.80 Gy, 29.65 Gy and 32.95 Gy). And 10.42%, 2.04%, and 9.76% patients achieved ≥45 Gy when treated with CRT, F-IMRT and I-IMRT. For the IMC dose in the first three intercostal spaces (ICS1-3), there was no difference to the three treatment plannings. The Dmean, V(20), V(30), V(40) and V(50) of the ICS-IMC2 and ICS-IMC3 were all obviously superior than ICS-IMC1 for all these three plannings. Moderate positive correlation was founded between Dmean for IMC and Dmean for heart for left breast cancer patients underwent CRT (r=0.338, P=0.01). Whereas for F-IMRT and I-IMRT groups, positive correlation were founded between Dmean for IMC and Dmean and V(20) for ipsilateral lung for all patients (F-IMRT: r=0.366, P=0.010; r=0.318, P=0.026; I-IMRT: r=0.427, P=0.005; r=0.411, P=0.008). Conclusions: In 3D-CRT, F-IMRT and I-IMRT planning methods, partial patients get IMC irradiated doses that could achieve therapeutic doses. Compared with 3D-CRT, F-IMRT and I-IMRT further reduced the dose of irradiated organs. However, there is no difference in the dose coverage of IMC for the three planned approaches when the IMC made an unplanned target.

Evaluation of overall survival rate of different therapies in the treatment of T1-T3 prostate cancer: a network meta-analysis

We performed this network meta-analysis (NMA) in order to compare the overall survival rate of six different therapies of T1-T3 prostate cancer (PC). The therapies include radiotherapy (RT), endocrine therapy (ET), Cryoablation (CRYO), radical prostatectomy (RP), RT+ET and RP+ET. Pubmed, Embase, Cochrane Library, Google Scholar, Web of Science and MEDLINE were searched to collect relevant literature from the inception of the study till February 2017. Cohort studies meeting the inclusion criteria were included in the study. A combination of direct and indirect evidence was performed to evaluate the odds ratio (OR) and draw surface under the cumulative ranking curves (SUCRA). Nine eligible cohort studies were included in this NMA, including 20,644 patients suffering from T1-T3 PC. The pairwise meta-analysis revealed that compared with the ET regimen, the RP and RP+ET regimens exhibited comparatively higher overall survival rates (OR = 2.81, 95%CI = 2.09 ~ 3.78; OR = 3.15，95%CI = 1.80 ~ 5.50, respectively). The results of SUCRA values demonstrated that the RP + ET regimen occupied the first place (89.5%) in terms of overall survival rate, and the RP regimen came second (84.83%). Thus, the RP+ET regimen had better efficacy in the treatment of T1-T3 PC in combined-therapeutic regimens, and the RP regimen presented better efficacy in mono-therapeutic regimen. Our findings indicate that the RP+ET regimen had better efficacy on improving the overall survival rate of T1-T3 PC patients, and the RP regimen ranked second.

In vitro and in vivo effects of miRNA-19b/20a/92a on gastric cancer stem cells and the related mechanism

We aimed to analyze the in vitro and in vivo effects of miRNA-19b/20a/92a on gastric cancer stem cells (GCSCs) and the related mechanism. GCSCs were cultured until adherence and differentiation, and subjected to miRNA microarray analysis to find and to verify miRNA deletion. Cells stably expressing lentivirus carrying miRNA-19b/20a/92a were constructed by transfection. The relationship between miRNA-19b/20a/92a and renewal of GCSCs was studied by the tumor sphere assay, and that between miRNA-19b/20a/92a and their proliferation was explored with MTT and colony formation assays. Target genes of miRNA for promoting the proliferation and self-renewal of GCSCs were found by using bioinformatics database, and verified by the reporter gene assay and Western blot. The expressions of miRNA-19b/20a/92a gradually decreased during the adherence and differentiation of GCSCs. The expressions of lentivirus carrying miRNA-17-19 gene in MKN28 and CD44^-/EpCAM^- cells were increased significantly. Transient transfection with pre-miRNA-19b/20a/92a elevated miRNA expressions in CD44^-/EpCAM^- and MKN28 cells, whereas transfection with pre-miRNA-19b/20a/92a antagonists reduced the expressions in SGC7901 and CD44⁺/EpCAM⁺ cells. Overexpression of lenti-miRNA-19b/20a/92a significantly enhanced the capability of GCSCs to form tumor spheres. In the presence of chemotherapeutic agent, the survival of lenti-miRNA-19b/20a/92a-infected cells was prolonged. Transient transfection with pre-miRNA-19b/20a/92a significantly increased the number of CD44⁺/EpCAM⁺ cells, but transfection with antagonists had the opposite outcomes. The stable miRNA-19b/20a/92a expression groups proliferated faster than the control group did. The proliferation of cells transfected with pre-miRNA-19b/20a/92a was accelerated, whereas that of cells transfected with the antagonists was decelerated. Compared with the control group, the number of colonies in the former group was higher, but that in the latter group was lower. miRNA-19b and miRNA-92a could bind the 3' untranslated region of HIPK1, while miRNA-20a was able to bind that of E2F1. Expressions of miRNA-20a and miRNA-92a in gastric cancer samples were negatively correlated with the prognosis of patients. miRNA-19b/20a/92a facilitated the self-renewal of GCSCs by targeting E2F1 and HIPK1 on the post-transcriptional level and activating the β-catenin signal transduction pathway. miRNA-92a was an independent factor and index predicting the prognosis of gastric cancer.

Butyrate and retinoic acid imprint mucosal-like dendritic cell development synergistically from bone marrow cells

Accumulating data show that the phenotypes and functions of distinctive mucosal dendritic cells (DCs) in the gut are regulated by retinoic acid (RA). Unfortunately, the exact role of butyrate in RA-mediated mucosal DC differentiation has not been elucidated thoroughly to date. Mucosal-like dendritic cell differentiation was completed in vitro by culturing bone marrow cells with growth factors [granulocyte-macrophage colony-stimulating factor (GM-CSF/interleukin (IL)-4], RA and/or butyrate. The phenotypes, cytokine secretion, immune functions and levels of retinal dehydrogenase of different DCs were detected using quantitative polymerase chain reaction (qPCR), enzyme-linked immunosorbent assay (ELISA) and flow cytometry, respectively. The results showed that RA-induced DCs (RA-DCs) showed mucosal DC properties, including expression of CD103 and gut homing receptor α₄ β₇ , low proinflammatory cytokine secretion and low priming capability to antigen-specific CD4⁺ T cells. Butyrate-treated RA-DCs (Bu-RA-DCs) decreased CD11c, but increased CD103 and α₄ β₇ expression. Moreover, the CD4⁺ T priming capability and the levels of retinal dehydrogenase of RA-DCs were suppressed significantly by butyrate. Thus, butyrate and retinoic acid have different but synergistic regulatory functions on mucosal DC differentiation, indicating that immune homeostasis in the gut depends largely upon RA and butyrate to imprint different mucosal DC subsets, both individually and collectively.

[A comparison of dosimetric variance for external-beam partial breast irradiation using three-dimensional and four-dimensional computed tomography]

Objective: To investigate the potential dosimetric benefits of four-dimensional computed tomography (4DCT) compared to three-dimensional CT (3DCT) in the planning of radiotherapy for external-beam partial breast irradiation (EB-PBI). Methods: Three-DCT and 4DCT scan sets were acquired for 20 patients who underwent EB-PBI. For each patient a conventional 3D conformal plan (3D-CRT) was generated based on end-inhalation phase (EI). The treatment plan based on the 4DCT EI phase images was copied and applied to the end-exhalation phase (EE) and 3DCT images (defined as EB-PBI(EI), EB-PBI(EE), EB-PBI(3D), respectively). Results: The median volumes of the tumour bed based on 3DCT, EI and EE were 20.99 cm(3,) 19.28 cm(3,) and 18.78 cm(3,) respectively. The tumour bed volume based on 3DCT was significantly greater than that of EI and EE volumes (P<0.05). The planning target volumes (PTV) coverage of EB-PBI(3D), EB-PBI(EI) and EB-PBI(EE) were 96.85%, 97.51%, 97.03%, respectively. The planning target volume (PTV) coverage of EB-PBI(3D) was significantly less than that of EB-PBI(EI) and EB-PBI(EE) (P<0.05). The median homogeneity indexs (HI) based on 3DCT, EI and EE were 0.13, 0.13, 0.13, respectively. The median conformal indexs (CI) based on 3DCT, EI and EE were 0.68, 0.69, 0.68, respectively. The median mean doses (D(mean)) based on 3DCT, EI and EE were 36.20 Gy, 36.20 Gy, 36.22 Gy, respectively. However there were no significant differences in the homogeneity index, conformity index and the mean dose of PTV between the three treatment plans (P>0.05). The EB-PBI(3D) plan resulted in the largest organs at risk dose (P<0.05). Conclusion: There was a significant benefit when using 4DCT to plan 3D-CRT for EB-PBI with regard to reduced non-target organ exposure, and might result in poor dose coverage when the PTV is determined using 3DCT.

[Value of low-dose multi-slice spiral CT chest scan in diagnosis of coal workers' pneumoconiosis]

Objective: To investigate the value of low-dose multi-slice CT (MSCT) chest scan in the diagnosis of coal workers' pneumoconiosis. Methods: A total of 90 patients with a confirmed diagnosis of coal workers' pneumoconiosis were enrolled, and under the conditions of fixed tube voltage, pitch, and slice thickness, they underwent CT scan with a normal dose (150 mA) and a low dose (30-50 mA). The quality of images obtained from two scans was compared, and the imaging findings, opacity profusion, stage, and radiation doses were also compared. Results: Compared with the normal-dose scan, low-dose scan increased the image noise, and the images obtained from scans with doses of 30, 40, and 50 mA did not show significant reductions in signal-to-noise ratio or contrast-to-noise ratio (P>0.05). There was no significant difference in the percentage of image quality between low-dose and normal-dose scans (P>0.05). There were no significant differences in the percentage of various imaging findings, opacity profusion, or percentage of different stages between low-dose (30, 40, and 50 mA) and normal-dose (150 mA) scans (P>0.05). Conclusion: There are no significant differences between low-dose MSCT chest scan and normal-dose CT in image quality, imaging findings of coal workers' pneumoconiosis, opacity profusion, and stage. Meanwhile, low-dose MSCT chest scan greatly reduces the radiation dose and can be used to assist the diagnosis and follow-up reexamination of coal workers' pneumoconiosis and cover the shortage of high-kilovoltage chest X-ray.

[Cone beam CT-derived adaptive radiotherapy for setup error assessment and correction in whole breast intensity modulated radiotherapy]

OBJECTIVE

To quantify the setup error (SE) in breast cancer patients treated with intensity modulated radiotherapy (IMRT) based on cone beam CT (CBCT), and to explore the feasibility of using several CBCT scans to presume and correct SE in the treatment for breast cancer patients.

METHODS

Eighteen breast cancer patients after breast conserving surgery who underwent whole breast IMRT were included in this study. Three dimensional interfraction motion before and after on-line CBCT-based corrections were quantified. The on-line CBCT-based corrections were performed using automated greyscale match. The system SE (Σ) and random error (σ) were calculated for each patient based on the consecutive multiple online scanning based on CBCT (≥5). The trends in magnitudes of Σ and σwere assessed during the treatment.

RESULTS

The magnitude variation of Σ was less than 1 mm before and after on-line CBCT-based corrections. As the CBCT scanning times increase (before 10 times), the Σ in anteroposterior (AP) direction was increased significantly, and σin three dimensional directions was also increased after 7 times of CBCT scanning. After on-line CBCT-based corrections, the Σ showed a steady trend by variation near zero for the first 20 times irradiation; but after 20 times, the Σ in AP and superoinferior (SI) directions was increased slightly (less than 0.5 mm), and σdecreased in three-dimensional directions. There were no significant differences for Σ, σand setup margin (SM) before and after on-line CBCT-based corrections in all three directions (P>0.05).

CONCLUSIONS

For breast cancer patients who underwent IMRT after breast conserving surgery, the setup error is relatively stable during the whole irradiation. The first 5 CBCT scans are suitable to presume and correct SE, and also can be used as the right time for adaptive radiotherapy planning revision.