[Doublecortin-like kinase 1 activates Hippo pathway to promote migration, invasion and proliferation of pancreatic cancer cells]

Objective: To explore the mechanism of Doublecortin-like kinase 1 (DCLK1) in promoting cell migration, invasion and proliferation in pancreatic cancer. Methods: The correlation between DCLK1 and Hippo pathway was analyzed using TCGA and GTEx databases and confirmed by fluorescence staining of pancreatic cancer tissue microarrays. At the cellular level, immunofluorescence staining of cell crawls and western blot assays were performed to clarify whether DCLK1 regulates yes associated protein1 (YAP1), a downstream effector of the Hippo pathway. Reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) was used to analyze the expressions of YAP1 binding transcription factor TEA-DNA binding proteins (TEAD) and downstream malignant behavior-promoting molecules CYR61, EDN1, AREG, and CTGF. Transwell test of the DCLK1-overexpressing cells treated with the Hippo pathway inhibitor Verteporfin was used to examine whether the malignant behavior-promoting ability was blocked. Analysis of changes in the proliferation index of experimental cells used real-time label-free cells. Results: TCGA combined with GTEx data analysis showed that the expressions of DCLK1 and YAP1 molecules in pancreatic cancer tissues were significantly higher than those in adjacent tissues (P<0.05). Moreover, DCLK1was positively correlated with the expressions of many effectors in the Hippo pathway, including LATS1 (r=0.53, P<0.001), LATS2 (r=0.34, P<0.001), MOB1B (r=0.40, P<0.001). In addition, the tissue microarray of pancreatic cancer patients was stained with multicolor fluorescence, indicated that the high expression of DCLK1 in pancreatic cancer patients was accompanied by the up-regulated expression of YAP1. The expression of DCLK1 in pancreatic cancer cell lines was analyzed by the CCLE database. The results showed that the expression of DCLK1 in AsPC-1 and PANC-1 cells was low. Thus, we overexpressed DCLK1 in AsPC-1 and PANC-1 cell lines and found that DCLK1 overexpression in pancreatic cancer cell lines promoted YAP1 expression and accessible to the nucleus. In addition, DCLK1 up-regulated the expression of YAP1 binding transcription factor TEAD and increased the mRNA expression levels of downstream malignant behavior-promoting molecules. Finally, Verteporfin, an inhibitor of the Hippo pathway, could antagonize the cell's malignant behavior-promoting ability mediated by high expression of DCLK1. We found that the number of migrated cells with DCLK1 overexpressing AsPC-1 group was 68.33±7.09, which was significantly higher than 22.00±4.58 of DCLK1 overexpressing cells treated with Verteporfin (P<0.05). Similarly, the migration number of PANC-1 cells overexpressing DCLK1 was 65.66±8.73, which was significantly higher than 37.00±6.00 of the control group and 32.33±9.61 of Hippo pathway inhibitor-treated group (P<0.05). Meanwhile, the number of invasive cells in the DCLK1-overexpressed group was significantly higher than that in the DCLK1 wild-type group cells, while the Verteporfin-treated DCLK1-overexpressed cells showed a significant decrease. In addition, we monitored the cell proliferation index using the real-time cellular analysis (RTCA) assay, and the proliferation index of DCLK1-overexpressed AsPC-1 cells was 0.66±0.04, which was significantly higher than 0.38±0.01 of DCLK1 wild-type AsPC-1 cells (P<0.05) as well as 0.05±0.03 of DCLK1-overexpressed AsPC1 cells treated with Verteporfin (P<0.05). PANC-1 cells showed the same pattern, with a proliferation index of 0.77±0.04 for DCLK1-overexpressed PANC-1 cells, significantly higher than DCLK1-overexpressed PANC1 cells after Verteporfin treatment (0.14±0.05, P<0.05). Conclusion: The expression of DCLK1 is remarkably associated with the Hippo pathway, it promotes the migration, invasion, and proliferation of pancreatic cancer cells by activating the Hippo pathway.

[Dermatophagoides farinae induces conjunctival epithelial cell damage to promote neutrophil migration and neutrophil extracellular traps formation]

OBJECTIVE

To investigate the mechanisms underlying allergic conjunctivitis caused by conjunctival epithelial cell damage, neutrophil migration and neutrophil extracellular traps (NETs) formation induced by crude extracts of Dermatophagoides farinae mite (CDM).

METHODS

Human conjunctival epithelial cells were stimulated with 500, 1 000, 2 000, 4 000 ng/mL, and the expression levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ) and IL-8 were detected using quantitative real-time PCR (qPCR) assay and enzyme-linked immunosorbent assay (ELISA). The culture supernatant of human conjunctival epithelial cells was collected and co-cultured with neutrophils. Neutrophil migration was measured using Transwell migration assay, and the expression of NETs markers myeloperoxidase (MPO) and citrullinated histone H3 (CitH3) was quantified using immunofluorescence staining. Neutrophils were stimulated with phorbol 12-myristate 13-acetate (PMA), and then NETs were collected for treatment of human conjunctival epithelial cells. Cell apoptosis was detected using flow cytometry, and the levels of IL-6, TNF-α, IFN-γ and IL-8 were measured in the cell culture supernatant using ELISA.

RESULTS

Treatment with CDM at concentrations of 2 000 ng/mL and 4 000 ng/mL up-regulated IL-6, TNF-α, IFN-γ and IL-8 expression in human conjunctival epithelial cells. Following treatment with CDM at concentrations of 2 000 ng/mL and 4 000 ng/mL, the culture supernatant of human conjunctival epithelial cells promoted neutrophil migration and induced increases in the staining intensity of MPO and CitH3. In addition, increased NETs triggered the apoptosis of human conjunctival epithelial cells and IL-6, TNF-α, IFN-γ and IL-8 secretion in the culture supernatant of human conjunctival epithelial cells.

CONCLUSIONS

CDM induces human conjunctival epithelial cell damages, thereby promoting neutrophil migration and NETs formation, while the release of NETs further aggravates human conjunctival epithelial cell damages.

A Biomass-Based Colorimetric Sulfur Dioxide Gas Sensor for Smart Packaging

Sulfur dioxide (SO₂) gas, which can effectively prohibit the growth of pathogenic microorganisms, has been internationally used in commercial food packaging to maintain high-quality food and reduce the incidence of foodborne illnesses. However, the current mainstream methods for SO₂ detection are either large and expensive instruments or synthesized chemical-based labels, which are not suitable for large-scale gas detection in food packaging. Recently, we discovered that petunia dye (PD), which is extracted from natural petunia flowers, demonstrates a highly sensitive colorimetric response to SO₂ gas with its total color difference (ΔE) modulation reaching up to 74.8 and detection limit down to 1.52 ppm. To apply the extracted petunia dye in smart packaging for real-time gas sensing and food-quality prediction, a flexible and freestanding PD-based SO₂ detection label is prepared by incorporating PD in biopolymers and assembling the films through a layer-by-layer approach. The developed label is utilized to predict grapes' quality and safety by monitoring the embedded SO₂ gas concentration. The developed colorimetric SO₂ detection label could potentially be used as an intelligent gas sensor for food status prediction in daily life, food storage, and supply chains.

[Efficacy and safety of neoadjuvant toripalimab combined with nimotuzumab and chemotherapy in patients with unresectable stage Ⅳ squamous cell carcinoma of penis]

Objective: To compare the efficacy and safety of neoadjuvant chemotherapy alone or combined with toripalimab and nimotuzumab in patients with unresectable locally advanced or metastatic squamous cell carcinoma of penis. Methods: A total of 33 patients with unresectable squamous cell carcinoma of penis undergoing neoadjuvant chemotherapy alone or combined with toripalimab and nimotuzumab at Sun Yat-sen University Cancer Center from May 2015 to June 2021 were enrolled retrospectively. All the patients were male, with a median age (M(IQR))of 49.0 (13.5) years (range: 30 to 70 years). According to the therapy protocols, patients were divided into the chemotherapy group (16 cases) and the triple combination group (17 cases). Log-rank test was used to compare the progression-free survival and overall survival. χ² test or Fisher exact method was used to compare the objective response rate, pathological down-stage rate and adverse events between these two groups. Results: The follow-up time was 28.1(19.2) months (range: 1.5 to 33.4 months). Patients of triple combination group were observed significantly longer progression-free survival (30.0 months vs. 8.2 months, χ²=3.998, P=0.046) than those of chemotherapy group. The median overall survival of the triple combination group and chemotherapy group were not reached and 15.2 months (χ²=3.298, P=0.069), respectively. Although there was no significant difference in the subsequent surgical resection rate between these two groups (12/17 vs.11/16, P=1), the objective response rate and the pathological complete response rate in triple combination group were significantly higher than in chemotherapy group (13/17 vs. 6/16, χ²=5.125, P=0.024; 6/7 vs. 0, P=0.001). The main common grade 1 to 2 adverse events in the triple combination group were alopecia (16 cases), anemia (15 cases), and nausea (14 cases). The main common grade 1 to 2 adverse events in the chemotherapy group were anemia (14 cases), alopecia (12 cases), decreased appetite (12 cases), and nausea (11 cases). The incidence of adverse events ≥grade 3 was similar in the triple combination group and chemotherapy group (8/17 vs. 6/16, χ²=0.308, P=0.579). There was no grade 3 adverse event in both groups. Conclusion: Compared with traditional chemotherapy alone, chemotherapy combined with toripalimab and nimotuzumab provides longer progression-free survival and similar toxicity for unresectable stage Ⅳ squamous cell carcinoma of penis.

[Impact of different obesity patterns on coronary microvascular function in male patients with non-obstructive coronary artery disease]

Objective: This study sought to investigate the impact of different obesity patterns on coronary microvascular function in male patients with non-obstructive coronary artery disease. Methods: We retrospectively analyzed clinical data of male patients diagnosed with suspected coronary microvascular dysfunction (CMD) in the First Hospital of Shanxi Medical University between December 2015 and August 2021. All patients underwent the one-day rest and stress ¹³N-ammonia positron emission tomography myocardial perfusion imaging. Overall obesity was defined by body mass index (BMI) ≥28 kg/m² and abdominal obesity was defined by waist circumference ≥90 cm. Hyperemic myocardial blood flow (MBF)<2.3 ml·min^-1·g^-1 or coronary flow reserve (CFR)<2.5 were referred as CMD. All patients were grouped based on their BMI and waist circumference. MBF, CFR, the incidence of CMD, hemodynamic parameters, and cardiac function were compared among the groups. Results: A total of 136 patients were included. According to BMI and waist circumference, patients were categorized into 3 groups: control group (n=45), simple abdominal obesity group (n=53) and compound obesity group (n=38). Resting MBF did not differ between groups (F=0.02,P=0.994). Compared with the control group, hyperemic MBF was significantly lower in the simple abdominal obesity and compound obesity groups ((2.82±0.64) ml·min^-1·g^-1, (2.44±0.85) ml·min^-1·g^-1 and (2.49±0.71) ml·min^-1·g^-1, both P<0.05, respectively). Hyperemic MBF was comparable among the groups of patients with obesity (P=0.772). CFR was significantly lower in the simle abdominal obesity group compared with the control group (2.87±0.99 vs. 3.32±0.62,P=0.012). Compared with the control group, CFR tended to be lower in the compound obesity group (3.02±0.91 vs. 3.32±0.62,P=0.117). The incidence of CMD was significantly higher in both the simple abdominal obesity and compound obesity groups than in the control group (62.3%, 52.6% vs. 22.2%, both P<0.01, respectively). Waist circumference was an independent risk factor for male CMD (OR=1.057, 95%CI: 1.013-1.103, P=0.011). Conclusions: In male patients with non-obstructive coronary artery disease, abdominal obesity is associated with decreased coronary microvascular function. Male patients with simple abdominal obesity face the highest risk of CMD.

[Willingness of receiving influenza vaccine and its influencing factors among health care workers in Yangtze River Delta region from 2020 to 2021]

Objective: To analyze the willingness of receiving influenza vaccine and its influencing factors among health care workers (HCWs) in Yangtze River Delta region from 2020 to 2021. Methods: Convenient sampling method was adopted. From July 2020 to March 2021, 76 hospitals in Jiangsu, Zhejiang, Anhui and Shanghai provinces were selected according to the hospital level and job position, and a questionnaire survey was conducted on the willingness of receiving influenza vaccination. Logistic regression model was used to analyze the influencing factors of vaccination intention. Results: A total of 1 332 HCWs were investigated, with a ratio of male to female about 1∶3.2, and the length of working years was (15.07±9.75) years. A total of 614 HCWs had received influenza vaccine in 2019, with a vaccination rate of 46.09%. About 63.21% (842/1 332) of HCWs were willing to be vaccinated with influenza vaccine. The results of binary logistic regression analysis showed that the willingness of receiving influenza vaccine among HCWs in primary hospitals was higher than that in secondary hospitals (OR=0.573) and tertiary hospitals (OR=0.357). The willingness of HCWs who had received influenza vaccine in 2019 was higher than that of HCWs who had not received influenza vaccine (OR=0.226) and had unknown history of influenza vaccination (OR=0.228). The willingness of HCWs in departments of prevention, health care and infection was higher than that in departments of pre-examination, outpatient, emergency, pediatrics and respiratory (OR=1.670). Conclusion: The willingness of receiving influenza vaccination among HCWs in Yangtze River Delta region is high, but it is still lower than that in developed countries. It is necessary to strengthen publicity and education to improve the influenza immunization level of HCWs.

Knowledge and attitudes toward repetitive transcranial magnetic stimulation (rTMS) as a treatment for postpartum and peripartum depression

Introduction

Postpartum and peripartum depression are debilitating disorders that impact the mother and their ability to care for their children’s emotional, social, and physical needs. Current treatments include psychotherapy, pharmacotherapy, and electroconvulsive therapy. These treatments are moderately effective or come with side effects that can negatively impact mother and child. As a result, many mothers view some treatments as unacceptable while pregnant or breastfeeding. Over the last decade, repetitive transcranial magnetic stimulation (rTMS) has shown promise as an effective and safe treatment option for postpartum and peripartum depression. However, little is known regarding people’s knowledge and attitudes towards this emerging technology, with no research assessing this in Canada.

Objectives

We aim to identify gaps in knowledge and to assess attitudes toward rTMS as a treatment for postpartum and peripartum depression in mental health professionals, patients, and the general public living in Canada.

Methods

A mixed methods study design will be employed. The qualitative portion will consist of individual semi-structured interviews. An inductive thematic analysis will be completed. The quantitative portion will consist of an anonymous, self-administered survey shared through REDCap. Focus groups with rTMS experts will be conducted to inform survey creation.

Results

No resulst at this time.

Conclusions

Understanding gaps in knowledge and attitudes toward rTMS is the first step toward ensuring that everyone is well informed and able to access safe and effective treatments. With limited treatment options available to a postpartum and/or peripartum depression patients being well informed on all treatments is crucial towards accessing treatments that best suit their needs.

Disclosure

No significant relationships.

[Advances in research of interchangeable immunization with live attenuated Japanese encephalitis vaccines and inactivated vaccines]

Japanese encephalitis (JE) virus is the leading cause of vaccine-preventable encephalitis in Asia and the Western Pacific, which mainly invades central nervous system. Vaccination is the most important strategy to prevent JE. Currently, both live attenuated Japanese encephalitis vaccines (JE-L) and inactivated vaccines (JE-I) are in use. Due to the supply of vaccines and the personal choice of recipients, there will be a demand for interchangeable immunization of these two vaccines. However, relevant research is limited. By reviewing domestic and foreign research evidence, this article summarizes the current situation of the interchangeable use of JE-L and JE-I, and makes recommendations when the interchangeable immunization is in urgent need, so as to provide reference for practical vaccination and policymaking in China.

[Epidemiological characteristics and spatiotemporal clustering of hepatitis A in Zhejiang Province from 2010 to 2019]

Objective: To analyze the epidemiological characteristics and spatiotemporal clustering of hepatitis A in Zhejiang Province from 2010 to 2019. Methods: The data of hepatitis A incidence in Zhejiang Province from 2010 to 2019 were collected from the infectious disease surveillance system of China Information System for Disease Control and Prevention. ArcGIS 10.7 software was used for spatial autocorrelation analysis. SaTScan 9.6 software was used for spatiotemporal scanning analysis. SPSS 25.0 software was used for additional analysis. Results: Zhejiang Province has reported 5 465 cases of hepatitis A in 2010-2019 years, with an average annual incidence rate of 1.00/100 000, and periodicity and seasonality are not obvious. The incidence of male was higher than that of female (P=0.023), and the highest incidence rate was 50-59 years old. Spatial autocorrelation analysis showed that there was a positive spatial correlation between the incidence of hepatitis A in Zhejiang Province from 2010 to 2017, with the weakest correlation in 2010 (Moran's I =0.103, Z=1.769, P=0.049), and the strongest correlation in 2016 (Moran's I=0.328, Z=4.979, P=0.001). Spatiotemporal scanning analysis showed that there was spatial aggregation of hepatitis A in Zhejiang Province from 2010 to 2019, with a total of three aggregation areas identified. Among them, the mostly aggregation area was concentrated in Xiangshan county of Ningbo city, which covered 10 counties (cities and districts), including Ninghai county and Yinzhou district, and appeared from January 1 to June 30, 2012. Conclusion: The incidence level of hepatitis A in Zhejiang Province shows a stable fluctuation trend from 2010 to 2019, and the seasonal regularity is not obvious. The population group aged 50-59 years old is the key population. There is spatial aggregation in the epidemic situation of hepatitis A. Targeted prevention and control measures of hepatitis A should be done based on the law of spatiotemporal aggregation and local incidence.

Preparation and insecticidal performance of sustained-release cinnamon essential oil microemulsion

BACKGROUND

To improve the utilization rate of cinnamon essential oil and compensate for the shortcomings of its easy decomposition and oxidation, the microemulsion of cinnamon essential oil was prepared using Tween 80 and anhydrous ethanol as surfactant and cosurfactant, respectively. The effects of the surfactant type, K_m value, preparation temperature and aqueous pH on the quality of the microemulsion were studied via a pseudo-ternary phase diagram. The slow-release performance of cinnamon essential oil microemulsion and the control performance of the insect repellent package on the rice weevil were characterized.

RESULTS

The results showed that, when Tween 80 was used as a surfactant and anhydrous ethanol was used as a cosurfactant, the K_m value was 3:1, preparation temperature was 40 °C, aqueous pH was 5 and prepared cinnamon essential oil microemulsion was of the O/W type. The microemulsion had strong stability and a 81.5-nm concentrated particle size distribution, and possessed excellent embedding and sustained-release effects. The prepared insect repellent active package prolongs the use time and the effect of cinnamon essential oil. The repellent rate of the rice weevil was as high as 100% after 48 h, and the contact mortality and fumigation mortality rates of the rice weevil also reached 96.67% and 86.67%, respectively, after 96 h.

CONCLUSION

The prepared cinnamon essential oil microemulsion and active packaging had a good sustained-release effect. © 2021 Society of Chemical Industry.

[Evaluating the real-world vaccine effectiveness using a regression discontinuity design]

Estimating the actual real-world effectiveness of the vaccine is an essential part of the post-marketing evaluation. This regression discontinuity design (RDD) using observational data is designed to quantify the effect of an intervention when eligibility for the intervention is based on a defined cutoff as age, making it suited to estimate vaccine effects. This approach can avoid the high cost and ethical issues; overcome difficulties in the organization and practice process in randomized controlled trials, which leads to a higher level of causal inference evidence and more realistic results. Here, we describe key features of RDD in general, and then specific scenarios, with examples, to illustrate that RDD are an essential tool for advancing our understanding of vaccine effects.

Measurements of neutral particle energy spectrum on EAST using a time-of-flight low-energy neutral particle analyzer

The neutral particles generated by charge exchange reactions can play an important role in erosion of first wall materials in fusion devices. In order to measure the flux and energy of neutral particles to the first wall, a low-energy neutral particle analyzer (LENPA) based on the time-of-flight method has been developed and successfully applied on the Experimental Advanced Superconducting Tokamak (EAST)' to measure the neutrals with an energy of 20-3000 eV. The LENPA works in the counting mode, and the signal of photons is used as the reference for the flight time of neutrals. The energy spectrum of low-energy neutral particles on EAST has been obtained for the first time. The new diagnostics can help in understanding the neutral particle generation and deposition on the first wall materials in tokamaks under different plasma conditions.

POS1128 COMBINATION TREATMENT OF AR882, A NEW URAT1 INHIBITOR, AND XANTHINE OXIDASE INHIBITORS ALLOPURINOL OR FEBUXOSTAT: EFFECT ON URIC ACID, HYPOXANTHINE AND XANTHINE IN PLASMA OR SERUM AND URINE

Background:

Xanthine oxidase inhibitors (XOI) are commonly used as urate lowering therapy (ULT) for the treatment of gout. Allopurinol, the first-line treatment, demonstrates low response rate (< 40%), defined as serum urate (sUA) lowering effect below 6 mg/dL, in multiple large-scale clinical trials. As recommended in EULAR guidelines and other literatures, targeting sUA <5 mg/dL or even <4 mg/dL, provides a better opportunity to lower incidence of gout flare and resolution of tophi in gout patients. Febuxostat, a more potent XOI, has been classified as a second-line ULT agent due to increased cardiovascular risks in certain patient populations. For XOI intolerance and non-responders, replacing the agent with a potent URAT1 inhibitor or adding an URAT1 inhibitor onto a current treatment regimen provides opportunities to improve response rates in patients with refractory gout. AR882 is a uricosuric agent that blocks the reabsorption of uric acid in the apical side of renal tubule, hence increases excretion of uric acid into the urine. A phase 2a study has demonstrated the additive effects of AR882 in combination with allopurinol or febuxostat.

Objectives:

To evaluate the effect of AR882 alone or in combination with allopurinol or febuxostat on circulating levels and urinary excretion of hypoxanthine, xanthine and uric acid. Furthermore, to elucidate the contribution of each drug towards the combination effect in sUA lowering.

Methods:

Plasma, serum, and urine samples were collected from 17 patients with gout who received a once-daily dosing of AR882 50 mg, allopurinol 300 mg or febuxostat 40 mg, or in combination for one week in a phase 2a study. Samples were collected to measure hypoxanthine, xanthine and uric acid levels in plasma or serum and the amount of each excreted in the urine. Plasma Cmax and AUC and 24-hour urine excretion amount (mg) of hypoxanthine and xanthine were calculated by non-compartmental analysis method.

Results:

In monotherapy, AR882 demonstrated better sUA lowering effect (↓53%) compared to allopurinol (↓35%) or febuxostat (↓39%). Combination of AR882 and allopurinol lowered sUA by 66% while combination of AR882 and febuxostat lowered sUA by 71%. Based on the change of xanthine in plasma following combination treatments, it can be calculated that allopurinol contributed 28% of the urate lowering effect, whereas AR882 contributed 38% of the effect. Similarly, febuxostat contributed 33% of the urate lowering effect and AR882 contributed to about 36-38% of the effect when used in combination. The combination treatments significantly increased the response ratio for patients achieving sUA levels < 5 mg/dL, 4 mg/dL, and even 3 mg/dL. In the combination with allopurinol, 100%, 100%, 100%, and 44% patients achieved sUA < 6 mg/dL, < 5 mg/dL, 4 mg/dL, and 3 mg/dL, respectively. Similar results were seen with the combination of AR882 and febuxostat. Treatment with allopurinol or febuxostat alone resulted in 8 to 10-fold and 16-fold increases of xanthine exposure, respectively. The combination of AR882 and allopurinol or febuxostat showed approximately 5-8 fold or 13-fold increases in plasma xanthine, respectively. Treatment with allopurinol or febuxostat alone resulted in 2-3 fold increase in hypoxanthine exposure. Relative changes of hypoxanthine were not significantly different in the presence versus absence of AR882. Increased excretion of xanthine and hypoxanthine was also observed in urine. AR882 was well tolerated in gout patients, showing a similar safety profile to that observed in healthy volunteer studies.

Conclusion:

AR882 dose alone had no effect on plasma or urine hypoxanthine and xanthine levels. AR882 contributed to a greater portion of the serum urate lowering effects when used in combination with XO inhibitors, and with 100% of patients achieving levels below 4 mg/dL when combined with allopurinol. The use of AR882 in combination with XO inhibitors may provide an option for preventing flares as well as tophi reduction in advanced patients.

Disclosure of Interests:

Zancong Shen Employee of: arthrosi therapeutics, Chris Colton Employee of: Arthrosi therapeutics Inc, Rongzi Yan Employee of: Arthrosi therapeutics Inc, Elizabeth Polvent Employee of: Arthrosi therapeutics Inc, Vijay Hingorani Consultant of: Arthrosi therapeutics Inc, Shunqi Yan Employee of: Arthrosi therapeutics Inc, Li-Tain Yeh Employee of: Arthrosi therapeutics Inc.

POS1130 PHARMACOKINETICS AND SERUM URATE LOWERING EFFECTS OF AR882, A NOVEL, POTENT AND SELECTIVE URICOSURIC AGENT, IN PATIENTS WITH GOUT

Background:

AR882 is a novel, potent and selective uric acid transporter 1 (URAT1) inhibitor in Phase 2 development for the treatment of hyperuricemia and gout. In Phase 1 healthy subject studies, AR882 demonstrated good dose proportionality, a long effective half-life and sustained serum urate (sUA) lowering effects, consequently making it suitable for once-daily dosing. In addition, AR882 was well tolerated following single and multiple dosing.

Objectives:

This Phase 2a study evaluated the pharmacokinetics (PK), pharmacodynamics (PD), and safety of AR882 following monotherapy in patients with gout. PK and sUA lowering effects in patients with renal impairment and normal renal function were also compared.

Methods:

A total of 30 adults with gout (sUA >7 mg/dL) were enrolled and 28 had post-baseline PKPD assessments performed. AR882 was administered at escalating doses of 25, 50 and 75 mg, with each dose administered once daily for 7 days. Serial blood samples were collected to measure AR882 PK and sUA levels at the end of each treatment week. Urine samples were collected for assessment of uric acid excretion. Laboratory safety tests, vital signs, and electrocardiograms were collected throughout the study.

Results:

Following once daily administration in patients with gout, AR882 exposures increased dose proportionally between 25 and 75 mg. Mean sUA levels were maximally reduced from baseline (mean 8.9 mg/dL) to 5.6, 4.2 and 3.2 mg/dL at the 25-, 50- and 75-mg dose levels, respectively. The corresponding percent reductions were 36.8%, 52.7% and 61.5%. The effects were sustained throughout the entire dosing day with minimal fluctuation. In patients receiving 25 mg AR882 (N=9), 56% achieved sUA levels below 6 mg/dL. At 50 mg (N=28), 96% of patients had sUA levels below 6 mg/dL and 93% were below 5 mg/dL. At the 75 mg dose (N=8), all patients (100%) achieved levels below 5 mg/dL, and 88% were below 4 mg/dL. Among these 28 gout patients, 17 patients had normal renal function (CrCL>90 mL/min) and 11 patients had mild impairment (CrCL 60-90 mL/min). AR882 exposures were similar between patients with mild renal impairment and those with normal renal function. Both groups showed nearly identical sUA lowering effects following each 7-day dosing period. Response rates were also similar between these groups, including at the 50 and 75 mg dose levels. Consistent with its sUA lowering effects, dose-dependent increases in fractional excretion of uric acid were observed across all doses.

AR882 was well tolerated at all doses tested. All AEs were mild or moderate in severity and most were considered not related to study treatment. There were no serious AEs or AEs resulting in study drug discontinuation. There were no clinically significant laboratory or ECG abnormalities noted.

Conclusion:

In patients with gout, AR882 exhibited dose proportional increases in plasma exposure and dose-dependent reductions in sUA. Nearly all patients had sUA levels below 5 mg/dL at doses ≥50 mg, and about 90% of patients had sUA levels <4 mg/dL at 75 mg dosing. Similar PK exposures and sUA lowering effects were observed in patients with mild renal impairment compared to those with normal renal function. Current data suggest that AR882 50 mg may offer improved efficacy over existing standard-of-care for gout and AR882 75 mg may have utility in the treatment of patients with severe or refractory gout disease.

Figure 1.

Percent of Patients with sUA below 6 mg/dL, 5 mg/dL, 4 mg/dL or 3 mg/dL Following Once-Daily Oral Doses of AR882.

Table 1.

Mean (SD) sUA Levels Following Once-Daily Oral Doses of AR882.

TreatmentNTime (hr), sUA (mg/dL)061224Baseline308.8 (1.1)8.8 (1.1)9.0 (1.0)8.9 (1.1)25 mg96.1 (0.4)5.6 (0.4)5.6 (0.3)5.8 (0.4)50 mg284.7 (0.9)4.2 (0.9)4.3 (0.8)4.7 (1.0)75 mg83.7 (1.1)3.2 (0.9)3.2 (0.8)3.6 (1.0)50 mg (normal renal function)174.8 (1.1)4.3 (1.1)4.4 (0.9)4.8 (1.2)50 mg (mild impairment)114.5 (0.6)4.1 (0.6)4.3 (0.5)4.6 (0.6)

Disclosure of Interests:

Zancong Shen Employee of: Arthrosi Therapeutics Inc, Elizabeth Polvent Employee of: Arthrosi Therapeutics Inc, Vijay Hingorani Consultant of: Arthrosi Therapeutics Inc, Andrea Clouser Roche Employee of: Arthrosi Therapeutics Inc, Chris Colton Employee of: Arthrosi Therapeutics Inc, Rongzi Yan Employee of: Arthrosi Therapeutics Inc, Shunqi Yan Employee of: Arthrosi Therapeutics Inc, Li-Tain Yeh Employee of: Arthrosi Therapeutics Inc.

[Amiodarone promotes heat-induced apoptosis, inflammation and oxidative stress in mouse HL1 atrial myocytes]

OBJECTIVE

To investigate the injury types of atrial myocytes induced by heat exposure and the effect of amiodarone on heat-induced injuries in atrial myocytes.

OBJECTIVE

The optimal temperature for heat exposure and optimal concentration of amiodarone were determined by measuring the cell viability exposed to different temperatures and different concentrations of amiodarone. Heat exposure of HL1 atrial myocytes was conducted using a water bath, and the effect of amiodarone on cell viability was assessed with MTS method; cell apoptosis was detected using flow cytometry, and the levels of IL-1β, IL-6, TNF-α, SOD and MDA were detected with enzyme-linked immunosorbent assay (ELISA).

OBJECTIVE

Compared with the blank control cells, the cells exposed to a temperature of 52 ℃ showed a significantly decreased survival rate and a lowered SOD activity (P < 0.001) with increased IL-1β and MDA levels (P < 0.01) and markedly increased apoptosis rate and IL-6 level (P < 0.001). Compared with the heat exposure group, amiodarone resulted in significantly decreased survival rate of the atrial myocytes (P < 0.01), obviously decreased SOD activity (P < 0.05), and increased cell apoptosis rate (P < 0.05) and IL-1β, IL-6, MDA and TNF-α levels (P < 0.01 or 0.001).

OBJECTIVE

Heat exposure induces apoptosis, inflammation and oxidative stress in mouse HL1 atrial myocytes, and amiodarone can enhance the effects of heat exposure to aggravate the cell injuries.

The biological characters of Bmelav-like genes in the development of Bombyx mori

The ELAV/Hu family is a conserved multigene family of pan-neuronal RNA-binding protein involved in post-transcriptional regulation in metazoans. In Drosophila, three members of this family, ELAV, RBP9 and FNE, are involved in neuronal differentiation, gene expression regulation and so on. This family is less well characterized in Bombyx mori. Two orthologs BmELAV-like-1 (BmEL-1) and BmELAV-like-2 (BmEL-2) share 55%-71% and 47%-62% identity with that of in Drosophila and humans, respectively. Bmel-1 is ubiquitously expressed while Bmel-2 is expressed in the head and ovaries specifically. Proteins encoded by both genes are localized in nuclear and cytoplasm. The weight of body, cocoon, pupae and cocoon shell are differently affected in Bmel-1^- /-2^- mutants created using CRISPR/Cas9 technology. Mutations of both genes increase the expression of four silk protein genes, Fib-L, Fib-H, P25 and Ser-1. In addition, the oviposition ability of Bmel-2^- females is decreased. This study not only provides valuable insights into the functional roles of Bmelav-like genes in the growth, cocoon characters and regulation of silk protein genes expression, but also provides useful information for silkworm variety breeding.

[A preliminary study on the mixed teaching of human parasitology based on MOOC resources and the experimental teaching digital platform]

The mixed teaching model combines the advantages of traditional teaching and network teaching in the "Internet +" era, which has become one of the important trends in the higher education teaching development. In order to follow this development trend, the human parasitology teaching team makes a reasonable use of modern information techniques, actively promotes the construction and application of online resources, and conducts mixed online and offline teaching based on MOOC resources and the experimental teaching digital platform. This mixed teaching model has shown a positive impact on both teaching and learning among teachers and students; however, students' personalized independent and deep learning remains unsatisfactory. It is suggested that the online course resources construction, teaching design and digital literacy remain to be increased, so as to create a high-level, innovative and challenging online-offline mixed "golden course".

MicroRNA-338-3p inhibits the progression of bladder cancer through regulating ETS1 expression

OBJECTIVE

MicroRNA-338-3p (miR-338-3p) was reported to influence the metastasis and development of several human cancers. However, in bladder cancer (BC), the special function of miR-338-3p remains unknown. Here, we aimed at exploring the miR-338-3p function in the progression of BC.

PATIENTS AND METHODS

miR-338-3p and ETS1 expressions were examined by quantitative Real-time polymerase chain reaction (qRT-PCR) in BC samples. Following that, transwell assays for cell migration and invasion were performed. And MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay for cell proliferation was conducted as well. Western blot was employed to examine the epithelial-mesenchymal transition (EMT) marker expressions. Finally, the relationship between miR-338-3p and E26 transformation specific-1 (ETS1) was verified by luciferase reporter assay.

RESULTS

The decreased miR-338-3p expression was examined in BC cells. Moreover, miR-338-3p upregulation repressed cell proliferation ability in BC. Next, miR-338-3p upregulation also depressed cell metastasis and EMT in BC cells. Furthermore, ETS1 was a direct target of miR-338-3p and inversely associated with its expression. And upregulation of ETS1 partially rescued the suppression of miR-338-3p for cell proliferation and metastasis in BC.

CONCLUSIONS

Upregulation of miR-338-3p inhibited the proliferation, metastasis and EMT in BC by suppressing ETS, showing that miR-338-3p might block the development of BC through regulating ETS1 expression.

Cogeneration of hot electrons from multiple laser-plasma instabilities

Interactions of two-plasmon decay (TPD) and side-stimulated Raman scattering (SSRS) were studied using three-dimensional particle-in-cell simulations under inertial-confinement-fusion-relevant conditions for linearly and circularly polarized lasers. In the linear stage, SSRS took place under n_{e}=0.235n_{c} and TPD dominated near the quarter-critical density surface and their growth rates agreed with theory. In the nonlinear stage, SSRS reduced TPD through pump depletion. Hot electrons were found to be first accelerated by SSRS plasma waves and then by TPD plasma waves through a cogeneration mechanism. Compared to the linearly polarized case with the same laser intensity, both SSRS and TPD were reduced due to the lower laser amplitude in the circularly polarized case. As a result, a 30% decrease in hot electron flux was observed.

A simple program for fast tilting electron-beam sensitive crystals to zone axes

Tilting crystals to proper zone axes is a necessary but tedious work in taking selected area electron diffraction patterns (SAED) and high-resolution images using transmission electron microscope (TEM). This process not only costs a lot of time but also limits the application of TEM in electron-beam sensitive materials. Therefore, it is desirable to develop a simple method for tilting crystals from random orientations to a specific zone axis quickly. Herein, we describe a novel program, Zones, which can index the electron diffraction pattern and calculate the tilting angles of a double-tilt sample holder from the current orientation to a desired zone axis. It can also bring crystals that are slightly deviated from a zone axis to the exact zone with the help of Laue ring in the diffraction pattern. This program has been successfully applied to studies of zeolites and metal-organic frameworks (MOFs), known as being electron-beam sensitive. The program shows its power not only in saving the operator's time but also in preventing the crystals from quick beam damages.

Three-dimensional particle-in-cell modeling of parametric instabilities near the quarter-critical density in plasmas

The nonlinear regime of laser-plasma interactions including both two-plasmon decay (TPD) and stimulated Raman scattering (SRS) instabilities has been studied in three-dimensional (3D) particle-in-cell simulations with parameters relevant to the inertial confinement fusion (ICF) experiments. SRS and TPD develop in the same region in plasmas, and the generation of fast electrons can be described accurately with only the full model including both SRS and TPD. The growth of instabilities in the linear stage is found to be in good agreement with analytical theories. In the saturation stage the low-frequency density perturbations driven by the daughter waves of the SRS side scattering can saturate the TPD and consequently inhibit the fast-electron generation. The fast-electron flux in 3D modeling is up to an order of magnitude smaller than previously reported in 2D TPD simulations, bringing it close to the results of ICF experiments.

Self-Similar Multimode Bubble-Front Evolution of the Ablative Rayleigh-Taylor Instability in Two and Three Dimensions

The self-similar nonlinear evolution of the multimode ablative Rayleigh-Taylor instability (ARTI) is studied numerically in both two and three dimensions. It is shown that the nonlinear multimode bubble-front penetration follows the α_{b}A_{T}(∫sqrt[g]dt)^{2} scaling law with α_{b} dependent on the initial conditions and ablation velocity. The value of α_{b} is determined by the bubble competition theory, indicating that mass ablation reduces α_{b} with respect to the classical value for the same initial perturbation amplitude. It is also shown that ablation-driven vorticity accelerates the bubble velocity and prevents the transition from the bubble competition to the bubble merger regime at large initial amplitudes leading to higher α_{b} than in the classical case. Because of the dependence of α_{b} on initial perturbation and vorticity generation, ablative stabilization of the nonlinear ARTI is not as effective as previously anticipated for large initial perturbations.

Spermatogenesis-associated 48 is essential for spermatogenesis in mice

Azoospermia, oligospermia and teratozoospermia all seriously impact male reproductive health. Spermatogenesis is a complex and precisely regulated process in which germ cells proliferate and differentiate and involves the regulation of multiple testis-specific genes. Here, we identified testis-specific gene spermatogenesis-associated 48 (SPATA48), the expression of which was age-dependent, indicating that it is involved in spermatogenesis. In humans and mice with azoospermia, expression of SPATA48 disappeared in the testis. Spata48-/- knockout male mice had smaller testis and defective spermatogenesis compared to wild-type (WT) mice. This study can help in the exploration of the genetic basis of male infertility and identify new targets for the diagnosis and treatment of male infertility.

Nonlinear excitation of the ablative Rayleigh-Taylor instability for all wave numbers

Small-scale perturbations in the ablative Rayleigh-Taylor instability (ARTI) are often neglected because they are linearly stable when their wavelength is shorter than a linear cutoff. Using two-dimensional (2D) and three-dimensional (3D) numerical simulations, it is shown that linearly stable modes of any wavelength can be destabilized. This instability regime requires finite amplitude initial perturbations and linearly stable ARTI modes to be more easily destabilized in 3D than in 2D. It is shown that for conditions found in laser fusion targets, short wavelength ARTI modes are more efficient at driving mixing of ablated material throughout the target since the nonlinear bubble density increases with the wave number and small-scale bubbles carry a larger mass flux of mixed material.

Synthesis of a lignin-based phosphorus-containing flame retardant and its application in polyurethane

In this work, new lignin-based flame retardant LHDs were successfully synthesized through the reaction between lignin, 9,10-dihydro-9-oxa-10-phosphaphenanthrene-10-oxide (DOPO) and hexamethylene diisocyanate (HDI). The chemical structure of LHD was characterized by FTIR, ¹H NMR, ³¹P NMR. The thermal stability of LHD was studied by TGA. The results showed that the residual carbon content of L15HD (15% of lignin in LHD) at 600 °C reached 16.55%, indicating that this prepared flame retardant can be a type of good char forming agent. LHDs were then applied to prepare flame-retardant lignin-based polyurethane (FLPU). Lignin-based polyurethane (LPU) was synthesized by the reaction between lignin, polyethylene glycol 200 (PEG 200) and hexamethylene diisocyanate (HDI). The limiting oxygen index (LOI) value of the FLPU reached 30.2% when the addition content of L15HD (15% lignin in LHD) in L₂₀PU (20% lignin in LPU) was 25%, exhibiting excellent flame-retardant properties. Scanning electron microscopy (SEM) analysis of the FLPU char residual showed that there was a continuous dense outer carbon layer on the residue surface, and the inner carbon layer had many expansion bubbles, indicating the LHDs have an excellent flame retardant effect for PU. In addition, FLPU presented better hardness and adhesion than PU. The hardness of F_L15-25L₂₀PU (lignin content in LPU was 20%, and added content of L15HD in LPU was 25%) reached 4H, and its adhesion was 0. These excellent properties illustrated that the LHDs are ideal flame retardants and reinforcing agents for LPU because of the co-curing and strong interface between LHD and LPU.

In this work, new lignin-based flame retardant LHDs were successfully synthesized through the reaction between lignin, 9,10-dihydro-9-oxa-10-phosphaphenanthrene-10-oxide (DOPO) and hexamethylene diisocyanate (HDI).

[Antibody persistence following on different vaccination strategies of domestic measles, mumps and rubella combined attenuated live vaccine: a 3-year follow-up study]

Objective: To assess the 3-year antibody persistence after vaccination of domestic measles, mumps and rubella combined attenuated live vaccine (MMR) with different program. Methods: Children from three different vaccination strategies (Group 8 m MR: 8 months and 18 months vaccinated with measles-rubella combined attenuated live vaccine and domestic MMR,respectively; Group 8 m MMR: 8 months and 18 months both vaccinated with domestic MMR; Group 12 m MMR: 12 months and 22 months both vaccinated with domestic MMR ) were followed up in Zhejiang province in July 2015. There were 170 participants in Group 8 m MR, 171 participants in Group 8 m MMR and 173 participants in Group 12 m MMR selected by simple random sampling method .Blood samples (venous blood 2-3 ml) were collected 1 month after the first dose vaccination of MMR (only in Group 8 m MMR and Group 12 m MMR) and 3 years (36-38 months) after the last dose vaccination of MMR and tested for antibody IgG against Measles, Mumps and Rubella using ELISA. Seropostive rate and Geometric mean concentration (GMC) were calculated and compared among different groups by Chi-square test or Fisher exact test and Kruskal-Wallis H test. Results: A total of 514 participants (8 m MR: 170; 8 m MMR:171; 12 m MMR:173) were enrolled. The overall seropositivity rate of measles, mumps and rubella was 98.1% (504), 93.4% (480) and 88.1% (453), respectively, with corresponding GMC was 1 012.33 mU/ml, 502.87 U/ml and 50.53 U/ml respectively. There was no significant difference of seropositivity rate for measles among three groups (all groups were>97%). The highest seropositivity rate for mumps was found in the Group 12 m MMR with the rate of 98.8% (171/173), followed by Group 8 m MMR and Group 8 m MR with 93.0% (159/171) and 88.2%(150/170) respectively (Fisher exact test, P<0.001). The highest seropositivity rate for rubella was also found in the Group 12 m MMR with the rate of 94.8% (164/173), followed by Group 8 m MMR and Group 8 m MR with 86.6%(148/171) and 82.9%(141/170) respectively (Fisher exact test, P=0.002). The highest GMC of antibody against measles, mumps and rubella were all found in Group 12 m MMR, with 1 217.30 (1 119.35-1 323.82) mU/ml, 717.07 (643.83-798.65) U/ml and 62.54(56.21-69.58) U/ml respectively. The lowest GMC of antibody against measles and mumps were both in Group 12 m MR with 812.01 (734.52-897.67) mU/ml and 363.28 (305.42-432.11) U/ml respectively. The lowest GMC of antibody against rubella was in Group 8 m MMR with 44.10 (39.08-49.76) U/ml. These differences of GMCs among three groups were all reach significant means (P<0.05). Conclusion: High level seropostive rates and GMCs were exist against measles and rubella after 3-year vaccination of domestic MMR among different program. Higher antibody level against mumps were found in those children with two doses vaccination of MMR.

Application of a Predictive Growth Model of Pseudomonas spp. for Estimating Shelf Life of Fresh Agaricus bisporus

For prediction of the shelf life of the mushroom Agaricus bisporus, the growth curve of the main spoilage microorganisms was studied under isothermal conditions at 2 to 22°C with a modified Gompertz model. The effect of temperature on the growth parameters for the main spoilage microorganisms was quantified and modeled using the square root model. Pseudomonas spp. were the main microorganisms causing A. bisporus decay, and the modified Gompertz model was useful for modelling the growth curve of Pseudomonas spp. All the bias factors values of the model were close to 1. By combining the modified Gompertz model with the square root model, a prediction model to estimate the shelf life of A. bisporus as a function of storage temperature was developed. The model was validated for A. bisporus stored at 6, 12, and 18°C, and adequate agreement was found between the experimental and predicted data.

[A Study on the establishment of immune thrombocytopenia model induced by anti-platelet GPⅠbα antibodies]

Objective: To establish primary immune thrombocytopenia (ITP) animal model induced by anti-platelet membrane glycoprotein GPⅠbα antibodies AN51 and R300. Methods: Twenty guinea pigs (6-8 week) were divided into 4 groups. Five guinea pigs in each group were intravenously injected with different doses of AN51 (0.05, 0.1, 0.2 μg/g) and 0.2 μg/g IgG as control. The whole blood was collected from inner angular venous plexus. Platelets number was determined by an automated cell counter and Swiss-Jim method. Then, the similar protocol was used to establish ITP nude mice model by intraperitoneal injection of different concentrations of anti-platelet GPⅠbα antibody R300, respectively. Results: ①Five minutes after intravenous injection of AN51 at 0.05, 0.1 and 0.2 μg/g, the platelet counts of guinea pigs reduced about 0-5%, 50%-60% and 70%-80% compared to the control group, respectively. The difference was statistically significant (P<0.01) . ②Six hours after intraperitoneal injection of R300 at 0.05, 0.1, 0.2 μg/g, the platelet counts of nude mice decreased about 20%-30%, 60%-70% and 80%-90% compared to the control group, respectively. The difference was statistically significant (P<0.01) . The nude mice, injected 0.2 μg/g R300 once a day for 2 weeks, showed typical ITP clinical manifestations including large number of petechiaes or ecchymoses on limbs, head and abdomen. Conclusion: AN51 at 0.2 μg/g and R300 at 0.2 μg/g could establish stable ITP model in guinea pigs and nude mice respectively.

Lactobacillus rhamnosus strain JB-1 reverses restraint stress-induced gut dysmotility

BACKGROUND

Environmental stress affects the gut with dysmotility being a common consequence. Although a variety of microbes or molecules may prevent the dysmotility, none reverse the dysmotility.

METHODS

We have used a 1 hour restraint stress mouse model to test for treatment effects of the neuroactive microbe, L. rhamnosus JB-1^™ . Motility of fluid-filled ex vivo gut segments in a perfusion organ bath was recorded by video and migrating motor complexes measured using spatiotemporal maps of diameter changes.

KEY RESULTS

Stress reduced jejunal and increased colonic propagating contractile cluster velocities and frequencies, while increasing contraction amplitudes for both. Luminal application of 10E8 cfu/mL JB-1 restored motor complex variables to unstressed levels within minutes of application. L. salivarius or Na.acetate had no treatment effects, while Na.butyrate partially reversed stress effects on colonic frequency and amplitude. Na.propionate reversed the stress effects for jejunum and colon except on jejunal amplitude.

CONCLUSIONS & INFERENCES

Our findings demonstrate, for the first time, a potential for certain beneficial microbes as treatment of stress-induced intestinal dysmotility and that the mechanism for restoration of function occurs within the intestine via a rapid drug-like action on the enteric nervous system.

A meta-analysis of serum p16 gene promoter methylation for diagnosis of nonsmall cell lung cancer

OBJECTIVES

To evaluate the diagnostic value of serum p16 gene promoter methylation for diagnosis of nonsmall cell lung cancer (NSCLC).

MATERIALS AND METHODS

By searching the databases of PubMed and CNKI, we included all the published articles related serum p16 gene promoter methylation and nonsmall lung cancer. The true positive, false positive, false negative, and true negative data for each included publication were extracted by the reviewers. The diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic (ROC) were pooled by MetaDiSc1.4 software.

RESULTS

Finally, 13 manuscripts with 1440 subjects were involving in this diagnostic meta-analysis. The pooled sensitivity and specificity were 0.25 (95% confidence interval [CI]: 0.18-0.32) and 0.95 (95% CI: 0.93-0.97), respectively, with randomized effect model. The pooled positive likelihood ratio and negative likelihood ratio were 5.08 (95% CI: 3.00-8.62) and 0.69 (95% CI: 0.62-0.77) with fixed effect model and randomized effect model, respectively. The diagnostic ROC curve for the included 13 publications was pooled by statistical software MetaDiSc14.0 according to the Bayes theorem. The pooled area under the ROC was 0.72 with its standard error of 0.10.

CONCLUSION

According to the published articles, high specificity and low sensitivity were found in this meta-analysis for the p16 gene promoter methylation in the diagnosis of NSCLC.