Chemoradiotherapy versus surgery after neoadjuvant chemoimmunotherapy in patients with stage III NSCLC: a real-world multicenter retrospective study

PURPOSE

The optimal treatment after neoadjuvant chemoimmunotherapy for patients with stage III non-small cell lung cancer (NSCLC) is unclear. This study aimed at comparing the efficacy and safety of chemoradiotherapy and surgery after neoadjuvant chemoimmunotherapy in stage III NSCLC.

MATERIALS AND METHODS

We conducted a real-world multicenter retrospective study on patients with stage III NSCLC who received surgery or chemoradiotherapy after neoadjuvant chemoimmunotherapy between October 2018 and December 2022. Progression-free survival (PFS) and overall survival (OS) were assessed from the initiation of neoadjuvant treatment and estimated by the Kaplan‒Meier method. Univariate and multivariate Cox regression models were used to examine potential prognostic factors. One-to-one propensity score matching (PSM) was used to further minimize confounding.

RESULTS

A total of 239 eligible patients were enrolled, with 104 (43.5%) receiving surgery and 135 (56.5%) receiving CRT. After 1:1 PSM, 1- and 2-year PFS rates in patients receiving radical surgery (rSurgery group) vs. patients receiving definitive cCRT (dCCRT group) were 80.0% vs. 79.2% and 67.2% vs. 53.1%, respectively (P = 0.774). One- and 2-year OS rates were 97.5% vs. 97.4% and 87.3% vs. 89.9%, respectively (P = 0.558). Patients in the dCCRT group had a numerically lower incidence of distant metastases compared to those in the rSurgery group (42.9% vs. 70.6%, P = 0.119). The incidence of treatment-related adverse events was similar in both groups, except that the incidence of grade 3/4 hematological toxicity was significantly higher in the dCCRT group (30.0% vs. 10.0%, P = 0.025).

CONCLUSION

Following neoadjuvant chemoimmunotherapy, definitive concurrent chemoradiotherapy may achieve noninferior outcomes to radical surgery in stage III NSCLC.

Induction chemoimmunotherapy may improve outcomes of chemoradiotherapy in patients with unresectable stage III NSCLC

Background

Currently, the value of induction chemoimmunotherapy before chemoradiotherapy (CRT) in unresectable stage III non-small cell lung cancer (NSCLC) has not been explored. This study was designed to explore the efficacy and safety of induction chemoimmunotherapy in patients with unresectable stage III NSCLC.

Methods

Unresectable stage III NSCLC patients who received CRT with or without induction chemoimmunotherapy between August 2014 and December 2021 were retrospectively enrolled. Progression-free survival (PFS) and overall survival (OS) were assessed from the initiation of treatment and estimated by the Kaplan-Meier method. The potential factors affecting PFS and OS were analyzed by univariate and multivariate Cox regression models. One-to-one propensity score matching (PSM) was used to further minimize confounding.

Results

A total of 279 consecutive patients were enrolled, with 53 (19.0%) receiving induction chemoimmunotherapy followed by CRT (I-CRT group), and the remaining 226 (81.0%) receiving CRT alone (CRT group). After PSM, the median PFS was 24.8 months in the I-CRT group vs. 13.3 months in the CRT group (P=0.035). The median OS was not reached (NR) vs. 36.6 months ((P=0.142). The incidence of treatment-related adverse events (TRAEs) was similar in both groups, except that the incidence of hematological toxicity was higher in the I-CRT group (77.1% vs. 58.3%, P=0.049). Compared to induction chemotherapy, induction chemoimmunotherapy demonstrated a superior objective response rate (60.4% vs. 22.2%, P<0.001) and further prolonged PFS (median NR vs. 13.2 months, P=0.009) and OS (median NR vs. 25.9 months, P=0.106) without increasing the incidence of TRAEs in patients receiving concurrent chemoradiotherapy.

Conclusion

Induction chemoimmunotherapy is safe and may improve outcomes of CRT in patients with unresectable stage III NSCLC. Moreover, induction chemoimmunotherapy may further improve treatment response and survival outcomes compared to induction chemotherapy before cCRT.

Azobenzene-Containing Liquid Crystalline Twisted Ribbons via Polymerization-Induced Hierarchical Self-Assembly

Polymerization-induced self-assembly incorporating liquid crystallization, as a polymerization-induced hierarchical self-assembly (PIHSA) method to produce polymeric particles with anisotropic morphologies facilely and efficiently, has drawn wide attention recently. However, the means of regulating the morphologies of liquid crystalline (LC) polymer assemblies still need to be explored. Herein, a route is presented to fabricate the twisted ribbons via PIHSA containing azobenzene based on poor reversible addition-fragmentation chain transfer (RAFT) control, called poorly controlled PIHSA. Cyano-4-(dodecylsulfanylthiocarbonyl)sulfanyl pentanoic acid-2-(2-pyridyldithio) ethyl ester is used as the RAFT agent with poor controllability, and the morphological evolution from ribbons to twisted ribbons can be observed in the corresponding PIHSA system. The formation mechanism of the twisted ribbons is studied systematically and the broad molecular weight distribution is considered to be the decisive factor. Moreover, the supramolecular chirality induced by symmetry breaking is also related to the twist of the ribbons. This study enriches the methods of controlling the morphologies of LC polymer particles and is helpful for further clarifying the mechanism of PIHSA.

Induction Immunotherapy vs. Consolidation Immunotherapy for Unresectable Stage III NSCLC

PURPOSE/OBJECTIVE(S)

Consolidation immunotherapy after chemoradiotherapy (CRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). However, whether upfront immunotherapy before CRT has similar benefits has not been addressed. This study aimed at exploring the efficacy and safety of induction immunotherapy for unresectable stage III NSCLC through real-world data.

MATERIALS/METHODS

Patients diagnosed with stage III NSCLC who received immunotherapy in combination with sequential (sCRT) or concurrent CRT (cCRT) between November 2018 and December 2021 were retrospectively identified. Patients were divided into induction (Ind), consolidation (Con) and induction plus consolidation (Ind+Con) immunotherapy groups. Progression-free survival (PFS) and overall survival (OS) were assessed from the initiation of treatment and estimated by Kaplan‒Meier method. The potential factors affecting PFS and OS were analyzed by univariate and multivariate Cox regression models.

RESULTS

One hundred and two patients were included, with 52 (51.0%) patients in the Ind group, 35 (34.3%) in the Con group and 15 (14.7%) in the Ind+Con group. Median PFS was 24.0 months vs. 36.0 months vs. 19.0 months in the three groups, and 2-year PFS were 43.0% vs 51.1% vs 44.4% (p = 0.940). Median OS was not reached (NR) vs. 44.0 months vs. NR, with a 2-year OS rate of 80.5% vs. 84.4% vs. 86.2% (p = 0.861). In the cCRT setting, 2-year PFS rates were 56.7% vs. 71.6% vs. 100.0% (p = 0.439), 2-year OS rates were 92.3% vs. 89.3% vs. 100.0% in the three groups (p = 0.827). In multivariate analysis, elder (HR = 0.487, p = 0.037) and cCRT (HR = 0.282, p = 0.001) were the independent factors favoring PFS, while only elder (HR = 0.088, p = 0.021) was the independent factors favoring OS. Adverse events were similar in the three arms. Further analysis found the objective response rate (ORR) and disease control rate (DCR) in the Ind and Ind+Con group after induction immunotherapy were 59.7% and 98.5%, respectively. Only 1 (1.5%) patient developed progression. Subgroup analysis showed no significant difference in PFS (p = 0.520) and OS (p = 0.116) between patients who responded to induction immunotherapy (PR+CR) and those who did not (SD+PD). Patients with <4 cycles of induction immunotherapy exhibited numerically better PFS than those with ≥4 cycles of induction immunotherapy (p = 0.113) and improved OS (p = 0.021).

CONCLUSION

Induction immunotherapy may achieve similar survival benefits to consolidation immunotherapy, and the combination of induction and consolidation immunotherapy with cCRT appears to achieve better outcomes. It seems feasible and safe to upfront immunotherapy before CRT, and further investigations on the combination of induction immunotherapy and CRT are warranted.

Antagonistic Activity of Oroxylin A against Fusarium graminearum and Its Inhibitory Effect on Zearalenone Production

Fusarium graminearum produces zearalenone (ZEA), a mycotoxin that is widely found in food and feed products and is toxic to humans and livestock. Piper sarmentosum extract (PSE) inhibits F. graminearum, and Oroxylin A appears to be a major antifungal compound in PSE. The aim of this study is to quantify the Oroxylin A content in PSE using UPLC-QTOF-MS/MS, and to investigate the antagonistic activity of Oroxylin A against F. graminearum and its inhibitory effect on ZEA production. The results indicate that Oroxylin A inhibits both fungal growth and ZEA production in a dose-dependent manner. Oroxylin A treatment downregulated the mRNA expression of zearalenone biosynthesis protein 1 (ZEB1) and zearalenone biosynthesis protein 2 (ZEB2). The metabolomics analysis of F. graminearum mycelia indicated that the level of ribose 5-phosphate (R5P) deceased (p < 0.05) after Oroxylin A treatment (64-128 ng/mL). Moreover, as the Oroxylin A treatment content increased from 64 to 128 ng/mL, the levels of cis-aconitate (p < 0.05) and fumarate (p < 0.01) were upregulated successively. A correlation analysis further showed that the decreased R5P level was positively correlated with ZEB1 and ZEB2 expression, while the increased cis-aconitate and fumarate levels were negatively correlated with ZEB1 and ZEB2 expression. These findings demonstrate the potential of Oroxylin A as a natural agent to control toxigenic fungi and their mycotoxin.

Concurrent chemoradiotherapy versus radiotherapy alone after induction chemoimmunotherapy for stage III NSCLC patients who did not undergo surgery: a single institution retrospective study

BACKGROUND

With remarkable success and few side effects, induction chemoimmunotherapy has been used to improve the prognosis of patients with resectable or potentially resectable non-small cell lung cancer (NSCLC), even in stage III disease. However, for patients who are medically inoperable, unresectable or refuse surgery after induction chemoimmunotherapy, it is unclear whether patients should be treated with concurrent chemoradiotherapy (cCRT) or radiotherapy (RT) alone considering patient safety and tolerability. This study aimed to determine whether cCRT is safe and superior to RT alone after chemoimmunotherapy for stage III NSCLC.

METHODS

Patients diagnosed with stage III NSCLC who received chemoimmunotherapy followed by cCRT/RT alone without surgery at Tianjin Cancer Hospital between November 2018 to December 2021 were retrospectively collected. Patients were divided into two groups: induction chemoimmunotherapy followed by cCRT (cCRT cohort) or RT alone (RT alone cohort). Kaplan-Meier method was used to estimate survival. Univariate and multivariate Cox regression models were adopted to estimate risk factors for PFS.

RESULTS

Sixty-five patients were included, with 44 (67.7%) received RT alone and 21 (32.3%) received cCRT. Patients in the cCRT group had significantly prolonged PFS (HR = 0.155, p = 0.004), LPFS (HR = 0.225, p = 0.029) and DMFS (HR = 0.028, p = 0.006) than those in the RT alone group. Albeit nonsignificant, a trend toward improved OS (HR = 0.030, p = 0.069) was also observed in the cCRT group. The multivariate analysis further confirmed that cCRT (HR = 0.141, p = 0.008) was the independent factor for promoting a favorable PFS. Treatment-related adverse events were similar between groups (p > 0.05). Patients with consolidation immunotherapy exhibited a trend of improved PFS (HR = 0.398, p = 0.274) and numerically better OS (HR = 0.018, p = 0.209) compared with those without.

CONCLUSIONS

For patients with unresectable stage III NSCLC, cCRT following chemoimmunotherapy appears to be safe and may prolong survival compared with radiotherapy alone. Further investigations on the combination of chemoimmunotherapy and CRT are warranted.

[STIP1 correlates with tumor immune infiltration and prognosis as a potential immunotherapy target: a pan-cancer bioinformatics analysis]

OBJECTIVE

To investigate the correlation of stress-inducible phosphoprotein 1 (STIP1) expression level with prognosis of different cancers and its potential role in immunotherapy.

METHODS

TCGA, TARGET and GTEx databases were used for bioinformatic analysis of STIP1 expression level and its prognostic value in different cancers. We also detected STIP1 expression immunohistochemically in 10 pairs of colorectal cancer and adjacent tissues. We further analyzed the correlation of STIP1 expression level with tumor mutational burden, microsatellite instability, immune cell infiltration, immune regulators and outcomes of different cancers. STIP1- related proteins were identified using protein- protein interaction (PPI) network analysis, and functional enrichment analysis was performed to analyze the regulatory pathways involving STIP1.

RESULTS

Bioinformatics analysis showed that STIP1 was highly expressed in most tumors compared with the normal tissues (P < 0.05), which was confirmed by immunohistochemistry of the 10 pairs of colorectal cancer tissues. STIP1 expression level was correlated with clinical stages of multiple cancers (P < 0.05), and in some cancer types, an upregulated STIP1 expression was correlated with a poor prognosis of the patients in terms of overall survival, disease-specific survival, disease-free survival and progression-free survival (P < 0.05). STIP1 expression was significantly correlated with tumor mutational burden, microsatellite instability, immune cell infiltration and immunomodulatory factors in most tumors (P < 0.05). PPI network analysis indicated that STIP1-related proteins included HSPA4, HSPA8, and HSP90AA1. KEGG enrichment analysis suggested that the high expression of STIP1 in liver cancer was related mainly with valerate metabolism, tryptophan metabolism, and butyrate metabolism pathways; HALLMARK enrichment analysis suggested high STIP1 expression in liver cancer was involved in bile acid and fatty acid metabolism.

CONCLUSION

STIP1 is up-regulated in multiple cancer types and its expression level is correlated with clinical tumor stage, tumor mutational burden, microsatellite instability, immune cell infiltration and immunomodulatory factors.

[Application of short-course radiotherapy with total neoadjuvant therapy in the treatment of middle and low rectal cancer]

Objective: To compare the efficacy and safety of short-course radiotherapy with total neoadjuvant therapy (SCRT-TNT) and neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced middle and low rectal cancer. Methods: A retrospective cohort study was carried out. A of 126 patients with locally advanced middle and low rectal cancer who were treated in the Department of Gastrointestinal Cancer Surgery of Fujian Cancer Hospital from September 2016 to March 2020 were enrolled, including 73 males and 53 females, with a mean age of (56.5±9.8) (23-77) years. Based on neoadjuvant regimen (nCRT treatment was performed before December 2018 and SCRT-TNT treatment was carried out after January 2019), patients were divided into nCRT group (n=68) and SCRT-TNT group (n=58). There were no statistically significant differences in age, sex, distance from tumor to anal verge, Eastern Cooperative Oncology Group (ECOG) performance status and clinical TNM stage between the two groups (all P>0.05). Patients in both groups received pelvic intensity-modulated radiotherapy (IMRT). The radiotherapy dose of nCRT group was 50Gy/25 times/5 weeks. Patients in nCRT group received oral capecitabine chemotherapy during radiotherapy and underwent surgery 6-8 weeks after chemoradiation. However, patients in SCRT-TNT group received CapeOX regimen (oxaliplatin+capecitabine) for 2 cycles of induction chemotherapy, followed by short-course radiotherapy (25Gy/5 times/5 days), then underwent a radical surgery two weeks after completion of consolidation chemotherapy (4 cycles). The adverse reactions, perioperative safety and efficacy of neoadjuvant therapy were compared and analyzed between the two groups. Results: Both groups completed neoadjuvant therapy as planned. Patients in nCRT group and SCRT-TNT group had similar incidence of adverse reactions to radiotherapy and chemotherapy, however, there were no statistically significant differences in the incidence of surgical complications, operation time, intraoperative blood loss and postoperative length of hospital stay (all P>0.05). A total of 119 patients underwent total mesenterectomy (TME), including 64 patients in the nCRT group and 55 patients in the SCRT-TNT group, all with R0 resection. The pathological complete response (pCR) rate was 10.9% (7/64) in the nCRT group and 25.5% (14/55) in the SCRT-TNT group, respectively, with a statistically significant difference (P=0.038). Two years after surgery, there was no statistically significant difference in local recurrence rate and overall survival rate between the two groups (both P>0.05). However, the clinical metastasis rate of SCRT-TNT group was significantly lower than that of nCRT group (20.3% vs 9.1%), with a statistically significant difference (P<0. 05). Conclusion: SCRT-TNT do not increase the adverse reactions of radio chemotherapy and perioperative risks in the treatment of locally advanced middle and low rectal cancer, and the tumor regression effect is good, which is worthy of clinical promotion.

[Surgical management of nipple areola complex in central breast cancer]

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.

Treatment-related adverse events as predictive biomarkers of efficacy in patients with advanced neuroendocrine tumors treated with surufatinib: results from two phase III studies

Background

No validated biomarkers currently exist for predicting the efficacy outcomes in patients with neuroendocrine tumors (NETs) treated with antiangiogenic therapy. We aimed to evaluate the association between treatment-related adverse events (TRAEs) and efficacy outcomes of surufatinib in patients with advanced NET.

Patients and methods

We included patients with NET treated with surufatinib in two multicenter, randomized, double-blind, placebo-controlled, phase III trials (SANET-p and SANET-ep) in this study. The main exposure was the presence of any of the TRAEs including hypertension, proteinuria, and hemorrhage in the first 4 weeks of surufatinib treatment. The primary outcome of the study was investigator-assessed progression-free survival (PFS). PFS outcomes were estimated using the Kaplan–Meier method with the log-rank test. Hazard ratios (HRs) were calculated by using univariable and multivariable Cox proportional hazard regression models. Blinded independent image review committee (BIIRC) assessments and 4-week landmark analysis were also performed as supportive evaluations.

Results

During the study period, a total of 242 patients treated with surufatinib were included in the analysis, and 164 (68%) patients had at least one of hypertension, proteinuria, and hemorrhage in the first 4 weeks of treatment. The presence of TRAEs in the first 4 weeks was associated with prolonged median PFS [11.1 versus 9.2 months; HR 0.67, 95% confidence interval (CI) 0.47-0.97; P = 0.036]. In multivariable Cox regression analysis, the presence of TRAEs was also significantly associated with longer PFS (HR 0.65, 95% CI 0.44-0.97; P = 0.035). Similar results were obtained in the BIIRC assessments and 4-week landmark analysis.

Conclusions

Treatment-related hypertension, proteinuria, and hemorrhage could be potential biomarkers to predict antitumor efficacy of surufatinib in patients with advanced NET. Future prospective studies are needed to validate the findings.

Trial registration

ClinicalTrials.govNCT02589821; https://clinicaltrials.gov/ct2/show/NCT02589821 and ClinicalTrials.gov NCT02588170; https://clinicaltrials.gov/ct2/show/NCT02588170

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Treatment-related hypertension, proteinuria, or hemorrhage is associated with longer survival in NETs.

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The association is confirmed by the BIIRC assessments and 4-week landmark analysis.

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TRAEs can be biomarkers to predict antitumor efficacy in patients with NET.

[Incision selection for nipple-sparing mastectomy with implant-based breast reconstruction]

Objective: To examine the outcome of different incision selection for nipple-sparing mastectomy (NSM) with implant-based breast reconstruction (IBBR). Methods: Ninety-Two cases accepted NSM and IBBR from totally 1 002 cases of breast cancer admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were analyzed retrospectively. All the patients were female, aging (42.0±7.5) years (range: 27 to 64 years). There were 12 patients at stage 0, 47 patients at stage Ⅰ, 17 patients at stage Ⅱ, and 16 patients at stage Ⅲ. The patients were divided in three groups by the incision: peri-areolar group (n=23), inframammary group (n=33) and lateral group (n=36). The age, tumor size, lymph node status, hormone receptor, operation method and postoperative complications were followed-up of three groups and compared by one-way ANOVA, χ² test or Fisher's exact test and expansion to comparied. Results: There was no significant difference in operation time ((180.7±54.0) minutes vs. (176.9±48.1) minutes vs. (194.6±37.5) minutes, F=1.401, P=0.252), postoperative drainage volume ((497.5±226.0) ml vs. (495.4±182.5) ml vs. (519.8±172.0) ml, F=0.167, P=0.846) and drainage time ((8.8±3.8) days vs. (8.0±2.5) days vs. (8.3±2.9) days, F=0.542, P=0.583) among the peri-areolar, inframammary, and lateral groups. The cumulative postoperative complications were relatively higher in the peri-areola group (26.1%(6/23) vs. 0 vs.8.3%(3/36), χ²=9.675, P=0.004). All female patients were followed up for (49.0±25.6) months(range: 12 to 112 months). Breast cancer related death rate was 2.2% (2/92), local recurrence was 1.1% (1/92), regional recurrence was 4.3% (4/92), distant metastasis was 6.5% (6/92), and the disease-free survival rate was 88.0% (81/92). Conclusion: The surgical effects of the peri-areolar, inframammary and lateral incisions for NSM and IBBR are approximate, the total complication rate of the peri-areolar incision is slightly higher.

POS0442 RELATIONSHIP BETWEEN PARAOXONASE-1 GENOTYPE, ACTIVITY AND MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING TOFACITINIB

Background:

Paraoxonase-1 (PON1) is a high-density lipoprotein (HDL)-associated enzyme with paraoxonase, lactonase and arylesterase activities.1 PON1 contributes to the antioxidant properties of HDL, and is being investigated for its atheroprotective properties.1 Patients (pts) with rheumatoid arthritis (RA) who are homozygous for the RR genotype of the Q192R gene polymorphism on PON1 (rs662) have increased paraoxonase activity, and lower risk of carotid plaques, vs those with QQ or QR genotypes.2 Tofacitinib is an oral Janus kinase inhibitor for the treatment of RA.

Objectives:

To investigate the relationship between PON1 genotype/activity and risk of major adverse cardiovascular events (MACE) in the tofacitinib RA clinical programme.

Methods:

In this post hoc analysis, data were pooled from pts enrolled in nine Phase 2/3 studies of tofacitinib in RA. Enzyme activities in pt plasma samples were measured at individual study baseline (BL) and at follow-up visits using three substrates: paraoxon (paraoxonase activity), dihydrocoumarin (lactonase activity) and phenylacetate (arylesterase activity). The effect of the PON1 Q192R genotype (QQ, QR or RR) on BL paraoxonase/lactonase/arylesterase activity was assessed using linear regression for each study, with age and sex as covariates, and then fixed-effect meta-analysis assessed effects across studies. The risk of MACE by enzyme activity was determined using Cox proportional hazards regression stratified by clinical studies. Univariate regression against BL enzyme activity and other risk factors, as well as both minimally and fully adjusted multivariable regressions against time-varying enzyme activity, are presented.

Results:

The analysis included 1969 pts with RA who received ≥1 dose of tofacitinib and had PON1 activity measures available at BL; 39 pts had ≥1 MACE event. Compared with the QQ genotype, the RR genotype had a highly significant positive association with BL paraoxonase activity, and a highly significant negative association with BL lactonase and arylesterase activity (Table 1). A univariate analysis identified several BL covariates significantly associated with risk of MACE (Figure 1a). Time-varying models found a highly significant association of increased paraoxonase activity over time with lower risk of future MACE, even after controlling for low-density lipoprotein or HDL cholesterol levels, and other traditional cardiovascular (CV) risk factors identified in univariate analysis (Figure 1b), with similar findings for lactonase and arylesterase (data not shown).

Table 1.

Effect of PON1 genotype (RR vs QQ) on BL enzyme activity

nEstimate95% CIp valueCochran’s Q testParaoxonase12291.0350.93, 1.141<0.00010.209Lactonase1188-0.375-0.505, -0.246<0.00010.025Arylesterase1231-1.016-1.382, -0.649<0.00010.251

Fixed-effects model; estimate >0 favours RR genotype and <0 favours QQ genotype

BL, baseline; CI, confidence interval

Conclusion:

Higher activity of the HDL-associated protein PON1 over time was associated with a significantly reduced risk of future MACE in pts with RA receiving tofacitinib, after controlling for traditional CV risk factors and cholesterol levels. Further investigation of PON1 as a novel functional lipid biomarker to assess CV risk in pts with RA is warranted.

References:

[1]Mackness & Mackness. Gene 2015; 567: 12-21.

[2]Charles-Schoeman et al. Arthritis Rheum 2013; 65: 2765-2772.

Acknowledgements:

Study sponsored by Pfizer Inc. Medical writing support was provided by Jennifer Higginson, CMC Connect, and funded by Pfizer Inc.

Disclosure of Interests:

Christina Charles-Schoeman Consultant of: AbbVie, Gilead, Pfizer Inc, Regeneron-Sanofi, Grant/research support from: AbbVie, Bristol-Myers Squibb, Pfizer Inc, Craig Hyde Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Shunjie Guan Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Neil Parikh: None declared, Jennifer Wang: None declared, Ani Shahbazian: None declared, Lori Stockert Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, John Andrews Shareholder of: Pfizer Inc, Employee of: Pfizer Inc

Inverse Bicontinuous Structure by Polymerization-Induced Self-Assembly Against Single-Chain Nanoparticles

Polymer particles with inverse bicontinuous structures have attracted considerable attention due to their diverse applications. The conventional generation requires controlling numerous key parameters under strict conditions, such as solvent property, polymer composition, and architecture. In order to improve the preparation efficiency within a broad window, we employed a method by polymerization-induced self-assembly (PISA) against intramolecularly folded single-chain nanoparticles (SCNPs). The SCNPs bear an active site for further polymerization. The SCNPs with smaller sizes facilitate easier controlling of the packing parameter above unity to meet the requirement of the unique structures. The concept is demonstrated by forming the inverse bicontinuous structure through PISA in ethanol against two SCNPs of P4VP(SCNP_x%)₃₅-CTA and P(PEGMA₂₀-co-TMSPMA₄)(SCNP_16.7%)-CTA. The unique structure is easily achieved when growing a relatively shorter polymer chain within a broad window. The work paves the avenue to prepare polymer particles with the unique structure in large scale, and other functional materials are expected by using the functional SCNPs or favorable growth of desired materials within the particles.

Synthesis of azobenzene-containing liquid crystalline block copolymer nanoparticles via polymerization induced hierarchical self-assembly

A facile synthesis of non-spherical photoresponsive azobenzene-containing liquid crystalline nanoparticles via polymerization-induced hierarchical self-assembly (PIHSA).

[Analysis of emergency venous sinus stenting in the treatment of acute visual impairment caused by idiopathic cranial hypertension]

Objective: To investigate the efficacy and safety of emergency venous sinus stenting in the treatment of acute visual impairment caused by idiopathic intracranial hypertension (IIH). Methods: A descriptive cross-sectional study design was used to retrospectively analyze 38 patients undergoing venous sinus stenting in the First Affiliated Hospital of Zhengzhou University from January 2013 to October 2019. A total of 9 patients who had sudden short-term vision loss met the inclusion criteria. Routine visual field and fundus examination were performed. The venous sinus stenosis (CVSS) was confirmed by MR venography or DSA. The pressure gradient at both ends of CVSS was ≥10 mmHg(1 mmHg=0.133 kPa). All patients were treated with emergency venous sinus stenting. Six-month follow-up data were collected for comparison, evaluation of the therapeutic effect, and observation of adverse reactions. Results: All 9 patients were successfully treated with venous sinus stent. The pressure gradient at the distal and proximal ends of the stenosis after stent implantation decreased to (2.3±1.2) mmHg. After 6 months of follow-up, the papilledema was significantly improved or disappeared in all patients. The average grade of papilledema decreased from 2.44±0.73 before operation to 0.56±0.53 after treatment (t=6.314, P<0.001). The visual acuity of 9 patients recovered to the pre-onset level or improved significantly after 6 months. The average baseline value of preoperative visual acuity (logMAR) was 0.12±0.11, which increased to 0.74±0.13 on average 6 months after operation (t=-10.827, P<0.001). No recurrence of symptoms or serious adverse reactions occurred in all patients during the follow-up period. Conclusion: For patients with acute visual impairment caused by idiopathic cranial hypertension, emergency venous sinus stenting is a relatively safe and effective treatment that can effectively improve visual acuity.

Clinical value of MRI T2-mapping quantitative assessment of carotid plaque

BACKGROUND

Stroke is a severe health problem, and magnetic resonance imaging (MRI) plays a significant role in stroke.

PURPOSE

To investigate the clinical value of MRI T2-mapping in carotid artery plaque.

MATERIAL AND METHODS

To locate the plaque in the carotid artery, 25 patients with carotid atherosclerosis were examined by 3.0-T MRI with three-dimensional (3D) time-of-flight and 3D fast spin-echo (FSE) T1-weighted scanning. The original images were obtained after T2-mapping (multi-spin-echo sequence) scanning. The T2 values of the plaque in the narrowest lumen were measured on T2 maps after postprocessing of the original images. Based on the symptoms, the patients were divided into two sub-groups; independent sample t-test was employed to compare the difference between the T2 values of the plaque in the two groups. We evaluated the optimal threshold and diagnostic efficacy of T2 values in predicting cerebrovascular symptoms by the receiver operating characteristic (ROC) curve.

RESULTS

The T2 values of the carotid artery plaque in symptomatic and asymptomatic patients were 111.43 ± 46.54 ms and 59.25 ± 39.77 ms, respectively (t = -3.421, P < 0.01). ROC analysis showed that the T2 value of 65.38 ms was the optimal threshold to predict cerebrovascular symptoms. The specificity, sensitivity, and accuracy attained were 94.1% (16/17), 93.3% (14/15), and 93.8% (30/32), respectively.

CONCLUSION

We quantitatively assessed carotid plaque components by MRI T2-mapping technology. The T2 values of the carotid plaque were associated with cerebrovascular symptoms. The T2 values of the symptomatic plaque group were significantly higher than those of the asymptomatic group.

Role of PTH1R Signaling in Prx1+ Mesenchymal Progenitors during Eruption

Tooth eruption is a complex process requiring precise interaction between teeth and adjacent tissues. Molecular analysis demonstrates that bone remodeling plays an essential role during eruption, suggesting that a parathyroid hormone 1 receptor (PTH1R) gene mutation is associated with disturbances in bone remodeling and results in primary failure of eruption (PFE). Recent research reveals the function of PTH1R signaling in mesenchymal progenitors, whereas the function of PTH1R in mesenchymal stem cells during tooth eruption remains incompletely understood. We investigated the specific role of PTH1R in Prx1⁺ progenitor expression during eruption. We found that Prx1⁺-progenitors occur in mesenchymal stem cells residing in alveolar bone marrow surrounding incisors, at the base of molars and in the dental follicle and pulp of incisors. Mice with conditional deletion of PTH1R using the Prx1 promoter exhibited arrested mandibular incisor eruption and delayed molar eruption. Micro-computed tomography, histomorphometry, and molecular analyses revealed that mutant mice had significantly reduced alveolar bone formation concomitant with downregulated gene expression of key regulators of osteogenesis in PTH1R-deficient cells. Moreover, culturing orofacial bone-marrow-derived mesenchymal stem cells (OMSCs) from Prx1Cre;PTH1R^fl/fl mice or from transfecting Cre recombinase adenovirus in OMSCs from PTH1R^fl/fl mice suggested that lack of Pth1r expression inhibited osteogenic differentiation in vitro. However, bone resorption was not affected by PTH1R ablation, indicating the observed reduced alveolar bone volume was mainly due to impaired bone formation. Furthermore, we found irregular periodontal ligaments and reduced Periostin expression in mutant incisors, implying loss of PTH1R results in aberrant differentiation of periodontal ligament cells. Collectively, these data suggest that PTH1R signaling in Prx1⁺ progenitors plays a critical role in alveolar bone formation and periodontal ligament development during eruption. These findings have implications for our understanding of the physiologic and pathologic function of PTH1R signaling in tooth eruption and the progression of PFE.

Abscopal effect of local irradiation treatment for thymoma: a case report

INTRODUCTION

With the rapid development of immunotherapy in recent years, growing clinical evidence suggests that a combination of radiotherapy and immunotherapy could improve the abscopal response rates and increase survival. However, observations on abscopal effects in patients receiving radiotherapy alone are still very rare. This study reports a rare case of a patient with type B3 thymoma with multiple lung metastases, who received localized irradiation.

CASE PRESENTATION

A 76-year-old Chinese woman was admitted to our hospital in November 2017, and her physical examination revealed a thymus mass with multiple lung metastases. Although the left lower lobe lesion was slightly larger than before, the patient presented with regression of the non-irradiated metastases after treatment with radiotherapy alone.

CONCLUSION

This patient experienced an apparent regression of metastatic mass, suggesting a radiation-induced abscopal effect.

Perpendicularly aligned nanodomains on versatile substrates via rapid thermal annealing assisted by liquid crystalline ordering in block copolymer films

The highly ordered perpendicularly aligned cylindrical and lamellar microdomains within block copolymer (BCP) films have important applications in diverse fields. However, the fast normal orientation of self-assembled nanostructures on arbitrary substrates without tedious pre- and postprocessing has been a challenging issue in manufacturing miniaturized devices. Here, we outline the potential for extending the hierarchical self-assembly within azobenzene-containing PS-b-PMA(Az) films to inherently assist in the formation of normally aligned domains using a rapid thermal annealing process (140 °C for 5 min). Liquid crystalline (LC) mesogens in PS-b-PMA(Az) films self-assemble to form a parallelly aligned sematic phase after thermal annealing, as confirmed by grazing-incidence small-angle X-ray scattering (GISAXS), wide-angle X-ray diffraction (WAXD) and ultraviolet-visible (UV-vis) spectra. This sub-phase contributes to broadening of the PS-cylinder-phase window (0.083 ≤ f _PS < 0.49) and ∼12 nm PS cylinder structures. Perpendicular cylinders or lamellae are observed on various substrates, such as silicon wafers, flexible polyethylene terephthalate (PET) sheets and conductive aluminum foils. Additionally, the good reactive ion etching (RIE) rate difference between the two blocks makes these BCPs more attractive for advancing the field of BCP lithographic applications for fabricating flexible microelectronic devices.

Palmatine alleviates hyperalgesia by inhibiting the expression of calcitonin gene-related peptide in the trigeminal ganglion of rats with chronic constriction injury of the infraorbital nerve

Trigeminal neuralgia is one of the most common of the neuropathic pains, and it can seriously influence patients' quality of life. Calcitonin gene-related peptide (CGRP) is a type of nociceptive neurotransmitter that is expressed in neurons of the trigeminal ganglion and plays a major part in transmitting pain. The rat model of trigeminal neuralgia was established by causing a chronic constriction injury of the infraorbital nerve (CCI-ION). Male Sprague-Dawley rats (n=24) were randomly divided into a sham control group (sham, n=6), sham-treated with palmatine group (sham+palmatine, n=6), trigeminal nerve model group (TN, n=6), and trigeminal nerve treated with palmatine group (TN+palmatine, n=6). Fifteen days after the operation the mechanical response threshold was decreased in the TN group compared with the sham group. From postoperative day 7 to day 15, the mechanical response threshold in the TN+palmatine group significantly increased compared with the TN group. On postoperative day 15 the results of quantitative polymerase chain reaction (qPCR), immunohistochemical staining, and western blotting showed an obvious increase in expression of CGRP and its receptors, serum concentrations of interleukin-1β (IL-1β), and tumour necrosis factor-α (TNF-α), and phosphorylation of protein kinase C (PKC) in the trigeminal ganglia of the TN group compared with the sham group, but these increases could be down-regulated by treatment with palmatine. Palmatine might therefore have therapeutic potential for the treatment of trigeminal neuralgia by inhibiting the expression of CGRP and its receptors in trigeminal ganglia, suppressing the serum concentrations of IL-1β and TNF-α, and decreasing the phosphorylation of PKC in the trigeminal ganglia of affected rats.

[Clinical analysis of 382 immediately breast reconstruction after mastectomy in Beijing City, Tianjin City and Hebei Province from 2012 to 2016]

Objective: To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province. Methods: A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ(2) test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ(2) test. Results: There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ(2)=47.028, P=0.000). Conclusions: There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients' demon.

One-Pot Synthesis of Cross-linked Block Copolymer Nanowires via Polymerization-Induced Hierarchical Self-Assembly and Photodimerization

Block copolymer (BCP) nanowires are crucially important in diversified fields. However, their applications typically suffer from a tedious fabrication process, heterogeneous morphology, and degradation. Herein, we propose a facile and robust approach to synthesize stilbene-containing BCP nanowires in homogeneous morphology with high stability at high solid content (5%-20% w/w) in one pot. It is realized by the polymerization-induced hierarchical self-assembly and subsequent photodimerization cross-linking under UV irradiation of stilbene mesogens in the core-forming block in the later stage of polymerization. Because of the strong liquid crystalline ordering and photodimerization of stilbene, the cross-linked nanowires can be obtained over a broad BCP composition, which show robust morphological stability when exposed to solvent dissolution tests and water dispersion stability tests. This efficient approach to stabilized nanowires with homogeneous morphology via in situ cross-linking would be useful in various fields, such as nanomedicine and Pickering emulsifiers.

A Contact-Sliding-Triboelectrification-Driven Dynamic Optical Transmittance Modulator for Self-Powered Information Covering and Selective Visualization

Triboelectrification-enabled self-powered flexible electronic/optical systems have aroused a new surge of interest in recent years. All-in-one integration of such a system, which could significantly improve its adaptability, operability, and portability, still remains a challenge due to the absence of suitable architectures and integration schemes. Herein, a previously reported self-powered optical switch (OS) is thoroughly remolded and upgraded to a fully integrated contact-sliding-triboelectrification-driven dynamic optical transmittance modulator (OTM). The OTM is constructed with a multilayered structure, comprising a transparent triboelectrification top layer, a SiO₂ -spaced polymer dispersed liquid crystal (PDLC) intermediate layer, and a flexible transparent conductive substrate. The working mechanism is that an alternating electric field can be induced once contact-sliding occurs upon the OTM, rendering the PDLC layer immediately switching its initial translucent state to an instantaneous transparent state. As such, a decent dimming range with the relative transmitted light intensity from 0.17 to 0.72 can be achieved at low mechanical thresholds of contact pressure (≈20 kPa) and sliding velocity (≈0.3 m s^-1 ). Moreover, for practical applications, demonstrations of information covering and selective visualization are successfully implemented without any extra optical elements nor external power supplies, explicitly showing great potential for the OTM in various self-powered optical interactive applications.

Light-Triggered Reversible Slimming of Azobenzene-Containing Wormlike Nanoparticles Synthesized by Polymerization-Induced Self-Assembly for Nanofiltration Switches

Photoresponsive wormlike block copolymer nanoparticles (NPs) have potential applications in versatile fields, but their preparation suffers from narrow worm phase region and tedious approaches. In this work, azobenzene-containing wormlike NPs based on poly(methylacrylic acid)-b-poly(4-((4-butylphenyl)diazenyl)phenyl methacrylate) are prepared via polymerization-induced self-assembly at high solids concentration in ethanol. The pure wormlike NPs occupy a remarkably broad region in the morphological phase diagram because of the rigid nature of the core-forming block. These wormlike NPs expand resulting from trans-cis transformation upon UV irradiation, and slim near to the original state via visible light irradiation. The diameter and its variation amplitude of worms increase with the chain length of core-forming block. Moreover, a nanofiltration switch for rhodamine B is assembled to illustrate one of its potential applications by remote trigger using light.

A Cut-and-Weld Process to 3D Architectures from Multiresponsive Crosslinked Liquid Crystalline Polymers

Crosslinked liquid crystalline polymers (CLCPs) have garnered extensive attention in recent years for their significant values in the design of light-driven soft actuators. However, poor processabilities due to the insoluble and infusible crosslinked networks prevent their practical applications severely. In this study, a weldable azobenzene-containing CLCP is designed with photo- and humidity-responsive actuations, which enables a cut-and-weld process to 3D CLCP architectures. The tensile properties and stability are almost unchanged after welding, much better than those of the films pasted by common adhesive tapes. Meanwhile, the mechanisms of the welding process are clarified on the base of surface hydrogen bonding and further crosslinking. By taking advantage of the cut-and-weld process, a 3D "claw" integrated into a robotic arm is realized for grabbing millimeter-scale objects by remote control. This work enhances significantly not only the processability of CLCP films but also the utilization of leftover pieces, which provides an efficient approach to create functional 3D structures from film precursors for the potential application in the smart materials.

Elastocapillary self-assembled neurotassels for stable neural activity recordings

Implantable neural probes that are mechanically compliant with brain tissue offer important opportunities for stable neural interfaces in both basic neuroscience and clinical applications. Here, we developed a Neurotassel consisting of an array of flexible and high-aspect ratio microelectrode filaments. A Neurotassel can spontaneously assemble into a thin and implantable fiber through elastocapillary interactions when withdrawn from a molten, tissue-dissolvable polymer. Chronically implanted Neurotassels elicited minimal neuronal cell loss in the brain and enabled stable activity recordings of the same population of neurons in mice learning to perform a task. Moreover, Neurotassels can be readily scaled up to 1024 microelectrode filaments, each with a neurite-scale cross-sectional footprint of 3 × 1.5 μm², to form implantable fibers with a total diameter of ~100 μm. With their ultrasmall sizes, high flexibility, and scalability, Neurotassels offer a new approach for stable neural activity recording and neuroprosthetics.

Light-Triggered Reversible Self-Engulfing of Janus Nanoparticles

Block copolymers containing azobenzene liquid crystalline (LC) mesogen are used to prepare snowman-like Janus nanoparticles (NPs) by emulsion solvent evaporation. The azobenzene-containing poly(methacrylate) (PMAAz) head of the Janus NPs is in the smectic LC phase with ordered stripes, which becomes amorphous and enlarged due to trans/cis transformation under UV irradiation. The expanded PMAAz can consequently engulf the other head. The self-engulfed NPs can recover to their original state in both shape and LC state via visible-light irradiation. This strategy is promising for programmable load and release of different payloads by remote trigger using light.

Liquid crystalline moiety-assisted perpendicular orientation of cylindrical domains within P4VP-b-PMA(Az) films with high aspect ratio

Block copolymer (BCP) films with perpendicularly aligned cylindrical domains of high aspect ratio have important applications in diverse fields. However, an aspect ratio of the cylinders as high as 200 has rarely been reported so far. Here we demonstrate an efficient route to the formation of normally aligned P4VP cylinders with high aspect ratio surrounded by a matrix of azobenzene-containing block (PMA(Az)) via hierarchical self-assembly. A crisscross structure, consisting of parallelly aligned liquid crystalline (LC) layers and normally aligned self-assembly domains, is expected to assist the formation of well-defined nanostructures. The LC layers in the cylindrical films self-assemble to form smectic phase after solvent annealing, as confirmed by WAXD and UV-vis spectra. We found that the aspect ratio of the vertical P4VP cylinders is up to 200 and the film thickness reaches 6 μm. P4VP is a functional polymer, making this P4VP-b-PMA(Az) film more suitable for advanced filters, multi-nanochannels, nanolithography, and high-density storage media, etc.

Formation of Anisotropic Liquid Crystalline Nanoparticles via Polymerization-Induced Hierarchical Self-Assembly

Polymeric nanoparticles (NPs) containing liquid crystalline (LC) mesogens with tunable anisotropic morphologies have applications in various fields, but their preparation typically suffers from tedious and low-throughput approaches. Here we present an efficient route to the preparation of anisotropic morphologies of azobenzene-containing block copolymers (BCPs) at high solids content via a polymerization-induced hierarchical self-assembly in ethanol. Various anisotropic NPs, including cuboids, short belts, lamellae, and ellipsoidal vesicles, have been obtained in a remarkably broad range of BCP compositions. The NPs exhibit a smectic phase with ordered stripes when observed under TEM. This internal LC ordering plays a significant role on the formation of these intriguing anisotropic morphologies. Morphological transitions from anisotropic to isotropic spheres can be obtained upon UV illumination due to the photoresponsive properties of the azobenzene mesogens. This work significantly expands the scope of accessible morphologies in PISA and suggests that the under explored LC BCPs may have an impactful role in the PISA field.

The deposition of metal nanoparticles on carbon surfaces: the role of specific functional groups

The influence of hydroxyl and carbonyl groups on the deposition of gold from solution onto graphite surfaces was explored: OH gives Au⁰ whereas CO results in Au³⁺.

Therapy of tacrolimus combined with corticosteroids in idiopathic membranous nephropathy

We evaluated the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN). One hundred seventy-seven biopsy-proven IMN patients were recruited in this retrospective clinical study. Sixty patients received TAC (target blood concentration of 4–8 ng/mL) and 117 patients received daily cyclophosphamide (CYC, 100 mg) combined with prednisone. Remission rates at the end of the first, second and third month in the TAC group were significantly higher than that in the CYC group (1st: 35.0 vs 19.7%, P<0.05; 2nd: 56.7 vs 38.5%, P<0.05; 3rd: 76.7 vs 59.0%, P<0.05). In the first 3 months, daily urinary protein and serum albumin in the TAC group obtained a better improvement than that in the CYC group (P<0.05). At the end of the sixth and the twelfth month, the remission rates, daily urinary protein and serum albumin were all comparable between the two groups (P>0.05). No significant difference of relapse rate between the groups was found (16.3 vs 12.0%, P>0.05). Patients were more likely to develop glucose intolerance in the TAC group. The TAC regimen obtained more benefits in treating IMN patients, especially in the first 3 months, than the CYC regimen.

[Endoscopic nipple-sparing mastectomy with skin lifting system followed by immediate breast reconstruction]

Objective: To discuss the surgical treatment and efficacy of endoscopic nipple-sparing mastectomy with skin lifting system (ENSMSLS) followed by immediate breast reconstruction. Methods: ENSMSLS was conducted on 21 patients followed by immediate breast reconstruction with implant via axillary incision from August 2014 to January 2016 in Oncology Center, Beijing Tongren Hospital, Capital Medical University. These 21 patients were frequency matched with 21 patients, who received nipple-sparing mastectomy via loop periareolar incision from November 2012 to May 2015 in the same center. These 21 patients formed the control group. The operation data of two groups were compared by t test and Fisher's exact test. Results: Differences in operation time ((185±43) minutes vs. (165±33) minutes, t=1.778, P=0.101), amount of bleeding ((60±48) ml vs. (75±57) ml, t=-0.535, P=0.329), and drainage ((240±112) ml vs. (201±91) ml, t=1.238, P=0.233) between these two groups of patients were not statistically significant. There was no nipple necrosis recorded in the ENSMSLS group, while there were three cases (14.3%) recorded in the control group. Two cases (9.5%) of nipple transposition were recorded in the ENSMSLS group, while five cases (23.8%) were recorded in the control group. Differences in nipple necrosis and nipple transposition were statistically significant (0 vs. 5, P=0.001). There were 16 cases (76.2%) of excellent appearance recorded in the ENSMSLS group, while there were 11 cases (52.4%) recorded in the control group. There were 5 cases (23.8%) of good appearance recorded in the ENSMSLS group, while there were 9 cases (42.9%) recorded in the control group. There was no case of fair appearance in the ENSMSLS group, while there was 1 case (4.8%) recorded in the control group. Difference in postoperative appearance was statistically significant (P=0.001). Conclusions: ENSMSLS significantly decreases the possibility of nipple necrosis and nipple transposition. This technique avoids visible incisions of breast. It also enhances the aesthetic appeal of reconstructed breasts.

Microbial Biofertilizer Decreases Nicotine Content by Improving Soil Nitrogen Supply

Biofertilizers have been widely used in many countries for their benefit to soil biological and physicochemical properties. A new microbial biofertilizer containing Phanerochaete chrysosporium and Bacillus thuringiensis was prepared to decrease nicotine content in tobacco leaves by regulating soil nitrogen supply. Soil NO3--N, NH4+-N, nitrogen supply-related enzyme activities, and nitrogen accumulation in plant leaves throughout the growing period were investigated to explore the mechanism of nicotine reduction. The experimental results indicated that biofertilizer can reduce the nicotine content in tobacco leaves, with a maximum decrement of 16-18 % in mature upper leaves. In the meantime, the total nitrogen in mature lower and middle leaves increased with the application of biofertilizer, while an opposite result was observed in upper leaves. Protein concentration in leaves had similar fluctuation to that of total nitrogen in response to biofertilizer. NO3--N content and nitrate reductase activity in biofertilizer-amended soil increased by 92.3 and 42.2 %, respectively, compared to those in the control, whereas the NH4+-N and urease activity decreased by 37.8 and 29.3 %, respectively. Nitrogen uptake was improved in the early growing stage, but this phenomenon was not observed during the late growth period. Nicotine decrease is attributing to the adjustment of biofertilizer in soil nitrogen supply and its uptake in tobacco, which result in changes of nitrogen content as well as its distribution in tobacco leaves. The application of biofertilizer containing P. chrysosporium and B. thuringiensis can reduce the nicotine content and improve tobacco quality, which may provide some useful information for tobacco cultivation.

Frailty in Relation to the Risk of Alzheimer's Disease, Dementia, and Death in Older Chinese Adults: A Seven-Year Prospective Study

OBJECTIVES

To explore the relationship of general health decline assessed by frailty and risk of dementia and Alzheimer's disease (AD).

DESIGN

A seven-year prospective cohort study.

SETTING

Secondary analysis of data from the Beijing Longitudinal Study on Aging.

PARTICIPANTS

Urban and rural community-dwelling people aged 60 and older at baseline.

MEASUREMENTS

Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 40 health deficits at baseline. Dementia was diagnosed by DSM-IIIR. AD and vascular dementia (VaD) were diagnosed by NINCDS-ADRDA and NINDS-AIREN. The relationships between frailty and the risk of dementia, AD and death were evaluated through multivariable models.

RESULTS

Of 2788 participants at baseline (1997), 171 (11.1%) reported a history of dementia. In seven years, 351 people developed dementia (13%: 223 AD and 128 other types of dementia) and 813 died (29%). After adjustment for age, sex, education, and baseline cognition, baseline frailty status significantly associated with Alzheimer's disease and dementia and death. For each deficit accumulated, the odds ratio of death increased by 5.7%, and the odds ratio of dementia increased by 2.9% (p < 0.001).

CONCLUSION

Frailty was associated with Alzheimer's disease and dementia over a seven years period. Frailty index might facilitate the identification of older adults at high risk of dementia for the application of the most effective, targeted prevention strategies.

HCV NS3Ag: a reliable and clinically useful predictor of antiviral outcomes in genotype 1b hepatitis C virus-infected patients

Since hepatitis C virus (HCV) non-structural 3 (NS3) protease inhibitor (PI) combined with pegylated interferon/ribavirin (PR) has been approved for chronic HCV genotype (GT) 1b infection, a reliable and clinically useful predictor combining with serum HCV RNA to predict early virologic response, breakthrough, and relapse is important during HCV antiviral treatment. We evaluated the role of HCV NS3 antigen (HCV NS3Ag) on the prediction of virologic response in patients with HCV GT1b during PR or PR/simeprevir (triple) therapy. Three hundred patients were recruited, and HCV RNA and HCV NS3Ag were tested at baseline and weeks 2, 4, 12, 24, 48, and 72. NS3Ag and HCV RNA were significantly related (r(2) = 0.67) in the whole patient selection. The kinetic pattern of HCV RNA and HCV NS3Ag during triple treatment was similar. HCV NS3Ag levels in the triple group closely followed those of HCV RNA; the r(2) values were 0.756 (baseline), 0.837 (2 weeks), 0.989 (4 weeks), and 0.993 (12 weeks), respectively. For patients treated with PR, the positive and negative predictive values (PPVs and NPVs) for viral response were 96.31 % and 67.19 %, respectively, at week 4 by using the decrease of NS3Ag (dHCV NS3Ag) combined with HCV RNA. At week 12, the PPV was similar at 94.16 %, while the NPV reached 87.26 %. The PPV and NPV for the prediction of relapse and breakthrough were 90.6 % and 76.7 %, respectively. HCV NS3Ag is a valuable marker and could be a supplementary predictor of HCV RNA for the prediction of antiviral response, breakthrough, or relapse during HCV antiviral treatment.

Effect of ranolazine on glycaemic control in patients with type 2 diabetes treated with either glimepiride or metformin

AIM

To report the results of two phase III trials assessing the efficacy of ranolazine for glycaemic control in patients with type 2 diabetes on metformin or glimepiride background therapy.

METHODS

In two double-blind trials we randomized 431 and 442 patients with type 2 diabetes to ranolazine 1000 mg twice daily versus placebo added to either glimepiride (glimepiride add-on study) or metformin background therapy (metformin add-on study). Patients receiving ranolazine added to metformin had their metformin dose halved (with the addition of a metformin-matched placebo) relative to the placebo group to correct for a metformin-ranolazine pharmacokinetic interaction. The primary endpoint of the trials was the change from baseline in glycated haemoglobin (HbA1c) at week 24.

RESULTS

When added to glimepiride, ranolazine caused a 0.51% least squares mean [95% confidence interval (CI) 0.71, 0.32] decrease from baseline in HbA1c at 24 weeks relative to placebo and roughly doubled the proportion of patients achieving an HbA1c of <7% (27.1 vs 14.1%; p = 0.001). When added to metformin background therapy, there was no significant difference in the 24-week HbA1c change from baseline [placebo-corrected LS mean difference -0.11% (95% CI -0.31, 0.1)].

CONCLUSIONS

Compared with placebo, addition of ranolazine in patients with type 2 diabetes treated with glimepiride, but not metformin, significantly reduced HbA1c over 24 weeks. The decreased dose of metformin used in the metformin add-on study complicates the interpretation of this trial. Whether an effective regimen of ranolazine added to metformin for glycaemic control can be identified remains unclear.

Isolation and characterization of novel polymorphic microsatellite loci in Perinereis aibuhitensis

Perinereis aibuhitensis is a commercially and ecologically important intertidal worm. In this study, eight polymorphic microsatellite loci were isolated in this species for the first time, and a wild population was used to estimate the properties of these loci. The number of alleles per locus ranged from 6 to 20, and the observed and expected heterozygosities ranged from 0.375 to 0.875 and from 0.590 to 0.946, respectively. These microsatellite loci will act as effective markers for related P. aibuhitensis studies, and the data will be helpful for the rational exploitation and conservation of this species.

Ordered mesoporous crystalline titania with high thermal stability from comb-like liquid crystal block copolymers

Ordered mesoporous crystalline titania with high thermal stability was synthesized by using a comb-like liquid crystal block copolymer PEO-b-PMA(Az) as the template.

Multiple Dirac Points and Hydrogenation-Induced Magnetism of Germanene Layer on Al (111) Surface

A continuous germanene layer grown on the Al (111) surface has recently been achieved in experiment. In this work, we investigate its structural, electronic, and hydrogenation-induced properties through first-principles calculations. We find that despite having a different lattice structure from its free-standing form, germanene on Al (111) still possesses Dirac points at high-symmetry K and K' points. More importantly, there exist another three pairs of Dirac points on the K(K')-M high-symmetry lines, which have highly anisotropic dispersions due to the reduced symmetry. These massless Dirac Fermions become massive when spin-orbit coupling is included. Hydrogenation of the germanene layer strongly affects its structural and electronic properties. Particularly, when not fully hydrogenated, ferromagnetism can be induced due to unpaired local orbitals from the unsaturated Ge atoms. Remarkably, we discover that the one-side semihydrogenated germanene turns out to be a two-dimensional half-semimetal, representing a novel state of matter that is simultaneously a half-metal and a semimetal.

Physiological fluxes and antioxidative enzymes activities of immobilized Phanerochaete chrysosporium loaded with TiO2 nanoparticles after exposure to toxic pollutants in solution

Immobilized Phanerochaete chrysosporium loaded with TiO2 nanoparticles (PTNs) are novel high-value bioremediation materials for adsorbing cadmium and for degrading 2,4-dichlorophenol (2,4-DCP). The real-time changes in H(+) and O2 fluxes were measured using the noninvasive microtest technique (NMT). The H(+) influx increased after the addition of 2,4-DCP, and shifted to efflux following the addition of Cd(2+). The O2 flux decreased after the addition of both 2,4-DCP and Cd(2+). A larger Cd(2+) flux was immediately observed after exposure to 0.5mM Cd(2+) (-351.25 pmol cm(-2) s(-1)) than to 0.1 mM Cd(2+) (-107.47 pmol cm(-2) s(-1)). The removal of Cd(2+) by the PTNs increased more after treatment with the 0.5 mM exposure solution (27.6 mg g(-1)) than with the 0.1 mM exposure solution (3.49 mg g(-1)). The enzyme activities were analyzed to review the antioxidative defense system of PTNs in a solution containing various concentrations of Cd(2+). The activities of the coenzyme nicotinamide adenine dinucleotide (NADH) oxidase as well as the enzyme catalase (CAT) plateaued at 6.5 U g(-1) FW and 9.7 U g(-1) FW, respectively, after exposure to 0.25 mM Cd(2+). The activity of superoxide dismutase (SOD) increased gradually in solutions containing 0.1-0.6 mM Cd(2+), and eventually reached a maximum (68.86 U g(-1) FW). These results illustrate how the antioxidative defense system and the physiological fluxes of PTNs respond to the stress caused by toxic pollutants.

The association between three promoter polymorphisms of IL-1 and stroke: a meta-analysis

AIM

The association between Interleukin-1 (IL-1) gene polymorphism and stroke remains controversial. The present study was designed to clarify this relationship through a pooled analysis of the numerous epidemiological studies focusing on this association.

METHODS

Published data addressing the association between polymorphism of the IL-1 gene and stroke were selected from electronic databases. A total of 21 studies from 19 publications including 5280 stroke patients and 5699 controls were included in this meta-analysis which detect whether IL-1α-889C/T, IL-1β-511C/T and IL-1 RN polymorphism were associated with stroke susceptibility.

RESULT

The combined results of overall analysis revealed that there was a significant association between IL-1α-889C/T polymorphism and stroke (allele model: OR = 1.39, 95% CI = 1.14-1.68, P < 0.001; recessive model: OR = 1.56, 95% CI = 1.27-1.90, P < 0.001; dominant model: OR = 1.45, 95% CI = 1.13-1.87, P = 0.004; additive model: OR = 1.70, 95% CI = 1.37-2.10, P < 0.001). On a subgroup analysis by ethnicity of study population, significant association was found in Asians (allele model: OR = 1.25 95% CI = 1.12-1.39, P < 0.001; recessive model: OR = 1.36, 95% CI = 1.09-1.69, P = 0.007; dominant model: OR = 1.29, 95% CI = 1.12-1.48, P < 0.001; additive model: OR = 1.42, 95% CI = 1.13-1.80, P = 0.003). There are no associations of IL-1β-511C/T and IL-RN polymorphisms on stroke risk were identified.

CONCLUSION

In conclusion, our results suggested that IL-1α-889C/T polymorphism is associated with stroke risk, especially in Asians. However, no associations of IL-1β-511C/T and IL-RN polymorphisms on stroke risk in overall analysis or subgroup analysis.