The impact of acute-phase reaction on mortality and re-fracture after zoledronic acid in hospitalized elderly osteoporotic fracture patients

This study involving 674 elderly osteoporotic fracture (OPF) patients undergoing orthopedic surgery investigated the long-term outcomes of acute phase reaction (APR) after initial zoledronic acid (ZOL). Those who had an APR had a 97% higher risk of mortality and a 73% lower rate of re-fracture than patients who did not.

INTRODUCTION

Annual infusion of ZOL efficiently decreases the risk of fracture. A temporary APR, consisting of flu-like symptoms, myalgia, and fever, is frequently observed within 3 days after the first dose. This work aimed to identify whether the occurrence of APR after initial ZOL infusion is a reliable indicator of drug efficacy for mortality and re-fracture in elderly OPF patients undergoing orthopedic surgery.

METHODS

This retrospectively observed work was constructed on a database prospectively collected from the Osteoporotic Fracture Registry System of a tertiary level A hospital in China. Six hundred seventy-four patients 50 years old or older with newly identified hip/morphological vertebral OPF who received ZOL for the first time after orthopedic surgery were included in the final analysis. APR was identified as a maximum axillary body temperature greater than 37.3 °C for the first 3 days after ZOL infusion. We utilized models of multivariate Cox proportional hazards to compare the risk of all-cause mortality in OPF patients with APR (APR+) and without APR (APR-). Competing risks regression analysis was used to examine the association between the occurrence of APR and re-fracture when mortality was taken into account.

RESULTS

In a fully adjusted Cox proportional hazards model, APR+ patients had a significantly higher risk of death than APR- patients with a hazard ratio [HR] 1.97 (95% CI, 1.09-3.56; P-value = 0.02). Furthermore, in an adjusted competing risk regression analysis, APR+ patients had a significantly reduced risk of re-fracture compared with APR- patients with a sub-distribution HR, 0.27 (95% CI, 0.11-0.70; P-value = 0.007).

CONCLUSIONS

Our findings suggested a potential association between the occurrence of APR and increased mortality risk. An initial dose of ZOL following orthopedic surgery was found to be protective against re-fracture in older patients with OPFs.

[A pre-conception cohort study of fertility and its related factors among couples with the intention of conception]

Objective: To describe fertility and explore factors associated with it among pre-conception couples of childbearing age. Methods: Based on the pre-conceptional offspring trajectory study of the School of Public Health of Fudan University, couples of childbearing age who participated in the pre-conception physical examination in Shanghai Jiading District from 2016 to 2021 were recruited and followed up. Couples' time to pregnancy (TTP) was analyzed and Cox proportional hazards regression model was used to explore the factors associated with TTP. Kaplan-Meier was used to calculate each menstrual cycle's cumulative pregnancy rate. Results: A total of 1 095 preconception couples were included in the analysis, the M(Q₁,Q₃)of TTP was 4.33 (2.41, 9.78) menstrual cycles. Age of women (FR=0.90, 95%CI: 0.85-0.95, P<0.001), women who were overweight or obese before pregnancy (FR=0.36, 95%CI: 0.24-0.55, P<0.001), women who were exposed to second-hand smoking (FR=0.63, 95%CI: 0.44-0.92, P=0.016), women whose home or office had been renovated in the past 2 years and had a particular smell (FR=0.46, 95%CI: 0.26-0.81, P=0.008) were risk factors for impaired fertility. Regular menstrual cycles (FR=1.64, 95%CI: 1.16-2.31, P=0.005), females who often drank tea/coffee (FR=1.55, 95%CI: 1.11-2.17, P=0.011) and males who took folic acid before conception (FR=2.35, 95%CI: 1.38-4.23, P=0.002) were associated with better fertility. The cumulative pregnancy rate of 3, 6, and 12 menstrual cycles was 37.6%, 64.4%, and 78.4%, respectively. Conclusion: Older couples, overweight or obesity before pregnancy, irregular menstruation, exposure to secondhand smoke and decoration pollutants in females are associated with impaired fertility. Frequent tea/coffee drinking before pregnancy in females and taking folic acid before pregnancy in males are associated with shortened conception time.

[Association between the presence of solid or micropapillary components and survival outcome in stage ⅠA lung adenocarcinoma cases: a retrospective cohort study]

Objectives: To examine the influence of the proportion of pathological subtypes on the prognosis of stage ⅠA lung adenocarcinoma cases, and to explore the association between the presence/absence of solid or micropapillary (S/M) components and survival outcome. Methods: Totally 321 patients with stage ⅠA lung adenocarcinoma who received complete surgical resection at Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital from January 2011 to December 2013 were retrospectively analyzed. There were 130 males and 191 females, aging 59(11) years (M(IQR)) (range: 55 to 66 years). The diagnostic value of the proportion of each pathological growth subtype on relapse-free survival (RFS) and overall survival (OS) were analyzed by using receiver operator characteristic curve. Patients were firstly divided into two groups according to the presence or absence of S/M components. And patients without S/M components were farther divided into two groups according to predominant growth pattern. There were three groups in total: with S/M components (group S/M⁺), without S/M components and lepidic growth pattern predominant (group S/M^-LPA), without S/M components and papillary or acinar growth pattern predominant (group S/M^-P/A). Kaplan-Meier method were used to draw the survival curves of the three groups, and Log-rank test were used to compare RFS and OS among the three groups. Cox proportional risk model was used to verify whether the presence of S/M components was a prognostic factor on RFS. Results: The proportion of S/M components had no diagnostic value for recurrence (solid: area under curve (AUC)=0.588, P=0.095; micropapillary: AUC=0.566, P=0.106) and death (AUC=0.589, P=0.104; AUC=0.607, P=0.056). The 5-year RFS rate of group S/M^-LPA, S/M^-P/A and S/M⁺ were 92.4%, 82.3% and 77.3%, respectively (all P<0.05), while the 5-year OS rate were 97.4%, 94.5% and 83.2%, respectively (all P<0.05). Multivariable analysis showed that the 3 groups were independent predictors of recurrence (S/M^-P/A vs. S/M^- LPA: HR=2.691, 95%CI: 1.249 to 5.799, P=0.011; S/M⁺ vs. S/M^-LPA, HR=6.763, 95%CI: 3.050 to 14.996, P<0.01). Conclusions: The proportion of S/M components in stage ⅠA lung adenocarcinoma with complete resection cases did not affect survival outcome. New grouping method based on the presence or absence of S/M components were significantly associated with patient survival outcomes: S/M⁺ patients had the worst prognosis and S/M^-LPA patients had the best prognosis.

[Clinical analysis of 23 cases with simultaneous double primary gynecological malignant tumors]

Objective: To investigate the clinicopathological features, diagnosis, treatment and prognosis of simultaneous double primary gynecological malignant tumors. Methods: A total of 23 patients with simultaneous double primary malignant tumors of female reproductive system primarily treated in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 1, 2010 to December 31, 2020 were retrospectively collected. The age, symptoms, tumor stage, tumor type, treatment and prognosis of patients were collected and followed up. Results: (1) The number of patients with gynecological tumors in our hospital increased year by year in the past 11 years. A total of 8 987 patients with gynecological malignant tumors were firstly diagnosed and cured in our hospital, including 3 474 cases of cervical cancer, 3 484 cases of endometrial cancer, 1 329 cases of ovarian malignancies, 171 cases of fallopian tube cancer, 182 cases of uterine sarcoma, 42 cases of vaginal cancer, 192 cases of vulvar cancer, 110 cases of trophoblastic tumor and 3 cases of other gynecological malignancies. The top three cancers were endometrial cancer, cervical cancer and ovarian malignancies. (2) There were 23 patients identified with simultaneous double primary gynecological tumors in the past 11 years, accounting for 0.26% (23/8 987) of female malignant tumors. There were 3 cases of cervical cancer complicated with endometrial cancer, 3 cases of cervical cancer complicated with ovarian cancer, 16 cases of endometrial cancer combined with ovarian cancer, and 1 patient with endometrial cancer combined with fallopian tube cancer. (3) All 23 patients underwent surgical treatment. According to the first diagnosis of the tumor, the surgical methods included cervical cancer radical surgery, endometrial cancer staging surgery and ovarian cancer cytoreductive surgery. After operation, radiotherapy and chemotherapy were supplemented according to the results of pathological examination and tumor staging. (4) The age of 23 patients ranged from 28 to 66 years, with an average age of (49.4±9.7) years. All patients had vaginal bleeding or conscious pelvic mass as their main clinical manifestation. The clinical stage was found in 7 patients (30%, 7/23) with advanced gynecological cancer (stage Ⅲ-Ⅳ), and 16 patients (70%, 16/23) with early stage gynecological cancer (stage Ⅰ-Ⅱ). According to the nonspecific tumor markers, 13 patients (57%, 13/23) had elevated CA₁₂₅ and CA₁₉₉. (5) Among the 23 patients, 1 case was uncontrolled and 3 cases recurred during the follow-up period, and the sites of uncontrolled or recurred were all located in the abdominopelvic cavity. Three cases died. Among the 3 patients who died, 1 patient was an uncontrolled patient, whose tumor type was cervical adenosquamous cell carcinoma combined with ovarian clear cell adenocarcinoma. The overall survival time was 19 months with postoperative supplementary radiotherapy and chemotherapy. There were 2 recurrent patients, and the tumor types were endometrioid carcinoma complicated with high-grade serous ovarian carcinoma and ovarian endometrioid carcinoma, respectively. After surgery, all patients received supplementary chemotherapy and recurred 60 and 21 months after surgery, respectively, and the overall survival time was 78 and 28 months, respectively. Another patient recurred 43 months after surgery, and survived with tumor for 14 months after recurrence. The remaining 19 patients were tumor-free and were still being followed up. Conclusions: There are no specific markers for simultaneous double primary gynecological malignant tumors. The most common clinical symptoms are vaginal bleeding or pelvic mass. The treatment principle of simultaneous double primary gynecological malignant tumor is the same as that of single gynecological malignant tumor, but need to be taken into account the characteristics of two tumors. Surgery is the main treatment method, and radiotherapy and chemotherapy play an important auxiliary role. The prognosis of simultaneous double primary gynecological malignancies is related to the late stage of the two malignancies.

[Analysis of causes of death among advanced schistosomiasis patients in Jiaxing City from 2010 to 2020]

OBJECTIVE

To analyze the cause of death among patients with advanced schistosomiasis in Jiaxing City of Zhejiang Province from 2000 to 2020.

METHODS

The medical records of 167 dead patients with advanced schistosomiasis that were registered in Jiaxing First Hospital and received national medical assistance program from 2010 to 2020 were collected, and compared with the data of advanced schistosomiasis patients without national medical assistance program in the same city from 1998 to 2008.

RESULTS

Among the 167 advanced schistosomiasis patients in Jiaxing City during the period from 2010 to 2020, the four most common causes of death included liver failure (22.16%), upper gastrointestinal hemorrhage (17.37%), hepatic encephalopathy (14.97%) and liver cancer (14.37%), and the dead patients were predominantly at ages of 70 to 74 years, with a mean age of 74.8 years. The four most common causes of death included upper gastrointestinal bleeding (34.16%), hepatic encephalopathy (22.28%), unexplained causes (22.28%) and liver failure (4.46%) among advanced schistosomiasis patients without national medical assistance in Jiaxing City from 1998 to 2008, and the dead patients were predominantly at ages of 60 to 69 years, with a mean age of 69.3 years. There were significant differences between patients detected from 2010 to 2020 and from 1998 to 2008 in terms of causes of death (χ² = 63.42, P = 0.00) and age of death (χ² = 50.09, P = 0.00).

CONCLUSIONS

There are significant changes in the cause of death among patients with advanced schistosomiasis in Jiaxing City from 2010-2020, which may be attributed to the implementation of the national medical assistance program.

The expression profile of long non-coding RNAs in the lung tissue of mice with cecal ligation and puncture-induced sepsis

When sepsis occurs, the lungs are the first organs that are affected. Injury to the lungs involves damage to and the subsequent repair of cells and tissue. However, the mechanism of both at a molecular level remains unclear. As mice have similar physiological and pathological processes to humans, the current research adopted mice models to explore the long non-coding ribonucleic acid (lncRNA) in the lung tissue of mice with cecal ligation and puncture (CLP)-induced sepsis using gene sequencing analysis. A total of 30 mice were randomly divided into two groups, i.e., the sham group and the CLP group, respectively. Three mice were randomly selected from each group, and their lung tissue was used for gene sequencing analysis. Overall, a total of 1,110 lncRNAs were found to be significantly differentially expressed between the two groups. Among these, 658 were over-expressed, and 452 were under-expressed (fold change ≥ 2.0, P < 0.05). Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed to predict the potential biological functions of these differentially expressed lncRNAs, and the top 10 over- and under-expressed lncRNAs were selected as candidates for further validation. Finally, three over-expressed lncRNAs (XLOC_025752, XLOC_086176, and XLOC_148721) and four under-expressed lncRNAs (XLOC_120813, XLOC_029657, XLOC_031620, and XLOC_096198) were validated and found to be the same as those identified by sequencing analysis. To the best of the authors's knowledge, this research is the first to explore the expression profile of lncRNAs in the lung tissue of mice with CLP-induced sepsis. The results showed different lncRNA expression profiles between the two groups, indicating that lncRNAs may contribute to the occurrence of and recovery from sepsis-induced acute lung injury through interacting with target genes.

[Association between serum vitamin D level and immune imbalance in advanced schistosomiasis patients with liver fibrosis]

OBJECTIVE

To examine the relationship between serum vitamin D level and immune imbalance in advanced schistosomiasis patients with liver fibrosis.

METHODS

A total of 120 advanced schistosomiasis patients with liver fibrosis that were admitted to the Department of Schistosomiasis of The First Hospital of Jiaxing City from May 2016 to September 2018 were recruited as the observation group, and 50 healthy volunteers randomly sampled from the hospital during the same period served as the control group. The serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4⁺ cell proportion, CD8⁺ cell proportion, 25-hydroxyvitamin D [25(OH)D] levels were compared between the two groups. Liver fibrosis was classified into grade I, II and III according to the classification criteria of liver fibrosis by ultrasonography, and the serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4⁺ proportion, CD8⁺ proportion, 25(OH)D levels were compared among patients with grade I, II and III liver fibrosis. In addition, all patients were classified into the sufficient group, the insufficient group and the deficient group according to the serum vitamin D level, and the serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4⁺ proportion, CD8⁺ proportion, 25(OH)D levels were compared among these three groups. Moreover, the associations of the serum vitamin D level with these immune indicators were examined.

RESULTS

The 120 advanced schistosomiasis patients with liver fibrosis included 58 men and 62 women, and had a mean age of (72.00 ± 3.00) years. There were 32 cases with grade I liver fibrosis, 46 cases with grade II liver fibrosis, and 42 cases with grade III liver fibrosis. There were no significant differences between the observation group and the control group in terms of serum D-dimer, total cholesterol (TC), triglyceride (TG), C3 complement or C4 complement levels (t = 2.467, 0.322, 0.790, -2.432 and -2.630, all P values > 0.05); however, there were significant differences seen in alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood calcium, blood phosphorus, IgG antibody, IgA antibody, CD4⁺ proportion, CD8⁺ proportion, and 25(OH)D levels (t = 5.130, 6.382, -1.341, 2.361, 8.708, 11.783, -2.995, -6.543 and -3.022, all P values < 0.05). In addition, there were significant differences in AST, ALT, blood phosphorus, IgA antibody, C3 complement, CD8⁺ cell proportion and 25(OH)D levels among patients with grades I, II and III liver fibrosis (F = 19.704, 16.254, 62.669, 49.347, 5.430, 5.434 and 5.783, all P values < 0.05). There were significant differences in ALT, blood phosphorus, IgA antibody, CD8⁺ cell proportion and 25(OH)D levels between patients with grades I and III liver fibrosis (all P values < 0.05), and significant differences were seen between patients with grades II and III liver fibrosis in terms of blood phosphorus, IgA antibody and CD8⁺ cell proportion (all P values < 0.05), while there was a significant difference in the CD8⁺ cell proportion between patients with grades I and II liver fibrosis (P < 0.05). Moreover, there were significant differences among the sufficient, insufficient and deficient groups in terms of IgG antibody, IgA antibody, C3 complement, CD4⁺ cell proportion and CD8⁺ cell proportion (F = 13.303, 59.623, 8.698, 9.969 and 12.805, all P values < 0.05), and there was a significant difference in the CD8⁺ cell proportion between the insufficient and deficient groups (P < 0.05). Pearson correlation analysis revealed that serum 25(OH)D level were negatively associated with IgG and IgA antibody levels (r = -0.754 and -0.773, both P values < 0.05), and positively associated with C3 complement, CD4⁺ cell proportion and CD8⁺ cell proportion in advanced schistosomiasis patients with liver fibrosis (r = 0.827, 0.850 and 0.830, all P values < 0.05).

CONCLUSIONS

Immune imbalance occurs in advanced schistosomiasis patients with liver fibrosis, and serum vitamin D level may correlate with immune imbalance in advanced schistosomiasis patients with liver fibrosis.

Knocking down PFL can improve myocardial ischemia/reperfusion injury in rats by up-regulating heat shock protein-20

OBJECTIVE

To investigate the effect and mechanism of long non-coding ribonucleic acid (lncRNA) PFL on myocardial ischemia/reperfusion (I/R) injury in rats, and to provide a reference for the prevention and treatment of myocardial infarction (MI) in clinic.

MATERIALS AND METHODS

According to the random number table, 60 male Sprague-Dawley (SD) rats were randomly divided into 3 groups: Control group (n=20), I/R group (n=20), and I/R + PFL small interfering ribonucleic acid (siRNA) group (n=20). The I/R model was established by ligating the left anterior descending coronary artery (LAD) and then recanalizing it. PFL siRNAs were injected intravenously into the tail vein of rats in I/R + PFL siRNA group to construct a PFL knockout model. Triphenyl tetrazolium chloride (TTC) test was used to detect the infarction area of each group. Echocardiography was adopted to measure the ejection fraction [EF (%)] and fraction shortening [FS (%)] of rats in each group. Hematoxylin and eosin (H&E) staining was applied to detect the morphological changes in myocardial cells in each group. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was conducted to detect the apoptosis levels of myocardial cells and fibroblasts in heart tissues in each group. Meanwhile, the protein expression levels of apoptosis-related genes, Bcl-2-associated X protein (BAX), and Bcl-2, were measured via Western blotting. Also, the expression level of heat shock protein 20 (HSP-20) in the heart of three groups of rats was examined using immunohistochemical staining. Finally, the effects of PFL siRNAs on the expression level of HSP-20 were detected via Western blotting.

RESULTS

PFL siRNAs could significantly improve I/R-induced cardiac insufficiency in rats, thus increasing EF (%) and FS (%) (p<0.05). Besides, PFL siRNAs could remarkably inhibit cardiac infarction caused by I/R injury and reduce the infarction area from (59.54±3.45)% to (24.85±1.30)% (p<0.05). H&E staining results manifested that, compared with those in I/R group, the cardiac myofilament was better in alignment, degradation and necrosis were milder, and cell edema was notably reduced in I/R + PFL siRNA group. Immunohistochemistry and Western blotting results showed that PFL siRNAs could remarkably reverse the decrease in the HSP-20 expression caused by I/R (p<0.05).

CONCLUSIONS

We found that PFL knockdown can significantly improve the myocardial injury caused by I/R and improve the cardiac function in rats. The mechanism may be related to the activation of HSP-20 by PFL siRNAs. Therefore, PFL is expected to become a new target for the treatment of MI.

Monitoring of lung malignant epithelial cells by gene methylation analysis in the conditionally reprogrammed cell cultures

Conditionally reprogrammed cell (CRC) technology is an effective method for culturing primary malignant cells and non-malignant epithelial cells in vitro. This can be useful for precision medicine applications, such as drug sensitivity assays. However, this approach is commonly hindered by the non-specific growth of non-malignant epithelial cells in CRC cultures and the lack of effective biomarkers/assays to distinguish them from primary tumor cells. In this study, we developed a DNA methylation-based, real-time PCR assay to investigate SHOX2 and PTGER4 gene promoters as sensitive markers for human lung cancer. We first found that in formalin-fixed, paraffin-embedded (FFPE) malignant lung samples, 90% (28/31) had increased SHOX2 and/or PTGER4 promoter methylation as compared with their adjacent non-malignant samples. We then applied this assay to fresh surgical tumors and found increased SHOX2 and/or PTGER4 promoter methylation in 80% (20/25) of tumor samples as compared with their corresponding adjacent non-malignant tissues. Increased methylation of SHOX2 or PTGER4 promoter regions was also detected in 52% (13/25) of CRC cultures. The presence of malignant cells was confirmed by growth in soft agar cultures, a hallmark of malignant transformation, as well by EGFR mutation analysis. These results demonstrate that SHOX2 and PTGER4 promoter methylation levels can be used to detect malignant lung epithelial cells in CRC cultures.

[Keratinized tissue augmentation techniques around dental implants]

Research have indicated that inadequate keratinized tissue has a negative effect on patient oral hygiene, resulting in peri-implant inflammation. It has been recommended that an apically repositioned flap alone or in combination with autogenous soft tissue grafts can increase the width of keratinized mucosa around dental implants, which promotes long term peri-implant health. This review summarized research progress on augmentation techniques of keratinized tissue arround implants in recent years, so as to provide reference for clinical practice and research design in the future.

[Serum vitamin D expression in advanced schistosomiasis patients with hepatic fibrosis and its association with disease progression]

OBJECTIVE

To compare the expression of serum vitamin D in advanced schistosomiasis patients with grade I and II hepatic fibrosis, and to preliminarily examine its associations with the internal diameter of the main portal vein and progression of hepatic fibrosis.

METHODS

The medical records of 126 advanced schistosomiasis patients with grade I and II hepatic fibrosis referred to Jiaxing First Hospital from March 2012 to September 2015 were retrospectively analyzed. The internal diameter of the main portal vein and serum 25-hydroxyvitamin D3 [25(OH)D3] level were measured. The progression of hepatic fibrosis was followed up, and the serum vitamin D level was compared between patient with disease progression and stable disease.

RESULTS

The 126 advanced schistosomiasis patients included 72 men and 54 women, and had ages of 62 to 80 years. There were 58 cases with grade I hepatic fibrosis and 68 cases with grade II hepatic fibrosis. There were significant differences between patients with grade I and II hepatic fibrosis in terms of hemoglobin, white blood cell count, prothrombin time, international normalized ratio, activated partial thromboplastin time, fibrinogen or 25(OH)D3 level (all P > 0.05), and significant differences were seen in alanine aminotransferase, aspartate aminotransferase, blood calcium, blood phosphorus levels and the internal diameter of the main portal vein (all P values < 0.05). In addition, a lower serum 25(OH)D3 level was detected in patients with broadened internal diameter of the main portal vein than in those with normal internal diameter of the main portal vein [(19.08 ± 1.36) nmol/L vs. (25.61 ± 6.69) nmol/L, P < 0.05]. Following 3-year follow-up, there were 73 cases with progression of hepatic fibrosis, and a significantly lower serum vitamin D level was found in patients with disease progression than in those with stable disease [(20.00 ± 0.81) nmol/L vs. (25.47 ± 5.91) nmol/L, P < 0.05].

CONCLUSIONS

Vitamin D deficiency is common in advanced schistosomiasis patients with hepatic fibrosis, and it may be associated with the internal diameter of the main portal vein and the progression of hepatic fibrosis disease.

Abstract PD9-12: Integrative molecular profiling of breast cancer brain metastasis and patient-derived xenograft organoids from resected breast cancer brain metastases to interrogate and prioritize therapeutic personalized strategies

Background: Breast cancer brain metastasis (BM) is an area of unmet need in metastatic breast cancer patients. Novel therapeutic interventions to help prevent and treat BM are warranted. We conducted integrative molecular profiling of BM and matched primary tumors (PT) using next-generation DNA and RNA sequencing to examine the molecular landscape. In addition, we established patient-derived xenograft/organoid (PDX/PDO) to examine drug sensitivity according to the molecular and clinical features of the BM.

Methods: Archived, formalin fixed paraffin-embedded BM was collected retrospectively. BM were also collected prospectively at the time of clinically indicated surgical resection through the central nervous system tissue banking and the Michigan Oncology Sequencing Center (MI-ONCOSEQ) protocols. Matched archived PT tissues were collected when available. Integrative next-generation sequencing was conducted using the MI-ONCOSEQ platform. The prospectively collected BM were further used to establish PDXs/ PDOs. Successfully established PDXs/PDOs were used for ex vivo drug testing via MiDrugScreen, a novel drug sensitivity testing platform, where testing was performed in a dose-response format with drug selection prioritized by clinical scenario and molecular alterations if known a priori.

Results: 12 matched BM-PT pairs were analyzed: 6 triple negative, 5 HER2 positive, and 1 ER positive HER2 negative. All except one (11/12) had TP53 mutations. When present, TP53 mutations in BM were also found in PT (except for 1 unknwon case in PT due to low coverage). ER+HER2- was the only one without TP53 mutation but had hyper-mutation (APOBEC signature). Driver mutations and unique copy number alterations (CDKN2A loss in 1/12, mutations in PIK3CA in 1/12 and ESR1 in 1/12, CCNE1 amplification in 1/12) were noted in BMs. In 75% of cases, mutational burden was higher in BM vs. PT. 2 PDX/PDO were available for drug testing. PDO-BC9 was noted to have RB1 (splice acceptor) and LOH. As predicted by this alteration, PDO-BC9 was insensitive to CDK4/6 inhibitors (palbociclib, abemaciclib) tested on MiDrugScreen panel. PDX-BC4 was established from PIK3CA and ESR1 mutated BM from an ER+HER2- patient who had previously progressed on endocrine therapy with a CDK4/6 inhibitor. As predicted, the PDX-BC4 was resistant to CDK4/6 inhibitor but interestingly sensitive to PIK3CA, ERK, and MEK inhibitors.

Conclusions: TP53 mutation was highly prevalent and may be a biomarker for increased risk of BM. Further study is warranted to see if specific TP53 mutations are associated with a risk of BM development and can be used in risk stratification for BM specific intervention. Unique molecular alterations in BM compared to matched PT may have a therapeutic implication as a target or resistance biomarker. Conducting drug testing in addition to molecular profiling has the strong potential of being informative in tailoring or prioritizing therapeutic agents in the era of precision medicine. Additional BM PDXs/PDOs from breast and other solid tumors are being examined using this novel therapeutic tailoring approach with the combination of MIONCOSEQ and MiDrugScreen.

Citation Format: Morikawa A, Robinson DR, Soellner M, Wu Y-M, Lonigro R, Gilani R, Cheng X, Lachacz E, Thomas D, McMurray K, Smerage J, Henry NL, Heth J, Chinnaiyan A, Hayes DF, Merajver S. Integrative molecular profiling of breast cancer brain metastasis and patient-derived xenograft organoids from resected breast cancer brain metastases to interrogate and prioritize therapeutic personalized strategies [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD9-12.

Parenchymal hyperdensity on C-arm CT images after endovascular therapy for acute ischaemic stroke predicts a poor prognosis

AIM

To investigate whether hyperdense areas (HDAs) observed after endovascular treatment on multisection computed tomography (CT) are related to outcome.

MATERIALS AND METHODS

Data on 82 patients with acute anterior circulation ischaemic stroke resulting from intracranial large artery occlusion were analysed retrospectively All patients underwent mechanical thrombectomy and/or emergency angioplasty, and partial or complete recanalisation was successfully achieved. C-arm CT was performed immediately after endovascular treatment for all patients. Clinical and radiological data were compared between patients with and those without HDA and between patients with good and those with poor outcomes.

RESULTS

Compared with non-HDA patients, HDA patients were more likely to present with severe neurological deficits (admission National Institutes of Health Stroke Scale [NIHSS] score: 18 versus 16, p=0.037) and had a higher number of stent retriever passes performed (2.9±1.3 versus 1.4±1, p<0.001), longer onset-to-presentation times (229±78 versus 171±90 minutes; p=0.002), longer onset-to-recanalisation times (418±94 versus 331±105 minutes; p<0.001), and longer puncture-to-recanalisation times (103±47 versus 69±42 minutes; p=0.001). Fewer HDA patients had a good prognosis (35.7% versus 70%, p<0.001). Multivariate analysis showed the presence of HDAs was an independent negative prognostic factor (OR=0.208; p=0.002).

CONCLUSION

HDAs on C-arm CT appear to be common in patients with acute ischaemic stroke who underwent successful endovascular treatment. HDA presence suggests a poor prognosis despite successful reperfusion.

Redefining Humicola sensu stricto and related genera in the Chaetomiaceae

The traditional concept of the genus Humicola includes species that produce pigmented, thick-walled and single-celled spores laterally or terminally on hyphae or minimally differentiated conidiophores. More than 50 species have been described in the genus. Species commonly occur in soil, indoor environments, and compost habitats. The taxonomy of Humicola and morphologically similar genera is poorly understood in modern terms. Based on a four-locus phylogeny, the morphological concept of Humicola proved to be polyphyletic. The type of Humicola, H. fuscoatra, belongs to the Chaetomiaceae. In the Chaetomiaceae, species producing humicola-like thick-walled spores are distributed among four lineages: Humicola sensu stricto, Mycothermus, Staphylotrichum, and Trichocladium. In our revised concept of Humicola, asexual and sexually reproducing species both occur. The re-defined Humicola contains 24 species (seven new and thirteen new combinations), which are described and illustrated in this study. The species in this genus produce conidia that are lateral, intercalary or terminal on/in hyphae, and conidiophores are not formed or are minimally developed (micronematous). The ascospores of sexual Humicola species are limoniform to quadrangular in face view and bilaterally flattened with one apical germ pore. Seven species are accepted in Staphylotrichum (four new species, one new combination). Thick-walled conidia of Staphylotrichum species usually arise either from hyphae (micronematous) or from apically branched, seta-like conidiophores (macronematous). The sexual morph represented by Staphylotrichum longicolleum (= Chaetomium longicolleum) produces ascomata with long necks composed of a fused basal part of the terminal hairs, and ascospores that are broad limoniform to nearly globose, bilaterally flattened, with an apical germ pore. The Trichocladium lineage has a high morphological diversity in both asexual and sexual structures. Phylogenetic analysis revealed four subclades in this lineage. However, these subclades are genetically closely related, and no distinctive phenotypic characters are linked to any of them. Fourteen species are accepted in Trichocladium, including one new species, twelve new combinations. The type species of Gilmaniella, G. humicola, belongs to the polyphyletic family Lasiosphaeriaceae (Sordariales), but G. macrospora phylogenetically belongs to Trichocladium. The thermophilic genus Mycothermus and the type species My. thermophilum are validated, and one new Mycothermus species is described. Phylogenetic analyses show that Remersonia, another thermophilic genus, is sister to Mycothermus and two species are known, including one new species. Thermomyces verrucosus produces humicola-like conidia and is transferred to Botryotrichum based on phylogenetic affinities. This study is a first attempt to establish an inclusive modern classification of Humicola and humicola-like genera of the Chaetomiaceae. More research is needed to determine the phylogenetic relationships of “humicola”-like species outside the Chaetomiaceae.

[Identification and drug susceptibility testing of Mycobacterium thermoresistibile and Mycobacterium elephantis isolated from a cow with mastitis]

Objective: To understand the etiological characteristics and drug susceptibility of Mycobacterium thermoresistibile and Mycobacterium elephantis isolated from a cow with mastitis and provide evidence for the prevention and control of infectious mastitis in cows. Methods: The milk sample was collected from a cow with mastitis, which was pretreated with 4% NaOH and inoculated with L-J medium for Mycobacterium isolation. The positive cultures were initially identified by acid-fast staining and multi-loci PCR, then Mycobacterium species was identified by the multiple loci sequence analysis (MLSA) with 16S rRNA, hsp65, ITS and SodA genes. The drug sensitivity of the isolates to 27 antibiotics was tested by alamar blue assay. Results: Two anti-acid stain positive strains were isolated from the milk of a cow with mastitis, which were identified as non-tuberculosis mycobacterium by multi-loci PCR, and multi-loci nucleic acid sequence analysis indicated that one strain was Mycobacterium thermoresistibile and another one was Mycobacterium elephantis. The results of the drug susceptibility test showed that the two strains were resistant to most antibiotics, including rifampicin and isoniazid, but they were sensitive to amikacin, moxifloxacin, levofloxacin, ethambutol, streptomycin, tobramycin, ciprofloxacin and linezolid. Conclusions:Mycobacterium thermoresistibile and Mycobacterium elephantis were isolated in a cow with mastitis and the drug susceptibility spectrum of the pathogens were unique. The results of the study can be used as reference for the prevention and control the infection in cows.

Abstract P2-09-26: Frequency and mechanisms of elevated somatic mutation burden in metastatic breast cancer and response to immune checkpoint blockade

Background: Immune checkpoint blockade (ICB) is effective in the treatment of various malignancies. Thus far, however, results in breast cancer have been mixed. Elevated tumor mutational load, and subsequent increased likelihood of forming immunogenic neoantigens, has been correlated with response to ICB. Mutational load observed in breast cancers varies widely. However, most studies have assessed mutational load using primary tumors. Few studies have explored the frequency of high mutational load, molecular mechanisms accounting for this phenomenon, and its potential impact on response to ICB in metastatic breast cancer (MBC).

Methods: From 2011-2016, 124 patients (pts) with MBC of varying subtypes underwent research biopsy of their metastatic disease for whole genome, exome and transcriptome sequencing of tumor and matched normal sample through the Michigan Oncology Sequencing Center (Mi-OncoSeq). Those pts with elevated somatic mutation load were defined as having greater than 10 mutations per megabase of targeted sequencing and mutational signatures accounting for high mutation load were noted. Pts treated subsequently with ICB were followed to assess response.

Results: Twelve MBC pts had high mutation load (10% of cohort). Eight pts had estrogen receptor (ER) positive MBC and 4 pts had metastatic triple negative breast cancer (TNBC). In 5 cases, a clear mutational signature accounting for high mutation load was evident. Two TNBC cases harbored an APOBEC mutational signature in addition to 1 TNBC and 2 ER positive tumors displaying a microsatellite instability signature (MSI-H). Among the tumors with MSI-H signature, 1 case was associated with a pathogenic germline alteration in MLH1. Two pts were subsequently treated with ICB on a clinical trial. One pt came off study after 3 months due to progressive brain metastases and another had partial response to therapy lasting 7 months.

Conclusions: Elevated somatic mutation burden in MBC is observed in approximately 10% of pts, and is detected in both ER positive and TNBC. Since high mutation burden has been associated with increased likelihood of response to ICB, identification of this genomic feature could have important therapeutic implications for MBC pts.

Citation Format: Cobain EF, Robinson DR, Wu Y-M, Lonigro R, Vats P, Rabban E, Kumar-Sinha C, Schott AF, Smerage JB, Morikawa A, Burness ML, Van Poznak CH, Griggs J, Wicha M, Hayes DF, Chinnaiyan AM. Frequency and mechanisms of elevated somatic mutation burden in metastatic breast cancer and response to immune checkpoint blockade [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-26.

[Natural changes of high-risk HPV in women with negative for intraepithelial lesion or malignancy: a prospective 1 year study]

Objective: To investigate the natural changes of high-risk HPV (HR-HPV) in women with negative for intraepithelial lesion or malignancy (NILM) for regulating HR-HPV screening. Methods: Four hundred and thirty-three newly-diagnosed women were enrolled from January 1st, 2015 to December 31, 2015 in Beijing Obstetrics and Gynecology Hospital. The ages of these patients were between 22 and 74 years, the average age was (45±21) years old. Two hundred and sixty-three cases were less than 50 years old, 170 cases were more and equal to 50 years old. One hundred and fifty-six cases were HR-HPV positive, 277 cases were HR-HPV negative. Follow up tests were conducted for all 433 patients, who were screened by ThinPrep cytologic test (TCT) combined with HR-HPV and were diagnosed with NILM, for a period of 1 year (at the 3, 6, 9 and 12 months intervals respectively), if the TCT results are abnormal and the HR-HPV test results are positive, will follow up colposcopy directed cervical biopsy. Results: (1) HR-HPV natural changes: of 156 NILM cases with HR-HPV infection, 42 cases (26.9%, 42/156) turned negative within 3 months, 88 cases (56.4%, 88/156) turned negative within 6 months, 99 cases (63.5%, 99/156) turned negative within 9 months, and 100 cases (64.1%, 100/156) turned negative within 12 months. The negative conversion ratio at 3, 6, 9 and 12 months for women at childbearing age (<50 years) were significantly higher than those at non-childbearing age (≥50 years old; all P<0.05). Of 277 NILM cases without HR-HPV infection, 35 cases (12.6%, 35/277) had new HR-HPV positive infections within 3 months, 70 cases (25.3%, 70/277) had new infections within 6 months, 80 cases (28.9%, 80/277) had new infections within 9 months, and 83 cases (30.0%, 83/277) had new infections within 12 months. The new infections rate at 3, 6, 9 and 12 months for women at childbearing age (<50 years old) were slightly higher than those at non-childbearing age (≥50 years old; all P>0.05). (2) The progress of cervical leision: of 156 NILM cases with HR-HPV positive, no case progressed during 12 months follow-up. Of 277 NILM cases with HR-HPV negative, 4 cases progressed to cervical intraepithelial neoplaisa (CIN) with HR-HPV infection and TCT abnormal during 12 months follow-up, including 2 cases pathology diagnosed with CINⅠ, 1 case with CINⅡ, and 1 case with CINⅢ. The progression rate was 1.4%(4/277), which accounts for 4.8% (4/83) of new HR-HPV infections cases in women. Conclusions: The results of cytology combined with HR-HPV screenings suggest every 6 months for simple HR-HPV positive women, colposcopy directed cervical biopsy is recommended to assess cervical lesions if necessary. Cytology combined with HR-HPV screenings suggest every 12 months for simple HR-HPV negative women to early detection of cervical leision.

MRI audit of complications in intracranial stenosis treated with Wingspan device

OBJECTIVES

To evaluate the safety and efficacy of the Wingspan device for the treatment of symptomatic intracranial atherosclerotic stenosis (ICAS).

METHODS

We audited a prospective ongoing database of consecutive patients who received Wingspan stenting between January 2013 and December 2015. All patients underwent MRI to audit any complications during the early follow-up period. We focused on the clinical demographics, lesion characteristics, treatment results, and periprocedural complications. Functional outcomes were measured with the modified Rankin Scale (mRS) at discharge and after 3 months.

RESULTS

Intracranial stenting was performed in 50 patients (100%). Mean stenosis pre-stenting was 76.5±13.1% and post-stenting residual stenosis was 19.8±13.8%. The overall 30-day rate of procedure-related complications was 6.0% (3/50). Two patients (4%) developed in-stent restenosis, one of whom had a dissection at the middle cerebral artery. Interestingly, on the follow-up MRI scan there was a high incidence of asymptomatic diffusion-weighted imaging (DWI) hyperintensities, 46% (23/50) presumed to be due to microembolic causes. At the 90-day, 180-day, and 1-year follow-up, three patients had further strokes resulting in a total complication rate of 12%. 92% had excellent outcomes (mRS 0-1) and only one patient had deterioration of his mRS score.

CONCLUSIONS

ICAS treated by Wingspan stenting using pre-placement balloon angioplasty appears safe and effective with a high technical success rate and favorable outcomes. There is a high incidence of asymptomatic DWI hyperintensites post-procedure, but these do not appear to result in long-term sequelae.

[Analysis on the polymorphisms of human B cell epitopes of 5 specificity antigens in Mycobacterium tuberculosis in China]

OBJECTIVE

To study the diversities of human B cell epitopes of five proteins (Mpt83, Mpt70, LpqH, PstS3, GroES) in Mycobacterium tuberculosis isolates from China.

METHODS

We selected 179 strains isolated from patients with tuberculosis in different regions of China, and cultured these strains by L-J medium. The gene sequences of these 5 proteins were amplified and sequenced by PCR. The variations (single nucleotide polymorphisms, SNP) of the DNA sequences were compared and analyzed according to the immune epitope database (IEDB). The synonymous mutation rate (dS), non-synonymous mutation rate (dN) and dN/dS values were calculated with MEGA6 software.

RESULTS

Among the 179 clinical MTBC isolates, 7 SNP mutations were found in the mpt83gene. The dN/dS value of the whole mpt83 gene was 0.88. One SNP mutation was found in the mpt70 gene. The dN/dS values of the whole pstS3 gene and non-B epitopes areas were 1.74 and 1.40 respectively. But no mutation was found in the groES gene.

CONCLUSION

The mpt83, lpqH and pstS3 genes of 179 MTBC strains contain gene SNPs and human B cell epitopes diversities, while the coding gene and human B cell epitopes of protein mpt70 and groES were conservative.

The association between the RAGE G82S polymorphism, sRAGE and chronic periodontitis in Taiwanese individuals with and without diabetes

BACKGROUND AND OBJECTIVE

The present study investigated the association between the RAGE G82S polymorphism, the plasma levels of sRAGE and chronic periodontitis in subjects with and without diabetes mellitus (DM).

MATERIAL AND METHODS

A total of 230 patients with DM and 264 non-DM participants were recruited for this study. Genotyping of the RAGE G82S polymorphism was accomplished using polymerase chain reaction-restriction fragment length polymorphism, and associations were analyzed with the chi-squared test and logistic regression analysis.

RESULTS

In the non-DM group, the chi-squared test showed that the frequency distributions of the G82S polymorphism were significantly different between chronic periodontitis and non-chronic periodontitis subjects (χ(2) = 8.39, p = 0.02). A multivariate logistic regression model showed that the (G82S + S82S) genotypes were associated with a significantly increased risk of chronic periodontitis development compared to the G82G genotype (adjusted odds ratio = 2.06, 95% confidence interval: 1.08-4.07). In the DM group, there was no association between the G82S polymorphism and chronic periodontitis development when a multivariate logistic regression was performed. Plasma levels of sRAGE were significantly higher in subjects with the G82G genotype compared to those with the (G82S + S82S) genotypes in both the non-DM (856.6 ± 332.0 vs. 720.4 ± 311.4 pg/mL, p = 0.003) and DM groups (915.3 ± 497.1 vs. 603.5 ± 298.3 pg/mL, p < 0.0001). However, there was no difference in plasma sRAGE levels between chronic periodontitis and non-chronic periodontitis subjects in both the DM and non-DM groups. Moreover, when the subjects were further sub-divided by the G82S polymorphism, the difference in plasma levels of sRAGE between chronic periodontitis and non-chronic periodontitis subjects in the DM and non-DM groups remained statistically insignificant.

CONCLUSIONS

The present study revealed that the RAGE G82S polymorphism was associated with chronic periodontitis in the non-DM group but not in the DM group. Our results also showed that the plasma levels of sRAGE were significantly higher in subjects with the RAGE G82G genotype, and this correlation was not affected by the presence of chronic periodontitis in the DM and non-DM groups.

Curcumin and resveratrol in combination modulate drug-metabolizing enzymes as well as antioxidant indices during lung carcinogenesis in mice

This study investigated combined chemopreventive potential of curcumin and resveratrol during benzo(a)pyrene (BP)-induced lung carcinogenesis in mice. The mice were segregated into five groups that included normal control, BP-treated, BP + curcumin-treated, BP + resveratrol-treated, and BP + curcumin + resveratrol-treated groups. A statistically significant increase in the levels of lipid peroxidation (LPO) was observed in the lungs of mice after 22 weeks of single dose of benzo(a)pyrene. Further, BP treatment also resulted in a significant increase in the enzyme activities of aryl hydrocarbon hydroxylase as well as drug-metabolizing enzymes, namely cytocrome P450 and cytochrome b5. On the other hand, reduced glutathione (GSH) levels, the activities of superoxide dismutase (SOD), glutathione reductase (GR), and glutathione- S-transferase (GST) were found to be significantly decreased following BP treatment. Supplementation with curcumin and resveratrol to BP-treated mice significantly decreased the LPO levels, GSH levels, and enzyme activities of drug-metabolizing enzymes. Further, treatment of curcumin and resveratrol to BP-treated mice significantly elevated the activities of SOD, GR, and GST. Histoarchitectural studies showed well-differentiated signs of lung carcinogenesis following BP administration to mice. However, combined treatment with curcumin and resveratrol resulted in a noticeable improvement in the lung histoarchitecture. This study, therefore, concludes that curcumin and resveratrol when supplemented in combination regulate drug-metabolizing enzymes as well as antioxidant enzymes during lung carcinogenesis in mice.

Expressions of survivin, P16(INK4a), COX-2, and Ki-67 in cervical cancer progression reveal the potential clinical application

PURPOSE OF INVESTIGATION

To explore the significance of survivin, P16(INK4a), COX-2, and Ki-67 expressions for prediction of cervical cancer progression.

MATERIALS AND METHODS

A retrospective study was performed in 129 cases including 24 squamous carcinoma of the cervix (SCC), 70 cervical intraepithelial neoplasias (CIN), 15 cervical condyloma acuminatum (CCA), ten chronic cervicitis (CC), and ten normal cervix (NC). Protein expressions were evaluated using immunohistochemistry.

RESULTS

Survivin, P16(INK4a); COX-2, and Ki-67 were highly expressed in SCC and CIN compared with others. Their expression rates were gradually increased in CIN I, CIN II, CIN III, and SCC groups, showing 72.00%, 88.00%, 90.00%, and 95.83% for P16(INK4a), 68.00%, 84.00%, 95.00% and 100.00% for COX-2, 76.00%, 96.00%, 100.00%, and 100.00 for Ki-67, respectively. There were significant correlations between survivin and P16(INK4a), COX-2, Ki-67, as well as P16(INK4a) and Ki-67.

CONCLUSION

Survivin, P16(INK4a), COX-2 and Ki-67 play critical roles for development and progression of cervical cancer.

Protective effects of curcumin and quercetin during benzo(a)pyrene induced lung carcinogenesis in mice

OBJECTIVE

Phytochemicals is one such family of chemopreventive agents that is being researched extensively the world over for its efficacies against several cancer pathways. Curcumin and quercetin belong to the family of phytochemicals and have anti-oxidative and anti-carcinogenic properties. In the present study, chemopreventive efficacy of curcumin and quercetin was investigated against benzo(a)pyrene (BP) induced lung carcinogenesis.

MATERIALS AND METHODS

The mice were segregated into five groups which included normal control, BP treated, BP+curcumin treated, BP+quercetin treated and BP+curcumin+quercetin treated groups. Lung carcinogenesis was induced by a single intra-peritoneal (IP) injection of BP (100 mg/kg body weight). Curcumin was supplemented to mice at a dose level of 60 mg/kg body weight in drinking water and quercetin was given at a dose level of 40 mg/kg body wt in drinking water.

RESULTS

The BP treatment resulted in a significant increase in LPO and ROS levels. GSH levels and the activities of SOD, GST as well as GR were found to be significantly decreased following BP treatment. Further, BP treatment brought about a significant increase in the activities of drug metabolizing enzymes (cytochrome P450 and b5). Curcumin and quercetin treatments to mice were able to decrease significantly the levels of LPO, ROS, as well as activities of SOD, GST. Also, the activities of drug metabolizing were markedly decreased by the administration of phytochemicals.

CONCLUSIONS

The results of this study suggest that combined treatment with curcumin and quercetin proved beneficial on antioxidant status and drug metabolizing enzymes during experimentally induced lung carcinogenesis in mice.

The activation of G protein-coupled receptor 30 (GPR30) inhibits proliferation of estrogen receptor-negative breast cancer cells in vitro and in vivo

There is an urgent clinical need for safe and effective treatment agents and therapy targets for estrogen receptor negative (ER−) breast cancer. G protein-coupled receptor 30 (GPR30), which mediates non-genomic signaling of estrogen to regulate cell growth, is highly expressed in ER− breast cancer cells. We here showed that activation of GPR30 by the receptor-specific agonist G-1 inhibited the growth of ER− breast cancer cells in vitro. Treatment of ER− breast cancer cells with G-1 resulted in G2/M-phase arrest, downregulation of G2-checkpoint regulator cyclin B, and induction of mitochondrial-related apoptosis. The G-1 treatment increased expression of p53 and its phosphorylation levels at Serine 15, promoted its nuclear translocation, and inhibited its ubiquitylation, which mediated the growth arrest effects on cell proliferation. Further, the G-1 induced sustained activation and nuclear translocation of ERK1/2, which was mediated by GPR30/epidermal growth factor receptor (EGFR) signals, also mediated its inhibition effects of G-1. With extensive use of siRNA-knockdown experiments and inhibitors, we found that upregulation of p21 by the cross-talk of GPR30/EGFR and p53 was also involved in G-1-induced cell growth arrest. In vivo experiments showed that G-1 treatment significantly suppressed the growth of SkBr3 xenograft tumors and increased the survival rate, associated with proliferation suppression and upregulation of p53, p21 while downregulation of cyclin B. The discovery of multiple signal pathways mediated the suppression effects of G-1 makes it a promising candidate drug and lays the foundation for future development of GPR30-based therapies for ER− breast cancer treatment.

Effects of Aspergillus Oryzae Culture and 2-Hydroxy-4-(Methylthio)-Butanoic Acid on In vitro Rumen Fermentation and Microbial Populations between Different Roughage Sources

An in vitro experiment was conducted to evaluate the effects of Aspergillus oryzae culture (AOC) and 2-hydroxy-4-(methylthio)-butanoic acid (HMB) on rumen fermentation and microbial populations between different roughage sources. Two roughage sources (Chinese wild rye [CWR] vs corn silage [CS]) were assigned in a 2×3 factorial arrangement with HMB (0 or 15 mg) and AOC (0, 3, or 6 mg). Gas production (GP), microbial protein (MCP) and total volatile fatty acid (VFA) were increased in response to addition of HMB and AOC (p<0.01) for the two roughages. The HMB and AOC showed inconsistent effects on ammonia-N with different substrates. For CWR, neither HMB nor AOC had significant effect on molar proportion of individual VFA. For CS, acetate was increased (p = 0.02) and butyrate was decreased (p<0.01) by adding HMB and AOC. Increase of propionate was only occurred with AOC (p<0.01). Populations of protozoa (p≤0.03) and fungi (p≤0.02) of CWR were differently influenced by HMB and AOC. Percentages of F. succinogenes, R. albus, and R. flavefaciens (p<0.01) increased when AOC was added to CWR. For CS, HMB decreased the protozoa population (p = 0.01) and increased the populations of F. succinogenes and R. albus (p≤0.03). Populations of fungi, F. succinogenes (p = 0.02) and R. flavefacien (p = 0.03) were increased by adding AOC. The HMB×AOC interactions were noted in MCP, fungi and R. flavefacien for CWR and GP, ammonia-N, MCP, total VFA, propionate, acetate/propionate (A/P) and R. albus for CS. It is inferred that addition of HMB and AOC could influence rumen fermentation of forages by increasing the number of rumen microbes.

PTEN inactivation by germline/somatic c.950_953delTACT mutation in patients with Lhermitte-Duclos disease manifesting progressive phenotypes

Lhermitte-Duclos disease (LDD), a neurological manifestation of Cowden syndrome (CS), is a rare and benign cerebellar disorder, featured by dysplastic cerebellar ganglion cells which replace granular and Purkinje cells. Phosphatase and Tensin Homolog (PTEN) is confirmed as the susceptibility gene for CS which represents the most complex features and is not easily recognizable. We reported two index patients with LDD diagnosed either in an isolated form or coexist with CS. These two patients displayed progressive though comparable phenotypes and were found to carry an identical PTEN c.950_953delTACT mutation in either germline or somatic sources of DNA, respectively. Negative or moderate expression levels of PTEN were validated by immunohistochemistry in the corresponding patients' affected tissues. This study has revealed a novel pathogenicity locus to LDD/CS as a candidate for early molecular diagnosis. In addition, the differential PTEN mutation status with corresponding LDD phenotypes suggests a potential correlation between germline or somatic mutation and coexisting LDD/CS or isolated LDD, respectively. Furthermore, our data could lend some reference to the underlying molecular mechanism of LDD pathogenesis in the future.

Cerebral diffusion tensor MR tractography in tuberous sclerosis complex: correlation with neurologic severity and tract-based spatial statistical analysis

BACKGROUND AND PURPOSE

The neurologic significance of residual cerebral white matter tracts, identified on diffusion tensor tractography, has not been well studied in tuberous sclerosis complex. We aimed to correlate the quantity of reconstructed white matter tracts with the degree of neurologic impairment of subjects with the use of DTI and determined differences in white matter integrity between patients with tuberous sclerosis complex and controls with the use of voxelwise analysis.

MATERIALS AND METHODS

In this case-control study, 16 patients with tuberous sclerosis complex and 12 control subjects underwent DTI. Major white matter tracts, comprising bilateral PF and CF, were reconstructed and assessed for quantity, represented by NOP and NOF. A neurologic severity score, based on the presence of developmental disability, seizure, autism, and other neuropsychiatric disorders, was calculated for each subject. We then correlated this score with white matter quantity. Voxelwise tract-based spatial statistics was used to determine differences in FA, axial, and radial diffusivity values between the tuberous sclerosis complex group and the control subjects.

RESULTS

NOP and NOF of CF, bilateral PF, and MWT in the tuberous sclerosis complex group were all significantly lower than those in the control subjects (P < .05). The neurologic severity score was moderately negatively correlated with NOF and NOP regarding CF (r = -.70; r = -.75), bilateral PF (r = -.66; r = -.68), and MWT (r = -.71; r = -.74). Tract-based spatial statistics revealed that patients with tuberous sclerosis complex showed a widespread reduction (P < .05) in FA and axial diffusivity in most cerebral white matter regions.

CONCLUSIONS

Patients with tuberous sclerosis complex with reduced residual white matter were neurologically more severely affected. Tract-based spatial statistics revealed decreased FA and axial diffusivity of the cerebral white matter in the tuberous sclerosis complex group, suggesting reduced axonal integrity.

Phosphatidylinositol 3 kinase/protein kinase B is responsible for the protection of paeoniflorin upon H₂O₂-induced neural progenitor cell injury

Promoting neural stem/progenitor cell (NSC/NPC) survival in the pro-apoptotic environment is critical to stem cell replacement for neurodegenerative disease therapy. Paeoniflorin (PF), one of the principal bioactive components in Paeoniae Radix, has been used widely in central nervous system (CNS) diseases treatment and serves as an antioxidant to protect neurons against oxidative stress. The present study investigated the protective effects of PF on NPC injury induced by hydrogen peroxide (H₂O₂). After challenge with 200 μM H₂O₂ for 2h, loss of cell viability and excessive apoptotic cell death were observed in cultured NPC, PF treatment conferred protective effects against the loss of cellular viability in a concentration-dependent manner. PF pretreatment also inhibited NPC apoptosis induced by H₂O₂ by reversing the decreased level of Procaspase-3 and balancing Bcl-2 and Bax expression. Furthermore, PF-mediated NPC protection was associated with an increase in phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt-1) phosphorylation in a time- and concentration-dependent manner. Selective inhibition of PI3K using LY294002 abolished PF-mediated phosphorylation of Akt-1 and NPC protection upon oxidative stress. These data suggest that PF-mediated NPC protection on H₂O₂ injury is reliant on the activation of the PI3K/Akt-1 pathway, giving insight to an essential role of PF in NPC protection.

Effects of dietary forage sources on rumen microbial protein synthesis and milk performance in early lactating dairy cows

The objective of this study was to evaluate the effects of dietary forage sources on milk performance, rumen microbial protein synthesis, and N utilization in early lactation dairy cows. Twelve primiparous Chinese Holstein dairy cows (45 ± 6.0 DIM) were used in a 3 × 3 Latin square design. Diets were isonitrogenous and isocaloric, with a forage-to-concentrate ratio of 45:55 [dry matter (DM) basis] and contained similar concentrate mixtures. Different forage sources were then added (on a DM basis): 21% corn silage, 19% corn stover, and 5% alfalfa hay (CS); 19% corn silage, 21% Chinese wild rye hay and 5% alfalfa hay (CWR); or 19% corn silage, 9% Chinese wild rye hay, and 17% alfalfa hay (AH). Each period lasted for 21 d, with the first 14 d for an adaptation period. Dry matter intake was not affected by the source of dietary forage. Milk yield was higher for cows fed AH than those fed CS, with an intermediate value for CWR. Milk protein content was higher in the cows fed AH compared with CWR (3.02 vs. 2.92%), with CS (2.95%) at an intermediate position. The contents of milk fat and lactose were not different among the treatments. However, milk efficiency (milk yield/DM intake) was higher for cows fed AH than those fed CS, with those fed CWR intermediate. Cows fed AH had higher microbial protein yield and metabolizable protein than those fed CS or CWR. The concentrations of urea N in the urine, blood, and milk were decreased for cows fed AH, indicating an increased N conversion. The results indicated that corn stover could replace Chinese wild rye grass in the diets for lactating cows and that a high proportion of alfalfa hay in the diet is beneficial for milk protein production by increasing microbial protein yield. This can be attributed to the improving the supply of rumen-available energy.

Contralateral de novo intraosseous arteriovenous malformation in a child with arteriovenous malformation of mandible treated by endovascular embolotherapy. A case report

We describe our experience of the development of contralateral de novo intraosseous AVMs in a ten-year-old girl with AVMs of the mandible who underwent endovascular embolotherapy. She initially presented with intermittent oral bleeding. Computed tomography and digital subtraction angiography demonstrated intraosseous AVMs within the right mandible. The AVMs were treated by transosseous direct-puncture and transarterial embolization with Guglielmi detachable coils and n-butyl cyanoacrylate glue. However, de novo intraosseous AVMs developed within the previously healthy contralateral mandible and resulted in dangerous oral bleeding. Therefore, we suggest regular follow-up and prompt retreatment of any residual mandibular AVMs in patients undergoing endovascular or surgical treatment to prevent subsequent development of "secondary" AVMs and life-threatening oral bleeding.

The effect of dilution and prolonged injection time on dexamethasone-induced perineal pruritus

Dexamethasone has been widely used before general anesthesia induction. However, previous studies have found that a pre-induction bolus dose of dexamethasone sometimes causes perineal pruritus. We hypothesized that an appropriate prolongation of the injection time might suppress dexamethasone-induced perineal pruritus. Four hundred patients requiring general anaesthesia were randomly allocated into four groups: group I receiving 2 ml dexamethasone (5 mg/ml); group II receiving 4 ml dexamethasone (2.5mg/ml); group III receiving 10 ml dexamethasone (1 mg/ml); and group IV receiving 20 ml dexamethasone (0.5 mg/ml). Dexamethasone was diluted with 0.9% sodium chloride. The injection time of dexamethasone was 5s in groups I, II and III; while the injection time of dexamethasone was 30s in group IV. Occurrence of perineal pruritus was significantly reduced in Group IV (0% vs 38%, 32% and 12% in Groups I, II and III, respectively, p < 0.05). The incidence was higher in females than in males (p < 0.05). The duration of perineal pruritus was longer in females than in males in groups I, II and III (p < 0.05). We conclude that the dilution of dexamethasone to 0.5 mg/ml with 0.9% sodium chloride combined with prolonged injection time to 30 s eliminates dexamethasone-induced perineal pruritus.

Prospective comparison of angio-seal versus manual compression for hemostasis after neurointerventional procedures under systemic heparinization

BACKGROUND AND PURPOSE

The use of arterial closure device in patients with prolonged high ACT values has not been extensively studied. The aim of this study was to compare the safety and efficacy of an arterial closure device, Angio-Seal, with manual compression in patients on anticoagulation following neurointerventional procedures.

MATERIALS AND METHODS

This was a 2-center prospective study approved by our institutional review boards. In total, 153 consecutive patients with 174 arteriotomies (86 men, 67 women; mean age, 56.1 ± 16.2 years) following femoral arterial puncture for neurointerventional procedures were enrolled in convenience sampling. All of the patients were systemically heparinized with an ACT between 250 and 500 seconds before removal of the sheath after the procedure. Group 1 consisted of 104 arteriotomies that were closed with an arterial closure device (Angio-Seal), and group 2 consisted of 70 arteriotomies treated with manual compression. The ACT before sheath removal, time to hemostasis, and complications immediately and 24 hours after the procedure were recorded.

RESULTS

The mean ACT before sheath removal was 284.8 ± 37.6 seconds (range, 250-414 seconds). The mean hemostasis time was significantly shorter in group 1 (2.4 ± 11.7 minutes) compared with group 2 (44.7 ± 27.4 minutes) (95% CI, 38.16-51.24 minutes; P < .001). Hematoma occurred in 9 patients in group 1 (8.6%) and 18 in group 2 (25.7%). One patient developed an arterial occlusion after hemostasis with the closure device, but this was successfully revascularized.

CONCLUSIONS

Angio-Seal was found to safely and effectively achieve rapid closure of the femoral access site in patients undergoing neuroendovascular procedures under systemic heparinization with an ACT in the range of 250-500 seconds.

The prediction of 30-day mortality in patients with primary pontine hemorrhage: a scoring system comparison

BACKGROUND AND PURPOSE

Owing to its low morbidity but high mortality, no accurate scoring system focuses on primary pontine hemorrhage (PPH) has been established. We aim to compare the performances of the Acute Physiology and Chronic Health Evaluation (APACHE) II and the Simplified Acute Physiology Score (SAPS) II with the ICH score in predicting the 30-day mortality in patients with PPH.

METHODS

We conducted a retrospective analysis of patients admitted with a diagnosis of PPH to a university-affiliated hospital in southern China from May 2000 to June 2011. Data related to patient demographics and that necessary to calculate APACHE II, SAPS II, and ICH score were recorded. Performances of these scoring systems were presented as calibration and discrimination, which were measured by the Hosmer-Lemeshow goodness-of-fit test and the area under the receiver operating characteristic (ROC) curve, respectively.

RESULTS

Among 75 patients with PPH finally included, 31 (41.3%) died within 30 days. SAPS II (χ(2) = 6.57, P = 0.682) had the best calibration, followed by APACHE II (χ(2) = 8.06, P = 0.428) and ICH score (χ(2) = 4.94, P = 0.176). Furthermore, in terms of area under the ROC curve, APACHE II (0.919) was more discriminative than SAPS II (0.890) and ICH score (0.844).

CONCLUSIONS

In predicting 30-day mortality in patients with PPH, SAPS II has the best calibration, while APACHE II has the highest discrimination. The ICH score, which is easier and simpler to calculate, should be modified for PPH.

A safe and efficacious alternative: sonographically guided internal jugular vein puncture for intracranial endovascular intervention

Transvenous interventions for intracranial vascular lesions are usually performed via venous access of a femoral vein puncture. However, the transjugular route is an alternative with a shorter and less tortuous vascular access for intracranial lesions. Although puncture of the internal jugular vein is generally believed to be too dangerous owing to potential hazardous complications, the safety of the sonographically guided retrograde internal jugular vein puncture technique for intracranial intervention has not been fully evaluated in the English literature. We present our experience with a total of 44 transjugular intervention procedures between April 1999 and June 2010. We believe sonographically guided internal jugular vein puncture is a safe and efficacious technique for establishing transvenous access for an intracranial endovascular intervention.

Effects of tripeptides and lactogenic hormones on oligopeptide transporter 2 in bovine mammary gland

This study was conducted to investigate the expression of oligopeptide transporter 2 (PepT2) and its potential function in bovine mammary gland. First, the PepT2 mRNA and protein were determined in cultured mammary epithelial cells. Then the effects of lactogenic hormones (prolactin, hydrocortisone or insulin) and substrate (threonyl-phenylalanyl-phenylalanine) on PepT2 were investigated. The PepT2 mRNA and protein were successfully detected in bovine mammary epithelial cells. PepT2 gene expression was enhanced by the addition of 50, 500 and 5000 ng/ml prolactin, 10 and 100 ng/ml hydrocortisone, and 50, 500, 5000 and 50,000 ng/ml insulin. PepT2 mRNA abundance was increased when 5, 10 and 15% of threonyl-phenylalanyl-phenylalanine was included. Responses of PepT2 to lactogenic hormones and oligopeptide inferred that it may play an important role in bovine mammary gland.

Effects of dietary supplementation of methionine and lysine on milk production and nitrogen utilization in dairy cows

The effect of the content of lysine and methionine in metabolizable protein (MP) on lactation performance and N utilization in Chinese Holstein cows was determined. A control diet (C) was formulated to be adequate in energy but slightly limiting in MP. The concentration of Met and Lys in MP was 1.87 and 5.93%, respectively. The treatments were as follows (% of Met or Lys in MP): L=diet C supplemented with L-lysine-HCl at 0.49% on a dry matter (DM) basis (Met, 1.87; Lys, 7.00); M=diet C supplemented with 2-hydroxy-4-(methylthio)-butanoic acid (HMB) at 0.15% (Met, 2.35; Lys, 5.93); ML=diet C supplemented with 0.49% L-lysine HCl and 0.15% HMB (Met, 2.39; Lys, 7.10). The diets were fed to 60 Chinese Holsteins in mid-lactation (average days in milk=120, and milk yield=32.0 kg/d) for 8 wk. Milk yield was increased by supplementation of either Lys (1.5 kg/d) or Met (2.0 kg/d), and supplementation of both Lys and Met further increased milk yield (3.8 kg/d). There was no significant difference in dry matter intake across treatment groups. Cows on treatments M (3.95%) and ML (3.90%) had higher milk fat content than those on C (3.60%) and L (3.67%), but there were no significant differences in milk protein and lactose contents or somatic cell count among treatments. Supplementation of Met or Lys significantly increased Met or Lys concentration in arterial plasma. Treatment ML had a higher conversion of intake N to milk N and lower urea N concentrations in serum, urine, and milk than did treatment C. Supplementing HMB and L-lysine-HCl to provide approximately 2.3% Met and 7.0% Lys of the MP in diets slightly limiting in MP increased milk production, milk protein yield, and N utilization efficiency.

Decreased renal mRNA expression of TRPM6 is associated with hypomagnesemia in C57BL/6 asthmatic mice

BACKGROUND AND OBJECTIVES

Hypomagnesemia has been reported up to 40% in asthma patients, and a relationship between hypomagnesemia and asthma severity has been previously characterized. However, the mechanism for hypomagnesemia in asthma patients is not clear. Transient receptor potential melastatin 6 (TRPM6) is a newly identified channel that is involved in active epithelial magnesium transport, and downregulation of TRPM6 in the kidney was related to reduced Mg2+ reabsorption in mouse model. The aim of the study was to investigate whether plasma and erythrocyte magnesium levels were correlated with renal expression of TRPM6 mRNA in C57BL/6 asthmatic mice.

MATERIALS AND METHODS

48 healthy C57BL/6 mice were randomly divided into asthmatic group and control group with 24 mice in each group. Each group were randomly taken out 8 mice at 1d, 21d, 34d to detect plasma Mg2+, intracellular Mg2+ and renal TRPM6 mRNA expressions.

RESULTS

There were no significant difference in plasma Mg2+, intracellular Mg2+ and TRPM6 mRNA expression of renal tissues between asthmatic group and control group at 1d. However, plasma Mg2+ and intracellular Mg2+ as well as TRPM6 mRNA of renal tissues in asthmatic group were significantly lower than that of control group at 21d and at 34d. Both plasma Mg2+ and intracellular Mg2+ were positively correlated with TRPM6 mRNA expression in the renal tissues.

CONCLUSION

This study indicates that the consistently reduced expression of TRPM6 mRNA may play a role in the pathogenesis of hypomagnesemia in C57BL/6 asthmatic mice.

Differentiating Components of Cerebral Arteriovenous Malformations Using T1-Weighted Gradient Recall Echo MR Imaging

Cerebral arteriovenous malformation (AVM) typically shows signal void on conventional MR images, making differentiation of each component difficult. We analyzed the MR signal intensity of AVM components on T1-weighted gradient recalled echo pulse sequence images. We retrospectively studied 29 patients with AVM between 2006 and 2008. Patients were excluded if they had 1) intracranial hemorrhage, 2) previous intervention for AVM. All patients underwent MR study on a 3T system (Magentom TIM Trio, Siemens). Pulse sequences included T1-weighted gradient recalled echo (T1GRE), T2-weighted (T2), time-of-flight (TOF), and contrast-enhanced T1-weighted (cT1) images. Digital subtracted angiography (DSA) was performed in all patients as a diagnostic standard. Signal intensity of each AVM component was recorded and compared between pulse sequences. Nine patients were studied (five men; mean age 39.1 years) and nine AVM were identified (mean size, 3.9 cm). Three different signal intensities (hypo-, iso-, and hyper-intensity) were observed in all nine patients on T1GRE. Only one signal intensity was seen on T2 (flow void) and cT1 images (hyperintensity) in nine patients. Two different signal intensities were observed in all seven patients with TOF images. The T1GRE image showed the largest number of different signal intensities of AVM when compared with other pulse sequences, thus providing clearer structural delineation. Routine use of the T1GRE pulse sequence can help pre-therapeutic planning or follow-up of AVM.

Measurements of h(c)(1P(1)) in psi' decays

We present measurements of the charmonium state h(c)(1P(1)) made with 106x10(6) psi' events collected by BESIII at BEPCII. Clear signals are observed for psi'-->pi0 h(c) with and without the subsequent radiative decay h(c)-->gamma eta(c). First measurements of the absolute branching ratios B(psi'-->pi0 h(c)) = (8.4+/-1.3+/-1.0) x 10(-4) and B(h(c)-->gamma eta(c)) = (54.3+/-6.7+/-5.2)% are presented. A statistics-limited determination of the previously unmeasured h(c) width leads to an upper limit Gamma(h(c))<1.44 MeV (90% confidence). Measurements of M(h(c)) = 3525.40+/-0.13+/-0.18 MeV/c2 and B(psi'-->pi0 h(c)) x B(h(c)-->gamma eta(c)) = (4.58+/-0.40+/-0.50) x 10(-4) are consistent with previous results.

Runx2, osx, and dspp in tooth development

The transcription factors Runx2 and Osx are necessary for osteoblast and odontoblast differentiation, while Dspp is important for odontoblast differentiation. The relationship among Runx2, Osx, and Dspp during tooth and craniofacial bone development remains unknown. In this study, we hypothesized that the roles of Runx2 and Osx in the regulation of osteoblast and odontoblast lineages may be independent of one another. The results showed that Runx2 expression overlapped with Osx in dental and osteogenic mesenchyme from E12 to E16. At the later stages, from E18 to PN14, Runx2 and Osx expressions remained intense in alveolar bone osteoblasts. However, Runx2 expression was down-regulated, whereas Osx expression was clearly seen in odontoblasts. At later stages, Dspp transcription was weakly present in osteoblasts, but strong in odontoblasts where Osx was highly expressed. In mouse odontoblast-like cells, Osx overexpression increased Dspp transcription. Analysis of these data suggests differential biological functions of Runx2, Osx, and Dspp during odontogenesis and osteogenesis.

Interleukin-10 (-592 C/A) and interleukin-12B (+16974 A/C) gene polymorphisms and the interleukin-10 ATA haplotype are associated with periodontitis in a Taiwanese population

BACKGROUND AND OBJECTIVE

Single nucleotide polymorphisms are assumed to be associated with the differential production of cytokines. We evaluated gene polymorphisms of interleukin-10 (-592C>A, -819C>T and -1082G>A) and interleukin-12B (+16974) in patients with chronic periodontitis (n = 145) and generalized aggressive periodontitis (n = 65) in comparison with healthy controls (n = 126).

MATERIAL AND METHODS

Gene promoter polymorphisms were analyzed by polymerase chain reaction with sequence-specific primers. Genotype and allele frequencies were analyzed using the chi-square test and logistic regression analysis.

RESULTS

The interleukin-10 -592 polymorphism showed significant differences among the three groups (p = 0.0330). The genotype frequencies of the -592 locus between the chronic periodontitis and healthy control groups were significantly different (AC vs. AA: odds ratio = 0.33). The combination ATA/ATA seemed to be associated with susceptibility to generalized aggressive periodontitis (p = 0.0276). Patients with the composite ATA/ACC were less likely to develop chronic periodontitis (p = 0.0248). The CC genotype of interleukin-12B (+16974) was related to chronic periodontitis (CC vs. AA, p = 0.0211; CC vs. AA+AC, p = 0.0187). The AC heterozygosity of interleukin-12B was significantly lower in chronic periodontitis vs. healthy controls (p = 0.0500).

CONCLUSION

The interleukin-10 gene polymorphism at position -592C>A may be associated with a lower risk for development of chronic periodontitis. The interleukin-10 haplotype ATA is associated with generalized aggressive periodontitis. On the other hand, interleukin-12B genetic variants at position +16974 are associated with susceptibility to chronic periodontitis.