Quorum sensing bacteria improve microbial networks stability and complexity in wastewater treatment plants

Quorum-sensing bacteria (QSB) are crucial factors for microbial communication, yet their ecological role in wastewater treatment plants (WWTPs) remains unclear. Here, we developed a method to identify QSB by comparing 16S rRNA gene sequences. QSB in 388 activated sludge samples collected from 130 WWTPs across China primarily were identified as rare taxa and conditionally rare taxa. A co-occurrence network shared by all sludge communities revealed that QSB exhibited higher average clustering coefficient (0.46) than non-QSB (0.15). Individual sludge networks demonstrated that quorum sensing microbiomes were positively correlated with network robustness and network complexity, including average clustering coefficient and link density. We confirmed that QSB keystones and QSB nodes have a positive impact on network complexity by influencing network modularity through a structural equation model. Meanwhile, QSB communities directly contributed to maintaining network robustness (r = 0.29, P < 0.05). Hence, QSB play an important role in promoting network complexity and stability. Furthermore, QSB communities were positively associated with the functional composition of activated sludge communities (r = 0.33, P < 0.01), especially the denitrification capacity (r = 0.45, P < 0.001). Overall, we elucidated the ecological significance of QSB and provided support for QS-based regulation of activated sludge microbial communities.

[Interpretation of specification for service of cancer screening for workers]

As the backbone force of China's social and economic construction, the health status of workers is closely related to the nation's productivity and social development. Currently, cancers have become one of the major diseases threatening the health of workers. However, there are still many shortcomings in the cancer screening services for the workers. To standardize cancer screening services for workers, ensure the quality of screening services, and improve the overall screening effectiveness, 19 institutions, including Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences, have jointly formulated the Group Standard "Specification for service of cancer screening for workers (T/CHAA 023-2023)". This standard follows the principles of "legality, scientific rigor, advancement, and feasibility" and combines the frontier scientific advances in cancer screening. It clarifies the relevant requirements for service principles, service design, service delivery, service management, service evaluation, and improving worker cancer screening. Implementing this group standard will help connect the common screening needs of workers, employers, and cancer screening service providers, standardize the screening process, improve screening quality, and ultimately increase the early diagnosis rate and survival rate of cancer patients. Consequently, this group standard will help safeguard workers' health rights and interests, ensure the labor force resources, promote the comprehensive coordinated and sustainable development of society, and contribute to realizing the "Healthy China 2030" strategic policy.

4D-MRI Guided Stereotactic Body Radiation Therapy for Unresectable Colorectal Liver Metastases

PURPOSE/OBJECTIVE(S)

This study evaluated the feasibilities and outcomes following four-dimensional magnetic resonance imaging (4D-MRI) guided stereotactic body radiation therapy (SBRT) for unresectable colorectal liver metastases (CRLM).

MATERIALS/METHODS

From March 2018 to January 2022, we identified 76 unresectable CRLM patients with 123 lesions who received 4D-MRI guided SBRT in our institution. 4D-MRI simulation with or without abdominal compression was conducted for all patients. The prescription dose was 50-65 Gy in 5-12 fractions. The image quality of computed tomography (CT) and MRI were compared using the Clarity Score. Clinical outcomes and toxicity profiles were evaluated.

RESULTS

The 4D-MRI significantly improved the image quality compared with CT images (mean Clarity Score: 1.67 vs 2.88, P < 0.001). The abdominal compression significantly reduced motions in cranial-caudal direction (P = 0.03) with 2 phase T2 weighted images assessing tumor motion. The median follow-up time was 12.5 months. For 98 lesions assessed for best response, the complete response, partial response and stable disease rate were 57.1 %, 30.6 % and 12.2 %, respectively. The local control (LC) rate at 2 year was 97.3%. 46.1% of patients experienced grade 1-2 toxicities and only 2.6% patients experienced grade 3 hematologic toxicities.

CONCLUSION

The 4D-MRI technique allowed precise target delineation and motion tracking in unresectable CRLM patients. High LC rate and mild toxicities were achieved. This study provided evidence for using 4D-MRI guided SBRT as an alternative treatment in unresectable CRLM.

[Impact of sinonasal anatomic changes after endoscopic anterior skull base surgery on nasal airflow and air conditioning: a computational fluid dynamics study]

Objective: To analyze the impact of the sinonasal anatomic changes after endonasal endoscopic anterior skull base surgery on the nasal airflow and heating and humidification by computational fluid dynamics (CFD), and to explore the correlation between the postoperative CFD parameters and the subjective symptoms of the patients. Methods: The clinical data in the Rhinology Department of the First Affiliated Hospital of Zhengzhou University from 2016 to 2021 were retrospectively analyzed. The patients received the endoscopic resection of the anterior skull base tumor were selected as the case group, and the adults whose CT scans had no sinonasal abnormalities were chosen as the control group. The CFD simulation was performed on the sinonasal models after reconstructed from the patients' sinus CT images during the post-surgical follow-up. All the patients were asked to complete the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) to assess the subjective symptoms. The comparison between two independent groups and the correlation analysis were carried out by using the Mann-Whitney U test and the Spearman correlation test in the SPSS 26.0 software. Results: Nineteen patients (including 8 males and 11 females, from 22 to 67 years old) in the case group and 2 patients (a male of 38 years old and a female of 45 years old) in the control group were enrolled in this study. After the anterior skull base surgery, the high-speed airflow moved to the upper part of the nasal cavity, and the lowest temperature shifted upwards on the choana. Comparing with the control group, the ratio of nasal mucosal surface area to nasal ventilation volume in the case group decreased [0.41 (0.40, 0.41) mm^-1 vs 0.32 (0.30, 0.38) mm^-1; Z=-2.04, P=0.041], the air flow in the upper and middle part of the nasal cavity increased [61.14 (59.78, 62.51)% vs 78.07 (76.22, 94.43)%; Z=-2.28, P=0.023], the nasal resistance decreased [0.024 (0.022, 0.026) Pa·s/ml vs 0.016 (0.009, 0.018) Pa·s/ml; Z=-2.29, P=0.022], the lowest temperature in the middle of the nasal cavity decreased [28.29 (27.23, 29.35)℃ vs 25.06 (24.07, 25.50)℃; Z=-2.28, P=0.023], the nasal heating efficiency decreased [98.74 (97.95, 99.52)% vs 82.16 (80.24, 86.91)%; Z=-2.28, P=0.023], the lowest relative humidity decreased [(79.62 (76.55, 82.69)% vs 73.28 (71.27, 75.05)%; Z=-2.28, P=0.023], and the nasal humidification efficiency decreased [99.50 (97.69, 101.30)% vs 86.09 (79.33, 87.16)%; Z=-2.28, P=0.023]. The ENS6Q total scores of all patients in the case group were less than 11 points. There was a moderate negative correlation between the proportion of the inferior airflow in the post-surgical nasal cavity negatively and the ENS6Q total scores (r_s=-0.50, P=0.029). Conclusions: The sinonasal anatomic changes after the endoscopic anterior skull base surgery alter the nasal airflow patterns, reducing the efficiency of nasal heating and humidification. However, the post-surgical occurrence tendency of the empty nose syndrome is weak.

Rare lysosomal disease registries: lessons learned over three decades of real-world evidence

Lysosomal storage disorders (LSD) are rare diseases, caused by inherited deficiencies of lysosomal enzymes/transporters, that affect 1 in 7000 to 1 in 8000 newborns. Individuals with LSDs face long diagnostic journeys during which debilitating and life-threatening events can occur. Clinical trials and classical descriptions of LSDs typically focus on common manifestations, which are not representative of the vast phenotypic heterogeneity encountered in real-world experience. Additionally, recognizing that there was a limited understanding of the natural history, disease progression, and real-world clinical outcomes of rare LSDs, a collaborative partnership was pioneered 30 years ago to address these gaps. The Rare Disease Registries (RDR) (for Gaucher, Fabry, Mucopolysaccharidosis type I, and Pompe), represent the largest observational database for these LSDs. Over the past thirty years, data from the RDRs have helped to inform scientific understanding and the development of comprehensive monitoring and treatment guidelines by creating a framework for data collection and establishing a standard of care, with an overarching goal to improve the quality of life of affected patients. Here, we highlight the history, process, and impact of the RDRs, and discuss the lessons learned and future directions.

Regulation of exogenous acyl homoserine lactones on sludge settling performance: Monitoring via ultrasonic time-domain reflectometry

Despite extensive studies, a comprehensive solution for sludge bulking has not yet been found. This study improves the sludge settling performance via quorum sensing (QS) by adding exogenous acyl homoserine lactones (AHLs). First, a novel approach based on ultrasonic time-domain reflectometry, which can automatically and in-situ assess a sludge volume index (SVI), was developed using the displacement in the ultrasonic spectra as a feasible indicator (R² = 0.98, p < 0.01). Next, the effects of typical AHLs, i.e., 3OC6-HSL, C12-HSL, and 3OC14-HSL, on sludge settling properties were investigated. Results indicated that the three AHLs significantly promoted the sludge settleability by 1.90, 2.03, and 1.62 times, respectively. The regulation mechanisms were investigated from the perspective of sludge physicochemical properties and biological community interactions. The draining degree of water to extracellular polymeric substances (EPS) significantly increased (p < 0.05) with all three AHLs. Meanwhile, the hydrophobic tryptophan content increased with the addition of 3OC6-HSL and C12-HSL. Hence, EPS hydrophobicity was promoted, which is conducive to microbial aggregation. In addition, molecular ecological networks of activated sludge (AS) indicated that bacterial community structures were more complex and species interactions were more intense when adding 3OC6-HSL and C12-HSL. Meanwhile, additional keystones were identified, with the proportion of QS species increasing by 63.6% and 22.2%, respectively. Exogenous 3OC6-HSL eventually decreased the gross relative abundance of filamentous bacteria by 2.37%. Overall, appropriate AHLs could enhance community stability and microbial cooperation by strengthening the communication hub role of QS species, thereby suppressing the overgrowth of filamentous bacteria and improving the sludge settleability. This study provides an effective strategy to determine the appropriate AHL to rapidly eliminate filamentous bulking problems.

[Comparison of application effects of colonoscopy, fecal immunochemical test and a novel risk-adapted screening approach in colorectal cancer screening in Xuzhou population]

Objective: To compare the application effect of the colonoscopy, fecal immunochemical test (FIT) and novel risk-adapted screening approach in colorectal cancer screening in Xuzhou population. Methods: From May 2018 to April 2019, 4 280 subjects aged 50-74 were recruited from Gulou district, Yunlong district and Quanshan district of Xuzhou. They were randomly assigned to the colonoscopy group (n=863), FIT group (n=1 723) and novel risk-adapted screening approach group (n=1 694) according to the ratio of 1∶2∶2. For the novel risk-adapted screening approach group, after the risk assessment, high-risk subjects were invited to undergo colonoscopy and low-risk subjects were invited to undergo FIT examination. All FIT positive subjects were invited to undergo colonoscopy. Colonoscopy participation rate [(the number of colonoscopies completed/the number of colonoscopies invited to participate)×100%], detection rate of colorectal lesions [(the number of diagnosed patients/the number of colonoscopies completed)×100%], colonoscopy resource load (the number of colonoscopies completed/the number of diagnosed advanced tumors) and FIT resource load in each group were calculated and compared. Results: The age of all subjects was (61±6) years old, including 1 816 males (42.43%). There was no statistically significant difference in the socio-demographic characteristics of the subjects in different screening groups. The colonoscopy participation rate was 22.60% (195/863) in the colonoscopy group, 57.04% (77/135) in the FIT group, and 33.94% (149/439) in the novel risk-adapted screening approach group, respectively. The colonoscopy participation rate was higher in the FIT group than in the colonoscopy group and the novel risk-adapted screening approach group (P<0.001). The colonoscopy participation rate of novel risk-adapted screening group was significantly higher than the colonoscopy group (P<0.001). The detection rates of advanced tumors were 6.67% (13/195), 9.09% (7/77) and 8.72% (13/149), respectively, and the difference was not statistically significant (P>0.05). The colonoscopy resource load (95%CI) was 15 (13-17) in the colonoscopy group, 11 (9-14) in the FIT group and 11 (10-13) in the novel risk-adapted screening approach group, respectively. Among them, the colonoscopy resource load of high-risk individuals in the novel risk-adapted screening approach group was 12 (9-15). FIT resource loads (95%CI) were 207 (196-218) and 88 (83-94) in the FIT group and the novel risk-adapted screening approach group. Conclusion: The combined application of risk-adapted screening approach and FIT may have a good application effect in colorectal cancer screening.

Application of an individualized nomogram in first-trimester screening for trisomy 21

OBJECTIVES

To develop and validate a nomogram based on fetal nuchal translucency thickness (NT) and ultrasonographic facial markers for screening for trisomy 21 in the first trimester of pregnancy.

METHODS

This was a retrospective case-control study using stored two-dimensional midsagittal fetal profile images captured at 11 + 0 to 13 + 6 weeks' gestation in singleton pregnancies. We included images from 302 trisomy-21 pregnancies and 322 euploid pregnancies. Cases were divided into a training set (200 euploid + 200 with trisomy 21) and a validation set (122 euploid + 102 with trisomy 21) at a ratio of approximately 2:1. For each, the maternal age, gestational age, fetal NT and karyotype were noted, and 12 ultrasonographic fetal facial markers were measured. The least absolute shrinkage and selection operator (LASSO) method and multivariable analysis were used to select automatically the discriminative markers. Logistic regression was used to develop a LASSO model, based on the selected markers, to screen for trisomy 21 in the first trimester of pregnancy. Furthermore, 60 of the 624 images were selected randomly as a retest set to evaluate the model's robustness. The predictive performance of screening for trisomy 21 of a model based on fetal NT and maternal age and of the LASSO model was assessed using the area under the receiver-operating-characteristics curve (AUC). A nomogram was developed as an individualized tool to predict patient-specific probability for trisomy 21, which is a more visual presentation of the LASSO model. The performance of the nomogram was assessed using the C-index and calibration curve.

RESULTS

Into the LASSO model were incorporated eight markers, including fetal NT, prenasal-thickness-to-nasal-bone-length ratio, facial profile line, frontomaxillary facial angle, frontonasal facial angle, mandibulomaxillary facial angle, maxilla-nasion-mandible angle and d2 (distance between the anterior edge of the prefrontal skin and the mandibulomaxillary line) (all P < 0.05). The AUCs of the LASSO model for screening for trisomy 21 were 0.983 (95% CI, 0.971-0.994) in the training set and 0.979 (95% CI, 0.966-0.993) in the validation set, and these were higher than the AUCs of all eight individual ultrasonographic markers included in the model. The AUC of the LASSO model in the retest set was 0.997 (95% CI, 0.990-1.000), indicating good robustness of the LASSO model. The AUC of the LASSO model was significantly higher than that of the model based on fetal NT and maternal age in both training and validation sets (P < 0.001 for both). The nomogram of the LASSO model showed good discrimination of trisomy 21, with C-indices of 0.983 in the training set and 0.981 in the validation set.

CONCLUSIONS

We present an individualized nomogram which incorporates fetal NT and a series of ultrasonographic facial profile markers selected by the LASSO method and multivariable analysis. This nomogram can potentially be utilized as a convenient and effective tool in screening for trisomy 21 in the first trimester of pregnancy. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

AHLs-mediated quorum sensing threshold and its response towards initial adhesion of wastewater biofilms

Quorum sensing (QS) plays a crucial role during initial biofilm formation, however the QS threshold and the response of biofilm formation towards N-acyl-homoserine lactones (AHLs) remains largely unknown due to the limitation of nondestructive online methods for monitoring bacterial adherence and the complexity of QS system, which limits the application of QS signal reagents in biofilm reactors. In this study, bacterial QS threshold and its response of biofilm formation to AHLs in purely cultured Sphingomonas rubra biofilm as well as in three different wastewater biofilms #1-3 were investigated via real time cell analysis (RTCA). The main perspective was to study the biomass adherence in response to 12 different forms of AHLs at different concentrations. Results showed that bacterial adhesion was significantly improved by exogenous AHLs with the maximum increase of 2.26-, 2.36-, 2.52-, and 2.80- times biomass production in the four respective biofilms. Although the preferred form of AHL differed for various biofilms, the long-chain AHLs (12-14 carbons) resulted in an overall improvement of bacterial adhesion due to their stronger hydrophobicity and hydrolysis resistance. In addition, bacterial QS threshold of AHLs was observed to have a wide range of concentration from 10 ng/L to 10 μg/L. Meanwhile, QS response time to AHLs also showed a significant difference in different biofilms. Biofilm #2 inoculated with bulking sludge had lower QS threshold of 10 ng/L and faster response to most AHLs that is less than 6 h. Thus, considering the improvement of biofilm adhesion by AHLs, 10 ng/L of C12-HSL, 10 ng/L of C12-HSL, and 10 ng/L of C6-HSL were preferentially selected for wastewater biofilms #1-3 respectively. Unexpectedly, adding high-concentration of AHLs detected in sludges did not significantly improved the bacterial adhesion. Infact the addition of these AHLs at low concentrations or even undetected concentrations substantially improved bacterial adhesion, which could be explained by bacterial communities composition. According to the Pearson correlation analysis, 62% of the top 50 most abundant genera in bacterial communities were significantly negatively related to the response time of multiple AHLs, representing their fast QS response. The QS bacteria, Dechloromonas and Nitrospira have fast QS response for C4-HSL and C8-HSL while, Comamonadaceae has fast QS response for 3OC8-HSL, 3OC10-HSL, 3OC12-HSL, and 3OC14-HSL. In contrast, the rest 38% of the top most abundant genera, such as Ferruginibacter, Hyphomicrobium, and Terrimonas quickly responded to only one AHL, showing significant negative relationship with the response time of C6-HSL. Overall, this study provides an effective and convenient means to select appropriate AHL reagents to promote bacterial adhesion in biofilm systems. Moreover, it also suggests that exogenous AHLs may be useful in improving the settling property of bulking sludge.

Defining heart disease risk for death in COVID-19 infection

BACKGROUND

Cardiovascular disease (CVD) was in common in coronavirus disease 2019 (COVID-19) patients and associated with unfavorable outcomes. We aimed to compare the clinical observations and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients with or without CVD.

METHODS

Patients with laboratory-confirmed SARS-CoV-2 infection were clinically evaluated at Wuhan Seventh People's Hospital, Wuhan, China, from 23 January to 14 March 2020. Demographic data, laboratory findings, comorbidities, treatments and outcomes were collected and analyzed in COVID-19 patients with and without CVD.

RESULTS

Among 596 patients with COVID-19, 215 (36.1%) of them with CVD. Compared with patients without CVD, these patients were significantly older (66 vs. 52 years) and had higher proportion of men (52.5% vs. 43.8%). Complications in the course of disease were more common in patients with CVD, included acute respiratory distress syndrome (22.8% vs. 8.1%), malignant arrhythmias (3.7% vs. 1.0%) including ventricular tachycardia/ventricular fibrillation, acute coagulopathy(7.9% vs. 1.8%) and acute kidney injury (11.6% vs. 3.4%). The rate of glucocorticoid therapy (36.7% vs. 25.5%), Vitamin C (23.3% vs. 11.8%), mechanical ventilation (21.9% vs. 7.6%), intensive care unit admission (12.6% vs. 3.7%) and mortality (16.7% vs. 4.7%) were higher in patients with CVD (both P < 0.05). The multivariable Cox regression models showed that older age (≥65 years old) (HR 3.165, 95% CI 1.722-5.817) and patients with CVD (HR 2.166, 95% CI 1.189-3.948) were independent risk factors for death.

CONCLUSIONS

CVD are independent risk factors for COVID-19 patients. COVID-19 patients with CVD were more severe and had higher mortality rate, early intervention and vigilance should be taken.

[The value of spectral CT-based radiomics in preoperative prediction of lymph node metastasis of advanced gastric cancer]

Objective: To investigate the spectral CT-based radiomics in predicting preoperatively the lymph node metastasis (LNM) of advanced gastric cancer. Methods: From January 2014 to October 2018, the spectral CT imaging and clinical data of 196 gastric adenocarcinoma patients confirmed by pathology in the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled (training set and test set were randomly divided according to the ratio of 1∶1). These 196 patients include143 males and 53 females, aged from 28 to 81 years, with an average age of (59±11) years, and were divided into nodular metastasis group and non-metastasis group according to clinicopathological data. The spectral parameters were measured and calculated, and the CT-reported lymph node (LN) status from CT images were obtained. 273 radiomics features were extracted from the dual-phases CT images in different energy level (40, 65 and 100 keV) to build the radiomics signature respectively. Univariate analysis was used to compare the differences of spectral parameters and radiomics features between two groups, and then the significant indicators were put into multivariable logistic regression analysis to construct combined prediction model and radiomics nomogram. In addition, the performance of prediction model in training and test set were measured using the receiver operating characteristics (ROC) curves and were compared using DeLong test. Results: Both in training set and in test set, the iodine concentration (IC) of tumor in venous phase (VP) in nodular metastasis group were higher than that in non-metastasis group [training set: 22.98 (100 mg/L)>20.31 (100 mg/L), P=0.086; test set: 25.14 (100 mg/L)>21.07 (100 mg/L), P=0.009]. The CT-reported LN status showed significant differences between the two group (P<0.001, P=0.001). The radiomics signatures 40 keV-arterial phase, 65 keV-venous phase, IC-VP of tumor and CT-reported LN status were independent indicators for prediction of preoperative LNM of advanced gastric cancer in combined prediction model (P<0.05). The radiomics nomogram predicated LNM with an area under curve (AUC) and 95% confidence interval (CI) of 0.822 (0.739-0.906) in training set and 0.819(0.732-0.906) in test set, and there were no significant differences in AUC between two sets (P>0.05). Conclusions: The spectral CT-based radiomics can be used to quantitatively predict the LNM of advanced gastric cancer preoperatively.

[Population's acceptance and attitude toward a novel fecal immunochemical test for colorectal cancer screening: a multi-center survey in China]

Objective: To investigate the acceptance and attitude toward a novel fecal immunochemical test (FIT) in colorectal cancer screening among populations in China. Methods: From May 2018 to May 2019, 2 474 people aged 50-74 years were recruited from five provinces of China (Zhejiang, Anhui, Jiangsu, Hunan and Yunnan). The general demographic characteristics, acceptance of the new FIT technology and operational difficulties through the whole screening process were obtained through questionnaire survey. Multivariate logistic regression model was used to analyze the factors related to difficulties encountered in sampling stool, reading and uploading results. Results: The subjects were (60.0±6.4) years old, and female, high school of above educated, unemployed/retired/other, married and with medical insurance status of "new rural cooperative medical care (NRCMC)" accounted for 61.7% (1 526), 29.0%(718), 34.3% (849), 92.7% (2 293) and 31.3%(775), respectively. The population's acceptance of the FIT technology was 94.8%. In the process of FIT screening, the percentage of occurred difficulties in sampling stool, reading and uploading results were 33.1% (819), 46.4% (1 147) and 62.9% (1 557), respectively. The main difficulties were the uncertainty about whether the sampling operation was standard (28.0%), the inability to accurately judge the result displayed (32.5%) and the need for help without using a smartphone (44.2%). The results of multivariate logistic regression model analysis showed that people aged 65-74 years old and with medical insurance status of "NRCMC" were more likely to encounter difficulties in sampling, and those who were unemployed/retired/other and living with 3 or more family members were less likely to encounter difficulties in sampling. Those aged 65-74 years old, farmers or migrant workers, and those with "NRCMC" were more likely to encounter difficulties in readingresults, and those with 3 or more family members were less likely to encounter difficulties in reading result. Those with "NRCMC" were more likely to encounter difficulties in uploading results, and those with education level of high school or above, living with more than 3 family members were less likely to encounter difficulties in uploading results. Conclusion: The acceptance of the new FIT technology is relatively high among the subjects. Age, education level, occupation, number of family members living together and medical insurance status might be related to difficulties encountered in sampling stool, reading and uploading results, and it can be further strengthened in terms of the technology and characteristics of sub-populations.

In-situ monitoring of the unstable bacterial adhesion process during wastewater biofilm formation: A comprehensive study

The initial bacterial adhesion phase is a pivotal and unstable step in the formation of biofilms. The initiation of biofilm formation is an unstable process caused by the reversible adhesion of bacteria, which is always time-consuming and yet to be elucidated. In this study, impedance-based real time cell analysis (RTCA) was employed to comprehensively investigate the initial bacterial adhesion process. Results showed that the time required for the unstable adhesion process was significantly (p < 0.05) reduced by increasing the initial concentration of bacteria, which is mainly attributed to the large deposition rate of bacteria at high concentrations. In addition, the unstable adhesion process is also regulated by shear stress, derived in this work from orbital shaking. Shear stress improves the reversibility of unstable bacterial attachment. Furthermore, attachment characteristics during the unstable phase vary between different species of bacteria (Sphingomonas rubra, Nakamurella multipartita and mixed bacteria). The S. rubra strain and mixed culture were more prone to adhere to the substratum surface during the unstable process, which was attributed to the smaller xDLVO energy barrier and motility of species in comparison with N. multipartita. Meanwhile, the molecular composition of extracellular polymeric substances (EPS) in the initial attachment phase presented a significant difference in expressed proteins, indicating the important role of proteins in EPS that strengthen bacterial adhesion. Overall, these findings suggest that during the biofilm reactor start-up process, seed sludge conditions, including the bacterial concentration, composition and hydraulics, need to be carefully considered.

Deep learning radiomic nomogram can predict the number of lymph node metastasis in locally advanced gastric cancer: an international multicenter study

BACKGROUND

Preoperative evaluation of the number of lymph node metastasis (LNM) is the basis of individual treatment of locally advanced gastric cancer (LAGC). However, the routinely used preoperative determination method is not accurate enough.

PATIENTS AND METHODS

We enrolled 730 LAGC patients from five centers in China and one center in Italy, and divided them into one primary cohort, three external validation cohorts, and one international validation cohort. A deep learning radiomic nomogram (DLRN) was built based on the images from multiphase computed tomography (CT) for preoperatively determining the number of LNM in LAGC. We comprehensively tested the DLRN and compared it with three state-of-the-art methods. Moreover, we investigated the value of the DLRN in survival analysis.

RESULTS

The DLRN showed good discrimination of the number of LNM on all cohorts [overall C-indexes (95% confidence interval): 0.821 (0.785-0.858) in the primary cohort, 0.797 (0.771-0.823) in the external validation cohorts, and 0.822 (0.756-0.887) in the international validation cohort]. The nomogram performed significantly better than the routinely used clinical N stages, tumor size, and clinical model (P < 0.05). Besides, DLRN was significantly associated with the overall survival of LAGC patients (n = 271).

CONCLUSION

A deep learning-based radiomic nomogram had good predictive value for LNM in LAGC. In staging-oriented treatment of gastric cancer, this preoperative nomogram could provide baseline information for individual treatment of LAGC.

Effect of salinity on mature wastewater treatment biofilm microbial community assembly and metabolite characteristics

The response mechanism of wastewater treatment biofilms to salt stress has not yet been fully established. The aim of this study was to reveal the comprehensive biological effects of salinity on biofilm microbial community and metabonomic characteristics. The study assessed performance at a range of sodium chloride (NaCl) concentrations of 0.6, 14 and 20 g/L. Biofilm coverage rate decreased significantly with increasing NaCl concentrations. High NaCl concentrations resulted in more compact and smoother biofilm morphologies. NaCl concentrations affected bacterial community variation at the class and genus level, with Gammaproteobacteria being the most dominant Proteobacteria, exhibiting NaCl tolerance at concentrations ranging from 0 to 20 g/L. Also, NaCl sensitive or tolerant species were identified, such as Pseudomonas and Planococcus, respectively. Dominant metabolites in wastewater treatment biofilms belonging to nucleotide, lipid, vitamin, amino acid and carbohydrate metabolism pathways decreased with increasing NaCl concentrations. High concentrations of NaCl regulated cell motility, transcription and membrane transport functions. In particular, the activity of ABC transporters were up-regulated at NaCl concentrations of 0.6 g/L and down-regulated at higher salinity concentrations. In addition, transcription machinery were inhibited under the stress of 14 g/L NaCl. These findings further our understanding of the short-term adaption mechanisms of wastewater treatment biofilms to high NaCl concentration environments.

Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer

Background

Occult peritoneal metastasis (PM) in advanced gastric cancer (AGC) patients is highly possible to be missed on computed tomography (CT) images. Patients with occult PMs are subject to late detection or even improper surgical treatment. We therefore aimed to develop a radiomic nomogram to preoperatively identify occult PMs in AGC patients.

Patients and methods

A total of 554 AGC patients from 4 centers were divided into 1 training, 1 internal validation, and 2 external validation cohorts. All patients’ PM status was firstly diagnosed as negative by CT, but later confirmed by laparoscopy (PM-positive n = 122, PM-negative n = 432). Radiomic signatures reflecting phenotypes of the primary tumor (RS1) and peritoneum region (RS2) were built as predictors of PM from 266 quantitative image features. Individualized nomograms of PM status incorporating RS1, RS2, or clinical factors were developed and evaluated regarding prediction ability.

Results

RS1, RS2, and Lauren type were significant predictors of occult PM (all P < 0.05). A nomogram of these three factors demonstrated better diagnostic accuracy than the model with RS1, RS2, or clinical factors alone (all net reclassification improvement P < 0.05). The area under curve yielded was 0.958 [95% confidence interval (CI) 0.923–0.993], 0.941 (95% CI 0.904–0.977), 0.928 (95% CI 0.886–0.971), and 0.920 (95% CI 0.862–0.978) for the training, internal, and two external validation cohorts, respectively. Stratification analysis showed that this nomogram had potential generalization ability.

Conclusion

CT phenotypes of both primary tumor and nearby peritoneum are significantly associated with occult PM status. A nomogram of these CT phenotypes and Lauren type has an excellent prediction ability of occult PM, and may have significant clinical implications on early detection of occult PM for AGC.

[A study on the targeted nanoparticles of isosorbide mononitrate on reducing the levels of inflammatory factors in rabbit models of rhinosinusitis]

Objective: To investigate the effect of isosorbide mononitrate (ISMN) targeted nanoparticles on inflammatory factors of sinusitis by establishing a rabbit model of rhinosinusitis. Methods: Thirty healthy rabbits, male and female, weighing 2.5-3.5 kg, were randomly divided into 6 groups with 5 rabbits in each group. Group A was the control group. The model of rabbit sinusitis was established in group B to F, and CT was used to confirm the model was successful. After placing tubes into the maxillary sinus in the group C to F, saline, 45 mg/ml ISMN, 45 mg/ml ISMN nanoparticles and 45 mg/ml ISMN targeted nanoparticles were used to wash the maxillary sinus, respectively. Blood samples were collected from the ear vein of rabbits on day 7, 14, 21, 28, 35 and 42 after modeling respectively. Changes in the expression levels of inflammatory factors in rabbits during the modeling process and after drug washing were detected by ELISA. After the drug intervention, the maxillary sinus mucosa was taken for real-time quantitative PCR to detect the changes in the mRNA level of inflammatory factors. SPSS 22.0 software was used to process the data. Results: Rabbit model of sinusitis was successfully established. ELISA showed that after the action of ISMN targeted nanoparticles of 1 week (42th day after modeling), the levels of (interleukin, IL) 4, IL-8, IL-17A and interferon γ (IFN-γ) in the blood were lower compared with that of 35th day after modeling, the difference was statistically significant (5.57±1.20 vs 19.73±0.68, 66.41±11.87 vs 154.68±13.13, 17.96±1.87 vs 28.23±0.80, 53.56±5.66 vs 111.93±7.29, all P<0.05). Compared with the ISMN nanoparticles and ISMN, the ISMN targeted nanoparticles reduced the levels of IL-4, IL-8, IL-17A and IFN-γ more obviously, the differences were statistically significant (13.26±1.43 vs 8.81±1.33 vs 7.14±2.16, 89.47±17.80 vs 41.07±7.77 vs 15.84±3.72, 10.28±2.07 vs 3.06±1.62 vs 1.82±0.90, 62.16±6.18 vs 35.12±4.62 vs 27.89±10.18, all P<0.05). Real-Time PCR showed that after the flushing of ISMN targeted nanoparticles, the levels of IL-4, IL-8, IL-17A and IFN-γ mRNA were lowest compared with that of the model group, ISMN nanoparticles and ISMN group. Conclusion: ISMN targeted nanoparticles can reduce the level of inflammatory factors in rabbit sinusitis model.

Nanostrain sensitivity in a wire torsion experiment

The feasibility of a thin-wire torsion stress-strain experiment with nanostrain sensitivity is demonstrated. A gauge length of 50 m was made possible by using The Monument, London, thereby restoring it to its original purpose as a scientific instrument. A wire of 150 μm diameter was studied using the load-unload method, and data were recorded in the elastic regime and through the elastic-plastic transition. Analysis of this preliminary experiment suggested some necessary improvements to the equipment and methods. Progress towards definitive experiments is described together with difficulties still to be overcome.

Alprostadil attenuates LPS-induced cardiomyocyte injury by inhibiting the Wnt5a/JNK/NF-κB pathway

Background

Clinical research has demonstrated that alprostadil has an anti-inflammatory effect; however, to date, its molecular mechanisms remain unclear. This study aimed to examine the anti-inflammatory activity and related mechanisms of alprostadil in lipopolysaccharide (LPS)-treated H9c2 cells.

Methods

Cell morphology was observed under an inverted light microscope, while cell viability was assessed with the 3‑(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay. Enzyme-linked immunosorbent assays (ELISA) were conducted to study biochemical indicators of cellular damage, such as released lactate dehydrase (LDH) and troponin, and inflammatory cytokine levels including interleukin-1β (IL-1β), IL-6, IL-17, and tumor necrosis factor-α (TNF-α). The mRNA expression levels of Wnt5a, c‑jun N‑terminal kinase (JNK), and nuclear factor kappa B (NF-κB) were further investigated by real-time quantitative polymerase chain reaction (RT-PCR). The effects of alprostadil on the Wnt5a/JNK/NF-κB pathway in H9c2 cells was examined by Western blotting.

Results

Alprostadil increased the cell viability of LPS-stimulated H9c2 cells, reduced LDH and troponin production, and attenuated IL-1β, IL-6, IL-17, and TNF-α secretion. Moreover, alprostadil reduced the mRNA expression of Wnt5a, JNK, and NF-κB and decreased the expression of Wnt5a, NF-κB, and the ratio of p‑JNK/JNK in H9c2 cells treated with LPS. The siWnt5a or JNK inhibitor SP600125 significantly augmented the inhibitory effects of alprostadil on the Wnt5a/JNK/NF-κB pathway.

Conclusion

Our results show that alprostadil has anti-inflammatory effects and could attenuate LPS-induced injury in H9c2 cardiomyocytes via the Wnt5a/JNK/NF-κB pathway.

[A novel nanoparticle in treatment of staphylococcus aureus and pseudomonas aeruginosa biofilms]

Objective:To investigate CPC-nanoparticles of low concentrations in treatment of staphylococcus aureus and pseudomonas aeruginosa biofilms in vitro. Method: We established specific biofilms of staphylococcus aureus ATCC 25923 and pseudomonas aeruginosa ATCC 15692, and prepared CPC-nanoparticles and CPC micelle solutions of low concentrations(0.010%, 0.025% and 0.050%). AlamarBlue was used to test the viability of both planktonic staphylococcus aureus and pseudomonas aeruginosa and their biofilms after treatment for 5 minutes and 2 hours respectively in the bactericidal efficacy study.The interaction between CPC-nanoparticles and staphylococcus aureus and pseudomonas aeruginosa biofilms was observed by confocal laser scanning microscope(CLSM). Result: 0.010%, 0.025% and 0.050% CPC-nanoparticles and CPC-micelle solutions had significant bactericidal effect on planktonic staphylococcus aureus and pseudomonas aeruginosa after fiveminute exposure(P<0.05), and staphylococcus aureus and pseudomonas aeruginosa biofilms after both five-minute and two-hour treatments(P<0.05). In CLSM study, the size of staphylococcus aureus biofilms decreased, while dead bacteria of pseudomonas aeruginosa biofilms increased after two-hour treatment. Conclusion: CPC-nanoparticles had significant bactericidal effects on staphylococcus aureus and pseudomonas aeruginosa biofilms, which could be used in treatment of CRS.

[Fabrication and verification of three-dimensional prototyped models of nasal cavities and paranasal sinuses]

Objective: To make three-dimensional prototyped models of nasal cavities and paranasal sinuses for endoscopic skills training and teaching and to verify and evaluate the fidelity of the models. Methods: Imaging data of a patient with nasal septum deviation was selected for prototyping the nasal cavities model, and the imaging data of a patient with chronic rhinosinusitis who underwent the endoscopic sinus surgery 4 months ago was selected for the paranasal sinuses model. Both patients came from the Department of Rhinology, the First Affiliated Hospital of Zhengzhou University. The models were printed by the desktop-level printer based on the fused deposition modeling (FDM). The evaluations of anatomical structures and prespecified tasks on the simulators were completed by 5 residents and 5 experts of Rhinology.The models were evaluated by survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated.Mann-Whitney nonparametric test was used to assess the differences between experts and residents groups. The statistical significance level was set at P<0.05. Results: All the components of the two models were prototyped in 24 h. For the nasal cavities model, the scores of each anatomical structure were more than 4.0. As to the paranasal sinuses model, except for the frontal sinus (3.6), the scores of each anatomical structure were more than 4.0. All the participants who performed the prespecified tasks evaluated the models well (>4.0). With the nasal cavity simulator, the experts completed the tasks (nasal cavity and nasopharyngeal endoscopy, removal of nasal foreign body, nasal packing, pledget insertion), and the other tasks (the nasal cavity and nasopharyngeal endoscopy, identification of ostiums of paranasal sinuses, maxillary sinus debridement with 70° nasal endoscopy) were completed with paranasal sinus model. The average time to complete each task by experts group and residents group (M (P(25), P(75))) were 10.3 (10.0, 10.7) s vs 17.1 (14.6, 20.7) s, 2.1 (2.0, 2.2) s vs 3.4 (2.6, 4.7) s, 30.1 (27.8, 32.8) s vs 59.2 (52.0, 65.4) s, 54.8 (50.1, 63.2) s vs 92.2 (79.3, 106.9) s, 9.3 (8.7, 9.9) s vs 14.5 (13.3, 14.9) s, 20.1 (19.3, 21.2) s vs 41.9 (35.5, 45.1) s, 31.1 (28.8, 35.2) s vs 52.8 (47.7, 56.3) s, respectively, and the average time to complete each task was shorter for the experts group than for the residents (U value was 0, 1.000, 0, 0, 0, 0, 0, respectively, all P<0.05). Conclusion: The models of nasal cavities and paranasal sinuses made by our desktop-level FDM 3D-printer are useful for endoscopic training skills.

[Retrospective analysis of 273 benign fibro osseous lesionsin the sinus and maxillofacial region]

Objective:To compare and analyze the incidence, clinical features ,imaging features, the preoperative serum alkalinosis phosphatase (ALP) and recurrence rates of osteoma, ossifying fibroma (OF), and fibrous dysplasia (FD) in sinus and maxillofacial benign fibrosis (FOLS). Method: The 273 cases of FOLS with paranasal sinus and maxillofacial region in our hospital, among which there were 153 cases of osteoma, 44 cases of OF, and 76 cases of FD, were reviewed retrospectively and were follow-up for 6 months to 5 years. The incidence, gender, age, lesion location, preoperative serum ALP levels and recurrence rate of different lesions were analyzed and compared. Result:Most Osteoma occurred in paranasal sinus (72.5%),among which the most common part was ethmoid sinus (50.3%) and followed by the frontal sinus (22.1%),the ratio of female to male was 2:1,and there were 27 cases (17.7%) accompanied by sinusitis.None of the patients relapsed. Most OF occurred in the maxillofaCIal bone (65.9%) and most of the lesions were monostotic (75.0%).For those occurred in the paranasal sinuses,the ethmoid sinus (27.3%)were the most common part than others. The ratio of femal to male was almost 1∶1 and there were 12 cases (27.3%) accompanied by sinusitis. The recurrence rate of the OF was 13.6%.Most FD occured in maxillofacial bone (64.5%) were the monostotic form(64.5%) ,and in which the most common part was the maxilla (50.0%). While,most of those occurred in the paranasal sinuses were the polyostotic ones,and sphenoid sinus (34.2%) were the most common parts.The ratio of femal to male was almost 1∶1 and there were 10 cases (13.2%) accompanied by sinusitis. 12 cases relapsed (14.5%),and there were 9 cases (75.0%) acceptted the first surgery before the age of 20.The average age of onset among Osteoma［(40.7±14.55)y］,OF［(28.0±17.9)y］ and FD［(20.32±15.2)y］ were significant different (P<0.01).The preoperative serum ALP content among Osteoma［(68.3±24.1)U/L, OF(130.1±107.0) U/L and FD were (127.7±78.7) U/L significant different(P<0.01).Nevertheless,there were no differences of the preoperative serum ALP content between the monostotic and polyostotic in OF cases［(117.2±92.6) U/L,(168.7±140.1) U/L respectively,( P>0.01)］,as well as that between FD cases［(122.2±82.9) U/L, (137.7±70.7) U/L (P>0.01)］. Conclusion:The differences of the inCIdence,the age of onset,leision location,preoperative serum ALP content and reccurence rate among Osteoma,OF and FD are statistically significant.Surgery is the most effective treatment at present.

CCR2- and CCR2+ corneal macrophages exhibit distinct characteristics and balance inflammatory responses after epithelial abrasion

Macrophages are distributed throughout the body and are crucial for the restoration of damaged tissues. However, their characteristics in the cornea and roles in the repair of corneal injures are unclear. Here we show that corneal macrophages can be classified as CCR2^- macrophages, which already exist in the cornea at embryonic day 12.5 (E12.5) and are similar to yolk sac-derived macrophages, microglia, in phenotype and gene expression, and CCR2⁺ macrophages, which do not appear in the cornea until E17.5. At a steady state, CCR2^- corneal macrophages have local proliferation capacity and are rarely affected by monocytes; however, following corneal epithelial abrasion, most CCR2^- corneal macrophages are replaced by monocytes. In contrast, CCR2⁺ macrophages are repopulated by monocytes under both a steady-state condition and following corneal wounding. Depletion of CCR2⁺ macrophages decreases corneal inflammation after epithelial abrasion, whereas depletion of CCR2^- macrophages increases inflammation of the injured cornea. Loss of either cell type results in a delay in corneal healing. These data indicate that there are two unique macrophage populations present in the cornea, both of which participate in corneal wound healing by balancing the inflammatory response.

Piccolo mediates EGFR signaling and acts as a prognostic biomarker in esophageal squamous cell carcinoma

The presynaptic cytomatrix protein Piccolo, encoded by PCLO, is frequently mutated and amplified in esophageal squamous cell carcinoma (ESCC), but its exact roles in ESCC remain unclear. Here we report that Piccolo expression correlates significantly with clinical stage, patient survival and tumor embolus. Functional studies demonstrate that PCLO knockdown remarkably attenuates ESCC malignancy in vitro and in vivo, and ectopic EGFR expression partially compensates for Piccolo loss. PCLO knockdown promotes ubiquitination and degradation of EGFR, which is associated with the negative regulatory effect of Piccolo on E3 ligase Siah1. An anti-Piccolo monoclonal antibody inhibited tumor proliferation in a mouse model of ESCC. These results demonstrate that Piccolo contributes to tumor aggressiveness in ESCC, likely by stabilizing EGFR and promoting EGFR-dependent signaling. Our results further suggest that Piccolo may represent a novel prognostic biomarker and therapeutic target for patients with ESCC.

Abstract P2-05-38: Spectral CT based radiomics signature: A potential biomarker for preoperative prediction of lymph node metastasis in breast cancer

Purpose:

To investigate the usefulness of radiomics signature based on computed tomographic (CT) spectral imaging, during the late arterial phase (AP) and portal venous phase (PVP), in preoperative predicting the lymph node (LN) metastasis in breast cancer (BC).

patients and methods:

This retrospective study was institutional review board approved, and written informed consent was obtained from all patients. We examined 60 female patients (LN metastasis positivity was 50%) with CT spectral imaging during the AP and the PVP and data was gathered from 2014 to 2016. Excised lymph nodes were located and labeled during surgery according to location on preoperative CT images and were evaluated histopathologically. For each patient, two 3D Hounsfeld Unit (HU) gradient maps which revealed the HU change of each voxel were built by quadratic fitting the spectral HU curves during the two phases respectively. Then the radiomics features were then extracted from the regions of BC and a suspicious LN judged manually in these maps. The potential association of the four groups of radiomics features with LN status was assessed by using a Mann-Whitney U test. The area under curves (AUC) of the receiver operating characteristic curves (ROC) were compared with data obtained from the conventional CT image.

results:

The 3D HU gradient map showed a great power of distinguishing among different components and was considered as a more effective tool for revealing the intratumour heterogeneity than the conventional CT image since the slope of spectral HU curves were significantly higher in malignant tumor. More than 500 radiomics features extracted from the regions of LN during the AP and the PVP exhibited significant differences (P &lt;0.05). Moreover, the numbers of this kind of features extracted from the regions of BC were more than 200. The highest AUC of single feature was 0.70, which was higher than those from the conventional CT image.

Conclusion:

Quantitative radiomics features based on 3D HU gradient maps have the potential to be exploited as an effective biomarker for preoperative prediction of lymph node metastasis in breast cancer.

Citation Format: Dong D, Zhang X, Fang M, Shen J, Tian J. Spectral CT based radiomics signature: A potential biomarker for preoperative prediction of lymph node metastasis in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-38.

Current epidemiological profile and features of traumatic spinal cord injury in Heilongjiang province, Northeast China: implications for monitoring and control

STUDY DESIGN

A retrospective hospital-based study.

OBJECTIVES

Traumatic spinal cord injury (TSCI) is considered to be an important public health problem worldwide. Only a few studies concerning the regional epidemiological characteristics of TSCI have been published in China. The purpose is to evaluate the epidemiological characteristics of TSCI in Heilongjiang province in northeast China.

SETTING

The Second Affiliated Hospital of Harbin Medical University and the Fifth Hospital of Harbin City, Heilongjiang province.

METHODS

Information of 232 patients who suffered from TSCI was gathered from their charts between January 2009 and December 2013. Information on sociodemographic variables was collected from each chart, including the patient's age, sex, occupation, injury time, causes and extent of injury.

RESULTS

The average age of patients with TSCI was 45.35±14.35 years. The male/female ratio was 4:1. The incidence of TSCI increased gradually with age and peaked in the 46- to 60-year-old age category. The most common occupation was farm laborer (35.34%). Motor vehicle collisions, followed by falls, were found to be the leading cause of TSCI. Furthermore, the majority of TSCI patients (76.29%) suffered a cervical injury.

CONCLUSION

The present study reveals that TSCI is an issue in the province, and it should not be ignored. Our results provide preliminary evidence and theoretical basis for developing an integrated control program for TSCI.

Systematic evaluation of pembrolizumab dosing in patients with advanced non-small-cell lung cancer

BACKGROUND

In the phase I KEYNOTE-001 study, pembrolizumab demonstrated durable antitumor activity in patients with advanced non-small-cell lung cancer (NSCLC). We sought to characterize the relationship between pembrolizumab dose, exposure, and response to define an effective dose for these patients.

PATIENTS AND METHODS

Patients received pembrolizumab 2 mg/kg every 3 weeks (Q3W) (n = 55), 10 mg/kg Q3W (n = 238), or 10 mg/kg Q2W (n = 156). Response (RECIST v1.1) was assessed every 9 weeks. The relationship between the estimated pembrolizumab area under the concentration-time curve at steady state over 6 weeks (AUCss-6weeks) and the longitudinal change in tumor size (sum of longest diameters) was analyzed by regression and non-linear mixed effects modeling. This model was simultaneously fit to all tumor size data, then used to simulate response rates, normalizing the trial data across dose for prognostic covariates (tumor PD-L1 expression and EGFR mutation status). The exposure-safety relationship was assessed by logistic regression of pembrolizumab AUCss-6weeks versus occurrence of adverse events (AEs) of interest based on their immune etiology.

RESULTS

Overall response rates were 15% [95% confidence interval (CI) 7%-28%] at 2 mg/kg Q3W, 25% (18%-33%) at 10 mg/kg Q3W, and 21% (95% CI 14%-30%) at 10 mg/kg Q2W. Regression analyses of percentage change from baseline in tumor size versus AUCss-6weeks indicated a flat relationship (regression slope P > 0.05). Simulations showed the exposure-response relationship to be similarly flat, thus indicating that the lowest evaluated dose of 2 mg/kg Q3W to likely be at or near the efficacy plateau. Exposure-safety analysis showed the AE incidence to be similar among the clinically tested doses.

CONCLUSIONS

No significant exposure dependency on efficacy or safety was identified for pembrolizumab across doses of 2-10 mg/kg. These results support the use of a 2 mg/kg Q3W dosage in patients with previously treated, advanced NSCLC.

CLINICALTRIALSGOV REGISTRY

NCT01295827.