Sex- and age-specific percentiles of body composition indices for Chinese adults using dual-energy X-ray absorptiometry

Purpose

The aims of the study were to develop sex- and age-specific percentiles for lean mass index (LMI), appendicular LMI (aLMI), fat mass index (FMI), and body fat distribution indices in Chinese adults using dual-energy X-ray absorptiometry (DXA), and to compare those indices with those of other ethnicities using the US NHANES data.

Methods

Whole-body and regional lean mass and fat mass (FM) were measured using DXA in 5688 healthy males (n = 1693) and females (n = 3995) aged 20–90 years. Body fat distribution indices were expressed as % fat trunk/% fat legs, trunk/appendicular FM ratio (FMR), and android/gynoid FMR. Percentile curves of LMI, aLMI, FMI, and body fat distribution indices were obtained by the Lambda–Mu–Sigma method.

Results

The aLMI and LMI were negatively associated with age, decreasing from the fifth decade for males, but were not associated with age in females. Females had more total FM than males, whereas males had greater central adiposity (% fat trunk/% fat legs ratio, trunk/appendicular FMR, and android/gynoid FMR) than females. Moreover, FMI and body fat distribution indices consistently increased with age in both sexes, especially in women. In comparison with white, black, and Mexican populations in the USA, Chinese adults had lower total FM, but had greater central adiposity (% fat trunk/% fat legs ratio and trunk/appendicular FMR). Additionally, older white and Mexican populations showed greater decreases for aLMI and LMI than their Chinese counterparts.

Conclusions

We present the sex- and age-specific percentiles for aLMI, LMI, FMI, and body fat distribution indices by DXA in Chinese adults, which may refine the individual assessment of the nutritional status of Chinese adults.

Abstract LB-365: Novel susceptibility loci for colorectal cancer: Findings from the colorectal transdisciplinary (CORECT) study OncoArray analysis

Genome-wide association studies (GWAS) have identified 58 susceptibility alleles across 37 regions associated with the incidence of colorectal cancer (CRC) with P<5E-08, yet much of the disease's familial risk remains to be explained. In its first phase, the Colorectal Transdisciplinary (CORECT) study, in collaboration with the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO), the Colon Cancer Family Registry (CCFR), the Asian Colorectal Cancer Consortium (ACCC) and the Multiethnic Cohort (MEC), identified 6 of these loci based on 18,299 cases and 19,656 controls. The CORECT consortium recently completed genotyping on approximately 26,000 cases and 18,000 controls using the Illumina Infinium® OncoArray platform with the goals of 1) identifying novel overall and ethnic-specific susceptibility alleles and 2) fine-mapping known CRC risk loci. Newly genotyped samples represent multiple ethnic groups and include individuals primarily of European (75%), Asian (19%) and Hispanic (2.5%) origins. Combining both phases of CORECT, this study constitutes the largest GWAS meta-analysis of CRC to date. Here, we present European-specific results derived from genetically-defined Europeans genotyped on the OncoArray (16,456 cases and 10,442 controls), CORECT Phase I (5,584 cases and 5,329 controls), and CCFR/GECCO (12,715 cases and 14,327 controls), for a total of 34,755 cases and 30,098 controls. OncoArray genotype data were imputed to the 1000 Genomes Phase III reference panel, and summary results from logistic regression adjusting for age, sex, global ancestry, and study-specific covariates were combined in a fixed-effects inverse variance-weighted meta-analysis. Preliminary results indicate at least 10 new low-penetrance risk variants that reach genome-wide significance (P<5E-08) and that are independent of known risk loci. Further, fine-mapping of well-established CRC susceptibility regions is underway. This investigation provides additional insight into the etiology of CRC and informs future risk modeling efforts.

Citation Format: Stephanie L. Schmit, Fredrick R. Schumacher, Christopher K. Edlund, Jian Gong, Gad Rennert, Wei Zheng, Loic Le Marchand, Ulrike Peters, Graham Casey, Li Hsu, Stephen B. Gruber, David V. Conti, CORECT, GECCO, CCFR, ACCC, and MEC. Novel susceptibility loci for colorectal cancer: Findings from the colorectal transdisciplinary (CORECT) study OncoArray analysis. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-365.

Abstract 2587: Comprehensive colorectal cancer risk prediction to inform personalized screening and intervention

Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States, despite the fact that it is one of the most preventable and treatable cancers when detected early via screening. The current screening guidelines for CRC are based on age, family history of CRC, and previous screening results. However, multiple environmental and lifestyle risk factors have been established or suspected for CRC, as have many common genetic susceptibility loci. It is critical to utilize this information to better stratify individuals into low- and high-risk groups for optimized and personalized screening and intervention recommendations.

Using data from two large consortia (8421 CRC cases and 9767 controls): the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) and the Colorectal Transdisciplinary study (CORECT), we developed risk prediction models for men and women based on family history, environmental and lifestyle risk factors, and known CRC susceptibility loci identified through genome-wide association studies. We constructed an environmental risk score (E-score) as a weighted sum of 19 established or potential environmental and lifestyle risk factors for CRC with weights obtained from a multivariate logistic regression analysis. Compared to the model that includes only family history, the E-score significantly improves the discriminatory accuracy for both men (AUC = 0.62 vs. 0.53, p-value < 1e-5) and women (AUC = 0.60 vs. 0.52, p-value < 1e-5). Similarly, we also constructed a genetic risk score (G-score) using 50 common variants associated with CRC risk, and the G-score also significantly improves the discriminatory accuracy for both men (AUC = 0.60 vs. 0.53, p-value < 1e-5) and women (AUC = 0.59 vs. 0.52, p-value < 1e-5) over the family history-only model. Compared to the model with family history and E-score, the inclusion of the G-score in the model further improves the discriminatory accuracy for both men (AUC = 0.65 vs. 0.62, p-value = 0.0152) and women (AUC = 0.63 vs. 0.60, p-value = 0.0005).

Our risk prediction models are the first to incorporate both comprehensive environmental and lifestyle risk factors, and known CRC common genetic variants. The E- and G-scores are independent risk predictors for CRC, and models that incorporate both scores improve the discriminatory accuracy significantly compared to family history-only models. Using risk-factor distributions available from nationally representative data (e.g., NHANES), we will provide absolute-risk estimates of CRC using both the E- and G-scores. We expect our comprehensive models incorporating both environmental and genetic risk factors to provide more accurate estimation of CRC, which will be useful for recommending individually tailored screening and intervention strategies to prevent this common cancer.

Citation Format: Jihyoun Jeon, Sonja I. Berndt, Hermann Brenner, Peter T. Campbell, Andrew T. Chan, Jenny Chang-Claude, Mengmeng Du, Graham Giles, Jian Gong, Stephen B. Gruber, Tabitha A. Harrison, Michael Hoffmeister, Loic LeMarchand, Li Li, John D. Potter, Gad Rennert, Robert E. Schoen, Martha L. Slattery, Emily White, Michael O. Woods, Ulrike Peters, Li Hsu. Comprehensive colorectal cancer risk prediction to inform personalized screening and intervention. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2587.

Small-angle neutron scattering spectrometer Suanni equipped with ultra-thin biconcave focusing lenses

The small-angle neutron scattering (SANS) spectrometer Suanni at the liquid hydrogen cold neutron source of the 20 MW China Mianyang Research Reactor has recently been upgraded. Ultra-thin biconcave MgF2lenses with a central thickness down to 0.2 mm have been installed between the collimator chamber and the sample stage. The lenses are able to improve the flux without too excessive an increase in the neutron beam size on the detector. A smaller minimumQ(Qmin) can be obtained by decreasing the beam size without changing the total length of the spectrometer. By testing the central beam profiles under different neutron wavelengths (∼0.56–1 nm) with both traditional pinhole SANS (PSANS) and focusing SANS (FSANS) geometries, the gain factor thanks to the neutron lenses is about one order of magnitude. Given the loss of intensity due to the absorption of neutrons by the lenses, the benefits of the focusing can only be realized if it is possible to increase the aperture size. With an identical source aperture, FSANS can minimize the nominalQminfrom 7.20 × 10−3 nm−1(for PSANS) to 5.55 × 10−3 nm−1at a neutron wavelength of 1 nm. The practical benefit provided by the lenses is verified with a solution of poly(methyl methacrylate) nanospheres, which yields a scattering intensity one order of magnitude higher and a better resolution with the FSANS geometry than with that of PSANS.

Mendelian randomization study of adiposity-related traits and risk of breast, ovarian, prostate, lung and colorectal cancer

BACKGROUND

Adiposity traits have been associated with risk of many cancers in observational studies, but whether these associations are causal is unclear. Mendelian randomization (MR) uses genetic predictors of risk factors as instrumental variables to eliminate reverse causation and reduce confounding bias. We performed MR analyses to assess the possible causal relationship of birthweight, childhood and adult body mass index (BMI), and waist-hip ratio (WHR) on the risks of breast, ovarian, prostate, colorectal and lung cancers.

METHODS

We tested the association between genetic risk scores and each trait using summary statistics from published genome-wide association studies (GWAS) and from 51 537 cancer cases and 61 600 controls in the Genetic Associations and Mechanisms in Oncology (GAME-ON) Consortium.

RESULTS

We found an inverse association between the genetic score for childhood BMI and risk of breast cancer [odds ratio (OR) = 0.71 per standard deviation (s.d.) increase in childhood BMI; 95% confidence interval (CI): 0.60, 0.80; P = 6.5 × 10(-5)). We also found the genetic score for adult BMI to be inversely associated with breast cancer risk (OR = 0.66 per s.d. increase in BMI; 95% CI: 0.57, 0.77; P = 2.5 × 10(-7)), and positively associated with ovarian cancer (OR = 1.35; 95% CI: 1.05, 1.72; P = 0.017), lung cancer (OR = 1.27; 95% CI: 1.09, 1.49; P = 2.9 × 10(-3)) and colorectal cancer (OR = 1.39; 95% CI: 1.06, 1.82, P = 0.016). The inverse association between genetically predicted adult BMI and breast cancer risk remained even after adjusting for directional pleiotropy via MR-Egger regression.

CONCLUSIONS

Findings from this study provide additional understandings of the complex relationship between adiposity and cancer risks. Our results for breast and lung cancer are particularly interesting, given previous reports of effect heterogeneity by menopausal status and smoking status.

Epicardial adipose tissue volume a diagnostic study for independent predicting disorder of circadian rhythm of blood pressure in patients with essential hypertension

The aim of the study was to determine whether epicardial adipose tissue volume (EATV), a new cardiometabolic risk factor, is associated with circadian changes of blood pressure (BP) in patients with newly diagnosed essential hypertension. Ninety patients with newly diagnosed essential hypertension underwent ambulatory blood pressure monitoring for 24 h. EATV was measured using cardiac computed tomography. These patients were categorized into three groups according to their BP patterns (group 1, n=46, dipper hypertension, also called normal pattern; group 2, n=24, non-dipper hypertension; group 3, n=20, anti-dipper hypertension; group 2 and 3 are also called abnormal pattern). Data were collected retrospectively and compared between hypertensive patients with normal pattern and abnormal pattern. The normal pattern hypertensive patient had significant lower mean EATV and BP ((EATV, 91.3±29.4 cm3) than those of abnormal pattern patients including group 2 (EATV, 116.2±31.06cm3, <0.01) and group 3 (EATV, 124.8±28.5cm3, P<0.01). Mean systolic BP over 24 h (BPs24) and mean diastolic BP over 24 h (BPd24) of group 1 (BPs24, 135.7 ± 12.6 mmHg; BPd24, 83.6 ± 10.6 mmHg) were significantly lower than those of group 2 (BPs24, 150.1± 17.6 mmHg, P<0.01; BPd24, 93.2 ± 16.5 mmHg, P<0.01) and group 3 (BPs24, 154.1 ± 16.6mmHg, P<0.01; BPd24, 93.8 ± 17.5 mmHg; P<0.01). Bivariate correlation analysis showed that correlation coefficient of EATV with abnormal blood pressure mode was 0.500 (p<0.001), partial correlation coefficient after adjustment for waist circumference and body mass index was 0.469 (p<0.001). When multivariate backward logistic regression analysis was performed to assess the correlation of BP pattern with EAT volume, it showed that the prevalence of abnormal BP pattern (non-dipper and anti-dipper BP pattern) increased by 1.54 times after adjusting for age and gender per additional 10 cm3 of EAT volume. Receiver operating characteristic curve for EAT alone indicated that the cutoff value of 95.17cm3 had the best performance in predicting abnormal BP pattern with a sensitivity of 75.0% and a specificity of 72.7%. EATV was elevated in newly diagnosed and untreated patients with non-dipper hypertension and anti-dipper hypertension. EATV measured by cardiac computed tomography can be used to indicate the increased risk of circadian rhythm of blood pressure.

Comparison of RECIST, EORTC criteria and PERCIST for evaluation of early response to chemotherapy in patients with non-small-cell lung cancer

PURPOSE

To compare the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the European Organization for Research and Treatment of Cancer (EORTC) criteria and the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0 using PET volume computer-assisted reading (PET VCAR) for response evaluation in patients with advanced non-small-cell lung cancer (NSCLC) treated with chemotherapy.

METHODS

A total of 35 patients with NSCLC were included in this prospective study. All patients received standard chemotherapy and underwent (18)F-FDG PET/CT scans before and after treatment. With the assistance of PET VCAR, the chemotherapeutic responses were evaluated according to the RECIST 1.1, EORTC criteria and PERCIST 1.0. Concordance among these protocols was assessed using Cohen's κ coefficient and Wilcoxon's signed-ranks test. Progression-free survival (PFS) was calculated using the Kaplan-Meier test.

RESULTS

RECIST 1.1 and EORTC response classifications were discordant in 20 patients (57.1 %; κ = 0.194, P < 0.05), and RECIST 1.1 and PERCIST 1.0 classifications were discordant in 22 patients (62.9 %; κ = 0.139, P < 0.05). EORTC and PERCIST 1.0 classifications were discordant in only 4 patients (11.4 %), resulting in better concordance (κ = 0.804, P > 0.05). Patients with a partial remission according to RECIST 1.1 had significantly longer PFS (P < 0.001) than patients with progressive disease, but not significantly longer than patients with stable disease (P = 0.855). According to both the EORTC criteria and PERCIST 1.0, patients with a partial metabolic response had a significantly longer PFS than those with stable metabolic disease and those with progressive metabolic disease (P = 0.020 and P < 0.001, respectively, for EORTC; both P < 0.001 for PERCIST 1.0).

CONCLUSION

EORTC criteria and PERCIST 1.0 are more sensitive and accurate than RECIST 1.1 for the detection of an early therapeutic response to chemotherapy in patients with NSCLC. Although EORTC criteria and PERCIST 1.0 showed similar results, PERCIST 1.0 is preferred because detailed and unambiguous definitions are given. We also found that response evaluations with PERCIST 1.0 using a single lesion and multiple lesions gave similar response classifications.

Compression deformation behavior of Zircaloy-4 alloy changing with activated twinning type at ambient temperature: experiment and modeling

It is widely accepted that twinning is important for the plastic deformation of zirconium alloys, although the corresponding roles of different types of twinning are rarely discussed. Here, the deformation behavior of Zircaloy-4 alloy at ambient temperature under compression along the rolling, transverse and normal directions of the rolled plate is studied by examination of macroscopic stress–strain curves, texture evolution andin situlattice strain, combined with elastic–plastic self-consistent simulation. It is concluded that tensile twinning {10\overline 12}〈10\overline 11〉, tensile twinning {11\overline 21}〈11\overline 26〉 and compressive twinning {11\overline 22}〈11\overline 2\overline 3〉 are the main deformation twinning types for compression along the three principal directions. A change in the activated twinning type induces differences in the plastic deformation mode and the stress/strain partitioning between parent and child grains. The work provides insight into the effects of deformation twinning on the plastic deformation behavior of Zircaloy-4 alloy.

Phosphatidylserine-targeting antibodies augment the anti-tumorigenic activity of anti-PD-1 therapy by enhancing immune activation and downregulating pro-oncogenic factors induced by T-cell checkpoint inhibition in murine triple-negative breast cancers

Background

The purpose of this study was to investigate the potential of antibody-directed immunotherapy targeting the aminophospholipid phosphatidylserine, which promotes immunosuppression when exposed in the tumor microenvironment, alone and in combination with antibody treatment towards the T-cell checkpoint inhibitor PD-1 in breast carcinomas, including triple-negative breast cancers.

Methods

Immune-competent mice bearing syngeneic EMT-6 or E0771 tumors were subjected to treatments comprising of a phosphatidylserine-targeting and an anti-PD-1 antibody either as single or combinational treatments. Anti-tumor effects were determined by tumor growth inhibition and changes in overall survival accompanying each treatment. The generation of a tumor-specific immune response in animals undergoing complete tumor regression was assessed by secondary tumor cell challenge and splenocyte-produced IFNγ in the presence or absence of irradiated tumor cells. Changes in the presence of tumor-infiltrating lymphocytes were assessed by flow cytometry, while mRNA-based immune profiling was determined using NanoString PanCancer Immune Profiling Panel analysis.

Results

Treatment by a phosphatidylserine-targeting antibody inhibits in-vivo growth and significantly enhances the anti-tumor activity of antibody-mediated PD-1 therapy, including providing a distinct survival advantage over treatment by either single agent. Animals in which complete tumor regression occurred with combination treatments were resistant to secondary tumor challenge and presented heightened expression levels of splenocyte-produced IFNγ. Combinational treatment by a phosphatidylserine-targeting antibody with anti-PD-1 therapy increased the number of tumor-infiltrating lymphocytes more than that observed with single-arm therapies. Finally, immunoprofiling analysis revealed that the combination of anti-phosphatidylserine targeting antibody and anti-PD-1 therapy enhanced tumor-infiltrating lymphocytes, and increased expression of pro-immunosurveillance-associated cytokines while significantly decreasing expression of pro-tumorigenic cytokines that were induced by single anti-PD-1 therapy.

Conclusions

Our data suggest that antibody therapy targeting phosphatidylserine-associated immunosuppression, which has activity as a single agent, can significantly enhance immunotherapies targeting the PD-1 pathway in murine breast neoplasms, including triple-negative breast cancers.

Association between adverse mental health and an unhealthy lifestyle in rural-to-urban migrant workers in Shanghai

BACKGROUND/PURPOSE

The association between adverse mental health and unhealthy lifestyle behaviors in migrant workers remains poorly defined in Chinese rural-to-urban migrants.

METHODS

A cross-sectional study was conducted regarding health-related behaviors in 5484 migrants (51.3% males) employed in Shanghai for at least 6 months. The Chinese version of the Symptom Checklist-90-Revised (SCL-90-R) was used to assess migrant mental health status. Logistic regression was applied to determine the contribution of adverse mental health to lifestyle behaviors.

RESULTS

Of the 5484 migrants, 21.1% had potential mental health problems and 63.1% had an unhealthy lifestyle. The three most prevalent mental disorders were obsessions-compulsions (O-C; 13.7%; 751/5484), interpersonal sensitivity (I-S; 11.0%; 603/5484), and hostility (HOS; 10.8%; 590/5484). Compared with the male participants, the female participants exhibited significantly increased mean scores for phobic anxiety (PHOB) and anxiety (ANX) (p < 0.001). Logistic regression indicated that after adjustment for potential confounding factors in both genders, an unhealthy lifestyle score was significantly associated with all nine subscales of the SCL-90-R. The male participants with psychoticism [PSY; odds ratio (OR) = 4.908, 95% confidence interval (CI) 2.474-9.735], ANX (OR = 4.022, 95% CI 2.151-7.518), or depression (DEP; OR = 3.378, 95% CI 2.079-5.487) were the most likely to have an unhealthy lifestyle. In the female participants, an unhealthy lifestyle was most associated with HOS (OR = 2.868, 95% CI 2.155-3.819), PSY (OR = 2.783, 95% CI 1.870-4.141), or DEP (OR = 2.650, 95% CI 1.960-3.582).

CONCLUSION

Lifestyle behaviors were significantly associated with mental health in rural-to-urban migrant workers, and these findings indicate the need to develop targeted psychological interventions to foster healthy lifestyles in migrants.

Selenium and Antioxidant Status in Dairy Cows at Different Stages of Lactation

Thirty-five multiparous Holstein cows averaging 550 ± 50 kg of body weight and in 2 to 4 parity were divided into three groups according to lactation stage (group A: nine cows from 4 to 1 weeks prepartum; group B: 11 cows from 1 to 30 days postpartum; group C: 15 cows from 30 to 100 days postpartum). Selenium concentration, malondialdehyde (MDA) level, glutathione peroxidase (GSH-Px) activity, thioredoxin reductase (TrxR) activity, and total antioxidant status (TAS) in serum were determined to evaluate selenium and antioxidant status in dairy cows at different stages of lactation. The results showed that mean serum selenium concentration, MDA level, and GSH-Px activity of cows in early lactation increased significantly (P < 0.05) when compared with cows in the dry period and peak lactation. Conversely, serum TrxR activity and TAS declined during this period (P < 0.05). The increase of serum MDA level during early lactation indicate that the reactive oxygen species, including lipid hydroperoxides, increase in this period, thus placing the cows at a greater risk of oxidative stress. The significant decrease in TrxR activity that is accompanied with a decrease in TAS during early lactation suggests that dairy cows have low antioxidant defense in this period and TrxR may be an important antioxidant defense mechanism in transition dairy cows.

Antibody-Mediated Phosphatidylserine Blockade Enhances the Antitumor Responses to CTLA-4 and PD-1 Antibodies in Melanoma

In tumor-bearing animals, the membrane phospholipid phosphatidylserine (PS) suppresses immune responses, suggesting that PS signaling could counteract the antitumor effect of antibody-driven immune checkpoint blockade. Here, we show that treating melanoma-bearing mice with a PS-targeting antibody enhances the antitumor activity of downstream checkpoint inhibition. Combining PS-targeting antibodies with CTLA-4 or PD-1 blockade resulted in significantly greater inhibition of tumor growth than did single-agent therapy. Moreover, combination therapy enhanced CD4(+) and CD8(+) tumor-infiltrating lymphocyte numbers; elevated the fraction of cells expressing the proinflammatory cytokines IL2, IFNγ, and TNFα; and increased the ratio of CD8 T cells to myeloid-derived suppressor cells and regulatory T cells in tumors. Similar changes in immune cell profiles were observed in splenocytes. Taken together, these data show that antibody-mediated PS blockade enhances the antitumor efficacy of immune checkpoint inhibition. Cancer Immunol Res; 4(6); 531-40. ©2016 AACR.

Clinical, pathological and genetic characteristics of autosomal dominant inherited dynamin 2 centronuclear myopathy

The aim of the present study was to report on a family with pathologically and genetically diagnosed autosomal dominant inherited centronuclear myopathy (CNM). In addition, this study aimed to investigate the clinical, pathological and molecular genetic characteristics of the disease. This pedigree was traced back three generations, four patients underwent neurological examination, two patients underwent muscle biopsy, and eight family members were subjected to dynamin 2 (DNM2) gene mutation analysis. DNM2 mutations were detected in seven family members, of which four patients exhibited DNM2 mutation‑specific clinical and pathological features. Lower extremity weakness was the predominant symptom of these patients, however, proximal and distal lower extremity involvement was inconsistent. All patients exhibited marked systematic muscle atrophy and various degrees of facial muscle involvement. The patients presented the typical pathological changes of CNM, and their muscle tissues were heavily replaced by adipose tissue, with clustered distribution of muscle fibers as another notable feature. DNM2‑CNM patients of this pedigree exhibited heterogeneous clinical and pathological features, providing a basis for further molecular genetic analysis.

Randomised clinical trial: prucalopride, a colonic pro-motility agent, reduces the duration of post-operative ileus after elective gastrointestinal surgery

BACKGROUND

Previous studies have shown that recovery of colonic transit is a major determinant of post-operative ileus and clinical recovery after gastrointestinal surgery. Prucalopride is a highly selective 5-hydroxytryptamine receptor-4 agonist with colonic pro-motility effects.

AIM

To evaluate the effect and safety of prucalopride on post-operative ileus and surgical outcomes after elective gastrointestinal surgery.

METHODS

In this phase II randomised clinical trial, 110 patients undergoing elective gastrointestinal surgery were randomised to either oral prucalopride (2 mg/day) (n = 55) or placebo (n = 55). Intervention was started 24 h after surgery and stopped after defecation or maximally at 7 days. The primary outcome was time to defecation. Secondary outcomes included time to first passage of flatus, tolerance of solid food, nasogastric tube reinsertion, post-operative length of stay, hospital readmission, overall cost, time to walk independently, surgical complications and inflammatory parameters.

RESULTS

Patients who received prucalopride had a shorter time to defecation (65.0 vs. 94.5 h, P = 0.001), passage of flatus (53.0 vs. 73.0 h, P < 0.001), and post-operative length of stay (7.0 vs. 8.0 days, P = 0.001) than controls. The number of patients with prolonged ileus (>5 days) (16.4% vs. 34.5%, P = 0.026) and the C-reactive protein level on post-operative day 5 (35.67 vs. 59.07 mg/L, P = 0.040) were lower in the prucalopride group. There was no significant difference in post-operative Clavien-Dindo grade III and IV complications (P = 0.606) between the groups.

CONCLUSION

Prucalopride is a safe and effective treatment to reduce post-operative ileus and systemic inflammation without affecting post-operative complications in patients undergoing elective gastrointestinal surgery. ClinicalTrials.gov: NCT02004652.

Altered cerebellar-cerebral functional connectivity in benign adult familial myoclonic epilepsy

OBJECTIVE

The pathogenesis of benign adult familial myoclonic epilepsy (BAFME) remains unknown, although cerebellar pathologic changes and brain hyperexcitability have been reported. We used resting-state functional magnetic resonance imaging (fMRI) to examine the functional connectivity between the cerebellum and cerebrum in a Chinese family with BAFME for the first time.

METHODS

Eleven adults with BAFME and 15 matched healthy controls underwent resting-state blood oxygen level-dependent (BOLD) fMRI scanning. The cerebellar seeds, including the bilateral crus I, lobule VIII, lobule VIIb, and lobule IV&V, were defined a priori. Next, regional time courses were obtained for each individual by averaging the BOLD time series over all voxels in each seed region. Then, seed-based functional connectivity z-maps were produced by computing Pearson's correlation coefficients (converted to z-scores by Fisher transformation) between each seed signal and the time series from all other voxels within the entire brain. Finally, a second-level random-effect two-sample t-test was performed on the individual z-maps in a voxel-wise manner.

RESULTS

Reduced functional connectivity of the right cerebellar crus I with the left middle frontal gyrus and right cerebellar lobule IX was observed in the default network of BAFME. Enhanced functional connectivity of the left cerebellar lobule VIII with the bilateral middle temporal gyri, right putamen, and left cerebellar crus I was found in the dorsal attention network of BAFME. Enhanced functional connectivity between the left cerebellar lobule VIIb and right frontal pole was found in the control network of BAFME.

SIGNIFICANCE

Altered cerebellar-cerebral functional connectivity may contribute to the understanding of the nosogenesis of BAFME and explain the cognitive dysfunction in this Chinese family with BAFME.

Gender Difference in Body Fat for Healthy Chinese Children and Adolescents

BACKGROUND

This study aimed to establish gender-related differences and the percentile curves for total body fat mass percentage (Total FM%), trunk/appendicular fat mass ratio (TrAppFMR), and fat mass ratio as % fat trunk/% fat lower limb (TrLLFMR) in Chinese children and adolescents using dual-energy X-ray absorptiometry (DXA).

METHODS

Children (n = 1541; 764 girls) and adolescents aged 5 to 19 years were recruited from southern China. Total FM% and regional FM were measured by DXA. TrAppFMR values were calculated as trunk FM divided by appendicular FM, and TrLLFMR values were calculated as the ratio between the percentage of trunk FM and the percentage of lower limb FM.

RESULTS

Total FM% peaks for boys were at approximately age 11 years and continued to increase for girls throughout adolescence. Median Total FM% at the age of 19 years was 15.53% and 28.06% for boys and girls, respectively. Median TrAppFMR and TrLLFMR increases were 61% and 81% from 5 to 19 years of age in boys compared with those in girls, 31% and 54%. The curves for median TrAppFMR and TrLLFMR in girls were relatively flat, with TrAppFMR and TrLLFMR remaining near 1.0 after 16 years of age, whereas in boys, median TrAppFMR and TrLLFMR increased with age until approximately 19 years.

CONCLUSIONS

Gender differences in the patterns of proportion and distribution of body fat were found. We present sex-specific percentile curves for Total FM%-age, TrAppFMR-age, and TrLLFMR-age relationships in this population.

BET inhibition represses miR17-92 to drive BIM-initiated apoptosis of normal and transformed hematopoietic cells

The BET (bromodomain and extraterminal domain) bromodomain-containing proteins, such as BRD4, are highly promising targets for treating lymphoid and myeloid malignancies. They act to modulate the expression of multiple genes that control diverse cellular processes including proliferation, survival and differentiation that are consequentially disrupted by small-molecule BET bromodomain inhibitors such as JQ1. By assessing the impact of these inhibitors on normal mouse hematopoietic cells or their transformed counterparts, we establish definitively that their cytotoxic action in vitro and in vivo relies predominantly on the activation of BAX/BAK-dependent mitochondrial (intrinsic) apoptosis. In large part, this is triggered by marked upregulation of the BH3-only protein BIM when the BET inhibitors suppress miR-17-92, a key post-transcriptional repressor of BIM expression. Thus, our study strongly suggests that mutations that permit the evasion of apoptosis (for example, BCL2 overexpression, BIM inactivation) are likely to blunt the activity of the BET bromodomain inhibitors and should be anticipated when therapy resistance develops. Strikingly, we also found that certain normal hematopoietic cells, especially those of lymphoid origin, are as prone to apoptosis induced by the BET inhibitors as their transformed counterparts, indicating that their susceptibility to BET inhibitors did not arise from oncogenic transformation.

Distal Pancreatectomy With En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis

Although distal pancreatectomy with en bloc celiac resection (DP-CAR) is used to treat locally advanced pancreatic cancer, the advantages and disadvantages of this surgical procedure remain unclear. The purpose of this study was to evaluate its clinical safety and efficacy.Studies regarding DP-CAR were retrieved from the following databases: PubMed, EMBASE, Web of Science, Cochrane Library, and Chinese electronic databases. Articles were selected according to predesigned inclusion criteria, and data were extracted according to predesigned sheets. Clinical, oncologic, and survival outcomes of DP-CAR were systematically reviewed by hazard ratios (HRs) or odds ratio (OR) using fixed- or random-effects models.Eighteen studies were included. DP-CAR had a longer operating time and greater intraoperative blood loss compared to distal pancreatectomy (DP). A high incidence of vascular reconstruction occurred in DP-CAR: 11.53% (95%CI: 6.88-18.68%) for artery and 33.28% (95%CI: 20.45-49.19%) for vein. The pooled R0 resection rate of DP-CAR was 72.79% (95% CI, 46.19-89.29%). Higher mortality and morbidity rates were seen in DP-CAR, but no significant differences were detected compared to DP; the pooled OR was 1.798 for mortality (95% CI, 0.360-8.989) and 2.106 for morbidity (95% CI, 0.828-5.353). The pooled incidence of postoperative pancreatic fistula (POPF) was 31.31% (95%CI, 23.69-40.12%) in DP-CAR, similar to that of DP (OR = 1.07; 95%CI, 0.52-2.20). The pooled HR against DP-CAR was 5.67 (95%CI, 1.48-21.75) for delayed gastric emptying. The pooled rate of reoperation was 9.74% (95%CI, 4.56-19.59%) in DP-CAR. The combined 1-, 2-, and 3-year survival rates in DP-CAR were 65.22% (49.32-78.34%), 30.20% (21.50-40. 60%), and 18.70% (10.89-30.13%), respectively. The estimated means and medians for survival time in DP-CAR patients were 24.12 (95%CI, 18.26-29.98) months and 17.00 (95%CI, 13.52-20.48) months, respectively. There were no significant differences regarding postoperative 1-, 2-, and 3-year survival rates between DP-CAR and DP, whereas DP-CAR had a better 1-year survival rate compared to palliative treatments. The pooled HR for overall survival between DP-CAR and DP was 1.36 (95%CI: 0.997-1.850); the pooled HR favoring DP-CAR was 0.38 (95%CI: 0.25-0.58) for overall survival compared to palliative treatments. The rate of cancer-related pain relief from DP-CAR was 89.20% (95%CI, 77.85-95.10%). The pooled incidence of postoperative diarrhea was 37.10% (95%CI, 20.79-57.00%); however, most diarrhea was effectively controlled.DP-CAR is feasible and acceptable in terms of its survival benefits and improved quality of life. However, it should be performed with caution due to its high postoperative morbidity.

Abstract B27: Targeting of phosphatidylserine by monoclonal antibody ch1N11 enhances the antitumor activity of immune checkpoint inhibitor PD-1/PD-L1 therapy in orthotopic murine breast cancer models

Introduction: Phosphatidylserine (PS) is a phospholipid that resides in the plasma membrane inner leaflet in many types of cells, including both tumor and tumor associated endothelial cells. Conditions that cause cellular stress, including those that occur from oxygen radicals, hypoxia, irradiation, and chemotherapy, cause a dramatic shift in PS localization in both tumor and tumor associated endothelial cells. This change in localization results in PS shifting to the outer plasma membrane, allowing its recognition by components of the tumor microenvironment. Recognition of PS promotes an immunosuppressive environment that encourages tumor growth, in part by promoting the recruitment of myeloid derived suppressor cells, immature dendritic cells, and M2-like macrophages, in addition to inducing production of anti-inflammatory cytokines. Currently the chimeric PS-targeting antibody, bavituximab, is being studied in combination with chemotherapies to treat patients with solid tumors in multiple late-stage clinical trials, where it is believed to help augment the efficacy of chemotherapeutics by blockade of PS-mediated immunosuppression and triggering an Fc-FcR mediated pro-inflammatory response in the tumor microenvironment. The results with PS targeting therapies and chemotherapeutics are encouraging, and the effectiveness of PS targeting therapies in combination with therapies directed towards immune checkpoint regulators warrants further attention.

Methods: Immune competent mice bearing established syngeneic EMT-6 or E0771 breast tumors were subjected to treatments comprising of a PS targeting antibody (ch1N11) and an anti-PD-1 antibody (to interrupt the PD-1/PD-L1 signaling axis) either as single or combination therapy. The anti-tumor effects of treatments were determined by measuring primary tumor growth inhibition and specific immunity was determined by tumor re-challenge.

Results: In both models, which showed distinct sensitivity to therapy, the combination of ch1N11 with an anti-PD-1 checkpoint blocking antibody had a significantly greater anti-tumor affect than single arm treatments. In the E0771 model, complete tumor regression was observed in 6 of 10 animals treated with combination treatment. Animals with no tumor growth for 30 days post study end were resistant to tumor re-challenge indicating the development of tumor-specific immunity.

Conclusions: These results suggest that the combination of PS targeting antibodies in conjunction with checkpoint inhibitors has the potential to block tumor immunosuppression in breast cancer and promote a durable antitumor immune response.

Citation Format: Michael J. Gray, Jian Gong, Van Nguyen, Michaela Schuler-Hatch, Chris Hughes, Jeff Hutchins, Bruce Freimark. Targeting of phosphatidylserine by monoclonal antibody ch1N11 enhances the antitumor activity of immune checkpoint inhibitor PD-1/PD-L1 therapy in orthotopic murine breast cancer models. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Breast Cancer Research; Oct 17-20, 2015; Bellevue, WA. Philadelphia (PA): AACR; Mol Cancer Res 2016;14(2_Suppl):Abstract nr B27.

Relationship between epithelial to mesenchymal transition and prognosis in pancreatic cancer

AIM: To investigate the relationship between epithelial to mesenchymal transition (EMT) and patient's prognosis in pancreatic cancer.

METHODS: E-cadherin and Vimentin protein expression was detected by immunohistochemistry in 60 pancreatic cancer specimens. EMT was divided into three grades according to the expression of E-cadherin and Vimentin: Ⅰ [E-cadherin (+)/ Vimentin (-)], Ⅱ [E-cadherin (-)/Vimentin (-)], and Ⅲ [E-cadherin (-)/Vimentin (+)]. Kaplan-Meier survival analysis was used to evaluate the relationship between EMT and patient's prognosis.

RESULTS: The 1-, 2-, and 3-year overall survival rates in 60 patients with pancreatic cancer were 50%, 29% and 50%, respectively. High expression of E-cadherin was associated with a good prognosis (P = 0.006), while elevated expression of Vimentin related with a poor prognosis (P = 0.002). Median survival of patients with grades Ⅰ, Ⅱ and Ⅲ EMT was 24.07 mo ± 4.50 mo, 11.97 mo ± 0.92 mo and 6.30 mo ± 0.52 mo, respectively. A higher grade of EMT was associated with a worse prognosis (P = 0.001). Cox proportional hazards models suggested that EMT was one of independent risk factors for poor prognosis in pancreatic cancer (P = 0.025), with HR = 1.779 (95%CI: 1.077-2.939).

CONCLUSION: EMT is an independent predicable risk factor for poor prognosis in pancreatic cancer.

Prevalence and risk factors for pulmonary arterial hypertension in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis

BACKGROUND

Pulmonary arterial hypertension (PAH) is a major complication in renal failure patients, but very little information is available on the cardiovascular parameters in these patients. The prevalence and risk factors for PAH were systematically evaluated in patients with end-stage renal diseases (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD).

METHODS

Between January 2010 and January 2014, 177 ESRD patients (85 males and 92 females) undergoing CAPD therapy were recruited. General data, biochemical parameters and echocardiographic findings were collected and PAH risk factors studied.

RESULTS

Study participants consisted of 65 patients (36.52%) with PAH (PAH group) and 112 patients without PAH (non-PAH group). The interdialytic weight gain, systolic blood pressure and diastolic blood pressure (DBP), mean arterial pressure and hypertensive nephropathy incidence in the PAH group were significantly higher than the non-PAH group (all p < 0.05). There were significant differences between PAH group and non-PAH group in C-reactive protein-positive rate, N-terminal pro-brain natriuretic peptide (NT-proBNP), hemoglobin, prealbumin and serum albumin levels (all p < 0.05). Compared with non-PAH group, PAH group showed significant increases in right ventricular internal diameter (RVID), right ventricular outflow tract diameter (RVOTD), main pulmonary artery diameter, left atrial diameter (LAD), left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular mass index, early diastolic mitral annulus velocity and valve calcification incidence (all p < 0.05), and decreased left ventricular ejection fraction (LVEF), tricuspid annulus plane systolic excursion (TAPSE) and early diastolic blood flow peak and mitral annulus velocity (E/E') (all p < 0.05). Logistic regression analysis revealed that DBP, NT-proBNP, LAD, RVID, RVOTD, LVEF, TAPSE and E/E' are major risk factors for PAH.

CONCLUSION

We observed a high incidence of PAH in ESRD patients undergoing CAPD. Logistic regression analysis revealed that DBP, NT-proBNP, LAD, RVID, RVOTD, LVEF, TAPSE and E/E' are high-risk factors for PAH in ESRD patients undergoing CAPD.