[Correlation between peripheral venous oxygen saturation and hemodynamic parameters in patients with pulmonary hypertension]

Objective: To investigate the correlation of peripheral venous oxygen saturation (SpvO(2)) with mixed venous oxygen saturation (SvO(2)), pulmonary vascular resistance (PVR) and cardiac index (CI) in patients with pulmonary hypertension (PH), in order to predict these parameters using SpvO(2) and assess the prognosis of patients. Methods: Hospitalized patients diagnosed with PH by right heart catheterization in the Guangzhou Institute of Respiratory Diseases from July 2015 to October 2016 were retrospectively analyzed. Parameters during the right heart catheterization, including SvO(2,)SpvO(2,)cardiac output (CO) and mean pulmonary arterial pressure (mPAP) were recorded, while CI, PVR and other parameters were indirectly calculated. The correlation between SpvO(2) and SvO(2,)CO, CI, mPAP, PVR and other parameters were respectively analyzed and compared between groups. Results: A total of 77 PH patients were selected, which comprised of 39 males and 38 females. The results revealed that SpvO(2) was correlated positively with SvO(2,)CI and PaO(2) (P<0.05), but negatively with PVR, total pulmonary resistance (TPR), systemic vascular resistance, right atrial diameter and right ventricular diameter (P<0.05). In the group with SpvO(2) <65%, the dilation of the right atrium and right ventricle was more significant, the WHO heart function grade was worse, CI, systemic systolic pressure and mean systemic pressure were lower, and PVR and TPR were higher, as compared to those in the group with SpvO(2) ≥65%. (P<0.05). Conclusions: There was good consistency between SpvO(2) and SvO(2). Furthermore, SpvO(2) could indirectly reflect the CI, PVR and changes in right heart structure of PH patients, providing reference for the clinical prediction of CI and PVR, as well as the prognosis of PH patients, through the use of SpvO(2). Low SpvO(2) indicated a severe condition and poor prognosis.

[Outcomes of severe primary fetal hydrothorax treated by prenatal intervention]

Objective: To investigate the effect of intrauterine intervention on severe primary fetal hydrothorax. Methods: Twelve cases with severe fetal primary hydrothorax who underwent prenatal intervention from January 2014 to December 2017 in Guangdong Women and Children Hospital were retrospectively reviewed. Results: The median gestational age of prenatal diagnosis was 30.8 weeks (24.0-33.0 weeks) . All cases were excluded congenital chromosomal abnormalities by prenatal diagnosis, and had no complications of pregnancy during prenatal diagnosis and had hydrothorax. Three cases (3/12) were right hydrothorax, the other 9 cases (9/12) were bilateral. Thoracoamniotic shunting was performed in 7 cases (7/12) . Thoracentesis was performed in 5 cases (5/12) , and the hydrothorax reappeared soon after operation in 4 cases, shunt placement was performed again. The hydrothorax was dissolved in 2 cases, released in 6 cases.Tube falling off occurred in 1 case,treatment was abandoned in 1 case and intrauterine fetal death happened in 1 case, and 1 case wasn't rechecked by ultrasonic due to premature birth following thoracentesis. In 10 cases who had deliveries, 5 newborns (5/10) were premature, 6 newborns (6/10) underwent assisted mechanical ventilation, 8 newborns (8/10) underwent thoracic close drainage, all of them were discharged when hydrothorax resolved. Conclusions: Antenatal intervention may improve the chance of survival in severe primary fetal hydrothorax. Thoracoamniotic shunting is the first-choice for the primary severe fetal hydrothorax.

Cryo-EM analysis of the T3S injectisome reveals the structure of the needle and open secretin

The bacterial type III secretion system, or injectisome, is a syringe shaped nanomachine essential for the virulence of many disease causing Gram-negative bacteria. At the core of the injectisome structure is the needle complex, a continuous channel formed by the highly oligomerized inner and outer membrane hollow rings and a polymerized helical needle filament which spans through and projects into the infected host cell. Here we present the near-atomic resolution structure of a needle complex from the prototypical Salmonella Typhimurium SPI-1 type III secretion system, with local masking protocols allowing for model building and refinement of the major membrane spanning components of the needle complex base in addition to an isolated needle filament. This work provides significant insight into injectisome structure and assembly and importantly captures the molecular basis for substrate induced gating in the giant outer membrane secretin portal family.

[Analysis of the characteristics of electrocardiogram in patients of different genders with pulmonary hypertension]

Objective: To analyze the characteristics of ECG in patients with pulmonary hypertension(PH) and explore their correlation with pulmonary vascular resistance(PVR), mean pulmonary arterial hypertension(mPAP) and cardiac index(CI). Methods: A total of 186 patients with right heart catheterization were enrolled in the Department of Respiratory of the First Affiliated Hospital of Guangzhou Medical University from August 2015 to October 2017. Patients with normal pulmonary artery pressure, incomplete clinical data and repeated examinations were excluded and there were 101 patients with pulmonary hypertension included. The results of ECG parameters and right heart catheterization were collected to analyze the ECG characteristics of patients with different genders and their correlation with PVR, mPAP and CI. Results: Among all PH patients, the duration of QRS axial in male group was significantly longer than that of the female group [(110.38±15.829) vs. (98.63±18.041) ms, P<0.001], and the S wave amplitude in V5 was significantly higher compared to female group [(1.304±1.356) vs. (0.648±0.663) mv, P<0.001]. Their heart rate-corrected QT interval (QTc), QRS axis, S wave amplitude in Ⅰ, S and R wave amplitude in V1, R/S ratio in V1, S wave amplitude V5, all had a correlation with their PVR and the S wave amplitude in V1 was negatively correlated with PVR (r=-0.441, P<0.001). In the male group, PVR was not correlated with R/S ratio in V1 and S wave amplitude in V5. While PVR in the female group was significantly correlated with QTc, R wave amplitude in V1, R / S ratio in V1. In all PH patients, their P wave duration in Ⅱ, QRS axis and S wave amplitude in Ⅰ, S wave and R wave amplitude in V1, S wave amplitude in V5, QTc, R/S ratio in V1, all had correlations with mPAP (P<0.05). In male group, mPAP was not correlated with QTc, P wave duration in Ⅱ, and the S wave amplitude in V5 (P>0.05). The mPAP in the female group was only related to the S wave and R wave amplitude in V1, and S amplitude in Ⅰ and S wave amplitude in V5 (P<0.05). The CI was positively correlated with the S wave amplitude in V1 (r=0.34, P<0.001), and negatively correlated with the QRS axis (r=-0.219, P=0.04); CI in male group was not correlated with QRS axis(P=0.073), but correlated with QTc (r=-0.296, P=0.044). Conclusion: There were gender differences in QRS duration and S wave amplitude in V5 in patients with pulmonary hypertension. The QRS axis and the S wave amplitude in V1 were related to the heart index. There was a difference in the correlation between ECG and PVR, mPAP and CI in patients of different genders with pulmonary hypertension.

Evaluation of the 3dMDface system as a tool for soft tissue analysis

OBJECTIVES

To evaluate the accuracy of three-dimensional stereophotogrammetry by comparing values obtained from direct anthropometry and the 3dMDface system. To achieve a more comprehensive evaluation of the reliability of 3dMD, both linear and surface measurements were examined.

SETTING AND SAMPLE POPULATION

UCLA Section of Orthodontics. Mannequin head as model for anthropometric measurements.

MATERIAL AND METHODS

Image acquisition and analysis were carried out on a mannequin head using 16 anthropometric landmarks and 21 measured parameters for linear and surface distances. 3D images using 3dMDface system were made at 0, 1 and 24 hours; 1, 2, 3 and 4 weeks. Error magnitude statistics used include mean absolute difference, standard deviation of error, relative error magnitude and root mean square error. Intra-observer agreement for all measurements was attained.

RESULTS

Overall mean errors were lower than 1.00 mm for both linear and surface parameter measurements, except in 5 of the 21 measurements. The three longest parameter distances showed increased variation compared to shorter distances. No systematic errors were observed for all performed paired t tests (P<.05). Agreement values between two observers ranged from 0.91 to 0.99.

CONCLUSIONS

Measurements on a mannequin confirmed the accuracy of all landmarks and parameters analysed in this study using the 3dMDface system. Results indicated that 3dMDface system is an accurate tool for linear and surface measurements, with potentially broad-reaching applications in orthodontics, surgical treatment planning and treatment evaluation.

Estimation of dispersion curves of water-loaded structures by using approximated acoustic mass

For coupled structures surrounded by heavy fluids, it is difficult to obtain dispersion curves from an eigenvalue analysis, because the external fluid term in the coupled equation includes transcendental functions for frequency and wavenumber. Thus, in this study, the acoustic mass of the external fluid was approximated as a function of frequency or wavenumber only. The coupled equation can then be used to calculate eigenvalues, and can estimate dispersion curves from an eigenvalue analysis. Because of this assumption, those dispersion curves will contain errors. Accordingly, those errors were evaluated in this study through a comparison with a dispersion curve derived from forced responses. The acoustic mass was also evaluated for a water-loaded plate; this can be formulated theoretically. As a result, the acoustic mass is less sensitive to frequency changes than wavenumber changes, and using the fluid term defined at a low frequency has advantages when estimating the dispersion curve. Finally, the generality of the proposed method was identified through the application for a submerged cylindrical shell.

[Oncomelania hupensis status monitoring in Changzhou City, Jiangsu Province from 2013 to 2016]

Objective To analyze the Oncomelania hupensis snail distribution and the changes of snail situation in Changzhou City from 2013 to 2016, so as to provide the evidence for formulating the schistosomiasis prevention and control interventions. Methods The data of snail monitoring in Changzhou City from 2013 to 2016 were collected and statistically analyzed. Results The total area with snails was 40.17 hm² and the newly discovered area was 30.63 hm² in Changzhou City from 2013 to 2016. In the four years, 3 454 snails were dissected, and no schistosome infected snails were found. There were totally 51 spots with snails, and the areas with snails of different types of marshland, inland and mountain were 12.13 (30.19%), 25.54 hm² (63.57%) and 2.51 hm² (6.24%), respectively. In the newly discovered snail environment, the areas of types of marshland and inland were 8.00 hm² (26.12%) and 22.63 hm² (73.88%), respectively. The main causes for snail existence were external input and adjacent diffusion. In the past four years, the total snail control area with molluscicides was 71.74 hm², the consolidated snail control area with molluscicides was 155.15 hm², and the total environmental modification areas in the current snail spots and historic snail spots were 15.90 hm² and 11.30 hm² respectively. Conclusion The diffusion of snails in inland rivers is the key of the newly discovered snail areas in Changzhou City in recent years, and the snail monitoring and control measures should be strengthened in the future.

CPT1A methylation is associated with plasma adiponectin

BACKGROUND AND AIMS

Adiponectin, an adipose-secreted protein that has been linked to insulin sensitivity, plasma lipids, and inflammatory patterns, is an established biomarker for metabolic health. Despite clinical relevance and high heritability, the determinants of plasma adiponectin levels remain poorly understood.

METHODS AND RESULTS

We conducted the first epigenome-wide cross-sectional study of adiponectin levels using methylation data on 368,051 cytosine-phosphate-guanine (CpG) sites in CD4+ T-cells from the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN, n = 991). We fit linear mixed models, adjusting for age, sex, study site, T-cell purity, and family. We have identified a positive association (regression coefficient ± SE = 0.01 ± 0.001, P = 3.4 × 10^-13) between plasma adiponectin levels and methylation of a CpG site in CPT1A, a key player in fatty acid metabolism. The association was replicated (n = 474, P = 0.0009) in whole blood samples from the Amish participants of the Heredity and Phenotype Intervention (HAPI) Heart Study as well as White (n = 592, P = 0.0005) but not Black (n = 243, P = 0.18) participants of the Bogalusa Heart Study (BHS). The association remained significant upon adjusting for BMI and smoking in GOLDN and HAPI but not BHS. We also identified associations between methylation loci in RNF145 and UFM1 and plasma adiponectin in GOLDN and White BHS participants, although the association was not robust to adjustment for BMI or smoking.

CONCLUSION

We have identified and replicated associations between several biologically plausible loci and plasma adiponectin. These findings support the importance of epigenetic processes in metabolic traits, laying the groundwork for future translational applications.

Effects of Bioactive Compounds on Odontogenic Differentiation and Mineralization

Direct pulp capping involves the placement of dental materials directly onto vital pulp tissues after deep caries removal to stimulate the regeneration of reparative dentin. This physical barrier will serve as a "biological seal" between these materials and the pulp tissue. Although numerous direct pulp capping materials are available, the use of small bioactive compounds that can potently stimulate and expedite reparative dentin formation is still underexplored. Here, the authors compared and evaluated the pro-osteogenic and pro-odontogenic effects of 4 small bioactive compounds- phenamil (Phen), purmorphamine (Pur), genistein (Gen), and metformin (Met). The authors found that these compounds at noncytotoxic concentrations induced differentiation and mineralization of preosteoblastic MC3T3-E1 cells and preodontoblastic dental pulp stem cells (DPSCs) in a dose-dependent manner. Among them, Phen consistently and potently induced differentiation and mineralization in vitro. A single treatment with Phen was sufficient to enhance the mineralization potential of DPSCs in vitro. More importantly, Phen-treated DPSCs showed enhanced odontogenic differentiation and mineralization in vivo. Our study suggests that these small bioactive compounds merit further study for their potential clinical use as pulp capping materials.

Characterization of the ultrastructure in the uterovaginal junction of the hen

In poultry, the infundibulum is the place of fertilization, eggshell production, and sperm storage, while its uterovaginal junction (UVJ) is regarded as the most important site, which has abundant sperm storage tubules (SST). We examined the ultrastructure of the epithelium with relation to its unique secretory cytology in the UVJ of hens using transmission electron microscopy. The epithelium of the UVJ is lined with ciliated and secretory cells. Ciliated cells are characterized with light and dense secretory granules in supernuclear cytoplasm. Dense secretory granules in ciliated cells are larger in diameter (one μm), surrounded with a transparent rim and concentric layers, whereas the dense granules in the ciliated cells of SST are smaller (0.52 μm) in size and not surrounded by any transparent rim or layer. Ciliated cells also are involved in the shedding of exosomes and secretory vesicles in the lumen. Secretory exosomes are in close contact with cilia and directly release from the apical border into the lumen. Cell junctions are widely distributed between these cells. The secretory cells are associated with the release of secretions via apocrine blebs from microvilli and secretory vesicles, which protrude out from the surface of the epithelium. The dense secretory granules in these cells are smaller in size (0.6 μm), absent of a transparent rim or layers, and are released into the lumen through secretory vesicles. The intracellular multivesicular body (MVB) also is observed in the supernuclear cytoplasm of secretory cells, which are related to the production of exosomes. In general, the apical protrusion of the epithelium in the form of apocrine secretions, the releasing of exosomes, the identification of intracellular MVB, and the release of dense granules give the epithelium a distinct morphology in the UVJ of the hen oviduct.

Abstract PD7-01: Interim analysis of multiplex gene panel testing for inherited susceptibility to breast cancer

Background: Emerging evidence demonstrates the effectiveness of targeted gene sequencing panels as a practical method for the diagnosis of inherited susceptibility to breast cancer. Sequencing of multiple high and moderate risk genes simultaneously accelerates the discovery of deleterious mutations (DM) or variants of unknown significance (VUS). However, a consequence of Multiplex Gene Panel (MGP) testing is the discovery of unexpected DMs in high or moderate risk genes other than BRCA1 or BRCA2 (BRCA1/2). The overall clinical utility and incremental gain of information conferred by MGP testing in hereditary cancer risk assessment is still unknown.

Methods: We are conducting a multicenter prospective cohort study of patients undergoing cancer-risk assessment using a 25 gene sequencing panel, which includes APC, ATM, BARD1, BMPR1A, BRCA1, BRCA2, BRIP1, CDH1, CDK4, CDKN2A, CHEK2, EPCAM, MLH1, MSH2, MSH6, MUTYH, NBN, PALB2, PMS2, PTEN, RAD51C, RAD51D, SMAD4, STK11, and TP53. Patients were recruited from August 2014 to June 2015 at three medical centers. Patients are enrolled if they meet standard criteria for genetic testing or are predicted to have a ≥ 2.5% probability of inherited susceptibility to cancer calculated by validated risk prediction models. We present a planned interim analysis after enrolling 500 of 2000 total participants.

Results: HCP testing was performed for 332 patients referred for clinical suspicion of hereditary breast and ovarian cancer (HBOC). In this cohort, 96.7% were female (n=321) and the mean age was 50 years (standard deviation, SD=12.2); race/ethnicity was 43.1% Hispanic (n=143), 37% Non-Hispanic White (n=123), 4.2% Black (n=14), 10.5% Asian (n=35), and 1.8% other (n=6). Among this cohort, 37 tested positive for one deleterious mutation (DM) (11.1%: 95% confidence interval (CI), 8.2% to 15%) and 118 patients carried at least one variant of uncertain significance (VUS) (35.5%: 95% CI, 30.6% to 69%). Excluding BRCA1 or BRCA2, 14 patients (4.3%: 95% CI, 2.6% to 7.2%) have a DM in ATM (n=3), CHEK2 (n=2), MSH6 (n=1), MUTYH (n=3), PALB2 (n=1), PMS2 (n=1), RAD51C (n=2), and TP53 (n=2). In a patient with an unexpected PMS2 mutation, enhanced cancer surveillance based on Lynch Syndrome guidelines was recommended. Among 160 patients with a history of invasive breast cancer or breast DCIS, 19 patients carried a DM (11.8 %: 95 CI, 7.7% to 17.8%).

Conclusion: In this multicenter prospective cohort study among a diverse group of participants undergoing 25-gene MGP testing, 11.1% of participants tested positive for a DM. Among participants testing negative for BRCA1 and BRCA2, MGP testing identified DMs in 4.3% of participants prompting clinically appropriate risk reduction recommendations and enhanced cancer surveillance. Ongoing recruitment and long-term follow-up are in progress.

Citation Format: Idos GE, Kurian AW, Mcdonnell KJ, Ricker CN, Sturgeon DY, Culver JO, Lowstuter K, Hartman A-R, Allen B, Teeter C-R, Kingham KE, Koff R, Lebensohn A, Chun NM, Mills MA, Petrovchich I, Hong C, Ladabaum U, Ford JM, Gruber SB. Interim analysis of multiplex gene panel testing for inherited susceptibility to breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD7-01.

Abstract P2-09-07: The patient experience in a prospective trial of multiplex gene panel testing for cancer risk

Background: Multiplex gene sequencing panels (MGP) are increasingly used for assessment of hereditary breast cancer risk. Compared to testing for BRCA1 and BRCA2 (BRCA1/2) only, testing more genes increases the likelihood of identifying a deleterious mutation (DM) and/or a variant of uncertain significance (VUS), which might cause distress, uncertainty or regret about testing. Little is known about the patient experience of MGP testing.

Methods: We conducted a prospective study of MGP testing, using a panel of 25 genes: APC, ATM, BARD1, BMPR1A, BRCA1, BRCA2, BRIP1, CDH1, CDK4, CDKN2A, CHEK2, EPCAM, MLH1, MSH2, MSH6, MUTYH, NBN, PALB2, PMS2, PTEN, RAD51C, RAD51D, SMAD4, STK11, and TP53. Participants were enrolled at three medical centers and were eligible if they met standard genetic testing guidelines or if they had a ≥2.5% probability of a DM in any gene on the panel, as calculated by predictive models (e.g. IBIS, Penn II, MMRPro). Participants were surveyed about their experiences with MGP testing including distress and uncertainty at baseline (before test results disclosure) and three months later. The 25-item Multidimensional Impact of Cancer Risk Assessment (MICRA) scale measured distress, uncertainty and positive experiences at three months after testing. We present a planned interim analysis after enrolling 500 of 2000 total participants.

Results: Of 500 participants, 332 (66%) were referred for suspicion of hereditary breast/ovarian cancer syndrome. Of these 332, 97% were female, 79% were white, 43% were Hispanic and 33% were Spanish-speaking only; for 25%, high school was their highest level of education. A total of 48% had breast cancer, 5% had ovarian cancer, and 7% had another cancer: 11% had a DM and 35% had VUS in one or more genes. At study entry most participants thought about cancer rarely or not at all (69%, 95% confidence interval (CI) 58%-77%), and few (7%, CI 3%-14%) had thoughts of cancer that affected their daily lives; results were unchanged three months later, after genetic results disclosure (Chi-squared test, p-value &gt;0.1). MICRA scores at three months were low for distress (mean score 2 out of a possible 30) and uncertainty (mean score 7 out of 45), and high for positive testing experiences (mean score 9 out of 15). Most (82%, CI 72%-88%) participants wanted to know all of their MGP results even if the clinical relevance was not fully understood, and most (87%, CI 79%-93%) never regretted learning their MGP results.

Conclusions: Among diverse participants of a prospective, multi-center MGP testing trial, cancer- and genetic testing-related distress were low at entry and remained low three months later. These results provide no evidence for an increase in distress or uncertainty after MGP. Longer-term follow-up in a larger cohort is underway.

Citation Format: Kurian AW, Idos G, McDonnell K, Ricker C, Sturgeon D, Culver J, Lowstuter K, Hartman A-R, Allen B, Rowe-Teeter C, Kingham KE, Koff RB, Lebensohn A, Chun NM, Petrovchich IM, Mills MA, Hong C, Ladabaum U, Ford JM, Gruber SB. The patient experience in a prospective trial of multiplex gene panel testing for cancer risk. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-07.

Challenges in the Management of Breast Cancer in a Low Resource Setting in South East Asia

BACKGROUND

Breast cancer is the second most common cancer in women in Cambodia, a low income country in SouthEast Asia. The Sihanouk Hospital Centre of Hope (SHCH) is a charity hospital set up by an international nongovernmental organisation, HOPE Worldwide. In 2008, SHCH partnered with AmeriCares, a global health organisation to set up and deliver a breast cancer programme to provide education, diagnosis and treatment for women with breast cancer. The objective of this study is to characterise the presentation, diagnosis, treatment and outcomes of women treated under this program.

MATERIALS AND METHODS

A total of 215 women newly diagnosed with breast cancer from 1 March 2008 until 31 March 2011 were studied. Age at diagnosis, tumour size, histological type, tumour grade, ER, lymph node involvement, treatment modalities (surgery, radiotherapy, chemotherapy, hormone therapy) were recorded. Data on mortality at 3 years were obtained whenever possible.

RESULTS

The median age was 47 years old. Some 77.8% were diagnosed with stage 3 and 4 lesions, and 78.5% underwent mastectomy, of which 28.4% the intent was palliative. Of those whose ER status were known, only 48.3% were ER positive. Only 6 patients could afford chemotherapy while only 1 patient had radiotherapy. Hormone therapy was provided free for those who were ER positive. The overall survival rate at 3 years was 39.1%.

CONCLUSIONS

Breast cancer presents at a late stage, and because treatment is suboptimal, survival is poor in Cambodia. A more aggressive approach to early detection and treatment needs to be developed to improve outcome from this potentially curable disease.