Clinical, pathological, and demographic factors associated with development of recurrences after surgical resection in elderly patients with neuroendocrine tumors

Background

Incidence of locoregional neuroendocrine tumors (NETs) is rising. However, after curative resection, the patterns and risk factors associated with recurrence remain unknown. Consensus guidelines recommend surveillance every 6-12 months for up to 10 years after surgery for resected, well-differentiated NETs irrespective of patient demographics, site, grade or stage of tumor with few exceptions.

Patients and methods

From the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified localized and regional stage NET patients who underwent surgical resection between January 2002 and December 2011. Development of recurrence was identified by capturing at least two claims indicative of metastatic disease until 31 December 2013.

Results

Of the 2366 identified patients (median age 73 years), 369 (16%) developed metastatic disease within 5 years and only an additional 1% developed metastases between years 5 and 10 with the majority dying due to unrelated causes. The 5-year risk of developing metastases (hazard ratio, HR) varied significantly (log-rank P < 0.001) by grade: 9.9% versus 25.9% (2.2) versus 48.1% (4.4) for grades 1, 2, and  ≥ 3, respectively; stage: 10.3% versus 31.1% (2.8) for localized versus regional; primary tumor size: 7.6% versus 15% (1.3) versus 26.6% (1.5) for <1, 1-2, and > 2 cm, respectively; and site: ranging from 11.3% for colon to 23.9% for pancreas.

Conclusions

Contrary to current guidelines, our study suggests that surveillance recommendations should be tailored according to patient and tumor characteristics. Surveillance past 5 years may be avoided in elderly patients with competing morbidities or low risk of recurrence. Pancreatic, lung, higher grade, and regional NETs have a higher risk of recurrence and may be considered for future adjuvant trials.

[The Role of CBS in Injury Time Estimation after Brain Contusion]

OBJECTIVES

To observe the changes of cystathionine β-synthase （CBS） expression in the cerebral cortex after brain contusion at different times.

METHODS

An experimental model of traumatic brain injury （TBI） in mice was established by an improved weight-drop device. Then Western blotting and immunohistochemical examination were used to detect the CBS expression in cerebral cortex around injury at different time points （1 h, 6 h, 12 h, 1 d, 2 d, 3 d, 7 d）.

RESULTS

The results of Western blotting revealed that the expression level of CBS was down-regulated and reached its lowest level at the 3rd days after injury, and then restored to normal level after 7 days. The results of immunohistochemistry showed that CBS was present in the normal brain cortex. CBS expression gradually decreased at the 3rd days after injury, and then restored to normal level after 7 days.

CONCLUSIONS

CBS has the potential to be a reference index for time estimation after brain contusion in forensic practice.

Activation of Aedes aegypti prophenoloxidase-3 and its role in the immune response against entomopathogenic fungi

Serine protease cascade-mediated melanization is an important innate immune response in insects and crustaceans, which involves the proteolytic activation of prophenoloxidase (PPO). In this study, we investigated the role of Aedes aegypti PPO3 in antifungal immune defence. We expressed and purified recombinant PPO3 (rPPO3) in Escherichia coli and demonstrated that rPPO3 was activated by ethanol and, to a lesser extent, by cetylpyridinium chloride. In the presence of Cu²⁺ , rPPO3 exhibited enzyme activity. Immunoblot results revealed that the rPPO3 was cleaved by the haemolymph from immune-challenged mosquitoes or purified Ostrinia furnacalis serine protease 105 in vitro. The cleaved rPPO3 converted dopamine to toxic intermediates that killed fungal conidia of Beauveria bassiana in vitro. In mosquitoes challenged with Be. bassiana, cleavage of rPPO3 produced a 50 kDa phenoloxidase (PO) fragment. Further analysis revealed that the survival rate of mosquitoes with fungal infection increased significantly following injection of rPPO3 into the haemocoel. Taken together, our results suggest that proteolytic cleavage of the mosquito PPO3 plays an important role in the antifungal immune response. This has led to a better understanding of the mechanism of PPO activation in the mosquito and the role of melanization in the antifungal immune response.

The effects of dietary leucine on the growth performances, body composition, metabolic abilities and innate immune responses in black carp Mylopharyngodon piceus

The present study was focused on the growth, body composition, metabolic abilities and innate immune responses in juvenile black carp Mylopharyngodon piceus fed with six levels of dietary leucine (7.3, 12.4, 16.2, 21.9, 28.3 and 34.5 g kg^-1) for 9 weeks. Results showed that the highest weight gain (WG) and the lowest feed conversion ratio (FCR) was obtained at 23.5 and 23.9 g kg^-1 dietary leucine using second-order polynomial model, respectively. Adequate dietary leucine content (21.9 and 28.3 g kg^-1) could significantly up-regulate the expression levels of neuropeptide Y (NPY) and ghrelin (GRL) in the brain of black carp juveniles. The protein efficiency ratio (PER), feed efficiency ratio (FER) and protein deposition ratio (PDR) were also significantly increased by adequate dietary leucine content (21.9 and 28.3 g kg^-1) (p < 0.05). Adequate dietary leucine content (21.9 and 28.3 g kg^-1) could significantly up-regulate the activities of metabolic enzymes, such as α amylase, trypsin, chymotrypsin and elastase in the liver of Black carp (p < 0.05). However, the activities of alanine transaminase (ALT), aspartate aminotransferase (AST) and leucine aminopeptidase (LAP) were significantly reduced in the fish serum by adequate dietary leucine content (21.9 and 28.3 g kg^-1) compared with leucine-deficient diet (7.3 and 12.4 g kg^-1). In addition, 21.9 and 28.3 g kg^-1 dietary leucine could significantly increase complement component 3 (C3) and C4 contents, lysozyme (LYZ) activities in the serum compared with the leucine-deficient diet (7.3 and 12.4 g kg^-1) (p < 0.05). Furthermore, optimal dietary leucine could also significantly up-regulate the mRNA expression levels of LYZ, interferon α (IFN-α), hepcidin (HEPC), natural resistance-associated macrophage protein (NRAMP), C3 and C9 in the blood of juvenile black carp compared with the leucine-deficient diets (7.3 and 12.4 g kg^-1) (p < 0.05). In conclusion, these results suggest that adequate dietary leucine (21.9 and 28.3 g kg^-1) could increase growth performances, improve metabolic abilities and then enhance non-specific immunities in black carp juveniles.

Cellular Delivery of Cntf but not Nt-4/5 Prevents Degeneration of Striatal Neurons in a Rodent Model of Huntington's Disease

The delivery of neurotrophic factors to the central nervous system (CNS) has gained considerable attention as a potential treatment strategy for neurodegenerative disorders such as Huntington's disease (HD). In the present study, we directly compared the ability of two neurotrophic factors, ciliary neurotrophic factor (CNTF), and neurotrophin-4/5 (NT-4/5), to prevent the degeneration of striatal neurons following intrastriatal injections of quinolinic acid (QA). Expression vectors containing either the human CNTF or NT-4/5 gene were transfected into a baby hamster kidney fibroblast cell line (BHK). Using a polymeric device, encapsulated BHK-control cells and those secreting either CNTF (BHK-CNTF) or NT-4/5 (BHK-NT-4/5) were transplanted unilaterally into the rat lateral ventricle. Seven days later, the same animals received unilateral injections of QA (225 nmol) into the ipsilateral striatum. Nissl-stained sections demonstrated that the BHK-CNTF cells significantly reduced the volume of striatal damage produced by QA. Quantitative analysis of striatal neurons further demonstrated that both choline acetyltransferase (ChAT)- and glutamic acid decarboxylase (GAD)-immunoreactive neurons were protected by CNTF implants. In contrast, the volume of striatal damage and loss of striatal ChAT and GAD-positive neurons in animals receiving BHK-NT-4/5 implants did not differ from control-implanted animals. These results help better define the scope of neuronal protection that can be afforded following cellular delivery of various neurotrophic factors. Moreover, these data further support the concept that implants of polymer-encapsulated CNTF-releasing cells can be used to protect striatal neurons from excitotoxic damage, and that this strategy may ultimately prove relevant for the treatment of HD.

[Effect of concentrated growth factors on the treatment of degree II furcation involvements of mandibular molars]

OBJECTIVE

Concentrated growth factors (CGF), a new generation of platelet concentrate products, appears to have more abundant growth factors because of its special centrifugation process. However, there are few studies supporting this. This study was designed to evaluate the effect of CGFs in the treatment of II° furcations of mandibular molars.

METHODS

In the present study, thirty-one II° furcation involvements in twenty mandiblular molars were included and randomly divided into two groups. The furcation involvements in the experimental group were treated with bone graft therapy combined with CGFs, and the furcation involvements in the control group were treated with bone graft therapy alone. The clinical examination and cone beam computed tomography (CBCT) were performed at baseline and 1 year post-surgery for the two groups. The changes of clinical and CBCT data at baseline and 1 year post-surgery were compared between the experimental group and the control group.

RESULTS

At baseline, there were no significant differences between the two groups in the probing depth (PD), vertical clinical attachment loss (CAL-V) and horizontal clinical attachment loss (CAL-H): PD (7.36±2.32) mm (the experimental group) vs. (7.53±2.06) mm (the control group); CAL-V (8.69±1.65) mm (the experimental group) vs. (8.81±1.53) mm (the control group); CAL-H (5.24±2.01) mm (the experimental group) vs. (5.35±2.14) mm (the control group). At the end of 1 year post-surgery, the clinical parameters of both groups were significantly improved (P<0.001). For the experimental group, the average vertical attachment gain was (2.78±1.66) mm, and the vertical attachment loss was improved significantly compared with the baseline (P<0.001); the average horizontal attachment gain was (2.10±1.89) mm, and the horizontal attachment loss were improved significantly compared with the baseline (P<0.001). Furthermore, the improvement degree of the experimental group was significantly higher than that of the control group (P<0.001). At baseline, there were no statistical differences in the vertical bone loss (BL-V) or horizontal bone loss (BL-H) between the two groups (P>0.05): BL-V (5.08±2.17) mm (the experimental group) vs. (5.84±2.65) mm (the control group); BL-H (5.85±2.13) mm (the experimental group) vs. (6.01±2.27) mm (the control group). At 1 year post-surgery, both groups showed significant radiographic bone gain at vertical and horizontal directions compared with baseline (P<0.001). For the experimental group, the average vertical radiographic bone gain was (2.20±1.98) mm, the horizontal radiographic bone gain was (2.51±2.18) mm, the vertical and horizontal radiographic bone loss were both significantly reduced compared with the baseline (P<0.001). For the control group, the average vertical radiographic bone gain was (1.89±2.15) mm, the horizontal radiographic bone gain was (1.30±2.47) mm, the vertical and horizontal radiographic bone losses were both significantly reduced compared with the baseline (P<0.001). And the experimental group showed significantly higher bone gain at vertical and horizontal directions compared with the control group (P<0.001).

CONCLUSION

Within the limitation of the present study, CGFs showed positive role in the treatment of II° furcation involvements of mandibular molars.

Knockdown of eIF3a ameliorates cardiac fibrosis by inhibiting the TGF-β1/Smad3 signaling pathway

Cardiac fibroblasts are key effector cells in the pathogenesis of cardiac fibrosis. The eukaryotic translation initiation factor (eIF) 3a is the largest subunit of the eIF3 complex and has been involved in renal fibrosis. However, the precise role of eIF3a in myofibroblast differentiation and cardiac fibrosis remains unknown. Accordingly, in our present study, we tested the expression of eIF3a in transforming growth factor β1 (TGF-β1)-induced rat CFs and found that eIF3a was upregulated in TGF-β1-induced rat CFs. Then the role and mechanism of eIF3a in cardiac fibrosis were explored. Our results found that the eIF3a expression was significantly up-regulated in TGF-β1-induced CFs. Knockdown of eIF3a significantly inhibited TGF-β1-induced CF proliferation, as well as suppressed the expression levels of α-smooth muscle actin (α-SMA) and SM22α. Mechanistically, knockdown of eIF3a attenuated TGF-β1-induced Smad3 activation in CFs. In summary, our present study firstly demonstrated that silencing eIF3a might alleviate TGF-β1-induced cardiac fibrogenesis in CFs by inhibiting Smad3 activation, and suggest that eIF3a may be positioned as a new and promising target for the prevention and treatment of cardiac fibrosis.

A Meta-analysis of Sequential Intravenous/Oral Moxifloxacin Monotherapy for Treatment of Skin and Skin Structure Infections

Moxifloxacin is widely recognized for the treatment of bacterial infections of the respiratory tract such as community acquired pneumonia, acute bacterial sinusitis and acute exacerbations of chronic bronchitis. However, the use of moxifloxacin for skin infections is much valued in recent years. This study is to compare the clinical efficacy and safety of moxifloxacin monotherapy among adults with skin and skin structure infections. The meta-analysis of RCTs is conducted by searching Medline, Embase, Pubmed and the Cochrane Library. 6 RCTs, involving a total of 2608 patients, were included in the meta-analysis. English and Chinese language papers were reviewed. The results of the meta-analysis showed that the moxifloxacin monotherapy has similar clinical cure rate, bacteriological success rates and mortality compared with the control group. The drug-related adverse of moxifloxacin was significantly higher than that in the control group, although the overall incidence of adverse events, serious adverse events, and serious drug-related adverse events were similar between the compared treatment groups. Through this meta-analysis, we can draw a conclusion that moxifloxacin monotherapy has similar effectiveness and relative safety as other recommended antibiotics for the treatment of SSSIs. At the same time, it possesses the superior bacteria eradication rate. The once-daily dosing of moxifloxacin monotherapy may be a useful alternative for other recommended antibiotic therapy.

Post-mortem assessment of the short and long-term effects of the trophic factor neurturin in patients with α-synucleinopathies

Substantial interest persists for developing neurotrophic factors to treat neurodegenerative diseases. At the same time, significant progress has been made in implementing gene therapy as a means to provide long-term expression of bioactive neurotrophic factors to targeted sites in the brain. Nonetheless, to date, no double-blind clinical trial has achieved positive results on its primary endpoint despite robust benefits achieved in animal models. A major issue with advancing the field is the paucity of information regarding the expression and effects of neurotrophic factors in human neurodegenerative brain, relative to the well-characterized responses in animal models. To help fill this information void, we examined post-mortem brain tissue from four patients with nigrostriatal degeneration who had participated in clinical trials testing gene delivery of neurturin to the putamen of patients. Each had died of unrelated causes ranging from 1.5-to-3-months (2 Parkinson's disease patients), to 4+-years (1 Parkinson's disease and 1 multiple-system atrophy-parkinsonian type patient) following gene therapy. Quantitative and immunohistochemical evaluation of neurturin, alpha-synuclein, tyrosine hydroxylase (TH) and an oligodendroglia marker (Olig 2) were performed in each brain. Comparable volumes-of-expression of neurturin were seen in the putamen in all cases (~15-22%; mean=18.5%). TH-signal in the putamen was extremely sparse in the shorter-term cases. A 6-fold increase was seen in longer-term cases, but was far less than achieved in animal models of nigrostriatal degeneration with similar or even far less NRTN exposure. Less than 1% of substantia nigra (SN) neurons stained for neurturin in the shorter-term cases. A 15-fold increase was seen in the longer-term cases, but neurturin was still only detected in ~5% of nigral cells. These data provide unique insight into the functional status of advanced, chronic nigrostriatal degeneration in human brain and the response of these neurons to neurotrophic factor stimulation. They demonstrate mild but persistent expression of gene-mediated neurturin over 4-years, with an apparent, time-related amplification of its transport and biological effects, albeit quite weak, and provide unique information to help plan and design future trials.

A Technique to Study Meloidogyne arenaria Resistance in Agrobacterium rhizogenes-Transformed Peanut

A reliable peanut root transformation system would be useful to study the functions of genes involved in root biology and disease resistance. The objective of this study was to establish an effective protocol to produce composite plants mediated by Agrobacterium rhizogenes transformation. In total, 75% of transformed peanut seedlings produced an average of 2.83 transgenic roots per plant. Peanut seed had the highest germination rate after treatment in a chlorine gas chamber for 8 h compared with 16 h in chlorine gas or Clorox and mercuric chloride immersion treatments. High transformation efficiency was achieved when the wound site for A. rhizogenes inoculation was covered with vermiculite instead of enclosing the whole plant in a high humidity chamber. On average, 2.5 galls from Meloidogyne arenaria infection were formed per transgenic root from susceptible genotype TifGP-2. These data indicate that A. rhizogenes-transformed roots can be used to phenotype the host response to nematode challenge. Transformation of RLP-2, a candidate resistance gene for M. arenaria integrated into a silencing construct, did not alter the resistance response of Tifguard, even though downregulation of endogenous RLP-2 expression was detected in transformed roots. It is likely that RLP-2 is not the gene conditioning M. arenaria resistance in peanut.

Chemerin suppresses murine allergic asthma by inhibiting CCL2 production and subsequent airway recruitment of inflammatory dendritic cells

BACKGROUND

Chemerin has been implicated to play opposing roles, either pro-inflammatory or anti-inflammatory, in various tissue inflammation processes primarily through the regulation of tissue recruitment of immune cells. However, the effect of chemerin in allergic asthma has not yet been explored. We sought to investigate the role of chemerin in the murine model of allergic asthma and explore the underlying mechanism.

METHODS

We examined the effect of intranasal (i.n.) administration of chemerin during antigen challenge in murine models of asthma. Moreover, we examined whether administration of CCL2 or bone marrow-derived dendritic cells (BMDCs) transfer reversed the effects of chemerin on ovalbumin-induced asthma. We finally examined the effect of chemerin on CCL2 expression in activated lung epithelial cells in vitro.

RESULTS

The administration of chemerin attenuated allergic airway inflammation and airway hyperreactivity during antigen challenge. Chemerin treatment caused significant decreases in BALF CD4(+) T-cell accumulation and mRNA expression of Th2-attracting chemokines, CCL17 and CCL22, which was accompanied by significantly decreased BALF CD11c(+) CD11b(+) inflammatory DC accumulation and CCL2 production. Furthermore, airway administration of exogenous CCL2 or adoptive transfer of CD11c(+) CD11b(+) BMDCs abrogated the suppressive effects of chemerin on allergic asthma. Finally, in vitro study showed that chemerin inhibited CCL2 secretion by low-dose LPS-stimulated lung epithelial cells, which led to decreased chemotaxis of BMDCs.

CONCLUSIONS

Our study demonstrates that chemerin plays a protective role in allergic asthma by suppressing airway recruitment of inflammatory CD11c(+) CD11b(+) DCs through the inhibition of CCL2 secretion by active lung epithelial cells.

Modulation of neutrophil development and homeostasis

Neutrophils are highly motile phagocytic cells that constitute the first line of defense of the innate immune system. Unlike the other innate immune cells, mature neutrophils fully equipped with an armory of granules are short lived cells which are differentiated and programmed from hematopoietic stem cells in the bone marrow. In blood, mature or nearly mature cells are devoid of proliferative potential. While the killing mechanisms of neutrophils have been the research focus in the past, attention was then directed toward granulocytopoiesis by the recent studies about the specific functional states and exact regulatory mechanisms in neutrophil development and homeostasis. Here, we focus on the recent findings regarding the mechanisms that control the generation and homeostasis of neutrophils.

Relative influence of heritability, environment and genetics on serum sclerostin

SUMMARY

We determined factors associated with serum sclerostin in 446 Afro-Caribbean family members. Age, weight, sex, diabetes and kidney function were associated with sclerostin. Sclerostin was heritable, and nine SNPs in the SOST gene region were associated with sclerostin. Variation in serum sclerostin is a heritable factor that is determined by both genetic and environmental factors.

INTRODUCTION

Sclerostin, encoded by the SOST gene, is a Wnt inhibitor that regulates bone mineralization and is a candidate gene locus for osteoporosis. However, little is known about the genetic and non-genetic sources of inter-individual variation in serum sclerostin levels.

METHODS

Serum sclerostin was measured in 446 Afro-Caribbean men and women aged 18+ from seven large, multigenerational families (mean family size, 64; 3,840 relative pairs). Thirty-six common single nucleotide polymorphisms (SNP) were genotyped within a 100 kb region encompassing the gene encoding sclerostin (SOST). Genetic and non-genetic factors were tested for association with serum sclerostin.

RESULTS

Mean serum sclerostin was 41.3 pmol/l and was greater in men than in women (P < 0.05). Factors associated with higher serum sclerostin were increased age and body weight, male sex, diabetes and decreased glomerular filtration rate, which collectively accounted for 25.4 % of its variation. Residual genetic heritability of serum sclerostin was 0.393 (P < 0.0001). Nine SNPs reached nominal significance with sclerostin. Three of those nine SNPs represented independent association signals (rs851056, rs41455049 and rs9909172), which accounted for 7.8 % of the phenotypic variation in sclerostin, although none of these SNPs surpassed a Bonferroni correction for multiple comparisons.

CONCLUSIONS

Serum sclerostin is a heritable trait that is also determined by environmental factors including age, sex, adiposity, diabetes and kidney function. Three independent common SNPs within the SOST region may collectively account for a significant proportion of the variation in serum sclerostin.

Coherent optical transitions in implanted nitrogen vacancy centers

We report the observation of stable optical transitions in nitrogen-vacancy (NV) centers created by ion implantation. Using a combination of high temperature annealing and subsequent surface treatment, we reproducibly create NV centers with zero-phonon lines (ZPL) exhibiting spectral diffusion that is close to the lifetime-limited optical line width. The residual spectral diffusion is further reduced by using resonant optical pumping to maintain the NV(-) charge state. This approach allows for placement of NV centers with excellent optical coherence in a well-defined device layer, which is a crucial step in the development of diamond-based devices for quantum optics, nanophotonics, and quantum information science.

PA28gamma emerges as a novel functional target of tumour suppressor microRNA-7 in non-small-cell lung cancer

BACKGROUND

MicroRNA-7 (miR-7) has been reported to be a tumour suppressor gene. However, whether it has a role in the growth of non-small-cell lung cancer (NSCLC) and what is its target involved in the tumour growth is still under investigation.

METHODS

NSCLC tissue sample, NSCLC cell lines and tissue microarray were investigated in this study. Total RNA, miRNA and protein were used for RT-PCR and western blot analysis. Immunohistochemistry was performed in tissues microarray. Cell culture and intervention experiments were performed in vitro and in vivo. Bioinformatics prediction, western blot and luciferase assay were identified the target of miR-7.

RESULTS

In this study, we found that the expression of miR-7 was significantly downregulated not only in NSCLC cell lines, but also in human NSCLC tissues compared with the matched adjacent tissues. Restoration of its expression through miR-7 mimics in A549 and H1299 NSCLC cells inhibited cell proliferation, colony formation, and cell-cycle progression in vitro. More importantly, the tumorigenicity in nude mice was reduced after administration of miR-7 in vivo. In advance, through bioinformatic analysis, luciferase assay and western blot, we identified a novel target of miR-7, PA28gamma (a proteasome activator) to be enrolled in the regulation with tumour. PA28gamma mRNA and protein levels are markedly upregulated in NSCLC cell lines and tumour samples, exhibiting a strong inverse relation with that of miR-7. In addition, knockdown of PA28gamma induced similar effects as overexpression of miR-7 in NSCLC cells. Furthermore, miR-7 overexpression or silencing of PA28gamma reduced the cyclinD1 expression at mRNA and protein level in NSCLC cell lines.

CONCLUSION

All these findings strongly imply that the overexpression of PA28gamma resulted from miR-7 downexpression in NSCLC has an important role in promoting cancer cell progress and consequently results in NSCLC growth. Thus, strategies targeting PA28gamma and/or miR-7 may become promising molecular therapies in NSCLC treatment.

Epitope specificity of cross-clade neutralizing sera from Chinese HIV-1-positive individuals

Induction of broadly neutralizing antibody is considered important for an effective HIV-1 vaccine. Identification and characterization of broadly neutralizing antibodies in HIV-1-infected patients will facilitate our understanding of the immune correlates to protection and the design of an effective prophylactic vaccine. A number of studies to probe the specificity of antibodies in broadly neutralizing sera in the United States and Europe have been reported. However, little is known about and would be interesting to investigate the immunological characteristics of HIV-1-positive sera in China where non-clade B viruses are prevalent and the circulating viral subtypes are distinct and more complex than both the United States and Europe. Here, we screened 80 Chinese HIV-1-positive sera against a minipanel of pseudoviruses representing various circulating HIV-1 subtypes in China and identified 8 cross-clade neutralizing sera (CNsera). Immunological characterization of the sera showed that gp120-targeting antibodies with multiple epitope specificities contributed to the cross-clade neutralizing activity of these CNsera. V3-directed antibodies were prevalent in these CNsera, but did not mainly contribute to their neutralization breath and potency while CD4bs-specific, 2F5- and 4E10-like antibodies were rarely detected. 2G12-like neutralizing antibodies were more frequently detected in HIV-1 patients from China where recombinant subtype viruses are prevalent than in United States and Europe. One broadly neutralizing serum (Serum 45) was identified to contain antibodies with unknown epitope specificities that were sensitive to terminal glycan modifications on virus Env and insensitive to N160K mutagenesis, and correlated with the cross-clade neutralization activity of Serum 45.