A randomised controlled trial of fibrinogen concentrate during scoliosis surgery

Bleeding and blood transfusion are common after scoliosis surgery. Fibrinogen is essential for blood clot formation and depletes quickly during haemorrhage. We randomly allocated 102 children 12-18 years old having surgery for idiopathic scoliosis, 51 to intra-operative fibrinogen concentrate 30 mg.kg^-1 (maximum 2 g) and 51 to saline placebo. Fibrinogen reduced peri-operative blood loss by a median (95%CI) volume of 155 (5-320) ml, from a median (IQR [range]) of 1035 (818-1420 [400-3030]) ml to 885 (755-1155 [270-2645]) ml, p = 0.04. Seven and four children received allogeneic red blood cell transfusion after fibrinogen and placebo, respectively, p = 0.34. There were no side-effects.

Acupuncture for recurrent urinary tract infection in women: a systematic review and meta-analysis

BACKGROUND

Increasing antibiotic resistance has motivated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (rUTI).

OBJECTIVES

To conduct a systematic review of the current state of evidence of acupuncture for uncomplicated rUTI in women.

SEARCH STRATEGY

Nine databases (PubMed, Embase, CENTRAL, CINAHL, AMED, CBM, CNKI, CQVIP, Wanfang) were searched from inception to February 2019.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating the effects of acupuncture and related therapies for prophylaxis or treatment of uncomplicated rUTI in women were included.

DATA COLLECTION AND ANALYSIS

Risk of bias was assessed, and the quality and strength of evidence evaluated using the GRADE framework. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).

MAIN RESULTS

Five RCTs involving 341 participants were included. Methodological quality of studies and strength of the evidence were low to moderate. The chance of achieving a composite cure with acupuncture therapies was greater than that with antibiotics (three studies, 170 participants, RR 1.92, 95% CI 1.31-2.81, I²  = 38%). The risk of UTI recurrence was lower with acupuncture than with no treatment (two studies, 135 participants, RR 0.39, 95% CI 0.26-0.58, I²  = 0%) and sham acupuncture (one study, 53 participants, RR 0.45, 95% CI 0.22-0.92).

CONCLUSIONS

Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs, noting the limitations of the current evidence. Given the growing challenge of antibiotic resistance, there is a need for high-quality RCTs of non-pharmacological interventions such as acupuncture.

TWEETABLE ABSTRACT

This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women.

AB1301-HPR COMORBIDITIES AND FACTORS INFLUENCING RECURRENT GOUT ATTACK IN PATIENTS WITH GOUT: A CROSS-SECTIONAL STUDY

Background:

Gout attack is characterized by painful arthritis, loss of function and reduced quality of life. Frequent gout attacks can exert negative an influence on gout management [1].

Objectives:

The objective was to identify the comorbidities of gout, to compare gender difference and to identify independent factors of multiple gout attacks.

Methods:

A cross-sectional study was performed to collect demographic, clinical variables, self-reported comorbidities, and relevant testing. Group comparison and correlation of serum uric acid (sUA) levels with other variables was performed. Univariate and multivariate logistic regression was used to detect independent risk factors of sUA.

Results:

653 gout patients were enrolled, including 553 (84.7%) males. The mean age was 48.3±15.8 years old, with a disease duration of 8.0±6.4 years. 170 (26.0%) patients had hypertension, and 57 (8.7%) had hyperlipidemia. Elevated total cholesterol (TC) was observed in 173 (26.5%) cases. 42 (37.1%) cases presented with increased triglycerides (TG) and 270 (41.3%) had increased low-density lipoprotein (LDL-C). Abnormalities including nephrolithiasis (29.4%), hydronephrosis (3.2%), and gallstones (11.9%) were detected in the patients who underwent ultrasound examination. Although female patients had a longer disease duration, they had lower levels of sUA, creatine and C-reactive protein (CRP). A positive correlation with sUA was found in TG and CRP (P<0.05) in female patients, which was not observed in males. Only gout duration (OR=1.406,P<0.001), sUA (OR=1.006,P<0.001) and LDL-C (OR=0.530,P=0.006) were independent factors of gout attack (>20 times).

Conclusion:

Comorbidity screening involving dyslipidemia is often neglected in gout patients. Gout duration and sUA level are risk factors of multiple gout attacks.

References:

[1]Wang Y, Yan S, Li C et al. Risk Factors for Gout Developed From Hyperuricemia in China: A Five-Year Prospective Cohort Study.Rheumatol Int. 2013; 3: 705-10.

Table 1.

Comparisons of clinical and laboratory variables between male and female patients with gout

VariableMale (n=553)Female (n=100)pAge (years)47.7±15.951.3±14.50.040*BMI (kg/ m2)24.5 (22.0-27.0)23.3 (20.3-25.3)0.001*Gout duration (years)6.0 (3.0-11.0)9.5 (4.0-15.0)0.001*Gout attack times•≤5209 (37.5)33 (33.0)•6-1097 (17.5)22 (22.0)•11-2070 (12.7)22 (23.0)•>20177 (32.0)23 (23.0)ComorbidiesHypertension, n (%)138 (25.0)32 (32.0)0.140Coronary heart disease, n (%)57 (10.3)10 (10.0)0.926Fatty liver disease53 (9.6)4 (4.0)0.069Laboratory testing•ALT(U/L)25.0 (17.0-40.0)19.2 (14.6-29.0)0.003*•ALB(g/L)43.5±6.342.4±3.90.025*•TB (μmol/L)12.7 (9.0-17.3)14.5 (12.1-17.4)0.002*•BUN (mmol/L)4.85 (3.98-6.27)4.85 (3.91-4.82)0.588•Creatine (mmol/L)94.0 (81.4-108.1)73.8 (67.4-87.2)<0.001*•UA (μmol/L)528.4±141.1363.8±122.9<0.001*•Glucose (mmol/L)5.62±1.675.43±1.170.317•TC (mmol/L)5.05±1.155.09±1.100.726•TG (mmol/L)2.11±1.661.94±1.860.335•HDL-C (mmol/L)1.14±0.301.52±0.41<0.001*•LDL-C (mmol/L)3.25±0.973.39±0.920.182•ESR (mm/h)40.1±32.437.4±20.80.402•CRP (mg/L)28.0±40.310.5±18.6<0.001*

*p< 0.05; BMI: body mass index; sUA: serum uric acid; ALT: alanine aminotransferase; ALB: albumin; TB: Total bilirubin; BUN: blood urea nitrogen; UA: uric acid; TC: total cholesterol; TG: triglycerides; HDL-C: high-density lipoprotein; LDL-C: Low-density lipoprotein; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein

Acknowledgments:

None.

Disclosure of Interests:

None declared

0568 Physiologic OSA Traits and CPAP Adherence Among Patients with Coronary Artery Disease and OSA

Introduction

Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), but adherence to continuous positive airway pressure (CPAP) in this population is poor. Low arousal threshold (ArTH), a pathophysiologic OSA trait, is associated with low rates of regular CPAP use in sleep clinic populations. We aimed to determine whether ArTH or other physiologic OSA traits (i.e. pharyngeal collapsibility, muscle compensation, loop gain) are associated with CPAP adherence in patients with CAD and OSA.

Methods

A secondary analysis of a randomized controlled trial of OSA treatment in patients with CAD (RICCADSA) was performed. OSA (apnea hypopnea index, AHI≥5/hour) was assessed by polysomnography. Arousal threshold (% eupneic ventilation, %Ve), loop gain (LG), pharyngeal collapsibility (%Ve) and compensation (%Ve) were estimated from polysomnography using a validated method. Adherence to auto-titrated CPAP (hours/night) was obtained from machine downloads at 1, 3, 6, 12 and 24 months. Mixed modelling was used to assess the association between OSA traits and CPAP adherence.

Results

Participants (n=262) were 64.1±7.9 years old, with BMI of 29.2±4.2 and 86% were men. The mean AHI was 40.8±23.6 events/hour with oxygen nadir of 81.3±7.1%. The median (IQR) CPAP adherence (hrs/night) was 3.0 (0.9, 5.8) at 1-mo and 3.0 (0.0, 5.6) at 24-mo. Compared to reference studies, the CAD patients exhibited an elevated LG 0.63 (0.53, 0.79), similar ArTH (%Ve) of 117.5% (106.5%, 136.4%), higher collapsibility (%Ve) at 90.1% (82.3%, 94.8%) and lower compensation (%Ve) at 3.7% (-0.7%, 8.7%).Only increasing pharyngeal muscle compensation was associated with lower CPAP adherence (β -0.04, p-value 0.048), effect modified by pharyngeal collapsibility (Compensation x Collapsibility, β &lt;0.01, p-value 0.042).

Conclusion

In this group of patients with CAD, increasing muscle compensation was associated with lower CPAP adherence. Physiologic OSA traits may provide insight into prediction of CPAP adherence among patients with OSA and CAD.

Support

Zinchuk: Parker B. Francis Fellowship Program in Clinical Research. Sands: American Heart Association. Peker: Swedish Research Council, Swedish Heart-Lung Foundation.

0627 Cognitive Perceptions Impact Short-Term CPAP Adherence in Asian Patients with Obstructive Sleep Apnea

Introduction

Adherence for the gold standard Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea (OSA) is poor worldwide. Studies have explored factors impacting CPAP adherence but data is limited for Asian patients where cultural and social norms differ. This study aimed to examine the role of disease and treatment-related perceptions in short-term CPAP adherence among patients from a multi-ethnic Southeast Asian country.

Methods

34 patients with newly diagnosed OSA were recruited from Changi General Hospital, a 1000-bed tertiary hospital in Singapore between September 2018 and February 2019. Psychological factors of self-efficacy, risk-perception and outcome expectancies were assessed with the Self-Efficacy Measure for Sleep Apnea (SEMSA) questionnaire. The SEMSA questionnaire has been previously validated for the evaluation of adherence-related cognitions. Patients were administered the SEMSA questionnaire before commencement of CPAP treatment and 1 month after.

Results

73.5% (25/34) of the patients were male (82.4% Chinese, 11.8% Malays, 2.9% Indians, 2.9% others). Mean age was 43.3 ± 11.8 years, mean apnea hypopnea index (AHI) was 45.2 ± 29.6 events/hr and mean CPAP usage at one month was 3.6±2.0 hours. 47% were adherent to CPAP, defined as average device use &gt; 4 hrs/day. Pre-treatment self-efficacy was significantly correlated with CPAP adherence (r = 0.498, P&lt;0.01). Outcome expectancies and self-efficacy measured after one-month CPAP use were significantly correlated with CPAP adherence (r = 0.702, P&lt;0.01; r = 0.467, P&lt;0.01, respectively). However, no association between risk perception and CPAP adherence was noted at either time points.

Conclusion

Consistent with previous literature in Western population, our study demonstrated that patients’ cognitive perceptions of outcome expectancies and sense of self-efficacy have an impact on CPAP adherence in a Southeast Asian population. Strategies targeting these aspects would be important in designing patient education programs.

Support

 

A 51 bp indel polymorphism within the PTH1R gene is significantly associated with chicken growth and carcass traits

Parathyroid hormone (PTH) is a crucial regulator of calcium homeostasis and bone remodeling, and the parathyroid hormone 1 receptor (PTH1R) belongs to a class II G-protein-coupled receptor. PTH activates PTH1R, which mediates catabolic and anabolic processes in the skeleton. However, the functional mechanism of PTH1R has not been thoroughly elucidated in organisms. This study identified a 51 bp indel mutation in the first intron of the PTH1R gene and elucidated the effect of this gene mutation on the growth and carcass traits in chickens. The results indicated that the 51 bp indel was significantly associated with subcutaneous fat thickness, abdominal fat weight, body weight and daily gain over 4-8 weeks. Furthermore, we found that PTH1R gene expression was highest in the kidney and liver tissues, and it showed a trend of decreasing in leg and breast muscle tissues at different embryonic stages. In addition, we examined the expression of the three genotypes of the PTH1R gene in the liver, breast muscle and abdominal fat and found that the II genotype was significantly higher than the DD and ID genotypes. In summary, these findings suggest that the PTH1R gene can serve as a potential molecular marker for chicken breeding.

Risk assessment of mycotoxins in stored maize: case study of Shandong, China

Risk characterisation of dietary exposure of aflatoxins (AFs), fumonisins (FBs), deoxynivalenol (DON), zearalenone (ZEA) in maize from Shandong Province was conducted in this study. A total of 520 maize samples were collected after harvesting in 2014 and 2015 from 26 selected villages in Shandong Province, China. A deterministic approach was used in the current study. The dietary intake data of maize was obtained from ‘Shandong Statistical Yearbook 2018’. The risk characterisation of FBs, DON, and ZEA was evaluated in 4 population groups (2 to 6-year-old children, standard adults, city adults and village adults) based on probable intake. 2 to 6-year-old children and adults were exposed to FBs (0.42 and 0.20 μg/kg body weight (bw)/day), DON (0.04 and 0.019 μg/kg bw/day), and ZEA (0.0024 and 0.0011 μg/kg bw/day) through mean maize consumption in diets, which was lower than the provisional maximum tolerable daily intake of each mycotoxin established by JECFA. Risk assessments showed a low risk for liver cancer due to consumption of aflatoxin B1 (0.027-0.21 cases per 100,000 persons per year) contaminated maize compared with China’s current liver cancer incidence of 24.6 cases per 100,000 persons per year.

The efficacy and safety of immunotherapy targeting the PD-1 pathway for advanced urothelial carcinoma: a meta-analysis of published clinical trials

INTRODUCTION

Urothelial carcinoma (UC) is an aggressive malignancy and has a poor prognosis in the metastatic state. Treatment of UC remains a challenge, and as a first-line regimen for advanced UC, standard platinum-based chemotherapy is unfit for many patients due to numerous comorbidities and poor performance status. Recently, five immune checkpoint inhibitors have been approved for the treatment of patients with advanced UC who were ineligible for platinum-based regimens or suffered tumor progression in post-platinum setting. However, not long ago, the U.S. Food and Drug Administration restricted the use of two common immune checkpoint blockades, atezolizumab and pembrolizumab, due to uncertain survival benefit as mono-therapy. In this scenario, we reviewed rapidly surfacing clinical trials to assess the efficacy and safety of immunotherapy targeting the PD-1 pathway for advanced UC.

METHODS

A comprehensive search was conducted in PubMed, EMBASE and Cochrane Library for all clinical trials where the efficacy and safety were reported. Our primary outcome was efficacy evaluated by objective response rate (ORR), 1-year overall survival (OS) rate and 1-year progression-free survival (PFS) rate, and second outcome was safety assessed by any grade and grade 3-4 treatment-related adverse events (TRAEs). We chose percentages with 95% confidence intervals (CI) as the evaluation indexes and used a random-effects model to account for heterogeneity.

RESULTS

We included 14 clinical trials with 2674 total patients in this meta-analysis. After removing unqualified studies on the basis of sensitivity analyses, 13 studies were pooled to evaluate the overall ORR, 8 studies for the 1-year OS rate and 6 studies for the 1-year PFS rate. The pooled data of ORR, 1-year OS rate, and 1-year PFS rate were 0.20 (95% CI 0.18-0.22, I² = 38.4%, P = 0.078), 0.50 (95% CI 0.46-0.53, I² = 30.3%, P = 0.186), and 0.17 (95% CI 0.14-0.20, I² = 0.0%, P = 0.668), respectively. Similarly, 13 trials were utilized to compute the pooled rate of any-grade TRAEs. The pooled estimation of any-grade was 0.65 (95% CI 0.63-0.67, I² = 1.7%, P = 0.429). The pooled rate of grade 3-4 TRAEs subgroups with Atezolizumab, Pembrolizumab, Durvalumab, Nivolumab and Avelumab were 0.11 (95% CI 0.06-0.15, I² = 83.5%, P = 0.000), 0.15 (95% CI 0.13-0.18, I² = 0.0%, P = 0.971), 0.06 (95% CI 0.03-0.09, I² = 0.0%, P = 0.566), 0.19 (95% CI 0.15-0.23, I² = 0.0%, P = 0.480) and 0.08 (95% CI 0.05-0.11, I² = 0.0%, P = 0.702), respectively.

CONCLUSION

This study showed that the immunotherapy targeting the PD-1 pathway had durable efficacy and acceptable safety in patients with advanced UC. The comprehensive role of immune checkpoint inhibitors in comparison to other treatments needs further confirmation basing on RCTs.

[Surveillance of echinococcosis in Yixing City from 2011 to 2018]

OBJECTIVE

To analyze the results of echinococcosis surveillance in Yixing City from 2011 to 2018, so as to provide insights into echinococcosis control in the city.

METHODS

All echinococcosis cases reported in Yixing City since 2007 that were captured from the China National Notifiable Infectious Disease Reporting Information System of Chinese Center for Disease Control and Prevention received a case study, and serological test and transabdominal B-mode ultrasound screening were performed among permanent residents and mutton market workers in Fangdong and Fangzhuang villages of Yixing City from 2011 to 2018. The cyst, mass and tubercle were detected in the liver and lung of the sheep from the mutton markets, and the Echinococcus coproantigen was detected in the canine stool samples from Fangdong and Fangzhuang villages. In addition, the awareness of echinococcosis prevention and control knowledge was investigated in the two villages using a questionnaire survey from 2011 to 2018.

RESULTS

A total of 7 cases with echinococcosis had been reported in Yixing City since 2007, with prevalence of 0.56/100 000, and all cases were E. granulosus-infected patients, including 2 cases with a history to travel to echinococcosis-endemic areas and 5 cases with a history of working in local mutton markets or dog contacts. From 2011 to 2018, a total of 1 861 residents received serological tests, with 0.54% seropositivity, and no seropositives were detected since 2016. Among the 1 807 individuals receiving transabdominal B-mode ultrasound screening, suspected cysts were found in 143 individuals (7.91%), and 1.40% (2/143) seropositivity was detected in these individuals. The mean positive rate of the Echinococcus coproantigen was 0.67% (3 /446) in the canine stool samples. Among the 4 010 sheep liver and lung specimens sampled from the mutton markets, 7 specimens (0.17%) were detected with cysts or tubercles. In addition, the mean awareness rate of echinococcosis prevention and control knowledge was 76.95% among the 538 subjects receiving questionnaire surveys from 2011 to 2018, and the overall awareness appeared a tendency towards a rise year after year.

CONCLUSIONS

Although the prevalence of echinococcosis and the seropositivity of anti-Echinococcus antibodies are low, there is still a risk of transmission of echinococcosis in Yixing City. The surveillance of echinococcosis should continue to be intensified and related control interventions are required.

Survival comparision of three-dimensional radiotherapy alone with concurrent chemoradiotherapy for non-surgical esophageal carcinoma

PURPOSE

Radiotherapy is the main treatment method for patients with locally advanced, unresectable esophageal cancer. The aim of this study is to compare overall survival (OS) using 3D radiotherapy (3DRT) alone with concurrent chemoradiotherapy (CCRT) in 296 non-surgical esophageal carcinoma patients.

PATENTS AND METHODS

Over 10 years, of the 480 patients with esophageal carcinoma treated with 3DRT with or without chemotherapy, 148 patients each comprised 3DRT and CCRT groups after propensity score matching.

RESULTS

The 5- and 10-year OS (P=0.337) and PFS (P=0.715) rates for 3DRT alone were 22.0%, 14.4% and 26.1%, 23.2%, respectively, compared with 28.8%, 18.6% and 34.7%, 29.1% for CCRT, respectively. CCRT did not improve 5-year and 10-year OS or PFS in 60-70Gy group (OS: 27.5% and 25.2%; 17.9% and 17.0%, P=0.938; PFS: 38.3% and 31.8%; 31.9% and 27.8%, P=0.890) nor reduce 10-year hematogenous metastasis (31.7% and 28.3%, P=0.698). CCRT improved 5-year OS and PFS of 50.0-59.9Gy group (OS: 33.3% and 12.0%, P=0.029; PFS: 33.1% and 10.6%, P=0.081). For 3DRT, the 5-year OS and PFS rates were significantly better in the 60-70Gy group (P=0.017) compared with 50.0-59.9Gy group (P=0.002). For CCRT group, 5-year OS and PFS favored the 50.0-59.9Gy group, but the difference was insignificant. Major toxicities were greater with CCRT compared with 3DRT.

CONCLUSION

For non-surgical esophageal carcinoma patients, 3DRT combined with CCRT was effective in prolonging both OS and PFS.

A benchmark for Monte Carlo simulation in gamma-ray spectrometry

Monte Carlo (MC) simulation is widely used in gamma-ray spectrometry, however, its implementation is not always easy and can provide erroneous results. The present action provides a benchmark for several MC software for selected cases. The examples are based on simple geometries, two types of germanium detectors and four kinds of sources, to mimic eight typical measurement conditions. The action outputs (input files and efficiency calculation results, including practical recommendations for new users) are made available on a dedicated webpage.

miR-30a-5p modulates traits of cutaneous squamous cell carcinoma (cSCC) via forkhead box protein G1 (FOXG1)

miRNA has shown its potential in the regulation of squamous cell carcinoma (SCC). However, the mechanism of such an effect was not quite clear. Therefore, we aimed to investigate whether miR-30a-5p participated in the regulation of cutaneous SCC (cSCC) and the possible mechanism involved. 5-Ethynyl-2'-deoxyuridine (EdU) and cell cycle were measured using flow cytometry. The formation of cell colony was tested by colony formation assay. The capacities of migration and invasion were tested by wound healing assay and Transwell invasion assay, respectively. The target of miR-30a-5p was predicted by bioinformatics and identified by luciferase assay. Western blot was used for the determination of proteins and qPCR was for mRNA levels. miR-30a-5p expression was lowered in SCL-1 and A431 cells, and its upregulation suppressed EdU positive cells, colony numbers, migration, invasion and Bcl-2 expression, and elevated Bcl-2-associated X protein (Bax) and cleaved Caspase-3 expressions, arresting cell cycle in G1 phase. Moreover, forkhead box protein G1 (FOXG1) was proved to be the target of miR-30a-5p, and FOXG1 overexpression partially offsets the decreased colony numbers, migration and invasion rates due to miR-30a-5p overexpression in SCL-1 and A431 cells. miR-30a-5p showed a regulatory role on the expression of FOXG1 and further modulated the progressing of cSCC cells, which could be a novel pathway intervening the development of cSCC.

Evaluating predictive factors for determining the presence of lateral pelvic node metastasis in rectal cancer patients following neoadjuvant chemoradiotherapy

AIM

The need or otherwise for lateral pelvic node dissection (LPND) in rectal cancer patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT) is controversial. This study was designed to explore the predictive factors for pathological LPNM in rectal cancer patients with clinical LPNM after nCRT.

METHOD

From January 2010 to February 2018, a consecutive series of patients with rectal cancer and clinical LPNM after nCRT who underwent total mesorectal excision and LPND were reviewed. Patient demographics, operative and pathological outcomes were collected and analysed.

RESULTS

A total of 76 consecutive cases were included in this study: 53 (69.7%) patients underwent unilateral LPND and 23 (30.3%) bilateral LPND. The pathological results showed that LPNM was found in 13 (17.1%) patients. Multivariate logistic regression analysis showed that the post-nCRT lateral pelvic node size ≥ 5 mm (OR = 7.67, 95% CI = 1.45-40.63, P = 0.017) and mucinous/signet-ring adenocarcinoma (OR = 4.60, 95% CI = 1.11-19.08, P = 0.035) were independent risk factors for pathological LPNM.

CONCLUSION

Post-nCRT lateral pelvic node size ≥ 5 mm and mucinous/signet-ring adenocarcinoma were independent predictive factors of pathological LPNM for rectal cancer patients with clinical LPNM after nCRT, and patients with these characteristics may benefit from LPND.

[Study on safety of adjuvant radiotherapy concurrent with weekly chemotherapy for stage ⅡB-ⅣA esophageal carcinoma after radical resection]

Objective: To evaluate the tolerability and short-term efficacy of chemo-radiotherapy in 125 patients with stage ⅡB-ⅣA esophageal carcinoma after radical resection. Methods: We retrospectively evaluated the rate of completion, toxicity and survival of patients undergoing adjuvant concurrent chemo-radiotherapy after radical resection of esophageal carcinoma from January 2004 to December 2014 in our institution. The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test. Multivariate prognostic analysis was performed using the Cox proportional hazard model. Results: 122 patients received more than 50 Gy dose (97.6%). A total of 52 patients received more than 5 weeks chemo-radiotherapy (41.6%), while 73 patients underwent only 1-4 weeks (58.4%). The median following up was 48.4 months. 8 patients lost follow up (6.4%). The 1-year and 3-year overall survival rate were 91.6% and 57.0%, respectively, with a median survival time of 64.4 months. The 1-year and 3-year disease free survival rate were 73.2% and 54.3%, respectively, with a median disease free survival time of 59.1 months. The most common acute complications associated with chemo-radiotherapy were myelosuppression, radiation esophagitis and radiation dermatitis, the majority of which were Grade 1-2. Of the 125 patients, there were 59 cases of recurrence, including 23 cases with local regional recurrence, 26 cases with hematogenous metastasis, and 8 cases with mixed recurrence. Univariate analysis showed that the numbers of concurrent chemotherapy was associated with the overall survival (P=0.006). But receiving more than 5 weeks was not the prognostic factor compared to 1 to 4 weeks chemotherapy (P=0.231). Multivariate analysis showed that only the numbers of concurrent chemotherapy was an independent prognostic factor (P=0.010). Conclusions: Postoperative radiotherapy concurrent with weekly chemotherapy could improve the overall survival and decrease the recurrence for stage ⅡB-ⅣA esophageal carcinoma after radical resection. However, the completion rate of chemotherapy was low, so it was necessary to explore reasonable regimens to improve the completion rate and carry out prospective randomized controlled trial.

[Dose-response relationship between maternal hemoglobin concentration and preterm birth, in pregnant women]

Objective: To investigate the dose-response relationship between hemoglobin concentration and preterm birth, during pregnancy. Methods: With Zhuang ethnicity, a total of 12 780 pregnant women and their infants that admitted to Wuming、Pingguo、Jingxi、Debao、Longan and Tiandong hospitals, were recruited, in Guangxi Zhuang Autonomous Region, from January 2015 to December 2017. Non-conditional logistic regression method was used to analyze the effect of anemia on preterm birth during pregnancy. Dose-response relationship between hemoglobin concentration and preterm birth was explored, using the restrictive cubic spline model. Results: After excluding 2 053 pregnant women with hypertension or aged 35 years and over, results from the non-conditional logistic regression analysis showed that the risk of preterm birth in the anemia group was 1.29 times (OR=1.29, 95%CI: 1.04-1.59, P=0.019) of the non-anemia group in the first trimester. Data from the restricted cubic sample showed that there appeared nonlinear "L" dose-response relationship between hemoglobin concentration and preterm birth in the first trimester and "U" shape in the third trimester (non-linearity test P<0.001). Conclusion: There appeared nonlinear dose-response relationship between the hemoglobin concentration and preterm birth, both in the first and third trimesters.

[Analysis of aluminum content in unprocessed grains from different areas of China]

Objective: To investigate the aluminium content in unprocessed grains from different areas of China. Methods: From June 2013 to December 2014, nine provinces (Jilin, Shandong, Hubei, Hunan, Guangdong, Guangxi, Henan, Anhui and Jiangsu) were selected as sampling areas using stratified random sampling method. Three cities, counties or townships were randomly selected from each sampling area. Grain stations, grain depots, planting areas or farmers' markets located in non-aluminium mining areas or non-aluminium-involved industrial pollution areas were selected from each sampling area using a purposive sampling method. A total of 470 unprocessed grain samples (500 g per sample) including wheat, rice, corn, millet and soybean were collected from local grain stations, grain depots, planting areas and farmers' markets. The dried grains samples were analysed for aluminium content by inductively coupled plasma mass spectrometry. Bootstrap resampling method was applied to calculate the upper bound values of 95%CI of P(99) of aluminium contents for each kind of grain, which could be regarded as levels of concern for corresponding categories. Results: A total of 454 grain samples, including 109 wheat samples, 111 rice samples, 78 corn samples, 69 millet samples and 87 soybean samples, were used for analysis after excluding outlier values. There were 420 positive samples with detected aluminium and the overall detection rate was 92.5%. Among them, the aluminium contents were high in wheat and soybean with median values about 9.59 and 7.12 mg/kg, and maximum values about 31.55 and 28.80 mg/kg, respectively. The median and maximum values of aluminium contents in corn were about 4.65 and 26.79 mg/kg. Aluminium contents were low in rice and millet, with median values about 1.49 and 2.21 mg/kg, and maximum values about 7.56 and 8.07 mg/kg, respectively. Based on Bootstrap resampling method, the upper bound values of 95%CI of P(99) of aluminium contents in wheat, soybean, corn, rice and millet were 29.86, 28.80, 26.79, 7.56 and 8.07 mg/kg, respectively, which could be regarded as levels of concern for corresponding grains. Conclusion: Aluminium has been detected in most unprocessed grains. The accumulation of aluminium varies in different grains species.

Tripterygium glycoside fraction n2: Alleviation of DSS-induced colitis by modulating immune homeostasis in mice

BACKGROUND

The Tripterygium glycosides (TG) is the main active extractive of Tripterygium wilfordii Hook F and is widely used in clinical practice to treat inflammatory diseases (including inflammatory bowel disease). However, due to its severe toxicity, TG is restricted to the treatment of many diseases. Therefore, it is necessary to study a new method to obtain the attenuated and synergistic extracts from TG.

PURPOSE

Tripterygium glycosides-n2 (TG-n2) was obtained from TG by a new preparation method. In this study, we aimed to investigate the difference in the chemical compositions between TG and TG-n2, further explored its toxicity and therapeutic effects on DSS-induced colitis in mice.

METHODS

The major chemical compositions of TG and TG-n2 were analyzed by ultra-performance liquid chromatography (UPLC). Subsequently, acute toxicity test was applied to evaluate the toxicity difference between TG and TG-n2. Dextran sulfate sodium (DSS)-induced acute colitis model was used to explore the therapeutic effect of TG and TG-n2 and their potential mechanisms of action.

RESULTS

We found that the chemical compositions of TG-n2 is different from TG. The main difference is the ratio of triptriolide (T11) / triptolide (T9). Acute toxicity test proved that TG-n2 was less toxic than TG. Base on this, further studies showed that TG-n2 has a similar therapeutic effect as compared to TG on attenuating the symptoms of colitis, such as diarrhea, bloody stools, body weight loss, colonic atrophy, histopathological changes, inhibiting cytokines secretion and reducing absolute lymph number. In addition, TG and TG-n2 can increase the apoptosis of T lymphocyte in vivo. Further investigated showed that TG and TG-n2 could increase the expressions of Bax and p62 on CD3-positive T cells.

CONCLUSION

This study showed that oral administration of TG-n2 is safer than TG. Moreover, the attenuated TG-n2 has the similar therapeutic effect on treating experimental colitis in mice when compared to TG. Its mechanism may be related to activating the expression of Bax in T cells and inducing T cells autophagy to regulate the survival of T lymphocytes in colitis mice, thus reducing inflammation in colon.

[The value of the planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of esophageal squamous cell carcinoma]

Objective: The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non-radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors. Methods: We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy (33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single-institution database.The survival rates were calculated by Kaplan-Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model. Results: The median follow-up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease-free survival (DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3-year OS were 75.5%, 57.4%, 27.3% (P<0.001) and 3-year DFS were 72.0%, 44.7%, 17.6% (P<0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3-year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7% of the negative group (both P<0.001). The 3-year OS and DFS of pathologic stage Ⅰ, Ⅱ, ⅢA, ⅢB and Ⅵ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3% (P<0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3% (P<0.001), respectively.The operation-related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS (P<0.05 for all). Conclusions: The planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.

Cortical bone resorption of fibular bone after maxillary reconstruction with a vascularized fibula free flap: a computed tomography imaging study

This study was performed to evaluate the cortical bone resorption of fibular bone after maxillary reconstruction with a fibula free flap. A total of 35 patients with maxillary defects that were repaired using a fibula flap (62 fibula segments) between January 2011 and January 2016 were enrolled. Computed tomography (CT) images taken 1 week and 1 year postoperative were used to evaluate cortical bone resorption. The 62 fibula segments were measured on four different surfaces in the CT images. At 1 week, the thickness of the cortical bone was 2.57 ± 0.58 mm, 2.72 ± 0.46 mm, 3.84 ± 0.98 mm, and 4.36 ± 0.90 mm for the exterior, interior, superior, and inferior sides, respectively. At approximately 1 year, the cortical bone thickness was significantly reduced to 2.00 ± 0.65 mm (P <  0.01), 2.25 ± 0.60 mm (P <  0.01), 3.37 ± 0.90 mm (P <  0.01), and 2.96 ± 0.84 mm (P <  0.01) for the exterior, interior, superior, and inferior sides, respectively. The cortical bone thickness of fibular bone is significantly reduced 1 year after the restoration of maxillary defects with a fibula free flap, most significantly on the inferior side.

[Quantification of optical coherence tomographic angiography images in type 2 diabetic patients]

Objective: To quantify optical coherence tomographic angiography (OCTA) images and to explore potential clinical values of each parameter in diabetic patients. Methods: A case-control and cross-sectional study of diabetic (129 eyes) and healthy (32 eyes) subjects was conducted. 3-mm OCTA scan, fundus photography and best corrected visual acuity measurement were performed. Image-pro plus was used to calculate microvascular and foveal avascular indices in nonsegmented and segmented OCTA images. Intraclass correlation coefficient and relative standard deviation were used to examine the reliability, reproducibility and accuracy. Correlation of each parameter was calculated, and so was the area under the receiver operating characteristic curve. Results: Vessel density (VD) of diabetic patients measured in the nonsegmented retinal layer (RL) and superficial retinal layer (SRL) was 49.146%±6.097%, 44.038%±5.641%, respectively, significantly lower than healthy subjects 52.212%±6.250%, 46.698%±5.417% (t=2.534, 2.405; P=0.012, 0.017), and vessel length (VL) was (19.905±2.285)mm, (17.596±2.149)mm, (14.479±2.091)mm in the three layers, which was significantly shorter than that in the healthy control group (21.037±2.185)mm, (18.739±1.994)mm, (15.343±2.266)mm (t=2.529, 2.731, 2.059; P=0.012, 0.007, 0.041). Compared with non-diabetes, foveal avascular zone (FAZ) in diabetes was (0.441±0.167)mm(2), larger compared to health eyes 0.352±0.109mm(2) (t=-2.831, P=0.005). FAZ demonstrated a negative correlation with VD and VL in RL or SRL(r=-0.227, -0.338; P<0.05) (r=-0.241, -0.332; P<0.05), while best corrected visual acuity showed a negative correlation with VL in each layer (r=-0.225, -0.201, -0.250; P=0.01, 0.022, 0.004), and VD in DRL (r=-0.197, P=0.026). All parameters showed high reproducibility between graders(intraclass correlation coefficient>0.965), while relative standard deviation was greater than 3.049%. AR had the highest area under the receiver operating characteristic curve (0.737), compared with AI (0.724). Conclusions: Our study demonstrates good reliability, reproducibility and accuracy of quantification of OCTA images and reveals changes of VD, VL and FAZ in diabetes, which may occur earlier than vision impairment. AR and AL may have great values in prompting early diabetic retinopathy in diabetic patients. (Chin J Ophthalmol, 2019, 55:273-279).

[Exposure status and health risk assessment of deoxynivalenol from cereals in Chinese population in different regions]

Objective: To evaluate the dietary exposure to deoxynivalenol (DON) from cereals and health risk in Chinese residents in different regions. Methods: The data of DON concentration in cereals was derived from the national food safety risk surveillance from 2010 to 2017, with 15 422 samples of cereals included. China was roughly divided into north part and south part, along with the Qinling Mountains-Huaihe River line. Sample size of each type of cereals, i.e. wheat flour, maize meal, oats and rice was 4 948, 696, 626, 1 006 in the north, while 5 648, 1 068, 266, 1 164 in the south. The data of cereals consumption was derived from China National Nutrition and Health Survey in 2002 and 68 335 respondents aged 3 and above, with 34 234 from the north and 34 101 from the south, were included. Simple distribution model was applied for calculation and comparison of the dietary exposure to DON from cereals in northern and southern residents based on individual consumption of cereals, body weight and average DON concentration in each type of cereals. Results: Average DON concentration in wheat flour, maize meal, oats, and rice sampled in northern China were 235.4, 121.6, 7.0 and 4.6 μg/kg, respectively, while 239.1, 124.3, 29.0 and 15.5 μg/kg in cereals sampled in southern China. The average DON exposure from cereals in surveyed Chinese inhabitants was 0.78 μg/(kg·d). Among them, the DON exposure of northern residents was higher than that of southern residents (P<0.001), and the average exposures were 1.15 and 0.41 μg/(kg·d), respectively. A total of 49.2% of northern residents exceeded provisional maximum tolerable daily intake for DON exposure from cereals, which was much higher than that of southern residents (8.6%) (P<0.001). Wheat-based food products were the main source of DON exposure, with a contribution rate of 96.5% in the north and 68.3% in the south. Average DON exposure was the highest in the 3-6 years [2.12 μg/(kg·d) for children in north and 0.73 μg/(kg·d) in south]. Conclusion: Exposure to DON from cereals in northern residents of China was considerably high, with a certain health risk. Northern children aged 3 to 6 exposed even more DON and needed significant attention.

Molecular cloning of WIF1 and HMGA2 reveals ear-preferential expression while uncovering a missense mutation associated with porcine ear size in WIF1

Considerable diversity exists in porcine ear size, which is an important morphological feature of pig breeds. Previously, we localized four crucial candidate genes-high mobility group AT-hook 2 (HMGA2), LEM domain-containing 3 (LEMD3), methionine sulfoxide reductase B3 (MSRB3) and Wnt inhibitory factor 1 (WIF1)-on Sus Scrofa chromosome 5 affecting porcine ear size, then cloned LEMD3 and MSBR3. In this study, we performed rapid amplification of cDNA ends to obtain full-length cDNA sequences of 2338-bp WIF1 and 2998-bp HMGA2. Using quantitative real-time PCR, we revealed that WIF1 expression was highest in ear cartilage of 60-day-old pigs and that this is therefore a better candidate gene for ear size than HMGA2. We further screened coding sequence variants in both genes and identified only one missense mutation (WIF1:c.1167C>G) in a conserved epidermal growth factor-like domain from the mammalian WIF1 protein. The protein-altering mutation was significantly associated with ear size across the Large White × Minzhu hybrid and Beijing Black pig populations. When WIF1:c.1167C>G was included as fixed effect in the model to re-run a genome-wide association study in the Large White × Minzhu intercross population the P-value of the peak SNP on SSC5 from re-running the genome-wide association study dropped from 2.45E-12 to 7.33E-05. Taken together, the WIF1:c.1167C>G could be an important mutation associated with ear size. Our findings provide helpful information for further studies of the molecular mechanisms controlling porcine ear size.

Abstract PD5-07: Comprehensive profiling of poor-risk paired primary and recurrent triple-negative breast cancers reveals immune phenotype shifts

Background: Prognosis for triple-negative breast cancer (TNBC) patients remains poor, due in part to the lack of effective targeted therapies in the advanced setting. Emerging clinical data indicates reduced efficacy of immune checkpoint inhibitors in heavily pre-treated TNBC, but the underlying mechanisms are poorly understood. To better understand the immune phenotypic evolution of paired TNBCs, we studied the genomic and transcriptomic profiles of tumors from patients undergoing treatment for TNBC.

Methods: We analyzed primary and recurrent TNBCs from 55 poor-risk patients, including 44 paired primary-metastatic samples and 11 paired metastatic tumors. FoundationOne® and RNAseq was successful on 89 specimens and 97 specimens, respectively. In addition to somatic alterations, FoundationOne® provided tumor mutational burden (TMB). From RNAseq, we ascertained the TNBC molecular subtypes, and the mRNA expression of immune-related genes. Stromal tumor-infiltrating lymphocytes (stromal TILs), recurrence-free survival, and overall survival were also studied.

Results: From FoundationOne® sequencing, a mutational landscape typical of TNBCs was observed across both primary and recurrent disease specimens, with TP53 mutated in 82.0% of specimens, and BRCA1 and BRCA2 mutated in 4.5% and 16.9% of specimens, respectively. Sample profiles revealed minimal shifts in copy number alterations and TMB over time, however, notable TNBC subtype shifts were observed between primary and recurrent tumors. These included an increase in the Lehmann/Pietenpol-defined basal-like 1 phenotype (BL1, 12.8% to 20.9%), an increase in the mesenchymal phenotype (M, 12.8% to 20.9%), and a significant decrease in the immunomodulatory phenotype (IM, 27.1% to 2.3%). Similarly, tumors exhibited a downward shift in gene expression delineating the Burstein-defined basal-like immune-activated phenotype (BLIA, 37.0% to 14.3%). Composite expression of immunomodulatory gene signatures representative of Th1/Th2 responses, IFNg-related inflammation, M1/M2 macrophage activation and suppression, etc., was decreased in the recurrent tumors compared to the primaries (p = 0.01), and histopathology-derived percent stromal TILs were significantly decreased in the recurrent TNBCs (p = 0.02). However, higher stromal TILs (≥30%) were not associated with improved overall survival when measured in primary specimens (p = 0.15), or with the time from relapse to death when measured in recurrent specimens (p = 0.65) in this cohort of immunotherapy-naïve patients.

Conclusion: In this retrospective study of paired TNBCs, significant transcriptomic phenotype shifts were observed as patients progressed, while only minor genomic shifts were seen. Selective immune profiling showed significantly reduced TILs and immune-activating gene expression signatures in recurrent TNBCs, which may explain the lack of efficacy of immunotherapeutic agents in heavily pretreated TNBCs. Further studies are ongoing to understand the proteomic landscape shifts in TNBCs over time and to identify novel targeted agents appropriate for recurrent disease.

Citation Format: Yuan Y, Yost SE, Chang C-W, Yoh KE, Johnson RM, Schmolze D, Liang J, Hutchinson KE. Comprehensive profiling of poor-risk paired primary and recurrent triple-negative breast cancers reveals immune phenotype shifts [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD5-07.