[Efficacy of anti-CD19 CAR-T cell therapy in 10 refractory recurrent B cell malignancies]

目的

探讨抗CD19 CAR-T细胞治疗难治复发B细胞肿瘤的疗效和不良反应。

方法

2015年12月至2017年7月北京大学第三医院血液科收治的10例患者，包括难治复发的急性B淋巴细胞白血病（B-ALL）6例，难治复发的B细胞非霍奇金淋巴瘤（NHL）4例，采用抗CD19 CAR-T细胞治疗后观察治疗效果及不良反应。

结果

输注后第28天进行近期疗效评估，其中6例ALL患者4例（66.7%）完全缓解（CR），1例（16.7%）部分缓解（PR）；总反应率（ORR）为83.3%。3例弥漫大B细胞淋巴瘤（DLBCL）患者1例达CR。1例套细胞淋巴瘤（MCL）患者大部分病灶消失，亦有顽固病灶呈进展状态。10例患者均发生细胞因子释放综合征（CRS），主要表现为发热；其中1例患者出现中枢神经系统症状，1例患者出现多脏器功能衰竭，经治疗不良反应均治愈。

结论

抗CD19 CAR-T细胞治疗难治复发B细胞血液系统肿瘤有效，不良反应可控。

[Prognostic significance of miRNA-223 targeting SOX11 in mantle cell lymphoma]

目的

探讨miR-223在套细胞淋巴瘤（MCL）患者中的表达及预后意义，并探讨可能的作用机制。

方法

以21例骨髓受累初治MCL患者为研究对象，以20例健康正常供者为正常对照，采用RQ-PCR法检测miR-223、SOX11 mRNA表达水平。构建过表达miR-223的MCL细胞系Granta519细胞，采用CCK8法和流式细胞术检测其增殖、周期和凋亡水平，采用Western blot法检测其SOX11蛋白表达水平，并利用双荧光素酶报告基因实验验证miR-223的靶基因。

结果

①21例MCL患者中，男15例，女6例，中位年龄58（37~72）岁，其中17例为中高危组。与正常对照组比较，MCL组患者miR-223表达水平显著下调（1 244.1±1 935.2对14.7±10.5，P<0.001），且其低表达与MCL的IPI评分高危组（P=0.001）、LDH升高（P=0.001）、ECOG评分≥2分（P=0.035）等高危临床特征相关。②以患者组miR-223中位表达水平为阈值，将患者分为高表达组（10例）和低表达组（11例），生存分析结果显示前者的总生存时间较后者延长（36个月对12个月，P=0.021）。③体外实验结果显示，与对照组比较，过表达miR-223的Granta519细胞增殖受抑（96 h时最明显，P<0.001）、处于G₂/M期的细胞明显减少（P<0.001）、细胞凋亡比例增加（P<0.001）；Granta519细胞的SOX11蛋白表达水平较对照组明显降低。④miR-223可抑制SOX11的3′非翻译区；MCL患者的miR-223与SOX11 mRNA表达水平呈明显负相关（r=−0.81，P<0.001）。

结论

miR-223在MCL患者中低表达，且与不良预后相关，机制上可能通过靶向SOX11而发挥作用。

Predictive and Diagnostic Value of Fractional Exhaled Nitric Oxide in Patients with Chronic Rhinosinusitis

Background

Fractional exhaled nitric oxide (FeNO) participates in the local defense of the upper respiratory tract. Abnormal FeNO level is directly related to the occurrence of nasal diseases. However, the clinical value of FeNO in the upper airway is limited, which greatly impedes the diagnosis and treatment of nasal diseases. Here, we assessed the level of FeNO and evaluated the diagnostic accuracy of FeNO for chronic rhinosinusitis.

Material/Methods

We enrolled 35 patients with confirmed nasal inflammation and 30 healthy subjects from December 2016 and June 2017. The FeNO level was measured using a fractional exhaled nitric oxide detector. The level of FeNO in patients with different clinicopathological factors was compared. The diagnostic potential of FeNO for chronic rhinosinusitis was evaluated by receiver operating characteristic (ROC) curve analysis.

Results

FeNO level was significantly lower in patients with nasal inflammation than in healthy subjects (P<0.05). For nasal inflammation diagnosis, FeNO had the highest area under the curve (AUC) at 0.760, with a sensitivity of 93.30% and a specificity of 68.60%. FeNO level was significantly downregulated in chronic rhinosinusitis patients relative to chronic rhinitis patients (P<0.05). FeNO had a good ability to discriminate between chronic rhinosinusitis patients and chronic rhinitis patients, with higher AUC, sensitivity, and specificity of 0.760, 93.30%, and 68.60%, respectively. However, FeNO levels were not significantly different between different histological types of chronic rhinosinusitis (P>0.05).

Conclusions

Our results show that FeNO is a useful marker for discriminating chronic rhinosinusitis, and has potential to provide valuable information in the early diagnosis of chronic rhinosinusitis.

[Risk factor analysis of secondary post-tonsillectomy hemorrhage in children]

Objective: To analyze the risk factors of secondary post-tonsillectomy hemorrhage (PTH) in children, and to provide a theoretical basis for reducing complications after tonsillectomy. Method: A retrospective analysis of 354 children underwent tonsillectomy was performed, among which 42 secondary hemorrhage cases were divided into bleeding group, and other 312 cases were divided into non-bleeding group. To analyze the risk factors of secondary PTH and to discusses the pathogenesis of the hemorrhage, statistical analysis was conducted among eight clinical data including gender, age, reason of surgery, degree of tonsil embedding, surgery approach, surgeon' s skill level, intra-operative hemorrhagic volume, and postoperative absence of upper respiratory tract infection. Result: Univariant analysis showed that there was no statistical difference of gender, reason for operation, surgeon' s skill level, intra-operative hemorrhagic volume and postoperative upper respiratory tract infection different between bleeding group and non-bleeding group, while there was significant statistical difference of age, degree of tonsillar embedding, and surgery approach. Further multivariate logistic regression analysis of the three relevant factors showed that there was a significant correlation between the degree of tonsillar embedding and the surgery approach and the hemorrhage. Conclusion: Hemorrhage after tonsillectomy is a common and potentially fatal complication, with risk factors of the degree of tonsillar embedding, and the surgery approach. .

20-Hydroxyecdysone-upregulated proteases involved in Bombyx larval fat body destruction

During insect larval-pupal metamorphosis, the obsolete larval organs and tissues undergo histolysis and programmed cell death to recycle cellular materials. It has been demonstrated that some cathepsins are essential for histolysis in larval tissues, but the process of tissue destruction is not well documented. Fat body, the homologous organ to mammalian liver and adipose tissue, goes through a distinct destruction process during larval-pupal transition. Herein, we found that most of the Bombyx proteases - including Bombyx cathepsin B (BmCatB) (BmCatLL-2), Bombyx cathepsin D (BmCatD), Bombyx cathepsin L like-1 (BmCatLL-1) and -2(BmCatLL-2), Bombyx fibroinase (BmBcp), Bombyx matrix metalloprotease (BmMmp), Bombyx A disintegrin and metalloproteinase with thrombospondin motifs 1 (BmAdamTS-1), Bombyx A disintegrin and metalloproteinase with thrombospondin motifs like (BmAdamTS L) and Bombyx cysteine protease inhibitor (Bmbcpi)- were expressed highly in fat body during feeding and metamorphosis, with a peak occurring during the nonfeeding moulting or prepupal stage, as well as being responsive to 20-hydroxyecdysone (20E). The aforementioned protease genes expression was upregulated by injection of 20E into the feeding larvae, while blocking 20E signalling transduction led to downregulation. Western blotting and immunofluorescent staining of BmCatB and BmBcp confirmed the coincident variation of their messenger RNA (mRNA) and protein level during the development and after the treatments. Moreover, BmCatB, BmBcp, BmMmp and BmAdamTS-1 RNA interference all led to blockage of larval fat body destruction. Taken together, we conclude that 20E regulates larval fat body destruction by upregulating related protease gene expression and protein levels during larval-pupal transition.

[Relationship between endometrial thickness and pregnancy outcomes based on frozen-thawed embryo transfer cycles]

Objective: To explore the relationship between endometrial thickness and clinical pregnancy outcomes in frozen-thawed embryo transfer cycles. Methods: A prospective study was performed for 1 475 frozen-thawed embryo transfer cycles at Peking University People's Hospital from January 2014 to December 2015. The patients were divided into different groups according to endometrial thickness of ovulation day in natural menstrual cycles or endometrial transformation day in hormone replacement cycles;patients with thin endometrium were enndometrial thickness ≤6 mm. Then the clinical pregnancy outcomes including clinical pregnancy rate, embryo implantation rate, abortion rate, multiple birth rate and live birth rate were analyzed. Results: In all, 1 475 frozen-thawed embryo transfer cycles were analyzed. The mean age of patients was (32.5±3.9) years old and mean endometrial thickness was (9.2±1.9) mm, and mean number of embryos was 2.03±0.37. The study included 518 (35.1%) natural menstrual cycles and 957 (64.9%) hormone replacement cycles. The number of embryo-transfer cycles and blastocyst-transfer cycles were respectively 700 (47.5%) and 775 (52.5%) . The overall clinical pregnancy rate, embryo implantation rate, abortion rate, multiple birth rate and live birth rate were 54.4%, 35.7%, 23.3%, 24.1%, 43.9%, respectively. The ectopic pregnancy rate in the study was 0.6%. In patients with thin endometrium,there were significant differences in 2 pronucleus count (P=0.016) and available embryo count (P=0.024) between cycles that resulted in pregnancy and those that did not;besides, the use of sildenafil and growth hormone did not improve pregnancy outcomes in patients with thin endometrium (P=0.183, P=0.400) . The clinical pregnancy rate, embryo implantation rate and live birth rate of embryo-transfer and blastocyst-transfer were similar in patients with thin endometrium (all P>0.05) . Conclusions: Patients with thin endometrium have poor pregnancy outcomes. The clinical pregnancy rate, embryo implantation rate and live birth rate of embryo-transfer and blastocyst-transfer are similar in patients with thin endometrium. Compared thin endometrium and non-thin endometrium patients, the clinical pregnancy rate and live birth rate of blastocysts have more substantial decline than those of embryos. Improving the quality of embryo could improve the pregnancy outcome of patients with thin endometrium. Sildenafil and growth hormone could not improve pregnancy outcome in patients with thin endometrium.

Effect of DACH1 on proliferation and invasion of laryngeal squamous cell carcinoma

BACKGROUND

To investigate the effect of DACH1 over-expression on proliferation and invasion of laryngeal squamous cell carcinoma (LSCC).

METHODS

The 120 cases of LSCC tumors and 114 adjacent non-neoplastic tissues were collected to detect the expression of DACH1 by immunohistochemistry. The changes of DACH1 expression from each group were assessed and correlated to the clinical parameters of the patients. Plasmid-DACH1 was transfected into Hep-2 cells to up-regulate the expression of DACH1C. Real-time PCR, Western blot, CCK8 and transwell assay were used to verify the cell proliferation and invasion after plasmid-DACH1 transfection.

RESULTS

The results indicated that DACH1 was downregulated in LSCC tissues as compared to corresponding adjacent non-neoplastic tissues. Decreased expression of DACH1 was found in the tumors upraglottic tumor, lymph node metastases, T3-4 stage and advanced clinical stage. In Hep-2 cells, transfection with plasmid-DACH1 could suppress cell proliferation, invasion and induce G1 phase extension in cell cycle.

CONCLUSIONS

DACH1 may act as a tumor suppressor gene and could be a potential target for therapeutic intervention of LSCC.

[Progress in diagnosis and treatment of vocal fatigue]

Summary Vocal fatigue is a common symptom of voice disease, but we prefer to regard vocal fatigue as a separate voice disease. In this paper, the etiology, pathogenesis and clinical diagnosis and treatment of vocal fatigue are reviewed in order to provide reference for the standardized diagnosis and treatment of this disease.

[Comparison of safety between continued warfarin therapy and bridging anticoagulation therapy in patients undergoing coronary intervention]

Objective: To compare the safety of continued warfarin therapy and bridging anticoagulation therapy during hospital stay in patients undergoing percutaneous coronary intervention (PCI). Methods: We retrospectively analyzed patients on warfarin therapy referred for PCI in Beijing Anzhen Hospital from January 2008 to December 2016. The patients were divided into continued warfarin therapy (n=195) or bridging anticoagulation therapy (n=311) groups. After Propensity Score Matching, data from matched patients (n=123 in each group) were analyzed. Bleeding complications and major adverse cardiac events including death, myocardial infarction, target vessel revascularization, and stent thrombosis were assessed. Results: There were no significant difference in the rate of death (2.4%(3/123) vs. 1.6%(2/123),P=0.54), acute myocardial infarction (4.1%(5/123) vs. 4.9%(6/123), P=0.78),re-revascularization (0.8%(1/123) vs. 1.6%(2/123),P=0.16), stent thrombosis (1.6%(2/123) vs. 1.6%(2/123),P=1.00) and stroke between the two groups. Prevalence of minor bleeding complications was significantly higher in the bridging therapy group (15.4%(19/123) vs. 9.8%(12/123),P=0.01). Rate of access-site complications (hematoma:4.1%(5/123) vs. 2.4%(3/123),P=0.20; pseudoaneurysm:2.4%(3/123) vs. 2.4%(3/123),P=1.00; arteriovenous fistula:0.8%(1/123) vs. 1.6%(2/123),P=0.09; and retroperitoneal hematoma:0(0/123) vs. 0.8%(1/123),P=0.23) were similar between the two groups. Conclusion: For patients receiving chronic warfarin therapy, the uninterrupted oral anticoagulant treatment is as safe as bridging therapy in PCI patients.

Limb-salvage treatment of malignant tumors of the limbs

The aim of this study was to explore the clinical efficacy of limb-salvage therapy for malignant bone tumors of the limbs using two surgical methods. This investigation presents a retrospective study of malignant bone tumors of the limbs in 42 patients. Participants were divided into two groups: group A of 25 patients who were treated with artificial prosthesis replacement, and group B of 17 patients treated with bone inactivation. By collection of clinical data, the survival rate, surgical complications, quality of life, pain relief and postoperative limb function following artificial prosthesis replacement and tumor inactivation were comprehensively evaluated in patients with malignant bone tumors of the limbs. Group A had significantly higher Karnofsky quality of life scores compared to group B after six months (P=0.027). The Enneking scores of limb functions in group A were significantly higher than those of group B (P=0.022). In group A the postoperative limb function score was good and excellent in 92% and in group B in 64.7%. There were significantly more postoperative complications in group B compared with group A (P=0.027), but no significant difference in the recurrence rate in the two group (P=0.976). The study results can provide reference for surgical treatment of the patients with malignant bone tumors.

Over-expression of MEOX2 promotes apoptosis through inhibiting the PI3K/Akt pathway in laryngeal cancer cells

The early-stage diagnosis and treatment for the recurrence of larynx carcinoma needs further investigation. Mesenchyme homeobox 2 (MEOX2) was speculated as a novel suppressor gene in larynx carcinoma in our study, the molecular mechanism was studied. Real-time quantitative PCR (RT-qPCR) and Western blot were used to detect mRNA and protein levels of MEOX2 in laryngeal cancer tissues and cells (Hep-2, TU212, AMC-NH-8 and TU686 cells), and also apoptosis and phosphoinositide 3-kinase (PI3K)/protein kinase (Akt) related factors in TU212 cells transfected with MEOX2. Cell counting kit-8 (CCK8) assay and Annexin-Ⅴ/PI staining assay were conducted to determine cell viability and apoptosis rates respectively.46 patients with larynx carcinoma were involved in this study. The expression of MEOX2 was lower in larynx carcinoma tissues than normal tissues, correlated with clinical stages, differentiated degrees, and survival times. The expression of MEOX2 was the lowest among those laryngeal cancer cells, and was chosen to be transfected with MEOX2 in the following study. Over-expression of MEOX2 inhibited cell viability and promoted apoptosis of TU212 cells, via increasing the expression levels of Caspase-3, and decreasing levels of C-Myc, XIAP, PI3K p110α, PI3K p110β, PI3K class III and p-Akt. In summary, the expression levels of MEOX2 were inhibited in larynx carcinoma than normal tissues, correlated with the progression of the cancer. Over-expression of MEOX2 in laryngeal cancer cells inhibited cell viability and promoted apoptosis, via regulating apoptosis and PI3K/Akt pathway related factors. It would provide evidence for MEOX2 to be used as a therapeutical gene in larynx carcinoma.

[Analysis of survival and treatment outcome of patients with primary diffuse large B cell lymphoma in reproductive system]

Objective: To analyze clinical feature and treatment outcome of patients with primary diffuse large B cell lymphoma(DLBCL) in reproductive system. Methods: A total of 26 patients with DLBCL in reproductive system were retrospectively analyzed, and the clinical features, laboratory data were included in Kaplan-Meier and prognostic analysis. Results: In our center, the incidence of primary diffuse large B cell lymphoma in reproductive system was 3.5% in all DLBCL patients, and the median age was 62.0 years. Male are more common with unilateral testicular involvement, and 38.5% patients belong to Ⅲ and Ⅳstage while 84.6% patients belong to non-germinal center B cell-like subgroup. The overall response rate(ORR) for the whole group was 88.5%. The complete response rate was 76.9%. The 3, 5-year progression free survival rate was 70.5% and 62.7% , and the 3, 5-year overall survival rate was 83.5% and 69.6%, respectively. The most common recurrent sites were contralateral testis and central nervous system. Rituximab can improve the survival of patients and combined with contralateral irradiation can furtherly improve progression free survival of patients(P=0.047). Clinical stage, B symptom, IPI, the level of LDH, and CRP, age>60 years, and initial treatment outcome were predictive of overall survival. Conclusion: Primary diffuse large B cell lymphoma in reproductive system is a rare type of extranodal DLBCL which occurs in older men with aggressive features. The most common sites of recurrence were contralateral testis and central nervous system. Surgery, rituximab , radiotherapy and prophylactic intrathecal injection can improve the survival of patients and may be the first-line treatment.

[Analysis on the clinical and retinal imaging characteristics of autosomal recessive bestrophinopathy]

Objective: To study the clinical and imaging features of autosomal recessive bestrophinopathy (ARB). Methods: Retrospective study. The clinical and imaging data of 14 participants were analyzed in using autofluorescence (AF), fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT). Ten patients were screened for mutations in BEST1 gene. Results: Retinopathy of ARB were shown as bilaterally and circularly distributed yellow subretinal deposits in the mid-peripheral and posterior retina, which was observed more clearly by AF and FA. The abnormalities were observed as hyperreflection between the sub-retinal pigment epithelium space as well as the subretinal space by SD-OCT imaging. All of the patients showed serous retinal detachment, and 4 of them were found to have intraretinal schisis. Other ocular complications include choroidal neovascularization (CNV) and angle closure glaucoma (ACG) were also found in the patients. Genetic examinations showed that the mutations are compound heterozygous in five patients, homozygous in one patient and heterozygous in only one of the rest 4 patients. Conclusions: The combination of clinical and retinal imaging data may facilitate the diagnosis of ARB. Physicians should be cautious of the vision-threatening complications of the disease. (Chin J Ophthalmol, 2018, 54: 263-269).

Identification of laryngeal cancer prognostic biomarkers using an inflammatory gene-related, competitive endogenous RNA network

Competitive endogenous RNAs (ceRNAs) act as molecular sponges for microRNAs (miRNAs), and are associated with tumorigenesis in various cancers, including laryngeal cancer (LC). In this work, we constructed an LC-specific inflammatory gene-related ceRNA network (IceNet). In IceNet, ceRNAs targeting inflammation-related genes tended to be network hubs. Additionally, the betweenness centralities of these hub ceRNAs were higher than those of the inflammation-related genes themselves, indicating that the hub ceRNAs in this study played critical roles in communication between IceNet molecules. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses indicated that IceNet molecules are associated with multiple cancer-related functions and signaling pathways. Using cFinder software and survival analyses, we identified a potential prognostic module within IceNet that contains 18 mRNAs and a long non-coding RNA (lncRNA), and we effectively stratified patients into high- and low-risk subgroups with different survival outcomes, independent of patient age and tumor grade. This 18-mRNA and one-lncRNA module provides a novel mechanism for potentially improving LC patient prognostic predictions. Applying the module clinically to differentiate high- and low-risk patients could inform therapeutic decision making and ultimately improve patient outcomes. In addition, these results demonstrate the potential importance of IceNet hub ceRNAs in LC development and progression.

Significant alterations of 6-keto prostaglandin F1a and NO levels in spermatic vein plexus patients with varicocele

To investigate the level variation of correlative factors between the spermatic vein plexus and peripheral blood in patients with varicocele, a total of 22 patients diagnosed with varicocele were enrolled in the study. All patients were performed a testicular artery-sparing microsurgical varicocelectomy. During the operation, a blood sample from the left spermatic vein plexus and a peripheral blood sample were collected. A radioimmunoassay was used to determine the 6-keto prostaglandin F1a (6-keto-PGF1a ). A colorimetric method was performed to determine the NO. The enzyme immunoassay method was used to determine the creatinine, urea nitrogen, adrenaline, noradrenaline, dopamine and 5-HT. The mean age of all patients was 29.3 ± 7.8 years. Compared with the level of 6-keto-PGF1a and NO in the peripheral blood, 6-keto-PGF1a and NO were significantly increased in left spermatic vein plexus (347.3 (230.8-415.1) versus 99.7 (80.4-119.9) pg/ml and 192.3 ± 178.5 versus 107.1 ± 73.6 μmol/L, p < .05). There were no differences in the level of creatinine, urea nitrogen, adrenaline, noradrenaline, dopamine and 5-HT between the peripheral blood and left spermatic vein plexus (p > .05). The 6-keto-PGF1a and NO concentrations in left spermatic vein plexus were significantly higher than that in peripheral blood patients with varicocele.

Expression of long non-coding RNA HOXA11-AS is correlated with progression of laryngeal squamous cell carcinoma

Long noncoding RNA HOXA11 antisense RNA (HOXA11-AS) is involved in tumorigenesis and development of some human cancers. However, the role of HOXA11-AS in human laryngeal squamous cell cancer (LSCC) is yet unclear. In this study, we firstly investigated the expression of HOXA11-AS in LSCC. Microarray and qRT-PCR showed that the level of HOXA11-AS was significantly higher in LSCC than that in the corresponding adjacent non-neoplastic tissues. ISH revealed that HOXA11-AS was strongly expressed in the nucleus and closely related to the T grade, neck nodal metastasis, and clinical stage. Patients with T3-4 grade, neck nodal metastasis, or advanced clinical stage presented a high HOXA11-AS expression. Kaplan-Meier analysis showed that high HOXA11-AS expression could predict a poor prognosis in LSCC patients. Furthermore, HOXA11-AS knockdown significantly inhibited the growth, migration, and invasion of LSCC cells. Taken together, the current data indicated that HOXA11-AS plays an oncogenic role in the cellular processes of LSCC and serve as a novel marker and a potential therapeutic target in LSCC patients.

A Dynamic Three-Dimensional Air Pollution Exposure Model for Hong Kong

INTRODUCTION

High-density high-rise cities have become a more prominent feature globally. Air quality is a significant public health risk in many of these cities. There is a need to better understand the extent to which vertical variation in air pollution and population mobility in such cities affect exposure and exposure-response relationships in epidemiological studies.

METHODS

We used a novel strategy to execute a staged model development that incorporated horizontal and vertical pollutant dispersion, building infiltration, and population mobility patterns in estimating traffic-related air pollution (TRAP) exposures in the Hong Kong Special Administrative Region (HK SAR).

Two street-level spatial monitoring campaigns were undertaken to facilitate the creation of a two-dimensional land-use regression (LUR) model. A network of approximately 100 passive nitric oxide-nitrogen dioxide (NO-NO2) monitors was deployed for two-week periods during the cool and warm seasons. Sampling locations were selected based on population and road network density with a range of physical and geographical characteristics represented. Eight sets of portable monitors for black carbon (BC) and particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) were rotated so as to be deployed at 80 locations for a 24-hour period. Land-use, geographical, and emissions layers were combined with the spatial monitoring campaign results to create spatiotemporal exposure models.

Vertical air pollution monitoring was carried out at six strategic locations for two weeks in the warm season and two weeks in the cool season. Continuous measurements were carried out at four different heights of a residential building and on both sides of a street canyon. The heights ranged from as close to street level as practically possible up to a maximum of 50 meters (i.e., below the 20th floor). Paired indoor monitoring was included to allow the calculation of infiltration coefficients to feed into the dynamic component of the exposure model.

The final phase of model development addressed population mobility. A population-representative travel behavior survey (n = 89,358) was used to produce the dynamic component of the model, with time-weighted exposure estimates split between home and work or school. Transport microenvironment exposures were taken from published literature. Time-activity exposure estimates were split by age, sex, and employment status.

Development of the exposure model in distinct packages allowed the application of a staged approach to an existing cohort data set. Mortality risk estimates for an elderly cohort of 66,000 Hong Kong residents were calculated using increasing exposure model complexity.

RESULTS

The street-level (2-dimensional [2D]) LUR modeling captured important spatial parameters and represented spatial patterns of air quality in Hong Kong that were consistent with the literature. Higher concentrations of gaseous pollutants were centered in Kowloon and the northern region of Hong Kong Island. PM2.5 and BC predictions exhibited a north-south/west-east gradient, with higher concentrations in the northwest due to regional transport of particulate pollutants from Mainland China. While the degree of explained variance of the models was in line with other LUR modeling efforts in Asia, R2 values ranged from 0.46 (NO2) to 0.59 (PM2.5).

Exponential decay rates (k) were calculated at each monitoring location. While it was clear that k values were higher during the warm season than the cool season, no robust patterns were identified relating to the canyon physical parameters. Therefore, a single decay rate was used for each pollutant across the whole region for derivation of the 3-dimensional (3D) exposure layer (k = 0.004 and 0.012 for PM2.5 and BC, respectively). An alternative decay profile that capped decay at 20 meters above street level was proposed and evaluated. The electrochemical sensors deployed during the canyon campaigns did not exhibit the degree of interunit precision necessary to detect vertical variations in gaseous pollutants, and these results were excluded from the study.

We found that values of the median infiltration efficiencies (Finf) for both BC and PM2.5 were especially high during the cool season (91%). Finf values were somewhat lower during the warm season (81% and 88% for PM2.5 and BC, respectively), and we found a significant negative correlation between air conditioning use and Finf. The Finf for a mechanically ventilated office building was 45% and 40% during the cool and warm seasons, respectively.

Dynamic exposure estimates were compared against home outdoor estimates. As expected, the addition of an indoor component decreased time-weighted exposure estimates, which were balanced out to some extent by the inclusion of transport microenvironments. Overall, mean time-weighted exposures for the full dynamic model were around 20% lower than home outdoor estimates.

Higher levels of exposures were found with working adults and students than for those neither in work nor study. This was due to the increased mobility of people going to work or school. The exposures to PM2.5, BC, and NO2 were, respectively, 13%, 39%, and 14% higher for people who were under age 18, compared with people who were 65 or older. Exposure estimates for the female population were approximately 4% lower.

The availability of an existing cohort data set of elderly Hong Kong residents (n = 66,820) facilitated the calculation and comparison of mortality risk estimates for the different exposure models.

Overall, results indicated that the application of exposure estimates that incorporated infiltration, vertical, and to a lesser extent, dynamic components resulted in higher hazard ratios (HRs) than the standard street-level model and increased the number of significant associations with all-natural-cause, cardiovascular, and respiratory mortality outcomes.

CONCLUSIONS

The results from the study provided the first evidence that considering air pollution exposure in a dynamic 3D landscape would benefit epidemiological studies. Higher HRs and a greater number of significant associations were found between mortality and pollutant exposures that would not have been found had standard 2D exposure models been used. Dynamic models can also identify differential exposures between population subtypes (e.g., students and working adults; those neither in work nor study).

Improved urban building design appears to be stimulating the dispersion of local TRAP in street canyons. Conversely, Finf values found in naturally ventilated buildings were high, and residences provided little protection from ambient air pollution.

We have demonstrated that the creation of effective advanced exposure models is possible in Asian cities without an undue burden on resources. We recommend that vertical exposure patterns be incorporated in future epidemiological studies in high-rise cities where the floor of residence is recorded in health record data.

Detection and genetic characterization of porcine deltacoronavirus in Tibetan pigs surrounding the Qinghai-Tibet Plateau of China

Porcine deltacoronavirus (PDCoV) is a recently discovered RNA virus that belongs to the family Coronaviridae and genus Deltacoronavirus. This virus causes enteric disease in piglets that is characterized by enteritis and diarrhoea. In our present investigation, 189 diarrhoeic samples were collected between July 2016 and May 2017 from Tibetan pigs inhabiting in three different provinces surrounding the Qinghai–Tibet Plateau of China. We then applied the molecular‐based method of reverse transcription polymerase chain reactions (RT‐PCRs) to detect the presence of PDCoV in collected samples, and RT‐PCR indicated that the prevalence of PDCoV was 3.70% (7/189) in Tibetan pigs. Four of 7 PDCoV‐positive pigs were monoinfections of PDCoV, three samples were co‐infections of PDCoV with porcine epidemic diarrhoea virus (PEDV), and 52 (27.51%) samples were positive for PEDV. Four strains with different full‐length genomes were identified (CHN/GS/2016/1, CHN/GS/2016/2, CHN/GS‐/2017/1 and CHN/QH/2017/1), and their genomes were used to analyse the characteristics of PDCoV currently prevalent in Tibetan pigs. We found a 3‐nt insertion in the spike gene in four strains in Tibetan pigs. Phylogenetic analysis of the complete genome and spike and nucleocapsid gene sequences revealed that these strains shared ancestors with the strain CHN‐AH‐2004, which was found in pigs from the Anhui province of China mainland. However, PDCoV strains from Tibetan pigs formed different branches within the same cluster, implying continuous evolution in the field. Our present findings highlight the importance of epidemiologic surveillance to limit the spread of PDCoV in livestock at high altitudes in China.

Wearable sensors: modalities, challenges, and prospects

Wearable sensors have recently seen a large increase in both research and commercialization. However, success in wearable sensors has been a mix of both progress and setbacks. Most of commercial progress has been in smart adaptation of existing mechanical, electrical and optical methods of measuring the body. This adaptation has involved innovations in how to miniaturize sensing technologies, how to make them conformal and flexible, and in the development of companion software that increases the value of the measured data. However, chemical sensing modalities have experienced greater challenges in commercial adoption, especially for non-invasive chemical sensors. There have also been significant challenges in making significant fundamental improvements to existing mechanical, electrical, and optical sensing modalities, especially in improving their specificity of detection. Many of these challenges can be understood by appreciating the body's surface (skin) as more of an information barrier than as an information source. With a deeper understanding of the fundamental challenges faced for wearable sensors and of the state-of-the-art for wearable sensor technology, the roadmap becomes clearer for creating the next generation of innovations and breakthroughs.

[Study on the change of optical zone after femtosecond laser assisted laser in situ keratomileusis]

Objective: To explore the change of optical zone after femtosecond laser assisted laser in sitn keratomileusis(FS-LASIK) so as to provide the reference for measurement and design of clinical optical zone. Methods: This retrospective case series study covers 41 eyes of 24 patients (7 males and 17 females, aged from 18 to 42 years old) with myopia and myopic astigmatism who have received FS-LASIK surgery at Corneal Refractive Department of Qingdao Eye Hospital and completed over 6 months of clinical follow-up. Pentacam system (with the application of 6 corneal topographic map modes including: the pure axial curvature topographic map, the pure tangential curvature topographic map, the axial curvature difference topographic map, the tangential curvature difference topographic map, the postoperative front elevation map and the corneal thickness difference topographic map), combined with transparent concentric software (a system independently developed by Qingdao Eye Hospital) was used to measure the optical zone at 1, 3 and 6 months postoperatively, the optical zone diameters measurement results among different follow-up times in group were analyzed with the repeated measures analysis of variance, and the actual measured values and the theoretical design values of the optical zone were analyzed with independent-samples t-testing. Spearman correlation coefficient (r(s)) have been applied to evaluate the relationship between postoperative optical zone measurement values and the potential influencing factors. Results: The optical zone diameters measured by pure axial curvature topographic map at 1, 3 and 6 months after FS-LASIK showed (6.55±0.50)mm, (6.50±0.53)mm and (6.48±0.53)mm respectively. The differences between values are of no statistical significance (F=1.60, P=0.21), the optical zone diameter measured by pure tangential curvature topographic map at 1, 3 and 6 months after FS-LASIK showed (5.44±0.46)mm, (5.46±0.52)mm and (5.44±0.50)mm respectively, the differences between values are of no statistical significance (F=0.17, P=0.85). The optical zone diameters measured by postoperative front elevation map at 1, 3 and 6 months after FS-LASIK showed (5.06±0.28)mm, (5.12±0.32)mm and (5.17±0.28)mm respectively. The differences between the values of 3 and 6 months postoperatively are of no statistical significance (F=6.14, P=0.15), the optical zone diameters measured by axial curvature difference topographic map at 1, 3 and 6 months after FS-LASIK showed (6.51±0.37)mm, (6.45±0.41)mm and (6.41±0.40)mm respectively, and the differences between the values of 3 and 6 months postoperatively are of no statistical significance (F=7.25, P=0.05). The optical zone diameters measured by tangential curvature difference topographic map at 1, 3 and 6 months after FS-LASIK showed (5.21±0.23)mm, (5.16±0.19)mm and (5.17±0.20) mm respectively, and the differences between the values of 1 and 3 months postoperatively are of statistical significance (F=1.75, P=0.04). The optical zone diameters measured by corneal thickness difference topographic map at 1, 3 and 6 months after FS-LASIK showed (6.53±0.40)mm, (6.39±0.43)mm and (6.41±0.47)mm respectively, and the differences between the values of 1 and 3 months postoperatively are of statistical significance (F=1.67, P=0.032). The actual measured optical zone values from the 6 different modes of Pentacam system are less than the theoretical design values (7.75 mm), and the differences were statistical significance (t=-15.42, -29.39, -59.27, -21.47, -81.69, -18.22, P<0.01). Conclusions: The optical zone measurement values tend to be stable at 3 months after FS-LASIK. The actual measured values from all the 6 different modes of Pentacam system were less than the theoretical design values. The results from pure tangential curvature topographic map, the tangential curvature difference topographic map and the postoperative front elevation map showed greater variation with clear border, which was beneficial for eccentric research. The results from pure axial curvature topographic map, the axial curvature difference topographic map and the corneal thickness difference topographic map were close to the theoretically designed values. Furthermore, the axial curvature difference topographic map showed clearer border and less variation thus maybe more favorable for measuring optical zone in clinical application.(Chin J Ophthalmol, 2018, 54: 39-47).

High Fructose and High Fat Exert Different Effects on Changes in Trabecular Bone Micro-structure

OBJECTIVES

To compare the effects of high-fat diet (HFD) and high-fructose diet (HFrD) on bone metabolism at different time points, dynamically observe the bone histology and femur trabecular micro-architecture, and analyze the underlying mechanisms.

METHODS

Sixty -Five male 6- to 7-week-old C57BL/6J mice were given HFD, HFrD, or standard diets (SD) for 8, 16, and 24 weeks. Micro-computed tomography (μCT) and bone histology were used to measure bone mass and trabecular micro-structure. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to determine the expression of genes related to bone and lipid metabolisms.

RESULTS

Compared to SD mice, femoral trabecular bone mass was significantly increased in both HFrD mice and HFD mice at 8 weeks, it continued to be higher in HFrD mice at 16 and 24 weeks with the highest level at 16 weeks, but it was significantly decreased in HFD mice at 16 and 24 weeks. HFD mice showed more epididymal fat accumulation than HFrD mice. mRNA expression of Runx2 was up-regulated at 8 and 16 weeks, but down-regulated at 24 weeks similarly in both HFrD mice and HFD mice. mRNA expression of MMP9 and CTSK was up-regulated at 8 and 16 weeks in HFD mice, but down-regulated at 24 weeks in both HFrD mice and HFD mice.

CONCLUSIONS

Our data indicated that the HFrD and HFD had different modulating effects on bone mass. After short-term feeding, both HFrD and HFD showed positive effects on bone mass; however, after long-term feeding, bone mass was decreased in HFD mice. In contrast, the bone mass was first increased and then decreased in the HFrD mice. On the basis of these findings, we speculated that chronic consumption of fat and fructose would exert detrimental effects on bone mass which might a combination action of body mass, fat mass, and bone formation/bone resorption along with proinflammatory factor and bone marrow environment.

A novel dominant COL11A1 mutation in a child with Stickler syndrome type II is associated with recurrent fractures

This case describes a child with blindness, recurrent low-impact fractures, low bone mass, and intermittent joint pain who was found to have a novel missense mutation in COL11A1, consistent with Stickler syndrome type II. The case illustrates the phenotypic variability of the syndrome, which may include increased fragility in childhood.

INTRODUCTION

Stickler syndrome type II is an autosomal dominant disorder caused by mutations in the gene that encodes the type XI collagen chain α1 (COL11A1). Manifestations include craniofacial dysmorphology and ocular abnormalities that may lead to blindness, hearing loss, and skeletal anomalies that range from joint pain and arthritis to scoliosis and hypermobility.

METHODS

Herein, we describe a child who carried the presumed diagnosis of osteoporosis-pseudoglioma syndrome because of the combined findings of recurrent low-impact fractures due to low bone mass and blindness. The child also suffered from joint pain but had no facial dysmorphism or hearing loss.

RESULTS

Targeted sequencing and deletion analysis of the LRP5, COL1A1, and COL1A2 genes failed to identify any mutations, and whole exome sequence analysis revealed a novel missense mutation (c.3032C>A:p.P1011Q) in COL11A1, consistent with Stickler type II.

CONCLUSION

This case highlights the phenotypic variability of Stickler type II, broadens the list of differential diagnosis of increased bone fragility in childhood, and highlights utility of unbiased genetic testing towards establishing the correct diagnosis in children with frequent fractures.

Regulation of laryngeal squamous cell cancer progression by the lncRNA H19/miR-148a-3p/DNMT1 axis

Laryngeal squamous cell carcinoma (LSCC) is a highly aggressive malignant cancer. The regulation of LSCC progression by long non-coding RNA (lncRNA) was not well understood. In this study, we reported that the lncRNA H19 was upregulated in LSCC. The expression levels of H19 were inversely correlated with the survival rate of LSCC patients. Knockdown of H19 expression inhibited LSCC cell migration, invasion and proliferation. We identified microRNA miR-148a-3p as an inhibitory target for H19. Overexpression of miR-148a-3p reduced LSCC migration, invasion and proliferation cell, while inhibition of miR-148a-3p did the opposite. The inhibition of LSCC progression induced by H19 knockdown required the activity of miR-148a-3p. We also identified DNA methyltransferase enzyme DNMT1 as a target of miR-148a-3p. Cellular DNA methylation levels were inhibited by both miR-148a-3p overexpression and H19 knockdown. In summary, our study demonstrated that the lncRNA H19 promoted LSCC progression via miR-148a-3p and DNMT1.

[Effect of three types of rapid maxillary expansion: a three-dimensional finite element study]

Objective: To evaluate the transverse displacement, stress distribution and tendency of change in tooth, alveolar bone and mid-palatal suture using three kinds of rapid maxillary expansion methods. Methods: Cone-beam CT image data was obtained by scanning skulls of a volunteer. Three-dimensional models of maxillary complex were re-established using Mimics and Geomagic Studio and models of Hyrax expander, Haas expander and miniscrew-assisted rapid palatal expander (MARPE) were established using ANSYS Workbench. Stress distribution, displacement and tendency of change in tooth, alveolar bone and mid-palatal suture were evaluated. Results: Hyrax expander brought 0.105 mm lateral displacement of crown, 0.022 mm mid-palatal suture width increase, wedge opening and clockwise rotation tendency of maxilla. Haas expander created uniform stress distribution, 0.216 mm lateral displacement of crown, and 0.031 mm mid-palatal suture width increase. In MARPE model, the lateral displacement of crown was 0.267 mm, and mid-palatal suture width increased 0.315 mm. The maximum of mid-palatal suture expansion and stress distribution appeared in the middle region, and maxilla had tendency of counterclockwise rotation. Conclusions: The lateral changes of teeth and bones brought by MARPE were the most significant. Haas expander had some advantages in comparison with Hyrax.

[Estimation of External Features of Eyes for the Adult Male of Han Nationality in Northeast China Based on the Characteristics of Skull]

OBJECTIVES

To explore the correlation between the imaging parameters of skull and the external features of eyes.

METHODS

Positive images of the head face and the frontal and lateral X-ray films were obtained from 101 cases of adult males of the Han nationality aged from 20 to 40 years old in Northeast China. The face width （x₁）, upper face width （x₂）, biorbital width （x₃）, all facial height （x₄）, upper facial height （x₅）, maximum breadth of skull （x₆）, minimum breadth of frontal bone （x₇）, orbital widthⅡ（x₈）, anterior interorbital breadth （x₉）, maximum height of skull （x₁₀）, minimum width of nasal bone （x₁₁） and orbital height （x₁₂） were measured and the data were statistically analysed.

RESULTS

Through the linear regression analysis, the regression equations of the presumed inboard canthi （y₁） and outboard canthi distances （y₂） were established, respectively, which were y₁=0.025 x₂+0.291 x₃-0.011 x₇+0.041 x₁₀-0.525（R=0.613, SEE=0.222 cm） and y₂=1.703-0.08 x₂+0.573 x₃-0.142 x₄+0.421 x₅+0.096 x₇-0.256 x₈+0.149 x₉+0.071 x₁₀（R=0.745, SEE=0.341 cm）. The back-substitution check showed that the accuracy rate of two equations at ±1SEE were 75.2% and 80.2%, respectively.

CONCLUSIONS

The established regression equations of external features of eyes have high estimation accuracy, which can be used to the practical work of facial reconstruction.

Does thyroid dysfunction increase the risk of breast cancer? A systematic review and meta-analysis

PURPOSE

To investigate the relationship between hypothyroidism, hyperthyroidism, thyroid hormone replacement, and the risk of breast cancer.

METHODS

We searched the PubMed, Cochrane Library, EMbase, Web of Science, and China Biology Medicine (CBM) databases through June 2016 to identify researches that assessed the relationship between thyroid dysfunction and the risk of breast cancer together with the impact of thyroid hormone substitution treatment on incidence of breast cancer. Quality of evidence was assessed per outcome, using GRADE.

RESULTS

A total of 13 population-based studies including 24,808 participants were identified as eligible for this meta-analysis. A meta-analysis of 12 researches illustrated that hypothyroidism was not related to the risk for breast cancer [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.64-1.08, P = 0.162]. 10 researches illustrated that hyperthyroidism was also not related to the risk of breast cancer (OR = 1.03, 95% CI 0.83-1.30, P = 0.767). The impact of therapy was evaluated in six researches; there was no proof of a relationship between thyroid hormone substitution treatment and breast cancer with an overall OR of 0.83 (95% CI 0.57-1.21, P = 0.965).

CONCLUSIONS

Our meta-analysis illustrated that thyroid dysfunction may not be related to increased risk of breast cancer as well as the thyroid hormone substitution treatment did not reduce the incidence of breast cancer; while this study has some confounders that might weaken the results of this meta-analysis, we believe that the findings provide valuable information for stakeholders concerned with outcomes in patients with thyroid dysfunction.

Vitamin D measurement standardization: The way out of the chaos

Substantial variability is associated with laboratory measurement of serum total 25-hydroxyvitamin D [25(OH)D]. The resulting chaos impedes development of consensus 25(OH)D values to define stages of vitamin D status. As resolving this situation requires standardized measurement of 25(OH)D, the Vitamin D Standardization Program (VDSP) developed methodology to standardize 25(OH)D measurement to the gold standard reference measurement procedures of NIST, Ghent University and CDC. Importantly, VDSP developed protocols for standardizing 25(OH)D values from prior research based on availability of stored serum samples. The effect of such retrospective standardization on prevalence of "low" vitamin D status in national studies reported here for The Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and the German Health Interview and Examination Survey for Children and Adolescents (KIGGS, 2003-2006) was such that in NHANES III 25(OH)D values were lower than original values while higher in KIGGS. In NHANES III the percentage with values below 30, 50 and 75 nmol/L increased from 4% to 6%, 22% to 31% and 55% to 71%, respectively. Whereas in KIGGS after standardization the percentage below 30, 50, and 70 nmol/L decreased from 28% to 13%, 64% to 47% and 87% to 85% respectively. Moreover, in a hypothetical example, depending on whether the 25(OH)D assay was positively or negatively biased by 12%, the 25(OH)D concentration which maximally suppressed PTH could vary from 20 to 35ng/mL. These examples underscore the challenges (perhaps impossibility) of developing vitamin D guidelines using unstandardized 25(OH)D data. Retrospective 25(OH)D standardization can be applied to old studies where stored serum samples exist. As a way forward, we suggest an international effort to identify key prior studies with stored samples for re-analysis and standardization initially to define the 25(OH)D level associated with vitamin D deficiency (rickets/osteomalacia). Subsequent work could focus on defining inadequacy. Finally, examples reported here highlight the importance of suspending publication of meta-analyses based on unstandardized 25(OH)D results.

Quantitative imaging of Candida utilis and its organelles by soft X-ray Nano-CT

Soft X-ray microscopy has excellent characteristics for imaging cells and subcellular structures. In this paper, the yeast strain, Candida utilis, was imaged by soft X-ray microscopy and three-dimensional volumes were reconstructed with the SART-TV method. We performed segmentation on the reconstruction in three dimensions and identified several types of subcellular architecture within the specimen cells based on their linear absorption coefficient (LAC) values. Organelles can be identified by the correlation between the soft X-ray LAC values and the subcellular architectures. Quantitative analyses of the volume ratio of organelles to whole cell in different phases were also carried out according to the three-dimensional datasets. With such excellent features, soft X-ray imaging has a great influence in the field of biological cellular and subcellular research.

[The regulation of CD44 expression by new tumor suppressor gene Arid2 and the influence of Arid2 on the invasion and metastasis in hepatocellular carcinoma cells]

OBJECTIVE

To investigate the effect of a new tumor-suppressor gene Arid2 on the expression level of CD44 and the mechanism that Arid2 regulates the invasion and metastasis in human hepatocellular carcinoma cells HepG2 and Huh7.

METHODS

Recombinant pGL3-CD44 reporter plasmids were transfected into hepatoma cell lines HepG2 and Huh7 cells infected with adenovirus Arid2(Ad-Arid2). Dual luciferase assays were used to determine the relative luciferase activities of reporter plasmids. Western blot technique was used to detect the influence of Arid2 on the expression of transmembrane glycoprotein CD44. Cell migration assays of tumor cells were employed to observe the impact of overexpression of Arid2 on the invasion and metastasis abilities of tumor cells. The sizes of transplanted tumors were recorded to observe the growth of subcutaneous transplanted tumors in nude mice. Statistical significance was analyzed by one-way ANOVA for multiple comparisons, and independent-samples t-test was utilized to compare two groups.

RESULTS

Luciferase assay showed cells were transfected with different length of CD44 reporter plasmids, and their relative luciferase activities were improved to different degrees, compared with pGL3-Basic control. Meanwhile, the mean luciferase activities of pGL3-CD44 -791~+224bp reporter plasmids were significantly repressed by the overexpression of Arid2 which inhibition rates were up to 73.83%±0.92%(P< 0.05, HepG2) or 48.99%±1.37% (P <0.05, Huh7), compared with Ad-GFP control. Western blot results showed that CD44 protein expression was obviously decreased by overexpression of Arid2. Cell migration assays confirmed that the invasion and metastasis abilities were inhibited by increasing Arid2 expression in Human HepG2 or Huh7 cells, which inhibition rates were 66.95%±0.59%(P< 0.05)in HepG2 cells and 73.86%±0.49%(P< 0.05) in Huh7 cells respectively. The animal experiment results indicated that Arid2 could obviously delay or restrict the subcutaneous transplanted tumors growth in nude mice, which was declined by 98.57%±0.34%(P< 0.05).

CONCLUSION

CD44 promoter activities and protein expressions were significantly down-regulated by Arid2 in vitro. The growth and metastasis of tumors were obviously restrained in the hepatocellular carcinoma cells and nude models. In brief, these researches indicate CD44 may play important roles in the process where the invasion and metastasis of hepatocellular carcinoma cells are under the control of Arid2.The studies introduce and evaluate the relationships between Arid2 and CD44, and further provide a new research direction with the occurrence and development of hepatocellular carcinoma.

Overexpression of miR-26b decreases the cisplatin-resistance in laryngeal cancer by targeting ATF2

Cisplatin is a common used chemotherapeutic drug for the treatment of laryngeal cancer. However, drug-resistance is a major obstacle in platinum-based chemotherapy for laryngeal cancer. Recent studies have demonstrated that dysregulation of microRNAs (miRNAs) is responsible for chemoresistance in multiple cancers including laryngeal cancer, but the potential mechanisms are required to be explored. In the present study, we constantly exposed the laryngeal cancer cell line Hep-2 with cisplatin to establish a cisplatin-resistant laryngeal cancer cell model (Hep-2/R). We found that Hep-2/R cells exhibited obvious resistance to cisplatin compared to the Hep-2 cells. However, overexpression of miR-26b significantly decreased the half maximal inhibitory concentration (IC50) of cisplatin to Hep-2/R. Mechanically, miR-26b in Hep-2/R decreased the expression of ATF2, and thus inhibiting the phosphorylation of ATF2 and formation of cellular ATF2-c-Jun complex induced by cisplatin. As the results, Hep-2/R cells failed to overexpress the Bcl-xl which is a key anti-apoptotic protein under the cisplatin treatment. Therefore, overexpression of miR-26b was found to be able to promote mitochondrial apoptosis induced by cisplatin.

[Analysis of survival and treatment outcome of young patients with high-risk diffuse large B cell lymphoma]

Objective: To analyze clinical feature and treatment outcome of young patients with high-risk diffuse large B cell lymphoma. Methods: A total of 122 young patients with high-risk diffuse large B cell lymphoma who were treated in Third Hospital of Peking University during the period from January 2000 to April 2015 were retrospectively analyzed, and the clinical features, laboratory data were included in Kaplan-Meier and prognostic analysis. Results: In our center, the incidence of young high-risk DLBCL was 27.1% in all DLBCL patients, median age was 44.0 years, 99.2% patients belong to Ⅲ and Ⅳstage, 50% patients had more than two extranodal organs involvement, and the higher proliferation index(Ki-67≥80%) was present in 63.1% of patients, Immunohistochemistry showed that 36.7% patients in 30 cases were double-expressed DLBCL. The overall response rate(ORR) for the whole group was 79.4%, the complete response rate was 39.7% , the 3, 5-year progression free survival rate was 59.8% and 57.0%, the 3, 5-year overall survival rate was 63.5% and 57.8%, respectively. 44.3% patients were refractory-relapsed DLBCL. Rituximab can improve the survival of patients and 3-year overall survival rate was 75.2% vs 46.1%(P=0.001). High-dose chemotherapy was superior to CHOP regimen which 3-year overall survival rate was 84.6% vs 54.1%(P=0.006). Compared with chemotherapy group , auto-hematopoietic stem cell transplantation can improve prognosis of patients and 3-year overall survival rate was 93.4% vs 48.3%(P<0.001). The level of Ki-67, B symptom, ECOG score, the level of LDH, WBC and albumin, ESR level, anemia, rituximab therapy, initial regimens, ASCT, initial treatment outcome and refractory-relapsed were predictive of overall survival. Multivariate analysis indicated that albumin level(RR=5.462, P=0.019), initial treatment outcome(RR=34.863, P<0.001) and refractory-relapsed (RR=24.374, P<0.001)were independent prognostic risk factors. Conclusions: Young patients with high-risk DLBCL were highly aggressive in clinical and pathological features . Rituximab and high-dose regimens can improve the survival of patients.

[The clinical signifinace of CEA, Cyfra21-1 and SCC in laryngeal carcinoma's clinicopathological parameters]

Objective:To investigate the clinical signifinace of carcinoembryonic antigen (CEA), cytokeratin fragment 21-1 (Cyfra21-1) or squamous cell carcinoma antigen (SCC) in laryngeal carcinoma's clinicopathological parametersthe.Method:CEA, Cyfra21-1, SCC in 53 laryngeal cancer's serum were routine preoperative detected to analyze the relationships between the tumor makers and the patient's age, primary tumor (T staging), lymph node metastasis (N staging), recurrence and metastasis.Result:According to age less than or equal to 60 years old and older than 60 years, lymph node metastasis or not lymph node metastasis, with or not with recurrence and metastasis and the T1+T2 and T3+T4 staging, the patients were divided into two groups. T test show that CEA was statistically significant in recurrence and metastasis (P= 0.047) and it is more prone to recurrence and metastasis, but CEA was not statistically significant in primary tumor (P= 0.252), lymph node metastasis (P= 0.268). Cyfra21-1 was not statistically significant in primary range (P= 0.402), but was statistically in lymph node metastasis (P= 0.041). While the lymph node metastasis, it is more prone to recurrence and metastasis in laryngeal cancer patients with Cyfra21-1's increasing (P= 0.027). SCC was not significant in primary lesions (P= 0.051),but was statistically significant in lymph node metastasis (P= 0.022). While lymph node metastasis, it is more prone to recurrence and metastasis in laryngeal cancer patients with SCC's increasing (P= 0.000). Logistic multivariate regression analization show that CEA,Cyfra21-1 and SCC were statistically significant in the recurrence and postoperative of laryngeal patients (P< 0.05) but not in the age of patient, primary tumor, the relationship and lymph node metastasis (P> 0.05).Conclusion:It is more prone to occurrence lymph node metastasis and recurrence and metastasis in the postoperative serum of laryngeal cancer patients with Cyfra21-1, SCC. CEA and Cyfra21-1 increasing. SCC were independent predictive factor of recurrence and metastasis after surgery. It is more prone to recurrence and metastasis after surgery in the laryngeal cancer patients with CEA, Cyfra21-1 and SCC preoperative increasing.

sPD-L1 Expression is Associated with Immunosuppression and Infectious Complications in Patients with Acute Pancreatitis

Acute pancreatitis (AP) with infectious complications has high mortality because of early-stage immunosuppression. The programmed cell death-1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway is an important host immunosuppression mechanism. Soluble PD-L1 (sPD-L1) expression regulates co-inhibitory signals in malignancies or autoimmune disorders; however, its effects in AP are unknown. Here, we evaluated whether serum sPD-L1 is involved in immune dysfunction and assessed its relationship with infectious complications in early AP. Blood samples were obtained from 56 patients with acute pancreatitis and 21 healthy individuals in this prospective study. Serum sPD-L1 levels within 48 h after AP onset were tested by enzyme-linked immunosorbent assays. Relevant immune parameters (human leucocyte antigen-DR, lymphocyte count) and inflammatory markers (C-reactive protein, white blood cell count) were analysed. sPD-L1 was significantly upregulated in patients with early AP, especially those with infectious complications, compared to healthy controls. Significant negative correlations were observed among monocyte HLA-DR expression, lymphocyte count and sPD-L1 levels in AP. Multivariate regression indicated that sPD-L1 was an independent risk factor for infectious complications in AP. The findings suggest that increased sPD-L1 expression appears to be involved in the development of immunosuppression in the early stage of AP and that sPD-L1 might be an early parameter for prediction of infectious complications in patients with AP.

Effects of heparin catheter-sealing solution for implantable venous access ports on D-dimer levels in older cancer patients

OBJECTIVE

To investigate the effects of different concentrations of heparin catheter-sealing solution for implantable venous access ports (VAPs) on D-dimers (D-D) in older cancer patients.

PATIENTS AND METHODS

A total of 208 older cancer patients who received intravenous chemotherapy for the first time were randomly divided into four groups: the normal saline group, the low concentration heparin group (25 U/ml), the medium concentration heparin group (50 U/ml), and the high concentration heparin group (75 U/ml), with 52 patients in each group. VAPs were sealed by the positive pressure technique every day before and after perfusion, as well as at the end of a course of chemotherapy when the butterfly needle was removed. The patients were followed-up for three courses of chemotherapy, and comparisons of the clinical effects were conducted.

RESULTS

Before treatment and at the end of follow-up, no significant differences among groups were found in platelet count, prothrombin time, thrombin time, or activated partial thromboplastin time (p>0.05). At the end of follow-up, the high concentration heparin group had reduced fibrinogen (FIB) and increased D-D compared with the other groups, and the differences were statistically significant (p<0.05). The other three groups showed no significant differences in FIB or D-D before treatment or at the end of follow-up (p>0.05). The high concentration heparin group had higher local bleeding rate, while the saline group had higher partial and complete prevalence of blockage compared with the other groups. The differences were statistically significant (p<0.05).

CONCLUSIONS

25-50 U/ml heparin catheter-sealing solution had little effect on blood circulation and coagulation. Additionally, it did not increase the risk of local bleeding or thrombotic blockage.

[Anatomic study and clinical practice of mesopancreas and total mesopancreatic excision]

Objective: To explore the anatomical characteristics of the mesopancreas, to define the range of the total mesopancreas excision and to evaluate the feasibility, safety and effectiveness in the treatment of pancreatic cancer. Methods: A regional anatomical and pathological study was performed on 14 cadavers with large slices and paraffin sections. The clinical and pathological data of 58 consecutive patients underwent total mesopancreas excision for pancreatic head carcinoma from January 2013 to December 2015 were prospectively collected and analysed. The perioperative morbidity, mortality and clinical outcomes of patients underwent total mesopancreas excision were compared with the patients underwent conventional pancreaticoduodenectomy from January 2010 to December 2012. Results: The mesopancreas located in the retropancreatic area, extending from the head, neck, and uncinated process of pancreas to the aorto-caval groove, in which there were loose areolar tissue, adipose tissue, nerve plexus, lymphatic and capillaries. Although no fibrous sheath or fascia like mesocolorectum was found around the structures, a relatively fixed extent could be defined according to its embryologic and anatomic characters. In clinical practice, total mesopancreas excision was classified into two levels according to the extent of resection in this series: level Ⅰ was a"standard total mesopancreas excision" or"total mesopancreas excision in a narrow sense" , which was similar to the extent of standard resection from consensus statement of ISGPS. Level Ⅱ was defined as any procedure extending the range of level Ⅰ, called the"extended total mesopancreas excision" or"total mesopancreas excision in a broad sense". In TMpE group, the intraoperative blood loss( (461.4±184.5)ml vs. (532.2±319.8)ml, P=0.301), operation time( (368.6±92.5)minutes vs. (397.1±112.7)minutes, P=0.559), total complication rate (39.7% vs. 51.2%, P=0.250), fistula mortality (25.9% vs. 30.2%, P=0.628) were all reduced. There were significantly higher R0 rate (91.4% vs.76.7%, P=0.041) and more harvested lymph nodes (16.2 vs. 11.4, P=0.000) and lower total and local recurrence: rate (half-year local recurrence rate: 7.8% vs. 23.7%, P=0.036; one-year local recurrence rate: 18.2% vs. 39.5%, P=0.018) and longer disease-free survival (16.9 months vs. 13.4 months, P=0.044) and overall survival(22.5 months vs. 19.9 months, P>0.05) were also found in the study group. Conclusions: Mesopancreas is different from mesorectum since it has no fascial envelop, which should be regarded as a surgical concept, rather than an anatomical structure. Total mesopancreas excision is safe and feasible for pancreatic head cancer and probably helps to increase the R0 resection rate and improve the clinical outcomes.

The effect of maternal obesity on fatty acid transporter expression and lipid metabolism in the full-term placenta of lean breed swine

This study was conducted to evaluate the influence of back-fat thickness (BF), at mating of sows, on the maternal and newborn circulating lipids, expression of placental fatty acids (FA) transporters and lipid accumulation in placenta. Full-term placentas were obtained by vaginal delivery from BFI (9-14 mm; n = 37), BFII (15-19 mm; n = 43) and BFIII (20-27 mm; n = 38) sows according to BF at mating, and frozen placental sections were analysed for fat accumulation. Blood samples were collected from the sows of day 105 pregnancy and from cord blood at delivery. mRNA and protein expression levels were evaluated with real-time RT-PCR and Western blotting. Our results demonstrated that BFII females had significantly increased litter weight and placental efficiency, decreased maternal triglyceride (TG) and non-esterified fatty acids (NEFA) levels, decreased maternal IL-6, TNFα and leptin levels compared to BFIII females (p < .05). BFIII sows were associated with significantly decreased newborn TG levels, increased newborn glucose, IL-6 and TNFα levels compared to BFI or BFII sows (p < .05). BFI and BFII females had significantly decreased placental TG, NEFA and cholesterol (CHOL) contents compared to BFIII females (p < .05). Moreover, decreased CD36, FATP1, FABP4, and FABP1 mRNA and protein and FATP4 protein expression, and increased LPL activity were also observed in BFIII group compared with BFII group (p < .05). PPARγ mRNA and protein and lipogenic genes such as SREBP-1c, ACSL1, ACCα, FAS and SCD mRNA expression were downregulated or upregulated, respectively, in the placentas of BFIII sows compared to BFI or BFII sows (p < .05). Overall, this study demonstrated that there is no advantage, in terms of litter live size, litter weight and placental FA transport and metabolism, in performing the mating of sows with BF>19 mm.

Abstract S4-02: The Y537S ESR1 mutation is a dominant driver of distant ER-positive breast cancer metastasis

Background: Estrogen receptor (ESR1) mutations occur at a high frequency in metastatic breast tumors in patients treated with hormonal therapy in the metastatic setting. We do not know if these mutations are involved in metastasis.

Experimental design and methods: We generated ESR1 Y537S homozygous mutations using CRISPR Casp-9 technology. Treatment synergy was evaluated using Compusyn. Athymic mice were used in tumor xenograft studies. ChIP-Seq and transcriptome analyses were performed.

Results: We generated CRISPR ESR1 Y537S mutation homozygous knock-in clones and lentiviral stable pools in MCF-7 cells. Transcriptome profiling revealed elevated expression of Hallmark pathways, including EMT and estrogen-regulated gene expression. The EMT in mutant cells was associated with a switch from E-cadherin to vimentin, and increased expression of SNAIL and TWIST. Mutant cell growth was resistant to tamoxifen, but responsive to fulvestrant treatment. Synergistic treatment effects were observed with fulvestrant and everolimus or palbociclib. CRISPR Y537S mutant knock-in cells grown in the mammary fat-pad of athymic mice spontaneously metastasized to distant organs including the lung, intestine, and kidneys. In the presence of estrogen, there was no difference in the frequency of distant macrometastases between parental wild-type ER and CRISPR Y537S mutant ER mice. However, in the absence of estrogen, 80% of CRISPR Y537S mutant ER mice displayed overt distant macrometastases, but none were observed in parental wild-type ER mice (p=0.04). Interestingly, although CRISPR Y537S mutant ER tumors grown in the mammary fat-pad were unresponsive to tamoxifen treatment, tamoxifen significantly inhibited the growth of mutant tumors at the distant microenvironment (8-fold). Distant tumors retained ER expression and hormone sensitivity. Comparison of residual tamoxifen-treated metastatic tumors with tumors grown at the primary mammary fat-pad site using immunoblot analysis demonstrated significant reduction in estrogen-regulated gene expression, but no effect on the expression of biomarkers associated with EMT, suggesting a disconnect between EMT and distant metastasis in mutant cells. EMT genes were also identified as direct binding site targets in Y537S mutant cells compared with wide-type ER using ChIPSeq. We discovered that expression of the Y537S mutant was dominant, driving the growth of distant metastatic tumors when co-expressed with wild-type ER cells. A Y537S ER mutant-specific gene expression signature predicted poor disease-free survival of ER-positive patients using the METABRIC database, and lung-specific metastasis-free survival in a Memorial Sloan Kettering dataset.

Conclusion: The Y537S ER mutation is a driver of distant metastasis in ER-positive breast cancer cells. Although tamoxifen treatment was ineffective at reducing the growth of mutant cells grown at the primary site, it was effective at reducing distant metastasis. A Y537S ER mutant-specific gene expression signature predicted poor disease-free, and distant lung metastasis in ER-positive patients. Mutation status is a potential new predictive factor for hormone therapy of metastatic breast cancer patients on maintenance hormonal therapy.

Citation Format: Fuqua SAW, Gu G, Rechoum Y, Gelsomino L, Dustin DJ, Corona-Rodriguez A, Beyer AR, Pejerrey SM, Gao M, Tsimelzon A, Tian L, Zhang X, Nagi C, Ando' S. The Y537S ESR1 mutation is a dominant driver of distant ER-positive breast cancer metastasis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S4-02.

Novel folliculin (FLCN) mutation and familial spontaneous pneumothorax

BACKGROUND

Familial spontaneous pneumothorax is one of the characteristics of Birt-Hogg-Dubé syndrome (BHDS), which is an autosomal dominant disease caused by the mutation of folliculin (FLCN).

AIM

To investigate the mutation of FLCN gene in a familial spontaneous pneumothorax.

DESIGN

Prospective case study.

METHODS

Clinical and genetic data of a Chinese family with four patients who presented spontaneous pneumothorax in the absence of skin lesions or renal tumors were collected. CT scan of patient's lung was applied for observation of pneumothorax. DNA sequencing of the coding exons (4-14 exons) of FLCN was performed for all 11 members of the family and 100 unrelated healthy controls.

RESULTS

CT scan of patient's lung showed spontaneous pneumothorax. A mutation (c. 510C > G) that leads to a premature stop codon (p. Y170X) was found in the proband using DNA sequencing of coding exons (4-14 exons) of FLCN. This mutation was also observed in the other affected members of the family.

CONCLUSIONS

A nonsense mutation of FLCN was found in a spontaneous pneumothorax family. Our results expand the mutational spectrum of FLCN in patients with BHDS.

Characteristics and computed tomography evaluation of primary retroperitoneal tumours: report of 113 cases

INTRODUCTION Benign and malignant primary retroperitoneal tumours (PRT) have different clinical manifestations and pathological characteristics. We explore the characteristics and evaluate the value of computed tomography (CT) for PRT. METHODS Fifty-six benign and fifty-seven malignant PRT with clinical, radiographic and surgical data were retrospectively investigated. Statistical analysis was carried out using SPSS software. RESULTS We found that mean size of benign tumours was 12.4 ± 7.7cm but 20.7 ± 11.6cm in malignant cases (P < 0.05). The accuracy of CT localisation was approximately 70%. The sensitivity and specificity of CT diagnosis for benign tumours were 96% and 85%, respectively; 51 (91%) underwent complete resection among benign cases but 42 (74%) in malignant cases (P < 0.05). Sensitivity of CT evaluation for invaded organs and vessels was 50% and 65%, respectively, and specificity was 88% and 81%, respectively. CONCLUSIONS Large size, no capsule, irregular margin, heterogeneous density and specific enhancement pattern on CT are highly suggestive of malignancy. CT is the most useful tool in assessing the size and characteristics of PRT but it does not have the sensitivity to assess the involvement of organs and vessels.

Analyzing Growth-Management Policies with Geographical Information Systems

It has been argued that urban sprawl leads to inefficient land-use patterns with leapfrogging and low-density development in the urban fringe. Communities can implement a number of growth-management programs to encourage more efficient and environmentally sound development patterns. However, a long time period is needed to monitor the progress of growth-management techniques and to determine if they have achieved the intended effects. Unfortunately, urban development is mostly an irreversible process that leaves no room for experiment. As a result, we use GIS to simulate the impact of various growth-management policies on future land-development patterns in Portage County, Ohio. A comprehensive database and population growth forecasts are compiled to support the GIS analyses that generate a set of alternative residential growth scenarios. As a spatial decision support system, the GIS is found to be an efficient tool to simulate the form and process of development for detailed assessment and planning. As an educational tool, development simulation with GIS allows the generation of alternative scenarios to help citizens and local officials make sound planning decisions today, define future policies, and plan for new growth.

Enucleation versus hepatectomy for giant hepatic haemangiomas: a meta-analysis

INTRODUCTION Hepatic haemangiomas are the most common benign liver tumours. They can be treated with surgical resection such as enucleation or hepatectomy if necessary. However, controversy remains over the clinical outcome and safety of these two methods. In this study, we performed a comprehensive meta-analysis to compare the efficacy of liver resection with enucleation for giant haemangiomas. METHODS The online databases PubMed, Embase and CNKI (China National Knowledge Infrastructure) were searched for relevant original articles. We compared operation time, blood loss, transfusion requirements, inflow occlusion time and postoperative complications between enucleation and hepatectomy. RESULTS Seven controlled clinical trials met the predefined inclusion criteria. Analysis indicated that the enucleation group had significantly shorter operation time (weighted mean difference, WMD -28.22, 95% confidence interval, CI, -54.82 to -1.62), less blood loss (WMD -395.92, 95% CI -521.25 to -270.58) and fewer complications (odds ratio, OR, 0.47, 95 % CI 0.34 to 0.65). There were no significant differences between enucleation and hepatectomy with regard to transfusion requirements (OR 0.61, 95% CI 0.22 to 1.68) and inflow occlusion time (WMD 7.91, 95% CI -5.62 to 21.44). CONCLUSIONS Enucleation has advantages over hepatectomy in relation to operation time, blood loss and complications. Enucleation is a safe and effective treatment for giant hepatic haemangioma.

The protective effects of bone morphogenetic protein-7 against epithelial injury and matrix metalloproteases upregulation induced by silica in vitro

OBJECTIVE

We investigate the effects of bone morphogenetic protein-7 (BMP-7) on models with silica-induced and macrophage-mediated fibrosis and its possible mechanisms in vitro.

METHODS

Rat alveolar II epithelial (RLE-6TN) cells were incubated with the supernatant of mouse macrophage-like cells (RAW264.7) and treated with 0, 25, 50, and 100 μg/mL silica. Using Western blotting, the epithelial markers (surfactant proteins-C and E-cadherin) and the mesenchymal markers (fibronectin (FN) and viminten (Vim)) were detected. After neutralizing the BMP-7, the progress of fibrosis was assessed by the content of hydroxyproline (Hyp) and collagen I, III protein levels as well as the Smad signaling pathway proteins, including phosphorylated Smad1/5(P-Smad1/5) and phosphorylated Smad2/3(P-Smad2/3). Collagen I was also identified by immunofluorescence and pretreated with SB-431542, LDN-193189, or anti-BMP-7-neutralizing antibody. In addition, the levels of matrix metalloproteinase-2 (MMP-2) and MMP-9 were detected using Western blotting.

RESULTS

The model of RLE-6TN cells was established successfully, the expressions of Vim, FN, MMP-2, and MMP-9 were upregulated, while the concentration of silica is increased. Neutralizing BMP-7 stimulated the decrease of P-Smad1/5 and the increase of P-Smad2/3, as well as the collagen I, collagen III, FN, and Hyp via Smad signaling pathway. Furthermore, pretreated with LDN-193189 or anti-BMP-7-neutralizing antibody, the expression of collagen I was increased, yet it was decreased with SB-431542 intervention.

CONCLUSION

The activated BMP/Smad and suppressed transforming growth factor-β/Smad pathways could suppress silica-induced fibrosis via a MMP-dependent mechanism. BMP-7 is expected to be the optimized strategy of delaying the interstitial changes.