The Ca2+ -regulated protein kinase CIPK1 integrates plant responses to phosphate deficiency in Arabidopsis thaliana

Phosphate (Pi) deficiency severely restricts plant growth and development, as Pi is an essential macronutrient. Calcium (Ca²⁺ ) is a ubiquitous second messenger in plants; calcineurin B-like proteins (CBL) and CBL-interacting protein kinases (CIPK) are signalling pathways that act as an important Ca²⁺ signalling network which integrates plants to fine tune the response to stress; however, whether CIPK are involved in Pi deficiency stress remains largely unknown. In this study, we carried out a reverse genetic strategy to screen T-DNA insertion mutants of CIPK isoforms under Pi deficiency in Arabidopsis thaliana. Then Pi content, transcription of phosphate starvation-induced (PSI) genes, acid phosphatase activity and hydrogen peroxide were determined in the wild-type (WT) and cipk1 mutant, respectively. The phenotype of CIPK1 complementation lines was analysed. The cipk1 mutant had a more sensitive phenotype, with lower root elongation and root length, and decreased Pi content compared with the WT under Pi deficiency. Moreover, CIPK1 mutation caused phosphate starvation-induced (PSI) genes to be significantly induced under Pi deficiency. Histological staining demonstrated that the cipk1 mutant had increased acid phosphatase activity and hydrogen peroxide concentration under Pi deficiency. By using the yeast two-hybrid system, we further demonstrated the interaction between CIPK1 and the WRKY transcription factors, WRKY6 and WRKY42. Overall, we demonstrate that CIPK1 is involved in the Pi deficiency signalling pathway in A. thaliana, revealing the important role of Ca²⁺ in the Pi nutrition signalling pathway, and potentially providing a theoretical foundation for molecular breeding of crops with better Pi utilization efficiency.

A Food and Drug Administration analysis of survival outcomes comparing the Adjuvant Paclitaxel and Trastuzumab trial with an external control from historical clinical trials

BACKGROUND

Although the Adjuvant Paclitaxel and Trastuzumab (APT) trial has been adopted clinically, single-arm trials have limitations, and interest remains whether these patients with small node-negative human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (EBC) would benefit from more intensive chemotherapy. This analysis explored whether external controls can contextualize single-arm studies to add to clinical decision making in the use of de-escalated therapy in patients with low-risk HER2-positive EBC.

PATIENTS AND METHODS

Patient-level data from five randomized trials supporting drug approval in adjuvant HER2-positive EBC were pooled, and patients with low-risk EBC were selected (n = 1770). Patients treated concurrently with trastuzumab and either anthracycline/cyclophosphamide/taxane/trastuzumab (ACTH) or taxane/carboplatin/trastuzumab (TCH; n = 1366) were matched (1:1) to patients treated with paclitaxel and trastuzumab (TH) in the APT trial (n = 406) using propensity scores. Patients treated with anthracycline/cyclophosphamide/taxane (ACT; n = 374) were also matched (1:1) to those treated with TH. Propensity scores were estimated using covariates of age, tumor stage, estrogen receptor status, progesterone receptor status, and histological grade.

RESULTS

After matching, the estimated probabilities of invasive disease-free survival (iDFS) at 3 and 5 years were 98.6% and 96.5% in the TH arm, and 96.6% and 92.9% in the ACTH/TCH arm, respectively. The estimated probabilities of overall survival (OS) at 3 and 5 years were 99.7% and 99.3% in the TH arm, and 99.0% and 97.4% in the ACTH/TCH arm, respectively. Comparing the TH arm with the ACT arm in the matched sample, the estimated difference in iDFS was 7.5% (TH 98.8% and ACT 91.3%) at 3 years and 12.6% (TH 96.1% and ACT 83.5%) at 5 years. The estimated difference in OS was 2.6% (TH 100% and ACT 97.4%) at 3 years, and 5.3% (TH 99.3% and ACT 94.0%) at 5 years.

CONCLUSIONS

Our analyses suggest that patients' outcomes in both arms were in general similar, thus providing additional reassurance regarding de-escalation of therapy.

Comparative risk-benefit profiles of different femoral drilling techniques in anterior cruciate ligament reconstruction: A protocol for a systematic review and network meta-analysis

BACKGROUND

Anterior cruciate ligament (ACL) injury experiences about 200,000 isolated cases annually, and ACL reconstruction has become the gold standard for the restoration of stability and functionality. In view of that incorrect graft placement is a common cause of ACL reconstruction failure, it is critically important to ensure that the tibial and femoral tunnels are properly placed during the operation. Therefore, we intend to conduct a network meta-analysis to comparatively evaluate the clinical outcomes among the different surgical techniques in ACL reconstruction.

METHODS

Embase, PubMed, and Cochrane Library will be searched through to retrieve the relevant literature up to April 2020. The outcomes include the International Knee Documentation Committee subjective/objective score, Lachman test, Lysholm score, laxity of knee joint, pivot-shift test, Tegner activity scale, and the number of adverse events. A Bayesian hierarchical framework will be used to evaluate the comparative efficacy among different fixation devices. Cochrane Q test and I statistics will be applied to evaluate the heterogeneity, and the Cochrane risk of bias assessment tool will be employed to evaluate the study quality and the risk of bias.

RESULTS

The comparative risk-benefit profiles of different femoral drilling techniques will be evaluated based on the existing evidence, in order to summarize a prioritization regimen.

CONCLUSION

Findings from this network meta-analysis will provide useful reference to patients, surgeons, and guideline makers in the related fields.

REGISTRATION

Open Science Framework (OSF) Preregistration. April 20, 2020. osf.io/uzahs.

Associations of serum iron and ferritin with hyperuricemia and serum uric acid

OBJECTIVES

To assess the serum iron and ferritin levels in relation to the prevalence of hyperuricemia (HU) and the serum uric acid (SUA) level.

METHODS

Serum iron and ferritin concentrations were detected by Ferene method and chemiluminescence method, respectively. SUA level was detected by uricase-PAP method. HU was defined as SUA ≥ 416 μmol/L for male and ≥ 357 μmol/L for female. Multivariable-adjusted logistic regressions were constructed to investigate the associations between serum iron/ferritin levels and prevalence of HU. Pearson correlation analysis and multivariable linear regression were performed to examine the correlations between serum iron/ferritin levels and SUA level.

RESULTS

A total of 2824 subjects (mean age 52.2 ± 7.2) were included. The overall prevalence of HU was 17.3%. Compared with the lowest quartile, the multivariable-adjusted odds ratios (OR) and its 95% confidence interval (CI) of HU were 1.33 (95%CI 0.97-1.82), 1.17 (95%CI 0.85-1.60), and 1.56 (95%CI 1.14-2.13) in the second, third, and fourth quartiles of serum iron, respectively (P for trend = 0.012), and were 1.29 (95%CI 0.89-1.88) in the second, 2.13 (95%CI 1.47-3.07) in the third, and 2.25 (95%CI 1.54-3.29) in the fourth quartile of serum ferritin (P for trend < 0.001). Pearson correlation coefficient indicated a weak positive correlation between serum iron (r = 0.2, P < 0.001) and ferritin (r = 0.3, P < 0.001) levels and SUA. Such positive correlations were further confirmed by multiple linear regression (serum iron: standardized β = 0.059, P < 0.001; serum ferritin: standardized β = 0.061, P = 0.001).

CONCLUSIONS

Both serum iron and ferritin showed a positive correlation with the prevalence of HU, and a weak positive correlation with SUA level. Key Points • Subjects with higher levels of serum iron or ferritin had higher prevalence of HU. • There was a weak positive correlation between serum iron/ferritin levels and SUA level.

Association between serum zinc and copper concentrations and copper/zinc ratio with the prevalence of knee chondrocalcinosis: a cross-sectional study

Background

Patients with chondrocalcinosis may suffer from a series of symptoms resembling acute gouty arthritis or septic arthritis, but the aetiology and pathogenesis of chondrocalcinosis have not been fully elucidated yet. This study was aimed to assess serum zinc and copper concentrations, as well as the ratio of serum copper to zinc concentrations (Cu/Zn ratio), in relation to the prevalence of knee chondrocalcinosis.

Methods

Data included in this analysis were retrieved from a large population-based cross-sectional study. A bilateral knee anteroposterior radiograph was obtained from each subject. Radiographic knee chondrocalcinosis was diagnosed if definite linear cartilage calcification was detected. Serum zinc and copper concentrations were measured using the spectrophotometric flow injection methods by Roche modular P800. The relations of serum zinc and copper concentrations and Cu/Zn ratio to the prevalence of knee chondrocalcinosis were examined using generalized estimating equations, respectively.

Results

The prevalence of knee chondrocalcinosis was 1.2% in the sample of this study (n = 12,362). In comparison with the lowest tertile, the odds ratios (ORs) of knee chondrocalcinosis adjusted by age, sex and body mass index were 0.74 (95% CI 0.50–1.09) in the second and 0.56 (95% CI 0.36–0.86) in the third tertiles of serum zinc concentrations (P for trend = 0.009), were 1.26 (95% CI 0.77–2.05) in the second and 2.01 (95% CI 1.25–3.24) in the third tertile of serum copper concentrations (P for trend = 0.003), and were 1.02 (95% CI 0.61–1.69) in the second and 2.23 (95% CI 1.38–3.59) in the third tertile of Cu/Zn ratio (P for trend < 0.001) respectively. These findings were not materially altered by adjustment for potential confounders.

Conclusions

The present study observed that higher serum zinc concentrations, lower serum copper concentrations or lower Cu/Zn ratio are associated with a lower prevalence of knee chondrocalcinosis in a dose-response relationship manner.

Association between dietary selenium intake and the prevalence of osteoporosis: a cross-sectional study

Objective

To examine the correlation between dietary selenium (Se) intake and the prevalence of osteoporosis (OP) in the general middle-aged and older population in China.

Methods

Data for analyses were collected from a population based cross-sectional study performed at the Xiangya Hospital Health Management Centre. Dietary Se intake was evaluated using a validated semi-quantitative food frequency questionnaire. OP was diagnosed on the basis of bone mineral density scans using a compact radiographic absorptiometry system. The correlation between dietary Se intake and the prevalence of OP was primarily examined by multivariable logistic regression.

Results

This cross-sectional study included a total of 6267 subjects (mean age: 52.2 ± 7.4 years; 42% women), and the prevalence of OP among the included subjects was 9.6% (2.3% in men and 19.7% in women). Compared with the lowest quartile, the energy intake, age, gender and body mass index (BMI)-adjusted odds ratios of OP were 0.72 (95% confidence interval [CI] 0.55–0.94), 0.72 (95% CI 0.51–1.01) and 0.47 (95% CI 0.31–0.73) for the second, third and fourth quartiles of dietary Se intake, respectively (P for trend = 0.001). The results remained consistent in male and female subjects. Adjustment for additional potential confounders (i.e., smoking status, drinking status, physical activity level, nutritional supplements, diabetes, hypertension, fibre intake, and calcium intake) did not cause substantial changes to the results.

Conclusions

In the middle-aged and older humans, participants with lower levels of dietary Se intake have a higher prevalence of OP in a dose-response manner.

Association of high-sensitivity C-reactive protein in middle-aged and elderly Chinese people with hyperuricaemia and risk of coronary heart disease: a cross-sectional study

OBJECTIVES

Patients with hyperuricaemia are at relatively high risk of developing coronary heart disease (CHD). The purpose of this study was to examine the relationship between high-sensitivity C-reactive protein (hs-CRP) and CHD risk in a middle-aged and elderly population with hyperuricaemia.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

This study was conducted in a health examination centre of China. Participants were diagnosed with hyperuricaemia based on uric acid concentrations. Specifically, males with a uric acid concentration ≥416 μmol/L were included, as well as females with a concentration ≥360 μmol/L.

MAIN OUTCOME MEASURES

10-year CHD risk for each individual was evaluated using Framingham risk score based on the Adult Treatment Panel III charts.

RESULTS

A total of 517 patients with hyperuricaemia (438 males and 79 females) aged from 40 to 85 years old were included in the present study. 193 (37.3%) patients were defined with relatively high 10-year CHD risk. Compared with the lowest quintile, the crude ORs of relatively high 10-year CHD risks were 1.43 (95% CI 0.78 to 2.63, p=0.245), 2.05 (95% CI 1.14 to 3.67, p=0.016), 2.77 (95% CI 1.54 to 4.98, p=0.001), 2.12 (95% CI 1.18 to 3.80, p=0.012) in the second, third, fourth and fifth quintiles of serum hs-CRP level, respectively (p for trend=0.057). The multivariable-adjusted ORs of relatively high 10-year CHD risk were 1.40 (95% CI 0.75 to 2.61, p=0.291) in the second, 2.05 (95% CI 1.13 to 3.72, p=0.019) in the third, 2.69 (95% CI 1.47 to 4.89, p=0.001) in the fourth and 2.10 (95% CI 1.15 to 3.84, p=0.016) in the fifth quintile of serum hs-CRP level when compared with the lowest quintile (p for trend=0.068).

CONCLUSION

This study showed that ORs of relatively high 10-year CHD risk were raised in patients with hyperuricaemia with higher serum hs-CRP level; however, there was a not significant but borderline trend association and that more research is needed.

In-hospital mortality after hip arthroplasty in China

Aims

There is an increasing demand for hip arthroplasty in China. We aimed to describe trends in in-hospital mortality after this procedure in China and to examine the potential risk factors.

Patients and Methods

We included 210 450 patients undergoing primary hip arthroplasty registered in the Hospital Quality Monitoring System in China between 2013 and 2016. In-hospital mortality after hip arthroplasty and its relation to potential risk factors were assessed using multivariable Poisson regression.

Results

During the study period, 626 inpatient deaths occurred within 30 days after hip arthroplasty. Mortality decreased from 2.9% in 2013 to 2.6% in 2016 (p for trend = 0.02). Compared with their counterparts, old age, male sex, and divorced or widowed patients had a higher rate of mortality (all p < 0.05). Risk ratio (RR) for mortality after arthroplasty for fracture was two-fold higher (RR 2.0, 95% confidence interval (CI) 1.5 to 2.6) than that for chronic disease. RRs for mortality were 3.3 (95% CI 2.7 to 3.9) and 8.2 (95% CI 6.5 to 10.4) for patients with Charlson Comorbidity Index (CCI) of 1 to 2 and CCI ≥ 3, respectively, compared with patients with CCI of 0. The rate of mortality varied according to geographical region, the lowest being in the East region (1.8%), followed by Beijing (2.1%), the North (2.9%), South-West (3.6%), South-Central (3.8%), North-East (4.1%), and North-West (5.2%) regions.

Conclusion

While in-hospital mortality after hip arthroplasty in China appears low and declined during the study period, discrepancies in mortality after this procedure exist according to sociodemographic factors. Healthcare resources should be allocated more to underdeveloped regions to further reduce mortality. Cite this article: Bone Joint J 2019;101-B:1209–1217

Association between dietary iron intake and the prevalence of nonalcoholic fatty liver disease: A cross-sectional study

The aim was to test the association between dietary iron intake and the prevalence of nonalcoholic fatty liver disease (NAFLD) in a large sample of middle-aged and elderly Chinese population.The data included in this analysis were collected from a population-based cross-sectional study, that is, the Xiangya Hospital Health Management Center Study. Dietary iron intake was assessed using a validated semiquantitative food frequency questionnaire. The relationship between dietary iron intake and the prevalence of NAFLD was examined using logistic and spline regressions.A cross-sectional study including 5445 subjects was conducted. The prevalence of NAFLD was 36.9%. Compared with the lowest quintile, the energy-adjusted odds ratios (ORs) of NAFLD were 1.33 (95% confidence interval [CI]: 1.07-1.64), 1.80 (95% CI: 1.41-2.29) and 2.11 (95% CI: 1.60-2.80) in the 3rd, 4th, and 5th quintile of iron intake, respectively (P-value for trend <.001). In addition, dietary iron intake was positively associated with the OR of NAFLD in a dose-response relationship manner (test for trend P < .001). However, after stratifying the data by gender, such association only remained in the male, but not in the female population. With adjustment of additional potential confounders, the results did not change materially.Subjects with higher dietary iron intake were subject to a higher prevalence of NAFLD in a dose-response relationship manner. However, such association probably only exists in males, but not in females.

Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies

OBJECTIVE

To examine the analgesic efficacy and safety of ketamine after total knee or hip arthroplasty.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, EMBASE and Cochrane Library from inception to 22 May 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials comparing the efficacy and safety of ketamine with placebo for postoperative pain relief in patients undergoing total knee or hip arthroplasty.

DATA EXTRACTION AND SYNTHESIS

Data (ie, pain intensity, morphine consumption, gastrointestinal and psychotic adverse effects) were extracted by two reviewers independently. The Cochrane Collaboration's recommended tool was used to determine the methodological quality of included studies.

RESULTS

A total of 10 studies were included. One of them was rated as low quality. Compared with placebo, intravenous ketamine was effective for pain relief during 0-8-hour (weighted mean difference (WMD) -1.21, 95% CI -1.45 to -0.98, p<0.001; three studies, 149 participants) but not during 8-24-hour postoperative periods, and effective for reduction of cumulative morphine consumption during both 0-24-hour (WMD -17.76, 95% CI -31.25 to -4.27, p=0.01; five studies, 366 participants) and 0-48-hour (WMD -21.79, 95% CI -25.46 to -18.11, p<0.001; four studies, 252 participants) postoperative periods, without increasing risks of gastrointestinal or psychotic adverse effects. The limited data available for intra-articular (WMD -0.49, 95% CI -0.70 to -0.29, p<0.001; two studies, 83 participants) and epidural (WMD -2.10, 95% CI -3.30 to -0.90, p<0.001; one study, 20 participants) ketamine pointed to a significant reduction in pain intensity during 8-24-hour postoperative period.

CONCLUSIONS

Intravenous administration of ketamine is effective and safe for postoperative pain relief in patients undergoing total knee or hip arthroplasty. Nevertheless, the analgesic efficacy and safety of ketamine in such patients seem to vary by different administration routes and still warrant further studies to explore.

Association Between Dietary Selenium Intake and the Prevalence of Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study

Objective: The aim was to examine the association between dietary selenium intake and nonalcoholic fatty liver disease (NAFLD) in a large group of middle-aged and elderly Chinese persons.Method: The data included in this analysis were from a population-based study, the Xiangya Hospital Health Management Center Study. NAFLD was diagnosed by (1) imaging or histological evidence of hepatic steatosis; (2) absence of specific etiologies of NAFLD; and (3) no heavy consumption of alcohol. Dietary selenium intake was assessed using a validated semi-quantitative food frequency questionnaire. The association between dietary selenium intake and the prevalence of NAFLD was evaluated using logistic and spline regression in a cross-sectional study of 5436 subjects.Results: The prevalence of NAFLD was 36.8%. Compared with the lowest quintile, the energy-adjusted odds ratios for NAFLD were 1.27 (95% confidence interval [CI], 1.07-1.52), 1.30 (95% CI, 1.09-1.55), and 1.58 (95% CI, 1.33-1.89) for the third, fourth, and fifth quintiles of selenium intake, respectively, and there was a positive dose-response relationship (r = 0.88, p for trend = 0.008). Similar results were observed for men and women separately. The findings were not materially altered by adjustment for potential confounders (i.e., age, gender, body mass index, smoking status, diabetes, hypertension, activity level, nutritional supplements, energy intake, fat intake, fiber intake, cholesterol and saturated fatty acid intake).Conclusions: In this middle-aged and elderly population, subjects with higher dietary selenium intake, even below the recommended nutrient intake in China, had higher prevalence of NAFLD in a dose-response relationship manner.

Association between chondrocalcinosis and osteoarthritis: A systematic review and meta-analysis

AIM

To systematically examine the existing literature on the associations between chondrocalcinosis (CC) and osteoarthritis (OA) at different joints, and to quantify such associations through meta-analysis.

METHODS

PubMed, Embase and Scopus databases were searched through from inception to June 2017. Cohort, case-control or cross-sectional studies were included if they examined the association between CC and OA. Data on the odds ratios (OR) and their 95% confidence intervals (CI) of the prevalence or progression of OA between the CC group and non-CC group with respect to the same joint were extracted.

RESULTS

A total of 14 studies were identified. Twelve studies were eligible for assessing the association between knee CC and knee OA. The combined data showed a positive association between them (OR = 2.84; 95% CI, 2.12-3.81; P < 0.001). Three studies were eligible for assessing the association between hip CC and hip OA. The data on the OR could only be extracted from one study (OR = 0.92; 95% CI, 0.68-1.24; P = 0.59). Two studies were eligible for assessing the association between hand CC and hand OA, and the data on the OR could only be extracted from one study which reported significant associations between CC and OA at the metacarpophalangeal joint (OR = 4.75; 95% CI, 2.12-10.64; P < 0.001) and the wrist joint (OR = 4.44; 95% CI, 3.56-5.54; P < 0.001).

CONCLUSION

This study established a strong association between knee CC and knee OA. However, the associations between CC and OA at the hip or hand still remain controversial and warrant further study.

Dose-response relationship between higher serum calcium level and higher prevalence of hyperuricemia: A cross-sectional study

The aim of the study was to examine the relationship between serum calcium (Ca) levels and the prevalence of hyperuricemia (HU).The data included in this analysis were extracted from a population-based study conducted at the Xiangya Hospital Health Management Centre. Serum Ca levels were measured using the Arsenazo III method. HU was defined as the uric acid ≥416 μmol/L for male subjects, and ≥360 μmol/L for female subjects. The association between serum Ca levels and the prevalence of HU was evaluated using logistic and spline regression.The present study included a total of 6337 subjects. The overall prevalence of HU for the target population was 17.5%. Compared with the lowest quintile, the odds ratios adjusted by age, sex, body mass index, smoking, and drinking for HU were 1.51 [95% confidence interval (CI): 1.20-1.91], 1.43 (95% CI: 1.13-1.82), 2.02 (95% CI: 1.61-2.54), and 2.54 (95% CI: 2.02-3.18) for the second, third, fourth, and fifth quintiles of serum Ca levels, respectively (P for trend <.001), and a positive dose-response relationship was observed. Similar results were observed for men and women, respectively. The findings were not materially altered by the adjustment for further potential confounders.Subjects with higher serum Ca levels are subject to a higher prevalence of HU in a dose-response relationship manner.

Abstract P4-04-11: A small amount of primary breast cancer shows high tumor mutation burden that may benefit from immune checkpoint inhibitor therapy

Background: Targeted therapy using immune checkpoint inhibitors (ICIs) is a major breakthrough in cancer treatment in the last decade. ICIs like PD1 or PD-L1 antibodies have been shown to be quite effective in cancer like melanoma. However, in most other tumor types including breast cancer, the situation is not as optimistic. Only a small percentage of those patients respond to ICIs therapy. This highlights the importance of identifying biomarkers to predict which patients may benefit from such treatment. Tumor Mutation Burden (TMB) has been shown to be a sensitive marker for ICI treatment. This study is to investigate whether TBM could be used as a biomarker for breast cancer treatment.

Methods: We reviewed next generation sequencing studies of breast cancer. Two such studies with raw data provided were included in our analysis. One study entitled METABRIC performed targeted sequencing of 173 cancer-related genes in around 2500 primary breast cancer tissues. The other study was from TCGA breast cancer project, which performed Whole Exome Sequencing (WES) of around 1000 primary breast cancer samples. Mutation data were downloaded from public data deposit. The number of mutations per sample was calculated. TBM was calculated by divide the coverage in million base pair from that of the total mutation counts.

Results: In METABRIC study, 17272 mutations were identified in 2369 samples, with a median of 7 mutations per sample (95% CI: 6 ˜ 7). The median TMB of METABRIC dataset was 5.8 SNVs/Mb (95% CI: 5 ˜ 5.8). Totally 30 out 2369 (1.3%) samples had a TMB equal or large than 20 SNVs/Mb. In another cohort from TCGA breast cancer study using WES technology, 90172 mutations were identified in 977 samples, with a median of 44 mutations per sample (95% CI: 39 ˜ 50). The median TMB was 1 SNVs/Mb (95% CI: 0.9 ˜ 1.1). Totally 13 out 977 (1.3%) samples had a TMB equal or large than 20 SNVs/Mb.

Conclusions: Breast cancer shows middle to low mutation burden compared to other cancer types. Around 1.3% of breast cancer has quite high TMB of at least 20 SNVs/Mb, which may be qualified for immune checkpoint inhibitors therapy. Our study indicates that TMB may be incorporated as a standard test for late stage breast cancer patients in the clinical practice.

Keywords: Breast cancer, Tumor Mutation Burden, Whole exome sequencing, Targeted sequencing, Immune checkpoint

Citation Format: Wang J, Chen W, Jiang Z, Lin X, Qin T, Yang X, Liu T, Hu H, Li Z, Xie D, Yao H, Song E. A small amount of primary breast cancer shows high tumor mutation burden that may benefit from immune checkpoint inhibitor therapy [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 P4-04-11.

Efficacy and safety of the pulsed electromagnetic field in osteoarthritis: a meta-analysis

OBJECTIVE

To investigate the efficacy and safety of the pulsed electromagnetic field (PEMF) therapy in treating osteoarthritis (OA).

DESIGN

Meta-analysis.

DATA SOURCES

PubMed, Embase, the Cochrane Library and Web of Science were searched through 13 October 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials compared the efficacy of PEMF therapy with sham control in patients with OA.

DATA EXTRACTION AND SYNTHESIS

Pain, function, adverse effects and characteristics of participants were extracted. RevMan V.5.2 was used to perform statistical analyses.

RESULTS

Twelve trials were included, among which ten trials involved knee OA, two involved cervical OA and one involved hand OA. The PEMF group showed more significant pain alleviation than the sham group in knee OA (standardised mean differences (SMD)=-0.54, 95% CI -1.04 to -0.04, p=0.03) and hand OA (SMD=-2.85, 95% CI -3.65 to -2.04, p<0.00001), but not in cervical OA. Similarly, comparing with the sham-control treatment, significant function improvement was observed in the PEMF group in both knee and hand OA patients (SMD=-0.34, 95% CI -0.53 to -0.14, p=0.0006, and SMD=-1.49, 95% CI -2.12 to -0.86, p<0.00001, respectively), but not in patients with cervical OA. Sensitivity analyses suggested that the exposure duration <=30 min per session exhibited better effects compared with the exposure duration >30 min per session. Three trials reported adverse events, and the combined results showed that there was no significant difference between PEMF and the sham group.

CONCLUSIONS

PEMF could alleviate pain and improve physical function for patients with knee and hand OA, but not for patients with cervical OA. Meanwhile, a short PEMF treatment duration (within 30 min) may achieve more favourable efficacy. However, given the limited number of study available in hand and cervical OA, the implication of this conclusion should be cautious for hand and cervical OA.

White blood cell count: an independent predictor of coronary heart disease risk in middle-aged and elderly population with hyperuricemia

Previous studies have shown that hyperuricemia is an independent risk factor for cardiovascular disease. The aim of the study was to examine the association between white blood cell (WBC) count and coronary heart disease (CHD) risk in middle-aged and elderly population with hyperuricemia.Data included in this analysis were from a population-based cross-sectional study, that is, the Xiangya Hospital Health Management Center Study. Hyperuricemia was defined as uric acid ≥416 μmol/L in male population and ≥360 μmol/L in female population. The WBC count was classified into 3 categories based on the tertile distribution of the study population. Framingham risk scores calculated by the Adult Treatment Panel III charts were used to estimate 10-year CHD risk for each participant. The relationship between WBC count and CHD risk in patients with hyperuricemia was examined using the multivariable logistic analysis.A total of 1148 hyperuricemia patients (855 males and 293 females) aged from 40 to 85 years were included and 418 (36.4%) of them were defined with relatively high 10-year CHD risk. Compared with the lowest tertile, the crude odds ratios (ORs) of high 10-year CHD risk were 1.43 (95% confidence interval [CI] 1.06-1.92) and 1.56 (95% CI 1.16-2.11) in the 2nd and 3rd tertiles of WBC count (P for trend = .004), and the multivariable adjusted ORs of high 10-year CHD risk were 1.39 (95% CI 1.03-1.89) and 1.47 (95% CI 1.08-2.00) in the 2nd and 3rd tertiles of WBC count (P for trend = .015).This study indicated that WBC count was associated with CHD risk in patients with hyperuricemia, suggesting that WBC count, an easily accessible biomarker, could probably predict CHD risk in middle-aged and elderly population with hyperuricemia.