Practical application of Six Sigma management in analytical biochemistry processes in clinical settings

BACKGROUND

Six Sigma methodology with a zero-defect goal has long been applied in commercial settings and was utilized in this study to assure/improve the quality of various analytes.

METHODS

Daily internal quality control (QC) and external quality assessment data were collected and analyzed by calculating the sigma (σ) values for 19 analytes based on the coefficient of variation, bias, and total error allowable. Standardized QC sigma charts were established with these parameters. Quality goal index (QGI) analysis and root cause analysis (RCA) were used to discover potential problems for the analytes.

RESULTS

Five analytes with σ ≥ 6 achieved world-class performance, and only the Westgard rule (1_3s ) with one control measurement at two QC material levels (N2) per QC event and a run size of 1000 patient samples between QC events (R1000) was needed for QC. In contrast, more control rules (2_2s /R_4s /4_1s ) along with high N values and low R values were needed for quality assurance for five analytes with 4 ≤ σ < 6. However, the sigma levels of nine analytes were σ < 4 at one or more QC levels, and a more rigorous QC procedure (1_3s /2_2s /R_4s /4_1s /8_x with N4 and R45) was implemented. The combination of QGI analysis and RCA further revealed inaccuracy or imprecision problems for these analytes with σ < 4 and discovered five aspects of potential causes considered for quality improvement.

CONCLUSIONS

Six Sigma methodology is an effective tool for evaluating the performance of biochemical analytes and is conducive to quality assurance and improvement.

[Follow-up study on natural course changes of obstructive sleep apnea hypopnea syndrome among young and middle aged patients]

Objective: To explore the natural course of obstructive sleep apnea-hypopnea syndrome (OSAHS) and its associated factors in young and middle-aged patients with OSAHS. Methods: A total of 52 young and middle-aged OSAHS patients were recruited in this study from West China Hospital of Sichuan University. All patients were performed twice overnight polysomnography (PSG) examinations. At the baseline, patients underwent the first PSG and clinical evaluation from September 2009 to September 2017 and the patients received the second PSG from January 2017 to January 2019. During the follow-up period, these patients had no treatment. All patients were categorized into two groups including mild-to-moderate [5/h≤ apnea-hypopnea index (AHI)<30/h] group and severe (AHI ≥ 30/h) group according to the baseline AHI value. Differences in the clinical characteristics and PSG variables between baseline and follow-up were compared in two groups separately using t-tests or Mann-Whitney U test. The general linear correlation analysis was used to explore the factors related to the severity of OSAHS including AHI, the mean oxyhemoglobin saturation and the minimal oxyhemoglobin saturation during the follow-up period. Results: This study recruited 28 OSAHS patients in mild-to-moderate group [mean age, (39.7±10.2) y] and 24 patients in severe group [mean age, (41.0±7.1) y]. Compared to the baseline, there was a significant increase in AHI value [(45.0±25.3) vs (33.6±27.3)/h, P<0.001] in all OSAHS patients. Notably, the increase of AHI was more significant in the mild-to-moderate OSAHS group [(32.1±22.2) vs (13.6±8.7)/h, P<0.05] but not in severe OSAHS patients [(60.7±19.5) vs (58.0±21.5)/h, P>0.05]. A person correlation analysis revealed that the AHI value was positively related to the age (r=0.531, P=0.004) in mild-to-moderate OSAHS patients. Conclusion: The severity of OSAHS is increased with the age in young and middle-aged patients with mild-to-moderate OSAHS, but not in those with severe OSAHS.

Clinical diagnostic significance of 14-3-3η protein, high-mobility group box-1, anti-cyclic citrullinated peptide antibodies, anti-mutated citrullinated vimentin antibodies and rheumatoid factor in rheumatoid arthritis

Introduction: Circulating markers of rheumatoid arthritis (RA) include the 14-3-3η protein, high-mobility group box-1 (HMGB1), anti-cyclic citrullinated peptide (anti-CCP) antibodies, anti-mutated citrullinated vimentin (anti-MCV) antibodies and rheumatoid factor (RF). We set out to determine which two markers in combination provided best discriminatory power for this disease.Methods: We recruited 108 RA patients, 102 non-RA patients (SLE, AS, Sjogren's syndrome, MCTD) and 90 healthy controls. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and the Youden index of each analyte were calculated and binary logistic regression analysis and receiver operating characteristic (ROC) curve were performed to evaluate their diagnostic value for RA alone and in paired combination.Results: As expected, all markers were elevated in RA patients (P < 0.05). Binary logistic regression analysis showed that 14-3-3η had the highest odds ratio (95% CI) at 2.4 (1.9-2.8). Anti-CCP and anti-MCV had the highest areas under the curves [AUC (95% CI)] at 0.85 (0.78-0.90) and 0.85 (0.78-0.91) respectively (both P < 0.001). In serial detection (one marker followed by another), no combination had a Youden index >0.6. In parallel analysis (both considered together) several combinations had a Youden index >0.7, of which the highest (0.78) was anti-CCP with anti-MCV, with a sensitivity of 93.3% and specificity of 84.7%.Conclusions: Despite individual increases in serum 14-3-3η, HMGB1, anti-CCP, anti-MCV and RF, the combination of anti-CCP and anti-MCV might be of great help for diagnostic in RA, and so should be considered as routine tests for this disease.

[Associations between objective sleepiness and cognition function before and after CPAP in obstructive sleep apnea patients]

Objective: To examine the association between objective sleepiness and neurocognitive function before and after continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients. Methods: A total of 53 patients with overnight polysomnography (PSG) determined moderate-to-severe OSA (apnea hypopnea index (AHI) ≥15 events/h) and with overnight CPAP therapy from West China Hospital, Sichuan University within the period from Feb 2018 to Dec 2018 were enrolled in the study. At the baseline, all patients underwent overnight PSG study, multiple sleep latency test (MSLT), psychomotor vigilance test (PVT), and Epworth sleepiness score (ESS). After CPAP therapy, all patients underwent MSLT and PVT. Paired nonparametric test or t test were used to compare the differences between daytime sleepiness and PVT performance before and after CPAP. Results: Compared with baseline data, AHI [68.8(42.2, 80.0) vs 7.4(3.1, 11.1) events/h, P<0.05] decreased, the percentages of non-rapid eye movement stage 3 sleep time [0(0, 0.5%) vs 4.4%(1.9%, 11.3%), P<0.05] and the percentages of rapid eye movement sleep time [18.6%(13.2%, 22.7%) vs 25.4%(23.85, 30.3%), P<0.05] increased after CPAP therapy. The reaction time (RT) [353.0(317.5, 429.5) vs 333.6(309.7, 381.4) ms, P<0.05], the slowest 10% RT [602.9(473.2, 841.3) vs 505.5(431.6, 618.8) ms, P<0.05] and the fastest 10% RT [260.8(236.6, 300.6) vs 251.4(233.6, 283.2) ms, P<0.05] shortened, and the lapse [6.0(2.5, 16.5) vs 3.0(1.0, 8.5) events, P<0.05] decreased. The mean sleep latency (MSL) [5.8 (3.4, 8.3) vs 7.5(4.7, 12.4) min, P<0.05] increased. The changes in PVT parameters [ΔRT (r=0.20, P>0.05), Δslowest 10% RT (r=0.15, P>0.05), Δfastest 10% RT (r=0.24, P>0.05), and Δlapse (r=0.15, P>0.05)] were not correlated with the change in MSL. The significant association between the slowest 10% RT and ESS was found in baseline data. Conclusions: The change in MSL is not associated with the change in PVT performance before and after CPAP therapy. MSLT and PVT may be different in nature.

Control of Synaptic Specificity by Establishing a Relative Preference for Synaptic Partners

The ability of neurons to identify correct synaptic partners is fundamental to the proper assembly and function of neural circuits. Relative to other steps in circuit formation such as axon guidance, our knowledge of how synaptic partner selection is regulated is severely limited. Drosophila Dpr and DIP immunoglobulin superfamily (IgSF) cell-surface proteins bind heterophilically and are expressed in a complementary manner between synaptic partners in the visual system. Here, we show that in the lamina, DIP mis-expression is sufficient to promote synapse formation with Dpr-expressing neurons and that disrupting DIP function results in ectopic synapse formation. These findings indicate that DIP proteins promote synapses to form between specific cell types and that in their absence, neurons synapse with alternative partners. We propose that neurons have the capacity to synapse with a broad range of cell types and that synaptic specificity is achieved by establishing a preference for specific partners.

[Association between mixed sleep apnea and treatment-emergent central sleep apnea]

Objective: To examine the association between mixed sleep apnea (MA) and treatment-emergent central sleep apnea (TE-CSA). Methods: A total of 256 patients meeting the diagnostic criteria of moderate to severe obstructive sleep apnea (OSA) based on overnight polysomnography (PSG) and receiving continuous positive airway pressure (CPAP) therapy in West China Hospital, Sichuan University during the period from August 2013 to November 2018 were enrolled in the study. Based on the mixed apnea index (MAI) and apnea-hypopnea index (AHI) in the baseline PSG study during non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, the subjects were categorized into three groups of A (MAI=0/h, n=110), B (NREM-MAI≥5/h and REM-MAI<5/h, n=72) and C (REM-MAI≥5/h and NREM-MAI< 5/h, n=74). Sleep and breathing related parameters before and after CPAP therapy among three groups and the difference of TE-CSA incidence were analyzed. Results: The AHI [(44.2(26.8,64.5)/h,66.6(56.0,81.7)/h, 79.8(63.6, 88.3)/h], REM-AHI [50.0(34.7, 64.7)/h, 60.1(49.1, 70.0)/h, 66.3(56.1, 74.6)/h] and NREM-AHI[43.5(25.9, 65.1)/h,67.6(53.7, 82.4)/h,81.3(64.2, 91.5)/h]) were higher in group B and C compared to group A (all P<0.05),while the mean and lowest oxygen saturation [(92.6%±3.5%),(90.8%±3.6%),(87.3%±5.1%) and (70.6%±14.1%), (61.0%±16.0%), (47.9%±17.0%)] were lower in group B and group C compared to group A (all P<0.05). The incidence of TE-CSA after initial CPAP was 7.8% in all patients, and the incidence was significantly higher in group B of 14.1% compared to group C of 4.1% and group A of 2.7% (all P<0.05). Conclusions: TE-CSA is correlated with baseline MA, and baseline MA in NREM sleep can predict the incidence of TE-CSA after initial CPAP.

Inflammation level and renal function injury in antineutrophil cytoplasmic antibody-associated vasculitis: a correlation with low albumin and high-density lipoprotein

Aim: To explore the correlation of inflammation level and organ involvement in antineutrophil cytoplasmic antibody-associated vasculitis (AAV) patients with Alb and HDL. Materials & methods: Serum levels of Alb and HDL were measured, with AAV patients being grouped according to serum Alb and HDL levels, and indicators reflecting inflammation and renal injury were compared. Results: Serum levels of creatinine (Cr), uric acid and CRP and renal involvement rates were higher in lower Alb patients; Cr, CRP, renal and cardiovascular involvement rates in lower HDL patients were higher. Alb and HDL were negatively correlated with CRP and erythrocyte sedimentation rate. Conclusion: Serum Alb and HDL were good indictors for disease monitoring in AAV.

Clinical significance of high-mobility group box-1 (HMGB1) in subjects with type 2 diabetes mellitus (T2DM) combined with chronic obstructive pulmonary disease (COPD)

Background

Simple method to predict type 2 diabetes mellitus (T2DM) combined with chronic obstructive pulmonary disease (COPD) is in great need clinically. This study aims to assess the clinical significance of high‐mobility group box‐1 (HMGB1) in predicting T2DM combined with COPD in Chinese patients with T2DM or COPD.

Methods

Serum concentrations of glycated hemoglobin (HbA1C), fasting plasma glucose (FPG), fasting insulin (FINS), total cholesterol (TC), triglyceride (TG), low‐density lipoprotein cholesterol (LDL‐c), high‐density lipoprotein cholesterol (HDL‐c), C‐reactive protein (CRP), fibrinogen (FIB), HMGB1, white blood cell count (WBC), neutrophil% (NEU%), and lung function text such as forced expiratory volume 1/forced vital capacity (FEV1/FVC) and forced expiratory volume 1% predicted value (FEV1%pred) were measured in 126 T2DM patients, 118 COPD patients, 112 T2DM combined with COPD patients, and 120 healthy controls. Logistic regression was used to estimate the risk factors for T2DM combined with COPD.

Results

High‐mobility group box‐1 elevated in patients with T2DM combined with COPD, significantly higher than other subjects (P < 0.05), and differences in HMGB1 also existed between patients with T2DM or COPD and healthy individuals (P < 0.01). HMGB1 was positively correlated with HOMA‐IR, FBG, and HbA1c (P < 0.01) and negatively correlated with FEV1/FVC and FEV1%pred (P < 0.01). Logistic regression showed that HMGB1 was identified to be independent risk factor for T2DM combined with COPD.

Conclusion

High‐mobility group box‐1 was independent risk factor for T2DM combined with COPD and can be served to predict the occurrence of T2DM combined with COPD.

Clinical significance of BPI-ANCA detecting in COPD patients with Pseudomonas aeruginosa colonization

Background

Antineutrophil cytoplasmic autoantibodies against neutrophil granule bactericidal/permeability‐increasing protein (BPI‐ANCA) has been found in many inflammatory diseases, such as COPD, which can reduce the killing effect of BPI on Gram‐negative bacteria. This study was aimed to assess the clinical significance of BPI‐ANCA detecting in COPD patients with Pseudomonas aeruginosa (P aeruginosa) colonization.

Methods

A total of 216 COPD patients with lung P aeruginosa colonization, 244 patients with P aeruginosa infection from June 2015 to June 2018, and 100 healthy individuals were included. Serum BPI‐ANCA, tumor necrosis factor (TNF)‐α, and interleukin (IL)‐6 and IL‐1β levels were detected by ELISA, and the lung function of the patients was measured at stable clinical stages. Patients with COPD were grouped according to BPI‐ANCA detection and GOLD criteria, and serum TNF‐α, IL‐6, and IL‐1β levels and indices reflecting lung function were compared and analyzed between groups.

Results

Positive rate of BPI‐ANCA in COPD patients with P aeruginosa colonization was 48.15%; and compared with BPI‐ANCA(‐) group, FEV₁%pred and FEV₁/FVC(%) in BPI‐ANCA(+) patients were significantly decreased, while TNF‐α, IL‐6, and IL‐1β levels were elevated. There were 31.73% and 36.54% BPI‐ANCA(+) patients with severe and very severe airflow limitation, respectively, which was significantly higher than that in the BPI‐ANCA(‐) group. FEV₁%pred and FEV₁/FVC(%) were negatively correlated with TNF‐α, IL‐6, IL‐1β, and NEU%. C‐reactive protein (CRP) was negatively correlated with FEV₁%pred, yet not significantly correlated with FEV₁/FVC(%).

Conclusion

BPI‐ANCA positivity is associated with inflammatory status in COPD patients with pulmonary P aeruginosa colonization and can be used as a potential biomarker assessing disease severity.

Prediction and monitoring of relapse in stage III melanoma using circulating tumor DNA

BACKGROUND

The advent of effective adjuvant therapies for patients with resected melanoma has highlighted the need to stratify patients based on risk of relapse given the cost and toxicities associated with treatment. Here we assessed circulating tumor DNA (ctDNA) to predict and monitor relapse in resected stage III melanoma.

PATIENTS AND METHODS

Somatic mutations were identified in 99/133 (74%) patients through tumor tissue sequencing. Personalized droplet digital PCR (ddPCR) assays were used to detect known mutations in 315 prospectively collected plasma samples from mutation-positive patients. External validation was performed in a prospective independent cohort (n = 29).

RESULTS

ctDNA was detected in 37 of 99 (37%) individuals. In 81 patients who did not receive adjuvant therapy, 90% of patients with ctDNA detected at baseline and 100% of patients with ctDNA detected at the postoperative timepoint relapsed at a median follow up of 20 months. ctDNA detection predicted patients at high risk of relapse at baseline [relapse-free survival (RFS) hazard ratio (HR) 2.9; 95% confidence interval (CI) 1.5-5.6; P = 0.002] and postoperatively (HR 10; 95% CI 4.3-24; P < 0.001). ctDNA detection at baseline [HR 2.9; 95% CI 1.3-5.7; P = 0.003 and postoperatively (HR 11; 95% CI 4.3-27; P < 0.001] was also associated with inferior distant metastasis-free survival (DMFS). These findings were validated in the independent cohort. ctDNA detection remained an independent predictor of RFS and DMFS in multivariate analyses after adjustment for disease stage and BRAF mutation status.

CONCLUSION

Baseline and postoperative ctDNA detection in two independent prospective cohorts identified stage III melanoma patients at highest risk of relapse and has potential to inform adjuvant therapy decisions.

Advances in In-silico B-cell Epitope Prediction

Identification of B-cell epitopes in target antigens is one of the most crucial steps for epitopebased vaccine development, immunodiagnostic tests, antibody production, and disease diagnosis and therapy. Experimental methods for B-cell epitope mapping are time consuming, costly and labor intensive; in the meantime, various in-silico methods are proposed to predict both linear and conformational B-cell epitopes. The accurate identification of B-cell epitopes presents major challenges for immunoinformaticians. In this paper, we have comprehensively reviewed in-silico methods for B-cell epitope identification. The aim of this review is to stimulate the development of better tools which could improve the identification of B-cell epitopes, and further for the development of therapeutic antibodies and diagnostic tools.

Molecular identification of Kalicephalus isolated from snakes in Hunan province, subtropical China

Parasite classification and identification are central to controlling parasitosis. Traditional methods for identifying parasite species are based on morphological features, but these are time-consuming and inaccurate, especially for cryptic species. The purpose of the present study was to select molecular markers to promote the development of molecular systematic for parasites. The internal transcribed spacers (ITS) of nuclear ribosomal DNA (rDNA) falls in between 18S, 5.8S, and 28S rDNA sequences, including ITS-1 and ITS-2 sequences. Previous studies have demonstrated that rDNA ITS sequences provide useful genetic markers for identifying parasitic nematodes. With the ultimate goal of controlling parasite transmission, we identified Kalicephalus belonging to three species using ITS rDNA genes. The ITS genes (750-797 bp) of 21 Kalicephalus belonging to 3 species were cloned and sequenced. Intra- and interspecific identities were 98.4% and 80%-89%, respectively. The phylogenetic tree reconstructed with the neighbour-joining (NJ) method revealed that congener Kalicephalus form the same branch, which is far apart from other branches of other nematodes. This is consistent with morphological classifications, demonstrating the accuracy of our molecular method. This is the first report stating that ITS genes can be used to classify Kalicephalus, and it lays the foundation for identification, molecular epidemiology, and phylogenetics of Kalicephalus and related parasitic nematodes.

Bone regeneration of hollow tubular magnesium‑strontium scaffolds in critical-size segmental defects: Effect of surface coatings

Segmental defects are formidable challenges for orthopedic surgeons that are caused by large osseous defects such as open injury, comminuted fracture as well as other severe traumas and infection. Current treatment options have practical and clinical shortcomings, calling for innovative bone graft materials. This study is related to hollow tubular magnesium‑strontium (MgSr) alloy scaffolds with autologous morselized bone filled inside and three different coatings were individually applied on MgSr scaffolds, respectively, to study the effects of degradation and bioactivity of the grafts on new bone growth. The optimal coating method was screened using immersion tests, cell proliferation and adhesion, alkaline phosphatase (ALP) assay in vitro, and 4 weeks' implantation in a critical-size segmental defect in vivo. More new bone formation was observed by radiographic tests and histology along the ulna defects, when magnesium scaffold grafts were implanted. Meanwhile, depression occurred for blank control group with only autologous morselized bone filled, because of rapid absorption rate of morselized bone during initial implantation. Therefore, biodegradable MgSr alloy grafts showed their potential application in treating the critical-size segmental defects. As for different coating methods, CaP chemically deposited (CaP) coated sample showed least H₂ evolution in vivo, demonstrating highest corrosion resistance and relative stable interfaces, however, the least beneficial ion release meanwhile. Micro-arc oxidation coating (MAO) degraded faster comparing with CaP, while with the main composition of MgO. They both indicate insufficient bioactivity in bone formation. The results suggest superior combination of bioactive surface, beneficial ions release and appropriate corrosion rate of Strontium phosphate conversion (SrP) coating, indicating superior comprehensive oeteoconductive and osteoinductive properties of coatings on hollow tubular MgSr alloy scaffold.

Abstract P6-09-07: Expression of miR-106b in circulating tumor cells is associated with EMT and prognosis in metastatic breast cancer patients

# Co-first author: W.T., G.L., X.X.

* Co-Correspondence: C.G. and W.G.J.

Abstract

Background: Circulating tumor cells (CTCs) display changes in epithelial-mesenchymal transition (EMT) markers and miRNAs regulate EMT in breast cancer cells. The association between EMT characteristics and miRNA expression in CTCs of metastatic breast cancer (MBC) patients and their clinical implications remain unknown.

Methods: CTC-specific miRNAs were screened based on comparison of the miRNA profile between CTC and primary tumor. RT-PCR was used to quantity the expression levels of EMT makers and miRNA candidates. We enrolled 219 MBC patients with CTCs ≥ 5/7.5mL blood from 2 cohorts and CTCs were detected and enriched by CellSearch. Overall survival (OS) and radiological response were analyzed. CTCs were divided into epithelial- (E-CTCs) and mesenchymal-like CTC (M-CTCs) phenotypes based on a cut-off value derived from suspended breast cancer cells recovered from PBMCs.

Results: MiR-106b displayed upregulation in CTCs, with a higher level in M-CTCs than E-CTCs. Patients with E-CTCs showed better OS than those with M-CTCs (HR 1.77, 95% CI 1.14-2.78, P =0.012). CTCs from chemo-resistant MBC patients exhibited higher miR-106b. CTC-specific miR-106b was negatively associated with therapy response and OS (HR 1.73, 95% CI 1.06-2.84, P = 0.029).

Conclusions: CTC-specific miR-106b was associated with EMT phenotypes of CTCs and may predict prognosis in MBC patients.

Citation Format: Tan W, Liang G, Xie X, Tan L, Sanders AJ, Liu Z, Ling Y, Zhong W, Jiang WG, Gong C. Expression of miR-106b in circulating tumor cells is associated with EMT and prognosis in metastatic breast cancer patients [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 P6-09-07.

Abstract P2-08-56: Effects of young age on prognosis in patients with node-negative tumors 2 cm or smaller breast cancer

Background It is still controversial to consider age as a prognostic factor into the treatment strategy of patients with T1N0M0 breast cancer.

Aim The main purpose of this study was to evaluate the effect of age on recurrence risk in patients diagnosed with T1N0M0 breast cancer as well as compare the prognosis of young aged patients(YA,≤40 years old) to non-young aged patients(non-YA,&gt;40 years old) by using a propensity score matching(PSM) analysis.

Methods 365 patients with T1N0M0 breast cancer diagnosed between 2003 and 2016 who received surgery in Sun Yat-sen Memorial Hospital Breast Cancer Center were included.The recurrence free survival (RFS) and risk factors for recurrence were identified by using Kaplan-Meier method and Cox proportional hazards models. PSM was then used to reduce the confounding effect of known risk factors on prognosis and then to compare 5-year RFS rates in patients between two age groups.

Results After a median follow up of 79 months, 54 patients developed recurrences and 5-year RFS was 87.6%. YA patients had lower RFS estimates (80.6%), compared to patients diagnosed in a later age (89.1% if older than 40-years old; P = 0.049). YA patients tended to have Her-2 positive, TNBC tumors, higher rate of Ki-67 expression and nuclear grade tumor. At multivariate analysis, Her-2 positive (HR 2.115; 95% CI 1.103-4.055, p=0.024) and TNBC (HR 2.963; 95% CI 1.485-5.914, p=0.002) resulted independent prognostic factors of patient with T1N0M0 breast cancer. In the subgroup analysis, we found significant poor RFS for YA patients with Her-2 positive breast cancer compared to the older counterparts(p=0.006) and YA patients were associated with significantly higher rates of the locoregional recurrence rather than metastasis(p=0.004), especially in first 5 years after diagnosis. After PSM, the baseline level and treatment status including tumor size, grade, HR status, Her-2 status, Ki67 expression breast surgery type and systemic adjuvant treatment(AST) of patients in the two age groups tended to be equal. As result, we found significant difference in the 5-year RFS between two age groups(p=0.008).

Conclusion Based on equal treatment condition, young age at presentation conferred a worse prognosis in patients with T1N0M0 breast cancer is independent on other pathological features.

Citation Format: Zhong W, Tan L, You N, Wang Y, Liang G, Liu Z, Ling Y, Tian Z, Gong C. Effects of young age on prognosis in patients with node-negative tumors 2 cm or smaller breast cancer [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 P2-08-56.

Abstract P2-07-12: A prognostic prediction nomogram (PDIDC) for breast Paget's disease with infiltrating ductal carcinoma patients: A SEER cohort analysis

Purpose

The aim of the study was to develop a specific nomogram for prediction of prognosis for breast Paget's disease with infiltrating ductal carcinoma (PD-IDC) patients.

Patients and Methods

Patients data were obtained by the Surveillance, Epidemiology, and End Results (SEER) program (N=2502). Study outcome was Breast Cancer Specific Survival (BCSS). Cox proportional hazards model was applied to identify risk factors and develop predictive model. For internal validation, discrimination was calculated with the concordance index (C-index) using the bootstrap method and calibration assessed.

Results

NPI classification, skin symptom, tumor site and age showed significant association with BCSS(table.1)and were used to build the PDIDC nomogram and to calculate risk score. PDIDC nomogram's C-index (0.791, 95%CI 0.783-0.818) showed better discrimination power than NPI classification (0.691, 95%CI, 0.650-0.735, P= 0.000) and AJCC staging (0.718, 95%CI, 0.695-0.741, P=0.000). Patients were divided into high-risk (1882/2502, 75.21%) and low-risk (620/2502, 24.78%) subgroups with the optimal cut-off of risk scores (4.28). The total BCSS of low-risk subgroup was 77.8% (95%CI 74.4%-81.4%) vs. 31.1% (95%CI 19.4-49.8) of high-risk group (P=0.000). Bootstrap internal validation demonstrated an average C-index of 0.739 (95% CI, 0.692-0.746). The nomogram calibration was validated to be accurate in predicting 5-year and 10-year survival.

Variable finally selected for risk predicted model.PredictorHazard RatioP Value95% CINPI classification Good1 Moderate2.170.0001.51-3.14Poor7.260.0004.96-10.63Skin symptom Without1 With1.760.0001.34-2.32Tumor site Centrally located1 Non-centrally located1.250.0421.07-1.56Age*1.010.0001.01-1.03* Continuous variable.

Conclusion

Utilizing NPI classification, skin symptom, tumor site and age, we developed the PDIDC nomogram to predict the 5-year and 10-year BCSS of breast PD-IDC patients.

Citation Format: Tan L, Chen K, Jiang WG, You N, Wang Y, Sanders A, Liang G, Liu Z, Ling Y, Zhong W, Tian Z, Gong C. A prognostic prediction nomogram (PDIDC) for breast Paget's disease with infiltrating ductal carcinoma patients: A SEER cohort analysis [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 P2-07-12.

Stereotyped terminal axon branching of leg motor neurons mediated by IgSF proteins DIP-α and Dpr10

For animals to perform coordinated movements requires the precise organization of neural circuits controlling motor function. Motor neurons (MNs), key components of these circuits, project their axons from the central nervous system and form precise terminal branching patterns at specific muscles. Focusing on the Drosophila leg neuromuscular system, we show that the stereotyped terminal branching of a subset of MNs is mediated by interacting transmembrane Ig superfamily proteins DIP-α and Dpr10, present in MNs and target muscles, respectively. The DIP-α/Dpr10 interaction is needed only after MN axons reach the vicinity of their muscle targets. Live imaging suggests that precise terminal branching patterns are gradually established by DIP-α/Dpr10-dependent interactions between fine axon filopodia and developing muscles. Further, different leg MNs depend on the DIP-α and Dpr10 interaction to varying degrees that correlate with the morphological complexity of the MNs and their muscle targets.

[Application of nasal saline irrigation in nasal inflammatory diseases]

Nasal irrigation is a common topical treatment in rhinology. Saline irrigation(SI) is the most common and basic way of nasal irrigation. Mechanisms of action of SI contain physical clearance, regulation of nasal mucociliary function, enhancement of antimicrobial activity of nasal secretions and the effects of ions.Current solutions for SI differ in composition and physicochemical properties, specifically presence of additional ions, concentration of saline, pH values and temperature. Positive pressure should be an optimized method of SI. The side effects of SI include nasal discomfort, otalgia, and pooling of saline in sinuses with subsequent drainage. Furthermore, solutions are at the risk of contamination in SI.Despite the widely use of SI in the therapy of acute upper respiratory tract infections, allergic rhinitis, chronic rhinosinusitis and vasomotor rhinitis, evidence is still insufficient to support it. Researches in the use of SI on children is urgently needed.

Transsynaptic interactions between IgSF proteins DIP-α and Dpr10 are required for motor neuron targeting specificity

The Drosophila larval neuromuscular system provides an ideal context in which to study synaptic partner choice, because it contains a small number of pre- and postsynaptic cells connected in an invariant pattern. The discovery of interactions between two subfamilies of IgSF cell surface proteins, the Dprs and the DIPs, provided new candidates for cellular labels controlling synaptic specificity. Here we show that DIP-α is expressed by two identified motor neurons, while its binding partner Dpr10 is expressed by postsynaptic muscle targets. Removal of either DIP-α or Dpr10 results in loss of specific axonal branches and NMJs formed by one motor neuron, MNISN-1s, while other branches of the MNISN-1s axon develop normally. The temporal and spatial expression pattern of dpr10 correlates with muscle innervation by MNISN-1s during embryonic development. We propose a model whereby DIP-α and Dpr10 on opposing synaptic partners interact with each other to generate proper motor neuron connectivity.

Neuron-Subtype-Specific Expression, Interaction Affinities, and Specificity Determinants of DIP/Dpr Cell Recognition Proteins

Binding between DIP and Dpr neuronal recognition proteins has been proposed to regulate synaptic connections between lamina and medulla neurons in the Drosophila visual system. Each lamina neuron was previously shown to express many Dprs. Here, we demonstrate, by contrast, that their synaptic partners typically express one or two DIPs, with binding specificities matched to the lamina neuron-expressed Dprs. A deeper understanding of the molecular logic of DIP/Dpr interaction requires quantitative studies on the properties of these proteins. We thus generated a quantitative affinity-based DIP/Dpr interactome for all DIP/Dpr protein family members. This revealed a broad range of affinities and identified homophilic binding for some DIPs and some Dprs. These data, along with full-length ectodomain DIP/Dpr and DIP/DIP crystal structures, led to the identification of molecular determinants of DIP/Dpr specificity. This structural knowledge, along with a comprehensive set of quantitative binding affinities, provides new tools for functional studies in vivo.

Molecular characterization and phylogenetic analysis of Taenia multiceps from China

Taenia multiceps, one of the most widely distributed zoonotic tapeworm parasites, is able to parasitize the small intestine of canids. The metacestode of T.multiceps is fatal to ruminants and causes important economic losses in livestock. However, molecular characteristics of T.multiceps and coenurus in China are still unclear. In this study, 36 goat isolates of the coenurus stage and 18 dog isolates of the adult stage of T.multiceps were obtained from three geographical areas in China and the isolated parasite above were analyzed by amplifying the partial of cytochrome coxidase subunit 1(pcox1), 12S ribosomal RNA (12S rRNA) from mitochondrial DNA (mtDNA) regions and an internal transcribed spacer (ITS) of ribosomal DNA (rDNA). These DNA sequences obtained from T.multiceps and coenurus were employed to evaluate the nucleotide diversity and confirm the relationship between T.multiceps and coenurus. Sequences variation were 0-1.4%, 0-1.5%, 0-4.2% for pcox1, 12S rRNA and ITS, respectively, among T.multiceps and coenurus isolates obtained in this study. In Sichuan province, sequence variations for Coenurus cerebralis isolated from Yaan city were 0-1.4% for pcox1, 0-1.0% for 12S rRNA and 0-2.1% for ITS. In Hunan province, variations were 0-1.0%, 0-1.5% and 0-3.3% for corresponding genes for non-coenurus cerebralis isolated from Changsha city, while variations of T.multiceps isolates from Xiangxi autonomous prefecture were 0-1.0%, 0-1.1% and 0-3.4% for pcox1, 12S rRNA and ITS, respectively. Phylogenetic analysis based on pcox1 sequences indicated that all cerebral and noncerebral metacestodes belong to T.multiceps. These results provide reference values for future molecular epidemiological and biological study on T.multiceps in dogs and intermediate hosts.

Clinical diagnostic significance of prealbumin, cholinesterase and retinol binding protein in liver cirrhosis combined with encephalopathy

OBJECTIVE

Hepatic encephalopathy is a common consequence of liver cirrhosis, but diagnosis can be difficult as it is based on clinical criteria alone. We hypothesised that serum prealbumin, cholinesterase and retinol binding protein (RBP) can help support the diagnosis of hepatic encephalopathy.

METHODS

We enrolled 306 cirrhotic patients (110 with encephalopathy), 100 chronic hepatitis B patients and 50 healthy controls, measuring routine liver function tests (ALT, AST, GGT, ALP, and bilirubin), albumin, prothrombin time, prealbumin, cholinesterase and RBP by routine methods. Logistic regression analysis and areas under the receiver operating characteristic curves (AUCs) were used to find predictive factors for hepatic encephalopathy.

RESULTS

There were differences in all laboratory indices between the three groups (all p < 0.001). In univariate analysis, albumin, prothrombin time, prealbumin, cholinesterase and RBP were significantly altered in those with encephalopathy (p < 0.01), but only prealbumin, cholinesterase and RBP levels were significant predictors in multivariate analysis, and each was linked to the severity of liver fibrosis defined by the Child-Pugh score (all p < 0.001). The AUCs (95% CI) of prealbumin, cholinesterase and RBP for diagnosing liver cirrhosis with hepatic encephalopathy were comparable at 0.85 (81-90), 0.81 (0.76-0.85) and 0.81 (0.76-0.86), respectively (all p < 0.01).

CONCLUSIONS

Serum prealbumin, cholinesterase and RBP levels are of potential clinical value in diagnosis of liver cirrhosis complicated by encephalopathy.

MAD2 Combined with Mitotic Spindle Apparatus (MSA) and Anticentromere Antibody (ACA) for Diagnosis of Small Cell Lung Cancer (SCLC)

BACKGROUND MAD2 is the gene controlling mitosis. Many studies have assessed MAD2 in various types of carcinoma. Antinuclear mitotic spindle apparatus antibody (MSA) and anticentromere antibody (ACA) are related mitotic antibodies, playing roles in autoimmune diseases and carcinomas, but the expression of MAD2, MSA, and ACA in SCLC is unclear. MATERIAL AND METHODS We enrolled 70 SCLC patients, 72 non-small cell lung cancer (NSCLC) patients, and 65 pulmonary nodule (PN) patients. MAD2 expression was measured through agarose electrophoresis and qt-PCR. Antinuclear mitotic spindle apparatus antibody (MSA) and anticentromere antibody (ACA) were detected by indirect immunofluorescence (IIF). RESULTS MAD2 was found both in SCLC and NSCLC. Interestingly, there was a significant difference found between SCLC and NSCLC using qt-PCR (P<0.05). The area under the ROC curve of MAD2 expression was 0.799, with medium diagnostic value. MAD2 expression was related to age, lymphatic metastasis, and survival time, but not with sex. The positivity for MSA and ACA by IIF assay were 37.20% and 34.00%, respectively, in the SCLC group, which were higher than in the NSCLC and pulmonary nodule groups (P<0.05). The kappa values of MSA and ACA with MAD2 expression were 0.73 and 0.65, respectively, with moderate consistency. Combining MAD2 with MSA and ACA enhanced the sensitivity and specificity for diagnosing SCLC. CONCLUSIONS MAD2 expression was found to be involved in carcinogenesis and prognosis of SCLC. The combination of MAD2 with MSA and ACA is useful for early diagnosis and shows promise in treatment of SCLC.

[Clinical efficacy of ultrasound-guided subacromial drug injection in the treatment of subacromial impingement syndrome]

Objective: To evaluate the clinical effects of ultrasound-guided subacromial injection of two drugs in treatment of subacromial impingement syndrome. Methods: This was a randomized controlled trial study, prospective collection of patients' data who were diagnosed as subacromial impingement syndrome at Orthopedic of Tianjin Fifth Central Hospital from January 2015 to August 2017. To ensure the randomness of the study, patients were randomized into two groups using a random number table. Pain(visual analogue scale(VAS)) and shoulder function (University of California Shoulder Score System(UCLA) and shoulder abduction) were performed before and after each injection.For continuous endings with multiple points in time, firstly, the normality, the homogeneity of variance, and the sphericity test of Mauchly were performed. After the condition was satisfied, the variance analysis of the two-factor repeated measurement data was performed. Results: Fifty-two patients completed the injection within 5 minutes and 41 patients got the final follow-up. Twenty-two patients in the corticosteroid group, 14 males and 8 females, aged (44.7±9.5) years old(range: 35-68 years old). The lesion involved 13 cases of superior shoulder, more than 1 time injection in 4 cases. There were 19 patients in the NSAID group, 7 males and 12 females, aged (37.2±10.1) years old(range: 27-63 years old), 10 cases with lesions involving superior shoulders, and 1 case with more than one injection. (1)VAS score: compared with pre-injection(Corticosteroid group 5.0(4.0-6.0)and NSAIDS group 5.0(4.0-6.0)), both groups showed significant pain relief at 60 minutes(1.0(1.0-2.0)and 1.0(1.0-2.0)) and 6 weeks(1.5(1.0-2.0)and 1.0(1.0-2.0)) after injection(χ²=47.293, 41.173, 45.174, 40.113; P<0.01). (2)UCLA score: compared with pre-injection(30.2±2.5 and 30.5±3.0), UCLA scores improved significantly in both groups at the 6-week after injection(Corticosteroid group: MD=9.727, t=19.218, P<0.001; NSAID Group: MD=9.579, t=11.467, P<0.01). The UCLA score improvement between the two groups was no statistical difference(all P>0.05). (3)shoulder abduction degree: compared with pre-injection(92.7±9.4 and 93.2±11.6), the abduction degree was significantly improved in both groups at 60 minutes(131.8±9.6 and 127.4±16.6) and 6 weeks(115.9±9. 1 and 127.9±14.4) after the injection, but the improvement in each time point has no statistical correlation(MD=4.450, t=1.069, P=0.292). NSAID group had better improvement of shoulder abduction degree than corticosteroid group at the 6 weeks after the injection(MD=-11.986, t=-3.238, P=0.002). Conclusions: Ultrasound-guided subacromial injection can reduce pain in patients with subacromial impingement syndrome.The effect of injection of NSAID drugs is the same as corticosteroid drugs, it can avoid hormone-induced complications and reduce the repeat of the punctures.

miR-155 Aggravates Liver Ischemia/reperfusion Injury by Suppressing SOCS1 in Mice

Liver ischemia/reperfusion injury (IRI) occurs during partial liver resection and liver transplantation. Activation of Toll-like receptors (TLRs) is a key event triggered by a range of proinflammatory cytokines during liver I/R. Although it has been reported that miR-155 takes part in both innate and adaptive immune responses, the potential role of miR-155 in liver IRI remains unknown. In this study, we found that expression of miR-155 was upregulated during liver I/R by many inflammatory cytokines, and forced expression of miR-155 aggravated hepatocyte injury following liver I/R both in vivo and in vitro. Mice transfected with Ago-miR-155-a chemically modified miR-155-showed enhanced liver severity compared to those transfected with negative control miRNA by inhibiting the expression of SOCS1, the target of miR-155. Thus by the inhibition of SOCS1, the overexpression of miR-155 promoted activation of NF-κB, and elevating the production of proinflammatory cytokines, such TNF-α and IL-6. In conclusion, miR-155 aggravates liver I/R injury in vivo and hepatocyte hypoxia/reoxygenation injury by suppressing the expression of SOCS1.

Neutrophil-to-C3 ratio and neutrophil-to-lymphocyte ratio were associated with disease activity in patients with systemic lupus erythematosus

BACKGROUND

Systemic lupus erythematosus is prone to recurrent attacks, and its treatment is related to disease activities. It is important to accurately assess the patient's disease activity. So, the purpose of this study was to investigate the relation between neutrophil-to-C₃ ratio (NC₃ R), neutrophil-to-lymphocyte ratio (NLR), and disease activity in patients with Systemic lupus erythematosus (SLE).

METHODS

This was a retrospective study. One hundred and ninety-four patients with SLE and 71 healthy controls were included in this study. We divided the patients into two groups according to the SLE disease activity (SLEDAI). Group 1 included patients with a score of >9 (patients with severe disease activity), and Group 2 included patients with a score of 9 and lower (patients with mild disease activity). Correlations between NC₃ R, NLR, and disease activity were analyzed.

RESULTS

NC₃ R and NLR in patients with SLE were obviously higher compared to healthy controls (P < 0.05). There was an obviously significant difference in NC₃ R and NLR between Group 1 and Group 2 (P < 0.05). SLEDAI scores were positively correlated with NC₃ R (r = 0.353, P < 0.01) and NLR (r = 0.237, P = 0.01). Receiver operating characteristic (ROC) curve analysis showed that the cutoff value of NC₃ R to identify SLE with high disease activity was 5.935, with sensitivity and specificity being 75.9% and 67.0%, while that of NLR was 2.293, with sensitivity being 68.9% and specificity being 82.8%.

CONCLUSION

NC₃ R and NLR are two useful inflammatory markers for evaluating disease activity in patients with SLE.

14-3-3η protein: a promising biomarker for rheumatoid arthritis

Effective management of rheumatoid arthritis (RA) depends on early identification followed by timely invention and proper monitoring of treatment responses which remain challenges facing rheumatologists for lacking biomarkers of high sensitivity and specificity. 14-3-3η has been reported to be a novel RA-related biomarker inducing the expression of multiple factors mediating the pathogenesis of RA, and increasing the diagnostic capture when combined with rheumatoid factor and anticyclic citrullinated peptide antibody. Besides, elevated serum 14-3-3η was relevant to more serious joint erosion and worse therapy outcomes. Here, we summarized the emerging knowledge regarding the roles 14-3-3η plays in RA and its clinical implications as diagnostic, prognostic and therapeutic response surrogate as well as potential drug target for RA.

Noninvasive indices for monitoring disease course in Chinese patients with autoimmune hepatitis

OBJECTIVE

Noninvasive and simple tests to forecast cirrhosis is in great need clinically. This study aimed to assess the clinical significance of several noninvasive indices in predicting cirrhosis in Chinese patients with autoimmune hepatitis (AIH).

MATERIALS AND METHODS

Liver function test and blood cell analysis were conducted in 76 AIH patients and 75 paired healthy subjects to calculate aspartate aminotransferase to alanine aminotransferase ratio(AAR), aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4), gamma-glutamyl transferase to platelet ratio (GPR), red blood cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR). Binary logistic regression was performed to analysis the risk factors of liver cirrhosis and receiver operating characteristic (ROC) curve was conducted to evaluate the diagnostic value of each index and compare their diagnostic performance with serum biomarkers commonly used in the clinical setting for liver fibrosis assessing including hyaluronic acid (HA), laminin(LN), procollagen III N terminal peptide (PIIINP) and type IV collagen (ColIV).

RESULTS

AAR, APRI, FIB-4, GPR, NLR and RDW were elevated remarkably in AIH patients with cirrhosis; AAR, FIB-4 and RDW were identified to be independent risk factors of cirrhosis with OR (95%CI) of 3.517 (1.300-9.514), 1.247(1.032-1.506) and 1.414 (1.086-1.842) respectively; ROC analysis showed that the area under the ROC curve (AUC) of AAR, FIB-4 and RDW were 0.801,0.82 and 0.739, with moderate diagnostic value and better than HA, LN, PIIINP and ColIV in identifying those with cirrhosis from AIH patients.

CONCLUSION

AAR, FIB-4 and RDW were independent risk factors of AIH cirrhosis and can be served as reference indices to monitor disease course in AIH.

Immunogenicity of sequential inactivated and oral poliovirus vaccines (OPV) versus inactivated poliovirus vaccine (IPV) alone in healthy infants: A systematic review and meta-analysis

BACKGROUND

The emergence of vaccine-associated paralytic poliomyelitis has become an ongoing burden of poliomyelitis. During this special period from OPV to IPV-only immunization schedule, we did a meta-analysis to compare the immunogenicity of sequential IPV and OPV versus IPV alone in healthy infants.

METHODS

This systematic review and meta-analysis was registered at international prospective register of systematic reviews (PROSPERO), and the number was CRD42017054889. We performed it as described.

RESULTS

Finally, 6 articles were qualified for our review. The results showed that seroconversion rates against all 3 serotype polioviruses were non-inferior and Geometric mean antibody titers (GMTs) were superior in sequential schedules compared with IPV-only schedule. Thus, the sequential vaccination schedules could induce a stronger immunogenicity.

CONCLUSIONS

To decrease vaccine-associated and vaccine-derived poliomyelitis, it is a reasonable option to select sequential schedules during this special transition from OPV to IPV-only immunization schedule, which coincides with the current WHO recommendations.

Nomogram to predict lymph node metastasis in patients with early oesophageal squamous cell carcinoma

Background

Lymph node status is crucial in determining the prognosis for early oesophageal squamous cell carcinoma (SCC). This study aimed to develop and validate a nomogram for the prediction of lymph node metastasis in patients with early SCC.

Methods

A prediction model was developed in a derivation cohort of patients with clinicopathologically confirmed early SCC. Patients who underwent oesophagectomy for pT1 SCC between January 2010 and December 2013 were identified from an institutional database. Risk factors for lymph node metastasis were assessed using a binary logistic regression modelling technique. A nomogram for the prediction of lymph node metastasis was constructed using the results of multivariable analyses. For internal validation, bootstraps with 1000 resamples were performed. The predictive performance of the nomogram was measured by Harrell's concordance index (C-index). An independent cohort from the same hospital was used to validate the nomogram. This cohort included consecutive patients with early SCC who underwent oesophagectomy from January 2014 to December 2015.

Results

The derivation cohort included 281 patients. Four variables associated with lymph node metastasis were included in the model: depth of tumour invasion (odds ratio (OR) 4·37, 95 per cent c.i. 1·59 to 12·03; P = 0·004), grade of differentiation (OR 4·47, 1·02 to 19·70; P = 0·048), tumour size (OR 2·52, 1·11 to 5·75; P = 0·028) and lymphovascular invasion (OR 6·58, 2·54 to 17·05; P &lt; 0·001). The C-index was 0·790 (95 per cent c.i. 0·717 to 0·864) in the derivation cohort and 0·789 (0·709 to 0·869) for the validation cohort (198 patients).

Conclusion

A validated nomogram for patients with early oesophageal SCC can predict the risk of lymph node metastasis.

Clinical significance of detecting HLA-DR, 14-3-3η protein and d-dimer in the diagnosis of rheumatoid arthritis

AIM

To investigate the clinical significance of detecting several biomarkers collectively in the diagnosis of rheumatoid arthritis (RA).

METHODS

128 RA patients, 174 non-RA patients and 80 healthy controls were enrolled. HLA-DR4 and HLA-DR53 were detected by the PCR-SSP method, 14-3-3η protein, anti-CCP and anti-Sa were detected by ELISA and DD was detected by latex immunoturbidimetric assay.

RESULTS

The positive rates of HLA-DR4, HLA-DR53, 14-3-3η protein, anti-CCP and anti-Sa were obviously higher in the RA group (43.8, 38.3, 51.6, 80 and 40.6%, respectively); anti-CCP was of highest sensitivity (79.68%), highest specificity (97.5%) and Youden index (0.77). The AUC of 14-3-3η protein, DD, anti-CCP, anti-Sa were 0.813, 0.859, 0.930, 0.861, respectively.

CONCLUSION

All biomarkers were strongly correlated risk factors for RA; the combination of multiple biomarkers might be of help for diagnostic and therapeutic strategies in RA of recent onset.