Oral anticoagulants for nonvalvular atrial fibrillation in frail elderly patients: insights from the ARISTOPHANES study

BACKGROUND

Patient frailty amongst patients with nonvalvular atrial fibrillation (NVAF) is associated with adverse health outcomes and increased risk of mortality. Additional evidence is needed to evaluate effective and safe NVAF treatment in this patient population.

OBJECTIVES

This subgroup analysis of the ARISTOPHANES study compared the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) amongst frail NVAF patients prescribed nonvitamin K antagonist oral anticoagulants (NOACs) or warfarin.

METHODS

This comparative retrospective observational study of frail, older NVAF patients who initiated apixaban, dabigatran, rivaroxaban or warfarin from 01JAN2013-30SEP2015 was conducted using Medicare and 3 US commercial claims databases. To compare each drug, 6 propensity score-matched (PSM) cohorts were created. Patient cohorts were pooled from 4 databases after PSM. Cox models were used to estimate hazard ratios (HR) of S/SE and MB.

RESULTS

Amongst NVAF patients, 34% (N = 150 487) met frailty criteria. Apixaban and rivaroxaban were associated with a lower risk of S/SE vs warfarin (apixaban: HR: 0.61, 95% CI: 0.55-0.69; rivaroxaban: HR: 0.79, 95% CI: 0.72-0.87). For MB, apixaban (HR: 0.62, 95% CI: 0.57-0.66) and dabigatran (HR: 0.79, 95% CI: 0.70-0.89) were associated with a lower risk and rivaroxaban (HR: 1.14, 95% CI: 1.08-1.21) was associated with a higher risk vs warfarin.

CONCLUSION

Amongst this cohort of frail NVAF patients, NOACs were associated with varying rates of stroke/SE and MB compared with warfarin. Due to the lack of real-world data regarding OAC treatment in frail patients, these results may inform clinical practice in the treatment of this patient population.

Global burden of noncommunicable diseases attributable to high fasting plasma glucose

BACKGROUND

Hyperglycemia is a major public health concern. An understanding of the latest trends of the global burden of noncommunicable diseases (NCDs) by high fasting plasma glucose (HFPG) is critical for determining research priorities and planning health policy.

METHODS

This is a comparative burden-of-disease study. We obtained global, regional, and national data on deaths and disability-adjusted life years (DALYs) of NCDs attributable to HFPG from the Global Burden of Disease Study 2017, performed a secondary analysis of deaths and DALYs by time, age, gender, location, and specific causes, and analyzed their associations.

RESULTS

In 2017, 6.39 million deaths and 166.36 million DALYs from NCDs were attributable to HFPG, accounting for 15.6% and 10.7% of all deaths and DALYs, respectively. The burden's rate decreased with time, increased with age and was significantly higher in males. A negative association was found between the sociodemographic index (SDI) and disease burden, and a positive association was found between SDI and male superiority by gender difference and gender ratio.

CONCLUSIONS

The burden of NCDs attributable to HFPG has increased significantly since 1990 and varied widely across regions. Greater efforts are needed to prevent and control hyperglycemia, especially in less developed countries and among males.

Indirect evaluation of device-endothelialization with cardiac-CT after transcatheter closure of atrial septal defect: how long should antiplatelet therapy last postoperatively?

Background

After transcatheter closure of atrial septal defect (ASD), it is still unclear about the in-vivo process of device-endothelialization in humans, which determines the duration of antiplatelet therapy. Based on contrast-uptake within device, cardiac-CT might have the potential to assess device-endothelialization indirectly.

Purpose

The study was conducted to investigate the status of device-endothelialization with cardiac-CT after transcatheter closure of ASD.

Methods

After more than 6 months of transcatheter ASD closure, cardiac-CT was performed in 119 patients (48M/71F; age: 46.7±14.4 years). According to contrast-uptake within device, complete or incomplete device-endothelialization was determined. In the latter, it was further divided into partial-endothelialization (with filling-defect) and no-endothelialization (without filling-defect). Multivariate logistic regression was used to determine the risk factors of incomplete device-endothelialization. In addition, device-endothelialization was analyzed grossly and histopathologically in 7 patients.

Results

During the implantation-period of 2.57±2.59 years, incomplete device-endothelialization was identified in 43.7% of patients (partial-endothelialization in 36 patients and no-endothelialization in 16 patients). Complete device-endothelialization occurred in 14.3% of patients during 0.5–1 year and 73.8% after one year. After 6-month antiplatelet therapy, migraine restarted in 15 patients with incomplete device-endothelialization and 3 patients with complete device-endothelialization. After one-year antiplatelet therapy, migraine was still detected in 4 of 15 patients with incomplete device-endothelialization. There was a significant association between high in-vivo device-thickness and incomplete device-endothelialization (P<0.001) after adjusted for confounding factors. Pathological findings from 7 patients corresponded well with cardiac-CT.

Conclusions

Cardiac-CT had the potential to evaluate the status of device-endothelialization after transcatheter closure of ASD and there was a good clinico-pathological correlation. Incomplete device-endothelialization was common postoperatively in humans and was associated with device-oversizing. Further research is required to determine the appropriate duration of antiplatelet therapy after device implantation.

Figure 1

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): National Natural Science Foundation of China

Manipulating Complex Hybrid Entanglement and Testing Multipartite Bell Inequalities in a Superconducting Circuit

Quantum correlations in observables of multiple systems not only are of fundamental interest, but also play a key role in quantum information processing. As a signature of these correlations, the violation of Bell inequalities has not been demonstrated with multipartite hybrid entanglement involving both continuous and discrete variables. Here we create a five-partite entangled state with three superconducting transmon qubits and two photonic qubits, each encoded in the mesoscopic field of a microwave cavity. We reveal the quantum correlations among these distinct elements by joint Wigner tomography of the two cavity fields conditional on the detection of the qubits and by test of a five-partite Bell inequality. The measured Bell signal is 8.381±0.038, surpassing the bound of 8 for a four-partite entanglement imposed by quantum correlations by 10 standard deviations, demonstrating the genuine five-partite entanglement in a hybrid quantum system.

MiR-372-3p promotes tumor progression by targeting LATS2 in colorectal cancer

OBJECTIVE

Many studies suggest that microRNAs can promote the malignant development of tumors. MiRNA-372-3p (miR-372-3p) has been proved to be associated with a variety of cancers. However, the role of miR-372-3p in colorectal cancer (CRC) is unclear.

PATIENTS AND METHODS

We analyzed the expression of miR-372-3p in CRC tissues and several CRC cell lines by quantitative Real Time-PCR. The relationship between miR-372-3p and clinical pathology was also analyzed in CRC patients. Kaplan-Meier analysis and Cox multivariate analysis were used to evaluate the prognostic significance of miR-372-3p in CRC. Next, we investigated the biological function of miR-372-3p, including cell proliferation, migration, and invasion and analyzed its potential molecular mechanism in vivo and in vitro.

RESULTS

Our data showed that the expression of miR-372-3p was dramatically increased in CRC tissues compared with normal tissues. Moreover, the high expression of miR-372-3p was significantly correlated with tumor size and differentiation. Kaplan-Meier analysis showed that the high miR-372-3p expression group patients had a significantly shorter recurrence-free survival (RFS) and disease-specific survival (DSS) than those with the low miR-372-3p group. The analysis of the prognostic factors revealed that miR-372-3p was an independent prognostic factor for RFS and DSS in CRC patients. The knockdown of miR-372-3p inhibited the proliferation, migration, and invasion in HCT116 and SW480 cells. Interestingly, the overexpression of LATS2 partially reversed the miR-372-3p -mediated cell proliferation, migration, and invasion of CRC. Besides, the Hippo signaling pathway was demonstrated to be activated by decreasing of miR-372-3p in CRC. Thus, our study revealed that miR-372-3p is involved in CRC progression by inhibiting the Hippo signaling pathway through its target LATS2. MiR-372-3p and its target genes with signaling pathways are new hope for precise treatment of CRC.

CONCLUSIONS

The upregulation of miR-372-3p was involved in the process of CRC progression by inhibiting the Hippo signaling pathway through inhibition of LATS2. We showed that miR-372-3p and its target genes with signaling pathways are a novel hope for precise treatment of CRC.

Observation of the Doubly Cabibbo-Suppressed Decay D^{+}→K^{+}π^{+}π^{-}π^{0} and Evidence for D^{+}→K^{+}ω

Using 2.93  fb^{-1} of e^{+}e^{-} collision data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, the first observation of the doubly Cabibbo-suppressed decay D^{+}→K^{+}π^{+}π^{-}π^{0} is reported. After removing decays that contain narrow intermediate resonances, including D^{+}→K^{+}η, D^{+}→K^{+}ω, and D^{+}→K^{+}ϕ, the branching fraction of the decay D^{+}→K^{+}π^{+}π^{-}π^{0} is measured to be (1.13±0.08_{stat}±0.03_{syst})×10^{-3}. The ratio of branching fractions of D^{+}→K^{+}π^{+}π^{-}π^{0} over D^{+}→K^{-}π^{+}π^{+}π^{0} is found to be (1.81±0.15)%, which corresponds to (6.28±0.52)tan^{4}θ_{C}, where θ_{C} is the Cabibbo mixing angle. This ratio is significantly larger than the corresponding ratios for other doubly Cabibbo-suppressed decays. The asymmetry of the branching fractions of charge-conjugated decays D^{±}→K^{±}π^{±}π^{∓}π^{0} is also determined, and no evidence for CP violation is found. In addition, the first evidence for the D^{+}→K^{+}ω decay, with a statistical significance of 3.3σ, is presented and the branching fraction is measured to be B(D^{+}→K^{+}ω)=(5.7_{-2.1}^{+2.5}_{stat}±0.2_{syst})×10^{-5}.

Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025

Diabetes mellitus is a leading cause of mortality and reduced life expectancy. We aim to estimate the burden of diabetes by type, year, regions, and socioeconomic status in 195 countries and territories over the past 28 years, which provide information to achieve the goal of World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2025. Data were obtained from the Global Burden of Disease Study 2017. Overall, the global burden of diabetes had increased significantly since 1990. Both the trend and magnitude of diabetes related diseases burden varied substantially across regions and countries. In 2017, global incidence, prevalence, death, and disability-adjusted life-years (DALYs) associated with diabetes were 22.9 million, 476.0 million, 1.37 million, and 67.9 million, with a projection to 26.6 million, 570.9 million, 1.59 million, and 79.3 million in 2025, respectively. The trend of global type 2 diabetes burden was similar to that of total diabetes (including type 1 diabetes and type 2 diabetes), while global age-standardized rate of mortality and DALYs for type 1 diabetes declined. Globally, metabolic risks (high BMI) and behavioral factors (inappropriate diet, smoking, and low physical activity) contributed the most attributable death and DALYs of diabetes. These estimations could be useful in policy-making, priority setting, and resource allocation in diabetes prevention and treatment.

Global burden of noncommunicable disease attributable to high body mass index in 195 countries and territories, 1990-2017

PURPOSE

The increasing burden of noncommunicable diseases (NCDs) attributable to high body mass index (BMI) represents both a threat and an opportunity for intervention. Estimates of the global latest trend of high BMI-related NCDs and its association with socioeconomic status can facilitate strategic intervention and inform further research.

METHODS

This global burden of disease study extracted global, regional, and national data on death and disability-adjusted life years (DALYs) attributable to high BMI-related NCDs from the GBD Study 2017. Secondary analyses were performed by year, age, sex, and specific causes of death and DALYs. The 2017 Socio-demographic Index (SDI) was used as an indicator of national socioeconomic status. The association between age-standardized death or DALYs rate and socioeconomic status were analyzed.

RESULTS

Worldwide, 4.7 million deaths and 147.7 million DALYs of NCDs were related to high BMI in 2017, with a projection to 5.5 million deaths and 176.9 million DALYs in 2025. Globally, high BMI-related burden showed an increasing trend with males being more heavily impacted overall. The trend and magnitude of high BMI-related disease burden varied substantially in different geographical and socioeconomic regions. Specifically, the low-middle, middle, and high-middle SDI countries were associated with a higher burden. The leading three causes of DALYs attributable to high BMI in 2017 were ischemic heart diseases, stroke, and diabetes mellitus.

CONCLUSIONS

High BMI-related burden of NCDs is worsening, particularly in developing countries. Our findings may enhance public awareness of interventions to reduce the diseases burden caused by high BMI.

Σ^{+} and Σ[over ¯]^{-} Polarization in the J/ψ and ψ(3686) Decays

From 1310.6×10^{6}  J/ψ and 448.1×10^{6}  ψ(3686) events collected with the BESIII experiment, we report the first observation of Σ^{+} and Σ[over ¯]^{-} spin polarization in e^{+}e^{-}→J/ψ[ψ(3686)]→Σ^{+}Σ[over ¯]^{-} decays. The relative phases of the form factors ΔΦ have been measured to be (-15.5±0.7±0.5)° and (21.7±4.0±0.8)° with J/ψ and ψ(3686) data, respectively. The nonzero value of ΔΦ allows for a direct and simultaneous measurement of the decay asymmetry parameters of Σ^{+}→pπ^{0}(α_{0}=-0.998±0.037±0.009) and Σ[over ¯]^{-}→p[over ¯]π^{0}(α[over ¯]_{0}=0.990±0.037±0.011), the latter value being determined for the first time. The average decay asymmetry, (α_{0}-α[over ¯]_{0})/2, is calculated to be -0.994±0.004±0.002. The CP asymmetry A_{CP,Σ}=(α_{0}+α[over ¯]_{0})/(α_{0}-α[over ¯]_{0})=-0.004±0.037±0.010 is extracted for the first time, and is found to be consistent with CP conservation.

A predictive survival model for patients with head and neck squamous cell carcinoma treated with immune check point inhibitors

BACKGROUND

ICIs have expanded treatment options for HNSCC. A minority of the patients respond to these expensive treatments.

PATIENTS AND METHODS

This is a single institutional retrospective review on 121 unresectable or metastatic HNSCC patients treated with ICIs. We predicted that inflammatory markers available through routine blood work, in addition to clinical characteristics may divide patients into groups more or less likely to respond to these agents. Here we develop and internally validate our nomogram to predict survival in patients treated with ICIs.

Measurements of Absolute Branching Fractions of Fourteen Exclusive Hadronic D Decays to η

Using 2.93  fb^{-1} of e^{+}e^{-} collision data taken at a center-of-mass energy of 3.773 GeV with the BESIII detector, we report the first measurements of the absolute branching fractions of 14 hadronic D^{0(+)} decays to exclusive final states with an η, e.g., D^{0}→K^{-}π^{+}η, K_{S}^{0}π^{0}η, K^{+}K^{-}η, K_{S}^{0}K_{S}^{0}η, K^{-}π^{+}π^{0}η, K_{S}^{0}π^{+}π^{-}η, K_{S}^{0}π^{0}π^{0}η, and π^{+}π^{-}π^{0}η; D^{+}→K_{S}^{0}π^{+}η, K_{S}^{0}K^{+}η, K^{-}π^{+}π^{+}η, K_{S}^{0}π^{+}π^{0}η, π^{+}π^{+}π^{-}η, and π^{+}π^{0}π^{0}η. Among these decays, the D^{0}→K^{-}π^{+}η and D^{+}→K_{S}^{0}π^{+}η decays have the largest branching fractions, which are B(D^{0}→K^{-}π^{+}η)=(1.853±0.025_{stat}±0.031_{syst})% and B(D^{+}→K_{S}^{0}π^{+}η)=(1.309±0.037_{stat}±0.031_{syst})%, respectively. The charge-parity asymmetries for the six decays with highest event yields are determined, and no statistically significant charge-parity violation is found.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

Experimental Implementation of Universal Nonadiabatic Geometric Quantum Gates in a Superconducting Circuit

Using geometric phases to realize noise-resilient quantum computing is an important method to enhance the control fidelity. In this work, we experimentally realize a universal nonadiabatic geometric quantum gate set in a superconducting qubit chain. We characterize the realized single- and two-qubit geometric gates with both quantum process tomography and randomized benchmarking methods. The measured average fidelities for the single-qubit rotation gates and two-qubit controlled-Z gate are 0.9977(1) and 0.977(9), respectively. Besides, we also experimentally demonstrate the noise-resilient feature of the realized single-qubit geometric gates by comparing their performance with the conventional dynamical gates with different types of errors in the control field. Thus, our experiment proves a way to achieve high-fidelity geometric quantum gates for robust quantum computation.

THU0048 THE FUNCTION CHANGES OF SNPS IN THE P2X7 RECEPTOR BY ALA348TO THR, GLU496TO ALA AND ARG307TO GLN IN THP-1 CELLS WITH HIGH URIC ACID

Background:

Previous studies[1] have shown that ATP acts on the sputum receptor P2X ligand-gated ion channel 7 (P2X7R) as a second signal to induce gouty arthritis.

Objectives:

In this study, the functional changes of three SNP genotypes, Ala348 to Thr, Glu 496 to Ala and Arg307 to Gln, in P2X7R were analyzed with high uric acid.

Methods:

After transfection of HEK-293T cells by lentivirus, observing the uptake ability of HEK-293T cells to ethidium bromide. The effect of three different mutants on the P2X7 receptor was thus observed on the P2X7 channel. In addition, THP-1 cells were also transfected, stable expression of a THP-1 cell line that has been transfected with a wild-type or different mutants and thus established. Then three types were set up separately, and each type was randomized into three groups: MSU(labeled M), MSU+ATP (labeled MA), and unstimulated control group (labeled C).Detection of IL-1β protein expression level in serum by ELISA and NLRP3, ASC and Caspase-1 mRNA levels in transfected THP-1 cells by qRT-PCR.

Results:

1.These three variants have different effects on the uptake function of ATP-induced ethidium+bromide in transfection of HEK-293T cells by lentivirus. Ala348to Thr increased P2X7-dependent ethidium+bromide uptake (145% of wild-type P2X7response, P<0.001). In contrast, Absent or very reduced P2X7function was found in Glu496to Ala and Arg307to Gln subjects, appeared to abolish P2X7-dependent dye uptake (38% and 32% of wild-type P2X7responses, P<0.001,), who were compared with wild-type.

2.Compared the IL-1β levels of the three variants with the wide-type and empty virus in THP-1 cells, the Ala348to Thr mutation significantly up-regulated the serum levels of IL-1β compared with the wide-type and empty virus in group MA with high uric acid (P=0.0007;P=0.013, respectively). Moreover, similar results have also been shown in IL-1β mRNA expressions (P=0.0334; P=0.0307, respectively). The Glu496to Ala and Arg307to Gln mutations down-regulated the serum levels of IL-1β compared with the wide-type in group MA (P=0.0189;P=0.0164, respectively).

3.NLRP3 mRNA was significantly increased in the Ala348to Thr mutation compared with the wide-type and empty virus in group MA (p =0.0003;P=0.0001, respectively). However, NLRP3 mRNA was significantly reduced in the Glu496to Ala and Arg307to Gln mutations compared with the wide-type in group MA (p =0.0294;P=0.0279, respectively).

4.Wild-type was signifcantly higher than empty virus in the ASC gene expression in group MA(P=0.0022). Morever, the Ala348to Thr mutation was higher than empty virus while Arg307to Gln mutation was lower than that in group MA (P=0.0138;P=0.0283, respectively).

5.Unlike NLRP3 gene expression, the data showed that the expression of caspase-1 mRNA in group C, M and MA all with no statistical significance, respectively (P>0.05).

Conclusion:

Our data revealed that Ala348to Thr up-regulate the functional status of P2X7R and Glu496to Ala and Gln460to Arg down-regulate the functional status of P2X7R, which resulted in a significant increase or decrease in IL-1β and NLRP3 expression levels with high uric acid.

References:

[1]Tao JH, Zhang Y, Li XP, et al. P2X7R: a potential key regulator of acute gouty arthritis[J].Semin Arthritis Rheum, 2013,43(3):376–380.

Disclosure of Interests:

None declared

Self-made Salmonella Pullorum agglutination antigen development and its potential practical application

Pullorum disease caused by Salmonella Pullorum is one of the most important infectious diseases in the poultry industry worldwide, which leads to serious economic losses in many developing countries because of its high mortality rate in young chicks. The traditional slide agglutination test with low cost, fast reaction, and on-site detection has been widely used in the diagnosis of Pullorum disease. However, in practice, the test performance is with the disadvantages of false positive results and unstable detection results. In this paper, we developed self-made agglutination antigens prepared by local isolates in the poultry farm and compare the detection performance with commercial agglutination antigens (China Institute of Veterinary Drug Control) and Group D Salmonella ELISA kit (BioChek UK Ltd). The results of detecting 200 serum samples indicated that the consistency of commercial agglutination antigen detecting in 2 times was only 79.5%. Using the ELISA kit as the reference method, the commercial agglutination antigen detecting results of the Kappa test were only moderately consistent (0.58 ∼ 0.59). Meanwhile, positive and total coincidence rates of the self-made agglutination antigen test with more reliable repeat could reach 97.4 and 88%, respectively, and the result of Kappa test was highly consistent (0.75). The Receiver Operating Characteristic curve analysis clarified that the area under the receiver-operating-characteristic curve values of self-made and commercial agglutination antigen tests could reach 0.861 and 0.804, respectively. These results were coincident when detecting known positive serum from the infected chickens. It's worth mentioning that the visible positive reaction of self-made agglutination antigen test appeared faster and stronger than commercial antigen test. In conclusion, self-made Salmonella Pullorum agglutination antigen developed in this study was much better than commercial agglutination antigen and is expected to be a valuable tool in the diagnosis of the epidemiology of Salmonella Pullorum.

Observation of a Resonant Structure in e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0}

A partial-wave analysis is performed for the process e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0} at the center-of-mass energies ranging from 2.000 to 2.644 GeV. The data samples of e^{+}e^{-} collisions, collected by the BESIII detector at the BEPCII collider with a total integrated luminosity of 300  pb^{-1}, are analyzed. The total Born cross sections for the process e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0}, as well as the Born cross sections for the subprocesses e^{+}e^{-}→ϕπ^{0}π^{0}, K^{+}(1460)K^{-}, K_{1}^{+}(1400)K^{-}, K_{1}^{+}(1270)K^{-}, and K^{*+}(892)K^{*-}(892), are measured versus the center-of-mass energy. The corresponding results for e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0} and ϕπ^{0}π^{0} are consistent with those of BABAR with better precision. By analyzing the cross sections for the four subprocesses, K^{+}(1460)K^{-}, K_{1}^{+}(1400)K^{-}, K_{1}^{+}(1270)K^{-}, and K^{*+}(892)K^{*-}(892), a structure with mass M=(2126.5±16.8±12.4)  MeV/c^{2} and width Γ=(106.9±32.1±28.1)  MeV is observed with an overall statistical significance of 6.3σ, although with very limited significance in the subprocesses e^{+}e^{-}→K_{1}^{+}(1270)K^{-} and K^{*+}(892)K^{*-}(892). The resonant parameters of the observed structure suggest it can be identified with the ϕ(2170), thus the results provide valuable input to the internal nature of the ϕ(2170).

Positive intergroup contact modulates fusiform gyrus activity to black and white faces

In this study, we investigated the effect of intergroup contact on processing of own- and other-race faces using functional Magnetic Resonance Imaging (fMRI). Previous studies have shown a neural own-race effect with greater BOLD response to own race compared to other race faces. In our study, white participants completed a social-categorization task and an individuation task while viewing the faces of both black and white strangers after having answered questions about their previous experiences with black people. We found that positive contact modulated BOLD activity in the right fusiform gyrus (rFG) and left inferior occipital gyrus (lIOC), regions associated with face processing. Within these regions, higher positive contact was associated with higher activity when processing black, compared to white faces during the social categorisation task. We also found that in both regions a greater amount of individuating experience with black people was associated with greater activation for black vs. white faces in the individuation task. Quantity of contact, implicit racial bias and negatively valenced contact showed no effects. Our findings suggest that positive contact and individuating experience directly modulate processing of out-group faces in the visual cortex, and illustrate that contact quality rather than mere familiarity is an important factor in reducing the own race face effect.

[Feasibility and efficacy of percutaneous pulmonary vein stenting for the treatment of patients with severe pulmonary vein stenosis due to fibrosing mediastinitis]

Objective: To evaluate the feasibility and safety percutaneous pulmonary vein intervention in patients with severe pulmonary vein stenosis (PVS) caused by fibrosing mediastinitis(FM). Methods: This retrospective analysis included 5 FM patients (2 male, 3 female, 54-77 years old) confirmed by clinical presentation and chest computed tomography (CT) scan from January to June 2018 who were from Gansu Provincial Hospital and Shanghai Chest Hospital. CT pulmonary angiography (CTPA) further revealed severe PVS caused by fibrotic tissue compression in mediastinum. After selective pulmonary vein angiography, gradually balloon angioplasty was used to expand the pulmonary vein and then stents were implanted in the pre-dilated stenotic pulmonary veins. Evaluation of therapeutic effect was made at 6 months after the procedure. Results: All of 11 serious compression PVS were treated with stent implantation (diameter: 7-10 mm, length: 17-27 mm). After stenting, degree of pulmonary vein stenosis decreased from (83±16)% to (12±4)% (P<0.01). The minimal diameter of the stenotic pulmonary vein was significantly increased from (0.8±0.5)mm to (7.5±0.8)mm (P<0.01). Trans-stenotic gradient decreased from (27.0±15.1)mmHg (1 mmHg=0.133 kPa) to (2.50±0.58)mmHg (P<0.05). Mean pulmonary pressure measured by cardiac catheter decreased from (45.0±9.0)mmHg to (38.7±8.4)mmHg (P<0.05). One patient experienced cardiac arrest due to vagal nerve reflex during big sizing balloon stent dilation and recovered after cardiopulmonary resuscitation. There were no other serious procedure related complications. During the follow-up, severe stenosis at end of proximal stent was evidenced in 1 patient due to fibrotic compression, and another patient developed in-stent thrombosis due to discontinuation of prescribed anticoagulant. Conclusion: Percutaneous intervention for severe pulmonary vein stenosis caused by FM is feasible and safe, and can improve hemodynamic caused by the compression of mediastinal vascular structures in these carefully selected patients.

4284The combined use of radiofrequency-ablation and balloon-dilation (CURB) in the creation of a stable inter-atrial communication: first-in-man use for patients with severe pulmonary arterial hypertension

Background

Recent preclinical research has suggested that combined use of radiofrequency-ablation and balloon-dilation (CURB) had the potential to create a stable inter-atrial communication. However, the related clinical data is still absent.

Purpose

This study describes the first-in-man use of CURB in the patients with severe pulmonary arterial hypertension (PAH).

Methods

Under the guidance of fluoroscopy and intra-cardiac echocardiography, CURB was attempted in 3 patients with severe PAH (age: 35.0±12.1 years, one idiopathic PAH and two PAH related to repaired congenital heart disease). With the aid of 3D location system, fossae ovalis was ablated with radiofrequency. Then the graded balloon-dilation was performed after transseptal puncture, and radiofrequency-ablation was repeated around the rim of fenestration created with balloon-dilation. The exercise capacity and fenestration-size were followed up.

Results

CURB was performed successfully in all 3 patients, and pulmonary vascular resistance was 30.3±10.9 Wood units. The fenestration size was 5.0±1.0 mm (range: 4–6 mm), and systemic arterial oxygen saturation decreased by 4.7±0.6% (range: 4–5%). World Health Organization functional class increased by 1.6±0.5 (P<0.001) and cardiac index increased by 0.58±0.34 L/min/m2 (P<0.001). In addition, exercise capacity improved significantly (+63.7 meters, P<0.001). Follow-up (6.0±1.0 months; range: 5–7 months) showed that all fenestrations were stable (P=0.808), and no complication occurred.

Figure 1. The combined use of radiofrequency-ablation and balloon-dilation (CURB) was performed in the patient with severe PAH. Left figures showed the procedure of CURB. Middle figures showed the created fenestration with MSCT, and the morphology and size of fenestration was provided in the right-inferior panel. In addition, the sizes of right atrium and ventricle were alleviated with increase of left atrium. Right figures indicated that the fenestration-size was stable during follow-up (one week, one month and six months, respectively).

Conclusions

In patients with severe PAH, CURB is feasible and effective to create a stable inter-atrial communication. Further research was required to evaluate the long-term result of this novel approach.

ClinicalTrials.gov ID: NCT03554330.

Acknowledgement/Funding

National Natural Science Foundation of China (81670283) and Beijing Natural Science Foundation (7162160)

Measurement of the cosmic ray proton spectrum from 40 GeV to 100 TeV with the DAMPE satellite

The precise measurement of the spectrum of protons, the most abundant component of the cosmic radiation, is necessary to understand the source and acceleration of cosmic rays in the Milky Way. This work reports the measurement of the cosmic ray proton fluxes with kinetic energies from 40 GeV to 100 TeV, with 2 ¹/₂ years of data recorded by the DArk Matter Particle Explorer (DAMPE). This is the first time that an experiment directly measures the cosmic ray protons up to ~100 TeV with high statistics. The measured spectrum confirms the spectral hardening at ~300 GeV found by previous experiments and reveals a softening at ~13.6 TeV, with the spectral index changing from ~2.60 to ~2.85. Our result suggests the existence of a new spectral feature of cosmic rays at energies lower than the so-called knee and sheds new light on the origin of Galactic cosmic rays.

The LEPR K109R and Q223R Might Contribute to the Risk of NAFLD: A Meta-Analysis

BACKGROUND

Leptin and insulin resistance have been pointed out to play a role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). Increasing genes were shown to be associated with the risk of NAFLD.

OBJECTIVE

The study aimed to investigate the genetic association between two leptin receptor (LEPR) polymorphisms (Q223R and K109R) and the NAFLD risk.

METHODS

Studies were retrieved and included by using PubMed, Web of Science, the Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI) and EMBASE database. Genetic associations were assessed with pooled odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Five case-control studies with 1711 NAFLD patients and 1732 healthy controls were included in this meta-analysis. The K109R was significantly associated with NAFLD in allelic model in Southeast Asian subgroup (p=0.01, OR=0.59, 95% CI [0.39- 0.90]), but not in Chinese subgroup (p=0.24, OR=1.10, 95% CI [0.94-1.29]). The Q223R was significantly associated with NAFLD in both allelic and recessive models (allelic model: p<0.001, OR=0.57, 95% CI [0.50-0.65]; recessive model: p=0.001, OR=0.67, 95% CI [0.52-0.85]). However, subgroup analysis showed that the significant association between Q223R and NAFLD in allelic model cannot be found in Southeast Asians subgroup (p=0.07, OR=0.67, 95% CI [0.52-0.85]).

CONCLUSION

LEPR K109R might be a susceptible factor for NAFLD in Southeast Asian population. And LEPR Q223R might be a susceptible factor for NAFLD in Chinese population.

[Expression of PD-1 and PD-L1 in the peripheral blood of advanced non-small-cell lung cancer patients and its implications]

Objective: To investigate the expression of programmed death 1(PD-1) and programmed death ligand 1 (PD-L1) on T lymphocyte and monocyte from peripheral blood of advanced non-small-cell lung cancer (NSCLC) patients and its potential role in immune escape of NSCLC. Methods: Forty-eight patients with advanced NSCLC (Lung Cancer Group) were included from the Department of Respiratory Diseases in The Second Affiliated Hospital of Soochow University from June 2014 to June 2015. Thirty-six healthy volunteers who received health examination at the same time, matching in sex, age were also enrolled as controls. The expression of PD-1 on peripheral blood CD4(+)T cells and CD8(+)T cells and PD-L1 on monocytes were detected by flow cytometry. Patients who received chemotherapy alone for 2-4 cycles and received sequential sampling were assessed with Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1). Seven cases of patients with significant response to treatment were selected as partial response (PR) group and ten patients with poor response to treatment were treated as progression disease(PD) group. The differences in the expression of PD-1 on the surface of CD4(+)T cells, CD8(+)T cells, and PD-L1 on the surface of monocyte before and after treatment were analyzed. Results: Compared with healthy control group, PD-1 expression level on both CD4(+) T and CD8(+) T cells from peripheral blood in lung cancer group were significantly increased [(25.9±7.4)% vs (20.6±6.2)%, (19.9±9.8)% vs (14.0±5.6)%, both P<0.05]. A higher level of PD-L1 expression on monocyte in lung cancer group was also found compared with the control group [(33.1±15.1)% vs (13.6±5.3)%, P<0.001]. The expression level of PD-1 on CD4(+)T and CD8(+)T cells and PD-L1 on monocytes in lung cancer group with good response to treatment was relatively lower than the baseline level of before treatment [(22.8±8.5)% vs (25.9±7.8)%, (17.1±8.4)% vs (20.4±8.6)%, (18.1±6.9)% vs (31.3±13.2)%, all P<0.05], but in lung cancer group with poor response to treatment, it was higher than the baseline level of before treatment [(33.5±6.5)% vs (23.9±4.2)%, (25.2±9.1)% vs (19.1±8.8)%, (43.1±18.3)% vs (29.7±10.6)%, all P<0.05]. Conclusion: Abnormal expression of PD-1 and PD-L1 exists in T cells and monocytes respectively, prompting PD-1/PD-L1 pathway may inhibit T cell proliferation during the interaction of T cell and monocyte, which may lead to non-small cell lung cancer immune escape.

Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke

BACKGROUND AND PURPOSE

Tirofiban is used off-label in clinical practice for acute ischaemic stroke (AIS). However, it is unknown whether tirofiban increases the bleeding risk or improves the outcome of endovascular treatment (EVT) in AIS. This study evaluated the efficacy and safety of tirofiban in combination with EVT for AIS.

METHODS

Consecutive patients with AIS receiving EVT were included in the prospective stroke registry from 2015 to 2018. The efficacy outcomes were modified Rankin Scale (mRS) score at 3 months and National Institutes of Health Stroke Scale (NIHSS) score at 24 h. The safety outcomes were symptomatic intracerebral hemorrhage (sICH), any in-hospital intracerebral hemorrhage, in-hospital death and 3-month death.

RESULTS

Of 211 patients, 82 (38.9%) received tirofiban. A total of 39 (48.1%) with tirofiban and 44 (36.1%) without tirofiban had mRS score 0-2 [adjusted odds ratio (OR), 2.41; 95% confidence interval (CI), 1.11-5.23, P = 0.026]. NIHSS score at 24 h was lower in the tirofiban group (9.5 vs. 12.0, adjusted P = 0.032). Five (6.1%) patients with tirofiban and 16 (12.4%) without tirofiban had sICH (adjusted OR, 0.54; 95% CI, 0.16-1.83, P = 0.32). In-hospital intracerebral hemorrhage occurred in 10 (12.2%) patients with tirofiban and 41 (31.8%) without tirofiban (adjusted OR, 0.32; 95% CI, 0.13-0.76, P = 0.01). In-hospital death occurred in 7 (8.5%) patients with tirofiban and 16 (12.4%) without tirofiban (adjusted OR, 0.69; 95% CI, 0.22-2.13, P = 0.52). A total of 13 (15.9%) patients with tirofiban and 22 (17.1%) without tirofiban were dead at 3 months (adjusted OR, 0.98; 95% CI, 0.40-2.40, P = 0.96).

CONCLUSIONS

Tirofiban in combination with EVT was associated with a lower mRS score at 3 months and NIHSS score at 24 h. It was not associated with a higher rate of sICH, in-hospital death and death at 3 months.

[Hydrogen can alleviate post-cardiac arrest myocardium injury in rabbits]

OBJECTIVE

To investigate the effects of hydrogen (H₂) on myocardium injury post-cardiac arrest (CA) in rabbits.

METHODS

Sixty New Zealand rabbits were randomly divided into H₂ treatment group (n = 30) and control group (n = 30) by random number table. The rabbit CA model was established by means of electrical stimulation of external membrane, both groups were mechanically ventilated. Cardiopulmonary resuscitation (CPR) was performed after 6 minutes of nonintervention, and stopped after restoration of spontaneous circulation (ROSC). Inhalation of 2% H₂ gas was conferred to rabbits immediately at the end of CA modeling for 72 hours in H₂ treatment group. Air was given to rabbits in control group instead. The survival rate of rabbits was analyzed. Heart rate, ventricular premature beat frequency, and the levels of blood samples cardiac troponin I (cTnI), left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP), and blood lactic acid (Lac) were collected before CA and after ROSC in all rabbits. Rabbits were sacrificed and microstructure injury was observed by electric microscope after ROSC 72 hours.

RESULTS

There were 28 animals ROSC in both groups; the survival number in H₂ treatment group was higher than that in control group at 72 hours after ROSC (number: 15 vs. 7, χ² = 4.791, P = 0.029). In the early stage of ROSC, the heart rate of two groups slowed down, the number of premature ventricular increased, and then gradually recovered; the heart rate in H₂ treatment group was returning to normal more quickly than that in control group at 48 hours after ROSC (bpm: 319±63 vs. 362±40, P < 0.05); the ventricular premature beat frequency was lower than that in control group at 72 hours after ROSC (times per minutes: 9.1±4.3 vs. 15.0±8.0, P < 0.05). The animals of two groups had different degrees of myocardial damage and cardiac insufficiency after ROSC, and restored with the extension of time. Compared with control group, the level of BNP in H₂ treatment group was significant decreased at 24 hours after ROSC (ng/L: 385±98 vs. 488±174, P < 0.05), the levels of cTnI and Lac were significant decreased at 48 hours after ROSC [cTnI (μg/L: 1.83±0.68 vs. 2.83±0.98, Lac (mmol/L): 5.5±1.6 vs. 7.9±2.6, both P < 0.01], the LVEF was slightly higher than that at 72 hours after ROSC (0.690±0.040 vs. 0.650±0.041, P = 0.051). Compared with control group, less damage to myocardial ultra structure was found in H₂ treatment group at 72 hours after ROSC.

CONCLUSIONS

Inhalation of H₂ alleviates cardiac dysfunction and myocardial injury after CPR.

[Human ear finite element model study of the effects of ear canal and middle ear cavity on air conduction and bone conduction]

Objective:To study the influence of the ear canal and middle ear cavity on air conduction and bone conduction. Method:A finite element model of the human middle ear was established. By establishing the external ear canal and the middle ear cavity, we evaluated the effects of the external canal and the middle ear cavity on air conduction and bone conduction. Result:In air conduction, the external canal improved the stapes response at the frequency range of 0.5 kHz to 6 kHz, and the maximum increase was 11 dB at 3 kHz. The middle ear cavity mainly reduced the response of stapes at mid-low frequency, with the drops of 2-4 dB under 2 kHz; in bone conduction, ear canal slightly reduced the low-frequency response, but increased the response of the stapes at the mid-high frequency, with a maximum increase of 1.9 dB at 1.5 kHz. The middle ear cavity mainly increased the stapes response at mid-frequency near 1.5 kHz, with a maximum increase of 2.5 dB. Conclusion:Our results show that, in air conduction, the ear canal significantly increases the middle-frequency response, while the middle ear cavity decreases the low-mid frequency response. Whereas, the ear canal and the middle ear cavity have slightly effect on bone conduction.

Abstract P2-06-02: Development of a first-in-class small molecule inhibitor (EC359) targeting oncogenic LIF/LIFR signaling for the treatment of triple negative breast cancer

Background: Leukemia inhibitory factor (LIF) and its receptor LIFR are over-expressed in multiple solid tumors and play a key role in tumor growth, progression, and resistance to standard anti-cancer treatments. Triple-negative breast cancer (TNBC) lacks targeted therapies and represents a disproportional share of breast cancer (BCa) mortality. TNBC exhibits autocrine stimulation of the LIF/LIFR axis and overexpression of LIF is associated with poorer relapse-free survival in BCa patients. LIF signaling also promotes maintenance of stem cells. Therefore, targeting the LIF/LIFR axis may have therapeutic utility in TNBC.

Methods: We rationally designed a small organic molecule (EC359) that emulates the LIF/LIFR binding site and functions as a LIFR inhibitor from a library of compounds. In silico docking studies were used to identify the putative interaction of the EC359 and LIF/LIFR complex. Direct binding of EC359 to LIFR was confirmed using surface plasmon resonance (SPR) and microscale thermophoresis technique (MST) assays. In vitro activity was tested using Cell-Titer Glo, MTT, invasion, and apoptosis assays. Mechanistic studies were conducted using Western blot, reporter gene assays, and RNA-seq analysis. Xenograft, patient-derived xenograft (PDX), and patient-derived explant (PDEX) models were used for preclinical evaluation and toxicity.

Results: Molecular docking studies showed that EC359 interacts at the LIF/LIFR binding interface. SPR and MST studies confirmed direct interaction of EC359 to LIFR. EC359 reduced the growth of TNBC cells with high potency (IC50 50-100nM) and promoted apoptosis. Further, EC359 treatment reduced invasion and stemness of TNBC cells. EC359 activity is dependent on the expression levels of LIFR and showed little or no activity on TNBC cells that have low levels of LIFR or ER+ve BCa cells. Further, EC359 significantly reduced the viability of cisplatin and taxane-resistant TNBC cells and enhanced the efficacy of HDAC inhibitors. Mechanistic and biochemical studies showed that EC359 interacts with LIFR and effectively blocking LIF/LIFR interactions. EC359 also blocked LIFR interactions with other LIFR ligands such as oncostatin M, ciliary neurotrophic factor, and cardiotrophin-1. EC359 treatment attenuated the activation of LIF/LIFR driven pathways including STAT3, mTOR, AKT, and MAPK. RNA-seq analysis identified regulation of apoptosis as one of the important pathway modulated by EC359. In TNBC xenograft and PDX assays, EC359 significantly reduced tumor progression. Further, using human primary BCa PDEX cultures, we demonstrated that EC359 has the potential to substantially reduce the proliferation of human BCa. Pharmacologically, EC359 exhibited high oral bioavailability and long half-life with a wide therapeutic window.

Conclusions: EC359 is a novel targeted therapeutic agent that inhibits LIF/LIFR oncogenic signaling in TNBC via a unique mechanism of action. EC359 has the distinct pharmacologic advantages of oral bioavailability, in vivo stability, and is associated with minimal systemic side effects. (DOD BCRP grant #BC170312)

Citation Format: Viswanadhapalli S, Luo Y, Sareddy GR, Santhamma B, Zhou M, Li M, Pratap UP, Altwegg KA, Li X, Srinivasan U, Ma S, Chang A, Riveros AC, Zhang KY, Dileep KV, Pan X, Murali R, Bajda M, Raj G, Brenner A, Manthati V, Rao M, Tekmal RR, Nair HB, Nickisch KJ, Vadlamudi RK. Development of a first-in-class small molecule inhibitor (EC359) targeting oncogenic LIF/LIFR signaling for the treatment of triple negative 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 P2-06-02.

Abstract P1-12-13: Initial report of a prospective, pilot study of patient-reported upper extremity dysfunction in women undergoing radiation for breast cancer

Objectives: Upper extremity dysfunction (UED) is a known side effect of breast cancer treatment. It is unclear, however, to what degree radiation contributes to this morbidity. We aimed to characterize the level of UED using patient-reported outcomes (PROs) prior to, during, and after treatment with radiation for breast cancer. Our secondary aims were to evaluate the association of UED with pain scores.

Methods: This is a single-institution, prospective, longitudinal cohort study of patients treated with radiation for breast cancer. The validated patient-reported outcome measure, Quick Disabilities of the Arm, Shoulder and Hand (QD) was used to capture UED prior to radiation, at the end of radiation, and 1 month following the completion of radiation. Pain scores were also collected at these intervals using the numeric pain reporting scale (NPRS) from 0 (no pain) to 10 (worst pain).

Results: Forty-four patients were enrolled on this study and 43 (97.7%) had completed radiation at the time of analysis. Thirteen patients (29.5%) were treated with mastectomy, axillary lymph node dissection and regional nodal irradiation in the supine position. The other 31 (70.5%) patients underwent lumpectomy and sentinel lymph node biopsy. Of these patients, 26 (83.9%) were treated in the prone position and 30 (96.8%) received whole breast irradiation. Median time from surgery to radiation was 69 days (range 35 – 212 days), 76 days for mastectomy and 68 days for lumpectomy. Median time from start to end of radiation was 38 days for mastectomy and 28 days for lumpectomy. Pre-treatment median QD score prior to radiation was 12.5 (11.4 for lumpectomy, 15.9 for mastectomy), 9.1 at the end of radiation (9.1 for lumpectomy, 18.2 for mastectomy), and 2.4 at 1 month after radiation (2.3 for lumpectomy, 2.5 for mastectomy). Median NPRS scores at pre-treatment, post-treatment and 1 month follow-up were 1, 1, and 1 for lumpectomy and 0, 1, 0 for mastectomy patients, respectively.

Conclusion: In this initial pilot study with 1 month of follow up, patient-reported UED as demonstrated by QD scores were higher pre-radiation and decreased by one month after. This likely reflects recuperation after surgical procedure. Median average pain scores were low at all time points. Further evaluation of UED over time to characterize the long-term effect of radiation and correlation with quality of life and other clinical factors is planned.

Citation Format: Healy E, Pan X, Beyer S, Washington I, Bazan J, White J. Initial report of a prospective, pilot study of patient-reported upper extremity dysfunction in women undergoing radiation for 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 P1-12-13.

Anterior Spinal Fusion and Posterior Spinal Fusion Both Effectively Treat Lenke Type 5 Curves in Adolescent Idiopathic Scoliosis: A Multicenter Study

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

Retrospective comparison of radiographic and clinical outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in surgical treatment of Lenke 5 curves.

SUMMARY OF BACKGROUND DATA

ASF and PSF are used for treatment of Lenke 5 curves in patients with adolescent idiopathic scoliosis (AIS). Currently, no consensus exists for optimal surgical treatment of Lenke 5 curves.

METHODS

Patients with Lenke 5 curves treated with either ASF or PSF were prospectively enrolled in a multicenter database and then retrospectively reviewed. Demographic data, perioperative measures, radiographic data, and SRS-22R scores were collected and compared for statistical significance.

RESULTS

A total of 149 patients were included in the study; 51 underwent PSF and 98 underwent ASF. There was no difference in demographics between groups. The PSF group was fused one level longer than the ASF group (5.9 levels PSF, 4.6 levels ASF, p < .0001). The PSF group had shorter operative times (223 minutes PSF, 297 minutes ASF; p < .0001) and a higher proportion of patients who received a postoperative blood transfusion (45% vs. 5%, p < .0001). PSF patients had longer hospital stays (6.1d PSF vs. 5d ASF, p = .031). The ASF group had larger preoperative major curve (48.2° ASF, 44.2° PSF; p < .01). Coronal balance, thoracolumbar/lumbar Cobb angle, shoulder height, trunk shift, and overall sagittal balance were not different between groups at two-year follow-up. Curve correction at two-year follow-up was similar between groups (66% ASF vs. 62% PSF). There were no significant differences in clinical outcomes or complication rates between groups.

CONCLUSION

There is no difference in radiographic or clinical outcomes in patients treated with ASF or PSF for Lenke 5 curves. ASF may save a fusion level, but has longer operative time than PSF. Ultimately, the risks and benefits of each approach merit consideration by surgeon and patient.

LEVEL OF EVIDENCE

Level II.

Targeting NEDD8-activating enzyme is a new approach to treat canine diffuse large B-cell lymphoma

Canine diffuse large B-cell lymphoma (DLBCL), the most common hematologic malignancy of dogs, is associated with poor overall survival. The lack of conventional chemotherapies with sustainable efficacy warrants investigation of novel therapies. Pevonedistat (MLN4924) is a potent and selective small molecule NEDD8-activating enzyme inhibitor. In human activated B-cell-like (ABC) diffuse large B-cell lymphoma, pevonedistat induces lymphoma cell apoptosis, DNA damage and G1 cell cycle arrest by inhibiting the nuclear factor-κB (NF-κB) pathway. Genomic and transcriptomic studies showed that the NF-κB pathway is deregulated in canine DLBCL. Our results showed that pevonedistat treatment significantly reduces the viability of canine DLBCL cells by inducing G1 cell cycle arrest and apoptosis. Pevonedistat treatment inhibits NF-κB pathway activation and downregulates NF-κB target genes in canine DLBCL. Moreover, administration of pevonedistat to mice bearing canine DLBCL xenograft tumours resulted in tumour regression. Our in vivo and in vitro studies provide justification for future clinical application of pevonedistat as a potential new anti-cancer therapy that may benefit both canine and human species.