Abstract P5-04-29: Efficacy and safety of low-dose everolimus in Chinese HR-positive, HER2-negative metastatic breast cancer patients

Background: Everolimus has been testified to be effective among postmenopausal women with hormone receptor-positive human epidermal growth factor receptor-2 negative (HR+/HER2-) metastatic breast cancer (MBC). However, everolimus at dose of 10mg was accompanied by a higher incidence of mTOR-inhibitor class-effect adverse events (AEs) which usually leading to dose reduction or interruption. Additionally, some studies suggested that there was no correlation between dose intensity (5 vs. 10 mg labeled dose) and efficacy. Consequently, we conducted the present study aiming to explore the efficacy and safety of everolimus at dose of 5 mg plus endocrine therapy in Chinese population.

Methods: 68 HR+/HER2- MBC patients were included in this exploratory study who received everolimus at the dose of 5mg in Zhejiang Cancer Hospital between September 2014 and September 2017. Progression free survival(PFS) and overall survival(OS) were estimated by the Kaplan- Meier method, and the hazard ratios(HRs) and corresponding 95% confidence intervals(CIs) were estimated using the Cox proportional harzard model. Besides, objective response rate(ORR), clinical benefitrate(CBR) and safety profile were also evaluated.

Results: After a median follow up of 14 months, PFS was 5.3 months (95%CI 4.2-6.4), and OS was immature. 16(23.5%) were at the first or second-line, 52(76.5%) were at third-line or later. PFS for the first and second-line is significantly longer than that for the third-line or later (12.9 months vs. 4.6 months, P=0.009, HR=0.395, 95% CI=0.192-0.811). 11(16.2%) achieved partial response (PR), 42(61.7%) had stable disease (SD), and 15(22.1%) reported progressive disease (PD). The ORR and CBR were 16.2%, 35.2%, respectively. Most common all grade adverse events were stomatitis(26.5%), fatigue(10.0%), infection(11.8%), thrombocytopenia(5.9%), anemia(4.4%), hyperglycemia(4.4%). The most common ≥3 grade adverse events were stomatitis(4.4 %), infection(2.2%) and thrombocytopenia(1.1%).

Conclusions: The combination of low-dose everolimus and endocrine therapy was highly effective especially at the earlier line in Chinese population. And the safety profiles were similar to previous studies but the incidences were greatly lower. The combination of low-dose everolimus and endocrine therapy may become a proper option for HR+/HER2- MBC.

Citation Format: Shao X, Wang X, Chen Z, Zheng Y. Efficacy and safety of low-dose everolimus in Chinese HR-positive, HER2-negative 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 P5-04-29.

How I do it: the horizontal-bilateral unfolding method for self-gripping (Progrip™) mesh placement in laparoscopic inguinal hernia repair

BACKGROUND

The use of the self-gripping mesh (Progrip™) during laparoscopic inguinal hernia has been proved to be effective and eliminates the need of additional fixation. However, the deployment of the self-gripping mesh is challenging due to its adhesive property. The purpose of this study was to introduce and describe an easy self-gripping mesh deployment method in laparoscopic inguinal hernia repair.

METHODS

The self-gripping mesh was folded bilaterally towards the center of the mesh and placed vertically to align with the inferior epigastric artery, centered on the internal defect, then unfolded in a horizontal-bilateral unfolding method, first laterally, then medially.

RESULTS

A total of 63 inguinal hernias were repaired laparoscopicly: 40 patients by TAPP or TEP technique with self-gripping mesh, and there were no perioperative complications. The average time of mesh placement was 186 s (45-250 s). The patients only feel minimal pain (less than VAS 3) the second postoperative morning, and most of the patients were discharged the next day postoperatively; the average postoperative hospital duration was 1 day (1-2 days).

CONCLUSION

The present "horizontal-bilateral unfolding" mesh deployment method is a relative easy method to implant the self-gripping mesh during laparoscopic inguinal hernia repair.

Distinct relaxation timescales of neurites revealed by rate-dependent indentation, relaxation and micro-rheology tests

Although the dynamic response of neurites is believed to play crucial roles in processes like axon outgrowth and formation of the neural network, the dynamic mechanical properties of such protrusions remain poorly understood. In this study, by using AFM (atomic force microscopy) indentation, we systematically examined the dynamic behavior of well-developed neurites on primary neurons under different loading modes (step loading, oscillating loading and ramp loading). Interestingly, the response was found to be strongly rate-dependent, with an apparent initial and long-term elastic modulus around 800 and 80 Pa, respectively. To better analyze the measurement data and extract information of key interest, the finite element simulation method (FEM) was also conducted where the neurite was treated as a viscoelastic solid consisting of multiple characteristic relaxation times. It was found that a minimum of three relaxation timescales, i.e. ∼0.01, 0.1 and 1 seconds, are needed to explain the observed relaxation curve as well as fit simulation results to the indentation and rheology data under different loading rates and driving frequencies. We further demonstrated that these three characteristic relaxation times likely originate from the thermal fluctuations of the microtubule, membrane relaxation and cytosol viscosity, respectively. By identifying key parameters describing the time-dependent behavior of neurites, as well as revealing possible physical mechanisms behind, this study could greatly help us understand how neural cells perform their biological duties over a wide spectrum of timescales.

MRI Abnormalities Predominate in the Bottom Part of the Sulcus with Type II Focal Cortical Dysplasia: A Quantitative Study

BACKGROUND AND PURPOSE

Type II focal cortical dysplasia is a common histopathological substrate in focal epilepsy. This study explored the spatial distribution of abnormal findings on MR imaging across the sulcus with type II focal cortical dysplasia using quantitative MR imaging postprocessing techniques.

MATERIALS AND METHODS

The morphometric analysis program and normalized FLAIR signal intensity analysis were applied to retrospectively analyze the MR imaging data of 58 patients with histopathologically confirmed type II focal cortical dysplasia. We divided the dysplastic sulcus into the bottom and nonbottom parts. Then spatial distribution types 1, 2, and 3 were arbitrarily defined as the abnormal findings on MR imaging (z-value > threshold) located in the bottom part, both the bottom and nonbottom parts, and the nonbottom part, respectively. For type 2, the mean z-values and standardized volumes of abnormal findings on MR imaging were compared between the bottom and nonbottom parts.

RESULTS

Abnormal findings on MR imaging were detected by quantitative techniques in 42 of 58 enrolled patients. Among these 42 patients, 38 and 26 patients showed gray-white matter junction blurring and cortical FLAIR hyperintensity, respectively, which were the 2 most common abnormal MR imaging features. Gray-white matter junction blurring manifested as types 1, 2, and 3 in 24, 13, and 1 patient, respectively, and the corresponding counts for cortical FLAIR hyperintensity were 12, 13, and 1 patient. For the 2 most common abnormal findings on MR imaging spatially manifested as type 2, higher mean z-values and larger corresponding standardized volumes of abnormalities were found in the bottom part.

CONCLUSIONS

Abnormal findings on MR imaging predominate in the bottom part of the sulcus with type II focal cortical dysplasia, which indicates that this malformation is bottom-of-sulcus-rooted.

Treatment of comminuted fractures of the base of the thumb metacarpal using a cemented bone-K-wire frame

We aimed to describe the treatment of comminuted fractures of the base of the thumb metacarpal using a cemented bone-K-wire frame. Between March 2010 and January 2016, 41 fractures of the base of the thumb were treated using a cemented bone-K-wire frame. The mean age of the patients was 34 years. The patients' history included a fall onto the hand in 7 cases, direct trauma in 31 cases, and polytrauma with an unclear mechanism of injury in 3 cases. At the final follow-up, hand grip and pinch strength were measured using a dynamometer. All measurements were compared with those of the opposite hand. The patients were assessed functionally using the Smith and Cooney score.All K-wires were left in place until the bone healed. Bone healing was achieved in all thumbs in an average of 5.2 weeks. Follow-up averaged 27 months. The mean hand pinch and grip strength was 8.7 kg ± 2.4 kg and 38.4 kg ± 5.9 kg, respectively. The mean measurements on the opposite side were 9.2 kg ± 2.5 kg and 40.2 kg ± 6.6 kg, respectively. Based on the Smith and Cooney score, we obtained an average score of 87 ± 9.3, with 25 excellent, 9 good, and 2 fair results. The cemented bone-K-wire frame is an external fixator alternative that can be used for treating comminuted intra-articular fractures of the base of the thumb metacarpal. The system is cheap, easy to apply, and provides rigid fixation, resulting in good functional recovery.

Extracting the surface tension of soft gels from elastocapillary wave behavior

Mechanically-excited waves appear as surface patterns on soft agarose gels. We experimentally quantify the dispersion relationship for these waves over a range of shear modulus in the transition zone where the surface energy (capillarity) is comparable to the elastic energy of the solid. Rayleigh waves and capillary-gravity waves are recovered as limiting cases. Gravitational forces appear as a pre-stress through the self-weight of the gel and are important. We show the experimental data fits well to a proposed dispersion relationship which differs from that typically used in studies of capillary to elastic wave crossover. We use this combined theoretical and experimental analysis to develop a new technique for measuring the surface tension of soft materials, which has been historically difficult to measure directly.

FAVORABLE EFFECT OF LEVOTHYROXINE ON NUTRITIONAL STATUS OF PATIENTS WITH STAGE 3-4 CHRONIC KIDNEY DISEASE

The aim of this study was to analyze the incidence of malnutrition in patients with stage 3-4 chronic kidney disease (CKD) and primary subclinical hypothyroidism and the effect of levothyroxine for improving nutritional status and delaying kidney disease.

PATIENTS AND METHODS

In the study were included 200 patients with stage 3-4 CKD: CKD3 stage group (n=100) and CKD4 stage group (n=100). These patients were further divided into: control group (non-treatment group) group a (n=65) and experiment group (treatment group) group b (n=135) according to their levothyroxine treatment. The CKD3 stage group is divided into c3 (n=35) and e3 (n=65), and CKD4 group is divided into c4 (n=30) and e4 (n=70) groups.

RESULTS

Upon treatment of subclinical hypothyroidism with levothyroxine, nutritional indicators of patients are improved, and the weight, left and right-hand grip strength, hemoglobin (HB), serum albumin are higher compared to control. After levothyroxine treatment, eGFR in the treatment group increased with each time point, while in the control group it could be seen a significant decrease. This effect was more robust in the CKD3 group than in the CKD4 group. In conclusion, levothyroxine treatment can delay the progression of kidney diseases with more efficacy in stage 3 patients.

Abstract P2-02-11: Not presented

This abstract was not presented at the symposium.

Abstract P2-05-12: Not presented

This abstract was not presented at the symposium.

Overcoming drug-resistant lung cancer by paclitaxel loaded tetrahedral DNA nanostructures

Drug-loaded tetrahedron DNA nanostructures and their cytotoxic effect on drug-resistant cells have been studied.

A combined experimental and theoretical investigation on cellular blebbing

Although accumulating evidence has demonstrated the important role of membrane blebbing in various cellular processes, the fundamental question of how the initiation/evolution of blebs are influenced by physical factors like membrane-cortex interactions and intracellular pressure remains unclear. Here, we report a combined modeling and experimental study to address this outstanding issue. Specifically, boundary integral method was used to track the motion of membrane (in 3D) during blebbing while possible rupture of the bilayer-cortex adhesion has also been taken into account. We showed that, for a given differential pressure across the cell membrane, the size of the weakened cortex must be over a critical value for blebbing to occur and the steady-state volume of a bleb is proportional to its initial growth rate, all in good agreement with recent experiments. The predicted shape evolution of blebs also matches well with our observations. Finally, a blebbing map, summarizing the essential physics involved, was obtained which exhibits three distinct regimes: no bleb formation corresponding to a low intracellular pressure or a small weakened cortex region; bleb formed with a fixed width when the disrupted cortex zone is very large; and a growing bleb resulted from progressive membrane-cortex detachment under intermediate weakened cortex size.

Polyphenols in Eucalyptus leaves improved the egg and meat qualities and protected against ethanol-induced oxidative damage in laying hens

Polyphenols in Eucalyptus leaves (PE) were value resources due to various pharmacological activities, but data on the effect on laying hens are very scare. This study was conducted to determine the effect of PE on the laying performance, egg traits, meat quality, antioxidant status and liver tissues of laying hens. One hundred and twenty 256-day-old Yueqinhuang laying hens were randomly assigned to four treatment groups (different levels of PE at 0, 0.5, 0.8 and 1.2 g/kg diet) for 63 days with 15 replicates per group. Addition of 0.8 g/kg PE not only improved the egg trait by increasing the eggshell thickness and decreasing MDA production and cholesterol content in the egg yolk, but also significantly enhanced meat quality of hens, as suggested by the increase pH_45 min (p < .01) and a* value, and decrease drip loss rate (p < .01). Meanwhile, under acute ethanol-induced oxidative damage condition, supplementation of 0.8 g/kg PE enhanced the serum antioxidant status by increasing enzymatic activities (GSH-PX, T-SOD, T-AOC), inhibited oxidative damage and provided protective effect to liver tissue. In conclusion, addition of 0.8 g/kg PE not only improved the egg traits and meat quality without obvious adverse effects, but also increased the serum antioxidant status of the hens and protected their liver tissue from ethanol-induced oxidative damage. This study indicated that PE could be utilized as an effective feed additive for laying hens to improve health performance and egg traits.

Body mass index and the risk of all-cause mortality among patients with nonvalvular atrial fibrillation: a multicenter prospective observational study in China

BACKGROUND/OBJECTIVES

High body mass index (BMI) is associated with increased incident atrial fibrillation (AF) and mortality rate. In patients presenting with nonvalvular AF (NVAF), the prognostic relevance of BMI remains unclear.

SUBJECTS/METHODS

In this prospective observational study, a total of 1759 patients with NVAF (69.9±12.9 years old, 47.9% male) were divided into three clinical settings according to estimated stroke risks (CHADS₂ score ⩽1 (low), =2 (moderate) and ⩾3 (high)). The primary outcome was all-cause mortality, and the secondary outcomes included thromboembolism and major bleeding. Cox-proportional hazard models were used to estimate the association between BMI levels and clinical outcomes.

RESULTS

During a mean follow-up of 1 year representing 1974 patient-years at risk, 256 patients died, 142 suffered from thromboembolism and 17 developed major bleeding. Multivariate adjusted Cox analysis indicated that a BMI of 24.0-27.9 kg/m² was independently associated with improved survival among all patients (hazard ratio (HR) 0.689, 95% confidence interval (CI) 0.512-0.928; P=0.018) and patients at high stroke risk (HR 0.622, 95% CI 0.410-0.943; P=0.024), but not among those at low or moderate stroke risks. No associations were observed between BMI levels and the incidence of thromboembolic events in various clinical settings.

CONCLUSIONS

A paradoxical BMI-all-cause mortality risk association was observed in Chinese patients with NVAF, and this association was pronounced among patients at high stroke risk rather than in those at low stroke risk.

The promoter polymorphisms of receptor for advanced glycation end products were associated with the susceptibility and progression of sepsis

Receptor for advanced glycation end products (RAGE) is considered a major pattern recognition receptor, which plays an important role in the development of sepsis. Increasing evidence showed an association between RAGE polymorphisms and the susceptibility to several inflammatory-related diseases. However, little is known about the clinical relationship between RAGE polymorphisms and sepsis. In this study, we analyzed the association of sepsis with three functional RAGE gene polymorphisms (rs1800624, rs1800625 and rs2070600) in a Chinese Han population (372 sepsis cases and 400 healthy controls). Significant differences were observed in the rs1800624 and rs1800625 genotype/allele distributions between the sepsis and controls, but no significant difference was observed in the rs2070600 genotype/allele. Moreover, our results also revealed a significant difference in the genotype/allele frequencies of the rs1800624 and rs1800625 polymorphisms between the sepsis and severe sepsis subtypes, the rs1800624 TT or rs1800625 TT genotype carriers exhibited a significant increase in RAGE mRNA, sRAGE, TNF-α and IL-6 expression compared with the rs1800624 AT/AA or rs1800625 CT/CC carriers in sepsis patients. Overall, this study might provide valuable clinical evidence between the RAGE gene polymorphisms and the risk or the development of sepsis.

A Non-Radioactive Microtitre Plate Reverse Transcriptase (RT) Assay, Based on Immobilized Template, for Screening of RT Activity Inhibitors and Evaluation of their Mode of Action

A new sensitive colorimetric reverse transcriptase (RT) activity assay utilizing a 96-well microtitre plate format, with solid phase-conjugated polyadenylic acid (prA), was investigated for simple analyses of the RT inhibiting capacity and mode of action of various substances. Three different technical procedures using the assay were evaluated: (i) direct lC50 determinations with various substances, using four different combinations of primer and dNTP amounts; (ii) analyses of the capacity of the substances to interfere with the binding of RT to template or template-primer (BIC50); (iii) analyses of the capacity of the substances to destroy the template-primer in presence or absence of RT (TDC50). The assay was found to be useful for all three purposes using small amounts of recombinant RT. In the IC50 analyses, the test substances gave values similar to those reported for soluble RT assays, and the values varied in accordance with their known mode of action in relation to the combination of primer and dNTP amount used. Only one of the substances, prG, in addition to DNA and RNA gave true RT binding inhibition. The template destruction assay showed that chain terminating substances gave destruction at low inhibitor concentrations. Furthermore, this destruction was RT-dependent, in contrast to the destruction obtained with substances that can base-pair with the template or primer. For optimum information on mode of action of a given substance all three assay procedures should be used. The use of the assay in relation to the screening and analyses of new RT inhibitory substances and characterization of RT in primary isolates or plasma is discussed.

A scientist's guide for submitting data to ZFIN

The Zebrafish Model Organism Database (ZFIN; zfin.org) serves as the central repository for genetic and genomic data produced using zebrafish (Danio rerio). Data in ZFIN are either manually curated from peer-reviewed publications or submitted directly to ZFIN from various data repositories. Data types currently supported include mutants, transgenic lines, DNA constructs, gene expression, phenotypes, antibodies, morpholinos, TALENs, CRISPRs, disease models, movies, and images. The rapidly changing methods of genomic science have increased the production of data that cannot readily be represented in standard journal publications. These large data sets require web-based presentation. As the central repository for zebrafish research data, it has become increasingly important for ZFIN to provide the zebrafish research community with support for their data sets and guidance on what is required to submit these data to ZFIN. Regardless of their volume, all data that are submitted for inclusion in ZFIN must include a minimum set of information that describes the data. The aim of this chapter is to identify data types that fit into the current ZFIN database and explain how to provide those data in the optimal format for integration. We identify the required and optional data elements, define jargon, and present tools and templates that can help with the acquisition and organization of data as they are being prepared for submission to ZFIN. This information will also appear in the ZFIN wiki, where it will be updated as our services evolve over time.