[Efficacy and safety of ombitasvir/paritaprevir/ritonavir and dasabuvir combined with ribavirin in Asian adult patients with chronic HCV genotype 1b infection and compensated cirrhosis]

Objective: To evaluate the efficacy and safety of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) 25/150/100 mg once daily and dasabuvir (DSV) 250 mg twice daily combined with ribavirin in adult patients of Mainland China with chronic HCV genotype 1b infection and compensated cirrhosis. Methods: An open-label, multicenter, phase 3 clinical trial study was conducted in mainland China, Taiwan, and South Korea. Adult patients with compensated cirrhosis (Metavir score =F4) who were newly diagnosed and treated for hepatitis C virus genotype 1b infection with ombitasvir/paritaprevir/ritonavir and dasabuvir combined with ribavirin for 12 weeks were included. Assessed SVR rate of patients obtained at 12 and 24 weeks after drug withdrawal. Efficacy and safety were evaluated in patients who received at least one time study drugs. Results: A total of 63 patients from mainland China were enrolled, 62 of whom (98.4%) had a baseline Child-Pugh score of 5 points. The overall rate of SVR12 and SVR24 in patients was 100% (95% CI: 94.3% to 100.0%). Most of the adverse events that occurred were mild. The incidence of common (≥10%) adverse events and laboratory abnormalities included elevated total bilirubin (36.5%), weakness (19.0%), elevated unconjugated bilirubin (19.0%) and conjugated bilirubin (17.5%), and anemia (14.3%). Three cases (4.8%) of patients experienced Grade ≥ 3 adverse events that were considered by the investigators to be unrelated to the study drug. None patients had adverse events leading to premature drug withdrawal. Conclusion: Mainland Chinese patients with chronic HCV genotype 1b infection and compensated cirrhosis who were treated with OBV/PTV/r plus DSV combined with RBV for 12 weeks achieved 100 % SVR at 12 and 24 weeks after drug withdrawal. Tolerability and safety were good, and majority of adverse events were mild.

Mouse Avatar Models of Colorectal Cancer Liver Metastasis: The Molecularly Annotated Platforms for Preclinical Evaluation of Novel Therapeutics

Background: Liver is the most common metastatic site in advanced colorectal cancer. Most patients with colorectal cancer liver metastasis (CRLM) could not benefit from the current treatment. Patient-derived xenograft (PDX) models with definite molecular signature are attractive preclinical models and essential for development of novel drugs. Aim: This study was designed to focus on the establishment, characterization of pathologic and molecular features of PDX models. Furthermore, we also validate potential therapeutic targets and explore novel drug therapies guided by genotyping or expression profiling, leading to potential implications for precision medicine. Methods: CRLM PDX models were established and elucidated their possible implications for preclinical research and personalized treatment from their fidelity of clinicopathologic characteristics, genomic landscape, and antitumor activities of novel targeted drugs. Response biomarkers were also explored. Results: A total of 56 PDX models from CRLM were successfully established (transplantation success 76.7%, 56/73). The transplantation rate was higher than that of primary specimens (61.5%, 16/26). No differences were observed between latency period and characteristics except the level of CEA. Along with the passaging, latency period became shorter and shorter. PDXs from CRLM recapitulated the pathologic, genetic, and protein properties of corresponding parental tumors. Frequent altered genes showed high consistency compared with patients' genomic alterations, and were enriched in MAPK, ErbB, cell cycle, focal adhesion, adherence junction pathways. Several potential drug targets, such as KRAS, HER2 and FGFR2, were selected and validated by corresponding inhibitors. In addition, PDX models could also used for patients with no druggable alterations identified to screen the efficient regimen. Conclusion: In this study, we have successfully established and validated a large panel of molecularly annotated CRLM platforms for preclinical evaluation of novel therapeutics and biomarker discovery.

Complication Follow-up With Ultrasonographic Analyses of 91 Cases With Donor Gallbladder Preservation in Living Donor Liver Transplantation of Left Lateral Sectionectomies

BACKGROUND

Preserving the donor's gallbladder during living donor liver transplantation (LDLT) is a better method for liver transplantation surgery, but not enough is known about gallbladder complications after the operation.

METHODS

We retrospectively investigated postsurgical donor gallbladder complications in clinical LDLT with gallbladder preservation. The feasibility of retaining the gallbladder during liver graft procurement is discussed. Ninety-one donors with retained gallbladder after LDLT with the hepatic left lateral sectionectomy (from June 2013 to October 2015) were retrospectively analyzed. Donors were followed for 12.6 to 40.7 months after surgery (median 26.1 months). Sonography was used to evaluate gallbladder characteristics before and after surgery.

RESULTS

Gallbladder function had recovered to almost normal 1 month after transplantation. Four donors (4.40%) experienced gallbladder enlargement that resolved after 3 days. Thickening of the gallbladder wall in 31 donors (34.07%) was restored within 2 to 75 days. Biliary sludge appeared in 9 donors (9.89%); 6 of them recovered within 3 to 34 days. Three (3.30%) and 1 donor (1.10%) suffered gallstone and gallbladder polyps, respectively, which persisted until the last follow-up.

CONCLUSION

The rate of postoperative complications of the gallbladder in donors was relative low. Preserving the gallbladder in liver transplantation donors during liver graft procurement is feasible and safe.

[Logistic regression analysis of risk factors for primary graft dysfunction after lung transplantation]

Objective: To explore the risk factors of primary graft dysfunction (PGD) after lung transplantation and provide a new therapeutic strategy for PGD. Methods: A retrospective analysis of lung transplant patients from January 2014 to July 2017 in Henan Provincial People's Hospital.According to the PGD classification standard established by the International Society for Heart and Lung Transplantation, the association of potential risk factors with PGD was analyzed by using multivariable Logistic regression. Results: Fourteen of 30 patients (46.7%) developed grade 3 PGD.There was no significantly statistical difference in gender, etiology, duration of anesthesia, amount of blood transfusion, amount of blood transfusion and donor gender(all P>0.05). Body mass index (BMI), donor pulmonary cold ischemia time, duration of operation, extracorporeal membrane lung oxygenator (ECMO), systolic pulmonary arterial pressure and donor smoking history were all higher than those of non-PGD patients (all P<0.05). Independent risk factors for PGD were donor pulmonary cold ischemia time (OR 1.032, 95%CI 1.000-1.065, P=0.048); systolic pulmonary arterial pressure (OR 1.258, 95%CI 0.969-1.632, P=0.007); donor smoking (OR 8.879, 95%CI 1.096-71.913, P=0.041). Conclusion: Donor pulmonary ischemic time, systolic pulmonary arterial pressure and donor smoking history are PGD risk factors, which provide new ideas for PGD treatment.

Outcomes of Pediatric Liver Transplantation: Deceased Donor Liver Transplantation vs Living Donor Liver Transplantation

BACKGROUND

The use of pediatric donor liver for pediatric liver transplantation (LT) remains controversial and few studies have focused on pediatric deceased donors. To address this issue, we decided to perform a retrospective research, trying to compare the clinical effects between deceased donor LTs (DDLTs) and living donor LTs (LDLTs).

METHODS

A retrospective review of pediatric LTs using grafts from deceased donors and living donors from June 2013 to August 2016 was performed. The children were divided into a DDLT group and a LDLT group based on their donor styles. The incidence of early vascular complications (VC), biliary complications, and graft and patient survival rates were observed between the 2 groups.

RESULTS

There were 217 cases of pediatric LTs performed in our hospital from June 2013 to August 2016 (83 DDLTs and 134 LDLTs). The 1-year cumulative survival rates of grafts and recipients were 89.16% and 91.57% in DDLTs, and 95.47% and 95.52% in LDLTs, respectively (P > .05). The incidence of early VC was lower in LDLTs than that in DDLTs (3.7% vs 19.3%, P < .001). The incidence of HAT in children aged less than 1 year was significantly higher in the DDLT group (P < .001) and can be up to 31.82%. The incidence of biliary complications was similar in the 2 groups (8.4% vs 13.5%, P = .285).

CONCLUSIONS

Pediatric DDLTs have similar graft and patient survival rates with LDLT. The incidence of early VC was higher in DDLTs, and children aged less than 1 year are at a higher risk of developing HAT.

[Myocardial revascularization among patients with severe left ventricular dysfunction: a comparison between on-pump beating-heart and off-pump coronary artery bypass grafting]

Objective: To evaluate the impacts of an on-pump beating-heart versus an off-pump coronary artery bypass grafting (CABG) technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (EF) of 35% or less. Methods: A total of 216 consecutive patients with an echocardiographic estimated EF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study and were divided into either an OBCAB group (patients who received on-pump beating-heart CABG surgery, n=88) or an OPCAB group (patients who received off-pump CABG surgery, n=128). The early clinical outcomes were investigated and compared. The outcomes were compared between groups by t-test, χ² test or Fisher's exact test, when appropriate. Results: No significant differences emerged between the two groups in baseline characteristics of the entire cohort except for more patients with diabetes and a larger left ventricular endo-diastolic diameter in the OBCAB group. Patients in the OBCAB group compared to the OPCAB group had a similar in-hospital mortality (3.4% vs. 4.7%, P= 0.741). Mean EF, as measured preoperatively and early postoperatively (before discharge), significantly improved from (31.0±2.8)% to (35.6±2.9)% (t=10.61, P=0.000) in the OBCAB group and from (31.0±2.9)% to (34.8±3.3)% (t=9.68, P=0.000) in the OPCAB group, respectively. The improvement of mean LVEF in the OBCAB group was significantly higher than that in the OPCAB group ((4.7±0.2)% vs. (3.6±0.3)%, t=29.53, P=0.000). Patients in the OBCAB group compared to the OPCAB group had a significant higher early postoperative EF ((35.6±2.9)% vs.(34.8±3.3)%, t=1.892, P=0.034) but shared a similar baseline EF ((31.0±2.8)% vs. (31.0±2.9)%, t=0.012, P=0.930). Patients in the OBCAB group compared to the OPCAB group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7±0.8 vs. 2.8±0.6, t=9.442, P=0.000; (715±187) ml vs. (520±148) ml, t=8.544, P=0.000, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Conclusion: The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated EF of 35% or less.

[Safety and efficacy of transcatheter aortic valve replacement through transcarotid approach for patients with severe aortic valve stenosis]

Objective: To investigate the safety and efficacy of transcatheter aortic valve replacement(TAVR) through transcarotid approach for patients with severe aortic valve stenosis. Methods: The clinical data of 9 symptomatic severe aortic valve stenosis patients who had high or prohibitive risk for surgery and not suitable for TAVR through femoral artery access,and thus received TAVR through transcarotid approach in our hospital from November 2015 to February 2017 were retrospectively analyzed.The patients were followed up to observe the safety and efficacy of the procedure. Results: There were 4 male and 5 female patients in this cohort, and age was (75.7±8.7) years old. The Society of Thoracic Surgery (STS) scores were (7.9±1.6)%. All patients were treated by left carotid artery approach. One patient experienced valve dislodgement during the procedure and received surgery, and TAVR procedure was successful in the rest 8 patients. Two patients were implanted with permanent pacemaker because of third degree atrioventricular block during the procedure.One patient had cardiac arrest during the procedure and recovered after external chest compression.One patient developed severe carotid stenosis,and there was no clinical manifestation of nerve function deficit after the procedure. All patients were followed up at (30±3) days after the procedure, and there were no adverse events. The modified Rankin scale score was 0. Echocardiography examination showed that the tranvalvular mean gradient was reduced from (63.0±19.2)mmHg(1 mmHg=0.133 kPa) on baseline to (18.1±4.9)mmHg(P<0.001), 4 cases had mild paravalvular leakage, and there was no moderate or severe paravalvular leakage.The NYHA classes was significantly improved at 30 days when compared with before the procedure(2 cases class Ⅱ, 4 cases class Ⅲ,3 cases class Ⅳ before the procedure,and 5 cases classⅠ, 4 cases class Ⅱ after the procedure, P=0.006) , and left ventricular ejection fraction increased from (55.9±13.1)% to (60.4±10.0)% (P=0.030). Conclusion: Our initial experience indicates that transcarotid TAVR is safe and effective for patients with severe aortic valve stenosis.

Role of miR-449a in the Activation and Metabolism of CD4+ T Cells

BACKGROUND

Acute rejection is a significant challenge after organ transplantation. The CD4⁺ T-cell‒mediated immune response plays an important role in acute transplant rejection. It was also found that miR-449a microRNA regulates the alloimmune response in a model of heart transplantation in mice. Our goal was to determine the role of miR-449a in the regulation of CD4⁺ T cells.

METHODS

We examined miR-449a expression in peripheral blood mononuclear cells (PBMCs) and graft-infiltrating lymphocytes (GILs) between syngeneic transplant and allogeneic transplant groups on day 7 post‒heart transplantation. We also examined miR-449a expression in CD4⁺ T-cell activation and mixed-lymphocyte reactions (MLRs) in vitro. To evaluate the effect of miR-449a on CD4⁺ T-cell metabolism, we analyzed key metabolic parameters using XFp extracellular flux analyses.

RESULTS

Our in vivo heart transplant models showed that the expression of miR-449a in PBMCs and in GILs significantly increased in the allogeneic groups in comparison to the syngeneic groups (P < .01). Furthermore, in vitro analysis confirmed that the expression of miR-449a was significantly elevated in activated CD4⁺ T cells. Reduction of miR-449a expression in CD4⁺ T cells decreased the mitochondrial respiration in the same CD4⁺ T cells.

CONCLUSION

Our results reveal that miR-449a microRNA was elevated in allogeneic heart allografts. This correlated with an increased miR-449a expression in activated CD4⁺ T cells. Inhibition of miR-449a in activated CD4⁺ T cells coincided with reduced mitochondrial respiration, suggesting that miR-449a influences CD4⁺ T-cell activation during the alloimmune response by regulating metabolic status.

Retrospective study of porcine circovirus 3 infection in China

PCV3 is an emerging swine virus associated with porcine dermatitis and nephropathy syndrome (PDNS), reproductive failure, respiratory diseases and systematic inflammation. Although first identified in 2015, the earliest case has been traced back to 2009 in the United States. In China, PCV3 infection was first detected in 2015, but little information has been available about its occurrence and prevalence there before 2015. In this study, 200 porcine clinical samples collected from 20 provinces, five autonomous regions and four municipalities between 1990 and 1999 were analysed for PCV3 infection by PCR. Results showed that 6.5% of the porcine samples collected from eight provinces and one autonomous region were PCV3 positive, with the earliest cases occurring in 1996. Nucleotide sequence analysis showed that PCV3 strains obtained in this study shared 96.6%-99.7% and 97.1%-99.4% sequence identity at the ORF2 gene and genome levels with all available reference strains from China and other countries, indicating the high genetic stability of PCV3 over the past 20 years.

[Effects of ammonium pyrrolidine dithiocarbamate (PDTC) on osteopontin expression and autophagy in tubular cells in streptozotocin-induced diabetic nephropathy rat]

Objective: To investigate the effects of ammonium pyrrolidine dithiocarbamate (PDTC) on tubulointerstitial inflammatory molecules and autophagy in diabetic nephropathy (DN) rats. Methods: Twenty-four male Sprague-Dawley rats were assigned to DN group (n=6) and DN+ PDTC group (n=6, PDTC, ip, 100 mg·kg^-1·d^-1), all received streptozotocin (STZ) 60 mg/kg intraperitoneally, and the other 12 rats were randomly divided into control group (n=6) and PDTC group (n=6). At the end of 12 weeks, after serum creatine (Scr) and 24-hour urinary protein were determined, rats were sacrificed to determined the renal pathological damages and the changes of nuclear factor (NF)-κB p65, p62, osteopontin (OPN), microtubule associated protein 1 light chain 3 (LC3)-Ⅱ/LC3-Ⅰ, nuclear p-NF-κB p65 by immunohistological stainning and Western blot, and ultrastructural changes of autophagic process was observed by electron microscopy (EM). Results: Scr was similar among the four groups (P>0.05). The levels of urinary protein in DN group and DN + PDTC group were significantly higher than the other two groups (all P<0.01), but the level of urinary protein in DN + PDTC group was lower than that of DN group (P<0.05). DN + PDTC group had less tubulointerstitial damage compared with DN group (P<0.05). Among the four groups, expressions of p62, p65, OPN of tubulointerstitial area in DN group were significantly higher than that of the other groups (all P<0.05), and Western blot showed that DN+ PDTC group had less expressions of NF-κB p65, nuclear p-p65, OPN and more expresssion of LC3-Ⅱ/LC3-Ⅰ compared with DN group (all P<0.05), which were consistent with the decreased autophagic vacuoles and increased mitochondria dysfunction revealed by EM. Correlation analysis showed that renal LC3-Ⅱ/LC3-Ⅰ was negatively correlated the expressions of nuclear p-p65 and OPN (r=-0.45, P=0.02; r=-0.50, P=0.01), and p62 was positively correlated the expressions of nuclear p-p65 and OPN (r=0.33, P=0.01; r=0.41, P=0.01). Conclusion: Tubular NF-κB activation is closely related to autophagy dysfunction in DN rats, and PDTC may enhance autophagy activity in tubule cells by blocking NF-κB activity.

[Influence of implants prepared by selective laser melting on early bone healing]

OBJECTIVE

To evaluate the influence of the rough surface of dental implants prepared by selective laser melting (SLM) on early bone healing around titanium implants.

METHODS

A total of sixteen titanium implants were involved in our research, of which eight implants were prepared by SLM (TIXOS Cylindrical, Leader-Novaxa, Milan, Italy; 3.3 mm×10 mm, internal hex) and the other eight were sandblasted, large-grit and acid-etched (SLA) implants (IMPLUS Cylindrical, Leader-Novaxa, Milan, Italy; 3.3 mm×10 mm, internal hex). All of the dental implants were inserted into the healed extraction sockets of the mandible of two adult male Beagle dogs. Half of the dental implants were designed to be healed beneath the mucosa and the other half were intended to be healed transgingivally and were immediately loaded by acrylic resin bridge restoration. Three types of tetracycline fluorescent labels, namely calcein blue, alizarin complexone and calcein, were administered into the veins of the Beagle dogs 2, 4, and 8 weeks after implant placement respectively for fluorescent evaluation of newly formed bone peri-implant. Both Beagle dogs were euthanized 12 weeks after implant insertion and the mandible block specimens containing the titanium implants and surrounding bone and soft tissue of each dog were carefully sectioned and dissected. A total of 16 hard tissue slices were obtained and stained with toluidine blue for microscopic examination and histomorphometric measurements. Histological observation was made for each slice under light microscope and laser scanning confocal microscope (LSCM). Comparison on new bone formation around titanium implants of each group was made and mineral apposition rate (MAR) was calculated for each group.

RESULTS

Dental implants prepared by selective laser melting had achieved satisfying osseointegration to surrounding bone tissue after the healing period of 12 weeks. Newly formed bone tissue was observed creeping on the highly porous surface of the SLM implant and growing into the pores of surface structure. Higher MAR values were shown for SLM implants compared with SLA implants (P<0.01).

CONCLUSION

Dental implants prepared by selective laser melting could promote early bone healing and improve mineral apposition rate.

Abstract OT2-03-04: Feasibility of assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone responsive early stage breast cancer

Background: Accelerated partial breast irradiation (APBI) delivers adjuvant radiation (RT) to the 1-2 cm of the breast at highest risk for recurrence surrounding the lumpectomy (L) cavity over 5-8 days and is an alternative to standard whole breast irradiation for hormone sensitive (HS) stage 1 (T1, N0) breast cancer (BC) based on 2 randomized controlled trials. External beam methods for APBI are common but have notable inherent drawbacks that include: inter-fraction inaccuracy due to patient setup based on anatomy, intra fraction error related to patient or respiratory motion, and inaccurate geometric targeting by relying on L cavity position instead of the tumor position. Postoperative RT has other limitations including delivery in the setting of disrupted blood or lymphatic supply that may be suboptimal for radio sensitivity and it eliminates observation of radiation-induced tumor response. MRI is an established tool for measuring BC extent and response from neoadjuvant systemic therapy. It's hypothesized that MRI directed pre-operative APBI using intensity modulated radiotherapy (IMRT) with image guidance (IGRT) will improve RT delivery, and that MRI features can be identified to correlate with pathologic radiation response.

Trial Design: There are 2 cohorts to this single arm prospective trial. The first cohort is for establishing and verifying patient flow and image fusion between MRI, CT and RT planning. In the second cohort eligible patients will receive preoperative APBI 38.5 Gy in 10 fractions BID with IMRT, IGRT in the prone position using MRI defined targets fused to CT treatment planning.

Eligibility: For cohort 1 it is HS Stage 1 BC that has completed CT in prone position for RT planning. Eligibility for cohort 2 requires: age &gt; 50 yo, clinical stage 1 BC, HS, HER2 negative, intending L, clinically negative axilla verified by ultrasound, able to tolerate the prone position, and MRI with contrast.

Specific aims: To determine the reproducibility of MRI directed preoperative APBI based on meeting 3 criteria: ability to define RT targets by MRI, quality of RT plans and completion of treatment (APBI and surgery). Additional aims include assessing toxicity, cosmetic outcome, local regional cancer control and collection of tissue for correlative studies.

Statistical methods: The optimal two-stage design by Simon is used. Sample size for cohort 2 is based on the first endpoint. 19 eligible patients will be required in the first stage; if 3 or more treatments are scored unacceptable, then early stopping will be recommended. Otherwise, accrual will continue to a total accrual of 30. If &gt; 4 of 30 treatments are scored unacceptable, the technique will be considered not reproducible, and a Phase II study will not be pursued. Under the null hypothesis of an 80% reproducibility rate, this two-stage design has an expected sample size of 24.4.

Patient accrual to cohort 1 has completed the targeted accrual of 3. Patient accrual to Cohort 2 is 5/30.

Contact information: Soyhun Mc Elroy (Sohyun.McElroy@osumc.edu) or Julia White (Julia.White@osumc.edu)

Funding source: Susan G Komen Breast Cancer Foundation Grant # GRT00035216

Citation Format: White J, McElroy S, Sekhon A, Wei L, Bazan J, Yang X, DiCostanzo D, Kuhn K, Gupta N, Knopp M. Feasibility of assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone responsive early stage breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-03-04.

Non-alcoholic fatty liver disease is associated with stroke severity and progression of brainstem infarctions

BACKGROUND AND PURPOSE

Non-alcoholic fatty liver disease (NAFLD) is closely correlated to visceral obesity, dyslipidaemia, insulin resistance and type 2 diabetes mellitus. We sought to assess the association between a specific stroke subgroup, brainstem infarctions (BSIs) and NAFLD. Furthermore, we evaluated whether NAFLD is an independent risk factor in patients with BSIs.

METHODS

Non-alcoholic fatty liver disease was assessed in 306 patients with radiologically confirmed BSIs via liver ultrasound. Differences between patients with and without NAFLD were compared. Data associated with stroke severity and progression after admission were collected.

RESULTS

Non-alcoholic fatty liver disease was found in 130 (42.5%) patients with acute BSIs; 58 (19.0%) had National Institutes of Health Stroke Scale scores >7 and 57 (18.6%) had progression after admission. Initial National Institutes of Health Stroke Scale scores, incidence of progression and stroke severity, and modified Rankin Scale scores at discharge were significantly higher in patients with NAFLD than in those without NAFLD. NAFLD was associated with stroke severity [Cox regression: hazard ratio (HR), 2.243; 95% confidence interval (CI), 1.254-4.013, P < 0.01]. This risk remained statistically significant after controlling for age, gender, diabetes mellitus and C-reactive protein (HR, 2.327; 95% CI, 1.252-4.324, P < 0.01). In addition, NAFLD was associated with progression (HR, 2.155; 95% CI, 1.201-3.865, P < 0.05) and remained significant after controlling for age, gender, diabetes mellitus, fibrinogen and C-reactive protein (HR, 2.378; 95% CI, 1.260-4.486, P < 0.01).

CONCLUSIONS

These results suggest that NAFLD is a potential risk factor when evaluating the severity and progression of acute BSIs. This relationship is independent of classic risk factors and metabolic syndrome features.

A comparative scanning electron microscopy evaluation of smear layer removal with chitosan and MTAD

The aim of the present study was to compare the efficacy of chitosan and MTAD for the smear layer removal from the root canal through a scanning electron microscope (SEM). Thirty teeth were randomly divided into three groups according to the final irrigants: 0.2% chitosan, MTAD, saline (control group). After the mechanical preparation, the samples were irrigated with saline (control group), 0.2% chitosan and MTDA respectively. Then, the samples were split and the smear layer at the apical, middle, and coronal thirds of each root canal was imaged using SEM. The statistical analysis was performed using the Kruskal-Wallis test and the Mann-Whitney U test (α = 5%). The difference between chitosan and MTDA was statistically significant in the apical region (p < 0.05), no significant difference was obtained in the coronal and middle regions in these two experiment groups (p > 0.05). The control group exhibited the lowest efficacy in smear layer removal in all regions. Thus, from the result of the present study, we may conclude that chitosan was more effective in smear layer removal than MTAD especially in the apical third.

CONTEXT

Irrigation, which serves a variety of purposes including antibacterial action, tissue dissolution, cleaning and chelating, plays a centric role in the final success of root canal treatment. Thus, more and more attention has been put on the improvement and development of various irrigation techniques or systems.

AIMS

The aim of the present study was to compare the efficacy of chitosan and MTAD for the smear layer removal from the root canal through scanning electron microscopy (SEM).

SETTINGS AND DESIGN

Thirty single-canal premolars were instrumented with rotary-files and then, randomly assigned to test groups which were irrigated with chitosan and MTDA, and control group was treated with saline. Thereafter, the efficacy of smear layer removal was evaluated by SEM.

MATERIALS AND METHODS

Thirty teeth were randomly divided into three groups according to the final irrigants: 0.2% chitosan, MTAD, saline (control group). After the mechanical preparation, the samples were irrigated with saline (control group), 0.2% chitosan and MTDA respectively. Then, the samples were split and the smear layer at the apical, middle, and coronal thirds of each root canal was imaged using SEM.

STATISTICAL ANALYSIS USED

Kruskal-Walli test and Mann-Whitney U test Results: The difference between chitosan and MTDA was statistically significant in the apical regions (p < 0.05), no significant difference was obtained in the coronal and middle regions in these two experiment groups (p > 0.05). The control group exhibited the lowest efficacy in smear layer removal in all regions.

CONCLUSION

Thus, from the result of present study, we may conclude that chitosan was more effective in smear layer removal than MTAD, especially in the apical third.

Epidemiological investigation of H9 avian influenza virus, Newcastle disease virus, Tembusu virus, goose parvovirus and goose circovirus infection of geese in China

To deepen the knowledge about epidemic prevalence in the goose breeding field, a triplex PCR assay was established, and 478 samples were collected from scaled goose farms in 11 provinces in China. The results of this epidemiological investigation showed that incidence rates of H9 avian influenza and goose circovirus were the highest among five infectious diseases that were evaluated. In addition, the triplex PCR assay established remarkable sensitivity, rapidity and versatility compared to other diagnostic methods. Dual infection comprised a large proportion of the co-infections in the field, of which the combinations of H9/Tembusu, H9/goose circovirus and goose circovirus/Tembusu co-infected cases were more common. Epidemics were more severe in winter and spring. Additionally, significant differences in the prevalence of these infectious diseases were observed in association with different age groups. In addition, phylogenetic analysis, determined by the neighbour-joining method, was carried out to investigate the evolution of these viruses during the study period. For the most part, virus strains isolated during the study were consistent with most goose-origin strains isolated from the Chinese mainland over the past few years. However, mutations were observed between isolated H9 avian influenza virus strains and sequences available from GenBank, which should draw much attention.

[Opportunities and challenges for the treatment of chronic hepatitis C]

Chronic hepatitis C is a great threat to human health. The World Health Organization presented Draft global health sector strategies in 2016, the goal of the draft strategy is to eliminate viral hepatitis as a public health threat by 2030, and to contribute to the achievement of universal health coverage.

[Efficacy and safety of pegylated interferon α-2b injection (Y shape, 40 kD) in treatment of patients with genotype 1/6 chronic hepatitis C]

Objective: To investigate the efficacy and safety of the new investigational drug pegylated interferon α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 µg/week) combined with ribavirin in the treatment of patients with genotype 1/6 chronic hepatitis C (CHC), with standard-dose Peg-IFN-α-2a combined with ribavirin as a positive control. Methods: A multicenter, randomized, open-label, and positive-controlled phase III clinical trial was performed. Eligible patients with genotype 1/6 CHC were screened out and randomly divided into Peg-IFN-α-2b(Y shape, 40kD) group and Peg-IFN-α-2a group at a ratio of 2:1. The patients in both groups were given oral ribavirin for 48 weeks in addition and then followed up for 24 weeks after drug withdrawal. Abbott Real Time HCV Genotype II was used to determine HCV genotype, and Cobas TaqMan quantitative real-time PCR was used to measure HCV RNA level at 0, 4, 12, 24, 48, and 72 weeks. Adverse events were recorded in detail. The primary efficacy endpoint was sustained virological response (SVR), and a non-inferiority test was also performed. Results: A total of 561 patients with genotype 1/6 CHC were enrolled, among whom 529 received treatment; 90.9% of these patients had genotype 1 CHC. The data of the full analysis set showed that SVR rate was 69.80% (95% CI 65.00%-74.60%) in the trial group and 74.16% (95% CI 67.73%-80.59%) in the control group (P = 0.297 0). The data of the per protocol set (PPS) showed that SVR rate was 80.63% (95% CI 76.04%-85.23%) in the trial group and 81.33% (95% CI 75.10%-87.57%) in the control group (P = 0.849 8), and the 95% CI of rate difference conformed to the non-inferiority standard. The analysis of the PPS population showed that of all subjects, 47.9% achieved rapid virologic response, with a positive predictive value of 93.8%. The incidence rate of adverse events was 96.30% in the trial group and 94.94% in the control group, and the incidence rate of serious adverse events was 5.13% in the trail group and 5.06% in the control group. Conclusion: In the regimen of Peg-IFN-α combined with ribavirin for the treatment of genotype 1/6 CHC, the new investigational drug Peg-IFN-α-2b(Y shape, 40 kD) has comparable clinical effect and safety to the control drug Peg-IFN-α-2a.

[Clinical effectiveness of pleural abrasion in video-assisted thoracic surgery for bullae resection]

Objective: To evaluate the efficacy of pleural abrasion in treatment of spontaneous pneumothorax with video-assisted thoracic surgery (VATS) for bullae resection. Methods: The clinical data of 158 patients with initial spontaneous pneumothorax who underwent video-assisted thoracic wedge resections with or without pleural abrasion in Henan Provincial People's Hospital from June 2010 to June 2015 were retrospectively analyzed. The patients were assigned to two equal groups according to whether pleural abrasion was applied or not: experimental group (with pleural abrasion) and control group (without pleural abrasion); and there were 79 patients in each group.There were 62 males and 17 females aged 15-60 years (mean age 34 years) in pleural abrasion group. And there were 70 males and 9 females aged 18-60 years (mean age 38 years) in non-pleural abrasion group.After surgery, all patients were evaluated for postoperative pain, chest tube removal time, hospital stay and other complications.Independent samples t test was used to compare the data between groups. Results: Surgeries for 158 patients were performed successfully.No mortality occurred.There was no conversion to thoracotomy.Postoperative pain, operation time, intraoperative blood loss, chest tube removal time, pleural canals flowand average hospital stay in non-pleural abrasion group was significantly lower for 4.4, 19 minutes, 10 ml, 21 hours, 87 ml and 1.4 days respectively when compared with those in pleural abrasion group (t=32.478, 7.140, 11.093, 7.288, 10.246, 8.070, all P<0.05). There was no missing case with a follow-up of 30 months.No complications, such as pneumothorax, was observed. Conclusions: Postoperative pain, chest tube removal time and hospital stay in non-pleural abrasion group are all lower than those in pleural abrasion group.And there is no significant difference in the recurrence of pneumothorax between the two groups after VATS bullae resection.

The higher prevalence of truncal obesity and diabetes in American than Chinese patients with chronic hepatitis C might contribute to more rapid progression to advanced liver disease

BACKGROUND

Chronic hepatitis C virus (HCV) infection is the leading cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States (US) and an emerging cause in China.

AIM

To compare the clinical characteristics of hepatitis C patients in the US and China, and factors influencing disease stage.

METHODS

Prospective study of 2 cohorts of HCV patients recruited at 1 site in the US and 3 sites in China. Standardised questionnaire on risk factors and medical history were used and diagnosis of cirrhosis and HCC was based on pre-defined criteria.

RESULTS

One thousand nine hundred and fifty seven patients (1000 US and 957 China) were enrolled. US patients were more likely to be men (61.4% vs 48.5%), older (median age 57 vs 53 years), obese (38.4% vs 16.8%) and diabetic (21.8% vs 10.8%). A significantly higher per cent of US patients had cirrhosis (38.2% vs 16.0%) and HCC (14.1% vs 2.7%). Investigator estimated time at infection in US was 10 years earlier than in Chinese patients but US patients were more likely to have advanced disease even after stratifying for duration of infection. Study site in the US, older age, truncal obesity, diabetes and prior HCV treatment were significant predictors of advanced disease on multivariate analysis.

CONCLUSIONS

HCV patients in the US had more advanced liver disease than those in China. We speculate that underlying fatty liver disease may be a major contributor to this difference, and management of glycometabolic abnormalities should occur in parallel with anti-viral therapy to achieve optimal outcomes.

Correlation of insulin-like growth factor 1 and osteoarthritic cartilage degradation: a spontaneous osteoarthritis in guinea-pig

OBJECTIVE

The pathogenesis of osteoarthritis centers on the imbalance between catabolic and anabolic processes in cartilage metabolism. Insulin growth factor 1 (IGF-1) has been shown to have anabolic effects in cartilage in vitro. This study aim to determine whether IGF-1 on cartilage is associated with loss of chondrocyte and extracellular matrix breakdown using the Hartley guinea pig model.

MATERIALS AND METHODS

Cartilage from the medial and lateral tibial plateau of 6-month and 12-month old Hartley guinea pigs were used for this study. Histological analysis was performed with hematoxylin-eosin (HE) and toluidine blue staining. Safranin-O staining was used to quantify proteoglycan (PG) loss and the extent of cartilage damage by Modified Mankin score. Distribution of IGF-1 was demonstrated with in situ hybridization techniques. IGF-1 mRNA levels were assessed using Real-time PCR.

RESULTS

Histological loss of chondrocytes, and cartilage matrix and decreased IGF-1 distribution were demonstrated in a temporal and spatial manner. Compared to the 6-month old samples, the 12-month specimens had significantly cartilage degeneration and less cartilage matrix and PGs staining. Decreased level of IGF-1 was also observed in the 12-month samples. These observations were more pronounced in the medial tibial plateau when compared to the lateral plateau.

CONCLUSIONS

The decreased level of IGF-1 may play a critical role for maintaining the balance between catabolic and anabolic processes in cartilage metabolism during the development of osteoarthritis. Thus, the increase of IGF-1 may be applicable to developing OA therapy.

Variants at the OCA2/HERC2 locus affect time to first cutaneous squamous cell carcinoma in solid organ transplant recipients collected using two different study designs

BACKGROUND

Variants at the oculocutaneous albinism 2 (OCA2)/HECT and RLD domain containing E3 ubiquitin protein ligase 2 (HERC2) locus have been associated with pigmentation phenotypes and risk of developing several types of skin cancer.

OBJECTIVES

To evaluate OCA2/HERC2 locus variants for their impact on time to develop cutaneous squamous cell carcinoma (cSCC) in organ transplant recipients (OTRs) who are at elevated risk of developing cSCC.

METHODS

Participants were solid OTRs ascertained from two centres (n = 125 and 261) with an average of 13·1 years of follow-up post-transplant. DNA was available for genotyping for all participants, in addition to medical records and questionnaire data. The Ohio State University study had a case-control design with prospective follow-up, and the University of California San Francisco study was a national cross-sectional survey with retrospective chart review.

RESULTS

OCA2 variants rs12913832 and rs916977 were significantly associated with time to first cSCC post-transplant. OTRs homozygous for the brown-eye alleles of rs916977 (GG) and rs12913832 (AA) had significant delays of time to first cSCC post-transplant compared with individuals homozygous for the blue-eye alleles (hazard ratio 0·34, P < 0·001 and hazard ratio 0·54, P = 0·012, respectively). Both variants were highly associated with eye colour in the combined studies (P < 0·001).

CONCLUSIONS

This study is the first to show an association between OCA2/HERC2 variants and time to first cSCC post-transplant. This may impact dermatological screening recommendations for high-risk populations.

[Bcl-2 associated athanogene 3 affects the epithelial-mesenchymal transition in human cervical cancer]

Objective: To investigate the expression of Bcl-2 associated athanogene 3 (BAG3) in cervical cancer tissues and cells and its role in epithelial mesenchymal transition (EMT) of cervical cancer. Methods: (1) Cervical cancer samples were collected from September 2015 to March 2017 in the Qilu Hospital of Shandong University and Shangdong Provincial Hospital. While, 50 normal tissues were collected from August 2015 to March 2017 in the Dezhou Municiple Hospital, which were obtained from patients with uterine myoma underwent hysterectomy and patients with cervical biopsy. Reverse transcription (RT)-PCR and western blot were used to detect the expression of BAG3 mRNA and protein, and their clinical significances were analyzed. (2) The expression of BAG3 mRNA and protein was detected using RT-PCR and western blot method in HeLa and SiHa cell lines and normal cervical epithelial cells. The experiment was divided into two groups, BAG3 small interfering RNA transfected group (si-BAG3) and the control group transfected with small interfering RNA (siRNA). Cell counting kit 8 (CCK-8) analysis was used to detect cell proliferation of two groups. Wound-healing and transwell assay were used to detect the migration and invasion ability of HeLa and SiHa cells. The xenograft model of cervical cancer in nude mice was used to observe the effect of BAG3 on tumor xenografts and the tumor-related biomarkers were tested by western blot. Results: (1) The expression levels of BAG3 mRNA and protein in cervical carcinoma tissues were 1.20±0.15 and 1.10±0.16, which were significantly higher than that in normal cervical tissue, 0.23±0.04 and 0.29±0.03 (both P<0.01). The results showed that the expression levels of BAG3 mRNA and protein were significantly correlated with cervical carcinoma staging and lymph node metastasis (P<0.05).However, its expression was not correlated with the patient's age, pathological grade, and diameter of tumor (all P>0.05). (2) Compared with normal cervical epithelial cells, the expression of BAG3 mRNA and protein levels in HeLa and SiHa cells were significantly increased (P<0.01), the expression levels of BAG3 mRNA and protein in HeLa and SiHa cells transfected with si-BAG3 were significantly lower than that in control group (all P<0.01). After post-transfected 72 hours, A value of HeLa and SiHa with transfection were significantly lower than those in control group [(0.88±0.08) vs (1.22±0.13), (0.92±0.09) vs (1.35±0.12); both P<0.01]. After post-transfected 24 hours, the migration level of HeLa and SiHa cells with transfection were significantly lower than those in the control group [(20.1±2.1)% vs (58.6±5.6)%, and (21.1±2.1)% vs (61.7±5.4)%; both P<0.01]. The transmembrane cell number in HeLa and SiHa cells with transfection were 76±11 and 71±8, which were significantly less than those in control group (131±12 and 129±14; both P<0.01). After the inoculation into nude mice, tumor formation time of HeLa and SiHa cells with transfection were (9.5±0.5) and (10.5±1.3) days, respectively, which were significantly longer than those in control group [(4.5±0.5) and (5.2±1.1) days; both P<0.05]. Compared with those in the control group, the expression level of Slug, N-cadherin and matrix metalloproteinase-2 (MMP-2) protein in HeLa and SiHa cells with transfected in tumor tissues were significantly decreased (all P<0.01), while the expression level of E-cadherin protein was significantly increased (P<0.01). Conclusion: BAG3 could be involved in the proliferation, migration and invasion of cervical cancer cells by affecting cervical cancer EMT, and BAG3 may be an effective target for the treatment of cervical cancer.

Effect and mechanism of propofol in hepatic ischemia/reperfusion injury of rat

OBJECTIVE

Hepatic ischemia/reperfusion (I/R) injury remains to be one of the most common clinical diseases. This study aimed to explore the potential effect and mechanism of propofol in protecting rat liver from I/R injury.

MATERIALS AND METHODS

The hepatic I/R model was established in Sprague-Dawley (SD) rats by perfusing the liver with heparinized cold saline through the portal vein for 20 min. The rats were then received a 100 mg/kg/d propofol administration for the continuously 10 days. The hepatic function indexes of ALT, AST, and GGT were detected by ELISA. The apoptosis of hepatic cells was assessed by TUNEL analysis, and Bax and Bcl-2 expression changes were detected by qRT-PCR and Western blotting. In addition, serum pro-inflammatory factors and the signaling pathway-related protein expressions were detected.

RESULTS

Propofol markedly attenuated the increases of ALT, AST, and GGT induced by I/R. Propofol reduced I/R-induced apoptosis and pro-inflammatory factors secretion. Furthermore, propofol could promote the expression of phosphorylated (p)-AKT and inhibited the expression of p-mTOR.

CONCLUSIONS

Propofol protects hepatic I/R injury partly by reducing apoptosis and reducing the release of pro-inflammatory cytokines, which is possibly involved in the modulation of the PI3K/AKT/mTOR signaling pathway. All these data suggest that propofol may play certain positive roles in protecting the liver from I/R injury.

Aerobic respiration by haemocyanin in the embryo of the migratory locust

It remains unresolved how insect embryos acquire sufficient oxygen to sustain high rates of respiratory metabolism during embryogenesis in the absence of a fully developed tracheal system. Our previous work showed that the two distinct subunits (Hc1 and Hc2) of haemocyanin (Hc), a copper-containing protein, display embryo-specific high expression that is essential for embryonic development and survival in the migratory locust Locusta migratoria. Here we investigated the role of haemocyanins in oxygen sensing and supply in the embryo of this locust. Putative binding sites for hypoxia-regulated transcription factors were identified in the promoter region of all of the Hc1 and Hc2 genes. Embryonic expression of haemocyanins was highly upregulated by ambient O₂ deprivation, up to 10-fold at 13% O₂ content. The degree of upregulation of haemocyanins increased with increasing levels of hypoxia. Compared with low-altitude locusts, embryonic expression of haemocyanins in high-altitude locusts from Tibetan plateau was constitutively higher and more robust to oxygen deprivation. These findings strongly suggest an active involvement of haemocyanins in oxygen exchange in embryos. We thus propose a mechanistic model for embryo respiration in which haemocyanin plays a key role by complementing the tracheal system for oxygen transport during embryogenesis.

Clinical research on correction of ankle arthritis-related factor levels via urea

OBJECTIVE

To investigate the reliability of urea as the internal reference of ankle irrigating fluid in correction of synovial fluid and related factor concentration dilution times, and to further determine the factor expression level in synovial fluid.

PATIENTS AND METHODS

A total of 91 patients, including 20 cases of non-posterior median foot lesions and 71 cases of unilateral ankle osteoarthritis, were enrolled in this study. AOFAS score, Takakura staging and visual analogue pain scale were given; the venous blood was collected and the ankle fluid and irrigating fluid were obtained from the affected side via puncture. The urea in serum, synovial fluid and irrigating fluid was quantified using an AU5800 biochemical instrument (Beckman Coulter). Statistical analysis was performed for the correlation between urea in serum and synovial fluid; the levels of TNF-α, IL-1β, IL-6, IGF-1 and HELIX-II in irrigating fluid quantified by enzyme linked immunosorbent assay (ELISA) were further corrected.

RESULTS

There was a good linear relationship between urea contents in synovial fluid and serum (R2=0.89), and the regression slope was 0.927. The levels and ratio of urea in serum and synovial fluid were independent of Takakura staging or pain degree. The expressions of IL-1β (p=0.000), IGF-1 (p=0.000) and HELIX-II (p=0.010) were significantly increased in synovial fluid in patients with ankle osteoarthritis. There was no significant difference in expression of IL-1β (p=0.514), and TNF-α was not detected in synovial fluid.

CONCLUSIONS

This study confirmed the dynamic stability of urea in the ankle fluid, and it is not affected by the progression of arthritis, age and other factors, which is the standard internal reference of correcting ankle irrigating fluid dilution times. The occurrence mechanism of ankle osteoarthritis may be different from that of other osteoarthritis, and IL-6 and IGF-1 are associated with the progression of the disease. Increased HELIX-II is an independent factor of predicting cartilage injury.

[Expression and clinical significance of Nrf2 and ERK pathway in papillary thyroid carcinoma]

Objective:To explore the expression and clinical significance of nuclear factor erythroid-2 related factor 2 (Nrf2) and ERK sinal in papillary thyroid carcinoma (PTC). Method:PTC microassy were detected by immunohistochemical method (IHC). The expression of Nrf2, ERK₂ and p-ERK½ in PTC, para-carcimoma and normal thyroid tissue were detected by Western blot. The transcriptional level of Nrf2 mRNA in PTC, para-carcimoma and normal thyroid tissue were detected by real-time quantitative PCR (qPCR) method. Result:Nrf2, ERK₂, p-ERK½ protein were high expression in group of lymph node metastasis PTC and negative or weak positive expression in para-carcinoma tissue (P<0.01). And the proteins of clinical stage Ⅲ-Ⅳ of PTC groups express higher than without lymph node metastasis group and clinical stage Ⅰ-Ⅱ of PTC group (P<0.05). The expression of Nrf2 protein was positively correlated with ERK₂ and p-ERK½ protein in PTC (r=0.723 2,r=0.668 6,P<0.05). The Western blot results of Nrf2, ERK₂, p-ERK½ had a higher level in PTC than those of paracarcinoma and normal thyroid tissue (P<0.01). The level of Nrf2 mRNA were higher than those of paracarcinoma and normal thyroid tissue (P<0.01). Conclusion:High expresion of Nrf2 may be associated with the progression of papillary thyroid carcinoma, and may relate to the high expression and activity of ERK pathway.

Left Lobe Auxiliary Liver Transplantation for End-stage Hepatitis B Liver Cirrhosis

Auxiliary liver transplantation (ALT) for hepatitis B virus (HBV)-related liver cirrhosis previously showed poor results, because the native liver was a significant source of HBV recurrence and the graft could be rapidly destroyed by HBV infection in an immunosuppressive condition. Four patients with HBV-related liver cirrhosis were unable to undergo orthotopic liver transplantation because the only available grafts of left lobe were too small. Under entecavir-based anti-HBV treatment, they underwent ALT in which the recipient left liver was removed and the small left lobe graft was implanted in the corresponding space. The mean graft weight/recipient weight was 0.49% (range, 0.38%-0.55%). One year after transplantation, the graft sizes were increased to 273% and the remnant livers were decreased to 44%. Serum HBV DNA was persistently undetectable. Periodic graft biopsy showed no signs of tissue injury and negative immunostaining for hepatitis B surface antigen and hepatitis B core antigen. After a mean follow-up period of 21 months, all patients live well with normal graft function. Our study suggests that ALT for HBV-related liver cirrhosis is feasible under entecavir-based anti-HBV treatment. Successful application of small left livers in end-stage liver cirrhosis may significantly increase the pool of left liver grafts for adult patients.

Correlation Between Survival Interval and CD4+ T-Cell Intracellular ATP Levels in Liver Transplant Recipients

OBJECTIVE

The objectives of this study were to analyze the potential correlation between post-liver transplantation survival interval and CD4⁺ T-cell intracellular ATP (iATP) levels, and to describe the distribution of CD4⁺ T-cell iATP levels in liver transplant recipients.

METHODS

This was a retrospective analysis of clinical data of 273 patients who underwent liver transplantation from July 2010 to October 2012 in our center and achieved long-term stable survival. CD4⁺ T-cell iATP level was detected using Cylex ImmuKnow assay. Post-liver transplantation survival was analyzed.

RESULTS

CD4⁺ T-cell iATP level significantly differed among patients with different post-liver transplantation survival intervals. The peak CD4⁺ T-cell iATP levels typically occurred within the first 3 postoperative months.

CONCLUSIONS

Post-liver transplantation survival interval is correlated with CD4⁺ T-cell iATP levels.

Multi-parameter based coagulant dosing control

The required coagulant dosage is strongly related to the quality of raw water or wastewater. Online sensors for most quality parameters are now readily available to treatment facilities, yet remain rarely used in treatment process control. This paper presents the evaluation of an advanced coagulant dosing control system based on online measurements in full-scale processes. The popular multivariate analytical method, partial least square regression, was used to build up the relationship between the coagulant dose and wastewater quality. The system was tested in two wastewater treatment plants (WWTPs) in Norway. Coagulant savings up to 30% in Norwegian plants were observed with feed forward calibrations. The considerable savings reduce sludge production, leading to further cost saving on sludge treatment. This paper presents the method, function and experiences of the full-scale implementation of the system in different WWTPs.

Reconstruction of the Outflow Tract in Cross-Auxiliary Double-Domino Donor Liver Transplantation

BACKGROUND

Auxiliary liver transplantation is accepted as an effective manner to expand the liver donor pool. A difficult surgical technical challenge of the procedure is hepatic vein reconstruction of the graft.

METHODS

To resolve this problem, complex techniques are used to perform an innovative outflow tract reconstruction in the world's first cross-auxiliary double-domino donor liver transplantation with two whole liver grafts. The inferior vena cava-sparing hepatectomy technique was applied at harvest in the two domino liver donors. For each donor, the three major hepatic veins (right, middle, and left) were joined together to create one single orifice, but there was no sufficient tissue to perform a direct anastomosis.

RESULTS

The hepatic vein was reconstructed with the use of a longitudinally opened iliac vein graft from a cadaveric donor to prolong the outflow tract for the piggyback suturing.

CONCLUSIONS

This new technique might provide an innovative surgical approach for reconstructing the complex outflow tract of domino transplantation.

Correlation Between Immunosuppressive Therapy and CD4(+) T-Cell Intracellular Adenosine Triphosphate Levels in Liver Transplant Recipients

OBJECTIVE

The aim of this work was to analyze the correlation between immunosuppressive therapy and CD4(+) T-cell intracellular adenosine triphosphate (iATP) levels after liver transplantation and to describe the distribution characteristics of iATP in CD4(+) T cells among liver transplant recipients.

METHODS

We studied 172 patients who were followed regularly after liver transplantation with long-term stable conditions from July 2010 to October 2012. CD4(+) T-cell iATP levels were detected with the use of the Cylex Immuknow Assay method and analyzed retrospectively according to immunosuppressive therapy protocol.

RESULTS

There was a significant difference in CD4(+) T-cell iATP level among the recipients receiving different immunosuppressive therapy protocols after liver transplantation. CD4(+) T-cell iATP level in the FK506 group and FK506 + prednisone (Pred) groups was higher than in the FK506 + mycophenolate mofetil (MMF), FK506 + MMF + Pred, and rapamycin (Rapa) groups. CD4(+) T-cell iATP level in patients receiving an MMF protocol was lower than in the group without MMF.

CONCLUSIONS

There is a relationship between distribution immunosuppressive therapy protocol and CD4(+) T-cell iATP level after liver transplantation. MMF and Rapa lower the CD4(+) T-cell iATP level significantly.

Efficiency of multi-beam Fourier phase gratings at 1.4 THz

We compare the results of simulated and measured power efficiency and far-field beam pattern, for two reflective Fourier phase gratings, designed to generate 2 × 2 and 2 × 4 beams respectively from a single-beam, coherent source at 1.4 THz. The designed surface structures were manufactured on aluminum plates by a computer numerical control (CNC) micro-milling machine. Despite small differences between the designed and fabricated gratings, we measured power efficiencies of both gratings to be around 70%, which is in a good agreement with the simulated values. We also find a good agreement between the simulated and measured diffracted beam size and spatial distribution. We demonstrate the application of both gratings as multiple beam local oscillators to simultaneously pump (or operate) a 4-pixel array of superconducting heterodyne mixers.

[Evaluation of production and clinical working time of computer-aided design/computer-aided manufacturing (CAD/CAM) custom trays for complete denture]

OBJECTIVE

To compare the technician fabrication time and clinical working time of custom trays fabricated using two different methods, the three-dimensional printing custom trays and the conventional custom trays, and to prove the feasibility of the computer-aided design/computer-aided manufacturing (CAD/CAM) custom trays in clinical use from the perspective of clinical time cost.

METHODS

Twenty edentulous patients were recruited into this study, which was prospective, single blind, randomized self-control clinical trials. Two custom trays were fabricated for each participant. One of the custom trays was fabricated using functional suitable denture (FSD) system through CAD/CAM process, and the other was manually fabricated using conventional methods. Then the final impressions were taken using both the custom trays, followed by utilizing the final impression to fabricate complete dentures respectively. The technician production time of the custom trays and the clinical working time of taking the final impression was recorded.

RESULTS

The average time spent on fabricating the three-dimensional printing custom trays using FSD system and fabricating the conventional custom trays manually were (28.6±2.9) min and (31.1±5.7) min, respectively. The average time spent on making the final impression with the three-dimensional printing custom trays using FSD system and the conventional custom trays fabricated manually were (23.4±11.5) min and (25.4±13.0) min, respectively. There was significant difference in the technician fabrication time and the clinical working time between the three-dimensional printing custom trays using FSD system and the conventional custom trays fabricated manually (P<0.05).

CONCLUSION

The average time spent on fabricating three-dimensional printing custom trays using FSD system and making the final impression with the trays are less than those of the conventional custom trays fabricated manually, which reveals that the FSD three-dimensional printing custom trays is less time-consuming both in the clinical and laboratory process than the conventional custom trays. In addition, when we manufacture custom trays by three-dimensional printing method, there is no need to pour preliminary cast after taking the primary impression, therefore, it can save the impression material and model material. As to completing denture restoration, manufacturing custom trays using FSD system is worth being popularized.

Abstract OT2-03-02: Feasibility of assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone sensitive early stage breast cancer

Background: Accelerated partial breast irradiation (APBI) delivers adjuvant radiation (RT) to the 1-2 cm of the breast at highest risk for recurrence surrounding the lumpectomy (L) cavity over 5-8 days and is an alternative to standard whole breast irradiation for hormone sensitive (HS) stage 1 (T1, N0) breast cancer (BC) based on 2 randomized controlled trials. External beam methods for APBI are common but have notable inherent drawbacks that include: inter-fraction inaccuracy due to patient setup based on anatomy, intra fraction error related to patient or respiratory motion, and inaccurate geometric targeting by relying on L cavity position instead of the tumor position. Postoperative RT has other limitations including delivery in the setting of disrupted blood or lymphatic supply that may be suboptimal for radio sensitivity and it eliminates observation of radiation-induced tumor response. MRI is an established tool for measuring BC extent and response from neoadjuvant systemic therapy. It's hypothesized that MRI directed pre-operative APBI using intensity modulated radiotherapy (IMRT) with image guidance (IGRT) will improve RT delivery, and that MRI features can be identified to correlate with pathologic radiation response.

Trial Design: There are 2 cohorts to this single arm prospective trial. The first cohort is for establishing and verifying patient flow and image fusion between MRI, CT and RT planning. In the second cohort eligible patients will receive preoperative APBI 38.5 Gy in 10 fractions BID with IMRT, IGRT in the prone position using MRI defined targets fused to CT treatment planning.

Eligibility: For cohort 1 it is HS Stage 1 BC that has completed CT in prone position for RT planning. Eligibility for cohort 2 requires: age &gt; 60 yo, clinical stage 1 BC, HS, HER2 negative, intending L, clinically negative axilla verified by ultrasound, able to tolerate the prone position, and MRI with contrast.

Specific aims: To determine the reproducibility of MRI directed preoperative APBI based on meeting 3 criteria: ability to define RT targets by MRI, quality of RT plans and completion of treatment (APBI and surgery). Additional aims include assessing toxicity, cosmetic outcome, local regional cancer control and collection of tissue for correlative studies.

Statistical methods: The optimal two-stage design by Simon is used. Sample size for cohort 2 is based on the first endpoint. 19 eligible patients will be required in the first stage; if 3 or more treatments are scored unacceptable, then early stopping will be recommended. Otherwise, accrual will continue to a total accrual of 30. If &gt; 4 of 30 treatments are scored unacceptable, the technique will be considered not reproducible, and a Phase II study will not be pursued. Under the null hypothesis of an 80% reproducibility rate, this two-stage design has an expected sample size of 24.4.

Patient accrual to cohort 1 is 2 and targeted accrual is 3. Patient accrual to Cohort 2 is 0 and targeted accrual is 30.

Contact information: Soyhun Mc Elroy ( Sohyun.McElroy@osumc.edu) or Julia White (Julia.White@osumc.edu)

Funding source: Susan G Komen Breast Cancer Foundation Grant # GRT00035216.

Citation Format: White J, McElroy S, Seykon A, Wei L, Bazan J, Yang X, DiCostanzo D, Gupta N, Knopp M. Feasibility of assessing radiation response with MRI/CT directed preoperative accelerated partial breast irradiation in the prone position for hormone sensitive early stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-03-02.