Prospects for observing and localizing gravitational-wave transients with Advanced LIGO, Advanced Virgo and KAGRA

We present our current best estimate of the plausible observing scenarios for the Advanced LIGO, Advanced Virgo and KAGRA gravitational-wave detectors over the next several years, with the intention of providing information to facilitate planning for multi-messenger astronomy with gravitational waves. We estimate the sensitivity of the network to transient gravitational-wave signals for the third (O3), fourth (O4) and fifth observing (O5) runs, including the planned upgrades of the Advanced LIGO and Advanced Virgo detectors. We study the capability of the network to determine the sky location of the source for gravitational-wave signals from the inspiral of binary systems of compact objects, that is binary neutron star, neutron star-black hole, and binary black hole systems. The ability to localize the sources is given as a sky-area probability, luminosity distance, and comoving volume. The median sky localization area (90% credible region) is expected to be a few hundreds of square degrees for all types of binary systems during O3 with the Advanced LIGO and Virgo (HLV) network. The median sky localization area will improve to a few tens of square degrees during O4 with the Advanced LIGO, Virgo, and KAGRA (HLVK) network. During O3, the median localization volume (90% credible region) is expected to be on the order of 10 5 , 10 6 , 10 7 Mpc 3 for binary neutron star, neutron star-black hole, and binary black hole systems, respectively. The localization volume in O4 is expected to be about a factor two smaller than in O3. We predict a detection count of 1 - 1 + 12 ( 10 - 10 + 52 ) for binary neutron star mergers, of 0 - 0 + 19 ( 1 - 1 + 91 ) for neutron star-black hole mergers, and 17 - 11 + 22 ( 79 - 44 + 89 ) for binary black hole mergers in a one-calendar-year observing run of the HLV network during O3 (HLVK network during O4). We evaluate sensitivity and localization expectations for unmodeled signal searches, including the search for intermediate mass black hole binary mergers.

[Analysis on the transmission characteristics of newly reported human immunodeficiency virus/acquired immunodeficiency syndrome cases based on the molecular transmission network in Huzhou, Zhejiang, 2017]

Objective: Using field epidemiological investigation and molecular analysis to construct the molecular transmission network of human immunodeficiency virus/acquired immunodeficiency syndrome cases (HIV/AIDS) newly diagnosed in Huzhou in 2017, Zhejiang Province. Methods: A total of 160 participants were obtained through a web-based system from Chinese Center for Disease Control and Prevention (CCDC) with the features of diagnosed in Huzhou in 2017 who also had been collected samples for the first follow-up. The basic information of demographic characteristics and risk factors was extracted from the website. RNA was extracted from plasma samples of untreated cases, followed by RT-PCR and nest-PCR for pol gene amplification, sequencing. Phylogenetic tree was constructed by MEGA software for HIV gene subtyping. TN93 model was used for calculating the distance between two sequences. Cytoscape software was used for drawing molecular transmission network. And then an epidemiological survey was conducted to cases in the primary cluster. Results: A total of 138 sequenced individuals (86.3%) were acquired from 160 individuals. Among which, 123 (89.1%) were male. The highest proportion of subtype was CRF07_BC (60, 43.5%), followed by CRF01_AE (46, 33.3%), and with four cases of Unique Recombinant Form (URF, CRF01_AE and CRF07_BC) and one case of URF (subtype B and C). A total of 18 molecular clusters included 56 individuals (40.6%) were found in the transmission network under the optimal genetic distance threshold (1.0%). The clustering proportion of CRF07_BC (66.1%, 37 cases) was higher than that of CRF01_AE. There were 9 clusters formed among CRF07_BC, including 37 cases (accounting for 61.7%, 37/60). The primary transmission cluster contained 11 cases, among which 9 cases were transmitted by homosexual sex. The first time of the cases to have homosexual behavior is range from 2010 to 2016, whose media number (P(25), P(75)) of partners was 6 (3.5, 8.5). Most of the cases come from Anhui Province and engaged in garment industry (5 cases), between which there were 8 cases used Blued software to seek for casual partners, 1 case seeking for casual partners in garden. Conclusion: With CRF07_BC and CRF01_AE predominantly circulating, HIV genetic diversity had been noticed in this area. The primary cluster was consisted of high proportion of locally new infections, and a specific population aggregation in limited place existed.

Lowly expressed EGFR-AS1 promotes the progression of preeclampsia by inhibiting the EGFR-JAK/STAT signaling pathway

OBJECTIVE

To detect the differentially expressed long non-coding RNA (lncRNA) EGFR-AS1 in the placenta tissues of preeclampsia (PE) patients and normal pregnancies. We also investigated the underlying mechanism of EGFR-AS1 in regulating PE development.

PATIENTS AND METHODS

21 PE patients and 21 normal pregnancies admitted in our hospital were selected. The expression of EGFR Antisense RNA1 (EGFR-AS1) in the placenta tissues of PE patients and normal pregnancies was detected by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). The regulatory effect of EGFR-AS1 on proliferation of HTR-8 cells was observed by Cell Counting Kit-8 (CCK-8) assay and colony formation assay. Cell cycle and apoptosis of HTR-8 cells after overexpression or knockdown of EGFR-AS1 were detected by flow cytometry. The expression changes of EGFR and proteins related to JAK/STAT signaling pathway after knockdown of EGFR-AS1 in HTR-8 cells were detected by Western blot. Rescue experiments were carried out after upregulating EGFR expression in HTR-8 cells.

RESULTS

QRT-PCR results showed that the mRNA expression of EGFR-AS1 in PE patients was lower than that in normal pregnancies. CCK-8 assay and colony formation assay showed that knockdown of EGFR-AS1 in HTR-8 cells inhibited cell proliferation. Flow cytometry results showed that knockdown of EGFR-AS1 blocked the cell cycle of HTR-8 cells. Overexpression of EGFR-AS1 obtained opposite results. Western blot results showed that the protein expressions of EGFR, p-JAK and p-STAT were decreased after knockdown of EGFR-AS1. Alterations in protein expressions of p-JAK and p-STAT, and proliferative ability of HTR-8 cells induced by EGFR-AS1 knockdown could be rescued after upregulation of EGFR.

CONCLUSIONS

The expression of lncRNA EGFR-AS1 is decreased in PE patients, which can promote the progression of preeclampsia by inhibiting EGFR-JAK/STAT signaling pathway.

LncRNA HOXD-AS1 promotes preeclampsia progression via MAPK pathway

OBJECTIVE

To investigate the role of HOXD-AS1 in preeclampsia and its underlying mechanism.

PATIENTS AND METHODS

A total of 50 preeclampsia primiparas and 34 normal pregnancies admitted in our hospital from July 2015 to July 2017 were selected as the study group and control group, respectively. Age, body weight, blood pressure, 24-h urinary protein and neonatal weight were compared between the two groups. HOXD-AS1 expression in the placenta tissues was detected by quantitative Real-time PCR (qRT-PCR). Preeclampsia patients were further assigned into high and low expression group according to their HOXD-AS1 expressions. The relationship between HOXD-AS1 expression and blood pressure, 24-h urinary protein and neonatal weight in preeclampsia patients were analyzed. For in vitro experiments, transfection efficacy of pcDNA-HOXD-AS1 and si-HOXD-AS1 were detected by qRT-PCR. Proliferative and colony formation abilities in BeWo and Wish cells were detected by CCK-8 and colony formation assay, respectively. Moreover, protein expressions of p-p38, p-JNK, and p-ERK were detected by Western blot.

RESULTS

The systolic blood pressure, diastolic blood pressure and urinary protein in preeclampsia patients were higher than those of normal pregnancies. However, neonatal weight in preeclampsia patients was lower than that of normal pregnancies. HOXD-AS1 expressions were gradually increased in normal pregnancies, patients with late onset preeclampsia and patients with early onset preeclampsia sequentially. Additionally, higher levels of systolic pressure, diastolic pressure and 24-h urinary protein, as well as lower neonatal weight, were observed in preeclampsia patients with high expression of HOXD-AS1 than those with low expression. In vitro results demonstrated that proliferative and colony formation abilities in trophoblasts were elevated after HOXD-AS1 knockdown. Western blot data illustrated that protein expressions of p-p38 and p-JNK were decreased, while p-ERK expression was increased after overexpression of HOXD-AS1 in trophoblasts.

CONCLUSIONS

HOXD-AS1 participates in the development and progression of preeclampsia by regulating trophoblast proliferation via the MAPK pathway.

Analyzing acoustoelastic effect of shear wave elastography data for perfused and hydrated soft tissues using a macromolecular network inspired model

Shear wave elastography (SWE) has enhanced our ability to non-invasively make in vivo measurements of tissue elastic properties of animal and human tissues. Recently, researchers have taken advantages of acoustoelasticity in SWE to extract nonlinear elastic properties from soft biological tissues. However, most investigations of the acoustoelastic effects of SWE data (AE-SWE) rely on classic hyperelastic models for rubber-like (dry) materials. In this paper, we focus solely on understanding acoustoelasticity in soft hydrated tissues using SWE data and propose a straightforward approach to modeling the constitutive behavior of soft tissue that has a direct microstructural/macromolecular interpretation. Our approach incorporates two constitutive features relevant to biological tissues into AE-SWE: static dilation of the medium associated with nonstructural components (e.g. tissue hydration and perfusion) and finite extensibility derived from an ideal network of biological filaments. We evaluated the proposed method using data from an in-house tissue-mimicking phantom experiment, and ex vivo and in vivo AE-SWE data available in the SWE literature. In conclusion, predictions made by our approach agreed well with measurements obtained from phantom, ex vivo and in vivo tissue experiments.

[Application of ultrasonography in etiologic judgment of hoarseness after thyroidecomy]

Objective:To explore the application value of ultrasound in etiologic judgement of hoarseness after thyroidecomy. Method:Sixty-three cases of hoarseness after thyroidecomy were examed by laryngeal ultrasonography. Vocal cord, arytenoid cartilage, pyriform fossa, thyroid operation area and recurrent laryngeal nerve pathway were evaluated. Regard electronic laryngoscope results as gold standard and compare the differences between the two methods. Result:Sixty-three patients were detected by ultrasound, then, 29 cases were diagnosed with left vocal cord paralysis, 24 cases with right vocal cord paralysis, 2 cases with bilateral vocal cord paralysis, 1 case with right vocal cord polyp, 3 cases with left vocal cord polyp, 1 case with renke layer edema, and 3 cases has normal laryngeal imaging. The accuracy of ultrasonography in determining the etiology of hoarseness after thyroidecomy is 92.1%, the sensitivity is 93.3%, and the specificity is 66.7%. Conclusion:The ultrasonography can not only show laryngeal structures, but also display thyroid operation area and recurrent laryngeal nerve pathway. Moreover, as an non-invasive method, ultrasonography has high accuracy in etiologic judgement of hoarseness after thyroidecomy and certain clinical application values.

Role and mechanism of Dvl3 in the esophageal squamous cell carcinoma

OBJECTIVE

The purpose of this project was to investigate the expression of Dishevelled-3 (Dvl3) in esophageal squamous cell carcinoma and cultured cells, and to determine the consequence of Dvl3 silencing in the tumorous properties of esophageal squamous cell carcinoma cells.

PATIENTS AND METHODS

The expression of Dvl3 mRNA and protein in 50 cases of esophageal squamous cell carcinoma was detected. The expression of Dvl3 mRNA and protein was significantly elevated in esophageal squamous cell carcinoma tissues compared with atypical hyperplasia and normal esophageal mucosa.

RESULTS

Dvl3 promoted the proliferation of esophageal squamous cell carcinoma cells and cell migration of cells expressing Dvl3 siRNA was significantly lower than that of the non-transfected cells. Flow cytometry showed that silencing Dvl3 promoted apoptosis of esophageal squamous cell carcinoma. Dvl3 overexpression cells in the subcutaneous tissue of nude mice promoted the formation of tumors. The expression of Dvl3 was associated with invasion and metastasis of the esophageal squamous cell carcinoma.

CONCLUSIONS

Overall, down-regulation of Dvl3 expression can control the progression of esophageal squamous cell carcinoma, inhibit the growth and promote the apoptosis of tumor cells. Thus, Dvl3 has potential applications for early diagnosis, prognosis and therapeutics in the esophageal squamous cell carcinoma.

[Predictive value of quantitative dynamic contrast-enhanced magnetic resonance imaging for the efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer]

Objective: To investigate the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters for the efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer. Methods: Sixty-five patients with locally advanced gastric cancer (LAGC) confirmed by gastroscopy and received neoadjuvant chemotherapy (NCT) were enrolled in this study. Quantitative DCE-MRI was performed before NCT, and the quantitative parameters were measured, including volume transfer constant (K(trans)), rate constant (K(ep)), volume fraction of extravascular extracellular space (V(e)) and volume fraction of plasma (V(p)). After NCT, all patients received radical gastrectomy. According to postoperative pathological tumor regression grade, patients were divided into response group and non-response group, and the differences of DCE quantitative parameters between the two groups were compared. ROC curve was utilized to analyze the predictive efficacy of DCE quantitative parameters for NCT response of LAGC, and multivariate logistic regression analysis was performed to analyze the predictive efficacy of combined parameters. Results: Thirty-seven patients were in response group and 28 patients were in non-response group. The pretreatment K(trans) in the response group were [0.216 min(-1) (0.130 min(-1), 0.252 min(-1))], significantly higher than [0.091 min(-1) (0.069 min(-1), 0.146 min(-1))] of non-response group (P<0.001), and V(e) in the response group were [0.354(0.228, 0.463)], significantly higher than [0.200(0.177, 0.253)]of non-response group (P<0.001). ROC analysis showed the AUCS of K(trans) and V(e) in predicting NCT efficacy were 0.881 and 0.756, respectively. Multiple logistic regression analysis showed that the combination of the two parameters could improve the AUC to 0.921, with the sensitivity and specificity of 86.5% and 89.3%, respectively. Conclusion: DCE-MRI quantitative parameters could help to predict the NCT response of LAGC, and the combination of parameters could improve the predictive efficacy.

IL-33 induced inflammation exacerbated the development of chronic obstructive pulmonary disease through oxidative stress

OBJECTIVE

We aimed at exploring the role of IL-33 in mouse chronic obstructive pulmonary disease and its potential molecular mechanism.

MATERIALS AND METHODS

The chronic obstructive pulmonary disease (COPD) mice model was established by cigarette smoking (CS). COPD mice were randomly assigned into PBS group and IL-33 antibody group. The peripheral blood and lung tissues of mice from two groups were collected for the following experiments. Pathological changes of the lung tissues in both groups were analyzed by hematoxylin and eosin (HE) staining. IL-33 positive cells in lung tissues were detected by immunohistochemistry. Then, the mRNA and protein levels of IL-33, sST2, ERK and TNF-α in the mice peripheral blood of the two groups were accessed by Real-time polymerase chain reaction (RT-PCR) and Western blot. Finally, the indicators related to oxidative stress, including superoxide dismutase (SOD), malondialdehyde (MDA) and reactive oxygen species (ROS) in the mice serum of two groups were measured.

RESULTS

After successful construction of COPD mouse model by CS, HE staining illustrated that the structure of airway wall of lung tissue in mice from PBS group was irregular. The ciliated columnar epithelium presented significant degeneration, necrosis and shedding. A large amount of inflammation cell infiltration was observed in vascular tissues. The alveolar epithelial structure was severely damaged and alveolar septum was narrowed and ruptured. Adjacent alveoli were found to be fused into larger cysts. The above pathological changes were relatively better in mice from IL-33 antibody group. Immunohistochemical results demonstrated that IL-33 was remarkably deposited in the lung tissue of PBS group. The mRNA and protein levels of IL-33, sST2, ERK and TNF-α in peripheral blood of PBS group were much higher than those of IL-33 antibody group. At the same time, SOD level in PBS group decreased, while MDA level and ROS production increased.

CONCLUSIONS

IL-33 aggravates lung injury in COPD mice by increasing inflammation response and oxidative stress, which may serve as a target for predicting and treating COPD.

5106A pattern-discovery-based outcome predictive tool integrated with clinical data repository: design and a case study on contrast related acute kidney injury

Introduction

Clinical data repositories (CDR) including electronic health record (EHR) data have great potential for outcome prediction and risk modeling. However, most CDRs were only used for data displaying, and using data from CDR for outcome prediction often requires careful study design and sophisticated modeling techniques before a hypothesis can be tested.

Purpose

We built a prediction tool integrated with CDR based on pattern discovery aiming to bridge the above gap and demonstrated a case study on contrast related acute kidney injury (AKI) with the system.

Methods

A cardiovascular CDR integrated with multiple hospital informatics systems was established. For the case study on AKI, we included patients undergoing cardiac catheterization from January 13, 2015 to April 27, 2017, excluding those with dialysis, end-stage renal disease, renal transplant, and missing pre- or post-procedural creatinine. To handle missing data, a prior-history-note composer was designed to fill in structured data of 14 diseases related to cardiovascular problem. Crucial data such as ejective fraction was extracted from the structured reports. AKI was defined according to Acute Kidney Injury Network by increase of serum creatinine from most recent baseline to the post-procedure 7-day peak. To build predictive modeling, we selected 17 variables covered in existing AKI models. Pattern discovery was recently developed as an interpretable predictive model which works on incomplete noisy data. In this study, we developed a pattern discovery based visual analytics tool, and trained it on 70% data up to August 2016 with three interactive knowledge incorporation modes to develop 3 models: 1) pure data-driven, 2) domain knowledge, and 3) clinician-interactive. In last two modes, a physician using the visual analytics could change the variables and further refine the model, respectively. We tested and compared it with other models on the 30% consecutive patients dated afterwards, which is shown in Figure 1.

Results

Among 2,560 patients in the final dataset with 17 pre-procedure variables derived from CDR data, 169 (7.3%) had AKI. We measured 4 existing models, whose areas under curves (AUCs) of receiver operating characteristics curve for the test set were 0.70 (Mehran's), 0.72 (Chen's), 0.67 (Gao's) and 0.62 (AGEF), respectively. A pure data-driven machine learning method achieves AUC of 0.72 (Easy Ensemble). The AUCs of our 3 models are 0.77, 0.80, 0.82, respectively, with the last being top where physician knowledge is incorporated.

Demo and demonstration

Conclusions

We developed a novel pattern-discovery-based outcome prediction tool integrated with CDR and purely using EHR data. On the case of predicting contrast related AKI, the tool showed user-friendliness by physicians, and demonstrated a competitive performance in comparison with the state-of-the-art models.

Search for Subsolar Mass Ultracompact Binaries in Advanced LIGO's Second Observing Run

We present a search for subsolar mass ultracompact objects in data obtained during Advanced LIGO's second observing run. In contrast to a previous search of Advanced LIGO data from the first observing run, this search includes the effects of component spin on the gravitational waveform. We identify no viable gravitational-wave candidates consistent with subsolar mass ultracompact binaries with at least one component between 0.2  M_{⊙}-1.0  M_{⊙}. We use the null result to constrain the binary merger rate of (0.2  M_{⊙}, 0.2  M_{⊙}) binaries to be less than 3.7×10^{5}  Gpc^{-3} yr^{-1} and the binary merger rate of (1.0  M_{⊙}, 1.0  M_{⊙}) binaries to be less than 5.2×10^{3}  Gpc^{-3} yr^{-1}. Subsolar mass ultracompact objects are not expected to form via known stellar evolution channels, though it has been suggested that primordial density fluctuations or particle dark matter with cooling mechanisms and/or nuclear interactions could form black holes with subsolar masses. Assuming a particular primordial black hole (PBH) formation model, we constrain a population of merging 0.2  M_{⊙} black holes to account for less than 16% of the dark matter density and a population of merging 1.0  M_{⊙} black holes to account for less than 2% of the dark matter density. We discuss how constraints on the merger rate and dark matter fraction may be extended to arbitrary black hole population models that predict subsolar mass binaries.

P4794Comparative effectiveness and safety of non-VKA oral anticoagulants versus warfarin in non-valvular atrial fibrillation patients with differential treatment duration: an ARISTOPHANES study analysis

Background

The ARISTOPHANES (Anticoagulants for Reduction In STroke: Observational Pooled analysis on Health outcomes ANd Experience of patientS) study showed that non-vitamin K antagonist oral anticoagulants (NOACs) were associated with lower risks of stroke/systemic embolism (S/SE) and variable comparative risks of major bleeding (MB) versus warfarin.

Purpose

To assess long-term use of non-VKA oral anticoagulants (NOACs) vs. warfarin in

ARISTOPHANES by evaluating the risk of S/SE and MB among non-valvular atrial fibrillation (NVAF) patients by duration of treatment (<1 and ≥1 year).

Methods

In the ARISTOPHANES study, NVAF patients initiating apixaban, dabigatran, rivaroxaban, or warfarin from 01/01/2013–09/30/2015 were identified from the CMS Medicare data and four US commercial claims databases, covering >180 million beneficiaries annually (∼56% of US population). After 1:1 propensity score matching (PSM) in each database between NOACs and warfarin (apixaban-warfarin, dabigatran-warfarin, and rivaroxaban-warfarin), the resulting patient records were pooled. Treatment duration was defined as time between the day after the treatment index date and discontinuation (30 days after a 30-day gap in the prescription), treatment switch, death, end of study period, or end of continuous medical and pharmacy enrollment, whichever occurred first. Matched patients with observed treatment duration <1 or ≥1 year were separately examined. Cox models were used to estimate hazard ratios of S/SE and MB (identified by inpatient claims) during observed treatment duration.

Results

The mean treatment duration for patients with shorter (<1 year) vs longer (≥1 year) duration was 4–5 months vs 18–21 months across the three matched cohorts. All the matched baseline variables remained balanced. The incidence rates of S/SE and MB and the proportion of patients with treatment discontinuation were higher in patients with shorter treatment duration. Regardless of treatment duration, apixaban patients had a lower risk of S/SE and MB versus warfarin; dabigatran patients had a lower risk of MB versus warfarin; and rivaroxaban patients had a lower risk of S/SE versus warfarin. Compared to warfarin patients, dabigatran patients with treatment duration <1 year had a similar risk of S/SE, while those with treatment duration ≥1 year had lower S/SE risk; rivaroxaban patients with treatment duration <1 year had a higher risk of MB, while those with treatment duration ≥1 year had similar MB risk.

Conclusions

Among NVAF patients with duration of treatment <1 and ≥1 year in the ARISTOPHANES study, apixaban and rivaroxaban were associated with lower risk of S/SE, while apixaban and dabigatran were associated with lower risk of MB, compared to warfarin. These findings indicate varying long-term effectiveness and safety outcomes between NOACs and warfarin.

Acknowledgement/Funding

This study was funded by Bristol-Myers Squibb and Pfizer Inc.

[The comparative study of endoscope versus open surgery on nipple sparing mastectomy with immediate reconstruction using prosthesis implantation]

Objective: To compare the clinical efficacy between endoscopic nipple-sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery. Methods: Totally 189 early-stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 67 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients' satisfaction of breast reconstruction were compared between the two groups using t test, Mann-Whitney U test, χ(2) test or non-parametric test. Results: There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups (P>0.05). The operative duration (sentinel lymph node biopsy: (178± 80) minutes vs. (198±42) minutes, t=-2.082, P=0.039; axillary lymph node dissection: (204±79) minutes vs. (233±49) minutes, t=-2.952, P=0.004), the volume of drainage in three days postoperative ((183±141)ml vs. (237±104) ml, t=- 2.938, P=0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs. (62± 36) ml, t=3.210, P=0.002). Patients' satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group. Conclusions: Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early-stage breast cancer patients.

P4768Comparative effectiveness and safety between non-VKA oral anticoagulants in non-valvular atrial fibrillation patients with differential duration of treatment: an analysis of the ARISTOPHANES study

Background

The ARISTOPHANES (Anticoagulants for Reduction In STroke: Observational Pooled analysis on Health outcomes ANd Experience of patientS) study showed that apixaban was associated with lower risks of stroke/systemic embolism (S/SE) and major bleeding (MB) versus dabigatran and rivaroxaban; dabigatran was associated with similar risk of S/SE and lower risk of MB compared to rivaroxaban.

Purpose

To assess long-term use of non-VKA oral anticoagulants (NOACs) in ARISTOPHANES by evaluating the risk of S/SE and MB among non-valvular atrial fibrillation (NVAF) patients receiving different NOACs by duration of treatment (<1 and ≥1 year).

Methods

In the ARISTOPHANES study, NVAF patients initiating apixaban, dabigatran, and rivaroxaban from 01/01/2013–09/30/2015 were identified from the CMS Medicare data and four US commercial claims databases, covering >180 million beneficiaries annually (∼56% of US population). After 1:1 propensity score matching (PSM) in each database between NOACs (apixaban-dabigatran, apixaban-dabigatran, and dabigatran-rivaroxaban), the resulting patient records were pooled. Treatment duration was defined as time between the day after the index treatment date and discontinuation (defined using a 30-day gap in the prescription), treatment switch, death, end of study period, or end of continuous medical and pharmacy enrollment, whichever occurred first. Matched patients with observed treatment duration <1 or ≥1 year were separately examined. Cox models were used to estimate hazard ratios of S/SE and MB (identified by inpatient claims) during observed treatment duration. S/SE included ischemic stroke, hemorrhagic stroke, and SE; MB included gastrointestinal (GI) bleeding, intracranial hemorrhage (ICH), and other MB.

Results

The mean treatment duration for patients with shorter (<1 year) vs longer (≥1 year) duration was ∼4 months vs 18–21 months across the three matched cohorts. All the matched baseline variables remained balanced. The incidence rates of S/SE and MB and the proportion of patients with treatment discontinuation were higher in patients with shorter treatment duration. Regardless of treatment duration, apixaban and dabigatran had a lower risk of MB versus rivaroxaban; and dabigatran had a similar risk of S/SE versus rivaroxaban. Compared to dabigatran patients, apixaban patients with treatment duration <1 year had a lower risk of S/SE and MB, while those with treatment duration ≥1 year had similar S/SE and MB risk. Compared to rivaroxaban patients, apixaban patients with treatment duration <1 year had a lower risk of S/SE, while those with treatment duration ≥1 year had similar S/SE risk.

Conclusions

Across NVAF patients with duration of treatment <1 and ≥1 year in the ARISTOPHANES study, both apixaban and dabigatran were associated with a lower risk of MB compared to rivaroxaban. These findings indicate varying long-term safety outcomes among different NOACs.

Acknowledgement/Funding

This study was funded by Bristol-Myers Squibb and Pfizer Inc.

[Efficacy analysis of fecal microbiota transplantation in the treatment of 2010 patients with intestinal disorders]

Objective: To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for intestinal disorders. Methods: A retrospectively descriptive cohort study was carried out. Clinical data of 2010 patients who underwent FMT and received follow-up for more than 3 months from May 2014 to November 2018 were collected, including 1,206 cases from Tongji University Shanghai Tenth People's Hospital and 804 cases from Nanjing Eastern Military General Hospital. Of the 2,010 patients, 797 were male and 1,213 were female, with a mean age of (49.4±16.5) years old. Inclusion criteria were those with indications for FMT and voluntary treatment of FMT. Pregnant or lactating women, patients with end-stage disease, cases who were participating or participated in other clinical trials within 3 months, and patients with previous bowel history of pathogen infection, oral antibiotics or proton pump inhibitors (PPI) for the recent2 weeks, and those at immunosuppressive state were excluded. Informed consent was obtained from the enrolled patients and their families. There were 1,356 cases of constipation, 175 cases of inflammatory bowel disease, 148 cases of chronic diarrhea, 127 cases of radiation enteritis, 119 cases of irritable bowel syndrome, and 85 cases of autism (complicating with intestinal disorders). FMT donor requirements: (1) 18 to 30 years old non-relatives, non-pregnant healthy adults with healthy lifestyle and good eating habits as volunteers to participate in fecal donation; (2) no administration of antibiotics within 3 months; (3) no chronic diseases such as constipation, irritable bowel syndrome, inflammatory bowel disease, etc., no autoimmune disease, not in immunosuppressive state, no history of malignant disease; (4) negative pathogen examination of infectious diseases (hepatitis B virus, hepatitis C virus, syphilis, HIV, etc.); (5) negative fecal examination (C.difficile, dysentery bacillus, Shigella, Campylobacter, parasites, etc.). The donor requirements after enrollment: (1) physical examination was reviewed once every two months, and the result still met the above requirements; (2) 16S rRNA sequencing was performed for every fecal donation in order to ensure that the composition and diversity of the fecal flora was stable and reliable. The preparation of the stool suspension referred to the Amsterdam criteria and the preparation process was less than 1 hour. The preparation of the FMT capsule was processed by pre-freezing the stool suspension after the preparation of the above suspension, and the frozen sample was transferred into a freeze dryer for freezing. The dried and lyophilized powder was encapsulated in capsules, and the capsule shell was made of acid-resistant hypromellose capsule (No.0) and pediatric-specific capsule (No.3), sealed and packaged in a-20℃ refrigerator. Three ways of accepting FMT treatment pathways included 6-day transplantation after the placement of the nasointestinal tube, 6-day oral FMT capsule transplantation and one-time transplantation through colonoscopy. Intestinal preparation (nasointestinal tube feeding of polyethylene glycol until watery stool) was carried out before transplantation. Other treatments were stopped during treatment and follow-up, and any medication was not recommended when necessary. Results: Of the 2010 patients, 1,497 cases received nasointestinal tube transplantation (nasointestinal tube group), 452 cases oral capsule transplantation (oral capsule group) and 61 cases colonoscopy (colonoscopy group). At 3 time points of 3, 12, and 36 months after FMT, the clinical cure rates and the clinical improvement rates were 41.3% (560/1 356), 35.2% (320/909), 31.4% (69/220), and 29.0% (393/1 356), 27.8% (253/909), 29.1% (64/220), respectively in constipation patients; 33.1% (58/175), 29.9% (35/117), 24.5% (12/49), and 31.4% (55/175), 27.4% (32/117), 57.1% (28/49), respectively in inflammatory bowel disease patients; 87.8% (130/148), 81.8% (81/99), 78.3% (36/46), and 8.1% (12/148), 7.1% (7/99), 4.3% (2/46), respectively in chronic diarrhea patients; 61.4% (78/127), 56.5% (48/85), 47.6% (20/42), and 21.2% (27/127), 15.3% (13/85), 14.3% (6/42), respectively in radiation enteritis patients; 53.8% (64/119), 45.0% (36/80), 6/15, and 21.0% (25/119), 26.2% (21/80), 4/15, respectively in irritable bowel syndrome patients; 23.5% (20/85), 22.8% (13/57), 20.0%(5/25), and 55.3% (47/85), 49.1% (28/57), 40.0% (10/25), respectively in autism patients. Meanwhile the clinical cure rates and the clinical improvement rates at 3, 12, and 36 months were 47.7% (714/1 497), 42.8% (425/994), 39.1% (128/327), and 29.1% (436/1 497), 27.0% (268/994), 28.1% (92/327), respectively in the nasointestinal tube group; 38.7% (175/452), 30.2% (91/301), 33.3% (16/48), and 24.3% (110/452), 26.2% (79/301), 25.0% (12/48), respectively in the oral capsule group; 34.4% (21/61), 32.7% (17/52), 18.2% (4/22), and 21.3% (13/61), 13.5% (7/52), 45.5% (10/22), respectively in colonoscopy group. No serious adverse events occurred during treatment and follow-up period. The adverse event of nasointestinal tube group presented higher ratio of discomfort in respiratorytract accounting for 13.1% (196/1497); the oral capsule group had a higher proportion of nausea and vomiting when swallowing capsules accounting for 7.1% (32/452); the colonoscopy group was mainly diarrhea, accounting for 37.7% (23/61). The above symptoms disappeared after the nasointestinal tube was removed, or after treatment ended, or within 1 to 3 days after hospitalization. Conclusion: FMT is a safe and effective method for the treatment of intestinal dysfunction.

Multivariate analysis of hemodynamic parameters on intracranial aneurysm initiation of the internal carotid artery

Although fluctuating hemodynamic wall stressors are known to impact intracranial aneurysms (IA) initiation, specificity of those stressors has not been evaluated. In this study, using human IA data, we investigated: (1) specificity of stressors in regions with and without IA eventual IA formation; and (2) how combinations of multiple stressors could improve IA formation prediction. 3D computational vasculatures were constructed based on angiographic images of 18 subjects having multiple closely-spaced IAs in the internal carotid artery. Two models were created: Model A with all IAs computationally removed, Model B which kept keep one IA. Computational fluid dynamics (CFD) simulated flow within models. Based on simulated flow fields, wall shear stress and its gradient (WSS, WSSG), oscillatory shear index (OSI), gradient oscillatory number (GON), aneurysm formation index (AFI), and mean number of swirling flow vortices (MV) were analysed. Multivariate logistic regression determined the accuracy of different combinations of those above-mentioned stressors. Overall, we found that combining hemodynamic stressors improves IA formation prediction over individual indices. Both Model A and Model B's parsimonious model was MV+WSS+GON: AUROC 0.88 and 0.83, respectively. Future studies are planned to understand biological meanings induced by fluctuating stressors.

High Performance Bi-2212 Round Wires Made with Recent Powders

Multifilamentary Bi₂Sr₂CaCu₂O_x (Bi-2212) wire made by the powder-in-tube technique is the only high temperature superconductor made in the round shape preferred by magnet builders. The critical current density (J _C ) of Bi-2212 round wire was improved significantly by the development of overpressure heat treatment in the past few years. Bi-2212 wire is commercially available in multiple architectures and kilometer-long pieces and a very promising conductor for very high field NMR and accelerator magnets. We studied the effects of precursor powder and heat treatment conditions on the superconducting properties and microstructure of recent Bi-2212 wires. Short samples of recent wire with optimized overpressure processing showed J _C (4.2 K, 15 T) = 6640 A/mm² and J _C (4.2 K, 30 T) = 4670 A/mm², which correspond to engineering critical current densities J _E (4.2 K, 15 T) = 1320 A/mm² and J _E (4.2 K, 30 T) = 930 A/mm².

High Precision Detection of Change in Intermediate Range Order of Amorphous Zirconia-Doped Tantala Thin Films Due to Annealing

Understanding the local atomic order in amorphous thin film coatings and how it relates to macroscopic performance factors, such as mechanical loss, provides an important path towards enabling the accelerated discovery and development of improved coatings. High precision x-ray scattering measurements of thin films of amorphous zirconia-doped tantala (ZrO_{2}-Ta_{2}O_{5}) show systematic changes in intermediate range order (IRO) as a function of postdeposition heat treatment (annealing). Atomic modeling captures and explains these changes, and shows that the material has building blocks of metal-centered polyhedra and the effect of annealing is to alter the connections between the polyhedra. The observed changes in IRO are associated with a shift in the ratio of corner-sharing to edge-sharing polyhedra. These changes correlate with changes in mechanical loss upon annealing, and suggest that the mechanical loss can be reduced by developing a material with a designed ratio of corner-sharing to edge-sharing polyhedra.

The dependence of leaf senescence on the balance between 1-aminocyclopropane-1-carboxylate acid synthase 1 (ACS1)-catalysed ACC generation and nitric oxide-associated 1 (NOS1)-dependent NO accumulation in Arabidopsis

Ethylene and nitric oxide (NO) act as endogenous regulators during leaf senescence. Levels of ethylene or its precursor 1-aminocyclopropane-1-carboxylate acid (ACC) depend on the activity of ACC synthases (ACS), and NO production is controlled by NO-associated 1 (NOA1). However, the integration mechanisms of ACS and NOA1 activity still need to be explored during leaf senescence. Here, using experimental techniques, such as physiological and molecular detection, liquid chromatography-tandem mass spectrometry and fluorescence measurement, we investigated the relevant mechanisms. Our observations showed that the loss-of-function acs1-1 mutant ameliorated age- or dark-induced leaf senescence syndrome, such as yellowing and loss of chlorophyll, that acs1-1 reduced ACC accumulation mainly in mature leaves and that acs1-1-promoted NOA1 expression and NO accumulation mainly in juvenile leaves, when compared with the wild type (WT). But the leaf senescence promoted by the NO-deficient noa1 mutant was not involved in ACS1 expression. There was a similar sharp reduction of ACS1 and NOA1 expression with the increase in WT leaf age, and this inflection point appeared in mature leaves and coincided with the onset of leaf senescence. These findings suggest that NOA1-dependent NO accumulation blocked the ACS1-induced onset of leaf senescence, and that ACS1 activity corresponds to the onset of leaf senescence in Arabidopsis.

Decreased A20 expression on circulating CD56bright NK cells contributes to a worse disease status in patients with ankylosing spondylitis

A20, a pivotal anti-inflammatory protein, preserves immune homeostasis and regulates prolonged inflammation. A previous study has shown that A20 expression levels are down-regulated in peripheral blood mononuclear cells (PBMCs) from patients with ankylosing spondylitis (AS). However, the precise role of A20 in reducing autoimmune disorders needs to be further elucidated. In this study, A20 expression was found to be preferentially reduced on circulating CD56^bright natural killer (NK) cells in patients with AS, and its level was negatively correlated with that of proinflammatory cytokines. Further investigation demonstrated that A20 reduces interferon (IFN)-γ and tumour necrosis factor (TNF)-α production in CD56^bright NK cells after stimulation with monokines or phorbol myristate acetate (PMA)/ionomycin(P/I). Furthermore, CD56^bright NK cells isolated from AS patients promote TNF-α secretion by autologous monocytes, and increasing the A20 expression level partially attenuates this process. More importantly, decreased A20 expression on circulating CD56^bright NK cells is associated with worse disease status in patients with AS. Our findings reveal that A20 participates in the pathogenesis of AS by negatively regulating CD56^bright NK cells and that its reduced expression contributes to a worsened disease status in patients with AS.

Temporal heterogeneity of the association between social capital and health: an age-period-cohort analysis in China

OBJECTIVES

The temporal heterogeneity of the association between social capital and health has not been fully discussed yet, so this study aimed to examine whether and how the association between social capital and health varied with age, period, and cohort.

STUDY DESIGN

Data were taken from the Chinese General Social Survey of 2005 and 2015, with 15,488 samples being collected.

METHODS

An ordinary least square model with interaction terms was used to examine the age, period, and cohort variations in the association between bonding/bridging social capital and self-rated health/depression from the perspective of urban-rural comparison.

RESULTS

In urban China, the association between bonding social capital and self-rated health varied with age, the association between bonding social capital and depression varied with age and cohort, the association between bridging social capital and self-rated health varied with period, and the association between bridging social capital and depression varied with period and cohort. By contrast, in rural China, only the association between bonding social capital and self-rated health varied with period and the association between bridging social capital and depression varied with cohort.

CONCLUSIONS

This study extends the traditional perspective of social capital and health study, and the results indicate that we should not only examine the association between social capital and health from the perspective of urban-rural comparison but also consider the impacts of life course and social development on this association. In this sense, specific interventions should be taken to improve social capital and health.

[Epidemiological characteristics of molecular transmission cluster among reported HIV/AIDS cases in Jiaxing city, Zhejiang province, 2017]

Objective: To understand the epidemiological characteristics of one large HIV molecular transmission cluster in Jiaxing city, Zhejiang province, 2017 in order to select those people under high-risk and providing basis for programs on prevention. Methods: During 2017, newly diagnosed HIV/AIDS cases in this city were recruited. Plasma samples were collected from subjects, followed by RNA extraction, RT-PCR and nest-PCR for pol gene amplification, before being sequenced and aligned. Mega 6.0 software was used to construct phylogenetic tree, and Cytoscape 3.6.0 software was used to identify HIV molecular transmission clusters. Cases within the large transmission clusters were investigated, using a field-epidemiology-questionnaire. Data related to socio-demographics and previous sexual behaviors were collected and EpiData 3.0 and SPSS 20.0 software were used. Results: In the large transmission cluster with subtype identified as CRF07_BC, in Jiaxing, 2017, 26 cases of the total 30 cases were investigated. A total of 80.8% (21/26) could be identified as newly infected within the last two years and 30.8%(8/26) could be identified as newly infected within the last one year, including 22 cases infected locally. Among several infected cases who were at age 45 years or older, they admitted that they had experienced unprotected sexual contacts in local city for long time and having had more than 10 disclosed sexual contacts within the last two years at the local venues. Conclusions: This molecular cluster had been formed and scaled up quickly in recent two years, it has played an important role in promoting and scaling up the HIV transmission. Three cases identificed as high risk played an importantrde role in scaling up this cluster.

Functional integrity of honeybee (Apis mellifera L.) resistant to dieldrin γ-aminobutyric acid receptor channels conjugated with three fluorescent proteins

To generate an efficient tool used in Xenopus oocyte expression for in situ investigation of channel receptor expression, distribution and function, the C-terminus of the honeybee (Apis mellifera L.) resistant to dieldrin (RDL) subunit was fused with *FP, including monomeric red, enhanced yellow or enhanced green fluorescent protein (referred to as mRFP, EYFP and EGFP, respectively). In the present study, all fused *FP-AmRDLs could be visualized using fluorescence and laser confocal microscopy in cRNA-injected oocytes. Fluorescence was distributed isotropically in the cellular membrane. The potencies of the agonist γ-aminobutyric acid (GABA), but not β-alanine, and the test antagonists (fipronil, flufiprole, dieldrin, α-endosulfan, bifenazate and avermectin B1a) in the *FP-AmRDL receptor did not significantly differ from that of the untagged receptor with two-electrode voltage clamp detection. The half maximal effective concentrations (EC50 s) of GABA in AmRDL, EGFP-AmRDL, EYFP-AmRDL and mRFP-AmRDL receptors were 11.98, 12.61, 18.92 and 22.11 μM, respectively, and those of β-alanine were 651.6, 629.6, 1643.0 and 2146.0 μM, respectively. Inhibition percentages of test antagonists against *FP-AmRDL and AmRDL were not significantly different from each other. Overall, the consistency in functional properties between *FP-AmRDL and AmRDL receptors makes pGH19-*FP a promising tool for further in situ investigation of GABA receptors.

Multiple parametric nanoscale measurements with high sensitivity based on through-focus scanning optical microscopy

High-throughput through-focus scanning optical microscopy (TSOM) involves defocusing along the optical axis and capturing a series of defocus images and is useful in optical nanoscale measurement. However, TSOM is usually affected by its optical and mechanical noises. In this study, the issue of sensitivity and application in three-dimensional (3D) multiple parameter measurement of TSOM is investigated. First, a TSOM system with objective scanning and its relative simulation algorithm are proposed. Second, based upon the system and algorithm, an experiment on an isolated Au line is performed and the corresponding matching library is established. Comparing the experimental TSOM image and simulated TSOM images of the library, 3D multiple parameter results of the Au line are extracted. Third, the precision of the system is analysed through a fidelity test particular for through-focus images. According to this study, the system is robust to the optical and mechanical noises and hence could be useful in 3D multiple parametric measurement and high-volume nanomanufacturing.

[Progression of diagnosis and treatment of medullary thyroid carcinoma]

Objective: To review and summarize recent update on preoperative diagnostic criteria, treatment and postoperative follow-up for medullary thyroid carcinoma. Methods: The relevant literatures and guidelines about medullary thyroid carcinoma were analyzed and summarized. Results: In the early stages of the disease radical surgery still dominated. Ultrasound results suggested that prophylactic lateral neck dissection was required for patients with high risk factors or high levels of carcinoembryonic antigen and calcitonin need prophylactic. Early hereditary medullary carcinoma could receive prophylactic thyroidectomy based on RET gene test results. Advanced progressive medullary thyroid carcinoma could be treated with palliative surgery,molecular targeted drugs and chemotherapy. Conclusions: The prognosis of medullary thyroid carcinoma is poor and lymph node metastasis is easy to occur early. The extent of initial operation should be enough. Locally advanced or distant metastatic medullary thyroid carcinoma can be treated with palliative surgery,molecular targeted drugs and chemotherapy.

Retinal and choroidal vascular changes in coronary heart disease: an optical coherence tomography angiography study

To reveal the association between retinal microvasculature changes and coronary heart disease (CHD), we assessed the full retinal thicknesses of eight areas, the vessel density of four layers (consisting of nine areas) and the flow area in two layers with optical coherence tomography angiography (OCTA) in CHD patients and healthy controls. The mean vessel density of several layers was significantly lower in patients. The difference in choroid capillary flow (negative correlation) between the two groups was significant. Decreased vessel density and blood flow were associated with coronary artery and branch stenosis. The decreases in retinal vessel density, choroidal vessel density, and blood flow area are closely related to coronary artery and branch stenosis.

A comparison of hyperelastic constitutive models applicable to shear wave elastography (SWE) data in tissue-mimicking materials

Shear wave elastography (SWE) techniques have received substantial attention in recent years. Strong experimental data in SWE suggest that shear wave speed changes significantly due to the known acoustoelastic effect (AE). This presents both challenges and opportunities toward in vivo characterization of biological soft tissues. In this work, under the framework of continuum mechanics, we model a tissue-mimicking material as a homogeneous, isotropic, incompressible, hyperelastic material. Our primary objective is to quantitatively and qualitatively compare experimentally measured acoustoelastic data with model-predicted outcomes using multiple strain energy functions. Our analysis indicated that the classic Neo-Hookean and Mooney-Rivlin models are inadequate for modeling the AE in tissue-mimicking materials. However, a subclass of strain energy functions containing both high-order/exponential term(s) and second-order invariant dependence showed good agreement with experimental data. Based on data investigated, we also found that discrepancies may exist between parameters inversely estimated from uniaxial compression and SWE data. Overall, our findings may improve our understanding of clinical SWE results.

Genetic association of DDIT3, RPL23A, SESN2 and NR4A1 genes with milk yield and composition in dairy cattle

Previously, we identified by RNA sequencing that DDIT3, RPL23A, SESN2 and NR4A1 genes were significantly differentially expressed between the mammary glands of lactating Holstein cows with extremely high and low milk protein and fat percentages; thus, these four genes are considered as promising candidates potentially affecting milk yield and composition traits in dairy cattle. In the present study, we further verified whether these genes have genetic effects on milk traits in a Chinese Holstein population. By re-sequencing part of the non-coding and the entire coding regions of the DDIT3, RPL23A, SESN2 and NR4A1 genes, a total of 35 SNPs and three insertions/deletions were identified, of which three were found in DDIT3, 12 in RPL23A, 16 in SESN2 and seven in NR4A1. Moreover, two of the insertions/deletions-g.125714860_125714872del and g.125714806delinsCCCC in SESN2-were novel and have not been reported previously. Subsequent single SNP analyses revealed multiple significant association with all 35 SNPs and three indels regressed against the dairy production traits (P-value = <0.0001-0.0493). In addition, with a linkage disequilibrium analysis, we found one, one, three, and one haplotype blocks in the DDIT3, RPL23A, SESN2 and NR4A1 genes respectively. Haplotype-based association analyses revealed that some haplotypes were also significantly associated with milk production traits (P-value = <0.0001-0.0461). We also found that 12 SNPs and two indels (two in DDIT3, two in RPL23A, nine in SESN2 and one in NR4A1) altered the specific transcription factor binding sites in the promoter, thereby regulating promoter activity, suggesting that they might be promising potential functional variants for milk traits. In summary, our findings first determined the genetic associations of DDIT3, RPL23A, SESN2 and NR4A1 with milk yield and composition traits in dairy cattle and also suggested potentially causal variants, which require in-depth validation.

Plasma metabolite changes in dairy cows during parturition identified using untargeted metabolomics

The metabolic responses of cows undergo substantial changes during the transition from late pregnancy to early lactation. However, the molecular mechanisms associated with these changes in physiological metabolism have not been clearly elucidated. The objective of this study was to investigate metabolic changes in transition cows from the perspective of plasma metabolites. Plasma samples collected from 24 multiparous dairy cows on approximately d 21 prepartum and immediately postpartum were analyzed using ultra-high-performance liquid chromatography/time-of-flight mass spectrometry in positive and negative ion modes. In conjunction with multidimensional statistical methods (principal component analysis and orthogonal partial least squares discriminant analysis), differences in plasma metabolites were identified using the t-test and fold change analysis. Sixty-seven differential metabolites were identified consisting of AA, lipids, saccharides, and nucleotides. The levels of 32 plasma metabolites were significantly higher and those of 35 metabolites significantly lower after parturition than on d 21 prepartum. Pathway analysis indicated that the metabolites that increased from late pregnancy to early lactation were primarily involved in lipid metabolism and energy metabolism, whereas decreased metabolites were related to AA metabolism.

Abstract P3-03-01: Comparison of sentinel lymph node detection performances using methylene blue in conjunction with indocyanine green or radioisotope in breast cancer patients: A prospective single-center cohort study

Aim: This cohort study aimed to compare the clinical efficacies between the novel dual tracer composed of indocyanine green (ICG) and blue dye (BD) and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node (SLN) mapping in breast cancer patients.

Methods: This study enrolled 471 clinically lymph node-negative patients with primary breast cancer. All the patients received mastectomy, while, for the sentinel lymph node biopsy (SLNB), they were randomized to receive BD plus radioisotope or BD plus ICG. Two hundred and twenty-seven patients received radioisotope plus BD (Control, RB group) for SLNB, while, 200 patients underwent the ICG plus BD (IB group) for SLNB. The detection performances on SLN identification rate, positive SLN counts, detection sensitivity, and false-negative rate were compared between the two groups. Following SLNB, axillary lymph node dissection (ALND) was performed only on patients with metastatic SLNs. Injection safety and potential side-effects of the two dual tracers were evaluated by a 24-month follow-up after the SLNB procedure.

Results: In the IB group, 97% (194/200) of the patients who underwent the ICG and BD dual tracer injection showed fluorescent-positive lymphatic vessels within 2-5 minutes. The identification rate of SLNs was comparable between the IB group (99.0%, 198/200) and the RB group (99.6%, 270/271) (P=0.79). No significant differences were observed in identification rate of metastatic SLNs (22.5% versus 22.9%, P&gt;0.05, RB group versus IB group, the same below), positive SLN counts (3.72±2.28 versus 3.91±2.13, P&gt;0.05), positive metastatic SLN counts (0.38±0.84 versus 0.34±0.78, P&gt;0.05), SLNB detection sensitivity (94.4% vs. 92.5%, P&gt;0.05), or false-negative rate (5.6% versus 7.5%, P&gt;0.05) between the two groups. No obvious allergic reaction or anaphylaxis, infection at the injection sites, skin necrosis or distal metastasis was reported in either group during the 24-month follow-up.

Conclusions: ICG can be used as a promising alternative tracer for radioisotope in SLN mapping, and when it is combined with BD in lymphangiography, it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.

Efficacy of indocyanine green vs. radioisotope + blue dye for sentinel lymph node mapping in breast cancer patients.Parameters99Tcm-Dx+BD(N=271)ICG+BD (N=200)P-valueSLN identification rate (%)99.6(270/271)99.0(198/200)0.79SLN counts3.91±2.133.72±2.280.09Metastatic SLN rate (%)22.9(62/271)25.5(51/200)0.51Metastatic SLN counts0.34±0.780.38±0.840.46Sensitivity92.5(62/67)94.4(51/54)0.96False-negative rate (%)7.5(5/67)5.6(3/54) 

Citation Format: Qi X, Yuan L, Zhang Y, Jiang J. Comparison of sentinel lymph node detection performances using methylene blue in conjunction with indocyanine green or radioisotope in breast cancer patients: A prospective single-center cohort study [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 P3-03-01.

Abstract OT1-01-04: Phase 1 study of D-0502, an orally bioavailable SERD with optimized pharmacological and PK/PD property for ER-positive breast cancer

Background: Endocrine therapy such as selective estrogen receptor degrader (SERD) fulvestrant has been used effectively to extend the life of HR+ (ER+ and PR+) and HER2- breast cancer patient, either alone or in combination with CDK4/6 inhibitors such as palbociclib or abemaciclib. D-0502 is an orally bioavailable SERD with potent activity in various HR+ and HER2- breast cancer cell lines and xenograft models. Its combination with palbociclib in both MCF-7 xenograft model and ESR-1 mutated (Y537S) patient derived breast cancer xenograft models resulted in further tumor growth inhibition or regression. Drug metabolism and pharmacokinetic studies both in vitro and in vivo demonstrated that D-0502 exhibits favorable PK profiles suitable for clinical development.

Trial Design: D-0502 is currently being evaluated in a phase 1 trial of women with advanced or metastatic HR+, HER2- breast cancer (MBC) (NCT03471663). This is a multicenter, open-label phase I study of D-0502 single agent and D-0502 in combination with standard dose of palbociclib. The primary objective is to characterize the safety and tolerability of D-0502 and D-0502 in combination with palbociclib, to identify an MTD and/or RP2D. The secondary objective is to evaluate the PK properties and the preliminary anti-tumor activities. Patients will receive D-0502 orally every day and treatment will be administered as 28-day cycles. The study has two parts: Dose Escalation (phase 1a) and Dose Expansion and Combination (phase 1b). In phase Ia, patients will be enrolled using a conventional dose-escalation algorithm (3+3 subjects per dose level) with 4 sequential dose cohorts to identify the MTD and RDE (recommended dose for expansion) in phase 1b) which will be at or below MTD. In phase 1b, there will be 2 cohorts, one is D-0502 single agent administered at RDE and the other is D-0502 in combination with standard dose of palbociclib, each with approximately 12 patients.

Key Eligibility Criteria: Eligible patients included women with confirmed HR+, HER2- MBC who have previously received no more than 2 prior chemotherapies for MBC; ECOG 0-1; evaluable (phase 1a) or measurable (phase 1b) disease (RECIST v1.1); premenopausal or postmenopausal status; adequate hematologic, hepatic and renal functions.

Current Status and Contact Information: At the time of abstract submission, the first cohort of 50 mg patients have started the study treatment. For inquiry of the study, please contact ling.zhang@inventisbio.com.

Citation Format: Zhang L, Dai D, Shi Z, Jiang J, Wang Y. Phase 1 study of D-0502, an orally bioavailable SERD with optimized pharmacological and PK/PD property for ER-positive 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 OT1-01-04.

Pulsed electromagnetic fields: promising treatment for osteoporosis

Osteoporosis (OP) is considered to be a well-defined disease which results in high morbidity and mortality. In patients diagnosed with OP, low bone mass and fragile bone strength have been demonstrated to significantly increase risk of fragility fractures. To date, various anabolic and antiresorptive therapies have been applied to maintain healthy bone mass and strength. Pulsed electromagnetic fields (PEMFs) are employed to treat patients suffering from delayed fracture healing and nonunions. Although PEMFs stimulate osteoblastogenesis, suppress osteoclastogenesis, and influence the activity of bone marrow mesenchymal stem cells (BMSCs) and osteocytes, ultimately leading to retention of bone mass and strength. However, whether PEMFs could be taken into clinical use to treat OP is still unknown. Furthermore, the deeper signaling pathways underlying the way in which PEMFs influence OP remain unclear.

Transcatheter aortic valve replacement in atypical valve anatomy using the Lotus valve : A Chinese single-center experience

BACKGROUND

In the West, the safety and efficacy of the Lotus valve have been demonstrated; however, data in the Chinese population are still lacking. Few studies have compared the clinical outcomes of transcatheter aortic valve replacement (TAVR) with the Lotus valve in patients with bicuspid or tricuspid aortic valve stenosis. Our aim was to assess TAVR outcomes with the Lotus aortic valve in a Chinese patient cohort.

METHODS

In total, 23 symptomatic, high-surgical risk patients with severe aortic valve stenosis were enrolled. Among them, nine patients (39%) had bicuspid aortic valves, and three patients had a large annulus dimension. The Lotus valve was successfully implanted in all patients. To facilitate accurate positioning, partial re-sheathing was attempted in ten patients (43.5%), while one patient had a full retrieval. One-year clinical follow-up was completed in all patients.

RESULTS

There were no deaths, strokes, or major adverse cardiac and cerebrovascular events in 22 of the 23 patients at 30 days; the all-cause mortality rate at 1 year was 4.4% (1 of 23 patients). The mean aortic valve gradient decreased from 51.5 ± 8.8 mm Hg at baseline to 13.4 ± 4.9 mm Hg (p < 0.001) and the valve area increased from 0.6 ± 0.2 cm² to 1.5 ± 0.4 cm² (p < 0.001) at 30 days. Paravalvular leakage was absent or mild (22%), and no patient had severe paravalvular leakage. Six patients (26.1%) required a postprocedural pacemaker. There was no difference regarding the procedural and the 1‑year outcomes between patients with bicuspid and tricuspid aortic valve stenosis.

CONCLUSION

Our single-center experience demonstrated that the Lotus valve is feasible and effective for Chinese patients with aortic valve stenosis, including atypical cases with bicuspid aortic valves or large aortic annulus size.