[Establishment and operation of schistosomiasis diagnostic reference laboratory in Jiangsu Province]

OBJECTIVE

To construct the schistosomiasis diagnostic reference laboratory in Jiangsu Province, and to examine the role and diagnostic efficiency of the reference laboratory.

METHODS

A schistosomiasis diagnostic reference laboratory was built in Jiangsu Province according to the requirements of the construction of the national schistosomiasis diagnostic reference laboratory in China. Inter-laboratory comparisons were conducted and the diagnostic capability of grassroots laboratories was evaluated in Jiangsu Province.

RESULTS

The organization structure, environmental conditions, administration and quality systems of the schistosomiasis diagnostic reference laboratory in Jiangsu Province all met the requirements for construction of the national schistosomiasis diagnostic reference laboratory in China, and the schistosomiasis diagnostic reference laboratory in Jiangsu Province was issued a certificate of a province-level schistosomiasis diagnostic reference laboratory. During the 6 inter-laboratory comparisons performed by national schistosomiasis diagnostic reference centers of China, the qualitative and quantitative results of each detection item were all in agreement with the reference samples (Kappa = 1), and the diagnostic capability was identified excellent. The results of indirect hemagglutination assay of 426 serum samples from 4 grassroots laboratories were re-examined, and the mean coincidence rate was 94.13% (range, 92.08% to 96.25%) with the grassroots laboratories, with a mean Kappa value of 0.85 (range, 0.83 to 0.86) and a mean missing rate of 10.19% (range, 0 to 17.65%).

CONCLUSIONS

The schistosomiasis diagnostic reference laboratory has been successfully established and effectively operated in Jiangsu Province, which plays an active role in improving the capability of schistosomiasis diagnostic equality in the province.

Smart identification of psoriasis by images using convolutional neural networks: a case study in China

BACKGROUND

Psoriasis is a chronic inflammatory skin disease, which holds a high incidence in China. However, professional dermatologists who can diagnose psoriasis early and correctly are insufficient in China, especially in the rural areas. A smart approach to identify psoriasis by pictures would be highly adaptable countrywide and could play a useful role in early diagnosis and regular treatment of psoriasis.

OBJECTIVES

Design and evaluation of a smart psoriasis identification system based on clinical images (without relying on a dermatoscope) that works effectively similar to a dermatologist.

METHODS

A set of deep learning models using convolutional neural networks (CNNs) was explored and compared in the system for automatic identification of psoriasis. The work was carried out on a standardized dermatological dataset with 8021 clinical images of 9 common disorders including psoriasis along with full electronic medical records of patients built over the last 9 years in China. A two-stage deep neural network was designed and developed to identify psoriasis. In the first stage, a multilabel classifier was trained to learn the visual patterns for each individual skin disease. In the second stage, the output of the first stage was utilized to distinguish psoriasis from other skin diseases.

RESULTS

The area under the curve (AUC) of the two-stage model reached 0.981 ± 0.015, which outperforms a single-stage model. And, the classifier showed superior performance (missed diagnosis rate: 0.03, misdiagnosis rate: 0.04) than 25 Chinese dermatologists (missed diagnosis rate: 0.19, misdiagnosis rate: 0.10) in the diagnosis of psoriasis on 100 clinical images.

CONCLUSIONS

Using clinical images to identify psoriasis is feasible and effective based on CNNs, which also builds a solid technical base for smart care of skin diseases especially psoriasis using mobile/tablet applications for teledermatology in China.

[Spatio-temporal analysis of Oncomelania hupensis along Jiangsu section of the Yangtze River from 2015 to 2017]

OBJECTIVE

To investigate the spatio-temporal characteristics of Oncomelania hupensis snails along the Jiangsu section of the Yangtze River, so as to provide evidence for eliminating schistosomiasis and formulating precision control measures in Jiangsu Province.

METHODS

A total of 75 marshlands were randomly sampled from Nanjing, Zhenjiang and Yangzhou cities along the Jiangsu section of the Yangtze River basin, and the spatio-temporal distribution and changing patterns of O. hupensis snails were investigated using the spatial autocorrelation analysis, kernel density analysis and hotspot analysis during the period from 2015 through 2017.

RESULTS

There was a spatial autocorrelation in the mean snail density along the Jiangsu section of the Yangtze River basin during the period from 2015 through 2017. The number of living snails and the density of living snails showed an overall decline in Yangzhou City; however, both showed a slight increase in 2016. Kernel density analysis and hotspot analysis showed that the hotspots of living snails were located in the regions neighboring the marshlands at the Yangzhou-Zhenjiang boundary areas along the Jiangsu section of the Yangtze River basin.

CONCLUSIONS

There is a spatial autocorrelation in the snail distribution with hotspots along the Jiangsu section of the Yangtze River basin, and the surveillance of snails should not be neglected in the marshlands in Jiangsu Province.

[Assessing the efficiency of schistosomiasis control programs in Jiangsu Province from 2005 to 2015 using data envelopment analysis (Malmquist index method)]

OBJECTIVE

To assess the total factor productivity (TFP) of schistosomiasis control programs in Jiangsu Province, so as to provide insights into sustainable schistosomiasis control.

METHODS

The data envelopment analysis-Malmquist index method was employed to analyze the human resources and financial investments in schistosomiasis control programs from health sectors in each schistosomiasis-endemic city of Jiangsu Province from 2005 to 2015, and assess the outputs of each schistosomiasis control project.

RESULTS

The overall productive efficiency of schistosomiasis control programs in Jiangsu Province showed an increasing tendency, and the mean fluctuation of annual TFP was 2.3%. The comprehensive technical efficiency, including pure efficiency and scale efficiency, appeared a steady increase with minor fluctuations, and the mean fluctuation of annual comprehensive technical efficiency was 3.8%. The growth rate of technical progress fluctuated greatly from 2005 to 2011, and showed a steady increase from 2012 to 2015, which became a major contributor to the growth of TFP. A higher growth rate of TFP was seen in Huai ' an and Changzhou cities, which showed a greater comprehensive technical efficiency, and a large fluctuation was observed in the growth rate of technical progress in Yancheng, Nanjing, Huai ' an and Yangzhou cities.

CONCLUSIONS

There is a continuous improvement in the technical level of schistosomiasis control programs in Jiangsu Province, and technical application and supervision and management capacity also show a steady increase. In addition, the application of new techniques and new strategies contributes greatly to TFP growth. In the future, the investment into new techniques and new strategies should be increased to ensure the sustainable schistosomiasis control in Jiangsu Province.

InGaP electron spectrometer for high temperature environments

In this work, a 200 μm diameter InGaP (GaInP) p⁺-i-n⁺ mesa photodiode was studied across the temperature range 100 °C to 20 °C for the development of a temperature-tolerant electron spectrometer. The depletion layer thickness of the InGaP device was 5 μm. The performance of the InGaP detector was analysed under dark conditions and then under the illumination of a 183 MBq ⁶³Ni radioisotope beta particle source. The InGaP photodiode was connected to a custom-made low-noise charge-sensitive preamplifier to realise a particle counting electron spectrometer. Beta spectra were collected at temperatures up to 100 °C with the InGaP device reverse biased at 5 V. The spectrum accumulated at 20 °C was compared with the spectrum predicted using Monte Carlo simulations; good agreement was found between the predicted and experimental spectra. The work is of importance for the development of electron spectrometers that can be used for planetary and space science missions to environments of high temperature or extreme radiation (e.g. Mercury, Jupiter’s moon Europa, near-Sun comets), as well as terrestrial applications.

Association between rs12742784 polymorphism and hip fracture, bone mineral density, and EPHB2 mRNA expression levels in elderly Chinese women

Objective: This study aimed to determine the association between rs12742784 polymorphism in the non-coding area and hip fracture, bone mineral density (BMD), and EPHB2 mRNA expression levels in elderly Chinese women.Methods: We investigated 250 Chinese women (mean age: 63.5 ± 8.3 years) including 123 hip fracture patients and 127 non-fracture controls. All participants underwent clinical examination to meet the inclusion criteria. Lumbar and hip BMD were detected by dual-energy X-ray absorptiometry. rs12742784 polymorphism was determined by restriction fragment length polymorphism and EPHB2 mRNA expression levels were measured by real-time polymerase chain reaction.Results: Distribution of rs12742784 genotypes agreed with Hardy-Weinberg equilibrium. The frequency of the CT + TT genotype was significantly associated with decreased risk of hip fracture (adjusted odds ratio = 0.57, p < 0.01) after adjusting for age and body mass index, and with increased BMD and EPHB2 mRNA expression levels. The T allele of the rs12742784 single nucleotide polymorphism (SNP) was a protective factor for hip fracture (adjusted odds ratio = 0.56, p < 0.01).Conclusion: rs12742784 polymorphism was associated with EPHB2 mRNA expression levels, BMD, and hip fracture in Chinese women. The T allele of the rs12742784 SNP was a protective factor for osteoporosis and hip fracture.

[HIV-1 drug resistance and influencing factors among people living with HIV/AIDS before antiretroviral therapy in Liangshan Yi Autonomous Prefecture]

Objective: To explore HIV-1 drug resistance and influencing factors among people living with HIV/AIDS before antiretroviral therapy in Liangshan Yi Autonomous Prefecture (Liangshan). Methods: Between January 1 and June 30, in both 2017 and 2018, a cross-sectional survey was conducted in Liangshan HIV-1 pol sequences were gathered and analyzed according to WHO Guidelines on HIV drug resistance surveillance of 2014. Both HyPhy 2.2.4 and Cytoscape 3.6.1 software were used to analyze the drug resistant strains of HIV-1 transmission network. Results: A total of 464 people living with HIV/AIDS was recruited. The proportion of HIV-1 CRF07_BC subtype was 88.6% (411/464), with HIV-1 drug resistance rate was 9.9% (46/464). The HIV-1 drug resistance rates of non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors(NRTI) and protease inhibitors (PI) were 6.7% (31/464), 1.9% (9/464) and 0.4% (2/464) respectively. New recombinant strains of HIV-1 URF_01BC subtype was independently clustered according to the drug resistant mutation sites. Results from the multivariate logistic analysis showed that injected drug users group had higher risk on HIV-1 drug resistance (aOR=3.03, 95%CI:1.40-6.54) than heterosexual group among people living with HIV/AIDS. Conclusions: HIV-1 drug resistance rate had already been in a high level before antiretroviral therapy was in place. The newly identified recombinant strains of HIV-1 URF_01BC subtype were independently clustered according to the drug resistant mutation sites. It was necessary to strengthen the prevention of the HIV-1 drug resistant strains transmission.

Long noncoding RNA PANDAR promotes progression and predicts poor prognosis via upregulating ROCK1 in prostate cancer

OBJECTIVE

Recent researches have proved that long noncoding RNAs (lncRNAs) play an important role in tumorigenesis. In this research, lncRNA PANDAR was explored to identify the role it played in the development of prostate cancer and how it achieves.

PATIENTS AND METHODS

Real-time quantitative polymerase chain reaction (RT-qPCR) was utilized to detect PANDAR expression in both prostate cancer tissue samples and cells. Moreover, the associations between expression level of PANDAR and patients' disease-free survival rate were studied respectively. Then wound healing assay and transwell assay were conducted. Furthermore, RT-qPCR and Western blot assay were used to explore the underlying mechanism.

RESULTS

By comparison with PANDAR expression in adjacent tissues, PANDAR expression level was significantly higher in prostate cancer samples, which was closely associated with patients' disease-free survival time. Moreover, after PANDAR was upregulated, cell migration and cell invasion capacities of prostate cancer cells were enhanced in vitro. In addition, after overexpression of PANDAR, the mRNA and protein expression of ROCK1 was upregulated, respectively. Furthermore, it was found that ROCK1 expression was positively correlated to PANDAR expression in prostate cancer tissues.

CONCLUSIONS

Results above suggest that PANDAR could enhance cell migration and invasion of prostate cancer by upregulating ROCK1, which may offer a potential therapeutic target in prostate cancer.

A data-driven approach for estimating the change-points and impact of major events on disease risk

Considering the impact of events on disease risk is important. Here, a Bayesian spatio-temporal accelerated failure time model furnished an ideal situation for modeling events that could impact survival experience via spatial and temporal frailty estimates. Through a hierarchical structure, this model allowed the data to detect the change-point(s) in addition to generating the event-related estimates. Both a real data case study and a simulation study were employed for testing these methods. The results suggested that meaningful and accurate change-points could be detected. Further, accurate event-related estimates for individuals in relation to those change-points could be obtained. By allowing the data to drive the change-point choices, the models were better fitting and the inference was more accurate.

Do repeat ultrasounds affect orchiectomy rate in patients with testicular torsion treated at a pediatric institution?

INTRODUCTION

Testicular torsion is a urological emergency; as the testicular salvage rate decreases with time, prompt intervention is required to restore the blood flow. Interhospital transfers and ultrasound examinations, while clinically essential to proper treatment and diagnosis, may adversely affect outcomes by delaying surgical intervention. Patients transferred to another institution for treatment of testicular torsion may experience a further time delay by undergoing two ultrasound examinations: one at the initial admitting institution and one at the receiving institution. To the knowledge of the authors, no study has yet explored the time delays and outcomes associated with these repeat ultrasounds.

OBJECTIVE

The objective was to investigate the impact of repeat ultrasound imaging on time to treatment and patient outcomes in patients with testicular torsion.

STUDY DESIGN

A retrospective chart review of 133 patients, aged 0-20 years, treated at the authors' institution for testicular torsion was conducted. Neonate patients and patients who did not receive ultrasound were excluded. Demographic and clinical variables were collected from the electronic medical record. Pearson Chi-squared and t-tests were used for univariate comparisons, and multivariate logistic regression analysis was performed to measure the relationships between variables.

RESULTS

Forty-nine percent of patients were primary patients, and 51% were transfer patients. Fifty-two percent of transfer patients received repeat ultrasounds. In comparison to salvaged patients, those who underwent orchiectomy experienced a greater delay between presentation at the institution and surgical intervention (229 min vs 177 min, p = 0.048). The transfer status does not appear to be related to the outcome, i.e. orchiectomy versus salvage. Patients who underwent orchiectomy were more likely than salvaged patients to have received repeat ultrasounds (p = 0.008). Repeat ultrasound patients had three times the likelihood of orchiectomy of single ultrasound patients. In a subset analysis of transfer patients, repeat ultrasound patients were more likely than single ultrasound patients to receive an orchiectomy (p = 0.03).

DISCUSSION

In agreement with previous studies, patients who underwent orchiectomy were found to experience greater treatment delays and trend toward transfer. Specifically, repeat ultrasound and time between presentation and intervention appear to influence patient outcomes. The effect of repeat ultrasound on outcomes appears to be independent of the transfer status. The study was limited by its retrospective nature and small sample size.

CONCLUSION

The analysis suggests that efforts to prevent repeat ultrasounds and minimize the time between presentation and intervention would improve patient outcomes. It is proposed that standardized clinical decision-making procedures, such as the TWIST scoring system, be incorporated into hospital protocols.

Novel homozygous nonsense mutations in LHCGR lead to empty follicle syndrome and 46, XY disorder of sex development

Empty follicle syndrome (EFS) is a disorder associated with female infertility and presents as a complete failure to retrieve oocytes during ART cycles despite normal follicle development and careful aspiration. To date, only two EFS cases have been reported with homozygous missense mutations in the luteinizing hormone/chorionic gonadotropin receptor (LHCGR) gene, and both cases showed normal estradiol (E2) production during ovulation induction. The molecular genetic mechanisms of EFS remain unknown. Herein, we report two novel homozygous inactivating LHCGR mutations, c.736 C>T (p.Q246*) and c.846dupT (p.R283*), in two female EFS patients from unrelated consanguineous families. The probands had impaired E2 production during the ART process, which differs from previously reported EFS cases. The inactivating mutations not only led to EFS in the two female probands, but also resulted in 46, XY disorder of sex development (46, XY DSD) in their male siblings. As far as we know, this is the first report of LHCGR mutations leading to both EFS and 46, XY DSD within the same pedigree. Our findings provide researchers and clinicians with a better understanding of phenotype-genotype correlations between EFS and 46, XY DSD and the LHCGR gene.

Intervals between bone mineral density testing with dual-energy X-ray absorptiometry scans in clinical practice

Intervals between dual-energy X-ray absorptiometry (DXA) scans were evaluated in a large cohort of typical clinical practice. Intensive DXA scanning (intervals < 23 months) decreased substantially, from 16.7% in 2006 to 6.7% in 2015.

INTRODUCTION

Serial dual-energy X-ray absorptiometry (DXA) measurements are suggested for patients at high risk of fractures. However, little is known about how often DXA testing occurs in clinical practice.

METHODS

We examined time intervals between DXA testing for monitoring purpose at two academic medical centers in the US between 2004 and 2017. The primary outcome was the presence of testing intervals < 23 months (termed "intensive DXA testing"). A generalized linear mixed model was used to evaluate the association between selected patient-level clinical factors and intensive DXA testing.

RESULTS

Forty-nine thousand four hundred ninety-four DXA tests from 20,200 patients were analyzed. The mean time interval between scans was 36 ± 21 months. Only 11.1% of the repeated DXA testing met the criterion for intensive testing. The percentage of intensive DXA testing dropped from 16.7% in 2006 to 6.7% in 2015 (p for trend < 0.001). After adjusting for age, gender, number of outpatient visits, and calendar year, correlates of intensive DXA testing included a baseline T-score < -2.5 at any anatomic site (OR, 4.8; 95%CI, 4.0-5.7), active use of drugs for osteoporosis (OR, 1.6; 95%CI, 1.3-1.9), and active use of glucocorticoids (OR, 1.3; 95%CI, 1.2-1.4).

CONCLUSIONS

The predictors of intensive DXA testing suggest that this practice is used preferentially in patients with multiple risk factors and to monitor the response to pharmacotherapy. However, intensive DXA testing has become less common in real-world clinical practice over the last decade. Further studies are required to better define the optimal use of bone mineral density testing in this vulnerable population.

[Effect of umbilical cord mesenchymal stem cells on biological characteristics of esophageal cancer EC1 cells]

Objective: To investigate the effects of human umbilical cord mesenchymal stem cells (MSCs) on the proliferation, apoptosis, migration, invasion and stemness of esophageal cancer EC1 cells. Methods: Human umbilical cord mesenchymal stem cells were isolated and cultured in vitro, and cell phenotype was identified by flow cytometry. MSCs or their conditioned medium were co-cultured with esophageal cancer EC1 cells. The effects on the proliferation, apoptosis, migration, invasion and stemness of EC1 cells were examined by cell counting kit-8 (CCK-8), flow cytometry, Transwell, quantitative real-time polymerase chain reaction (RT-qPCR) and spheroid formation assays. Results: MSCs inhibited the proliferation of EC1 cells in a concentration dependent manner. When the ratio of MSCs to EC1 cells was 0∶1, 1∶1, 2∶1, 5∶1, the apoptotic rates of EC1 cells were (4.07±0.34)%, (8.90±0.36)%, (10.80±0.50)% and (15.23±1.06)%, respectively, suggesting that MSCs promoted the apoptosis of EC1 cells in a concentration dependent manner (all P<0.05). The expression levels of OCT2, SOX2, KLF4, CXCR4 and CXCR7 in EC1 cells cultured in 80% conditioned medium were 0.53±0.03, 0.49±0.02, 0.73±0.09, 0.57±0.05 and 0.24±0.02, respectively, which were lower than those in the regular medium group (all P<0.05). The numbers of migrated cells in regular medium as well as 10%, 40%, and 80% conditioned medium were 287.3±21.6, 280.7±15.5, 264.3±16.8, and 257.7±8.0, respectively. Meanwhile, the numbers of invasive cells were 194.3±16.6, 213.7±24.3, 221.0±16.0, (252.0±20.4), respectively. There was no significant difference between the groups (all P>0.05). Conclusion: Human umbilical cord mesenchymal stem cells can inhibit the proliferation, promote apoptosis and reduce the stemness, and have no significant effect on the migration and invasion of EC1 cells.

Humanin levels in human seminal plasma and spermatozoa are related to sperm quality

BACKGROUND

Humanin has reportedly been expressed in testis and spermatozoa, but no study has yet reported its presence in human seminal plasma (SP).

OBJECTIVE

The aim of this study was to investigate the presence of humanin in human SP and to determine the correlation between humanin levels in SP/spermatozoa and sperm quality.

MATERIALS AND METHODS

Semen samples for SP/sperm humanin level measurement were collected from 164 patients who attended our andrology clinic for fertility evaluation. The localization of humanin in spermatozoa was evaluated using an immunofluorescence method, and SP/sperm humanin levels were measured with ELISA. Correlations between SP/sperm humanin levels and sperm parameters were analyzed.

RESULTS

Humanin was expressed in the midpiece of the spermatozoa. Humanin concentrations in the SP ranged from 24.4 to 285.1 pg/mL, with a median of 89.7 pg/mL. The SP humanin concentrations in patients with normospermia were significantly higher than those in patients with oligospermia (p < 0.001), asthenospermia (p = 0.002), and oligoasthenospermia (p < 0.001). Spearman analysis showed a positive and significant correlation between SP humanin concentration and sperm concentration (r = 0.75, p < 0.001), and progressive sperm motility (r = 0.29, p < 0.001). Sperm humanin level was significantly and positively associated with progressive sperm motility (r = 0.70, p < 0.001). In addition, a significantly higher level of humanin was found in swim-up spermatozoa than in non-swim-up spermatozoa (p = 0.03).

CONCLUSIONS

Seminal plasma and sperm humanin levels were significantly and positively correlated with sperm quality, especially sperm motility. Further studies of the origin of SP humanin and its role in spermatogenesis should be conducted.

Structural and electrical characterization of monolithic core-double shell n-GaN/Al/p-AlGaN nanowire heterostructures grown by molecular beam epitaxy

We have studied the epitaxy and structural characterization of monolithic n-GaN/Al/p-AlGaN nanowire heterostructures. It is found that high quality, nearly defect free, full shell epitaxial Al can be grown in situ on Al(Ga)N nanowires and vice versa. Detailed scanning transmission electron microscopy (STEM), high-resolution transmission electron microscopy (HRTEM) and X-ray diffraction (XRD) suggest that the Al (111) plane maintains an epitaxial relationship with Al(Ga)N (0001) in the nanowire growth direction. Full ultraviolet composition range (340 nm-210 nm) Al/Al(Ga)N core-double shell nanowire backward diode characteristics were investigated. We have demonstrated a monolithic n⁺⁺-GaN/Al/p⁺⁺-Al(Ga)N nanowire backward diode, wherein an epitaxial Al layer serves as the tunnel junction. Such an Al(Ga)N-based n-p-n nanowire backward diode exhibits record low resistivity (<1.5 × 10^-4Ω cm²) and a low turn-on voltage of ∼2.7 V.

[Diagnostic and therapeutic values of interphase fluorescence in situ hybridization in B-cell lymphomas: a clinicopathologic analysis of 604 cases]

Objective: To investigate the feasibility and value of interphase fluorescence in situ hybridization (FISH) in the pathological diagnosis, differential diagnosis and therapeutic assessment of B-cell lymphomas. Methods: The cohort included 604 cases of B-cell lymphoma which were collected at West China Hospital from May 2010 to December 2016.And all were subjected to interphase FISH using 11 break apart or fusion probes (MYC, bcl-2, bcl-6, IRF4, MYC/IgH, bcl-2/IgH, CCND1/IgH, IgH, API2/MALT1, p53/ATM, and D13S319/CEP12). Results: The median age of the 604 B-cell lymphoma patients was 47.7 (aged 2-90) years including 372 men and 232 women. All the cases was divided into 463 large B cell lymphomas(LBL) and 141 small B cell lymphomas, and the total interphase FISH positive rate was 59.8% (361/604). Among the 463 LBL, 12.5% (58/463), 9.5% (44/463) and 2.2% (10/463) of cases showed MYC, bcl-6 and bcl-2 gene rearrangements respectively; and 363 diffuse large B cell lymphoma (DLBCLs) were reclassified as germinal center B-cell (GCB) subtype (38.6%, 140/363) and non-GCB subtype (61.4%, 223/363) by Hans algorithm. The rearrangement rates in GCB and non-GCB DLBCL were 45.7%(64/140)and 21.5%(48/223; P=0.001), respectively. Compared to the non-GCB DLBCL, GCB DLBCL showed higher MYC and bcl-2 gene rearrangements (P=0.001). Eleven (2.4%, 11/463) cases had MYC and bcl-6 or bcl-2 gene rearrangement (double-hit lymphoma); one (0.2%, 1/463) case had MYC, bcl-6 and bcl-2 gene rearrangements (triple-hit lymphoma); two (0.4%, 2/463) cases had bcl-2 and bcl-6 gene rearrangements. MYC translocation and MYC/IgH fusion were detected in 94.2%(81/86) and 83.7%(72/86) cases of Burkitt lymphomas. IRF4 rearrangement was detected in two cases of IRF4+ LBCL. Genetic abnormalities were detected in 9/19, 100%(29/29), 30.8%(12/39) and 68.5%(37/54) cases of follicular lymphoma, mantle cell lymphoma, MALT lymphoma and chronic lymphocytic leukemia, respectively. Conclusions: Interphase FISH can rapidly and accurately detect the genetic changes in B-cell lymphomas. Different genetic changes are specifically valuable to the diagnosis, differential diagnosis, prognosis evaluation and treatment guidance of various B-cell lymphomas.

An electrically injected AlGaN nanowire defect-free photonic crystal ultraviolet laser

We report on the demonstration of an electrically injected AlGaN nanowire photonic crystal laser that can operate in the ultraviolet spectral range. The nanowire heterostructures were grown on sapphire substrate using a site-controlled selective area growth process. By exploiting the topological high-Q resonance of a defect-free nanowire photonic crystal, we have demonstrated electrically pumped lasers that can operate at 369.5 nm with a relatively low threshold current density of ~2.1 kA/cm² under continuous wave operation at room-temperature. This work provides a promising approach for achieving low threshold semiconductor laser diodes operating in the UV spectral range that were previously difficult.

Abstract P3-08-11: Multi-omics profiling reveals distinct molecular features in young and elderly triple negative breast cancer

Purpose

Age at breast cancer diagnosis not only predicts clinical outcome, but also indicates distinct molecular features thus we can choose the most appropriate treatment strategies. Yet little is known about the molecular profile of young and elderly triple negative breast cancers (TNBCs).

Methods

Clinical, genomic and transcriptome features of young (&lt;40 year-olds) and elderly (≥65 year-olds) TNBC patients were studied in a cohort of 473 TNBCs from Fudan University Shanghai Cancer Center.

Results

In this study, 50, 354 and 69 patients were &lt;40, 40–64 and ≥65 years of age, respectively. Young TNBCs had more relapse or metastasis within the first 2 years after surgery (P=0.036) which was also significant in the basal-like subgroup (P=0.004), while elderly TNBCs were more likely to be luminal androgen receptor (LAR) subtype (46%) harboring frequent PIK3CA and KMT2C/KMT2D somatic mutations, with more fibrosis or mesenchymal-like (MES) subtype (in the basal-like subgroup) and featured by significantly lower Ki-67 index. Gene set enrichment analyses revealed that young TNBCs showed elevated expression of genes involved in cell cycle, nucleotide metabolism and DNA damage repair. In further discussion on nucleotide metabolism, TYMS, a crucial gene encoding thymidylate synthase while is also the target of fluorouracil and capecitabine, were identified to be enriched in young TNBCs independent of molecular subtype in both our cohort (adjusted P&lt;0.001) and METABRIC (adjusted P=0.027). We next studied DNA damage features and found that while TNBCs of different age groups had comparable somatic mutation load, their mutations had distinct generation mechanism that homologous recombination deficiency (HRD) related signature and Aging related signature tend to be enriched in younger and elder patients, respectively. We also observed higher germline BRCA1 mutation rate in young TNBCs (23%). Interestingly, while germline BRCA2 mutation rate was comparable among the groups, copy number (CN) loss of Chr13q13 (with BRCA2 in the 'peak') was almost exclusively found in young patients (adjusted P&lt;0.05). We also found enriched CN loss at Chr15q13 (with FAN1 in the 'peak') and CN amplification at Chr1p34 (with KDM4A in the 'peak') in young patients. These two events significantly affected the expression levels of FAN1 and KDM4A, respectively, and were both corrected with genomic based HRD indexes.

Conclusions

TNBCs of different age had distinct clinical and molecular features. We should pay attention to that nearly half of the TNBCs diagnosed at 65 years-old or later were not basal-like cancers but a special group with positive AR staining. Taking together with the higher fibrosis/MES proportion in elderly TNBC, we should reconsider the benefit of specific treatment strategies (like neoadjuvant chemotherapy) in these patients. The young TNBCs were characterized by activated cell cycle, elevated nucleotide metabolism (especially TYMS expression and corresponding pyrimidine metabolism) and enhanced DNA damage (especially HRD). These molecular features supported the aggressive phenotypes of young TNBC, while also provide us with potential therapeutic strategies.

Citation Format: Ma D, Jiang Y-Z, Xie M-D, Xiao Y, Zhao S, Shao Z-M. Multi-omics profiling reveals distinct molecular features in young and elderly triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-11.

Abstract P4-06-24: Microenvironment heterogeneity of triple-negative breast cancer reveals distinct immune escape mechanisms and potential driver events

Background The microenvironment phenotypes strongly affect the immunotherapeutic strategies for triple-negative breast cancer (TNBC). Although the multi-omics profile of TNBC has been comprehensively characterized, few studies have focused on the microenvironment phenotypes of TNBC.

Methods With multi-omics data for the largest single-center TNBC cohort (n=386), we first established a TNBC-specific microenvironment cell signature. We further used single sample gene set enrichment analysis to calculate the relative number of microenvironment cell subsets in each sample. Then, we performed k-means clustering to classify the TNBC microenvironment phenotypes into heterogeneous clusters. Furthermore, we systematically analyzed the extrinsic and intrinsic immune escape mechanisms of different TNBC microenvironment clusters. In addition, we explored genomic alterations that might decrease immune infiltration in certain TNBC microenvironment clusters.

Results We classified the TNBC microenvironment phenotypes into three heterogeneous clusters. Cluster 1 (type 1 “cold tumor”) had low microenvironment cells infiltration. Cluster 2 (type 2 “cold tumor”) was characterized by resting innate immune cells, fibroblasts and endothelial cells infiltration. Cluster 3 (“hot tumor”) was featured by adaptive immune cells infiltration. Analysis of immune escape mechanism revealed that an incapability to attract innate immune cells (resulting in failure of adaptive immunity) led to immune escape of cluster 1. The chemotaxis but inactivation of innate immunity (also leading to failure of adaptive immunity) and low tumor antigen burden resulted in immune escape of cluster 2. High expression of immune checkpoint molecules contributed to immune escape of cluster 3. In addition, we found that tumor infiltrating lymphocytes (TILs) were positively correlated with immune checkpoint molecules expression, while mutation load was negatively correlated with those indicators in triple-negative breast cancer. Analysis of enrichment pathways, mutations and somatic copy number variations between the “cold tumor” and “hot tumor” clusters revealed that amplification of MYC and activation of MYC-related pathways might decrease the immune infiltration of cluster 1. Mutations in PI3K-AKT pathway members and activation of fibroblasts-related pathways might decrease the immune infiltration of cluster 2.

Conclusion Utilizing the largest single-center TNBC cohort with multi-omics data, our study first revealed the heterogeneity of the TNBC microenvironment, with translational significance both clinically and biologically. First, we identified a subtype of “hot tumor” in TNBC (cluster 3), for which immune checkpoint blockers (ICBs) might be effective. TILs and immune checkpoint molecules expression but not mutation load might predict the efficacy of ICBs. Second, we presumed some genomic alterations that might drive “cold tumor” formation in TNBC. Our study represents a step toward personalized immunotherapy for TNBC patients.

Key Words triple-negative breast cancer, multi-omics, microenvironment heterogeneity, immune escape

Citation Format: Xiao Y, Ma D, Zhao S, Jiang Y-Z, Shao Z-M. Microenvironment heterogeneity of triple-negative breast cancer reveals distinct immune escape mechanisms and potential driver events [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 P4-06-24.

Abstract P3-07-12: Identification of luminal A-like subgroup among ER+/PR+/HER2+ breast cancers and its clinical implications

Background Triple positive breast cancers (TPBCs), i.e. estrogen receptor-positive (ER+)/ progesterone receptor-positive (PR+)/ human epidermal growth factor receptor 2-positive (HER2+) breast cancers, constitute a therapeutic challenge due to the functional crosstalk between the hormone receptors and HER2 pathways. The intrinsic molecular subtyping of TPBCs has rarely been studied and may have implications for the prognostic evaluation and therapeutic decision-making.

Methods Our study included four cohorts of patients with TPBC. The first one consisted of 82 patients from The Cancer Genome Atlas (TCGA). The second and third ones were from two publicly available microarray datasets (GSE2603 and GSE2109) and included 37 and 30 patients respectively. The forth one comprised 165 patients from Fudan University Shanghai Cancer Center. First, we examined the PAM50 intrinsic subtypes of TPBCs in the first three cohorts. Then, we tried to find several differentially expressed genes (DEGs) between luminal A and the other subtypes. In cohort 1, we identified DEGs using LIMMA. In cohort 2 and 3, we further filtered and validated them using Wilcoxon's rank sum test. We also performed Receiver operating characteristic analyses to evaluate the accuracy of candidate DEGs in identifying TPBCs of luminal A subtype and determined the top 3 DEGs according to the area under the curve. Finally, in cohort 4, we detected the expression of these 3 genes by immunohistochemical (IHC) staining of tissue sections, defined a group of luminal A-like TPBCs and examined the prognosis and effect of adjuvant trastuzumab for them.

Results The distribution of PAM50 intrinsic subtypes of TPBCs was shown as follows. The three genes that exhibited the highest accuracy in identifying TPBCs of luminal A subtype were STC2, BCL2 (highly expressed in luminal A subtype) and MKI67 (lowly expressed in luminal A subtype). In cohort 4, we defined a group of luminal A-like TPBCs as TPBCs with low expression of MKI67 as well as high expression of STC2 and/or BCL2. Compared with patients with non-luminal A-like TPBC (n = 110), those with luminal A-like TPBC (n = 55) had better disease-free survival (DFS) in both univariate (Log-rank P = 0.029) and multivariate analyses (hazard ratio = 0.25, P = 0.025). In the group with non-luminal A-like TPBCs, patients treated with trastuzumab (n = 67) showed better DFS than those not treated with it (n = 43) (Log-rank P = 0.019), while in the group with luminal A-like TPBCs, there is no difference in DFS between patients treated with trastuzumab (n = 22) and those not treated with it (n = 33) (Log-rank P = 0.993).

PAM50 intrinsic subtypes of TPBCsPAM50 intrinsic subtypeCohort 1Cohort 2Cohort 3 N (%)N (%)N (%)Luminal A43 (52.4)15 (40.5)13 (43.3)Luminal B28 (34.1)17 (45.9)12 (40.0)HER2-enriched9 (11.0)2 (5.4)3 (10.0)Normal-like1 (1.2)2 (5.4)1 (3.3)Basal-like1 (1.2)1 (2.7)1 (3.3)

Conclusions TPBCs are heterogeneous in terms of intrinsic molecular subtype. Evaluating the expression of STC2, BCL2 and MKI67 by IHC staining can help us to conveniently identify a group of luminal A-like TPBCs. Patients with this group of TPBCs have relatively good prognosis and may only gain limited benefit from adjuvant trastuzumab.

Citation Format: Zhao S, Jin X, Jiang Y-Z, Shao Z-M. Identification of luminal A-like subgroup among ER+/PR+/HER2+ breast cancers and its clinical implications [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 P3-07-12.

Phosphoproteome profiling revealed abnormally phosphorylated AMPK and ATF2 involved in glucose metabolism and tumorigenesis of GH-PAs

PURPOSE

Protein phosphorylation plays a key role in tumorigenesis and progression. However, little is known about the phosphoproteome profiles of growth hormone-secreting pituitary adenomas (GH-PAs). The aim of this study was to identify critical biomarkers and signaling pathways that might play important roles in GH-PAs and may, therefore, represent potential therapeutic targets.

METHODS

The differential phosphoprotein expression patterns involved in GH-PAs were investigated by nano-LC-MS/MS in a group of samples. The phosphoprotein expression data were analyzed by bioinformatics. The expression levels of the candidate phosphorylated AMPK (ser496) and ATF2 (ser112) were validated by Western blot analysis in another group of samples.

RESULTS

A total of 1213 phosphorylated protein sites corresponding to 667 proteins were significantly different between GH-PAs and healthy pituitary glands. Among these phosphorylated sites, 871 exhibited lower levels of phosphorylation in GH-PAs. Moreover, 140 novel phosphosites corresponding to 93 proteins were differentially phosphorylated between GH-PAs and healthy pituitary glands, 101 of which showed decreased phosphorylation in GH-PAs. The majority of differentially expressed phosphorylated proteins were significantly enriched in glycolysis and the AMPK signaling pathway in GH-PAs. The AMPK signaling pathway was demonstrated to be inhibited in GH-PAs by pathway activity analysis (z score = - 2.324). Notably, the phosphorylated levels of AMPK (ser496) and ATF2 (ser112) were significantly lower in GH-PAs than in healthy pituitary glands.

CONCLUSION

These findings suggest that decreased phosphorylation of the AMPK/ATF2 pathway may be critical for glucose metabolism and tumorigenesis in GH-PAs.