Stressful life events are associated with the risk of multiple sclerosis

BACKGROUND AND PURPOSE

Unexpected stressful life events may alter immune function and affect susceptibility to autoimmune diseases including multiple sclerosis (MS). Current results from epidemiological investigations examining the role of stress in MS remain inconsistent. The aim was to conduct the hitherto largest population-based case-control study on this topic.

METHODS

Extensive questionnaire information collected on lifestyle environmental factors available for 2930 incident MS cases and 6170 controls were used to assess the association of 10 major life events that had occurred before disease onset with the risk of MS by unconditional logistic regressions, adjusting for potential confounders. Stratified analyses were also performed by sex and time.

RESULTS

Compelling evidence was found for a link between major life events and risk of MS - most events significantly increased disease risk by 17%-30%. It was further observed that women were affected to a greater extent than men under certain stressful scenarios, and that most events that happened recently (≤5 years prior to MS onset) had significant effects on MS, indicating a critical window in disease development.

CONCLUSION

Stressful life events may have an adverse effect on the risk of MS. Research into the mechanisms of this observation may give important clues to triggering pathogenetic events in MS.

[Immediate rehabilitation of the edentulous and potential edentulous jaws with implant-supported full-arch prostheses: a retrospective analysis of 225 cases]

Objective: To evaluate the outcomes of immediate rehabilitation of the edentulous and potential edentulous jaws with implant-supported full-arch prostheses and analyse the risk factors of the complications. Methods: This retrospective study included 273 patients treated with immediate rehabilitation of the edentulous and potential edentulous jaws with implant-supported full-arch prostheses from April 2008 to December 2018 in Department of Implantology, Peking University School and Hospital of Stomatology. The patients' sex, age, place of residence, jaw position, opposing dentition, number of implants, diameter and length of implants, abutment height and abutment angle were recorded. The survival rate of implants and marginal bone loss were calculated and analyzed. Cox proportional hazards ratio model was adopted to analyze the potential risk factors of prosthetic complications. Results: A total of 225 patients (288 jaws) and 1 260 implants were included, with 126 males and 99 females, aged (57.3±11.0) years, with a following time of (5.04±3.08) years. The 1-year cumulative survival rate of implants was 98.0% (1 235/1 260). Forty-eight implants were lost during the follow-up, with 39 implants in the maxillae and 9 implants in the mandible. The risk of implant failure of the maxillae ［7.2% （39/541）］ is significantly higher than that of the mandible ［1.3% （9/719）］ (P<0.01). Average marginal bone loss at 1 and 5 years was (0.7±0.2） mm and （1.1±0.3） mm. One hundred and twenty patients experienced prosthetic complications including screw/abutment loosening (44 cases), screw/abutment fracture (2 cases) and artificial tooth/denture base fracture (99 cases). The possibility of immediate prosthesis fracture within 6-8 months was high but declined over the following years with the final prosthesis delivered. Cox regression analysis showed that the use of 17° abutments in the anterior region was significantly related to the prosthetic complications （hazard ratio=1.797, P=0.002）. Conclusions: Immediate rehabilitation of the edentulous jaws with implant-supported full-arch prostheses can be a predictable technique. The immediate prosthetic mechanical complication prevalence was high. The use of 17° abutments in the anterior region may increase the risk of screw/abutment loosening. It is necessary to review in time.

Erratum: Evolution of π^{0} Suppression in Au+Au Collisions from sqrt[s_{NN}]=39 to 200 GeV [Phys. Rev. Lett. 109, 152301 (2012)]

This corrects the article DOI: 10.1103/PhysRevLett.109.152301.

Small RNA sequencing reveals miRNAs important for hypoxic adaptation in the Tibetan chicken

1. The Tibetan chicken, which is an indigenous breed living on the Tibetan Plateau, exhibits hypoxic adaptations to its high-altitude environment. However, the molecular mechanism behind this hypoxic adaptation is still unclear. This study aimed to investigate differentially expressed miRNAs involved in hypoxic adaptation through high-throughput RNA sequencing. 2. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to verify the differentially expressed miRNAs and their target genes in chicken embryonic heart tissues and fibroblasts. Luciferase reporter assays were performed to confirm the relationship between miRNAs and target genes. 3. The study identified 37 differentially expressed miRNAs in Tibetan chicken embryonic heart tissues, including 20 up- and 17 down-regulated miRNAs, compared to those found in lowland chickens. Differentially expressed miRNAs were mainly involved in biological processes, such as cell cycle arrest, toll-like receptor signalling pathways, and I-kappa B kinase/NF-kappa B signalling. The data showed that gga-miR-34 c-5p was significantly upregulated in Tibetan chicken tissues and hypoxic fibroblasts, while EHHADH, a target gene of gga-miR-34 c-5p, was downregulated. Moreover, gga-miR-34 c-5p dramatically decreased the luciferase activity of the wild EHHADH, whereas no effect on the mutational EHHADH was found. 4. This study identified miRNA expression profiles in the Tibetan chicken and suggested that miR-34 c-5p acts as a novel miRNA associated with hypoxic adaptation. This facilitates the understanding of molecular mechanisms that underlie long-term exposure to hypoxia.

Low body mass index is associated with ectopic pregnancy following assisted reproductive techniques: a retrospective study

OBJECTIVE

To investigate the association between body mass index (BMI) and ectopic pregnancy (EP) following embryo transfer (ET).

DESIGN

Retrospective cohort study.

SETTING

University-affiliated hospital.

POPULATION

A total of 16 378 pregnancies derived from either fresh ET or frozen-thawed ET between January 2008 and December 2017.

METHODS

We used the generalised estimating equation (GEE) to analyse the association between BMI categories and EP, as one woman may contribute to more than one pregnancy. Generalised additive models were also used to demonstrate the non-linear association. Models were adjusted for age, parity, gravidity, previous history of ectopic pregnancy, duration of infertility, polycystic ovary syndrome, endometriosis, diagnosis of tubal problems, ovarian reserve markers, ovarian stimulation parameters, insemination protocol, endometrial thickness and embryo transfer policies.

MAIN OUTCOME MEASURES

Ectopic pregnancy.

RESULTS

According to the WHO criteria, the number of cycles with low (<18.5 kg/m² ), normal (18.5-24.9 kg/m² ) and high (≥25 kg/m² ) BMI were 2155, 13 447 and 776, respectively. In comparison with the normal BMI group, the rate of EP was significantly increased in the low BMI group (2.92% versus 2.02%, relative risk 1.45, 95% CI 1.11-1.90), but not in the high BMI group (2.84%, relative risk 1.41, 95% CI 0.92-2.20). Adjusted for confounding factors, the odds ratio for EP comparing low BMI versus normal BMI was 1.61 (95% CI 1.19-2.16) and that comparing high BMI versus normal BMI was 1.12 (95% CI 0.72-1.76).

CONCLUSIONS

Low BMI is associated with an increased risk of EP.

TWEETABLE ABSTRACT

The ectopic pregnancy rate after embryo transfer for lean women is higher than that for women of normal weight.

MiR-204 inhibits inflammation and cell apoptosis in retinopathy rats with diabetic retinopathy by regulating Bcl-2 and SIRT1 expressions

OBJECTIVE

To explore the influences of micro ribonucleic acid (miR)-204 on the rats with diabetic retinopathy by regulating the expressions of B-cell lymphoma 2 (Bcl-2) and sirtuin 1 (SIRT1).

MATERIALS AND METHODS

A total of 36 Sprague-Dawley rats were randomly assigned into normal group (n=12), model group (n=12), and miR-204 mimics group (n=12). No treatment was performed in the normal group, the diabetic retinopathy model was established in model group, and miR-204 mimics were administered for intervention after modeling in the inhibitor group. After 7 d, materials were sampled for detection. The expressions of Bcl-2 and SIRT1 were detected via immunohistochemistry, and their relative protein expression levels were determined via Western blotting (WB). Quantitative Polymerase Chain Reaction (qPCR) was performed to detect the expression of miR-204, and the content of inflammatory factors interleukin (IL)-6, IL-18, and tumor necrosis factor-α (TNF-α) was measured using enzyme-linked immunosorbent assay (ELISA). Finally, cell apoptosis was evaluated via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL).

RESULTS

Immunohistochemistry results showed that the positive expression levels of Bcl-2 and SIRT1 were substantially lower in the model and miR-204 mimics groups than those in the normal group (p<0.05), and their positive expression levels in miR-204 mimics group were notably higher than those in model group (p<0.05). According to Western blot (WB) results, the relative protein expression levels of Bcl-2 and SIRT1 markedly declined in the other two groups compared with those in the normal group (p<0.05), while miR-204 mimics group exhibited remarkably higher relative protein expression levels of Bcl-2 and SIRT1 than the model group (p<0.05). The results of qPCR revealed that the relative expression level of miR-204 was markedly lowered in model and miR-204 mimics groups compared with that in the normal group (p<0.05), and its relative expression level in miR-204 mimics group was remarkably higher than that in the model group. It was found through enzyme-linked immunosorbent assay (ELISA) that compared with normal group, the other two groups had substantially increased content of IL-6, IL-18, and TNF-α (p<0.05), and the content of IL-6, IL-18, and TNF-α in miR-204 mimics group was markedly lower than that in the model group (p<0.05). According to TUNEL results, the apoptosis rate of cells rose substantially in the other two groups compared with that in the normal group (p<0.05), while was notably lower in the miR-204 mimics group than that in the model group (p<0.05).

CONCLUSIONS

MiR-204 up-regulates Bcl-2 and SIRT1 expressions to inhibit the inflammation and cell apoptosis in rats with diabetic retinopathy.

Prevalence and clinical characteristics of perinatal chronic lung disease by infant gestational age

BACKGROUND:

Children with perinatal chronic lung disease (CLD) are at elevated risk for severe respiratory syncytial virus (RSV) disease in the first two years of life. The American Academy of Pediatrics policy does not recommend RSV immunoprophylaxis for infants with CLD born at ≥32 weeks’ gestational age (wGA). The objective of this study was to describe the number and clinical characteristics of US infants in this population.

METHODS:

Birth hospitalization data from the Kids’ Inpatient Database were utilized to estimate the prevalence of CLD (International Classification of Diseases, Ninth Revision [ICD-9] = 770.7) in 2003-2012 overall and by gestational age (ICD-9 = 765.21–765.29). CLD birth hospitalizations were evaluated by length of stay, costs, ventilatory support, and inpatient mortality.

RESULTS:

A total of 33,537 infants were diagnosed with CLD, representing 0.2% of US births; 79% had wGA coded in the database. Among infants with CLD with wGA, 3.5% were born at >32 wGA, representing 7 of every 100,000 US births, or approximately 300 infants annually. Across all wGA categories, birth hospitalization length of stay and costs were elevated, and mechanical ventilation use ranged from 73% to 97%. All-cause inpatient mortality was highest among those <27 wGA and >32 wGA.

CONCLUSIONS:

Approximately 300 infants born at >32 wGA are diagnosed with CLD annually in the United States. The all-cause perinatal mortality rate is high in this population. The rationale for excluding this small but high-risk group of infants from the recommendations for RSV immunoprophylaxis is unclear.

Sdccag3 Promotes Implant Osseointegration during Experimental Hyperlipidemia

Hyperlipidemia adversely affects bone metabolism, often resulting in compromised osseointegration and implant loss. In addition, genetic networks associated with osseointegration have been proposed. Serologically defined colon cancer antigen 3 (Sdccag3) is a novel endosomal protein that functions in actin cytoskeleton remodeling, protein trafficking and secretion, cytokinesis, and apoptosis, but its roles in the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and in implant osseointegration under hyperlipidemic conditions have not been uncovered. Here, we performed microarray and RNA sequencing analysis to determine the differential expression of the Sdccag3 gene and related noncoding RNAs (ncRNAs) and to assess the long noncoding RNA (lncRNA) MSTRG.97162.4-miR-193a-3p-Sdccag3 coexpression network in bone tissues within the region 0.5 mm around implants in hyperlipidemic rats. In this experiment, we found that Sdccag3 and the previously uncharacterized lncRNA-MSTRG.97162.4 were downregulated during hyperlipidemia, while miR-193a-3p was upregulated. Sdccag3 overexpression increased new trabecular formation, the bone volume/total volume (BV/TV) (1.24-fold), and bone-implant combination ratio (BIC%) (1.26-fold). An RNA pulldown experiment revealed that Sdccag3 protein targeted lncRNA-MSTRG.97162.4 nucleotides 361 to 389. In addition, lncRNA-MSTRG.97162.4 overexpression significantly enhanced Sdccag3 (2.78-fold) expression and increased BV/TV (1.45-fold) and BIC% (1.07-fold) at the bone-implant interface. Taken together, these findings indicate that Sdccag3 overexpression enhances implant osseointegration under hyperlipidemic conditions by binding to lncRNA-MSTRG.97162.4. Furthermore, miR-193a-3p overexpression inhibited lncRNA-MSTRG.97162.4 (0.63-fold) and Sdccag3 (0.88-fold) expression and induced poor implant osseointegration (BV/TV, 0.86-fold; BIC%, 0.82-fold), while miR-193a-3p downregulation produced the opposite results (lncRNA-MSTRG.97162.4, 10.69-fold; Sdccag3, 6.96-fold; BV/TV, 1.20-fold; BIC%, 1.26-fold). Therefore, our findings show that Sdccag3 promotes implant osseointegration, and its related lncRNA-MSTRG.97162.4 and miR-193a-3p play an important role in osseointegration during hyperlipidemia, which might be a promising therapeutic target for improving dental implantation success rates.

Analysis of risk factors of stage IV gastric cancer from the SEER database

INTRODUCTION

Gastric cancer is the fourth most common cancer in the world. By the time the patients are diagnosed with stage IV gastric cancer, many patients already have distant metastases. There is no unified systemic treatment plan in existence. The use of gastrectomy is ambiguous in patients with stage IV gastric cancer. The objective of this study was to evaluate the beneficial outcome of gastrectomy in patients with stage IV gastric cancer.

METHODS

Clinical information of patients with gastric cancer from 2000 to 2010 in the Surveillance, Epidemiology, and End Results database were extracted and analysed. The risk factors for stage IV gastric cancer were also analysed.

RESULTS

We observed that the median survival time for patients after surgery was greater than that for patients not treated surgically. The five-year survival rate for chemotherapy patients was higher than that of non-chemotherapeutic patients. Patients who receive both chemotherapy and surgery could achieve a more significant survival benefit. The risks following gastrectomy (partial, subtotal, hemi-) were lower than those of other surgical procedures, which provided guidance on the choice of surgical method. The numbers of regional lymph node metastasis were found to be related to prognosis.

CONCLUSIONS

In patients with stage IV gastric cancer, gastrectomy (partial, subtotal or hemi) should be selected when surgery is necessary. The number of regional lymph node metastasis could be considered as a prognostic factor for patients with stage IV gastric cancer and lymph node dissection could reduce the risk of patients undergoing surgery.

Antimicrobial peptide GH12 as root canal irrigant inhibits biofilm and virulence of Enterococcus faecalis

AIM

The objectives of this laboratory-based study were to investigate the effects of GH12 on Enterococcus faecalis biofilm and virulence.

METHODOLOGY

Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of GH12 against E. faecalis were first determined. A time-kill assay was further conducted. The effects of GH12 on the expression of virulence and stress genes in E. faecalis were evaluated by RT-qPCR. Crystal violet stain was used to investigate the effects of GH12 on E. faecalis biofilm formation and 1-day-old biofilm. Finally, an ex vivo tooth model contaminated with E. faecalis was used to evaluate the antimicrobial activity of GH12 as an irrigant by CFU counting, SEM and CLSM. One-way anova and Tukey's multiple comparisons test were used to compare the differences amongst groups (α = 0.05).

RESULTS

The MICs and MBCs of GH12 against E. faecalis were 8.0 ± 0.0 and 16.0 ± 0.0 mg L^-1 , respectively, and GH12 at 32.0 mg L^-1 reduced the bacterial numbers by more than 99.9% within 1 min. Various virulence genes (efaA, esp and gelE) and stress genes (dnaK, groEL, ctsR and clpPBCEX) in E. faecalis were significantly downregulated by GH12 at sub-MIC levels (P < 0.05). Additionally, both E. faecalis biofilm formation and the biomass of 1-day-old E. faecalis biofilm were significantly reduced by GH12 (P < 0.05). Elimination of E. faecalis in biofilms from root canal walls was achieved through irrigation with 64.0 mg L^-1 GH12 for 30 min. CLSM analysis revealed that GH12 at 64.0 mg L^-1 was most effective in eliminating bacteria within dentinal tubules (P < 0.05).

CONCLUSION

In a laboratory setting, and when used as an irrigant, GH12 suppressed E. faecalis, downregulated specific virulence and stress-associated genes, eliminated intracanal E. faecalis protected by biofilms and killed bacteria in dentinal tubules. These results emphasize the need for preclinical and clinical studies to explore the potential of GH12 as an antimicrobial agent during root canal treatment.

Ethanol combined with coil embolisation for the treatment of arteriovenous malformations in a patient with Parkes Weber syndrome

Parkes Weber syndrome is a rare congenital condition of the vascular system with severe symptoms and life-threatening complications. The challenge is to manage the arteriovenous malformations, and there is no consensus on optimal treatment. We report the case of an 18-year-old woman with Parkes Weber syndrome who was treated with ethanol combined with coil embolisation at an early stage. After two sessions of embolisation, a significant devascularisation was achieved. No sign of recurrence was observed two years after the initial procedure. The patient's symptoms and signs were greatly relieved during the follow-up period. This case raises awareness of Parkes Weber syndrome and highlights the importance of timely intervention, as well as offering a promising therapeutic option for this condition.

[Establishment and characterization of patient derived xenograft model of malignant peritoneal mesothelioma in nude mice]

Objective: To establish patient derived xenograft (PDX) model of malignant peritoneal mesothelioma (MPM), and to identify the key characteristics of tumor biology of the model, so as to provide an experiment platform for studying the pathologic mechanisms and new therapeutic strategies for MPM. Methods: Surgically excised MPM tumor tissues were inoculated subcutaneously in BALB/c-nu/nu mice for 3 stable passages. In the 4th passage, the subcutaneous tumors were harvested under aseptic conditions, cleaned and made into MPM tumor cell homogenate. Four nude mice (two males and two females) were selected and one male and one female nude mouse were inoculated in the abdominal cavity at the dose of 100 μL, others were inoculated at a dose of 200 μL. The PDX model of MPM was established. The changes of body mass in nude mice were measured regularly, the extent of abdominal and pelvic tumors was judged by experimental peritoneal cancer index (ePCI) score, and the pathologic characteristics of tumors were analyzed. Results: The subcutaneous and abdominal animal models of MPM were successfully established. The subcutaneous tumor model grew into tumor on the 20th day, followed by a slow growth stage between the 20th and 29th day, then a rapid growth stage between the 30th and 57th day. According to the dose of tumor cells (100, 200 μL) and timing (14th and 69th days after grafting), the abdominal tumor model successfully simulated the early and late clinical stages of MPM. The HE staining results of the MPM nude mice model showed that the tumor was epithelial mesothelioma and invaded most of the organs, including liver, spleen, pancreas, mesentery. Immunohistochemical staining for calretinin, cytokeratin 5/6, WT1 and Ki-67 were positive. Whole-genome exon sequencing identified 26 and 36 high frequency gene mutations in tumors derived from the PDX model and clinical sample from patients, including 21 common gene mutations. Conclusions: The PDX model of MPM is established. The model is characterized by highly malignant tumor with rapid growth and high invasiveness.

Identification of the New Psychoactive Substance Dibutylone

Abstract

Objective To establish a method to identify unknown samples based on combined use of gas chromatography-mass spectrometry （GC-MS）, high resolution mass spectrometry （HRMS） and nuclear magnetic resonance spectrum （NMR） technique. Methods The unknown samples were dissolved in methanol solution containing internal standard SKF525A and detected by GC-MS and HRMS. The mixed samples were separated and purified by silica gel column chromatography, and then dissolved in methanol-d4 solution for structural analysis of ¹H nuclear magnetic resonance spectroscopy （¹H NMR）. Results The characteristic fragment ions （m/z） were 86.1 （base peak）, 71.2, 121.1, and 149.0, and the accurate mass number of molecular ion peak was measured by HRMS to be 236.128 89. By combined use of data analysis and database comparison, a new psychoactive substance of the cathinone class, Dibutylone, was detected in the sample, and the sample also contained a small amount of caffeine. The sample was purified, then identified using ¹H NMR, and was further confirmed to be Dibutylone. In addition, the GC-MS retention time and characteristic fragment ions of the main components of the sample were consistent with those of Dibutylone reference material. Conclusion The method established in this study can be used for the identification of Dibutylone in mixed samples.

Effects of early nutritional intervention on oral mucositis in patients with radiotherapy for head and neck cancer

BACKGROUND

To observe the effect of early nutritional intervention on radiation-induced oral mucositis and nutritional status in patients with head and neck cancer (HNC).

METHODS

A total of 54 HNC patients were divided into early (28 cases) and late (26 cases) nutritional intervention groups. The early group received enteral nutrition at the beginning of radiotherapy (RT), while the late group received enteral nutrition after restricted feeding. Operators reported and assessed the timing and extent of oral mucositis and nutritional status during treatment. The nutritional status assessment indicators included body weight; body mass index (BMI); Patient-Generated-Subjective Global Assessment (PG-SGA) score; levels of albumin, hemoglobin and pre-albumin and total lymphocyte count.

RESULTS

The incidence of high-grade oral mucositis was significantly lower in the early group than that in the late group (P < 0.05). Nutritional status assessments showed more significant weight and BMI losses in the late group than in the early group at weeks 4 and 7 after RT (P < 0.01). The albumin decreased in the late group at week 7 after RT was more significant than that in the early group (P < 0.05). Albumin, hemoglobin and pre-albumin levels and total lymphocyte count decreased significantly in both groups (P > 0.05). During therapy, more patients in the early group were well-nourished and fewer were malnourished according to PG-SGA scores (P < 0.05).

CONCLUSION

Early nutritional intervention can reduce the incidence of high-grade oral mucositis during RT in patients with HNC and improve the nutritional status during treatment, which has important clinical significance.

Rydberg-Mediated Entanglement in a Two-Dimensional Neutral Atom Qubit Array

We demonstrate high fidelity two-qubit Rydberg blockade and entanglement on a pair of sites in a large two-dimensional qubit array. The qubit array is defined by a grid of blue detuned lines of light with 121 sites for trapping atomic qubits. Improved experimental methods have increased the observed Bell state fidelity to F_{Bell}=0.86(2). Accounting for errors in state preparation and measurement we infer a fidelity of F_{Bell}^{-SPAM}=0.88. Accounting for errors in single qubit operations we infer that a Bell state created with the Rydberg mediated C_{Z} gate has a fidelity of F_{Bell}^{C_{Z}}=0.89. Comparison with a detailed error model based on quantum process matrices indicates that finite atom temperature and laser noise are the dominant error sources contributing to the observed gate infidelity.

[Epidemiological analysis of the deaths with antiretroviral treatment among adult HIV/AIDS patients in Liangshan Yi Autonomous Prefecture from 2005 to 2015]

Objective: To analyze the deaths with antiretroviral treatment among adult HIV/AIDS patients in Liangshan Yi Autonomous Prefecture from 2005 to 2015, in order to understand the epidemiological characteristics and to further reduce the mortality rate in Liangshan Prefecture. Methods: The relevant information was collected through the Management Database of Antiretroviral Treatment from the National AIDS Comprehensive Prevention Information System. Results: From 2005 to 2015, a total of 14 219 adult HIV/AIDS patients received antiretroviral treatment and 1 425 death cases were reported during the treatment. The cause of death was mainly AIDS-related diseases (58.9%), and the cumulative mortality rate was 10.02%. Gender, age, the way of infection, duration of antiretroviral therapy, clinical stage when received antiretroviral therapy, and CD(4)(+) T lymphocyte levels were factors for the mortality rate (P<0.001). The mortality increased with older age, higher initiation clinical stage and lower level of CD(4)(+) T lymphocyte. Among the death cases, 82.6% were male, 1 182 (82.9%) were married or cohabited, most aged between 30-39 years old (48.6%). At the initial point of receiving antiretroviral therapy, 49.7% of the cases with CD(4)(+)T lymphocytes levels< 200/μl, 61.2% of the deaths cases were>1 000 copies/ml during the last viral load test, and 16.2% of deaths were ≥500/μl in the last CD(4)(+)T lymphocyte test; 44.5% of deaths were received antiretroviral treatment within one year. Conclusion: Early and timely antiretroviral therapy should be carried out. It is necessary to strengthen the propaganda of antiretroviral therapy and to improve the management quality of follow-up information of antiretroviral therapy case files, and to improve the medication compliance of patients.

P3657Annulus-sparing should be adopted in all suitable patients with Tetralogy of Fallot

Background

Ongoing controversy focuses on whether relieving obstruction of dysplastic pulmonary valve annulus (PVA) requires transannular patch enlargement (TAPE) in TOF patients.

Purpose

Aiming to investigate clinical outcomes of annulus-sparing (AS) repair in nonselective TOF patients.

Methods

87 TOF patients was included, underwent AS repair and traditional TAPE and PV-specific technical performance score (TPS) was selected to evaluate adequacy of PV.

Results

One patient died and one required reintervention. 100% patients achieved AS. After a mean follow-up of 24.8 months, there is no significant difference between AS groups in severe pulmonary stenosis (PS) in Class 3 (7.4% vs 3.0%, p=0.583) and a downtrend of annular peak gradient (APG) in PVA z-score <−2 (-3.2±1.9) with AS repair regardless of a higher rate of PS in Class 2 (74.1% vs 42.5%, p=0.014). Compared with TAPE in PVA z-score <−2 (-3.5±0.9), there is no significant difference in PS in Class 3 (7.4% vs 7.4%, p=1.000) but a lower rate in PR in Class 3 (27.3% vs 70.4%, p=0.006), shorter ventilation duration (20.0h vs 29.0h, p=0.039), quicker recovery from ICU (2.0d vs 4.0d, p=0.022) and fewer postoperative hospitalized days (8.0d vs 11.0d, p=0.008), and APG in TAPE group was demonstrated an upward trend.

Table 1. Clinical outcomes Outcomes AS P value (A vs. B) TAPE P value (B vs. C) Group A Group B Group C Z-score ≥−2 (N=33) Z-score <−2 (N=27) Z-score <−2 (N=27) Repump 2 (6.1) 2 (7.4) 1.000 2 (7.4) 1.000 Hospital mortality 0 (0.0) 0 (0.0) 1.000 1 (3.7) 1.000 Reintervention 1 (3.0) 0 (0.0) 0.413 0 (0.0) 0.601 Adequacy of PV repair TPS for degree of PS   Class 1 (APG <20 mmHg) 18 (54.5) 5 (18.5) 0.004 19 (70.4) <0.001   Class 2 (APG 20–40 mmHg) 14 (42.5) 20 (74.1) 0.014 6 (22.2) <0.001   Class 3 (APG >40 mmHg) 1 (3.0) 2 (7.4) 0.583 2 (7.4) 1.000 TPS for degree of PR   Class 1 (none/trivial PR) 18 (54.5) 9 (33.3) 0.100 3 (11.1) 0.050   Class 2 (mild/mild-moderate PR) 12 (36.4) 9 (33.3) 0.807 5 (18.5) 0.214   Class 3 (moderate or greater PR) 3 (9.1) 9 (33.3) 0.020 19 (70.4) 0.006 Moderate PR 0 (0.0) 8 (29.6) 0.008 11 (40.7) 0.393 Severe PR 2 (6.1) 1 (3.7) 1.000 7 (25.9) 0.048

Figure 1. The trend of RVOT or APG.

Conclusions

AS remained higher APG at discharge but had a downtrend over time and long-term reintervention was rare and minimally invasive, as an alternative to TAPE in dysplastic PVA.

P1942A trait of inflammation pathogenesis in human atherosclerosis: inflammasome driven interleukin-1 signaling in complex atherosclerotic plaques via hyperlipidemia trained innate immunity

Objectives

We aimed to investigate interleukin (IL)-1 generation and the regulatory role of inflammasome in human advanced atherosclerosis.

Background

IL-1β is key contributor to the inflammatory process associated with atherosclerosis and its complications. Recent studies suggested that IL-1β blockade reduces the burden of inflammation and recurrence of cardiovascular events. Yet, other cytokines in IL-1 family and the regulation of IL-1 generation in patients with atherosclerosis remains poorly understood.

Methods and results

A focused transcriptomic analysis in human atherosclerotic specimens discovered that human atherosclerotic plaques host a broad reservoir of inflammasome components, characterised by expression of canonical inflammasome gene NLRP6, NLRP12, NLRC4, NLRP3 and non-canonical inflammasome gene caspase 4 significantly elevated in the symptomatic plaques versus the asymptomatic plaques. Upregulation of NLRP3 inflammasome expression in plaque validated by immunohistochemistry staining suggested it as a distinctive characteristic of plaque vulnerability and complexity. Functional studies on atherosclerotic explants obtained from patients undergoing carotid endarterectomy revealed constitutive generation of IL-1β accompanied by secretion of comparable levels of IL-1α from the majority of the plaques, while IL-18 and IL-33 generation from some of the plaques. Stimulation of the plaques with inflammasome activators showed an inducible generation of both IL-1α and IL-1β, not IL-18 or IL-33, mediated by specific canonical and non-canonical inflammasome pathways. Analysis on the medication records of these patients indicated that plaques from patients with suboptimally controlled hyperlipidemia, imaging signs for plaque instability and inadequate statins therapy possessed higher recruitable production of IL-1β, suggesting the conventional atherogenic factor in regulation of inflammasome immunity and disease activity. Mechanistic studies on tissue and cells isolated from atheromatous plaques demonstrate that generation of mature IL-1β is via a mechanism controlled by NLRP3 and the effector caspase-1.

Conclusions

The study supports a profound canonical and non-canonical inflammasomes mediated plaque IL-1α/β generation, via a key mechanism by NLRP3 and caspase-1. The results provide biological insights into the clinical merit of high-intensity cholesterol lowering and anti-IL-1 signalling-directed therapies in high-risk patients with atherosclerosis.

Acknowledgement/Funding

KI-Mayo collaboration project, the Swedish Research Council, the Swedish Heart-Lung Foundation, European Union FP7 projects, the NIH

Tea consumption and risk of fractures: an updated meta-analysis

This meta-analysis included 16 studies, involving seven cohort studies and nine case-control studies, and the results indicated that tea consumption may be associated with a reduced the risk of fractures.

INTRODUCTION

Regarding relationship of tea consumption with the risk of fractures remains controversial. We performed a meta-analysis to elucidate the association between tea consumption and the risk of fractures.

METHODS

Relevant articles were identified up to March 2019 by searching PubMed, Web of Science, and Embase databases. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were computed utilizing fixed or random effects model based on heterogeneity.

RESULTS

Altogether 16 studies (seven cohort and nine case-control studies) were included in this meta-analysis, involving 772,707 participants with 37,166 fracture cases. The RRs (95% CIs) of fracture for the highest versus lowest category of tea consumption were 0.86 (0.78-0.94). Subgroup analysis indicated significant associations in cohort studies (0.90 (0.86-0.94)) and case-control studies (0.77 (0.69-0.85)).

CONCLUSIONS

The current meta-analysis indicates that tea consumption may be associated with a reduced the risk of fractures.

P4671A well-defined subgroup of chronic thromboembolic pulmonary hypertension patients are positive for antiphospholipid antibodies

Introduction

Recurrent thromboembolism is a major risk factor for chronic thromboembolic pulmonary hypertension (CTEPH). Antiphospholipid antibodies (aPL) are a recognized risk factor for recurrent thromboembolism, however, their contribution to the development of CTEPH is currently unknown.

Purpose

The aim of this study was to evaluate the prevalence of antiphospholipid autoantibodies in a large cohort of consecutive patients with CTEPH.

Methods

Starting May 2013 to December 2018, 297 CTEPHpatients were consecutively enrolled. Diagnosis was confirmed with standardized right heart catheterization, 2D or/and 3D pulmonary angiography in all patients.All patients were also screened for thrombophilia including lupus anticoagulant IgG/IgM anticardiolipin antibodies and IgG/IgM aβ2GPI antibodies. Clinical and demographic characteristics, laboratory profile and hemodynamic data were compared between patients with aPL positive and aPL negative laboratory profiles.

Results

Overall, 297 consecutive patients with CTEPH were assessed for aPLs. Of these, 23 patients (7.7%) resulted positive for laboratory tests exploring aPL. Among patients with positive aPL, profile 17 (74%) were positive for all three test exploring aPL (LA+, aCL+, aB2GPI+). When compared to CTEPH patients without aPL test positivity, those positive for aPL were significantly younger (30.0 vs 55.6 years, p<0.0001), had a positive history of pulmonary embolism (95.6% vs 65.7%, p=0.003), deep venous thrombosis (78.3% vs 41.9%, p=0.0008) and were more frequently affected by other autoimmune diseases (43.5% vs 2.9%, p<0.0001). Moreover, positive aPL patients showed better hemodynamics on right heart catheterization, had more proximal lesions, and had more frequently level I and II surgical classification (82.6% vs 40.5%, p=0.0002) on pulmonary angiography.

Conclusions

These findings suggest that young patients with pulmonary embolism should be assessed for aPLs to guide anticoagulation therapy and prevent recurrences. Additionally, younger age, more proximal lesions and less severe hemodynamic profiles make majority patients with APS good candidates for PEA surgery.

Nuclear Dependence of the Transverse Single-Spin Asymmetry in the Production of Charged Hadrons at Forward Rapidity in Polarized p+p, p+Al, and p+Au Collisions at sqrt[s_{NN}]=200 GeV

We report on the nuclear dependence of transverse single-spin asymmetries (TSSAs) in the production of positively charged hadrons in polarized p^{↑}+p, p^{↑}+Al, and p^{↑}+Au collisions at sqrt[s_{NN}]=200  GeV. The measurements have been performed at forward rapidity (1.4<η<2.4) over the range of transverse momentum (1.8<p_{T}<7.0  GeV/c) and Feynman x (0.1<x_{F}<0.2). We observed positive asymmetries for positively charged hadrons in p^{↑}+p collisions, and significantly reduced asymmetries in p^{↑}+A collisions. These results reveal a nuclear dependence of TSSAs for charged-hadron production in a regime where perturbative techniques are applicable. These results provide new opportunities to use p^{↑}+A collisions as a tool to investigate the rich phenomena behind TSSAs in hadronic collisions and to use TSSAs as a new handle in studying small-system collisions.

Route from single-pulse to multi-pulse states in a mid-infrared soliton fiber laser

State-of-the-art ultrafast mid-IR fiber lasers deliver optical solitons with durations of several hundred femtoseconds. The Er- or Ho-doped fluoride gain fibers generally used in these lasers have strong anomalous dispersion at ∼3 µm, which generally forces them to operate in the soliton regime. Here we report that a pulse-energy clamping effect, caused by the buildup of intracavity nonlinearities, limits the shortest obtainable pulse durations in these mid-infrared soliton fiber lasers. Excessive intra-cavity energy results in soliton instability, collapse and fragmentation into a variety of stable multi-pulse states, including phase-locked soliton molecules and harmonically mode-locked states. We report that the spectral evolution of the mid-IR laser pulses can be recorded between roundtrips through stretching their second-harmonic signal in a 25-km-length of single-mode fiber. Using a modified dispersive Fourier transform set-up, we were able to perform for the first time spectro-temporal measurements of mid-IR laser pulses both in the pulsed state and during pulse collapse and fragmentation. The results provide insight into the complex nonlinear dynamics of mid-IR soliton fiber lasers and open up new opportunities for obtaining a variety of stable multi-pulse mode-locked states at mid-IR wavelengths.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Leadership in an academic discipline

Leading an academic discipline poses moral and ethical challenges, requiring a special set of capabilities. Leadership in a clinical academic discipline involves leading the transformation of education, research, leadership and patient care. Daily struggles within strategic, political and cultural milieu are the norm and effective leaders are able to navigate through these struggles and see opportunities for growth.

Thermal resistance of Clostridium difficile endospores in dairy compost upon exposure to wet and dry heat treatments

AIM

Thermal resistance of Clostridium difficile endospores in finished dairy compost was compared at 55 and 65°C under wet and dry heat conditions.

METHODS AND RESULTS

A three-strain cocktail of C. difficile endospores was inoculated into dairy compost to a final concentration of c. 5·5 log CFU per gram and the moisture content (MC) of the compost was adjusted to be 20, 30 and 40%. For the dry heat treatment at 55 and 65°C, the compost samples were placed in an environmental chamber, whereas for the wet heat treatment, the inoculated compost samples were placed in a tray submerged in a water bath. The MCs of composts were maintained well throughout the wet heat treatment while the dry heat treatment reduced the MCs of composts to <10% by the end of come-up time. During the come-up time, the log endospore reductions at a selected temperature were not significantly different in compost with three selected MCs, in each heat treatment. During the holding time, endospore counts reduced by <0·5 log CFU per gram at 55 and 65°C of dry heat treatment, whereas 0·7-0·8 and 0·6-3·0 log CFU per gram reductions were observed at 55 and 65°C in wet heat treatment respectively.

CONCLUSION

The recommended minimum composting guidelines were not sufficient to reduce C. difficile endospore counts to an undetectable level (five endospores per gram). Increasing the temperature of thermophilic phase to 65°C, and maintaining higher MCs of composting feedstocks have significant (P < 0·05) effects on the endospore inactivation.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our study identified factors that significantly affecting the thermal resistance of C. difficile endospores during composting, and the results suggest the current composting guidelines need to be amended in order to reduce the dissemination of C. difficile endospores in agricultural environment.

[Cellular damage of low-dose combined exposure to mercury, lead and cadmium on hippocampal neurons in rats]

Objective: To observe the cellular damage of low-dose combined exposure to Hg, Pb and Cd on hippocampal neurons in rat. Methods: SH-SY5Y cells were randomly divided into 8 groups by 2×2×2 factorial design: control group, Pb exposure group, Hg exposure group, Pb+Hg exposure group, Pb+Cd exposure group, Hg+Cd exposure group and Pb+Cd+Hg exposure group. And the cell viabilities were measured. On this basis, an animal model was established. Twenty eight-week-old SD pregnant rats were randomly divided into four groups by random number table, and five in each group: the control group(distilled water), 1-fold metal mixture exposure group (1×MM, poisoning solution containing mercury chloride 0.15 mg/L, lead acetate trihydrate 25 mg/L, cadmium chloride 7.5 mg/L), 5-fold metal mixture exposure group (5×MM, poisoning solution containing mercury chloride 0.75 mg/L, lead acetate trihydrate 125.00 mg/L, cadmium chloride 37.50 mg/L), 10-fold metal mixture exposure group (10×MM, poisoning solution containing mercury chloride 1.50 mg/L, lead acetate trihydrate 250.00 mg/L, cadmium chloride 75.00 mg/L). Pregnant rats drank water until delivery. Twenty male pups were selected and exposed to these metals through breast milk until weaned. The heavy metals dose of poisoning water was adjusted, and then the weaned rats were exposed to heavy metals via drinking poisoning water until adulthood (postnatal day 83). The blood samples and brain hippocampus samples were collected to observe the ultrastructural changes of hippocampus, and to determine the levels of Hg, Pb and Cd in blood. In addition, apoptosis rate and fluorescence intensity of reactive oxygen species and intracellular free calcium concentration ([Ca(2+)](i)) in hippocampal neurons were measured. Results: Cellular factorial design analysis showed that Hg+Pb+Cd (at no observed adverse effect level, 1.0, 0.5 and 0.1 μmol/L, respectively)had a interaction on cell viability after 48 or 72 hours of combined exposure (P<0.05). The results of ultrastructure showed that mitochondria decreased, ridges and matrixes gradually dissolved in rat hippocampal neurons of 5×MM group; nuclear chromatin aggregated, more ridges and matrixes dissolved and the mitochondria also decreased in rat hippocampal neurons of 10×MM group. The concentration of Hg, Pb and Cd in the blood of 1×MM group, 5×MM group and 10×MM group were higher than those in the control group, and the differences were statistically significant (P<0.001). There was no significant difference in apoptosis rate between the 1×MM group and the control group. The apoptosis rate of 5×MM group and 10×MM group was higher than that in the control group, and the differences were statistically significant (P<0.001). There was no statistically significant difference in the fluorescence intensity of reactive oxygen species in hippocampal neurons of the 1×MM group and the control group. The fluorescence intensity of reactive oxygen species in the 5×MM group and the 10×MM group was higher than that in the control group, the difference was statistically significant (P<0.05). There was no significant difference in the fluorescence intensity of [Ca(2+)](i) between the 1×MM group and the control group. The fluorescence intensity values of [Ca(2+)](i) in the 5×MM group and the 10×MM group were higher than the control group, the differences were statistically significant (P<0.001). Conclusion: Low-level combined exposure to Hg, Pb, and Cd caused synergistic neurotoxic damage, and the process may be related to the changes of neuronal apoptosis, reactive oxide species, and [Ca(2+)](i) levels.

Expression of odorant-binding proteins in mouthpart palps of the desert locust Schistocerca gregaria

Odorant-binding proteins (OBPs) are essential molecular elements of the insect chemosensory system, which is composed of the antennae and the mouthpart palps (maxillary and labial). In this study, we have analysed the expression and the sensilla specificity of 14 OBP subtypes in the palps of the desert locust Schistocerca gregaria. The locust palps comprise only a low number of sensilla basiconica but a high number of sensilla chaetica. Employing a variety of approaches, we found that only a subset of the antennal OBP repertoire was expressed in both palp types. These OBPs were previously shown to be expressed either in sensilla basiconica or sensilla chaetica of the antennae. Comparing the expression pattern in the two chemosensory organs revealed similarities and differences; most remarkably, two OBP subtypes, OBP6 and OBP8, were found in both sensilla types on palps, whereas on the antennae they were solely expressed in one sensillum type. Together, the data indicate a differential, but partly overlapping, expression of OBPs in the two sensilla types of the palps. The differences in the expression pattern of OBP subtypes between antennae and palps might be indicative for distinct functions of the OBPs in the two chemosensory organs.

MXene-based saturable absorber for femtosecond mode-locked fiber lasers

We report simple and compact all-fiber erbium-doped soliton and dispersion-managed soliton femtosecond lasers mode-locked by the MXene Ti₃C₂Tx. A saturable absorber device fabricated by optical deposition of Ti₃C₂Tx onto a microfiber exhibits strong saturable absorption properties, with a modulation depth of 11.3%. The oscillator operating in the soliton regime produces 597.8 fs-pulses with 5.21 nm of bandwidth, while the cavity with weak normal dispersion (~0.008 ps²) delivers 104 fs pulses with 42.5 nm of bandwidth. Our results contribute to the growing body of work studying the nonlinear optical properties of MXene that underpin new opportunities for ultrafast photonic technology.

[Clinical study of real-time shear wave elastography for diagnosis of severity of acute cholecystitis]

Objective: To assess the clinical value of real-time shear wave elastography (SWE) in distinguishing between mild and severe cholecystitis. Methods: A total of 176 patients with cholecystitis who meet the criteria of Tokyo Guideline in Wuxi People's Hospital of Nanjing Medical University from January 2017 to March 2018 were recruited, 95 male, 81 female, age range of 23-88 years, average age (48±16)years, and divided into severe (91 cases) and mild (85 cases) groups according to disease severity. All patients underwent routine ultrasound and SWE examination to assess gallbladder morphology, hepatic flow signals and liver cirrhosis adjacent to the gallbladder. Two sonographers with different diagnostic experience independently reviewed ultrasound images alone and in combination with SWE, respectively, and compared the diagnostic consistency of two sonographers in assessing severe cholecystitis. Results: The SWE value of liver in the severe group of cholecystitis was significantly higher than that of mild group (t=10.34, P=0.01). The area under the ROC curve of SWE value for diagnosing severe cholecystitis was 0.809 with the optimal cut-off value of 7.2 kPa. The sensitivity, specificity was 78.0% and 83.5%, respectively. In distinguishing between mild and severe cholecystitis, the diagnostic sensitivity (84.6%, 95.6%) was high and the specificity (49.4%, 35.3%) was low in diagnosing gallbladder edema and sludge.The diagnostic sensitivity (14.3%, 26.4%) was low and the specificity (100%, 95.3%) was high in diagnosing pericholecystic fluid and blood flow signal of the gallbladder wall.Two sonographers reviewed ultrasound images independently for diagnosing severe cholecystitis in good agreement (κ =0.75). Combining SWE to conventional ultrasound, the diagnostic consistency of the two sonographers in diagnosing server cholecystitis was excellent (κ=0.86), and the difference was statistically significant (P=0.02), the diagnostic efficacy of which was higher than that of conventional ultrasound alone. Conclusions: Compared with conventional ultrasound alone, combining with SWE can improve the diagnostic efficacy of distinguishing between mild and severe cholecystitis, and the clinical experience of sonographers has less influence on the diagnostic accuracy.

Abstract P5-09-01: Racial/ethnic differences in BRCA1/2 and multigene panel testing among young breast cancer patients

Background: Breast cancer (BC) patients diagnosed at age 50 and under are recommended to have germline genetic testing for hereditary BC due to a high likelihood of carrying a pathogenic mutation in a moderate or high penetrance risk gene. Completion of genetic testing among racial/ethnic minorities, particularly multigene panel testing, is understudied. We examined predictors of completion of BRCA1/2 and multigene panel testing among women with early onset BC and assessed racial/ethnic differences in genetic testing completion and results.

Methods: We performed a retrospective cohort study of 1370 BC patients diagnosed at &lt;50 years of age at Columbia University Medical Center (CUMC) from January 2007-December 2016.Data on socio-demographics, clinical factors, and genetic testing completion and results were collected from the medical record. We conducted descriptive statistics and univariate and multivariable logistic regression models.

Results: Our study population had a median age of 44 years (range, 19-50); 44% non-Hispanic white, 24% Hispanic, 13% non-Hispanic black, 10% Asian, 9% other; 61% private insurance, 22% Medicaid, 17% other. Nearly half of the women (N=607; 44.3%) had genetic testing performed. In the multivariable regression model, genetic testing completion was less likely with increasing age at diagnosis (odds ratio [OR]=0.93; 95% confidence interval [CI]=0.91-0.95) and stage 0 or 4 BC compared to stage 1 (OR=0.67; 95% CI=0.46-0.97 and OR=0.35; 95% CI=0.19-0.64, respectively). Completion of genetic testing was more likely with a family history of BC (OR=5.55; 95% CI=3.92-7.87). Genetic testing completion did not vary by race/ethnicity or insurance coverage. Across all racial/ethnic groups, the frequency of pathogenic/likely pathogenic variants identified was 13.0% and 10.5% had at least 1 variant of uncertain significance (VUS). The highest VUS frequency was among Asians (21.2%). The percentage of women undergoing genetic testing increased over time from 18.5% in 2007 and reached a peak of 69.3% in 2015. From 2007 to 2016, the percentage of pathogenic/likely pathogenic variants detected increased from 3.4% to 9.1% and the VUS frequency rose from 3.4% to 13.3% with increasing use of panel testing.

Frequency of pathogenic variants and VUS among women ≤ 50 years diagnosed with BC at CUMC (2007-2016) Pathogenic variantsVUSTotal81 (5.9%)74 (5.4%)BRCA144 (3.2%)10 (0.7%)BRCA221 (1.5%)10 (0.7%)ATM3 (0.2%)9 (0.6%)CHEK23 (0.2%)8 (0.5%)Other variants detected in: APC, BARD1, BRIP1, CDH1, CDKN2A, MEN1, MLH1, MRE11A, MSH2, MSH6, MUTYH, NBN, NF1, PALB2, PHOX2B, PMS2, POLE, PTEN, RAD50, RAD51C, SDHA, STK11, TP53

Conclusions and Relevance: Nearly half of the women with early onset BC had genetic testing. We did not observe disparities in genetic testing by race/ethnicity or insurance coverage. Genetic testing completion, as well as the frequency of pathogenic/likely pathogenic variants and VUS detection, increased over time as panel testing replaced BRCA1/2 testing. Counseling on the likelihood of obtaining uncertain results should be provided to all patients undergoing hereditary BC genetic testing, particularly to racial/ethnic minorities.

Citation Format: Trivedi MS, Jones T, Jiang X, Underhill ML, Bose S, Silverman T, Chung WK, Kukafka R, Crew KD. Racial/ethnic differences in BRCA1/2 and multigene panel testing among young breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-01.

Potential Mutations in Chinese Pathologic Myopic Patients and Contributions to Phenotype

Purpose

Pathologic myopia is a leading cause of visual impairment in East Asia. The aim of this study was to investigate the potential mutations in Chinese pathologic myopic patients and to analyze the correlations between genotype and clinical phenotype.

Method

One hundred and three patients with pathologic myopia and one hundred and nine unrelated healthy controls were recruited from Zhongshan Ophthalmic Center. Detailed clinical data, including ultra-widefield retinal images, measurements of best-corrected visual acuity, axial length, refractive error and ophthalmic examination results, were obtained. Blood samples were collected for high-throughput DNA targeted sequencing. Based on the screening results, phenotype-genotype correlations were analyzed.

Results

The study included 196 eyes of 103 patients (36 men and 67 women) with an average age of 52.19 (38.92 – 65.46) years, an average refractive error of -11.80 D (-16.38 – -7.22) and a mean axial length of 28.26 mm (25.79 – 30.73). The patients were subdivided into three groups: myopic chorioretinal atrophy (190 eyes of 101 patients), myopic choroidal neovascularization (17 eyes of 15 patients), and myopic traction retinopathy (71 eyes of 61 patients). Systematic analysis of variants in the 255 genes revealed six potential pathogenic mutations: PEX7, OCA2, LRP5 (rs545382, c.1647T>C), TSPAN12 (rs41623, c.765G>T), RDH5 (rs3138142, c.423C>T) and TTC21B (rs80225158, c.2385G>C). OCA2 mutations were primarily observed in patients with myopic traction maculopathy.

Conclusion

Genetic alterations contribute to various clinical characteristics in Chinese pathologic myopic patients. The study may provide new insights into the etiology of pathologic myopia and potential targets for therapeutic interventions.