[Effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

Objective: To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Retrospective analysis of 258 patients with AML in CR (186 cases in CR(1), 72 cases in CR(2)) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. Results: ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34(+) cell number and transfused CD3(+) cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR(2) compared to that in CR(1) (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Conclusion: Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR(1) and CR(2) patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.

[Effect of minimal residual disease monitoring by multiparameter flow cytometry pre-conditioning on prognosis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

目的

分析预处理前多参数流式细胞术（MFC）监测的骨髓微小残留病（MRD）对急性髓系白血病（AML）异基因造血干细胞移植（allo-HSCT）预后的影响，探讨MFC监测MRD在AML allo-HSCT预后评估中的价值。

方法

回顾性分析2012年4月至2015年3月行allo-HSCT的186例AML患者，预处理前骨髓细胞形态学均达第1次完全缓解（CR₁）。采用8色MFC对预处理前骨髓进行MRD检测，任何水平异常均定义为MRD阳性。

结果

①186例AML患者中151例MRD阴性；35例MRD阳性，其中25例MRD<1%，10例MRD为1%~3%。②2年总体无病生存（DFS）率为80.0%（95% CI 68.5%~92.3%）。与MRD阴性组比较，MRD阳性组DFS率低[62.9%（95% CI 50.6%~75.2%）对88.9%（95%CI 76.6%~100.0%），P<0.001]、复发率高[11.4%（95%CI 4.1%~29.0%）对3.3%（95%CI 0.6%~20.9%），P=0.003]、非复发死亡率（NRM）高[25.7%（95%CI 8.1%~43.3%）对7.9%（95%CI 1.3%~26.5%），P=0.001]。继发性AML组DFS率低（P=0.004），NRM高（P=0.003）。③多因素分析结果显示预处理前MFC检测的MRD阳性是DFS[HR=4.565（95%CI 2.918~9.482），P<0.001]、复发[HR=5.854（95% CI 1.538~22.288），P=0.010]及非复发死亡[HR=3.379（95%CI 1.361~8.391），P=0.009]的独立危险因素。

结论

预处理前MFC监测的MRD阳性是影响allo-HSCT治疗CR₁-AML独立危险因素，MFC监测MRD可用于AML allo-HSCT的预后评估。

Evidence of interaction between genes in the folate/homocysteine metabolic pathway in controlling risk of non-syndromic oral cleft

OBJECTIVE

Little consistent evidence is available for the association between the risk of non-syndromic cleft lip with or without cleft palate (NSCL/P) and any of the individual genes in the folate/homocysteine metabolic pathway. We investigated the genes in the folate pathway to further clarify its potential influence on the risk of NSCL/P considering gene-gene (G×G) interaction.

SUBJECTS AND METHODS

We selected markers in 18 genes from the pathway and applied Cordell's method to test for G×G interaction using 1,908 NSCL/P case-parent trios ascertained in an international consortium where a genomewide association study (GWAS) of oral clefts was conducted.

RESULTS

We found intriguing signals among Asian and European ancestry groups for G×G interaction between markers in betaine-homocysteine methyltransferase gene (BHMT/BHMT2) and dimethylglycine dehydrogenase gene (DMGDH) attaining genomewide significance. In the pooled data, the top significant interaction was found between rs13158309 (BHMT) and rs10514154 (DMGDH, p = 1.45 × 10^-12 ).

CONCLUSIONS

Our study illustrated the importance of taking into account potential G×G interaction for genetic association analysis in NSCL/P, and this study suggested both BHMT/BHMT2 and DMGDH should be considered as candidate genes for NSCL/P in future studies.

[Progress in research of family-based cohort study on common chronic non-communicable diseases in rural population in northern China]

Family-based cohort study is a special type of study design, in which biological samples and environmental exposure information of the member in a family are collected and related follow up is conducted. Family-based cohort study can be applied to explore the effect of genetic factors, environmental factors, gene-gene interaction, and gene-environment interaction in the etiology of complex diseases. This paper summarizes the objectives, methods and results, as well as the opportunities and challenges of the family-based cohort study on common chronic non-communicable diseases in rural population in northern China.

Staphylococcal enterotoxin C2 promotes osteogenesis of mesenchymal stem cells and accelerates fracture healing

Objectives

As one of the heat-stable enterotoxins, Staphylococcal enterotoxin C2 (SEC2) is synthesized by Staphylococcus aureus, which has been proved to inhibit the growth of tumour cells, and is used as an antitumour agent in cancer immunotherapy. Although SEC2 has been reported to promote osteogenic differentiation of human mesenchymal stem cells (MSCs), the in vivo function of SCE2 in animal model remains elusive. The aim of this study was to further elucidate the in vivo effect of SCE2 on fracture healing.

Materials and Methods

Rat MSCs were used to test the effects of SEC2 on their proliferation and osteogenic differentiation potentials. A rat femoral fracture model was used to examine the effect of local administration of SEC2 on fracture healing using radiographic analyses, micro-CT analyses, biomechanical testing, and histological analyses.

Results

While SEC2 was found to have no effect on rat MSCs proliferation, it promoted the osteoblast differentiation of rat MSCs. In the rat femoral fracture model, the local administration of SEC2 accelerated fracture healing by increasing fracture callus volumes, bone volume over total volume (BV/TV), and biomechanical recovery. The SEC2 treatment group has superior histological appearance compared with the control group.

Conclusion

These data suggest that local administration of SEC2 may be a novel therapeutic approach to enhancing bone repair such as fracture healing.

Cite this article: T. Wu, J. Zhang, B. Wang, Y. Sun, Y. Liu, G. Li. Staphylococcal enterotoxin C2 promotes osteogenesis of mesenchymal stem cells and accelerates fracture healing. Bone Joint Res 2018;7:179–186. DOI: 10.1302/2046-3758.72.BJR-2017-0229.R1.

Perampanel, an AMPA receptor antagonist: From clinical research to practice in clinical settings

Epileptic seizures are refractory to treatment in approximately one-third of patients despite the recent introduction of many newer antiepileptic drugs (AEDs). Development of novel AEDs therefore remains a high priority. Perampanel is a first-in-class non-competitive selective AMPA receptor antagonist with a unique mechanism of action. Clinical efficacy and safety of perampanel as adjunctive treatment for focal seizures with/without secondary generalization (±SG) and primary generalized tonic-clonic (PGTC) seizures have been established in five phase 3 randomized controlled trials (RCTs), and a long-term extension study, and perampanel is approved as monotherapy for focal seizures ±SG in the USA. In patients with focal seizures ±SG, add-on perampanel resulted in median percent reduction in seizure frequency 23.3%-34.5% and ≥50% responder rate 28.5%-37.6%; in PGTC seizures, these results were 76.5% and 64.2%, respectively. Efficacy among adolescents (reduction in seizure frequency 34.8%-35.6%; ≥50% responder rate 40.9%-45.0%) and elderly people (reduction in seizure frequency 12.5%-16.9%; ≥50% responder rate 22.2%-42.9%) is similar to those in adults, and results remain comparable between Asian (reduction in seizure frequency 17.3%-38.0%) and global populations. Perampanel has been extensively studied in real-world clinical practice, with similar efficacy and safety results to the RCTs (≥50% responder rate 12.8%-75.0%; adverse events of somnolence/sedation, dizziness, ataxia, and behavioral changes). Real-world observational studies suggest that perampanel tolerability can be improved by slow titration (2 mg every 2-4 weeks), and bedtime administration can mitigate somnolence and dizziness. Counseling about the potential for behavioral changes and close monitoring are recommended.

[Progress in next-generation sequencing research of non-syndromic oral clefts]

Non-syndromic oral clefts (NSOC) are among the most common birth defects. The prevalence of NSOC is 1.13-1.30 per 1 000 live births in China, which is higher than those in other major ethnic groups. The etiology of NSOC is complex and heterogeneous, which involves both genetic and environmental risk factors. Although genome-wide association studies have identified a number of risk loci, these loci can only account for a small proportion of the heritability of NSOC. The next-generation sequencing research provides new ideas for further exploring the genetic risk factors of NSOC. This paper summaries the progress in the next-generation sequencing research of NSOC.

Evidence for negative thermal expansion in the superconducting precursor phase SmFeAsO

The fluorine-doped rare-earth iron oxypnictide series SmFeAsO1-x F x (0 [Formula: see text] 0.10) was investigated with high resolution powder x-ray scattering. In agreement with previous studies (Margadonna et al 2009 Phys. Rev. B. 79 014503), the parent compound SmFeAsO exhibits a tetragonal-to-orthorhombic structural distortion at [Formula: see text]  =  130 K which is rapidly suppressed by [Formula: see text] 0.10 deep within the superconducting dome. The change in unit cell symmetry is followed by a previously unreported magnetoelastic distortion at 120 K. The temperature dependence of the thermal expansion coefficient [Formula: see text] reveals a rich phase diagram for SmFeAsO: (i) a global minimum at 125 K corresponds to the opening of a spin-density wave instability as measured by pump-probe femtosecond spectroscopy (Mertelj et al 2010 Phys. Rev. B 81 224504) whilst (ii) a global maximum at 110 K corresponds to magnetic ordering of the Sm and Fe sublattices as measured by magnetic x-ray scattering (Nandi et al 2011 Phys. Rev. B 84 055419). At much lower temperatures than [Formula: see text], SmFeAsO exhibits a significant negative thermal expansion on the order of  -40 ppm · K-1 in contrast to the behaviour of other rare-earth oxypnictides such as PrFeAsO (Kimber et al 2008 Phys. Rev. B 78 140503) and the actinide oxypnictide NpFeAsO (Klimczuk et al 2012 Phys. Rev. B 85 174506) where the onset of [Formula: see text] 0 only appears in the vicinity of magnetic ordering. Correlating this feature with the temperature and doping dependence of the resistivity and the unit cell parameters, we interpret the negative thermal expansion as being indicative of the possible condensation of itinerant electrons accompanying the opening of a SDW gap, consistent with transport measurements (Tropeano et al 2009 Supercond. Sci. Technol. 22 034004).

Inverse association between plasma homocysteine concentrations and type 2 diabetes mellitus among a middle-aged and elderly Chinese population

BACKGROUND AND AIMS

Plasma homocysteine concentrations have been reported to be associated with type 2 diabetes mellitus (T2DM) with controversial findings. The aim of the present study was to investigate the association between plasma homocysteine concentrations and T2DM.

METHODS AND RESULTS

A cross-sectional study including 19,085 eligible participants derived from the Dongfeng-Tongji cohort was conducted. Plasma homocysteine concentrations were measured by Abbott Architect i2000 Automatic analyzer and T2DM was defined according to American Diabetes Association criteria. Logistic regression model was used to explore the association between plasma homocysteine concentrations and T2DM. The prevalence of T2DM was 19.0% in the whole population (mean age 62.9 years), 21.8% in males, and 17.1% in females. In the multivariable logistic regression analyses, compared with those in the lowest quintile, the OR (95% CI) of T2DM was 1.05 (0.92-1.21), 0.99 (0.86-1.14), 0.90 (0.78-1.05), and 0.77 (0.66-0.90) for quintile 2 to quintile 5 of homocysteine concentrations after adjustment for potential confounders (P for trend < 0.0001). Homocysteine concentrations were associated with decreased T2DM prevalence risk (OR = 0.88 per SD increase of homocysteine concentration; 95% CI: 0.84-0.93). A significant interaction between homocysteine concentrations and drinking status on T2DM prevalence risk was observed (P for interaction = 0.03). The inverse association of plasma homocysteine concentrations with T2DM prevalence risk was observed in non-drinkers but not in current drinkers.

CONCLUSION

Plasma homocysteine concentrations were inversely correlated with T2DM among a middle-aged and elderly Chinese population.

Associations between daily cooking duration and the prevalence of diabetes and prediabetes in a middle-aged and elderly Chinese population: A cross-sectional study

Experimental and epidemiological studies indicated that ambient air pollution was positively associated with diabetes. Few studies investigated the associations between household air pollution, for example, daily cooking duration and diabetes or prediabetes. We conducted a cross-sectional study to investigate the associations of daily cooking duration with the prevalence of diabetes and prediabetes among a middle-aged and elderly population. A total of 26 089 individuals (11 250 males and 14 839 females) derived from the Dongfeng-Tongji cohort study were included. Daily cooking duration was assessed by questionnaire. Diabetes and prediabetes were identified according to the criterion of American Diabetes Association. No significant association was observed between daily cooking duration and the prevalence risk of diabetes (odds ratio[OR] = 0.97, 95% confidence interval[CI]: [0.81-1.16], P for trend = .74); however, longer daily cooking duration was associated with higher prevalence risk of prediabetes (OR = 1.26, 95% CI: 1.07-1.47; P for trend = .003) and hyperglycemia (OR = 1.21, 95% CI: 1.05-1.41; P for trend = .005). Our study suggested that daily cooking duration was not associated with diabetes but with higher prevalence risk of prediabetes/hyperglycemia in a middle-aged and elderly Chinese population.

Abstract P4-02-03: Pre-neoadjuavnt therapy MRI phenotype can predict response to neoadjuvant endocrine therapy

OBJECTIVE: Neoadjuvant endocrine therapy (NET) is increasingly used for the treatment of low and intermediate grade, hormone receptor positive, HER2 negative breast cancer. Several MRI phenotypes that may predict response to neoadjuvant chemotherapy (NAC) have been identified, but little data exists for phenotypes associated with response to NET. This study analyzed imaging phenotypes for all patients treated with NET with the aim to identify specific features that can be predictive of response to therapy.

MATERIALS AND METHODS: The study was retrospective and included 21 patients with clinical stage I, II, and III breast cancer. The tumors were grade 1 or 2, estrogen receptor (ER) positive in &gt;20% of cells, and HER2 non-amplified. MRI examinations were performed in all women before NET. MRI interpretation included mass shape, non-mass enhancement (NME) pattern, background parenchymal enhancement, and MRI phenotype (I well-defined unicentric mass; II well defined multilobulated mass; III area enhancement with nodularity; IV area enhancement without nodularity; V septal spreading). Type of neoadjuvant endocrine therapy included: tamoxifien alone, an aromatase inhibitor (AI) alone, AI + ovarian suppression, and AI + a non-chemotherapeutic agent. Patients received NET for a total duration ranging between 3 - 6 months, with one patient receiving therapy for 18 months. Clinically meaningful response was defined as stable or decreased tumor size by clinical exam and confirmed at resection by comparing final pathologic T stage with clinical T stage.

RESULTS: Twenty-one patients were identified. Median age was 62 (range 36-84) years. Most were post-menopausal 17 (81%). Pre-neoadjuvant meadian tumor size on MRI was 3.9 (range 1.0-7.5) cm and comprised T1 3 (14.3%), T2 8 (38.1%), T3/4 10 (47.6%). Pre-treatment N stage was N0 14 (66.7%), N1 7 (33.3%) and pre-NET stage was I in 3 (14.3%), II in 8 (38.1%), and III in 10 (47.6%) patients. The majority 17 (81%) had some tumor reduction, and 4 (19%) had no response. No one achieved a complete response. Of the 17 responders, 7 (41%) had a good response defined as &gt;25% decrease in tumor size. Median tumor size after NET was 3.1 (range 0.6-11) cm and the distribution of T stage was T1 7 (33.3%), T2 9 (42.9%), and T3/4 5 (23.8%). Eleven of 12 (92%) patients with well-defined phenotypes had a response as compared to 6 of 9 (67%) patients with non-well defined phenotypes. Phenotype was not predictive of a good response to therapy, 4 were in the well-defined phenotype and 3 were in the non-well defined phenotype groups. All 4 non-responders had moderate or marked background enhancement as compared to 5 of 17 responders (p = 0.02).

CONCLUSION: A well-defined pre treatment MRI phenotype was significantly predictive of a positive response to NET, while a non well-defined MRI phenotype and higher degree of background enhancement was significantly predictive of negative response to NET. This warrants further prospective evaluation, especially in association with Ki-67 levels. If validated, pre treatment MRI phenotype can be applied in the clinical decision to either initiate NET or referral for upfront surgical resection.

Citation Format: Hilal T, Covington M, Pockaj B, Northfelt D, Wu T, Zwart C, Li J, Patel BK. Pre-neoadjuavnt therapy MRI phenotype can predict response to neoadjuvant endocrine therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-03.

Downregulation of Chilo suppressalis alkaline phosphatase genes associated with resistance to three transgenic Bacillus thuringiensis rice lines

Insecticidal crystal (Cry) proteins produced by the bacterium Bacillus thuringiensis are highly toxic to lepidopteran pests. Strains of transgenic rice expressing cry genes have been developed that are resistant to rice pests. Understanding the mode of action of Cry toxins in rice pests will improve our ability to use them effectively as insecticides. In this study, we tested the hypothesis that alkaline phosphatases (ALPs) are involved in Cry1A, Cry2Aa and Cry1Ca toxicity in Chilo suppressalis, an important insect pest of rice crops in China. We first cloned three novel C. suppressalis alps (Csalps) from the larval midgut of C. suppressalis. RNA interference knockdown of six different Csalp genes (Csalp1, Csalp2, Csalp3, Csalp4, Csalp5 and Csalp6) showed that knockdown of three of these, Csalp1, Csalp2 and Csalp4, reduced larval mortality to the transgenic rice strain TT51, which expresses a fusion protein of Cry1Ab and Cry1Ac, whereas suppression of Csalp1, Csalp2, Csalp3, Csalp4 and Csalp6 transcripts decreased the susceptibility of larvae to the transgenic rice strain T2A-1, which expresses cry2Aa. Moreover, downregulation of Csalp1, Csalp2, Csalp3, Csalp4 and Csalp5 transcripts conferred significant tolerance to the transgenic rice strain T1C-19, which expresses cry1Ca. These results suggest that these ALPs play a key role in the toxicity of Cry1A, Cry2A and Cry1C to C. suppressalis.

Knowledge gaps and research priorities in the prevention and control of hepatitis E virus infection

Hepatitis E virus (HEV), family Hepeviridae, is a main cause of epidemic hepatitis in developing countries and sporadic and cluster cases of hepatitis in industrialized countries. There are an increasing number of reported cases in humans especially in industrialized countries, and there is a high potential for transboundary spread of zoonotic genotypes of the virus through the transport of pigs, pig products and by-products. Bloodborne transmission of the virus has been reported with a significant medical concern. To better coordinate HEV research and design better control measures of HEV infections in animals, a group of HEV experts reviewed the current knowledge on the disease and considered the existing disease control tools. It was concluded that there is a lack of in-depth information about the spread of the virus from pigs to humans. The role of animals other than pigs in the zoonotic transmission of the virus to humans and the extent of foodborne transmission are poorly understood. Factors involved in development of clinical disease such as infectious dose, susceptibility and virulence of virus strains need to be studied more extensively. However, such studies are greatly hindered by the absence of a broadly applicable, efficient and sensitive in vitro cell culture system for HEV. Diagnostic tools for HEV are available but need to be further validated, harmonized and standardized. Commercially available HEV vaccines for the control of HEV infection in animal populations are needed as such vaccines can minimize the zoonotic risk for humans. Anti-HEV drugs for treatment of HEV-infected patients need to be studied more extensively. The detailed expert review can be downloaded from the project website at http://www.discontools.eu/.

Iron deficiency stress can induce MxNAS1 protein expression to facilitate iron redistribution in Malus xiaojinensis

Iron (Fe) is a vital trace element in plants, and deficiency of this element in apple trees can reduce fruit quality. Nicotianamine (NA) is known to play an important role in Fe transport and endogenous hormone balance. In the present study, we investigated the role of a nicotianamine synthase 1 gene (MxNas1) in an apple species, Malus xiaojinensis, that has a more Fe-efficient genotype than other apple species and ecotypes. To characterise the response of M. xiaojinensis to Fe deficiency, we used quantitative Q-PCR to determine the level of expression of MxNas1 and Western blot to measure protein levels. Immunohistochemical staining and GFP fluorescence localisation of the MxNAS1 protein were also carried out. HPLC and polarised absorption spectrophotometry were performed to investigate the effects of overexpression of MxNas1 in order to elucidate the role of MxNAS1 in the cellular uptake of active Fe in tobacco suspension cells. We found that MxNas1 expression and protein levels were higher under Fe deficiency stress than under Fe sufficiency. Immunohistochemical staining showed that MxNAS1 was localised mainly in the epidermal and vascular tissues of the roots, vascular tissues of the stem and palisade cells of mature leaves, and in parenchyma cells of young leaves. MxNAS1 was mainly localised in the plasma membranes and vesicles of protoplasts. In addition, overexpression of MxNas1 in stable transgenic tobacco cells increased NA and active Fe content under Fe sufficiency. The results suggest that MxNas1 expression in M. xiaojinensis is induced in response to Fe deficiency stress, resulting in higher levels of the protein. MxNAS1 may be involved in the redistribution of Fe in M. xiaojinensis under Fe deficiency.

[Mechanism of cross talk between tissue factor/active coagulation factor VII and epidermal growth factor receptor signalings in colon cancer cells in culture]

OBJECTIVE

To preliminarily verify the cross talk between tissue factor/active coagulation factor VII (TF/FVIIa) and epidermal growth factor receptor (EGFR) pathways in human colon cancer cells in culture.

METHODS

FVIIa was treated to HT-29 (KRAS-wild type) and LoVo (KRAS-mutant) colon cancer cells to activate TF/FVIIa pathway, qRT-PCR and Western blot were used to detect the expressions of amphiregulin (AREG) and epiregulin (EREG), ligands of EGFR on mRNA and protein levels, respectively. After knocking down expression of TF by TF-targeted siRNA transfection, FVIIa was treated and mRNA expressions of AREG and EREG were detected to see whether the FVIIa-induced effects were dependent on TF. Expressions of mRNA of TF and FVII were detected by qRT-PCR following the activation of EGFR pathway by treatment with epidermal growth factor (EGF) to HT-29 and LoVo cells.

RESULTS

After TF/FVIIa pathway was activated, for HT-29 cells, expressions of AREG (on mRNA level) and EREG (both on mRNA and protein level) were significantly down-regulated versus those of control group, gene expressions of AREG and EREG were 0.55±0.09 vs.0.99 ±0.09, 0.67±0.10 vs.1.02±0.02, protein expressions of EREG were 0.54±0.09 vs.1.04±0.13, all P<0.05. For LoVo cells, expressions of AREG (both on mRNA and protein level) and EREG (on protein level) were significantly up-regulated versus those of control group, gene expression of AREG were 1.87±0.39 vs. 0.93±0.23, protein expressions of AREG and EREG were 3.09±0.73 vs.1.11±0.21, 1.53±0.19 vs.0.97±0.23, all P<0.05. The regulating effect of AREG and EREG mRNA expression by FVIIa in HT-29 and LoVo cells could both be partly blocked by knocking down TF expression. For HT-29 cells, activation of EGFR pathway induced no significant TF mRNA expression, FVII mRNA expression was not detected. However,for LoVo cells, activation of EGFR pathway induced significantly higher mRNA expressions of both TF and FVII, expressions were 1.53±0.23 vs.1.00±0.23, 53.20±6.08 vs.1.00±0.15, all P<0.05.

CONCLUSION

In colon cancer cell LoVo, when activated, TF/FVIIa pathway and EGFR pathway could interact through upregulating the other pathway's effectors, and mutant KRAS might play a critical role in the two pathways' cross talk.

[Progress of molecular subtypes of colorectal cancer]

Colorectal cancer is one of the leading causes of morbidity and mortality around the world. Although the staging and classification systems, such as tumor/node/metastasis (TNM) staging, are widely used in clinic, there are some limitations. For example, the patients with the same pathological type, TNM stage and treatment regimen show a completely different prognosis and outcome. In the present, molecular subtyping was concerned for a more precise and accurate staging of colorectal cancer. Herein, we reviewed the literature of the molecular subtypes of colorectal cancer in the past decades. The clinical significance of various molecular subtyping systems was evaluated and compared. It will provide reference for the precision medicine of colorectal cancer in the future.

[Prevalence of type-specific human papillomavirus infection among 18-45 year-old women from the general population in Liuzhou, Guangxi Zhuang Autonomous Region: a cross-sectional study]

Objective: To analyze the type-specific prevalence of human papillomavirus (HPV) among women aged 18-45 years from the general population in Liuzhou, Guangxi Zhuang Autonomous Region. Methods: Totally, 2 300 women aged 18-45 years old were enrolled in Liuzhou,from March to July, 2013. Cervical exfoliated cells were collected for liquid based cytological and HPV DNA tests. Women were referred to colposcopy exam, based on the clinical practice guideline. Results: Overall, the prevalence rates of any HPV or oncogenic HPV appeared as 22.7% (95% CI: 21.0%-24.4%) and 17.3% (95% CI: 16.0%-19.1%), respectively in this population under study. The high-risk HPV prevalence peaked at the age groups of 18-25 and 41-45, increasing along with the severity through cytological and histological tests. Statistically significant differences between the prevalence of CIN2+ (Cervical intraepithelial neoplasia 2+) in women older than 26 years (1.7%, 95% CI: 1.0%-2.4%) and 18-25 years (1.2%, 95% CI: 0.5%-1.9%) of age, were not observed. Among samples diagnosed as CIN2+, positivity of HPV bivalent (16/18) and nine-valent (6/11/16/18/31/33/45/52/58) vaccine, related high risks on the types of HPV types appeared as 44.1% and 97.1%. Conclusions: The age-specific HPV prevalence rates in the general women aged 18-45 in Liuzhou presented as having bimodal distribution, suggesting that the disease burden of cervical diseases in women aged 26-45 years should not be ignored. Nine-valent HPV vaccine might provide more effective prevention outcomes on cervical cancer in China.

Imatinib-induced ophthalmological side-effects in GIST patients are associated with the variations of EGFR, SLC22A1, SLC22A5 and ABCB1

Imatinib-induced ophthalmological side-effects, including conjunctiva hemorrhage and periorbital oedema, although very common and still remain relatively little understood. The present study investigated the effects of genetic polymorphisms of drug targets and membrane transporters on these side effects. We found that the minor allele of EGFR rs10258429 and SLC22A1 rs683369 were significant risk determinants of conjunctival hemorrhage with OR of 7.061 (95%CI=1.791-27.837, P=0.005 for EGFR rs10258429 CT+TT vs CC), and 4.809 (95%CI=1.267-18.431, P=0.021 for SLC22A1 rs683369 GG+CG vs CC). The minor allele of SLC22A5 rs274558 and ABCB1 rs2235040 were protective factors to periorbital oedema with OR of 0.313 (95%CI=0.149-0.656, P=0.002 for SLC22A5 rs274558 AA+AG vs GG), and 0.253 (95%CI=0.079-0.805, P=0.020 for ABCB1 rs2235040 CT vs CC). These results indicated that variants in EGFR, SLC22A1, SLC22A5 and ABCB1 influenced the incidence of Imatinib-induced ophthalmological toxicities, and polymorphism analyses in associated genes might be beneficial to optimize Imatinib treatment.

[Efficacy of PVD regimen combined with IMRT for early-stage extranodal nasal NK/T-cell lymphoma]

Objective: To evaluate the efficacy of PVD chemo-regimen (Pegaspargase, vincristine and dexamethasone) combined with intensity-modulated radiotherapy (IMRT) for patients with early-stage extranodal nasal NK/T-cell lymphoma (ENKL). Methods: Clinical data of 52 patients with early-stage ENKL were collected during May 2010 and June 2015 in Department of Lymphoma, Cancer Hospital of Guizhou Medical University, and these patients firstly received a concurrent chemoradiotherapy of two-cycle of PVD and IMRT (gross tumor volume primary: 12.6-59.4 Gy) and then 2 to 4 cycles of PVD as subsequent chemotherapy, the efficacy and adverse responses were retrospectively analyzed and observed. Results: Follow-up stopped until December 2015, complete remission was seen in 44 cases (84.6%) and partial remission 7 cases (13.5%), out of 52 cases. A total of 1 case died of progression disease during treatment and within 1 year after treatment, 1 case died of pulmonary infection within 1 week after treatment, 2 cases survived with tumor; so the objective response rate and clinical benefit rate were both 98.1%, 1-year, 2-year and 3-year overall survival rates and progression free survival rates were all 93.6%, 1-year and 2-year disease free survival rates were both 90.3%; the correlation analysis showed that the radiotherapy dose was related to the curative effect (P<0.05). Short term adverse responses were observed in 6 cases (11.5%) with grade 3 leucocytopenia, in 5 cases (9.6%) with grade 3-4 dyslipidemia and in 2 cases (3.8%) with grade 3 hypoalbuminemia during chemoradiotherapy. All the patients had different degrees of radiation oral mucositis and radiation dermatitis. Conclusion: For early-stage ENKL, a concurrent chemoradiotherapy of PVD regimen and IMRT have a good therapeutic effect and adverse response can be tolerated.

[Bone marrow-derived fibrocytes and thyroid-associated opthalmopathy]

Thyroid-associated opthalmopathy(TAO) is a common autoimmune syndrome affecting the thyroid and orbit, which can result in the fibrosis of extraoular muscles and hyperplasia of adipose tissue. Advanced TAO patients could even lose vision caused by cornea ulcer and congestion of optic nerve from expansion of the extraocular muscles and orbit fat. Currently, there are no therapies shown to prevent it, because its cellular and molecular mechanisms are not clear. Some studies have recently implicated bone marrow-derived fibroblast-like, called fibrocytes are involved in the pathogenesis of TAO. We reviewed and summarized the research advances of TAO and also the relationship between the fibrocytes and pathogenesis of TAO in the paper. (Chin J Ophthalmol, 2017, 53: 470-473).

[The value of DCE-MRI in assessing the course of thyroid associated ophthalmopathy]

Objective: To explore the feasibility of the semi-quantitative rectus extraocular muscle (EOM) parameters of dynamic contrast-enhanced magetic resonance imaging (DCE-MRI) in assessing the clinical course of thyroid associated ophthalmopathy (TAO). Methods: It was a retrospective case series study. A total of 136 cases of TAO were recruited from March 2011 to October 2012 in the Tianjin the first center hospital including 63 males and 72 females, aged 24.0-65.0 years, with an average age of (40.5±10.9) years. Forty healthy volunteers were recruited as control group (CG). According to clinical activity score (CAS), all TAO patients were divided into 2 groups, activity group (AG) and inactivity group (IAG). MRI and DCE-MRI orbit scan were performed in each subject. Drew time-intensity curves (TIC) by Siemens 3.0 MR (syngo) post-processing workstation. The semi-quantitative parameters of DCE-MRI were calculated. The semi-quantitative paramters based on TIC include early enhancement coefficient (EEC), maximum enhancement coefficient (Emax) and wash-out coefficient (WC(5min)). Kruskal-Wallis H rank test was used for comparing signal intensity among 3 groups, and Nemenyi test for pairwise comparison between groups. The DCE-MRI parameters (EEC, Emax, WC(5 min)) among groups were compared by one-way ANOVA, and Bonferroni t test is for pairwise comparison between groups. The diagnostic value of mean EEC, mean Emax, WC(5min) for assessment of the clinical course in TAO was analyzed by ROC curve. Results: There were significant difference in signal intensity (SI) of rectus EOM on T(2)WI among CG, AG and IAG, which is significantly different in 88 cases of AG including 45 cases of high intensity 51.1%, 23 cases of moderate intensity 26.1%, and 20 cases of low intensity 22.7%,compared with CG and IAG. EEC (P<0.05), Emax and WC5min values of rectus EOM of TAO group were significantly lower than those of CG(P<0.05), which values of rectus EOM of TAO active group of EEC are 0.63±0.06、0.61±0.05、0.56±0.09、0.57±0.09, and values of rectus EOM of TAO inactive group of EEC are 0.49±0.05、0.50±0.08、0.57±0.10、0.55±0.09. The values of rectus EOM of TAO active group of Emax are 1.35±0.09、1.28±0.09、1.21±0.17、1.25±0.10, and the values of rectus EOM of TAO inactive group of Emax are 1.04±0.06、1.05±0.10、1.20±0.19、1.16±0.11. The values of rectus EOM of TAO active group of WC(5 min) are 0.13±0.03、0.13±0.03、0.13±0.06、0.13±0.03 and the values of rectus EOM of TAO inactive group of WC5min are 0.08±0.02、0.79±0.03、0.11±0.06、0.09± 0.03. EEC (χ(2)=9.20, P<0.05), Emax and WC(5min) values of rectus EOM of TAO group were significantly lower than those of CG (P<0.05). EEC, Emax and WC(5min) values of medial rectus and inferior rectus EOM of IAG were significantly lower than those of AG(P<0.05). WC(5min) values of superior rectus EOM of IAG were significantly lower than those of AG (P<0.05). There were no differences in EEC and Emax values of lateral rectus and superior rectus EOM between IAG and AG (P>0.05). There were no differences in WC(5min) values of lateral rectus EOM between IAG and AG (P>0.05). The area under the curve (AUC) were 0.771, 0.879, 0.898 for mean EEC, mean Emax, and mean WC(5min), respectively. Conclusion: The semi-quantitative paramters of DCE-MRI can show the clinical activity of TAO patients and can be considered as the quantitative index of TAO activity staging. (Chin J Ophthalmol, 2017, 53: 430-435).

[Research progress regarding the clinical evaluation on recombinant human papillomavirus vaccines]

Human papillomavirus (HPV) is the main cause for cervical cancer, anogenital cancers and genital warts. Three HPV vaccines have been licensed abroad. Data from clinical trials showed high efficacy of the HPV vaccines in young women with 90%-100% vaccine-related HPV diseases prevented. Though efficacy of the vaccine appears lower in older women, this population can still benefit from vaccination. Immunobriging trials show that the two-dose schedule in 9-14 years old girls elicits non-inferior immune response than the three-dose one in young adults. In addition, HPV vaccines can reduce the recurrent rates in CIN2+ patients after therapeutic surgery and the vaccines have cross-protection aganist diseases caused by non-vaccine type HPV. Safety data on HPV vaccines are assuring. Thus HPV vaccine should be widely used in adolescent girls and women of appropriate age groups.

Characterization of retroviral infectivity and superinfection resistance during retrovirus-mediated transduction of mammalian cells

Retroviral vectors including lentiviral vectors are commonly used tools to stably express transgenes or RNA molecules in mammalian cells. Their utilities are roughly divided into two categories, stable overexpression of transgenes and RNA molecules, which requires maximal transduction efficiency, or functional selection with retrovirus (RV)-based libraries, which takes advantage of retroviral superinfection resistance. However, the dynamic features of RV-mediated transduction are not well characterized. Here, we engineered two murine stem cell virus-based retroviral vectors expressing dual fluorescence proteins and antibiotic markers, and analyzed virion production efficiency and virion stability, dynamic infectivity and superinfection resistance in different cell types, and strategies to improve transduction efficiency. We found that the highest virion production occurred between 60 and 72 h after transfection. The stability of the collected virion supernatant decreased by >60% after 3 days in storage. We found that RV infectivity varied drastically in the tested human cancer lines, while low transduction efficiency was partially overcome with increased virus titer, prolonged infection duration and/or repeated infections. Furthermore, we demonstrated that RV receptors PIT1 and PIT2 were lowly expressed in the analyzed cells, and that PIT1 and/or PIT2 overexpression significantly improved transduction efficiency in certain cell lines. Thus, our findings provide resourceful information for the optimal conditions of retroviral-mediated gene delivery.

Controlled-release mitomycin C-polylactic acid film prevents epidural scar hyperplasia after laminectomy by inducing fibroblast autophagy and regulating the expression of miRNAs

OBJECTIVE

To design a new controlled-release MMC-PLA film and explore whether and how this film could prevent epidural scar hyperplasia and adhesion in a post-laminectomy rat model.

MATERIALS AND METHODS

All procedures were performed under the approval and supervision of the Institutional Animal Care and Use Committee (IACUC) of Nanjing Medical University. A total of 120 Sprague-Dawley (SD) rats were randomly placed into four groups after laminectomy (each group=30 rats). In Group I, the laminectomy area was flushed with saline as a control; in Group II, 25 mg of PLA film was applied to the dura mater in the laminectomy area; in Group III, a cotton pad soaked with 0.01% MMC solution was kept on the laminectomy area; and in Group IV, 25 mg of PLA film containing 0.01% MMC was implanted on the laminectomy area. Magnetic resonance imaging (MRI), hematoxylin-eosin (HE) staining and Masson staining were used to evaluate scar adhesion and collagen deposition one month after the operation. Autophagy-related proteins, including autophagy-related gene 5 (ATG5), beclin 1, light chain-3B-2/1 (LC3B-2/1) and protein 53 (p53), were detected by Western blotting. A microRNA microarray analysis was performed to screen for scar tissue miRNAs, especially those associated with autophagy, and changes in expression were confirmed by reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

A total of 112 rats recovered uneventfully from the surgery. MRI showed that the scar adhesion and scar area of the MMC-PLA group were significantly reduced compared with those of the PLA, MMC, and saline groups. Accordingly, scar adhesion and the deposition of collagen in the rats treated with MMC-PLA were also significantly reduced, as indicated by HE and Masson staining. In the scar tissue, the levels of autophagy-related proteins (ATG5, beclin 1, LC3B-2/1 and p53) were significantly elevated in the MMC-PLA group. Additionally, in the MMC-PLA group, the expression levels of miR-34a, miR-146a and miR-200 were significantly increased, while the levels of miR-16, miR-221 and miR-378a were significantly decreased.

CONCLUSIONS

The controlled-release MMC-PLA film could alleviate epidural scar hyperplasia after laminectomy; this outcome might be associated with increased autophagy and altered expression of miRNAs in the scar tissue.

MRI-Based Texture Analysis to Differentiate Sinonasal Squamous Cell Carcinoma from Inverted Papilloma

BACKGROUND AND PURPOSE

Because sinonasal inverted papilloma can harbor squamous cell carcinoma, differentiating these tumors is relevant. The objectives of this study were to determine whether MR imaging-based texture analysis can accurately classify cases of noncoexistent squamous cell carcinoma and inverted papilloma and to compare this classification performance with neuroradiologists' review.

MATERIALS AND METHODS

Adult patients who had inverted papilloma or squamous cell carcinoma resected were eligible (coexistent inverted papilloma and squamous cell carcinoma were excluded). Inclusion required tumor size of >1.5 cm and preoperative MR imaging with axial T1, axial T2, and axial T1 postcontrast sequences. Five well-established texture analysis algorithms were applied to an ROI from the largest tumor cross-section. For a training dataset, machine-learning algorithms were used to identify the most accurate model, and performance was also evaluated in a validation dataset. On the basis of 3 separate blinded reviews of the ROI, isolated tumor, and entire images, 2 neuroradiologists predicted tumor type in consensus.

RESULTS

The inverted papilloma (n = 24) and squamous cell carcinoma (n = 22) cohorts were matched for age and sex, while squamous cell carcinoma tumor volume was larger (P = .001). The best classification model achieved similar accuracies for training (17 squamous cell carcinomas, 16 inverted papillomas) and validation (7 squamous cell carcinomas, 6 inverted papillomas) datasets of 90.9% and 84.6%, respectively (P = .537). For the combined training and validation cohorts, the machine-learning accuracy (89.1%) was better than that of the neuroradiologists' ROI review (56.5%, P = .0004) but not significantly different from the neuroradiologists' review of the tumors (73.9%, P = .060) or entire images (87.0%, P = .748).

CONCLUSIONS

MR imaging-based texture analysis has the potential to differentiate squamous cell carcinoma from inverted papilloma and may, in the future, provide incremental information to the neuroradiologist.

The influence of a low air pressure environment on human metabolic rate during short-term (< 2 h) exposures

Passengers in aircraft cabins are exposed to low-pressure environments. One of the missing links in the research on thermal comfort under cabin conditions is the influence of low air pressure on the metabolic rate. In this research, we simulated the cabin pressure regime in a chamber in which the pressure level could be controlled. Three pressure levels (101/85/70 kPa) were tested to investigate how metabolic rate changed at different pressure levels. The results show that as pressure decreased, the respiratory flow rate (RFR) at standard condition (STPD: 0°C, 101 kPa) significantly decreased. Yet the oxygen (O₂ ) consumption and carbon dioxide (CO₂ ) production significantly increased, as reflected in the larger concentration difference between inhaled and exhaled air. A significant increase in the respiratory quotient (RQ) was also observed. For metabolic rate, no significant increase (P > 0.05) was detected when pressure decreased from 101 kPa to 85 kPa; however, the increase associated with a pressure decrease from 85 kPa to 70kPa was significant (P < 0.05). Empirical equations describing the above parameters are provided, which can be helpful for thermal comfort assessment in short-haul flights.

Quasiparticle Scattering off Defects and Possible Bound States in Charge-Ordered YBa_{2}Cu_{3}O_{y}

We report the NMR observation of a skewed distribution of ^{17}O Knight shifts when a magnetic field quenches superconductivity and induces long-range charge-density-wave (CDW) order in YBa_{2}Cu_{3}O_{y}. This distribution is explained by an inhomogeneous pattern of the local density of states N(E_{F}) arising from quasiparticle scattering off, yet unidentified, defects in the CDW state. We argue that the effect is most likely related to the formation of quasiparticle bound states, as is known to occur, under specific circumstances, in some metals and superconductors (but not in the CDW state, in general, except for very few cases in 1D materials). These observations should provide insight into the microscopic nature of the CDW, especially regarding the reconstructed band structure and the sensitivity to disorder.

Passenger thermal comfort and behavior: a field investigation in commercial aircraft cabins

Passengers' behavioral adjustments warrant greater attention in thermal comfort research in aircraft cabins. Thus, a field investigation on 10 commercial aircrafts was conducted. Environment measurements were made and a questionnaire survey was performed. In the questionnaire, passengers were asked to evaluate their thermal comfort and record their adjustments regarding the usage of blankets and ventilation nozzles. The results indicate that behavioral adjustments in the cabin and the use of blankets or nozzle adjustments were employed by 2/3 of the passengers. However, the thermal comfort evaluations by these passengers were not as good as the evaluations by passengers who did not perform any adjustments. Possible causes such as differences in metabolic rate, clothing insulation and radiation asymmetry are discussed. The individual difference seems to be the most probable contributor, suggesting possibly that passengers who made adjustments had a narrower acceptance threshold or a higher expectancy regarding the cabin environment. Local thermal comfort was closely related to the adjustments and significantly influenced overall thermal comfort. Frequent flying was associated with lower ratings for the cabin environment.

The CD4+ T-lymphocyte count is an important predictor for the prognosis of cryptococcosis

There is great heterogeneity of immunity among patients with cryptococcosis, and severe immunodeficiency can lead to negative clinical outcomes. Underlying disease is a poor surrogate for immune status and inferior in predicting an individual’s prognosis. This study was intended to determine whether T-lymphocyte subgroups would be more suitable indicators regarding the severity of infection and clinical outcomes of such patients. We retrieved clinical data on 101 patients with cryptococcosis and compared the validity of multiple parameters (underlying disease and T-lymphocyte subgroups) in predicting the severity of infection and clinical outcome in these patients. For patients with CD4⁺ T-lymphocyte counts lower than 400/μL, the odds ratio of disseminated cryptococcosis was 23.3 (P = 0.005). There was a moderate negative correlation between CD4⁺ T-cell count and Apache II score (−0.609, P < 0.001). Mortality among patients with low levels of CD4⁺ T lymphocytes was significantly higher than among those with normal levels (23.8% vs 5.3%, P = 0.016). However, the difference was not significant if the patients were grouped by underlying disease (P = 0.067). The CD4⁺ T-lymphocyte count in peripheral blood is a simple and more accurate biomarker for predicting severity of infection and clinical outcome in patients with cryptococcosis.

The associations of TERT-CLPTM1L variants and TERT mRNA expression with the prognosis of early stage non-small cell lung cancer

Lung cancer is the leading cause of cancer-related death in the world. Several genome-wide association studies (GWAS) have identified TERT-CLPTM1L as plausible causative locus for lung cancer development. This study aimed to investigate the associations of genetic variations in TERT-CLPTM1L and the expression level of TERT with the survival of early stage non-small cell lung cancer (NSCLC) patients. We selected three single-nucleotide polymorphisms of TERT-CLPTM1L (rs2853669, rs2736108 and rs31490) and genotyped in 140 early stage NSCLC patients by TaqMan assay. Associations between these variations and survival outcome of early stage NSCLC patients were further investigated. We also used TCGA data to evaluate the associations of TERT messenger RNA (mRNA) expression and survival outcome of early stage NSCLC patients. Survival analysis showed that, compared with early NSCLC patients carrying TERT rs2853669 TT+TC genotypes, patients with rs2853669 CC genotype had significantly longer median survival time (MST=102.2 vs 52.4 months; log-rank P=0.028) and lower death risk [hazard ratio (HR) with 95% confidence interval (CI))=0.38(0.17-0.82), P=0.014]. Early NSCLC patients carrying TERT rs2736108 AA genotype had significantly shorter MST (MST=29.0 vs 63.3 months; log-rank P=0.020) and increased death risk [HR (95% CI)=2.22(1.01-5.80), P=0.046], when compared with patients carrying rs2736108 GG genotypes. TCGA data revealed that early NSCLC patients with higher expression level of TERT mRNA in lung tumor tissues had a longer MST and decreased death risk than those with low expression level of TERT mRNA [MST=54.4 vs 49.0 months; log-rank P=0.041; adjusted HR (95% CI)=0.68(0.50-0.94)]. These findings may add potential evidence to understand the prognostic value of TERT and provide a new prospect of individualized prevention and treatment for early stage NSCLC.