Reduction in surgical stoma rates in Crohn's disease: a population-based time trend analysis

AIM

Trends in surgical rates for Crohn's disease (CD) in the biological era are controversial. We aim to assess modern trends in the formation rates of surgical stomas.

METHOD

Population-based surveillance in the Calgary Health Zone (CHZ), Canada, was conducted between 1 April 2002 and 31 March 2011, using the Discharge Abstract Database to identify adult patients with CD admitted to hospital and treated with surgical stoma formation (n = 545). Annual stoma incidence was calculated by dividing the number of incident stomas by the prevalence of CD in the CHZ. Time trend analysis of the stoma-formation rate was performed, expressed as annual percentage change (APC) with 95% CI. Stoma-formation rates were stratified according to procedure (emergency vs elective) and duration of stoma [temporary (reversed within 2 years of formation) vs permanent].

RESULTS

The overall rate of stoma formation between 2002 and 2011 showed a downwards trend, of a mean of 5.2% (95% CI: -8.5 to -1.8) per year, from a rate of 2.30 stomas/100 person-years (PY) in 2002 to 1.51 stomas/100 PY in 2011. The rate of emergency stoma formation decreased significantly from 2002 to 2011 (mean APC = -9.4%; 95% CI: -15.6 to -2.8), while the rate of elective ostomies essentially showed no change (mean APC = -0.9%; 95% CI: -5.3 to 3.8). The rate of temporary stoma formation decreased significantly, by 4.6% (95% CI: -7.3 to -1.8) per year, while permanent stoma formation was stable (APC = 1.0%; 95% CI: -4.0 to +6.3).

CONCLUSION

A reduction in the overall rate of stoma formation in CD has been driven by fewer emergency stomas, although rates of permanent stoma have remained stable.

MR-based cardiac and respiratory motion correction of PET: application to static and dynamic cardiac 18F-FDG imaging

Motion of the myocardium deteriorates the quality and quantitative accuracy of cardiac PET images. We present a method for MR-based cardiac and respiratory motion correction of cardiac PET data and evaluate its impact on estimation of activity and kinetic parameters in human subjects. Three healthy subjects underwent simultaneous dynamic ¹⁸F-FDG PET and MRI on a hybrid PET/MR scanner. A cardiorespiratory motion field was determined for each subject using navigator, tagging and golden-angle radial MR acquisitions. Acquired coincidence events were binned into cardiac and respiratory phases using electrocardiogram and list mode-driven signals, respectively. Dynamic PET images were reconstructed with MR-based motion correction (MC) and without motion correction (NMC). Parametric images of ¹⁸F-FDG consumption rates (K_i) were estimated using Patlak's method for both MC and NMC images. MC alleviated motion artifacts in PET images, resulting in improved spatial resolution, improved recovery of activity in the myocardium wall and reduced spillover from the myocardium to the left ventricle cavity. Significantly higher myocardium contrast-to-noise ratio and lower apparent wall thickness were obtained in MC versus NMC images. Likewise, parametric images of K_i calculated with MC data had improved spatial resolution as compared to those obtained with NMC. Consistent with an increase in reconstructed activity concentration in the frames used during kinetic analyses, MC led to the estimation of higher K_i values almost everywhere in the myocardium, with up to 18% increase (mean across subjects) in the septum as compared to NMC. This study shows that MR-based motion correction of cardiac PET results in improved image quality that can benefit both static and dynamic studies.

Limited effects of the comprehensive pricing healthcare reform in China

OBJECTIVES

To evaluate the effects of China's very recent comprehensive pricing healthcare reform, taking the patients' perspective.

STUDY DESIGN

Two survey studies were conducted using the same protocol in Beijing in July 2017 and 2018, respectively.

METHODS

The same questionnaire was used and contains two sections, with the first on demographic and personal information and the second on various assessments of the reform.

RESULTS

Findings different from those in the government-led evaluations were made. Specifically, the majority of the patients thought the level of medical service fee and cost of medicine still high, and experienced no change or an increase in overall medical cost. The overall assessment of the reform was not sufficiently positive. Multiple problems in healthcare were identified. Development from 2017 to 2018 was not significantly positive.

CONCLUSIONS

Patients' assessments of the reform were not as positive as those made in the government-led evaluations. In extending the reform to the whole country, the government and healthcare providers may need to further tune the reform to better serve the public.

Body mass index cut-off points for predicting chronic non-communicable disease should differ by gender and age group

OBJECTIVES

The objective of this study to determine whether body mass index (BMI) in different genders and age groups need different thresholds when predicting chronic non-communicable diseases (CNCDs).

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data were obtained from the China Health and Nutrition Survey conducted in 2009. Sequential sample cluster analysis was used to group age according to BMI. Propensity score matching was used to eliminate the influence of age. Receiver operating characteristic curve based on gender and age group was used to evaluate the cut-off values and efficiency of BMI in each group.

RESULTS

A total of 8469 individuals were enrolled in this study. Results of sequential sample cluster analyses showed age was divided into three groups: 18-39, 40-59 and 60-99 years. There were significant differences in the distribution of BMI among the three groups for both males and females (P < 0.001). Statistical differences were observed in the distribution of BMI between genders in the 18-39- and 60-99-year-old age groups (P < 0.001). For men, the cut-off values of BMI were ≥25 kg/m², ≥24 kg/m² and ≥23 kg/m² in the 18-39, 40-59 and 60-99 years old groups, respectively; for women, the corresponding cut-off points were ≥25 kg/m², ≥23 kg/m² and ≥25 kg/m² in groups.

CONCLUSIONS

The thresholds for BMI might be different between gender and age group. In addition, it might not be suitable to determine cut-off values of BMI to predict CNCDs for people aged ≥60 years.

The molecular structure and imprinting status of the IPW (imprinted gene in the Prader-Willi syndrome region) gene in cattle

IPW (imprinted gene in the Prader-Willi syndrome region), a long non-coding RNA, is a paternally expressed gene in the PWS/AS imprinted domain on human chromosome 15 and mouse chromosome 7. Disruption of the PWS/AS region is associated with three neurogenic disorders in humans. In this study, we identified the bovine homolog of the IPW gene; multiple transcripts obtained by RT-PCR and RACE showed a complex and tissue-specific expression pattern of IPW in the brain, heart, kidney, liver, lung, spleen and skeletal muscle. An informative single nucleotide polymorphism (rs133341090) in the long exon H was identified by sequencing the genomic DNA, and mono-allelic expression of IPW was confirmed by sequencing the cDNAs of heterozygous individuals, indicating that IPW may be imprinted in cattle. The protein-coding potential of IPW transcripts was assessed using coding potential calculator (cpc) software, which showed a negative score. In addition, sequencing analysis also indicated multiple small open reading frames in the bovine IPW transcript, but none of the ATGs was consistent with Kozak consensus. Taken together, the IPW transcripts are most likely long non-coding RNAs.

Gut microbiota of newborn piglets with intrauterine growth restriction have lower diversity and different taxonomic abundances

Aim

Intrauterine growth retardation (IUGR) is a prevalent problem in mammals. The present study was conducted to unveil the alterations in intestinal microbiota in IUGR piglets.

Methods and Results

We identified the alterations of small intestinal microbiota in IUGR piglets on 7, 21 and 28 days of age using 16S rRNA sequencing. The results showed that IUGR piglets had a decreased alpha diversity of jejunum microbiota at 7 and 21 days of age; had lower abundances of Bacteroidetes and Bacteroides in the jejunum at 7, 21 and 28 days of age, Oscillibacter in the jejunum at 21 days of age, and Firmicutes in the ileum at 21 days of age; whereas they had higher abundances of Proteobacteria and Pasteurella in the ileum at 21 days of age and Escherichia–Shigella in the jejunum at 28 days of age. Correlation analysis showed that Bacteroides, Oscillibacter and Ruminococcaceae_UCG‐002 compositions were positively associated with the body weight (BW) of IUGR piglets, nevertheless Proteobacteria and Escherichia–Shigella relative abundances were negatively correlated with the BW of IUGR piglets. Gene function prediction analysis indicated that microbiota‐associated carbohydrate metabolism, lipid metabolism, glycan biosynthesis and metabolism, amino acid metabolism, and xenobiotics biodegradation and metabolism were downregulated in the IUGR piglets compared to control piglets.

Conclusions

The present study profiled the intestinal microbiota of newborn piglets with IUGR and the newborn IUGR piglets have lower diversity and different taxonomic abundances. Alterations in the abundances of Bacteroidetes, Bacteroides, Proteobacteria Escherichia–Shigella and Pasteurella may be involved in nutrient digestion and absorption, as well as the potential mechanisms connecting to the growth and development of IUGR in mammals.

Significance and Impact of the Study

The small intestinal microbiota were highly shaped in the IUGR piglets, which might further mediate the growth and development of IUGR piglets; and the gut microbiota could serve as a potential target for IUGR treatment.

MicroRNA-24 attenuates vascular remodeling in diabetic rats through PI3K/Akt signaling pathway

BACKGROUND AND AIMS

The vascular remodeling plays a crucial role in pathogenesis of diabetic cardiovascular complications. In this study, we intended to explore the effects and potential mechanisms of microRNA-24 (miR-24) on vascular remodeling under diabetic conditions.

METHODS AND RESULTS

MiR-24 recombinant adenovirus (Ad-miR-24-GFP) was used to induce miR-24 overexpression either in carotid arteries or high glucose (HG)-induced vascular smooth muscle cells (VSMCs). Cell proliferation was analyzed using CCK-8 method. Cell migration was examined using wound-healing and transwell assay. mRNA and protein expressions of critical factors were, respectively, measured by real-time PCR and western blot as follows: qRT-PCR for the levels of miR-24, PIK3R1; western blot for the protein levels of PI3K (p85α), Akt, p-Akt, mTOR, p-mTOR, 4E-BP1, p-4E-BP1, p70s6k, p-p70s6k, MMP 2, MMP 9, collagen Ⅰ, as well as collagen Ⅲ. Carotid arteries in diabetic rats suffered balloon injury were harvested and examined by HE, immunohistochemical and Masson trichrome staining. The expression of miR-24 was decreased in HG-stimulated VSMCs and balloon-injured carotid arteries of diabetic rats, accompanied by increased mRNA expression of PIK3R1. The up-regulation of miR-24 suppressed VSMCs proliferation, migration, collagen deposition not only induced by HG in vitro, but also in balloon-injured diabetic rats, which were related to inactivation of PI3K/Akt signaling pathway.

CONCLUSION

The up-regulation of miR-24 significantly attenuated vascular remodeling both in balloon-injured diabetic rats and HG-stimulated VSMCs via suppression of proliferation, migration and collagen deposition by acting on PIK3R1 gene that modulated the PI3K/Akt/mTOR axes.

Prevalence of underweight and overweight among young adolescents aged 12-15 years in 58 low-income and middle-income countries

BACKGROUND

The co-existence of underweight and overweight is a great challenge for public health in low-income and middle-income countries (LMICs).

OBJECTIVES

The objective of the study is to report the prevalence of underweight, overweight and obesity among young adolescents in 58 LMICs.

METHODS

Data were from the Global School-based Student Health Survey (2007-2013) in 57 LMICs and from the Chinese National Surveys on Students' Constitution and Health (2010). A total of 177 325 young adolescents aged 12-15 years from 58 LMICs were included. Weight status was defined based on both the updated International Obesity Task Force (IOTF) and World Health Organization (WHO) criteria.

RESULTS

Based on the IOTF/WHO criteria, the overall prevalence of weight categories among young adolescents in LMICs was 13.4%/4.7% for underweight, 15.4%/17.3% for overweight and 5.6%/8.6% for obesity. However, the prevalence varied largely across countries and regions. Based on the IOTF criteria, the prevalence of underweight ranged from 0.0% in Niue to 48.8% in Sri Lanka and obesity ranged from 0.1% in Vanuatu to 35.0% in Niue; a prevalence exceeding 10.0% for both underweight and excess weight (overweight and obesity combined) was found in 29.3% of these countries. Underweight was more prevalent in Southeast Asia and Africa, while obesity was more frequent in Central and South Americas. There were no age and sex differences in the prevalence of weight categories for most countries.

CONCLUSIONS

Our data confirm the continued dual burden of underweight and overweight in young adolescents in many LMICs and the need for policy and programmes to address both conditions.

Abstract P4-04-02: Identifying ERBB-2 activating mutations (mts) in HER2 negative tumors for clinical trials – Impact of institute-wide genomic testing and trial matching on trial enrollment in clinical practice

Introduction

Tailored treatment trials with biomarker-driven hypotheses are becoming an important strategy in drug development. Umbrella, basket and enrichment trials with eligibility predicated upon results of tumor sequencing are increasingly common. Several institutional and commercial genomic assays have been developed. However, the value of broad-based testing in recruiting patients (pts) to molecular-based clinical trials designed for small subgroups has not been fully evaluated and has been challenging to assess in a real-world setting. We evaluated the likelihood of trial enrollment based upon an institute-wide genomic test.

Methods

Since 2013, all pts with metastatic breast cancer (MBC) seen at least once at Dana-Farber Cancer Institute have been offered the option of tumor sequencing using multiplexed copy number variation (CNV) and mts detection across the full coding regions of a total of 447 cancer genes and 191 regions across 60 genes for rearrangement detection (Oncopanel; OP). For our primary analysis, we selected the ongoing multi-center phase II trial (NCT01670877) activated at our site on Sep 30, 2013, evaluating neratinib in ERBB-2 mutated pts, as the study provided a clear delineation of eligible mts, and timing of slot availability was retrievable retrospectively over an extended time frame. Our primary aim was to describe the proportion of pts with a qualifying ERBB-2 mt detected by OP who enrolled on the selected trial. Secondary objectives included median time from OP result to trial registration and description of ERBB-2 mts spectrum within each subtype. Associations were calculated by Fisher's test.

Results

We identified a total of 1,046 pts with HER-2 negative MBC and who had OP results between Sep 1, 2013 and Jun 1, 2017. A total of 43 pts (4.1%) were found to have ERBB-2 mts. Of these, 20 (1.9%) had activating eligible mts. The proportion of these pts who enrolled in the trial was 30% (6/20). Of the remaining 14 pts, 5 screen-failed and 2 were enrolled with known ERBB-2 mt through other testing modalities. Seven of 20 (35%) molecularly eligible pts were not approached (3 pts lost to follow-up, 3 enrolled in other clinical trials and 1 pt chose standard treatment). The median time from OP result to trial enrollment was 85 days (34-554). A significantly higher frequency of ERBB2 activating mts was found in ER+ compared to ER- primary tumors (2.5% vs. 0.3%, p =0.036), and in lobular tumors compared with ductal (5.5% vs. 1.25%, p=0.003). Frequency of eligible mts in primary tumors were similar to metastatic site (1.9% and 1.8%, respectively p=1.0)

Discussion

In this cohort, activating ERBB-2 mts were present in 20 of 1046 (1.9%) pts tested. Although over half of pts with eligible mts on OP testing were approached for NCT01670877, only 0.5% of the total tested population were enrolled (6/1046). Our data illustrate the substantial challenges in screening and enrolling to trials of rare subsets, even within a large academic institution, and point to the need for creative and novel approaches to leverage pts and community- and academic-based providers to more effectively support the success of such studies.

Citation Format: Exman P, Garrido-Castro A, Hughes ME, Freedman RA, Ma C, Bose R, Cerami E, Wagle N, Barroso-Sousa R, Fitz CD, Lindeman NI, MacConaill L, Bychkovsky BL, Lloyd MR, Mackichan CR, Kumari P, Tolaney SM, Krop IE, Winer EP, Dillon DA, Lin NU. Identifying ERBB-2 activating mutations (mts) in HER2 negative tumors for clinical trials – Impact of institute-wide genomic testing and trial matching on trial enrollment in clinical practice [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-04-02.

Abstract OT1-01-05: Endocrine treatment alone as primary treatment for elderly patients with estrogen receptor positive good prognosis operable breast cancer: A single arm phase II, single institution study

Background: It is estimated that approximately 46,000 women age &gt;75 are diagnosed annually with breast cancer. Due to competing co-morbidities, there is wide variation in treatment recommendations which can lead to over- or under-treatment. Though surgery for breast cancer is considered low-morbidity, many elderly women given a choice, choose not to have surgery. Previous randomized trials comparing surgery with tamoxifen versus endocrine therapy alone in women age &gt;70 unselected for ER status demonstrated similar overall survival with poorer local control in the latter group. A new standard of care needs to be defined for elderly women with good prognosis ER+ tumors, since these women may benefit from endocrine therapy alone to treat their cancer without compromising local and distant control.

Hypothesis: We hypothesize that endocrine therapy alone provides adequate local and systemic control of breast cancer in a subpopulation of women age 70 or older with ER+ breast cancer and good prognostic characteristics.

Primary Objective

To correlate response to neoadjuvant endocrine treatment at 6 months with Oncotype DX Recurrence Score (RS) in women with early-stage ER+ breast cancer who are age &gt;70.

Secondary Objective

1. To determine the breast cancer-specific survival of women with early-stage ER+ breast cancer, age &gt;70, treated with endocrine therapy alone.

2. To determine the rate of overall survival of women with early-stage ER+ breast cancer, age &gt;70 treated with endocrine therapy alone.

Study Design: This is a prospective single arm phase II study. Patients with clinical stage I/II ER+ breast cancer, grade 1-2, Ki67&lt;30 or RS &lt;18 (performed on the diagnostic core biopsy) continue to be enrolled and followed for time to progression. A Kaplan-Meier model will be used to estimate the 5-year local progression rate. If the true 5-year progression rate is 10%, then 50 patients will provide power = .90 at a one-sided .05 significance level to demonstrate that the rate is less than 25.5%. Exploratory objectives include: evaluation of the molecular characteristics of breast cancers of responders versus non-responders, determine compliance with medications, evaluate cost-effectiveness, and quality of life.

Results: Between February 2017 and April 2018, 11 patients were enrolled into the study. Two patients could not tolerate endocrine therapy and received standard of care treatment. For the 9 patients on study, average tumor size was 1.7cm, average Ki67 was 15%, average RS was 14. All of the patients received an aromatase inhibitor. At 6 months, 71% of the patients had a partial response, 28% had stable disease. None of the patients developed progressive disease.

Conclusion: A new standard of care needs to be defined for women age &gt;70 with good prognosis ER+ tumors, since these women may benefit from endocrine therapy alone to treat their cancer without compromising local and distant control. We continue to enroll patients to determine the optimal tumor markers for identifying women who can be treated with PET only to control their cancer.

Citation Format: Aft R, Cherian M, Frith A, Suresh R, Glover-Collins K, Naughton M, Moon C, Conant L, Ma C. Endocrine treatment alone as primary treatment for elderly patients with estrogen receptor positive good prognosis operable breast cancer: A single arm phase II, single institution study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-01-05.

Abstract PD6-02: A randomized, controlled trial of high dose vs. standard dose vitamin D for aromatase inhibitor-induced arthralgia in breast cancer survivors

Background: Approximately half of women on aromatase inihbitor (AI) therapy develop AI-induced arthralgia (AIA), and many discontinue the medication because of this common side effect. While Vitamin D has been studied as a treatment for AIA, trial results have been conflicting thus far.

Patients and Methods: All subjects were post menopausal women who were beginning adjuvant AI therapy for stage I-III hormone receptor positive breast cancer. Patients were randomized 1:1 to receive standard dose vitamin D3 (800 IU daily for 52 weeks) or high dose vitamin D3 (50,000 IU weekly for 12 weeks, followed by 2000 IU daily for 40 weeks). All patients also took oral calcium 600 mg daily. The primary endpoint was development of AIA, as defined by pre-specified changes in the Health Assessment Questionnaire II (HAQ-II). Secondary endpoints include compliance with AI therapy, and correlation between grip strength and development of AIA. Exploratory endpoint was measurement of inflammatory cytokine reduction in each arm. The trial was designed to enroll 184 patients, but this futility analysis was performed after 93 patients were enrolled. The futility boundary for stopping the trial early was calculated as p = 0.47.

Results: All 93 patients (46 in the high dose arm, and 47 in the standard dose arm) enrolled in the study at the time of the interim analysis were evaluable. The HAQ-II was completed at 12 weeks in 76% on the high dose arm, and 68% in the standard dose arm. Subjects who did not complete the questionnaire were deemed as study failures (i.e. development of AIA was assumed). In the high dose arm, 25 patients (54%) developed AIA, compared to 27 patients (57%) in the standard dose arm. The one-tailed p value is 0.3818, and the Z-score is 0.3, yielding only a 38% conditional power that that study would find a significant difference between the two arms. Thus, the study was terminated early for futility. There was no significant difference between the two arms in adherence to AI therapy. The grip strength and inflammatory cytokine data are pending at this time. They will be ready by the time of the conference.

Conclusions: There was no significant signal for benefit of high dose vitamin D supplementation, as compared to standard dose vitamin D, for AIA prevention in post menopausal women taking adjuvant AI therapy. These results further characterize the role of Vitamin D in AIA, and they inform future clinical trials in this arena. Further research is necessary, as this remains an important cause of non-adherence to this highly effective therapy.

Citation Format: Niravath P, Wang T, Hilsenbeck SG, Lipscomb K, Pavlick A, Jiralerspong S, Nangia J, Ellis M, Ademuyiwa F, Cherian M, Frith A, Ma C, Park H, Rigden C, Suresh R, Osborne CK, Rimawi MF. A randomized, controlled trial of high dose vs. standard dose vitamin D for aromatase inhibitor-induced arthralgia in breast cancer survivors [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 PD6-02.

Abstract P3-10-18: Elucidating the role of functional signal transduction pathway activity in sensitivity and response of triple negative breast cancer to PI3K inhibition

Introduction

The PI3K signaling pathway is frequently active in triple negative breast cancer (TNBC), but response to PI3K inhibition is still poorly understood. To gain insights in therapy response and resistance, it is important not only to assess genetic alterations of these tumors, but also their phenotypic characteristics. Furthermore, not only is the functional status of the PI3K pathway important to know, but also other signal transduction pathways that may drive tumor growth, as they may explain primary or acquired therapy resistance.

Material & Method

We analyzed 17 patient derived xenograft (PDX) models of TNBC with varying response to buparlisib treatment. Long-term response (˜30 days) was assessed by comparing growth rates between buparlisib and vehicle treated PDXs. For characterization, mRNA expression analysis was performed on tumor material post 3 days of vehicle or buparlisib treatment of each PDX model. Functional pathway activity was determined using computational Bayesian networks that look at mRNA levels of pathway target genes resulting from activation (Verhaegh et al, Cancer Res 2014), amongst others for the FOXO-PI3K (van Ooijen et al, Am J Pathol, in press), ER, AR, Hedgehog, TGFbeta and Wnt pathways. These computational networks were calibrated on samples with known pathway activity, and biologically validated on various healthy and diseased cell and tissue types.

Results

On an initial set of 6 PDX models, pathway activity clearly varied between different TNBC PDXs, and between vehicle and buparlisib treatment. ER pathway activity was low in all samples, as expected in TNBC. Two PDX models with the most growth reduction by buparlisib showed high PI3K activity, of which one based on low FOXO activity and the other on oxidative stress. The former, best responding PDX showed a clear reduction in PI3K activity (restoring FOXO activity), when comparing 3 days buparlisib to vehicle treatment. Of the two PDX models with least growth reduction, one had low PI3K activity, while the other one, carrying a PIK3CA mutation, did show high PI3K activity (low FOXO), but this remained after treatment.

Other differences in pathway activity that were found, included slightly elevated AR and Wnt activity in one PDX with good response, and somewhat higher TGFbeta activity in four PDXs (good, medium and poor response). Analysis of the remaining 11 PDXs is ongoing, including other signal transduction pathways, to investigate the variation in pathway activity across the entire panel and to shed more light on the differences in tumor biology between the PDX models.

Conclusion

Our computational Bayesian networks measured differences in functional activity of signal transduction pathways across a collection of TNBC PDX models, which may be expected due to the large variation between TNBC tumors. Functional PI3K activity was related to growth inhibition by buparlisib treatment, and reduction of PI3K pathway activity was observed upon treatment in responding PDX models. Other pathways also showed variation across PDXs. Further clinical evaluation of our signal transduction pathway activity measurement is ongoing. RT-qPCR based analysis is available, optimized for FFPE tissue and small samples.

Citation Format: Guo Z, Verhaegh W, Hoog J, Rajput S, van Strijp D, van de Stolpe A, Li S, Ma C. Elucidating the role of functional signal transduction pathway activity in sensitivity and response of triple negative breast cancer to PI3K inhibition [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-10-18.

[Histocompatibility of an original Chinese-made mid-urethral sling in a rabbit model]

Objective: To evaluate the histocompatibility of an original Chinese-made mid-urethral sling (Repelvica mid-urethral sling). Methods: In total 10 female New Zealand white rabbits were implanted with Repelvica mid-urethral sling or tension-free vaginal tape-obturator tape (TVT-O; Gynecare). Both brands of sling were implanted under deep fascia of the abdominal wall and in the space between vagina and bladder. All animal groups were sacrificed at set time intervals (4 weeks and 12 weeks), and the abdominal and vaginal slings were harvested for histological evaluation. Results: All slings appeared to be well incorporated into the abdominal wall and anterior vaginal wall. All specimens showed a thin, loose, fibrous interface between the synthetic graft and abdominal wall or vaginal wall, along with mild inflammatory reaction from 4 weeks to 12 weeks. Abdominal grafts of Repelvica mid-urethral sling and TVT-O induced comparable tissue reaction (histological score 10.5 versus 10.5 at 4 weeks, 10.0 versus 9.5 at 12 weeks; both P>0.05). Vaginal grafts of Repelvica mid-urethral sling had lower histological score than TVT-O (histological score 6.0 versus 12.0 at 4 weeks, 8.5 versus 12.5 at 12 weeks), however the differences were not statistically significant (both P>0.05). Conclusions: Chinese-made Repelvica mid-urethral sling exhibits good histocompatibility. Vaginal graft of Repelvica mid-urethral sling evoks minor tissue reaction, which could be attributed to its lightweighted property and favored its clinical application.

A new hope: the immunotherapy in small cell lung cancer

Small cell lung cancer (SCLC) is of a high-grade malignancy with a high metastatic potential and poor clinical prognosis. Unfortunately, SCLC initially exhibits a good response to chemotherapy and radiation therapy, but inevitably, relapses decrease patients' chance of survival. Despite tremendous advances on the development of new chemotherapeutic agents, the prognosis of this disease remains poor. Immunotherapy plays a role in eliciting an anticancer response by modulating the patient's immune response of the tumor. Several studies have demonstrated that abnormal autoimmune regulation has a close relationship with SCLC. Thus, several immunotherapy trials are focused on SCLC treatment, including such approaches as immune checkpoints blockers, tumor vaccine, antigenic targets and adoptive cellular immunotherapy to benefit patients with SCLC. To date, the results from immunotherapy in SCLC have not been promising. For example, tumor vaccines have not been demonstrated to have a significant survival benefit. However, there have been many promising advances with immune checkpoints blockers. This review will provide a general overview of immunotherapy in SCLC. The landmark clinical trials in previous successful immunotherapy studies are summarized here. Finally, the challenges of immunotherapy in SCLC are discussed to facilitate the prediction of possible and valuable strategies for future therapy.