[Evaluation of endometriosis fertility index in follow-up treatment of endometriosis combined with infertility patients after laparoscopic surgery]

Objective: To explore the application of endometriosis fertility index (EFI) in guidance after laparoscopic surgery of endometriosis patients combined with infertility and to explore methods to improve pregnancy rate in different EFI groups. Methods: A prospective research was done in endometriosis patients combined with infertility in Beijing Obstetrics and Gynecology Hospital from January 2010 to June 2011, after laparoscopic surgery, these 146 patients were divided into 3 groups by EFI score. Using different pregnancy guidance, these patients had 5 years follow-up. Results: (1) The 5 years overall pregnancy rate was 89.0% (130/146). The pregnancy rate was 95.7% (45/47) in EFI≥9 group, 92.8% (77/83) in EFI 5-8 group and 8/16 in EFI≤4 group, three groups were all reach satisfactory pregnancy rate; the rate of the first two groups had no statistically significance (P=0.498), but had significant difference with the last group (P<0.01). (2) In EFI≥5 patients, pregnancy rate was the highest in 6 months after operation; in EFI≥9 group, the pregnancy rate was 66.7% (30/45), and EFI 5-8 group was 50.6% (39/77). (3) EFI≥9 group had the highest natural pregnancy rate [83.6% (46/55)], natural pregnancy rate was significant statistical different in different EFI groups (P=0.001). Conclusions: EFI score is a useful evaluation in predicting and guiding pregnancy in endometriosis patients combined with infertility after laparoscopic surgery. EFI score guidance, strict post-operation management and positive pregnancy scheme could significantly improve the pregnancy rate of endometriosis patients with infertility.

[Effects and related mechanism of bivalirudin on the survival of random skin flap on the back of rat]

Objective: To investigate the effects and related mechanism of bivalirudin on the survival of random skin flap on the back of rat. Methods: Thirty SD rats were divided into bivalirudin group and normal saline group according to the random number table, with 15 rats in each group. The random flap model with size of 9 cm×3 cm was reproduced on the back of rats in two groups. Immediately post injury, rats in bivalirudin group were intraperitoneally injected with 5 mg/mL bivalirudin (0.8 mL/kg), while rats in normal saline group were intraperitoneally injected with normal saline (0.8 mL/kg) once a day. The continuous injection lasted for 7 days. The flap was divided into distal area, middle area and proximal area averagely based on the flap blood supply. On post injury day (PID) 1, 3, and 7, the overall survival of each area of flap was observed with naked eyes. On PID 7, the survival rate of flap was calculated, and then the morphology of skin tissue at the center of the three areas of flap was observed by HE staining, the microvessel density (MVD) of the middle area of flap was calculated, and the expression of vascular endothelial growth factor (VEGF) of the middle area of flap was detected with immunohistochemical staining. Data were processed with t test. Results: (1) On PID 1, flaps of rats in two groups had different degrees of swelling, mainly concentrated in distal area, but there was no obvious necrosis. The middle area and proximal area of flaps in two groups were survived. On PID 3, the necrosis of flaps of rats in two groups was concentrated in the middle area, while the proximal area of flap was still in survival state, and most distal area of flap was necrosis with a little scab. On PID 7, the necrosis of middle area of flaps of rats in two groups was gradually fused, and the survival area of flap of rats in bivalirudin group was larger than that in normal saline group. The distal area of flap was almost necrotic, and the proximal area of flap was almost survived. (2) On PID 7, the survival rate of flap of rats in bivalirudin group was (64±4)%, significantly higher than that in normal saline group [(45±3)%, t=13.49, P<0.01]. (3) On PID 7, the histological morphology of distal area of flap of rats in two groups was similar, the inflammatory cells were infiltrated abundantly, and tissue edema was obvious. A large number of new blood vessels appeared in the middle area of flap of rats in bivalirudin group, with the formation of collateral vessels, and basic dilation of new blood vessels was seen. There were fewer new blood vessels appeared in the middle area of flap of rats in normal saline group, and dilation of new blood vessels was not obvious. There was little inflammatory cells infiltration in the proximal area of flap of rats in two groups. Compared with that in normal saline group, tissue edema extent of proximal area of flap of rats in bivalirudin group was less, and expansion was observed in more blood vessels. (4) The MVD of middle area of flap of rats in bivalirudin group was (26±5)/mm(2,) significantly higher than that in normal saline group [(18±3)/mm(2,) t=5.43, P<0.05]. (5) The expression of VEGF of middle area of flap of rats in bivalirudin group was 6 534±384, significantly higher than that in normal saline group (4 659±448, t=12.31, P<0.05). Conclusions: Bivalirudin can promote the survival of random skin flap in rats, and the mechanisms may include reducing the formation of thrombosis, improving the blood supply of flap, and increasing the expression of VEGF, promoting the formation of new blood vessels.

Time-to-Event Analysis of Polatuzumab Vedotin-Induced Peripheral Neuropathy to Assist in the Comparison of Clinical Dosing Regimens

Polatuzumab vedotin, an antibody-drug conjugate containing monomethyl auristatin E, was associated with an incidence of grade ≥2 peripheral neuropathy (PN) of 55-72% in patients with indolent non-Hodgkin lymphoma in a phase II study, when dosed 1.8-2.4 mg/kg every 3 weeks until progression or for a maximum of 17 cycles. To quantify the correlation of conjugate exposure and treatment duration with PN risk, a time-to-event model was developed using data from phase I and II studies. The model suggested that PN risk increased with conjugate exposure and treatment cycles, and a trend for increased risk with body weight and albumin concentration. When capping the treatment duration to six to eight cycles, the risk ratio of a dose of 2.4 mg/kg vs. 1.8 mg/kg was ≥1.29; the predicted incidence of grade ≥2 PN at 1.8-2.4 mg/kg dose levels was 17.8-37.2%, which is comparable with other antimicrotubule agents for lymphoma treatment.

Beneficial effects of renal denervation on cardiac angiogenesis in rats with prolonged pressure overload

AIM

Renal denervation (RDN) has beneficial effects on cardiac remodelling and function in resistant hypertension. We aimed to investigate the impact of RDN on cardiac angiogenesis during prolonged pressure overload.

METHODS

Cardiac pressure overload was reproduced by transverse aorta constriction (TAC) procedure in adult Sprague Dawley male rats (n = 35). RDN/sham-RDN procedure was performed in surviving rats at 5 weeks after TAC.

RESULTS

Five weeks post-TAC, transthoracic echocardiography revealed that myocardial hypertrophy occurred in TAC rats, with ejection fraction and fractional shortening not significantly changed. At the end of 10 weeks, cardiac systolic function was preserved in RDN group, but not in sham group. CD31 immunohistochemical staining showed that RDN-treated rats had higher cardiac capillary density than sham rats. However, no significant between-group difference was observed in the kidneys. A decreased protein expression of left ventricle vascular endothelial growth factor (VEGF) was observed in sham group, while RDN attenuated this decrease. Compared with sham, RDN resulted in a higher protein expression of VEGF receptor 2 (VEGFR2) and phosphorylated endothelial nitric oxide synthase (p-eNOS) in the heart.

CONCLUSION

Renal denervation benefits cardiac angiogenesis during sustained pressure overload, involving regulation of VEGF and VEGFR2 expression as well as activation of eNOS.

Searching for large-gap quantum spin hall insulators: boron-nitride/(Pb, Sn)/α-Al2O3 sandwich structures

Topological insulators hold great potential for efficient information processing and storage. Using density functional theory calculations, we predict that a honeycomb lead monolayer can be stabilized on an Al₂O₃ (0001) substrate to become topologically non-trivial with a sizeable band gap (∼0.27 eV). Furthermore, we propose to use a hexagonal boron-nitride (h-BN) monolayer as a protection for the topological states of Pb/Al₂O₃ and Sn/Al₂O₃. Our findings suggest new possibilities for designing and protecting two-dimensional TIs for practical applications.

Abstract P4-22-07: Long-term safety of palbociclib in combination with endocrine therapy in treatment-naive and previously treated women with HR+ HER2– advanced breast cancer: A pooled analysis from randomized phase 2 and 3 studies

Background: Palbociclib (PAL) is a selective and reversible oral cyclin-dependent kinase 4 and 6 inhibitor. Large randomized phase (ph) 2 and 3 trials showed significant improvement in progression-free survival (PFS) when PAL was combined with endocrine therapy (ET) vs ET alone in treatment (trt)-naive and previously treated hormone receptor?positive human epidermal growth factor receptor 2?negative (HR+ HER2–) advanced breast cancer (ABC) patients (pts). The median PFS with PAL+ET is &gt;2 years as a first-line therapy for ABC and 11.2 mo in endocrine-resistant ABC. We evaluated the long-term safety in PALOMA-1, -2, and -3.

Methods: We analyzed the tolerability of PAL in combination with ET in 3 randomized trials. Pts untreated for ABC were randomized to receive PAL+letrozole (LET) vs LET alone in PALOMA-1 (ph 2, open-label; 1:1) or randomized to receive PAL+LET vs placebo (PBO)+LET in PALOMA-2 (ph 3, double-blind; 2:1). PALOMA-3 included pts who progressed on prior ET, randomized to receive PAL+fulvestrant (FUL) or PBO+FUL (ph 3, double-blind; 2:1). Safety assessments, including a complete blood count, were done at baseline, on D1 of each cycle, and on D14 of the first 2 cycles. We evaluated adverse events (AEs) by 6-mo intervals (out to 36 mo) and cumulatively (12-, 24-, and 36-mo time points), and assessed latency (event onset) of pertinent adverse drug reactions (ADRs) in all pts treated in PALOMA-1, -2, and -3.

Results: A total of 1352 pts were pooled for this analysis; 872 pts received PAL+ET (527 pts, PAL+LET; 345 pts, PAL+FUL). Median duration of trt was 421 days in PALOMA-1 (January 2015), 603 days in PALOMA-2 (February 2016), and 330 days in PALOMA-3 (July 2015). PAL+LET was received by 119 pts as first-line trt in PALOMA-1 and 2 for 24–&lt;30 months and 11 pts were treated for &gt;36 mo. PAL+FUL was received by 140 pts for &gt;12 mo as second-line trt in PALOMA-3. The most commonly reported ADRs across all studies were neutropenia, fatigue, nausea, anemia, and leukopenia. The 6-mo-interval analyses of the most common (&gt;15%) AEs (by preferred term [PT]) from PALOMA-1, -2, and -3 indicated that these AEs were reported with the highest frequency during the first 6-mo interval and typically decreased in incidence over time to 30–&lt;36-mo; the most common hematologic AEs (clustered PTs) are shown (Table). The cumulative incidence of AEs after the first vs the second and third years showed similar frequencies of most AEs, including the most common ADRs.

Conclusions: Based on these long-term safety analyses, there is no evidence of specific cumulative or delayed toxicity resulting from prolonged trt with PAL+ET for HR+ HER2– ABC. This supports the ongoing investigation of PAL+ET in early breast cancer (NCT02513394).

Table. Pooled hematologic AEs: all grades and all causality clustered PTs reported for ≥10% of PAL+ET (LET/FUL)-treated ptsTime interval, mo0–&lt;66–&lt;1212–&lt;1818–&lt;2424–&lt;3030–&lt;36≥36Patients, N8726764912891192711TEAEs, %       Neutropenia75.758.649.349.842.937.054.5Leukopenia40.027.416.711.87.611.118.2Anemia20.812.710.011.19.211.118.2Thrombocytopenia15.18.76.15.55.914.836.4TEAEs=treatment-emergent adverse events.

Sponsor: Pfizer.

Citation Format: Diéras V, Rugo HS, Gelmon K, Finn RS, Cristofanilli M, Loi S, Colleoni M, Lu D, Gauthier E, Huang-Bartlett C, Turner NC, Schnell P. Long-term safety of palbociclib in combination with endocrine therapy in treatment-naive and previously treated women with HR+ HER2– advanced breast cancer: A pooled analysis from randomized phase 2 and 3 studies [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-07.

Treatment of pediatric forearm midshaft fractures: Is there a difference between types of orthopedic surgeon?

PURPOSE OF THE STUDY

The objective of this study was to compare the clinical and radiological outcomes of pediatric forearm midshaft fractures treated operatively with titanium elastic nails (TENs) by pediatric orthopedists and non-pediatric orthopedists.

MATERIAL AND METHODS

We conducted a prospective cohort study of 88 children of forearm midshaft fractures, who were randomized to operative stabilization either by pediatric orthopedists (Group A, 44 cases) or by non-pediatric orthopedists (Group B, 44 cases) from April 2013 to February 2014. At baseline, the groups were comparable with respect to age, sex, AO classification, injured side and interval from injury to surgery. We collected data on operative and radiation time, open reduction rate, length of hospitalization, bone union time, return to full physical activity time, complications, and measured clinical results using the Children's Hospital of Philadelphia (CHOP) Forearm Fracture Fixation Outcome Classification.

RESULTS

The mean follow-up period was 15.8±3.3 months for Group A and 15.2±4.2 months for Group B (P=0.491). No significant difference existed in time to union (P=0.282), the overall complication rate (P=0.750), return to activity time (P=0.408), and clinical outcomes according to CHOP classification (P=0.908) between the two groups. However, the mean operating time and radiation time was significantly longer in Group B than in Group A (P=0.001 and P=0.001, respectively). In addition, there was a trend for patients of Group B to have a higher rate of open reduction (P=0.035).

DISCUSSIONS

Our results indicated that children forearm midshaft fractures treated surgically by pediatric orthopedists offered potential advantages including a shorter operating time and radiation time, a lower rate of open reduction. However, both pediatric and non-pediatric orthopedists had achieved satisfactory clinical results in treatment of these injuries.

LEVEL OF EVIDENCE

Level II prospective randomized study.

IA comparison of two minimally invasive procedures for intra-articular displaced calcaneal fractures in older children

The purpose of this study was to compare the clinical outcomes of displaced intra-articular calcaneal fractures in older children treated with poking reduction and cannulated screws fixation or with plate fixation using a sinus tarsi approach. From June 2008 to May 2012, fifty patients were randomised to operative stabilisation either by poking reduction and cannulated screws fixation (Group A, 28) or by plates fixation using a sinus tarsi approach (Group B, 22). The two groups were comparable with respect to age, gender, BMI, the affected side, cause of injury, fracture type, time from injury to surgery and follow-up time. We collected data on operative time and radiation time, length of hospitalization, hospital costs, union time, full weight-bearing time, full physical activity time and complications and measured joint function using the American Orthopaedic Foot and Ankle surgery (AOFAS) score. The average follow-up time of Group A was 36.5±9.3 months and 40.2±10.6 months in Group B. No significant difference between these two groups was found in radiation time, average length of hospitalization, union time, full weight-bearing time, full physical activity time and the average AOFAS score. However, the patients of Group B had longer operation time (38.0±10.6 min vs. 66.5±9.4 min, P<0.05) and more hospital costs (6200±800 RMB vs. 15000±2000 RMB, P<0.05). The average Bohler's angle and Gissane's angle preoperative were 10.9±5.3 and 141.3±12.1 in Group A, and became 31.2±5.1 and 128.5±5.4 after operation. The average Bohler's angle and Gissane's angle preoperative in Group B were 11.7±4.0 and 138.8±16.2, respectively, and they became 30.9±5.2 and 124.6±6.8 after operation. Bohler's angle and Gissane's angle were significantly restored after surgery (P<0.05). Postoperative incision pain was more frequent in Group B than in Group A (P<0.05). Our results indicated that both cannulated screws and plates were efficient methods for intra-articular calcaneal fractures in older children. However, poking reduction and cannulated screws fixation had the advantages of a shorter operative time, fewer hospital costs and less incision pain.

Development of Precision Small-Molecule Proneurotrophic Therapies for Neurodegenerative Diseases

Age-related neurodegenerative diseases, such as Alzheimer's disease, will represent one of the largest future burdens on worldwide healthcare systems due to the increasing proportion of elderly in our society. As deficiencies in neurotrophins are implicated in the pathogenesis of many age-related neurodegenerative disorders, it is reasonable to consider that global neurotrophin resistance may also become a major healthcare threat. Central nervous system networks are effectively maintained through aging by neuroprotective and neuroplasticity signaling mechanisms which are predominantly controlled by neurotrophin receptor signaling. Neurotrophin receptors are single pass receptor tyrosine kinases that form dimeric structures upon ligand binding to initiate cellular signaling events that control many protective and plasticity-related pathways. Declining functionality of the neurotrophin ligand-receptor system is considered one of the hallmarks of neuropathological aging. Therefore, it is imperative to develop effective therapeutic strategies to contend with this significant issue. While the therapeutic applications of cognate ligands for neurotrophin receptors are limited, the development of nonpeptidergic, small-molecule ligands can overcome these limitations, and productively regulate this important receptor system with beneficial effects. Using our advanced knowledge of the high-dimensionality complexity of receptor systems, the future generation of precision medicines targeting these systems will be an attainable goal.

Observation of Orbital Order in the Half-Filled 4f Gd Compound

Half-filled electron systems, even with the maximized spin angular moment, have been given little attention because of their zero-orbital angular moment according to Hund's rule. Nevertheless, there are several measurements that show evidence of a nonzero orbital moment as well as spin-orbit coupling. Here we report for the first time the orbital order in a half-filled 4f-electron system GdB_{4}, using the resonant soft x-ray scattering at Gd M_{4,5}-edges. Furthermore, we discovered that the development of this orbital order is strongly coupled with the antiferromagnetic spin order. These results clearly demonstrate that even in half-filled electron systems the orbital angular moment can be an important parameter to describe material properties, and may provide significant opportunities for tailoring new correlated electron systems.

Integrated Two-Analyte Population Pharmacokinetic Model for Antibody-Drug Conjugates in Patients: Implications for Reducing Pharmacokinetic Sampling

An integrated pharmacokinetics (PK) model that simultaneously describes concentrations of total antibody (Tab) and antibody‐conjugated monomethyl auristatin E (acMMAE) following administration of monomethyl auristatin E (MMAE)‐containing antibody–drug conjugates (ADCs) was developed based on phase I PK data with extensive sampling for two ADCs. Two linear two‐compartment models that shared all parameters were used to describe the PK of Tab and acMMAE, except that the deconjugation rate was an additional clearance pathway included in the acMMAE PK model compared to Tab. Further, the model demonstrated its ability to predict Tab concentrations and PK parameters based on observed acMMAE PK and various reduced or eliminated Tab PK sampling schemes of phase II data. Thus, this integrated model allows for the reduction of Tab PK sampling in late‐phase clinical development without compromising Tab PK characterization.

A comparison of double Endobutton and triple Endobutton techniques for acute acromioclavicular joint dislocation

PURPOSE OF THE STUDY

The purpose of this study was to evaluate the results of patients treated with either double Endobutton device or triple Endobutton device for acute acromioclavicular joint dislocations.

PATIENTS AND METHODS

Eighty patients were randomized to operative stabilization either by double Endobutton device (group A, 40) or by triple Endobutton device (group B, 40). Preoperative variables included the patients' age, sex, the affected side, cause of injury, Rockwood classification and time from injury to surgery. Peri-operative variables were incision length, blood loss, the operative time and the radiation time, length of hospitalization and hospital costs. Postoperative variables were complications, the Constant and VAS scores and the ability to return to previous work. The coracoclavicular (CC) distance of the affected shoulder was assessed on a standard radiograph and compared with the contralateral normal one.

RESULTS

The average follow-up time of group A was 26.5±7.3months and group B was 24.2±6.6months. The overall complication rate was similar in both groups (26/40 vs. 24/40, P=0.644). There were no significant differences in the mean incision length, blood loss, the operative and radiation time, length of hospitalization, the Constant and VAS scores, and the ability to return to previous work between the two groups. However, the patients of group B had more hospital costs (3802.5±258.5 vs. 2433.6±182.5 USD, P=0.000). The radiological assessment revealed no significant difference in the CC distance between the two groups (P=0.625).

DISCUSSIONS

Triple Endobutton technique did not show significant clinical advantages over double Endobutton technique.

LEVEL OF EVIDENCE

Level II prospective randomized study.

Berberine in combination with yohimbine attenuates sepsis-induced neutrophil tissue infiltration and multiorgan dysfunction partly via IL-10-mediated inhibition of CCR2 expression in neutrophils

Infiltration of activated neutrophils into the vital organs contributes to the multiple organ dysfunctions in sepsis. In the present study, we investigated the effects of berberine in combination with yohimbine (BY) on neutrophil tissue infiltration and multiple organ damage during sepsis, and further elucidated the involved mechanisms. Sepsis was induced in mice by cecal ligation and puncture (CLP). BY or CCR2 antagonist was administered 2h after CLP, and anti-IL-10 antibody (IL-10 Ab) or control IgG was injected intraperitoneally just before BY treatment. We found that IL-10 production was enhanced by BY therapy in septic mice. BY significantly attenuated neutrophil tissue infiltration and multiple organ injury in CLP-challenged mice, all of which were completely reversed by IL-10 Ab pretreatment. The levels of KC, MCP-1, MIP-1α and MIP-2 in the lung, liver and kidney were markedly increased 6h after CLP. BY reduced the tissue concentrations of these chemokines in septic mice, but IL-10 Ab pretreatment did not completely eliminate these inhibitory effects of BY. Particularly, dramatically increased CCR2 expression in circulating neutrophils of septic mice was reduced by BY and this effect was completely abolished by IL-10 Ab pretreatment. Furthermore, CCR2 antagonist also inhibited lung and renal injury and neutrophil infiltration in septic mice. Taken together, our data strongly suggest that BY therapy attenuates neutrophil tissue infiltration and multiple organ injury in septic mice, at least in part, via IL-10-mediated inhibition of CCR2 expression in circulating neutrophils.

Synchronized 4 × 12 GHz hybrid harmonically mode-locked semiconductor laser based on AWG

We report a monolithically integrated synchronized four wavelength channel mode-locked semiconductor laser chip based on arrayed waveguide grating and fabricated in the InP material system. Device fabrication was completed in a multiproject wafer foundry run on the Joint European Platform for Photonic Integration of Components and Circuits. The integrated photonic chip demonstrated 5th harmonic electrical hybrid mode-locking operation with four 400 GHz spacing wavelength channels and synchronized to a 12.7 GHz RF clock, for nearly transform-limited optical pulse trains from a single output waveguide. A low timing jitter of 0.349 ps, and RF frequency locking range of ~50 MHz were also achieved.

Neuroprotective Effect of Lutein on NMDA-Induced Retinal Ganglion Cell Injury in Rat Retina

Lutein injection is a possible therapeutic approach for retinal diseases, but the molecular mechanism of its neuroprotective effect remains to be elucidated. The aim of this study was to investigate its protective effects in retinal ganglion cells (RGCs) against N-methyl-D-aspartate (NMDA)-induced retinal damage in vivo. Retinal damage was induced by intravitreal NMDA injection in rats. Each animal was given five daily intraperitoneal injections of Lutein or vehicle along with intravitreal NMDA injections. Electroretinograms were recorded. The number of viable RGCs was quantified using the retinal whole-mount method by immunofluorescence. Proteins were measured by Western blot assays. Lutein reduced the retinal damage and improved the response to light, as shown by an animal behavior assay (the black-and-white box method) in rats. Furthermore, Lutein treatment prevented the NMDA-induced reduction in phNR wave amplitude. Lutein increased RGC number after NMDA-induced retina damage. Most importantly, Bax, cytochrome c, p-p38 MAPK, and p-c-Jun were all upregulated in rats injected with NMDA, but these expression patterns were reversed by continuous Lutein uptake. Bcl-2, p-GSK-3β, and p-Akt in the Lutein-treated eyes were increased compared with the NMDA group. Lutein has neuroprotective effects against retinal damage, its protective effects may be partly mediated by its anti-excitability neurotoxicity, through MAPKs and PI3K/Akt signaling, suggesting a potential approach for suppressing retinal neural damage.