[Effects of airway management team in the treatment of severely mass burn patients combined with inhalation injury]

Objective: To explore and analyze the effects of airway management team (AMT) in the treatment of severely mass burn patients combined with inhalation injury. Methods: The clinical data of 58 severely burned patients combined with inhalation injury hospitalized in our unit from January 2012 to August 2014, conforming to the inclusion criteria, were retrospectively analyzed. According to whether airway management was implemented by AMT or not, patients hospitalized from January 2012 to July 2014 were divided into control group (n=27), while patients in Kunshan factory aluminum dust explosion accident hospitalized on 2nd August 2014 were divided into observation group (n=31). Patients in control group received regular airway nursing carried out by nurses on duty, while patients in observation group received specialized airway concentration nursing implemented by AMT. The concrete implementation included overall assessment of patients' airway, elaborate airway care, and controlled management of mechanical ventilation. Arterial blood gas indexes and oxygenation index of patients in the two groups on post injury day (PID) 1, 7, and 14 were compared. Sputum viscosity, ventilator-associated pneumonia (VAP) occurrence rate, and ventilation time of patients in the two groups in post injury week(s) 1, 2, and 3 after admission were monitored and recorded. Survival rates of patients in the two groups were compared. Data were processed with analysis of variance for repeated measurement, t test and Bonferroni correction, chi-square test, and Wilcoxon rank sum test. Results: (1) There were no statistically significant differences in pH value, arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)), and oxygenation index of patients in the two groups on PID 1 (t=0.595, -0.166, 1.518, -0.828, 0.458, P>0.05). The pH values of patients in observation group on PID 7 and 14 were 7.327±0.050 and 7.367±0.043, respectively, significantly better than those in control group (7.304±0.021 and 7.390±0.029, respectively, t=-2.385, 2.391, P<0.05). The PaO(2) values of patients in observation group on PID 7 and 14 were (95.1±6.7) and (106.3±7.8) mmHg (1 mmHg=0.133 kPa), respectively, significantly higher than those in control group [(91.6±5.7) and (102.0±8.3) mmHg, respectively, t=-2.109, -2.059, P<0.05]. The PaCO(2) values of patients in observation group on PID 7 and 14 were (41±4) and (40±4) mmHg, respectively, significantly lower than those in control group [(43±5) and (43±4) mmHg, respectively, t=2.220, 2.304, P<0.05]. The SaO(2) values of patients in observation group on PID 7 and 14 were 0.95±0.04 and 0.96±0.04, respectively, significantly higher than those in control group (0.93±0.05 and 0.94±0.05, respectively, t=-2.201, -2.016, P<0.05). The oxygenation indexes of patients in observation group on PID 7 and 14 were (286±18) and (329±20) mmHg, significantly higher than those in control group [(277±14) and (306±58) mmHg, respectively, t=-2.263, -2.022, P<0.05]. (2) Sputum viscosity of patients in observation group in post injury week(s) 1, 2, and 3 were superior to that in control group (Z=-2.096, -2.076, -2.033, P<0.05). (3) VAP occurrence rate of patients in observation group was lower than that in control group, and time of mechanical ventilation of patients in observation group was shorter than that in control group (χ(2)=4.244, t=2.425, P<0.05). (4) Survival rate of patients in observation group was higher than that in control group (χ(2)=4.244, P<0.05). Conclusions: The special intensive care of airway management by AMT can effectively improve the oxygenation status of severely burned patients combined with inhalation injury, alleviate the sputum viscosity, reduce the occurrence of VAP, and shorten the time of mechanical ventilation, thus benefits the treatment of severely mass burn patients combined with inhalation injury.

Recombinant streptavidin fusion proteins as signal reporters in rapid test of human hepatitis C virus infection

BACKGROUND

Early diagnosis of hepatitis C virus (HCV) infection is very important for the treatment of the disease. Development of sensitive and specific rapid detection assays is of great significance for the diagnosis. Here, we describe a promising method of using gold-labeled streptavidin fusion proteins as novel signal reporter in a rapid detection assay for HCV infection.

METHODS

Recombinant genes encoding streptavidin fused with Escherichia coli maltose-binding protein (MBP) or with a portion of bacterial translational initiation factor 2 were cloned in expression vectors pMAL-5CX and pET28 and transformed in proper Escherichia coli host strains. The genes were induced and streptavidin fusion proteins, named M-STV and IF-STV, respectively, were purified by affinity chromatography to over 90% purity. The biotin-binding activity of M-STV and IF-STV was tested by enzyme-linked immunosorbent assay (ELISA). M-STV was labeled with colloidal gold nanoparticles and used as a signal reporter to develop a lateral flow-based rapid test for detecting anti-HCV antibodies in human blood samples.

RESULTS

M-STV showed slightly higher biotin-binding activity and similar binding specificity as compared to commercial streptavidin. The gold-labeled M-STV bound specifically to biotin moieties immobilized on the rapid test strips in a dose-responsive manner and was successfully used in detecting HCV antibodies in serum samples of patients infected with HCV. The rapid test displayed higher detection sensitivity than gold-labeled commercial NeutrAvidin.

CONCLUSION

Our results indicate that gold-labeled M-STV is a promising agent in rapid tests of HCV infection and possibly other viral infections.

Engineering Vaccines to Reprogram Immunity against Head and Neck Cancer

The recent Food and Drug Administration's approval of monoclonal antibodies targeting immune checkpoint receptors (ICRs) for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) offers exciting promise to improve patient outcome and reduce morbidities. A favorable response to ICR blockade relies on an extensive collection of preexisting tumor-specific T cells in the tumor microenvironment (TME). ICR blockade reinvigorates exhausted CD8+ T cells and enhances immune killing. However, resistance to ICR blockade is observed in about 85% of patients with HNSCC, therefore highlighting the importance of characterizing the mechanisms underlying HNSCC immune escape and exploring combinatorial strategies to sensitize hypoimmunogenic cold HNSCC to ICR inhibition. Cancer vaccines are designed to bypass the cold TME and directly deliver cancer antigens to antigen-presenting cells (APCs); these vaccines epitomize a priming strategy to synergize with ICR inhibitors. Cancer cells are ineffective antigen presenters, and poor APC infiltration as well as the M2-like polarization in the TME further dampens antigen uptake and processing, both of which render ineffective innate and adaptive immune detection. Cancer vaccines directly activate APC and expand the tumor-specific T-cell repertoire. In addition, cancer vaccines often contain an adjuvant, which further improves APC function, promotes epitope spreading, and augments host intrinsic antitumor immunity. Thus, the vaccine-induced immune priming generates a pool of effectors whose function can be enhanced by ICR inhibitors. In this review, we summarize the major HNSCC immune evasion strategies, the ongoing effort toward improving HNSCC vaccines, and the current challenges limiting the efficacy of cancer vaccines.

[Prevalence and clinical features of familial hypercholesterolemia in Chinese patients with myocardial infarction]

Objective: To analyze the prevalence and clinical features of familial hypercholesterolemia (FH) in Chinese patients with myocardial infarction (MI). Method: This retrospective study recruited a total of 2 119 consecutive patients (age (56.7±10.9) years old) undergoing coronary angiography with first MI from April 2011 to December 2016. Patients were divided into 2 groups: premature MI (male<55 years old, female<60 years old) and non-premature MI. The diagnosis of FH was established according to Dutch Lipid Clinic Network (DLCN) diagnostic criteria and referred as definite/probable FH in our study. The prevalence and clinical features of FH, including lipid level, MI characteristics and stain therapy, were explored. Multivariable logistic regression analysis was used to assess the predictive value of FH for the presence of premature MI. Results: The prevalence of definite/probable FH was 3.68% (78/2 119) in MI patients and 7.28% (68/934) in premature MI patients. Onset of MI occurred 10 years earlier in patients with definite/probable FH than those without FH ((47.9±9.4) years vs. (58.8±10.7) years, P<0.01). Additionally, we found that the risk of premature MI was significantly and independently increased in definite/probable FH patients (OR=5.32, 95%CI 2.77-10.22, P<0.01). None of FH patients reached the target of LDL-C<1.8 mmol/L under statin therapy. Conclusions: The prevalence of FH in Chinese patients with MI is not rare. Clinically, FH is linked with the early onset of MI.

Absence of TetB identifies minocycline-susceptible isolates of Acinetobacter baumannii

Minocycline is one of the few options available to treat infections caused by Acinetobacter baumannii. Acquired resistance to minocycline in A. baumannii is associated with presence of the TetB efflux pump. Previous studies suggested that the absence of tetB may predict minocycline minimum inhibitory concentrations (MICs) of ≤4 µg/mL. In this study, a collection of 258 A. baumannii isolates was used to generate MIC frequency distributions for the tetB-positive and -negative sets of isolates. Of the 93 tetB-negative strains, all had minocycline MICs ≤ 4 µg/mL, resulting in a negative predictive value of 100%. Of the 165 tetB-positive strains, 154 had minocycline MICs > 4 µg/mL, resulting in a positive predictive value of 93.3%. In conclusion, this study shows that tetB is highly associated with MICs above the current US Food and Drug Administration (FDA) and Clinical and Laboratory Standards Institute (CLSI) susceptible breakpoint of 4 µg/mL.

Alkannin Inhibited Hepatic Inflammation in Diabetic Db/Db Mice

Background/Aims: The current study was designed to investigate the protective role of alkannin (ALK) on liver injury in diabetic C57BL/KsJ-db/db mice and explore its potential mechanisms. Methods: An oral glucose tolerance test (OGTT) was performed. The levels of insulin, alanine aminotransferase (ALT), aspartate aminotransaminase (AST), total cholesterol (TC) and triglyceride (TG) were determined by commercial kits. The pro-inflammatory cytokines interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α were determined by ELISA. The levels of the ROCK/NF-κB pathway were determined by Western blotting. Results: The contents of pro-inflammatory cytokines interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α were inhibited by ALK, metformin or fasudil in diabetic db/db mice. Further, Western blotting analysis showed that the expression of Rho, ROCK1, ROCK2, p-NF-κBp65, and p-IκBα was significantly reversed by ALK treatment. In human hepatic HepG2 cells, the hepatoprotective effects of ALK were further characterized. With response to palmitic acid-challenge, increased amounts of insulin, ALT, AST, TG, and TC were observed, whereas ALK pretreatment significantly inhibited their leakage in HepG2 cells without appreciable cytotoxic effects. The inflammation condition was recovered with ALK treatment as shown by changes of IL-1β, IL-6 and TNF-α. Further, Western blotting analysis also suggested that ALK improves hepatic inflammation in a Rho-kinase pathway. Conclusion: The present study successfully investigated the role of Rho-kinase signalling in diabetic liver injury. ALK exhibited hepatoprotective effects in diabetic db/db mice, and it might act through improving hepatic inflammation through the Rho-kinase pathway.

Genetic association of the ACACB gene with milk yield and composition traits in dairy cattle

Previously, we re-sequenced the whole genomes of eight Holstein bulls with high or low milk protein and fat percentage, and we detected two indels in the ACACB (acetyl-CoA carboxylase beta) gene that were polymorphic between the two groups. Thus, we considered ACACB as a promising candidate gene potentially affecting milk composition traits. Herein, we verified the genetic effects of ACACB on five milk traits in a Chinese Holstein population. We identified six SNPs in the 5'-promoter region, five in the 5'- untranslated region (UTR), 11 in exons, four in the 3'-UTR and three in the 3'-flanking region by re-sequencing the entire coding and regulatory regions of ACACB. One of these SNPs (ss1987461005) is reported here for the first time, and three of the SNPs (rs109482081, rs110819816 and rs109281947) were predicted to result in amino acid replacements. Genotype-phenotype association analyses showed that all the identified SNPs, except for ss1987461005, rs208919019 and rs134447911, were significantly associated with milk yield, fat yield, fat percentage, protein yield or protein percentage (P < 0.0001 to 0.0484). Linkage disequilibrium analyses were conducted among the identified SNPs to confirm the genetic associations. Two SNPs-rs135874354 (g.66218726T>C) and rs210928430 (g.66218117G>A)-were predicted to alter transcription factor binding sites in the 5'-promoter region of ACACB. A luciferase activity assay showed that the promoter activity of haplotype TG was significantly higher than that of CG (P = 0.0002) and that the promoter activity of haplotype TA was remarkably higher than that of CA (P = 7.4285E-09), showing that the T allele of rs135874354 increased promoter activity. Thus, rs135874354 was considered to be a potentially functional mutation. Our findings have, for the first time, profiled the genetic effect of ACACB on milk production traits in dairy cattle and revealed a potentially causal mutation that requires further the in-depth validation.

Abstract P6-11-03: Association of systemic paclitaxel concentrations with severity and progression of paclitaxel-induced peripheral neuropathy

Background: Paclitaxel is commonly used in combination regimens in patients with early stage breast cancer, but its use is often limited by the development of severe paclitaxel-induced peripheral neuropathy (PIPN). Paclitaxel pharmacokinetics (PK), specifically the maximum paclitaxel concentration (Cmax) and amount of time the concentration remains above 0.05 µM (Tc&gt;0.05), have been associated with occurrence of severe, clinician-documented (NCI CTCAE) neuropathy. Patient-reported outcomes are more reliable, sensitive, and responsive than clinician-documented neuropathy, particularly for subjective toxicities. The objective of this study was to confirm that paclitaxel PK predicts occurrence and progression of patient-reported PIPN.

Methods: This observational trial enrolled patients with early stage breast cancer receiving adjuvant/neoadjuvant weekly 1-hour paclitaxel infusions (80 mg/m2 x 12 cycles) at the University of Michigan Comprehensive Cancer Center. Patients with existing neuropathy or previous neuropathic chemotherapy treatment were excluded. Paclitaxel concentration was measured via liquid chromatograph/mass spectrometry (LC/MS) in plasma samples collected at the end of (Cmax) and 16-24 hours after (Tc&gt;0.05) first infusion. Patient-reported neuropathy was collected (EORTC CIPN20) at baseline and each treatment cycle. The 8-item sensory subscale of the CIPN20 (CIPN8, range 8-32) was estimated for each patient and cycle of treatment to calculate the change from baseline (ΔCIPN8, range 0-24). The analysis was conducted using two approaches. In the first analysis, the cohort was stratified into cases and controls by the median ΔCIPN8 and in the second, each patient was described by the rate of change of CIPN8 per treatment cycle. The association of Cmax and Tc&gt;0.05 with case/control definition was tested using Wilcoxon rank sum and t-tests. Associations with rate of change of CIPN8 were tested using linear regression.

Results: 60 patients were enrolled in this observational clinical study. The mean age was 52.4 years, 93% of patients were Caucasian, and 5% had diabetes diagnosis. At baseline there was very little patient-reported neuropathy (mean baseline CIPN8=8.3). The median ΔCIPN8 was 4. Patients with ΔCIPN8&gt;4 had greater Cmax than patients with ΔCIPN8≤4 (p=0.010). In the regression modeling, there was a significant correlation between patient's Tc&gt;0.05 and the rate of increase in ΔCIPN8 (r=0.28, p=0.03).

Conclusions: Our preliminary findings suggest that a single PK sample collected at the end of the first cycle (Cmax) or 16-24 hours later (Tc&gt;0.05) are indicative of a patient's risk of experiencing PIPN during paclitaxel treatment. Ongoing modeling that accounts for dosing decreases, delays, and discontinuations will further characterize the contribution of paclitaxel pharmacokinetics to PIPN development and enable identification of genetic and metabolomic biomarkers that predict which patients experienced more severe PIPN than would be anticipated based on their paclitaxel PK.

Citation Format: Hertz DL, Kidwell KM, Vangipuram K, Sun D, Henry NL. Association of systemic paclitaxel concentrations with severity and progression of paclitaxel-induced peripheral neuropathy [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 P6-11-03.

Genome-wide association study for reproductive traits in a Large White pig population

Using the PorcineSNP80 BeadChip, we performed a genome‐wide association study for seven reproductive traits, including total number born, number born alive, litter birth weight, average birth weight, gestation length, age at first service and age at first farrowing, in a population of 1207 Large White pigs. In total, we detected 12 genome‐wide significant and 41 suggestive significant SNPs associated with six reproductive traits. The proportion of phenotypic variance explained by all significant SNPs for each trait ranged from 4.46% (number born alive) to 11.49% (gestation length). Among them, 29 significant SNPs were located within known QTL regions for swine reproductive traits, such as corpus luteum number, stillborn number and litter size, of which one QTL region associated with litter size contained the ALGA0098819 SNP for total number born. Subsequently, we found that 376 functional genes contained or were near these significant SNPs. Of these, 14 genes—BHLHA15, OCM2, IL1B2, GCK, SMAD2, HABP2, PAQR5, GRB10, PRELID2, DMKN, GPI, GPIHBP1, ADCY2 and ACVR2B—were considered important candidates for swine reproductive traits based on their critical roles in embryonic development, energy metabolism and growth development. Our findings contribute to the understanding of the genetic mechanisms for reproductive traits and could have a positive effect on pig breeding programs.

Overexpression of microRNA-133b reduces myocardial injuries in children with viral myocarditis by targeting Rab27B gene

The present study is to measure the expression of microRNA (miRNA or miR)-133b in circulating blood of children with viral myocarditis before and after drug treatment, and to investigate its relationship with the severity of myocardial lesions. A total of 36 children patients with viral myocarditis who received treatments at our hospital between June 2014 and June 2016 were enrolled in the present study, including 21 boys and 15 girls (age range, 9 months - 16 years).Quantitative real-time polymerase chain reaction was used to determine the expression of miR-133b in peripheral blood of patients and cardiomyocytes infected with CVB3. CCK-8 assay was used to test the proliferation of cardiomyocytes. ELISA was used to determine the levels of creatine kinase (CK-MB) and lactate dehydrogenase (LDH) in peripheral blood and cardiomyocyte culture supernatants. Western blotting and ELISA were performed to measure the levels of tumor necrosis factor-α and interleukin-6 in cardiomyocytes infected by CVB3 and cell culture supernatants. Bioinformatics was used to predict the target gene of miR-133b. Silencing of Rab27B gene was achieved by transfection with its small-interfering RNA. Dual luciferase reporter assay was carried out to test whether miR-133b directly targets Rab27B. Reduced expression of miR-133b in peripheral blood was possibly correlated with myocardial injuries in viral myocarditis miR-133b. Expression of miR-133b was significantly reduced in cardiomyocytes infected with CVB3 virus. Overexpression of miR-133b inhibited cardiomyocyte injuries caused by CVB3 virus infection, and the enhanced production and release of cytokines TNF-α and IL-6 by cardiomyocytes infected with CVB3 virus. Rab27B promoted injuries of cardiomyocytes induced by CVB3 infection and facilitated the synthesis and release of cytokines TNF-α and IL-6 by cardiomyocytes. miR-133b was able to bind to the 3'-untranslated region seeding region of Rab27B mRNA. The present study demonstrates that expression of miR-133b in peripheral blood from children with viral myocarditis is reduced, and negatively correlated with myocardial injuries. miR-133b inhibits the proliferation of cardiomyocytes and the release of cytokines TNF-α and IL-6, and alleviates CVB3 infection-induced myocardial injuries by targeting Rab27B.

Prognostic value of the cancer oncogene Kelch-like 6 in gastric cancer

Background

Kelch-like 6 (KLHL6) is a cancer oncogene previously associated with specific human cancers, such as chronic lymphocytic leukaemia. Here, the mechanisms of KLHL6 function were explored in gastric cancer (GC) cells, in an in vivo experimental tumour model, and the prognostic value of KLHL6 analysis in GC tissue evaluated in a cohort of patients with GC.

Methods

Associations between clinicopathological and survival data and KLHL6 expression in GC tissues were analysed. The effects of downregulation of KLHL6 in GC cells was investigated using proliferation, invasion, apoptosis and lymphangiogenesis assays, and analysis of tumour growth in an in vivo experimental model.

Results

KLHL6 was upregulated in 43 per cent of GC tissues compared with 5 per cent of paired non-tumour tissues from 84 patients. KLHL6 protein expression in GC tissues was much higher than that in atrophic gastritis, intestinal metaplasia and dysplasia tissues from benign gastric disease samples. KLHL6 expression was positively related to the intestinal Laurén classification in GC tissues. Downregulated expression of KLHL6 in MGC-803 GC cells reduced colony formation, proliferation, viability, migration and invasion, enhanced apoptosis and inhibited the cell cycle in the G1 phase. Downregulated expression of KLHL6 also suppressed tumour growth in mice. Furthermore, downregulated expression of KLHL6 mRNA reduced the expression of nuclear-associated antigen Ki-67, vascular endothelial growth factor C, hepatocyte growth factor and matrix metalloproteinase 2 in vitro, and KLHL6 protein in tumour tissue of mice.

Conclusion

Abnormal expression of the KLHL6 oncogene promoted GC progression in vitro and in vivo, and its expression level in tumour tissue was found to be of prognostic value.

Cascade of Magnetic-Field-Induced Lifshitz Transitions in the Ferromagnetic Kondo Lattice Material YbNi_{4}P_{2}

A ferromagnetic quantum critical point is thought not to exist in two- and three-dimensional metallic systems yet is realized in the Kondo lattice compound YbNi_{4}(P,As)_{2}, possibly due to its one-dimensionality. It is crucial to investigate the dimensionality of the Fermi surface of YbNi_{4}P_{2} experimentally, but common probes such as angle-resolved photoemission spectroscopy and quantum oscillation measurements are lacking. Here, we study the magnetic-field dependence of transport and thermodynamic properties of YbNi_{4}P_{2}. The Kondo effect is continuously suppressed, and additionally we identify nine Lifshitz transitions between 0.4 and 18 T. We analyze the transport coefficients in detail and identify the type of Lifshitz transitions as neck or void type to gain information on the Fermi surface of YbNi_{4}P_{2}. The large number of Lifshitz transitions observed within this small energy window is unprecedented and results from the particular flat renormalized band structure with strong 4f-electron character shaped by the Kondo lattice effect.

Comparison of effectiveness and safety between conbercept and ranibizumab for treatment of neovascular age-related macular degeneration. A retrospective case-controlled non-inferiority multiple center study

Purpose

To compare the efficacy and safety of conbercept and ranibizumab when administered according to a treat-and-extend (TREX) protocol for the treatment of neovascular age-related macular degeneration (AMD) in China.

Patients and methods

Between May 2014 and May 2015, 180 patients were treated in a 1 : 1 ratio using conbercept or ranibizumab from four hospitals. Patients received either conbercept 0.5 mg or ranibizumab 0.5 mg intravitreal injections. Follow-up time was 1 year and treated based on a TREX approach. Main outcomes and measures include best-corrected visual acuity (BCVA), using Early Treatment Diabetic Retinopathy Study (ETDRS); number of injections; central retinal thickness (CRT); and leakage of choroidal neovascularization before and after the treatment was analyzed by fluorescein fundus angiography and indocyanine green angiography.

Results

The 1-year visit was completed by 168 (93.3%) of patients. Mean BCVA was equivalent between two cohorts, and were improved by 12.7±7.770 and 12.3±7.269 letters in the conbercept and ranibizumab cohorts, respectively (P=0.624). There was no significant difference in measured CRT, with a mean decrease of 191.5 μm for conbercept and 187.8 μm for ranibizumab (P=0.773). There was a statistically significant difference (P=0.001) between the drugs regarding the number of treatments: 7.4 for conbercept and 8.7 for ranibizumab. The difference in the distribution of injection intervals was statistically significant between two groups (P=0.011). During the study, there were no cases of endophthalmitis or intraocular inflammation.

Conclusion

Both drugs had equivalent effects in visual and anatomic gains at 1 year when administered. In the conbercept group, longer treatment intervals were achieved with more patients.