SURG-06. FOLLOWING INTRAOPERATIVE TUMOR-FREE PRINCIPLES IS AN EFFECTIVE APPROACH TO IMPROVE SURVIVAL OF PATIENTS WITH GLIOBLASTOMA

The intraoperative tumor-free principles refer to the operation techniques that must be carried out to prevent the exfoliation and planting of tumor cells during the operation, so as to prevent local recurrence and distant metastasis. Following the intraoperative tumor-free principles has been valued in resection of extracranial solid tumors. However, the significance of intraoperative tumor-free principles for brain tumors is still unclear. We retrospectively analyzed 106 patients with primary glioblastoma who underwent resection following the intraoperative tumor-free principles from 2010 to 2016. By February 28, 2019, 11 (10.4%) patients were lost to follow-up. The median overall survival (OS) was 20.2 months, and the 1-, 3-, and 5-year survival rates were 71%, 30%, and 26%, respectively. For patients with complete tumor resection, the median OS was 24.8 months, and the 1-, 3-, and 5-year survival rates were 80%, 38%, and 36%, respectively. Patients who received postoperative Stupp regimen had a median OS of 74.1 months, and the 1-, 3-, and 5-year survival rates were 82%, 51%, and 51%, respectively. A total of 36 patients had complete tumor resection followed by Stupp regimen. Their 1-, 3-, and 5-year survival rates were 94%, 68%, and 68%, respectively. Median OS was not reached. The patient with the longest OS had survived for 108 months and was still alive. In summary, the OS of patients in this study was relatively longer than that reported in most previous literatures, which suggests that following the intraoperative tumor-free principles in resection of GBM can benefit patient survival.

Can multiple harvests of plants improve nitrogen removal from the point-bar soil of lake?

Point bar areas around lakes can provide ecological service functions. For example, plants growing on point bars absorb and remove nutrients from the soil and water. However, if the point-bar plants are unregulated, in the fall and winter, plant debris will decompose, releasing nutrients that then enter the water body and cause eutrophication. Therefore, any harvesting should be managed. But how to harvest plants and how often to harvest them, and there is little research on these. In this study, the point bar at Qingcaosha Reservoir was used to study the effects of three plant harvesting modes (M1: unharvested; M2: one harvest in the fall; and M3: one harvest in summer and one in the fall) on the removal of nitrogen (N) from point-bar soil. The largest amount of N was removed by the plants when the M3 mode was used (26.93 g/m²). However, the M2 mode removed the most N from the soil during the plant growth season (81.62 g/m²), which implied that the nitrification and denitrification effects of soil microorganisms make the largest contribution to N removal from this point-bar soil. The nitrification and denitrification activity of microorganisms was higher for M2 than for M1 and M3 in the following year. Additionally, summer harvesting (M3) had a negative effect on nitrification efficiency in the current season because anaerobic bacteria in the soil significantly increased and nitrifying bacteria significantly decreased after harvesting. However, after a period of recovery, the number of microbial nitrifiers increased again and nitrification activity rose in the following year. The reduction in oxygen supply after harvesting may be the main reason for low nitrification in the current season, but it was beneficial to nitrification and denitrification in the following year because there was luxuriant plant growth. Therefore, when considering both the current season and the following year, harvesting should not be too frequent and one harvest in the fall (M2) led to the largest removal of N from the soil.

Pretreatment neutrophil-to-lymphocyte ratio plus albumin-to-gamma-glutamyl transferase ratio predict the diagnosis of grade III glioma

Background

The present study explored the predictive value of systemic inflammatory indexes in diagnosing grade III gliomas of oligodendroglial origin.

Methods

A retrospective study of 154 patients with grade III gliomas was conducted. Systemic inflammatory indexes, including neutrophil-to-lymphocyte ratio (NLR), albumin-to-gamma-glutamyl transferase ratio (AGR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, prognostic nutritional index, and fibrinogen-to-albumin ratio, were reviewed. The resulting predictive model was externally validated using a demographic-matched cohort of 49 grade III glioma patients.

Results

In the training set, gliomas of oligodendroglial origin tended to have a lower NLR (P=0.018) and a higher AGR (P=0.036) than those with tumors of astrocytic origin. Moreover, both NLR and AGR had predictive value for oligodendroglial tumors, when compared with astrocytic tumors. The best diagnostic value was obtained using NLR + AGR (AUC =64.9%, 95% CI: 55.5-74.3%, P=0.005). In the validation set, NLR + AGR satisfactorily predicted the presence of oligodendroglial tumors (AUC =66.5%, 95% CI: 50.6-82.4%, P<0.05) and co-deletion of 1p/19q (AUC =73.7%, 95% CI: 59.2-88.1%, P=0.005). Multivariate analysis further demonstrated NLR + AGR as an independent predictor for overall survival.

Conclusions

Pretreatment NLR and AGR aid in prognosis and diagnosing grade III oligodendroglial gliomas.

A Novel Three-Axial Magnetic-Piezoelectric MEMS AC Magnetic Field Sensor

We report a novel three-axial magnetic-piezoelectric microelectromechanical systems (MEMS) magnetic field sensor. The sensor mainly consists of two sensing elements. Each of the sensing elements consists of a magnetic Ni thick film, a Pt/Ti top electrode, a piezoelectric lead zirconate titanate (PZT) thin film, a Pt/Ti bottom electrode, a SiO₂ insulation layer, and a moveable Si MEMS diaphragm. When the sensor is subjected to an AC magnetic field oscillating at 7.5 kHz, a magnetic force interaction between the magnetic field and Ni thick film is produced. Subsequently, the force deforms and deflects the diaphragms as well as the PZT thin film deposited on the diaphragms. The deformation and deflection produce corresponding voltage outputs due to the piezoelectric effect. By analyzing the voltage outputs through our criterion, we can obtain details of the unknown magnetic fields to which the sensor is subjected. This achieves sensing of three-axial magnetic fields. The experimental results show that the sensor is able to sense three-axial magnetic fields ranging from 1 to 20 Oe, with X-axial, Y-axial, and Z-axial sensitivities of 0.156 mV_rms/Oe, 0.156 mV_rms/Oe, and 0.035 mV_rms/Oe, respectively, for sensing element A and 0.033 mV_rms/Oe, 0.044 mV_rms/Oe, and 0.130 mV_rms/Oe, respectively, for sensing element B.

Identification and functional analysis of LecRLK genes in Taxodium 'Zhongshanshan'

Background

Lectin receptor-like protein kinases (LecRLKs) can transform external stimuli into intracellular signals and play important regulatory roles in plant development and response to environmental stressors. However, research on the LecRLK gene family of conifers has seldom been reported.

Methods

Putative LecRLK genes were identified in the transcriptome of Taxodium 'Zhongshanshan'. The classification, domain structures, subcellular localization prediction, and expression patterns of LecRLK genes, as well as co-expressed genes, were analyzed using bioinformatics methods. Fifteen representative genes were further selected for qRT-PCR analysis in six tissues and under five different environmental stressor conditions.

Results

In total, 297 LecRLK genes were identified, including 155 G-type, 140 L-type, and 2 C-type. According to the classification, G-type and L-type LecRLK genes both can be organized into seven groups. The domain architecture of G-type proteins were more complex compared with that of L- and C-type proteins. Conservative motifs were found in G-type and L-type diverse lectin domains. Prediction and transient expression experiments to determine subcellular localization showed that LecRLKs were mainly concentrated in the cell membrane system, and some members were located at multiple sites at the same time. RNA-seq-based transcriptomics analysis suggested functional redundancy and divergence within each group. Unigenes co-expressed with LecRLKs in the transcriptome were found to be enriched in pathways related to signal transduction and environmental adaptation. Furthermore, qRT-PCR analysis of representative genes showed evidence of functional divergence between different groups.

Conclusions

This is the first study to conduct an identification and expression analysis of the LecRLK gene family in Taxodium. These results provide a basis for future studies on the evolution and function of this important gene family in Taxodium.

Abstract 406: Plasminogen Regulates Mesenchymal Stem Cell-mediated Tissue Repair After Ischemia Through Cry61

Objective: Stem cell transplantation has emerged as a promising strategy for improving post-ischemic tissue repair. However, the poor survival and persistence of the transplanted cells including mesenchymal stem cells (MSCs) in the hostile ischemic microenvironments represents a major therapeutic barrier. Previous work shows that plasminogen (Plg) promotes post-injury tissue repair by mobilizing hematopoietic stem cell from bone marrow to circulation. Here our studies aim to define the role of Plg in microenvironment-dependent, MSC-mediated tissue repair after hindlimb ischemia.

Approach and Results: Our studies show that Plg stimulates MSC proliferation and migration under normoxia and promotes MSC survival under hypoxia. Hindlimb ischemia was induced in Plg-deficient (Plg -/- ) and wild-type (Plg +/+ ) mice by ligation of femoral artery, followed by injection with fLuc/tdTomato + MSCs into the ischemic limbs. Our data show that Plg deficiency abolishes MSC survival, migration, and proliferation in the ischemic limbs, and abrogates MSC-mediated blood reperfusion, neovascularization and tissue repair after ischemia, suggesting that Plg is critical for MSC-mediated tissue repair. Furthermore, multiplex cytokine array analysis identifies Cyr61, a pro-angiogenic factor, as a downstream target of Plg in MSCs. Plg cleaves and activates Cyr61, which is required for Plg-stimulated MSC survival and migration. Finally, Plg-mediated Cry61 cleavage further promotes EC migration and neovascularization in vitro and in vivo.

Conclusions: Our study suggests that Plg promotes MSC survival and persistence in ischemic limbs and improves tissue repair. We identify an underlying mechanism, by which Plg induces Cyr61 cleavage and activation in MSCs, enhancing MSC survival and migration and promoting EC migration and neovascularization. Thus, targeting Plg/Cyr61 may offer exciting therapeutic opportunities for strengthening MSC therapy in ischemic diseases.

Assessment of ctDNA in CSF may be a more rapid means of assessing surgical outcomes than plasma ctDNA in glioblastoma

We aimed to develop a high-throughput deep DNA sequencing assay of cerebrospinal fluid (CSF) to identify clinically relevant oncogenic mutations that contribute to the development of glioblastoma (GBM) and serve as biomarkers to predict patients' responses to surgery. For this purpose, we recruited five patients diagnosed with highly suspicious GBM according to preoperative magnet resonance imaging. Subsequently, patients were histologically diagnosed with GBM. CSF was obtained through routine lumbar puncture, and plasma from peripheral blood was collected before surgery and 7 days after. Fresh tumor samples were collected using routine surgical procedures. Targeted deep sequencing was used to characterize the genomic landscape and identify mutational profile that differed between pre-surgical and post-surgical samples. Sequence analysis was designed to detect protein-coding exons, exon-intron boundaries, and the untranslated regions of 50 genes associated with cancers of the central nervous system. Circulating tumor DNAs (ctDNAs) were prepared from the CSF and plasma from peripheral blood. For comparison, DNA was isolated from fresh tumor tissues. Non-silent coding variants were detected in CSF and plasma ctDNAs, and the overall minor allele frequency (MAF) of the former corresponded to an earlier disease stage compared with that of plasma when the tumor burden was released (surgical removal). Gene mutation loads of GBMs significantly correlated with overall survival (OS, days) (Pearson correlation = -0.95, P = 0.01). We conclude that CSF ctDNAs better reflected the sequential mutational changes of driver genes compared with those of plasma ctDNAs. Deep sequencing of the CSF of patients with GBM may therefore serve as an alternative clinical assay to improve patients' outcomes.

Gonadotrophin-releasing hormone agonist combined with high-intensity focused ultrasound ablation for adenomyosis: a clinical study

OBJECTIVES

This study was to investigate the clinical efficacy of a gonadotrophin-releasing hormone agonist (GnRH-a) combined with high-intensity focused ultrasound (HIFU) ablation treatment for adenomyosis.

DESIGN

A non-randomized prospective study.

SETTING

Gynaecological Minimally Invasive Centre in a single hospital.

POPULATION

Patients with adenomyosis.

METHODS

Seventy-nine patients with adenomyosis were enrolled, including 55 patients in the control group treated with only HIFU and 24 patients in the study group treated with GnRH-a combined with HIFU. All the patients follow up 6 months after the HIFU procedure. The related parameters in the two groups were assessed before and 3 months as well as 6 months after treatment including serum levels of tumor marker and cytokine, volumes of uterine, adenomyotic lesion, and menstrual blood, as well as dysmenorrheal scores.

MAIN OUTCOME MEASURES

Differences between the group treated with HIFU alone and the group treated with GnRH-a combined with HIFU.

RESULTS

Before HIFU treatment, no significant difference was observed in serum levels of CA125, CA19-9, and interleukin-6 (IL-6), the volumes of uterine, adenomyotic lesion, and menstrual blood, as well as dysmenorrhea scores between the two groups. (P > 0.05). The serum CA125 levels significantly decreased in both groups after HIFU, but the serum CA125 levels in the study group were still significantly lower than those in the control group (P < 0.05). The volume of uterine and adenomyotic lesion significantly decreased in both groups after HIFU procedure, and decreased even more in the study group 3 and 6 months after treatment (P < 0.05). Dysmenorrhea scores and menstruation volumes significantly decreased in both groups after HIFU treatment. Moreover in the study group were significantly lower than those in the control group after 3 and 6 months (P < 0.05). No significant difference was observed in the rate of adverse effects between the two groups.

CONCLUSIONS

The short-term follow-up results indicate that the combination of GnRH-a and HIFU treatment significantly decreased serum CA125 levels, volumes of uterine, adenomyotic lesion and menstrual blood, as well as dysmenorrhea scores, and improved the clinical outcomes compared with the HIFU ablation alone in patients with adenomyosis. However, the further follow-up is needed to explore the long-term effects.

TWEETABLE ABSTRACT

A combination of GnRH-a with HIFU in the treatment of adenomyosis significantly decreased serum CA125 levels, uterine and adenomyotic lesion volumes, dysmenorrhea scores, and menstrual blood volumes.

Low frequency, weak MCP-1 secretion and exhausted immune status of peripheral monocytes were associated with progression of severe enterovirus A71-infected hand, foot and mouth disease

A minority of hand, foot and mouth disease (HFMD) caused by enterovirus A71 (EV-A71) results in severe neural complications. However, whether monocyte-mediated immunity is involved in the disease progression of HFMD remains unknown. One hundred and twenty mild and 103 severe HFMD patients were recruited and enzyme-linked immunosorbent assay (ELISA), flow cytometry and Transwell culture were performed in the study. Peripheral monocyte counts were lower in both absolute counts and frequencies in severe cases compared to mild cases. After screening 10 monocyte-related cytokines by ELISA, only monocyte chemoattractant protein-1 (MCP-1) was found at higher levels in sera of mild cases compared to those with severe symptoms. Monocytes purified from mild cases produced more MCP-1 than the cells from severe patients when stimulated in vitro. We observed that immune exhaustion markers programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) were highly regulated on the surface of monocytes from severe cases compared to mild cases. PD-L1 blockade induced a higher production of MCP-1 in the supernatant of a Transwell system. The production of MCP-1 also increased following PD-L1 blockade of purified monocytes activated by granulocyte-macrophage colony-stimulating factor (GM-CSF) combined with R848 or EV-A71 virus. Our results indicate that absolute count, frequency and levels of MCP-1 secretion of peripheral monocytes, together with their immune status, probably contribute to differential disease prognosis in EV-A71-associated HFMD.

High Expression of Indoleamine 2, 3-Dioxygenase in Adenosquamous Lung Carcinoma Correlates with Favorable Patient Outcome

Background: Indoleamine 2,3-dioxygenase (IDO), an enzyme involved in tryptophan (Trp) metabolism, is generally considered to be an immunosuppressive molecule. The prognostic role of IDO expression in tumor has not been well studied in non-small cell lung cancer (NSCLC) and even not been reported in adenosquamous lung carcinoma (AdSqLC). Herein, the aim of this study is to investigate the prognostic significance of IDO expression in patients with AdSqLC.

Patients and Methods: We conducted immunohistochemical analyses of IDO expression, as well as CD3 and CD8 expression, in 183 primary tumor tissue samples from patients with AdSqLC treated at our institution between July 1999 and September 2014. Patients' clinicopathological characteristics were retrospectively reviewed. Survival analysis was performed in the entire cohort of patients and those who received radical resection, respectively.

Results: IDO was expressed in 146 (79.8%) tumor samples. A higher level of IDO expression was significantly associated with increased CD8+ tumor-infiltrating lymphocytes (TILs) in tumor tissues (P<0.001). Surprisingly, overall survival (OS) was significantly better for patients with high IDO expression (hazard ratio (HR)= 0.505; confidence interval (CI)= 0.329-0.775; P=0.002) for the entire cohort. In patients who were unable to be treated with radical resection, IDO expression had no effect on OS (P=0.598). In contrast, a significant, independent association between high expression of IDO and better OS (HR=0.469; CI=0.290-0.758; P=0.002) was identified in patients who received radical resection.

Conclusions: IDO is expressed in most AdSqLC tissues, with a higher level of IDO expression associated with an occurrence of CD8+ TILs. Moreover, IDO expression in tumor promises to serve as a strongly independent favorable prognostic factor, particularly in patients who received radical resection.

Scalable synthesis of high-purity TiO2 whiskers via ion exchange method enables versatile applications

In this work, high-purity titanium dioxide (TiO₂) whiskers with different crystal forms were synthesized via ion exchange and controlled calcination methods. TiO₂ whiskers are of 5–10 μm in length with a length-to-diameter ratio of 10–20. A systematic investigation was established to explore the hydration process of K⁺/H⁺ exchange, anatase-rutile transformation in the calcination process and the applications of TiO₂ whiskers. Compared with the other strategies previously used for the synthesis of TiO₂ whiskers, it was found that large-scale production was obtained under mild reaction conditions, which represented a facile and mild route for industrial production and expanded the versatile applications of TiO₂ whiskers. Moreover, with the addition of nano TiO₂ colloid as a special accelerant, the calcination process yielding uniform morphology and controllable crystal form was explored. Confirmatory experiments indicated that anatase and rutile TiO₂ whiskers respectively show excellent photocatalytic activities and unique carrier performance for fabricating functional whiskers.

In this work, high-purity titanium dioxide (TiO₂) whiskers with different crystal forms were synthesized via ion exchange and controlled calcination methods.

Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment

Purpose

The presence of brain metastasis (BM) in patients with colorectal cancer (CRC) is usually associated with terminal-stage illness; however, a subgroup of patients receiving aggressive treatment can have a satisfactory prognosis. This study was designed to investigate the profile of prognostic factors in CRC patients with BM treated aggressively.

Patients and methods

CRC patients with BM were retrospectively reviewed. Survival analysis was performed to identify potential prognostic factors in the entire cohort of patients and a subgroup of patients treated aggressively. Aggressive treatments included surgical resection, radiotherapy, and/or chemotherapy. Overall survival was defined as the time between the diagnosis of BM and death or until the date of the last follow-up visit.

Results

A total of 78 CRC patients were confirmed as having BM. Sixty-eight of them had extracranial metastases at the time of their BM diagnosis. The most common sites of extracranial metastases were lung (n=51, 65.4%), followed by liver (n=25, 32.1%) and bone (n=12, 15.4%). Fifty-one patients who were treated aggressively had significantly longer overall survival than those who accepted palliative care (14.1 months vs 2.0 months, P<0.0001). Multivariate analysis was applied, and the results showed that aggressive treatment (n=51), recursive partitioning analysis class I/II (hazard ratio [HR]=0.27, 95% CI: 0.12–0.6, P=0.001), and fewer BM (HR=0.4, 95% CI: 0.21–0.78, P=0.07) predicted longer survival. In contrast, the presence of bone metastasis, rather than lung or liver metastasis, at the time of diagnosis of BM (HR=2.38, 95% CI: 1.08–5.28, P=0.032) predicted a poor prognosis.

Conclusions

Although the prognosis of CRC patients having BM is frequently very poor, those with good performance status and few brain lesions responded to aggressive treatment, while those with bone metastasis at the time of diagnosis of BM had relatively dismal survival rates, even when treated aggressively.

Clofazimine improves clinical outcomes in multidrug-resistant tuberculosis: a randomized controlled trial

OBJECTIVES

We carried out a randomized multicentre study in China to investigate whether the clofazimine would improve the efficacy of the standardized regimen in patients with multidrug-resistant tuberculosis (MDR-TB).

METHODS

Patients with MDR-TB managed in 17 TB specialist hospitals in China between September 2009 and September 2011 were randomly assigned to the treatment groups at enrolment. In the intervention group, 100 mg clofazimine per day was added to the standardized regimen. The primary outcome was the proportion of patients with successful outcomes.

RESULTS

From the 156 patients that were screened, 74 were assigned to the control group and 66 to the clofazimine group. Of the 66 cases analysed for clinical outcome in the clofazimine group, 36 patients were cured, and seven completed treatment, yielding a favourable outcome rate of 65.1%. The proportion of patients with favourable outcomes receiving the control regimen was 47.3% (35/74), which was significantly lower than that in the clofazimine group (p 0.034, relative risk 0.661, 95% CI 0.243-0.949).

CONCLUSIONS

The addition of clofazimine to the standard regimen improved the treatment of MDR-TB.

Case of severe acute hepatitis A virus infection in United Nations peacekeepers in South Sudan

Hepatitis A virus (HAV) is a major cause of acute viral hepatitis, which can lead to severe cases and acute liver failure. A 41-year-old Chinese military officer of the United Nations peacekeeping forces in South Sudan manifested fever, jaundice and coagulation dysfunction. The patient initially had a negative anti-HAV IgM antibody test result but a positive anti-HAV-IgM antibody test result five days after his alanine aminotransferase (ALT) levels peaked. He was given telemedicine consultation and was transferred to a Chinese military hospital specialising in infectious diseases for treatment of severe acute HAV infection. The peak ALT, aspartate aminotransferase, total bilirubin and international standard ratio were 5410 U/L, 3475 U/L, 225.1 µmol/L and 2.12 during hospitalisation, respectively. Military personnel undergoing missions in areas with high prevalence of HAV should be tested for previous HAV infection before departure if they have not been previously vaccinated. If negative results are obtained, they should be vaccinated. Anti-HAV-IgM examination should be repeated after the first negative test result is obtained to eliminate the effects of a window period if a clinical suspicion exists. If a life-threatening case of HAV infection is present, the patient should be transported to a base military hospital specialising in infectious diseases for treatment.