P4649Whole exome sequencing and whole genome sequencing improves genetic diagnosis of fetals with heterotaxy syndrome revealed by prenatal ultrasound

Background

Heterotaxy (Htx) syndrome is an congenital disorders resulting from incorrectly establishment of left-right patterning during embryogenesis. Over 96% of patients with Htx exhibit some form of congenital heart disease (CHD),and has relatively poor survival. Multiple lines of evidence support genetic contributions to the etiology of Htx. As a specific genetic etiology is currently identifiable in only a minority of patients, there remains enormous potential for novel gene and pathway discovery.

Purpose

The aim of this study was to investigate the diagnostic yield of whole-exome sequencing (WES) and whole-genome sequencing (WGS) in fetuses with the pathogenesis of Htx, to explore candidate genes for Htx and to expand the clinical phenotype of known genetic conditions.

Method

WES and WGS were performed on specimens from 46 fetuses diagnosed with Htx and their parents. The single-nucleotide variants (SNVs) and copy-number variants (CNVs) were filtered and annotated by standard analysis process. All reported variants were classified according to he American College of Medical Genetics and Genomics guidelines.

Results

In the 46 fetuses, the detection rates of pathogenic and likely pathogenic variations were21.7% (10/46) and 10.9% (5/46) respectively. Ten pathogenic variations were identified on genes of CCDC114, DNAH11, ARMC4, STRA6, PQBP1 (hemizygote), HYDIN, RAI1 (Alagille Syndrome), ZFMP2 and Del(22q11.2) Syndrome. Five likely pathogenic variation were on DNAAF1 (Holshner syndrome), NF1, NEXN, NOTCH3 and FOXC1. Of 30 fetuses with prenatally diagnosed right atrial isomerism (RAI), the main intracardiac anomalies were atrioventricular canal (AV canal), isomerism of right atrial appendages, pulmonary stenosis or atresia (PS & PA) and right aortic arch. In 16 fetuses diagnosed left atrial isomerism (LAI) the main intracardiac anomalies were isomerism of left atrial appendages, interrupted IVC and azygos vein continuation. Of the 10 positive cases, 8 fetus were diagnosed of RAI and 2 were diagnosed of LAI by prenatal ultrasonic examination or fetal autopsy. The detection rate was 8/30 (26.7%) for RAI and 2/16 (12.5%) for LAI.

Conclusion

This study outlines the way for a substantial improvement in the diagnostic yield of prenatal genetic disorders in Htx through WES and WGS. Our experience also expanded the knowledge of the clinical phenotype of known genetic conditions. Our results indicate that the proportion of SNV in Htx of prenatal cases was significantly higher than that in patients with other congenital heart abnormalities, and the recessive inheritance occurred in a higher proportion in Htx. Our results have important implications for clinical management and genetic counseling of Htx.

Acknowledgement/Funding

Ministry of Science and Technology of the People's Republic of China

CD44-Targeted Multifunctional Nanomedicines Based on a Single-Component Hyaluronic Acid Conjugate with All-Natural Precursors: Construction and Treatment of Metastatic Breast Tumors in Vivo

Metastasis is responsible for >90% of the deaths of breast cancer patients in the clinic. Here, we report on cross-linked multifunctional hyaluronic acid nanoparticles carrying docetaxel (DTX-CMHN) for enhanced suppression of highly metastatic 4T1 breast tumors in vivo. DTX-CMHN was formed from a single and all-natural hyaluronic acid-g-polytyrosine-lipoic acid conjugate (HA-g-PTyr-LA; HA, 20 kDa; PTyr, 2.2 kDa), and the size of DTX-CMHN increased from 69 to 78 to 96 nm as the increasing degree of substitution (DS) of PTyr increased from 4 to 11 to 15, respectively. Robust encapsulation of DTX was obtained when DS ≥ 11. DTX-CMHN while steady in a nonreducing environment was destabilized under 10 mM glutathione releasing ∼90% of the DTX within 24 h. It is noteworthy that DTX-CMHN exhibited better antitumor, antimigration, and anti-invasion activity in CD44-overexpressed 4T1-Luc breast cancer cells than free DTX. Interestingly, DTX-CMHN displayed a long elimination half-life of 5.75 h, in contrast to half-lives of 2.11 and 0.75 h for its non-cross-linked counterpart (DTX-MHN) and free DTX, respectively. In vivo therapeutic studies showed significantly better inhibition of primary 4T1-Luc tumor growth and lung metastasis and lower toxicity of DTX-CMHN compared with that of free DTX. These multifunctional nanoformulations based on a single and all-natural hyaluronic acid conjugate emerge as a potential nanoplatform for targeted treatment of CD44-positive metastatic tumors.

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

Objectives

CT-based three-column classification (TCC) has been widely used in the treatment of tibial plateau fractures (TPFs). In its updated version (updated three-column concept, uTCC), a fracture morphology-based injury mechanism was proposed for effective treatment guidance. In this study, the injury mechanism of TPFs is further explained, and its inter- and intraobserver reliability is evaluated to perfect the uTCC.

Methods

The radiological images of 90 consecutive TPF patients were collected. A total of 47 men (52.2%) and 43 women (47.8%) with a mean age of 49.8 years (sd 12.4; 17 to 77) were enrolled in our study. Among them, 57 fractures were on the left side (63.3%) and 33 were on the right side (36.7%); no bilateral fracture existed. Four observers were chosen to classify or estimate independently these randomized cases according to the Schatzker classification, TCC, and injury mechanism. With two rounds of evaluation, the kappa values were calculated to estimate the inter- and intrareliability.

Results

The overall inter- and intraobserver agreements of the injury mechanism were substantial (κ_inter = 0.699, κ_intra = 0.749, respectively). The initial position and the force direction, which are two components of the injury mechanism, had substantial agreement for both inter-reliability or intrareliability. The inter- and intraobserver agreements were lower in high-energy fractures (Schatzker types IV to VI; κ_inter = 0.605, κ_intra = 0.721) compared with low-energy fractures (Schatzker types I to III; κ_inter = 0.81, κ_intra = 0.832). The inter- and intraobserver agreements were relatively higher in one-column fractures (κ_inter = 0.759, κ_intra = 0.801) compared with two-column and three-column fractures.

Conclusion

The complete theory of injury mechanism of TPFs was first put forward to make the TCC consummate. It demonstrates substantial inter- and intraobserver agreement generally. Furthermore, the injury mechanism can be promoted clinically.

Cite this article: B-B. Zhang, H. Sun, Y. Zhan, Q-F. He, Y. Zhu, Y-K. Wang, C-F. Luo. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res 2019;8:357–366. DOI: 10.1302/2046-3758.88.BJR-2018-0331.R1.

Cellular Targeting of Bispecific Antibody-Functionalized Poly(ethylene glycol) Capsules: Do Shape and Size Matter?

In the present study, a capsule system that consists of a stealth carrier based on poly(ethylene glycol) (PEG) and functionalized with bispecific antibodies (BsAbs) is introduced to examine the influence of the capsule shape and size on cellular targeting. Hollow spherical and rod-shaped PEG capsules with tunable aspect ratios (ARs) of 1, 7, and 18 were synthesized and subsequently functionalized with BsAbs that exhibit dual specificities to PEG and epidermal growth factor receptor (EGFR). Dosimetry (variation between the concentrations of capsules present and capsules that reach the cell surface) was controlled through "dynamic" incubation (i.e., continuously mixing the incubation medium). The results obtained were compared with those obtained from the "static" incubation experiments. Regardless of the incubation method and the capsule shape and size studied, BsAb-functionalized PEG capsules showed >90% specific cellular association to EGFR-positive human breast cancer cells MDA-MB-468 and negligible association with both control cell lines (EGFR negative Chinese hamster ovary cells CHO-K1 and murine macrophages RAW 264.7) after incubation for 5 h. When dosimetry was controlled and the dose concentration was normalized to the capsule surface area, the size or shape had a minimal influence on the cell association behavior of the capsules. However, different cellular internalization behaviors were observed, and the capsules with ARs 7 and 18 were, respectively, the least and most optimal shape for achieving high cell internalization under both dynamic and static conditions. Dynamic incubation showed a greater impact on the internalization of rod-shaped capsules (∼58-67% change) than on the spherical capsules (∼24-29% change). The BsAb-functionalized PEG capsules reported provide a versatile particle platform for the evaluation and comparison of cellular targeting performance of capsules with different sizes and shapes in vitro.

Texture analysis of multi-phase MRI images to detect expression of Ki67 in hepatocellular carcinoma

AIM

To determine whether texture analysis of preoperative magnetic resonance imaging (MRI) images could be used to detect Ki67 expression, a widely used cell proliferation marker in hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

In total, 83 patients were included, 25 with low Ki67 (Ki67 ≤10%) HCC expression and 58 with high Ki67 (Ki67 ≥10%) HCC expression as demonstrated by retrospective surgical evaluation. All patients were examined using a 3 T MRI unit with one standard protocol. The region of interest was drawn manually by one radiologist. Texture analysis included histogram, co-occurrence matrix, run-length matrix, gradient, auto-regressive model, and wavelet transform features as calculated by MaZda (version 4.6; quantitative texture analysis software). The features reduced by the Fisher, probability of classification error, and average correlation coefficient (POE+ACC), mutual information were used to select the features that predicted Ki67 proliferation status with highest accuracy and then using the B11 program for data analysis and classification.

RESULTS

The misclassification rate of the principal component analysis (PCA) in the hepatobiliary phase (HBP), T2-weighted imaging (T2WI), arterial phase (AP), and portal vein phase (PVP) was 36/83 (43.37%), 35/82 (42.68%), 40/83 (48.19%), and 34/83 (40.96%), respectively. The misclassification of the linear discriminant analysis in HBP, T2WI, AP, and PVP phase was 13/83 (15.66%), 21/82 (25.61%), 9/83 (10.84%), and 8/83 (9.64%), respectively. The misclassification of the nonlinear discriminant analysis in HBP, T2WI, AP, and PVP phase was 7/83 (8.43%), 6/82 (7.32%), 5/83 (6.02%), and 7/83 (8.43%), respectively.

CONCLUSIONS

Texture analysis of HBP, AP, and PVP were helpful for predicting Ki67 expression and may provide a less-invasive method to investigate critical histopathology markers for HCC.

Fetal cardiac tumor: echocardiography, clinical outcome and genetic analysis in 53 cases

OBJECTIVE

To analyze the imaging and clinical features of fetal cardiac tumors, and to explore the relationship between tuberous sclerosis complex (TSC) and cardiac rhabdomyoma in the fetus.

METHODS

Fifty-three women pregnant with a fetus affected by cardiac tumor(s) were examined by standardized fetal echocardiography (FE), and fetuses, mothers and fathers, including other relevant family members if necessary, underwent familial TSC genetic testing. Relevant pathological features, including pathological findings at clinical examination of liveborn infants and autopsy findings in terminated cases, were noted.

RESULTS

Of the 53 fetuses, 37 had multiple cardiac tumors and 16 had a single cardiac tumor detected by FE. In all 53 fetuses and their families, TSC genetic testing was successful, showing that 37 of the fetuses had a TSC1 (n = 6) or TSC2 (n = 31) pathogenic or suspected pathogenic mutation, of which 25 were spontaneous and 12 were familial mutations. The proportion of single and multiple cardiac tumors at FE was significantly different between the group of fetuses with positive genetic test results and that with negative results for TSC (31% and 86%, respectively), although the presence of multiple or single tumors was not associated with the type of TSC mutation. The decision to terminate the pregnancy was made by 45 women and their families, and eight fetuses were liveborn. Autopsy was performed in 38 fetuses, which revealed 36 cases with pathologically confirmed cardiac rhabdomyoma, one case of hemangioma and one case of fibroma. 93% of fetuses with multiple rhabdomyomas at autopsy and 71% of those with a single cardiac rhabdomyoma harbored a TSC1 or TSC2 mutation.

CONCLUSION

Cardiac rhabdomyoma is the most common cardiac tumor in the fetus. The correlation between cardiac rhabdomyoma and TSC is strong regardless of the presence of single or multiple tumors. For fetuses with suspected cardiac rhabdomyoma identified by FE, prenatal genetic testing for TSC of both fetus and family members is recommended. A positive genetic diagnosis can help in counseling and planning for neonatal treatment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

RNA interference-mediated silencing of aquaporin (AQP)-5 hinders angiogenesis of colorectal tumor by suppressing the production of vascular endothelial growth factor

Aquaporin (AQP)-5 is an essential member of AQP family involved in the tumorigenesis of various malignant tumors. However, its role in the angiogenesis of colorectal cancer is unclear and requires further investigation. In this study, a pRNA-H1.1 vector containing the short hairpin RNA (shRNA) targeting AQP5 mRNA was constructed to inhibit the endogenous expression of AQP5 in human umbilical vein endothelial cells (HUVECs). We found that the AQP5-silenced HUVECs acquired decreased proliferation, migration and tube formation ability. AQP5 shRNA also inhibited the enzyme activity of matrix metalloprotease (MMP)-9 in HUVECs without affecting the MMP-2. Further, two colorectal cancer cell lines (HT29 and HCT116) stably transfected with scrambled or AQP5 shRNA were established. The expression and secretion of vascular endothelial growth factor (VEGF)-A (a pro-angiogenic factor) in colorectal cancer cells were downregulated by AQP5 shRNA. HUVECs cultured in low-VEGF conditioned media (CM) obtained from cancer cells developed less vessel-like tubes and had decreased proliferation and migration. The growth and angiogenesis of xenograft tumors were suppressed when the endogenous AQP5 in HT29 cells was knocked down. Tumor samples were additionally collected from patients with colorectal cancer to analyze the expression of AQP5. The immunofluorescence data indicated that AQP5 was expressed in both inner cancer areas and CD31-positive vessels. Taken together, our study suggests AQP5 as a novel anti-angiogenesis target for colorectal cancer.

Different role of TTX-sensitive voltage-gated sodium channel (NaV 1) subtypes in action potential initiation and conduction in vagal airway nociceptors

KEY POINTS

The action potential initiation in the nerve terminals and its subsequent conduction along the axons of afferent nerves are not necessarily dependent on the same voltage-gated sodium channel (Na_V 1) subunits. The action potential initiation in jugular C-fibres within airway tissues is not blocked by TTX; nonetheless, conduction of action potentials along the vagal axons of these nerves is often dependent on TTX-sensitive channels. This is not the case for nodose airway Aδ-fibres and C-fibres, where both action potential initiation and conduction is abolished by TTX or selective Na_V 1.7 blockers. The difference between the initiation of action potentials within the airways vs. conduction along the axons should be considered when developing Na_V 1 blocking drugs for topical application to the respiratory tract.

ABSTRACT

The action potential (AP) initiation in the nerve terminals and its subsequent AP conduction along the axons do not necessarily depend on the same subtypes of voltage-gated sodium channels (Na_V 1s). We evaluated the role of TTX-sensitive and TTX-resistant Na_V 1s in vagal afferent nociceptor nerves derived from jugular and nodose ganglia innervating the respiratory system. Single cell RT-PCR was performed on vagal afferent neurons retrogradely labelled from the guinea pig trachea. Almost all of the jugular neurons expressed the TTX-sensitive channel Na_V 1.7 along with TTX-resistant Na_V 1.8 and Na_V 1.9. Tracheal nodose neurons also expressed Na_V 1.7 but, less frequently, Na_V 1.8 and Na_V 1.9. Na_V 1.6 were expressed in ∼40% of the jugular and 25% of nodose tracheal neurons. Other Na_V 1 α subunits were only rarely expressed. Single fibre recordings were made from the vagal nodose and jugular nerve fibres innervating the trachea or lung in the isolated perfused vagally-innervated preparations that allowed for selective drug delivery to the nerve terminal compartment (AP initiation) or to the desheathed vagus nerve (AP conduction). AP initiation in jugular C-fibres was unaffected by TTX, although it was inhibited by Na_V 1.8 blocker (PF-01247324) and abolished by combination of TTX and PF-01247324. However, AP conduction in the majority of jugular C-fibres was abolished by TTX. By contrast, both AP initiation and conduction in nodose nociceptors was abolished by TTX or selective Na_V 1.7 blockers. Distinction between the effect of a drug with respect to inhibiting AP in the nerve terminals within the airways vs. at conduction sites along the vagus nerve is relevant to therapeutic strategies involving inhaled Na_V 1 blocking drugs.

Jasmonic acid-induced hydrogen sulfide activates MEK1/2 in regulating the redox state of ascorbate in Arabidopsis thaliana leaves

In this paper, we investigated the relationship between hydrogen sulfide (H₂S) and mitogen-activated protein kinase kinase (MEK1/2) in jasmonic acid (JA)-regulated the redox state of ascorbate in the leaves of Arabidopsis thaliana. The results showed that JA significantly enhanced the phosphorylation level of MEK1/2, the production of endogenous H₂S and the ratio of reduced ascorbate (AsA) to dehydroascorbate (DHA) (AsA/DHA) in wild type of A. thaliana (WT). However, there were no obvious effects of JA on above indicators in H₂S synthetic mutant of A. thaliana (MT). H₂S scavenger hypotaurine (HT) markedly reduced JA-induced the phosphorylation level of MEK1/2, AsA/DHA ratio and the production of endogenous H₂S in WT. Application of H₂S donor sodium hydrosulfide (NaHS) to JA-treated MT plants increased above indicators. Application of NaHS to (HT+JA)-treated MT plants did not reverse the effects of HT on above JA-induced indicators. MEK1/2 inhibitor PD98059 decreased JA-induced AsA/DHA ratio and the transcript levels and the activities of ascorbate peroxidase (APX), glutathione reductase (GR), monodehydroascorbate reductase (MDHAR), dehydroascorbate reductase (DHAR) and L-galactono-1,4-lactone dehydrogenase (GalLDH) in WT. However, PD98059 had no effect on JA-induced the production of endogenous H₂S in WT. Compared with Control-MT, there were no obvious effects of JA on the production of endogenous H₂S, AsA/DHA ratio and the transcript levels and activities of above enzymes in MT. However, application of PD98059 reduced above JA-induced indicators except the production of endogenous H₂S and DHA content in MT. Our results suggested that H₂S activated MEK1/2 in JA-regulated AsA/DHA ratio in A. thaliana leaves through enzymes in ascorbate metabolism.

Small hepatocellular carcinoma: using MRI to predict histological grade and Ki-67 expression

AIMS

To investigate the predictive indicators of small aggressive hepatocellular carcinomas by examining the association between preoperative magnetic resonance imaging (MRI) parameters and Ki-67 expression and histological grade.

MATERIALS AND METHODS

Sixty patients with small hepatocellular carcinomas (tumour diameter: ≤3 cm, tumour numbers: ≤2) who underwent curative resection or biopsy after contrast-enhanced and diffusion-weighted MRI were evaluated retrospectively. Signal intensity (SI) of the whole lesion and erector spinae muscle was measured quantitatively. Tumour-to-muscle SI ratio was calculated. The association between these MRI parameters and histological grade and Ki-67 level was then investigated.

RESULTS

There was a significant correlation between tumour-to-muscle SI ratio and histological grade in tissues captured during the non-enhanced T1-weighted (p=0.001), arterial phase (p=0.001), and portal venous phase (p=0.036) of dynamic contrast-enhanced MRI and apparent diffusion coefficient (p=0.027). Arterial inhomogeneous enhancement was also correlated with high-Ki-67 expression (p=0.032).

CONCLUSIONS

Preoperative MRI may serve as a non-invasive tool for prediction of small, aggressive hepatocellular carcinomas, which may otherwise be treated conservatively.

[Screening of optimal siRNA interference sequence of CIT gene and its inhibition expression in hepatoma SK-Hep-1]

Objective: To construct and screen optimal siRNA interference sequence of CIT gene and to detect its interference efficiency as well as proliferation effect in human hepatoma cell line SK-Hep-1. Methods: Three siRNA target spots were designed and synthesized according to the CIT gene sequence. SK-Hep-1 HCC cells were transfected by liposome transfection. The knockdown efficiency of the target CIT gene was detected by real-time PCR and Western blot. Expressional change of CIT in SK-Hep-1 cells after 48 hours of siRNA interference were observed by immunohistochemistry and confocal microscopy. The proliferation of SK-Hep-1 cells after 48 hours of siRNA interference was detected by EdU cell proliferation assay. A t-test was used to compare the mean of two samples, and one-way ANOVA was used to compare the mean of multiple samples. Results: Western blot results showed that the three interference sequences were targeted at different target spots. The expression level of CIT protein in KD-1,-2, and-3 groups were decreased (P < 0.01) than control, while the protein expression level of KD1 group was the lowest. Real-time PCR results showed that compared with the control group, the expression level of CIT mRNA in KD-1, -2, and -3 groups decreased (P < 0.01), while that in KD1 group was the lowest. Laser confocal microscopy also confirmed that the morphological expression of CIT attenuated significantly after transfection with siRNA. The results of EdU proliferation assay showed that siRNA transfected with CIT significantly attenuated the proliferation of SK-Hep-1 hepatoma cells (P < 0.05). Conclusion: The successful construction and screening of siRNA fragments can effectively inhibit the expression and proliferation of CIT gene in hepatoma SK-Hep-1.

HLA-A*02:01:01:28, a novel HLA allele identified by next-generation sequencing in a Chinese family

HLA-A*02:01:01:28 differs from A*02:01:01:01 by one nucleotide transition, T>A 2952 in intron 6.

Next-generation sequencing-based typing of a new allele HLA-DQB1*03:01:01:20 in a Chinese family

DQB1*03:01:01:20 showed one nucleotide difference when compared to DQB1*03:01:01:01 at 224 (C>T).

Genetic parameter estimates for body conformation traits using composite index, principal component, and factor analysis

Information about genetic parameters is population specific and it is crucial for designing animal breeding programs and predicting response to selection. This study was carried out to estimate the genetic parameters for 23 body conformation traits of 45,517 Chinese Holstein reared in Eastern China from 1995 to 2017 with the Bayesian inference method using a linear animal mixed model. The methods to integrate these traits included (1) using the composite index from the Dairy Association of China and (2) applying principal component analysis and factor analysis to explore the relationship between the conformation traits. Estimates of heritability using the composite index were low (0.04; feet and legs) to moderate (0.23; body capacity). Strong genetic correlations were observed between the individual body conformation traits. Both principal components (1 to 7; eigenvalues ≥ 1) and latent factors (1 to 7; eigenvalues ≥ 1) explained 60.37% of total variability. Principal component 1 and factor 1 accounted for the traits that are usually associated with milk production. Moderate to low heritability were estimated through multi-trait analysis for principal components (from 0.07 to 0.21) and latent factors (from 0.07 to 0.23). Genetic correlations among the 2 multivariate techniques are typically lower compared with the one existing among the measured traits. Results from these analyses suggest the possibility of using both principal component analysis and factor analysis in morphological evaluation, simplifying the information given by the body conformation traits into new variables that could be useful for the genetic improvement of the Chinese Holstein population. This information could also be used to avoid analyzing large number of correlated traits, thereby improving precision and reducing computation burdens to analyze large and complex data.

The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: an intervention and prospective cohort study in China

OBJECTIVES

To explore the effect of isolated maternal hypothyroxinemia (IMH) during the first and second trimester of gestation on pregnancy outcomes. To explore whether levothyroxine (L-T4) treatment of women who had IMH identified in the first trimester improves pregnancy outcomes.

METHODS

Women in the early pregnancy in the iodine-sufficient area (n = 3398) were recruited to this prospective cohort study (ChiCTR-TRC-12002326). Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were detected. Women with IMH before 12 weeks chose to receive L-T4 or remain untreated. The L-T4 dose was adjusted to attain a normal FT4 and TSH level. Pregnancy outcomes were evaluated during follow-up.

RESULTS

IMH in the first trimester was not associated with increased risk of adverse pregnancy outcome compared with controls. The incidence of macrosomia (p = 0.022) and gestational hypertension (p = 0.018) was significantly higher in IMH identified in the second trimester of gestation compared with controls. IMH identified in the second trimester of gestation was a risk factor for macrosomia [adjusted odds ratio (aOR) 1.942, 95% CI 1.076-3.503, p = 0.027] and gestational hypertension (aOR 4.203, 95% CI 1.611-10.968, p < 0.01), when body mass index in the early pregnancy was < 25 kg/m².

CONCLUSIONS

IMH in the first trimester did not increase the risk of adverse outcomes irrespective of whether women received L-T4 treatment. However, IMH identified in the second trimester was associated with increased risk of adverse pregnancy outcome. The results suggest that thyroid function follow-up during the second trimester is necessary, even if thyroid function is normal during the first trimester.

Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9-mediated mutagenesis of the multiple edematous wings gene induces muscle weakness and flightlessness in Bactrocera dorsalis (Diptera: Tephritidae)

The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9) system is a versatile, efficient and heritable gene editing tool that can be useful for genome engineering. Bactrocera dorsalis (Hendel) is a major pest of agriculture that causes great economic losses. We used the B. dorsalis multiple edematous wings (Bdmew) gene as the target gene to explore the effectiveness of CRISPR/Cas9 for B. dorsalis genome manipulation. We studied the physiological functions of the Bdmew gene, particularly those related to muscle development. Site-specific genome editing was feasible using direct microinjection of specific guide RNA and the Cas9-plasmid into B. dorsalis embryos. Mutation frequencies ranged from 12.1 to 30.2% in the injected generation. Mosaic G0, with the mew mutation, was heritable to the next generation. The G1 displayed a series of defective phenotypes including muscle weakness, flightlessness, failure to eclose, wing folds and unbalanced movement. These results demonstrated that CRISPR/Cas9 can act as a highly specific, efficient, heritable tool for genome manipulation in B. dorsalis and this has significance for gene function research and genetic control of pests. The Bdmew gene possesses key functions in muscle development of B. dorsalis. Bdmew mutations cause a series of serious defects by interfering with muscle development and may provide a means for controlling B. dorsalis via a gene-based method such as gene drive.

Systematic analyses for candidate genes of milk production traits in water buffalo (Bubalus Bubalis)

Water buffalo (Bubalus bubalis) is of great economic importance as a provider of milk and meat in many countries. However, the milk yield of buffalo is much lower than that of Holstein cows. Selection of candidate genes related to milk production traits can be applied to improve buffalo milk performance. A systematic review of studies of these candidate genes will be greatly beneficial for researchers to timely and efficiently understand the research development of molecular markers for buffalo milk production traits. Here, we identified and classified the candidate genes associated with buffalo milk production traits. A total of 517 candidate genes have been identified as being associated with milk performance in different buffalo breeds. Nineteen candidate genes containing 47 mutation sites have been identified using the candidate gene approach. In addition, 499 candidate genes have been identified in six genome-wide association studies (GWASes) including two studies performed with the bovine SNP chip and four studies with the buffalo SNP chip. Genes CTNND2 (catenin delta 2), APOB (apolipoprotein B), FHIT (fragile histidine triad) and ESRRG (estrogen related receptor gamma) were identified in at least two GWASes. These four genes, especially APOB, deserve further study to explore regulatory roles in buffalo milk production. With growth in the number of buffalo genomic studies, more candidate genes associated with buffalo milk production traits will be identified. Therefore, future studies, such as those investigating gene location and functional analyses, are necessary to facilitate the exploitation of genetic potential and the improvement of buffalo milk performance.

Evaluation of Diffusional Kurtosis Imaging in Sub-acute Ischemic Stroke: Comparison with Rehabilitation Treatment Effect

Stroke is a serious worldwide medical condition that causes neurological function disability. Diffusional kurtosis imaging, which measures the non-Gaussianity of water diffusion, has been demonstrated to be a sensitive biomarker in many neuro-pathologies. This study explores the relationship between neural function recovery and transformation of the ischemic lesion and/or corticospinal tract during the sub-acute phase after stroke by using diffusional kurtosis imaging. We performed a prospective study of function recovery and K metrics of 43 patients with sub-acute ischemic stroke in the middle cerebral artery territory. The effect of rehabilitation treatment was evaluated using both the Fugl-Meyer motor function score and modified Barthel index score at post-treatment compared with admission, and patients were allocated to two groups: good and poor rehabilitation effect (GRE and PRE). Metrics of diffusional kurtosis imaging within ischemic lesion and along the corticospinal tract were acquired, respectively. All three relative axial diffusional kurtoses (rKas) along the corticospinal tract in the GRE group ( n = 21) were significantly larger than those of the PRE group ( n = 22), including rKa in the posterior limb of internal capsule, rKa in the cerebral peduncle, and rKa in the basal part of the pons ( p = 0.014, 0.005, and 0.021, respectively). This multi-parametric magnetic resonance imaging study showed that diffusional kurtosis imaging has the potential to complement existing stroke imaging techniques and revealed its own advantages in elucidating the possible biophysical mechanism of functional restoration underlying ischemic stroke.

cRGD-decorated biodegradable polytyrosine nanoparticles for robust encapsulation and targeted delivery of doxorubicin to colorectal cancer in vivo

The clinical success of nanomedicines demands on the development of simple biodegradable nanocarriers that can efficiently and stably encapsulate chemotherapeutics while quickly release the payloads into target cancer cells. Herein, we report that cRGD-decorated biodegradable polytyrosine nanoparticles (cRGD-PTN) boost encapsulation and targeted delivery of doxorubicin (DOX) to colorectal cancer in vivo. The co-assembly of poly(ethylene glycol)-poly(L-tyrosine) (PEG-PTyr) and cRGD-functionalized PEG-PTyr (mol/mol, 80/20) yielded small-sized cRGD-PTN of 70 nm. Interestingly, cRGD-PTN exhibited an ultra-high DOX encapsulation with drug loading contents ranging from 18.5 to 54.1 wt%. DOX-loaded cRGD-PTN (cRGD-PTN-DOX) was highly stable against dilution, serum, and Triton X-100 surfactant, while quickly released DOX in HCT-116 cancer cells, likely resulting from enzymatic degradation of PTyr. Flow cytometry, confocal microscopy and MTT assays displayed that cRGD-PTN-DOX was efficiently internalized into α_vβ₅ overexpressing HCT-116 colorectal cancer cells, rapidly released DOX into the nuclei, and induced several folds better antitumor activity than non-targeted PTN-DOX and clinically used liposomal DOX (Lipo-DOX). SPECT/CT imaging revealed strong tumor accumulation of ¹²⁵I-labeled cRGD-PTN, which was 2.8-fold higher than ¹²⁵I-labeled PTN. Notably, cRGD-PTN-DOX exhibited over 5 times better toleration than Lipo-DOX and significantly more effective inhibition of HCT-116 colorectal tumor than non-targeted PTN-DOX control, affording markedly improved survival rate in HCT-116 tumor-bearing mice with depleting side effects at 6 or 12 mg DOX equiv./kg. cRGD-PTN-DOX with great simplicity, robust drug encapsulation and efficient nucleic drug release appears promising for targeted chemotherapy of colorectal tumor.

MMP-8-Responsive Polyethylene Glycol Hydrogel for Intraoral Drug Delivery

Currently available drug delivery systems for oral diseases suffer from short retention time and poor local concentrations at the target site. A biodegradable stimulus-responsive hydrogel was synthesized in the present study to evaluate its application as an environmentally sensitive carrier for on-demand intraoral drug delivery. The hydrogel was synthesized from diacrylate-containing polyethylene glycol-based scaffolds and a cysteine-terminated peptide crosslinker (CGPQG↓IWGQC) via a Michael-type addition reaction. Because CGPQG↓IWGQC can be cleaved by matrix metalloproteinase 8 (MMP-8), minocycline hydrochloride, bovine serum albumin, or an antibacterial peptide (KSL) was incorporated into the scaffolds to evaluate the MMP-8-responsive release behavior of the on-demand drug delivery system. Hydrogel characterization and gelation kinetics were examined with gel time, Fourier-transform infrared spectroscopy, scanning electron microscopy, and measurements of rheologic parameters. Degradation behavior and MMP-8-responsive drug release were performed by high-performance liquid chromatography and protein-specific assay. Biocompatibility evaluation indicated that the hydrogels were noncytotoxic. Antibacterial testing demonstrated that the released drugs were able to maintain bioactivity. Taken together, these results suggest that the MMP-8-sensitive hydrogel is a promising candidate for on-demand intraoral localized drug delivery. Because MMP-8 is one of the most important biomarkers for periodontitis, the MMP-8-responsive hydrogel has potential to be used for in situ adaptive degradation in response to chronic periodontitis and peri-implantitis. This notion has to be tested in animal models of periodontal disease.

6-year change in resting heart rate is associated with incident type 2 diabetes mellitus

BACKGROUND AND AIMS

Elevated resting heart rate (RHR) is associated with risk of type 2 diabetes mellitus (T2DM). However, the association of change in RHR (ΔRHR) and incident T2DM is not fully elucidated. We aimed to assess the dose-response association between 6-year ΔRHR and T2DM.

METHODS AND RESULTS

A total of 12155 non-T2DM participants ≥18 years old were enrolled during 2007-2008 and followed up during 2013-2014. ΔRHR was calculated by subtracting the baseline RHR from the RHR value at 6-year follow-up. Age-, sex-, and RHR-specific relative risks (RRs) and 95% confidence intervals (CIs) for the effect of ΔRHR on incident T2DM were calculated by using modified Poisson regression models. As compared with ΔRHR of 0 beats/min, the adjusted risk of T2DM was significantly increased with RHR increment and reduced with RHR reduction. ΔRHR was positively associated with future risk of T2DM [RR per unit increase: 1.03 (1.03-1.04)]. As compared with stable change in RHR group (-5<ΔRHR<5 beats/min), for ΔRHR ≤ -10 beats/min, -10<ΔRHR ≤ -5 beats/min, 5≤ΔRHR<10 beats/min, and ΔRHR ≥10 beats/min groups, the pooled adjusted RR (95% CI) of T2DM was 0.69 (0.55-0.86), 0.90 (0.73-1.11), 1.31 (1.07-1.61), and 1.90 (1.59-2.26), respectively. This significant association still existed on subgroup analyses based on age, sex, and baseline RHR and sensitivity analyses.

CONCLUSIONS

Dynamic RHR change was significantly associated with incident T2DM. Our study suggests that RHR may be a non-invasive clinical indicator for interventions aiming to reduce incident T2DM in the general population.

[Effects of sIL-13Rα2 on the nasal mucosa goblet cell apoptosis of allergic rhinitis of rats]

Objective: To investigate the effects of sIL-13Rα2 on the apoptosis of goblet cell in nasal mucosa of allergic rhinitis rats. Methods: Forty healthy male Wistar rats were randomly divided into 4 groups (10 rats per group): control group (group A), AR group (group B), sIL-13Rα2 group (group C) and triamcinolone acetonide group (group D). Ovalbumin (OVA) and aluminum hydroxide were used to establish the AR rat model. After the establishment of AR rat models, 50 μl PBS, 100 μg/50 μl IL-13Rα2 and 3.5 μg/50 μl triamcinolone acetonide were respectively dropped into each nasal cavity of every rat two times a week from 4 to 10 week in group B, group C and group D. Group A was operated with saline instead of OVA. The nasal mucosa tissues were collected at 24 h after the final administration. AB-PAS staining method was used to detect the quantity and secretion of goblet cells in the nasal mucosa tissue of all groups. Immunohistochemistry method was used to detect the expression of Bax proteins.Apoptosis was detected by TUNEL method.ANOVA analysis was used to compare multiple groups, and LSD-t test was used to compare the two groups.Pearson correlation analysis was used to analyze the correlation between the Bax positive cell rate of goblet cells and the rate of apoptotic cells. The difference was statistically significant with P<0.05. Results: Compared with group A, there were more goblet cells and hypersecretion of mucus in the nasal mucosa tissue of rats in group B while fewer in group C. The goblet cells in group C and group D were significantly fewer than that in group B (0.639 00±0.831 vs 0.956 7±0.980, 0.661 90±0.657 vs 0.956 7±0.980, t value was 2.748, 2.767, respectively, all P<0.05). The immunohistochemistry results showed that the positive expression rates of Bax protein in goblet cells of group C and group D were significantly higher than that in group B (0.880 2±0.125 vs 0.568 7±0.953, 0.938 4±0.200 vs 0.568 7±0.953, t value was -2.292, -2.685, respectively, all P<0.05). The apoptosis rates of goblet cell in nasal mucosa of group C and group D were also significantly higher than that in group B (0.516 0±0.079 vs 0.274 0±0.056, 0.535 4±0.829 vs 0.274 0±0.056, t value was -17.671, -2.225, respectively, all P<0.05). The expression of Bax protein and apoptosis of goblet cells were positively correlated (r=0.859, P<0.01). Conclusion: sIL-13Rα2 can induce apoptosis of the goblet cells in nasal mucosa of allergic rhinitis rats, by inhibiting IL-13 and up regulating Bax.

Abstract P6-17-38: Clinical and pathological features of breast cancer with 'polysomy' of Chromosome 17

Background: Anti-HER2 therapy is a standard of care for patients with HER2+ breast cancer. HER2 status is routinely evaluated using immunohistochemical stain and/or florescence in situ hybridization (FISH). Interpretation of FISH results may be challenging in tumors with 'polysomy' of chromosome 17 ('polysomy'17), which is defined by increased chromosome enumeration probe 17 (CEP17) signal number. There is evident that 'polysomy'17 might account for anti-HER2 therapy response in breast cancer (BC) with normal HER2/CEP17 ratio. This study aims to study the clinical and pathological features of BC with 'polysomy'17. Method: Primary BC were selected based on elevated CEP17 count (≥3.0) in HER2 FISH performed at MD Anderson Cancer Center between April 2014 and March 2018 (n=385). Patient charts were reviewed for detailed clinical and pathological features. These cases were further divided into four groups according to HER2/CEP17 and HER2 copy number, based on ASCO-CAP guidelines: group 1 (HER2+) – HER2/CEP17≥2.0, HER2 copies≥4.0; group 3 (HER2+) – ratio&lt;2.0, HER2 copies≥ 6.0; group 4 (HER2 equivocal) – ratio &lt;2.0, HER2 copies ≥4.0 and &lt;6.0; group 5 (HER2-) – ratio&lt;2.0, HER2 copies&lt;4.0. Chi-square tests were performed to study the difference of these characters. Results: In comparison with groups 1 and 3, BC in groups 4 and 5 are more commonly seen in elder patients (p=0.001). Also, these tumors show higher pathological category (p&lt;0.001) and higher rate of lymph nodes metastasis (p&lt;0.05). The clinical and pathological features are summarized in [Table 1]. Conclusion: Understanding the clinical and pathological features of BC with 'polysomy'17 may help clinically to choose patients who might be benefit from anti-HER2 therapy. Further study is to follow up the therapy response of those who received anti-HER2 treatment in this cohort of patients.

Clinical and pathological characteristics of breast cancer with 'polysomy' of chromosome 17  Total (N=385)Group 1 ( N=131)Group 3 (N=25)Group 4 (N=69)Group 5 (N=160)P valueAge (year)Mean (range)56.8 (25-94)53.9 (25-83)52.8 (26-75)58 (33-92)59.3 (29-94)0.001Race RaceBlack (%)37 (9.6)14 (10.7)4 (16)5 (7.2)14 (8.8)0.873 Hispanic (%)61 (15.8)23 (17.6)3 (12)12 (17.4)23 (14.4)  White (%)251 (65.2)82 (62.6)14 (56)44 (63.8)111 (69.4)  Other (%)36 (9.4)12 (9.1)4 (16)8 (11.6)12 (7.4) GenderFemale (%)383 (99.5)131 (100)25 (100)68 (98.6)159 (99.4)0.478 Male (%)2 (0.5)0 (0)0 (0)1 (1.4)1 (0.6) Histology typeIDC, NOS (%)350 (90.9)121 (92.4)20 (80)66 (95.7)143 (89.4)0.471 ILC (%)9 (2.3)3 (2.3)1 (4)0 (0)5 (3.1)  Others (%)26 (6.8)7 (5.3)4 (16)3 (4.3)12 (7.5) Nuclear gradeI (%)4 (1.2)2 (1.8)0 (0)1 (1.8)1 (0.7)0.044 II (%)122 (37)30 (26.3)12 (50)19 (33.3)61 (45.5)  III (%)203 (61.8)82 (71.9)12 (50)37 (64.9)72 (53.8)  NA561711226 Pathological tumor categorypT0+Tis (%)61 (21)36 (36.3)3 (20)5 (10.9)17 (13.1)&lt;0.001 pT1 (%)125 (43.2)39 (39.4)7 (46.7)20 (43.5)59 (45.4)  pT2+T3+T4 (%)104 (35.8)24 (24.3)5 (33.3)21 (45.6)54 (41.5)  NA9532102330 Pathological lymph node categorypN0 (%)187 (65.4)81 (82.7)11 (73.3)22 (47.8)73 (57.5)0.048 pN1+N2+N3 (%)99 (34.6)17 (17.3)4 (26.7)24 (52.2)54 (42.5)  pNx (%)9933102333 

Citation Format: Sun H, Chen H, Lim B, Sahin AA. Clinical and pathological features of breast cancer with 'polysomy' of Chromosome 17 [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 P6-17-38.

Abstract P2-14-28: Local surgery improves survival in patients with primary metastatic breast cancer: A population-based study

Background

The aim of this study was to assess the prognosis of breast cancer patients with distant metastasis after surgery of the primary tumor and provide new understanding of treatment for these patients.

Methods

We retrospectively analyzed 8922 primary metastatic breast cancer (PMBC) patients from Surveillance, Epidemiology, and End Results (SEER) Database. The patients' clinical and pathological characteristics were investigated. Overall survival (OS) and breast cancer-specific survival (BCSS) were calculated by Kaplan-Meier method. Independent risk factors associated with disease special mortality were identified by Cox regression analysis.

Results

A total of 8922 PMBC patients from SEER database were identified, while 1724 (19.3%) of them received surgery therapy (ST) and 7198 (80.1%) patients were identified as no surgery therapy group (NST). Patients' underwent ST had dramatically increased OS (P&lt;0.001) and BCSS (P&lt;0.001) compared with those in NST group. And the result figured out that the patients with 1 or 2 distant metastatic sites might benefit most from local surgery, while the prognosis of patients with 3 or more showed no significant difference (p= 0.073 for OS, p= 0.091 for BCSS).

Furthermore, no differences were found in the survival rates between different surgical procedure groups (p= 0.886 for OS, p= 0.943 for BCSS). PMBC patients with ST tented to have increased OS (hazard ratio [HR] = 0.642; 95% confidence interval [CI], 0.583-0.707, p &lt; 0.001) and BCSS (HR = 0.649; 95% CI, 0.587-0.718, p &lt; 0.001), while age, grade, T stage, breast subtype, radiation, the number of metastatic site were also independent prognostic factors.

Conclusions

The current study demonstrated the survival benefit of ST in PMBC patients, especially those has 1 or 2 distant metastatic sites. Enlarged surgical range could not prolong survival. However, a large randomized clinical trial to validate the efficacy of ST in PMBC is essential in the future.

Key words: primary metastatic breast cancer; SEER Database; survival; surgery

Citation Format: Zhao Y, Sun H, Yang X, Zhao Y, Chen M, Jin W. Local surgery improves survival in patients with primary metastatic breast cancer: A population-based 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 P2-14-28.

Abstract P5-08-08: Not presented

This abstract was not presented at the conference.

Citation Format: Zhao Y, Sun H, Jin W. Not presented [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 P5-08-08.

Abstract OT2-07-09: A phase Ib study of neratinib, pertuzumab, and trastuzumab with paclitaxel in patients with metastatic and locally advanced breast cancer

Background: Neratinib, a potent irreversible pan-ErbB tyrosine kinase inhibitor that blocks signal transduction through HER1, HER2, and HER4, has demonstrated activity against metastatic HER2-positive breast cancer (HER2+ BC) in patients pretreated with trastuzumab. The FDA recently approved neratinib as an adjuvant treatment for HER2+ BC patients who have received trastuzumab for at least 1 year. Preclinical data demonstrate that trastuzumab-resistant BC cells remain sensitive to neratinib. Also, neratinib enhances responses to trastuzumab possibly by increasing trastuzumab's internalization, immune-mediated action, and other mechanisms. Taken together, these findings provide the rationale for adding neratinib to the standard of care combination of trastuzumab and pertuzumab with paclitaxel to enhance anti-HER2 efficacy in advanced HER2+ BC. Here, we report on the phase Ib portion of an ongoing phase Ib/II trial of this drug combination.

Trial Design: Patients with metastatic or locally advanced HER2+ BC will be enrolled in the phase Ib portion of the trial. Neratinib is given orally in 3-week cycles. The initial neratinib dose of 80 mg daily is increased to 120, 160, and 200 mg daily after safety assessments of each dose level. Other agents are administered as per the standard of care. Patients continue therapy with per-protocol dose escalation and de-escalation according to toxicity until the maximum tolerated dose (MTD) of neratinib is reached. The target maximum dose-limiting toxicity rate is 20%. All patients receive 4 cycles of the combination therapy. If patients do not have disease progression or excessive toxicity, they may receive 2-4 additional cycles at the treating physician's discretion. During therapy, patients undergo blood tests every week and have clinical visits and restaging scans every 3 weeks. Because gastrointestinal toxicity, mainly diarrhea, is anticipated, patients receive prophylactic antidiarrheal medication (e.g., loperamide, budesonide) beginning with the first dose of neratinib.

Eligibility Criteria: Eligible patients must have histologically confirmed metastatic or locally advanced HER2+ BC (BC may be inflammatory or non-inflammatory and have any hormone receptor status); an ECOG performance status score of 0 or 1; and adequate hematologic and organ function, including adequate cardiac function (as indicated by a left ventricle ejection fraction of ≥50%).

Specific Aims:

1- To determine the MTD of neratinib in combination with paclitaxel, pertuzumab, and trastuzumab.

2- Pharmacodynamic markers will be measured on biologic specimens. Neratinib-induced changes in pEGFR and/or HER2 expression will be analyzed and compared between dose levels.

Statistical Methods: The Bayesian modified toxicity probability interval is used to determine dose adjustment.

Accrual: The target enrollment for the phase Ib cohort is 20 patients. The trial has enrolled 3 patients since its activation in January 2018. This trial is supported by Puma Biotechnology, Aggressive Breast Cancer Research Program Grant.

Citation Format: Al-Awadhi A, Kono M, Marx A, Moseley T, Willey J, Sun H, Fu M, Whitman GJ, Valero V, Ueno NT, Lim B. A phase Ib study of neratinib, pertuzumab, and trastuzumab with paclitaxel in patients with metastatic and locally advanced breast cancer [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 OT2-07-09.

[Efficacy and safety of IA regimen containing different doses of idarubicin in de-novo acute myeloid leukemia for adult patients]

目的

探讨含不同剂量去甲氧柔红霉素（IDA 8、10、12 mg/m²）的IA方案诱导治疗成人初发急性髓系白血病（AML）（非急性早幼粒细胞白血病）的临床疗效和安全性。

方法

采用多中心、单盲、非随机、临床对照研究，纳入2011年5月至2015年3月苏州大学附属第一医院及其他36家单位收治的1 215例成人初发AML患者，根据诱导化疗方案中IDA的剂量对患者进行分组，分析不同剂量IDA联合阿糖胞苷（100 mg/m²）组成的IA方案在成人初发AML诱导治疗中的完全缓解（CR）率、血液学及非血液学不良事件。

结果

可纳入缓解率分析的AML患者共1 207例，IDA 8 mg/m²、10 mg/m²和12 mg/m²组的CR率分别为73.6%（215/292）、84.1%（662/787）和86.7%（111/128），差异有统计学意义（P<0.001）；以IDA 8 mg/m²组为参照组，在调整了年龄、骨髓原始细胞比例、FAB分型、危险度分层后，IDA 10 mg/m²和IDA 12 mg/m²为影响患者CR的有利因素[OR=0.49（95% CI 0.34~0.70），P<0.001；OR=0.36（95%CI 0.18~0.71），P=0.003]。在中、低危组中三组CR率分别为76.5%（163/213）、86.9%（506/582）和86.1%（68/79），差异有统计学意义（P=0.007）；在调整了年龄、骨髓原始细胞比例、FAB分型因素后，IDA 10 mg/m²为影响患者CR的有利因素[OR=0.47（95% CI 0.31~0.71），P<0.001]。在高危组中，三组CR率分别为50.0%（18/36）、60.6%（43/71）和81.8%（18/22），差异无统计学意义（P=0.089），但在调整了年龄、骨髓原始细胞比例、FAB分型因素后，IDA 12 mg/m²为影响患者CR的有利因素[OR=0.22（95% CI 0.06~0.80），P=0.022]。8 mg/m²、10 mg/m²和12 mg/m²组中性粒细胞≤0.5×10⁹/L的中位持续时间分别为14（11~18）、15（11~20）和18（14~22）d，差异有统计学意义（P=0.012）；三组PLT≤20×10⁹/L的中位持续时间分别为14（7~17）、15（11~20）和17（15~21）d，差异有统计学意义（P=0.001）；三组肺部感染发生率分别为9.8%、13.5%和25.2%，差异有统计学意义（P<0.001）。

结论

在中国成人（18~60岁）初发AML中，建议中、低危组患者采用含IDA 10 mg/m²的IA方案进行诱导治疗；而高危组AML建议选择含IDA 12 mg/m²的IA方案进行诱导治疗。

Automated E-FRET microscope for dynamical live-cell FRET imaging

Acceptor-sensitised 3-cube fluorescence resonance energy transfer (FRET) imaging (also termed as E-FRET imaging) is a popular fluorescence intensity-based FRET quantification method. Here, an automated E-FRET microscope with user-friendly interfaces was set up for dynamical online quantitative live-cell FRET imaging. This microscope reduces the time of a quantitative E-FRET imaging from 12 to 3 s. After locating cells, calibration of the microscope and E-FRET imaging of the cells can be performed automatically by clicking 'Capture' button on interfaces. E-FRET imaging was performed on the microscope for living cells expressing different FRET tandem constructs. Dynamical E-FRET imaging on the microscope for live cells coexpressing CFP-Bax and YFP-Bax treated by staurosporine (STS) revealed three Bax redistribution stages: Bax translocation from cytosol to mitochondria within 10 min, membrane insertion with conformational change on mitochondrial membrane within about 30 min, and subsequent oligomerisation within about 10 min. Because of excellent user-friendly interface and stability, the automated E-FRET microscope is a convenient tool for quantitative FRET imaging of living cell. LAY DESCRIPTION: Acceptor-sensitised 3-cube fluorescence resonance energy transfer (FRET) imaging (also termed as E-FRET) is a popular fluorescence intensity-based FRET quantification methods. E-FRET measurements are currently performed manually, and a complete FRET measurement takes about 12 s. E-FRET measurement necessitates not only a skilled operator and specialised equipment but also expertise in the interpretation of FRET signals, a considerable challenge in the application of FRET technology in living cells. Furthermore, manual E-FRET microscope is hard to perform dynamical quantitative FRET measurement, the ever-increasing applications in mapping the biochemical signal transduction within cells. Here, an automated E-FRET microscope with user-friendly interfaces was set up for dynamical online quantitative live-cell FRET imaging. This microscope reduces the time of a quantitative E-FRET imaging from 12 to 3 s. After locating cells, calibration of the microscope and E-FRET imaging of the cells can be performed automatically by clicking 'Capture' button on interfaces. Because of excellent user-friendly interface and stability, the automated E-FRET microscope is a convenient tool for quantitative FRET imaging of living cell.

Pan-Asian adapted Clinical Practice Guidelines for the management of patients with metastatic non-small-cell lung cancer: a CSCO-ESMO initiative endorsed by JSMO, KSMO, MOS, SSO and TOS

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of metastatic non-small-cell lung cancer (NSCLC) was published in 2016. At the ESMO Asia Meeting in November 2017 it was decided by both ESMO and the Chinese Society of Clinical Oncology (CSCO) to convene a special guidelines meeting immediately after the Chinese Thoracic Oncology Group Annual Meeting 2018, in Guangzhou, China. The aim was to adapt the ESMO 2016 guidelines to take into account the ethnic differences associated with the treatment of metastatic NSCLC cancer in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with metastatic NSCLC representing the oncological societies of China (CSCO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence, and was independent of both the current treatment practices and the drug availability and reimbursement situations in the six participating Asian countries. During the review process, the updated ESMO 2018 Clinical Practice Guidelines for metastatic NSCLC were released and were also considered, during the final stages of the development of the Pan-Asian adapted Clinical Practice Guidelines.

A global meta-analysis of the economic values of provisioning and cultural ecosystem services

Despite a growing demand to integrate ecosystem services into sustainability decision-making, our understanding of the global distribution of the economic value of ES is scarce. We extracted information from provisioning and cultural ecosystem services (PCES) from The Economics of Ecosystems and Biodiversity (TEEB) database using a meta-analytical approach. We then employed geostatistical methods to analyze the relationship between economic values and environmental and socio-economic predictors. Here we show that anthropogenic related factors such as accessibility, spatially explicit gross domestic product and ecosystem services scarcity explain global trends of PCES economic values. We observe higher PCES values in agricultural areas of strong human presence such as the British Isles, Southwest of Brazil and India and lower values in less disturbed natural areas. These findings highlight the decisive role that human systems play in the economic realization of PCES and caution that single-criterion sustainability and conservation policies aimed at maximizing the economic returns of PCES may not overlap with wild nature.