[The status analysis of diagnosis and treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China: a report of 1 003 cases in 16 domestic medical centers]

Objective: To analyze the status of domestic surgical treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China. Methods: Clinicopathological data of patients who underwent surgery from October 2003 to October 2018 in 16 domestic medical centers was retrospectively analyzed. Excel database was created which covered 77 fields of 7 parts: baseline information of patients, laboratory tests, imaging tests, chemoradiotherapy information, intra-operative findings, postoperative pathology and follow-up data. The Wilcoxon rank-sum test was used for comparison of the measurement data between groups. The χ(2) test was used for comparison of the categorical data between groups. The survival curve was calculated by the Kaplan-Meier method. Results: Of the 1 003 patients, there were 575 male and 428 female patients with the age of (58.5±14.1) years (range: 18 to 92 years). In a total of 920 patients, the carcinoma of sigmoid colon was performed in 292 cases (31.8%) with the highest ratio. The proportion of patients with liver metastasis and lung metastasis were 27.9% (219/784) and 8.3% (64/769). Preoperative detection of carcino-embryonic antigen level was the most common method in China (87.74%, 880/1 003), and the positive rate was 64.5% (568/880). The correct rate of preoperative imaging tests was 40.7% (280/688). The ratio of peritoneal carcinomatosis index (PCI) scores between 0 and 10 was the highest (59.6%, 170/285). Two hundred and sixty-two (27.0%) patients were performed by totally laparoscopic operation in 971 patients. The resection of primary tumor was performed in 588 of the 817 patients (72.0%). In a total of 457 cases, 253 (55.4%) patients were performed cytoreduction which group scored completeness of cytoreduction (CCR) 0. The postoperative hyperthermic intraperitoneal chemotherapy was implemented in 70 of the 334 cases (21.0%). Among 1 003 cases, 562 cases (56.03%) had complete follow-up data and the median overall survival was 15 months. The primary tumor resection and the CCR scores were affected by the PCI scores. The patients underwent primary tumor resection (187/205 vs. 26/80, χ(2)=105.085, P=0.000) and the patients were performed cytoreduction which scored CCR 0 or CCR 1 (162/204 vs. 8/78, Z=-10.465, P=0.000) had significant difference between the groups of PCI<20 and ≥20. There was a close correlation between the surgical method and the CCR scores (Z=-3.246,P=0.001).When the maximum degree of tumor reduction was planned, most surgeons would choose laparotomy. The overall survival time was longer in patients with primary tumor resection (P=0.000). The median survival time was 18.6 months in the group of primary tumor resection. Conclusions: It is difficult to diagnose the synchronous peritoneal carcinomatosis from colorectal cancer before the operation. Primary tumor resection has an obvious effect to prolong the survival time. It is necessary to standardize the treatment of peritoneal metastasis.

P3567Genetic screening for monogenic hypertension in hypertensive individuals in a clinical setting

Objectives

Monogenic hypertension describes a series of hypertension syndromes inherited by Mendelian law and present with complex phenotypes.

Methods

1179 cases with monogenic hypertension potential were evaluated by sequencing 37 causative genes. Pathogenic variants were classified by using American College of Medical Genetics guidelines. Additionally, 49 variants of unknown significance were selected to receive functional analysis. The yield of combined genetic and functional analysis was evaluated.

Results

21 deleterious variants were identified in 33 of 1179 (2.80%). Functional analysis for 49 unknown significant variants showed 32 variants harbored by 61 individuals led to abnormally expressed protein levels. Overall, combining genetic screening with functional analysis promoted diagnostic yield to 8.73%. The main etiology established was primary aldosteronism, with CACNA1H harboring the greatest mutation burden. Logistic regression analysis showed hypertension complicated with special manifestations had the strongest correlation with disease causing variants detection (p=0.03).

Sequencing Results Summary Number of variants Number of individuals* Percentage† Individuals with no variant 0 524 44.44% Individuals with variants identified 592 655 55.56% Individuals with single contributing variant 297 480 40.71% Individuals with two or multiple contributing variants 295 175 14.84% Number of variants identified   Pathogenic and likely pathogenic variants 21 33 2.80%   Variants of unknown significance 570 634 53.77%   Benign or likely benign variants 1 1 0.08% Type of variant   Frameshift deletion 8 15 1.27%   Frameshift insertion 5 5 0.42%   Nonframeshift deletion 10 10 0.85%   Nonframeshift insertion 6 12 1.02%   Nonsynonymous SNV 546 607 51.48%   Stopgain SNV 18 30 2.54% WES, whole-exome sequencing. *The statistics in this table was based on 1179 individuals. †The percentage was calculated by the number of individuals in each category.

A flow chart of this study.

Conclusion

Our findings demonstrate an enhanced diagnostic ability by combining genetic analysis with functional evaluation and enables targeted treatment and prevention of hypertension.

Acknowledgement/Funding

This work was supported by National Basic Research Program of China (973 Program, 2014CB542300, 2014CB542302).

P2875Comparison between ejection fraction, global longitudinal strain, mechanical dispersion and delta contraction duration in predicting first and subsequent arrhythmic events in ICD patients

Background

According to current guidelines, left ventricular ejection fraction (LVEF) is currently the most important parameter for primary prevention of sudden cardiac death in patients with structural heart disease. Unfortunately, LVEF has low sensitivity in detecting arrhythmic events and presents a significant intra- and inter-operator variability. For these reasons, alternative predictors in patients with structural heart disease are being sought. Among those, speckle-tracking derived parameters such as global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD) have been proposed as better alternatives.

Purpose

To assess speckle-tracking derived parameters as predictors of first and subsequent arrhythmic events in implantable cardioverter-defibrillator (ICD) patients with structural heart disease, and to compare their performance with LVEF.

Methods

Prospective, observational study enrolling all consecutive patients with structural heart disease admitted for an ICD implant. Patients not followed by a home-monitoring system were excluded. 2D speckle-tracking analysis was used to derive GLS, MD, and DCD of all patients at enrolment. Home monitoring was checked weekly in order to detect all ventricular arrhythmias (VA) and ICD therapies. A recurrent-event statistical approach (Prentice, Williams, and Peterson model) was applied in order to evaluate subsequent events after the first ones.

Results

Two-hundred-and-three patients were consecutively enrolled and followed-up for a median follow-up of 2.2 years. Kaplan-Meier curves showed an increased risk of ATP or shock (Log-rank p=0.003) and VAs (Log-rank p=0.001) associated with lower quartiles of GLS (Figure 1). An impaired GLS was independently associated with an increased risk for the first ICD therapy (HR 1.94; 95% CI 1.30–2.91; p=0.001), and for the first VA (HR 1.42; 95% CI 1.01–1.98; p=0.04). GLS impairment was not significantly associated with an increased risk of recurrent ICD therapies or VAs. LVEF, MD and DCD were not associated with an increased risk of first, second and third ICD therapy or VA.

Conclusions

Impaired GLS is associated with an increased risk of VAs and appropriate ICD therapies in a consecutive, “real-world”, unselected population of remote-monitored patients with structural heart disease, although it does not seem reliable in predicting further arrhythmic event after the first one. LVEF, MD, and DCD do not predict first or subsequent arrhythmic events in ICD patients with structural heart disease.

Acknowledgement/Funding

Marche Polytechnic University

Double benefits of mechanical wounding in enhancing chilling tolerance and lodging resistance in wheat plants

Chilling and lodging are major threats to wheat production. However, strategies that can be used to effectively mitigate the adverse effects of these threats are still far from clear. Mechanical wounding is a traditional agronomic measure, whereas information about the role it plays in wheat chilling and lodging is scant. The aim of the present study was to investigate mechanisms underlying the protective roles of mechanical wounding in alleviating damage from chilling at jointing stage and enhancing lodging resistance after anthesis of winter wheat (Triticum aestivum L.). Our data show that net photosynthesis rate, maximum photochemical efficiency of photosystem II, activity of the antioxidant enzymes and osmolytes were significantly increased in the latest fully expanded leaves of wounded plants under chilling. Wounding also reduced hydrogen peroxide accumulation, electrolyte leakage and water loss in wounded plants. Moreover, mechanical wounding significantly reduced the length but increased the diameter and wall thickness of the basal second internode of the main stem. Quantitative and histochemical analysis further indicated that wounding increased lignin accumulation and activity of enzymes involved in lignin synthesis, which resulted in increased mechanical strength and the lodging resistance index in the main stem. We conclude from our data that mechanical wounding confers both cold tolerance by alleviating the damage caused by chilling at jointing stage and lodging resistance after anthesis of wheat plants.

First principle study on the predicted phase transition of MN (M = Zr, La and Th)

First principle (FP) calculations were performed to systematically study the structural properties of ZrN, LaN and ThN with GGA correction. The ground state properties, wave velocities and Debye temperature of B1, P6₃/mmc, Pnma and B2 phase in ZrN, LaN and ThN were investigated and agree well with other theoretical and experimental results. More importantly, some novel phases are predicted in these materials, i.e. with the increasing pressure the phase transition sequence in ZrN and ThN is found to be B1  →  P6₃/mmc  →  B2 phase, while in LaN, the sequence of B1  →  Pnma  →  B2 is observed. Furthermore, our calculated elastic properties also confirm the prediction of phase transition under high pressure. These phase transitions arise from the optical phonon softening of B1 at around X, M and G points of Brillouin zone and P6₃/mmc (or Pnma) structure at around G, and H-K points.

Diagonal nematicity in the pseudogap phase of HgBa2CuO4+δ

The pseudogap phenomenon in the cuprates is arguably the most mysterious puzzle in the field of high-temperature superconductivity. The tetragonal cuprate HgBa₂CuO_4+δ, with only one CuO₂ layer per primitive cell, is an ideal system to tackle this puzzle. Here, we measure the magnetic susceptibility anisotropy within the CuO₂ plane with exceptionally high-precision magnetic torque experiments. Our key finding is that a distinct two-fold in-plane anisotropy sets in below the pseudogap temperature T^*, which provides thermodynamic evidence for a nematic phase transition with broken four-fold symmetry. Surprisingly, the nematic director orients along the diagonal direction of the CuO₂ square lattice, in sharp contrast to the bond nematicity along the Cu-O-Cu direction. Another remarkable feature is that the enhancement of the diagonal nematicity with decreasing temperature is suppressed around the temperature at which short-range charge-density-wave formation occurs. Our result suggests a competing relationship between diagonal nematic and charge-density-wave order in HgBa₂CuO_4+δ.

Effects of compound porcine cerebroside and ganglioside on neurotoxicity caused by oxaliplatin chemotherapy: preliminary results

OBJECTIVE

Oxaliplatin has shown good anti-tumour activity in the treatment of tumours involving the digestive system. However, its application is limited because of severe neurotoxicity in some patients. The purpose of this study was to evaluate whether compound porcine cerebroside and ganglioside (CPCG) can reduce or prevent oxaliplatin-induced neurotoxicity.

PATIENTS AND METHODS

Patients with digestive system tumour who received oxaliplatin-based chemotherapy were retrospectively divided into experimental and control groups according to the receipt of CPCG during chemotherapy. Adverse events at the end of each chemotherapy cycle were recorded. We compared the incidence of neurotoxicity between the two groups and graded the neurotoxicity symptoms using the Common Terminology Criteria for Adverse Events v5.0.

RESULTS

The study included 115 patients (experimental group, 57; control group, 58). The number of chemotherapy cycles (6.65 vs. 6.41, p=0.540) and oxaliplatin dose (775.92 mg/m2 vs. 724.20 mg/m2, p=0.250) were comparable between the two groups. All patients developed grade 1 to 3 neurotoxicity; grade 4-5 neurotoxicity was not observed. The incidence of neurotoxicity and the probability of advanced neurotoxicity were significantly lower in the experimental group than in the control group (p<0.05). After a 6 to 18 months follow-up, the two groups showed no significant differences in the chemotherapy response and recurrence rate (p=0.846).

CONCLUSIONS

CPCG reduces oxaliplatin-induced neurotoxicity without reducing the efficacy of oxaliplatin-based regimens; thus, it can be used for preventing oxaliplatin-induced neurotoxicity in patients with cancer.

A new multi-channel Mach probe measuring the radial ion flow velocity profile in the boundary plasma of the W7-X stellarator

Ion flow velocity measurement in the edge and scraper-off layer region is beneficial to understand the confinement related phenomenon in fusion devices such as impurity transport and plays an important role in impurity control. During the Wendelstein 7-X (W7-X) operation phase 1.2a, a multi-channel (MC) Mach probe mounted on the multi-purpose manipulator has been used to measure radial profiles of edge ion flow velocity. This MC-Mach probe consists of two polar and two radial arrays of directional Langmuir pins (28 pins in total) serving for different aims, of which the polar arrays could obtain a polar distribution of ion saturation current, while the radial arrays can be used to study the dynamic process of a radially propagated event. In this paper, we report the observation of the radially outward propagation of a low frequency mode with a speed of around 200 m/s. The first measurement of the radial ion flow velocity profile using the MC-Mach probe in the boundary plasma of the W7-X with an island divertor will also be presented.

Electronic structure of multiferroic BiFeO3: Electron energy-loss spectroscopy and first-principles study

The electronic structure of BiFeO₃ has been investigated by using electron energy loss spectrum and first-principle calculations. Assignments of the individual interband transitions have been accomplished by comparing the interband transition energy with the calculated PDOS. The DOS is mainly divided into two regions, the hybridized region of O 2p with Fe 3p in the valence band and that of O 2p hybridized with Bi 6p in the conduction band. From the simulation of high energy-loss near-edge structure, the core-hole effect is believed to be more significant. The feature groups for the experimental spectra of O K-edge and Fe L_2,3-edge are consistent with simulation results.

Circ_0009910 regulates growth and metastasis and is associated with poor prognosis in gastric cancer

OBJECTIVE

Circular RNAs (circRNAs) have recently shown capabilities as gene regulators in mammals. In this study, we aimed to evaluate the effects and mechanism of circ_0009910 in gastric cancer (GC).

PATIENTS AND METHODS

Circ_0009910 expression was quantified by Real-time PCR in human GC cell lines and tissues. Association between circ_0009910 levels and clinicopathological factors and patient's prognosis was analyzed. The roles of circ_0009910 in regulating GC cell proliferation, colony formation, migration, and invasion were evaluated in vitro. Western blot analysis was conducted to detect the expressions of molecular markers of epithelial-mesenchymal transition (EMT).

RESULTS

Circ_0009910 expression level was elevated in GC tissues and cell lines and associated with clinical stage (p = 0.032), distant metastasis (p = 0.028) and differentiation (p = 0.007). Kaplan-Meier survival analysis indicated that circ_0009910 expression in positive group has a worse overall survival compared to the negative group (p = 0.0013). Multivariate analysis showed that circ_0009910 was an independent risk factor for GC (HR = 2.346, 95% CI: 1.673-3.775, p = 0.006). Knockdown of circ_0009910 expression can suppress BGC823 and AGS cells proliferation, migration and invasion in vitro experiments. The results of Western blot indicated that knockdown of circ_0009910 increased expression of E-cadherin and decreased expression of the mesenchymal markers, snail and N-cadherin.

CONCLUSIONS

Altogether, we demonstrate that circ_0009910 acts as a prognostic biomarker and promote cell proliferation, migration, invasion and EMT in GC, indicating that circ_0009910 may be a novel potential biomarker and therapeutic target of GC.

[Clinical features and risk factors of surgical complications after intersphincteric resection for low rectal cancer following neoadjuvant chemoradiotherapy]

Objective: To explore clinical features and prognosis factors of surgical complications after intersphincteric resection (ISR) for low rectal cancer following neoadjuvant chemoradiotherapy. Methods: The clinical data of 132 patients with low rectal cancer who underwent ISR following neoadjuvant chemoradiotherapy from September 2010 to June 2017 at Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University were retrospectively reviewed. There were 100 males and 32 females, with the age of (52.9±11.4) years and distance to anal verge of 3.9 cm. Records of perioperative complication (POC) within 30 days after surgery, anastomotic leakage (AL), and anastomotic stenosis (AS) were analyzed. POC was recorded according to the Clavien-Dindo classification. AL was graded by ISREC system and classified into the early AL within 30 days after surgery and delayed AL beyond 30 days. AS was defined as narrowing of the bowel lumen at the anastomosis that prevented passage through a colonoscope with a 12 mm diameter. According to the shape of narrowing, AS was recorded as the stenosis in situ or stenosis with long-segment bowel above. Univariate and multivariate analysis were used to identify risk factors of anastomotic complications. Results: Among the 132 patients, full-dose radiotherapy and diverting stoma were performed in 128 (97.0%) patients, respectively. In entire cohort, AL was found in 41 (31.1%) patients, including 32 patients with clinical leakage (24.2%). The median time for diagnosis of AL was 37 days (2 to 214 days) after surgery. There were 25 patients (18.9%) who were diagnosed with delayed AL beyond 30 days. Chronic presacral sinus formation was detected in 22 of 129 (17.1%) patients at 12 months from surgery. Among the 128 eligible patients, 36 (28.1%) were diagnosed as AS, including 24 (18.8%) patients with stenosis in situ and 12 (9.4%) patients with bowel stenosis above. After a median follow-up of 26 months, 7(5.3%) patients received permanent colostomy and the other 20(15.2%) patients retained a persistent ileostomy, owing to anastomotic complications. Results of multivariate analysis showed that radiation colitis was an independent prognosis factor of AL after ISR (OR=5.04, 95% CI: 2.05 to 12.43, P=0.000); male gender (OR=5.19, 95% CI: 1.24 to 21.75, P=0.024) and AL (OR=8.49, 95% CI: 3.32 to 21.70, P=0.000) were independent prognosis factors of AS after ISR. Conclusions: Surgical complications are common after ISR for low rectal cancer patients with neoadjuvant chemoradiotherapy. A high rate of AL is observed after long-term follow-up, which is associated with AS. Increasing awareness of anastomotic complications after ISR should be raised, especially for male patients with radiation colitis.

External Validation of Equations that Use Demographic and Anthropometric Measurements to Predict Percent Body Fat

OBJECTIVE

Numerous equation to predict percent body fat using demographics and anthropometrics have been published but external validation of these equations is limited. The objective of this study was to validate published equations that use anthropometrics for prediction of percent body fat using external data.

METHODS

Data were from the Visceral Fat, Metabolic Rate, and Coronary Heart Disease Risk I (VIM I) Study and the Fels Longitudinal Study (Fels). VIM I was conducted in a subset of subjects from the CARDIA study and included black and white adults 28-40 years (n = 392). Fels consisted of white participants 8-88 years (n = 1,044). Percent body fat assessed by dual X-ray absorptiometry (DXA) in these two studies was compared to results calculated using 13 equations from Stevens et al. and nine other published equations.

RESULTS

In general, the Stevens equations performed better than equations from other studies. For example, equation "I" in women in VIM I, Fels adults, and Fels youth, R2 estimates were 0.765, 0.757 and 0.789, respectively. In men the estimates were 0.702 in VIM I, 0.822 in Fels adults and 0.905 in Fels youth. None of the results from the nine published equations showed R2 this high in corresponding groups.

CONCLUSIONS

Our results indicate that several of the Stevens equations have external validity superior to that of nine other published equations among varying age groups, genders and races.