PD-L1 expression, tumor mutational burden, and response to immunotherapy in patients with MET exon 14 altered lung cancers

Background

MET exon 14 alterations are actionable oncogenic drivers. Durable responses to MET inhibitors are observed in patients with advanced MET exon 14-altered lung cancers in prospective trials. In contrast, the activity of immunotherapy, PD-L1 expression and tumor mutational burden (TMB) of these tumors and are not well characterized.

Patients and methods

Patients with MET exon 14-altered lung cancers of any stage treated at two academic institutions were identified. A review of clinicopathologic and molecular features, and an analysis of response to single-agent or combination immune checkpoint inhibition were conducted. PD-L1 immunohistochemistry was carried out and TMB was calculated by estimation from targeted next-generation sequencing panels.

Results

We identified 147 patients with MET exon 14-altered lung cancers. PD-L1 expression of 0%, 1%-49%, and ≥50% were 37%, 22%, and 41%, respectively, in 111 evaluable tumor samples. The median TMB of MET exon 14-altered lung cancers was lower than that of unselected non-small-cell lung cancers (NSCLCs) in both independently evaluated cohorts: 3.8 versus 5.7 mutations/megabase (P < 0.001, n = 78 versus 1769, cohort A), and 7.3 versus 11.8 mutations/megabase (P < 0.001, n = 62 versus 1100, cohort B). There was no association between PD-L1 expression and TMB (Spearman's rho=0.18, P = 0.069). In response-evaluable patients (n = 24), the objective response rate was 17% (95% CI 6% to 36%) and the median progression-free survival was 1.9 months (95% CI 1.7-2.7). Responses were not enriched in tumors with PD-L1 expression ≥50% nor high TMB.

Conclusion

A substantial proportion of MET exon 14-altered lung cancers express PD-L1, but the median TMB is lower compared with unselected NSCLCs. Occasional responses to PD-1 blockade can be achieved, but overall clinical efficacy is modest.

[The changes of perioperative immunity index in patients with breast cancer and its clinical significance]

Objective: To investigate the changes of perioperative immune index in patients with breast cancer and its clinical significance. Methods: Th1 cells, Th2 cells, Th1/Th2 ratio and regulatory T cells (Treg) were detected in peripheral blood of 103 patients with primary breast cancer and 116 patients with breast fibroma before surgery and on the 1st, 3rd and 5th day following operation. The relationship of changes in T lymphocyte subsets and clinicopathological characteristics, as well as tumor-free survival of breast cancer patients, was analyzed. Results: The levels of Th1 cells in breast cancer group on the 1st, 3rd and 5th day following operation were (12.20±0.45)%, (13.89±0.47)%, (14.04±0.49)%, which were significantly lower than those before operation [(15.82 + 0.51)%, all P<0.05 ]. Treg cells, however, with the number of (3.82±0.13)%, (3.25±0.11)%, (2.95 ±0.11)%, were remarkably higher than those before operation [(2.53 ±0.11)%, all P<0.05]. With respect to breast fibroma patients, there was no significant difference compared with those before operation of Th1 cells, Th2 cells and Treg cells (all P>0.05). The changes of Th1 cells were associated with the degree of differentiation, T stage, N stage, TNM stage, HER-2 status and Ki-67 (all P<0.05). Treg cells were related to T stage, N stage and HER-2 status (all P<0.05). Tumor-free survival in the Th1-cell-increasing group was significantly better than that in the Th1-cell-decreasing group (P=0.045), while cell-decreasing group of Treg showed the improved outcomes (P=0.012). Conclusions: The levels of Th1 cells and Treg cells are important indicators of cellular immune function in patients with breast cancer. Moreover, the perioperative changes of Th1 cells and Treg cells are associated with the size of tumors, pathological parameters, clinical stages and tumor-free survival outcomes.

Enhanced serum immunoglobulin G clearance in myotonic dystrophy-associated hypogammaglobulinemia: a case series and review of the literature

BACKGROUND

Myotonic dystrophy type 1 is an autosomal dominant disorder characterized by muscle weakness, myotonia, cataracts, and cardiac conduction defects; it is associated with expansions of cytosine-thymine-guanine repeats in the myotonic dystrophy protein kinase. Hypogammaglobulinemia is a lesser known association of myotonic dystrophy type 1 and the underlying pathogenesis of immunoglobulin G depletion remains unclear.

CASE PRESENTATION

Here we report a kindred of two members (a 62-year-old white woman and a 30-year-old white man; mother and son) with myotonic dystrophy type 1-associated hypogammaglobulinemia associated with altered intravenous immunoglobulin elimination kinetics and reduced half-life. There was no history of systemic immunosuppression or renal or gastrointestinal protein loss in either patient, and no underlying case for a secondary immunodeficiency could be found. One patient required fortnightly intravenous immunoglobulin to maintain adequate trough immunoglobulin G levels.

CONCLUSIONS

Ongoing study of myotonic dystrophy type 1-associated hypogammaglobulinemia using contemporary tools of genomic medicine may help to further delineate the pathogenesis of this entity.

Effects of thermal boundary condition on methane oxidation in landfill cover soil at different ambient temperatures

Microbial aerobic methane oxidation (MAMO) has been considered as an environmental-friendly method for mitigating methane emission from municipal landfill sites. Soil column has in a landfill cover under one-dimensional (1-D) condition. However, most of the published soil column tests failed to simulate 1-D heat transfer due to the use of thermal conductive boundary at the sidewall. In the present study, a heavily instrumented soil column was developed to quantify the effects of thermal boundary condition on the methane oxidation efficiency under different ambient temperatures in landfill cover soil. The sidewall of the soil column was thermally insulated to ensure 1-D heat transport as would have been typically expected in the field condition. Two soil column tests with and without thermal insulation were conducted at a range of controlled ambient temperatures from 15 to 30°C, for studying how soil moisture, matric suction, gas pressure, soil temperature and gas concentration evolve with MAMO. The test results reveal that ignoring thermal insulation in a soil column test would result in a greater loss of soil heat generation by MAMO and hence oxidation efficiency by up to 100% for the range of temperature considered. When the ambient temperature increased to 30°C (but less than the optimum temperature for MAMO), the MAMO efficiency increased abruptly at first but then decreased substantially with time, and this is likely due to the accumulation of biomass generated by MAMO.

[Prevalence and risk factors of Blastocystis hominis infection in inpatients in Jiangjin District, Chongqing City]

OBJECTIVE

To understand the prevalence and risk factors of Blastocystis hominis infection in inpatients in Jiangjin District, Chongqing City.

METHODS

A cross-sectional study was conducted in a community hospital in Jiangjin District, Chongqing City, and the inpatients were surveyed by questionnaires. After obtaining the informed consent from the inpatients or legal guardians, the stool and blood samples were collected and examined by microscopy and PCR from April 17 to May 1, 2018. The univariate analysis and logistic regression analysis were used to analyze the risk factors of the B. hominis infection.

RESULTS

A total of 198 hospitalized patients were investigated, and the infection rate of B. hominis was 10.61% (21/198), and the infection rate of the females (12.10%) was higher than that of the males (8.11%), but the difference was not statistically significant. The highest rate of infection was 19.23% in the age group of 10 to 20 years, followed by 17.74% in the age group of 60 years and above, and the lowest rate was 2.38% in the age group of 20 to 40 years. The difference in infection rates of B. hominis among the different age groups was statistically significant (P < 0.05). The infection rate of B. hominis in the people who used dry pail latrines was 33.30%, which was higher than that of the people who used water flush toilets (9.10%) (P < 0.05). The genotypes of B. hominis were ST1, ST3, ST6 and ST7, and ST6 and ST3 being the most predominant genotypes which accounted for 47.62% (10/21) and 38.10% (8/21) respectively, and among the infected males, the genotypes were only ST3 and ST6. The multiple logistic regression analysis showed that among the factors affecting B. hominis infection, only keeping pets was a risk factor [OR = 3.798, 95% CI (1.245, 11.581), P < 0.05].

CONCLUSIONS

A high prevalence of B. hominis infection is found in the inpatients in Jiangjin District, Chongqing City, the predominant genotypes are ST6 and ST3, and keeping pets may be one of the main risk factors.

[Status of non-steroidal anti-inflammatory drugs use in areas with a high incidence of upper gastrointestinal cancer in China: a multi-center cross-sectional survey]

Objective: To describe the status of non-steroidal anti-inflammatory drugs (NSAIDs) use in areas with a high incidence of upper gastrointestinal cancer in China. Methods: This study was based on the National Key Research and Development Program of "National Precision Medicine Cohort of Esophageal Cancer" and "Study on Identification and Prevention of High-risk Populations of Gastrointestinal Malignancies (Esophageal cancer, Gastric cancer and Colorectal cancer)" . From January 2017 to August 2018, 212 villages or communities with a high incidence of esophageal cancer or gastric cancer were selected from 12 regions in 6 provinces. A total of 35 910 residents aged between 40 and 69 years old who met the inclusion criteria and signed the informed consent were investigated and enrolled in this study. The use of NSAIDs, demographic characteristics, health-related habits, height, weight, and blood pressure were collected by the questionnaire and physical examination. The status of main NSAIDs (aspirin, acetaminophen and ibuprofen) use with the difference varying in genders, age groups and regions were analyzed by using χ(2) test and Cochran-Armitage trend analysis method. Results: Of 35 910 subjects, the mean age was (54.6±7.1) years old and males accounted for 43.42% (15 591). The overall prevalence of NSAIDs intake was 4.56% (1 638), but it significantly varied in different provinces (P<0.001). The overall prevalence of NSAIDs intake was 4.87% (1 750) in females, which was significantly higher than that in males 4.24% (1 524) (P<0.001). The prevalence of NSAIDs intake increased with age (P for trend <0.001). As the frequency of NSAIDs intake increased, the incidence of gastrointestinal symptoms, gastrointestinal ulcers and black stools increased (P for trend <0.05 for all). Conclusion: The use of NSAIDs is prevalent in some areas with a high incidence of upper gastrointestinal cancer in China. The increased use of NSAIDs may lead to more adverse effects related to the gastrointestinal tract.

[Dentification and correction of the lead-time bias and length bias in cancer screening studies]

Lead-time bias and length bias were common systematic errors in observational screening studies, which might be a common cause of overstating or distorting the true screening effects. One of key concerns in observational screening studies was how to estimate the screening effects based on the consideration of these two biases. This paper illustrated how to identify and correct the lead-time bias using the tumor volume doubling time and the non-homogeneous Poisson process, and how to correct the length bias using a weighted method. The application conditions of each method were also discussed to present several useful toolboxes to correct the lead-time bias and length bias appropriately and evaluate the effectiveness of the cancer screening program accurately.

The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries

Chronic obstructive pulmonary disease (COPD) is one of the top three causes of death worldwide, but governments and non-governmental organisations have not given its prevention and treatment the priority it requires. This is particularly true in low- and middle-income countries, where most of the people suffering from this disease live. The United Nations (UN) has targeted a reduction of premature deaths from non-communicable diseases (NCDs) by a third by 2030; however, a coordinated UN/World Health Organization (WHO) strategy to address the burden of COPD (one of the most important NCDs) is still lacking. To explore the extent of the problem and inform the development of policies to improve the situation, the Board of Directors of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) held a 1-day Summit. The key themes that emerged were the need to ensure accurate data on prevalence, raise awareness of the disease among the public, healthcare professionals and governments, including the fact that COPD aetiology goes beyond smoking (and other inhaled pollutants) and includes poor lung development in early life, and ensure that spirometry and both pharmacological and non-pharmacological therapies are available and affordable. Here, we present the actions that must be taken to address the impact of COPD. We believe that the WHO is particularly well-positioned to co-ordinate an attack on COPD, and GOLD will do all it can to help and rally support.

Clostridium butyricum promotes intestinal motility by regulation of TLR2 in interstitial cells of Cajal

OBJECTIVE

Clostridium butyricum (C. butyricum) as a probiotic has been reported to have an important role in the pathogenesis of gastrointestinal diseases. However, the effects of C. butyricum on regulation of intestinal motility of ulcerative colitis (UC) remain unclear. Our study aimed to explore the cross-regulation effect of C. butyricum and toll-like receptor 2 (TLR-2) on UC.

MATERIALS AND METHODS

Interstitial cells of Cajal (ICCs) were treated by C. butyricum for 2 h, the mRNA and protein levels of TLR-2, IL-6, and IL-8 were detected by RT-qPCR and Western blot. Then, TLR2-specific small interfering RNA (si-TLR2) was transfected into ICCs, and the relative expressions of IL-6 and IL-8, SCF, cell viability, ghrelin, SP, and ET were measured by RT-qPCR, Western blot, CCK-8, and ELISA. Besides, the signal pathways of NF-κB and JNK were determined by Western blot.

RESULTS

C. butyricum significantly increased TLR2, IL-6, and IL-8 expressions in ICCs. However, TLR2 silence alleviated C. butyricum-induced IL-6 and IL-8 expressions. Moreover, TLR2 silence significantly inhibited C. butyricum-induced cell viability in ICCs. Additionally, C. butyricum significantly increased SCF expression and promoted the secretion of ghrelin and SP. However, a significant reduction in the levels of SCF, ghrelin, and SP was evident in the silence of TLR2 expression. Besides, TLR2 silence reduced C. butyricum-activation NF-κB and JNK signal pathways in ICCs.

CONCLUSIONS

These findings revealed that C. butyricum promoted intestinal motility by regulation of TLR2 in ICCs, which contributed to understand the molecular mechanisms of C. butyricum on UC.

P5396CRISPR/Cas9 mediated miR-29b editing restores muscle atrophy and exercise capacity in mice

Background

Muscle atrophy is the loss of skeletal muscle mass and strength in response to diversity catabolic stimuli, such as heart failure. At present, no effective treatment except exercise is validated on reducing multiple muscle atrophy clinically. We have recently reported that microRNA-29b (miR-29b) promotes multiple types of muscle atrophy.

Purpose

The goal of this study was to assess whether genome editing using a clustered regularly interspaced short palindromic repeat/Cas9 (CRISPR/Cas9) system can efficiently introduce loss-of-function mutations into the endogenous miR-29b in vivo and as a potential therapy by treating muscle atrophy.

Methods

We used lentivirus to express CRISPR-associated 9 and a CRISPR guide RNA targeting miR-29b. Mutagenesis rate of miR-29b and off-target mutagenesis were detected by T7 Endonuclease I (T7EI) Assay. The expression level of miR-29b were measured in vitro and vivo after administration of the virus by using qRT-PCR. After intramuscular administration of the virus, the angiotensin II (AngII), immobilization and denervation-induced muscle atrophy were performed. Then muscle function was assessed in exercise capacity, the appearance and weight of muscle, the size of the muscle fibers, molecular and cellular detection.

Results

Here, we report that CRISPR/Cas9 mediated genome editing through intramuscular administration efficiently targeting the biogenesis processing sites in pre-miR-29b. No off-target mutagenesis was detected in 10 selected sites. This CRISPR-based treatment resulted in decreased miR-29b levels specifically. In vivo, this CRISPR-based treatment could ameliorate the muscle atrophy induced by angiotensin II (AngII), immobilization and denervation via activation of PI3K-AKT-mTOR signaling pathway and protect against AngII-induced apoptosis in mice. Moreover, the exercise capacity is also significantly enhanced.

Conclusion

Our work establishes CRISPR/Cas9 based gene targeting on miRNA as a potential durable therapy for treatment of muscle atrophy and expands the strategies available interrogating miRNA function in vivo.

Acknowledgement/Funding

The grants from National Natural Science Foundation of China (81722008, 91639101 and 81570362 to JJ Xiao)

P819Post-procedural cholesterol and inflammatory risk in acute myocardial infarction patients undergoing percutaneous coronary intervention

Objective

This study sought to depict the combined association of post-procedural cholesterol and inflammatory risk with clinical outcomes among acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) and pick out patients with highest comprehensive risk.

Methods

A total of 4802 AMI-PCI patients were divided into quartiles according to post-procedural low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP) level respectively and in combinations for risk analysis. Univariate and adjusted multivariate analysis with Cox model were performed. Hazard ratio (HR) for short-term (90 days) and long-term (1 year) were compared for major adverse cardiovascular events (MACE), including cardiac death, recurrent myocardial infarction and ischemic stroke.

Results

A significant change in the hazards of 90-day MACE was seen among patients in the highest quartile of post-procedural LDL-C [HR: 0.526 (0.291, 0.951), p=0.034] and highest quartile of CRP [HR: 2.119 (1.150, 3.920), p=0.016]. For 1-year outcomes, only a trend for increasing risk was seen in patients with higher post-procedural CRP (p-trend = 0.016). Combination analysis for cholesterol/inflammatory risk showed that patients lying simultaneously in the lowest quartile of LDL-C and highest quartile of CRP gained the highest risk in the 90-day [HR: 3.16 (1.124, 8.886), p=0.029] and 1-year [HR: 2.515 (1.153, 5.486), p=0.020] follow up.

Hazard ratios (HR) for short-term (90 days) and long-term (1 year) primary outcomes according to cholesterol and inflammatory risk 90 days 1 year Type of risk Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend LDL, mmol/L   Quartile 2 0.742 (0.441, 1,248) 0.260 0.663 (0.390, 1.125) 0.128 0.033 0.722 (0.364, 1.125) 0.150 0.683 (0.435, 1.072) 0.097 0.251   Quartile 3 0.653 (0.381, 1.121) 0.122 0.597 (0.344, 1.038) 0.068 0.850 (0.557, 1.229) 0.453 0.850 (0.550, 1.312) 0.462   Quartile 4 0.517 (0.288, 0.928) 0.027 0.526 (0.291, 0.951) 0.034 0.673 (0.427, 1.061) 0.088 0.708 (0.444, 1.131) 0.149 CRP, mg/L   Quartile 2 1.365 (0.717, 2.599) 0.334 1.295 (0.654, 2.522) 0.448 0.007 1.063 (0.656, 1.722) 0.805 0.998 (0.608, 1.636) 0.992 0.016   Quartile 3 1.306 (0.681, 2.502) 0.442 1.279 (0.654, 2.499) 0.472 0.999 (0.612, 1.630) 0.996 0.968 (0.586, 1.597) 0.897   Quartile 4 2.354 (1.312, 4.221) 0.004 2.119 (1.150, 3.920) 0.016 1.657 (1.069, 2.570) 0.024 1.528 (0.967, 2.413) 0.069 Multivariate analysis was adjusted for age, sex and traditional cardiovascular risk factors.

Combined cholesterol/inflammatory risk

Conclusion

AMI-PCI patients with lower post-procedural LDL-C and higher CRP might encounter greater cardiovascular risk. Patients with the lowest LDL-C and highest CRP gained extremely high risk and required special attention.

Cellular and molecular mechanisms of low dose prolactin potentiation of testicular development in cockerels

The aim of this study was to determine the cellular and molecular mechanisms of prolactin (PRL) in testicular development of prepubertal cockerels. In an in vivo animal experiment, active immunization against PRL severely depressed prepubertal testicular development by significantly reducing testicular weights at both 122 and 164 d of age. The number of elongated spermatids in the seminiferous tubules was also significantly decreased by immunization with 199-residue chicken PRL (cPRL) at age 122 d. Inhibition of testicular development by cPRL immunization was associated with decreases in LH receptor (LHR), FSH receptor (FSHR), Stat5b, P450scc, steroidogenic acute regulatory (StAR) protein, and 3β-hydroxysteroid dehydrogenase (3β-HSD) mRNA expression levels in testicular tissue. In in vitro experiments, testosterone production by cultured Leydig cells isolated from prepubertal cockerel testes was dose-dependently enhanced by treatment with bioactive recombinant PRL, but a lesser response was seen with high concentrations of PRL. The distinct changes in testosterone production in response to high and low concentrations of added PRL were paralleled by similar patterns of change in the mRNA levels of Stat5b, LHR, P450scc, StAR, 3β-HSD, and CYP17A1 in cultured Leydig cells, as well as protein amounts of phosphorylated Jak2 and Stat5a/b. In conclusion, low to medium doses of PRL potentiate testis development in prepubertal cockerels by enhancing testosterone secretion from Leydig cells via activation of PRLR/Stat5b signal transduction, which upregulates mRNA expression of LHR and testosterone synthesizing enzymes. However, this positive regulation was weaker in response to a high dose of PRL, which reduced PRLR/Stat5b signal transduction and the expression of genes involved in LH signaling and testosterone synthesis.

[Relationship between smoking and the severity of OSA]

Objective:To explore the relationship between smoking and the severity of OSA. Method:There were 719 patients included in the study, who were accompanied by snoring, daytime sleepiness and other symptoms. Laboratory-based polysomnographic variables （including AHI, oxygen desaturation index and microarousal index, etc.）, and anthropometric measurements （including weight, neck circumference, waist circumference, hip circumference etc.） were collected for all participants. The severity of OSA was determined by AHI. No OSA was defined as AHI<5, mild OSA as AHI of 5 to 15，moderate OSA as AHI of >15 to 30, and severe OSA as AHI of >30. Smoking severity was determined by the smoking index （SI）. Light smoke was defined as SI<200, moderate smoke was as SI 200 to 400, and severe smoke as SI>400. Result:There were 138 cases of non-OSA and 581 cases of OSA. There were 381 non-smokers, 279 smokers and 59 quit smokers. The smoking rate of OSA group was significantly higher than that of non-OSA group （41.5% vs. 27.5%,P<0.01）. After excluding 59 quit smokers, the remaining 660 subjects were divided into four groups according to the severity of smoking, then each group was further divided into four groups according to OSA severity. Unadjusted analysis showed that OSA severity positively correlated with smoking severity （r=0.203,P<0.01）. The positive correlation remained significant after further adjustment for age, BMI and waist-hip ratio. In addition, logistic regression analysis showed that compared to non-smokers, the odd ratios for OSA in moderate smokers were 1.72 （95%CI 1.08-2.75） and in severe smokers were 2.68 （95%CI 1.61-4.46）, after adjustment for age, BMI and waist-hip ratio. Conclusion:The severity of smoking significantly correlated with the severity of OSA. There was increased risk of OSA in patients with severe smoke. The correlation was independent of some confounders such as age and obesity.

Field-induced magnetic transitions and strong anisotropy in α-CoV2O6 single crystal

The Ising-like antiferromagnet α-CoV₂O₆ has received considerable interests because of stabilized 1/3 magnetization plateau around 5 K under magnetic field applied along magnetic easy c-axis. In this work, this magnetization plateau was studied by varying temperature or rotating magnetic field. As temperature decreased, this stabilized plateau collapsed, and additional magnetic transitions were observed. As a result, a rich magnetic phase diagram was constructed and extended to temperature lower than previously reported. When magnetic field moved from the c to b (or a) axis, the magnetization plateau developed with field directions and vanished finally when the field was restricted in the ab plane. An impressive observation is that this 1/3-plateau can be stabilized and remain robust even when magnetic field deviated from the c axis, accompanied by the evolutions of the magnetic moments and the critical transition fields. We suppose that the origins of these temperature and angular dependences of the 1/3 magnetization plateau are related to strong spin-orbital coupling. Indeed, electron spin resonance (ESR) measurement gives large Landé factor of 8.9, evidencing that there exists strong spin-orbital coupling.

The Development of an Antimicrobial Contact Lens - From the Laboratory to the Clinic

Contact lens wear is generally safe and provides excellent vision. However, contact lens wear is often associated with the risk of developing ocular surface infection and inflammation, and in severe cases, the infection can result in loss of vision. Antimicrobial peptide-coated contact lenses have been made to help reduce the incidence of infection and inflammation. This paper reviews the research progress from conception, through the laboratory and preclinical tests to the latest information on clinical testing of an antimicrobial contact lens. We provide insights into the pathways followed and pitfalls that have been encountered. The journey has not always been linear or smooth, but has resulted in some of the first published clinical testing of antimicrobial peptide-coated contact lenses in humans. We hope this may help lead to the development and commercialisation of antimicrobial contact lenses in the future.

Tumour stiffness associated with tumour response to conventional transarterial chemoembolisation for hepatocellular carcinoma: preliminary findings

AIM

To evaluate whether elastic (stiffness) characteristics of tumours were associated with treatment responses and survival of patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolisation (TACE).

MATERIALS AND METHODS

A retrospective cohort study of 59 HCC patients with unresectable HCC who underwent TACE was undertaken. Acoustic radiation force impulse imaging (ARFI) was used to measure tissue stiffness of the index tumours and non-tumoural liver before TACE treatment. The correlation between the parameters of tumour stiffness and treatment response to TACE was assessed using mRECIST criteria as well as according to patient survival.

RESULTS

Tumour stiffness and its stiffness difference between tumour and non-tumoural liver were significantly associated with tumour response to TACE (p=0.019 and 0.010, respectively). Patients with tumour stiffness of <2 m/s or stiffness difference between tumour and non-tumoural liver of <0.5 were more likely to have treatment response to TACE. Univariate analysis showed that the difference in stiffness between tumour and non-tumoural livers (p=0.039) was one of the significant predictors of overall survival (OS). In multivariate analysis, alpha-fetoprotein (AFP) (p=0.006) and Barcelona Clinic Liver Cancer (BCLC) stage (p=0.017) were identified as independent predictors of survival.

CONCLUSION

Tumour stiffness characteristics might be an added predictive marker of treatment response to TACE in patients with HCC.

[Cluster analysis and significance of clinical subtypes in patients with obstructive sleep apnea hypopnea syndrome]

Objective: To study the clinical subtypes of obstructive sleep apnea hypopnea syndrome (OSAHS) by cluster analysis, and to discuss the characteristics and clinical significance of these subtypes. Methods: A retrospective analysis was done among patients who were diagnosed with OSAHS in the Sleeping Center of the Second Affiliated Hospital of Soochow University from January 2010 to June 2018. In this cluster analysis, 16 main symptoms, 7 comorbidities and 3 assessment scales were included. After selecting the best model, the parameters and characteristics of different subtypes were compared and analyzed. Results: A total of 2 592 patients with complete data were included in this study. After cluster analysis, they were divided into 4 groups: sleep apnea group (1 173 cases, 45.3%), daytime sleepiness group (518 cases, 20.0%), insomnia and memory loss group (212 cases, 8.2%), mild symptom group (689 cases, 26.6%). In the sleep apnea group, the patients were found to be younger [(40.2±10.4) years old], with higher body mass index (BMI) [(27.7±3.7) kg/m(2)] when compared to the other groups. In addition, the prevalence of comorbidities of this group was found to be lower, whereas the probability of sleep apnea symptom was the highest (94.7%). In daytime sleepiness group, the Epworth Sleepiness Scale (ESS) score was the highest [(12.4±5.5) points], and the probability of daytime sleepiness symptom was also found to be the highest (88.0%). The age of patients in the insomnia and memory loss group was the highest [(51.1±13.0) points], with the highest percentage of women (19.3%). The probability of insomnia was found to be 70.3%, and memory loss symptoms was 88.2% which were the highest when compared to the other groups. The prevalence of comorbidities was the highest, and the scores of short mental state scale (MMSE) and Montreal cognitive assessment (MoCA) were the lowest with a mean of [(28.5±2.4) points] and [(25.4±3.2) points], respectively, among the 4 groups. The probability of most symptoms and comorbidities were found be the lowest in the mild symptom group. There were significant differences in the main symptoms among the 4 groups (P<0.05). Symptoms like sleep apnea, daytime sleepiness, insomnia, memory loss, headache and dry mouth upon awakening were found significantly different in pairwise comparisons among the groups (P<0.002). Conclusion: The patients with OSAHS can be divided into four clinical subtypes by cluster analysis, each of which is significantly heterogeneous, and this is helpful to evaluate the condition and guide individualized treatment.

[Efficacy of nasal CPAP and aerobic exercise of different intensity in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes mellitus]

Objective: To explore the therapeutic efficacy of nasal Continuous Positive Airway Pressure (CPAP) and aerobic exercise of different intensity in patients with Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) and Type 2 Diabetes Mellitus (T2DM). Methods: A total of 112 patients with OSAHS and T2DM, including 53 males and 59 females, with a mean age of (66.9±7.8) years old, from the Fourth Rehabilitation Hospital of Shanghai and the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 were enrolled prospectively. There were divided into two groups based on whether received nasal CPAP therapy: 50 cases in nasal CPAP+aerobic exercise group and 62 cases in aerobic exercise group. Subsequently, patients in nasal CPAP+aerobic exercise group were randomly divided into two subgroups: moderate and low intensity aerobic exercise (26 and 24 cases respectively). All patients completed nasal CPAP and (or) aerobic exercise of different intensity for 20 weeks. The therapeutic efficacy of polysomnography (PSG) parameters, glycolipid metabolism, 6 minutes walking distance (6 MWD), and rate of perceived exertion (RPE) were compared between each group before and after treatment. Results: Pre-and post-intervention, PSG parameters, body mass index (BMI) [(26.6±3.7) vs (24.3±2.8) kg/m(2)], RPE [(16.4±1.3) vs (12.2±2.6) score], 6 MWD [(372.6±59.7) vs (441.5±75.6) m] and glucolipid metabolism indexes were improved significantly in nasal CPAP+aerobic exercise group (all P<0.05), such as fasting blood glucose [(7.4±2.4) vs (6.2±1.6) mmol/L], glycosylated hemoglobin [(7.6±1.2)% vs (6.6±0.7)%], fasting insulin [(10.8±4.4) vs (6.9±3.4) μU/L], insulin resistance index [(3.5±1.9) vs (1.9±1.2)], total cholesterol [(4.0±0.9) vs (3.5±0.9) mmol/L], low density lipoprotein cholesterol [(4.2±0.6) vs (3.1±0.8) mmol/L]; BMI, exercise endurance, some glucolipid metabolism indexes and PSG parameters were also improved in aerobic exercise group (P<0.05). After 20 weeks' intervention, it showed statistically significant differences in PSG parameters, glycometabolism, some lipid metabolism indexes and RPE (all P<0.05), and no significantly difference in BMI [(24.3±2.7) vs (24.3±2.8) kg/m(2)] between the two groups. Compared with the low intensity subgroup, there were significant improvement in 2 hours' postprandial insulin, insulin resistance index, low density lipoprotein cholesterol, lipoprotein A, RPE, 6 MWD in moderate subgroup (P<0.05). Conclusion: Nasal CPAP combined with moderate intensity aerobic exercise can effectively improve the glucolipid metabolism, insulin resistance and exercise tolerance in patients with OSAHS and T2DM.

Magnetism study on a triangular lattice antiferromagnet Cu2(OH)3Br

Magnetism of Cu₂(OH)₃Br single crystals based on a triangular lattice is studied by means of magnetic susceptibility, pulsed-field magnetization, and specific heat measurements. There are two inequivalent Cu²⁺ sites in an asymmetric unit. Both Cu²⁺ sublattices undergo a long-range antiferromagnetic (AFM) order at [Formula: see text] K. Upon cooling, an anisotropy crossover from Heisenberg to XY behavior is observed below 7.5 K from the anisotropic magnetic susceptibility. The magnetic field applied within the XY plane induces a spin-flop transition of Cu²⁺ ions between 4.9 T and 5.3 T. With further increasing fields, the magnetic moment is gradually increased but is only about half of the saturation of a Cu²⁺ ion even in 30 T. The individual reorientation of the inequivalent Cu²⁺ spins under field is proposed to account for the magnetization behavior. The observed spin-flop transition is likely related to one Cu site, and the AFM coupling among the rest Cu spins is so strong that the 30 T field cannot overcome the anisotropy. The temperature dependence of the magnetic specific heat, which is well described by a sum of two gapped AFM contributions, is a further support for the proposed scenario.

The effect of oral polyethylene glycol combined with simethicone for colonoscopy on cecal intubation rate, tolerability and acceptability : a systematic review and meta-analysis

OBJECTIVE

To assess the efficacy adjunction of oral simethicone to polyethylene glycol as bowel preparation agent on cecal intubation rate.

METHODS

We searched EMBASE, PubMed and Cochrane library for randomized controlled trials regarding simeticone plus polyethylene glycol as oral drinking agents before gastroscopy,we used the soft RevMan5.3 to perform statistical analysis and stata12.0 for publication bias.

RESULTS

12 randomized trials that met the inclusion criteria were therefore pooled into a meta-analysis, which included a total of 5,112 patients. There were no significant differences on cecal intubation rate in two groups(RR=1.0,95%CI : 0.99-1.01, P=0.93) with moderate level of evidence;Subgroups analysis of 2LPEG+ Simethicone VS 2LPEG(RR =1.0, 95% CI : 0.98,1.01), 2LPEG+ Simethicone VS 4L PEG (RR=1.00, 95% CI : 0.98,1.02), PEG+ Simethicone with bisacodyl vs PEG (RR =1.00, 95% CI : 0.99,1.02), PEG+Simethicone without bisacodyl vs PEG (RR =1.00, 95% CI : 0.98,1.02) showed no difference on cecal intubation rate.There was aslo no significant difference on cecal intubation time.Abdominal bloating incidence was lower in PEG+Simethicone group than that in PEG group (RR=0.53, 95%CI : 0.31, 0.91, P=0.02). The meta-analysis result also showed a better acceptability in PEG+Simethicone group (RR=1.28, 95% CI : 1.01, 1.49, P=0.001).

CONCLUSION

Adjunction of oral simethicone to polyethylene glycol as bowel preparation agent dose not improve cecal intubation rate on colonoscopy,but with better gastrointestinal tolerability and acceptability.

A chemiluminescence resonance energy transfer strategy and its application for detection of platinum ions and cisplatin

A novel chemiluminescence resonance energy transfer (CRET) system was developed and combined with a structure-switching aptamer for the highly sensitive detection of platinum. Platinum was chosen as a model analyte to demonstrate the generality of the new CRET system. This aptameric platform consisted of a streptavidin labeled aptamer against platinum and a streptavidin-coated magnetic bead for the selective separation of platinum-bound aptamer. The platinum-aptamer probe contained several guanine (G) bases bound to the 3,4,5-trimethoxyphenyl-glyoxal (TMPG) donor group at the 5' end, a fluorescent acceptor (6-carboxy-2',4,7,7'-tetrachlorofluorescein, TET) at the 3' end, and a streptavidin aptamer sequence in which several base pairs were replaced by the G-G mismatch to induce the platinum-oligonucleotide coordination. The chemiluminescence (CL) generated by TMPG/G bases is transferred to the acceptor (TET). In the presence of platinum, the platinum-aptamer probe was folded such that the G bases at the 5' end and TET at the 3' were in close proximity. The complex was separated using streptavidin-coated magnetic beads by the addition of TMPG to form the TMPG/G bases complex. The ultraweak CL from the TMPG/G bases was strongly enhanced by TET. This novel CRET-based method can be easily performed with high limit of detection (50 ng·mL^-1) and selectivity over other metal ions. This technique provides a novel method for simple, fast, and convenient point-of-care diagnostics for monitoring proteins and metal ions. Graphical abstract Schematic presentation of chemiluminescence resonance energy transfer (CRET) detection of platinum(II) by Pt-base pair coordination to the aptamer. TMPG: 3,4,5-trimethoxyphenyl-glyoxal, fluorophore TET: 6-carboxy-2',4,7,7'-tetrachlorofluorescein.

[The characteristics and determining factors of attention and short-term memory impairment in young patients with obstructive sleep apnea-hypopnea syndrome]

Objective: To explore the characteristics and determining factors of attention and short-term memory impairment in young patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: A total of 203 eligible patients with snoring were recruited for the study at Sleep Center, Second Affiliated Hospital of Soochow University from July 2016 to July 2017, and they were all monitored with overnight polysomnography(PSG), recording sleep parameters [NREM (Ⅰ+Ⅱ) sleep ratio, NREM Ⅲ sleep ratio, REM sleep ratio] and respiratory parameters (AHI, ODI, LSaO(2), TS90%, RRMAI). Based on apnea/hypopnea index(AHI), the patients were categorized into non-OSAHS group (0<AHI≤5/h), mild and moderate OSAHS group (5<AHI≤30/h), and severe OSAHS group (AHI>30/h). All patients were assessed for sleepiness and the Motreal Cognitive Assessment (MoCA) questionnaires, Mini-mental State Examination (MMSE), Epworth Sleepiness Scale(ESS), attention and short-term memory assessment which included Trail Marking Test(TMT), digit span test(DST), and Complex Figure Test(CFT). The PSG parameters, ESS scores, total MoCA scores, attention and short-term memory were compared among groups, and a multivariate logistic regression analysis was conducted to investigate the characteristics of attention and short-term memory impairment in young patients with OSAHS and their determining factors. Results: In the overall cognitive function assessment, severe OSAHS patients's MoCA scores were lower than those of the other two groups [27.0 (25.0, 28.0) vs 27.0 (26.0, 28.0) , 27.0 (26.0, 27.0) , P<0.01]. In the sleepiness self-assessment, severe OSAHS patients's ESS scores were significantly higher than those of the other groups (11.4±5.4 vs 5.3±4.5, 8.0±5.0, P<0.01) . In the attention tests, scores on the DST-D (8.1±1.1 vs 8.8±0.9, 8.5±1.0) and DST-B[5.5 (4.0, 7.0) vs 6.0 (5.0, 7.0) , 6.0 (5.0, 7.0) ] were significantly lower in severe OSAHS patients than in the other two groups (P<0.01) . In the memory tests, the re-drawing scores of severe OSAHS patients were significantly lower than those of the other two groups [23.0 (16.0, 27.0) vs 26.0 (24.0, 28.0) , 24.0 (20.0, 28.0) , P<0.01]. In the executive function tests, severe OSAHS patients spent much longer on both TMT-A (46.7±19.0 vs 40.2±17.4, 34.6±17.2) and TMT-B (76.9±32.6 vs 67.2±21.2, 58.6±27.5) than the other two groups (P<0.01). Multivariate logistic stepwise regression analysis showed that, AHI, ODI and NREM (Ⅰ+Ⅱ) sleep ratios were the independent determining factors. Conclusion: Attention and short-term memory functions of young patients with OSAHS were impaired. The severity of apnea and hypoxia, NREM (Ⅰ+Ⅱ) ratio were all determining factors.

[Expression and prognosis effect of methylation-regulated SLIT3 and SPARCL1 genes in smoking-related lung adenocarcinoma]

Objective: To investigate the expression and prognosis effect of methylation-regulated SLIT3 and SPRCL1 genes in smoking-related lung adenocarcinoma. Methods: The expression levels of SLIT3 and SPARCL1 in cigarette smoke-induced malignant transformed cell (S30) and lung adenocarcinoma (LUAD) cell lines were measured by real-time fluorescence quantitative PCR (qPCR). Datasets of mRNA expression, DNA methylation and patient information data were obtained from The Cancer Genome Altas (TCGA) database. The mRNA expression levels of SLIT3 and SPARCL1 were validated in LUAD tissues. The 10-year survival curve of LUAD patients with different smoking history was plotted, and the correlation between mRNA expression level and DNA methylation level of LUAD patients was further analyzed. S30 cells were treated with 5-azacytidine (5-aza), an inhibitor of DNA methyltransferase, to analyze the methylation regulatory mechanism of SLIT3 and SPRCL1. Results: The qPCR results showed the significant down-regulation of SLIT3 and SPARCL1 in S30 cell and four LUAD cell lines (SLIT3: 0.493±0.134 and 0.041±0.014, 0.161±0.023, 0.277±0.055, 0.035±0.005; SPARCL1: 0.507±0.131 and 0.453±0.045, 0.420±0.040, 0.153±0.035, 0.430±0.050; all P<0.01). Bioinformatics analysis showed that SLIT3 and SPARCL1 were low expressed in LUAD tissue (8.12±1.58 vs 10.84±0.69 and 11.46±1.06 vs 13.57±0.67; both P<0.001) compared with adjacent peritumoral tissues, and expression levels of SLIT3 and SPARCL1 were significantly correlated with smoking history (both P<0.001). Non-smoker with high expression of SLIT3 and SPARCL1 was associated with better prognosis among LUAD patients. There was a significant negative correlation between promoter methylation and mRNA expression level of the two genes (r=-0.208, -0.574; both P<0.001). 5-aza treatment significantly up-regulated the expression levels of SLIT3 and SPARCL1 genes in S30 cells (2.137±0.281, 3.657±0.882; both P<0.01). Conclusion: SLIT3 and SPARCL1 can be regulated by DNA methylation and down-regulated in LUAD tissue, which has important prognostic significance on the smoking-induced LUAD patients.

Glucocorticoid receptor involvement in goose (Anas cygnoides) pituitary somatotroph differentiation induced by glucocorticoids during embryonic development

1. In this study, geese (Anas cygnoides) embryonic pituitary cells were cultured in vitro to determine if glucocorticoids could induce growth hormone (GH) expression and to investigate the molecular mechanisms involved in this process. 2. On embryonic day 15 (e15) and e20 the pituitary cells were treated with corticosterone (CORT), membrane impermeable bovine serum albumin-conjugate corticosterone (CORT-BSA), dexamethasone (DEX), and a glucocorticoid receptor (GR) antagonist (RU486) to detect responsiveness of somatotrophs to glucocorticoids. 3. Treatment with CORT, CORT-BSA, and DEX for as little as 6 h increased the percentage of GH-positive cells (P < 0.01) and increased GH mRNA expression (P < 0.01) in e15 goose pituitary cells compared to the control. CORT significantly increased the level of GH protein secreted from cultured e15 goose embryonic pituitary cells, and CORT-BSA increased GH secretion from e20 goose embryonic pituitary cells. 4. A significant increase was observed in the glucocorticoid receptor in GR transcription levels (P < 0.01) with CORT, CORT-BSA, and DEX treatment. Furthermore, the CORT-stimulated GH mRNA expression was completely negated by pre-treatment with RU486. 5. These findings demonstrate that glucocorticoids can stimulate somatotroph differentiation in vitro, as characterised by enhanced GH protein secretion andmRNA expression in cultured geese embryonic pituitary cells. The membrane GR was involved in pituitary somatotroph differentiation induced by glucocorticoids during the embryonic development of geese.

Development and potential application of a simultaneous multiplex assay of Golgi protein 73 and alpha-fetoprotein for hepatocellular carcinoma diagnosis

OBJECTIVE

Detecting a single serum marker, such as Golgi protein 73 (GP73) or alpha-fetoprotein (AFP), may not meet the requirements for the early diagnosis of hepatocellular carcinoma (HCC) due to low sensitivity and specificity. Therefore, this study aimed to develop a simultaneous multiplex assay of GP73 and AFP.

PATIENTS AND METHODS

Anti-human GP73- and AFP-coupled microsphere beads and biotin-labeled detectable antibodies were prepared to develop a multiplex assay of GP73 and AFP using the Luminex xMAP technology. The assay was evaluated for cross-reactivity, standard curve, sensitivity, range of detection, and precision. Additionally, the assay was used to determine the levels of serum GP73 and AFP in healthy controls and patients with chronic hepatitis, liver cirrhosis, and HCC.

RESULTS

The multiplex assay was successfully developed to simultaneously detect GP73 and AFP without cross-reactivity. The sensitivity for GP73 detection was 0.215 ng/mL and that for AFP detection was 0.666 ng/mL. The ranges of GP73 and AFP detection were 0.98-861.08 ng/mL and 2.01-1848.73 ng/mL, respectively. The intra- and inter-assay coefficients of variation (CVs) were <10%, indicating good precision, with recovery rates of 75-125%. The levels of serum GP73 in healthy controls, chronic hepatitis patients, liver cirrhosis patients, and HCC patients were 61.64 ± 30.60 ng/mL, 208.4 ± 99.42 ng/mL, 183.7 ± 82.78 ng/mL, and 214.1 ± 160.5 ng/mL, respectively. The levels of serum AFP in healthy controls, chronic hepatitis patients, liver cirrhosis patients, and HCC patients were 24.87 ± 14.52 ng/mL, 134.4 ± 216.5 ng/mL, 66.45 ± 133.4 ng/mL, and 891.4 ± 1278 ng/mL, respectively. The receiver operating characteristic (ROC) results showed that the area under the curves (AUC) for the combination of GP73 and AFP was 0.972, which was larger than the AUC for each marker. The sensitivity and specificity of the combined detection of GP73 and AFP for the diagnosis of HCC were 90.91% and 98.86%, respectively. The multiplex assay demonstrated a good correlation with enzyme-linked immunosorbent assay (ELISA), with correlation coefficients of 0.818 and 0.982 for GP73 (p<0.001) and AFP (p<0.001), respectively.

CONCLUSIONS

A multiplex assay for the simultaneous detection of GP73 and AFP with high sensitivity and accuracy was developed for the diagnosis of HCC. This assay may provide a reliable reference for the early diagnosis of HCC.

[Factors that related to the depressive symptoms among elderly in urban and rural areas of China]

Objective: The aim of this research was to study the prevalence and differences of depressive symptoms and related factors in elderly in both urban and rural areas so as to develop relative strategies on this issue. Methods: Ten-question-version of the Center Epidemiologic Studies-Depression scale (CES-D) was applied to score the depressive status. Data used in this research was from the 2013 China Health and Retirement Longitudinal Study (CHARLS). Binary logistic regressions method was applied to examine the influential factors related to depression symptoms. Results: In the elderly population, the mean score on depressive symptoms was 8.3±5.9, with a prevalence as 26.8%. The incidence rates on 'Elderly depression' in urban and rural areas were 16.4% and 30.0% respectively. The prevalence of depressive symptoms was relatively low (P<0.05) with protective factors including: being male, status related to self-rated health, without chronic diseases, active participation in social activities etc. noticed, among elderly in both urban and rural areas. Age and alcohol consumption appeared factors that influencing the depressive symptoms of the elderly in rural areas, while the average income was an influencing factor on the elderly in urban areas. Incidence of depression was relatively low in age ≥75 years group in rural areas. However, elderly in the rural areas with abstinence of alcohol intake showed higher incidence of depressive symptoms (P<0.05). Incidence of depression was reltively low (P<0.05) among elderly with high income in the urban areas. Conclusions: Incidence of depression appeared high among the elderly and even higher in the rural areas. Strategies would include the following points: to strengthen the construction of urban-rural integration, improving and strengthening the rural pension insurance system, upgrading the urban social assistance for low-income elderly, strengthening the psychological consultation service of primary medical institutions and actively developing the three-tier levels related to the prevention of chronic diseases.

Development of a sandwich ELISA for determining plasma prolactin concentration in domestic birds

The present study was conducted to establish a sandwich ELISA for the determination of prolactin (PRL) concentrations in the plasma of domestic fowls. The assay uses a recombinant goose PRL as the reference standard, expressed in a eukaryotic system, and as the antigen for raising a polyclonal antibody in rabbit. This rabbit anti-goose PRL polyclonal antibody was used for coating the wells of the ELISA plate, and its biotinylated form served as the detection antibody. An avidin-conjugated horseradish peroxidase was used to bind the detection antibody and to catalyze the chromogenic reaction using 3,3',5,5'-tetramethylbenzidine as the substrate. The assay showed a linear relationship between the optical density and concentration of the standard PRL in the 0 to 12.5 ng/mL range, and the assay was sensitive to a concentration as low as 0.39 ng/mL. The intra- and inter-assay CVs were <7% and 11%, respectively. The response curves of the serially diluted plasma samples from goose, duck, and chicken exhibited similar parallel relationships to that observed for the reference standards. Consistent with previous findings, the assay effectively detected differences in PRL concentration in plasma samples from chicken, duck, and goose at various reproductive stages.

Effect and molecular regulatory mechanism of monochromatic light colors on the egg-laying performance of Yangzhou geese

Photoperiodic control is essential for manipulating the reproductive performance of avian species. This study was conducted to assess the neuroendocrine mechanisms that regulate reproductive functions of Yangzhou geese when there are different monochromatic light colors from light emitter diode (LED) sources. A flock of geese was divided into four groups with white, red, blue, and green light treatments being imposed. The results indicated that peak laying rates and reproductive performance were greater in geese treated with white or red as compared with blue or green light treatments. The fertilization rate of eggs and hatchability of fertilized eggs were greater with the white or red as compared with blue or green light treatments. There was a greater abundance of OPN5, Dio2, c-Fos, and GnRH-I mRNA in the hypothalamus earlier in the treatment period and abundances of these hypothalamic factors were greater with the white or red light treatments. Abundances of pituitary LH beta and FSH beta mRNA increased at a lesser rate with the blue or green light treatments and were in greater abundances with the white or red light treatments. The lighting regimen also resulted in photo-refractoriness with there being greater abundances of GnIH, VIP, and PRL mRNA with the use of white or red light treatments. The results indicate that the use of white or red monochromatic lights while imposing a long photoperiod of 11 h daily could result in sustaining functions of the reproductive system of Yangzhou geese for considerably longer times, thus, resulting in greater egg-laying performance.