The Role of Vitamin D in the Transcriptional Program of Human Pregnancy

Background

Patterns of gene expression of human pregnancy are poorly understood. In a trial of vitamin D supplementation in pregnant women, peripheral blood transcriptomes were measured longitudinally on 30 women and used to characterize gene co-expression networks.

Objective

Studies suggest that increased maternal Vitamin D levels may reduce the risk of asthma in early life, yet the underlying mechanisms have not been examined. In this study, we used a network-based approach to examine changes in gene expression profiles during the course of normal pregnancy and evaluated their association with maternal Vitamin D levels.

Design

The VDAART study is a randomized clinical trial of vitamin D supplementation in pregnancy for reduction of pediatric asthma risk. The trial enrolled 881 women at 10–18 weeks of gestation. Longitudinal gene expression measures were obtained on thirty pregnant women, using RNA isolated from peripheral blood samples obtained in the first and third trimesters. Differentially expressed genes were identified using significance of analysis of microarrays (SAM), and clustered using a weighted gene co-expression network analysis (WGCNA). Gene-set enrichment was performed to identify major biological pathways.

Results

Comparison of transcriptional profiles between first and third trimesters of pregnancy identified 5839 significantly differentially expressed genes (FDR<0.05). Weighted gene co-expression network analysis clustered these transcripts into 14 co-expression modules of which two showed significant correlation with maternal vitamin D levels. Pathway analysis of these two modules revealed genes enriched in immune defense pathways and extracellular matrix reorganization as well as genes enriched in notch signaling and transcription factor networks.

Conclusion

Our data show that gene expression profiles of healthy pregnant women change during the course of pregnancy and suggest that maternal Vitamin D levels influence transcriptional profiles. These alterations of the maternal transcriptome may contribute to fetal immune imprinting and reduce allergic sensitization in early life.

Trial Registration

clinicaltrials.gov NCT00920621

An Open-Label Pilot Study of Metformin as a Concomitant Therapy on Patients with Prostate Cancer Undergoing Androgen Deprivation Treatment

PURPOSE

The study aimed to evaluate the effects of metformin on insulin, C-peptide and body weight in Chinese men undergoing androgen deprivation therapy (ADT).

METHODS

Between March 2013 and June 2014, 62 newly diagnosed patients of prostate cancer (PCa) due to receive ADT were recruited from 7 hospitals in Shanghai. Patients were randomized to respectively receive ADT (n = 31) and ADT + metformin (n = 31) for 6 months. Fasting and postprandial serum levels of insulin and C-peptide, blood glucose, prostate specific antigen, body mass index (BMI) and waist circumference (WC) were measured at the beginning and end of 6-month treatment.

RESULTS

Baseline characteristics were comparable between the 2 groups. Controlling for baseline levels, the ADT group had significantly higher levels of fasting glucose (p = 0.01) and higher WC (p = 0.04) than the ADT + metformin group. The levels of insulin, C-peptide and BMI did not differ significantly.

CONCLUSIONS

Metformin may be potentially efficient as a concomitant therapy on patients with PCa undergoing androgen deprivation treatment.

Development of hepatolithiasis due to a celery stalk retained within the bile ducts of the liver

INTRODUCTION

Commonly encountered foreign bodies are remnants from surgical procedures and ingested materials. Rarely, the latter cause stone formation in the biliary tract.

CASE HISTORY

We describe a 51-year-old female who underwent choledoduodenostomy and who presented with abdominal distension caused by multiple stones in the bile ducts within the liver (hepatolithiasis) and an intact celery stalk. Hepatolithiasis was demonstrated by ultrasonography and computed tomography of the abdomen. The celery stalk was not confirmed until exploration of the biliary duct.

CONCLUSIONS

Here, we describe, for the first time, an intact, undigested celery stalk in the biliary tract which induced hepatolithiasis. We believe that choledochojejunostomy favoured reflux of the celery stalk from the duodenum into the biliary tract.

Study to Improve Cardiovascular Outcomes in high-risk older patieNts (ICON1) with acute coronary syndrome: study design and protocol of a prospective observational study

INTRODUCTION

The ICON1 study (a study to Improve Cardiovascular Outcomes in high-risk older patieNts with acute coronary syndrome) is a prospective observational study of older patients (≥75 years old) with non-ST-elevation acute coronary syndrome managed by contemporary treatment (pharmacological and invasive). The aim of the study was to determine the predictors of poor cardiovascular outcomes in this age group and to generate a risk prediction tool.

METHODS AND ANALYSIS

Participants are recruited from 2 tertiary hospitals in the UK. Baseline evaluation includes frailty, comorbidity, cognition and quality-of-life measures, inflammatory status assessed by a biomarker panel, including microRNAs, senescence assessed by telomere length and telomerase activity, cardiovascular status assessed by arterial stiffness, endothelial function, carotid intima media thickness and left ventricular systolic and diastolic function, and coronary plaque assessed by virtual histology intravascular ultrasound and optical coherence tomography. The patients are followed-up at 30 days and at 1 year for primary outcome measures of death, myocardial infarction, stroke, unplanned revascularisation, bleeding and rehospitalisation.

ETHICS AND DISSEMINATION

The study has been approved by the regional ethics committee (REC 12/NE/016). Findings of the study will be presented in scientific sessions and will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT01933581: Pre-results.

Hhip haploinsufficiency sensitizes mice to age-related emphysema

Genetic variants in Hedgehog interacting protein (HHIP) have consistently been associated with the susceptibility to develop chronic obstructive pulmonary disease and pulmonary function levels, including the forced expiratory volume in 1 s (FEV1), in general population samples by genome-wide association studies. However, in vivo evidence connecting Hhip to age-related FEV1 decline and emphysema development is lacking. Herein, using Hhip heterozygous mice (Hhip(+/-)), we observed increased lung compliance and spontaneous emphysema in Hhip(+/-) mice starting at 10 mo of age. This increase was preceded by increases in oxidative stress levels in the lungs of Hhip(+/-) vs. Hhip(+/+) mice. To our knowledge, these results provide the first line of evidence that HHIP is involved in maintaining normal lung function and alveolar structures. Interestingly, antioxidant N-acetyl cysteine treatment in mice starting at age of 5 mo improved lung function and prevented emphysema development in Hhip(+/-) mice, suggesting that N-acetyl cysteine treatment limits the progression of age-related emphysema in Hhip(+/-) mice. Therefore, reduced lung function and age-related spontaneous emphysema development in Hhip(+/-) mice may be caused by increased oxidative stress levels in murine lungs as a result of haploinsufficiency of Hhip.

Engaging older patients in cardiovascular research: observational analysis of the ICON-1 study

Background

As a consequence of population ageing, the number of older patients presenting with acute coronary syndrome (ACS) is increasing. The historical underrepresentation of older patients in many pivotal ACS clinical trials undermines the practice of evidence-based medicine in this high-risk cohort. This study evaluates the feasibility of recruitment of older patients to a longitudinal, clinical study.

Methods

The study to Improve Cardiovascular Outcomes in high-risk patieNts with ACS (ICON-1) is an observational, prospective cohort study investigating predictors of poor outcome in older patients with ACS. All patients aged ≥75 years, referred to a tertiary cardiovascular centre in the North East of England for coronary angiography with a view to urgent percutaneous coronary intervention, were screened for inclusion. A screening log was prospectively maintained, and a detailed analysis was performed to identify the factors associated with recruitment and non-recruitment to ICON-1.

Results

Of the 629 patients screened over 34 months, 457 (72.7%) satisfied the a priori-defined study inclusion/exclusion criteria. Of those eligible to participate, 300 (68.5%) provided informed consent and were recruited to the study; 59 (13.5%) were unable to consent due to a lack of capacity or limitations in communication, and 79 patients (18.0%) declined to participate in the study. Those lacking adequate capacity to consent were older than those able to provide informed consent (83.0±4.7 vs 81.0±4.7 years, p=0.002). Women were more likely to decline than men (25.1% vs 10.0%, p<0.001).

Conclusions

The recruitment of patients was robust, comparing favourably to previous longitudinal studies within this age group. Although enrolling older people to research remains challenging, this cohort is enthusiastic to participate. The contribution of older patients must not be ignored, particularly in the setting of an ever-ageing population, in whom cardiovascular disease burden is high.

Trial registration number

NCT01933581; Pre-results.

[Effects of Sp1 on the basic transcriptional activity of intestinal trefoil factor promoter]

OBJECTIVE

To explore response element that maintains basic transcriptional activity of intestinal trefoil factor (ITF) promoter.

METHODS

Truncated and mutant 5' flanking sequences of ITF gene were cloned from ITF promoter sequences by PCR, and then they were inserted into the pGL3-basic vector to construct truncated and mutant luciferase vectors to conduct the following experiments. (1) Human embryonic kidney 293 (HEK293) cells were divided into pGL3-basic group, pGL3-300 group, pGL3-280 group, pGL3-260 group, pGL3-240 group, pGL3-220 group, and pGL3-200 group according to the random number table (the same grouping method below), with 3 wells in each group, and they were respectively transfected with 500 ng corresponding plasmids and 15 ng renilla luciferase reporter plasmids pRL-TK. After being cultured for 48 hours, the relative luciferase activity of cells was measured by single tube detection system. (2) Another batch of HEK293 cells were divided into pGL3-basic group, pGL3-300 group, mutant 1, 2, 3, and 4 groups, with 3 wells in each group, and they were respectively transfected with 500 ng pGL3-basic, pGL3-300, mutant 1, 2, 3, and 4 plasmids and 15 ng pRL-TK plasmids. After being cultured for 48 hours, the relative luciferase activity of cells was measured as in (1). (3) Another batch of HEK293 cells were divided into blank control group and 10, 50 μmol/L mithramycin groups, with 3 wells in each group. After being transfected with 500 ng pGL3-300 plasmids and 15 ng pRL-TK plasmids, cells in blank control group were not transfected with mithramycin, while cells in the latter two groups were respectively transfected with 10 and 50 μmol/L mithramycin. After being cultured for 24 hours, the relative luciferase activity of cells was measured as in (1). (4) Another batch of HEK293 cells were divided into blank control group and 0.1, 0.2, and 0.3 μg pcDNA3.1-Sp1 groups, with 3 wells in each group. After being transfected with 500 ng pGL3-300 plasmids and 15 ng pRL-TK plasmids, cells in blank control group were not transfected with pcDNA3.1-Sp1 plasmids, while cells in the latter three groups were respectively transfected with 0.1, 0.2, and 0.3 μg pcDNA3.1-Sp1 plasmids. After being cultured for 48 hours, the relative luciferase activity of cells was measured as in (1). Data were processed with one-way analysis of variance and LSD test.

RESULTS

(1) The relative luciferase activity of cells in pGL3-basic group, pGL3-300 group, pGL3-280 group, pGL3-260 group, pGL3-240 group, pGL3-220 group, and pGL3-200 group was 1.00, 7.99±0.51, 2.03±0.55, 2.50±0.40, 2.50±0.15, 1.72±0.19 and 2.10±0.21, respectively. The relative luciferase activity of cells in pGL3-280 group, pGL3-260 group, pGL3-240 group, pGL3-220 group, and pGL3-200 group was significantly lower than that in pGL3-300 group (with P values below 0.01). (2) The relative luciferase activity of cells in pGL3-basic group, pGL3-300 group, mutant 1, 2, 3, and 4 groups was 1.00, 7.99±0.51, 2.10±0.56, 7.03±1.05, 5.09±1.40 and 8.15±1.48, respectively. The relative luciferase activity of cells in mutant 1 group was significantly lower than that in pGL3-300 group (P<0.01). The relative luciferase activity of cells in pGL3-300 group, mutant 2, 3, and 4 groups was similar (with P values above 0.05). (3) The relative luciferase activity of cells in 10 and 50 μmol/L mithramycin groups was respectively 3.07±0.60 and 2.93±0.55, which was significantly lower than that in blank control group (8.05±0.83, with P values below 0.01). (4) The relative luciferase activity of cells in 0.1, 0.2, and 0.3 μg pcDNA3.1-Sp1 groups was respectively 12.74±1.12, 14.52±1.25, and 15.66±1.82, which was significantly higher than that in blank control group (8.13±0.71, with P values below 0.05).

CONCLUSIONS

One Sp1 binding site, locating in the region from -301 to -293 bp of ITF promoter, is the core element for regulating the basic transcriptional activity of ITF.

A Chronic Obstructive Pulmonary Disease Susceptibility Gene, FAM13A, Regulates Protein Stability of β-Catenin

RATIONALE

A genetic locus within the FAM13A gene has been consistently associated with chronic obstructive pulmonary disease (COPD) in genome-wide association studies. However, the mechanisms by which FAM13A contributes to COPD susceptibility are unknown.

OBJECTIVES

To determine the biologic function of FAM13A in human COPD and murine COPD models and discover the molecular mechanism by which FAM13A influences COPD susceptibility.

METHODS

Fam13a null mice (Fam13a(-/-)) were generated and exposed to cigarette smoke. The lung inflammatory response and airspace size were assessed in Fam13a(-/-) and Fam13a(+/+) littermate control mice. Cellular localization of FAM13A protein and mRNA levels of FAM13A in COPD lungs were assessed using immunofluorescence, Western blotting, and reverse transcriptase-polymerase chain reaction, respectively. Immunoprecipitation followed by mass spectrometry identified cellular proteins that interact with FAM13A to reveal insights on FAM13A's function.

MEASUREMENTS AND MAIN RESULTS

In murine and human lungs, FAM13A is expressed in airway and alveolar type II epithelial cells and macrophages. Fam13a null mice (Fam13a(-/-)) were resistant to chronic cigarette smoke-induced emphysema compared with Fam13a(+/+) mice. In vitro, FAM13A interacts with protein phosphatase 2A and recruits protein phosphatase 2A with glycogen synthase kinase 3β and β-catenin, inducing β-catenin degradation. Fam13a(-/-) mice were also resistant to elastase-induced emphysema, and this resistance was reversed by coadministration of a β-catenin inhibitor, suggesting that FAM13A could increase the susceptibility of mice to emphysema development by inhibiting β-catenin signaling. Moreover, human COPD lungs had decreased protein levels of β-catenin and increased protein levels of FAM13A.

CONCLUSIONS

We show that FAM13A may influence COPD susceptibility by promoting β-catenin degradation.

Circulating MicroRNAs: Association with Lung Function in Asthma

BACKGROUND

MicroRNAs are key transcriptional and network regulators previously associated with asthma susceptibility. However, their role in relation to asthma severity has not been delineated.

OBJECTIVE

We hypothesized that circulating microRNAs could serve as biomarkers of changes in lung function in asthma patients.

METHODS

We isolated microRNAs from serum samples obtained at randomization for 160 participants of the Childhood Asthma Management Program. Using a TaqMan microRNA array containing 754 microRNA primers, we tested for the presence of known asthma microRNAs, and assessed the association of the individual microRNAs with lung function as measured by FEV1/FVC, FEV1% and FVC%. We further tested the subset of FEV1/FVC microRNAs for sex-specific and lung developmental associations.

RESULTS

Of the 108 well-detected circulating microRNAs, 74 (68.5%) had previously been linked to asthma susceptibility. We found 22 (20.3%), 4 (3.7%) and 8 (7.4%) microRNAs to be associated with FEV1/FVC, FEV1% and FVC%, respectively. 8 (of 22) FEV1/FVC, 3 (of 4) FEV1% and 1 (of 8) FVC% microRNAs had functionally validated target genes that have been linked via genome wide association studies to asthma and FEV1 change. Among the 22 FEV1/FVC microRNAs, 9 (40.9%) remain associated with FEV1/FVC in boys alone in a sex-stratified analysis (compared with 3 FEV1/FVC microRNAs in girls alone), 7 (31.8%) were associated with fetal lung development, and 3 (13.6%) in both. Ontology analyses revealed enrichment for pathways integral to asthma, including PPAR signaling, G-protein coupled signaling, actin and myosin binding, and respiratory system development.

CONCLUSIONS

Circulating microRNAs reflect asthma biology and are associated with lung function differences in asthmatics. They may represent biomarkers of asthma severity.

Abstract P5-03-12: Selenocystine inhibits triple-negative breast cancer cell proliferation by inducing cell apoptosis and S-phase arrest

Introduction: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with limited effective treatment options. New therapeutic approaches are urgently needed to improve the prognosis of TNBC. Reactive oxygen species (ROS) are inherent byproducts of oxidative metabolism, and forced stimulation of glucose oxidation in cancer cells raises oxidative stress and sensitizes cells to different stresses. Therefore, targeting the antioxidant capacity of cancer cells has become a promising anticancer strategy. As a redox modulator, selenocystine (SeC) has received a great deal of attention and has been shown effective against human melanoma, hormone receptor-positive breast cancer, and cancers of liver, lung and cervical in vitro. However, whether SeC exerts an anticancer effect on TNBC cells has never been explored.

Methods: The dose-response effects and time course of effects of SeC on three different TNBC cell lines, MDA-MB-231, MDA-MB-436 and MDA-MB-468, were investigated in this study. Cellular viability was determined by the CCK-8 assay and cell morphology were recorded under a light microscope. Cellular apoptosis was detected using Annexin V/PI staining assay and cell cycle distribution was analyzed by flow cytometry.

Results: SeC induced cell growth inhibition in all three TNBC cell lines. For 24, 48 and 72 hours of SeC treatments, the IC50 values were 40.8, 12.8 and 9.2 μM for MDA-MB-231 cells; 14.6, 5.4 and 3.0 μM for MDA-MB-436 cells; and 69.6, 29.3 and 19.9 μM for MDA-MB-468 cells. The changes of cellular morphology of TNBC cells in response to SeC treatment were similar to those cells undergoing apoptotic pathway. This result was confirmed by Annexin V/PI staining assays (Table 1). Cell cycle analysis further revealed that SeC also induced S-phase arrest in a dose-dependent manner (Table 2).

Conclusion: In summary, SeC inhibited TNBC cell viability in a dose- and time-dependent manner which was attributed to the induction of apoptosis and S-phase arrest. Our finding indicates that SeC is a potential therapeutic agent for TNBC.

Table 1. Apoptotic rate of TNBC cells after SeC treatment.Conc.(μM)MDA-MB-231MDA-MB-436MDA-MB-46805.8 %18.1 %26.7 %1025.5 %45.8 %60.7 %2040.1 %67.1 %70.9 %4054.7 %70.7 %74.5 %

Table 2. SeC induces S-phase arrest in TNBC cells in a dose-dependent manner. Conc.(μM)G0/G1 (%)S (%)G2/M (%)MDA-MB-231016.655.927.5 1050.139.310.6 2045.548.16.4 4041.753.05.3MDA-MB-436042.127.630.3 1036.335.028.7 2034.340.725.0 4032.445.422.2MDA-MB-468059.123.717.2 1054.929.315.8 2050.135.714.2 4043.843.113.1

Citation Format: Long M, Qiu W, Wu J, Liu R, Su H. Selenocystine inhibits triple-negative breast cancer cell proliferation by inducing cell apoptosis and S-phase arrest. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-03-12.

A Comparative Study of Tests for Homogeneity of Variances with Application to DNA Methylation Data

Variable DNA methylation has been associated with cancers and complex diseases. Researchers have identified many DNA methylation markers that have different mean methylation levels between diseased subjects and normal subjects. Recently, researchers found that DNA methylation markers with different variabilities between subject groups could also have biological meaning. In this article, we aimed to help researchers choose the right test of equal variance in DNA methylation data analysis. We performed systematic simulation studies and a real data analysis to compare the performances of 7 equal-variance tests, including 2 tests recently proposed in the DNA methylation analysis literature. Our results showed that the Brown-Forsythe test and trimmed-mean-based Levene's test had good performance in testing for equality of variance in our simulation studies and real data analyses. Our results also showed that outlier profiles could be biologically very important.

d-Alanine metabolism is essential for growth and biofilm formation of Streptococcus mutans

Part of the d-alanine (d-Ala) metabolic pathway in bacteria involves the conversion of l-alanine to d-Ala by alanine racemase and the formation of d-alanyl-d-alanine by d-alanine-d-alanine ligase, the product of which is involved in cell wall peptidoglycan synthesis. At present, drugs that target the metabolic pathway of d-Ala are already in clinical use - e.g. d-cycloserine (DCS) is used as an antibiotic against Mycobacterium tuberculosis. Streptococcus mutans is the main cariogenic bacterium in the oral cavity. Its d-Ala metabolism-associated enzymes alanine racemase and d-alanine-d-alanine ligase are encoded by the genes smu.1834 and smu.599, respectively, which may be potential targets for inhibitors. In this study, the addition of DCS blocked the d-Ala metabolic pathway in S. mutans, leading to bacterial cell wall defects, significant inhibition of bacterial growth and biofilm formation, and reductions in extracellular polysaccharide production and bacterial adhesion. However, the exogenous addition of d-Ala could reverse the inhibitory effect of DCS. Through the means of drug regulation, our study demonstrated, for the first time, the importance of d-Ala metabolism in the survival and biofilm formation of S. mutans. If the growth of S. mutans can be specifically inhibited by designing drugs that target d-Ala metabolism, then this may serve as a potential new treatment for dental caries.

Correcting AUC for Measurement Error

Diagnostic biomarkers are used frequently in epidemiologic and clinical work. The ability of a diagnostic biomarker to discriminate between subjects who develop disease (cases) and subjects who do not (controls) is often measured by the area under the receiver operating characteristic curve (AUC). The diagnostic biomarkers are usually measured with error. Ignoring measurement error can cause biased estimation of AUC, which results in misleading interpretation of the efficacy of a diagnostic biomarker. Several methods have been proposed to correct AUC for measurement error, most of which required the normality assumption for the distributions of diagnostic biomarkers. In this article, we propose a new method to correct AUC for measurement error and derive approximate confidence limits for the corrected AUC. The proposed method does not require the normality assumption. Both real data analyses and simulation studies show good performance of the proposed measurement error correction method.

Smoking-Associated Site-Specific Differential Methylation in Buccal Mucosa in the COPDGene Study

DNA methylation is a complex, tissue-specific phenomenon that can reflect both endogenous factors and exogenous exposures. Buccal brushings represent an easily accessible source of DNA, which may be an appropriate surrogate tissue in the study of environmental exposures and chronic respiratory diseases. Buccal brushings were obtained from a subset of current and former smokers from the COPDGene study. Genome-wide DNA methylation data were obtained in the discovery cohort (n = 82) using the Illumina HumanMethylation450K array. Empirical Bayes methods were used to test for differential methylation by current smoking status at 468,219 autosomal CpG sites using linear models adjusted for age, sex, and race. Pyrosequencing was performed in a nonoverlapping replication cohort (n = 130). Current smokers were significantly younger than former smokers in both the discovery and replication cohorts. Seven CpG sites were associated with current smoking at a false discovery rate less than 0.05 in the discovery cohort. Six of the seven significant sites were pyrosequenced in the replication cohort; five CpG sites, including sites annotated to CYP1B1 and PARVA, were replicated. Correlations between cumulative smoke exposure and time since smoking cessation were observed in a subset of the significantly associated CpG sites. A significant correlation between reduced lung function and increased radiographic emphysema with methylation at cg02162897 (CYP1B1) was observed among female subjects. Site-specific methylation of DNA isolated from buccal mucosa is associated with exposure to cigarette smoke, and may provide insights into the mechanisms underlying differential susceptibility toward the development of smoking-related chronic respiratory diseases.

Expression Quantitative Trait Loci Information Improves Predictive Modeling of Disease Relevance of Non-Coding Genetic Variation

Disease-associated loci identified through genome-wide association studies (GWAS) frequently localize to non-coding sequence. We and others have demonstrated strong enrichment of such single nucleotide polymorphisms (SNPs) for expression quantitative trait loci (eQTLs), supporting an important role for regulatory genetic variation in complex disease pathogenesis. Herein we describe our initial efforts to develop a predictive model of disease-associated variants leveraging eQTL information. We first catalogued cis-acting eQTLs (SNPs within 100kb of target gene transcripts) by meta-analyzing four studies of three blood-derived tissues (n = 586). At a false discovery rate < 5%, we mapped eQTLs for 6,535 genes; these were enriched for disease-associated genes (P < 10⁻⁰⁴), particularly those related to immune diseases and metabolic traits. Based on eQTL information and other variant annotations (distance from target gene transcript, minor allele frequency, and chromatin state), we created multivariate logistic regression models to predict SNP membership in reported GWAS. The complete model revealed independent contributions of specific annotations as strong predictors, including evidence for an eQTL (odds ratio (OR) = 1.2–2.0, P < 10⁻¹¹) and the chromatin states of active promoters, different classes of strong or weak enhancers, or transcriptionally active regions (OR = 1.5–2.3, P < 10⁻¹¹). This complete prediction model including eQTL association information ultimately allowed for better discrimination of SNPs with higher probabilities of GWAS membership (6.3–10.0%, compared to 3.5% for a random SNP) than the other two models excluding eQTL information. This eQTL-based prediction model of disease relevance can help systematically prioritize non-coding GWAS SNPs for further functional characterization.

The clinical efficacy of laparoscopy combined with choledochoscopy for cholelithiasis and choledocholithiasis

OBJECTIVE

To compare and analyze the clinical efficacy of laparoscopy combined with choledochoscopy, and laparoscopy combined with duodenoscopy, for cholelithiasis and choledocholithiasis.

PATIENTS AND METHODS

A total of 105 patients with cholelithiasis and choledocholithiasis from our hospital, from January 2014 to January 2015, were enrolled in this study. All patients weren given primary treatment. After obtaining consent from our hospital Ethics Committee and the patients, all 10529 cases were divided into two groups according to their time of admission. The observation group consisted of 59 cases and the control group consisted of 46 cases. The control group were treated by laparoscopy combined with duodenoscopy (cholecystectomy +ERCP+calculi extraction with an endoscope) and the observation group were treated by laparoscopy combined with choledochoscopy. We then compared the clinical efficacy between the two groups of patients.

RESULTS

The success rate of the first surgery in the observation group, was higher than that in the control group. The time of surgery and intra-operative blood loss of the observation group were less than the control group. The differences had statistical significance p < 0.05). When compared the post-operative fasting and evacuation time, average hospital stay and hospitalization expenses for the observation group were less than those of the control group. The difference had statistical significance (p < 0.05). The prevalence of post-operative complications and recurrence rate in the observation group were statistically significantly (p < 0.05) less than the control group (p < 0.05).

CONCLUSIONS

Laparoscopy combined with choledochoscopy was effective and safe for treating cholelithiasis and choledocholithiasis. Its treatment outcomes might be superior to laparoscopy combined with duodenoscopy.

Computed tomography-guided iodine-125 interstitial implantation as an alternative treatment option for lung cancer

PURPOSE

The aim was to evaluate the safety, feasibility and efficacy of computed tomography (CT)-guided percutaneous interstitial brachytherapy using radioactive iodine-125 ( 125 I) seeds for the treatment of lung cancer.

MATERIALS AND METHODS

Included in this study were 45 male and 35 female patients aged 52-85 years (mean 72-year) who were diagnosed with lung cancer. Of the 80 cases of lung cancer, 38 were pathologically confirmed as squamous cell carcinoma, 29 as adenocarcinoma, 2 as small cell lung cancer, and 11 as metastatic lung cancer. Percutaneous interstitial implantation of radioactive 125 I seeds was performed under CT guidance. The treatment planning system was used to reconstruct three-dimensional images of the tumor to determine the quantity and distribution of 125 I seeds to be implanted. Under CT guidance, 125 I seeds were embedded into the tumor, with the matched peripheral dose set at 100-130 Gy. Follow-up CT scan was done in 2-month to explore the treatment efficacy.

RESULTS

The procedure was successful in all patients. No major procedure-associated death occurred. The duration of follow-up was 6-month. Complete response (CR) was seen in 38 cases (47.5%), partial response (PR) in 27 cases (33.75%), stable disease (SD) in 10 cases (12.5%), and progressive disease in 5 cases (6.25%), with a local control rate (CR + PR + SD) of 93.75%. The 2-, 4- and 6-month overall response rate (CR + PR) was 78%, 83% and 81%, respectively.

CONCLUSION

Implantation of CT-guided 125 I seeds is a safe and effective alternative option for the treatment of lung cancer.

Outcomes in patients with cardiogenic shock following percutaneous coronary intervention in the contemporary era: an analysis from the BCIS database (British Cardiovascular Intervention Society)

OBJECTIVES

This study sought to determine mortality rates among cardiogenic shock (CGS) patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome in the contemporary treatment era and to determine predictors of mortality.

BACKGROUND

It is unclear whether recent advances in pharmacological and interventional strategies have resulted in further improvements in short- and long-term mortality and which factors are associated with adverse outcomes in patients presenting with CGS and undergoing PCI in the setting of acute coronary syndrome.

METHODS

This study analyzed prospectively collected data for patients undergoing PCI in the setting of CGS as recorded in the BCIS (British Cardiovascular Intervention Society) PCI database.

RESULTS

In England and Wales, 6,489 patients underwent PCI for acute coronary syndrome in the setting of CGS. The mortality rates at 30 days, 90 days, and 1 year were 37.3%, 40.0%, and 44.3%, respectively. On multiple logistic regression analysis, age (for each 10-year increment of age: odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.51 to 1.68; p < 0.0001), diabetes mellitus (OR: 1.47, 95% CI: 1.28 to 1.70; p < 0.0001), history of renal disease (OR: 2.03, 95% CI: 1.63 to 2.53; p < 0.0001), need for artificial mechanical ventilation (OR: 2.56, 95% CI: 2.23 to 2.94; p < 0.0001), intra-aortic balloon pump use (OR: 1.57, 95% CI: 1.40 to 1.76; p < 0.0001), and need for left main stem PCI (OR: 1.90, 95% CI: 1.62 to 2.23; p < 0.0001) were associated with higher mortality at 1 year.

CONCLUSIONS

In this large U.K. cohort of patients undergoing PCI in the context of CGS, mortality remains high in spite of the use of contemporary PCI strategies. The highest mortality occurs early, and this time period may be a particular target of therapeutic intervention.

Impact of cataract surgery on vision-related life performances: the usefulness of Real-Life Vision Test for cataract surgery outcomes evaluation

PURPOSE

Real-Life Vision Test (RLVT) is a newly developed performance-based measures of functional vision. This present study is designed to determine whether it could be a meaningful assessment for cataract surgery outcomes evaluation.

PATIENTS AND METHODS

Age-related cataract patients (56) who scheduled for bilateral cataract surgery and 44 age-matched controls were evaluated by four types of measurements: (1) demographic, medical, cognitive and depressive evaluation, and the reaction time testing; (2) clinical measures (visual acuity, contrast sensitivity, stereopsis, and color perception); (3) the 25-item National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ); (4) the RLVT. Spearman's coefficients and multiple regression analysis were conducted to investigate the relationship among RLVT, clinical measures, and self-report assessment of visual function.

RESULTS

The results of RLVT, clinical measures, and NEI-VFQ total scores were improved significantly after cataract surgery. There were no differences between control subjects and post-surgery patients with respect to NEI-VFQ-25 total scores, self-rating depression scale scores and three tasks of RLVT. Change of RLVT was significantly associated with the change of clinical measures in the cataract group. Multiple regression analysis demonstrated that change of distance, intermediate, and near visual acuity, and binocular contrast sensitivity were significant predictors of improvements of RLVT.

CONCLUSIONS

Cataract surgery could improve real-world visual ability effectively for cataract patients. Our study highlights the potential usefulness of RLVT as an adjunct to the current outcomes evaluation system for cataract surgery. The use of RLVT combined with clinical and self-survey methods may be the comprehensive strategy to manifest the impact of cataract surgery on patients' overall vision-related quality of life.

Glucocorticoid genes and the developmental origins of asthma susceptibility and treatment response

Antenatal corticosteroids enhance lung maturation. However, the importance of glucocorticoid genes on early lung development, asthma susceptibility, and treatment response remains unknown. We investigated whether glucocorticoid genes are important during lung development and their role in asthma susceptibility and treatment response. We identified genes that were differentially expressed by corticosteroids in two of three genomic datasets: lymphoblastoid cell lines of participants in the Childhood Asthma Management Program, a glucocorticoid chromatin immunoprecipitation/RNA sequencing experiment, or a murine model; these genes made up the glucocorticoid gene set (GCGS). Using gene expression profiles from 38 human fetal lungs and C57BL/6J murine fetal lungs, we identified developmental genes that were in the top 5% of genes contributing to the top three principal components (PCs) most highly associated with post-conceptional age. Glucocorticoid genes that were enriched in this set of developmental genes were then included in the developmental glucocorticoid gene set (DGGS). We then investigated whether glucocorticoid genes are important during lung development, and their role in asthma susceptibility and treatment response. A total of 232 genes were included in the GCGS. Analysis of gene expression demonstrated that glucocorticoid genes were enriched in lung development (P = 7.02 × 10(-26)). The developmental GCGS was enriched for genes that were differentially expressed between subjects with asthma and control subjects (P = 4.26 × 10(-3)) and were enriched after treatment of subjects with asthma with inhaled corticosteroids (P < 2.72 × 10(-4)). Our results show that glucocorticoid genes are overrepresented among genes implicated in fetal lung development. These genes influence asthma susceptibility and treatment response, suggesting their involvement in the early ontogeny of asthma.