Abstract NG11: Landscape analysis of neoepitope-specific T-cell responses to immunotherapy

In infectious disease, polyclonal T cell responses against immunodominant epitopes drive successful immune responses. In cancer, neoepitopes (neoE) derived from non-synonymous mutations, similarly to the immunodominant epitopes in viral infections, are potentially highly immunogenic because the T cells recognizing these antigens are not subjected to the mechanisms of tolerance. Indeed, early studies support that neoE derived from non-synonymous mutations are the primary target of T cell responses induced by immune checkpoint blockade therapy and have been successfully targeted by adoptively transferred T cell therapies (ACT) in multiple cancer histologies. However, there is limited knowledge on the immunodominance and evolution of neoE's, or the clonality of the T cell responses against these neoE. Furthermore, little is known regarding the correlation between the presence and expansion of neoE-specific T cells and the clinical response to immunotherapy in patients. To characterize the neoE-specific T cell responses induced after immunotherapy, we collected peripheral blood mononuclear cells (PBMCs) over time (longitudinally) and established expanded tumor infiltrating lymphocyte cultures (TILs) and autologous tumor cell lines from the patient's tumor biopsies. We performed whole exome and RNA sequencing of the tumor and normal tissue controls for the computational prediction and ranking of patient-specific neoEs. We then generated a library of capture reagents consisting of the patient HLA class I molecules loaded with predicted neoE (Peng et al. AACR 2019) and isolated neoE-specific T cells from the patients' PBMC or TIL samples. Once isolated, the paired neoE-specific TCR alpha and beta chains (neoTCR) were obtained by single cell sequencing. For functional characterization of the neoTCRs, healthy donor primary human T cells were modified to express the neoTCR using CRISPR-based, non-viral precision genome engineering by replacing the endogenous TCR with the respective neoTCR (Jacoby et al., AACR 2019, Sennino et al., AACR 2019). These gene-edited T cells were then used in co-culture experiments with the patient autologous cell lines. We analyzed T cell responses in three patients (PT1, PT2, and PT3) with metastatic melanoma receiving immunotherapy. PT1 had a fast and durable anti-tumor response to anti-PD-1 therapy. Sequencing identified 2556 somatic coding mutations. A library of 243 neoE-specific pMHC capture reagents across 3 HLA types, HLA-A*03:01, A*24:01, and C*12:03 was generated and used for screening of PBMCs or TILs derived from multiple longitudinal time points. Several hundred neoE-specific T cells were isolated. Importantly, this neoE-specific T cell response was comprised of 17 different neoE-specific T cells clones targeting only 5 different HLA-neoE complexes supporting the immunodominance hypothesis. On the other hand, PT2 and PT3 showed marginal responses to immunotherapy. Patient two progressed after being treated with anti-PD1. This patient had 24 somatic coding mutations. Seventeen neoE-HLA reagents across 3 HLAs, B*35:03, C*12:03, and C*08:01 were generated and used to capture neoE-specific T cells from TILs and PBMCs. While 14 different TCRs targeting 7 HLA-neoE complexes were identified from expanded TILs, no neoE-reactive T cells were captured from the peripheral blood. PT3 presented with progressive disease after being treated with local TVEC. This patient had 61 somatic coding mutations; 78 neoE-specific pHLA capture reagents covering HLA-A*02:01, A*03:01, B*07:02, C*05:01, and C*07:02 were generated and used to screen for neoE-specific T cells in the patient's TIL and PBMCs. In contrast to PT2, 2 different neoTCRs targeting the same HLA-neoE complexes were isolated from PBMCs, but none from TILs. To further characterize the T cell responses from patients that responded or did not respond to immunotherapy, we generated 18 separate T cell products, each expressing a different neoTCR isolated from PT1, PT2 and PT3. For PT1, we characterized 14 different neoTCRs specific for neoE's in the mutated IL8, PUM1 and TPP2 genes. All 14 T cell products displayed specific cytotoxicity against the matched autologous melanoma cell line established from a biopsy of patient one (50-75% tumor growth inhibition compared to melanoma cell line growth in co-culture with a mismatched control TCR, 96 hour assay using a product to target ratio (P:T) of 1:1, p < 0.000001 for each comparison). No cytotoxic effect against an unmatched human melanoma cell line was observed. Furthermore, neoE TCR T cells upregulated 4-1BB and OX-40, secreted IFNγ, IL-2, TNFα, and IL6, and induced T cell proliferation and degranulation. Again, no unspecific T cell activation was observed when T cells were co-cultured with unmatched targets. Interestingly, precision genome engineered T cell products expressing neoTCRs identified from patients that did not respond to therapy (PT2 and PT3), also potently killed autologous tumor cells. Four neoTCRs were studied (2 TCR for PT2 and 2 TCRs for PT3), and three of them showed specific cytotoxicity against the matched autologous melanoma cell line (50-100% tumor growth inhibition compared to melanoma cell line growth in co-culture with a mismatched control TCR, 96 hour assay using P:T 5:1, p < 0.05 for each comparison). Additionally, upon co-culture with the matched melanoma cell line, but not against an unmatched melanoma cell line control, neoE TCR T cells upregulated 4-1BB and OX-40, secreted IFNγ, IL-2, TNFα, and IL6, and induced T cell proliferation and degranulation. These data demonstrate that even patients that did not respond to immunotherapy harbor neoTCRs that, when expressed in ‘fresh' T cells, are able to kill the autologous tumor cell lines. Using newly developed techniques to isolate and capture neoE-specific single T cells, as well as non-viral gene editing, we isolated and characterized neoE-specific T cells that can recognize the cancer cells and induce an anti-tumor response. We also studied the neoE immunodominance and TCR clonality over time of the natural T cell repertoire that induce anti-tumor responses to ICB therapy. Our results show that in a patient with a good response to anti-PD-1, there is a polyclonal response that targets a limited number of neoE-HLA complexes (2% of the neoE tested in the case of patient one) highlighting the immunodominance of these epitopes. Interestingly, different T cell clonotypes targeting the same mutations evolve over time, suggesting functional differences amongst the TCRs. In addition, our results demonstrate that even patients that did not respond to these therapies harbor neoE-specific T cells, as we were able to isolate neoE-specific T cells that recognized and killed patient-derived cancer cells. This suggests that even in patients that do not respond to immunotherapy, neoE-specific TCRs can be isolated and could be potentially used for personalized ACT. Finally, our results also show how non-viral precision genome engineering can successfully redirect T cells to neoE-expressing tumors, enabling the personalized ACT.

Citation Format: Cristina Puig-Saus, Barbara Sennino, Bhamini Purandare, Duo An, Boi Quach, Songming Peng, Huiming Xia, Sidi Zhao, Zheng Pan, Yan Ma, Justin Saco, Sameeha Jilani, Christine Shieh, Katharine Heeringa, Olivier Dalmas, Robert Moot, Diana Nguyen, William Lu, Kyle Jacoby, Andrew Conroy, Jasreet Hundal, Malachi Griffith, Stefanie Mandl, Alex Franzusoff, Antoni Ribas. Landscape analysis of neoepitope-specific T-cell responses to immunotherapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr NG11.

Influence of electron cyclotron resonance ion source parameters on high energy electrons

In order to diagnose the electron cyclotron resonance (ECR) plasma, a high-efficiency collimation system has been developed at the Institute of Modern Physics, and the bremsstrahlung spectra in the range of 10 keV-300 keV were measured on a third generation superconducting ECR ion source, SECRAL-II, with a CdTe detector. Used as a comparative index of the mean energy of the high energy electron population, the spectral temperature, T_s, is derived through a linear fitting of the spectra in a semi-logarithmic representation. The influences of some main source parameters, such as the neutral gas pressure, extraction voltage, microwave power, and bias disk voltage, on the high energy electrons are systemically investigated.

Efficacy and safety of duloxetine in osteoarthritis or chronic low back pain: a Systematic review and meta-analysis

OBJECTIVE

To evaluate the efficacy and safety of duloxetine in the treatment of patients with osteoarthritis (OA) or chronic low back pain (CLBP).

METHODS

Relevant randomized controlled trials (RCTs) were searched in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Included RCTs compared the efficacy and safety of duloxetine vs placebo in the treatment of OA or CLBP. Weighted mean difference (WMD) were calculated for continuous outcomes while risk ratio (RR) were calculated for dichotomous outcomes.

RESULTS

Nine RCTs were included in our meta-analysis. Duloxetine had significant improvement over placebo in Brief Pain Inventory 24-h average pain [WMD: -0.67; 95% confidence interval (CI):-0.80, -0.53], weekly mean of the 24-h average pain (WMD: -0.65; 95% CI: -0.79, -0.52), Patient's Global Impression of Improvement (WMD: -0.41; 95% CI: -0.49, -0.32), Clinical Global Impression of Severity (WMD: -0.32; 95% CI: -0.38, -0.25), European Quality of Life Questionnaire-5 Dimension (WMD: 0.04; 95% CI: 0.02, 0.07). In addition, duloxetine is associated with more treatment-emergent adverse events (TEAEs) (RR: 1.25; 95% CI: 1.17, 1.33) and discontinuations for adverse events (AEs) (RR: 2.31; 95% CI: 1.81, 2.94). However, there was no statistically significant difference in serious AEs between duloxetine and placebo.

CONCLUSION

Duloxetine had modest to moderate effects on pain relief, function improvement, mood regulation and improvement in quality of life with mild AEs in the treatment of OA or CLBP. Future RCTs should focus on comparing duloxetine with other oral drugs and assessing the long-term safety of duloxetine.

Automated Analysis of Public Health Laboratory Test Results

This study investigates the use of machine learning methods for classifying and extracting structured information from laboratory reports stored as semi-structured point-form English text. This is a novel data format that has not been evaluated in conjunction with machine learning classifiers in previous literature. Our classifiers achieve human-level predictive accuracy on the binary Test Performed and 4-class Test Outcome labels. We consider symbolic approaches for predicting the highly multi-class Organism Genus and Organism Species labels. Results are discussed from the viewpoint of interpretability and generalizability to new incoming laboratory reports. Code has been made public at https://github.com/enchainingrealm/UbcDssgBccdc-Research/tree/master/src.

[Selection of the cutoff value on tuberculin skin test in diagnosing tuberculosis infection: a population-based cross-sectional study in Eastern China]

Objective: To confirm the cutoff induration diameter of tuberculin skin test (TST) so as to decrease the false positive of the TST. Methods: Fasting blood glucose test, TST and Quanti FERON-TB (QFT) Gold In-Tube test were administered to recruit participants at the baseline stage. QFT was used as the gold standard to determine the cutoff of the TST test. Results: Overall, 5 405 participants were enrolled in this study, of whom 1 104 (20.4%) were QFT positive. Among all the 5 405 participants that without stratification, diagnostic value reached the highest when the induration diameter was 10.25 mm with sensitivity and specificity as 0.731 and 0.727, respectively. When the participants were divided into groups as nondiabetics, confirmed diabetics, undiagnosed diabetics, the sensitivities and specificities appeared as 0.701, 0.837, 0.824 and 0.805, 0.821, 0.778 with induration diameters as 11.25 mm, 10.25 mm and 11.25 mm, respectively. Conclusions: Findings of this study confirmed that the specificity of tuberculin test could be significantly improved by using 10-12 mm as the cutoff value for diagnosing the latent tuberculosis infection.

Spinopelvic alignment predicts disc calcification, displacement, and Modic changes: Evidence of an evolutionary etiology for clinically-relevant spinal phenotypes

Lumbar disc-displacement, Modic changes (MCs), and UTE Disc Sign (UDS) on MRI are clinically relevant spinal phenotypes that can lead to sciatica/LBP. Not all degenerated discs result in disc-displacement, MCs and UDS, suggesting varied etiologies. Spinopelvic parameters have been implicated in various spinal disorders. Pelvic incidence (PI) is "fixed parameter" since skeletal maturity. No study has addressed disc-displacement, MCs and UDS in context of spinopelvic parameters. Therefore, the aim of study was to determine if spinopelvic parameters are associated and predict clinically-relevant MRI-phenotypes. One hundred and eight population-based subjects (mean age: 52.3 years) were recruited. Spondylolisthesis and scoliosis individuals were excluded. Lumbar lordosis (LL), PI, sacral slope (SS), and pelvic tilt (PT) were assessed on lateral plain radiographs. Disc degeneration was assessed and summated, and presence or not of disc-displacement and MCs were noted on T2W MRI. UDS was detected on UTE. Following exclusion criteria, 95 subjects were assessed. Disc-displacement (82.1%), MCs (52.6%), and UDS (37.9%) were associated with lower PI, SS, LL, and LL/PI index. On multivariate analyses, lower PI was significantly related to development of these MRI phenotypes (adjusted OR range:0.95-0.92; P < .05), with critical PI value of 42° or lower exhibiting fourfold increase risk of combined phenotypes (P = .020). Of UDS discs, 39.3% had adjacent MCs and 83.6% had disc-displacement. 87.5% of MC had directly adjacent UDS. The first study to note that PI may "predict" the development of disc-displacement, MCs and UDS, suggesting potential sub-variants and mechanistic susceptibility that may be grounded in spinopelvic evolution. An "evolutionary etiological pathway" of spinal phenotype development is proposed.

Sleep Deprivation Affects Tau Phosphorylation in Human Cerebrospinal Fluid

Tau hyperphosphorylation is an early step in tau-mediated neurodegeneration and is associated with intracellular aggregation of tau as neurofibrillary tangles, neuronal and synaptic loss, and eventual cognitive dysfunction in Alzheimer disease. Sleep loss increases the cerebrospinal fluid concentration of amyloid-β and tau. Using mass spectrometry, we measured tau and phosphorylated tau concentrations in serial samples of cerebrospinal fluid collected from participants who were sleep-deprived, treated with sodium oxybate, or allowed to sleep normally. We found that sleep loss affected phosphorylated tau differently depending on the modified site. These findings suggest a mechanism for sleep loss to increase risk of Alzheimer disease. ANN NEUROL 2020;87:700-709.

Overview of high intensity ion source development in the past 20 years at IMP

Ion source development over the last 20 years at the IMP is reviewed. For versatile purposes, several types of ion sources have been involved in the research and development work at the IMP, i.e., the highly charged ECR (Electron Cyclotron Resonance) ion source, intense microwave ion source or the 2.45 GHz intense beam ECR ion source, and laser ion source (LIS). In the development of ECR ion sources, SECRAL (Superconducting ECR ion source with Advanced design in Lanzhou), Lanzhou ECR ion source, and Lanzhou all permanent magnet ECR ion source series have been made, which can cover the operation microwave frequency range of 10-28 GHz. The LIS with an Nd:YAG laser with a maximum output energy of 8 J in 8 ns pulse duration has been developed for very intense short pulse ion beams from solid materials such as C, Ti, Ni, Ag, and so on. Microwave ion sources have been built to produce intense pulsed or direct current beams from several mA to 100 mA for either high intensity accelerators or applications. This paper will give an overview of the high intensity ion source development at the IMP, especially on the recent progress and new results, such as the status of the fourth generation ECR ion source (first fourth generation ECR ion source), the production of recorded highly charged ion beams with SECRAL sources, key technology research studies, and so on.

A new room temperature LECR5 ion source for the SESRI project

The Space Environment Simulation and Research Infrastructure project, which uses various ion beams as irradiated materials in life science research, is being built at the Harbin Institute of Technology. A new room temperature electron cyclotron resonance ion source, the Lanzhou Electron Cyclotron Resonance Ion Source No. 5 (LECR5), has been designed and constructed. It is an intense, highly charged, heavy ion beam injector which generates ion beams from H to Bi, typically ∼50 eμA ²⁰⁹Bi³²⁺. The LECR5 is designed to operate at microwave frequencies in the range of 14.5-18 GHz. The typical magnetic parameters are designed based on those optimized for SECRAL, which operates at 18 GHz. This paper presents the LECR5 ion source, its test bench, and the preliminary beam results.

Circulating MicroRNA-19b Identified From Osteoporotic Vertebral Compression Fracture Patients Increases Bone Formation

Circulating microRNAs (miRNAs) play important roles in regulating gene expression and have been reported to be involved in various metabolic diseases, including osteoporosis. Although the transcriptional regulation of osteoblast differentiation has been well characterized, the role of circulating miRNAs in this process is poorly understood. Here we discovered that the level of circulating miR-19b was significantly lower in osteoporotic patients with vertebral compression fractures than that of healthy controls. The expression level of miR-19b was increased during osteoblastic differentiation of human mesenchymal stem cells (hMSCs) and MC3T3-E1 cells, and transfection with synthetic miR-19b could promote osteoblastic differentiation of hMSCs and MC3T3-E1 cells. PTEN (phosphatase and tensin homolog deleted from chromosome 10) was found to be directly repressed by miR-19b, with a concomitant increase in Runx2 expression and increased phosphorylation of AKT (protein kinase B, PKB). The expression level of circulating miR-19b in aged ovariectomized mice was significantly lower than in young mice. Moreover, the osteoporotic bone phenotype in aged ovariectomized mice was alleviated by the injection of chemically modified miR-19b (agomiR-19b). Taken together, our results show that circulating miR-19b plays an important role in enhancing osteoblastogenesis, possibly through regulation of the PTEN/pAKT/Runx2 pathway, and may be a useful therapeutic target in bone loss disorders, such as osteoporosis. © 2019 American Society for Bone and Mineral Research.

A new microwave coupling scheme for high intensity highly charged ion beam production by high power 24-28 GHz SECRAL ion source

The efficiency of the microwave-plasma coupling is a key issue to enhance the performance of electron cyclotron resonance ion sources (ECRISs) in terms of higher ion beam intensity yield. The coupling properties are affected by the microwave coupling scheme, especially for the high frequency (f > 20 GHz) and high power (P > 5 kW) ECR ion sources. Based on the study of 24 GHz SECRAL ion source performances working at different launching systems, a new microwave coupling scheme, called the Vlasov launcher, is proposed, which can not only realize efficient power matching and feeding but also enhance the microwave power distribution on the ECR surface. The first promising results are presented in this article. Then, a prototype dedicated to the next generation ECRIS is described.

Emittance study of the high intensity highly charged heavy ion beams extracted from electron cyclotron resonance ion source

According to the requirements of ion beams extracted from an electron cyclotron resonance ion source transverse phase space coupling research and the afterglow beam property effective measurement, a pepper pot type meter called PEMiL (Pepper Pot Emittance Meter in Lanzhou) has been designed, fabricated, and commissioned to obtain the emittance of high intensity highly charged heavy ion beams. The direct current beam emittance measurement results verify the coupling property caused by the semisolenoid field. This paper also describes the scheme of multiple exposure accumulation which was applied to measure the afterglow beam property, and the transverse phase space distribution of the oxygen afterglow beam which was measured for the first time is presented.

Efficient total nitrogen removal from wastewater by Paracoccus denitrificans DYTN-1

Bioaugmentation is an effective treatment method to reduce nitrogenous pollutants from wastewater. A strain of DYTN-1, which could effectively remove TN from sewage, was isolated from the sludge of a wastewater treatment plant and was identified as Paracoccus denitrificans. The TN in wastewater reduced to <20 mg l^-1 within 12 h under optimal conditions by free cells of P. denitrificans DYTN-1. To enhance the removal of TN, P. denitrificans DYTN-1 cells were immobilized in sodium alginate (SA) using different divalent metal ions as cross-linking agents. It was found that the immobilized P. denitrificans DYTN-1 cells could reduce the TN concentration from 100 to below 20 mg l^-1 within 8 h. After the optimization of an orthogonal experiment, the immobilized P. denitrificans DYTN-1 cells could reduce the TN concentration from 100 mg l^-1 to below 20 mg l^-1 within 1 h and significantly reduce the fermentation cycle. These findings would provide an economical and effective method for the removal of total nitrogen in wastewater by immobilized cells of P. denitrificans DYTN-1. SIGNIFICANCE AND IMPACT OF THE STUDY: We identified a new Paracoccus denitrificans strain (DYTN-1) for removal of the total nitrogen in wastewater. The total nitrogen could be removed effectively by P. denitrificans DYTN-1 within 12 h in wastewater. Using sodium alginate as the carrier and Ba²⁺ as cross-linking agent, the immobilized P. denitrificans DYTN-1 cells could improve the removal efficiency of total nitrogen in wastewater and significantly reduce the fermentation cycle. The assay has provided an economical and effective method for the removal of total nitrogen in wastewater by immobilized cell.

[Severe facial malformation caused by secondary hyperparathyroidism in uremia: report of 4 cases]

Objective: To investigate the etiology, characteristics and prevention of severe facial deformity in patients with uremia entering the dialysis stage. Methods: Four cases with uremia in the dialysis stage who presented with severe facial deformity between October 2011 and November 2018 were reviewed, including 3 males and 1 female. The ages were 31, 15, 51 and 61, respectively. The general information, clinical symptoms, biochemical indicators, relevant imaging indicators, diagnoses, treatments and efficacies of the 4 patients admitted to the First Affiliated Hospital of Anhui Medical University were collected. Results: All the 4 patients appeared obviously shorter, accompanied by a certain degree of decline in self-care ability, multiple bone and joint pain and severe facial deformity. They presented with significantly increased serum levels of alkaline phosphatase, calcium, phosphorus and parathyroid hormone, and parathyroid hormone level>2 500 pg/ml.Ultrasonography and (99)Tc(m) radionuclide scan showed in situ or ectopic hyperplasia of parathyroid tissue. Bone radiography showed local decrease of bone mineral density and cystic changes.After parathyroidectomy, the serum levels of alkaline phosphatase, parathyroid hormone, calciumand phosphorus decreased significantly, while bone pain symptoms and facial deformities gradually improved. Conclusion: Secondary hyperparathyroidism is a serious complication in patients with dialysis and few of patients may have severe facial deformity (Sagliker syndrome) affecting their normal life and social activities. Parathyroidectomy can improve the facial deformity and the quality of life of patients.

Proximal Bone Remodeling in Lower Limb Amputees Reconstructed With an Osseointegrated Prosthesis

Mobility outcomes and changes in bone mineral density (BMD) of the spine and femoral necks in response to unilateral osseointegrated implants was investigated over a 3-year period. A total of 48 unilateral amputees who received an osseointegrated implant, comprising 33 trans-femoral amputees (TFA) and 15 trans-tibial amputees (TTA), underwent dual-energy X-ray absorptiometry (DXA) scans of the lumbar spine (L2-L4) and femoral necks at baseline, 1-, and 3-years follow-ups. Mobility outcomes, including the Six-Minute-Walk Test (6MWT) and Timed-Up-and-Go (TUG), were measured before surgery, at 1 year, and more than 2 years following the osseointegration procedure. We observed a significant increase (p < 0.05) in Z-score values in the femoral neck of the amputated side in TFA patients without a femoral neck lag screw at the 1- and 3-year follow-ups, as well as in TFA patients with a lag screw present at 3-year follow-up. The BMD at 1-year follow-up was found to be positively correlated with pre-surgery 6MWT values in patients who were mobile using a traditional socket prosthesis before receiving an osseointegrated implant. These results suggest that osseointegrated implants induce a physiological response in the femoral neck of recipients and appear to be evidence of restored biomechanical loading in the proximal femur. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2524-2530, 2019.

Evaluation of MASTDISCS combi Carba plus for the identification of metallo-β-lactamases, KPC and OXA-48 carbapenemase genes in Enterobacteriaceae clinical isolates

The increasing frequency of class A KPC enzymes, class B metallo-β-lactamases (MBLs) and class D OXA-48 enzymes in Enterobacteriaceae makes their early identification urgent. A simple commercial MASTDISCS combi Carba plus disc system (MAST-Carba plus) was designed for the identification of MBLs, KPC and OXA-48 carbapenemase genes in Enterobacteriaceae. To validate the MAST-Carba plus, a total of 77 isolates of carbapenemase-producing Enterobacteriaceae (CPE) and 84 isolates of noncarbapenemase-producing Enterobacteriaceae (non-CPE) were selected for differentiation of the genes of Enterobacteriaceae by MAST-Carba plus. Meanwhile, the carbapenemase genes such as bla_KPC , bla_IMP , bla_VIM , bla_NDM-1 and bla_OXA-48 were detected by PCR (polymerase chain reaction). Thus, when considered on the basis of PCR results, the sensitivity of MAST-Carba plus detection of KPC strains is 82·3%, the specificity is 100·0%, the positive predictive value is 100·0% and the negative predictive value is 92·4%. For MBLs strains, the sensitivity is 100·0%, the specificity is 97·1%, the positive predictive value is 84·6% and the negative predictive value is 100·0%. For OXA-48 strains, the sensitivity is 100·0%, the specificity is 99·4%, the positive predictive value is 80·0% and the negative predictive value is 100·0%. Our findings suggest that MAST-Carba plus is a rapid and promising method for identifying the MBLs, KPC and OXA-48 carbapenemase genes in Enterobacteriaceae, which could be exploited in basic microbiology laboratory to prevent the transmission of CPE. SIGNIFICANCE AND IMPACT OF THE STUDY: Not only detection of carbapenemases but also identification of their genes accurately and rapidly in Enterobacteriaceae is still a major challenge for clinical laboratories in order to prevent the transmission of carbapenemase-producing Enterobacteriaceae (CPE). Therefore, this study aimed to evaluate the performance of a new rapid method (MASTDISCS combi Carba plus) for the identification of metallo-β-lactamases (MBLs), KPC and OXA-48 carbapenemase genes in Enterobacteriaceae clinical isolates.

Integrated approach in designing biphasic nanocomposite collagen/nBCP scaffolds with controlled porosity and permeability for bone tissue engineering

The bone scaffold for tissue engineering should be biomimetic, particularly in simulating the porosity features of natural bony tissue including pore size, pore shape, pore distribution pattern, and porosity percentage. Control of these can impact the scaffold hydrophilicity and permeability, which in turn influence the protein adsorption, cellular functions, and vascularization process. Various methods have been investigated for control of porosity parameters; however, the field still suffers from major challenges, that is, inadequate control of porosity and hydrophilicity at different levels. In this study, we developed an integrated approach for generation and control of porosity within nanocomposite collagen/nanobiphasic calcium phosphate (collagen/nBCP) scaffold. A modified freeze-drying procedure was applied alongside a chemical foaming method exploring the ability of "Tween 20" as a potent biocompatible porogen. Several processing variables were also examined including; quenching rate (-18 and -80°C), collagen/nBCP ratio (92/8% and 85/15%), and Tween ratio (10%, 20%, and 30%). Detailed physicochemical and porosimetry analysis confirmed the ability of Tween to actively modify the scaffold permeability and pore size by increasing the range of pore size while quenching rate mostly influenced the pore shape, and collagen/nBCP ratio affected total porosity and roughness. The collagen/nBCP ratio of 92/8% treated with low Tween ratios (10% and 20%) and exposed to -80°C quenching rate displayed more favorable physicochemical behavior, significantly higher permeability, a gradient porosity, and better in vitro performances. The proposed technique in this study provides an insight into the production of customized scaffolds for various tissue engineering applications.

HOTAIR promotes inflammatory response after acute myocardium infarction by upregulating RAGE

OBJECTIVE

The aim of this study was to explore the role of HOTAIR in inflammatory response after acute myocardium infarction (AMI) and to investigate its underlying mechanism.

MATERIALS AND METHODS

The AMI model was first constructed in rats, and heart tissues were harvested. Expression levels of HOTAIR and receptor of advanced glycation end-products (RAGE) in rat heart were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The protein expression level of pEKR in rat heart was detected by Western blot. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in rats were determined by enzyme-linked immunosorbent assay (ELISA). The hypoxia-induced H9C2 cells were used to construct the MI model in vitro. Meanwhile, the expression levels of HOTAIR and RAGE in H9C2 cells were detected. The levels of TNF-α and IL-6 in the culture medium were determined by ELISA. Rescue experiments were conducted by co-transfecting pcDNA-HOTAIR and si-RAGE in H9C2 cells. Subsequently, the levels of pERK, TNF-α, and IL-6 were detected.

RESULTS

The mRNA expression levels of HOTAIR and RAGE in the AMI group were significantly higher than those of the control group. Western blot showed remarkably higher protein levels of RAGE and pERK in AMI rats when compared with those of controls. Similarly, results of ELISA indicated that the levels of TNF-α and IL-6 in AMI rats were significantly higher than those of controls. Meanwhile, overexpression of HOTAIR in H9C2 cells remarkably elevated the expression levels of HOTAIR and RAGE. In addition, upregulated pERK, TNF-α, and IL-6 were observed in H9C2 cells overexpressing HOTAIR, which could be reversed by RAGE knockdown.

CONCLUSIONS

HOTAIR promotes inflammatory response after AMI by upregulating RAGE expression.

[Clinical classification and characteristics of alcoholic myocardial injury]

Objective: To explore the clinical classification and characteristics of patients with alcoholic myocardial injury in the early and late stages, and to improve the understanding of early diagnosis of alcoholic myocardial injury. Methods: From December 2016 to December 2018, a total of 102 patients with long-term history of excessive alcohol consumption, cardiovascular symptoms and evidence of myocardial injury who were admitted to the cardiology outpatient clinic of Hangzhou First People's Hospital, the Third People's Hospital of Yuhang, Dajiangdong Hospital, the Second People's Hospital of Fuyang, and the People's Hospital of Linan were enrolled. According to diagnostic criteria of alcoholic cardiomyopathy (ACM), the patients were divided into ACM group (36 cases) and non-ACM group (66 cases). The baseline data, electrocardiogram and echocardiography characteristics of the two groups were recorded and analyzed. Results: There was no significant difference in the baseline between the two groups (P>0.05), including consumption and duration of alcohol. The left ventricular end-diastolic and right ventricular diameters in ACM group were (59±5) mm and (24±4) mm, respectively, which were significantly higher than those in non-ACM group ((51±4)mm, (22±4) mm, P<0.001 and P=0.044) . The left ventricular ejection fraction in ACM group was 41%±4%, which was significantly lower than that of non-ACM group (63%±8%, P<0.001). The incidence of biatrial enlargement in non-ACM group was 57.58%, which was significantly higher than that of ACM group (36.11%, P=0.038). The incidence of atrial fibrillation in non-ACM group was 54.55%, which was significantly higher than that of ACM group (27.78%, P=0.009). The incidence of diastolic heart failure in non-ACM group was significantly higher than that of ACM group (P=0.005). Conclusions: ACM is characterized by ventricular enlargement, decreased ejection fraction and heart failure, while non-ACM may belong to the early stage of alcoholic myocardial injury, characterized by biatrial expansion, atrial fibrillation and diastolic insufficiency. Due to the lack of understanding and no clinical diagnostic criteria, non-ACM is prone to be missed diagnosed and misdiagnosed.