Adalimumab medium-term dosing strategy in moderate-to-severe hidradenitis suppurativa: integrated results from the phase III randomized placebo-controlled PIONEER trials

Background

Weekly adalimumab (Humira^®) is approved for the treatment of hidradenitis suppurativa (HS) based on the 12‐week placebo‐controlled periods of the two phase III PIONEER trials.

Objectives

Using PIONEER integrated trial results, we aimed to evaluate the optimal medium‐term adalimumab maintenance dosing strategy for moderate‐to‐severe HS.

Methods

Each trial had two double‐blind periods; 12‐week Period A and 24‐week Period B. Patients randomized to adalimumab 40 mg every week (ADAew) (Period A), were rerandomized in Period B to ADAew (ADAew/ew), ADA every other week (ADAew/eow), or placebo (ADAew/pbo). Placebo‐randomized patients were reassigned in Period B to ADAew (PIONEER I) or placebo (PIONEER II). The primary outcome was HS Clinical Response (HiSCR). Patients who lost response during Period B were discontinued from the study and offered an option to enter the open‐label extension (OLE) to receive ADAew. Results are reported across the two study periods, and data were combined from the two study periods and the OLE.

Results

For week‐12 HiSCR achievers, the HiSCR week‐36 rate was 48·1% (ADAew/ew) vs. 46·2% (ADAew/eow) and 32·1% (ADAew/pbo). Combining (post hoc) these patients with week‐12 partial responders further differentiated outcomes in Period B (ADAew/ew 55·7% vs. ADAew/eow 40·0% and ADAew/pbo 30·1%). Period‐B adverse‐event rates were ADAew/ew 59·6% vs. ADAew/eow 57·4% and ADAew/pbo 65·0%. One patient (ADAew/ew) reported a serious infection.

Conclusions

Weekly adalimumab treatment, effective throughout 36 weeks, was the optimal maintenance medium‐term dosing regimen for this population. At least partial response after 12 weeks with continued weekly dosing had better outcomes than dose reduction or interruption. Patients who do not show at least a partial response to weekly adalimumab by week 12 are unlikely to benefit from continued therapy. No new safety risks were identified.

What's already known about this topic?

Hidradenitis suppurativa (HS) is a chronic inflammatory disease, commonly misinterpreted as an infection and treated with long‐term antibiotic regimens or surgical incisions.

Based on the chronicity of HS and the lack of evidence for efficacious and safe long‐term HS treatments, it is important to evaluate medium‐ to long‐term therapies for HS.

Weekly adalimumab (Humira^®) is approved for the treatment of moderate‐to‐severe HS based on the two phase III PIONEER trials.

What does this study add?

This study pooled data from the two PIONEER trials, providing a more robust assessment of outcomes.

After at least partial treatment success with weekly adalimumab short‐term therapy (12 weeks), continuing weekly dosing during the subsequent 24 weeks had better outcomes than dose reduction or treatment interruption.

Patients who do not show at least a partial response to weekly adalimumab by week 12 are unlikely to benefit from continued therapy.

Linked Comment: https://doi.org/10.1111/bjd.18437.

https://www.bjdonline.com/article/adalimumab-medium-term-dosing-strategy-in-moderate-to-severe-hidradenitis-suppurativa-integrated-results-from-the-phase-iii-randomized-placebo-controlled-pioneer-t/

[Retrospective analysis of 4 rare cases of temporomandibular joint disc ossification]

Objective: To summarize the clinical manifestation and treatment of temporomandibular joint (TMJ) disc ossification, providing reference for clinical diagnosis and treatment of TMJ disc ossification. Methods: From January 2006 to January 2018, 4 patients with TMJ disc ossification (2 males and 2 females, aged 20-55 years with an average age of 35.5 years) which were admitted to the Department of Oral and Maxillofacial Surgery, Shenzhen Second People's Hospital were analyzed retrospectively. Ossification of TMJ disc was found in 4 cases during TMJ surgery. Two cases underwent partial ossification resection plus disc reduction and anchorage, and two cases underwent discectomy plus temporalis myofascial flap replacement. The causes, clinical manifestations and surgical effects of TMJ disc ossification were analyzed by comparing the maximal interincisal opening, visual analogue scale (VAS) score and MRI imaging indexes before and after operation. Results: The history of anterior disc displacement of TMJ in 4 patients was long (average 11.5 years). In clinic, TMJ disc ossification was characterized by TMJ pain and limitation of mouth opening. The maximal interincisal opening was (32.1±6.1) mm and the VAS score was (7.3±0.4) before operation. MRI showed that the displaced discs of the affected sides were displaced and the condyle bones were worn. During the operation, ossification of TMJ discs was found yellow and hard, and the original elasticity was lost. Pathologic findings showed that the TMJ disc cartilage were ossified to osteoid tissue. Under the microscope, bone cells scattered around the bone cells and red trabecular bone were seen, and there were bone trabecula formed. In a follow-up of one year, TMJ pain was significantly decreased [VAS: (1.7±0.2)], and the maximal interincisal opening was (38.5±2.2) mm. MRI showed that the TMJ disc returned to normal position, and the sign of repairing and reconstruction of condyle bone could be found. Conclusions: Long term displacement of TMJ disc may cause ossification with pain and limitation of interincisal opening. According to the degree and extent of ossification, partial ossification plus disc reduction and anchorage or discectomy plus temporalis myofascial flap replacement is feasible, and the clinical effects are satisfactory.

Comparison of microRNAs in adipose and muscle tissue from seven indigenous Chinese breeds and Yorkshire pigs

Elucidation of the pig microRNAome is essential for interpreting functional elements of the genome and understanding the genetic architecture of complex traits. Here, we extracted small RNAs from skeletal muscle and adipose tissue, and we compared their expression levels between one Western breed (Yorkshire) and seven indigenous Chinese breeds. We detected the expression of 172 known porcine microRNAs (miRNAs) and 181 novel miRNAs. Differential expression analysis found 92 and 12 differentially expressed miRNAs in adipose and muscle tissue respectively. We found that different Chinese breeds shared common directional miRNA expression changes compared to Yorkshire pigs. Some miRNAs differentially expressed across multiple Chinese breeds, including ssc-miR-129-5p, ssc-miR-30 and ssc-miR-150, are involved in adipose tissue function. Functional enrichment analysis revealed that the target genes of the differentially expressed miRNAs are associated mainly with signaling pathways rather than metabolic and biosynthetic processes. The miRNA-target gene and miRNA-phenotypic traits networks identified many hub miRNAs that regulate a large number of target genes or phenotypic traits. Specifically, we found that intramuscular fat content is regulated by the greatest number of miRNAs in muscle tissue. This study provides valuable new candidate miRNAs that will aid in the improvement of meat quality and production.

Autonomic Activity in Overweight-Obese Children During the Morning Transition in Cardiac Circadian Regulation (P21-065-19)

Objectives

Regulation of the autonomic nervous system is disturbed in obese children and adults. This dysregulation—which includes sympathetic nervous system (SNS) over activity and disruption of cardiac circadian rhythms—is of interest because of the negative impact of these effects on cognition, regulation of energy homeostasis, cardiovascular health, and metabolic functions. The present study evaluated heart rate (HR) measures during the first hours following awakening from sleep when circadian cardiac control transitions from an emphasis on parasympathetic nervous system activity (PNS) during sleep to an emphasis on SNS activity during wakefulness.

Methods

Resting HR recordings (5 min) were obtained from healthy normal weight (NW: BMI < 85th %ile; n = 47; 25 boys) and overweight-obese (OB: BMI > 95th %ile; n = 48; 24 boys) 10 yr olds enrolled in the ACNC's Brain Food study. The first of two recording sessions (T1) took place 2 hrs after awakening (1 hr after a standardized breakfast), and the second (T2) 1 hr later. Recordings were processed for measures of sympathetic [low frequency (LF)] and parasympathetic [high frequency (HF); vagal tone (VT); root mean square of intervals between adjacent heart beats (RMSSD)] activities.

Results

Separate ANOVAs (recording session by group by sex) were conducted for each measure. Previous reports of higher HR in girls than boys and in OB than NW groups were confirmed (both P ≤ 0.001) HR slowed significantly from T1 to T2 for OB (P = 0.021), but not NW. These effects were associated with T1 to T2 increases in SNS LF activity for both groups (both P ≤ 0.003), but significant increases in PNS measures (HF, RMSSD, VT; all P < 0.05) for only OB children. Increases in PNS activity across recording sessions for OB children attenuated group HR differences during T2 (T1: OB > NW, P = 0.008; T2: OB > NW, P = .051). Gender differences were consistent with faster HR in girls which was maintained across groups and recording sessions.

Conclusions

The results are the first to show that autonomic dysregulation in obese children modulates the shift in SNS-PNS balance characteristic of the transition from sleep to waking. These findings may inform the development of new early intervention strategies to attenuate obesity that consider the role played by circadian rhythms.

Funding Sources

Funded by USDA-ARS Project 6026-51000-010-05S.

Role of the Innate Cytokine Storm Induced by the Influenza A Virus

Influenza A viruses (IAVs) can be classified into dozens of subtypes based on their hemagglutinin (HA) and neuraminidase (NA) proteins. To date, 18 HA subtypes and 11 NA subtypes of IAVs that spread in animals and humans have been found. Following infection, the IAV first induces the innate immune system, which can rapidly recruit innate immune cells and cytokines to the site of infection. Influenza-induced cytokine storms have been associated with uncontrolled proinflammatory responses, which may lead to significant immunopathy and severe disease. Cytokine storms are complicated by several types of cytokines and chemokines that have various activities. In addition to their direct effects, their crossregulation causes cytokine networks to form; these networks determine the outcome of viral infections. In this review, we focus on cytokine storms and their signaling pathways that are triggered by the different subtypes of IAV.

Polygraph Accuracy of Control Question Test in Criminal Cases

Objective To explore polygraph accuracy of Control Question Test （CQT）and whether it could be influenced by examinee's education level and type of violation of law. Methods Real cases of CQT （n=104） and the data from MAO （n=296） were collected. The polygraph accuracy of CQT was calculated. Variance analysis on three groups of different education levels was used to compare their age, and then the chi-square test was employed to compare polygraph accuracy among the groups. Independent sample t test was used to compare the age of subjects in the two groups of different types of violation of law, and then chi-square test was used to compare the true positive rate and true negative rate of lie detection after integration. Results In CQT lie detection of criminal cases, the true positive rate was 87.00%, the false negative rate was 13.00%, the true negative rate was 82.20%, and the false positive rate was 17.80%. There was no statistical significance in the differences between the true positive rate and the true negative rate （P>0.05）. In CQT lie detection of the groups of different education levels, there was no statistical significance in the differences between the true positive rates （P>0.05） while the differences between the true negative rates had statistical significance （P<0.05）. There was no statistical significance in the differences of both the true positive rates and the true negative rates between the violent violation of law and non-violent violation of law （P>0.05）. Conclusion There is no significant difference between the efficiency of CQT lie detection of identifying criminals and excluding innocents. However, a comparatively high false positive rate and false negative rate still exist. The efficiency of CQT lie detection identifying criminals may not influenced by the examinee's education level and type of violation of law, but its efficiency of excluding innocents may be influenced by the examinee's education level.

The potential of cadmium ion-immobilized Rhizobium pusense KG2 to prevent soybean root from absorbing cadmium in cadmium-contaminated soil

AIMS

Because the effect of Cd2+ -immobilized microbe on Cd uptake of plants in Cd-contaminated soil remains underexplored, this study focuses on the effect of Cd2+ -immobilized rhizobia on Cd uptake of soybean.

METHODS AND RESULTS

Strain KG2 from soybean nodule was identified as Rhizobium pusense KG2 by phylogenetic analysis. Rhizobium pusense KG2 showed the 120 mg l-1 of minimal lethal concentration for Cd2+ . In 50 and 100 mg l-1 of Cd2+ liquid, approximately 2 × 1010 cells removed 56·71 and 22·11% of Cd2+ , respectively. In pot soil containing 50 and 100 mg kg-1 of Cd2+ , strain KG2 caused a 45·9 and 35·3% decrease in soybean root Cd content, respectively. Meanwhile, KG2 improved the root and shoot length, nitrogen content and biomass of soybean plants and superoxide dismutase activity.

CONCLUSIONS

The Cd2+ -immobilized rhizobia could inhibit soybean plants to absorb Cd2+ from soil, promote plant growth and improve plant's tolerance against Cd. This study is the first time to report that R. pusense is an effective nodulating rhizobium of legume.

SIGNIFICANCE AND IMPACT OF THE STUDY

Some Cd2+ -immobilized microbe lowering Cd uptake of plant and promoting plant growth should be considered as an effective strategy for producing safety crops in the Cd-contaminated agricultural soil.

Abstract P5-16-08: Applications of rib sparing technique in internal mammary vessels exposure of abdominal free flap breast reconstructions

Background:

Internal mammary vessels (IMVs) are widely used recipient vessels in abdominal free flaps breast reconstructions. Exposure of IMVs usually needs to resect a segment of costal cartilage or rib during the operations. The rib sparing technique is an alternative method with less damage. This study aims to analysis the applicability and advantages of rib sparing technique of IMVs exposure in breast reconstruction.

Methods:

medical records of 215 patients who underwent abdominal free flap reconstruction from November 2006 to December 2017 were analyzed. The factors influencing the choice of vessels and rib sparing were analyzed. The outcomes of rib sparing were assessed. Intercostal space (ICS) width and other related data were measured by the preoperative thin slice chest computed tomography (CT) scan images.

Results:

Among all 215 patients with 218 flaps, 172 flaps used IMVs as the recipient vessels while 13 used thoracodorsalvessels and 33 used subscapular vessels. The proportion of IMVs as recipient vessels showed a rising trend in general and remained over 90% for the last three years in our center. Patients with immediate reconstruction (p=0.005) and axillary lymph nodes dissection(ALND) (p&lt;0.001) were less likely to use IMVs, both in univariate and multivariate logistic regression analysis. Patients' BMI and radiotherapy history showed no statistically significant differences between the IMVs group and the other vessels group (p=0.338 and 0.811). The rib sparing rate in IMVs exposure increased yearly and exceeded 40% in 2013, now it maintained more than 60% during the recent 3 years. Additionally, among the patients who received rib sparing IMVs exposure in 2017, the mean ICS width was relatively smaller than that in 2013 (2.54cm V.S 2.93cm, p=0.124). Compared with rib resection group, patients with rib sparing were higher (163.57 ± 4.44 cm vs. 161.83 ± 4.30 cm, p=0.047) and with a wider ICS (2.65 ± 0.54 cm vs. 2.25± 0.38 cm, p&lt;0.01), while the depth from the surface of the pectoralis major muscle to the IMVs and distance between the parasternal line and IMVs had no difference between the two groups. Rib sparing group has a shorter surgery and hospitalization time, as well as a lower severe complication rate, but the differences were not statistically significant (p= 0.120, 0.450 and 0.296).

Conclusion:

IMVs were used more frequently as the recipient vessels in abdominal free flap breast reconstructions, especially when axillary operation was not carried out at the same time. Rib sparing technique had the potential to decrease surgery time and hospitalization days, as well as the severe complications rate. It could be used in most of patients received free flap reconstruction when IMVs were used, particularly in higher patients and patients with a wider ICS. Preoperative slice chest CT scan can be used to measure the ICS width to provide suggestions for dealing with the ribs.

Citation Format: Zhang Q, Xiao Q, Guo R, Wu J, Gu Y, Xiu B. Applications of rib sparing technique in internal mammary vessels exposure of abdominal free flap breast reconstructions [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-08.

Abstract P5-04-13: Splicing factor ESRP1 controls ER-positive breast cancer progression by altering metabolic pathway genes

Background Epithelial Splicing Regulatory Protein (ESRP1)is a key splicing factor that regulates Epithelial-to-Mesenchymal Transition (EMT) splicing program. Our previous study demonstrated that high levels of ESRP1 are associated with poor prognosis in human ER-positive (ER+) breast tumors in an independent manner of EMT process. We next explored the potential mechanisms that contribute to the role ESRP1 in endocrine therapy-resistant breast cancer.

Methods Probe based-Human Transcriptome Array 2.0 (HTA; Applied Biosystems/Thermo Fisher) was performed using RNAs from control and ESRP1 knockdown cells (LCC2 versus 2C3 ESRP1 and LCC9 versus 9C2 ESRP1) of endocrine resistant breast cancer. Functional enrichment analyses were performed using the DAVID functional annotation tool (http://david.abcc.ncifcrf.gov/). To confirm the functional importance of ESRP1 on regulation of cellular metabolism, we have performed experiments that analyze the metabolic substrate flux in response to ESRP1 knockdown in resistant cells (The Seahorse XFp Cell Energy Phenotype Assay). Differentially expressed genes were validated using Western blotting assay.

Results Transcriptome profiling of ESRP1in 2C3 and 9C2 knockdown models revealed differentially expressed genesusing HTA 2.0 platform. In LCC2 versus 2C3 ESRP1 knockdown, expression of 1186 genes (1263 transcripts) have been altered significantly, while 413 genes (432 transcripts) have been significantly regulated in LCC9 versus 9C2 ESRP1 knockdown with FDR&lt;0.1 Of these significant genes, 34 downregulated and 68 upregulated (102 genes total) were shared by both 2C3 and 9C2 ESRP1 knockdowns. Using the DAVID Functional Annotation Clustering Tool, we identified the biological processes altered significantly in response to ESRP1 knockdown. The most significant annotation clusters downregulated in ESRP1 knockdown consists of fatty acid metabolism/lipid metabolism (SCD, ACACA, FASN, ACAT2, PLCH1, and HPGD), and oxireductase processes (SCD, PHGDH, FASN, DHTKD1 and HPGD. We confirmed the altered metabolic function using the Seahorse analyzer. These analyses confirmed that ESRP1 knockdown altered the glycolysis rate (extracellular acidification rate; ECAR) in both tamoxifen-resistant and fulvestrant-resistant models. In addition, ESRP1 knockdown decreased the mitochondrial respiration in tamoxifen-resistant cells, but not fulvestrant resistant cells. Using Western blotting, we validated the altered levels of fatty acid synthase (FASN) and Stearoyl-CoA desaturase 1 (SCD1), key enzymes in fatty acid metabolism. Phosphoglycerate Dehydrogenase (PHGDH), a poor prognosis marker in cancers including breast cancer, was also downregulated in response to ESRP1 knockdown. Taken together, we have demonstrated a novel functional impact of ESRP1 on the regulation of tumor growth at the functional and molecular level independent of EMT.

Conclusions For the first time, we show the role of ESRP1 in altering the cellular metabolism thereby contributing to tumor growth. The study provides a molecular evidence for the role of altered metabolism in determining adverse prognosis of ER+ breast cancer via the control of ESRP1, a splicing factor. Further studies to determine the therapeutic value are underway.

Citation Format: Gokmen-Polar Y, Gu Y, Gu X, Badve SS. Splicing factor ESRP1 controls ER-positive breast cancer progression by altering metabolic pathway genes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-04-13.

Abstract P6-02-19: Machine learning based analysis of CT radiomics for the simultaneous indeterminate pulmonary nodules of breast cancer

PURPOSE: To investigate texture features of simultaneous indeterminate pulmonary nodules of breast cancer for predicting their potential metastasis.

METHODS AND MATERIALS: 150 patients with simultaneous breast cancer diagnosed by biopsy and pulmonary nodules (diameter: 5-20mm) detected by preoperative CT were enrolled in this study. After surgery and breast cancer treatment, the patients were followed up for at least half a year or longer by CT to observe the changes of lung nodules, thereby inferring the potential of metastasis. We classify pulmonary nodules into two groups: the reduced or enlarged pulmonary nodules were defined as highly metastasis possibility (Group 1), and long-term stable pulmonary nodules were defined as low metastasis possibility (Group 2). In addition, pathologic proven primary lung cancer in this study (Group 3) was compared with Group 1. Therefore, we carried out a comparative analysis of the texture features between the groups, and additional statistical were used three regression testing to extract texture features. Finally, we construct a machine learning classifier and calculate the accuracy of cross-validation.

RESULTS: We collected 106 features by the texture analysis(TA). There are 18 features with significant differences between Group 1 and the Group 2(p&lt;0.05), and 76 features with significant differences in the Group 1 and Group 3 (p&lt;0.05). We tried to find key features related to pathology in 106 features using three methods: lasso regression, ridge regression and forward stepwise regression. The accuracy in different regressions respectively is 94.5%,94.5%,89.7% using KNN between Group 1 and Group 2. The accuracy in different regressions respectively is 96.2%(KNN),96.2%(Tree),92.3%(Linear Discriminant)in the Group 1 and Group 3.

CONCLUDES: The identified radiomics features have the potential to be used as a biomarker for metastasis prediction of simultaneous indeterminate pulmonary nodules in breast cancer patients, and it may contribute to preoperative treatment and postoperative follow-up planning.

Citation Format: Xiao Q, Gu Y, Wu J, Wang Z, Huang Y. Machine learning based analysis of CT radiomics for the simultaneous indeterminate pulmonary nodules of breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-19.

Columbianadin Suppresses Lipopolysaccharide (LPS)-Induced Inflammation and Apoptosis through the NOD1 Pathway

Columbianadin (CBN) is one of the main bioactive constituents isolated from the root of Angelica pubescens. Although the anti-inflammatory activity of CBN has been reported, the underpinning mechanism of this remains unclear. In this study, we investigated the anti-inflammatory effect of CBN on lipopolysaccharide (LPS)-stimulated THP-1 cells and explored the possible underlying molecular mechanisms. The results showed that CBN suppressed LPS-mediated inflammatory response mainly through the inactivation of the NOD1 and NF-κB p65 signaling pathways. Knockdown of NOD1 reduced the degree to which inflammatory cytokines decreased following CBN treatment, whereas forced expression of NOD1 and CBN treatment reduced NF-κB p65 activation and the secretion of inflammatory cytokines. Furthermore, CBN significantly reduced cellular apoptosis by inhibiting the NOD1 pathway. Collectively, our results indicate that CBN suppressed the LPS-mediated inflammatory response by inhibiting NOD1/NF-κB activation. Further investigations are required to determine the mechanisms of action of CBN in the inhibition of NOD signaling: However, CBN may be employed as a therapeutic agent for multiple inflammatory diseases.

Intratumoral IL17-producing cells infiltration correlate with antitumor immune contexture and improved response to adjuvant chemotherapy in gastric cancer

BACKGROUND

Tumor IL17-producing (IL17A+) cells infiltration has different prognostic values among various cancers. The objective of this study was to assess the effect of IL17A+ cells in gastric cancer.

PATIENTS AND METHODS

The study included two patient cohorts, the Cancer Genome Atlas cohort (TCGA, n = 351) and the Zhongshan Hospital cohort (ZSHC, n = 458). The TCGA and ZSHC were used for mRNA-related and cells infiltration-related analyses, respectively. The roles of IL17A mRNA and IL17A+ cells in overall survival (OS), response to adjuvant chemotherapy (ACT), and immune contexture were evaluated. Another independent cohort was included to identify the correlation between mRNA of IL17A and IL17A+ cells infiltration (the preliminary Zhongshan Hospital cohort, PZSHC, n = 21).

RESULTS

The infiltration of IL17A+ cells was positively correlated with the expression of IL17A mRNA (Spearman's ρ = 0.811; P < 0.001). High IL17A mRNA expression and intratumoral IL17A+ cells were correlated with improved OS and remained to be significant after adjusted for confounders. Patients with TNM II/III disease whose tumor present higher intratumoral IL17A+ cells or lower peritumoral IL17A+ cells can benefit more from ACT. Elevated IL17A mRNA expression and increased intratumoral IL17A+ cells infiltration was associated with more antitumor mast cells and nature killer cells infiltration and less pro-tumor M2 macrophages infiltration. High IL17A mRNA expression represented a Th17 cells signature and immune response process and was correlated with increased cytotoxic GZMA, GZMB, IFNG, PRF1, and TNFSF11 expression.

CONCLUSIONS

IL17A mRNA expression and intratumoral IL17A+ cells infiltration were correlated with antitumor immune contexture. IL17A+ cells infiltration could be used as an independent prognostic biomarker for OS and predictive biomarker for superior response to ACT, and further prospective validation needs to be conducted.

Treatment Strategy for Unruptured Intracranial Aneurysm in Elderly Patients: Coiling, Clipping, or Conservative?

An increasing number of unruptured intracranial aneurysms (UIAs) has been discovered in elderly patients in recent years, but the optimal treatment strategy for these patients remains controversial. We report our six-year experience treating UIAs in elderly patients (≥ 70 years old). A retrospective review was conducted of elderly patients who harbored UIAs treated by conservative observation, microsurgical clipping, or endovascular coiling between January 2009 and December 2014. The patients’ clinical and imaging information was recorded. Treating methods, procedure-related complications, imaging results, and clinical outcomes were analyzed. A total of 141 consecutive elderly patients with 166 UIAs were enrolled in our study. In all, 64 patients with 79 aneurysms were treated with coiling, and 14 patients with 14 aneurysms were treated with clipping. The remaining 63 patients with 73 aneurysms were placed under conservative observation. The average modified Rankin scale was 0.99 (range 0–6) in the full cohort after a mean follow-up of 50.4 months (range 0–70 months). There was no significant difference of modified Rankin scale in patients with UIAs treated by different methods. Multivariate analysis showed that age (p=0.030) and aneurysm size (p=0.011) were independent risk factors for unfavorable outcome of UIAs in the elderly. Patient age (p=0.010) and aneurysm size (p=0.020) were also significantly associated with unfavorable outcome of UIAs managed with observation initially. Our results indicated that endovascular coil embolization and clipping were both safe and effective treatment methods for UIAs in the elderly. Aggressive treatment for UIAs in elderly patients with risk factors of aneurysm rupture should be considered positively.

Daidzein exerts anti-tumor activity against bladder cancer cells via inhibition of FGFR3 pathway

Bladder cancer is one of the causes of cancer‑related death and has a high mortality rate. Daidzein, a natural isoflavone compound predominantly extracted from soybeans, has been reported to exhibit several bioactivities, including anti-tumor. However, the effects of daidzein on bladder cancer remains unrevealed. Here we investigated the effects and molecular mechanisms of daidzein on bladder cancer using multiple in vitro cell lines and in vivo xenograft mice studies. Our results showed that daidzein reduced cell viability in a time- and concentration‑dependent manner. Daidzein significantly impaired colony formation, caused G1/S cell cycle arrest and induced apoptosis of the bladder cancer cells. We also verified that daidzein efficiently suppressed RT112 cell xenograft tumor growth in nude mice. Mechanism studies indicated that significant down-regulation of the FGFR3 signaling pathway was responsible for the efficacy of daidzein. The phosphorylation levels of FGFR3, Akt and Erk proteins were suppressed in association with the decreasing of some apoptosis-suppressing molecules under the daidzein treatment. Knockdown of endogenous FGFR3 impaired the activity of daidzein against bladder cancer, which suggested that the effect of daidzein was mainly mediated by FGFR3 pathway. In addition, the function model of daidzein was similar with FGFR3 antagonist PD173074 in RT112 cells. Taken together, the results this study demonstrate that daidzein is capable of inhibiting bladder cancer growth and might be a novel effective chemotherapeutic agent for the application to combat bladder carcinoma.

Nanoscale extracellular vesicle-derived DNA is superior to circulating cell-free DNA for mutation detection in early-stage non-small-cell lung cancer

Background

The comparison between relatively intact nanoscale extracellular vesicle-derived DNA (nEV-DNA) and fragmented circulating cell-free DNA (cfDNA) in mutation detection among patients with non-small-cell lung cancer (NSCLC) has not been carried out yet, and thus deserves investigation.

Patients and methods

Both nEV-DNA and cfDNA was obtained from 377 NSCLC patients with known EGFR mutation status and 69 controls. The respective EGFRE19del/T790M/L858R mutation status was interrogated with amplification-refractory-mutation-system-based PCR assays (ARMS-PCR).

Results

Neither nEV-DNA nor cfDNA levels show a strong correlation with tumor volumes. There is no correlation between cfDNA and nEV-DNA levels either. The detection sensitivity of nEV-DNA and cfDNA using ARMS-PCR in early-stage NSCLC was 25.7% and 14.2%, respectively, with 96.6% and 91.7% specificity, respectively. In late-stage NSCLC, both nEV-DNA and cfDNA show ∼80% sensitivity and over 95% specificity.

Conclusions

nEV-DNA is superior to cfDNA for mutation detection in early-stage NSCLC using ARMS-PCR. However, the advantages vanish in late-stage NSCLC.

Lactobacillus acidophilus and Clostridium butyricum ameliorate colitis in murine by strengthening the gut barrier function and decreasing inflammatory factors

Ulcerative colitis is a type of chronic inflammation present in the intestines for which the aetiology is not yet clear. The current therapies for ulcerative colitis cannot be considered to be long-term management strategies due to their significant side effects. Therefore, it is essential to identify an alternative therapeutic strategy for ulcerative colitis. The present study focused on the evaluation of the anti-inflammatory activities of Lactobacillus acidophilus CGMCC 7282 and Clostridium butyricum CGMCC 7281. The roles of both single and combination of L. acidophilus CGMCC 7282 and C. butyricum CGMCC 7281 in ulcerative colitis were investigated in 2,4,6-trinitrobenzenesulfonic acid-induced acute colitis (Th1-type colitis) in Sprague-Dawley rats and oxazolone-induced chronic colitis (Th2-type colitis) in BALB/c mice. The in vivo studies showed that the administration of L. acidophilus CGMCC 7282, C. butyricum CGMCC 7281 and L. acidophilus CGMCC 7282 plus C. butyricum CGMCC 7281 could reduce the Th1-type colitis as well as the Th2-type colitis, and the combination of the two strains exhibited the most notable effects, as indicated by the reduced mortality rates, the suppressed disease activity indices, the improved body weights, the reduced colon weight/colon length and colon weight/body weight ratios, and the improved gross anatomic characteristics and histological features (ameliorations of neutrophil infiltration and ulceration in the colon). It was found that the alterations of the gut microbiome, the barrier function changing and the selected inflammation-related cytokines are observed in the ulcerative colitis rats/mice treated with L. acidophilus CGMCC 7282 and C. butyricum CGMCC 7281. The combination of L. acidophilus CGMCC 7282 plus C. butyricum CGMCC 7281 also exerted a stronger anti-inflammatory effect than either of the single strains alone in vitro. These findings provide evidence that the administration of L. acidophilus CGMCC 7282 plus C. butyricum CGMCC 7281 may be a promising therapy for ulcerative colitis.