A plain language summary of the results from the group of patients in the CHRYSALIS study with EGFR exon 20 insertion-mutated non-small-cell lung cancer who received amivantamab

WHAT IS THIS SUMMARY ABOUT?

This is a plain language summary of an article published in the Journal of Clinical Oncology in 2021. It describes the first results from 1 group of patients in the phase 1 CHRYSALIS study with epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations. This part of the CHRYSALIS study (called cohort D) investigated the bispecific antibody amivantamab (brand name RYBREVANT®) in patients with non-small-cell lung cancer (NSCLC) with an EGFR ex20ins mutation. EGFR mutations are one of the most common causes of NSCLC tumors, with EGFR ex20ins mutations being more common among people of Asian descent. Patients who took part in this study had cancer that could not be removed by surgery, and whose cancer had worsened after receiving other forms of treatment, such as chemotherapy. Typically, patients with this type of mutation are difficult to treat or do not experience treatment response with commonly used therapies that target EGFR.

WHAT WERE THE RESULTS?

The CHRYSALIS study took place between May 27, 2016, and June 8, 2020, in select hospitals in the USA, Japan and South Korea. In cohort D, amivantamab showed promising results, with an overall response rate of 40%. This means that 4 of every 10 patients in CHRYSALIS cohort D had tumors that shrank or were no longer measurable. Clinical Trial Registration: NCT02609776 (the CHRYSALIS Phase I Study) (ClinicalTrials.gov).

International Association for the Study of Lung Cancer Study of Reproducibility in Assessment of Pathologic Response in Resected Lung Cancers After Neoadjuvant Therapy

INTRODUCTION

Pathologic response has been proposed as an early clinical trial end point of survival after neoadjuvant treatment in clinical trials of NSCLC. The International Association for the Study of Lung Cancer (IASLC) published recommendations for pathologic evaluation of resected lung cancers after neoadjuvant therapy. The aim of this study was to assess pathologic response interobserver reproducibility using IASLC criteria.

METHODS

An international panel of 11 pulmonary pathologists reviewed hematoxylin and eosin-stained slides from the lung tumors of resected NSCLC from 84 patients who received neoadjuvant immune checkpoint inhibitors in six clinical trials. Pathologic response was assessed for percent viable tumor, necrosis, and stroma. For each slide, tumor bed area was measured microscopically, and pre-embedded formulas calculated unweighted and weighted major pathologic response (MPR) averages to reflect variable tumor bed proportion.

RESULTS

Unanimous agreement among pathologists for MPR was observed in 68 patients (81%), and inter-rater agreement (IRA) was 0.84 (95% confidence interval [CI]: 0.76-0.92) and 0.86 (95% CI: 0.79-0.93) for unweighted and weighted averages, respectively. Overall, unweighted and weighted methods did not reveal significant differences in the classification of MPR. The highest concordance by both methods was observed for cases with more than 95% viable tumor (IRA = 0.98, 95% CI: 0.96-1) and 0% viable tumor (IRA = 0.94, 95% CI: 0.89-0.98). The most common reasons for discrepancies included interpretations of tumor bed, presence of prominent stromal inflammation, distinction between reactive and neoplastic pneumocytes, and assessment of invasive mucinous adenocarcinoma.

CONCLUSIONS

Our study revealed excellent reliability in cases with no residual viable tumor and good reliability for MPR with the IASLC recommended less than or equal to 10% cutoff for viable tumor after neoadjuvant therapy.

The American Association for Thoracic Surgery (AATS) 2023 Expert Consensus Document: Staging and multidisciplinary management of patients with early-stage non-small cell lung cancer

Novel targeted therapy and immunotherapy drugs have recently been approved for use in patients with surgically resectable lung cancer. Accurate staging, early molecular testing, and knowledge of recent trials are critical to optimize oncologic outcomes in these patients.

Discrete unified gas-kinetic wave-particle method for flows in all flow regimes

This work proposes a discrete unified gas-kinetic wave-particle (DUGKWP) method for simulation of flows in all flow regimes. Unlike the discrete velocity method (DVM) and the direct simulation Monte Carlo (DSMC) method which solve the governing equations by either the deterministic method or the stochastic method, the DUGKWP combines the advantages of these two methods. In the DUGKWP, the information of microscopic particles as well as macroscopic flow variables are both evolved. Specifically, the microscopic particles are updated by the free-transport and resampling processes, while the macroscopic flow properties are evolved via solving the macroscopic governing equations of conservation laws with the finite volume method. According to the discrete characteristic solution to the Boltzmann-BGK equation utilized in the DUGKWP, in the highly rarefied flow regime, the motion of microscopic particles greatly determines the fluxes for the macroscopic governing equations. Conversely, for the continuum flow, no microscopic particle exists in the computational domain and the DUGKWP is degraded to the Navier-Stokes solver. Numerical studies validate that the DUGKWP can accurately predict the flow properties in all flow regimes. Furthermore, compared with the deterministic method, the DUGKWP enjoys superior efficiency with less memory consumption for both high-speed rarefied flows and flows close to the continuum regime.

Release of Interface Confined Water Significantly Improves Dentin Bonding

Water residue and replacement difficulty cause insufficient adhesive infiltration in demineralized dentin matrix (DDM), which produces a defective hybrid layer and thus a bonding durability problem, severely plaguing adhesive dentistry for decades. In this study, we propose that the unique properties of a highly hydrated interface of the porous DDM can give rise to 1 new type of interface, confined liquid water, which accounts for most of the residue water and may be the main cause of insufficient infiltration. To prove our hypothesis, 3 metal ions with increasing binding affinity and complex stability (Na⁺, Ca²⁺, and Cu²⁺) were introduced respectively to coordinate negatively charged groups such as -PO₄^3-, -COO^- abundant in the DDM interface. Strong chelation of Ca²⁺ and Cu²⁺ rapidly released the confined water, significantly improving penetration of hydrophobic adhesive monomers, while Na⁺ had little effect. A significant decrease of defects in the hybrid layer and a much decreased modulus gap between the hybrid layer and the adhesive layer greatly optimized the microstructure and micromechanical properties of the tooth-resin bonding interface, thus improving the effectiveness and durability of dentin bonding substantially. This study paves the way for a solution to the core scientific issue of contemporary adhesive dentistry: water residue and replacement in dentin bonding, both theoretically and practically.

CircNDST1 promotes papillary thyroid cancer progression via its interaction with CSNK2A1 to activate the PI3K-Akt pathway and epithelial-mesenchymal transition

BACKGROUND

Multiple studies have established a strong relationship between circRNA and cancer progression. Cervical lymph node metastasis is a key factor influencing the surgical approach and distant metastasis of papillary thyroid cancer (PTC). However, the role of circNDST1 in PTC has not been investigated. Our research focused on revealing the function and mechanism of action of circNDST1 in PTC.

METHODS

High-throughput sequencing and qPCR were used to assess the expression of circRNA in PTC tissues with extensive cervical lymph node metastasis and circNDST1 in cell lines, respectively. The proliferative effects of circNDST1 in vitro and in vivo were analyzed using CCK8, clone formation assay, EdU, and nude mouse tumorigenesis assay. The transwell scratch assay was employed in the scrutiny of the effect of circNDST1 on the migration and invasion abilities of thyroid cancer cells, while circNDST1's influence on the PI3K-Akt pathway and the Epithelial-Mesenchymal Transition (EMT) key protein expression was evaluated utilizing RNA sequencing and western blot. RNA pull-down and RIP were used to examine the binding of circNDST1 to CSNK2A1.

RESULTS

CircNDST1 was highly expressed in PTC cell lines, but knocking it down inhibited the proliferation, migration, and invasive abilities of TPC1 and KTC1 cell lines. CircNDST1 bonded with CSNK2A1 and promoted the interaction between CSNK2A1 and Akt, leading to the activation of the PI3K-Akt pathway and EMT.

CONCLUSION

CircNDST1's high expression boosted thyroid cancer progression through the activation of the PI3K-Akt pathway and EMT in a CSNK2A1-dependent manner.

[Clinical characteristics of Wilson's disease with onset of acute liver failure in 19 children]

Objective: To analyze the clinical characteristics of Wilson's disease (WD) with onset of acute liver failure (ALF) in children. Methods: Clinical data of 19 children diagnosed with WD presented with ALF in Xi'an Children's Hospital from January 2016 to April 2021 were retrospectively analyzed, including general condition, clinical manifestation, laboratory examination, and gene detection. The children were divided into the death group and survival group according to the clinical outcome. The children who had hepatic WD with non-ALF onset during the same period were selected as the control. The general conditions and laboratory indexes were compared between death group and survival group, ALF group and non-ALF group. T-test, Mann Whitney U test or χ² test were used to compare the differences between the two groups. Results: Of the 19 WD children with ALF onset, 10 were females and 9 were males. The age of admission was (10.1±2.6) years and time to onset of first visit was 9 (4, 15) days. Among the WD children with ALF onset, 4 children were lost to follow-up, 5 cases death (death group) and 10 cases survived (survival group). The ceruloplasmin in the death group was higher than that in the survival group (0.078 (0.055, 0.105) vs. 0.033 (0.027, 0.058) g/L, Z=-2.33, P=0.020). There were 95 children who had hepatic WD with non-ALF onset. The WD patients with ALF onset were older at admission (9.9 (8.0, 11.1) vs. 5.4 (3.7, 6.9) years, Z=-5.25, P<0.001), had higher ceruloplasmin (0.060 (0.030, 0.078) vs. 0.024 (0.006, 0.060) g/L, Z=-3.11, P=0.002), 24 h urinary copper (674 (205, 1 803) vs. 149 (108, 206) μg, Z=-4.25, P<0.001), and positive rate of K-F ring [17/19 vs. 7%(7/95), χ²=50.17, P<0.001] while shorter onset time at initial visit (0.3 (0.1, 0.5) vs. 1.0 (0.7, 6.0) months, Z=-4.28, P<0.001). There was no gender difference between the two groups [9/19 vs. 61%(58/95), χ²=1.22, P=0.269]. Of the 19 WD children with ALF onset, 13 had the ATP7B gene tested, and 15 reported variants were detected. The main variations were c.2333G>T (p. Arg778Leu), c.2621C>T (p. Ala874Val) and c.2975C>T (p. Pro992Leu). The allele frequencies were 6/26(23%), 4/26(15%) and 3/26(12%), respectively. Conclusions: Children of WD onset with ALF are school-aged and above. They have an acute onset, a short course of the disease, and poor prognosis. The positive rate of K-F ring, ceruloplasmin and urinary copper are higher than those of the hepatic WD children with non-ALF onset.

Development of explicit formulations of G45-based gas kinetic scheme for simulation of continuum and rarefied flows

In this work, the explicit formulations of the Grad's distribution function for the 45 moments (G45)-based gas kinetic scheme (GKS) are presented. Similar to the G13 function-based gas kinetic scheme (G13-GKS), G45-GKS simulates flows from the continuum regime to the rarefied regime by solving the macroscopic governing equations based on the conservation laws, which are widely used in conventional Navier-Stokes solver. These macroscopic governing equations are discretized by the finite volume method, where the numerical fluxes are evaluated by the local solution to the Boltzmann equation. The initial distribution function is reconstructed by the G45 distribution function, which is a higher order truncation of the Hermite expansion of distribution function compared with the G13 distribution function. Such high order truncation of Hermite expansion helps the present solver to achieve a better accuracy than G13-GKS. Moreover, the reconstruction of distribution function makes the development of explicit formulations of numerical fluxes feasible, and the evolution of the distribution function, which is the main reason why the discrete velocity method is expensive, is avoided. Several numerical experiments are performed to examine the accuracy of G45-GKS. Results show that the accuracy of the present solver for almost all flow problems is much better than G13-GKS. Moreover, some typical rarefied effects, such as the direction of heat flux without temperature gradients and thermal creep flow, can be well captured by the present solver.

Variant of gas kinetic flux solver for flows beyond Navier-Stokes level

In this paper, a variant of gas kinetic flux solver (GKFS) is presented for simulation of flows beyond the Navier-Stokes (NS) level. The method retains the framework of GKFS and reconstructs the numerical fluxes by the moments of distribution function at the cell interface, which is given from the local solution of the Boltzmann equation. In the conventional GKFS, the first-order Chapman-Enskog (CE) expansion is utilized to approximate the initial distribution function. By using the differential chain rule, it was found that the CE expansion form could be linked to the stress tensor and the heat flux. For flows in the NS level, the stress tensor and heat flux can be simply calculated from the linearized constitutive relationship and Fourier's law, respectively. However, for flows beyond the NS level, due to the strong nonequilibrium effect, the linearized constitutive relationship and Fourier's law are insufficient to predict the stress tensor and the heat flux. To overcome this difficulty, this paper introduces correction terms to the stress tensor and heat flux in the initial distribution function. These correction terms will take effect in the strong nonequilibrium region for flows beyond the NS level. To avoid finding complex expressions or solving complicated partial differential equations for the correction terms, a simple and iterative procedure is proposed to update the correction terms based on the framework of GKFS. The proposed method is validated by three benchmark cases which cover the flow from the continuum regime to the transition regime. Numerical results show that the present solver can provide accurate solution in the continuum regime. It is indeed the correction terms that take effect in the strong nonequilibrium region for flows beyond the NS level, which enables the present solver to capture the nonequilibrium phenomenon with reasonable accuracy for rarefied flows at moderate Knudsen number.

Abstract P05-01: A phase 1b study evaluating the safety and efficacy of sotorasib, a KRASG12C inhibitor, in combination with trametinib, a MEK inhibitor, in KRAS p.G12C-Mutated Solid Tumors

Background KRAS p.G12C is an oncogenic driver in solid tumors, including non-small cell lung cancer (NSCLC) and colorectal cancer (CRC). Sotorasib, a specific, irreversible KRASG12C inhibitor, was recently approved by the FDA for treatment of adults with KRAS p.G12C-mutated locally advanced or metastatic NSCLC who received at least one prior systemic therapy. Sotorasib combined with trametinib, a selective allosteric MEK1/MEK2 inhibitor, displayed synergist antitumor activity in tumor xenografts. Here we report the first safety and interim efficacy of sotorasib in combination with trametinib in advanced KRAS p.G12C-mutated solid tumors in this phase 1b CodeBreaK101 master study. Methods In this dose exploration/expansion study, patients (pts) with KRAS p.G12C-mutated solid tumors were treated with 960 mg QD sotorasib and trametinib (1 or 2 mg QD). For NSCLC, prior anti-PD1/PD-L1 and/or platinum-based combination chemotherapy and targeted therapy (if applicable) was required. For CRC, at least 1 prior systemic regimen including fluoropyrimidine, oxaliplatin, and irinotecan-based regimens was required. 1° endpoint was safety/tolerability. 2° endpoint was efficacy. Results Based on a July 12, 2021 snapshot, 41 pts (22 male, median age: 60.0 y [34-84]) were enrolled and treated with combination of sotorasib and trametinib (18 pts NSCLC, 18 pts CRC, 5 pts other). Thirty-three pts (80.5%) received ≥2 prior lines of therapy (range, 0–8); 11 pts (26.8%) received prior KRASG12C inhibitor. Median treatment duration of the sotorasib and trametinib combination was 84.0 days (Q1, 42.0; Q3, 140.0). No new or unexpected toxicities were identified. The most common treatment-related adverse events (TRAEs) included diarrhea (43.9% pts), rash (34.1% pts), nausea (29.3% pts), and vomiting (22.0% pts), predominantly ≤grade 2. Ten pts (24.4%) discontinued sotorasib and/or trametinib due to a TRAE (2 pts-diarrhea). One dose-limiting toxicity (grade 3 maculo-papular rash, trametinib-related) was observed out of 33 pts treated with 2 mg trametinib/960 mg sotorasib QD. For the 1 mg trametinib/960 mg sotorasib QD CRC exploration cohort (N=3); 1 confirmed partial response (PR) and 1 stable disease (SD) were reported in pts with prior KRASG12C inhibitor; 1 SD was reported in a KRASG12C inhibitor-naïve pt. For the 2 mg trametinib/960 mg sotorasib QD CRC cohort (N=15), all 4 pts with prior KRASG12C inhibitor had SD; for naïve pts, 1-confirmed PR, 7-SD, and 3-progressive disease (PD) were reported. In NSCLC pts (N=18) treated with 2 mg trametinib/960 mg sotorasib QD, of pts with prior KRASG12C inhibitor, 2-SD and 1-PD were reported; of naïve pts, 3-confirmed PR, 10-SD, 1-PD, and 1-not evaluable were reported. Conclusions Combination of sotorasib and trametinib is safe and tolerable. The maximum tolerated dose tested was 2 mg trametinib/960 mg sotorasib QD. Antitumor activity was observed including responses in pts with prior KRASG12C inhibitor. Triplet combination therapy of sotorasib with trametinib and panitumumab currently are under investigation in solid tumors.

Citation Format: Suresh Ramalingam, Marwan Fakih, John Strickler, Ramaswamy Govindan, Bob T. Li, Sarah Goldberg, David Gandara, Timothy Burns, Minal Barve, Catherine Shu, Richard Frank, Davendra Sohal, Pegah Jafarinasabian, Tian Dai, Omar Mather, David Hong. A phase 1b study evaluating the safety and efficacy of sotorasib, a KRASG12C inhibitor, in combination with trametinib, a MEK inhibitor, in KRAS p.G12C-Mutated Solid Tumors [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P05-01.

Efficient high-order radial basis-function-based differential quadrature-finite volume method for incompressible flows on unstructured grids

This paper presents an efficient high-order radial basis-function-based differential quadrature-finite volume method for incompressible flows on unstructured grids. In this method, a high-order polynomial based on the Taylor series expansion is applied within each control cell to approximate the solution. The derivatives in the Taylor series expansion are approximated by the mesh-free radial basis-function-based differential quadrature method. The recently proposed lattice Boltzmann flux solver is applied to simultaneously evaluate the inviscid and viscous fluxes at the cell interface by the local solution of the lattice Boltzmann equation. In the present high-order method, a premultiplied coefficient matrix appears in the time-dependent term, reflecting the implicit nature. The implicit time-marching techniques, i.e., the lower-upper symmetric Gauss-Seidel and the explicit first stage, singly diagonally implicit Runge-Kutta schemes, are incorporated to efficiently solve the resultant ordinary differential equations. Several numerical examples are tested to validate the accuracy, efficiency, and robustness of the present method on unstructured grids. Compared with the k-exact method, the present method enjoys higher accuracy and better computational efficiency.

Gas kinetic flux solver based high-order finite-volume method for simulation of two-dimensional compressible flows

In this work, a high-order gas kinetic flux solver (GKFS) is developed for simulation of two-dimensional (2D) compressible flows. Different from the conventional gas kinetic scheme, which uses the local integral solution to the Boltzmann equation to reconstruct the numerical fluxes of macroscopic governing equations, the GKFS evaluates the numerical fluxes by the local asymptotic solution to the Boltzmann equation. This local asymptotic solution consists of the equilibrium distribution function and its substantial derivative at the cell interface. To achieve high-order accuracy in the simulation, the substantial derivative is discretized by a difference scheme with second-order accuracy in time and fourth-order accuracy in space, which results in a polynomial of the equilibrium distribution function at different locations and time levels. The Taylor series expansion is then introduced to simplify this polynomial. As a result, a simple high-order accurate local asymptotic solution to the Boltzmann equation is obtained and the numerical fluxes of macroscopic governing equations are given explicitly. A series of numerical examples are presented to validate the accuracy and capability of the developed high-order GKFS. Numerical results demonstrate that the high-order GKFS can achieve the desired accuracy on both the quadrilateral mesh and the triangular mesh and it outperforms the second-order counterpart.

Synthesis and characterization of an anti-caries and remineralizing fluorine-containing cationic polymer PHMB-F

Dental caries have become a major global public health problem. Plaque control and remineralization of initial enamel lesions are paramount for the prevention and control of caries. Polyhexamethylene biguanide (PHMB) is a type of cationic amphipathic antibacterial agent with broad-spectrum antibacterial properties and good biological safety. Fluoride delays demineralization and promotes the remineralization of hard dental tissues. However, a high concentration is needed for it to function as an antibacterial agent. In order to create a PHMB with the benefits associated with fluoride, we synthesized a fluorine-containing cationic polymer, PHMB-F. Fourier transform-infrared spectroscopy and solid state nuclear magnetic resonance characterization confirmed the successful synthesis of PHMB-F. Antibacterial tests showed that PHMB-F had better antiseptic efficacy for Streptococcus mutans compared with just PHMB. Moreover, positively-charged PHMB-F allows fluoride ions to exist closer to the enamel surface with negative potential, which markedly lowers the ion concentrations in the microenvironment adjacent to hard dental tissues needed to maintain equilibrium. Thus, only low concentrations of PHMB-F are required for enamel remineralization.

Phase-field-simplified lattice Boltzmann method for modeling solid-liquid phase change

This article proposes a phase-field-simplified lattice Boltzmann method (PF-SLBM) for modeling solid-liquid phase change problems within a pure material. The PF-SLBM consolidates the simplified lattice Boltzmann method (SLBM) as the flow solver and the phase-field method as the interface tracking algorithm. Compared with conventional lattice Boltzmann modelings, the SLBM shows advantages in memory cost, boundary treatment, and numerical stability, and thus is more suitable for the present topic which includes complex flow patterns and fluid-solid boundaries. In contrast to the sharp interface approach, the phase-field method utilized in this work represents a diffuse interface strategy and is more flexible in describing complicated fluid-solid interfaces. Through abundant benchmark tests, comprehensive validations of the accuracy, stability, and boundary treatment of the proposed PF-SLBM are carried out. The method is then applied to the simulations of partially melted or frozen cavities, which sheds light on the potential of the PF-SLBM in resolving practical problems.

LncRNA CHRF promotes cell invasion and migration via EMT in gastric cancer

OBJECTIVE

Long non-coding RNAs (lncRNAs) have been verified to involve in the development and progression of gastric cancer (GC). However, the expression of lncRNA CHRF level in GC has not been mentioned before. Here, we focused on the function of lncRNA CHRF played in GC.

PATIENTS AND METHODS

A total of 103 GC tissues and paired para-tumor tissues from GC patients were collected. The quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was applied to measure the lncRNA CHRF level in these samples and GC cell lines. The Wound-healing experiment, transwell assay, and Matrigel assay were employed to study the migration and invasion abilities of GC cells. The underlying molecular of lncRNA CHRF was measured using Western-blot.

RESULTS

LncRNA CHRF expression was significantly higher in 103 GC tissue samples compared with the adjacent para-tumor samples. In GC cells, lncRNA CHRF showed increased expression levels than the human fetal gastric epithelial cells (GES-1). Inhibition of lncRNA CHRF reduced the invasion and migration of MKN-7 cells while the over-expression of lncRNA CHRF promoted HGC-27 cells metastasis. Furthermore, we found that lncRNA CHRF could promote the progression of epithelial-mesenchymal transition (EMT) to promote the GC cell metastasis.

CONCLUSIONS

Our current study demonstrated that lncRNA CHRF functioned as an oncogene in GC and promoted cell invasion and migration via EMT. This might furnish a potential target for the GC biological diagnosis and therapy.

Three-dimensional lattice Boltzmann flux solver for simulation of fluid-solid conjugate heat transfer problems with curved boundary

A three-dimensional (3D) lattice Boltzmann flux solver is presented in this work for simulation of fluid-solid conjugate heat transfer problems with a curved boundary. In this scheme, the macroscopic governing equations for mass, momentum, and energy conservation are discretized by the finite-volume method, and the numerical fluxes at the cell interface are reconstructed by the local solution of lattice Boltzmann equation. For solving the 3D fluid-solid conjugate heat transfer problems, the density distribution function (D3Q15 model) is utilized to compute the numerical fluxes of continuity and momentum equations, and the total enthalpy distribution function (D3Q7 model) is introduced to calculate the numerical flux of the energy equation. The connections between the macroscopic fluxes and the local solution of the lattice Boltzmann equation are provided by the Chapman-Enskog expansion analysis. As compared with the lattice Boltzmann method, in which the time step and grid spacing are correlated, the local solution of the lattice Boltzmann equation at each cell interface used in the present scheme is independent of each other. As a result, the drawback of the tie-up between the time step and grid spacing can be effectively removed and the developed method applies very well to nonuniform mesh and curved boundaries. To validate the performance of the developed method, the steady and unsteady natural convection in a finned 3D cavity and in a finned 3D annulus are simulated. Numerical results showed that the present scheme can effectively solve the 3D conjugate heat transfer problems with a curved boundary.

Lung cancer cytology and small biopsy specimens: diagnosis, predictive biomarker testing, acquisition, triage, and management

In the 21st century, there has been a dramatic shift in the management of advanced-stage lung carcinoma, and this has coincided with an increasing use of minimally invasive tissue acquisition methods. Both have had significant downstream effects on cytology and small biopsy specimens. Current treatments require morphologic, immunohistochemical, and/or genotypical subtyping of non-small cell lung carcinoma. To meet these objectives, standardized classification of cytology and small specimen diagnoses, immunohistochemical algorithms, and predictive biomarker testing guidelines have been developed. This review provides an overview of current classification, biomarker testing, methods of small specimen acquisition and triage, clinical management strategies, and emerging technologies.

High-order least-square-based finite-difference-finite-volume method for simulation of incompressible thermal flows on arbitrary grids

In this work, a high-order (HO) least-square-based finite difference-finite volume (LSFD-FV) method together with thermal lattice Boltzmann flux solver (TLBFS) is presented for simulation of two-dimensional (2D) incompressible thermal flows on arbitrary grids. In the present method, a HO polynomial based on Taylor series expansion is applied within each control cell, where the unknown spatial derivatives at each cell center are approximated by least-square-based finite difference (LSFD) scheme. Then the recently developed TLBFS is applied to evaluate the convective and diffusive fluxes simultaneously at the cell interface by local reconstruction of thermal lattice Boltzmann solutions of the density and internal energy distribution functions. The present HO LSFD-FV method is verified and validated by 2D incompressible heat transfer problems. Numerical results indicate that the present method can be effectively and flexibly applied to solve thermal flow problems with curved boundaries on arbitrary grids. Compared with the conventional low-order finite volume method, higher efficiency and lower memory cost make the present HO method more promising for practical thermal flow problems.

[Mediating effect of work engagement between job stress and depressive symptoms in State Grid employees]

Objective: To explore the relationship between job stress, work engagement and depressive symptoms of State Grid workers, and to analyze the mediating effect of work engagement between job stress and depressive symptoms. Methods: A cross-sectional survey was conducted to investigate 845 employees from a State Grid company, using the brief job stress questionnaire, the Patient Health Questionnaire (PHQ-9) and 9-item Utrecht Work Engagement Scale (UWES-9) in March 2017. Results: The average score of work engagement was 4.49±1.42, the mean value of job stress was 1.15±0.33, the average score of depressive symptoms was 6.44±4.30, and the positive rate of depressive symptoms was 66.9%.There was a negative correlation between work engagement with both job stress and depressive symptoms (r=-0.193, -0.397, both P<0.01) , and job stress was positively correlated with depressive symptoms (r=0.260, P<0.01) . The relationship between job stress and depressive symptoms was partly mediated by work engagement, and the mediating effect accounted for 27.2% of the total effect. Conclusion: The work engagement of State Grid staff acts as the mediator between job stress and depressive symptoms, alleviating the depressive symptoms caused by job stress.

[Association between Long Working Hours and Job Stress and Depression among Employees from a State Grid Company]

Objective: This study was to understand the current situation of long working hours and identify the association of long working hours and job stress and depression among workers from one district company of state grid. Methods: The project was done with the cross-sectional survey. All questionnaires were completed by self-administered with informed consent. Employees' weekly working hours was reported by themselves; Using the PHQ-9 scale to assess depression, the JDC Model to evaluate job stress, and SPSS software to analyze data, the single factor chi-square test and multivariate Logistic analysis were performed to identify the association between long working hours and job stress, depression. Results: there were 35.3 percent employees with over 44 hours a week. The association between increasing weekly working hours and job stress and depression was statistically significant. Compared to the reference group (≤44 h) , for those who worked more than 44 hours per week, the odds ratio of job stress was 2.02 (95%CI=1.27-3.23) times increased, and the odds ratio of depression was 1.60 (95%CI=1.01-2.55) times increased, especially for those (≥60 h) , the odds ratio was 3.69 (95%CI=1.45-9.41) and 2.76 (95%CI=1.09-7.03) respectively. Conclusion: Long working hours can significantly increase the risk of job stress and depression among workers. When their weekly working hours exceeds 60, long working hours will be the independent risk factor for both job stress and depression.

[Procedure selection of left subclavian artery revascularization in thoracic endovascular aortic repair]

In order to require ideal proximal landing zone and durable long-term outcome, it is necessary to reconstruct the left subclavian artery(LSA) blood supply as much as possible in thoracic aortic endovascular repair(TEVAR). With the advent and progress of diverse assisted techniques and devices, several procedures for the reconstruction of the left subclavian artery have been developed and widely utilized, including surgical LSA bypass or transposition, chimney technique, periscope technique, fenestration and branched stent-graft, which have expanded the proximal landing zone and widened the indication for original TEVAR. This article describes the advantages and pitfalls of each revascularization methods. Anatomies of aortic arch and LSA, urgency and types of pathologies, proficiency of the surgeon with different revascularization techniques and pre-operative risk score of patient should be evaluated in procedure selection. In clinical application, patient-specific evaluations and individualized considerations are essential for initialize the therapeutic strategy and decision making.

Kramers-Kronig detection with Brillouin-amplified virtual carrier: publisher's note

This publisher's note corrects an error in the title in Opt. Lett.43, 1367 (2018)OPLEDP0146-959210.1364/OL.43.001367.

Development of an efficient gas kinetic scheme for simulation of two-dimensional incompressible thermal flows

In this work, an efficient gas kinetic scheme is presented for simulation of two-dimensional incompressible thermal flows. In the scheme, the macroscopic governing equations for mass, momentum, and energy conservation are discretized by the finite volume method and the numerical fluxes at the cell interface are reconstructed by the local solution of the Boltzmann equation. To compute these fluxes, two distribution functions are involved. One is the circular function, which is used to calculate the numerical fluxes of mass and momentum equations. Due to the incompressible limit, the circle at the cell interface can be approximately considered to be symmetric so that the expressions for the conservative variables and numerical fluxes at the cell interface can be given explicitly and concisely. Another one is the D2Q4 model, which is utilized to compute the numerical flux of the energy equation. By following the process for derivation of numerical fluxes of mass and momentum equations, the numerical flux of the energy equation can also be given explicitly. The accuracy, efficiency, and stability of the present scheme are validated by simulating several thermal flow problems. Numerical results showed that the present scheme can provide accurate numerical results for incompressible thermal flows at a wide range of Rayleigh numbers with less computational cost than that needed by the thermal lattice Boltzmann flux solver (TLBFS), which has been proven to be more efficient than the thermal lattice Boltzmann method (TLBM).

Abstract A081: A phase 1b, open-label, dose escalation and expansion study of demcizumab plus pembrolizumab in patients with locally advanced or metastatic solid tumors

Introduction: Delta-like ligand 4 (DLL4) is a ligand that activates the Notch pathway. Demcizumab is a humanized, anti-DLL4 antibody that has been shown using an in vivo tumorigenicity limiting dilution assay to inhibit tumor growth and decrease cancer stem cell frequency in minimally passaged human xenograft models. In addition, inhibition of DLL4 has also been shown in preclinical studies to cause an antiangiogenic effect and to decrease the number of monocytic myeloid-derived suppressor cells (MDSCs) within the tumor. Finally, xenograft studies showed enhanced activity when demcizumab was combined with anti-PD1. Therefore, we hypothesized that demcizumab in combination with anti-PD1 may be effective in cancers that are refractory to anti-PD1 therapy and where MDSCs play a role in prognosis such as castrate-resistant prostate cancer and/or may augment the activity of anti-PD-1 in sensitive tumor types. Methods: This was an open-label, phase 1b dose study of demcizumab plus pembrolizumab in patients with advanced or metastatic solid tumors. Patients were enrolled in two stages: a dose-escalation stage and an expansion stage. In the dose escalation phase, patients received demcizumab 2.5 or 5 mg/kg administered IV once every 3 weeks for two 63-day truncated courses (second course starting on Day 168). Pembrolizumab was given at 2 mg/kg administered IV over 30 minutes every 3 weeks. Three cohorts of 10 patients each (anti-PD1 naïve 2L non-squamous NSCLC, anti-PD1 refractory, and advanced castrate-resistant prostate cancer) were planned to be enrolled in the dose escalation portion of the trial and treated with the MTD of demcizumab that was established in the dose escalation phase of the trial. Results: Twenty-seven patients were enrolled in the study: 9 in dose escalation and 18 in expansion. The MTD of demcizumab was determined to be 5 mg/kg (i.e., the highest dose tested). One partial response was observed in a NSCLC patient and 8 patients had stable disease. Peripheral MDSCs were measured over time in 5 of the prostate cancer patients, but no consistent impact was observed on the monocytic MDSCs. Demcizumab plus pembrolizumab was well tolerated. The most common adverse events were fatigue (44%), vomiting (41%), nausea (37%), headache (26%), BNP increased (22%), and decreased appetite (22%). Nine immune-related AEs occurred with only 2 being Grade 3 or greater. Conclusion: Demcizumab plus pembrolizumab therapy was well tolerated, but there was no evidence of enhanced antitumor activity.

Citation Format: Melissa Johnson, Drew Rasco, Brian Schneider, Catherine Shu, Robert Jotte, Hema Parmer, Robert Stagg, Juanita Lopez. A phase 1b, open-label, dose escalation and expansion study of demcizumab plus pembrolizumab in patients with locally advanced or metastatic solid tumors [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A081.

Incorporating an immersed boundary method to study thermal effects of vascular systems during tissue cryo-freezing

In this paper, the three-dimensional thermal effects of a clinically-extracted vascular tissue undergoing cryo-freezing are numerically investigated. Based on the measured experimental temperature field, the numerical results of the Pennes bioheat model combined with the boundary condition-enforced immersed boundary method (IBM) agreed well with experimental data with a maximum temperature discrepancy of 2.9°C. For simulating the temperature profile of a tumor sited in a dominantly vascularized tissue, our model is able to capture with ease the thermal effects at specified junctions of the blood vessels. The vascular complexity and the ice-ball shape irregularity which cannot be easily quantified via clinical experiments are also analyzed and compared for both two-dimensional and three-dimensional settings with different vessel configurations and developments. For the three-dimensional numerical simulations, a n-furcated liver vessels model from a three-dimensional segmented volume using hole-making and subdivision methods is applied. A specific study revealed that the structure and complexity of the vascular network can markedly affect the tissue's freezing configuration with increasing ice-ball irregularity for greater blood vessel complexity.

[Association between sense of coherence and occupational stress of workers in modern service industry in Shanghai, China]

Objective: To investigate understand the current status of the sense of coherence and occupational stress in modern service workers, and to analyze the association between occupational stress and the sense of coherence. Methods: From March to April, 2016, 834 modern service workers from 3 companies in Shanghai, China (in air transportation industry, marketing industry, and travel industry) were surveyed by non-ran-dom sampling. The self-completion questionnaires were filled out anonymously given the informed consent of the workers. The occupational stress questionnaire was used to evaluate occupational stress, and the Chinese version of the Sense of Coherence Scale (SOC-13) was used to assess the mental health. Results: The mean score for the sense of coherence of the respondents was 61.54±10.46, and 50.1% of them were self-rated as having occupational stress. There were significant differences in SOC score between groups with different ages, marital status, positions, lengths of service, family per capita monthly income, and weekly work hours (P<0.05). The occupational stress score differed significantly across groups with different marital status, lengths of service, and weekly work hours (P<0.05). The scores for working autonomy, social support, and occupational stress differed significantly between groups with different SOC levels (P<0.05). There were significant differences in SOC score and the distribution of low-SOC respondents between groups with different levels of working autonomy, social support, and occupational stress. High SOC is a protective factor for occupational stress (OR=0.39, 95%CI 0.26~ 0.59). Conclusion: Modern service workers in Shanghai have high SOC and moderate occupational stress. Therefore, improving SOC may reduce occupational stress.

Development of a discrete gas-kinetic scheme for simulation of two-dimensional viscous incompressible and compressible flows

In this work, a discrete gas-kinetic scheme (DGKS) is presented for simulation of two-dimensional viscous incompressible and compressible flows. This scheme is developed from the circular function-based GKS, which was recently proposed by Shu and his co-workers [L. M. Yang, C. Shu, and J. Wu, J. Comput. Phys. 274, 611 (2014)]. For the circular function-based GKS, the integrals for conservation forms of moments in the infinity domain for the Maxwellian function-based GKS are simplified to those integrals along the circle. As a result, the explicit formulations of conservative variables and fluxes are derived. However, these explicit formulations of circular function-based GKS for viscous flows are still complicated, which may not be easy for the application by new users. By using certain discrete points to represent the circle in the phase velocity space, the complicated formulations can be replaced by a simple solution process. The basic requirement is that the conservation forms of moments for the circular function-based GKS can be accurately satisfied by weighted summation of distribution functions at discrete points. In this work, it is shown that integral quadrature by four discrete points on the circle, which forms the D2Q4 discrete velocity model, can exactly match the integrals. Numerical results showed that the present scheme can provide accurate numerical results for incompressible and compressible viscous flows with roughly the same computational cost as that needed by the Roe scheme.

First Report of Dieback of Camellia azalea Caused by Glomerella cingulata f. sp. camelliae in Guangdong, China

Camellia azalea Wei (Theaceae) is a critically endangered species with high ornamental value in China. Its wild individual plants, less than 1,000, are only found in Yangchun, Guangdong Province, China. Since 2010, a severe dieback on C. azalea has been observed in several commercial plantations in Foshan, Guangdong Province, during the process of artificial propagation. The infection started from the middle portion of the new shoots, where necrosis spots developed and expanded to girdle the stems. Consequently, the shoots died and became brown in color. Later, the necrotic spots turned pale gray, and many small, black fruiting bodies emerged. In the end, more than half of the dead shoots broke off from the necrotic spots. Generally, about 10 to 20% new shoots were infected for one individual plant. Although the older branches with leaves were not infected and showed no symptoms, the dieback of crown outer layer greatly reduced the ornamental value of the plants and the sale price went down. Another part of the plants that is often infected is the stalk, resulting in the drop of fruits. By using routine isolation methods and single-spore purification technique, 18 single-conidial isolates with similar colony morphology were obtained from five diseased plants. The cultures of single-conidial isolates grew at an average rate of 6.8 mm per day on PDA at 28°C. The central part of colony became gray-green with age, and acervuli formed on the medium after incubation for 7 to 10 days. Conidia, round at both ends, were 13.65 to 18.3 × 3.61 to 5.92 μm (avg. = 16.1 ± 1.6 × 4.8 ± 0.8 μm, n = 50) in size. After culturing for 50 to 60 days, perithecia matured. Ascopores were hyaline, straight, aseptate, and 10.02 to 13.77 × 3.27 to 4.45 μm (avg. = 12.2 ± 1.1 × 3.9 ± 0.4 μm, n = 50) in size. The cultural and morphological characteristics of these isolates are consistent with the description of Glomerella cingulata f. sp. camelliae (1). The sequences (GenBank Accession Nos. KJ668576, KJ668577, KJ676642, KJ689374, KJ689375, and KJ689376) of ITS, GPDH, GS, actin, β-tubulin, and CAL regions of three representative isolates are identical and share 99, 99, 100, 99, 100, and 100% identity with those of the type specimen of G. cingulata f. sp. camelliae ICMP 10643 (JX010224, JX009908, JX010119, JX009540, JX010436, and JX009630), respectively (2). Twenty randomly selected shoots with young leaves on the top of them, detached from different trees, were scratched in the middle part with a fine scalpel to generate a 5-mm-long wound, 50 μl conidial suspension (1 × 10⁵ conidia ml^-1) was then dropped onto the wound for inoculation. The control shoots were inoculated with the same volume of sterile distilled water. All inoculated shoots were placed into an intelligent artificial climate incubator with 12-h photoperiod and 100% relative humidity at 28 ± 1°C. Each treatment replicated on five shoots, and the tests were repeated twice. Symptoms resembling those in the field were observed on all conidia-inoculated shoots after 10 to 14 days, and control shoots were asymptomatic. The same fungus G. cingulata f. sp. camelliae was consistently re-isolated from the diseased shoots, fulfilling Koch's postulates. G. cingulata f. sp. camelliae has been reported on other species of Camellia outside China, but this is the first report in China where the species is endemic and endangered (1,2). References: (1) J. S. W. Dickens et al. Plant Pathol. 38:75, 1989. (2) B. Weir et al. Stud Mycol. 73:115, 2012.

First Report of Anthracnose of Alocasia macrorrhiza Caused by Colletotrichum karstii in Guangdong, China

Alocasia macrorrhiza (L.) Schott. (Araceae), native to South America, is a common, herbaceous perennial ornamental plant in tropical and subtropical areas (1). A severe leaf spot disease was observed on this plant in several places on the campus of authors' university in Guangzhou, Guangdong Province, China, in April 2013. Initial symptoms were water-soaked, dark green leaf spots. These small spots gradually expanded to 6- to 11-mm circular lesions. They were grayish-white in color with a yellow halo and many small, black, concentric dots were observed on them. Microscopic examination revealed that these small dots were acervuli, which were 100 to 300 μm in diameter, developing beneath the epidermis and becoming erumpent with age. By using routine tissue-isolation method and single-spore purification technique, four single-conidial isolates were obtained from each of four diseased leaves. These isolates formed a grayish-white colony with numerous pink spore masses on PDA at 28°C. Their mycelial radial growth rate was about 4.5 mm per day. Conidia were single-celled, hyaline, and cylindrical with an obtuse apex and protruding base; they were 12.7 to 14.2 × 4.8 to 5.9 μm in size. Conidial appressoria were irregular in shape, sepia to dark brown, solitary, and 6.9 to 8.5 × 4.6 to 5.9 μm. These morphological characteristics were consistent with the description of Colletotrichum karstii (2). The sequences of beta-tubulin gene (TUB2) and partial actin gene (ACT) of a representative isolate CAM1 were obtained by PCR amplification with primers BT2a/BT2b and ACT512F/ACT783R, respectively. These sequences were deposited in GenBank under the accession numbers of KF444947 and KF460435. BLAST searches showed a 99% homology with the TUB2 and ACT sequences of C. karstii (JX625209, KC843559). Therefore, the fungus isolated from A. macrorrhiza was identified as C. karstii by morphological and molecular characteristics. Pathogenicity tests were performed on 30-day-old plants of A. macrorrhiza grown in plastic pots (0.8 L) by spraying 15 ml conidial suspension (1 × 10⁶ conidia ml^-1) of this fungus onto each plant. The control plants were sprayed only with sterile distilled water. These plants then were placed in an intelligent artificial climate incubator with 12-h photoperiod and 100% relative humidity at 24 ± 1°C. Three replicates, each with five plants, were included in a test, and the test was repeated twice. Seven days after inoculation, the inoculated plants showed necrotic lesions on leaves similar to those observed on the campus, but no symptoms were observed on any non-inoculated controls. The same fungus C. karstii was re-isolated from the infected leaves. Although C. karstii is a well-known anthracnose pathogen on some plants belonging to family Orchidaceae (2), this is the first report of the same pathogen causing anthracnose on A. macrorrhiza in Guangdong, China. References: (1) S. Li et al. PLoS ONE 8(6):e66016, 2013. (2) Y. Yang et al. Cryptogr. Mycol. 32:229, 2011.

Free-energy-based lattice Boltzmann model for the simulation of multiphase flows with density contrast

A free-energy-based phase-field lattice Boltzmann method is proposed in this work to simulate multiphase flows with density contrast. The present method is to improve the Zheng-Shu-Chew (ZSC) model [Zheng, Shu, and Chew, J. Comput. Phys. 218, 353 (2006)] for correct consideration of density contrast in the momentum equation. The original ZSC model uses the particle distribution function in the lattice Boltzmann equation (LBE) for the mean density and momentum, which cannot properly consider the effect of local density variation in the momentum equation. To correctly consider it, the particle distribution function in the LBE must be for the local density and momentum. However, when the LBE of such distribution function is solved, it will encounter a severe numerical instability. To overcome this difficulty, a transformation, which is similar to the one used in the Lee-Lin (LL) model [Lee and Lin, J. Comput. Phys. 206, 16 (2005)] is introduced in this work to change the particle distribution function for the local density and momentum into that for the mean density and momentum. As a result, the present model still uses the particle distribution function for the mean density and momentum, and in the meantime, considers the effect of local density variation in the LBE as a forcing term. Numerical examples demonstrate that both the present model and the LL model can correctly simulate multiphase flows with density contrast, and the present model has an obvious improvement over the ZSC model in terms of solution accuracy. In terms of computational time, the present model is less efficient than the ZSC model, but is much more efficient than the LL model.

First Report of Phomopsis longicolla Causing Stem Canker of Eggplant in Guangdong, China

Eggplant (Solanum melongena L.) is an economically important vegetable crop worldwide. In August 2012, severe stem cankers were observed on eggplant at the early stage of maturation in several fields in Guangdong Province, China. Diseased plants raised cankers on the stems and branches, which resulted in wilting and stunting. No symptoms developed on eggplant fruit. Disease incidence was as high as 40% within affected fields. By using routine fungal-isolation methods and single-spore purification technique, five single-conidial isolates were obtained from each diseased stem. Colonies were grayish-white, circular, and got yellow pigmentation when placed in acidified potato dextrose agar (PDA) in an incubator at pH 4.5 and 25°C with a 12-h photoperiod. Stromata were black, large, and spreading in a concentric pattern. Conidiomata were pycnidial, and the pycnidia were round, oblate, triangular or irregular, and unilocular. Conidiophores were colorless, separated, dichotomous, and 10.0 to 18.0 × 1.5 to 2.0 μm. Alpha conidia were single-celled, ellipsoidal to fusiform, guttulate, and 6.0 to 8.0 × 2.0 to 2.5 μm. Beta conidia, produced on oat meal agar in 2 weeks at 25°C in the dark, were filiform, hamate, and 16.0 to 28.0 × 0.7 to 1.0 μm. Based on these morphological characters, the fungus was identified as Phomopsis longicolla Hobbs (1). The ITS-rDNA sequence (GenBank Accession No. KC886605) of the isolate EPPL1 of this fungus (P. longicolla EPPL1) was obtained by using universal primers ITS5/ITS4 (1). BLAST searches showed a 98% homology with the sequence of the ITS region of rDNA of P. longicolla. Phylogenetic analysis showed that P. longicolla EPPL1 clustered with P. longicolla SYJM15 and formed a distinct clade distantly related to P. vexans PV3 (GU373630), a well-known pathogen of eggplant. Digestion of PCR-amplified DNA with Alu I yielded two restriction fragments of sizes consistent with those reported for P. longicolla (2). Pathogenicity tests were performed on 30-day-old plants of cv. Yuefengzihongqie grown in a plastic pot (1 liter) in a greenhouse by using mycelial plugs and conidial suspensions of isolate EPPL1 as inocula. A mycelial plug (4 mm in diameter) from a 7-day-old PDA culture was placed on stems of both wounded and non-wounded plants and covered with sterile absorbent cotton moistened with sterile distilled water. Both wounded and non-wounded plants were inoculated with 0.5 ml of conidial suspension (1 × 10⁶ conidia ml^-1) dropped onto sterile absorbent cotton covering the stems. Control assays were performed with agar plugs and sterile distilled water only. Inoculated plants were placed in a greenhouse with a 12-h photoperiod at 28°C. Each treatment was replicated on five plants, and the test was repeated. Twenty-five days after inoculation, both wounded and non-wounded plants inoculated with either method showed raised cankers at the points of inoculation and canker lesions similar to those observed in the field expanded up and down the stems to reach lengths of 15 to 30 mm. Later, sparse, small, black pycnidia formed on the surface of the lesions. The inoculated plants exhibited stunting and premature senescence compared to controls. P. longicolla was re-isolated from the infected stems of inoculated plants. Control plants were asymptomatic. To our knowledge, this is the first report of P. longicolla causing stem canker in eggplant in Guangdong, China. Considering the economic importance of eggplant in Guangdong Province and throughout the world, further study of phomopsis stem canker of eggplant is warranted. References: (1) T. W. Hobbs et al. Mycologia 77:535, 1985. (2) A. W. Zhang et al. Plant Dis. 81:1143, 1997.

Emergency endovascular stent-grafting for acute type B aortic dissection with symptomatic malperfusion

AIM

The aim of this paper was to analyze the durability and efficacy of emergency thoracic endovascular aortic repair (TEVAR) for acute Stanford type B aortic dissection (TBAD) with malperfusion syndrome.

METHODS

A retrospective analysis of acute TBAD with spinal cord, kidney, viscera, and extremity malperfusion was performed. Emergency TEVAR to cover primary tear site by stent-graft was strongly suggested to included candidates. Computed tomography (CT) scans and clinical findings were carried out in diagnosis and follow-up.

RESULTS

One hundred twenty-seven TBAD patients (101 men, 46.1±11.4 year, range 34~76) who presented with acute end-organ malperfusion, including sudden paraplegia (N.=4), acute renal failure (N.=26), acute viscera ischemia (N.=61) and limb ischemia (N.=36), received aortic stent-grafting 2~48 hours after onset. Technical success was achieved in all primary TEVAR. The overall endoleak rate was 7.1% (9/127; typeI:3; typeII: 4; typeIV: 2). The 30-day mortality was 0.8% (2/127). 125 patients were followed for 19.1±14.5 (1~86) months, one patient died 50 days post-TEVAR due to myocardial infarction. Four patients required reintervention with additional stent grafts. Follow-up CT angiography showed enlargement of the true lumen and different degrees of thrombosis in the distal false lumen (complete thrombosis in 48, partial thrombosis in 52 and patency in 24).

CONCLUSION

Emergency TEVAR is an effective method to treat acute TBAD complicated with end-organ malperfusion. Covering of the proximal entry site of TBAD by stent-graft leads to flow increased in the true lumen and thrombosis of the false lumen of varying degree, which may improve end-organ perfusion and restore branch vessels patency.

High-dose preoperative fractionated radiotherapy does not affect the patency and healing of ePTFE vascular prosthesis after replacement of canine abdominal aorta and inferior vena cava

BACKGROUND

Fractionated radiotherapy allows for the safe administration of larger doses without the development of immediate or late toxicity. The influence of preoperative fractionated radiotherapy on neointima formation for expanded polytetrafluoroethylene (ePTFE) graft has not been determined.

METHODS

Twenty mongrel dogs were randomly divided into radiotherapy group (a total dose of 35 Gy) or control group (no radiation). The infrarenal abdominal aorta and inferior vena cava were replaced by ePTFE grafts at 3 months after irradiation in the radiotherapy group. Grafts were explanted at 4 weeks after surgery. Histopathological techniques were undertaken to evaluate graft neointima formation. The control group was managed the same as the radiotherapy group except for not receiving irradiation.

RESULTS

Four grafts implanted into inferior vena cava in the irradiated group and three in the control group were found to be completely occluded. None of the grafts implanted into abdominal aorta were obstructed. In the case of the inferior vena cava graft, the thickness of the graft neointima did not differ significantly between the irradiated and control groups. However, for the abdominal aorta graft, the neointima thickness in the irradiated groups was significantly thinner than that in the control group.

CONCLUSION

Preoperative fractionated radiotherapy affects vascular healing via suppressing the development of neointima formation in the abdominal aorta graft.

Polymorphism H558R in the Human Cardiac Sodium Channel SCN5A Gene is Associated with Atrial Fibrillation

Atrial fibrillation (AF) is one of the most common sustained cardiac arrhythmias and its prevalence is increasing worldwide in line with the growing elderly population. Many single nucleotide polymorphisms and mutations are associated with AF, including the common loss-of-function histidine-558-to-arginine (H558R) polymorphism of the human cardiac sodium channel, voltage-gated, type V, α subunit (encoded by the SCN5A gene). The H558R polymorphism results from the T-C transition in the SCN5A gene. This study recruited 135 patients with AF and 296 healthy controls to scan for and perform targeted genotyping of the H558R polymorphism of the SCN5A gene. Logistic regression analysis showed that the TC and CC genotypes (i.e. genotypes that result in the R558 polymorphism) were significantly associated with an increased risk of developing AF. The R558 polymorphism conferred an odds ratio for AF of 3.451 (95% confidence interval 1.718, 6.931). In conclusion, this study provided evidence for the role of the H558R polymorphism of the SCN5A gene in increasing the susceptibility to AF.

A review of SA aneurysms with a small subsection on aneurysms arising from a splenomesenteric trunk

SA aneurysm (SAA) accounts for up to 50% to 75% of all visceral artery aneurysms associated with a high mortality rate of 25% in case of aneurysm rupture. It is the third most common intra-abdominal aneurysm following those of the aorta and the iliac arteries. The incidence of SAA varies from 0.1 to 10.4% in the general population. It has anatomic variations in about 10% of the population, 1% of which emerging from the superior mesenteric artery. Accordingly, SAA arising from a spleno-mesenteric trunk is very rare. To our best knowledge, there are only a few cases reported in the literature up to date. This is a review of literature and reported cases with anomalous SAAs arising from a spleno-mesenteric trunk, which had been diagnosed by ultrasound (US), computed tomography angiography (CTA), digital subtraction angiography (DSA), and managed by open surgery.