Study on the mechanism of multidimensional cutting teeth and the influencing factors of rock breaking efficiency

The innovative cutting mechanism of multi-dimensional teeth presents a groundbreaking approach to drill bit design, particularly optimizing drilling efficiency in challenging geological formations such as interlayers and gravel-rich layers within the Changqing Oilfield. Nevertheless, compared to conventional flat-tooth PDC drill bits, several aspects of the cutting mechanism and design parameters for multi-dimensional teeth require further elucidation. This article employs a linear cutting finite element model to establish cutting models for traditional flat teeth and two distinct types of multi-dimensional teeth, designated as Ridge and Benz. It systematically investigates the influence of varying cutting parameters on the effectiveness of rock-crushing within the multi-dimensional tooth-cutting mechanism. This study conducts laboratory-based single-tooth rock-crushing experiments to validate the numerical simulation results. Furthermore, applying principles derived from soil plastic mechanics contrasts the stress states experienced by rocks during the rock-crushing process between multi-dimensional teeth and conventional flat teeth, shedding light on the rock-crushing mechanism employed by multi-dimensional teeth. This research categorizes PDC cutting teeth on the drill bit into two groups: those near the center and those near the outer shoulder. A linear cutting model for teeth positioned near the outer shoulder is developed to analyze the impacts of different rake angles, side clearance angles, and welding errors on the tooth helix angle and the rock-crushing efficiency of the Benz tooth. This comprehensive study is a valuable reference for tailored drill bit design and holds potential for publication in a prestigious scientific journal.

Desmoglein-2 Affects Vascular Function in Moyamoya Disease by Interacting with MMP-9 and Influencing PI3K Signaling

The pathogenesis and development of Moyamoya disease are still unclear. This study aimed to investigate the effect of desmoglein-2 (DSG2) on Moyamoya disease and determine the inhibitory effect of DSG2 in vascular remodeling in Moyamoya disease.RNA sequencing, immunohistochemistry (IHC), and western blotting were used to detect the expression of DSG2 in the superficial temporal artery (STA) tissues of Moyamoya disease. The association between DSG2 and endothelial cells' biological activities was investigated by cell counting kit-8 (CCK-8), migration assay, tube formation assay, flow cytometry with Annexin V-FITC/PI staining, and TUNEL apoptotic cell detection kit. Pathways affected by overexpression or knockdown of DSG2 were identified in endothelial cells.The expression of DSG2 in the STA tissues of Moyamoya disease was lower than that in normal controls. Overexpression of DSG2 inhibits the proliferation and migration but promotes apoptosis in endothelial cells, and low DSG2 levels result in impaired angiogenesis. In addition, there was an interaction between DSG2 and MMP-9, and DSG2 acted through the PI3K signaling in endothelial cells.Our results indicate that DSG2 affects PI3K signaling in vascular endothelial cells, and MMP-9 is involved in DSG2-mediated vascular changes in Moyamoya disease.

Classify patients with Moyamoya disease according to their cognitive performance might be helpful in clinical and practical with support vector machine based on hypergraph

Moyamoya disease (MMD) patients were now classified according to their cerebrovascular manifestations, with cognition and emotion ignored, which attenuated the therapy. The present study tried to classify them based on their cognitive and emotional performance and explored the neural basis underlying this classification using resting-state fMRI (rs-fMRI). Thirty-nine MMD patients were recruited, assessed mental function and MRI scanned. We adopted hierarchical analysis of their mental performance for new subtypes. Next, a three-step analysis, with each step consisting of 10 random cross validation, was conducted for robust brain regions in classifying the three subtypes of patients in a support vector machine (SVM) model with hypergraph of rs-fMRI. We found three new subtypes including high depression-high anxiety-low cognition (HE-LC, 50%), low depression-low anxiety-high cognition (LE-HC, 14%), and low depression-low anxiety-low cognition (LE-LC, 36%), and no hemorrhagic MMD patients fell into the LE-HC group. The temporal and the bilateral superior frontal cortex, and so forth were included in all 10 randomized SVM modeling. The classification accuracy of the final three-way classification model was 67.5% in average of 10 random cross validation. In addition, the S value between the frontal cortex and the angular cortex was positively correlated with the anxiety score and backward digit span (p < .05). Our results might provide a new perspective for MMD classification concerning patients' mental status, guide timely surgery and suggest angular cortex, and so forth should be protected in surgery for cognitive consideration.

[Exploration and practice of process assessment in Human Parasitology teaching for international medical students]

Teaching evaluation is an important measure to test the teaching quality. In order to better achieve the training objectives among international medical students based on the specific conditions of foreign students and the characteristics of Human Parasitology, a process-based assessment and evaluation system has been established for international medical students. The process assessment highlights the characteristics of assessment process, diversified forms and inquires of test questions. Following implementation of process assessment, the proportion of excellence (examination scores of 90 and higher) improved from 3.25% (10/308) to 13.09% (50/382) (t = 5.995, P < 0.001) and the proportion of good marks (examination scores of 80 to 89) increased from 18.83% (58/308) to 36.13% (138/382) (t = 7.505, P < 0.001) during the semester assessment among international medical students at five grades, while the proportion of failure in examination pass (examination scores of below 60) reduced from 12.34% (38/308) to 3.24% (10/382) (t = 7.303, P < 0.000 1), indicating that the process-based assessment and evaluation system improves the examination score of Human Parasitology among international medical students and the teaching quality of Human Parasitology.

[Correlation analysis of smell and taste loss with COVID-19 outbreak trend based on big data of internet]

Objective: To analyze the correlation between loss of smell/taste and the number of real confirmed cases of coronavirus disease 2019 (COVID-19) worldwide based on Google Trends data, and to explore the guiding role of smell/taste loss for the COVID-19 prevention and control. Methods: "Loss of smell" and "loss of taste" related keywords were searched in the Google Trends platform, the data were obtained from Jan. 1 2019 to Jul. 11 2021. The daily and newly confirmed COVID-19 case number were collected from World Health Organization (WHO) since Dec. 30 2019. All data were statistically analyzed by SPSS 23.0 software. The correlation was finally tested by Spearman correlation analysis. Results: A total of data from 80 weeks were collected. The retrospective analysis was performed on the new trend of COVID-19 confirmed cases in a total of 186 292 441 cases worldwide. Since the epidemic of COVID-19 was recorded on the WHO website, the relative searches related to loss of smell/taste in the Google Trends platform had been increasing globally. The global relative search volumes of "loss of smell" and "loss of taste" on Google Trends was 10.23±2.58 and 16.33±2.47 before the record of epidemic while 80.25±39.81 and 80.45±40.04 after (t value was 8.67, 14.43, respectively, both P<0.001). In the United States and India, the relative searches for "loss of smell" and "loss of taste" after the record of epidemic were also much higher than before (all P<0.001). The correlation coefficients between the trend of weekly new COVID-19 cases and the Google Trends of "loss of smell" in the global, United States, and India was 0.53, 0.76, and 0.82 respectively (all P<0.001), the correlation coefficients with Google Trends of "loss of taste" was 0.54, 0.78, and 0.82 respectively (all P<0.001). The lowest and highest point of loss of smell/taste search curves of Google Trends in different periods appeared 7 to 14 days earlier than that of the weekly newly COVID-19 confirmed cases curves, respectively. Conclusions: There is a significant positive correlation between the number of newly confirmed cases of COVID-19 worldwide and the amount of keywords, such as "loss of smell" and "loss of taste", retrieved in Google Trends. The trend of big data based on Google Trends might predict the outbreak trend of COVID-19 in advance.

Correlation Between Apelin and Collateral Circulation in Patients with Middle Cerebral Artery Occlusion and Moyamoya Disease

Background and Objectives

Moyamoya disease (MMD) is a unique cerebrovascular occlusive disease with abnormal vascular hyperplasia, which causes cerebrovascular accidents like intracranial arteriosclerosis. This study aimed to explore whether plasma apelin levels are related to good collateral circulation in ischemic diseases, which may be higher in patients with MMD than middle cerebral artery (MCA) occlusion or healthy controls, and may have a connection with the MMD grades.

Methods

We recruited 68 MMD patients and 25 MCA occlusion patients diagnosed by angiography, including 29 patients without cerebrovascular problems as controls. We examined the plasma apelin, serum nitric oxide (NO), and vascular endothelial growth factor (VEGF) levels of all subjects by ELISA kit. We compared the relationship between apelin, NO, and VEGF in the blood of three groups, to explore the relationship. We also investigated whether the plasma apelin-13, apelin-17, and apelin-36 levels correlate with the MMD classification.

Results

Univariate analyses indicated that the MMD group had the higher plasma apelin-13, apelin-17, apelin-36, and serum NO levels than the MCA occlusion and healthy control groups. Binary logistic regression analyses further showed that the apelin-13 level was substantially higher in MMD patients than in MCA occlusion patients. Patients with MMD were significantly younger than patients with MCA occlusion by their mean ages. Linear regression analyses were performed to compare apelin levels between different grades of the patients with MMD. Apelin-13, apelin-17, and apelin-36 levels increased with the gradual increase of compensation grades level independent of NO and VEGF. Apelin-13 and apelin-36 showed a positive effect on the compensation scores in MMD.

Conclusion

Our study demonstrated that apelin-13 was significantly increased in patients with MMD than patients with MCA occlusion independent of NO and VEGF. Moreover, plasma apelin-13, apelin-17, and apelin-36 levels increase with the grades of MMD.

Surgical revascularization vs. conservative treatment for adult hemorrhagic moyamoya disease: analysis of rebleeding in 322 consecutive patients

Whether surgical revascularization can prevent recurrent hemorrhage in hemorrhagic moyamoya disease (HMD) patients remains a matter of debate. This study mainly aims at the comparison of treatment effect between surgical revascularization and conservative treatment of adult HMD patients. We retrospectively enrolled 322 adult HMD patients, including 133 in revascularization group and 189 in conservative group. The revascularization group included patients who underwent combined (n = 97) or indirect revascularization alone (n = 36). Ninety-two and forty-one patients underwent unilateral and bilateral revascularization respectively. The modified Rankin scale (mRS) was used to assess the functional status. The comparison was made based on initial treatment paradigm among two categories: (1) revascularization vs. conservative, (2) unilateral vs. bilateral revascularization. The rebleeding rate was significantly lower in revascularization group than that in conservative group (14.3% vs. 27.0%, P = 0.007). As for the functional outcomes, the average mRS was significantly better in revascularization group (1.7 ± 1.5) than that in conservative group (2.8 ± 1.9) (P < 0.001). The death rate in revascularization group was 8.3% (11/133), comparing to 20.1% (38/189) in conservative group (P = 0.004). While comparing between unilateral and bilateral revascularization within the revascularization group, the result demonstrated lower annual rebleeding rate in bilateral group (0.5%/side-year) than that in unilateral group (3.3%/side-year) (P = 0.001). This study proved the better treatment efficacy of surgical revascularization than that of conservative treatment in HMD patients, regarding both in rebleeding rate and mortality rate. Furthermore, bilateral revascularization seems more effective in preventing rebleeding than unilateral revascularization.

Non-Coding RNAs in Glioma Microenvironment and Angiogenesis

Glioma, especially glioblastoma, is the most common and lethal brain tumor. In line with the complicated vascularization processes and the strong intratumoral heterogeneity, tumor-associated blood vessels in glioma are regulated by multiple types of cells through a variety of molecular mechanisms. Components of the tumor microenvironment, including tumor cells and tumor-associated stromata, produce various types of molecular mediators to regulate glioma angiogenesis. As critical regulatory molecules, non-coding RNAs (ncRNAs) inside cells or secreted to the tumor microenvironment play essential roles in glioma angiogenesis. In this review, we briefly summarize recent studies about the production, delivery, and functions of ncRNAs in the tumor microenvironment, as well as the molecular mechanisms underlying the regulation of angiogenesis by ncRNAs. We also discuss the ncRNA-based therapeutic strategies in the anti-angiogenic therapy for glioma treatment.

Plasma metabolite changes in anestrous dairy cows with negative energy balance identified using 1H NMR technology

ABSTRACT The objective of the present study was to investigate the different plasma metabolites between anestrus and estrus postpartum dairy cows and to provide a theoretical basis for prevention of anestrus in dairy farm cows. In the experiment, one hundred and sixty-seven Holstein dairy cows were selected with similar age and parity. According to the concentration of β-hydroxybutyric acid, non-esterified fatty acids and glucose in plasma during 14 to 21 days in milk, all dairy cows were determined as having a status of energy balance. According to the results of clinical symptom, rectal and B ultrasound examination at 60 to 90 days postpartum, these cows were divided into twenty estrus and twenty-four anestrus group, other dairy cows were removed. 1H nuclear magnetic resonance technology was utilized to detect the plasma metabolites changes and screen different plasma metabolites between anestrus and estrus cows. Ten different metabolites including alanine, glutamic acid, asparagine, creatine, choline, phosphocholine, glycerophosphocholine, low-density lipoprotein, and very-low-density lipoprotein were significantly decreased in anestrous cows compared with estrous cows. Metabolic pathway analyses indicated that differential metabolites were primarily involved in amino acid and glycerophospholipid metabolism. These metabolites and their enrichment pathways indicate that reduced steroid hormone synthesis precursors result in lower levels of estradiol and progesterone and cause anestrus in negative energy balance. These data provide a better understanding of the changes that may affect estrus of postpartum dairy cows at NEB status and lay the ground for further research.

Identification of hepatosensitive region and their neural connections in the hippocampus of rats

BACKGROUND

Visceral function localization of the brain is very complex. For many years, people have been actively exploring the neural mechanism regulating visceral and substance metabolism, clarifying the complex relationship between the brain and peripheral nervous system related to the regulation of visceral activity, and analyzing its complex neural pathways. The brain is the advanced center of visceral function regulation. As an advanced center for substance metabolism and visceral regulation, the hippocampus is crucial for regulating visceral function. The liver is the core organ of material metabolism, and its afferent signals are mainly projected to the Nucleus of the solitary tract(NTS) through vagus nerve, and then they are projected to the hypothalamus and limbic system.

MATERIALS AND METHODS

We placed a stereotaxic instrument on the head of each rat and performed craniotomy to open a window above the left hippocampus. We used gold-plated tungsten electrodes to monitor hippocampal neuronal discharges. Grounding was achieved using screws and silver wire. We electrically stimulated the liver branch of the vagus nerve and observed changes in hippocampal neuron discharges using a biological method; in this way, we identified hepatosensitive hippocampal region. We injected FluoroGold into this region and related brain areas. After 3 days, the rats were sacrificed and perfused; the hippocampi were fixed, dehydated, frozen, sectioned, and subjected to fluorescence microscopy.

RESULTS

Nerve discharge frequency and amplitude significantly increased in the hippocampal CA3 region (AP: -4.9, ML: -5.1, DV: -5.0 mm). After FluoroGold was injected into the left hepatosensitive region in the hippocampus, labeled cells were found in the contralateral hippocampus, ipsilateral piriform cortex (PC), locus coeruleus (LC) and bilateral lateral hypothalamus (LHA); fluorescence in the ipsilateral hypothalamus was stronger than that of the contralateral hypothalamus. FluoroGold was injected into the LHA, PC, and LC; no labeled cells were found in the hippocampal CA3 region or in the control group.

CONCLUSIONS

The hippocampal CA3 area of rats may contain a hepatosensitive region that plays important roles in the regulation of liver and other organ function. These region may receive input from the LHA, PC, and LC.

Plasma metabolic differences in cows affected by inactive ovaries or normal ovarian function post partum

Anestrus is essential to an unsuccessful pregnancy in dairy cows. One of the many factors that influences anestrus is the inactive ovary. To characterize in detail the plasma metabolic pro- file, anestrus cows suffering from inactive ovaries were compared with those with natural estrus. The Holstein cows 60 to 90 day postpartum in an intensive dairy farm were assigned into inactive ovaries groups (IO, n=20) and natural estrus group (CON, n=22) according to estrus signs and rectal palpation of ovaries. Plasma samples from two groups of cows were collected from the tail vein to screen differential metabolites using gas chromatography/mass spectrometry (GC/MS) techniques and multivariate statistical analysis and pathways. The results showed that 106 compounds were screened by GC/MS and 14 compounds in the IO group were decreased by analyzing important variables in the projection values and p values of MSA.Through pathway analysis, 14 compounds, mainly associated with carbohydrate metabolism and amino acid meta- bolism, were identified to results in IO, which may seriously affect follicular growth. Metabolo- mics profiling, together with MSA and pathway analysis, showed that follicular growth and development in dairy cows is related to carbohydrate and amino acid metabolism by a single or multiple pathway(s).

Subclinical ketosis risk prediction in dairy cows based on prepartum metabolic indices

ABSTRACT Ketosis can seriously impair cow performance. This study detected changes in prepartum blood metabolic parameters for predicting postpartum ketosis occurrence in dairy cows. Body condition score (BCS) was assessed before and after delivery. Blood samples of 63 cows were collected from 10 days before calving to 10 days after calving to measure metabolic parameters including β-hydroxybutyric acid (BHBA), non-esterified fatty acid (NEFA), glucose (GLU), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), total protein (TP), albumin (ALB), globulin (GLO), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). There was a postpartum subclinical ketosis incidence of 42.25%. Compared with prepartum, plasma, levels of BHBA, AST, and NEFA significantly increased postpartum, and prepartum AST (R=0.57) and NEFA (R=0.45) showed a significant positive correlation with ketosis postpartum. Plasma GLU level significantly decreased postpartum and was significantly negatively correlated with ketosis (R=-0.21). Receiver operating characteristic curve analysis revealed prepartum BSC < 2.88, and prepartum plasma AST > 68.0 U/L, GLU < 3.97mmol/L, NEFA > 0.27mmol/L, and BHBA > 0.43mmol/L, indicating a high risk of subclinical ketosis postpartum. These levels can be used as risk indicators to predict the occurrence of subclinical ketosis in postpartum cows.

Can safe and radical resection of all types of parasagittal meningiomas be achievable? -the introduction of a simplified surgical strategy

Background: Surgery of parasagittal meningiomas (PSMs) is still technically challenging, for the balance between radical resection and preservation of venous circulation. In this article, we'd systemically introduce the technical nuances of a simplified strategy for radical resection of all types of PSMs. All the cases were operated by one single neurosurgeon from a single institution.Methods: Clinical charts of patients with PSMs between 2014 and 2020were retrospectively reviewed. A simplified classification method was adopted, which was based on the relationship between the tumor and superior sagittal sinus (SSS). Surgery aiming at radical resection and venous flow preservation was performed. Only in case of total occlusion of SSS, we performed tumor resection without reconstruction of the venous sinus.Results: Clinical data obtained in 55 consecutive patients (47 primary and 8 recurrent cases) were analyzed, among which 20 were with patent sinus, 27 were with partially occluded sinus and 8 were with completely occluded sinus. Forty-two (76.4%) and 13 patients (23.6%) had the same and improved functional status as compared to that of pre-operation, respectively. Four patients (7.3%) experienced transient neurological deterioration but improved to the normal level in the long-term follow-up. All patients achieved Simpson I/II radical resection. No patients suffered from post-operative recurrence in the follow-up duration of 27.05 ± 19.55 (2-91) months.Conclusion: Radical and safe resection of all types of PSMs is achievable and not difficult if the simplified surgical strategy mentioned in the article is adopted, no matter to which extent the sinus is invaded.

Individualized Perioperative Blood Pressure Management for Adult Moyamoya Disease: Experience from 186 Consecutive Procedures

BACKGROUND

In adult patients with moyamoya disease (MMD) underwent combined revascularization, cerebral infarction during the acute postoperative phase is common and can lead to neurological dysfunction after revascularization in MMD patients. The aim of this study was to share the experience of individualized perioperative blood pressure (BP) management for adult MMD patients in one single center.

METHODS

We retrospectively reviewed 144 adult patients with MMD who underwent 186 procedures of combined revascularization at our institution from March 2013 to July 2019. Clinical features and outcomes were analyzed, in particular regarding cerebral infarction and hyperperfusion syndrome (HPS). All of the patients received individualized management perioperatively, especially about the blood pressure management according to the characteristics of moyamoya disease.

RESULTS

Postoperative cerebral infarction and HPS within 14 days after revascularization were recorded. Cerebral infarction occurred in four (2.1%) procedures among four patients. No patients suffered from a malignant cerebral infarction and only one patient had permanent neurological deficits. The incidence of HPS was 10.8% and no one presented with intracranial hemorrhage. All of the symptoms were reversible without any brain parenchymal injury.

CONCLUSIONS

Our findings suggest that we can decrease the incidence and extent of cerebral infarction in adult MMD patients following combined revascularization by individualized perioperative BP management.

Relationship between cardiovascular risk factors and coronary calcification in a middle-aged Dutch population: the Imalife study

Background

Systematic COronary Risk Evaluation (SCORE) has been proposed to assess the 10-year risk of fatal cardiovascular diseases, with distinction between low-risk and high-risk countries. Risk modifiers are recommended to further improve risk reclassification, for example the coronary artery calcium (CAC) score. CAC scoring can significantly improve risk prediction for coronary events based on outcome studies. The impact of CAC scoring on risk classification in a middle-aged cohort from a low-risk country in comparison to SCORE is unknown.

Purpose

To assess presence of coronary calcification and association with cardiovascular risk factors and related SCORE risk in a middle-aged population from a low risk country.

Methods

Coronary calcification and classical cardiovascular risk factors were analyzed in 4,083 Dutch participants aged 45–60 years (57.9% women) without a known history of coronary artery disease in the population-based ImaLife (Imaging in Lifelines) study. Individuals underwent non-contrast cardiac CT using third generation dual-source CT. Coronary artery calcium (CAC) scores were quantified using Agatston's method. Age- and sex- specific distributions of CAC categories (0, 1–99, 100–299, ≥300) and percentiles were assessed. Distribution of CAC categories was compared to SCORE risk categories (&lt;1%, ≥1% to 5%, and ≥5%) for low risk countries. Relationship between risk factors and CAC presence was evaluated by logistic regression models. Population attributable fractions (PAFs) of classical risk factors for CAC presence were estimated to investigate potential prevention strategy.

Results

CAC was present in 54.5% of men and in 26.5% of women. With increasing age, an increasing percentage had a positive CAC score, from 38.1% of men and 15.2% of women at age 45–49 years, to 66.9% of men and 36.6% of women at age 55–60. Mean SCORE was 1.3% (2.0% in men, 0.7% in women). In SCORE risk &lt;1%, 32.7% of men and 17.1% of women had CAC. In men with SCORE risk ≥5% (0.1% of women), 26.9% had no CAC. Overall PAF for presence of CAC of the classical risk factors was 18.5% in men and 31.4% in women. PAF was highest for hypertension (in men 8.0%, 95% CI 4.2–11.8%; in women 13.1%, 95% CI 7.9–18.2%) followed by hypercholesterolemia and obesity.

Conclusion

In this middle-aged Dutch cohort, slightly over half of men and a quarter of women had any CAC. With age there was an increase in CAC presence for both sexes. Only a minor proportion of CAC presence was attributable to classical risk factors. This provides further support that CAC scoring can impact risk classification in a middle-aged population of a low-risk country.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The ImaLife study is supported by an institutional research grant from Siemens Healthineers and by the Ministry of Economic Affairs and Climate Policy by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships.

Calcium scores distribution across coronary artery by age and sex: the ImaLife study

Background

The distribution of coronary artery calcium (CAC) across the coronary system increases the ability to predict coronary events compared to traditional CAC scoring alone. Reference values for regional distribution of CAC by age and sex are not yet available for a general European population.

Purpose

To investigate the distribution of CAC across the coronary arteries by age and sex in the population-based ImaLife study.

Methods

ImaLife is part of Lifelines, a multi-generational, prospective cohort study with over 167,000 participants from the northern Netherlands. From 2017–2019, 5,531 participants aged 45–84 years underwent non-contrast cardiac CT using third-generation dual-source CT. Total and vessel-specific CAC scores (Agatston's method) were acquired semi-automatically using dedicated software. Participants with a positive CAC score were classified into three groups: total CAC score 1–100, 101–300 and &gt;300. The diffusivity index (equation: 1 – [highest one-vessel CAC/total CAC]) was calculated. The diffusivity index is an expression of the relative distribution of CAC across the coronary arteries. Data were analyzed for the whole population and by sex and age groups. Mann-Whitney U test was used to analyze the diffusity index in men and women. Kruskal-Wallis H tests were performed to test the diffusivity index in different age groups.

Results

In total 2,376 men (mean age 56.4±7.7 years) and 3,155 women (mean age 56.0±7.5 years) were analyzed. In participants with CAC, 1, 2, 3 or 4 vessels were affected in 523 (22.0%), 560 (17.7%), 371 (15.6%) and 257 (8.1%) of men, respectively, and in 385 (16.2%), 175 (5.5%), 185 (7.8%) and 81 (2.6%) of women, respectively (P&lt;0.001). The number of 1, 2, 3 or 4 vessels affected were significantly different by age (p&lt;0.001). In age category 45–49 years, CAC in 1, 2, 3, and 4 vessels was present in 60.1%, 21.6%, 15.5%, and 2.9%, respectively; for age 74+ years, these percentages were 19.3%, 19.3%, 31.1% and 30.3%, respectively. The number of affected vessels were significantly different in different CAC categories (p&lt;0.001), see Figure. More vessels were affected in higher CAC categories. The median diffusivity index was higher in men than in women (0.10 (IQR: 0–0.36) vs 0 (IQR: 0–0.24), p&lt;0.001) and increased by increasing age. For age categories of 45–49, 50–54, 55–59,60–64, 65–69, 70–74, and &gt;74 years, diffusivity indexs were 0 (IQR: 0–0.12), 0 (IQR: 0–0.22), 0.02 (IQR: 0–0.28), 0.10 (IQR: 0–0.35), 0.16 (IQR: 0–0.42), 0.20 (IQR: 0–0.44), and 0.28 (IQR: 0.03–0.45) (p&lt;0.001).

Conclusions

In this Dutch population-based study, male participants had higher prevalence of CAC with higher number of involved vessels, and a higher diffusivity index compared to women. For both sexes, involved vessels and diffusivity index increased with age. The reference values of this regional distribution of CAC in a European population can assist in risk categorization of cardiovascular events.

The CAC distribution in ImaLife

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Siemens Healthineers

[Histopathological and genetical diagnosis of one case of neonatal ectodermal dysplasia/skin fragility syndrome]

On August 6, 2015, a male infant with ectodermal dysplasia/skin fragility syndrome at 6 hours of birth was admitted to the Burn Department of Tongren Hospital of Wuhan University & Wuhan Third Hospital. The ulcerous skin tissue in thoracic area was harvested. The histopathological change of wound tissue was observed with hematoxylin-eosin staining. The result showed that the epidermal muscle cell layer was slightly released, there were bullae under the epidermis, the dermal papilla layer disappeared, and a small amount of inflammatory cells infiltrated in the dermis. The expression of plakophilin 1 (PKP1) in wound tissue was observed with immunohistochemical staining. The result showed that the PKP1 expression was completely absent. The PKP1 gene mutation site was identified by target sequencing. The result showed that the PKP1 gene had a homozygous mutation at intron (PKP1: c.203-1G>A). Most of the wounds of the pediatric patient healed after 35 days of treatment, with many scattered residual wounds visible, and new blisters and skin lesions continue to appear.

Activated inducible co-stimulator-positive programmed cell death 1-positive follicular helper T cells indicate disease activity and severity in ulcerative colitis patients

Inducible co-stimulator-positive (ICOS) and programmed cell death 1-positive (PD-1) are important markers for follicular helper T cells (Tfh); however, their roles and clinical values in ulcerative colitis (UC) remain unknown. In this study, we recruited 68 UC patients and 34 healthy controls. Circulating ICOS⁺ , PD-1⁺ and ICOS⁺ PD-1⁺ Tfh subsets were analyzed by flow cytometry. Twelve active UC patients achieving remission after treatment with 5-aminosalicylic acid were followed-up and Tfh subset changes were analyzed. Serum immunoglobulin (Ig)G, C-reactive protein (CRP), interleukin (IL)-4 and IL-21 levels and B cell subsets were analyzed and Mayo scores were calculated. Correlation analyses were performed between Tfh subsets and the clinical indicators. Receiver operating characteristic (ROC) curves were generated to evaluate the efficiency of Tfh subsets for disease monitoring. We found that levels of ICOS⁺ , PD-1⁺ and ICOS⁺ PD-1⁺ Tfh cells were significantly increased in active UC and significantly decreased when achieving clinical remission. Activated ICOS⁺ PD-1⁺ Tfh cells were positively correlated with serum CRP and Mayo scores. Furthermore, ICOS⁺ PD-1⁺ Tfh cells were significantly correlated with circulating new memory B cells and plasmablasts, as well as serum IgG, IL-4 and IL-21. ROC analyses showed that when ICOS⁺ PD-1⁺ Tfh cells were used in combination with PD-1⁺ Tfh cells, the diagnostic efficacy in distinguishing active UC from stable remission patients was higher than that of any one used alone, with area under curve (AUC) value 0·931. Our findings suggest that increased ICOS⁺ PD-1⁺ Tfh cells are associated with the activation of B cells in the pathogenesis of UC, and may be a potential biomarker for UC disease monitoring.

Variations in submicron aerosol liquid water content and the contribution of chemical components during heavy aerosol pollution episodes in winter in Beijing

The aerosol liquid water content (ALWC) of submicron particles (PM₁) was calculated in this work by three methods based on the aerosol physical and chemical properties measurement campaigns in winter in Beijing, including (a) the PM₁ volume difference between the ambient and dry states by applying the particle number size distribution and particle hygroscopicity measurement; (b) the thermodynamic equilibrium model (ISORROPIA II) based on the chemical composition; and (c) the κ-Köhler theory of chemical composition with a volume mixing scheme. The three methods agreed well with reasonable uncertainties. The ALWC showed an exponential trend depending on the relative humidity (RH), and an abundant ALWC was also favored by the high PM₁ mass loading. The contribution of different chemical component to the ALWC was evaluated by the κ-Köhler method, which revealed that during the measurement, the inorganics and organics could contribute to ~80% and ~20%, respectively, under ambient RH conditions, with the largest contributor of ammonium nitrate. When the RH was above 85%, the mass concentration of ALWC was comparable to, or even larger than, that of the dry PM₁.

P5309Age and gender distributions of coronary artery calcium in the Dutch adult population: preliminary results of the ImaLife study

Background

Coronary artery calcium (CAC) scoring is a promising tool for cardiovascular risk classification. Population-based reference values are important for the clinical interpretation of CAC scores.

Purpose

To establish standards of CAC distributions by age and gender in an unselected Dutch population, which can be used to determine reference values.

Methods

ImaLife (Imaging in Lifelines) is a computed tomography (CT) based substudy of the Lifelines cohort, with a primary aim to establish reference values of imaging biomarkers for early stages of coronary artery disease in adults (above 45 years old). In total, 12,000 participants will be enrolled from an unselected adult population in the northern Netherlands for CAC scoring with third generation dual-source CT. CAC is quantified with dedicated commercial software using the Agatston method.

Results

Included so far were 3,702 participants (57.5% females, mean age 54 years, range 45–82 years). CAC was present in 39.2% of participants, with a higher prevalence of CAC in men (55.3%) than in women (27.3%). CAC scores increased with increasing age in both genders. The percentiles of CAC scores by age and gender groups are summarized in the table.

Agatston CAC score percentiles by age and gender Percentiles Women – Age, years Men – Age, years 45–49 50–54 55–59 60–64 65∼ 45–49 50–54 55–59 60–64 65∼ N 505 634 719 260 10 355 473 543 185 18 25th 0 0 0 0 0 0 0 0 1 75 50th 0 0 0 0 4 0 1 6 22 556 75th 0 0 6 33 386 6 21 72 129 751 90th 4 26 77 120 1037 49 154 242 500 1803

Conclusion

This preliminary result presents CAC distribution by age and gender in a middle-aged unselected Dutch population. Compared with the Heinz Nixdorf Recall study, CAC scores in our cohort for both genders were lower in the 5-year age groups between 45 and 64 years. Based on the overall data, expected within 2 years, reference values of CAC for the Dutch population can be established.

P1555Agreement of coronary calcium scoring on chest CT and ECG triggered cardiac CT: a population-based study

Background

Low-dose chest computed tomography (CT) is increasingly used in lung cancer screening. The heart is inherently visualized on chest CT. Coronary artery calcium (CAC) identified on chest scans has predictive value for risk of cardiovascular disease. There is discussion whether non-ECG-triggered chest CT is reliable for CAC scoring.

Purpose

To investigate the agreement between chest CT and ECG-triggered cardiac CT in CAC identification and risk classification.

Methods

We included 1000 ImaLife participants who underwent a cardiac scan immediately followed by a non-ECG triggered chest scan. Third-generation dual-source CT and dedicated software were used for scan acquisition and CAC measurement. Chest scans were analyzed after cardiac scans with an interval of at least a month and in a different order. To ensure a comparable prevalence of CAC with previous studies and adequate samples in CAC strata, after the inclusion of the 500th consecutive participants with zero CAC, only participants with >0 CAC based on dedicated cardiac CT were included. CAC scores were divided into four risk strata: 0, 1–99, 100–399, 400. Kappa was used to assess agreement in CAC identification (0 versus >0) and risk classification.

Results

The mean age was 54 years (range 45–77), 42.5% were women, average body mass index (BMI) was 26.1kg/m2. Compared with dedicated cardiac CT, non-ECG triggered chest CT had an accuracy of 0.97, sensitivity of 0.96 and specificity of 0.99 for identifying CAC, and agreement between scans was very high (kappa 0.95) for CAC presence. In terms of CAC risk strata, chest CT had a very high agreement with cardiac CT (kappa 0.95). Total misclassification rate of CAC strata was 6.5%, with most misclassified cases shifting one risk category downward (55/65, 85%). BMI of discordant pairs was significantly higher than concordant pairs, while no difference in heart rate was found.

Conclusion

Non-ECG triggered chest CT may be reliably used for CAC identification and risk classification since chest CT has very high agreement with dedicated cardiac CT results.

[Clinical research on the expression of three vascular regulatory factors in different morphological regions of Marjolin ulcer and their relationship with angiogenesis]

Objective: To investigate the expressions of vascular endothelial growth factor (VEGF), hypoxia inducible factor-1 alpha (HIF-1α), and epidermal growth factor receptor (EGFR) in different morphological regions of Marjolin ulcer and their clinical relationship with angiogenesis. Methods: From January 2012 to December 2017, the patients admitted to our hospital who met the inclusion criteria were selected, including 92 patients with Marjolin ulcer [56 males and 36 females, aged (55±15) years], 100 patients with chronic non-cancerous skin ulcer [59 males and 41 females, aged (51±16) years], and 100 patients performed with other skin-related surgery [58 males and 42 females, aged (52±15) years], and they were enrolled into Marjolin ulcer group (MU), chronic non-cancerous ulcer group (CNU), and other skin surgery group (OSS) respectively. The etiology, pathogenic site, ulcer diameter, and course of patients in group MU were retrospectively analyzed. Ulcer tissue specimens from patients of group MU and group CNU and specimens of normal skin tissue attached to the tissue resected during operation from patients of group OSS were collected. The expressions of VEGF, HIF-1α, EGFR, and CD34 in the above-mentioned tissue and the surrounding normal skin, ulcer, epitheliomatous hyperplasia, and canceration areas in Marjolin ulcer tissue were detected by immunohistochemical method, and the positive expression rate and protein expression level were calculated. Data were processed with Pearson chi-square test, Mann-Whitney U test, Bonferroni method, and Bonferroni correction, and Spearman correlation analysis was used to analyze the relationship among the total protein expression levels. Results: In group MU, burns accounted for 91.3% (84/92) of the causes of patients, 44.6% (41/92) of the patients had tumors in the lower extremities, 62.0% (57/92) of the patients had skin ulcer diameter of 2.1-5.0 cm, and 75.0% (69/92) of the patients had a course of disease of more than 20 years. The positive rates of VEGF, HIF-1α, and EGFR in ulcer tissue of patients in group CNU were 41.0% (41/100), 77.0% (77/100), and 83.0% (83/100), respectively, significantly higher than those of normal skin tissue of patients in group OSS [12.0% (12/100), 45.0% (45/100), and 67.0% (67/100), χ(2)=21.589, 21.522, 6.827, P<0.01]. The positive rates of VEGF, HIF-1α, and EGFR in ulcer tissue of patients in group MU were 91.3% (84/92), 100.0% (92/92), and 100.0% (92/92), respectively, which were significantly higher than those in corresponding tissue of patients in group CNU and group OSS (χ(2)=53.372, 24.772, 17.159; 120.543, 72.777, 36.661, P<0.01). In ulcer tissue of patients in group MU, the positive expression rates of VEGF in ulcer, epitheliomatous hyperplasia, and canceration areas were significantly higher than the rate in surrounding normal skin area (χ(2)=87.120, 42.368, 89.624, P<0.01); the positive expression rates of VEGF in canceration and ulcer areas were significantly higher than the rate in epitheliomatous hyperplasia area (χ(2)=22.586, 16.060, P<0.01). In ulcer tissue of patients in group MU, the positive expression rates of EGFR in ulcer, epitheliomatous hyperplasia, and canceration areas were significantly higher than the rate in surrounding normal skin area (χ(2)=21.679, 27.600, 27.600, P<0.01), but the positive expression rates of HIF-1α in four morphological areas were similar (χ(2)=3.008, P>0.05). In ulcer tissue of patients in group MU, the protein expression levels of VEGF and CD34 in ulcer, epitheliomatous hyperplasia, and canceration areas were significantly higher than those in surrounding normal skin area (Z=-6.765, -6.819; -6.765, -6.640; -6.765, -6.819, P<0.01), the protein expression levels of VEGF and CD34 in epitheliomatous hyperplasia area were significantly lower than those in ulcer area (Z=-4.484, -5.266, P<0.01), and the protein expression levels of VEGF and CD34 in canceration area were significantly higher than those in ulcer area (Z=-6.427, -6.723, P<0.01) and epitheliomatous hyperplasia area (Z=-6.427, -6.462, P<0.01). In ulcer tissue of patients in group MU, the protein expression levels of HIF-1α and EGFR in ulcer, epitheliomatous hyperplasia, and canceration areas were significantly higher than those in surrounding normal skin area (Z=-6.819, -6.393; -6.819, -6.393; -6.819, -6.393, P<0.01), the protein expression levels of HIF-1α and EGFR in ulcer area were significantly lower than those in epitheliomatous hyperplasia and canceration areas (Z=-6.118, -5.638; -6.640, -6.393, P<0.01), and the protein expression levels of HIF-1α and EGFR in canceration area were significantly higher than those in epitheliomatous hyperplasia area (Z=-6.558, -6.819, P<0.01). In ulcer tissue of patients in group MU, the total protein expression levels of VEGF, HIF-1α, and EGFR were significantly positively correlated with the total protein expression level of CD34 (r=0.772, 0.415, 0.502, P<0.01) respectively; the total protein expression level of EGFR was significantly positively correlated with that of HIF-1α (r=0.839, P<0.01), both of which were significantly positively correlated with the total protein expression level of VEGF (r=0.531, 0.440, P<0.01) respectively. Conclusions: The expressions of VEGF, HIF-1α, and EGFR are the highest in Marjolin ulcer canceration area, and EGFR may promote angiogenesis through HIF-1α or directly increasing the expression of VEGF.

Retractorless Surgery for Giant Vestibular Schwannomas via the Retrosigmoid Approach

BACKGROUND

A fixed retractor is routinely used during surgery for vestibular schwannoma to maintain the surgical corridor; however, brain injuries can be caused by use of retractors. The aim of this study was to present strategies for retractorless surgery for giant vestibular schwannomas and compare retractorless surgery with traditional retractor-assisted surgery to illustrate feasibility and potentially superiority of retractorless surgery.

METHODS

Clinical data of 61 patients with giant (≥4 cm diameter) vestibular schwannomas undergoing craniotomy were retrospectively analyzed. Patients were divided into 2 cohorts: 1) 35 patients with traditional retractor surgery performed between June 2016 and July 2017; 2) 26 patients with retractorless surgery performed between June 2016 and July 2018. Duration of operation, intraoperative blood loss, extent of resection, rate of retention of facial nerve function, postoperative brain injury rate, intracranial infection rate, hospitalization time, and grade of facial nerve function were compared between the 2 groups.

RESULTS

The incidence of postoperative brain injury was 3.84% in the retractorless surgery group, which was significantly lower compared with the traditional retractor surgery group (22.86%) (P < 0.05). No significant differences were found regarding the other characteristics compared.

CONCLUSIONS

Through appropriate comprehensive measures, retractorless surgery for giant vestibular schwannomas is an achievable goal. This procedure can reduce the incidence of postoperative brain injury with satisfactory tumor resection.

Aβ1-42 increases the expression of neural KATP subunits Kir6.2/SUR1 via the NF-κB, p38 MAPK and PKC signal pathways in rat primary cholinergic neurons

ATP-sensitive potassium channels (KATP) may mediate a potential neuroprotective role in Alzheimer's disease (AD). Given that exposure to Aβ1-42 in cultured primary cholinergic neurons for 72 h significantly upregulates the expression of KATP subunits Kir6.2/SUR1, we aim to study the underlying signal transduction mechanisms that are involved in Aβ_1-42-induced upregulation of KATP subunits Kir6.2/SUR1. In the present study, we first identified the primary cultured rat cortical and hippocampal neurons using immunocytochemistry. 0.5 μM NF-κB inhibitor SN-50, 2 μM p38MAPK inhibitor SB203580 or 2 μM PKC inhibitor Chelerythrine chloride (CTC) were then added in three separate groups, followed by 2 μM Aβ_1-42 30 min later in all 3 groups. Western Blot was performed 72 h later to detect the expression of KATP subunits Kir6.2/SUR1. We found that Aβ_1-42 significantly increased the level of KATP subunits Kir6.2/SUR1 expression at 72 h when compared with the control group ( p < 0.05). However, when compared with the Aβ_1-42 group, the level of KATP subunits Kir6.2/SUR1 expression at 72 h significantly decreased in the SN50 + Aβ_1-42 group, SB203580 + Aβ_1-42 group, and the CTC + Aβ_1-42 group ( p < 0.05). Our findings suggest that the NF-κB, p38 MAPK, and PKC signal pathways are partially involved in the upregulation of KATP subunits Kir6.2/SUR1 expression induced by Aβ_1-42 cytotoxicity in neurons, which supports a potential theoretical basis of targeting these signal pathways in the treatment of AD.

Three-Dimensional Computed Tomography Angiography Assisted Resection of Ventral Foramen Magnum and Jugular Foramen Tumours via Modified Far Lateral Suboccipital Approach

Objective: The anatomical relationship of ventral foramen magnum and jugular foramen tumour is complex and the operation is very difficult. The aim of this study was to summarize the microsurgical experience of the removal of the ventral foramen magnum and jugular foramen tumours via the modified far lateral suboccipital approach assisted by three-dimensional computed tomography angiography (3D-CTA). Methods: The clinical data and follow-up results of 13 cases of 3D-CTA assisted suboccipital far lateral approach from July 2011 to September 2017 were analyzed retrospectively. There were 5 males and 8 females. Preoperative CT and MRI were used for routine imaging diagnosis, and the 3D-CTA simulated surgical approach was performed. The preoperative operation scheme was established, and the risk of operation was evaluated according simulated operation. After individualized exposure, the modified far lateral suboccipital approach was completed under the neuroelectrophysiological monitoring technique. Results: The preoperative images were completely consistent with the findings in the surgery. There were 9 cases of jugular foramen tumour and 4 cases of ventral foramen magnum tumour. Of the 13 cases, only 1 case of jugular glomus tumour had extra-cranial residual, while the whole intracranial tumour was removed. In other 12 cases, the tumours were completely removed under the microscope. After operation, the headache disappeared, and hearing loss was improved. There was no perioperative deaths, infection and cerebrospinal fluid leakage. The facial paralysis was occurred in 1 patient. After 3–39 months of follow-up, there was no recurrence of tumour, or new nerve function defect. Hoarseness, choking of drinking water and numbness of limbs were all improved at the end of the follow-up period. The symptoms of postoperative facial paralysis were also improved during the follow-up period. Conclusion: After the preoperative simulation and evaluation by 3D-CTA, the ventral foramen magnum and jugular foramen tumours can be rescted safely and effectively via far modified lateral suboccipital approach.

[Correlation between syrinx resolution after posterior fossa decompression and cervical sagittal profile change in adolescents with Chiari malformation and syringomyelia]

Objective: To evaluate the long term change of the cervical sagittal profile in adolescent Chiari malformation type Ⅰ (CMI)/syringomyelia undergoing posterior fossa decompression (PFD) and to further evaluate the correlation between the syrinx resolution and cervical sagittal profile. Methods: A retrospective radiographic study was performed in 32 adolescents undergoing PFD for CMI/syringomyelia from October 2011 to August 2015 with a minimum 2-year follow-up. There were 23 males and 9 females, with a mean age of (13.7±2.8) years (range, 10-16 years). The following parameters including upper cervical angle (C(0)-C(2)), lower cervical angle (C(2)-C(7)), sagittal balance (C(2)-C(7)SVA), cervical curvature index (CCI), syrinx size and length were compared preoperatively and at the last follow-up. The correlation of syrinx resolution and cervical sagittal parameters were further analyzed with Pearson correlation analysis. Results: All patients received a followed-up for 2.0-6.5 years [mean (3.9±1.1) years]. The lower cervical angle and CCI were-29.8°±11.4° and 29.1%±7.1% at the last follow-up, respectively, which were significantly higher than those before surgery (-15.2°±8.8°, 13.4%±4.2%)(t=2.917, 2.902, both P<0.05). The syrinx size and length were also obviously decreased at the last follow-up. No significant difference was found in the upper cervical angle and C(2)-C(7)SVA before operation and at the last follow-up (t=0.302, 0.871, both P>0.05). There were significantly positive correlations between the differences of syrinx width and the lower cervical angle, and the CCI before and after surgery (r=0.611, 0.652, both P<0.05). Significantly positive correlations were also observed between the differences of syrinx length and the lower cervical angle, and the CCI before and after surgery (r=0.504, 0.514, both P<0.05). Conclusions: The cervical lordosis can be restored after PFD in adolescents with CMI/syringomyelia. The resolution of syrinx may play an important role in restoring the cervical sagittal alignment.

[Clinical application of a self-developed bone dust collector in mastoid cavity obliteration following mastoidectomy]

Objective: To introduce a self-developed bone dust collector designed by the authors and evaluate its efficiency in mastoid obliteration following mastoidectomy. Methods: Consecutive patients, from April 2017 to March 2018, who prepared to receive mastoidectomy were randomly divided into two groups, and in each group the bone dust was harvested by self-developed bone dust collector or by conventional used method respectively in mastoidectomy. The amount of the harvested bone dust and the time consumed in the collecting procedure were compared between two groups. The infection of the bone dust after mastoid obliteration was also evaluated during follow up. Results: 33 patients were recruited in bone dust collector group, and 31 patients in conventional method group.There is no significance of difference between two groups in sex ratio, age and pneumatization of mastoid cells (P>0.05 for all). The median amount of bone dust harvested by bone dust collector was significantly larger than that collected by conventional method (1.8 g vs 1.1 g, P<0.05). The median time spent in bone dust collector group was significantly shorter than that spent in conventional method group (4 minutes vs 6 minutes, P<0.05). No bone dust infection was found in the follow-up in all patients. Conclusion: The present self-developed bone dust collector is a easy and useful apparatus which can significantly improve the efficiency of collecting bone dust in mastoidectomy.

A high-energy-density lithium-oxygen battery based on a reversible four-electron conversion to lithium oxide

Lithium-oxygen (Li-O2) batteries have attracted much attention owing to the high theoretical energy density afforded by the two-electron reduction of O2 to lithium peroxide (Li2O2). We report an inorganic-electrolyte Li-O2 cell that cycles at an elevated temperature via highly reversible four-electron redox to form crystalline lithium oxide (Li2O). It relies on a bifunctional metal oxide host that catalyzes O–O bond cleavage on discharge, yielding a high capacity of 11 milliampere-hours per square centimeter, and O2 evolution on charge with very low overpotential. Online mass spectrometry and chemical quantification confirm that oxidation of Li2O involves transfer of exactly 4 e–/O2. This work shows that Li-O2 electrochemistry is not intrinsically limited once problems of electrolyte, superoxide, and cathode host are overcome and that coulombic efficiency close to 100% can be achieved.

Kaposiform haemangioendothelioma: clinical features, complications and risk factors for Kasabach-Merritt phenomenon

BACKGROUND

Few studies have reported the clinical features, complications and predictors of Kasabach-Merritt phenomenon (KMP) associated with Kaposiform haemangioendothelioma (KHE).

OBJECTIVES

To determine the clinical characteristics present at diagnosis and to identify features that may aid clinicians in managing KHE.

METHODS

We conducted a cohort study of 146 patients diagnosed with KHE.

RESULTS

KHE precursors or lesions were present at birth in 52·1% of patients. In 91·8% of patients, lesions developed within the first year of life. The median age at diagnosis of KHE was 2·3 months (interquartile range 1·0-6·0). The extremities were the dominant location, representing 50·7% of all KHEs. Among KHEs in the cohort, 63·0% were mixed lesions (cutaneous lesions with deep infiltration). Approximately 70% of patients showed KMP. A KHE diagnosis was delayed by ≥ 1 month in 65·7% of patients with KMP. Patients with KMP were more likely to have major complications than patients without KMP (P = 0·023). Young age (< 6 months), trunk location, large lesion size (> 5·0 cm) and mixed lesion type were associated with KMP in a univariate analysis. In the multivariate analysis, only age [odds ratio (OR) 11·9, 95% confidence interval (CI) 4·07-34·8; P < 0·001], large lesion size (OR 5·08, 95% CI 2·24-11·5; P < 0·001) and mixed lesion type (OR 2·96, 95% CI 1·23-7·13; P = 0·016) were associated with KMP.

CONCLUSIONS

Most KHEs appeared before 12 months of age. KHEs are associated with various major complications, which can occur in combination and develop early in the disease process. Young age, large lesion size and mixed lesion type are important predictors of KMP.

Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013

Background

The burden of cancer in China is high, and it is expected to further increase. Information on cancers attributable to potentially modifiable risk factors is essential in planning preventive measures against cancer. We estimated the number and proportion of cancer deaths and cases attributable to ever-smoking, second-hand smoking, alcohol drinking, low fruit/vegetable intake, excess body weight, physical inactivity, and infections in China, using contemporary data from nationally representative surveys and cancer registries.

Methods

The number of cancer deaths and cases in 2013 were obtained from the National Central Cancer Registry of China and data on most exposures were obtained from the China National Nutrition and Health Survey 2002 or 2006 and Global Adult Tobacco Smoking 2010. We used a bootstrap simulation method to calculate the number and proportion of cancer deaths and cases attributable to risk factors and their corresponding 95% confidence intervals (CIs), allowing for uncertainty in data.

Results

Approximately 718 000 (95% CI 702 100-732 200) cancer deaths in men and 283 100 (278 800-288 800) cancer deaths in women were attributable to the studied risk factors, accounting for 52% of all cancer deaths in men and 35% in women. The numbers for incident cancer cases were 952 500 (95% CI 934 200-971 400) in men and 442 700 (437 200-447 900) in women, accounting for 47% of all incident cases in men and 28% in women. The greatest proportions of cancer deaths attributable to risk factors were for smoking (26%), HBV infection (12%), and low fruit/vegetable intake (7%) in men and HBV infection (7%), low fruit/vegetable intake (6%), and second-hand smoking (5%) in women.

Conclusions

Effective public health interventions to eliminate or reduce exposure from these risk factors, notably tobacco control and vaccinations against carcinogenic infections, can have considerable impact on reducing the cancer burden in China.

First-in-human phase I study of copanlisib (BAY 80-6946), an intravenous pan-class I phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors and non-Hodgkin's lymphomas

BACKGROUND

To evaluate the safety, tolerability, pharmacokinetics, and maximum tolerated dose (MTD) of copanlisib, a phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors or non-Hodgkin's lymphoma (NHL).

PATIENTS AND METHODS

Phase I dose-escalation study including patients with advanced solid tumors or NHL, and a cohort of patients with type 2 diabetes mellitus. Patients received three weekly intravenous infusions of copanlisib per 28-day cycle over the dose range 0.1-1.2 mg/kg. Plasma copanlisib levels were analyzed for pharmacokinetics. Biomarker analysis included PIK3CA, KRAS, BRAF, and PTEN mutational status and PTEN immunohistochemistry. Whole-body [(18)F]-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) was carried out at baseline and following the first dose to assess early pharmacodynamic effects. Plasma glucose and insulin levels were evaluated serially.

RESULTS

Fifty-seven patients received treatment. The MTD was 0.8 mg/kg copanlisib. The most frequent treatment-related adverse events were nausea and transient hyperglycemia. Copanlisib exposure was dose-proportional with no accumulation; peak exposure positively correlated with transient hyperglycemia post-infusion. Sixteen of 20 patients treated at the MTD had reduced (18)FDG-PET uptake; 7 (33%) had a reduction >25%. One patient achieved a complete response (CR; endometrial carcinoma exhibiting both PIK3CA and PTEN mutations and complete PTEN loss) and two had a partial response (PR; both metastatic breast cancer). Among the nine NHL patients, all six with follicular lymphoma (FL) responded (one CR and five PRs) and one patient with diffuse large B-cell lymphoma had a PR by investigator assessment; two patients with FL who achieved CR (per post hoc independent radiologic review) were on treatment >3 years.

CONCLUSION

Copanlisib, dosed intermittently on days 1, 8, and 15 of a 28-day cycle, was well tolerated and the MTD was determined to be 0.8 mg/kg. Copanlisib exhibited dose-proportional pharmacokinetics and promising anti-tumor activity, particularly in patients with NHL.

CLINICALTRIALSGOV

NCT00962611; https://clinicaltrials.gov/ct2/show/NCT00962611.

Deep insemination with sex-sorted Cashmere goat sperm processed in the presence of antioxidants

Flow cytometrically sex-sorted sperm have been widely used for improving reproductive management in the dairy industry. However, the industrial application of this technology in other domestic species is largely limited by the lower fertility after insemination. The aim of this study was to investigate effects of antioxidant supplementation during the sex-sorting and freezing process on the quality and functions of sorted sperm from Liaoning Cashmere goats. We tested the effects of antioxidant supplementation during sex-sorting and freezing process, including ascorbic acid-2-glucoside AA-2G, glutathione, melatonin and vitamin C (VC), on the quality and functions of sex-sorted fresh and frozen-thawed sperm. Based on these experiments, we performed deep insemination with sex-sorted sperm using our improved strategy, in comparison to unsorted sperm. In Experiment 1, compared with control group and other antioxidants, AA-2G supplementation significantly alleviated the degradation of motility and viability of fresh sperm after sorting and showed the highest percentage of sperm with normal morphology. In addition, AA-2G supplementation showed an evident protection against the sorting process-induced membrane and acrosome damage. In Experiment 2, AA-2G supplementation was most effective in protecting motility, while melatonin supplementation appears to facilitate the degradation of quality of frozen-thawed sex-sorted sperm. In Experiment 3, we performed deep insemination with sperm that were sorted and frozen in the presence of AA-2G and obtained a satisfying pregnancy rate comparable to that from unsorted sperm. The results showed that AA-2G supplementation efficiently protects quality and function of both fresh and frozen-thawed sex-sorted sperm of Cashmere goats, thus obtaining a satisfying pregnancy outcome.

Association between single nucleotide polymorphisms in AKT1 and the risk of prostate cancer in the Chinese Han population

AKT1, also known as v-akt murine thymoma viral oncogene homolog 1, is involved in the regulation of cell-survival and anti-apoptotic activities, which may affect the pathogenesis of various cancers. However, the association between genetic variants of AKT1 and the risk of developing prostate cancer has not been investigated before. This study investigated the associations between three polymorphisms (rs1130214, rs3730358, and rs2494732) in AKT1 and the risk of development of prostate cancer in the Chinese Han population. Sequenom MassARRAY & iPLEX technology were used to genotype these polymorphisms in 493 Chinese Han patients with prostate cancer and 309 age-matched healthy individuals. Compared to the CC genotype of the rs3730358 polymorphism, the CT genotype of the same polymorphism was strongly associated with a decreased risk of prostate cancer (OR = 0.617, 95%CI = 0.390-0.976, P = 0.037). However, there was no significant difference between the allele frequency of the rs3730358 polymorphism and those of the other two polymorphisms (P > 0.05). Moreover, no significant difference was found in the haplotype analysis (P > 0.05). Our study found that the variant genotype CT of rs3730358 of AKT1 was associated with a decreased risk of prostate cancer, which suggested that this polymorphism could play an important role in the development of the disease.

Daratumumab: monoclonal antibody therapy to treat multiple myeloma

Daratumumab (Darzalex[TM]) is a human monoclonal antibody (MAb) that targets CD38; a surface protein highly expressed across multiple myeloma (MM) cells. Preclinical studies have shown daratumumab induces MM cell death through several mechanisms, including complement-dependent cytotoxicity (CDC) antibody-dependent cell-mediated cytotoxicity (ADCC), antibody-dependent cellular phagocytosis (ADCP), apoptosis upon secondary crosslinking and immunomodulatory effects via a decrease in immune suppressive cells. Daratumumab has a favorable toxicity profile and encouraging clinical activity as a single agent and in combination with lenalidomide in heavily pretreated, relapsed patients in whom other novel agents (such as bortezomib, thalidomide and lenalidomide) and stem cell transplant have already failed. Given the encouraging efficacy and acceptable safety profile, daratumumab has emerged as a novel treatment option for MM both as a monotherapy and in combination with conventional and novel anti-MM agents. This review will focus on preclinical pharmacology, pharmacokinetics, safety and clinical development of daratumumab in MM.

Abstract P3-10-04: Disparities in human epidermal growth factor receptor 2 testing completion: A population-based retrospective cohort study, 2010-2013

Introduction: Human epidermal growth factor receptor 2 (HER2) is an established biomarker predictive for response to HER2-targeted therapies. Testing breast cancer specimens for HER2 protein overexpression or gene amplification is the standard of care. Earlier work showed inconsistent delivery of HER2 testing to some patient groups. We sought to understand current imbalances in HER2 testing.

Methods: Our retrospective cohort analysis of Surveillance, Epidemiology and End Results Program data included women diagnosed with microscopically confirmed, first primary malignant breast cancer from 2010-2013. Women were categorized by race, stage, age, and whether they received HER2 testing. Those with unknown information in any of these variables were excluded. Descriptive analyses and multivariate logistic regression assessed the effect of these factors on the likelihood of not receiving HER2 testing.

Results: The full cohort included 182,032 women, of which 3,551 (2.0%) did not undergo testing for HER2 (Table 1). The portion of HER2 untested tumors was higher for African American women (2.3%) and other non-white women (2.2%), women over age 70 (2.3%) and women with Stage I (2.3%) or Stage IV disease (5.0%). Within the African American cohort similar patterns were seen: age &gt;70 (2.8%), Stage I (2.8%) and Stage IV (5.4%). The portion of women with untested tumors decreased from 2010 to 2013: 2.6% to 1.6% (p&lt;0.001) for the full cohort, and 2.9% to 1.9% (p&lt;0.001) for African Americans. On multivariate analysis, odds of not undergoing testing were highest for African American women (OR=1.27, p&lt;0.001), women of age &gt;70 (OR=1.26, p&lt;0.001), and women with Stage IV disease (OR=4.07, p&lt;0.001) (Table 2). Odds of not undergoing HER2 testing decreased over time (OR=0.60 for 2013 vs 2010, p&lt;0.001).

Conclusion: Persistent, and significant, disparities in completion of HER2 testing suggest that reasons for not testing extend beyond technical issues. While proportionally small, given the prevalence of breast cancer, addressing these disparities in HER2 testing may offer an opportunity to deliver life-prolonging, often well tolerated, therapy to significant numbers of patients. The improvements in delivery of HER2 testing seen over time are reassuring.

Table 1. Portion of women not having HER2 testing.  Full Cohort African Americans   N%p-valueN%p-valueN3,5512.0 4702.3 Race       White2,7081.9&lt;0.001    African American4702.3 4702.3  Other3732.2    Age at diagnosis       &lt;507081.7&lt;0.0011051.90.024 50-598921.9 1302.3  60-698941.9 1202.4  70+1,0572.3 1152.8 Stage       I2,0692.3&lt;0.0012232.8&lt;0.001 II7621.3 1111.4  III2211.0 441.4  IV4495.0 925.4 Year of diagnosis       20101,0662.6&lt;0.0011322.9&lt;0.001 20119432.1 1442.8  20128011.7 931.7  20137411.6 1011.9 

Table 2. Multivariate logistic regression for odds of not having HER2 testing.  OR*p-valueRace   Whiteref  African American1.27&lt;0.001 Other1.24&lt;0.001Age at diagnosis   &lt;50ref  50-591.080.128 60-691.010.795 70+1.26&lt;0.001Stage   Iref  II1.87&lt;0.001 III0.81&lt;0.001 IV4.07&lt;0.001Year of diagnosis   2010ref  20110.80&lt;0.001 20120.66&lt;0.001 20130.60&lt;0.001* Odds of group not being tested vs being tested, compared to the reference group and controlling for all other factors.

Citation Format: Schroeder MC, Neuner JM, Xia C, Thomas A. Disparities in human epidermal growth factor receptor 2 testing completion: A population-based retrospective cohort study, 2010-2013 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-04.

Reduction Levels and the Effects of High-Molecular-Weight Adiponectin via AMPK/eNOS in Chinese Type 2 Diabetes

Aim: This study was to investigate the change of high-molecula-weight (HMW) adiponectin (APN) isoform, the association between type 2 diabetes mellitus (T2DM) and HMW APN isoform, the variation of Disulfide-bond A oxidoreductase-like protein (DsbA-L), the effect of HMW APN isoform on AMP-dependent protein kinase (AMPK) and endothelial nitric oxide synthase (eNOS) in Chinese T2DM. Method: 169 patients aged at (48.7±9.4) years and 107 healthy control subjects aged at (42.6±7.8) years took part in this study. Anthropometric measures of the characters were assayed and different APN isoforms, DsbA-L, AMPK and eNOS levels were determined. Results: Ln(sRAGE) and Ln(Adiponectin) were significantly lower and significantly higher for the other characteristics in T2DM. Ln(Adiponectin) was negatively and significantly correlated with WHR, Ln(triglycerides), fasting plasma glucose, HbA1c (%) in control subjects and T2DM patients. Plasma and adipose tissue total APN and HMW APN were significantly reduced in newly diagnosed T2DM patients. DsbA-L was markedly down-regulated in diabetic adipose tissue. HMW APN caused significant decreases in AMPK and eNOS phosphorylation levels of human umbilical vein endothelial cells (HUVECs). Conclusions: Our results demonstrated that total APN levels was closely related to the risk of T2DM and HMW APN reduction was involved in the diabetic vascular AMPK/eNOS signal pathway. The findings will provide insight into novel therapeutic approaches for reducing the elevated cardiovascular risk associated with T2DM.

[Study on IGF-1 and IGFBP-3 gene expression in liver of young rats with intermittent hypoxia]

Objective:Using the model of young rats with intermittent hypoxia, to study the expression of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) in liver, and to provide objective evidence for the possible existence of growth retardation in children with OSAHS. Method:Divided 24 rats randomly into three groups, as control group and the mild and severe hypoxia group. Normally fed control group, without treatment, the other two groups were kept in the cabin has been simulated mild and severe intermittent hypoxia conditions of OSAHS in children. 8-hour day cycle of intermittent hypoxia, a total of 35 days. To the last day, animals were sacrificed and fresh liver tissues were fixed in liquid nitrogen, stored in the -80°C refrigerator, then took the molecular biology experiment of IGF-1 and IGFBP-3 in the liver. Result:The expression of IGF-1 mRNA in liver, semi-quantitative analysis showed that the difference of mRNA expression of IGF-1 among the three groups was statistically significant (P<0.05), pairwise comparison, mild hypoxia group was higher than control and severe group, there were significant differences (P<0.05), the control group and severe hypoxia had no significant difference (P>0.05). The expression of IGFBP-3 mRNA in liver showed that, differences between the three groups was not significant (P>0.05). IGF-1 expression in liver tissue analysis showed that, differences between the three groups was statistically significant (P<0.05), pairwise comparisons, its expression in the control group was lower than mild hypoxia group and severe group, there were significant differences (P<0.05), mild hypoxia and severe hypoxia group had no significant difference (P>0.05). IGFBP-3 expression in liver tissue analysis showed that, differences between the three groups was statistically significant (P<0.05), pairwise comparisons, the control group was higher than mild and severe hypoxic group, there were significant differences (P<0.05), mild hypoxia and severe hypoxia group had no significant difference (P>0.05). Conclusion:IGF-1 and IGFBP-3 in the liver of mild hypoxia group, severe hypoxic group and control group showed that their transcription levels and the severity of hypoxia had no significant correlation.