KCNH2A561V Heterozygous Mutation Inhibits KCNH2 Protein Expression via The Activation of UPR Mediated by ATF6

The potassium channel protein KCNH2 is encoded by KCNH2 gene, and there are more than 300 mutations of KCNH2. Unfolded protein response (UPR) is typically initiated in response to an accumulation of unfolded and/or misfolded proteins in the endoplasmic reticulum (ER). The present study aimed to explore the UPR process and the role of activating transcription factor 6 (ATF6) in the abnormal expression of potassium voltage-gated channel subfamily H member 2 (KCNH2)A561V. The wild-type (wt) KCNH2 and A561V mutant KCNH2 was constructed with his-tag. The 293 cells were used and divided into KCNH2wt+KCNH2A561V, KCNH2wt and KCNH2A561V groups. The expression levels of ATF6 and KCNH2 in different groups were detected by Western blotting, reverse transcription-quantitative PCR, immunofluorescence and immuno-coprecipitation assays. The protein types and abundance of immuno-coprecipitation samples were analyzed by mass spectrometry. The proteomic analysis of the mass spectrometry results was carried out by using the reactome database and GO (Gene Ontology) tool. The mRNA expression levels of KCNH2 and ATF6 in the KCNH2wt+KCNH2A561V group were higher compared with the KCNH2A561V group. However, the full-length protein expression of ATF6 was inhibited, indicating that ATF6 was highly activated and a substantial number of ATF6 was sheared in KCNH2wt+KCNH2A561V group compared with control group. Furthermore, A561V-KCNH2 mutation leading to the accumulation of the immature form of KCNH2 (135 kDa bands) in ER, resulting in the reduction of the ratio of 155 kDa/135 kDa. In addition, the abundance of UPR-related proteins in the KCNH2A561V group was higher compared with the KCNH2wt+KCNH2A561V group. The 'cysteine biosynthetic activity' of GO:0019344 process and the 'positive regulation of cytoplasmic translation activity' of GO:2000767 process in the KCNH2A561V group were higher compared with the KCNH2wt+KCNH2A561V group. Hence, co-expression of wild-type and A561V mutant KCNH2 in 293 cells activated the UPR process, which led to the inhibition of protein translation and synthesis, in turn inhibiting the expression of KCNH2. These results provided a theoretical basis for clinical treatment of Long QT syndrome.

[Diagnostic value of contrast-enhanced ultrasound in hepatic epithelioid hemangioendothelioma]

Objective: To investigate the features of contrast-enhanced ultrasound (CEUS) in hepatic epithelioid hemangioendothelioma (HEHE) in order to improve the preoperative diagnosis rate. Methods: CEUS images of 32 pathologically-proven cases of hepatic epithelioid hemangioendothelioma from January 2004 to August 2021 were collected. Lesions were analyzed to observe the features of enhancement mode, enhancement intensity, and distinct enhancement phases. Results: Among the 32 cases, one had a solitary lesion, 29 had multiple lesions, and two had diffuse-type lesions. Contrast-enhanced ultrasound revealed a total of 42 lesions in 32 cases. In terms of arterial phase enhancement, 18 lesions had overall enhancement, six lesions had uneven dendritic enhancement, 16 lesions had rim-like enhancement, and two lesions had just slight peripheral spot enhancement around the lesions. Among the three cases, there were multiple lesions that had overall enhancement and ring enhancement. In terms of the enhancement phase, 20 lesions showed "fast progression", 20 lesions showed "same progression", and two lesions showed "slow progression". During the late arterial or early portal venous phases with rapid washout, all lesions manifested as hypoechoic. With peaked enhanced intensity, 11 lesions had a lower enhancement intensity than the surrounding normal liver parenchyma; 11 lesions had the same enhancement degree as the surrounding normal liver parenchyma; and 20 lesions had a higher enhancement degree than the surrounding normal liver parenchyma. All 16 ring-enhancing lesions had marked hyperenhancement. In the typical enhancing lesions, four showed hyperenhancement, five showed low enhancement, and nine showed isoenhancement. In the dendrite-enhancing lesions, there were two isoenhancing and four hypoenhancing. Contrast-enhanced ultrasound delineated the boundaries of all lesions more clearly than two-dimensional ultrasound. Conclusion: Contrast-enhanced ultrasound has certain value in the diagnosis of hepatic epithelioid hemangioendothelioma.

[Analysis of the core knowledge level of chronic diseases in Chinese adults and related factors]

Objective: To understand the core knowledge level and influencing factors of chronic disease prevention and control in Adults in China, and to provide a scientific basis for formulating chronic disease prevention and control measures. Methods: In this study, cross-sectional survey and quota sampling were used to recruit 173 819 permanent residents aged 18 and above from 302 counties of adult chronic diseases and nutrition surveillance in China to conduct an online questionnaire survey, including basic information and core knowledge of chronic diseases. The scores of the core knowledge of chronic disease prevention and control were described by median and interquartile range, the Wilcoxon rank sum test or the Kruskal Wallis test was used for the inter-group comparison, and the correlation factors of the total score were analyzed by the multilinear regression model. Results: A total of 172 808 participants were surveyed in 302 counties and districts, of which 42.60%(73 623) were male and 57.40%(99 185) were female; The proportion of respondents aged 18-44, 45-59, and 60 years old and above was 54.74% (94 594), 30.91% (53 423) and 14.35% (24 791), respectively. The total score of the core knowledge of chronic prevention and control in the total population was 66(13), and the scores of different characteristic groups were different, and the differences were statistically significant: the eastern region had the highest score at 67(11) (H=840.66, P<0.01), the urban 66(12) was higher than the rural 65(14) (Z=-31.35, P<0.01), and the male 66(14) was lower than female 66(12) (Z=-11.66, P<0.01), 18-24 years old 64(13) was lower than other age groups(H=115.80, P<0.01), and undergraduate degree and above had the highest score compared to other academic qualifications, with 68(9) points(H=2 547.25, P<0.01). Multivariate analysis showed that eastern (t=27.42, P<0.01), central (t=17.33, P<0.01), urban (t=5.69, P<0.01), female (t=17.81, P<0.01), high age (t=46.04, P<0.01) and high education (t=57.77, P<0.01) had higher scores of core knowledge of chronic disease prevention and control than other groups, the scores of core knowledge of chronic disease prevention and control of professional and technical personnel (t=8.63, P<0.01), state enterprises and institutions (t=38.67, P<0.01), agriculture, forestry, animal husbandry, fishery and water conservancy production (t=5.30, P<0.01), production, transportation and commercial personnel (t=24.87, P<0.01), and other workers (t=8.89, P<0.01) were higher than those of non-employed people. Conclusion: There are differences in the total scores of the core knowledge of chronic disease prevention and control in different characteristics of people in China, and in the future, health education on the prevention and treatment of chronic diseases should be strengthened for specific groups to improve the knowledge level of residents.

[Progress in research of regional longevity level]

Regional longevity refers to a phenomenon of population age distribution in which longevity level in a certain area is significantly higher than the surrounding area at a certain point or period of time, and its longevity level is among the best in the whole country. In recent years, experts and scholars both at home and abroad have carried out multi studies of the influencing factors of individual longevity, but there are still relatively less studies to evaluate regional longevity level. This paper introduces the domestic and foreign evaluation research of regional longevity in terms of evaluation indicators and results, research scales and data sources, and proposes some advice for the future development. First, making full use of population death surveillance data to evaluate regional longevity level. Second, adopting multi-dimensional composite indexes to comprehensively, dynamically evaluate and accurately depict the regional longevity levels and its spatio-temporal change trend. Third, transforming regional longevity level evaluation to regional health and longevity level evaluation to promote healthy population aging.

[Analysis of changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention]

Objective: To analyze the changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention. Methods: From August to November 2014, a 3-month community-based self-management intervention study of type 2 diabetes patients was implemented in Fangshan District, Beijing. 510 patients were recruited through posters, household inquiries and telephone notification and then were randomly divided into intervention group (260 patients) and control group (250 patients). Finally, 500 patients completed the study, including 259 in the intervention group and 241 in the control group. Self-efficacy score was measured through face-to-face interview at different time points, including pre-intervention, post-intervention, 2 years after the intervention and 5 years after the intervention, respectively. A two-level random coefficient model was fitted to analyze the long-term trend of self-efficacy and its relationship with group intervention. Results: Individual-level educational attainment, disease duration as well as their treatment plans had a positive correlation with self-efficacy of type 2 diabetic patients while gender and age did not affect their self-efficacy. Patients with junior middle school education, senior high school education and university and above education had 4.66 (P<0.05), 6.40 (P<0.05) and 11.02 (P<0.05) points higher than those with primary education, respectively. The self-efficacy of diabetic patients increased by 0.23 (P<0.05) for each additional course year. The effect of treatment plan on self-efficacy was mainly reflected in the self-efficacy of taking medication or insulin injection as prescribed and blood glucose monitoring. After controlling for the confounding factors, i.e., gender, age, disease duration, educational attainment, and treatment plan, self-efficacy scores at the post-intervention increased in both groups compared to those at the pre-intervention. The intervention group had 7.95 points higher than the control group (P<0.05). After the intervention, the self-efficacy scores of both groups decreased year by year while the intervention group declined faster, with 5.41 points (P<0.05) at 2 years after the intervention and 8.94 points (P<0.05) at 5 years after the intervention. Conclusion: Community-based self-management group intervention could improve the self-efficacy of type 2 diabetic patients while the self-efficacy decreases year by year in the absence of follow-up intervention.

Neighboring sp-Hybridized Carbon Participated Molecular Oxygen Activation on the Interface of Sub-nanocluster CuO/Graphdiyne

Activation of O₂ is a crucial step in oxidation processes. Here, the concept of sp-hybridized C≡C triple bonds as an electron donor is adopted to develop highly active and stable catalysts for molecular oxygen activation. We demonstrate that the neighboring sp-hybridized C and Cu sites on the interface of the sub-nanocluster CuO/graphdiyne are the key structures to effectively modulate the O₂ activation process in the bridging adsorption mode. The as-prepared sub-nanocluster CuO/graphdiyne catalyst exhibited the highest CO oxidation activity and readily converted 50% CO at around 133 °C, which is 34 and 94 °C lower than that for CuO/graphene and CuO/active carbon catalysts, respectively. In situ diffused reflectance infrared Fourier transform spectroscopy and density functional theory calculation results proved that the neighboring sp-hybridized C is more favorable to promote the rapid dissociation of carbonate than sp²-hybridized C without overcoming any energy barrier. The gaseous CO directly reacts with the active molecular oxygen and tends to proceed through the E-R mechanism with a relatively low energy barrier (0.20 eV). This work revealed that sp-hybridized C of graphdiyne-based materials could effectively improve the O₂ activation efficiency, which could facilitate the low-temperature oxidation processes.

[Comprehensive treatment options and influencing factors in elderly patients with breast cancer]

Objective: To investigate the treatment options for breast cancer patients aged 65 and over, and analyze the influencing factors. Methods: The clinical data of 521 elderly patients aged 65 years or older,who underwent surgery in Peking Union Medical College Hospital from January 2009 to December 2015, were collected. They were all female and 65-98 years old. The patients were divided into 65-74 years old group (n=353) and ≥ 75 years old group (n=168). The differences of variables including age, functional status, treatment methods, pathological characteristics, comorbidities and survival time between the two groups were compared, and the differences of comprehensive treatment methods and their impact on clinical efficacy were analyzed. Results: The main operation methods of the two groups were modified radical mastectomy [39.1% (138/353) and 33.9% (57/168), respectively], breast conserving surgery [56.9% (201/353) and 61.3% (103/353), respectively]. Among the patients choosing adjuvant therapy, there was no significant difference between the two groups except chemotherapy (all P>0.05). Univariate analysis showed that the choice of chemotherapy was related to age, surgical methods, pathological types, tumor burden, molecular typing, functional status and comorbidities (all P<0.05). The Eastern Cooperative Oncology Group (ECOG) score and the number of comorbidities were independent factors affecting the choice of chemotherapy for breast cancer in the elderly: [ECOG score: adjusted OR=0.45 (95CI: 0.26-0.75), number of comorbidities: adjusted OR = 0.63 (95CI:0.41-0.98); all P<0.05]. The 5-year disease-free survival rate of 521 elderly patients with breast cancer was 86.3%, 5-year overall survival rate was 88.8%, and the breast cancer specific survival rate was 94.3%. Conclusions: The comprehensive treatment of breast cancer patients aged 65 and above is not affected by age, but is associated with tumor burden, pathological type, molecular typing, comorbidities and ECOG score. Among them, ECOG score and the number of comorbidities are the independent factors influencing the choice of adjuvant chemotherapy.

[Evaluation on the quality of 236 National Demonstration Areas for comprehensive prevention and control of chronic diseases betweem 2017 and 2019]

Objective: To evaluate the quality of the National Demonstration Area for Comprehensive Prevention and Control of NCDs (referred to as "the Demonstration Area"). Methods: Based on the evaluation scores of the Demonstration Area field survey from 2017 to 2019, we counted the scores of each indicator, comparing the scores among indicators and regions. x±s was used to describe the scores. The 95%CI of the score was used to test the statistical difference among regions. Each score was converted into a hundred-mark system to compare the scores among indicators. Results: Of 236 Demonstration Areas, the total score was 83.5. The scores of the first-level indicator listed from high to low appeared as Integrating System of NCD Prevention and Control (92.8), Policy Perfection (90.3), Building Supportive Environment for NCD Prevention and Control (88.4), Implementation of Health Education and Health Promotion (87.4), Whole-course Management of NCDs (78.1), Innovation and Guidance (76.5), Surveillance and Evaluation (75.1). Total scores were higher in the east (259.2±18.8) comparing to the middle (243.2±15.2) or the west (245.4±19.7) regions. Conclusions: Substantial variations on the quality in the Demonstration Area existed across different regions in China. These disparities are important to the government when developing health policies and allocating resources. Whole-course Management of NCDs, Surveillance and Evaluation, and Innovation and Guidance in the Demonstration Area also needs to be improved.

Identification of potential mechanosensitive ion channels involved in texture discrimination during Drosophila suzukii egg-laying behaviour

Drosophila suzukii (spotted wing drosophila) has become a major invasive insect pest of soft fruits in the America and Europe, causing severe yield losses every year. The female D. suzukii shows the oviposition preference for ripening or ripe fruit by cutting the hard skin with its serrated ovipositor. A recent study reported that mechanosensation is involved in the texture discrimination during egg-laying behaviour in D. suzukii. However, the underlying mechanism and molecular entity that control this behaviour are not known. The transient receptor potential (TRP) channels and degenerin/epithelial sodium channels (DEG/ENaC) are two candidate gene families of mechanically activated ion channels. Thus, we first identified TRP and DEG/ENaC genes in D. suzukii by bioinformatic analysis. Using transcriptome sequencing, we found that many TRP genes were expressed in the ovipositor in both D. suzukii and D. melanogaster, while some DEG/ENaCs showed species-specific expression patterns. Exposure to drugs targeting TRP and DEG/ENaC channels abolished the oviposition preference for harder texture in female D. suzukii. Therefore, mechanosensitive ion channels may play significant roles in the texture assessment of egg-laying behaviour in D. suzukii, which has promising implications to further research on the development of novel control measures.

[The design of interrupted time series and its analytic methods]

Interrupted time series (ITS) is a statistical method for the quasi-experimental design specific to the outcome of time series, in which the effectiveness of an intervening measure is evaluated by examining change in slope and immediate change in level. The key feature of ITS is that the secular trend of time series prior to the intervention can be effectively controlled so as to accurately estimate the intervention effect. The design principle and statistical method for ITS were illustrated by an example of evaluating halving policy for the expert registration fee in the general hospital of a city. The segmented linear regression was used to fit the above time series data and the results were explained in detail. Meanwhile, the study design and model fitting along with explanations of the results with respect to the effects of two types of successive interventions and on different time-points of an intervention were illustrated as well in this paper. The existed upward or downward trend should be taken into account in order to accurately estimate the intervention effect as it exists in most of the public health surveillance data. Two parameters, known as change in slope and immediate change in level, were employed to evaluate the effect of the intervention. The ITS analysis can be widely applied to the program evaluation as it could enrich methods of the evaluation compared to the traditional model of the program evaluation.

[The impact evaluation of a community-based intervention supporting type 2 diabetes mellitus patients in their self-management of the disease]

Objective: To evaluate the effect of a community-based intervention supporting type 2 diabetes mellitus patients in their self-management of the disease. Methods: This research was a randomized controlled trial conducted in communities in Fangshan District, Beijing, China. Adult patients with type 2 diabetes from 17 communities in 4 sub-district of Fangshan District were randomly assigned to either the intervention or control group. Participants in the intervention group participated in a three-month group-based diabetes self-management intervention service. Data were collected both in intervention and control group at baseline and after the intervention to evaluate the effect of the intervention. A questionnaire survey was completed by all participants to collect their demographic information, diabetes related health behaviors and skills. A physical examination and lab testing including height, weight, blood pressure, and waist circumference as well as HbA1c, fasting blood glucose, lipid profile were conducted before and after the intervention. Results: A total of 500 valid questionnaires were received, including 259 in the intervention group and 241 in the control group. Patients in the intervention group who learned how to conduct the self-monitoring of blood glucose increased from 56.76% (n=147) to 87.26% (n=226) after the intervention, higher than that of control group (63.07%, n=152) (P<0.001). 69.50% (n=180) patients in intervention group had blood glucose monitor at home, which was 60.62% (n=157) prior to the intervention and higher than that of control group (57.68%, n=139) (P=0.004). After the intervention, 3.09% (n=8) patients in intervention group ceased to take medicine by themselves, which was 16.22% (n=42) before the intervention, while the control group was 8.30% (n=20) after the intervention (P=0.009). Patients in the intervention group made significant improvements in implementing self monitoring on blood glucose (SMBG), which was increased from one day per week to 2 days per week, and foot self-examination, which increased from 2 days per week to 7 days per week. The body weight of patients in the intervention group reduced 1.62 kg on average after the intervention, while it increased 0.88 kg in the control group. Similar improvement was found in waist circumstance between the intervention and control group (-0.83 cm vs -0.16 m). There was a significant reduction on body weight and waist circumstance in the intervention group (P<0.05). Conclusion: The group activities focusing on people with type 2 diabetes resulted in improvement in their lifestyle and self management behaviors, as well as their body weight and waist circumstance.

[Trend on mortalities in all-cause and chronic non-communicable diseases among the labor force population in China, 2007-2016]

Objective: To analyze the trends on mortalities of all-cause and deaths caused by chronic and non-communicable diseases (NCDs) among Chinese labor force population during 2007 to 2016. Methods: Data on cause-of-death that collected from the National Mortality Surveillance System was used to analyze the age and area-related specific crude mortality rates, age-standardized mortality rates and component ratios of NCDs, among the Chinese labor force population, during 2007 to 2016. Trend of crude mortality rates and mortality component ratios of the three major diseases (infectious diseases, maternal and infant diseases, nutritional deficiency diseases; NCDs; injuries) were analyzed. Age-standardized mortality of cancer, COPD, cardiovascular and cerebrovascular diseases were also analyzed by gender. Age-standardized mortality was calculated based on the Year 2010 Population Census of China. Joinpoint regression model was used to obtain annual percentage change and 95%CI was set for assessing the trend. Results: In 2016, the age-standardized all-cause mortality rate was 217.23 per 100 000 among the Chinese labor force population, but decreased by -2.8% (95%CI: -3.8%- -1.7%) annually from 2007 to 2016. The gap between different gender and regions gradually narrowed. The proportion of deaths caused by NCDs increased annually by 0.8% (95%CI: 0.7%-0.9%). The age-standardized mortality rate of NCDs appeared as 171.89/100 000, among the Chinese labor force population in 2016, showing a downward trend by -2.4% (95%CI:-3.3% - -1.4%). However, in females, there appeared the greatest decrease, with an average annual change of -3.3% (95%CI:-4.0% - -2.5%). Diseases as cancer, COPD, cardiovascular and cerebrovascular diseases all showed downward trends in the whole country, with an average range of -2.0% (95%CI: -2.6%--1.3%), -8.0% (95%CI: -8.9% - -7.1%), -1.5% (95%CI: -2.9% - -0.1%), -2.3% (95%CI: -2.8% - -1.8%) in a ten-year period, respectively. Conclusion: All-cause and age-standardized mortality rates caused by NCDs among Chinese labor force population were decreasing during 2007 to 2016. However, the constituent ratios appeared increasing, year by year. Close attention needs to be paid on NCDs which affecting the health of the labor force population in China.

[Disease burden of diabetes attributable to high body mass index in China,1990-2016]

Objective: To analyze the burden of disease (BOD) on diabetes attributable to high BMI in China from 1990 to 2016. Methods: Data based on population of the 2016 Global Burden of Disease Study for China were used to analyze the attributable fractions (PAF) of BOD for diabetes attributable to high BMI. Measurements for attributable BOD of diabetes included disability adjusted life years (DALY), years of lost life (YLL), years living with disability (YLD), death number and mortality rate. The average world population from 2010 to 2035 was used as a reference. Results: In 2016, death number of diabetes attributable to high BMI was 40 310, which was significantly higher than that in 1990 (15 008). Age-standardized death rate of diabetes attributable to high BMI increased from 2.01/100 000 in 1990 to 2.60/100 000 in 2016, which showed a more significant increasing trend in both males and people aged 15-49 years. DALYs of diabetes attributable to high BMI increased from 1.09 million person years to 3.30 million person years. YLL and YLD also showed increasing trends. The highest increasing rate of YLD was in people aged 15-49 years. High BMI was responsible for 26.01% of the diabetes deaths in 2016 in China, an increase of 39.39% compared with that in 1990 (18.66%). Most provinces in China experienced a sharp increase of DALY of diabetes attributable to high BMI from 1990 to 2016. Inner Mongolia, Xinjiang, Zhejiang, Macao SAR, Sichuan and Qinghai had the most significant increase tendency in terms of DALY rate during this period. Conclusions: There was a rapid increase of the deaths and mortality rate of diabetes attributable to high BMI, causing a heavy disease burden, in China from 1990 to 2016. The BOD varied in both different age and gender groups. More attention should be paid to males and people aged 15-49 years in the prevention and control programs of diabetes.

Abstract P1-03-05: Long term survival and tumor biology of screen-detected small non-palpable breast cancer in Chinese women: The smaller, the better?

Background: Tumor biology would reflect the prognosis and potentially the lead time and over-diagnosis rate of screen-detected small breast cancer [PMID: 28591529, 21452022 and 24888816]. Chinese women had earlier peak age of breast cancer incidence and used ultrasound as the primary screening imaging test on a hospital-basis [2016 SABCS P5-02-05, PMID: 27689334]. In our previous work, we showed that US detected non-palpable breast cancer (NPBC) had higher percentage of invasive and lymph node positive cancer, yet still could be regarded as low-risk cancer [PMID:27689334, 28412736]. This study was performed to investigate the prognostic impact of immunohistochemical subtypes and tumor size: the smaller the NPBC, the better the tumor biology and prognosis?

Methods: From January 2001 to December 2017, 6,423 consecutive asymptomatic women underwent mammography (MG) or ultrasound (US) guided biopsy in Peking Union Medical College Hospital. Among them, 159 T1a, 239 T1b, 377 T1c and 72 T2 NPBC were diagnosed and treated. The clinicopathological features, treatment choice, 10-year disease-free survival (DFS) and overall survival (OS) of the small NPBC (defined as≤1.0cm, T1a+b) were reviewed and compared with T1c and T2 NPBC. Prognostic factors of these subgroups of invasive NPBC were identified.

Results: Compared to big NPBC, the T1a+b small NPBC showed more lymph node negative (p&lt;0.001) and low Ki67 (&lt;14%, p&lt;0.001) cancers with earlier TNM stage (p&lt;0.001), more luminal A subtype (p=0.003) and significantly improved 10-year DFS and OS (p=0.004). T1c+T2 NPBC had more triple-negative subtype and received more chemotherapy (p&lt;0.001) and targeted therapy (p=0.008). Breast conserving rate and the use of radiation and endocrine therapy showed no significant difference.

Table 1.Comparison of clinicopathological factors and long term survival of small vs big screen-detected NPBCScreen-detected NPBC(2001-2017    Clinical&prognostic factors T1a+T1b(n=398)T1c+T2(n=449)P valueScreening methodUS-NPBC(n,%)336(84.4)406(90.4)0.008 MG-NPBC(n,%)62(15.6)43(9.6) Lymph node statusNegative(n,%)343(86.2)315(70.2)&lt;0.001 Positive(n,%)55(13.8)134(29.8) TNM stageI(n,%)344(86.4)277(61.7)&lt;0.001 II(n,%)37(9.3)134(29.8)  III(n,%)17(4.3)38(8.5) Ki67&lt;14%(n,%)208(52.2)168(37.4)&lt;0.001 ≥14%(n,%)183(46.0)274(61.0) SubtypeLuminal A(n,%)164(41.3)135(30.1)0.003 Luminal B(n,%)155(38.9)218(48.6)  Her2(n,%)28(7.0)27(6.0)  TNBC(n,%)31(7.8)52(11.6)  Unknown(n,%)20(5.0)17(3.7) 10-year survivalDFS(%)94.688.80.004 OS(%)100.096.4 

Conclusion: Small asymptomatic NPBCs were detected when small because they were good in terms of low Ki67 index, favorable subtype, tumor biology and long term prognosis. On the contrary, T1c and T2 NPBCs were screened when already big or even with positive nodes without clinical symptoms indicating that they might have larger chance of becoming interval cancers.

Citation Format: Xu Y, Pan B, Yao R, Zhou Y-D, Mao F, Zhu Q-L, Wu H-W, Lin Y, Shen S-j, Sun Q. Long term survival and tumor biology of screen-detected small non-palpable breast cancer in Chinese women: The smaller, the better? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-05.

Abstract P2-14-30: Survival outcomes of breast conserving surgery versus mastectomy for ultrasound detected non-palpable breast cancer in hospital-based screening among Chinese women

Background: Some population-base studies have reported similar or improved survival for breast-conserving surgery (BCS) plus radiotherapy compared with mastectomy (Mx) in early breast cancer [PMID: 22373563, 27344114]. Among the screening detected early breast cancer, ultrasound (US) could detect more invasive non-palpable breast cancer (NPBC) with positive lymph nodes in hospital-based asymptomatic Chinese women, who could achieve comparable 10-year DFS and OS as mammography (MG)-detected NPBC [2016 SABCS P5-02-05, PMID: 27689334]. However, there is little data about the surgical outcomes of BCS verse Mx in the low-risk screening detected NPBC with US as the initial imaging test.

Methods: From 2001 to 2017, 6,423 consecutive asymptomatic women underwent mammography or ultrasound guided biopsy in Peking Union Medical College Hospital. Among them, 1130 NPBC including 914 US-detected and 216 MG-detected NPBC were diagnosed and treated. There were 349 (30.9%) patients underwent BCS including 286 (25.3%) patients received radiation therapy and 63 (5.6%) elderly patients (&gt;70 years) who did not. The clinicopathological features, treatment choice, 10-year disease-free survival (DFS) and overall survival (OS) were compared between breast conservingsurgery (BCS) versus mastectomy(Mx) in all NPBC and between the US-detected and MG-detected NPBC.

Result: Compared to those who received BCS, the 781 (69.1%) patients who underwent Mx had more cancers with relatively higher histologic grade (p=0.003), positive lymph node (18.8% vs 12.0%, p=0.005), ER-negative (22.5% vs 11.5%, p&lt;0.001), PR-negative (29.6% vs 16.3, p&lt;0.001), Her2-positive (16.3% vs 8.9%, p=0.001), and received chemotherapy (37.6% vs 28.7%, p=0.003). The breast conserving rates of US-NPBCwere higher than that of MG-NPBC (32.6% vs 23.6%, p=0.010), but the breast conserving rates were similar between ductal carcinoma in situ (DCIS) and invasive cancers. The 10-year DFS and OS were similar among BCS with radiation therapy, BCS without radiation therapy and Mx as well as among US-NPBC with BCS, US-NPBC with Mx, MG-NPBC with BCS and MG-NPBC with Mx. However, MG-NPBC with Mx had favorable 10-year DFS than that of MG-NPBC with BCS (p=0.041).

Table 1.Kaplan-Meier estimated 10-year DFS and OS of all NPBC§Patients (No.)NPBC GroupNumber (%)10-year DFS (%)P value10-year OSP valueAll NPBC (1130)BCS without Radiotherapy63 (5.6)85.00.10592.30.722 BCS with Radiotherapy286 (25.3)92.7 99.5  Mastectomy781 (69.1)93.2 98.7        All NPBC (1130)US+BCS298 (26.4)90.40.24896.30.542 US+Mx616 (64.5)92.4 98.4  MG+BCS51 (4.5)90.3 100.0  MG+Mx165 (14.6)96.1 100.0 § Kaplan-Meier survival curves would be displayed in the poster.

Conclusion: The 10-year DFS and OS of breast conserving surgery versus mastectomy were similar among all NPBC patients. As the current initial imaging test, US-detected NPBC patients would receive significantly more BCS compared to MG. There was no significant difference in surgical outcomes among BCS and Mx in US-detected NPBC. However, among MG-detected NPBC, patients with Mx reached a better DFS but a similar OS than those with BCS. The radiation therapy could be safely omitted in the elderly patients (&gt;70 years) with NPBC.

Citation Format: Yao R, Pan B, Xu Y, Zhou Y, Zhu Q, Zhang J, Wu H, Mao F, Lin Y, Shen S, Sun Q. Survival outcomes of breast conserving surgery versus mastectomy for ultrasound detected non-palpable breast cancer in hospital-based screening among Chinese women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-30.

Abstract P1-03-06: Risk stratification by ultrasound for screen-detected non-palpable breast cancer in Chinese women: Regular low risk versus ultra-low risk?

Background: Mammography (MG) screen-detected breast cancer has been established as low-risk in the western world. However, ultrasound (US) is currently the 'real-world' initial imaging test for breast cancer in China. In our previous work, we firstly showed with a multi-center randomized controlled trial that US could detect breast cancer with improved sensitivity and accuracy in high risk Chinese women [PMID: 25668012]. Then we demonstrated on a hospital-screening basis that US and MG detected non-palpable breast cancer (NPBC) had similar survival [2016 SABCS P5-02-05, PMID: 27689334]. This study was performed to test the hypothesis [Hypothesis would be published in the journal of Medical Hypothesis, 118 (2018):9-12] whether MG+/US- NPBC could be taken as ultra-low risk cancer which had more favorable clinical characteristics and survival than the regular low-risk NPBC.

Methods: From 2015-2017, 1,478 consecutive patients received biopsy with initial positive screening US (BI-RADS 4 and 5) at Peking Union Medical College Hospital. Among them, 206 US+/MG- and 135 US+/MG+ NPBC were diagnosed. Meanwhile, 371 patients who had negative initial screening US (BI-RADS 1, 2 and 3) and positive additional MG (BI-RADS 4 and 5) underwent MG-guided biopsies, and 88 MG+/US- NPBC were diagnosed. Clinical characteristics, treatment and 3-year disease free survival (DFS) and overall survival (OS) were analyzed and compared. Prognostic factors were identified.

Results: There was no significant difference in age, lymph node status, hormone receptor status, endocrine therapy, chemotherapy, targeted-therapy among the three subgroups of NPBC. MG detected significantly more ductal carcinoma in situ (DCIS, 59.1% vs 22.8% and 28.1%, p&lt;0.001) whereas ultrasound diagnosed more invasive cancers (77.2% and 71.9% vs 40.9%, p&lt;0.001), multifocal cancer (p=0.020) and patients who received breast-conserving surgery (p&lt;0.001) and needed radiotherapy (P=0.001). No significant difference was found for 3-year DFS and 3-year OS were all 100%, although MG+/US- NPBC showed a trend of better DFS.

Table 1.Comparison of positive predictive value (PPV), pathology and prognosis of US+/MG-, US+/MG+ and MG+/US- NPBCPathologyRadiology (2015-2017)US-detected NPBL (N=1,478)US-detected NPBL(N=1,478)MG-detected NPBL (N=371)MG & US positivityUS+/MG- (N=1,108)US+/MG+ (N=370)MG+/US- (N=371)Imaging presentationNoduleNodule + micro-calcificationsMicro-calcificationsBreast cancer (PPV %)206 (18.6%)135 (36.5%)88 (23.7%)Pathology (p&lt;0.001)   DCIS (%)47 (22.8)38 (28.1)52 (59.1)Invasive (%)159 (77.2)97 (71.9)36 (40.9)3-Year survival   DFS (%)92.391.196.5OS (%)100.0100.0100.0

Conclusion: MG+/US- NPBC had satisfactory prognosis, higher percentage of DCIS and might be taken as 'ultra-low risk' cancer. Hence US had the potential of stratifying the screen-detected NPBC into regular low risk (US+/MG+ and US+/MG-) and ultra-low risk (MG+/US-).

Citation Format: Xu Y, Pan B, Yao R, Zhou Y-d, Mao F, Zhu Q-L, Zhang J, Lin Y, Shen S-j, Sun Q. Risk stratification by ultrasound for screen-detected non-palpable breast cancer in Chinese women: Regular low risk versus ultra-low risk? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-06.

Abstract P1-02-02: Is ultrasound screening justified for non-palpable breast cancer in asymptomatic Chinese women: A real-world study based on long-term survival of consecutive cohort (2001-2017)

Background: Ultrasound (US) is an effective initial screening test for breast cancer both in Caucasian and Chinese women [PMID: 26712110, 26715161, and 25668012]. The real-world modality of breast cancer screening in the China is hospital-based screening among asymptomatic self-referred women. In our previous study, we showed that US and mammography (MG) detected non-palpable breast cancer (NPBC) had similar long-term survival and that US detected more invasive NPBC with positive lymph node [2016 SABCS P5-02-05, PMID: 27689334]. This study was to investigate whether these findings would be still true with more NPBC cases included and longer follow-up in the consecutive hospital cohort.

Methods: From 2001 to 2017, 5,264 asymptomatic women with positive (BI-RADS 4 and 5) initial screening US underwent biopsies in PUMC Hospital, and 914 US-NPBC in 883 women were diagnosed. Meanwhile, women without dense breasts (defined as BI-RADS category C and D) also received screening MG after physical examination and US. There were 1,159 patients with positive (BI-RADS 4 and 5) MG and normal US (BI-RADS 1, 2 and 3) underwent MG-guided biopsies and 216 MG-NPBC were diagnosed in 214 women. The clinicopathological characteristics and 10-year disease-free survival (DFS) and overall survival (OS) were reviewed and compared between the US-NPBC and MG-NPBC. Prognostic factors of NPBC were identified by univariate and multivariate Cox analysis.

Result: Compared to MG, US could detect more invasive (81.2% vs 48.6%, p&lt;0.001), lymph node positive (18.3% vs 10.2%, p&lt;0.001), stage II+III (21.7% vs 12.5%, p&lt;0.001) and low grade cancer (p=0.001).Between invasive US-NPBC and MG-NPBC, no significant difference was identified for lymph node status, TNM stage or subtype.US-NPBC received more breast conserving surgery (32.6% vs 24.1%, p&lt;0.001) and chemotherapy (37.5% vs 23.6%, p&lt;0.001). There was no significant difference in DFS or OS between US- vs MG-NPBC among ductal carcinoma in situ (DCIS), invasive and all NPBC. For the US-NPBC, the DFS factors included TNM stage and Hormone receptor status whereas OS-predictors were pN and subtype.

Table 1.Kaplan-Meier estimates of DFS and OS between US-NPBC and MG-NPBC§Patients (No.) 10-year DFS (%)P value10-year OS (%)P valueAllUS-NPBC (914)92.40.57098.20.143 MG-NPBC (216)94.7 100.0 DCISUS-NPBC (172)97.70.170100.0- MG-NBPC (111)95.3 100.0 InvasiveUS-NPBC (742)91.20.45897.90.251 MG-NPBC (105)94.4 100.0 § Kaplan-Meier survival curves between each two subgroups would be displayed in the poster.

Conclusion: Overall, US could detect more invasive NPBC patients with positive lymph node and advanced stage compared to MG, and screen invasive NPBC at similar TNM stage and subtype distribution as MG. US-NPBC patients received more breast conserving surgery and chemotherapy, and could achieve comparable 10-year DFS and OS as MG-detected NPBC. Hence US is justified in the real-world as the initial imaging modality in hospital-based screening Chinese women.

Citation Format: Yao R, Pan B, Xu Y, Zhou Y, Zhu Q, Zhang J, Wu H, Mao F, Lin Y, Shen S, Sun Q. Is ultrasound screening justified for non-palpable breast cancer in asymptomatic Chinese women: A real-world study based on long-term survival of consecutive cohort (2001-2017) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-02.

[Effect of intervention programs regarding community "5+1" staged diabetes target management on patients with type 2 diabetes mellitus]

Objective: To analyze the effect of intervention programs and influencing factors regarding the community "5+1" staged diabetes target management on patients with type 2 diabetes mellitus (T2DM) and to provide evidence for improving the quality of life (QOL). Methods: A total of 12 community health service centers from Shanxi province, Jiangsu province, and Ningxia Hui autonomous region were selected as intervention group and control group, by stratified cluster sampling method. "5+1" model was used in intervention groups and basic public health services model was applied in control groups for this two-year follow-up. Data was collected through a questionnaire on demographic and disease-related information, while the QOL was measured with SF-36. Multiple linear regression and conducted by SAS 9.4. Results: A total of 2 467 subjects were included at baseline and 1 924 had completed a two-year-long management service. After intervention programs being implemented, the net effect of PCS score between the intervention and the control groups was 13.6, with the net effect of MCS score as 29.8. Results from the multiple linear regression showed that the main factors affecting PCS scores included age, type of medical insurance, baseline PCS score and regions of residency. Main factors related to MCS score included age, type of medical insurance, baseline MCS score, hypertension, and region of residency. Conclusion: Community "5+1" staged diabetes target management model presented favorable effect of improving the QOL on T2DM patients.

[Impact of the 21-gene recurrence score assay in clinical treatment and prognosis analysis for patients with hormone receptor positive early-stage breast cancer]

Objective: To explore the association between the 21-gene recurrence score (RS) and clinicopathologic characteristics as well as prognosis in patients with axillary lymph node negative, hormone receptor (HR) positive breast cancer. Methods: The clinicopathologic data of 439 early breast cancer patients who underwent 21 gene RS testing was retrospectively analyzed. According to the 21 gene RS, the patients were divided into low risk (295 cases), intermediate risk (111 cases) and high-risk (33 cases) group. The relationship between the 21 gene RS and clinicopathological characteristics, treatment, recurrence and metastasis was analyzed. Univariate and multivariate statistical analyses were used to analyze the risk factors for relapse free survival (RFS). Results: Tumor grade, estrogen receptor (ER), progesterone receptor (PR) and Ki-67 index were significantly different among the 3 risk cohorts (P<0.001 for all). After a median follow-up of 32 months, the recurrence rate in low risk group (3.7%) was significantly lower than that in the intermediate-high risk group (9.0%), the locoregional recurrence (LRR) rate of low, intermediate and high risk group was 2.4%, 6.3% and 9.1%; and the distant metastasis (DM) rate in low risk group was 1.4% and 2.1% in the intermediate-high risk group. Univariate analysis showed RS, ER status and endocrine therapy were prognostic factors for RFS (P<0.05 for all). Multivariate analysis showed that RS was an independent significant predictor for RFS (P=0.04). Conclusions: The 21-gene RS is related to tumor grade, ER, PR and Ki-67 index. RS is an independent risk factor for RFS in patients with hormone receptor positive early-stage breast cancer.

[Impact of the 21-gene recurrence score assay in clinical treatment and prognosis analysis for patients with hormone receptor positive early-stage breast cancer]

Objective: To explore the association between the 21-gene recurrence score (RS) and clinicopathologic characteristics as well as prognosis in patients with axillary lymph node negative, hormone receptor (HR) positive breast cancer. Methods: The clinicopathologic data of 439 early breast cancer patients who underwent 21 gene RS testing was retrospectively analyzed. According to the 21 gene RS, the patients were divided into low risk (295 cases), intermediate risk (111 cases) and high-risk (33 cases) group. The relationship between the 21 gene RS and clinicopathological characteristics, treatment, recurrence and metastasis was analyzed. Univariate and multivariate statistical analyses were used to analyze the risk factors for relapse free survival (RFS). Results: Tumor grade, estrogen receptor (ER), progesterone receptor (PR) and Ki-67 index were significantly different among the 3 risk cohorts (P<0.001 for all). After a median follow-up of 32 months, the recurrence rate in low risk group (3.7%) was significantly lower than that in the intermediate-high risk group (9.0%), the locoregional recurrence (LRR) rate of low, intermediate and high risk group was 2.4%, 6.3% and 9.1%; and the distant metastasis (DM) rate in low risk group was 1.4% and 2.1% in the intermediate-high risk group. Univariate analysis showed RS, ER status and endocrine therapy were prognostic factors for RFS (P<0.05 for all). Multivariate analysis showed that RS was an independent significant predictor for RFS (P=0.04). Conclusions: The 21-gene RS is related to tumor grade, ER, PR and Ki-67 index. RS is an independent risk factor for RFS in patients with hormone receptor positive early-stage breast cancer.

FOXC1 overexpression is a marker of poor response to anthracycline-based adjuvant chemotherapy in sporadic triple-negative breast cancer

Purpose

Because of its aggressive characteristics and poor prognosis, triple-negative breast cancer (TNBC) has become a hot topic in cancer research. Chemotherapy is currently the only treatment for patients with TNBC. The transcription factor FOXC1 has been associated with TNBC prognosis, but little is known about its effect on chemosensitivity. The aim of this study was to investigate the effects of FOXC1 on chemosensitivity.

Methods

A case–control study was performed on 25 TNBC patients who experienced relapse and/or metastasis. Another 25 patients without relapse or metastasis were randomly selected as controls. Medical records were reviewed for relevant information, and immunohistochemistry was performed to measure FOXC1 levels. The Kaplan–Meier method and Cox analysis were used to analyze differences in disease-free survival (DFS) and overall survival (OS). The correlation of FOXC1 expression with chemosensitivity was analyzed. Data were analyzed using SPSS 21.0 software, and a P value <0.05 was considered to be statistically significant.

Results

In 15 of 22 case patients, FOXC1 was overexpressed, whereas only 8 control patients exhibited FOXC1 overexpression (P < 0.05). FOXC1 expression had no correlation with pathological indicators. An anthracycline-based regimen was administered to 21 study patients and 23 control patients. FOXC1 expression was significantly associated with a worse DFS (HR 2.62, 95% CI 1.05–6.50, P = 0.038) but presented no correlation with OS (HR 2.53, 95% CI 0.76–8.40, P = 0.131) among these 44 patients.

Conclusions

This study shows that FOXC1 is correlated with chemosensitivity to anthracycline and could be used as an indicator of chemosensitivity in sporadic TNBC.

Electronic supplementary material

The online version of this article (doi:10.1007/s00280-017-3319-4) contains supplementary material, which is available to authorized users.

Pharmacokinetic and pharmacodynamic integration and modeling of acetylkitasamycin in swine for Clostridium perfringens

The aim of this study was to establish an integrated pharmacokinetic/pharmacodynamic (PK/PD) modeling approach of acetylkitasamycin for designing dosage regimens and decreasing the emergence of drug-resistant bacteria. After oral administration of acetylkitasamycin to healthy and infected pigs at the dose of 50 mg/kg body weights (bw), a rapid and sensitive LC-MS/MS method was developed and validated for determining the concentration change of the major components of acetylkitasamycin and its possible metabolite kitasamycin in the intestinal samples taken from the T-shape ileal cannula. The PK parameters, including the integrated peak concentration (C_max ), the time when the maximum concentration reached (T_max ) and the area under the concentration-time curve (AUC), were calculated by WinNonlin software. The minimum inhibitory concentration (MIC) of 60 C. perfringens strains was determined following CLSI guideline. The in vitro and ex vivo activities of acetylkitasamycin in intestinal tract against a pathogenic strain of C. perfringens type A (CPFK122995) were established by the killing curve. Our PK data showed that the integrated C_max , T_max , and AUC were 14.57-15.81 μg/ml, 0.78-2.52 hR, and 123.84-152.32 μg hr/ml, respectively. The PD data show that MIC₅₀ and MIC₉₀ of the 60 C. perfringens isolates were 3.85 and 26.45 μg/ml, respectively. The ex vivo growth inhibition data were fitted to the inhibitory sigmoid E_max equation to provide the values of AUC/MIC to produce bacteriostasis (4.84 hr), bactericidal activity (15.46 hr), and bacterial eradication (24.99 hr). A dosage regimen of 18.63 mg/kg bw every 12 hr could be sufficient in the prevention of C. perfringens infection. The therapeutic dosage regimen for C. perfringens infection was at the dose of 51.36 mg/kg bw every 12 hr for 3 days. In summary, the dosage regimen for the treatment of C. perfringens in pigs administered with acetylkitasamycin was designed using PK/PD integrate model. The designed dose regimen could to some extent decrease the risk for emergence of macrolide resistance.

[On National Demonstration Areas: a cluster analysis]

Objective: To understand the 'backward' provinces and the relatively poor work among the construction of National Demonstration Area, so as to promote communication and future visions among different regions. Methods: Methods on Cluster analysis were used to compare the development of National Demonstration Area in different provinces, including the coverage of National Demonstration Area and the scores of non-communicable disease (NCDs) prevention and control work based on a standardized indicating system. Results: According to the results from the construction of National Demonstration Area, all the 29 provinces and the Xinjiang Production and Construction Corps (except Tibet and Qinghai) were classified into 6 categories: Shanghai; Beijing, Zhejiang, Chongqing; Tianjin, Shandong, Guangdong and Xinjiang Production and Construction Corps; Hebei, Fujian, Hubei, Jiangsu, Liaoning, Xinjiang, Hunan and Guangxi; Shanxi, Jilin, Henan, Hainan,Sichuan, Anhui and Jiangxi; Inner Mongolia, Shaanxi, Ningxia, Guizhou, Yunnan, Gansu and Heilongjiang. Based on the scores gathered from this study, 24 items that representing the achievements from the NCDs prevention and control endeavor were classified into 4 categories: Manpower, special day on NCD, information materials development, policy/strategy support, financial support, mass media, enabled environment, community fitness campaign, health promotion for children and teenage, institutional structure and patient self-management; healthy diet, risk factors on NCDs surveillance, tobacco control and community diagnosis; intervention of high-risk groups, identification of high-risk groups, reporting system on cardiovascular and cerebrovascular events, popularization of basic public health service, workplace intervention programs, construction of demonstration units and mortality surveillance; oral hygiene and tumor registration. Contents including oral hygiene, tumor registration, intervention on high-risk groups, identification of high-risk population, reporting system on cardiovascular and cerebrovascular events, popularization of basic public health service, workplace intervention programs, construction of demonstration units and mortality surveillance were discerned as the relatively weak areas in the construction programs of National Demonstration Area. Conclusions: Western regions, especially in some remote provinces had the poorest performance during the construction of National Demonstration Area. Programs regarding chronic disease surveillance, identification and intervention on high-risk groups showed the lowest scores and these outcome-oriented tasks should be further focused on, during the next term of review, in these areas.

Abstract P5-02-05: Biology and long-term prognosis of screening detected non-palpable breast cancer by ultrasound in hospital-based Chinese population (2001-2014)

Background: Milestone studies showed that ultrasound (US) was an effective primary screening test for breast cancer both in the western world and in China [PMID: 26712110, 26715161, and 25668012]. Ultrasound has been officially designated to be the initial imaging test for breast cancer screening in Beijing and several other cities in China, due to its improved sensitivity in Chinese women who usually have denser breasts and develop breast cancer earlier than Caucasian counterparts. Study showed that it would take 40 years to screen each woman in the target age group once [PMID: 26808342].The mainstay modality of breast cancer screening in China is the hospital-based opportunistic screening among asymptomatic self-referred women. However, there is little data about the tumor biology and long-term survival of the US-detected non-palpable breast cancer (NPBC) in hospital-based Chinese population.

Methods: From January 2001 to December 2014, 3,786 asymptomatic women with positive (BI-RADS 4 and 5) initial screening US underwent biopsies in Peking Union Medical College Hospital, and 572 NPBC in 556 women were diagnosed. Women without dense breasts (defined as BI-RADS category C and D) also received screening mammography (MG) after physical examination and ultrasound. 788 patients with positive (BI-RADS 4 and 5) mammogram (MG) and normal US (BI-RADS 1, 2 and 3) underwent MG-guided biopsies and another 127 NPBC were diagnosed in 126 women. The clinicopathological features, treatment choice, 10-year disease-free survival (DFS) and overall survival (OS) were reviewed and compared between the US-detected and MG-detected NPBC. Prognostic factors of NPBC were identified.

Results: Overall, US could detect more invasive NPBC (83.4% vs 54.3%, p&lt;0.001), lymph node positive cancer (19.1% vs 10.2%, p&lt;0.001)and multifocal cancer (19.2% vs 6.3%, p&lt;0.001). In invasive NPBC, US detected more low grade cancer (21.4% vs 10.2%, p=0.001), multifocal cancer (20.7% vs 2.9%, p&lt;0.001), Her2 negative cancer (77.6% vs 62.3%, p=0.001) and larger tumor (pT1c+pT2, 53.3% vs 37.6%, p&lt;0.001). There was no significant difference in immunophenotype/subtype, treatment methods, DFS or OS between US- and MG-NPBC among ductal carcinoma in situ (DCIS), invasive and all NPBC. For all NPBC and the US-NPBC, the common DFS-factors included pT, pN and p53 whereas OS-predictors were pN and immunophenotype/subtype.

Table 1. Kaplan-Meier estimates of DFS and OS between US-NPBC and MG-NPBC§.Patients (No.)10-year DFS (%)P value10-year OS (%)P valueAllUS-NPBC (572)90.60.73896.10.142 MG-NPBC (127)92.7 100.0 DCISUS-NPBC (94)100.00.060100.0- MG-NPBC (58)93.8 100.0 InvasiveUS-NPBC (478)88.60.68095.20.239 MG-NPBC (69)92.0 100.0 § Kaplan-Meier survival curves between each two subgroups would be displayed in the poster.

Conclusion: Compared to MG, US detected more invasive NPBC with positive lymph node in hospital-based asymptomatic self-referred Chinese women, who could achieve comparable 10-year DFS and OS as MG-detected NPBC. US could serve as the feasible initial imaging modality in hospital-based opportunistic screening Chinese women.

Citation Format: Yao R, Pan B, Zhu Q, Xu Q, Zhou Y, Zhang J, Mao F, You S, Lin Y, Shi J, Guan J, Wang X, Zhang Y, Zhang X, Shen S, Zhong Y, Xu Y, Liang Z, Jiang Y, Sun Q. Biology and long-term prognosis of screening detected non-palpable breast cancer by ultrasound in hospital-based Chinese population (2001-2014) [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 P5-02-05.

[Clinical value of contrast-enhanced ultrasound in evaluating portal hypertension in patients with decompensated liver cirrhosis]

OBJECTIVE

To investigate the correlation between contrast-enhanced ultrasound parameters and hepatic venous pressure gradient (HVPG), and to develop a new noninvasive method for the evaluation of portal hypertension in patients with decompensated liver cirrhosis.

METHODS

One-hundred patients with decompensated liver cirrhosis were examined by contrast-enhanced ultrasound, and the dynamic images were collected for offline analysis. The contrast arrival time was obtained in the hepatic artery (HA), portal vein (PV), and hepatic vein (HV), and HA-HV transit time (HA-HVTT) and PV-HV transit time (PV-HVTT) were calculated. At the same time, HVPG was measured within 24 hours after contrast-enhanced ultrasound, Pearson correlation analysis was performed between each parameter and HVPG, and the receiver operating characteristic (ROC) curve was also used for analysis.

RESULTS

HV arrival time (HVAT), HA-HVTT, and PV-HVTT were negatively correlated with HVPG (r = -0.385, -0.409, and -0.572, respectively). The area under the ROC curve (AUROC) was 0.903 for PV-HVTT < 2.5 s in judging HVPG≥ l0 mmHg in patients with decompensated liver cirrhosis, and the sensitivity and specificity were 74.4% and 89.5%, respectively. The AUROC was 0.861 for PV-HVTT < 1.5 s in judging HVPG≥l6 mmHg in these patients, and the sensitivity and specificity were 80.4% and 81.5%, respectively.

CONCLUSIONS

HVAT and intrahepatic transit time demonstrate negative linear correlations with HVPG in patients with decompensated liver cirrhosis, and among all parameters, PV-HVTT shows the strongest correlation with HVPG and can be used to determine and predict the severity of portal hypertension.

Abstract P6-05-12: Prognosis of subtypes of the mucinous breast carcinoma in Chinese women: A population-based study of 32-year experience (1983-2014)

Background: The heterogeneous nature of the mucinous breast cancer (MBC), with its subtypes of pure (PMBC) and mixed carcinoma (MMBC), calls for more precise individualized prognosis assessment. PMBC showed favorable prognosis in both Chinese and Caucasian women, with nodal status and TNM stage as the prognostic predictors [PMID: 18026874, 22451233]. However, few studies had investigated tumor biology and prognosis of MMBC in Chinese population, especially with respect to the different co-existing cancer components.

Methods: From January 1983 to December 2014, 197 consecutive MBC patients, including 117 PMBC and 80 MMBC, received breast cancer surgery in Peking Union Medical College Hospital. The clinicopathological characteristics, treatment choice, disease-free survival (DFS) and overall survival (OS) were compared both between PMBC vs MMBC, and among subgroups of MMBC according to the mixed entities, including 24 women with ductal caricinoma in situ (DCIS) and 45 with IDC. Univariate and Cox multivariate analyses were performed to identify the prognostic factors.

Results: The 197 MBC comprised 1.9% of contemporary 10,192 breast cancer (BC). Compared to PMBC, MMBC had significantly more lymph node metastasis (p=0.038), Her2 positivity (p=0.036), high Ki-67 index (defined as &gt;20%, p=0.026) and anti-Her2 targeted therapy (p=0.006). All these differences remained significant when the comparison were performed among PMBC, MBC+DCIS and MBC+IDC, and additional significant difference were identified in tumor size (p=0.036), pTNM stage (p=0.003) and chemotherapy (p=0.003). However, no significant difference was found in DFS or OS between any two subtypes/subgroups of MBC, including PMBC, MMBC, MBC+DCIS and MBC+IDC.

Table 1. Comparison of survival outcomes among PMBC, MBC+DCIS and MBC+IDC§SurvivalPMBC (N=117, Median, range, and Mean±SD)MBC+DCIS (N=24, Median, range, and Mean±SD)MBC+IDC (N=45, Median, range, and Mean±SD)P-ValueDFS (months)43 (1-233), 52.7±45.227 (1-84), 34.3±25.326 (1-113), 33.1±26.60.187OS (months)46 (1-312), 56.9±51.827 (1-84), 34.4±25.326 (1-113), 34.8±28.70.628§ Kaplan-Meier survival curves would be displayed in the poster

High Ki-67 index (p=0.046) appeared to be the significant DFS related prognostic factor for PMBC, whereas estrogen receptor (ER) status (univariate p=0.000, multivariate p=0.062) and immunophenotype (luminal, her2, or triple-negative, univariate p=0.000, multivariate p=0.079) might be the potential DFS predictors for MMBC. None of the above-mentioned clinicopathological factors could serve as OS predictors for MBC.

Conclusion: This population-based study showed that there were significant difference in nodal status, Ki-67, Her2 positivity and targeted therapy between PMBC and MMBC, and furthermore in tumor size, stage and chemotherapy among PMBC and subgroups of MMBC such as MBC+DCIS and MBC+IDC. However, survival outcomes were similar between these clinical entities and subgroups, suggesting the intra-tumoral heterogeneity might not interfere with survival outcomes of MBC in Chinese woman. High Ki-67 index was identified as the significant DFS related prognostic factor for PMBC, whereas ER status and immunophenotype as the potential DFS predictors for MMBC.

Citation Format: Yao R, Pan B, Sun Q, Zhou Y, Mao F, Lin Y, Guan J, Wang X, Zhang Y, Zhang X, Shen S, Zhong Y, Xu Y, Shi J, Zhu Q, Cai F, Liang Z. Prognosis of subtypes of the mucinous breast carcinoma in Chinese women: A population-based study of 32-year experience (1983-2014). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-05-12.

Impact of the 21-Gene Recurrence Score Assay in adjuvant chemotherapy selection for node-negative, hormone receptor-positive breast cancer in the Chinese population

The 21-Gene Recurrence Score Assay has been intensively studied and recommended by major guidelines for treatment decision in early breast cancer. Its impact in adjuvant chemotherapy selection for Chinese population has not been revealed.The prospective part of this study enrolled consecutive node-negative, hormone receptor-positive patients who underwent 21-gene RS testing at Breast Surgery Department of PUMCH (n=134) between May 2012 and August 2013(21-gene RS group). Risk categories were assigned based on the RS and on standard clinicopathologic criteria according to St. Gallen and Adjuvant! Online. The chemotherapy selection and the oncologists' confidence in decision-making before and after RS testing were recorded. The retrospective part of this study compared the chemotherapy decision in the 21-gene RS group and a control group without RS testing (diagnosed between Jan 2011 and Apr 2012,n=170). A total of 304 patients were included in the analysis (134 21-gene RS group, 170 controls). Based on RS, 97 patients were classified as low risk, 29 patients as intermediate risk, and 8 patients as high risk. Tumor grade (P=0.002), PR expression (P<0.001) and Ki-67 index (P<0.001) were significantly different between the 3 risk cohorts.Comparing the St. Gallen guidelines and RS, there was a 41% concordance between risk groups. By using Adjuvant! Online, the correlation between the predicted BCSM and RS was nominal (r=0.10). A total of 29% 21-gene RS group patients changed their treatment decisions after RS testing (P<0.001, 95% CI, 0.18 to 0.49) with 6% (8/134) patients changing to receive chemotherapy besides endocrine therapy and 23% (31/134) changing to reject chemotherapy. After RS testing, more than one half of the oncologists increased their confidence level in treatment recommendation. In the control group, 67.6% (115/170) patients chose chemotherapy plus endocrine therapy. The chemotherapy percentage was much higher than that of 21-gene RS group (30/134, 22%).This is the first study to demonstrate a reduction in the use of adjuvant chemotherapy in women with node-negative hormone receptor-positive breast cancer, based on use of the RS. The RS had an impact on the physicians' treatment decision-making.

Recombinant Mycobacterium smegmatis expressing an ESAT6-CFP10 fusion protein induces anti-mycobacterial immune responses and protects against Mycobacterium tuberculosis challenge in mice

The currently used vaccine against tuberculosis, Bacille Calmette-Guérin (BCG), has variable efficacy, so new vaccine development is crucial. In this study, we evaluated a recombinant vaccine prepared from non-pathogenic Mycobacterium smegmatis (rMS) that expresses a fusion of early secreted antigenic target 6-kDa antigen (ESAT6) and culture filtrate protein 10 (CFP10). C57BL/6 mice were immunized with the rMS expressing the ESAT6-CFP10 fusion protein (rM.S-e6c10) or with BCG. The mice in the rM.S-e6c10 group had a significantly higher titre of anti-ESAT6-CFP10 antibodies than did animals in the BCG or saline groups. Spleen cells from rM.S-e6c10-immunized mice exhibited a cytotoxic response to ESAT6 and CFP10-expressed target cells, but spleen cells from animals in the other groups did not. Levels of IFN-γ and IL-2 production by purified T cells from spleens were significantly higher in rM.S-e6c10 group than in BCG group. Finally, after M. tuberculosis (MTB)-challenged mice, dramatic reduction in the numbers of MTB colony-forming units (CFUs) in the lungs was observed for the mice immunized with the rMS. The protective efficacy of rM.S-e6c10 and BCG vaccination was similar based on measures of MTB burden and lung pathology. Our data indicate that the recombinant M. smegmatis vaccine expressing the ESAT6-CFP10 fusion protein has potential in clinic application.

Tcf4 can specifically recognize beta-catenin using alternative conformations

Accumulation of the Wnt pathway effector beta-catenin is a hallmark of a number of cancers, including colon cancer. As beta-catenin accumulates in the cell, it forms a complex with Tcf family transcription factors and activates the transcription of several critical genes involved in cell proliferation. Because Tcf4 is the predominant Tcf factor present in colon cancer cells, drugs that specifically disrupt the beta-catenin-Tcf4 complex could be useful in treating colon cancers. Earlier structural and biochemical studies demonstrated that the central region of the beta-catenin binding domain of Tcf is essential for anchoring Tcf to beta-catenin via two conserved lysines in beta-catenin (called the charged 'buttons'). Here we report the crystal structure of a beta-catenin-Tcf4 complex at 2.0 A resolution. Our structural and mutagenesis studies show that Tcf4 docks specifically to beta-catenin using several distinct conformations in its essential central region. These conformations allow different glutamate residues in the central region of Tcf4 to form a salt bridge with the same critical charged button, Lys 312 of beta-catenin. We propose that this interaction may be the first event in beta-catenin-Tcf4 recognition.

Crystal structure of a beta-catenin/Tcf complex

The Wnt signaling pathway plays critical roles in embryonic development and tumorigenesis. Stimulation of the Wnt pathway results in the accumulation of a nuclear beta-catenin/Tcf complex, activating Wnt target genes. A crystal structure of beta-catenin bound to the beta-catenin binding domain of Tcf3 (Tcf3-CBD) has been determined. The Tcf3-CBD forms an elongated structure with three binding modules that runs antiparallel to beta-catenin along the positively charged groove formed by the armadillo repeats. Structure-based mutagenesis defines three sites in beta-catenin that are critical for binding the Tcf3-CBD and are differentially involved in binding APC, cadherin, and Axin. The structural and mutagenesis data reveal a potential target for molecular drug design studies.

Prostate boundary segmentation from 2D ultrasound images

Outlining, or segmenting, the prostate is a very important task in the assignment of appropriate therapy and dose for cancer treatment; however, manual outlining is tedious and time-consuming. In this paper, an algorithm is described for semiautomatic segmentation of the prostate from 2D ultrasound images. The algorithm uses model-based initialization and the efficient discrete dynamic contour. Initialization requires the user to select only four points from which the outline of the prostate is estimated using cubic interpolation functions and shape information. The estimated contour is then deformed automatically to better fit the image. The algorithm can easily segment a wide range of prostate images, and contour editing tools are included to handle more difficult cases. The performance of the algorithm with a single user was compared to manual outlining by a single expert observer. The average distance between semiautomatically and manually outlined boundaries was found to be less than 5 pixels (0.63 mm), and the accuracy and sensitivity to area measurements were both over 90%.

Segmentation of carotid artery in ultrasound images: method development and evaluation technique

Segmentation of carotid artery lumen in two-dimensional and three-dimensional ultrasonography is an important step in computerized evaluation of arterial disease severity and in finding vulnerable atherosclerotic plaques susceptible to rupture causing stroke. Because of the complexity of anatomical structures, noise as well as the requirement of accurate segmentation, interactions are necessary between observers and the computer segmentation process. In this paper a segmentation process is described based on the deformable model method with only one seed point to guide the initialization of the deformable model for each lumen cross section. With one seed, the initial contour of the deformable model is generated using the entropy map of the original image and mathematical morphology operations. The deformable model is driven to fit the lumen contour by an internal force and an external force that are calculated, respectively, with geometrical properties of deformed contour and with the image gray level features. The evaluation methodology using distance-based and area-based metrics is introduced in this paper. A contour probability distribution (CPD) method for calculating distance-based metrics is introduced. The CPD is obtained by generating contours of the lumen using a set of possible seed locations. The mean contour can be compared to a manual outlined contour to provide accuracy metrics. The variance computed from the CPD can provide metrics of local and global variability. These metrics provide a complete performance evaluation of an interactive segmentation algorithm and a means for comparing different algorithm settings.

Alexa dyes, a series of new fluorescent dyes that yield exceptionally bright, photostable conjugates

Alexa 350, Alexa 430, Alexa 488, Alexa 532, Alexa 546, Alexa 568, and Alexa 594 dyes are a new series of fluorescent dyes with emission/excitation spectra similar to those of AMCA, Lucifer Yellow, fluorescein, rhodamine 6G, tetramethylrhodamine or Cy3, lissamine rhodamine B, and Texas Red, respectively (the numbers in the Alexa names indicate the approximate excitation wavelength maximum in nm). All Alexa dyes and their conjugates are more fluorescent and more photostable than their commonly used spectral analogues listed above. In addition, Alexa dyes are insensitive to pH in the 4-10 range. We evaluated Alexa dyes compared with conventional dyes in applications using various conjugates, including those of goat anti-mouse IgG (GAM), streptavidin, wheat germ agglutinin (WGA), and concanavalin A (ConA). Conjugates of Alexa 546 are at least twofold more fluorescent than Cy3 conjugates. Proteins labeled with the Alexa 568 or Alexa 594 dyes are several-fold brighter than the same proteins labeled with lissamine rhodamine B or Texas Red dyes, respectively. Alexa dye derivatives of phalloidin stain F-actin with high specificity. Hydrazide forms of the Alexa dyes are very bright, formaldehyde-fixable polar tracers. Conjugates of the Alexa 430 (ex 430 nm/em 520 nm) and Alexa 532 (ex 530 nm/em 548 nm) fluorochromes are spectrally unique fluorescent probes, with relatively high quantum yields in their excitation and emission wavelength ranges.

7-Amino-4-methyl-6-sulfocoumarin-3-acetic acid: a novel blue fluorescent dye for protein labeling

7-Amino-4-methyl-6-sulfocoumarin-3-acetic acid (AMCA-S, also called Alexa 350) 2 was synthesized as a new water-soluble blue fluorescent dye for protein labeling. Compared with its nonsulfonated counterpart (AMCA) 1 the new dye gave significantly higher fluorescence quantum yields on proteins.

Localization of carbonic anhydrase in living osteoclasts with bodipy 558/568-modified acetazolamide, a thiadiazole carbonic anhydrase inhibitor

We describe the synthesis of Bodipy 558/568-modified acetazolamide, a fluorescent inhibitor of carbonic anhydrase and its use to localize the enzyme in living cells. The modified acetazolamide, with its specific sulfonamide group intact, labeled cells at concentrations as low as 10(-9) M, with a minimal loading time of 5 min. The staining was decreased by 57.4% by preincubating cells with unaltered acetazolamide (1:100) or with trifluoromethane sulfonamide, 6-ethoxyzolamide, and 5-(3-hydroxybenzoyl)-thiophene-2-sulfonamide. The efficacy of the inhibitor was unchanged by the fluorescent label, as determined by an acridine orange assay that detects acidification of osteoclasts, the cell model used in this study. This compound should prove to be useful for studying carbonic anhydrase in many organisms because of the high degree of conservation of the active site of this enzyme. (J Histochem Cytochem 47:545-550, 1999)

Fragmentary window filtering for multiscale lung nodule detection: preliminary study

RATIONALE AND OBJECTIVES

The authors evaluated computer-assisted diagnostic (CAD) methods used to detect suspicious areas on lung radiographs.

MATERIALS AND METHODS

The authors designed a fragmentary window filtering (FWF) algorithm for detecting lung nodule patterns, which generally appear as circular areas of high opacity on the chest radiograph. The FWF algorithm helps differentiate circular patterns from overlapping radiographic background. A multiscale analysis was performed to locate multiscale nodules. Receiver operating characteristic analysis was performed by using a lung nodule that was extracted from a chest radiograph. The nodule underwent scalings and subsequent superimposition onto 140 normal regions of interest from six chest radiographs.

RESULTS

The FWF method was superior to the matched filtering method in the detection of suspicious areas.

CONCLUSION

The proposed FWF-based method should provide improved detection of lung nodules on chest radiographs.

Cathepsin B contributes to bile salt-induced apoptosis of rat hepatocytes

BACKGROUND & AIMS

Bile salt-induced apoptosis is mediated by a trypsin-like nuclear protease. The aims of this study were to identify this protease and to elucidate its mechanistic role in bile salt-induced hepatocyte apoptosis.

METHODS

Rats, isolated rat hepatocytes, and a rat hepatoma cell line stably transfected with a bile salt transporter (McNtcp.24) were used for this study.

RESULTS

In the bile duct-ligated rat, a threefold increase in apoptosis and a fourfold increase in trypsin-like nuclear protease activity were observed. The nuclear protease activity was purified from bile duct-ligated rats and identified as cathepsin B. Specific, structurally dissimilar cathepsin B inhibitors blocked glycochenodeoxycholate (GCDC)-induced apoptosis in cultured rat hepatocytes. Furthermore, stable transfection of McNtcp.24 cells with the complementary DNA for cathepsin B in the antisense orientation reduced cathepsin B activity and GCDC-induced apoptosis by >75%. Next, cathepsin B cellular localization during apoptosis was determined by immunoblot analysis of nuclear cell fractions, immunocytochemistry, and by determining the compartmentation of expressed cathepsin B fused to green fluorescent protein. All three approaches showed translocation of cathepsin B from the cytoplasm to the nucleus during GCDC-induced apoptosis.

CONCLUSIONS

The data suggest that translocation of cathepsin B from the cytoplasm to the nucleus is a mechanism contributing to bile salt-induced apoptosis of hepatocytes.

Spatio-temporal grouping for the formation of vascular segments in coronarography image sequences

This work is aimed at the extraction of vascular structures using perceptual grouping methods. The approach is based on structural feature matching, between images in the time sequence. These features correspond to junctions (or bifurcation points) and are paired by means of a local criteria. A global refinement procedure is then applied by means of a relaxation scheme. The feature trajectories over the entire image sequence are examined to further build sets of vascular segments, which better describe vascular branches. The resulting performances are exemplified on a standard biplane coronarographic examination.