Mortality in patients admitted to hospital with heart failure in China: a nationwide Cardiovascular Association Database-Heart Failure Centre Registry cohort study

BACKGROUND

China has the largest burden of heart failure worldwide. However, large-scale studies on heart failure mortality are scarce. We aimed to investigate mortality and identify risk factors for mortality among patients with heart failure in China.

METHODS

This prospective cohort study used data from the China Cardiovascular Association (CCA) Database-Heart Failure Centre Registry, which were linked to the National Mortality Registration Information Management System by the Chinese Centre for Disease Control and Prevention. We included patients enrolled from Jan 1, 2017, to Dec 31, 2021, across 572 CCA Database-Heart Failure Centre certified hospitals in 31 provinces of mainland China. Eligible patients were aged 18 years or older (younger than 100 years) with a principal discharge diagnosis of heart failure based on Chinese heart failure guidelines. All-cause mortality at 30 days, 1 year, and 3 years for patients with heart failure were calculated and the causes of death were recorded. Multivariable analysis was used to analyse factors associated with all-cause mortality and cardiovascular mortality. This study was registered with the Chinese Clinical Trial Registry, ChiCTR2200066305.

FINDINGS

Of the 327 477 patients in the registry, 230 637 eligible adults with heart failure were included in our analyses. Participant mean age was 69·3 years (SD 13·2), 94 693 (41·1%) participants were female, and 135 944 (58·9%) were male. The median follow-up time was 531 days (IQR 251-883). Post-discharge all-cause mortality of patients with heart failure at 30 days was 2·4% (95% CI 2·3-2·5), at 1 year was 13·7% (13·5-13·9), and at 3 years was 28·2% (27·7-28·6). Cardiovascular death accounted for 32 906 (71·5%) of 46 006 all-cause deaths. Patients with heart failure with reduced ejection fraction had the highest all-cause mortality. A lower guideline adherence score was independently associated with the increase of all-cause and cardiovascular mortality.

INTERPRETATION

In China, mortality for patients with heart failure is still high, especially in patients with reduced ejection fraction. Our findings suggest that guideline-directed medical therapy needs to be improved.

FUNDING

National High Level Hospital Clinical Research Funding, the Capital's Funds for Health Improvement and Research, and the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

[Pathological study on the relationship between nucleic acid oxidative stress and heart failure with preserved ejection fraction in patients aged over 85 years]

Objective: To investigate the level of nucleic acid oxidation in myocardial tissue of patients aged over 85 with heart failure with preserved ejection fraction (HFpEF) and the correlation with myocardial amyloid deposition. Methods: This was a retrospective case-control study. Data of patients≥85 years old who underwent systematic pathological autopsy in Beijing Hospital from 2003 to 2017 were retrospectively collected. Twenty-six patients were included in the HFpEF group and 13 age-and sex-matched patients who had not been diagnosed with heart failure and died of non-cardiovascular diseases served as the control group. The left ventricular myocardium slices of both groups were semi-quantitatively analyzed using immunohistochemical staining of 8-oxidized guanine riboside (8-oxo-G) and 8-oxidized guanine deoxyriboside (8-oxo-dG) to evaluate the oxidation of RNA and DNA in cardiomyocytes. Using the median of the mean absorbance value of 8-oxo-G immunohistochemical staining as the cut-off value, patients were divided into high-absorbance group and low-absorbance group. Congo red staining was used to compare myocardial amyloid deposition between the two groups. Results: The mean age of patients in HFpEF group was (91.8±3.7) years, 24 (92.3%) were males. The mean age of patients in control group was (91.7±3.7) years old, 11 (84.6%) were males. The median mean optical absorbance value of 8-oxo-G immunohistochemical staining of myocardium was significantly higher in HFpEF patients than in control group (0.313 8 (0.302 2, 0.340 6) vs. 0.289 2 (0.276 7, 0.299 4), Z=-3.245, P=0.001). The median mean absorbance value of 8-oxo-dG immunohistochemical staining of myocardial tissue was similar between the two groups (0.300 0 (0.290 0, 0.322 5) vs. 0.300 0 (0.290 0, 0.320 0), Z=-0.454, P=0.661). Proportion of patients with moderate and severe cardiac amyloid deposition was significantly higher in the high-absorbance group than in the low-absorbance group ((85.0%, 17/20) vs. (31.6%, 6/19), P=0.001). Conclusion: The RNA oxidation degree of myocardium in HFpEF patients is higher than that in elderly people without heart failure. Degree of myocardial amyloid deposits is higher in patients with high levels of RNA oxidation.

Implication of different frailty criteria in older people with atrial fibrillation: a prospective cohort study

BACKGROUND

the prevalence of physical and multidimensional frailty and their prognostic impact on clinical outcomes in patients with atrial fibrillation (AF) is unclear.

OBJECTIVE

to evaluated frailty in a cohort of patients with AF according to different criteria, and studied the prevalence and its prognostic impact on clinical outcomes.

METHODS

in this multicenter prospective cohort, 197 inpatients ≥ 65 years old with AF were recruited from September 2018 to April 2019.We used Fried Frailty phenotype (Fried) to assess physical frailty, and comprehensive geriatric assessment-frailty index (CGA-FI) to assess multidimensional frailty. The primary outcome was a composite of all-cause mortality or rehospitalization.

RESULTS

the prevalence of frailty was determined as 34.5% by Fried, 42.6% by CGA-FI. Malnutrition and ≥ 7 medications were independently associated with frailty. Kaplan-Meier survival curve showed that the presence of frailty by CGA-FI had significantly lower all-cause mortality or rehospitalization survival rate (log-rank P = 0.04) within 1 year. Multivariate Cox regression adjusted for age and sex showed that the frailty by CGA-FI was significantly associated with the risk of all-cause mortality or rehospitalization within 1 year (HR 1.79, 95% CI 1.10-2.90). However, those associations were absent with the physical frailty. After broader multivariate adjustment, those associations were no longer statistically significant for both types of frailty.

CONCLUSIONS

in older people with AF, Multidimensional frailty is more significantly associated with a composite of all-cause mortality or rehospitalization within 1 year than physical frailty, but these association are attenuated after multivariate adjustment.

CLINICAL TRIAL REGISTRATION

ChiCTR1800017204; date of registration: 07/18/2018.

Effects of empagliflozin on cardiac structure, function and biomarkers in patients with heart failure with preserved ejection fraction: study protocol for a randomised, placebo-controlled prospective trial

INTRODUCTION

Heart failure (HF) with preserved ejection fraction (HFpEF) has become the main type of HF worldwide. Although large randomised controlled studies have demonstrated the beneficial effects of sodium-glucose cotransporter 2 inhibitors among patients with HFpEF, the mechanisms remain unclear. Basic research suggests that empagliflozin inhibits myocardial fibrosis. Myocardial extracellular volume (ECV) can be calculated using cardiac MRI (CMRI), which can reflect the degree of diffuse myocardial fibrosis. Studies show that empagliflozin can reduce ECV and left ventricular mass (LVM) assessed by CMRI in patients with diabetes with coronary heart disease and patients without diabetes with HF with reduced ejection fraction. However, whether empagliflozin reduces ECV and LVM among patients with HFpEF is unclear. This study intends to use CMRI to evaluate ECV and LVM, combined with echocardiography and an assessment of related biomarkers, to determine whether empagliflozin can improve myocardial fibrosis and left ventricular remodelling in patients with HFpEF.

METHODS AND ANALYSIS

This report describes the study design of a prospective, multicentre, randomised, double-blind, placebo-controlled and parallel-group clinical study. A total of 180 participants with HFpEF aged 40-80 years old who meet the inclusion and exclusion criteria will be randomly divided into an empagliflozin treatment group or a placebo control group. The empagliflozin treatment group will receive 10 mg of empagliflozin per day for 6 months in addition to guideline-directed medical treatment, while the control group will receive placebo oral administration with guideline-directed medical therapy for 6 months. The primary outcomes are ECV and LVM changes measured by CMRI after 6 months of treatment.

ETHICS AND DISSEMINATION

The study design is approved by the ethical committee of Beijing Hospital (2022BJYYEC-070-02). The trial is registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn). The trial results will be published in peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry (ChiCTR2200060862).

Straight and twisted open nodal-line phonon states in the CaI2 family of materials

Based on first-principles calculations and symmetry analysis, we propose that trigonal CaI₂ with the space group P3̄m1 possesses straight and twisted open nodal-line phonon states with linear dispersion. The symmetry analysis indicates that joint symmetry PT and rotational symmetry C_3z protect the straight nodal lines along Γ-A and K-H while PT and mirror symmetry M₀₁₀ (M₁₁₀) maintain the twisted nodal lines that traverse Γ-M (Γ-K) and A-L (A-H). The calculated π Berry phase suggests that all the nodal lines are nontrivial and the corresponding drumhead-like surface states are clearly visible in the observation window, which is less than 6 THz, suggesting a significant chance for them to be measured using meV-resolution inelastic X-ray scattering. The distribution of the nodal lines in the Brillouin zone is also confirmed by the phononic tight-binding model. Furthermore, the isostructural compounds MgBr₂ and MgI₂ show similar phonon spectra and topological nontrivial surface states. This work provides promising candidates for investigating straight and twisted open nodal-line phonon states in a single material, which will facilitate future experimental observation.

A huge verrucous carcinoma of the lower lip reconstructed by double Abbe flap: A case report and literature review

Lip verrucous carcinoma is a rare low-grade neoplasm, with an unsightly appearance and locally aggressive nature. Treatment of verrucous carcinoma is as yet challenging, no well-defined guidelines for effective and safe management of this disease are available. A case of a patient with a huge verrucous carcinoma of the lower lip successfully treated by surgical excision and double Abbe flap reconstruction technique is presented, and striking features of lip locations of this tumor as well as their management are discussed.

Prevalence and prognosis of frailty in older patients with stage B heart failure with preserved ejection fraction

AIMS

Frailty in older patients with stage B heart failure with preserved ejection fraction (HFpEF) has not been fully explored. We evaluated the prevalence and prognostic significance of frailty in older patients diagnosed with stage B HFpEF.

METHODS

Our prospective cohort study included inpatients aged ≥65 years who were followed up for 3 years. Stage B HFpEF was defined as cardiac structural or functional abnormalities with a left ventricular ejection fraction (LVEF) ≥ 50% without signs or symptoms. Frailty was assessed using the Fried phenotype. The primary outcome was 3-year all-cause mortality or readmission.

RESULTS

Overall, 520 older inpatients diagnosed with stage B HFpEF [mean ± standard deviation age: 75.5 ± 6.25 years, male: 222 (42.7%)] were included in the study. Of these, 145 (27.9%) were frail. Frail patients were older (78.5 ± 6.23 vs. 74.3 ± 6.22 years, P < 0.001), with a lower body mass index (24.6 ± 3.60 vs. 25.7 ± 3.27 kg/m² , P = 0.001), higher level of N-terminal pro-B-type natriuretic peptide [279 (interquartile range: 112.4, 596) vs. 140 (67.1, 266) pg/mL, P < 0.001], longer timed up-and-go test result (19.9 ± 9.71 vs. 13.3 ± 5.08 s, P < 0.001), and poorer performance in the short physical performance battery (4.1 ± 3.26 vs. 8.2 ± 2.62, P < 0.001), basic activities of daily living (BADL, 4.7 ± 1.71 vs. 5.7 ± 0.57, P < 0.001), and instrumental activities of daily living (IADL, 4.4 ± 2.73 vs. 7.4 ± 1.33, P < 0.001). Frail patients were more likely to have a Mini-Mental State Examination (MMSE) score <24 (55.9% vs. 28.8%, P < 0.001) and take more than five medications (64.1% vs. 47.2%, P = 0.001). Frail patients had a higher incidence of all-cause mortality or readmission (62.8% vs. 47.7%, P = 0.002), all-cause readmission (56.6% vs. 45.9%, P = 0.029), and readmission for non-heart failure (55.2% vs. 41.3%, P = 0.004) during the 3-year follow-up, with a 1.53-fold (95%CI 1.11-2.11, P = 0.009) higher risk of all-cause mortality or readmission, a 1.52-fold (95%CI 1.09-2.11, P = 0.014) higher risk of all-cause readmission, and a 1.70-fold (95%CI 1.21-2.38, P = 0.002) higher risk of readmission for non-clinical heart failure, adjusted for sex, age, polypharmacy, Athens Insomnia Scale, MMSE, LVEF, BADL, and IADL.

CONCLUSIONS

Frailty is common in elderly patients with stage B HFpEF. Physical frailty, particularly low physical activity, can independently predict the long-term prognosis in these patients.

The movement and settlement behaviour of cyprids of Balanus reticulatus on the surfaces of the titanium alloys

The motion paths of Balanus reticulatus cyprids were similar on all the titanium alloys surfaces. On the parallel grinding surfaces, the temporary attachment duration and the settlement ratio of the cyprids were influenced by the roughness and the composition of the surfaces and correlated positively. The surface roughness could also change the contact area and the numbers of the attachment points of the cyprids in the similar pattern. Consequently, the roughness and the composition of the surfaces regulated the cyprid settlement by the temporary attachment duration. The cross grinding increased the temporary attachment duration but drastically decreased the settlement ratio to 0 compared to the parallel grinding, possibly due to the voids and the drastic decrease of the contact area and the numbers of the attachment points of the cyprids on the cross grinding surface, respectively. The cross grinding therefore significantly reduced the cyprid settlement compared to the parallel grinding.

Updated Role of High-frequency Ultrasound in Assessing Dermatological Manifestations in Autoimmune Skin Diseases

Autoimmune skin diseases are a group of disorders that arise due to the dysregulated immune system attacking self-antigens, causing multiple tissue and organ lesions. With disease progression, the physical and psychological health of patients may be seriously damaged. High-frequency ultrasound is non-invasive, reproducible, and suitable for visualizing the fine structure of external organs. The usage of high-frequency ultrasound has increased in recent years in the auxiliary diagnosis and monitoring of various skin diseases; it serves as a promising tool for dermatological disease assessment. This review summarizes the characteristics of high-frequency ultrasound imaging in common autoimmune skin diseases, including systemic lupus erythematosus, scleroderma, psoriasis, dermatomyositis, and pemphigus/pemphigoid. The objective of this review is to provide new ideas and strategies for dermatologists to diagnose and track the prognosis of autoimmune skin diseases.

Facilitating Reversible Cation Migration and Suppressing O2 Escape for High Performance Li-Rich Oxide Cathodes

High-capacity Li-rich Mn-based oxide cathodes show a great potential in next generation Li-ion batteries but suffer from some critical issues, such as, lattice oxygen escape, irreversible transition metal (TM) cation migration, and voltage decay. Herein, a comprehensive structural modulation in the bulk and surface of Li-rich cathodes is proposed through simultaneously introducing oxygen vacancies and P doping to mitigate these issues, and the improvement mechanism is revealed. First, oxygen vacancies and P doping elongates OO distance, which lowers the energy barrier and enhances the reversible cation migration. Second, reversible cation migration elevates the discharge voltage, inhibits voltage decay and lattice oxygen escape by increasing the Li vacancy-TM antisite at charge, and decreasing the trapped cations at discharge. Third, oxygen vacancies vary the lattice arrangement on the surface from a layered lattice to a spinel phase, which deactivates oxygen redox and restrains oxygen gas (O₂ ) escape. Fourth, P doping enhances the covalency between cations and anions and elevates lattice stability in bulk. The modulated Li-rich cathode exhibits a high-rate capability, a good cycling stability, a restrained voltage decay, and an elevated working voltage. This study presents insights into regulating oxygen redox by facilitating reversible cation migration and suppressing O₂ escape.

Performance of Prognostic Risk Scores in Elderly Chinese Patients with Heart Failure

Purpose

Elderly heart failure (HF) patients have different clinical characteristics and poorer prognosis compared with younger patients. Prognostic risk scores for HF have not been validated well in elderly patients. We aimed to validate the Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in an elderly Chinese HF cohort.

Patients and Methods

This retrospective study enrolled 675 elderly HF patients (age≥70 years) discharged from our hospital between 2012 and 2017. The performance of the two risk scores was evaluated in terms of discrimination, using receiver-operating characteristic analysis, and calibration using a calibration plot and Hosmer–Lemeshow (H-L) test. Absolute risk reclassification was used to compare the two scores.

Results

During the mean follow-up time of 32.6 months, 193 patients (28.6%) died, and 1-year mortality was 10.5%. The predicted median 1-year mortality was 8% for the SHFM and 18% for the MAGGIC score. A Kaplan–Meier survival curve demonstrated that event rates of all-cause mortality significantly increased with increasing SHFM and MAGGIC scores. The discriminatory capacity of the SHFM was greater than that of the MAGGIC score (c-statistics were 0.72 and 0.67, respectively; P = 0.05). The calibration plot for the SHFM was better than that for MAGGIC score for 1-year mortality (SHFM: H-L χ² =8.2, P = 0.41; MAGGIC: H-L χ² =18.8, P =0.02). Compared with the MAGGIC score, the net reclassification index (NRI) of the SHFM was 2.96% (Z=5.88, P< 0.0001).

Conclusion

The SHFM performs better than MAGGIC score, having good discrimination, calibration and risk classification for the prediction of 1-year mortality in elderly Chinese HF patients.

Prevalence and Incidence of Heart Failure Among Urban Patients in China: A National Population-Based Analysis

BACKGROUND

Large-scale and population-based studies of heart failure (HF) incidence and prevalence are scarce in China. The study sought to estimate the prevalence, incidence, and cost of HF in China.

METHODS

We conducted a population-based study using records of 50.0 million individuals ≥25 years old from the national urban employee basic medical insurance from 6 provinces in China in 2017. Incident cases were individuals with a diagnosis of HF (International Classification of Diseases code, and text of diagnosis) in 2017 with a 4-year disease-free period (2013-2016). We calculated standardized rates by applying age standardization to the 2010 Chinese census population.

RESULTS

The age-standardized prevalence and incidence were 1.10% (1.10% among men and women) and 275 per 100 000 person-years (287 among men and 261 among women), respectively, accounting for 12.1 million patients with HF and 3.0 million patients with incident HF ≥25 years old. Both prevalence and incidence increased with increasing age (0.57%, 3.86%, and 7.55% for prevalence and 158, 892, and 1655 per 100 000 person-years for incidence among persons who were 25-64, 65-79, and ≥80 years of age, respectively). The inpatient mean cost per-capita was $4406.8 and the proportion with ≥3 hospitalizations among those hospitalized was 40.5%. The outpatient mean cost per-capita was $892.3.

CONCLUSIONS

HF has placed a considerable burden on health systems in China, and strategies aimed at the prevention and treatment of HF are needed. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: ChiCTR2000029094.

[Clinical characteristics of heart failure with recovered ejection fraction]

Objective: To summarize the clinical characteristics of heart failure patients with recovered ejection fraction (HFrecEF) and identify variables capable of predicting left ventricular ejection fraction (LVEF) recovery. Methods: This case control study included patients with heart failure, who admitted to Department of Cardiology of Beijing Hospital from January 1, 2009 to December 31, 2017. The patients were divided into 3 groups based on the baseline LVEF and changes of LVEF: heart failure with reduced ejection fraction (HFrEF, baseline LVEF≤40%, follow-up LVEF≤40% or follow-up LVEF>40% but LVEF increase<10% from baseline), HFrecEF(baseline LVEF≤40%, follow-up LVEF>40% and increase≥10% from baseline), and heart failure with preserved ejection fraction (HFpEF, baseline LVEF>40%). Clinical data were collected and endpoint events (all-cause death, cardiovascular death and sudden death) were recorded. The Log-rank test was used to evaluate the differences of terminal events in different groups, and Kaplan-Meier survival analysis was performed. Logistic regression equation was used to identify prognostic factors of HFrecEF. Results: A total of 310 patients with heart failure were included. There were 91(29.4%) HFrEF patients, 38(12.3%) HFrecEF patients and 181(58.4%) HFpEF patients. Compared with HFrEF patients and HFpEF patients, HFrecEF patients were featured by younger age, more likely to be female, higher systolic blood pressure, diastolic blood pressure and resting heart rate (all P<0.05). Dilated cardiomyopathies were more common, while old myocardial infarctions were less common in HFrecEF (both P<0.05). During a median follow-up of 36.7(18.0, 63.9) months, Kaplan-Meier survival analysis found that HFrecEF patients had the lowest all-cause mortality (Log-rank P=0.047, HFrecEF vs. HFpEF P=0.017, HFrecEF vs. HFrEF P=0.016, and HFpEF vs. HFrEF P=0.782).The cardiovascular mortality ranged from low to high was in HFrecEF patients, HFpEF patients, and HFrEF patients (Log-rank P<0.001, HFrecEF vs. HFpEF P=0.029, HFrecEF vs. HFrEF P<0.001, HFrEF vs. HFpEF P=0.005). Sudden death rate was similar among the three groups (Log-rank P=0.520). Logistic regression analysis showed that left ventricular end-diastolic diameter (LVEDD)≤55 mm (OR=5.922, 95%CI 1.685-20.812, P=0.006), higher diastolic blood pressure (OR=1.058, 95%CI 1.017-1.100, P=0.005), faster resting heart rate (OR=1.042, 95%CI 1.006-1.080, P=0.024), absence of old myocardial infarction (OR=5.343, 95%CI 1.731-16.488, P=0.004) were independent prognostic factors of LVEF recovery after clinical treatment. Conclusions: Patients with HFrecEF are associated with a better prognosis as compared to patients with HFrEF and HFpEF. LVEDD≤55 mm, higher diastolic blood pressure, faster heart rate,and absence of old myocardial infarction are independent prognostic factors of LVEF recovery after clinical treatment.

Microbiologically Influenced Corrosion Behavior of Carbon Steel in the Presence of Marine Bacteria Pseudomonas sp. and Vibrio sp

The microbiologically influenced corrosion (MIC) behavior of carbon steel is investigated in the presence of Vibrio and Pseudomonas. Sterilized natural seawater inoculated with Pseudomonas, Vibrio, and the mixture of Pseudomonas and Vibrio, separately, and they are utilized as the media for corrosion characterizations, which are closer to the natural environment in seawater. Weight loss measurements, electrochemical techniques (the open-circuit potential, electrochemical impedance spectroscopy (EIS), and potentiodynamic polarization curves), and surface analysis (scanning electron microscopy (SEM)) are performed to explore the synergistic effect of Pseudomonas and Vibrio on the corrosion behavior of carbon steel. As seen from the growth curves of bacteria, the growth and propagation of Pseudomonas and Vibrio are affected by their metabolic activities. Besides, the results obtained by SEM show that more severe pitting corrosion is observed on the coupons exposed to the sterilized natural seawater inoculated with the mixture of Pseudomonas and Vibrio. Further, the results from electrochemical measurements and weight loss measurements suggest that under the synergistic effect of Pseudomonas and Vibrio, the initial corrosion rate of carbon steel is inhibited, while the latter corrosion is enhanced.

A Phase 1 randomized study compare the pharmacokinetics, safety and immunogenicity of HLX02 to reference CN- and EU-sourced trastuzumab in healthy subjects

PURPOSE

This study evaluated the bioequivalence of China-manufactured biosimilar, HLX02, to reference China (CN)- and European Union (EU)-sourced trastuzumab.

METHODS

This was a two-part Phase 1 study conducted in healthy Chinese males. Part 1 evaluated the safety of different doses of HLX02 (2, 4, 6 or 8 mg/kg; intravenous infusion over 90 min, n = 3 per group). Part 2, a randomized, double-blind study, investigated the pharmacokinetics (PK), safety and immunogenicity of study drugs (HLX02 [n = 37], CN-trastuzumab [n = 35] or EU-trastuzumab [n = 37] at the dose suggested by Part 1 results). The primary PK endpoint was the area under the serum concentration-time curve from time 0 to infinity (AUC_inf). Equivalence was concluded if the 90% confidence interval (CI) for the geometric least squares mean ratio (GLSMR) fell in the equivalence criteria of 0.80-1.25.

RESULTS

In Part 1, all doses of HLX02 were well tolerated and 6 mg/kg was suggested for Part 2. The GLSMRs and 90% CIs for AUC_inf were: 0.950 (0.891-1.013), 0.914 (0.858-0.973) and 0.962 (0.902-1.025) for HLX02 versus CN-trastuzumab, HLX02 versus EU-trastuzumab and CN-trastuzumab versus EU-trastuzumab, respectively. Secondary endpoints comparisons also fell in the equivalence criteria. Treatment-emergent adverse events were reported in 75.7, 86.5 and 70.3% of the subjects in HLX02, CN-trastuzumab, and EU-trastuzumab groups, respectively. No serious adverse events or deaths occurred. No treatment-related anti-drug antibodies were detected.

CONCLUSION

This study demonstrated comparable safety profiles and PK bioequivalence among HLX02, CN-trastuzumab and EU-trastuzumab in healthy Chinese male subjects.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT02581748, registered at October 19, 2015.

Dynamics of chiral state transitions and relaxations in an FeGe thin plate via in situ Lorentz microscopy

Studying the magnetic transition between different topological spin textures in noncentrosymmetric magnets under external stimuli is an important topic in chiral magnetism. Here, using in situ Lorentz transmission electron microscopy (LTEM) we directly visualize the thermal-driven magnetic transitions and dynamic characteristics in FeGe thin plates. A novel protocol-dependent phase diagram of FeGe thin plates was obtained via pulsed laser excitation. Moreover, by setting the appropriate specimen temperature, the relaxation of chiral magnetic states in FeGe specimens was recorded and analyzed with an Arrhenius-type relaxation mechanism. We present the field-dependent activation energy barriers for chiral state transitions and the magnetic transition pathways of these spin textures for FeGe thin plates. Our results unveil the effects of thermal excitation on the topological spin texture transitions and provide useful information about magnetic dynamics of chiral magnetic state relaxation.

Magnetic quantification of single-crystalline Fe and Co nanowires via off-axis electron holography

Investigating the local micromagnetic structure of ferromagnetic nanowires (NWs) at the nanoscale is essential to study the structure-property relationships and can facilitate the design of nanostructures for technology applications. Herein, we synthesized high-quality iron and cobalt NWs and investigated the magnetic properties of these NWs using off-axis electron holography. The Fe NWs are about 100 nm in width and a few micrometers in length with a preferential growth direction of [100], while the Co NWs have a higher aspect-ratio with preferential crystal growth along the [110] direction. It is noted that compact passivation surface layers of oxides protect these NWs from further oxidation, even after nearly two years of exposure to ambient conditions; furthermore, these NWs display homogeneous ferromagnetism along their axial direction revealing the domination of shape anisotropy on magnetic behavior. Importantly, the average value of magnetic induction strengths of Fe NWs (2.07 {±} 0.10 T) and Co NWs (1.83 {±} 0.15 T) is measured to be very close to the respective theoretical value, and it shows that the surface oxide layers do not affect the magnetic moments in NWs. Our results provide a useful synthesis approach for the fabrication of single-crystalline, defect-free metal NWs and give insight into the micromagnetic properties in ferromagnetic NWs based on the transmission electron microscopy measurements.

Corrosion Behavior of AISI 1045 Steel in Seawater in the Presence of Flavobacterium sp

A systematic comparison study was carried out to investigate the effect of Flavobacterium sp. on AISI 1045 steel corrosion by weight loss, fluorescence microscopy (FM), surface analysis, cell count, pH measure, electrochemical impedance spectroscopy (EIS), and polarization curves. The impedances were considerably increased by Flavobacterium sp. between 1 and 7 day exposure and after 30 day exposure but considerably decreased by Flavobacterium sp. after 15 and 21 day exposure, which were supported by the I_corr results and the weight loss data. Furthermore, the biofilm was formed on the coupons. The pH values were considerably decreased by Flavobacterium sp. after 15 and 21 day exposure. The results proved that Flavobacterium sp. decreased the corrosion rates between 1 and 7 day exposure and after 30 day exposure and increased the corrosion rates between 15 and 21 day exposure, which could be ascribed to the protective biofilm and the secreted corrosive acid, respectively. In addition, Flavobacterium sp. considerably increased the pit numbers, the maximum pit depths, and the corresponding widths and considerably decreased the E_pit values. Importantly, the coverage and the heterogeneity of the biofilm were positively correlated with the increases in the maximum pit depths and the corresponding widths and the decreases in the E_pit values by Flavobacterium sp. The results demonstrated that Flavobacterium sp. increased the pitting corrosion, which could involve the heterogeneous biofilm cover.

[Contemporary epidemiology and treatment of hospitalized heart failure patients in real clinical practice in China]

Objective: To observe the etiology, comorbidities, clinical features and treatment patterns of hospitalized patients with heart failure (HF) in China. Methods: Data were collected prospectively on hospitalized patients with HF who were enrolled in China Heart Failure Center Registry Study from 169 participating hospitals from January 2017 to August 2018. In this cross-sectional study, patients were stratified by left ventricular ejection fraction (LVEF) category: heart failure with reduced ejection fraction (HFrEF, LVEF<40%); heart failure with mid-ranged ejection fraction (HFmrEF, 40%≤LVEF<50%) and heart failure with preserved ejection fraction (HFpEF, LVEF≥50%). The clinical data were collected, including demographic information, diagnosis, signs, electrocardiogram, echocardiography, laboratory tests, and treatment. Results: A total of 31 356 hospitalized patients with HF were included, 19 072 (60.8%) were males and the average age was (67.9±13.6) years old. The common causes of HF were hypertension (57.2%), coronary heart disease (54.6%), dilated cardiomyopathy (14.7%), valvular heart disease (9.2%). The common complications were atrial fibrillation/atrial flutter (34.1%), diabetes (29.2%), and anemia (26.7%). 32.8% of patients had a history of hospitalization for HF within the previous 12 months. There were 11 034 (35.2%) patients with HFrEF, 6 825 (21.8%) patients with HFmrEF and 13 497 (43.0%) patients with HFpEF. Compared with patients with HFpEF, patients with HFrEF had a lower systolic blood pressure ((124.7±21.1)mmHg(1 mmHg=0.133 kPa) vs. (134.9±22.9)mmHg), faster heart rate ((85±19) beats/minutes vs. (81±19)beats/minutes), and higher percentage of New York Heart Association (NYHA) class Ⅳ, smoking, alcohol, left bundle branch block, and QRS time≥130 ms, and higher levels of blood uric acid, BNP, and NT-proBNP (all P<0.05). Compared with patients with HFmrEF and HFrEF, patients with HFpEF were older, more women, and higher comorbidity burden including hypertension, atrial fibrillation/atrial flutter, anemia and chronic obstructive pulmonary disease (all P<0.05). HFmrEF took a mid-position between HFrEF and HFpEF in age, gender, heart rate, systolic blood pressure, hypertension, atrial fibrillation/atrial flutter, anemia, and chronic obstructive pulmonary disease (all P<0.05). Patients with HFmrEF had the highest proportion of coronary heart disease, myocardial infarction and percutaneous coronary intervention (all P<0.05). During hospitalization, loop diuretics were used in 90.2% of patients, and intravenous inotropics were used in 20.4% of patients. The use of ACEI/ARB/ARNI, β blockers and aldosterone receptor antagonists at discharge were 71.8%, 79.1% and 83.6% in HFrEF and 69.9%, 75.5% and 72.4% in HFmrEF, respectively. The use of digoxin at discharge was 25.3% (HFrEF 36.7%, HFmrEF 23.1%, HFpEF 17.0%). The rates of cardiac resynchronization therapy and implantable cardioverter defibrillator in HFrEF were 2.7% and 2.1%. Conclusions: Among the hospitalized patients with HF in China, coronary heart disease and hypertension are the mostly prevalent causes. HFpEF accounts for a large proportion of hospitalized patients with HF. HFrEF, HFmrEF and HFpEF have different etiology and clinical features. In real-world, there are still large gaps in the effective application of the guideline recommended therapies to HF patients, especially the non-pharmacological therapy option, which needs to be improved further in China.

CdSSe nanowire-chip based wearable sweat sensor

Background

Sweat, as an easily accessible bodily fluid, is enriched with a lot of physiological and health information. A portable and wearable sweat sensor is an important device for an on-body health monitoring. However, there are only few such devices to monitor sweat. Based on the fact that sweat is mainly composed of moisture and salt which is much more abundant than other trace ions in sweat, a new route is proposed to realize wearable sweat sensors using CdSSe nanowire-chips coated with a polyimide (PI) membrane.

Results

Firstly, the composition-graded CdS_1−xSe_x (x = 0–1) nanowire-chip based sensor shows good photo-sensitivity and stress sensitivity which induces linear humidity dependent conductivity. This indicates good moisture response with a maximum responsivity (dI/I) 244% at 80% relative humidity (RH) even in the dark. Furthermore, the linear current decrease with salt increase illustrates the chip sensor has a good salt-sensing ability with the best salt dependent responsivity of 80%, which guarantees the high prediction accuracy in sweat sensing. The sensor current is further proven to nonlinearly correlate to the amount of sweat with excellent stability, reproducibility and recoverability. The wearable sweat sensor is finally applied on-body real-time sweat analysis, showing good consistence with the body status during indoor exercise.

Conclusions

These results suggest that this CdSSe nanowire-chip based PI-coated integrated sensor, combined with inorganic and organic functional layers, provides a simple and reliable method to build up diverse portable and wearable devices for the applications on healthcare and athletic status.

Electronic supplementary material

The online version of this article (10.1186/s12951-019-0480-4) contains supplementary material, which is available to authorized users.

Characterization of urinary biomarkers and their relevant mechanisms of zoledronate-induced nephrotoxicity using rats and HK-2 cells

The aim of this study was to identify biomarkers of zoledronate-induced nephrotoxicity and to further characterize the mechanisms underlying this process by analyzing urinary metabolites. Twenty-four rats were randomly divided into four groups containing four (two control groups) or eight rats (two zoledronate groups) per group. The rats were injected intravenously with saline or zoledronate (3 mg/kg) singly (single, 3 weeks) or repeatedly eight times (3 weeks/time, 24 weeks). Serum blood urea nitrogen, serum creatinine, creatinine clearance, and kidney injury observed by hematoxylin and eosin and immunohistochemical staining were changed only in the repeated zoledronate group (3 mg/kg, 3 weeks/time, 24 weeks). Urinary levels of S-adenosylmethionine, S-adenosylhomocysteine, l-cystathionine, l-γ-glutamylcysteine, and glutathione related to glutathione metabolism and fumaric acid and succinic acid related to the tricarboxylic acid cycle in the zoledronate-treated group (3 mg/kg, 3 weeks/time, 24 weeks) were significantly lower than those in the control group, suggesting that zoledronate may cause cellular oxidative stress. Besides, urinary levels of uracil and uridine related to pyrimidine metabolism also decreased after zoledronate treatment (3 mg/kg, 3 weeks/time, 24 weeks), while the levels of hypoxanthine related to purine metabolism, histamine related to histamine metabolism, and several amino acids were significantly increased. Moreover, zoledronate-induced enhanced oxidative stress and histamine overproduction were confirmed by reactive oxygen species (ROS) and histamine measurement in a human proximal tubular cell line. Taken together, zoledronate-induced nephrotoxicity may be attributed to it inducing perturbations in glutathione biosynthesis and the tricarboxylic acid cycle, further causing ROS overproduction, oxidative stress, and cellular inflammation, thereby leading to nephrotoxicity.

Accuracy enhancement of laser induced breakdown spectra using permittivity and size optimized plasma confinement rings

The inevitable problems in laser induced breakdown spectroscopy are matrix effect and statistical fluctuation of the spectral signal, which can be partly avoided by utilizing a proper confined unit. The dependences of spectral signal enhancement on relative permittivity were studied by varying materials to confine the plasma, which include polytetrafluoroethylene(PTFE), nylon/dacron, silicagel, and nitrile-butadiene rubber (NBR) with the relative permittivity 2.2, ~3.3, 3.6, 8~13, 15~22. We found that higher relative permittivity rings induce stronger enhancement ability, which restricts the energy dissipation of plasma better and due to the reflected electromagnetic wave from the wall of different materials, the electromagnetic field of plasma can be well confined and makes the distribution of plasma more orderly. The spectral intensities of the characteristic lines Si I 243.5 nm and Si I 263.1 nm increased approximately 2 times with relative permittivity values from 2.2 to ~20. The size dependent enhancement of PTFE was further checked and the maximum gain was realized by using a confinement ring with a diameter size of 5 mm and a height of 3 mm (D5mmH3mm), and the rings with D2mmH1mm and D3mmH2mm also show higher enhancement factor. In view of peak shift, peak lost and accidental peaks in the obtained spectra were properly treated in data progressing; the spectral fluctuation decreased drastically for various materials with different relative permittivities as confined units, which means the core of plasma is stabilized, attributing to the confinement effect. Furthermore, the quantitative analysis in coal shows wonderful results-the prediction fitting coefficient R² reaches 0.98 for ash and 0.99 for both volatile and carbon.

[Pathological characteristics of the heart and coronary artery from elderly heart failure patients with preserved ejection fraction and coronary artery disease]

Objective: To analyze the pathological feathers of the heart in elderly (60-99 years old) heart failure patients with preserved ejection fraction (HFpEF) and coronary artery disease (CAD) and to explore the misdiagnosis and missed diagnosis rates. Method: This retrospective study included 154 HFpEF (left ventricular ejection fraction (LVEF)≥50%) cases and 49 heart failure with reduced ejection fraction (HFrEF) (LVEF≤40%) cases aged 60-99 years old out of 1 485 consecutive autopsy cases. Pathological changes of the heart and coronary artery were compared between patients with HFpEF and HFrEF. The misdiagnosis and missed diagnosis rates of HFpEF were analyzed based on pathological examination. Results: Patients with HFpEF were older than those with HFrEF ((85.7±7.4) vs. (82.9±7.8) years old, P=0.017). Among all the cases, CAD was diagnosed in 105 (68.2%) HFpEF patients and 38 (77.6%) HFrEF patients. Compared with patients with HFrEF, HFpEF patients displayed less acute myocardial infarction (12.3%(19/154) vs. 59.2%(29/49), P<0.01) and more chronic myocardial ischemia (18.2%(28/154) vs. 6.1%(3/49), P=0.041). 51.9% (80/154) HFpEF and 71.4% (35/49) HFrEF patients (P=0.017) displayed >50% left anterior descending artery stenosis. Prevalence of >75% coronary arterial stenosis (51% (25/49) vs. 20.1%(31/154), P<0.001) and more than one vessel lesions (55.1%(27/49) vs. 33.8%(52/154), P=0.008) were significantly higher in HFrEF patients than in HFpEF patients. The misdiagnosis rate of CAD in HFpEF was 63.3% (31/49). Among HFpEF, the missed diagnosis rate of acute myocardial infarction was 57.9% (11/19) and the missed diagnosis rate of old myocardial infarction was 57.7% (45/78). Conclusions: CAD and chronic myocardial ischemia are common in elderly patients with HFpEF. Chronic myocardial ischemia may play an important role in the development of HFpEF of elderly CAD patients. Among HFpEF patients, the misdiagnosis rate of CAD and missed diagnosis rate of myocardial infarction are high, so the accurate evaluation of myocardial ischemia status is of great importance.

[Pathological features at autopsy in elderly patients with acute myocardial infarction]

Objective: To analyze the cardiac pathological features of elderly coronary artery disease (CAD) patients (60 years and over) and evaluate the pathological features at autopsy and risk factors of patients with acute myocardial infarction (AMI). Methods: Data from 471 elderly patients (aged from 60 to 100 years old) with CAD confirmed by autopsy hospitalized in our hospital from April 1969 to October 2013 were retrospectively reviewed. Patients were divided into 2 groups: AMI group(n=128) with AMI as the primary cause of death and the rest served as control group(n=343). The pathological features of coronary lesion and related risk factors of AMI were analyzed. Results: In patients aged 60 and over with CAD, 48.8%(230/471) had severe coronary stenosis, 18.7%(88/471) had three-vessel disease, 71.8% cases (338/471) had left anterior descending artery(LAD)grade Ⅲ and over stenosis, 29.9% (141/471) had LAD grade Ⅳ stenosis, 25.9%(122/471) had left main coronary artery(LM) grade Ⅲ and over stenosis, 9.6%(45/471) had LM grade Ⅳ stenosis, 27.1%(128/471) had AMI. The first AMI accounts for 39.1%(50/128), and 60.9%(78/128) had both AMI and old MI. Compared with the control group, AMI group were younger ((77.1±11.6) years vs. (83.2±9.1) years, P<0.01), had more severe coronary artery stenosis lesion (77.3%(99/128) vs. 38.2%(131/343), P<0.01), higher coronary index which reflects the overall arteriosclerosis (9.9±2.8 vs. 8.0±2.5, P<0.01), more three-vessel disease (30.3%(43/128) vs. 13.7%(45/343), P<0.01), heavier heart weight ((447.8±90.6)g vs. (426.6±99.1)g, P<0.05), higher prevlence of pulmonary congestion or edema (57.8%(74/128) vs. 39.9%(137/343), P<0.01). Twenty-three cardiac ruptures (23/128, 18.0%) were observed in AMI group. Logistic regression analysis showed that grade Ⅳ LAD stenosis (OR=3.55, 95%CI 2.05-6.17, P<0.01), three-vessel disease(OR=2.47, 95%CI 1.30-4.67, P<0.01) were the independent risk factors of AMI in elderly patients with CAD. Conclusions: Severe coronary stenosis is common in CAD patients aged 60 and over. Patients aged 60 and over with AMI have more severe coronary artery stenosis lesion and heavier heart weight. Cardiac rupture is not uncommon in elderly patients with AMI. Severe LAD stenosis and three-vessel disease are the independent risk factors of AMI in the elderly.

β-Fluorinated porpholactones and metal complexes: synthesis, characterization and some spectroscopic studies

We describe the synthesis of β-fluorinated porpholactones by oxidation of the fluorinated CC bond of the pyrrolic subunit in porphyrin using the “RuCl₃ + Oxone®” protocol.

Reduction of lasing threshold by protecting gas and the structure dependent visual lasing mode of various CdS microstructures

The lasing behaviours of semiconductor micro/nanostructures were studied in different gaseous surroundings, and the lasing threshold of the nanowire was reduced from 10.5 MW/cm² in air to 9.82 MW/cm², 8.25 MW/cm² and 7.22 MW/cm² in Ar, N₂ and He environment, respectively. It is attributed to the transient polarization of molecular gas. Moreover, the narrow-bandwidth lasing from the junction of a comb-like microstructure is hard to realize compared to that in nanowire and nanobelt due to the absence of good resonance cavities, and the only amplified spontaneous emission was observed by the ICCD dynamic images of the photoluminescence. The PL spectra and ICCD dynamic images, as well as lifetime measurement, prove the occurrence of lasing in nanowires and nanobelts with the pumping power increase, which should originate from the exciton-electron scattering and the formation of EHP, respectively. The whispering-gallery-mode lasing in nanowire and Fabry-Perot-Mode lasing in nanobelt were intuitively demonstrated by the ICCD images. The results provide one route to reduce the lasing threshold by the gas protection.

The polarization modulation and fabrication method of two dimensional silica photonic crystals based on UV nanoimprint lithography and hot imprint

Based on a silica sol-gel technique, highly-structurally ordered silica photonic structures were fabricated by UV lithography and hot manual nanoimprint efforts, which makes large-scale fabrication of silica photonic crystals easy and results in low-cost. These photonic structures show perfect periodicity, smooth and flat surfaces and consistent aspect ratios, which are checked by scanning electron microscopy (SEM) and atomic force microscopy (AFM). In addition, glass substrates with imprinted photonic nanostructures show good diffraction performance in both transmission and reflection mode. Furthermore, the reflection efficiency can be enhanced by 5 nm Au nanoparticle coating, which does not affect the original imprint structure. Also the refractive index and dielectric constant of the imprinted silica is close to that of the dielectric layer in nanodevices. In addition, the polarization characteristics of the reflected light can be modulated by stripe nanostructures through changing the incident light angle. The experimental findings match with theoretical results, making silica photonic nanostructures functional integration layers in many optical or optoelectronic devices, such as LED and microlasers to enhance the optical performance and modulate polarization properties in an economical and large-scale way.

Induction of C/EBP homologous protein-mediated apoptosis and autophagy by licochalcone A in non-small cell lung cancer cells

Licochalcone A (LCA), a flavonoid isolated from the famous Chinese medicinal herb Glycyrrhiza uralensis Fisch, presents obvious anti-cancer effects. In this study, the anti-cancer effects and potential mechanisms of LCA in non-small cell lung cancer (NSCLC) cells were studied. LCA decreased cell viability, increased lactate dehydrogenase release, and induced apoptosis in a concentration-dependent manner in NSCLC cells while not in human embryonic lung fibroblast cells. The expression of phosphatidylethanolamine-modified microtubule-associated protein light-chain 3 (LC3-II) and formation of GFP-LC3 punta, two autophagic markers, were increased after treatment with LCA. LCA-induced LC3-II expression was increased when combined with chloroquine (CQ), while knock-down of autophagy related protein (ATG) 7 or ATG5 reversed LCA-induced LC3-II expression and GFP-LC3 punta formation, suggesting that LCA induced autophagy in NSCLC cells. Inhibition of autophagy could not reverse the LCA-induced cell viability decrease and apoptosis. In addition, LCA increased the expression of endoplasmic reticulum stress related proteins, such as binding immunoglobulin protein and C/EBP homologous protein (CHOP). Knock-down of CHOP reversed LCA-induced cell viability decrease, apoptosis, and autophagy. Taken together, LCA-induced autophagic effect is an accompanied phenomenon in NSCLC cells, and CHOP is critical for LCA-induced cell viability decrease, apoptosis, and autophagy.

[Clinicopathological characteristics of aortic aneurysm in elderly patients]

OBJECTIVE

To explore the prevalence and clinicopathological features of aortic aneurysm (AA) in elderly inpatients at autopsy.

METHODS

All the AA cases were retrospectively analyzed in 909 autopsy cases aged 60-100 years in our hospital. The pathological changes, comorbidities and death reasons were evaluated.

RESULTS

AA was diagnosed pathologically in 59 patients (6.5%), clinical diagnosis was not made in 37(62.7%) cases. The AA prevalence in patients aged ≥ 80 years was significantly higher than patients <80 years (10.2% vs. 2.9%, χ(2)=19.97, P<0.01). Abdominal AA was more common (91.5%) and the prevalence of multiple AA was 20.3%. Coronary artery disease (CAD) was diagnosed in 44 AA patients (74.6%) including 21(35.6%) with severe coronary artery stenosis and 7(11.9%) with three-vessel disease, 31 patients (52.5%) died of cardiac-cerebral diseases, including 7(11.9%) with ruptured AA.

CONCLUSIONS

The prevalence of AA was high in elderly inpatients aged ≥80 years with a relatively high missed diagnosis rate. AA was often complicated with CAD. The main cause of death of AA patients was cardiac-cerebral diseases. The screening, evaluation and treatment of AA should be enhanced in elderly patients, especially in patients aged 80 years and over.

[Pathological characteristics of coronary artery disease in elderly patients aged 80 years and over]

OBJECTIVE

To define the pathological changes of coronary artery and compare the clinical diagnosis and pathological diagnosis differences in elderly patients aged 80 and over.

METHODS

A total of 909 autopsy cases aged 60-100 years in our hospital from April 1st 1969 to October 31th 2013 were analyzed. The prevalence and pathological features of coronary artery disease (CAD) in cases aged 80 years and over were compared with those aged 60-79 years old. The misdiagnosis and missed diagnosis rate were calculated.

RESULTS

The prevalence of CAD by autopsy (63.8% (289/453) vs. 39.9% (182/456), P<0.01), old myocardial infarction (OMI) by autopsy (63.0% (182/289) vs. 51.6% (94/182), P<0.05) and chronic myocardial ischemia by autopsy (22.5% (65/289) vs. 7.1% (13/182), P<0.01) were significantly higher while the prevalence of acute myocardial infarction (AMI) by autopsy was significantly lower (22.1% (64/289) vs. 42.9% (78/182), P<0.01) in aged 80 and over group compared to 60-79 years old group. The misdiagnosis rate of CAD was 65.2% (107/164), the missed diagnosis rate of OMI was 62.1% (113/182) and the missed diagnosis rate of AMI was 37.5% (24/64) in the aged 80 and over group.

CONCLUSIONS

The prevalence of CAD and misdiagnosis and missed diagnosis rate are high in dead inpatients aged 80 years and over. OMI is more common but often missed in this group. Thus, the diagnosis and evaluation of CAD should be enhanced in this patient group.

Phase II study of dendritic cell vaccination combined with recombinant adenovirus-p53 in treatment for patients with advanced pancreatic carcinoma

3049

Background: There are few choices of treatments for advanced pancreatic carcinoma (PC) due to the resistances to chemo- or radio-therapy. Immunotherapy based on dendritic cell (DC) vaccines and p53-based gene therapy are two promising therapeutic modalities. They also demonstrated favorable safety profiles. In this study, we compared the immunological and clinical response between DC vaccine therapy and DC vaccine combined with recombinant adenovirus-p53 (rAd-p53) gene therapy. Methods: Thirty-six patients with a stage IV pancreatic cancer, 21 men and 15 women with an average age of 56.2 years old, were included in this study and randomly assigned to two groups: 16 patients in DC group (DCG) and 20 in DC plus rAd-p53 group (DPG). The DCG patients received autologous antigen-loaded DC (antigen from isolated pancreatic cancer cells) and the DPG patients received both DC and rAd-p53. DC vaccines were injected intra-dermally once every week for 4 injections and rAd-p53 were given by intravenous injections once per 3 days for 5 times at a dose of 3 x 1012viral particles. The response, safety and peripheral blood lymphocyte subsets were investigated. Results: The post-treatment CD3+, CD3+CD4+, CD4+/CD8+ ratio of patients’ peripheral blood in both groups were increased. But the percent of CD4+CD25+ regulatory T cells were significantly decreases. In DPG, 5 patients had a partial response (PR) and 4 patients had stable disease (SD) according to the RECIST standard. The 3 and 3 DCG patients achieved a PR and SD, respectively. The disease control rates (PR+SD) were 45.0% and 37.5% for DPG and DCG, respectively. The 6-month overall survival rates were 50.0% and 43.8% for DPG and DCG, respectively. The median survival times were 6.8 and 5.5 months for DPG and DCG, respectively. Mild to medium grade fever was observed in most of the patients in the two groups. No serious adverse events were found. Conclusions: DC-based immunotherapy and p53 gene therapy are safe and appropriate treatments for patients with advanced pancreatic carcinoma. The combined treatments showed more beneficial results than the DC immunotherapy alone.