Intensive Treatment of Organic Wastewater by Three-Dimensional Electrode System within Mn-Loaded Steel Slag as Catalytic Particle Electrodes

Developing a green, low-carbon, and circular economic system is the key to achieving carbon neutrality. This study investigated the organics removal efficiency in a three-dimensional electrode reactor (3DER) constructed from repurposed industrial solid waste, i.e., Mn-loaded steel slag, as the catalytic particle electrodes (CPE). The CPE, a micron-grade material consisting primarily of transition metals, including Fe and Mn, exhibited excellent electric conductivity, catalytic ability, and recyclability. High rhodamine B (RhB) removal efficiency in the 3DER was observed through a physical modelling experiment. The optimal operating condition was determined through a single-factor experiment in which 5.0 g·L-1 CPE and 3 mM peroxymonosulfate (PMS) were added to a 200 mL solution of 10 mM RhB under a current intensity of 0.5 A and a 1.5 to 2.0 cm distance between the 2D electrodes. When the initial pH value of the simulated solution was 3 to 9, the RhB removal rate exceeded 96% after 20 min reaction. In addition, the main reactive oxidation species in the 3DER were determined. The results illustrated that HO• and SO4•- both existed, but that the contribution of SO4•- to RhB removal was much lower than that of HO• in the 3DER. In summary, this research provides information on the potential of the 3DER for removing refractory organics from water.

Ten-Year Outcomes of Hypofractionated (45 Gy in 9 Fractions) Intensity Modulated Radiotherapy for Localized Prostate Cancer

PURPOSE/OBJECTIVE(S)

We reported 10-year outcomes of localized prostate cancers treated with hypofractionated intensity-modulated radiotherapy of 45 Gy in 9 consecutive fractions.

MATERIALS/METHODS

From October 2011 to April 2017, thirty patients with localized prostate cancer were enrolled in this prospective trial. The median age of the patients was 72.5 years. According to NCCN recurrence risk criteria, eight patients were at low-risk group, 17 at intermediate risk group, 5 at high-risk group. All patients were treated with hypofractionated intensity-modulated radiotherapy (IMRT) of 45 Gy in 9 consecutive fractions to their prostate with or without seminal vesicles. Before radiotherapy, three gold fiducials were implanted into the prostate. In order to reduce the rectal high dose irradiation volume, an inflated rectal balloon was placed in the rectum at simulation and every treatment and patients were treated with comfortable full bladder. Static Intensity-modulated radiotherapy (SIMRT) was applied in 1 patient, Volumetric Modulated Arc Therapy (VMAT) in 27 patients, and tomotherapy in 2 patients. Image guided radiotherapy (IGRT) with gold fiducial registration was adopted. Twenty-six patients also received androgen deprivation therapy (ADT). The median time of ADT was 6 months. Progression⁃free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier analysis. All grade ≥1 genitourinary (GU) and gastrointestinal (GI) toxicities were recorded using Common Terminology Criteria for Adverse Event version 5.0 (CTCAE 5.0) and Radiation Therapy Oncology Group (RTOG) late morbidity criteria, and GU and GI toxicities were cumulatively calculated.

RESULTS

After a median follow-up of 102 months (65∼131 months), the 10-year OS was 90.0% (95% confidence interval, 83.3%-96.7%), and the 10-year PFS was 86.5% (95% confidence interval, 79.1%-93.9%). According to CTCAE 5.0, grade 1 acute gastrointestinal (GI) toxicity developed in 12 patients, grade 2 in 2 patients, grade 3 in 2 patients, and grade 1 acute genitourinary (GU) toxicity developed in 12 patients, grade 2 in 2 patients, and no grade 3 or higher toxicity occurred. According to RTOG late morbidity criteria, late (≥3 months after radiotherapy) grade 1 GI toxicity developed in 4 patients (13.3%), grade 2 in 1 (3.3%), grade 3 in 1 (3.3%), and late grade 1 GU toxicity occurred in 1 patient (3.3%), grade 2 in 1 (3.3%), grade 3 in 1 (3.3%). No grade 4 or higher GI and GU toxicities developed. Only one grade 3 GI and one grade 2 GU toxicities were observed for the maximum toxicity at the last follow-up. The potency was not evaluated.

CONCLUSION

The 10-year oncologic outcomes of this shortened hypofractionated IMRT regimen for mainly low/intermediate risk prostate cancer patients is favorable with acceptable acute and late toxicities.

[Clinical features of SF3B1 mutation in patients with myelodysplastic syndrome with excess blasts]

Objective: To exploring the clinical features of SF3B1-mutated myelodysplastic syndrome with excess blasts (MDS-EB) and analyzing the association between SF3B1 mutation, and efficacy and prognostic significance for patients with MDS-EB. Methods: This was a retrospective case series study. The clinical data of 266 patients with MDS-EB diagnosed in the First Affiliated Hospital of Zhengzhou University between April 2016 and November 2021 were analyzed. The observed indicators included blood routine counts, mutated genes, overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and leukemia-free survival (LFS). The Kaplan-Meier method was used to depict the survival curves. The Log-rank test method was equally used to compare survival across groups and performed the Cox proportional hazard regression model for prognostic analysis. Results: In 266 patients with MDS-EB, 166 (62.4%) were men, and the median age was 57 (17-81) years. Moreover, there were included 26 and 240 patients in the SF3B1-mutated and SF3B1 wild-type groups. Patients in the SF3B1-mutated group were older [median age 65 (51, 69) years vs. 56 (46, 66) years, P=0.033], had higher white blood cell (WBC) counts [3.08 (2.35, 4.78) × 10⁹/L vs. 2.13 (1.40, 3.77) × 10⁹/L], platelet (PLT) counts [122.5 (50.5, 215.0) ×10⁹/L vs. 49.0 (24.3, 100.8) × 10⁹/L], absolute neutrophil counts (ANC) [1.83 (1.01, 2.88) × 10⁹/L vs. 0.80 (0.41, 1.99) × 10⁹/L]and occurrence of DNMT3A mutation [23.1% (6/26) vs. 6.7% (16/240)] (all P<0.05). The ORR were similar in both groups after 2 and 4 cycles of therapy (P=0.348, P=1.000). Moreover, the LFS (P=0.218), PFS (P=0.179) and OS (P=0.188) were similar across the groups. Univariate Cox analysis revealed that SF3B1 mutation did not affect the prognosis of patients with MDS-EB (OS: P=0.193; PFS: P=0.184). Conclusions: Patients with SF3B1 mutation were older, with greater WBC, PLT, and ANC, and SF3B1 mutation easily co-occurred with DNMT3A mutation. From this model, there were no significant differences in efficacy and survival of MDS-EB with or without SF3B1 mutation.

Long-term Cardiovascular Risks of Gonadotropin-releasing Hormone Agonists and Antagonists: a Population-based Cohort Study

AIMS

Gonadotropin-releasing hormone (GnRH) agonists and antagonists, critical medications for prostate cancer (PCa) treatment, may differ in cardiovascular safety. This prospective cohort study aimed to compare the long-term cardiovascular risks between GnRH agonists and antagonists.

MATERIALS AND METHODS

Patients with PCa receiving GnRH agonists or antagonists during 2013-2021 in Hong Kong were identified. Patients with <6 months' prescriptions, who were switching between drugs, had missing baseline prostate-specific antigen level or had a prior stroke or myocardial infarction were excluded. Patients were followed up until September 2021. The primary outcome was major adverse cardiovascular events (MACE) as in the PRONOUNCE trial (MACE_PRONOUNCE), i.e. a composite of all-cause mortality, stroke and myocardial infarction. The secondary outcome was MACE_CVM, i.e. a composite of cardiovascular mortality, stroke and myocardial infarction. Inverse probability treatment weighting was used to balance covariates between groups. The Log-rank test was used to compare the cumulative freedom from the primary outcome between groups.

RESULTS

In total, 2479 patients were analysed (162 GnRH antagonist users and 2317 agonist users; median age 75.0 years, interquartile range 68.0-81.6 years). Inverse probability treatment weighting achieved good covariate balance between groups. Over a median follow-up duration of 3.0 years (interquartile range 1.7-5.0 years), 1115 patients (45.0%) had MACE_PRONOUNCE and 344 (13.9%) had MACE_CVM. GnRH agonist users had lower risks of MACE_PRONOUNCE (Log-rank P < 0.001) and MACE_CVM (Log-rank P = 0.027). However, no differences were observed within 1 year of follow-up (MACE_PRONOUNCE: Log-rank P = 0.308; MACE_CVM: Log-rank P = 0.357). Among patients without cardiovascular risk factors at baseline, GnRH agonist users had lower risks of MACE_PRONOUNCE (Log-rank P < 0.001) and MACE_CVM (Log-rank P = 0.001), whereas no differences were observed in those with such risk factor(s) (MACE_PRONOUNCE: Log-rank P = 0.569; MACE_CVM: Log-rank P = 0.615).

CONCLUSIONS

GnRH antagonists may be associated with higher long-term, but not short-term, cardiovascular risks than agonists in Asian patients with PCa, particularly in those without known cardiovascular risk factors.

[The efficacy of radiotherapy based combined therapy for unresectable locally invasive bladder cancer and its associated factors analysis]

Objective: Retrospective analysis of the efficacy and influencing factors of bladder preservation integrated therapy for unresectable invasive bladder cancer confined to the pelvis was done, also including the bladder function preservation and adverse effects analysis. Methods: Sixty-nine patients with unresectable locally invasive bladder cancer who received radiotherapy-based combination therapy from March 1999 to December 2021 at our hospital were selected. Among them, 42 patients received concurrent chemoradiotherapy, 32 underwent neoadjuvant chemotherapyand 43 with transurethral resection of bladder tumors (TURBT) prior to radiotherapy. The late adverse effect of radiotherapy, preservation of bladder function, replase and metastasis and survival were followed-up. Cox proportional hazards models were applied for the multifactorial analysis. Results: The median age was 69 years. There were 63 cases (91.3%) of uroepithelial carcinoma, 64 of stage Ⅲ and 4 of stage Ⅳ. The median duration of follow-up was 76 months. There were 7 grade 2 late genito urinary toxicities, 2 grade 2 gastrointestinal toxicities, no grade 3 or higher adverse events occurred. All patients maintained normal bladder function, except for 8 cases who lost bladder function due to uncontrolled tumor in the bladder. Seventeen cases recurred locally. There were 11 cases in the concurrent chemoradiotherapy group with a local recurrence rate of 26.2% (11/42) and 6 cases in the non-concurrent chemoradiotherapy group with a local recurrence rate of 22.2% (6/27), and the difference in local recurrence rate between the two groups was not statistically significant (P=0.709). There were 23 cases of distant metastasis (including 2 cases of local recurrence with distant metastasis), including 10 cases in the concurrent chemoradiotherapy group with a distant metastasis rate of 23.8% (10/42) and 13 cases in the non-concurrent chemoradiotherapy group with a distant metastasis rate of 48.1% (13/27), and the distant metastasis rate in the non-concurrent chemoradiotherapy group was higher than that in the concurrent chemoradiotherapy group (P=0.036). The median 5-year overall survival (OS) time was 59 months and the OS rate was 47.8%. The 5-year progression-free survival (PFS) time was 20 months and the PFS rate was 34.4%. The 5-year OS rates of concurrent and non-concurrent chemoradiotherapy group were 62.9% and 27.6% (P<0.001), and 5-year PFS rates were 45.4% and 20.0%, respectively (P=0.022). The 5-year OS rates of with or without neoadjuvant chemotherapy were 78.4% and 30.1% (P=0.002), and the 5-year PFS rates were 49.1% and 25.1% (P=0.087), respectively. The 5-year OS rates with or without TURBT before radiotherapy were 45.5% and 51.9% (P=0.233) and the 5-year PFS rates were 30.8% and 39.9% (P=0.198), respectively. Multivariate Cox regression analysis results showed that the clinical stage (HR=0.422, 95% CI: 0.205-0.869) was independent prognostic factor for PFS of invasive bladder cancer. The multivariate analysis showed that clinical stages (HR=0.278, 95% CI: 0.114-0.678), concurrent chemoradiotherapy (HR=0.391, 95% CI: 0.165-0.930), neoadjuvant chemotherapy (HR=0.188, 95% CI: 0.058-0.611), and recurrences (HR=10.855, 95% CI: 3.655-32.638) were independent prognostic factors for OS of invasive bladder cancer. Conclusion: Unresectable localized invasive bladder cancer can achieve satisfactory long-term outcomes with bladder-preserving combination therapy based on radiotherapy, most patients can retain normal bladder function with acceptable late adverse effects and improved survival particularly evident in patients with early, concurrent chemoradiotherapy and neoadjuvant chemotherapy.

[Clinical features and survival analysis of microscopic polyangiitis-associated interstitial lung disease:a retrospective study of 28 patients]

Objective: To explore the clinical features, laboratory examination and imaging features of microscopic polyangiitis (MPA)-associated interstitial lung disease (ILD), and to perform survival analysis. Methods: The records of 28 patients with MPA-ILD who were treated at the Affiliated Hospital of Medical School of Ningbo University were reviewed retrospectively from August 2014 to November 2021. The patients' clinical features, laboratory parameters, pulmonary function test, echocardiography, chest CT scan findings and therapeutic regimen were analyzed, and the relevant data were statistically analyzed. Results: There were 18 males and 10 females, with an average age of (70.1±9.3) years. Among them, 13 patients had a history of smoking. The main clinical manifestations were cough (14/28), fever (12/28), chest tightness, shortness of breath (12/28) and hemoptysis (3/28). Sixteen patients had renal involvement, and 78.57% (22/28) and 89.28% (25/28) of the patients had elevated C-reactive protein (CRP) and ESR respectively. Sixteen (16/28) patients had increased rheumatoid factor (RF), and the positive rate of myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) was 82.12% (23/28). 96.43% (27/28) of ILDs were diagnosed before or at the same time as MPA. The chest radiological pattern was mainly usual interstitial pneumonia (UIP) or UIP-like (15/28), followed by nonspecific interstitial pneumonia (NSIP) (8/28). Compared with non-UIP-like patients, UIP or UIP-like patients were older (P=0.018), and had higher serum LDH level (P=0.041), but serum creatinine level was significantly lower (P=0.041). Univariate and multivariate survival analysis showed that inappropriate treatment (HR=9.81, 95%CI: 1.68-57.29, P=0.011) and elevated serum LDH (HR=4.11, 95%CI: 0.99-17.00, P=0.051) were independent risk factors for shortened survival of MPA-ILD, while elevated RF (HR=0.22, 95%CI: 0.06-0.91, P=0.037) was a protective factor for prolonged survival. Conclusions: MPA-ILD patients had fewer systemic vasculitis symptoms. Most of the ILD patients were diagnosed before or at the same time as MPA. The chest radiological pattern was mainly UIP or UIP-like, followed by NSIP. Early use of glucocorticoids combined with immunosuppressant or rituximab could improve the survival rate of MPA-ILD. The elevated serum LDH was an independent risk factor for shortened survival of MPA-ILD, while elevated RF was a protective factor for prolonged survival.

Stabilization of flavin mononucleotide by capturing its "tail" with porous organic polymers for long-term photocatalytic degradation of micropollutants

Flavin mononucleotide (FMN) produces photo-induced reactive oxygen species (ROS), making it a bio-based and sustainable photosensitizer for micropollutant degradation. However, the rapid self-degradation of FMN under light poses challenges in practical applications. We propose for the first time to use porous organic polymer (POP) structures as particles and in situ grown on nanofibrous membranes to capture the ribityl side chain ("tail") of FMN by electrostatic-driven guest-host interaction. By restraining the free bending mode of FMN in POP, its self-degradation is highly inhibited, showing a prolonged half-life (102.7 and 79.7 times to that in solution and in β-cyclodextrin, respectively) without any impact on the ROS production even after 16 h of UVA irradiation. As a proof-of-concept, the photocatalytic degradation efficiency of FMN-POP complexes can be achieved at 58-93% against micropollutants under UVA. The stabilization of FMN by the "tail" capture in the POP allows its photocatalytic degradation function to be continuously online.

Deep learning-based classification of dermatological lesions given a limited amount of labeled data

BACKGROUND

Artificial intelligence (AI) techniques are promising in early diagnosis of skin diseases. However, a precondition for their success is the access to large-scaled annotated data. Until now, obtaining this data has only been feasible with very high personnel and financial resources.

OBJECTIVES

The aim of this study was to overcome the obstacle caused by the scarcity of labeled data.

METHODS

To simulate the scenario of label shortage, we discarded a proportion of labels of the training set. The training set consisted of both labeled and unlabeled images. We then leveraged a self-supervised learning technique to pre-train the AI model on the unlabeled images. Next, we fine-tuned the pre-trained model on the labeled images.

RESULTS

When the images in the training dataset were fully labeled, the self-supervised pre-trained model achieved 95.7% of accuracy, 91.7% of precision and 90.7% of sensitivity. When only 10% of the data was labeled, the model could still yield 87.7% of accuracy, 81.7% of precision and 68.6% of sensitivity. In addition, we also empirically verified that the AI model and dermatologists are consistent in visually inspecting the skin images.

CONCLUSIONS

The experimental results demonstrate the great potential of the self-supervised learning in alleviating the scarcity of annotated data.

Performance of a Three-Dimensional Electrochemical Reactor (3DER) on Bisphenol A Degradation

This study constructed a three-dimensional electrochemical reactor (3DER) using meshed stainless steel sheets and titanic magnetite particles (TMP) to investigate bisphenol A (BPA) degradation through the synergistic action of electrical current and TMP. We examined some TMP characteristics, such as particle size, specific surface areas, X-ray diffraction, surface imaging, elemental constituents, and electrical resistivity. It was found that TMP was a micron-level material with excellent electrical conductivity, and it could be regarded as a magnetite-based material comprising Fe(II) and Fe(III). The single-factor experiment determined the optimal conditions for BPA removal in 3DER, specifically by introducing 200 ml of BPA-simulated wastewater (10 mg L⁻¹) into 3DER. At the initial pH of 9.00, current and electrodes gap of 300 mA and 15 mm, respectively, and adding 1 ml of 0.5 M potassium peroxymonosulfate and 1 g TMP, > 98% of BPA was removed after 55 min of electrochemical reaction. In addition, liquid chromatography–mass spectrometry identified the intermediates formed during the BPA treatment, showing two possible pathways for BPA degradation. The final degradation intermediates were chain organics with simple molecular structures. This research provided an understanding of the potential application of 3DER for BPA removal in water.

[Correlation between professional quality of life and social support of Chinese nurses: a meta-analysis]

Objective: To systematically evaluate the correlation between professional quality of life and social support of Chinese nurses based on Pearson and Spearman correlation coefficients. Methods: In databases including PubMed, Cochrane Library, CINAHL, Medline, CBM, CNKI、Wanfang, and other databases were searched by computer for the literatures on correlation between Chinese nurses' professional quality of life and social support from January 2005 to July 2020. The Chinese and English search terms are "nurse" "professional quality of life" "empathy satisfaction" "empathy fatigue" "professional quality of life" "ProQOL" "comparison satisfaction" "comparison fatigue" "social support" "competent social support" "SSRS" "PSSS", etc. Literatures were screened according to the inclusion and exclusion criteria. After evaluating quality and extracting data, meta-analysis was conducted using RevMan 5.3 software. Results: A total of 12 studies were included. The meta analysis showed that nurses' compassion satisfaction, burnout, secondary traumatic stress were related to social support, summary r were 0.35, -0.26 and -0.23 respectively. The correlation between compassion satisfaction and social support were increased with sample, the south was higher than the north, and comprehensive departments were higher than other departments (P<0.05) . The correlation between burnout and social support were increased with time and sample, and the south was higher than the north, oncology was higher than others, non-random sampling was higher than random sampling, using ProQOL and Perceived Social Support Scale (PSSS) was higher than Professional Quality of Life Scale (ProQOL) and Social Support Racting Scale (SSRS) (P<0.05) . The correlation coefficient between secondary traumatic stress and social support in oncology was higher than others, random sampling was higher than non-random sampling, using ProQOL and PSSS was higher than ProQOL and SSRS (P<0.05) . Conclusion: There is a positive and weak correlation between compassion satisfaction and social support, and a negative and weak correlation between burnout and secondary traumatic stress and social support. There are differences in different time, research design, region and department.

[The effectiveness of psychological intervention on nursing staff' compassion fatigue: a meta-analysis]

Objective: To systematically evaluate the impact of psychological intervention on nursing staff' compassion fatigue. Methods: From March to May 2020, PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, Wanfang and other databases were electronically searched to collect randomized controlled trials (RCTs) on the influence of psychological intervention on nursing staff' compassion fatigue with the main search terms including compassion fatigue, nurs*, psychological intervention, mental intervention, RCT and so on from inception to March 31, 2020. Screened literature, extracted data and assessed the risk of bias of included studies. The Stata 16.0 software was used to calculate the pooled effectiveness of psychological intervention on nursing staff' compassion fatigue. Results: All 13 RCTs were enrolled, including 940 nursing staff. Meta-analysis results demonstrated that the psychological intervention group was superior to the control group in the improvement of the compassion fatigue score (SMD=-0.96, 95%CI: -1.17-0.74, P=0.001) , compassion satisfaction score (SMD=0.61, 95%CI: 0.45-0.77, P=0.002) , burnout score (SMD=-0.46, 95%CI: -0.62-0.29, P=0.006) , secondary trauma score (SMD=-0.40, 95%CI: -0.68-0.12, P=0.020) , and the difference was statistically significant. Subgroup analysis found that the psychological intervention group was more effective than the control group in improving compassion satisfaction score, reducing burnout score and secondary trauma score, and the differences were statistically significant (P<0.05) in different intervention time (<8 weeks and ≥8 weeks) and intervention methods. Conclusion: The psychological intervention can improve the level of compassion satisfaction, and reduce the compassion fatigue among nursing staff, and have a certain preventive effect on compassion fatigue.

[Familial interstitial lung disease associated with surfactant protein C gene mutation in adults: report of two cases and literature review]

Objective: To improve the understanding of clinical manifestations, imaging findings, diagnosis and treatment of surfactant protein C gene (SFTPC) mutation associated with familial interstitial lung disease in adults. Methods: Two cases of adult SFTPC gene mutation associated with familial interstitial lung disease diagnosed in the Affiliated Hospital of Medical School of Ningbo University were analyzed retrospectively, and the literature was reviewed. The literatures were retrieved with "family interstitial lung disease" "SFTPC gene" "surface protein C gene" "SFTPC gene mutation associated with familial international lung disease" and "surface protein C gene mutation associated with familial international lung disease" in PubMed, Embase, Ovid, Wanfang database and China National Knowledge Infrastructure (CNKI). Results: There were two patients with familial interstitial lung diseases(one male and one female) with an average age of 27.5 years. Ⅱ-2 patient had symptoms of dry cough and shortness of breath, and Ⅱ-1 patient had no symptoms. There were multiple cysts and fine reticular shadows in both cases. Ⅱ-2 patient had multiple ground glass opacities in both lower lungs. TheⅡ-2 patient was diagnosed with usual interstitial pneumonia (UIP) by transbronchial lung cryobiopsy. A total of 35 patients were included in this literature review, including 20 males, with an average age of 33.5 years. Of all the patients, the clinical symptoms were described in 30 patients. The main manifestations were shortness of breath (22/30), dry cough (18/30), clubbing finger (12/30), and 30% (9/30) of them were found by chest computerized tomography (CT) without symptoms. There were 17 cases with detailed description of chest CT imaging. The most common chest CT findings were multiple intralobular reticular opacities (17/17), multiple cysts (12/17) and ground glass opacities (7/17). The main histopathological pattern was UIP (24/26). Conclusions: The main clinical manifestations of SFTPC gene mutation associated with familial interstitial lung disease in adults are shortness of breath, dry cough and clubbing fingers. The main manifestations are multiple cysts and intralobular reticular opacities in combination with multiple ground glass opacities. There is no specific drug in the treatment at present and early treatment with hydroxychloroquine may have better curative effect. When the imaging findings show multiple cysts and intralobular reticular opacities in combination with multiple ground glass opacities, especially the age of onset is less than 50 years old, this disease should be considered.

What We Are Learning from COVID-19 for Respiratory Protection: Contemporary and Emerging Issues

Infectious respiratory diseases such as the current COVID-19 have caused public health crises and interfered with social activity. Given the complexity of these novel infectious diseases, their dynamic nature, along with rapid changes in social and occupational environments, technology, and means of interpersonal interaction, respiratory protective devices (RPDs) play a crucial role in controlling infection, particularly for viruses like SARS-CoV-2 that have a high transmission rate, strong viability, multiple infection routes and mechanisms, and emerging new variants that could reduce the efficacy of existing vaccines. Evidence of asymptomatic and pre-symptomatic transmissions further highlights the importance of a universal adoption of RPDs. RPDs have substantially improved over the past 100 years due to advances in technology, materials, and medical knowledge. However, several issues still need to be addressed such as engineering performance, comfort, testing standards, compliance monitoring, and regulations, especially considering the recent emergence of pathogens with novel transmission characteristics. In this review, we summarize existing knowledge and understanding on respiratory infectious diseases and their protection, discuss the emerging issues that influence the resulting protective and comfort performance of the RPDs, and provide insights in the identified knowledge gaps and future directions with diverse perspectives.

Unique "posture" of rose Bengal for fabricating personal protective equipment with enhanced daylight-induced biocidal efficiency

The aggregation-caused self-quenching of photosensitizers (PS), especially on a solid substrate, has highly limited their photo-induced biocidal efficiency in practical applications. Here, we designed a unique "posture" of rose Bengal (RB) on cotton-based super-adsorptive fibrous equipment, with RB being separately captured in the mesopores of porous organic polymers (POPs). The resultant daylight-induced biocidal cotton fabric with enhanced efficiency was named as DBwEE-Cotton. The enhanced biocidal activity of the DBwEE-Cotton was achieved based on two mechanisms: (1) the separation of RB in mesopores on the fabric avoids the aggregation-caused self-quenching; and (2) other than singlet oxygen generation, RB is forced to undergo type I photoreaction by surrounding the RB with massive amounts of good hydrogen donors (i.e., POP) under daylight irradiation. Given the enhanced production efficiency of reactive oxygen species by the DBwEE-Cotton, 99.9999% of E. coli and L. innocua bacteria were killed within 20 min of daylight exposure. The DBwEE-Cotton also presents excellent wash and light durability with no biocidal function loss. The development of DBwEE-Cotton provides a facile strategy of avoiding aggregation-caused self-quenching and modulating photoreactions of PS on a flexible substrate, which may guide the design of novel personal protective equipment (PPE) integrated with improved biocidal efficiency, wearability, and repeated and long-term applicability for protecting people from lethal infectious diseases.

Accurate diagnosis of colorectal cancer based on histopathology images using artificial intelligence

BACKGROUND

Accurate and robust pathological image analysis for colorectal cancer (CRC) diagnosis is time-consuming and knowledge-intensive, but is essential for CRC patients' treatment. The current heavy workload of pathologists in clinics/hospitals may easily lead to unconscious misdiagnosis of CRC based on daily image analyses.

METHODS

Based on a state-of-the-art transfer-learned deep convolutional neural network in artificial intelligence (AI), we proposed a novel patch aggregation strategy for clinic CRC diagnosis using weakly labeled pathological whole-slide image (WSI) patches. This approach was trained and validated using an unprecedented and enormously large number of 170,099 patches, > 14,680 WSIs, from > 9631 subjects that covered diverse and representative clinical cases from multi-independent-sources across China, the USA, and Germany.

RESULTS

Our innovative AI tool consistently and nearly perfectly agreed with (average Kappa statistic 0.896) and even often better than most of the experienced expert pathologists when tested in diagnosing CRC WSIs from multicenters. The average area under the receiver operating characteristics curve (AUC) of AI was greater than that of the pathologists (0.988 vs 0.970) and achieved the best performance among the application of other AI methods to CRC diagnosis. Our AI-generated heatmap highlights the image regions of cancer tissue/cells.

CONCLUSIONS

This first-ever generalizable AI system can handle large amounts of WSIs consistently and robustly without potential bias due to fatigue commonly experienced by clinical pathologists. It will drastically alleviate the heavy clinical burden of daily pathology diagnosis and improve the treatment for CRC patients. This tool is generalizable to other cancer diagnosis based on image recognition.

DGCR8 promotes the metastasis in triple-negative breast cancer by epigenetically regulating TGF-β

OBJECTIVE

Breast cancer (BC) is one of the most ordinary fatal cancers. Recent studies have identified the vital role of genes in the development and progression of Tri-negative breast cancer (TNBC). In this research, DGCR8 was studied to identify how it functioned in the metastasis of TNBC.

PATIENTS AND METHODS

DGCR8 expression of tissues was detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) in 50 TNBC patients. Wound healing assay and transwell assay were used to observe the changes in the biological behaviors of TNBC cells through knockdown or overexpression of DGCR8. In addition, qRT-PCR and Western blot assay were performed to discover the potential target protein of DGCR8 in TNBC.

RESULTS

DGCR8 expression level in TNBC samples was higher than that of adjacent ones. Besides, the migration ability and invasion ability of TNBC cells were inhibited after DGCR8 was silenced, while they were promoted after DGCR8 was overexpressed. In addition, TGF-β was downregulated after silencing of DGCR8 in TNBC cells, while TGF-β was upregulated after overexpression of DGCR8 in TNBC cells. Furthermore, TGF-β was upregulated in TNBC tissues, which was positively associated with DGCR8.

CONCLUSIONS

Our study uncovers a new oncogene in TNBC and suggests that DGCR8 can enhance TNBC cell migration and invasion via targeting TGF-β, which provides a novel therapeutic target for TNBC patients.

Daylight-activated fumigant detoxifying nanofibrous membrane based on thiol-ene click chemistry

Daylight-activated detoxifying nanofibrous membranes (LDNMs) are fabricated by grafting benzophenone-3,3',4,4'-tetracarboxylic dianhydride (BD) and biological thiols successively on poly(vinyl alcohol-co-ethylene) (EVOH) nanofibrous membrane. Taking the merits of photoactivity of BD, high-reactivity of biological thiols, and high specific surface area and porosity of the nanofibrous membrane, 1,3-dichloropropene (1,3-D) can be efficiently detoxified on the LDNMs under daylight irradiation via a thiol-ene click reaction. The detoxification function of the LDNMs is "switched on" by light irradiation and continues by following a cascade of chemical attacks of thiyl radicals formed during the photoexcitation process. The resultant LDNMs present rapid detoxification rate (i.e., t_1/2 =~30 min) and massive detoxification amount (i.e., ~12 mg/g) against 1,3-D vapor under ambient conditions. More importantly, the LDNMs perform a detoxification tailing effect after moving the light-irradiated membrane to a dark environment, thus ensuring the protective function in the absence of sufficient light sources. The detoxification property of the LDNMs in an outdoor environment with sunlight irradiation shows comparable results to the lab-scale outcomes, enabling them to serve as innovative materials for personal protective equipment in practical applications. The successful fabrication of LDNMs may inspire new insights into the design of protective materials providing aggressive protection.

Daylight-Induced Antibacterial and Antiviral Cotton Cloth for Offensive Personal Protection

Cotton fabrics with durable and reusable daylight-induced antibacterial/antiviral functions were developed by using a novel fabrication process, which employs strong electrostatic interaction between cationic cotton fibers and anionic photosensitizers. The cationic cotton contains polycationic short chains produced by a self-propagation of 2-diehtylaminoehtyl chloride (DEAE-Cl) on the surface of cotton fibers. Then, the fabric (i.e., polyDEAE@cotton) can be readily functionalized with anionic photosensitizers like rose Bengal and sodium 2-anthraquinone sulfate to produce biocidal reactive oxygen species (ROS) under light exposure and consequently provide the photo-induced biocidal functions. The biocidal properties of the photo-induced fabrics (PIFs) were demonstrated by ROS production measurements, bactericidal performance against bacteria (e.g., E coli and L. innocua), and antiviral results against T7 bacteriophage. The PIFs achieved 99.9999% (6 log) reductions against bacteria and the bacteriophage within 60 min of daylight exposure. Moreover, the PIFs showcase excellent washability and photostability, making them ideal materials for reusable face masks and protective suits with improved biological protections compared with traditional PPE. This work demonstrated that the cationized cotton could serve as a platform for different functionalization applications, and the resulting fiber materials could inspire the development of reusable and sustainable PPE with significant bioprotective properties to fight the COVID-19 pandemic as well as the spread of other contagious diseases.

Robust, rapid, and ultrasensitive colorimetric sensors through dye chemisorption on poly-cationic nanodots

Colorimetric sensors were fabricated by incorporation of anionic colorimetric probes on a hierarchical nanofibrous membrane containing poly-cationic nanodots through intense electrostatic interaction. Unique poly-cationic nanodots were covalently grown on poly (4-vinylpyridine)/polyacrylonitrile nanofibrous membrane through a self-propagation reaction of 2-diethylaminoethyl chloride (DEAE-Cl). The nanodots on the nanofiber surfaces possess strong adsorption affinity and high adsorption capacity toward anionic probes, which contributed to excellent detection sensitivity and sensor stability compared with the co-electrospun sensor. As a proof-of-concept study, phenol red was selected to functionalize the as-fabricated substrate (polyDEAE@P4VP/PAN NFM) to a colorimetric sensor, which shows responses to alkaline vapors. The as-fabricated sensor showed rapid color changes to ammonia and triethylamine (response time < 10 s), whose detection limits reached 1 ppm and 5 ppm, respectively. The sensor can be repeatedly used for at least 20 cycles by regenerating it in air for 1 min. Taking advantage of the intense attractive force between poly-cationic nanodots and anionic probes, polyDEAE@P4VP/PAN NFM is a promising media to be used for the development of robust, rapid, and ultrasensitive colorimetric sensors.

SAT0453 DELAYED DENOSUMAB INJECTIONS AND FRACTURES RISK AMONG SUBJECTS WITH OSTEOPOROSIS: A POPULATION-BASED COHORT STUDY

Background:

Denosumab is effective for osteoporosis, but discontinuation leads to rapid reversal of its therapeutic effect[1].

Objectives:

To estimate the risk for fracture among users of denosumab who delayed subsequent dosages compared with users who received dosages on time.

Methods:

Population-based cohort study. We included patients aged over 45 years who initiated denosumab for osteoporosis from UK THIN database, 2010 to 2019. Observational data were used to “emulate a hypothetical trial”[2, 3] with three dosing intervals: subsequent denosumab injection 24-28 weeks after prior dose (“on time”), delay by 4-16 weeks (“short delay”), and delay by over 16 weeks (“long delay”). The primary outcome was a composite of all fracture types. Secondary outcomes included major osteoporotic fracture, vertebral fracture, and hip fracture.

Results:

The rate of composite fracture per 1000 person-years was 58.9 for on-time, 61.7 for short delay, and 85.4 for long delay of subsequent denosumab injections. Compared to on-time injections, short delay had a hazard ratio (HR) for composite fracture 1.03 (95% CI 0.63-1.69) and long delay HR 1.44 (95% CI 0.96-2.17; p for trend 0.093). For major osteoporotic fractures, short delay had an HR 0.94 (95% CI 0.57-1.55) and long delay an HR of 1.69 (95% CI 1.01-2.83; p for trend 0.056). For vertebral fractures, short delay had an HR 1.48 (95% CI 0.58-3.79) and long delay 3.91 (95% CI 1.62-9.45; p for trend 0.005).

Conclusion:

While delayed subsequent denosumab dosages over 16 weeks was associated with an increased risk of vertebral and major osteoporotic fracture compared to no delay, composite fracture risk was not increased with longer delays.

References:

[1]Cummings SR, Ferrari S, Eastell R, et al. Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension. J Bone Miner Res, 2017.

[2]Hernán MA. How to estimate the effect of treatment duration on survival outcomes using observational data. BMJ 2018.

[3]Hernán MA, Robins JM. Using Big Data to Emulate a Target Trial When a Randomized Trial Is Not Available. Am J Epidemiol 2016.

Table.

Rates and Adjusted Hazard Ratios of Fracture

On-timeShort delayLong delayP for linear trendComposite FractureRate (per 1000 person-years)5961.785.4-Unadjusted HR (95 %)Ref1.05 (0.62, 1.76)1.45 (0.95, 2.21)0.097Adjusted HR (95% CI)†Ref1.03 (0.63, 1.69)1.44 (0.96, 2.17)0.093Major Osteoporotic FractureRate (per 1000 person-years)34.831.958-Unadjusted HR (95 %)Ref0.92 (0.55, 1.53)1.67 (0.98, 2.84)0.074Adjusted HR (95% CI)†Ref0.94 (0.57, 1.55)1.69 (1.01, 2.83)0.056Vertebral FractureRate (per 1000 person-years)4.97.319.4-Unadjusted HR (95 %)Ref1.47 (0.58, 3.71)3.93 (1.59, 9.72)0.006Adjusted HR (95% CI)†Ref1.48 (0.58, 3.79)3.91 (1.62, 9.45)0.005Hip FractureRate (per 1000 person-years)10.29.618.3-Unadjusted HR (95 %)Ref0.94 (0.43, 2.04)1.78 (0.80, 3.97)0.18Adjusted HR (95% CI)†Ref0.97 (0.44, 2.12)1.75 (0.81, 3.79)0.173

†Adjusted model: adjusted by age, sex, baseline CCI index, major osteoporotic fracture, oral BP duration (years), 10-year risk of major osteoporotic fracture, prior denosumab doses.

Acknowledgments:

We acknowledge Dr. Dani Prieto-Alhambra for kindly providing Read codes.

Disclosure of Interests:

Houchen Lyu: None declared, Kazuki Yoshida: None declared, Sizheng Steven Zhao: None declared, Xabier García-Albéniz: None declared, Jie Wei: None declared, Chao Zeng: None declared, Sara Tedeschi: None declared, Benjamin Leder Grant/research support from: Research funding from Amgen, Guanghua Lei: None declared, Peifu Tang: None declared, Daniel Solomon Grant/research support from: Funding from Abbvie and Amgen unrelated to this work

Frequency Characteristics of AEPs in Normal Young Adults and Comparison of Their Response Threshold and Pure Tone Audiometry Threshold

Objective The tests of three types of auditory evoked potentials （AEPs） were performed on normal young adults, to understand the frequency characteristics of different testing methods and the relationship between response threshold and pure tone audiometry threshold of different methods, and to discuss the forensic value of 3 types of AEPs to evaluate hearing function. Methods Twenty normal young adults were selected, their standard pure tone audiometry threshold, short-term pure tone audiometry threshold and the response threshold of 3 types of AEPs （tone burst-auditory brainstem response, 40 Hz auditory event-related potential and slow vertex response） at 0.5 kHz, 1.0 kHz, 2.0 kHz and 4.0 kHz were recorded. The relationship between the response threshold and standard pure tone audiometry threshold, short-term pure tone audiometry threshold of 3 types of AEPs at different frequencies as well as the differences between different types of AEPs were analyzed. Results The short-term pure tone audiometry threshold was higher than the standard pure tone audiometry threshold at each frequency. The response threshold and standard pure tone audiometry threshold of the 3 types of AEPs all had a certain correlation, and the response threshold of the 3 types of AEPs was higher than short-term pure tone audiometry threshold and standard pure tone audiometry threshold at each frequency. The differences in the differences between the response threshold and standard pure tone audiometry threshold of the 3 types of AEPs at different frequencies had statistical significance. Linear regression mathematical models were established to infer the standard pure tone audiometry threshold （hearing level） from response threshold （sound pressure level） of 3 types of AEPs of normal young adults. Conclusion When using response threshold of different types of AEPs to estimate pure tone audiometry threshold, conversion and correction are needed. Combined use of different types of AEPs could improve the accuracy of hearing function evaluation.

Porphyromonas gingivalis Sphingolipid Synthesis Limits the Host Inflammatory Response

Porphyromonas gingivalis, like other bacteria belonging to the phylum Bacteroidetes, synthesizes sphingolipids (SLs). However, their exact roles in microbial physiology and their potential role in mediating interactions with their eukaryotic host are unclear. Our working hypothesis for this study was that synthesis of SLs (host-like lipids) affords a mechanism that allows P. gingivalis to persist in homeostasis with its host. In a previous study, we deleted a gene (PG1780 in strain W83) predicted to encode a serine palmitoyl transferase (SPT)-the enzyme that catalyzes the first conserved step in the synthesis of SLs-and we determined that the mutant was unable to synthesize SLs. Here, we characterized the SPT enzyme encoded by PG1780, analyzed the impact of SPT deletion on P. gingivalis gene expression (RNA-Seq analysis), and began to define the impact of SL synthesis on its interactions with host cells. Enzymatic analysis verified that the protein encoded by PG1780 is indeed an SPT. RNA-Seq analysis determined that a lack of SL synthesis results in differential expression of extracytoplasmic function sigma factors, components of the type IX secretion system (T9SS), and CRISPR and cas genes. Our data demonstrate that when human THP1 macrophage-like cells were challenged with the wild type (W83) and the SL-null mutant (W83 ΔSPT), the SL-null strain elicited a robust inflammatory response (elevated IL-1β, IL-6, IL-10, IL-8, RANTES, and TNFα) while the response to the parent strain W83 was negligible. Interestingly, we also discovered that SLs produced by P. gingivalis can be delivered to host cells independent of cell-to-cell contact. Overall, our results support our working hypothesis that synthesis of SLs by P. gingivalis is central to its ability to manipulate the host inflammatory response, and they demonstrate the integral importance of SLs in the physiology of P. gingivalis.

Comparison of routine field epidemiology and whole genome sequencing to identify tuberculosis transmission in a remote setting

Yukon Territory (YT) is a remote region in northern Canada with ongoing spread of tuberculosis (TB). To explore the utility of whole genome sequencing (WGS) for TB surveillance and monitoring in a setting with detailed contact tracing and interview data, we used a mixed-methods approach. Our analysis included all culture-confirmed cases in YT (2005-2014) and incorporated data from 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) genotyping, WGS and contact tracing. We compared field-based (contact investigation (CI) data + MIRU-VNTR) and genomic-based (WGS + MIRU-VNTR + basic case data) investigations to identify the most likely source of each person's TB and assessed the knowledge, attitudes and practices of programme personnel around genotyping and genomics using online, multiple-choice surveys (n = 4) and an in-person group interview (n = 5). Field- and genomics-based approaches agreed for 26 of 32 (81%) cases on likely location of TB acquisition. There was less agreement in the identification of specific source cases (13/22 or 59% of cases). Single-locus MIRU-VNTR variants and limited genetic diversity complicated the analysis. Qualitative data indicated that participants viewed genomic epidemiology as a useful tool to streamline investigations, particularly in differentiating latent TB reactivation from the recent transmission. Based on this, genomic data could be used to enhance CIs, focus resources, target interventions and aid in TB programme evaluation.

Hepatocyte Transplantation to the Liver via the Splenic Artery in a Juvenile Large Animal Model

Hepatocyte transplantation (HcTx) is a promising approach for the treatment of metabolic diseases in newborns and children. The most common application route is the portal vein, which is difficult to access in the newborn. Transfemoral access to the splenic artery for HcTx has been evaluated in adults, with trials suggesting hepatocyte translocation from the spleen to the liver with a reduced risk for thromboembolic complications. Using juvenile Göttingen minipigs, we aimed to evaluate feasibility of hepatocyte transplantation by transfemoral splenic artery catheterization, while providing insight on engraftment, translocation, viability, and thromboembolic complications. Four Göttingen Minipigs weighing 5.6 kg to 12.6 kg were infused with human hepatocytes (two infusions per cycle, 1.00E08 cells per kg body weight). Immunosuppression consisted of tacrolimus and prednisolone. The animals were sacrificed directly after cell infusion (n=2), 2 days (n=1), or 14 days after infusion (n=1). The splenic and portal venous blood flow was controlled via color-coded Doppler sonography. Computed tomography was performed on days 6 and 18 after the first infusion. Tissue samples were stained in search of human hepatocytes. Catheter placement was feasible in all cases without procedure-associated complications. Repetitive cell transplantations were possible without serious adverse effects associated with hepatocyte transplantation. Immunohistochemical staining has proven cell relocation to the portal venous system and liver parenchyma. However, cells were neither present in the liver nor the spleen 18 days after HcTx. Immunological analyses showed a response of the adaptive immune system to the human cells. We show that interventional cell application via the femoral artery is feasible in a juvenile large animal model of HcTx. Moreover, cells are able to pass through the spleen to relocate in the liver after splenic artery infusion. Further studies are necessary to compare this approach with umbilical or transhepatic hepatocyte administration.

Design and Synthesis of Core-Shell Carbon Polymer Dots with Highly Stable Fluorescence in Polymeric Materials

In recent years, fluorescent carbon dots have attracted great attention due to their good luminescence and low toxicity. Here, blue fluorescent core-shell structured carbon polymer dots (CPDs) with high stability under a wide range of pH values, long storage time and excellent fluorescence in various solvents and even in solid state were prepared by hydrothermal synthesis of dendritic tris(2-aminoethyl)amine (TAEA) and citric acid. The CPDs core structure provides strong fluorescent luminescence, a shell structure of the core possesses high amount of dendritic primary amino groups connected by ethylene groups to the core. This unique structure prevents aggregation of the cores and self-quenching effect of CPDs. As a result, the CPDs have high fluorescence in both aqueous and hydrophobic solutions and even as pure solid-state powder. In addition, the CPDs are also insensitive to pH of solutions, and the fluorescence intensity of the solution was stable in the pH range of 4-14. The CPDs embedded polymer films and fibers revealed excellent fluorescent properties.

Phenotypic analysis of atopic dermatitis in children aged 1-12 months: elaboration of novel diagnostic criteria for infants in China and estimation of prevalence

BACKGROUND

Atopic dermatitis (AD) is the most common skin disorder in infancy. However, the diagnosis and definite significance of infantile AD remains a debated issue.

OBJECTIVE

To analyse the phenotypes of AD in infancy, to establish diagnostic criteria and to estimate the prevalence of this condition in China.

METHODS

This is a multicentric study, in which 12 locations were chosen from different metropolitan areas of China. Following careful and complete history-taking and skin examination, the definite diagnosis of AD was made and the severity based on the SCORAD index was determined by local experienced dermatologists. Based on the detailed phenotyping, the major and representative clinical features of infantile AD were selected to establish the diagnostic criteria and evaluate their diagnostic efficacy.

RESULTS

A total of 5967 infants were included in this study. The overall point prevalence of AD was 30.48%. The infantile AD developed as early as at the second month of life, and its incidence peaked in the third month of life at 40.81%. The proportion of mild, moderate and severe AD was 67.40%, 30.57% and 2.03%, respectively. The most commonly seen manifestations in the infantile AD were facial dermatitis (72.07%), xerosis (42.72%) and scalp dermatitis (27.93%). We established the novel diagnostic criteria of infants, which included: (i) onset after 2 weeks of birth; (ii) pruritus and/or irritability and sleeplessness comparable with lesions; and (iii) all two items above with one of the following items can reach a diagnosis of AD: (i) eczematous lesions distributed on cheeks and/or scalp and/or extensor limbs, and (ii) eczematous lesions on any other parts of body accompanied by xerosis.

CONCLUSIONS

In China, the prevalence of AD in infancy is 30.48% according to clinical diagnosis of dermatologists. The novel Chinese diagnostic criteria for AD in infants show a higher sensitivity and comparable specificity.

Colorimetric Detection of Carcinogenic Alkylating Fumigants on a Nylon 6 Nanofibrous Membrane. Part II: Self-Catalysis of 2-Diethylaminoethyl-Modified Sensor Matrix for Improvement of Sensitivity

A nylon 6 nanofibrous membrane (N6NFM) was covalently modified with 2-diethylaminoethylchloride (DEAE-Cl) to provide self-catalytic functions to facilitate the formation of color compounds in reactions of 4-( p-nitrobenzyl)pyridine with alkylating fumigants. The 2-diethylaminoethyl group on the DEAE-Cl-modified N6NFM (DEAE@N6NFM) enables effective elimination of hydrohalogenic acids from intermediates that were formed from reactions between the alkylating fumigants and NBP and consequently improve their detection sensitivities, especially for 1,3-dichloropropene at room temperature. Moreover, DEAE@N6NFM can be recycled and reused multiple times without obvious loss in the sensing functions or any noticeable material damage. The naked-eye detection limits of the sensor to 1,3-dichloropropene, methyl iodide, and methyl bromide on DEAE@N6NFM are improved to 0.2, 0.1, and 0.1 ppm, respectively, which are much lower than their occupational exposure limits. The reaction mechanism is demonstrated through a computational method by analyzing the thermodynamics of the reaction. The modification of DEAE@N6NFM also provides an insight into the development of functionalized materials with improved reactivities for versatile sensing applications.

Abstract P1-13-02: Real world outcomes of adjuvant FECD, ddACT and ACT for the treatment of early stage breast cancer - A multicenter retrospective analysis

Background: Adjuvant chemotherapy combining anthracyclines and taxanes for early stage breast cancer (ESBC) have demonstrated disease-free survival (DFS) and overall survival (OS) benefits. Among the 3rd generation regimens, 2 options have been favoured: FEC-Docetaxel (FECD) and AC-Paclitaxel (ACT). ACT may be delivered with dose-dense (ddACT) or weekly taxane scheduling (ddACWT), compared to traditional every 3-weekly (q3ACT) scheduling. Despite literature supporting both FECD and (dd)ACT regimens in the management of ESBC, no direct prospective trial has evaluated their comparative effectiveness.

Methods: A retrospective review of the BC Cancer Breast Cancer Outcomes Unit (BCOU) and the Alberta Health Services (AHS) databases was performed to identify patients with HER2 negative, stage 1-3 ESBC, who received adjuvant chemotherapy between 2007-2014. The primary endpoint was OS and the secondary endpoint was RFS, defined as freedom from local (invasive), regional or distant recurrence or breast cancer death. Outcome comparisons were made between FECD, ddACT/ddACWT and q3ACT using the Kaplan Meier method. Treatment arms were compared using a log-rank test for univariate analysis. A multivariate analysis was also conducted for OS comprising age, stage, grade, receptor status and type of chemotherapy received (FECD vs combined ACT group).

Results: A total of 4047 patients met inclusion criteria, including 2685 FECD, 1259 ddACT and 103 ACT. Median age was 53 (24-77) in the FECD group vs 52 (26-68) in the ddACT/ddACWT group and 58 (43-78) in the q3ACT group. The majority had stage 2 disease, 51.3%, 53.5% and 50.5% in the FECD, ddACT/ddACWT and q3ACT groups, respectively. Most were HR+, 84.5% in the FECD group vs 66.9% in both the ddACT/ddACWT and q3ACT groups. In the FECD group, 42.8% had a grade 2 tumour and 48.2% a grade 3 tumour vs 35.4% and 56.4% in the ddACT/ddACWT group and 35.0% and 58.3% in the q3ACT group. Lymphovascular invasion (LVI) was present in 40.7% of patients who received FECD vs 39.7% for ddACT/ddACWT and 26.2% for ACT. 5-year OS, for the FECD group was 90.3% (95%CI 89.1,91.4) vs 87.0% (95%CI 84.3,89.2) for the ddACT/ddACWT and 84.9% (95%CI 75.5,90.8) for the q3ACT groups, p=0.0907. 5-year RFS was 85.5% (95%CI 84.0-86.8) with FECD vs 84.4% (95% 81.9,86.6) for ddACT/ddACWT and 87.7% (95%CI 79.2,92.8) with q3ACT,p=0.4200. In multivariate analysis: age, stage and grade were significantly associated with OS whereas type of chemotherapy received (FECD vs ACT) was not (p=0.165). Finally, OS rates were compared across provinces and no significant differences were identified, 87.0% vs 88.0% (p=0.6294). Subgroup analyses by receptor type, comparing HR+ and TNBC are ongoing.

Conclusions: The use of FECD as compared to ACT based chemotherapy did not reveal significant differences in OS or RFS in this population-based study. Further, chemotherapy regimen was not associated with differences in overall survival, as compared to other well recognized prognostic factors. While the results were obtained from a retrospective analysis, conclusive prospective data is lacking. These results may therefore reassure physicians and patients alike on a comparable efficacy of these regimens in a real-life setting.

Citation Format: LeVasseur N, Veitch Z, Diocee RM, Gondara L, Cheung W, Khan O, Cossetti R, Gelmon KA, King K, Lupichuk S, Chia SK, Tang P, Simmons C. Real world outcomes of adjuvant FECD, ddACT and ACT for the treatment of early stage breast cancer - A multicenter retrospective analysis [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 P1-13-02.

Bio-inspired ultrasensitive colorimetric detection of methyl isothiocyanate on nylon-6 nanofibrous membrane: A comparison of biological thiol reactivities

Living organisms, including human beings, rapidly show skin color changes after chemical poisonings, a result of toxicological or detoxification reactions caused by biological thiol compounds. On the other side, quick and portable detection of highly-volatile toxicants is an urgent need for improving human safety and personal protection, especially real-time monitoring of fumigants at low level for protection of farm workers and residents from overexposure of fumigants, vaporous pesticides. Here, we designed a rapid and portable detection method for methyl isothiocyanate (MITC) vapor by mimicking detoxification reactions of biological thiols in human bodies with MITC. The detection reaction was implemented on a nylon-6 nanofibrous membrane with ultrahigh surface areas to show color signals with the addition of Ellman's reagent. The reactivities of glutathione, N-acetyl-L-cysteine, L-homocysteine, cysteamine, and thioglycolic acid toward MITC were experimentally explored and theoretically discussed. The detection sensitivity is tunable in different biological thiol systems, which broadens the sensor applications in detection of trace amount of MITC in ambient environment and improves the protection of human safety. The new sensor system reduced the sensor operation time to 15 min and achieved the detection limit of 99 ppb, much lower than its permissible exposure limit (220 ppb).

Combination therapy with parathyroid hormone analogs and antiresorptive agents for osteoporosis: a systematic review and meta-analysis of randomized controlled trials

Combination therapy with parathyroid hormone (PTH) analogs and antiresorptive agents may be more effective than monotherapy for the treatment of osteoporosis. This study aimed to estimate the effectiveness and safety of this combination therapy for osteoporosis. MEDLINE, EMBASE, and Cochrane Library were searched from inception to May 1, 2018, including randomized controlled trials (RCTs) with a duration of at least 6 months on adults with osteoporosis treated with combination therapy versus monotherapy. Outcomes included fractures, bone mineral density (BMD) changes, and adverse events. A meta-analysis was performed using a random-effect model, to estimate risk ratios (RRs) for fractures, and mean differences (MDs) for BMD changes. A total of 19 RCTs and 2177 patients were included. Compared with monotherapy, combination therapy had an advantage of 36% (RR, 0.64; 95% confidence interval (CI), 0.42-0.98) regarding fracture risk reduction. It also appears to improve lumbar spine BMD by 4.06% (95%CI = 2.60-5.53) and total hip BMD by 1.89% (95%CI = 1.25-2.53). No RCT reported an increased risk of serious adverse events. Among patients with osteoporosis, combination therapy was superior to monotherapy regarding improvement of the lumbar spine and total hip BMD, without risk of serious adverse events. Combination therapy also had an advantage over monotherapy on fracture risk reduction. However, owing to the limited sample size, additional larger studies are required to confirm this benefit.

Whole genome sequencing for improved understanding of Mycobacterium tuberculosis transmission in a remote circumpolar region

Few studies have used genomic epidemiology to understand tuberculosis (TB) transmission in rural and remote settings - regions often unique in history, geography and demographics. To improve our understanding of TB transmission dynamics in Yukon Territory (YT), a circumpolar Canadian territory, we conducted a retrospective analysis in which we combined epidemiological data collected through routine contact investigations with clinical and laboratory results. Mycobacterium tuberculosis isolates from all culture-confirmed TB cases in YT (2005-2014) were genotyped using 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) and compared to each other and to those from the neighbouring province of British Columbia (BC). Whole genome sequencing (WGS) of genotypically clustered isolates revealed three sustained transmission networks within YT, two of which also involved BC isolates. While each network had distinct characteristics, all had at least one individual acting as the probable source of three or more culture-positive cases. Overall, WGS revealed that TB transmission dynamics in YT are distinct from patterns of spread in other, more remote Northern Canadian regions, and that the combination of WGS and epidemiological data can provide actionable information to local public health teams.

Colorimetric Detection of Carcinogenic Alkylating Fumigants on Nylon-6 Nanofibrous Membrane. Part I: Investigation of 4-( p-Nitrobenzyl)pyridine as a "New" Sensing Agent with Ultrahigh Sensitivity

Alkylating fumigants are widely used in agricultural production for the control of soil-borne pests, but the acute toxicity and carcinogenicity of these chemicals pose a health threat to farm workers, as well as residents. A nanofibrous membrane-based colorimetric sensor relying on the nucleophilic substitution reaction of 4-( p-nitrobenzyl)pyridine (NBP) is introduced for the convenient and portable detection of alkylating fumigants. Comparing with the traditional use of NBP in detecting alkylating agents, this sensor system achieves a parts per billion level detection sensitivity toward alkylating fumigant gases without a high-temperature incubation or the addition of extra bases. The mechanisms of the detection reaction and the detection sensitivities of different fumigants were studied with computational methods, and the results comprehensively prove the proposed optimized detection mechanisms. The detection limit of methyl iodide, methyl bromide, and 1,3-dichloropropene successfully reaches to the limiting exposure concentrations (PEL or REL) with a naked-eye detectable color difference within 5 min with a dynamic detection procedure. The designed sensing system is promising for a real-time monitoring of the air quality related to alkylating fumigants in the environment, especially in agricultural and industrial areas.

Catalytic and ionic cross-linking actions of l-glutamate salt for the modification of cellulose by 1,2,3,4-butanetetracarboxylic acid

The sodium l-glutamate is reported as an efficient catalyst for the cross-linking between 1,2,3,4-butanetetracarboxylic acid (BTCA) and cellulose. Results presented ester absorbance of the treated fabrics strongly increased in the presence of the homemade l-glutamate salt, a mixture of l-glutamic acid (LGA) and NaOH at a specific ratio. Importantly, anti-wrinkle properties of the treated fabrics were significantly improved. Based on the relative concentration calculation, l-glutamate promoted the reaction of BTCA with cellulose by accelerating the formation of BTCA anhydrides and the esterification of anhydrides with cellulose. Besides, the improved anti-wrinkle property was partially attributed to the fact that the generated LGA reacted with cellulose and formed ionic cross-linking networks through amino groups with carboxyl groups in BTCA, which was confirmed by the Fourier transform infrared spectra and the computational calculations. Through detailed comparisons, l-glutamate catalyzed fabrics showed as good durability as sodium hypophosphite, indicating a possible alternative for phosphorus-containing catalysts.

[Clinical and prognostic significance of ABO promotor methylation level in adult leukemia and myelodydysplastic syndrome]

Objective: To investigate the clinical and prognostic significance of ABO promotor methylation level in adult patients with leukemia and myelodydysplastic syndrome(MDS). Methods: ABO promoter methylation level of 182 malignant hematological disease patients and 68 normal controls were detected by bisulfite sequencing PCR.Then clinical features and outcome were compared between hypermethylation group and hypomethylation group. Results: The median methylation rate of ABO promoter in newly diagnosed acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) were 46.98% and 11.01% respectively, which were both higher than that in controls (2.30%, P<0.05). The methylation rates in remission AML and ALL were 1.58% and 2.30% respectively, which were comparable with that in normal group (P>0.05). As to relapse AML and ALL, methylation rates were 41.26% and 17.50% respectively, also significantly higher than that in controls (P<0.05).In patients with chronic myeloid leukemia (CML) chronic phase, the median methylation rate was 1.00%, which was similar to normal group. But a CML patient who transformed to ALL hadextremely high methylation rate 92.56%. The median methylation rate in patients with MDS significantly elevated as 5.81% compared with that in controls (P<0.05). The median overall survival (OS) of ALL and AML (non-M3) patients with hypermethylation were 12.5 months and 15.3 months, which were significantly shorter than those with hypomethylation (24.0 months and 20.0 months)(P<0.05).The median disease-free survival (DFS) of ALL and AML (non-M3) patients with hypermethylation were 9.9 months and 12.0 months, which were significantly shorter than those with hypomethylation (22.3 months and 18.5 months), (P<0.05). Multivariable analysis suggested that ABO promoter methylation level was an independent predictive factor of OS and DFS in ALL and AML (non-M(3)) patients. Conclusion: ABO promoter hypermethylation is closely related to genesis, development and prognosis of leukemia and MDS. Hypermethylationis related to a clinical poor prognosis compare with hypomethylation.

Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all-cause mortality: a prospective study with 2-year follow-up

This study aims to detect whether there remains valuable prognostic information in fluctuation of red cell distribution width (RDW) in hip fracture patients. Results show that this readily available parameter may provide a more effective strategy for assessment of mortality risk, therefore providing a reference for clinical planning and decision-making.

INTRODUCTION

Prognostic values have been found in the fluctuation of some hematologic parameters. The red cell distribution width (RDW) routinely reported with all complete blood cell counts (CBC) has proven to be associated with poor outcomes in various diseases. However, whether the fluctuation in RDW is predictive of long-term mortality in hip fracture patients treated with surgery remains unknown.

METHODS

One thousand three hundred thirty hip fracture patients who underwent surgery from January 1, 2000 to November 18, 2012 were recruited in this prospective cohort study. Fluctuation in the RDW between admission and discharge was measured, and a Kaplan-Meier (KM) analysis and multivariable Cox regression model were applied to evaluate the relationship between this fluctuation and mortality. Risk factors for a larger fluctuation were detected by using Logistic regression analyses.

RESULTS

In addition to the admission RDW, a high RDW level at the time of discharge was also associated with an increased risk of death, while no significant difference was found in the postoperative RDW. Fluctuation in the RDW between admission and discharge was an independent risk predictor for 2-year mortality (HR 1.45 95%CI 1.06-2.00, p = 0.022). Factors affecting the change in the RDW between admission and discharge included both the demographic characteristics of the patients and clinical interventions.

CONCLUSION

Hip fracture patients who experience a greater fluctuation in RDW during the hospital course are at a heightened risk for 2-year all-cause mortality.

Acute Deep Vein Thrombosis Treated with Porcine Plasmin

The thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.

A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.

This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.

Sensitivity-Tunable Colorimetric Detection of Chloropicrin Vapor on Nylon-6 Nanofibrous Membrane Based on a Detoxification Reaction with Biological Thiols

Detoxification reaction of chloropicrin in the human body with biological thiols was selected for detection of chloropicrin in the air. The consumption of free sulfhydryl group in biological thiols by chloropicrin is colorimetrically detectable with the addition of the Ellman's reagent. In this study, glutathione, N-acetyl-l-cysteine, l-homocysteine, cysteamine, and thioglycolic acid were tested as sensing agents for chloropicrin vapor detection in ppb concentration range. The reactivity of the selected biological thiols was investigated based on both their redox properties and the nucleophilic strength of the sulfhydryl groups. Nylon-6 nanofibrous membrane and an organic solvent were used as a sensor matrix and a vapor sorbent, respectively, to provide solid supports with ultrahigh surface area and enhanced adsorption to chloropicrin vapor. The tunable sensitivity and detection range by using different biological thiols was achieved on the sensors due to the different reactivity of thiols toward chloropicrin.

[Comparison of the prognostic value of the seventh and eighth edition of The AJCC Esophageal Cancer Staging System for the patients with stage Ⅱ and Ⅲesophageal squamous cell carcinoma]

Objective: To compare and evaluate the prognostic value of the 7(th) and 8(th) edition of The AJCC Esophageal Cancer Staging System for patients with stage Ⅱ and Ⅲ esophageal squamous cell carcinoma. Methods: The clinical data of 328 esophageal cancer patients who received operation at Department of Esophageal Cancer, Tianjin Tumour Hospital from January 2006 to December 2010 were restrospectively analyzed. There were 63 female and 265 male patients. The mean age was 65 (range: 33 to 87) years. Univariate and multivariate analysis were performed to identify the prognosis factors. Results: The five years overall survival rates among patients with stage Ⅱ and Ⅲ were both significantly different (χ(2)=87.035, 84.730, all P=0.000) according to the 7(th) and 8(th) editions of the TNM staging systems. The five years overall survival rate among patients with stage ⅡB and ⅢA were significantly different (39.6% vs 23.4%, P=0.001) according to the 7(th) edition of the esophageal cancer staging systems.According to the 8(th) edition of the esophageal cancer staging system, the 5 years survival rate of patients with stage ⅡA and ⅡB, ⅢB and Ⅳ was statistically significant (58.5% vs. 35.5%, P=0.040; 18.9% vs. 0, P=0.000). In multivariate analysis, tumor size, T staging, N staging and tumor differentiation (HR=1.592, 95%CI: 1.185 to 2.139, P=0.002; HR=1.519, 95% CI: 1.236 to 1.867, P=0.000; HR=1.647, 95% CI: 1.448 to 1.874, P=0.000; HR=1.404, 95% CI: 1.059 to 1.861, P=0.018) were the main independent prognosis factors affecting the prognosis of esophageal squamous cell carcinoma patients. Conclusions: Both the 7(th) and the 8(th) editions of TNM staging systems are able to reflect the clinical prognosis of patients receiving radical resection of esophageal cancer, and the factors of tumor size, differentiaton, invasion depth and lymph node metastases are the independent predictors of prognosis. The 8(th) edition provides a more detailed and more reasonable for the staging of stage Ⅱ and Ⅲ for esophageal cancer patients than the 7(th) edition, and it is more accurate for the prognosis of patients with esophageal cancer after surgery.

Abstract P3-12-11: Disparities in adjuvant hormone adherence in breast cancer patients within a universal healthcare model

Background: Patient adherence to adjuvant hormonal therapy for breast cancer (BC) is correlated with improved survival. Recent publications have demonstrated ethnic disparities in adjuvant hormone adherence (AHA) for privatized healthcare models.

Objective: To identify disparities in AHA for BC patients within a universal healthcare system in Alberta, Canada.

Methods: Patients diagnosed from 2007-2014 with stage I-III, ER+/HER2- BC receiving adjuvant FECD or DC chemotherapy and at least one month of adjuvant hormonal therapy in Alberta, Canada were retrospectively assessed. Hormone monotherapy (tamoxifen, AI), switch strategies (tam to AI), and treatment duration were collected. Compliance was assessed with central pharmacy data. Patient ethnicity was identified using patient first/last and parental last name via Onolytics® ethnographic software. Ethnicity was further verified using a centrally collected place of birth. Age, AJCC stage, psychiatric diagnoses (mood, bipolar), and comorbidity were collected. Log rank and Chi squared were used to assess difference between adjuvant hormonal therapy for variables at 1, 2, and 5 years. Log rank p-values at 2 years are reported.

Results: A total of 2,399 ER+ patients were included for analysis. AHA was non-significant for ethnicity (p=0.797), comorbidity (p=0.623), psychiatric disorders (p=0.145), or elderly cohorts (p= 0.814). AHA by stage was significant with stage III &gt; II &gt; I (p=0.004) having the highest compliance rates. AHA was highest for planned hormonal switch strategies (p=0.004) compared to monotherapy.

Hormone Adherence RatesCharacteristicsNo. of Patients% AdherenceEthnicity  Caucasian211891.6Asian15293.4Middle Eastern/African9593.7Hispanic2491.7Age  &lt;65207791.8&gt;6534192.1Comorbidity  096191.21-3134392.2&gt;311493Psychiatric Dx  Yes31189.7No210792.1Stage  I45388.3II151292.1III45394.5Hormone Strategy  Monotherapy173190.9Switch68794.2

Conclusion: AHA is not dependent on ethnicity, age, comorbidity, or psychiatric diagnosis in a universal healthcare model. Conversely, higher rates of AHA are seen with planned switch strategy compared to monotherapy, contradictory to the BIG I-98 trial. Patients with higher stage, and thus higher risk of BC recurrence have increased adherence compared to their low risk counterparts. Reinforcement of AHA for low/moderate risk BC patients, in addition to tamoxifen to AI switch strategies may improve overall adherence.

Citation Format: Veitch ZW, Khan OF, Tilley D, Kostaras X, King K, Lupichuk S, Tang P. Disparities in adjuvant hormone adherence in breast cancer patients within a universal healthcare model [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-11.

BNIP3 induces apoptosis and protective autophagy under hypoxia in esophageal squamous cell carcinoma cell lines: BNIP3 regulates cell death

Bcl-2/adenovirus E1B 19-kDa interacting protein (BNIP3), a pro-apoptosis protein regulated by the methylation status of its promoter, has been implicated in inducing autophagy. However, the roles of BNIP3 and BNIP3-induced autophagy under hypoxia remain uncertain in esophageal squamous cell carcinoma (ESCC). Two esophageal squamous cancer cell lines, CAES17 and KYSE140, were selected on the basis of the expression and methylation status of BNIP3 to investigate the features of BNIP3 under hypoxia. Hypoxia increased cell death and the expression of BNIP3, whose promoter status was lower methylation, in a time-dependent manner. BNIP3 knockdown by RNA interference downregulated cell death. These studies demonstrated that the exposure of ESCC cells to hypoxia increased the autophagic punctate distribution of MDC staining and GFP-LC3 and that autophagy rate could be inhibited by BNIP3-siRNA. In addition, under hypoxia, cells transfected with BNIP3-siRNA exhibited a lower apoptosis rate than the control, and the apoptosis induced by BNIP3 exhibited a caspase-independent manner. Furthermore, the administration of the autophagic inhibitor 3-methyladenine (3-MA) could augment BNIP3-induced cell apoptosis and death, suggesting that autophagy plays a protective role under hypoxia. Together, our studies indicated that BNIP3 exerts prodeath effects through the induction of caspase-independent apoptosis under hypoxia in ESCC, though BNIP3-induced autophagy acting as a survival mechanism.