The safety and feasibility of same-day discharge for the management of patients undergoing pulmonary lobectomy

OBJECTIVES

Is same-day discharge mode safe and feasible for thoracoscopic lobectomy? This study assesses the safety and feasibility of same-day discharge for patients undergoing thoracoscopic lobectomy.

METHODS

We conducted a prospective cohort study from January to December 2022, all patients undergoing thoracoscopic lobectomy were screened for eligibility, and participating eligible patients were separated into a same-day discharge lobectomy (SDDL) group and an inpatient lobectomy (InpL) group based upon length of stay. All discharged patients underwent 30-day postoperative follow-up performed by a team of medical professionals. In addition, eligible patients that underwent thoracoscopic lobectomy from January to December 2021 were included in the historical lobectomy (HisL) group.

RESULTS

Of the 52 patients that met the eligibility criteria for same-day discharge, 17 were discharged within 24 h after surgery. In the SDDL group, of whom 1 (5.9%) underwent emergency treatment and readmission within 30 days after surgery due to a pulmonary infection, no patients experienced complications such as reoperation, air leakage, atelectasis, chylothorax, or blood transfusion events during the follow-up period. No differences in overall postoperative complication rates were detected between the SDDL and InpL groups (P>0.05), there was a non-significantly higher rate of readmission and emergency visits in the SDDL group relative to the other two groups (P>0.05).

CONCLUSIONS

These results emphasize the safety and feasibility of same-day discharge for patients undergoing thoracoscopic lobectomy, it may further revolutionize the general approach to the hospitalization of thoracoscopic lobectomy patients.

[Efficacy analysis of laparoscopic sleeve gastrectomy in morbidly obese patients aged 10-21 years]

Objective: To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients aged 10 to 21 years. Methods: We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020. The primary outcome measures were the completion rate of LSG, the incidence of perioperative complications, and weight-related indicators 3, 6, 12, and ≥24 months postoperatively. Additionally, we compared glucose metabolism, lipid metabolism, vitamin levels, liver function, and other relevant biochemical variables before and after surgery. Normally distributed continuous data are presented as x±s. Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively, independent sample t-tests were used for intergroup comparisons. Non-normally distributed continuous data are presented as M(Q1, Q3), and Mann-Whitney U tests were used for intergroup comparisons. Results: Among the 89 patients, 35 were male (39.3%), the mean age was (18±2) years, and mean body mass index (BMI) 38.5±4.8 kg/m²; 37 of the patients having a BMI greater than 40 kg/m². Additionally, 63 patients (70.8%) had fatty livers, 34 (38.2%) hyperuricemia, 31(34.8%) sleep apnea syndrome, 20 (22.4%) gastroesophageal reflux, eight (8.9%) type 2 diabetes, and two (2.2%) hypertension. All 89 patients underwent LSG surgery successfully, with no conversions to open surgery. During the perioperative period, there were no cases of major bleeding, gastric leakage, or infections. Notable postoperative symptoms included nausea, vomiting, and pain, most of which improved by the second postoperative day. BMI values 3, 6, and 12 months postoperatively had decreased to 31.5±5.8 kg/m², 28.6±4.3 kg/m², and 26.3±4.4 kg/m², respectively. All of these BMI values differed significantly from preoperative values (all P<0.05). At 12 and ≥24 months postoperatively, the percentages of total weight loss were (31.3±9.3)% and (33.1±10.5)%, respectively, both differing significantly from 3 months postoperatively (20.5±5.1)% (all P<0.05). The percentages of excess weight loss at 12 and ≥24 months postoperatively were 91% (70%, 113%) and 95% (74%, 118%) , respectively, both differing significantly from the percentage of total weight loss 3 months postoperatively (56% [45%, 72%]) (both P<0.05). Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4 (25.5, 100.5) U/L and 29.0 (9.5, 48.0) U/L to 14.0 (10.8, 18.3) U/L and 13.0 (10.5, 17.3) U/L, respectively, ≥24 months postoperatively. Hemoglobin A1c decreased from 5.6 (5.3, 5.8)% preoperatively to ≥24 months postoperatively 5.3 (5.0, 5.4)%. High-density lipoprotein increased from 1.0 (0.9, 1.2) mmol/L preoperatively to 1.4 (1.1, 1.6) mmol/L ≥24 months postoperatively. Vitamin B12 decreased from 350.0 (256.8, 441.3) μg/L preoperative to 230.3(195.4, 263.9) μg/L ≥24 months postoperatively. All differed significantly from preoperative values (all P<0.05). Conclusion: LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years. However, further confirmation is required through long-term, multicenter, randomized, controlled trials.

[Dilemma and breakthrough in the advancement of bariatric and metabolic surgery in China]

China currently has the largest population of overweight and obese individuals globally. Bariatric surgery is by far the most effective approach to address obesity and associated metabolic conditions. To manage the significant growth of obesity, China's bariatric and metabolic surgery has assumed a pivotal role. Despite a delayed start compared to other nations, China has made significant progress in bariatric metabolic surgery over the past two decades. Presently, the annual number of surgeries ranks ahead worldwide. However, the proportion of eligible obese patients undergoing bariatric surgery in China remains lower than global averages. Looking ahead, China's bariatric metabolic surgery field offers ample room for growth and improvement. This paper aims to highlight the achievements in bariatric and metabolic surgery within China while also addressing challenges, such as the high proportion of laparoscopic sleeve gastrectomy, adherence to operation standards and guidelines, postoperative management and loss of follow-up, and quality control of database. By analyzing the current landscape and challenges, it is anticipated that China's bariatric metabolic surgery will continue to make remarkable progress in the future, bolstered by the collective dedication of the medical community.

[Advances in endoscopic sleeve gastroplasty for the treatment of obesity and metabolic disease]

Obesity poses a serious threat to human health, and although bariatric surgery has been proven effective treatment for morbidly obese patients, its surgical risks and high medical costs limit its clinical application and popularity. Endoscopic sleeve gastroplasty (ESG), as a relatively new endoscopic surgery technique for weight loss, has satisfactory weight loss effects compared to laparoscopic sleeve gastrectomy and lifestyle interventions, while preserving the normal structure of the stomach. Its weight loss effects and safety have been validated in multicenter studies abroad. Although, ESG has not yet been widely performed in China, with the gradual maturity of this technique, its prospects are worth attention in the field of weight loss. In the future, large-scale, long-term, multi-center studies are urgently needed in China to clarify the long-term effects, remission of comorbidities, and occurrence of complications of ESG surgery in obese and metabolic disease patients.

The Plasma Concentration of Ticagrelor and Aspirin as a Predictor of Bleeding Complications in Chinese Acute Coronary Syndrome Patients With Dual Antiplatelet Therapy: A Prospective Observational Study

PURPOSE

This study evaluated the association among the plasma concentration of ticagrelor, ARC124910XX, aspirin, and salicylic acid with the risk of recent bleeding in patients with the acute coronary syndrome. To this end, we developed an accurate model to predict bleeding.

METHODS

A total of 84 patients included in this study cohort between May 2021 and November 2021. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic curve to verify the accuracy of the prediction model.

RESULTS

Multivariable logistic analysis showed that ticagrelor concentration (odds ratio [OR]: 2.47, 95% confidence interval [CI], 1.51-4.75, P = 0.002), ST-segment elevation acute myocardial infarction (OR: 32.2, 95% CI, 2.37-780, P = 0.016), and lipid-lowering drugs (OR: 11.52, 95% CI, 1.91-110, P = 0.015) were positively correlated with bleeding. However, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (OR: 0.04, 95% CI, 0.004-0.213, P < 0.001) was negatively correlated with bleeding. The receiver operating characteristic curve analysis showed that ticagrelor concentration and these factors together predict the occurrence of bleeding (area under receiver operating characteristic curve = 0.945, 95% CI, 0.896-0.994) and that ticagrelor concentration >694.90 ng/mL is the threshold of bleeding concentration (area under receiver operating characteristic curve = 0.696, 95% CI, 0.558-0.834).

CONCLUSION

In patients with acute coronary syndrome treated with dual antiplatelet therapy, ticagrelor concentration >694.90 ng/mL was an independent risk factor for bleeding (OR: 2.47, 95% CI, 1.51-4.75, P = 0.002), but ARC124910XX and salicylic acid concentration did not affect bleeding risk ( P > 0.05).

[Correlation between bioelectrical impedance and nutritional status in neurocritical care patients]

Objective: To explore the correlation between electrical impedance indicators and commonly used nutritional indicators in neurocritical care patients. Methods: A cross-sectional study was conducted to collect 58 neurocritical care patients in neurosurgery Department of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from June to September 2022. Bioelectrical impedance tests were performed after surgery or one week after injury, and nutrition-related biochemical indicators of the patients were collected on the same day, including nutritional status related indicators, inflammation related indicators, anemia related indicators and blood lipid related indicators. The patients were assessed with acute physiology and chronic health evaluation (APACHE) Ⅱ score and sequential organ failure assessment (SOFA) score. Based on the results obtained, the patients were assessed with nutritional score and spearman correlation analysis. The correlations of electrical impedance with nutrition related indicators and nutrition risk related indicators were analyzed. The prediction model of nutritional status was constructed by multi-factor binary logistic regression. Stepwise regression was used to screen electrical impedance indicators related to nutritional status. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated to evaluate the predictive ability of the nutritional status prediction model. Results: A total of 58 patients were collected, including 33 males and 25 females, and aged 72.0 (59.0, 81.8) years. Extracellular water (ECW) was positively correlated with interleukin 6 (r=0.529, P<0.001). The edema index [ECW/total body water (TBW)] was negatively correlated with albumin (r=-0.700, P<0.001), hematocrit (r=-0.641, P<0.001) and hemoglobin (r=-0.667, P<0.001). The phase angle was positively correlated with albumin (r_RA=0.667, r_LA=0.649, r_RL=0.669, r_LL=0.685, all P<0.001), hematocrit (r_RA=0.600, r_LA=0.604, r_TR=0.565, r_RL=0.529, r_LL=0.602, all P<0.001) and hemoglobin (r_RA=0.626, r_LA=0.635, r_TR=0.594, r_RL=0.624, r_LL=0.631, all P<0.001). By stepwise regression screening of predictive factors for nutritional status and incorporating age, gender and white blood cells as confounding factors into the model, the final model was obtained as follows: nutritional status=-0.01×age+1.22×gender-0.12×white blood cells+202.20×ECW/TBW+0.5 torso phase angle -82.16 [The OR value of ECW/TBW: 20.8 (95%CI: 3.7-117.1), P<0.001], with the AUC of 0.921. Conclusion: Bioelectrical impedance indicators have good correlations with commonly used clinical nutritional indicators, and can provide a new method for nutritional evaluation of neurocritical care patients.

Implementation of ovarian tissue cryopreservation in Hong Kong

INTRODUCTION

Worldwide, >130 babies have been born from ovarian tissue cryopreservation (OTC) and ovarian tissue transplantation (OTT). Ovarian tissue cryopreservation can improve quality of life among young female cancer survivors. Here, we assessed the feasibility of OTC and subsequent OTT in Hong Kong via xenografts in nude mice.

METHODS

This pilot study was conducted in a university-affiliated tertiary hospital. Fifty-two ovarian tissues were collected from 12 patients aged 29 to 41 years during ovarian surgery, then engrafted into 34 nude mice. The efficacies of slow freezing and vitrification were directly compared. In Phase I, non-ovariectomised nude mice underwent ovarian tissue engraftment. In Phase II, ovariectomised nude mice underwent ovarian tissue engraftment, followed by gonadotrophin administration to promote folliculogenesis. Ovarian tissue viability was assessed by gross anatomical, histological, and immunohistochemical examinations before and after OTC. Follicular density and morphological integrity were also assessed.

RESULTS

After OTC and OTT, grafted ovarian tissues remained viable in nude mice. Primordial follicles were observed in thawed and grafted ovarian tissues, indicating that the cryopreservation and transplantation protocols were both effective. The results were unaffected by gonadotrophin stimulation.

CONCLUSION

This study demonstrated the feasibility of OTC in Hong Kong as well as primordial follicle viability after OTC and OTT in nude mice. Ovarian tissue cryopreservation is ideal for patients who cannot undergo the ovarian stimulation necessary for oocyte or embryo freezing as well as prepubertal girls (all ineligible for oocyte freezing). Our findings support the clinical implementation of OTC and subsequent OTT in Hong Kong.

Ultrasonic optic nerve sheath diameter could improve the prognosis of acute ischemic stroke in the intensive care unit

Objectives: Stroke patients with high intracranial pressure (ICP) may have poor prognosis. Non-invasive ultrasonic optic nerve sheath diameter (ONSD) could evaluate increased ICP. To investigate whether ONSD is valuable for prognosis of patients with acute ischemic stroke (AIS). Methods: AIS receiving intensive care were recruited with the Glasgow Coma Scale (GCS) score. Patients in group A underwent ultrasonic ONSD to assess ICP voluntarily, whereas group B without ONSD. Patients were followed up at discharge and once a week for 3 months with Glasgow Outcome Scale (GOS) score (four to five scores indicated good prognosis and one to three scores indicated poor prognosis). Results: Forty-nine patients were included. GCS scores did not differ significantly between groups A (26 patients) and B (8 ± 3 vs. 7 ± 3, p < 0.05). In group A, ONSD was 5.01 ± 0.48 mm, which correlated with GCS score (p < 0.05). At discharge, the GOS score was higher in group A than in group B (3.35 ± 1.35 vs. 2.57 ± 1.121, p = 0.034). The proportion of patients with a good prognosis was higher in group A than in group B (46.2% vs. 13.0%, p = 0.006). At discharge and after 3 months of follow-up, ONSD at admission was correlated with the GOS score in group A (r = -0.648 [p < 0.05] and -0.731 [p < 0.05], respectively). After 3 months of follow-up, the GOS score was higher in group A than group B (3.00 ± 1.673 vs. 2.04 ± 1.430, p < 0.05). The proportion of patients with a good prognosis was higher in group A than in group B (46.2% vs. 21.2%, p = 0.039). The Kaplan-Meier curve showed a higher rate of good prognosis in group A than in group B. ONSD (p < 0.05) was an independent predictor of poor prognosis. Conclusion: Non-invasive ultrasonic ONSD could be useful in improving the prognosis of patients with AIS receiving intensive care.

[Effects of bariatric surgery on sex hormones in male patients with obesity]

Objective: To analyze and evaluate the differences in sex hormones after laparoscopic Roux-en-Y Gastric Bypass Surgery (LRYGB) and laparoscopic sleeve gastrectomy (LSG) in male patients with obesity. Methods: This study was a retrospective cohort study. The inclusion criteria were (1) male patients with obesity who met the surgical indications of the "Chinese Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes" (2019 Edition); (2) patients with a body mass index (BMI) of ≥27.5 kg/m2 and obesity-related metabolic diseases, or patients with severe obesity and a BMI of ≥35 kg/m2; and (3) sex hormone levels checked 1 year after surgery. The exclusion criteria included (1) patients with endocrine diseases (thyrotoxicosis, hyperprolactinemia) and hypothalamic-pituitary lesions and (2) those with severe major organ dysfunction who could not tolerate anesthesia or surgery. According to the above criteria, the clinical data of male patients with obesity admitted to the Gastrointestinal Surgery/Bariatric Center of the First Affiliated Hospital of Jinan University from October 2017 to January 2020 were included. A total of 52 male patients with obesity were included in this study. The mean age, body weight, BMI, and total testosterone level were (29.3±10.2) years, (123.6±35.4) kg, (40.1±11.1) kg/m², and 7.6 (5.5, 9.1) nmol/L, respectively. Forty-five patients (86.5%) exhibited testosterone deficiency. Among all the patients, 29 underwent LSG (LSG group) and 23 underwent LRYGB surgery (LRYGB group). The main outcome measure was the change in sex hormone levels before and after bariatric surgery in all the patients. The secondary outcome measures were the comparison of changes in sex hormone levels before and after LSG and LRYGB. Results: Pearson correlation analysis showed that preoperative estradiol was positively correlated with waist circumference (R=0.299, P<0.05), hip circumference (R=0.326, P<0.05), and chest circumference (R=0.388, P<0.05). Testosterone was negatively correlated with BMI (R=-0.563, P<0.01), waist circumference (R=-0.521, P<0.01), hip circumference (R=-0.456, P<0.01), chest circumference (R=-0.600, P<0.01), and neck circumference (R=-0.547, P<0.01). One year following bariatric surgery, the serum testosterone (7.6 [5.5, 9.1] nmol/L vs. 13.6 [10.5, 15.4] nmol/L, Z=-5.910, P<0.001), follicle-stimulating hormone (4.7 [2.7, 5.3] IU/L vs. 6.5 [3.6, 7.8] IU/L, Z=-4.658, P<0.001), and progesterone (1.2 [0.4, 1.5] nmol/L vs. 1.9 [0.8, 1.3] nmol/L, Z=-2.542, P=0.011) levels were significantly higher in all the patients. Both estradiol (172.8 [115.6, 217.5] pmol/L vs. 138.3 [88.4, 168.1] pmol/L, Z=-2.828, P=0.005) and prolactin (11.4 [6.4, 14.6] mIU/L vs. 8.6 [4.8, 7.3] mIU/L, Z=-2.887, P=0.004) levels were decreased. In addition to prolactin levels in the LRYGB group, there were statistically significant differences in the levels of estradiol (P=0.030), follicle-stimulating hormone (P < 0.001), luteinizing hormone (P=0.033), progesterone (P=0.034), and testosterone (P<0.001) compared with their preoperative levels. In the LSG group, there were statistically significant differences in the levels of follicle-stimulating hormone (P=0.011), prolactin (P=0.023), and testosterone (P<0.001) compared with their preoperative levels. Conclusion: The degree of obesity in men was negatively correlated with testosterone levels. Both LRYGB and LSG can significantly improve sex hormone levels in male patients with obesity, and testosterone levels show a significant increase after surgery.

[Application of the concept of precision obesity metabolic surgery in laparoscopic Roux-en-Y gastric bypass]

Due to the complexity and heterogeneity of obesity, the diagnosis and treatment of obesity vary greatly. Five to 10 percent of body weight can be lost through lifestyle modifications, nutritional and behavioral counseling, and the use of approved weight reduction medicines for obesity and diabetes; however, these non-surgical treatments are not effective for all patients. Compared to medical therapy, bariatric surgery is associated with higher rates of type 2 diabetes remission, lower mortality from vascular complications, and long-term, sustained weight loss. With the advent of precision medicine in surgical therapy, bariatric surgeons' fundamental understanding of laparoscopic Roux-en-Y gastric bypass surgery has evolved in recent years. The objective of surgery has shifted from short-term weight loss to the safe and successful long-term management of patient weight and comorbidities. In laparoscopic Roux-en-Y gastric bypass surgery, the concept of precision bariatric and metabolic surgery is mainly reflected in three aspects: accurate preoperative assessment, precise intraoperative operation, and comprehensive postoperative management. A new direction for the future development of precision laparoscopic Roux-en-Y gastric bypass surgery and obesity metabolic surgery is to formulate precise and individualized surgical treatment plans for patients and to use artificial intelligence and big data technology to improve the standardization of specialist data.

Real-world effectiveness and safety of edoxaban in patients with and without a history of ischaemic stroke: results from the ETNA-AF programme

Background

Atrial fibrillation (AF) patients with a history of ischaemic stroke (IS) have a higher risk for recurrent IS events and were largely excluded from the pivotal, randomised, controlled phase 3 trials on oral anticoagulants. Thus, the effectiveness and safety of edoxaban in these patients need to be studied in a real-world setting.

Purpose

To compare edoxaban real-world effectiveness and safety in AF patients with or without an IS history.

Methods

The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients receiving edoxaban for stroke prevention. This snapshot analysis summarises baseline characteristics with medical history and 2-year annualised rates of all-cause death, cardiovascular (CV) death, stroke (haemorrhagic, ischaemic, any), and bleeding (including major bleeding [MB], major gastrointestinal [GI] bleeding, intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding [CRNMB], and any bleeding) in patients with or without IS history.

Results

Data from 27,333 patients (3215 with prior IS and 24,118 without) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with IS history were significantly older, more likely ≥75 years of age, and had a lower mean body weight and creatinine clearance (P&lt;0.0001 for all; Table). Patients with IS history also had significantly higher baseline stroke (CHA2DS2-VASc) and bleeding (HAS-BLED) risk scores (P&lt;0.0001 for both; Table). A significantly higher percentage of patients with IS history had previous transient ischaemic attacks (TIA), MB, and ICH (P&lt;0.0001 for all; Table). Patients with IS history more likely received edoxaban 30 mg vs 60 mg at baseline (P&lt;0.0001). Effectiveness and safety outcomes hazard ratios are shown in the Figure. Patients with IS history had significantly higher rates of all-cause death (4.5% vs 3.0%; P&lt;0.0001), CV death (1.9% vs 1.4%; P=0.004), IS (2.5% vs 0.5%; P&lt;0.0001), any stroke (3.1% vs 0.7%; P&lt;0.0001), and TIA (0.5% vs 0.2%; P=0.0002). Patients with IS history had significantly higher annualised rates of MB (1.6% vs 1.0%; P&lt;0.0001), major GI bleeding (0.8% vs 0.5%; P=0.003), ICH (0.6% vs 0.3%; P&lt;0.0001), haemorrhagic stroke (0.5% vs 0.2%; P&lt;0.0001), CRNMB (2.3% vs 1.3%; P&lt;0.0001), and any bleeding (6.1% vs 4.1%; P&lt;0.0001).

Conclusions

Patients with AF who have a history of IS are more likely elderly; have histories of MB, ICH, and TIA; and have high baseline stroke and bleeding risk scores. Patients with IS history receiving edoxaban have a considerably higher likelihood of experiencing IS or TIA, whereas the risk of experiencing any bleeding event (with the exception of ICH) is only modestly higher than in those without IS history.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo

The real-world effectiveness and safety of edoxaban treatment in 27,333 Global ETNA-AF programme patients with and without a history of heart failure

Background

Heart failure (HF) occurs in approximately 26% of patients with atrial fibrillation (AF). Real-world data of oral anticoagulation with edoxaban in AF patients with HF history are limited.

Purpose

To compare edoxaban effectiveness and safety in AF patients with or without HF history.

Methods

The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients receiving edoxaban for stroke prevention. This snapshot analysis summarises baseline characteristics and 2-year annualised rates of all-cause death, cardiovascular (CV) death, stroke (haemorrhagic, ischaemic, any), and bleeding (major bleeding [MB], major gastrointestinal [GI] bleeding, intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding [CRNMB], and any bleeding) in patients with or without HF history. Univariate Cox regression models assessed clinical outcomes.

Results

Data from 27,333 patients (5258 with HF history) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with HF history were significantly older and had lower mean body weight and creatinine clearance (P&lt;0.0001 all; Table). Patients with HF history had significantly higher baseline stroke (CHA2DS2-VASc) and bleeding (HAS-BLED) risk scores (P&lt;0.0001 both; Table). Significantly more patients with HF history reported previous experiences with MB (P=0.001) and major GI bleeding (P=0.007); these patients were also more likely to receive 30 mg edoxaban vs 60 mg edoxaban (P&lt;0.0001; Table). Patients with HF history had significantly (P&lt;0.0001 both) higher rates of all-cause (6.1% vs 2.5%; hazard ratio [HR] (95% confidence interval [CI]), 2.41 [2.17–2.68]) and CV death (2.8% vs 1.2%; HR [95% CI], 2.39 [2.05–2.80]), and fatal bleeding (0.3% vs 0.2%; HR [95% CI], 1.86 [1.20–2.89]; Figure). The proportion of all-cause deaths that were fatal bleeding events was 6% and 7% for patients with and without HF, respectively. Additionally, patients with HF history had significantly (P&lt;0.0001 both) higher rates of MB (1.7% vs 0.9%; HR [95% CI], 1.87 [1.53–2.28]) and major GI bleeding (1.1% vs 0.4%; HR [95% CI], 2.69 [2.07–3.49]), with a greater proportion of MB events classified as major GI bleeding (64.5% vs 44.8%; P&lt;0.0001). Patients with HF history also had significantly (P&lt;0.0001 both) higher rates of CRNMB (HR [95% CI], 1.87 [1.58–2.21]) and any bleeding (HR [95% CI], 1.49 [1.34–1.65]). Rates of ICH and haemorrhagic stroke were similar in both groups.

Conclusions

In AF patients receiving edoxaban, the rates of MB, major GI bleeding, and CV or all-cause death were higher when comparing those with versus without HF history. The higher incidence of MB and major GI bleeding in patients with HF history did not lead to proportionally higher fatal bleeding rates among all-cause deaths.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo

Two-year effectiveness and safety outcomes in 27,333 edoxaban-treated patients with and without a history of major bleeding from the Global ETNA-AF programme

Background

Atrial fibrillation patients with a history of major bleeding (MB) are at high risk of future bleeding events; this history was an exclusion criterion in pivotal phase 3 trials of anticoagulation for stroke prevention. Real-world edoxaban effectiveness and safety in patients with a history of MB were analysed from the global ETNA programme.

Purpose

To compare edoxaban effectiveness and safety in AF patients with or without an MB history.

Methods

The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients treated with edoxaban for stroke prevention. This snapshot analysis summarises global baseline characteristics and 2-year annualised rates of all-cause death, cardiovascular death, stroke (haemorrhagic, ischaemic, any), and bleeding (including MB, major gastrointestinal bleeding [MGIB], intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding, and any bleeding) in patients with or without MB history.

Results

Data from 27,333 patients (479 with MB history and 26,854 without) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with MB history were significantly older (P&lt;0.0001) and more likely to be ≥75 years of age (P=0.0003), to be male (P=0.024), and to have a lower body weight and creatinine clearance (P&lt;0.0001 for both) (Table). Globally, antiplatelet use was significantly higher in patients with MB history compared with patients without (P=0.005). Patients with MB history were more likely to have previously diagnosed heart failure (HF, P=0.001) and to receive 30 mg vs 60 mg edoxaban at baseline (P&lt;0.0001). Hazard ratios for effectiveness and safety outcomes are shown in the Figure. Patients with MB history had significantly higher annualised rates of all-cause death (5.7% vs 3.1%; P&lt;0.0001), ischaemic stroke (1.8% vs 0.7%; P=0.002), and any stroke (3.1% vs 0.9%; P&lt;0.0001) than patients without MB history. Patients with MB history also had significantly higher annualised rates of MB (3.6% vs 1.0%; P&lt;0.0001), MGIB (1.5% vs 0.5%; P=0.001), ICH (1.5% vs 0.3%; P&lt;0.0001), fatal bleeding (0.9% vs 0.2%; P&lt;0.0001), and fatal ICH (0.5% vs 0.1%; P=0.0002). Among patients with MB history, the annualised rate of ICH did not differ between patients with ICH history (1.42%/yr) vs without (1.65%/yr); whereas the annualised rate of MGIB was significantly higher in patients with MGIB history vs without (4.14%/yr vs 1.08%/yr; P=0.0337).

Conclusions

Patients with AF receiving edoxaban and who have a history of MB are more likely elderly, male, and have comorbidities, including HF. These patients are also more susceptible to any adverse cardiovascular event. ICH event rates were not higher in patients with prior ICH than those with non-ICH major bleedings, whereas history of MGIB was associated with a high risk of MGIB recurrence.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo

[Occurrence of gastric cancer after laparoscopic Roux-en-Y gastric bypass: a systematic review]

Laparoscopic Roux-en-Y gastric bypass (RYGB) is an important obesity surgery. The risk of remnant gastric cancer after RYGB for obesity is gaining growing attention from bariatric surgeons and patients with obesity. This systematic review included articles from major databases internationally and domestically that specifically described the remnant gastric cancer after RYGB intervention, a total of 21 cases was subsequently analyzed. The average median time from post-operative RYGB to diagnosis of gastric cancer was 11 years (1-28 years), the duration of gastric cancer symptoms lasted 7 days to 6 years, abdominal pain is the most common (71.4%), especially in the upper abdomen (33.3%), followed by nausea and vomiting (33.3%), over-weight loss (33.3%), and abdominal bloating (28.6%), etc. Neoplasm location was reported to occur in the antrum or the pre-pyloric region (71.4%), with adenocarcinoma being the most common tumor histology observed (71.4%), tumor stage III-IV as the most diagnosed, 38.1% of tumor were deemed to be unresectable, 52.4% of the patients performed subtotal gastrectomy and lymphadenectomy. In addition, a global article investigating the occurrence of esophageal gastric cancer after RYGB in 64 cases revealed the common preoperative medical history include smoking habits (37.5%), alcohol issues (14.0%), GERD (86.0%), presence with Barret esophagus (10.9%), patients that has other malignant tumor medical history (6.3%), first-degree relatives (6.3%), or other family members with gastric esophagus cancer family history. Although the incidence of gastric cancer after RYGB is rare, the increasing prevalence of gastric cancer development is one of great concern. A rise in clinical cases of patients treated with RYGB presents a target for future studies. Risk of gastric cancer after RYGB should be evaluated and considered in high-risk cases.

[Research advances on the function of skin touch receptor Merkel cells]

The reconstruction of tactile function during the repair of skin damage caused by factors including burns is inseparable from the functional regeneration of tactile receptor Merkel cells. Merkel cells mainly exist in the basal layer of the epidermis and are closely connected with nerves to form Merkel cell-nerve complexes, which play an important role in biological organisms. A large number of studies have shown that Merkel cells conduct precise transmission of mechanical force stimuli through the mechanically gated ion channels PIEZO2, and perform the function of tactile receptors. In this paper, we discussed the characteristics of Merkel cells and analyzed the different subgroups that may possibly exist in this type of cells and their functions, at the same time, we investigated the animal model research of touch-related diseases and the clinical diseases related to touch, revealing the importance of Merkel cell function research.

Effectiveness and safety of edoxaban in 27,333 patients from ETNA-AF with and without a history of intracranial haemorrhage after 2 years of treatment

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo, Inc. Medical writing and editorial support were provided by Atreju Lackey, PhD of AlphaBioCom, LLC, and funded by Daiichi Sankyo, Inc.

Background/Introduction

Once-daily edoxaban significantly reduced the risk of intracranial haemorrhage (ICH) compared with well-managed warfarin in atrial fibrillation (AF) patients in the ENGAGE AF-TIMI 48 trial. The effectiveness and safety of edoxaban in patients with prior ICH is unknown.

Purpose

To compare the effectiveness and safety of edoxaban in AF patients with or without a history of ICH.

Methods

The Global ETNA-AF programme is composed of and, thus, integrates data from multiple prospective, observational, and noninterventional regional studies collecting data of AF patients treated with edoxaban for stroke prevention. This snapshot analysis presents global and regional baseline characteristics with medical history and 2-year annualised rates of all-cause mortality, stroke (haemorrhagic, ischaemic, any), and bleeding (major bleeding [MB] including ICH, clinically relevant nonmajor bleeding [CRNMB], any bleeding), in patients with or without ICH history.

Results

Overall, 27,333 patients from Europe, Japan, South Korea, and Taiwan were analysed, including 367 with prior ICH and 26,966 without prior ICH. There were proportionally fewer patients with a history of ICH in the European population. Patients with a history of ICH were older (P=0.006), had a lower body mass index (P&lt;0.0001), had a lower creatinine clearance (P=0.0001), and had more comorbidities, with a higher percentage of patients with a history of stroke, transient ischaemic attack (TIA), or MB (Table 1); the higher level of comorbidities noted in patients with a history of ICH was also reflected by higher baseline CHA2DS2-VASc and HAS-BLED scores (Table 1). Patients with a history of ICH were more likely receiving 30 mg edoxaban at baseline, whereas patients without ICH history were more often on 60 mg edoxaban (each P&lt;0.0001). In patients with vs without ICH history, all-cause mortality (5.10% vs 3.14%; P=0.01), ischaemic stroke (1.79% vs 0.73%; P=0.006), and any stroke rates (3.25% vs 0.95%; P&lt;0.0001) were higher (Table 2). Patients with vs without ICH history had higher annualised rates of MB (2.50% vs 1.00%; P=0.001), ICH (1.42% vs 0.27%; P&lt;0.0001), haemorrhagic stroke (1.42% vs 0.20%; P&lt;0.0001), CRNMB (2.49% vs 1.40%; P=0.04), and any bleeding (7.57% vs 4.27%; P=0.001), but these rates were low compared to other high-risk populations. ICH was not selected as a predictor of cardiovascular outcomes on multivariate prediction modelling. ICH had non-significant effects in predicting all-cause death (HR 1.22), ischemic stroke (HR 1.14), and major bleeding (HF 1.37) and repeat ICH (HR 1.94).

Conclusions

Patients with a history of ICH are a small, elderly, multimorbid subgroup of patients with AF. Treatment with the non-vitamin K antagonist oral anticoagulant edoxaban resulted in relatively low rates of major events.

Recurrent umbilical varix rupture with hemoperitoneum: a case report and review of literature

Background

Non-traumatic hemoperitoneum was a rare event with the risk of sudden death. Spontaneous rupture of hepatocellular carcinoma is the most intuitive diagnosis when hemoperitoneum occurs in cirrhotic patients who are not regularly followed up. However, other etiologies of hemoperitoneum, such as intra-abdominal varix rupture, should be kept in mind.

Case presentation

A 44-year-old man with alcoholic liver cirrhosis, Child–Pugh B was sent to our emergency department (ED) because of recurrent abdominal pain and hypovolemic shock. He had similar symptoms one month ago and was diagnosed as hepatocellular carcinoma (HCC) rupture with hemoperitoneum, therefore he underwent trans-arterial embolization (TAE). However, the follow-up magnetic resonance imaging (MRI) showed less possibility of hepatocellular carcinoma. Contrast enhanced abdominal computed tomography (CT) showed possible umbilical vein contrast agent extravasation. Exploratory laparotomy confirmed the diagnosis of rupture umbilical varix with hemoperitoneum.

Conclusion

Although umbilical varix rupture is a rare cause of hemoperitoneum, it should be kept in mind in cirrhotic patients with unexplained hemoperitoneum.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-022-02167-3.

Markers of Iron Metabolism and Stroke Risk: Cross-Sectional and Longitudinal Findings from the China Health and Nutrition Survey (CHNS)

Background:

The association of iron metabolism or status with the stroke risk remains unclear. We aimed to examine the associations between markers of iron metabolism or status and stroke risk using data from the China Health and Nutrition Survey (CHNS).

Methods:

Overall, 8589 in the CHNS in 2009, and 7290 participants between 2009 and 2015 were included in the cross-sectional and longitudinal analyses, respectively. Markers included hemoglobin, ferritin (FET), transferrin (TRF), soluble transferrin receptor (sTRF-R), and ratio of sTRF-R/log FET (sTfR-F index). Multivariable logistic regression and Cox proportional hazards models were used to analyze the associations between those markers and risk of stroke. Age, gender, high-sensitivity CRP (hsCRP), body mass index (BMI), current smoking, drinking status, diabetes and hypertension were included as potential confounding factors.

Results:

We observed longitudinal associations of hemoglobin (HR: 1.54, 95% CI: 1.15 – 2.06, P = 0.004), and sTfR-F index (HR: 0.68, 95% CI: 0.46 – 0.99, P = 0.044) with stroke risk among the participants whose BMI ≤ 23 kg/m². In addition, FET levels were significantly associated with stroke risk among female (HR: 1.45, 95% CI: 1.00 – 2.09, P = 0.049) after a median of 6.1 years follow-up. Hemoglobin, FET, TRF, sTRF-R, and sTfR-F index were not associated with the risk of stroke in overall analyses.

Conclusion:

FET among female, hemoglobin and sTfR-F index among those BMI ≤ 23 kg/m² may be contributing factors for stroke.

[Analysis of the clinical manifestations of 3 425 patients with orofacial pain of temporomandibular disorders]

Objective: To describe and analyze the clinical manifestations of patients with orofacial pain of temporomandibular disorders (TMD). Methods: A retrospective study on orofacial pain was conducted for 3 425 patients diagnosed as TMD based on clinical symptoms and signs in the Department of Temporomandibular Disorders and Orofacial Pain, School of Stomatology, The Fourth Military Medical University. The patients included 1 158 males and 2 267 females with a median age of 32 years. The gender, age, course of disorders, pattern and site of pain, CT imaging diagnosis of temporomandibular joint (TMJ) were analyzed. The distribution of gender, age and disorder course interval were described. The differences in frequency of the pattern and site of pain, imaging diagnosis in different gender, age and disease course interval were compared. Chi-square test and non-parametric rank sum test were performed using software SPSS 23.0. Results: Of the 3 425 patients, 29.1% (997/3 245) had signs of joint popping, and 40.1% (1 373/3 425) had restricted opening. The pain frequency was higher in males who had disorder course less than 1 month (P<0.01) and also in males who had open-and-close and/or lateral excursion and/or protrusion pain without tenderness or other pain without tenderness (P<0.05). However, the pain frequency was higher in females who had tenderness (P<0.01). The pain frequencies in those over 56 years old with tenderness combined with open-and-close and/or lateral excursion and/or protrusion pain were higher than in patients of other ages (P<0.01). In patients with unilateral TMJ pain, the frequency in males was higher than females(P<0.01), while the frequency in females was higher in patients with unilateral TMJ pain combined with unilateral or bilateral myalgia and the frequency was higher in patients under 15 years old having bilateral TMJ pain and/or unilateral or bilateral myalgia (P<0.05). In patients with unilateral TMJ pain, the frequency in those with disorder course≤1 month was higher than in those with other disease duration intervals (P<0.01), while in patients with bilateral myalgia or TMJ pain plus unilateral or bilateral myalgia, the frequency in those with disorder course>3 years was higher than in those with other disease duration intervals(P<0.01). In patients with unilateral TMJ pain, the frequency was higher in those having open-and-close and/or lateral excursion and/or protrusion pain (P<0.01). In patients with unilateral myalgia and bilateral myalgia, the frequency was higher in those having tenderness (P<0.01). The frequency of TMJ space changes in male patients was higher than females and the frequency of hyperosteogeny and resorption in females were higher than males (P<0.05). The frequency of TMJ space changes and developmental problems were higher in patients aged 16 to 35 years, while the frequencies of hyperosteogeny, bone resorption and cystis in those over 56 years were higher than other ages (P<0.01). The frequency of TMJ space changes in patients with disorder course≤1 month was higher than in those with other disease duration intervals (P<0.01), while the frequency of hyperosteogeny was higher in patients with disorder course>3 years (P<0.01). Conclusions: The male to female ratio in the present patients with orofacial pain of TMD was about 1 to 2. Most of the patients visited hospital within half a year after the disorders occurred. The pattern and site of the orofacial pain, signs on TMJ CT images showed some distribution regularities in views of gender, age and disorder course.

[Clinical analysis of two brothers with Imerslund-Gräsbeck syndrome]

The clinical data of two children with Imerslund-Gräsbeck syndrome (IGS) who were admitted to the First Affiliated Hospital of Zhengzhou University in August 2019 was analyzed retrospectively. The two cases were siblings, aged 8 years and 8 months and 6 years and 2 months, respectively. These two boys had megaloblastic anemia, low level of vitamin B₁₂, hyperhomocysteinemia, accompanied by proteinuria and renal tubular injury, while they showed normal folate level and renal function. Blood tandem mass spectrometry and urine organic acid analysis suggested methylmalonic acidemia (MMA). The initial diagnosis was MMA with homocysteinemia. No known pathogenic gene mutation related to MMA was found by gene sequencing. Compound heterozygous variants of amnionless (AMN) gene were detected: c.43+5G>A and c.C717G. The corrected diagnosis was IGS. Both brothers were treated with long-term intramuscular injection of vitamin B₁₂. After follow-up for one year, these two cases had no clinical symptoms, and their blood indicators remained normal, but proteinuria and renal tubular injury persisted. Blood tandem mass spectrometry and urine organic acid analysis alone may easily lead to misdiagnosis, but combined with genetic testing can improve the accuracy of diagnosis of IGS. Lifelong parenteral vitamin B₁₂ replacement therapy can effectively reverse the clinical and biochemical results, but is uncertain in alleviating albuminuria and renal tubule injury. It's necessary to monitor the renal function regularly.

O-145 Green Tea catechins EGCG and pro-drug of EGCG (Pro-EGCG) inhibit endometriosis through targeting molecules regulating macrophages and B cells

Study question

What are the therapeutic targets and mechanisms of green tea EGCG and Pro-EGCG in treating endometriosis?

Summary answer

EGCG and Pro-EGCG have unique molecular targets to regulate interactions of B cells, macrophages and endometriotic cells and limit the growth and development of endometriosis.

What is known already

Current treatments of endometriosis are mainly hormonal suppression and surgical ablation or removal. Our previous studies showed EGCG significantly inhibits development of experimental endometriosis in mice. Pro-EGCG is more effective than EGCG in term of anti-endometriosis, anti-angiogenesis and anti-oxidation (Wang, et. al., 2013; Xu, et al., 2011). Dysfunctional immunological activities of macrophages and B cells were found in women with endometriosis. The molecular targets, underlying mechanism and differential therapeutic efficacy of EGCG and Pro-EGCG, as well as their anti-inflammatory activities are still not known.

Study design, size, duration

Multiplexed Proteome Integral Stability Alteration (PISA) assay (Gaetani et al.,2019), followed by MS/MS was applied to identify the molecular targets of EGCG and Pro-EGCG in endometriotic cells. Pharmacological studies of EGCG and Pro-EGCG on endometriotic cell line and endometriosis models in mice were performed to characterise their anti-endometriosis and anti-inflammatory effects. Gene silencing and over-expression experiments were conducted to confirm the immunoregulatory mechanisms.

Participants/materials, setting, methods

Endometriotic (Hs832(C)T) cell lines in culture and lysate were treated for chemical proteomics analysis. SiRNA and overexpression vectors were transfected to the cells in vitro and lesions in vivo. Hs832(C).T, monocytic cells (THP-1) and control B cell (Raji null) lines were used for co-culture assays to study the interaction between endometriotic and immune cells in vitro. Endometriosis mice model was established for immunostaining and microarray analysis of lesions to characterise the molecular pathways in vivo.

Main results and the role of chance

MTDH and PXK were the strongest and most differential targets of EGCG and Pro-EGCG in both cells lysate and cell culture of Hs832(C).T, respectively. Gene silencing and overexpression of the protein targets in vitro and in vivo significantly altered expressions of downstream proteins, including BLK and EGF after PXK, and MYC and AKT after MTDH, as well as endometriosis-related genes such as VEGFC and MMP9. Co-culture assays of Hs832(C).T with Raji null or THP-1 induced macrophages showed that expressions of PXK, MTDH, downstream targets, and immune-related genes were significantly increased after incubation of recombinant proteins, but were significantly decreased after EGCG and Pro-EGCG treatment. M1 and M2 macrophages, as well as B cells were significantly reduced after the treatments in vitro and in vivo. Double immunofluorescent staining of lesions showed that CD68, CD163 or CD20 co-expressed with MTDH, PXK and downstream targets, and numbers of the co-expressed cells were significantly reduced after treatments in vivo. Microarray experiment further identified the upstream and downstream genes of MTDH or PXK contributing to the growth and development of endometriosis.

Limitations, reasons for caution

Results of this pharmacological and mechanistic study require clinical samples to validate the anti-endometriosis effects of EGCG and Pro-EGCG. Effects of other potential pharmaceuticals targeting the macrophages and B cells on endometriosis are needed.

Wider implications of the findings

The findings provide pharmacological and mechanistic data for future development of EGCG and Pro-EGCG as new treatment for endometriosis. This study shows that macrophage and B cell could be potential therapeutic targets for treatment of endometriosis, which opens up new horizon for the novel immunotherapy for endometriosis.

Trial registration number

NA

P–368 Dynamic metabolomic profiling during early implantation period

Study question

To investigate the different metabolomic profiling in serum between pregnant and non-pregnant women during early implantation period.

Summary answer

Metabolomics of progesterone-related hormones enhances from ET day3 for pregnancy women compared with non-pregnancy women.

What is known already

Metabolomics is based on high-throughput analytical methods to identify and quantify metabolites. Compared to other omics study, metabolomics is the closest one to the phenotype, allowing the observation of dynamic changes in phenotype at specific timepoints. So far there is no published work about the metabolomics profile in human early implantation period. Study design, size, duration: Study design: comparative study. Size: 14 pregnancy women and 14 non-pregnancy women. duration: time-course.

Participants/materials, setting, methods

Participants: pregnancy women and unpregnancy women after embryo transfer (ET). Setting: university-based study. Methods: Peripheral blood were collected at ET day0, 3, 6 and 9. metabolomic profiling in serum by platforms of capillary electrophoresis-mass spectrometry (CE-MS) and liquid chromatography–mass spectrometry (LC-MS).

Main results and the role of chance

There were no statistical difference of the age, BMI, basal FSH level, endometrium thickness on the day of embryo transfer, distribution of primary and secondary fertility, embryo transfer cycle as well as the infertile types between the two groups. After deleting those with over 50% missing data, we finally have 310 metabolites into statistical analysis. Among the 310 metabolite, lipid metabolites account the largest percentage, nearly half of all metabolites. The second biggest class of metabolites in our data was organic acids. Combined results in repeated measurement ANOVA (RM-ANOVA) and ANOVA-simultaneous component analysis (ASCA) as well as multivariate empirical Bayes time-series analysis (MEBA), we finally found that progesterone-related hormones were the most important metabolites for the whole time-series data. Those significant metabolites showed a significant down regulation from ET day0 to ET day3 and up regulation from ET day3 to ET day9.

Limitations, reasons for caution

we have limited sample size for this study and further validation is necessary for confirmation.

Wider implications of the findings: The phenomenon of upregulation of progesterone-related hormones from day3 in pregnancy group might be related to the embryo-originated hcg. Because the embryo has entered into endometrium at day3 and produced cytokines, hcg and other interaction with endometrium.

Trial registration number

NA

P–408 Inadequate increase in Tim–3 on peripheral NK cells after blastocyst transfer is associated with early miscarriage

Study question

Whether the changing peripheral levels of Tim–3/Galectin–9 (Gal–9) and PD–1/PL–1 over 4 weeks after ET in ongoing pregnancies is different from pregnancies destined to miscarry.

Summary answer

A significant and sustained increase of Tim–3 in pNK cells was observed in pregnancies which were ongoing but not in pregnancies which later miscarried.

What is known already

The importance of maternal immune adaptation and tolerance to the implanting embryo, an allograft, has been extensively investigated for decades. Immune checkpoint molecules, like T-cell immunoglobulin mucin–3 (Tim–3) and programed cell death–1 (PD–1), are co-stimulatory receptors negatively regulating immune responses. During pregnancy, Tim–3 and PD–1 are expressed by several immune cells in the decidua and participate in the maternal-fetal immune interactions to mediate maternal immune tolerance through binding to their ligands Gal–9 and progressed death-ligand 1 (PD-L1) produced by trophoblast and immune cells. In addition to the implantation site, Tim–3 and PD–1 expressions in peripheral lymphocytes are modified during pregnancy.

Study design, size, duration

A prospective observational study includes 81 women who achieved ongoing pregnancy and 17 women who suffered from miscarriage after single day–5 blastocyst transfer. All the subjects were recruited from November 2018 to January 2020 in a university teaching hospital.

Participants/materials, setting, methods

Women undergoing single blastocyst transfer after in-vitro-fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment were recruited on the day of ET following informed, written consent. They had serial blood samples taken on the day of ET, and 4, 5, 6 and 7 weeks of gestation for measurement of (1) membranous Tim–3 and PD–1 expression on various peripheral lymphocytes by flow cytometry; and (2) serum concentrations of ligands Gal–9 and PD-L1 by ELISA.

Main results and the role of chance

The comparisons between two groups showed there was no significant difference between the 2 groups in baseline levels among all the parameters measured. In women who achieved ongoing pregnancy, a significant and sustained increase of Tim–3 in either peripheral NK (pNK) subsets was observed at 4-week, 5-week, 6-week and 7-week gestations compared to the baseline (Tim–3+CD56dimNK 39.14±1.51%, 41.14±1.62%, 41.34±1.94%, and 41.69±2.12% vs. 30.27±1.49%; Tim–3+CD56brihgtNK cells, 24.54±1.71%, 25.43±1.54%, 27.26±1.88% and 24.70±1.64% vs. 19.08±1.13%), and the concentration of serum PD-L1 was significantly increased at 6-week and 7-week gestations (48.33±17.78 pg/ml, 52.53±20.60 pg/ml) when compared to the day of blastocyst transfer (41.40±16.01 pg/ml). The expressions of Tim–3 in T, NKT cells and PD–1 in NK, T, NKT cells were not significantly changed across the 5 time points. In women who conceived but later miscarried, all the parameters examined from 4–7 weeks of gestation were not significantly different when compared with the baseline measurement. The only measurement which showed a significant difference between the 2 groups and across all time points after ET was the proportion of Tim–3+CD56dimNK cells which was significantly higher in women who achieved ongoing pregnancies compared with women who destined to miscarry from 4 to 7 weeks of gestation.

Limitations, reasons for caution

It is uncertain if the observation would be different between miscarriage associated with aneuploid embryo or euploid embryo as we had not been able to obtain karyotyping result in most of the miscarriage cases.

Wider implications of the findings: Our preliminary observation suggests that the proportion of Tim–3+pNK cells as early as 4-week gestation could be a potential immuno-bio-marker to predict if a pregnancy is likely to progress normally or result in a miscarriage. Clearly, the finding in this study needs to be confirmed in a larger cohort study

Trial registration number

not applicable.

P–417 A comparison of baseline and sequential changes of extended cytokine profile during implantation window between women who did and did not conceive after embryo transfer

Study question

To compare the changing peripheral levels of inflammation-related cytokine profile during a 9-day period after blastocyst transfer between women who did and did not conceive.

Summary answer:Successful implantation is associated with transient increase in serum pro-inflammatory cytokine profile followed by a switch to anti-inflammatory cytokine profile prior to confirmation of pregnancy.What is known already: Immunomodulation is thought to be important for the prevention of rejection of the implanting semi-allograft embryo and successful establishment of pregnancy. A successful pregnancy is characterized by a dominance of anti-inflammatory cytokine profile in the peripheral blood in the first and second trimesters of pregnancy. It is achieved by a complex interplay between various immune cells and cytokines at the fetal-maternal interface, among which the key-players are interleukine–10 (IL–10) and transforming growth factor-β1 (TGF-β1). The circulating inflammatory response in the first few days after embryo transfer to the pathophysiology of implantation failure remains unclear. Study design, size, duration: This prospective observational and longitudinal study on 47 women with infertility was performed in an in vitro fertilization unit from December 2018 to August 2019. The amounts of a range of cytokines was measured on serial blood samples obtained during a 9-day period after blastocyst transfer.

Participants/materials, setting, methods

Serial blood samples were obtained on the day of embryo transfer, and 3, 6, and 9 days afterward for measurement of serum interferon gamma (IFN-γ), tumor necrosis factor alpha, interleukin (IL)–2, IL–4, IL–10, IL–12, IL–13, IL–17, IL–18, and IL–22 using cytometric bead arrays; transforming growth factor beta 1 (TGF-β1) was measured using commercial enzyme-linked immunosorbent assay kits.

Main results and the role of chance

The cytokine profile was similar between the women who conceived and those who did not on the day of blastocyst transfer. In women who conceived, IFN-γ and IL–17 (pro-inflammatory cytokines) exhibited a transient and significant increase on day 3 after blastocyst transfer, which decreased to the baseline levels by day 6. Meanwhile, IL–10 (anti-inflammatory cytokine) was increased significantly on days 6 and 9, and TGF-β1 (anti-inflammatory cytokine) was increased significantly on day 9 after blastocyst transfer. In women who did not conceive, there was a more pronounced increase in IFN-γ and IL–17 (pro-inflammatory cytokines) on day 3, which was sustained on days 6 and 9 without a switch to an anti-inflammatory cytokine profile. Among women who conceived after blastocyst embryo transfer, there was a transient and modest increase in serum pro-inflammatory cytokine profile (IFN-γ and IL–17) 3 days after blastocyst transfer, which was followed by a switch to anti-inflammatory cytokine profile (increase IL–10 and TGF-β1) by 6 days after blastocyst transfer and the latter increase was sustained 9 days after blastocyst transfer, when pregnancy was confirmed.

Limitations, reasons for caution

This is an observational study on peripheral blood cytokine levels, so it is not possible to draw conclusions if the implantation failure is due primarily to failure of the embryo to elicit a trigger for the switch or failure of maternal response to a normal trigger released by the embryo.

Wider implications of the findings: The characteristic change in peripheral cytokine profile during successful implantation, well before confirmation of pregnancy, may provide an opportunity to develop serum biomarkers to monitor implantation and to understand the mechanism of its failure, especially in women who experience recurrent implantation failure after IVF.

Trial registration number

Not applicable

[Clinical pathological characteristics of 4 cases of gastric gland-derived tumors]

Objective: To investigate the pathological features of gastric tumor originated from the fundic gland, including oxyntic gland adenoma (OGA) and gastric adenocarcinoma of the fundic gland (GA-FG). Methods: A retrospective analysis of 2 cases of OGA and 2 cases of GA-FG admitted to our hospital from February 2019 to September 2019 was performed. The histological features were analyzed by immunohistochemical staining combined with endoscopic observation. Results: The four cases arose from the deep layer of the lamina propria mucosae and well differentiated. Two cases of OGA confined to the mucosa, including 1 case of irregular tubules showing low-degree dysplasia and another case of irregular branching and anastomosing tubules showing high-degree dysplasia. Two cases of GA-FG combined with submucosal invasion, showed irregular branching and anastomosing tubules and formed a so-called "endless glands" pattern. Atypia, helicobacter pylori (HP) infection, chronic gastritis, intestinal metaplasia, or gastric atrophy were not observed in the superficial epithelium covering the tumor extent. Two cases of OGA and 2 cases of GA-FG showed the same result of immunohistochemical staining: pepsinogen-1 was diffusely positive in the tumor tissues and indicated chief cell differentiation, while positive ATPase and PDGFRA-α indicated parietal cells differentiation. The expression of Syn were positive in all cases, while CD10, MUC2 and CD-X2 were negative. The upregulation of p53 protein or nuclear positivity of β-catenin was not observed. The Ki-67 labeling index in the hot area was approximately 1-5%. Conclusions: GA-FG is a well-differentiated, low-grade malignant novel subtype of gastric cancer. The immunohistochemical markers and narrowband imaging combined with magnifying endoscopy (NBI-ME) enhance the diagnostic sensitivity. Whether Syn positive expression can be one of the diagnostic item needs to be further investigate. The process of tumorigenesis of GA-FG might be the transition from low-grade dysplasia to high-grade dysplasia of OGA and further to submucosal infiltration. However, the mechanism of GAFG was still unclear. Disregulation of the Shh and Wnt/β-catenin signaling pathway might be associated with tumorigenesis of GA-FG. Endoscopic submucosal dissection (ESD) is often the preferred and curative treatment.

Deep learning model for classifying endometrial lesions

BACKGROUND

Hysteroscopy is a commonly used technique for diagnosing endometrial lesions. It is essential to develop an objective model to aid clinicians in lesion diagnosis, as each type of lesion has a distinct treatment, and judgments of hysteroscopists are relatively subjective. This study constructs a convolutional neural network model that can automatically classify endometrial lesions using hysteroscopic images as input.

METHODS

All histopathologically confirmed endometrial lesion images were obtained from the Shengjing Hospital of China Medical University, including endometrial hyperplasia without atypia, atypical hyperplasia, endometrial cancer, endometrial polyps, and submucous myomas. The study included 1851 images from 454 patients. After the images were preprocessed (histogram equalization, addition of noise, rotations, and flips), a training set of 6478 images was input into a tuned VGGNet-16 model; 250 images were used as the test set to evaluate the model's performance. Thereafter, we compared the model's results with the diagnosis of gynecologists.

RESULTS

The overall accuracy of the VGGNet-16 model in classifying endometrial lesions is 80.8%. Its sensitivity to endometrial hyperplasia without atypia, atypical hyperplasia, endometrial cancer, endometrial polyp, and submucous myoma is 84.0%, 68.0%, 78.0%, 94.0%, and 80.0%, respectively; for these diagnoses, the model's specificity is 92.5%, 95.5%, 96.5%, 95.0%, and 96.5%, respectively. When classifying lesions as benign or as premalignant/malignant, the VGGNet-16 model's accuracy, sensitivity, and specificity are 90.8%, 83.0%, and 96.0%, respectively. The diagnostic performance of the VGGNet-16 model is slightly better than that of the three gynecologists in both classification tasks. With the aid of the model, the overall accuracy of the diagnosis of endometrial lesions by gynecologists can be improved.

CONCLUSIONS

The VGGNet-16 model performs well in classifying endometrial lesions from hysteroscopic images and can provide objective diagnostic evidence for hysteroscopists.

[Effects of sleeve gastrectomy base on "membrane anatomy" concept on postoperative nausea and vomiting in patients with obesity or metabolic diseases]

Objective: To explore the effects of the application of membrane anatomy concept in sleeve gastrectomy on postoperative nausea and vomiting (PONV) in patients with obesity or metabolic diseases. Methods: A retrospective cohort study was conducted. Clinical data of 88 patients with obesity or metabolic diseases who underwent laparoscopic sleeve gastrectomy in The First Affiliated Hospital of Jinan University from September 2018 to June 2019 were retrospectively analyzed. Forty patients underwent sleeve gastrectomy with membrane anatomy concept as membrane anatomy group, and the other 48 patients underwent traditional sleeve gastrectomy as traditional operation group. There were no significant differences in baseline data between the two groups (all P>0.05). The PONV score of and the times of antiemetic drugs used during 0-6 h and 6-24 h after operation were compared between the two groups. Higher PONV represents more serious nause and vomiting, the score ≥5 is defined as clinical significant PONV. Results: All patients of the two groups successfully completed the operation, and there was no conversion to open, reoperation, and operation-related death. The intraoperative blood loss in the membrane anatomy group was significantly less than that in the traditional surgery group [median: 5.0 (5.0, 5.8) ml vs. 10.0 (5.0, 10.0) ml, Z=-3.265, P=0.001]. There were no significant differences between the two groups in terms of operative time, postoperative hospital stay, gastroesophageal reflux, pain score and postoperative complications (all P>0.05). There was no postoperative bleeding or gastric leakage in either groups. There were no significant differences in PONV score, incidence of clinically significant PONV and use of antiemetics 0-6 h after operation between two groups (all P>0.05). From 6 to 24 hours after operation, compared with traditional surgery group, the membrane anatomy group had lower PONV score (4.6±0.9 vs. 5.1±0.7, t=-2.192, P=0.007), lower incidence of clinically significant PONV [55.0% (22/40) vs. 83.3% (40/48), χ(2)=8.414, P=0.004] and less use of antiemetics [3 times: 10.0% (4/40) vs. 27.1% (13/48), Z=-2.880, P=0.004]. Postoperative follow-up ranged from 1 to 6 months (median 3), 32 cases in membranous anatomy group and 38 cases in the traditional operation group were followed up. One case in the traditional operation group received symptomatic treatment in the local hospital due to functional intestinal obstruction 1 month after surgery and was discharged after recovery. The remaining patients had no postoperative complications and were not readmitted to hospital. Conclusion: Sleeve gastrectomy based on membrane anatomy in the treatment of patients with obesity or metabolic syndrome can make surgical procedure more precise and meticulous, reduce the intraoperative bleeding and the incidence of PONV.

[Concept of membrane anatomy in laparoscopic sleeve gastrectomy procedure]

Membrane anatomy refers to the fascia and/or serosa enveloping the organs and their blood vessels and hanging on the posterior wall of the body cavity, which emphasizes the entirety and integrity of the membrane during operation. The concept can also be applied to most surgical operations. This article mainly expounds the application of the concept of membrane anatomy in the process of laparoscopic sleeve gastrectomy, which is embodied in the key steps of separating the greater omentum, mobilizing the fundus, mobilizing the posterior wall of the stomach, cutting the greater curvature of the stomach, reinforcing the staple line of the stomach, and suturing the greater omentum with staple line, in order to make the laparoscopic sleeve gastrectomy more accurate and precise with less bleeding, fewer complications and faster postoperative recovery.

[Effect of knockdown of O-Glcnac transferase on hepatocyte fat synthesis]

Objective: To investigate the effect of knockdown of O-GlcNAc transferase (OGT) on hepatocyte fat synthesis. Methods: Liver cell line L02 were used to established the model of hepatic steatosis. The levels of OGT and O-GlcNAc protein were detected by Western blot. The OGT knockdown cell line of L02 cells was established, and its lipid formation ability was detected after induction of oleic acid (OA). Real-time quantitative PCR (qRT-PCR) and Western blot were used to detect mRNA and protein expression of enzymes related to fat synthesis. An independent sample t test was used. Results: Western blot showed that the expression of OGT and O-GlcNAc was increased in L02 cells after adipogenesis (P < 0.05). After shOGT lentivirus infects L02 cells, OGT mRNA levels were down-regulated (P < 0.01). Oil red O staining showed that the lipid in L02 shOGT cells decreased, qRT-PCR showed that the mRNA expressions of fat synthase (ACC1), (FASN) and (SCD1) were decreased, the difference was statistically significant (P < 0.05), protein Expression is consistent with mRNA expression. Conclusion: Knockdown of OGT can inhibit hepatocyte fat synthesis by reducing O-GlcNAc levels.

Isosbestic light absorption by metallic dimers: effect of interparticle electromagnetic coupling

Isosbestic plasmonic nanostructures, which feature an invariance of optical absorption and heat generation upon varying the incident light polarization, have broad application in many fields such as nanochemistry, optical nanoantennas, and microbubble formation. In this study, we focus on the isosbestic optical absorption by metallic dimers and systematically investigate the coupling between two interacting particles by using both the superposition T-matrix method and dipole approximation model. We observe that the interparticle coupling effects on particle absorption can be both positive and negative, compared to an isolated particle. Meanwhile, the optical absorption properties of spheres with small size parameters can realize more flexible control through changing the sphere size, interparticle distance, and incident light wavelength. For illuminations with incident light propagating perpendicularly to the line joining the centers of the two spheres, isosbestic conditions will be satisfied as long as the absorption efficiencies for transverse and longitudinal illuminations are equal. For transverse illuminations along the dimer axis, the ratio of absorption efficiency of the two metallic spheres presents the fluctuation change with the interparticle distance. Owing to the strong interparticle coupling effects, it even leads to the absorption efficiency of the far sphere being higher than that of the near sphere. Our results are aimed at expanding our understanding of the interparticle electromagnetic coupling effects on isosbestic light absorption in plasmonic nanoparticle systems.

P4785Clinical characteristics and 1-year outcomes in atrial fibrillation patients with or without history of intracranial haemorrhage treated with edoxaban: snapshot analysis of the Global ETNA-AF program

Background

Patients with atrial fibrillation (AF) who survive an intracranial haemorrhage (ICH) are at high risk of stroke, death, and recurrent haemorrhage. Effectiveness and safety of the nonvitamin K antagonist oral anticoagulant (NOAC) edoxaban in this patient population has not been reported.

Purpose

This snapshot analysis from the global ETNA-AF program compared 1-year outcomes in AF patients with and without history of ICH treated with edoxaban from Europe, Japan, and Korea/Taiwan.

Methods

Global ETNA-AF (EU: NCT02944019, Japan: UMINehz745.116117011, Korea/Taiwan: NCT02951039) is a multinational, multicentre, prospective, noninterventional program of AF patients receiving edoxaban in regular clinical care. Demographics, baseline characteristics, and outcomes at 1-year follow-up were reported for 19416 patients with and without a history of ICH.

Results

Of the 19416 patients, 297 had a history of ICH. At 1-year follow-up, incidences of International Society on Thrombosis and Haemostasis (ISTH) major bleeding (including ICH) and clinically relevant nonmajor bleeding (CRNMB) were generally low. The rate of ischaemic stroke was higher in patients with a history of ICH than in those without prior ICH.

Europe (N=7672) Korea/Taiwan (N=1701) Japan (N=10043) History of ICH, n (%) Yes No Yes No Yes No 36 (0.5) 636 (99.5) 27 (1.6) 1674 (98.4) 234 (2.3) 9809 (97.7) Age, median (IQR) 75 (69, 78) 74 (68, 80) 70 (66, 76) 72 (66, 77) 76 (71, 82) 75 (68, 81) Gender, male % 72.2 57.4 70.4 59.9 60.7 59.3 Weight, median (IQR) kg 80.0 (75.0, 88.0) 80.0 (70.0, 92.0) 68.0 (54.0, 77.0) 65.0 (58.0, 73.0) 57.0 (50.0, 65.0) 59.0 (51.0, 68.0) CHA2DS2-VASc, mean (SD) 4.2 (1.44) 3.1 (1.38) 3.9 (1.63) 3.0 (1.43) 4.0 (1.56) 3.4 (1.64) HAS-BLED, mean (SD) 4.3 (1.23) 2.6 (1.12) 3.9 (1.55) 2.4 (10.7) 3.7 (1.07) 2.3 (1.12) CrCl [mL/min], median (IQR) 70.5 (58.8, 85.1) 70.4 (53.8, 90.1) 63.7 (45.8, 84.2) 61.6 (48.4, 78.1) 58.5 (46.0, 73.2) 60.2 (46.1, 77.0) Edoxaban 60/30 mg, % 83.3 / 16.7 77.1 / 22.9 55.6 / 44.4 50.2 / 49.8 21.8 / 78.2 27.8 / 72.2 1-year outcome, n (%/year)   Major bleeding (ISTH) 2 (5.94) 66 (0.92) 0 (0) 13 (0.82) 3 (1.92) 66 (0.96)   Intracranial haemorrhage 1 (2.91) 19 (0.26) 0 (0) 5 (0.32) 1 (0.64) 18 (0.26)   Major GI* bleeding 0 (0.00) 20 (0.28) 0 (0) 2 (0.13) 2 (1.28) 30 (0.43)   CRNMB 0 (0.00) 102 (1.43) 0 (0) 11 (0.70) 6 (3.82) 219 (3.20)   Ischaemic stroke 1 (2.93) 41 (0.57) 1 (4.04) 11 (0.70) 4 (2.57) 78 (1.13) *Gastrointestinal.

Conclusion

Our data underpin the need for effective stroke prevention. In AF patients with a history of ICH, data suggest that edoxaban can be safely and effectively administered in patients with and without prior ICH in regular clinical care.

Acknowledgement/Funding

Daiichi Sankyo

Light scattering by densely packed optically soft particle systems, with consideration of the particle agglomeration and dependent scattering

Light scattering and radiative transfer in optically soft particle systems are important problems in many fields of natural sciences and engineering, such as biology, ocean optics, atmospheric science, solar energy utilization, and so on. Due to the effects of particle agglomeration and dependent scattering, the radiative transfer problem will become more complex with the increase of particle volume fraction. In this study, the scattering properties and radiative transfer characteristics of densely packed optically soft particle systems, with consideration of the effects of dependent scattering and particle agglomeration, are investigated. The dependent scattering properties of densely packed silicon-dioxide spherical particles embedded in water are calculated by using the Lorenz-Mie theory and Percus-Yevick sticky hard-sphere model. The directional-hemispherical reflectance of the dispersed plane-parallel layer is obtained by using the Monte Carlo method. The results show that dependent scattering and particle agglomeration have significant influence on the scattering properties of particles. With the increase of particle agglomeration degree, the scattering coefficients and asymmetry factors of the particles increase obviously, which can be even larger than the results for independent scattering under certain circumstances. Due to the combined interaction of multiple scattering, dependent scattering, and particle agglomeration, for different size particles, the variation tendency of the hemispherical reflectance is obviously different with increasing particle agglomeration degree.

Effect of host medium absorption on polarized radiative transfer in dispersed media

This paper focuses on polarized radiative transfer in a thin layer composed of titanium dioxide particles while considering the effect of host medium absorption on particle scattering. The single-scattering properties of particles in an absorbing medium are calculated using the modified Lorenz-Mie program recently developed based on the first-principles theory of electromagnetic scattering, and the vector radiative transfer equation is solved by using the spectral element method. The relative errors of Stokes parameters caused by using the conventional Lorenz-Mie theory are systemically investigated. The results show that neglecting the effect of host medium absorption on particle scattering has a more significant impact on the radiation intensity than the polarization components in most cases. Meanwhile, the relative errors of Stokes parameters induced by using the conventional Lorenz-Mie theory obviously increase with the increase of the host medium absorption index and particle size parameter. Due to the larger scattering coefficients and scattering albedos (i.e., for the case of particle size parameter x=10.0 in this study), the relative errors of Stokes parameters of monodisperse particles are obviously larger than those of polydisperse particles. Moreover, it is found that the relative errors of the Stokes parameters change nonlinearly with the particle volume fraction, especially for large size particles.

miR-200c-3p Suppresses the Proliferative, Migratory, and Invasive Capacities of Nephroblastoma Cells via Targeting FRS2

Objectives: miR-200c-3p has been shown to serve as a tumor suppressor in various tumor types. However, the biological function of miR-200c-3p in nephroblastoma remains unknown. This study aims to investigate the biological function and regulatory mechanisms of miR-200c-3p in nephroblastoma development. Methods: The expression of miR-200c-3p in nephroblastoma tissues and cells was evaluated by quantitative real-time polymerase chain reaction (qRT-PCR). The effects of miR-200c-3p on the proliferation and cell cycle of SK-NEP-1 nephroblastoma cell line were evaluated by CCK-8 assay, colony formation assay, and flow cytometry. The effects of miR-200c-3p on the migratory and invasive capacities of SK-NEP-1 cells were measured by wound healing assay and transwell assay. The ability of miR-200c-3p to target fibroblast growth factor receptor substrate 2 (FRS2) was detected by quantitative PCR, western blot, and luciferase reporter assay. Results: The expression of miR-200c-3p was significantly downregulated in nephroblastoma tissues and cells compared with that in normal renal tissues and cells. miR-200c-3p inhibited the proliferative, migratory, and invasive capacities of nephroblastoma cells by targeting FRS2. Conclusions: miR-200c-3p suppresses the malignant behaviors of nephroblastoma cells by downregulating the expression of FRS2.

[Quantitative evaluation of intravoxel incoherent motion diffusion-weighted imaging and three-dimensional arterial spin labeling in Ki-67 labeling index and grading of brain gliomas]

Objective: To investigate the value of multiple parameters derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and three-dimensional arterial spin labeling (3D-ASL) in Ki-67 labeling index (Ki-67 LI) and grading of human brain gliomas. Methods: From December 2015 to May 2018, 45 patients of gliomas confirmed by surgical pathology in Li Huili Hospital, Ningbo Medical Center were divided into low-grade group (20 cases of WHO grade Ⅱ) and high-grade group (12 cases of WHO grade Ⅲ, 13 cases of WHO grade Ⅳ), and the Ki-67 LI of glioma was obtained by immunohistochemistry. All patients, 24 males and 21 females, aged 25-83 years, mean(53±12)years, underwent conventional magnetic resonance imaging (MRI), IVIM-DWI and 3D-ASL before operation, then measured the true water diffusion coefficient (D), microcirculation perfusion coefficient (D(*)), perfusion fraction (f) and cerebral blood flow (CBF) in the tumor solid area and the contralateral normal white matter area. Those parameters and the Ki-67 LI were compared between the low-and high-grade groups with Mann-Whitney U test. Spearman's correlation was used to analyze the correlation between the quantitative parameters and Ki-67 LI. The ROC curve was used to assess the diagnostic efficacy of parameters in the grading assessment of brain gliomas. Results: The D(0.791×10(-3)mm(2)/s) and f (0.261) of the high-grade group were lower than those of the low-grade group, whereas D(*) (4.153×10(-3) mm(2)/s), CBF(102.027 ml·min(-1)·100 g(-1)) and Ki-67 LI (0.25) were higher (P<0.05). There was a moderate negative correlation between D, f and Ki-67 LI(r=-0.513,-0.457, all P<0.05). There was no significant correlation between D(*) and Ki-67 LI (P=0.571). The area under the curve (AUC) for identifying high-and low-grade gliomas by D, D(*), f and CBF values was 0.965, 0.745, 0.842, and 0.830 respectively (all P<0.05). Conclusion: D and f can be used for quantitative prediction of Ki-67 LI. IVIM-DWI and 3D-ASL are helpful in the grading assessment of gliomas, and the diagnostic efficiency of D is the highest.

Genetic analysis of surgical margins in oral cavity cancer

BACKGROUND

A histological, tumour-free surgical margin does not guarantee recurrence-free survival in patients with cancer. This study investigated the association between microsatellite alteration in tumour-free surgical margins and local recurrence in patients with oral cavity squamous cell carcinoma.

METHODS

Patients with histologically confirmed oral cavity squamous cell carcinoma were enrolled in this prospective study. Cancerous specimens, corresponding surgical margins and peripheral blood were obtained. Microsatellite alteration was investigated using six dinucleotide microsatellite markers. All samples were amplified by PCR, followed by automatic fragment analysis.

RESULTS

Microsatellite alteration was identified in 100 specimens (69·0 per cent) from 145 patients. Among them, 85 specimens carried loss of heterozygosity, whereas 55 had microsatellite instability (MSI). Patients with MSI at the surgical margin had a higher risk of local recurrence on multivariable analysis (odds ratio 7·17, 95 per cent c.i. 3·49 to 14·73).

CONCLUSION

Molecular assessment of surgical margins can help identify patients at risk of local recurrence.

Influences of Copper/Zinc-Loaded Montmorillonite on Growth Performance, Mineral Retention, Intestinal Morphology, Mucosa Antioxidant Capacity, and Cytokine Contents in Weaned Piglets

The effects of copper/zinc-loaded montmorillonite (Cu/Zn-Mt) on growth performance, mineral retention, intestinal morphology, mucosa antioxidant capacity, and cytokine contents in weaned piglets were investigated in the present study. One hundred eight piglets weaned at 21 ± 1 days of age (Duroc × Landrace× Yorkshire; average initial weight of 6.36 kg) were allotted to three treatments for 2 weeks. The three treatments were as follows: (1) control group: basal diet; (2) Cu/Zn-Mt group: basal diet + 39 mg/kg Cu and 75 mg/kg Zn as Cu/Zn-Mt; (3) Cu + Zn + Mt group: basal diet + mixture of CuSO₄, ZnSO₄, and Mt (equal amount of Cu, Zn, and Mt to the Cu/Zn-Mt group). Each treatment had six pens of six piglets. The results showed that as compared with the control group and the Cu + Zn + Mt group, Cu/Zn-Mt supplementation increased (P < 0.05) the average daily gain and the gain/feed ratio; Cu/Zn-Mt supplementation increased (P < 0.05) the Cu and Zn concentrations in serum, jejunum, and ileum mucosa, villus height, the ratio of villus height to crypt depth, and the activities of SOD, GSH-Px, and IL-10 levels, and decreased the malondialdehyde concentrations in the jejunum and ileum, and intestinal IL-1β, IL-6, and TNF-α levels. Moreover, supplementation with the mixture of CuSO₄, ZnSO₄, and Mt had no effect on the growth performance, but increased the mucosa Cu and Zn concentrations, intestinal morphology, antioxidant capacity, and immune function in the duodenum, while it had no effect on the above indexes in the jejunum and ileum. The results indicated that Mt could be used as a controlled carrier for Cu and Zn, which made Cu/Zn-Mt have better biological activities in the intestine than the mixture of Cu, Zn, and Mt.