The impacts of exposure to risk factors during youth on the increasing global trend of early-onset pancreatic cancer

OBJECTIVES

An increasing trend of pancreatic cancer in young adults has emerged in some countries. This study aimed to investigate global trends of pancreatic cancer in young adults and explore the impact of exposure to risk factors on pancreatic cancer incidence during youth.

METHODS

Global and national data on pancreatic cancer incidence, disability-adjusted life-years, attributive mortality, and summary exposure values of risk factors were retrieved from the Global Burden of Disease 2019. The average annual percent change (AAPC) of incidence and mortality was calculated. Additionally, generalized additive models were applied to explore the non-linear associations between the levels and changes in the Human Development Index and AAPC.

RESULTS

Global pancreatic cancer incidence increased during various periods from 1990 to 2019, particularly in adults aged <45 years from 2010 to 2019, at an average annual increase rate of 0.7% (95% confidence interval: 0.4-1.0%). The AAPC of early-onset pancreatic cancer incidence from 2010 to 2019 was negatively correlated with Human Development Index levels in both 2010 and 2019 but positively correlated with Human Development Index acceleration. Significant increases in early-onset pancreatic cancer incidence were observed over this period in 32 of 88 countries, primarily in South America, North America, Oceania, and Africa. Early-onset pancreatic cancer mortality attributed to high body mass index and fasting plasma glucose increased, while that attributed to tobacco use declined.

CONCLUSIONS

An increasing trend has emerged in the global incidence and burden of early-onset pancreatic cancer over the last few decades. This rise may partly be attributed to global epidemics of high body mass index and fasting plasma glucose.

Magnetic properties and critical behaviors of the nodal-line semimetal candidate ErIn3

The AuCu3-type intermetallic compoundsReIn3(Re= a rare earth ion) with type-IV magnetic space groups are predicted to show topologically nontrivial electronic states. Here, we grow ErIn3single crystals, and study their magnetic properties and critical behaviors by means of the magnetic susceptibility, and magnetization isotherm measurements. Combining a detailed analysis of the magnetic susceptibility and isothermal magnetization, we find that this compound harbors a complicated magnetic phase diagram, and its magnetic moment arrangement appears not to simply follow the fashion as observed in the isostructural counterpart GdIn3(it adopts a conventional type-Cmagnetic structure that belongs to type-IV magnetic space groups). A careful study of the magnetic properties around the antiferromagnetic (AFM)-paramagnetic transition yields the critical exponentsβ= 0.309 (0.297),γ= 1.117 (1.038), andδ= 4.617 (4.454), indicating that the tricritical mean field model or the three-dimensional Ising model works for ErIn3's magnetic behaviors and the presence of a long-range AFM interaction therein. Besides, the exchange interaction distanceJ(r) ∼r-4.665as well confirms a long-range magnetic coupling in ErIn3. Our results offer the clues that the magnetic structure varies from one member ofReIn3family to another, and to confirm their electronic features in the AFM phases further experimental and theoretical studies are still desired.

Synergistic effect of PARP inhibitor and BRD4 inhibitor in multiple models of ovarian cancer

Ovarian cancer has the highest facility rate among gynaecological tumours. Current therapies including PARP inhibitors have a defect that ovarian tumour is easy to recurrent and become resistant to therapy. To solve this problem, we found that BRD4 inhibitor AZD5153 and PARP inhibitor olaparib had a widespread synergistic effect in multiple models with different gene backgrounds. AZD5153 sensitizes cells to olaparib and reverses the acquired resistance by down-regulating PTEN expression levels to destabilize hereditary materials. In this study, we used the following multiple ovarian cancer models PDX, PDO and 3D/2D cell lines to elucidate the co-effect of AZD5153 and olaparib in vivo and in vitro. The similar results of these models further proved that the mechanism identified was consistent with the biological process occurring in ovarian cancer patients after drug treatment. This consistency between the results of different models suggests the possibility of translating these laboratory research findings into clinical studies towards developing treatments.

The Diversity of Vaginal Microbiota Predicts Neoadjuvant Chemotherapy Responsiveness in Locally Advanced Cervical Cancer

The vaginal microbiota is closely related to HPV infection and cervical cancer (CC), but its relationship with platinum-based chemotherapy responsiveness is unknown. The study aimed to investigate the vaginal microbiota diversity of women with locally advanced cervical cancer (LACC) and compare the differences between responders and nonresponders. We characterized the 16S rRNA gene sequencing of vaginal microbiome of 66 vaginal samples, including 26 LACC patients before neoadjuvant chemotherapy and 40 healthy controls. Compared with the healthy controls, alpha diversity was significantly increased in CC patients (p <0.05) with more unconventionality bacterial colonization. Beta diversity also significantly differed between cervical cancer patients and controls (p <0.01). Within the CC patients, alpha diversity in vaginal samples was significantly higher in the nonresponders versus the responders (p <0.01), and the Ace index and Chao index were negatively correlated with mass reduction (p <0.001). Moreover, the Bacteroides genus enriched in the nonresponders had a ROC-plot AUC value reaching 0.84. The study suggests the vaginal microbiota in LACC patients is associated with platinum-based chemotherapy responsiveness. Alpha diversity and Bacteroides abundance have the potential of identifying platinum-resistant patients at an early time. These findings provide a basis for further research on the relationship between vaginal microbiome and chemotherapy effect in LACC.

Inhibiting the IRE1α Axis of the Unfolded Protein Response Enhances the Antitumor Effect of AZD1775 in TP53 Mutant Ovarian Cancer

Targeting the G2/M checkpoint mediator WEE1 has been explored as a novel treatment strategy in ovarian cancer, but mechanisms underlying its efficacy and resistance remains to be understood. Here, it is demonstrated that the WEE1 inhibitor AZD1775 induces endoplasmic reticulum stress and activates the protein kinase RNA-like ER kinase (PERK) and inositol-required enzyme 1α (IRE1α) branches of the unfolded protein response (UPR) in TP53 mutant (mtTP53) ovarian cancer models. This is facilitated through NF-κB mediated senescence-associated secretory phenotype. Upon AZD1775 treatment, activated PERK promotes apoptotic signaling via C/EBP-homologous protein (CHOP), while IRE1α-induced splicing of XBP1 (XBP1s) maintains cell survival by repressing apoptosis. This leads to an encouraging synergistic antitumor effect of combining AZD1775 and an IRE1α inhibitor MKC8866 in multiple cell lines and preclinical models of ovarian cancers. Taken together, the data reveal an important dual role of the UPR signaling network in mtTP53 ovarian cancer models in response to AZD1775 and suggest that inhibition of the IRE1α-XBP1s pathway may enhance the efficacy of AZD1775 in the clinics.

The Immunological Role of CDK4/6 and Potential Mechanism Exploration in Ovarian Cancer

Background

Ovarian cancer (OC) is one of the most lethal gynecologic cancers. Growing evidence has proven that CDK4/6 plays a key role in tumor immunity and the prognosis of many cancers. However, the expression and function of CDK4/6 in OC remain unclear. Therefore, we aimed to explore the influence of CDK4/6 in OC, especially on immunity.

Methods

We analyzed CDK4/6 expression and prognosis using The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO) and Genotype Tissue Expression (GTEx) data. Subsequently, we used the cytoHubba plug-in of Cytoscape software and starBase to identify the noncoding RNAs (ncRNAs) regulating CDK4/6. Finally, we verified the effect of CDK4/6 on immunity in OC cell lines and animal models.

Results

CDK4/6 expression was higher in OC tissues than in normal ovarian tissues, and the high expression levels of CDK4/6 contributed to the immunosuppressive state of OC and were thus related to the poor prognosis of OC patients. This was also in general agreement with the results of OC cell line and animal experiments. Mechanistically, the CDK4/6 inhibitor palbociclib increased the secretion of interferon (IFN)-γ and the interferon-stimulated gene (ISG) response, thereby upregulating the expression of antigen-presenting molecules; this effect was partly dependent on the STING pathway and thus activated immunity in OC. Additionally, according to public data, the LRRC75A-AS1-hsa-miR-330-5p axis could inhibit the immune response of OC patients by upregulating CDK4/6, leading to a poor prognosis.

Conclusion

CDK4/6 affects the immune microenvironment of OC and correlates with the prognosis of OC patients.

WEE1 inhibition induces anti-tumor immunity by activating ERV and the dsRNA pathway

Targeted therapies represent attractive combination partners with immune checkpoint blockade (ICB) to increase the population of patients who benefit or to interdict the emergence of resistance. We demonstrate that targeting WEE1 up-regulates immune signaling through the double-stranded RNA (dsRNA) viral defense pathway with subsequent responsiveness to immune checkpoint blockade even in cGAS/STING-deficient tumors, which is a typical phenotype across multiple cancer types. WEE1 inhibition increases endogenous retroviral elements (ERVs) expression by relieving SETDB1/H3K9me3 repression through down-regulating FOXM1. ERVs trigger dsRNA stress and interferon response, increasing recruitment of anti-tumor T cells with concurrent PD-L1 elevation in multiple tumor models. Furthermore, combining WEE1 inhibition and PD-L1 blockade induced striking tumor regression in a CD8+ T cell-dependent manner. A WEE1 inhibition-induced viral defense signature provides a potentially informative biomarker for patient selection for combination therapy with WEE1 and ICB. WEE1 inhibition stimulates anti-tumor immunity and enhances sensitivity to ICB, providing a rationale for the combination of WEE1 inhibitors and ICB in clinical trials.

AZD5153 reverses palbociclib resistance in ovarian cancer by inhibiting cell cycle-related proteins and the MAPK/PI3K-AKT pathway

The CDK4/6 inhibitor, palbociclib has recently entered clinic-trial stage for breast cancer treatment. However, translating its efficacy to other solid tumors has been challenging, especially for aggressive solid tumors. We found that the effect of palbociclib as a single agent was limited due to primary and acquired resistance in multiple ovarian cancer (OC) models. Among these, patient-derived organoid and xenograft models are two most representative models of drug responsiveness in patients with OC. In preclinical models, this study demonstrated that activated MAPK/PI3K-AKT pathway and cell cycle-related proteins induced the resistance to palbociclib, which was overcome by the addition of the bromodomain protein 4 (BRD4) inhibitor AZD5153. Moreover, this study revealed that AZD5153 and palbociclib had a synergistic lethal effect on inducing the cell cycle arrest and increasing apoptosis, even in RB-deficient cell lines. Based on these results, it is anticipated that this class of drugs, including AZD5153, which inhibit the cell cycle-related protein and MAPK/PI3K-AKT pathway, will exhibit synergistic effects with palbociclib in OC.

Impact of chemotherapy and immunotherapy on the composition and function of immune cells in COVID-19 convalescent with gynecological tumors

Ongoing pandemic and potential resurgence of Coronavirus disease 2019 (COVID-19) has prompted urgent efforts to investigate the immunological memory of convalescent patients, especially in patients with active cancers. Here we performed single-cell RNA sequencing in peripheral blood samples of 3 healthy donors (HDs), 4 COVID-19 patients (Covs) and 4 COVID-19 patients with active gynecological tumor (TCs) pre- and post- anti-tumor treatment. All Covs patients had recovered from their acute infection. Interestingly, the molecular features of PBMCs in TCs are similar to that in Covs, suggesting that convalescent COVID-19 with gynecologic tumors do not have major immunological changes and may be protected against reinfection similar to COVID-19 patients without tumors. Moreover, the chemotherapy given to these patients mainly caused neutropenia, while having little effect on the proportion and functional phenotype of T and B cells, and T cell clonal expansion. Notably, anti-PD-L1 treatment massively increased cytotoxic scores of NK cells, and T cells, and facilitated clonal expansion of T cells in these patients. It is likely that T cells could protect patients from SARS-CoV-2 virus reinfection and anti-PD-L1 treatment can enhance the anti-viral activity of the T cells.

Efficacy of Bifidobacterium animalis subsp. lactis, BB-12® on infant colic - a randomised, double-blinded, placebo-controlled study

To evaluate the administration of Bifidobacterium animalis subsp. lactis, BB-12^® (BB-12) on infant colic in breastfed infants, a double-blind, placebo-controlled randomised study was conducted in Chengdu, China from April 2016 to October 2017 with 192 full-term infants less than 3 months of age and meeting the ROME III criteria for infant colic. After a 1-week run-in the infants were randomly assigned to receive daily BB-12 (1×10⁹ cfu/day) or placebo for 3 weeks. Crying/fussing time were recorded using a 24 h structured diary. The primary endpoint was the proportion of infants achieving a reduction in crying and fussing time of ≥50% from baseline. Parent's/caregiver's health related quality of life was measured using a modified PedsQL^™ 2.0 Family Impact Module and immunological biomarkers were evaluated from faecal samples at baseline and after the 21-day intervention. The percentage of infants achieving a reduction in the daily crying/fussing time ≥50% after the 21-day intervention was significantly higher in the infants supplemented with BB-12 (P<0.001). The mean number of crying episodes was significantly reduced in the BB-12 group compared to the placebo group (10.0±3.0 to 5.0±1.87 vs 10.5±2.6 to 7.5±2.8, respectively) (P<0.001) and the mean daily sleep duration was markedly increased from baseline to end of intervention in the BB-12 group compared to the infants in the placebo group (60.7±104.0 vs 31.9±102.7 min/day, respectively) (P<0.001). The faecal levels of human beta defensin 2, cathelicidin, slgA, calprotectin and butyrate were statistically higher in the BB-12 group compared to the placebo group after the 21-day intervention. At the end of the intervention the parent's/caregiver's physical, emotional and social functioning scores were significantly higher for the BB-12 group compared to the placebo group (all P<0.05). Supplementation of BB-12 is effective in reducing crying and fussing in infants diagnosed with infant colic.

Trends and age-period-cohort effects on mortality of the three major gynecologic cancers in China from 1990 to 2019: Cervical, ovarian and uterine cancer

BACKGROUND

Gynecologic cancers seriously threaten women's life and health. This study aims to assess the long-term trends of mortality from the three major gynecologic cancers in China and to examine the age-, period-, and cohort-specific effects behind them during the period 1990 to 2019.

METHODS

The mortality data of cervical, ovarian, and uterine cancer in China were obtained from the Global Burden of Disease Study 2019 and were analyzed with the age-period-cohort framework.

RESULTS

It was found that the net drift for cervical cancer mortality was -0.19% (95% CI, -0.46% to 0.08%) per year, for ovarian cancer was 0.76% (95% CI, 0.57% to 0.95%) per year, and for uterine cancer was -3.09% (95% CI, -3.44% to -2.76%) per year from 1990 to 2019. During this period, while cervical cancer remained the most common cause of death among gynecologic cancers among Chinese women, ovarian cancer replaced uterine cancer as the second leading cause of death in gynecologic cancers after about 2005. Significant age, cohort, and period effects were found for the mortality trends of all three major gynecologic cancers.

CONCLUSIONS

The secular trends of mortality from the three major gynecologic cancers in China and their underlying age, period, and cohort effects are likely to reflect the progress of diagnosis and treatment, rapid socio-economic transitions, and the accompanying lifestyle and behavior changes. More priorities of further epidemiology studies and efforts on the prevention and control should be given to three major gynecologic cancers.

Worldwide cancer statistics of adolescents and young adults in 2019: a systematic analysis of the Global Burden of Disease Study 2019

Background

The cancer burden in adolescents and young adults (AYAs) deserves more attention. However, global cancer statistics for AYAs are often presented as aggregates, concealing important heterogeneity. This study aimed to describe the worldwide profile of cancer incidence, mortality, and corresponding trends from 1990 to 2019 among 15-39-year olds by focusing on the patterns by age, sex, sociodemographic index (SDI), and regions.

Patients and methods

Global, regional, and country data on the number of cancer cases and cancer-related deaths for 29 cancer types were collected from the 2019 Global Burden of Disease (GBD) Study. We also summarized the results using five levels of the SDI and 21 GBD regions.

Results

In 2019, an estimated 1 335 100 new cancer cases and 397 583 cancer-related deaths occurred among AYAs worldwide. While the incidence rate increased mildly, the death rate decreased significantly between 1990 and 2019, with an estimated annual percentage change of 0.38 (95% confidence interval 0.36-0.39) and −0.93 (95% confidence interval −0.95 to −0.92), respectively. The cancer burden was disproportionally greater among women than among men. The cancer profiles varied substantially across geographical regions, with the highest burden being in South Asia and East Asia. Besides, the cancer incidence in the high SDI regions was four times higher than that in the low SDI regions; however, the mortality burden in the high SDI region was lower than that in the low SDI region, which reflected the differences in cancer profiles across SDI regions and the inferior outcomes in the low SDI regions.

Conclusion

This study updates the previous epidemiological data of the cancer burden of AYAs. The cancer burden in AYAs varied substantially according to age, sex, SDI, and geographical regions. These findings highlight that the specific cancer profile of AYA patients requires targeted cancer control measures to reduce the cancer burden in this age group.

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The cancer burden in AYAs varied substantially according to age, sex, SDI, and geographical regions.

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Cancer burden in AYAs was disproportionally greater among women than among men.

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Cancer profiles of AYAs varied across different geographical regions and SDI regions.

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Cancer burden in AYAs was still considerable in the low SDI regions.

Clinical and molecular characteristics of COVID-19 patients with persistent SARS-CoV-2 infection

The characteristics of COVID-19 patients with persistent SARS-CoV-2 infection are not yet well described. Here, we compare the clinical and molecular features of patients with long duration of viral shedding (LDs) with those from patients with short duration patients (SDs), and healthy donors (HDs). We find that several cytokines and chemokines, such as interleukin (IL)-2, tumor necrosis factor (TNF) and lymphotoxin α (LT-α) are present at lower levels in LDs than SDs. Single-cell RNA sequencing shows that natural killer (NK) cells and CD14+ monocytes are reduced, while regulatory T cells are increased in LDs; moreover, T and NK cells in LDs are less activated than in SDs. Importantly, most cells in LDs show reduced expression of ribosomal protein (RP) genes and related pathways, with this inversed correlation between RP levels and infection duration further validated in 103 independent patients. Our results thus indicate that immunosuppression and low RP expression may be related to the persistence of the viral infection in COVID-19 patients.

[Trend analysis on morbidity and mortality of pancreatic cancer in China, 2005-2015]

Objective: To analyze the trend of morbidity and mortality of pancreatic cancer in China from 2005 to 2015 and estimate the related age, period and cohort effect, respectively. Methods: Joinpoint regression analysis was used to analyze the trend of morbidity rate and mortality rate of pancreatic cancer during 2005-2015 and calculate the annual percentage change and average annual percentage change based on the data in the annual report of China Cancer Registry. Population aged 20-84 years was fitted by the Age-Period-Cohort model to estimate the effect parameters of age, period and cohort. Results: The trend variations of the crude morbidity rate and crude mortality rate of pancreatic cancer were consistent. The morbidity rate of pancreatic cancer firstly increased before 2008 and then decreased. The morbidity rate and mortality rate of pancreatic cancer were higher in men than women, and higher in urban areas than in rural areas. From 2005 to 2015, the overall age-standardized morbidity rate of pancreatic cancer increased by 2.78% annually and the overall age standardized mortality rate of pancreatic cancer increased by 2.24% annually. The age standardized morbidity of pancreatic cancer in rural men changed more rapidly, with an average annual increase of 3.74%, and the age standardized mortality rate of pancreatic cancer in urban men changed more rapidly, with an average annual increase of 3.57%. The age effect on the morbidity and mortality of pancreatic cancer increased with age, and the effect was most obvious in age group 70-80 years, the period effect increased over time and the cohort effect decreased with year, but rebound or fluctuation was observed after 1976. Conclusions: The morbidity rate and mortality rate of pancreatic cancer in China increased slightly in past decades. Strategies on effective prevention and control of pancreatic cancer should be developed in the future.

Dynamics and Correlation Among Viral Positivity, Seroconversion, and Disease Severity in COVID-19 : A Retrospective Study

BACKGROUND

The understanding of viral positivity and seroconversion during the course of coronavirus disease 2019 (COVID-19) is limited.

OBJECTIVE

To describe patterns of viral polymerase chain reaction (PCR) positivity and evaluate their correlations with seroconversion and disease severity.

DESIGN

Retrospective cohort study.

SETTING

3 designated specialty care centers for COVID-19 in Wuhan, China.

PARTICIPANTS

3192 adult patients with COVID-19.

MEASUREMENTS

Demographic, clinical, and laboratory data.

RESULTS

Among 12 780 reverse transcriptase PCR tests for severe acute respiratory syndrome coronavirus 2 that were done, 24.0% had positive results. In 2142 patients with laboratory-confirmed COVID-19, the viral positivity rate peaked within the first 3 days. The median duration of viral positivity was 24.0 days (95% CI, 18.9 to 29.1 days) in critically ill patients and 18.0 days (CI, 16.8 to 19.1 days) in noncritically ill patients. Being critically ill was an independent risk factor for longer viral positivity (hazard ratio, 0.700 [CI, 0.595 to 0.824]; P < 0.001). In patients with laboratory-confirmed COVID-19, the IgM-positive rate was 19.3% in the first week, peaked in the fifth week (81.5%), and then decreased steadily to around 55% within 9 to 10 weeks. The IgG-positive rate was 44.6% in the first week, reached 93.3% in the fourth week, and then remained high. Similar antibody responses were seen in clinically diagnosed cases. Serum inflammatory markers remained higher in critically ill patients. Among noncritically ill patients, a higher proportion of those with persistent viral positivity had low IgM titers (<100 AU/mL) during the entire course compared with those with short viral positivity.

LIMITATION

Retrospective study and irregular viral and serology testing.

CONCLUSION

The rate of viral PCR positivity peaked within the initial few days. Seroconversion rates peaked within 4 to 5 weeks. Dynamic laboratory index changes corresponded well to clinical signs, the recovery process, and disease severity. Low IgM titers (<100 AU/mL) are an independent risk factor for persistent viral positivity.

PRIMARY FUNDING SOURCE

None.

Vitamin D Supplementation Is Associated with a Reduction in Self-Reported Falls among Older Adults with Previous Fall History – Feasibility Study

Background: Vitamin D insufficiency contributes to muscle weakness and a higher risk of falls in older adults. Objectives: This study explored the impact of vitamin D supplementation on self-reported falls and physical function in older adults with low vitamin D levels and a recent fall history. Materials and Methods: Twenty-five older adults ≥ 70 years with two or more falls during the past year, low vitamin D blood levels (≥10 ng/ml and < 30 ng/mL), and slow gait speed (1.2 m/s) participated in a 6-month vitamin D supplementation (800 IU/day) study. A modified version of the Morse Fall Scale questionnaire was used to assess frequency of falls over one-year prior to study enrollment. Functional outcomes (short physical performance battery, handgrip strength, gait Timed Up and Go, and six-minute walk), and vitamin D levels were assessed at baseline and 6-month follow-up. Results: Based on diaries and pill counts, participants were generally adherent to the intervention (6 of 7 days per week). Supplementation with 800 IU/day of vitamin D for 6 months increased blood vitamin D levels from 23.25±4.8 ng/ml to 29.13±6.9 ng/ml (p<0.001). Self-reported number of falls decreased from an average of 3.76 ± 2.2 falls in one-year to 0.76 ± 1.4 falls (p <0.0001) over the 6-month intervention. No changes in functional outcome measures were observed. Conclusions: Vitamin D supplementation at the currently recommended dose of 800 IU/day increased blood vitamin D levels and reduced frequency of falls in older adults with low vitamin D levels and a recent fall history.

Integrating pathology, chromosomal instability and mutations for risk stratification in early-stage endometrioid endometrial carcinoma

Background

Risk stratifications for endometrial carcinoma (EC) depend on histopathology and molecular pathology. Histopathological risk stratification lacks reproducibility, neglects heterogeneity and contributes little to surgical procedures. Existing molecular stratification is useless in patients with specific pathological or molecular characteristics and cannot guide postoperative adjuvant radiotherapies. Chromosomal instability (CIN), the numerical and structural alterations of chromosomes resulting from ongoing errors of chromosome segregation, is an intrinsic biological mechanism for the evolution of different prognostic factors of histopathology and molecular pathology and may be applicable to the risk stratification of EC.

Results

By analyzing CIN25 and CIN70, two reliable gene expression signatures for CIN, we found that EC with unfavorable prognostic factors of histopathology or molecular pathology had serious CIN. However, the POLE mutant, as a favorable prognostic factor, had elevated CIN signatures, and the CTNNB1 mutant, as an unfavorable prognostic factor, had decreased CIN signatures. Only if these two mutations were excluded were CIN signatures strongly prognostic for outcomes in different adjuvant radiotherapy subgroups. Integrating pathology, CIN signatures and POLE/CTNNB1 mutation stratified stageIendometrioid EC into four groups with improved risk prognostication and treatment recommendations.

Conclusions

We revealed the possibility of integrating histopathology and molecular pathology by CIN for risk stratification in early-stage EC. Our integrated risk model deserves further improvement and validation.

Over-expression of RNA interference (RNAi) core machinery improves susceptibility to RNAi in silkworm larvae

RNA interference (RNAi), one of the strategies that organisms use to defend against invading viruses, is an important tool for functional genomic analysis. In insects, the efficacy of RNAi varies amongst taxa. Lepidopteran insects are, in large part, recalcitrant to RNAi. The overall goal of this study is to overcome such insensitivity in lepidopterans to RNAi. We hypothesize that over-expression of core RNAi machinery enzymes can improve RNAi efficacy in traditionally recalcitrant species. A transgenic Bombyx mori strain, Baculovirus Immediate-Early Gene, ie1, promoter driven expression of silkworm Dicer2 coding sequence (IE1-BmDicer2), which over-expresses BmDicer2, was generated by piggyBac transposon-mediated transgenesis. Two indexes, the ratio of animals that showed a silencing phenotype and the duration of silencing, were used to evaluate silencing efficiency. Significant knockdown of target gene expression was observed at 48 h postinjection at both the transcriptional and translational levels. Furthermore, we coexpressed B. mori Argonaute 2 BmAgo2）and BmDicer 2 and found that 22% of the animals (n = 18) showed an obvious silencing effect even at 72 h, suggesting that coexpression of these two RNAi core machinery enzymes further increased the susceptibility of B. mori to injected double-stranded RNAs. This study offers a new strategy for functional genomics research in RNAi-refractory insect taxa in general and for lepidopterans in particular.

Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis

BACKGROUND

Although research on the effects of comorbidities on coronavirus disease 2019 (COVID-19) patients is increasing, the risk of cancer history has not been evaluated for the mortality of patients with COVID-19.

METHODS

In this retrospective study, we included 3232 patients with pathogen-confirmed COVID-19 who were hospitalized between January 18th and March 27th, 2020, at Tongji Hospital in Wuhan, China. Propensity score matching was used to minimize selection bias.

RESULTS

In total, 2665 patients with complete clinical outcomes were analyzed. The impacts of age, sex, and comorbidities were evaluated separately using binary logistic regression analysis. The results showed that age, sex, and cancer history are independent risk factors for mortality in hospitalized COVID-19 patients. COVID-19 patients with cancer exhibited a significant increase in mortality rate (29.4% vs. 10.2%, P < 0.0001). Furthermore, the clinical outcomes of patients with hematological malignancies were worse, with a mortality rate twice that of patients with solid tumors (50% vs. 26.1%). Importantly, cancer patients with complications had a significantly higher risk of poor outcomes. One hundred nine cancer patients were matched to noncancer controls in a 1:3 ratio by propensity score matching. After propensity score matching, the cancer patients still had a higher risk of mortality than the matched noncancer patients (odds ratio (OR) 2.98, 95% confidence interval (95% CI) 1.76-5.06). Additionally, elevations in ferritin, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, procalcitonin, prothrombin time, interleukin-2 (IL-2) receptor, and interleukin-6 (IL-6) were observed in cancer patients.

CONCLUSIONS

We evaluated prognostic factors with epidemiological analysis and highlighted a higher risk of mortality for cancer patients with COVID-19. Importantly, cancer history was the only independent risk factor for COVID-19 among common comorbidities, while other comorbidities may act through other factors. Moreover, several laboratory parameters were significantly different between cancer patients and matched noncancer patients, which may indicate specific immune and inflammatory reactions in COVID-19 patients with cancer.

Effect of algae or fish oil supplementation and porcine maternal stress on the adrenal transcriptome of male offspring fed a low-quality protein diet

Offspring adrenal function may be negatively affected in utero by maternal stressors such as microbial infection. Maternal supplementation with immunomodulatory compounds such as omega-3 polyunsaturated fatty acids (n-3 PUFA) may help minimize the adverse effects of maternal stress on fetal hypothalamic-pituitary-adrenal development and improve offspring health. Presently, n-3 PUFA sources are primarily fish-based, but n-3 PUFA microalgae (AL) may be an alternative. Previously, it was determined that maternal AL or fish oil (FO) supplementation to sows, in addition to maternal stress induced by Escherichia coli lipopolysaccharide (LPS) challenge appeared to have a greater influence on the stress response of male offspring compared to females. To further elaborate on these findings, this study assessed the effects of maternal AL or FO supplementation combined with a maternal LPS challenge on adrenal gene expression in male offspring fed a nursery diet containing low-quality protein sources. Forty-eight sows were fed gestation diets starting on gestation day (gd) 75 containing either 3.12% AL, 3.1% FO, or a control diet containing 1.89% corn oil. On gd 112, half the sows in each treatment were administered 10 ​μg/kg LPS i.m. Piglets were weaned at 21 days of age onto a common low-quality plant-based protein diet, and one week after weaning, four piglets per sow were administered 40 ​μg/kg LPS i.m. Two hours later, the piglets were euthanized to obtain adrenal tissue, and total RNA was extracted to carry out transcriptome analysis using the Affymetrix GeneChip WT Plus assay and subsequent validation by real-time PCR. Analysis revealed that adrenal steroidogenesis, fatty acid metabolism and immune function were significantly influenced by maternal diet and stress. Increased expression of immune-related genes including lymphocyte antigen 96, TLR-2 and NF-κB suggests that maternal AL supplementation may increase offspring sensitivity to inflammation after weaning. Decreased expression of lymphocyte antigen 96 in male offspring from sows receiving maternal LPS challenge also suggests a possible role of maternal stress in diminishing the offspring immune response to immune stress challenge. Increased expression of the genes encoding the 11BHSD2 enzyme in offspring from sows fed FO may also reduce the magnitude of the stress response. These data provide insight to the immune and metabolic mechanisms that may be influenced by maternal diet and stress.

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Expression of adrenal steroidogenesis genes were influenced by maternal treatment.

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Expression of lipid metabolism genes and immune function genes were enriched.

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Maternal algae supplementation may increase offspring sensitivity to inflammation.

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Maternal stress may reduce the offspring immune response to immune challenges.

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Maternal fish oil supplementation may reduce the offspring stress response.

Higher dose of resveratrol elevated cardiovascular disease risk biomarker levels in overweight older adults - A pilot study

Older adults are at high risk of developing cardiovascular disease (CVD). Pre-clinical studies indicate that resveratrol (RSV), a polyphenol commonly found in grapes and red wine, may help prevent development of CVD. Based on our previous reports where the 300 mg and 1000 mg doses appeared safe and improved psychomotor function in a dose-dependent manner, our hypothesis was that RSV would reduce biomarkers of CVD risk in overweight, but otherwise healthy older adults and that 1000 mg would lower CVD biomarkers >300 mg. This analysis was performed on samples from older participants (65 years and older) who were randomized to a 90 day RSV treatment with 300 mg (n = 10), 1000 mg (n = 9) or placebo (n = 10). We measured levels of CVD risk biomarkers i.e. oxidized low-density lipoprotein (oxLDL), soluble E-selectin-1 (sE-selectin), soluble Intercellular Adhesion Molecule-1 (sICAM-1), Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1), total plasminogen activator inhibitor (tPAI-1). Statistical significance was set at p < 0.05. Both sVCAM-1 and tPAI increased significantly more in the 1000 mg vs. 300 mg and placebo groups. Other biomarkers (300 mg vs. 1000 mg vs. placebo: oxLDL, sEselectin-1 and sICAM-1) followed the same trend toward higher levels in the 1000 mg group compared to the 300 mg and placebo groups, without reaching statistical significance. This pilot project suggests that a higher dose of RSV may increase the levels of CVD risk biomarkers in overweight older adults. Given no change in the CVD risk biomarkers in response to a lower dose, future studies should test the effects of different doses of RSV to evaluate potential detrimental effects of higher doses on CVD biomarkers and measures of cardiovascular function in older adults at risk for CVD.

Boson Sampling with 20 Input Photons and a 60-Mode Interferometer in a 10^{14}-Dimensional Hilbert Space

Quantum computing experiments are moving into a new realm of increasing size and complexity, with the short-term goal of demonstrating an advantage over classical computers. Boson sampling is a promising platform for such a goal; however, the number of detected single photons is up to five so far, limiting these small-scale implementations to a proof-of-principle stage. Here, we develop solid-state sources of highly efficient, pure, and indistinguishable single photons and 3D integration of ultralow-loss optical circuits. We perform experiments with 20 pure single photons fed into a 60-mode interferometer. In the output, we detect up to 14 photons and sample over Hilbert spaces with a size up to 3.7×10^{14}, over 10 orders of magnitude larger than all previous experiments, which for the first time enters into a genuine sampling regime where it becomes impossible to exhaust all possible output combinations. The results are validated against distinguishable samplers and uniform samplers with a confidence level of 99.9%.

Synchronous crop failures and climate-forced production variability

Large-scale modes of climate variability can force widespread crop yield anomalies and are therefore often presented as a risk to food security. We quantify how modes of climate variability contribute to crop production variance. We find that the El Niño Southern Oscillation (ENSO), the Indian Ocean Dipole (IOD), tropical Atlantic variability (TAV), and the North Atlantic Oscillation (NAO) together account for 18, 7, and 6% of globally aggregated maize, soybean, and wheat production variability, respectively. The lower fractions of global-scale soybean and wheat production variability result from substantial but offsetting climate-forced production anomalies. All climate modes are important in at least one region studied. In 1983, ENSO, the only mode capable of forcing globally synchronous crop failures, was responsible for the largest synchronous crop failure in the modern historical record. Our results provide the basis for monitoring, and potentially predicting, simultaneous crop failures.

Symmetry-Breaking Assisted Landau-Zener Transitions in Rydberg Atoms

We report the observation of a controlled Landau-Zener transition (LZT) in Rydberg atoms by breaking the symmetry of the underlying Hamiltonian. For a nonhydrogenic Rydberg atom inside a changing electric (F) field, a LZT occurs between the avoided crossing energy levels of neighboring Rydberg states only for a sufficiently high changing rate. If a transverse magnetic (B) field is applied as we implement, the atomic level symmetry is broken, which causes the Stark manifolds denoted by a different |m| (m is the magnetic quantum number) to interact with each other. The mixed state levels end up pushing the adiabatically repelled target states closer and additionally they serve as stepping stones for the sequential LZTs between the neighboring sublevels. Such a feature significantly decreases the changing rate required for an efficient LZT inside a pure electric field. We report experimental observations that support the above scenario. It opens a versatile approach for engineering a controlled LZT in more general systems.

Electronic properties and structure of single crystal perylene

The transport properties of electronic devices made from single crystalline molecular semiconductors typically outperform those composed of thin-films of the same material. To further understand the superiority of these extrinsic device properties, an understanding of the intrinsic electronic structure and properties of the organic semiconductor is necessary. An investigation of the electronic structure and properties of single crystal α-phase perylene (C₂₀H₁₂), a five-ringed aromatic molecule, is presented using angle-resolved ultraviolet photoemission, x-ray photoelectron spectroscopy (XPS), and field-effect transistor measurements. Key aspects of the electronic structure of single crystal α-perylene critical to charge transport are determined, including the energetic location of the highest occupied molecular orbital (HOMO), the HOMO bandwidth, and surface work function. In addition, using high resolution XPS, we can distinguish between inequivalent carbon atoms within the perylene crystal and, from the shake-up satellite structure in XPS, gain insight into the intramolecular properties in α-perylene. From the device measurements, the charge carrier mobility of α-perylene is found to depend on the device structure and the choice of dielectric, with values in the range of 10^-3 cm² V^-1 s^-1.

Microfluidic co-culture platform for investigating osteocyte-osteoclast signalling during fluid shear stress mechanostimulation

Bone cells exist in a complex environment where they are constantly exposed to numerous dynamic biochemical and mechanical stimuli. These stimuli regulate bone cells that are involved in various bone disorders, such as osteoporosis. Knowledge of how these stimuli affect bone cells have been utilised to develop various treatments, such as pharmaceuticals, hormone therapy, and exercise. To investigate the role that bone loading has on these disorders in vitro, bone cell mechanotransduction studies are typically performed using parallel plate flow chambers (PPFC). However, these chambers do not allow for dynamic cellular interactions among different cell populations to be investigated. We present a microfluidic approach that exposes different cell populations, which are located at physiologically relevant distances within adjacent channels, to different levels of fluid shear stress, and promotes cell-cell communication between the different channels. We employed this microfluidic system to assess mechanically regulated osteocyte-osteoclast communication. Osteoclast precursors (RAW264.7 cells) responded to cytokine gradients (e.g., RANKL, OPG, PGE-2) developed by both mechanically stimulated (fOCY) and unstimulated (nOCY) osteocyte-like MLO-Y4 cells simultaneously. Specifically, we observed increased osteoclast precursor cell densities and osteoclast differentiation towards nOCY. We also used this system to show an increased mechanoresponse of osteocytes when in co-culture with osteoclasts. We envision broad applicability of the presented approach for microfluidic perfusion co-culture of multiple cell types in the presence of fluid flow stimulation, and as a tool to investigate osteocyte mechanotransduction, as well as bone metastasis extravasation. This system could also be applied to any multi-cell population cross-talk studies that are typically performed using PPFCs (e.g. endothelial cells, smooth muscle cells, and fibroblasts).

Harmonic trap resonance enhanced synthetic atomic spin-orbit coupling

Spin-orbit coupling (SOC) plays an essential role in many exotic and interesting phenomena in condensed matter physics. In neutral-atom-based quantum simulations, synthetic SOC constitutes a key enabling element. The strength of SOC realized so far is limited by various reasons or constraints. This work reports tunable SOC synthesized with a gradient magnetic field (GMF) for atoms in a harmonic trap. Nearly ten-fold enhancement is observed when the GMF is modulated near the harmonic-trap resonance in comparison with the free-space situation. A theory is developed that well explains the experimental results. Our work offers a clear physical insight into and analytical understanding of how to tune the strength of atomic SOC synthesized with GMF using harmonic trap resonance.

Direct regeneration of cathode materials from spent lithium iron phosphate batteries using a solid phase sintering method

A direct regeneration of cathode materials from spent LiFePO₄ batteries using a solid phase sintering method has been proposed in this article.

Synthesis, Crystal Structure, and Photoluminescent Properties of a Series of LnIII–CuI Heterometallic Coordination Polymers Based on Cu4I3 Clusters and Ln–ina Rod Units

A novel series of LnIII–CuI heterometallic coordination polymers (HCPs) {[Ln2Cu4I3(ina)7(DMA)2]n·nDMA, Ln = La (1), Ce (2), Pr (3) Nd (4), Sm (5), Eu (6), Gd (7), Tb (8), Dy (9) Ho (10), Er (11), Yb (12), Hina = isonicotinic acid, DMA = N,N-dimethylacetamide} were synthesised by a solvothermal reaction. The structures of compounds 1–12 were characterised by elemental analysis, FT-IR spectroscopy, thermogravimetric analysis, and powder X-ray diffraction. Single crystal X-ray diffraction studies revealed that 1–12 are isomorphous and are 3D heterometallic coordination polymers based on inorganic Cu4I3 clusters and Ln2(ina)7(DMA) rod units. In addition, the luminescent properties of compounds 5–9 have been investigated in detail. All of them exhibited green light emission due to the synergistic effects of characteristic emissions of lanthanide ions and iodide-to-copper charge transfer.

Cadmium sulphide quantum dots with tunable electronic properties by bacterial precipitation

We present a new method to fabricate semiconducting, transition metal nanoparticles (NPs) with tunable bandgap energies using engineered Escherichia coli. These bacteria overexpress the Treponema denticola cysteine desulfhydrase gene to facilitate precipitation of cadmium sulphide (CdS) NPs. Analysis with transmission electron microscopy, X-ray diffraction, and X-ray photoelectron spectroscopy reveal that the bacterially precipitated NPs are agglomerates of mostly quantum dots, with diameters that can range from 3 to 15 nm, embedded in a carbon-rich matrix. Additionally, conditions for bacterial CdS precipitation can be tuned to produce NPs with bandgap energies that range from quantum-confined to bulk CdS. Furthermore, inducing precipitation at different stages of bacterial growth allows for control over whether the precipitation occurs intra- or extracellularly. This control can be critically important in utilizing bacterial precipitation for the environmentally-friendly fabrication of functional, electronic and catalytic materials. Notably, the measured photoelectrochemical current generated by these NPs is comparable to values reported in the literature and higher than that of synthesized chemical bath deposited CdS NPs. This suggests that bacterially precipitated CdS NPs have potential for applications ranging from photovoltaics to photocatalysis in hydrogen evolution.

Selecting optimal surgical procedures for intraductal papillary mucinous neoplasm (IPMN): An analysis based on the Surveillance, Epidemiology, and End Result registry database

INTRODUCTION

Intraductal papillary mucinous neoplasm (IPMN) is a field defect disease of pancreas that has malignant potential. Many studies have recommended surgery as the preferred treatment. We investigated whether a total pancreatectomy (TP) can improve patient prognosis compared to a pancreatoduodenectomy (PD) and the indications for each approach.

PATIENTS AND METHODS

We obtained data of 548 malignant IPMN patients who underwent either a TP or a PD from SEER database. The survival rates were analyzed using the Kaplan-Meier method and a Cox regression model. Cases were subdivided to investigate the advantages of each procedure.

RESULTS

The surgical procedures (PD and TP) did not significantly affect either cancer-specific survival (CSS) times or overall survival (OS) times in both Kaplan-Meier analysis and Cox regression (Kaplan-Meier: PCSS = 0.919, POS = 0.996; Cox: PCSS = 0.735, POS = 0.820). In the subgroup analyses, patients in stage T4 and AJCC stage III in the TP group had a longer survival time than did those in the PD group (33 months vs 14 months), but not significant (T4: PCSS = 0.124, AJCC III: PCSS = 0.102). In addition, PD had the trend to be better for poorly differentiated patients (Pos = 0.055) and older patients.

CONCLUSION

TP did not offer any significant OS and CSS benefits as compared to PD. However, for patients in stage T4 and AJCC stage III, TP may extend survival time in some degree. In older or histologically poorly differentiated patients, PD may be preferable to TP. The results are rational, but still warrant further verification due to limited sample volumes of specific subgroups.

Tunable atomic spin-orbit coupling synthesized with a modulating gradient magnetic field

We report the observation of synthesized spin-orbit coupling (SOC) for ultracold spin-1 ⁸⁷Rb atoms. Different from earlier experiments where a one dimensional (1D) atomic SOC of pseudo-spin-1/2 is synthesized with Raman laser fields, the scheme we demonstrate employs a gradient magnetic field (GMF) and ground-state atoms, thus is immune to atomic spontaneous emission. The strength of SOC we realize can be tuned by changing the modulation amplitude of the GMF, and the effect of the SOC is confirmed through the studies of: 1) the collective dipole oscillation of an atomic condensate in a harmonic trap after the synthesized SOC is abruptly turned on; and 2) the minimum energy state at a finite adiabatically adjusted momentum when SOC strength is slowly ramped up. The condensate coherence is found to remain very good after driven by modulating GMFs. Our scheme presents an alternative means for studying interacting many-body systems with synthesized SOC.

Modeling for regional ecosystem sustainable development under uncertainty--A case study of Dongying, China

In this study, a superiority-inferiority two-stage stochastic programming (STSP) method is developed for planning regional ecosystem sustainable development. STSP can tackle uncertainties expressed as fuzzy sets and probability distributions; it can be used to analyze various policy scenarios that are associated with different levels of economic penalties when the promised targets are violated. STSP is applied to a real case of planning regional ecosystem sustainable development in the City of Dongying, where ecosystem services valuation approaches are incorporated within the optimization process. Regional ecosystem can provide direct and indirect services and intangible benefits to local economy. Land trading mechanism is introduced for planning the regional ecosystem's sustainable development, where wetlands are buyers who would protect regional ecosystem components and self-organization and maintain its integrity. Results of regional ecosystem activities, land use patterns, and land trading schemes have been obtained. Results reveal that, although large-scale reclamation projects can bring benefits to the local economy development, they can also bring with negative effects to the coastal ecosystem; among all industry activities oil field is the major contributor with a large number of pollutant discharges into local ecosystem. Results also show that uncertainty has an important role in successfully launching such a land trading program and trading scheme can provide more effective manner to sustain the regional ecosystem. The findings can help decision makers to realize the sustainable development of ecological resources in the process of rapid industrialization, as well as the integration of economic and ecological benefits.

Efficacy and Safety of Bromocriptine-QR in Type 2 Diabetes: A Systematic Review and Meta-Analysis

Bromocriptine-QR (quick release) is a novel treatment for type 2 diabetes. The objective of this study is to assess the efficacy and safety of bromocriptine-QR in adults with type 2 diabetes mellitus based on randomized controlled trials published in peer-reviewed journals or as abstracts. We performed a comprehensive literature search of MEDLINE, Pubmed, Web of Science, EMBASE, and the Cochrane Library up to May 2015. Randomized controlled trials of bromocriptine-QR therapy in type 2 diabetes mellitus were eligible. Two reviewers independently assessed the eligibility of trials based on predefined inclusion criteria. Information was collected concerning basic study data, patient characteristics, efficacy and safety outcomes, and methodological quality. Bromocriptine-QR add-on therapy lowered hemoglobin A1c compared with placebo (weighted mean difference, - 6.52 mmol/mol; 95% CI, - 8.07 to - 4.97 mmol/mol). Bromocriptine-QR exhibited an increase in achieving an HbA1c level ≤ 53 mmol/mol (≤ 7.0%) (32.0 vs. 9.5%; odds ratio, 4.57; 95% CI, 2.42-8.62). Fasting plasma glucose was reduced with bromocriptine-QR compared with placebo (weighted mean difference,-1.04 mmol/l; 95% CI,-1.49 to-0.59 mmol/l). Moreover, bromocriptine-QR had neutral effects on postprandial glycemia, Body Mass Index (BMI), and lipid profile. Bromocriptine-QR had more gastrointestinal side effects of nausea and vomiting. Bromocriptine-QR had no increased risk of hypoglycemia, hypotension, or cardiovascular effects. Bromocriptine-QR therapy offers an alternative option to currently available antidiabetic agents for type 2 diabetes mellitus adults. Neither hypoglycemia nor other metabolic changes occur with this drug. More data for long-term efficacy and safety are needed for further observation.

Alendronate sodium/vitamin D3 combination tablet versus calcitriol for osteoporosis in Chinese postmenopausal women: a 6-month, randomized, open-label, active-comparator-controlled study with a 6-month extension

This study compares efficacy of ALN/D5600 versus that of calcitriol in osteoporotic Chinese postmenopausal women. ALN/D5600 produced greater bone mineral density (BMD) increases, greater bone turnover marker decreases, and less vitamin D insufficiency. This study provided detailed clinical information regarding ALN/D5600 treatment versus calcitriol 0.25 μg/day. The study did not evaluate fracture risk.

INTRODUCTION

The aim of this study is to investigate efficacy of alendronate 70 mg/vitamin D3 5600 IU combination tablets (ALN/D5600) versus calcitriol in osteoporotic Chinese postmenopausal women.

METHODS

This study is a 6-month, randomized, open-label, active-comparator study with 6-month extension (clinicaltrials.gov number NCT01350934) in postmenopausal women aged >55 years with osteoporosis (low bone mineral density (BMD) with/without prior fragility fracture). Patients were randomized to ALN/D5600 once weekly or calcitriol 0.25 μg daily. The primary efficacy end point of the base study was percent change from baseline in lumbar spine BMD (month 6). Hypercalcemia and hypercalciuria were safety events of special interest.

RESULTS

A total of 219 patients (ALN/D5600 n = 111, calcitriol n = 108) were randomized. Baseline characteristics were similar, 30.3 % baseline 25-hydroxyvitamin D (25(OH)D) ≤15 ng/mL. At months 6 and 12, changes in lumbar spine BMD from baseline were 3.5 versus 1.6 % and 5.2 versus 2.3 % for ALN/D5600 versus calcitriol (between-group differences p < 0.001), respectively. Between-group differences for ALN/D5600 versus calcitriol were significant (p < 0.001) at months 6 and 12 for change from baseline in procollagen type 1 N-terminal propeptide (-59.1 versus -16.8 %, -68.1 versus -17.0 %) and serum C-telopeptides (-79.2 versus -27.2 %, -76.2 versus -24.2 %). Drug-related adverse events (AEs) and discontinuations due to drug-related AEs occurred in 15 (14.0 %) versus 8 (7.4 %) patients and 3 (2.8 %) versus 0 patients in the ALN/D5600 and calcitriol group, respectively. Hypercalciuria 12-month incidence (24-h urine Ca >300 mg) was 8.4 (ALN/D5600) versus 13.9 % (calcitriol) (p > 0.05). One patient (calcitriol) had hypercalcemia.

CONCLUSIONS

ALN/D5600 produced greater increases in lumbar spine BMD and greater decreases in bone turnover markers versus calcitriol in osteoporotic Chinese women. It is not known whether the greater increase in BMD results in fewer fractures. ALN/D5600 was generally well tolerated in Chinese patients.