Association of Circulating Tumor DNA and Circulating Tumor Cells After Neoadjuvant Chemotherapy With Disease Recurrence in Patients With Triple-Negative Breast Cancer: Preplanned Secondary Analysis of the BRE12-158 Randomized Clinical Trial.

Importance: A significant proportion of patients with early-stage triple-negative breast cancer (TNBC) are treated with neoadjuvant chemotherapy. Sequencing of circulating tumor DNA (ctDNA) after surgery, along with enumeration of circulating tumor cells (CTCs), may be used to detect minimal residual disease and assess which patients may experience disease recurrence. Objective: To determine whether the presence of ctDNA and CTCs after neoadjuvant chemotherapy in patients with early-stage TNBC is independently associated with recurrence and clinical outcomes. Design, Setting, and Participants: A preplanned secondary analysis was conducted from March 26, 2014, to December 18, 2018, using data from 196 female patients in BRE12-158, a phase 2 multicenter randomized clinical trial that randomized patients with early-stage TNBC who had residual disease after neoadjuvant chemotherapy to receive postneoadjuvant genomically directed therapy vs treatment of physician choice. Patients had blood samples collected for ctDNA and CTCs at time of treatment assignment; ctDNA analysis with survival was performed for 142 patients, and CTC analysis with survival was performed for 123 patients. Median clinical follow-up was 17.2 months (range, 0.3-58.3 months). Interventions: Circulating tumor DNA was sequenced using the FoundationACT or FoundationOneLiquid Assay, and CTCs were enumerated using an epithelial cell adhesion molecule-based, positive-selection microfluidic device. Main Outcomes and Measures: Primary outcomes were distant disease-free survival (DDFS), disease-free survival (DFS), and overall survival (OS). Results: Among 196 female patients (mean [SD] age, 49.6 [11.1] years), detection of ctDNA was significantly associated with inferior DDFS (median DDFS, 32.5 months vs not reached; hazard ratio [HR], 2.99; 95% CI, 1.38-6.48; P = .006). At 24 months, DDFS probability was 56% for ctDNA-positive patients compared with 81% for ctDNA-negative patients. Detection of ctDNA was similarly associated with inferior DFS (HR, 2.67; 95% CI, 1.28-5.57; P = .009) and inferior OS (HR, 4.16; 95% CI,1.66-10.42; P = .002). The combination of ctDNA and CTCs provided additional information for increased sensitivity and discriminatory capacity. Patients who were ctDNA positive and CTC positive had significantly inferior DDFS compared with those who were ctDNA negative and CTC negative (median DDFS, 32.5 months vs not reached; HR, 5.29; 95% CI, 1.50-18.62; P = .009). At 24 months, DDFS probability was 52% for patients who were ctDNA positive and CTC positive compared with 89% for those who were ctDNA negative and CTC negative. Similar trends were observed for DFS (HR, 3.15; 95% CI, 1.07-9.27; P = .04) and OS (HR, 8.60; 95% CI, 1.78-41.47; P = .007). Conclusions and Relevance: In this preplanned secondary analysis of a randomized clinical trial, detection of ctDNA and CTCs in patients with early-stage TNBC after neoadjuvant chemotherapy was independently associated with disease recurrence, which represents an important stratification factor for future postneoadjuvant trials. Trial Registration: ClinicalTrials.gov Identifier: NCT02101385.

Deterministic culturing of single cells in 3D.

Models using 3D cell culture techniques are increasingly accepted as the most biofidelic in vitro representations of tissues for research. These models are generated using biomatrices and bulk populations of cells derived from tissues or cell lines. We present an alternate method to culture individually selected cells in relative isolation from the rest of the population under physiologically relevant matrix conditions. Matrix gel islands are spotted on a cell culture dish to act as support for receiving and culturing individual single cells; a glass capillary-based microfluidic setup is used to extract each desired single cell from a population and seed it on top of an island. Using examples of breast and colorectal cancers, we show that individual cells evolve into tumors or aspects of tumors displaying different characteristics of the initial cancer type and aggressiveness. By implementing a morphometry assay with luminal A breast cancer, we demonstrate the potential of the proposed approach to study phenotypic heterogeneity. Results reveal that intertumor heterogeneity increases with time in culture and that varying degrees of intratumor heterogeneity may originate from individually seeded cells. Moreover, we observe that a positive relationship exists between fast growing tumors and the size and heterogeneity of their nuclei.

High-purity isolation of rare single cells from blood using a tiered microchip system.

We present a two-tiered microchip system to capture and retrieve rare cells from blood samples with high purity. The first module of the system is a high throughput microfluidic interface that is used to immunomagnetically isolate targeted rare cells from whole blood, and discard > 99.999% of the unwanted leukocytes. The second module is a microwell array that furthers the purification by magnetically guiding each cell into a separate well concurrently, and allows individual retrieval of each cell. We demonstrate the design of the system as well as its characterization by experiments using model cell lines that represent circulating fetal trophoblasts. Our results show that single cells can be retrieved with efficiencies and purities as high as 100% within 145 mins.

Methods for Single-Molecule Sensing and Detection Using Bacteriophage Phi29 DNA Packaging Motor.

Bacteriophage phi29 DNA packaging motor consists of a dodecameric portal channel protein complex termed connector that allows transportation of genomic dsDNA and a hexameric packaging RNA (pRNA) ring to gear the motor. The elegant design of the portal protein has facilitated its applications for real-time single-molecule detection of biopolymers and chemicals with high sensitivity and selectivity. The robust self-assembly property of the pRNA has enabled biophysical studies of the motor complex to determine the stoichiometry and structure/folding of the pRNA at single-molecule level. This chapter focuses on biophysical and analytical methods for studying the phi29 motor components at the single-molecule level, such as single channel conductance assays of membrane-embedded connectors; single molecule photobleaching (SMPB) assay for determining the stoichiometry of phi29 motor components; fluorescence resonance energy transfer (FRET) assay for determining the structure and folding of pRNA; atomic force microscopy (AFM) for imaging pRNA nanoparticles of various size, shape, and stoichiometry; and bright-field microscopy with magnetomechanical system for direct visualization of viral DNA packaging process. The phi29 system with explicit engineering capability has incredible potentials for diverse applications in nanotechnology and nanomedicine including, but not limited to, DNA sequencing, drug delivery to diseased cells, environmental surveillance, and early disease diagnosis.

Bone regeneration imaging after bone grafting using phase-contrast computed tomography with synchrotron radiation / 中国组织工程研究

BACKGROUND: With a clear distinction from traditional computed tomography (CT) imaging with information absorption, phase-contrast CT with synchronous radiation has implemented the microstructure imaging of soft tissues in organisms with an unprecedented imaging mechanism. OBJECTIVE: To explore the synchrotron radiation phase-contrast CT imaging technology in the bone regeneration imaging after bone grafting. METHODS: Four New Zealand white rabbits were used to make a metaphyseal defect model. Then, model rabbits were randomized into a group with calcium phosphate bone grafting and a group with Bio-Oss bone grafting in the defects. The specimens were imaged by the synchrotron radiation phase-contrast CT and stained with hematoxylin-eosin and sirius red 2 weeks after bone grafting. RESULTS AND CONCLUSION: (1) Bio-Oss bone graft material group: Osteoid was observed not only around the graft material but also in the area far from the graft bone material as reticulate structure by the synchrotron radiation phase-contrast CT. Hematoxylin-eosin staining showed a large amount of red osteoid tissues arranged as trabecular bone, and a large amount of osteoblasts with obvious osteogensis. Sirius red-stained pathological sections were largely stained yellow, and there were round or oval osteoblasts with strongly expressed type I collagen. (2) Calcium phosphate bone graft material group: There was no reticulate structure shown by the synchrotron radiation phase-contrast CT, and the creep of osteoid tissues was only around the bone graft. Hematoxylin-eosin staining showed a large amount of red osteoid tissues, and sirius red-stained pathological sections were stained yellow and red. To conclude, the synchronous radiation phase-contrast CT can clearly display the regenerated structure of bone grafts.

Separation and dual detection of prostate cancer cells and protein biomarkers using a microchip device.

Current efforts for the detection of prostate cancer using only prostate specific antigen are not ideal and indicate a need to develop new assays - using multiple targets - that can more accurately stratify disease states. We previously introduced a device capable of the concurrent detection of cellular and molecular markers from a single sample fluid. Here, an improved design, which achieves affinity as well as size-based separation of captured targets using antibody-conjugated magnetic beads and a silicon chip containing micro-apertures, is presented. Upon injection of the sample, the integration of magnetic attraction with the micro-aperture chip permits larger cell-bead complexes to be isolated in an upper chamber with the smaller protein-bead complexes and remaining beads passing through the micro-apertures into the lower chamber. This enhances captured cell purity for on chip quantification, allows the separate retrieval of captured cells and proteins for downstream analysis, and enables higher bead concentrations for improved multiplexed ligand targeting. Using LNCaP cells and prostate specific membrane antigen (PSMA) to model prostate cancer, the device was able to detect 34 pM of spiked PSMA and achieve a cell capture efficiency of 93% from culture media. LNCaP cells and PSMA were then spiked into diluted healthy human blood to mimic a cancer patient. The device enabled the detection of spiked PSMA (relative to endogenous PSMA) while recovering 85-90% of LNCaP cells which illustrated the potential of new assays for the diagnosis of prostate cancer.

Experience of Treatment Cases According to Syndrome Differentiation of Intracoronary Stenting Postoperatively / 中国中医药信息杂志

Through three treatment cases according to syndrome differentiation of intracoronary stenting postoperatively by warming the spleen and stomach for dispelling cold, replenishing qi to invigorate the spleen, eliminating phlegm and dredging channel blockade, invigorating vital energy, soothing the liver and regulating the spleen, and relieving mental stress, this article discussed the application of treatment according to syndrome differentiation in intracoronary stenting postoperatively.

Concurrent Detection of Cellular and Molecular Cancer Markers Using an Immunomagnetic Flow System.

We report a detection system for simultaneous measurement of cellular and molecular markers of cancer. Magnetic beads conjugated with antibodies against a specific antigen are used to capture both free molecules and whole cells overexpressing the antigen. The target-bound beads then flow through a microfluidic chamber where they are drawn to a glass surface by an external magnetic field. The cells and molecules captured on the surface are quantitatively analyzed using fluorescent microscopy. The system was characterized by detecting free folate receptor (FR) and an FR+ cancer cell line (KB) in culture media. The system detected as low as 10 pM of FR and captured 87% of the spiked KB cells at a volumetric throughput of 3 mL/min. We further demonstrated the detection of 100 KB cells and 200 pM FR spiked into healthy human blood to simulate detection of rare cells and protein biomarkers present in a cancer patient's blood sample. The FR concentration was measured to be 244 pM (including the intrinsic FR present in the blood), and the total number of KB cells in the sample was estimated to be 98. The potential of this approach in clinical diagnostics was also demonstrated by detecting both FR+ cells and free FR in an ascites sample obtained from an ovarian cancer patient. Because of the system's capability to detect multiple targets at the same time, its high throughput, and its overall simplicity, we expect it to be highly useful in a wide range of research settings.

Circulating tumor cell detection using a parallel flow micro-aperture chip system.

We report on-chip isolation and detection of circulating tumor cells (CTCs) from blood samples using a system that integrates a microchip with immunomagnetics, high-throughput fluidics and size-based filtration. CTCs in a sample are targeted via their surface antigens using magnetic beads functionalized with antibodies. The mixture is then run through a fluidic chamber that contains a micro-fabricated chip with arrays of 8 µm diameter apertures. The fluid runs parallel to the microchip while a magnetic field is generated underneath to draw the beads and cells bound to them toward the chip surface for detection of CTCs that are larger than the apertures and clear out free beads and other smaller particles bound to them. The parallel flow configuration allows high volumetric flow rates, which reduces nonspecific binding to the chip surface and enables multiple circulations of the sample fluid through the system in a short period of time. In this study we first present models of the magnetic and fluidic forces in the system using a finite element method. We then verify the simulation results experimentally to determine an optimal flow rate. Next, we characterize the system by detecting cancer cell lines spiked into healthy human blood and show that on average 89% of the spiked MCF-7 breast cancer cells were detected. We finally demonstrate detection of CTCs in 49 out of 50 blood samples obtained from non-small cell lung cancer (NSCLC) patients and pancreatic cancer (PANC) patients. The number of CTCs detected ranges from 2 to 122 per 8 mL s of blood. We also demonstrate a statistically significant difference between the CTC counts of NSCLC patients who have received therapy and those who have not.

On-demand weighing of single dry biological particles over a 5-order-of-magnitude dynamic range.

We report a simple and highly versatile system to select and weigh individual dry biological particles. The system is composed of a microtweezer to pick and place individual particles and a cantilever-based resonator to weigh them. The system can weigh entities that vary from a red blood cell (~10(-11) g) to the eye-brain complex of an insect (~10(-6) g), covering a 5-order-of-magnitude mass range. Due to its versatility and ease of use, this weighing method is highly compatible with established laboratory practices. The system can provide complementary mass information for a wide variety of individual particles imaged using scanning electron microscopy and determine comparative weights of individual biological entities that are attached to microparticles as well as weigh fractions of individual biological entities that have been subjected to focused ion beam milling.

Application of Downey classification used in the diagnosis and treatment of children's snakebite / 中华实用儿科临床杂志

Objective To analyze the application of Downey classification and to improve the diagnosis and treatment for children bitten by venomous snakes.Methods The consecutive 76 snakebite children were treated according to the guidance of Downey classification in Children's Hospital of Chongqing Medical University from Jan.2005 to Dec.2011.Their epidemiological and clinical characteristics,treatment and outcomes were reviewed and analyzed.The Chinese traditional classification method was adopted to classify children of snakebites as a contrast at the same time,and the correlation of the 2 methods was studied.Correlations in Downey level,treatment time,length of hospital stay,osteofascial compartment syndrome (OCS) and the occurrence of myocardial damage were studied respectively.Results The 76 cases of snakebites all occurred from Apr.to Nov.,the time of injuries focused on the period of 18:01 to 00:00 (60 cases,78.94％),and limbs were the main injury parts(73 cases,96.05％).According to Downey's system,patients of grade 0 were 3 cases (3.95 ％),grade Ⅰ were 9 cases (11.84％),grade Ⅱ were 26 cases (34.21％),grade Ⅲ were 30 cases (39.47 ％),and grade Ⅳ were 8 cases (10.53 ％).All children victims were given comprehensive and symptomatic treatment,in which 74 cases were clinically cured and 2 cases were disabled,but no deaths.There was positive correlation between the traditional classification method and Downey classification method (r=0.85,P ＜ 0.05),and there was also positive correlation between treatment time and length of hospital stay (r =0.91,P ＜ 0.05).There was positive correlation between Downey level and OCS,the occurrence of myocardial damage,treatment time and length of hospital stay(r =0.90,0.95,0.48,0.96,respectively,all P ＜ 0.05).Conclusions The diagnosis and treatment were more specified after using the Downey classification,snake venom poisoning in children is a medical emergency requiring immediate attention,early diagnosis and proper treatment can reduce its fatality and disability rate.

Interfacial electron transfer from CdSe/ZnS quantum dots to TiO2 nanoparticles: size dependence at the single-molecule level.

Electron transfer (ET) kinetics of CdSe/ZnS core/shell quantum dots (QDs) on bare coverslips and a TiO(2) nanoparticle-coated thin film has been investigated at the single-molecule level. The QDs prepared have three different diameters of 3.6, 4.6, and 6.4 nm. The trajectories of fluorescence intensity are acquired with respect to the arrival time. The on-time events and subsequent fluorescence lifetimes are shorter with decreasing size. Given the lifetime measurements for QDs on glass and TiO(2), the rate constant of ET from QDs to TiO(2) may be determined to be 1.3×10(7), 6.0×10(6), and 4.7×10(6) s(-1) for the increasing sizes of the QDs. The plot of on-time probability density versus arrival time is characterized by power-law statistics in the short time region and a bending tail in the long time region. Marcus's ET model is employed to satisfactorily fit the bending tail behavior and to further calculate the ET rate constants. The theoretical counterparts for the different sizes are 1.4×10(7), 6.4×10(6), and 1.9×10(6) s(-1), showing good agreement with the experimental results.

Laser-treated hydrophobic paper: an inexpensive microfluidic platform.

We report a method for fabricating inexpensive microfluidic platforms on paper using laser treatment. Any paper with a hydrophobic surface coating (e.g., parchment paper, wax paper, palette paper) can be used for this purpose. We were able to selectively modify the surface structure and property (hydrophobic to hydrophilic) of several such papers using a CO(2) laser. We created patterns down to a minimum feature size of 62±1 µm. The modified surface exhibited a highly porous structure which helped to trap/localize chemical and biological aqueous reagents for analysis. The treated surfaces were stable over time and were used to self-assemble arrays of aqueous droplets. Furthermore, we selectively deposited silica microparticles on patterned areas to allow lateral diffusion from one end of a channel to the other. Finally, we demonstrated the applicability of this platform to perform chemical reactions using luminol-based hemoglobin detection.

Engineering of the fluorescent-energy-conversion arm of phi29 DNA packaging motor for single-molecule studies.

The bacteriophage phi29 DNA packaging motor contains a protein core with a central channel comprising twelve copies of re-engineered gp10 protein geared by six copies of packaging RNA (pRNA) and a DNA packaging protein gp16 with unknown copies. Incorporation of this nanomotor into a nanodevice would be beneficial for many applications. To this end, extension and modification of the motor components are necessary for the linkage of this motor to other nanomachines. Here the re-engineering of the motor DNA packaging protein gp16 by extending its length and doubling its size using a fusion protein technique is reported. The modified motor integrated with the eGFP-gp16 maintains the ability to convert the chemical energy from adenosine triphosphate (ATP) hydrolysis to mechanical motion and package DNA. The resulting DNA-filled capsid is subsequently converted into an infectious virion. The extended part of the gp16 arm is a fluorescent protein eGFP, which serves as a marker for tracking the motor in single-molecule studies. The activity of the re-engineered motor with eGFP-gp16 is also observed directly with a bright-field microscope via its ability to transport a 2-microm-sized cargo bound to the DNA.

Bright-field analysis of phi29 DNA packaging motor using a magnetomechanical system.

We report a simple and robust magnetomechanical system for direct visual observation of the DNA packaging behavior of the bacteriophage phi29 in real time. The system comprises a micron-sized magnetic bead attached to the free end of the viral DNA, a magnet and a bright-field microscope. We show that the phi29 DNA packaging activity can be observed and dynamically analyzed at the single molecular level in bright field with a relatively simple system. With this system we also visually demonstrate the phi29 motor transporting a cargo 10 000 times the viral size.

Immunomagnetic diffractometry for detection of diagnostic serum markers.

We describe an integrated approach for detection of diagnostic markers using in situ assembled optical diffraction gratings in combination with immunomagnetic capture. Folate receptor (FR), a serum protein indicative of various cancers, was chosen as a model system to demonstrate the potential of the method. Magnetic beads coupled to FR antibody were used to capture FR from serum. The FR-bound magnetic beads self-assembled onto microcontact-printed folate-coupled BSA (F-BSA) patterns to form diffraction gratings which served to detect FR by measuring the diffraction intensities caused by laser illumination. The FR-containing beads, upon binding to the F-BSA surface, served as intrinsic signal enhancement agents, circumventing the need for additional enzymatic signal amplification or fluorescent labeling steps. With this approach, a detection sensitivity of 700 fM (20 pg/mL) was achieved. The potential use of this approach in clinical diagnostics was demonstrated by measuring FR concentration in blood samples obtained from cancer patients.

An optical biosensor for rapid and label-free detection of cells.

We report a broadly applicable optical method for rapid and label-free detection of as few as 45 cells. In this method, bacterial cells are detected by measuring the amount of laser light transmitted through a small glass well functionalized with antibodies which specifically recognize and capture the cells. The described approach is simple, rapid, economical, and promising for portable and high-throughput detection of a wide variety of pathogenic and infectious cells.