Forensic Analysis on 52 Medical Malpractice Cases of Cardiac Death

OBJECTIVES

To synthetically analyse the medical malpractice cases of cardiac death in forensic identification, and to explore the generality and characteristic of cause of death, medical malpractice and assessment of participation degree.

METHODS

Totally 52 medical malpractice cases of cardiac death examined in the Xiaoshan Branch Office, Hangzhou Minghao Forensic Judical Appraisal Institute, from January 2015 to April 2018 were collected. The general information of cases, medical institutions and situations of hospital stay, cause of death, medical malpractice and assessment of participation degree were retrospectively analysed.

RESULTS

In 52 cases, the male to female ratio was 2.25:1, and most subjects aged >50-60. Cardiac death caused by hypertensive heart disease or coronary heart disease was most common （67.3%）, followed by viral myocarditis and cardiomyopathy （13.5%）. There were 24 cases involved surgery, and the survival time after surgery was from 1 h to 118 d with a 7 d medium value. There were 63 medical institutes involved in these medical malpractices. Medical malpractice presented in most hospitals more or less, and the participation degree was >20%-30%.

CONCLUSIONS

Forensic appraisal contributes to determine causes of death, which not only provides scientific evidence for medical malpractice identification, but also improves diagnosis and treatment levels of medical institutions.

Association between household physical activity level and type 2 diabetes among urban males in northern China

OBJECTIVES

Physical activity contributes to preventing type 2 diabetes (T2D). Doing housework is an unstructured mild-intensity physical activity. We aimed to investigate the association between household physical activity level (HPAL) and T2D in urban Chinese men.

STUDY DESIGN

This is a cross-sectional study.

METHODS

This study contained 13,862 male adults aged 35-78 (48.4 ± 7.1) years. According to the self-reported time (hours/day [h/d]) spent on housework, they were stratified into three levels: 0 h/d, >0-2 h/d, and >2 h/d. The association of HPAL with T2D was investigated by logistic regression analysis.

RESULTS

The odds ratios (ORs) for T2D across increasing categories of HPAL were 1.00 (reference), 0.80 (95% confidence interval [CI] 0.72-0.89), and 0.60 (95% CI 0.51-0.70), respectively (P for trend <0.001), after adjusting for confounding factors. Further adjustment for waist circumference or body mass index (BMI) had a minimal impact on these ORs. The inverse association of HPAL with T2D was persistent in subgroup analyses based on age, hypertension, family history of diabetes, smoking, BMI, waist circumstance, and fasting plasma glucose level.

CONCLUSION

Our findings indicated that HPAL was inversely associated with the risk of T2D among urban males in northern China. This implied that household physical activity may contribute to long-term glucose control. Well-designed longitudinal studies are required to improve our understanding of this association.

A novel on-line organic mercury digestion method combined with atomic fluorescence spectrometry for automatic mercury speciation

A novel on-line digestion method was developed based on organic mercury (Org-Hg) oxidation at ambient temperature using potassium permanganate in the presence of sulphide. The digestion of Org-Hg was instantaneous and quantitative. Consequently, a simple mercury speciation method was developed to differentiate inorganic mercury (In-Hg) and Org-Hg in water samples with a sequential injection analytical system in conjunction with atomic fluorescence spectrometric detection by using Hg²⁺ as the sole standard for calibration. In-Hg was determined after acidification and decomposition of the organic matter in the sample matrix with KMnO₄, while total mercury (T-Hg) was determined after online Org-Hg digestion, and Org-Hg was calculated as the difference between T-Hg and In-Hg. The operational parameters were optimized and the possible role that sulphide played in the digestion of Org-Hg was discussed. A detection limit (3σ criterion) of 3 ng L^-1 Hg was achieved, which is far below the guideline value of Hg in drinking water set by WHO, viz., 1 μg L^-1. The method was applied to the analysis of lake water samples for the determination of In-Hg and Org-Hg. Relative recoveries of 94-97% for In-Hg and 93.5-94.5% for T-Hg with relative standard deviations of 1.1-3.1% were obtained in real samples spiked with 100 ng L^-1 Hg²⁺ and 100 ng L^-1 Org-Hg, respectively, indicating the feasibility of the automatic method for the determination of Hg species at the low ng L^-1 level.

[Effects of titanium dioxide nanoparticles and lipopolysaccharide on antioxidant function of liver tissues in mice]

OBJECTIVE

To compare the effects of different sized titanium dioxide (titanium dioxide, TiO₂) on the antioxidant function of liver tissues in mice, and study the effect of TiO₂ nanoparticles on the susceptibility of lipopolysaccharide (LPS) on liver tissues.

METHODS

Ninety 4-week-old clean-grade male ICR mice were divided into 18 groups, in which the mice were fed for different feed involving ordinary feed, nanometer TiO₂ feed which meant the feed including 1% (mass fraction) TiO₂ nanoparticles, and submicron TiO₂ feed which meant the feed including 1% (mass fraction) TiO₂ submicron particles. Respectively, they were fed for 1 month, 3 months and 6 months. On the second day after the feeding, respectively, 0 and 10 mg/kg LPS were given by gavage. The mice were harvested after 4 h and the body weight and liver weight for calculating the liver coefficient were recorded. Then the liver tissue homogenates were prepared for determining the antioxidant indexes including the total antioxidant capacity (T-AOC), total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-PX), and malondialdehyde (MDA).

RESULTS

The change of body weight in mice was only discovered in group fed for 1 month, which showed significant decrease of body weight in treatment groups compared with control group. And there was no significant change of the liver coefficient in each group. Compared with control groups, nanometer TiO₂ groups and submicron TiO₂ group, the activity of T-AOC, T-SOD and MDA of nanometer TiO₂+LPS group and submicron TiO₂+LPS group in which the mice were fed for 1 month and 6 months increased in different degree. And another result was also existing. The MDA activity of liver in different sized treatment groups fed for 3 months decreased. Neither significant difference between the results of different sized TiO₂ treatment groups, nor significant difference among different sized TiO₂ groups and the control groups were observed.

CONCLUSION

Longterm peroral TiO₂ nanoparticles and TiO₂ submicron particles are more likely to cause damage to the liver in the growing mice, and the damage may be either reductive or oxidative. In addition, small sized TiO₂ can increase the susceptibility of mice liver to LPS and the susceptibility will increase with the increase of exposure time.

[EB virus-positive T/NK lymphoproliferative diseases: an analysis of 156 patients]

Objective: To investigate the clinicopathological features of EBV-positive T/NK cell lymphoproliferative diseases (EBV(+) T/NK-LPD). Methods: The clinical characteristics of 156 cases of EBV(+) T/NK-LPD were collected from August 2002 to March 2015 at Beijing Friendship Hospital, Capital Medical University. Immunohistochemical staining, EBER in situ hybridization and clonal analysis of TCR gene were performed. All patients were followed up. Results: There were 106 male and 50 female patients; patients' age ranged from 1 to 75 years (median 20 years). The course of the diseases before diagnosis ranged from 2 to 540 months (median 20 months). Fever was noted in 122 patients (78.2%), 108 patients had lymphadenopathy (69.2%), and 75 patients had hepatosplenomegaly (48.1%). Thirty-three cases were grade 1, 68 cases were grade 2, and 55 cases were grade 3. TCR gene arrangement analysis was performed in 45 cases, and 33 cases (73.3%) showed clonal rearrangement. The follow-up period ranged from 1-134 months, and 44 patients (28.2%) died. There was a trend of increased death rate associated with increasing grade (P>0.05). Conclusions: There are many types of EBV(+) T/NK-LPD, and they can be classified as systemic, relatively localized and localized. The prognosis should be based on a comprehensive analysis of pathology and clinical data. There is no significant correlation between morphological grade and mortality. An important goal of therapy is to prevent serious complications.

[Clinicopathologic features and prognosis of mantle cell lymphoma: an analysis of 349 cases]

Objective: To investigate clinicopathologic features and prognostic factors of mantle cell lymphoma(MCL). Methods: The clinical data of 349 MCL patients diagnosed at Beijing Friendship Hospital from January 2004 to January 2016 were retrospectively collected. Corresponding histological sections were reviewed. Additional studies included immunohistochemical staining using the MaxVision two-step method, IgH/CCND1 fusion gene detection by fluorescent in situ hybridization (FISH), and correlative statistical analysis. Results: Of 349 patients with MCL, the median patient age was 61 years (range: 25-83 years, M∶F=2.7∶1.0) and the age of 243 patients ranged from 51 to 70 years (69.6%). Those with B symptoms accounted for 22.4% (70/313). Most of the patients presented with superficial lymphadenopathy and the clinical stage Ⅲ-Ⅳ accounted for 76.1% (235/309). Extranodal involvement was seen in 47.9% (148/309), among which the gastrointestinal tract accounted for 31.8% (47/148) and splenic involvement accounted for 15.4% (47/305). Three hundred and nine (88.5%) cases were of classical type and 40 (11.5%) cases were of aggressive variant type, and all were composed of proliferating lymphoid cells. All the tumors were positive for CD20 and cyclin D1, and 98.6% (344/349) tumors were weakly positive or positive for CD5. FISH test was positive in 12 cases that were CD5 negative and with cyclin D1 partial expression.Two hundred and forty-three (69.6%) patients had a median follow-up of 26 months (range: 3-108 months). The 3- and 5-year overall survival rates for patients were 63.0% and 34.8%, respectively. Single factor analysis showed that age of >60 years, splenic involvement, aggressive variant type, incompletely overlapping type [Based on the degree of overlap ≥90% and <90% between the follicular dendritic cell (FDC) meshwork and tumor cells, the tumors were divided into the completely overlapped type and incompletely overlapped type] and Ki-67 index >40% had poor prognosis (P<0.05). Multiple factor Cox proportional risk regression analysis after removing the aggressive variant type showed that age, splenic involvement, the degree of overlap between the FDC meshwork and tumor cells and Ki-67 index were independent prognostic factors for overall survival rate of MCL patients (P<0.05). Conclusions: MCL is more commonly found among middle-aged and elderly men. Patient age, splenic involvement, degree of overlap between FDC meshwork and tumor cells and Ki-67 index are the independent prognostic indicators for MCL.

[Knowledge, related behavior and on AIDS/HIV infection among rural adults with Derung minority, in Yunnan province, 2016]

Objective: To understand the related risk behaviors, knowledge and status of HIV/AIDS infection among rural adults of Derung minority, to provide relevant messages for the development of HIV/AIDS intervention strategy in this minority group. Methods: We used system sampling method to conduct a cross-sectional survey in 6 administration villages of Derung Township, Gongshan Derung and Nu Autonomous County in Nujiang Lisu Autonomous Prefecture of Yunnan Province, with a sample size estimated as 383. Adult residents with Derung minority in six villages of Gongshan County were involved, with relevant information collected through door-to-door visit. HIV antibody was tested and SPSS 17.0 was used for statistical analysis. Results: Information on 394 valid respondents was collected, with age as between 18 and 65 (34.39±9.74), 80.7% (318/394) as married, 54.0% (213/394) having had primary school education, 13.2% (52/394) as migrant workers. In this population, the overall HIV infection rate appeared as 0.5% (2/400), mainly through sexually transmission. The rate of awareness on HIV/AIDS was 69.8% (275/394), mainly through free publicized materials 50.0% (197/394). Rates on premarital sexual behavior on multiple sexual partners in the past year, on temporary sexual partners in the past year, having commercial sexual experiences in the past year and ever used condoms when engaging in casual sex, were 6.4% (60/366), 18.0%(66/366), 5.7%(21/366), 1.9%(7/366) and 8.0%(25/311), respectively. Conclusions: Few numbers of HIV infections were identified among the migrating workers with Derung minority, with sexual transmission as the major route, along with the increased number of rural migrant workers and the low rates both on AIDS knowledge and condom use, accompanied by the high risk sexual behavior appeared in this rural adult residents of Derung minority. Relative strategies on HIV/AIDS intervention and control should be developed.

High Time- and Size-Resolved Measurements of PM and Chemical Composition from Coal Combustion: Implications for the EC Formation Process

Inefficient coal combustion is a significant source of elemental carbon (EC) air pollution in China, but there is a limited understanding of EC's formation processes. In this study, high time-resolved particle number size distributions (PNSDs) and size-resolved chemical compositions were obtained from the combustion of four bituminous coals burned in a quartz tube furnace at 500 and 800 °C. Based on the distinct characteristics of PNSD, the flaming stage was divided into the first-flaming stage (with a PNSD peak at 0.3-0.4 μm) and the second-flaming stage (with a PNSD peak at 0.1-0.15 μm). For the size-segregated EC and OC measurements, more soot-EC was observed in particles larger than 0.3 μm, whereas the smaller ones possessed more char-EC. The results indicated that gas-phase and direct-conversion EC generation mechanisms dominate different burning stages. The analysis of 16 parent PAHs showed more high-molecular-weight PAHs in the second-flaming stage particles, which supports the idea of different formation processes for char-EC and soot-EC. For all four coals, the PNSD and chemical compositions shared a similar trend, confirming that the different formation processes of EC in different flaming stages were common. This study provides novel information concerning EC formation.

[Analysis of clinical data, esophageal motility and reflux characteristics in patients with non-erosive reflux disease(NERD) and reflux esophagitis(RE)]

Objective: To compare the clinical data, esophageal motility and reflux characteristic in patients with non-erosive reflux disease (NERD) and reflux esophagitis (RE). Methods: A total of 167 patients of NERD were enrolled in the study[60 males, 107 females, mean age(44.1±13.4) years old], and 151 patients of RE were enrolled [74 males, 77 females, mean age(46.5±9.9) years old]. All patients were surveyed by questionnaires to investigate the clinical data. All patients accepted the esophageal highresolution manometry and 24 hours pH+ impedance monitoring to investigate the esophageal motility and reflux characteristic. Results: The proportion of female patients in group NERD was significantly higher than that in group RE(60/107 vs 74/77, P=0.049). The reflux symptom scores and the proportion of reflux in group NERD were significantly lower than those in group RE[(4.5±2.4) vs (5.6±2.1), 44.91% vs 64.24%, P<0.05). The Demeester score of group NERD was significantly lower than that of group RE[12.54(1.60, 10.80) vs 17.31(3.40, 16.64), P=0.044]. The proportion of Demeester scores positive patients in group NERD was significantly lower than that in group RE(15.1% vs 23.8%, P=0.018). The number of acid reflux in group NERD was significantly lower than that in group RE[17.49(3.00, 22.22) vs 21.69(4.00, 30.00), P=0.042]. Conclusions: There are more female patients in group NERD. The reflux symptoms of the group NERD are less serious than those of group RE.RE patients have more acid reflux events. There is no significant difference in the esophageal motility between the two groups.

[Rare primary proximal epithelioid sarcoma in skull base: clinical analysis of four cases]

Objective: To report the clinical and pathological features of primary proximal epithelioid sarcoma (PES) in skull base. Methods: The clinical and pathological features of four cases of PES in skull base from Sanbo Brain Institute of Capital Medical University and Kunming Sanbo Brain Institute were analysed retrospectively. Results: Three cases was female, and one male, the age ranged from 46 to 52 years.All cases occurred in skull base, and sellar region was the main site of involvement.Under the microscope, the tumor cells characterized by epithelioid cell changes, with or without rhabdoid tumor cells.Mitotic figure was active.Immunohistochemical staining showed that AE1/AE3, EMA and CD34 were variously expression in tumor cells.INI-1 protein was lost in all cases.Three cases were detected by FISH, and INI1 (22q11.2) gene locus was absent in them.Three patients died less than 3 months after surgery, and case 4 was under treatment after five months of surgery. Conclusions: Primary PES in skull base mostly occurs in sellar region and its clinical prognosis is poor.It features with epithelioid/rhabdoid tumor cells with lack granuloma structure as distal ES.It has epithelial and mesenchymal differentiation characteristics.CD34 is always positive.INI1 gene deletion and protein loss expression are characteristic molecular alteration of PES.

[Clinicopathologic characteristics of Burkitt-like lymphoma with chromosome 11q aberration]

Objective: To analyze clinical, pathological, molecular and genetic characteristics of Burkitt-like lymphoma with chromosome 11q aberration. Methods: A case of Burkitt-like lymphoma with 11q aberration was presented at Beijing Friendship Hospital in November 2016 with detailed clinicopathological features, immunophenotypes, Epstein-Barr virus(EBV) status and molecular genetic characteristics. Results: The patient was a 38-year-old man presenting with the cervical lymphadenopathy. In morphology, the tumor had the similar characteristics of Burkitt lymphoma, including diffuse infiltration of medium to large lymphoid cells, and presence of"starry sky"phenomenon. Immunophenotypically, the tumor cells were positive for CD20, CD10, bcl-6, but negative for bcl-2. MUM-1 showed weak and patchy positivity. Ki-67 index was more than 95%. C-MYC expression was seen in about 50% of tumor cells. EBV in situ hybridization was negative. IgH and IgK genes were clonally rearranged.Fluorescence in situ hybrization detection using MYC break probe was negative but ATM gene amplification on chromosome 11q was detected. The patient did not receive any chemotherapy or radiotherapy and had not recurrence during the 10 months follow-up. Conclusion: Burkitt-like lymphoma with chromosome 11q aberration has similar clinical, morphological and immunological characteristics to classic Burkitt's lymphoma.

[The molecular-cytogenetic characterization and tyrosine kinase inhibitors efficacy in newly diagnosed chronic phase CML patients with variant Philadelphia chromosomes]

Objective: To investigate the molecular-cytogenetic characterization and impact on tyrosine kinase inhibitors (TKIs) therapy in chronic phase of chronic myeloid leukemia (CML-CP) patients with variant Ph chromosome (vPh). Methods: The clinical data of 32 patients with vPh chromosomes were collected and compared with 703 patients with typical Ph chromosome in newly diagnosed CML-CP who were on first-line imatinib (IM) and with BCR-ABL transcript of P210. Results: There was no significant difference in demographic and hematological characteristics between vPh and classic Ph patients. 3(9.4%) of the 32 vPh cases were simple variant translocations. Among the remaining 29 cases with complex variant translocations, 28 cases (87.5%) involved 3 chromosomes, and only 1 (3.1%) involved 4 chromosomes. Except for 8, 15, 18, X, and Y chromosomes, the other chromosomes were involved. The frequency of chromosome 12q(15.5%) and 1p (12.1%) were higher involved. The most common FISH signal pattern was 2G2R1Y (74.1%), followed by 1G1R2F (14.8%), 2G1R1Y (3.7%), 1G2R1Y (3.7%), 1G1R1Y (3.7%). The comparison of complete cytogenetic response (CCyR) (P=0.269), major molecular response (MMR) (P=0.391) were carried out between simple and complex mechanisms, without difference. Compared with the classic Ph, the patients with vPh had higher IM primary resistance rate (χ2=3.978, P=0.046), especially primary hematological resistance (χ2=7.870, P=0.005), but the difference of CCyR (χ2=0.192, P=0.661), MMR (χ2=0.822, P=0.365), EFS (χ2=0.509, P=0.476), OS (χ2=3.485, P=0.062) were not statistically significant, and multivariate analysis showed that the presence of vPh did not affect OS (RR=0.692, 95%CI 0.393-1.765, P=0.658)、EFS (RR=0.893, 95%CI 0.347-2.132, P=0.126) and PFS (RR=1.176, 95%CI 0.643-2.682, P=0.703). Conclusion: CML-CP patients with vPh and classic Ph had similar demographic and hematological characteristics. Except for 22q11, 9q34, the frequency of chromosome 12q and 1p were higher involved. The most common FISH signal pattern was 2G2R1Y, and different mechanisms had no impact on TKIs therapy. Compared with cases with classic Ph chromosomes, the patients with vPh chromosomes had higher risk of IM primary resistance, especially primary hematological resistance, which can obtain deeper molecular response quickly after changing to second-generation TKIs and didn't affect long-term outcomes and OS.

[Stratified sampling survey of major human parasitic diseases in Henan province]

Objective: To understand the prevalence of major human parasitic diseases and related factors in Henan province. Methods: This stratified sampling survey was carried out according to the requirement of national survey protocol of major human parasitic diseases, 2014-2015. The prevalence of soil-transmitted helminths infection, taeniasis and intestinal protozoiasis were surveyed in 104 sites selected from 35 counties (districts) and the prevalence of clonorchiasis was surveyed in 62 sites selected from 37 townships. In each survey spot, 250 persons were surveyed. A total of 26 866 persons and 15 893 persons were surveyed. Modified Kato-Katz thick smear was used to detect the eggs of intestinal helminthes. Tube fecal culture was used to identify the species of hookworm. The Enterobius eggs were detected in children aged 3 to 6 years by using adhesive tape. The cyst and trophozoite of intestinal protozoa were examined with physiological saline direct smear method and iodine stain method. Results: The overall infestation rate of intestinal parasites was2.02% in Henan, and the worm infection rate was higher than protozoa infection rate. Fourteen kinds of intestinal parasites were found, including nematode (5 species), trematode (2 species), and protozoan (7 species). The infection rate of Enterobius vermicularis was highest, and Qinba Mountain ecological area had the highest infestation rate of intestinal parasites in 4 ecological areas of Henan. There was no significant difference in intestinal parasite infection rate between males and females (χ(2)=3.630, P=0.057), and the differences in intestinal parasite infection rate among different age groups had significance (χ(2)=124.783, P=0.000 1). The infection rate reached the peak in age group ≤9 years and the major parasite was Enterobius vermicularis. Furthermore the overall human infection rate of parasite showed a downward trend with the increase of educational level of the people (χ(2)=70.969, P=0.000 1), the differences had significance (χ(2)=120.118, P=0.000 1). For different populations, the infection rate of intestinal parasites was highest among preschool children. The infection of intestinal helminth was mainly mild, only 2 severe cases were detected. The infection rate of Clonorchis sinensis in urban residents was only 0.006%. Logistic regression analysis showed that being preschool children (χ(2)=15.765, P=0.000 1) and drinking well water (χ(2)=45.589, P=0.000 1) were the risk factors for intestinal parasite infection, and annual income per capita of farmers was the protective factor against intestinal parasite infection. The infection rates of protozoa and intestinal parasites decreased sharply compared with the results of previous two surveys, and the rate of intestinal helminth infection also dropped sharply compared with the second survey. The numbers of protozoa, helminth and intestinal parasites detected in this survey were all less than the numbers found in the previous two surveys. Conclusions: Compared the results of three surveys in Henan, the infection rate of protozoa and intestinal parasites showed a downward trend. The prevention and treatment of Enterobius vermicularis infection in children should be the key point of parasitic disease control in the future.

[Clinicopathologic characteristics and prognositic indicators of tonsillar mantle cell lymphoma]

Objective: To investigate clinicopathological features and prognosis of tonsillar mantle cell lymphoma(TMCL). Methods: Clinical data of 25 patients with TMCL at Beijing Friendship Hospital, Capital Medical University from 2002 to 2016 were included. All the cases were reviewed microscopically. Various immunohistochemical stains were performed using the MaxVision two-step method. IgH/CCND1 gene fusion was detected by fluorescent in situ hybridization(FISH). Additionally, randomly selected 40 cases of non-tonsil MCL of the same period were compared. Results: Among all mantle cell lymphomas (MCL), TMCL accounted for 5.6%(25/449). The median age of the patients was 60 years(range: 44-82 years) with a M∶F ratio of 5.3 to 1.0. The main symptoms were sore throat and foreign body sensation and patients usually presented with enlargement or mass of tonsil. At the early stage of the disease, 18 cases(72.0%) were clinically misdiagnosed as tonsillitis. Lymph node involvement was present in 76.0%(19/25) of the patients. There were 4 cases(16.0%)with current splenic involvement, 11 cases(44.0%) with pharyngeal focal recidivism, and 3 cases(12.0%) with involvement of other non-lymphoid organs. Morphologically, tonsillar architectures were effaced at various degrees. Eighteen MCL cases showed classical type and 7 cases were blastoid variant. All tumors were positive for CD20 and cyclin D1. 92.0%(23/25) tumors showed weakly positive or positive expression for CD5. FISH test that IgH/CCND1 gene fusion was positive in two CD5 negative classical cases. 18 patients(72.0%) had a median follow-up time of 26 months(range: 6-81 months). The difference of survival rate between stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ patients was not statistically significant(P>0.05). Compared with NTMCL, TMCL was found to have higher proportion of stage Ⅰ-Ⅱ disease (χ(2)=12.789, P<0.01), lower the proportion of non-lymphatic organ involvement (χ(2)=8.125, P<0.01), and better prognosis (χ(2)=4.351, P=0.037). Conclusion: The incidence of TMCL is low and prone to be misdiagnosed as tonsillitis. Patients with TMCL are more likely at stage Ⅰ-Ⅱ at presentation and the prognosis is better than that of NTMCL.

Rapamycin inhibits ox-LDL-induced inflammation in human endothelial cells in vitro by inhibiting the mTORC2/PKC/c-Fos pathway

Rapamycin and its derivative possess anti-atherosclerosis activity, but its effects on adhesion molecule expression and macrophage adhesion to endothelial cells during atherosclerosis remain unclear. In this study we explored the effects of rapamycin on ox-LDL-induced adhesion molecule expression and macrophage adhesion to endothelial cells in vitro and the underlying mechanisms. Ox-LDL (6-48 μg/mL) dose-dependently increased the protein levels of two adhesion molecules, intercellular adhesion molecule-1 (ICAM-1) and E-selectin, in human umbilical vein endothelial cells (HUVECs), whereas pretreatment with rapamycin (1-10 μmol/L) dose-dependently inhibited ox-LDL-induced increase in the adhesion molecule expression and macrophage adhesion to endothelial cells. Knockdown of mTOR or rictor, rather than raptor, mimicked the effects of rapamycin. Ox-LDL (100 μg/mL) time-dependently increased PKC phosphorylation in HUVECs, which was abolished by rapamycin or rictor siRNA. Pretreatment with PKC inhibitor staurosporine significantly reduced ox-LDL-stimulated adhesion molecule expression and macrophage adhesion to endothelial cells, whereas pretreatment with PKC activator PMA/TPA attenuated the inhibitory effect of rapamycin on adhesion molecule expression. Ox-LDL (100 μg/mL) time-dependently increased c-Fos levels in HUVECs, and pretreatment with rapamycin or rictor siRNA significantly decreased expression of c-Fos. Knockdown of c-Fos antagonized ox-LDL-induced adhesion molecule expression and macrophage adhesion to endothelial cells. Our results demonstrate that rapamycin reduces ox-LDL-stimulated adhesion molecule expression and macrophage adhesion to endothelial cells by inhibiting mTORC2, but not mTORC1, and mTORC2 acts through the PKC/c-Fos signaling pathway.

[Clinical outcome of allogeneic hematopoietic stem cell transplantation in the treatment of 9 myeloid leukemia patients with granulocytic sarcoma]

To explore the efficacy and influencing factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myeloid leukemia and granulocytic sarcoma (GS). Clinical outcome including hematopoietic reconstitution, transplant-related complications, survival and relapse were collected and retrospectively analyzed in 9 patients with myeloid leukemia and GS after allo-HSCT. Hematopoiesis reconstitution was achieved in all the 9 recipients. Four cases developed acute graft-versus-host disease (GVHD), and 1 with chronic GVHD. The median follow-up time after transplantation was 10(4-81) months. Only 2 cases survived, the other 7 died of relapse. The median time of relapse after transplantation was 5(3-19) months. Allo-HSCT is relatively effective treatment for patients with myeloid leukemia and GS. Relapse after transplantation remains the major factor of mortality.

CD38 expression on paraffin sections distinguishes follicular lymphoma from reactive follicular hyperplasia

This study explored the utility of CD38 immunodetection in paraffin-embedded tissue sections for differentiating follicular lymphoma (FL) from reactive follicular hyperplasia (RFH) by examining RFH (n = 47) and FL (n = 178). In RFH specimens, uniform weak-to-moderate CD38 immunostaining was observed in centrocytes and centroblasts across germinal centers (GCs). Moreover, these specimens contained a subset of strongly CD38-positive cells predominantly located in the light zone, which may represent antigen-selected surviving centrocytes that are committed to differentiate into plasma cells, i.e., centrocytoid plasma cells (CPCs). In FL specimens, CD38 staining yielded two patterns. In pattern I (146 specimens), weak-to-moderate CD38 staining was observed in tumor cells within neoplastic follicles. Neoplastic follicles in 126 of the 146 specimens did not contain strongly CD38-positive CPCs. Furthermore, individual neoplastic follicles in the remaining 20 FL specimens contained very few strongly CD38-positive cells (which may represent normal residual CPCs). In pattern II (32 cases), neoplastic follicles exhibited loss of CD38 expression accompanied by disappearance of CPCs. In conclusion, compared with RFH, the decrease of strongly CD38-positive CPCs in neoplastic follicles was a striking alteration, reflecting blocks in the lymphoid differentiation pathway. Moreover, loss of CD38 expression in neoplastic GC B-cells in some FL specimens can serve as an immunophenotypic characteristic of FL.

Establishing Decision Trees for Predicting Successful Postpyloric Nasoenteric Tube Placement in Critically Ill Patients

BACKGROUND

Despite the use of prokinetic agents, the overall success rate for postpyloric placement via a self-propelled spiral nasoenteric tube is quite low.

METHODS

This retrospective study was conducted in the intensive care units of 11 university hospitals from 2006 to 2016 among adult patients who underwent self-propelled spiral nasoenteric tube insertion. Success was defined as postpyloric nasoenteric tube placement confirmed by abdominal x-ray scan 24 hours after tube insertion. Chi-square automatic interaction detection (CHAID), simple classification and regression trees (SimpleCart), and J48 methodologies were used to develop decision tree models, and multiple logistic regression (LR) methodology was used to develop an LR model for predicting successful postpyloric nasoenteric tube placement. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models.

RESULTS

Successful postpyloric nasoenteric tube placement was confirmed in 427 of 939 patients enrolled. For predicting successful postpyloric nasoenteric tube placement, the performance of the 3 decision trees was similar in terms of the AUCs: 0.715 for the CHAID model, 0.682 for the SimpleCart model, and 0.671 for the J48 model. The AUC of the LR model was 0.729, which outperformed the J48 model.

CONCLUSION

Both the CHAID and LR models achieved an acceptable discrimination for predicting successful postpyloric nasoenteric tube placement and were useful for intensivists in the setting of self-propelled spiral nasoenteric tube insertion.

Fast and Environmentally Friendly Microfluidic Technique for the Fabrication of Polymer Microspheres

This paper reports on a novel microfluidic technique for the fabrication of microspheres of synthetic polymers including poly(vinyl chloride) (PVC), poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP), poly(lactic acid) (PLA), and polystyrene (PS). The polymers are dissolved in tetrahydrofuran (THF) and the method is based on the diminished solubility of THF in a 20% (w/v) NaCl solution which allows the formation of droplets of the polymer solution. These polymer solution droplets are generated in a microfluidic system and their desolvation is accomplished within seconds by allowing the droplets to rise by buoyancy through a NaCl solution with a concentration lower than 15%. The size and morphology of the resultant polymer microspheres have been investigated by optical and scanning electron microscopy. Apart from the elimination of the use of highly toxic solvents as in conventional methods for manufacturing of polymer microspheres, the newly developed technique has the advantages of providing faster desolvation of the polymer solution droplets and a higher yield of microspheres compared to emulsification-based techniques.