Efficacy and safety of basiliximab in liver transplantation for patients with hepatitis B virus-related diseases: a single centre study

AIMS

We aim to evaluate the efficacy and safety of basiliximab in liver transplantation (LT) for patients with hepatitis B virus-related diseases.

METHODS

A total of 268 patients with hepatitis B virus-related diseases undergoing LT were enrolled and divided into two groups according to the usage of basiliximab. Total survival, the survival of high-risk patients defined by the posttransplant model for predicting mortality, acute rejection rate, biochemical parameters and other follow-up data were compared between the two groups.

RESULTS

Group Bas was composed of 131 patients who received basiliximab, and Group Triple enrolled the other 137 patients who did not. Between the two groups, there was no significant difference in the cumulative survival of patients without hepatocellular carcinoma (HCC) or in the cumulative survival of patients with HCC. For patients with benign end-stage liver diseases, Group Bas had more patients with a high risk of short- and medium-term mortality than Group Triple (22.81% vs. 8.85%, p = 0.017), but the survival curves of the two groups were not significantly different. The 1-year incidence of acute rejection was lower in Group Bas, although the difference was not significant (8.75% vs. 15.33%, p > 0.05). In both Group Bas and Group Triple, the level of serum creatinine (Scr) at 1 week posttransplantation was significantly lower than pretransplantation (61.00 vs. 88.50 μmol/l, p < 0.001; 61.50 vs. 74.00 μmol/l, p < 0.001; respectively). There was a significant difference in the pretransplantation Scr between the two groups (88.50 vs. 74.00 μmol/l, p = 0.005), but the values of Scr decreased to the same level 1 week (61.00 vs. 61.50 μmol/l, p > 0.05) and 4 weeks (61.00 vs. 59.00 μmol/l, p > 0.05) after transplantation. Significantly fewer recipients in Group Bas experienced hepatitis B relapse than in Group Triple (2/131 vs. 13/137, p = 0.006).

CONCLUSIONS

A basiliximab-induced immunosuppressive protocol is a safe regimen that achieves similar survival without increasing the acute rejection rate for LT recipients with hepatitis B virus-related diseases. For patients with benign end-stage liver diseases, this regimen reduces medium-term mortality in high-risk patients. This regimen remarkably improves renal function in the first month after LT and is correlated with a decreased hepatitis B recurrence rate in adult patients after LT.

Regional lymph node involvement in patients undergoing liver resection for colorectal cancer metastases

BACKGROUND

While the indications for surgery among patients with colorectal cancer liver metastases (CRCLM) are expanding, the role of surgery in patients with hepatic lymph node involvement remains controversial. We report management and outcomes in a population-based cohort of patients undergoing hepatectomy with concomitant hepatic lymphadenectomy for CRCLM.

METHODS

All cases of hepatectomy for CRCLM in the Canadian Province of Ontario from 2002 to 2009 were identified using the population-based Ontario Cancer Registry and linked electronic records of treatment. Pathology reports were used to identify concomitant lymphadenectomy with liver resection as well as extent of disease and surgical procedure.

RESULTS

Among 1310 patients who underwent resection for CRCLM, 103 (8%) underwent simultaneous regional lymphadenectomy. Seventy-one percent of cases with lymphadenectomy (70/103) had a major liver resection (≥3 segments). Of the 103 lymphadenectomy cases, 80 (78%) were hepatic pedicle, 16 (16%) were celiac and 7 (7%) were para-aortic. The mean number of nodes removed was 2.2 (range 1-15). Ninety-day mortality was 6%. Twenty-nine percent (30/103) of cases had positive nodes. Unadjusted overall survival at 5 years for positive vs negative nodes was 21% vs 42% (p = 0.003); cancer-specific survival was 10% vs 43% (p < 0.001). In adjusted analyses, hepatic node involvement was associated with inferior OS (HR 2.19, p = 0.010) and CSS (HR 3.07, p = 0.002).

CONCLUSIONS

Patients with resected CRC liver metastases with regional lymph node involvement have inferior survival compared to patients with negative nodes. Despite this poor prognostic factor, a small proportion of cases with involved nodes will achieve long-term survival.

[Clinical effect and airway changes of adjustable oral appliance in the treatment of adult obstructive sleep apnea hypopnea syndrome]

Objective:To investigate the effect of adjustable oral appliance on airway changes and clinical effect in obstructive sleepApnea hypopnea syndrome,and to observe the effect of jaw joints.Method:Forty adult cases diagnosed as OSAHS by polysomnography(PSG), were treated with adjustable oral appliance.After six months,the sleep apnea hypoventilation index(AHI)and the lowest oxygen saturation (LSaO₂) by PSG were evaluated. And three-dimensional cone beam computed tomography(CBCT) reconstruction was used to analyze the morphological changes of the upper airway,and the gap of jaw joint preliminarily.Result:After such treatment, LSaO₂ level of all cases increased, and AHI reduced(P< 0.01).The total volume and area of the upper airway increased significantly(P< 0.01), There was no obvious anomalies found in jaw joints.Conclusion:The adjustable oral appliance applied to in adult OSAHS can increase the shape and size of the airway,improve the airway ventilation effectively, and have no affection to the jaw joints in initial observation.

[Clinic characters analysis of 52 cases with sinus fungus ball disease]

Objective:To explore the clinic characters and the associated factors for the onset of the sinus fungus ball disease. Method:Analyze 52 cases who have received surgery with sinus fungus ball disease retrospectively. The effect factors of age, sex, occupation, the side of the lesion, involving sinus group number, accompany with merger polyps or not, presence of nasal septum deviation, vesicular middle turbinate, paradoxical middle turbinate, infraorbital cells，routine blood leukocyte classification, serum specific IgE, pathogenic fungi species have all been taken into consideration for statistical analysis. Result:In 52 cases of sinus fungus ball disease, 36 cases only suffered in maxillary sinus, 1 case only suffered in ethmoid sinus, 4 cases only suffered in sphenoid sinus, 7 cases suffered from two sinus lesions with the combination of maxillary sinus and ethmoid sinus in all, 4 cases fuffered from three sinus lesions with the combination of maxillary sinus, ethmoid sinus and sphenoid sinus in 2 cases, maxillary sinus, ethmoid sinus and frontal sinus in 2 cases. 26 cases have the lesion on left side,17 cases on the right side, 8 cases on both sides. Aspergillus is the main pathogenic fungus for sinus fungus ball. Maxillary sinus is the most susceptible single sinus for sinus fungus ball. Nasal polyps is commonly seen in multiple sinuses fungus ball(P<0.01). Single sphenoid sinus fungus ball is more commonly seen in the patients with diabetes mellitus(P<0.01). Lesion side of sinus fungus ball has nothing to do with the nasal anatomy abnormalities of nasal septum deviation, vesicular middle turbinate, paradoxical middle turbinate, infraorbital cells. Conclusion:The present study indicates that maxillary sinus fungus ball is the most common type for sinus fungus ball. Aspergillus is the main pathogenic fungus for sinus fungus ball. Nasal polyps is more involved in multiple sinuses fungus ball,Single sphenoid sinus fungus ball is more commonly seen in the patients with diabetes mellitus. Lesion side of sinus fungus ball has none relationship with common nasal anatomy abnormalities.

Chemotherapy delivery for resected colorectal cancer liver metastases: Management and outcomes in routine clinical practice

BACKGROUND

International guidelines recommend peri-operative chemotherapy for patients with resectable colorectal cancer liver metastases (CRCLM). Chemotherapy delivery in routine practice is not well described.

METHODS

All cases of CRC who underwent resection of LM in 2002-2009 were identified using the population-based Ontario Cancer Registry. Electronic treatment records identified chemotherapy delivered within 16 weeks before or after hepatectomy. All pathology reports were reviewed to describe extent of LM. Modified Poisson regression was used to evaluate factors associated with chemotherapy delivery. Cox proportional hazards model and propensity score analysis were used to explore the association between post-operative chemotherapy and cancer-specific (CSS) and overall (OS) survival.

RESULTS

We identified 1310 patients. Sixty-two percent of cases (815/1310) received peri-operative chemotherapy; 25% (200/815) pre-operative, 45% (366/815) post-operative, and 31% (249/815) pre- and post-operative. Utilization of chemotherapy increased over time from 51% in 2002 (57/112) to 73% in 2009 (157/216, p < 0.001). Fifty-four percent of patients received FOLFOX, 41% FOLFIRI, and 10% 5-FU monotherapy. Factors that were independently associated with greater utilization of post-operative chemotherapy included younger age (p < 0.001), female sex (p = 0.050), shorter disease-free interval (p = 0.006), and no prior adjuvant chemotherapy (p < 0.001). Utilization of chemotherapy varied substantially across geographic regions (from 24% to 71%, p = 0.001). Post-operative chemotherapy was associated with improved CSS (HR 0.58, 95%CI 0.44-0.76) and OS (HR 0.49, 95%CI 0.38-0.61); results were consistent in propensity score analysis.

CONCLUSION

Utilization of chemotherapy for resected CRCLM in routine practice has evolved with emerging evidence. Post-operative chemotherapy is associated with improved survival in the general population.

Roles of ERα and ERβ in estrogen-induced DDP chemoresistance in non-small cell lung cancer

The role of estrogen in inducing chemoresistance is not yet fully understood. The objective of this study was to observe the relationship between estrogen levels and cellular response to chemotherapeutic drugs in non-small cell lung cancer (NSCLC) and to reveal the potential mechanisms involved. Cell viability was analyzed after pre-treating NSCLC cells with different levels of estrogen (E2), followed by treatment with an anti-tumor drug for 48 h. The roles of various estrogen receptors (ERs) were examined in vitro by blocking the activity of each ER individually. The ER pathway was further confirmed in NSCLC tissues. It was found that 10-1000 nM E2 resulted in a decreased cellular response to DDP in H1650 cells compared to the use of cisplatin alone (P < 0.05). However, this result was not demonstrated in H1299 cells, which lack p53. Both ERa and ERb were associated with E2-induced cisplatin chemoresistance, though they had opposite functions. p53 expression did not correlate with the expression of ERa or ERb individually. However, a statistically significant correlation between p53 expression and ERa to ERb mRNA ratio was observed (P < 0.001, R = -0.676). These findings suggest that E2-induced DDP chemoresistance depends on the balance between ERa and ERb expression and the p53 pathway.

Association of C1q Binding Status With De Novo HLA Antibody Clinical Features and Allograft Function in Kidney Transplantation Patients During Eight Years of Dynamic Follow-up

BACKGROUND

C1q-binding donor-specific antibody (DSA) is detrimental to transplanted kidney function. However, the factors that affect C1q binding status are unclear.

METHODS

A total of 519 samples from 129 consecutive kidney transplantation patients during 8 years of dynamic follow-up were collected for HLA antibody (Ab) screening and C1q detection.

RESULTS

Among the detected HLA Abs, the majority were class II, and the DQ subtypes composed the highest proportion. The C1q-binding Abs were all HLA-II, and the DQ subtypes had the highest rate of C1q positivity. With a cutoff mean fluorescence intensity (MFI) value of 7349, the sensitivity and specificity of detecting C1q-binding Abs from all HLA-II Abs were 84.48% and 83.56%, respectively. Additionally, C1q is more likely to be bound by DSA than non-donor-specific antibody (NDSA). Compared with free DSA/NDSA, the MFI values of C1q-binding DSA/NDSA are more closely correlated with serum creatinine levels and reflect the effect of anti-antibody-mediated rejection treatment more sensitively.

CONCLUSIONS

HLA-II Abs (particularly DQ subtypes), high titers of Abs, and DSA are important relevant factors of C1q positivity. The MFI value of C1q-binding DSA may be a useful clinical indicator of HLA antibody-mediated graft injury before the appearance of histologically typical humoral rejection.

The developmental transcriptome landscape of bovine skeletal muscle defined by Ribo-Zero ribonucleic acid sequencing

Ribonucleic acid sequencing (RNA-Seq) libraries are normally prepared with oligo(dT) selection of poly(A)+ mRNA, but it depends on intact total RNA samples. Recent studies have described Ribo-Zero technology, a novel method that can capture both poly(A)+ and poly(A)- transcripts from intact or fragmented RNA samples. We report here the first application of Ribo-Zero RNA-Seq for the analysis of the bovine embryonic, neonatal, and adult skeletal muscle whole transcriptome at an unprecedented depth. Overall, 19,893 genes were found to be expressed, with a high correlation of expression levels between the calf and the adult. Hundreds of genes were found to be highly expressed in the embryo and decreased at least 10-fold after birth, indicating their potential roles in embryonic muscle development. In addition, we present for the first time the analysis of global transcript isoform discovery in bovine skeletal muscle and identified 36,694 transcript isoforms. Transcriptomic data were also analyzed to unravel sequence variations; 185,036 putative SNP and 12,428 putative short insertions-deletions (InDel) were detected. Specifically, many stop-gain, stop-loss, and frameshift mutations were identified that probably change the relative protein production and sequentially affect the gene function. Notably, the numbers of stage-specific transcripts, alternative splicing events, SNP, and InDel were greater in the embryo than in the calf and the adult, suggesting that gene expression is most active in the embryo. The resulting view of the transcriptome at a single-base resolution greatly enhances the comprehensive transcript catalog and uncovers the global trends in gene expression during bovine skeletal muscle development.

Inhibitory effect of microRNA-27b on interleukin 17 (IL-17)-induced monocyte chemoattractant protein-1 (MCP1) expression

We investigated the effect of microRNA-27b (miR-27b), a gene expression regulatory factor, on the expression of monocyte chemoattractant protein-1 (MCP1) stimulated by interleukin 17 (IL-17). After IL-17 had been added to H9C2 cardiomyocytes, an miR-27b mimic was transfected into the H9C2 cells. The mRNA expression levels of miR-27b and MCP1 in the H9C2 cells were detected by SYBR green I fluorescence quantitative reverse transcription polymerase chain reaction. Enzyme-linked immunosorbent assay was used to measure the expression levels of MCP1 protein in the H9C2 cells. The expression of MCP1 mRNA in the H9C2 cells began to increase 2 h after IL-17 stimulation, reached a peak at 4 h, and then decreased. The MCP1 protein level increased gradually in the 24 h following IL-17 stimulation. After transfection with the miR-27b mimic, the expression of miR-27b in the H9C2 cells significantly increased than that in the miRNA negative control group (P < 0.01). The MCP1 mRNA and protein levels in the miR-27b mimic + IL-17 group were significantly reduced than that in the miRNA negative control + IL-17 group (P < 0.01). miR-27b inhibited IL-17-induced MCP1 expression in the H9C2 cells, which demonstrates that treatment with microRNA could alleviate myocardial injury in viral myocarditis.

[Expression of cadherin17 in metanephric adenoma and its value in differential diagnosis]

OBJECTIVE

To study the expression of cadherin17(CDH17) in metanephric adenoma (MA), and to explore the value of CDH17 in the diagnosis of metanephric adenoma.

METHODS

Immunohistochemical EnVision method was used to detect the expression of CDH17, WT1, CD57, P504S and EMA in 21 cases of MAs, 16 epithelial-predominant Wilms tumors (e-WT), and 20 solid variant of papillary renal cell carcinomas (s-PRCC). The expression of CDH17 was also examined in other common renal epithelial tumors, including 10 cases of clear cell renal cell carcinomas (CCRCC), 10 chromophobe renal cell carcinomas (CHRCC), and 10 oncocytomas.

RESULTS

Twenty (95.2%) of 21 cases of MAs demonstrated membranous CDH17 immunoreactivity in all components (acinar, tubular, and papillary), whereas only 1 (1/16) e-WT was positive for CDH17 and all s-PRCCs were negative (P<0.05). WT1 was negative in s-PRCC and was positive in all cases of e-WT (16/16) and MA (100%, 21/21). All MAs (100%) were strongly positive for CD57; however, this marker was also positive in 13 (13/16) e-WTs and 9 (45.0%, 9/20) s-PRCCs. P504S was strongly positive in all s-PRCCs (100%), but reactivity was seen in 3 (14.3%, 3/21) MAs and all e-WTs were negative. The positive rates of EMA in MAs, e-WTs and s-PRCCs were 19.0%(4/21), 14/16 and 17/20, respectively. The sensitivity and specificity of CDH17 in the diagnosis of MA were 95% and 97%. CDH17 was negative in all cases of CCRCC, CHRCC and oncocytoma.

CONCLUSIONS

CDH17 is a highly sensitive and specific marker for MA and should be considered in the immunohistochemistry panel for distinguishing MA from its mimics and other common renal epithelial tumors.