Chinese herbal compounds against SARS-CoV-2: Puerarin and quercetin impair the binding of viral S-protein to ACE2 receptor

The outbreak of COVID-19 raises an urgent need for the therapeutics to contain the emerging pandemic. However, no effective treatment has been found for SARS-CoV-2 infection to date. Here, we identified puerarin (PubChem CID: 5281807), quercetin (PubChem CID: 5280343) and kaempferol (PubChem CID: 5280863) as potential compounds with binding activity to ACE2 by using Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP). Molecular docking analysis showed that puerarin and quercetin exhibit good binding affinity to ACE2, which was validated by surface plasmon resonance (SPR) assay. Furthermore, SPR-based competition assay revealed that puerarin and quercetin could significantly affect the binding of viral S-protein to ACE2 receptor. Notably, quercetin could also bind to the RBD domain of S-protein, suggesting not only a receptor blocking, but also a virus neutralizing effect of quercetin on SARS-CoV-2. The results from network pharmacology and bioinformatics analysis support a view that quercetin is involved in host immunomodulation, which further renders it a promising candidate against COVID-19. Moreover, given that puerarin is already an existing drug, results from this study not only provide insight into its action mechanism, but also propose a prompt application of it on COVID-19 patients for assessing its clinical feasibility.

VENTHEART is required for cardiomyocyte specification and function

Background

Long noncoding RNAs (lncRNAs) control early stages of cardiac differentiation, however their role in later specification and maturation is still not well explored.

Methods and results

We performed single cell RNA-seq for 2, 6 and 12 week-old hESC-CM. Weighted correlation network analysis (WGCNA) identified core genes significantly upregulated, along with a subset of lncRNAs. Importantly, these lncRNAs are highly abundant and unique to human heart. Through independent integrative analysis of genome-wide association studies (GWAS) and expression quantitative trait locus (eQTL) data using human hearts, we also identified a long intergenic noncoding RNA (we call VENTHEART, VHRT) as co-regulated with core cardiac contractile genes, and strongly associated with heart failure. VHRT was highly expressed in MYL2+ hESC-CMs in our single cell dataset, and its locus is antisense and downstream of MYL2. VHRT knockdown (KD) in 6-weeks old hESC-CMs downregulated MYL2 and other key cardiac genes. Patch clamp recordings with VHRT KD cells showed a loss of the ventricular-like action potential. Concordantly, CRISPR-mediated excision of the VHRT locus led to impaired CM sarcomere formation, and loss of CM specification gene programs. VHRT transcript replacement in VHRT-KO cells was however insufficient to rescue the phenotype. Instead, we established by 3C assay, that the VHRT locus loops and interacts with the MYL2 promoter, bearing histone marks characteristic of a super-enhancer.

Conclusion

Thus, we conclude that both the VHRT lncRNA transcript and its genomic locus are required for proper CM specification and function, and may play a role in heart failure progression.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): EMBO, Singapore National Research Council

Unraveling the action mechanism of polygonum cuspidatum by a network pharmacology approach

As a popular Chinese herbal medicine (CHM), polygonum cuspidatum is widely used to treat various diseases in China. However, its biological function and action mechanism have yet to be systematically explored. In the present study, we first identified 14 potential active ingredients of polygonum cuspidatum using the TCMSP server and then conducted an in silico target prediction for these ingredients using PharmMapper. The subsequent KEGG pathway enrichment analysis of the 57 identified potential targets revealed that they were closely associated with cancer and gynecological disorders. Furthermore, a protein-protein interaction network of these targets was constructed using STRING and Cytoscape, through which 11 core targets were excavated according to degree, a key topological parameter. Meanwhile, we developed a novel formula, in which the "R value" is determined by average shortest path length and closeness centrality, two other key topological parameters, to evaluate the reliability of these predicted core targets. Intriguingly, among the top 10 core targets excavated using this new formula, 7 overlapped with the former 11 core targets, showing a good consistency in these core targets between the different prediction algorithms. Next, 7 ingredients were identified/validated from the crude extract of polygonum cuspidatum using UPLC-MS/MS. Noteworthy, 6 potential targets predicted for these 7 ingredients overlapped with the 7 core targets excavated from the previous in silico analyses. Further molecular docking and druggability analyses suggested that polydatin may play a pivotal role in manifesting the therapeutic effects of polygonum cuspidatum. Finally, we carried out a series of cell functional assays, which validated the anti-proliferative effects of polygonum cuspidatum on gynecological cancer cells, thus demonstrating our network pharmacology approach is reliable and powerful enough to guide the CHM mechanism study.

Integrated bioinformatics analysis revealing independent prognostic long non-coding RNAs DNAH17-AS1 and RP11-400N13.2 and their potential oncogenic roles in colorectal cancer

The aberrant expression of long non-coding RNAs (lncRNAs) has been associated with a variety of malignancies, including colorectal cancer (CRC); however, the key lncRNAs associated with patient prognosis and their biological roles in CRC are yet to be determined. The aim of the present study was to determine the key lncRNAs associated with patient prognosis as well as their biological roles in CRC. Therefore, a dataset from The Cancer Genome Atlas containing the lncRNA expression data of 521 CRC and normal colorectal mucosal tissues, as well as the corresponding clinical data, were screened. A total of 1,180 significantly differentially expressed lncRNAs were associated with CRC as determined by t-tests in edgeR. Kaplan-Meier analysis revealed that 56 of the 1,180 lncRNAs were associated with overall survival (OS); 7 of the 56 lncRNAs were identified as key lncRNAs associated with the Tumor-Node-Metastasis stage of CRC by Kruskal-Wallis test. Subsequent univariate and multivariate Cox regression analyses of the 7 lncRNAs revealed 2 lncRNAs, DNAH17-AS1 and RP11-400N13.2, as potential independent prognostic factors for the OS of patients with CRC. Furthermore, the expression levelsof these 2 lncRNAs were significantly upregulated in CRC compared with those in normal tissues, which suggested that they may serve an oncogenic role in CRC. In addition, networks comprising the 2 lncRNAs and their respective co-expressed protein-coding genes (PCGs) were constructed using cor.test in R. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses of these PCGs were conducted; DNAH17-AS1- and RP11-400N13.2-associated PCGs were reported to be involved in G-protein coupling-related functions. Thus, these independent prognostic lncRNAs and their associated functions identified in the present study may provide novel insight into potential prognostic biomarkers and therapeutic targets for the treatment of CRC.

UBE2C overexpression in melanoma and its essential role in G2/M transition

Ubiquitin‑conjugating enzyme E2C (UBE2C) is a key regulator of cell cycle progression, and its aberrant expression has been implicated in various malignancies. However, its clinical and biological roles in malignant melanoma is still unclear. In this study, we found a significant high expression level of UBE2C in melanoma by an in silico analysis of The Cancer Genome Atlas (TCGA) database, which was further validated using fresh melanoma samples. The KM plotter showed that UBE2C level was statistically related to the overall survival (OS) of melanoma patients (p<0.01). RNA interference of UBE2C inhibited the growth of melanoma cells via deactivating ERK/Akt signaling pathways, and blocked the G2/M transition through downregulation of both the level and the activity of mitosis promoting factor (MPF), triggering the apoptosis of melanoma cells. Further, silencing of UBE2C significantly inhibited the xenografted tumor growth on nude mice, indicating an important role of UBE2C in melanoma growth in vivo. Together, our results show that UBE2C may serve as a novel prognostic biomarker as well as a potential therapeutic target for melanoma.

Elevated aspartate aminotransferase and monocyte counts predict unfavorable prognosis in patients with malignant pleural mesothelioma

Limited biomarkers predicting prognosis of malignant pleural mesothelioma (MPM) have been identified. The present study aims to assess potential laboratory prognostic factors of MPM. We retrospectively reviewed the clinical data of 105 patients with MPM. The overall survival and prognostic factors were assessed by Kaplan-Meier curves and Cox regression analysis. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values. The mean age of the 105 patients (62 men, 43 women) was 56.0 years. The major clinical presentations were dyspnea, cough and chest pain. The most common laboratory abnormalities were thrombocytosis and elevated monocyte count. Significant prognostic factors on univariate analysis were performance status (PS), serum albumin, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), monocyte, platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and treatment strategy. Multivariate analysis showed PS, AST, monocyte, and treatment strategy were statistically significant (p<0.05). Higher AST level and monocyte count were both related to the presence of anemia (p=0.001 and 0.010, respectively) and higher ALP level (p=0.049 and 0.001, respectively). A higher AST level was also associated with higher alanine aminotransferase (ALT) and LDH level (p<0.05). A higher monocyte count was also correlated with male patients, higher white blood cell (WBC), platelet, neutrophil counts, lower red blood cell (RBC) and LMR counts (p<0.05). In conclusion, our data show that PS<2, normal AST level, lower monocyte count, and multimodality treatment are independent positive prognostic factors of MPM. The elevated AST and monocyte levels represent unfavorable prognostic biomarkers of MPM.

Abstract P1-03-05: Long term survival and tumor biology of screen-detected small non-palpable breast cancer in Chinese women: The smaller, the better?

Background: Tumor biology would reflect the prognosis and potentially the lead time and over-diagnosis rate of screen-detected small breast cancer [PMID: 28591529, 21452022 and 24888816]. Chinese women had earlier peak age of breast cancer incidence and used ultrasound as the primary screening imaging test on a hospital-basis [2016 SABCS P5-02-05, PMID: 27689334]. In our previous work, we showed that US detected non-palpable breast cancer (NPBC) had higher percentage of invasive and lymph node positive cancer, yet still could be regarded as low-risk cancer [PMID:27689334, 28412736]. This study was performed to investigate the prognostic impact of immunohistochemical subtypes and tumor size: the smaller the NPBC, the better the tumor biology and prognosis?

Methods: From January 2001 to December 2017, 6,423 consecutive asymptomatic women underwent mammography (MG) or ultrasound (US) guided biopsy in Peking Union Medical College Hospital. Among them, 159 T1a, 239 T1b, 377 T1c and 72 T2 NPBC were diagnosed and treated. The clinicopathological features, treatment choice, 10-year disease-free survival (DFS) and overall survival (OS) of the small NPBC (defined as≤1.0cm, T1a+b) were reviewed and compared with T1c and T2 NPBC. Prognostic factors of these subgroups of invasive NPBC were identified.

Results: Compared to big NPBC, the T1a+b small NPBC showed more lymph node negative (p&lt;0.001) and low Ki67 (&lt;14%, p&lt;0.001) cancers with earlier TNM stage (p&lt;0.001), more luminal A subtype (p=0.003) and significantly improved 10-year DFS and OS (p=0.004). T1c+T2 NPBC had more triple-negative subtype and received more chemotherapy (p&lt;0.001) and targeted therapy (p=0.008). Breast conserving rate and the use of radiation and endocrine therapy showed no significant difference.

Table 1.Comparison of clinicopathological factors and long term survival of small vs big screen-detected NPBCScreen-detected NPBC(2001-2017    Clinical&prognostic factors T1a+T1b(n=398)T1c+T2(n=449)P valueScreening methodUS-NPBC(n,%)336(84.4)406(90.4)0.008 MG-NPBC(n,%)62(15.6)43(9.6) Lymph node statusNegative(n,%)343(86.2)315(70.2)&lt;0.001 Positive(n,%)55(13.8)134(29.8) TNM stageI(n,%)344(86.4)277(61.7)&lt;0.001 II(n,%)37(9.3)134(29.8)  III(n,%)17(4.3)38(8.5) Ki67&lt;14%(n,%)208(52.2)168(37.4)&lt;0.001 ≥14%(n,%)183(46.0)274(61.0) SubtypeLuminal A(n,%)164(41.3)135(30.1)0.003 Luminal B(n,%)155(38.9)218(48.6)  Her2(n,%)28(7.0)27(6.0)  TNBC(n,%)31(7.8)52(11.6)  Unknown(n,%)20(5.0)17(3.7) 10-year survivalDFS(%)94.688.80.004 OS(%)100.096.4 

Conclusion: Small asymptomatic NPBCs were detected when small because they were good in terms of low Ki67 index, favorable subtype, tumor biology and long term prognosis. On the contrary, T1c and T2 NPBCs were screened when already big or even with positive nodes without clinical symptoms indicating that they might have larger chance of becoming interval cancers.

Citation Format: Xu Y, Pan B, Yao R, Zhou Y-D, Mao F, Zhu Q-L, Wu H-W, Lin Y, Shen S-j, Sun Q. Long term survival and tumor biology of screen-detected small non-palpable breast cancer in Chinese women: The smaller, the better? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-05.

Abstract P2-14-30: Survival outcomes of breast conserving surgery versus mastectomy for ultrasound detected non-palpable breast cancer in hospital-based screening among Chinese women

Background: Some population-base studies have reported similar or improved survival for breast-conserving surgery (BCS) plus radiotherapy compared with mastectomy (Mx) in early breast cancer [PMID: 22373563, 27344114]. Among the screening detected early breast cancer, ultrasound (US) could detect more invasive non-palpable breast cancer (NPBC) with positive lymph nodes in hospital-based asymptomatic Chinese women, who could achieve comparable 10-year DFS and OS as mammography (MG)-detected NPBC [2016 SABCS P5-02-05, PMID: 27689334]. However, there is little data about the surgical outcomes of BCS verse Mx in the low-risk screening detected NPBC with US as the initial imaging test.

Methods: From 2001 to 2017, 6,423 consecutive asymptomatic women underwent mammography or ultrasound guided biopsy in Peking Union Medical College Hospital. Among them, 1130 NPBC including 914 US-detected and 216 MG-detected NPBC were diagnosed and treated. There were 349 (30.9%) patients underwent BCS including 286 (25.3%) patients received radiation therapy and 63 (5.6%) elderly patients (&gt;70 years) who did not. The clinicopathological features, treatment choice, 10-year disease-free survival (DFS) and overall survival (OS) were compared between breast conservingsurgery (BCS) versus mastectomy(Mx) in all NPBC and between the US-detected and MG-detected NPBC.

Result: Compared to those who received BCS, the 781 (69.1%) patients who underwent Mx had more cancers with relatively higher histologic grade (p=0.003), positive lymph node (18.8% vs 12.0%, p=0.005), ER-negative (22.5% vs 11.5%, p&lt;0.001), PR-negative (29.6% vs 16.3, p&lt;0.001), Her2-positive (16.3% vs 8.9%, p=0.001), and received chemotherapy (37.6% vs 28.7%, p=0.003). The breast conserving rates of US-NPBCwere higher than that of MG-NPBC (32.6% vs 23.6%, p=0.010), but the breast conserving rates were similar between ductal carcinoma in situ (DCIS) and invasive cancers. The 10-year DFS and OS were similar among BCS with radiation therapy, BCS without radiation therapy and Mx as well as among US-NPBC with BCS, US-NPBC with Mx, MG-NPBC with BCS and MG-NPBC with Mx. However, MG-NPBC with Mx had favorable 10-year DFS than that of MG-NPBC with BCS (p=0.041).

Table 1.Kaplan-Meier estimated 10-year DFS and OS of all NPBC§Patients (No.)NPBC GroupNumber (%)10-year DFS (%)P value10-year OSP valueAll NPBC (1130)BCS without Radiotherapy63 (5.6)85.00.10592.30.722 BCS with Radiotherapy286 (25.3)92.7 99.5  Mastectomy781 (69.1)93.2 98.7        All NPBC (1130)US+BCS298 (26.4)90.40.24896.30.542 US+Mx616 (64.5)92.4 98.4  MG+BCS51 (4.5)90.3 100.0  MG+Mx165 (14.6)96.1 100.0 § Kaplan-Meier survival curves would be displayed in the poster.

Conclusion: The 10-year DFS and OS of breast conserving surgery versus mastectomy were similar among all NPBC patients. As the current initial imaging test, US-detected NPBC patients would receive significantly more BCS compared to MG. There was no significant difference in surgical outcomes among BCS and Mx in US-detected NPBC. However, among MG-detected NPBC, patients with Mx reached a better DFS but a similar OS than those with BCS. The radiation therapy could be safely omitted in the elderly patients (&gt;70 years) with NPBC.

Citation Format: Yao R, Pan B, Xu Y, Zhou Y, Zhu Q, Zhang J, Wu H, Mao F, Lin Y, Shen S, Sun Q. Survival outcomes of breast conserving surgery versus mastectomy for ultrasound detected non-palpable breast cancer in hospital-based screening among Chinese women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-30.

Abstract P1-03-06: Risk stratification by ultrasound for screen-detected non-palpable breast cancer in Chinese women: Regular low risk versus ultra-low risk?

Background: Mammography (MG) screen-detected breast cancer has been established as low-risk in the western world. However, ultrasound (US) is currently the 'real-world' initial imaging test for breast cancer in China. In our previous work, we firstly showed with a multi-center randomized controlled trial that US could detect breast cancer with improved sensitivity and accuracy in high risk Chinese women [PMID: 25668012]. Then we demonstrated on a hospital-screening basis that US and MG detected non-palpable breast cancer (NPBC) had similar survival [2016 SABCS P5-02-05, PMID: 27689334]. This study was performed to test the hypothesis [Hypothesis would be published in the journal of Medical Hypothesis, 118 (2018):9-12] whether MG+/US- NPBC could be taken as ultra-low risk cancer which had more favorable clinical characteristics and survival than the regular low-risk NPBC.

Methods: From 2015-2017, 1,478 consecutive patients received biopsy with initial positive screening US (BI-RADS 4 and 5) at Peking Union Medical College Hospital. Among them, 206 US+/MG- and 135 US+/MG+ NPBC were diagnosed. Meanwhile, 371 patients who had negative initial screening US (BI-RADS 1, 2 and 3) and positive additional MG (BI-RADS 4 and 5) underwent MG-guided biopsies, and 88 MG+/US- NPBC were diagnosed. Clinical characteristics, treatment and 3-year disease free survival (DFS) and overall survival (OS) were analyzed and compared. Prognostic factors were identified.

Results: There was no significant difference in age, lymph node status, hormone receptor status, endocrine therapy, chemotherapy, targeted-therapy among the three subgroups of NPBC. MG detected significantly more ductal carcinoma in situ (DCIS, 59.1% vs 22.8% and 28.1%, p&lt;0.001) whereas ultrasound diagnosed more invasive cancers (77.2% and 71.9% vs 40.9%, p&lt;0.001), multifocal cancer (p=0.020) and patients who received breast-conserving surgery (p&lt;0.001) and needed radiotherapy (P=0.001). No significant difference was found for 3-year DFS and 3-year OS were all 100%, although MG+/US- NPBC showed a trend of better DFS.

Table 1.Comparison of positive predictive value (PPV), pathology and prognosis of US+/MG-, US+/MG+ and MG+/US- NPBCPathologyRadiology (2015-2017)US-detected NPBL (N=1,478)US-detected NPBL(N=1,478)MG-detected NPBL (N=371)MG & US positivityUS+/MG- (N=1,108)US+/MG+ (N=370)MG+/US- (N=371)Imaging presentationNoduleNodule + micro-calcificationsMicro-calcificationsBreast cancer (PPV %)206 (18.6%)135 (36.5%)88 (23.7%)Pathology (p&lt;0.001)   DCIS (%)47 (22.8)38 (28.1)52 (59.1)Invasive (%)159 (77.2)97 (71.9)36 (40.9)3-Year survival   DFS (%)92.391.196.5OS (%)100.0100.0100.0

Conclusion: MG+/US- NPBC had satisfactory prognosis, higher percentage of DCIS and might be taken as 'ultra-low risk' cancer. Hence US had the potential of stratifying the screen-detected NPBC into regular low risk (US+/MG+ and US+/MG-) and ultra-low risk (MG+/US-).

Citation Format: Xu Y, Pan B, Yao R, Zhou Y-d, Mao F, Zhu Q-L, Zhang J, Lin Y, Shen S-j, Sun Q. Risk stratification by ultrasound for screen-detected non-palpable breast cancer in Chinese women: Regular low risk versus ultra-low risk? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-06.

Abstract P1-02-02: Is ultrasound screening justified for non-palpable breast cancer in asymptomatic Chinese women: A real-world study based on long-term survival of consecutive cohort (2001-2017)

Background: Ultrasound (US) is an effective initial screening test for breast cancer both in Caucasian and Chinese women [PMID: 26712110, 26715161, and 25668012]. The real-world modality of breast cancer screening in the China is hospital-based screening among asymptomatic self-referred women. In our previous study, we showed that US and mammography (MG) detected non-palpable breast cancer (NPBC) had similar long-term survival and that US detected more invasive NPBC with positive lymph node [2016 SABCS P5-02-05, PMID: 27689334]. This study was to investigate whether these findings would be still true with more NPBC cases included and longer follow-up in the consecutive hospital cohort.

Methods: From 2001 to 2017, 5,264 asymptomatic women with positive (BI-RADS 4 and 5) initial screening US underwent biopsies in PUMC Hospital, and 914 US-NPBC in 883 women were diagnosed. Meanwhile, women without dense breasts (defined as BI-RADS category C and D) also received screening MG after physical examination and US. There were 1,159 patients with positive (BI-RADS 4 and 5) MG and normal US (BI-RADS 1, 2 and 3) underwent MG-guided biopsies and 216 MG-NPBC were diagnosed in 214 women. The clinicopathological characteristics and 10-year disease-free survival (DFS) and overall survival (OS) were reviewed and compared between the US-NPBC and MG-NPBC. Prognostic factors of NPBC were identified by univariate and multivariate Cox analysis.

Result: Compared to MG, US could detect more invasive (81.2% vs 48.6%, p&lt;0.001), lymph node positive (18.3% vs 10.2%, p&lt;0.001), stage II+III (21.7% vs 12.5%, p&lt;0.001) and low grade cancer (p=0.001).Between invasive US-NPBC and MG-NPBC, no significant difference was identified for lymph node status, TNM stage or subtype.US-NPBC received more breast conserving surgery (32.6% vs 24.1%, p&lt;0.001) and chemotherapy (37.5% vs 23.6%, p&lt;0.001). There was no significant difference in DFS or OS between US- vs MG-NPBC among ductal carcinoma in situ (DCIS), invasive and all NPBC. For the US-NPBC, the DFS factors included TNM stage and Hormone receptor status whereas OS-predictors were pN and subtype.

Table 1.Kaplan-Meier estimates of DFS and OS between US-NPBC and MG-NPBC§Patients (No.) 10-year DFS (%)P value10-year OS (%)P valueAllUS-NPBC (914)92.40.57098.20.143 MG-NPBC (216)94.7 100.0 DCISUS-NPBC (172)97.70.170100.0- MG-NBPC (111)95.3 100.0 InvasiveUS-NPBC (742)91.20.45897.90.251 MG-NPBC (105)94.4 100.0 § Kaplan-Meier survival curves between each two subgroups would be displayed in the poster.

Conclusion: Overall, US could detect more invasive NPBC patients with positive lymph node and advanced stage compared to MG, and screen invasive NPBC at similar TNM stage and subtype distribution as MG. US-NPBC patients received more breast conserving surgery and chemotherapy, and could achieve comparable 10-year DFS and OS as MG-detected NPBC. Hence US is justified in the real-world as the initial imaging modality in hospital-based screening Chinese women.

Citation Format: Yao R, Pan B, Xu Y, Zhou Y, Zhu Q, Zhang J, Wu H, Mao F, Lin Y, Shen S, Sun Q. Is ultrasound screening justified for non-palpable breast cancer in asymptomatic Chinese women: A real-world study based on long-term survival of consecutive cohort (2001-2017) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-02.

Postoperative Complication Assessments of Different Reconstruction Procedures after Total Pharyngolaryngoesophagectomy: Tubular Gastric Pull-Up versus Whole Gastric Pull-Up

Hypopharynx carcinoma tends to be diagnosed at advanced stage and usually has a poor prognosis because of the high incidence of submucosal spreading and lymphatic metastasis. Total pharyngolaryngoesophagectomy (PLE) is mostly used as a curative intervention for this deadly disease, and a commonly used reconstruction method after PLE is gastric pull-up, which could be further divided into tubular gastric pull-up and whole gastric pull-up procedures. Aiming to achieve a precise guidance on optimal reconstruction method after PLE, the present study evaluated the postoperative complications involving in different gastric pull-up procedures in patients with hypopharynx cancer. A total of 52 consecutive patients with hypopharyngeal cancer who underwent total PLE with gastric pull-up reconstruction in Tianjin Medical University Cancer Institute and Hospital between 1996 and 2014 were analyzed in this study. Of these patients, 28 underwent tubular gastric pull-up reconstruction procedure (Group A), whereas 24 underwent whole gastric pull-up reconstruction procedure (Group B). We compared the postoperative complications between these two groups retrospectively. Postoperative anastomotic fistulas occurred in three patients in Group A (3/28) versus eight patients in Group B (8/24), leading to an incidence rate of 10.71 and 33.33 per cent, respectively. The incidence of intrathoracic stomach syndrome was 21.43 per cent in Group A (6/28) versus 58.33 per cent in Group B (14/24), and the incidence of reflux was 35.71 per cent in Group A (10/28) versus 66.67 per cent in Group B (16/24). All of the above postoperative complications exhibited statistical differences between two groups ( P ≤ 0.05). This retrospective observation study suggests that compared with whole gastric pull-up, tubular gastric pull-up is a better reconstruction procedure of choice after PLE, evidenced by reduced incidences of postoperative anastomotic fistula, intrathoracic stomach syndrome, and reflux.

Postoperative Complication Assessments of Different Reconstruction Procedures after Total Pharyngolaryngoesophagectomy: Tubular Gastric Pull-Up versus Whole Gastric Pull-Up

Hypopharynx carcinoma tends to be diagnosed at advanced stage and usually has a poor prognosis because of the high incidence of submucosal spreading and lymphatic metastasis. Total pharyngolaryngoesophagectomy (PLE) is mostly used as a curative intervention for this deadly disease, and a commonly used reconstruction method after PLE is gastric pull-up, which could be further divided into tubular gastric pull-up and whole gastric pull-up procedures. Aiming to achieve a precise guidance on optimal reconstruction method after PLE, the present study evaluated the postoperative complications involving in different gastric pull-up procedures in patients with hypopharynx cancer. A total of 52 consecutive patients with hypopharyngeal cancer who underwent total PLE with gastric pull-up reconstruction in Tianjin Medical University Cancer Institute and Hospital between 1996 and 2014 were analyzed in this study. Of these patients, 28 underwent tubular gastric pull-up reconstruction procedure (Group A), whereas 24 underwent whole gastric pull-up reconstruction procedure (Group B). We compared the postoperative complications between these two groups retrospectively. Postoperative anastomotic fistulas occurred in three patients in Group A (3/28) versus eight patients in Group B (8/24), leading to an incidence rate of 10.71 and 33.33 per cent, respectively. The incidence of intrathoracic stomach syndrome was 21.43 per cent in Group A (6/28) versus 58.33 per cent in Group B (14/24), and the incidence of reflux was 35.71 per cent in Group A (10/28) versus 66.67 per cent in Group B (16/24). All of the above postoperative complications exhibited statistical differences between two groups (P ≤ 0.05). This retrospective observation study suggests that compared with whole gastric pull-up, tubular gastric pull-up is a better reconstruction procedure of choice after PLE, evidenced by reduced incidences of postoperative anastomotic fistula, intrathoracic stomach syndrome, and reflux.

[The role of IL-22 in T cell reconstitution after thymus damage induced by ionizing radiation]

Objective: To explore the levels of IL-22 in thymus damaged by γ-ray total body irradiation (TBI), and to study the role of IL-22 in T cell reconstitution after thymic injury induced by TBI. Methods: To induce thymic injury, mice were treated by sub-lethal TBI. Levels of intra-thymic and circulatory IL-22 were detected by using ELISA assay. Untreated mice were used as control. After receiving sub-lethal TBI, mice were intraperitoneally injected with PBS or recombinant mouse IL-22, which were marked as TBI+PBS or TBI+IL-22, respectively. Mice were monitored for counts of total thymic cells and circulatory white blood cells. Flow cytometry was applied to analyze percentages of thymic epithelial cells (TEC), thymocyte subsets and circulatory T cells. Real-time PCR assay was applied to analyze the mRNA expression levels of Foxn1, Ccl25, Aire and Dll4 in thymus. Results: ①Sub-lethal TBI treated mice expressed higher levels of intra-thymic and circulatory IL-22, compared with untreated ones (all P<0.05). ②After injection of recombinant IL-22, TBI+IL-22 mice had higher levels of intra-thymic IL-22 than TBI+PBS mice (all P<0.05). ③On day 14 after irradiation, real-time PCR assay showed that TBI+IL-22 mice had higher mRNA levels of Foxn1, Ccl25, Aire and Dll4 in thymus compared with TBI+PBS ones. Meanwhile, the TBI+IL-22 mice had higher counts of total thymic cells[(5.93±3.19)×10(6)/ml vs (1.42±0.46)×10(6)/ml, t=3.128, P=0.033] and circulatory white blood cells[(3.08±0.94)×10(6)/ml vs (1.43±0.30)×10(6)/ml, t=3.730, P=0.015] than those of TBI+PBS mice. Flow cytometry analysis indicated that TBI+IL-22 mice had higher counts of TEC and thymocytes than TBI+PBS mice on day 14 after irradiation (all P<0.05). On days 7 and 14 after irradiation, TBI+IL-22 mice had higher counts of circulatory white blood cells and T cells than TBI+PBS mice (all P<0.05). Conclusion: Sub-lethal TBI induces upregulation of intra-thymic IL-22, and injecting of recombinant IL-22 increases level of IL-22 in thymus. Injecting of recombinant IL-22 improves recovery of TEC and increases numbers of thymocyte subsets and circulatory T cell after thymic injury.

Add-On therapy with Chinese herb medicine Bo-Er-Ning capsule (BENC) improves outcomes of gastric cancer patients: a randomized clinical trial followed with bioinformatics-assisted mechanism study

As a Chinese herb medicine (CHM), Bo-Er-Ning capsule (BENC) has been approved in China for adjuvant treatment of cancer, but the particular therapeutic effect of BENC on gastric cancer (GC) has yet to be evaluated. In this study, we implemented an efficacy-driven approach by directly starting the study with a randomized clinical trial to assess the add-on therapeutic effect of BENC on advanced GC patients. Our results showed that the addition of BENC to chemotherapy resulted in higher Karnofsky performance scores and better 3-year overall survival, compared to those treated with the conventional chemotherapy regimen. Subsequently, we explored the mechanism of BENC action on GC cells in the assistance of BATMAN-TCM, the first online bioinformatics analysis tool designed especially for the mechanism study of CHM, by which we identified 263 candidate protein targets of BENC involved in GC treatment. The further enrichment analysis suggested that BENC treatment affected a diversity of biological processes of GC cells, such as cell proliferation, cell cycle and apoptosis, which were further validated in the following in vitro and in vivo assays, indicating such a bioinformatics-assisted approach was feasible and powerful to CHM mechanism study. Thus, as exemplified by BENC, we provided an efficacy-driven and bioinformatics-assisted strategy for CHM research, which may help promote the discovery and application of novel CHM drugs on patients with refractory diseases.

[Application of vascular replacement technique with allogenic blood vessel in radical resection for pancreatic carcinoma: a report of 33 cases]

Objective: To analyze the application of vascular replacement technique with allogenic blood vessel in radical resection for pancreatic carcinoma. Methods: The clinical data of 33 patients with vascular invasion of pancreatic carcinoma who underwent radical resection from April 2013 to April 2017 in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital were retrospectively analyzed. There were 14 males and 19 females with age of (62.5±10.6)years(ranging from 35 to 78 years). Vascular replacement technique with allogenic blood vessel was used on all patients who underwent radical resection for pancreatic carcinoma. The operation procedure was made according to the specific location of the carcinoma, and the allogenic blood vessel was selected according to the type of vascular invasion. The matching vessel was selected for replacement to the patient who was invaded only one vessel. And the "Y" type of iliac vein was selected for replacement to the patient who was invaded the confluence of portal vein, splenic vein and superior mesenteric vein. After the operation, the patients were followed up by telephone and outpatient review. Results: All of 33 patients were successfully completed the operations. There were 28 patients underwent pancreaticoduodenectomy with vascular replacement, and 5 patients underwent total pancreatectomy with vascular replacement. All the patients were confirmed pancreatic carcinoma and R0 resection according to the postoperative pathology. There were 16 patients with the carcinoma invasion the confluence of portal vein, splenic vein and superior mesenteric vein, 12 patients with the carcinoma invasion the superior mesenteric vein, and 5 patients with the carcinoma invasion the portal vein. There was no perioperative death in this group and no complications related to allogenic blood vessel. The incidence of postoperative complications was 18.2% (6/33), and the incidence of pancreatic fistula was 6.1% (2/33), all of which were biochemical fistula. There were 32 patients were followed up, and the follow-up rate was 96.9%. The median survival time was 14.6 months. The half-year, 1-year and 2-year survival rates were 75.6%, 37.6% and 27.4%. Conclusion: The application of vascular replacement technique with allogenic blood vessel for pancreatic carcinoma has a great significance for improving the R0 resection rate and the prognosis of patients.

Uncovering the action mechanism of polydatinvianetwork pharmacological target prediction

Polydatin (PD), a small natural compound originally extracted fromPolygonum cuspidatum, exerts distinct biological functions in a variety of diseases.