Comparisons of different neoadjuvant chemotherapy regimens with or without stereotactic body radiation therapy for borderline resectable pancreatic cancer: study protocol of a prospective, randomized phase II trial (BRPCNCC-1)

Background

Few patients with pancreatic cancer may be candidates for immediate surgical resection at the initial diagnosis. Even if patients with borderline resectable pancreatic cancer (BRPC), micrometastases may occur before surgery. Therefore, neoadjuvant therapy is vital for improved survival, which has been confirmed in previous studies that neoadjuvant chemotherapy with or without radiotherapy provides superior overall compared with upfront surgery. However, question of whether the addition of radiotherapy to neoadjuvant chemotherapy can improve prognosis compared with chemotherapy alone is a challenging matter. Moreover, most of previous studies only adopted conventional radiotherapy as the neoadjuvant modality though stereotactic body radiation therapy (SBRT) has been proven effective and commonly employed in pancreatic cancer. Also, no studies have evaluated the efficacy of S-1 as the neoadjuvant chemotherapy regimen for BRPC albeit similar prognosis has been found between S-1 and gemcitabine in advanced pancreatic cancer. Hence, the aim of this study is to investigate whether neoadjuvant chemotherapy plus SBRT results in better outcomes compared with neoadjuvant chemotherapy alone and also compare the efficacy of gemcitabine plus nab-paclitaxel with SBRT and S-1 plus nab-paclitaxel with SBRT.

Methods

Patients with biopsy and radiographically confirmed BRPC, no prior treatment and severe morbidities are enrolled. They will be randomly allocated into three groups: neoadjuvant gemcitabine plus nab-paclitaxel, neoadjuvant gemcitabine plus nab-paclitaxel with SBRT and neoadjuvant S-1 plus nab-paclitaxel with SBRT. Standard doses of gemcitabine and nab-paclitaxel are used. The radiation dose of SBRT is 7.5-8Gy/f for 5 fractions. Surgical resection will be performed 3 weeks after SBRT. Artery first approach pancreaticoduodenectomy or radical antegrade modular pancreatosplenectomy will be used for the tumor in the head or body and tail of the pancreas, respectively. The primary endpoint is overall survival. The secondary outcomes are disease free survival, pathological complete response rate, R0 resection rate and incidence of adverse effects.

Discussion

If results show the survival benefits of neoadjuvant chemotherapy plus SBRT and similar outcomes between S-1 and gemcitabine, it may provide evidence of clinical practice of this modality for BRPC.

Trial registration

The study has been registered in ClinicalTrial.gov (NCT03777462).

[Influencing factors for non/low-response to hepatitis-B vaccine in infants of HBsAg positive mothers]

Objective: To investigate the influencing factors for non/low-response to hepatitis B vaccine in infants of HBsAg-positive mothers. Methods: A total of 286 HBsAg-positive pregnant women and their infants were recruited from the Third People's Hospital of Taiyuan during July 2011 to January 2013. The infants were immunized with hepatitis B vaccine according to the 0-1-6 month vaccination schedule and followed up for 12 months. The serum HBV DNA level of mothers, neonates and infants were detected by electro chemilum inescence immunoassay kits and fluorescene quantiative polymerase chain rection. Results: Among 286 infants, the rate of non/low-response to hepatitis B vaccine was 18.53% (53/286). Non-conditional logistic regression analysis indicated that the mother's HBV DNA level ≥1×10(7) copies/ml (OR=2.592, 95%CI: 1.121-5.996) and natural birth (OR=1.932, 95%CI: 1.021-3.654) were the risk factors for non/low-response to hepatitis B vaccine, the risks were 2.592 times and 1.932 times higher compared with the infants whose mothers were HBV DNA negative and the infants whose mothers had cesarean delivery. There was no multiplicative or additive interaction between high HBV DNA load and natural birth (OR=1.055, 95%CI: 0.209-5.321), (RERI=1.617, 95%CI: -4.038-7.272; AP=0.364, 95%CI: -0.527-1.225; SI=1.195, 95%CI: 0.270-13.135). After stratified analysis of mother's HBV DNA level, delivery mode of mothers was not associated with non/low-response of their infants. Conclusion: The mother's load of HBV DNA≥1×10(7) copies/ml might be the factor for non/low-response to hepatitis B vaccine in infants of HBsAg positive mothers.

[Relationship between the HBsAg-positive infection status of mothers and the non/low-response to hepatitis B vaccine of their infants]

Objective: To explore the relationship between the status of HBsAg-positive infection of mothers and the non/low-response to hepatitis B vaccine of their infants. Methods: A total of 225 pairs of mothers and their infants were recruited in our cohort from June 2011 to July 2013. Infants were given three doses of hepatitis B vaccine at hour 24, first month and month 6(t)h respectively and were followed up for one year after birth. HBV serological markers and HBV DNA in the peripheral blood of both mothers and infants were detected by Electro-chemiluminescence immunoassay and fluorescence quantitative Polymerase Chain Reaction. Results: Six HBV infection models were detected in HBsAg-positive mothers, and "HBsAg (+), HBeAg (+), anti-HBc (+)" (model one) and "HBsAg (+), anti-HBe (+), anti-HBc (+)" (model two) accounted for 92.5%(208/225) of all the models. Rate of non/low-response to hepatitis B vaccine in infants born to mothers in model one was lower than those in model two, the differences are statistically significant (χ(2)=4.80, P=0.029). The rate of non/low-response to hepatitis B vaccine in infants showed a downward trend with the rising of HBeAg level in their mothers (χ(2)=4.86, P=0.028). Results from the unconditional logistic regression analysis showed that the HBeAg of the HBsAg-positive mothers was significantly correlated with the low risk of non/low-response to hepatitis B vaccine in infants (OR=0.598, 95%CI: 0.378-0.947). The positive rate of serum HBV DNA in HBsAg-positive mothers was 54.2%, while the rate of non/low-response to hepatitis B vaccine in infants born to HBV DNA positive mothers was similar to those infants born to HBV DNA negative mothers (χ(2)=0.22, P=0.640). Conclusions: "HBsAg (+), HBeAg (+), anti-HBc (+)" and "HBsAg (+), anti-HBe(+), anti-HBc (+)" were the common models seen in HBsAg-positive mothers, and the rate of non/low-response to hepatitis B vaccine was different between the two models. HBeAg of HBsAg-positive mothers might have positive effects on the immune response to hepatitis B vaccine in infants but the mechanisms remained not clear. HBV DNA of the HBsAg-positive mothers did not seem to be correlated with the immune response to hepatitis B vaccine in infants.

Oncological and genetic factors impacting PDX model construction with NSG mice in pancreatic cancer

A patient-derived xenograft (PDX) approach, which relies on direct transplantation of tumor specimens into an immunocompromised animal, is a commonly used method for investigating tumor therapy predictions in vivo. This study evaluated influencing factors, including clinical, oncological, and genetic variables, for a pancreatic PDX model in mice. Tumor specimens were obtained from 121 patients with pancreatic ductal adenocarcinoma who underwent surgical resection at the Changhai Pancreatic Surgery Medical Center (Shanghai, China) between April 2016 and February 2017. Pancreatic cancer (PC) samples <3 mm³ were subcutaneously implanted into the NOD/Shi-scid/IL-2Rγnull (NSG) mice. Once the xenograft reached 300-500 mm³ or reached 180 d after cell inoculation, the tumor was excised. Part of the tumor was subsequently transplanted to next-generation mice, and another part was analyzed by using immunohistochemistry. Among the 121 patients with PC, tumor xenograft was successfully generated in 86 patients (71.1%). Primary tumor >3.5 cm in size was independently associated with xenograft formation rate. In addition, several enriched mutated genes within the VEGF pathway and higher microvessel density were found in the positive group (with xenograft) compared with the negative group (without xenograft). We concluded that tumor size and mutated VEGF pathway in PC are important factors affecting PDX model construction with NSG mice.-Guo, S., Gao, S., Liu, R., Shen, J., Shi, X., Bai, S., Wang, H., Zheng, K., Shao, Z., Liang, C., Peng, S., Jin, G. Oncological and genetic factors impacting PDX model construction with NSG mice in pancreatic cancer.

Thermal-noise-limited higher-order mode locking of a reference cavity

Higher-order mode locking has been proposed to reduce the thermal noise limit of reference cavities. By locking a laser to the HG₀₂ mode of a 10-cm long all ultra-low expansion (ULE) cavity and measuring its performance with the three-cornered-hat method among three independently stabilized lasers, we demonstrate a thermal-noise-limited performance of a fractional frequency instability of 4.9×10^-16. The results match the theoretical models with higher-order optical modes. The achieved laser instability improves the all ULE short cavity results to a new low level.

[Relationship between HBeAg from HBsAg positive mothers and regulatory T cells in neonates and its influence on HBV intrauterine transmission]

Objective: To explore the relationship between HBeAg in HBsAg positive mothers and CD(4)(+)CD(25)(+)Foxp3(+)regulatory T cells (Treg) in newborns, as well as how they would influence the increasing risk on HBV intrauterine transmission. Methods: We collected information on general demographic characteristics and delivery on 270 HBsAg positive mothers and their newborns from the Third People's Hospital of Taiyuan. Fluorescence quantitative polymerase chain reaction (FQ-PCR) and chemiluminescence immunoassay (CLIA) were used to detect HBV DNA and HBV serological markers in peripheral blood from both mothers and neonates. The expression of Treg and other immune cells in peripheral blood of neonates were detected with flow cytometry (FCM). Results: Maternal HBeAg positive rates were associated with an increased risk of intrauterine transmission (OR=4.08, 95%CI: 1.89-8.82). Rates of Treg in newborns born to HBsAg-positive mothers were higher than that of the negative group (Z=2.29, P=0.022). Each pair of the subjects was assigned to five different groups according to the HBeAg titers of mothers. Frequencies of both Treg and HBeAg in newborns and HBV DNA in mothers between the above said 5 groups showed similar trends of changing patterns and the differences between groups were statistically significant(χ(2)=18.73, P<0.001; χ(2)=181.60, P<0.001; χ(2)=183.09, P<0.001). Results from partial correlation analysis showed that after adjusting for neonatal HBeAg and maternal HBV DNA, mother's HBeAg titers were positively related to the percentage of Treg in their newborns (r(s)=0.19, P=0.039). In addition, the frequencies of Treg were negatively correlated with pDC and CD(4)(+) T cell in their newborns (r(s)=-0.21, P=0.017; r(s)=-0.23, P=0.009). Conclusion: HBeAg from HBsAg positive mothers might have inhibited the function of neonatal DC cells and T cells to reduce the immune response to HBV by up-regulating the proportion of Treg and finally increased the risk of HBV intrauterine transmission.

[Analysis on the clinical therapeutic effects of arterial first approach pancreatoduodenectomy in the treatment of borderline resectable pancreatic adenocarcinoma]

Objective: To compare the clinical therapeutic effects of arterial first approach pancreaticoduodenectomy(AFA-PD) with standard approach pancreaticoduodenectomy(SPD) in the treatment of borderline resectable pancreatic cancer (BRPC). Methods: A retrospective analysis of the clinical data of 113 cases of pancreatic cancer patients from January 2014 to August 2015 at Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital, the Second Military Medical University, including 43 cases in AFA-PD group and 70 cases in SPD group.Every patient had gone high-resolusion computed tomography before the surgery, when BRPC was definitely diagnosed by both experienced radiologist and pancreatic surgeon.There were 24 males and 19 females in the AFA-PD group, with average age of (61.6±10.2)years.And in the SPD group, there were 47 males and 23 females, with average age of (62.7±9.4)years. Results: The operation time was (210.7±31.5)minutes in AFA-PD group, (187.9±27.4)minutes in SPD group, and peroperative bleeding volume was (1 007.1±566.3)ml in AFA-PD group, (700.0±390.0)ml in the other group.Those two indicators of AFA-PD group, compared with SPD group, were relatively higher, the difference was statistically significant(all P<0.01). And with regard to postoperative diarrhea(9.3% vs.5.7%), postoperative 1, 3 days of white blood cells(postoperative 1 day: (13.3±1.1)×10(9)/L vs.(12.4±2.4)×10(9)/L; postoperative 3 days: (12.7±1.6)×10(9)/L vs.(11.7±2.5)×10(9)/L), postoperative 1, 3, 5 days of peritoneal drainage fluid volume(postoperative 1 day: (184±42)ml vs.(156±54)ml; postoperative 3 days: (155±48)ml vs.(133±35)ml; postoperative 5 days: (66±20)ml vs.(47±31)ml), the differences between the two groups were statistically significant (all P<0.05). One patient in the SPD group was treated with unplanned secondary surgery for postoperative intraperitoneal hemorrhage, and the patient was cured and discharged.There was no death in the two groups within 30 days after surgical operation and no patient with positive gastric margin, duodenal margin, or anterior margin.The resection rate of superiormesenteric artery(SMA) margin R0 in AFA-PD group was higher than that in SPD group (P=0.019). The two groups were followed up for 14 to 30 months.As for AFA-PD group, the average survival time, progression free survival time and median survival time was respectively (20.4±1.2)months, (21.5±1.4)months and 20 months.There were 3 cases(7.0%) with local recurrence and 8 cases(18.6%) with liver metastasis or distant metastasis.In the SPD group, the average survival time, progression free survival time and median survival time was (17.1±1.1)months, (16.4±1.3)months and 16 months, respectively.There were 13 cases(18.6%) with local recurrence and 25 cases(35.7%) with liver metastasis or distant metastasis.As a result, the AFA-PD group had longer survival time(P=0.001)and progression free survival time(P=0.002). However, the lower local recurrence and distant metastasis rate in AFA-PD group did not reach statistical standard (P>0.05). Conclusion: The arterial first approach pancreaticoduodenectomy is safe and effective in the treatment of borderline resectable pancreatic cancer, which can improve the resection rate of SMA margin R0, and prolong patient survival time.

[Effect of telbivudine on infants born to HBsAg-positive mothers with non-/hypo-response to hepatitis B vaccine during their second and third trimesters of pregnancy]

Objective: To explore the effect of telbivudine treatment in a prevention program on infants born to HBsAg-positive mothers with non-/hypo-responsiveness to hepatitis B vaccine. Methods: A retrospective cohort study with a total of 321 HBsAg-positive pregnant women and their infants enrolled, was conducted. The mothers were recruited from the Third People' s Hospital of Taiyuan, from July 2011 to January 2013. According to the situation of telbivudine intake in second and third trimesters of pregnancy, the participants were divided into two groups: with telbivudine-treated or as control. The neonates were followed up till the age of 12 months. Maternal, neonatal and infantile HBV-M together with HBV DNA in serum were measured using the electro-chemiluminescence immuno-assay (ECLIA) kits and fluorescence quantitative polymerase chain reaction (FQ-PCR) assay, respectively. Results: The rate of non-/hypo-response was 17.99%. After adjusting the potential confounding factors, the telbivudine treatment on HBsAg-positive mothers in the second and third trimesters of pregnancy seemed as the protective factor for non-/hypo-response to hepatitis B vaccine in infants (aRR=0.119, 95% CI: 0.014-0.974). Levels of IFN-γ and IL-10 in telbivudine-treated group were higher than those in the controls (aRR=8.684, 95%CI: 1.977-38.140; aRR=5.330, 95% CI: 1.278-22.236). When the serum levels of IFN-γ and IL-10 in neonatal peripheral blood were higher than 228.47 pg/ml and 174.05 pg/ml respectively, the infants were less likely to be non-/hypo-responsive to the hepatitis B vaccine (aRR=0.300, 95%CI: 0.105-0.857) (aRR= 0.104, 95% CI: 0.030-0.354). Conclusion: Telbivudine treatment provided for the HBsAg-positive mothers in second and third trimesters of pregnancy were less likely to develop non-/low-responsive to hepatitis B vaccine in infants since IFN-γ and IL-10 might have played a vital role in this process.

Human umbilical cord stem cell conditioned medium versus serum-free culture medium in the treatment of cryopreserved human ovarian tissues in in-vitro culture: a randomized controlled trial

BACKGROUND

To reduce young female fertility loss, the in-vitro culture of cryopreserved ovarian cortical tissues (OCTs) is considered an effective approach without delaying treatment and undergoing stimulation medicine. However, ischemic damage and follicular loss during the in-vitro culture of OCTs are major technical challenges. Human umbilical cord stem cells (HUMSCs) and their conditioned medium (HUMSC-CM) have been considered to be potential resources for regeneration medicine because they secrete cytokines and enhance cell survival and function. The aim of this study was to determine whether HUMSC-CM improves the development of frozen-thawed in-vitro cultured ovarian tissues compared with a serum-free culture medium (SF-CM).

METHODS

The thawed OCTs (n = 68) were cultivated in HUMSC-CM and SF-CM in vitro for 8 days, and the ovarian tissues were processed and analyzed by a classical histological evaluation. The microvessel density (MVD) and apotosis detection during in-vitro culture of OCTs were also performed.

RESULTS

A significant difference in the rate of morphologically normal primordial follicles in the HUMSC-CM group was observed compared to that in the SF-CM group (group C) from days 2 to 4 (day 2: group B 58.0 ± 2.45% vs group C 32.0 ± 5.83%, p = 0.002; day 3: group B 55.5 ± 4.20% vs group C 21.0 ± 9.80%, p = 0.048; day 4: group B 52.0 ± 4.08% vs group C 21.5 ± 8.19%, p = 0.019). The microvessel density (MVD) detection showed a time-dependent increase and peaked on day 4. There was a significant difference between groups B (49.33 ± 0.58) and C (24.33 ± 3.79) (p = 0.036). The percentage of apoptotic follicles in group B was lower than that in group C on day 1 (13.75 ± 2.50% vs 27.0 ± 10.10%, p = 0.003), day 5 (11.75 ± 1.50% vs 51.0 ± 10.5%, p = 0.019) and day 7 (15.0 ± 5.10% vs 46.5 ± 21.75%, p = 0.018).

CONCLUSIONS

These data have provided the first experimental evidence of the effect of HUMSC-CM on frozen-thawed OCTs in vitro. The results showed that the HUMSC-CM group provided a better protecting effect on the in-vitro culture of the cryopreserved OCTs compared to the SF-CM group.

Associations of common IL-4 gene polymorphisms with cancer risk: A meta-analysis

Cancer incidence is dramatically increasing worldwide, therefore improved prediction and therapeutic methods are needed. Single nucleotide polymorphisms in cytokine genes may contribute to carcinogenesis. Interleukin (IL)-4 gene polymorphisms have been intensively studied with regard to their associations with cancer. However, the results of these previous studies remain inconclusive. The present study, therefore, aimed to conduct a meta-analysis of previously published studies in order to clarify the association of IL-4 with cancer risk. Eligible published articles were searched in Medline, PubMed, Embase and China National Knowledge Infrastructure databases up to March 2016. Odds ratios and 95% confidence intervals were used to identify potential associations between IL-4 genetic polymorphisms and the risk of cancer. A meta-analysis was then performed on 10,873 patients and 14,328 controls for IL-4 rs2243250 polymorphism, 3,970 patients and 5,686 controls for IL-4 rs2070874 polymorphism, and 1,896 patients and 2,526 controls for IL-4 rs79071878 polymorphism. A significant association with cancer risk was observed for rs2243250 and rs79071878 polymorphisms. In the subgroup analysis by cancer type, rs2243250 polymorphism was demonstrated to be associated with an increased risk of gastric cancer and breast cancer, rs2070874 polymorphism was correlated with leukemia and oral carcinoma, and rs79071878 polymorphism was relevant to bladder carcinoma risk. In the subgroup analysis by ethnicity, IL-4 rs2243250 polymorphism was demonstrated to be associated with cancer risk in both Caucasian and Asian populations, rs2070874 was associated with cancer risk in Asian populations, while rs79071878 polymorphism was associated with cancer risk in Caucasian populations. In conclusion, the present results suggested that the IL-4 rs2243250 and rs79071878 polymorphisms were associated with cancer susceptibility. Further subgroup analyses revealed that the effects of IL-4 gene polymorphisms on cancer risk may vary by cancer type and by ethnicity.

[IgG4 immunohistochemistry in Riedle thyroiditis]

Objective: To observe the histopathological changes and immunohistochemical expression of IgG4 in Riedle thyroiditis (RT) and to study the relationship between RT and IgG4-related diseases (IgG4-RD). Methods: A total of 5 RT patients were collected from the Department of Pathology, Peking Union Medical College Hospital during April 2012 to August 2014. The clinical and immunohistochemical features were analyzed in the 5 patients. Histopathologic analysis was performed on hematoxylin and eosin-stained sections. Results: There were one male and four female patients, aged 52 to 78 years (median 59 years). Five cases were characterized by multiple nodules of thyroid, which increased year by year. All patients were found to have surrounding tissue compression symptoms and signs. Two female patients were found to have hypothyroidism. The serum concentration of IgG was elevated in 2 cases, and the serum concentration of IgG was not tested before operation in the remaining patients. By ultrasound, all presented as low echo or medium low echo. Strong echo occasionally appeared in hypoechoic nodules. Microscopically, fibrous tissue hyperplasia was infiltrated with varying numbers of lymphocytes and plasma cells. The occlusion of phlebitis was found in 4 cases and eosinophils were found in 3 cases. IgG4 counts and IgG4/IgG ratios in 5 cases were 20/HPF, 16%; 60/HPF, 82%; 22/HPF, 28%; 400/HPF, 266% and 33/HPF, 71%, respectively. Conclusions: With the similar pathological manifestations between RT and IgG4-RD, immunohistochemical staining shows that the number of IgG4 positive plasma cells and IgG4/IgG ratio of RT are increased in varying degrees. Some cases meet the diagnostic criteria of IgG4-RD, and speculate that some cases of RT belong to IgG4-RD.

Associations of IL-10 genetic polymorphisms with the risk of urologic cancer: a meta-analysis based on 18,415 subjects

Background

Interleukin-10 (IL-10) is a powerful modulator of anti-tumor immune responses. The IL-10 promoter region polymorphisms are known to regulate IL-10 production, and thus are thought to be implicated in tumorigenesis. Recently, the roles of these polymorphisms in urologic cancer have been extensively studied, with conflicting results. Therefore, we conducted the present meta-analysis to better elucidate the correlations between IL-10 polymorphisms and urologic cancer risk.

Methods

Eligible articles were searched in PubMed, Medline, Embase, Scopus and CNKI up to May 2016. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to detect any potential associations between IL-10 polymorphisms and the risk of urologic cancer.

Results

A total of 22 case–control studies including 8572 patients and 9843 controls were analyzed. The overall meta-analysis results showed that IL-10 −592C>A polymorphism was significantly associated with urologic cancer in CA versus AA (P = 0.04, OR 0.87, 95% CI 0.76–0.99) and AA versus CC+CA (P = 0.03, OR 1.15, 95% CI 1.02–1.31). Subgroup analyses by cancer types suggested there were significant associations between all the three investigated IL-10 polymorphisms and bladder cancer. However, subgroup analyses by ethnicity only detected a weak association between IL-10 −819C>T and Asian population.

Conclusions

Our findings suggests that IL-10 −592C>A polymorphism may implicate with urologic cancer risk. Besides, promoter region polymorphisms of IL-10 may serve as potential biological markers, especially for bladder cancer. Furthermore, IL-10 −819C>T polymorphism may contribute to urologic cancer susceptibility in Asians while all the three studied variants of IL-10 did not relate to Caucasian urologic cancer predisposition.

[Study on the influence of laryngeal lesions on the prognosis of pneumomediastinum in dermatomyositis]

Objective:To investigate the influence of laryngeal lesions on the prognosis of pneumomediastinum in patients with dermotomyositis(DM). Method:The clinical data of patients with DM were retrospectively analyzed. Hoarseness, laryngeal lesions and pneumomediastinum in patients with DM were analyzed to evaluate the influence of laryngeal lesions and hoarseness on the prognoses and diagnosis of pneumomediastinum in patients with DM. Result:Forty-two patients with a diagnosis of DM were included in the study.Twenty of all the patients were diagnosed of interstitial lung disease(ILD) with the incidence of 47.6%. Four of the patients displayed hoarseness with the incidence of 9.5%. Three cases were complicated by pneumomediastinum with the incidence of 7.1%. All patients have normal vocal cord movement. One of the 4 patients with hoarseness showed congestion of her vocal folds, and the other 3 patients showed white change on both of the vocal folds. All the 3 patients with white change on both vocal folds complicated by pneumomediastinum and died on respiratory failure. There were statistical differences(P<0.01) on the prognosis and occurrence of pneumomediastinum between patients with or without hoarseness and laryngeal lesions. Conclusion:Hoarseness and laryngeal lesions may associate with poor prognosis and occurrence of pneumomediastinum in DM.

Characterization of electrical noise limits in ultra-stable laser systems

We demonstrate thermal noise limited and shot noise limited performance of ultra-stable diode laser systems. The measured heterodyne beat linewidth between such two independent diode lasers reaches 0.74 Hz. The frequency instability of one single laser approaches 1.0 × 10^-15 for averaging time between 0.3 s and 10 s, which is close to the thermal noise limit of the reference cavity. Taking advantage of these two ultra-stable laser systems, we systematically investigate the ultimate electrical noise contributions, and derive expressions for the closed-loop spectral density of laser frequency noise. The measured power spectral density of the beat frequency is compared with the theoretically calculated closed-loop spectral density of the laser frequency noise, and they agree very well. It illustrates the power and generality of the derived closed-loop spectral density formula of the laser frequency noise. Our result demonstrates that a 10^-17 level locking in a wide frequency range is feasible with careful design.

[Spontaneous intracranial hypotension: 12 case reports and follow-up]

Objective: To investigate the pathogenesis, clinical presentation, imaging features and prognosis of spontaneous intracranial hypotension. Methods: Clinical manifestation and imaging changes of 12 patients with spontaneous intracranial hypotension were reported. They were followed up regularly. The clinical and neuroimaging characteristics were summarized. Results: All the 12 cases were adults, presenting with orthostatic headache. They all recovered with conservative therapy. Head MRI demonstrated cerebral lobe hemorrhage, subdural hematoma, pituitary hyperemia, subarachnoid hemorrhage, enhancement of the pachymeninges, sagging of the brain, etc. Conclusions: Spontaneous intracranial hypotension is characterized by orthostatic headaches and is associated with compensatory changes following loss of CSF volume. The long-time prognosis is not bad.

Associations of NKX2-5 Genetic Polymorphisms with the Risk of Congenital Heart Disease: A Meta-analysis

The NKX2-5 gene is a vital regulator of cardiac formation and development. Recently, the roles of NKX2-5 63A>G polymorphism and 606G>C polymorphism in congenital heart disease (CHD) have been extensively studied, with conflicting results. The aim of the present study was to better elucidate the associations between NKX2-5 genetic polymorphisms and CHD risk through a meta-analysis. Eligible articles were searched in PubMed, MEDLINE, EMBASE, Google Scholar and CNKI up to December 2015. Odds ratios (ORs) and 95 % confidence intervals were used to detect any potential associations between NKX2-5 genetic polymorphisms and CHD risk. Heterogeneity between studies was assessed with Q test and I (2) statistic. Subgroup analysis and sensitivity analysis were performed to test the reliability and stability of the results, and funnel plots were applied to estimate publication bias. A total of 13 case-control studies including 2245 CHD patients and 1953 healthy controls were analyzed. The overall meta-analysis results showed that NKX2-5 63A>G polymorphism and 606G>C polymorphism were not significantly associated with CHD risk. Subgroup analysis was further performed for NKX2-5 63A>G polymorphism based on types of CHD and ethnicity of study population, and similar negative results were found in all subgroups. Our findings suggested that NKX2-5 63A>G polymorphism and 606G>C polymorphism may not be implicated in the pathogenesis of CHD.

Association between matrix metalloproteinase-9 rs3918242 polymorphism and development of coronary artery disease in a Chinese population

We conducted a case-control study to investigate the role of one single nucleotide polymorphism of MMP-9 rs3918242 in the development of coronary artery disease. The rs3918242 was amplified with 435-bp DNA fragments using polymerase chain reaction coupled with restriction fragment length polymorphism. When compared with control subjects, patients with coronary artery disease had higher systolic and diastolic blood pressure, as well as higher triglycerides (P < 0.05), were more likely to suffer from diabetes mellitus, and had lower total cholesterol and high-density lipopolysaccharides. Using unconditional logistic analysis, we found that individuals with CT and TT genotypes were associated with increased risk of coronary artery disease in a co-dominant model, and the ORs (95%CI) were 1.50 (1.02-2.20) and 6.89 (2.51-23.41) for CT and TT, respectively. We observed that the T allele of rs3918242 was correlated with increased risk of coronary artery disease (OR = 1.88, 95%CI = 1.39-2.55). In conclusion, we suggest that the TT and CT genotypes and T allele of MMP-9 rs3918242 polymorphism is correlated with an increased risk of coronary artery disease in a Chinese population.

Efficacy and Safety of Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valves: A Systematic Review and Meta-Analysis

PURPOSE

To elucidate the performance of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) patients through a systematic review and meta-analysis.

METHODS

A systematic literature review was performed by searching eligible articles in PubMed, Medline, EMBASE, Google Scholar and CNKI. Meta-analysis of included case-control/cohort studies was further conducted. Relative risks (RRs) and the corresponding 95% confidence intervals (CIs) were used to compare clinical outcomes of BAV patients and non-BAV patients.

RESULTS

A total of 17 articles including eight case reports, four case series and five case-control/cohort studies with 166 BAV patients were analyzed. Device success rate achieved for TAVI in this cohort of BAV patients was 95.2%. The 30-day mortality rate was 8.4%, and the medium-term (range from 6 months to 2 years) mortality rate reported was 17.9%. Overall, the performance of TAVI in BAV patients was comparable to that in non-BAV patients, as reported by the included case-control/cohort studies (30-day mortality rate: RR = 1.05, 95%CI 0.57-1.95, p = 0.87; Device success rate: RR = 1.00, 95%CI 0.95-1.05, p = 0.94; Incidence of moderate to severe paravalvular regurgitation: RR = 1.25, 95%CI 0.85-1.84, p = 0.25).

CONCLUSION

The present study suggested that TAVI may be a feasible and safe treatment modality for BAV patients.

Design verification of large time constant thermal shields for optical reference cavities

In order to achieve high frequency stability in ultra-stable lasers, the Fabry-Pérot reference cavities shall be put inside vacuum chambers with large thermal time constants to reduce the sensitivity to external temperature fluctuations. Currently, the determination of thermal time constants of vacuum chambers is based either on theoretical calculation or time-consuming experiments. The first method can only apply to simple system, while the second method will take a lot of time to try out different designs. To overcome these limitations, we present thermal time constant simulation using finite element analysis (FEA) based on complete vacuum chamber models and verify the results with measured time constants. We measure the thermal time constants using ultrastable laser systems and a frequency comb. The thermal expansion coefficients of optical reference cavities are precisely measured to reduce the measurement error of time constants. The simulation results and the experimental results agree very well. With this knowledge, we simulate several simplified design models using FEA to obtain larger vacuum thermal time constants at room temperature, taking into account vacuum pressure, shielding layers, and support structure. We adopt the Taguchi method for shielding layer optimization and demonstrate that layer material and layer number dominate the contributions to the thermal time constant, compared with layer thickness and layer spacing.

Association of haemoglobin level with morbidity and mortality of patients with locally advanced oesophageal carcinoma undergoing radiotherapy--a secondary analysis of three consecutive clinical phase III trials

AIMS

To investigate the strength of association between anaemia and overall survival, locoregional control, and late radiation complications in patients with locally advanced oesophageal carcinoma undergoing radiotherapy with or without chemotherapy and hyperthermia.

MATERIALS AND METHODS

Between March 1996 and December 2002, 303 patients with locally advanced squamous cell carcinoma of oesophagus enrolled in three consecutive prospective phase III trials conducted in our department were included in this study. These patients received one of the following four irradiation schedules: late course accelerated hyperfractionated (LCAF) radiotherapy alone, LCAF combined with concurrent chemotherapy, LCAF combined with hyperthermia, and continuous accelerated hyperfractionated (CAHF) radiotherapy according to each protocol. According to the haemoglobin levels measured before radiotherapy, patients were stratified to normal haemoglobin group (> or = 12.0 g/dl for men, or > or = 11.0 g/dl for women) or anaemic group (< 12.0 g/dl for men, or < 11.0 g/dl for women). Overall survival, locoregional control rate and late irradiation toxicity were estimated by Kaplan-Meier method.

RESULTS

Of 303 eligible patients, 243 patients (80.2%) had normal haemoglobin level and 60 patients (19.8%) were anaemic. The 5-year overall survival was 39% in patients with normal haemoglobin level, whereas, 22%, with anaemia patients (P = 0.001). The 5-year locoregional control rate at 5 years was 68% in patients with normal haemoglobin, versus 62%, with anaemia patients (P = 0.050). The 5-year rate of radiation toxicity of grade 3 or greater was 29% in patients with normal haemoglobin level, but it was 8%, with anaemic patients (P = 0.033). From multivariate analyses, T stage, location of tumour and haemoglobin level were found to be independent predictors for survival. T stage, gender and haemoglobin level were independent predictors for locoregional control. It was also detected that age and haemoglobin level played as independent predictors for development of radiation toxicity.

CONCLUSIONS

For patients with locally advanced oesophageal carcinoma undergone irradiation, anaemia associated a statistically significant reduction in survival and locoregional control rates, but also decreased radiation toxicity rates. Therefore, haemoglobin level should be considered as a stratification variable in prospective clinical trials.

The Gly482Ser variant of the PPARGC1 gene is associated with Type 2 diabetes mellitus in northern Chinese, especially men

AIMS

To investigate the prevalence of the Gly482Ser polymorphism of the PPARGC1 gene in a northern Chinese population and to clarify the susceptibility of individuals with the Gly482Ser polymorphism to insulin resistance and related diseases.

METHODS

We studied the association of the Gly482Ser polymorphism identified in the PPARGC1 gene with Type 2 diabetes mellitus (T2DM) in 390 unrelated patients with T2DM and 525 control subjects with normal glucose tolerance. Clinical parameters and measures of insulin resistance were recorded. Genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, which was further confirmed by direct sequencing in 20 randomly selected cases.

RESULTS

The Gly482Ser polymorphism was common in the northern Chinese population. Univariate analysis indicated no statistically significant differences in allele frequencies or genotype frequencies of the Gly482Ser polymorphism in diabetic and control subjects (minor 482Ser allele frequency 44.4 vs. 41.4%, P = 0.169). However, logistic regression analysis demonstrated a positive 1.645-fold higher risk of the Ser/Ser genotype for T2DM (P = 0.039, 95% CI = 1.026-2.632). After stratification by gender, the risk of Type 2 diabetes in men was increased 1.852-fold (95% CI = 1.125-3.049) in those with the Ser/X genotype compared with those with the Gly/Gly genotype (P = 0.015). No associations were observed between the Gly482Ser polymorphism and parameters of insulin resistance, obesity and hypertension.

CONCLUSION

The Gly482Ser variant of the PPARGC1 gene might contribute to susceptibility to T2DM in northern Chinese subjects. The Ser/X genotype of the Gly482Ser polymorphism in the PPARGC1 gene appears to be a risk factor for T2DM in northern Chinese men.

Discovery of a regulatory motif that controls the exposure of specific upstream cyclin-dependent kinase sites that determine both conformation and growth suppressing activity of pRb

The conformation and activity of pRb, the product of the retinoblastoma susceptibility gene, is dependent on the phosphorylation status of one or more of its 16 potential cyclin-dependent kinase (cdk) sites. However, it is not clear whether the phosphorylation status of one or more of these sites contributes to the determination of the various conformations and activity of pRb. Moreover, whether and how the conformation of pRb may regulate the phosphorylation of the cdk sites is also unclear. In the process of analyzing the function and regulation of pRb, we uncovered the existence of an unusual structural motif, m89 (amino acids 880-900), the mutation of which confers upon pRb a hypophosphorylated conformation. Mutation of this structural domain activates, rather than inactivates, the growth suppressor function of pRb. In order to understand the effect of the mutation of m89 on the phosphorylation of cdk sites, we identified all the cdk sites (Thr-356, Ser-807/Ser-811, and Thr821) the phosphorylation of which drastically modify the conformation of pRb. Mutation of each of these four sites alone or in combinations results in the different conformations of pRb, the migration pattern of which, on SDS-polyacrylamide gel electrophoresis, resembles various in vivo hypophosphorylated forms. Each of these hypophosphorylated forms of pRb has enhanced growth suppressing activity relative to the wild type. Our data revealed that the m89 structural motif controls the exposure of the cdk sites Ser-807/Ser-811 in vitro and in vivo. Moreover, the m89 mutant has enhanced growth suppressing activity, similar to a mutant with alanine substitutions at Ser-807/Ser-811. Our recent finding, that the m89 region is part of a structural domain, p5, conserved antigenically and functionally between pRb and p53, suggests that the evolutionarily conserved p5 domain may play a role in the coordinated regulation of the activity of these two tumor suppressors, under certain growth conditions.

Late course accelerated fractionation in radiotherapy of esophageal carcinoma

PURPOSE

To evaluate the efficacy of adding accelerated fractionation after completing two thirds of routine fractionated radiotherapy in esophageal carcinoma.

METHODS AND MATERIALS

From April 1988 to April 1990, 85 patients with histologically confirmed carcinoma of the esophagus were randomized into two groups. (1) The conventional fractionation (CF) group, received 1.8 Gy per day five times a week to a total dose of 68.4 Gy in 7-8 weeks, and (2) the late course accelerated hyperfractionated (LCAF) group which received the same schedule as the CF group during the first two thirds of the course of radiotherapy to a dose of 41.4 Gy/23 fx/4 to 5 weeks. This was then followed by accelerated hyperfractionation using reduced fields. In the LCAF portion of the radiotherapeutic course, the irradiation schedule was changed to 1.5 Gy twice a day, with an interval of 4 h between fractions, to a dose of 27 Gy/18 fx. Thus the total dose was also 68.4 Gy, the same as the CF group, but the course of radiotherapy was shorter, being only 6.4 weeks. The same Cobalt 60 teletherapy unit was used to treat all the cases.

RESULTS

The 5 year actuarial survival and disease-free survival rates in the LCAF group were 34% and 42%, as compared to 15% and 15% respectively in the CF group, all statistically significant. Better local control was seen in the LCAF group than in the CF group, the 5 year control rates being 55% versus 21% (P = 0.003). The acute reactions were increased but acceptable in the LCAF patients, the radiation treatments could be completed without any breaks. The late reactions as observed after 5 years were not increased in comparison with the CF patients.

CONCLUSIONS

The results from this study show that the late course accelerated hyperfractionated radiotherapy regime can improve results in esophageal carcinoma, with acceptable acute reactions as compared to conventional radiotherapy.

Morphine inhibited respiratory burst of neutrophils and scavenged oxygen free radicals

AIM

To study the effects of morphine on active oxygen free radicals.

METHOD

Chemiluminescence method was used to measure (a) active oxygen generation induced by respiratory burst of neutrophils from human blood stimulated with phorbol myristate acetate (PMA), (b) Superoxide anion (O2.-) induced by xanthine-xanthine oxidase system, (c) hydroxyl radical (.OH) generated by ascorbic acid (AA)-Cu(2+)-zymosan, and (d) the release of H2O2.

RESULTS

The (a), (b), (c), and (d) were scavenged by morphine and their median inhibitory concentrations (IC50 and 95% confidence limits) were 21.1 (13.0-34.0), 54.1 (50.0-58.5), 224.0 (128.2-390.8), and 66.9 (62.9-71.0), nmol L-1, respectively.

CONCLUSION

The immunosuppressant effect of morphine was related to its free radicals scavenging action.

The Rb gene suppresses the growth of normal cells

The suppression of tumor formation, first demonstrated by somatic cell hybrid and microcell fusion experiments, suggests the existence of a class of genes that selectively suppress the growth of tumor cells but not normal cells. The reintroduction of these genes into tumor cells presumably renders the cells responsive to in vivo growth inhibitory environment. As the inheritance of a defective retinoblastoma gene (Rb-1) allele results in a predisposition to the development of various cancers, and since inactivation of both alleles are observed in tumor cells, the Rb gene has been suspected to have the ability to suppress tumor growth. Data presented here demonstrated that different types of normal cells, which have a limited life span, were also growth arrested by a transfected Rb gene. Cell lines which are resistant to the growth suppression effect of the Rb gene in vitro, retain the ability to form tumors in nude mice even in the presence of a stable and highly expressed wild type Rb protein. We conclude that while the Rb gene can suppress the growth of many tumor cell lines, its growth suppression effect is not tumor specific.

A 5-year surveillance of sensitivity in vivo of Plasmodium falciparum to pyronaridine/sulfadoxine/pyrimethamine in Diaoluo area, Hainan Province

The surveillance of sensitivity of P. falciparum to pyronaridine/sulfadoxine/pyrimethamine has been carried out in Diaoluo area in Hainan Province where chloroquine-resistant falciparum malaria is endemic, covering an area of 406 square kilometers, with a population of 3745 in 1986. From 1986 all outpatients diagnosed as falciparum malaria were administered with PND/S/P as the only antimalarial. In vivo sensitivity of P. falciparum was measured in some patients who were treated in hospital. It was demonstrated that P. falciparum in the Diaoluo area has retained its sensitivity to a single oral dose of PND/S/P of 500/1,000/50 mg with 100% cure rate for at least 5 years.

[Treatment of primary gastric non-Hodgkin's lymphoma]

Fifty-five patients with primary gastric non-Hodgkin's lymphoma were treated in our hospital from 1970 to 1986. The overall 5-year survival rate was 70.5%. For patients with Stages IE and IIE, the 5-year survival rates were 90.5% and 57.1%, respectively. No significant relation to survival was observed concerning sex, age and course of disease. The important prognostic factors of primary gastric non-Hodgkin's lymphoma were: stage, histologic type, depth of invasion and mode of management. Postoperative radiation therapy with or without chemotherapy was better than surgery alone. Total 60Co abdominal irradiation by moving strip technique was better than multifield irradiation. While no evidence was in favor of post-operative radiotherapy plus chemotherapy for stage IE and IIE lesions, multi-disciplinary approach should be considered for patients at high risk of recurrence and metastasis.

[Combined action of pyronaridine and sulfadoxine/pyrimethamine against Plasmodium berghei ANKA strain in mice]

Pyronaridine, a highly effective antimalarial drug, was synthesized and developed by this institute. In order to test whether the joint blood schizontocidal action of pyronaridine (PND) and 2:1 mixture of sulfadoxine/pyrimethamine (SP) resulted in a potentiation or an additive effect, groups of P berghei ANKA strain-infected mice were treated with various single oral doses of PND and SP. Thin blood smears were made after 72 h and the parasitemia-negative rates were calculated. The ED50 values obtained were plotted in isobolograms. An additive action of this triple combination was demonstrated. Mice were inoculated with P berghei ANKA strain-infected erythrocytes 3 and 2 d after the mice were given a single oral dose of PND 10 mg/kg alone, or combined with SP 3 mg/kg. Thin blood smears made on d 3, 5, 8 and 10 revealed that the parasitemia-positive rates and the duration of residual blood schizontocidal action of PND used alone was similar to that of PND used in combination (P greater than 0.05). Three groups of mice carrying P berghei ANKA strain gametocytes were administered orally with pyrimethamine 0.1 mg/kg, SP 0.3 mg/kg and SP 0.3 mg/kg plus PND 0.5 mg/kg, respectively. Anopheles stephensi were then fed on the mice 2 h after the medication. There resulted no significant differences of gametocytocidal and sporontocidal effects among the 3 groups, since the oocyst-positive rate and the glandpositive rate were similar in these groups.

Antimalarial and toxic effect of triple combination of pyronaridine, sulfadoxine and pyrimethamine

The triple combination of pyronaridine, sulfadoxine and pyrimethamine which has been proven to be efficient in delaying emergence of drug resistance of rodent malarial parasites was further studied for potential application to malaria control. The antimalarial effect of the triple combination on Plasmodium berghei ANKA-infected mice and the toxic effects in mice and rats were additive. A single dose of pyronaridine 500 mg in combination with sulfadoxine, 1000 or 1500 mg, and pyrimethamine, 50 or 75 mg, given to 72 acute falciparum malaria patients resulted in a 100% cure rate with nil or mild side effects, and no recrudescence of asexual parasite over 4-week follow-up. Preliminary experiments on the drug effect on sporogony showed that the drug combination at the dose used could not completely interrupt the sporozoite formation although many retarded oocysts were found.

Genomic organization of the human retinoblastoma gene

Sequence analysis of the human retinoblastoma gene cDNA revealed the presence of repeated elements in the form of direct repeats, inverted repeats and dyad symmetries. The clustering of the dyad symmetrical elements in some exons, #16 and #17, coincides with the hot spots for structural aberrations of the RB-1 locus previously observed in tumors. The RB-1 gene is divided into at least 27 exons distributed over 200 kbp. Three potential Sp1 binding sites are presented within 600 bp upstream of the translation start site. A DNA fragment containing these Sp1 sites ligated to a promotorless CAT gene can promote its transcription in transfected cell culture.

Dye laser in ophthalmic disease

From September 1978 to May 1980, dye lasers have been used in the treatment of 56 cases of eye disease (60 eyes), including among others peripheral retinal breaks, macular breaks, prebreak stage degeneration, congenital iris residual membrane, incomplete surgical iridectomy, secondary glaucoma iris bombé, closed-angle glaucoma, vireous hemorrhage, periphlebitis retinae, Coats disease, thrombosis of central and branch retinal vein. Most of the results are satisfactory. Dye laser irradiation has the advantage in iridotomy. Only one pulse can perforate the iris and no serious complication has been encountered. There is a definite therapeutic effect in treatment of vitreous hemorrhage by dye laser.