[Expression and influencing factors of hepcidin in classical paroxysmal nocturnal hemoglobinuria]

目的

研究铁调素在经典型阵发性睡眠性血红蛋白尿症（PNH）患者血清中的表达及其影响因素。

方法

以2016年3月至2017年3月36例经典型PNH患者为研究对象，采用ELISA方法检测血清铁调素水平，并结合患者铁稳态状况和临床资料，分析经典型PNH患者血清铁调素水平与血清铁蛋白（SF）、可溶性转铁蛋白受体、C反应蛋白、EPO、网织红细胞绝对值、网织红细胞血红蛋白等血液学参数的相关性。

结果

36例经典型PNH患者血清铁调素水平为32.03（23.11，118.48）µg/L，明显低于正常对照组的181.42（106.80，250.53）µg/L（z=−5.107，P<0.001）。其中，铁蛋白正常经典型PNH患者血清铁调素水平为56.41（44.60，95.06）µg/L，经典型PNH伴缺铁组血清铁调素水平为23.75（21.77，30.35）µg/L，均低于正常对照组；而经典型PNH伴铁蛋白升高组血清铁调素水平为336.19（304.19，375.08）µg/L，高于正常对照组、铁蛋白正常经典型PNH组及经典型PNH伴缺铁组。多重线性回归分析显示SF、转铁蛋白饱和度和血清白蛋白水平是经典型PNH患者血清铁调素水平的独立影响因素。

结论

经典型PNH患者血清铁调素水平减低，其表达主要受铁代谢因素影响。

[Survey of Schistosoma japonicum infections in wild animals in hilly transmission-controlled areas of Jiangxi Province]

OBJECTIVE

To understand the situation of Schistosoma japonicum infections in wild animals in transmission-controlled schistosomiasis-endemic areas in Jiangxi Province, so as to provide scientific evidence for implementing precision control interventions and achieving the goal of transmission interruption and elimination of schistosomiasis.

METHODS

Five endemic villages from Ruichang City and Pengze County that were heavily endemic for schistosomiasis in Jiangxi Province, were selected as the study villages. Wild animals like wild mice were captured, and the livers of wild animals were purchased from the snail habitats in the study villages for detection of S. japonicum infections. In the study villages, S. japonicum human infections were screened using indirect hemagglutination assay (IHA) followed by parasitological examinations with miracidial hatching test and Kato-Katz method, and the S. japonicum infection in livestock was tested using a miracidial hatching test with a plastic tube. In addition, snail survey was conducted in the study villages by means of systematic sampling combined with environmental sampling, and the S. japonicum infection in snails was detected using a loop-mediated isothermal amplification (LAMP) assay.

RESULTS

A total of 240 liver specimens were sampled or purchased from 5 species of wild animals in the study villages, including wild mice, weasels, pigs, deer and rabbits. A total of 172 wild mice were captured, with a 2.91% rate of S. japonicum infection, and there was no S. japonicum infection detected in other wild animals. The prevalence of Capillaria hepatica infection was 12.21%, 1.96% and 12.50% in wild mice, deer and pigs, respectively. In addition, there was no S. japonicum infection found in either humans or livestock in the study villages, and the mean snail density varied from 0.13 to 0.80 snails/0.1 m² in the study villages. LAMP assay detected S. japonicum infection in 2 tubes in a study village.

CONCLUSIONS

The role of wild animals in schistosomiasis transmission and their potential risks can not be neglected in hilly schistosomiasis-endemic areas of Jiangsu Province after transmission control. Intensified surveillance and targeted control measures should be implemented to consolidate schistosomiasis control achievements.

[A preliminary study on optical coherence tomography of the lacrimal punctum in normal adults]

Objective: To study the imaging characteristics and accumulate data of optical coherence tomography (OCT) of the lacrimal punctum in normal adults. Methods: From September to November 2018, 59 healthy adults (90 eyes) with normal lacrimal punctum structure were enrolled in this cross-sectional study conducted at the Lacrimal Center of Ophthalmology, Third Medical Center of PLA General Hospital, including 21 males (34 eyes) and 38 females (56 eyes), aged 18-65 years. All the subjects were examined by slit lamp microscopy to measure the maximum transverse diameter. OCT was performed to observe the inferior lacrimal punctum, including the external punctal diameter, the punctal diameter at 100 μm and 200 μm depth. The difference in the diameter of different parts of the punctum was analyzed. Independent sample t test and single factor analysis of variance were used for statistical analysis. Results: In normal adults, the maximum transverse diameter under a slit lamp was (545.6±149.3) μm, the external punctal diameter on OCT images was (548.4±130.5) μm, and the punctal width at 100 μm and 200 μm depth on OCT images was (262.8±120.8) μm and (179.2±110.0) μm, respectively. There was no significant difference between the maximum transverse diameter of the punctum under a slit lamp microscope and the OCT outer diameter of the punctum (t=0.133, P=0.894). There were significant differences between the diameter of the lacrimal punctum in the different scanning sites of the OCT (F=213.237, P<0.01). There was significant difference between the punctal width at 100 μm and the external punctal diameter on OCT images (t=15.229, P<0.01). There was significant difference between the punctal width at 200 μm and the external punctal diameter on OCT images (t=20.517, P<0.01). There was significant difference between the punctal width at 100 μm and 200 μm depth on OCT images (t=4.855, P<0.01). Conclusion: The width of different parts of the lacrimal punctum in healthy adults is different on OCT images, and the punctal width at 200 μm depth is the narrowest. (Chin J Ophthalmol, 2019, 55: 695-699).

P4506New indices of arterial stiffness correlates with disease severity and mid-term prognosis in acute decompensated heart failure

Background

Arterial stiffness has been implicated in pathophysiology of heart failure (HF) since it is involved in the ventricular-vascular coupling. Recently, new indices obtained by a cuff oscillometric technique, the arterial velocity-pulse index (AVI) for the stiffness of central arteries and the arterial pressure-volume index (API) for the stiffness of peripheral arteries have been developed and validated. However, the AVI and API measurement has not been attempted in HF population.

Purpose

This study aimed to investigate the relationship between the AVI, API and clinical outcomes in HF patients.

Methods

A prospective cohort of patients with acute decompensated HF were enrolled within 6 months, who were admitted to a tertiary referral hospital in China. Measurement of the AVI and API (AVE-1500, Shisei Datum, Tokyo, Japan) was performed on the day of admission and discharge. Patients were followed up to 6 months for the composite endpoint of all-cause death and HF rehospitalization.

Results

A Total of 127 patients were recruited for analysis (60±15 years, 70% male). 80% of the patients were in New York Heart Association (NYHA) Class III or above at admission, who presented a mean left ventricular ejection fraction (LVEF) of 34±9%. During hospitalization, all patients received guideline directed medical therapy if not contraindicated. The AVI (27.3±5.2 vs. 28.6±6.7, p=0.002) and API (24.9±4.9 vs. 26.0±6.5, p=0.05) were lower at discharge than at admission. By dividing the patients into tertiles according to the amino-terminal pro-brain natriuretic peptide (NT-proBNP), LVEF, transmitral E velocity over mitral annular e' velocity (E/e' ratio) and systolic blood pressure (SBP) at admission, it was observed that the AVI increased with a higher level of NT-proBNP (p for trend <0.001), a larger E/e' (p<0.001) and a lower LVEF (p=0.001), while the API increased as the SBP became higher (p=0.005).The improvement in AVI at discharge was correlated with that in LVEF (R=-0.3024, p<0.05) and NT-proBNP (R=0.3118, p<0.05), while the change in API was positively correlated with that in SBP (R=0.3897, p<0.001). In 6 months after discharge, there were 52 predefined events including 15 deaths and 44 HF rehospitalization. Apart from the level of NT-proBNP, the AVI at discharge of ≥26 showed a trend of being associated with the composite outcome (2.747, 1.411–5.349, p<0.001 for univariate analysis; 1.8648, 0.8928–3.8949, p=0.0973 for multivariate analysis).

Conclusions

New noninvasive arterial stiffness indices as the AVI and API reflected severity of illness and mid-term prognosis in admitted HF patients. Further studies are warranted for understanding its mechanisms and developing clinical applications.

P4376Circumferential ascending aortic strain in healthy adults aged 24 to 75 years

Background

Two-dimensional speckle-tracking echocardiography (2D-STE) for the measurement of circumferential ascending thoracic aortic strain (CAAS) in healthy adults is not elucidated. We aimed to establish normal adult STE-derived CAAS and to evaluate associations with age, gender and other physiologic parameters.

Methods

One hundred eighty-one healthy subjects aged 24–75 were prospectively gathered and examined with two-dimensional echocardiography. The global peak CAAS was the parameter used, and an average of six segments of arterial wall deformation was calculated. The corrected CAAS was calculated as the global CAAS/pulse pressure (PP). Aortic stiffness (β2) index was assessed according to ln(Ps/Pd)/CAAS.

Results

We included 171 healthy subjects (age 44.3±10.9 years, 50% female, CAAS16.0±6.9%). The CAAS was independently predicted by age (β=−0.387, P<0.001), and gender (β=−2.701, P=0.001). The corrected CAAS was independently predicted by age (β=−0.009, P<0.001), SAC (β=−0.206, P<0.001) and gender (β=−0.068, P=0.001). The β2 index was independently predicted by age (β=0.136, P<0.001), and PP (β=0.059, P=0.007).

Conclusion

CAAS using 2D-STE can be performed on a clinical basis and may become an important method for the assessment of aortic mechanical parameter. Age, gender and LV afterload-related variables were the most import determinants of 2D-STE global CAAS. Therefore, these factors should be taken into account for strain interpretation in clinical practice.

[Guillain-Barre syndrome complicated on post-operation with renal carcinoma and meningioma: a case report]

Guillain-Barre syndrome (GBS) is an autoimmune disease on the injury of peripheral nerve myelin proteins or axon, of which the acute motor axonal neuropathy (AMAN) as a subtype is of infrequence and an extremely low incidence of post-operation. This article originally reported one case from Peking University People's Hospital on successful treatment of severe GBS (AMAN) on post-operation with renal carcinoma and meningioma. The diagnostic criteria of AMAN refer to AIDP, of which the feature of AMAN suggests a pure motor nerve dysfunction and significant damage on motor axon. It is reported that infection and surgery may induce GBS. The positive result of IgM and IgG was considered the application of ganglioside and blood-brain barrier might be damaged after meningioma surgery which eased the drug to enter the cerebrospinal fluid circulation and induced lesions, therefore the etiology on this GBS case was of high confidence of administrating ganglioside drugs. Autonomic nerve dysfunctions, such as blood pressure fluctuations and arrhythmia could be caused in GBS, of which about 3%-10% of GBS patients would die. Early use of gamma globulin or plasma exchange was recommended internationally, but recently some new ideas, to some extent, of significance on GBS treatment emerged. However, there was still no consensus on GBS treatment systematically all over the world. Till now, the general treatment program on GBS may be still gamma globulin or plasma exchange and a curious judgment of prognosis is essential in order to make a reasonable plan. That it was usually of no omen on severe autonomic nerve dysfunction must be successively monitored, the same as the management of the respiratory tract and nutrition support. The key measures taken on lung recruitment was postural drainage on this case with a low cost but a qualified effectiveness. This case report aimed to deepen the understanding of AMAN and acquaint the cutting-edge advances on the treatment of GBS, as well as providing successful treatment experience for the prevention on similar cases.

[Application of recurrent neural network in prognosis of peritoneal dialysis]

OBJECTIVE

Deep learning models, including recurrent neural network (RNN) and gated recurrent unit (GRU), were used to construct the clinical prognostic prediction models for peritoneal dialysis (PD) patients based on routine clinical data. The performance of the RNN and GRU were compared with logistic regression (LR), which is commonly used in medical researches. The possible underlining clinical implications based on the result from the GRU model were also investigated.

METHODS

We used the clinical data from the PD center of Peking University Third Hospital as the data source. Both the baseline data at the beginning of dialysis, and the follow-up and prognostic data of the patients were used by the RNN and GRU prediction models. The hyper-parameters were tuned based on the 10-fold cross-validation. The risk prediction performance of each model was evaluated via area under the receiver operation characteristic curve (AUROC), recall rate and F1-score on the testset.

RESULTS

A total of 656 patients with the 261 occurrences of death were included in the experiment. The total number of all diagnostic records were 13 091. The results on the testset showed that the AUROC of the LR model, RNN model, and GRU model was 0.701 4, 0.786 0, and 0.814 7, respectively. The predictive performances of the GRU and RNN models were significantly better than that of the LR model. The performances of the GRU and RNN models assessed by recall rate and F1-score were also significantly better than that of the LR model, in which the GRU model reached the best performance. In addition, the recall rates were different among different causes of death or by different prediction time windows.

CONCLUSION

The recurrent neural network model, especially the GRU model, is more effective in predicting PD patients' prognosis as compared with the LR model. This new model may be helpful for clinicians to provide timely intervention, thus improving the quality of care of PD.

[Application of immunophenotypic analysis and molecular genetics in the diagnosis of acute promyelocytic leukemia]

目的

研究免疫表型分析及分子遗传学在急性早幼粒细胞白血病（APL）诊断中的应用价值。

方法

对2012年5月–2017年12月门诊或住院的798例APL患者的流式细胞术（FCM）免疫分型、染色体核型及染色体荧光原位杂交（FISH）进行回顾性分析，并深入研究FCM免疫表型及分子遗传学在APL诊断中的应用价值。

结果

FCM诊断APL敏感性为91.9%，特异性为98.7%。APL具有独特免疫表型特点：典型APL的表型为侧向（SSC）偏大，CD34和HLA-DR表达缺失，表达或强表达CD33，均一表达CD13、CD9、CD123，可伴有CD56、CD7、CD2的表达。约10%的患者为非典型APL表型，一般伴有CD34和（或）HLA-DR表达，SSC减小，经常伴有CD2表达，而FCM免疫分型很难明确诊断为APL，需要依赖遗传学或者分子生物学检查结果。约1/3的患者除存在t（15;17）（q22;q21）外，还存在额外染色体异常；伴有t（15；17）的复杂核型、变异易位或者t（11;17）、t（5;17）等变异型的APL，FCM表型与单纯t（15；17）APL差异无统计学意义（P>0.05）。

结论

FCM能够快速诊断APL，伴有额外染色体异常患者和单纯t（15；17）患者FCM免疫表型没有明显差异。遗传学是诊断APL的金标准，免疫分型中约10%的患者依赖于分子遗传学来确诊。

New Isotope ^{220}Np: Probing the Robustness of the N=126 Shell Closure in Neptunium

A new short-lived neutron-deficient isotope ^{220}Np was synthesized in the fusion-evaporation reaction ^{185}Re(^{40}Ar,5n)^{220}Np at the gas-filled recoil separator SHANS. Based on the measurement of the correlated α-decay chains, the decay properties of ^{220}Np with E_{α}=10040(18)  keV and T_{1/2}=25_{-7}^{+14}  μs were determined, which are in good agreement with theoretical predictions. From the new experimental results coupled with the recently reported α-decay data of ^{219,223}Np, the α-decay systematics for Np isotopes around N=126 was established, which allows us for the first time to test the robustness of the N=126 shell closure in Z=93 Np isotopes. The results also indicate that, in the region of nuclei with Z≥83, the proton drip line has been reached for all odd-Z isotopes up to Np.

[Discussion on the indications of internal mammary sentinel lymph node biopsy in breast cancer in the era of precision medicine]

Objective: To determine the clinical benefits of internal mammary sentinel lymph node biopsy (IM-SLNB) acquired by breast cancer patients with clinically positive axillary lymph node (ALN), and further optimize the IM-SLNB indications. Methods: All primary breast cancer patients with clinically positive ALN from February 2014 to September 2017 were prospectively recruited in this study. IM-SLNB was performed under the guidance of the modified injection technique. The success rate and visualization rate of IM-SLNB, metastatic rate of internal mammary sentinel lymph node (IMSLN) and its related factors were analyzed, and the clinical benefits were accessed according to the current guidelines. Results: Among 126 patients, all of 94 patients (74.6%) who showed internal mammary drainage successfully underwent IM-SLNB. The incidence of internal mammary artery bleeding and pleural lesion were 4.3%(4/94) and 9.6%(9/94), respectively. The metastatic rate of IMSLN was 38.3% (36/94), which was significantly associated with the number of positive ALN (P<0.001) and tumor size (P=0.024). The lymph node staging of 94 patients who underwent IM-SLNB was more accurate. Among them, 36 cases with positive IMSLN underwent internal mammary radiotherapy (IMRT), while the other 58 cases with negative IMSLN avoided radiotherapy. Conclusions: IM-SLNB should be routinely performed in patients with positive ALN. IM-SLNB can provide more accurate staging and guide tailored IMRT to benefit more breast cancer patients.

[Results for the treatment of fresh type thoracolumbar vertebral fracture according to the intraoperative CT scan]

Objective: To evaluate the value of intraoperative CT scanning in the treatment of fresh thoracolumbar burst fractures. Methods: From January 2008 to January 2015 , 161 patients with thoracolumbar fractures in Department of Orthopedics, Luohe City Central Hospital, were divided into two groups: 79 cases were treatment group which were treated with intraoperative CT scan and decompression mode was determined according to CT scan results during the period from October 2012 to January 2015. 82 patients as the observation group were treated without intraoperative CT scan and direct laminectomy were performed during the period. In the treatment group, it is no further decompression of the spinal canal when the CT showed a reduction of the fracture block into the spinal canal, if the intraoperative CT showed that the fractures still occupied the spinal dura mater according to the three-dimensional CT information, the position and the size of the fracture of the spinal canal were determined, and the unilateral laminectomy was performed corresponding to the position of the lamina and intervertebral ligamentum flavum. The operative time, bleeding volume, neurological function, height of the anterior vertebral compression and Cobb angle were compared between the two groups. Results: In the treatment group, CT scan showed 48 cases (60.8%) entered the spinal canal fracture completely or basically reset.31 cases (39.2%) still occupied the spinal canal compression spinal dura mater. There were significant differences in the operation time and bleeding volume between the two groups. The treatment group was less than the control group. There was no infection, secondary spinal cord injury, loose fixation and other complications. There was no difference in the ASIA classification before and after operation(χ(2)=0.268 vs χ(2)=1.372, P>0.05). The anterior vertebral height and COBB angle of the two groups were significantly improved compared with those before operation. There was no significant difference between the two groups in the postoperative height and COBB angle[(40.3±11.8)° vs(82.1±4.2)°, (-10.3±2.6)° vs(6.9±3.3)°, P<0.05], but after 2 years the difference was statistically significant between the two groups, to retain the rear ligament complex treatment group was significantly better than the control group. Conclusions: Patients of thoracolumbar vertebral fracture in hyperextension position combined with internal fixation can achieve good correction effect. Orthopedic postoperative CT scan and according to the results of the scan precision treatment can simplify the operation, there was no difference in clinical efficacy compared with total laminectomy, but some patients avoid the spinal canal decompression and part were treated by small fenestration laminectomy decompression, which is conducive to the protection of spinouts ligament complex integrity.

[Efficacy of bronchoalveolar lavage and its influence factors in the treatment of Mycoplasma pneumoniae pneumonia with atelectasis]

Objective: To investigate the efficacy of bronchoalveolar lavage (BAL) and its influence factors in the treatment of Mycoplasma pneumoniae pneumonia (MPP) with atelectasis. Methods: A retrospective case control study was performed on hospitalized MPP patients with atelectasis and received BAL in the Department of Pulmonology, Children's Hospital Zhejiang University School of Medicine from January 1, 2015 to July 31, 2017. Fever relieved in 48 hours and chest imaging improved in one week after BAL were considered effective. Clinical data, including age, sex, blood routine tests, lactate dehydrogenase (LDH), cytokines, complications, fever duration before BAL, course of disease before BAL, sputum plug, atelectasis area and its CT values of atelectasis site were collected. Student's t test, Mann-Whitney U test, or chi square test were used. Results: (1) A total of 163 patients were enrolled, including 69 boys and 94 girls, with the ratio of 1∶1.36. Their ages ranged from 6 months to 12.6 years. (2) On the day of bronchoscope, 113 patients still had fever. They were divided into effective group (n=66) and ineffective group (n=47) according to whether fever was relieved in 48 hours after BAL. The effective group were found to have less sputum plug compared with the ineffective group (33% (22/66) vs. 57% (27/47), χ(2)=6.499, P=0.011). The other factors such as sex, age, fever duration before BAL, course of disease before BAL, C reactive protein (CRP), LDH, IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, atelectasis area and CT value showed no significant difference between the two groups (all P>0.05). (3)A total of 122 cases had chest imaging after BAL. According to chest imaging improvement, they were divided into effective group (n=81) and ineffective group (n=41). The effective group showed lower CT value ((58±9) vs. (63±8) HU, t=-2.436, P=0.017), IL-6 and IL-10 (M(Q(1), Q(3))) (21.0 (1.9, 48.4) vs. 36.4(21.8, 93.6), 4.9 (3.7, 9.6) vs. 7.7 (4.4, 12.0) ng/L, Z=-2.387,-2.009, P=0.017, 0.045). Sex, age, fever duration before BAL, course of disease before BAL, CRP, LDH, IL-2, IL-4, TNF, IFN-γ, atelectasis area showed no significant differences between the two groups (all P>0.05). (4) Patients were divided into sputum plug group (57 cases) and non sputum plug group (106 cases) according to bronchoscopic findings. The sputum plug group showed higher LDH, CRP, IL-6, IFN-γ, incidence of pleural effusion and extrapulmonary complications (585(433, 833) vs. 369 (312, 588) U/L, 42 (19, 103) vs. 25 (12, 45) mg/L, 38.8 (22.1, 71.3) vs. 20.7 (9.2, 48.3) ng/L, 33.1 (13.5, 89.3) vs. 12.7 (6.5, 33.6) ng/L, 73.7% (42/57) vs. 52.8% (56/106), 40.4% (23/57) vs. 17.0% (18/106)), with statistically significant differences (Z=-4.865,-3.435,-3.098,-3.704, χ(2)= 0.010, 0.001, all P<0.01) . Additionally, fewer patients showed fever relief within 48 hours after BAL in the cases with sputum plug cases compared those without sputum plug (44.9% (22/49) vs. 68.8% (44/64), χ(2)= 0.011, P=0.009). Fewer patients showed chest imaging improvement within one week after BAL in the cases with sputum plug compared with those without sputum plug, but did not show significant difference (56.5% (26/46) vs. 72.4% (55/76), χ(2)=0.073, P=0.056). Conclusions: BAL has some therapeutic effect on fever or atelectasis in MPP children complicated with atelectasis. Chest imaging improvement or fever relief may be hampered by sputum plug, increased IL-6 or IL-10.

[Effect of biofeedback therapy on metabolic syndrome under different levels of job stress]

Objective: To investigate the effect of biofeedback therapy on metabolic syndrome (MS) and the effect of different levels of job stress on the outcome. Methods: The physicians in tertiary hospitals who were diagnosed with MS from January to December, 2016 were divided into biofeedback group and health education group according to different intervention methods, and moderate group, medium group, and high group according to different levels of job stress. A 6-month intervention was implemented from May to October, 2017. A two-way factorial design was used to analyze the main effect of biofeedback on physical and biochemical parameters and the interaction of biofeedback and job stress. Results: After 6 months of intervention, the patients in both the biofeedback group and the moderate group had significantly decreased waist circumference, body mass index, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , and levels of triglyceride (TG) , total cholesterol, low-density lipoprotein cholesterol (LDL-C) , and fasting plasma glucose (FPG) and a significantly increased level of high-density lipoprotein cholesterol (HDL-C) (all P<0.05) ; the patients in both the health education group and the moderate group had significantly decreased SBP, DBP, and levels of TG, LDL-C, and FPG (P<0.05) . The factorial analysis of variance showed that there was a synergistic interaction between the intervention method and job stress level in SBP, DBP, TG, HDL-C, LDL-C, and FPG among MS patients (P<0.05) . The high group had significantly more improvements in all indices compared with the medium group and the moderate group (P<0.05) . Conclusion: Biofeedback therapy can effectively improve blood pressure, blood lipids, and blood glucose in MS patients, and is more effective for patients with high job stress level.

[In vitro and in vivo effects of 5-aminolevulinic acid-mediated photodynamic therapy against oral squamous cell carcinoma]

Objective: To investigate the in vitro and in vivo effects of 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy against oral squamous cell carcinoma (OSCC) and preliminarily explore the possible mechanisms. Methods: SCC25 cells were divided into the control group (5-ALA of 0 mg/L) and the experimental group (5-ALA of 10, 25, 50, 100 and 150 mg/L). The production of protoporphyrin Ⅸ (PpⅨ) induced by 5-ALA in SCC25 cells was detected using the flow cytometry. SCC25 cells were divided into the control group (5-ALA of 0 mg/L), lazer alone group, 5-ALA alone group (5-ALA of 100 mg/L) and the 5-ALA combined with laser irradiation group (5-ALA of 5, 10, 25, 50 and 100 mg/L), the cytotoxicity of 5-ALA combined with laser irradiation (wave length 635 nm, power density 87 mW/cm(2) and laser dose 10.4 J/cm(2)) was evaluated in SCC25 cells using the methyl thiazolyltetrazolium assay (incubation times of 4, 8 and 12 h in each group) and the induction effect of combination treatment on the cell apoptosis was assessed by the flow cytometry (incubation time of 12 h in each group). The intracellular production of reactive oxygen species (ROS) triggered by 5-ALA combined with laser irradiation was determined using a fluorescence probe method (incubation time of 12 h in each group). A mouse OSCC xenograft model bearing SCC25 tumor was built, and the mice were divided into control group (saline), 5-ALA group (5-ALA of 50 mg/kg) and 5-ALA combined with laser irradiation group (5-ALA of 10, 25 and 50 mg/kg). Antitumor effect of 5-ALA combined with laser irradiation (wave length 635 nm, power density 158 mW/cm(2) and laser dose 94.8 J/cm(2)) was further measured. Results: 5-ALA induced the production of PpⅨ in SCC25 cells in a drug concentration (0-150 mg/L)-and incubation time (0-24 h)-dependent manner. When the 5-ALA concentration was 100 mg/L, the intracellular PpⅨ production was in a relatively stable state. Cell viability and apoptosis rate of 5, 10, 25, 50, 100 mg/L 5-ALA combined with laser irradiation are, respectively, (82.3±5.2)%, (3.13±0.38)%; (74.6±9.3)%, (5.38±0.55)%; (38.3±9.7)%, (17.97±2.72)%; (9.2±3.8)%, (24.47±3.37)%; (7.2±0.8)%, (43.01±5.96)%, which indicated that 5-ALA combined with laser irradiation notably inhibited the growth of SCC25 cells and also induced significant cell apoptosis compared with the control group [(96.3±6.0)%, (0.35±0.13)%, P<0.05]. After combination treatment (5-ALA of 5, 10, 25, 50 and 100 mg/L combined with laser irradiation, the mean fluorescence intensity of dichlorofluorescein is (1.46±0.12)×10(4), (2.16±0.30)×10(4), (3.57±0.34)×10(4), (81.70±13.05)×10(4), (113.00±7.35)×10(4), respectively, a large amount of ROS was produced in SCC25 cells compared with the control group [(0.96±0.15) ×10(4), P<0.05], which was in positive correlation with the intracellular PpⅨ content. 5-ALA (concentration of 10, 25 and 50 mg/kg) combined with laser irradiation greatly suppressed the tumor growth in SCC25 tumor-bearing mice compared to the control group (P<0.05). Conclusions: 5-ALA-mediated photodynamic therapy can trigger the generation of intracellular ROS that has significant cytotoxicity and apoptosis induction effect, and thus inhibit the tumor growth both in vitro and in vivo.

[Infiltration of tumor associated macrophages in multiple myeloma and its clinical significance]

目的

探讨肿瘤相关性巨噬细胞（TAM）在多发性骨髓瘤（MM）中的临床意义及其与肿瘤血管生成、免疫抑制的关系。

方法

以2015年8月至2017年6月就诊的70例MM患者为观察对象，以20例良性血液病（缺铁性贫血13例，巨幼细胞性贫血7例）患者为对照，采用免疫组化法检测骨髓标本中CD163、CD34、VEGF的表达，采用流式细胞术检测Treg细胞比例，采用ELISA法检测IL-10水平，结合临床特征进行分析。

结果

①70例患者中，男31例，女39例，中位年龄65（50~78）岁。MM患者组的TAM浸润密度、微血管密度（MVD）、VEGF表达水平、Treg细胞比例及IL-10水平均较对照组升高（P值均<0.05）。②在MM患者组中，疾病稳定组（15例）患者的上述指标均较初诊组（35例）和复发难治组（20例）低（P值均<0.05）；后两组差异无统计学意义（P值均>0.05）。③35例初诊MM患者中27例完成4个疗程治疗，有效组（15例）治疗后TAM浸润密度较治疗前明显下降，差异有统计学意义[（20.20±7.66）对（28.87±11.97）个/高倍，t=2.362，P=0.025]；无效组（12例）治疗前后差异无统计学意义[（42.00±13.76）对（48.25±13.59）个/高倍，t=1.119，P=0.275]。④硼替佐米方案治疗有效组患者（21例次）的TAM浸润密度较非硼替佐米方案治疗有效组（18例次）减低[（16.52±4.26）对（19.27±5.82）个/高倍，t=1.662，P=0.170]。⑤MM患者的TAM浸润密度与MVD、VEGF表达水平、Treg细胞比例及IL-10水平呈正相关（P值均<0.001）。

结论

骨髓微环境中浸润的TAM与MM发生、发展、疗效及治疗耐药有关，其作用机制可能与TAM促进肿瘤血管形成及抑制免疫反应有关。

[Comparison of percutaneous endoscopic lumbar discectomy versus transforaminal lumbar interbody fusion in treating upper lumbar disc herniation]

Objective: To compare the efficacy of percutaneous endoscopic transforaminal discectomy (PTED) and transforaminal lumbar interbody fusion (TLIF) in the treatment of high lumbar disc herniation. Methods: The clinical data of patients with high lumbar disc herniation from February 2010 to February 2015 were retrospective analyzed. According to the inclusion criteria, a total of 63 cases were enrolled, including PTED group 33 cases, TLIF group 30 cases. The improvement of the two groups before and after surgery was assessed by visual analogue scale (VAS) and Oswestry dysfunction index (ODI). The operative time, intraoperative blood loss, drainage volume at 48 h postoperatively, hospitalization time, number of fluoroscopy, complication, recurrence rate and postoperative recovery were compared between the two groups. The follow-up period was 12 to 33 months. Results: The operation time, intraoperative blood loss, drainage amount and hospitalization time in PTED group were significantly less than those in TLIF group[(71±19) vs (121±22) min, (30±21) vs (317±50) ml, 0 vs (93±29) ml, (3.5±1.9) vs (12.5±2.1) d]. The number of fluoroscopy in PTED group was significantly higher than TLIF group[(16.2±8.3) vs (6.7±4.2)](all P<0.05). There was no significant difference in VAS score and ODI improvement rate between the two groups after operation (both P>0.05). There was no significant difference between the two groups in the excellent rate of surgery and the recurrence rate (both P>0.05). Conclusions: PTED has the advantages of less trauma and bleeding, rapid postoperative recovery in the treatment of upper lumbar disc herniation compared with TLIF, and the curative effect and recurrence rate are similar with TLIF. Therefore, PTED is an effective method for the treatment of upper lumbar disc herniation.

Application of Multiple Kits in Special Parentage Testing Cases

OBJECTIVES

To analyse the genetic polymorphism of 21 autosome STR loci in Han population of Shandong Province and the cases with loci mutation or allelic loss typed by Goldeneye® DNA identification system 25A.

METHODS

Totally 40 autosome STR loci types of 273 unrelated individuals in Han population of Shandong Province were typed by Goldeneye® DNA identification system 25A and 22NC, and the genetic polymorphism of 21 STR loci in those was analysed. Meanwhile, six cases with loci mutation were analysed by adding the tests with Goldeneye® DNA identification system 22NC, 20Y and 17X. Another three cases with allelic loss were tested by AmpFℓSTR® Identifiler® Plus PCR and analysed by gene sequencing.

RESULTS

The genetic parameters of 21 autosome STR loci in Han population of Shandong Province were obtained. When STR loci were added up to 40, five of those with loci mutation met the identification requirements, and the results of X-STR or Y-STR types were consistent with that of STR loci. There was another duo case with one suspected loci mutation, biological source of six STR loci genotypes could not be found in the genotypes of supposed father. The Y-STR genotype of two individuals was identical that indicated both of them came from same paternal line. However, the fatherhood was excluded according to the autosome STR loci system. For two cases with allelic loss on D18S51, base mutation or loss were found in the primer binding domain of mother and child by gene sequencing. Another mother-child case with allelic loss on D13S317 was certified by AmpFℓSTR® Identifiler® Plus PCR kit.

CONCLUSIONS

The 21 autosome STR loci in Han population of Shandong Province have high polymorphism, which can be used in routine cases of paternity identification. For some duo cases with loci mutation, Goldeneye® DNA identification system 25A cannot satisfy the identification requirements, thus more autosome STR loci should be added properly. For the cases with allelic loss, the problem can be resolved by gene sequencing or using different merchant kits.

[Meta analysis of surgical treatment for old Monteggia fracture in children]

Objective: To analysis the treatment effect of the ulnar osteotomy and ring-shaped ligament reconstruction for the treatment of old Monteggia fracture in children by using Meta analyze, and the difference of clinical curative effect was compared in order to provide the basis for the selection of clinical treatment options for old Monteggia fractures in children. Methods: We searched databases such as CNKI, Wanfang database, Medline, PubMed, Embase and Science through computer, at the same time, the references of relevant documents were retrieved manually, and the data processing was carried out by the RevMan5.3 statistical software provided by the Cochrane cooperation network by incorporating the exclusion criteria. The results were obtained and analyzed. Results: A total of 17 standard literature, 438 cases, 224 cases of ulnar osteotomy, 214 cases with ring ligament repair and reconstruction were obtained. The operation scheme, which was mainly based on the lengthening of ulna osteotomy, was superior to the reconstruction of ring ligament reconstruction. The complications and second operation rates of the former was less than that of the latter. Conclusion: The surgical methods for the reconstruction of the ulna osteotomy and the ring-shaped ligament have advantages and disadvantages. The choice of the operative plan for the old Monteggia fracture should be based on the following factors: the time of the old Monteggia fracture formation, the degree of the ulnar and radial deformity and the familiarity of the operative method.

[Genetic Polymorphisms of 19 STR Loci in Populations of Three Culture Region in Shandong]

OBJECTIVES

To analyse the genetic polymorphisms of 19 autosomal STR loci in Han population of east, middle-northwest and southwest-south Shandong and to explore its genetic relationships among the population of these three regions.

METHODS

STR loci of 1 044 unrelated Han individuals in three Shandong regions were typed with a Goldeneye® DNA ID System 20A kit. The allele frequency and population genetics parameters of 19 autosomal STR loci were statistically analysed by Modified-Powerstates software. The genetic distances among the population in three regions were calculated by Arlequin v3.5 software. The phylogenetic tree was conducted using MEGA v4.0 software.

RESULTS

Fifteen of 19 autosomal STR loci were detected with the H values greater than 0.7, PIC values greater than 0.7, and DP values greater than 0.9 in the populations of all three Shandong regions. Among the populations in these three regions, the genetic distance between the populations in middle-northwest and southwest-south Shandong was closest （F_st=0.000 16）, followed by east and southwest-south Shandong （F_st=0.0003 6）. The genetic distance between the populations in east and middle-northwest Shandong was the farthest （F_st=0.000 66, P<0.05）.

CONCLUSIONS

The 19 autosomal STR loci show good genetic polymorphisms in Han population of three Shandong regions, and 15 of them are high. There are genetic differences between the populations in east and middle-northwest Shandong.

[High risk factors analysis of stillbirth]

Objective: To explore the high risk factors of stillbirth. Methods: 176 cases of stillbirth were collected in the Obstetrics and Gynecology Hospital of Fudan University from January 1(st), 2010 to December 31(st), 2016. All cases were analyzed retrospectively, including general profile, high risk factors of stillbirth in different years and pregnancy periods. Results: (1) The incidence of stillbirth was 0.178%(176/98 785). Stillbirth occured mostly at 28-28(+6) gestational weeks (10.8%,19/176), and the second peak was 29-29(+6) weeks(10.2%,18/176), while the third common period was 37-37(+6) weeks (9.1%,16/176). After 39 weeks, it maintained at a low level. (2) The top 5 high risk factors of stillbirth were infection (18.2%,32/176), unexplained (13.6%,24/176), hypertention disorders in pregnancy (13.1%, 23/176), umbilical cord torsion (12.5%, 22/176) and fetal malformations (10.2%, 18/176). (3) From 2010 to 2012, the top 3 high risk factors were unexplained, the umbilical cord torsion and infection, while hypertention in pregnancy, infection and fetal malformation became the top 3 high risk factors after 2013. (4) Early stillbirth (20-27(+6) weeks) accounted for 21.6%(38/176); and unexplained (47.4%, 18/38), fetal edema (13.2%, 5/38),infection (13.2%, 5/38), umbilical cord torsion (5.3%, 2/38) were the top 4 high risk factors. Late stillbirth (≥28 weeks) accounted for 78.4%(138/176), with infection (19.6%,27/138), hypertention in pregnancy (15.9%,22/138), umbilical cord torsion (14.5%,20/138) and fetal malformation(12.3%,17/138)being the top 4 high risk factors. Conclusions: More attention should be paid to maternal complications, especially infection and hypertension in pregnancy. Antenatal fetal monitoring, timely termination of pregnancy, standard management of stillbirth and looking for the causes may help reduce the incidence of stillbirth.

Targeted sequencing of maternal plasma for haplotype-based non-invasive prenatal testing of spinal muscular atrophy

Five pregnant women with a child affected by spinal muscular atrophy (SMA) were recruited between November 2014 and March 2015. Deletion of exons 7 and/or 8 in the SMN1 gene were identified by multiplex ligation-dependent probe amplification (MLPA), the current standard diagnostic test for SMA. Parental and fetal haplotypes of the SMN1 gene were determined in each family from haplotype-based non-invasive testing of blood samples and maternal plasma, respectively. Fetal haplotype was compared with the results of MLPA of fetal DNA obtained from amniotic fluid or chorionic villi. Parental haplotypes were constructed successfully in the five families. Assisted by the information on parental haplotype, non-invasive testing of maternal plasma identified one fetus with homozygous deletion of exons 7 and 8, two fetuses with heterozygous deletion of exons 7 and 8 and two normal fetuses. These results were consistent with the diagnosis by MLPA. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

[Clinical analysis of seven cases of pulmonary malignant tumors in children]

Objective: To understand the clinical manifestation, imaging characteristics and outcomes of pulmonary malignant tumors in children. Method: We retrospectively collected information about seven cases of pulmonary malignant tumors in children in our hospital from Jan 2010 to Dec 2016. The information included clinical manifestation, imaging characteristics, pathologic results, and treatment. Result: (1) All the seven patients firstly visited pediatric internal medicine departments. Symptoms included cough (n=6), dyspnea (n=4), fever (n=2), anorexia (n=2), chest tightness (n=1), chest pain (n=1), lameness (n=1), abdominal distension and constipation (n=1). We did not find hemoptysis, wheezing or weight loss in those patients. Physical examinations revealed unilateral reduced breath sounds (n=5), moist rales and wheezes (n=1), and normal (n=1). Extrapulmonary signs included abdominal distension (n=2), left hip tenderness (n=1), and mass in left scrotum. We did not identify clubbing finger, anemic appearance, lymph node enlargement, or hepatosplenomegaly etc. (2) Laboratory examination results: complete blood count showed white blood cells in normal range except one case (17.44×10(9)/L). Neutrophil percentage ranged from 0.348 to 0.767. C reactive protein ranged between<1 and 162 mg/L. Hemoglobin was normal. Three out of four cases had abnormal blood tumor markers.(3) Imaging results showed multiple nodes (n=3), multiple cystic lesions in lungs (n=2) (both with pleuropulmonary blastoma), endobronchial soft tissue mass (n=1), pulmonary round-shaped mass (n=1), and mediastinal mass (n=1). Imaging results also found atelectasis (n=3), pneumonia (n=2), pneumothorax (n=2), longitudinal diaphragmatic hernia (n=2), pleural effusion (n=1), subcutaneous emphysema (n=1). (4) All the patients underwent tumor puncture biopsy or tumor resection. Pathology revealed the final diagnosis of pleuropulmonary blastoma (n=3), endodermal sinus tumors (n=2), squamous cell carcinoma of lung (n=1), and thyroid papillary carcinoma (n=1). All of them were malignant tumors. We followed up them. Two patients died (both with pleuropulmonary blastoma) after their parents refused any medical help. Two cases were lost to follow-up. Three patients survived (followed up for 19 months, 11 months and tow months, respectively). One case with thyroid papillary carcinoma pulmonary metastasis underwent right thyroid cancer radical plus left thyroid lobe resection plus modified selective central lymph node dissection, then iodine (131) treatment. One case with endodermal sinus tumor pulmonary metastasis underwent three times of chemotherapies, resection of left retroperitoneal tumor and left testicular tumor, and six additional chemotherapies. Another one case of endodermal sinus tumor pulmonary metastasis underwent three times of chemotherapies and was discharged. Conclusion: Pulmonary malignant tumors are rare diseases in children. Clinical signs are often non-specific. For those with chest CT showing multiple cystic lesions, endobronchial soft tissue mass or multiple nodes, but no significant infection manifestation or no response to anti-infection therapy, pulmonary malignant tumors should be considered. Biopsy may be needed to confirm the final diagnosis.

Analysis of the 19 Y-STR and 16 X-STR loci system in the Han population of Shandong province, China

The sex-linked short tandem repeats (STR), Y-STR and X-STR, are important for autosomal STRs in forensic paternity testing. We evaluated the forensic parameters of 19 Y-STRs and 16 X-STRs in the Han population of Shandong province, China. A Goldeneye 20Y kit (DYS391, DYS389I, DYS390, DYS389II, DYS348, DYS456, Y-GATA-H4, DYS447, DYS19, DYS392, DYS393, DYS388, DYS439, DYS635, DYS448, DYS460, DYS458, DYS437, DYS385 a/b) was used to analyze the forensic parameters of 534 unrelated males. A Goldeneye17X system (DXS6795, DXS9902, DXS8378, HPRTB, GATA165B12, DXS7132, DXS7424, DXS6807, DXS6803, GATA172D05, DXS6800, DXS10134, GATA31E08, DXS10159, DXS6789, DXS6810, amelogenin) was used to analyze 97 unrelated males and 214 females. In addition, we used the kits to examine 5 cases with abnormal amelogenin test results, as well as a male child with agenosomia typed by autosomal STR. We found 203 Y-STR haplotypes with allele frequencies ranging from 0.0019 to 0.7959, and GD ranging from 0.3429 to 0.9667. Expect in DXS6803, the allele frequencies of the other 15 X-STR loci showed no differences between females and males. PD_F ranged from 0.5504 to 0.9638, while PD_M ranged from 0.3176 to 0.8377. With the exception of DXS6803 and DXS6810, the allele frequencies of other X-STR loci were in accordance with Hardy-Weinberg equilibrium in females. One amelogenin negative case was characterized as a deletion of Y-DYS458. This paper provided data regarding the genetic polymorphism of Y-STRs and X-STRs in the Han population, and demonstrated the importance of Y-STR and X-STR in forensic autosomal STR analysis.

[Efficacy of Coflex in the treatment of lumbar spondylolisthesis]

Objective: To study the clinical results of Coflex and lumbar posterior decompression and fusion in the treatment of lumbar degenerative spondylolisthesis at L(4-5). Methods: Thirty-eight patients with Grade Ⅰ degenerative spondylolisthesis, from January 2008 to December 2011 in Beijing Chaoyang Hospital, Capital Medical University were reviewed, and patients were divided into two groups by randomness. Group A was treated with Coflex and group B with pedicle instrumentation and interbody fusion. Fifteen patients were included in group A, and 23 patients were included in group B. In group A, the average age was (56.3±9.1) years. In group B, the average age was (58.2±11.2) years. The clinical results were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI). Slip distance (SD) was measured before and after surgery, and the changes of intervertebral angle at index level and adjacent level were also recorded. Results: The follow-up period was 36 to 68 months, with the average of (39±14) months in the both groups. The operation time and bleeding volume of patients in group A were significantly less than that of group B (P<0.05). In both groups, the difference of ODI and VAS before operation and postoperative follow-up were statistically significant (P<0.05). There was no significant difference between lumbar intervertebral angle and the sliding distance in group A at all time points. In the group B, there was a significant increase in the intervertebral angle and the sliding distance at L(3-4) and L(5)-S(1 )level after surgery, the difference at upper and below adjacent segment before and after surgery were statistically significant. Conclusions: Coflex interspinous dynamic stabilization system has same excellent clinical results as pedicle screw instrumentation and fusion surgery for the treatment of L(4-5) degenerative spondylolisthesis; no significant progression of spondylolisthesis been observed during more than 3 years follow-up, and no obvious adjacent segment degeneration has been found.

Endothelial microparticles are increased in congenital heart diseases and contribute to endothelial dysfunction

Background

We previously demonstrated that endothelial microparticles (EMPs) are increased in mitral valve diseases and impair valvular endothelial cell function. Perioperative systemic inflammation is an important risk factor and complication of cardiac surgery. In this study, we investigate whether EMPs increase in congenital heart diseases to promote inflammation and endothelial dysfunction.

Methods

The level of plasma EMPs in 20 patients with atrial septal defect (ASD), 23 patients with ventricular septal defect (VSD), and 30 healthy subjects were analyzed by flow cytometry. EMPs generated from human umbilical vascular endothelial cells (HUVECs) were injected into C57BL6 mice, or cultured with HUVECs without or with siRNAs targeting P38 MAPK. The expression and/or phosphorylation of endothelial nitric oxide synthase (eNOS), P38 MAPK, and caveolin-1 in mouse heart and/or in cultured HUVECs were determined. We evaluated generation of nitric oxide (NO) in mouse hearts, and levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in cultured HUVECs and in mice.

Results

EMPs were significantly elevated in patients with ASD and VSD, especially in those with pulmonary hypertension when compared with controls. EMPs increased caveolin-1 expression and P38 MAPK phosphorylation and decreased eNOS phosphorylation and NO production in mouse hearts. EMPs stimulated P38 MAPK expression, TNF-α and IL-6 production, which were all inhibited by siRNAs targeting P38 MAPK in cultured HUVECs.

Conclusions

EMPs were increased in adult patients with congenital heart diseases and may contribute to increased inflammation leading to endothelial dysfunction via P38 MAPK-dependent pathways. This novel data provides a potential therapeutic target to address important complications of surgery of congenial heart disease.

Electronic supplementary material

The online version of this article (doi:10.1186/s12967-016-1087-2) contains supplementary material, which is available to authorized users.

[Epidemic features of dyslipidemia among Uygur, Kazakh and Han ethnic groups in Urumqi]

Objective: To analyze the epidemic features of dyslipidemia among 39 980 Uygur, Kazak and Han ethnic groups in Urumqi, and to explore the methods of prevention and treatment on dyslipidemia. Methods: The differences of blood total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) of health examination population with different ethnics, genders, and ages were compared, from 2012 to 2014 in the First Affiliated Hospital of Xinjiang Medical University. Results: Among the Uygur, Kazak and Han ethnic groups, the positive rate was respectively 35.0%, 37.0%, 30.3% in TC; 34.5%, 30.1% and 32.0% in TG; 24.9%, 18.3%, and 18.2% in HDL-C; 30.1%, 31.6% and 23.3% in LDL-C. In the same ethnic group, the abnormality rate of blood lipid in the female was lower than that of the male (P<0.001). The blood lipid abnormality rate increased significantly in those with 30-39 years, and reached the highest value in the 50-59 years group, then it decreased in those aged over 60 years (P<0.001). Conclusion: The lipid abnormality rate of the Uygur and Kazak residents was higher than that of the Han nationality, and the abnormal levels of TC and LDL-C were particularly evident in Urumqi.

[Shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy analyzed with part-mount sub-serial sectioning and three-dimensional reconstruction technique]

OBJECTIVE

The aim of this study is to evaluate the shrinkage mode of the primary tumor in women with breast cancer after neoadjuvant chemotherapy (NAC) determined by part-mount sub-serial section (PMSS) and three-dimensional (3D) reconstruction technique.

METHODS

Eighty-six women with pathologically proven solitary invasive ductal carcinoma (ⅡA-ⅢC) were recruited. They were divided into two groups. Group A (n=25) received half cycles of NAC and Group B (n=61) received whole cycles of NAC. Breast specimen was prepared with PMSS, and residual tumors were microscopically outlined, scanned and registered by Photoshop software. The 3D model of residual tumors was reconstructed with 3D-Doctor software to evaluate the shrinkage mode. Further, the clinicpathologic shrinkage modes were divided into 2 categories: concentric shrinkage mode (CSM, the longest diameter of the pathological residual tumors was less than 50% and ≤2 cm in comparison with the primary tumor before NAC), and non-concentric shrinkage mode (NCSM, the longest diameter of the pathological residual tumors was more than 50% and/or >2 cm in comparison with the primary tumor before NAC).

RESULTS

Pathological shrinkage modes: Group A: modes Ⅰ, Ⅱ, and Ⅴ were observed in 1, 1, and 23 cases, respectively; Group B: modesⅠ, Ⅱ, Ⅲ, Ⅳ, and Ⅴwere observed in 18, 3, 12, 21, and 7 cases, respectively (P<0.001). The multivariate analysis showed that patients with lower primary tumor stage, PR(-) or mammographic malignant calcification before NAC(-) and lymph nodes down-staging after NAC were more likely to present with CSM after NAC (P<0.05 for all).

CONCLUSIONS

The pathologic reconstruction of breast residual tumors can fully and three-dimensionally reveal the shrinkage mode of the primary breast tumor in women with breast cancer after NAC. PMSS and 3D reconstruction of pathology provide a new platform in this area. Primary tumor stage, PR expression and mammographic malignant calcification before NAC and lymph node down-staging after NAC are independent predictors of the clinicopathologic shrinkage mode.

Characterization of submicron particles during biomass burning and coal combustion periods in Beijing, China

An Aerodyne high-resolution time-of-flight aerosol mass spectrometer (HR-ToF-AMS) was deployed along with other observation instruments to measure the characteristics of PM1 (particulate matter with a vacuum aerodynamic diameter of ≤1μm) during the biomass burning period (October 1 to 27; BBP) and the coal combustion period (December 10 to 31; CCP) in Beijing in 2014. The average PM1 mass concentrations during the BBP and CCP were 82.3 and 37.5μgm(-3), respectively. Nitrate, ammonium and other pollutants emitted by the burning processes, especially coal combustion, increased significantly in association with increased pollution levels. Positive matrix factorization (PMF) was applied to a unified high-resolution mass spectra database of organic species with NO(+) and NO2(+) ions to discover the relationships between organic and inorganic species. One inorganic factor was identified in both periods, and another five and four distinct organic factors were identified in the BBP and CCP, respectively. Secondary organic aerosols (SOAs) accounted for 55% of the total organic aerosols (OAs) during the BBP, which is higher than the proportion during the CCP (oxygenated OA, 40%). The organic nitrate and inorganic nitrate were first successfully separated through the PMF analysis based on the HR-ToF-AMS observations in Beijing, and organic nitrate components accounted for 21% and 18% of the total nitrate mass during the BBP and CCP, respectively. Although the PM1 mass concentration during the CCP was much lower than in the BBP, the average concentration of polycyclic aromatic hydrocarbons (PAHs) during the CCP (107.3±171.6ngm(-3)) was ~5 times higher than that in the BBP (21.9±21.7ngm(-3)).

[Surgical treatment of ventriculoperitoneal shunt guided by ultrasound to the patients with idiopathic intracranial hypertension]

OBJECTIVE

To investigate the clinical efficacy of ventriculoperitoneal shunt treatment to patients with idiopathic intracranial hypertension.

METHODS

The clinical data of 32 patients with idiopathic intracranial hypertension who were admitted to Henan Provincial People's Hospital from August 2011 to February 2014 were collected.The underlying diseases included occlusion of the superior sagittal sinus (2 cases) and occlusion of transverse sinus (2 cases), and all 4 cases had a history of chronic otitis media.Twenty eight cases, with a history of oral contraceptive drugs (2 cases) and unclear etiology (26 cases), had normal venous sinus confirmed by imaging examination.All of 32 patients underwent ventriculoperitoneal shunt.

RESULTS

The symptoms of 32 patients such as headache, nausea, and vomiting were relieved obviously after surgery.The symptom of visual impairment of 31 cases got better in varying degrees except that 1 case went blind before operation.Besides 2 cases of loss of follow-up, the remaining 30 cases were followed up for 2 years.Thirty cases had no perioperative infection.One case had infection 1 year after operation.No one had the shunt tube blockage.

CONCLUSIONS

Patients with idiopathic intracranial hypertension should be taken active surgical treatment when drug therapy fails and could obtain satisfactory clinical curative effect by accepting treatment of ventriculoperitoneal shunt.By intraoperative ultrasound guiding lateral ventricle puncture can be achieved accurately.

A single-phase elastic hyperbolic metamaterial with anisotropic mass density

Wave propagation can be manipulated at a deep subwavelength scale through the locally resonant metamaterial that possesses unusual effective material properties. Hyperlens due to metamaterial's anomalous anisotropy can lead to superior-resolution imaging. In this paper, a single-phase elastic metamaterial with strongly anisotropic effective mass density has been designed. The proposed metamaterial utilizes the independently adjustable locally resonant motions of the subwavelength-scale microstructures along the two principal directions. High anisotropy in the effective mass densities obtained by the numerical-based effective medium theory can be found and even have opposite signs. For practical applications, shunted piezoelectric elements are introduced into the microstructure to tailor the effective mass density in a broad frequency range. Finally, to validate the design, an elastic hyperlens made of the single-phase hyperbolic metamaterial is proposed with subwavelength longitudinal wave imaging illustrated numerically. The proposed single-phase hyperbolic metamaterial has many promising applications for high resolution damage imaging in nondestructive evaluation and structural health monitoring.

Effects of Inulin Supplementation in Low- or High-Fat Diets on Reproductive Performance of Sows and Antioxidant Defence Capacity in Sows and Offspring

This experiment was conducted to investigate the effects of inulin supplementation in low- or high-fat diets on both the reproductive performance of sow and the antioxidant defence capacity in sows and offspring. Sixty Landrace × Yorkshire sows were randomly allocated to four treatments with low-fat diet (L), low-fat diet containing 1.5% inulin (LI), high-fat diet (H) and high-fat diet containing 1.5% inulin (HI). Inulin-rich diets lowered the within-litter birth weight coefficient of variation (CV, p = 0.05) of piglets, increased the proportion of piglets weighing 1.0-1.5 kg at farrowing (p < 0.01), reduced the loss of body weight (BW) and backfat thickness (BF) during lactation (p < 0.05) and decreased the duration of farrowing as well as improved sow constipation (p < 0.05). Sows fed fat-rich diets gained more BW during gestation (p < 0.01), farrowed a greater number of total (+1.65 pigs, p < 0.05) and alive (+1.52 pigs p < 0.05) piglets and had a heavier (+2.06 kg, p < 0.05) litter weight at birth as well as a decreased weaning-to-oestrous interval (WEI, p < 0.01) compared with sows fed low-fat diets. However, it is worth noting that the H diet significantly decreased the serum activities of superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-Px) and increased the serum malondialdehyde (MDA) levels in sows and piglets (p < 0.05). In contrast, HI diet enhanced the activities of T-SOD and GSH-Px and decreased the serum MDA concentrations (p < 0.05) in sows and piglets. In summary, the fat-rich diets fed to sows during gestation had beneficial effects on reproductive performance, but aggravated the oxidative stress in sow and piglets. Inulin-rich diets fed to sow during gestation had beneficial effects on within-litter uniformity of piglet birthweight and enhanced the antioxidant defence capacity of sows and piglets.

Wnt1-overexpressing skeletal myoblasts as an improved cell therapy for cardiac repair following myocardial infarction

AIM

Recent findings highlight the critical role of the Wnt signaling pathway in cardiac repair and stem cell regulation. Our previous study shows that lithium chloride (LiCl) optimizes skeletal myoblast (SkM) for transplantation by mimicking the Wnt/β-catenin signaling activities. In this study, we evaluate the therapeutic potential of SkMs genetically modified with Wnt1gene (Wnt1 SkMs) in a rat model with myocardial infarction (MI).

METHODS

We harvested neonatal SkMs using Wistar rats (1-3-day old) transfected with p-EGFP-C3-Wnt1 plasmid. RT-PCR and immunofluorescence showed a higher expression of Wnt1 in the Wnt1 SkMs. We observed that Wnt1 SkMs increased connexin 43 (Cx43) expression, reduced apoptosis induced by hydrogen peroxide (H2O2) and decreased caspase-3 expression via the canonical Wnt signaling pathways compared to the empty vector transfected SkMs (control SkMs). For in vivo studies, the myocardial infarction model was developed in the Wistar rats. The rats were grouped to receive 100 μL basal DMEM without cells or containing 1.5×106SkMs and Wnt1 SkMs. Histological studies revealed improved survival of SkMs, reduced cardiomyocytes apoptosis, and upregulated expression of Cx43 in Wnt1 SkMs therapy group. Echocardiography monitored four weeks after therapy showed improvement of the left ventricular function in rats treated with Wnt1SkMs compared to other groups.

CONCLUSION

Transplantation of Wnt1 SkMs improves rat myocardial function and enhances anti apoptotic properties of both SkMs and cardiomyocytes and upregulation of tissue Cx43 after infarction via the canonical Wnt/β-catenin signaling activities.

All optical mode controllable Er-doped random fiber laser with distributed Bragg gratings

An all-optical method to control the lasing modes of Er-doped random fiber lasers (RFLs) is proposed and demonstrated. In the RFL, an Er-doped fiber (EDF) recoded with randomly separated fiber Bragg gratings (FBG) is used as the gain medium and randomly distributed reflectors, as well as the controllable element. By combining random feedback of the FBG array and Fresnel feedback of a cleaved fiber end, multi-mode coherent random lasing is obtained with a threshold of 14 mW and power efficiency of 14.4%. Moreover, a laterally-injected control light is used to induce local gain perturbation, providing additional gain for certain random resonance modes. As a result, active mode selection of the RFL is realized by changing locations of the laser cavity that is exposed to the control light.

Inhibitory effect of liposomal quercetin on acute hepatitis and hepatic fibrosis induced by concanavalin A

Immune response plays an important role in the development of hepatic fibrosis. In the present study, we investigated the effects of quercetin on hepatitis and hepatic fibrosis induced by immunological mechanism. In the acute hepatitis model, quercetin (2.5 mg/kg) was injected iv into mice 30 min after concanavalin A (Con A) challenge. Mice were sacrificed 4 or 24 h after Con A injection, and aminotransferase tests and histopathological sections were performed. Treatment with quercetin significantly decreased the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Consistent with this observation, treatment with quercetin markedly attenuated the pathologic changes in the liver. A hepatic fibrosis model was also generated in mice by Con A challenge once a week for 6 consecutive weeks. Mice in the experimental group were treated with daily iv injections of quercetin (0.5 mg/kg). Histopathological analyses revealed that treatment with quercetin markedly decreased collagen deposition, pseudolobuli development, and hepatic stellate cells activation. We also examined the effects of quercetin on the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and transforming growth factor beta (TGF-β) pathways by immunohistochemistry and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). NF-κB and TGF-β production was decreased after treatment with quercetin, indicating that the antifibrotic effect of quercetin is associated with its ability to modulate NF-κB and TGF-β production. These results suggest that quercetin may be an effective therapeutic strategy in the treatment of patients with liver damage and fibrosis.

Association of interleukin-1β -511C/T promoter polymorphism with COPD risk: a meta-analysis

Studies examining the role of interleukin (IL)-1β -511C/T promoter polymorphism in the pathogenesis of chronic obstructive pulmonary disease (COPD) have shown inconsistent results. This meta-analysis was performed to assess the association between the IL-1β-511C/T promoter polymorphism and COPD susceptibility. Published case-control, cross-sectional, and cohort studies from Pubmed, Embase, and China National Knowledge Infrastructure databases were retrieved. Data were extracted and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Twelve studies with 1692 cases and 2009 controls were included in this meta-analysis. Pooled effect size showed an overall but not significantly decreased risk of IL-1β-511 C/T with COPD susceptibility (OR = 0.89, 95%CI = 0.78-1.01) in a complete overdominant genetic model (TT+CC vs CT), indicating that homozygous individuals (CC and TT) have a decreased risk for COPD compared with heterozygotes (CT). In subgroup analysis by ethnicity, IL-1β-511C/T was significantly correlated with a decreased risk of COPD in Asians (OR = 0.73, 95%CI = 0.60-0.88, P = 0.001), but not in Caucasians (OR = 1.02, 95%CI = 0.83- 1.24, P = 0.46), confirming a protective role of IL-1β-511C/T in COPD in Asians. Moreover, after excluding studies that included populations not in Hardy-Weinberg equilibrium, the pooled results were robust and no publication bias was observed. This meta-analysis suggests that the IL-1β-511C/T promoter polymorphism deceases the risk of COPD in Asians.

Short-segment posterior instrumentation combined with calcium sulfate cement vertebroplasty for thoracolumbar compression fractures: radiographic outcomes including nonunion and other complications

OBJECTIVE

To evaluate the radiographic outcomes of short-segment posterior instrumentation plus vertebroplasty using injectable calcium sulfate cement (CSC) for thoracolumbar compression fractures.

MATERIALS AND METHODS

Twenty-eight patients with a single-level thoracolumbar compression fracture, who underwent short-segment pedicle screw fixation and CSC vertebroplasty, were included in the study. The anterior vertebral body height ratio, local kyphosis angle, and the height of the intervertebral disc adjacent to the fractured vertebra were used to evaluate the radiographic results. Complications including bone nonunion, instrument failure, cement leakage, and disc vacuum formation were also assessed.

RESULTS

The patients were followed up for an average of 24.20±5.40 months. The relative preoperative anterior body height was 55.71±15.29%, which improved to 94.93±5.39% immediately after surgery (P<0.001), and at final follow-up showed a 6.50±3.89% loss of height correction (P<0.001). The mean preoperative local kyphosis angle was 22.23±5.65°, which corrected to 2.67±4.43° immediately after surgery (P<0.001), but reverted to 6.71±4.95° at final follow-up, showing a 4.04±1.91° loss of correction (P<0.001). The mean height of the intervertebral disc proximal to the fractured vertebra was 9.87±0.91 mm before surgery, 12.53±0.98 mm after operation (P<0.001), and the loss of correction at final follow-up was 2.35±1.15 mm with a significant difference compared to immediate postoperative values (P<0.001). Bone nonunion occurred in 7 patients, 2 patients had hardware failure, 9 patients had cement leakage, and 10 patients had disc vacuum phenomenon adjacent to the fractured vertebra.

CONCLUSIONS

The patients who underwent this procedure had a loss of correction of vertebral height and local kyphosis. Complications such as bone nonunion, instrument failure, cement leakage, and disc vacuum may occur. Rapid CSC resorption accounts for these radiographic outcomes and complications.

LEVEL OF EVIDENCE

Level IV, retrospective study.

P53-Mediated Repression of the Reprogramming in Cloned Bovine Embryos Through Direct Interaction with HDAC1 and Indirect Interaction with DNMT3A

P53 is a transcriptional activator, regulating growth arrest, DNA repair and apoptosis. We found that the expression level of P53 and the epigenetic profiles were significantly different in bovine somatic cell nuclear transfer embryos from those in vitro fertilization (IVF) embryos. So we inferred that abnormally expression of P53 might contribute to the incomplete reprogramming. Using bovine foetal fibroblasts, we constructed and screened a highly efficient shRNA vector targeting bovine P53 gene and then reconstituted somatic cell nuclear transfer embryos (RNAi-SCNT). The results indicated that expression levels of P53 were downregulated significantly in RNAi-SCNT embryos, and the blastulation rate and the total number of cell increased significantly. Moreover, methylation levels of CpG islands located 5' region of OCT4, NANOG, H19 and IGF2R in RNAi -SCNT embryos were significantly normalized to that IVF embryos, and the methylation levels of genome DNA, H3K9 and H4K5 acetylation levels were also returned to levels similar to the IVF embryos. Differentially expressed genes were identified by microarray, and 28 transcripts were found to be significantly different (> twofolds) in RNAi-SCNT embryos compared to the control nuclear transfer embryos (SCNT). Among the 28 differentially expressed transcripts, just HDAC1 and DNMT3A were closely associated with the epigenetic modifications. Finally, ChIP further showed that P53 might repress the epigenetic reprogramming by regulating HDAC1 directly and DNMT3A indirectly. These findings offer significant references to further elucidate the mechanism of epigenetic reprogramming in SCNT embryos.

Effects of estrogen intervention on the biomechanical characteristics of serum SOD, MDA, and middle cerebral artery in aged female rats

OBJECTIVE

This study aims to study the biological and biomechanical characteristics of the middle cerebral artery (MCA) in aged and estrogen-intervened aged rats, thereby providing biomechanical basis for clinics.

MATERIALS AND METHODS

Thirty 18-month-old Sprague Dawley (SD) rats, 30 18-month-old estrogen-intervened SD rats, and 30 four-month-old SD rats were studied. The estrogen-intervened rats were given estradiol benzoate on the fifth feeding day. Thirty-four days after the feeding, the serum of each rat was obtained. The radioimmunoassay was performed for the content determination of serum E2, ER, malondialdehyde (MDA), and superoxide dismutase (SOD). The tensile test was performed to evaluate the MCA of each rat.

RESULTS

Through the estrogen intervention, the serum contents of E2, ER, SOD, and MDA in old rats were restored to normal levels. The maximum stress, maximum strain, and elastic limit of the MCA in the aged estrogen-intervened rat group were greater than those of the non-intervened aged rat group, with a significant difference (p < 0.05). The elastic modulus in the aged estrogen-intervened rat group was less than that of the non-intervened aged rat group, with a significant difference (p < 0.05).

CONCLUSION

E2 intervention can improve the flexibility, toughness, and compliance of MCA in aged rats.

Artificial neural network models for predicting 1-year mortality in elderly patients with intertrochanteric fractures in China

The mortality rate of older patients with intertrochanteric fractures has been increasing with the aging of populations in China. The purpose of this study was: 1) to develop an artificial neural network (ANN) using clinical information to predict the 1-year mortality of elderly patients with intertrochanteric fractures, and 2) to compare the ANN's predictive ability with that of logistic regression models. The ANN model was tested against actual outcomes of an intertrochanteric femoral fracture database in China. The ANN model was generated with eight clinical inputs and a single output. ANN's performance was compared with a logistic regression model created with the same inputs in terms of accuracy, sensitivity, specificity, and discriminability. The study population was composed of 2150 patients (679 males and 1471 females): 1432 in the training group and 718 new patients in the testing group. The ANN model that had eight neurons in the hidden layer had the highest accuracies among the four ANN models: 92.46 and 85.79% in both training and testing datasets, respectively. The areas under the receiver operating characteristic curves of the automatically selected ANN model for both datasets were 0.901 (95%CI=0.814-0.988) and 0.869 (95%CI=0.748-0.990), higher than the 0.745 (95%CI=0.612-0.879) and 0.728 (95%CI=0.595-0.862) of the logistic regression model. The ANN model can be used for predicting 1-year mortality in elderly patients with intertrochanteric fractures. It outperformed a logistic regression on multiple performance measures when given the same variables.

Morphology variation and optical properties of ZnO nanostructures grown using bio-template

ZnO nanostructures of different morphologies were grown by immersing eggshell membranes into Zn(NO3)2 ethanol solution with different pH values and subsequently sintered at 500 degrees C. Effects of the solution pH value, immersing time and Mg incorporation on the nanostructure morphology and photoluminescence were studied. ZnO nanostructure morphology was very sensitive to pH value of the solution, immersing time and layer of the templates. Different morphologies of nanofibers, nanotubes, hexagonal nanosheets and hexagonal nanosheets with tips were grown. All nanostructures had strong green emission at 520 nm and weak ultraviolet emission at 377 nm. The green emission weakened in the interwoven nanofibers while the ultraviolet emission enhanced in the hexagonal nanosheets. Incorporation of Mg ions in the solution with a pH of 7 would result in combination of the interwoven nanofibers and enhance the green emission greatly. UV emission at 355 nm from ZnMgO alloys was observed in Mg incorporated nanofibers.

Immobilizing natural macromolecule on PLGA electrospun nanofiber with surface entrapment and entrapment-graft techniques

Surface entrapment is a convenient method to immobilize the natural macromolecules on the surface of synthetic polymers. In this study, the gelatin modified and sodium alginate/gelatin modified PLGA nanofibrous membranes were fabricated via surface entrapment and entrapment-graft techniques. The surface morphology of the each single modified PLGA nanofiber was as smooth as that of untreated PLGA nanofibers. The results of water angle contact measurements and tensile tests showed that the surface entrapment cannot only improve the hydrophilicity but also enhance mechanical properties of the modified nanofibrous membranes. In addition, the sodium alginate/gelatin modified electrospun PLGA nanofibrous membrane exhibited higher hydrophilicity and better biocompatibility than the simply gelatin modified PLGA nanofibrous membrane, which suggested the surface entrapment is a facile and efficient approach to surface modification for electrospun nanofibours membranes.

Valsartan attenuated oxidative stress, decreased MCP-1 and TGF-β1 expression in glomerular mesangial and epithelial cells induced by high-glucose levels

Our previous studies revealed that valsartan, an angiotensin II type I receptor blocker, exhibited renoprotective effects through decreasing urine protein excretion levels due to improving glomerular permeability in rats with diabetic nephropathy (DN). In this study, we sought to investigate the underlying mechanisms in perspectives of oxidative stress, transforming growth factor beta-1 (TGF-β1) and monocyte chemoattractant protein-1 (MCP-1) expressions in glomerular mesangial cells (GMCs) and glomerular epithelial cells (GECs) since their roles are well-established in the development and progression of DN. High-glucose levels significantly increased oxidative stress in GMCs and GECs, as evidenced by enhanced generation of reactive reactive oxygen species (ROS), reduced levels of glutathione (GSH) and antioxidant enzyme superoxide dismutase (SOD), and increased production of malondialdehyde (MDA). Treatment with valsartan significantly restored the levels of those oxidative stress relevant molecules. Furthermore, valsartan obviously diminished the expression of proinflammatory cytokine MCP-1 in GMCs and GECs induced by high-glucose levels both at mRNA and protein levels, as determined by real-time PCR, immunocytochemistry, western blotting, and ELISA. In addition, the increased expressions of TGF-β1 mRNA and protein induced by high-glucose level were also abrogated by valsartan treatment in GMCs, as evaluated by real-time PCR and ELISA. These results suggest that the renoprotective effects of valsartan may be related to its potential in decreasing oxidative stress and the expressions of MCP-1 and TGF-β1 in GMCs and GECs.

Temporal contrast enhancement of picosecond pulses based on phase-conjugate wave generation

A practical technique based on the phase-conjugate wave (PCW) generation is proposed to improve the temporal contrast of the picosecond pulses. Our theory predicts the temporal contrast of the picosecond pulses can be enhanced to about the cube of the temporal contrast of the input pulse via the PCW generation, in which the conversion efficiency from the incident pulse to the PCW is about 25%. In a proof-of-principle experiment, the temporal contrast of picosecond pulses was enhanced from 1.7×10(3) to 8.6×10(8) with the conversion efficiency of 10%. This technique is promising to effectively eliminate the background of the ultrashort and ultraintense laser pulses in the future.

P3-07-03: One-Step Nucleic Acid Amplification (OSNA) for the Diagnosis of Sentinel Lymph Nodes of Breast Cancer – Results of the China Multicenter Study CBCSG-001c

Background

With the adoption of sentinel lymph node (SLN) biopsy as the standard of care, there is an increasing need for the rapid and accurate intra-operative diagnosis of SLNs. CBCSG-001c was a prospective multicenter trial to validate the One-step nucleic acid amplification (OSNA) assay in China. The primary endpoint was the concordance rates of intraoperative OSNA assay with the in-depth permanent histological analyses based both on cases and SLNs.

Methods: From Feb. to Dec. 2010, 1188 SLNs from 552 breast cancer patients were enrolled in the CBCSG-001c study at 5 centers. SLNs were cut into alternating ∼2mm sections. One half of the sections were sampled for H&E, with 4 sections at different intervals. The other half was fully tested with the OSNA assay. Predetermined cutoffs were calibrated so only metastases &gt;0.2 mm were detected.

Results: The concordance rate was 89.1% (95% CI, 86.3−91.5%), sensitivity 87.7% (95% CI, 81.0−92.7%), and specificity 89.6% (95% CI, 86.3−92.4%) based on 552 cases, and the concordance rate was 91.4% (95% CI, 89.7−92.9%), sensitivity 83.7% (95% CI, 77.7−88.6%), and specificity 92.9% (95% CI, 91.1−94.4%) based on the 1188 SLNs. This quantitative molecular assessment allows the distinction of the size of the metastasis, and the PPV of OSNA [++] for macrometastases was 83.2% (95% CI, 75.0- 89.1%). Discordant results were thought to be partly due to the fact that different tissue sections were used for OSNA assay and histology, and SLNs with ITCs were not considered as histological positive nodes. After discordant case investigation, the senstivity of OSNA assay was significantly higher than that of intraoprative frozen section and touch imprint cyctology.

Discussion: As the largest OSNA study to date, our results, together with that of Japan, Germany, and France study, proved the OSNA assay based on CK19 mRNA expression to be a reliable and standardized tool for the intraoperative detection of SLN metastases of breast cancer patients as compared to in-depth permanent histology. The high sensitivity of OSNA assay means reducing the risk of second operation for ALND, medical care costs and patients anxiety.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-03.