[Improving outcomes of patients with heterotaxy and functional single ventricle: a 10-year follow-up of 70 cases in a single institution]

Objective: To review current-era palliation outcomes of patients with heterotaxy and functional single ventricle in a single institution. Methods: The clinical data of 70 consecutive patients with heterotaxy undergoing multistage single ventricle palliation in Guangzhou Women and Children's Medical Center from January 2008 to December 2017 were retrospectively reviewed, and the prognosis factors for mortality were analyzed. There were 53 male and 17 female patients.The median age was 13.3 months (range: 6 days to 150 months). Single ventricle multistage palliation included 1(st) stage palliation surgery, 2(nd) bidirectional Glenn shunt, and 3(rd) stage modified Fontan.The Kaplan-Meier method was used to estimate the probability of survival. Multivariate analysis was performed by Cox regression model. Results: Sixty-two patients had right atrial isomerism while eight had left atrial isomerism. Eighteen patients (25.7%) required the first stage palliation. Fifty-five patients received the Glenn shunt, and the Fontan procedure was completed in 27 patients. Overall, mortality occurred in 17 patients (24.3%) including 9 after the first stage palliation, 6 after the Glenn shunt, and 2 following the Fontan procedure. Survival estimates for the entire cohort following surgery were 81% (95%CI: 72% to 90%), 74%(95%CI: 64% to 85%), and 74% (95%CI: 64% to 85%) at 1 year, 5 years and 10 years, respectively. Survival estimates following the first stage palliation were 56% (95%CI: 33% to 79%) and 49% (95%CI: 26% to 73%) at 1 year and 5 years, respectively. Multivariate Cox regression analysis revealed that total anomalous pulmonary venous connection (TAPVC) (HR=6.16, 95%CI: 1.65 to 22.95, P=0.007), atrioventricular valve regurgitation more than moderate (HR=3.81, 95%CI: 1.32 to 10.94, P=0.013) and required the first palliation surgery (HR=4.58, 95%CI: 1.34 to 15.72, P=0.016) were prognosis factors for overall mortality. Conclusions: The management of heterotaxy patients with functional single ventricle remains challenging, and the outcomes are continously improving in china. TAPVC, atrioventricular valve regurgitation more than moderate and required the first palliation surgery still are prognosis factors for overall mortality in heterotaxy syndrome.

[Mechanism of long non-coding RNA-metastasis associated lung adenocarcinoma transcript 1 induced invasion and metastasis of esophageal cancer cell EC-109]

Objective: To investigate the effect and mechanism of long non-coding RNA-metastasis associated lung adenocarcinoma transcript 1, (LncRNA-MALAT1) on invasion and metastasis of esophageal cancer cell EC-109. Methods: EC-109 cells were transfected with lentiviral vector carrying short hairpin RNA of MALAT1( shRNA-MALAT1) or a nonspecific shRNA control (shRNA-control). The expressions of MALAT1, microRNA-200a, ZEB1 and ZEB2 were detected by qRT-PCR. The effect of shRNA-MALAT1 on invasion of EC-109 cells was determined by transwell assay. The expressions of components of epithelial-msenchymal transition pathway in EC-109 cells were determined by immunofluorescence array and western blotting. The expression relationship between MALAT1 and miR-200a in EC-109 cells was detected by dual-luciferase reporter assay. Results: The result of qRT-PCR showed that the expressions levels of MALAT1, ZEB1 and ZEB2 in shRNA-MALAT1 group were 0.43±0.06, 0.64±0.04 and 0.51±0.04, respectively, significantly lower than 0.97±0.08, 1.06±0.07 and 0.98±0.05 in shRNA-control group and 1 in control group, respectively(all P<0.05). Transwell assay showed that the number of invaded cells in shRNA MALAT1 group was (96.81±10.43) per low-power field, markedly lower than that of (278.44±13.28) per low-power field in shRNA-control group (P<0.01). Immunofluorescence staining and Western blotting showed that MALAT1 downregulation significantly reduced the expressions of proteins related to EMT signal pathway in EC-109 cells.Dual luciferase reporter assay showed that compared to negative control, the activities of luciferase reporter in EC-109 cells co-transfected with pmirGLO-MALAT1-wt and miR-200a were significantly down-regulated. While co-transfected pmirGLO-MALAT1-mut with miR-200a mimics had no effect on the luciferase reporter activities of MALAT1. Conclusion: LncRNA MALAT1 functions as a competing endogenous RNA to regulate the expressions of ZEB1 and ZEB2 by sponging miR-200a and promotes invasion and migration of esophageal cancer cells through inducing epithelial-mesenchymal transition.

[Patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction in 393 patients]

OBJECTIVE

To explore the patterns and influencing factors of lymph node metastasis of adenocarcinoma of the esophagogastric junction (AEG).

METHODS

Clinicopathological data of 393 AEG patients who underwent radical resection and lymphadenectomy in the thoracic or abdominal cavity were collected. We analyzed the metastatic patterns of 5 119 excised lymph nodes with an average of 13 nodes per patient according to Siewert classification, and the associations between lymphatic metastasis and clinicopathological factors, such as tumor invasion, differentiation, maximum diameter, or pathological type were analyzed.

RESULTS

The lymph node metastasis rate and ratio (LNR) were 70.0% (275/393) and 29.1% (1 492/5 119), respectively. All the Siewert subtypes of AEG mainly metastasize downwards to the abdominal lymph nodes, while also spread upwards to the mediastinal lymph nodes. Among them, the lymph node metastasis rate was highest in Siewert type Ⅰ and lowest in Siewert type Ⅲ AEG. The lymph node metastasis rate and ratio in T1, T2, T3, T4 AEGs were 0%, 29.4%, 75.0%, 74.6% and 0%, 10.1%, 14.2%, 32.0%, respectively (χ(2)=35.305, P<0.001 and χ(2)=134.034, P<0.001). The lymph node metastasis rate and ratio of the poorly differentiated adenocarcinoma were 36.0% and 79.3%, respectively, significantly higher than 22.1% and 61.7% of the well-differentiated adenocarcinoma (χ(2)=14.468, P<0.001 and χ(2)=120.009, P<0.001). The lymph node metastasis rate and ratio of patients with a tumor in maximum diameter ≥4 cm were 73.1% and 30.9%, significantly higher than 46.8% and 14.6%, respectively, in the patients with a tumor in maximum diameter of <4 cm (χ(2)=13.636, P<0.001 and χ(2)=64.767, P<0.001). The group of vascular tumor thrombus showed significantly higher lymph node metastasis rate and ratio than those in the group with no vascular tumor thrombus (84.6% versus 67.1%, χ(2)=7.946, P=0.005; and 45.0% versus 26.0%, χ(2)=112.723, P<0.001). The lymph node metastasis ratio of mucinous and signet ring cell adenocarcinoma was 34.9%, significantly higher than 28.5% of the adenocarcinoma (χ(2)=8.710, P<0.001) The depth of tumor invasion and degree of tumor differentiation were independent factors affecting lymph node metastasis (P=0.001 and P<0.001).

CONCLUSIONS

The lymph node metastasis rate and ratio of AEG are high and influenced by many clinicopathological factors. The patterns of lymph node metastasis are different among different Siewert subtype AEGs.The depth of tumor invasion and differentiation degree are independent factors affecting lymphatic metastasis.

The expression of HDAC7 in cancerous gastric tissues is positively associated with distant metastasis and poor patient prognosis

PURPOSE

To characterize the expression patterns of HDAC7 in patients with gastric cancer and evaluate the prognostic value of HDAC7 in gastric cancer.

METHODS

The expression of histone deacetylase 7 (HDAC7) was detected in paraffin-embedded gastric cancer samples from 86 patients by immunohistochemistry, and the differences in the expression of HDAC7 between cancerous and corresponding adjacent noncancerous tissues were compared using the Wilcoxon matched-pairs signed rank test. The correlation between HDAC7 expression and Ki-67 expression or clinicopathologic characteristics was evaluated using a Spearman rank correlation test. Prognostic outcomes that correlated with HDAC7 were examined using a Kaplan-Meier analysis and Cox proportional hazards model. Moreover, the effects of HDAC7 on the proliferation, migration and invasion of gastric cancer cells were investigated in vitro using human gastric carcinoma AGS cells.

RESULTS

We found that HDAC7 was downregulated in cancerous gastric tissues (P = 0.0019). However, the expression of HDAC7 in cancerous gastric tissues positively correlated with Ki-67 expression (P = 0.0325) and distant metastasis (P = 0.020). Moreover, overall survival was shorter for patients expressing higher levels of HDAC7 in cancerous tissues (P = 0.042). Mechanistically, the disruption of the HDAC7 gene attenuated the capacity of cell growth, migration and invasion and induced G0/G1 arrest in AGS cells. Conversely, forced ovperexpression of HDAC7 promoted cell growth, migration and invasion and G1/S transition in AGS cells.

CONCLUSIONS

These results indicate that high HDAC7 expression in cancerous gastric tissues correlates with distant metastasis and predicts a poor prognosis for patients with gastric cancer.

Sevoflurane-induced isoelectric EEG and burst suppression: differential and antagonistic effect of added nitrous oxide

The objective of this study was to investigate whether nitrous oxide influenced the ED50 of sevoflurane for induction of isoelectric electroencephalogram (ED50_isoelectric ) differently from its influence on the ED50 of sevoflurane for electroencephalogram burst suppression (ED50_burst ). In a prospective, randomised, double-blind, parallel group, up-down sequential allocation study, 77 ASA physical status 1 and 2 patients received sevoflurane induction and, after tracheal intubation, were randomly allocated to receive sevoflurane with either 40% oxygen in air (control group) or 60% nitrous oxide in oxygen mixture (nitrous group). The ED50_isoelectric in the two groups was determined using Dixon's up and down method, starting at 2.5% with 0.2% step size of end-tidal sevoflurane. The electroencephalogram was considered as isoelectric when a burst suppression ratio of 100% lasted > 1 min. The subsequent concentrations of sevoflurane administered were determined by the presence or absence of isoelectric electroencephalogram in the previous patient in the same group. The ED50_isoelectric in the nitrous group 4.08 (95%CI, 3.95-4.38)% was significantly higher than that in the control group 3.68 (95%CI, 3.50-3.78)% (p < 0.0001). The values for ED50_burst were 3.05 (95%CI, 2.66-3.90)% and 3.02 (95%CI, 3.00-3.05)% in nitrous group and control group, respectively (p = 0.52). The addition of 60% nitrous oxide increases ED50_isoelectric , but not the ED50_burst of sevoflurane. Neither result indicates an additive effect of anaesthetic agents, as might be expected, and possible reasons for this are discussed.

Correlation analysis of MR/CT on colorectal cancer lymph node metastasis characteristics and prognosis

OBJECTIVE

Colorectal cancer incidence showed increasing trend with living standard improvement and lifestyle changes. This study investigated the relationship and diagnostic value of colorectal cancer lymph node metastasis and prognosis using magnetic resonance (MR) and computed tomography (CT).

PATIENTS AND METHODS

Siemens Avanto 3.0T MR and GE Light Speed Pro 64 row helical CT were used to scan 318 cases of colorectal cancer patients diagnosed by pathology. The relationship between colorectal cancer lymph node metastasis and prognosis after surgery was analyzed.

RESULTS

The accuracy of MR and CT in judging colorectal cancer lymph node metastasis ratio (LNR) was 92.5% and 75.5%, respectively. MR showed significantly higher accuracy than CT (p < 0.05). The coincidence rate of LNR result derived from MR and CT with colorectal cancer histopathological results was 57.6% and 54.7%, respectively. MR and CT sensitivity were 42.6% and 25.0%, while their specificity was 74.1% and 41.3%, respectively. The positive predictive value and negative predictive value of MR and CT were 61.1% and 51.4%, 57.1% and 66.7%, respectively. c2-test showed that MR diagnosis result was consistent with histopathological result (p < 0.05). The coincidence rate of MR and CT evaluation on 5-year disease-free survival and overall survival were 56.7% and 43.8%, respectively.

CONCLUSIONS

MR showed a better effect on prognosis than CT and could be treated as the first choice to predict LNR and prognosis. MR demonstrated a good correlation with pathological results and could be used to predict LNR and prognosis.

[Radical antegrade modular pancreatosplenectomy procedure in pancreatic body/tail adenocarcinoma]

Radical antegrade modular pancreatosplenectomy(RAMPS) has been applied more and more in clinical practice to improve the R0 resection rate in pancreatic body/tail adenocarcinoma.Comparing with traditional procedure, the resection plane in RAMPS is deeper with en-bloc resection of renal fascia, anterior renal fat capsule and even left adrenal gland and regional lymph nodes including No.7, 8, 9, 10, 11p, 11d, partial 14p/d, partial 16a2 and 18.Despite that RAMPS is in favor of improving R0 resection rate, there are many problems about this procedure unsolved and effect on patient survival is still awaited.

[Esophageal adenocarcinoma: the clinicopathologic features, patterns of lymph node metastasis and its influencing factors]

OBJECTIVE

To investigate the clinicopathological characteristics, patterns of lymph node metastasis and the influencing factors in esophageal adenocarcinoma.

METHODS

A total of 201 cases of esophageal adenocarcinoma were selected for this study, including 89 cases of pure adenocarcinoma, 57 cases of adenoacanthoma cell carcinoma, 33 cases of mucoepidermoid carcinoma and 22 cases of adenoid cystic carcinoma. A total of 2026 lymph nodes were dissected with an average of 10 lymph nodes. The rule of lymph node metastasis in patients with esophageal adenocarcinoma was analyzed, and the risk factors for lymph node metastasis were identified.

RESULTS

Esophageal adenocarcinoma in the middle thoracic esophagus accounted for 50.7% of all patients, and 43.8% in the lower thoracic esophagus. Ninety out of 201 cases (44.8%) had lymph node metastasis. 322 lymph nodes were positive for metastatic adenocarcioma with a metastatic ratio of 15.9% (322/2026). Among the patients with upper-thoracic esophageal carcinoma, 9.1% (1/11) of the cases had lymph node metastasis in the superior mediastinum but no lymph node metastasis was found in the middle mediastinum, lower mediastinal and abdominal lymph nodes. The middle-thoracic esophageal adenocarcinoma showed more extensive lymph node metastasis. Lower mediastinal and abdominal lymph node metastases were common in lower-thoracic esophageal cancer. Multivariate analysis showed that gender, length of lesion, depth of invasion and vascular invasion were independent risk factors for lymph node metastasis in esophageal adenocarcinoma (P=0.010, P=0.006, P=0.000, P=0.019, respectively). Male patients had more lymph node metastasis than female patients (49.1% vs 26.3%,P=0.011). The rates of lymph node metastasis in the tumor length ≤3 cm group, 3.1-5 cm group and >5 cm group were 20.4%, 42.9% and 65.7%, respectively. Lymphatic metastasis rates in the T1, T2, T3, T4 stage cancers were 7.1%, 36.8%, 38.1% and 69.4%, respectively, (P<0.001). Patients with vascular invasion had a higher rate of lymph node metastasis (73.9%) than the patients without vascular invasion (41.0%) (P=0.003).

CONCLUSIONS

Most of the esophageal adenocarcinoma are distributed in the middle thoracic esophagus, followed by that in the lower thoracic segment. The lymph node metastasis rate, lymph node metastasis ratio and pattern of lymph node metastasis are similar to those of esophageal squamous cell carcinoma. Male, tumor length, depth of invasion and vascular invasion are risk factors of lymph node metastasis for patients with esophageal adenocarcinoma.

PHACTR4 regulates proliferation, migration and invasion of human hepatocellular carcinoma by inhibiting IL-6/Stat3 pathway

OBJECTIVE

Phosphatase and actin regulator 4 (PHACTR4) is one member of the largely uncharacterized PHACTR family of protein phosphatase 1 (PP1)-and actin-binding proteins. PHACTR4 is significantly deleted or mutant in many tumor subtypes, such as breast, colorectal, lung, neural, ovarian, and renal cancers. However, the role of PHACTR4 in human hepatocellular carcinoma (HCC) is completely unknown.

MATERIALS AND METHODS

Ten paired HCC tissues and adjacent non-cancerous tissues were used to detect the expression PHACTR4. Real-time PCR was used to detect the mRNA level of PHACTR4 in clinic samples. The protein level of PHACTR4 was determined by Western blot. Retrovirus-based gene transduction was used to generate Flag-tagged PHACTR4 HepG2 stable cell line. BrdU assay was used to determine the cell growth of HepG2 cells. The cell cycle distribution was detected by flow cytometry assay. In vitro scratch wounding and Matrigel invasion assays were used to test the migration and invasion ability of HepG2 cells.

RESULTS

The expression of PHACTR4 was noticeably decreased in clinical HCC tissues, compared to the non-tumoral tissues. Overexpression of PHACTR4 inhibited HCC cells proliferation, colony formation, migration and invasion, and resulted in significant cycle arrest. PHACTR4 attenuated both constitutive and IL-6-induced phosphorylation of signal transducer and activator of transcription 3 (Stat3), and inhibited Stat3 downstream genes expression.

CONCLUSIONS

Overall, our results suggest that PHACTR4 is a tumor suppressor in HCC by inhibiting IL-6/ Stat3 pathway.

Racial differences of endothelial function and plasma endothelin 1 level in preclinical Tibetan and Han male population

OBJECTIVE

The differences in endothelial function between Tibetan and Han nationality population have not been fully investigated. The aim of this work is to investigate the differences in endothelial function and plasma endothelin 1 (ET-1) concentration between Tibetan and Han male population.

PATIENTS AND METHODS

Totally 272 Tibetan male subjects aged 42.9 ± 9.4 years were enrolled in this study to stand for Tibetan population. All of them were native residents in Lhasa City. And 580 Qinghai-Tibet Railway constructors with Han nationality aged 41.8 ± 11.1 years were enrolled in this study to stand for Han nationality population. All of them were male subjects and lived in Lhasa City for at least 1 year. All subjects lived in the same high-altitude area (the altitude of Lhasa is 3658 m). Height, weight, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure were evaluated. Body mass index (BMI) was calculated. Brachial artery flow-mediated dilation (FMD) was measured in the fasting state using high-resolution B-mode ultrasound. Computer-assisted analysis software was used to calculate brachial artery diameters. Venous blood was sampled for the measurement of total cholesterol (CH), triglyceride (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL) and HbA1c. Plasma ET-1 was quantitated using a commercially available ELISA kits.

RESULTS

Totally 272 Tibetan subjects and 580 Han nationality subjects were enrolled in this study. BMI and waist-hip ratio in Tibetan subjects were much higher than those in Han subjects (p < 0.01). LDL cholesterol level and plasma ET-1 concentration in Tibetan subjects were significantly higher than Han subjects (p < 0.01). The baseline brachial artery diameter in Tibetan group was much higher than that of Han group (p < 0.01). The absolute and percent changes in brachial artery diameter were lower in Tibetan population compared with Han population (p < 0.01). The linear regression analysis showed that LDL cholesterol, and plasma ET-1 were correlated with FMD (p < 0.01).

CONCLUSIONS

Endothelial function and plasma ET-1 concentration were different between Tibetan and Han male populations.

Statin ameliorates endothelial dysfunction and insulin resistance in Tibet women with polycystic ovary syndrome

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. In Tibet population, little is known about the correlation between PCOS and endothelial function and insulin resistance. In this study, we investigated the efficacy of simvastatin on ameliorating endothelial dysfunction and insulin resistance in Tibet patients with PCOS.

PATIENTS AND METHODS

A group of 21 PCOS women was compared with 21 age-paired controls for blood pressure, body mass index (BMI), lipids, glucose and insulin levels. Plasma ET-1 was quantitated using a commercially available ELISA kits. The invasive vascular endothelial function was evaluated through the measurement of brachial artery flow-mediated dilation (FMD) in the fasting state using high-resolution B-mode ultrasound and ankle-brachial index (ABI) by using a blood pressure cuff and a Doppler instrument.

RESULTS

PCOS women had higher BMI (p < 0.05), blood pressure (p < 0.05), cholesterol (p < 0.05), triglyceride (p < 0.05), LDL cholesterol (p < 0.05) and lower HDL cholesterol (p < 0.05). Fasting insulin (p < 0.001) and 2-hour plasma glucose (p < 0.001) of PCOS were also found to be higher than that of controls. HOMA-IR of PCOS was calculated to be much higher than that of the control group (p < 0.001). ET-1 levels were significantly higher in the PCOS women compared with the control group (p < 0.001). FMD and ABI were impaired in the PCOS group when compared with the controls (p < 0.001). After simvastatin intervention for 6 months, FMD, ABI, HOMA-IR, lipid profile, BMI were ameliorated in PCOS women. Also, FMD, ABI, HOMA-IR, lipid profile were nearly normalized in PCOS women after statin treatment compared with the control women. Tibet PCOS patients present a clustering of atherosclerosis risk factors (obesity, adverse lipid profile, hypertension and hyperglycemia) and more prevalent in insulin resistance and endothelial dysfunction than non-PCOS women.

CONCLUSIONS

The endothelial function and insulin resistance of PCOS patients were ameliorated

CONCLUSIONS

The endothelial function and insulin resistance of PCOS patients were ameliorated after statin administration.

Clinicopathological and phenotypic features of chronic NK cell lymphocytosis identified among patients with asymptomatic lymphocytosis

INTRODUCTION

Chronic natural killer (NK) cell lymphocytosis is currently a provisional entity. This study demonstrated NK cell lymphocytosis in patients with asymptomatic lymphocytosis and presented the hematological and phenotypic findings.

METHODS

Flow cytometry analysis was performed for investigation of unexplained peripheral lymphocytosis. NK cells were determined by the phenotype of CD3-/CD16+/CD56+. Chronic NK cell lymphocytosis was defined by a NK cell count of ≥ 2 × 10(9)/L, persistent for over 6 months, no evidence of B- or T-cell clonality and no hematologic disorders.

RESULTS

Among 190 patients with peripheral lymphocytosis, 15(7.9%) patients, age 42-72 years, were identified to have NK cell lymphocytosis, with a median NK cell count of 3.1 × 10(9)/L (range 2.1-7.3 × 10(9)/L). Persistent NK cell lymphocytosis was confirmed with a median follow-up of 18 months. CD56(bright) NK cell populations were seen in eight patients and CD56(dim) NK cells in seven patients. CD57 co-expression was seen in both CD56(dim) and CD56(bright) cells. CD7, CD2, or CD8 expression was seen in some of the NK populations. The NK cell lymphocytosis appeared stable and no progression to NK cell leukemia during the follow-up period.

CONCLUSION

This study demonstrated that chronic NK cell lymphocytosis, similar to monoclonal B lymphocytosis or T-cell clones, may account for asymptomatic lymphocytosis. There were no identifiable causes of the NK cell expansion. The variable phenotype may represent the heterogeneity and pathological features of NK lymphocytosis.