Tracking the Correlation Between CpG Island Methylator Phenotype and Other Molecular Features and Clinicopathological Features in Human Colorectal Cancers: A Systematic Review and Meta-Analysis

Objectives:

The controversy of CpG island methylator phenotype (CIMP) in colorectal cancers (CRCs) persists, despite many studies that have been conducted on its correlation with molecular and clinicopathological features. To drive a more precise estimate of the strength of this postulated relationship, a meta-analysis was performed.

Methods:

A comprehensive search for studies reporting molecular and clinicopathological features of CRCs stratified by CIMP was performed within the PubMed, EMBASE, and Cochrane Library. CIMP was defined by either one of the three panels of gene-specific CIMP markers (Weisenberger panel, classic panel, or a mixture panel of the previous two) or the genome-wide DNA methylation profile. The associations of CIMP with outcome parameters were estimated using odds ratio (OR) or weighted mean difference (WMD) or hazard ratios (HRs) with 95% confidence interval (CI) for each study using a fixed effects or random effects model.

Results:

A total of 29 studies involving 9,393 CRC patients were included for analysis. We observed more BRAF mutations (OR 34.87; 95% CI, 22.49–54.06) and microsatellite instability (MSI) (OR 12.85 95% CI, 8.84–18.68) in CIMP-positive vs. -negative CRCs, whereas KRAS mutations were less frequent (OR 0.47; 95% CI, 0.30–0.75). Subgroup analysis showed that only the genome-wide methylation profile-defined CIMP subset encompassed all BRAF-mutated CRCs. As expected, CIMP-positive CRCs displayed significant associations with female (OR 0.64; 95% CI, 0.56–0.72), older age at diagnosis (WMD 2.77; 95% CI, 1.15–4.38), proximal location (OR 6.91; 95% CI, 5.17–9.23), mucinous histology (OR 3.81; 95% CI, 2.93–4.95), and poor differentiation (OR 4.22; 95% CI, 2.52–7.08). Although CIMP did not show a correlation with tumor stage (OR 1.10; 95% CI, 0.82–1.46), it was associated with shorter overall survival (HR 1.73; 95% CI, 1.27–2.37).

Conclusions:

The meta-analysis highlights that CIMP-positive CRCs take their own molecular feature, especially overlapping with BRAF mutations, and clinicopathological features and worse prognosis from CIMP-negative CRCs, suggesting CIMP could be used as an independent prognostic marker for CRCs.

Temperature sensitive auditory neuropathy

Temperature sensitive auditory neuropathy is a very rare and puzzling disorder. In the present study, we reported three unrelated 2 to 6 year-old children who were diagnosed as auditory neuropathy patients who complained of severe hearing loss when they had fever. Their hearing thresholds varied from the morning to the afternoon. Two of these patients' hearing improved with age, and one patient received positive results from cochlear implant. Genetic analysis revealed that these three patients had otoferlin (OTOF) homozygous or compound heterozygous mutations with the genotypes c.2975_2978delAG/c.4819C>T, c.4819C>T/c.4819C>T, or c.2382_2383delC/c.1621G>A, respectively. Our study suggests that these gene mutations may be the cause of temperature sensitive auditory neuropathy. The long term follow up results suggest that the hearing loss in this type of auditory neuropathy may recover with age.

Connexin26 gap junction mediates miRNA intercellular genetic communication in the cochlea and is required for inner ear development

Organ development requires well-established intercellular communication to coordinate cell proliferations and differentiations. MicroRNAs (miRNAs) are small, non-coding RNAs that can broadly regulate gene expression and play a critical role in the organ development. In this study, we found that miRNAs could pass through gap junctions between native cochlear supporting cells to play a role in the cochlear development. Connexin26 (Cx26) and Cx30 are predominant isoforms and co-express in the cochlea. Cx26 deficiency but not Cx30 deficiency can cause cochlear developmental disorders. We found that associated with Cx26 deletion induced the cochlear developmental disorders, deletion of Cx26 but not Cx30 disrupted miRNA intercellular transfer in the cochlea, although inner ear gap junctions still retained permeability after deletion of Cx26. Moreover, we found that deletion of Cx26 but not Cx30 reduced miR-96 expression in the cochlea during postnatal development. The reduction is associated with the cochlear tunnel developmental disorder in Cx26 knockout (KO) mice. These data reveal that Cx26-mediated intercellular communication is required for cochlear development and that deficiency of Cx26 can impair miRNA-mediated intercellular genetic communication in the cochlea, which may lead to cochlear developmental disorders and eventually congenital deafness as previously reported.

Reproductive management through integration of PGD and MPS-based noninvasive prenatal screening/diagnosis for a family with GJB2-associated hearing impairment

A couple with a proband child of GJB2 (encoding the gap junction protein connexin 26)-associated hearing impairment and a previous pregnancy miscarriage sought for a reproductive solution to bear a healthy child. Our study aimed to develop a customized preconception-to-neonate care trajectory to fulfill this clinical demand by integrating preimplantation genetic diagnosis (PGD), noninvasive prenatal testing (NIPT), and noninvasive prenatal diagnosis (NIPD) into the strategy. Auditory and genetic diagnosis of the proband child was carried out to identify the disease causative mutations. The couple then received in-vitro-fertilization treatment, and eight embryos were obtained for day 5 biopsy. PGD was performed by short-tandem-repeat linkage analysis and Sanger sequencing of GJB2 gene. Transfer of a GJB2c.235delC heterozygous embryo resulted in a singleton pregnancy. At the 13th week of gestation, genomic DNA (gDNA) from the trio family and cell-free DNA (cfDNA) from maternal plasma were obtained for assessment of fetal chromosomal aneuploidy and GJB2 mutations. NIPT and NIPD showed the absence of chromosomal aneuploidy and GJB2-associated disease in the fetus, which was later confirmed by invasive procedures and postnatal genetic/auditory diagnosis. This strategy successfully prevented the transmission of hearing impairment in the newborn, thus providing a valuable experience in reproductive management of similar cases and potentially other monogenic disorders.

Resveratrol in the treatment of pancreatic cancer

Pancreatic cancer (PCa), which is now the fourth most frequent cause of cancer-related death, has a median survival of less than 6 months and a 5-year survival rate of <6%. The hallmarks of this cancer include poor outcome, short survival duration, and resistance to therapy. The poor prognosis of PCa is related to its local recurrence, lymph node and liver metastases, and peritoneal dissemination. Recent studies have indicated that resveratrol has cancer-chemopreventive and anticancer activities. In this short review we summarize the chemopreventive and treatment effects of resveratrol in PCa, as follows: resveratrol inhibits the proliferation of pancreatic cancer cells; induces apoptosis and cell cycle arrest; inhibits metastasis and invasion of PCa cells; inhibits the proliferation and viability of PCa stem cells; enhances the chemoradiosensitization of PCa cells; and can affect diabetes mellitus in addition to PCa. On the basis of these data, resveratrol may be considered a potential anticancer agent for the treatment of PCa.

The Role of Remote Ischemic Preconditioning in Ischemia-Reperfusion Injury in Rabbits with Transplanted Lung

BACKGROUND

To observe the influence of remote ischemic preconditioning (R-IPC) and remote ischemic perconditioning (R-IPER) on the lower limbs of rabbits with lung allograft ischemia-reperfusion injury (IRI).

METHODS

Sixty rabbits were randomly divided into one of four groups: control (C), classic ischemic preconditioning (C-IPC), R-IPC, and R-IPER. The allogeneic lung transplantation model was established in rabbits, and the protective effects of R-IPC and R-IPER on transplanted lungs were determined and compared to classic ischemic preconditioning (C-IPC) IRI. Changes in blood oxygen were measured in each group before and after transplantation. After transplantation, levels of serum malondialdehyde (MDA), superoxide dismutase (SOD), and tumor necrosis factor-α (TNF-α), lung wet/dry weight ratio, as well as quantitative and organizational differences in the lungs were analyzed.

RESULTS

After reperfusion, blood oxygen values in the R-IPC group and C-IPC groups were higher than in the C and R-IPER groups at 60 minutes and 120 minutes after transplantation (p < 0.05). Serum SOD content in the R-IPC and C-IPC groups was higher than in the C and R-IPER groups (p < 0.05) after reperfusion. Serum MDA, TNF-α level, and lung wet/dry weight ratio and quantitative measurements of histological damage were lower in the R-IPC and the C-IPC groups than those in the C and R-IPER groups (p < 0.05). No statistically significant differences were observed between the L-IP and the C-IP groups or between the R-IPER and the C groups.

CONCLUSIONS

Classic preconditioning and remote preconditioning of rabbit lung allograft IRI had similar protective effects. The lower limb ischemia with the remote processing method used in this experiment did not produce a protective effect for lung allograft IRI.

Mutations in apoptosis-inducing factor cause X-linked recessive auditory neuropathy spectrum disorder

Background

Auditory neuropathy spectrum disorder (ANSD) is a form of hearing loss in which auditory signal transmission from the inner ear to the auditory nerve and brain stem is distorted, giving rise to speech perception difficulties beyond that expected for the observed degree of hearing loss. For many cases of ANSD, the underlying molecular pathology and the site of lesion remain unclear. The X-linked form of the condition, AUNX1, has been mapped to Xq23-q27.3, although the causative gene has yet to be identified.

Methods

We performed whole-exome sequencing on DNA samples from the AUNX1 family and another small phenotypically similar but unrelated ANSD family.

Results

We identified two missense mutations in AIFM1 in these families: c.1352G>A (p.R451Q) in the AUNX1 family and c.1030C>T (p.L344F) in the second ANSD family. Mutation screening in a large cohort of 3 additional unrelated families and 93 sporadic cases with ANSD identified 9 more missense mutations in AIFM1. Bioinformatics analysis and expression studies support this gene as being causative of ANSD.

Conclusions

Variants in AIFM1 gene are a common cause of familial and sporadic ANSD and provide insight into the expanded spectrum of AIFM1-associated diseases. The finding of cochlear nerve hypoplasia in some patients was AIFM1-related ANSD implies that MRI may be of value in localising the site of lesion and suggests that cochlea implantation in these patients may have limited success.

Stromal-derived factor-1α/CXCL12-CXCR4 chemotactic pathway promotes perineural invasion in pancreatic cancer

Perineural invasion (PNI) is considered as an alternative route for the metastatic spread of pancreatic cancer cells; however, the molecular changes leading to PNI are still poorly understood. In this study, we show that the CXCL12/CXCR4 axis plays a pivotal role in the neurotropism of pancreatic cancer cells to local peripheral nerves. Immunohistochemical staining results revealed that CXCR4 elevation correlated with PNI in 78 pancreatic cancer samples. Both in vitro and in vivo PNI models were applied to investigate the function of the CXCL12/CXCR4 signaling in PNI progression and pathogenesis. The results showed that the activation of the CXCL12/CXCR4 axis significantly increased pancreatic cancer cells invasion and promoted the outgrowth of the dorsal root ganglia. CXCL12 derived from the peripheral nerves stimulated the invasion and chemotactic migration of CXCR4-positive cancer cells in a paracrine manner, eventually leading to PNI. In vivo analyses revealed that the abrogation of the activated signaling inhibited tumor growth and invasion of the sciatic nerve toward the spinal cord. These data indicate that the CXCL12/CXCR4 axis may be a novel therapeutic target to prevent the perineural dissemination of pancreatic cancer.

Identification of a novel mutation of PJVK in the Chinese non-syndromic hearing loss population with low prevalence of the PJVK mutations

CONCLUSION

To our knowledge, this is the first report of PJVK gene mutation in a Chinese non-syndromic sensorineural hearing loss (NSHL) family. Our data indicate that the PJVK gene contributes to hearing impairment in the Chinese population, but it is not a major cause.

OBJECTIVE

To investigate the contribution of PJVK mutations to NSHL in the Chinese population.

METHODS

We screened for the PJVK gene in a sample of 65 autosomal recessive NSHL families without GJB2, SLC26A4, or mitochondrial 12S rRNA gene mutations. Seven pairs of PCR primers were designed to amplify all of the exons and their flanking regions of the PJVK gene. The PCR products were sequenced and analyzed for identification of mutations.

RESULTS

In all, we identified one novel frameshift mutation, c.930_931del AC (p.C312W fsX19), co-segregating with the phenotype in one consanguineous family with a prevalence of 1.5% (1/65). The p.C312W fsX19 mutation was just positioned in the zinc-fingers domain, which was important to the function of pejvakin, and resulted in a stop codon after 19 additional amino acids. It was not identified in the controls and was considered as the causative mutation of family 804566 with autosomal recessive, non-syndromic, prelingual sensorineural hearing impairment.

Connexin26 (GJB2) deficiency reduces active cochlear amplification leading to late-onset hearing loss

Connexin26 (Cx26, GJB2) mutations account for >50% of nonsyndromic hearing loss. The deafness is not always congenital. A large group of these patients (∼30%) demonstrate a late-onset hearing loss, starting in childhood. They have normal hearing early in life and are therefore good candidates for applying protective and therapeutic interventions. However, the underlying deafness mechanism is unclear. In this study, we used a time-controlled, inducible gene knockout technique to knockout Cx26 expression in the cochlea after birth. We found that deletion of Cx26 after postnatal day 5 (P5) in mice could lead to late-onset hearing loss. Similar to clinical observations, the mice demonstrated progressive, mild to moderate hearing loss. The hearing loss initiated at high frequencies and then extended to the middle- and low-frequency range. The cochlea showed normal development and had no apparent hair cell loss. However, distortion product otoacoustic emission (DPOAE) was reduced. The reduction was also progressive and large at high-frequencies. Consistent with DPOAE reduction, we found that outer hair cell electromotility-associated nonlinear capacitance was shifted to the right and the slope of voltage dependence was reduced. The endocochlear potential was reduced in Cx26 conditional knockout (cKO) mice but the reduction was not associated with progressive hearing loss. These data suggest that Cx26 deficiency may impair active cochlear amplification leading to late-onset hearing loss. Our study also helps develop newer protective and therapeutic interventions to this common nonsyndromic hearing loss.

Targeted high-throughput sequencing identifies pathogenic mutations in KCNQ4 in two large Chinese families with autosomal dominant hearing loss

Autosomal dominant non-syndromic hearing loss (ADNSHL) is highly heterogeneous, among them, KCNQ4 is one of the most frequent disease-causing genes. More than twenty KCNQ4 mutations have been reported, but none of them were detected in Chinese mainland families. In this study, we identified a novel KCNQ4 mutation in a five generation Chinese family with 84 members and a known KCNQ4 mutation in a six generation Chinese family with 66 members. Mutation screening of 30 genes for ADNSHL was performed in the probands from thirty large Chinese families with ADNSHL by targeted region capture and high-throughput sequencing. The candidate variants and the co-segregation of the phenotype were verified by polymerase chain reaction (PCR) amplification and Sanger sequencing in all ascertained family members. Then we identified a novel KCNQ4 mutation p.W275R in exon 5 and a known KCNQ4 mutation p.G285S in exon 6 in two large Chinese ADNSHL families segregating with post-lingual high frequency-involved and progressive sensorineural hearing loss. This is the first report of KCNQ4 mutation in Chinese mainland families. KCNQ4, a member of voltage-gated potassium channel family, is likely to be a common gene in Chinese patients with ADNSHL. The results also support that the combination of targeted enrichment and high-throughput sequencing is a valuable molecular diagnostic tool for autosomal dominant hereditary deafness.

Efficacy evaluation of subtotal and total gastrectomies in robotic surgery for gastric cancer compared with that in open and laparoscopic resections: a meta-analysis

Purposes

Robotic gastrectomy (RG), as an innovation of minimally invasive surgical method, is developing rapidly for gastric cancer. But there is still no consensus on its comparative merit in either subtotal or total gastrectomy compared with laparoscopic and open resections.

Methods

Literature searches of PubMed, Embase and Cochrane Library were performed. We combined the data of four studies for RG versus open gastrectomy (OG), and 11 studies for robotic RG versus laparoscopic gastrectomy (LG). Moreover, subgroup analyses of subtotal and total gastrectomies were performed in both RG vs. OG and RG vs. LG.

Results

Totally 12 studies involving 8493 patients met the criteria. RG, similar with LG, significantly reduced the intraoperative blood loss than OG. But the duration of surgery is longer in RG than in both OG and LG. The number of lymph nodes retrieved in RG was close to that in OG and LG (WMD = −0.78 and 95% CI, −2.15−0.59; WMD = 0.63 and 95% CI, −2.24−3.51). And RG did not increase morbidity and mortality in comparison with OG and LG (OR = 0.92 and 95% CI, 0.69−1.23; OR = 0.72 and 95% CI, 0.25−2.06) and (OR = 1.06 and 95% CI, 0.84−1.34; OR = 1.55 and 95% CI, 0.49−4.94). Moreover, subgroup analysis of subtotal and total gastrectomies in both RG vs. OG and RG vs. LG revealed that the scope of surgical dissection was not a positive factor to influence the comparative results of RG vs. OG or LG in surgery time, blood loss, hospital stay, lymph node harvest, morbidity, and mortality.

Conclusions

This meta-analysis highlights that robotic gastrectomy may be a technically feasible alternative for gastric cancer because of its affirmative role in both subtotal and total gastrectomies compared with laparoscopic and open resections.

Death decoy receptor overexpression and increased malignancy risk in colorectal cancer

AIM: To evaluate human epidermal growth factor receptor 2 (HER2) and death decoy receptor (DcR3) as colorectal cancer prognostic indicators.

METHODS: Colorectal carcinoma specimens from 300 patients were analyzed by immunohistochemistry to detect the staining patterns of HER2 and DcR3. Classification of HER2 staining was carried out using the United States Food and Drug Administration semi-quantitative scoring system, with scores of 0 or 1+ indicating a tumor-negative (normal expression) status and scores of 2+ and 3+ indicating a tumor-positive (overexpression) status. Classification of DcR3 was carried out by quantitating the percentage of positive cells within the stained section, with < 10% indicating a tumor-negative status and ≥ 10% indicating a tumor-positive status. Correlation of the HER2 and DcR3 staining status with clinicopathological parameters [age, sex, tumor size, differentiation, and the tumor, node, metastasis (pTNM) classification] and survival was statistically assessed.

RESULTS: Tumor-positive status for HER2 and DcR3 was found in 18.33% and 58.33% of the 300 colorectal carcinoma specimens, respectively. HER2 tumor-positive status showed a significant correlation with tumor size (P = 0.003) but not with other clinicopathological parameters. DcR3 tumor-positive status showed a significant correlation with tumor differentiation (P < 0.001), pTNM stage (P < 0.001), and lymph node metastasis (P < 0.001). However, correlation coefficient analysis did not indicate that a statistically significant correlation exists between tumor-positive status for the HER2 and DcR3 overexpression (P = 0.236). Patients with specimens classified as DcR3-overexpressing had a significantly worse overall survival (OS) rate than those without DcR3 overexpression (median OS: 42.11 vs 61.21 mo; HR = 50.27, 95%CI: 44.90-55.64, P < 0.001). HER2 overexpression had no significant impact on median OS (35.10 mo vs 45.25 mo; HR = 44.40, 95%CI: 39.32-49.48, P = 0.344). However, patients with specimens classified as both HER2- and DcR3-overexpressing had a significantly poorer median OS than those with only HER2 overexpression (31.80 mo vs 52.20 mo; HR = 35.10, 95%CI: 22.04-48.16, P = 0.006).

CONCLUSION: HER2 overexpression is not an independent prognostic marker of colorectal cancer, but DcR3 overexpression is highly correlated with lymph node metastasis and poor OS.

[Analysis of characteristics of tinnitus in patients with auditory neuropathy spectrum disorder]

OBJECTIVE

To investigate the characteristics of tinnitus in patients with auditory neuropathy spec- trum disorder (ANSD).

METHOD

This study recruited 14 ANSD patients with tinnitus. All the ANSD patients un- derwent detailed history taking, audiological examinations and assessments of tinnitus. This study analyzed the correlation of tinnitus status and hearing loss, and discussed the effects of sex, age, and the course of disease on tinnitus in ANSD patients.

RESULT

(1) In the ANSD patients, tinnitus often occurred in 3 years after the onset of hearing loss; (2) Tinnitus was highly prevalent in ANSD patients, and the severity of tinnitus was mostly from mild to moderate; (3) There was no obvious correlation between the subjective grading of tinnitus and hearing loss de- gree, and the impact of curve patterns of hearing loss on the level of tinnitus need much more evidence-based proof; (4) Along with the course extension, the impact of tinnitus on the quality of life was much more obvious; (5) Some risk factors such as noise exposure could be the reasons of aggravating the degree of tinnitus.

CONCLUSION

Tinnitus in ANSD patients has its unique clinical features. The study of Tinnitus in ANSD patients can provide clinical basis for further research in ANSD.

Edaravone protects endotoxin-induced liver injury by inhibiting apoptosis and reducing proinflammatory cytokines

Studies have shown that edaravone may prevent liver injury. This study aimed to investigate the effects of edaravone on the liver injury induced by D-galactosamine (GalN) and lipopolysaccharide (LPS) in female BALB/c mice. Edaravone was injected into mice 30 min before and 4 h after GalN/LPS injection. The survival rate was determined within the first 24 h. Animals were killed 8 h after GalN/LPS injection, and liver injury was biochemically and histologically assessed. Hepatocyte apoptosis was measured by TUNEL staining; proinflammatory cytokines [tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)] in the liver were assayed by ELISA; expression of caspase-8 and caspase-3 proteins was detected by Western blot assay; and caspase-3 activity was also determined. Results showed that GalN/LPS induced marked elevations in serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Edaravone significantly inhibited elevation of serum AST and ALT, accompanied by an improvement in histological findings. Edaravone lowered the levels of TNF-α and IL-6 and reduced the number of TUNEL-positive cells. In addition, 24 h after edaravone treatment, caspase-3 activity and mortality were reduced. Edaravone may effectively ameliorate GalN/LPS-induced liver injury in mice by reducing proinflammatory cytokines and inhibiting apoptosis.

CpG island methylator phenotype, Helicobacter pylori, Epstein-Barr virus, and microsatellite instability and prognosis in gastric cancer: a systematic review and meta-analysis

Background

The controversy of CpG island methylator phenotype (CIMP) in gastric cancer persists, despite the fact that many studies have been conducted on its relation with helicobacter pylori (H. pylori), Epstein-Barr virus (EBV), and microsatellite instability (MSI) and prognosis. To drive a more precise estimate of this postulated relationship, a meta-analysis was performed based on existing relevant studies.

Methods

We combined individual patient data from 12 studies which involved 1000 patients with gastric cancer, which met the criteria. We tabulated and analyzed parameters from each study, including H. pylori, EBV, MSI, and clinical information of patients.

Results

The overall OR for H. pylori infection in CIMP positive group vs. negative group revealed that significantly elevated risks of positive H. pylori infection in the former were achieved (OR 2.23 95% CI, 1.25–4.00; P = 0.007, P_{heterogeneity} = 0.05). Similarly, strong relation between EBV infection and CIMP was achieved by OR 51.27 (95% CI, 9.39–279.86; P<0.00001, P_{heterogeneity} = 0.39). The overall OR for MSI in CIMP positive group vs. negative group was 4.44 (95% CI, 1.17–16.88; P = 0.03, P_{heterogeneity} = 0.01). However, there did not appear to be any correlations with clinical parameters such as tumor site, pathological type, cell differentiation, TNM stage, distant metastasis, lymph node metastasis, and 5-year survival.

Conclusions

The meta-analysis highlights the strong relation of CIMP with H. pylori, EBV, and MSI, but CIMP can not be used as a prognostic marker for gastric cancer.

Comparative study of mutation spectrums of MT-RNR1 m.1555A>G, GJB2, and SLC26A4 between familial and sporadic patients with nonsyndromic sensorineural hearing loss in Chinese Han

BACKGROUND

The mutation frequencies of three common deafness genes (MT-RNR1 m.1555A>G, GJB2, and SLC26A4) among patients with nonsyndromic sensorineural hearing loss (NSHL) were different in previous studies. Inconsistent selection criteria for recruiting patients could have led to differences in estimating the frequencies of genetic mutations thus resulting in different mutation frequencies among these studies. The aim of this study was to reveal the differences in the mutation spectrums of the three common genes between familial and sporadic Chinese Han patients.

METHODS

Totally, 301 familial probands and 703 sporadic patients with NSHL were enrolled in this study. Three genes, MT-RNR1 m.1555A>G, GJB2, and SLC26A4, were screened for mutation in our study cohort. A χ(2) test was performed to compare the mutation frequencies between the two groups.

RESULTS

The study showed that the disease-causing mutation frequencies of MT-RNR1 m.1555A>G, GJB2, and SLC26A4 were 12.29%, 14.62%, and 18.27% in familial probands and 3.56%, 18.63%, and 18.92% in sporadic patients, respectively. The mutation frequency of MT-RNR1 m.1555A>G in familial probands was significantly higher than in sporadic patients (χ(2) test, P = 0.000), while there were no significant differences in the mutation frequencies of GJB2 and SLC26A4 between the familial and sporadic groups (χ(2) test, P > 0.05).

CONCLUSIONS

It is necessary to reveal the differences in gene mutation frequencies between patients of different sources or characteristics by comparative studies in order to avoid selection bias. The mutations of GJB2, SLC26A4, and MT-RNR1 m.1555A>G are the most important etiological factors in Chinese Han patients, among which SLC26A4 might be the most frequent.

Correlation analysis of genotypes, auditory function, and vestibular size in Chinese children with enlarged vestibular aqueduct syndrome

CONCLUSION

In children with enlarged vestibular aqueduct syndrome (EVAS), their hearing was more related to genotype than VA size, and VA size was related to genotype.

OBJECTIVE

To study genotypes of the SLC26A4 gene, types and levels of hearing loss, and vestibular aqueduct (VA) size in children with EVAS.

METHODS

A total of 271 children with nonsyndromic sensorineural hearing loss and EVA underwent SLC26A4 gene screening. According to genotype typing, the phenotypes including pure tone average (PTA), distribution of subjects, and diameters of the external aperture and middle portion of the VA, were compared by t test or Pearson's χ(2) tests. Further, divided by the dilated level of the VA, subject distribution in different hearing loss levels was compared by Pearson's χ(2) test.

RESULTS

In all, 66 types of mutations were identified and 2 were novel (c.665G >T and c.1639G >A). Biallelic genotype was found in 207 subjects, monoallelic in 56, and no mutation in 8. The hearing loss was more stable in the subjects with monoallelic mutation than in other genotype groups. An air-bone gap was more frequently found in subjects with biallelic missense mutations than in other groups. The patients with no mutation had the most slightly enlarged VA. There was no dominant correlation between hearing loss level and VA size, and between VA size and different genotypes.

Accessory spleen arising from the gastric fundus mimicking gastrointestinal stromal tumor following splenectomy: A case report

The current case report presents an accessory spleen mimicking gastrointestinal stromal tumor (GIST) of the stomach in a patient who had undergone a splenectomy ~20 years previously. A 61-year-old male, who presented with upper abdominal discomfort lasting three months, underwent gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a smooth, hemispherical mass of ~2 cm in diameter, with homogenous echogenicity originating from the gastric muscular layer. Abdominal contrast-enhanced computed tomography showed that the well-marginated ovoid mass was ~2.6×1.9 cm in size. The patient was diagnosed with GIST. Subsequent therapy consisted of partial gastrectomy. The pathological results indicated the mass contained splenic tissue, which confirmed it to be an accessory spleen. Changes in the postoperative platelet count were noted. The observations of this case study highlight that platelet count should be used as a routine indicator for monitoring accessory spleen arising from gastric fundus lesion.

[Clinical analysis of in-patients with large vestibular aqueduct syndrome]

OBJECTIVE

This study is to investigate the clinical materials of in-patients with the large vestibular aqueduct syndrome (LVAS), and explore the feature, diagnosis and treatment measures of the disease.

METHOD

A retrospective review was conducted including the medical history, audiological examinations, vestibular function examinations, imaging examinations and treatment methods of 44 in patients (87 ears) suffering LVAS admitted to our hospital in the past 4 years(from 2008 to 2012).

RESULT

ln the 44 in patients, there were 24 male cases and 20 female cases, and the male-female ratio was 1.2 :1. The average of the onset age was 3.39 years. Five cases (11. 36%) had related familial history. The profound hearing loss was found in 67 ears (77.01%), and the severe hearing loss was found in 20 ears (22.99%). After systemic treatment,the hearing of 38 ears improved effectively,but that of 49 ears did not improve obviously. The analysis found that patients suffering sudden hearing loss got better curative effect than those with progressive hearing loss. Patients received combined drug therapy improving arterial circulation as well as venous reflux got better therapeutic effect. There was a significant difference on effect between the patients with course of treatment more than 7 days and those less than 7 days. There was no significant correlation between therapeutic effect and other factors.

CONCLUSION

In part of LVAS patients,the hearing level can be effectively improved through a standard internal medicine treatment. We can improve the personalized and standardized treatment strategy for this disease through analysis of diagnosis and treatment of in-patients with complete clinical data.

Newborn genetic screening for high risk deafness-associated mutations with a new Tetra-primer ARMS PCR kit

OBJECTIVE

Previous epidemiological studies indicate that GJB2, SLC26A4 or mtDNA 12S rRNA mutations were chiefly responsible for the hearing loss in children. A cost-effective method for screening deafness-associated mutations at early age is needed. This study aimed to develop a simple kit for screening of high risk deafness-associated mutations in newborns using tetra-primer amplification refractory mutation system PCR.

METHODS

The screening kit was designed to detect high risk deafness-associated mutations (GJB2 c.235delC, SLC26A4 c.919-2A>G, mtDNA 12S rRNA mt.1555A>G and mt.1494C>T). The kit was able to amplify both wild-type and mutant alleles with a control fragment. The proposed method was conducted to genotype the above four deafness gene mutations in four PCR reactions. Each mutation was genotyped by a set of four primers, two allele-specific inner primers, and two common outer primers. A mismatch at the penultimate or antepenult nucleotide of the 3' terminus was introduced in order to maximize specificity. The 16 primers were used for the amplification of genomic DNA as a template. Amplified fragments were separated by electrophoresis. We designed and validated the kit with wild and mutant type DNA samples that had been previously been confirmed by Sanger sequencing. Then 1181 newborns were enrolled, and those samples with mutations were further validated with sequencing too.

RESULTS

Among 1181 newborns, 29 individuals had one or two mutant alleles, with the carrier rate being 2.46% (29/1181). For GJB2 c.235delC mutation, one case was homozygote and 12 cases were heterozygote carriers. For SLC26A4 c.919-2A>G mutation, 12 cases were heterozygotes carriers, and no homozygotes were found; for mtDNA 12S rRNA mt.1555A>G mutation, one case was identified; three cases of mtDNA 12S rRNA mt.1494C>T mutation were detected. All mutations were detected with high specificity. Mutation samples were confirmed via Sanger sequencing. No false positive was found.

CONCLUSION

A user-friendly screening kit for deafness-associated mutations was successfully developed. It provided rapid, reproducible, and cost-effective detection of deafness gene mutation without special equipment. The kit allowed the detection of the four high risk deafness-associated mutations with only 4 single tube PCR reactions. In the future, the kit could be applied to large population-based epidemiological studies for newborn hearing defects screening.

Surgical and chemotherapeutic experience regarding a urachal carcinoma with repeated relapse: case report and literature review

Background

Urachal carcinoma is a rare tumor that is usually associated with a poor prognosis, especially the pathological type, urachal mucinous adenocarcinoma. Surgery remains the primary treatment in prolonging the overall survival time of patients.

Case presentation

We report on a 41-year-old woman with urachal mucinous adenocarcinoma who underwent three surgeries and several courses of chemotherapy over a 42-month period. The first surgery, involving en-bloc excision of the urachal mass, partial urinary bladder, urachal ligament, and umbilicus was performed in May 2007. It is well known that the correct surgical scheme plays a key role in preventing recurrence or metastasis. However, a second debulking surgery with only a single salpingo-oophorectomy may have contributed directly to the patient’s subsequent left ovarian metastasis. Therefore, we strongly recommend performing a bilateral salpingo-oophorectomy once ovarian metastasis has been detected, even if the metastasis is only present on one side. Although postoperative adjuvant chemotherapy regimens, first with Taxol, carboplatin, gemcitabine, and cisplatin, and then with IFO, EPI, and mesna were consecutively administered after the first and second surgeries, they seemed less effective, since recurrence and metastasis occurred shortly after each surgical treatment. After a third debulking surgery in June 2009, docetaxel, oxaliplatin, and capecitabine were administered. This chemotherapy regimen was chosen based on an immunohistochemical test that involved the multidrug resistance gene; this test indicated that the urachal mucinous adenocarcinoma was resistant to the two chemotherapy regimens used previously. Surprisingly, the patient exhibited a marker response to the new regimen and the metastatic foci entered into a stable disease stage. However, the patient still died of diffuse metastatic disease 1.5 years later. During the whole period of treatment, we found that serum tumor markers including CA724, CA125, CA19-9, and CEA were elevated in a linear pattern, with parallel increases in line with peritoneal carcinomatosis and parallel reductions in line with response to personalized chemotherapy.

Conclusion

Personalized treatment can be given to those patients who experience a poor response to initial therapy. Moreover, an immunohistochemical test for the multidrug resistance gene and serum tumor markers may supply key information in the choice of reasonable chemotherapeutics.

Exome sequencing and linkage analysis identified tenascin-C (TNC) as a novel causative gene in nonsyndromic hearing loss

In this study, a five-generation Chinese family (family F013) with progressive autosomal dominant hearing loss was mapped to a critical region spanning 28.54 Mb on chromosome 9q31.3-q34.3 by linkage analysis, which was a novel DFNA locus, assigned as DFNA56. In this interval, there were 398 annotated genes. Then, whole exome sequencing was applied in three patients and one normal individual from this family. Six single nucleotide variants and two indels were found co-segregated with the phenotypes. Then using mass spectrum (Sequenom, Inc.) to rank the eight sites, we found only the TNC gene be co-segregated with hearing loss in 53 subjects of F013. And this missense mutation (c.5317G>A, p.V1773M ) of TNC located exactly in the critical linked interval. Further screening to the coding region of this gene in 587 subjects with nonsyndromic hearing loss (NSHL) found a second missense mutation, c.5368A>T (p. T1796S), co-segregating with phenotype in the other family. These two mutations located in the conserved region of TNC and were absent in the 387 normal hearing individuals of matched geographical ancestry. Functional effects of the two mutations were predicted using SIFT and both mutations were deleterious. All these results supported that TNC may be the causal gene for the hearing loss inherited in these families. TNC encodes tenascin-C, a member of the extracellular matrix (ECM), is present in the basilar membrane (BM), and the osseous spiral lamina of the cochlea. It plays an important role in cochlear development. The up-regulated expression of TNC gene in tissue repair and neural regeneration was seen in human and zebrafish, and in sensory receptor recovery in the vestibular organ after ototoxic injury in birds. Then the absence of normal tenascin-C was supposed to cause irreversible injuries in cochlea and caused hearing loss.

[Clinical and prognostic analyses of juvenile sudden sensorineural hearing loss]

OBJECTIVE

To explore the clinical profiles of juvenile sudden sensorineural hearing loss (JSSNHL) and examine its clinical characteristics and prognosis.

METHODS

A retrospective review was conducted for the clinical symptoms, audiological characteristics, hematological indices and prognosis in JSSNHL during the past 2 years (from June 2008 to November 2010). All patients were divided into 2 groups according to age, that is group childhood (A, 0-12 years old) and group adolescence (B, 13-18 years old).

RESULTS

JSSNHL patients were rarely associated with "aural fullness" symptoms. Two groups of patients with "tinnitus" symptom accounted for 88.2% and 89.5%. Those with "vertigo" symptom accounted for 47.1% and 44.4% respectively. Most patients (81.6%) showed severe and profound hearing loss. The most common types of audiometric curve were flat and total deafness. Some obvious differences existed between two groups in hematological indices, such as platelet count, concentrations of electrolyte ions, mean corpuscular volume and mean corpuscular hemoglobin. Almost half of them (42.1%) improved hearing level during systemic medical treatment. The patients of two groups showed no significant difference in efficacies. And the hearing enhancement degree of patients in group B was more apparent than that of group A.

CONCLUSIONS

JSSNHL has different clinical features in different age groups. And the outcomes of personalized treatment regimens may be further improved through classification and grading.

Pouch Roux-en-Y vs No Pouch Roux-en-Y following total gastrectomy: a meta-analysis based on 12 studies

After a total resection of the stomach, the continuity of the gastrointestinal tract can be restored either by Roux-en-Y esophagojejunostomy with or without a pouch. There is still no consensus on the best reconstruction technique. The aim of this report was to derive a more precise estimation of Roux-en-Y esophagojejunostomy with a pouch compared with Roux-en-Y esophagojejunostomy without a pouch. Studies were identified by PubMed and Embase searches, and the inclusion criteria were randomized controlled trials (RCTs) comparing reconstruction techniques between Roux-en-Y with and without a pouch. A total of 12 studies including 1,018 patients were included. The meta-analysis shows that pouch Roux-en-Y does not significantly increase total postoperative complications, anastomotic leakage or mortality. Importantly, there is no significant difference in 5-year survival rates between the two groups. Patients with Roux-en-Y esophagojejunostomy complained significantly less of reflux symptoms and dumping syndrome, and had significantly less severe reflux esophagitis. Quality of life was significantly improved in patients with Roux-en-Y esophagojejunostomy with a pouch compared with patients who received Roux-en-Y reconstruction without a pouch. The results indicate the need for Roux-en-Y esophagojejunostomy with a pouch is a gastric substitute after total gastrectomy by comparison with Roux-en-Y esophagojejunostomy without a pouch.

Colon angiolipoma with intussusception: a case report and literature review

Angiolipomas are frequently observed benign tumors. They have a typical vascular component and are often located in subcutaneous tissues, and more rarely, in the gastrointestinal tract. We present the case of a 58-year-old man who complained of abdominal discomfort in the left lower quadrant and two to three bloody stools a day without any obvious etiology. These symptom became more severe in the next three days, due to a large angiolipoma located in the descending colon, which was diagnosed intraoperatively. In a literature review, we found only 22 cases of angiolipomas involving the gastrointestinal tract which are reported in the literature from 1960 to 2012 in PubMed; the key words used in the search are gastrointestinal tract angiolipoma, esophagus, stomach, duodenum, intestine, ileocecal junction, colon, rectum angiolipomas. Colon angiolipoma with intussusception, as seen in this case, is rare and may require emergent surgical intervention.

Giant solitary fibrous tumor arising from greater omentum

Extrathoracic solitary fibrous tumors (SFTs) have been described at almost every anatomic location of human body, but reports of SFT in the abdominal cavity are rare. We herein present a rare case of SFT originating from greater omentum. Computed tomography revealed a 15.8 cm × 21.0 cm solid mass located at superior aspect of stomach. Open laparotomy confirmed its mesenchymal origin. Microscopically, its tissue was composed of non-organized and spindle-shaped cells exhibiting atypical nuclei, which were divided up by branching vessel and collagen bundles. Immunohistochemical staining showed that this tumor was negative for CD117, CD99, CD68, cytokeratin, calretinin, desmin, epithelial membrane antigen, F8 and S-100, but positive for CD34, bcl-2, α-smooth muscle actin and vimentin. The patient presented no evidence of recurrence during follow-up. SFT arising from abdominal cavity can be diagnosed by histological findings and immunohistochemical markers, especially for CD34 and bcl-2 positive cases.

A case of congenital giant gallbladder with massive hydrops mimicking celiac cyst

We present a case of a 55-year-old female who suffered from a mass in the right upper abdomen, which had been present for over six months. Pre-operative blood examinations, including tumor markers, were normal. Initially, the admitting diagnosis was a giant celiac cyst, due to its liquid cystic appearance and large size (approximately 30.0×18.0 cm), visible in the hepatic region under ultrasound. Following the discovery of a cystic duct during surgery, the diagnosis was corrected to be a giant gallbladder. As no obstructive matter was observed, the giant gallbladder was considered to be congenital.

Correlation between p16 expression and malignant risk of gastrointestinal stromal tumor: evidence from nine studies

BACKGROUND/AIMS

The published data about p16 expression and its potential value in malignant risk of GIST patients seems inconclusive. To derive a more precise estimation of this relationship a meta-analysis was performed.

METHODOLOGY

Studies were identified using PubMed and Embase. Inclusive criteria were GIST patients, evaluation of p16 expression and malignant risk. The odds ratios for positive rate of p16 in NIH very low risk group vs. NIH low risk group, for positive rate of p16 in NIH low risk group vs. NIH intermediate risk group, for positive rate of p16 in NIH intermediate risk group vs. NIH high risk group, and for positive rate of p16 in NIH very low risk/low risk group vs. NIH intermediate risk/high risk group, were calculated with 95% CI for each study as an estimation of potential value of p16 in malignant risk of GIST.

RESULTS

A total of 9 studies including 817 patients were involved in this meta-analysis. The meta-analyses of positive rate of p16 among NIH VL group vs. NIH L group vs. NIH I group vs. NIH H group did not attain significant differences, but the overall OR for positive rate of p16 in NIH VL+L group vs. NIH I+H group revealed that significantly elevated risks of positive p16 in NIH VL+L group were achieved.

CONCLUSIONS

The results indicate p16 loss correlates with the increase of malignant risk for GIST and has a close relationship within the NIH I risk group and NIH H risk group.

Cell degeneration is not a primary causer for Connexin26 (GJB2) deficiency associated hearing loss

Connexin26 (Cx26, GJB2) mutations can induce congenital deafness and are responsible for ∼50% of nonsyndromic hearing loss in children. Mouse models show that Cx26 deficiency induces cochlear development disorder, hair cell loss, and spiral ganglion (SG) neuron degeneration. Hair cell loss and cell degeneration have been considered as a primary causer responsible for Cx26 deficiency associated hearing loss. In this study, by coincidental examination of cochlear postnatal development with recording of auditory brainstem response (ABR) and hair cell function, we found that occurrence of hearing loss in Cx26 knockout (KO) mice was ahead of hair cell loss and cochlear cell degeneration. ABR was absent at the whole-frequency range (8-40 kHz) after birth. However, cochlear cells including SG neurons had no significant degeneration throughout postnatal development. Severe cochlear hair cell loss and SG neuron degeneration were only visible in middle and basal turns, i.e., in middle and high frequency regions, in the adult Cx26 KO mouse cochlea. Functional tests show that hair cells in Cx26 KO mice functioned normally; outer hair cells retained electromotility. These data suggest that cell degeneration is not a primary causer of Cx26 deficiency associated hearing loss. Some mechanisms other than cell degeneration, such as cochlear development disorders, may play an essential role in this common hereditary deafness.

Efficacy evaluation of imatinib in the treatment of patients with gastrointestinal stromal tumors

BACKGROUND/AIMS

Published data on the dose of imatinib to treat gastrointestinal stromal tumors seemed inconclusive. To derive a more precise estimation of dose of imatinib to treat gastrointestinal stromal tumors, a meta-analysis was performed.

MATERIAL AND METHODS

Studies have been identified by searching PubMed and Embase. Inclusion criteria were patients with incurable or advanced gastrointestinal stromal tumors, received chemotherapy of imatinib of 400 mg once a day (low-dose group) or 300 mg/400 mg twice a day (high-dose group) for controlled trial, and efficacy evaluation were cumulative response based on SWOG criteria, including complete response and partial response. The safety evaluation of imatinib included toxic effect and dose reduction. The odds ratio for cumulative response, toxic effect and dose reduction in patients with low-dose of imatinib over those with high-dose of imatinib with 95% confidence interval was calculated for each study as an estimation of the better effect of imatinib.

RESULTS

A total of 3 studies including 1,787 patients were involved in this meta-analysis. The overall odds ratio for cumulative response, toxic effect and dose reduction were 0.91 (95% confidence interval, 0.75-1.09; p=0.31, Pheterogeneity=0.80), 0.55 (95% confidence interval, 0.42-0.72; p<0.0001, Pheterogeneity=0.01), respectively.

CONCLUSION

The meta-analysis indicated that cumulative response for patients with low-dose imatinib showed no significant difference compared with that with high-dose imatinib. However, high-dose imatinib brought patients more toxic effect and more dosage adjustment for down regulation was made for these patients with severe toxic effect. With long follow-up of the patients, result of neither progression-free survival nor overall survival reached statistical significance between low-dose arm and high-dose arm.

[Effect of human saliva on wound healing]

OBJECTIVE

To observe the effects of saliva on impaired raw surface so as to elucidate the possible mechanism in wound healing by comparing with Yunnan baiyao.

METHODS

Six wounds (2.5 cm x 2.5 cm in size) were established at both sides on the back of 6 3-month-old adult Japanese rabbits (weighing 2.0-2.5 kg). According to treatment, 36 wounds were randomly divided into 3 groups: wounds were treated with 0.4 mL normal saline (blank control group, n = 12), 0.5 g Yunnan baiyao powder (Yunnan baiyao group, n = 12), and 0.4 mL saliva of health adult (saliva group, n = 12) for 15 days, respectively. And the general observation of raw surface, the scar formation time, wound healing rate, and histopathology were used to evaluate the effectiveness of saliva on wound healing.

RESULTS

The wound healing speeds of saliva group and Yunnan baiyao group were faster than that of blank control group. The wound healing rates of saliva group were significantly higher than those of blank control group and Yunnan baiyao group at 5, 8, and 11 days after injury (P < 0.05). No obvious hemorrhage or necrosis of raw surfaces was observed in saliva group, and the raw surfaces generally were covered with epidermis at 15 days after injury. The inflammatory cells and microvessel density in saliva group were significantly less than those of Yunnan baiyao group and control group (P < 0.05).

CONCLUSION

Saliva could obviously improve wound healing, which is related to its effects on reducing inflammatory cell infiltration, preventing wound infection, accelerating collagen fibers proliferation, and promoting vessel reconstruction in the process of wound healing.

Billroth I vs. Billroth II vs. Roux-en-Y following distal gastrectomy: a meta-analysis based on 15 studies

BACKGROUND/AIMS

After a distal resection of the stomach, the continuity of the gastrointestinal tract can be restored by either a gastroduodenal anastomosis (Billroth I), a gastrojejunal anastomosis (Billroth II) or a Roux-en-Y gastrojejunostomy. There is still no consensus on the reconstruction technique of choice. The aim of this report was to assess the value of Roux-en-Y (RY) gastrojejunostomy as a gastric substitute after distal gastrectomy, compared with Billroth I (BI) gastroduodenal anastomosis or Billroth II (BII) gastrojejunal anastomosis.

METHODOLOGY

A systematic literature search was carried out and a meta-analysis was executed according to the QUOROM statement. Only randomized controlled trials (RCTs) comparing reconstruction techniques among BI, BII and RY were eligible for inclusion. Data on total postoperative complications, local anastomotic leakage, mortality, local recurrence, reflux symptoms, dumping syndrome, reflux esophagitis, reflux gastritis, operation time, intraoperative bleeding and hospital stay were extracted from the RCTs for meta-analysis using fixed-effects models for the calculation of pooled estimates of treatment effects.

RESULTS

Fifteen RCTs comparing reconstruction techniques among BI, BII and RY were included. The results of the meta-analyses show that RY reconstruction does not significantly increase postoperative complications. Patients with RY reconstruction complained significantly less of reflux symptoms and had significantly reduced reflux gastritis and esophagitis. Quality of life was significantly improved in patients with RY reconstruction compared with patients with BI or BII reconstruction.

CONCLUSIONS

This meta-analysis highlights some clinical advantages of RY reconstruction after distal gastrectomy.

Unilateral auditory neuropathy spectrum disorder

CONCLUSIONS

The majority of the patients with unilateral auditory neuropathy spectrum disorder (UANSD) were pediatric and mostly showed a great degree of hearing loss when diagnosed. Abnormal auditory brainstem response (ABR) and preserved otoacoustic emissions (OAEs) and/or cochlear microphonics (CM) were important features to differentiate it from common sensorineural deafness and central nerve hearing loss.

OBJECTIVE

To identify the clinical characteristics of patients with UANSD.

METHODS

This was a retrospective study involving 14 patients diagnosed as having UANSD between 2004 and 2010 in the Chinese PLA Hospital.

RESULTS

In all, 50% of the cases were males (1:1 sex ratio) and the average age of onset was 4.1 years. Of the 14 affected ears with UANSD in these cases, 6 were left-sided, while 8 were right-sided. Of the 14 contralateral ears, 4 presented with sensorineural hearing loss, while the other 10 showed normal hearing. The degree of hearing loss in the 14 affected ears varied, including moderate in 1, moderately severe in 4, severe in 5, and profound in 4. ABRs were absent in the 14 affected ears, while the OAEs, and/or CM were present.

Correlation between P53 expression and malignant risk of gastrointestinal stromal tumors: evidence from 9 studies

PURPOSE

The published data about p53 expression and its potential value in malignant risk of Gastrointestinal Stromal Tumors patients seemed inconclusive. To derive a more precise estimation of the relationship between p53 and Malignant risk of GIST, a meta-analysis was performed.

MATERIALS AND METHODS

Studies have been identified by searching PubMed and Embase. Inclusive criteria were GIST patients, evaluation of p53 expression and malignant risk. The odds ratio (OR) for positive rate of p53 in NIH very low risk group vs. NIH low risk group, the odds ratio (OR) for positive rate of p53 in NIH low risk group vs. NIH Intermediate risk group and the odds ratio (OR) for positive rate of p53 in NIH Intermediate group vs. NIH high risk group were calculated with 95% confidence interval (CI) for each study as an estimation of potential value of p53 in malignant risk of GIST.

RESULTS

A total of 9 studies including 768 patients were involved in this meta-analysis. The meta-analysis of positive rate of p53 in NIH VL group vs. NIH L group did not attain significant difference (OR 0.38 95% CI, 0.11-1.28; P = 0.12 P(heterogeneity) = 0.51). However the overall OR for positive rate of p53 in NIH L group vs. NIH I group revealed that significantly elevated risks of positive p53 in NIH I group were achieved (OR 0.44 95% CI, 0.24-0.82; P = 0.009 P(heterogeneity) = 0.32). The overall OR for NIH I group vs. NIH H group was 0.62 (95% CI, 0.37-1.02; P = 0.06 P(heterogeneity) = 0.25).

CONCLUSION

The results indicate p53 overexpression correlate with the malignant risk increasing of GIST and have a primary and closest relationship within the NIH I risk group of GIST.

Predictive value of p53 expression in the risk of malignant gastrointestinal stromal tumors: Evidence from 19 studies

The current published data on p53 expression and its predictive value in the risk of malignant gastrointestinal stromal tumors (GIST) has are inconclusive. To derive a more precise estimation of the correlation between p53 and the biological behavior of GIST, a meta-analysis was performed. Studies were identified by searching PubMed and Embase. Inclusion criteria were GIST patients, and the evaluation of p53 expression and risk of malignancy. The odds ratio (OR) for a positive rate of p53 in the benign group vs. that in the malignant group and the ORs for the positive rate of p53 in the National Institutes of Health (NIH) very low risk + low risk group (VL+L) vs. the NIH intermediate risk + high risk (I+H) group were calculated with a 95% confidence interval (CI) for each study as an estimation of the predictive value of p53. A total of 19 studies including 1163 patients were involved in this meta-analysis. The overall OR for the positive rate of p53 in the malignant group vs. the benign group revealed that significantly elevated risks of positive p53 in the malignant group were achieved (OR 0.14, 95% CI: 0.06-0.31, P<0.00001, P(heterogeneity)=0.86). Moreover, significantly elevated risks of correlation between p53 expression and the NIH I+H group were achieved in the comparison of the NIH VL+L group vs. the NIH I+H group (OR, 0.25; 95% CI, 0.17-0.38; P<0.00001, P(heterogeneity)=0.04). The results indicate that p53 expression correlates with poor prognosis in GIST and has a close relationship within the NIH I+H group.

Clinical experience and analysis of laparoscopic total mesorectal excision combined with improved Bacon for the treatment of lower rectal cancer

This study is aimed at assessing the safety and feasibility of laparoscopic total mesorectal excision (LTME) combined with improved Bacon (IB) procedure in the treatment of lower rectal cancer. There were 347 patients undergoing sphincter-preserving operation at the authors hospital from 2003 to 2009. Of these, there were 201 cases with double stapler technique (DST) anastomosis in high-location group (range 6 to 12cm); 76 cases with DST anastomosis in low-location subgroup A (range 5 to 6cm); and 70 cases with IB anastomosis in low-location subgroup B (range 5 to 6cm). In high-location group vs. low-location subgroup A, anastomotic leak rate and covering stoma rate in low-location subgroup A were obviously higher (p=0.038 and p=0.040); in low-location subgroup A vs. low-location subgroup B, operative time in low-location subgroup B was a little longer (p=0.000). However, anastomotic leak rate and covering stoma rate were significantly higher in low-location subgroup A (p=0.043 and p=0.043). DST can be applied as the first choice if the inferior margin of tumor to anal verge is 6 to 12cm. For lower rectal cancer, 5 to 6cm from anal verge, when DST is not suitable for sphincter-preserving operation, IB anastomosis can be applied.

[Correlation study between obstructive level diagnosed by Apnea Graph and cephalometric posterior airway space in obstructive sleep apnea hypopnea syndrome]

OBJECTIVE

To study the correlation between Apnea Graph (AG) analysis of airway obstruction and cephalometric assessment of the posterior airway space in the diagnosis of obstructive level in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), so as to improve the preoperative diagnostic accuracy and the therapeutic outcome.

METHODS

Thirty patients (28 males and two females) who were diagnosed with severe OSAHS (mean AHI 58.6) by overnight polysomnography in recent 3 months were enrolled. The ages of the patients ranged from 35 to 59 years old with the median age of 41.5 years old. The mean body mass index (BMI, x(-) ± s) was (28.8 ± 4.1) kg/m(2). Mean apnea-hypopnea index (AHI) was (58.6 ± 16.4)/h. The lowest oxygen saturation was averaged to 0.69 ± 0.09. All patients underwent AG study as well as cephalometric analysis preoperatively. A correlation analysis was performed between the percentage of lower level obstructions measured by AG and the posterior airway space (PAS) evaluated by cephalometric analysis.

RESULTS

All of the 30 patients had the obvious narrow PAS of 4.4 - 10.8 mm, with the average of (7.6 ± 2.1) mm. Their constituent ratios of lower level obstruction ranged from 2 to 87 percent with the median ratio of 15.5% [9.0%; 35.8%]. Among all the patients, only 2 cases had more than 50 percent obstruction of the airway at lower level, 8 cases had 30 to 40 percent obstruction, and 6 cases had the narrow PAS less than 6 mm. The constituent ratio of lower level obstructions had a negative rectilinear correlation with the data of PAS (r = -0.6511, P < 0.01), which meant the patient with a higher percentage of lower obstruction had the tendency to have a corresponding narrower PAS. Two cases whose constituent ratios of lower level obstructions were not compatible with the rectilinear tendency due to tonsillar hypertrophy were reported.

CONCLUSIONS

AG analysis of airway obstruction and cephalometric assessment of the PAS could provide comparable and consistent results for the diagnosis of obstructive level in OSAHS. However, the tonsillar hypertrophy should be considered when using AG to identify the airway obstruction.

Gastric cavernous hemangioma: A rare case with upper gastrointestinal bleeding

Upper gastrointestinal bleeding caused by a gastric hemangioma is a relatively rare occurrence. We report the case of a 65-year-old woman who suffered a sudden onset of hematemesis. Endoscopy revealed a 4×3 cm mass located in the gastric fundus. Abdominal contrast-enhanced CT revealed the shadow of enhancing linear blood vessels located in the gastric fundus. Based on her clinical appearance and the laboratory results, the patient was diagnosed with gastric hemangioma. In the laparotomy, a proximal gastrectomy was performed. The final diagnosis of cavernous hemangioma arising from the gastric fundus was confirmed by postoperative pathological examination.

Coding regions of INHBA, SFRP4 and HOXA10 are not implicated in familial endometriosis linked to chromosome 7p13-15

Endometriosis is a common, chronic gynaecological disease affecting up to 10% of women in their reproductive years. Its aetiology still remains unclear, but evidence indicates genetic factors play a role. We previously identified a region of significant linkage on chromosome 7 in 52 families comprising at least three affected women, stretching ∼6.4 Mb. We screened coding regions and parts of the regulatory regions of three candidate genes with a known role in endometrial development and function-INHBA, SFRP4 and HOXA10-located under or very near the linkage peak, for potential causal mutations using Sanger sequencing. Sequencing was conducted in 47 cases from the 15 families contributing most to the linkage signal (Z(mean) ≥ 1). Minor allele frequencies (MAFs) of observed variants were compared with MAFs from two publicly available reference populations of European ancestry: 60 individuals in HapMap and 150 individuals in the 1000 Genomes Project. A total of 11 variants were found, 5 (45%) of which were common (MAF > 0.05) among the 15 case families and the reference populations (P-values for MAF difference: 0.88-1.00). The remaining six were rare and unlikely to be individually or cumulatively responsible for the linkage signal. The results indicate that the coding regions of these three genes do not harbour mutations responsible for linkage to endometriosis in these families.

Molecular epidemiological analysis of mitochondrial DNA12SrRNA A1555G, GJB2, and SLC26A4 mutations in sporadic outpatients with nonsyndromic sensorineural hearing loss in China

CONCLUSION

GJB2 mutation was frequent in sporadic outpatients and its mutation frequency was significant higher in the prelingual group than in the postlingual group, whereas the mutation of mtDNA A1555G and SLC26A4 was very rare in Chinese sporadic outpatients with nonsyndromic sensorineural hearing loss (NSHL). Standard and comprehensive inclusion and grouping criteria are necessary for epidemiological studies of deafness-related gene mutations.

OBJECTIVES

This study aimed to examine the mutations of the three common deafness genes GJB2, SLC26A4, and mtDNA A1555G in Chinese sporadic outpatients with NSHL and to discuss the factors that influence the detection accuracy of mutation frequencies.

METHODS

A total of 473 sporadic NSHL patients without any type of inner ear malformation, including both prelingual and postlingual groups were enrolled in this study. Three genes of mtDNA A1555G, GJB2, and SLC26A4 were screened for mutation in our study cohort. A chi-square test was performed to compare mutation frequencies between prelingual and postlingual groups.

RESULTS

The mutation frequencies of MtDNA A1555G, GJB2, and SLC26A4 were 1.63%, 13.63%, and 0%, respectively, in our study cohort. The mutational hot spot of GJB2 was c.235delC, whose allele frequency was 12.68% in sporadic outpatients. Mutation frequency of GJB2 in the prelingual group was significantly higher than in the postlingual group (p < 0.05).

Efficacy evaluation of imatinib treatment in patients with gastrointestinal stromal tumors: A meta-analysis

AIM: To perform a meta-analysis to derive a more precise estimation of imatinib treatment for different genotypes of gastrointestinal stromal tumors (GIST).

METHODS: Studies were identified by searching PubMed and Embase. Inclusive criteria were patients with exon 9-mutant, exon 11-mutant or wide type (WT) GIST, receiving chemotherapy of imatinib for clinical trial, and efficacy evaluation was cumulative response (CR) including complete response and partial response. The odds ratios (OR) for CR in stem cell factor receptor (KIT) mutation patients vs WT genotype patients, KIT exon 11-mutant genotype patients vs KIT exon 9-mutant genotype patients and KIT exon 9-mutant genotype patients vs WT genotype patients were calculated with 95% confidence interval (CI) for each study as an estimation of the efficacy of imatinib.

RESULTS: Five studies including 927 patients were involved in this meta-analysis. The overall OR (KIT group vs WT group) was 3.34 (95% CI: 2.30-4.86, P < 0.00001, P_{heterogeneity} = 0.04). The overall OR in KIT exon 11 group vs KIT exon 9 group was 3.29 (95% CI: 2.17-5.00, P < 0.00001, P_{heterogeneity} = 0.33). The overall OR in KIT exon 9 group vs WT group was 1.23 (95% CI: 0.73-2.10, P = 0.44, P_{heterogeneity} = 0.42).

CONCLUSION: Most patients with different genotypes of GIST and KIT exon 11-mutant will benefit from the individualized treatment of imatinib.

The large Chinese family with Y-linked hearing loss revisited: clinical investigation

CONCLUSION

The DFNY1 phenotypes shared many characteristics with some autosomal dominant hearing loss, in the aspects of age of onset, severity and audiometric configuration. However, the typical, outstanding feature of this trait was its remarkable pattern of inheritance. Similar traits, if ever encountered, can be most easily identified by discerning this exceptional and rare pattern of inheritance.

OBJECTIVES

To analyze the audiological features in Chinese Y-linked non-syndromic hearing impairment, the extended DFNY1 family.

SUBJECTS AND METHODS

A nine-generation Chinese family (DFNY1) was ascertained and expanded from the year of 2000 to 2006. The audiometric evaluations included pure-tone audiometry, tympanometry, and auditory brainstem responses. Some subjects received computerized tomography scan of the temporal bone.

RESULTS

52 out of 276 members in this family received clinical examinations. 24 live subjects had hearing impairment consisting of 23 patrilineal males and one female. In the affected lineage, 92% patrilineal males were well characterized as having hearing loss and 2 children remained to be diagnosed. Based on the audiological examinations on the male members, the degree of hearing loss was from mild (3 patients), moderate (7 patients) to severe (11 patients). The audiometry displayed 48% subjects with sloping in high frequencies, 38% flat in all frequencies, and the rest (14%) the U-shape. The age of onset ranged from 5-27 years with the average of 11.5 years.

A distinct spectrum of SLC26A4 mutations in patients with enlarged vestibular aqueduct in China

There is a worldwide interest in studying SLC26A4 mutations that are responsible for enlarged vestibular aqueduct (EVA) in different ethnic background and populations. The spectrum of SLC26A4 mutations in Chinese population is yet to be fully characterized. In this study, all the 21 exons of SLC26A4 were screened in 107 Chinese patients with hearing loss associated with EVA or both EVA and Mondini dysplasia (MD), taken from six multiplex and 95 simplex families. The two types of control populations consisted of 84 normal-hearing subjects and 46 sensorineural hearing loss subjects without inner ear malformations. Biallelic mutations were found in 12 patients from multiplex families and 84 patients (88.4%) from the simplex families. In addition, monoallelic variant was detected in nine patients in the remaining 11 simplex families. Overall, up to 97.9% patients were found having at least one possible pathogenic variant in SLC26A4, with most having biallelic variants consistent with recessive inheritance of this disorder. A total of 40 mutations including 25 novel mutations were identified in the Chinese patients but were not detected in all the controls except for one normal subject. For the Chinese mutation spectrum of SLC26A4 gene, IVS 7-2A>G mutation was the most common form accounting for 57.63% (102/177) of all the mutant alleles.

[Gene mapping for autosomal dominant nonsyndromic hearing loss DFNA11]

OBJECTIVE

To map the gene locus in a Chinese pedigree with autosomal dominant nonsyndromic hearing loss.

METHODS

A genome wide screening was performed with 394 microsatellite markers distributed with an average spacing of 10 cM (ABI Prism Linkage Mapping Set 2, Applied Biosystems, Foster City, CA, U.S.A.).

RESULTS

Affected family members showed a bilateral, symmetrical, progressive neurosensory deafness. Significant linkage was found to marker D1 S937 (maximum two point LOD score of 5. 71 at theta = 0.05) on chromosome 11q. The position of the novel deafness locus, DFNA11, was delimited by analysis of the recombinant haplotypes (D11S165-D11S1874). This analysis placed DFNA11 between the proximal marker D11S1314 and the distal marker D11S898, which define a critical interval of 25.34 cM.

CONCLUSIONS

Mapping of the DFNA11 locus further confirms the great genetic heterogeneity underlying the autosomal dominant forms of hereditary deafness. Reports of more families with hearing impairment linked to this locus should contribute to the identification of the responsible gene, providing insights into the auditory function and the molecular pathophysiology of age related hearing loss.

A review of microwave-assisted polymer chemistry (MAPC)

As a relatively new source of processing energy, microwave energy offers many compelling advantages in materials processing over conventional heat sources. These advantages include greater flexibility, greater speed and energy savings, improved product quality and properties, and synthesis of new materials that cannot be produced by other heating methods. Studies of microwave processing of polymeric materials in the early 1960s led to a successful industrial application in the rubber industry. Since the mid-1980's, there has been a great deal of interest in microwave processing of polymeric materials worldwide. The discipline can be categorized in two major fields: microwave-assisted polymer physics (MAPP) and microwave assisted polymer chemistry (MAPC). This paper offers an overview of the state-of-the-art research on the field of MAPC, including polymer processing (curing of thermosets, processing of thermoplastics, and joining), polymer synthesis, plasma modification of polymer surfaces, plasma polymerization, polymer degradation, and production of nanomaterials. Most of these studies have focused on laboratory-scale, exploratory efforts. Challenges and possible future directions for the commercialization of microwave processing technologies are discussed.

[Influence of planting density and precipitation on N2O emission from a winter wheat field]

To investigate the impact of plant density on N2O emission from winter wheat field and the cause of seasonal variation in the emission, field experiment with four planting rates of 0, 90, 180 and 270 kg/ha was conducted at the Jiangning County near Nanjing during 1999-2000 winter wheat growing season. Data of the field measurements indicated that the N2O emission rates during the season from planting to overwintering were not influenced by the plant density, while the emission was positively correlated with the planting density during the season from turning green to maturity. The emissions from the field plots with planting rates of 0 and 90 kg/ha were not found to be significantly different. A further analysis suggested that the seasonal variation of N2O emission be mainly influenced by precipitation, which could be quantitatively described by an exponential function of a weighted average precipitation of 6-day period before measurement.

P[Switch], a system for spatial and temporal control of gene expression in Drosophila melanogaster

We have developed a method for turning on and off the expression of transgenes within Drosophila in both time and space. Two different enhancer detector elements carrying an RU486-inducible form of the yeast transcription factor GAL4 were constructed and used to generate enhancer detector lines. These lines were screened for RU486-inducible reporter gene expression in the adult head. We identified lines that exhibit inducible expression in many cell and tissue types, verifying that the elements respond to nearby enhancers. No expression was detected in the absence of the ligand. The P[Switch1] element responded to genomic enhancers less efficiently than P[Switch2] but produced more specific patterns of expression. Two P[Switch] lines were used to ablate fat body tissue in adult females through the induced expression of diphtheria toxin. These females were sterile, which correlates with fat body loss, and they died prematurely.

[Association of human leukocyte antigen-DQA1 with endometriosis of women in southern China]

OBJECTIVE

To study the genetic susceptibility in patients with endometriosis by genotyping their human leukocyte antigen-DQA1 (HLA-DQA1) alleles.

METHODS

The allelic types of HLA-DQA1 were detected by polymerase chain reaction single specific primers (PCR-SSP) technique in 51 patients with endometriosis proven by laparoscopy or histological examination, and 44 control women who had laparoscopic sterilization and without endometriosis.

RESULTS

The frequency of HLA-DQA * 0401 allele (12%) in patients with endometriosis group was markedly higher than that in the control group (0%) (P = 0.019). Contrarily, the frequency of HLA-DQA1 * 0301 allele (39%) in control group was higher than that in endometriosis group (14%) (P = 0.005, odds ratio = 0.253).

CONCLUSION

Our result indicated that HLA-DQA1 * 0401 may be a susceptible gene in correlation with endometriosis, whereas HLA-DQA1 * 0301 may be a protective gene against endometriosis.