Staging accuracy of endoscopic ultrasound for esophageal cancer after neoadjuvant chemotherapy: a meta-analysis and systematic review

This study aims to evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer after neoadjuvant chemotherapy (NAC). Articles were searched in Medline, Pubmed, Cochrane Database of Systemic Reviews, Google scholar, and EMBASE. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratio (DOR). Pooling was conducted using either fixed-effects model or random-effects model depending on the heterogeneity across studies. Sixteen studies (n = 724) were included in this analysis. The pooled sensitivity and specificity of EUS to diagnose T1 stage tumor was 23% (95% confidence interval [CI] 16-32%) and 95% (95%CI 93-97%), respectively. For T2 stage, EUS had a pooled sensitivity and specificity of 29% (95%CI 19-41%) and 84% (95%CI 77-88%). The pooled sensitivity and specificity of EUS were 81% (95%CI 72-88%) and 42% (95%CI 33-52%) in determining T3 stage tumor. To diagnose T4 stage tumor, EUS had a pooled sensitivity of 43% (95%CI 31-56%) and specificity of 96% (95%CI 94-97%), respectively. In determining N stage, the pooled sensitivity and specificity of EUS were 69% (95%CI 58-79%) and 52% (95%CI 42-62%). EUS is a moderately accurate technique in staging esophageal cancer after NAC. Its sensitivity is relatively high in T3 while specificity is high in other T stages (T1, T2, and T4). Tumors restaged by EUS as T4 should not be assigned to surgery because it is very likely to be inoperable. EUS is not reliable for N staging with its poor sensitivity and specificity. Subgroup analysis shows that staging accuracy did not improve with time.

Serum levels of high-sensitivity troponin T: a novel marker for left ventricular remodeling and performance in hypertensive subjects

It has been well established that high-sensitivity cardiac troponin T (hs-TnT) is a specific and highly sensitive marker in acute coronary syndromes. On the other hand, studies on serum concentrations of hs-TnT in patients with hypertension in the absence of significant coronary stenosis are limited. Therefore, we hypothesized that hs-TnT levels are related to left ventricular (LV) remodeling and performance in hypertension. We included 537 hemodynamically stable hypertensive subjects, 247 males aged 60.7 ± 11.1 years, and 100 normotensive subjects of similar age and gender. Clinical examination, clinical assessment and laboratory assays were performed for all hypertensive and normotensive subjects. The detectable rate (>0.003 ng/mL) and elevated rate (>0.013 ng/mL) of hs-TnT were higher in hypertensive subjects than those in normotensive subjects. hs-TnT level gradually increased in hypertensive subjects with LV normal geometry, concentric remodeling, concentric hypertrophy and eccentric hypertrophy. hs-TnT was independently related to age, gender, hypertension, fasting blood glucose, renal function, and LV hypertrophy, and diastolic function on multiple analysis during the whole participation. An increase in hs-TnT levels could be a reliable biomarker of cardiac remodeling and function in hypertension, as an indicator of subclinical ongoing cardiomyocyte injury.

The MYB proto-oncogene suppresses monocytic differentiation of acute myeloid leukemia cells via transcriptional activation of its target gene GFI1

The MYB gene is a master regulator of hematopoiesis and contributes to leukemogenesis in several species including humans. Although it is clear that MYB can promote proliferation, suppress apoptosis and block differentiation, the identities of the MYB target genes that mediate these effects have only been partially elucidated. Several studies, including our own, have collectively identified substantial numbers of MYB target genes, including candidates for each of these activities; however, functional validation, particularly in the case of differentiation suppression, has lagged well behind. Here we show that GFI1, which encodes an important regulator of hematopoietic stem cell (HSC) function and granulocytic differentiation, is a direct target of MYB in myeloid leukemia cells. Chromatin immunoprecipitation and reporter studies identified a functional MYB-binding site in the promoter region of GFI, whereas ectopic expression and small hairpin RNA-mediated knockdown of MYB resulted in concomitant increases and decreases, respectively, in GFI1 expression. We also demonstrate that GFI1, like MYB, can block the induced monocytic differentiation of a human acute myeloid leukemia cell line, and most importantly, that GFI1 is essential for MYB's ability to block monocytic differentiation. Thus, we have identified a target of MYB that is a likely mediator of its myeloid differentiation-blocking activity, and which may also be involved in MYB's activities in regulating normal HSC function and myeloid differentiation.

Association of serum pigment epithelium-derived factor with high-sensitivity C-reactive protein in women with polycystic ovary syndrome

BACKGROUND

The basic studies showed that Pigment epithelium-derived factor (PEDF) plays an important role in inflammation.

AIM

This study aims to investigate the association of serum PEDF with high-sensitivity C-reactive protein (hs-CRP) in women with polycystic ovary syndrome (PCOS).

METHODS

Ninety-six PCOS women and 63 healthy, age-matched controls were enrolled in this study. Serum levels of PEDF, hs-CRP, Complement C3 (C3), glucose, insulin, lipids, and total testosterone were measured. Ninety-six PCOS women and 20 controls underwent hyperinsulinemiceuglycemic clamp to assess their insulin sensitivity, which was expressed as M value.

RESULTS

Serum PEDF levels and hs- CRP levels were much higher in PCOS women than in controls. In PCOS women, PEDF positively correlated with body mass index (BMI), hs-CRP, C3, LDL cholesterol (LDL-c), and systolic blood pressure (SBP), and negatively correlated with M value and HDL cholesterol (HDL-c). After controlling for BMI, PEDF was still positively correlated with hs-CRP. Multiple linear regression analysis revealed that in PCOS women, hs-CRP, SBP, LDL-c and M value were independent determinants of serum PEDF.

CONCLUSION

The serum PEDF levels are closely associated with hs-CRP in women with PCOS. PEDF may play a role in the development of chronic inflammation in PCOS.

Expression patterns of tight junction components induced by CD24 in an oral epithelial cell-culture model correlated to affected periodontal tissues

BACKGROUND AND OBJECTIVE

Previously we demonstrated uniformly strong expression of CD24 in the epithelial attachment to the tooth and in the migrating epithelium of the periodontitis lesion. Titers of serum antibodies autoreactive with CD24 peptide correlated with reduced severity of periodontal disease. Ligation of CD24 expressed by oral epithelial cells induced formation of tight junctions that limited paracellular diffusion. In this study, we aimed to reveal that the lack of uniform expression of tight junction components in the pocket epithelium of periodontitis lesions is likely to contribute to increased paracellular permeability to bacterial products. This is proposed as a potential driver of the immunopathology of periodontitis.

MATERIAL AND METHODS

An epithelial culture model with close correspondence for expression patterns for tight junction components in periodontal epithelia was used. Immunohistochemical staining and confocal laser scanning microscopy were used to analyse patterns of expression of gingival epithelial tight junction components.

RESULTS

The minimally inflamed gingival attachment was characterized by uniformly strong staining at cell contacts for the tight junction components zona occludens-1, zona occludens-2, occludin, junction adhesion molecule-A, claudin-4 and claudin-15. In contrast, the pocket epithelium of the periodontal lesion showed scattered, uneven staining for these components. This pattern correlated closely with that of unstimulated oral epithelial cells in culture. Following ligation of CD24 expressed by these cells, the pattern of tight junction component expression of the minimally inflamed gingival attachment developed rapidly.

CONCLUSION

There was evidence for non-uniform and focal expression only of tight junction components in the pocket epithelium. In the cell-culture model, ligation of CD24 induced a tight junction expression profile equivalent to that observed for the minimally inflamed gingival attachment. Ligation of CD24 expressed by gingival epithelial cells by lectin-like receptors of commensal oral streptococci could mediate the phenotype of health, whereas pathogenic organisms associated with periodontal disease might not signal effectively through CD24.

Anti-inflammatory and anti-oxidative effects of corilagin in a rat model of acute cholestasis

Background

Nowadays, treatments for cholestasis remain largely nonspecific and often ineffective. Recent studies showed that inflammatory injuries and oxidative stress occur in the liver with cholestasis. In this study, we would use corilagin to treat the animal model of acute cholestasis in order to define the activity to interfere with inflammation-related and oxidative stress pathway in cholestatic pathogenesis.

Methods

Rats were administrated with alpha-naphthylisothiocyanate to establish model of cholestasis and divided into corilagin, ursodeoxycholic acid, dexamethasone, model and normal groups with treatment of related agent. At 24h, 48h and 72h time points after administration, living condition, serum markers of liver damage, pathological changes of hepatic tissue, nuclear factor (NF)-kappaB, myeloperoxidase (MPO), malondialdehyde (MDA), superoxide dismutase (SOD) and nitric oxide (NO) were examined and observed.

Results

Compared to model group, corilagin had remarkable effect on living condition, pathological manifestation of liver tissue, total bilirubin, direct bilirubin, (P<0.01), but no effect on alanine aminotransferase (ALT) and aspartate aminotransferase (AST). With corilagin intervention, levels of MPO, MDA and translocation of NF-κB were notably decreased, and levels of SOD and NO were markedly increased (P<0.05 or P<0.01).

Conclusions

It is shown that corilagin is a potential component to relieve cholestasis through inflammation-related and oxidation-related pathway.

Establishment of an acute rejection model by transplanting both renal grafts into two different rats using a modified method of ureterovesical anastomosis

OBJECTIVE

To establish an acute rejection model after kidney transplantation in the rat using a modified method of ureterovesical anastomosis.

METHODS

Thirty-nine Wistar rat donors, were transplanted into 70 male SD rats. Wistar rats (group 1; n = 18) underwent harvest of both kidneys, cold perfusion, and transplantation into 36 SD rats. Wistar rats (group 2; n = 18) underwent left kidney harvest, cold perfusion and transplantation into 18 SD rats. Groups 1 and 2 did not receive immunosuppression after transplantation. Six kidneys were harvested from 3 Wistar rats (group 3), were transplanted into 6 SD rats that were treated with CsA (5 mg/kg per day) postoperatively, and humanely killed at 21 days. There were 10 SD in sham operated rats (group 4). The renal allograft vein was end-to-end anastomosed to the recipient renal vein using an epidural catheter. The renal allograft was anastomosed end-to-side to the recipient abdominal aorta with an abdominal aortic flap. The renal allograft ureterovesical flap was directly inserted into the recipient bladder, and attached by 4-5 interrupted sutures. The recipient's right kidney vessels were ligated at 3 days postoperatively.

RESULTS

The success rates were 91.7% and 88.9% in groups 1 and 2, respectively. Except for the time for removal of the renal allografts, the operative durations and warm ischemia times differed insignificantly between both groups (P > .05). Blood creatinine levels increased significantly after kidney transplantation in groups 1 and 2 compared with the sham operated and CsA-treated cohorts (P < .01), but insignificantly between groups 1 and 2 (P > .05).

CONCLUSIONS

A dual renal allograft model was established in the rat using a modified ureterovesical anastomosis. The technique can be reproduced reliably, reducing costs and shorten using overall operative duration.

Laparoscopic versus open surgery for rectal cancer: a clinical comparative study

OBJECTIVE

To compare short-term surgical outcomes and long-term survival following laparoscopic or open resection for rectal cancer.

METHODS

A total of 381 patients undergoing laparoscopic surgery and 276 undergoing open surgery for curative resection of rectal cancer were included. Long-term survival and peri- and postoperative data were retrospectively reviewed from a prospectively-collected database.

RESULTS

Surgical groups were comparable regarding age, gender, tumour stage and preoperative comorbidities. Laparascopic surgery was associated with significantly longer duration of surgery, less intraoperative blood loss and fewer postoperative infections than open surgery. Patients who underwent laparoscopic resection had significantly earlier recovery of gastrointestinal function than those who underwent open surgery. There were no significant between-group differences in number of lymph nodes excised, specimen length or distal margin. The 3- and 5-year survival rates and overall survival were similar in the two groups, and survival was not influenced by tumour location.

CONCLUSION

Laparoscopic surgery can achieve the same oncological results as open resection in patients with rectal cancer, supporting its continued use in the management of this disease.

Pioglitazone attenuates myocardial ischemia-reperfusion injury via up-regulation of ERK and COX-2

Our previous study demonstrated that the peroxisome proliferator-activated receptor (PPAR) γ agonist, pioglitazone (PIO), may be cardioprotective against ischemia-reperfusion injury; however, modulation of p42/p44 extracellular signal-regulated kinases (ERK1/2) and cyclooxygenase (COX)-2 by PIO in the myocardium with respect to ischemia-reperfusion (I/R) is only partially understood. We determined if PIO reduces I/R-induced apoptosis in cardiomyocytes, and whether or not this protective effect is due to modulation of ERK1/2 and COX-2. Sixty male Sprague-Dawley rats were randomized and assigned to 1 of 6 groups: I/R; I/R + PIO (5 mg•kg(-1)•day(-1)); I/R + PIO (10 mg•kg(-1)•day(-1)); I/R + PIO (10 mg•kg(-1)•day(-1)) + the ERK1/2 inhibitor, PD98059; I/R + PIO ( 10 mg•kg(-1)•day(-1)) + GW9662;and I/R + PD98059. Rats underwent 30 min of myocardial ischemia and 120 min of reperfusion, and then hearts were harvested for analysis. RT-PCR and Western blotting were performed to detect expression of ERK1/2 and COX-2. The number of TUNEL-positive cardiomyocytes and NEC in the PIO groups (5 and 10 mg•kg(-1)•day(-1)) was much lower than the I/R group. The cardioprotective effect of PIO was abrogated by PD98059 and GW9662. Phosphorylation of ERK1/2 and COX-2 was increased in the PIO-treated group compared with the I/R group. GW9662 reversed the expression of ERK1/2 and COX- 2 phosphorylation induced by PIO. PD98059 reversed the expression of COX-2 induced by PIO. PIO was shown to be cardioprotective in an I/R injury model in rats via inhibition of cardiomyocyte apoptosis. PIO limited the infarct size in a PPAR-γ-dependent manner. These results show that PIO triggers the MAPK signaling pathway involving ERK1/2 using COX-2 as the downstream target.

Anti-interleukin-12/23p40 antibody attenuates chronic rejection of cardiac allografts partly via inhibition γδT cells

In our previous study, we showed that treatment with an anti-interleukin (IL)-12/23p40 antibody inhibits acute cardiac allograft rejection via inhibiting production of interferon (IFN)-γ and IL-17a. However, the impact of this antagonistic anti-p40 antibody on chronic cardiac rejection was unclear. Hearts of B6.C-H2bm12/KhEg mice were transplanted into major histocompatibility complex (MHC) class II-mismatched C57Bl/6J mice (wild-type, γδTCR (-/-) and IL-17(-/-) ), which is an established murine model of chronic allograft rejection without immunosuppression. The mice were treated with control immunoglobulin (Ig)G or 200 µg anti-p40 monoclonal antibody on post-operative days, respectively. Abdominal palpation and echocardiography were used to monitor graft survival. The mice administered with anti-p40 antibody showed a significant promotion in graft survival (median survival time >100 days), and histological analyses revealed that cardiac allograft rejection was attenuated. Quantitative real-time polymerase chain reaction (qRT-PCR) and immunofluorescence analyses demonstrated that anti-p40 antibody down-regulated the level of ingraft cytokine and chemokine expression (IL-6, IFN-γ, IL-17a, CCL2 and CCL20). Flow cytometry analyses showed that γδ T cells are an important ingraft source of IFN-γ and IL-17a and inhibit the production of inflammation cytokine by anti-p40 antibody. Compared with the wild-type group, the graft survival time in the γδ T cell receptor(-/-) and IL-17(-/-) mice was prolonged significantly. Therefore we propose that, in the chronic allograft rejection model, treatment with anti-p40 antibody prolongs graft survival possibly by reducing the amount of reactive inflammatory cells, especially γδ T cells.

Ethanol Extract from Ampelopsis sinica Root Exerts Anti-Hepatitis B Virus Activity via Inhibition of p53 Pathway In Vitro

Ampelopsis sinica root is widely used in Chinese folk medicine for treating liver disorders caused by the hepatitis B virus (HBV). The present study was performed in order to investigate the anti-HBV activity and mechanisms of the ethanol extract from A. sinica root (EASR) in vitro. The antiviral activity of EASR was examined by detecting the levels of HBsAg, HBeAg and extracellular HBV DNAs in stable HBV-producing human hepatoblastoma HepG2 2.2.15 cells. We found that EASR effectively suppressed the secretion of HBsAg and HBeAg from HepG2 2.2.15 cells in a dose-dependent manner, and it also suppressed the amount of extracellular HBV DNA. After EASR treatment, the percentage of apoptotic cells was found to be significantly higher than that of control by flow cytometric analysis. A luciferase reporter gene assay was used to determine the effects of EASR on the activities of HBV promoters and intracellular signaling pathways. The results showed that EASR selectively inhibited the activities of HBV promoters (Cp, S1p and Fp) and the p53 signaling pathway in HepG2 cells significantly. These data indicate that EASR exerts anti-HBV effects via inhibition of HBV promoters and the p53-associated signaling pathway, which helps to elucidate the mechanism underlying the potential therapeutic value of EASR.

[Enhancement of antiviral immunity in HBV mouse model by blocking PD-1/PD-L1 signaling pathway]

OBJECTIVE

To establish a mouse model for human chronic HBV infection, and to investigate the role of PD-1/PD-L1 signaling pathway in antiviral immunity.

METHODS

A mouse model was established by hydrodynamic injection of the plasmid pAAV/HBV1.2-GFP into the tail vein of C57BL/6 mice, HBV markers were assayed at different time points after injection. After intraperitoneal injection of anti-PD-L1 monoclonal antibody, the serum ALT, and HBV DNA in the serum, liver and kidney were assayed.

RESULTS

The chronic HBV infection mouse model were established successfully, serum HBsAg and high load of HBV DNA were detectable 90 days after plasmid injection. After blocking of the PD-1/PD-L1 pathway, the serum ALT level of mice were significantly increased (P < 0.01), and the HBV DNA load in serum (P < 0.01), liver (P < 0.05) and kidney (P < 0.05) were decreased significantly.

CONCLUSION

Blocking the PD-1/PD-L1 signaling pathway can enhance antiviral response in mice with chronic HBV infection.

The Treg/Th17 imbalance in patients with idiopathic dilated cardiomyopathy

To assess whether Treg/Th17 balance was broken in patients with idiopathic dilated cardiomyopathy (DCM). We studied 25 patients who were diagnosed as idiopathic DCM (18 men and seven women, mean age 35.6 +/- 5.2) and 25 normal persons (18 men and seven women, mean age 33.8 +/- 4.9). Then, we detected Treg/Th17 functions on different levels including cell frequencies, related cytokine secretion and key transcription factors in patients with idiopathic DCM and controls. The results demonstrated that patients with idiopathic DCM revealed significant increase in peripheral Th17 number, Th17-related cytokines (IL-17, IL-6, IL-23) and transcription factor (RORgammat) levels and obvious decrease in Treg number, Treg-related cytokines (TGF-beta1 and IL-10) and transcription factor (Foxp3) levels when compared to normal persons. Results indicated that Treg/Th17 functional imbalance existed in patients with idiopathic DCM, suggesting a potential role for Treg/Th17 imbalance in the development of idiopathic DCM.