Diagnostic conundrum of a perineal tumour: a rectal gastrointestinal stromal tumour mimic

Gastrointestinal stromal tumour (GIST) is a common mesenchymal tumour arising in the gastrointestinal tract, but not frequently encountered in the rectum. Herein, we describe a case of a rectal GIST which mimicked histomorphological features of a schwannoma; thus, making intraoperative frozen section evaluation challenging. Although subsequent immunohistochemistry and molecular findings readily confirmed the diagnosis of a GIST, we wish to draw attention to three clues that will help the pathologist steer clear of this potential diagnostic pitfall. One, GISTs are relatively more common than schwannomas in the rectum. Two, schwannomas usually have very little mitoses. Three, rectal GISTs commonly exhibit nuclear palisades. We also discuss the diagnostic, prognostic and therapeutic functions of immunohistochemical and molecular investigations. As the surgical intent for rectal GISTs is for en-bloc excision with wide margins, we surmise that the intraoperative consult should include GIST as a possible differential diagnosis for rectal mesenchymal tumours. In view of the potential for neoadjuvant treatment with imatinib before surgical excision to preserve sphincter function, a multidisciplinary approach is recommended for establishing most effective treatment strategy in these rare complex cases.

Molecular and structural changes related to hepatitis E virus antigen and its expression in testis inducing apoptosis in Mongolian gerbil model

Hepatitis E virus (HEV) infection has been associated with a wide range of extrahepatic manifestations, so this study was designed to examine the effect and role of HEV on structural and molecular changes in the testicular tissues of Mongolian gerbils experimentally infected with swine HEV. HEV RNA was first detected in testis at 14 days post-inoculation and reached a peak between 28 and 42 days later with viral load between 3.12 and 6.23 logs/g by PCR assays. Changes including vacuolation, sloughing of germ cells, formation of multinuclear giant cells, degeneration, necrosis of tubules and damaged blood-testis barrier were observed through transmission electron microscopy. HEV ORF2 antigen was detected in the sperm cell cytoplasm along with decrease in relative protein of zonula occludens-1 through immunohistochemistry. HEV ORF3 antigen and ZO-1 protein were detectable by Western blotting. Lower (P<.05) serum testosterone and higher (P<.05) blood urea nitrogen level was observed in inoculated Mongolian gerbils. Likewise, increased (P<.05) germ cell apoptosis rate was detected with significant increased expression of Fas-L and Fas in HEV-inoculated groups at each time points. Up-regulation (P<.05 or P<.01) in mRNA level of Fas-L, Fas, Bax, Bcl-2 and caspase-3 was observed in HEV RNA-positive testes. Our study demonstrated that after experimental inoculation, HEV can be detected in testis tissues and viral proteins produce structural and molecular changes that in turn disrupt the blood-testis barrier and induce germ cell apoptosis.

Metformin improves the glucose and lipid metabolism via influencing the level of serum total bile acids in rats with streptozotocin-induced type 2 diabetes mellitus

OBJECTIVE

To study the effects of metformin on streptozotocin-induced type 2 diabetes mellitus (T2DM) in rats.

MATERIALS AND METHODS

Wistar male rats were divided into two groups: standard diet (SD, n = 20) group and high-fat diet (HFD, n = 80) group. Twenty rats in HFD group were randomly treated with metformin (EI group). After 6 weeks, among rats in HFD group, 20 rats were intraperitoneally injected with citrate buffered saline (IR group), 20 rats treated with metformin per day for 4 weeks (LI group), and 20 rats were given nothing (DM group). Rats in SD group were injected with citrate buffered saline as normal control (NC) group. Moreover, streptozotocin (STZ) was used for inducing diabetes. The metabolic parameters, such as body weight, fasting blood glucose (FBG), fasting insulin concentration (FINS), total cholesterol (TC), total triglycerides (TG), low-density lipoprotein cholesterol (LDLC) and total bile acid (TBA) were measured.

RESULTS

Compared with SD group, the levels of body weight, FBG, TC, LDLC, TBA and FINS and AUC (glucose) were significantly higher in HFD group. After administration of metformin, the levels of FBG, TG, TC, LDLC and TBA in DM and LI group were higher than NC group. Besides, the FBG, TG, TC, TBA and LDLC levels in EI group were higher than DM group.

CONCLUSIONS

Metformin may help to improve the glucose and lipid metabolism by influencing the level of serum total bile acids. A combination of HFD and metformin could be effective in the treatment of rats with T2DM.

Abstract P5-14-02: Triple negative breast cancer - Adjuvant chemotherapy use and survival outcomes in Stage IA disease

Background: The potential benefit of adjuvant chemotherapy in patients with Stage IA triple negative breast cancer (TNBC) has not been defined. In general, patients with T1a and T1b lesions have not been included in adjuvant chemotherapy trials and the inclusion of T1c tumors has been limited. In this study using National Cancer Data Base (NCDB) we investigated the actual use of adjuvant chemotherapy in Stage IA TNBC patients relative to tumor size (T1a, T1b, T1c) and report their survival outcomes.

Patients and Methods: Using NCDB we evaluated a cohort of 13,065 women with TNBC diagnosed between 2010-2012 who had American Joint Committee on Cancer Stage IA (node-negative with pathological T1a, T1b or T1c) tumors. Overall survival (OS) was the primary outcome variable. Based on the tumor size, patients were stratified on receipt of adjuvant chemotherapy or not. Patients were also stratified according to receipt of adjuvant radiation, radiation with boost, or none. Other adjusted variables included: age, race, Charlson comorbidity index, payer status, income, education, distance traveled, treating facility, and treatment delays. Multivariate Cox regression was employed to analyze the effect of adjuvant chemotherapy on overall survival.

Results: The mean patient age for the entire cohort was 59.2 years (range 22-90 years), 55.8 years for the chemotherapy group, and 67.8 years for the non-chemotherapy group. There were 1275 T1a, 3197 T1b, and 7729 T1c patients. Tumor size was a very strong predictor of survival. Compared to T1a tumors, HR for death was 1.43 (95% CI: 0.86 –2.37) for T1b tumors and 3.00 (95% CI: 1.86 – 4.83) for T1c tumors. Out of all T1a, T1b, and T1c tumors in this cohort, 48.1 %, 72.6%, and 89.3% of patients received adjuvant chemotherapy respectively. A hazard ratio (HR) of death was 0.42 (95% CI: 0.31 – 0.57) for all patients who received chemotherapy compared to non-chemotherapy group. 4-year OS by tumor size and chemotherapy usage is listed in the table indicating an absolute increase of OS with adjuvant chemotherapy employment. HR for death was 0.90 (CI: 0.62 – 1.31) with use of radiation only and 0.67 (95% CI: 0.53 – 0.85) with use of radiation with boost when compared to no radiation therapy.

4-year OS (in percentage) with and without adjuvant chemotherapy use for node-negative T1a, T1b, and T1c TNBCTumor sizeNo ChemotherapyChemotherapyP ValueT1a93.78 %98.36 %0.146T1b91.91 %97.10 %&lt;0.0001T1c80.62 %94.41 %&lt;0.0001

Conclusion: NCDB indicated that the majority of patients with Stage IA TNBC received adjuvant chemotherapy, including 48% of patients with T1a lesions. Our data analysis demonstrated a statistically significant 4-year OS benefit in patients with T1b and T1c tumors who received adjuvant chemotherapy compared to those who did not. The survival benefit of adjuvant chemotherapy in patients with T1a tumors, however, did not reach statistical significance. Prospective randomized trials could define the potential benefits of adjuvant chemotherapy in patients with Stage IA TNBC, particularly for those with T1a and T1b tumors.

Citation Format: Patel AN, Shi R, Peddi P, Burton GV. Triple negative breast cancer - Adjuvant chemotherapy use and survival outcomes in Stage IA disease [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-14-02.

Evidence of Hepatitis E virus breaking through the blood-brain barrier and replicating in the central nervous system

Neurologic dysfunctions such as Guillain-Barre' syndrome, encephalitis, meningitis and transverse myelitis occur frequently in patients with hepatitis E virus (HEV) infection, and this study was conducted to better characterize the role of HEV in the pathogenesis of neurologic disorders. Genotype 4 strain of swine HEV was used to inoculate Mongolian gerbils. Reverse transcription-nested polymerase chain reaction (RT-nPCR), ELISA, histopathology, ultrastructural pathology and enzyme immunohistochemistry method were conducted to investigate the replication and localization of HEV in the central nervous system (CNS) and the consequent pathological changes. Both positive- and negative-strand HEV RNA was detectable in brain and spinal cord from 7 to 28 dpi (days postinoculation) via RT-nPCR. Various pathological changes such as perineural invasion, neuron necrosis, microglia nodule, lymphocyte infiltration, perivascular cuff and myelin degeneration were observed in HEV-positive brains and spinal cords. Immunohistochemical (IHC) staining targeting on HEV ORF2 protein revealed positive signals concentrated mainly in the cytoplasm of neuron, ependymal epithelium and choroid plexus area. Positive area density of ZO-1 (zonula occludens-1) in brain of HEV-positive gerbils decreased, while the GFAP (glial fibrillary acidic protein) expression was upregulated compared with control groups. These results provide strong evidence that HEV is able to damage the blood-brain barrier (BBB), replicate in brain and spinal cord, and hammer the causative role of HEV in the pathogenesis of neurologic disorders.

Hypoxia regulates sumoylation pathways in intervertebral disc cells: implications for hypoxic adaptations

OBJECTIVE

To explore the hypoxic regulation of sumoylation pathways and cell viability in nucleus pulposus (NP) and annulus fibrosus (AF) cells.

DESIGN

Expression of small ubiquitin-like modifier (SUMO) molecules, SUMO E1 activating enzymes SAE1 and SAE2, SUMO E2 conjugating enzyme UBC9, and de-sumoylation enzyme sentrin/SUMO-specific proteases (SENP)1 was immunolocalized in rat intervertebral disc (IVD) cells. NP and AF cells were cultured in hypoxia and cell viability was evaluated by quantifying cell proliferation, cellular senescence, apoptosis, and cell cycle distribution. Hypoxic regulation of sumoylation pathways was studied by analyzing the transcription and expression of SUMO molecules and sumoylation enzymes. Loss of function study using SENP1 siRNA was performed to investigate the regulatory role of sumoylation on the function of hypoxia inducible factor 1α (HIF-1α) and the hypoxic tolerance of IVD cells.

RESULTS

Sumoylation pathways were expressed in IVD cells and localized predominantly in nuclei. Both NP and AF cells maintained viability under hypoxia and upregulated the expression of SENP1. In NP cells hypoxia transiently increased the expression of SUMO-1, SUMO-2/3, SAE2, and UBC9, whereas SUMO-1 was elevated while SUMO-2/3, SAE1, SAE2, and UBC9 were reduced by low oxygen tensions in AF cells. Although downregulation of SENP1 decreased the transcriptional activity of HIF-1α, the viability of disc cells showed no significant loss under hypoxia.

CONCLUSIONS

NP and AF cells equally tolerate oxygen deficiency, but differently regulate the sumoylation pathways under hypoxia. The distinct sumoylation dynamics may help extend our understanding of the cell-specific regulation of the molecular basis that promotes cell survival in the hypoxic IVD.

Aging and age related stresses: a senescence mechanism of intervertebral disc degeneration

Intervertebral disc (IVD) degeneration is a complicated process that involves both age-related change and tissue damage caused by multiple stresses. In a degenerative IVD, cellular senescence accumulates and is associated with reduced proliferation, compromised self-repair, increased inflammatory response, and enhanced catabolic metabolism. In this review, we decipher the senescence mechanism of IVD degeneration (IVDD) by interpreting how aging coordinates with age-related, microenvironment-derived stresses in promoting disc cell senescence and accelerating IVDD. After chronic and prolonged replication, cell senescence may occur as a natural part of the disc aging process, but can potentially be accelerated by growth factor deficiency, oxidative accumulation, and inflammatory irritation. While acute disc injury, excessive mechanical overloading, diabetes, and chronic tobacco smoking contribute to the amplification of senescence-inducing stresses, the avascular nature of IVD impairs the immune-clearance of the senescent disc cells, which accumulate in cell clusters, demonstrate inflammatory and catabolic phenotypes, deteriorate disc microenvironment, and accelerate IVDD. Anti-senescence strategies, including telomerase transduction, supply of growth factors, and blocking cell cycle inhibitors, have been shown to be feasible in rescuing disc cells from early senescence, but their efficiency for disc regeneration requires more in vivo validations. Guidelines dedicated to avoiding or alleviating senescence-inducing stresses might decelerate cellular senescence and benefit patients with IVD degenerative diseases.

A novel laparoscopic surgical technique for severe adenomyoma

Qbjctives: The aim of this study was to investigate the feasibility and safety of the treatment of laparoscopic adenomyomectomy for severe adenomyoma.

STUDY DESIGN

The study included 216 patients with severe adenomyoma, who underwent a laparoscopic adenomyomectomy between January 2008 and September 2012 in the Department of Gynecology, Second People's Hospital of Changzhou, affiliated with Nanjing Medical University.

RESULTS

The mean age of the patients was 37 (± 3.3) years and the BMI was,26 (± 2.7). The volume of bleeding during surgery was 150.2 ± 22.7 ml, the mean operative time was 60 ±48.6 minutes, the mean time for anal ex- haust was one ±1.8 days, and the mean time of hospital stay was five ±1.2 days. During the surgeries, no bladder or bowel injuries occurred, and all the surgeries were completed successfully, with no conversions to open laparotomies. Of the 176 patients, 170 (96.6%) showed significant improvement in their dysmenorrheal symptoms after the surgeries, whereas six patients had a poor clinical outcome. Of the 157 patients,151 (96.2%) had an obvious effect on their menstrual cycle. Concluitons: Laparoscopic adenomyomectomy is feasible and safe for severe adenomyoma.

Mouse undifferentiated spermatogonial stem cells cultured as aggregates under simulated microgravity

Dynamic simulated microgravity (SMG) culture systems provide environments that stimulate stem cell proliferation and differentiation. However, the effect of SMG on spermatogonial stem cells (SSCs) remains unclear. Here, we used a rotating cell culture system (RCCS) to determine its effect on mouse SSC proliferation and differentiation. SSCs were enriched from mouse pub testis and cocultured with Sertoli cell feeders pre-treated with mitomycin C on fibrin scaffolds in a rotary bioreactor for 14 days. Our results show that mouse SSCs cultured in a rotary bioreactor exhibited enhanced proliferation surpassing those cultured in static conditions, although SSC cultures in SMG underwent a growth lag at initial 3 days. After 14 days, mouse SSCs and feeders grew into cell aggregates with average diameters of 242.63 ± 16.53 μm compared with those in conventional static culture (49.51 ± 15.64 μm). Related detection revealed that proliferating SSCs in SMG remained undifferentiated, maintained clone-forming capacity and were capable of differentiation into round spermatids with flagella. The growth characteristics of mouse SSCs in RCCS suggest that the resulting aggregates are similar to native in vivo cells. Rotary bioreactors that create SMG environments may be an alternative to conventional systems for the clinical application of SSCs.

GLP-1-Exendin-4/IgG4 (Fc) fusion protein as a novel drug for diabetes treatment

In this paper, we aimed to look for a potent long acting GLP-1 receptor agonist for diabetes treatment. In this work, we constructed the eukaryotic expression vector of GLP-1-Exendin-4/IgG4 (Fc)-pOptiVEC™-TOPO(®) and then transfected it into Chinese hamster ovary DG44 (CHO/DG44) cells using liposome method. Then the beta-cell line INS-1 cells were treated with purified GLP-1-Exendin-4/IgG4 (Fc) fusion protein (0.01, 0.1, 1.0 mM respectively) and randomly assigned to 2 groups, each group were then grown in KRB buffer in the presence of 2.8 mM or 16.8 mM glucose for 2 h separately. In addition, single dose of fusion protein was intraperitoneally injected into male CD1 mice for pharmacokinetic study. Besides, multiple low doses of streptozotozin (STZ) induced diabetes mice were used to evaluate the effect of fusion protein for anti-diabetes in male CD1 mice. GLP-1-Exendin-4/IgG4 (Fc) had stimulatory effect on insulin secretion glucose-dependently from INS-1 cells in a dose-dependent manner. Pharmacokinetic studies showed that the GLP-1 level increased significantly after injecting fusion protein and maintained a higher level for 200 h. Besides, multiple-low-dose STZ-induced diabetes mice which received intraperitoneal injections of fusion protein did not show sign of diabetes. Our results indicated that GLP-1-Exendin-4/IgG4 (Fc) fusion protein retained native GLP-1 activities and had effect on long-term glucose regulation. All the results suggest that this fusion protein may serve as a potent long acting GLP-1 receptor agonist.

Molecular mechanisms of acrolein-mediated myelin destruction in CNS trauma and disease

Myelin is a critical component of the nervous system facilitating efficient propagation of electrical signals and thus communication between the central and peripheral nervous systems and the organ systems that they innervate throughout the body. In instances of neurotrauma and neurodegenerative disease, injury to myelin is a prominent pathological feature responsible for conduction deficits, and leaves axons vulnerable to damage from noxious compounds. Although the pathological mechanisms underlying myelin loss have yet to be fully characterized, oxidative stress (OS) appears to play a prominent role. Specifically, acrolein, a neurotoxic aldehyde that is both a product and an instigator of OS, has been observed in studies to elicit demyelination through calcium-independent and -dependent mechanisms and also by affecting glutamate uptake and promoting excitotoxicity. Furthermore, pharmacological scavenging of acrolein has demonstrated a neuroprotective effect in animal disease models, by conserving myelin's structural integrity and alleviating functional deficits. This evidence indicates that acrolein may be a key culprit of myelin damage while acrolein scavenging could potentially be a promising therapeutic approach for patients suffering from nervous system trauma and disease.

Nutritional status of an elderly population in Southwest China: a cross-sectional study based on comprehensive geriatric assessment

OBJECTIVE

Few data is available on the nutritional status of old Chinese. The present study aimed to describe the nutritional status and clinical correlates for malnutrition risk in the older people.

DESIGN

Cross-sectional study.

SETTING

Hospital- and community-based older people were recruited in the region of Chongqing, China.

PARTICIPANTS

558 individuals aged 60 years old or over between April 2011 and October 2012.

MEASUREMENTS

Comprehensive geriatric assessment was performed and nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF). Nutrition-associated factors were analyzed, including health status (chronic diseases, depression, cognition, function impaired), social factors (education status, marital status, the type of work before 60 years old) and life style factors (smoking, drinking, diet).

RESULTS

The mean age was 73.1±8.0 years and 43.9% were men. Prevalence of malnutrition and risk for malnutrition were 3.2% and 19.3 %, respectively. Several factors increased poor nutrition independently including self-rated health, comorbidity, chronic obstructive pulmonary disease, gastrointestinal disease and cognitive impairment. Fish decreased the risk of poor nutrition.

CONCLUSIONS

The prevalence was relatively low in older people of Chongqing, Southwest China. Poor nutrition was found to be increased due to the common health problems. Thus the patients with these problems should pay more attention on nutritional status. The older people should often have fish because of their nutritional benefit.