[Clinical features and risk factors of surgical complications after intersphincteric resection for low rectal cancer following neoadjuvant chemoradiotherapy]

Objective: To explore clinical features and prognosis factors of surgical complications after intersphincteric resection (ISR) for low rectal cancer following neoadjuvant chemoradiotherapy. Methods: The clinical data of 132 patients with low rectal cancer who underwent ISR following neoadjuvant chemoradiotherapy from September 2010 to June 2017 at Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University were retrospectively reviewed. There were 100 males and 32 females, with the age of (52.9±11.4) years and distance to anal verge of 3.9 cm. Records of perioperative complication (POC) within 30 days after surgery, anastomotic leakage (AL), and anastomotic stenosis (AS) were analyzed. POC was recorded according to the Clavien-Dindo classification. AL was graded by ISREC system and classified into the early AL within 30 days after surgery and delayed AL beyond 30 days. AS was defined as narrowing of the bowel lumen at the anastomosis that prevented passage through a colonoscope with a 12 mm diameter. According to the shape of narrowing, AS was recorded as the stenosis in situ or stenosis with long-segment bowel above. Univariate and multivariate analysis were used to identify risk factors of anastomotic complications. Results: Among the 132 patients, full-dose radiotherapy and diverting stoma were performed in 128 (97.0%) patients, respectively. In entire cohort, AL was found in 41 (31.1%) patients, including 32 patients with clinical leakage (24.2%). The median time for diagnosis of AL was 37 days (2 to 214 days) after surgery. There were 25 patients (18.9%) who were diagnosed with delayed AL beyond 30 days. Chronic presacral sinus formation was detected in 22 of 129 (17.1%) patients at 12 months from surgery. Among the 128 eligible patients, 36 (28.1%) were diagnosed as AS, including 24 (18.8%) patients with stenosis in situ and 12 (9.4%) patients with bowel stenosis above. After a median follow-up of 26 months, 7(5.3%) patients received permanent colostomy and the other 20(15.2%) patients retained a persistent ileostomy, owing to anastomotic complications. Results of multivariate analysis showed that radiation colitis was an independent prognosis factor of AL after ISR (OR=5.04, 95% CI: 2.05 to 12.43, P=0.000); male gender (OR=5.19, 95% CI: 1.24 to 21.75, P=0.024) and AL (OR=8.49, 95% CI: 3.32 to 21.70, P=0.000) were independent prognosis factors of AS after ISR. Conclusions: Surgical complications are common after ISR for low rectal cancer patients with neoadjuvant chemoradiotherapy. A high rate of AL is observed after long-term follow-up, which is associated with AS. Increasing awareness of anastomotic complications after ISR should be raised, especially for male patients with radiation colitis.

[The association of metastasis-related indexes of lymph nodes and the prognosis of stage N2b colorectal cancer patients]

Objective: To evaluate the prognostic value of lymph node metastasis-related indexes in patients with stage N2b colorectal cancer. Methods: Clinicopathologic data of 245 patients with stage N2b colorectal cancer who initially underwent radical operation in Cancer Hospital, Chinese Academy of Medical Sciences between January 2007 and December 2012 were retrospectively analyzed. The prognostic values of several indexes, including number of positive lymph nodes, number of negative lymph nodes, lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) were analyzed. Results: The 5-year overall survival rate of 245 patients with colorectal cancer was 54.0%, and the 5-year recurrence-free survival rate was 48.5%.Univariate analysis showed that perineural or blood vessel invasion, T stage, postoperative adjuvant therapy, number of positive lymph nodes, number of negative lymph nodes, LNR, and LODDS were significantly associated with the 5-year overall survival of colorectal cancer patients (P<0.05). Multivariate cox regression analysis showed that, number of positive lymph nodes, number of negative lymph nodes, LNR, LODDS were all independent prognostic factors for stage N2b colorectal cancer patients (P<0.05). The areas under the receiver operating characteristic curve (ROC) curves of number of positive lymph node, number of negative lymph nodes, LNR and LODDS were 0.649, 0.667, 0.690 and 0.683, respectively, however, no statistical significance was observed between the number of negative lymph nodes (P=0.622), LNR (P=0.178) or LODDS (P=0.272) and the number of positive lymph nodes. Conclusion: The number of positive lymph nodes, number of negative lymph nodes, LNR and LODDS were all independent prognostic factors for patients with stage N2b colorectal cancer.

Current but not past hepatitis B virus infection is associated with a decreased risk of nonalcoholic fatty liver disease in the Chinese population: A case-control study with propensity score analysis

The relation between hepatitis B virus (HBV) infection and fatty liver has been addressed by several observational studies, but their results remain controversial. To date, no study has precisely investigated the association of current and past HBV infection with the risk of nonalcoholic fatty liver disease (NAFLD) in the Chinese population. Therefore, we conducted a hospital-based case-control study in southwestern China to clarify this issue. A total of 631 newly ultrasound-diagnosed NAFLD cases and 2357 controls were selected from 123 243 consecutive patients admitted to a tertiary-care hospital between January 2015 and December 2016. Multivariate logistic regression was employed to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A propensity score was developed for adjustment and matching. Subgroup analysis was conducted to identify potential effect modifiers. Current and past HBV infection had an overall prevalence of 9.7% and 55.2%, respectively. In the fully adjusted model, current HBV infection was associated with a decreased risk of NAFLD (OR 0.64; 95% CI 0.42-0.95). A similar inverse association was observed in both propensity-score-adjusted (OR 0.58; 95% CI 0.40-0.86) and propensity-score-matched analyses (OR 0.61; 95% CI 0.40-0.92).The inverse association was stronger in patients with hypertension than in those without (P_interaction  = .018).No significant association between past HBV infection and NAFLD risk was found. In conclusion, current but not past HBV infection is associated with a decreased risk of NAFLD in the Chinese population. The corresponding biological mechanisms remain to be elucidated.

[Clinicopathologic features and prognosis of inflammatory pseudotumor-like follicular dendritic cell sarcomas in liver and spleen: an analysis of seven cases]

Objective: To investigate the clinicopathological features and prognostic parameters of the inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) of liver and spleen. Methods: Ninteen cases of inflammatory pseudotumor (IPT) and 5 cases of IPT-like FDCS of the liver and spleen were collected at the First Affiliated Hospital, Army Medical University from 2006 to 2016. HE sections, immunohistochemical staining, and Epstein-Barr virus encoded nuclear RNA (EBER) in situ hybridization were reviewed along with a summary of the literature. Results: Among the previously diagnosed 19 cases of IPT of the liver and spleen, 2 cases were misdiagnosed (the ratio of 2/19). Among 7 new cases including 3 males and 4 females, 3 cases involved the liver and 4 cases involved the spleen. The age range was 37-64 years (mean 53 years). The maximum tumor diameter ranged from 3.0 to 11.0 cm (mean 6.5 cm). Surgical resections were performed in all patients with follow-up time ranging from 3 to 84 months.All patients were disease-free.7 new cases were all positive for EBER, and showed the expression of at least one of the FDC markers, including CD21, CD23, and CD35. The rest of 17 cases of IPT were all negative for EBER and essentially negative for FDC markers, but were all positive for SMA. Conclusions: IPT-like FDCS of the liver and spleen is a rare low-grade malignant tumor morphologically mimicking inflammatory pseudotumor, and is easy to be misdiagnosis due to under-recognition. EBER in situ hybridization and FDC markers are indispensable for confirming the diagnosis.

Correction to: Molecular characterization of Blastocystis sp. in captive wild animals in Qinling Mountains

There were errors in Fig. 1 of the originally published article. Correct fig. 1 is presented here.

[Clinicopathological characteristics of papillary thyroid microcarcinoma and risk factors for central lymph node metastasis]

Objective: To analyze the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) and risk factors for central lymph node metastasis(CLNM) in PTMC. Methods: The data of 900 patients with PTMC initially treated in our hospital from January 2004 to December 2015 were retrospectively analyzed. Chi-square test and Logistic regression analysis were performed to determine the risk factors for CLNM. Results: CLNM affected 162 (22.9%) of 707 patients treated with central lymph node dissection. Age, maximum tumor size, multifocality, bilaterality, and extracapsular spread (ECS) were significantly correlated with CLNM (all P<0.01). Age<45 years, maximum tumor size>5 mm, multifocality, bilaterality, and extracapsular spread were independently correlated with CLNM. Conclusion: A prophylactic central lymph node dissection should be considered in PTMC patients with age<45 years, maximum tumor size>5 mm, multifocality, bilaterality, and extracapsular spread.

[Effect of sandblasting on bending strength and subcritical crack growth of the dental zirconia ceramics]

Objective: To evaluate the effect of sandblasting on bending strength and subcritical crack growth (SCG) under cyclic loading of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) ceramics. Methods: After being polished, sixty bar-shaped specimens of Y-TZP (Wieland zirconia ceramics) were assigned to two groups (n=30) according to the random number table, the sandblasting group (SG) which was treated with sandblasting and the control group (CG) which remained untouched. In each group, half of the specimens (n=15) were subjected to bending strength test, and the results were examined by Weibull statistics and analyzed with ANOVA. The other 15 specimens in each group were subjected to fatigue tests. The results were examined by Weibull statistics and subcritical crack propagation rates were calculated. Results: The bending strengths of SG and CG were (1 291±133) and (1 140±124) MPa (F=10.117, P=0.004), and the Weibull modules of the two groups were 11.06 and 10.64 respectively. The crack growth rate of SCG of SG was lower than that of CG under the same cyclic loading. Conclusions: Proper sandblasting on Y-TZP ceramic can increase its bending strength and resistance to SCG.

Diverse application of MRI for mouse phenotyping

Small animal models, particularly mouse models, of human diseases are becoming an indispensable tool for biomedical research. Studies in animal models have provided important insights into the etiology of diseases and accelerated the development of therapeutic strategies. Detailed phenotypic characterization is essential, both for the development of such animal models and mechanistic studies into disease pathogenesis and testing the efficacy of experimental therapeutics. MRI is a versatile and noninvasive imaging modality with excellent penetration depth, tissue coverage, and soft tissue contrast. MRI, being a multi-modal imaging modality, together with proven imaging protocols and availability of good contrast agents, is ideally suited for phenotyping mutant mouse models. Here we describe the applications of MRI for phenotyping structural birth defects involving the brain, heart, and kidney in mice. The versatility of MRI and its ease of use are well suited to meet the rapidly increasing demands for mouse phenotyping in the coming age of functional genomics. Birth Defects Research 109:758-770, 2017. © 2017 Wiley Periodicals, Inc.

A phase III randomised controlled trial of erlotinib vs gefitinib in advanced non-small cell lung cancer with EGFR mutations

Background:

A phase III trial was conducted to compare the safety and efficacy of erlotinib with that of gefitinib in advanced non-small cell lung cancer harbouring epidermal growth factor receptor mutations in exon 19 or 21.

Methods:

Eligible patients were randomised to receive erlotinib (150 mg per day) or gefitinib (250 mg per day) orally until disease progression or unacceptable toxicity. We aimed to determine whether erlotinib is superior to gefitinib in efficacy. The primary end point was progression-free survival.

Results:

A total of 256 patients were randomised to receive erlotinib (N=128) or gefitinib (N=128). Median progression-free survival was not better with erlotinib than with gefitinib (13.0 vs 10.4 months, 95% confidence interval (CI) 0.62–1.05, P=0.108). The corresponding response rates and median overall survival were 56.3% vs 52.3% (P=0.530) and 22.9 vs 20.1 months (95% CI 0.63–1.13, P=0.250), respectively. There were no significant differences in grade 3/4 toxicities between the two arms (P=0.172).

Conclusions:

The primary end point was not met. Erlotinib was not significantly superior to gefitinib in terms of efficacy in advanced non-small cell lung cancer with epidermal growth factor receptor mutations in exon 19 or 21, and the two treatments had similar toxicities.

[The evaluation of binocular visual field and clinical application of glaucoma]

Visual field is an important means of the assessment of visual function. In our daily life, the actual visual function is consist of both eyes. Therefore, the binocular visual field test is significant to understand the real visual function. Currently, the binocular vision assessment methods included Esterman visual test and Integrated visual fields. The IVF includes: binocular summation, best location, best eye and average eye. In this review, the significance of binocular visual field inspection, binocular visual field integration methods and its practical application in daily life and clinical glaucoma research work are summarized. We hope that it can do some favors to clinical and scientific researches of assessment and application of binocular visual field. (Chin J Ophthalmol, 2016, 52: 872-875).

Role of COL9A1 genetic polymorphisms in development of congenital talipes equinovarus in a Chinese population

Talipes equinovarus is a common congenital deformity. COL9A1 polymorphisms are associated with the development of articular cartilage-related diseases. In the current study, we evaluated the relationship between COL9A1 rs1135056, rs35470562, and rs592121 genetic polymorphisms and risk of congenital talipes equinovarus. Between January 2013 and July 2015, 87 children with congenital talipes equinovarus and 174 control subjects were recruited from the Fourth People's Hospital of Shaanxi and the First Hospital of Yulin. Genotyping of COL9A1 rs1135056, rs35470562, and rs592121 was performed using polymerase chain reaction-restriction fragment length polymorphism. Using conditional regression analysis, the AA genotype of COL9A1 rs35470562 was found to be significantly associated with increased risk of congenital talipes equinovarus compared to the GG genotype [odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.06-6.32]. In addition, under a recessive model, rs35470562 AA carriers were observed to be at higher risk for this condition in comparison to individuals with GG or GA genotypes (OR = 2.23, 95%CI = 1.03-5.04). However, no significant relationship was established between the COL9A1 rs1135056 and rs592121 polymorphisms and congenital talipes equinovarus in any of the genetic models tested. In conclusion, our results indicate that the COL9A1 rs35470562 variant may contribute to congenital talipes equinovarus susceptibility in the Chinese population examined.

[Expression of hypoxia-inducible factor 1α in gastric cancer and its clinical signficance]

OBJECTIVE

To explore the expression level and location of hypoxia-inducible factor 1α (HIF-1α) in gastric cancer (GC) tissues and their relationship with clinicopathological features and clinical outcomes.

METHODS

From July to September 2015, 27 pairs of fresh paired GC tissues and adjacent normal tissues were gathered from the Eighth Department of General Surgery of the First Affiliated Hospital of Anhui Medical University. Quantitative real-time PCR (qRT-PCR) and Western blot were performed to detect the expression of HIF-1α mRNA and protein in these tissues. A total of 191 GC tissues and 46 randomly selected adjacent normal gastric tissues were consecutively collected between December 2006 and September 2008 from Department of General Surgery of the same hospital. Immunohistochemistry were performed on them to detect the expression of HIF-1α and CD34[described in terms of microvessel density (MVD)], and correlation of different locations of HIF-1α (in cytoplasm or nucleus) with MVD, clinicopathological features, and clinical prognosis was analyzed.

RESULTS

The average relative expression level of HIF-1α mRNA in GC tissues (0.625±0.170) was significantly higher than in normal adjacent tissues (0.218±0.036, t=2.336, P=0.023) by qRT-PCR. From the results of Western blot, the expression level of HIF-1α protein increased in GC tissues compared with its corresponding normal tissues. Immunohistochemistry results revealed that positive HIF-1α staining was observed in 67.54% GC tissues and 45.65% normal tissues, with significant difference (P=0.006). And 35.08% in GC and 45.65% in normal tissues were cytoplasmic positive (P=0.138); while 37.17% in GC and only 2.17% in normal tissues were nuclear positive, with significant difference (P<0.001). High differentiation group and TNM clinical early stage (Ⅰ+ Ⅱ) group had significantly higher cytoplasmic HIF-1α expression positive rate compared with low differentiation group (P=0.008) and TNM clinical intermediate-advanced stage (Ⅲ+ Ⅳ) group (P=0.019); whereas low differentiation group had significantly higher nuclear HIF-1α expression positive rate compared with high differentiation group (P=0.043). The mean MVD in the nuclear HIF-1α positive GC group (115.6 ± 7.8) was higher than that in the cytoplasmic HIF-1α positive GC group (93.1±7.5, t=2.077, P=0.040). The median follow-up time was 56(3-81)months. Kaplan-Meier survival analysis and Log-Rank test results showed that nuclear HIF-1α positive patients had a shorter survival time (median 45 months) than cytoplasmic HIF-1α positive patients (median 64 months, P<0.001). Multivariate Cox regression analysis revealed that differentiation (HR=1.713; 95% CI: 1.019-2.882), depth of invasion (tumor stage, HR=6.137; 95% CI: 1.832-20.556) and lymph node metastasis (HR=2.788; 95% CI: 1.313-5.920) were independent prognostic factors for GC (all P<0.05).

CONCLUSION

Different location of HIF-1α protein may be realted to the tumorigenesis and progression of GC, and may become a potential prognostic indicator of GC.

[Clinical features of multiple myeloma patients with renal insufficiency as the initial clinical manifestation]

OBJECTIVE

To analyze the clinical features of multiple myeloma (MM) with renal insufficiency as the initial manifestation, and to improve the level of clinical diagnosis of MM, and reducing misdiagnosis of this disease.

METHODS

To retrospectively analyze the clinical data of 140 patients with MM, who were admitted in our Department of Nephrology and Hematology. They were diagnosed as MM by bone marrow aspiration biopsy. The patients were divided into renal insufficiency group and normal renal function group, based on the criterion of serum creatinine >177 μmol/L. The two groups were statistically analyzed byt test, rank sum test,χ(2) test and binary logistic regression analysis.

RESULTS

55.7% of the patients in the renal insufficiency group presented low level of three immunoglobulin classes (IgG, IgA, IgM), while in the normal-renal function group, 54.3% of patients mainly presented IgG subtype, showing statistically significant differences between the two groups (P<0.001). Univariate analysis showed that IgM level (<0.4 g/L), hemoglobin, white blood cells, erythrocyte sedimentation rate (ESR), total protein, globulin, uric acid, corrected serum calcium, proteinuria and hematuria were statistically significantly different between the two groups (P<0.05 for all). Unconditional logistic regression analysis showed that lower level of IgM (OR=19.992, 95%CI: 1.327-301.202), hemoglobin, uric acid, ESR, serum total protein, proteinuria and hematuria are independent risk factors for the development of renal insufficiency in MM patients (P<0.05 for all).

CONCLUSIONS

Low level of IgM (<0.4 g/L) is an important clinical characteristics of MM patients with renal insufficiency as the initial clinical manifestation. For middle-aged and elderly patients, who present as low levels of three IgG classes (IgG, IgA, IgM) or low level of IgM, multiple myeloma should be excluded, so as to reduce the misdiagnosis.

A New Method for Preparing Mesenchymal Stem Cells and Labeling with Ferumoxytol for Cell Tracking by MRI

Mesenchymal stem cells (MSCs) are among the major stem cells used for cell therapy and regenerative medicine. In-vivo cell-tracking by magnetic resonance imaging (MRI) is crucial for regenerative medicine, allowing verification that the transplanted cells reach the targeted sites. Cellular MRI combined with superparamagnetic iron-oxide (SPIO) contrast agents is an effective cell-tracking method. Here, we are reporting a new “bio-mimicry” method by making use of the “in-vivo environment” of MSCs to prepare native MSCs, so that (i) the phagocytic activity of cultured MSCs can be recovered and expanded MSCs can be ex-vivo labeled with Ferumoxytol, which is currently the only FDA approved SPIO nanoparticles for human use. Using our new method, 7-day cultured MSCs regain the capability to take up Ferumoxytol and exhibit an intracellular iron concentration of 2.50 ± 0.50 pg/MSC, comparable to that obtained by using Ferumoxytol-heparin-protamine nanocomplex; and (ii) cells can be re-sized to more native size, reducing from 32.0 ± 7.2 μm to 19.5 ± 5.2 μm. Our method can be very useful for expanding MSCs and labeling with Ferumoxytol, without the need for transfection agents and/or electroporation, allowing cell-tracking by MRI in both pre-clinical and clinical studies.

Ultrafast Dynamics Evidence of High Temperature Superconductivity in Single Unit Cell FeSe on SrTiO_{3}

We report the time-resolved excited state ultrafast dynamics of single unit cell (1 UC) thick FeSe films on SrTiO_{3} (STO), with FeTe capping layers. By measuring the photoexcited quasiparticles' density and lifetime, we unambiguously identify a superconducting (SC) phase transition, with a transition temperature T_{c} of 68 (-5/+2)  K and a SC gap of Δ(0)=20.2±1.5  meV. The obtained electron-phonon coupling strength λ is as large as 0.48, demonstrating the likely crucial role of electron-phonon coupling in the high temperature superconductivity of the 1 UC FeSe on STO systems. We further find a 0.05 THz coherent acoustic phonon branch in the capping layer, which provides an additional decay channel to the gluing bosons.

[The clinical characteristics and the diagnosis and treatment of tumors of duodenal papilla]

OBJECTIVE

To assess the clinical features, diagnosis, treatment and prognosis of duodenal papilla tumors.

METHODS

The clinical data of 76 patients diagnosed as tumor of duodenal papilla for endoscopic or surgical treatment, in the Second Affiliated Hospital of Zhejiang University, School of Medicine since April 2004 to April 2015 were collected and analyzed retrospectively. There were 50 male and 26 female patients aging from 38 to 83 years with a median age of 62 years. All patients were diagnosed by ultrasound, CT or endoscopic retrograde cholangiopancreatography. All the 76 patients accepted surgical treatment, among which 61 cases accepted pancreaticoduodenectomy, 6 cases accepted trans-duodenum papillae resection and reconstruction, 5 cases accepted endoscopic duodenal papilla tumor resection and 4 cases accepted palliative operations. Kaplan-Meier method was used to analyze the survival rate.

RESULTS

Among the 76 cases of patients, the pathological diagnosis included 10 cases of benign tumors, 8 cases of precancerous lesions, 58 cases of malignant tumor. Death cases were not caused by postoperative complications. Coincidence rate of preoperative biopsy and postoperative pathological diagnosis was 77.6%. Postoperative follow-up was 2 to 120 months, the results showed that the 1, 3, 5 year survival rates were 73.2%, 51.8%, 32.1% for 53 patients with duodenal papillary carcinoma.

CONCLUSIONS

Duodenal papilla tumors had varied clinical manifestations, ultrasound, CT and endoscopic examination and ERCP can improve the diagnostic rate of duodenal papilla tumors. For benign tumors and early stage malignant tumors, local excision or endoscopic resection was safe and effective. For advanced malignancies, radical pancreaticoduodenectomy was essential.

Mapping immune cell infiltration using restricted diffusion MRI

PURPOSE

Diffusion MRI provides a noninvasive way to assess tissue microstructure. Based on diffusion MRI, we propose a model-free method called restricted diffusion imaging (RDI) to quantify restricted diffusion and correlate it with cellularity.

THEORY AND METHODS

An analytical relation between q-space signals and the density of restricted spins was derived to quantify restricted diffusion. A phantom study was conducted to investigate the performance of RDI, and RDI was applied to an animal study to assess immune cell infiltration in myocardial tissues with ischemia-reperfusion injury.

RESULTS

Our phantom study showed a correlation coefficient of 0.998 between cell density and the restricted diffusion quantified by RDI. The animal study also showed that the high-value regions in RDI matched well with the macrophage infiltration areas in the H&E stained slides. In comparison with diffusion tensor imaging (DTI), RDI exhibited its outperformance to detect macrophage infiltration and delineate inflammatory myocardium.

CONCLUSION

RDI can be used to reveal cell density and detect immune cell infiltration. RDI exhibits better specificity than the diffusivity measurement derived from DTI. Magn Reson Med 77:603-612, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

GlpC gene is responsible for biofilm formation and defense against phagocytes and imparts tolerance to pH and organic solvents in Proteus vulgaris

Biofilm-forming bacteria are highly resistant to antibiotics, host immune defenses, and other external conditions. The formation of biofilms plays a key role in colonization and infection. To explore the mechanism of biofilm formation, mutant strains of Proteus vulgaris XC 2 were generated by Tn5 random transposon insertion. Only one biofilm defective bacterial species was identified from among 500 mutants. Inactivation of the glpC gene coding an anaerobic glycerol-3-phosphate dehydrogenase subunit C was identified by sequence analysis of the biofilm defective strain. Differences were detected in the growth phenotypes of the wild-type and mutant strains under pH, antibiotic, and organic solvent stress conditions. Furthermore, we observed an increase in the phagocytosis of the biofilm defective strain by the mouse macrophage RAW264.7 cell line compared to the wild-type strain. This study shows that the glpC gene plays an important role in biofilm formation, in addition to imparting pH, organic solvent, and antibiotic tolerance, and defense against phagocytosis to Proteus sp. The results further clarified the mechanism of biofilm formation at the genomic level, and indicated the importance of the glpC gene in this process. This data may provide innovative therapeutic measures against P. vulgaris infections; furthermore, as an important crocodile pathogen, this study also has important significance in the protection of Chinese alligators.

Final overall survival results from a randomised, phase III study of erlotinib versus chemotherapy as first-line treatment of EGFR mutation-positive advanced non-small-cell lung cancer (OPTIMAL, CTONG-0802)

BACKGROUND

The OPTIMAL study was the first study to compare efficacy and tolerability of the epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) erlotinib, versus standard chemotherapy in first-line treatment of patients with EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC). Findings from final overall survival (OS) analysis and assessment of post-study treatment impact are presented.

PATIENTS AND METHODS

Of 165 randomised patients, 82 received erlotinib and 72 gemcitabine plus carboplatin. Final OS analyses were conducted when 70% of deaths had occurred in the intent-to-treat population. Subgroup OS was analysed by Cox proportional hazards model and included randomisation stratification factors and post-study treatments.

RESULTS

Median OS was similar between the erlotinib (22.8 months) and chemotherapy (27.2 months) arms with no significant between-group differences in the overall population [hazard ratio (HR), 1.19; 95% confidence interval (CI) 0.83-1.71; P = 0.2663], the exon 19 deletion subpopulation (HR, 1.52; 95% CI 0.91-2.52; P = 0.1037) or the exon 21 L858 mutation subpopulation (HR, 0.92; 95% CI 0.55-1.54; P = 0.7392). More patients in the erlotinib arm versus the chemotherapy arm did not receive any post-study treatment (36.6% versus 22.2%). Patients who received sequential combination of EGFR-TKI and chemotherapy had significantly improved OS compared with those who received EGFR-TKI or chemotherapy only (29.7 versus 20.7 or 11.2 months, respectively; P < 0.0001). OS was significantly shorter in patients who did not receive post-study treatments compared with those who received subsequent treatments in both arms.

CONCLUSION

The significant OS benefit observed in patients treated with EGFR-TKI emphasises its contribution to improving survival of EGFR mutant NSCLC patients, suggesting that erlotinib should be considered standard first-line treatment of EGFR mutant patients and EGFR-TKI treatment following first-line therapy also brings significant benefits to those patients.

CLINICALTRIALSGOV IDENTIFIER

NCT00874419.

Association between XRCC1 Arg280His polymorphism and risk of hepatocellular carcinoma: a systematic review and meta-analysis

Hepatocellular carcinoma (HCC) is one of the most life-threatening malignancies worldwide. Defects in DNA repair genes may increase the risk of HCC. X-ray cross-complementing group 1 gene (XRCC1) is a major DNA repair gene involved in base excision re-pair. Recently, several studies have indicated that an association exists between XRCC1 polymorphism and HCC, particularly the Arg280His polymorphism. However, the data is inconsistent and incomplete. In this study, we conducted a meta-analysis to investigate the association between the XRCC1 Arg280His polymorphism and HCC risk. A total of 10 case-control studies included 1848 HCC cases and 1969 controls were examined in this analysis. Our results suggest that variant geno-types of the XRCC1 Arg280His gene are associated with a significantly increased risk of HCC in homozygote comparison (HisHis vs ArgArg, odds ratio, 1.55, 95% confidence interval, 1.10-2.18, P = 0.013); no het-erogeneity was observed (I2 = 0%). Our analysis suggests that the XRCC1 Arg280His polymorphism is associated with a higher risk of HCC.

Improved subspace estimation for low-rank model-based accelerated cardiac imaging

Sparse sampling methods have emerged as effective tools to accelerate cardiac magnetic resonance imaging (MRI).Low-rank model-based cardiac imaging uses a predetermined temporal subspace for image reconstruction from highly undersampled (k, t)-space data and has been demonstrated effective for high-speed cardiac MRI. The accuracy of the temporal subspace isa key factor in these methods, yet little work has been published on data acquisition strategies to improve subspace estimation. This paper investigates the use of non-Cartesian k-space trajectories to replace the Cartesian trajectories that are omnipresent but are highly sensitive to readout direction. We also propose "self-navigated" pulse sequences that collect both navigator data (for determining the temporal subspace) and imaging data after every RF pulse, allowing for even greater acceleration. We investigate subspace estimation strategies through analysis of phantom images and demonstrate in vivo cardiac imaging in rats and mice without the use of ECG or respiratory gating. The proposed methods achieved 3-D imaging of wall motion, first-pass myocardial perfusion, and late gadolinium enhancement in rats at 74 frames/s,as well as 2-D imaging of wall motion in mice at 97 frames/s.

Mapping stain distribution in pathology slides using whole slide imaging

Background:

Whole slide imaging (WSI) offers a novel approach to digitize and review pathology slides, but the voluminous data generated by this technology demand new computational methods for image analysis.

Materials and Methods:

In this study, we report a method that recognizes stains in WSI data and uses kernel density estimator to calculate the stain density across the digitized pathology slides. The validation study was conducted using a rat model of acute cardiac allograft rejection and another rat model of heart ischemia/reperfusion injury. Immunohistochemistry (IHC) was conducted to label ED1⁺ macrophages in the tissue sections and the stained slides were digitized by a whole slide scanner. The whole slide images were tessellated to enable parallel processing. Pixel-wise stain classification was conducted to classify the IHC stains from those of the background and the density distribution of the identified IHC stains was then calculated by the kernel density estimator.

Results:

The regression analysis showed a correlation coefficient of 0.8961 between the number of IHC stains counted by our stain recognition algorithm and that by the manual counting, suggesting that our stain recognition algorithm was in good agreement with the manual counting. The density distribution of the IHC stains showed a consistent pattern with those of the cellular magnetic resonance (MR) images that detected macrophages labeled by ultrasmall superparamagnetic iron-oxide or micron-sized iron-oxide particles.

Conclusions:

Our method provides a new imaging modality to facilitate clinical diagnosis. It also provides a way to validate/correlate cellular MRI data used for tracking immune-cell infiltration in cardiac transplant rejection and cardiac ischemic injury.

Self-navigated low-rank MRI for MPIO-labeled immune cell imaging of the heart

Super-paramagnetic iron oxide (SPIO) particles can magnetically label immune cells in circulation; the accumulation of labeled cells can then be detected by magnetic resonance imaging (MRI). This has enormous potential for imaging inflammatory responses in the heart, but it has been difficult to do in vivo using conventional free-breathing, ungated cardiac imaging. Subspace imaging with temporal navigation and sparse sampling of (k, t)-space has previously been used to accelerate several cardiac imaging applications, conventionally alternating between acquiring navigator data and sparse data every other TR. Here we describe a more efficient self-navigated pulse sequence to acquire both navigator and sparse (k, t)-space data in the space of a single TR, doubling imaging speed to approach 100 frames per second (fps). We show the feasibility of using the resulting method to assess myocardial inflammation in a pre-clinical rodent ischemic reperfusion injury (IRI) model using micron-sized paramagnetic iron oxide (MPIO) particles to label immune cells in situ.