[Impact factor of postoperative prognosis of esophageal cancer patients with stage pT2N0~1M0]

Objective: To investigate the postoperative prognosis and the related factors of patients with stage pT2N0-1M0 of thoracic esophageal carcinoma(EC). Methods: From 2008 to 2011, clinical data of 275 cases with stage pT2N0-1M0 of thoracic EC treated by esophagectomy were enrolled. These cases includ 180 male and 95 female. Among them, 32 cases were upper thoracic EC, 186 cases were middle thoracic EC and 57 cases were lower thoracic EC. Alternatively, 205 cases were stage pN0, 70 cases were stage pN1. 155 cases received esophagectomy alone and 120 cases received esophagectomy and postoperative adjuvant therapy. Results: The end of follow-up time was on September 30th, 2014. The 1-, 3-, 5-year overall survival (OS) rates were 91.6%, 70.2% and 63.7%, respectively. The 1- 3-, 5-year progression-free survival (PFS) rates were 83.9%, 64.0% and 60.0%, respectively. The result of univariate analysis showed that the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with OS (all of P<0.05). Moreover, the gender, the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with PFS (all of P<0.05). Cox multivariate analysis showed that the location of primary tumor and pN stage were the independent factors of OS (both P<0.05). The gender, pN stage and postoperative adjuvant therapy were the independent factors of PFS (all of P<0.05). Conclusion: Among the patients with pT2N0~1M0 stage of thoracic EC, patients with upper thoracic EC or pN1 stage have poorer postoperative prognosis compared with others, and postoperative adjuvant treatment is recommended for these patients.

THE CORRELATION BETWEEN NECK CIRCUMFERENCE AND UMBILICAL ARTERY BLOOD FLOW IN PHYSIOLOGIC PREGNANCIES

Objective

To study the correlation between neck circumference(NC) and umbilical artery blood flow in physiologic pregnancies.

Methods

One hundred and one healthy pregnant woman in the third trimester were enrolled. Anthropometric measurements and ultrasonic testing were done.

Results

The women with NC ≥34.7cm had a more elevated umbilical artery pulsatility index(PI) and systolic/diastolic ratio (S/D) than the women with NC <34.7cm (P<0.01). NC were positively correlated with PI(r=0.224,P=0.024) and S/D ratio(r=0.415,P=0.0001). In multivariate analysis, NC was independently associated with PI (β=0.026, P=0.016) and S/D ratio (β=0.132, P=0.0001).

Conclusions

Obesity has an adverse impact on feto-placetal vessels, and NC was superior to body mass index.

Increased Expression of Programmed Cell Death-1 in Regulatory T Cells of Patients with Severe Sepsis and Septic Shock: An Observational Clinical Study

While regulatory T cells (Tregs) constitutively express programmed cell death-1 (PD-1), the role of PD-1 expression in Tregs of patients with sepsis remains unclear. Thus, we determined PD-1 expression in Tregs from the peripheral blood of patients with severe sepsis and septic shock. Seventy-eight patients with severe sepsis and 40 with septic shock, as well as 21 healthy subjects, were enrolled in this study. The percentage of peripheral blood PD-1⁺ Tregs, as well as absolute Treg counts, were compared between these three groups. PD-1 expression in Tregs and absolute Treg counts were also compared between survivors and non-survivors in patients with sepsis. PD-1 expression in Tregs increased in patients with sepsis compared to healthy controls. Conversely, absolute Treg counts were significantly decreased in patients with sepsis compared to healthy controls; patients with septic shock had the lowest absolute Treg counts. Among patients with sepsis, survivors had lower levels of PD-1 expression in Tregs, as well as higher absolute Treg counts, than non-survivors. Additionally, the percentage of PD-1⁺ Tregs correlated positively with lactate levels as well as the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores in patients with sepsis. PD-1 was upregulated in Tregs of patients with sepsis and may indicate a state of immune dysfunction. Overexpression of PD-1 in Tregs was associated with more severe sepsis as well as poor outcomes.

Targeting viperin improves diet-induced glucose intolerance but not adipose tissue inflammation

Viperin is an interferon-inducible antiviral protein, responsible for antiviral response to a variety of viral infections. Here, we show that silencing viperin by antisense oligonucleotides (ASO) protects against diet-induced glucose intolerance, and yet exacerbates adipose tissue inflammation. In high-fat diet-fed mice, viperin ASO improves glucose homeostasis, reduces plasma triglyceride concentrations and ameliorates diet-induced hepatic steatosis. Peripheral delivery of viperin by adeno-associated virus elevates fasting plasma glucose and insulin concentrations and reduces insulin-stimulated glucose uptake in skeletal muscle. Viperin overexpression reduces epinephrine- stimulated lipolysis in white adipose tissue, whereas viperin ASO increases expression of lipolytic genes. Targeting viperin by antisense oligonucleotides promotes reciprocal regulation of hepatic and adipose lipogenesis by reducing hepatic lipid content and increasing triacylglycerol content in adipose tissue. These findings reveal viperin as an important target to improve glucose metabolism, and suggest that suppressing antiviral potential may improve the metabolic adaptability to high-fat diet.

[Patterns of recurrence in patients with stage Ⅲ thoracic esophageal squamous cell carcinoma after radical resection]

Objective: To evaluate the patterns of recurrence and their value on target delineation for postoperative radiotherapy (RT) in patients with stage Ⅲ thoracic esophageal squamous cell carcinoma (ESCC) after esophagectomy. Methods: 395 patients (302 male and 93 female) of stage Ⅲ thoracic ESCC after radical resection were enrolled in this study. Among them, 375 patients were treated with two-field and other 20 with three-field esopahgectomy. 97 patients were treated with surgery alone, 212 with adjuvant postoperative chemotherapy (CT), 56 with radiotherapy (RT) and 30 with CT plus RT. Diagnosis of recurrence was primarily based on CT images, some of which were biopsy confirmed. The location and patterns of tumor recurrence were analyzed. Results: The overall failure rates was 75.7% (299/395). Locoregional recurrence (LR) was found in 48.4% of the patients, distant metastasis (DM) in 16.2%, and LR plus DM in 4.3%. There were 208 patients occurred with LR, 26.9% (56) recurred in supraclavicular/neck (51 in supraclavicular), 69.7% (145) in mediastinum (88.7% in upper-mediastinum), and 19.7% (41) in upper abdomen (38 in para-aortic lymph node). Chi-square test and logistic multivariate regression analysis showed that TNM stage and adjuvant therapy were significantly associated with LR (P<0.05). Postoperative RT reduced LR (mainly LR in mediastinum), but postoperative CT did not decrease LR. Conclusions: The recurrence rate is very high in stage Ⅲ thoracic ESCC patients, LR is the main pattern of failure. TNM stage is one of the most important factors for LR. Postoperative radiotherapy can reduce LR but postoperative chemotherapy does not decrease LR. Upper-mediastinum is the most common site of recurrence, followed by supraclavicular and para-aortic regions; these areas should be considered as the key target of postoperative radiotherapy.

[Study of effects of micheliolide on ovarian cancer cell lines and its mechanism]

Objective: To study the roles of micheliolide on ovarian cancer cells. Methods: Firstly, human ovarian cancer cell lines HeyA8, SKOV3 and A2780/DDP were treated with different concentration of micheliolide(0.25, 0.5, 1, 2.5, 5, 10, 20, 50 μmol/L)for 72 hours, then methyl thiazolyl tetrazolium(MTT)assay was used wo detect the growth of the human ovarian cancer cell lines and the stongest inhibited cell line were selected for the following test. Secondly, after HeyA8 cell line was treated with different concentration(5, 10, 20 μmol/L)of micheliolide for 24 hours, the HeyA8 cell apoptosis was measured byflow cytometry. Thirdly, the expression of RelA mRNA in HeyA8 cell was detected through real-time PCR, the expressions of nuclear factor κB(NF-κB)signal pathway related protein RelA and the activited cysteinyl aspartate specific proteinase(caspase-9)were detected by western blot analysis. Results: (1)The growth of HeyA8, SKOV3 and A2780/DDP cells were all significantly inhibited after being treated with different concentration of micheliolide for 72 hours and the roles of inhibition were all concentration dependant(P<0.05). The half maximal inhibitory concentration(IC₅₀)of HeyA8, SKOV3 and A2780/DDP were(9.8±2.2),(12.0±2.1)and(12.8±1.8)μmol/L, respectively. We chose HeyA8 cell to do the following expreriments because of its best inhibited effect.(2)After HeyA8 cell was treated with micheliolide of different concentrations, as the concentration increased(20 and 0 μmol/L, for example), the apoptosis rate of HeyA8 cell raised from(7.2±1.0)% to(17.4±1.1)%, the percentage of survived cells reduce from(92.8 ± 1.3)% to(82.6 ± 1.4)%, and the relative mRNA level of RelA decreased from 1.00 ± 0.13 to 0.18 ± 0.00(P<0.01); furthermore, the expression of RelA protein was weaken and the activited caspase-9 protein expression was increased gradually. Conclusions: Micheliolide plays a significantly inhibited role in HeyA8, SKOV3 and A2780/DDP cells. The inhibited role of micheliolide inovarian cancer cells might through inhibiting nuclear factor-kappa B(NF-кB)signaling pathway, and inducing the expression of activited caspase-9 protein to promoting apoptosis of HeyA8 cell.

Early Mitochondrial Adaptations in Skeletal Muscle to Obesity and Obesity Resistance Differentially Regulated by High-Fat Diet

The mechanism for different susceptibilities to obesity after short-term high-fat diet (HFD) feeding is largely unknown. Given the close association between obesity occurrence and mitochondrial dysfunction, the early events in skeletal muscle mitochondrial adaptations between HFD-induced obesity (DIO) and HFD-induced obesity resistant (DIO-R) lean phenotype under excess nutritional environment were explored.ICR/JCL male mice were randomly divided into 2 groups, as follows: low-fat diet (LFD) and HFD groups. After 6 weeks on HFD, HFD-fed mice were classified as DIO or DIO-R according to their body weight gain. Serum parameters, oxidative stress biomarkers, the activation of AMPK/ACC axis, and the expression profiles of mitochondrial biogenesis were measured by using corresponding methods among the LFD control, DIO, and DIO-R groups. Serum glucose, total cholesterol, low-density lipoprotein, and high-density lipoprotein levels were significantly increased in DIO and DIO-R mice compared with LFD controls. However, DIO-R mice had significantly higher MDA levels and exhibited a significantly higher level of AMP-activated protein kinase (AMPK) activation and acetyl-CoA carboxylase (ACC) inactivation than DIO mice. Furthermore, the transcript and protein levels of transcriptional coactivator peroxisome proliferator-activated receptor γ (PPARγ) coactivator 1α (PGC-1α) and estrogen-related receptor-α (ERRα) in DIO-R mice were significantly up-regulated compared with the DIO mice. Although the body weight gain differed, the DIO and DIO-R mice had similar metabolic disturbance of glucose and lipids after short-term HFD consumption. The diverse alterations on fatty acid oxidation and mitochondrial biogenesis pathway induced by AMPK activation might be involved in different susceptibilities to obesity when consuming HFD.

Leptin receptor knockout-induced depression-like behaviors and attenuated antidepressant effects of exercise are associated with STAT3/SOCS3 signaling

Relatively little has been known about pathophysiological mechanisms contributing to the development of neuropsychiatric symptoms in the context of metabolic syndrome. Impaired leptin signaling activation in db/db mice has been proposed as a potential link between behavioral and metabolic disorders. Our previous studies have shown that exercise has the beneficial effects on a depression-like and insulin-resistant state in mice. The present study aimed to determine whether and how leptin receptor knockout (db/db) induces depression-like behaviors, and to identify the antidepressant effects of swimming exercise in db/db mice. Our results support the validity of db/db mice as an animal model to study depression with metabolic abnormalities, but fail to confirm the improvement of exercise on depression. LepRb knockout-induced depression-like behaviors are associated with STAT3/SOCS3 signaling but independent of IKKβ/NFκB signaling. Our findings suggest the potential importance of LepRb as an exercise-regulated target for depression, also representing a new target underlying treatment-resistant depression.

Targeting mitochondrial phenotypes for non-communicable diseases

The concept that "Exercise is Medicine" has been challenged by the rising prevalence of non-communicable chronic diseases (NCDs). This is partly due to the fact that the underlying mechanisms of how exercise influences energy homeostasis and counteracts high-fat diets and physical inactivity is complex and remains relatively poorly understood on a molecular level. In addition to genetic polymorphisms in humans that lead to gross variations in responsiveness to exercise, adaptation in mitochondrial networks is central to physical activity, inactivity, and diet. To harness the benefits of exercise for NCDs, much work still needs to be done to improve health effectively on a societal level such as developing personalized exercise interventions aided by advances in high-throughput genomics, proteomics, and metabolomics. We propose that understanding the mitochondrial phenotype according to the molecular information of genotypes, lifestyles, and exercise responsiveness in individuals will optimize exercise effects for prevention of NCDs.

The mechanisms underlying the beneficial effects of exercise on bone remodeling: Roles of bone-derived cytokines and microRNAs

Bone remodeling is highly dynamic and complex in response to mechanical loading, such as exercise. In this review, we concluded that a number of individual factors are disturbing the clinical effects of exercise on bone remodeling. We updated the progress made on the differentiation of osteoblasts and osteoclasts in response to mechanical loading, hoping to provide a theoretical basis to improve bone metabolism with exercise. Increasing evidences indicate that bone is not only a structural scaffold but also an endocrine organ, which secretes osteocalcin and FGF23. Both of them have been known as a circulating hormone to promote insulin sensitivity and reduce body fat mass. The effects of exercise on these bone-derived cytokines provide a better understanding of how exercise-induced "osteokine" affects the whole-body homeostasis. Additionally, we discussed recent studies highlighting the post-transcriptional regulation of microRNAs in bone remodeling. We focus on the involvement of the microRNAs in osteoblastogenesis and osteoclastogenesis, and suggest that microRNAs may be critical for exercise-induced bone remodeling.

[Impact of number of dissected lymph nodes on survival in patients with thoracic esophageal squamous cell carcinoma after radical resection]

OBJECTIVE

To evaluate the impact of the number of dissected lymph nodes on survival of patients with stage T3N0M0 thoracic esophageal squamous cell carcinoma (ESCC).

METHODS

The clinicopathlogical dada of 249 patients with stage T3N0M0 thoracic ESCC were analyzed retrospectively. The median age of the 249 patients (171 males and 78 females) was 60-year old. The primary lesions were located in the upper- in 40, middle- in 177, and lower-thoracic esophagus in 45 patients. The median length of the lesions was 5 cm (range 2-12 cm). As for the severity of adhesion after surgery, there were 35 with no adhesion, 90 with mild-, and 124 patients with severe adhesion. The median number of dissected lymph nodes (dissected LN) at surgery was 9 (range 1-27), among them, less than 6 dissected LNs in 55, 6-11 dissected LNs in 133, and 11 or more dissected LNs in 61 cases. There were 210 patients with moderately or highly, and 39 with poorly differentiated cancer. 98 patients were treated with surgery alone, and 151 with postoperative adjuvant treatment.

RESULTS

The follow-up deadline was July 2013. The 1-, 3-, and 5-year overall survival rates were 90.0%, 68.7% and 55.2%, respectively. The 1-, 3-, and 5-year survival rates were 85.5%, 63.6% and 39.1% in patients with <6 dissected LNs, 89.5%, 67.7% and 56.9% in patients with 6-11 dissected LNs, and 95.1%, 75.4% and 66.2% in patients with >11 dissected LNs, respectively (P=0.073). The survival was shorter in patients with <6 dissected LNs than patients with >11 dissected LNs (P=0.022). The subgroup analysis showed that in patients with middle-thoracic ESCC, the length of lesion ≤5 cm or mild adhesion after surgery and the number of dissected LNs were associated with survival after surgery.

CONCLUSIONS

For patients with stage T3N0M0 thoracic ESCC after surgery, the number of dissected LNs is an important factor affecting the survival, and at least 6 or more lymph nodes should be dissected. If lymphadenectomy is not adequately performed, postoperative adjuvant therapy should be recommend.

Contact force-guided catheter ablation for the treatment of atrial fibrillation: a meta-analysis of randomized, controlled trials

Contact force (CF) sensing technology allows real-time monitoring during catheter ablation for atrial fibrillation (AF). However, the effect of CF sensing technology on procedural parameters and clinical outcomes still needs clarification. Because of the inconsistent results thus far in this area, we performed a meta-analysis to determine whether CF sensing technology can improve procedural parameters and clinical outcomes for the treatment of AF. Studies examining the benefits of CF sensing technology were identified in English-language articles by searching the MEDLINE, Web of Science, and Cochrane Library databases (inception to May 2015). Ten randomized, controlled trials involving 1834 patients (1263 males, 571 females) were included in the meta-analysis (681 in the CF group, 1153 in the control group). Overall, the ablation time was significantly decreased by 7.34 min (95%CI=-12.21 to -2.46; P=0.003, Z test) in the CF group compared with the control group. CF sensing technology was associated with significantly improved freedom from AF after 12 months (OR=1.55, 95%CI=1.20 to 1.99; P=0.0007) and complications were significantly lower in the CF group than in the control group (OR=0.50, 95%CI=0.29 to 0.87; P=0.01). However, fluoroscopy time analysis showed no significantly decreased trend associated with CF-guided catheter ablation (weighted mean difference: -2.59; 95%CI=-9.06 to 3.88; P=0.43). The present meta-analysis shows improvement in ablation time and freedom from AF after 12 months in AF patients treated with CF-guided catheter ablation. However, CF-guided catheter ablation does not decrease fluoroscopy time.

Obesity-associated sympathetic overactivity in children and adolescents: the role of catecholamine resistance in lipid metabolism

BACKGROUND

Obesity in children and adolescents is characterized by chronic sympathetic overdrive and reduced epinephrine-stimulated lipolysis. This resistance to catecholamines occurs during the dynamic phase of fat accumulation. This review will focus on the relationship between sympathetic-adrenal activity and lipid metabolism, thereby highlighting the role of catecholamine resistance in the development of childhood obesity.

RESULTS AND CONCLUSIONS

Catecholamine resistance causes lipid accumulation in adipose tissue by reducing lipolysis, increasing lipogenesis and impeding free fatty acid (FFA) transportation. Exercise improves catecholamine resistance, as evidenced by attenuated systemic sympathetic activity, reduced circulating catecholamine levels and enhanced β-adrenergic receptor signaling. Insulin resistance is mostly a casual result rather than a cause of childhood obesity. Therefore, catecholamine resistance in childhood obesity may promote insulin signaling in adipose tissue, thereby increasing lipogenesis. This review outlines a series of evidence for the role of catecholamine resistance as an upstream mechanism leading to childhood obesity.

The effect of treadmill training and N-acetyl-l-cysteine intervention on biogenesis of cytochrome c oxidase (COX)

Mitochondrial biogenesis refers to increased content of mitochondria, which has been shown to be promoted by aerobic exercise. During this process, oxidative stress is considered the essential initiator. Even though some studies have addressed the issue as to whether antioxidants would hamper the effects of exercise on mitochondrial biogenesis, no consensus has been achieved. Therefore, the purpose of the present study was to investigate the effects of exercise and antioxidant intervention on mitochondrial biogenesis, as well as COX biogenesis. Thirty-two clean-grade male ICR mice were randomly assigned to a control group (Con), exercise group (Ex), N-acetyl-l-cysteine group (NAC), or NAC plus exercise group (NEx). The NAC and NEx groups were injected with NAC (0.1 mg/g/2 days) intraperitoneally for 3 weeks, whereas the Con and Ex groups were administered saline for the same period of time. Mice assigned to Ex and NEx groups started exercise training 1 week before drug intervention was initiated. After 1 week of acclimatization, the mice were allowed to run at a speed of 28 m/min for 60 min, 6 days a week. The results showed that exercise training caused an increase in mRNA and protein levels of COXIV, whereas NAC intervention lowered the two so significantly that even exercise training could not reverse the effect of NAC intervention. Our data suggest that even though antioxidant intervention could alleviate oxidative damage caused by exercise, it was not necessarily beneficial for mitochondrial biogenesis.

Preparation of solid lipid nanoparticles loaded with garlic oil and evaluation of their in vitro and in vivo characteristics

OBJECTIVE

Solid lipid nanoparticles (SLN) are colloidal drug carriers and may be suitable for delivery of garlic oil, a nutraceutical with medicinal properties, whose use has been limited by its poor solubility. We tested whether poor solubility of garlic oil would be overcome by complexing with SLN by high-pressure homogenization and ultrasound techniques. The effects of lipid phase, surfactant mixture and loading concentration of garlic oil on particle size and distribution were also investigated.

MATERIALS AND METHODS

High pressure homogenization technique was used to prepare SLN, using orthogonal experiment method to optimize entrapment efficiency, loading efficiency, and recovery of SLN. Pharmacokinetics of garlic oil loaded solid lipid nanoparticles after oral administration to rats was studied by using LC/MS/MS method.

RESULTS

Mean particle size and zeta potential of SLN were, respectively, 106.5 ± 40.3 nm and -30.2 mv. The majority of SLN had a less ordered arrangement of crystals at room temperature, which was beneficial for increasing the drug loading capacity. Drug entrapment efficiency was > 90 percent and showed a relatively long-term physical stability. It was feasible to prepare a lyophilized product with good long-term stability. When 10% trehalose and 5% sucrose were used as cryopreservants, SNL particle size increased from 106.5 nm prior to lyophilisation to 155.3 nm after reconstitution. The garlic oil content in SLN decreased to about 85% (respectively, 34.3 vs. 39.4 mg/mL prior to lyophilisation) due to volatility of garlic oil. Pharmacokinetic studies in rats demonstrated that distribution and elimination of diallyl trisulfide (DATS) and diallyl disulfide (DADS) in garlic oil were rapid. Additionally, elimination of garlic oil-SLN complex is faster than that of garlic oil alone, probably, due to phagocytosis.

CONCLUSIONS

An SLN complex with garlic oil exhibits characteristics similar to those of parenteral emulsions, even after lyophilization and reconstitution.

Satisfactory Usage of a Lacerated Kidney for Transplantation: A Case Report

BACKGROUND

Organ shortage is the main bottleneck in the wait-list for transplantation; therefore, expanding the donor pool is an effective way to solve the problem. Usage of the traumatized liver for transplantation has been applied, but the use of lacerated kidneys for transplant donor is rarely reported.

METHODS

We reported a successful case of donation after brain death. The donor committed suicide by jumping from a campus dormitory building. One of the donated kidneys was severely injured. Two lacerations measured 4 × 1 × 1 cm in the medial margin of the graft and 1 × 1 × 1.5 cm in the front side of the graft, respectively. After repair with continuous absorbable suture, the lacerated kidney was transplanted to a recipient.

RESULTS

The post-transplantation renal function gradually recovered. Furthermore, serious complications, such as large amounts of hemorrhage, delayed graft function, or urinary fistula did not occur. The serum creatinine dropped from 1232 μmol/L to 120 μmol/L and maintained normal range after surgery. In addition, the daily urine output was normal. At day 12 after operation, the patient was discharged.

CONCLUSIONS

Our case shows that the use of a lacerated donor kidney appears to be feasible, but long-term effects need further observation.