4284The combined use of radiofrequency-ablation and balloon-dilation (CURB) in the creation of a stable inter-atrial communication: first-in-man use for patients with severe pulmonary arterial hypertension

Background

Recent preclinical research has suggested that combined use of radiofrequency-ablation and balloon-dilation (CURB) had the potential to create a stable inter-atrial communication. However, the related clinical data is still absent.

Purpose

This study describes the first-in-man use of CURB in the patients with severe pulmonary arterial hypertension (PAH).

Methods

Under the guidance of fluoroscopy and intra-cardiac echocardiography, CURB was attempted in 3 patients with severe PAH (age: 35.0±12.1 years, one idiopathic PAH and two PAH related to repaired congenital heart disease). With the aid of 3D location system, fossae ovalis was ablated with radiofrequency. Then the graded balloon-dilation was performed after transseptal puncture, and radiofrequency-ablation was repeated around the rim of fenestration created with balloon-dilation. The exercise capacity and fenestration-size were followed up.

Results

CURB was performed successfully in all 3 patients, and pulmonary vascular resistance was 30.3±10.9 Wood units. The fenestration size was 5.0±1.0 mm (range: 4–6 mm), and systemic arterial oxygen saturation decreased by 4.7±0.6% (range: 4–5%). World Health Organization functional class increased by 1.6±0.5 (P<0.001) and cardiac index increased by 0.58±0.34 L/min/m2 (P<0.001). In addition, exercise capacity improved significantly (+63.7 meters, P<0.001). Follow-up (6.0±1.0 months; range: 5–7 months) showed that all fenestrations were stable (P=0.808), and no complication occurred.

Figure 1. The combined use of radiofrequency-ablation and balloon-dilation (CURB) was performed in the patient with severe PAH. Left figures showed the procedure of CURB. Middle figures showed the created fenestration with MSCT, and the morphology and size of fenestration was provided in the right-inferior panel. In addition, the sizes of right atrium and ventricle were alleviated with increase of left atrium. Right figures indicated that the fenestration-size was stable during follow-up (one week, one month and six months, respectively).

Conclusions

In patients with severe PAH, CURB is feasible and effective to create a stable inter-atrial communication. Further research was required to evaluate the long-term result of this novel approach.

ClinicalTrials.gov ID: NCT03554330.

Acknowledgement/Funding

National Natural Science Foundation of China (81670283) and Beijing Natural Science Foundation (7162160)

Experience of pediatric urogenital tract inserted objects: 10-year single-center study

INTRODUCTION

Urogenital tract foreign bodies (FBs) have been rarely reported in children, and the management is still challenging.

OBJECTIVE

The aim of this study is to review a 10-year experience with urogenital tract FBs in a single center.

PATIENTS AND METHODS

The authors reviewed the records of children suspected with urogenital tract FBs and first admitted to the hospital, including demographic characteristics, presenting symptoms, methods of diagnosis, and management. The authors compared the surgery strategies in different locations of FBs and age, and the locations of FBs in different age groups.

RESULTS

Two hundred and thirty-nine cases were reviewed, and 188 were confirmed to retain urogenital tract FBs (150 girls and 38 boys). The number of the patients increased progressively in the last 10 years and mainly concentrated in spring and summer in the last 4 years. The peak ages were 3-5 years old and 9-13 years old. General anesthesia surgeries were performed on 20 patients (Fig. 1). Vagina FBs were more likely to require day surgery, whereas bladder FBs required surgery in hospital. Patients younger than 6 years were more likely to be girls with vagina FBs, and patients older than 11 years were more likely to be boys with bladder FBs.

DISCUSSION

Urogenital tract FBs in children is a great challenge. As the vagina is shorter and wider than the urethra, girls with vagina FBs are usually treated by day surgery and adolescent boys of urethra FBs are treated by hospital surgery. Misdiagnosis may occur when patients conceal FBs insert history, have severe urinary tract infections, or have previous surgery history. Ultrasonography helps to reduce misdiagnosis. FBs should be taken into consideration when patients have new symptoms after hypospadias repair, and postoperative changes of hypospadias repair, such as urinary calculi, have been excluded. Appropriate surgery techniques, based on the size, nature, and location of FBs, should be performed for complete removal of FBs with minimal complications to reduce secondary injury. Sharp FBs could be migrated among the digestive system, urogenital system, and deep pelvic. If the procedure is difficult, patients with a stable needle can be conservatively managed with close follow-up. Nevertheless, symptomatic patients should be treated actively.

CONCLUSION

The awareness of potential severity of pediatric urogenital tract FBs should be raised. Appropriate toys and timely sex education help prevent children from urogenital tract FBs insertion. Selecting appropriate techniques for particular situations is the best way to reduce secondary injury, especially for cases with migrated FBs (needles), magnetic FBs, and postoperative FBs.

Ewing sarcoma/primitive neuro-ectodermal tumor of the urogenital system in children: a retrospective observational case series

INTRODUCTION

Pediatric Ewing sarcoma (ES)/primitive neuro-ectodermal tumor (PNET) occurring in the genitourinary system has been rarely reported. And the result of long-term follow-up is still a matter of debate.

OBJECTIVE

The aim of the study was to identify the characteristics, therapeutic strategies, and long-term outcomes of pediatric ES/PNET in the genitourinary system.

PATIENTS AND METHODS

All children with genitourinary system PNET from a single center were retrospectively reviewed. The American Joint Committee on Cancer (AJCC) staging system was used to evaluate tumor grade.

RESULTS

Four patients were included. Three were boys, and 1 was a girl. The locations of the lesions were the penis in 1 patient, ureter in 1 patient, and kidney in 2 patients. Two patients were of AJCC stage IVB, and the other 2 patients were of stage IIA. In the follow-up ranging from 2.5 to 8.0 years, 3 patients had survival, and 1 patient died. The patient with penis PNET survived during the 8 years of follow-up. One patient with renal PNET had tumor thromboses in the renal vein, inferior vena cava, and right atrium, which was the first definite report in children (case 3).

DISCUSSION

Primitive neuro-ectodermal tumor as a highly malignant subgroup of blue round cell tumor is extremely rare in the genitourinary system, especially in children. The current case series represents the first report of penis PNET in children with the longest (8 years) follow-up and first definite report of pediatric renal PNET with vena cava and atrium tumor thrombus. In contrast to the previous literature, the patient with ureteral PNET in this study was much younger, who was the youngest child to be reported in the literature thus far. Although the key prognostic factor of the outcomes is detectable metastases at diagnosis, the patient with penis PNET and bone and lung metastasis in this series still survived. It was hypothesized from the data of present cases that young age was a protective factor, which was consistent with the previous literature. Aggressive therapy is not trivial for patients with multiple recurrences who can also be a long-term survivor. The survival outcomes of these high-stage patients were favorable with combination treatment. As the patient with penis PNET in this series had bone metastasis at his 7.5 years after definite diagnosis, five years of follow-up was not enough. The follow-up period should be extended, even to a lifetime follow-up.

CONCLUSIONS

Children with PNET have a better prognosis than adults. Aggressive combination treatment should be performed to improve prognosis and the survival rate. It is better to monitor the changes of the disease by extending the follow-up period.

[Effects of parthenolide on estradiol-synthesizing enzyme, ER isoforms and VEGF in human endometriotic stromal cells]

Objective: To evaluate the effects of parthenolide on estradiol-synthesizing enzyme, steroidogenic acute regulatory protein (StAR), and ER isoforms,VEGF in human endometriotic stromal cells. Methods: Primary endometriotic stromal cells were treated with different concentrations (1, 5, 10 and 20 μmol/L) of parthenolide. The mRNA of StAR, ER isoforms (ERα and ERβ), PR, vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), tumour necrosis factor-α (TNFα), tumour necrosis factor receptor (TNFR) 1, TNFR2 were measured by real-time PCR. The levels of estradiol and progesterone in the cell supernatant were measured by ELISA. Results: Different concentrations of parthenolide could up-regulate the mRNA of StAR in primary endometriotic stromal cells (F=5.722, P<0.05); the mRNA of StAR in the group of 20 μmol/L was significantly higher than that of the control group [2.6±0.3 versus 1.0, P<0.01]. Different concentrations of parthenolide could down-regulate the mRNA of ERα (F=6.921, P<0.01); the mRNA of ERα in the group of 20 μmol/L and 10 μmol/L were significantly lower than those of the control group [0.2±0.3 versus 0.3±0.3 versus 1.0, all P<0.05]. Different concentrations of parthenolide could down-regulate the ratios of ERα/ERβ mRNA levels (F=4.209, P<0.05). Different concentrations of parthenolide could up-regulate the mRNA of VEGF and TNFR1 (F=10.964, P<0.01; F=7.286, P<0.01). There were no statiscal significances with different concentrations of parthenolide on the mRNA of ERβ, PR, IL-6, TNFα and TNFR2, and the levels of estradiol and progesterone in the cell supernatant (all P>0.05). Conclusions: Parthenolide may regulate the expression of estradiol-synthesizing enzyme, ER isoforms and angiogenesis in endometriotic stromal cells. Parthenolide may promote the development of endometriosis.

Microarray expression analysis of MYCN-amplified neuroblastoma cells after inhibition of CDK2

The study aimed to explore the underlying molecular mechanisms of CDK2 inhibition in neuroblastoma by bioinformatics analysis. Gene expression profile GSE16480 was downloaded from the Gene Expression Omnibus. The differentially expressed genes (DEGs) were identified from IMR32 between each time point and average expression of all time points. Gene significance was calculated using dSVDsig algorithm of dnet package. Protein-protein interaction (PPI) network was built. Then, integrated with gene significance, a core PPI network was detected by dNetPipeline algorithm in dnet package. Finally, pathway enrichment analysis was performed for genes in network. Totally, 1524 DEGs were identified. CCNA2 (cyclin A2), EXO1 (exonuclease 1), RAD51AP1 (RAD51 associated protein 1), TOP2A (topoisomerase (DNA) II alpha) and CDK1 (cyclin-dependent kinase 1) were selected as DEGs with higher connectivity after PPI network analysis. In the network, CCNA2, CDK1, BUB1B (BUB1 mitotic checkpoint serine/threonine kinase B) and CCNB1 (cyclin B1) were involved in cell cycle pathway. Additionally, CCNB1, CDK1, CCNE2 (Cyclin E2), and RRM2B (ribonucleotide reductase subunit M2B) were involved in p53 signaling pathway. Cell cycle and p53 signaling pathway were closely associated with neuroblastoma after CDK2 inhibition. The DEGs, such as CCNA2, CCNB1, CDK1 and RRM2B may be the potential targets for neuroblastoma.

Abstract P6-02-17: Hand-held impulse-radar detector for breast cancer: development and a pilot study

Background: Microwave breast imaging, which using the difference in the dielectric properties between breast cancer and normal breast tissue, is a painless and non-radiation method. We have created a novel hand-held prototype of breast cancer detector using impulse-radar based imaging system, and conducted a pilot clinical study.

Methods: The detector consists of complementary metal-oxide-semiconductor (CMOS) integrated circuits covering the ultrawideband width from 3.1 to 10.6 GHz, which enable the generation and transmission of Gaussian monocycle pulse (GMP) trains and single port eight throw switching matrices (SP8T-SW) for controlling a 4×4 cross-shaped dome antenna array. The size of the detector was 19.1 × 17.7 × 18.8 cm. After evaluation using a breast tumor phantom and the resected breast specimens obtained through mastectomy, we recruited 5 patients with histologically confirmed breast cancers in the clinical study. The detector was placed on the breast with the patient in a supine position. The primary endpoint was a detection rate of breast cancers, and the secondary endpoints were positional accuracy and adverse event. This study was registered with the UMIN Clinical Trials Registry (UMIN000026181).

Results: The three-dimensional positions of the tumors in the imaging results using a phantom and resected specimens are consistent with the results of histopathology analysis. In the clinical study, all 5 targeted breast cancers were detected and were visualized at the sites confirmed by other diagnostic modalities. Among 5 tumors, one was not detected via mammography because of heterogeneously dense breast and another was a microinvasive carcinoma of invasive tumor size 0.5 mm. No study-related adverse events occurred.

Conclusions: We succeeded in creating a new device of hand-held impulse-radar detector for breast cancer. The detector has sufficient detective capability, is safe for clinical use, and might detect an early stage breast cancer. In the future, we will proceed with the development to clinical application.

Citation Format: Sasada S, Masumoto N, Song H, Goda N, Kajitani K, Emi A, Kadoya T, Arihiro K, Kikkawa T, Okada M. Hand-held impulse-radar detector for breast cancer: development and a pilot study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-17.

Molecular dynamics simulation of phase competition in terbium

The competition among multiple solid phases determines the final microstructures of a material. Such competition can originate at the very beginning of the solidification process. We report the results of molecular dynamics simulation of the phase competition between the hexagonal close-packed (hcp), face-centered cubic (fcc), and body-centered cubic (bcc) phases during the solidification of pure Tb. We found that the liquid supercooled below the hcp melting temperature has both bcc and hcp/fcc nuclei, but only the bcc nuclei grow such that the liquid always solidifies into the bcc phase, even at temperatures where the hcp phase is more stable. The hcp phase can only form in the last liquid droplet or at the bcc grain boundaries. Depending on the bcc grain orientations, the hcp phase jammed between the bcc grains either completely disappears or slowly grows via a solid-state massive transformation mechanism. Once the hcp phase becomes large enough, the stresses associated with its appearance can trigger a martensitic transformation. Yet, not the entire bcc phase is consumed by the martensitic transformation and the remaining bcc phase is transformed into the hcp phase via the solid-state massive transformation mechanism. Finally, if the supercooling is too large, the nucleation becomes almost barrier free and the liquid solidifies into a structure consisting of ultra-fine hcp and bcc grains after which the bcc phase quickly disappears.

Evaluation of coagulation disorders by thromboelastography in children with systemic lupus erythematosus

Background

The coagulation status of patients with systemic lupus erythematosus (SLE) is quite complicated, and there are currently no simple efficient methods for its evaluation. We explored the feasibility of thromboelastography (TEG) for this purpose.

Methods

Paediatric SLE patients were divided into different groups based on Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores. TEG parameters were compared between patients and healthy controls (HCs) and in patients by level of disease activity. Six patients treated with pulse methylprednisolone were also analysed before and after treatment.

Results

Thirty-nine children with SLE were enrolled, one of whom had bleeding and three of whom had thrombosis. The four TEG tracings of these four children were different. The TEG parameters of the patients (except the four children mentioned above) showed hypercoagulability, shortened R and K times, increased α-angle and maximum amplitude (MA), decreased LY30 and increased clot index (CI) compared with the parameters of the HCs ( P < 0.05). With respect to disease activity, patients with higher SLEDAI scores showed more obvious hypercoagulability with shortened R and K times and increased α-angle and CI ( P < 0.05). Furthermore, there was a negative correlation between both the R time and K time and SLEDAI scores ( r = –0.435, P < 0.01 and r  =  –0.572, P  < 0.001, respectively) and a positive correlation between both α-angle and CI and SLEDAI scores ( r = 0.581, P  < 0.001 and r  =  0.544, P  < 0.01, respectively). No significant difference in coagulation status was found between pre- and post-pulse therapy.

Conclusions

Compared with the HCs, paediatric SLE patients showed hypercoagulability caused by increased coagulation and decreased fibrinolysis. These coagulation changes were associated with disease activity. TEG could be a potential tool for evaluating the coagulation status of children with SLE.

MiR-216a-3p promotes differentiation of BMMSCs into ACE II cells via Wnt/β-catenin pathway

OBJECTIVE

To explore whether miR-216a-3p could promote differentiation of bone marrow mesenchymal stem cells (BMMSCs) into type II alveolar epithelial cells (ACE II) via Wnt/β-catenin pathway, thereby alleviating neonatal respiratory distress syndrome (NRDS).

MATERIALS AND METHODS

BMMSCs were directionally differentiated into ACE II cells. Expressions of ACE II cell-specific transcription factors Occludin, KGF, CK18, SpA, SpB, and SpC were detected at the different time points after cell differentiation. Enzyme-linked immunosorbent assay (ELISA) was applied to detect inflammatory factors in the culture medium, including interleukin-1 (IL-1), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and Interferon-α (INF-α). After overexpression or knockdown of miR-216a-3p in BMMSCs, expressions of ACE II cell-specific transcription factors and inflammatory factors were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blot. Rescue experiments were carried out after DKK-1 treatment in BMMSCs.

RESULTS

Expressions of ACE II cell-specific transcription factors Occludin, KGF, CK18, SpA, SpB, and SpC were elevated with the prolongation of cell differentiation. Overexpression of miR-216a-3p elevated levels of pro-inflammatory factors (IL-1, TNF-α, and INF-α) and reduced anti-inflammatory factor (IL-10). Expressions of ACE II cell-specific transcription factors Occludin, KGF, CK18, SpA, SpB, and SpC were remarkably increased at 7 d and 14 d compared to those detected at 1 d. Overexpression of miR-216a-3p in BMMSCs downregulated Wnt3a expression. The regulatory effect of miR-216a-3p on BMMSCs differentiation was partially reversed by DKK-1 treatment.

CONCLUSIONS

Knockdown of miR-216a-3p induces differentiation of BMMSCs into ACE II cells through Wnt/β-catenin pathway, thereby alleviating NRDS.

SuFEx in Metal-Organic Frameworks: Versatile Postsynthetic Modification Tool

A new type of click reaction, sulfur(VI) fluoride exchange (SuFEx), has been utilized to prepare five postsynthetically modified UiO-67 series metal-organic frameworks (MOFs). The postsynthetic modification (PSM) via SuFEx can be achieved selectively for the sulfonyl fluoride (R-SO₂F) without degrading the MOF structure as confirmed by X-ray crystallographic analysis. The present SuFEx method provides a straightforward tool for introducing new functionality inside MOFs. Introduction of an imidazolium group into the MOF afforded a heterogeneous catalyst for the benzoin condensation reaction.

Genetic alterations in the transforming growth factor receptor complex in sporadic endometrial carcinoma

Cellular responses to the transforming growth factor beta (TGFbeta) ligand, including inhibition of cell proliferation, are mediated by a heteromeric receptor complex composed of TGFbeta types I and II receptors (TbetaR-I and TbetaR-II). Loss of responsiveness to TGFbeta, attributed to inactivation of the TbetaR complex, has been implicated in the development of tumors in a number of human epithelial and lymphoid tissues. To gain a better understanding of TGFbeta signal transduction pathways in endometrial carcinogenesis, we have investigated the role of the TbetaR complex by evaluating the TbetaR-I and TbetaR-II genes for mutations throughout the entire coding region in human sporadic endometrial tumors. Using reverse transcription-PCR, "Cold" single-strand conformation polymorphism analysis, and direct DNA sequencing, it was found that 1 of 39 (2.6%) and 7 of 42 samples (17%) contained code-altering changes in the kinase domain of TbetaR-I and TbetaR-II, respectively. In 7betaR-I, a 3-bp deletion was found resulting in replacement of Arg and Glu at codon 237 and 238 by Lys. With TbetaR-II, mutations were found in the kinase, the extracellular, and the C-terminal domains. No frameshift mutations were detected; however, a silent population polymorphism (AAC-->AAT at codon 389) in TbetaR-II was found in 19 of 42 (44%) tumor samples. These results suggest that alteration in TbetaR-II, but not TbetaR-I, has an important role in the development of endometrial carcinoma.

A genome-wide association study of growth and fatness traits in two pig populations with different genetic backgrounds

Improvement in growth and fatness traits are the main objectives in pig all breeding programs. Tenth rib backfat thickness (10RIBBFT) and days to 100 kg (D100), which are good predictors of carcass lean content and growth rate, respectively, are economically important traits and also main breeding target traits in pigs. To investigate the genetic mechanisms of 10RIBBFT and D100 of pigs, we sampled 1,137 and 888 pigs from 2 Yorkshire populations of American and British origin, respectively, and conducted genome-wide association study (GWAS) through combined analysis and meta-analysis, to identify SNPs associated with 10RIBBFT and D100. A total of 11 and 7 significant SNPs were identified by combined analysis for 10RIBBFT and D100, respectively. And in meta-analysis, 8 and 7 significant SNPs were identified for 10RIBBFT and D100, respectively. Among them, 6 and 5 common significant SNPs in two analysis results were, respectively, identified associated with 10RIBBFT and D100, and correspondingly explained 2.09% and 0.52% of the additive genetic variance of 10RIBBFT and D100. Further bioinformatics analysis revealed 10 genes harboring or close to these common significant SNPs, 5 for 10RIBBFT and 5 for D100. In particular, Gene Ontology analysis highlighted 6 genes, PCK1, ANGPTL3, EEF1A2, TNFAIP8L3, PITX2, and PLA2G12, as promising candidate genes relevant with backfat thickness and growth. PCK1, ANGPTL3, EEF1A2, and TNFAIP8L3 could influence backfat thickness through phospholipid transport, regulation of lipid metabolic process through the glycerophospholipid biosynthesis and metabolism pathway, the metabolism of lipids and lipoproteins pathway. PITX2 has a crucial role in skeletal muscle tissue development and animal organ morphogenesis, and PLA2G12A plays a role in the lipid catabolic and phospholipid catabolic processes, which both are involved in the body weight pathway. All these candidate genes could directly or indirectly influence fat production and growth in Yorkshire pigs. Our findings provide novel insights into the genetic basis of growth and fatness traits in pigs. The candidate genes for D100 and 10RIBBFT are worthy of further investigation.