[Evaluation of postoperative complications registration status of gastric cancer by medical information: A single center feasibility study]

Objective: To explore the feasibility of assessing complications registration through medical information. Methods: A descriptive case series study was performed to retrospectively collect medical information and complication registration information of gastric cancer patients at Department of Gastrointestinal Cancer Center Ward I, Peking University Cancer Hospital from November 1, 2016 to March 1, 2017 (the first period), and from November 1, 2018 to March 1, 2019 (the second period). Case inclusion criteria: (1) adenocarcinoma confirmed by gastroscopy and biopsy; (2) patients undergoing open surgery or laparoscopic radical gastrectomy; (3) complete postoperative medical information and complication information. Patients who were directly transferred to ICU after surgery and underwent emergency surgery were excluded. Because difference of the complication registration procedure at our department existed before and after 2018, so the above two periods were selected to be used for analysis on enrolled patients. The prescription information during hospitalization, including nursing, medication, laboratory examination, transference, surgical advice, etc. were compared with the current Standard Operating Procedure (SOP, including preoperative routine examinations, inspection, perioperative preventive antibiotic use, postoperative observational tests, inspection, routine nutritional support, prophylactic anticoagulation, and prophylactic inhibition of pancreatic enzymes, etc.) for gastric cancer at our department. Medical order beyond SOP was defined as medical order variation. Postoperative complication was diagnosed using the Clavien-Dindo classification criteria, which was divided into I, II, IIIa, IIIb, IVa, IVb, and V. Medical order variation and complication registration information were compared between the two periods, including consistence between medical order variation and complication registration, missing report, underestimation or overestimation of medical order variation, and registration rate of medical order variation [registration rate = (total number of patients-number of missing report patients)/total number of patients], severe complications (Clavien-Dindo classification ≥ III), medical order variation deviating from SOP and the corresponding inferred grading of complication. The data was organized using Microsoft Office Excel 2010. Results: A total of 177 gastric cancer patients were included in the analysis. The first period group and the second period group comprised 89 and 88 cases, respectively. The registrated complication rate was 23.6% (21/89) and 36.4% (32/88), and the incidence of severe complication was 2.2% (2/89) and 4.5% (4/88) in the first and the second period, respectively. The complication rate inferred from medical order variation was 74.2% (66/89) and 78.4% (69/88), and the incidence of severe complication was 7.9% (7/89) and 4.5% (4/88) in the first and second period, respectively. In the first and second period, the proportions of medical order variation in accordance with registered complication were 36.0% and 45.5% respectively; the proportion of underestimation, overestimation and missing report were 5.6% and 4.5%, 4.5% and 4.5%, 53.9% and 45.5%, respectively; the registration rate of medical order variation was 46.1% and 54.5%; the number of case with grade I complications inferred from medical order variation was 34 (38.2%) and 25 (28.4%), respectively; and the number of grade II was 12 (13.5%) and 15 cases (17.0%), respectively. The reason of the missing report of medical order variation corresponding to grade I complication was mainly the single use of analgesic drugs outside SOP, accounting for 76.5% (26/34) and 64.0% (16/25) in the first and second period respectively, and that corresponding to grade II complication was mainly the use of non-prophylactic antibiotics, accounting for 9/12 cases and 5/15 cases, respectively. Conclusions: Medical information can evaluate the morbidity of complication feasibly and effectively. Attention should be paid to routine registration to avoid specific missing report.

Prior Antiplatelet Therapy, Excluding Phosphodiesterase Inhibitor Is Associated with Poor Outcome in Patients with Spontaneous Intracerebral Haemorrhage

There is conflicting results on whether prior antiplatelet therapy (APT) is associated with poor outcome in spontaneous intracerebral haemorrhage (ICH) patients. To determine whether prior APT is associated with spontaneous ICH, and whether there is a difference between the different types of APT, including cyclooxygenase inhibitor (COX-I), adenosine diphosphate receptor inhibitor (ADP-I) and phosphodiesterase inhibitor (PDE-I). A retrospective study of patients with ICH diagnosed between 2001 and 2013 in the National Health Insurance Research Database. Baseline unbalance between APT and non-APT groups was solved by multivariable adjustment (primary analysis) and propensity score matching (sensitivity analysis). Patients with prior APT had a higher rate of in-hospital death (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.09-1.23) compared to non-APT group. Compared to non-APT group, there was a greater rate of in-hospital death with spontaneous ICH with ADP-I (OR, 1.49; 95% CI, 1.24-1.79) and COX-I (OR, 1.17; 95% CI, 1.09-1.25). PDE-I exhibited no difference in in-hospital death with spontaneous ICH (OR, 1.03; 95% CI, 0.91-1.16) compared to non-APT group. Remarkably, the in-hospital mortality rate was significantly higher in the ADP-I group than in the PDE-I group (hazard ratio, 1.45; 95% CI, 1.17-1.80). In this study, ADP-I and COX-1, but not PDE-I, are the most likely contributors to the association of APT with poor outcome with spontaneous ICH patients. These findings suggest that the complexity of the different mechanism of actions of prior APT can alter the outcome in spontaneous ICH.

[Analysis of herpes zoster incidence and hospitalization in three areas of Beijing in 2015 based on health information system of medical institutions]

Objective: Using data of health information system (HIS) of medical institutions to study the incidence and hospitalization of herpes zoster in three districts of Beijing. Methods: According to the different level of economic development and geographical features in Beijing, 3 districts of Xicheng, Changping and Miyun were chosen and all 110 medical institutions of the first level and above in the 3 districts are included in the survey. All the outpatient and inpatient herpes zoster cases in 2015 were retrospectively reviewed by HIS system. After distinguishing the reduplicated cases, Using the first outpatient case as a molecule and the resident population as denominator to estimate the annual incidence rate, as well as the annual hospitalization rate was estimated based on primary diagnostic hospitalized cases as molecule and the resident population as denominator. Results: A total of 32 313 primary visit outpatient cases were investigated, of which 18 360 cases (56.8%) were women and 20 923 cases (64.8%) were ≥50 years old. The overall estimated incidence of the 3 districts was 8.8‰ with an increase trends with age and reached to the highest in ≥80 years old (30.5/1 000). The incidence of Xicheng, Changping and Miyun districts are respectively 16.2‰, 4.0‰ and 5.7‰. A total of 701 primary visit inpatient cases were identified, of which 366 cases (52.2%) were women and 651 cases (92.9%) were ≥50 years old. The estimated annual hospitalization rate was 19.4/100 000, with the primary and secondary diagnostic hospitalization rate are respectively 5.9/100 000 (212 cases) and 13.5/100 000 (489 cases). The disease types of secondary diagnostic inpatient herpes zoster cases were as follows: cardiovascular disease (19.0%, 93 cases), stroke (14.5%, 71 cases), pneumonia/chronic obstructive pulmonary disease (14.1%, 69 cases), tumor (12.5%, 61 cases) and diabetes (5.7%, 28 cases). Conclusion: Most of the herpes zoster cases in Beijing are over 50 years old, and the incidence of female is slightly higher than male. This disease should become a public health issue of great concern.

[The effective mutation of epidermal growth factor receptor in synchronous multiple primary lung cancers: study of clinical, radiographic and pathological factors]

Objective: To investigate the clinical, pathological and CT features associated with the effective mutation of epidermal growth factor receptor (EGFR) in multiple primary lung cancers (MPLCs) , and to determine the target population of EGFR mutations tests. Methods: A total of 558 nodules from 232 patients with MPLCs who underwent surgery in the Cancer Hospital of Chinese Academy of Medical Sciences from August 2017 to December 2017 were selected. Two hundreds and sixteen nodules were detected by DNA direct sequencing. Chi-square test and Mann-Whitney U test were used to compare the clinical, pathological and CT features of 216 nodules in the EGFR effective mutation group and the non-effective mutation group. Logistic regression analysis was used to explore the independent risk factors of EGFR mutation. The cut off value was determined using the receiver operating characteristic(ROC) curve. Of 232 cases 558 nodules of surgically resected MPLCs, EGFR mutation of 216 nodules was determined by direct DNA sequencing. Results: There were 58 males and 174 females with MPLCs(male︰female=1︰3). There were 117 cases of age ≥59 years old and 115 cases of age <59 years old. There were 192 non-smokers, accounting for 82.8% of all patients. There were 2-7 nodules in the patient's lungs, of which 170 patients had two nodules in the lungs, 44 patients had 3 nodules, and another patient had 7 nodules. Among them, 216 nodules were detected by EGFR gene, 136 were effective mutations, and 80 were non-effective mutations (including wild type and null mutation). EGFR effective mutation group and non-effective mutation group were statistically significant in lung adenocarcinoma patients with different gender, age, smoking history, histological type, and differentiation degree (P=0.006, 0.002, 0.002, 0.015, 0.025).Among them, the effective mutation group were 107 females, 85 cases≥ 59 years old, 117 cases with no smoking history, 68 acinar-based, 89 moderate differentiation. In the count data, 127 nodule edges were lobed, and only 9 nodule edges were smooth. Among the measurement data, the GGO CT value was approximately (-459±147) HU in the EGFR mutation group, with statistical difference (P=0.037). The GGO diameter was approximately (11±9)mm,P=0.279.Multivariate Logistic regression analysis showed that GGO diameter (OR=0.873, 95%CI: 0.780-0.997; P=0.018) and smooth margins (OR=0.183,95%CI: 0.041-0.824; P=0.027) were independent protective factors of effective mutations of EGFR. Conclusions: In MPLCs, effective EGFR mutation is more common, and associated with elder female, age≥59 years, non-smoking, GGO attenuation <-548 HU, moderately differentiated, predominant invasive papillary adenocarcinoma. Patients with MPLCs and these risk factors may be encouraged to have postoperative EGFR molecular test.

[The clinicopathological features and HPV detection of conjunctival actinic keratosis]

Objective: To describe the clinicopathological features of conjunctival actinic keratosis (AK) and relation to the infection of human papillomavirus (HPV). Method: Retrospective case series study. Eighteen cases (18 eyes) of conjunctival AK were obtained in Tianjin Eye Hospital and Institute (2005-2018). The clinical and histopathological features were studied. HPV was detected by a modified general primer HPV polymerase chain reaction (PCR) system in all formalin-fixed, paraffin-embedded specimens. Results: The male to female ratio was 5∶1. The mean age at diagnosis was 60 years (range: 43-79 years). Sixteen cases were located in the nasal interpalpebral region, and two cases were located in the temporal interpalpebral region. All cases were located in corneal limbus, and the mean distance of corneal invasion was 2 mm (range, 1-4 mm). The mean diameter was 4.6 mm (range, 2.0-8.0 mm). Clinically, most lesions (16 cases) appeared as a white or milky, flat plaque with clear borderline and conjunctival hyperemia; a few lesions (2 cases) showed a brown-black mass, partially white. Pathologically, conjunctival AK was a proliferation of epithelium with prominent parakeratosis or hyperkeratosis, stratum spinosm thickening and basal cell proliferation. Many AKs show solar elastosis and a mild inflammatory infiltrate of lymphocytes and plasma cells in the stroma. Most lesions (15 cases) were hypertrophic type, two cases were pigmented type, and one case was acantholytic type. HPV was negative in 18 cases. All case were removed by complete surgical excision. The rage of follow-up period was 1.0-10.4 years, ten cases were recorded, and no case recurred after surgical excision. Conclusions: Conjunctival AK is epithelial precancerous lesion that occurs in the keratoconjunctival margin. HPV infection might not be a causative factor in conjunctival AK. (Chin J Ophthalmol, 2019, 55: 531-535).

[Risk factors of cervical anastomotic leakage after thoracoscopic-lapacoscopic esophagectomy in patients with esophageal carcinoma]

Objective: To analyze the risk factors of cervical anastomotic leakage after thoracoscopic-lapacoscopic esophagectomy. Methods: 530 patients with esophageal cancer underwent thoracoscopic-lapacoscopic esophagectomy at the Cancer Hospital, Chinese Academy of Medical Sciences from Jan 2011 to Dec 2015. The demographic, surgical and clinical data of patients were retrospectively analyzed. Multivariate logistic regression was used to evaluate risk factors of cervical anastomotic leakage in these patients. Results: A total of 530 patients undergoing thoracoscopic-lapacoscopic esophagectomy were enrolled in this study. There were 421 males and 109 females. The mean age was (59.40±8.08) years old, and 91 patients with cervical anastomotic leakage. Sigle factor analysis revealed that the risk grading by American Society of Aneshesiologists, previous history of chest surgery, respiratory comorbidity, diffusion capacity for carbon monoxide of the lung, operation time, anastomosis, average days of postoperative hospitalization, death within 30 days after surgery, respiratory complications, pleural effusion or empyema, and poor healing of the incision were statistically associated with cervical anastomotic leakage (all P<0.05). Multivariate analysis showed that previous history of chest surgery, hepatic insufficiency, manual anastomosis, prolonged postoperative hospitalization, and poor healing of the incision were independent risk factors for cervical anastomotic leakage after thoracoscopic-lapacoscopic esophagectomy (all P<0.05). Conclusions: Previous history of chest surgery, hepatic insufficiency, poor healing of the incision, manual anastomosis and prolonged postoperative hospitalization were significantly associated with cervical anastomotic leakage after thoracoscopic-lapacoscopic esophagectomy. It's important to strengthen perioperative nursing and surgical techniques to prevent anastomotic leakage after thoracoscopic-lapacoscopic esophagectomy.

Flexible Organometal-Halide Perovskite Lasers for Speckle Reduction in Imaging Projection

Disorder is emerging as a strategy for fabricating random laser sources with very promising materials, such as perovskites, for which standard laser cavities are not effective or too expensive. We need, however, different fabrication protocols and technologies for reducing the laser threshold and controlling its emission. Here, we demonstrate an effectively solvent-engineered method for high-quality perovskite thin films on a flexible polyimide substrate. The fractal perovskite thin films exhibit excellent optical properties at room temperature and easily achieve lasing action without any laser cavity above room temperature with a low pumping threshold. The lasing action is also observed in curved perovskite thin films on flexible substrates. The lasing threshold can be further reduced by increasing the local curvature, which modifies the scattering strengths of the bent thin film. We also show that the curved perovskite lasers are extremely robust with respect to repeated deformations. Because of the low spatial coherence, these curved random laser devices are efficient and durable speckle-free light sources for applications in spectroscopy, bioimaging, and illumination.

TET1 reprograms the epithelial ovarian cancer epigenome and reveals casein kinase 2α as a therapeutic target

Ten-eleven translocation methylcytosine dioxygenase-1, TET1, takes part in active DNA demethylation. However, our understanding of DNA demethylation in cancer biology and its clinical significance remain limited. This study showed that TET1 expression correlated with poor survival in advanced-stage epithelial ovarian carcinoma (EOC), and with cell migration, anchorage-independent growth, cancer stemness, and tumorigenicity. In particular, TET1 was highly expressed in serous tubal intraepithelial carcinoma (STIC), a currently accepted type II EOC precursor, and inversely correlated with TP53 mutations. Moreover, TET1 could demethylate the epigenome and activate multiple oncogenic pathways, including an immunomodulation network having casein kinase II subunit alpha (CK2α) as a hub. Patients with TET1^high CK2α^high EOCs had the worst outcomes, and TET1-expressing EOCs were more sensitive to a CK2 inhibitor, both in vitro and in vivo. Our findings uncover the oncogenic and poor prognostic roles of TET1 in EOC and suggest an unexplored role of epigenetic reprogramming in early ovarian carcinogenesis. Moreover, the immunomodulator CK2α represents a promising new therapeutic target, warranting clinical trials of the tolerable CK2 inhibitor, CX4945, for precision medicine against EOC. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Previous Antithrombotic Therapy, Particularly Anticoagulant, Is Associated with Unfavorable Outcomes in Patients with Primary Spontaneous Intracerebral Hemorrhage Receiving Craniotomy: A Nationwide Population-Based Cohort Study

OBJECTIVE

The impact of antithrombotic agents on patients with primary intracerebral hemorrhage (ICH) remains controversial, especially patients who require emergent craniotomy. This study was undertaken to evaluate clinical outcomes in operated patients with ICH with and without previous antithrombotic agents.

METHODS

This is a retrospective cohort study. Between January 2001 and December 2013, all patients with ICH who received emergent craniotomy and who were present in Taiwan's National Health Insurance Research Database were screened and divided into those with previous antiplatelet therapy, anticoagulant therapy, and nonantithrombotic therapy according to their health care claims data within 3 months of index admission. The primary end points included in-hospital mortality and complications and short-term outcome.

RESULTS

Of 18,872 eligible patients, 16,251 (87.1%) did not receive any antithrombotic therapy, 2267 patients had antiplatelet therapy, and 354 patients had anticoagulation therapy. After propensity score matching, significantly more blood transfusions and craniectomies were identified in the patients with previous antithrombotic treatment compared with those undergoing nonantithrombotic therapy. Compared with the nonantithrombotic treatment cohort, patients under previous anticoagulant treatment had significantly higher in-hospital mortality (odds ratio, 2.12; 95% confidence interval, 1.45-3.10). Furthermore, during the 6-month follow-up period, previous anticoagulant therapy was independently associated with a greater risk of all-cause mortality (P = 0.001). The in-hospital and 6-month all-cause mortality of patients with previous antiplatelet treatment was not significantly different from patients with nonantithrombotic treatment.

CONCLUSIONS

These findings suggested an increased risk of in-hospital mortality and poor short-term outcome among operated patients with ICH with previous antithrombotic therapy, particularly anticoagulant therapy, but not with antiplatelet therapy.

Targeting analysis of a novel parietal approach for deep brain stimulation of the anterior nucleus of the thalamus for epilepsy

PURPOSE

Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a promising treatment for refractory epilepsy; however, it remains challenging to successfully target the ANT. The results of Medtronic Registry for Epilepsy (MORE) supported a frontal transventricular(TV) compared to frontal extraventricular (EV) lead trajectory for ANT DBS may have better coverage of the ANT. Here we report the safety and targeting efficacy of a novel, posterior parietal extraventricular (PEV) approach to the ANT.

METHODS

We conducted a retrospective analysis of ten patients who underwent bilateral ANT DBS (20 total trajectories) for medically-refractory epilepsy. Similar targeting methodology as the MORE trial was used, and the DBS Intrinsic Template Atlas (DISTAL) was utilized for ANT localization and contact position relative to ANT. Clinical data were assessed for DBS targeting efficacy and surgical complications.

RESULTS

The demonstrated PEV trajectory showed a successful ANT targeting rate of 90% bilaterally. Two or more contacts within ANT were presented in 75% of all leads. Mean contact number in ANT was 2.2+ 1.2. There were no intracranial hemorrhages, cerebrospinal fluid leakage, or permanent neurologic deficits.

CONCLUSION

In this small series, the novel PEV for ANT DBS is feasible with good targeting accuracy and potential safety advantages. The high accuracy of the PEV trajectory suggests that it is a reasonable alternative trajectory for ANT DBS. Larger studies will be needed to assess this trajectory on clinical outcome of DBS treatment to epilepsy.

A PEG-Based Hydrogel for Effective Wound Care Management

It is extremely challenging to achieve strong adhesion in soft tissues while minimizing toxicity, tissue damage, and other side effects caused by wound sealing materials. In this study, flexible synthetic hydrogel sealants were prepared based on polyethylene glycol (PEG) materials. PEG is a synthetic material that is nontoxic and inert and, thus, suitable for use in medical products. We evaluated the in vitro biocompatibility tests of the dressings to assess cytotoxicity and irritation, sensitization, pyrogen toxicity, and systemic toxicity following the International Organization for Standardization 10993 standards and the in vivo effects of the hydrogel samples using Coloskin liquid bandages as control samples for potential in wound closure.

Key space enhancement of optical chaos secure communication: chirped FBG feedback semiconductor laser

Optical chaos communication has advantages of high speed and long transmission distance. Unfortunately, the key space of the traditional transceiver, i.e. semiconductor laser with mirror feedback, is limited due to the time delay signature. In this paper, we propose and numerically demonstrate a key space enhancement by using semiconductor laser with optical feedback from a chirped fiber Bragg grating (FBG). The chirped FBG feedback can make feedback delay a key parameter by eliminating the time delay signature. Moreover, the grating dispersion and center frequency can also be used as new keys. As a result, the dimension of key space is increased. By taking a bidirectional communication scheme as an example, numerical results show that the key space is raised by 2⁴⁴ times as against mirror feedback with a data rate of 2.5 Gb/s and a coupling strength of 0.447. As the coupling strength decreases, the key space increases due to the fact that chaos synchronization becomes more sensitive to parameter mismatch.

Decreased fracture incidence with traditional Chinese medicine therapy in patients with osteoporosis: a nationwide population-based cohort study

BACKGROUND

There are no published studies regarding the efficacy of traditional Chinese medicine (TCM) for the prevention of osteoporotic fracture. Therefore, we conducted this nationwide, population-based cohort study to investigate the probable effect of TCM to decrease the fracture rate.

METHODS

We identified cases with osteoporosis and selected a comparison group that was frequency-matched according to sex, age (per 5 years), diagnosis year of osteoporosis, and index year. The difference between the two groups in the development of fracture was estimated using the Kaplan-Meier method and the log-rank test.

RESULTS

After inserting age, gender, urbanization level, and comorbidities into the Cox's proportional hazard model, patients who used TCM had a lower hazard ratio (HR) of fracture (adjusted HR: 0.47, 95% CI: 0.37-0.59) compared to the non-TCM user group. The Kaplan-Meier curves showed that osteoporosis patients who used TCM had a lower incidence of fracture events than those who did not (p < 0.00001). Our study also demonstrated that the longer the TCM use, the lesser the fracture rate.

CONCLUSION

Our study showed that TCM might have a positive impact on the prevention of osteoporotic fracture.

[Combination of CT mulitplane 3D reconstruction, radial endobronchial ultrasound and rapid on-site evaluation for diagnosing peripheral solitary pulmonary nodules]

Objective: To evaluate the diagnostic efficiency of combination of CT multiplane 3D reconstruction (CT-3DR), radial endobronchial ultrasound (R-EBUS), and rapid on-site evaluation (ROSE) for peripheral solitary pulmonary nodules (SPN). Methods: A total of 176 patients with peripheral solitary pulmonary nodule were included from the Nanjing Chest Hospital from March 2016 to March 2017. According to different methods, all the patients were divided into four groups: EG (i.e. R-EBUS+Guiding sheath (GS))group, CTE (i.e. CT-3DR+R-EBUS) group, RE (i.e. ROSE+R-EBUS) group, and triad (i.e. CT-3DR+ROSE+R-EBUS) group. Sampling was performed by transbronchial lung biopsy. The diagnostic yield and complications, procedure time and influencing factors in these four groups were retrospectively analyzed. The value of ROSE and combination of CT-3DR+ROSE+R-EBUS in diagnosis for SPN also was evaluated. Results: The diagnostic yield for total SPNs among four groups were 70.5% in EG group, 70.0% in CTE group, 69.0% in RE group and 74.0% in triad group, respectively. There was no significant difference among four groups (all P>0.05). The procedure time of EG group, CTE group, RE group and triad group were (34.0±6.3), (26.6±6.8), (27.2±7.8) and (19.4±5.4) min, respectively. The procedure time was the shortest in triad group compared with the other three groups (all P<0.001) and the time of CTE and RE groups were significantly shorter than the EG group (both P<0.001). The coincidence rates of CT-3DR navigation position with target bronchus were 87.5% in CTE group and 90.0% in triad group with no significant difference between these two groups (P>0.05). The diagnostic yield was higher for SPNs with their major diameter ≥2 cm than those with their major diameter<2 cm in all four groups (all P<0.05). The positive diagnostic yield was higher with ultrasonic probe located within SPN lesion than the probe adjacent to or deviated the lesion in all four groups (all P<0.05). In EG and RE groups, for those SPNs with the distance between the lesion and pleura≥2 cm, the diagnostic yield were higher than those withe the distance<2 cm (P<0.05) but no similar phenomenon was observed in CTE and triad groups. No significant correlation was detected between the diagnostic yield and the density of SPN lesions among four groups (all P>0.05). ROSE was used in RE and triad groups. The coincidence rate of ROSE with histopathology was 82.6% and the value of Kappa was 0.608. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of ROSE were 0.818, 0.846, 0.931 and 0.647, respectively. Conclusions: CT-3DR navigation and ROSE help to improve the diagnostic efficiency of R-EBUS for SPN. Combination of CT-3DR, R-EBUS and ROSE is of diagnostic value for peripheral SPN and with significant shortening of procedure time.

[Role of Magnetic Resonance Imaging in distinguishing the origin of adenocarcinoma at the junction of the lower uterine segment and endocervix]

Objective: To evaluate Magnetic Resonance Imaging (MRI) at 3.0T in differential diagnosis of the origin of adenocarcinoma at the junction of the lower uterine segment and endocervix. Methods: 71 patients with adenocarcinoma at the junction of the lower uterine segment and endocervix were retrospectively collected. Pelvic MR examinations, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences, were performed within 2 weeks before surgery. MR images were analyzed and measured by two radiologists, including the location of the tumor center, the enhancement pattern, the anterior and posterior diameters, the left and right diameters, the upper and lower diameters, and the apparent diffusion coefficient (ADC) of the tumor. Immunohistochemical method was used as gold standard in distinguishing cervical adenocarcinoma and uterine adenocarcinoma. Results: The upper and lower diameters of uterine adenocarcinoma were [(5.80±2.31) cm], significantly larger than those of cervical adenocarcinoma [(4.16±2.17) cm, P=0.009]. Using 4.5cm as the best cutoff point value, the sensitivity and specificity in distinguishing uterine adenocarcinoma and cervical adenocarcinoma were 68.4% and 65.4%, respectively. According to the location of tumor center, the sensitivity and specificity were 84.2% and 73.1%, respectively. Using tumor enhancement pattern as the criterion, the sensitivity and specificity of diagnosing uterine adenocarcinoma and cervical adenocarcinoma were 68.4% and 80.8% respectively. Conclusions: MRI has certain clinical value in evaluating the origin of adenocarcinoma at the junction of the lower uterine segment and endocervix. The lesions can be diagnosed according to the main location, the characteristics of dynamic enhancement and the growth pattern of the tumor.

[An immunohistochemical study of CTHRC1,Vimentin,E-cadherin expression in papillary thyroid carcinoma]

Objective:To investigate the expression and significance of CTHRC1 in patients with papillary thyroid cancinoma.Method:We collected 63 specimens of papillary thyroid carcinoma tissue with 36 specimens of the adjacent normal thyroid tissue and 23 specimens of thyroid nodular goiter. The expressions of CTHRC1 protein in these tissues were detected by immunohistochemical staining. The correlations between the expressions of CTHRC1 with clinicopathologic features,E-cadherin and Vimentin expression were analyzed.Result:CTHRC1 protein expression levels in papillary thyroid carcinoma tissue were significantly higher than those in adjacent normal thyroid tissue and benign disease(P<0.01);CTHRC1 expression was significantly correlated with lymph node metastases(P<0.05). Moreover,CTHRC1 expression was correlated with the expression of E-cadherin and Vimentin(P<0.01).Conclusion:CTHRC1 is related with the occurrence and miligant transformation of papillary thyroid cancinoma. We speculated that CTHRC1 might play a role in the epithelial-mesenchymal transition of papillary thyroid cancinoma.

[Effect of α7nAChR mediated cholinergic anti-inflammatory pathway on inhibition of atrial fibrillation by low-level vagus nerve stimulation]

Objective: To investigate the effect of α7nAChR mediated cholinergic anti-inflammatory pathway on inhibition of atrial fibrillation by low-level vagus nerve stimulation(LL-VNS). Methods: Eighteen beagles were randomized into control group (n=6), LL-VNS group (n=6) and methyllycaconitine (MLA) + LL-VNS group (n=6). All the beagles were subjected to rapid atrial pacing at 800 beats/min for 6 hours.And the effective refractory period (ERP) of atriums and pulmonary veins and induced atrial fibrillation (AF) were measured hourly during non-pacing.After cessation of pacing for 3 hours, the beagles in control group were injected with saline into four ganglionated plexis (GPs), the beagles in LL-VNS group were given LL-VNS and saline injected into four GPs, and the beagles in MLA+ LL-VNS group were injected with MLA into four GPs combined with LL-VNS.And the levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and acetylcholine (ACh) in the plasma at baseline condition, 3 h and 6 h were measured.At the end of this experiment, atrial tissues were collected to examine the levels of TNF-α, IL-6, ACh, NF-κBp65 and STAT3 proteins. Results: During the right atrium pacing for the first 3 hours, the ERPs were gradually decreased while AF inducibility were gradually increased in all groups. At the end of this experiment, compared with the control group and MLA+ LL-VNS group, the ERPs in LL-VNS group were increased, and the induced times and duration of AF were significantly decreased. The levels of TNF-α and IL-6 in plasma were all significantly decreased in LL-VNS group and MLA+ LL-VNS group when compared with the control group(pg/ml) [IL-6: (101±6) vs (119±7), P<0.05; (102±5) vs (119±7), P<0.05; TNF-α: (17.8±1.7) vs (22.1±2.0), P<0.05; (17.9±2.2) vs (22.1±2.0), P<0.05]. And the levels of ACh were higher than in the control group(μg/ml)[(151±13) vs (123±10), P<0.05; (145±5) vs (123±10), P<0.05]. After cessation of pacing for 6 hours, compared with the control groupand MLA+ LL-VNS group, the tissue levels of TNF-α and IL-6 were significantly decreased in LL-VNS group (P<0.05). The concentrations of NF-κBp65 proteins in atrial tissues were lower in the LL-VNS group (P<0.05), and the levels of STAT3 proteins in those tissues were higher in the LL-VNS group than in thein the two other groups (P<0.05). Conclusion: LL-VNS could inhibit the atrial electrical remodeling and atrial fibrillation induction; cholinergic anti-inflammatory pathway mediated by α7nAChR may be the important mechanism in vagal nerve regulated AF.

[Assessment of renal function with intravoxel incoherent motion and diffusion tensor imaging in type 2 diabetic patients]

Objective: To evaluate the application value of intravoxel incoherent motion (IVIM) and diffusion tensor imaging (DTI) in detecting early-stage diabetic nephropathy and to assess the damage of ralated renal function. Methods: A total of 52 patients with type 2 diabetes diagnosed in Zhongda Hospital were collected from April 2016 to May 2017 and were assigned to DM group (diabetes without nephropathy, n=32) and DN group (diabetes with nephropathy, n=20) according to detection of microalbuminuria, a cohort of healthy recipients were included as control group (n=27) in the meantime. All of the subjects underwent IVIM and DTI examination. The cortical and medullary parameters[IVIM: perfusion fraction f, tissue diffusivity D, pseudodiffuvisity D(*;) DTI: fractional anisotropy FA, apparent diffusion coefficient ADC, principal diffusivities (λ1, λ2, λ3)]were obtained respectively and were compared among groups. The relationship between MRI related parameters and estimated glomerular filtration rate (eGFR) were statistically investigated; and diagnostic performance of IVIM and DTI in discriminating DM and DN group was evaluated by receiver operating characteristic analysis. Results: The cortical and medullary f, D values in DN group were lower than those in DM group and control group (F=17.32, 15.69, 6.71, 10.94, all P<0.05). D values of all subjects showed positive correlations with eGFR (cortex r=0.518, medulla r=0.538, both P<0.05). The diagnostic efficiency of cortical f values to discriminate diabetes and diabetic nephropathy was 0.817, the cut-off value was 0.205. The medullary FA value in DM group was lower than that in control group ((0.371±0.051 vs 0.423±0.043, t=4.188, P<0.05); and the medullary FA value in DN group (0.315±0.062) was lower than that in control and DM group (F=25.08, P<0.05). The medullary λ3 values in DM group and DN group were all significantly higher than that in control group (F=7.86, P<0.05). The diagnostic efficiency of medullary FA values to discriminate diabetes and diabetic nephropathy was 0.763, the cut-off value was 0.344. Conclusion: IVIM and DTI can reflect the abnormal perfusion and diffusion during early-stage diabetic nephropathy and have the potential value to assess the damage of ralated renal function.

[The expression and prognostic significance of microRNA-34a in Uygur and Han patients with chronic lymphocytic leukemia in Xinjiang Uygur Autonomous Region in China]

To investigate the expression of microRNA-34a (miR-34a) in patients with chronic lymphocytic leukemia (CLL) in Xinjiang Uygur and Han nationalities and its prognostic significance. Our data showed that miR-34a expression in Uygur and Han CLL patients was significantly higher than that in their respective healthy controls, while miR-34a levels were similar between Uygur and Han patients. By comparing with known prognostic factors, receiver operating characteristic (ROC) curves showed that miR-34a was a good predictive factor for the prognosis of CLL (demarcation value was 3.567 6). Survival analysis was further performed according to miR-34a expression level, that low expression of miR-34a translated into poor prognosis.

[Surgical resection for gastric cancer patients with liver metastasis]

Objective: To explore the surgical results and clinicopathological features of gastric cancer patients with liver metastases. Methods: The clinicopathological data and post-operative survival of 37 patients who underwent resection of liver metastasis from gastric cancer at our department from Dec. 2007 to Dec. 2014 were analyzed. Results: The 1-, 3-, and 5-year overall survival rates after resection were 91.4%, 57.9%, and 22.0%, respectively, with a median survival of 37 months. Univariate analysis revealed that lymph node metastasis, multiple hepatic metastases and no preoperative chemotherapy are unfavorable prognostic factors for overall survival. Multivariate analysis identified that lymph node metastasis and number of liver metastasis are independent prognostic factors. Conclusions: Gastric cancer patients with a solitary liver metastasis may be good candidates for gastric D2 resection combined with liver R0 resection.

GATA3 as a master regulator and therapeutic target in ovarian high-grade serous carcinoma stem cells

Ovarian high-grade serous carcinoma (HGSC) is the most lethal gynecological malignancy. Prevailing evidences suggest that drug resistance and recurrence of ovarian HGSC are caused by the presence of cancer stem cells. Therefore, targeting cancer stems is appealing, however, all attempts to date, have failed. To circumvent this limit, we analyzed differential transcriptomes at early differentiation of ovarian HGSC stem cells and identified the developmental transcription factor GATA3 as highly expressed in stem, compared to progenitor cells. GATA3 expression associates with poor prognosis of ovarian HGSC patients, and was found to recruit the histone H3, lysine 27 (H3K27) demethylase, UTX, activate stemness markers, and promote stem-like phenotypes in ovarian HGSC cell lines. Targeting UTX by its inhibitor, GSKJ4, impeded GATA3-driven stemness phenotypes, and enhanced apoptosis of GATA3-expressing cancer cells. Combinations of gemcitabine or paclitaxel with GSKJ4, resulted in a synergistic cytotoxic effect. Our findings provide evidence for a new role for GATA3 in ovarian HGSC stemness, and demonstrate that GATA3 may serve as a biomarker for precision epigenetic therapy in the future.

Effects of female sex hormones on chemotherapeutic paclitaxel-induced neuropathic pain and involvement of inflammatory signal

Paclitaxel is used for the treatment of several types of cancers. However, one of its significant limiting complications is painful peripheral neuropathy during therapy. Gender is considered to play a role in modifying pain intensity. The present study examined the effects of female sex hormones on paclitaxel-induced neuropathic pain and the engagement of inflammatory signal of sensory nerves. Ovariectomies were performed on rats and subsequent hormone replacement with the combination of 17β-estradiol and progesterone was given. ELISA was used to determine the levels of proinflammatory cytokines (PICs) such as IL-1β, IL-6 and TNF-α in the dorsal root ganglion (DRG) of rats with different conditions of female sex hormones; moreover, Western blot analysis was used to examine expression of PIC receptors. The results of our study demonstrated that the increases of IL-1β, IL-6 and TNF-α; and expression of their respective receptors induced by paclitaxel were less in the DRG of ovariectomized rats with lack of female sex hormones. Thresholds of pain responses to mechanical and thermal stimuli appeared to be greater in ovariectomized rats with lack of female sex hormones. Overall, the findings indicate that circulating 17β-estradiol and progesterone contribute to the modulation of neuropathic pain response after administration of paclitaxel, likely via PIC signal in the sensory nerves, which is implicated to consider sex difference for pain management with application of chemotherapeutic paclitaxel.

Epigenetic loss of heparan sulfate 3-O-sulfation sensitizes ovarian carcinoma to oncogenic signals and predicts prognosis

Precision medicine requires markers for therapeutic guidance. The purpose of this study was to determine whether epithelial ovarian cancer (EOC) epigenetics can lead to the identification of biomarkers for precision medicine. Through integrative methylomics, we discovered and validated the epigenetic signature of NEFH and HS3ST2 as an independent prognostic factor for type II EOC in our dataset (n = 84), and two independent methylomics datasets (total n = 467). Integrated transcriptomics dataset (n = 1147) and tissue microarrays (n = 54) of HS3ST2 also related to high-methylation statuses and the EOC prognosis. Mechanistic explorations of HS3ST2 have assessed responses to oncogenic stimulations such as IL-6, EGF, and FGF2 in cancer cells. The combination of HS3ST2 and various oncogenic ligands also confers the worse outcome. 3-O-sulfation of heparan sulfate by HS3ST2 makes ovarian cancer cells intrinsically sensitive to oncogenic signals, which sheds new light on the application of HS3ST2 as a companion diagnostic for targeted therapy using kinase inhibitors or therapeutic antibodies.