Abstract 679: Pdgf/snail-mediated Endothelial Plasticity Drives Non-productive Neovascularization and Impedes Tissue Repair After Myocardial Infarction

Ischemic heart disease is the most common cause of death in the Western world, largely due to myocardial infarction (MI). After MI, formation of new blood vessels, i.e. , neovascularization, is crucial for ischemic tissue reperfusion, repair and regeneration. However, the newly formed vasculatures in infarcted tissue are characterized by functional and structural abnormalities, which compromise vascular delivery function and impede cardiac recovery after MI. Likewise, aberrant non-productive neovascularization, albeit previously under-appreciated, represents a promising therapeutic target for post-MI treatment. Here we reveal that mesenchymal transformation-mediated endothelial cell (EC) plasticity induces aberrant post-ischemic neovascularization. In contrast to the old concept implicating that ECs undergo endothelial mesenchymal transitions to generate fibroblasts de novo in infarcted cardiac tissue, we suggest that ECs acquire mesenchymal phenotypes including high proliferation and motility to generate excessive abnormal vasculatures after MI. By utilizing genetic EC lineage tracing and single-cell RNAseq technologies with a mouse MI model induced by ligation of left anterior descending coronary artery, our transcriptome analysis uncovers that ECs undergo mesenchymal transformation in infarcted tissues. Moreover, exposure of cardiac ECs to ischemic microenvironment in vitro induces EC expression of mesenchymal genes including S100A4, ACTA2, and CDH2, and interestingly, EC functions including tube formation and uptake of ac-LDL are retained, suggesting EC mesenchymal transformation without lineage transition. Furthermore, we identify a PDGF/Snail-mediated axis that controls EC transformation under hypoxia. Notably, genetic ablation of PDGF receptor-β in ECs promotes blood perfusion and tissue repair after hindlimb ischemia and MI in mice. These findings identify a novel cellular mechanism controlling non-productive neovascularization after ischemia, and suggest that targeting EC plasticity may offer promising therapeutic opportunities for normalization of aberrant neovasculature and improvement of tissue repair in ischemic heart diseases.

Abstract 674: Vesselin Controls Vascular Morphogenesis by Activating Small Gtpases in Endothelial Cells

Vascularization is a fundamental process in development, wound healing, and the progression of cardiovascular diseases. Formation of new blood vessels with functional and structural integrity is crucial for organ growth as well as post-injury tissue repair and regeneration. Although vascular sprouting and outgrowth, i.e. , angiogenesis, has been extensively studied, the underlying mechanisms for vessel formation remain largely unexplored. Here we reveal a critical role of phosphatidylinositol 4,5-bisphosphate (PIP2) for vessel formation in endothelial cells (ECs). Moreover, by using mass spectrometry, our identified Tbc1d2b as a novel PIP2-binding protein in vessel-formatting ECs. Considering its critical function in vessel formation, we name this protein “vesselin”. We showed that vesselin preferentially localizes to blood vessels in various human tissues, and that its siRNA-mediated knockdown inhibits EC tube formation, supporting its major role in vessel formation. Remarkably, injection of inhibitory vesselin morpholino into the embryos blocks blood vessel formation and zebrafish development. Vesselin contains PH (pleckstrin homology) and TBC (Tre2/Bub2/Cdc16) domains, which are known to bind phosphatidylinositols and display GTPase-activating protein (GAP) activities towards Rab GTPases, respectively. Consistently, we found by mass spectrometry that vesselin interacts with the small GTPase Rab13 and small GTPase Rac1. Finally, our further mechanistic studies showed that vesselin interacts with Rac1 and Rab13 during EC vessel formation, and regulates their activity in a PIP2-dependent manner. Thus, we uncover a previously unidentified regulatory system for EC vessel formation, providing molecular resolution of vascular morphogenesis. Targeting vesselin may provide new therapeutic strategies in cardiovascular diseases.

Evaluation of cumulative prognostic score based on pretreatment plasma fibrinogen and serum albumin levels in patients with newly diagnosed high-grade gliomas

This retrospective study was designed to determine the prognostic value of a cumulative score (FA score) based on pretreatment plasma fibrinogen and serum albumin levels for 326 patients newly diagnosed high-grade glioma (HGG). Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values. Univariate and multivariate analysis were performed to evaluate the independent prognostic value of the FA scores associated with overall survival (OS) and progression-free survival (PFS). The optimal cut-off values were 2.815 g/L for fibrinogen and 43.65 g/L for albumin. PFS and OS were significantly worse for patients with higher FA scores. Patients with elevated fibrinogen level and decreased albumin levels had 3.00-fold higher risk of tumor progression and had a 3.23-fold higher risk of death compared with those with normal values. Multivariate analysis demonstrated FA score was an independent predictive factor for PFS and OS. Moreover, PFS and OS were better for the patients with lower FA score, either in patients with grade III or IV gliomas. These findings indicated that the pretreatment FA score could serve as a simple and noninvasive marker to predict the prognosis of patients with HGG.

KIF-2C expression is correlated with poor prognosis of operable esophageal squamous cell carcinoma male patients

To determine the prognostic significance of Kinesin family member 2C (KIF-2C) expression in patients with operable esophageal squamous cell carcinoma (ESCC), we conducted an immunohistochemical analysis of KIF-2C expression in 415 surgically resected primary tumor tissues and 40 adjacent non-cancerous tissues from patients with operable ESCC. The median duration of postoperative follow-up was 76.0 months. Higher KIF-2C expression was associated with significantly increased risks of higher pathologic tumor (pT) status (P=0.038) and poorer tumor differentiation (P=0.022). For the entire cohort, KIF-2C expression was not an independent factor significantly associated with overall survival (OS) (P=0.097) or disease-free survival (DFS) (P=0.152). In female patients, KIF-2C expression had no effect on OS (P=0.880) and DFS (P=0.864). However, OS (hazard ratio (HR)=1.480, P=0.013) and DFS (HR=1.418, P=0.024) were worse for male patients with high KIF-2C expression compared with male patients with low KIF-2C expression. Moreover, the OS and DFS of male patients with high KIF-2C expression were also significantly shorter compared with female patients with low KIF-2C expression (P=0.022, P=0.029) and female patients with high KIF-2C expression (P=0.014, P=0.018). Based on these findings, KIF-2C expression in tumor tissues promises to serve as an independent prognostic marker for male, but not female, patients with operable ESCC. Prognosis was worse for male patients with high KIF-2C expression compared with patients with the same pathologic tumor-node-metastasis (pTNM) stage.

Vascular niche IL-6 induces alternative macrophage activation in glioblastoma through HIF-2α

Spatiotemporal regulation of tumor immunity remains largely unexplored. Here we identify a vascular niche that controls alternative macrophage activation in glioblastoma (GBM). We show that tumor-promoting macrophages are spatially proximate to GBM-associated endothelial cells (ECs), permissive for angiocrine-induced macrophage polarization. We identify ECs as one of the major sources for interleukin-6 (IL-6) expression in GBM microenvironment. Furthermore, we reveal that colony-stimulating factor-1 and angiocrine IL-6 induce robust arginase-1 expression and macrophage alternative activation, mediated through peroxisome proliferator-activated receptor-γ-dependent transcriptional activation of hypoxia-inducible factor-2α. Finally, utilizing a genetic murine GBM model, we show that EC-specific knockout of IL-6 inhibits macrophage alternative activation and improves survival in the GBM-bearing mice. These findings illustrate a vascular niche-dependent mechanism for alternative macrophage activation and cancer progression, and suggest that targeting endothelial IL-6 may offer a selective and efficient therapeutic strategy for GBM, and possibly other solid malignant tumors.

Hematopoiesis is prognostic for toxicity and survival of 223Radium treatment in patients with metastatic castration-resistant prostate cancer

OBJECTIVE

We evaluated the impact of pre-therapeutic hematopoiesis on survival, hematotoxicity (HT) and number of ²²³Radium (²²³Ra) treatments in patients with metastatic castration-resistant prostate cancer.

SUBJECTS AND METHOD

Hemoglobin-levels (Hb), the number of platelets (Plts), leukocytes (Leuk), and survival data were collected in 56 patients treated with ²²³Ra. Pre-therapeutic hematopoiesis as well as adverse events during and after therapy were scored (grade 0-4) according to the CTCAE recommendations. The association of pre-therapeutic hematopoiesis, survival, HT and numbers of ²²³Ra cycles was analyzed.

RESULTS

Median survival in all patients was 69.9 weeks; 77% of patients had pre-existing impaired Hb (1.7% grade 3, 12.5% grade 2, 62.5% grade 1). 8/56 (14.3%) had impaired Plt (grade 1) Maximum toxicity (Tox) grades of patients during treatment were grade 4 (Hb 1.7%; Plt 1.7%), grade 3 (Hb 14.3%; Plt 7.1%; Leu 7.1%), grade 2 (Hb 33.9%; Plt 7.1%; Leu 23.2%), grade 1 (Hb 46.4%; Plt 17.9%; Leu 23.2%) and grade 0 (Hb 5.4%; Plt 66.1%; Leu 44.6%). Interestingly, patients with thrombocytopenia had a significantly shorter survival compared to those with normal Plt levels (21 weeks vs not reached; P<0.003). As expected patients with pre-therapeutic low Hb-level (<10g/dL) had a significantly shorter survival compared to those with Hb-level >10g/dL (28 weeks vs not reached, P<0.004), whereas survival of patients with mildly impaired Hb (>10 but <13.5g/dL) did not differ from patients with normal levels of Hb (X vs. Y, P=...). Also patients with impaired Hb also developed significantly more grade 3 and 4 HT (Hb <10g/dL: 42.9 vs 14.3%, P<0.001; Plt <150G/mL: 25.0% vs 6.3%; P=0.002) and received significantly fewer treatment cycles (Hb<10g/dL: 5.1 vs 5.8, P<0.04; Plt <150G/mL: 3.4 vs 5.6; P<0.001). Neither extent of bone metastases nor previous chemotherapy were associated with survival, number of ²²³Ra cycles and HT.

CONCLUSION

Patients with metastatic castration-resistant prostate cancer and impaired hematopoiesis, in particular thrombocytopenia and anemia, before ²²³Ra therapy suffer from significantly more high-grade HT, shorter survival and receive significantly fewer ²²³Ra treatments. Therefore, Hb-levels and platelet counts are essential parameters for adequate patient selection for ²²³Ra therapy.

[Analysis of related factors on effects of uterine artery embolization in the treatment of dysmenorrhea of adenomyosis and the construction and validation of prediction model]

Objective: To investigate the related factors on effects of uterine artery embolization(UAE)in the treatment of dysmenorrhea in patients with adenomyosis, and to construct and validate the efficacy prediction model. Methods: A total of 127 cases of adenomyosis patients with symptoms of dysmenorrhea in Guangzhou No.1 People's Hospital and Nanfang Hospital of Southern Medical University from June 1999 to December 2009 were reviewed. The evaluation standard was to improve the degree of dysmenorrhea, the related factors of efficacy were analysed. Combined with artificial neural network theory, the effect prediction model was constructed, and the effectiveness of the model was evaluated using receiver operating characteristic(ROC)curve, and the effectiveness of the cut-off point was calculated. The model was validated by 68 cases of patients with adenomyosis in the Nanfang Hospital from January 2010 to November 2014. Results: (1)In 127 cases of dysmenorrhea patients, UAE treatment was effective in 98 cases, effective rate was 77.2%(98/127).(2)Age was an independent predictor of effective UAE treatment(HR= 1.129, P=0.026); in the range of this study, the greater the age, the higher the UAE treatment efficiency.(3)The developing situation of ovary branches of uterine artery was an independent predictor of effective UAE treatment(HR=0.460, P=0.020), the efficiency of patients whose intraoperative bilateral uterine artery ovarian branch did not develop was 89.7%(35/39), the efficiency of patients whose unilateral uterine artery ovarian branch was developing was 84.1%(37/44)and the efficiency of patients whose bilateral uterine artery ovarian branch were developing was 59.1%(26/44).(4)Blood supply of adenomyosisis was an independent predictor of effective UAE treatment(HR=0.313, P=0.001). Type Ⅰ(bilateral predominated)patients, efficiency was 93.5%(43/46); type Ⅱ(bilateral balanced)patients, efficiency was 78.0%(39/50); type Ⅲ(unilateral predominated)patients, efficiency was 51.6%(16/31).(5)UAE for the treatment of adenomyosis efficacy of artificial neural network prediction model was constructed, the model's area under the ROC curve was 0.808, the optimal cut-off point was 0.669 13. Actual verification of the model, sensitivity was 96.5%, specificity was 81.8%, positive predictive value was 96.5% and negative predictive value was 81.8%, the total accuracy was 94.1%. Conclusions: (1)Age, the developing situation of ovary branches and blood supply of adenomyosis are the independent predictors of effective UAE treatment.(2)The artificial neural network prediction model is satisfied with the accuracy and the accuracy of prediction.

Regulation of enterovirus 2A protease-associated viral IRES activities by the cell's ERK signaling cascade: Implicating ERK as an efficiently antiviral target

In a previous study the ERK1/2 pathway was found to be crucially involved in positive regulation of the enterovirus A 71(EV-A71) IRES (vIRES), thereby contributing to the efficient replication of an important human enterovirus causing death in young children (<5yrs) worldwide. This study focuses on unraveling more about the detailed mechanism of ERK's involvement in this regulation of vIRES. Through the use of siRNAs and specifically pharmacological inhibitor U0126, the ERK cascade was shown to positively regulate EV-A71-mediated cleavage of eIF4GI that established the cellular conditions which favour vIRES-dependent translation. Site-directed mutagenesis of the viral 2A protease (2A^pro) was undertaken to show that the positive regulation of virus replication by the ERK cascade was mediated through effects on both the cis-cleavage of the viral polyprotein by 2A^pro and its trans-cleavage of cellular eIF4GI. This ERK-2A^pro linked network coordinating vIRES efficiency was also found in other important human enteroviruses. This identification of the ERK cascade as having a key role in maintaining the 2A^pro proteolytic activity required to maximize enterovirus IRES activity, expands current understanding of the diverse functions of the ERK signaling cascade in the regulation of viral translation, therefore providing a potentially comprehensive drug target for anti-enterovirus infection.

Abstract P5-06-04: Distinct BRCA1 and BRCA2 specific functions at stalled replication forks - Clinical implications for differences between BRCA1 and BRCA2 mutation driven cancer

This abstract was withdrawn by the authors.

[Expression of ER and PR in the endometrium of patients with intrauterine adhesions]

Objective: To estimate the expression of ER and PR in the endometrium of both intrauterine adhesions (IUA) and non-IUA specimens. Methods: The endometrium specimens from patients undergoing hysteroscopy for confirmed moderate IUA (n=20: 10 in proliferative phase, and 10 in secretory phase) were enrolled as the IUA group in Beijing Obstetrics and Gynecology Hospital from October 2014 to August 2015. The specimens scheduled for hysteroscopy due to infertility were recruited into the control group (n=26: 13 in proliferative phase, and 13 in secretory phase). Immunohistochemistry and quantificational real-time PCR (qRT-PCR) were used to detect the expression of ER-α, ER-β and PR in endometrium with different menstrual period in both groups. Results: (1) Location: in both groups, the expression of ER-α, ER-β and PR appeared in the endometrial glandular epithelial cells and the stromal cells of the endometrium. The positive brown granules of ER-α, ER-β and PR appeared mainly in cell nucleus. (2) ER-α and ER-β in the endometrium: the protein expression of ER-α and ER-β in IUA group (proliferative phase: 0.657±0.028, 0.493±0.023; secretory phase: 0.537±0.020, 0.365±0.031) were significantly higher than those of control group (proliferative phase: 0.586±0.025, 0.437±0.022; secretory phase: 0.459±0.025, 0.323±0.017; all P<0.01). And the ER-α and ER-β mRNA expressions in IUA group were 2.524±0.296, 1.947±0.339, higher than those of control group in the proliferative phase (all P<0.01), and in the secretory phase (1.977±0.333, 1.345±0.292) were also higher than those in the control group (all P<0.01). (3) PR in the endometrium: the protein expression of PR was not significantly different between IUA group (proliferative phase: 0.248±0.025, secretory phase: 0.194±0.024) and control group (proliferative phase: 0.234±0.019, secretory phase: 0.186±0.020; P=0.162, 0.359). Meanwhile, there were no statistical differences in the mRNA expression of PR in both groups with different menstrual period (proliferative phase: 1.144±0.384 versus 0.981±0.306, secretory phase: 0.763±0.237 versus 0.631±0.203; P=0.270, 0.166). (4) ER and PR expression in menstrual cycles: the expression of ER-α, ER-β and PR in the IUA group changed with the menstrual cycles, and their expression in the proliferative phase were higher than those in the secretory phase (all P<0.05). Conclusions: The expression of ER-α and ER-β in the endometrium of IUA patients changes with menstrual cycle, and are higher compared with those in normal endometrium. No difference is found in the PR expression between the two groups.

Clinical significance of changes in serum neuroglobin and HIF-1α concentrations during the early-phase of acute ischemic stroke

BACKGROUND

Neuroglobin (NGB) has been described as a neuroprotective agent in cerebral ischemia, hypoxia inducible factor (HIF) has shown an important role in modulating hypoxic and ischemic injury, and therefore they have the potential to impact outcomes after acute ischemic stroke (AIS). Thus, we investigated early changes in the concentrations of serum NGB and HIF-1α after AIS and evaluated the relations of both NGB and HIF-1α to stroke severity and prognosis.

METHODS

We prospectively measured the serum concentrations of NGB and HIF-1α in 40 patients with AIS at 24, 48, 72, and 96h after stroke. Correlation combined with infarct size and National Institutes of Health Stroke Scale (NIHSS) score of the patients was analyzed. Receiver operating characteristic (ROC) curve was used to appraise their value in predicting the 90-day outcome after AIS.

RESULTS

Serum NGB concentrations increased and peaked at 72h after AIS, whereas serum concentrations of HIF-1α increased for 48h. Peak serum NGB concentration correlated significantly with both infarct size (R²=0.484, p<0.001) and admission NIHSS score (R²=0.578, p<0.001), while serum HIF-1α concentration was only correlated to a patient's infarct size (R²=0.394, p<0.001). ROC curve analysis suggested that the serum NGB concentration had a significantly better predictive power for poor outcome.

CONCLUSIONS

NGB level increased in serum after AIS accompanied by increases in serum HIF-1α, and was suggested as a predictor of stroke severity and poor prognosis.

Low preoperative prognostic nutritional index predicts poor survival in patients with newly diagnosed high-grade gliomas

Preoperative prognostic nutritional index (PNI) has been widely demonstrated to predict survival of patients with malignant tumors. Its utility in predicting outcomes in patients with high-grade gliomas (HGG) remains undefined. A retrospective study of 188 HGG patients was conducted. An optimal PNI cut-off value was applied to stratify patients into high PNI (≥52.55, n = 78) and low PNI (<52.55, n = 110) groups. Univariate and multivariate analysis was performed to identify prognostic factors associated with overall survival (OS) and progression free survival (PFS). The resulting prognostic models were externally validated using a demographic-matched cohort of 130 HGG patients. In the training set, PNI value was negatively correlated with age (p = 0.027) and tumor grade (p = 0.048). Both PFS (8.27 vs. 20.77 months, p < 0.001) and OS (13.57 vs. 33.23 months, p < 0.001) were significantly worse in the low PNI group. Strikingly, patients in high PNI group had a 52% decrease in the risk of tumor progression and 55% decrease of death relative to low PNI. Multivariate analysis further demonstrated PNI as an independent predictor for PFS (HR = 0.62, 95% CI 0.43-0.87) and OS (HR = 0.56, 95% CI 0.38-0.80). The PNI retained independent prognostic value in the validation set for both PFS (p = 0.013) and OS (p = 0.003). On subgroup analysis by tumor grade and treatment modalities, both PFS and OS were better for the patients with high PNI. The PNI is a potentially valuable preoperative marker for the survival of patients following HGG resection.

A giant nabothian cyst with massive abnormal uterine bleeding: a case report

The authors describe a rare case of a giant nabothian cyst in a 52-year-old woman. The patient had a history of massive abnormal uterine bleeding after heavy physical work. A giant cystic mass, originating from the cervix, was found completely filling the upper third of the vagina. The authors combined hysteroscopy examination with ultrasound to assess the cystic mass' localization, origin, and relationship with other organs. With the tentative diagnosis of a giant nabothian cyst, the patient was treated with a simple cervical incision and local drainage. The patient recovered well postoperatively and the diagnosis was confirmed through pathological examination.

[EFFECT OF CHANGE OF TISSUE INTERFACE STIFFNESS ON OSTEOGENIC DIFFERENTIATION OF RAT BONE MARROW MESENCHYMAL STEM CELLS]

OBJECTIVE

To investigate the effect of tissue interface stiffness change on the spreading, proliferation, and osteogenic differentiation of rat bone marrow mesenchymal stem cells (BMSCs), and to find the suitable stiffness range for stem cell differentiation.

METHODS

Bone marrow of male Sprague Dawley rats (4 weeks old) were selected to isolate and culture BMSCs by whole bone marrow cell adherent method. The third generation BMSCs (1×10⁵ cells/mL) were inoculated into the ordinary culture dishes covered with polyacrylamide hydrophilic gel (PA) which elastic modulus was 1, 4, 10, 40, and 80 kPa (cells seeded on PA), and ordinary culture dish (75 MPa extreme high elastic modulus) as control. Spreading of cells in different stiffness of PA was observed under light microscope. The elastic modulus values of 4, 10, and 40 kPa PA were selected as groups A, B, and C respectively; the ordinary culture dish (75 MPa extreme high elastic modulus) was used as control group (group D). Cell counts was used to detect the growth conditions of BMSCs, alkaline phosphatase (ALP) kit to detect the concentration of ALP, alizarin red staining technique to detect calcium deposition status, and real-time quatitative PCR technique to detect the expressions of bone gla protein (BGP), Runx2, and collagen type I mRNA.

RESULTS

With increased PA stiffness, BMSCs spreading area gradually increased, especially in 10 kPa and 40 kPa. At 1 and 2 days after culture, the growth rate showed no significant difference between groups (P>0.05); at 3-5 days, the growth rate of groups B and C was significantly faster than that of groups A and D (P<0.05), but difference was not statistically significant between groups A and D (P<0.05); at 5 days, the proliferation of group C was significantly higher than that of group B (P<0.05). ALP concentrations were (53.69±0.89), (97.30±1.57), (126.60±14.54), and (12.93±0.58) U/gprot in groups A, B, C, and D respectively; groups A, B, and C were significantly higher than group D, and group C was significantly higher than groups A and B (P<0.05). Alizarin red staining showed that the percentages of calcium nodules was 20.07%±4.24% in group C; group C was significantly higher than groups A, B, and D (P<0.05). The expression levels of BGP and collagen type I mRNA were significantly higher in groups A, B, and C than group D, and in group C than groups A and B (P<0.05). The expression level of Runx2 mRNA was significantly higher in groups B and C than group D, and in group C than group B (P<0.05), but no significant difference was found between groups A and D (P>0.05).

CONCLUSIONS

PA elastic modulus of 10-40 kPa can promote the proliferation and osteogenic differentiation of BMSCs, and the higher the stiffness, the stronger the promoting effect.

Gene sequencing and variable site analyzing of coding region of two enterovirus A71 isolates with different clinical phenotypes

Currently, it is still controversial that if the pathogenicity of EV-A71 causing severe or mild hand, foot, and mouth disease (HFMD) is associated with viral nucleotide or amino acid sequence(s). In this study, 19 clinical strains were detected in samples from diagnosed patients of EV-A71-caused HFMD with mild or severe symptoms. Then, VP1-2A fragment sequences of 19 EV-A71 isolates were determined, the phylogenetic analysis, based on VP1 sequences of 19 EV-A71 stains in this study and which of 62 EV-A71 strains with different clinical phenotypes reported before, were carried out. Our results showed that no difference in the genotype and evolution distribution was observed among the EV-A71 strains mentioned above. Furthermore, two EV-A71 isolates, which with much close evolutionary relationship but different clinical manifestations, were purified by plaque assay, the complete genome sequencing was done, and deduced amino acid sequence analysis of 11 proteins coded by EV-A71 was carried out. Eight variable amino acid sites were found and further verified with those of 62 strains reported before. Our study provides further evidence that the potential pathogenicity of EV-A71 causing severe or mild HFMD seems not to be associated with viral genotype and even the amino acid substitution.

Characterization of Th17 and FoxP3(+) Treg Cells in Paediatric Psoriasis Patients

Psoriasis is one of the most common inflammatory skin conditions affecting both children and adults. Growing evidence indicates that T-helper 17 (Th17) cells and CD4(+) CD25(+) regulatory T (Treg) cells play an important role in the pathogenesis of psoriasis. However, the relationship between Th17 and Treg cells and their dynamic variations in paediatric psoriasis remain unclear. In this study, we found that both Th17 and FoxP3(+) Treg cells and the ratio of Th17 to Treg cell frequency in the peripheral circulation were increased in patients with paediatric psoriasis and were positively correlated with the disease severity. The function of Treg to suppress CD4(+) CD25(-) T cell proliferation and IFN-γ secretion was impaired during the onset of psoriasis. After disease remission, both the Th17 and Treg cell frequencies were decreased, and the suppressive function of the Treg cells was obviously restored. However, neither Treg cells from the disease onset nor those after remission can regulate IL-17 secretion by CD4(+) T cells. These findings will further our understanding of the associations between Th17 and Treg cells in paediatric psoriasis and their influence on disease severity.

[Clinical evaluation of amniontic products after transcervical resection of intensive degree of intrauterine adhesions]

OBJECTIVE

To evaluate the effect of amniotic products after transcervical resection of uterine adhesions (TCRA).

METHODS

This study was carried out in 57 patients with intensive degree of intrauterine adhesions (IUA) who had been treated by TCRA between Jun. 2013 to Jun. 2014. These patients were devided into two groups randomly. In group amnion, 29 patients were placed amniontic scaffold balloon after TCRA; in group balloon, 28 patients were placed Foley's balloon after TCRA. The two groups' balloons were taken out after TCRA 7 days. All patients were taken artificial cycle treatment. The uterine cavity form and the menstruation of 2 groups were observed in 3 months after TCRA.

RESULTS

In group amnion, IUA score dropped from 10.1±0.5 preoperatively to 3.2±1.5 postoperative (P<0.01), in group balloon, IUA score dropped from 10.1±0.5 preoperatively to 6.3±2.5 postoperative (P<0.01). In group amnion, the menstrual score increased from 13.3 ± 4.4 preoperatively to 32.6 ± 5.5 postoperative (P<0.01), in group balloon, the menstrual score increased from 11.1±5.8 to 26.5±5.6 (P<0.01). The menstrual improvement of group amnion was better than that of group balloon significantly (P=0.002). In group amnion, the recurrence rate of adhesion was 21% (6/29), in group balloon, the recurrence rate of adhesion was 36% (10/28). There was no significant difference (P=0.248). The pregnancy rate of group amnion was 28% (8/29), the pregnancy rate of group balloon was 21% (6/28). The difference of pregnancy rate in two groups was not significant (P=0.760).

CONCLUSION

This small sample observation indicate that amniotic products used in the treatment of intensive IUA could improve menstrual, reduce the recurrence of adhesion, but the impovement of the pregnancy rate should be confirmed by large sample observation.

[Clinical characters of pre-malignant and malignant polyp in postmenopausal women and the diagnostic value of hysteroscopy]

OBJECTIVE

To investigate the clinical characteristics of pre-malignant and malignant polyps in postmenopausal patients and to evaluate the diagnositic value of hysteroscopy in this disease.

METHODS

From June 2005 to October 2014, 403 postmenopausal patients with polyps were treated in the Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital. There were 27 patients including 22 patients with pre-malignant and 5 patients with malignant polyps. All malignant lesions were endometrioid adenocarcinoma. The clinical data were retrospectively analyzed. Based on pathology, the diagnostic value of hysteroscopy was evaluated.

RESULTS

(1) CLINICAL CHARACTERISTICS: there were 27 cases with pre-malignant and malignant polyps (group 1) and 376 cases with benign polyps (group 2). Compared the two groups, the average age was (60±8) vs (58±6) years old, the period of menopause was (9.8±8.1) vs (8.3±6.9) years. Thirteen cases (48.1%, 13/27) in group 1 and 159 cases (42.3%, 159/376) in group 2 had clinical symptoms including postmenopausal bleeding and vaginal discharge. Twelve cases (44.4%, 12/27) in group 1 and 140 cases (37.2%, 140/376) in group 2 were with hypertension. Five cases (18.5%, 5/27) in group 1 and 43 cases (11.4%, 43/376) in group 2 were with diabetes. The measures above were no significant differences (P>0.05) (2) Ultrasound features: the average thick of endometrium in group 1 and group 2 were respectively (1.3±0.7) and (0.8±0.4) cm, which had statistical significance (t=4.98, P=0.001). (3) Hysteroscopic diagnosis: the average diameters of polyp in group 1 and group 2 were respectively (2.4±1.0) and (1.6±1.0) cm, which had statistical significance (t=2.93, P=0.004). Six cases in group 1 were diagnosed by hysteroscopy including 4 cases of malignant polyp and 2 cases of pre-malignant polyp. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy were 22.2% (6/27), 100.0% (376/376), 100.0% (6/6), 94.7% (376/397) and 94.8% (382/403), respectively.

CONCLUSIONS

Pre-malignant and malignant endometrial polyps are more common in the subjects with the larger diameters and the thicker endometrium. All polyps should be under complete resection by hysteroscopy and through pathology examination.