[Study on the change of optical zone after femtosecond laser assisted laser in situ keratomileusis]

Objective: To explore the change of optical zone after femtosecond laser assisted laser in sitn keratomileusis(FS-LASIK) so as to provide the reference for measurement and design of clinical optical zone. Methods: This retrospective case series study covers 41 eyes of 24 patients (7 males and 17 females, aged from 18 to 42 years old) with myopia and myopic astigmatism who have received FS-LASIK surgery at Corneal Refractive Department of Qingdao Eye Hospital and completed over 6 months of clinical follow-up. Pentacam system (with the application of 6 corneal topographic map modes including: the pure axial curvature topographic map, the pure tangential curvature topographic map, the axial curvature difference topographic map, the tangential curvature difference topographic map, the postoperative front elevation map and the corneal thickness difference topographic map), combined with transparent concentric software (a system independently developed by Qingdao Eye Hospital) was used to measure the optical zone at 1, 3 and 6 months postoperatively, the optical zone diameters measurement results among different follow-up times in group were analyzed with the repeated measures analysis of variance, and the actual measured values and the theoretical design values of the optical zone were analyzed with independent-samples t-testing. Spearman correlation coefficient (r(s)) have been applied to evaluate the relationship between postoperative optical zone measurement values and the potential influencing factors. Results: The optical zone diameters measured by pure axial curvature topographic map at 1, 3 and 6 months after FS-LASIK showed (6.55±0.50)mm, (6.50±0.53)mm and (6.48±0.53)mm respectively. The differences between values are of no statistical significance (F=1.60, P=0.21), the optical zone diameter measured by pure tangential curvature topographic map at 1, 3 and 6 months after FS-LASIK showed (5.44±0.46)mm, (5.46±0.52)mm and (5.44±0.50)mm respectively, the differences between values are of no statistical significance (F=0.17, P=0.85). The optical zone diameters measured by postoperative front elevation map at 1, 3 and 6 months after FS-LASIK showed (5.06±0.28)mm, (5.12±0.32)mm and (5.17±0.28)mm respectively. The differences between the values of 3 and 6 months postoperatively are of no statistical significance (F=6.14, P=0.15), the optical zone diameters measured by axial curvature difference topographic map at 1, 3 and 6 months after FS-LASIK showed (6.51±0.37)mm, (6.45±0.41)mm and (6.41±0.40)mm respectively, and the differences between the values of 3 and 6 months postoperatively are of no statistical significance (F=7.25, P=0.05). The optical zone diameters measured by tangential curvature difference topographic map at 1, 3 and 6 months after FS-LASIK showed (5.21±0.23)mm, (5.16±0.19)mm and (5.17±0.20) mm respectively, and the differences between the values of 1 and 3 months postoperatively are of statistical significance (F=1.75, P=0.04). The optical zone diameters measured by corneal thickness difference topographic map at 1, 3 and 6 months after FS-LASIK showed (6.53±0.40)mm, (6.39±0.43)mm and (6.41±0.47)mm respectively, and the differences between the values of 1 and 3 months postoperatively are of statistical significance (F=1.67, P=0.032). The actual measured optical zone values from the 6 different modes of Pentacam system are less than the theoretical design values (7.75 mm), and the differences were statistical significance (t=-15.42, -29.39, -59.27, -21.47, -81.69, -18.22, P<0.01). Conclusions: The optical zone measurement values tend to be stable at 3 months after FS-LASIK. The actual measured values from all the 6 different modes of Pentacam system were less than the theoretical design values. The results from pure tangential curvature topographic map, the tangential curvature difference topographic map and the postoperative front elevation map showed greater variation with clear border, which was beneficial for eccentric research. The results from pure axial curvature topographic map, the axial curvature difference topographic map and the corneal thickness difference topographic map were close to the theoretically designed values. Furthermore, the axial curvature difference topographic map showed clearer border and less variation thus maybe more favorable for measuring optical zone in clinical application.(Chin J Ophthalmol, 2018, 54: 39-47).

High Fructose and High Fat Exert Different Effects on Changes in Trabecular Bone Micro-structure

OBJECTIVES

To compare the effects of high-fat diet (HFD) and high-fructose diet (HFrD) on bone metabolism at different time points, dynamically observe the bone histology and femur trabecular micro-architecture, and analyze the underlying mechanisms.

METHODS

Sixty -Five male 6- to 7-week-old C57BL/6J mice were given HFD, HFrD, or standard diets (SD) for 8, 16, and 24 weeks. Micro-computed tomography (μCT) and bone histology were used to measure bone mass and trabecular micro-structure. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to determine the expression of genes related to bone and lipid metabolisms.

RESULTS

Compared to SD mice, femoral trabecular bone mass was significantly increased in both HFrD mice and HFD mice at 8 weeks, it continued to be higher in HFrD mice at 16 and 24 weeks with the highest level at 16 weeks, but it was significantly decreased in HFD mice at 16 and 24 weeks. HFD mice showed more epididymal fat accumulation than HFrD mice. mRNA expression of Runx2 was up-regulated at 8 and 16 weeks, but down-regulated at 24 weeks similarly in both HFrD mice and HFD mice. mRNA expression of MMP9 and CTSK was up-regulated at 8 and 16 weeks in HFD mice, but down-regulated at 24 weeks in both HFrD mice and HFD mice.

CONCLUSIONS

Our data indicated that the HFrD and HFD had different modulating effects on bone mass. After short-term feeding, both HFrD and HFD showed positive effects on bone mass; however, after long-term feeding, bone mass was decreased in HFD mice. In contrast, the bone mass was first increased and then decreased in the HFrD mice. On the basis of these findings, we speculated that chronic consumption of fat and fructose would exert detrimental effects on bone mass which might a combination action of body mass, fat mass, and bone formation/bone resorption along with proinflammatory factor and bone marrow environment.

A novel dominant COL11A1 mutation in a child with Stickler syndrome type II is associated with recurrent fractures

This case describes a child with blindness, recurrent low-impact fractures, low bone mass, and intermittent joint pain who was found to have a novel missense mutation in COL11A1, consistent with Stickler syndrome type II. The case illustrates the phenotypic variability of the syndrome, which may include increased fragility in childhood.

INTRODUCTION

Stickler syndrome type II is an autosomal dominant disorder caused by mutations in the gene that encodes the type XI collagen chain α1 (COL11A1). Manifestations include craniofacial dysmorphology and ocular abnormalities that may lead to blindness, hearing loss, and skeletal anomalies that range from joint pain and arthritis to scoliosis and hypermobility.

METHODS

Herein, we describe a child who carried the presumed diagnosis of osteoporosis-pseudoglioma syndrome because of the combined findings of recurrent low-impact fractures due to low bone mass and blindness. The child also suffered from joint pain but had no facial dysmorphism or hearing loss.

RESULTS

Targeted sequencing and deletion analysis of the LRP5, COL1A1, and COL1A2 genes failed to identify any mutations, and whole exome sequence analysis revealed a novel missense mutation (c.3032C>A:p.P1011Q) in COL11A1, consistent with Stickler type II.

CONCLUSION

This case highlights the phenotypic variability of Stickler type II, broadens the list of differential diagnosis of increased bone fragility in childhood, and highlights utility of unbiased genetic testing towards establishing the correct diagnosis in children with frequent fractures.

Regulation of laryngeal squamous cell cancer progression by the lncRNA H19/miR-148a-3p/DNMT1 axis

Laryngeal squamous cell carcinoma (LSCC) is a highly aggressive malignant cancer. The regulation of LSCC progression by long non-coding RNA (lncRNA) was not well understood. In this study, we reported that the lncRNA H19 was upregulated in LSCC. The expression levels of H19 were inversely correlated with the survival rate of LSCC patients. Knockdown of H19 expression inhibited LSCC cell migration, invasion and proliferation. We identified microRNA miR-148a-3p as an inhibitory target for H19. Overexpression of miR-148a-3p reduced LSCC migration, invasion and proliferation cell, while inhibition of miR-148a-3p did the opposite. The inhibition of LSCC progression induced by H19 knockdown required the activity of miR-148a-3p. We also identified DNA methyltransferase enzyme DNMT1 as a target of miR-148a-3p. Cellular DNA methylation levels were inhibited by both miR-148a-3p overexpression and H19 knockdown. In summary, our study demonstrated that the lncRNA H19 promoted LSCC progression via miR-148a-3p and DNMT1.

[Effect of three types of rapid maxillary expansion: a three-dimensional finite element study]

Objective: To evaluate the transverse displacement, stress distribution and tendency of change in tooth, alveolar bone and mid-palatal suture using three kinds of rapid maxillary expansion methods. Methods: Cone-beam CT image data was obtained by scanning skulls of a volunteer. Three-dimensional models of maxillary complex were re-established using Mimics and Geomagic Studio and models of Hyrax expander, Haas expander and miniscrew-assisted rapid palatal expander (MARPE) were established using ANSYS Workbench. Stress distribution, displacement and tendency of change in tooth, alveolar bone and mid-palatal suture were evaluated. Results: Hyrax expander brought 0.105 mm lateral displacement of crown, 0.022 mm mid-palatal suture width increase, wedge opening and clockwise rotation tendency of maxilla. Haas expander created uniform stress distribution, 0.216 mm lateral displacement of crown, and 0.031 mm mid-palatal suture width increase. In MARPE model, the lateral displacement of crown was 0.267 mm, and mid-palatal suture width increased 0.315 mm. The maximum of mid-palatal suture expansion and stress distribution appeared in the middle region, and maxilla had tendency of counterclockwise rotation. Conclusions: The lateral changes of teeth and bones brought by MARPE were the most significant. Haas expander had some advantages in comparison with Hyrax.

[Estimation of External Features of Eyes for the Adult Male of Han Nationality in Northeast China Based on the Characteristics of Skull]

OBJECTIVES

To explore the correlation between the imaging parameters of skull and the external features of eyes.

METHODS

Positive images of the head face and the frontal and lateral X-ray films were obtained from 101 cases of adult males of the Han nationality aged from 20 to 40 years old in Northeast China. The face width （x₁）, upper face width （x₂）, biorbital width （x₃）, all facial height （x₄）, upper facial height （x₅）, maximum breadth of skull （x₆）, minimum breadth of frontal bone （x₇）, orbital widthⅡ（x₈）, anterior interorbital breadth （x₉）, maximum height of skull （x₁₀）, minimum width of nasal bone （x₁₁） and orbital height （x₁₂） were measured and the data were statistically analysed.

RESULTS

Through the linear regression analysis, the regression equations of the presumed inboard canthi （y₁） and outboard canthi distances （y₂） were established, respectively, which were y₁=0.025 x₂+0.291 x₃-0.011 x₇+0.041 x₁₀-0.525（R=0.613, SEE=0.222 cm） and y₂=1.703-0.08 x₂+0.573 x₃-0.142 x₄+0.421 x₅+0.096 x₇-0.256 x₈+0.149 x₉+0.071 x₁₀（R=0.745, SEE=0.341 cm）. The back-substitution check showed that the accuracy rate of two equations at ±1SEE were 75.2% and 80.2%, respectively.

CONCLUSIONS

The established regression equations of external features of eyes have high estimation accuracy, which can be used to the practical work of facial reconstruction.

Does thyroid dysfunction increase the risk of breast cancer? A systematic review and meta-analysis

PURPOSE

To investigate the relationship between hypothyroidism, hyperthyroidism, thyroid hormone replacement, and the risk of breast cancer.

METHODS

We searched the PubMed, Cochrane Library, EMbase, Web of Science, and China Biology Medicine (CBM) databases through June 2016 to identify researches that assessed the relationship between thyroid dysfunction and the risk of breast cancer together with the impact of thyroid hormone substitution treatment on incidence of breast cancer. Quality of evidence was assessed per outcome, using GRADE.

RESULTS

A total of 13 population-based studies including 24,808 participants were identified as eligible for this meta-analysis. A meta-analysis of 12 researches illustrated that hypothyroidism was not related to the risk for breast cancer [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.64-1.08, P = 0.162]. 10 researches illustrated that hyperthyroidism was also not related to the risk of breast cancer (OR = 1.03, 95% CI 0.83-1.30, P = 0.767). The impact of therapy was evaluated in six researches; there was no proof of a relationship between thyroid hormone substitution treatment and breast cancer with an overall OR of 0.83 (95% CI 0.57-1.21, P = 0.965).

CONCLUSIONS

Our meta-analysis illustrated that thyroid dysfunction may not be related to increased risk of breast cancer as well as the thyroid hormone substitution treatment did not reduce the incidence of breast cancer; while this study has some confounders that might weaken the results of this meta-analysis, we believe that the findings provide valuable information for stakeholders concerned with outcomes in patients with thyroid dysfunction.

Vitamin D measurement standardization: The way out of the chaos

Substantial variability is associated with laboratory measurement of serum total 25-hydroxyvitamin D [25(OH)D]. The resulting chaos impedes development of consensus 25(OH)D values to define stages of vitamin D status. As resolving this situation requires standardized measurement of 25(OH)D, the Vitamin D Standardization Program (VDSP) developed methodology to standardize 25(OH)D measurement to the gold standard reference measurement procedures of NIST, Ghent University and CDC. Importantly, VDSP developed protocols for standardizing 25(OH)D values from prior research based on availability of stored serum samples. The effect of such retrospective standardization on prevalence of "low" vitamin D status in national studies reported here for The Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and the German Health Interview and Examination Survey for Children and Adolescents (KIGGS, 2003-2006) was such that in NHANES III 25(OH)D values were lower than original values while higher in KIGGS. In NHANES III the percentage with values below 30, 50 and 75 nmol/L increased from 4% to 6%, 22% to 31% and 55% to 71%, respectively. Whereas in KIGGS after standardization the percentage below 30, 50, and 70 nmol/L decreased from 28% to 13%, 64% to 47% and 87% to 85% respectively. Moreover, in a hypothetical example, depending on whether the 25(OH)D assay was positively or negatively biased by 12%, the 25(OH)D concentration which maximally suppressed PTH could vary from 20 to 35ng/mL. These examples underscore the challenges (perhaps impossibility) of developing vitamin D guidelines using unstandardized 25(OH)D data. Retrospective 25(OH)D standardization can be applied to old studies where stored serum samples exist. As a way forward, we suggest an international effort to identify key prior studies with stored samples for re-analysis and standardization initially to define the 25(OH)D level associated with vitamin D deficiency (rickets/osteomalacia). Subsequent work could focus on defining inadequacy. Finally, examples reported here highlight the importance of suspending publication of meta-analyses based on unstandardized 25(OH)D results.

Quantitative imaging of Candida utilis and its organelles by soft X-ray Nano-CT

Soft X-ray microscopy has excellent characteristics for imaging cells and subcellular structures. In this paper, the yeast strain, Candida utilis, was imaged by soft X-ray microscopy and three-dimensional volumes were reconstructed with the SART-TV method. We performed segmentation on the reconstruction in three dimensions and identified several types of subcellular architecture within the specimen cells based on their linear absorption coefficient (LAC) values. Organelles can be identified by the correlation between the soft X-ray LAC values and the subcellular architectures. Quantitative analyses of the volume ratio of organelles to whole cell in different phases were also carried out according to the three-dimensional datasets. With such excellent features, soft X-ray imaging has a great influence in the field of biological cellular and subcellular research.

[The regulation of CD44 expression by new tumor suppressor gene Arid2 and the influence of Arid2 on the invasion and metastasis in hepatocellular carcinoma cells]

OBJECTIVE

To investigate the effect of a new tumor-suppressor gene Arid2 on the expression level of CD44 and the mechanism that Arid2 regulates the invasion and metastasis in human hepatocellular carcinoma cells HepG2 and Huh7.

METHODS

Recombinant pGL3-CD44 reporter plasmids were transfected into hepatoma cell lines HepG2 and Huh7 cells infected with adenovirus Arid2(Ad-Arid2). Dual luciferase assays were used to determine the relative luciferase activities of reporter plasmids. Western blot technique was used to detect the influence of Arid2 on the expression of transmembrane glycoprotein CD44. Cell migration assays of tumor cells were employed to observe the impact of overexpression of Arid2 on the invasion and metastasis abilities of tumor cells. The sizes of transplanted tumors were recorded to observe the growth of subcutaneous transplanted tumors in nude mice. Statistical significance was analyzed by one-way ANOVA for multiple comparisons, and independent-samples t-test was utilized to compare two groups.

RESULTS

Luciferase assay showed cells were transfected with different length of CD44 reporter plasmids, and their relative luciferase activities were improved to different degrees, compared with pGL3-Basic control. Meanwhile, the mean luciferase activities of pGL3-CD44 -791~+224bp reporter plasmids were significantly repressed by the overexpression of Arid2 which inhibition rates were up to 73.83%±0.92%(P< 0.05, HepG2) or 48.99%±1.37% (P <0.05, Huh7), compared with Ad-GFP control. Western blot results showed that CD44 protein expression was obviously decreased by overexpression of Arid2. Cell migration assays confirmed that the invasion and metastasis abilities were inhibited by increasing Arid2 expression in Human HepG2 or Huh7 cells, which inhibition rates were 66.95%±0.59%(P< 0.05)in HepG2 cells and 73.86%±0.49%(P< 0.05) in Huh7 cells respectively. The animal experiment results indicated that Arid2 could obviously delay or restrict the subcutaneous transplanted tumors growth in nude mice, which was declined by 98.57%±0.34%(P< 0.05).

CONCLUSION

CD44 promoter activities and protein expressions were significantly down-regulated by Arid2 in vitro. The growth and metastasis of tumors were obviously restrained in the hepatocellular carcinoma cells and nude models. In brief, these researches indicate CD44 may play important roles in the process where the invasion and metastasis of hepatocellular carcinoma cells are under the control of Arid2.The studies introduce and evaluate the relationships between Arid2 and CD44, and further provide a new research direction with the occurrence and development of hepatocellular carcinoma.

Overexpression of miR-26b decreases the cisplatin-resistance in laryngeal cancer by targeting ATF2

Cisplatin is a common used chemotherapeutic drug for the treatment of laryngeal cancer. However, drug-resistance is a major obstacle in platinum-based chemotherapy for laryngeal cancer. Recent studies have demonstrated that dysregulation of microRNAs (miRNAs) is responsible for chemoresistance in multiple cancers including laryngeal cancer, but the potential mechanisms are required to be explored. In the present study, we constantly exposed the laryngeal cancer cell line Hep-2 with cisplatin to establish a cisplatin-resistant laryngeal cancer cell model (Hep-2/R). We found that Hep-2/R cells exhibited obvious resistance to cisplatin compared to the Hep-2 cells. However, overexpression of miR-26b significantly decreased the half maximal inhibitory concentration (IC50) of cisplatin to Hep-2/R. Mechanically, miR-26b in Hep-2/R decreased the expression of ATF2, and thus inhibiting the phosphorylation of ATF2 and formation of cellular ATF2-c-Jun complex induced by cisplatin. As the results, Hep-2/R cells failed to overexpress the Bcl-xl which is a key anti-apoptotic protein under the cisplatin treatment. Therefore, overexpression of miR-26b was found to be able to promote mitochondrial apoptosis induced by cisplatin.

[Analysis of survival and treatment outcome of young patients with high-risk diffuse large B cell lymphoma]

Objective: To analyze clinical feature and treatment outcome of young patients with high-risk diffuse large B cell lymphoma. Methods: A total of 122 young patients with high-risk diffuse large B cell lymphoma who were treated in Third Hospital of Peking University during the period from January 2000 to April 2015 were retrospectively analyzed, and the clinical features, laboratory data were included in Kaplan-Meier and prognostic analysis. Results: In our center, the incidence of young high-risk DLBCL was 27.1% in all DLBCL patients, median age was 44.0 years, 99.2% patients belong to Ⅲ and Ⅳstage, 50% patients had more than two extranodal organs involvement, and the higher proliferation index(Ki-67≥80%) was present in 63.1% of patients, Immunohistochemistry showed that 36.7% patients in 30 cases were double-expressed DLBCL. The overall response rate(ORR) for the whole group was 79.4%, the complete response rate was 39.7% , the 3, 5-year progression free survival rate was 59.8% and 57.0%, the 3, 5-year overall survival rate was 63.5% and 57.8%, respectively. 44.3% patients were refractory-relapsed DLBCL. Rituximab can improve the survival of patients and 3-year overall survival rate was 75.2% vs 46.1%(P=0.001). High-dose chemotherapy was superior to CHOP regimen which 3-year overall survival rate was 84.6% vs 54.1%(P=0.006). Compared with chemotherapy group , auto-hematopoietic stem cell transplantation can improve prognosis of patients and 3-year overall survival rate was 93.4% vs 48.3%(P<0.001). The level of Ki-67, B symptom, ECOG score, the level of LDH, WBC and albumin, ESR level, anemia, rituximab therapy, initial regimens, ASCT, initial treatment outcome and refractory-relapsed were predictive of overall survival. Multivariate analysis indicated that albumin level(RR=5.462, P=0.019), initial treatment outcome(RR=34.863, P<0.001) and refractory-relapsed (RR=24.374, P<0.001)were independent prognostic risk factors. Conclusions: Young patients with high-risk DLBCL were highly aggressive in clinical and pathological features . Rituximab and high-dose regimens can improve the survival of patients.

[The clinical signifinace of CEA, Cyfra21-1 and SCC in laryngeal carcinoma's clinicopathological parameters]

Objective:To investigate the clinical signifinace of carcinoembryonic antigen (CEA), cytokeratin fragment 21-1 (Cyfra21-1) or squamous cell carcinoma antigen (SCC) in laryngeal carcinoma's clinicopathological parametersthe.Method:CEA, Cyfra21-1, SCC in 53 laryngeal cancer's serum were routine preoperative detected to analyze the relationships between the tumor makers and the patient's age, primary tumor (T staging), lymph node metastasis (N staging), recurrence and metastasis.Result:According to age less than or equal to 60 years old and older than 60 years, lymph node metastasis or not lymph node metastasis, with or not with recurrence and metastasis and the T1+T2 and T3+T4 staging, the patients were divided into two groups. T test show that CEA was statistically significant in recurrence and metastasis (P= 0.047) and it is more prone to recurrence and metastasis, but CEA was not statistically significant in primary tumor (P= 0.252), lymph node metastasis (P= 0.268). Cyfra21-1 was not statistically significant in primary range (P= 0.402), but was statistically in lymph node metastasis (P= 0.041). While the lymph node metastasis, it is more prone to recurrence and metastasis in laryngeal cancer patients with Cyfra21-1's increasing (P= 0.027). SCC was not significant in primary lesions (P= 0.051),but was statistically significant in lymph node metastasis (P= 0.022). While lymph node metastasis, it is more prone to recurrence and metastasis in laryngeal cancer patients with SCC's increasing (P= 0.000). Logistic multivariate regression analization show that CEA,Cyfra21-1 and SCC were statistically significant in the recurrence and postoperative of laryngeal patients (P< 0.05) but not in the age of patient, primary tumor, the relationship and lymph node metastasis (P> 0.05).Conclusion:It is more prone to occurrence lymph node metastasis and recurrence and metastasis in the postoperative serum of laryngeal cancer patients with Cyfra21-1, SCC. CEA and Cyfra21-1 increasing. SCC were independent predictive factor of recurrence and metastasis after surgery. It is more prone to recurrence and metastasis after surgery in the laryngeal cancer patients with CEA, Cyfra21-1 and SCC preoperative increasing.

sPD-L1 Expression is Associated with Immunosuppression and Infectious Complications in Patients with Acute Pancreatitis

Acute pancreatitis (AP) with infectious complications has high mortality because of early-stage immunosuppression. The programmed cell death-1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway is an important host immunosuppression mechanism. Soluble PD-L1 (sPD-L1) expression regulates co-inhibitory signals in malignancies or autoimmune disorders; however, its effects in AP are unknown. Here, we evaluated whether serum sPD-L1 is involved in immune dysfunction and assessed its relationship with infectious complications in early AP. Blood samples were obtained from 56 patients with acute pancreatitis and 21 healthy individuals in this prospective study. Serum sPD-L1 levels within 48 h after AP onset were tested by enzyme-linked immunosorbent assays. Relevant immune parameters (human leucocyte antigen-DR, lymphocyte count) and inflammatory markers (C-reactive protein, white blood cell count) were analysed. sPD-L1 was significantly upregulated in patients with early AP, especially those with infectious complications, compared to healthy controls. Significant negative correlations were observed among monocyte HLA-DR expression, lymphocyte count and sPD-L1 levels in AP. Multivariate regression indicated that sPD-L1 was an independent risk factor for infectious complications in AP. The findings suggest that increased sPD-L1 expression appears to be involved in the development of immunosuppression in the early stage of AP and that sPD-L1 might be an early parameter for prediction of infectious complications in patients with AP.

Effects of heparin catheter-sealing solution for implantable venous access ports on D-dimer levels in older cancer patients

OBJECTIVE

To investigate the effects of different concentrations of heparin catheter-sealing solution for implantable venous access ports (VAPs) on D-dimers (D-D) in older cancer patients.

PATIENTS AND METHODS

A total of 208 older cancer patients who received intravenous chemotherapy for the first time were randomly divided into four groups: the normal saline group, the low concentration heparin group (25 U/ml), the medium concentration heparin group (50 U/ml), and the high concentration heparin group (75 U/ml), with 52 patients in each group. VAPs were sealed by the positive pressure technique every day before and after perfusion, as well as at the end of a course of chemotherapy when the butterfly needle was removed. The patients were followed-up for three courses of chemotherapy, and comparisons of the clinical effects were conducted.

RESULTS

Before treatment and at the end of follow-up, no significant differences among groups were found in platelet count, prothrombin time, thrombin time, or activated partial thromboplastin time (p>0.05). At the end of follow-up, the high concentration heparin group had reduced fibrinogen (FIB) and increased D-D compared with the other groups, and the differences were statistically significant (p<0.05). The other three groups showed no significant differences in FIB or D-D before treatment or at the end of follow-up (p>0.05). The high concentration heparin group had higher local bleeding rate, while the saline group had higher partial and complete prevalence of blockage compared with the other groups. The differences were statistically significant (p<0.05).

CONCLUSIONS

25-50 U/ml heparin catheter-sealing solution had little effect on blood circulation and coagulation. Additionally, it did not increase the risk of local bleeding or thrombotic blockage.

[Anatomic study and clinical practice of mesopancreas and total mesopancreatic excision]

Objective: To explore the anatomical characteristics of the mesopancreas, to define the range of the total mesopancreas excision and to evaluate the feasibility, safety and effectiveness in the treatment of pancreatic cancer. Methods: A regional anatomical and pathological study was performed on 14 cadavers with large slices and paraffin sections. The clinical and pathological data of 58 consecutive patients underwent total mesopancreas excision for pancreatic head carcinoma from January 2013 to December 2015 were prospectively collected and analysed. The perioperative morbidity, mortality and clinical outcomes of patients underwent total mesopancreas excision were compared with the patients underwent conventional pancreaticoduodenectomy from January 2010 to December 2012. Results: The mesopancreas located in the retropancreatic area, extending from the head, neck, and uncinated process of pancreas to the aorto-caval groove, in which there were loose areolar tissue, adipose tissue, nerve plexus, lymphatic and capillaries. Although no fibrous sheath or fascia like mesocolorectum was found around the structures, a relatively fixed extent could be defined according to its embryologic and anatomic characters. In clinical practice, total mesopancreas excision was classified into two levels according to the extent of resection in this series: level Ⅰ was a"standard total mesopancreas excision" or"total mesopancreas excision in a narrow sense" , which was similar to the extent of standard resection from consensus statement of ISGPS. Level Ⅱ was defined as any procedure extending the range of level Ⅰ, called the"extended total mesopancreas excision" or"total mesopancreas excision in a broad sense". In TMpE group, the intraoperative blood loss( (461.4±184.5)ml vs. (532.2±319.8)ml, P=0.301), operation time( (368.6±92.5)minutes vs. (397.1±112.7)minutes, P=0.559), total complication rate (39.7% vs. 51.2%, P=0.250), fistula mortality (25.9% vs. 30.2%, P=0.628) were all reduced. There were significantly higher R0 rate (91.4% vs.76.7%, P=0.041) and more harvested lymph nodes (16.2 vs. 11.4, P=0.000) and lower total and local recurrence: rate (half-year local recurrence rate: 7.8% vs. 23.7%, P=0.036; one-year local recurrence rate: 18.2% vs. 39.5%, P=0.018) and longer disease-free survival (16.9 months vs. 13.4 months, P=0.044) and overall survival(22.5 months vs. 19.9 months, P>0.05) were also found in the study group. Conclusions: Mesopancreas is different from mesorectum since it has no fascial envelop, which should be regarded as a surgical concept, rather than an anatomical structure. Total mesopancreas excision is safe and feasible for pancreatic head cancer and probably helps to increase the R0 resection rate and improve the clinical outcomes.

The effect of maternal obesity on fatty acid transporter expression and lipid metabolism in the full-term placenta of lean breed swine

This study was conducted to evaluate the influence of back-fat thickness (BF), at mating of sows, on the maternal and newborn circulating lipids, expression of placental fatty acids (FA) transporters and lipid accumulation in placenta. Full-term placentas were obtained by vaginal delivery from BFI (9-14 mm; n = 37), BFII (15-19 mm; n = 43) and BFIII (20-27 mm; n = 38) sows according to BF at mating, and frozen placental sections were analysed for fat accumulation. Blood samples were collected from the sows of day 105 pregnancy and from cord blood at delivery. mRNA and protein expression levels were evaluated with real-time RT-PCR and Western blotting. Our results demonstrated that BFII females had significantly increased litter weight and placental efficiency, decreased maternal triglyceride (TG) and non-esterified fatty acids (NEFA) levels, decreased maternal IL-6, TNFα and leptin levels compared to BFIII females (p < .05). BFIII sows were associated with significantly decreased newborn TG levels, increased newborn glucose, IL-6 and TNFα levels compared to BFI or BFII sows (p < .05). BFI and BFII females had significantly decreased placental TG, NEFA and cholesterol (CHOL) contents compared to BFIII females (p < .05). Moreover, decreased CD36, FATP1, FABP4, and FABP1 mRNA and protein and FATP4 protein expression, and increased LPL activity were also observed in BFIII group compared with BFII group (p < .05). PPARγ mRNA and protein and lipogenic genes such as SREBP-1c, ACSL1, ACCα, FAS and SCD mRNA expression were downregulated or upregulated, respectively, in the placentas of BFIII sows compared to BFI or BFII sows (p < .05). Overall, this study demonstrated that there is no advantage, in terms of litter live size, litter weight and placental FA transport and metabolism, in performing the mating of sows with BF>19 mm.

Enucleation versus hepatectomy for giant hepatic haemangiomas: a meta-analysis

INTRODUCTION Hepatic haemangiomas are the most common benign liver tumours. They can be treated with surgical resection such as enucleation or hepatectomy if necessary. However, controversy remains over the clinical outcome and safety of these two methods. In this study, we performed a comprehensive meta-analysis to compare the efficacy of liver resection with enucleation for giant haemangiomas. METHODS The online databases PubMed, Embase and CNKI (China National Knowledge Infrastructure) were searched for relevant original articles. We compared operation time, blood loss, transfusion requirements, inflow occlusion time and postoperative complications between enucleation and hepatectomy. RESULTS Seven controlled clinical trials met the predefined inclusion criteria. Analysis indicated that the enucleation group had significantly shorter operation time (weighted mean difference, WMD -28.22, 95% confidence interval, CI, -54.82 to -1.62), less blood loss (WMD -395.92, 95% CI -521.25 to -270.58) and fewer complications (odds ratio, OR, 0.47, 95 % CI 0.34 to 0.65). There were no significant differences between enucleation and hepatectomy with regard to transfusion requirements (OR 0.61, 95% CI 0.22 to 1.68) and inflow occlusion time (WMD 7.91, 95% CI -5.62 to 21.44). CONCLUSIONS Enucleation has advantages over hepatectomy in relation to operation time, blood loss and complications. Enucleation is a safe and effective treatment for giant hepatic haemangioma.

Abstract S4-02: The Y537S ESR1 mutation is a dominant driver of distant ER-positive breast cancer metastasis

Background: Estrogen receptor (ESR1) mutations occur at a high frequency in metastatic breast tumors in patients treated with hormonal therapy in the metastatic setting. We do not know if these mutations are involved in metastasis.

Experimental design and methods: We generated ESR1 Y537S homozygous mutations using CRISPR Casp-9 technology. Treatment synergy was evaluated using Compusyn. Athymic mice were used in tumor xenograft studies. ChIP-Seq and transcriptome analyses were performed.

Results: We generated CRISPR ESR1 Y537S mutation homozygous knock-in clones and lentiviral stable pools in MCF-7 cells. Transcriptome profiling revealed elevated expression of Hallmark pathways, including EMT and estrogen-regulated gene expression. The EMT in mutant cells was associated with a switch from E-cadherin to vimentin, and increased expression of SNAIL and TWIST. Mutant cell growth was resistant to tamoxifen, but responsive to fulvestrant treatment. Synergistic treatment effects were observed with fulvestrant and everolimus or palbociclib. CRISPR Y537S mutant knock-in cells grown in the mammary fat-pad of athymic mice spontaneously metastasized to distant organs including the lung, intestine, and kidneys. In the presence of estrogen, there was no difference in the frequency of distant macrometastases between parental wild-type ER and CRISPR Y537S mutant ER mice. However, in the absence of estrogen, 80% of CRISPR Y537S mutant ER mice displayed overt distant macrometastases, but none were observed in parental wild-type ER mice (p=0.04). Interestingly, although CRISPR Y537S mutant ER tumors grown in the mammary fat-pad were unresponsive to tamoxifen treatment, tamoxifen significantly inhibited the growth of mutant tumors at the distant microenvironment (8-fold). Distant tumors retained ER expression and hormone sensitivity. Comparison of residual tamoxifen-treated metastatic tumors with tumors grown at the primary mammary fat-pad site using immunoblot analysis demonstrated significant reduction in estrogen-regulated gene expression, but no effect on the expression of biomarkers associated with EMT, suggesting a disconnect between EMT and distant metastasis in mutant cells. EMT genes were also identified as direct binding site targets in Y537S mutant cells compared with wide-type ER using ChIPSeq. We discovered that expression of the Y537S mutant was dominant, driving the growth of distant metastatic tumors when co-expressed with wild-type ER cells. A Y537S ER mutant-specific gene expression signature predicted poor disease-free survival of ER-positive patients using the METABRIC database, and lung-specific metastasis-free survival in a Memorial Sloan Kettering dataset.

Conclusion: The Y537S ER mutation is a driver of distant metastasis in ER-positive breast cancer cells. Although tamoxifen treatment was ineffective at reducing the growth of mutant cells grown at the primary site, it was effective at reducing distant metastasis. A Y537S ER mutant-specific gene expression signature predicted poor disease-free, and distant lung metastasis in ER-positive patients. Mutation status is a potential new predictive factor for hormone therapy of metastatic breast cancer patients on maintenance hormonal therapy.

Citation Format: Fuqua SAW, Gu G, Rechoum Y, Gelsomino L, Dustin DJ, Corona-Rodriguez A, Beyer AR, Pejerrey SM, Gao M, Tsimelzon A, Tian L, Zhang X, Nagi C, Ando' S. The Y537S ESR1 mutation is a dominant driver of distant ER-positive breast cancer metastasis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S4-02.

Novel folliculin (FLCN) mutation and familial spontaneous pneumothorax

BACKGROUND

Familial spontaneous pneumothorax is one of the characteristics of Birt-Hogg-Dubé syndrome (BHDS), which is an autosomal dominant disease caused by the mutation of folliculin (FLCN).

AIM

To investigate the mutation of FLCN gene in a familial spontaneous pneumothorax.

DESIGN

Prospective case study.

METHODS

Clinical and genetic data of a Chinese family with four patients who presented spontaneous pneumothorax in the absence of skin lesions or renal tumors were collected. CT scan of patient's lung was applied for observation of pneumothorax. DNA sequencing of the coding exons (4-14 exons) of FLCN was performed for all 11 members of the family and 100 unrelated healthy controls.

RESULTS

CT scan of patient's lung showed spontaneous pneumothorax. A mutation (c. 510C > G) that leads to a premature stop codon (p. Y170X) was found in the proband using DNA sequencing of coding exons (4-14 exons) of FLCN. This mutation was also observed in the other affected members of the family.

CONCLUSIONS

A nonsense mutation of FLCN was found in a spontaneous pneumothorax family. Our results expand the mutational spectrum of FLCN in patients with BHDS.

Characteristics and computed tomography evaluation of primary retroperitoneal tumours: report of 113 cases

INTRODUCTION Benign and malignant primary retroperitoneal tumours (PRT) have different clinical manifestations and pathological characteristics. We explore the characteristics and evaluate the value of computed tomography (CT) for PRT. METHODS Fifty-six benign and fifty-seven malignant PRT with clinical, radiographic and surgical data were retrospectively investigated. Statistical analysis was carried out using SPSS software. RESULTS We found that mean size of benign tumours was 12.4 ± 7.7cm but 20.7 ± 11.6cm in malignant cases (P < 0.05). The accuracy of CT localisation was approximately 70%. The sensitivity and specificity of CT diagnosis for benign tumours were 96% and 85%, respectively; 51 (91%) underwent complete resection among benign cases but 42 (74%) in malignant cases (P < 0.05). Sensitivity of CT evaluation for invaded organs and vessels was 50% and 65%, respectively, and specificity was 88% and 81%, respectively. CONCLUSIONS Large size, no capsule, irregular margin, heterogeneous density and specific enhancement pattern on CT are highly suggestive of malignancy. CT is the most useful tool in assessing the size and characteristics of PRT but it does not have the sensitivity to assess the involvement of organs and vessels.

Analyzing Growth-Management Policies with Geographical Information Systems

It has been argued that urban sprawl leads to inefficient land-use patterns with leapfrogging and low-density development in the urban fringe. Communities can implement a number of growth-management programs to encourage more efficient and environmentally sound development patterns. However, a long time period is needed to monitor the progress of growth-management techniques and to determine if they have achieved the intended effects. Unfortunately, urban development is mostly an irreversible process that leaves no room for experiment. As a result, we use GIS to simulate the impact of various growth-management policies on future land-development patterns in Portage County, Ohio. A comprehensive database and population growth forecasts are compiled to support the GIS analyses that generate a set of alternative residential growth scenarios. As a spatial decision support system, the GIS is found to be an efficient tool to simulate the form and process of development for detailed assessment and planning. As an educational tool, development simulation with GIS allows the generation of alternative scenarios to help citizens and local officials make sound planning decisions today, define future policies, and plan for new growth.

The protective effects of bone morphogenetic protein-7 against epithelial injury and matrix metalloproteases upregulation induced by silica in vitro

OBJECTIVE

We investigate the effects of bone morphogenetic protein-7 (BMP-7) on models with silica-induced and macrophage-mediated fibrosis and its possible mechanisms in vitro.

METHODS

Rat alveolar II epithelial (RLE-6TN) cells were incubated with the supernatant of mouse macrophage-like cells (RAW264.7) and treated with 0, 25, 50, and 100 μg/mL silica. Using Western blotting, the epithelial markers (surfactant proteins-C and E-cadherin) and the mesenchymal markers (fibronectin (FN) and viminten (Vim)) were detected. After neutralizing the BMP-7, the progress of fibrosis was assessed by the content of hydroxyproline (Hyp) and collagen I, III protein levels as well as the Smad signaling pathway proteins, including phosphorylated Smad1/5(P-Smad1/5) and phosphorylated Smad2/3(P-Smad2/3). Collagen I was also identified by immunofluorescence and pretreated with SB-431542, LDN-193189, or anti-BMP-7-neutralizing antibody. In addition, the levels of matrix metalloproteinase-2 (MMP-2) and MMP-9 were detected using Western blotting.

RESULTS

The model of RLE-6TN cells was established successfully, the expressions of Vim, FN, MMP-2, and MMP-9 were upregulated, while the concentration of silica is increased. Neutralizing BMP-7 stimulated the decrease of P-Smad1/5 and the increase of P-Smad2/3, as well as the collagen I, collagen III, FN, and Hyp via Smad signaling pathway. Furthermore, pretreated with LDN-193189 or anti-BMP-7-neutralizing antibody, the expression of collagen I was increased, yet it was decreased with SB-431542 intervention.

CONCLUSION

The activated BMP/Smad and suppressed transforming growth factor-β/Smad pathways could suppress silica-induced fibrosis via a MMP-dependent mechanism. BMP-7 is expected to be the optimized strategy of delaying the interstitial changes.