Multiple endocrine neoplasia type 1: atypical presentation, clinical course, and genetic analysis of multiple tumors

Multiple endocrine neoplasia type 1 (MEN1) is characterized by the development of endocrine tumors of the parathyroid and pituitary glands, pancreas, and duodenum. Less frequently occurring tumors associated with MEN1 include non-endocrine tumors such as lipomas and angiofibromas. An increased incidence of thyroid neoplasms, leiomyomas, adrenal cortical hyperplasia, hepatic focal nodular hyperplasia, and renal angiomyolipoma has been noted in the MEN1 population. The pathogenesis of non-neuroendocrine tumors in MEN1 is unknown. We report a complex clinical course and a detailed morphologic and genetic analysis of a series of tumors that developed in a patient with MEN1. All tumors were microdissected and analyzed for loss of heterozygosity of the MEN1 gene. A germline mutation of the MEN1 gene was detected, and deletions of the MEN1 gene were consistently detected in multiple neuroendocrine tumors involving the parathyroid glands and the pancreas and a hepatic neuroendocrine tumor metastasis, as predicted by Knudson's "two hit" hypothesis. Two hits of the MEN1 gene were also detected in esophageal leiomyoma tissue, suggesting that tumorigenesis was directly related to the patient's underlying MEN1. In contrast, follicular thyroid adenoma, papillary thyroid carcinoma, hepatic focal nodular hyperplasia, and adrenal cortical hyperplasia consistently showed retained heterozygosity of the MEN1 gene with flanking markers and an intragenic marker. Therefore, these tumors appear to develop along pathogenetic pathways that are different from classical MEN1-associated tumors.

Robot-Assisted Reduction of the Ankle Joint via Multi-Body 3D-2D Image Registration

Purpose

Robot-assisted orthopaedic joint reduction offers enhanced precision and control across multiple axes of motion, enabling precise realignment according to predefined plans. However, the high levels of forces encountered may induce unintended anatomical motion and flex mechanical components. To address this, this work presents an approach that uses 2D fluoroscopic imaging to verify and readjust the 3D reduction path by tracking deviations from the planned trajectory.

Methods

The proposed method involves a 3D-2D registration algorithm using a pair of fluoroscopic images, along with prior models of each body in the radiographic scene. This objective is formulated to couple and constrain multiple object poses (fibula, tibia, talus, and robot end effector), and incorporate novel methods for automatic view and hyperparameter selection to improve robustness. The algorithms were refined through cadaver studies and evaluated in a preclinical trial, employing a robotic system to manipulate a dislocated fibula.

Results

Studies with cadaveric specimens highlighted the joint-specific formulation's high registration accuracy (Δ x = 0.3 ± 1.5 mm ), further improved with the use of automatic view and hyperparameter selection (Δ x = 0.2 ± 0.8 mm ). Preclinical studies demonstrated a high deviation between the intended and the actual path of the robotic system, which was accurately captured (Δ x < 1 mm ) using the proposed techniques.

Conclusions

The solution offers to close the loop on image-based guidance of robot-assisted joint reduction by tracking the robot and bones to dynamically correct the course. The approach uses standard clinical images and is expected to lower radiation exposure by providing 3D information and allowing the staff to stay clear of the x-ray beam.

[Distribution of androgen receptor in primary liver cancer and its clinical significance]

A method of receptor binding assay (RBA) was adopted to measure the distribution of androgen receptor (AR) in liver cancer and tissue in its vicinity in 63 patients with primary liver cancer undergone laparotomy and in non-tumor liver tissue in 7 cases with gastric carcinoma. The results showed (1) AR was demonstrated in the liver cancer tissue and surrounding non-tumorous tissue, and the non-tumor liver tissue. The content of AR in the nucleus was significantly higher than that in the cytoplasm. (2) There was no difference in the amount of AR between the tumor tissue and tissue surrounding it. The expression of AR in the liver cancer tissue or the surrounding tissue was more marked than that in the non-tumor tissue. (3) Expression of AR in the tumor tissue seemed to correlate with more frequent tumor recurrence one year after radical resection.

Morphometric evaluation on myocardial protection of cold crystalloid versus warm blood cardioplegia

Twenty patients undergoing open-heart valve replacement were divided randomly into two groups in this study; intermittent perfusion of cold crystalloid (St. Thomas Hospital solution) with hypothermic cardiopulmonary bypass (CPB) (hypothermic group) and continuous administration of warm blood cardioplegia with normothermic CPB (normothermic group) respectively. Tissue samples were taken from the right atrium before weaning from CPB and from the right appendage 30 minutes after removal of the cross-clamp. The results of pathological study in these two groups were as follows: the structural alterations were most severe during the ischemic period in the hypothermic group. Damages of the myocardial mitochondria examined with transmission electron microscope were found more severe in the hypothermic group than in the normothermic group, and in the reperfusion period than in the ischemic period. Loss of integrity of the mitochondrial membrane could be noted during reperfusion in the hypothermic group. The surface to volume ratios of mitochondria of each period of the two groups were calculated by computerizing the microphotographs of the myocardium. It was shown that the average of the surface to volume ratios was smallest in the reperfusion period in the normothermic group. It seemed that the volumes of the mitochondria were larger in the warm group than in the cold one. Probably the results were due to more severe damages of the mitochondrial membranes in the hypothermic group, which led to the release of the contents out of the mitochondria while in the normothermic group, the sodium-pump was disordered and it made the mitochondria swell. Pathologically, blood cardioplegic perfusion with the use of normothermic CPB is a feasible method for myocardial protection in open-heart surgery.

[Effect of dietary and/or exercise intervention on incidence of diabetes in 530 subjects with impaired glucose tolerance from 1986-1992]

577 subjects with impaired glucose tolerance (IGT) aged from 25 to 74 were identified in Daqing in 1986. They were stratified according to BMI > or = 25 (352 cases) and BMI < 25 (225 cases) and subjects in each BMI group were randomly assigned to four groups: control, diet, exercise and diet plus exercise intervention groups (each group had similar age, BMI, fasting and 2-hour plasma glucose level). A six-year follow up study indicated that incidence of diabetes per 100-person-year was 15.7, 10.0, 8.3 and 9.6 in control, diet, exercise and diet plus exercise groups respectively. Proportional hazards regression analysis controlling for differences in baseline factors (age, sex, BMI and plasma glucose) showed that diet and/or exercise intervention were inversely related to the incidence of diabetes. The better the actual intervention, the less the incidence of diabetes. Therefore, the results strongly indicate that diet and/or exercise intervention treatment are effective methods to reduce the incidence of diabetes.

[Application of reverse transcription-polymerase chain reaction in rapid diagnosis and serotype identification of dengue virus infections]

RT-PCR was developed for the amplification of partial E genome fragment from four dengue serotypes. Of the six oligonucleotide primers designed one was shared by dengue virus type 1 and type 2, and one by type 3 and type 4. Each of the other four primers was type specific. Amplified products with 240, 150, 333 and 421 bp, respectively were identified by electrophoresis on 2% agarose gel and digestion with restriction enzyme Hind III. RT-PCR can detect dengue viral RNA from at least 5TCID50 virus, which was confirmed by detection of serial dilutions of culture supernatants. RT-PCR was also applied to serum samples from 60 acute patients. The findings showed that RT-PCR was of the same specificity as isolation of virus, followed by indirect fluorescent antibody tests. RT-PCR was more sensitive than cell culture and can be used for the rapid diagnosis and serotype identification of dengue virus infections.

A clinical study on severe hydroa vacciniforme

OBJECTIVE

To describe a severe type of hydroa vacciniforme (HV) in order to provide basis for treatment and prevention of this disease.

METHODS

Nine cases of HV were collected in our outpatient department, and clinical and laboratory examinations were performed.

RESULTS

All the cases had erythemas, papules, bullae, erosions or ulcers on exposed sites, with recurrences, gradually resulting in deformation. Five patients suffered from hand deformation manifesting rigidity, flexor tetanus, or malposition of the first, second and third interphalangeal joints of hands. Two of the above mentioned patients manifested partial bone absorption of fingers. Five patients showed partial defect of auricle. Two patients showed saddle nose, and partial absorption of nasal cartilage. One patient displayed cicatricial contracture of lower lip, with incisor extrusion. Four patients showed opacity of cornea. Through laboratory examinations, porphyrinopathies were excluded. Phototests showed increased sensitivity to ultraviolet-A radiation (UVA).

CONCLUSIONS

Based on the clinical features and laboratory examinations, these patients were diagnosed as having severe HV. It is believed that this condition belongs to a disease spectrum induced by ultraviolet light. Our analysis suggests that for children with severe type of HV, preventive measures and therapeutic agents should be taken as soon as possible in order to avoid deterioration of the disease and malformations.

Searching eye movement, smooth pursuit eye movement and schizophrenia

OBJECTIVE

To detect whether the smooth pursuit eye movement (SPEM) and searching eye movement (SEM) could be considered as a biological marker of schizophrenia, and used as a tool in helping diagnosis of schizophrenia.

METHODS

88 schizophrenics, 77 patients with mood disorders, 32 with "neurosis", and 74 normal healthy controls were examined for SPEM and SEM individually. The authors verified the results in all the first-visit 150 outpatients in March 1993 by comparing the examination results with the clinical diagnoses after a 6-month follow-up.

RESULTS

Significant differences were found in the number of eye fixation (NEF) and total eye scanning length (TESL) of SEM between schizophrenics and normal controls or patients with other disorders. Less NEF and shorter TESL could be helpful in differential diagnosis, and the agreement rate, Kappa coefficient was 0.62. No significant differences were found in SPEM in this investigation between non-medicated schizophrenics and normal controls.

CONCLUSION

Searching eye movement (SEM) might be considered as a biological marker of schizophrenia and might be used as a supplementary tool in its diagnosis.

[Studies on the fine structures of inner ear vessels in guinea pigs]

In order to investigate the characters of inner ear vessels using the microvascular corrosion casting technique and scanning electron microscope the three-dimensional spatial picture of the vessels in cochlear basilar membrane, utriculus, sacculus and three ampullae of guinea pig were observed. It was found that arteriole coils were present in the modiolus ampullae, utriculus and sacculus. The length of arterioles was therefore prolonged and could keep the blood supply in inner ear stable. The possibility of blood coagulation in these segments increased because the blood flow became slower here. Another character was that the capillary networks appeared denser in stria vascularis and central part of the crista, whereas the vessel meshes in basilar membrane of cochlea and in planum semiculatum of ampullae were looser. These findings suggested that the metabolism in stria vascularis and central part of the crista would be more prosperous than that in the basilar membrane and planum semiculatum of ampullae.

Experimental study on spontaneous DNA synthesis of tonsillar lymphocytes in chronic recurrent tonsillitis and focal tonsillitis

The immune function of tonsils and the immunological mechanisms of focal tonsillitis are still controversial. We do have some knowledge about the structure of tonsillar cells, but their functional status is still not clear. In 40 cases of chronic recurrent tonsillitis and 20 cases of focal tonsillitis with glomerular nephritis, cell culture of tonsillar lymphocytes was removed in vitro and 3H-tymidin incorporation applied to investigate the spontaneous DNA synthesis of tonsillar lymphocytes. The results demonstrated that: i) In chronic tonsillitis, spontaneous DNA synthesis of tonsillar lymphocytes in children is significantly stronger than that in adults (19,946 +/- 5,612 vs 9,216 +/- 5,702 cpm) (p <0.01). ii) Spontaneous DNA synthesis of tonsillar lymphocytes in focal tonsillitis is significantly stronger than that in the chronic recurrent tonsillitis in patients of the same age (25,307 +/- 12,231 cpm vs 12,455 +/- 7,914 cpm) (p <0.01). This indicates that the tonsillar lymphocytes are active in focal tonsillitis, can produce large amounts of memory B-cell clones, which reach other parts of the body through the blood and cause autoimmune reaction which can be blocked by tonsillectomy, thus curing the systemic disease.

[Observation of AChE location in chicken cochlea]

The efferent auditory innervation of the chicken was investigated by means of AChE histochemical stain. The localization of AChE in the chicken was observed by use of mounted and freezing microtome in basilar papilla. The positive fibers of AChE stain were distributed over the lateral aspect of the superior cartilaginous plate of the basilar papilla. Radical fibers leave this lontigudinal boundle to supply the hair cells. Two types of efferent synapsis could be distinguished: short hair cells with large cup-like efferent terminal, and tall cells with small, irregular terminal. The characteristics and the significance of experimental study are also discussed.

Activation and transdominant suppression of MHC class II and HLA-DMB promoters by a series of C-terminal class II transactivator deletion mutants

The class II transactivator (CIITA) is a highly specific transcription factor that activates only genes known to be involved in the class II MHC processing pathway, including class II MHC, invariant chain, and HLA-DMA/B genes. In this work, we show the requirement of a new region in CIITA that is critical for its function. Deletion mutants lacking varying length of the C terminus show that the C-terminal 41 amino acids of CIITA are indispensable for the activation of both the conventional DRA and nonconventional DMB promoters. This region contains a highly charged stretch of amino acids that is homologous to a yeast transcription factor, repression activator protein-1 (RAP1)-interacting factor 1. Mutants lacking the C terminus were tested in a transdominant-negative assay to examine their capacity to block the wild-type CIITA function. Two of these deletion mutants suppressed the activity of endogenously expressed wild-type CIITA to activate both DRA and DMB promoters. It may be possible to utilize these mutants to modulate MHC class II and DM gene expression.

[Establishment of partial gene expression map of 7q32 in nasopharyngeal carcinoma and primary culture normal nasopharyngeal epithelial cells]

OBJECTIVE

To establish partial gene expression map of 7q32 in nasopharyngeal carcinoma (NPC) cell line, tissues and primary culture normal nasopharyngeal epithelial cells.

METHODS

We detected the expression of 20 ESTs at 7q32 in NPC cell line HNE1,13 NPC biopsies and primary culture normal nasopharyngeal epithelial cells using differential RT PCR and Northern hybridization.

RESULTS

8 ESTs (AA188181, AA13079,N27556, AA031919, N22721, H20825, T91284, AA001936) expressed equally in both of HNE1 and primary culture normal nasopharyngeal epithelial cells; 7 ESTs (T64215, AA025822, R60014,R80002,H06688, R60192,R95096) expressed in neither of them; 3 ESTs (H19830,W72688,AA130630) overexpressed in HNE1 ; and 2 ESTs (AA070437, H90882) overexpressed in primary culture normal nasopharyngeal epithelial cells. W72688 and H19830 each overexpressed in 77%(10/13) of NPC biopsies; AA070437 down-expressed in 30.7% of NPC biopsies.

CONCLUSION

Partial gene expression map of 7q32 in nasopharyngeal carcinoma cell line ,tissues and primary culture normal nasopharyngeal epithelial cells has been established. The up-regulation of W72688, H19830 and down-regulation of AA070437 may be related to the occurrence of NPC.

A clinical investigation on zhi ling tang for treatment of senile dementia

Zhi Ling Tang (ZLT [symbol: see text], a TCM prescription designed for replenishing essence, supplementing marrow, invigorating qi, warming yang, removing blood stasis and phlegm, tonifying the brain, and invigorating mental activity) was used in 32 cases of senile dementia (SD). After treatment, the levels of serum cholesterol (Tch), triglyceride (TG), and plasma lipid peroxides (LPO) were lowered; the content of high density lipoprotein (HDL) and the activity of superoxide dismutase (SOD) in RBC significantly elevated, the cerebral blood flow was increased; latent period of P300 and P3 waves was shortened while the amplitude of P3 elevated; and topographic electroencephalogram, revised Hasegawa dementia scales (HDS) scores (P < 0.05-0.01) and clinical symptoms were improved. The total effective rate was 81.3%, indicating that ZLT exhibits relatively good therapeutic effects for treating senile dementia.

[Efficiency of the Modified Ottawa ankle rules for the differential diagnosis of fracture in acute foot and ankle injury]

Objective: To evaluate the efficiency of modified Ottawa Ankle Rules (OAR) for the differential diagnosis of fractures in acute foot and ankle injuries. Methods: From October 2016 to December 2016, 272cases (135 males and 137 females) of foot and ankle injury in emergency department of Tianjin Hospital were prospective enrolled in the study.The median age was 27.5 years (7-87); left limb 155, right 117 cases; injury time ranged from 0.3 to 24 h (median 4 h). Conventional and modified OAR was applied on physical examination, subsequently radiography performed to determine the occurrence of fractures.The efficiency of the two methods were compared and analyzed. Results: Fractures were found in 100 cases (36.8%), 49 cases of ankle and 51 cases of foot fractures.With the imaging results as the standard, the sensitivity for conventional and modified OAR were 93.0% and 100%, specificity were 9.9% and 8.7%, the positive predictive value were 37.5% and 38.9%, the negative predictive value were 70.8% and 100%, the accuracy were 40.4% and 42.3%, missed diagnosis rate were 7% and 0% respectively.The sensitivity, positive likelihood ratio, positive predictive value, negative predictive value, accuracy, negative likelihood ratio and missed diagnosis ratio were better than in modified OAR compared with Conventional OAR, while the specificity was slightly lower compared to Conventional OAR.The Kappa value of modified OAR was 0.065 (P>0.05), which is better than conventional OAR.Conventional OAR can reduce 6.3% (17/272) X-ray and modified OAR decline 5.5% (15/272). Conclusion: Modified OAR significantly reduces the rate of missed diagnosis of foot fractures, but its specificity is poor. Ultrasound can be assisted to improve the specificity and reduce the number of unnecessary X-rays.

Cancer/testis antigens for therapeutic use

Since van der Bruggen and colleagues first identified specific human tumour-associated antigens of the MAGE family, numerous potential immunotherapeutic targets have been discovered, often belonging to the so-called cancer/ testis gene family. Several members of this group have been described as immunogenic and have been utilised in clinical trials. In a search for interesting targets within this family, our laboratory has focussed its works for a number of years on two novel cancer/testis antigens called T21 and HAGE. In this article, we will focus our discussion on their levels of expression in a wide variety of both normal and cancer tissues, their possible role in tumour cell development and proliferation, and their immunogenic potential.

Observation of Three Charmoniumlike States with J^{PC}=1^{--} in e^{+}e^{-}→D^{*0}D^{*-}π^{+}

The Born cross sections of the process e^{+}e^{-}→D^{*0}D^{*-}π^{+} at center-of-mass energies from 4.189 to 4.951 GeV are measured for the first time. The data samples used correspond to an integrated luminosity of 17.9  fb^{-1} and were collected by the BESIII detector operating at the BEPCII storage ring. Three enhancements around 4.20, 4.47, and 4.67 GeV are visible. The resonances have masses of 4209.6±4.7±5.9  MeV/c^{2}, 4469.1±26.2±3.6  MeV/c^{2}, and 4675.3±29.5±3.5  MeV/c^{2} and widths of 81.6±17.8±9.0  MeV, 246.3±36.7±9.4  MeV, and 218.3±72.9±9.3  MeV, respectively, where the first uncertainties are statistical and the second systematic. The first and third resonances are consistent with the ψ(4230) and ψ(4660) states, respectively, while the second one is compatible with the ψ(4500) observed in the e^{+}e^{-}→K^{+}K^{-}J/ψ process. These three charmoniumlike ψ states are observed in the e^{+}e^{-}→D^{*0}D^{*-}π^{+} process for the first time.

Observation of h_{c} Radiative Decay h_{c}→γη^{'} and Evidence for h_{c}→γη

A search for radiative decays of the P-wave spin singlet charmonium resonance h_{c} is performed based on 4.48×10^{8} ψ^{'} events collected with the BESIII detector operating at the BEPCII storage ring. Events of the reaction channels h_{c}→γη^{'} and γη are observed with a statistical significance of 8.4σ and 4.0σ, respectively, for the first time. The branching fractions of h_{c}→γη^{'} and h_{c}→γη are measured to be B(h_{c}→γη^{'})=(1.52±0.27±0.29)×10^{-3} and B(h_{c}→γη)=(4.7±1.5±1.4)×10^{-4}, respectively, where the first errors are statistical and the second are systematic uncertainties.