[Prediction of pathological remission of head and neck squamous cell carcinoma patients after neoadjuvant immunochemotherapy and construction of clinical model based on clinical features and inflammatory markers]

Objective: To analyze the potential clinical biological factors influencing the major pathological response (MPR) to neoadjuvant immunochemotherapy in patients with resectable head and neck squamous cell carcinoma (HNSCC). Methods: This retrospective study enrolled patients with resectable HNSCC who underwent neoadjuvant immunochemotherapy at Sun Yat-sen University Cancer Center from June 1, 2019 to December 31, 2021. Binary logistic regression was used to analyze the correlation between clinical characteristics, inflammatory markers and MPR, and a nomogram model was constructed. The calibration curve and decision curve analysis were used to verify the predictive ability and accuracy of the nomogram model. Results: A total of 173 patients were included in the study, with 141 males and 32 females, aged from 22 to 83 years. After pathological assessment, the patients were divided into two groups: MPR group (108 cases) and non MPR group (65 cases). Logistics regression analysis indicated that the patients with HPV+oropharyngeal cancer, partial response or complete response by imaging assessment, low pre-treatment platelet/lymphocyte ratio, low pre-treatment C reactive protein/albumin ratio and lower pre-and post-treatment C reactive protein/albumin ratio difference were more likely to have MPR (all P<0.05). Nomogram model was constructed based on the above factors, with a C-index of 0.826 (95%CI: 0.760-0.892), and the calibration curve and decision curve analysis confirmed the prediction accuracy of the model. Conclusion: This study shows that many factors are related to MPR of patients with resectable HNSCC receiving neoadjuvant immunochemotherapy and the constructed nomogram model helps to develop personalized treatment strategies for the patients.

[Survey on the cognition of the "undetectable equals untransmittable" concept among HIV-infected men who have sex with men receiving antiviral treatment]

Objective: To explore the cognition of the "undetectable equals untransmittable" ("U=U") concept and associated factors among HIV-infected men who have sex with men (MSM) receiving antiviral treatment (ART) in Shenzhen, and provide evidence for designing promotion and advocacy strategies for the "U=U" concept. Methods: We recruited HIV-infected MSM receiving ART using convenient sampling method combined with routine follow-up in Shenzhen through conducting observational survey. The sample size was estimated to be 475. A questionnaire was administered to collect socio-demographic characteristics, sexual behaviors, ART, viral load testing and the cognition towards "U=U" in HIV-infected MSM. Logistic regression was used to access factors associated with acceptance of "U=U". Results: A total of 490 HIV-infected MSM receiving ART were recruited. Of whom, 60.2% (295/490) were aware of "U=U" and 50.6% (248/490) accepted "U=U". Multiple logistic regression showed that participants who had an educational level of college or above (aOR=1.76,95%CI: 1.12-2.75) were more likely to accept "U=U". Those who had no local residency (aOR=0.51,95%CI: 0.29-0.92), had viral load >0 copies/ml in the last testing (aOR=0.61,95%CI: 0.38-0.98) and were unaware of "U=U" (aOR=0.13, 95%CI: 0.09-0.21), were less likely to accept "U=U". Conclusions: HIV-infected MSM receiving ART had a low cognition level of "U=U" in Shenzhen. Promotion and advocacy on this concept through healthcare workers should be enhanced in combination with routine follow-up in order to improve their ART adherence and outcome of treatment. Furthermore, developing related guidelines on "U=U" according to the characteristics of HIV-infected individuals is warranted to improve the normalization of promotion and advocacy on "U=U".

Characterization of immunomodulatory factors and cells in bronchoalveolar lavage fluid for immune checkpoint inhibitor-related pneumonitis

As immune checkpoint inhibitors (ICIs) are widely used, a series of immune-related adverse events (irAEs) have been reported, including immune checkpoint inhibitor-related pneumonitis (ICI-pneumonitis). The incidence of ICI-pneumonitis is higher in reality than in clinical trials. The diagnosis is challenging, mainly based on clinical and imaging features, and requires the exclusion of other causes. The data on the biological mechanisms of ICI-pneumonitis are scarce, resulting in little knowledge of the best treatment for ICI-pneumonitis. Bronchoalveolar lavage (BAL) may be helpful to identify the biological differences or find predictive biomarkers, and may in turn help to develop phenotype-specific targeted drugs to treat ICI-pneumonitis. Herein, we outline the characterization of immunomodulatory factors and cells in bronchoalveolar lavage fluid for ICI-pneumonitis. Through careful sorting and literature review, we find crosstalk between pathogenic Th17/Th1 cells (i.e., Th17.1) and pro-inflammatory monocytes, and activation of Th17(/Th1)/IL-17A (/IFN-γ) pathways may play a key role in the pathogenesis of ICI-pneumonitis. Disruption of the interaction between pathogenic Th17/Th1 cells and pro-inflammatory monocytes (such as, anti-IL-23) may be a potential treatment for ICI-pneumonitis. We first describe the possible pathophysiological mechanisms of ICI-pneumonitis, hoping to contribute to the optimization of diagnosis and treatment, as well as provide readers with research inspiration.

[Analysis on the diagnosis of suspected occupational diseases in Guangzhou from 2014 to 2019]

Objective: To understand the diagnosis of suspected occupational diseases reported in Guangzhou from 2014 to 2019, so as to provide theoretical basis and technical support for the supervision of suspected occupational disease reports. Methods: By cluster sampling, the suspected occupational disease report card, occupational disease report card and pneumoconiosis report card reported by Guangzhou from January 1, 2014 to December 31, 2019 in the occupational disease and occupational health information monitoring system were collected for matching analysis to understand the diagnosis of suspected occupational disease patients. Results: From 2014 to 2019, a total of 1426 suspected occupational cases in 7 categories and 32 species were reported in Guangzhou. The average number of reported cases per year was about 240. The main diseases of suspected occupational diseases were suspected occupational noise deafness (68.44%, 976/1426) , suspected occupational chronic benzene poisoning (16.48%, 235/1426) , suspected occupational other pneumoconiosis (4.84%, 69/1426) , suspected occupational silicosis (3.23%, 46/1426) and suspected occupational welder pneumoconiosis (1.82%, 26/1426) . The diagnostic rate required to enter the occupational disease diagnostic program is 36.61% (522/1426) , and the diagnostic rate is 59.20% (309/522) . In 2019, the diagnosis rate of suspected occupational diseases was the lowest (23.92%, 61/255) , Huadu District was the lowest (8.33%, 9/108) , suspected occupational pneumoconiosis was the lowest (28.03%, 44/157) , the diagnosis rate of suspected occupational diseases reported by the Centers for Disease control and prevention was the lowest (17.43%, 19/109) , and the diagnosis rate of suspected occupational diseases reported by outpatient treatment was the lowest (22.22%, 2/9) . The suspected occupational diseases reported by institutions outside Guangzhou did not enter the occupational disease diagnosis procedure. Suspected occupational skin diseases, suspected occupational diseases caused by physical factors and suspected occupational tumors were diagnosed, and the diagnosis rate of occupational disease prevention and control institutions was the highest (94.87%, 37/39) . Conclusion: The main types of suspected occupational diseases reported during these six years are noise deafness, chronic benzene poisoning and pneumoconiosis. The overall diagnosis rate and diagnosis rate of suspected occupational diseases are not high. It is suggested to improve the network direct reporting system of suspected occupational diseases and strengthen the follow-up management and supervision of suspected occupational diseases.

[Clinical analysis of 16 cases of pulmonary epithelioid hemangioendothelioma]

Objective: To improve the diagnosis and treatment of pulmonary epithelioid hemangioendothelioma (P-EHE). Methods: Sixteen patients diagnosed with P-EHE in Fuzhou Pulmonary Hospital of Fujian Province from January 2009 to July 2020 were collected. Their gender, age, imaging findings, pathological characteristics, treatment protocols, survival and other clinical data were summarized and analyzed. Results: The ratio of male to female among the 16 patients was 1∶1; and the average age of onset was 47.75 years. Most cases of PEHE (9/16) were found by physical examination, while some cases developed respiratory symptoms such as cough, sputum, shortness of breath, hemoptysis, chest pain, etc. (7/16). In most patients the lesions were localized to the lungs (11/16), while bone metastasis (1/16), lymph node metastasis (1/16), and pleural metastasis (4/16) also occurred. The pathological tissues were obtained mainly through surgical thoracoscopy. Chest CT images showed multiple nodules in both lungs, with most of the nodules less than 2.0 cm in diameter, and calcifications were seen, while solitary nodules and masses were rare, and pleural metastases could be manifested as pleural thickening and pleural effusion. The pathological findings were well-defined eosinophilic nodules with irregularly arranged nest-like structures. Those eosinophilic nodules had few central cells and abundant peripheral cells, which extended into the alveolar cavity like papillae. The tumor cells were epithelioid with small atypia, and vacuoles and red blood cells could be seen in the cytoplasm of individual tumor cells. Immunohistochemically, the tumor cells were positive to CD34, CD31, Factor Ⅷ andvimentin (VIM). Follow-up of 0.5 to 11 years showed that four patients died, two lost to follow-up, and the rest of the patients were in good condition, with a median overall survival (OS) of 4.58 years. Conclusions: PEHE is a rare low-grade lung tumor with no specific clinical manifestations. It can be diagnosed with chest imaging and pathological immunohistochemistry. Moreover, there is currently no standard treatment for PEHE, and most patients have a good prognosis.

[A retrospective investigation of new cases of pneumoconiosis from 1958 to 2018 in Guangzhou City]

Objective: To describe the characteristics and the survival status of pneumoconiosis cases reported in Guangzhou City from 1958 to 2018, and to investigate the epidemiological trends of pneumoconiosis. This study is aiming to provide basic data for formulating the guidelines and policies for control of pneumoconiosis, and for evaluating the control effects of pneumoconiosis. Methods: From July 2019 to January 2020, based on the data collected in the pneumoconiosis case cards and database as well as the retrospective follow-up investigate of pneumoconiosis cases, we conducted a descriptive analysis for all the new cases of pneumoconiosis reported from 1958 to 2018 in Guangzhou City. The statistical indices included the number of new pneumoconiosis cases in each decade, types of pneumoconiosis, regional and industrial distributions, survival status, and the change tendency of the diagnosis age and the dust exposure time of pneumoconiosis cases. Results: From 1958 to 2018, a total of 1194 new cases of pneumoconiosis were reported in Guangzhou City, including 1147 males (96.1%) and 47 females (3.9%) . Silicosis (60.1%, 718/1194) and welder's pneumoconiosis (21.5%, 257/1194) were the main types of pneumoconiosis. The top three districts for reporting new cases were Huangpu District (29.0%, 346/1194) , Nansha District (12.6%, 151/1194) and Baiyun District (11.1%, 132/1194) , respectively. The top three industries for reporting new cases were civil engineering construction industry (25.0%, 298/1194) , railway ship aerospace and other transportation equipment manufacturing industry (16.1%, 192/1194) and non-metal mining industry (15.7%, 187/1194) . The diagnosis age for new cases was 47.8 (23.6-79.1) years old, and the dust exposure time was 12.3 (0.4-49.1) years. Both of these two statistical indicators rose first and fell later from 1958 to 2018. As of December 31, 2019, a total of 963 new cases of pneumoconiosis were followed up, of which 467 (48.5%) survived, mainly silicosis (41.3%, 193/467) and welder's pneumoconiosis (43.3%, 203/467) . 496 cases (51.5%) died, and the age of death was 69.9 (32.4-96.9) years old. Conclusion: According to the epidemiological characteristics of pneumoconiosis in Guangzhou, we should focus on key districts and industries in the prevention and control of pneumoconiosis. Besides, the staffs in the occupational disease diagnosis institutions should try the best to collect the complete dust exposure data of new cases of pneumoconiosis. Moreover, the health administrative departments should pay more attention to the management of pneumoconiosis death case reports.

[Epidemiological characteristics of newly diagnosed cases of occupational noise deafness in Guangzhou from 2011 to 2018]

Objective: To provide scientific evidence for the prevention and control strategies of noise-induced deafness, to analyze the epidemiological characteristics of the occupational noise-induced deafness diagnostic applicants in Guangzhou city during 2011-2018. Methods: In March 2019, by consulting the occupational disease diagnosis records, we investigated the distribution of all 471 occupational noise-induced deafness diagnostic applicants in Guangzhou Occupational Disease Prevention and Treatment Center from 2011 to 2018. Frequency and constituent ratio were used to describe the distribution. Results: From 2011 to 2018, there were 471 cases of occupational noise-induced deafness diagnostic applicants and 211 of the applicants were diagnosed as occupational noise-induced deafness (44.8%, 211/471) . The new cases were mainly mild (83.9%, 177/211) , with the predilection age of 40.0-49.0 years old (41.7%, 88/211) and the predilection seniority of 5.0-9.9 years (38.9%, 82/211) . Among the new cases, there were mainly males (88.6%, 187/211) . Most of the new cases were distributed in Nansha district (23.2%, 49/211) , Huangpu district (22.7%, 48/211) and Panyu district (21.8%, 46/211) . Besides, in terms of industry distribution, they were concentrated in manufacturing industry (82.0%, 173/211) . The scale of enterprises was mainly medium-sized (42.7%, 90/211) , and the most of their economic type was domestic-funded (40.8%, 86/211) . Conclusion: Although most of the newly diagnosed cases of occupational noise deafness in Guangzhou are mild, they still need to be paid attention to and strengthen the noise industry protection education.

Myositis-myasthenia gravis overlap syndrome complicated with myasthenia crisis and myocarditis associated with anti-programmed cell death-1 (sintilimab) therapy for lung adenocarcinoma

Immune checkpoint inhibitors (ICIs) have improved clinical outcomes with a number of advanced malignancies. However, diverse immune-related adverse events (iRAEs) occurred with the widespread use of ICIs, some of which are rarely and life-threatening. Here we report a 66-year-old patient with lung adenocarcinoma who received two doses of sintilimab, a human monoclonal antibody against programmed cell death-1 (PD-1), experienced a fatal storm of iRAEs. He was admitted to the intensive care unit (ICU) by immune induced-myositis/myocarditis and rhabdomyolysis. Despite immediate immunosuppressive therapy with methylprednisolone (MP) and immunoglobulin intravenously, he developed into myositis-myasthenia gravis (MG) overlap syndrome complicated with myasthenia crisis. We commenced plasma exchange (PLEX), mechanical ventilation, immunosuppressive therapy, as well as other supportive therapies. Three months later, the patient's serum creatine phosphate kinase (CPK) and anti-acetylcholine receptor antibody (anti-AChR-Ab) returned to normal despite tumor progression. Herein we discuss the incidence, operating mechanism and management strategies of the fatal iRAEs. Early admission to the ICU and multidisciplinary collaborative treatment for unstable patients with iRAEs could help to achieve a favorable outcome.

[To discuss the problems existing in the labor ability appraisal of an occupational chronic benzene poisoning incidence]

Three female workers in a golf club production company in Guangzhou were diagnosed with occupational chronic mild benzene poisoning. Two of the female workers were assessed as Grade 7 disabilities. One female worker showed the symptoms of the decline of whole blood cells for unknown reasons in the later stages of the medical period. The final assessment was a Class 5 disability. The problems in this work ability appraisal include: the injury condition of the patient who has not been stable during the work ability appraisal, and the contradiction between the disability grade and the occupational disease diagnosis conclusion. In order to avoid similar situations, the following recommendations are recommended: after the worker's injury situation is relatively stable, the assessment will be conducted, the employer will actively exercise the right to review and appraisal, and the diagnosis of occupational diseases will be included in the evaluation criteria for disability grade.

[Analysis of 9 cases of nodular type of pulmonary cryptococcosis with coexisting lung cancer confirmed by pathological examinations]

Objective: To describe the characteristics of the nodular type of pulmonary cryptococcosis (PC) with coexisting lung cancer. Methods: A total of 9 cases of PC with coexisting lung cancer, admitted to Fuzhou Pulmonary Hospital of Fujian from 1st January 2009 to 31th December 2016, and confirmed by pathological examinations, were studied and the related literature were reviewed. Results: The patients consisted of 1 male and 8 females, with a mean age of (53±10) years (range, 38 to 68 years). Four patients (44.4%) had underlying diseases, 3 with diabetes mellitus and 1 with gastric cancer surgery. The main clinical manifestations of most cases were cough and phlegm. The lesions of PC on chest CT were mostly solitary or multiple nodules with a diameter < 1 cm, and the lesions of carcinoma were shown as solitary nodules with a variety of signs suggestive of malignancy. All the patients were confirmed to have concomitant PC and lung adenocarcinoma by pathological examinations. Lung cancer stage was early (Tis and Ⅰ-Ⅱ) in 88.9 % (8 cases) of the cases. All the patients received surgery and postoperative medical therapy. The prognosis was relatively good in most of them except 1 case with death due to lung cancer metastasis and 1 case with lung cancer recurrence. Conclusions: Coexistence of PC and lung cancer is rare and the clinical symptoms are not specific. When PC coexists with carcinoma and manifests as pulmonary nodule, it mimics malignant lesions and is extremely easy to be misdiagnosed. Therefore PC must be considered in the differential diagnosis of pulmonary nodules.

[Results analysis of occupational physical examination for silica dust, benzene and noise-exposed laborer in 2016 in Guangzhou City]

Objective: To analyze the results of occupational physical examination for silica dust, benzene and noise-exposed laborer in 2016 in Guangzhou, to provide basis for occupational health supervise. Methods: The data were derived from "occupational disease and health information surveillance system" and the summary data reported by all the occupational physical examination agencies, and analyzed by descriptive epidemiology method. Results: 77506 data from 21 agencies of 12 district were collected, and 63 suspected occupational disease were detected, which including 1 silicosis, 8 benzene poisoning, 54 noise deafness. Conclusion: Noise exposure was distributed widely, noise deafness had to be focused on, occupational chronic benzene poisoning and silicosis should be monitored continuously. Small, foreign economy and manufacturing industry should be supervised firstly.

[Retrospective analysis of 117 cases of pulmonary cryptococcosis]

The clinical symptoms of PC were diverse and nonspecific. Halo sign and proximal air bronchogram are helpful for the diagnosis of PC. The outcome of most patients was satisfactory after appropriate treatment.

[A study on the effects of exposure to benzene on the activity of immunoglobulin E]

Objective: To analyze the level of immunoglobulin E (IgE) changes with benzene exposure workers. Methods: Firstly, through occupational health monitoring, 68 hospitalized cases were discovered who were suspected chronic benzene poisoning. Secondly, according to the GBZ68-2013《The diagnosis of occupational benzene poisoning》standard diagnosis and indexing, 68 cases were divided into the benzene poisoning group (n= 29) and the benzene exposure group (n=39) . 50 cases of healthy workers without benzene exposure were for the control group. Use the immune luminescence method to detect IgE levels. Thirdly, Case-control study was used, observing IgE changes though the three groups by statistical analysis. Results: Compared with control group, the level of leukocyte、neutrophil and IgE was drop in benzene exposure group with statistically significant (P<0.05) . Compared with benzene exposure group, IgE of benzene poisoning group was rise, with statistically significant (P<0.05) , IgE of mild benzene poisoning group rise the most obvious, with statistically significant (P<0.05) . Compared with benzene exposure group, IgE of moderate benzene poisoning group was drop, without statistically significant (P>0.05) . Conclusion: Benzene occupational exposure can induce immunosuppression, IgE decreases, and reduces immune surveillance. The response of the IgE level in the mild benzene poisoning patients was significantly elevated, whether it is protective response of the body immune function needs to be studied further investigated.

[Three dimensional reconstruction measurement study of palatal contour changes in different bone ages after rapid maxillary expansion]

Objective: To compare dental and skeletal changes after rapid maxillary expansion in patients with different bone ages. Methods: Thirty-seven patients in different growth period were divided into three groups according to cervical vertebral maturation (CVM). There were 13 patients in the growth acceleration group, 13 patients in growth peak group, and 11 patients in growth deceleration group. Cone-beam computed tomography (CBCT) images were segmented and reconstructed using Mimics image processing software to assess the change of palatal morphology before and after treatment. Statistical analysis was carried out using SPSS 17.0 software. Results: After the expansion the posterior teeth and alveolar bone were tilted and the mid-palatal suture was opened in all three groups. The first molar angle in the three groups decreased by 2.66°±1.04°, 3.53°±0.81° and 12.32°±1.64°, respectively and no significant difference was found between the acceleration group and the peak group (P >0.05), but the changes in the acceleration group and the peak groups were significantly less than that in the deceleration group (P<0.05). The palatal angle in the three groups increased by 6.01° ± 2.06°, 4.79° ± 1.31° and 6.73° ± 1.71°, respectively and no significant difference was found between the acceleration group and the deceleration group (P>0.05), but the changes in the acceleration group and the deceleration group were significantly greater than that in the peak group (P<0.05). The palatal cemento-enamel junction (CEJ) width, the middle palate width and the mid-palatal suture width in the three groups increased by (7.37 ± 1.31), (6.68 ± 0.72) and (5.13 ± 1.42) mm; (5.72±1.68), (4.82±1.66) and (3.42±1.15) mm; (3.14±0.45), (2.98±0.51) and (0.96±0.83) mm, respectively and no significant difference was found between the acceleration group and the peak group (P >0.05), but the changes in the acceleration group and the peak group were significantly greater than that in the deceleration group (P <0.05). Conclusions: The mid-palatal suture could be opened in patients in different CVM period. More skeletal and less dental effects were found in patients in the growth acceleration and peek group than in those in the growth deceleration group and the inclination of the alveolar bone could be avoided to a greater degree in patients in the growth peek group.

[Growth behavior and metastatic pattern of cervical cancer U14 transfected with human papillomavirus in inbred mouse]

OBJECTIVE

To investigate the growth behavior and metastatic pattern of murine cervix cancer U14 transfected with human papillomavirus(HPV) in inbred 615-strain mouse.

METHODS

We transfected HPV 16 E6 and E7 genes into mouse cervix carcinoma cell strain NO. 14(U14) by electroporation and liposome, respectively. The transfectants were selected by G418, and several high-expressed HPV16 E6 and E7 clonal cell lines (E6+ U14, E7+ U14) were detected by PCR and by immunohistochemistry. We transplanted those cells into inbred 615-strain mice both subcutaneously and intraperitoneally to observe the growth behavior and metastasis of them.

RESULTS

The durations of tumor appearance were 5-7 d, 11-14 d, and 8-10 d after having been transplanted subcutaneously with wild type U14, E6+ U14, and E7+ U14, respectively(P < 0.05). The mean survival times of mice were 29 d, 43 d, and 35 d, respectively. Metastasis could be found both in lymph nodes (90%, 30%, and 40%, respectively) and lungs (60%, 10%, and 20%, respectively). After intraperitoneal inoculation, the mean survival durations of mice were 14.2 d, 20.6 d and 18.3 d. We could not find metastasis both in lymph nodes and lungs.

CONCLUSION

Murine cervix cancer U14 cells transfected with HPV16 E6 and E7 have different growth behavior and metastatic patterns after transplanted in inbred mice, which provide useful models for studying their immunotherapy or other strategies for cervical cancer with E6 and E7 as a target.

[Analysis of the HLA A/B local haplotype among the females of Han nationality in Hunan province]

OBJECTIVE

To investigate and analyse HLA A/B local haplotype gene frequency (HGF) in the females of Han nationality in Hunan.

METHODS

HLA-A, B local antigen polymorphisms were investigated via microcytotoxicity assay. Haplotype was inferred by means of linkage disequilibrium parameter.

RESULTS

Among the 46 haplotypes, HGF high were: A11-B60 (HGF = 0.1381), A2-B60 (HGF = 0.0861), A24-B48 (HGF = 0.0709). Three haplotype's linkage disequilibrium parameter have significant difference, they are A2-B52, A11-B13, A24-B52.

CONCLUSION

The female of Han Nationality of Hunan HLA-A, B especially B local antigen frequency exists difference sompare with Han Nationality in Hunan and other areas in China of mix public of both sexes. When study relativity of the female disease of Han Nationality of Hunan with HAL, should notice HLA distributing particularity, be assure data veracity. Among the 46 haplotypes, A2-B52, A11-B13, A24-B52 three haplotypes exist significant linkage disequilibrium, probably they are own haplotypes at the female of Han Nationality in Hunan.

[Expression of bcl-2 in the normal endometrium and endometrium of adenomyosis]

Using immunohistochemical ABC staining, we detected the expression and role of bcl-2 in normal endometrium(n = 17) and eutopic and ectopic endometrium with adenomyosis(n = 16) during the menstrual cycle. The first result was that the expressions of bcl-2 in the eutopic endometrium were the same as the normal endometrium, showing predominantly in the glandular epithelial cells, and obviously cyclic changes throughout the menstrual cycle. This result suggests that these changes may be regulated by ovarian hormone and play an important role in the proliferation and physiologic death of normal endometrial glandular epithelial cells to regulate the menstrual cycle. Bcl-2 expression in the glandular cells of ectopic endometrium of adenomyosis had no cyclic change and bcl-2 staining had remained in the whole menstrual cycle. The second result suggests that the above mentioned phenomena may play an important role in the pathogenesis of adenomyosis.

Gliotoxin inactivates alcohol dehydrogenase by either covalent modification or free radical damage mediated by redox cycling

The fungal metabolite gliotoxin shows selective toxicity to cells of the immune system and has been implicated in the aetiology of invasive aspergillosis. The related toxin sporidesmin is the causative agent of facial eczema in sheep. The toxicity of these compounds has been related to their ability to redox cycle intracellularly and thus produce damaging free radicals. These toxins are also potentially capable of forming mixed disulphides with thiol groups on proteins by virtue of their bridged disulphide structure. We show here that gliotoxin can inactivate horse liver alcohol dehydrogenase by either oxidative damage or covalent modification of thiol groups on the enzyme. Either Cys-281 or Cys-282 is selectively modified. Neither of these residues are at the active site. Covalent modification occurs in the absence of reducing agents such as dithiothreitol. In the presence of dithiothreitol no protection is observed and the rate of inactivation is enhanced although as expected no covalent modification occurs. Gliotoxin can therefore inhibit alcohol dehydrogenase by either pathway and this will depend on the availability of reducing agents such as glutathione and/or how readily the reactive oxygen species generated are removed.

Cellular uptake and release of the immunomodulating fungal toxin gliotoxin

Uptake of the immunomodulating agent gliotoxin into a panel of cells using biosynthetically radiolabelled 35S toxin showed rapid association of the toxin with all cell types studied with 70-85% of the total counts in the media becoming cell associated. A difference in kinetics was observed for cell lines when compared to the primary cells thymocytes, activated T-cells and macrophages. In the latter uptake was maximal after 10-15 min and radiolabel was lost from the cells as early as 100 min. In the cell lines studied, uptake was complete in less than 1 min with no loss of label after 100 min. The exception to this was a Wilms tumour line. Analysis of the fate of gliotoxin taken up into sensitive (activated T-cells) and resistant (human fibroblast) cells by HPLC showed: (a) up to 30% of the original gliotoxin taken up by sensitive cells was released as free gliotoxin over a 22 hr period. The remainder was metabolized to inorganic sulphate; (b) in T-cells gliotoxin is reduced to the dithiol form in significant amounts and this reduction may be modulated by glutathione; and (c) no reduced gliotoxin could be detected in the resistant fibroblast cell line 27Sk even though up to 50% of the original gliotoxin was still present in the free form in these cells at 22 hr. Gliotoxin became covalently associated with macromolecules in both cell types studied. Very little free gliotoxin is released into extracellular medium by the fibroblast cell line. Gliotoxin at 500 nM was found to induce apoptosis or programmed cell death in the Wilms tumour cell line but not in any other cell line studied, and this may account for the different kinetics of release of the toxin from the Wilms tumour cell line.

Synthesis and Activity of New Epipolythiopiperazine-2,5-dione Compounds. I

The new lipophilic epipolythiopiperazine-2,5-diones 1,4-dibutylepidithiopiperazine-2,5-dione. 1,4-dibenzylepidithiopiperazine-2,5-dione, 1-benzyl-4-methylepidithiopiperazine-2,5-dione and 3,3′-dithiobis(1,4-dimethylpiperazine-2,5-dione) were synthesized. Unlike the parent compound, the fungal toxin and immunomodulating agent gliotoxin, these compounds did not affect macrophage adherence and cell proliferation in vitro. Like the reduced form of gliotoxin and other simple analogues, these new compounds induce oxidative damage to naked DNA. We conclude that an increase in lipophilicity plays no part in the biological activity of these compounds and in fact abrogates almost all activity. We also synthesized an intermolecular disulfide analogue which also lacked activity.

[Epidemiologic investigation of carcinoma of the esophagus and gastric cardia carcinoma in Nanao County, Guangdong province]

Nanao county, Guangdong province is a high incidence area of carcinoma of esophagus and gastric cardia carcinoma. By retrospective investigation of data in the past 14 years (1970 to 1983), the annual average crude mortality of carcinoma of esophagus and gastric cardia carcinoma was found to be 88.65/100,000, the age adjusted mortality of Chinese population was 82.91/100,000 and that of the world population was 113.09/100,000. The mortality of the male was 100.65/100,000 and of the female was 67.24/100,000 with the ratio of 1.38:1. As regards the relationship between the age and mortality, the highest rate occurs from 50 to 74. A higher mortality was also observed in the population engaged in salt production and fishing. The mortality was higher in the lower elevation areas than in the elevated regions.