[Primary hepatic angiosarcoma: a clinicopathological analysis of nine cases]

Objective: To investigate the clinical manifestations, histomorphology, and differential diagnosis of primary hepatic angiosarcoma. Methods: Nine cases of primary hepatic angiosarcoma diagnosed in the Department of Pathology, the First Affiliated Hospital of Nanjing Medical University from January 2014 to December 2021 were collected, including biopsy and surgical specimens. The histomorphology, clinical, and radiologic findings were analyzed. The relevant literature was also reviewed. Results: There were six males and three females, aged 30 to 73 years (mean 57 years). Grossly, the growth pattern of the tumor was classified as either mass formation or non-mass formation (sinusoidal). Microscopically, the mass-forming primary hepatic angiosarcoma were further subdivided into vasoformative or non-vasoformative growth patterns; and those non-vasoformative tumors had either epithelioid, spindled, or undifferentiated sarcomatoid features. Sinusoidal primary hepatic angiosarcoma on the other hand presented with markedly dilated and congested blood vessels of varying sizes, with mild to moderately atypical endothelial cells. Follow-up in all nine cases revealed 8 mortality ranging from 1 to 18 months (mean 5 months) from initial diagnosis. One patient was alive with disease within a period of 48 months. Conclusions: Primary hepatic angiosarcoma is a rare entity with a wide spectrum of histomorphology, and often misdiagnosed. It should be considered when there are dilated and congested sinusoids, with overt nuclear atypia. The overall biological behavior is aggressive, and the prognosis is worse.

[CIC-rearranged sarcoma with rhabdoid features: a clinicopathological analysis]

Objective: To investigate the histopathologic, immunohistochemical, molecular genetic characteristics of CIC-rearranged sarcoma (CRS) with rhabdoid features. Methods: The clinical and pathologic data of two cases of CRS diagnosed between 2019 and 2021 at the Department of Pathology, Jiangsu Province Hospital were analyzed. Immunohistochemical study and fluorescence in situ hybridization (FISH) were performed. The relevant literature was reviewed. Results: Both patients were female, one was 58 years old, with tumor located in left thigh; the other was 43 years old, with tumor located in left pelvic cavity. Microscopically, both tumors were composed of small to medium-sized round, oval cells, arranged in nodules or sheets. The tumor cells showed irregular nuclear outline, coarse chromatin with prominent nucleoli and brisk mitotic activity. Both cases showed rhabdoid phenotype with myxoid stromal changes. Immunohistochemically, both cases were positive for CD99 and c-myc. High WT1 reactivity was seen in classic area, with low reactivity in rhabdoid area. There was no INI1 lost in both cases. Both were negative for NKX2.2 and NKX3.1. By FISH both cases demonstrated convincing break-apart signals of CIC gene. One patient died of disease after 1 month, and the other died of disease after 3 months. Conclusions: CRS is a small round cell undifferentiated sarcoma of the bone and soft tissue defined by molecular genetic characteristics, and may show atypical morphologic and immunophenotypic characteristics such as rhabdoid features. A correct understanding of its rare morphologic and immunophenotypic characteristics, combined with molecular pathologic detection, is conducive to correct diagnosis.

Characterization of biochar-derived organic matter extracted with solvents of differing polarity via ultrahigh-resolution mass spectrometry

In recent years, biochar, a porous carbon-based material, has gained attention for its application prospects in contaminated soil remediation and soil improvement. Biochar-derived organic matter has a key role in influencing the migration and transformation of soil elements and pollutants. However, existing research concerning the molecular characteristics of biochar-derived organic matter is limited. Here, we used four polar solvents - dichloromethane (CH₂Cl₂), acetone (CH₃COCH₃), methanol (CH₃OH), and distilled water (H₂O) - to extract organic matter from soybean straw biochar and wheat straw biochar by accelerated solvent extraction (ASE). We characterized the extracts using Fourier-transform ion cyclotron resonance mass spectrometry (FT-ICR-MS). We found considerable differences in organic matter according to the extraction solvents; such differences were related to the polarity of the solvent, as well as intermolecular forces between the solvent and organic matter. CH₃OH extracted the most biochar-extractable organic matter components because CH₃OH can weaken or destroy oxygen bridge bonds in biochar and form hydrogen bonds with small-molecule organic compounds. CH₃OH and H₂O have strong extraction capacity for compounds containing heteroatoms. CH₂Cl₂-extractable organic matter is relatively labile and bioavailable, while CH₃OH- and H₂O-extractable organic matters are relatively stable. In addition, the binding capacity of biochar-derived organic matter for minerals and pollutants differed among fractions, in part because of differences in molecular weight, atomic O/C and H/C ratios, heteroatom distribution, and biomolecular compounds present in biochar-derived organic matter. The findings in this study help to select appropriate extractants to analyze biochar-derived organic matter for various research purposes, and provides a theoretical basis for biochar-based remediation of contaminated soil.

[Research progress on the relationship between circular RNAs and cataract]

Cataract is the leading cause of visual impairment and blindness on a global scale. The pathogenesis of cataract is not completely understood. Circular RNAs (circRNAs) are a special kind of non-coding RNAs with high stability and conservation. They are widely involved in a variety of biological processes and diseases. Abnormal expression of circRNAs can participate in the development of cataract, affecting the function of lens epithelial cells through interacting with proteins and sponging microRNAs. They are possible targets for cataract prevention and treatment. This article reviews the research progress on the role of circRNAs in the occurrence and development of cataract.

Feasibility of salvage colonoscopy by water exchange for failed air-insufflated patients: a prospective, randomized, controlled trial

BACKGROUND

A complete colonoscopy is crucial for screening colorectal diseases and colorectal cancer. However, a failure rate of up to 43% still exists. Several studies have indicated that the water exchange method can enhance the cecal intubation rate while reducing discomfort of the patient. Water exchange colonoscopy (WEC) might be a salvage treatment for the patients who failed from air insufflation colonoscopy (AIC). We aimed to assess the feasibility of WEC as a salvage measure following the failure of conventional AIC.

METHODS

Patients willing to undergo unsedated colonoscopy at a tertiary-care referral center in China were randomly assigned 1:1 to WEC or AIC group for salvage after the initial AIC attempt failed. Patients were blinded to group assignment. The primary outcome was cecal intubation rate, the secondary outcomes included time to the cecum, maximum pain scores, and technical difficulty level.

RESULTS

Recruited 104 patients were randomized to the WEC (n = 52) or AIC (n = 52) group. WEC significantly increased the cecal intubation rate (92.3% vs 73.1%; p = .02). The maximum pain scores and technical difficulty level in the WEC group were significantly lower than the AIC group during salvage procedure (p < .001).

CONCLUSIONS

This randomized, controlled trial confirms that the WEC significantly enhanced cecal intubation rate in difficult colonoscopy in unsedated patients after the failure of standard AIC. The increased cecal intubation rate, lower pain scores and technical difficulty level suggest WEC is a good alternative for incomplete unsedated colonoscopy. Clinical trial registration number: ChiCTR2100051483.

[Clinical application of extracorporeal membrane oxygenation in the treatment of burn patients with acute respiratory distress syndrome: a retrospective analysis and systematic review]

Objective: To analyze the clinical effect of extracorporeal membrane oxygenation (ECMO) in the treatment of burn patients with acute respiratory distress syndrome (ARDS). Methods: The retrospective observational study and the systematic review were applied. From March 2014 to July 2020, five burn patients with ARDS received ECMO treatment in the First Affiliated Hospital of Army Medical University (the Third Military Medical University). All the five patients were male, aged from 40 to 62 years. The average total burn surface area was 58.8% total body surface area (TBSA) and four cases had severe inhalation injury. Patient's ECMO starting time, duration and mode, and whether successfully weaned or the cause of death, and others. were recorded. Furthermore, the changes of oxygenation and infection before, during, and after utilizing ECMO were analyzed. PubMed and Web of Science from the establishment of each database to August 2021 were searched using "Extracorporeal Membrane Oxygenation", "ECMO", "burn", "inhalation" as the search terms and "Title/Abstract" as the field to retrieve the clinical articles that meet the selection criteria . Basic information were extracted from the articles, including sample size, gender, age, total burn area, inhalation injury, the indication of ECMO, the start and lasting time of ECMO, ECMO mode, rate of successful weaning, complications of ECMO, mortality, the combined application of continuous renal replacement therapy (CRRT). Results: Five patients started venovenous ECMO on an average of 10.2 days after injury and lasted an average of 180.4 hours. Three out of 5 patients were weaned successfully with one patient survived. Four patients died of multiple organ dysfunction syndrome (MODS) and septic shock. Compared with those before ECMO treatment, the arterial oxygen partial pressure (PaO2) and oxygen saturation in arterial blood (SaO2) of three successfully weaned patients obviously increased during and after ECMO treatment. The fraction of inspired oxygen (FiO2) decreased below 50% and PaO2/FiO2 ratio increased above 200 mmHg (1 mmHg=0.133 kPa) during and after ECMO. Furthermore, lactic acid and respiratory rate decreased, basically. Compared with those before ECMO, PaO2 and SaO2 in the other two patients during ECMO, who failed to be weaned, continuously decreased while lactic acid increased. Before and during ECMO, the PaO2/FiO2 ratios of unsuccessfullg weaned cases were less than 200 mmHg, and partial pressure of carbon dioxide in arterial blood (PaCO2) were more than 40 mmHg. Compared with those before ECMO, there were no significant changes in body temperature during and after ECMO, which were less than 38 ℃. Compared with those before ECMO, the leucocyte number (the index without this in unsuccessfully weaned cases was omitted, the same as below) in four patients showed a significant decrease during ECMO, but rose after removal of ECMO. The proportion of neutrophils in three patients were slightly higher during ECMO than before ECMO, and did not change significantly after removal of ECMO. Compared with those before ECMO, platelet counts in three patients were significantly reduced during ECMO, and all five patients during ECMO were below normal levels. Compared with those before ECMO, the procalcitonin levels in four deaths were significantly increased during ECMO. Catheter culture of microorganism was performed in three successfully weaned patients, all of which were negative. A total of 13 literature were included, ranging from 1990 to 2019. The sample size in 6 studies was less than 10, and the sample size in 4 studies was between 10 and 20, and only 2 literatures had a sample size larger than 50. ECMO was applied in 295 burn patients with overall mortality of 48.8% (144/295), including 157 adults and 138 children. The most common indication of ECMO was severe ARDS. Among 157 adult burn patients (95 males and 65 females), 36 cases had inhalation injury. The average burn area was 27%-37%TBSA in 5 reported studies and was more than 50%TBSA in 2 reported studies. The most common mode was venovenous ECMO. ECMO treatment began 26.5 hours to 7.4 days after injury and lasted from 90 hours to 18 days, and the rate of successful weaning ranged from 50% to 100%. The most common complications were bleeding and infection. The mortality was 52.9% (83/157). MODS and sepsis were the leading causes of death. Among 138 pediatric burn patients (77 boys and 61 girls), 29 patients had inhalation injury. The average burn area was 17%-50.2%TBSA in 3 studies. ECMO treatment lasted from 165.2 hours to 324.4 hours. Bleeding was the most common complication. The mortality was 44.2% (61/138). Conclusions: ECMO is an effective strategy for the salvage treatment of burns complicated with ARDS. Furthermore, the prevention and treatment of bleeding, infection and organ dysfunction should be emphasized during the use of ECMO. More importantly, evidence-based guidelines for burns are urgently needed to further improve the clinical effect of ECMO.

Comparison of smear cytology with liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis

BACKGROUND

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) is a safe and accurate technique to confirm the diagnosis of pancreatic cancers. Recently, numerous studies comparing the diagnostic efficacy of smear cytology (SC) and liquid-based cytology (LBC) for pancreatic lesions yielded mixed results.

AIM

To compare and identify the better cytology method for EUS-FNA in pancreatic lesions.

METHODS

A comprehensive search of PubMed, Embase, and Cochrane was undertaken through July 18, 2020. The primary endpoint was diagnostic accuracy (sensitivity and specificity). Secondary outcomes included sample adequacy and post procedure complications. In addition, factors affecting diagnostic efficacy were discussed.

RESULTS

Data on a total of 1121 comparisons from 10 studies met the inclusion criteria. Pooled rates of sensitivity for SC and LBC were 78% (67%-87%) vs 75% (67%-81%), respectively. In any case, both SC and LBC exhibited a high specificity close to 100%. Inadequate samples more often appeared in LBC compared with SC. However, the LBC samples exhibited a better visual field than SC. Very few post procedure complications were observed.

CONCLUSION

Our data suggested that for EUS-FNA in pancreatic lesions (particularly solid lesions), SC with Rapid On-Site Evaluation represents a superior diagnostic technique. If Rapid On-Site Evaluation is unavailable, LBC may replace smears. The diagnostic accuracy of LBC depends on different LBC techniques.

[Clinical application effect of modified nasopharyngeal swab sampling for 2019 novel coronavirus nucleic acid detection]

Objective: To study the clinical application effect of modified nasopharyngeal swab sampling for 2019 novel coronavirus nucleic acid detection. Methods: This study covered the period from January 14 to March 1, 2020.The supine position method and the protective face screen were used to collect nasopharyngeal swabs from February 24 onwards, before which, the nasopharyngeal swabs were collected by sitting position method. All the patients who were diagnosed with suspected/confirmed 2019 novel coronavirus infection were admitted from February 19 with the nasopharyngeal swabs collected outside the hospital before admission. (1) Thirty-four swabbing operators meeting the inclusion criteria of the study were recruited in this retrospective cohort study. They were grouped according to the collection method of nasopharyngeal swabs. Sixteen operators of Wuhan Taikang Tongji Hospital who applied the supine position method and the protective face screen were included in supine position method+ protective face screen group (15 males and 1 female, aged 34-49 years); 18 operators (12 from the First Affiliated Hospital of Army Medical University (the Third Military Medical University), 1 from Wuhan Jiangxia Mobile Cabin Hospital, 5 from the East District of People's Hospital of Wuhan University) who applied the traditional sitting position method were included in sitting position method group (2 males and 16 females, aged 25-49 years). In supine position method+ protective face screen group, when collecting sample, the patient lay flat and wore a special protective face screen for nasopharyngeal swab sampling, with neck slightly extending and face turning to the opposite side of the operator about 10°. The self-designed questionnaire was used to investigate the cooperation, the incidence of nausea, coughing, sneezing, and struggling of patients evaluated by the operators, the operation time for a single swab sample, the fear of operation and the perceived exposure risk of operators in the two groups. (2) Sixty-five patients (22 males and 43 females, aged 25-91 years) admitted to Wuhan Taikang Tongji Hospital who successively received the sitting position method and supine position method+ protective face screen for nasopharyngeal swabs sampling and with complete nucleic acid detection results were included. The positive rates of nucleic acid detection by the two sampling methods of nasopharyngeal swabs of the patients were statistically analyzed. (3) Forty-one patients who could express their feelings accurately were selected out of those 65 patients (12 males and 29 females, aged 27-83 years). The comfort of patients in the process of sampling by the two methods was investigated. (4) Thirty-four patients (10 males and 24 females, aged 25-83 years) with two or more consecutive negative results of nucleic acid detection of nasopharyngeal swabs by sitting position method were selected from the above 65 patients. The positive rate of nucleic acid detection of nasopharyngeal swab of patients by supine position method+ protective face screen, i. e. negative to positive rate was statistically analyzed. Data were statistically analyzed with t test, Wilcoxon signed rank test, and chi-square test. Results: (1) Compared with those of sitting position method group, the cooperation score of patients evaluated by the operators in supine position method+ protective face screen group was significantly higher (Z=-4.928, P<0.01), the incidence of nausea, choking cough, sneezing, and struggling of patients evaluated by the operators, and the fear of operation score and the perceived exposure risk score of operators in supine position method+ protective face screen group were significantly lower (Z=-5.071, -5.046, -4.095, -4.397, -4.174, -5.049, P<0.01), and the operation time for a single swab sample in supine position method+ protective face screen group was significantly longer (t=223.17, P<0.01). (2) The positive rate of nucleic acid detection of nasopharyngeal swabs by supine position method+ protective face screen was 60.00% (39/65), which was obviously higher than 41.54% (27/65) by sitting position method (χ(2)=4.432, P<0.05). (3) The comfort score of the 41 patients during nasopharyngeal swabs sampling by supine position method+ protective face screen was significantly higher than that by sitting position method (Z=-5.319, P<0.01). (4) Of the 34 patients with two or more consecutive negative results of nucleic acid detection of nasopharyngeal swabs by sitting position method, the rate of negative to positive of nucleic acid detection was 26.47% (9/34) after sampling by supine position method+ protective face screen. Conclusions: Compared with the traditional sitting position method, detection of 2019 novel coronavirus nucleic acids of nasopharyngeal swabs collected by supine method combined with protective face screen is worth promoting, because of its better comfort of patients, low exposure risk for operators, in addition to reducing in the false negative result to some extent, which may help reduce false recurrence of discharged patients.

[Recommendations for normalizing the medical practices of burn treatment during the outbreak of coronavirus disease 2019]

2019 novel coronavirus (2019-nCoV) is one of the beta coronaviruses and is identified as the pathogen of the severe " coronavirus disease 2019 (COVID-19)" in 2019. China manages COVID-19 according to the reguirement of the highest level infectious diseases in China. Currently, the prevention and control of COVID-19 in China is at a critical period. Burn Department as an emergency discipline is confronted with risk of 2019-nCoV infection. Based on the guidelines for the diagnosis and treatment of COVID-19 (6th trial edition), in combination with the latest literature at home and abroad, the features of the COVID-19, the recommendations for the COVID-19 prevention and control issued by the National Health Commission of China, and the management experience of COVID-19 diagnosis and treatment of other related disciplines, we put forward some recommendations for the medical practices of burn treatment during the outbreak of the COVID-19 in outpatient and emergency, inpatient treatment, and the management of operation theatres and wards, etc. We hope these recommendations could benefit the medical professionals in the field of burn treatment and relevant hospital management during the outbreak of COVID-19, improve burn treatment, and avoid or reduce the risk of infection of medical staff.

[Polarization of bone marrow-derived macrophages induced by recombinant Trichinella spiralis cysteine protease inhibitors in vitro]

OBJECTIVE

To investigate the regulatory role of recombinant Trichinella spiralis cysteine protease inhibitors (rTs-Cys) in induction of polarization of bone marrow-derived macrophages (BMDMs) in vitro.

METHODS

BMDMs were captured and cultured in conditioned medium for 7 days. Then, mature BMDMs were harvested and assigned into four groups. Cells in Group A (negative control) were given 10 ng/mL IFN-γ combined with 100 ng/mL LPS, cells in Group B (positive control) were treated with IL-4 and IL-10 (at 10 ng/mL both), and cells in Group C (recombinant protein alone) were stimulated with 1 μg/mL rTs-Cys, while cells in Group D (protein co-culture) were simultaneously treated with 1 μg/mL rTs-Cys, 10 ng/mL IFN-γ and 100 ng/mL LPS. Cells and culture supernatant were collected 24 hour post-treatment, and the proportions of F4/80⁺, CD11b⁺, CD206⁺ and CD11c⁺ cells were detected by flow cytometry. The levels of interleukin IL-6 (IL-6), tumor necrosis factor-α (TNF-α), IL-10 and transforming growth factor-β (TGF-β) in the cell culture supernatant were measured by ELISA and the CD86⁺ and CD206⁺ phenotypes were identified by immunofluorescent staining.

RESULTS

Flow cytometry detected no significant difference in the proportion of F4/80⁺ CD11b⁺ CD11c⁺ cells among the four groups (F = 46.184, P < 0.001), and a lower proportion of F4/80⁺ CD11b⁺ CD11c⁺ cells was seen in groups C and D than in group A (all P values < 0.001). There was a significant difference in the proportion of F4/80⁺ CD11b⁺ CD206⁺ cells among the four groups (F = 11.032, P < 0.001), and a greater proportion of F4/80⁺ CD11b⁺ CD206⁺ cells was seen in groups C and D than in group A (all P values < 0.01). Immunofluorescent staining showed higher CD206⁺ expression and lower CD86⁺ expression in groups C and D than in Group A. There were significant differences in the IL-6 and (F = 3.950, P < 0.001) and TNF-α (F = 205.827, P < 0.001) levels in the cell culture supernatants among the four groups, and significantly lower IL-6 and TNF-α levels were measured in groups C and D than in Group A (both P < 0.05). There were significant differences in the IL-10 and (F = 8.274, P < 0.001) and TGF-β (F = 13.559, P < 0.01) levels in the cell culture supernatants among the four groups, and greater IL-10 and TGF-β levels were measured in Group C than in Group A (both P values < 0.01). In addition, the TGF-β level was significantly higher in Group D than in Group A (P < 0.05); however, there was no significant difference in the IL-10 level between groups D and A (P > 0.05).

CONCLUSIONS

rTs-Cys may induce the polarization of BMDMs to antiinflammatory M2 macrophages in vitro and inhibit the activation of M1 macrophages.

[The surgical management of upper parapharyngeal regions]

Objective: To find proper the surgical approval and evaluate clinical efficacy to treat the tumor of upper parapharyngeal space involving the base of skull and intracranial skull. Method: The data of 9 cases from June 2013 and June 2018 were analyzed retrospectively including schwannoma in 6 cases, pleomorphic adenoma in 2 cases and hemangioma in 1 case. All cases received preoperative high resolution CT and MRI, some cases also did the DSA examination. Tumor invaded top of nasopharyngeal in 4 cases, the base of skull in 3 cases, and intraskull in 2 cases. 9 cases were treated with surgery alone. Surgical approach: transcervical approach (n=1), transcervical approach and mandibular fracture surgery(n=2), transoral approach(n=3), transnasal transpterygoid approach(n=2), transparotid gland approach(n=1). Result: Tumors in 8 cases were completely removed, and 1 case was performed by partial excision. Hemorrhage(>500 ml) occurred in 2 cases, tongue deflection and cerebrospinal fluid leakage occurred in 1 case. No death, tumor recurrence and wound infection was found. Conclusion: The position of benign upper parapharyngeal space tumors is deep and tumor often invade in the base of the skull and brain tissue. It is close to the important nerve, vessels of the skull base and meninges. The appropriate surgical approach should be selected according to the individual situation. The main point of the operation is complete the tumor resection with preserving or reconstructing the important function of the blood vessel and nerve.

[Comparison of clinical outcomes of frozen-thawed blastocysts derived from non-pronucleus or two pronucleus zygotes]

Objective: To evaluate the application value of the blastocysts derived from non-pronucleus (0PN) zygotes by the good quality blastocyst formation rate and the clinical outcomes of frozen-thawed blastocyst transfers. Methods: The good quality blastocyst formation rate derived from 0PN zygotes was compared with that derived from2 pronucleus (2PN) zygotes in in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles from January 2015 to December 2016. In addition, the clinical pregnancy, embryo implantation and live birth rates of frozen-thawed blastocyst transfers with blastocysts derived from 0PN and 2PN zygotes were analyzed on corresponding dates. Results: (1) In IVF cycles, the high quality blastocysts formation rate of 2PN embryos was significantly higher than that of 0PN (46.64% versus 42.42%, P<0.01) . In ICSI cycles, the high quality blastocysts formation rate of 2PN embryos was markedly higher than that of 0PN (41.96% versus 21.73%, P<0.01) . (2) In frozen-thawed embryo transfer cycles for IVF, the clinical pregnancy, implantation and live birth rates of D5 0PN blastocysts were significantly higher than those of D6 2PN (52.64% versus 46.78%, 49.91% versus 41.20%, 46.54% versus 39.56%, all P<0.05) , however, the abortion and newborn abnormal rates of D5 0PN blastocysts were lower than those of D6 2PN blastocysts (17.37% versus 23.36%, 1.31% versus 4.21%, both P<0.05) ; the clinical pregnancy, implantation and livebirth rates of D5 2PN blastocysts were significantly higher than those of D5 0PN (59.73% versus 52.64%, 55.95% versus 49.91%, 53.03% versus 46.54%, all P<0.05) , but newborn abnormal rate was a little higher than that of D5 0PN (3.90% versus 1.31%, P<0.05) ; the clinical pregnancy, implantation and live birth rates of D5 2PN blastocysts were significantly higher than those of D6 2PN (59.73% versus 46.78%, 55.95% versus 41.20%, 53.03% versus 39.56%, all P<0.05) , and the abortion rate of D5 2PN blastocysts was lower than that of D6 2PN blastocysts (18.23% versus 23.36%, P<0.05) . Conclusions: Although the blastocysts derived from 0PN could be transffered, the blastocysts derived from 2PN zygotes are preferred in all cycles. In IVF cycles, the good quality blastocysts derived from 2PN or 0PN zygotes will be transferred.

[Clinical efficacy of of endoscopic assisted open pathway combined with radiotherapy in the treatment of advanced maxillary sinus malignant tumor]

Objective:The aim of this study is to analyze the clinical effect of endoscopic assisted open pathway combined with radiotherapy in the treatment of patients with advanced maxillary sinus malignant tumor.Method:A retrospective analysis was performed on the survival of 29 patients with advanced maxillary sinus malignant tumor treated by endoscopic assisted open approach combined with radiotherapy.Result:A total of twenty nine patients with cancer lesions were successfully resected, of which 7 cases underwent preoperative radiotherapy plus surgery plus postoperative radiotherapy, 22 cases were treated by surgery plus radiotherapy after operation. The median follow up time was 60 months (23-129 months). The 3 year and 5 year survival rate of the patients was 72% and 61%, respectively (90% and 80% was in Ⅱ stage respectively. 63% and 51% was in Ⅲ+Ⅳ stage respectively).Conclusion:Endoscopic assisted open pathway combined with radiotherapy is an effective method for the treatment of maxillary sinus carcinoma, and it can still be well treated with preoperative radiotherapy in patients with stage Ⅳ without distant metastasis.

[Minimum battery of test inhalant allergens needed in screeningallergic rhinitis patients in Beijing]

Objective:The aim was to assess the prevalence of sensitized inhalant allergens in patients with allergic rhinitis (AR), analyze the differences of aeroallergen sensitization rates (SRs) in different areas, and define the minimal number and the type of aeroallergens required to identify patients as sensitized. Method:Six thousand two hundred and eighty five patients suffering from AR symptoms in Beijing, Heilongjiang, Inner Mongolia, Hebei and Shandong areas underwent standardized skin prick test (SPT) with 20 common aeroallergens during the period from Jan 2011 to Jul 2013 when seeking medical help in Beijing Tongren Hospital. The differences of aeroallergen sensitization rates in different areas were compared. Chi square was used in statistical analysis. Conditional approach allowed to determine the aeroallergen selection. Result:Among the 6 285 self-reported AR patients investigated, 5 575 (88.7%) patients had at least one positive skin prick reaction. The most common aeroallergen in Beijing, Heilongjiang, Hebei and Shandongwere house dust mites (HDMs). SRs of HDMs in these four areas decreased with latitude increment, whereas SRs of mugwort, ragweed and dandelion in these four areas increased with latitude increment. The three most prevalent aeroallergens in Inner Mongolia were mugwort (59.86%), ragweed (47.62%) and dandelion (46.26%), respectively. Overall, 8 allergens allowed identification ≥95% of sensitized subjects in Beijing. Conclusion:Der f was the most prevalent allergen in patients with AR in Beijing, Heilongjiang, Hebei and Shandong Areas, whereas SR of mugwort was highest in Inner Mongolia. Sensitization pattern of aeroallergens varied with areas. Eight allergens allowed identification of the majority of sensitized subjects in screening panels for allergy in Beijing.

[Mechanism of protective effects of tumor necrosis factor receptor associated protein 1 on hypoxic cardiomyocytes of rats]

Objective: To investigate the mechanism of protective effects of tumor necrosis factor receptor associated protein 1 (TRAP1) on hypoxic cardiomyocytes of rats. Methods: Primary cultured cardiomyocytes were obtained from neonatal Sprague-Dawley rats (aged 1 to 3 days) and then used in the following experiments. (1) Cells were divided into group TRAP1 and control group according to the random number table (the same grouping method below), and then the total protein of cells was extracted. Total protein of cells in group TRAP1 was added with mouse anti-rat TRAP1 monoclonal antibody, while that in control group was added with the same type of IgG from mouse. Co-immunoprecipitation and protein mass spectrography analysis were used to determine the possible proteins interacted with TRAP1. (2) Cells were divided into normoxia blank control group (NBC), normoxia+ TRAP1 interference control group (NTIC), normoxia+ TRAP1 interference group (NTI), normoxia+ TRAP1 over-expression control group (NTOC), and normoxia+ TRAP1 over-expression group (NTO), with 1 well in each group. Cells in group NBC were routinely cultured, while cells in the latter four groups were respectively added with TRAP1 RNA interference empty virus vector, TRAP1 RNA interference adenovirus vector, TRAP1 over-expression empty virus vector, and TRAP1 over-expression adenovirus vector. Another batch of cells were divided into group NBC, hypoxic blank control group (HBC), hypoxic+ TRAP1 interference control group (HTIC), hypoxic+ TRAP1 interference group (HTI), hypoxic+ TRAP1 over-expression control group (HTOC), and hypoxic+ TRAP1 over-expression group (HTO), with 1 well in each group. Cells in hypoxic groups were under hypoxic condition for 6 hours after being treated as those in the corresponding normoxia groups, respectively. The mRNA expression of cytochrome c oxidase subunit Ⅱ (COXⅡ) of cells in each group was detected by real time fluorescent quantitive reverse transcription polymerase chain reaction. Experiments were repeated for three times. (3) Cells were divided into group NBC, group HBC, group HTOC, group HTO, hypoxic+ TRAP1 over-expression+ COXⅡinterference control group (HTOCIC), and hypoxic+ TRAP1 over-expression+ COXⅡinterference group (HTOCI), with 3 wells in each group. Cells in the previous 4 groups were treated as those in experiment (2). Cells in group HTOCIC and HTOCI were respectively transfected with COXⅡ RNA interference empty virus vector and COXⅡ RNA interference adenovirus vector, and then both added with TRAP1 over-expression adenovirus vector. The proliferation activity of cells was determined by cell counting kit 8 and microplate reader, and the ratio of death cells was measured by propidium lodide and Hoechst 33342 staining. Another batch of cells were divided into group NBC, group HBC, group HTIC, group HTI, hypoxic+ TRAP1 interference+ COXⅡover-expression control group (HTICOC), and hypoxic+ TRAP1 interference+ COXⅡ over-expression group (HTICO), with 3 wells in each group. Cells in the previous 4 groups were treated as those in experiment (2). Cells in group HTICOC and HTICO were both transfected with TRAP1 RNA interference adenovirus vector, and then respectively added with COXⅡ over-expression empty virus vector and COXⅡ over-expression adenovirus vector. The proliferation activity of cells and the ratio of death cells were detected as before. Experiments were repeated for three times. Data were processed with one-way analysis of variance and LSD test. Results: (1) The expression of TRAP1 was found in cells of group TRAP1, while that was not found in cells of control group. The possible proteins interacted with TRAP1 were keratin, COXⅡ, and an unknown protein with predicted molecular weight 13×10³. (2) Compared with that in group NBC, the mRNA expression of COXⅡof cells had no significant change in group NTIC and group NTOC (with P values above 0.05), but significantly decreased in group NTI (P<0.01), and significantly increased in group NTO (P<0.01). Compared with that in group NBC, the mRNA expression of COXⅡof cells in group HBC was significantly decreased (P<0.01). Compared with that in group HBC, the mRNA expression of COXⅡof cells had no significant change in group HTIC and group HTOC (with P values above 0.05), but significantly decreased in group HTI (P<0.01), and significantly increased in group HTO (P<0.01). (3) The proliferation activity of cells in group NBC, group HBC, group HTOC, group HTO, group HTOCIC, and group HTOCI was respectively 0.498±0.022, 0.303±0.018, 0.313±0.032, 0.456±0.031, 0.448±0.034, and 0.335±0.026, and the ratios of death cells in above groups were respectively (4.7±1.5)%, (24.7±3.1)%, (26.0±2.7)%, (13.3±2.5)%, (12.7±2.1)%, and (21.0±1.7)%. Compared with those in group NBC, the proliferation activity of cells in HBC was decreased, while the ratio of death cells was increased (with P values below 0.01). Compared with those in group HBC, the proliferation activity of cells and the ratio of death cells in group HTOC had no significant change (with P values above 0.05), while the proliferation activity of cells was increased and the ratio of death cells was decreased in group HTO (with P values below 0.01). Compared with those in group HTO, the proliferation activity of cells and the ratio of death cells in group HTOCIC had no significant change (with P values above 0.05), while the proliferation activity of cells was decreased and the ratio of death cells was increased in group HTOCI (with P values below 0.01). (4) The proliferation activity of cells in group NBC, group HBC, group HTIC, group HTI, group HTICOC, and group HTICO was respectively 0.444±0.025, 0.275±0.016, 0.283±0.021, 0.150±0.009, 0.135±0.011, and 0.237±0.017, and the ratios of death cells in above groups were respectively (3.7±0.6)%, (21.0±2.7)%, (20.3±3.1)%, (31.7±2.5)%, (33.3±3.2)%, and (19.3±1.5)%. Compared with those in group HBC, the proliferation activity of cells and the ratio of death cells in group HTIC had no significant change (with P values above 0.05). Compared with those in group HBC and group HTIC, the proliferation activity of cells was decreased and the ratio of death cells was significantly increased in group HTI (with P values below 0.01). Compared with those in group HTI, the proliferation activity of cells and the ratio of death cells in group HTICOC had no significant change (with P values above 0.05), while the proliferation activity of cells was increased and the ratio of death cells was significantly decreased in group HTICO (with P values below 0.01). Conclusions: TRAP1 can up-regulate the expression of COXⅡ mRNA, and COXⅡ is one of the downstream effector molecules that TRAP1 mediates its protective effects on hypoxic cardiomyocytes.

[Research Progress of the Relationship between the Expression of TAR DNA-binding Domain Protein 43 and Brain Injury]

TAR DNA-binding domain protein 43 （TDP-43） is a highly conserved and widely expressed nuclear protein. Nowadays, the expression of TDP-43 can be found in most neurodegenerative diseases such as Alzheimer's disease, which makes it become a neurodegenerative disease associated marker protein. From the current research status at homeland and abroad, and around the relationship between the expression of TDP-43 and brain injury, this article emphatically probes into the specific expression and function of TDP-43 in acute and chronic brain injury based on the knowledge of its biological characteristics, which aims to explore the feasibility for determining the cause of death and the injury and disability situations by TDP-43 in forensic pathology.

A new phase of phosphorus: the missed tricycle type red phosphorene

We predict a new two-dimensional allotrope of phosphorus, which we call red phosphorene, by restructuring the segments of the previously proposed blue and black phosphorenes. Its atomic and electronic structures as well as the thermodynamic and dynamic stabilities are systematically studied by first-principles calculations. The results indicate that the red phosphorene is dynamically stable and possesses remarkably thermodynamical stability comparable to that of the black one. Because of the sp(3)-hybridization and the formation of a localized lone pair, red phosphorene is a semiconductor with an indirect band gap of about 1.96 eV, which can be effectively modulated by in-plane strains due to its wave-like configuration. We find that the red, black and blue phosphorenes show evident distinction in their layer thicknesses, surface work functions, and possible colors, based on which one can distinguish them in future experiments.

Investigation of relationships among gastroesophageal reflux disease subtypes using narrow band imaging magnifying endoscopy

AIM: To investigate the relationships among subtypes of gastroesophageal reflux disease (GERD) using narrow band imaging (NBI) magnifying endoscopy.

METHODS: A reflux disease questionnaire was used to screen 120 patients representing the three subtypes of GERD (n = 40 for each subtypes): nonerosive reflux disease (NERD), reflux esophagitis (RE) and Barrett’s esophagus (BE). NBI magnifying endoscopic procedure was performed on the patients as well as on 40 healthy controls. The demographic and clinical characteristics, and NBI magnifying endoscopic features, were recorded and compared among the groups. Targeted biopsy and histopathological examination were conducted if there were any abnormalities. SPSS 18.0 software was used for all statistical analysis.

RESULTS: Compared with healthy controls, a significantly higher proportion of GERD patients had increased number of intrapapillary capillary loops (IPCLs) (78.3% vs 20%, P < 0.05), presence of microerosions (41.7% vs 0%, P < 0.05), and a non-round pit pattern below the squamocolumnar junction (88.3% vs 30%, P < 0.05). The maximum (228 ± 4.8 vs 144 ± 4.7, P < 0.05), minimum (171 ± 3.8 vs 103 ± 4.4, P < 0.05), and average (199 ± 3.9 vs 119 ± 3.9, P < 0.05) numbers of IPCLs/field were also significantly greater in GERD patients. However, comparison among groups of the three subtypes showed no significant differences or any linear trend, except that microerosions were present in 60% of the RE patients, but in only 35% and 30% of the NERD and BE patients, respectively (P < 0.05).

CONCLUSION: Patients with GERD, irrespective of subtype, have similar micro changes in the distal esophagus. The three forms of the disease are probably independent of each other.

Associations of lifestyle-related factors, hsa-miR-149 and hsa-miR-605 gene polymorphisms with gastrointestinal cancer risk

To explore the associations of SNPs within hsa-miR-605 (rs2043556) and hsa-miR-149 (rs2292832) and lifestyle-related factors with gastrointestinal cancer, a case-control study including 762 cases and 757 controls was conducted. Marginally significant associations were found both for hsa-miR-149 rs2292832 with gastric cancer risk (TC + CC vs. TT, OR = 0.68, 95% CI: 0.44-1.04) and for hsa-miR-605 rs2043556 with colorectal cancer risk (AG + GG vs. AA, OR = 0.70, 95% CI: 0.48-1.02) in males. Tea drinking showed a protective effect on gastric cancer risk (OR = 0.28, 95% CI: 0.13-0.60), while smoke inhalation increased the risk of gastric cancer (OR = 1.94, 95% CI: 1.08-3.47). Irritability was found to be a risk factor for both colorectal cancer (OR = 1.61, 95% CI: 1.02-2.53) and gastric cancer (OR = 1.96, 95% CI: 1.17-3.29). Among those that engaged in smoke inhalation, miR-149 CT/CC and miR-605 AG/GG genotype carriers had increased susceptibilities to colorectal cancer (OR = 1.90, 95% CI: 1.11-3.25) and gastric cancer (OR = 1.87, 95% CI: 1.03-3.42), respectively. Among the tea drinkers, there exists a marginally protective effect of miR-605 AG/GG genotypes on colorectal cancer incidence (OR = 0.71, 95% CI: 0.47-1.06) and a significantly protective effect of miR-149 CT/CC on gastric cancer incidence (OR = 0.47, 95% CI: 0.29-0.77). The SNPs of rs2292832 and rs2043556 might be able to modify the susceptibility to male gastric and colorectal cancers, respectively. Tea drinking is a protective factor, while smoke inhalation is a risk factor for gastric cancer, and they might have the potential to modify the associations between miR-149 and miR-605 polymorphisms with gastrointestinal cancer risk. In addition, irritability was shown to be a risk factor for both gastric and colorectal cancers.

[Side effects of non-steroidal anti-inflammatory drugs on gastric mucosa and preventive effects of teprenone]

OBJECTIVE

To evaluate the side effects of non-steroidal anti-inflammatory drugs (NSAID) on gastric mucosa, and to study the preventive effects of teprenone in patients.

METHODS

108 patients taking NSAID for more than 3 months with no infection of helicobacter pylori (Hp) were collected. All patients were screened by endoscopy and their upper gastrointestinal symptoms were evaluated. Then, 16 patients with ulcers were excluded and 92 patients were randomly divided into intervention group with teprenone and control group. After follow-up for 3 months, patients were screened again by endoscopy and their upper gastrointestinal symptoms were also evaluated. Specimens of gastric mucosa were studied by PAS dyeing, and Cyclooxygenase (COX) level were evaluated by immunohistochemical technique.

RESULTS

Of patients taking NSAIDs, the erosion was found in 48 (44.4%) patients while 16 (14.8%) were found with peptic ulcers. The damages were improved significantly (Z = -4.96, P = 0.000) in the intervention group with teprenone (n = 45) as compared with control group (n = 47) after follow-up for 3 months. Both the cox-1 level [31.1% (14/45) vs 6.7% (3/45), P = 0.003] and mucus thickness [66.7% (30/45) vs 13.3% (6/45), P= 0.000] also increased in the intervention group as compared with control group. No significant difference was found on COX-2 level between these two groups [28.9% (13/45) vs 31.1% (14/45), P = 0.82].

CONCLUSION

Long-term use of NSAID caused severe damages on gastric and duodenal mucosa; teprenone improved NSAID-related gastric side effects and increased the COX-1 level and mucus thickness.

Significance of DNA ploidy analysis and carcinoembryonic antigen assay for differential diagnosis between benign and malignant ascites

AIM: To investigate the differential diagnostic significance of DNA ploidy analysis and serum, ascetic carcinoembryonic antigen (CEA), ascites/serum CEA ratios assay in malignant (PHC and non-PHC malignancy) and benign ascites.

METHODS: Flow cytometry (FCM) was used for DNA ploidy analysis and enzyme linked immunosorbent assay (ELISA) for CEA assay in 56 malignant (31 PHC and 25 non-PHC) ascites. As a control, 50 nonmalignant ascites were evaluated at the same time. If the serum or ascitic CEA value >5 μg/L, and the ascites/serum CEA ratios >1, then the CEA assay was defined as positive. If an aneuploidy was detected, the result of the DNA ploidy analysis was defined as positive.

RESULTS: The sensitivity and specificity of ascitic CEA, ascites/serum CEA ratios>1 and aneuploidy in differential diagnosis of PHC ascites and non-PHC with malignant ascites or with benign ascites were 35.48%, 84% and 72%, 84%; 35.48%, 98% and 72%, 98%; 70.97%, 86% and 71.43%, 86%, respectively. The sensitivity and specificity of the combination assay of aneuploidy and ascites/serum CEA ratios >1 in differential diagnosis of PHC ascites and non-PHC with malignant ascites or with benign ascites were 93.55%, 100%; 92%, 100%, respectively.

CONCLUSION: Our study confirmed the differential diagnostic value between benign and malignant ascites of the combination assay of ascites/serum CEA ratios assay and the DNA ploidy analysis.

A new strategy for prenatal diagnosis of homozygous alpha(0)-thalassemia

OBJECTIVES

We have shown previously that ultrasound examination performed by one experienced operator can be useful to exclude homozygous alpha(0)-thalassemia in a tertiary referral center. This study aimed to determine whether the technique was still applicable when performed by several operators and in different centers.

METHODS

At the Maternal and Neonatal Hospital of Guangzhou (MNH) and Tsan Yuk Hospital of Hong Kong (TYH), women at risk of homozygous alpha(0)-thalassemia were given the option of a non-invasive approach (using serial ultrasound examinations at 12-15, 16-20 and 25-30 weeks' gestation) to exclude an affected pregnancy. The fetal cardiothoracic ratio (CTR) was measured at each of these examinations and the placental thickness was measured at 12-15 weeks' gestation. The operators of MNH received training on the ultrasound examination techniques at TYH and the quality of the subsequent ultrasound examinations was checked regularly. The final diagnosis of homozygous alpha(0)-thalassemia was confirmed using an invasive test.

RESULTS

Of 832 at-risk pregnancies studied in the two hospitals, 168 (20.2%) were affected. The overall sensitivity and specificity of the non-invasive approach was 100% and 95.6%, respectively. At MNH, the need for an invasive test was reduced by 80.8%, and all the affected pregnancies were diagnosed before 24 weeks' gestation. The results achieved at MNH were comparable with those at TYH. The at-risk pregnancies including the affected ones presented at a more advanced gestational age at MNH. At each hospital, one affected pregnancy was missed at the 12-week scan but this was subsequently detected at the 15-18-week scan.

CONCLUSIONS

This non-invasive approach to exclude homozygous alpha(0)-thalassemia can be applicable when it is performed by several operators and in different centers.

False-positive fluorine-18 fluorodeoxy-D-glucose positron emission tomography imaging caused by retained gauze in a woman with recurrent ovarian cancer: a case report

We report a case of a 47-year-old woman with a false-positive [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) result caused by retained gauze during resection of liver metastasis for a Stage IV ovarian cancer at primary cytoreductive surgery. She achieved complete remission and remained free of progression for seven years. Owing to elevation of CA-125, computed tomography and PET studies were performed, and both showed two potentially resectable lesions. One was located ventral to the diaphragmatic surface of the left hepatic lobe and the other was around the gauze at the right hepatorenal fossa. During surgical intervention, the left supraheptic tumor was excised and the gauze with surrounding granulation was removed. However, the former proved to be recurrent ovarian cancer with the latter proven false-positive. This case demonstrates that PET results should be interpreted with caution in differentiating a benign inflammatory process from malignant abnormalities, especially in regions with a high probability of granulomatous lesions.

Liver graft-versus-host disease after donor lymphocyte infusion for relapses of hematologic malignancies post allogeneic hematopoietic stem cell transplantation

Graft-versus-host disease (GVHD) is the commonest complication after donor lymphocyte infusion (DLI). In 19 patients undergoing DLI for relapses of hematologic malignancies post hematopoietic stem cell transplantation (HSCT), 11 developed GVHD, of whom nine had isolated liver involvement, and two had liver and skin involvement. The clinical diagnosis of liver GVHD was hepatitic in six patients (55%) and classical in five patients (45%). Patients with GVHD post-DLI showed a different clinical pattern when compared to a cohort of 106 cases of GVHD post-HSCT, in having significantly more isolated liver involvement (9/11 vs 17/106, P<0.001), and less skin (2/11 vs 80/106, P<0.001) and gut (0/11 vs 28/106, P<0.001) involvement. However, liver GVHD post-DLI and post-HSCT had comparable patient characteristics, underlying diseases, clinical subtypes (classical and hepatitic) and response to treatment.

Non-myeloablative allogeneic peripheral stem cell transplantation for multiple myeloma

OBJECTIVE

To present an institution's 2-year experience of non-myeloablative allogeneic stem cell transplantation among Chinese patients.

DESIGN

Retrospective study.

SETTING

Bone marrow transplantation unit at a university hospital, Hong Kong.

PATIENTS

Ten patients with multiple myeloma who received non-myeloablative allogeneic stem cell transplantation between March 2000 and October 2002.

INTERVENTION

Fludarabine (90 mg/m(2)) and total body irradiation (300 cGy) were given as conditioning regimens, followed by non-myeloablative allogeneic stem cell transplantation.

MAIN OUTCOME MEASURES

Engraftment, regimen-related toxicity, treatment-related mortality (in the first 100 days), incidence of graft-versus-host disease, chimerism, disease response, and survival rate.

RESULTS

All 10 patients had active disease before transplantation. The donors were eight human leukocyte antigen-matched siblings, a mismatched sibling, and a matched daughter. Satisfactory engraftment before day 21 was achieved without early treatment-related mortality. Five patients developed full donor chimerism by day 28 and three other patients had 100% donor chimerism by day 100. Acute graft-versus-host disease developed in six patients (five with grade III and one with grade IV disease), and chronic graft-versus-host disease developed in eight patients (four with extensive disease). Complete remission and partial response were achieved in three and four patients, respectively. Three patients did not respond to treatment, and one case of relapse was observed. Only one patient, who had shown a partial response, received donor lymphocyte infusion; seven patients received thalidomide for graft-versus-host disease with or without graft-versus-myeloma effect. All patients were alive after a median follow-up of 1 year.

CONCLUSION

Non-myeloablative allogeneic stem cell transplantation for multiple myeloma is effective, has low toxicity, and results in low treatment-related mortality. Studies of more cases with longer follow-up durations are required.

Nontuberculous mycobacterial infections in Chinese hematopoietic stem cell transplantation recipients

Between 1995 and 2002, nine cases of nontuberculous mycobacterium (NTM) were isolated from 462 allogeneic stem cell transplant (SCT) recipients (1.9%), and none from 139 autologous cases. They included three cases each of Mycobacterium fortuitum and M. chelonae, and single cases of M. scrofalaceum, M. gordonnae and M. avium complex. Seven cases were respiratory, including five cases requiring treatment, and two involved infected catheters and vascular conduits. Compared with nine cases of mycobacterium tuberculosis (MTB) isolated in the same period, NTM isolation occurred later after HSCT and involved more unrelated donors. Important risk factors for NTM infection included significant aGVHD (P=0.043), leukemia relapse (P=0.022), MUD and mismatch SCT (P<0.001) and existence of BO (P<0.001). Coinfection with aspergillus was common. Invasive NTM disease required prolonged antimicrobial treatment in five cases due to M. fortuitum and M. chelonae. With better MTB prophylaxis, intensive immunosuppression and better awareness, NTM has become an emerging threat in oriental allogeneic HSCT recipients. The cutoff between colonization and infection, and the threshold for starting treatment is unclear. NTM isolation is a marker for severe immunosuppression and poor prognosis. When there is doubt over species identity or extent of infection, broad-spectrum cover may be prudent.

Disseminated zoster, hyponatraemia, severe abdominal pain and leukaemia relapse: recognition of a new clinical quartet after bone marrow transplantation

Reactivation of varicella-zoster virus (VZV) is one of the commonest complications after stem cell transplantation, and often presents with atypical manifestations. We describe two unusual cases of occult disseminated zoster in allogeneic stem cell transplant recipients, presenting as severe abdominal pain and syndrome of inappropriate antidiuretic hormone secretion/hyponatraemia, and accompanied by leukaemia relapse. There was complete clinical recovery with high-dose aciclovir and intravenous immunoglobulin. Prompt treatment of leukaemia relapse also resulted in complete remission. A possible immunological link between concurrent breakdown of immune control of VZV and leukaemia is discussed.

Portal hypertensive gastropathy and its interrelated factors

OBJECTIVE

To investigate the influences of helicobacter pylori (Hp) infection, liver function, gastroesophageal varicosity, esophageal varicosity ligation (EVL), and esophageal varicosity sclerotherapy (EVS) on patients with portal hypertensive gastropathy (PHG).

METHODS

Fourty-seven patients with liver cirrhosis included 34 patients with PHG and 13 patients without PHG. Liver function, Hp infection, and gastroesophageal varicosity were investigated clinically in all patients, and gastroscopy was made again in patients with EVL 1-2 months after operation to observe the changes of PHG.

RESULTS

The rate of Hp infection was lower in patients with liver cirrhosis than in controls. There was no relationship between Hp infection and PHG. The patients with gastroesophageal varicosity had a high incidence of PHG.

CONCLUSIONS

Despite no relationship between Hp infection and PHG, liver dysfunction can affect and promote PHG. Gastroesophageal varicosity may be closely related to PHG, but their degrees are not related. PHG can be caused or promoted by EVL.

A patient with congenital ichthyosis hystrix (disseminated congenital naevus) and acute lymphoblastic leukaemia

Congenital ichthyosis is an uncommon spectrum of hereditary and sporadic hyperkeratotic epidermolytic disorders that may occur in isolation or in association with other clinical syndromes. The pattern of distribution of the hyperkeratotic lesions and family history form the basis of diagnosis. Ichthyosis may be a marker for immune deficiency and cancer prone conditions. We report a 16-year old Chinese patient with a diagnosis of ichthyosis hystrix hystrix (disseminated congenital naevus) since birth who presented with T cell acute lymphoblastic leukaemia with tetraploid clones. There are four reports of acute leukaemia complicating ichthyosis, all involving paediatric acute lymphoblastic leukaemia. The possible mechanisms involved are discussed.

Unbiased morphological measurements show no neuronal loss in the substantia nigra in Alzheimer's disease

This is the first study to use the unbiased stereological method, the disector, to estimate the total number of pigmented neurons in the pars compacta of the substantia nigra (SNpc) in Alzheimer's disease (AD) patients as compared to healthy controls. The right half of the SNpc of 11 AD patients and 24 controls was studied. We also used single sections to determine the neuronal number and area in different subregions of the SNpc. The results showed that there was no significant difference in the total number of pigmented neurons in the SNpc (154,415+/-13,593 for AD and 160,163+/-8027 for controls) or in the volume of the SNpc between the patients with AD and controls. Studies on single sections revealed that even subregionally there was no significant difference in the neuronal number or area in the SNpc between AD patients and controls.

Differential role of CD18 integrins in mediating lung neutrophil sequestration and increased microvascular permeability induced by Escherichia coli in mice

The in vivo contributions of CD18 integrin-dependent and -independent mechanisms in mediating the increases in lung neutrophil (polymorphonuclear leukocyte; PMN) sequestration and microvascular permeability are not well understood. We determined the time course of these responses to Gram-negative sepsis in the mouse lung and addressed the specific contributions of CD18 integrins and ICAM-1. PMN sequestration in the lung was assessed by morphometric analysis, and transalveolar PMN migration was assessed by bronchoalveolar lavage. Lung tissue PMN number increased by 6-fold within 1 h after i.p. Escherichia coli challenge; this value peaked at 3 h (7-fold above control) and decreased at 12 h (3.5-fold above control). PMN migration into the airspace was delayed; the value peaked at 6 h and remained elevated up to 12 h. Saturating concentrations of anti-CD18 and anti-ICAM-1 mAbs reduced lung tissue PMN sequestration and migration; however, peak responses at 3 and 6 h were inhibited by 40%, indicating that only a small component of PMN sequestration and migration was CD18 dependent at these times. In contrast to the time-dependent decreased role of CD18 integrins in mediating PMN sequestration and migration, CD18 and ICAM-1 blockade prevented the increase in lung microvascular permeability and edema formation at all times after E. coli challenge. Thus, Gram-negative sepsis engages CD18/ICAM-1-independent mechanisms capable of the time-dependent amplification of lung PMN sequestration and migration. The increased pulmonary microvascular permeability induced by E. coli is solely the result of engagement of CD18 integrins even when PMN accumulation and migration responses are significantly CD18 independent.

Neuropathology of mice carrying mutant APP(swe) and/or PS1(M146L) transgenes: alterations in the p75(NTR) cholinergic basal forebrain septohippocampal pathway

Cholinergic basal forebrain (CBF) projection systems are defective in late Alzheimer's disease (AD). We examined the brains of 12-month-old singly and doubly transgenic mice overexpressing mutant amyloid precursor protein (APP(swe)) and/or presenilin-1 (PS1(M146L)) to investigate the effects of these AD-related genes on plaque and tangle pathology, astrocytic expression, and the CBF projection system. Two types of beta-amyloid (Abeta)-immunoreactive (ir) plaques were observed: type 1 were darkly stained oval and elongated deposits of Abeta, and type 2 were diffuse plaques containing amyloid fibrils. APP(swe) and PS1(M146L) mouse brains contained some type 1 plaques, while the doubly transgenic (APP(swe)/PS1(M146L)) mice displayed a greater abundance of types 1 and 2 plaques. Sections immunostained for the p75 NGF receptor (p75(NTR)) revealed circular patches scattered throughout the cortex and hippocampus of the APP(swe)/PS1(M146L) mice that contained Abeta, were innervated by p75(NTR)-ir neurites, but displayed virtually no immunopositive neurons. Tau pathology was not seen in any transgenic genotype, although a massive glial response occurred in the APP(swe)/PS1(M146L) mice associated with amyloid plaques. Stereology revealed a significant increase in p75(NTR)-ir medial septal neurons in the APP(swe) and PS1(M146L) singly transgenic mice compared to the APP(swe)/PS1(M146L) mice. No differences in size or optical density of p75(NTR)-ir neurons were observed in these three mutants. p75(NTR)-ir fibers in hippocampus and cortex were more pronounced in the APP(swe) and PS1(M146L) mice, while the APP(swe)/PS1(M146L) mice showed the least p75(NTR)-ir fiber staining. These findings suggest a neurotrophic role for mutant APP and PS1 upon cholinergic hippocampal projection neurons at 12 months of age.

Galanin transgenic mice display cognitive and neurochemical deficits characteristic of Alzheimer's disease

Galanin is a neuropeptide with multiple inhibitory actions on neurotransmission and memory. In Alzheimer's disease (AD), increased galanin-containing fibers hyperinnervate cholinergic neurons within the basal forebrain in association with a decline in cognition. We generated transgenic mice (GAL-tg) that overexpress galanin under the control of the dopamine beta-hydroxylase promoter to study the neurochemical and behavioral sequelae of a mouse model of galanin overexpression in AD. Overexpression of galanin was associated with a reduction in the number of identifiable neurons producing acetylcholine in the horizontal limb of the diagonal band. Behavioral phenotyping indicated that GAL-tgs displayed normal general health and sensory and motor abilities; however, GAL-tg mice showed selective performance deficits on the Morris spatial navigational task and the social transmission of food preference olfactory memory test. These results suggest that elevated expression of galanin contributes to the neurochemical and cognitive impairments characteristic of AD.

Loss of nucleus basalis neurons containing trkA immunoreactivity in individuals with mild cognitive impairment and early Alzheimer's disease

Recent studies indicate that there is a marked reduction in trkA-containing nucleus basalis neurons in end-stage Alzheimer's disease (AD). We used unbiased stereological counting procedures to determine whether these changes extend to individuals with mild cognitive impairment (MCI) without dementia from a cohort of people enrolled in the Religious Orders Study. Thirty people (average age 84.7 years) came to autopsy. All individuals were cognitively tested within 12 months of death (average MMSE 24.2). Clinically, 9 had no cognitive impairment (NCI), 12 were categorized with MCI, and 9 had probable AD The average number of trkA-immunoreactive neurons in persons with NCI was 196, 632 +/- 12,093 (n = 9), for those with MCI it was 106,110 +/- 14,565, and for those with AD it was 86,978 +/- 12,141. Multiple comparisons showed that both those with MCI and those with AD had significant loss in the number of trkA-containing neurons compared to those with NCI (46% decrease for MCI, 56% for AD). An analysis of variance revealed that the total number of neurons containing trkA immunoreactivity was related to diagnostic classification (P < 0.001), with a significant reduction in AD and MCI compared to NCI but without a significant difference between MCI and AD. Cell density was similarly related to diagnostic classification (P < 0.001). There was a significant correlation with the Boston Naming Test and with a global score measure of cognitive function. The number of trkA-immunoreactive neurons was not correlated with MMSE, age at death, education, apolipoprotein E allele status, gender, or Braak score. These data indicate that alterations in the number of nucleus basalis neurons containing trkA immunoreactivity occurs early and are not accelerated from the transition from MCI to mild AD.

Neurodegeneration prevented by lentiviral vector delivery of GDNF in primate models of Parkinson's disease

Lentiviral delivery of glial cell line-derived neurotrophic factor (lenti-GDNF) was tested for its trophic effects upon degenerating nigrostriatal neurons in nonhuman primate models of Parkinson's disease (PD). We injected lenti-GDNF into the striatum and substantia nigra of nonlesioned aged rhesus monkeys or young adult rhesus monkeys treated 1 week prior with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Extensive GDNF expression with anterograde and retrograde transport was seen in all animals. In aged monkeys, lenti-GDNF augmented dopaminergic function. In MPTP-treated monkeys, lenti-GDNF reversed functional deficits and completely prevented nigrostriatal degeneration. Additionally, lenti-GDNF injections to intact rhesus monkeys revealed long-term gene expression (8 months). In MPTP-treated monkeys, lenti-GDNF treatment reversed motor deficits in a hand-reach task. These data indicate that GDNF delivery using a lentiviral vector system can prevent nigrostriatal degeneration and induce regeneration in primate models of PD and might be a viable therapeutic strategy for PD patients.

Galanin regulates the postnatal survival of a subset of basal forebrain cholinergic neurons

The neuropeptide galanin colocalizes with choline acetyltransferase, the synthetic enzyme for acetylcholine, in a subset of cholinergic neurons in the basal forebrain of rodents. Chronic intracerebroventricular infusion of nerve growth factor induces a 3- to 4-fold increase in galanin gene expression in these neurons. Here we report the loss of a third of cholinergic neurons in the medial septum and vertical limb diagonal band of the basal forebrain of adult mice carrying a targeted loss-of-function mutation in the galanin gene. These deficits are associated with a 2-fold increase in the number of apoptotic cells in the forebrain at postnatal day seven. This loss is associated with marked age-dependent deficits in stimulated acetylcholine release, performance in the Morris water maze, and induction of long-term potentiation in the CA1 region of the hippocampus. These data provide unexpected evidence that galanin plays a trophic role to regulate the development and function of a subset of septohippocampal cholinergic neurons.

Pramipexole attenuates the dopaminergic cell loss induced by intraventricular 6-hydroxydopamine

The D3 preferring dopamine agonist pramipexole has been shown to attenuate the cell loss induced by levodopa in vitro. Pramipexole was herein evaluated in the 6-hydroxydopamine lesion model to determine its in vivo effect. Rats were treated with pramipexole or saline before and after an intracerebroventricular 6-hydroxydopamine injection. In the preliminary study, 6-hydroxydopamine produced a 68% reduction in striatal dopamine and a 62% loss in tyrosine hydroxylase immunoreactive (THir) cell counts in the substantia nigra. Pramipexole treated animals exhibited a 29% and a 27% reduction in striatal dopamine and THir cell counts, respectively. THir cell counts and striatal dopamine were significantly correlated. In the stereological study, 6-hydroxydopamine reduced THir cell counts by 47% in saline treated animals and 26% in pramipexole treated animals. These data demonstrate that pramipexole attenuates the biochemical and THir cell changes normally produced by 6-hydroxydopamine consistent with its neuroprotective actions in vitro.

Reduction in TrkA-immunoreactive neurons is not associated with an overexpression of galaninergic fibers within the nucleus basalis in Down's syndrome

Down's syndrome (DS) individuals develop neuropathological features similar to Alzheimer's disease (AD), including degeneration of cholinergic basal forebrain (CBF) neurons. In AD a reduction in CBF/trkA-containing neurons has been suggested to trigger a hyperexpression of galaninergic fibers within the nucleus basalis subfield of the basal forebrain. The present study examined the interrelationship between reductions in CBF/trkA-containing neurons and the overexpression of galaninergic fibers within the nucleus basalis in DS. Within the nucleus basalis stereologic evaluation revealed a 46% reduction in the number of trkA-immunopositive neurons, whereas optical density measurements displayed a nonsignificant 18% reduction in neuronal trkA immunoreactivity in DS as compared with age-matched controls. Western blot analysis also showed a significant reduction in cortical trkA protein levels in DS. A semiquantitative examination of galaninergic fibers in the nucleus basalis revealed only a modest hypertrophy of galaninergic fibers within the nucleus basalis in DS. The present findings indicate a significant reduction in trkA within the nucleus basalis and cortex with only a moderate hypertrophy of galaninergic fibers in DS. These observations suggest that DS may not be an exact genetic model for investigation of changes in the AD basal forebrain.

Lentiviral gene transfer to the nonhuman primate brain

Lentiviral vectors infect quiescent cells and allow for the delivery of genes to discrete brain regions. The present study assessed whether stable lentiviral gene transduction can be achieved in the monkey nigrostriatal system. Three young adult Rhesus monkeys received injections of a lentiviral vector encoding for the marker gene beta galatosidase (beta Gal). On one side of the brain, each monkey received multiple lentivirus injections into the caudate and putamen. On the opposite side, each animal received a single injection aimed at the substantia nigra. The first two monkeys were sacrificed 1 month postinjection, while the third monkey was sacrificed 3 months postinjection. Robust incorporation of the beta Gal gene was seen in the striatum of all three monkeys. Stereological counts revealed that 930,218; 1,192,359; and 1,501,217 cells in the striatum were beta Gal positive in monkeys 1 (n = 2) and 3 (n = 1) months later, respectively. Only the third monkey had an injection placed directly into the substantia nigra and 187,308 beta Gal-positive cells were identified in this animal. The injections induced only minor perivascular cuffing and there was no apparent inflammatory response resulting from the lentivirus injections. Double label experiments revealed that between 80 and 87% of the beta Gal-positive cells were neurons. These data indicate that robust transduction of striatal and nigral cells can occur in the nonhuman primate brain for up to 3 months. Studies are now ongoing testing the ability of lentivirus encoding for dopaminergic trophic factors to augment the nigrostriatal system in nonhuman primate models of Parkinson's disease.

Unbiased morphometrical measurements show loss of pigmented nigral neurones with ageing

This study used the dissector method to evaluate pigmented nigral neuronal loss in the substantia nigra pars compacta with age. Dissector counts can be used to estimate the absolute and accurate total neurone numbers. In addition, the area and diameter of the neuronal cell body was estimated by using a computerized morphometric analysis in a single section of the substantia nigra pars compacta. Brain samples from 26 people with an age range from 17 to 90 years were studied. A significant decrease in the total number of pigmented neurones (r=-0.83, P<0.001) and their density (r=-0.83, P<0.001) with age was found in the substantia nigra pars compacta. The number of pigmented neurones counted from a single section also showed an age-dependent decline (r=-0.76, P<0.001). According to the regression equations, the total number of pigmented neurones estimated by dissector counts decreased by 9.8% per decade and the neuronal density decreased by 7.4% per decade. The area of the neuronal cell body decreased by 3.2% per decade. This latter change corresponds to an approximate 4.4% decrease per decade in neuronal volume. These findings show that both the number of pigmented neurones and their size in the substantia nigra pars compacta decreases with age. However, the reductions in the total number of pigmented neurones are more dramatic than the reduction in neurone size with ageing.

Clinicopathological findings following intraventricular glial-derived neurotrophic factor treatment in a patient with Parkinson's disease

As part of a safety and tolerability study, a 65-year-old man with Parkinson's disease (PD) received monthly intracerebroventricular injections of glial-derived neurotrophic factor (GDNF). His parkinsonism continued to worsen following intracerebroventricular GDNF treatment. Side effects included nausea, loss of appetite, tingling, L'hermitte's sign, intermittent hallucinations, depression, and inappropriate sexual conduct. There was no evidence of significant regeneration of nigrostriatal neurons or intraparenchymal diffusion of the intracerebroventricular GDNF to relevant brain regions. Alternative GDNF delivery systems should be explored.

Dopamine transporter-immunoreactive neurons decrease with age in the human substantia nigra

Unbiased disector stereologic cell counting was applied to sections from the human substantia nigra that were immunostained by using a monoclonal antibody against the dopamine transporter (DAT). This antibody was found to penetrate the full thickness of the stained section. Quantification of the number of DAT immunostained neurons was performed in human cases stratified into three age groups, young (ages 0-49 years), middle aged (ages 50-69 years), and aged (ages 70-85 years). The number of DAT-immunoreactive nigral neurons was normalized for each case by constructing a ratio of the number of DAT-containing neurons to total number of neuromelanin-containing cells in each subject's sample. Three types of DAT nigral neurons were seen: type 1, intensely stained; type 2, lightly stained; and type 3, DAT-immunonegative neuromelanin-containing perikarya. By 50 years of age, the number of type 1 neurons decreased significantly (P < 0.0001), whereas the number of type 2 neurons increased with age (P < 0.0001). Type 3 neurons also increased with age (P < 0.01), although less robustly than type 2 neurons. Type 1 neurons decreased by 11.2% per decade, and the total number of nigral neurons (types 1-3) decreased by 6.7% per decade. Relative to the young group, there were 75% and 88% reductions in type 1 neurons in the middle-aged and aged groups, respectively. This contrasts with the 35% and 41% reductions in total number of neuromelanin-containing neurons seen in middle-aged and aged groups, respectively. The young group had significantly more type 1 neurons and fewer type 2 neurons compared with middle-aged and aged participants. Post-hoc analyses indicated that the young group had significantly fewer type 3 neurons compared with middle-aged and aged participants. These findings demonstrate an age-related reduction in the number of substantia nigra DAT-immunoreactive neurons. Therefore, insight into the mechanisms regulating the rate of DAT synthesis may aid in our understanding of the decline of DATs with aging and its functional significance.

Age-related declines in nigral neuronal function correlate with motor impairments in rhesus monkeys

Although the role of dopamine dysfunction is well established in Parkinson's disease, the effect of nigrostriatal degeneration on motor performance during normal aging is less well understood. In this study, aged rhesus monkeys (25-27 years old) displayed significant impairments relative to young (3-5 years old) cohorts in motor function as assessed on a fine motor task and home cage activity. Additionally, the clinical motor function of aged monkeys was impaired relative to young monkeys as assessed on a clinical rating scale. Unbiased stereologic measurements of the substantia nigra revealed a significant age-related loss of tyrosine hydroxylase-immunoreactive (TH-ir; 50.3%) and dopamine transporter-immunoreactive (DAT-ir; 33.2%) nigral neurons. The monkeys performance on the fine motor task and on the clinical rating scale was correlated with TH-ir neuronal counts. The number of DAT-ir nigral neurons was correlated with activity and clinical rating scale scores. Our results suggest that age-related motor impairments in nonhuman primates are associated with spontaneous decreases in TH-ir and DAT-ir nigral cells. The correlation of motor deficits with the loss of TH-ir and DAT-ir nigral neurons suggests that aged nonhuman primates may provide a useful model for mimicking changes seen in human aging and early Parkinson's disease.

Correlation between neuromorphometry in the substantia nigra and clinical features in Parkinson's disease using disector counts

Previous studies based on single sections have suggested a significant correlation between pigmented neuronal loss in the substantia nigra (SN) and clinical features in Parkinson's disease (PD). However, disector (DS) counts-unbiased and accurate stereological estimates have not been available. To evaluate total neuron numbers in the pars compacta of the substantia nigra (SNpc) in relation to clinical features, we estimated the neuron counts in the SNpc by the DS method in brain samples from 12 controls and 12 PD patients. The total number of pigmented neurons in the whole SNpc was significantly reduced in PD patients (to 45% of the control mean, P < 0.001). The density of pigmented neurons (neuron/mm3) was reduced to 51% of the average control value (P < 0.001). No significant difference was seen in the volume (mm3) of the SNpc between PD patients and controls. Furthermore, the total number of pigmented neurons in the SNpc showed a significant negative correlation with the duration of disease (r = -0.86, P < 0.001) and with the stage of disease (r = -0.58, P < 0.05) in PD patients. Using an unbiased neuron counting method, these relationships, for the first time, demonstrate that the more severe pigmented neuronal loss in the SNpc is associated with the longer duration and the more severe stage of disease in PD patients.