Life disturbance and hospital visit experiences among Chinese patients with benign prostatic hyperplasia: a qualitative study

BACKGROUND

The impact of lower urinary tract symptoms (LUTS) on the quality of life of patients with benign prostatic hyperplasia (BPH) has been rarely reported. Additionally, the challenges faced by these patients in seeking medical care have often been overlooked. In order to explore the personal struggles caused by LUTS and the difficulties or barriers experienced by Chinese patients with BPH when seeking help, we conducted a qualitative interview study.

METHODS

Qualitative interviews were conducted among 46 patients with BPH who were hospitalized in three tertiary hospitals in China from July 2021 to November 2022. Grounded theory was adopted as the methodology for the qualitative study. After obtaining written informed consent from the study participants, semi-structured interviews were conducted according to the question guidelines. The interview process was audio-recorded; subsequently, the recordings were transcribed, coded, and thematically analyzed.

RESULTS

The difficulties faced by Chinese patients with BPH were classified into seven main themes: (i) disturbed life, (ii) mental burden, (iii) disease cognition and communication, (iv) delayed treatment, (v) medication status, (vi) hospital visits barriers, and (vii) medical insurance issues. Further, each theme was subdivided into 2-5 sub-themes.

CONCLUSIONS

LUTS have a certain effect on the life and spirit of patients with BPH. These patients face different degrees of difficulties in treatment and hospital visits. Therefore, better healthcare systems and additional social support are crucial for improving the current plight of these patients.

[Prognostic value of the Second Revision of the International Staging System in patients with newly diagnosed transplant-eligible multiple myeloma]

Objective: To verify the predictive value of the Second Revision of the International Staging System (R2-ISS) in newly diagnosed patients with multiple myeloma (MM) who underwent first-line autologous hematopoietic stem cell transplantation (ASCT) in a new drug era in China. Methods: This multicenter retrospective cohort study enrolled patients with newly diagnosed MM from three centers in China (Beijing Chao-Yang Hospital, Capital Medical University; the First Affiliated Hospital, Sun Yat-Sen University, and the Second Affiliated Hospital of Naval Medical University) from June 2008 to June 2018. A total of 401 newly diagnosed patients with MM who were candidates for ASCT were enrolled in this cohort, all received proteasome inhibitor and/or immunomodulator-based induction chemotherapy followed by ASCT. Baseline and follow-up data were collected. The patients were regrouped using R2-ISS. Progression-free survival (PFS) and overall survival (OS) were analyzed. The Kaplan-Meier method was used to analyze the survival curve and two survival curves were compared using the log-rank test. Cox regression analysis were performed to analyze the relationship between risk factors and survival. Results: The median age of the patients was 53 years (range 25-69 years) and 59.5% (240 cases) were men. Newly diagnosed patients with renal impairment accounted for 11.5% (46 cases). According to Revised-International Staging System (R-ISS), 74 patients (18.5 %) were diagnosed with stage Ⅰ, 259 patients (64.6%) with stage Ⅱ, and 68 patients (17.0%) with stage Ⅲ. According to the R2-ISS, the distribution of patients in each group was as follows: 50 patients (12.5%) in stage Ⅰ, 95 patients (23.7%) in stage Ⅱ, 206 patients (51.4%) in stage Ⅲ, and 50 patients (12.5%) in stage Ⅳ. The median follow-up time was 35.9 months (range, 6-119 months). According to the R2-ISS stage, the median PFS in each group was: 75.3 months for stage Ⅰ; 62.0 months for stage Ⅱ, 39.2 months for stage Ⅲ, and 30.3 months for stage Ⅳ; and the median OS was not reached, 86.6 months, 71.6 months, and 38.5 months, respectively. There were statistically significant differences in PFS and OS between different groups (both P<0.001). Multivariate Cox regression analysis showed that stages Ⅲ and Ⅳ of the R2-ISS were independent prognostic factors for PFS (HR=2.37, 95%CI 1.30-4.30; HR=4.50, 95%CI 2.35-9.01) and OS (HR=4.20, 95%CI 1.50-11.80; HR=9.53, 95%CI 3.21-28.29). Conclusions: The R2-ISS has significant predictive value for PFS and OS for transplant-eligible patients with MM in the new drug era. However, the universality of the R2-ISS still needs to be further verified in different populations.

Multi-omics investigation of the resistance mechanisms of pomalidomide in multiple myeloma

Background

Despite significant therapeutic advances over the last decade, multiple myeloma remains an incurable disease. Pomalidomide is the third Immunomodulatory drug that is commonly used to treat patients with relapsed/refractory multiple myeloma. However, approximately half of the patients exhibit resistance to pomalidomide treatment. While previous studies have identified Cereblon as a primary target of Immunomodulatory drugs' anti-myeloma activity, it is crucial to explore additional mechanisms that are currently less understood.

Methods

To comprehensively investigate the mechanisms of drug resistance, we conducted integrated proteomic and metabonomic analyses of 12 plasma samples from multiple myeloma patients who had varying responses to pomalidomide. Differentially expressed proteins and metabolites were screened, and were further analyzed using pathway analysis and functional correlation analysis. Also, we estimated the cellular proportions based on ssGSEA algorithm. To investigate the potential role of glycine in modulating the response of MM cells to pomalidomide, cell viability and apoptosis were analyzed.

Results

Our findings revealed a consistent decrease in the levels of complement components in the pomalidomide-resistant group. Additionally, there were significant differences in the proportion of T follicular helper cell and B cells in the resistant group. Furthermore, glycine levels were significantly decreased in pomalidomide-resistant patients, and exogenous glycine administration increased the sensitivity of MM cell lines to pomalidomide.

Conclusion

These results demonstrate distinct molecular changes in the plasma of resistant patients that could be used as potential biomarkers for identifying resistance mechanisms for pomalidomide in multiple myeloma and developing immune-related therapeutic strategies.

[Integrated Analysis on Source-exposure Risk of Heavy Metals in Farmland Soil Based on PMF Model: A Case Study in the E-waste Dismantling Area in Zhejiang Province]

In order to explore the characteristics and sources of heavy metals in farmland soil and their risks to human health and to provide an important scientific basis for farmland pollution control, 133 surface soils (0-20 cm) were collected from typical agricultural production areas in Zhejiang Province, and the contents of soil Cd, Pb, Cr, Cu, Zn, Ni, As, and Hg were determined. Various methods were applied to evaluate the degree of heavy metal pollution in farmland and its ecological risks in the study area. The method of combining Kriging interpolation and positive definite matrix factor analysis (PMF) was applied to analyze the pollution sources and quantify the contribution of each pollution source. Combined with the health risk assessment model, the risk to human health of each pollution source was evaluated from the perspective of source exposure. The results showed that the average ω(Cd), ω(Pb), ω(Cr), ω(Cu), ω(Zn), ω(Ni), ω(As), and ω(Hg) were 0.76, 65.22, 92.02, 103.92, 198.49, 36.65, 5.97, and 0.20 mg·kg^-1, respectively. The average contents of Cd and Cu were higher than the risk screening values of soil contamination of agricultural land, and 85.71% and 96.24% of soil was contaminated by heavy metals. The average contents of Pb, Cr, Zn, and Ni exceeded the soil background values of the Wenhuang Plain in Zhejiang Province, and the As and Hg contents were within the limit values. The potential soil ecological risks were mainly light-moderate, accounting for 90.98%, and both high and higher risk accounted for 4.51%; Cd was the main potential ecological risk element. The main sources of heavy metal pollution in the study area were the sources of the electronic waste dismantling process (26.82%), the mixed sources of coal combustion and traffic emissions (34.50%), mixed sources of natural parent materials and agricultural inputs (25.59%), and e-waste pickling runoff and solid waste leaching sources (13.09%). The health risk of heavy metal exposure to children was significantly greater than that in adults. Mixed sources of natural parent materials and agricultural inputs contributed the most to human health risks, and Cr was the element with the greatest contribution to human health risks.

[Surgical management strategies of thulium laser enucleation of the prostate in different prostate volumes]

As the good functions of cutting, vaporization and hemostasis, the thulium laser has high safety and effectiveness in the enucleation of prostate. The surgery strategy of thulium laser also changes when enucleating different volumes of the prostate. In this paper, the prostate volume is divided into three types: small volume (<40 ml), moderate volume (40-80 ml), and large volume(>80 ml). The surgical strategies of thulium laser enucleation of the prostate in three different prostate volumes are discussed respectively. The operative techniques of thulium laser and preventive measures for complications are emphasized to cope with complex situations and provide reference for clinicians.

Four-year follow-up of LCAR-B38M in relapsed or refractory multiple myeloma: a phase 1, single-arm, open-label, multicenter study in China (LEGEND-2)

Background

LCAR-B38M is a chimeric antigen receptor T cell product with two binding domains targeting B cell maturation antigen. Our previous reports showed a remarkable efficacy of LCAR-B38M in patients with relapsed/refractory multiple myeloma (RRMM) at a median follow-up of 2 years. Here, we report long-term safety and efficacy data from a median follow-up of 4 years.

Methods

LEGEND-2 was a phase 1, single-arm, open-label study conducted in four registered sites in China. Seventy-four participants with RRMM received LCAR-B38M treatment. Lymphodepletion was performed using cyclophosphamide or cyclophosphamide plus fludarabine. LCAR-B38M, at a median dose of 0.513 × 10⁶ cells/kg, was intravenously administered either in three split infusions or in a single infusion. The primary objective was the safety of LCAR-B38M, and the secondary objective was efficacy.

Results

As of May 25, 2021, the median follow-up was 47.8 months. All patients experienced ≥ 1 adverse events (AEs). Grade ≥ 3 AEs were observed in 45/74 (60.8%) patients. Cytokine release syndrome (CRS) occurred in 68/74 (91.9%) cases; 7 (9.5%) had grade ≥ 3 CRS. One patient experienced grade 1 central nervous system toxicity. The overall response rate was 87.8%. Fifty-four out of 74 (73.0%) patients achieved complete response. The median progression-free survival was 18.0 months, and the median overall survival for all patients was not reached. The median duration of response was 23.3 months. Four patients experienced viral infection more than 6 months post-infusion, and four patients developed second primary non-hematological malignancies at a median time of 11.5 months post-CAR-T cell transfer.

Conclusions

The 4-year follow-up data of LCAR-B38M therapy demonstrated a favorable long-term safety profile and a durable response in patients with RRMM.

Trial registration Clinicaltrials.gov NCT03090659 (retrospectively registered on March 27, 2017); ChiCTR-ONH-17012285.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13045-022-01301-8.

Efficacy and safety of pomalidomide and low-dose dexamethasone in Chinese patients with relapsed or refractory multiple myeloma: a multicenter, prospective, single-arm, phase 2 trial

Background

Pomalidomide in combination with dexamethasone has demonstrated positive results in patients with relapsed or refractory multiple myeloma (RRMM), but no data are available in China. We conducted a multicenter, single-arm trial to examine the efficacy and safety of bioequivalent generic pomalidomide plus low-dose dexamethasone in Chinese RRMM patients.

Methods

Adult (≥ 18 years of age) RRMM patients who progressed after at least two previous treatments, including bortezomib and lenalidomide, were eligible. Pomalidomide was given orally at 4 mg/day on days 1 to 21 of a 28-day cycle. Dexamethasone was given at 40 mg/day (either orally or intravenously; 20 mg/day at 75 years or older) on days 1, 8, 15, and 22 of each cycle. Treatment continued until disease progression or intolerable adverse events (AEs). The primary end point was objective response rate (ORR).

Results

Seventy-four patients were enrolled between February 2017 and February 2019. All patients had progressed within 60 days of their last therapy. 74.3% of the patients were resistant to lenalidomide, 31.1% had renal insufficiency and 33.8% had high-risk cytogenetic RRMM. The median follow-up duration was 33.0 months (range 31.1–34.8 months). The ORR was 37.8% in the overall analysis, 32.7% in lenalidomide-refractory patients, 36.0% in patients with high-risk cytogenetics and 34.8% in RRMM patients with renal impairment. The median progression-free survival was 5.7 months (95% CI 3.7–8.8 months). The median overall survival was 24.3 months (95% CI 14.4–41.1 months). The most common grade 3 and 4 treatment-emergent adverse events (TEAEs) were neutropenia (63.5%), leukopenia (37.8%), thrombocytopenia (28.4%), and anemia (31.1%). Pulmonary infection (27.0%) was the most frequent grade 3 and 4 nonhematologic TEAE. No previously unreported AEs were observed. No venous thromboembolism was reported.

Conclusions

Pomalidomide in combination with low-dose dexamethasone is effective and safe in Chinese RRMM patients.

Trial registration

The study is registered at Chinese Clinical Trial Registry (ChiCTR) (ChiCTR-OIC-17013234, first registered on 03/11/2017).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09802-y.

[Microbial Composition and Diversity in Soil of Torreya grandis cv. Merrillii Relative to Different Cultivation Years After Land Use Conversion]

In order to explore the impacts of the land use conversion from a Phyllostachy pubescens (moso bamboo) forest to a Torreya grandis cv. Merrillii plantation, as well as the cultivating years of the T. grandis cv. Merrillii plantation, on the soil microbial community, this research studied the soil microbial structure and diversity of a moso bamboo forest, T. grandis cv. Merrillii plantations (5, 10, and 30 a), and a T. grandis cv. Merrillii-mountain rice interplanting plantation (5 a) using the high-throughput sequencing technique, and the relationship between the microbial community and environmental factors was further explored. The results showed that after the land use change, the Shannon index and Chao1 index of the soil bacterial community increased significantly; the Simpson index increased significantly in the 30 a T. grandis cv. Merrillii plantation, whereas the Shannon index decreased significantly. Both the Simpson index and Chao index of the soil fungal community had no significant difference under different land use types. whereas the Shannon index was significantly decreased in the 30 a T. grandis cv. Merrillii plantation. PCoA analysis of the soil microbial community at the genus level showed that land use type played a vital role in driving the changes in soil bacterial and fungal communities. The compositions of the soil microbial communities between the two 5 a stands were most similar. The dominant phyla of soil bacteria mainly included Acidobacteria, Proteobacteria, Actinobacteria, and Chloroflexi. The results of cluster analysis showed that the soil bacterial community changed significantly at the genus level after the conversion of land use; the abundance of most dominant bacterial communities decreased with increasing cultivation. The fungal community was mainly composed of Ascomycota, Basidiomycota, and Zygomycota, whose changes in community characteristics were similar to those of bacteria. The results of RDA analysis showed that pH, organic matter, available phosphorus, available potassium, and water-soluble organic carbon and nitrogen were significantly correlated with soil microbial community. Therefore, these soil fertility properties might be the driving factors affecting the structure of bacterial communities. This study provided a theoretical basis for solving the problem of soil quality deterioration in T. grandis cv. Merrillii stand land management.

Doxycycline Combined With Bortezomib-Cyclophosphamide-Dexamethasone Chemotherapy for Newly Diagnosed Cardiac Light-Chain Amyloidosis: A Multicenter Randomized Controlled Trial

Background: Doxycycline was demonstrated in a retrospective study to be associated with greater survival in patients with light chain (AL) amyloidosis. Therefore, we prospectively compared the efficacy of bortezomib-cyclophosphamide-dexamethasone (CyBorD) and CyBorD combined with doxycycline for cardiac AL amyloidosis. Methods: This was a multicenter, open-label randomized controlled trial. Patients with Mayo 2004 stage II-III AL amyloidosis were included. Patients were randomized to doxycycline 100 mg twice daily along with 9 cycles of CyBorD (doxycycline group) or to 9 cycles of CyBorD alone (control group). The primary outcome was 2-year progression-free survival (PFS). PFS was defined as the time from randomization to death, hematologic progression or organ progression (heart, kidney or liver). Hematologic progression was defined based on substantial increase in free light chain. Increase in either N-terminal pro B-type natriuretic peptide or cardiac troponin was the main criterion for defining cardiac progression. Cardiac PFS, defined as the time from randomization to cardiac progression or death, was compared between groups in an exploratory analysis. The corresponding treatment hazard ratio was estimated using a Cox regression model. Results: 140 patients underwent randomization, with 70 in each group. The median age was 61 (range, 33-78) years with a male: female ratio of 1.75:1. Stage II disease was present in 34 (48.6%) and 33 (47.1%) patients in the doxycycline and control groups, respectively. After a median follow-up duration of 24.4 months, 32/70 (45.7%) of patients in the doxycycline group and 30/70 (42.9%) of patients in the control group experienced progression. PFS was not significantly different between groups (hazard ratio 0.97, 95% CI, 0.59-1.60, p=0.91). Cardiac progression occurred in 29/70 (41.4%) of patients in the doxycycline group and 26/70 (37.1%) of patients in the control group. The death rates for both groups by the end of follow-up was the same, 25/70 (35.7%). There were no significant differences observed for either cardiac PFS (hazard ratio 0.91, 95% CI, 0.54-1.55, p=0.74) or overall survival (hazard ratio 1.04, 95% CI, 0.60-1.81, p=0.89). Conclusions: Our trial demonstrated that doxycycline combined with CyBorD failed to prolong PFS or cardiac PFS compared with CyBorD alone in cardiac AL amyloidosis. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03401372.

[Spatial Distribution Characteristics and Risk Assessment of Cadmium Pollution in Soil-crops system of an E-waste Dismantling Area]

With the rapid development of electronic technology, soil heavy metal contamination caused by electronic waste dismantling activities has attracted the attention of many researchers. To investigate the contamination status and spatial distribution of Cd in soil-crop systems around an e-waste dismantling area, 171 pairs of soil and crop samples were collected for analysis. The concentrations of cadmium in root vegetable soil, leaf vegetable soil, solanaceous vegetable soil, and orchard soil were (1.292±0.647), (1.010±0.201), (0.921±0.125), and (0.861±0.135) mg·kg^-1, respectively. The average values of cadmium in these four soil types were 10.0, 7.8, 7.1, and 6.3 times the background values of soil Cd in Zhejiang Province, respectively, and 4.31, 3.4, 3.07, and 2.72 times the risk screening values for soil contamination of agricultural land, clearly indicating cadmium accumulation in the soil. However, only a small percentage of crops contained cadmium levels that exceeded food safety limits. Moreover, different types of crops showed different capacities for cadmium enrichment and can be ranked accordingly: leaf vegetables > root vegetables > solanaceous vegetables > fruits. The single factor pollution index and the potential ecological risk assessment revealed severe Cd contamination in the study area, with a high potential ecological risk. Cadmium exposure posed a higher health risk for children than for adults. However, the single heavy metal cadmium pollution index does not indicate a threat to local residents at this time. Moran's I index and kriging interpolation results revealed that Cd has significant spatial autocorrelation, with high values mainly concentrating around the e-waste dismantling area, indicating a significant correlation with e-waste dismantling activities.

[Clinical characteristics and prognosis of Waldenström's macroglobulinemia: a clinical data report from a single center]

Objective: To summarize the clinical characteristics and prognosis of 51 patients with Waldenström's macroglobulinemia (WM) and evaluate the efficacy and adverse reactions of ibrutinib in the treatment of WM. Methods: We carried out a single-center retrospective study, including 51 patients with WM of our single center from November 2008 to October 2019. Results: The median age at diagnosis was 65 years with a male-to-female ratio of 2.64∶1. There were 9 (18%) , 21 (41%) , and 21 (41%) ISSWM stage low-, intermediate- and high-risk patients identified, respectively. A total of 27 (73%) patients harbored MYD88(L265P) mutation. The median follow-up time was 38.6 (0.3-120.0) months, the median progression free survival was 46.4 months, and the median overall survival was not reached. The overall remission and major remission rates of patients who received ibrutinib were 87% and 80%, respectively. The median time to achieve at least partial remission of patients treated with ibrutinib was 8 weeks, which was earlier than those treated with other drugs (P<0.05) . Conclusion: WM is often seen in elderly men. MYD88(L265P) had a high frequency in WM. The findings of our study validate the efficacy of ibrutinib monotherapy. Even in patients with advanced age and at high risk of ISSWM, the overall remission rate and major remission rate are high. Ibrutinib is a safe and effective therapy because of its rapid onset and rare serious adverse reactions.

[Clinical characteristics and survival analysis of 15 cases of HIV-negative plasmablastic lymphoma]

目的

分析HIV阴性的浆母细胞淋巴瘤（PBL）患者的临床病理特征及转归。

方法

回顾性分析海军军医大学附属长海医院2013年1月至2019年8月诊断及治疗的15例HIV阴性PBL患者的临床病理资料及随访结果。

结果

15例HIV阴性PBL患者中男8例，女7例，中位年龄59（17~69）岁，均无明确的免疫抑制状态。所有患者均出现结外受累，Ann Arbor-Cotswolds分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为1例（6.7%）、2例（13.3%）、3例（20.0%）、9例（60.0%）。病理形态表现为类似免疫母细胞的大肿瘤细胞弥漫性增生，免疫组化示肿瘤细胞主要表达浆细胞标志CD38、CD138、Mum-1，B细胞标志CD20、CD10、PAX-5、BCL-6少见，Ki-67中位数为80%（70%~90%）。3例患者行EBER原位杂交检测，1例阳性。15例患者均接受化疗，80%（12/15）联合硼替佐米作为一线治疗。最佳疗效6例完全缓解（其中2例分别于治疗后4.9和26.1个月疾病进展），2例部分缓解（分别于治疗后3.0和6.8个月疾病进展），4例疾病进展，3例无法评估。中位随访时间30.3（4.8~61.1）个月，11例患者中位无进展生存（PFS）期6.8（95%CI 2.5~11.1）个月，预计3年PFS率为21.2%（95%CI 1.4%~56.8%）。所有患者中位总生存（OS）期为17.9（95%CI 5.6~30.2）个月，预计3年OS率为38.5%（95%CI 12.0%~65.0%）。

结论

HIV阴性PBL侵袭性强，结外受累常见，多数患者诊断时分期较晚。通过以硼替佐米为基础的强化疗方案序贯自体造血干细胞移植可望获得长期生存。

[A pathological report of three COVID-19 cases by minimal invasive autopsies]

Objective: To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19). Methods: Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV. Results: Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs. Conclusions: The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.

A four-coordinate Cu(I)–N-heterocyclic carbene complex: Synthesis, structure, properties, and application in amination for the synthesis of 1-(2-N-heteroaryl)-1H-pyrazoles

A new luminescent, cationic, heteroleptic, four-coordinate Cu(I)– N-heterocyclic carbene complex [Cu(Br-Pyim)(POP)](PF6) is successfully prepared and characterized, where Br-Pyim and POP are 1-(6-bromopyridin-2-yl)imidazole-3-benzyl-2-ylidene and bis[2-(diphenylphosphino)phenyl]ether, respectively. Its detailed structure is determined by single-crystal X-ray analysis. It exists as a crystalline powder at room temperature and exhibits bright yellow-green emission. The use of the Cu(I)– N-heterocyclic carbene complex as a catalyst for amination reactions is also investigated and is found to be very efficient for the amination of 2- N-heteroaryl chlorides with pyrazoles, giving the desired substituted 1-(2- N-heteroaryl)-1 H-pyrazoles in good yields.

[Clinical prognosis analysis of patients with "double hit" multiple myeloma]

目的

分析并探讨“双打击”多发性骨髓瘤（MM）患者的临床特征及预后。

方法

研究对象为2010–2016年第二军医大学长征医院诊断的89例MM患者，通过FISH检测染色体变化，基因测序检测TP53基因突变情况，根据最新Walker BA学者提出的“双打击”骨髓瘤定义，分析“双打击”MM患者的临床特征及预后。

结果

“双打击”MM患者15例（16.85%），中位无进展生存（PFS）时间（8.4个月）和中位总生存（OS）时间（22.2个月）较非“双打击”MM患者的中位PFS时间（14.2个月）和中位OS时间（39.2个月）显著降低（P均<0.05）。多因素预后风险分析显示，“双打击”是影响患者PFS（HR=2.171，95%CI 1.206~3.907，P=0.010）和OS（HR=4.106，95%CI 2.116~7.969，P<0.001）的独立预后不良因素，且“双打击”患者的中位PFS时间（8.4个月）和中位OS时间（22.2个月）分别较R-ISS Ⅲ期患者的中位PFS时间（11.8个月）和中位OS时间（24.3个月）显著缩短（P均<0.05）。

结论

“双打击”MM患者预后极差，亟待前瞻性临床研究改善此类患者预后。

[Rosai-Dorfman disease: a clinicopathologic analysis and whole exome sequencing in 23 cases]

目的

分析Rosai-Dorfman disease（RDD）的临床病理特征，利用全基因组外显子测序探讨RDD的发病机制。

方法

回顾性分析第二军医大学附属长海医院、长征医院2010年1月至2018年7月收治的23例RDD患者临床病理资料，并对9例患者石蜡包埋组织标本进行了全基因组外显子测序。

结果

23例RDD患者中位年龄47（10~79）岁，19例为结外型，3例为淋巴结型，1例为混合型。所有患者均接受了手术切除病灶，19例患者中位随访24（1~67）个月，均无复发。病理形态主要表现为淋巴结窦内或结外组织中组织细胞增生伴有噬淋巴细胞现象，免疫组化示组织细胞表达S100、CD68、CD163，不表达CD1a。全基因组外显子测序发现mTOR、KMT2D和NOTCH1基因突变。

结论

mTOR、KMT2D和NOTCH1基因突变可能参与了RDD的发病机制，其临床意义仍需要进一步研究。

[Evaluation and comparison of prognostic value of serum free light chain ratio/difference in patients with newly diagnosed multiple myeloma]

目的

比较评估初诊时血清游离轻链比值（rFLC）及差值（dFLC）对多发性骨髓瘤（MM）患者预后的价值。

方法

收集整理2012年1月至2016年3月有FLC检测记录的479例初治MM患者的相关临床资料，采用四分位间距法将rFLC、dFLC进行分组。将rFLC分别为3组：≤14.828、14.828~364.597、≥364.597。将dFLC分为3组：≤112.85 mg/L、112.85~2 891.83 mg/L、≥2 891.83 mg/L。随后分别对不同分组进行预后分析比较。使用Kaplan-Meier进行无进展生存（PFS）和总生存期（OS）比较，使用Cox回归进行单因素、多因素预后相关性分析。

结果

不同截断范围rFLC或dFLC患者的OS及PFS差异均有统计学意义。rFLC≤14.828组OS明显优于其他两组（未达到对61个月对47个月，P=0.019）；PFS与rFLC 14.828~364.597组相比，差异无统计学意义（P=0.227），与rFLC≥364.597相比，差异有统计学意义（P=0.024）。dFLC≤112.85 mg/L组与其他两组相比PFS、OS差异均有统计学意义。单因素、多因素分析显示rFLC仅与患者OS显著相关，而dFLC与患者OS、PFS均显著相关。4年OS率比较，rFLC≤14.828组4年OS率达90.84%，明显高于其他两组（59.29%、62.26%）；dFLC≤112.85 mg/L组4年OS率达89.97%，明显高于其他两组（41.32%、71.95%）（P<0.05）。

结论

对于初治MM患者，不同截断范围的rFLC、dFLC对患者生存预后影响不同。其中rFLC≤14.828或dFLC≤112.85 mg/L，其生存预后差异更为明显，且具有更低的死亡风险，危险比也更低。以此截断值判断患者预后较为理想。

Synthesis, Crystal Structure and Antitumour Activity of 3-Amino-4-Morpholino-1H-Indazol-1-yl(3-Fluorophenyl)Methanone

3-Amino-4-morpholino-1H-indazol-1-yl(3-fluorophenyl)methanone was synthesised by condensation of 3-fluorobenzoic acid with 4-morpholino-1H-indazol-3-amine, which was prepared from 2,6-difluorobenzonitrile by amination with morpholine and then cyclisation with hydrazine hydrate. The molecular structure was tested by single crystal X-ray diffraction. Preliminary biological tests showed that the compound possesses distinct inhibition on the proliferation of A549, BGC-823 and HepG-2 cancer cell lines.

C–H Monoarylation of Naphthylpyrimidines with Aryl Chlorides Catalyzed by a Water-Soluble Ruthenium Complex

Selective monoarylation of naphthylpyrimidines with a variety of aryl chlorides through C–H bond activation in water was achieved by using a water-soluble [RuCl2-(η6-PhOCH2CH2OH)]2/phosphine catalytic system. The monoarylation occurred at the C-2 carbon of the naphthalene moiety, and selectively polysubstituted naphthylpyrimidines were obtained by a one-pot reaction involving a subsequent hetarylation with 2-pyridyl chlorides.

[Spatial Variation of Soil Heavy Metals in Lin'an City and Its Potential Risk Evaluation]

Urban soil is an important part of the urban ecosystem, which is strongly correlated with human health and life quality. In this study, Lin'an city was chosen as a typical small city to study the spatial variation and distribution of heavy metals in urban soils and their pollution characteristics using multivariate analysis, geostatistics, and GIS techniques. A total of 62 soil samples were collected from the study areas. The results indicated that the average concentrations of soil Mn, Cu, Zn, Pb, Cr, and Cd were 439.42, 42.23, 196.80, 62.55, 63.65, and 0.22 mg·kg^-1, respectively. Compared with the background values and the environmental quality standards, these heavy metals were accumulated in urban soils to some extent. Almost 80% of the study area was polluted by heavy metals. The single potential ecological risk index of heavy metals indicated that Pb had the highest ecological risk. The pH and most of the heavy metals had strong correlations, and there were strong correlations among the heavy metals. The principle component analysis (PCA) showed that Pb, Zn, and Cu had the same pollution source, which was related to vehicle exhausts; Mn and Cr were mainly from the parent material; and Cd was from the emissions of manufacturing plants. The spatial structure and distribution of heavy metals and their corresponding available fractions had strong spatial autocorrelation with all of the C₀/(C₀+C)<50%. Their spatial patterns were influenced by human activities.

In vivo and in vitro anti-sepsis effects of physcion 8-O-β-glucopyranoside extracted from Rumex japonicus

The present study was designed to investigate the anti-sepsis effects of physcion 8-O-β-glucopyranoside (POG) isolated from Rumex japonicas and explore its possible pharmacological mechanisms. POG was extracted from R. japonicas by bioactivity-guided isolation with the anti-sepsis agents. Survival analysis in septic mouse induced by LPS and heat-killed Escherichia coli were used to evaluate the protective effect of POG (40 mg·kg^-1, i.p.) on sepsis. Cytokines including TNF-α, IL-1β and IL-6 in RAW 264.7 cells induced by LPS (100 ng·mL^-1) were determined by ELISA. In addition, the proteins expressions of TLR2 and TLR4 were determined by Western blotting assay. Our results demonstrated that POG (40 mg·kg^-1, i.p.) possessed significant protective activity on the endotoxemic mice. The POG treatment (20, 40, and 80 μg·mL^-1) significantly decreased the TNF-α, IL-1β and IL-6 induced by LPS (P < 0.01) in a concentration-dependent manner. Furthermore, the TLR4 and TLR2 proteins were also down-regulated by POG at 20 (P < 0.01), 40 (P < 0.01), and 80 μg·mL^-1 (P < 0.01). The present study demonstrated that the POG extracted from R. japonicas possessed significant anti-sepsis effect on endotoxemic mice, and can be developed as a novel drug for treating sepsis in the future.

[Spatial Variation of Soil Heavy Metals in an E-waste Dismantling Area and Their Distribution Characteristics]

A total of 90 soil samples were collected from the study area. The spatial variation of soil heavy metals and their spatial distribution characteristics were studied. The results indicated that the mean soil concentrations of five heavy metals including Cd, Cu, Zn, Pb and Ni were 0.38, 35.13, 121.38, 35.40 and 28.13 mg·kg^-1, respectively. Compared with the background values in Zhejiang, the heavy metals were enriched in paddy soils of the study area. Part of study area was seriously contaminated by heavy metals. For the soil Cd, it had obvious contamination characteristics with a high P_{i Ave}value (>1). The Cd, and Pb concentrations in paddy soil had strong coefficients of variance (C.V.): 121.05% and 109.38%, respectively. Soil pH and organic matter (SOM) had significant correlations with most of the total heavy metals and their available fractions in soils. The total heavy metals and their available fractions also had strong correlations, such as total Cd and available Cd in soils. Geostatistics and the Local Moran's Ⅰ were used to identify the contaminated hotspots of these five metals. It was found out that the high soil Cd, Cu, Zn, Pb were located in Daxi and Zeguo towns, which could be attributed to E-waste dismantling and other anthropogenic activities. Soil Ni was mainly influenced by the parent material. The heavy metals in soils may pose a potential threat to local ecosystem and human health.

[A perfusion system for preparing canine ureteral acellular matrix]

OBJECTIVE

To explore the feasibility of preparing ureteral acellular matrix (UAM) using perfusion systems.

METHODS

Using the luminal structure of the ureter, the UAM was prepared by perfusing canine ureter with SDS, TritonX-100, or both. The residual nuclei in the UAM were evaluated using HE staining, DAPI staining, DNA quantification, and agarose gel electrophoresis. The three-dimensional ultrastructure and the bioactive components were evaluated by Masson's trichrome staining, Alcian Blue staining, collagen quantification, GAG quantification, scanning electron microscopy (SEM), and toxicity detection.

RESULTS

HE staining and DAPI staining showed the absence of obvious nuclear materials in the combined group, which was further confirmed by DNA quantification and agarose gel electrophoresis. Masson's trichrome staining, Alcian Blue staining, collagen quantification and GAG quantification all verified that the ultrastructure and the bioactive components were well preserved in the combined group. SEM showed a large amount of porous structure on the surface of the UAM prepared by combined perfusion, and toxicity assay confirmed that the prepared UAM was nontoxic.

CONCLUSION

Perfusion of canine ureter with SDS and TritonX-100 is feasible to prepare UAM for ureteral reconstruction.

Study of clinical practical model of urinary system injury

Background:

In order to improve the clinical treatment level of urinary system injury, it is necessary to build up an animal model of urinary system wound, which is not only analogous to real clinical practice, but also simple and practical.

Methods:

We have developed the third generation of firearm fragment wound generator based on the first and the second producer. The best explosive charge of the blank cartridge was selected by gradient powder loading experiments. The firearm fragment injuries were made to the bulbous urethra of 10 New Zealand male rabbits. One week preoperatively and 2, 4 and 8 weeks postoperatively, all the animals underwent urethroscopy and urethrography. At 2, 4 and 8 weeks postoperatively, two animals were randomly selected and killed, and the urethra was cut off for pathological examination.

Results:

The shooting distance of the third generation of firearm fragment wound generator is 2 cm. The best explosive charge of the blank cartridge is 1 g of nitrocotton. All rabbits survived the procedures and stayed alive until they were killed. Injuries were limited to bulbous urethra and distal urethra. Round damaged areas, 1–1.5 cm in length, on the ventral wall were observed. Ureteroscopy results showed that canal diameter gradually shrank by over 50% in 9 rabbits. The rate of success was 90%. Urethrography result noted that a 1–1.3 cm stricture was formed at the bulbous urethra. Histology results of injured stricture urethra showed that fibrous connective tissue hyperplasia and hyaline degeneration caused further stricture in the canal.

Conclusions:

The third generation of firearm fragment wound generator imitates the bullet firing process and is more accurate and repeatable. The corresponding rabbit model of traumatic complex urethral stricture simulates the real complex clinical conditions. This animal model provides a standardized platform for clinical researches on treating traumatic injuries to the urinary system.

β-catenin SUMOylation is involved in the dysregulated proliferation of myeloma cells

Over-activation of SUMOylation is correlated with poor prognosis in multiple myeloma (MM), with the mechanism unclear. Wnt signaling is one of the aberrantly regulated pathways related to cancer tumorigenesis and progression. Whether SUMOylation is involved in regulating the activity of Wnt/β-catenin pathway, however, has not been reported in MM. Here we found that the TOPflash reporter activity and the expression of Wnt/β-catenin target genes can be down-regulated after interference with SUMOylation through SUMO-1 small interfering RNA (siRNA). SUMOylation inhibition down-regulated β-catenin at protein level via promotion of ubiquitin-proteasomal mediated degradation. Furthermore, over-expression of β-catenin rescued Wnt/β-catenin pathway activity and partially prevented increased apoptosis and growth inhibition induced by SUMOylation inhibition, indicating that β-catenin was responsible for the observed effect on Wnt/β-catenin pathway. To gain a clearer view, we exploited the inter-protein interactions of β-catenin and SUMO-1 in myeloma cell lines. Immunoprecipitation and immunofluorescence assay proved that β-catenin is subjected to SUMOylation in vivo, which may, at least partially explain the impact of SUMOylation inhibition on β-catenin. The association of SUMO-1 and β-catenin was confirmed in myeloma patient samples. Taken together, our data proved that SUMOylation inhibition down-regulates Wnt/β-catenin pathway by promoting the ubiquitin-proteasomal mediated degradation of β-catenin. SUMOylation of β-catenin is part of the mechanisms involved in the dysregulated proliferation of myeloma cells.

N-heterocyclic carbene (NHC)-modulated Pd/Cu cocatalyzed three-component synthesis of 2,6-diarylquinolines

An efficient NHC-modulated Pd/Cu cocatalyzed three-component coupling reaction for the synthesis of 2,6-diarylquinolinesviaoxidation, cyclization and Suzuki reactions.

Extramedullary plasmacytoma in the presence of multiple myeloma: clinical correlates and prognostic relevance

Objective

We studied the clinical and laboratory features and outcomes of multiple myeloma (MM) with extramedullary plasmocytoma (EP) disease both at diagnosis and during the course of MM.

Patients and methods

Forty-two patients of 467 patients with MM were retrospectively analyzed from both the 100th Hospital of the People’s Liberation Army and Shanghai Changzheng Hospitals. The clinical characteristics, laboratory parameters, responses, risk factors, and outcomes were analyzed.

Results

The median age was 53 years with a male/female sex ratio of 34:8. Twenty-six patients had EP disease at the time of diagnosis, and 16 patients developed EP during the course of the disease. We found that the Durie–Salmon stage, serum lactate dehydrogenase level, beta-2-microglobulin, complete blood counts, albumin, and the type of immunoglobulin (Ig) were not associated with the development of EP disease. Patients who developed EP during the course of MM had a higher ratio of plasmocytes and premature plasmocytes in the bone marrow with lower C-reactive protein level and earlier stage of International Staging System for Lung Cancer at the diagnosis of MM compared with patients who presented with EP at diagnosis. Once the patients developed EP disease, they frequently showed resistance to chemotherapy. With a median follow-up of 30 months, 19 patients were alive. Log-rank univariate analysis showed that patients with EP who had normal C-reactive protein, higher hemoglobin, lower serum lactate dehydrogenase, and stage I of International Staging System for Lung Cancer had longer survival. However, cyclooxygenase multivariate analysis failed to show statistical significance for any factor.

Conclusions

EP disease is the MM end-phase and is not a rare manifestation of MM with a cumulative incidence of 9% of MM. The prognosis is very poor once the diagnosis of EP disease is concurrent with MM.

Comparison of a biodegradable ureteral stent versus the traditional double-J stent for the treatment of ureteral injury: an experimental study

Ureteral injury remains a major clinical problem; here we developed a biodegradable ureteral stent and compared its effectiveness with a double-J stent for treating ureteral injury. Eighteen dogs with injured ureters were subdivided into two groups. In group A, one injured ureter was treated with a biodegradable stent, whereas only end-to-end anastomosis was performed on the other side. In group B, one injured ureter was treated with a biodegradable stent, while a double-J stent was used on the other side. Intravenous urography, radioactive renography, histological examinations, scanning electron microscopy (SEM) and elemental composition analysis were performed at 40, 80 and 120 days postoperatively. Results showed that the biodegradable stent could effectively prevent hydronephrosis and hydroureter secondary to ureteral injury. Moreover all biodegradable stents gradually degraded and discharged completely in 120 days. SEM and elemental composition analysis of the surface of the double-J stent confirmed calcification at 80 days and calcific plaque at 120 days, while no signs of calcification were found in the biodegradable stent group. Histological studies found no difference between the biodegradable stented ureters and double-J stented ureters. It is concluded that the biodegradable ureteral stent was more advantageous than the double-J stent for treating ureteral injury in a canine model.

A human health risk assessment of mercury species in soil and food around compact fluorescent lamp factories in Zhejiang Province, PR China

This study investigated total mercury (THg) and methylmercury (MeHg) contamination in a major production center of compact fluorescent lamps (CFLs) located in Gaohong, Zhejiang Province, China. This was a result of the growing concern associated with the release of mercury into the environment from such components. The results of the study included the following mean concentrations for THg and MeHg of 157±11 (61-518)ng/gdw and 0.28±0.07 (0.07-0.67)ng/gdw in agricultural soil, respectively, and 18.6±6.5 (3.2-47.8)ng/gww and 0.11±0.03 (0.02-0.37)ng/gww in vegetable samples, respectively. A significant correlation was observed between THg in vegetables and corresponding soil samples (r=0.64, p<0.01). THg and MeHg in sediment samples had respective concentrations ranging from 28 to 1019ng/gdw and 0.11 to 3.15ng/gdw. Mud skipper bought from the local market contained the highest Hg (THg: 170±45ng/gww, MeHg: 143±37ng/gww) amongst all fish species (THg: 14-170; MeHg: 11-143ng/gww) of the study. The risk assessment indicated that fish consumption should not result in a MeHg EDI exceeding the RfD (0.1μg/kgbw/d) for both adults and children, when MeHg bioaccessibility is taken into account.

Tissue engineering of ureteral grafts by seeding urothelial differentiated hADSCs onto biodegradable ureteral scaffolds

The study is aimed to evaluate the differentiation potential of human adipose-derived stem cells (hADSCs) into urothelial lineage, and to assess possibility of constructing ureteral grafts using the differentiated hADSCs and a novel polylactic acid (PLA)/collagen scaffolds. HADSCs were indirectly cocultured with urothelial cells in a transwell coculture system for urothelial differentiation. After 14 days coculturing, differentiation was evaluated by detecting urothelial lineage markers (cytokeratin-18 and uroplakin 2) in mRNA and protein level. Then the differentiated hADSCs were seeded onto PLA/collagen ureteral scaffolds and cultured in vitro for 1 week. The biocompatibility of the scaffolds was tested by scanning electron microscopy (SEM) and MTT analysis. At last, the cell/scafflod grafts were subcutaneously implanted into 4-week-old female athymic mice for 14 days. The results demonstrated that the hADSCs could be efficiently induced into urothelial lineage by indirect coculture. The differentiated cells seeded onto the PLA/collagen ureteral scaffolds survived up to 7 days and maintained proliferation in vitro, which indicated that the scaffolds displayed good biocompatibility. In vivo study showed that the differentiated cells in the grafts survived, formed multiple layers on the scaffolds and expressed urothelial lineage markers. In conclusion, hADSCs may serve as an alternative cell resource in cell-based tissue engineering for ureteral reconstruction. These cells could be employed to construct a model of ureteral engineering grafts and be effectively applied in vivo, which could be a new strategy on ureteral replacement with applicable potential in clinical research.

Synthesis and characterization of triphenylphosphine adducts of ferrocene-based palladacycles and their performance in the Suzuki and Sonogashira reactions with bromo- and chloroarenes

A new triphenylphosphine adduct of cyclopalladated ferrocenylpyridazine containing a chloride anion, 2a, has been synthesized from the reaction of the chloride-bridged palladacyclic dimer 1a with triphenylphosphine. The corresponding adducts 3a,b containing iodide anion have been readily prepared through anion exchange reactions of 2a,b with NaI in acetone. These complexes were characterized by elemental analysis, IR and 1H-NMR. Additionally, their crystal structures have been determined by X-ray diffraction and intermolecular C-H···X (Cl, Br, I) bonds were found in the crystals. The use of these palladacycles as catalysts for the Suzuki and Sonogashira reactions was examined. The complexes 2a,b exhibited higher catalytic activity than the corresponding 3a,b in the Suzuki reaction. However, the order of activity of adducts with varying halogen anions is 3a~3b > 2a~>2b in the Sonogashira reaction.

[Microscopic versus laparoscopic varicocelectomy in the treatment of varicocele: effects and complications]

OBJECTIVE

To compare the effects and postoperative complications of microscopic varicocelectomy (MV) and laparoscopic varicocelectomy (LV) in the treatment of varicocele.

METHODS

We assigned 72 varicocele patients to two groups of equal number to be treated by MV and LV. We compared the two groups in the semen parameters before and 3 months after surgery, postoperative complications, and pregnancy rates of the patients'wives.

RESULTS

The operative time was significantly longer in the MV than in the LV group (P<0.05). The postoperative hospital stay showed no significant difference between the MV and LV groups ([2.2 +/- 2.7] d vs [2.8 +/- 0.8] d). Sperm concentration, sperm motility and the percentage of grade a + b sperm were significantly increased in both groups after surgery (P<0.05), but with no significant differences between the two. The pregnancy rate was 65.2% in the former and 57.1% in the latter. Postoperative hydrocele occurred in 5 cases in the LV, but none in the MV group. There were no statistically significant differences in recurrence between the two groups (P>0.05).

CONCLUSION

MV is superior to LV for its minimal invasiveness, economical anesthesia, faster recovery and lower rates of postoperative complications and recurrence.