Prenylated indole diketopiperazine alkaloids as phosphatase inhibitors from the marine-derived fungus Talaromyces purpureogenus

Six previously undescribed prenylated indole diketopiperazine alkaloids, talaromyines A-F (1-6), were isolated from the marine-derived fungus Talaromyces purpureogenus SCSIO 41517. Their structures including absolute configurations were elucidated on the basis of comprehensive spectroscopic data including NMR, HR-ESI-MS, and electronic circular dichroism calculations, together with chemical analysis of hydrolysates. Compounds 1-5 represent the first example of spirocyclic indole diketopiperazines biosynthesized from the condensation of L-tryptophan and L-alanine. Compounds 2 and 4-5 showed selective inhibitory activities against phosphatases TCPTP and MEG2 with IC50 value of 17.9-29.7 μM, respectively. Compounds 4-5 exhibited mild cytotoxic activities against two human cancer cell lines H1975 and HepG-2.

Microascones, Decahydrofluorene-Class Alkaloids from the Marine-Derived Fungus Microascus sp. SCSIO 41821

Eight new decahydrofluorene-class alkaloids, microascones A and B (1 and 2), 2,3-epoxyphomapyrrolidone C (3), 14,16-epiascomylactam B (4), 24-hydroxyphomapyrrolidone A (5), and microascones C-E (6-8), along with five known analogs (9-13) were isolated from the marine-derived fungus Microascus sp. SCSIO 41821. Compounds 1 and 2 have an unprecedented complex macrocyclic alkaloid skeleton with a 6/5/6/5/6/5/13 polycyclic system. Their structures and absolute configurations were determined by spectroscopic analysis, quantum chemical calculations of ECD spectra, and 13C NMR chemical shifts. Compounds 10-13 showed selective enzyme inhibitory activity against PTPSig, PTP1B, and CDC25B, and 4, 9, and 10 exhibited strong antibacterial activity against seven tested pathogens. Their structure-bioactivity relationship was discussed, and a plausible biosynthetic pathway for 1-8 was also proposed.

Effect of exposures to multiple metals on blood pressure and hypertension in the elderly: a community-based study

A chronic disease, hypertension (HTN) is prevalent among the elderly. Exploring the factors that influence HTN and blood pressure (BP) changes is of great public health significance. However, mixed exposure to multiple serum metals has had less research on the effects on BP and HTN for the elderly. From April to August 2019, 2372 people participated in the community physical examination program for the elderly in Tongling City, Anhui Province. We measured BP and serum levels of 10 metals and collected basic demographic information. We analyzed the relationship between metal levels and changes in BP and HTN by the least absolute shrinkage and selection operator regression, Bayesian kernel machine regression model, and generalized linear model. In multiple models, lead (Pb) and cadmium (Cd) were still significantly associated with HTN occurrence after adjusting for potential confounders (Pb: ORquartile 4 VS quartile 1 = 1.20, 95% CI 1.01-1.43; Cd: ORquartile 4 VS quartile 1 = 1.37, 95% CI 1.16-1.62). In the male subgroup, results were similar to those of the general population. In the female group, Cd was positively correlated with HTN and systolic blood pressure, while Pb was not. According to this study, Pb and Cd were correlated with BP and HTN positively, and there was a certain joint effect. To some extent, our findings provide clues for the prevention of hypertension in the elderly.

Prediction of positive pulmonary nodules based on machine learning algorithm combined with central carbon metabolism data

BACKGROUND

Lung cancer causes a huge disease burden, and early detection of positive pulmonary nodules (PPNs) as an early sign of lung cancer is extremely important for effective intervention. It is necessary to develop PPNs risk recognizer based on machine learning algorithm combined with central carbon metabolomics.

METHODS

The study included 2248 participants at high risk for lung cancer from the Ma'anshan Community Lung Cancer Screening cohort. The Least Absolute Shrinkage and Selection Operator (LASSO) was used to screen 18 central carbon-related metabolites in plasma, recursive feature elimination (RFE) was used to select all 42 features, followed by five machine learning algorithms for model development. The performance of the model was evaluated using area under the receiver operator characteristic curve (AUC), accuracy, precision, recall, and F1 scores. In addition, SHapley Additive exPlanations (SHAP) was performed to assess the interpretability of the final selected model and to gain insight into the impact of features on the predicted results.

RESULTS

Finally, the two prediction models based on the random forest (RF) algorithm performed best, with AUC values of 0.87 and 0.83, respectively, better than other models. We found that homogentisic acid, fumaric acid, maleic acid, hippuric acid, gluconic acid, and succinic acid played a significant role in both PPNs prediction model and NPNs vs PPNs model, while 2-oxadipic acid only played a role in the former model and phosphopyruvate only played a role in the NPNs vs PPNs model. This model demonstrates the potential of central carbon metabolism for PPNs risk prediction and identification.

CONCLUSION

We developed a series of predictive models for PPNs, which can help in the early detection of PPNs and thus reduce the risk of lung cancer.

Corrigendum: The prognosis value of CONUT and SIS score for recurrent or metastatic esophageal squamous cell carcinoma patients treated with second-line immunotherapy

[This corrects the article DOI: 10.3389/fonc.2023.1167625.].

Immune checkpoint inhibitors combined with or without radio(chemo)therapy for locally advanced or recurrent/metastatic esophageal squamous cell carcinoma

OBJECTIVE

This study was designed to investigate the efficacy and prognostic factors for immune checkpoint inhibitors (ICIs) combined with or without radio(chemo)therapy and to evaluate their toxicity in patients with locally advanced or recurrent/metastatic esophageal squamous cell carcinoma (LA/RM ESCC).

METHODS

In this study, 198 patients with locally advanced or recurrent/metastatic (LA/RM) ESCC who received ICIs combined with or without radiotherapy/chemotherapy in the Department of Radiotherapy of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. Univariate and multivariate analyses were performed to determine the prognostic factors for overall survival (OS) and progression free survival (PFS). The factors affecting treatment response and the occurrences of treatment-related adverse events (trAEs) were analyzed.

RESULTS

The median OS and PFS were 30.4 months (95% confidence interval [CI] 15.1-45.7 months) and 15.3 months (95% CI 12.8-17.8 months), respectively. Univariate and multivariate analysis showed that the number of ICI cycles, the intervention of radiotherapy and dysphagia were independent factors affecting OS (Hazard ratio [HR] = 0.39, 2.043 and 0.365, respectively; P = 0.018, 0.001 and 0.032, respectively). The intervention of radiotherapy was an independent factor for PFS (hazard ratio [HR] = 18.149, P = 0.013). The median OS and PFS for patients who had complete response and partial response (Objective response, ORR) were 50.8 months (95% CI 25.8-75.7 months) and 20.5 months (95% CI 14.1-27.0), respectively, which were significantly higher than those in the non-ORR group (OSnon-ORR:17.5 months, 95% CI 14.0-21.0; χ2 = 13.881, P < 0.001; PFSnon-ORR: 12.1 months, 95% CI 10.1-14.1, χ2 = 10.676, P = 0.001). The intervention of radiotherapy could improve treatment response (χ2 = 47.725, P = 0.000). In entire study population, 83 patients (41.9%) had ≥ grade 2 trAEs.

CONCLUSIONS

ICIs combined with radiotherapy/chemotherapy are safe and effective in LA/RM ESCC patients. Intervention of radiotherapy, the number of immunotherapy cycles and occurrence of dysphagia affecting the overall survival of LR/RM ESCC patients. Intervention of radiotherapy was an independent prognosis factor for OS and PFS and associated with better treatment response.

[The application of a new type of sterile elastic exsanguination tourniquet in aspiration surgery for upper limb lymphedema]

Objective: To evaluate the effect of a new type of sterile elastic exsanguination tourniquet (SEET) in aspiration surgery for upper limb lymphedema. Methods: The clinical data of 159 patients who underwent aspiration surgery for upper limb lymphedema from January 2017 to June 2022 in the Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. Among them, 54 patients were treated with SEET (SEET group), while 105 patients were not treated with SEET (No-SEET group). The propensity score matching method was used, and the surgical indicators and complications were compared between the two groups. The factors affecting intraoperative bleeding volume were analyzed through multiple linear regression analysis. Results: A total of 49 pairs of patients were successfully matched by the propensity score method. The age of patients in the SEET and No-SEET groups was (57.7±8.9) years and (56.8±9.1) years, respectively. Compared with the Non-SEET group, the SEET group had less bleeding volume [(311±164) ml vs (437±173) ml, P<0.001]. The results of multiple linear regression analysis showed that the factors affecting intraoperative bleeding volume included age (β=-0.142, P=0.041), using the SEET (β=-0.249, P=0.002), surgical time (β=0.195, P=0.010) and the amount of fat mixture sucked out (β=0.464, P<0.001). Conclusions: The clinical application of the SEET in aspiration surgery for upper limb lymphedema is safe, and can significantly reduce the bleeding volume and alleviate blood shortage.

The prognosis value of CONUT and SIS score for recurrent or metastatic esophageal squamous cell carcinoma patients treated with second-line immunotherapy

Objective

To investigate the predictive value of Controlling Nutritional Status (CONUT) score and systemic inflammation (SIS) score in the prognosis, short-term efficacy, and immune-related side effects of patient with recurrent or metastatic esophageal squamous cell carcinoma (R/M ESCC) receiving immunotherapy as second line therapy combined with or without radiotherapy.

Methods

Forty-eight patients with R/M ESCC who received second-line therapy with Camrelizumab were retrospectively studied. They were divided into the high and low score groups according to the CONUT and SIS score. Univariate and multivariate analyses were used to analyze factors that might affect patient prognosis and the effects of different CONUT score and SIS on the short-term efficacy and immune-related toxic and side effects of patients.

Results

The 1- and 2-year overall survival (OS) and progression-free survival (PFS) rates were 42.9% and 22.5%, and 29.0% and 5.8%, respectively. The CONUT score ranged from 0 to 6 (3.31 ± 1.43), whereas the SIS score ranged from 0 to 2 (1.19 ± 0.73). Multivariate analysis showed that treatment related toxicity, number of cycles of Camrelizumab used, short-term effect and SIS score were independent prognostic factors for OS (P=0.044, 0.021, 0.021, 0.030, respectively), whereas SIS and CONUT scores were independent prognostic factors for PFS (P=0.005, 0.047, respectively). Patients with low CONUT/SIS score had a low incidence rate of immune-related adverse reactions (X2 = 9.735, 5.693; P=0.002, 0.017) and better short-term efficacy (X2 = 4.427, 7.438; P=0.035, 0.006).

Conclusion

R/M ESCC patients with low CONUT/SIS score have better prognosis, higher objective response rate, lower incidence of immune-related toxic and side effects after receiving immunotherapy as second-line therapy. CONUT scores and SIS scores may be reliable prognostic indicators for patient receiving immunotherapy as second-line therapy for R/M ESCC.

Relationship between postoperative nodal skip metastasis of mid-thoracic esophageal squamous cell carcinoma and patient prognosis and its value in guiding postoperative adjuvant treatment

Objective

To evaluate the predictive role of nodal skip metastasis (NSM) in the prognosis of lymph node-positive mid-thoracic esophageal squamous cell carcinoma, and to evaluate the significance of postoperative adjuvant treatment in patients with different sites of metastatic nodes.

Methods

A retrospective analysis was performed on clinical data of 321 lymph node-positive mid-thoracic esophageal squamous cell carcinoma patients who underwent surgery in the Fourth Hospital of Hebei Medical University. Based on the site and condition of lymph node metastasis by postoperative pathology, the patients were divided into two groups: NSM group and non-NSM (NNSM) group. The propensity score matching (PSM) method was employed to match the two groups. The prognostic factors of patients before and after PSM as well as the effect of different adjuvant treatment modes on the prognosis of patients before and after PSM were analyzed. SPSS 29.0 statistical software was used for analysis.

Results

PSM in a 1 : 1 matching ratio was performed, 103 patients were assigned to NSM group and NNSM group respectively. Significant differences were found in the 3- and 5-year OS and DFS between the two groups before PSM, the 3- and 5-year OS also showed a significant difference after PSM (P < 0.05). Multivariate analysis illustrated that gender, postoperative adjuvant treatment mode, N stage and lymph node metastasis were independent risk factors for OS and DFS after PSM (P < 0.05); for NSM patients, postoperative adjuvant chemotherapy and radiotherapy significantly prolonged OS and DFS before and after PSM (P < 0.05). But no significant difference was found in OS and DFS for NNSM patients after PSM (P > 0.05).

Conclusion

Postoperative NSM is a good prognostic factor for patients with mid-thoracic esophageal squamous cell carcinoma, postoperative adjuvant chemoradiotherapy was recommended for those group, thereby gaining survival benefits.

Construction of a predictive model of abdominal lymph node metastasis in thoracic esophageal squamous cell carcinoma and preliminary analysis of its effect on target for postoperative radiotherapy

Purpose

To investigate the influencing factors of abdominal lymph node metastasis in thoracic esophageal squamous cell carcinoma (TESCC), and to construct its predictive model, in order to analyze the targets for postoperative radiotherapy.

Methods and materials

From January 2008 to December 2014, the clinicopathological data of 479 patients who underwent radical resection for esophageal cancer in the Fourth Hospital of Hebei Medical University were collected and retrospectively analyzed. The influencing factors of postoperative abdominal lymph node metastasis were analyzed, and a predictive model was constructed based on their independent influencing factors. Receiver operating characteristic (ROC) curve was utilized to analyze the predictive value of this model; in the meantime, the postoperative locoregional recurrence (LRR) of this group was analyzed.

Results

The postoperative pathology of all patients showed that the lymph node metastasis rate (LNR) was 39.7%, of which the abdominal lymph node metastasis rate was 22.0%. Logistic regression analysis revealed that the patient's lesion location, pN stage, vascular invasion, LND and mediastinal lymph node metastasis were independent risk factors for the positive rate of abdominal lymph nodes after surgery (P = 0.000, 0.000, 0.033, 0.000, 0.000). The probability of abdominal lymph node metastasis was Y = ex/(1 + ex), and X = −5.502 + 1.569 × lesion location + 4.269 × pN stage + 1.890 × vascular invasion + 1.950 × LND-4.248 × mediastinal lymph node metastasis. The area under the ROC curve (AUC) of this model in predicting abdominal lymph node metastasis was 0.962 (95% CI, 0.946–0.977). This mathematical model had a high predictive value for the occurrence of abdominal lymph node metastasis (P = 0.000), and the sensitivity and specificity of prediction were 94.6% and 88.3% respectively. The overall survival rate was significantly higher (X2 = 29.178, P = 0.000), while abdominal lymph node recurrence rate was lower in patients with negative abdominal lymph nodes than in those with negative lymph nodes (1.4%&amp;7.7%, X2 = 12.254, P = 0.000).

Conclusion

The lesion location, pN stage, vascular invasion, LND and mediastinal lymph node metastasis are independent influencing factors of abdominal lymph node metastasis in patients with TESCC. The mathematical model constructed by these indicators can accurately predict abdominal lymph node metastasis, which can help clinicians to choose the targets for postoperative radiotherapy.

Endoscopic classification and pathological features of primary intestinal lymphangiectasia

BACKGROUND

The appearance of the intestinal mucosa during endoscopy varies among patients with primary intestinal lymphangiectasia (PIL).

AIM

To classify the endoscopic features of the intestinal mucosa in PIL under endoscopy, combine the patients’ imaging and pathological characteristics of the patients, and explain their causes.

METHODS

We retrospectively analyzed the endoscopic images of 123 patients with PIL who were treated at the hospital between January 1, 2007 and December 31, 2018. We compared and analyzed all endoscopic images, classified them into four types according to the endoscopic features of the intestinal mucosa, and analyzed the post-lymphographic computed tomography (PLCT) and pathological characteristics of each type.

RESULTS

According to the endoscopic features of PIL in 123 patients observed during endoscopy, they were classified into four types: nodular-type, granular-type, vesicular-type, and edematous-type. PLCT showed diffuse thickening of the small intestinal wall, and no contrast agent was seen in the small intestinal wall and mesentery in the patients with nodular and granular types. Contrast agent was scattered in the small intestinal wall and mesentery in the patients with vesicular and edematous types. Analysis of the small intestinal mucosal pathology revealed that nodular-type and granular-type lymphangiectasia involved the small intestine mucosa in four layers, whereas ectasia of the vesicular- and edematous-type lymphatic vessels largely involved the lamina propria mucosae, submucosae, and muscular layers.

CONCLUSION

Endoscopic classification, combined with the patients’ clinical manifestations and pathological examination results, is significant and very useful to clinicians when scoping patients with suspected PIL.

Filling GRACE Gaps Using GRACE-Derived Time Varying Model &#160;.. [DOI: 10.5194/egusphere-egu22-3208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

&lt;p&gt;Using time-variable gravity field models has recently become essential for studying the hydrology change, ice melting, Earth&amp;#8217;s crust deformation, etc. One of the most successful missions for establishing the time-variable gravity field model is the Gravity Recovery and Climate Experiment (GRACE) mission and its successor GRACE-Follow On (GARCE-FO) mission. However, the eleven-month gap between the end of GRACE's life span and the start of GRACE-FO observations hinders the study continuation. This investigation is devoted to model the GRACE data using time-variable gravity field model employing a smart least-squares regression technique. The GRACE-derived time-variable gravity field model is validated first using available GRACE data used in the modeling technique (to measure the internal precision of the model) as well as using available GRACE data which have not been used in the modeling technique (to measure the external accuracy of the model). The assessment of the derived model has been carried out at two different levels in the frequency domain (through the harmonic coefficients and the degree variances) and in the space domains (through the total water storage change in Africa). The GRACE-derived time-variable gravity field model has then been used to fill in the GRACE/GRACE-FO gap. A comparison among the existing techniques of filling-in the GRACE gaps versus the derived technique within the current investigation is given and widely discussed. This study is supported by the National Natural Science Foundations of China (NSFC) under Grants 41874023, 41721003, 41631072.&lt;/p&gt;&lt;p&gt;Keywords: GRACE, GRACE-FO, Gravity, GRACE gap, TWS, Least square adjustment.&amp;#160;&lt;/p&gt;

[Lower extremity lymphedema as the initial symptom of malignant disease]

To investigate the diagnosis of malignancy with lower extremity lymphedema as the initial manifestation. We performed a retrospective study of 33 patients with malignant lymphedema treated at the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, from May 22, 2007 to December 31, 2018. A total of 33 cases of lower extremity lymphedema caused or aggravated by malignant tumors were found. The age range of 33 patients with malignant lymphedema was 21 to 84 years. Twenty-two patients were male, and 11 patients were female, with a mean age of (57.5±15.0) years. The time from the occurrence of lymphedema to the diagnosis of malignant tumors ranged from a month to 2 years. The proportion of patients with abnormal tumor markers was 88.9% (24/27), the prevalence of anemia among patients with malignant lymphedema was 42.4% (14/33), and the positive rates of ultrasonography, CT, MRI, and radionuclide imaging were 100.0% (17/17), 100.0% (25/25), 100.0% (4/4) and 60.0% (12/20), respectively. Twenty-seven cases with malignant tumors were confirmed by pathological diagnosis. To avoid delays in the diagnosis and therapy of malignant lymphedema, physicians should actively look for signs or symptoms of lymphedema during the follow-up period and promptly manage patients developing problems.

Carotane sesquiterpenoids A–G from the desert endophytic fungus Fusarium sp. HM 166

Seven undescribed carotane sesquiterpenoids named fusanoids A–G (1–7), along with one known analog (8) and two known sesterterpenes (9 and 10), were isolated from the fermentation broth of the desert endophytic fungi Fusarium sp. HM166. The structures of the compounds, including their absolute configurations, were determined by spectroscopic data, single-crystal X-ray diffraction analysis, and ECD calculations. Compound 10 showed cytotoxic activities against human hepatoma carcinoma cell line (Huh-7) and human breast cell lines (MCF-7 and MDA-MB-231), and compound 2 showed cytotoxic activity against MCF-7, while compounds 4–9 were inactive against all the tested cell lines. Compounds 4 and 10 showed potent inhibitory activities against the IDH1^R132h mutant.

Seven undescribed carotane sesquiterpenoids were isolated from the endophytic fungi Fusarium sp. HM166. Single-crystal X-ray diffraction and ECD defined absolute configurations. Cytotoxicity for Huh-7, MCF-7, and MDA-MB-231 cancer cell lines and IDH1^R132h mutant were studied.

Preliminary analysis of the benefits of different irradiation types on patients with postoperative locoregional recurrence of esophageal cell squamous carcinoma

BACKGROUND

To explore the benefits of different types of irradiation on patients with postoperative locoregional recurrence (LRR) of thoracic esophageal squamous cell carcinoma (ESCC).

METHODS

We analyzed the medical records of 344 patients with recurrent esophageal cancer (EC) at the Fourth Hospital of Hebei Medical University. All patients met an inclusion criteria that included having postoperative LRR (without distant metastasis), and having received either chemotherapy, radiotherapy, or chemoradiotherapy after LRR. Patients either received elective nodal irradiation (ENI) or involved field irradiation (IFI), with a stratified analysis performed on both groups. SPSS 19.0 software (IBM Corporation, Armonk, NY USA) was then used for statistical analysis.

RESULTS

The median overall survival time of all patients after surgery was 33 months [95% confidence interval (CI): 28.3-37.7 months]; the median overall survival time of patients after recurrence after radiotherapy was 12.8 months (95% CI: 11.3-14.3 months). There were 276 cases (80.2%) of single local recurrence after surgery, and 68 cases (19.8%) of multiple local recurrence (≥2). The results of our multivariate analysis showed that the patient's gender, log odds of positive lymph nodes (LODDS), and the number of courses of chemotherapy were all independent factors affecting the patient's prognosis (P=0.003, P<0.001, and P<0.001). The results of stratified analysis showed that patients with esophageal lesion length <5.0 cm, stage N0, ≤9 surgically dissected lymph nodes, no positive regional lymph node metastasis (LNM), and LODDS ≤0.030 could benefit from ENI treatment (X2=4.208, P=0.032; X2=6.262, P=0.012; X2=10.359, P=0.001; X2=6.327, P=0.012; X2=6.026, P=0.014); and patients with ≥16 surgically dissected lymph nodes could benefit from IFI treatment (X2=4.429, P=0.035).

CONCLUSIONS

Chemotherapy, radiotherapy, and chemoradiotherapy are all effective modes of treatment for patients with postoperative LRR of EC. Patients with shorter esophageal lesions determined by preoperative esophagography, earlier postoperative pathological N staging, lower LODDS scores, and fewer surgically dissected lymph nodes might benefit more from ENI treatment than from IFI. However, patients with a larger number of lymph nodes dissected during surgery might benefit more from IFI treatment. To further confirm this study's conclusions, multiple prospective studies should be undertaken in the future.

Talaromyoxaones A and B: Unusual Oxaphenalenone Spirolactones as Phosphatase Inhibitors from the Marine-Derived Fungus Talaromyces purpureogenus SCSIO 41517

(+)- and (-)-talaromyoxaones A and B (1 and 2, respectively), two new oxaphenalenone derivatives with a hemiacetal frame and an unprecedented spirolactone frame of a 2'H,3H,4'H-spiro[isobenzofuran-1,3'-pyran]-3-one unit that show biosynthetic enantiodivergence, and two new oxaphenalenone analogues (±)-11-apopyrenulin (3) and (+)- or (-)-abeopyrenulin (4) were isolated from the marine-derived fungus Talaromyces purpureogenus SCSIO 41517. Their structures were elucidated by spectroscopic analysis, single-crystal X-ray diffraction, and quantum chemical calculations of ECD spectra. Compounds 1 and 2 showed selective inhibitory activity against phosphatases SHP1, SHP2, and MEG2 with IC₅₀ values of 1.3-3.4 μM, and the potential modes of action for 1 were investigated by a preliminary molecular docking study.

[Long-term efficacy and safety of simultaneous integrated boost radiotherapy in non-operative esophageal squamous cell carcinoma: a multicenter retrospective data analysis (3JECROG R-05)]

Objective: To analyze the survival benefits and treatment related toxic effects of simultaneous integrated boost intensity-modulated radiotherapy (SIB-RT) for non-operative esophageal squamous cell carcinoma patients. Methods: The data of 2 132 ESCC patients who were not suitable for surgery or rejected operation, and underwent radical radiotherapy from 2002 to 2016 in 10 hospitals of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG) were analyzed. Among them, 518 (24.3%) cases underwent SIB (SIB group) and 1 614 (75.7%) cases did not receive SIB (No-SIB group). The two groups were matched with 1∶2 according to propensity score matching (PSM) method (caliper value=0.02). After PSM, 515 patients in SIB group and 977 patients in No-SIB group were enrolled. Prognosis and treatment related adverse effects of these two groups were compared and the independent prognostic factor were analyzed. Results: The median follow-up time was 61.7 months. Prior to PSM, the 1-, 3-, and 5-years overall survival (OS) rates of SIB group were 72.2%, 42.8%, 35.5%, while of No-SIB group were 74.3%, 41.4%, 31.9%, respectively (P=0.549). After PSM, the 1-, 3-, and 5-years OS rates of the two groups were 72.5%, 43.4%, 36.4% and 75.3%, 41.7%, 31.6%, respectively (P=0.690). The univariate survival analysis of samples after PSM showed that the lesion location, length, T stage, N stage, TNM stage, simultaneous chemoradiotherapy, gross tumor volume (GTV) and underwent SIB-RT or not were significantly associated with the prognosis of advanced esophageal carcinoma patients who underwent radical radiotherapy (P<0.05). Cox model multivariate regression analysis showed lesion location, TNM stage, GTV and simultaneous chemoradiotherapy were independent prognostic factors of advanced esophageal carcinoma patients who underwent radical radiotherapy (P<0.05). Stratified analysis showed that, in the patients whose GTV volume≤50 cm(3), the median survival time of SIB and No-SIB group was 34.7 and 30.3 months (P=0.155), respectively. In the patients whose GTV volume>50 cm(3), the median survival time of SIB and No-SIB group was 16.1 and 20.1 months (P=0.218). The incidence of radiation esophagitis and radiation pneumonitis above Grade 3 in SIB group were 4.3% and 2.5%, significantly lower than 13.1% and 11% of No-SIB group (P<0.001). Conclusions: The survival benefit of SIB-RT in patients with locally advanced esophageal carcinoma is not inferior to non-SIB-RT, but without more adverse reactions, and shortens the treatment time. SIB-RT can be used as one option of the radical radiotherapy for locally advanced esophageal cancer.

[Clinical features of primary isolated chylopericardium: a retrospective review study]

Objective: To examine the clinical characteristics and abnormal reflux branches of primary isolated chylopericardium. Methods: Totally 43 patients with primary isolated chylopericardium at Department of Lymphatic Surgery, Affiliated Beijing Shijitan Hospital,Capital Medical University from June 2007 to January 2018 were recruited in this study. There were 21 males and 22 females, aging (23.0±15.9) years (range: 2 to 57 years). The levels of triglyceride, total cholesterol, total protein and albumin in pericardial effusion and blood were compared by paired-t test, and the characteristics of lymphatic system in direct lymphangiography and postoperative CT were analyzed. Results: Pericardial effusion was mainly milky white and monocytes, and 95.3%(41/43) were positive for Rivalta test. The level of triglyceride in pericardial effusion was significantly higher than that of blood ((9.67±5.11) mmol/L vs. (1.28±0.89) mmol/L, t=10.557, P<0.01), and the levels of total cholesterol ((2.19±0.52) mmol/L vs. (4.12±1.06) mmol/L, t=-3.732, P<0.01), total protein ((61.25±16.17) g/L vs. (68.26±8.30) g/L, t=-2.958, P=0.005) and albumin ((36.63±7.06) g/L vs. (42.32±4.73) g/L, t=-5.747, P<0.01) were significantly lower than that of blood. In the direct lymphangiography, the imaging of iliac and retroperitoneal lymphatics showed dilated or tortuous in 90.7% (39/43), the thoracoabdominal segment of thoracic duct showed dilation in 46.5% (20/43), and cervical thoracic duct imaging showed dilation in 44.2% (19/43) and stenosis in 55.8% (24/43). The image of lipiodol flowing into the vein showed obstruction at the venous angle. There were 60.5%(26/43) of the patients with lipiodol reflux through the bronchomediastinal trunk (type Ⅰ), 11.6%(5/43) with lipiodol diffusion to the pericardium through the abnormal pathway from the thoracic segment of the thoracic duct (type Ⅱ), while no communication pathway between the thoracic duct and the pericardial cavity (type Ⅲ) found in 27.9%(12/43). CT images obtained after the direct lymphangiography showed 34.9%(15/43) had abnormal distribution of lipiodol in pericardium, mediastinal lymph nodes and lung hilar lymph nodes, 46.5%(20/43) in mediastinal lymph nodes and lung hilar lymph nodes, 14.0%(6/43) only mediastinal lymph nodes, 4.6%(2/43) had no lipiodol in the above areas. Conclusions: Pericardial effusion compared with same period blood, has higher triglyceride, lower total cholesterol, total protein and albumin. The obstruction of the cervical segment of the thoracic duct and the formation of abnormal reflux branches would be corelative to primary isolated chylopericardium.

Effect of SIB-IMRT-based selective dose escalation of local tumor on the prognosis of patients with esophageal cancer

BACKGROUND

To investigate the effect of SIB-IMRT-based selective dose escalation to local tumor on the prognosis of patients with esophageal cancer (EC).

METHODS

A total of 302 EC patients were enrolled. The prognostic factors of the entire group were initially analyzed, and the composition ratios of the two groups and the different doses of each fraction for PTV were compared. The propensity-score matching (PSM) was carried out (1:1 ratio), and the prognostic factors for the two groups were analyzed according to the results of COX.

RESULTS

The median overall survival (OS) for all patients was 30.0 months (23.495-36.505 months), and the median disease-free survival (DFS) was 21.3 months (7.698-24.902 months). In multivariate analysis, chemotherapy, cTNM stage and dose-per-fraction for the PTV were independent prognostic factors for OS (P = 0.013, 0.000, 0.028) and DFS (P = 0.033, 0.000, 0.047). Multivariate analysis of patients after PSM revealed that cTNM staging and dose-per-fraction were the independent prognostic factors for OS (P = 0.000, 0.015). Chemotherapy, cTNM staging and dose-per-fraction for the PTV were the independent prognostic factors for DFS (P = 0.025, 0.010, 0.015). There was no significant difference in grade ≥ 2 acute toxicities between the two groups. A subgroup analysis of patients with a single dose of 2 Gy and > 2 Gy in the SIB-IMRT group showed that OS and DFS of the latter were significantly better than those of the former.

CONCLUSION

The selective dose escalation to local tumors based on SIB-IMRT technique can improve the survival of patients received radical radiotherapy without increasing toxicities.

Validation of Using SWARM to Fill-in the GRACE/GRACE-FO Gap: Case Study in Africa.. [DOI: 10.5194/egusphere-egu21-2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

&lt;p&gt;The American/German missions Gravity Recovery and Climate Experiment (GRACE) and the GRACE Follow-On (GRACE-FO) and the European mission (Swarm) play an important role in study of the Earth's gravity field with unprecedented high-precision and high-resolution measurements. The aim of this study is to use Swarm data to fill-in the data-gap between GRACE and GRACE-FO missions from July 2017 to May 2018, and evaluate the new datasets in Africa. We used the available data from the triple GRACE processing centers CSR, GFZ and JPL, in addition to the Swarm TVGF data provided by the Czech Academy of Sciences (ASU) and the International Combination Service for Time-variable Gravity (COST-G). The GRCAE and Swarm date have been tested in the frequency and space domains. For the frequency domain, the data assessed in two different levels: the potential degree variances and the harmonic coefficients themselves. The results show consistency between GRACE/GRACE-FO and Swarm for all processing centers. In the space domain, a comparison between GRACE/GRACE-FO and Swarm for the TWS, gravity anomaly, and the potential/geoid have been carried out. For the TWS, an artificial gap (AG) - simulating the gap between GRACE and GRACE-FO &amp;#8211; has been artificially made in the GRACE data from July 2015 to May 2016. The GRACE AG has been filled by the two sets of the Swarm data for CSR, GFZ and JPL. The results indicated that the best agreement has been achieved between GRACE-CSR and Swarm COST-G. For the gravity anomaly and the potential/geoid, a better agreement between GRACE and Swarm data has been concluded. Eventually, we chose Swarm COST-G data to fill-in the gap between GRACE and GRACE-FO CSR in order to be used, among others, to estimate the TWS in Africa for the period from April 2002 to October 2020. This study is supported by the National Natural Science Foundations of China (NSFC) under Grants Nos. 42030105, 41721003, 41804012, 41631072, and 41874023.&lt;/p&gt;

Clinical characteristics of systemic lupus erythematosus with chylothorax and/or chylous ascites: An analysis of 15 cases in China

This analysis of clinical data from systemic lupus erythematosus (SLE) patients with chylothorax and/or chylous ascites was conducted to guide further clinical work.From June 2008 to June 2019, 15 SLE patients (14 females and 1 male) with chylothorax and/or chylous ascites were hospitalized at the Beijing Shijitan Hospital. Sixty SLE patients without chylothorax and chylous ascites were randomly selected as controls. Patients', clinical data was investigated.The mean age of onset of chylothorax and/or chylous ascites in patients with SLE was 35.7 ± 3.7 years (range, 15-69 years). The mean disease duration of chylothorax and/or chylous ascites in patients with SLE was 13.7 ± 3.4 months (range, 1-48 months). Patients with chylothorax and/or chylous ascites were always diagnosed at later stages of SLE compared with the controls. Among cases, glomerulonephritis and hematologic system involvement were the most common complications. Anti-Sjogren's syndrome antigen A antibody was positive in 7 cases (46.7%). Among cases, direct lymphangiography was performed in 13 patients, indicating thoracic duct outlet obstruction or a poor backflow at the terminal of the thoracic duct. Subsequently, 13 patients were treated with corticosteroids, combined with immunosuppressants in 11 patients and thoracic duct surgery in 6 patients. Eleven patients were followed up for 0.5 to 7.0 years. One patient died of infection. Eight patients (53.3%) achieved remission.Chylothorax and/or chylous ascites are rare complications of SLE. An early diagnosis and timely initiation of glucocorticoids, immunosuppressants, and surgery are critical to relieve symptoms and to improve prognosis.

[Efficacy analysis of the radiotherapy and chemotherapy in patients with stage Ⅳ esophageal squamous carcinoma: a multicenter retrospective study of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG R-01F)]

Objective: To evaluate the survival and prognostic factors of radiotherapy in patient with Ⅳ stage esophageal squamous carcinoma treated with radiation or chemoradiation. Methods: The medical records of 608 patients with stage Ⅳ esophageal squamous cell carcinoma who met the inclusion criteria in 10 medical centers in China from 2002 to 2016 were retrospectively analyzed. The overall survival and prognostic factors of all patients at 1, 3 and 5 years were analyzed. Results: The 1-, 3-, 5- year overall survival (OS) rates was 66.7%, 29.5% and 24.3% in stage ⅣA patients, and 58.8%, 29.0% and 23.5% in stage ⅣB patients. There was no statistical difference between the two groups (P=0.255). Univariate analysis demonstrated that the length of lesion, treatment plan, planned tumor target volume (PGTV) dose, subsequent chemotherapy, and degrees of anemia, radiation esophagitis, radiation pneumonia were related to the prognoses of patients with Ⅳ stage esophageal carcinomas after radiotherapy and chemotherapy (P<0.05). Multivariate analysis demonstrated that PGTV dose (OR=0.693, P=0.004), radiation esophagitis (OR=0.867, P=0.038), and radiation pneumonia (OR=1.181, P=0.004) were independent prognostic factors for OS. Conclusions: For patients with stage Ⅳ esophageal squamous cell carcinoma, chemoradiotherapy followed by sequential chemotherapy is recommended, which can extend the total survival and improve the prognosis of the patients. PGTV dose more than 60 Gy has better efficacy.

Magnetic Curvatures of a Uniformly Magnetized Tesseroid Using the Cartesian Kernels

In recent years, the gravitational curvatures, the third-order derivatives of the gravitational potential (GP), of a tesseroid have been introduced in the context of gravity field modeling. Analogous to the gravity field, magnetic field modeling can be expanded by magnetic curvatures (MC), the third-order derivatives of the magnetic potential (MP), which are the change rates of the magnetic gradient tensor (MGT). Exploiting Poisson's relations between ( n + 1 ) th-order derivatives of the GP and nth-order derivatives of the MP, this paper derives expressions for the MC of a uniformly magnetized tesseroid using the fourth-order derivatives of the GP of a uniform tesseroid expressed in terms of the Cartesian kernel functions. Based on the magnetic effects of a uniform spherical shell, all expressions for the MP, magnetic vector (MV), MGT and MC of tesseroids have been examined for numerical problems due to singularity of the respective integral kernels (i.e., near zone and polar singularity problems). For this, the closed analytical expressions for the MP, MV, MGT and MC of the uniform spherical shell have been provided and used to generate singularity-free reference values. Varying both height and latitude of the computation point, it is found numerically that the near zone problem also exists for all magnetic quantities (i.e., MP, MV, MGT and MC). The numerical tests also reveal that the polar singularity problems do not occur for the magnetic quantity as a result of the use of Cartesian as opposed to spherical integral kernels. This demonstrates that the magnetic quantity including the newly derived MC 'inherit' the same numerical properties as the corresponding gravitational functional. Possible future applications (e.g., geophysical information) of the MC formulas of a uniformly magnetized tesseroid could be improved modeling of the Earth's magnetic field by dedicated satellite missions.

[Prognostic analysis of definitive radiotherapy for early esophageal carcinoma(T1-2N0M0): a multi-center retrospective study of Jing-Jin-ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group]

Objective: To evaluate the prognostic factors of T1-2N0M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy. Methods: The clinical data of 196 patients with T1-2N0M0 ESCC who were treated with definitive radiotherapy in 10 hospitals were retrospectively analyzed. All sites were members of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG). Radiochemotherapy were applied to 78 patients, while the other 118 patients received radiotherapy only. 96 patients were treated with three-dimensional conformal radiotherapy (3DCRT) and 100 treated with intensity-modulated radiotherapy (IMRT). The median dose of plan target volume(PTV) and gross target volume(GTV) were both 60 Gy. The median follow-up time was 59.2 months. Log rank test and Cox regression analysis were used for univariat and multivariate analysis, respectively. Results: The percentage of normal lung receiving at least 20 Gy (V(20)) was (18.65±7.20)%, with average dose of (10.81±42.05) Gy. The percentage of normal heart receiving at least 30 Gy (V(30)) was (14.21±12.28)%. The maximum dose of exposure in spinal cord was (39.65±8.13) Gy. The incidence of radiation pneumonia and radiation esophagitis were 14.80%(29/196) and 65.82%(129/196), respectively. The adverse events were mostly grade 1-2, without grade 4 toxicity. Median overall survival (OS) and progression-free survival (PFS) were 70.1 months and 62.3 months, respectively. The 1-, 3- and 5-year OS rates of all patients were 75.1%、57.4% and 53.2%, respectively. The 1-, 3- and 5-year PFS rates were 75.1%、57.4% and 53.2%, respectively. Multivariate analysis demonstrated that patients'age (HR=1.023, P=0.038) and tumor diameter (HR=1.243, P=0.028)were the independent prognostic factors for OS, while tumor volume were the independent prognostic factor for PFS. Conclusions: Definitive radiotherapy is a promising therapeutic method in patients with T1-2N0M0 ESCC. Patients' age, tumor diameter and tumor volume may impact patients' prognosis.

Dosimetric Predictors of Radiation Gastritis Due to Postoperative Intensity Modulated Irradiation Therapy in Patients with Esophageal Squamous Cell Carcinoma After Radical Esophagectomy

Objective: To explore the association between the incidence of acute radiation gastritis attributed to postoperative intensity modulated irradiation therapy (IMRT) and the dose volume of intrathoracic stomach of patients with esophageal squamous cell carcinoma (ESCC) after radical esophagectomy. Methods: The authors retrospectively collected the data of 49 ESCC patients who participated in postoperative IMRT treatment after radical esophagectomy, and analyzed the incidence of acute radiation gastritis during the treatment. Results: Among all the 49 patients, acute grade ≥2 radiation gastritis was observed in 19 patients (39%). Receiver operating characteristic (ROC) curve analysis showed that the physical variables, such as stomach D_max, D_mean, length of the whole stomach received 5-40 Gy (LSTT₅-LSTT₄₀), and V₁₀-V₅₀, were associated with acute radiation gastritis. Patients were grouped according to cutoff values in physical indicators obtained from the ROC curve. Other than V₅, the incidence of acute grade ≥2 radiation gastritis was significantly higher in the group with indicators above cutoff values than that below cutoff values, and the between-group difference was statistically significant in terms of physical indicators. Multivariate analysis suggested that LSTT₅ and V₄₀ could be acted as indicators to predict the incidence of acute grade ≥2 radiation gastritis. Conclusions: In the postoperative IMRT treatment for ESCC patients, protection of intrathoracic stomach is strongly recommended. Dose-volume histogram is a preferable predictive indicator for the occurrence of acute radiation gastritis, especially for the stomach LSTT₅ and V₄₀. Nevertheless, a larger sample size is needed to provide insight into the relevant study.

The browning of white adipose tissue and body weight loss in primary hyperparathyroidism

Background

Parathyroid hormone related protein (PTHrP) triggers white adipose tissue (WAT) browning and cachexia in lung cancer mouse models. It remains unknown whether excessive PTH secretion affects WAT browning and to what extent it contributes to body weight change in primary hyperparathyroidism (PHPT).

Methods

Using the adeno-associated virus injection, Pth gene over-expressed mice mimicking PHPT were firstly established to observe their WAT browning and body weight alteration. The association between PTH and body weight was investigated in 496 PHPT patients. The adipose browning activities of 20 PHPT and 60 control subjects were measured with PET/CT scanning.

Findings

Elevated plasma PTH triggered adipose tissue browning, leading to increased energy expenditure, reduced fat content, and finally decreased body weight in PHPT mice. Higher circulating PTH levels were associated with lower body weight (β = −0.048, P = .0003) independent of renal function, serum calcium, phosphorus,and albumin levels in PHPT patients. PHPT patients exhibited both higher prevalence of detectable brown/beige adipose tissue (20% vs 3.3%, P = .03) and increased browning activities (SUV in cervical adipose was 0.77 vs 0.49,P = .02) compared with control subjects.

Interpretation

Elevated serum PTH drove WAT browning program, which contributed in part to body weight loss in both PHPT mice and patients. These results give insights into the novel pathological effect of PTH and are of importance in understanding the metabolic changes of PHPT.

Fund

This research is supported by the National Key Research and Development Program of China and National Natural Science Foundation of China.

Quantitative determination and validation of octreotide acetate using 1 H-NMR spectroscopy with internal standard method

Quantitative nuclear magnetic resonance (qNMR) is a well-established technique in quantitative analysis. We presented a validated ¹ H-qNMR method for assay of octreotide acetate, a kind of cyclic octopeptide. Deuterium oxide was used to remove the undesired exchangeable peaks, which was referred to as proton exchange, in order to make the quantitative signals isolated in the crowded spectrum of the peptide and ensure precise quantitative analysis. Gemcitabine hydrochloride was chosen as the suitable internal standard. Experimental conditions, including relaxation delay time, the numbers of scans, and pulse angle, were optimized first. Then method validation was carried out in terms of selectivity, stability, linearity, precision, and robustness. The assay result was compared with that by means of high performance liquid chromatography, which is provided by Chinese Pharmacopoeia. The statistical F test, Student's t test, and nonparametric test at 95% confidence level indicate that there was no significant difference between these two methods. qNMR is a simple and accurate quantitative tool with no need for specific corresponding reference standards. It has the potential of the quantitative analysis of other peptide drugs and standardization of the corresponding reference standards.

Analysis of the causes of failure after radical surgery in patients with PT3N0M0 thoracic esophageal squamous cell carcinoma and consideration of postoperative radiotherapy

BACKGROUND

Five-year overall survival rate of TESCC after surgery is low (approximately 30% to 60%), so it is meaningful to discuss the significance of PORT.

METHODS

We retrospectively collected the data of 227 patients with _PT₃N₀M₀ esophageal cancer (EC). The failure pattern after surgery was analyzed. Difference of adjuvant PORT in patients with _PT₃N₀M₀ TESCC and the appropriate population were explored based on the relevant studies.

RESULTS

There were 58 cases with intrathoracic locoregional recurrence (LRR) after radical surgery and 27 cases with distant metastasis, including 10 cases of recurrence. The recurrence rate of mediastinal lymph nodes in the thoracic cavity was 50.0%. Univariate analysis revealed that compared with patients with middle and lower thoracic EC, the 3/5-year survival rate of patients with upper thoracic EC was significantly lower, accompanied with remarkably higher thoracic LRR. Compared with those with moderately- and well-differentiated TESCC, the 3/5-year survival rate of patients with poorly differentiated TESCC was significantly lower, whereas the distant metastasis rate was notably higher. Multivariate analysis revealed that different lesion locations and different pathologic differentiation were the independent prognostic factors. The lesion location and degree of differentiation were the independent influencing factors for thoracic LRR and distant metastasis, respectively.

CONCLUSION

The intrathoracic LRR is the major failure pattern for patients with _PT₃N₀M₀ TESCC after conventional two-field lymphadenectomy. In addition, recurrence rate of _PT₃N₀M₀ TESCC was significantly higher in upper thoracic EC than in middle and lower thoracic EC. PORT is recommended to patients with _PT₃N₀M₀ upper TESCC.

[Liposuction combined with lymphatico-venous anastomosis for treatment of secondary lymphedema of the lower limbs: a report of 49 cases]

Objective: To study the clinical effects of liposuction combined with lymphatico-venous anastomosis for treatment of secondary lymphedema of the lower limbs. Methods: A retrospective analysis was performed for 49 patients who had undergone liposuction combined with lymphatico-venous anastomosis to treat secondary lymphedema of the lower limbs at Department of Lymph Surgery, Beijing Shijitan Hospital from November 2013 to February 2015.All patients were female aging from 31 to 70 years with median age of (52±10)years.All patients had history of pelvic surgery.There were 32 cases with cervical carcinoma, 11 cases with endometrial cancer, 1 case with ovarian cancer who accepted radical hysterectomy, 2 cases with benign tumor who accepted resection, 2 cases accepted inguinal lymph node dissection, 1 case with rectal cancer accepted radical resection.There were 30 cases with history of radiation therapy and 23 cases with history of erysipelas recurrent((2.1±3.9)/year). The limb swelling degree in preoperative and postoperative patients was explored using one-way analysis of variance with replicate measures and paired sample t-test. Meanwhile the incidence of lymphogenous infection was used as an evaluation of operation efficacy. Results: The mean lower limb circumference difference at 7 days, 6 months and 12 months was (0.17±1.36)cm, (1.25±1.62)cm and(1.58±1.56)cm, respectively, which was significantly decreased compared with preoperative((4.92±2.16)cm) (t=-5.712, -5.777, -5.765; all P<0.01). The mean lower limb volume difference at 7 days, 6 months and 12 months was (522±799)ml, (726±973)ml and (889±895)ml, respectively, which was significantly decreased compared with preoperative((2 729±1 335) ml)(t=-5.905, -6.093, -5.777; all P<0.01). The incidence of erysipelas was 0.0(0.0, 0.0)/6 months within 6 months after operation and 0.0(0.0, 0.0)/6 months within 6-12 months after operation, which was significantly lower than that before operation(0.0(0.0, 2.0)/year). The feeling of tightness and heaviness of the limb was significantly improved compared with preoperative. Conclusion: Liposuction combined with lymphatico-venous anastomosis is an effective method for the treatment of secondary lymphedema of the lower limbs.

Seasonal Mass Changes and Crustal Vertical Deformations Constrained by GPS and GRACE in Northeastern Tibet

Surface vertical deformation includes the Earth’s elastic response to mass loading on or near the surface. Continuous Global Positioning System (CGPS) stations record such deformations to estimate seasonal and secular mass changes. We used 41 CGPS stations to construct a time series of coordinate changes, which are decomposed by empirical orthogonal functions (EOFs), in northeastern Tibet. The first common mode shows clear seasonal changes, indicating seasonal surface mass re-distribution around northeastern Tibet. The GPS-derived result is then assessed in terms of the mass changes observed in northeastern Tibet. The GPS-derived common mode vertical change and the stacked Gravity Recovery and Climate Experiment (GRACE) mass change are consistent, suggesting that the seasonal surface mass variation is caused by changes in the hydrological, atmospheric and non-tidal ocean loads. The annual peak-to-peak surface mass changes derived from GPS and GRACE results show seasonal oscillations in mass loads, and the corresponding amplitudes are between 3 and 35 mm/year. There is an apparent gradually increasing gravity between 0.1 and 0.9 μGal/year in northeast Tibet. Crustal vertical deformation is determined after eliminating the surface load effects from GRACE, without considering Glacial Isostatic Adjustment (GIA) contribution. It reveals crustal uplift around northeastern Tibet from the corrected GPS vertical velocity. The unusual uplift of the Longmen Shan fault indicates tectonically sophisticated processes in northeastern Tibet.

[Clinical analysis of two cases with diffuse pulmonary lymphatic disease]

OBJECTIVE

To analyze the clinical characteristics and diagnosis of 2 cases with diffuse pulmonary lymphatic disease.

METHOD

Clinical manifestations of the children were retrospectively analyzed. Two patients were both from Beijing Children Hospital in 2013 and 2014.Diffuse pulmonary lymphatic disease was diagnosed by pathology of pleura in case 1 and by lymphoscintigraphy in case 2.

RESULT

The first patient was a male aged 10-year-5-month who presented with a history of pleural effusion for 2 years. Examination revealed chylothorax and pericardial effusion. After pleural decortications and ligation of thoracic duct was performed, he still had recurrent chylothorax. Pathology of pleura revealed lymphangioma. Physical examination showed diminished breath sound and heart sounds. A bronchoscope revealed too much white viscous secretions. Thorax ultrasound revealed lymphangioma in bilateral lower thoracic cavity and post inferior mediastinum. Chest computed tomography showed diffuse thickening of the interlobular septa and bronchovascular bundle in both lungs, many punctate calcification in the lower field. Abdomen ultrasound revealed a small quantity seroperitoneum. Lymphoscintigraphy revealed radioactivity enhancement in bilateral thoracic cavity. The second patient was a female aged 6 years and 9 months, who presented with a history of recurrent cough for 2 years and 9 months. Physical examination showed normal result. Pulmonary function showed mixed ventilation function disturbance. A bronchoscopy showed extensive viscous secretions. Mediastinum, heart and abdomen were normal on ultrasound. Chest computed tomography showed diffuse thickening of the interlobular septa and bronchovascular bundle in both lungs and bilateral pleural thickening. Lymphoscintigraphy revealed diffuse lymphangiectasis in both lungs. Both patients received a diagnosis of diffuse pulmonary lymphatic disease. Case 1 who had died was diagnosed with diffuse pulmonary lymphangiomatosis. Case 2 had no exacerbation after 9 months' treatment with prednisone.

CONCLUSION

Diffuse pulmonary lymphatic disease might present with cough and shortness of breath and result in diffuse interstitial disease with thickening of the interlobular septa, refractory chylothorax, multiple lymphangioma in mediastinum, pericardial effusion and seroperitoneum. It could be diagnosed by pleura or lung tissue pathology and lymphoscintigraphy.

Analysis of failure patterns in patients with resectable esophageal squamous cell carcinoma receiving chemoradiotherapy

PURPOSE

This study investigates the failure pattern after chemoradiotherapy of patients with resectable esophageal squamous cell carcinoma (ESCC).

MATERIALS AND METHODS

We retrospectively analyzed 92 patients with T1-2, N0-1, and M0 ESCC. These patients were inoperable because of poor performance, comorbidities, poor tumor region, or refusal of operation.

RESULTS

Among the 92 patients, 29 cases displayed simple locoregional recurrence, 12 cases displayed simple distant metastasis, and 6 cases displayed distant metastasis with locoregional recurrence. Univariate analysis shows that the incidence of recurrence in the middle thoracic region was significantly higher than other regions (χ2 = 14.415, P = 0.001). For the 18 patients with distant metastasis, incidence of distant metastasis in the lower thoracic region was significantly higher than the other regions (= 39.359, P < 0.001). Among 35 cases with regional recurrence, 7 cases reached complete remission (14.6%) and 28 cases reached partial remission (PR; 63.6%) (χ2= 23.435, P < 0.001). Multivariate analysis shows that the patient age, tumor node metastasis (TNM) stage, and short-term efficacy were independent factors for locoregional recurrence. Patient age, TNM stage, X-ray length of the lesions, and short-term efficacy were the independent factors for distant metastases.

CONCLUSION

The incidence of locoregional recurrence and distant metastasis in patients with upper thoracic esophageal cancer was lower than those who had middle thoracic and lower thoracic esophageal cancer. The incidence of locoregional recurrence and distant metastasis in patients who achieved complete response after treatment was low.

Quantitative analysis of sitagliptin using the19F-NMR method: a universal technique for fluorinated compound detection

¹⁹F-NMR spectroscopy is employed to expand the application scope of NMR technology in quantitative analysis of pharmaceutical ingredients.

Pathological characteristics of esophageal cancer

The pathological characteristics of esophageal squamous cell carcinoma, which include regularly occurring multiple carcinogenic lesions (MLs), severe dysplasia (SD) and direct intramural infiltration (DI), were investigated using large pathological sections. A total of 52 esophageal cancer patients underwent surgical resection and were diagnosed with esophageal squamous cell carcinoma. Large sections of the surgical resection specimens were then made for pathological examination. The actual length of the carcinoma was calculated during surgery from the length determined microscopically. ML, SD and DI were identified during pathological examination of the large sections by microscope and were statistically analyzed. The lesion lengths obtained by the various inspection methods differed from each other. ML, SD and DI were identified in 15, 28 and 41 patients, respectively. Furthermore, a higher incidence of DI was observed in patients with lymphatic infiltration or those with a later stage of disease. ML, SD and DI were identified as characteristics of esophageal squamous cell carcinoma, and ML and DI were found to correlate with lymphatic infiltration.

The performance of thiol-terminated PEG-paclitaxel-conjugated gold nanoparticles

A series of thiol-terminated polyethylene glycol (PEG)-paclitaxel (PTX) derivatives are designed and synthesized to fabricate PTX-conjugated gold nanoparticles (PTX@GNPs) and improve their overall performance. By extending the molecular weight of PEG from 400 to 1000 Da, the optimized water solubility of the conjugate reaches 184 mg/mL, equal to 4.6 × 10(5) times that of PTX alone (0.4 μg/mL). High drug loading is obtained by eliminating the steric hindrance between PTX molecules on the surface of GNPs. The gold conjugate shows double simultaneous stimulation-induced drug release behavior in the presence of both esterase and high concentrations of glutathione. The synergic release characteristics of this conjugate results in significant performance improvements, including prolonged circulation due to high stability in vivo, targeted release of PTX inside tumor cells, and increased tumor cell killing efficiency. Improving the in vitro properties of the conjugate not only significantly enhances its therapeutic efficacy in a murine liver cancer model, but also allows drug-conjugated gold nanoparticles to be used as a promising nanoprodrug system in the cancer therapeutics.

Osteomalacia and osteoporosis associated with primary intestinal lymphangiectasis

Primary Intestinal lymphangiectasia (PIL) is a common cause of protein losing enteropathy (PLE). It will affect enter-hepatic circulation of lipid-soluble vitamin, and absorption of electrolytes, cause malnutrition related osteomalacia or osteoporosis. While seldom health care workers noted to assess and treat osteomalacia or osteoporosis in PIL. Here we report a related case. We found increased parathyroid hormone, decreased 25(OH)D3, low bone mineral density, which indicated that the PIL patient had osteomalacia and/or osteoporosis. Adequate calcium and vitamin D supply can relieve the condition efficaciously. We should pay attention to osteomalacia and osteoporosis in PIL patients.

Dosimetric and clinical predictors of radiation-induced lung toxicity in esophageal carcinoma

AIMS AND BACKGROUND

Radiation-induced lung toxicity occurs frequently in patients with esophageal carcinoma. This study aims to evaluate the clinical and three-dimensional dosimetric parameters associated with lung toxicity after radiotherapy for esophageal carcinoma.

METHODS AND STUDY DESIGN

The records of 56 patients treated for esophageal carcinoma were reviewed. The Radiation Therapy Oncology Group criteria for grading of lung toxicity were followed. Spearman's correlation test, the chi-square test and logistic regression analyses were used for statistical analysis.

RESULTS

Ten of the 56 patients developed acute toxicity. The toxicity grades were grade 2 in 7 patients and grade 3 in 3 patients; none of the patients developed grade 4 or worse toxicity. One case of toxicity occurred during radiotherapy and 9 occurred 2 weeks to 3 months after radiotherapy. The median time was 2.0 months after radiotherapy. Fourteen patients developed late irradiated lung injury, 3 after 3.5 months, 7 after 9 months, and 4 after 14 months. Radiographic imaging demonstrated patchy consolidation (n = 5), atelectasis with parenchymal distortion (n = 6), and solid consolidation (n = 3). For acute toxicity, the irradiated esophageal volume, number of fields, and most dosimetric parameters were predictive. For late toxicity, chemotherapy combined with radiotherapy and other dosimetric parameters were predictive. No obvious association between the occurrence of acute and late injury was observed.

CONCLUSIONS

The percent of lung tissue receiving at least 25 Gy (V25), the number of fields, and the irradiated length of the esophagus can be used as predictors of the risk of acute toxicity. Lungs V30, as well as chemotherapy combined with radiotherapy, are predictive of late lung injury.

1,1'-Bis(1-acetyl-5-methyl-1H-pyrazol-3-yl)ferrocene

The title compound, [Fe(C(11)H(11)N(2)O)(2)], crystallizes with two independent mol-ecules in the asymmetric unit which have have different conformations. In one mol-ecule, the two ferrocene cyclo-penta-dienyl rings are fully eclipsed and the two pyrazole rings are syn to each other; in the other, the two cyclo-penta-dienyl rings are synclinal and the pyrazole rings are anti. In both mol-ecules, the acetyl group attached to the pyrazole ring is oriented away from the iron-cyclo-penta-dienyl group of ferrocene.

Monoclinic form of (Z)-1-ferrocenyl-3-(3-hy-droxy-anilino)but-2-en-1-one

The title compound, [Fe(C₅H₅)(C₁₅H₁₄NO₂)], is a monoclinic polymorph of the previously reported triclinic form [Shi et al. (2006 ▶). Acta Cryst. C62, m407–m410]. The polymorphs feature the same strong intra­molecular N—H⋯O=C hydrogen bonds, but show different packing modes. The mol­ecules in the monoclinic form associate into double chains via O—H⋯O=C and (Cp)C—H⋯O—H inter­actions.

Undeca-carbonyl-μ(2)-methane-thiol-ato-μ(2)-[(pyridin-2-yl)methane-thiol-ato]-μ(4)-sulfido-tetra-iron(II)(2 Fe-Fe)

The title compound, [Fe(4)(C(6)H(6)NS)(CH(3)S)S(CO)(11)], com-prises two butterfly-shaped sub-cluster cores, Fe(2)S(2)N and Fe(2)S(2), joined together by a spiro-type μ(4)-S atom. The (pyridin-2-yl)methane-thiol-ate ligand is attached to the Fe(2)(CO)(5) unit in a μ-κN:κ(2)S mode, and the methane-thiol-ate ligand is coordinated to the Fe(2)(CO)(6) unit in a μ-κ(2)S fashion.

Diagnostic value of intraoperative endoscopic examination in patients with intestinal lymphangiectasia: an analysis of 6 cases

AIM: To assess the diagnostic value of intraoperative endoscopic examination in patients with intestinal lymphangiectasia (IL).

METHODS: Six patients with IL and protein-losing enteropathy underwent intraoperative endoscopic examination during the study. Intraoperative endoscopic examination was performed via an intestinal incision to locate the site of lymph fluid leakage.

RESULTS: Endoscopic findings included white fluid in the intestinal lumen, multiple scattered white spots, and white and swollen villi in all the 6 patients, polyps in 3 patients, and mucosal erosion in 2 patients. After subserosal injection of methylene blue, the sites of lymph fluid leakage were successfully located in 5 patients (83.3%).

CONCLUSION: Endoscopic examination is a very important diagnostic test for patients with IL, especially for locating the site of lymph fluid leakage.

[Metabonomic study on the effects of allicin on rats]

To investigate the effects of allicin on rats by NMR-based metabonomic method, the changes of endogenous metabolites in normal rat urine and the influences on metabolism were analyzed with bio-nuclear magnetic resonance (NMR) method and partial least-squares discriminant analysis (PLS-DA) after intraperitoneal administration of allicin solution. The identified biochemical effects associated with allicin dosing included elevated then gradually recovered urinary levels of Kreb's cycle intermediates, such as citrate, alpha-ketoglutarate and succinate and increased concentrations of ketones. Meanwhile, decreased urinary concentrations of glucose, lactate, alanine, hippurate and trimethylamine oxide were observed. The PLS-DA revealed that the metabonomic profiles of allicin treated groups were obviously different from those of the control group. Allicin may change metabolism significantly in normal rats. The study of the pharmacologic mechanism of allicin by metabonomic method is practicable and it could be explored further.

Intestinal lymphangiectasia complicated by viral hepatitis: an analysis of 2 cases

Two patients in our hospital diagnosed as intestinal lymphangiectasia were studied. The two patients had chronic intestinal lymphangiectasia complicated by virus hepatitis. They presented with edema, abdominal distension and diarrhea. Serological finding indicated hypoproteinemia (including albumin and globulin) and significantly decreased peripheral lymphocytes. Enteroscopy showed that the normal intestinal villous morphology were lost and there were diffuse generalized white-yellowish nodular changes, villous edema and lengthways erosion. Pathological observation revealed the presence of dilated lymphatic vessels without evidence of inflammatory cell infiltration and granuloma.

[Effects of RNA interference on CHK1 and CHK2 expression and G2/M arrest in esophageal carcinoma cell line TE13 after irradiation]

BACKGROUND & OBJECTIVE

Cell cycle of tumor cells often changes after irradiation. This study was to observe the effect of RNA interference (RNAi) on mRNA and protein expression of human checkpoint kinases CHK1 and CHK2 and on cell cycle of esophageal carcinoma cell line TE13 after irradiation.

METHODS

Short hairpin RNAs (shRNAs) of CHK1 and CHK2 genes were designed and constructed, and then transfected into TE13 cells. The expression of CHK1 and CHK2 were detected by Western blot and reverse transcription-polymerase chain reaction (RT-PCR). Cell cycle was measured by flow cytometry after 5-Gy radiation. Cell survival after irradiation was evaluated with colony forming assay.

RESULTS

After transfection of CHK1 and CHK2 shRNAs, the mRNA and protein expression of CHK1 and CHK2 in TE13 cells were inhibited obviously. At 24 h after 5-Gy radiation, G2/M phase proportion was higher in irradiated TE13 cells than in control TE13 cells (61.47% vs. 32.17%), and significantly lower in CHK1 shRNA-and CHK2 shRNA-transfected TE13 cells than in untransfected TE13 cells (28.13% and 42.80% vs. 61.47%, P<0.05)û cell survival rates were 27% in simplex irradiation group, 14% in CHK1 shRNA transfection plus irradiation group, and 21% in CHK2 shRNA transfection plus irradiation group. In the first generation of transfected TE13 cells, the inhibition of CHK1 and CHK2 expression was almost diminished at 120 h after transfection. At 120 h after transfection and 24 h after 5-Gy irradiation, G2/M phase proportion was significantly higher in CHK1 shRNA-and CHK2 shRNA-transfected groups than in simplex irradiation group (P<0.05)û but at 144 h after transfection and 48 h after 5-Gy irradiation, the difference between transfection groups and simplex irradiation group was not significant (P>0.05).

CONCLUSIONS

RNAi could inhibit the expression of CHK1 and CHK2, release G2/M phase arrest after irradiation, and enhance radiosensitivity of TE-13 cells. G2/M phase of TE-13 cells after irradiation may be regulated by CHK1 and CHK2.

Randomized clinical trial on seven-day-per-week continuous accelerated irradiation for patients with esophageal carcinoma: Preliminary report on tumor response and acute toxicity

AIM: Tumor response and normal tissue toxicity of seven-day-per-week continuous accelerated irradiation (CAIR) for patients with esophageal carcinoma were evaluated and compared to conventional irradiation (CR).

METHODS: Sixty patients with squamous cell carcinoma of the esophagus were randomized into two groups: the CAIR group (30 patients) and the CR group (30 patients). Patients in the CAIR group received radiotherapy (RT) with 2 Gy/fraction per day at 7 d/wk with a total dose of 50-70 Gy (average dose 64.2 Gy). The overall time of irradiation was 3.6-5.0 wk (average 4.6 wk). RT in the CR group was 2 Gy/fraction per day at 5 d/wk with a total dose of 40-70 Gy (average dose 61.7 Gy). The overall time of irradiation was 4.0-7.0 wk (average 6.4 wk).

RESULTS: The data showed that the immediate tumor response to RT was better in the CAIR group than in the CR group. Efficiency rates (CR plus PR) were 82.8% (24/29) and 58.6% (17/29), respectively (P = 0.047). In both groups the incidences of esophagitis and tracheitis were insignificant (P = 0.376, 0.959), and no patient received toxicity that could not be tolerated.

CONCLUSION: CAIR shortens overall treatment time and is well tolerated by patients. It may be superior to CR in enhancing the local response of tumor, but its remote effect for esophageal carcinoma awaits further follow-up.