Integrated analysis of single-cell and bulk RNA-seq establishes a novel signature for prediction in gastric cancer

BACKGROUND

Single-cell sequencing technology provides the capability to analyze changes in specific cell types during the progression of disease. However, previous single-cell sequencing studies on gastric cancer (GC) have largely focused on immune cells and stromal cells, and further elucidation is required regarding the alterations that occur in gastric epithelial cells during the development of GC.

AIM

To create a GC prediction model based on single-cell and bulk RNA sequencing (bulk RNA-seq) data.

METHODS

In this study, we conducted a comprehensive analysis by integrating three single-cell RNA sequencing (scRNA-seq) datasets and ten bulk RNA-seq datasets. Our analysis mainly focused on determining cell proportions and identifying differentially expressed genes (DEGs). Specifically, we performed differential expression analysis among epithelial cells in GC tissues and normal gastric tissues (NAGs) and utilized both single-cell and bulk RNA-seq data to establish a prediction model for GC. We further validated the accuracy of the GC prediction model in bulk RNA-seq data. We also used Kaplan–Meier plots to verify the correlation between genes in the prediction model and the prognosis of GC.

RESULTS

By analyzing scRNA-seq data from a total of 70707 cells from GC tissue, NAG, and chronic gastric tissue, 10 cell types were identified, and DEGs in GC and normal epithelial cells were screened. After determining the DEGs in GC and normal gastric samples identified by bulk RNA-seq data, a GC predictive classifier was constructed using the Least absolute shrinkage and selection operator (LASSO) and random forest methods. The LASSO classifier showed good performance in both validation and model verification using The Cancer Genome Atlas and Genotype-Tissue Expression (GTEx) datasets [area under the curve (AUC)_min = 0.988, AUC_1se = 0.994], and the random forest model also achieved good results with the validation set (AUC = 0.92). Genes TIMP1, PLOD3, CKS2, TYMP, TNFRSF10B, CPNE1, GDF15, BCAP31, and CLDN7 were identified to have high importance values in multiple GC predictive models, and KM-PLOTTER analysis showed their relevance to GC prognosis, suggesting their potential for use in GC diagnosis and treatment.

CONCLUSION

A predictive classifier was established based on the analysis of RNA-seq data, and the genes in it are expected to serve as auxiliary markers in the clinical diagnosis of GC.

[A single-center study on the distribution and antibiotic resistance of pathogens causing bloodstream infection in patients with hematological malignancies]

Objective: To study the incidence of bloodstream infections, pathogen distribution, and antibiotic resistance profile in patients with hematological malignancies. Methods: From January 2018 to December 2021, we retrospectively analyzed the clinical characteristics, pathogen distribution, and antibiotic resistance profiles of patients with malignant hematological diseases and bloodstream infections in the Department of Hematology, Nanfang Hospital, Southern Medical University. Results: A total of 582 incidences of bloodstream infections occurred in 22,717 inpatients. From 2018 to 2021, the incidence rates of bloodstream infections were 2.79%, 2.99%, 2.79%, and 2.02%, respectively. Five hundred ninety-nine types of bacteria were recovered from blood cultures, with 487 (81.3%) gram-negative bacteria, such as Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa. Eighty-one (13.5%) were gram-positive bacteria, primarily Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecium, whereas the remaining 31 (5.2%) were fungi. Enterobacteriaceae resistance to carbapenems, piperacillin/tazobactam, cefoperazone sodium/sulbactam, and tigecycline were 11.0%, 15.3%, 15.4%, and 3.3%, with a descending trend year on year. Non-fermenters tolerated piperacillin/tazobactam, cefoperazone sodium/sulbactam, and quinolones at 29.6%, 13.3%, and 21.7%, respectively. However, only two gram-positive bacteria isolates were shown to be resistant to glycopeptide antibiotics. Conclusions: Bloodstream pathogens in hematological malignancies were broadly dispersed, most of which were gram-negative bacteria. Antibiotic resistance rates vary greatly between species. Our research serves as a valuable resource for the selection of empirical antibiotics.

[Impact of interventional therapy on top of standard drug therapy on left ventricular structure and function in HFrEF patients complicating with middle aortic syndrome caused by Takayasu arteritis]

Objective: To evaluate the impact of interventional therapy on top of drug therapy on cardiac function and structure in heart failure with reduced ejection fraction (HFrEF) patients complicating with middle aortic syndrome caused by Takayasu arteritis (TA-MAS). Methods: It was a retrospective longitudinal study. The data of patients with TA-MAS and HFrEF, who received interventional therapy on top of drug therapy in Fuwai Hospital from January 2010 to September 2020, were collected and analyzed. Baseline clinical data (including demographic data, basic treatment, etc.) were collected through the electronic medical record system. Changes of indexes such as New York Heart Association (NYHA) classification, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) before and after therapy were analyzed. Results: A total of 10 patients were collected. There were 8 females in this patient cohort, age was (18.4±5.0) years and onset age was (15.3±5.0) years. All 10 patients received standard heart failure medication therapy in addition to hormone and/or immunosuppressive anti-inflammatory therapy, but cardiac function was not improved, so aortic balloon dilatation and/or aortic stenting were performed in these patients. The median follow-up was 3.3(1.3, 5.6) years. On the third day after interventional therapy, the clinical symptoms of the 10 patients were significantly improved, NYHA classfication was restored from preoperative Ⅲ/Ⅳ to Ⅱ at 6 months post intervention(P<0.05). Compared with preoperation, NT-proBNP (P=0.028), LVEDD (P=0.011) and LVMI (P=0.019) were significantly decreased, LVEF was significantly increased (P<0.001) at 6 months after operation. Compared with preoperation, NT-proBNP (P=0.016), LVEDD (P=0.023) and LVMI (P=0.043) remained decreased, LVEF remained increased (P<0.001) at 1 year after operation. Conclusion: Results from short and medium term follow-up show that interventional therapy on top of heart failure drug therpay can effectively improve left cardiac function and attenuate cardiac remodeling in patients with TA-MAS comorbid with HFrEF.

[A descriptive analysis of tea consumption in adult twins in China]

Objective: To describe the distribution characteristics of tea consumption in adult twins recruited in the Chinese National Twin Registry (CNTR) and provide clues to genetic and environmental influences on tea consumption. Methods: Enrolled in CNTR during 2010-2018, 25 264 twin pairs aged 18 years and above were included in subsequent analysis. Random effect models were used to estimate tea consumption in the population and regional distribution characteristics. The concordance rate of the behavior and difference in consumption volume of tea within pairs were also described. Results: The mean age of all subjects was (35.38±12.45) years old. The weekly tea consumers accounted for 17.0%, with an average tea consumption of (3.36±2.44) cups per day. The proportion of weekly tea consumers was higher among males, 50-59 years old, southern, urban, educated, and the first-born in the twin pair (P<0.05), and lower among unmarried individuals (P<0.001). Within-pair analysis showed that the concordance rate of tea consumption of monozygotic (MZ) twins was higher than that of dizygotic (DZ) twins and the overall heritability of tea consumption was 13.45% (11.38%-15.51%). Stratified by the characteristics mentioned above, only in males, the concordance rate of MZ showed a tendency to be greater than that of DZ (all P<0.05). The differences in consumption volume of tea within twin pairs were minor in MZ among males (P<0.05), while the differences were not significant in female twins. Conclusion: There were discrepancies in the distribution of tea consumption among twins of different demographic and regional characteristics. Tea consumption was mainly influenced by environmental factors and slightly influenced by genetic factors. The size of genetic factors varied with gender, age, and region, and gender was a potential modified factor.

[A descriptive analysis on coronary heart disease in adult twins in China]

Objective: To describe the distribution characteristics of coronary heart disease in adult twins recruited from Chinese Twin Registry (CNTR), and provide clues and evidence for the effect of genetic and environmental influences on coronary heart disease. Methods: By using the data of CNTR during 2010-2018, a total of 34 583 twin pairs aged ≥18 years who completed questionnaire survey and had related information were included in the current study to analyze the population and area distribution characteristics of coronary heart disease. Random effect models were used to compare the differences between groups. The concordane rate of coronary heart disease were calculated respectively in monozygotic (MZ) twin pairs and dizygotic (DZ) twin pairs to estimate the heritability. Results: The twin pairs included in this analysis were aged (34.2±12.4) years. The overall prevalence rate of coronary heart disease in twin pairs was 0.7%. Twin pairs who were women, older, obese and lived in northern China had higher prevalence of coronary heart disease (P<0.05). Intra-pair analysis in the same-sex twin pairs found that the concordane rate of coronary heart disease was higher in MZ twin pairs (25.3%) than in DZ twins (7.4%), and the difference was statistically significant (P<0.001). The overall heritability of coronary heart disease was 19.3% (95%CI: 11.8%-26.8%). Stratified by gender, age and area, the concordane rate was still higher in MZ twin pairs than in DZ pairs. Participants who were women, aged 18-30 years or ≥60 years and lived in northern China had a higher heritability of coronary heart disease. Conclusion: The distribution of coronary heart disease in twin pairs differed in populations and areas. The prevalence of coronary heart disease was affected by genetic factors, but the effect varied with age, gender and area.

[A descriptive analysis on type 2 diabetes in twins in China]

Objective: To describe the distribution characteristics of type 2 diabetes in twins in Chinese National Twin Registry (CNTR), provide clues and evidence for revealing the influence of genetic and environmental factors for type 2 diabetes. Methods: Of all twins registered in the CNTR during 2010-2018, a total 18 855 twin pairs aged ≥30 years with complete registration information were included in the analysis. The random effect model was used to describe the population and area distribution characteristics and concordance of type 2 diabetes in twin pairs. Results: The mean age of the subjects was (42.8±10.2) years, the study subjects included 10 339 monozygotic (MZ) twin pairs and 8 516 dizygotic (DZ) twin pairs. The self-reported prevalence rate of type 2 diabetes was 2.2% in total population and there was no sighificant difference between MZ and DZ. Intra-twin pairs analysis showed that the concordance rate of type 2 diabetes was 38.2% in MZ twin pairs, and 16.0% in DZ twin pairs, the difference was statistically significant (P<0.001). The concordance rate of type 2 diabetes in MZ twin parts was higher than that in DZ twin pairs in both men and women, in different age groups and in different areas (P<0.05). Further stratified analysis showed that in northern China, only MZ twin pairs less than 60 years old were found to have a higher concordance rate of type 2 diabetes compared with DZ twin pairs (P<0.05). In southern China, the co-prevalence rate in male MZ twin pairs aged ≥60 years was still higher than that in DZ twin pairs (P<0.05). Conclusion: The twin pairs in this study had a lower self-reported prevalence of type 2 diabetes than the general population. The study results suggested that genetic factors play a role in type 2 diabetes prevalence in both men and women, in different age groups and in different areas, however, the effect might vary.

Calcitonin gene-related peptide (CGRP) receptor antagonists: Heterocyclic modification of a novel azepinone lead

In our efforts to identify orally bioavailable CGRP receptor antagonists, we previously discovered a novel series of orally available azepinone derivatives that unfortunately also exhibited the unwanted property of potent time-dependent human CYP3A4 inhibition. Through heterocyclic replacement of the indazole ring, we discovered a series of heterocycle derivatives as high-affinity CGRP receptor antagonists. Some of them showed reasonable oral exposures, and the imidazolone derivatives that showed good oral exposure also exhibited substantially reduced time-dependent CYP3A4 inhibition. Several compounds showed strong in vivo efficacy in our marmoset facial blood flow assay with up to 87% inhibition of CGRP-induced activity. However, oral bioavailability generally remained low, emphasizing the challenges we and others encountered in discovering clinical development candidates for this difficult Class B GPCR target.

[Levels of sgRNA as a Major Factor Affecting CRISPRi Knockdown Efficiency in K562 Cells]

To determine how nuclease deactivated Cas9 (dCas9) or single-guide RNA (sgRNA) expression levels affect the knockdown efficiency of CRISPRi, we created K562 cell clones expressing KRAB-dCas9 protein either with the inducible Tet-on system or with the constitutive SFFV promotor. Single clones were selected by fluorescence-activated cell sorting (FACS) for further study. Six genes with various expression levels were targeted using lentiviral sgRNA from two libraries in four cell clones with various KRAB-dCas9 expression levels. The expression level of dCas9 protein/sgRNA levels and the knockdown efficiency were determined by flow cytometry. The cell clone with the highest KRAB-dCas9 expression level achieved effective CRISPRi knockdown. The data describing this clone were statistically different from that on other clones, indicating the strong KRAB-dCas9 expression might be a prerequisite for CRISPRi. By adopting different multiplicity of infection (MOI) in lentiviral transduction of this clone, we modified the expression level of sgRNA and found that the knockdown efficiency was neither affected by the target gene expression level nor correlated with KRAB-dCas9 levels, which remained relatively constant across all knockdown experiments (coefficient of variation = 2.2%). As an example, the following levels of the knockdowns: 74.72, 72.28 and 39.08% for mmadhc, rpia and znf148 genes, respectively, were achieved. These knockdown efficiencies correlated well with the respective sgRNA expression levels. Linear regression models built using this data indicate that the knockdown efficiency may be significantly affected by the levels of both KRAB-dCas9 and sgRNA. Notably, the sgRNA levels have greater impact, being a major factor affecting CRISPRi efficiency.

[The effects of stelleta ganglion resection on heart failure in response to pressure overload]

Objective: To observe the impact and difference of resection of left stellate ganglion (LSG) or right stellate ganglion (RSG) on rats with heart failure. Methods: Thirty male SD rats were divided into 3 groups (n=10 each) by random number table method: control group, LSG group, RSG group. All three groups underwent TAC surgery to establish a pressure-overloaded heart failure model. Then, LSG and RSG were bluntly separated and removed in rats assigned to the LSG group or RSG group by surgery, while rats in the control group underwent sham operation. The changes in blood pressure and heart rate before operation, 30 minutes and 10 weeks after operation were recorded; echocardiography was performed before operation and 10 weeks after operation to detect the thickness of the ventricular septum, left ventricle posterior wall diameter, left ventricular end diastolic diameter, left ventricular end diastolic volume, and calculate the left ventricular fractional shortening and left ventricular ejection fraction. HE staining and Masson staining were performed to observe the degree of myocardial hypertrophy and myocardial fibrosis, and to judge the ventricular remodeling. Results: The heart rates of the three groups of rats were (352.4±4.3), (320.3±4.0) and (297.9±5.9) beats/min, and the blood pressure was (142.8±2.3), (123.4±2.7) and (129.6±2.9) mmHg(1 mmHg=0.133 kPa) at thirty minutes after surgery; the heart rates of the three groups of rats were (352.9±4.0), (321.6±3.4) and (301±4.1) beats/min, and the blood pressure was (145.6±1.9), (124.8±1.7) and (130.4±4.4) mmHg at 10 weeks after surgery. The heart rate and blood pressure in the LSG group and RSG group at 30 min and 10 weeks after surgery were significantly lower than those in the control group; at 10 weeks after surgery, the heart rate in the RSG group was significantly lower than that in the LSG group (P both<0.001). After 10 weeks, rats in the control group developed severe left ventricular dilatation. Degree of left ventricular hypertrophy was significantly reduced in the LSG group and RSG group than in the control group, the thickness of the ventricular septum was (3.2±0.3), (2.5±0.1) and (2.5±0.1) mm; the left ventricular end-diastolic diameters were (7.5±0.3), (5.5±0.3) and (5.7±0.2) mm; the left ventricular end-diastolic volume was (9.5±0.3), (4.5±0.2) and (4.8±0.2) ml; the left ventricular fractional shortening was (21.6±1.3)%, (49.1±3.9)% and (47.4±1.5)%; and the left ventricular ejection fraction was (50.9±2.5)%, (81.9±2.1)% and (80.0±2.3)%, respectively in the control group, LSG group and RSG group. Compared with the control group, the left ventricular posterior wall diameter, left ventricular end-diastolic diameter and left ventricular end-diastolic volume were significantly lower and the left ventricular fractional shortening and left ventricular ejection fraction were significantly higher in the LSG group and RSG group (all P<0.001). 10 weeks after operation, the values of type Ⅰ collagen in the control group, LSG group, and RSG group were (0.354±0.013), (0.211±0.012) and (0.243±0.013), respectively. Ratio of type Ⅰ/Ⅲ collagen was (1.109±0.065), (0.737±0.055) and (0.839±0.075), respectively. Compared with the control group, the ratio of type Ⅰcollagen and ratio of type Ⅰ/Ⅲ collagen were significantly lower in the LSG group and RSG group (P<0.001). Conclusion: Both left and right stellate ganglion resection can similarly reduce ventricular remodeling caused by pressure overload and delay the progression of heart failure in tis TAC rat model.

[Investigation of an epidemic cluster caused by COVID⁃19 cases in incubation period in Shanghai]

Objective: To analyze the epidemiological characteristics of a cluster of 5 confirmed COVID⁃19 cases related with the transmission in incubation period of initial case, and find out the infection source and transmission chain.. Methods: According to "The Prevention and Control Protocol for Coronavirus Disease 2019 (Third Edition)" issued by the National Health Commission, a field epidemiological survey was conducted for the 5 cases in January 2020. Nasopharyngeal swabs and sputum samples were collected from them for the detection of 2019-nCoV by real time RT-PCR. Multi prevention and control measures were taken, such as tracking and screening close contacts, medical isolation observation, investigating the epidemiological link, analyzing transmission chain. Results: Case 1, who had common environmental exposure with other COVID⁃19 cases, got sick on 20 January, 2020 and was confirmed on 1 February. Case 2 became symptomatic on 22 January and was confirmed on 27 January. Case 3 got sick on 25 January and was confirmed on 30 January. Case 4 had illness onset on 20 January and was confirmed on 1 February. Case 5 got sick on 23 January and was confirmed on 31 January. Among the 5 cases, case 2 died and the illness of other cases were effectively controlled. After exclusion of other common exposure factors, case 1 had a 6-hour meeting with case 2 and case 3 on 19 January. Case 2 and case 3 might be infected by case 1 during the incubation period. It is the key point for epidemiological investigation. Conclusion: The epidemiological investigation indicates that the transmission might occur in the incubation period of COVID-19 case, close attention should be paid to it in future COVID-19 prevention and control.

[Epidemiological characteristics of COVID-19 in Gansu province]

Objective: To understand the epidemiological characteristics of COVID-19 cases in different epidemic stages in Gansu province. Methods: Epidemiological investigation was conducted to collect the information of confirmed COVID-19 cases, including demographic, epidemiological and clinical information. Results: As of 25 February 2020, a total of 91 confirmed COVID-19 cases had been reported in Gansu. The epidemic of COVID-19 in Gansu can be divided as three different stages, i.e. imported case stage, imported-case plus indigenous case stage, and indigenous case stage. A total of 63 cases were clustered cases (69.23%), 3 cases were medical staff infected with non-occupational exposure. The initial symptoms included fever (54.95%, 50/91), cough (52.75%, 48/91), or fatigue (28.57%, 26/91), the proportion of each symptom showed a decreasing trend along with the three epidemic stages, but only the differences in proportions of fever (trend χ2=2.20, P<0.05) and fatigue (trend χ2=3.18, P<0.05) among the three epidemic stages were statistically significant. The cases with critical severe symptoms accounted for 42.85% (6/14), 23.73% (14/59) and 16.67% (3/18), respectively, in three epidemic stages, showed a decreasing trend (H=6.45, P<0.05). Also, the incubation period prolonged along with the epidemic stage (F=51.65, P<0.01), but the intervals between disease onset and hospital visit (F=5.32, P<0.01), disease onset and diagnosis (F=5.25, P<0.01) became shorter along with the epidemic stage. Additionally, the basic reproduction number (R0) had decreased from 2.61 in imported case stage to 0.66 in indigenous case stage. Conclusions: The COVID-19 epidemic in Gansu was caused by the imported cases, and about 2/3 cases were clustered ones. No medical worker was observed to be infected by occupational exposure. With the progression of COVID-19 epidemic in Gansu, the change in initial symptom and incubation period suggests, the early screening cannot only depend on body temperature monitoring.

Clinical significance of expression of MEG8 and TGM2 genes in gastric cancer

BACKGROUND

Gastric cancer (GC) is one of the common malignant tumors, and its incidence and mortality rates are among the highest in China and even the world, posing an important threat to human health. There is still a lack of early diagnosis, treatment, and prognosis-related gene targets for GC.

AIM

To investigate the expression of maternally expressed gene 8 (MEG8) and transglutaminase-2 (TGM2) in GC and analyze their clinical significance.

METHODS

The expression of MEG8 and TGM2 in 30 pairs of GC and tumor-adjacent tissues was detected by fluorescence quantitative polymerase chain reaction. The correlation between MEG8 and TGM2 expression and clinicopathological features of GC patients was analyzed. The difference of TGM2 expression and its correlation with the survival status of GC patients were analyzed by employing the relevant research data in Oncomine database.

RESULTS

The expression of MEG8 in GC tissues was significantly lower than that in tumor-adjacent tissues (0.462 ± 0.082 vs 1.048 ± 0.149, P < 0.05), and the expression of TGM2 in GC tissues was significantly higher than that in tumor-adjacent tissues (1.202 ± 0.143 vs 0.742 ± 0.083, P < 0.05). The expression of MEG8 was correlated with age and clinical stage, and the expression of TGM2 was correlated with clinical stage (P < 0.05). The expression of TGM2 was not related to the survival status of patients with GC (P > 0.05).

CONCLUSION

MEG8 and TGM2 may be involved in the occurrence and development of GC and can be used as potential targets for the diagnosis and prognosis of GC.

Stat-3 signaling promotes cell proliferation and metastasis of gastric cancer through PDCD4 downregulation

The present study explored a new downstream regulator of Stat-3 signaling, miR-499-5p and its target gene programmed cell death 4 (PDCD4) in cell survival and metastasis of gastric cancer. Our results showed that miR-499-5p is significantly upregulated in human gastric cancer cell line SGC-7901. We further demonstrated that miR-499-5p promotes gastric cancer cell proliferation and invasion in vitro. Mechanistically, we demonstrated that upregulation of miR-499-5p expression associated with inhibition of PDCD4; STAT3 transcriptional activation by IL-6 is crucial for the upregulation of miR-499-5p expression. These results indicate that the STAT3-miR-499-5p-PDCD4 signaling axis plays an important role in gastric cancer progression and a potentially therapeutic target for gastric cancer treatment.

[Clinical experience in the diagnosis and treatment of aortic stenosis caused by Takayasu arteritis in pediatric patients]

Objective: To analyze the clinical features and summarize the experience on the diagnosis and treatment of aortic stenosis caused by Takayasu arteritis in pediatric patients. Methods: This study was a retrospective study. Five pediatric patients diagnosed as aortic stenosis caused by Takayasu arteritis in Fuwai Hospital of Chinese Academy of Medical Sciences from January 2016 to August 2018 were included. The clinical features, methods of examination, treatment and outcome were analyzed. Results: There were 2 male and 3 female patients in this cohort. The age of onset ranged from 10 to 13 years. The main clinical symptoms were as follows: intermittent claudication and hypertension (5 patients), heart failure (3 patients). Three patients with heart failure were misdiagnosed with dilated cardiomyopathy in other hospitals. Except 1 patient died due to disease aggravation before operation, the other 4 patients received interventional therapy for severe heart failure or refractory hypertension on the basis of hormone anti-inflammatory treatment, including 2 patients treated with aortic balloon dilatation and 2 patients treated with aortic balloon dilatation and stent implantation. In post-operational follow-up, clinical symptoms and laboratory examination values of the 4 patients treated with interventional therapy were significantly improved. Conclusions: The clinical symptoms of pediatric patients with aortic stenosis caused by Takayasu arteritis mainly present with intermittent claudication, hypertension and heart failure. Aortic intervention strategy should be applied for pediatric patients with severe heart failure or refractory hypertension as early as possible.

[Epidemiological and spatial-temporal distribution of several natural focus diseases in Gansu province, 2014-2018]

Objective: To analyze the epidemiological and spatial-temporal distribution of Brucellosis, epidemic encephalitis B and hemorrhagic fever with renal syndrome (HFRS) in Gansu province during 2014-2018 so as to provide evidence for the prevention and control of those diseases. Methods: A database was established in Gansu province from 2014 to 2018, using the geographical information system. A spatial distribution map was drawn, with trend analysis and space-time clustering used to study the 3-dimention of the diseases, by using both ArcGIS 10.5 and SaTScan 9.6 softwares. Results: Results from the trend surface analysis showed that the incidence of Brucellosis decreased gradually from north to south parts while the U type curve could reflect the distribution from the east to the west areas. Incidence of epidemic encephalitis B decreased significantly from south to north areas in the province, with incidence higher in the eastern than in the mid-west region. Difference on the incidence of HFRS was not significantly visible in the eastern and western regions, while the incidence was slightly higher in the southern than the northern parts of the province. Spatial and space-time clustering did exist among the 3 diseases in Gansu from 2014 to 2018. The areas with clusters of Brucellosis appeared in the eastern parts during 2014-2015, including 19 counties. The areas with secondary clusters of Brucellosis were seen in the Hexi district, including 4 counties, during 2017-2018. The areas with high incidence of epidemic encephalitis B were clustered in the middle and southeast areas, including 32 counties, during 2017-2018. Areas with most clusters of HFRS appeared in Min county of Dingxi city in 2018, with the areas of secondary clusters in 8 counties of the eastern areas in 2018. Conclusions: The overall incidence rates of the 3 natural focus diseases were in a upward trend and showing obvious characteristics on spatial clustering. According to the distributive characteristics, effective measures should be developed accordingly.

Combining I148M and E167K variants to improve risk prediction for nonalcoholic fatty liver disease in Qingdao Han population, China

Background

PNPLA3 I148M variant and TM6SF2 E167K variant are recognized as the major genetic modifiers of nonalcoholic fatty liver disease (NAFLD). The present study sought to evaluate the potential additive effect of the two variants on the risk of NAFLD in Qingdao Han Population, China.

Methods

We genotyped PNPLA3 I148M variant and TM6SF2 E167K variant in a cohort of 512 unrelated NAFLD patients and 451 healthy controls by sequencing and polymerase chain reaction analysis. In addition, serum lipid profiles and liver enzymes were determined by standard clinical laboratory methods.

Results

The minor allele frequencies were 45.48% for PNPLA3 148 locus G allele and 6.69% for TM6SF2 167 locus T allele. The PNPLA3 I148M variant was significantly associated with the risk of NAFLD in an additive model (CG, OR = 2.092, 95% CI: 1.551–2.820, P = 0.000; GG, OR = 4.566, 95% CI: 3.141–6.638, P = 0.000, respectively). And, our data suggested a strong link between the TM6SF2 E167K variant and the risk of NAFLD in a dominant model (CT + TT, OR = 2.327, 95% CI: 1.542–3.513, P = 0.000). In addition, the increasing of the number of risk alleles were associated with the risk of NAFLD (1 risk allele, OR = 1.687, P = 0.001; 2 risk alleles, OR = 4.326, P = 0.000; 3 risk alleles, OR = 6.018, P = 0.027, respectively).

Conclusions

Combining the I148M and E167K variants in a manner of an additive effect could improve risk prediction for NAFLD in a Qingdao Han Population cohort.

Trial registration

Chinese Clinical Trial Register.gov: ChiCTR1800015426.

[Primary mucinous adenocarcinoma of the larynx: a case report]

Mucinous adenocarcinoma is most commonly found in the digestive tract,and the prognosis is poor.We present here a case of primary mucinous adenocarcinoma of the larynx, which is an extremely rare entity and very few have been reported in the literature.A 72-year-old male complained of intermittent hoarseness for over 2 months of duration.Fiberoptic laryngoscope showed negative result for tumor.While CT scan showed laryngeal space occupying lesion,and thyroid cartilage damage was observed.The patient underwent total laryngectomy.Histopathological examination and immunohistochemistry(IHC) analysis supported the diagnosis of mucinous adenocarcinoma.

[Multiple-factor analysis of serum allergen distribution of patients with allergic rhinitis and level of main allergen IgE in Shenyang area]

Objective:To discuss multiple-factor analysis of serum allergen distribution of patients with allergic rhinitis and level of main allergen IgE in Shenyang area, and to provide a scientific basis for the prevention of allergic rhinitis in this area.Method:Serum IgE was detected in 749 cases［501 cases of male (66.8%), and 248 cases of female (33.2%)］, with allergic rhinitis.The age range was from 3 to 65 years old, and they were divided into 5 groups based on age. A questionnaire survey was conducted to analyze the distribution of serum allergens and to carry out a multiple-factor analysis of level of the main allergen IgE in patients.Result:The primary allergen was house dust mite/dust mite in each age group, and the differences in the positive rate of elm, mold, cat/dog fur scurf, cockroach and ragweed among different groups were statistically significant（P<0.01 or P<0.05）.The ingested allergen sequencing for all age groups: the distribution of 7-14 years old group and 15-35 years old group were consistent with that of the whole, among the under 6 years old group, mango and pineapple was ranked 1st,beef and mutton was ranked 2nd,the occurrence rate of shrimp and crab rose to the 3rd place, among the 36-60 years old group, mango, pineapple and milk was ranked 1st, egg was ranked 2nd, and beef and mutton ranked 3rd, the differences in positive rate of mango and pineapple, beef and mutton, crab and nut among all groups were statistically significant(P<0.01 or P<0.05).The IgE level of cockroach was impacted by the allergic history, home cultivation of flowers and plants and animal domestication. The IgE level of mold was impacted by sex, allergy history, home rearing of pet and furniture updates. The IgE level of wormwood was impacted by allergy history and asthma history. The IgE level of peanut was impacted by age and allergy history. The IgE level of egg was impacted by history of food and drink allergy, home cultivation of flowers and plants and home rearing of pet. The IgE level of crab was impacted by the allergy history and home rearing of pet.Conclusion: The primary inhaled allergen in all groups is house dust mite/dust mite, and the ingested allergen varies in each group, which has provided a reference basis for prevention of ingested allergy.The varying influence factors for IgE level of primary allergens could be used to prevent the patients from contacting the allergen,and each risk factor has become a focus of prevention and control for patients, offering a major help to the prevention and treatment of allergic rhinitis.

C1QTNF6 is overexpressed in gastric carcinoma and contributes to the proliferation and migration of gastric carcinoma cells

In the present study, proteins differentially expressed between gastric cancer tissue and para‑tumoral normal gastric tissues were screened, and the function of the highly expressed protein C1QTNF6 in gastric carcinoma was investigated. The differential expression of mRNAs extracted from the tumor and adjacent tissues was analyzed using GeneChip assay. An AGS si‑C1QTNF6 cell line was constructed using shRNA‑C1QTNF6 lentivirus. The cell invasion and migration ability of C1QTNF6‑knockdown cells were determined by Transwell chamber migration and wound healing assays, respectively. The effects of C1QTNF6 on AGS cell cycle distribution and apoptosis were detected using a FACScan flow cytometer. The results demonstrated that the expression of 109 genes was increased and the expression of 129 was decreased in tumor tissues. Among these genes, the C1QTNF6 gene was highly expressed in tumor tissues and the AGS7901 cell line. C1QTNF6‑knockdown decreased the cell growth, and the proliferative and migration ability, as well as increasing the apoptosis of gastric carcinoma cells. In addition, the number of AGS cells in the G2/M phase was significantly increased after 5 days of C1QTNF6‑shRNA lentivirus infection. The results of the present study indicated that C1QTNF6 serves an important role in the development of gastric carcinoma. C1QTNF6 is involved in promoting the proliferation and migration, and in reducing the apoptosis of gastric carcinoma cells. These results provided a potential therapeutic target for the treatment of gastric carcinoma.

Clinical significance of Helicobacter pylori in the grouth of ulcerative colitis

AIM

To investigate the relationship between Helicobacter pylori (H. pylori) infection and ulcerative colitis (UC).

METHODS

One hundred and forty-six patients with UC diagnosed by colonoscopy and pathological examination were selected as a UC group. In addition, 150 volunteers who had no obvious colonic lesions as detected by electronic colonoscopy were collected as a control group. Rapid urease test and histopathological biopsy were used to detect H. pylori infection.

RESULTS

In UC Group, 146 cases, 27 positive, H. pylori infection positive rate of 18.49%, control group of 150 cases, 64 positive, H. pylori infection positive rate 42.67%, UC group is significantly lower than the control group, the difference is statistically significant (P < 0.05). According to lesion Range: Rectal Group 27 cases, 7 positive, H. pylori positive rate is 21.88%, left half colon group 48 cases, 9 cases positive, H. pylori positive rate is 18.75%, extensive colon group 66 cases, 11 cases positive, H. pylori positive rate is 16.67%. There was no statistically significant difference among the three groups (P > 0.05). Active period of UC patients in 117 cases (80.14%), remission period of UC patients in 29 cases. The positive rate of H. pylori infection was the highest in remission period (37.93%), the lowest rate of severe activity was (6.25%), the difference was obvious (P < 0.05).

CONCLUSION

H. pylori infection may have a preventive effect on the grouth of UC, with the severity of the disease increasing, the H. pylori positive rate decreased. In addition, it will be very important to strengthen the follow-up compliance of UC patients.

[Study on early warning threshold values for 7 common communicable diseases in Gansu province, 2016]

Objective: To optimize the warning threshold values of common communicable diseases in Gansu province, and improve the early warning effect. Method: An early warning model was set up for influenza, scarlet fever, other infectious diarrheal diseases, dysentery, typhoid and paratyphoid, viral hepatitis type E and hand foot and mouth disease (HFMD) respectively in Gansu by using the moving percentile method and cumulative sum method. By calculating the sensitivity, specificity, predictive value of positive test, predictive value of negative test, Youden' index and receiver-operating characteristic curve, the optimum early warning threshold values for communicable diseases in Gansu were selected. Results: The optimum early warning boundary values of influenza, scarlet fever, other infectious diarrheal diseases, dysentery, typhoid and paratyphoid, and viral hepatitis type E were P(90), P(80), P(95), P(90), P(80) and P(90) respectively. The optimum early warning parameters of HFMD were k=1.2, H=5σ. Under the optimum early warning boundary values/parameters, the early warning sensitivities of influenza, scarlet fever, other infectious diarrheal diseases, dysentery, typhoid and paratyphoid, viral hepatitis type E and HFMD were 86.67%, 100.00%, 91.67%, 100.00%, 100.00%, 100.00% and 100.00%, the specificities were 86.49%, 62.22%, 75.00%, 100.00%, 97.92%, 89.13% and 74.47%. The predictive values of positive test were 72.22%, 29.17%, 52.38%, 100.00%, 80.00%, 54.55% and 29.41%, and the predictive values of negative test were 94.12%, 100.00%, 96.77%, 100.00%, 100.00%, 100.00% and 100.00%, and the Youden' indexes were 0.73, 0.62, 0.67, 1.00, 0.98,0.89 and 0.74. Receiver-operating characteristic curve showed that the values/parameters of this warning boundary were the points closest to the upper left of the coordinate diagram. Conclusion: The early warning thresholds of influenza, other infectious diarrheal diseases, dysentery and hepatitis E in Gansu may be raised appropriately and the early warning parameters of HFMD need to be adjusted to improve the effectiveness of early warning.

Daclatasvir plus asunaprevir in treatment-naïve patients with hepatitis C virus genotype 1b infection

AIM

To assess daclatasvir plus asunaprevir (DUAL) in treatment-naïve patients from mainland China, Russia and South Korea with hepatitis C virus (HCV) genotype 1b infection.

METHODS

Patients were randomly assigned (3:1) to receive 24 wk of treatment with DUAL (daclatasvir 60 mg once daily and asunaprevir 100 mg twice daily) beginning on day 1 of the treatment period (immediate treatment arm) or following 12 wk of matching placebo (placebo-deferred treatment arm). The primary endpoint was a comparison of sustained virologic response at posttreatment week 12 (SVR12) compared with the historical SVR rate for peg-interferon plus ribavirin (70%) among patients in the immediate treatment arm. The first 12 wk of the study were blinded. Safety was assessed in DUAL-treated patients compared with placebo patients during the first 12 wk (double-blind phase), and during 24 wk of DUAL in both arms combined.

RESULTS

In total, 207 patients were randomly assigned to immediate (n = 155) or placebo-deferred (n = 52) treatment. Most patients were Asian (86%), female (59%) and aged < 65 years (90%). Among them, 13% had cirrhosis, 32% had IL28B non-CC genotypes and 53% had baseline HCV RNA levels of ≥ 6 million IU/mL. Among patients in the immediate treatment arm, SVR12 was achieved by 92% (95% confidence interval: 87.2-96.0), which was significantly higher than the historical comparator rate (70%). SVR12 was largely unaffected by cirrhosis (89%), age ≥ 65 years (92%), male sex (90%), baseline HCV RNA ≥ 6 million (89%) or IL28B non-CC genotypes (96%), although SVR12 was higher among patients without (96%) than among those with (53%) baseline NS5A resistance-associated polymorphisms (at L31 or Y93H). During the double-blind phase, aminotransferase elevations were more common among placebo recipients than among patients receiving DUAL. During 24 wk of DUAL therapy (combined arms), the most common adverse events (≥ 10%) were elevated alanine aminotransferase and upper respiratory tract infection; emergent grade 3-4 laboratory abnormalities were infrequently observed, and all grade 3-4 aminotransferase abnormalities (alanine aminotransferase, n = 9; aspartate transaminase, n = 6) reversed within 8-11 d. Two patients discontinued DUAL treatment; one due to aminotransferase elevations, nausea, and jaundice and the other due to a fatal adverse event unrelated to treatment. There were no treatment-related deaths.

CONCLUSION

DUAL was well-tolerated during this phase 3 study, and SVR12 with DUAL treatment (92%) exceeded the historical SVR rate for peg-interferon plus ribavirin of 70%.

[Study on the incidence and characteristics of carotid canal dehiscence with high resolution CT]

Objective:To discuss the total incidence and characteristics of carotid canal dehiscence in Chinese adults with high resolution CT. At the same time, it provide basic data for otology clinical medical personnel to further understand the anatomical structure of ear and carry out auditory surgery.Method:Temporal bone HRCT images of 643 consecutive subjects who underwent CT scanner were analyzed retrospectively. The coronal, sagittal, and oblique sagittal plane were reconstructioned for some suspected subjects. Contrast the incidence of carotid canal dehiscence in different sex, bilateral and age groups.Result:In 643 patients, 43 cases found the carotid canal dehiscence, and the total incidence of carotid canal dehiscence was 6.7%.The incidence of carotid canal dehiscence for male and female were 5.9%(16/269)and 7.2%(27/374)(P > 0.05),and there was no statistically significant difference in the incidence of carotid canal dehiscence between sexes. The incidence of carotid canal dehiscence for age 40-59 was much higher than those of other age groups (P< 0.05),however, there was no significant difference between groups of age 20-39 and ≥60(P> 0.05).The location of the carotid canal dehiscence in 43 cases was located in the mesotympanum near the Eustachian tube orifice. Carotid artery tube ruptures are mostly small defects, but 11 cases with major defect.Conclusion:The toatal incidence of carotid canal dehiscence is 6.7% in Chinese adults (males: 5.9%,females: 7.2%), especially high incidence at group of age 40-59 (10.7%). Carotid canal dehiscence can be diagnosed accurately by HRCT and multiplanar reconstruction.

[Study on the classification of dominant pathogens related to febrile respiratory syndrome, based on the method of Bayes discriminant analysis]

Objective: To understand the dominant pathogens of febrile respiratory syndrome (FRS) patients in Gansu province and to establish the Bayes discriminant function in order to identify the patients infected with the dominant pathogens. Methods: FRS patients were collected in various sentinel hospitals of Gansu province from 2009 to 2015 and the dominant pathogens were determined by describing the composition of pathogenic profile. Significant clinical variables were selected by stepwise discriminant analysis to establish the Bayes discriminant function. Results: In the detection of pathogens for FRS, both influenza virus and rhinovirus showed higher positive rates than those caused by other viruses (13.79%, 8.63%), that accounting for 54.38%, 13.73% of total viral positive patients. Most frequently detected bacteria would include Streptococcus pneumoniae, and haemophilus influenza (44.41%, 18.07%) that accounting for 66.21% and 24.55% among the bacterial positive patients. The original-validated rate of discriminant function, established by 11 clinical variables, was 73.1%, with the cross-validated rate as 70.6%. Conclusion: Influenza virus, Rhinovirus, Streptococcus pneumoniae and Haemophilus influenzae were the dominant pathogens of FRS in Gansu province. Results from the Bayes discriminant analysis showed both higher accuracy in the classification of dominant pathogens, and applicative value for FRS.

[Correlation between the thresholds acquired with ASSR and sbjective thresholds in cochlear implants in prelingually deaf children]

Objective:To learn the relationship between the auditory steady state responses(ASSR)threshold and C-level and behavior T-level in cochlear implants in prelingually deaf children.Method:One hundred and twelve children with Nucleus CI24R(CA) cochlear implants were divided into residual hearing group and no residual hearing group on the basis of the results of ASSR before operation in this study.Compare the difference between the two groups in C-level and behavior T-level one year after operation. Result:There was difference in C-level and behavior T-level between residual hearing group and no residual hearing group(P<0.05 or P<0.01). Conclusion:According to the results of ASSR before operation,we can estimate the effect of cochlear implants,providing reference for the selection of choosing operating ears,and providing a reasonable expectation for physicians and parents of the patients.

[Clinical research about the consecutive pain and flubiprofen axetil analgesia following uvulopalatopharyngoplasty]

Objective:To evaluate the postoperative pain degree on OSAHS patients following UPPP, analyze the pain characteristic during seven consecutive days, and discuss the mechanism. To observe the analgesia effect by using flubiprofen axetil. Finally making a comprehensive understanding about UPPP perioperative period and providing more choices about analgesia treatment.Method:Fifty-five patients who underwent UPPP in the First Hospital of China Medical University were divided into analgesia group（n=30）and control group（n=25）.Normal saline 50 ml+ flubiprofen axetil 100 mg was used bid for pain relief in analgesia group during seven days following operation, and normal saline 50ml was used in control group.A visual analog scale(VAS) was used for measuring mean pain intensity each day during the period from operative day to the post-operative 7th day，scores were recorded. Continuous changes about pharynx pain were observed and VAS pain scores were compared betweenanalgesia groupand control group. Result:VAS pain scores were the highest on the operative day and the post-operative 1st day, median (interquartile range) was 7（5.5-8.25），7（6-8）respectively,then decreased gradually. The most significantly decrease happened on the post-operative 2nd and 5th day(P<0.01). Pain scores in analgesia group were most significantly lower than control group from the operative day to the post-operative 4th day(P<0.01), were lower during the post-operative 5th and 6th day(P<0.05),no difference on the post-operative 7th day. Conclusion:The most painful period following UPPP is from the operative day to the post-operative 1st day, then pain decreases gradually. The pain reduces significantly on the post-operative 2nd and 5,6th day.Surgical trauma, in flammatory reaction and suture pulling may be the reason of pain. Flubiprofen axetil effectively reduces pain and the suggested analgesia period is from the operative day to the post-operative 4th-6th day.

[Effect of stenting for the proximal atherosclerotic extracranial vertebral artery stenosis]

Objective: To evaluate the effect of stenting for proximal atherosclerotic extracranial vertebral artery stenosis. Methods: A total of 204 proximal atherosclerotic extracranial vertebral artery stenosis patients underwent stent implantation at Fuwai Hospital were enrolled consecutively between August 2007 and June 2014 prospectively. Medical records were collected and the clinical results were obtained through outpatient and telephone follow up. Results: (1) The patients were (64.1±7.9) years old, and 179 were male (87.7%). (2) Stent implantation was performed on 210 proximal atherosclerotic extracranial vertebral artery stenosis lesions with 210 stents (156 on the left, 54 on the right), and 6 patients received both sides stent implantations. Technical success rate was 100%(210/210). The stenosis of the lesions was decreased from (85.1±6.4) % to (6.5±3.2) % after the stent implantation (P<0.01). (3) Three (1.5%) patients experienced transient ischemic attack during the procedure, and two (1.0%) patients suffered from minor posterior circulation ischemic strokes on the 2nd and 10th day after the procedure, respectively. (4)The median follow-up was 1.5 (0.8-2.5) years. Three(1.5%) patients died (two non-vacular deaths, and the other one due to sudden cardiac death). Three (1.5%) patients developed stroke (one case ipsilateral posterior circulation stroke, and two cases unrelated area stroke). Four (2.0%) patients experienced transient ischemic attack. One patient suffered nonfatal myocardial infraction. In-stent restenosis occurred in thirty nine (19.4%) patients, of which fourteen (35.9%) patients were totally occluded and four (10.3%) patients with symptomatic restenosis. Kaplan-Meier survival curve showed that the primary patency rate of the vertebral artery were 85.6%, 78.6%, 72.2% and 64.4% at 1, 2, 3 and 5 years, respectively. Conclusions: Stenting for proximal atherosclerotic extracranial vertebral artery stenosis is safe and feasible, with a good middle to long-term patency rate. However, further trials are required to validate the effective results found in this patients cohort.

[The clinical and pathological features of laryngeal tuberculosis]

OBJECTIVE

To investigate the clinical and pathological features of laryngeal tuberculosis.

METHODS

The clinical data of 75 patients with laryngeal tuberculosis from Jan 2010 to Jan 2013 in our hospital were studied retrospectively. There were 50 male and 25 female patients, aged from 18 to 91 years, with a median age of 44 years. The course of disease was 1 to 19 months.

RESULTS

The prominent presenting symptoms were hoarseness (n=59, 79%), and sore throat (n=48, 64%). Systemic symptoms included fatigue with weight loss (n=26, 35%) and fever (n=17, 23%). Primary laryngeal tuberculosis was found in 23 patients (31%) while secondary laryngeal tuberculosis together with pulmonary tuberculosis in 52 patients (69%). There were 2 or less lesions in the larynx in 44 patients, while multiple lesions were found in 31 patients. Vocal cords were the most common sites affected(n=51, 68%), followed by epiglottis(n=41, 55%). Proliferation was the main type of lesions (n=34, 45%). After pathologic diagnosis, all patients received systemic anti-tuberculosis therapy, and the prognosis was good.

CONCLUSIONS

Severe local symptoms of the larynx with slightly general symptoms are the clinical characteristics of laryngeal tuberculosis for the time being. Primary laryngeal tuberculosis often present with fewer (2 or less) lesions. Different morphology of laryngeal lesions can exist at the same time. The diagnosis of laryngeal tuberculosis depends on pathological biopsy. The treatment should be systemic anti-tuberculosis therapy.

[Application of objective audiological tests in bilateral tinnitus patients with normal hearing capability]

Objective:To analyze the relationship of tinnitus and early stage damage of cochlear, to explore the clinical applied value of distortion product otoacoustic emission(DPOAE) and auditory brainstem response(ABR) in the bilateral tinnitus patients with normal hearing capability. Method:There are 30 cases(60 ears) in the tinnitus group with bilateral tinnitus patients with normal hearing capability, and there are 30 cases(60 ears) in the control group without tinnitus of normal hearing capability. The two groups both test the DPOAE and ABR,and compare the results of the DPOAE and ABR. Result:The passing rate of DPOAE in all frequencies was 100% in the control group,42.67% in the tinnitus group. Significant differences existed between the two groups(P<0.05).The DPOAE could be checked out at all frequencies under 2 kHz except 0.75 kHz in the tinnitus group, and the passing rates of DPOAE were significantly lower than those in control group(P<0.05).There were 3 cases could not be checked out at 0.75 kHz frequency, but there were no significant difference(P>0.05).The DPOAE amplitudes at frequencies of 3 to 8 kHz in tinnitus ears were significantly lower than those in nontinnitus ears(the P value were 0.011,0.013,0.008,0.027 ).Wave Ⅰ,Ⅲ and Ⅴcould be detected in all ears tested at 80 dB nHL. The latencies of WaveⅠin tinnitus group were obviously prolonged.The latencies of Wave Ⅲ and Ⅴ in tinnitus group were also prolonged, but there was no significant difference(P>0.05).The interval between waves Ⅰand Ⅲ,waves Ⅲ and Ⅴand wavesⅠand Ⅴ showed no difference. Conclusion:The maybe cochlear early injury in fractional bilateral tinnitus patients with normal hearing capability, DPOAE and ABR can act as an objective method for diagnosing peripheral tinnitus.

[Site of prelingual cochlear stimulation and its effect on electrically evoked compound action potentials and refractory using the Nucleus 24 standard]

Objective:To investigate the correlation between the site of prelingual cochlear stimulation and its effect on electrically evoked compound action potentials. Method:Recordings of auditory nerve responses were conducted in 32 prelingual subjects to demonstrate the feasibility of ECAP recordings using the nerve response telemetry(NRT) feature of the Nucleus CI24R(CA) system software. These recordings were then analyzed based on the site of cochlear stimulation defined as basal, middle and apical to determine if the amplitude, threshold and slope of the amplitude growth function and the refractory time differs depending on the region of stimulation. Result:Findings of our prelingual children showed significant differences in the ECAP recordings depending on the stimulation site. Comparing the apical with the basal region, on average higher amplitudes, lower thresholds and steeper slopes of the amplitude growth function hadbeen observed. The refractory time showed an overall dependence on cochlear region; however post-hoc tests showed no significant effect between individual regions. Conclusion:Obtaining ECAP recordings is also possible in the most apical region of the cochlea. However, differences can be observed depending on the region of the cochlea stimulated. Specifically, significant higher ECAP amplitude, lower thresholds and steeper amplitude growth function slopes have been observed in the apical region. These differences between prelingual children and adults could be explained by the location of the stimulating electrode with respect to the neural tissue in the cochlea, a higher density, or an increased neural survival rate of neural tissue in the apex.

Clinicopathological and prognostic significance of programmed cell death ligand 1 (PD-L1) expression in patients with esophageal squamous cell carcinoma: a meta-analysis

BACKGROUND

The clinicopathological and prognostic significance of programmed cell death ligand 1 (PD-L1) expression in patients with esophageal squamous cell carcinoma (ESCC) remains controversial. To investigate this question, we conducted a meta-analysis.

METHODS

A comprehensive literature search of electronic databases (up to July 10, 2016) was performed for relevant studies using multiple search strategies. Correlation between PD-L1 expression and clinicopathological features/overall survival (OS) was analyzed.

RESULTS

A total of 1,350 ESCC patients from eight studies were included. The pooled odds ratios (ORs) indicated that none of the clinicopathological characteristics was correlated with PD-L1 expression, including gender [OR =0.84; 95% confidence interval (CI): 0.59-1.18; P=0.31], histological differentiation (OR =1.33; 95% CI: 0.95-1.85; P=0.09), tumor depth (OR =0.66; 95% CI: 0.33-1.35; P=0.26), status of lymph node metastasis (OR =0.67; 95% CI: 0.30-1.52; P=0.34), distal metastasis (OR =0.66; 95% CI: 0.40-1.09; P=0.10) and tumor node metastasis (TNM) stage (OR =0.93; 95% CI: 0.49-1.75; P=0.82). The combined hazard ratio (HR) for OS showed a trend that overexpression of PD-L1 might be associated with the survival outcome of ESCC, though the difference was not statistically significant (HR =1.65; 95% CI 0.95-2.85; P=0.07).

CONCLUSIONS

Based on the published studies, PD-L1 overexpression in ESCC was not associated with common clinicopathological characteristics. PD-L1 might be a poor prognostic biomarker for ESCC. Further large-scale research should be performed to reveal the precise clinicopathological and prognostic significance of PD-L1 in ESCC by unified testing standard.

[Analysis of clinical characteristics and treatment outcome of atypical early stage malignant laryngeal tumor]

Objective:To observe the clinical characteristics of 22 cases of malignant laryngeal tumor manifested as smooth mass, and explore the diagnosis, pathological types and treatment of the disease.Method:Manifested as smooth mass, 22 cases diagnosed as malignant or borderline tumor by biopsy were collected to summarize the characteristics of pathology, treatment and prognosis. Result:The sex ratio was 13∶9. Eleven cases were diagnosed as malignant tumors of epithelial or mesenchymal origin, 7 cases of tumors of lymphoid hematopoietic system, 4 cases of borderline tumor.Thirteen patients received surgical treatment, and recurrence was not found in postoperative follow-up.Nine patients received radiotherapy and/or chemotherapy, 7 of them were in remission while 2 cases presented progression and metastasis of cervical lymph nodes. Conclusion:Because of lacking typical clinical manifestations in early stage,smooth mass of larynx often easily lead to misdiagnosis.If found and operated early,the prognosis can be satisfied,but the treatment outcome of lymphoma is poor.

[Sunitinib induces autophagy via suppressing Akt/mTOR pathway in renal cell carcinoma]

OBJECTIVE

To determine the mechanism of sunitinib-induced autophagy in renal cell carcinoma cells.

METHODS

MTS assay was applied to detect the cell viability alteration under the treatment of sunitinib (2, 8 μmol/L). The sunitinib-induced autophagy as well as cell apoptosis was measured and compared after knocking down autophagy-related protein Beclin1 and microtubule associated protein 1 light chain 3 fusion protein (LC3) by RNA interference. The transmission electron microscope was used to observe the formation of autophagosomes in ACHN cells. The fluorescence microscope was used to monitor distribution and aggregation of endogenous LC3-II. The expressions of protein such as LC3-II, the autophagic regulation molecules protein kinase B/ mammalian target of rapamycin (Akt/mTOR) and the symbol of apoptosis poly ADP-ribose polymerase (PARP) were capable to be detected by immunoblotting assay.

RESULTS

Sunitinib was able to significantly trigger cell viability loss in the renal carcinoma cell ACHN, which was both in a concentration-dependent and time-dependent manner (P<0.05). After reducing the autophagy by knocking down Beclin1 and LC3, the number of cleavage of PARP was increased remarkably, whereas there was nearly not any cleavage in the mock group. By the transmission electron microscope, there were more autophagic vacuoles in ACHN cells after being administrated with sunitininb compared with the control. And the nuclear-to-cytosol translocation as well as aggregation of LC3-II was presented after sunitinib treatment by the fluorescence microscope, which was the proof of the enhanced autophagy. According to the immunoblotting, sunitinib was able to increase the accumulation of LC3-II . At the same time, the result of sunitinib combined with chloroquine, a drug which blocked the fusion of autophagosomes and lysosomes, demonstrated that the increasing amount of LC3-II was due to the enhanced autophagy flux by sunitinib treatment in ACHN cells. However, phosphorylation of Akt as well as mTOR was decreased at the same time. The rapamycin (mTOR inhibitor) or knocking down Akt subunits could change the sunitinib-induced LC3 -II accumulation, whereas overexpression of Akt subunits decreased the autophagic flux, indicating that Akt/mTOR was the target of sunitinib in autophagy.

CONCLUSION

Sunitinib induced autophagy via suppressing Akt/mTOR pathway, and the autophagy was involved in apopotosis.

[Impact of long-term continuous positive airway pressure treatment for patients with obstructive sleep apnea syndrome]

OBJECTIVE

To investigate the long-term efficacy of continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnea syndrome (OSAS).

METHODS

This case control study was performed among 154 patients with moderate or severe OSAS between September 2009 and September 2014. Patients were divided into treatment group (n=66, 53 patients with hypertension) and control group (n=88, 67 patients with hypertension). The long-term efficacy of CPAP treatment on clinical events and blood pressure was evaluated.

RESULTS

The combined incidence of death, myocardial infarction, coronary revascularization and stroke events was 1.5% (1/66) in treatment group and 11.4% (10/88) in control group (P<0.05). CPAP treatment also led to more significant reduction in systolic blood pressure ((12.24±18.06) mmHg(1 mmHg=0.133 kPa) to (4.24±16.63) mmHg, P<0.05) in the patients with hypertension in these two groups.

CONCLUSIONS

CPAP treatment could reduce the risk of cardiovascular and neurovascular events for patients with moderate or severe OSAS.

[Sunitinib induces autophagy via suppressing Akt/mTOR pathway in renal cell carcinoma]

OBJECTIVE

To determine the mechanism of sunitinib-induced autophagy in renal cell carcinoma cells.

METHODS

MTS assay was applied to detect the cell viability alteration under the treatment of sunitinib (2, 8 μmol/L). The sunitinib-induced autophagy as well as cell apoptosis was measured and compared after knocking down autophagy-related protein Beclin1 and microtubule associated protein 1 light chain 3 fusion protein (LC3) by RNA interference. The transmission electron microscope was used to observe the formation of autophagosomes in ACHN cells. The fluorescence microscope was used to monitor distribution and aggregation of endogenous LC3-II. The expressions of protein such as LC3-II, the autophagic regulation molecules protein kinase B/ mammalian target of rapamycin (Akt/mTOR) and the symbol of apoptosis poly ADP-ribose polymerase (PARP) were capable to be detected by immunoblotting assay.

RESULTS

Sunitinib was able to significantly trigger cell viability loss in the renal carcinoma cell ACHN, which was both in a concentration-dependent and time-dependent manner (P<0.05). After reducing the autophagy by knocking down Beclin1 and LC3, the number of cleavage of PARP was increased remarkably, whereas there was nearly not any cleavage in the mock group. By the transmission electron microscope, there were more autophagic vacuoles in ACHN cells after being administrated with sunitininb compared with the control. And the nuclear-to-cytosol translocation as well as aggregation of LC3-II was presented after sunitinib treatment by the fluorescence microscope, which was the proof of the enhanced autophagy. According to the immunoblotting, sunitinib was able to increase the accumulation of LC3-II . At the same time, the result of sunitinib combined with chloroquine, a drug which blocked the fusion of autophagosomes and lysosomes, demonstrated that the increasing amount of LC3-II was due to the enhanced autophagy flux by sunitinib treatment in ACHN cells. However, phosphorylation of Akt as well as mTOR was decreased at the same time. The rapamycin (mTOR inhibitor) or knocking down Akt subunits could change the sunitinib-induced LC3 -II accumulation, whereas overexpression of Akt subunits decreased the autophagic flux, indicating that Akt/mTOR was the target of sunitinib in autophagy.

CONCLUSION

Sunitinib induced autophagy via suppressing Akt/mTOR pathway, and the autophagy was involved in apopotosis.

Comparative study of clinical efficacy of laparoscopy-assisted radical gastrectomy versus open radical gastrectomy for advanced gastric cancer

The purpose of this study is to compare the efficacy of laparoscopy-assisted radical gastrectomy (LARG) versus that of open radical gastrectomy (ORG). Clinical data of 355 patients who underwent radical gastrectomy (160 in the LARG group and 195 in the ORG group) were analyzed retrospectively. Efficacy indices were compared and analyzed between the two groups. The operating time of LARG was longer than that of ORG (228.43 ± 34.77 versus 207.59 ± 28.39 min). However, patients in the LARG group lost less blood than did those in the ORG group (169.46 ± 82.92 versus 193.86 ± 82.09 mL), and more lymph nodes were removed in the LARG group (19.84 ± 4.7 versus 18.04 ± 4.14 per case). The recovery of intestinal function was faster (3.72 ± 1.03 versus 4.41 ± 1.30 days) in the LARG group. Patients in the LARG group were administered a semi-fluid diet earlier (5.66 ± 2.27 versus 7.09 ± 2.33 days) and had a shorter hospital stay (9.44 ± 3.06 versus 11.07 ± 7.91 days) than did those in the ORG group, and these differences were statistically significant (P < 0.05). No significant differences were found in the length of proximal and distal resection margin and the incidence of complications (P > 0.05) between the two groups. Thus, LARG is safe, feasible, and effective for treating advanced gastric cancer.

Lack of association between apolipoprotein C3 gene polymorphisms and risk of nonalcoholic fatty liver disease in a Chinese Han population

AIM: To investigate the association between two polymorphisms of apolipoprotein C3 (APOC3) and risk of nonalcoholic fatty liver disease (NAFLD) in a Chinese Han population.

METHODS: Genotypes for rs2854116 and rs2854117 in APOC3 and the known rs738409 in patatin-like phospholipase domain-containing protein 3 (PNPLA3) in 390 patients with NAFLD and 409 control subjects were determined by sequencing and polymerase chain reaction analysis. Serum lipid profiles were determined using biochemical methods, and an index of insulin resistance (IR, HOMA-IR), serum APOC3 concentrations and total antioxidant status (TAS) were also assessed.

RESULTS: No significant differences in genotype and allele frequencies of rs2854116 and rs2854117 were found between the NAFLD population and the controls (P > 0.05). The OR for the association between -455C and -482T allele carriers and the risk of NAFLD were 1.06 (95%CI: 0.72-1.57, P > 0.05) and 1.00 (95%CI: 0.68-1.48, P > 0.05), respectively. The variant carriers did not have a significantly increased risk of NAFLD or elevated clinical and biochemical parameters such as APOC3 concentrations, IR (1.42 ± 0.43 vs 1.48 ± 0.52, P > 0.05), liver enzymes and TAS (13.94 ± 2.01 vs 14.38 ± 1.92, P > 0.05) compared with the controls. Moreover, the results were similar when testing was carried out independent of the genetic variation in PNPLA3.

CONCLUSION: The two polymorphisms of the APOC3 gene are not associated with a risk of NAFLD, or with lipid profiles, IR and oxidative stress in the Chinese Han population.

Chemotherapy and resection for gastric cancer with synchronous liver metastases

AIM: To investigate the effect of surgery and chemotherapy for gastric cancer with multiple synchronous liver metastases (GCLM).

METHODS: A total of 114 patients were entered in this study, and 20 patients with multiple synchronous liver metastases were eligible. After screening with preoperative chemotherapy, 20 patients underwent curative gastrectomy and hepatectomy for GCLM; 14 underwent major hepatectomy, and the remaining six underwent minor hepatectomy. There were 94 patients without aggressive treatment, and they were in the non-operative group. Two regimens of perioperative chemotherapy were used: S-1 and cisplatin (SP) in 12 patients, and docetaxel, cisplatin and 5-fluorouracil (DCF) in eight patients. These GCLM patients were given preoperative chemotherapy consisting of two courses chemotherapy of SP or DCF regimens. After chemotherapy, gastrectomy and hepatectomy were preformed. Evaluation of patient survival was by follow-up contact using telephone and outpatient records. All patients were assessed every 3 mo during the first year and every 6 mo thereafter.

RESULTS: Twenty patients underwent gastrectomy and hepatectomy and completed their perioperative chemotherapy and hepatic arterial infusion before and after surgery. Ninety-four patients had no aggressive treatment of liver metastases because of technical difficulties with resection and severe cardiopulmonary dysfunction. In the surgery group, there was no toxicity greater than grade 3 during the course of chemotherapy. The response rate was 100% according to the response evaluation criteria in solid tumors criteria. For all 114 patients, the overall survival rate was 8.0%, 4.0%, 4.0% and 4.0% at 1, 2, 3 and 4 years, respectively, with a median survival time (MST) of 8.5 mo (range: 0.5-48 mo). For the 20 patients in the surgery group, MST was 22.3 mo (range: 4-48 mo). In the 94 patients without aggressive treatment, MST was 5.5 mo (range: 0.5-21 mo). There was a significant difference between the surgery and unresectable patients (P = 0.000). Three patients in surgery group were still alive at the end of the cut-off date.

CONCLUSION: Perioperative weekly DCF and SP achieved a good response, and combined with surgery, they could improve prognosis of GCLM.

Relationship between promoter methylation of the Runx3 and Rassf1a genes and Dnmt1 expression in gastric cancer

AIM: To analyze the promoter methylation of the human runt-related transcription factor 3 (Runx3) and ras-association domain family 1a (Rassf1a) genes and Dnmt1 protein expression in gastric cancer and to analyze their relationship with gastric carcinogenesis.

METHODS: Methylation status of the Runx3 and Rassf1a genes in 68 gastric carcinoma tissues and 68 paired surgical marginal normal gastric tissues was detected using methylation-specific PCR. Real-time RT-PCR was used to detect the expression of Runx3, Rassf1a, and Dnmt1 mRNAs, and immunohistochemistry was used to detect the expression of RUNX3, RASSF1a, and DNMT1 proteins in the above samples.

RESULTS: The positive rates of promoter methylation of the Runx3 and Rassf1a genes were significantly higher in gastric cancer than in normal tissue (45.59% vs 10.29%; 64.70% vs 7.35%; both P < 0.0001). The positive rates of Runx3 and Rassf1a mRNA expression in gastric cancer were significantly lower than those in normal tissue (36.76% vs 100%; 27.94% vs 97.06%; both P < 0.0001), while that of Dnmt1 mRNA expression was higher compared to normal tissue (80.88% vs 17.65%, P < 0.0001). The expression patterns of RUNX3, RASSF1a, and DNMT1 proteins were consistent with those of Runx3, Rassf1a, and Dnmt1 mRNAs. The negative rates of Runx3 and Rassf1a mRNA expression in gastric cancer were significantly higher in the methylation group than in the non-methylation group (72.09% vs 0%; 85.71% vs 2.94%; both P < 0.0001). There was a negative correlation between the expression of RUNX3 and RASSF1a proteins and that of DNMT1 protein in gastric cancer tissue (r = -0.627, P < 0.0001; r = - 0.477, P < 0.0001).

CONCLUSION: The promoter methylation of the Runx3 and Rassf1a genes and high expression of Dnmt1 may be associated with the occurrence of gastric cancer.

Clinical significance of serum levels of IGF-1 and IGFBP-3 in patients with colorectal adenoma

AIM: To investigate the clinical significance of serum levels of IGF-1 and IGFBP-3 in patients with colorectal adenoma.

METHODS: Blood samples collected from 120 patients with colorectal adenoma (CRA), 48 patients with colorectal cancer (CRC) and 34 healthy controls were used to determine serum levels of IGF-l and IGFBP-3 by radioimmunoassay (RIA) and immunoradiometric assay (IRMA), respectively.

RESULTS: Serum levels of IGF-1 and IGF-1/IGFBP-3 ratio in the CRC group (247.35 ± 60.77; 0.063 ± 0.010) and CRA group (224.75 ± 69.45; 0.055 ± 0.010) were significantly higher than those in the healthy control group (195.39 ± 63.37; 0.047 ± 0.013) (both P < 0.05). Serum IGF-1, IGFBP-3, and IGF-1/IGFBP-3 ratio in CRA showed no significant association with gender, age, history of smoking and drinking, family history of cancer, and the size, number, site or histological classification of polyps. Serum levels of IGF-1 and IGF-1/IGFBP-3 ratio in the CRC group (247.35 ± 60.77; 0.063 ± 0.010) and high-risk CRA group (235.81 ± 73.72; 0.056 ± 0.011) were significantly higher than those in the advanced CRA group (208.15 ± 59.44; 0.052 ± 0.008) (all P < 0.05). There was a positive correlation between serum levels of IGF-1 and IGFBP-3 in CRA (r = 0.796, P < 0.001).

CONCLUSION: High serum levels of IGF-1 and IGF-1/ IGFBP-3 may play a role in the malignant transformation of colorectal adenoma, and detection of them can be used to screen precancerous lesions.

Lifestyle intervention in non-alcoholic fatty liver disease in Chengyang District, Qingdao, China

AIM

To evaluate the effect of a 6 and 12 mo lifestyle modification intervention in nonalcoholic fatty liver diseases (NAFLD) in Chengyang District of Qingdao.

METHODS

Participants with NAFLD who had resided in Chengyang District for more than 5 years were enrolled in this study. After the 6 and 12 mo lifestyle modification intervention based on physical activity, nutrition and behavior therapy, parameters such as body weight, body mass index (BMI), waist circumference, serum alanine aminotransferase (ALT), aspartate aminotransferase values, serum cholesterol, triglycerides, fasting glucose, fasting insulin and visceral fat area (VFA), the liver-spleen ratio and the homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated and compared between participants with and without the intervention.

RESULTS

Seven hundred and twenty-four participants were assigned to the lifestyle intervention group (LS) and 363 participants were assigned to the control group (CON). After the intervention, body weights in the LS group were significantly decreased compared to those in the CON group at 6 mo (11.59% ± 4.7% vs 0.4% ± 0.2%, P = 0.001) and at 12 mo (12.73% ± 5.6% vs 0.9% ± 0.3%, P = 0.001). Compared with the CON group, BMI was more decreased in the LS group after 6 and 12 mo (P = 0.043 and P = 0.032). Waist circumference was more reduced in the LS group than in CON (P = 0.031 and P = 0.017). After the 6 and 12 mo intervention, ALT decreased significantly in the LS group (P = 0.003 and P = 0.002). After 6 and 12 mo, the metabolic syndrome rate had decreased more in the LS group compared with the CON group (P = 0.026 and P = 0.017). After 12 mo, the HOMA-IR score decreased more obviously in the LS group (P = 0.041); this result also appeared in the VFA after 12 mo in the LS group (P = 0.035).

CONCLUSION

Lifestyle intervention was effective in improving NAFLD in both 6 and 12 mo interventions. This intervention offered a practical approach for treating a large number of NAFLD patients in the Chengyang District of Qingdao.

Endoscopic stenting and concurrent chemoradiotherapy for advanced esophageal cancer: A case-control study

AIM: To evaluate the role of endoscopic stenting with or without concurrent 3-dimensional conformal chemoradiotherapy (3D-CRT) in patients with inoperable esophageal cancer.

METHODS: Advanced esophageal cancer patients indicated for esophagectomy received esophageal stents. A part of patients completed 3D-CRT after stenting. Efficacy was assessed by endoscopy and computed tomographic scan before and 4 wk after completion of the treatment. The median survival, 3D-CRT toxicity and complications were compared between 3D-CRT and control groups.

RESULTS: From 1999 to 2008, 99 consecutive patients with T3/T4 disease and unsuitable for esophagectomy were placed with esophageal stents. Sixty-seven patients received 3D-CRT, while 36 patients treated with endoscopic stents alone were recruited as controls. After 3D-CRT treatment, the median tumor volume of 3D-CRT patients were reduced significantly from 43.7 ± 10.2 cm³ to 28.8 ± 8.5 cm³ (P < 0.05). The complete and partial response rate was 85.1%, and no response was 14.9%. After 3D-CRT, the incidence rate of T2 and T3 disease evident on CT scan increased to 78.4% while T4 decreased from 66.7% to 21.6% (P < 0.05). 3D-CRT Karnofsky Performance Status improved in 3D-CRT patients compared with the control group (P = 0.031). 3D-CRT patients had a longer survival than the control group (251.7 d vs 91.1 d, P < 0.05). And the median half-year survival rate in 3D-CRT group (91%) was higher than in the control group (50%, P < 0.05). The most common toxicity was leukocytopenia in the 3D-CRT group (46.7% vs 18.8%, P = 0.008). The control group had a higher rate of restenosis than the 3D-CRT group (81.3% vs 9.0%, P < 0.05). The rate of nephrotoxicity was increased in 3D-CRT as compared with the control group (31.3% vs 15.6%, P < 0.05).

CONCLUSION: 3D-CRT can improve dysphagia in patients with inoperable esophageal carcinoma. 3D-CRT combined with stenting results in better survival as compared with endoscopic stents used alone.

Freshwater toxic cyanobacteria induced DNA damage in apple (Malus pumila), rape (Brassica napus) and rice (Oryza sativa)

Cyanobacteria in freshwater ecosystems can present a harmful effect on growth and development of plants through irrigation with contaminated water. In this study, the effects of microcystins (MCs)-containing cyanobacteria extract (CE) on DNA damage of apple, rape and rice were investigated to explore the phytotoxic mechanism of MCs through DNA fragmentation and RAPD analysis. Determination of DNA fragmentation by fluorescent dye DAPI showed that significant DNA damage was observed in rice seedlings after exposure to CE while DNA fragmentation in rape seedlings and apple cultures did not differ significantly between treatment and control groups. Qualitative characterization of genomic DNA fragmentation by agarose gel electrophoresis supported the quantitative determination using DAPI. The main changes in RAPD profiles of rape seedlings following exposure of lower doses of CE were variation in band intensity for the primers F03 and S01, while higher doses of CE caused loss of normal bands and appearance of new bands except band intensity changes. The data presented here demonstrate that DNA damage in plants occurs following exposure of microcystins, and the polymorphic RAPDs may be used as an investigation tool for environmental toxicology and as a useful biomarker for the detection of genotoxic effects of microcystins on plants.

Specific HLA-DQB1 alleles associated with risk for development of hepatocellular carcinoma: A meta-analysis

AIM: To evaluate the association of human leukocyte antigen (HLA)-DQB1 alleles with hepatocellular carcinoma (HCC) through meta-analysis of published data.

METHODS: Case-control studies on HLA-DQB1 allele association with HCC published up to January 2010 were included in the analyses. The odds ratios (ORs) of HLA-DQB1 allele distributions in HCC patients were analyzed and compared with healthy controls. The meta-analysis software REVMAN 5.0 was applied for investigating heterogeneity among individual studies and for summarizing all the studies. A meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. Seven case-control studies containing 398 cases and 594 controls were included in the final analysis.

RESULTS: Among the five family alleles, two (DQB1*02 and DQB1*03) were found to be significantly associated with the risk of HCC. The combined OR for the association of DQB1*02 and DQB1*03 allele with the risk for HCC was 1.78 (95% CI: 1.05-3.03, P = 0.03) and 0.65 (95% CI: 0.48-0.89, P = 0.007), respectively. Among the 13 specific alleles, two (DQB1*0502 and DQB1*0602) were significantly associated with risk of HCC. The combined OR for the association of DQB1*0502 and DQB1*0602 allele with the risk for HCC was 1.82 (95% CI: 1.14-2.92, P = 0.01) and 0.58 (95% CI: 0.36-0.95, P = 0.03), respectively. No significant association was established for other HLA-DQB1 family alleles and specific alleles.

CONCLUSION: Our results support the hypothesis that specific HLA-DQB1 allele families and alleles might influence the susceptibility or resistance to HCC, although it needs further investigations.

Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis

The aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to update the 2007 meta-analysis to systematically assess the accuracy of APRI in predicting significant fibrosis, severe fibrosis, and cirrhosis stage in hepatitis C virus (HCV) monoinfected and HCV / human immunodeficiency virus (HIV) coinfected individuals. Studies comparing APRI versus biopsy in HCV patients were identified via a thorough literature search. Areas under summary receiver operating characteristic curves (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to examine the APRI accuracy for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis. Heterogeneity was explored using meta-regression. Twenty-one additional studies were eligible for the update and, in total, 40 studies were included in this review (n = 8,739). The summary AUROC of the APRI for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis were 0.77, 0.80, and 0.83, respectively. For significant fibrosis, an APRI threshold of 0.7 was 77% sensitive and 72% specific. For severe fibrosis, a threshold of 1.0 was 61% sensitive and 64% specific. For cirrhosis, a threshold of 1.0 was 76% sensitive and 72% specific. Moreover, we found that the APRI was less accurate for the identification of significant fibrosis, severe fibrosis, and cirrhosis in HIV/HCV coinfected patients.

CONCLUSION

Our large meta-analysis suggests that APRI can identify hepatitis C-related fibrosis with a moderate degree of accuracy. Application of this index may decrease the need for staging liver biopsy specimens among chronic hepatitis C patients.