Camrelizumab and apatinib plus induction chemotherapy and concurrent chemoradiotherapy in stage N3 nasopharyngeal carcinoma: a phase 2 clinical trial

The antiangiogenic agent apatinib has been shown to clinically improve responses to immune checkpoint inhibitors in several cancer types. Patients with N3 nasopharyngeal carcinoma have a high risk of distant metastasis, however, if the addition of immunotherapy to standard treatment could improve efficacy is unclear. In this phase II clinical trial (ChiCTR2000032317), 49 patients with stage TanyN3M0 nasopharyngeal carcinoma were enrolled and received the combination of three cycles of induction chemotherapy, camrelizumab and apatinib followed by chemoradiotherapy. Here we report on the primary outcome of distant metastasis-free survival and secondary end points of objective response rate, failure-free survival, locoregional recurrence-free survival, overall survival and toxicity profile. After induction therapy, all patients had objective response, including 13 patients (26.5%) with complete response. After a median follow-up of 28.7 months, the primary endpoint of 1-year distant metastasis-free survival was met for the cohort (1-year DMFS rate: 98%). Grade≥3 toxicity appeared in 32 (65.3%) patients, with the most common being mucositis (14[28.6%]) and nausea/vomiting (9[18.4%]). In this work, camrelizumab and apatinib in combination with induction chemotherapy show promising distant metastasis control with acceptable safety profile in patients with stage TanyN3M0 nasopharyngeal carcinoma.

[Exploring the factors affecting music-related quality of life in post-lingual deaf adults with cochlear implants]

Objective: To observe the feelings of listening to music and the importance of music in the daily life of post-lingual deaf adults with cochlear implants, and to explore the relevant influencing factors. Methods: This was a cross-sectional survey study. From January 2021 to August 2021,the Music-Related Quality of Life Scale was used to evaluate the music needs and music experiences of 63 post-lingual deaf adults who met the inclusion criteria, including 27 males and 36 females, aged (40.7±12.3) years, at the time of surgery (36.8±13.1) years, and with a preoperative hearing aid ineffective time of (3.9±5.8) years. Indicators analyzed included age, duration of ineffective preoperative hearing aid wear, preoperative music preference, duration of postoperative cochlear implant use, current hearing aid modality, and auditory rehabilitation outcomes. Whether the six factors mentioned above constituted an influence on the subjects' music listening was investigated using SPSS 25.0 statistical software. Results: All of the observations in the scale were correlated with a single factor. The two sub-dimensions of music experience section were related to the effect of auditory rehabilitation. In the importance section, the effect of auditory rehabilitation was the influential factor of the dimension of "participation importance", and the preoperative enjoyment of music was the relevant influential factor of the dimension of "perceived importance". There was a significant difference between the groups when they were grouped by the above factors (P value<0.05), while there was no statistically significance between the groups when they were grouped by other factors (P value>0.05). Conclusions: Post-lingual deaf adults show the need and attempt to listen to music after cochlear implantation. The effectiveness of auditory rehabilitation and the degree of music preference preoperatively are two important factors that influence music listening in implant recipients. Once the level of auditory communication has been restored to a certain degree, it is important to pay more attention to the needs of music for implant recipients and train them in time, especially for those with music preferences preoperatively.

Efficacy and safety of sintilimab plus bevacizumab in metastatic nasopharyngeal carcinoma after failure of platinum-based chemotherapy: an open-label phase 2 study

Background

There are limited treatment options for patients with metastatic nasopharyngeal carcinoma (mNPC) after failure of platinum-based chemotherapy. In this trial, we assessed the efficacy and safety of sintilimab plus bevacizumab in patients with mNPC where platinum-based chemotherapy has been ineffective.

Methods

This was a single-centre, open-label, single-arm, phase 2 trial in Guangzhou, China for patients with mNPC progressed after at least one line of systemic therapy. Eligible patients were between 18 and 75 years old, were histologically confirmed differentiated or undifferentiated non-keratinized NPC, were ineffective after platinum-based chemotherapy, and they had at least one measurable metastatic lesion assessed with Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST V.1.1) by investigators and unsuitable for local surgery or radiotherapy. Key exclusion criterion was previous treatment with anti-PD-1/PD-L1 antibodies plus anti-VEGF antibodies and high risk of hemorrhage or nasopharyngeal necrosis. Patients were enrolled and received sintilimab (200 mg) plus bevacizumab (7.5 mg/kg) intravenously every 3 weeks. Intention-to-treat population was included in primary endpoint analyses and safety analyses. The primary endpoint was objective response rate (ORR) assessed by investigators following the guidelines of RECIST V1.1. Key secondary endpoints were progression-free survival (PFS), overall survival (OS), duration of response (DOR), and safety. This trial is registered with ClinicalTrials.gov (NCT04872582).

Findings

Between July 29, 2021 and August 16, 2022, 33 patients were enrolled. Median age was 46 years (range, 18-64 years), and 63.6% of patients had previously received two or more lines of chemotherapy for metastatic disease. Median follow-up was 7.6 months (range, 4.1-17.5 months). ORR was 54.5% (95% CI, 36.4-71.9%) with 3 complete responses (9.1%) and 15 partial responses (45.5%). Median PFS was 6.8 months (95% CI, 5.2 months to not estimable). Median DOR was 7.2 months (95% CI, 4.4 months to not estimable). Median OS was not reached. The most common potential immune-related adverse event (AE) was Grade 1-2 hypothyroidism (42.4%). Treatment-related grade 3 or 4 AEs occurred in 7 patients (21.2%), including nasal necrosis (3/33), hypertension (1/33), pruritus (1/33), total bilirubin increased (1/33) and anaphylactic shock (1/33). No treatment-related deaths and severe epistaxis occurred.

Interpretation

This phase 2 trial showed that sintilimab plus bevacizumab demonstrated promising antitumour activity and manageable toxicities in patients with mNPC after failure of platinum-based chemotherapy. Further trials are warranted, and the detailed mechanisms need to be elucidated.

Funding

The Guangdong Basic and Applied Basic Research Foundation, the National Natural Science Foundation of China, the Natural Science Foundation of Guangdong Province, and the Science and Technology Planning Project of International Cooperation of Guangdong Province.

[Research advances of stem cell-based tissue engineering repair materials in promoting the healing of chronic refractory wounds on the body surface]

Repairing chronic refractory wounds on the body surface is a complex medical problem involving all stages of wound healing. In recent years, stem cells (SCs) and tissue engineering (TE) have brought hope for repairing chronic refractory wounds. SCs have excellent regenerative and paracrine effects; various TE strategies have the potential to repair chronic refractory wounds on the body surface and also improve the delivery efficiency of SCs. This article reviews the pathological characteristics of chronic refractory wounds, SCs used to repair chronic refractory wounds, and SC-based TE wound repair strategies.

[An exploratory clinical study of the efficacy and safety of tumor-infiltrating lymphocytes in the treatment of metastatic osteosarcoma]

Objective: To explore the safety and efficacy of tumor-infiltrating lymphocytes (TILs) extracted from tumor tissue in patients with pulmonary metastasis of osteosarcoma, the TILs were amplified in vitro to reach clinical dosage and reinfused to the patients combined with high-dose interleukin 2 (IL-2). Methods: Twelve subjects with pathologically diagnosed osteosarcoma were enrolled from December 2019 to June 20, 2021 in Shanghai General Hospital. All subjects progressed with metastasis after standard chemotherapy and failed multiple lines of treatments. Fresh tumor tissue was obtained from the metastatic site and extracted and amplified by Good Manufacturing Practice (GMP) workshop to produce TILs to clinical treatment dosage (10⁹-10¹¹). High-dose IL-2 (100 000-200 000 U/kg) was administered immediately after autogenous TILs infusion to promote the activation, proliferation and antitumor cytolytic activity in vivo. Adverse events (AE) were graded according to Common Terminology Criteria for Adverse Events (CTCAE) standard and tumor response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Results: One patient did not receive treatment due to failure in isolating TILs, total of 11 patients received a single re-infusion of autologous TILs. There were 10 males and 1 female with a median age of 19.9 years (12-33 years). Six of these patients received higher dose levels of 1.0×10¹⁰ TILs. The 11 patients were followed-up for 1 to 13 months and tolerated well. The most common adverse events reported were fever (10/11), constipation (3/11) and elevated gamma-glutamyl transferase (GGT) (3/11). The high incidence of fever was due to the IL-2 infusion. All patients experienced a transient drop in lymphocyte count and leukopenia leading to non-myeloid ablative lymphocyte clearance. The AE included grade 4 hematologic toxicity, including 8 cases of lymphocytopenia, 2 cases of neutropenia and 1 case of thrombocytopenia. No AE of neurotoxicity occurred. Of all the 11 patients, 9 patients got stable disease (SD) and 2 patients had progressive disease (PD). The disease control rate was 9/11. The median duration of SD was more than 4 months, and the maximum tumor volume decreased by close to 20%. Patient number 9 had sustained SD status for more than 6 months. Conclusions: TILs with in vitro expansion ability could be isolated from tumor tissues of advanced osteosarcoma patients. TILs amplified and reinfused in vitro have anti-osteosarcoma activity.

[Postoperative rehabilitation effect and influence factors of adult prelingual deafness with cochlear implant]

Objective: To investigate whether pre-lingual deafness adult caused by inadequate auditory compensation in childhood can benefit from cochlear implants and the related influencing factors. Methods: A total of 26 prelingual deafness as experimental group [11 males and 15 females, the age of operation was (24.5±5.7) years] and 13 postlingual deafness as control group [5 males and 8 females, the age at the time of operation was (42.2±11.4) years] were recruited. Objective assessment included hearing threshold and speech recognition rate tests while wearing cochlear implants. Subjective assessment used Nijmegen Cochlear Implant Questionnaire to assess hearing-related quality of life of subjects. The changes of hearing ability in the prelingual deafness group before and after operation and the differences with the postlingual deafness group were compared, and the correlation between speech recognition ability and the age diagnosed as severe or profound deafness, the age of hearing aid invalid, and duration of wearing cochlear implant were analyzed as factor indicators. All statistical results were analyzed by SAS 9.4 software. Results: In terms of objective indicators, the speech recognition rate of pre-lingual deafness was significantly lower than that of post-lingual deafness [(35.4±28.0)% vs (80.9±8.0)%,t=7.67, P<0.001], while there was no statistical difference in hearing threshold between the two groups [(34.8±4.0) dB HL vs (33.1±3.7) dB HL, t=1.30, P>0.05]. The indicators in the subjective questionnaire showed that the prelingual deafness group was only weaker in advanced sound perception, confidence and total mean score than the post-lingual deafness group (P<0.05), and there was no significant difference in other aspects(P>0.05), meanwhile, all indicators of the prelingual deafness group were significantly improved compared with the preoperative level (P<0.001). There was a moderate positive correlation between the hearing quality and the speech recognition rate in the prelingual deafness group(r=0.51, P=0.008). The regression analysis showed that the invalid age of hearing aid was the exact influencing factor of speech recognition rate. Conclusions: Certain prelingual deaf adults can adapt to cochlear implants and obtain different degrees of auditory assistance. Compared with the improvement of objective auditory ability assessment, the patient who received cochlear implantation gain more improvement in auditory related quality of life subjectively. The ineffective age of preoperative hearing aid is an important factor, which needs to be aroused sufficient preoperative attention.

[Effects of high protein diet on anthropometric indices and blood lipid in overweight and obese children: a Meta-analysis]

Objective: To evaluate the effects of a high-protein diet on anthropometric indices and blood lipid in overweight and obese children and provide evidence for their dietary management. Methods: This was a Meta-analysis. The randomized controlled trials on the effects of a high-protein diet on anthropometric indices and blood lipid in overweight and obese children published up to January 19, 2022 were searched in PubMed, Web of Science, Embase, Cochrane Library and CNKI database, with the key words of "child" "adolescent" "obesity" "overweight" "pediatric obesity" "weight loss" "dietary protein" "dietary carbohydrate" "caloric restrict" both in English and Chinese. The quality of the included literature was evaluated according to the "risk of bias" assessment tool, which included bias from the randomization process, deviation from intended interventions, missing outcome data, measurement of the outcome and selection of the reported results. Moreover, calculated the pooled mean difference, perform heterogeneity test, and assess publication bias. Results: A total of 8 articles were selected from the retrieved 4 836 articles, all in English. The sample sizes ranged from 4 to 120. The analysis showed that the post-intervention body mass index (mean difference (MD)=-0.66, 95%CI -1.76-0.44), body mass index Z-scores (MD=-0.09, 95%CI-0.23-0.05), fat content percentage (MD=-1.07, 95%CI-2.88-0.74), high density lipoprotein (MD=0.02, 95%CI-0.02-0.06) and low density lipoprotein (MD=0.04, 95%CI-0.08-0.17) were not significantly different with those of the standard protein diet group, with P values being 0.240, 0.220, 0.250, 0.360 and 0.480, respectively. Subgroup analysis showed that after excluding one study, the difference in body mass index between the short-term intervention group and control group was statistically significant (MD=-1.60, 95%CI-3.14--0.06, P=0.040). Conclusions: A short-term high-protein diet intervention seems to improve the body mass index status of overweight and obese children. Nevertheless, a high-protein diet does not affect any other selected anthropometric indices and blood lipids. More studies with large sample sizes, higher quality and comparable standard of high-protein diet are needed for further demonstration.

[Effects of temperature-sensitive hydroxybutyl chitosan hydrogel on wound healing of full-thickness skin defect in rats]

Objective: To investigate the effects of temperature-sensitive hydroxybutyl chitosan hydrogel on wound healing of full-thickness skin defect in rats. Methods: The experimental research method was used. Fifty-one no matter male or female Sprague-Dawley rats aged 7-10 weeks were selected, and two round full-thickness skin defect wounds with a diameter of 2 cm were created on the back of each rat at a distance about 1.0 cm to the spine. The rats were divided into temperature-sensitive hydrogel group, gel group, and blank control group according to the random number table, with 17 rats and 34 wounds in each group. Wounds of rats in the first two groups were applied respectively with 0.3 mL temperature-sensitive hydroxybutyl chitosan hydrogel and carboxymethyl chitosan hydrogel immediately after injury, and the wounds of rats in blank control group received no treatment. The wounds of rats in the three groups were all covered with vaseline oil gauze. The states of temperature-sensitive hydroxybutyl chitosan hydrogel in wounds of rats in temperature-sensitive hydrogel group and carboxymethyl chitosan hydrogel in wounds of rats in gel group were observed every day when the dressings were changed, and the difficulty of vaseline oil gauze removal was recorded. On the 3rd, 7th, 10th, 14th, and 21st day after injury, the wound healing of rats in the three groups was observed and the wound healing rates were calculated. On the 3rd, 7th, 10th, 14th, and 21st day after injury, tissue from 4 wounds of 2 rats in each group was collected for the following observation and detection. The infiltration of inflammatory cells, angiogenesis, and re-epithelialization were observed by hematoxylin eosin staining. The regeneration and remodeling of collagen fibers were observed by Masson staining, and the collagen volume fraction was calculated. The expressions of interleukin-6 (IL-6), transforming growth factor β₁ (TGF-β₁), and matrix metalloproteinase-1 (MMP-1) were detected by enzyme-linked immunosorbent assay method. Data were statistically analyzed with analysis of variance for factorial design, one-way analysis of variance, and Bonferroni test. Results: The carboxymethyl chitosan gel in wounds of rats in gel group was liquid gel and could flow with the body position, while the temperature-sensitive hydroxybutyl chitosan hydrogel in wounds of rats in temperature-sensitive hydrogel group was solid gel and could not flow with the body position, and the distribution of the latter was more uniform. The vaseline oil gauzes were easily removed in wounds of rats in temperature-sensitive hydrogel group, while the vaseline oil gauzes were difficult to remove in the other two groups. On the 3rd, 7th, 10th, 14th, and 21st day after injury, the wound granulation tissue of rats grew well in temperature-sensitive hydrogel group and gel group, with no obvious infection, and two rats in blank control group died of wound infection on the 3rd and 5th day after injury. On the 7th, 10th, 14th, and 21st day after injury, the wound healing rates of rats in temperature-sensitive hydrogel group and gel group were significantly higher than that in blank control group (P<0.01). On the 10th day after injury, the wound healing rate of rats in temperature-sensitive hydrogel group was significantly higher than that in gel group (P<0.05). A large number of neutrophils and lymphocytes infiltrated into the wounds of rats in the three groups on the 3rd day after injury. The infiltration of inflammatory cells was gradually reduced and the wound healed gradually in rats of temperature-sensitive hydrogel group and gel group from the 7th to 21st day after injury, and the epidermis and dermis could be seen, without hair follicles and other skin appendages. The wounds of rats in blank control group did not heal completely on 21st day after injury. From the 3rd to 10th day after injury, the newly formed collagen fibers increased gradually in the wounds of rats in the three groups. On the 14th and 21st day after injury, the collagen fibers in the wounds of rats in temperature-sensitive hydrogel group and gel group were denser and more orderly than those in blank control group. On the 10th, 14th, and 21st day after injury, the collagen volume fraction of wounds of rats in temperature-sensitive hydrogel group and gel group was significantly higher than that in blank control group (P<0.01). On the 14th day after injury, the collagen volume fraction of wounds of rats in temperature-sensitive hydrogel group was significantly higher than that in gel group (P<0.01). On the 3rd, 7th, and 10th day after injury, the expressions of IL-6 in wounds of rats in temperature-sensitive hydrogel group were significantly higher than those in gel group and blank control group (P<0.01), and the expressions of IL-6 in wounds of rats in gel group were significantly lower than those in blank control group (P<0.01). On the 3rd, 7th, and 10th day after injury, the expressions of TGF-β₁ in wounds of rats in temperature-sensitive hydrogel group were significantly higher than those in gel group and blank control group (P<0.01). The expressions of TGF-β₁ in wounds of rats in gel group were significantly lower than those in blank control group on the 3rd and 7th day after injury (P<0.01), and the expression of TGF-β₁ in wounds of rats in gel group was significantly higher than that in blank control group on the 10th day after injury (P<0.01). On the 14th day after injury, the expression of TGF-β₁ in wounds of rats in gel group was significantly higher than that in temperature-sensitive hydrogel group and blank control group (P<0.01). On the 21st day after injury, the expression of TGF-β₁ in wounds of rats in temperature-sensitive hydrogel group was significantly lower than that in gel group and blank control group (P<0.01), and the expression of TGF-β₁ in wounds of rats in gel group was significantly lower than that in blank control group (P<0.01). On the 7th day after injury, the expression of MMP-1 in wounds of rats in gel group was significantly higher than that in temperature-sensitive hydrogel group and blank control group (P<0.01). On the 10th, 14th, and 21st day after injury, the expressions of MMP-1 in wounds of rats in temperature-sensitive hydrogel group were significantly higher than those in gel group and blank control group (P<0.01). On the 10th day after injury, the expression of MMP-1 in wounds of rats in gel group was significantly lower than that in blank control group (P<0.01). On the 14th and 21st day after injury, the expressions of MMP-1 in wounds of rats in gel group were significantly higher than those in blank control group (P<0.01). Conclusions: Temperature-sensitive hydroxybutyl chitosan hydrogel can promote the healing of full-thickness skin defect wounds in rats by increasing the expressions of IL-6, TGF-β₁, and MMP-1, regulating the wound healing environment, inhibiting inflammatory reaction, improving the strength of tissue repair, and promoting collagen synthesis or decomposition.

[Comparison of corneal refractive power and astigmatism measured by the new anterior segment optical coherence tomographic device and Scheimpflug imaging device in age-related cataract patients]

Objective: To compare the difference and agreement of corneal refractive power and astigmatism measured by the new swept-source anterior segment optical coherence tomography (SS-AS-OCT) device (CASIA2) and Scheimpflug imaging device (Pentacam) in age-related cataract patients. Methods: In this cross-sectional study, 112 eyes of 112 patients with age-related cataract were examined before phacoemulsification in the Tianjin Medical University Eye Hospital from April to May 2020. The steep keratometry (Ks), flat keratometry (Kf), mean keratometry (Km), degree and axis of astigmatism of the corneal anterior and posterior surfaces and the total cornea were recorded. The difference in astigmatism was analyzed by the arithmetic method and the vector method. The difference of data was evaluated using Paired t test or Wilcoxon test. The agreement of data was evaluated using Bland-Altman plots. Results: The patients were 44 males and 68 females with an average age of (67±10) years. There were no statistically differences in the Ks and Km values of the corneal anterior surface between the Pentacam and the CASIA2 (both P>0.05). There was significant difference in the Kf values of the corneal anterior surface between the Pentacam and the CASIA2 [(44.24±1.73) D vs. (44.14±1.64) D; t=2.278; P<0.05]. The Ks, Kf, and Km values of the posterior surface of the cornea measured by the Pentacam and the CASIA2 were (-6.60±0.29) D vs. (-6.45±0.28) D, (-6.34±0.27) D vs. (-6.17±0.25) D, and (-6.47±0.26) D vs. (-6.31±0.25) D, respectively. The Ks, Kf, and Km values of the total cornea measured by the two instruments were (45.08±1.84) D vs. (43.94±1.64) D, (44.18±1.85) D vs. (43.02±1.64) D, and (44.63±1.82) D vs. (43.48±1.60) D, respectively. There were significant differences in the Ks, Kf, and Km values of the posterior surface of the cornea and the total cornea (t=-14.440, -13.522, -17.186, 21.016, 21.819, 22.981; all P<0.01). The degree and axis of astigmatism of the corneal anterior and posterior surfaces and the total cornea showed no statistically significant difference (all P>0.05). Vector operation results showed that the astigmatism difference vector (DV) of the Pentacam and the CASIA2 on the anterior surface of the cornea was 0.06 D@57°±0.64 D,>0.50 D in 47 eyes (41.96%). The astigmatism DV on the posterior surface of the cornea was 0.07 D@174°±0.21 D, >0.50 D in 2 eyes (1.79%). The astigmatism DV on the total cornea was 0.13 D@3°±0.69 D,>0.50 D in 59 eyes (52.68%). The results of the two devices were positively correlated (r values of the Ks, Kf, Km, and astigmatism degree on the anterior surface of the cornea were 0.970, 0.968, 0.976, and 0.697, respectively, on the posterior surface of the cornea were 0.918, 0.875, 0.925, and 0.517, respectively, and on the total cornea were 0.951, 0.955, 0.959, and 0.622, respectively; all P<0.01). Bland-Altman analysis showed that the Ks, Kf, Km, and astigmatism degree of the corneal anterior and posterior surfaces measured by the two devices were consistent, with 2.68% to 8.04% of the measured values outside 95% limits of agreement (95%LoA). The 95%LoA of the total corneal Ks, Kf, and Km between the two devices was 0.01 to 2.28 D, 0.06 to 2.27 D, and 0.10 to 2.20 D, respectively, with a wide 95%LoA range and poor consistency. Conclusions: The corneal refractive power and astigmatism measured by the CASIA2 and the Pentacam shows little difference on the anterior surface of the cornea, with good agreement. However, the refractive power results of the posterior surface of the cornea and the total cornea show great difference, suggesting that these two instruments cannot be used interchangeably in clinical practice. (Chin J Ophthalmol, 2021, 57: 48-55).

[Clinical comparison analysis in surgically induced astigmatism of the total, anterior and posterior cornea after 2.2-mm versus 3.0-mm clear corneal incision cataract surgery]

Objective: To compare the surgical induced astigmatism(SIA) of the total, anterior and posterior cornea between eyes with 2.2-mm and 3.0-mm clear corneal incisions in phacoemulsification. Methods: A prospective double-blind randomized controlled study was conducted on 131 patients (131 eyes) with age-related cataract from October 2017 to June 2018. They were randomized according to the random number table. Sixty-nine patients received phacoemulsification through a 2.2-mm clear corneal incision at 140 degrees; 62 patients were recruited in the control group with a 3.0-mm clear corneal incision at the same position. Lens density was graded and compared between the groups preoperatively. Total corneal refractive power (TCRP), simulated keratometry (SimK) and posterior corneal astigmatism (PCA) (Apex, 4-mm zone) were recorded through the Pentacam preoperatively and at 1 week, 1 month and 3 months postoperatively. Corneal astigmatism was decomposed to vertical/horizontal (X) and oblique changes (Y) using the power vector analysis. Independent sample t test and matched t test were used for statistical analysis. Results: A total of 123 patients (123 eyes) completed 3 months of follow-up including 65 in the 2.2-mm group and 58 in the control group. The age of the two groups was (69±9) and (71±10) years old, and the lens density was (2.08±0.47) and (2.12±0.46) grades, respectively. Both the age and the lens density of the two groups were not statistically significant (both P>0.05). Preoperative TCRP, SimK and PCA were not statistically significant (all P>0.05). SIA was calculated using the vector analysis. Centroid SIA conducted from TCRP, SimK and PCA in the 2.2-mm group was -0.11 D@146°, -0.11 D@151° and -0.03 D@67°, respectively, at 3 months postoperatively. In the 3.0-mm group, it was -0.25 D@158°, -0.24 D@147° and -0.04 D@47°, respectively. Statistical significance was found between the two groups in the Y polar value of SIA of the anterior surface [(-0.10±0.30) vs.(-0.22±0.37) D, t=-2.133, P=0.035] and the SIA of the posterior surface [(0.24±0.16) vs. (0.19±0.12) D, t=2.009, P=0.047] at 3 months postoperatively. In the comparison of the SIA of TCRP and anterior surface, statistical significance was found in the absolute value of SIA at all the intervals in the 2.2-mm group [(0.87±0.80) vs. (0.58±0.48) D, (0.58±0.48) vs. (0.50±0.28)D, (0.57±0.37) vs. (0.47±0.28) D, t=5.102, 4.155, 3.877, all P<0.01] and at 1 week and 1 month in the 3.0-mm group [(0.82±0.57) vs. (0.58±0.41) D, (0.59±0.36) vs. (0.50±0.28) D, t=5.034, 3.919, both P<0.01]. X components of SIA(TCRP) and SIA(simk) were significantly different at 3 month postoperatively in 3.0-mm group (P<0.05). Y components of SIA(TCRP) and SIA(SimK) were significantly different at 1 week postoperatively in the 2.2-mm group[(-0.48±0.85) vs.(-0.24±0.42) D, P<0.01] and 3.0-mm group [(-0.58±0.66) vs. (-0.37±0.42) D, P<0.01]. Conclusions: Compared with the 3.0-mm incision, the 2.2-mm coaxial micro-incision cataract surgery has a lower and more stable SIA. The effect of a clear corneal incision in cataract surgery on the total cornea is more obvious than that on the anterior surface of the cornea. The difference is significant in the early stage and gradually decrease with time. (Chin J Ophthalmol, 2019, 55: 495-501).

Overexpression of LncRNA GHET1 predicts an unfavourable survival and clinical parameters of patients in various cancers

Recently, increasing studies have reported that long non‐coding RNA (lncRNA) gastric carcinoma highly expressed transcript 1 (GHET1) is highly expressed in variety of cancers and relevant to poor prognosis of cancer patients. Nevertheless, the results were inconsistent and the systematic analysis of lncRNA GHET1 in cancers has not been inspected. Thus, we aim to evaluate the relationship between lncRNA GHET1 expression and clinical outcomes in human cancers. We searched keywords in PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrial.gov. Stata SE12.0 software was used in the quantitative meta‐analysis. Pooled hazard ratio (HR) and odds ratio with 95% confidence interval (95% Cl) were calculated to evaluate the clinical significance of lncRNA GHET1. Twelve studies totalling 761 patients with cancers were included for analysis. The pooled results of this study indicated that high lncRNA GHET1 expression level was significantly associated with poor overall survival (OS, HR = 2.30, 95% CI: 1.75‐3.02) in human cancers. The statistical significance was also detected in subgroup analysis stratified by analysis method, cancer type, sample size and follow‐up time respectively. In addition, the elevated lncRNA GHET1 expression was also significantly related to more advanced clinical stage, earlier lymph node metastasis, earlier distant metastasis and bigger tumour size. LncRNA GHET1 may serve as a promising biomarker for prognosis in Asians with cancers.

[Relationship between coronary tortuosity and coronary microvascular disease]

Objective: To explore the relationship between coronary tortuosity and coronary microvascular disease (CMVD). Methods: Patients with typical angina symptoms and without serious coronary artery stenosis by coronary angiography were enrolled from June 2014 to December 2016, and CMVD was diagnosed by single photon emission tomography (SPECT). According to the SPECT results, patients were divided to the CMVD group and non-CMVD group. The baseline clinical characteristics, results of coronary angiography were compared between the two groups. The logistic analysis was used to analyze the relationship between coronary tortuosity and CMVD. Result: A total of 117 cases were enrolled, with 69 cases in the CMVD group and 48 cases in the non-CMVD group. No differences were found in gender distribution, age, hypertension, lipid abnormality, hyperuricemia and uses of statins between the two groups (all P>0.05). Incidence of diabetes (78.26%(54/69) vs. 35.42% (17/48) , P<0.05), hs-CRP ((4.29±2.15)mmol/L vs. (2.63±1.20)mmol/L, P<0.001), LDL-C ((2.98±0.96)mmol/L vs. (2.52±0.83)mmol/L, P=0.008) and homocysteine ((13.7±5.61)mmol/L vs. (11.5±4.38)mmol/L, P=0.025) levels were higher in the CMVD group than in the non-CMVD group. The data derived from echocardiographic examination were similar between the two groups. The Corrected TIMI frame counts were higher in the CMVD group than in non-CMVD group (LAD: 31.56±4.92 vs. 27.31±3.75, LCX: 29.47±4.18 vs. 26.62±3.19, RCA: 29.09±5.05 vs. 26.24±3.28, all P<0.001). The incidences of coronary atherosclerosis (76.81% (53/69) vs. 27.08% (13/48) , P<0.001) and coronary tortuosity ( (60.87% (42/69) vs. 33.33% (16/48) , P=0.035) were also higher in the CMVD group than in non-CMVD group. Logistic analysis found that coronary tortuosity (OR=6.111, 95%CI 2.707-13.794, P<0.001), diabetes (OR=6.565, 95%CI 2.883-14.948, P<0.001) and coronary atherosclerosis (OR=8.918, 95%CI 3.822-20.808, P<0.001) were independent risk factors of CMVD. Conclusion: Coronary tortuosity, diabetes and coronary atherosclerosis are related to CMVD in this patient cohort.

[The long-term benefits of cochlear implantation for children and their families]

Objective:To study the auditory language ability of children with artificial cochlea after entering normal schools as well as the school life conditions and to evaluate the long-term comprehensive benefits of surgery on children along with their families. Method:The questionnaire was designed referring to the categories of auditory performance (CAP), the speech intelligibility rating (SIR), and family burden scale of diseases (FBS), with the questions involving four aspects of the general conditions, the auditory language ability, the school life conditions and the family conditions. Altogether 50 families were participated. Children who had applied artificial cochlea for at least two years and studied in normal schools were selected as the studying objects. The follow-up questionnaire was conducted on the parents. The differences were compared in the auditory language ability and the school life conditions, grouped by gender, age at surgery, parents' educational level, residence, service time of artificial cochlea and parent-child time in general. Meanwhile, the differences of 15 family conditions were compared before and after surgery. Result:The variable factors were of no obvious statistical significance in the comparison among groups of the auditory language ability (P>0.05); In the comparison of the school life conditions, there were significant differences in the number of making friends when grouped by parent-child time (P<0.05), there wes no statistical significance in the comparison among groups of the remaining various factors (P>0.05); In the comparison of family conditions before and after surgery, the rest of the indexes were of significant differences (P<0.05), there was no significant differences in the economic burden and social time of parents (P>0.05). Family conditions improved evidently after surgery. Conclusiont:Under the circumstances of different variable factors, after 2 years of rehabilitation, children are able to acquire better auditory language ability, and adjust themselves to the school life, finishing their studies, still there is a deficiency in the aspect of organizational competence in comparison to age-matched children. In addition, with children's recovery and attending schools, parents' mental stress is significantly reduced, family life returns to normal, and family atmosphere becomes harmonious. Not only can the artificial cochlea help rid children of disability, but also it can be of obvious benefits to their families.

[The progress and prospect of application of genetic testing technology-based gene detection technology in the diagnosis and treatment of hereditary cancer]

Hereditary cancer is caused by specific pathogenic gene mutations. Early detection and early intervention are the most effective ways to prevent and control hereditary cancer. High-throughput sequencing based genetic testing technology (NGS) breaks through the restrictions of pedigree analysis, provide a convenient and efficient method to detect and diagnose hereditary cancer. Here, we introduce the mechanism of hereditary cancer, summarize, discuss and prospect the application of NGS and other genetic tests in the diagnosis of hereditary retinoblastoma, hereditary breast and ovarian cancer syndrome, hereditary colorectal cancer and other complex and rare hereditary tumors.

[The comparation of fusion targeting biopsy and systematic biopsy in the clinical diagnosis of prostate cancer: a meta-analysis]

Objective: To systematically compare the differences in the detection rate of prostate cancer with fusion targeting biopsy and systemic biopsy. Methods: A computer-based search of PubMed, Medline, China Biomedical Literature Database and Wanfang database (from the beginning of establishment of library to October 2016) on the detection rate of prostate cancer by fusion targeting biopsy and systemic biopsy was performed manually.The inclusion and exclusion criteria were formulated by 2 reviewers, and the data were extracted and evaluated respectively. RevMan5.3 software was used to analyze the detection rate of prostate cancer by two biopsy methods. Results: A total of 15 related clinical studies were included, 5 337 cases were enrolled in the study, including 2 667 cases of targeted fusion biopsy and 2 670 cases of routine systemic biopsy. The results showed that the overall detection rate of prostate cancer in targeting fusion biopsy was significantly higher than that of conventional systemic biopsy (OR=1.16, 95% CI 1.04-1.30, P=0.007). The detection rates of prostate cancer with different risk grades by two biopsy methods were conducted. We found that targeted fusion biopsy had a significant advantage compared with conventional system biopsy (OR=1.37, 95% CI 1.19-1.58, P<0.05) in middle and high risk prostate cancer with Gleason ≥ 7 points. In low-risk prostate cancer patients with Gleason score <7, the detection rate of prostate cancer by targeted fusion biopsy was lower (OR=0.76, 95% CI 0.65-0.89, P<0.05) than that of conventional systemic biopsy. Conclusions: Targeted fusion biopsy was significantly better than systemic biopsy in the overall detection rate of prostate cancer and the detection rate of the middle and high risk prostate cancer with Gleason ≥7 points. However, systemic biopsy performed better in patients with Gleason<7 points of low-risk prostate cancer.

Autofluorescence of collagen fibres in scar

BACKGROUND/PURPOSE

Autofluorescence has become an important factor associated with diagnosis and treatment of many diseases.

METHODS

Full thickness skin grafts and scar biopsies were obtained from five volunteers. The normal skin or scar tissue paraffin-wax sections were stained with HE and the autofluorescence of collagen fibres was viewed under fluorescence microscopy.

RESULTS

In normal skin, the autofluorescence was showed in dermis, specifically in collagen fibres. There was very weak autofluorescence in epidermis. The spectrum was excited at 488 nm and the peak value of autofluorescence was significantly different between reticular layer (169.24±9.18) and papillar layer of dermis (103.91±15.23). In scar tissue, the autofluorescence was showed in collagen fibres and the peak value was 176.71±20.69. The structure of collagen fibres in normal skin or scar tissue was different in loose degree, thickness, boundle size, and morphology by their autofluorescence.

CONCLUSION

The different peak value of autofluorescence between scar and normal skin may due to the different density of collagen fibtes in them. This study may provide us a simple and effective assessment indicator and method for diagnosis and treatment of scar.

Effects of vitamin D or its analogues on the mortality of patients with chronic kidney disease: an updated systematic review and meta-analysis

The objective of this study was to assess whether vitamin D (VD) treatment alters the overall all-cause and cardiovascular mortalities in a chronic kidney disease (CKD) population. We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials without language restriction, until the publication date of 22 February 2016. All related literatures that compared VD treatment with non-VD treatment and reported the mortality of patients with CKD (including those undergoing dialysis) were identified. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated by using the random- and fixed-effects models. Randomised controlled trials (RCTs) that used the intention-to-treat principle and observational studies (OSs) were analysed separately. For this study, 38 studies involving 223 429 patients (17 RCTs, n=1819 and 21 OSs, n=221610) were included. In the OSs, VD treatment was significantly associated with reductions in both all-cause and cardiovascular mortalities; however, such significant association was not found in the RCTs. The existing RCTs do not provide sufficient or precise evidence that VD supplementation affects the mortality of patients with CKD, although subsets of patients that could potentially benefit from VD treatment can be identified by using the existing data from the RCTs. Nevertheless, large-size RCTs are needed in the future to assess any potential differences in survival prospectively.

Proliferation and differentiation of human osteoblasts from a type 2 diabetic patient in vitro

We investigated the proliferation and differentiation potential of human osteoblasts from a type 2 diabetic patient in vitro. Human osteoblasts were obtained from a healthy subject and a type 2 diabetic patient and were cultured in vitro using the tissue explant adherent method. Differences in cell morphology were observed under a phase contrast microscope. The osteogenic differentiation capacity was evaluated by alizarin red staining, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, alkaline phosphatase (ALP) staining, and detection of bone Gla-protein (BGP) and Col-1. Expression of Runx-2 and Col-1 was detected using RT-PCR and western blot. Our data indicated that alveolar bone osteoblasts from the type 2 diabetic patient exhibited poorer growth, smaller calcium nodule formation, slower proliferation, and lower ALP, BGP, and Col-1 concentrations in the cell culture supernatant, as compared to control cells (P < 0.05). Combined, our study indicated that alveolar bone osteoblasts from a type 2 diabetic patient exhibited slower proliferation and decreased differentiation, as compared to healthy control, when cultured in vitro.

Comparison of the antiviral effects of entecavir and adefovir dipivoxil in chronic HBV infection: a randomized control trial

AIMS

The purpose of this study is to compare the antiviral efficacy of entecavir (ETV) and adefovir dipivoxil (ADV) at various time points during the treatment.

METHODS

A randomized, controlled, open-label study was designed to analyze the kinetics of HBeAg seroconversion, HBV DNA level, and liver and renal functions in 72 ETV-treated chronic hepatitis B (CHB) patients and 66 ADV-treated CHB patients. The data was collected every 12 weeks up to 96 weeks after drug administration.

RESULTS

The negative rate of HBeAg seroconversion was significantly increased at 24 weeks in ETV-treated patients, whereas in ADV-treated patients, these changes were not significant. The serum HBV DNA levels were significantly decreased from 24 weeks in both ETV- and ADV-treated patients. Other than ETV showing significantly decreased levels of HBV DNA at 24 weeks when compared with ADV, there was no difference in virological response between two treatments at any other time points. The serum alanine aminotransferase (ALT) and total bilirubin (TBIL) levels were significantly decreased 12 weeks after either ETV- or ADV-treated patients without differences between two treatments. The urea nitrogen levels were in normal range and there was no difference between two groups.

CONCLUSIONS

Our study suggested that both ETV and ADV could be used as monotherapy for nucleotide-naive patients, but ETV has displayed potential efficacy in HBeAg seroconversion.

Prevalence of obesity and associated risk factors in Northeastern China

AIM

To investigate the prevalence of obesity and associated risk factors in the Northeastern Chinese city of Dehui.

METHODS

A cross-sectional study involving random sampling methods generated 3598 completed questionnaires by permanent residents of Dehui. Binary multivariate logistic regression analysis was used to identify factors that were significantly associated with obesity.

RESULTS

Based on the 2000 WHO diagnostic criterion regarding populations in the Asia-Pacific region, the prevalence of obesity was 37.71% (34.77% of females; 41.11% of males). Elevated body mass index (BMI) was significantly associated with cardiovascular disease (CVD)-associated conditions (P<0.05), and increased prevalence of abnormally high transaminase levels (P<0.05). Binary logistic regression analysis demonstrated the following variables were associated with obesity: increased age (odds ratio [OR]: 1.01, 95% confidence interval [CI]: 1.0-1.02), high total cholesterol (TC) (OR: 1.26, 95% CI: 1.03-1.54), high triglycerides (TG) (OR: 1.38, 95% CI: 1.16-1.64), hypertension (OR: 1.62, 95% CI: 1.39-1.90), fatty liver (OR: 2.91, 95% CI: 2.41-3.49), living in an urban setting (OR: 2.84, 95% CI: 2.39-3.38), and advanced education (OR: 1.22, 95% CI: 1.06-1.40).

CONCLUSIONS

Obesity is prevalent among the adult population in Northeastern China and is significantly associated with CVD risk factors such as hypertension, dyslipidemia, as well as transaminase abnormalities.

Green waxes, adhesives and lubricants

General characteristics of waxes, adhesives and lubricants as well as the recent fundamental investigations on their physical and mechanical behaviour are introduced. The current R&D status for new type/generation of waxes, adhesives and lubricants from natural products is reviewed, with an emphasis on their tribological applications. In particular, some crucial issues and challenges relating to technological improvement and materials development are discussed. Based on the current predicted shortage of energy resources and environmental concerns, prospective research on the development of green waxes, adhesives and lubricants is suggested.

Epidemiological Investigation of Metabolic Syndrome and Analysis of Relevant Factors in North-Eastern China

This epidemiological study was conducted to investigate the prevalence of metabolic syndrome and associated risk factors in Chinese subjects from Dehui in northeastern China. Using a random sampling method, a questionnaire was completed by 3785 permanent residents aged 18-72 years and relevant clinical data were collected from each subject. Binary multivariate logistic regression analysis was used to identify factors that were significantly associated with metabolic syndrome. Based on the International Diabetes Federation definition, the prevalence of metabolic syndrome was 22.4%, which is higher than that of the general Chinese population. Metabolic syndrome occurred more frequently in females and the prevalence gradually increased with age. Living in an urban setting and being female, > 50 years old, overweight, having total cholesterol ≥ 5.18 mmol/l, low-density lipoprotein cholesterol ≥ 3.1 mmol/l, and a fatty liver were significant risk factors associated with metabolic syndrome.

Generator sources of EEG large waves elicited by mental stress of memory recall or mental calculation

Preceding mental sweating response (MSR) during mental stress, small wavelets and large waves are observed on EEG. In the present study, locations of current sources of the large waves were estimated. The results revealed that the current dipole was estimated around the orbits, reflecting activity of the eyelid or eye muscles.

Microwave-assisted [6+4]-cycloaddition of fulvenes and alpha-pyrones to azulene-indoles: facile syntheses of novel antineoplastic agents

A microwave-enhanced [6+4]-cycloaddition reaction between 6-aminofulvene and pyrones followed by CO(2) extrusion provides azulene-indoles which display interesting antineoplastic activity.

Lipopolysaccharides induce p8 mRNA expression in vivo and in vitro

Systemic LPS endotoxin is associated with acute pancreatic damage. Whether damage results from direct interaction of LPS with pancreatic cells is unknown. We addressed that question by monitoring p8 expression in reponse to LPS, in vivo and in vitro, because overexpression of the p8 protein is a sensitive marker of pancreatic agression. For in vivo studies, rats were sacrificed at different times after a single intraperitoneal injection of LPS, and pancreas, liver, kidney, lung, brain, and intestine were processed for RNA preparation. In vitro, pancreatic acinar AR4-2J cells were cultivated with 0.1, 1, or 10 micrograms/ml LPS for 6, 12, or 24 h. p8 mRNA expression was monitored by Northern blotting. In vivo, it was strongly increased in the pancreas after 12 h of treatment and remained elevated after 24 h. It was also induced in kidney and liver, with a maximum at 6 and 12 h, respectively, but not in lung, brain, or intestine. In AR4-2J cells, basal p8 mRNA expression was very low and increased in a time- and dose-dependent manner after treatment with LPS. LPS-induced overexpression of p8 mRNA in vivo confirmed the adverse effect of endotoxemia on pancreas and its overexpression in vitro demonstrated a direct interaction of LPS with pancreatic cells.

Thymic microenvironments, 3-D versus 2-D?

Lympho-stromal interactions in the thymus crucially de- termine the fate of developing T cells. Epithelial cells, inter- digitating reticular cells, macrophages and fibroblasts all play a role in the shaping of the T cell repertoire. Recently published evidence shows that lympho-stromal interaction acts bi-directional. Developing T cell themselves, at different stages of differentiation, control the microarchitecture of thymic microenvironments, a phenomenon designated as 'crosstalk'. This paper reviews experiments showing that developing T cells crosstalk to different thymic epithelial cells in a stepwise fashion. In this way, correctly organized thymic microenvironments guarantee normal thymopoiesis.

[Effects of "qing kai ling" injection on experimental cerebral hematoma in rabbits]

OBJECTIVE

To observe the effect of "Qingkailing" (QKL) on cerebral hematoma.

METHODS

The experimental cerebral hematoma models were produced by injecting autogenous clot in the rabbit. The influences of QKL on blood gas, brain index, contents of water, sodium, potassium, calcium, magnesium in brain tissues and changes of cerebrovascular permeability, histomorphology at the third day, seventh day, fourteenth day after cerebral hematoma were observed.

RESULTS

In the pathological group brain index and contents of water, sodium, calcium of brain tissue, ventilation of lung were increased progressively, cerebrovascular permeability were raised obviously, especially in the side of hematoma (right brain). After the forming of cerebral hematoma cerebral edema was reduced, brain index, contents of water, sodium, calcium in brain tissue and cerebrovascular permeability, hyperventilation were all less than pathological group and close to the control group.

CONCLUSION

QKL was advantageous in the treatment of encephal edema induced by experimental cerebral hematoma.

The thiostrepton-resistance-encoding gene in Streptomyces laurentii is located within a cluster of ribosomal protein operons

A common approach to identify and clone biosynthetic gene from an antibiotic-producing streptomycete is to clone the resistance gene for the antibiotic of interest and then use that gene to clone DNA that is linked to it. As a first step toward cloning the genes responsible for the biosynthesis of thiostrepton (Th) in Streptomyces laurentii (Sl), the Th resistance-encoding gene (tsnR) was cloned as a 1.5-kb BamHI-PvuII fragment in Escherichia coli (Ec), and shown to confer Th resistance when introduced into S. lividans TK24. The tsnR-containing DNA fragment was used as a probe to isolate clones from cosmid libraries of DNA in the Ec cosmid vector SuperCos, and pOJ446 (an Ec/streptomycete) cosmid vector. Sequence and genetic analysis of the DNA flanking the tsnR indicates that the Sl tsnR is not closely linked to biosynthetic genes. Instead it is located within a cluster of ribosomal protein operons.

Fatty acid composition of blood lipids in Chinese children consuming high erucic acid rapeseed oil

The fatty acid patterns of oils, blood plasma and erythrocyte lipids from 28 children in the Shaanxi province of the People's Republic of China were determined by capillary gas liquid chromatography. The main source of fat in this region is rapeseed oil. The analysis of locally available rapeseed oil shows a high erucic acid content (mean 43.83%, range 33.91-50.48%). According to protocol data, about 3% of the daily nutrient energy is provided by erucic acid. Despite a low fat intake in Chinese children, the composition of the fatty acids of the fractions analyzed showed normal patterns. However, erucic acid was found in all fractions analyzed. Data on erucic acid in human tissue are scarce. Although there are no indications of erucic acid toxicity in man, it is known to cause cardiac lipidosis and necrosis in rats. The question remains open if erucic acid aggravates selenium deficiency symptoms which are known to be associated with Keshan disease, an endemic cardiomyopathy.

[Clinical effect and laboratory observation of ofloxacin in the treatment of typhoid fever, bacillary dysentery and gonorrhea]

Ofloxacin was used in the treatment of 20 cases of typhoid fever, 32 cases of bacillary dysentery and 50 cases of gonococcal infection. Altogether 102 cases were treated, 53 being male and 49 female. The daily dosage was 400 mg to 600 mg, divided into two times. The result showed that the clinical effective rate for typhoid fever, bacillary dysentery and gonococcal infections was 100%, 97% and 94% respectively, while the bacterial eradication rate was 100%, 100% and 94% respectively. the bacterial eradication rate was 100%, 97% and 94% respectively. The side effects were mild in degree. The authors are of the opinion that since ofloxacin can be administered orally with only two times a day, its absorption is nearly complete and the cure rate is high, it should be considered as the drug of choice in the treatment of typhoid fever, bacillary dysentery and gonorrhea, especially in the drug resistant cases. It is suggested that this drug be used more widely.

[Establishment of a human pulmonary adenocarcinoma cell line Lu-YePa and its biological characteristics]

This paper presents the establishment of a human pulmonary adenocarcinoma cell line Lu-YePa and its biological characteristics. The primary cells of Lu-YePa cell line were derived from a twenty six year old patient with poorly differentiated adenocarcinoma of the lung. After 36 days' culture, transfer was made and the cells proliferated steadily and rapidly afterwards. The doubling time was 34.6 hours. Mitotic index reached 49.5% on day 5. Chromosome number was subtriploid with the mode of 62. The large submetacentric marker chromosome was presented in 68% of cells. PAS positive granules were found in the cytoplasm. The study of concanavalin A condensation, electron microscopic observation, heterotransplantation and plating efficiency indicates that Lu-YePa cells are concordant with the human pulmonary adenocarcinoma cells in morphology and biological behavior.