A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

Background

Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma (HCC) patients. The impact of the degrees of cirrhosis on prediction of post-hepatectomy liver failure (PHLF) remains poorly defined. This study aimed to construct and validate a combined pre- and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center's data.

Methods

Consecutive HCC patients who underwent hepatectomy between May 18, 2019 and Dec 19, 2020 were enrolled at five tertiary hospitals. Preoperative cirrhotic severity scoring (CSS) and intra-operative direct liver stiffness measurement (DSM) were performed to correlate with the Laennec histopathological grading system. The performances of the pre-operative nomogram and combined pre- and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.

Results

For 327 patients in this study, histopathological studies showed the rates of HCC patients with no, mild, moderate, and severe cirrhosis were 41.9%, 29.1%, 22.9%, and 6.1%, respectively. Either CSS or DSM was closely correlated with histopathological stages of cirrhosis. Thirty-three (10.1%) patients developed PHLF. The 30- and 90-day mortality rates were 0.9%. Multivariate regression analysis showed four pre-operative variables [HBV-DNA level, ICG-R15, prothrombin time (PT), and CSS], and one intra-operative variable (DSM) to be independent risk factors of PHLF. The pre-operative nomogram was constructed based on these four pre-operative variables together with total bilirubin. The combined pre- and intra-operative nomogram was constructed by adding the intra-operative DSM. The pre-operative nomogram was better than the conventional models in predicting PHLF. The prediction was further improved with the combined pre- and intra-operative nomogram.

Conclusions

The combined pre- and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.

Trial Registration

Clinicaltrials.gov Identifier: NCT04076631.

[The occurrence, precaution and treatment strategies of postoperative fecal incontinence in rectal and anal diseases]

In the surgical treatment of hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas, inadvertent damage to the nerves or muscles responsible for bowel control may potentially lead to varying degrees of fecal incontinence (FI). Surgeons need to conduct preoperative assessments based on the patient's individual condition to select an appropriate surgical plan, aiming to minimize the incidence of postoperative FI and improve the patient's postoperative quality of life as much as possible while effectively treating the disease. Additionally, the proficiency of the surgeon's skills, appropriate preoperative dietary adjustments for the patient, regular bowel habits, and exercises targeting the pelvic floor muscles all contribute to reducing the incidence of postoperative FI in patients. For patients who have already developed FI after surgery, on the basis of suitable diet, regular bowel habits, and medication, clinical practitioners can adopt such methods as biofeedback, pelvic floor muscle exercise, sacral nerve stimulation, percutaneous tibial nerve stimulation, acupuncture, injectable bulking agents, anal or vaginal inserts, transanal irrigation, surgical interventions, psychological support, etc., to individualized treatment for patients' conditions. This article, combining the literature, summarizes the current status of common diseases that may lead to postoperative FI. It elaborates on strategies for the prevention and treatment of postoperative FI, aiming to serve as a reference for peers in the field.

Collagen I-DDR1 signaling promotes hepatocellular carcinoma cell stemness via Hippo signaling repression

Cancer stem cells (CSCs) are a minority population of cancer cells with stemness and multiple differentiation potentials, leading to cancer progression and therapeutic resistance. However, the concrete mechanism of CSCs in hepatocellular carcinoma (HCC) remains obscure. We found that in advanced HCC tissues, collagen I was upregulated, which is consistent with the expression of its receptor DDR1. Accordingly, high collagen I levels accompanied by high DDR1 expression are associated with poor prognoses in patients with HCC. Collagen I-induced DDR1 activation enhanced HCC cell stemness in vitro and in vivo. Mechanistically, DDR1 interacts with CD44, which acts as a co-receptor that amplifies collagen I-induced DDR1 signaling, and collagen I-DDR1 signaling antagonized Hippo signaling by facilitating the recruitment of PP2AA to MST1, leading to exaggerated YAP activation. The combined inhibition of DDR1 and YAP synergistically abrogated HCC cell stemness in vitro and tumorigenesis in vivo. A radiomic model based on T2 weighted images can noninvasively predict collagen I expression. These findings reveal the molecular basis of collagen I-DDR1 signaling inhibiting Hippo signaling and highlight the role of CD44/DDR1/YAP axis in promoting cancer cell stemness, suggesting that DDR1 and YAP may serve as novel prognostic biomarkers and therapeutic targets in HCC.

[Status of HVPG clinical application in China in 2021]

Objective: The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China. Methods: This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems. Results: According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%). Conclusion: Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

First Report of Alternaria alternata Causing Leaf Spot Disease on Daylily in China

Daylilies (Hemerocallis spp.; Xanthorrhoeaceae) originated from Eastern Asia and are widely cultivated as perennial ornamentals from the tropics to their native high latitudes. In June 2021, daylily cultivar 'Tao Hua Zhai' with leaf spot symptoms were found at the Shanghai Institute of Technology, Shanghai, China. The disease prevalence was about 14.5 % in a 33,000 m2 planting area indicated by survey statistics. Symptoms of the disease initially appeared as small, circular, brown spots on the leaves. As disease progressed, spots increased gradually until they were distributed uniformly over the lamina, the leaf tip became withered and the rest of the leaf became chlorotic. Symptomatic leaf tissue pieces (5 × 5 mm) from lesion margins were sterilized with 75 % ethanol for 1 min, rinsed three times with sterile distilled water, then incubated on potato dextrose agar (PDA) plates at 28 °C in the dark. A pure culture (ATHF-1) was obtained. Its upper surface on PDA was olive green with loose aerial hyphae, and its lower surface was brown.Conidiophores were brown, single or branched, producing numerous short chains conidia. Conidia were obclavate to obpyriform or ellipsoid, pale brown to dark brown, with a short cylindrical beak at the tip, contained 2-6 transverse septa and 0-4 longitudinal septa. The size of conidia were 15.9-47.3 µm × 7.6-16.6 µm (n=50), and length/width ratios were 1.51 to 4.92. Based on the morphological characteristics, the fungus was identified as Alternaria spp. (Simmons, 2007). For molecular characterization, three genes (the internal transcribed spacers [ITS], plasma membrane ATPase [ATPase] and major allergen Alt a 1) of ATHF-1 were amplified with primer pairs ITS1/ITS4 (White et al. 1990), ATPDF1/ATPDR1 (Lawrence et al. 2013) and Alt-for/Alt-rev (Hong et al. 2005), respectively. The sequences were deposited in GenBank (ITS, MZ983611; ATPase, MZ962978; Alt a 1, OK021654). Blastn searches showed the nucleotide sequences of ATHF-1 were highly similar to the reference sequences of Alternaria tenuissima (ITS, 99 % to KU982591; ATPase, 98 % to MT833928; Alt a 1, 100 % to MT109294). A phylogenetic tree based on the ITS, ATPase and Alt a 1 sequences was constructed by MEGA7.0, which showed that ATHF-1 was closely related to A. tenuissima and A. alternata. But according to Woudenberg et al. (2015), they were synonymized under the species name A. alternata. So, based on morphological and molecular characteristics, the fungus was identified as A. alternata. For pathogenicity tests, ten healthy two-month-old potted seedlings from tissue culture daylilies were sprayed with 20 ml of suspension (approximately 2×105 spores/ml), ten daylilies were used as controls and sprayed with sterile water. After covering with transparent plastic bags for 48 h to maintain humidity, the plants were placed in the greenhouse at 25 ℃ with 12 h photoperiod. The pathogenicity tests were repeated twice. Seven days after inoculation, lesions appeared on the plants inoculated with the pathogen, which were consistent with the symptoms observed in the field, while the controls remained symptomless. The morphological characteristics and gene sequences of the re-isolated strain from the diseased leaves were consistent with those of the inoculated strain. To our knowledge, this is the first report of A. alternata affecting leaf spot disease on daylily in China. Identification of the causal agent of the disease is important for developing effective disease management strategies. References: Hong, S.G., et al. 2005. Fungal Genet Biol. 42(2):119-129. https://doi.org/10.1016/j.fgb.2004.10.009 Lawrence, D.P., et al. 2013. Mycologia. 105(3):530-546. https://doi.org/10.3852/12-249 Simmons, E.G. 2007. Alternaria: An Identification Manual. CBS Fungal Biodiversity Centre, Utrecht, the Netherlands. White, T. J., et al. 1990. Amplification and Direct Sequencing of Fungal Ribosomal RNA Genes for Phylogenetics. PCR protocols: a guide to methods and applications, 18(1), 315-322. Woudenberg J.H.C., et al. 2015. Studies in Mycology. 82(82):1-21. https://doi.org/10.1016/j.simyco.2015.07.001.

[Focusing the role of surgery in the treatment of liver cirrhotic portal hypertension]

Portal hypertension treatment has always been regarded as complex and diverse. With the innovation of concepts and technologies, its treatment model has been transformed from a single-disciplinary diagnosis and treatment model to a multidisciplinary collaborative diagnosis and treatment model. In the multidisciplinary diagnosis and treatment model, the surgical treatment of portal hypertension is not a treatment that is about to disappear soon, but one of the indispensable treatment methods under the multidisciplinary diagnosis and treatment model, and it will play an increasingly important role. Surgeons should formulate individualized, standardized, and minimally invasive treatment methods under the input of new concepts, master the surgical indications and individualized surgical methods for different populations, and maximize the optimization surgical treatment methods for portal hypertension. Therefore, it is necessary to re-examine the role of surgical treatment in the diagnosis and treatment of liver cirrhotic portal hypertension.

[Relationship between circular RNA and liver disease]

CircRNA is a new endogenous non-coding RNA(ncRNA ) and a member of the competitive endogenous RNA(ceRNA) family. Some researches have found that circRNA exists widely in organisms and interacts with miRNA, which has certain influence on the occurrence and development of liver diseases. This article reviews the research progress of circRNA and its biological functions, as well as the relationship between circRNA and liver disease, in order to expound the role of circRNA in liver diseases and guide clinical practice better.

[Surveillance and genetic characteristics of imported cases of measles virus of D8 genotype in Hebei province]

Objective: To understand the epidemiological and genotypic characteristics of imported cases of measles virus of D8 genotype in Hebei province. Methods: Epidemiological investigation of measles cases in surveillance was carried out. The throat swabs of the measles cases in acute phase were collected for real time RT-PCR identification, measles virus culture and genotype identification. Results: A total of 36 imported measles cases of genotype D8 were detected. The cases were mainly distributed in 8 counties of Handan city. Number of confirmed measles cases in Cheng'an county was the highest, accounting for 58.33% (21/36) of all the reported cases. All patients had fever and rash, and 55.55% (20/36) of the cases were under 2 years old and 86.11% (31/36) of the cases had no immunization history. The children with pneumonia accounted for 44.12% (15/34) of the total children with D8 genotype measles virus infection. The nucleotide and amino acid homologies between the imported measles virus genotype D8 and the WHO reference strain of D8 genotype (D8-Manchester.UNK/30.94) were 98.4%-98.6% and 97.3%, respectively. Compared with the strains of H1 genotype in China, the nucleotide and amino acid homologies were 92.8%-93.1% and 93.3%, respectively. Conclusions: The imported cases of measles virus of D8 genotype might have caused local transmission in Hebei province. Molecular epidemiological surveillance for measles virus needs to be further strengthened. It is necessary to detect and control the epidemic early and improve the coverage rate and timely rate of measles vaccination. It is also important to prevent cross infection in hospitals.

Morphine Suppresses Liver Cancer Cell Tumor Properties In Vitro and In Vivo

Morphine is an analgesic widely adopted to relieve cancer pain. A number of discrepancies, however, are presented by the published literature, with reports suggesting that opioids may either promote or inhibit the spread of cancer. It is of great significance to determine whether morphine may increase the risk of metastasis while utilized in liver cancer surgical treatment. In this study, we explore the effects of morphine on liver cancer cells in vitro and in vivo. Our results showed that morphine does not promote proliferative ability to cultured liver cancer cells. While morphine could increase the apoptosis rate of Hep3B/HepG2 cells. Furthermore, morphine could significantly inhibit the migratory and invasion ability of Hep3B/HepG2 cells. Subsequent investigations disclosed that morphine could inhibit sphere formation ability of Hep3B/HepG2 cells by using sphere formation assay. Based on nude mouse models, we demonstrated that morphine significantly reduced pulmonary tumorigenicity of Hep3B/HepG2 cells. In conclusion, our results found that morphine at clinical concentrations could suppress liver cancer cell tumor properties in vitro and in vivo, indicating the safety of morphine utilization in HCC patients' pain management.

[Expert consensus on the treatment of oral and maxillofacial space infections]

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts' expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig's angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

[Application of arthrography with cone-beam CT imaging in the diagnosis of temporomandibular disorders]

Objective: To evaluate the meaning of arthrography with cone-beam CT（CBCT） imaging in the diagnosis of temporomandibular disorders(TMD). Methods: Four hundred and forty-eight cases of temporomandibular upper joint cavity arthrography with CBCT imaging were retrospectively analyzed. The distribution of disc displacement with reduction or without reduction, disc perforation, enlargement or tearing of joint capsule were analyzed. The characteristics of arthrography with CBCT imaging were also described. Results: There were 384 female and 64 male among the 448 cases of TMD with CBCT arthrographic images. The median age was 31.5 years， range from 14 to 81 years old. As about the age distribution, there were 63 cases in the group of ≤20 years old, 150 cases in the group of >20 and ≤30 years old, 86 cases in the group of >30 and ≤40 years old, 59 cases in the group of >40 and ≤50 years old, 58 cases in the group of>50 and ≤60 years old, and 32 cases in the group of >60 years old. There were 356 cases with disc displacement, in which there were 328 cases of disc displacement without reduction, and 28 cases of disc displacement with reduction. There were 152 cases with disc perforation, and 12 cases with articular capsule tearing or laxation. Conclusions: Arthrography with CBCT imaging was a meaningful approach to diagnose the TMD with structure disorders.

[Experts consensus on MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement]

The document represented the consensus amongst the professionals from the Society of TMD & Occlusion, Chinese Stomatological Association and provided guidelines with the MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement.

[Advances in the prevention and treatment of postoperative ileus]

With the development and progress in the concepts and techniques of perioperative management, especially the latest reports of clinical trials, the prospect of prevention and treatment of postoperative ileus (POI) is promising. Proper nutritional support therapy, optimized surgical and anesthetic treatment, individualized fluid management, timely psychosocial intervention, and active anti-inflammation and traditional Chinese medicine treatment can effectively reduce occurrence of POI. Nevertheless, how to optimize and combine perioperative treatments to comprehensively prevent and treat POI still needs further study.

[Analysis of baseline liver biochemical parameters in 324 cases with novel coronavirus pneumonia in Shanghai area]

Objective: To summarize the clinical characteristics and liver biochemical parameters of 324 cases admitted with novel coronavirus pneumonia in Shanghai area. Methods: Clinical data and baseline liver biochemical parameters of 324 cases with novel coronavirus pneumonia admitted to the Shanghai Public Health Clinical Center from January 20, 2020 to February 24, 2020 were retrospectively analyzed. Patients were divided into two groups based on the status of illness: mild type (mild and typical) and severe type (severe and critical).The differences in clinical data and baseline liver biochemical parameters of the two groups were described and compared. The t-test and Wilcoxon rank-sum test were used for measurement data. The enumeration data were expressed by frequency and rate, and chi-square test was used. Results: Of the 324 cases with novel coronavirus pneumonia, 26 were severe cases (8%), with median onset of 5 days, 20 cases were HBsAg positive (6.2%), and 70 cases (21.6%) with fatty liver, diagnosed with X-ray computed tomography. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), total bilirubin (TBil), albumin(ALB) and international normalized ratio (INR) of 324 cases at baseline were 27.86 ± 20.02 U/L, 29.33 ± 21.02 U/L, 59.93 ± 18.96 U / L, 39.00 ± 54.44 U/L, 9.46 ± 4.58 μmol / L, 40.64 ± 4.13 g / L and 1.02 ± 0.10. Of which, ALT was > than the upper limit of normal (> ULN), accounting for 15.7% (51/324). ALT and AST > ULN, accounting for 10.5% (34/324). ALP > ULN, accounting for 1.2% (4/324). ALP and GGT > ULN, accounting for 0.9% (3/324). INR > ULN was lowest, accounting for 0.6% (2/324). There were no statistically significant differences (P > 0.05) in ALT [(21.5 vs. 26) U / L, P = 0.093], ALP [(57 vs.59) U/L, P = 0.674], and GGT [(24 vs.28) U/L, P = 0.101] between the severe group and the mild group. There were statistically significant differences in AST (23 U/L vs. 34 U/L, P < 0.01), TBil (10.75 vs. 8.05 μmol / L, P < 0.01), ALB (35.79 ± 4.75 vs. 41.07 ± 3.80 g/L, P < 0.01), and INR (1.00 vs. 1.04, P < 0.01). Conclusion: The baseline liver biochemical parameters of 324 cases with novel coronavirus pneumonia in Shanghai area was comparatively lower and the liverinjury degree was mild, and the bile duct cell damage was rare.

Mesenchymal derived exosomes enhance recovery of motor function in a monkey model of cortical injury

BACKGROUND

Exosomes from mesenchymal stromal cells (MSCs) are endosome-derived vesicles that have been shown to enhance functional recovery in rodent models of stroke.

OBJECTIVE

Building on these findings, we tested exosomes as a treatment in monkeys with cortical injury.

METHODS

After being trained on a task of fine motor function of the hand, monkeys received a cortical injury to the hand representation in primary motor cortex. Twenty-four hours later and again 14 days after injury, monkeys received exosomes or vehicle control. Recovery of motor function was followed for 12 weeks.

RESULTS

Compared to monkeys that received vehicle, exosome treated monkeys returned to pre-operative grasp patterns and latency to retrieve a food reward in the first three-five weeks of recovery.

CONCLUSIONS

These results provide evidence that in monkeys exosomes delivered after cortical injury enhance recovery of motor function.

[Design and clinical application of goal-oriented retroperitoneoscopic adrenalectomy]

Objective: To investigate the goal-oriented retroperitoneoscopic adrenalectomy and report the initial experiment. Methods: A total of 102 patients were selected to our clinic experiment, and performed retroperitoneoscopic adrenalectomy with the new method. including adrenal cortex adenoma 76 cases, phaochromocytoma 12 cases, adrenal cyst 6 cases, myelolipoma 4 cases, gangliocytoma 1 case and corticohyperplassia 3 cases. The mean diameter of the tumors was 2.8 cm (0.5-5.8 cm). The operative procedure was briefly described as such, with ultrasound guiding, a needle was punched percutaneously up to the adrenal mass or the renal upper pole from lateral to posterior axillary line just below the inferior border of the 12th rib. labeled the pathway of the needle with methylene blue. Along the way of the needle, a 12 mm port was introduced into the retroperitoneal space with closed method, and the laparoscope with a working tunnel was introduced to make a tunnel along the label up to the adrenal for finally removing it. Additional port should be used when it was needed in the procedure. Results: The procedures of all patients were successful, and 10 patients were performed with only one port, 81 patients with two ports, 11 patients with three ports. The operative duration was 49 (31-115) min, the average blood loss was 38 (0-260) ml. There was no transition to open surgery and no perioperative complications. The length of postoperative hospital stay was 4.1 d (2-7 d). 98 patients were available for follow-up of 16.5 months (1-38 months), no complication was found. Conclusions: The new method of retroperitoneoscopic adrenalectomy is feasible and safe for renal masses, and compared to the conventional method, it may be less trauma to the abdominal wall and retropertoneal tissue, and it was also better on cosmetics.

[Detection of tuberculosis genes associated with drug-resistance in paraffin-embedded tissue specimens using next generation sequencing technology]

Objective: To evaluate the use of multiplex PCR amplicon sequencing (mPCR-NGS) technology in detecting gene mutations related to drug resistance of Mycobacterium tuberculosis (MTB) in formalin-fixed paraffin-embedded tissue specimens, and to explore its clinical value in the diagnosis of drug-resistant tuberculosis. Methods: Fifty clinical MTB strains isolated in the Changping District Tuberculosis Control Institute of Beijing from April 2013 to October 2015 with drug susceptibility test (DST) results of rifampicin, isoniazid, ethambutol, streptomycin, ofloxacin, capreomycin, kanamycin and amikacin available were recovered, including 42 drug-resistant strains and 8 drug-sensitive strains. The mPCR-NGS test was established to detect genes related to the 8 anti-tuberculosis drugs according to the previously published studies and databases. Fifty-five paraffin-embedded tissue specimens from drug-resistant tuberculosis patients were collected in the Department of Pathology, Beijing Chest Hospital, Capital Medical University during November 2017 to September 2018. All the specimens showed no less than one mutation in the gene regions related to drug resistance of any of the 4 drugs (rifampicin, isoniazid, ethambutol or fluoroquinolones) by probe melting curve assay. The effectiveness of mPCR-NGS test was evaluated on clinical MTB isolates using phenotypic DST as the reference. Clinical evaluation of mPCR-NGS test on formalin-fixed paraffin-embedded specimens from TB patients was performed using probe melting curve assay as the reference. The sensitivity, specificity and coincidence of mPCR-NGS were analyzed. Results: Using phenotypic DST as the reference, the sensitivities of the mPCR-NGS for detecting drug-resistance of rifampicin, isoniazid, streptomycin, and ethambutol were 95% (38/40), 93% (27/29), 93% (27/29), and 72% (13/18), respectively; and the specificities were 100% (10/10), 95% (20/21), 100% (21/21), and 94% (30/32), respectively. The sensitivities for capreomycin, kanamycin and amikacin were all 100% (2/2, 3/3, 3/3), and the specificities were 98% (47/48), 100% (33/33) and 100% (47/47), respectively. The sensitivity and specificity of ofloxacin were 70% (7/10) and 100% (40/40), respectively. The total coincidence rate for the 8vdrugs was 94%, and the Kappa value was 0.87. The 55 paraffin-embedded tissue specimens included in this study were all tested by probe melting curve assays. Among them 28 were resistant to rifampicin, 37 resistant to isoniazid, 13 resistant to ethambutol, and 17 resistant to fluoroquinolones. Using the probe melting curve assay as the reference, the sensitivities of the mPCR-NGS for detecting resistant to rifampicin, isoniazid, ethambutol, and fluoroquinolones were 100% (28/28), 95% (35/37), 100%, and 100%, respectively; and the specificities were all 100% (42/42, 38/38). The total coincidence rate of the two methods was 99%, and the Kappa value was 0.98. Conclusions: mPCR-NGS showed good sensitivities and specificities in detecting drug-resistant gene mutations both in clinical MTB isolates and paraffin-embedded tissue specimens. mPCR-NGS has the potential to be an accurate and rapid molecular pathological technology for diagnosis of drug-resistant tuberculosis.

Combined Laparoscopic Splenectomy and Esophagogastric Devascularization versus Open Splenectomy and Esophagogastric Devascularization for Portal Hypertension due to Liver Cirrhosis

This study was conducted to compare the feasibility, safety and effectiveness of the combined-laparoscopic splenectomy and esophagogastric devascularization (C-LSED) with open splenectomy and esophagogastric devascularization surgery (OSED) in patients with portal hypertension due to liver cirrhosis. From February 2014 to June 2018, 68 patients with portal hypertension were diagnosed as having serious gastroesophageal varices and/or hypersplenism in our center. Thirty patients underwent C-LSED and 38 patients received OSED. Results and outcomes were compared retrospectively. No patients of C-LSED group required an intraoperative conversion to open surgery. Significantly shorter operating time, less blood loss, lower transfusion rates, shorter postoperative hospital stay, lower rates of complications were found in C-LSED group than in C-LSED group (P<0.05). No death and rebleeding were documented in both groups during the follow-up periods of one year. Postoperative endoscopy revealed that varices in the patients of both groups were alleviated significantly from severe to mild, and in a part of cases, the varices disappeared. The final results suggest that the C-LSED technique is superior to open procedure, due to slightly invasive, simplified operative procedure, significantly shorter operating time, less intraoperative bleeding and lower post-operative complication rates. And C-LSED offers comparable long-term effects to open surgery.

Severe Complications After Splenic Artery Embolization for Portal Hypertension Due to Hepatic Cirrhosis

Background

Splenomegaly/hypersplenism is one of the most common complications of portal hypertension. Splenic artery embolization (SAE) has been increasingly used for treatment of splenomegaly/hypersplenism. However, few studies focused on the severe complications after embolization. In this paper, we reported 16 cases of severe complications after SAE for portal hypertension.

Methods

From February 2011 to January 2019, 16 cirrhotic patients were diagnosed with severe complications after embolization. The clinical symptoms, therapies and prognosis were analyzed.

Results

In these patients, the splenic embolization volume was between 50% and 70%. Among 16 cases, 7 patients were diagnosed with splenic abscess and/or left subphrenic abscess, suffered from the insistent fever, and eventually underwent the surgical therapy; 6 patients with left refractory pleural effusion, suffered from severe chest distress, and underwent repeated thoracocentesis or thoracic closed drainage; 3 patients with thrombosis in portal vein needed oral warfarin therapy.

Conclusion

In cirrhotic patients, the severe complications after SAE are not uncommon after the procedure. It causes more suffering, prolonged hospital stay and more medical cost in these patients. It was debatable whether this technique was an appropriate technique for portal hypertension due to liver cirrhosis, patients contraindicated for the treatment should be carefully identified to avoid the complications.

Analysis of Soybean Somatic Embryogenesis Using Chromosome Segment Substitution Lines and Transcriptome Sequencing

Soybean is an important cash crop that is widely used as a source of vegetable protein and edible oil. The regeneration ability of soybean directly affects the application of biotechnology. In this study, we used the exogenous hormone 2,4-D to treat immature embryos. Different levels of somatic incidence were selected from the chromosome segment substitution lines (CSSLs) constructed by SN14 and ZYD00006. Transcriptome sequencing of extreme materials was performed, and 2666 differentially expressed genes were obtained. At the same time, a difference table was generated by combining the data on CSSL rearrangement. In the extreme materials, a total of 93 differentially expressed genes were predicted and were then analyzed by cluster analysis and Gene Ontology (GO) annotation. After screening and annotating the target genes, three differentially expressed genes with hormone pathways were identified. The expression patterns of the target genes were verified by real-time quantitative PCR (qRT-PCR). Haplotype polymorphism detection and linkage disequilibrium analysis were performed on the candidate gene Glyma.09g248200. This study provided more information on the regulation network of soybean somatic embryogenesis and regeneration processes, and further identified important genes in the soybean regeneration process and provided a theoretical basis for accelerating the application of biotechnology to soybean for improving its breeding efficiency.

Analysis of miRNAs Targeted Storage Regulatory Genes during Soybean Seed Development Based on Transcriptome Sequencing

Soybeans are an important cash crop and are widely used as a source of vegetable protein and edible oil. MicroRNAs (miRNA) are endogenous small RNA that play an important regulatory role in the evolutionarily conserved system of gene expression. In this study, we selected four lines with extreme phenotypes, as well as high or low protein and oil content, from the chromosome segment substitution line (CSSL) constructed from suinong (SN14) and ZYD00006, and planted and sampled at three stages of grain development for small RNA sequencing and expression analysis. The sequencing results revealed the expression pattern of miRNA in the materials, and predicted miRNA-targeted regulatory genes, including 1967 pairs of corresponding relationships between known-miRNA and their target genes, as well as 597 pairs of corresponding relationships between novel-miRNA and their target genes. After screening and annotating genes that were targeted for regulation, five specific genes were identified to be differentially expressed during seed development and subsequently analyzed for their regulatory relationship with miRNAs. The expression pattern of the targeted gene was verified by Real-time Quantitative PCR (RT-qPCR). Our research provides more information about the miRNA regulatory network in soybeans and further identifies useful genes that regulate storage during soy grain development, providing a theoretical basis for the regulation of soybean quality traits.

Distinguishing external and internal coke depositions on micron-sized HZSM-5 via catalyst-assisted temperature-programmed oxidation

The general idea of CatA-TPO for distinguishing external coke from internal coke on HZSM-5.

[Immunogenicity of inacitivated quadrivalent influenza vaccine in adults aged 18-64 years: A systematic review and Meta-analysis]

Objective: To evaluate the immunogenicity of inactivated quadrivalent influenza vaccine (QIV) in adults aged 18-64 years, through a Meta-analysis. Methods: Literature was retrieved by searching the Medline, Cochrane Library, Science Direct in the past decade. All the studies were under random control trial (RCT) and including data related to immunogenicity which involving sero-protection rate (SPR) and sero-conversion rate (SCR) of the QIV, versus inactivated trivalent influenza vaccine (TIV) in the population aged 18 to 64. Revman 5.3 software was employed to manipulate the pooled date of the included literature. Result: A total of 8 studies for the SPR and SCR of the shared strains (two A lineage and one B lineage) were included. There appeared no significant differences in the response rates between the two vaccines. As for QIV versus TIV (B/Yamagata), the pooled RR of the SPR for B/Victoria was 1.28 (95%CI: 1.08-1.51, P<0.05), with the pooled RR of the SCR for B/Victoria as 1.94 (95%CI: 1.50-2.50, P<0.05). For QIV versus TIV (B/Victoria), the pooled RR of the SPR for B/Yamagata as 1.10 (95%CI: 1.02-1.18, P<0.05), and the pooled RR of SCR for B/Yamagata as 1.99 (95%CI: 1.34-2.97, P<0.05). Conclusion: In the population aged 18-64 years, inactivated QIV was equivalently immunogenic against the shared three strains included in the activated TIV while a superior immunogenic effect was noticed in the vaccine strain which did not include the inactivated QIV.

Nasal high flow, but not supplemental O2, reduces peripheral vascular sympathetic activity during sleep in COPD patients

Introduction

Patients with COPD have increased respiratory loads and altered blood gases, both of which affect vascular function and sympathetic activity. Sleep, particularly rapid eye movement (REM) sleep, is known to exacerbate hypoxia and respiratory loads. Therefore, we hypothesize that nasal high flow (NHF), which lowers ventilatory loads, reduces sympathetic activity during sleep and that this effect depends on COPD severity.

Methods

We performed full polysomnography in COPD patients (n=17; FEV₁, 1.6±0.6 L) and in matched controls (n=8). Participants received room air (RA) at baseline and single night treatment with O₂ (2 L/min) and NHF (20 L/min) in a random order. Finger pulse wave amplitude (PWA), a measure of vascular sympathetic tone, was assessed by photoplethysmography. Autonomic activation (AA) events were defined as PWA attenuation ≥30% and indexed per hour for sleep stages (AA index [AAI]) at RA, NHF, and O₂).

Results

In COPD, sleep apnea improved following O₂ (REM-apnea hypopnea index [AHI] with RA, O₂, and NHF: 18.6±20.9, 12.7±18.1, and 14.4±19.8, respectively; P=0.04 for O₂ and P=0.06 for NHF). REM-AAI was reduced only following NHF in COPD patients (AAI-RA, 21.5±18.4 n/h and AAI-NHF, 9.9±6.8 n/h, P=0.02) without changes following O₂ (NHF-O₂ difference, P=0.01). REM-AAI reduction was associated with lung function expressed as FEV₁ and FVC (FEV₁: r=−0.59, P=0.001; FEV₁/FVC: r=−0.52 and P=0.007).

Conclusion

NHF but not elevated oxygenation reduces peripheral vascular sympathetic activity in COPD patients during REM sleep. Sympathetic off-loading by NHF, possibly related to improved breathing mechanics, showed a strong association with COPD severity.

Synchronous cancers of gallbladder carcinoma and combined hepatocellular cholangiocarcinoma: an unusual case and literature review

Background

Synchronous primary cancers in gallbladder and liver are rarely reported. Here we report an unusual case of synchronous cancers of gallbladder carcinoma and combined hepatocellular cholangiocarcinoma.

Case presentation

Several lesions in the gallbladder and in adjacent parenchyma of liver were discovered in a 65-years-old woman by imaging examination. Surgical resection was performed following a diagnosis of primary gallbladder carcinoma with local hepatic metastasis. Histological examination confirmed the diagnosis of primary gallbladder carcinoma, and the lesions in the liver consisted of hepatocellular carcinoma simultaneously with cholangiocarcinoma. Adjuvant chemoradiation therapy was not performed due to the patient’s refusal of the treatment. Unfortunately, the patient died of widespread metastasis 8 months after the operation.

Conclusions

The disease needed to be differentially diagnosed from gallbladder carcinoma with hepatic metastasis. Aggressive surgical approach should be based on a balance between the risk of surgery (morbidity and mortality) and the outcome.

[Effect of resection of adenoids and tonsillectomy on immune function in children with obstructive sleep apnea hypopnea syndrome]

Objective:To remove the immune function of children with obstructive sleep apnea hypopnea syndrome by resection of adenoids and tonsillar. Method: The fasting peripheral venous blood of children with OSAHS and healthy children were collected. The lymphocyte subsets, NK cells and immunoglobulin levels were compared between the two groups. The fasting blood samples of OSAHS children were collected again after 2d, 30d, 60d and 90d after operation. The changes of lymphocyte subsets, NK cells and immunoglobulin levels were observed after operation. Result: Before operation, at the 0.05 test level, it was not yet clear that the levels of IgG, IgM, IgA, NK, CD3+, CD4+ and CD8+ in OSAHS children were significantly different from those in the control group. The levels of IgA, CD3+ and CD4+ decreased significantly in children at 2d and OSAHS after operation, and IgG, IgM, IgA, NK, CD3+ and IgA continued to rise after 60d until ninetieth day after operation. Conclusion: There is no statistical disorder of immune level in children with OSAHS compared with healthy children. The implementation of adenoidectomy and tonsillectomy in children with OSAHS, the level of immunity in 90 days can be restored to the preoperative level.

[Clinical analysis of pulmonary cryptococcosis in non-human immunodeficiency virus infection patients]

OBJECTIVE

To improve the understanding of the clinical features of pulmonary cryptococcosis in non-human immunodeficiency virus (non-HIV) infection patients and reduce delay in diagnosis, or misdiagnosis.

METHODS

The clinical features, imaging characteristics, laboratory examinations, treatment and prognosis of 34 cases of pulmonary cryptococcosis were retrospectively analyzed. The data were collected from Peking University First Hospital from June 1997 to June 2016.

RESULTS

There were 34 cases diagnosed with pulmonary cryptococcosis, including 22 males and 12 females, aged from 20 to 75 years [average: (50.1±15.0) years]. There were 16 cases with host factors and (or) underlying diseases named immunocompromised group. In the study, 67.6% patients had clinical symptoms while 32.4% patients had no symptoms. The most common symptoms included cough, fever, chest pain, shortness of breath, and hemoptysis in sequence. Common chest imaging findings were patchy infiltrates, consolidation, single or multiple nodular or masses shadows. Among the 20 cases with cryptococcal capsular polysaccharide antigen detection, 19 were positive. Eleven cases underwent routine cerebrospinal fluid examination, and 3 cases complicated with central nervous system cryptococcal infection. At first visit, 24 cases were misdiagnosed, among which, 11 cases were misdiagnosed as lung cancer. The diagnosis of 15 cases was proved by percutaneous lung biopsy and 11 were confirmed by surgery, while 8 were diagnosed clinically. Then 11 cases were treated by surgical resection, and in median 4 years' followp, there was 1 case of recurrence. And 23 cases were treated with antifungal therapy, and in median 8 years' follow-up, 3 cases lost to the follow-up and 1 case of recurrence. Compared with normal immune group, immunocompromised patients had higher ages (P=0.017), more crackles (P=0.006) and more percentage of increase of peripheral white blood cells or neutrophils (P=0.003), but no significant difference in symptoms, imaging characteristics or hospitalization time.

CONCLUSION

There were no specific clinical symptoms and signs for pulmonary cryptococcosis in non-HIV patients. Diagnosis of pulmonary cryptococcosis depends on pathology. Percutaneous lung biopsy was mostly recommended for clinical highly suspected patients. Cryptoeoccal capsular polysaccharide antigen detection had a high sensitivity for the clinical diagnosis. Antifungal drug therapy was the major treatment, and the prognosis of the most patients was good.

1α,25-Dihydroxyvitamin D3 inhibits aflatoxin B1-induced proliferation and dedifferentiation of hepatic progenitor cells by regulating PI3K/Akt and Hippo pathways

Hepatic progenitor cells (HPCs) might be the origin of hepatocellular carcinoma. 1α,25-Dihydroxyvitamin D3 (1,25(OH)₂D₃) (VD3) has been documented as an anticancer agent for various cancers. However, the potential effect of VD3 on the proliferation and malignant transformation of HPCs induced by aflatoxin B1 (AFB1) has not been determined. In this study, we found that AFB1 exhibited the stimulative effects on the proliferation, dedifferentiation and invasion of HPCs via activating AKT pathway but turning off Hippo pathway, which were terminated when VD3 was used in combination with AFB1. Furthermore, in AFB1-induced liver damage mouse model, VD3 also showed protective effect by reducing HPCs population. Together, these preclinical data not only provide a newly identified mechanism by which AFB1 affects HPCs but also strengthen the idea of developing VD3 as an anticancer agent.

miR-122-5p inhibits tumor cell proliferation and induces apoptosis by targeting MYC in gastric cancer cells

MicroRNAs (miRNAs) play crucial roles in the development and progression of human cancers, including Gastric cancer (GC). In this study, we investigated the correlation of miR-122-5p expression with cell proliferation, and apoptosis in a GC cell line. GC cells SCG 7901 were transfected with control, miR-122-5p or miR-122-5p inhibitor and MTT assay, western blot, and BrdU staining were respectively used to investigate the effect of miR-122-5p on GC cell cycle. The overexpression of miR-122-5p could reduce cell proliferation in SCG7901 cells, and BrdU staining finally verified miR-122-5p induced cell growth arrest by upregulation p27 expression in SCG7901cells. On the other hand, cells apoptosis research showed that miR-122-5p induced apoptosis by targeting MYC in SCG7901 cells. Finally, in this study, miR-122-5p was confirmed inhibiting tumor GC cells proliferation and inducing cells apoptosis by targeting MYC. All these findings suggest that miR-122-5p may be involved in progression of GC and could be a new therapeutic target for this disease.

[Effects of ubiquitin-specific proteases 2-69 on proliferation of breast cancer cells]

Objective: To investigate the expression and significance of ubiquitin-specific proteases 2-69(USP2-69) in invasive ductal carcinoma of breast. Methods: Twenty-four cases of human breast tissue with invasive ductal carcinoma diagnosed at Huanshan Hospital, Fudan University from 2013 to 2015 were collected, and the expression of USP2-69 mRNA and protein was detected by molecular hybridization, Western blot and immunohistochemistry. USP2-69 was over-expressed in cultured human breast cancer cell line MCF-7 by USP2-69 plasmid transfection. The cellular proliferative activity was investigated in vitro. Results: The USP2-69 mRNA and protein were highly expressed in breast invasive ductal carcinoma, compared to adjacent normal tissues (P<0.01). Ki-67 protein expression was also increased in cases with high USP2-69 protein level. Western blot showed significantly higher USP2-69 protein level in cancer tissue compared to the adjacent normal tissue. In the cultured tumor cells, there was increased S phase fraction, cellular proliferation rate, flat positive clones, cyclin D1 expression and decreased p27 expression in USP2-69-transfected MCF-7 cells. Conclusions: USP2-69 is over-expressed in breast invasive ductal carcinoma, and is closely related to proliferation promoting effects. The data provide an important experimental basis for further study on the molecular mechanism of breast cancer cell proliferation.

IDH1 mutation correlates with a beneficial prognosis and suppresses tumor growth in IHCC

BACKGROUND

Isocitrate dehydrogenase 1/2 (IDH1/2) mutations have been reported in intrahepatic cholangiocarcinoma (IHCC). However, the prognosis of a single IDH1 mutation and impact of mutant IDH1 on IHCC tumor growth remain unclear.

METHODS

A total of 85 IHCC tumor samples were sequenced. Prognosis and clinicopathological correlation were analyzed. The role of mutant IDH1 in IHCC tumor growth was measured by cell proliferation assay, colony formation assay in soft agar, and xenograft tumor models. Akt, ERK, p38 MAPK, and JNK signaling, which commonly affect tumor growth, were examined by Western blotting to explore the potential mechanism.

RESULTS

IDH1 mutations correlated with a beneficial prognosis and smaller tumor size. Mutant IDH1 exhibited a growth-inhibitory effect on IHCC cell lines in vitro and in vivo. Akt signaling was suppressed in IHCC cell lines expressing a mutant IDH1. The reactivation of Akt signaling by SC79 restored the inhibited growth of cell lines expressing a mutant IDH1 in IHCC.

CONCLUSIONS

Collectively, we demonstrated that mutant IDH1 correlates with a beneficial prognosis and inhibits tumor growth by suppressing Akt signaling in IHCC. We suggest that patients with IDH1 mutations could be considered for both less-aggressive therapy and therapy tailored to the presence of their mutant enzyme in the future.

A modified surgical approach of hepatopancreatoduodenectomy for advanced gallbladder cancer: Report of two cases and literature review

Gallbladder cancer (GBC) is the most common cancer of the biliary tract, constituting 80%-95% of malignant biliary tract tumors. Surgical resection is currently regarded as the sole curative treatment for GBC. Hepatopancreatoduodenectomy (HPD) has been adopted to remove the advanced gallbladder tumor together with the infiltrated parts within the liver, lower biliary tract and the peripancreatic region of GBC patients. However, patients who underwent HPD were reported to have a distinctly higher postoperative morbidity (71.4%, ranging from 30.8% to 100%) and mortality (13.2%, ranging from 2.4% to 46.9%) than those given pancreatoduodenectomy (PD) alone. We present two patients with advanced GBC who underwent a modified surgical approach of HPD: PD with microwave ablation (MWA) of adjacent liver tissues and the technique of intraductal cooling of major bile ducts. No serious complications like bile leakage, pancreatic fistula, hemorrhage and organ dysfunction, etc. occurred in the two patients. They had a rapid recovery with postoperative hospital stay being 14 days. Application of this approach effectively eliminated tumor-infiltrated adjacent tissues, and maximally reduced the postoperative morbidity and mortality. This modified surgical method is secure and efficacious for the treatment of locally advanced GBC.

MicroRNA-630 suppresses tumor metastasis through the TGF-β- miR-630-Slug signaling pathway and correlates inversely with poor prognosis in hepatocellular carcinoma

The epithelial-mesenchymal transition (EMT) is the key process that drives tumor metastasis. Accumulating evidence suggests that the deregulation of some microRNAs (miRNAs), is implicated in this process. Here, we highlight the function and molecular mechanism of miR-630 and its potential clinical application in hepatocellular carcinoma (HCC). First, we identified the clinical relevance of miR-630 expression in a screen of 97 HCC patient tissues. Patients with low miR-630 expression had higher recurrence rates and shorter overall survival than those with high miR-630 expression. Functional studies demonstrated the overexpression of miR-630 in HCC cells attenuated the EMT phenotype in vitro. Conversely, inhibition of miR-630 promoted EMT in HCC cells. Mechanistically, our data revealed that miR-630 suppressed EMT by targeting Slug. Knockdown of Slug expression reversed miR-630 inhibitor-mediated EMT progression. Furthermore, we found that the TGF-β-Erk/SP1 and JNK/c-Jun signaling pathways repressed miR-630 transcription through occupying transcription factor binding sites. Ectopic expression of miR-630 restored the TGF-β-activated EMT process. Taken together, these findings demonstrate, in HCC cells, miR-630 exerts its tumor-suppressor functions through the TGF-β-miR-630-Slug axis and provides a potential prognostic predictor for HCC patients.

[Genotyping and drug susceptibility of Mycobacterium tuberculosis isolated in Changping district in Beijing, 2011-2015]

Objective: To understand the genotype distribution of Mycobacterium tuberculosis and the drug susceptibility of M. tuberculosis with different genotypes in Changping district of Beijing and evaluate the application of genotyping of M. tuberculosis in local tuberculosis (TB) prevention and control. Methods: A total of 1 099 M. tuberculosis strains isolated in Changping from 2011 to 2015 were used. Spoligotyping and 12-locus VNTR recommended by Gao were used for the genotyping of these isolates. In addition, the susceptibility of the M. tuberculosis isolates to rifampin (RFP), isoniazid (INH), ethambutol (EMB), streptomycin (SM), amikacin (AMK) and ofloxcin (OFX) were detected by using conventional drug susceptibility test. Results: From 2011 to 2015, the detection rate of OFX-resistance increased from 2.9% to 8.9% (P=0.01). Of all the M. tuberculosis isolates, 976 belonged to Beijing genotype (88.8%), and the other 123 belonged to non-Beijing genotype (11.2%). In addition, there were 189 ancient Beijing genotype isolates and 787 modern Beijing genotype isolates, respectively. The proportion of Beijing genotype strains showed no significant increase in the past five years (81.1% in 2011 vs. 82.0% in 2015). On the basis of VTNR genotyping, only 2 isolates belonged to one cluster (0.1%). In addition, the AMK resistant rate of Beijing genotype strains (1.7%) was significantly lower than that of non-Beijing genotype strains (4.9%, P=0.02). Compared with modern Beijing genotype strains, the SM resistant rate of ancient Beijing genotype strains was significantly higher (28.0% vs. 15.7%, P=0.01). Conclusions: In the past five years, the OFX- resistant rate of M.tuberculosis in Changping was in increase. There was no significant difference in the detection of Beijing genotype strains during this period. In addition, the low clustering rate indicated that the TB transmission rate was low in Changping.

[Analysis of factors related to the number of mesenchymal stem cells derived from synovial fluid of the temporomandibular joint]

Objective: To analyze related factors on the number of mesenchymal stem cells in the synovial fluid of the temporomandibular joint (TMJ) and provide an research basis for understanding of the source and biological role of mesenchymal stem cells derived from synovial fluid in TMJ. Methods: One hundred and twenty-two synovial fluid samples from 91 temporomandibular disorders (TMD) patients who visited in Department of TMJ Center, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University from March 2013 to December 2013 were collected in this study, and 6 TMJ synovial fluid samples from 6 normal volunteers who were studying in the North Campus of Sun Yat-sen University were also collected, so did their clinical information. Then the relation between the number of mesenchymal stem cells derived from synovial fluid and the health status of the joints, age of donor, disc perforation, condylar bony destruction, blood containing and visual analogue scale score of pain were investigated using Mann-Whitney U test and Spearman rank correlation test. Results: The number of mesenchymal stem cells derived from synovial fluid had no significant relation with visual analogue scale score of pain (r=0.041, P=0.672), blood containing (P=0.063), condylar bony destruction (P= 0.371). Linear correlation between the number of mesenchymal stem cells derived from synovial fluid and age of donor was very week (r=0.186, P=0.043). The number of mesenchymal stem cells up-regulated when the joint was in a disease state (P=0.001). The disc perforation group had more mesenchymal stem cells in synovial fluid than without disc perforation group (P=0.042). Conclusions: The number of mesenchymal stem cells derived from synovial fluid in TMJ has no correlation with peripheral blood circulation and condylar bony destruction, while has close relation with soft tissue structure damage of the joint.

[Discriminatory power of variable number on tandem repeats loci for genotyping Mycobacterium tuberculosis strains in China]

Objective: Using the standard genotype method, variable number of tandem repeats (VNTR), we constructed a VNTR database to cover all provinces and proposed a set of optimized VNTR loci combinations for each province, in order to improve the preventive and control programs on tuberculosis, in China. Methods: A total of 15 loci VNTR was used to analyze 4 116 Mycobacterium tuberculosis strains, isolated from national survey of Drug Resistant Tuberculosis, in 2007. Hunter-Gaston Index (HGI) was also used to analyze the discriminatory power of each VNTR site. A set combination of 12-VNTR, 10-VNTR, 8-VNTR and 5-VNTR was respectively constructed for each province, based on 1) epidemic characteristics of M. tuberculosis lineages in China, with high discriminatory power and genetic stability. Results: Through the completed 15 loci VNTR patterns of 3 966 strains under 96.36% (3 966/4 116) coverage, we found seven high HGI loci (including QUB11b and MIRU26) as well as low stable loci (including QUB26, MIRU16, Mtub21 and QUB11b) in several areas. In all the 31 provinces, we found an optimization VNTR combination as 10-VNTR loci in Inner Mongolia, Chongqing and Heilongjiang, but with 8-VNTR combination shared in other provinces. Conclusions: It is necessary to not only use the VNTR database for tracing the source of infection and cluster of M. tuberculosis in the nation but also using the set of optimized VNTR combinations in monitoring those local epidemics and M. tuberculosis (genetics in local) population.

[Blood-borne occupational exposure and protection in medical staff of a traditional Chinese medicine hospital]

Objective: To investigate blood-borne occupational exposure and related protection in the medical staff of a traditional Chinese medicine hospital, and to provide a reference for reducing the risk of blood-borne occupational exposure. Methods: Forty-eight medical workers with blood-borne occupational exposure in 2015 were selected to analyze the incidence of blood-borne occupational exposure, influencing factors, operations that caused blood-borne occupational exposure, pathogens, and occupational protection. Results: The incidence rate of blood-borne occupational exposure in the medical staff of the traditional Chinese medicine hospital in 2015 was 3.30% (48/1 455) , and the frequency was 0.04 time/person/year. The workers with blood-borne occupational exposure were mostly nurses, females, workers aged <30 years, workers with <5 working years, and workers with a junior professional title. There was a significant difference in the incidence rate of blood-borne occupational exposure between workers with different ages and working years. The main way of blood-borne occupational exposure was sharp injury (96.08%) . The main operations that caused blood-borne occupational exposure were covering or separating the syringe needle after injection and disposing used sharp instruments. The main exposure site was the hand (96.08%) , with the thumb and index finger for the left hand and the middle finger and index finger for the right hand; there was no significant difference in the exposure site distribution between the two hands (P<0.05) . The main pathogen that caused blood-borne occupational exposure was hepatitis B virus (68.96%) . The rate of correct local treatment for blood-borne occupational exposure was 88.24%. The rate of prophylactic medication was 74.51%, and hepatitis B immunoglobulin (HBIG) plus hepatitis B vaccine was the main way, followed by HBIG. In all workers with blood-borne occupational exposure, 62.74% did not wear gloves. Conclusion: The medical workers with few working years have a high risk of blood-borne occupational exposure, so the training on protection against blood-borne occupational exposure should be strengthened to reduce the risk of blood-borne occupational exposure and infection.

NaYbF4 nanoparticles as near infrared light excited inorganic photosensitizers for deep penetration in photodynamic therapy

Photodynamic therapy (PDT) is a non-invasive therapy with many advantages over other therapeutic methods, but it is restricted to treat superficial cancers due to the shallow tissue penetration of visible light. The biological window in the near infrared region (NIR) offers hope to extend the penetration depth, but there is no natural NIR excited photosensitizer. Here, we report a novel photosensitizer: NaYbF₄ nanoparticles (NPs). By using a 1,3-diphenylisobenzofuran (DPBF) sensor, we show that the Yb³⁺ ions can absorb the NIR light and transfer energy directly to oxygen to generate reactive oxygen species (ROS). The efficiency of transferring energy to oxygen by NaYbF₄ NPs is comparable to that of traditional photosensitizers. We have carried out PDT both in vitro and in vivo based on NaYbF₄ NPs; the results demonstrate that NaYbF₄ NPs are indeed an effective NIR photosensitizer, which can help extend the application of PDT to solid tumors owing to the much deeper penetration depth of NIR light.

Controlling thermal emission of phonon by magnetic metasurfaces

Our experiment shows that the thermal emission of phonon can be controlled by magnetic resonance (MR) mode in a metasurface (MTS). Through changing the structural parameter of metasurface, the MR wavelength can be tuned to the phonon resonance wavelength. This introduces a strong coupling between phonon and MR, which results in an anticrossing phonon-plasmons mode. In the process, we can manipulate the polarization and angular radiation of thermal emission of phonon. Such metasurface provides a new kind of thermal emission structures for various thermal management applications.

[Scalp surface skin grafts in reconstruction of external auditory meatus in congenital aural atresia]

OBJECTIVE

To investigate the clinical application of scalp skin grafts in reconstruction of external auditory meatus in congenital aural atresia.

METHODS

We conducted a retrospective study on 85 patients of congenital aural atresia, all of whom were unilateral, operated from March of 2008 to December of 2010 in ENT department of the Sun Yat-Sen Memorial Hospital. The patients enrolled in the study were between 6 to 37 years old (median age 12 years), 55 male and 30 female. Scalp surface graft in ipsilateral temporal region was harvested to cover the bony external auditory meatus.

RESULTS

All of these scalp split-thickness skin grafts survived without necrosis, no restenosis was found in these external auditory meatus. Neither scar nor alopecia was found in the skin-harvesting region, and hairs grew well. Granulations occurred in 27 cases in the first to sixth month posteroperatively, 20 cases recovered after local treatment. In the first year, 30 cases obtained hearing improvement more than 15 dB, 36 cases gained more than 25 dB and 19 cases gained more than 35 dB. Totally 8 patients were lost in the 4 to 5 years of follow-up, 70 cases (70/77, 90.9%) developed new external auditory meatus, 7 cases (7/77, 9.1%) suffered from stenosis in different degrees, but no atresia was found in these patients.

CONCLUSION

Scalp split-thickness skin grafts has significant clinical advantage in meatoplasty of congenital aural atresia.

Single-trial detection for intraoperative somatosensory evoked potentials monitoring

Abnormalities of somatosensory evoked potentials (SEPs) provide effective evidence for impairment of the somatosensory system, so that SEPs have been widely used in both clinical diagnosis and intraoperative neurophysiological monitoring. However, due to their low signal-to-noise ratio (SNR), SEPs are generally measured using ensemble averaging across hundreds of trials, thus unavoidably producing a tardiness of SEPs to the potential damages caused by surgical maneuvers and a loss of dynamical information of cortical processing related to somatosensory inputs. Here, we aimed to enhance the SNR of single-trial SEPs using Kalman filtering and time-frequency multiple linear regression (TF-MLR) and measure their single-trial parameters, both in the time domain and in the time-frequency domain. We first showed that, Kalman filtering and TF-MLR can effectively capture the single-trial SEP responses and provide accurate estimates of single-trial SEP parameters in the time domain and time-frequency domain, respectively. Furthermore, we identified significant correlations between the stimulus intensity and a set of indicative single-trial SEP parameters, including the correlation coefficient (between each single-trial SEPs and their average), P37 amplitude, N45 amplitude, P37-N45 amplitude, and phase value (at the zero-crossing points between P37 and N45). Finally, based on each indicative single-trial SEP parameter, we investigated the minimum number of trials required on a single-trial basis to suggest the existence of SEP responses, thus providing important information for fast SEP extraction in intraoperative monitoring.

Abstract B47: Incomplete RFA-generated heat shock response provokes colorectal cancer liver metastases (CRLMs) recurrence by inducing cancer cell stemness and invasion

Even now, radiofrequency ablation (RFA) is accepted as a curative therapy for colorectal cancer liver metastasis (CRLMs). Accumulating data have shown that incomplete radiofrequency ablation (ICR) associates with increase of tumor recurrence and more aggressive malignant phenotype. We determined the mechanisms of this progression, including effectively predict biologic behaviors.We established a mouse model highly mimicking the process of RFA treatment. Functional studies were performed in vitro and in vivo. Our xenograft model unveiled ICR increases the risk in CRLMs recurrence. Here we focused on the heat shock (HS)-induced CRC malignance. Sublethal HS in CRC cell lines provoked cell growth, invasion, and tumor initiation in vitro. Consistently, the xenograft mouse model also confirmed the effects of HS in promoting tumor growth. With Western blot analysis, we found that Fra-1, which is a typical down-stream of the transcription factor ERK1/2, was significantly increased by heat shock stimuli compared with the untreated CRC cells. Furthermore, we demonstrated that silence of Fra-1 in HS treated cells could abolish the effects of HS in promoting malignant phenotype. Significantly, proliferation markers (Ki67, c-Myc, CyclinD1, CDK2), stem cell markers (Sox-2, Sox-9, Oct3/4, Lgr5) and invasion related MMP1 were up-regulated in the HS treated cells and in xenograft model. Taken together, this study established a novel mouse model to study the effect of ICR in CRLM. HS induces CRC proliferation and metastasis by targeting Fra-1, which is a potential prognostic marker and a promising therapeutic strategy for CRC recurrence after RFA treatment.

Citation Format: Zhan-Guo Zhang, Wan-Guang Zhang, Yan-Hui Wu, Hui-Fang Liang, Bi-Xiang Zhang, Xiao-Ping Chen. Incomplete RFA-generated heat shock response provokes colorectal cancer liver metastases (CRLMs) recurrence by inducing cancer cell stemness and invasion. [abstract]. In: Proceedings of the AACR Special Conference on Myc: From Biology to Therapy; Jan 7-10, 2015; La Jolla, CA. Philadelphia (PA): AACR; Mol Cancer Res 2015;13(10 Suppl):Abstract nr B47.

Animal and cellular models of hepatocellular carcinoma bone metastasis: establishment and characterisation

BACKGROUND

An increasingly high occurrence of bone metastases in hepatocellular carcinoma (HCC) patients highlights the importance of fundamental research on HCC bone metastasis, which has been limited in its success due to the lack of a model system.

PURPOSE

Establishment of animal and cellular models of HCC bone metastasis and discovery of HCC bone metastasis-related genes.

METHODS

Luciferase-transfected HCC cell lines HCCLM3, MHCC97H, and SMMC-7721 were used to inoculate nude mice intracardially. Formation of bone metastases was examined by bioluminescence imaging, SPECT, and pathology study. Metastatic cells in bone were isolated and subcultured. Differences between bone metastatic cells and their parental cells were studied by in vitro/in vivo assays.

RESULTS

Mouse model of HCC bone metastasis was successfully established. Injected tumour cells formed metastases in the skull, the spine, the hind limbs, and the sternum, causing osteolytic lesions via act of MMP-1 and recruitment of osteoclasts. Four bone metastatic cell lines were extracted from HCCLM3-inoculated mice and were demonstrated to exhibit a much stronger ability to form bone metastases as well as other phenotypes, including enhanced in vitro migration/invasion and colony formation. Moreover, the expression of PTHrP, MMP-1, and CTGF was significantly elevated in bone metastatic cells compared to parental HCC cells.

CONCLUSION

The nude mouse model and bone metastatic cell lines together provide an effective simulation of HCC bone metastasis. This model system will become powerful tool with which to explore the mechanisms and therapies of HCC bone metastasis. Additionally, PTHrP, MMP-1, and CTGF are candidate genes related to HCC bone metastasis.

Multiple linear regression to estimate time-frequency electrophysiological responses in single trials

Transient sensory, motor or cognitive event elicit not only phase-locked event-related potentials (ERPs) in the ongoing electroencephalogram (EEG), but also induce non-phase-locked modulations of ongoing EEG oscillations. These modulations can be detected when single-trial waveforms are analysed in the time-frequency domain, and consist in stimulus-induced decreases (event-related desynchronization, ERD) or increases (event-related synchronization, ERS) of synchrony in the activity of the underlying neuronal populations. ERD and ERS reflect changes in the parameters that control oscillations in neuronal networks and, depending on the frequency at which they occur, represent neuronal mechanisms involved in cortical activation, inhibition and binding. ERD and ERS are commonly estimated by averaging the time-frequency decomposition of single trials. However, their trial-to-trial variability that can reflect physiologically-important information is lost by across-trial averaging. Here, we aim to (1) develop novel approaches to explore single-trial parameters (including latency, frequency and magnitude) of ERP/ERD/ERS; (2) disclose the relationship between estimated single-trial parameters and other experimental factors (e.g., perceived intensity). We found that (1) stimulus-elicited ERP/ERD/ERS can be correctly separated using principal component analysis (PCA) decomposition with Varimax rotation on the single-trial time-frequency distributions; (2) time-frequency multiple linear regression with dispersion term (TF-MLR_d) enhances the signal-to-noise ratio of ERP/ERD/ERS in single trials, and provides an unbiased estimation of their latency, frequency, and magnitude at single-trial level; (3) these estimates can be meaningfully correlated with each other and with other experimental factors at single-trial level (e.g., perceived stimulus intensity and ERP magnitude). The methods described in this article allow exploring fully non-phase-locked stimulus-induced cortical oscillations, obtaining single-trial estimate of response latency, frequency, and magnitude. This permits within-subject statistical comparisons, correlation with pre-stimulus features, and integration of simultaneously-recorded EEG and fMRI.

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ERP/ERD/ERS are reliably isolated using PCA + Varimax rotation on single-trial TFDs.

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TF-MLR_d enhances the SNR of ERP/ERD/ERS in single trials.

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TF-MLR_d provides an unbiased estimation of single-trial parameters of ERP/ERD/ERS.

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Availability of single-trial estimates permits within-subject statistical comparison.