[Incidence of postoperative complications in Chinese patients with gastric or colorectal cancer based on a national, multicenter, prospective, cohort study]

Objective: To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications. Methods: This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression. Results: The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion: Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer

BACKGROUND

Laparoscopic radical gastrectomy is widely used, and perioperative complications have become a highly concerned issue.

AIM

To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery, guide perioperative treatment strategies for gastric cancer patients, and prevent serious complications.

METHODS

In total, 998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model, and 398 patients were included in the validation group. The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected. Three machine learning methods, lasso regression, random forest, and artificial neural networks, were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy, and their prediction efficacy and accuracy were evaluated.

RESULTS

The constructed complication model, particularly the random forest model, could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy. It exhibited stable performance in external validation and is worthy of further promotion in more centers.

CONCLUSION

Using the risk factors identified in multicenter datasets, highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established. We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

Association between serum homocysteine and postoperative acute kidney injury in patients undergoing cardiac surgery

Background: To explore the relationship between homocysteine (Hcy) and cardiac surgery-associated acute kidney injury (AKI). Methods: A total of 944 patients who underwent cardiac surgery were enrolled. The association between Hcy levels and the risk of cardiac surgery-associated AKI was evaluated. Results: A total of 135 patients were diagnosed with AKI and the prevalence of AKI was 14.30%. The AKI group had significantly higher levels of Hcy compared with the non-AKI group (16.90 vs 13.56 umol/l; p < 0.001). The incidence rates of AKI increased from 7.2% to 26.72% across increasing Hcy quartiles (p < 0.001). Compared with the first Hcy quartile group, the odds ratio of cardiac surgery-associated AKI was 4.43 (95% CI: 2.27-8.66) in the highest Hcy group. Conclusion: Elevated Hcy level is an independent risk factor for cardiac surgery-associated AKI.

Objective Boundary Generation for Gross Target Volume and Organs at Risk Using 3D Multi-Modal Medical Images

PURPOSE/OBJECTIVE(S)

Accurate delineation of Gross Target Volume (GTV) and Organs at Risk (OARs) in medical images is an essential but challenging step in radiotherapy. Deep-learning based automated delineation methods, which learn from manual annotations, are currently prevalent in academic research. However, the limited resolution of medical images and the fuzzy boundaries of lesions and organs present a challenge to the precision of manual annotations. By leveraging the complementary information from multi-modal medical images, this study proposed a novel method to generate objective boundaries of GTV and OARs.

MATERIALS/METHODS

We present a novel method of objective boundary generation, inspired by image matting primarily used for 2D RGB natural images, to process 3D grayscale medical images. The proposed method has the following advantages. 1) It allows for flexible input modalities and assigns weights to each modality according to their relative significance when computing information flows in the matting algorithm. 2) It computes 3D spatial information flow among voxels, which has more advantages over its 2D counterpart. 3) It has a closed-form solution that generates deterministic results. To evaluate the characteristics of the generated boundaries, patients with stage I nasopharyngeal carcinoma (NPC) were studied, with CT images and multi-modal MR images (T1, T1C, T2) aligned using deformable registration. Region of Interests (ROIs), i.e., GTV and parotid gland, were used, with a rough trimap marking extremely few foreground voxels, many background voxels, and a large unknown region. The proposed algorithm leverages the connection between each voxel and its nearest neighbors in the feature space, to propagate the opacity information.

RESULTS

We evaluated the results by employing both qualitative and quantitative methods. Using qualitative evaluation, experienced clinicians confirmed that the results were in agreement with the input data, especially for areas where borders were visible in most modalities (e.g., between air and tumor). For more challenging regions, where boundaries were unclear in the images, the results displayed fine-grained opacity transitions indicating the confidence of each voxel belonging to the ROI. When compared to the delineations made by clinicians, we found our results are usually more compact. We define a precision metric that evaluates the ratio of the matted foreground inside clinicians' delineations versus the entire matted foreground. Using a threshold of 0.4, our binarized result scored 0.95 for GTV and 0.92 for parotid gland.

CONCLUSION

The proposed method demonstrated satisfactory results on challenging ROIs. The objective boundaries generated by this method have advantages in many aspects, including improvement of delineation protocols, enhancement of manual annotation consistency, and increase of deep-learning based automated delineation accuracy.

Early Prediction of Radiation Treatment Response via Longitudinal Analysis of CBCT Radiomic Features for Locally Advanced Rectal Cancer

PURPOSE/OBJECTIVE(S)

Patients respond to the same radiation treatment course differently due to inter- and intra- patient variability in radiosensitivity. Despite widespread use of AI/ML in radiation oncology, there is a lack of monitoring strategies used during treatment courses to evaluate early predictors of treatment response in a systematic fashion. This work advances a straightforward, yet effective, method for the early detection of treatment response through systematically analyzing daily CBCT radiomic features. The goal is to aid clinicians in assessing the treatment efficacy routinely with a view towards optimizing personalized treatment.

MATERIALS/METHODS

We included a cohort of 30 patients diagnosed with locally advanced rectal cancer who underwent neo-adjuvant fractionated radiation treatment (RT) with a prescription dose of 50.4 Gy (28 fractions), followed by total mesorectal excision surgery after completion of ChemoRT. Daily IGRT imaging was acquired prior to each fraction resulting in a total of 840 CBCTs. Patients were divided into responder (14 patients) and non-responder (16 patients) groups based on post-RT pathological response. Mutual information algorithms were utilized to rigorously register daily CBCT images to the planning CT, and longitudinal radiomic features of the target were extracted from the daily CBCTs during the entire treatment course. All longitudinal features for a given patient were standardized with Z-Score normalization, followed by linear fitting using the least square method, resulting in radiomic feature trends (RFT) represented by slope values. Statistical significance was established via a two-sample U test and P-value with a threshold of 0.05. Logistic regression was performed to eliminate RFT with accuracy rates lower than 0.5. The final trending model was developed using random forest. For each patient at fraction N, our investigation involved independent 27 group experiments, where each experiment considered image group from fraction #1 to N, to confirm the effectiveness and stability of the model.

RESULTS

The proposed RFT demonstrated a high level of precision and consistency for post-RT response based on longitudinal CBCT images for LARC patients. The trending model yielded an accuracy of 0.9556, 95% CI (0.94, 0.972) when each daily image was considered, the prediction consistency was 0.964. Given the first 14 experiments (considering group images of fraction #1-15), the prediction accuracy was 0.9357, 95% CI (0.915, 0.956) and the prediction consistency was 0.952.

CONCLUSION

A strategy for monitoring and early prediction of LARC patients' radioresponse was evaluated via longitudinal CBCT assessment. Our trending models demonstrate a significant difference between the responder vs non-responder groups as early as the 15th fraction. Our strategy achieved superior accuracy and consistency to predict post-RT response of LARC patients.

The Lyman Normal Tissue Complication Probability Model and Risk Prediction for Temporal Lobe Injury after Re-Irradiation in Patients with Recurrent Nasopharyngeal Carcinoma

PURPOSE/OBJECTIVE(S)

The risk of temporal lobe injury (TLI) in recurrent nasopharyngeal carcinoma (rNPC) patients with intensity-modulated radiation therapy (IMRT) is high. We aimed to construct the normal tissue complication probability (NTCP) model for TLI of rNPC and establish a risk predictive model.

MATERIALS/METHODS

We retrospectively analyzed 103 patients with rNPC who had received two courses of IMRT in our institution. The 206 temporal lobes (TLs) of these patients were randomly divided into a training (n = 144) and validation group (n = 62). We determined the mean value of the following parameters to construct the Lyman NTCP model: TD50(1) (the dose with a 50% probability of complications to an organ when all volumes are irradiated), m [steepness of the dose-response at TD50(1)], and n (the parameter related to volume effect). The most predictive dosimetric parameter and clinical variables were integrated in Cox proportional hazards models. A nomogram was developed for predicting risk of TLs.

RESULTS

The parameters of the fitted NTCP model were TD50(1) = 107.84 Gy (95% confidence interval (CI), [97.15, 118.54]), m = 0.16 (95% CI, [0.14, 0.19]), and n = 0.04 (95% CI, [0.01, 0.06]). The cumulative dose delivered to 0.1 cm3 of temporal lobe volume (D0.1cc-c) was the most predictive dosimetric parameter for TLI. The Kaplan-Meier curves showed a significant difference in 2-year TLI-free survival among different risk groups according to the total score of nomograms.

CONCLUSION

The TD50(1) of TLI in patients with rNPC is 107.84 Gy in Lyman NTCP model. The nomogram model can accurately predict the risk of TLI for individual.

Characteristics and risk assessment of chilling injury on Morchella esculenta in Western Sichuan Plateau, China

The development of precise climate risk zoning for chilling injury of Morchella esculenta can provide scientific basis for agricultural cultivation planning, dynamic assessment of chilling injury, and disaster prevention strategies. Based on meteorological data from 17 counties (cities) that located below the altitude of 3000 m in the Western Sichuan Plateau from 2011 to 2020, we analyzed the critical meteorological conditions for M. esculenta disasters in typical years. With the average yearly cold accumulation and cold injury frequency during the first day when the temperature remained stable between 5 ℃ and 10 ℃ during mushroom emergence as zoning indicators, we established a geographical spatial distribution model of the cold injury index, and then divided the risk level of M. esculenta cold injury in the Western Sichuan Plateau, evaluated the risk of cold injury. The results showed that the temperature index for chilling injury risk of M. esculenta in the study area was the daily minimum temperature ≤2.0 ℃. The daily average temperature <6.0 ℃ would cause slow growth or the cessation of growth, which was set as a warning indicator for chilling injury risk. Along the Dadu River and Minjiang River basins, the frequency of chilling injury on M. esculenta increased from south to north. Wenchuan, Maoxian, and Lixian had the fewest overall chilling injuries during the study period, whereas Jiulong, Yajiang, and Batang had the most. The duration for cold injury was mainly 1-3 d, followed by 4-5 d, and rarely for >5 d. The frequency of chilling injury lasting for more than 5 d in Xiangcheng, Batang, Jiulong, Yajiang, and Xiaojin was more than that lasting for 4-5 d. The annual average days of chilling injury of was 3.0-27.4 d, the daily average minimum temperature was -0.84-1.36 ℃, the extreme lowest temperature was -5.8-0.1 ℃, and the average accumulated cold was 0.16-9.64 ℃·d during the period of chilling injury. With the increases of elevation and latitude, the average days of chilling injury and the average accumulated cold increased. The largest duration of chilling injury was 3-20 d, the maximum accumulated cold was 0.44-13.34 ℃·d. The risk of chilling injury to M. esculenta increased from south to north and from low elevation to high elevation. The suitable planting areas were distributed in strips and branches along the direction of mountains and rivers, mainly in the flat areas of low mountains and valleys below the altitude of 2200 m, including Kangding, Luding, Danba, Wenchuan, Lixian, Maoxian, Jiuzhaigou, and Songpan.

[Effect of jejunal feeding tube placement on complications after laparoscopic radical surgery in patients with incomplete pyloric obstruction by gastric antrum cancer]

Objective: To assess the effect of jejunal feeding tube placement on early complications of laparoscopic radical gastrectomy in patients with incomplete pyloric obstruction by gastric cancer. Methods: This was a retrospective cohort study. Perioperative clinical data of 151 patients with gastric antrum cancer complicated by incomplete pyloric obstruction who had undergone laparoscopic distal radical gastrectomy from May 2020 to May 2022 in the First Affiliated Hospital of Nanchang University were collected. Intraoperative jejunal feeding tubes had been inserted in 69 patients (nutrition tube group) and not in the remaining 82 patients (conventional group). There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The operating time, intraoperative bleeding, time to first intake of solid food, time to passing first flatus, time to drainage tube removal, and postoperative hospital stay, and early postoperative complications (occurded within 30 days after surgery) were compared between the two groups. Results: Patients in both groups completed the surgery successfully and there were no deaths in the perioperative period. The operative time was longer in the nutritional tube group than in the conventional group [(209.2±4.7) minutes vs. (188.5±5.7) minutes, t=2.737, P=0.007], whereas the time to first postoperative intake of food [(2.7±0.1) days vs. (4.1±0.4) days, t=3.535, P<0.001], time to passing first flatus [(2.3±0.1) days vs. (2.8±0.1) days, t=3.999, P<0.001], time to drainage tube removal [(6.3±0.2) days vs. (6.9±0.2) days, t=2.123, P=0.035], and postoperative hospital stay [(7.8±0.2) days vs. (9.7±0.5) days, t=3.282, P=0.001] were shorter in the nutritional tube group than in the conventional group. There was no significant difference between the two groups in intraoperative bleeding [(101.1±9.0) mL vs. (111.4±8.7) mL, t=0.826, P=0.410]. The overall incidence of short-term postoperative complications was 16.6% (25/151). Postoperative complications did not differ significantly between the two groups (all P>0.05). Conclusion: It is safe and feasible to insert a jejunal feeding tube in patients with incomplete outlet obstruction by gastric antrum cancer during laparoscopic radical gastrectomy. Such tubes confer some advantages in postoperative recovery.

Avoidance of urinary drainage during perioperative period of open elective colonic resection within enhanced recovery after surgery programme

Background

Urinary catheterization (UC) is a conventional perioperative measure for major abdominal operation. Optimization of perioperative catheter management is an essential component of the enhanced recovery after surgery (ERAS) programme. We aimed to investigate the risk factors of urinary retention (UR) after open colonic resection within the ERAS protocol and to assess the feasibility of avoiding urinary drainage during the perioperative period.

Methods

A total of 110 colonic-cancer patients undergoing open elective colonic resection between July 2014 and May 2018 were enrolled in this study. All patients were treated within our ERAS protocol during the perioperative period. Data on patients’ demographics, clinicopathologic characteristics, and perioperative outcomes were collected and analysed retrospectively.

Results

Sixty-eight patients (61.8%) underwent surgery without any perioperative UC. Thirty patients (27.3%) received indwelling UC during the surgical procedure. Twelve (10.9%) cases developed UR after surgery necessitating UC. Although patients with intraoperative UC had a lower incidence of post-operative UR [0% (0/30) vs 15% (12/80), P = 0.034], intraoperative UC was not testified as an independent protective factor in multivariate logistic analysis. The history of prostatic diseases and the body mass index were strongly associated with post-operative UR. Six patients were diagnosed with post-operative urinary-tract infection, among whom two had intraoperative UC and four were complicated with post-operative UR requiring UC.

Conclusion

Avoidance of urinary drainage for open elective colonic resection is feasible with the implementation of the ERAS programme as the required precondition. Obesity and a history of prostatic diseases are significant predictors of post-operative UR.

The Identification of Alternative Polyadenylation in Stomach Adenocarcinomas Using the Genotype-Tissue Expression Project and the Cancer Genome Atlas- Stomach Adenocarcinoma Profiles

Objective

Alternative polyadenylation (APA) is a common mechanism that is present in most human genes and determines the length of the messenger ribonucleic acid (mRNA) three prime untranslated region (3ʹ-UTR), which can give rise to changes in mRNA stability and localization. However, little is known about the specific changes related to APA in stomach adenocarcinomas (STADs).

Methods

We integrated RNA sequencing data from The Cancer Genome Atlas and Genotype-Tissue Expression project to comprehensively analyze APA events in 289 cases of STAD.

Results

Our results showed that APA events were widespread in patients with STAD and were rich in genes related to known STAD pathways. The APA events result in the loss of tumor-suppressing micro-ribonucleic acid (miRNA) binding sites and increased heterogeneity in the length of the 3ʹ-UTR altered genes. Survival analysis revealed that specific subsets of 3ʹ-UTR-altered genes independently characterized a poor prognostic cohort among patients with STAD, thereby indicating the potential of APA as a new prognostic biomarker.

Conclusion

Our single-cancer analysis showed that by losing miRNA regulation, APA can become a driving factor for regulating the expression of oncogenic genes in STAD and promote its development. Our research revealed that APA events regulated STAD genes that were functionally related, thereby providing a new approach for gaining a better understanding of the progress of STADs and a means for identifying new drug targets as avenues of treatment.

Development and preliminary application of novel genomewide SSR markers for genetic diversity analysis of an economically important bio-control agent Platygaster robiniae (Hymenoptera: Platygastridae)

Platygaster robiniae Buhl and Duso (Hymenoptera: Platygastridae) is an egg-larvae parasitoid of the black locust gall midge (Obolodiplosis robiniae) (Haldeman) (Diptera: Cecidomyiidae) which is a serious invasive pest in China, where it attacks an important hardwood species, the black locust tree, Robini pseudoacacia L. (Fabales: Fabaceae). Despite the use of P. robiniae as an effective biocontrol agent, the absence of sequence data and other molecular markers have limited its genetic applications for pest management in forests. Simple-sequence repeats (SSRs) are valuable molecular markers for population genetic structure studies. In the present study, we identified 14,123 SSRs, of which 7799 SSR primer pairs were successfully designed. Subsequently, 240 SSR were chosen and tested with 48 P. robiniae accessions from two geographically separated populations in north and south China. Of these, 34 were polymorphic, with an average of three alleles (N_a) and four genotypes (N_G) each. The average values of observed heterozygosity (H_o) was 0.3514, expected heterozygosity (H_e) 0.4167, Shannon's information index (I) 0.7143, and polymorphism information content (PIC) 0.3558, respectively. Neighbour joining analysis (bootstrap 1000) revealed that Chengdu (CD) and Dangdong (DD) popluations clustered into two main divisions, and some individuals from two popluations clustered together as the third devision, which indicated the gene flow and genetic differentiation were present between two populations. Our finding indicates that these SSR markers will be useful for further studies on the genotype identification and genetic mapping of the genus Platygaster.

[Genetic expression differences of 11 beta-hydroxysteroid dehydrogenase in the bone microvascular endothelial cells derived from different regions of the human femoral head]

Objective: To investigate the expression levels and activation differences of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) gene in bone microvascular endothelial cells (BMECs) in different regions of human femoral head. Methods: Tissue specimens of femoral heads were obtained from hip arthroplasty carried out in China-Japan Friendship Hospital from January 2017 to June 2018. And the BMECs we isolated, purified, identified and cultured from different regions of the human femoral head: in the subchondral and cancellous bone regions. The BMECs from the two regions were intervened by hydrocortisone with a series of low concentration gradients (0, 0.03, 0.06, 0.10 mg/ml) respectively. The cell phenotype and functional status of BMECs and cell migration were detected by scratch experiments, and the angiogenesis in different regions of the femoral head was observed. The mRNA and protein expression of 11beta-HSD1, 11beta-HSD2 in BMECs were detected by real-time fluorescence quantitative polymerase chain reaction (RT-PCR) and Western-blot method, respectively. Results: With the increase of the concentration of hydrocortisone, the 11beta-HSD1 mRNA and protein expression of BMECs in the subchondral and cancellous bone regions of the femoral head increased significantly, and the 11beta-HSD1 mRNA and protein expression of BMECs in the subchondral bone region was significantly lower than those in cancellous bone region (all P<0.05). The 11beta-HSD2 mRNA and protein expression of BMECs in the cancellous bone region showed a slow decrease first and then increased slightly at 0.10 mg/ml, while the expression in the subchondral bone region was the opposite. The 11beta-HSD2 mRNA and protein expression of BMECs in subchondral bone region was slightly higher than those in cancellous bone region (all P<0.05), but there was no significant statistical difference between the two regions at 0.10 mg/ml (0.123±0.018 vs 0.126±0.021, 0.577±0.231 vs 0.609±0.174, t=1.380, 0.409, both P>0.05). At different times of the 0.06 mg/ml hydrocortisone intervention, there was no significant differences in scratch closure rate, the number of BMECs lumen, the number of buds and the length of tubule branches in different regions of the femoral head (all P>0.05). Conclusion: The 11beta-HSD expression of BMECs in different regions of human femoral head is significantly different. The 11beta-HSD1 is high-expressed, but 11beta-HSD2 is low-expressed in BMECs of the cancellous bone region, and those are opposite in the subchondral bone region, which helps to explain the pathological characteristics and pathogenesis of hormonal osteonecrosis.

Relationship between Postmortem Interval and FTIR Spectroscopy Changes of the Rat Skin

Abstract

Objective To infer postmortem interval （PMI） based on spectral changes of the dorsal skin of rats within 15 days postmortem using Fourier transform infrared （FTIR） spectroscopy. Methods The rats were sacrificed by cervical dislocation after anesthesia, and then placed at 25 ℃ and relative humidity of 50%. The FTIR spectral data collected from the dorsal skin at PMI points were modeled with machine learning technique. Results There was no significant difference of absorption peak location among all the PMI groups but their peak intensities changed as a function of PMIs. The model for PMI estimation was constructed using partial least squares （PLS） regression, reaching a R² of 0.92 and a root mean square error （RMSE） of 1.30 d. As shown in variable importance for projection （VIP）, four spectral bands including 1 760-1 700 cm^-1, 1 660-1 640 cm^-1, 1 580-1 540 cm^-1 and 1 460-1 420 cm^-1 were determined as important contributions to model prediction. Conclusion Application of the FTIR technique to detect postmortem spectral changes of the rat skin provides a novel proposal for PMI estimation.

[Minimal residual disease in adults with Philadelphia chromosome negative acute lymphoblastic leukemia in high-risk]

目的

探讨高危Ph阴性急性淋巴细胞白血病（Ph⁻ALL）中微小残留病（MRD）对预后和治疗策略的影响。

方法

回顾性分析2008年1月1日至2017年12月31日收治的初治成人高危Ph⁻ALL并获得完全缓解（CR）患者的临床资料，通过Cox回归模型和Landmark分析，寻找预后相关因素。

结果

177例患者纳入研究，其中男性99例（56%），中位年龄40（16~65）岁，95例（54%）在第1次完全缓解（CR₁）后接受异基因造血干细胞移植（移植组）。多因素分析显示，巩固治疗1个疗程后MRD阴性（HR=0.52，95%CI 0.30~0.89，P=0.017）、诱导化疗4周达到CR（HR=0.43，95%CI 0.24~0.79，P=0.006）是影响患者无病生存（DFS）的有利因素，CR₁移植是影响患者DFS（HR=0.13，95%CI 0.08~0.22，P<0.001）和总生存（OS）（HR=0.24，95%CI 0.15~0.41，P<0.001）的共同有利因素。121例患者进入Landmark分析，在巩固治疗1个疗程后MRD阴性的85例患者中进行多因素分析显示，巩固治疗3个疗程后MRD阴性是影响患者DFS（HR=0.18，95%CI 0.05~0.64，P=0.008）和OS（HR=0.14，95%CI 0.04~0.50，P=0.003）的有利因素。在巩固治疗1个疗程和3个疗程后MRD均阴性的患者中，移植组患者3年DFS率有高于化疗组的趋势（75.2%对51.3%，P=0.082），但3年OS率相近（72.7%对68.7%，P=0.992）。巩固治疗1个疗程和3个疗程后MRD至少1次阳性的患者中，移植组的3年DFS率（64.8%对33.3%，P=0.006）和3年OS率（77.0%对33.3%，P=0.028）均显著高于化疗组，与这两个时间点MRD均阴性的移植患者的预后差异无统计学意义（P>0.05）。

结论

在高危成人Ph⁻ALL患者中，巩固治疗1个疗程后MRD阴性是预后良好的独立影响因素。巩固治疗1个疗程和3个疗程MRD均阴性的患者，接受移植或化疗的生存率相似。移植显著改善了巩固治疗1个疗程和3个疗程后MRD至少一次阳性患者的预后。

[Morphological changes of the central sulcus in children with complete growth hormone deficiency: a 3.0 T MRI study]

Objective: To analyze morphological changes in central sulcus of the cerebral cortex in children with complete growth hormone deficiency (CGHD). Methods: Patients attending the Shandong Provincial Hospital who were diagnosed with CGHD or idiopathic short stature were recruited from January 2015 to January 2019. Thirty children with CGHD (18 males and 12 females, 5 to 14 years old) and 30 children with idiopathic short stature (22 males and 8 females, 5 to 14 years old) were included. Measurements of the central sulcus, including the average width, maximum depth, average depth, top length, bottom length and depth position-based profiles (DPP), were obtained using Brain VISA software. The significant differences between groups were statistically analyzed. Results: The average width of bilateral central sulci in children with CGHD (left: (2.26±0.41) mm; right: (2.19±0.34) mm) were significantly higher than those in children with idiopathic short stature (left: (2.10±0.27) mm; right: (2.02±0.18) mm) (P<0.05) ; The maximum depth of the left central sulcus ((19.67±1.29) mm) and the average depth of the right central sulcus ((14.18±1.41) mm) were significantly lower than those in children with idiopathic short stature (left maximum depth: (20.69±1.43) mm; right average depth: (14.92±1.21) mm) (P<0.05) . Children with CGHD had significantly lower DPP at the middle part of the left central sulcus (sites: 46-54) and the inferior part of the right central sulcus(sites: 91-98). Conclusion: There are significant morphological changes of the central sulcus in children with CGHD, which may represent the structural basis of their relatively slower development in motor, cognitive and linguistic functional performance.

Long Noncoding RNA UCA1 Regulates PRL-3 Expression by Sponging MicroRNA-495 to Promote the Progression of Gastric Cancer

Gastric cancer (GC) is among the most frequently occurring malignancies worldwide. In recent years, long noncoding RNAs (lncRNAs) have been widely studied because of their ability to regulate the cellular processes involved with tumorigenesis. The present study aims to investigate the underlying molecular mechanism by which lncRNA urothelial carcinoma-associated 1 (UCA1) influences the progression of GC. Differentially expressed lncRNA UCA1 was initially identified by microarray-based analysis, after which a high expression of UCA1 was determined in GC tissues and cells. It is important to note that UCA1 could upregulate the expression of phosphatase of regenerating liver-3 (PRL-3) by sponging miR-495. The expression of UCA1 and miR-495 was altered in human GC cells to evaluate cell activity in vitro, as well as peritoneal metastasis and tumor formation ability in vivo. Results suggested that increased expression of UCA1 promoted cell proliferation, migration, and invasion, accompanied by suppressed cell apoptosis, as well as enhanced peritoneal metastasis and tumorigenesis of GC cells. Meanwhile, the upregulated expression of miR-495 could reverse the promotive effects exerted by UCA1. Taken conjointly, UCA1, as a competing endogenous RNA (ceRNA) of miR-495, could accelerate the development of GC by upregulating PRL-3, highlighting a potentially promising basis for the targeted intervention treatment of GC.

Calcium-sensing receptor antagonist NPS-2143 suppresses proliferation and invasion of gastric cancer cells

NPS-2143 is a calcium-sensing receptor (CaSR) antagonist that has been demonstrated to possess anticancer activity. To date, the effects of NPS-2143 on gastric cancer (GC) cell growth, motility, and apoptosis have not been investigated. In the present study, we firstly investigated the expression of CaSR in GC tissues using immunohistochemistry and western blotting. Then Cell Counting Kit-8 and colony formation assays were conducted to explore the effect of the NPS-2143 on the proliferation of GC cell line AGS. Transwell invasion and migration assays were performed to test the effect of NPS-2143 on AGS cell motility. We determined the percentage of apoptotic cells by flow cytometry and explored the changes of apoptosis-related protein by western blotting. Furthermore, we constructed a CaSR knockdown AGS cell line to determine whether NPS-2143 acted via inhibition of CaSR. We found that the protein expression level of CaSR was higher in GC tissues compared with the paired adjacent normal tissues. In addition, NPS-2143 treatment caused an inhibitory effect on the proliferation, invasion, and migration of AGS cells and a promoting effect on AGS apoptosis. The expression of Bcl-2 was decreased while the levels of Bax and active caspase 3 were enhanced in AGS cells after NPS-2143 treatment. Mechanistically, NPS-2143 lead to a significant decrease in the expression of phosphorylated (p)-AKT, phosphorylated mechanistic target of rapamycin (p-mTOR), p70, and cyclin D1. Knockdown of CaSR also suppressed cell proliferation, invasion, and migration and promoted cell apoptosis. No significant difference was observed between CaSR-silenced AGS cells with and without NPS-2143 treatment. These results confirmed that NPS-2143 has an inhibitory influence on AGS cell growth via inhibiting CaSR, which then suppresses the PI3K/Akt signaling pathway.

WeChat as a Platform for Problem-Based Learning in a Dental Practical Clerkship: Feasibility Study

Background

Problem-Based-Learning (PBL) has been widely accepted in student-centered medical education. Since WeChat is the most popular communication app in China, we have chosen to use WeChat as new platform for online PBL in order to reduce the limitations of traditional PBL in dental practical clerkships.

Objective

This study aims to demonstrate the feasibility and acceptability of online PBL using WeChat (WeChat-PBL) in a dental practical clerkship.

Methods

A total of 72 students in a dental practical clerkship and 10 tutors participated in this study from June to August 2017. We created 10 WeChat groups to provide a communication platform for the PBL teaching, in which the students selected the PBL cases themselves from their practical clerkship. After each individual PBL case, group members were required to complete an evaluation on the PBL process itself. A final questionnaire survey was completed by the participants to summarize the long-term evaluation of the whole WeChat-PBL experience after the 3-month clerkship. Data from the PBL cases, WeChat messages, periodic evaluations, and long-term evaluations were collected for analysis.

Results

There were 45 cases presented in the WeChat-PBL within the 3-month clerkship. All students had positive reactions to the communication within the PBL groups. The results of the periodic evaluation showed that the students and tutors were quite satisfied with the process of WeChat-PBL and appreciated the group members’ contributions and performance. The final questionnaire results indicated that the WeChat-PBL had achieved positive effects.

Conclusions

The results of this study indicate the feasibility and acceptability of the app, WeChat, for problem-based learning in a dental practical clerkship.

[Analysis of Phenotype and L12R Mutation in Signal Peptide and 3' Non-translation Region c11814-insAA Mutation of F7 Gene in a Family with Hereditary Coagulation Factor VII Deficiency]

OBJECTIVE

To examine one young female patient with hereditary FVII deficiency and her family members, to observe the gene mutation and clinical phenotype, and to investigate the molecular mechanism of the dysfunction.

METHODS

Prothrombin time (PT), activated partial thromoploastin time (APTT), fibrinogen (Fg) and FVII activity (FVII:C) and FVII antigen (FVII:Ag) were tested. The gene mutations were sought by DNA sequencing for all of the exons and flanks, 5' and 3' non-translation region of F7 gene. To confirm the role of the found gene mutation, the reverse sequence were determined with Chromas software. To infer the influence of the mutation on the synthesis and function of FVII protein, the FVII protein molecule model containing the found mutation was constructed and the function prediction was performed by the signal peptide prediction database.

RESULTS

Compared with the normal population, the proband's PT value was significantly prolonged, and the ratio % FVII:C and that of FVII:Ag were significantly decreased by 1.1% and 0.9%, respectively. The PT, APTT, FVII:C and FVII:Ag of the proband's parents were both normal. Heterozygous 556th nucleotide mutations T/G were found in the proband's and his father's exon lA of F7 gene, with codon CTG turning into CGG, corresponding leucine (L) into arginine (R), i.e Leu12Arg. Function prediction showed that L12R mutations affected the segmentation of different parts of the signal peptide and its corresponding function, which could result in the decline in the mature protein synthesis and its activity obviously. In addition, a spontaneous 3' untranslated region c11814-insAA heterozygous mutation was detected in the proband's F7 gene, while her parents didn't possess this mutation.

CONCLUSION

A new hererozygous mutation (L12R) located in signal peptide of F7 gene is the primary molecular basis of the case with hereditary FVII deficiency. At the same time, the proband's spontaneous 3' non-translation region c11814-insAA mutation may lead to the further reduetion of the FVII synthesis.

[Correlation of the single nucleotide polymorphism rs662 of PON1 with the risk of male infertility]

OBJECTIVE

To investigate the correlation between the single nucleotide polymorphism (SNP) rs662 of the paraoxonase 1 gene (PON1) and the risk of male infertility.

METHODS

This case-control study included 403 male idiopathic infertility patients aged 29.00 ± 4.48 years in the case group and 329 normal fertile men aged 28.28 ± 4.08 years as healthy controls. We obtained DNA from the peripheral venous blood of the subjects, genotyped the SNP rs662 of PON1 by Sequenom MassArray, and analyzed the association between different genotypes of PON1 rs662 and male infertility using the logistic regression model.

RESULTS

Compared with the normal controls, the infertility patients showed a significantly increased level of follicle-stimulating hormone (FSH) (［16.30 ± 17.76］ vs ［4.72 ± 2.51］ U/L, P < 0.01) but a decreased percentage of progressively motile sperm (PMS) (［7.40 ± 14.17］ % vs ［41.93 ± 9.06］ %, P < 0.01) and sperm concentration (［2.74 ± 3.64］ vs ［75.83 ± 63.66］ ×10⁶/ml, P < 0.01). Statistically significant differences were not found in the other parameters between the two groups of subjects, nor in the correlation of male infertility with the heterozygous genotype GA versus the wild homozygous genotype GG (OR = 0.98, 95% CI: 0.63－1.53, P = 0.923) or the homozygous genotype AA versus the wild homozygous genotype GG (OR = 0.87, 95% CI: 0.56－1.34, P = 0.525).

CONCLUSIONS

The SNP rs662 of PON1 was not correlated with male infertility, which, however, needs to be confirmed by further studies with larger samples from a larger area.

Efficacy of Complex Banmao Capsules combined with chemotherapy in treatment of patients with advanced gastric carcinoma

AIM

To evaluate the efficacy of Compound Banmao Capsules combined with chemotherapy in the treatment of patients with advanced gastric carcinoma.

METHODS

Eighty patients with advanced gastric carcinoma treated from January 2014 to December 2014 at our department were randomly divided into either a study group or a control group. All of the patients had undergone radical gastrectomy with D2 lymphadenectomy. According to the UICC/AJCC TNM staging system for gastric cancer (seventh edition), all of the patients were confirmed to have stage Ⅱb-Ⅲc disease. The patients in the control group were treated with XELOX chemotherapy only, and the patients in the study group were treated with XELOX chemotherapy plus Compound Banmao Capsules. After treatment, clinical efficacy, quality of life, and adverse reactions were compared between the two groups.

RESULTS

The Karnofsky performance score was significantly better and the incidence of adverse reactions was significantly lower in the study group than in the control group (P < 0.05). There was no significant difference in the 3-year survival rate between the two groups (P > 0.05). However, the survival of patients in the study group showed an increasing tendency compared with the control group.

CONCLUSION

Compound Banmao Capsules may reduce the adverse effects of chemotherapy and improve the quality of life and compliance of patients with gastric cancer .

The Efficacy of 24-Month Metformin for Improving Menses, Hormones, and Metabolic Profiles in Polycystic Ovary Syndrome

CONTEXT

The long-term effects of metformin in women with polycystic ovarian syndrome (PCOS) are inadequately studied.

OBJECTIVE

The effects of metformin on women with PCOS during 24 months with respect to menses, hormones, and metabolic profiles are assessed.

DESIGN

Prospective cohort.

SETTING

A reproductive endocrinology clinic in a university-affiliated medical center.

PATIENTS

One hundred nineteen women with PCOS, defined by the Rotterdam criteria, were enrolled.

INTERVENTION

Metformin was given daily for 24 months.

MAIN OUTCOME MEASURES

The primary outcome was the proportion of patients with regular menstruation during treatment. Changes in anthropometric, hormonal, and metabolic parameters were also assessed. Analyses were performed using segmented regression analysis with a generalized estimating equation methodology. Outcomes are expressed as magnitude of change from the baseline.

RESULTS

Both overweight (OW) and normal-weight (NW) women with PCOS had increased menstrual frequency and decreased body mass index (BMI), testosterone, and luteinizing hormone levels in the first 6 months. Further stratification showed that NW women exhibiting elevated testosterone at baseline had the largest magnitude of improvement at 6 months [odds ratio (OR), 7.21; 95% confidence interval (CI), 2.35 to 22.17], whereas OW patients with normal testosterone were most likely to achieve normal menses at 12 months (OR, 0.63; 95% CI, 0.47 to 0.77).

CONCLUSIONS

Metformin was associated with improvements in the menstrual cycle and most hormonal profiles in OW and NW women with PCOS during 24 months of treatment. Most parameters reached maximal response and steady-state after 6 months. Phenotypic differences in baseline BMI and testosterone level can be used as patient selection criteria or treatment prognostics.

Using an Event-History with Risk-Free Model to Study the Genetics of Alcoholism

Case–control genetic association studies typically ignore possible later disease onset in currently healthy subjects and assume that subjects with diseases equally contribute to the likelihood for inference, regardless of their onset age. Therefore, we used an event-history with risk-free model to simultaneously characterize alcoholism susceptibility and onset age in 65 independent non-Hispanic Caucasian males in the Collaborative Study on the Genetics of Alcoholism. Following data quality control, we analysed 22 single nucleotide polymorphisms (SNPs) on 12 candidate genes. The single-SNP analysis showed that the dominant minor allele of rs2134655 on DRD3 increases alcoholism susceptibility; the dominant minor allele of rs1439047 on NTRK2 delays the alcoholism onset age, but the additive minor allele of rs172677 on GRIN2B and the dominant minor allele of rs63319 on ALDH1A1 advance the alcoholism onset age; and the dominant minor allele of rs1079597 on DRD2 shortens the onset age range. Similarly, multiple-SNPs analysis revealed joint effects of rs2134655, rs172677 and rs1079597, with an adjustment for habitual smoking. This study provides a more comprehensive understanding of the genetics of alcoholism than previous case–control studies.

Differential localization of distinct CD4 T cell subsets in the female genital tract during the menstrual cycle is regulated by CCR5

CD4 T cells are essential for optimal immune responses against sexually transmitted infections, yet the composition of the CD4 T cell pool localized in the female genital tract (FGT), and the impact of the menstrual cycle on the CD4 T cell population dynamics in the FGT, remains poorly defined. Here we show the FGT CD4 T cell pool is comprised of distinct subsets of memory CD4 T cells based upon trafficking profile, anatomic regionalization, and effector responses. Based on expression of trafficking and tissue retention markers, FGT CD4 T cells are comprised of both migratory memory (TMM) and resident memory (TRM), with TMM expressing a broad array of trafficking markers that would enable their ability to perform immune surveillance in diverse tissues. Furthermore, these subsets differ in both their regionalization throughout the FGT and in their cytokine responses, notably IL-2 production. The frequency of TMM in the FGT increased during the luteal phase of the menstrual cycle and correlated with increased CCR5 expression on circulating memory CD4 T cells. Using a dual adoptive transfer mouse model, we observed that CCR5-mediated trafficking was required for the localization of memory CD4 T cells to the luminal surface of the FGT. In addition, to test cycle influence on T cell trafficking into the FGT, we administered a CCR5 antagonist to pigtail macaques at different stages of the menstrual cycle and found that inhibition of CCR5 signaling selectively reduced TMM numbers solely at luteal time points. Together, these data provide broader insight into role that distinct tissue resident CD4 T cell subsets play in barrier defenses at the FGT and also demonstrate a role for the menstrual cycle in modulating immune protection through CCR5 signaling.

Pulmonary monocytes promote the establishment of lung tissue-resident CD8 T cell memory following influenza infection

Lung tissue resident memory CD8 T cells (TRM) are critical for protection against heterologous influenza virus challenge by promoting rapid viral clearance. Unlike other mucosal tissues, we have found that local environmental signals are insufficient for the establishment of lung TRM, and that pulmonary antigen encounter is necessary for TRM to differentiate in the lung. Therefore, we investigated the role of lung antigen presenting cell (APC) subsets in the establishment of lung CD8 TRM following influenza infection. The initial appearance of flu-specific CD8 T cells in the lung with a TRM phenotype begins around day 10 post-infection, which coincides with viral clearance. Correspondingly, while most lung APC subsets contain influenza antigens over the course of infection, monocytes are the most numerous lung APC subset containing influenza antigens at the time of TRM appearance. Furthermore, imaging shows direct interaction between monocytes and T cells in the lung, supporting the idea that monocytes can act as drivers of lung TRM differentiation. In a murine influenza model, CCR2−/− mice, which have a defect in monocyte recruitment to the lung, had significantly fewer flu-specific lung CD8 TRM than WT controls. Notably, this defect was not observed in the flu-specific CD8 memory T cells in the lung vasculature or mediastinal lymph node, indicating this effect is specific for tissue-resident memory cells. In addition, this phenotype is not driven by a lack of CCR2 on T cells, as adoptive transfer of wild-type OT-I T cells into CCR2−/− mice yields the same deficiency of lung TRM. Thus, these data show that antigen presentation by lung CCR2+ monocytes has an important role in the establishment of lung CD8 TRM.

Role of phosphatase of regenerating liver 3 in gastric carcinoma

Gastric carcinoma is one of the most common malignancies worldwide and remains the third leading cause of cancer death in both sexes worldwide. Phosphatase of regenerating liver 3 (PRL-3) is a tyrosine phosphatase that has been reported to be overexpressed in gastric tissues and play an important role in lymphatic metastasis and peritoneal metastasis of gastric carcinoma. It has also been reported that PRL-3 has a negative relationship with the prognosis of gastric carcinoma patients. More and more researchers have focused on the regulatory mechanism of PRL-3 in gastric carcinoma, aiming to elucidate the possible pathway and influencing factors. However, the exact mechanism of PRL-3 in promoting lymphatic metastasis, peritoneal metastasis and recurrence of gastric cancer is unknown. This paper will review the role of PRL-3 in gastric carcinoma with regard to its structure, function and possible mechanism in gastric carcinoma development.

Clinical application of hand-assisted laparoscopy in transverse colectomy for middle transverse colon cancer

AIM: To assess the safety, feasibility and clinical application value of hand-assisted laparoscopy in transverse colectomy for middle transverse colon cancer.

METHODS: From April 2012 to April 2015, a total of 20 patients with middle transverse colon cancer underwent radical transverse colon resection at Department of Gastrointestinal Surgery of the First Affiliated Hospital of Nanchang University, of whom 11 underwent hand assisted laparoscopic surgery (HALS), and 9 underwent laparoscopic-assisted surgery (LAS). The clinical data of all the patients were retrospectively analyzed and compared between the two groups.

RESULTS: All the 20 patients had successful surgery. There was no conversion to open surgery or no operative death. Operative time was significantly shorter in the HALS group than in the LAS group (153.6 min ± 28.1 min vs 190.6 min ± 35.0 min, P = 0.017). There were no significant differences between the two groups in blood loss (121.8 mL ± 79.4 mL vs 116.1 mL ± 78.1 mL), number of lymph nodes harvested (15.4 ± 5.4 vs 17.6 ± 11.7), rate of postoperative complications (9.1% vs 11.1%), postoperative exhaust time (3.1 d ± 0.7 d vs 2.9 d ± 0.6 d), or postoperative hospital stay (7.4 d ± 0.7 d vs 7.8 d ± 1.1 d) (P > 0.05). The patients were followed for 2-38 months. In the HALS group, one patient developed intestinal obstruction at 1 mo and one patient developed liver metastases at 8 mo. In the LAS group, one patient died of extensive abdominal metastasis.

CONCLUSION: The hand-assisted laparoscopic technique is feasible and safe in the radical resection of middle transverse colon cancer. Due to a small number of patients included and short follow-up time in this study, further studies are required.

Retroperitoneal laparoscopy management for ureteral fibroepithelial polyps causing hydronephrosis in children: a report of five cases

INTRODUCTION

Hydronephrosis is a common disease in children and may be caused by ureteral fibroepithelial polyps (UFP). Ureteral fibroepithelial polyps are rare in children and are difficult to precisely diagnose before surgery. Surgical treatment for symptomatic UFP is recommended. At the present institution, retroperitoneal laparoscopy has been used to treat five boys with UFP since 2006.

OBJECTIVE

To highlight the significance of UFP as an etiological factor of hydronephrosis in children and evaluate the applicative value of retroperitoneal laparoscopy in the treatment of children with UFP.

METHODS

Between 2006 and 2013 five boys underwent retroperitoneal laparoscopy at the present institution. They were identified with UFP by review of the clinical database. Detailed data were collected, including: radiographic studies, gross anatomical pathology, and pathology and radiology reports. All boys had been followed up at least every 6 months.

RESULTS

All of the boys were aged between 7 and 16 years (mean 9.8 years). The main symptoms were flank pain (all five) and hematuria (three). Radiographic examination showed that all of the boys presented with incomplete ureteral obstruction and hydronephrosis. The ureteral fibroepithelial polyps were located near the left UPJ or the left proximal ureter. All of the boys had the UFP removed: three underwent retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty and polypectomy, and two had retroperitoneal laparoscopic ureteral anastomosis. These polyps were all on the left side and between 15 and 35 mm in length (mean 22 mm) (Figure). All of the boys recovered well and were discharged from hospital. The postoperative histological report confirmed that the specimens were UFP. Hydronephrosis was periodically assessed by ultrasonography (using the same method as pre-surgical ultrasonography) after surgery. Mean follow-up was 33 months (range 6-58 months) and no complications were found afterwards.

CONCLUSIONS

Ureteral fibroepithelial polyps are rare but rather important as they can cause UPJ obstruction, which often manifests as hydronephrosis. It is most important to confirm the site of ureteral obstruction before surgery as this may have an effect on the surgical management. It is recommended that UFP be successfully managed in children with retroperitoneal laparoscopy.

Diagnosis and treatment of peritoneal metastasis of gastric cancer

As the main reason of death in patients with gastric cancer, peritoneal metastasis is still a major problem to be solved. As we all know, peritoneal metastasis is the main form of advanced gastric cancer and gastric cancer recurrence, which involves a complex, multi-stage, multifactorial pathological process. The diagnosis and treatment of peritoneal metastasis of gastric cancer are particularly difficult. The good news is that through active exploration and clinical research, several important achievements have been made and gradually bring the gospel to clinical patients. This paper will review the recent progress in the diagnosis and treatment of peritoneal metastasis of gastric cancer.

Segmental Duodenectomy in Surgical Therapy of Tumor of the Third and Fourth Portions of Duodenum

BACKGROUND/AIMS

To analyze our experience of segmental duodenectomy for tumors located at the third and fourth portion of the duodenum and attempt to explore the security and feasibility of this surgical procedure.

METHODOLOGY

A retrospective cohort study of five patients who underwent segmental duodenectomy in our hospital, medical records were analyzed in this study.

RESULTS

The initial symptoms in five patients are not specific. Five were surgically treated by segmental resection. All patients without postoperative anastomotic leakage, the gastroparesis and anastomotic stenosis each appeared in a case and all recovered after supportive care. Pathological examination showed: 3 cases of stromal tumor, 1 :ases of lymphangioma, diffuse large B-cell lymphoma. Postoperative gastrointestinal bleeding does not appear in the lymphangioma,two cases of high risk group of stromal tumor patients received targeting therapy with Imatinib Mesylate for 2 years after resection, the patient with lymphoma administer postoperative adjuvant chemotherapy. All patients are still alive and the lymphoma patient developed postoperative local recurrence after approximately six months.

CONCLUSIONS

Segmental duodenectomy is a reliable and curative option for most duodenal benign tumor and stromal tumor located at the third and fourth portion. It is also applicable to some malignant tumor.

Clinical application of omental bursa wash detection in gastric carcinoma

AIM: To evaluate the application value of omental bursa wash detection in gastric carcinoma.

METHODS: Omental bursa washes from 78 patients with gastric carcinoma were collected. The expression of carcino-embryonic antigen (CEA) in omental bursa washes was detected by flow cytometry (FCM). Peritoneal lavage cytology (PLC) examinations were also carried out.

RESULTS: The FCM and PLC positive rates of omental bursa washes were 37.1% (29/78) and 11.5% (9/78), respectively, which had a significant difference (P = 0.001). The positive rate of omental bursa washes correlated well with the width of tumor, location of lesion, and depth of invasion (P < 0.05). The age, gender, differentiation, vessel carcinoma embolus, and area of invasion were not relevant to omental bursa wash detection.

CONCLUSION: FCM can be well used to detect omental bursa washes. The best use of omental bursa wash detection is to assess tumor progression and to predict the emergence of gastric carcinoma micrometastases.

Clinical application of circular anastomotic stapler in colostomy after laparoscopic abdominoperineal resection for low rectal cancer

AIM: To explore the value of circular anastomotic stapler in colostomy after laparoscopic abdominoperineal resection for low rectal cancer.

METHODS: A retrospective analysis was performed of the clinical data for 38 patients with permanent stoma after laparoscopic Miles operation for rectal cancer from January 2012 to January 2014. All of them received extraperitoneal colostomy using a circular anastomotic stapler. During the operation of colostomy, the sigmoid colon was pulled out, and the stapler pedestal was inserted in the sigmoid colon stump. The purse-string suture was then tied on the abdominal wall to complete extraperitoneal colostomy. The safety of the procedure, postoperative colostomy related complications, and postoperative colostomy function recovery were assessed.

RESULTS: All of the cases were followed for 8 to 32 mo (median 18 mo). Colostomy-related complications occurred in three (7.9%) patients. The majority of patients (31/38, 81.6%) started to have defecation reflex 2-3 mo postoperatively. The rate of satisfaction to the artificial anal function was higher, and the incidence of mental disorders was low.

CONCLUSION: Extraperitoneal colostomy using circular anastomotic stapler in laparoscopic abdominoperineal resection is easy to operate, and the operation is safe and reliable, and has fewer colostomy-related complications.

Halovenus rubra sp. nov., isolated from salted brown alga Laminaria

Halophilic archaeal strain R28(T) was isolated from the brown alga Laminaria produced at Dalian, Liaoning Province, China. The cells of the strain were pleomorphic and lysed in distilled water, stained Gram-negative, and formed red-pigmented colonies. Strain R28(T) was able to grow at 25-50 °C (optimum 42 °C), in the presence of 3.1-5.1 M NaCl (optimum 3.9 M NaCl), with 0.005-1.0 M MgCl(2) (optimum 0.01 M MgCl(2)) and at pH 6.0-9.5 (optimum pH 7.0-7.5). The minimal NaCl concentration to prevent cell lysis was 15 % (w/v). The major polar lipids of the strain were identified as phosphatidic acid, phosphatidylglycerol, phosphatidylglycerol phosphate methyl ester, and two glycolipids chromatographically identical to those of Halovenus aranensis CGMCC 1.11001(T). The 16S rRNA gene and rpoB' gene of strain R28(T) were phylogenetically related to the corresponding genes of Hvn. aranensis CGMCC 1.11001(T) (91.9-97.2 and 82.9 % nucleotide identity, respectively). The DNA G+C content of strain R28(T) was determined to be 56.3 mol%. The phenotypic, chemotaxonomic, and phylogenetic properties suggest that strain R28(T) (=CGMCC 1.10592(T) = JCM 17269(T)) represents a novel species of the genus Halovenus, for which the name Halovenus rubra sp. nov. is proposed.

Clinical application of hand-assisted laparoscopic left hemicolectomy

AIM: To assess the clinical value of hand-assisted laparoscopic (HALS) left hemicolectomy.

METHODS: The clinical data for 41 patients who underwent HALS left hemicolectomy at our hospital were retrospectively analyzed.

RESULTS: All patients successfully recovered after HALS surgery. No patients had spleen injury and underwent splenectomy. No operative deaths occurred. Mean operative time was 136.0 min ± 21.0 min. Average amount of bleeding was 87.0 mL ± 13.0 mL. The number of harvested lymph nodes for postoperative pathological examination was 11.0 ± 5.0. Mean postoperative hospital stay was 7.0 d ± 4.0 d. The procedure had the advantage of mild pain. The average length of incision was 6.0 cm ± 1.5 cm. There was no severe operative complications like hemorrhage, anasnomotic leak, intestinal obstruction, etc. The median follow-up duration was 29.5 (3-48) mo, and there were three deaths during follow-up, 2 due to liver metastasis and 1 to peritoneal metastasis. The 3-year cumulative survival rate of the patients was 83.6%.

CONCLUSION: HALS in colon cancer is feasible and safe. The procedure basically reaches the required standard for minimally invasive surgery and radical resection of tumor; however, its long-term outcome needs further investigation.

Halopenitus salinus sp. nov., isolated from the brine of salted brown alga Laminaria

A halophilic archaeal strain, SKJ47(T), was isolated from a commercial preparation of the brown alga Laminaria produced at Dalian, Liaoning Province, China. Cells of the strain were observed to be short rods, stain Gram-negative, and to form red-pigmented colonies on solid media. Strain SKJ47(T) was found to be able to grow at 20-50 °C (optimum 37 °C), at 0.9-4.8 M NaCl (optimum 2.6-3.1 M), at pH 6.0-9.5 (optimum pH 7.0). The cells lysed in distilled water and the minimal NaCl concentration to prevent cell-lysis was found to be 5% (w/v). The major polar lipids of the strain were identified as phosphatidylglycerol, phosphatidylglycerol phosphate methyl ester, phosphatidylglycerol sulfate and two glycolipids chromatographically identical to those of Halopenitus persicus IBRC 10041(T). The 16S rRNA gene and rpoB' gene of strain SKJ47(T) were found to be phylogenetically related to the corresponding genes of Halopenitus malekzadehii IBRC-M 10418(T) (96.3 and 91.9% nucleotide identity, respectively) and Hpt. persicus IBRC 10041(T) (96.2 and 93.8%). The DNA G+C content of strain SKJ47(T) was determined to be 65.0 mol%. The phenotypic, chemotaxonomic and phylogenetic properties suggested that strain SKJ47(T) (=CGMCC 1.12229(T) = JCM 18641(T)) represents a new species of the genus Halopenitus, for which the name Halopenitus salinus sp. nov. is proposed.

MicroRNAs related to invasiveness and metastasis of gastric cancer

Metastasis plays an important role in the prognosis of patients with cancer. It is known that several steps are necessary for clonal cells to disseminate from their primary tumor site and colonize distant tissues. It will provide useful insights for effective treatment of cancer to investigate the molecular actors regulating this process. MicroRNAs, 19-25 nt in length, are a class of non-coding RNA, and they can result in degradation of specific mRNAs or inhibit their translation. They have been known as negative regulators of gene expression and are involved in many biological processes, including cell growth, differentiation and apoptosis. The relationship between the abnormal expression of microRNAs and tumors has been widely studied. Some recent research has clarified the role of microRNAs in tumor invasion and metastases. This paper reviews the recent progress in research of microRNAs related to invasiveness and metastasis of gastric cancer.

DJ-1 is involved in the peritoneal metastasis of gastric cancer through activation of the Akt signaling pathway

Peritoneal metastasis is a major cause of death in patients with advanced gastric carcinoma. DJ-1 is now considered to play an important role in the metastasis of various malignancies. However, it remains largely unclear whether DJ-1 is involved in the development of peritoneal metastasis by gastric carcinoma. In the present study, we showed that the expression of DJ-1 was significantly upregulated in gastric cancer specimens with peritoneal metastasis compared to those without peritoneal metastasis. Knockdown of DJ-1 expression significantly inhibited invasion and migration, in vitro and the in vivo peritoneal metastatic abilities of SGC7901 gastric cancer cells. Moreover, knockdown of DJ-1 also diminished the expression of matrix metallopeptidase (MMP)-2 and MMP-9. All of these effects were reversed by restoration of DJ-1 expression. Following investigation of the pathway through which DJ-1 regulates cell invasion and migration, DJ-1 was found to cause phosphorylation of Akt in SGC7901 gastric cancer cells. Inhibition of the Akt pathway in SGC7901 cells mimicked the effects of DJ-1 knockdown on cell migration, invasion, MMP-2 and MMP-9 expression, and abolished the effects of DJ-1 in promoting SGC7901 cell invasion and migration. Taken together, the present study revealed that DJ-1 plays an important role in the development of peritoneal carcinomatosis from gastric carcinoma, at least partially through activation of the Akt pathway and consequent upregulation of MMP-2 and MMP-9 expression. Thus, DJ-1 may be a potential therapeutic target for peritoneal carcinomatosis of gastric carcinoma.

[Detection of DPY19L2 gene mutation in a globozoospermia patient]

OBJECTIVE

Globozoospermia is mostly associated with homozygous deletion of the DPY19L2 gene. This study aimed to investigate the DPY19L2 gene mutation in a globozoospermia patient.

METHODS

We observed the sperm histomorphology of a patient with globozoospermia using Wright-Giemsa's staining and transmission electron microscopy, detected the mutation of the DPY19L2 gene by PCR amplification and DNA sequencing, and compared the findings with the sequences issued in the Genbank.

RESULTS

Wright-Giemsa's staining showed that all the spermatozoa were round-headed and lacked the acrosome, with the head nucleus darkly, fully and densely stained. Transmission electron microscopy revealed larger round sperm heads, with an even layer of unit membrane surrounding the nuclei and dispersed cytoplasmic vacuoles but no acrosomal structure. No DPY19L2 gene mutation was found by PCR amplification and DNA sequencing.

CONCLUSION

No homozygous mutation of the DPY19L2 gene was found in the globozoospermia patient, and therefore some other disease-causing genes might be involved.

Halobellus litoreus sp. nov., a halophilic archaeon isolated from a Chinese marine solar saltern

Halophilic archaeal strain GX31(T) was isolated from a marine solar saltern of China. The cells of the strain were rod-shaped and lysed in distilled water, stain Gram-negative and formed red-pigmented colonies. It was neutrophilic, and required at least 0.9 M NaCl and 0-1.0 M MgCl2 for growth under the optimum growth temperature of 37 °C. The major polar lipids of the strain were phosphatidylglycerol (PG), PG phosphate methyl ester, PG sulphate, and two major glycolipids chromatographically identical to sulphated mannosyl glucosyl diether (S-DGD-1) and mannosyl glucosyl diether (DGD-1), respectively. Trace amounts of two unidentified lipids were also detected. On the basis of 16S rRNA gene sequence analysis, strain GX31(T) was closely related to the members of Halobellus of the family Halobacteriaceae with similarities of 94.1-98.7 %. Strain GX31(T) showed 89.8-95.4 % of the rpoB' gene similarity to the members of Halobellus. The DNA G+C content of strain GX31(T) was 66.8 mol%. Strain GX31(T) showed low DNA-DNA relatedness with two most related members of the genus Halobellus. The phenotypic, chemotaxonomic and phylogenetic properties suggest that strain GX31(T) represent a novel species of the genus Halobellus, for which the name Halobellus litoreus sp. nov. is proposed. The type strain is GX31(T) (=CGMCC 1.10387(T) = JCM 17118(T)).

Abdominal lymphangioma: An analysis of 18 cases

AIM: To analyze the clinical manifestations, imaging features, diagnosis and treatment of abdominal lymphangioma.

METHODS: Clinical data for 18 patients with abdominal lymphangioma who received treatment at our hospital from January 2008 to December 2012 were retrospectively analyzed.

RESULTS: Most of the tumors had clear boundaries and were round, oval or lobulated. All patients with tumors ranging from 7 to 19 cm underwent operation. Pathological analysis showed that the tumor was composed of irregular and expanded lymphatic vessels. Postoperative recovery was good in all patients, and no recurrence occurred.

CONCLUSION: Abdominal lymphangioma is a rare clinical abdominal disease, whose diagnosis relies on preoperative comprehensive physical and imaging examinations. The prognosis for abdominal lymphangioma treated by surgery is good.

Halobellus rarus sp. nov., a halophilic archaeon from an inland salt lake of China

Two halophilic archaeal strains, YC21(T) and YC77, were isolated from an inland salt lake of China. Both have pleomorphic rod-shaped cells that lyse in distilled water, stain Gram-negative and form red-pigmented colonies. They are neutrophilic, require at least 2.1 M NaCl for growth under the optimum growth temperature of 37 °C. The major polar lipids of the two strains were phosphatidylglycerol (PG), phosphatidylglycerol phosphate methyl ester (PGP-Me), phosphatidylglycerol sulfate (PGS), two major glycolipids (GL1 and GL2) chromatographically identical to sulfated mannosyl glucosyl diether (S-DGD-1) and mannosyl glucosyl diether (DGD-1), respectively. Trace amounts of two unidentified lipids (GL0-1 and GL0-2) were also detected. The 16S rRNA gene sequences of the two strains are 99.9 % identical, show 94.0-98.9 % similarity to the closest relative members of Halobellus of the family Halobacteriaceae. The rpoB' gene similarity between strains YC21(T) and YC77 is 99.8 % and show 90.3-95.3 % similarity to the closest relative members of Halobellus. The DNA G+C content of strains YC21(T) and YC77 were 66.1 and 66.2 mol%, respectively. The DNA-DNA hybridization value between strain YC20(T) and strain YC77 was 89 %, and the two strains showed low DNA-DNA relatedness with Halobellus limi TBN53(T), the most related member of Halobellus. The phenotypic, chemotaxonomic and phylogenetic properties suggest that strains YC21(T) and YC77 represent a novel species of the genus Halobellus, for which the name Halobellus rarus sp. nov. is proposed. The type strain is YC21(T) (=CGMCC 1.12121(T) = JCM 18362(T)).

MiR495- and miR551a-mediated down-regulation of PRL-3 expression inhibits peritoneal metastasis in a mouse model of gastric cancer

AIM: To investigate the effect of miR495 and miR551 on PRL-3 expression in gastric cancer SGC7901 cells to explore gene interference therapies for gastric cancer.

METHODS: SGC7901 cells stably transfected with miR495 or miR551a and non-transfected SGC7901 cells were inoculated intraperitoneally in BALB/CA (nu/nu) nude mice. One month after inoculation, the mice were killed to observe the rate of tumor formation, tumor growth and migration. Real-time PCR was performed to quantify mRNA levels of miR495, miR551a and PRL-3.

RESULTS: Compared to nude mice inoculated with non-transfected cells, miR495 and miR551a levels were increased, PRL-3 level was decreased, and migration of gastric cancer was suppressed in mice inoculated with SGC7901 cells stably transfected with miR495 or miR551a.

CONCLUSION: MiR495 and miR551a can suppress the migration of gastric cancer by inhibiting PRL-3 expression in mice.

Suppressive effect of miR495 and miR551a on PRL-3 expression in gastric cancer SGC7901 cells

AIM: To construct miRNA495 and miRNA551a expression vectors targeting the PRL-3 gene, and to observe the effect of vector transfection on the expression of PRL-3 in gastric cancer SGC7901 cells.

METHODS: Specific pre-miRNA495 and pre-miRNA551a sequences targeting the PRL-3 gene were designed, synthesized, and ligated with the pcDNA6.2-GW/EmGFP-miR vector. After sequencing to confirm correct insertion, the recombinant vectors were transfected into SGC7901 cells with Lipofectamine™ 2000. The expression of PRL-3 in transfected cells was detected by real-time PCR and Western blot.

RESULTS: The PRL-3 pre-miRNA495 and pre-miRNA551a recombinant plasmids were successfully constructed, and they could effectively promote the expression of miRNA495 and miRNA551a and inhibit PRL-3 mRNA and protein expression in SGC7901 cells.

CONCLUSION: The miRNA495 and miRNA551a expression vectors for silencing the PRL-3 gene have been constructed successfully, which could effectively promote the expression of miRNA495 and miRNA551a and inhibit PRL-3 mRNA and protein expression in SGC7901 cells.

Update of PROFEAT: a web server for computing structural and physicochemical features of proteins and peptides from amino acid sequence

Sequence-derived structural and physicochemical features have been extensively used for analyzing and predicting structural, functional, expression and interaction profiles of proteins and peptides. PROFEAT has been developed as a web server for computing commonly used features of proteins and peptides from amino acid sequence. To facilitate more extensive studies of protein and peptides, numerous improvements and updates have been made to PROFEAT. We added new functions for computing descriptors of protein–protein and protein–small molecule interactions, segment descriptors for local properties of protein sequences, topological descriptors for peptide sequences and small molecule structures. We also added new feature groups for proteins and peptides (pseudo-amino acid composition, amphiphilic pseudo-amino acid composition, total amino acid properties and atomic-level topological descriptors) as well as for small molecules (atomic-level topological descriptors). Overall, PROFEAT computes 11 feature groups of descriptors for proteins and peptides, and a feature group of more than 400 descriptors for small molecules plus the derived features for protein–protein and protein–small molecule interactions. Our computational algorithms have been extensively tested and used in a number of published works for predicting proteins of specific structural or functional classes, protein–protein interactions, peptides of specific functions and quantitative structure activity relationships of small molecules. PROFEAT is accessible free of charge at http://bidd.cz3.nus.edu.sg/cgi-bin/prof/protein/profnew.cgi.