Desmoglein 2 and desmocollin 2 depletions promote malignancy through distinct mechanisms in triple-negative and luminal breast cancer

BACKGROUND

Aberrant expressions of desmoglein 2 (Dsg2) and desmocollin 2(Dsc2), the two most widely distributed desmosomal cadherins, have been found to play various roles in cancer in a context-dependent manner. Their specific roles on breast cancer (BC) and the potential mechanisms remain unclear.

METHODS

The expressions of Dsg2 and Dsc2 in human BC tissues and cell lines were assessed by using bioinformatics analysis, immunohistochemistry and western blotting assays. Wound-healing and Transwell assays were performed to evaluate the cells' migration and invasion abilities. Plate colony-forming and MTT assays were used to examine the cells' capacity of proliferation. Mechanically, Dsg2 and Dsc2 knockdown-induced malignant behaviors were elucidated using western blotting assay as well as three inhibitors including MK2206 for AKT, PD98059 for ERK, and XAV-939 for β-catenin.

RESULTS

We found reduced expressions of Dsg2 and Dsc2 in human BC tissues and cell lines compared to normal counterparts. Furthermore, shRNA-mediated downregulation of Dsg2 and Dsc2 could significantly enhance cell proliferation, migration and invasion in triple-negative MDA-MB-231 and luminal MCF-7 BC cells. Mechanistically, EGFR activity was decreased but downstream AKT and ERK pathways were both activated maybe through other activated protein tyrosine kinases in shDsg2 and shDsc2 MDA-MB-231 cells since protein tyrosine kinases are key drivers of triple-negative BC survival. Additionally, AKT inhibitor treatment displayed much stronger capacity to abolish shDsg2 and shDsc2 induced progression compared to ERK inhibition, which was due to feedback activation of AKT pathway induced by ERK inhibition. In contrast, all of EGFR, AKT and ERK activities were attenuated, whereas β-catenin was accumulated in shDsg2 and shDsc2 MCF-7 cells. These results indicate that EGFR-targeted therapy is not a good choice for BC patients with low Dsg2 or Dsc2 expression. Comparatively, AKT inhibitors may be more helpful to triple-negative BC patients with low Dsg2 or Dsc2 expression, while therapies targeting β-catenin can be considered for luminal BC patients with low Dsg2 or Dsc2 expression.

CONCLUSION

Our finding demonstrate that single knockdown of Dsg2 or Dsc2 could promote proliferation, motility and invasion in triple-negative MDA-MB-231 and luminal MCF-7 cells. Nevertheless, the underlying mechanisms were cellular context-specific and distinct.

[Construction of a nomogram model for predicting 2-year survival rate of small cell lung cancer based on more comprehensive variables]

Objective: To construct a novel prognostic nomogram model based on more comprehensive variables for patients with small-cell lung cancer (SCLC). Methods: The data of 722 patients with SCLC confirmed by pathology in Affiliated Cancer Hospital of Shanxi Medical University from January 2015 to December 2018 were retrospectively analyzed [including 592 males and 130 females, aged from 23 to 82(61±9) years]. A random seed count of 133 was used to divide those patients into training set (n=422) and validation set (n=300). Kaplan-Meier was used for survival curves analysis and univariate Log-rank test was used for evaluating the influence of clinical variables on the prognosis of sclc, variables with P<0.05 in univariate analysis were included in a multivariate Cox regression model. The nomogram was constructed based on the variables which P<0.05 in multivariate analysis. Receiver operating characteristic (ROC) curve, calibration by Integrated Brier score (IBS) and clinical net benefit by decision curve analysis (DCA) were used to evaluate model discriminative power, prediction error value, and clinical net benefit, and compared with the American Joint Committee on Cancer 8th TNM. Results: Male, abnormal monocyte (MON) counts, abnormal neuron specific enolase (NSE), abnormal cytokeratin 19 fragment (Cyfra211), M1a stage, M1b stage, M1c stage, radiotherapy (RT), chemotherapy ≥4 cycles and prophylactic cranial irradiation (PCI) were prognostic factors for SCLC[HR(95%CI)=1.39(1.00-1.92), 1.29(1.02-1.63), 1.41(1.11-1.80), 2.02(1.48-2.76), 1.09(0.77-1.55), 1.44(0.94-2.22), 2.01(1.49-2.71), 0.75(0.57-0.98), 0.40(0.31-0.51)and 0.42(0.26-0.68), respectively, all P<0.05]. The area under ROC curve (AUC) of the nomogram in training set and validation set were 0.814(95%CI: 0.765-0.862)and 0.787 (95%CI: 0.725-0.849), which were higher than TNM [0.616(95%CI: 0.558-0.674) and 0.648(95%CI: 0.581-0.715)].The calibration curve showed a good correlation between the nomogram prediction and actual observation for the 2-year overall survival (OS). IBS indicted a lower prediction error rate (training set: 0.132 vs 0.169; validation set: 0.138 vs 0.169). DCA showed a wider threshold range than TNM (training set: 0.01-0.96 vs 0.01-0.85, validation set: 0.01-0.94 vs 0.01-0.86) and a greater improvement of the clinical net benefit (in training set the nomogram had a greater clinical benefit than TNM in the range of 0.19-0.96, and remained in validation set in the range of 0.19-0.94). Conclusion: The established nomogram model for predicting 2-year OS in patients with SCLC based on 8 variables, including gender, MON, NSE, Cyfra211, M stage, RT, CT cycles and PCI can be used for an more accurately prognosis prediction and reference for therapeutic regimen selection.

[Surveillance of soil-borne nematodiasis in Yancheng City from 2016 to 2020]

OBJECTIVE

To understand the prevalence of soil-transmitted nematode infections in Yancheng City from 2016 to 2020, so as to provide insights into the development of the scheme for further soil-transmitted nematodiasis surveillance.

METHODS

Soil-borne nematode infections were detected using the modified Kato-Katz method (two slides for one sample) among the permanent residents living in Yancheng City from 2016 to 2020, and Enterobius vermicularis infection was additionally detected among children at ages of 12 years and lower using the adhesive cellophane-tape perianal swab method. The prevalence and intensity of human soil-borne nematode and E. vermicularis infections were descriptively analyzed.

RESULTS

A total of 51 259 person-time residents were detected for soil-borne nematode infections in Yancheng City from 2016 to 2020, and 48 egg-positives were identified, with a 0.09% prevalence. The soil-borne nematodes infecting residents included Ascaris lumbricoides, hookworm and Trichuris trichiura, with 0.04%, 0.05% and 0.002% prevalence rates of infections, and all infections were mild. There was a region-specific prevalence of soil-borne nematode infections in Yancheng City (χ² = 18.21, P = 0.02), with the highest prevalence seen in Funing County (0.21%), while no infections were detected in Dafeng District for five successive years. The overall prevalence of E. vermicularis infections was 0.22% among children at ages of 12 years and lower in Yancheng City.

CONCLUSIONS

The prevalence of soil-borne nematode infections appears a gradual decline in residents living in Yancheng City from 2016 to 2020, and is at an extremely low level. Further surveillance of soil-transmitted nematodiasis requires to be intensified targeting key regions and populations to consolidate the control achievements.

CatLet score and Clinical CatLet score as predictors of long-term outcomes for patients with acute myocardial infarction undergoing delayed percutaneous coronary intervention

Background

We have recently developed a Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system based on the 17 myocardial segment model, law of competitive blood supply, and law of flow conservation. This novel angiographic scoring system can be utilized to account for the variable coronary anatomy, the severity and complexity of coronary artery lesions, and to standardize the collection of angiographic data. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score for patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). The current study aimed at assessing whether the CatLet score (CS) and the Clinical CatLet score (CCS) predicted clinical outcomes for AMI patients undergoing delayed PCI.

Methods

The CS was calculated in 1018 consecutively prospectively enrolled AMI patients. Primary end point was major adverse cardiac events (MACEs), a composite of myocardial infarction, cardiac death, and ischemia-driven revascularization. CCS was calculated multiplying the CS by the ACEF score constructed using age, creatinine, and LVEF. Tertile partitioning of CS and CCS were as follows: CSlow ≤12, CSmid 13–18, and CStop ≥19; CCSlow ≤13, CCSmid 14–24, and CCStop ≥25, respectively. Cox regression analysis was employed to identify the associations between predictors and clinical outcomes.

Results

Four-year MACE rates were significantly higher with CStop compared with CSlow [4.82 (3.39–6.85), P&lt;0.001], which was also the case for all-cause death, cardiac death, myocardial infarction, and ischemia-driven revascularization; for all these endpoints, there were a significant trend (P&lt;0.001) for higher event rates with the increasing CS tertiles as shown in Figure 1. Stratifying outcomes across CCS tertiles resulted in similar results for the comparisons between CCStop and CCSlow. For MACEs, CCS had a significantly increased C-index [(C-index (95% CI), 0.725 (0.692–0.759) vs. 0.693 (0.659–0.727), P=0.001] compared with CS, which was also the case for all-cause death, cardiac death, and myocardial infarction. However, for ischemia-driven revascularization, CCS had a slightly decreased C-index [0.655 (0.609–0.701) vs. 0.670 (0.625–0.716), P=0.235] compared with CS, without a significant difference. In terms of calibration, CCS was comparable to CS for MACEs, all-cause death, cardiac death, and myocardial infarction. However, calibration for ischemia-driven revascularization worsened for CCS compared with CS (χ2=22.07, P=0.004 vs. χ2=7.79, P=0.454). Both scores remained to be independent predictors of clinical outcomes (in separate models) after adjustment for a broad spectrum of risk factors.

Conclusions

CS and to a greater extent CCS were able to risk-stratify long-term outcomes in AMI patients undergoing delayed PCI.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): 2020YFC2004705 & SYS2019040 Figure 1. Kaplan-Meier curves for endpoints

[Investigation on the risk of of Anisakis infection among high - risk populations along the coastal areas of Jiangsu Province]

OBJECTIVE

To investigate the risk of Anisakis infections among high-risk populations along the coastal areas of Jiangsu Province, so as to develop the strategy for the prevention and control of anisakiasis in the province.

METHODS

Three counties along the coastal areas of Jiangsu Province were selected as the study sites in 2018, including Rudong County in Nantong City, Haizhou District in Lianyungang City and Dongtai City in Yancheng City. The knowledge, attitude and practice (KAP) of anisakiasis prevention and control, and the prevalence of serum specific IgG antibody against Anisakis were investigated among high-risk populations among these three study sites, including fishermen, fish seller and people who liked eating fresh and live marine fish. Factors affecting the prevalence of the specific IgG antibody against Anisakis were identified using a multiple logistic regression model. In addition, Anisakis larvae infections were detected in fresh and live marine fish samples collected from local markets, and the prevalence and intensity of Anisakis infections were estimated.

RESULTS

A total of 625 high-risk populations were investigated, including 349 men (55.8%). Only 13.0% of the subjects heard about anisakiasis, and a low awareness rate of anisakiasis prevention and control knowledge was seen among these three types of high-risk populations. There were 21.6% of the subjects eating raw or half-cooked marine fish, 5.8% eating undercooked marine fish, 3.2% presenting vomiting, nausea and diarrhea after eating marine fish, 5.1% developing systemic allergic symptoms, and 65.6% using the same chopping board for raw and cooked food. The sero-prevalence of the anti-Anisakis IgG antibody was 7.0% among the study subjects. Multiple logistic regression analysis identified education level [OR = 0.687, 95% CI (0.478, 0.987)] and development of systemic allergic symptoms [OR = 4.641, 95% CI(1.411, 15.268)]as factors affecting the positive anti-Anisakis IgG antibody among the study subjects. Among 494 fresh and live marine fish detected, the prevalence and intensity of Anisakis larvae infection was 64.0% and 8.1 larvae per fish, with high prevalence seen in Trichiurus haumela and Pneumatophorus japonicas.

CONCLUSIONS

The awareness of anisakiasis prevention and control knowledge is low among the high-risk populations living along the coastal areas of Jiangsu Province, and there are high-risk behaviors, such as eating raw or half-cooked food, using the same chopping board for raw and cooked food. In addition, the prevalence of Anisakis infections is high in the marine fish in these areas. Therefore, the health education and health promotion for anisakiasis prevention and control should be intensified.

[Investigation of Anisakis infections in market-available marine fish in Dongtai City]

OBJECTIVE

To understand the situation of Anisakis infection of in market-available marine fish in Dongtai City, so as to provide the evidence for the assessment of the risk of human Anisakis infections.

METHODS

Raw and fresh marine fish caught in the sea of Dongtai City for sale were collected in 2018. The fish were weighted and dissected for the identification of Anisakis, and the prevalence and intensity of Anisakis infections were calculated. In addition, the correlation between the weight of Anisakis-infected marine fish and the infection intensity of Anisakis was examined.

RESULTS

There were four species of marine fish infected with Anisakis, including Trichiurus haumela, Scomberomorus niphonius, Pneumatophorus japonicus and Larimichthys polyactis. Among the 149 fish samples, there were 78 with Anisakis infections, with a prevalence rate of 52.35%. The prevalence of Anisakis infection was 100.00% (28/28), 30.00% (9/30), 0 (0/30), 53.33% (16/30) and 80.65% (25/31) in T. haumela, S. niphonius, cuttle fish, P. japonicus and L. polyactis, respectively. A total of 1 049 Anisakis worms were collected, and the overall intensity of infection was 13.45 worms per fish. Spearman correlation analysis showed a positive correlation between the weight of T. haumela and the intensity of Anisakis infection (rs = 0.38, P = 0.047), and no correlation was found in other fish species.

CONCLUSIONS

There is a high rate of Anisakis infection in marine fish along the offshore areas of Dongtai City. Intensification of health education is required and healthy and safe dietary habits are encouranged.

Long non-coding RNA highly up-regulated in liver cancer promotes exosome secretion

BACKGROUND

Highly upregulated in liver cancer (HULC) is a long non-coding RNA (lncRNA) which has recently been identified as a key regulator in hepatocellular carcinoma (HCC) progression. However, its role in the secretion of exosomes from HCC cells remains unknown.

AIM

To explore the mechanism by which HULC promotes the secretion of exosomes from HCC cells.

METHODS

Serum and liver tissue samples were collected from 30 patients with HCC who had not received chemotherapy, radiotherapy, or immunotherapy before surgery. HULC expression in serum exosomes and liver cancer tissues of patients was measured, and compared with the data obtained from healthy controls and tumor adjacent tissues. The effect of HULC upregulation in HCC cell lines and the relationship between HULC and other RNAs were studied using qPCR and dual-luciferase reporter assays. Nanoparticle tracking analysis was performed to detect the quantity of exosomes.

RESULTS

HULC expression in serum exosomes of patients with HCC was higher than that in serum exosomes of healthy controls, and HULC levels were higher in liver cancer tissues than in tumor adjacent tissues. The expression of HULC in serum exosomes and liver cancer tissues correlated with the tumor-node-metastasis (TNM) classification, and HULC expression in tissues correlated with that in serum exosomes. Upregulation of HULC promoted HCC cell growth and invasion and repressed apoptosis. Notably, it also facilitated the secretion of exosomes from HCC cells. Moreover, qPCR assays showed that HULC repressed microRNA-372-3p (miR-372-3p) expression. We also identified Rab11a as a downstream target of miR-372-3p. Dual-luciferase reporter assays suggested that miR-372-3p could directly bind both HULC and Rab11a.

CONCLUSION

Our findings illustrate the importance of the HULC/miR-372-3p/Rab11a axis in HCC and provide new insights into the molecular mechanism regulating the secretion of exosomes from HCC cells.

[Effect of CCR1 gene overexpression on the migration of bone marrow - derived mesenchymal stem cells towards hepatocellular carcinoma]

Objective: To evaluate the effect of human CCR1 (hCCR1) gene overexpression on the migration of human bone marrow-derived mesenchymal stem cells (hMSCs) towards hepatocellular carcinoma (HCC), and to examine the application prospects of MSCs as gene delivery vectors in the treatment of HCC. Methods: The hCCR1 gene was subcloned into a lentiviral vector to generate the recombinant plasmid pLV-hCCR1. The pLV-hCCR1 plasmid and two other packaging plasmids were co-transfected into 293T cells using calcium phosphate, and the virus-containing supernatant was collected. hMSCs were then infected with the recombinant lentivirus, and the expression of hCCR1 mRNA and protein was analyzed by RT-PCR and Western blot, respectively. The effect of CCR1 gene overexpression on the in vitro migration of hMSCs was examined using the Transwell migration assay. Orthotopic nude mice models of HCC were established using the MHCC-97H-GFP cell line, and the mice were divided into two groups (n = 8 per group). hMSCs were then intravenously injected via the tail vein into the tumor-bearing nude mice to examine the effect of hCCR1 overexpression on the in vivo migration of hMSCs towards HCC. Unpaired Student's t-test was used for two-group comparisons, and one-way ANOVA was used for multi-group comparisons. Results: Restriction enzyme digestion and DNA sequencing demonstrated that the recombinant plasmid pLV-hCCR1 was constructed successfully. The LV-hCCR1 lentivirus packaged by 293T cells has high infection efficiency in hMSCs, and hCCR1 was overexpressed in hMSCs after LV-hCCR1 infection. Transwell migration assay showed that hCCR1-transfected hMSCs had significantly enhanced migration towards HCC cell line-derived condition medium (CM) compared with the control RFP-hMSCs [(134.8±15.7)/LPF vs (83.5±10.9)/LPF, t = 10.40, P < 0.01]. In vivo migration experiment also demonstrated that there was significantly higher number of hCCR1-hMSCs localized within the MHCC-97H-GFP xenografts than hMSCs-RFP on day 14 following intravenous injection of hMSCs in mice [(86.7±14.1)/HPF vs (54.5±9.6)/HPF, t = -7.32, P < 0.01]. Conclusion: Overexpression of CCR1 gene can significantly enhance the migration capacity of hMSCs towards HCC cells in vitro and in vivo. This study provides evidence for potential clinical application of MSCs as more effective delivery vehicles in cancer gene therapy.

[Expressions and prognostic significance of PTEN and PD-1 protein in patients with classical Hodgkin's lymphoma]

目的

分析肿瘤免疫耐受信号通路的重要因子PD-1和PTEN在经典型霍奇金淋巴瘤（CHL）患者中的表达及其与患者临床特征和预后的相关性。

方法

回顾性分析2003年2月至2013年8月诊治的56例CHL患者的临床资料。采用免疫组织化学染色法检测CHL患者PD-1和PTEN蛋白的表达，采用原位杂交法检测EBV及EBV编码的小mRNA（EBER），并结合患者的临床特征与生存状态进行相关性分析。

结果

①56例患者中，男34例，女22例，中位年龄25（7~71）岁，PTEN阳性者11例（19.64%），PD-1阳性者14例（25.00%）。②PTEN和PD-1表达呈正相关（rs=0.320，P=0.016）；PTEN表达与Ann Arbor分期、IPS评分和有无大包块（≥5 cm）明显相关，PD-1仅与有无大包块相关（P值均<0.05）。③中位随访43（5~86）个月，多因素分析结果显示：年龄≥45岁（P<0.001）、IPS评分>2分（P=0.026）、EBER阳性（P=0.004）、PTEN蛋白高表达（P=0.035）是影响患者5年总生存的不良预后因素，也是影响5年无进展生存的不良预后因素（P值分别为0.007、0.014、0.002、0.024）。

结论

肿瘤免疫逃逸信号通路因子PTEN与CHL患者的预后相关，对CHL患者的预后判断有一定作用，同时也为CHL的免疫治疗提供了新思路和理论依据。

[Clinical application of LDLT after reconstruction of IVC using artificial blood vessel in the treatment of HCC beyond Milan Criteria]

Objective: To assess application of reconstruction of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation (LDLT) in the treatment of hepatocellular carcinoma (HCC) beyond Milan Criteria. Methods: The clinical data of 9 HCC patients who underwent right lobe liver transplantation after reconstruction of retrohepatic inferior vena cava using artificial blood vessel between June 2015 and Nov 2016 at Liver Transplantation Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The liver of the patients was removed with retrohepatic inferior vena cava, and then the right donor graft was implanted by conventional orthotopic liver transplantation. Results: All 9 liver transplantations were performed successfully. The time of reconstruction of hepatic venous outflow of the donor graft was (22.6±3.0) min, anhepatic time was (45.0±7.1) min, and total operation time was (321.9±52.5) min. All patients recovered uneventfully, ICU and hospital stay day were (1.2±0.4) days and (18.4±3.0) days. 2 patients suffered from thrombosis of artificial blood vessel, one recovered after conservative treatment and another was treated by placement of vein stent. No abdominal/pulmonary infection and non-artificial blood vascular complications were found, and none died in perioperative period. Postoperative pathological results showed that all patients were hepatocellular carcinomas and vascular tumor thrombosis was found in 5 cases. All patients were follow up, 1 patient died of pulmonary and brain metastasis 10 months after operation. One patient survived with local recurrence of tumor in liver. The other patients had no tumor recurrence and metastasis. Conclusion: Replacement of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation is safe and feasible in the treatment of HCC beyond Milan Criteria, and might improve the resection rate of diseased liver and the prognosis of HCC patients after living donor liver transplantation.

[Analysis of curative effect of transoral radiofrequency ablation microsurgery on glottic carcinoma with anterior commissure involvement at the early stage]

Objective: To explore the key technique and outcome of transoral radiofrequency ablation microsurgery for early stage of glottic carcinoma with anterior commissure involvement (ACI). Methods: A retrospective analysis was conducted on 31 patients, who were diagnosed as early stage glottic carcinoma during January 2010 to March 2016 in ENT Department. According to whether the anterior commissure was involved or not, two groups were divided. There were eleven cases with ACI (stages T1a, T1b, and T2). Twenty cases without ACI (stages Tis, T1a, and T2). All the patients received transoral radiofrequency ablation microsurgery and followed up closely.Only one case received radiotheraphy after surgery. SPSS19.0 software was used to analyze data. Results: The follow-up time was 12-67 months, and the median follow-up time was 30 months. Nine among 11 cases with ACI obtained good oncologic outcomes, initial local recurrence was identified in 2/11 cases, including 2 cases of T2. Two cases ultimately required salvage total laryngectomy. Meanwhile, initial local recurrence was identified in 2/20 cases without ACI, including 1 case of T1a and 1 case of T2. One case underwent elective neck dissection, and another one received salvage total laryngectomy.Compared to the patients without ACI, it seemed that the cases with ACI always accomponied with a little higher initial local recurrence and lower overall laryngealpreservation, but the difference had no significance (P>0.05). Conclusions: Transoral radiofrequency ablation microsurgery is an effective treatment for glottic carcinoma with ACI. Its advantages, such as more flexibility and deformability, make it more feasible to operate at the narrow space of anterior commissure assisted with laryngeal endoscopy.Good oncologic outcomes can be obtained by this technique with lower initial local recurrence as well as higher overall laryngeal preservation rate.

[Complications analysis of adenoidectomy and tonsillectomy assisted with ablation on children]

Objective:To analyze the complications of adenotonsilectomy assisted with coblation in children. Method:Complications of 2 089 cases of children with adenoid and tonsil surgery assisted with coblation, in our hospital nearly 10 years, were analyzed by epidemiological methods through the method of retrospective analysis. Result:①the sex ratio of male to female was 2.08：1, average age (5.87±3.12) years old, and most of 2 089 cases 76.35% (1 595/2 089) were 3-7 years old; ②all cases underwent adenoidectomy. Different surgery methods of tonsil consisted of three groups as partial resection associated with ablation was 69.17% (1 445/2 089), ablation (channeling) alone was 22.26% (465/2 089) and total resection was 8.57% (179/208). The amount of bleeding in operation was (8.52±3.18)ml, average operation time was (30.15±8.26) minutes, the postoperative pain score was (3.77±1.61); ③The incidence of postoperative complications: postoperative bleeding (all were secondary bleeding cases) rate was 0.24% (5/2 089), recurrence rate was 0.14% (3/2 089), prevertebral lymphadenitis was 0.96% (20/2 089), the other was 0.29% (torus hyperplasia in 2 cases, dyspnea in 2 cases, 1 cases of angle of mouth burned, nasopharyngeal adhesion in 1 cases). Postoperative fever rate was 9.81% (205/2 089). Conclusion:coblation technique is a good method for the treatment of children's adenoids and tonsil diseases with high efficiency and low complications. But improving the operation procedure proficiency level and skills of operation is an important link to reduce complications.

[Expression and prognostic significance of microenvironment related prognostic factors in patients with classical Hodgkin's lymphoma]

Objective: To observe the expression of three microenvironment related prognostic factors, i. e. programmed death 1 (PD-1), forkhead box protein 3(FOXP3) and colony-stimulating factor 1 receptor(CSF-1R) protein in classical Hodgkin's lymphoma (CHL) patients, and to explore the correlation between the protein expression and the prognosis of the patients. Methods: A total of 45 cases of CHL patients, who had been admitted to the Tianjin Medical University Cancer Institute and Hospital and Chinese PLA General Hospital from February 2005 to August 2010 were analyzed, including clinical features, prognostic factors, and treatment regimens. CHL patients' specimens were collected and the expression of PD-1, FOXP3, and CSF-1R proteins analyzed by immunohistochemical staining. Epstein-Barr virus encoded mRNA (EBER) was detected by in situ hybridization analysis. The relationship between the protein expression of PD-1, FOXP3 and CSF-1R and the patients' outcome was analyzed with clinical and follow-up data. Survival analysis was performed by Kaplan-Meier method, the Cox proportional hazard model was used to perform multivariate analysis. Results: In this cohort of 45 CHL patients, PD-1 positive was found in 7 cases (15.6%), FOXP3 high expression in 23 cases (51.1%), CSF-1R positive in 18 cases (40.0%). In the univariate analysis, the expression of FOXP3 and CSF-1R, International Prognostic Index (IPI) score, Ann Arbor stage and EBER were related with the patients' 5-year overall survival (OS); IPI score, the expression of FOXP3 and EBER were related with the patients' 5-year progress-free survival (PFS). Multivariate analysis indicated that CSF-1R protein expression was the independent prognostic factor affecting the patients' 5-year OS(HR: 8.918, P=0.020), and FOXP3 protein expression was the independent prognostic factor affecting the patients' 5-year PFS (HR: 0.122, P<0.001). And EBV was an independent prognostic factor of PFS and OS in the CHL patients. Conclusion: Microenvironment related prognostic factors FOXP3, CSF-1R and EBV may be independent prognostic factors of CHL and this study may provide novel strategies for targeted therapy of CHL.

[Photodynamic therapy by topical drup for the treatment of juvenile onset laryngeal papillomatosis]

Objective:To observe the therapeutic effect of photodynamic therapy(PDT) on the treatment of juvenile onset laryngeal papillomatosis. Method:Twenty-eight cases of children with laryngeal papilloma were treated,only 2 cases for the first time, and the rest were repeatedly treated outside our hospital, the average hospital surgery were more than 4 times. Under self retaining laryngoscope and microscope and endoscope assisted by semiconductor laser and plasma and cold instrument method，visible tumor resection and local affixed deposited 20% 5-aminolevulinic acid(photosensitizer) 3 hours later, with 635 nm semiconductor laser photodynamic,200-280 mW and can volume density of 80 to 120 J/cm², 20 min irradiation. PDT should be repeated after 25 days until no visible tumor.Then,2 times PDT must be done. Result:In 28 cases, 24 cases were followed up for more than 1 years(12 cases were followed up for 3 years),19 had no recurrence, the cure rate was 79.2%(19/24)；5 cases recurrence, and the recurrence rate was 20.8%(5/24)，among them,2 cases were abandoned because of the relapse，the other 3 cases were cure after 3 times of PDT.The main complications were adhesion of larynx. Conclusion:The preliminary effect of PDT by topical drug for the treatment of juvenile onset laryngeal papillomatosis is encouraging. The principle of PDT and the principle of the recurrence of laryngeal papilloma in children were also introduced in this paper.

MicroRNA-506 is up-regulated in the development of pancreatic ductal adenocarcinoma and is associated with attenuated disease progression

BACKGROUND

MicroRNA-506 (miR-506) has been reported to function in several tumors as a tumor suppressor gene or oncogene. However, the expression and role of miR-506 in pancreatic ductal adenocarcinoma (PDAC) remains unclear. In this study, we aimed to evaluate the phenotype of miR-506 in PDAC.

METHODS

Using miRNA in situ hybridization, we examined the expression of miR-506 in 113 PDACs and 87 paired normal pancreatic tissues. We evaluated miR-506 expression in PDAC cells, normal pancreatic ducts, and acinus/islands, and we analyzed the associations between miR-506 expression and the clinicopathologic characteristics of PDAC patients.

RESULTS

miR-506 expression was higher in PDAC than in matched normal pancreatic ductal cells (P < 0.001). On the other hand, the combined group of well and moderately differentiated PDACs showed higher levels of miR-506 than the poorly differentiated ones (P = 0.023). Moreover, miR-506 expression was negatively associated with pathologic T category (P = 0.004) and lymph node metastasis (P = 0.033), suggesting that miR-506 might inhibit the progression of PDAC.

CONCLUSIONS

Our results suggest that miR-506 either plays a role as an oncogene in the tumorigenesis and a tumor suppressor in the progression or serves as a house-keeping, tumor-suppressing miRNA, whose expression can be activated by oncogenic signals in early development to hinder the progression of PDAC.

[Clinical effect analysis of adenoidectomy and tonsillectomy assisted with ablation on children]

Objective:This study aims to explore the clinical effect of adenoidectomy and tonsillectomy assisted with ablation on children.Method:The investigation took the form of retrospective review of 2 089 cases of children applied with adenoidectomy and tonsillectomy assisted with ablation in our hospital in recent 10 years. We obtained data of these children with epidemiological methods based on analyzing the status of general information and operation selections, and then analyzing the scores of snoring and breath preoperation and postoperation.Result:①General information of 2 089 cases followed with: the ratio of male and female was 2.08∶1，the average onset age was（5.87±3.12）years old, mostly ranged from 3 to 7 years old, which consists of 76.35%（1595/2089）of the group.②Different surgery methods of tonsil consisted of three groups as: partial resection associate with ablation was 69.17%(1445/2089), ablation alone was 22.26%(465/2089) and partial resection alone was 8.57%(179/2089) of the group.③A high level scores of snoring and breath more frequently found in preoperative cases than in postoperative cases(P <0.01).There are no differentiation among the scores of above three groups(P >0.05).The postoperative effect evaluation were related to allergic rhinitis, recurrent of tonsillitis, obesity, circular occipital hyperplasia and nasopharyngeal adhesion.Conclusion:The results suggested that surgery assisted with ablation has its advantage in adenoidectomy and tonsillectomy. Individual therapy for different children will improve the curative effect and relieve the pain of operation, thus is worth a wide application.

[Evaluate the prevalence of trachoma in high risk area of China]

OBJECTIVE

To determine the prevalence of trachoma in urban and rural area in China. To provide the data evidence for the strategies of eliminating trachoma in China.

METHODS

Survey was conducted in 13 suspect trachoma high prevalence provinces according to the World Health Organization trachoma grading system and Trachoma Rapid Assessment(TRA).

RESULTS

From 2004 to 2007, a total number of examined children which were younger than 10 years old was 59 630. The prevalence of TF was 0.94%. To sum up the data of 2004 and 2005, the prevalence of active trachoma was 1.71% for children.TT and CO was not reported. The results for subjects older than 50 years old showed that the prevalence of TT was 0.34%. We examined 26 857 adults in both 2004 and 2005.The prevalence of TF, TI, TS and CO was 0.03%,0.08%,0.88% and 0.05% respectively.

CONCLUSIONS

The prevalence of active trachoma of younger children was under 5%. However,the prevalence of TT of the adults was not reached the target.

Genetic differentiation of Octopus minor (Mollusca, Cephalopoda) off the northern coast of China as revealed by amplified fragment length polymorphisms

Octopus minor (Sasaki, 1920) is an economically important cephalopod that is found in the northern coastal waters of China. In this study, we investigated genetic differentiation in fishery populations using amplified fragment length polymorphisms (AFLPs). A total of 150 individuals were collected from five locations: Dalian (DL), Yan-tai (YT), Qingdao (QD), Lianyungang (LY), and Zhoushan (ZS), and 243 reproducible bands were amplified using five AFLP primer combinations. The percentage of polymorphic bands ranged from 53.33 to 76.08%. Nei's genetic identity ranged from 0.9139 to 0.9713, and the genetic distance ranged from 0.0291 to 0.0900. A phylogenetic tree was constructed using the unweighted pair group method with arithmetic mean, based on the genetic distance. The DL and YT populations originated from one clade, while the QD, LY, and ZS populations originated from another. The results indicate that the O. minor stock consisted of two genetic populations with an overall significantly analogous FST value (0.1088, P < 0.05). Most of the variance was within populations. These findings will be important for more sustainable octopus fisheries, so that this marine resource can be conserved for its long-term utilization.

Role of Bcl-2 and its associated miRNAs in vasculogenic mimicry of hepatocellular carcinoma

OBJECTIVE

An investigation of the role of the anti-apoptotic protein Bcl-2 and its associated miRNAs in vasculogenic mimicry (VM) in hepatocellular carcinoma.

METHODS

The Bcl-2 expression plasmid was constructed for transfection into the hepatocellular carcinoma cell line HepG2. Changes in the expression profiles of the miRNAs induced by Bcl-2 overexpression and their relationships with vasculogenic mimicry were analysed. Real-time PCR was performed in frozen tissue specimens from 42 cases of hepatocellular carcinoma to analyse the relationship between Bcl-2 and miR-27a; Immunohistochemical staining was performed in paraffin-embedded tissue samples from 97 cases of hepatocellular carcinoma to analyse the relationship between Bcl-2 expression and the expression of vasculogenic mimicry (VM) related molecules VEGF and HIF1A, which were target genes of the Bcl-2 related miRNAs.

RESULTS

Overexpression of Bcl-2 results in a significant change in the expression of a wide range of miRNAs, and the target genes of these miRNAs are composed of various vasculogenic mimicry related genes; Bcl-2 expression was positively correlated with the expression of the miRNA target genes VEGF and HIF1A. The expression of VEGF and HIF1A was significantly and positively correlated with VM and poor prognosis of patients.

CONCLUSION

Bcl-2 may play a role in vasculogenic mimicry through miRNAs by targeting angiogenesis associated genes.

Comparison of high-intensity focused ultrasound therapy under nasal endoscopy guidance versus first-line drug treatment in patients with persistent allergic rhinitis

The aim of this study was to determine whether high-intensity focused ultrasound (HIFU) therapy under nasal endoscopy guidance could provide better efficacy and safety in patients with persistent allergic rhinitis (PAR) than the first-line drugs recommended by the World Health Organization. A total of 120 adult patients with PAR were randomly divided into 2 groups (N = 60 each). One group underwent HIFU therapy under nasal endoscopy guidance using an ultrasound rhinitis therapeutic machine. The other group served as the control group and was treated with corticosteroid nasal spray and oral cetirizine hydrochloride. All patients underwent follow-up treatment for 1 year, after which the efficacy and safety were evaluated. There was no significant difference between the two groups (P > 0.05) in the total effective rate. Moreover, no complications such as nasal adhesion, septal perforation, mucosal atrophy, and hyposmia were observed, indicating that HIFU was as effective as the first-line drug treatments recommended by the World Health Organization for symptom relief in PAR patients. The treatment efficacy, repeatability, safety, economical aspects, ease of performance, and few complications of HIFU therapy strongly suggest that HIFU should be routinely incorporated into clinical practice.

Key nodes of a microRNA network associated with the integrated mesenchymal subtype of high-grade serous ovarian cancer

Metastasis is the main cause of cancer mortality. One of the initiating events of cancer metastasis of epithelial tumors is epithelial-to-mesenchymal transition (EMT), during which cells dedifferentiate from a relatively rigid cell structure/morphology to a flexible and changeable structure/morphology often associated with mesenchymal cells. The presence of EMT in human epithelial tumors is reflected by the increased expression of genes and levels of proteins that are preferentially present in mesenchymal cells. The combined presence of these genes forms the basis of mesenchymal gene signatures, which are the foundation for classifying a mesenchymal subtype of tumors. Indeed, tumor classification schemes that use clustering analysis of large genomic characterizations, like The Cancer Genome Atlas (TCGA), have defined mesenchymal subtype in a number of cancer types, such as high-grade serous ovarian cancer and glioblastoma. However, recent analyses have shown that gene expression-based classifications of mesenchymal subtypes often do not associate with poor survival. This “paradox” can be ameliorated using integrated analysis that combines multiple data types. We recently found that integrating mRNA and microRNA (miRNA) data revealed an integrated mesenchymal subtype that is consistently associated with poor survival in multiple cohorts of patients with serous ovarian cancer. This network consists of 8 major miRNAs and 214 mRNAs. Among the 8 miRNAs, 4 are known to be regulators of EMT. This review provides a summary of these 8 miRNAs, which were associated with the integrated mesenchymal subtype of serous ovarian cancer.

Coexpression of MYC and BCL-2 predicts prognosis in primary gastrointestinal diffuse large B-cell lymphoma

AIM: To investigate whether MYC and BCL-2 coexpression has prognostic significance in primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) patients, and explore its associations with patients’ clinical parameters.

METHODS: Fresh and paraffin-embedded tumor tissue samples from 60 PGI-DLBCL patients who had undergone surgery at the Tianjin Medical University Cancer Institute and Hospital from January 2005 to May 2010 were obtained, and 30 lymphoid tissue samples from reactive lymph nodes of age- and sex-matched patients represented control samples. Staging and diagnostic procedures were conducted according to the Lugano staging system. All patients had been treated with three therapeutic modalities: surgery, chemotherapy, or radiotherapy. Expression of MYC and BCL-2 were detected at both protein and mRNA levels by immunohistochemistry and real-time RT-PCR.

RESULTS: Positive expression levels of MYC and BCL-2 proteins were detected in 35% and 45% of patients, respectively. MYC⁺/BCL-2⁺ protein was present in 30% of patients. MYC and BCL-2 protein levels were correlated with high MYC and BCL-2 mRNA expression, respectively (both P < 0.05). We found that advanced-stage disease (at IIE-IV) was associated with MYC and BCL-2 coexpression levels (P < 0.05). In addition, MYC⁺/BCL-2⁺ patients had more difficulty in achieving complete remission than others (P < 0.05). Presence of MYC protein expression only affected overall survival and progression-free survival (PFS) when BCL-2 protein was coexpressed. The adverse prognostic impact of MYC⁺/BCL-2⁺ protein on PFS remained significant (P < 0.05) even after adjusting for age, Lugano stage, international prognostic index, and BCL-2 protein expression in a multivariable model.

CONCLUSION: MYC⁺/BCL-2⁺ patients have worse chemotherapy response and poorer prognosis than patients who only express one of the two proteins, suggesting that assessment of MYC and BCL-2 expression by immunohistochemistry has clinical significance in predicting clinical outcomes of PGI-DLBCL patients.

Resistance to apoptosis should not be taken as a hallmark of cancer

In the research community, resistance to apoptosis is often considered a hallmark of cancer. However, pathologists who diagnose cancer via microscope often see the opposite. Indeed, increased apoptosis and mitosis are usually observed simultaneously in cancerous lesions. Studies have shown that increased apoptosis is associated with cancer aggressiveness and poor clinical outcome. Furthermore, overexpression of Bcl-2, an antiapoptotic protein, is linked with better survival of cancer patients. Conversely, Bax, CD95, Caspase-3, and other apoptosis-inducing proteins have been found to promote carcinogenesis. This notion of the role of apoptosis in cancer is not new; cancer cells were found to be short-lived 88 years ago. Given these observations, resistance to apoptosis should not be considered a hallmark of cancer.

Prognostic factors associated with solitary plasmacytoma

Solitary plasmacytoma (SP) is a rare tumor with low incidence. The aim of this study was to investigate the clinical features, treatment strategies, and relative prognostic factors of 66 patients with SP. These patients made up 10.25% of the 644 patients with plasma cell dyscrasias treated at the Tianjin Medical University Cancer Institute and Hospital over the past 12 years. SP always presented with either solitary bone plasmacytoma (SBP) or extramedullary plasmacytoma (EMP), as determined by the location of the lesions. SBP occurred most frequently in the vertebral column and EMP in the upper respiratory tract. In addition to other factors, tumor size, serum M protein level, urinary Bence Jones protein level, and disease progression toward multiple myeloma were significantly different between the two groups (P<0.05). Larger tumor size (≥5 cm) was associated with poor prognosis of local control, multiple myeloma–free survival, overall survival and progression-free survival for SBP patients. Radiotherapy and serum β₂ microglobulin <3.5 mg/L were favorable prognostic factors for local control, multiple myeloma-free survival, and progression-free survival in patients with EMP.

Autophagy enhances the aggressiveness of human colorectal cancer cells and their ability to adapt to apoptotic stimulus

Objective

To investigate LC3B-II and active caspase-3 expression in human colorectal cancer to elucidate the role of autophagy, and to explore the relationship of autophagy with apoptosis in human colorectal cancer.

Methods

LC3B expression was detected by immunohistochemistry in 53 human colorectal cancer tissues and 20 normal colon tissues. The protein levels of LC3B-II and active caspase-3 were also determined by Western blot analysis in 23 human colorectal cancer tissues and 10 normal colon tissues.

Results

LC3B was expressed both in cancer cells and normal epithelial cells. LC3B expression in the peripheral area of cancer tissues was correlated with several clinicopathological factors, including tumor differentiation (P=0.002), growth pattern of the tumor margin (P=0.028), pN (P=0.002), pStage (P=0.032), as well as vessel and nerve plexus invasion (P=0.002). The protein level of LC3B-II in cancer tissue was significantly higher than in normal tissue (P=0.038), but the expression of active forms of procaspase-3 in cancer tissue was lower (P=0.041). There was a statistically significant positive correlation between the expression levels of LC3B-II and the active forms of procaspase-3 (r=0.537, P=0.008).

Conclusions

Autophagy has a prosurvival role in human colorectal cancer. Autophagy enhances the aggressiveness of colorectal cancer cells and their ability to adapt to apoptotic stimulus.

Vasculogenic mimicry is a key prognostic factor for laryngeal squamous cell carcinoma: a new pattern of blood supply

BACKGROUND

Recurrence and local lymph node metastasis affected the prognosis of patients with laryngeal cancer. The aim of this study was to analyze clinical and pathological significance of vasculogenic mimicry (VM) in laryngeal squamous cell carcinoma (LSCC) and evaluate its contribution to prognosis.

METHODS

Data of 168 cases of LSCC were reviewed retrospectively to reveal clinical pathology and prognostic significance of VM. CD31 and periodic acid-Schiff double staining was used to identify VM.

RESULTS

VM in LSCC contributed to lymph node metastasis (P = 0.003) and clinical progression. VM correlated to histopathology grade (P = 0.001) of LSCC. VM was an adverse prognostic factor for both disease-specific survival (P = 0.039) and metastasis-free survival (P = 0.042) by univariate survival analyses. And it was an independent prognostic factor for only disease-specific survival (P = 0.003) by multivariate survival analyses.

CONCLUSIONS

VM existed in LSCC. LSCC with VM has more potential to invasion and metastasis.

Predictive value of circulating endothelial cells for efficacy of chemotherapy with Rh-endostatin in non-small cell lung cancer

PURPOSE

The present study was designed to elucidate the fluctuation of activated CECs (aCECs) during different therapies and to investigate their predictive value for efficacy of anti-angiogenesis and chemotherapy in advanced non-small cell lung cancer (NSCLC).

METHODS

Seventy-two patients were randomized into three arms, treated with concomitant NP (vinorelbine and cisplatin) and Rh-endostatin, Rh-endostatin followed by NP, and single NP up to a maximum of six cycles. Response, time to progression (TTP), and aCECs levels were observed. The correlation between aCECs and efficacy was analyzed.

RESULTS

We found that TTP was 8.5 months in concomitant NP and Rh-endostatin versus 5.3 months in NP (p = 0.04) and 6.0 months in Rh-endostatin followed by NP. aCECs fluctuated during the therapeutic period, with a significantly high level from baseline on 8th day of Rh-endostatin followed by NP regimen, that is, when single Rh-endostatin was administered for 1 week, and upon completion of therapy in cases of progressive disease in each group (all p < 0.05). When TTP was longer than 10 months, aCECs count difference (∆aCECs, the difference in the aCECs by post-therapeutic amount minus pre-therapeutic amount) was reversely correlated to TTP (p = 0.003, r = -0.647).

CONCLUSIONS

An improved synergistic effect was achieved from concomitant NP and Rh-endostatin compared with Rh-endostatin followed by NP and single NP. aCECs increased when the disease was aggravated or single Rh-endostatin treatment of Rh-endostatin was administered, while they decreased when a clinical response to the combined therapy was obtained. Our results suggest ∆aCECs as an ideal marker to predict the response to Rh-endostatin combined with chemotherapy.

Comparison of the effects of recombinant human endostatin and docetaxel on human umbilical vein endothelial cells in different growth states

BACKGROUND

Recombinant human endostatin (rh-endostatin, Endostar) has been proved to be an inhibitor of angiogenesis. Docetaxel has been also considered as a common chemotherapeutic agent with inhibition of angiogenesis of malignancies. However, their function has been seldom compared and a best synergism protocol is not determined. This study aimed to compare the effects of two drugs, investigate their combined impact on human umbilical vein endothelial cells (HUVECs), a molecular basis and find ideal protocols to inhibit endothelial cell proliferation.

METHODS

HUVECs on confluent growth or activated by vascular endothelial growth factor (VEGF) were treated by rh-endostatin or/and docetaxel at respective gradient concentration in following operations as cell proliferation determined by MTT assay, cell cycle distribution, apoptosis and markers of CD146, CD62E and CD105 detected by flow cytometery, the structure of the channel formed by HUVECs measured by tube formation count.

RESULTS

Rh-endostatin exhibited time dependent inhibition of proliferation while docetaxel showed both time and dose dependent inhibition. HUVECs accumulated in G(0)-G(1) with decreased numbers of cells in G(2) after a single treatment of rh-endostatin or that followed by docetaxel treatment. Cells accumulated in G(2) after both a single docetaxel and simultaneous administration. Both the number of cells in G(0)-G(1) and apoptotic cells were increased by docetaxel followed by rh-endostatin treatment. The number of non-apoptotic cells at G(0)-G(1) was increased by first administering rh-endostatin then docetaxel. Sequential treatment of docetaxel followed by rh-endostatin resulted in the greatest increase in apoptosis (34.7%) and the second highest apoptosis was seen with simultaneous administration (18.2%). Expression of CD146 and CD105 on confluent HUVECs was reduced at certain doses of rh-endostatin and/or docetaxel. However, rh-endostatin reduced CD105 without any apparent impact on either CD146 or CD62E expression, whereas these markers were down-regulated by docetaxel after pre-activation by VEGF. Rh-endostatin treatment maintained tube-like structures for a limited time. In contrast, docetaxel swiftly reduced tube formation. Simultaneous treatment, or docetaxel followed by rh-endostatin, exhibited a stronger inhibition on tube formation than either agent alone.

CONCLUSIONS

Both rh-endostatin and docetaxel can inhibit HUVEC proliferation while the high apoptotic rate after combined administration was probably owing to different sequent administration by docetaxel followed by rh-endostatin or simultaneous treatment. Both proliferation and adhesion molecules on HUVECs of confluent growth are down-regulated by the two drugs. The rh-endostatin decreased proliferation markers, but only slightly modified adhesion molecules, while both markers were down-regulated by docetaxel on HUVECs activated by VEGF. Rh-endostatin could maintain adhesion of HUVECs at first then induce cells apoptosis to damage tube formation. We hypothesize that it could lead to vascular normalization in short time. In contrast, docetaxel can suppress HUVEC proliferation, adhesion, and reduced tube formation swiftly due to its cytotoxicity. Combined treatments can induce a synergistic inhibition of tube formation.

Inhibition of tumor growth and vasculogenic mimicry by curcumin through down-regulation of the EphA2/PI3K/MMP pathway in a murine choroidal melanoma model

This study aims to investigate the underlying mechanism by which curcumin inhibits tumor growth and reduces vasculogenic mimicry (VM) in a murine choroidal melanoma model. Sixty mice were given subretinal injection with B16F10 cells and divided into a treatment and a control group. Curcumin was administered to the treatment group once a day at a dose of 100 mg/kg for 18 days starting at d3 (the day of inoculation is designated as d0); an equivalent volume of poloxamer-F68 was administered to the control group. Immunohistochemical and histochemical double staining were ued to detect the different blood supply patterns. The amounts of epithelial cell kinase (EphA2), phosphatidylinositol-3-kinase (PI3K), and matrixmetalloproteinase-2 and -9 (MMP-2, MMP-9) proteins expressed in the tumor tissue were analyzed using immunohistochemical staining; mRNA levels were measured using real-time PCR analysis. Results indicate that the tumor volume is reduced (P=0.000) and that the numbers of VM (P=0.000), mosaic vessels (P=0.031), and endothelium-dependent vessels (P=0.000) are significantly decreased by curcumin (P=0.001). The expression levels of EphA2, PI3K, MMP-2, and -9 are also lower in the treatment group than in the control group (P=0.001); similarly, mRNA levels in the treatment group are lower than those in the control group (P=0.000). In conclusion, curcumin has the ability to inhibit the growth of engrafted melanoma VM channels through the regulation of vasculogenic factors that could be related to the down-regulation of the EphA2/PI3K/MMPs signaling pathway. Thus, curcumin has the potential of being a clinical inhibitor of VM of choroidal melanoma.

Plexin-B1 is a target of miR-214 in cervical cancer and promotes the growth and invasion of HeLa cells

Plexin-B1, the receptor for Sema4D, has been reported to trigger multiple and sometimes opposing cellular responses in various types of tumor cells. It has been implicated in the regulation of tumor-cell survival, proliferation, angiogenesis, invasion and metastasis. However, the plexin-B1 gene expression and its regulatory mechanism in cervical cancer remain unclear. The present study shows that plexin-B1 is over-expressed in cervical tumor tissues compared to normal cervical tissues by immunohistochemistry, Western blotting and quantitative RT-PCR. The expression of plexin-B1 is significantly associated with cervical tumor metastasis and invasion according to the analysis of the clinicopathologic data. Plexin-B1 also promotes proliferation, migration and invasion in human cervical cancer HeLa cells. We also found that the plexin-B1 levels are inversely correlated with miR-214 amounts in both cervical cancer tissues and HeLa cells. And miR-214 expression level is also associated with metastasis and invasion of cervical tumor. Furthermore, we demonstrate that plexin-B1 is inhibited by miR-214 through a miR-214 binding site within the 3'UTR of plexin-B1 in HeLa cells. Ectopic expression of miR-214 could inhibit the proliferation capacity, migration and invasion ability of HeLa cells. Our findings suggest that plexin-B1, a target of miR-214, may function as an oncogene in human cervical cancer HeLa cells.

Expression and functional significance of Twist1 in hepatocellular carcinoma: its role in vasculogenic mimicry

The up-regulation and nuclear relocation of epithelial-mesenchymal transition (EMT) regulator Twist1 have been implicated in the tumor invasion and metastasis of human hepatocellular carcinoma (HCC). The term vasculogenic mimicry (VM) refers to the unique capability of aggressive tumor cells to mimic the pattern of embryonic vasculogenic networks. However, the relationship between Twist1 and VM formation is not clear. In this study, we explored HCC as a VM and EMT model in order to investigate the role of Twist1 in VM formation. We first examined the expression of Twist1 in human HCC samples and cell lines and found that Twist1 was frequently overexpressed in the nuclear relocation occurring in VM-positive HCCs (13/18 [72%]). Twist1 nuclear expression was likewise significantly associated with VM formation. Clinicopathological analysis revealed that both VM and Twist1 nuclear expressions present shorter survival durations than those without expression. We consistently demonstrated that an overexpression of Twist1 significantly enhanced cell motility, invasiveness, and VM formation in an HepG2 cell. Conversely, a knockdown of Twist1 by the short hairpin RNA approach remarkably reduced Bel7402 cell migration, invasion, and VM formation. Using chromatin immunoprecipitation, we also showed that Twist1 binds to the vascular endothelial (VE)-cadherin promoter and enhances its activity in a transactivation assay.

CONCLUSION

The results of this study indicate that Twist1 induces HCC cell plasticity in VM cells more through the suppression of E-cadherin expression and the induction of VE-cadherin up-regulation than through the VM pattern in vivo and in a three-dimensional in vitro system. Our findings also demonstrate a novel cogitation in cancer stem-like cell differentiation and that related molecular pathways may be used as novel therapeutic targets for the inhibition of HCC angiogenesis and metastasis.

[The mechanisms of microenvironments influence on vasculogenic mimicry between intraocular and subcutaneous melanoma]

OBJECTIVE

To investigate the influence of different microenvironments on melanoma vasculogenic mimicry, invasiveness and metastasis behavior.

METHODS

It was an experimental study. Sixty C57BL/6J mice were randomly divided into two groups with 30 mice per group. Melanoma B16 cells were injected into the subretinal space and groin area of mice synchronously. The number of each type of microcirculation pattern was counted. The invasion and metastasis were observed. EphA2, MMP-2 and MMP-9 expression and their mRNA levels were detected by immunohistochemical staining and real time RT-PCR and compared between two groups.

RESULTS

Five invasions and six lung metastases were found in the subretinal group while no invasion and metastasis were found in the groin group. The number of VM channels was significantly higher in subretinal group (t = 4. 188, P = 0.000). However, no significant difference of mosaic vessel and endothelium-dependent vessel was observed between two groups (t = 1.473, 1.805; P = 0.146, 0.076, respectively). EphA2, MMP-2 and MMP-9 expression was significantly higher in the subretinal group (data not shown). The mRNA levels of EphA2, MMP-2 and MMP-9 were rather higher in the subretinal tumor (t = 3.642, 8.109, 9.357; P = 0.002, 0.001 and 0.001, respectively). There was a positive association in melanoma cells of the VM between expression of EphA2 (r = 0.412, P = 0.021) but no statistically significant correlation between VM and MMP-2 (P > 0.05), nor between VM and MMP-9.

CONCLUSIONS

Different microenvironments affect invasiveness and blood supply patterns of melanoma. Melanoma cells in intraocular microenvironment increased EphA2 expression which induced the formation of VM channels. Moreover, the expression of MMP-2 and MMP-9 in tumor tissue increased to enhance the invasiveness and metastasis behavior.

[Pilot study of differentiation of bone marrow derived mesenchymal stem cells into endothelial cells induced by B16 melanoma cells in vitro]

OBJECTIVE

Bone-marrow derived mesenchymal stem cells (BMSC) have the potential to differentiate into endothelial cells. The aim of the study was to investigate the induction process of BMSC by B16 melanoma cells in vitro and to analyze the role of VEGF-a in the process.

METHODS

A co-culture system containing BMSC and B16 melanoma cells based on transwell indirect model was established, and the induction process of BMSC by B16 melanoma cells was studied in vitro.

RESULTS

BMSC were isolated from the bone marrow of C57 mice. BMSC expressed CD105, CD90, CD73, CD44 and CD166, and acquired expressin of endothelial phenotype markers including VEGFR-1, VEGFR-2 and Factor VIII after co-culture with B16 melanoma cells for 48 hours. The expression level of VEGFR-2 would be double and Factor VIII threefold more by extending the co-culture time to 72 hours. In the co-culture system, B16 melanoma cells also up-regulated the expression of VEGF-a.

CONCLUSIONS

VEGF-a plays a significant role in the differentiation of BMSC into cells of endothelial phenotype, therefore, is important to tumor angiogenesis.

[Correlation between expressions of matrix metalloproteinase-2 & 9 and vasculogenic mimicry in gastrointestinal stromal tumors]

OBJECTIVE

To study the correlation between the expression of matrix metalloproteinase (MMP)-2, MMP-9, vascular endothelial growth factor (VEGF) and vasculogenic mimicry (VM) in gastrointestinal stromal tumors (GIST).

METHODS

The immunohistochemical staining indices (SI) of MMP-2, MMP-9, VEGF were assessed on specimens of 84 human cases with GIST (21 VM-positive cases). Gelatin zymography analysis of the activity of MMP-2 and MMP-9 activities were performed on another 42 human cases of GIST with fresh tissue (22 VM-positive cases).

RESULTS

The staining indices (SI) of MMP-2 and MMP-9 were higher in the VM-positive group (4.10 +/- 2.05 and 3.43 +/- 1.89 respectively) than in the VM-negative group (2.98 +/- 1.97 and 2.38 +/- 1.84 respectively, both P < 0.05); there was no statistic difference in the SI of VEGF between VM-positive and VM-negative group. Gelatin zymography analysis showed that the activity of MMP-2 and MMP-9 were significantly higher in the VM-positive group (3.62 +/- 3.95 and 4.77 +/- 5.29 respectively) than in the VM-negative group (1.26 +/- 1.21 and 2.11 +/- 1.54 respectively, both P < 0.05).

CONCLUSION

The expression of MMP-2 and MMP-9 correlates with VM formation in GIST.

[Diagnostic value of SYT-SSX fusion gene detection by fluorescence in-situ hybridization for synovial sarcoma]

OBJECTIVE

To establish a method of SYT-SSX fusion gene detection by FISH and to explore its diagnostic value for synovial sarcoma.

METHODS

The presence of SYT-SSX fusion gene was determined by FISH using a tissue microarray containing 62 known synovial sarcomas, 60 non-synovial sarcomas and 133 equivocal synovial sarcomas. FISH results were compared with those of RT-PCR published previously.

RESULTS

Overall, 96.9% (247/255) of the cases were successfully analyzed by FISH. The sensitivity of FISH for known synovial sarcomas was 96.7% (58/60), and the specificity for the non-synovial sarcoma was 100% (59/59). Moreover, SYT-SSX gene fusion was detected in 78.1% (100/128) of the equivocal synovial sarcomas. The concordance rate between FISH and RT-PCR was 83.6% (102/122) in those equivocal synovial sarcomas, and overall 79.7% (106/133) of these cases were confirmed as synovial sarcomas either by RT-PCR or by FISH.

CONCLUSIONS

The sensitivity and specificity of FISH detection of SYT-SSX fusion gene are high. FISH and RT-PCR are complementary to each other in the confirmation of synovial sarcomas, particularly those questionable cases.

Functional significance of VEGF-a in human ovarian carcinoma: role in vasculogenic mimicry

Ovarian cancer is a silent killer, and shows early extensive tumor invasion and peritoneal metastasis. The microcirculation of most tumors includes cooperation of pre-existing vessels, intussusceptive microvascular growth, postnatal vasculogenesis, glomeruloid angiogenesis and vasculogenic mimicry (VM). VM is critical for a tumor blood supply and is asscociated with aggressive features and metastasis. Our studies highlight the plasticity of aggressive human ovarian carcinoma cells and call into question the underlying significance of their ability to form VM in vitro induced by VEGF-a. These studies also show their clinicalpathological features of the cancers with human Paraffin-embedded tumor tissue samples. Results show that the process: VEGF-a-->EphA2-->MMPs-->VM is the main pathway for VM formation and VEGF-a appears to play an important role in the formation of VM based on our in vitro assays and clinical immunohistochemical analyses. VM-targeting strategies for ovarian cancer include anti-VEGF-a treatment, knocking down the EphA2 gene and using antibodies against human MMPs if the tumor is VM positive. This strategy may be of significant value in laying the foundation for a more explicit anti-tumor angiogenesis therapy.

[The influence of different microenvironments on melanoma invasiveness and microcirculation patterns]

OBJECTIVE

To investigate the influence of different microenvironments on tumor microcirculation patterns and invasive capability.

METHODS

Melanoma B16 cells were injected into the peritoneal cavity and skeletal muscle of C57 mice synchronously. CK18 expression in melanoma was assessed to distinguish the malignant phenotype of tumors in the peritoneal cavity from that in the skeletal muscle. HIF-1alpha, MMP-2 and MMP-9 protein and mRNA expression were compared in the two microenvironments. Cells positive for each immunohistochemical stain and the vessels representative of each type of microcirculation pattern were evaluated in two microenvironments.

RESULTS

CK18 and HIF-1alpha expression in melanoma were significantly higher in the skeletal muscle than in the peritoneal cavity (t = 8.142, t = 3.645, P < 0.05). Compared with the peritoneal cavity, melanoma cells in the skeletal muscle overexpressed MMP-2 and MMP-9 (t = 4.916, t = 7.782, P < 0.05). Real time-PCR results also showed that MMP-2 and MMP-9 mRNA levels in melanoma were higher in the skeletal muscle than in the peritoneal cavity (t = 36.814, t = 26.025, P < 0.05). Vasculogenic mimicry channels and endothelium-dependent vessels were the major microcirculation patterns in the skeletal muscle and in the peritoneal cavity respectively.

CONCLUSIONS

Different microenvironments affect invasiveness and blood supply patterns of melanoma. Different microenvironment induced tumor cell secretion of more invasion-related proteins and affect invasiveness and blood supply patterns of melanoma.

Epigenetic regulation of bone morphogenetic protein-6 gene expression in breast cancer cells

Bone morphogenetic protein-6 (BMP-6) is closely correlated with tumor differentiation and skeletal metastasis. Our previous research found that BMP-6 gene expression can be activated dose-dependently by estrogen in estrogen receptor positive (ER(+)) breast cancer cell line MCF-7, but not in ER negative (ER(-)) cell line MDA-MB-231. This experiment is designed to investigate the epigenetic regulatory mechanism of the BMP-6 gene expression in breast cancer cell lines MDA-MB-231, MCF-7 and T47D with regard to the methylation status in the 5' flanking region of the human BMP-6 gene. The endogenous level of BMP-6 mRNA in ER(-) cell line MDA-MB-231 was relatively lower than that in ER(+) MCF-7 and T47D cell lines. After the treatment with 5-aza-2'-deoxycytidine (5-aza-dC, especially in the concentration of 10 microM), the BMP-6 mRNA expression in MDA-MB-231 was obviously up-regulated. However, 5-aza-dC treatment failed to regulate the expression of BMP-6 in MCF-7 and T47D cells. Using enzyme restriction PCR (MSRE-PCR), as well as bisulfite sequencing (BSG), methylation of human BMP-6 gene promoter was detected in MDA-MB-231; while in MCF-7 and T47D, BMP-6 gene promoter remained demethylated status. In 33 breast tumor specimens, promoter methylation of BMP-6 was detected by methylation-specific PCR, hypermethylation of BMP-6 was observed in ER negative cases (16 of 16 cases (100%)), while obviously lower methylation frequency were observed in ER positive cases (3 of 17 cases (18%)), indicating that BMP-6 promoter methylation status is correlated with ER status in breast cancer.

Effect of FLIP small interfering RNA on apoptosis of colorectal cancer cells

AIM: To investigate the promotion effect of small interfering RNA of FADD-like IL-1β converting enzyme inhibitory protein (FLIP) on the cell apoptosis in colorectal cancer.

METHODS: Human colorectal cancer cell line HT-29 was cultured in vitro and transfected with two siRNAs (different loci) of FLIP by electroporation technique. The level of FLIP mRNA expression before and after interfering was detected by semi-quantitative polymerase chain reaction (PCR). The specificity and time effect for interference and the interfering effect between the two siRNAs were compared. Then the cells were treated with agonistic anti-Fas antibody to induce apoptosis. The apoptosis before and after interfering was determined by Annexin V and DNA degration.

RESULTS: The level of FLIP mRNA in HT-29 cells was inhibited by the specific siRNAs. The decrease of FLIP mRNA expression began to appear 24 hours after transfection. And the most apparent interfering efficiency was 65.02% 48 hours after transfection, which was markedly higher than that in the cells transfected with the control siRNAs. Both siRNAs (siRNA-F1 and siRNA-F2) from different loci had interfering effect on FLIP mRNA expression, but there was no significant difference between them. Compared with those in non-transfected cells (1.76%), the apoptotic rates were significantly higher in siRNA transfected cells (29.50%) after treated with agonistic anti-Fas antibody.

CONCLUSION: Small interfering RNA of FLIP can markedly decrease the expression of FLIP mRNA and sensitize the Fas-mediated apoptosis of colorectal cancer cell line HT-29. The RNA interfering technique targeted on FLIP may provide a new method in the gene therapy of colorectal cancer.

Role of cytokines in promoting immune escape of FasL-expressing human colon cancer cells

AIM: To investigate the potential role of cytokines in promoting Fas ligand (FasL)-expressing colon cancer cells.

METHODS: Immunohistochemical SABC method was used to observe the expression of Fas receptor and ligand in SW620 colon cancer cell line and Jurkat T cells in order to provide the morphological evidence for the functions of Fas receptor and ligand. To examine the cytotoxicity of effector cells, CytoTox96 non-radioactive cytotoxicity assay was adopted to measure the lactate dehydrogenase-releasing value after SW620 cells were co-cultured with Jurkat T lymphocytes.

RESULTS: The FasL of colon cancer SW620 cells was positive. The positive substances were distributed in the cell membrane and cytoplasm. The Fas receptor of colon cancer SW620 cells was negative. The Fas receptor and ligand of Jurkat T lymphocytes turned out to be positive. The positive substances were distributed in the cell membrane. After phytohemagglutinin (PHA)-stimulated Jurkat T lymp-hocytes were co-cultured with phorbol 12-myristate 13-acetate (PMA)-plus-ionomycin-stimulated (for 48 h) SW620 cells or tumor necrosis factor-alpha (TNF-α)-stimulated (for 48 h) SW620 cells or unstimulated SW620 cells for 4 h, the cytotoxicity of SW620 cells to PHA-stimulated Jurkat cells at effector-to-target ratios of 10:1, 5:1, 2.5:1, and 1.25:1 was 74.6%, 40.8%, 32.4%, and 10.9% (F = 8.19, P < 0.05); or 54.9%, 35.3%, 22.0%, and 10.3% (F = 11.12, P < 0.05); or 14.9%, 10.5%, 6.9%, and 5.8% (F = 3.45, P < 0.05). After PHA-stimulated Jurkat T lymphocytes were co-cultured with unstimulated SW620 cells for 8 h, the cytotoxicity of SW620 cells to PHA-stimulated Jurkat cells at effector-to-target ratios of 5:1, 2.5:1, and 1.25:1 from the experiment was 83.9%, 74.1%, and 28.5% (F = 137.04, P < 0.05) respectively. Non-radioactive cytotoxicity assay showed that the apoptotic rate of Jurkat cells remarkably increased with the increase of planting concentration of SW620 cells and co-culture time after the SW620 cells were co-cultured with the Jurkat T lymphocytes. The cytotoxicity was significantly enhanced by PMA+ionomycin or TNF-α.

CONCLUSION: The FasL expressed in human colon cancer cells may be regulated by endogenous factors in the microenvironment of the host and facilitate the escape of tumor cells from the host immune system.

Sulindac induces apoptosis and protects against colon carcinoma in mice

AIM: To study the effect of sulindac on colon cancer induction in mice.

METHODS: The chemo-preventive action of 80 ppm sulindac fed during initiation and post-initiation and 100 ppm sulindac fed during progressive stages of induction of colon carcinogenesis in mice was investigated using 1,2-dimethylhydrazine (DMH). Using the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) technique and PCNA immunohistochemical staining, we observed the apoptotic and proliferative cell density changes at different carcinogenic stages and the effect of sulindac on these two phenomena.

RESULTS: Dietary sulindac significantly inhibited the incidence of colonic neoplasmas in mice. Compared with the control group, feeding sulindac during initiation and post-initiation stages inhibited the incidence by 46.7-50.4%, and feeding sulindac during progressive stages inhibited the incidence by 41.1%. Animals that were fed sulindac showed less serious pathological changes than those that were fed the control diet (P<0.01, H = 33.35). There was no difference in the density of proliferating cells among those groups which were or were not fed sulindac. In the same period, feeding sulindac resulted in a higher density of apoptotic cells than feeding control diet.

CONCLUSION: Sulindac has an anti-carcinogenic function in mice. Its effect on preventing colon carcinogenesis is better than its effect on treating established tumors. By inducing apoptosis, sulindac inhibited the development of colon cancer and delayed canceration. Sulindac has no effect on proliferation. The anti-carcinogenic properties of sulindac are most effective in the moderate and severe stages of dysplasia and canceration.

[Screening of differential expression genes between primary breast cancer and its lymph node metastasis using single primer amplification of cDNA for microarray]

OBJECTIVE

To screen genes related to breast cancer metastasis by comparing difference of expression profile between primary breast cancer and its lymph node metastasis.

METHODS

The cell total RNA was extracted from 10 breast cancer specimens, including the primary cancer and metastatic cancer tissues of axillary lymph nodes resected during operation. Single primer amplification (SPA) was used to prepare fluorescence-labeled targets and then Oligo microarray concluding 21 000 human functional genes was used to screen out 1.5 fold or more differential expression genes in at least 5 pairs of samples. The screened-out genes were identified by real-time PCR.

RESULTS

Preparing targets by using SPA reduced the initial RNA to 0.25 microg, with 57 genes screened out, the expression of 19 of which were up-regulated and the expression of 38 of which were down-regulated in the metastatic tissues. Eight differentially expressed genes were related to cell migration and adhesion, 14 to signal transduction, and 14 to cell growth or metabolism. Real-time PCR showed that the fibronectin (FN) mRNA expression in the lymph node metastasis was only 1/3.6 of that in the matched primary breast cancer in 30 cases (t = -3.188, P = 0.003).

CONCLUSION

SPA is a sensitive method for preparing targets. Genes related to cell migration and adhesion, signal transduction, and cell growth or metabolism, which are associated with the biology process of metastasis have been screened out. FN as a potent marker may contribute to diagnosis of metastasis and prognosis for breast cancer patients.

High-resolution cDNA microarray CGH mapping of genomic imbalances in osteosarcoma using formalin-fixed paraffin-embedded tissue

Formalin-fixed paraffin embedded (FFPE) tumor tissue provides an opportunity to perform retrospective genomic studies of tumors in which chromosomal imbalances are strongly associated with oncogenesis. The application of comparative genomic hybridization (CGH) has led to the rapid accumulation of cytogenetic information on osteosarcoma (OS); however, the limited resolving power of metaphase CGH does not permit precise mapping of imbalances. Array CGH allows quantitative detection and more precise delineation of copy number aberrations in tumors. Unfortunately the high cost and lower density of BACs on available commercial arrays has limited the ability to comprehensively profile copy number changes in tumors such as OS that are recurrently subject to genomic imbalance. In this study a cDNA/EST microarray including 18,980 human cDNAs (which represent all 22 pairs of autosomal chromosomes and chromosome X) was used for CGH analysis of eight OS FFPE. Chromosomes 1, 12, 17, and X harbored the most imbalances. Gain/amplification of X was observed in 4/8 OS, and in keeping with other recent genomic analyses of OS, gain/amplification of 17p11.2 was often accompanied by a distal deletion in the region of the p53 gene. Gain/amplification of the X chromosome was verified using interphase FISH carried out on a subset of OS FFPE sections and OS tissue arrays.

Expression of Fas and p53 in different stages of large intestinal malignant transformation and their association with apoptosis

AIM: To explore the expression of Fas and p53 in the large intestinal adenocarcinoma, malignantly transformed adenoma, tubulo-villous adenoma, and tubular adenoma, and to assess their influence on the pathogenesis of large intestinal carcinoma.

METHODS: Using in-situ hybridization, immunohistochemistry and TUNEL techniques, we examined a number of paraffin-embedded tissues including 37 cases of large intestinal adenocarcinomas, 26 cases of malignantly transformed adenomas, 30 cases of tubulo-villous adenomas, and 24 cases of tubular adenomas for Fas mRNA, p53 protein and DNA fregment. 6 cases of non-tumor mucosa were used as control group.

RESULTS: Fas mRNA positive cell density was: 39.60±6.51 in non-tumor mucosa, 50.93 21.64 in tubular adenoma, 45.91±24.15 in tubulo-villous adenoma, 25.47±14.76 in non-malignantly transformed area of adenoma, 11.92±9.47 in malignantly transformed area of adenoma, and 5.88±5.10 in adenocarcinoma, which was significantly lower in the malignant lesions than in adenomas (P <0.001). p53 protein positive cell density was: 8.40±2.67 in non-tumor mucosa, tubular adenoma 13.19±8.95, tubulo-villous adenoma 13.50±7.29, non-malignantly transformed area of adenoma 12.24±7.16, malignantly transformed area of adenoma 73.31±28.57, adenocarcinoma 80.99±44.54, among which it was the lowest in the non-tumor mucosa, slightly increased in adenoma, and significantly increased in malignant lesions (P <0.001). Apoptotic cell density was: non-tumor mucosa 15.02±11.14, tubular adenoma 46.31±18.86, tubulo-villous adenoma 29.43±16.66, non-malignantly transformed area of adenoma 68.42±19.61, malignantly transformed area of adenoma 22.01±12.07, adenocarcinoma 18.64±12.88, which was higher in adenomas, but lower in malignant lesions (P <0.001). The positively expressed cell density of p53 protein was reversely related with that of the apoptotic epithelial cells (r = -0.389, P <0.001). The positively expressed cell density of Fas mRNA was related with that of the apoptotic epithelial cells (r = 0.190, P <0.05).

CONCLUSION: The apoptotic cell death is inhibited via downregulation of Fas expression and upregulation of p53 expression in large intestinal adenocarcinoma, and a so-called "Fas resistance" mechanism is induced.

Validating a model of patient satisfaction with emergency care

STUDY OBJECTIVE

We sought to validate a previously developed model of emergency department patient satisfaction in a general population using a standard mailed format. The study aims to export the findings of a comprehensive ED quality-of-care study to an easily measured patient population.

METHODS

A double-sided, single-page survey was mailed to all patients discharged home from 4 teaching hospital EDs during a 1-month period. Determinants of patient satisfaction were analyzed with a previously developed multivariate, ordinal logistic-regression model.

RESULTS

The mail survey response rate was 22.9% (2,373/10,381). The survey validates the importance of previously identified determinants of patient satisfaction, including age, help not received when needed, poor explanation of problem, not told about wait time, not told when to resume normal activity, poor explanation of test results, and not told when to return to the ED (P <.01). Greater age predicted higher patient satisfaction, whereas all other variables correlated with lower patient satisfaction. In contrast with prior findings, black race was not a significant predictor of satisfaction in the mail survey population. Low ratings of overall care are strongly correlated with reduced willingness to return (P <.0001).

CONCLUSION

A patient satisfaction model was previously developed from a comprehensive research survey of ED care. We demonstrate the generalizability of this model to a mail survey population and replicate the finding that satisfaction strongly predicts willingness to return. The response rate of this study is typical of commercial patient-satisfaction surveys. The validated model suggests that ED patient satisfaction improvement efforts should focus on a limited number of modifiable and easily measured factors.

Treatment of collagen induced arthritis in DBA/1 mice with L-asparaginase

OBJECTIVE

To evaluate the safety and efficacy of L-asparaginase as an immunosuppressive agent in a mouse model of rheumatoid arthritis.

METHODS

Male DBA/1 mice with collagen-induced arthritis (CIA) were treated at different intervals with various doses of native and pegylated L-asparaginase from E. coli. The mice were observed for 4 weeks during which time arthritis was scored. Outcome parameters included effect on severity and progression of established arthritis as well as prevention of disease. In addition, X-rays from the affected joints were obtained for comparison.

RESULTS

Both native L-asparaginase at a dose of 50 IU/injection intraperitoneally three days a week and pegylated asparaginase (PEG-L-asparaginase) at a dose of 25 IU/injection twice a week, significantly reduced the mean arthritic score (MAS) in mice with established arthritis (p < 0.001 for PEG-L-asparaginase). When native L-asparaginase was administered before the onset of arthritis (days 14-post immunization) the number of mice developing arthritis as well as the number of arthritic paws and the severity of arthritis in the treatment group were significantly decreased (p < 0.0001). Significant differences were found in the X-ray evaluation between treated and control mice. None of the animals died due to drug related events or showed signs of asparaginase induced toxicity.

CONCLUSION

Our data provide the first direct evidence that L-asparaginase is a potent antiarthritic agent and may represent an effective second line agent for future treatment studies in juvenile and adult rheumatoid arthritis.

Modifications in surgical implantation of the Penn State electric total artificial heart

BACKGROUND

Two modifications of the surgical implantation protocol for the Penn State Total Artificial Heart (ETAH) were evaluated: Phrenic nerve ischemia was prevented by minimizing dissection and traction; and hemostasis was augmented and ETAH cuff anastomoses reinforced by using fibrin glue.

METHODS

Thirteen Holstein calves underwent orthotopic surgical implantation of the Penn State ETAH between February 1998 and August 2000. Mean hemodynamic and laboratory chemistry variables from the first postoperative week were compared between calves receiving the original (n = 7) and modified (n = 6) protocol.

RESULTS

Calves assigned to the modified protocol displayed an improvement in the Po2/FiO2 ratio compared to original (419.4 +/- 17.5 vs 336.3 +/- 35.4, respectively; p = 0.05). All additional parameters were equivalent between groups. The percent survival of animals receiving the modified protocol at 2, 4, and 12 weeks was higher than that of animals that underwent the original protocol. Original-protocol calf deaths consisting of hemothorax (n = 3), and respiratory failure (n = 1) were prevented in the modified protocol.

CONCLUSIONS

Our results suggest that manipulations in surgical protocol may promote increased survival in calves implanted with the Penn State ETAH.

Determinants of patient satisfaction and willingness to return with emergency care

STUDY OBJECTIVE

To identify emergency department process of care measures that are significantly associated with satisfaction and willingness to return.

METHODS

Patient satisfaction and willingness to return at 5 urban, teaching hospital EDs were assessed. Baseline questionnaire, chart review, and 10-day follow-up telephone interviews were performed, and 38 process of care measures and 30 patient characteristic were collected for each respondent. Overall satisfaction was modeled with ordinal logistic regression. Willingness to return was modeled with logistic regression.

RESULTS

During a 1-month study period, 2,899 (84% of eligible) on-site questionnaires were completed. Telephone interviews were completed by 2,333 patients (80% of patients who completed a questionnaire). Patient-reported problems that were highly correlated with satisfaction included help not received when needed (odds ratio [OR] 0.345; 95% confidence interval [CI] 0.261 to 0.456), poor explanation of causes of problem (OR 0.434; 95% CI 0.345 to 0.546), not told about potential wait time (OR 0.479; 95% CI 0.399 to 0.577), not told when to resume normal activities (OR 0.691; 95% CI 0.531 to 0.901), poor explanation of test results (OR 0.647; 95% CI 0.495 to 0.845), and not told when to return to the ED (OR 0.656; 95% CI 0. 494 to 0.871). Other process of care measures correlated with satisfaction include nonacute triage status (OR 0.701, 95% CI 0.578 to 0.851) and number of treatments in the ED (OR 1.164 per treatment; 95% CI 1.073 to 1.263). Patient characteristics that significantly predicted less satisfaction included younger age and black race. Determinants of willingness to return include poor explanation of causes of problem (OR 0.328; 95% CI 0.217 to 0.495), unable to leave a message for family (OR 0.391; 95% CI 0.226 to 0. 677), not told about potential wait time (OR 0.561; 95% CI 0.381 to 0.825), poor explanation of test results (OR 0.541; 95% CI 0.347 to 0.846), and help not received when needed (OR 0.537; 95% CI 0.340 to 0.846). Patients with a chief complaint of hand laceration were less willing to return compared with a reference population of patients with abdominal pain. Willingness to return is strongly predicted by overall satisfaction (OR 2.601; 95% CI 2.292 to 2.951).

CONCLUSION

These data identify specific process of care measures that are determinants of patient satisfaction and willingness to return. Efforts to increase patient satisfaction and willingness to return should focus on improving ED performance on these identified process measures.