[The efficacy and safety of immunotherapy combined with chemotherapy neoadjuvant in locally advanced resectable hypopharyngeal squamous cell carcinoma]

Objective: To explore the efficacy and safety of immunoneoadjuvant therapy with pembrolizumab combined with chemotherapy in locally advanced resectable hypopharyngeal squamous cell carcinoma patients. Methods: This study was a prospective, single arm, single center clinical study that was opened for enrollment in April 2021. Patients who met the inclusion criteria at the Cancer Hospital of the Chinese Academy of Medical Sciences were treated with neoadjuvant therapy of pembrolizumab combined with cisplatin and paclitaxel, and after treatments, received surgery and postoperative adjuvant therapy. The main endpoint of this study was postoperative pathological complete response (pCR), and other observations included adverse reactions and long-term prognoses of patients after neoadjuvant therapy. Results: By September 2023, a total of 23 patients who underwent neoadjuvant therapy and surgery were enrolled in the study and all patients were males aged 49-74 years. All patients were locally advanced stage, including 3 patients in stage Ⅲ and 20 patients in stage Ⅳ. There were 12 cases of primary lesions with posterior ring involvement accompanied by fixation of one vocal cord and 20 cases of regional lymph node metastases classified as N2. Eighteen cases received a two cycle regimen and 5 cases received a three cycle regimen for neoadjuvant therapy. The postoperative pCR rate was 26.1% (6/23), with no surgical delay caused by adverse drug reactions. The laryngeal preservation rate was 87.0% (20/23). Pharyngeal fistula was the main surgical complication, with an incidence of 21.7% (5/23). The median follow-up time was 15 months, and 3 patients experienced local recurrence. Conclusions: The immunoneoadjuvant therapy of pembrolizumab combined with chemotherapy has a high pCR rate in locally advanced resectable hypopharyngeal squamous cell carcinoma, with increased laryngeal preservation rate and no significant impact on surgical safety.

[Pembrolizumab plus nab-paclitaxel and platinum as first-line treatment in patients with recurrent or metastatic head and neck squamous-cell carcinoma: a prospective phaseⅡstudy]

Objective: To evaluate the efficacy and safety of pembrolizumab plus nab-paclitaxel and platinum as first-line treatment in patients with recurrent or metastatic head and neck squamous-cell carcinoma (R/M HNSCC). Methods: This was a prospective, single-arm, open label, phase 2 clinical study enrolling patients at the Cancer Hospital of the Chinese Academy of Medical Sciences with R/M HNSCC treated with pembrolizumab plus nab-paclitaxel and cisplatin or carboplatin. After six cycles of treatment, patients received pembrolizumab as maintenance therapy until disease progression or intolerable toxicity or completion of 35 cycles of treatment. The primary endpoint was objective response rate, and secondary endpoints included overall survival, progression-free survival, and safety profile. Efficacy was evaluated according to the response evaluation criteria in solid tumors 1.1, survival analysis was performed using the Kaplan-Meier method, and adverse events were assessed using the America National Cancer Institute Common Terminology Criteria for Adverse Events 5.0. Results: A total of 30 patients with R/M HNSCC were enrolled from 23 April 2021 to 22 March 2023, including 28 males and 2 females, with a median age of 67 years. The median follow-up time was 14.5 months, the objective response rate was 70.0%, the disease control rate was 96.7%, and the median progression-free survival and overall survival of all patients were 11.6 months and 18.8 months, respectively. Median duration of response was up to 17.3 months. Grade≥3 treatment-related adverse events were leukopenia (26.7%), neutropenia (26.7%), peripheral neurotoxicity (3.3%), rash (3.3%), hyperalgesia (3.3%), and immune-related pneumonitis (3.3%). The most common immune-related adverse event was hypothyroidism (40.0%). Conclusion: Pembrolizumab combined with nab-paclitaxel and platinum shows encouraging antitumor activity accompanied with a manageable safety profile in untreated R/M HNSCC patients in China.

[Correlation of MYB/NFIB gene fusion with the grade and prognosis of head and neck adenoid cystic carcinoma and the concordance of two detection methods]

Objective: To explore the correlation between MYB/NFIB gene fusion and clinicopathological features such as tumor grade and prognosis of head and neck adenoid cystic carcinoma (ACC), and to assess the concordant rate of fluorescent in situ hybridization (FISH) with MYB and NFIB immunohistochemistry. Methods: FISH detection of MYB/NFIB gene fusion was performed on 48 head and neck ACC cases and 15 non-ACC salivary gland tumors at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China during April 2014 and January 2020. ACC cases were divided into grade Ⅰ-Ⅱ, grade Ⅲ and high-grade transformation, according to pathological grading criteria. Prognosis, FISH results and other clinicopathological characteristics were analyzed. MYB and NFIB immunohistochemistry was performed on the 48 ACC and 15 non-ACC cases. The diagnostic accuracy of FISH and immunohistochemistry was compared. Results: FISH detected MYB/NFIB gene fusion in 41.7% (20/48) of the ACC. Its positive rate was inversely correlated with higher pathological grades (P=0.036). The higher histological grade was linked to worse progression-free survival (P=0.024), whereas there was no correlation between the status of gene fusion detected by FISH and progression-free survival (P=0.536). FISH didnot detect MYB/NFIB gene fusion in 15 non-ACC salivary gland tumors The specificity of diagnosing ACC is 100% for both FISH detection of gene fusion and immunohistochemical detection of MYB expression. However, the sensitivity for both methods was only about 41.7%, respectively. By combining FISH and MYB immunohistochemistry, the sensitivity for diagnosing ACC was increased to 66.7%. Conclusions: MYB/NFIB gene fusion has a lower detection rate in grade Ⅲ ACC and high-grade transformation ACC. Meanwhile gene fusion status is not correlated with prognosis. The sensitivity for diagnosing ACC can be improved by combining FISH and MYB immunohistochemistry.

Combination of Chinese medicinal formulas and chemotherapy for triple-negative breast cancer strengthens body resistance to eliminate pathogenic factors

BACKGROUND

To evaluate the efficacy and safety of strengthening the body's resistance to eliminate pathogenic factors in Chinese medicinal formulas combined with chemotherapy (hereafter referred to as combined therapy [CT]) in triple-negative breast cancer.

METHODS

By searching the 7 electronic databases, PubMed, EMBASE, Web of Science, Cochrane Library, Chinese Academic Journal, Wanfang Database, and Chinese Science and Technology Journal, from the beginning of the establishment to April 2022 to identify eligible randomized controlled trial studies.

RESULTS

The meta-analysis showed that compared with chemotherapy, CT can effectively improve the objective remission rate (risk ratio [RR]: 1.39; 95% confidence interval [CI]: 1.28, 1.52; P < .00001, I2 = 3%), reduce the recurrence rate (RR: 0.33; 95% CI: 0.14, 0.78; P = .01, I2 = 0%) metastasis rate (RR: 0.48; 95% CI: 0.31, 0.73; P = .0006, I2 = 0%) and the incidence of toxic and side reactions, lower tumor marker levels, regulated T lymphocyte subset changes, and increased average progression-free survival (standardized mean difference: 2.78; 95% CI: 1.41, 4.14; P < .0001, I2 = 97%), and improve the quality of life (RR: 1.55; 95% CI: 1.21, 1.99; P = .0005, I2 = 52%).

CONCLUSION

This study suggests that CT appears to be an effective and safe treatment approach. Although this conclusion requires further confirmation owing to insufficient quality of the included trials.

Mixed large and small cell neuroendocrine carcinoma of the stomach: A case report and review of literature

BACKGROUND

Gastric neuroendocrine carcinoma (GNEC) is a rare histological subtype of gastric cancer, which is categorized into small cell and large cell neuroendocrine carcinomas. It is characterized by strong invasiveness and poor prognosis. Mixed large and small cell neuroendocrine carcinoma (L/SCNEC) is an extremely rare pathological type of gastric cancer, and there have been no reports on this situation until now.

CASE SUMMARY

Herein, we first present a 57-year-old patient diagnosed with L/SCNEC of the stomach. A 57-year-old Chinese male presented with epigastric discomfort. Outpatient gastroscopic biopsy was performed, and pathological examination revealed that the cardia was invaded by adenocarcinoma. The patient underwent laparoscopic-assisted radical proximal subtotal gastrectomy and was diagnosed with L/SCNEC. He refused adjuvant treatment and was followed up every 3 mo. Eight months after the operation, the patient showed no evidence of local recurrence or distant metastasis.

CONCLUSION

We advocate conducting further genomic studies to explore the origin of gastric large cell and small cell neuroendocrine carcinoma and using different chemotherapy schemes according to large or small cell neuroendocrine carcinoma of the stomach for clinical research to clarify the heterogeneity of GNEC and improve the prognosis of patients with GNEC.

Long-term survival of a patient with pancreatic cancer and lung metastasis: A case report and review of literature

BACKGROUND

Pancreatic cancer (PC) is a leading cause of cancer-related death, given its poor prognosis and the limited benefits of traditional therapies. As tumors become more genetically disorganized as they progress, genetic mutations might become new markers for us to predict their behavior. Nowadays, many inhibitors can selectively target gene products as a form of targeted therapy, with some showing promise as treatment for various types of cancer.

CASE SUMMARY

We describe a rare case of a PC patient with long-term survival of more than 8 yr. The patient was diagnosed with pancreatic ductal adenocarcinoma (PDAC) with BAP1 and PIK3CA gene mutations and Raf1 fusion and achieved partial response twice after treatment with apatinib in combination with chemotherapy.

CONCLUSION

BAP1, PIK3CA mutations, and Raf1 fusion are rare in PDAC. Patients with these three gene alterations of PDAC may achieve long-term survival with apatinib. Further research in other contexts is needed to determine whether apatinib has ideal efficacy for PC treatment.

Urinary biomarkers of early renal injury in antiretroviral-naïve HIV-positive persons in Shanghai, China: comparison with the general population

Objectives

People living with HIV (PLWH) have a high risk of kidney injury. Measurement of serum creatinine, along with proteinuria, is not sensitive to detect early kidney injury. Here, we investigated novel urinary biomarkers of early renal injury in PLWH.

Methods

We performed a cross‐sectional study of 166 antiretroviral‐naïve PLWH and 99 HIV‐negative persons who all had an estimated glomerular filtration rate > 90 mL/min/1.73 m². We compared the levels of seven urinary biomarkers between the two groups using the propensity score matching (PSM) approach and explored the risk factors associated with elevated urinary biomarkers in PLWH.

Results

Eighty‐three pairs were successfully matched based on PSM. Compared with the HIV‐negative group, the HIV‐positive group had higher ratios of N‐acetyl‐β‐D‐glucosaminidase (NAG) to urine creatinine (UCr), alpha1‐microglobulin (α1‐M) to UCr, kidney injury marker‐1 (KIM‐1) to UCr, neutrophil gelatinase‐associated lipocalin to UCr, and epidermal growth factor to UCr, whereas the Tamm–Horsfall protein to UCr ratio and the abnormal albumin to UCr ratio were not significantly different. Positive correlations were observed between HIV RNA level and NAG: UCr (r_s = 0.32; P < 0.001) and α1‐M:UCr (r_s = 0.24; P = 0.002) ratios, and negative correlations were observed between CD4 cell count and NAG:UCr (r_s = –0.34; P < 0.001), KIM‐1:UCr (r_s = –0.16; P = 0.042) and α1‐M:UCr (r_s = –0.36; P < 0.001) ratios. In multivariate linear regression analyses, older age, lower total cholesterol and higher HIV RNA were independently associated with higher NAG:UCr; older age, lower total cholesterol and lower CD4 cell count were independently associated with higher α1‐M:UCr.

Conclusions

In comparioson with HIV‐negative participants, PLWH were more likely to have tubular injury. Early antiretroviral treatment might mitigate the development of kidney injury.

A retrospective cohort study of early mortality among patients with HIV/TB co-infection in Shanghai municipality

OBJECTIVES

Tuberculosis (TB) is the most common and fatal opportunistic co-infection among HIV-infected individuals. While TB-associated mortality predominantly occurs in the first 90 days after admission, such a correlation remains unclear in HIV/TB co-infected patients. Thus, we aimed to investigate the 90-day mortality and associated risk factors among HIV/TB co-infected patients in China.

METHODS

Adult patients with HIV and a newly confirmed TB diagnosis admitted to the Shanghai Public Health Clinical Center between September 2009 and August 2017 were enrolled. Clinical and laboratory characteristics, key treatments and outcomes were collected retrospectively. The associations between different factors and early mortality were analysed.

RESULTS

Of the 485 laboratory-confirmed HIV/TB patients [median (range) age = 39 (19-79) years], 413 (85.15%) were male. Diagnosis was confirmed by culture, pathology and acid-fast bacilli smear alone in 362 (74.6%), 6 (1.2%) and 117 (24.1%) patients, respectively. Multiple drug-/rifampin-resistant TB was detected in 21 (5.8%) of the 367 patients with a positive culture. Rifampin or rifabutin was administered to 402 (82.9%) patients. Additionally, 66 (13.6%) and 86 (17.7%) died within 90 days and 1 year of admission, respectively. Of the 64 TB-related deaths, 59 (92.2%) occurred within 90 days of admission. In Cox regression, central nervous system (CNS) TB [odds ratio (OR) = 2.49, 95% confidence interval (CI): 1.46-4.23, P < 0.001], no antiretroviral therapy (ART) within 3 months after admission (OR = 11, 95% CI: 6.4-18.9, P < 0.001), and plasma albumin level < 25 g/L (OR = 1.91, 95% CI: 1.07-3.40, P = 0.021) were associated with early death.

CONCLUSIONS

Tuberculosis co-infection was prevalent and fatal in HIV-infected patients, with most deaths occurring within 90 days of admission. Early mortality was associated with CNS-TB, no ART, and serum albumin level < 25 g/L.

[Differential protein expressions in papillary thyroid carcinoma patients with or without Hashimoto's thyroiditis]

Objective: To explore the differential protein expressions in papillary thyroid carcinoma (PTC) with or without Hashimoto's thyroiditis (HT). Methods: Tissue microarray was prepared and the protein expression levels of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF), vascular endothelial growth factor (VEGF), cyclinD1, mesothelial cell (MC) , CD56 and Galectin3 in the PTC tissues with or without HT were detected by immunohistochemical staining. Results: The positive expression rates of BRAF protein in the PTC tissues with or without HT groups were 55.4% (36/65) and 63.6% (42/66), respectively, without significant difference (P=0.336). The positive expression rates of VEGF protein in the PTC tissues with or without HT groups were 25.7% (19/74) and 25.8%(17/66), respectively, without significant difference (P=0.991). The positive expression rates of cyclin D1 protein in the PTC tissues with or without HT groups were 93.4% (71/76) and 97.6% (80/82), without significant difference (P=0.206). The positive expression rates of MC protein in the PTC tissues with or without HT groups were 86.1% (62/72) and 83.5%(71/85), without significant difference (P=0.654). The positive expression rates of Galectin3 protein in the PTC tissues with or without HT groups were 98.7% (76/77) and 97.5% (78/80), without significant difference (P=0.583). The positive expression rates of CD56 in the PTC tissues and adjacent thyroid follicular epithelial cells were 27.4% (32/117) and 65.0% (76/117), respectively, and the difference was statistically significant (P=0.001). The positive expression rates of CD56 in PTC tissues with or without HT were 35.5% (24/68) and 16.5% (13/79), respectively, and the difference was statistically significant (P=0.009). Conclusions: There are no significant differences in the expressions of BRAF, VEGF, CyclinD1, MC and Galectin3 between the PTC tissues with or without HT. However, the significantly differential expression of CD56 between the two group suggests that CD56 may be related to the pathogenesis of PTC with HT. CD56 may be used as a potential molecular marker in PTC diagnosis.

Recurrent granular cell tumor of the thyroid: a case report and literature review

BACKGROUND

Granular cell tumor (GCT) of the thyroid is a rare benign tumor of Schwann cell origin with a favorable prognosis and only 10 cases have been reported so far in scientific literature. The present case study describes the first case of recurrent thyroid GCT.

CASE PRESENTATION

Our case describes a 20-year-old woman who had undergone lobectomy for GCT of the thyroid 4 years ago. Hematoxylin-eosin (HE) staining revealed that the lesion was composed of epithelioid cells with an abundance of eosinophilic granular cytoplasm. Immunohistochemical analysis showed that tumor cells tested positive for S-100 protein and negative for desmin. Both histological and immunohistochemical analyses supported the diagnosis of recurrent GCT of the thyroid.

CONCLUSIONS

Our case suggested that a tumor-free margin excision and post-operative follow-up are necessary for the treatment of GCT of the thyroid.

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

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

[Guidelines for diagnosis and treatment of dengue in China]

Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease. As a dengue non-endemic country, China has experienced several dengue outbreaks in recent years. However, dengue patients in China displayed distinct clinical characteristics compared to patients in endemic countries. To standardize the diagnosis and treatment of dengue fever, the experts of the Society of Infectious Diseases, Society of Tropical Medicine and Parasitology of Chinese Medical Association, and the Society of Emergency Medicine, China Association of Chinese Medicine have reached this guideline based on guidelines for diagnosis, treatment, prevention and control of dengue (World Health Organization, 2009); guidelines for diagnosis and treatment of dengue (National Health and Family Planning Commission of the People's Republic of China, 2014, Edition 2), health industry standard of the People's Republic of China "diagnosis for dengue fever (WS216-2018)" and systemic reports on dengue. The guideline includes 8 aspects: introduction, terminology, epidemiology and prevention, etiology and pathogenesis, clinical features, diagnosis, treatment and problems to be solved.

Primary renal synovial sarcoma: two cases and review of the literature

OBJECTIVE

To investigate the clinicopathological features, treatment, and prognosis of primary renal synovial sarcoma.

METHOD

Retrospectively collected and analyzed clinical and pathological data of two cases of patients with renal primary synovial sarcoma, and reviewed domestic and foreign related literature.

RESULTS

The first patient was admitted for progressive enlargement of a left renal mass, then she underwent a radical resection of left kidney and adrenal gland, and the final diagnosis was primary renal synovial sarcoma. However, the tumor progressed with multiple nodules in the left peritoneal retroperitoneal space and abdominal wall 3 months later. The second patient was hospitalized for a left lung mass and left renal mass after 3 months. She received left nephrectomy and left lower lobectomy. The final diagnosis was primary renal synovial sarcoma with extensive metastasis in both lungs and pelvic and abdominal cavity. The patient underwent chemotherapy and targeted therapy after operation, and died because of tumor burden after 23 months.

CONCLUSION

Primary renal synovial sarcoma is a rare soft tissue tumor in the kidney with a poor prognosis. An accurate diagnosis needs consideration of the morphology, immunohistochemistry, and SYT-SSX gene results. Clinically, radical nephrectomy is the main strategy, and adjuvant ifosfamide-based chemotherapy after operation has benefits.

[Expert consensus on the diagnosis and treatment of cryptococcal meningitis]

Cryptococcal meningitis is a common and refractory central nervous system infection, with high rates of mortality and disability. The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion. Based on the current situation of cryptococcal meningitis in China, the management of cryptococcal meningitis includes 6 aspects: introduction, microorganism identification, clinical manifestations and diagnosis, principles of antifungal therapy, treatment of refractory and recurrent meningitis, treatment of intracranial hypertension. There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis. This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines. The importance of early diagnosis, combined long-term antifungal therapy, control of intracranial hypertension are emphasized.

Association between BRAFV600E mutation and the clinicopathological features of solitary papillary thyroid microcarcinoma

The B-Raf proto-oncogene serine/threonine kinase (BRAF)^V600E mutation is an important oncogene in the development of papillary thyroid carcinoma (PTC) and has been identified as a risk factor for poor prognosis in patients with PTC. However, whether the BRAF^V600E mutation is a prognostic marker in patients with solitary papillary thyroid microcarcinoma (sPTMC) has not yet been established. The present study aimed to identify the association between BRAF^V600E mutation and the clinicopathological features of patients with sPTMC. A total of 108 patients with sPTMC who underwent surgery at the Cancer Institute and Hospital of the Chinese Academy of Medical Sciences between December 2010 and December 2012 were analyzed retrospectively. Exon 15 of the BRAF gene was amplified using the polymerase chain reaction and direct sequencing was performed to detect the BRAF^V600E mutation. Statistical analysis was subsequently performed using SPSS software (version 16.0). The association between BRAF^V600E mutation and clinicopathological features of sPTMC was tested with the χ² test or Fisher's exact test, as appropriate. There were 27 males and 81 females in the cohort, who were aged between 22 and 66 years old, with an average age of 42 years. The BRAF^V600E mutation was found in 59 out of 108 (54.6%) patients with sPTMC. The presence of the BRAF^V600E mutation was demonstrated to be significantly associated with extrathyroidal extension (P=0.019), advanced Tumor-Node-Metastasis stage (P=0.007) and the presence of autoimmune thyroiditis (P=0.010). The BRAF^V600E mutation was not significantly associated with gender, anatomic location or subtype of sPTMC (P>0.05). In addition, the BRAF^V600E mutation indicated poor prognosis in patients with sPTMC. These results suggest that the BRAF^V600E mutation is a risk factor for poor prognosis in patients with sPTMC. This knowledge will aid in the risk stratification and post-operative management of patients with sPTMC.

Comparison between meat quality of Hanzhong White pigs and carcass weight

A total of 48 carcasses of crossbred Hanzhong White pigs were divided into 3 groups (I, 90-99 kg; II, 100-109 kg; III, 110-119 kg) to investigate the influence of carcass weight on meat quality. The intramuscular fat content of the 3 groups increased from 1.90 to 4.90%; for meat color, Warner-Bratzler shear force, drip loss, and oxidation-type muscle fiber percentage, and muscle fiber diameter of the longissimus lumborum, the indices in group II and group III were better than those in group I (P < 0.05). The saturated fatty acid and polyunsaturated fatty acid percentages of the longissimus lumborum muscle (2.80 and 37.30%, respectively) in group II were significantly lower than those in the other 2 groups, while the monounsaturated fatty acid percentage was the highest (59.10%). In conclusion, our results suggest that a carcass weight of 100-109 kg is sufficient to produce acceptable meat quality of Hanzhong White pigs.

Identification of biomarkers for hepatocellular carcinoma by semiquantitative immunocytochemistry

AIM: To investigate the expression of key biomarkers in hepatoma cell lines, tumor cells from patients’ blood samples, and tumor tissues.

METHODS: We performed the biomarker tests in two steps. First, cells plated on coverslips were used to assess biomarkers, and fluorescence intensities were calculated using the NIH Image J software. The measured values were analyzed using the SPSS 19.0 software to make comparisons among eight cell lines. Second, eighty-four individual samples were used to assess the biomarkers’ expression. Negative enrichment of the blood samples was performed, and karyocytes were isolated and dropped onto pre-treated glass slides for further analysis by immunofluorescence staining. Fluorescence intensities were compared among hepatocellular carcinoma (HCC) patients, chronic HBV-infected patients, and healthy controls following methods similar to those used for cell lines. The relationships between the expression of biomarkers and clinical pathological parameters were analyzed by Spearman rank correlation tests. In addition, we studied the distinct biomarkers’ expression with three-dimensional laser confocal microscopy reconstructions, and Kaplan-Meier survival analysis was performed to understand the clinical significance of these biomarkers.

RESULTS: Microscopic examination and fluorescence intensity calculations indicated that cytokeratin 8/18/19 (CK) expression was significantly higher in six of the seven HCC cell lines examined than in the control cells, and the expression levels of asialoglycoprotein receptor (ASGPR) and glypican-3 (GPC3) were higher in all seven HCC cell lines than in the control. Cells obtained from HCC patients’ blood samples also displayed significantly higher expression levels of ASGPR, GPC3, and CK than cells from chronic HBV-infected patients or healthy controls; these proteins may be valuable surface biomarkers for identifying HCC circulating tumor cells isolated and enriched from the blood samples. The stem cell-like and epithelial-mesenchymal transition-related biomarkers could be detected on the karyocyte slides. ASGPR and GPC3 were expressed at high levels, and thus three-dimensional reconstructions were used to observe their expression in detail. This analysis indicated that GPC3 was localized in the cytoplasm and membrane, but that ASGPR had a polar localization. Survival analyses showed that expression of GPC3 and ASGPR is associated with a patient’s overall survival (OS).

CONCLUSION: ASGPR, GPC3, and CK may be valuable HCC biomarkers for CTC detection; the expression of ASGPR and GPC3 might be helpful for understanding patients’ OS.

Inhibition of atypical protein kinase Cι induces apoptosis through autophagic degradation of β-catenin in esophageal cancer cells

Atypical protein kinase Cι (PKCι) has been identified as an oncoprotein in esophageal squamous cell carcinomas. However, the mechanisms underlying the role of PKCι in this disease remain unclear. In the present work, we found that inhibition of PKCι expression by RNAi induced apoptosis via the down-regulation of β-catenin in esophageal cancer cells. Furthermore, we found that PKCι regulated β-catenin in an autophagy dependent way. Since down-regulation of β-catenin induced by knockdown of PKCι could be rescued by autophagy inhibition; knockdown of PKCι activated autophagy and promoted the recruitment of β-catenin into autophagosome. These results suggested that PKCι positively regulated β-catenin through negatively regulated autophagy and depletion of PKCι promoted apoptosis via autophagic degradation of β-catenin in esophageal cancer cells. These data provide new insights into PKCι signaling in human cancer.

Soft-tissue osteoma in the neck paravertebral space

Osteoma is a rare, slow-growing benign neoplasm located primarily in the skeleton. Soft-tissue osteoma is exceedingly rare. We report a case of soft-tissue osteoma occurring in the neck paravertebral space in a 25-year-old man. CT examination demonstrated a cancellous densely ossified mass in the right side of neck paravertebral space, with irregular lobulation and clear margin, but without relation to the adjacent vertebrae. The mass was resected, and the pathology confirmed soft-tissue osteoma.

Type I aortic dissection in a patient with human immunodeficiency virus infection

The use of highly active antiretroviral therapy in patients with HIV infection has significantly reduced HIV-related infectious complications and improved their survival. With effective antiretroviral therapy, cardiovascular disease has gained prominence as a cause of morbidity and mortality in HIV-infected persons. Aortic dissection is an uncommon but potentially fatal disease with catastrophic complications. The spread of AIDS is a major public health problem in China, but there is scant literature regarding the clinical outcome for HIV/AIDS patients with aortic dissection in China. This case report describes a patient with HIV and type I aortic dissection who survived without surgical repair. This report is provided to describe a detailed and successful outcome for a patient with type I aortic dissection and HIV in China.

Synchronous primary carcinosarcoma and adenosquamous carcinoma of the esophagus

Reports of adenosquamous carcinoma and carcinosarcoma found at the same esophagus are rare in the literature. We report a case of synchronous adenocarcinoma and carcinosarcoma of the esophagus. The sarcomatous components were immunoreactive for vimentin. Carcinoma, sarcoma, and adenocarcinoma cells distinctively metastasized to different lymph nodes. Further investigations are required to reveal the biological behavior of the tumor.

Clinical features, treatments and prognosis of the initial cases of pandemic influenza H1N1 2009 virus infection in Shanghai China

BACKGROUND AND OBJECTIVE

As of 13 December 2009, more than 208 countries and overseas territories or communities have reported laboratory-confirmed cases of pandemic influenza H1N1 2009, which have resulted in at least 10 582 deaths. As of 7 December 2009, 4328 severe cases were reported in Mainland China, resulting in 326 deaths. This study's objective was to determine the clinical features, treatments and prognosis of the initial cases of Pandemic influenza H1N1 2009 virus infection in Shanghai, China, and how its clinical features related to patient gender.

METHODS

A total of 224 confirmed 2009 influenza A/H1N1-infected patients treated and discharged by Shanghai Public Health Clinical center between 24 May and 20 July 2009 were included in the study. Patients' personal information, signs and symptoms, laboratory and imagery data, disease course, hospitalization period and seroconversion duration for viral nucleic acid after antiviral treatment were analyzed.

RESULTS

Among the 224 patients, 118 were male and 106 were female, yielding a sex ratio of 1.1:1. Approximately 52% of the patients came from Australia, and 63.8% were between 18 and 40 years old. Clinical manifestations included fever, cough and congestion of the throat, and lab findings were characterized by elevated C-reaction protein (CRP) and neutrophils. Female patients had significantly lower serum Prealbumin (PA) levels than male patients (P < 0.05). The patients' serum CRF levels significantly decreased after treatment (P < 0.05), while the levels of CD3, CD4 and CD8 significantly increased after treatment (P < 0.01). Approximately 29.9% of the patients had abnormal signs on chest computer tomography scan, and 21.9% had obvious signs indicating pneumonia. However, blood cultures were negative in these patients. The average disease course was 3.9 +/- 1.4 days, the average hospitalization period was 5.0 +/- 1.7 days, and the seroconversion duration for viral nucleic acid after antiviral treatment was 3.8 +/- 1.3 days.

CONCLUSION

Initial cases of pandemic influenza H1N1 2009 were characterized by fever, cough and throat congestion, with elevated CRP and neutrophils being the most significant lab findings. The pandemic influenza H1N1 2009 strain was able to affect multiple organs, including the hepatic synthesis of PA and immune functioning. The novel 2009 Influenza A/H1N1 virus was mild clinically, with a short disease course and good prognosis.

[Diagnosis,treatment, and prognostic of liver sarcoma: analysis of 16 cases]

OBJECTIVE

To explore the diagnosis, treatment, and prognostic factors of liver sarcoma.

METHODS

The clinical data of 16 liver sarcoma patients, 9 males and 7 females, aged 46.7 (12-73), treated 1980-2005, were analyzed retrospectively.

RESULTS

The most common symptoms were right upper quadrant pain (56.3%) and mass in the right upper abdomen (56.3%). Alpha fetoprotein (AFP) was negative in all the patients. None was correctly diagnosed by imaging examination preoperatively. Fifteen patients underwent surgical treatment, including radical operation in 7 patients (46.7%) and palliative resection/biopsy in 8 patients. 1 patient took transcatheter hepatic arterial chemo-embolization rather than operation because of multifocal tumor. Pathological analysis diagnosed 6 patients (37.5%) as with leiomyosarcoma, 5 patients (31.25%) with angiosarcoma, 2 patients (12.5%) with fibrosarcoma, 1 patient (12.5%) with epithelioid hemangioendothelioma, 1 patient (12.5%) with myxoid liposarcoma, and 1 patient (12.5%) with undifferentiated embryonal sarcoma. The 1-year, 3-year, and 5-year survival rates were 71.4%, 41.7%, and 33.3% respectively. The 1-year, 3-year, and 5-year survival rates of the patients who received R0 were 100.0%, 83.3%, and 66.7% respectively, all significantly higher than those of the patients who did not receive R0 (all P = 0.011). The 1-year, 3-year, and 5-year survival rates of the patients with the tumor size < 5 cm were 100%, 100%, and 75% respectively, all higher than those of the patients with the tumor size > 5 cm, however, not significantly (all P = 0.084).

CONCLUSION

Liver sarcoma is difficult to be diagnosed preoperatively. Surgical resection is the mainstay of the treatment of liver sarcoma. R0 and tumor size are of prognostic values.

Expression of IQGAP2 and its clinical significance in hepatocellular carcinoma

AIM: To investigate the expression of IQ motif containing GTPase activating protein 2 (IQGAP2) and its correlation with the clinicopathological parameters in hepatocellular carcinoma (HCC), and to reveal the potential mechanisms of IQGAP2 underlying human hepatocarcinogenesis.

METHODS: Western blot, immunofluorescence staining and immunohistochemical staining (IHC) were used to detect the expression and subcellular localization of IQGAP2 in 7 liver cancer and normal liver cell lines, as well as in 51 HCC tissue specimens. Meanwhile, the corresponding clinical data were analyzed retrospectively.

RESULTS: Only two liver cancer cell lines, HepG2 and Hep3B, expressed IQGAP2 at the protein level. In addition, immunofluorescence results revealed that IQGAP2 was localized in cytoplasm and nuclei. Apparent nucleolus and karyotheca staining was observed in HepG2 cells. Furthermore, histological validation of clinical samples showed that IQGAP2 expression was significantly down-regulated in tumor tissues (56.9%, 29/51). Meanwhile, the expression of IQGAP2 was associated with tumor size, AJCC staging and alpha-fetoprotein (AFP) expression level (P = 0.020; P = 0.017; P = 0.002). The immunohistochemical staining results from 38 HCC specimens showed that IQGAP2 was mainly localized at cytoplasm in the tumor and adjacent normal liver cells. In addition, partial cells had cell membrane and nuclear localization. However, definite association was not observed between IQGAP2 levels and tumor size, histological degree, AJCC staging or AFP expression status.

CONCLUSION: IQGAP2 expression is down-regulated in tumor tissues of HCC cases, and IQGAP2 may be a potential marker and tumor suppressor gene involved in HCC. These novel findings may provide a basis for the determination of mechanism(s) underlying human hepatocarcinogenesis.

A computational study of the interaction noise from a small axial-flow fan

Small axial-flow fans used for computer cooling and many other appliances feature a rotor driven by a downstream motor held by several cylindrical struts. This study focuses on the aerodynamic mechanism of rotor-strut interaction for an isolated fan. The three-dimensional, unsteady flow field is calculated using FLUENT, and the sound radiation predicted by acoustic analogy is compared with measurement data. Striking differences are found between the pressure oscillations in various parts of the structural surfaces during an interaction event. The suction surface of the blade experiences a sudden increase in pressure when the blade trailing edge sweeps past a strut, while the process of pressure decrease on the pressure side of the blade is rather gradual during the interaction. The contribution of the latter towards the total thrust force on the structure is cancelled out significantly by that on the strut. In terms of the acoustic contributions from the rotor and strut, the upstream rotor dominates and this feature differs from the usual rotor-stator interaction acoustics in which the downstream part is responsible for most of the noise. It is therefore argued that the dominant interaction mechanism is potential flow in nature.

Genetic modification of hematopoietic progenitor cells for combined resistance to 4-hydroperoxycyclophosphamide, vincristine, and daunorubicin

AIM

To investigate whether human peripheral blood hematopoietic progenitor cells (PBPC) modified with human aldehyde dehydrogenase class-3 gene (ALDH-3) and multidrug resistance gene 1 (MDR1) would increase chemotherapy resistance to 4-hydroperoxycyclophosphamide (4-HC) and -glycoprotein effluxed drugs.

METHODS

A bicistronic retroviral vector G1Na-ALDH3-IRES-MDR1 cDNA was constructed and used to transfect the packaging cell lines PA317 by electroporation. CD34+ PBPC were isolated with a high-gradient magnetic cell sorting system (MACS), and then were transfected with supernatant of retrovirus containing human ALDH-3 and MDR1 cDNA. PCR, RT-PCR, Southern blot, Northern blot, FACS, and MTT assay were used to evaluate the transfection and expression of the transgene in target cells.

RESULTS

The bicistronic retroviral vector construction was verified by PCR and restriction endonuclease analysis. Dual drug resistance genes were integrated into the genomic DNA of CD34+ PBPC and expressed efficiently. The efficiency of gene transfection in CD34+ PBPC was tested to be 18 % on colonies. Nested PCR and Neor rescue assay indicated that no helper virus was present in this system. Compared with the untransduced cells, transgene recipient cells conferred 4.5-fold resistance to 4-HC, 6.6-fold and 7.8-fold resistance to P-glycoprotein effluxed drug, vincristine and daunorubicin, respectively.

CONCLUSION

Efficient transduction of two different types of drug resistance genes into human peripheral blood hematopoietic progenitor cells and the co-expression may decrease cumulative myelosuppression of combination chemotherapy.

[Mechanism of injury of intestine, liver and lung in acute cholangitis of severe type model and the protective effect of huoxue qingjieling]

Lung capillary permeability was measured with 125I labelled bovine serum albumin, the progression of hepato-cellular injury was quantitatively assessed using atriphenyltetrazolium chloride assay, injury of small intestinal mucosa was determined by the changes of diamine oxidase (DAO) level, content of oxygen free radicals (OFR) was measured by electron spin resonance spectrometer and levels of phospholipase A2(PLA2) of intestine, hepatocellular viability were observed by bioassay methods respectively. The results showed that function of lung, liver and intestine was seriously injuried in ACST rats. These injuries demonstrated by increase of capillary permeability and decrease of hepatocellular viability as well as DAO in intestinal mucosa (P < 0.01) in comparing with control, while the levels of OFR and PLA2 in the above-mentioned 3 organs were elevated simultaneously (P < 0.01). As for the comparison of efficacy of different treatment, Huoxue Qingjieling was the best one, the bile duct decompression or ampicillin showed little benefit on injury protection even aggravated in some tissues, they displayed a close relationship with their influence on the OFR and PLA2. Besides, the levels of OFR or PLA2 in various tissues were different from each other, therefore, the serum levels of OFR or PLA2 can not reflect the real levels occurred in organ or tissue level.

Reduced water exchange in sickle cell anemia red cells: a membrane abnormality

We have measured the diffusional water permeability of sickle cell anemia red blood cells under isotonic conditions using pulsed nuclear magnetic resonance (NMR) techniques. We have found that the equilibrium diffusional permeability for sickle cells is about 1.61.10(-3) cm/s, or about 60% of the value measured for normal cells. This abnormality is not related to the heterogeneity generally found in cell populations in sickle red cells with different mean corpuscular hemoglobin concentrations. We speculate that the abnormality of water exchange under isotonic conditions in sickle cells reflects an alteration of membrane proteins responsible for water exchange, possibly caused by oxidation of Band 3 proteins.

Quantitative detection of rapid motions in spectrin by NMR

Previous high resolution proton NMR data on human erythrocyte spectrin molecules has indicated the existence of regions exhibiting rapid internal motions within the intact molecules [L. W.-M. Fung, H.-Z. Lu, R. P. Hjelm, jr, M. E. Johnson, FEBS Lett., 197, 234 (1986)]. We have extended the studies by developing quantitative NMR methods to determine the fraction of spectrin protons exhibiting rapid internal motions, in both the isolated molecule and within the spectrin-actin network. Using both one-pulse and spin echo pulse sequences, we find that the fraction of the protons in rapid motion is about 15% of the total protons in the spectrin molecule at 37 degrees C in phosphate buffer with 150 mM NaCl at pH 7.4. Quantitative information on these rapid motions will be important in understanding the structural, mechanical and functional properties of spectrin molecules, as well as in understanding filamentous protein structures in general.

Selective detection of rapid motions in spectrin by NMR

Human erythrocyte spectrin molecules exhibit relatively sharp (30-50 Hz) proton NMR signals in the aliphatic region. A standard solvent presaturation pulse sequence that also partially suppresses the broad envelope from protons with rigid structures in spectrin and selectively enhances the sharp resonances has been used to characterize the behavior of these resonances. The overall resonance pattern strongly resembles that of the denatured spectrin. The observed spectra are also quite similar to the line-broadened spectrum from a mixture of amino acids that corresponds to the composition of the spectrin molecule. These data indicate the existence of regions exhibiting rapid internal motions within the intact spectrin molecule, and suggest that the amino acid composition of the residues giving rise to the sharp resonances is quite similar to that of the full spectrin molecule.

Binding of a spin-labeled phenylalanine analog to sickle hemoglobin: EPR and NMR studies

We have synthesized a spin-label analog of phenylalanine as a competitive inhibitor probe of the sickle hemoglobin aggregation process. Sickle hemoglobin gelation measurements indicate that the spin-label phenylalanine analog is a potent inhibitor of deoxy sickle hemoglobin aggregation. We have also used spin label EPR and high-resolution proton NMR to study the interaction of the phenylalanine analog with hemoglobin, and find that the kinetic off-rate is comparable to, or slower than the hemoglobin rotational rate (i.e., greater than or equal to 10(8) s-1), and that at least one, and perhaps two significant localized interaction region(s) exist within a few angstroms of the beta chain N- and C-termini. Correlation with other known structural information suggests that the observed interaction sites may be relevant to the mechanism for inhibition of sickle hemoglobin aggregation.