[The value of machine learning models based on biparametric MRI for diagnosis of prostate cancer and clinically significant prostate cancer]

Objective: To evaluate the value of machine learning (ML) models based on biparametric magnetic resonance imaging (bpMRI) for diagnosis of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). Methods: A total of 1 368 patients, aged from 30 to 92 (69.4±8.2) years, from 3 tertiary medical centers in Jiangsu Province were retrospectively collected from May 2015 to December 2020, including 412 cases of csPCa, 242 cases of clinically insignificant prostate cancer (ciPCa) and 714 cases of benign prostate lesions. The data of center 1 and center 2 were randomly divided into training cohort and internal testing cohort at a ratio of 7∶3 by random number sampling without replacement using Python Random package, and the data of center 3 were used as the independent external testing cohort. The training cohort includs 243 cases of csPCa, 135 cases of ciPCa and 384 cases of benign lesions, the internal testing cohort includs 104 cases of csPCa, 58 cases of ciPCa and 165 cases of benign lesions, and the external testing cohort includs 65 cases of csPCa, 49 cases of ciPCa and 165 cases of benign lesions. The radiomics features were extracted on T₂-weighted imaging, diffusion-weighted imaging and apparent diffusion coefficient map, and optimal radiomics features were selected by using Pearson correlation coefficient method and analysis of variance. The ML models were built using two ML algorithms, including support vector machine and random forest (RF) and were further tested in the internal testing cohort and external testing cohort. Finally, the PI-RADS scores evaluated by the radiologists were adjusted by the ML models which had superior diagnostic performance, namely adjusted PI-RADS. The receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of the ML models and PI-RADS. DeLong test was used to compare the areas under curve (AUC) of models with those of PI-RADS. Results: For PCa diagnosis, in internal testing cohort, the AUC of ML model using RF algorithm and PI-RADS were 0.869 (95%CI: 0.830-0.908) and 0.874 (95%CI: 0.836-0.913), respectively, and the difference between the model and PI-RADS did not reach to the statistical significance (P=0.793). In the external testing cohort, the AUC of model and PI-RADS were 0.845 (95%CI: 0.794-0.897) and 0.915 (95%CI: 0.880-0.951), respectively, and the difference was statistically significant (P=0.01). For csPCa diagnosis, the AUC of ML model using RF algorithm and PI-RADS were 0.874 (95%CI: 0.834-0.914) and 0.892 (95%CI: 0.857-0.927), respectively, in internal testing cohort, and the difference between the model and PI-RADS was not statistically significant (P=0.341). In the external testing cohort, the AUC of model and PI-RADS were 0.876 (95%CI: 0.831-0.920) and 0.884 (95%CI: 0.841-0.926), respectively, and the difference between the model and PI-RADS was not statistically significant (P=0.704). When PI-RADS assessment was adjusted with the assistance of ML models, the specificities increased from 63.0% to 80.0% in the internal testing cohort and from 92.7% to 93.3% in the external test group in diagnosing PCa. In diagnosing csPCa, the specificities increased from 52.5% to 72.6% in the internal testing cohort and from 75.2% to 79.9% in the external testing cohort. Conclusions: The ML models based on bpMRI showed comparable diagnostic performance to PI-RADS assessed by senior radiologists and achieved good generalization ability in both diagnosing PCa and csPCa. The specificities of the PI-RADS were improved by ML models.

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

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

[Establishment and evaluation of a model for predicting ISUP pathological grade≥2 before radical prostatectomy]

Objective: Based on the 2014 version of the International Association of Urological Pathology (ISUP) pathological classification standards, a prediction model that can predict the pathological classification of ISUP ≥2 in patients with prostate cancer (PCa) before radical prostatectomy (RP) was established and evaluated. Methods: The clinical data of 171 patients who had undergone RP from January 2017 to September 2020 in the Second Affiliated Hospital of Soochow University and obtained postoperative pathological results of all specimens were retrospectively collected. The patients were 46-83 (70±7) years old. For patients with RP ISUP pathologic stage as the gold standard, according to the pathological grading is level 2 or higher is divided into two groups(42 patients with ISUP grade=1 and 129 patients with ISUP grade ≥2). the predictors of ISUP pathology grade ≥2 after RP were screened by logistics regression analysis, predictive models were established and ROC curves were used to evaluate the efficacy of each model in diagnosing RP with pathological grade ≥2, and comparisons were conducted by DeLong test. Results: Compared with patients with ISUP grade=1, patients with ISUP grade≥2 had higher prostate specific antigen (PSA) and prostate specific antigen density (PSAD) (14.21(8.57, 24.98)ng/ml vs 7.98(5.41, 12.54)ng/ml, 0.33(0.20, 0.74)μg.L^-1.ml^-1 vs 0.16(0.12, 0.24)μg.L^-1.ml^-1), lower prostate volume (PV) (48.62(34.17,73.99)ml vs 38.94(28.15,54.84)ml)(all P<0.05). Multi-parameter magnetic resonance imaging (mp-MRI) prostate imaging and reporting system (PI-RADS) score, the positive ratio of puncture needles and the pathological grade of puncture ISUP were also significantly different between the two groups (all P<0.05). The combined mp-MRI PI-RADS score (OR=3.337, 95%CI: 1.990-5.593, P<0.001) and puncture ISUP pathological grading (OR=4.041, 95%CI: 1.960-8.334, P<0.001) had the highest diagnostic efficacy for pathological grading ≥2 after RP (AUC=0.916, P<0.05). Conclusion: The combined mp-MRI PI-RADS score and puncture ISUP pathological grading had the highest diagnostic efficacy for pathological grading ≥2 after RP.

[The diagnostic value of version 2.1 prostate imaging reporting and data system for prostate transitional zone lesions]

Objective: To compare and analyze the diagnostic value of prostate imaging reporting and data system (PI-RADS) version 2.1 and version 2 for prostate transitional zone lesions. Methods: The imaging data of 159 patients with major prostate lesions located in the transitional zone collected by the Department of Radiology of the Second Affiliated Hospital of Suzhou University from January to December 2017 were retrospectively analyzed. Two radiologists used PI-RADS V2.1 and V2 scoring system respectively to perform diagnostic scores on the enrolled cases. The weighted Kappa test was used to evaluate the consistency of PI-RADS V2.1 and V2 scores between the two radiologists. The receiver operating characteristic (ROC) curve was used to evaluate and compare the diagnostic efficiency of two radiologists using two scoring systems for transitional zone prostate cancer (PCa) and clinically significant PCa (csPCa). Results: The weighted Kappa values between the scores of all lesions, benign lesions, PCa lesions, and csPCa lesions by the two radiologists using PI-RADS V2.1 and V2 scoring systems were 0.754, 0.643, 0.734, 0.782 and 0.808, 0.738, 0.775, 0.826, respectively. The PI-RADS V2.1 scoring system had a better consistency. There were no statistically significant differences in sensitivity, specificity, area under the ROC curve (AUC) between the PI-RADS V2.1 and V2 scoring system for PCa and csPCa (all P>0.05). However, in this set of data, the sensitivity and AUC value of PI-RADS V2.1 scoring system in diagnosing PCa and csPCa were higher than those of P-RADS V2. The diagnostic sensitivity of PI-RADS V2.1 and V2 for PCa were 86.7% and 80.0%, the diagnostic sensitivity for csPCa were 94.4% and 88.9%, the diagnostic AUC for PCa were 0.857 and 0.816, and the diagnostic AUC of csPCa were 0.917 and 0.886, respectively. Conclusion: The consistency of PI-RADS V2.1 in scoring prostate transitional zone lesions was better than PI-RADS V2. The diagnostic efficiency of PI-RADS V2.1 for transitional carcinoma was not lower than or slightly higher than PI-RADS V2.

[The value of 3.0T magnetic resonance -diffusion kurtosis imaging in the differential diagnosis of rectal mucinous adenocarcinoma and common adenocarcinoma]

Objective: To investigate the value of 3.0T MRI diffusion kurtosis imaging (DKI) quantitative histogram parameters in the differential diagnosis of rectal mucinous adenocarcinoma (MC) and common adenocarcinoma (AC). Methods: One hundred and ten patients from Department of Radiology, the Second Affiliated Hospital of Soochow University between September 2015 and September 2019 with complete magnetic resonance imaging (MRI) and DKI results confirmed by surgery and pathology were retrospectively analyzed, including 16 patients in MC group and 94 patients in AC group. Two physicians outlined the region of interest (ROI) on the DKI image with b=1 000 s/mm(2), and obtained quantitative DKI parameters, including the diffusion coefficient (D value) and kurtosis coefficient (K value) corrected for non-Gaussian distribution. The apparent diffusion coefficient (ADC) values of quantitative parameters of diffusion-weighted imaging (DWI) were obtained through image registration, and histogram analysis was performed to obtain the mean value, 25th percentile, 50th percentile, 75th percentile, skewness and kurtosis of the above parameters, respectively. The difference between the quantitative histogram parameter analysis results of the rectal MC group and the AC group was evaluated, and the main indicators and multivariate comprehensive analysis indicators was screened, and the effectiveness of quantitative histogram parameters related to histopathological classification in the differential diagnosis of rectal MC and AC was evaluated. Results: There was no significant differences in gender, age, lesion location, T stage or N stage between MC group and AC group (all P>0.05). The multivariate binary logistic stepwise regression screening showed that D50th percentile and K25th percentile are statistically significant indicators (B values were 2 966.166 and -4.550, respectively; Wals values were 9.000 and 15.720, respectively; and P values were 0.003 and <0.001, respectively). The combined area under the curve of the two indictors was 0.85, but there was no statistically significant difference in pairwise comparison using DeLong method (P>0.05). The results of histogram analysis of quantitative parameters measured by the two physicians were consistent, and the inter-group correlation coefficient ranged from 0.880 to 0.981. Conclusions: The quantitative parameter histogram analysis of the DKI double-index model is helpful for the differentiation of rectal MC and AC, in which the D50th percentile and K25th percentile have differential diagnosis significance, and are superior to the ADC value of the single-index model.

Global Interest in Oral and Maxillofacial Surgery: Analysis of Google Trends Data

PURPOSE

Oral and maxillofacial surgery (OMS) has an expansive scope, with myriad diagnoses treated by practicing surgeons. Patients and referring providers are increasingly turning to Web-based sources to find information about clinical conditions before consultations or in conjunction with ongoing care. The purpose of this study was to examine the current trends of public interest of OMS procedures as assessed by online search trends.

MATERIALS AND METHODS

A cross-sectional study of Internet search data obtained via Google Trends (GT; Alphabet, Mountain View, CA) was conducted. Data were collected using GT for OMS-related search terms between January 2004 and May 2019. The search terms used in the analysis were "wisdom teeth," "TMJ," "dental implants," "jaw surgery," "jaw fracture," "facial trauma," and "facial cosmetic surgery," defined to be the core surgical aspects of OMS based on public awareness campaigns sponsored by the American Association of Oral and Maxillofacial Surgeons. Relative search volumes, trends over time, geographic trends, and seasonal trends were analyzed. For all analyses, P ≤ .05 was considered significant.

RESULTS

Overall search volume trends for OMS procedures showed an increase over time, with seasonal and geographic trends. "Wisdom teeth" was the most searched term and had the greatest increase in search volume over time. "Facial trauma" was the least searched term, with no appreciable trend over time. Geographic search volume was greatest in the United States. Seasonal changes were most apparent with searches for "wisdom teeth" and "jaw surgery."

CONCLUSIONS

Analysis of GT data shows substantial interest in core OMS procedures, with seasonal variations noted for certain areas of practice (third molars and jaw surgery) and consistent interest in other areas (facial cosmetic surgery, dental implant reconstruction, and temporomandibular disorders). The use of GT data may be a powerful tool for predicting demand for OMS services and for public education campaigns.

[The clinical decision-making value of prostate specific antigen and its derived indicators in prostate imaging reporting and data system version 2 3 lesions]

Objective: To explore the decision-making value of clinical data in prostate imaging reporting and data system version 2 (PI-RADS V2) 3 lesions, and to compare the diagnostic value of related data for prostate cancer (PCa) and clinically PCa(csPCa). Methods: From March 2016 to October 2018,a subset of 121 men with 121 PI-RADS 3 index lesions were retrospectively analyzed. There were 31 PCa lesions and 14 csPCa lesions, aged from 46 to 91 years with a mean age of (71±9) years. The clinical data of the age, prostate specific antigen (PSA), free PSA (fPSA), f/tPSA, PSA density (PSAD) and prostate volume (PV) were compared between PCa group and non-PCa group, csPCa group and non-csPCa group using univariate analysis, respectively.The receiver operating characteristic (ROC) curve was used to evaluate the efficiency of statistically data in detecting PCa and csPCa in men with PI-RADS 3 index lesions. Results: The differences of PSA, f/tPSA and PSAD were all statistically significant (Z=-2.004, -2.527, -2.623, all P<0.05) between PCa group and non-PCa group, and they were all also statistically significant(Z=-2.415, -2.158, -2.870, all P<0.05) between csPCa group and non-csPCa group. Both PSAD had the best diagnostic efficiency, the ROC curve of detecting PCa and csPCa was 0.658 and 0.736, respectively. If used PSAD>0.20 μg·L(-1)·ml(-1) as the biopsy threshold, the sensitivity, specificity, positive predictive value and negative predictive value of csPCa were 78.6%, 58.9%, 20.0%, 95.4%, and 54.5% (66/121) of the enrolled men can avoid biopsy, resulting only 3 cases of csPCa missed. Conclusion: PSA, f/tPSA, PSAD, especially PSAD can improve the detection efficiency of PCa,especially csPCa in PI-RADS 3 lesions, assisting clinical decision-making.

[Diagnostic value of optical imaging combined with indocyanine green-guided sentinel lymph node biopsy in gastric cancer: a meta-analysis]

Objective: To systematically evaluate the diagnostic value of optical imaging combined with indocyanine green (ICG)-guided sentinel lymph node (SLN) biopsy in gastric cancer, and to identify potential factors that would influence diagnostic accuracy. Methods: Study was carried out by searching the electronic database of PubMed, Embase, Medline, Web of Science, and the Cochrane Library with keywords as "gastric/stomach" and "cancer/carcinoma/tumor/tumour/adenocarcinoma/neoplasm" and "sentinel lymph node" and "near-infrared/NIR or fluorescent imaging" and "indocyanine green/ICG" . Literature inclusion criteria: (1) gastric cancer clinical stage was cT0-3; (2) clinical stage determined by at least 2 kinds of imaging modalities; (3) optical imaging (near-infrared or fluorescence imaging) combined with ICG-guided SLN biopsy; (4) prospective study to predict lymph node metastasis; (5) intraoperative or postoperative pathology for all lymph nodes removed; (6) patients number in the literature >10 cases. Exclusion criteria: (1) patients with a history of ICG allergy or chemoradiotherapy; (2) previous history of endoscopic mucosal resection or endoscopic submucosal dissection; (3) patients with a variety of gastrointestinal tumor; (4) case reports, conference abstracts, clinical guidelines, editorials, reviews, meta-analysis and correspondence letters; (5) in vitro or animal experiments; (6) insufficient diagnostic efficacy data. The meta-analysis was performed in the Stata12.0 software using the "bivariate mixed-effects model" combined with the "midas" command to pool the data. Information such as true positive value, false positive value, false negative value, and true negative value of each included articles were extracted. The literature quality assessment map was drawn to describe the overall quality of the articles; the heterogeneity analysis was performed with the forest map, with P<0.01 considered as statistical significance; the funnel plot was used to describe publication bias, with P<0.1 considered as statistically significant. Area under curve (AUC) of summary receiver operator characteristic (SROC) was used to describe the diagnostic accuracy and the AUC closer to 1 indicated higher diagnostic accuracy. If there was heterogeneity (I(2)>50%) among studies, regression analysis and subgroup analysis were performed. P<0.05 was considered as statistically significant. Results: A total of 15 studies (1020 patients) were included. The optical imaging contained near-infrared (NIR) and fluorescent imaging (FI). The diagnostic value of optical imaging combined with ICG-guided SLN biopsy in gastric cancer was as follows: the pooled sensitivity (Sen) was 0.95 (95% CI: 0.82 to 0.99), specificity (Spe) was 1.00 (95% CI: 0.92 to 1.00), positive likelihood ratio (PLR) was 30.39 (95% CI: 9.14 to 101.06), negative likelihood ratio (NLR) was 0.05 (95% CI:0.01 to 0.20), diagnostic odds ratio (DOR) was 225.54 (95% CI: 88.81 to 572.77), AUC was 1.00 (95% CI: 0.99 to 1.00), threshold value was sensitivity=0.95 (95% CI: 0.82 to 0.99) and specificity=1.00 (95% CI: 0.92 to 1.00). Deeks method revealed DOR funnel plot of SLN biopsy was not asymmetrical obviously with significant difference (P=0.01), which indicated remarkable publishing bias. Meta-subgroup analysis showed that compared to FI, NIR imaging had higher sensitivity (0.98 vs. 0.73); compared to 0 minutes, optical imaging performed 20 minutes after ICG injection had higher sensitivity (0.98 vs. 0.70); compared to mean detected number of SLN of 4, mean detected number≥4 had higher sensitivity (0.96 vs. 0.68); compared to HE stain, immunohistochemistry + HE had higher sensitivity (0.99 vs. 0.84); compared to subserous injection of ICG, submucosa injection of ICG had higher sensitivity (0.98 vs. 0.40); compared to injection of 5 g/L ICG, 0.5 g/L and 0.05 g/L had higher sensitivity (0.98 vs. 0.83); compared to cT2-3 tumor, early stage (cT1) tumor had higher sensitivity (0.96 vs. 0.72); compared to ≤ enrolled 26 cases in the study, > 26 cases had higher sensitivity (0.96 vs. 0.65); compared to papers before 2010, papers after 2010 had higher sensitivity (0.97 vs. 0.81); whose differences were all significant. Sensitivity differences between mean tumor diameter of ≤30 cm and >30 cm, open surgery and laparoscopic surgery, lymph node regional dissection and retrieved dissection were not significant (all P>0.05). Conclusions: Optical imaging combined with ICG-guided SLN biopsy is clinically feasible, and especially suitable for early gastric cancer. However, the ICG being used in current studies may be overdosed. Higher sensitivity may be achieved from NIR imaging when compared with FI method.

Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery

BACKGROUND

Penile inversion vaginoplasty is the most common gender-affirming procedure for transfeminine patients. Patients undergoing this procedure may require revision labiaplasty and clitoroplasty. This study describes complications and outcomes from the largest reported cohort in the United States to undergo penile inversion vaginoplasty with subsequent revision labiaplasty and/or clitoroplasty.

METHODS

A retrospective chart review was performed of a single surgeon's experience with penile inversion vaginoplasty with or without revision labiaplasty and/or clitoroplasty between July of 2014 and June of 2016 in a cohort of gender-diverse patients assigned male at birth. Patient demographic data, complications, and quality of life data were collected. Univariate and multivariate comparisons were completed.

RESULTS

A total of 117 patients underwent penile inversion vaginoplasty. Of these, 28 patients (23.9 percent) underwent revision labiaplasty and/or clitoroplasty, with nine patients (7.7 percent) undergoing both procedures. Patients who underwent penile inversion vaginoplasty necessitating revision were significantly more likely to have granulation tissue (p = 0.006), intravaginal scarring (p < 0.001), and complete vaginal stenosis (p = 0.008). The majority of patients who underwent revision labiaplasty and/or clitoroplasty reported satisfaction with their final surgical outcome (82.4 percent) and resolution of their genital-related dysphoria (76.5 percent).

CONCLUSIONS

Patients who developed minor postoperative complications following penile inversion vaginoplasty were more likely to require revision surgery to address functional and aesthetic concerns. Patients responded with high levels of satisfaction following revision procedures, with the majority of patients reporting resolution of genital-related dysphoria. Transfeminine patients who undergo penile inversion vaginoplasty should be counseled on the possibility of revisions during their postoperative course.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

[Discussion of correlation between histogram analysis of quantitative diffusion weighted imaging and Gleason score of prostate cancer]

Objective: To discuss the correlation between histogram analysis of quantitative mono-exponential, bi-exponential and diffusion kurtosis models in diffusion weighted imaging and the Gleason score of prostate cancer, and evaluate the application value and diagnostic efficiency in identifying low and high grade prostate cancer. Methods: A total of 50 patients with histologically confirmed as prostate cancer were examined from May 2015 to May 2016 in the Second Affiliated Hospital of Soochow University using DWI performed at 3.0 T with an extended b-value range from 0 to 2 000 s/mm(2). Data were post-processed by whole tumor histogram analysis,the ROI was manually drown in DWI (b=1 000 s/mm(2)) step by step along the outline of cancer, and quantitative analysis were performed respectively by mono-exponential, bi-exponential and diffusion kurtosis models for quantification of apparent diffusion coefficients (ADCs), diffusivity D, pseudo-diffusivity D(*), perfusion fraction f, diffusion coefficients by non-Gaussian distribution (D(k)) and kurtosis coefficient (K).Then the histogram analysis was performed to get the mean, median, 25th percentile, 75th percentile, skewness and kurtosis. The correlation between histogram analysis results of these quantitative parameters and Gleason score of prostate cancer were evaluated by Spearman correlation coefficient. The diagnostic performance of histogram analysis results of each quantitative parameters in identifying low (Gleason score≤6) and high (Gleason score>6) grade prostate cancer was performed by comparing the area under the ROC curve and the curve values. Results: The values of ADC, D and D(k) (mean, median, 25th, 75th) were negatively correlated with Gleason score of prostate cancer (r value was -0.388--0.624, P<0.05). The values of D (skewness and kurtosis) had a certain correlation with Gleason score of prostate cancer (r value were 0.413 and 0.402, P<0.05). The histogram analysis results of D(*) and f had no statistically significant correlation with Gleason score of prostate cancer (P>0.05). The values of K (mean, median, 25th, kurtosis) were positively correlated with Gleason score of prostate cancer (r value was 0.423-0.699,P<0.05). The diagnostic efficiency of histogram analysis results of these quantitative parameter values in identifying low and high grade prostate cancer showed that the ADC (median), D (25th), D(k) (mean) and K (25th) had a larger area under the curve, and were 0.844, 0.873, 0.815, and 0.919 respectively, the differences of area under the curve between any two of these parameters above were not statistically significant (all P>0.05). Conclusions: The quantitative parameters of three diffusion models (ADC, D, D(k), K) in DWI are all related to the Gleason score of prostate cancer, but in the differential diagnosis of low and high grade prostate cancer, the diagnostic efficacy of mono-exponential model is sufficient. The more complex model such as bi-exponential and diffusion kurtosis may complement it in other ways.

CDK4 expression in chordoma: A potential therapeutic target

Chordomas are rare bone tumors and treatment is commonly based on a combination of surgery and radiotherapy. There is no standard chemotherapy treatment for chordoma. The aim of this study was to determine the expression of cyclin-dependent kinase 4 (CDK4) in chordoma and its therapeutic implications. We evaluated CDK4 expression both in chordoma cell lines and in chordoma tissues. Also, we investigated the functional roles of CDK4 in chordoma cell growth and proliferation. Furthermore, the therapeutic implications of targeting CDK4 in chordoma were evaluated. We found CDK4 highly expressed in chordoma cell lines and in a majority (97.7%) of chordoma tissues. Higher CDK4 expression correlated with metastasis and recurrence of chordoma. Treatment of chordoma cells using CDK4 inhibitor palbociclib could efficiently inhibit chordoma cells growth and proliferation. These data demonstrate that targeting CDK4 may be useful as a novel strategy in the treatment of chordoma. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1581-1589, 2018.

[The quantitative evaluation of early radiation-induced changes in the salivary glands using MRI]

Objective: To quantitatively evaluate the early radiation injury of salivary glands in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). Methods: Twenty patients with NPC between 2014 and 2015 from the Second Affiliated Hospital of Soochow University were retrospectively analyzed.All patients underwent an MRI scan before and after IMRT.The volumes, T(1)WI, T(2)WI signal intensity(SIs) and apparent diffusion coefficient (ADCs) of the parotid and submandibular glands were measured.The relative signal intensity (RSIs) of each salivary gland was calculated with cerebrospinal fluid as control.The quantitative parameters of salivary glands were compared before and after radiotherapy. Results: The volumes (cm(3)) and T(1)WI RSIs of the parotid and submandibular glands (14.88±6.00, 5.21±1.76, 2.98±1.05, 1.88±0.42, respectively) were significantly lower than those before radiotherapy (22.26±8.26, 7.76±2.45, 3.58±1.02, 2.27±0.50, respectively) (t=9.921, 4.013, 10.126, 4.202, respectively, P=0.000 for all). The T(2)WI RSIs and ADCs (×10(-3) mm(2)/s) of the parotid and submandibular glands (0.50 ± 0.08, 0.41±0.04, 1.31±0.19, 1.50±0.13, respectively) were significantly higher than those before radiotherapy (0.45±0.07, 0.33±0.05, 1.02±0.21, 1.23±0.13, respectively) (t=-4.846, -9.276, -9.957, -10.679, respectively, P=0.000 for all). The volumes of parotid and submandibular glands were correlated with ADCs (r=-0.512, P=0.000; r=-0.358, P=0.001; respectively). The volumes and ADCs of submandibular glands were correlated with T(1)WI RSIs and T(2)WI RSIs(P<0.05). Conclusion: MRI can quantitatively evaluate the early changes of salivary glands after radiotherapy of nasopharyngeal carcinoma as a noninvasive method, and has high clinical application potential.

Expression and therapeutic implications of cyclin-dependent kinase 4 (CDK4) in osteosarcoma

Overexpression and/or hyperactivation of cyclin-dependent kinase 4 (CDK4) has been found in many types of human cancers, and a CDK4 specific inhibitor, palbociclib, has been recently approved by the FDA for the treatment of breast cancer. However, the expression and the therapeutic potential of CDK4 in osteosarcoma remain unclear. In the present study, CDK4 was found to be highly expressed in human osteosarcoma tissues and cell lines as compared with normal human osteoblasts. Elevated CDK4 expression correlated with metastasis potential and poor prognosis in osteosarcoma patients as determined by immunohistochemical analysis in a human osteosarcoma tissue microarray (TMA). CDK4 inhibition by either palbociclib or specific small interference RNA (siRNA) exhibited dose-dependent inhibition of osteosarcoma cell proliferation and growth, accompanied by suppression of the CDK4/6-cyclinD-Rb signaling pathway. Flow cytometry analysis showed that CDK4 knockdown arrested osteosarcoma cells in the G1 phase of the cell cycle and induced cell apoptosis. Furthermore, inhibition of CDK4 significantly decreased osteosarcoma cell migration in vitro determined by the wound healing assay. These data highlight that CDK4 may be a potential promising therapeutic target in the treatment of human osteosarcoma.

[Preliminary applicability evaluation of Prostate Imaging Reporting and Data System version 2 diagnostic score in 3.0T multi-parameters magnetic resonance imaging combined with prostate specific antigen density for prostate cancer]

Objective: To investigate the preliminary applicability of Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score in the condition of 3.0T multi-parametric magnetic resonance imaging (Mp-MRI) combined with clinical classic indicators for the diagnosis of prostate cancer (PCa). Methods: The clinical and MRI materials of 247 patients of suspicious prostate disease treated in Second Affiliated Hospital of Soochow University from June 2015 to November 2016 were analyzed retrospectively, including 110 cases with PCa and 137 cases without cancer.All cases underwent the high-resolution axial T(2)-weighted imaging (T(2)WI), diffusion weighted imaging (DWI) and dynamic contrast enhancement-magnetic resonance imaging (DCE-MRI) and were confirmed pathologically by puncture biopsies.The Mp-MRI materials of all cases were scored according to PI-RADS v2.The prostate volume and prostate specific antigen (PSA) density (PSAD) value were calculated according to the formulas.The univariate and multivariate analysis were performed for the observed indicators (age, prostate volume, PSA, PSAD and PI-RADS v2 score) to determine the independent predictors for PCa.Then, a Logistic regression model (combined prediction model) was established by the independent predictors for combined diagnosis of PCa.The receiver operating characteristic curve (ROC) curve analysis was performed to get the sensitivity and specificity of each independent predictor and the model to diagnose PCa.The differences of AUC values of each independent predictor and the model were compared with each other to evaluate the diagnostic performance for PCa. Results: The differences in the age, prostate volume, PSA, PSAD and the PI-RADS v2 score between patients with PCa and non-cancer group were all statistically significant (t=2.870, Z=-4.230, -7.787, -9.477, -10.826, all P<0.05). The PSAD and PI-RADS v2 score were independent predictors for PCa (OR=3.331, 10.546, both P<0.05). The Logistic regression combined prediction model by PI-RADS v2 score and PSAD to forecast PCa was Logit(P)=-5.097+ 2.309×PSAD+ 1.214×PI-RADS v2 score.The area under the curve (AUC) of ROC in the combined model (0.911) was higher than that in the PI-RADS v2 score (0.886) and PSAD (0.851) and the differences were all statistically significant (Z=2.416, 2.716, both P<0.05); but the difference in the AUC value between PI-RADS v2 score and PSAD was not statistically significant (Z=1.191, P=0.234). The diagnostic sensitivity of PSAD, PI-RADS v2 score and the model were: 0.891, 0.782 and 0.855, respectively; the specificity were 0.449, 0.912 and 0.847, respectively on their positive thresholds (0.15 μg·L(-1)·ml(-1,) 4 and -0.82). Conclusion: PI-RADS v2 score combined with PSAD in diagnosing PCa is superior to the single application of them and it can lead to high diagnostic sensitivity and specificity for PCa.

Noncoding RNA in drug resistant sarcoma

Sarcomas are a group of malignant tumors that arise from mesenchymal origin. Despite significant development of multidisciplinary treatments for sarcoma, survival rates have reached a plateau. Chemotherapy has been extensively used for sarcoma treatment; however, the development of drug resistance is a major obstacle limiting the success of many anticancer agents. Sarcoma biology has traditionally focused on genomic and epigenomic deregulation of protein-coding genes to identify the therapeutic potential for reversing drug resistance. New and more creative approaches have found the involvement of noncoding RNAs, including microRNAs and long noncoding RNAs in drug resistant sarcoma. In this review, we discuss the current knowledge of noncoding RNAs characteristics and the regulated genes involved in drug resistant sarcoma, and focus on their therapeutic potential in the future.

Facial Layer-by-Layer Engineering of Upconversion Nanoparticles for Gene Delivery: Near-Infrared-Initiated Fluorescence Resonance Energy Transfer Tracking and Overcoming Drug Resistance in Ovarian Cancer

Development of multidrug resistance (MDR) contributes to the majority of treatment failures in clinical chemotherapy. We report facial layer-by-layer engineered upconversion nanoparticles (UCNPs) for near-infrared (NIR)-initiated tracking and delivery of small interfering RNA (siRNA) to enhance chemotherapy efficacy by silencing the MDR1 gene and resensitizing resistant ovarian cancer cells to drug. Layer-by-layer engineered UCNPs were loaded with MDR1 gene-silencing siRNA (MDR1-siRNA) by electrostatic interaction. The delivery vehicle enhances MDR1-siRNA cellular uptake, protects MDR1-siRNA from nuclease degradation, and promotes endosomal escape for silencing the MDR gene. The intrinsic photon upconversion of UCNPs provides an unprecedented opportunity for monitoring intracellular attachment and release of MDR1-siRNA by NIR-initiated fluorescence resonance energy transfer occurs between donor UCNPs and acceptor fluorescence dye-labeled MDR1-siRNA. Enhanced chemotherapeutic efficacy in vitro was demonstrated by cell viability assay. The developed delivery vehicle holds great potential in delivery and imaging-guided tracking of therapeutic gene targets for effective treatment of drug-resistant cancers.

Regulation of microRNA-1 (miR-1) expression in human cancer

MicroRNAs (miRs) have been found to play important roles in tumorigenesis, apoptosis, metastasis, and drug resistance in cancer. Among a number of miRs, miR-1 was shown to be predominantly downregulated in almost all examined human cancers. As a tumor suppressor miR involved in post-transcriptional regulation of crucial tumor associated gene expression, miR-1 represents a promising target for anticancer therapy. Re-expression of miR-1 can suppress cancer cell proliferation, promote apoptosis, and reverse drug resistance in cancers both in vitro and in vivo. Recently, the regulatory mechanisms of miR-1 expression have been studied in various cancers in different model systems. In this review, we summarize the mechanisms of miR-1 expression through epigenetic, transcriptional, and post-transcriptional regulation. These regulatory mechanisms of miR-1 expression could help us to understand the functions of altered miR-1 expression and provide valuable insights for further investigations into miR-1 based cancer therapy.

Aberrant DNA methylations in chondrosarcoma

Chondrosarcoma (CS) is the second most common primary malignant bone tumor. Unlike other bone tumors, CS is highly resistant to conventional chemotherapy and radiotherapy, thus resulting in poor patient outcomes. There is an urgent need to establish alternative therapies for CS. However, the etiology and pathogenesis of CS still remain elusive. Recently, DNA methylation-associated epigenetic changes have been found to play a pivotal role in the initiation and development of human cancers, including CS, by regulating target gene expression in different cellular pathways. Elucidating the mechanisms of DNA methylation alteration may provide biomarkers for diagnosis and prognosis, as well as novel treatment options for CS. We have conducted a critical review to summarize the evidence regarding aberrant DNA methylation patterns as diagnostic biomarkers, predictors of progression and potential treatment strategies in CS.

[Predictor measures on CT for hematoma expansion following acute intracerebral hemorrhage]

OBJECTIVE

To evaluate the worth of solid predictors in acute intracerebral hematoma(ICH) expansions in computer tomography images.

METHODS

A total of 105 patients with acute ICH in The Second Affiliated Hospital of Soochow University during January 2012 to February 2015 were enrolled. CT plain scan, CTA within 6 hours since the symptoms and CT plain scan recheck within 24 hours were executed. Hematoma location, initial volume of hematoma, shape of hematoma, "spot sign" , UHG speed were analyzed with single factor and binary Logistic regression between the patients with and without hematoma expansion.

RESULTS

There were 30 cases with hematoma expansion and 75 cases with no hematoma expansion in 105 patients. In single factor comparisons, hematoma location(χ(2) =13.125, P<0.05), hematoma shape(χ(2) =23.987, P<0.05), spot sign(χ(2) =25.846, P<0.05), UHG speed(χ(2) =20.328, P<0.05) and the initial hematoma volume(t=-3.183, P<0.05) between the hematoma expansions and the non-hematoma expansions made significant differences. In binary Logistic regression, hematoma shape(irregular (P=0.033) and cleavage(P=0.009)), spot sign(P=0.000) and UHG speed(P=0.040) had significant differences between the two groups. ROC curve areas of hematoma shape, spot sign and UHG speed were 0.776(95%CI 0.682-0.870), 0.740(95%CI 0.625-0.855) and 0.720(95% CI 0.604-0.836). The high specificities of hematoma shape(84%), spot sign (88%)and UHG speed(84%)revealed their great reliabilities with equal sensitivity (60%).

CONCLUSION

Hematoma shape, spot sign and UHG speed are solid predictors of hematoma expansion among which spot sign has promising specificity, hematoma shape and UHG speed are more convenient to be observed.

Evaluation of P-glycoprotein (Pgp) expression in human osteosarcoma by high-throughput tissue microarray

Survival of osteosarcoma patients is currently limited by the development of metastases and multidrug resistance (MDR). A well-established cause of MDR involves overexpression of P-glycoprotein (Pgp) in tumor cells. However, some discrepancies still exist as to the clinical significance of Pgp in osteosarcoma. We sought to elucidate further whether the Pgp expression correlated with clinical behavior in a series of patients with osteosarcoma via high-throughput tissue microarray (TMA) analysis. Immunohistochemical analysis of Pgp expression in a TMA of 114 specimens with a retrospective review of 70 osteosarcoma patients admitted to the Massachusetts General Hospital (MGH) was performed. High Pgp expression was correlated with metastasis development and poor response to pre-operative chemotherapy in osteosarcoma patients. Eighteen of the fifty-seven patients initially admitted with primary osteosarcoma showed high Pgp expression. Among these 18 patients with high Pgp expression, 13 of 18 (72%) patients eventually developed metastases. There was no significant clinical relevance between Pgp expression and osteosarcoma survival. These results support that high expression of Pgp is important, but cannot be assigned as, an individual predictor in the development of human osteosarcoma. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1606-1612, 2016.

The emerging roles and therapeutic potential of cyclin-dependent kinase 11 (CDK11) in human cancer

Overexpression and/or hyperactivation of cyclin-dependent kinases (CDKs) are common features of most cancer types. CDKs have been shown to play important roles in tumor cell proliferation and growth by controlling cell cycle, transcription, and RNA splicing. CDK4/6 inhibitor palbociclib has been recently approved by the FDA for the treatment of breast cancer. CDK11 is a serine/threonine protein kinase in the CDK family and recent studies have shown that CDK11 also plays critical roles in cancer cell growth and proliferation. A variety of genetic and epigenetic events may cause universal overexpression of CDK11 in human cancers. Inhibition of CDK11 has been shown to lead to cancer cell death and apoptosis. Significant evidence has suggested that CDK11 may be a novel and promising therapeutic target for the treatment of cancers. This review will focus on the emerging roles of CDK11 in human cancers, and provide a proof-of-principle for continued efforts toward targeting CDK11 for effective cancer treatment.

Targeting EZH2-mediated methylation of H3K27 inhibits proliferation and migration of Synovial Sarcoma in vitro

Synovial sarcoma is an aggressive soft tissue sarcoma genetically defined by the fusion oncogene SS18-SSX. It is hypothesized that either SS18-SSX disrupts SWI/SNF complex inhibition of the polycomb complex 2 (PRC2) methyltransferase Enhancer of Zeste Homologue 2 (EZH2), or that SS18-SSX is able to directly recruit PRC2 to aberrantly silence target genes. This is of potential therapeutic value as several EZH2 small molecule inhibitors are entering early phase clinical trials. In this study, we first confirmed EZH2 expression in the 76% of human synovial sarcoma samples. We subsequently investigated EZH2 as a therapeutic target in synovial sarcoma in vitro. Knockdown of EZH2 by shRNA or siRNA resulted in inhibition of cell growth and migration across a series of synovial sarcoma cell lines. The EZH2 selective small-molecule inhibitor EPZ005687 similarly suppressed cell proliferation and migration. These data support the hypothesis that targeting EZH2 may be a promising therapeutic strategy in the treatment of synovial sarcoma; clinical trials are initiating enrollment currently.

MiR-708 promotes steroid-induced osteonecrosis of femoral head, suppresses osteogenic differentiation by targeting SMAD3

Steroid-induced osteonecrosis of femoral head (ONFH) is a serious complication of glucocorticoid (GC) use. We investigated the differential expression of miRs in the mesenchymal stem cells (MSCs) of patients with ONFH, and aimed to explain the relationship between GC use and the development of MSC dysfunction in ONFH. Cells were collected from bone marrow of patients with ONFH. Samples were assigned to either GCs Group or Control Group at 1:1 matched with control. We then used miRNA microarray analysis and real-time PCR to identify the differentially expressed miRs. We also induced normal MSCs with GCs to verify the differential expression above. Subsequently, we selected some of the miRs for further studies, including miRNA target and pathway prediction, and functional analysis. We discovered that miR-708 was upregulated in ONFH patients and GC-treated MSCs. SMAD3 was identified as a direct target gene of miR-708, and functional analysis demonstrated that miR-708 could markedly suppress osteogenic differentiation and adipogenesis differentiation of MSCs. Inhibition of miR-708 rescued the suppressive effect of GC on osteonecrosis. Therefore, we determined that GC use resulted in overexpression of miR-708 in MSCs, and thus, targeting miR-708 may serve as a novel therapeutic biomarker for the prevention and treatment of ONFH.

MicroRNA-155 expression is independently predictive of outcome in chordoma

Background

Chordoma pathogenesis remains poorly understood. In this study, we aimed to evaluate the relationships between microRNA-155 (miR-155) expression and the clinicopathological features of chordoma patients, and to evaluate the functional role of miR-155 in chordoma.

Methods

The miRNA expression profiles were analyzed using miRNA microarray assays. Regulatory activity of miR-155 was assessed using bioinformatic tools. miR-155 expression levels were validated by reverse transcription-polymerase chain reaction. The relationships between miR-155 expression and the clinicopathological features of chordoma patients were analyzed. Proliferative, migratory and invasive activities were assessed by MTT, wound healing, and Matrigel invasion assays, respectively.

Results

The miRNA microarray assay revealed miR-155 to be highly expressed and biologically active in chordoma. miR-155 expression in chordoma tissues was significantly elevated, and this expression correlated significantly with disease stage (p = 0.036) and the presence of metastasis (p = 0.035). miR-155 expression also correlated significantly with poor outcomes for chordoma patients (hazard ratio, 5.32; p = 0.045). Inhibition of miR-155 expression suppressed proliferation, and the migratory and invasive activities of chordoma cells.

Conclusions

We have shown miR-155 expression to independently affect prognosis in chordoma. These results collectively indicate that miR-155 expression may serve not only as a prognostic marker, but also as a potential therapeutic target in chordoma.

Development and potential applications of CRISPR-Cas9 genome editing technology in sarcoma

Sarcomas include some of the most aggressive tumors and typically respond poorly to chemotherapy. In recent years, specific gene fusion/mutations and gene over-expression/activation have been shown to drive sarcoma pathogenesis and development. These emerging genomic alterations may provide targets for novel therapeutic strategies and have the potential to transform sarcoma patient care. The RNA-guided nuclease CRISPR-Cas9 (Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-associated protein-9 nuclease) is a convenient and versatile platform for site-specific genome editing and epigenome targeted modulation. Given that sarcoma is believed to develop as a result of genetic alterations in mesenchymal progenitor/stem cells, CRISPR-Cas9 genome editing technologies hold extensive application potentials in sarcoma models and therapies. We review the development and mechanisms of the CRISPR-Cas9 system in genome editing and introduce its application in sarcoma research and potential therapy in clinic. Additionally, we propose future directions and discuss the challenges faced with these applications, providing concise and enlightening information for readers interested in this area.

The emerging roles and therapeutic potential of microRNAs (miRs) in liposarcoma

Liposarcoma (LPS) is a common subtype of soft tissue sarcoma and accounts for approximately 20% of adult sarcomas. Despite the progress in diagnosis and treatment of LPS, there is still a high mortality rate due to local recurrence or metastasis. The mechanisms underlying the development of recurrence and metastasis of LPS remain elusive. MicroRNAs (miRNAs or miRs) are non-coding RNAs that regulate target gene expression, influencing many cellular functions, including cell proliferation, apoptosis, differentiation, oncogenesis, and drug resistance in malignant cells. The dysregulation of miRs is involved in the initiation and progression of human cancers, including LPS. Functional studies have shown the potent pro- and anti-tumorigenic activity of specific miRs both in vitro and in vivo. miR signatures that are unique to specific types of LPS have been proposed. Several lines of evidence have shown that miRs can act either as oncogenes or tumor suppressor genes, as well as diagnostic and prognostic biomarkers for LPS. In addition, miRs may be a powerful therapeutic target in LPS, although obstacles such as delivery of miRs in vivo need to be overcome. In this review, we discuss the emerging roles of miRs in different histological subtypes of LPS.

Targeting CDK11 in osteosarcoma cells using the CRISPR-Cas9 system

Osteosarcoma is the most common type primary malignant tumor of bone. Patients with regional osteosarcoma are routinely treated with surgery and chemotherapy. In addition, many patients with metastatic or recurrent osteosarcoma show poor prognosis with current chemotherapy agents. Therefore, it is important to improve the general condition and the overall survival rate of patients with osteosarcoma by identifying novel therapeutic strategies. Recent studies have revealed that CDK11 is essential in osteosarcoma cell growth and survival by inhibiting CDK11 mRNA expression with RNAi. Here, we apply the Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas9 system, a robust and highly efficient novel genome editing tool, to determine the effect of targeting endogenous CDK11 gene at the DNA level in osteosarcoma cell lines. We show that CDK11 can be efficiently silenced by CRISPR-Cas9. Inhibition of CDK11 is associated with decreased cell proliferation and viability, and induces cell death in osteosarcoma cell lines KHOS and U-2OS. Furthermore, the migration and invasion activities are also markedly reduced by CDK11 knockout. These results demonstrate that CRISPR-Cas9 system is a useful tool for the modification of endogenous CDK11 gene expression, and CRISPR-Cas9 targeted CDK11 knockout may be a promising therapeutic regimen for the treatment of osteosarcoma.

Targeting programmed cell death ligand 1 in osteosarcoma: an auto-commentary on therapeutic potential

Programmed cell death ligand 1 (PDL1) expression was recently shown to correlate with tumor-infiltrating lymphocytes (TILs) in a subset of osteosarcoma patients. Among clinical factors evaluated across human osteosarcoma samples, a pulmonary origin of metastases correlated with high PDL1 expression and prominent TILs. Considering that multiple agents targeting PD-1/PDL1 are under development, targeting this immune checkpoint may be a novel immunotherapeutic route for osteosarcoma in future clinical trials.

MicroRNA-1 (miR-1) inhibits chordoma cell migration and invasion by targeting slug

Recent studies have revealed that expression of miRNA-1 (miR-1) is frequently down-regulated in several cancer types including chordoma. Identifying and validating novel targets of miR-1 is useful for understanding the roles of miR-1 in chordoma. We aimed to further investigate the functions of miR-1 in chordoma. Specifically, we assessed whether restoration of miR-1 affects cell migration and invasion in chordoma, and focused on the miR-1 potential target Slug gene. Migratory and invasive activities were assessed by wound healing and Matrigel invasion assays, respectively. Cell proliferation was determined by MTT assay. Slug expression was evaluated by Western blot, immunofluorescence, and immunohistochemistry. Restoration of miR-1 expression suppressed the migratory and invasive activities of chordoma cells. Transfection of miR-1 inhibited cell proliferation both time- and dose-dependently in chordoma. MiR-1 transfected cells showed inhibited Slug expression. Slug was over-expressed in chordoma cell lines and advanced chordoma tissues. In conclusion, we have shown that miR-1 directly targets the Slug gene in chordoma. Restoration of miR-1 suppressed not only proliferation, but also migratory and invasive activities, and reduced the Slug expression in chordoma cells. These results collectively indicate that miR-1/Slug pathway is a potential therapeutic target because of its crucial roles in chordoma cell growth and migration.

Genotyping cancer-associated genes in chordoma identifies mutations in oncogenes and areas of chromosomal loss involving CDKN2A, PTEN, and SMARCB1

The molecular mechanisms underlying chordoma pathogenesis are unknown. We therefore sought to identify novel mutations to better understand chordoma biology and to potentially identify therapeutic targets. Given the relatively high costs of whole genome sequencing, we performed a focused genetic analysis using matrix-assisted laser desorption/ionization-time of flight mass spectrometer (Sequenom iPLEX genotyping). We tested 865 hotspot mutations in 111 oncogenes and selected tumor suppressor genes (OncoMap v. 3.0) of 45 human chordoma tumor samples. Of the analyzed samples, seven were identified with at least one mutation. Six of these were from fresh frozen samples, and one was from a paraffin embedded sample. These observations were validated using an independent platform using homogeneous mass extend MALDI-TOF (Sequenom hME Genotyping). These genetic alterations include: ALK (A877S), CTNNB1 (T41A), NRAS (Q61R), PIK3CA (E545K), PTEN (R130), CDKN2A (R58*), and SMARCB1 (R40*). This study reports on the largest comprehensive mutational analysis of chordomas performed to date. To focus on mutations that have the greatest chance of clinical relevance, we tested only oncogenes and tumor suppressor genes that have been previously implicated in the tumorigenesis of more common malignancies. We identified rare genetic changes that may have functional significance to the underlying biology and potential therapeutics for chordomas. Mutations in CDKN2A and PTEN occurred in areas of chromosomal copy loss. When this data is paired with the studies showing 18 of 21 chordoma samples displaying copy loss at the locus for CDKN2A, 17 of 21 chordoma samples displaying copy loss at PTEN, and 3 of 4 chordoma samples displaying deletion at the SMARCB1 locus, we can infer that a loss of heterozygosity at these three loci may play a significant role in chordoma pathogenesis.

Programmed cell death ligand 1 expression in osteosarcoma

Programmed cell death ligand 1 (PDL1, also known as B7H1) is a cell-surface protein that suppresses the cytotoxic CD8(+) T-cell-mediated immune response. PDL1 expression and its clinical relevance in sarcomas are not well understood. Therefore, we sought to measure RNA expression levels for PDL1 in 38 clinically annotated osteosarcoma tumor samples and aimed to determine if PDL1 expression correlates with clinical features and tumor-infiltrating lymphocytes (TIL). Quantitative real-time RT-PCR for PDL1 was optimized in 18 cell lines, of which 5 were osteosarcoma derived. qRT-PCR results were validated via flow cytometry and immunohistochemistry (IHC) in select cell lines. Total RNA was isolated from 38 human osteosarcoma samples for qRT-PCR analysis. Clinical data were sorted, and significance was determined by the Student t test. TILs were examined in patient samples by tissue microarray hematoxylin-eosin staining. We confirmed the constitutive PDL1 mRNA expression in cell lines by qRT-PCR, flow cytometry, and IHC. Across human osteosarcoma samples, PDL1 mRNA gene expression ranged over 4 log (>5,000-fold difference). Relative expression levels were evaluated against clinical factors such as age/gender, metastasis, recurrence, chemotherapy, percentage of necrosis, and survival; no significant associations were identified. The presence of TILs was associated with high PDL1 expression (R(2) = 0.37; P = 0.01). In summary, we developed an RNA-based assay to determine PDL1 expression levels, and we show, for the first time, that high levels of PDL1 are expressed in a subset of osteosarcoma, and PDL1 expression is positively correlated with TILs. Multiple agents targeting PD1/PDL1 are in clinical development, and this may be a novel immunotherapeutic strategy for osteosarcoma clinical trials.

Oxidative damage in age-related macular degeneration

Epidemiologic studies have suggested that elderly patients who consumed diets rich in antioxidants throughout their lives are less likely to be afflicted with age-related macular degeneration (AMD). This led to the Age-Related Eye Disease Study, which showed that supplements containing antioxidant vitamins and zinc reduce the risk of progression to severe stages of AMD. Despite these data that indirectly implicate oxidative damage in the pathogenesis of AMD, there has not been any direct demonstration of increased oxidative damage in the retinas of patients with AMD. In this study, we used biomarkers of oxidative damage in postmortem eyes from patients with AMD and comparably aged patients without AMD to directly assess for oxidative damage. Sections from 4 eyes with no pathologic features of AMD showed no immunofluorescent staining for markers of oxidative damage, while sections from 8 of 12 eyes with advanced geographic atrophy showed evidence of widespread oxidative damage in both posterior and anterior retina. Only 2 of 8 eyes with choroidal neovascularization and 2 of 16 eyes with diffuse drusen and no other signs of AMD showed evidence of oxidative damage. These data suggest that widespread oxidative damage occurs in the retina of some patients with AMD and is more likely to be seen in patients with advanced geographic atrophy. This does not rule out oxidative damage as a pathogenic mechanism in patients with CNV, but suggests that a subpopulation of patients with geographic atrophy may have a major deficiency in the oxidative defense system that puts the majority of cells in the retina at risk for oxidative damage.

[Relationship between hepatitis B virus genotypes and basic core promoter/precore mutations in patients with severe hepatitis.]

BACKGROUND

To investigate the relationship between hepatitis B virus genotypes and basic core promoter (BCP)/precore mutations in patients with severe hepatitis.

METHODS

HBV genotypes were determined by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) in 52 patients with severe hepatitis and 52 cases with chronic hepatitis B (CHB). Eight samples of genotypes B and C were randomly selected and their S gene was directly sequenced, and then their phylogenetic trees were analyzed. Fifteen samples of each of genotypes B and C were randomly selected and their BCP and precore genes were directly sequenced with PCR, and then the relationship between genotypes and BCP(T1762/A1764)/precore (A1896) mutations were analyzed.

RESULTS

Genotype B C and mixed genotypes (B and C) were detected in patients with severe hepatitis in Quanzhou area. Genotype B was the majority with a proportion 48.08% others had a proportion 30.77% and 17.31%, respectively. Genotype A, E and F were not detected. The percents of genotype C, mixed B and C in severe hepatitis were significantly higher than that in CHB. The double mutation in BCP (T1762/A1764) was significantly more frequent in severe hepatitis with genotype C than that in genotype B (P less than 0.05). However, there was no significant difference in the distribution of precore mutant with A1896 between genotype B and C patients (P greater than 0.05).

CONCLUSION

Genotype C may induce more severe liver inflammation than that genotype B may do. Mixed genotypes B and C infection may be an important determinant of inducing severe hepatitis. The double mutation in BCP (T1762/A1764) was more common in severe hepatitis with genotype C than that with genotype B.

Clinical Application of Artificial Dura Mater to Avoid Cerebrospinal Fluid Leaks after Microvascular Decompression Surgery

OBJECTIVE

Although technological advances combined with many surgical innovations have helped to minimize its occurrence, cerebrospinal fluid (CSF) leak still remains to be one of the most common postoperative complications following microvascular decompression (MVD) surgeries. The objectives of this study are 1) to detail our experience with the clinical application of artificial dura mater for the avoidance of CSF leaks in a group of 103 patients who underwent MVD surgeries and 2) to compare the results of CSF leak and deep wound infection between the group with and one without using artificial dura mater.

METHODS

From July, 2002 to June, 2004 217 consecutive patients who underwent MVD surgeries for hemifacial spasm or trigeminal neuralgia in our center were enrolled into this study. Among them, 103 patients underwent the application of artificial dura mater (Neuro-patch) in the surgical closure procedure to prevent postoperative CSF leak. The handling techniques were detailed and the postoperative results were evaluated. The follow-up period was at least 6 months.

RESULTS

No postoperative CSF leak occurred in the group of patients receiving artificial dura mater whereas 6 cases of CSF leak (2 otorrhea, 2 rhinorrea and 2 CSF wound leak) were found in the group not receiving artificial dura mater. There was no statistical difference of wound infection rates found between these two groups, 1.9 % vs. 2.6 %.

CONCLUSIONS

The use of the artificial dura mater in the closure procedure of MVD surgery seems to be a safe and effective way to prevent CSF leaks. However, further investigations on a larger number of cases still need to be done to substantiate its validity.

Synthesis and anti-HIV activity of oleanolic acid derivatives

Thirteen oleanolic acid derivatives were prepared and evaluated for anti-HIV activity in H9 lymphocytes. Saturating the C(12)-C(13) double bond and converting the C(17)-carboxyl group to an aminomethyl group led to compounds 13-15 and 19-20, respectively, which showed improved anti-HIV activity. Compound 15 was the most potent derivative with EC(50)=0.0039 microg/mL and TI=3570.

A 3D structural model of memapsin 2 protease generated from theoretical study

AIM

To build a 3D structural model of memapsin 2 (M2) protease for theoretical study and drug design.

METHODS

Structural alignment was performed based on multiple and pairwise sequence alignment of three templates. After the initial model was generated, energy minimization was completed by applying molecular mechanics method. Molecular dynamics (MD) technique was used to do further structural optimization.

RESULTS

The 3D structural model of memapsin 2 was constructed. The model is reasonable according to several validation criteria. The active-site motifs of M2 are structurally supported by a beta-sheet rich domain and linked together with this domain through alpha helices. Tyr132 contained in beta-hairpin is a general characteristic of aspartic protease. The Calpha atom superimposing result is a direct verification that M2 is structurally unique but still belongs to the aspartic protease superfamily.

CONCLUSION

The 3D-structure model from our study is informative to guide future molecular biology study about M2 and drug design based on database searching.

The portosystemic shunt protects liver against ischemic reperfusion injury

BACKGROUND

The goal of this study was to characterize the importance of splanchnic viscera in liver ischemic reperfusion injury and to enhance the tolerance of liver to warm ischemia injury with portosystemic shunt.

METHODS

The hepatic blood flow of male Sprague Dawley rats was subjected to 45, 60, 120, and 150 min liver warm ischemia with or without portosystemic shunt (splenic-caval shunt). The production of tumor necrosis factor a (TNFa), nuclear factor-kappaB activation, inducible NO synthase (iNOS) expression, and apoptosis were examined.

RESULTS

A total of 67% of rats with 45 min liver warm ischemia (n=6) and 100% of rats with 60 min liver warm ischemia (n=6) died within 1 day. However, all rats with 120 min (n=8) liver warm ischemia in splenic-caval shunt group survived for over 1 day, 6/8 for over 3 days, and 5/8 for over 5 days without significant histological changes of the liver. Serum tumor necrosis factor levels in liver warm ischemic rats were increased, This increase was significantly reversed after portosystemic shunt. After challenge with lipopolysaccharide (1 mg/kg, p.v.), naive rats survived for over 5 days (n=4) with the peak value of rat tumor necrosis factor (240 pg/ml) at 90 min. In contrast, all rats died within one day (n=5) with the peak value of rat tumor necrosis factor a (465 pg/ml) at 45 min after administration of lipopolysaccharide in the rats with liver warm ischemia plus splenic-caval shunt. iNOS expression and nuclear factor-kappaB activation were very strongly increased in the hepatocytes after liver warm ischemia with portosystemic shunt, compared with liver ischemia without portosytemic shunt.

CONCLUSIONS

We conclude that the splanchnic viscera can contribute to liver ischemic reperfusion injury. Portosystemic shunt enhances the tolerance of liver to warm ischemia through the protective role of iNOS and nuclear factor-kappaB (NF-kappaB).

Anti-AIDS agents. 34. Synthesis and structure-activity relationships of betulin derivatives as anti-HIV agents

Succinyl and 3'-substituted glutaryl betulin derivatives showed stronger anti-HIV activity and higher therapeutic index (TI) values than their dihydrobetulin counterparts, with ratios of 1.2:1 to 15:1 (cf. 7 and 15, 9 and 17, 10 and 18, 11 and 19, and 12 and 20). For various 3'-substituted glutaryl compounds, the order of anti-HIV effects, from strong to weak inhibition, was 3',3'-dimethyl, 3'-methyl, 3'-ethyl-3'-methyl, followed by 3',3'-tetramethylene glutaryl derivatives (10 > 9 > 11 > 12, 18 > 17 > 19 > 20). The most potent compound, 10, has two 3',3'-dimethylglutaryl groups and displays significant anti-HIV potency with an EC50 value of 0.000 66 microM and a TI of 21 515. Results for compounds (22 and 23) without a C-3 acyl group confirmed the importance of the C-3 acyl group to the anti-HIV effect. With 3',3'-tetramethylene glutaryl derivatives, triacyl 29 showed stronger inhibition than diacyl 12; in contrast, 3',3'-dimethylglutaryl compounds displayed opposite results. 3-Keto compounds (35 and 36) and 2,3-dihydro compounds (39 and 40) had EC50 values in the range of 4.3-10.0 microM, suggesting that A ring modification led to decreased potency. The reduced activity of amide (33 and 34), ester (41), and oxime (42) analogues suggested that the orientation and linkage of the C-3 acyl side chain play crucial roles in the potent anti-HIV activity. Finally, replacing the C-28 acyl group with a bulky non-carboxylic group produced a less potent compound (44). In the study of mechanism of action, our results indicated that fusion is not the primary target for the anti-HIV activity of 10. It appears to inhibit HIV replication at a late stage of the viral life cycle, i.e., after viral protein synthesis.

FK506 treatment in combination with leflunomide in hamster-to-rat heart and liver xenograft transplantation

BACKGROUND

In the experiment described here, we investigated the effects of the immunosuppressants FK506 and leflunomide (Lef) on the survival of hamster hearts and liver xenografts in Lewis rats.

METHODS

Lewis rats were used as recipients of hamster heart or liver grafts using different regimens of FK506 and Lef. Donor-matched heart grafts were transplanted into long-term surviving Lewis rat recipients of hamster xenografts to test donor-specific prolongation of xenograft survival. Hyperimmune, late xenograft rejection, and naive sera were transferred into long-term surviving Lewis rat recipients of hamster heart xenografts to determine whether these sera could inhibit the efficacy of donor-specific long-term survival. Anti-donor-specific antibodies were analyzed by flow cytometry.

RESULTS

After a short induction with FK506 plus Lef, maintenance treatment with FK506 alone was sufficient to prolong survival of hamster xenografts. All hamster heart and four of six hamster liver xenografts survived for more than 3 months. Second hamster hearts were permanently accepted by Lewis rats bearing long-term surviving hamster heart xenografts when rats were treated with FK506 monotherapy (mean survival time >60 days, n=4). Long-term surviving hamster heart grafts were rejected after transfer of hyperimmune serum but not late xenograft rejection serum or naive serum. Lef and FK506 significantly reduced the production of anti-donor-specific antibodies in Lewis rats transplanted with hamster liver and heart xenografts.

CONCLUSION

Long-term survival of hamster liver and heart xenografts in Lewis rats could be induced by a regimen of short-term FK506 in combination with Lef followed by FK506 monotherapy. The acquired sensitivity of late xenoreactivity to FK506 reflects primarily a modification in the host immune response to the hamster graft.

Anti-AIDS agents. 32. Synthesis and anti-HIV activity of betulin derivatives

Eleven betulin derivatives were prepared and evaluated for anti-HIV activity in H9 lymphocytes. Compound 4 was found to be the most active with EC50 and TI values of 0.00066 microM and 21,515, respectively.

Manuifolins D, E, and F: new isoflavonoids from Maackia tenuifolia

Chemical examination of roots of Maackia tenuifolia yielded three new isoflavans, manuifolins D, E, and F, along with the known (6aR, 12aR)-pterocarpin and (6aR,12aR)-maackiain. The new compounds were established as (3R)-5'-(1,1-dimethyl-2-propenyl)-4'- O-(3-methyl-2-butenyl)- 7,2'-dihydroxyisoflavan (1), (3R)-6,5'-bis(1,1-dimethyl-2-propenyl)-7,2',4', -trihydroxyisoflavan (2), and (3R)-5'-(1-isopropylethenyl)-8-(3-methyl-2-butenyl)-7,2',4'- trihydroxyisoflavan (3), respectively, by spectroscopic methods.

Increased endothelin-1 in the rabbit model of middle cerebral artery occlusion

Endothelin-mediated vasoconstriction may theoretically aggravate ischemic neuronal damage. Although investigators have demonstrated that endothelins are produced by cerebral microvessel endothelial cells, astrocytes and neurons in vitro, whether endothelins are produced during cerebral ischemia is still unclear. The purpose of this study, therefore, was to measure endothelin-1 in brain tissue and plasma following middle cerebral artery occlusion and to examine the relationship between brain tissue and plasma endothelin-1 levels. The middle cerebral artery of rabbits was occluded for 2, 4 or 24 h. The amount of endothelin-1 in both brain tissue and plasma was determined by RIA. The results demonstrate that the concentrations of endothelin-1 in the ischemic brain tissue and plasma are both significantly increased after focal cerebral ischemia (P < 0.01). The data confirm that an acute and marked increase of endothelin-1 in brain tissue and plasma is associated with focal ischemic events. The possibility that endothelin-1 has a role in neuronal cell damage following focal ischemia warrants further attention.

[Midline malignant reticulosis: a histopathological, ultrastructural and immunohistochemical study of 11 cases]

Eleven cases of midline malignant reticulosis were studied morphologically, and the monoclonal antibodies used were capable of phenotyping malignant lymphomas in routinely fixed and processed tissue, such as the leukocyte common antigen (LCA), pan-T cell marker UCHL-1 and pan-B cell marker Ki-B3 etc. The results indicated that the 11 cases of midline malignant reticulosis were peripheral T cell lymphomas. According to the updated Kiel's classification, 7 cases were low grade pleomorphic small cell type; the other 4 cases were high grade pleomorphic medium and large cell type of peripheral T cell lymphoma. The diagnosis, differential diagnosis, cell origin and gradation of midline malignant reticulosis are discussed.

Antifungal activity in human cerebrospinal fluid and plasma after intravenous administration of Allium sativum

Commercial Allium sativum (garlic) extract was given intravenously to two patients with cryptococcal meningitis and three patients with other types of meningitis. Plasma titers of anti-Cryptococcus neoformans activity rose twofold over preinfusion titers. Anti-C. neoformans activity was detected in four of five cerebrospinal fluid samples but not in pooled normal cerebrospinal fluid.