[Feasibility analysis of the application of programmed process endoscopic lateral neck dissection via chest-breast approach in papillary thyroid carcinoma surgery]

Objective: To explore the feasibility of endoscopic lymph node dissection(LND) with programmed breast approach for the treatment of papillary thyroid cancer. Methods: A case series study. The clinical data of 39 patients with papillary thyroid cancer who underwent endoscopic LND treatment with programmed breast approach in Shenzhen People's Hospital from January to November 2022 were retrospectively analyzed. There were 10 males and 29 females, aged (35.95±10.17) years. LND time, total surgical time, intraoperative bleeding volume, postoperative drainage volume, postoperative hospital stay and postoperative complications were analyzed. Results: Among 39 patients, there were 18 cases of unilateral thyroid cancer, 21 cases of bilateral thyroid cancer, 35 cases of unilateral LND, and 4 cases of bilateral LND. The maximum diameter of thyroid cancer lesions was (1.48±0.69) cm, and the maximum diameter of lymph node metastases was (1.63±0.58)cm. The operative time of unilateral neck dissection was (124.11±19.92) min (102-170 min), and the total operative time was (226.42±55.68) min (110-390 min). The number of lymph nodes cleaned was (32.40±10.44)(12-54), the number of metastasis and detection was 207/1 393. The postoperative drainage volume was (174.64±82.33) ml(41-350 ml). There were no neck hematomas, no skin burns or no shrugging disorders in the postoperative period. There were 7 cases of numbness and discomfort in neck skin sensation, which gradually relieved after half a year. Postoperative discharge time (4.77±1.94) d(3-15 d). Conclusion: It is safe and feasible to treat papillary thyroid cancer with endoscopic LND with programmed breast approach, which can improve surgical efficiency and clinical application value.

Modified Y-V plasty based on MRU evaluation for iatrogenic bladder outlet obliteration: a multicentre experience in China

PURPOSE

To compare the diagnostic ability of traditional radiographic urethrography and magnetic resonance urethrography (MRU) for iatrogenic bladder outlet obliteration (BOO), and explore the efficacy and complications of laparoscopic modified Y-V plasty for patients selected based on MRU evaluation.

METHODS

31 patients with obliteration segments ≤ 2 cm and no false passages or diverticula based on MRU evaluation from eight centers in China were included. Obliteration segments were measured preoperatively by MRU and conventional RUG/VCUG and compared with intra-operative measurements. Surgical effects were evaluated by uroflow rates, urethrography, or cystoscopy at 1, 3, 6, and 12 months post-operation and then every 12 months. Postoperative urinary continence was assessed by 24-h urine leakage (g/day).

RESULTS

The results showed that MRU measured the length of obliteration more accurately than RUG/VCUG (MRU 0.91 ± 0.23 cm, RUG/VCUG 1.72 ± 1.08 cm, Actual length 0.96 ± 0.36 cm, p < 0.001), and clearly detected false passages and diverticula. Laparoscopic Y-V plasty was modified by incisions at 5 and 7 o'clock positions and double-layer suture with barbed sutures. All operations were successfully completed within a median time of 75 (62-192) minutes and without any complications. Urethral patency and urinary continence rates were 90.3% (28/31) and 87.1% (27/31), respectively. Three recurrences were cured by direct visual internal urethrotomy. Four patients had stress urinary incontinence after catheter removal 14 days post-operation, with urine leakage of 80-120 g/day, not relieved during follow-up.

CONCLUSIONS

Laparoscopic modified Y-V plasty based on MRU evaluation is a promising approach for iatrogenic BOO, with a high patency rate and a low incontinence rate.

A randomized-controlled trial of ischemia-free liver transplantation for end-stage liver disease

BACKGROUND & AIMS

Ischemia-reperfusion injury (IRI) has thus far been considered as an inevitable component of organ transplantation, compromising outcomes, and limiting organ availability. Ischemia-free organ transplantation is a novel approach designed to avoid IRI, with the potential to improve outcomes.

METHODS

In this randomized, controlled clinical trial, recipients of livers from donors after brain death were randomly assigned to receive either an ischemia-free or a 'conventional' transplant. Primary end point was the incidence of early allograft dysfunction. Secondary end points included complications related to graft IRI.

RESULTS

65 out of 68 randomized patients underwent transplants and were included in the analysis. 32 patients received ischemia-free liver transplantation (IFLT), and 33 received conventional liver transplantation (CLT). Early allograft dysfunction occurred in 2 (6%) randomized to IFLT and in 8 (24%) randomized to CLT (difference, -18%; 95% CI, -35% to -1%; P=.044). Post-reperfusion syndrome occurred in 3 (9%) randomized to IFLT and in 21 (64%) randomized to CLT (difference, -54%; 95% CI, -74% to -35%; P < .001). Non-anastomotic biliary strictures diagnosed with protocol magnetic resonance cholangiopancreatography at 12 months were observed in 2 recipients (8%) randomized to IFLT and in 9 recipients (36%) randomized to CLT (difference, -28%; 95% CI, -50% to -7%; P = .014). The comprehensive complication index at one year after transplantation was 30.48 (95% CI, 23.25-37.71) in the IFLT group vs 42.14 (95% CI, 35.01-49.26) in the CLT group (difference, -11.66; 95% CI, -21.81 to -1.51; P = .025).

CONCLUSIONS

Among patients with end-stage liver disease, IFLT, compared with conventional approach, significantly reduced complications related to ischemia reperfusion injury.

CLINICAL TRIAL REGISTRATION

Chictr.org. ChiCTR1900021158 IMPACT AND IMPLICATIONS: Ischemia reperfusion injury has thus far been considered as an inevitable event in organ transplantation, compromising outcomes and limiting organ availability. Ischemia-free liver transplantation is a novel approach of transplanting donor livers without interruption of blood supply. We showed that in patients with end-stage liver disease, ischemia-free liver transplantation, compared with conventional approach led to reduced complications related to ischemia reperfusion injury in this randomized trial. This new approach is expected to change the current practice in organ transplantation improving transplant outcomes, increasing organ utilization, while providing a clinical model to delineate the impact of organ injury on alloimmunity.

A prognostic risk prediction model based on ferroptosis-related long non-coding RNAs in bladder cancer: A bulk RNA-seq research and scRNA-seq validation

BACKGROUND

To construct a prognostic risk model of bladder cancer (BC) from the perspective of long non-coding RNAs (lncRNAs) and ferroptosis, in order to guide clinical prognosis and identify potential therapeutic targets.

METHODS

In-hours BC samples were collected from 4 patients diagnosed with BC, who underwent radical cystectomy. Single cell transcriptome sequencing was performed and Seurat package were used for quality control and secondary analysis. LncRNAs expression profiles of BC samples were extracted from The Cancer Genome Atlas database. And sex, age, tumor, node, metastasis stage and other clinical data was downloaded at the same time. Ferroptosis-related lncRNAs were identified by co-expression analysis. We constructed a risk model by Cox regression and least absolute shrinkage and selection operator regression analyses. The predictive strength of the risk model for overall survival (OS) of patients with BC was evaluated by the log-rank test and Kaplan-Meier method. Finally, the enrichment analysis was performed and visualized.

RESULTS

We identified and included 15 prognostic ferroptosis-related lncRNAs (AL356740.1, FOXC2AS1, ZNF528AS1, LINC02535, PSMB8AS1, AL590428.1, AP000347.2, OCIAD1-AS1, AP001347.1, AC104986.2, AC018926.2, LINC00867, AC099518.4, USP30-AS1, and ARHGAP5-AS1), to build our ferroptosis-related lncRNAs risk model. Using this risk model, BC patients were divided into high and low-risk groups, and their respective survival lengths were calculated. The results showed that the OS of the low-risk group was significantly longer than that of the high-risk group. A nomogram was utilized to predict the survival rate of BC patients. As indicated in the nomogram, risk score was the most important indicator of OS in patients with BC. The ferroptosis-related lncRNAs risk model is an independent tool for prognostic risk assessment in patients with BC. Single cell transcriptome sequencing suggests that ferroptosis-related lncRNAs express specifically in BC tumor microenvironment. AL356740.1, LINC02535 and LINC00867 were mainly expressed in tumor cells.

CONCLUSION

The risk model based on the ferroptosis-related lncRNAs and the genomic clinico-pathological nomogram could be used to accurately predict the prognosis of patients with BC. The lncRNAs used to build this model might become potential therapeutic targets in the future.

[Prevalence and risk factors of deep venous thrombosis of lower extremity in patients with stage and pressure ulcers on admission]

Objective: To investigate the incidence and risk factors of deep venous thrombosis (DVT) of lower extremity in patients with stage Ⅲ and Ⅳ pressure ulcer on admission. Methods: A retrospective case series study was conducted. A total of 241 patients with stage Ⅲ and Ⅳ pressure ulcers who met the inclusion criteria and were discharged from the Department of Wound Repair of the First People's Hospital of Zhengzhou from January 1, 2015 to December 31, 2019 were enrolled in this study, including 134 males and 107 females, aged 22 to 93 years, with a median age of 68 years; 37 patients were with stage Ⅲ pressure ulcers and 204 patients were with stage Ⅳ pressure ulcers. The DVT occurrence of patients was recorded. According to whether DVT of lower extremity veins was diagnosed by color Doppler ultrasound within 48 h after admission or not, the patients were divided into DVT group (n=37) and non-DVT group (n=204). Data of patients in the two groups were collected and compared, including gender, age, duration of pressure ulcer, time in bed, and combination with diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia, sepsis/septic shock, and paraplegia, and the plasma D-dimer level and Caprini score within 24 h after admission. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. The indicators with statistically significant differences between the two groups were analyzed with multivariate logistic regression analysis to screen the independent risk factors influencing the DVT of lower extremity in 241 patients with stage Ⅲ and Ⅳ pressure ulcers on admission. Results: The incidence of DVT of lower extremity was 15.4% (37/241), of which 86.5% (32/37) were asymptomatic DVT. Among the DVT of 46 lower limbs, only 29 involved the inferior genicular veins, accounting for 63.0%. There were no statistically significant differences in gender, duration of pressure ulcer, combination with diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia, and sepsis/septic shock of patients between the two groups (P>0.05), while there were statistically significant differences in age, time in bed, combination with paraplegia, the plasma D-dimer level and Caprini score of patients between the two groups(t=-3.19, Z=-2.04, χ2=4.44, Z=-3.89, t=-2.14, respectively, P<0.05 or P<0.01). Multivariate logistic regression analysis showed that age and plasma D-dimer level were independent risk factors influencing the DVT of lower extremity in 241 patients with stage Ⅲ and Ⅳ pressure ulcers on admission (with odds ratios of 1.03 and 1.18, respectively, with 95% confidence intervals of 1.00-1.06 and 1.05-1.33, respectively, P<0.05 or P<0.01). Conclusions: The patients with stage Ⅲ and Ⅳ pressure ulcers have a higher incidence of DVT on admission, with age and plasma D-dimer level being the independent risk factors for DVT of lower extremity. It is necessary to pay attention to the targeted screening of DVT and education of its prevention.

[Association and gender difference analysis of obstructive sleep apnea hypopnea syndrome and liver injury]

Objective: To investigate the correlation and sex difference between obstructive sleep apnea hypopnea syndrome (OSAHS) and liver injury. Methods: A total of 974 OSAHS patients (444 cases of mild to moderate, 530 cases of severe) and 111 cases of simple snoring in the First Affiliated Hospital of Fujian Medical University and Zhangzhou Municipal Hospital from November 2015 to September 2019 were included in the study. The basic information of the patients was obtained through face-to-face survey with self-made questionnaire, physical examination, sleep monitoring and blood biochemical and liver function index detection were carried out among the included subjects. Multiple logistic regression model was used to analyze the correlation between OSAHS and liver injury and the gender differences. Results: The subjects were (50±14) years old, including 841 males (77.5%). Statistically significant differences in total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), fasting blood glucose, alamine aminotransferase (ALT), aspartate aminotransferase (AST), ALT/AST, gamma glutamyltransferase (GGT), the rate of elevated ALT, AST and liver injury were observed among the three groups (all P values<0.05). There was no significant difference in total bilirubin and ALP among all groups (all P values>0.05). Multivariate logistic regression showed that after adjusting for confounding factors, severe OSAHS was positively correlated with liver injury [OR (95%CI): 2.25 (1.22-4.14)]. Subgroup analysis by gender showed that severe OSAHS was positively correlated with liver injury in males [OR (95%CI): 2.20 (1.04-4.65)], but not in females, mild to moderate OSAHS [OR (95%CI): 1.56 (0.52-4.71)] or severe OSAHS [OR (95%CI): 2.07(0.64-6.75)], after adjusting for confounding factors. Conclusion: Severe OSAHS is positively correlated with liver injury in males, while female OSAHS is not associated with liver injury.

Ischaemia-free liver transplantation in humans: a first-in-human trial

Background Ischaemia-reperfusion injury is considered an inevitable component of organ transplantation, compromising organ quality and outcomes. Although several treatments have been proposed, none has avoided graft ischaemia and its detrimental consequences. Methods Ischaemia-free liver transplantation (IFLT) comprises surgical techniques enabling continuous oxygenated blood supply to the liver of brain-dead donor during procurement, preservation, and implantation using normothermic machine perfusion technology. In this non-randomised study, 38 donor livers were transplanted using IFLT and compared to 130 conventional liver transplants (CLT). Findings Two recipients (5•3%) in the IFLT group experienced early allograft dysfunction, compared to 50•0% in patients receiving conventional transplants (absolute risk difference, 44•8%; 95% confidence interval, 33•6-55•9%). Recipients of IFLT had significantly reduced median (IQR) peak aspartate aminotransferase levels within the first week compared to CLT recipients (365, 238-697 vs 1445, 791-3244 U/L, p<0•001); likewise, median total bilirubin levels on day 7 were significantly lower (2•34, 1•39-4•09 mg/dL) in the IFLT group than in the CLT group (5•10, 1•90-11•65 mg/dL) (p<0•001). Moreover, IFLT recipients had a shorter median intensive care unit stay (1•48, 0•75-2•00 vs 1•81, 1•00-4•58 days, p=0•006). Both one-month recipient (97•4% vs 90•8%, p=0•302) and graft survival (97.4% vs 90•0%, p=0•195) were better for IFLT than CLT, albeit differences were not statistically significant. Subgroup analysis showed that the extended criteria donor livers transplanted using the IFLT technique yielded faster post-transplant recovery than did the standard criteria donor livers transplanted using the conventional approach. Interpretation IFLT provides a novel approach that may improve outcomes, and allow the successful utilisation of extended criteria livers. Funding This study was funded by National Natural Science Foundation of China, Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology, and Guangdong Provincial international Cooperation Base of Science and Technology. Panel: Research in context.

Single-center experience of organ transplant practice during the COVID-19 epidemic

In order to safely carry out organ donation transplants during the outbreak of coronavirus disease 2019 (COVID-19), we have formulated strict procedures in place for organ donation and transplantation. We retrospectively analyzed our transplantation work from January 20 to May 5, 2020, to discuss whether organ transplantation can be carried out safely during the epidemic period. From January 20 to May 5, 43 cases of donation were carried out in our hospital, and the utilization rate of liver, kidney, heart, lung, and pancreas donations was more than 90%. Forty-one cases of liver transplantation and 84 cases of kidney transplantation were performed. No graft loss or recipient death occurred within one month after kidney transplantation, and one patient (2.4%) died after liver transplantation. There was no significant difference in the length of hospital stay compared with that during the same period in the previous three years. More importantly, COVID-19 infection did not occur among healthcare providers, donors, patients, or their accompanying families in our center. Under the premise of correct protection, it is safe and feasible to carry out organ transplantation during the epidemic period. Our experience during the outbreak might provide a clinical reference for countries facing COVID-19 worldwide.

[Seroepidemiological survey of Toxoplasma gondii infections in patients with diabetes mellitus in Hangzhou City]

OBJECTIVE

To investigate the seroprevalence of Toxoplasma gondii infections among patients with diabetes mellitus in Hangzhou City.

METHODS

A total of 337 patients with type 1 diabetes mellitus, 624 patients with type 2 diabetes mellitus and 384 patients with gestational diabetes mellitus living in Hangzhou City during the period from March 2017 through May 2020 were recruited as the study subjects, while age- and gender-matched healthy volunteers and pregnant women without gestational diabetes mellitus served as controls. Enzyme-linked immunosorbent assay (ELISA) was employed to detect serum IgG and IgM antibodies against T. gondii in patients with diabetes mellitus and controls, and the seroprevalence of anti-T. gondii antibody was compared between diabetes mellitus patients and controls.

RESULTS

The overall seroprevalence of anti-T. gondii antibody (18.10% vs. 4.45%, χ² = 31.38, P < 0.01) and the seroprevalence of anti-T. gondii IgG antibody (14.54% vs. 2.97%, χ² = 28.28, P < 0.01) were both significantly higher in patients with type 1 diabetes mellitus than in healthy controls, while no significant difference was seen in the seroprevalence of anti-T. gondii IgM antibody between patients and controls (3.56% vs. 1.48%, χ² = 2.96, P > 0.05). The seroprevalence rates of serum anti-T. gondii (23.56% vs. 6.57%, χ² = 70.37, P < 0.01) and anti-T. gondii IgG antibodies (21.15% vs. 5.45%, χ² = 66.73, P < 0.01) were significantly higher in patients with type 2 diabetes mellitus than in healthy controls, while no significant difference was seen in the seroprevalence of anti-T. gondii IgM antibody between patients and controls (2.40% vs. 1.12%, χ² = 2.96, P > 0.05). In addition, the overall seroprevalence of serum anti-T. gondii antibody (26.30% vs. 19.53%, χ² = 4.98, P < 0.05) and the seroprevalence of anti-T. gondii IgG antibody (23.70% vs. 17.71%, χ² = 4.20, P < 0.05) were both significantly higher in patients with gestational diabetes mellitus than in pregnant women without gestational diabetes mellitus, while no significant difference was seen in the seroprevalence of anti-T. gondii IgM antibody between pregnant women with and without gestational diabetes mellitus (2.60% vs. 1.82%, χ² = 0.54, P > 0.05).

CONCLUSIONS

The patients with diabetes mellitus present a higher seroprevalence rate of anti-T. gondii antibody than controls in Hangzhou City. Screening of T. gondii infections and health education pertaining to toxoplasmosis prevention and control knowledge should be reinforced in patients with diabetes mellitus.

[The malignant phenotype of calcineurin B homologous protein 2 in gastric cancer and its clinical significance]

Objective: To study the expression and clinical significance of calcineurin B homologous protein 2 (CHP2) in gastric cancer (GC) and its effect on malignant phenotype of GC cells. Methods: The protein expression of CHP2 in 297 GC tissue and 198 normal gastric tissue samples were detected by immunohistochemistry. The relationship between the expression of CHP2 and clinicopathologic parameters of GC were analyzed. CHP2-overexpression plasmids and CHP2-interference plasmids were transfected into GC cell lines respectively. Wound healing assay and Transwell experiment was used to detect the invasion and migration ability of GC cells, and cell counting kit-8 (CCK-8) method was used to detect the proliferation ability of GC cells. Results: The positive expression rate of CHP2 in GC was 68.7% (204/297), which was higher in benign margin (34.1%) (31/91), chronic gastritis (59.1%) (13/22), intestinal metaplasia (34.2%) (13/38), low-grade intraepithelial neoplasia (40.0%) (12/30) and high-grade intraepithelial neoplasia (41.2%)(7/17). The positive expression of CHP2 was correlated with tumor, node and metastasis (TNM) stage, lymph node metastasis and distant metastasis (all P<0.05), but not with gender, age, Laurén classification, human epidermal growth factor receptor 2 (HER2) levels, depth of invasion, carcinoembryonic antigen (CEA) level and CEA 19-9 level (all P>0.05). The results of multivariate analysis showed that high expression of CHP2 and TNM stage were both independent parameters for predicting GC patient prognosis (both P<0.05). Interference of CHP2 expression in HGC-27 cells suppressed proliferation and migration significantly (P<0.05). However, over-expression CHP2 in AGS cells promoted proliferation, and migration significantly (P<0.05). Conclusion: CHP2 plays an important role in the development of GC, which is expected to be a molecular marker for patient prognosis and a potential target of targeted therapy for GC patients.

[Cardiovascular disease risk in diabetes patients aged 40 years old and above in China]

Objective: To evaluate the incidence of cardiovascular disease (CVD), ischemic and hemorrhagic cardiovascular events among Chinese diabetic patients aged 40 years and above with different CVD risk levels. Methods: This study enrolled participants aged 40 years and above in 15 provinces from a prospective cohort study, the China-PAR project (Prediction for Atherosclerotic Cardiovascular Disease Risk in China). Participants were categorized into two groups according to the presence or absence of diabetes at baseline. Individuals were further classified into low (0-4.9%), moderate (5%-9.9%) and high risk groups (≥10%), based on predicted ten-year CVD risk using the China-PAR equations. Two followed-up surveys were conducted between 2007 and 2015 to identify CVD events, which were defined as nonfatal acute myocardial infarction, or death due to coronary heart disease, or stroke. Ischemic cardiovascular events included nonfatal acute myocardial infarction, or death due to coronary heart disease, or ischemic stroke. Hemorrhagic cardiovascular events included subarachnoid hemorrhage and intracerebral hemorrhage. The incidences of CVD, ischemic and hemorrhagic cardiovascular events were compared in diabetes and non-diabetes population with different CVD risk levels. Results: This study included 89 209 participants aged 40 years and above, the average follow-up period was 8.5 years. The age was (54.8±9.4) years, and 36 794 (41.2%) were men, and 5 730 (6.4%) were diabetic patients. In diabetes patients aged 40 years and above, 53.7% (3 075/5 730) were at high risk of CVD. Age-and sex-adjusted incidence of CVD, ischemic and hemorrhagic cardiovascular events (1 066.93/100 000 person-years, 824.23/100 000 person-years, and 211.56/100 000 person-years) were significantly lower in diabetes patients than those in non-diabetes population with high CVD risk (1 773.73/100 000 person-years, 1 228.18/100 000 person-years, and 446.49/100 000 person-years) (all P<0.001). Among high CVD risk populations, incidence of ischemic events was significantly higher in diabetic patients than in non-diabetes population (1 638.47/100 000 person-years vs. 1 228.18/100 000 person-years, P<0.001), but incidence of hemorrhagic events tended to be lower in diabetic patients than in non-diabetes population (415.70/100 000 person-years vs. 446.49/100 000 person-years, P=0.635). Incidence of ischemic and hemorrhagic events were similar between diabetes patients and non-diabetes population at low or moderate CVD risk groups (all P>0.05). Conclusions: More than half of diabetes patients aged 40 years and above in China have high CVD risk. The incidence of CVD, ischemic and hemorrhagic cardiovascular events are different in diabetic patients with different CVD risk levels.

[Clinical effect of one-stage total knee arthroplasty for knee osteoarthritis with femoral extra-articular deformity]

Objective: To investigate the application and efficacy of the one-stage total knee arthroplasty (TKA) of intra-articular compensation osteotomy in knee osteoarthritis(KOA) patients with extra-articular deformity (EAD). Methods: A retrospective study of 9 patients with end-stage KOA and EAD undergoing one-stage TKA from January 2014 to December 2017 in the First Affiliated Hospital of Zhejiang Chinese Medical University was performed. There were 3 males and 6 females with an average age of 56 years(range, 19-77 years);5 cases of simple coronal deformity (varus 10°-27°, mean 18.2°), 3 cases of sagittal deformity (recurvatum15°-35°, mean 22.6°), 1 case combined with coronal and sagittal deformity (varus 16°, recurvatum 31°); hemophilia dysplasia in 1 case, fracture malformation in 8 cases. Main outcome measures included the mechanical axis, range of motion (ROM) and Hospital for Special Surgery Knee Score (HSS). Results: The mean follow-up period was 33.2 months (range, 25-47 months). The mechanical axis angle was restored from 12.4°±4.1°to 1.4°±0.9°(t=7.954, P<0.01). The HSS was improved from 28±14 preoperatively to 87±7 postoperatively (t=-11.174, P=0.013). The ROM increased from 56°±22°to 99°±8° (t=-5.480, P=0.010). There was no complications such as joint instability, infection, fracture, common peroneal nerve injury and early prosthesis loosening. Conclusions: For KOA patients with femoral EAD, one-stage TKA with intra-articular compensatory osteotomy can effectively restore the mechanical axis and obtain satisfying joint function. Through a series of measures such as preoperative measurement, soft tissue evaluation and 3D printing, the accuracy of surgery can be improved and the difficulty of surgery can be reduced.

The First Case of Ischemia-Free Kidney Transplantation in Humans

Background: Ischemia-reperfusion injury (IRI) has been considered an inevitable event in organ transplantation since the first successful kidney transplant was performed in 1954. To avoid IRI, we have established a novel procedure called ischemia-free organ transplantation. Here, we describe the first case of ischemia-free kidney transplantation (IFKT). Materials and Methods: The kidney graft was donated by a 19-year-old brain-dead donor. The recipient was a 47-year-old man with end-stage diabetic nephropathy. The graft was procured, preserved, and implanted without cessation of blood supply using normothermic machine perfusion. Results: The graft appearance, perfusion flow, and urine production suggested that the kidney was functioning well-during the whole procedure. The creatinine dropped rapidly to normal range within 3 days post-transplantation. The levels of serum renal injury markers were low post-transplantation. No rejection or vascular or infectious complications occurred. The patient had an uneventful recovery. Conclusion: This paper marks the first case of IFKT in humans. This innovation may offer a unique solution to optimizing transplant outcomes in kidney transplantation.

Characterization of mRNA Expression and Endogenous RNA Profiles in Bladder Cancer Based on The Cancer Genome Atlas (TCGA) Database

Background

Bladder cancer is a multifactorial disease with increasing incidence and mortality. Genetic alterations and altered expressions of mRNAs, long non-coding RNAs (lncRNAs), and miRNAs have been shown to play important roles in the tumorigenesis of bladder cancer. However, the functions of key RNAs and their regulatory network in bladder cancer are still to be elucidated.

Material/Methods

RNA profiles were downloaded from The Cancer Genome Atlas (TCGA) database. The differentially expressed mRNAs, lncRNAs, and miRNAs in bladder cancer were acquired through analyses of data from 414 bladder cancer tissues and 19 normal bladder tissues. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis was performed by using “DAVID6.8” and the R package “ClusterProfile”. Protein–protein interaction and competing endogenous RNA (ceRNA) networks were constructed by using “STRING” database and Cytoscape 3.6.2. Based on the clinical data and Cox regression, a prognosis model was established, and survival analysis was performed.

Results

A total of 1819 mRNAs, 659 lncRNAs, and 160 miRNAs were identified as significantly differentially expressed in bladder cancer of which 52 mRNAs, 58 lncRNAs, and 22 miRNAs were incorporated in the ceRNA network. CFL2 and TPM2 were found to be downregulated and showed significant correlation to each other in bladder cancer. HOXB5 and 6 lncRNAs (ADAMTS9-AS1, AC112721.1, LINC00460, AC110491.1, LINC00163, and HCG22) were strongly associated with high-grade, disease stages, and overall survival.

Conclusions

In this study, we have identified differentially expressed mRNAs, lncRNAs, and miRNAs in bladder cancer which were strongly associated with oncogenesis and prognosis. Further experimental studies are necessary to validate these results.

[The value of the planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of esophageal squamous cell carcinoma]

Objective: The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non-radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors. Methods: We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy (33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single-institution database.The survival rates were calculated by Kaplan-Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model. Results: The median follow-up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease-free survival (DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3-year OS were 75.5%, 57.4%, 27.3% (P<0.001) and 3-year DFS were 72.0%, 44.7%, 17.6% (P<0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3-year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7% of the negative group (both P<0.001). The 3-year OS and DFS of pathologic stage Ⅰ, Ⅱ, ⅢA, ⅢB and Ⅵ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3% (P<0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3% (P<0.001), respectively.The operation-related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS (P<0.05 for all). Conclusions: The planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.

Factors Influencing Rust (Melampsora apocyni) Intensity on Cultivated and Wild Apocynum venetum in Altay Prefecture, China

Rust (Melampsora apocyni) on Apocynum venetum is the major constraint to the commercial development of this medicinal herb. To determine the factors influencing rust intensity (maximum disease index [DI_max]), rust was investigated from 2011 to 2015 in both cultivated and wild A. venetum plants. Partial least squares path modeling (PLS-PM) was used to analyze the paths and extent of the factors related to pathogen, environment, and host that affect rust intensity. DI_max exhibited considerable variations across years and study sites, with variations linked to various factors fostering disease development. PLS-PM explained 80.0 and 70.1% of variations in DI_max in cultivated and wild plants, respectively. Precipitation was the key factor determining DI_max in both cultivated and wild plants (path coefficient [PC] = 0.313 and 0.544, respectively). In addition, the topsoil water content in cultivated plants and the total vegetation coverage in wild plants were also critical determinants of DI_max via their effects on the microclimatic factor (contribution coefficients [CC] = 0.681 and 0.989, respectively; PC = 0.831 and 0.231, respectively). In both cultivated and wild plants, host factors were mainly dominated by A. venetum density (CC = 0.989 and 0.894, respectively), and their effect on DI_max via the microclimatic factor (PC = 0.841 and 0.862, respectively) exceeded that via the inoculum factor (PC = 0.705 and 0.130, respectively). However, the indirect effects led to DI_max variation, while the dilution effect on host (CC = 0.154) from weed in wild plants led to the indirect effect size in wild plants of 0.200, which was lower than -0.699 in cultivated plants.

Infrared Spectral Characteristics of Electrical Injuries on Swine Skin Caused by Different Voltages Based on Machine Learning Algorithms

OBJECTIVES

To explore infrared spectrum characteristics of different voltages induced electrical injuries on swine skin by using Fourier transform infrared-microspectroscopy （FTIR-MSP） combined with machine learning algorithms, thus to provide a reference to the identification of electrical skin injuries caused by different voltages.

METHODS

Electrical skin injury model was established on swines. The skin was exposed to 110 V, 220 V and 380 V electric shock for 30 s and then samples were took, with normal skin tissues around the injuries as the control. Combined with the results of continuous section HE staining, the FTIR-MSP spectral data of the corresponding skin tissues were acquired. With the combination of machine learning algorithms such as principal component analysis （PCA） and partial least squares-discriminant analysis （PLS-DA）, different spectral bands were selected （full band 4 000-1 000 cm^-1 and sub-bands 4 000-3 600 cm^-1, 3 600-2 800 cm^-1, 2 800-1 800 cm^-1, and 1 800-1 000 cm^-1）, and various pretreatment methods were used such as orthogonal signal correction （OSC）, standard normal variables （SNV）, multivariate scatter correction （MSC）, normalization, and smoothing. Thus, the model was optimized, and the classification effects were compared.

RESULTS

Compared with simple spectrum analysis, PCA seemed to be better at distinguishing electrical shock groups from the control, but was not able to distinguish different voltages induced groups. PLS-DA based on the 3 600-2 800 cm^-1 band was used to identify the different voltages induced skin injuries. The OSC could further optimize the robustness of the 3 600-2 800 cm^-1 band model.

CONCLUSIONS

It is feasible to identify electrical skin injuries caused by different voltages by using FTIR-MSP technique along with machine learning algorithms.

Knockdown of lncRNA SNHG7 inhibited cell proliferation and migration in bladder cancer through activating Wnt/β-catenin pathway

It is identified that long non-coding RNAs (lncRNAs) play important roles in tumorigenesis. LncRNA SNHG7 has been found to be an oncogene in varieties of tumors including bladder cancer. However, its potential regulatory mechanism in bladder cancer still remains unknown. In this study, we discovered that the expression levels of SNHG7 were significantly increased in bladder cancer tissues and cell lines. Patients with high expression level of SNHG7 suffered from poor prognosis. Additionally, knockdown of SNHG7 induced declined cell viability, proliferation as well as G0/G1 cell cycle arrest. Furthermore, we found that cell migratory ability was markedly reduced after silencing SNHG7. Next, we verified that knockdown of SNHG7 reduced the protein level of β-catenin and thus decreased the level of its downstream targets including c-myc, cyclin D1 and E-cadherin, implying that SNHG7 might impact bladder cancer via Wnt/β-catenin pathway. Subsequently, the rescue assays performed in SNHG7 silenced T24 cells by using activator of Wnt/β-catenin signaling elucidated that re-activation of this pathway partly restored the inhibitory effects of SNHG7 suppression on biological behaviors of T24 cells. Collectively, SNHG7 elicited carcinogenic functions in bladder cancer partially via activating Wnt/β-catenin signaling pathway, suggesting a potential target for the treatment and prognosis of bladder cancer.

Anti-proliferative benefit of curcumol on human bladder cancer cells via inactivating EZH2 effector

We investigated the molecular mechanism of curcumol-induced apoptosis in bladder cancer cells. The mitochondrial membrane potential was measured using JC-1 staining. ROS generation of bladder cancer cells was determined using the DCFH staining method. The apoptosis of bladder cancer cells was examined using the Annexin V-FITC and PI double-staining method. Enforced expression of EZH2 in bladder cancer cells was accomplished by transfecting an EZH2 expression plasmidinto EJ and T24 cells. siRNAs targeting EZH2 were used to inhibit endogenous expression of EZH2. Curcumol dose-dependently inhibited proliferation and colony formation and induced apoptosis in EJ and T24 bladder cancer cells. These effects correlated with decreased accumulation of EZH2. In addition, suppression of EZH2 enhanced the inhibitory effects of curcumol on cell growth and colony formation and increased curcumol-induced apoptosis. Conversely, enforced expression of EZH2 ameliorated the inhibitory effects of curcumol on cell growth and colony formation and decreased curcumol-induced apoptosis in EJ and T24 cells. We also found that suppression of EZH2 induced ROS generation and MMP loss in both EJ and T24 cells. Conversely, up-regulation of EZH2 suppressed ROS generation and MMP loss. Our data indicate that curcumol inhibits proliferation and induces apoptosis by targeting EZH2 and modulating the mitochondrial apoptosis pathway.

The first case of ischemia-free organ transplantation in humans: A proof of concept

Ischemia and reperfusion injury (IRI) is an inevitable event in conventional organ transplant procedure and is associated with significant mortality and morbidity post-transplantation. We hypothesize that IRI is avoidable if the blood supply for the organ is not stopped, thus resulting in optimal transplant outcomes. Here we described the first case of a novel procedure called ischemia-free organ transplantation (IFOT) for patients with end-stage liver disease. The liver graft with severe macrovesicular steatosis was donated from a 25-year-old man. The recipient was a 51-year-old man with decompensated liver cirrhosis and hepatocellular carcinoma. The graft was procured, preserved, and implanted under continuous normothermic machine perfusion. The recipient did not suffer post-reperfusion syndrome or vasoplegia after revascularization of the allograft. The liver function test and histological study revealed minimal hepatocyte, biliary epithelium and vascular endothelium injury during preservation and post-transplantation. The inflammatory cytokine levels were much lower in IFOT than those in conventional procedure. Key pathways involved in IRI were not activated after allograft revascularization. No rejection, or vascular or biliary complications occurred. The patient was discharged on day 18 post-transplantation. This marks the first case of IFOT in humans, offering opportunities to optimize transplant outcomes and maximize donor organ utilization.

Long non-coding RNA cartilage injury-related promotes malignancy in bladder cancer

Recent advances have highlighted the important roles of long non-coding RNAs (lncRNAs) in a number of biological processes, including oncogenesis. However, the function of lncRNA cartilage injury-related (lncRNA-CIR) in bladder cancer progression remains elusive. A novel function for lncRNA-CIR in bladder cancer was identified in the present study. Reverse transcription quantitative polymerase chain reaction, viability, invasion assay and in vivo implantation were used to evaluate the role of lncRNA-CIR. It was identified that the expression of lncRNA-CIR was frequently upregulated in 52 cancerous tissues and selected bladder cancer cell lines. Additionally, upregulating lncRNA-CIR was demonstrated to promote viability and invasion in T24 and SW780 cells, whereas siRNA-mediated lncRNA-CIR-knockdown consistently exhibited the opposite effects. High lncRNA-CIR levels also dictated poor overall survival among patients with bladder cancer. Furthermore, in vivo implantation experiments also supported a tumorigenic function for lncRNA-CIR, as decreasing lncRNA-CIR levels markedly attenuated Ki-67 staining and xenograft tumor growth. Overall, the present study identified a novel function of lncRNA-CIR and indicates that lncRNA-CIR may serve as a potential biomarker for bladder cancer treatment.

[Relationship of lipid accumulation product with hypertension and diabetes among Beijing residents study]

Objective: To explore the lipid accumulation product (LAP) formula for Beijing adults and to investigate the relationship between lipid accumulation product and hypertension, as well as diabetes. Methods: A cross-sectional study with a representative sample of 19 606 residents in Beijing aged 18-79 years was conducted in 2011. The sex-specific hypothetical minimum waist circumference (WC) was calculated in order to obtain the more applicable LAP formula. Multivariate logistic regression was used to analyze the associations of LAP, combination of LAP and body mass index (BMI) with hypertension and diabetes. Results: The LAP formula for Beijing adults was established as follows: LAP (male)= (WC-61.3) × TG, and LAP (female)= (WC-55.6) × TG. There was an obvious trend of increased risk of hypertension and diabetes with an increment in the tertiles of the LAP both in men and women. The OR (95%CI) for hypertension in the group with highest tertile LAP was 3.62 (3.11-4.22) in men, and 5.79 (4.84-6.93) in women, compared with the lowest tertile group, respectively; and the corresponding OR for diabetes was 3.47 (2.73-4.41) in men, and 4.10 (2.90-5.80) in women, respectively. Compared with the lowest tertile of LAP and normal BMI group, the OR (95%CI) for hypertension in the highest tertile of LAP and obesity group was 6.79 (5.50-8.37) in men, and 9.75 (7.76-12.25) in women, respectively; while the corresponding value for diabetes was 3.97 (2.87-5.49) in men, and 4.13 (2.78-6.14) in women, respectively. Conclusion: The elevated level of LAP was associated with an increased risk of hypertension and diabetes among Beijing adults. LAP could be an important predictor for hypertension and diabetes.

MiR-26a inhibits cell proliferation and induces apoptosis in human bladder cancer through regulating EZH2 bioactivity

Bladder cancer is the second most common malignant tumor of the urinary tract worldwide and is associated with significant morbidity and mortality. EZH2, the enzymatic subunit of Polycomb repressive complex 2 (PRC2), is frequently overexpressed in multiple tumor types including Bladder cancer and plays multiple roles in tumor cell proliferation and apoptosis. Previous study showed that miR-26a has different roles in different tumors and the expression of EZH2 is identified as a potential target of miR-26a which miR-26a has been found to decrease in bladder cancer. But the mechanism between EZH2 and miR-26a is not completely clear in bladder cancer. Western blot and Real-time PCR were involved to detect both expression of mRNA and protein of EZH2. And we used mimics-miR26a to elaborate the relationship between EZH2 and miR-26a in cell proliferation and apoptosis process through lots of specific assays. The results showed that EZH2 express mainly in bladder tumor tissues than para-carcinoma tissues. Meanwhile, miR26a can down-regulate the expression of EZH2 through suppressing EZH2 activity. Both miR26a and downregulated EZH2 can induce bladder cancer cell apoptosis and increase cell at G1 stage as well as suppress cell proliferation. The further assays reveal that miR-26a can suppress cell proliferation and enhance cell apoptosis through EZH2. In this study, we found that EZH2 was overexpressed in bladder tumor tissue and miR-26a could downregulate the expression of EZH2 to inhibit proliferation and enhance apoptosis in bladder cancer.

[Tea, coffee intakes and risk of oral squamous cell carcinoma: a case-control study]

Objective: To evaluate the effects of tea and coffee intakes on oral squamous cell carcinoma (OSCC) stratified by milk intake. Methods: A case-control study involving 593 OSCC patients confirmed by pathological diagnoses and 1 128 gender-age frequency matched controls was conducted in Fujian province during September 2010-March 2016. Unconditional logistic regression was used to calculate adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) to assess the effects of coffee, tea intakes and related variables on OSCC. Additive interaction was estimated by relative excess risk interaction (RERI), attributable proportions interaction (API) and synergy index (SI). Results: Tea intake was significantly associated with decreased risk of OSCC: the adjusted ORs were 0.54 for all subjects (95%CI: 0.41-0.71), 0.47 for milk consumers (95%CI: 0.31-0.71) and 0.57 for non-milk consumers (95%CI: 0.40-0.81). Moreover, starting tea drinking at age ≥25 years, moderate tea concentration and water temperature, drinking green tea and oolong tea showed effects to decrease the risk for OSCC in three groups. Additionally, there was a tendency of a reduced risk with increased daily tea drinking and longer tea-drinking period (all trend P<0.05). No significant association was observed between coffee intake and OSCC. A multiplicative but not additive interactions was found between tea drinking and milk intake. Additionally, we did not observe multiplicative and additive interaction between coffee drinking and milk intake. Conclusion: Tea drinking is a protective factor for OSCC, and there is a multiplicative interaction between tea drinking and milk intake. Therefore, tea drinking and increasing intake of milk can reduce the risk of OSCC at certain extent.

[Pickled food, fish, seafood intakes and oral squamous cell carcinoma: a case-control study]

Objective: To investigate the effects between fish, seafood and pickled food intakes on oral squamous cell carcinoma (OSCC). Methods: A case-control study was carried out in Fujian area during September 2010 to December 2016, in which 604 newly diagnosed primary OSCC cases confirmed by pathological diagnosis were collected from hospital and 1 343 control subjects were enrolled from community and healthy hospital population. Demographic data, history of smoking drinking and tea drinking, oral hygiene status and dietary behaviors (fish, seafood and pickled food intakes) were collected by in-person interviews using a standard questionnaire.Using unconditional logistic regression to estimate adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) to assess the effects of fish, seafood and pickled food intakes on OSCC. Analysis stratified by smoking, alcohol drinking and bad prosthesis to explore the possible difference in association between subgroups. Multiplicative interactions and additive interactions between fish and bad prosthesis, seafood and alcohol drinking, pickled food and bad prosthesis were assessed by unconditional logistic regression, relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). Results: The average age of case group and control group were separately (58.69±13.92) years old and (59.27±11.37) years old (χ(2)=4.75, P=0.191). The people whose fish and seafood intakes ≥3 times/week had the lower risk of OSCC, the adjusted OR (95%CI) values were 0.63 (0.52-0.77) and 0.51 (0.41-0.64); The stratified analysis indicated that the people having bad prosthesis had the lower risk of OSCC if they eating fish ≥3 times/week, and the adjusted OR (95%CI) values was 0.53 (0.39-0.71); the people having bad prosthesis had the higher risk of OSCC if they eating pickled food ≥3 times/week, the adjusted OR (95%CI) values was 1.37 (1.02-1.88). Regularly eating seafood can decrease the risk of OSCC for non-smokers, smokers, non-drinkers, drinkers, people without bad prosthesis and had bad prosthesis, the adjusted OR (95%CI) values were 0.49 (0.36-0.68), 0.52 (0.37-0.73), 0.41 (0.31-0.55), 0.77 (0.51-0.96), 0.49 (0.36-0.67), 0.59 (0.42-0.83). Crossover analysis showed fish and bad prosthesis exist multiplication interaction relationship (adjusted OR=0.66, 95%CI: 0.44-0.97) and additional interaction relationship (RERI=-0.81, 95%CI:-1.43--0.19; AP=-0.76, 95%CI:-1.35--0.17; S=0.08, 95%CI: 0.01-0.98); pickled food and bad prosthesis exist multiplication interaction relationship (adjusted OR=1.63, 95%CI: 1.06-2.51) and addition interaction relationship (RERI=0.65, 95%CI:0.08-1.22; AP=0.36, 95%CI:0.10-0.62; S=5.19, 95%CI:1.32-54.49). Conclusion: Reducing the consumption of pickled food, quitting smoking and limiting alcohol consumption, and regularly eating fish and seafood can prevent the occurrence of OSCC.

Utility of Fluorescence In Situ Hybridization (FISH) to Sub-Classify Low-Grade Urothelial Carcinoma for Prognostication

Background

Fluorescence in situ hybridization (FISH) is used widely to detect cancer levels, but its value in urothelial carcinoma remains unclear. The aim of this study was to use FISH to examine the urine specimens of low-grade urothelial carcinoma (UC) patients to determine the possibility of sub-classifying the prognosis of UC.

Material/Methods

We diagnosed 107 patients with low-grade UC using a UroVysion kit to detect chromosomes 3, 7, 17, and P16 in the urine. An average 46.6-month follow-up completed in January 2016 combined with the clinical follow-up data were evaluated with Spearman’s correlation analysis to analyze the aberration of chromosomes in relation to the prognostication. Univariate and multivariate analysis using the Mantel-Cox log-rank test for overall, cancer-specific, and disease-free survival were used to determine the prognostic significance of CSP7/CSP17 and CSP3/GLPp16.

Results

In the 107 samples, 84 showed positive reaction in the FISH test. Furthermore, CSP7/CSP17 was found to be significantly related with age, tumor size, T stage, and tumor numbers, but not in CSP3/GLPp16. In addition, Kaplan-Meier analysis and Cox proportional hazards regression revealed a significant negative correlation between CSP7/CSP17 and survival, while CSP3/GLPp16 showed no significantly differences.

Conclusions

CSP7/CSP17 positivity on FISH test appears to play a critical role in low-grade UC and may be considered as a high-risk and prognosis factor.

LncROR Promotes Bladder Cancer Cell Proliferation, Migration, and Epithelial-Mesenchymal Transition

BACKGROUND

LncRNA ROR, a tumor oncogene associated with various human cancers, has been reported to be involved in regulating various cellular processes, such as proliferation, apoptosis and invasion through targeting multiple genes. However, the molecular biological function in bladder cancer has not been clearly elucidated. The aim of this study is to explore ROR expression levels and evaluated its function in bladder cancer.

METHODS

LncRNA ROR expression levels in the 36 pairs of bladder cancer tissues (and corresponding non-tumor tissues) and bladder cancer cells were assessed by qRT-PCR. MTT assay, colony formation assay, flow cytometric analysis, wound healing assay, cell transwell assays, attachment/detachment and western blotting were performed to assess the effects of ROR on proliferation, apoptosis, migration/invasion and epithelial-to-mesenchymal (EMT) phenotypes in BC cells in vitro. ZEB1 is target of ROR. Rescue assays were performed to further confirm that ROR contributes to the progression of BC cells through targeting ZEB1.

RESULTS

LncRNA ROR was up-regulated in bladder cancer tissues (compared to adjacent non-tumor tissues) and was almost overexpression in bladder cancer cells (compared with normal urothelial cell line SVHUC-1 cells). Increased lncRNA ROR expression significantly promoted tumor cells proliferation, inhibited cells apoptosis, facilitated cells metastasis and contributed to the formation of EMT phenotype. While down-regulated ROR could obviously inhibit cells proliferation, promote cells apoptosis, inhibit metastasis and reverse EMT to MET. ZEB1 was a target gene of ROR and was positive correlation with the level of ROR in cancer tissues.

CONCLUSION

These results indicated that lncRNA ROR was associated with tumor progression in bladder cancer cells.

Brain metastases from hepatocellular carcinoma: recent advances and future avenues

The incidence of brain metastases from hepatocellular carcinoma (BMHCC) is becoming more frequent than that of the past as a result of prolonged survival of patients with HCC. Compared with brain metastases from other types of cancer, BMHCC tends to exhibit a high incidence of intracerebral hemorrhage (ICH) and poor liver function. Unfortunately, the prognosis is extremely poor for patients with BMHCC owing to the limited treatment selection. Currently, optimal treatment requires multidisciplinary approaches including surgery, whole-brain radiation therapy and stereotactic radiosurgery. Besides these traditional approaches, novel treatments such as target therapy and immunotherapy provide an opportunity to improve the survival of these patients. This review provides an overview of the incidence, characteristics, prognosis, and current and potential future management strategies for BMHCC.

[Influence of manganese exposure via intracerebral injection on behavioristics and substantia nigra dopaminergic neurons in rats]

OBJECTIVE

To investigate the changes in behavioristics, substantia nigra tyrosine hydroxylase (TH) immunoreactive cells, and ultrastructure of substantia nigra neurons in rats after manganese exposure via intracerebral injection.

METHODS

A total of 72 healthy male Sprague-Dawley rats were randomly divided into exposure group and control group, with 36 rats in each group. The stereotactic technique was used for injection of 1 μl MnCl2·4H2O (1 mol/L) into the corpus striatum in the exposure group, and the control group was injected with the same volume of normal saline. The changes in rotational behavior, number of TH immunoreactive cells in the substantia nigra, and ultrastructure of the substantia nigra induced by apomorphine were observed at 8 hours and 1, 3, 7, 15, and 30 days after injection, and this measure was compared with manganese exposure via intraperitoneal injection.

RESULTS

After apomorphine induction for 30 minutes, the exposure group showed a gradual increase in the number of rotations over the time of manganese exposure (F= 176.921, P<0.01) and a significantly higher number of rotations than the control group (F=482.654, P<0.01). The exposure group showed a gradual reduction in the mean A value of TH immunoreactive cells in the injured substantia nigra over the time of exposure (F=12.009, P<0.01) , and this value differed significantly between the injured substantia nigra in the exposure group and the contralateral substantia nigra in the exposure group and the injured side in the control group (F=36.131, P<0.01). At 3, 7, 15, and 30 days after exposure, the injured substantia nigra showed a significantly lower mean A value of TH immunoreactive cells than the contralateral side in the exposure group (all P<0.01). At 7, 15, and 30 days, the injured substantia nigra in the exposure group showed a significantly lower mean A value than the injured side in the control group (all P<0.01). After manganese exposure, substantia nigra neurons showed the changes including mitochondrial swelling, dilatation of the endoplasmic reticulum, and demyelination of nerve fibers in different stages, which suggested the dynamic process of dopaminergic neuron injuries. Compared with manganese exposure via intraperitoneal injection, manganese exposure via intracerebral injection can induce behavioral changes and injuries of the substantia nigra-striatum system more quickly.

CONCLUSION

Manganese exposure via intracerebral injection induces behavioral changes and injuries of substantia nigra dopaminergic neurons in rats within a short time.

Therapeutic effect of Pleurotus eryngii cellulose on experimental fatty liver in rats

The aim of this study was to explore the therapeutic effect of Pleurotus eryngii cellulose on experimental fatty liver in rats. Rats were fed high-fat fodder to establish a rat fatty liver model, and were then fed different concentrations of Pleurotus eryngii cellulose for six weeks. Lipitor was used as a positive control. Measured levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), and total triglyceride (TG); the activity of malondialdehyde (MDA), superoxide dismutase (SOD), hepatic lipase (HL), and lipoprotein lipase; and liver histopathological changes. Successfully established rat fatty liver model after feeding high-fat fodder for one week. A diet of P. eryngii cellulose for six weeks significantly reduced ALT, AST, TC, and TG levels in rat serum (P < 0.01); TC and AST levels in P. eryngii cellulose high-dose group and Lipitor group were not significantly different from those of the control (P > 0.05). SOD activity increased significantly, while MDA and HL activity decreased (P < 0.05); fatty degeneration and fat accumulation both decreased in hepatic tissue. Hepatic protection of P. eryngii cellulose showed dose-related effect. P. eryngii cellulose can affect lipid metabolism, having therapeutic effects on fatty liver in rats.

Selection for Duration of Fertility and Mule Duck White Plumage Colour in a Synthetic Strain of Ducks (Anas platyrhynchos)

A synthetic strain of ducks (Anas platyrhynchos) was developed by introducing genes for long duration of fertility to be used as mother of mule ducklings and a seven-generation selection experiment was conducted to increase the number of fertile eggs after a single artificial insemination (AI) with pooled Muscovy semen. Reciprocal crossbreeding between Brown Tsaiya LRI-2 (with long duration of fertility) and Pekin L-201 (with white plumage mule ducklings) ducks produced the G0. Then G1 were intercrossed to produce G2 and so on for the following generations. Each female duck was inseminated 3 times, at 26, 29, and 32 weeks of age. The eggs were collected for 14 days from day 2 after AI. Individual data regarding the number of incubated eggs (Ie), the number of fertile eggs at candling at day 7 of incubation (F), the total number of dead embryos (M), the maximum duration of fertility (Dm) and the number of hatched mule ducklings (H) with plumage colour were recorded. The selection criterion was the breeding values of the best linear unbiased prediction animal model for F. The results show high percentage of exhibited heterosis in G2 for traits to improve (19.1% for F and 12.9% for H); F with a value of 5.92 (vs 3.74 in the Pekin L-201) was improved in the G2. Heritabilities were found to be low for Ie (h (2) = 0.07±0.03) and M (h (2) = 0.07±0.01), moderately low for Dm (h (2) = 0.13±0.02), of medium values for H (h (2) = 0.20±0.03) and F (h (2) = 0.23±0.03). High and favourable genetic correlations existed between F and Dm (rg = 0.93), between F and H (rg = 0.97) and between Dm and H (rg = 0.90). The selection experiment showed a positive trend for phenotypic values of F (6.38 fertile eggs in G10 of synthetic strain vs 5.59 eggs in G4, and 3.74 eggs in Pekin L-201), with correlated response for increasing H (5.73 ducklings in G10 vs 4.86 in G4, and 3.09 ducklings in Pekin L-201) and maximum duration of the fertile period without increasing the embryo mortality rate. The average predicted genetic response for F was 40% of genetic standard deviation per generation of selection. The mule ducklings' feather colour also was improved. It was concluded that this study provided results for a better understanding of the genetics of the duration of fertility traits in the common female duck bred for mule and that the selection of a synthetic strain was effective method of improvement.

Voluntary organ donation system adapted to Chinese cultural values and social reality

Organ donation and transplant systems have unique characteristics based on the local culture and socioeconomic context. China's transplant and organ donation systems developed without regulatory oversight until 2006 when regulation and policy were developed and then implemented over the next several years. Most recently, the pilot project of establishing a voluntary citizen-based deceased donor program was established. The pilot program addressed the legal, financial, and cultural barriers to organ donation in China. The pilot program has evolved into a national program. Significantly, it established a uniquely Chinese donor classification system. The Chinese donor classification system recognizes donation after brain death (category I), donation after circulatory death (category II), and donation after brain death followed by circulatory death (category III). Through August 2014, the system has identified 2326 donors and provided 6416 organs that have been allocated though a transparent organ allocation system. The estimated number of donors in 2014 is 1147. As China's attitudes toward organ donation have matured and evolved and as China, as a nation, is taking its place on the world stage, it is recognizing that its past practice of using organs from executed prisoners is not sustainable. It is time to recognize that the efforts to regulate transplantation and provide voluntary citizen-based deceased organ donation have been successful and that China should use this system to provide organs for all transplants in every province and hospital in China. At the national organ transplant congress on October 30, 2014, the Chairman of the China's national organ donation and transplantation committee, Jeifu Huang required all hospitals to stop using organs from executed prisoners immediately and the civilian organ donation will be sole source for organ transplant in China starting January 2015.

Surgical resection improves the outcome of the patients with neuroendocrine tumor liver metastases: large data from Asia

How to properly manage neuroendocrine liver metastasis (NELM) remains debatable, and only limited clinical data have been published from Asian population. The objective of this study is to identify possible prognostic factors affecting overall survival time and to provide a guideline for future clinical practice. A retrospective study was performed on 1286 patients who had neuroendocrine tumors in our specialized center, and data from 130 patients who had NELM were summarized. Demographic and clinicopathologic data, tumor grade, treatment method, and prognosis were statistically analyzed. Most of the NELMs originated from pancreas (65.4%). Important prognostic factors that included tumor location and size were identified with multivariate analysis. Patients with either primary tumor resection or liver metastasis resection showed a 5-year survival of 35.7% or 33.3%, respectively, whereas resection of both resulted in a 50% 5-year survival. More importantly, resection was performed on 7 patients with grade 3 (G3) tumors, and resulted in 1-year, 3-year, and 5-year survival of 100%, 42.8%, and 28.6%, respectively, whereas the other 9 G3 patients without resection died within 3 years. P = 0.49 comparing the resected group with nonresected group in G3 patients. Besides, the overall 5-year survival rates for resected and nonresected patients were 40.5% and 5.4%, respectively. Multiple prognostic factors influenced the overall outcome of NELM including patient age, tumor location, and size, etc. Aggressive surgical approaches could be considered for maximum survival time disregarding the pathological grade of the tumor. Study with larger sample size should be considered to reevaluate the recommendation of the WHO guidelines for G3 neuroendocrine tumors.

Using Dynamic 99mT c-GSA SPECT/CT fusion images for hepatectomy planning and postoperative liver failure prediction

BACKGROUND

Available tools in liver surgery planning rely on the future remnant liver (FRL) volume. Inappropriate decision might be made since the same FRL volume might represent different liver functions depending on the severity of underlying liver damage. This study developed an alternative system to estimate FRL function and to predict the risk of postoperative liver failure.

METHODS

Current study recruited 71 prehepatectomy patients and 71 healthy volunteers. A technetium-99-labelled asialoglycoproteins was given to participants and SPECT was used to capture the intensity of the signal, represented by uptake index (UI). The agreement between preoperative UI values, liver function tests, and Child scores were evaluated. Linear regression was used to evaluate the agreement between predicted UI for FRL and postoperative UI values. Area under the receiver operating characteristic (AUC) curve was used to evaluate the discriminative performance of UI in differentiating patient with high risk of liver failure.

RESULTS

Preoperative UIs are highly correlated with Child score (P < 0.0001), especially to identify patients with ascites and elevated bilirubin. The predicted UIs were in close agreement with the actual postoperative UI values (r = 0.95 P < 0.001). The AUC analysis indicated that UI values had a high accuracy in predicting the risk of liver failure (AUC = 0.95, P < 0.0001). The best cut-off point was 0.9 and the corresponding sensitivity was 100 % and specificity was 92 %.

CONCLUSIONS

The new methodology reliably estimates FRL function and predicts the risk of liver failure. It provides a visual aid for liver surgeon in surgery planning and risk assessment.

Identification of prognostic biomarkers in hepatitis B virus-related hepatocellular carcinoma and stratification by integrative multi-omics analysis

BACKGROUND & AIMS

The differentiation of distinct multifocal hepatocellular carcinoma (HCC): multicentric disease vs. intrahepatic metastases, in which the management and prognosis varies substantively, remains problematic. We aim to stratify multifocal HCC and identify novel diagnostic and prognostic biomarkers by performing whole genome and transcriptome sequencing, as part of a multi-omics strategy.

METHODS

A complete collection of tumour and somatic specimens (intrahepatic HCC lesions, matched non-cancerous liver tissue and blood) were obtained from representative patients with multifocal HCC exhibiting two distinct postsurgical courses. Whole-genome and transcriptome sequencing with genotyping were performed for each tissue specimen to contrast genomic alterations, including hepatitis B virus integrations, somatic mutations, copy number variations, and structural variations. We then constructed a phylogenetic tree to visualise individual tumour evolution and performed functional enrichment analyses on select differentially expressed genes to elucidate biological processes involved in multifocal HCC development. Multi-omics data were integrated with detailed clinicopathological information to identify HCC biomarkers, which were further validated using a large cohort of HCC patients (n = 174).

RESULTS

The multi-omics profiling and tumour biomarkers could successfully distinguish the two multifocal HCC types, while accurately predicting clonality and aggressiveness. The dual-specificity protein kinase TTK, which is a key mitotic checkpoint regulator with links to p53 signaling, was further shown to be a promising overall prognostic marker for HCC in the large patient cohort.

CONCLUSIONS

Comprehensive multi-omics characterisation of multifocal tumour evolution may improve clinical decision-making, facilitate personalised medicine, and expedite identification of novel biomarkers and therapeutic targets in HCC.

Golgi protein 73, not Glypican-3, may be a tumor marker complementary to α-Fetoprotein for hepatocellular carcinoma diagnosis

BACKGROUND AND AIM

This study aimed to evaluate the effectiveness of serum Golgi protein 73 (GP73) and Glypican-3 (GPC-3) as tumor markers for diagnosis of hepatocellular carcinoma (HCC).

METHODS

A total of 257 subjects were enrolled and consisted of 61 healthy controls, 32 hepatitis B virus carriers, 80 cirrhosis patients, and 84 HCC patients. Diagnosis was performed based on established clinical procedure. Serum GP73, GPC-3, and α-fetoprotein were measured. Receiving operating characteristic (ROC) curves were plotted to determine the sensitivity and specificity of each serum marker and their combinations.

RESULT

Serum GP73 levels were significantly increased in HCC patients. No significant differences were observed between GP73 and α-fetoprotein (AFP) as markers for HCC diagnosis. However, GP73 was more sensitive than AFP in the diagnosis of small HCC. A combination of GP73 and AFP tests increased the sensitivity and specificity for HCC diagnosis. The area under the ROC curve (AUC) of combined test was 0.93 compared with 0.88 for GP73 and 0.90 for AFP alone. GPC-3 tests were negative in all 84 HCC patients. The AUC for GPC-3 is 0.43, indicating that serum GPC-3 was not an effective tumor marker for HCC diagnosis.

CONCLUSION

Serum GP73 is a potential tumor marker for HCC diagnosis, especially for differential diagnosis of small HCC and cirrhosis. The combination of GP73 and AFP is more sensitive than AFP alone. Serum GPC-3 does not appear to be an effective tumor marker for HCC diagnosis.

Diagnosis and treatment of hepatic angiomyolipoma

BACKGROUND

Hepatic angiomyolipoma (HAML) is a rare liver tumor. This paper summarized the clinical, radiological and pathological features of HAML.

METHODS

Seventeen cases of HAML were analyzed retrospectively. All patients were subjected to surgical resection of tumor, one of which was performed emergency surgery because of hemorrhage of tumor.

RESULTS

There are 13 females and 4 males, most of whom were asymptotic except 4 had minimal abdominal discomfort. US, CT and/or MRI were taken and corresponding data was comprehensively analyzed with other clinical signs and symptoms. Correct preoperative diagnosis was able to be achieved in 9 patients. Pathological analysis and immunohistochemistry of HMB-45 was used as final diagnosis. All patients were followed up and survived without recurrence.

CONCLUSIONS

Preoperative diagnosis of HAML can be benefited from comprehensive analysis of clinical manifestations. The malignant potential and fast growth of tumor suggested surgical removal of tumor while it was diagnosed.

Peripheral primitive neuroectodermal tumors arising in the pancreas: the first case report in Asia and a review of the 14 total reported cases in the world

OBJECTIVE

To discuss the diagnosis and treatment of peripheral primitive neuroectodermal tumors of the pancreas based on our case and all the cases in the world.

METHODS

The first case of peripheral primitive neuroectodermal tumors of the pancreas in Asia was preliminarily reported by our group in 2006. The patient underwent three operations for the primary tumor and recurrences over 41 months prior to the patient's death in November 2007. All 14 reported cases of pancreatic PNETs in the world were analyzed. The corresponding literatures on its diagnosis and treatment of were reviewed.

RESULTS

A 13 year-old female patient was diagnosed with pancreatic PNETs by the clinical, microscopic, immunohistochemical features, and cytogenetic analysis after the resection of the tumor located in the uncinate process of the pancreas at PUMC Hospital. During the follow-up course, radiotherapy and chemotherapy were given after the first operation. Two additional operations were performed 10 months and 25 months after the first one, respectively, because of tumor recurrence. The patient died 41 months after the initial diagnosis with the recurrence and metastasis that were not suitable for a further surgery. Primitive neuroectodermal tumors of the pancreas are extremely rare. A review of the world's literature on this tumor identified fourteen cases with a mean survival time of 12 months (ranging from 6 to 50 months). These patients often have no specific clinical symptoms, but most do present with abdominal pain and/or jaundice. The diagnosis is established by small round tumor cells seen on light microscopy, immunohistochemical features of positive P30/32(MIC2) with at least two positive neuronal markers., and cytogenetic analysis showing characteristic translocation of t[11;22][q24;q12]. Since pancreatic PNETs are highly aggressive, early diagnosis, immediate surgical resection and re-resection if possible, early radiotherapy and chemotherapy and close follow-up are required.

CONCLUSIONS

Peripheral primitive neuroectodermal tumors can arise in pancreas. The diagnosis and treatment should be made as early as possible, aggressive surgeries for the primary and recurrences may help to improve the prognosis.

Double-prism domain PPLN for simultaneous laser Q-switching and optical parametric oscillation in a Nd:YVO4 laser

We report a design and demonstration of an electro-optically Q-switched intracavity optical parametric oscillator (IOPO) based on a unique ramped duty-cycle periodically poled lithium niobate (PPLN) in a diode-pumped 1064-nm Nd:YVO(4) laser. The PPLN crystal, having a double-prism domain (DPD) structure with a domain period of 30 μm, can work simultaneously as an electro-optic (EO) beam deflector (and therefore an EO Q-switch in the laser cavity) and an optical parametric down converter. The characterized deflection sensitivity of the DPD PPLN device was 1.15°/kV-cm. At a 180-V Q-switching voltage and a 1-kHz switching rate, we measured a down-converted signal at 1550 nm with pulse energy of >8.1 μJ (or peak power of >2.3 kW) from the constructed IOPO at 7.5-W diode pump power. Continuous wavelength tuning of the IOPO signal was also demonstrated.

Clinical diagnosis and treatment of alpha-fetoprotein-negative small hepatic lesions

OBJECTIVE

We examined 103 cases over the last five years and discussed diagnosis and treatment of alpha-fetoprotein (AFP)-negative small hepatic lesions.

BACKGROUND

Small hepatic lesions (less than 2 cm in diameter) usually have no typical imaging characteristics and therefore are difficult to diagnose, especially when AFP tests provide a negative result.

METHODS

A total of 103 patients with AFP-negative small hepatic lesions from January 2003 to December 2008 were retrospectively reviewed. Differential diagnosis was performed by digital subtraction angiography (DSA), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), contrast-enhanced ultrasound (CEUS), or positron emission tomography-computed tomography (PET-CT) based on the multiplicity of lesions. Ninety-four patients with suspected cancers underwent partial hepatectomy. Clinical data were collected from hospital records and follow-up questionnaires.

RESULTS

Hepatocellular carcinoma (HCC) diagnostic sensitivity of DSA, DCE-MRI, CEUS and PET-CT was 88.2%, 93.9%, 88.9% and 88.9%, respectively. The surgery-related complication rate was 6.4%. Prognosis was good, with 1- and 3-year survival rates of 98.8% and 76.1%, respectively.

CONCLUSIONS

DSA, DCE-MRI, CEUS and PET-CT are valuable for diagnosis of small hepatic lesions. Partial hepatectomy is a preferred surgical procedure. Surgery for small liver cancers usually has little risk and good prognosis, therefore it can be actively applied in suspected HCC cases.

Supine lithotomy versus prone position in minimally invasive percutaneous nephrolithotomy for upper urinary tract calculi

OBJECTIVE

To compare operative time, safety and effectiveness of minimally invasive percutaneous nephrolithotomy (MPCNL) in the supine lithotomy versus prone position.

METHODS

Between January 2008 and December 2010, a total of 109 consecutive patients with upper urinary tract calculi were enrolled and randomly divided into group A (53 patients, supine lithotomy position) and group B (56 patients, prone position). The MPCNL procedures were performed under the guidance of real-time grayscale ultrasound system. The preoperative characteristics, intraoperative and postoperative parameters were analyzed and compared.

RESULTS

All patients were successfully operated. There was no significant difference between the two groups in stone-free rate (group A 90.1 vs. group B 87.5%, p = 0.45), mean blood loss, number of access tracts, calyx puncture, mean hospital stay (group A 6 ± 1.1 vs. group B 6 ± 1.5 days, p = 0.38) and complications. But the operative time was significantly shortened in supine lithotomy position (group A 56 ± 15 vs. group B 86 ± 23 min, p < 0.001).

CONCLUSIONS

The effectiveness and safety of the supine lithotomy position for MPCNL were similar to the prone position. However, the supine lithotomy position has an important advantage of reducing the operative time. The supine lithotomy position could be a good choice to perform MPCNL.