[Analysis of clinical characteristic of children with progressive familial intrahepatic cholestasis type 3]

Objective: To analyze the clinical manifestations, pathology, and gene variant characteristics in children with progressive familial intrahepatic cholestasis type 3 (PFIC3). Methods: This retrospective study assessed the clinical manifestations, pathological features, gene variants, and prognosis data of 11 children with PFIC3 hospitalized in the Department of Hepatology, Fifth Medical Center, PLA General Hospital, from January 2015 to December 2022. Panel or whole exome sequencing was performed on the probands, followed by Sanger sequencing for verification within the family. Detected pathogenic variants were compared with known disease databases. Additionally, the new variants were predicted the deleteriousness and protein structure using relevant software to evaluate their pathogenicity. Results: Among the 11 PFIC3 children, 8 were boys and 3 were girls. The age of onset was 3.1 (0.2, 15.6) years. The main complaint of onset was different in the 11 patients;5 of them were abnormal liver function, 3 of them were liver and spleen enlargement, 2 of them were abdominal distension, and 1 of them was jaundice. Alanine aminotransferase, asparate aminotransferase and γ-glutamyltransferase increased in all the patients, which were(113±40), (150±44) and (270±156) U/L respectively. Moreover, direct bilirubin increased in 9 patients, and cholestasis was showed in 8 patients. All patients showed liver fibrosis on imaging, and 8 patients had cirrhosis. The pathological features of 8 cases by liver biopsy were as follows: 8 cases of fibrosis in the portal area, 7 cases of small bile duct hyperplasia, 4 cases of positive copper staining, and 5 cases of cirrhosis. A total of 17 ABCB4 gene variants were detected, including 9 new variants: c.589C>T(p.Q197X), c.1230+1G>A(Splicing), c.2914G>A(P.D972N), c.1058G>A(p.C353Y), c.956G>T(p.G319V), c.473T>A(p.L158Q), c.164T>C(p.L55S), c.2493G>C(p.R831S), and c.1150G>C(p.G384R). All 11 patients were treated with ursodeoxycholic acid and followed up for 5.1(0.6, 7.4) years. Among them, 4 cases of cirrhosis progressed continuously, 3 cases had liver transplantations, and the remaining 4 cases were stable after medical treatment. Conclusions: Children with PFIC3 have early onset, diverse clinical manifestations, rapid progression of fibrotic and cholestasis, as well as poor prognosis. Genetic testing helps to confirm the diagnosis.

[Prognostic significance of textbook outcome in advanced gastric patients who underwent neoadjuvant chemotherapy followed by surgical resection]

Objective: To investigate the risk factors and prognostic value of the textbook outcome (TO) in patients with advanced gastric cancer (AGC) who underwent neoadjuvant chemotherapy followed by surgical resection. Methods: This is a retrospective cohort study. A total of 253 patients with AGC who underwent neoadjuvant chemotherapy combined with gastrectomy and D2 lymphadenectomy in the Department of Gastric Surgery, Fujian Medical University Union Hospital from January 2010 to December 2019 were retrospectively included. There were 195 males and 58 females, aged (60.3±10.0) years (range: 27 to 75 years). The patients were then divided into the TO group (n=168) and the non-TO group (n=85). Multivariate Logistic regression was used to analyze the independent predictors of TO. Univariate and multivariate Cox analysis were used to analyze independent prognosis factors for overall survival (OS) and disease-free survival (DFS). Propensity score matching was performed to balance the TO and non-TO groups, and the Kaplan-Meier method was used to calculate survival rates and draw survival curves. Results: Among the 253 patients, 168 patients (66.4%) achieved TO. The Eastern Cooperative Oncology Group score (OR=0.488, 95%CI: 0.278 to 0.856, P=0.012) and ypN stage (OR=0.626, 95%CI:0.488 to 0.805, P<0.01) were independently predictive of TO. Multivariate analysis revealed that TO was an independent risk factor for both OS (HR=0.662, 95%CI: 0.457 to 0.959,P=0.029) and DFS (HR=0.687, 95%CI: 0.483 to 0.976, P=0.036). After matching, the 5-year OS rate (42.2% vs. 27.8%) and the 5-year DFS rate (37.5% vs. 27.8%) were significantly higher in the TO group than in the non-TO group (both P<0.05). Furthermore, patients in the non-TO group benefited significantly from postoperative chemotherapy (both P<0.05), but those in the TO group did not (both P>0.05). Conclusion: TO is an independent prognosis factor in patients undergoing neoadjuvant chemotherapy and surgery for AGC and is associated with postoperative chemotherapy benefits.

Targeting innate immune pathways for cancer immunotherapy

The innate immune system is critical for inducing durable and protective T cell responses to infection and has been increasingly recognized as a target for cancer immunotherapy. In this review, we present a framework wherein distinct innate immune signaling pathways activate five key dendritic cell activities that are important for T cell-mediated immunity. We discuss molecular pathways that can agonize these activities and highlight that no single pathway can agonize all activities needed for durable immunity. The immunological distinctions between innate immunotherapy administration to the tumor microenvironment versus administration via vaccination are examined, with particular focus on the strategies that enhance dendritic cell migration, interferon expression, and interleukin-1 family cytokine production. In this context, we argue for the importance of appreciating necessity vs. sufficiency when considering the impact of innate immune signaling in inflammation and protective immunity and offer a conceptual guideline for the development of efficacious cancer immunotherapies.

[Effect of splenic hilar lymphadenectomy on locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction with a tumor diameter ≥4 cm: a five-year survival analysis]

Objective: To examine the long term outcome of splenic hilar lymphadenectomy (SHL) for locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) with a tumor diameter ≥4 cm. Methods: A total of 489 locally advanced Siewert type Ⅱ and Ⅲ AEG patients with a tumor diameter ≥4 cm who underwent radical resection from January 2010 to April 2016 were included. There were 383 males and 106 females. There were 225 patients aged≥65 years and 264 patients aged <65 years. SHL was conducted in 270 patients(SHL group). Wilcoxon rank-sum test or χ² test were conducted for inter-group comparison. Cox proportional hazard regression was used to analyze the long term outcome of SHL and the prognosis factors of overall survival. Kaplan-Meier curve was drawn finally. The results of survival analysis were verified by Log-rank test. Results: Followed-up to April 2021,the median follow-up time was 78.0 months (range: 74.0 to 85.0 months), the follow-up rate was 95.5%(467/489). The splenic hilar lymphnode metastasis rate of the SHL group was 12.6% (34/270). Younger patients (<65 years old), less complications, higher proportion of patients received adjuvant chemotherapy were demonstrated in the SHL group (χ²: 5.644 to 6.744, all P<0.05). Multivariate analysis showed that SHL was the independent prognosis factor of overall survival for patients with Siewert type Ⅱ and Ⅲ AEG and a tumor diameter≥4 cm (HR=0.68, 95%CI: 0.52 to 0.88, P=0.004) along with preoperative CA19-9, pathological T stage, pathological N stage, adjuvant chemotherapy and postoperative complication. Further subgroup analysis demonstrated that the SHL group had better 5-year overall survival than non-SHL group (62.4% vs. 39.2%, χ²=17.983, P=0.006) in Siewert type Ⅲ AEG rather than in Siewert type Ⅱ AEG(57.3% vs. 53.7%, χ²=3.031, P=0.805). Conclusion: In experienced center, splenic hilar lymphadenectomy can improve the prognosis of Siewert type Ⅲ AEG with a tumor diameter ≥4 cm.

Hypokalemia-Induced Rhabdomyolysis in a Child with Autism Affected by the COVID-19 Pandemic

OBJECTIVE

Pediatric patients with autism spectrum disorder (ASD) often have coexisting feeding disorders. We hope to emphasize the significant implications that these feeding disorders can have on this patient population through a unique case of hypokalemia-induced rhabdomyolysis.

METHOD

We present a unique case of a 3-year-old boy with ASD and a longstanding history of food selectivity whose routine was disrupted during the COVID-19 pandemic resulting in avoidant/restrictive food intake disorder and severe undernutrition, who presented with profound hypokalemia and was subsequently found to have elevated muscle enzymes consistent with rhabdomyolysis despite only subtle complaints of difficulty walking.

RESULTS

The patient was treated with aggressive hydration, electrolyte therapy, and nasogastric tube feeds, which resulted in clinical and biochemical evidence of improvement. He was also reconnected to ASD-related care services that had lapsed during the COVID-19 pandemic.

CONCLUSION

This case exemplifies the adverse impact that feeding disorders can have on patients with ASD, particularly in the setting of stressors such as a global pandemic, and is also the first documented pediatric case of rhabdomyolysis secondary to hypokalemia from severe undernutrition. It demonstrates that physicians should have a low threshold to assess for clinical and laboratory evidence of rhabdomyolysis in patients with profound hypokalemia because symptoms of hypokalemia-induced rhabdomyolysis can often be subtle, which can delay diagnosis and thereby increase the risk for life-threatening complications from extensive muscle damage.

["Point line anterograde dissection" for the safe preparation of supraclavicular flap]

Objective: To investigate the application in the preparation of supraclavicular island flap by "point line anterograde dissection (PLAD) ". Methods: A retrospective analysis was performed on 45 flaps of 43 patients treated with supraclavicular artery island flap from the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2013 to June 2019. The patients were all male, aged 35-72 years old. There were 26 cases of hypopharyngeal cancer, 4 cases of recurrent laryngeal cancer, 2 cases of cervical esophageal cancer, 1 case of tonsillar cancer, 1 case of parotid gland cancer, 3 cases of postoperative pharyngeal fistula after hypopharyngeal cancer, 2 cases of esophageal fistula after trauma, 2 cases of esophageal stricture after hypopharyngeal carcinoma operation, 1 case of autoimmune laryngeal stenosis, and 1 case of cheek defect after maxillary sinus cancer operation."Point" was the origin of the supraclavicular artery in the transverse carotid artery. "Line" was an extension line made along the starting point of the supraclavicular vessel for anterograde anatomy of 1-2 cm and the direction of the blood vessel. The extension line was used as the central axis of the designed island flap. Characteristics of flap blood supply, the time of flap preparation, flap survival, donor area recovery and clinical follow-up were recorded. Results: The arterial blood supply of the flap was constant, and the venous reflux was variable. The area of the prepared flap was (4-8) cm×(10-18) cm, and the preparation time was 30-60 min, with a median of 42 min. Skin flap survival rate was 100%. Partial necrosis of skin flap occurred in 1 patient and postoperative pharyngeal fistula occurred in 5 patients, all of whom were cured by dressing change. The donor site defects were closed and sutured directly. 3 patients had partial incision dehiscence and healed after dressing change. During the follow-up, 1 patient was lost, and the remaining 42 patients were followed up for 8 to 55 months.40 patients involved swallowing function, all of them returned to regular diet or soft fluid after operation.40 patients involved malignant tumors and local tumor recurrence in 3 patients among whom, there were 2 cases of lymph node recurrence, and 2 cases of distant metastasis, including 1 case of lung metastasis and 1 case of bone metastasis. Conclusion: PLAD is a simple, safe and efficient method for the preparation of supraclavicular island flap.

[Clinical features and reasons for missed diagnosis of allergic bronchopulmonary aspergillosis]

Objective: To summarize the clinical features of allergic bronchopulmonary aspergillosis (ABPA) and analyze the common causes of missed diagnosis. Methods: The clinical data of patients with ABPA who were admitted into Qilu Hospital of Shandong University from October 2014 to November 2017 were retrospectively analyzed, including baseline data, eosinophil count in peripheral blood, serum total IgE, A. fumigates-specific antibody (sIgE, sIgG and sIgM), pulmonary function tests and chest CT, etc. Then the correlations between serum total IgE, sIgE and forced expiratory volume in one second (FEV₁) as percentage of predicted value (FEV₁%pred) was conducted, as well as that between serum total IgE, sIgE and FEV₁/forced vital capacity (FEV₁/FVC). The clinical features of the patients were summarized and the causes of missed diagnosis were analyzed. Results: There were 46 patients with ABPA (21 males and 25 females, 48.3±13.2 years old) in total. Only 2 cases (4.3%) were diagnosed after the first symptom onset, and 44 cases (95.7%) were treated repeatedly for many years before being diagnosed. The misdiagnoses were asthma (26 cases, 56.5%), bronchiectasis (13 cases, 28.3%), pneumonia (4 cases, 8.7%), pulmonary tuberculosis (3 cases, 6.5%), and lung cancer (4 cases, 8.7%). Common symptoms of ABPA included cough, expectoration, wheezing, chest tightness, fever, weight loss, chest pain, etc. Peripheral blood eosinophil count increased in 37 patients (80.4%). Serum total IgE in 37 patients (80.4%) were higher than 1 000 U/ml, and 9 cases (19.6%) were less than 1 000 U/ml. The positive rate of sIgE, sIgG and sIgM was 100.0%, 89.1% and 54.3%, respectively. All patients underwent pulmonary function tests and 35 cases (76.1%) had obstructive ventilation dysfunction, 5 cases (10.9%) with mixed ventilation dysfunction, 5 cases (10.9%) were normal and 1 case (2.2%) with restrictive ventilation dysfunction. All patients underwent Chest CT examination, 28 cases (60.9%) showed bronchiectasis, 8 cases (17.4%) manifested mucus plugs (among them, 4 cases with high-attenuation mucus) and 10 cases (21.7%) had other atypical imaging. Serum total IgE and sIgE had no correlations with FEV₁%pred and FEV₁/FVC. Conclusions: ABPA is characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. The main reasons of misdiagnosis in ABPA patients were: atypical symptoms, variety of predisposing diseases, early atypical imaging changes, limitations and misunderstandings of screening indicators, interference with tumor markers, and the presence of pulmonary aspergillus overlap syndrome. The severity of asthma attacks is not related to the degree of fungal sensitization.

Fidgetin-Like 2 siRNA Enhances the Wound Healing Capability of a Surfactant Polymer Dressing

Microtubules (MTs) are intracellular polymers that provide structure to the cell, serve as railways for intracellular transport, and regulate many cellular activities, including cell migration. The dynamicity and function of the MT cytoskeleton are determined in large part by its regulatory proteins, including the recently discovered MT severing enzyme Fidgetin-like 2 (FL2). Downregulation of FL2 expression with small interfering RNA (siRNA) results in a more than twofold increase in cell migration rate in vitro as well as translates into improved wound-healing outcomes in in vivo mouse models. Here we utilized a commercially available surfactant polymer dressing (SPD) as a vehicle to deliver FL2 siRNA. To this end we incorporated collagen microparticles containing FL2 siRNA into SPD (SPD-FL2-siRNA) for direct application to the injury site. Topical application of SPD-FL2 siRNA to murine models of full-thickness excision wounds and full-thickness burn wounds resulted in significant improvements in the rate and quality of wound healing, as measured clinically and histologically, compared with controls. Wound healing occurred more rapidly and with high fidelity, resulting in properly organized collagen substructure. Taken together, these findings indicate that the incorporation of FL2 siRNA into existing treatment options is a promising avenue to improve wound outcomes.

[Clinical and pathological characteristics and outcome of 46 children with autoimmune hepatitis]

Objective: To review and analyze the clinical and pathological data of children with autoimmune hepatitis (AIH). Methods: Medical records of 46 patients hospitalized in Pediatric Liver Diseases Treatment and Research Center, Fifth Medical Center, General Hospital of People's Liberation Army(PLA) from April 2012 to April 2018 were extracted. Medical data included type of AIH, clinical manifestations, biochemical parameters, liver biopsy results, and outcomes of treatment were analyzed retrospectively. Among 46 children, 19 were males and 27 were females. The age of onset was 10.1(1.4-18.0) years old. Chi-Square test, Rank sum test or t test were used for inter-group comparison. Results: There were 32 (70%)AIH-I cases and 14 (30%)AIH-Ⅱ cases (χ(2)=12.565, P=0.000). Among the 46 patients, there were 5 modes of onest: 17 cases (37%) had acute viral hepatitis-like presentation, 2 cases (4%) had fulminant hepatic failure, 9 cases (20%) had insidious onset, 5 cases (11%) showed cirrhosis and portal hypertension, and 13 cases (28%) were incidentally found to be due to elevated hepatic aminotransferases. Comorbidities including primary sclerotic cholangitis (n=3), primary biliary cholangitis (n=1), systemic lupus erythematosus (n=1) and inflammatory bowel disease (n=2), were all seen in AIH-Ⅰ cases. The elevated biochemical parameters of these patients were as follows: alanine aminotransferase (n=46), aspartate transminase (n=46), total bilirubin (n=35) γ-glutamyl transpeptadase (n=39), γ-globulin (n=32) and IgG (n=33). The γ-globulin and IgG levels were significantly higher in AIH-Ⅰ patients than those with AIH-Ⅱ((32±9)% vs. (23±8)%, t=3.217, P=0.002,(27±10) vs. (18±8)g/L, t=3.193, P=0.003, respectively). Thirty-nine patients received liver biopsy, among whom 22 (56%) with inflammation grade (G)≥3, 26(67%) with fibrosis stage (S) ≥3, and 7 with hepatic cirrhosis (S4) according to pathological analysis. Typical histopathological changes of AIH included: 36 cases of interfacial hepatitis (92%), 23 cases of lymphocyte/plasma cell infiltration (59%), 3 cases of rosette (8%). Forty patients received prednisolone monotherapy or combined with azathioprine after diagnosis. Complete remission was seen in 29 (72%) patients, partial remission in 10 (25%) patients and no response in 1 (3%) patient. Among complete remission patients, 15 (52%) had relapse in the process of prednisolone reduction. Repeated liver biopsy performed in 8 patients after treatment showed that hepatic inflammation and fibrosis were both improved in 6 patients, only inflammation was alleviated without fibrosis improvement in 1 patient, and neither inflammation nor fibrosis was improved in 1 case. The length of follow-up was 3.3 (0.3-10.5) years, and none of the 39 prednisolone-responded cases discontinued treatment successfully. Adverse effect of long-term prednisolone therapy included bilateral cataract (n=6), spinal fracture accompanied with delayed bone age development (n=1). Conclusions: AIH-Ⅰ is more common than AIH-Ⅱ in children, with diverse clinical characteristics. Most cases have progressive liver inflammation and fibrosis when diagnosed. Prednisolone monotherapy or combined with azathioprine could achieve both biochemical and pathological improvement, but relapse is inevitable during drug tapering, hence long-term treatment is essential.

Atg7 inhibits Warburg effect by suppressing PKM2 phosphorylation resulting reduced epithelial-mesenchymal transition

Metabolic reprogramming is a distinct hallmark in tumorigenesis. Autophagy can rewire cell metabolism by regulating intracellular homeostasis. Warburg effect is a specific energy metabolic process that allows tumor cells to metabolize glucose via glycolysis into lactate even in the presence of oxygen. Although both autophagy and Warburg effect are involved in the stress response to energy crisis in tumor cells, their molecular relationship has remained largely elusive. We found that Atg7, a key molecule involved in autophagy, inhibits the Warburg effect. Mechanistically, Atg7 binds PKM2 and prevents its Tyr-105 phosphorylation by FGFR1. Furthermore, the hyperphosphorylation of PKM2 and its induced Warburg effect due to Atg7 deficiency promote epithelial-mesenchymal transition (EMT). Conversely, overexpression of Atg7 inhibits PKM2 phosphorylation and the Warburg effect, thereby inhibiting EMT of tumor cells. Our work reveals a molecular link between Atg7 and the Warburg effect, which may provide insight into novel strategies for cancer treatment.

Effects of Leukaemia Inhibitory Factor Receptor on the Early Stage of Osteogenic Differentiation of Human Bone Marrow Mesenchymal Cells

Leukaemia inhibitory factor (LIF) has a wide variety of biological activities. While recent studies have focused on the role of LIF in osteoblast differentiation, the exact role of LIFR during the early stage of osteogenic differentiation remains unclear. We observed that LIFR expression gradually decreased during the early stage of osteogenic differentiation of hMSCs. To evaluate how LIFR regulates osteogenic differentiation in greater depth, we transfected hMSCs with LIFR overexpression and siRNA lentiviral plasmids. Cells were divided into four groups: a negative overexpression control group, a LIFR overexpression group, a negative siRNA control group, and a LIFR siRNA group. On different days (0, 3, and 6) of the osteogenic differentiation of hMSCs, alkaline phosphatase (ALP) activity was assayed with an ALP staining and activity assay kit. Cells were harvested to assess the mRNA and protein expression of LIF, LIFR, and osteogenesis-related factors (ALP; RUNX2; osteonectin) by qRT-PCR and western blot analyses, respectively. In addition, culture supernatants were tested for the LIF content by ELISA. Our results showed that overexpression of LIFR significantly suppressed the osteoblast differentiation of hMSCs. In contrast, LIFR siRNA markedly improved this osteoblast differentiation as determined by ALP staining and activity measurements. Moreover, RUNX2, ALP, and ONN expression was also significantly changed by altering LIFR expression. We further analysed the expression of LIF and LIFR, revealing consistent LIF and LIFR trends during the osteogenic differentiation of hMSCs. Together, these results suggested that LIFR may be a novel negative regulator during the early stage of hMSC osteogenic differentiation.

[A retrospective study on the liver pathological characteristics and the effect of antiviral treatment for 1 to 7 years old children with heptitis B e antigen negative chronic hepatitis B]

OBJECTIVE

To investigate the liver pathological characteristics and the clearance rate of hepatitis B surface antigen (HBsAg) with antiviral treatment for 1 to 7 years old children with heptitis B e antigen(HBeAg)-negative chronic hepatitis B.

METHOD

A total of 49 cases with HBeAg-negative chronic hepatitis B were treated with interferon (IFN) or IFN treatment for 6 months added with lamivudine, and were followed up for at least 6 months.Retrospective analysis was performed on the liver pathological characteristics, the efficacy of antivirus treatment and its influencing factors of the HBsAg clearance rate in the cases from June 2006 to December 2013 in the 302 Hospital of People's Liberation Army.The χ(2) test was used to compare the rates.

RESULT

(1)The median age of cases was 3 years old(1-7 years old), 38 children were male(78%). Cases in the age group 1-2, >2 -3, >3 -4, >4-5, >5-6 and >6-7 were 7, 8, 14, 6, 6 and 8 respectively. HBsAg was 100% positive in mother of the cases. (2)There were 7 children whose pre-treatment alanine aminotransferase (ALT) were ≤80 U/L and pre-treatment ALT>200 U/L in 25 children. There were 24 children whose pre-treatment HBVDNA ≥1×10(7) U/ml. Genetype analysis was detected in 43 children, 3 children were B genotype, 38 were C genotype, 2 were B and C genotype. (3)Liver biopsy was performed in all children. The degree of liver inflammation ≥2 was seen in 48 (98%) children.Severe liver fibrosis and cirrhosis were found in 21(43%) children. (4)In the age group 1-2, >2-3, >3-4, >4-5, >5-6 and >6-7 years old , the clearance of HBsAg was 5, 6, 2, 1, 0 and 0 respectively. The HBsAg clearance rate between 1-3 years old group and 3-7 years old group has significant difference ((73%(11/15) vs. 9%(3/34), χ(2)=18.180, P=0.000). (5)The clearance of HBsAg in male group was 11, but 3 in female group.It showed no significant difference between two groups (χ(2)=0.073, P=0.787). (6) The clearance rate of HBsAg were 0, 24%(4/17) and 40%(10/25) in the groups of pre-treatment ALT ≤80 U/L, 80<ALT≤200 U/L and ALT >200 U/L, respectively. There were no significant difference between the groups of ALT≤200 U/L and ALT > 200 U/L(χ(2)=2.223, P=0.136). In the groups with pre-treatment HBV DNA <1×10(7)U/ml and HBV DNA≥1×10(7)U/ml, the clearance rate of HBsAg was 28%(7/25) and 29%(7/24). There were no significant elifference between two groups(χ(2)=0.008, P=0.928). (7)The clearance rate of HBsAg was 33%(7/21) in children with severe liver fibrosis and cirrhosis, while 25%(7/28) in children who had no severe liver fibrosis and cirrhosis.There were no significant difference between two groups(χ(2)=0.408, P=0.523).

CONCLUSION

There are obvious liver injuries and severe liver fibrosis in 1-7 years old children with HBeAg-negative chronic hepatitis B. The HBsAg clearance rate in the children with antiviral treatment correlated with age, among those who received antiviral treatment before 3 years old, the HBsAg clearance rate is relatively higher.

[Clinical comparative analysis of comprehensive laparoscopic and laparotomic staging of early-stage epithelial ovarian cancer]

Objective: To investigate the value of laparoscopy in comprehensive early ovarian cancer staging by comparing the feasibility and safety of laparoscopy and laparotomy in surgical staging of early-stage epithelial ovarian cancer (EOC). Methods: A total of 102 patients with EOC who underwent comprehensive laparoscopic (LPS group, n=71) or laparotomic (LPT group, n=31) staging at Southwest Hospital from November 2007 to November 2014 were retrospectively analyzed. The perioperative parameters, postoperative complication rate and the long-term curative effect were compared between the two groups. Results: (1) LPS group had less intra-operative blood loss [(288±239) vs (631±463) ml], lower rate of blood transfusion (14% vs 58%) , larger number of pelvic dissected lymph nodes (18.1±5.6 vs 15.5±4.6), lower vasual analogue scalescore (VAS) pain score (2.1±1.6 vs 3.0±1.1), shorter gastrointestinal recovery time [(2.6±0.8) vs (3.5±0.9) days] and shorter hospital stay [(9.9±2.9) vs (11.3±5.0) days] when compared with LPT group (all P<0.01). No significant difference were found in operation time, number of para-aortic lymph nodes, rate of postoperative upstaging and adjuvant chemotherapy between the two groups (all P>0.05). (2) No significant difference was found in postoperative rate of complications [11%(8/71) vs 19% (6/31), χ(2)=1.192, P=0.275]. (3) No significant difference was found in recurrence rate [17%(11/66) vs 14%(4/29), χ(2)=0.125, P=0.724] and 5-year overall survival (86.7% vs 86.8%, P=0.874) . Conclusion: Compared with LPT group, there are no significance differences in recurrence rate and mortality between two groups, laparoscopic staging, which could be recommended as a choice of surgical treatment of early ovarian cancer, shows more favorable operative outcomes including minimally invasive, less intra-operative blood loss, less postoperative pain and quicker recovery.

Abstract 244: Distinct Regulation of Fat and Dachsous Cadherins in Response to Arterial Injury

Molecular mechanisms that control the activities of vascular smooth muscle cells (VSMCs) in the diseased or injured arterial wall remain incompletely understood. The atypical cadherin FAT1 is prominently expressed in VSMCs after vascular injury. In recent work, we found that processing of FAT1, a type I transmembrane protein, releases its intracellular domain, the FAT1ICD; in turn, FAT1ICD fragments accumulate in mitochondria and interact with electron transport complexes I and II to restrict VSMC respiration and control cell growth and neointimal formation. We hypothesized that FAT1 processing (and therefore these VSMC activities) is controlled by extracellular ligands that may interact physically via FAT1’s extended cadherin repeat or transmembrane domains. FAT4 and Dachsous 1 (DCHS1) are leading candidates for such interactions, but these proteins have not been studied in VSMCs or vascular injury response. Accordingly, we analyzed expression profiles of FAT4 and Dachsous 1 (DCHS1) during the vascular response to injury, using a rat carotid artery balloon injury model. Interestingly, FAT4 transcripts increased transiently after injury, peaking at day 7 (6.99±0.21-fold over baseline, P<.001), in a pattern reminiscent of FAT1. In contrast, DCHS1 levels decreased by day 3 after injury (0.49±0.02-fold of baseline, P<.001), remained low through day 14, and recovered by day 30. Physical interactions of FAT4 either with DCHS1 or with FAT1 have both been reported previously; therefore, decreased DCHS1 coincident with increased FAT4 suggest an increase in FAT4 availability and/or interaction with FAT1 during injury response. How this increase in FAT4 affects FAT1 function and VSMC metabolism and growth is the subject of ongoing investigation. FAT1 induction and processing after vascular injury represent an important novel molecular mechanism by which VSMC metabolism and growth are controlled after vascular injury. Increased availability of FAT4 cadherin due to FAT4 induction together with DCHS1 downregulation after vascular injury provides a likely upstream regulatory mechanism to govern FAT1 activities.

[Surgical outcomes after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for patients with advanced gastric cancer: a case-control study using a propensity score method]

Objective: To investigate the surgical outcomes after the laparoscopy-assisted distal gastrectomy (LADG) for patients with advanced gastric cancer. Methods: The data of 213 patients who underwent LADG and 213 treated by open distal gastrectomy (ODG) were selected using the propensity score matching method from a prospectively constructed database of 641 patients who underwent radical distal gastrectomy between January 2005 and June 2012 in Department of Gastric Surgery, Fujian Medical University Union Hospital. The baseline characteristics and surgical outcomes were compared using a paired t-test or the Wilcoxon signed ranks test for continuous variables. The cumulative survival rates were compared using the Kaplan-Meier method and log-rank test. Results: Among all patients, there were significant differences in tumor location, digestive tract reconstruction, histologic type, pT stage, and pTNM stage between LADG and ODG group (P<0.05). After propensity score matching, patient distributions were closely balanced. There was no significant difference in clinicopathologic characteristics between the two groups (P>0.05). Regarding perioperative characteristics, the time to first flatus, and time to resumption of diet, did not differ between the two groups (P>0.05), while there were significant differences in the operation time (t=-11.28, P=0.000), blood loss (t=-5.674, P=0.000), number of dissected lymph nodes (t=4.727, P=0.000), and post-operative hospital stay (t=-2.193, P=0.038). LADG group has less morbidity than ODG group (χ²=4.777, P=0.029). Multivariate analysis revealed that the laparoscopic surgery (RR=0.392, P=0.009) was the protected factor for determining postoperative complications. There was no significant difference in the cumulative survival rate at total and each UICC stage between the two groups, either (P>0.05). Conclusion: LADG is an oncological safe minimally invasive procedure for advanced gastric cancer yields comparable oncological outcomes with ODG.

Exercise improved lipid metabolism and insulin sensitivity in rats fed a high-fat diet by regulating glucose transporter 4 (GLUT4) and musclin expression

This study aimed to evaluate the effects of exercise training on triglyceride deposition and the expression of musclin and glucose transporter 4 (GLUT4) in a rat model of insulin resistance. Thirty male Sprague-Dawley rats (8 weeks old, weight 160±10 g) were fed a high-fat diet (40% calories from fat) and randomly divided into high-fat control group and swimming intervention group. Rats fed with standard food served as normal control. We found that 8-week swimming intervention significantly decreased body weight (from 516.23±46.27 to 455.43±32.55 g) and visceral fat content (from 39.36±2.50 to 33.02±2.24 g) but increased insulin sensitivity index of the rats fed with a high-fat diet. Moreover, swimming intervention improved serum levels of TG (from 1.40±0.83 to 0.58±0.26 mmol/L) and free fatty acids (from 837.80±164.25 to 556.38±144.77 μEq/L) as well as muscle triglycerides deposition (from 0.55±0.06 to 0.45±0.02 mmol/g) in rats fed a high-fat diet. Compared with rats fed a standard food, musclin expression was significantly elevated, while GLUT4 expression was decreased in the muscles of rats fed a high-fat diet. In sharp contrast, swimming intervention significantly reduced the expression of musclin and increased the expression of GLUT4 in the muscles of rats fed a high-fat diet. In conclusion, increased musclin expression may be associated with insulin resistance in skeletal muscle, and exercise training improves lipid metabolism and insulin sensitivity probably by upregulating GLUT4 and downregulating musclin.

[Aging changes of the root canal morphology in maxillary first premolars observed by cone-beam computerized tomography]

OBJECTIVE

To observe the morphological changes of root canals with aging in maxillary first premolars by using cone-beam computerized tomography(CBCT)in order to facilitate endodontic management of root canals in various aged patients.

METHODS

The digital CBCT data of the maxillary first premolars in 405 cases from the patients in Oral Medical Center of The First Affiliated Hospital, Jinan University from March 2011 to June 2015 were collected. The CBCT images were divided into 6 groups according to the patients' ages: groups 11-20, 21-30, 31-40, 41-50, 51-60 and >60 years-olds, respectively. Changes of morphologies of root canals with aging including such parameters as types of the root canal, incidence of double root canals in single rooted teeth, distance between both root canal orifices of double rooted canals, and morphological change of the cross section of roots. Chi-square test and liner trend test were adopted in statistical analysis in the present study.

RESULTS

The distribution of various types of the root canals were significantly different amongst various aged groups(P<0.05). Type Ⅳ is the most common type(210/405, 51.8%), and the following groups were typeⅡ(65/405, 16.0%), typeⅠ(55/405, 13.6%)and type Ⅲ(27/405, 6.7%). Along with aging, the percentages of type Ⅰ and type Ⅲ decreased while type Ⅱ increased. However, there were no remarkable changes of type Ⅳ observed. The incidence of double rooted canals in single rooted teeth gradually increased with aging especially in 20-years-old and above groups, e.g. 51.7%(31/60)in group 11-20 years-olds and 83.0%(44/53)in group 21-30 years-olds. However, there was no significant increase observed after the age of 40. The distance between both root canal orifices of double rooted canals became shorter with aging except in groups of 40-years-olds and above. The morphologies of the cross sections in most aged groups were flat shaped(1 020/2 105, 48.5%)and oval shape(594/2 105, 28.2%). Along with aging, the percentage of circular shape gradually increased while flat and oval shapes decreased.

CONCLUSIONS

The morphology of root canal could be clearly showed by the CBCT images. The change of morphologies of the root canals in maxillary first premolars was significantly related to aging. Along with aging, the morphology of the root canal became more and more complicated.

[Correlation between job burnout and salivary cortisol concentration in employees]

OBJECTIVE

To investigate the correlation between job burnout and salivary cortisol concentration.

METHODS

In September 2014, a cross-sectional survey was used to perform a questionnaire survey for 237 employees in a solar photovoltaic company. Meanwhile, saliva was collected through chewing with a tube for saliva collection, and enzyme-linked immunosorbent assay was used to measure salivary cortisol concentration.

RESULTS

The salivary cortisol concentration showed no significant differences between employees with different ages, working years, educational backgrounds, and shifts(P>0.05). The salivary cortisol concentration was positively correlated with the scores of emotional exhaustion, depersonalization, and job burnout(r=0.182, 0.229, and 0.222, P<0.05). The employees with emotional exhaustion, depersonalization, and job burnout had significantly higher salivary cortisol concentrations than those without emotional exhaustion, depersonalization, and job burnout(80.22±13.34 μg/L vs 75.86±14.75 μg/L, t=2.029, P<0.05; 80.69±12.99 μg/L vs 75.27±14.89 μg/L, t=2.607, P<0.05; 80.06±12.63 μg/L vs 72.76±16.04 μg/L, t=3.248, P<0.05). The stepwise regression analysis showed that salivary cortisol concentration was mainly influenced by depersonalization.

CONCLUSION

Job burnout is correlated with salivary cortisol concentration, and can be used as an objective assessment index for job burnout.

[Influence of occupational stress on salivary immunoglobulin G concentration in employees]

OBJECTIVE

To investigate the possibility of salivary immunoglobulin G(IgG) as an objective assessment index for occupational stress.

METHODS

In September 2014, a total of 186 employees in a solar photovoltaic company were selected as research subjects, and a questionnaire survey was performed. Enzyme-linked immunosorbent assay was used to measure salivary IgG concentration.

RESULTS

The salivary IgG concentration showed a significant difference between employees with different working years and shifts(P<0.05). The employees with ≤15 working years had a lower salivary IgG concentration than those with >20 working years (49.93±7.97 μg/ml vs 53.80±8.22 μg/ml), and the employees with long-day shifts had a higher salivary IgG concentration than those with day-night shifts(54.98±7.62 μg/ml vs 51.85±7.94 μg/ml). The employees with low levels of job demands and job danger had a significantly higher salivary IgG concentration than those with high levels(54.09±6.68 μg/ml vs 50.65±8.81 μg/ml, P<0.05; 53.73±7.35 μg/ml vs 50.73±8.73 μg/ml, P<0.05). The employees with a high score of mental health had a significantly higher salivary IgG concentration than those with a low score(54.39±5.28 μg/ml vs 50.73±9.36 μg/ml, P<0.05). The salivary IgG concentration was positively correlated with the score of mental health(r=0.314, P<0.05), but negatively correlated with job demands, job routinization, job danger, job prospects, physical complaints, and daily stress(r=-0.249, -0.159, -0.157, -0.030, -0.035, and -0.176, all P<0.05). The multivariate linear regression analysis showed that the salivary IgG concentration was mainly influenced by job demands and mental health.

CONCLUSION

Salivary IgG concentration can be applied as an objective assessment index for occupational stress.

Effect of 1-methylcyclopropene on shelf life, visual quality and nutritional quality of netted melon

The effects of 1-methylcyclopropene (1-MCP) on shelf life, fruit visual quality and nutritional quality were investigated. Netted melons were treated with air (control) and 0.6 µl l(-1) 1-MCP at 25 ℃ for 24 h, and then stored at 25 ℃ or 10 ℃ for 10 days. 1-MCP significantly extended the shelf life, inhibited weight loss and delayed firmness decline of melon fruits. Ethylene production was also inhibited and respiration rate was declined. 1-MCP retarded 1-aminocyclopropane-1-carboxylic acid (ACC) increases and inhibited ACC synthase and ACC oxidase activity. Moreover, 1-MCP treatment reduced the decrease in total soluble solids and titratable acidity, as well as the decrease of the content of sugars (sucrose, fructose and glucose). These results indicated that 1-MCP treatment is a good method to extend melon shelf life and maintain fruit quality, and the combination of 1-MCP and low temperature storage resulted in more acceptable fruit quality.

Status epilepticus stimulates peroxisome proliferator-activated receptor γ coactivator 1-α/mitochondrial antioxidant system pathway by a nitric oxide-dependent mechanism

Peroxisome proliferator-activated receptor (PPAR) γ coactivator 1-α (PGC-1α) is a transcriptional coactivator identified as an upstream regulator of lipid catabolism, mitochondrial number and function. PGC-1α protects neurons against oxidative damage by inducing several members of the mitochondrial antioxidant system such as superoxide dismutase 2 (SOD2) and uncoupling protein 2 (UCP2). Its role in seizure-induced oxidative stress has not been studied. Here we showed that pilocarpine-induced status epilepticus (SE) stimulates the PGC-1α/mitochondrial antioxidant system signaling pathway in the rat hippocampus. Because nitric oxide (NO) is the key factor of mitochondrial biogenesis through the transcriptional induction of PGC-1α, we investigated whether NO is involved in activation of the PGC-1α/mitochondrial antioxidant system after SE. Treatment with the NO synthase (NOS) inhibitor N(G)-nitro-l-argininemethyl ester (l-NAME) attenuated the increased expression of the PGC-1α/mitochondrial antioxidant system after SE and enhanced oxidative stress. These results suggest that SE can induce the PGC-1α/mitochondrial antioxidant system signaling pathway, which may represent a protective mechanism against SE-induced oxidative stress. Furthermore, NO may positively regulate the mitochondrial antioxidant system by inducing PGC-1α in pilocarpine-induced SE.

A selective requirement for 53BP1 in the biological response to genomic instability induced by Brca1 deficiency

The molecular pathways leading from genomic instability to cellular senescence and/or cell death remain incompletely characterized. Using mouse embryonic fibroblasts with constitutively increased DNA damage due to the absence of the full-length form of the tumor suppressor Brca1 (Brca1(Delta 11/Delta 11)), we show that deletion of p53 binding protein 1 (53BP1) selectivity abrogates senescence and cell death stimulated by reduced Brca1 activity. Furthermore, the embryonic lethality induced by Brca1 mutation can be alleviated by 53BP1 deletion. Adult Brca1(Delta 11/Delta 11)53BP1(-/-) manifest constitutively high levels of genomic instability, yet age relatively normally, with a surprisingly low incidence of overall tumor formation. Together, these in vitro and in vivo data suggest that 53BP1 is specifically required for the development of premature senescence and apoptosis induced by Brca1 deficiency. These observations may have important implications for Brca1-mediated tumor formation as well as for the molecular pathway leading from genomic instability to organismal aging.

Absence of full-length Brca1 sensitizes mice to oxidative stress and carcinogen-induced tumorigenesis in the esophagus and forestomach

Environmental and genetic factors are important both in affecting life span and neoplastic transformation. We have shown previously that mice, which are homozygous for full-length breast cancer-associated gene-1 (Brca1) deletion and heterozygous for a p53-null mutation (Brca1(Delta11/Delta11)p53(+/-)), display premature aging and high frequency of spontaneous lymphoma and mammary tumor formation. To investigate the role of Brca1 in regulation of organ homeostasis and susceptibility of Brca1 deficiency to environmental carcinogens, we examined biological function of Brca1 in maintaining organ homeostasis and carcinogen-induced tumorigenesis. Brca1(Delta11/Delta11)p53(+/-) mice showed altered gastrointestinal tract homeostasis, including hyperkeratosis in the esophagus and forestomach. At 6 months of age, most mutant mice displayed hyperplasia in their forestomach and esophagus, leading to dysplasia and carcinoma formation in older animals. Brca1 mutant mice exhibited increased expression of Redd1, elevated reactive oxygen species and are more sensitive to oxidative stress induced lethality. Upon methyl-N-amylnitrosamine (MNAN) treatment, 70% Brca1 mutant mice developed tumors within 4 months whereas only 14% control animals developed tumor at the same period of the time. Our further analysis revealed that the tumorigenesis is accompanied by the loss of p53 and increased expression of a number of oncogenes, including Cyclin D1, phosphorylated form of Akt, beta-catenin, Runx-2 and c-Myc. These results suggest that Brca1 is involved in renewable organ homeostasis, linking the environmental and genetic factors in carcinogenesis and aging, and providing new insights into genomic instability in organism maintenance and tumorigenesis.