[Mutational analysis of RNA splicing machinery genes SF3B1, U2AF1 and SRSF2 in 118 patients with myelodysplastic syndromes and related diseases]

目的

探讨RNA剪接体复合物编码基因SF3B1、U2AF1和SRSF2突变在MDS及相关疾病中的突变率、突变特点及临床意义。

方法

以118例MDS及相关疾病患者为研究对象，采用PCR扩增产物直接测序法分别检测SF3B1（K700E）、U2AF1（S34、Q157P）和SRSF2（P95）突变情况。

结果

118例MDS患者中，男76例，女42例，中位年龄53.5（13~84）岁。对全部患者均进行SF3B1（K700E）基因突变分析，SF3B1（K700E）的突变率为19.49%（118例中23例）。在突变的22例MDS患者中，14例环形铁粒幼红细胞（RS）比例≥15%，其中难治性贫血伴环状铁粒幼红细胞（RARS）7例、难治性血细胞减少伴有多系发育异常（RCMD）6例、难治性贫血（RA）1例。与未突变组相比，突变组患者的年龄偏大[58（32~78）岁对51（13~84）岁，z=−1.981，P=0.048]、PLT偏高[121（22~888）×10⁹/L对59（6~1 561）× 10⁹/L，z=−3.305，P=0.001]、骨髓原始细胞比例偏低[0.007（0~0.122）对0.017（0~0.268），z=−2.885，P=0.004]、RS比例偏高[0（0~64%）对0（0~58%），z=−4.664，P<0.001]，HGB偏低[63（40~95）g/L对77（34~144）g/L，z=−3.192，P=0.001]。对105例患者进行U2AF1（S34、Q157P）基因突变分析，突变率为21.90%（105例中23例）。突变组患者各临床特征与未突变组相比差异均无统计学意义。107例患者有SRSF2（P95）突变结果，8例突变，突变率为7.48%，突变组患者初诊时年龄偏高，中位年龄63（50~84）岁，其中难治性贫血伴有原始细胞增多-1（RAEB-1）4例，突变率为14.29%（28例中4例）；MDS转化的急性髓系白血病3例。1例患者同时出现SF3B1（K700E）和SRSF2（P95H）突变，2例患者同时出现SF3B1（K700E）和U2AF1（S34Y）突变。

结论

SF3B1、U2AF1和SRSF2剪接体复合物蛋白编码基因中，仅SF3B1基因突变与环状铁粒幼红细胞增多性贫血密切相关，是该亚型的主要致病基因。

[Distributed lag effects on the relationship between daily mean temperature and the incidence of bacillary dysentery in Lanzhou city]

OBJECTIVE

To discuss the lag effects of daily average temperature on the daily cases of bacillary dysentery in Lanzhou city.

METHODS

The data of daily cases of bacillary dysentery were collected during 2008 and 2015 in the city, and the meteorological data at the same period was integrated. The distributed lag non-linear model was used to analyze the relevance between daily average temperature and the daily cases of bacillary dysentery.

RESULTS

The exposure response relationship between the daily temperature and the incidence of bacillary dysentery was "J" type, the lowest incidence temperature was 17 °C, and the effect of high temperature on different gender and age groups was higher than that of the intermediate effect. The effect of high temperature and intermediate effect on the male and female groups showed an acute effect, the effect of the day was the highest, followed by fluctuations in temperature, and the greater the impact on women. In different age groups, high temperature effect and the intermediate effect of bacterial dysentery in 0-3 years old groups were the biggest; the effects of high and intermediate temperature on people aged 0-3 and 19-64 year all showed acute effects, which were the maximum value at the day, then decreased volatility; and for people aged over 65 years, the day after the onset, decreases and then increases slowly. There were obviously increasing risks of bacillary dysentery both the high temperature (32 °C) and the middle temperature (26 °C) with respect to 17 °C. The accumulative effects were highest at lag14 days, and the RR (95%CI) values of middle temperature was 2.30 (1.53-3.13), 2.45 (1.65-3.30), 2.41 (1.59-3.28), 2.54 (1.40-3.79), 1.82 (0.41-3.43), 1.98 (1.11-2.93), and 1.73 (0.68-2.88) among the males, females, 0-3 years old, 4-11 years old, 12-18 years old, 19-64 years old and over 65 years old people, respectively; while the high temperature was 2.93 (1.38-4.69), 3.08 (1.48- 4.90), 3.26 (1.60-5.16), 3.12 (1.06-5.56), 1.94 (0.73-5.39), 2.31 (0.54-4.36), and 2.06 (0.02-4.51), respectively.

CONCLUSION

The high temperature may increase risks of bacillary dysentery, and the females and younger people were the sensitive population. Meteorological factors play an important role in the occurrence and development of bacillary dysentery in Lanzhou. The incidence of bacillary dysentery is affected by multiple meteorological factors, but the primary one is high temperature. The temperature has not a direct effect on the incidence of bacillary dysentery, but an indirect influence in different populations through the impacts of various aspects of the incidence of bacterial dysentery (residents living habits, communication channels and the habits of the susceptible population).

[Tympanoplasty without mastoidectomy for active otitis media]

Objective:The study aims to assess the effect of tympanoplasty without mastoidectomy for the middle ear under different infected states.Method:One hundred and thirteen cases (113 ears) with chronic otitis media (COM) received tympanoplasty without mastoidectomy. All the patients were found inflammatory proliferative lesions in the mastoid and tympanic antrum via CT scan before surgery and were followed up over 1 year. The patients were placed into the infected ear group (72 ears) and uninfected ear group (41 ears) according to the infective condition. We used SPSS statistical software to analyze the efficacy.Result:Of 113 cases, 92 ears had dry ear canals in 1/2 to 1 month after surgery, and the negative air pressure in the tympanum gradually disappeared in 3-6 months after surgery. Of the 72 ears in the infected ear group, 69 ears had postoperative dry ears, and a large amount of intraoperative purulent secretion was seen in the tympanum in 4 cases, which all had dry ear canals. Three cases had relapse, for a dry ear canal rate of 95.8%. Three ears showed dry tympanic membrane perforations, and effective ears with air-bone conduction differences smaller than or equal to 20 dB accounted for 51.4% of cases. Of the 41 ears in the uninfected group, 40 ears had postoperative dry ears, 1 case had relapse, for a dry ear canal rate of 97.6%. Two ears showed dry tympanic membrane perforations. Effective ears with air-bone conduction differences smaller than or equal to 20 dB accounted for 48.8% of cases. No case of facial paralysis, dizziness, formation of invaginations of the tympanic membrane and cholesteatoma were seen in the patients included in this study during the follow-up visits.Conclusion:Whether there are inflammatory proliferative lesions in the mastoidor not, tympanoplasty without mastoidectomy is feasible for chronic active otitis media. Moreover, different infection statuses of the middle ear do not cause difference in the postoperative relapse rate and hearing improvement.

[Prognosis and risk factors of 1 791 patients with breast cancer treated with breast-conserving surgery based on real-world data]

Objective: To investigate the overall efficacy of early breast cancer after breast-conserving treatment. To analyze risk factors affecting local regional recurrence (LRR), distant metastasis (DM) and survival. Methods: 1 791 breast cancer patients treated with breast-conserving surgery were retrospectively analyzed. The inclusion criteria were pathologic diagnosis of invasive breast cancer without supraclavicular and internal mammary node metastasis, T1-2N0-3M0, and no neoadjuvant therapy. Univariate analysis of survival was performed by Kaplan-Meier method and log rank test. Cox regression model was used for multivariate analysis. Results: The median follow-up time was 4.2 years. For all patients, the 5-year LRR, DM, disease-free survival(DFS) and overall survival(OS) rates were 3.6%, 4.6%, 93.0% and 97.4%, respectively. The LRR rates of patients with Luminal A, Luminal B1, Luminal B2, HER-2 over-expressed and triple-negative breast cancer were 2.0%, 6.1%, 5.9%, 0 and 10.0%, while the DM rates were 3.2%, 6.7%, 8.3%, 4.8% and 7.3%, respectively. Among the N0 patients, axillary dissection was performed in 689 cases and sentinel lymph node biopsy in 652 cases. The 5-year LRR rates were 3.3% and 3.2% (P=0.859), and the OS rates were 98.2% and 98.3% (P=0.311) respectively, which showed no statistically significant. There were 1 576 patients that underwent postoperative radiotherapy. Postoperative radiotherapy significantly reduced the 5-year LRR compared with surgery alone (2.5% vs 12.9%). The 5-year LRR rates of patients who received conventional fractionated radiotherapy and hypo-fractionated radiotherapy were 2.7% and 3.1%, respectively. But the difference was not statistically significant (P=0.870). Multivariate analysis showed that age, lymphovascular invasion, pathological T staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors of LRR in breast cancer patients (all P<0.05). Histological grade and pathological N staging were independent factors of DM (all P<0.05). The age, lymphovascular invasion, pathological T and N staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors for DFS (all P<0.05). Histological grade, pathological N staging, ER/PR status and endocrine therapy were factors for OS (all P<0.05). Conclusions: With contemporary standard treatment, the recurrence rate of early breast cancer after breast conserving treatment is less than 10%. Node-negative patients after sentinel lymph node biopsy did not need axillary dissection. The overall utilization of radiotherapy after breast conserving surgery is satisfactory. Hypofractionated radiotherapy is as effective as conventional fractionated radiotherapy. Local regional recurrence and distant metastasis have different risk factors.

[Clinical outcome of receptor expression discordance between primary and metastatic breast cancer]

Objective: To investigate the clinical outcome of expression discordance of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) in primary breast cancer and the corresponding metastatic lesions. Methods: A retrospective analysis was performed on 178 breast cancer patients with metastasis confirmed by the National Cancer Center & Cancer Hospital, Chinese Academy of Medical Sciences in the past 6 years. The data of expressions of ER, PR and HER-2 in primary and metastatic breast cancer, the metastatic sites, disease progression were collected and the relationships of the expression discordance of receptors with prognosis were analyzed. Results: The discordance rates of ER, PR and HER-2 between the primary tumor and the metastatic sites were 27.0%, 39.8% and 18.7%, respectively. The discordance rates of ER, PR and HER-2 of patients with locoregional recurrence were 21.9%, 36.6% and 12.7%, respectively, while those of patients with distant metastases were 31.3%, 42.7% and 23.8%. The median progression free survivals (PFS) of ER+/+、ER+/-、ER-/+、ER-/- of primary tumor and metastatic sites were 17.7 months, 10.3 months, 14.0 months and 9.0months, respectively (P=0.025). The median PFS of PR+/+, PR+/-, PR-/+, PR-/- were 23.0 months, 10.7 months, 14.0 months and 9.2months, respectively (P=0.002). The median PFS of HER-2+/+, HER-2+/-, HER-2-/+, HER-2-/- were 14.9 months, 15.2 months, 12.3 months and 14.0 months, respectively, without significant differences (P=0.588). Conclusions: This study confirms that expression discordances of ER, PR and HER-2 between primary breast cancer and the corresponding metastatic lesions are dramatic, especially in the patients with distant metastasis. The unstable levels of ER and PR seem to be significantly associated with prognosis of breast patients.

[Helicobacter pylori and hepatic encephalopathy]

Hepatic encephalopathy (HE) is caused by severe liver disease or portal shunt. Metabolic disorders and central nervous system dysfunctions are the main symptoms of this syndrome. Ammonia is considered to play a central role in the pathogenesis of HE. Helicobacter pylori (H. pylori) have been suggested as a possible source of ammonia production because of its high urease content. However, the relationship between H.pylori and blood ammonia and HE, as well as the therapeutic effect of H.pylori eradication on HE, is inconclusive, and the results are full of contradictions. The aim of this review is to summarize current knowledge on the association of H. pylori with HE and to address the question of whether H. pylori eradication may be beneficial in the management of HE.

Effects of dietary vitamin C, vitamin E, and alpha-lipoic acid supplementation on the antioxidant defense system and immune-related gene expression in broilers exposed to oxidative stress by dexamethasone

Vitamin C, vitamin E, and alpha-lipoic acid (ALA) are potent nutritional antioxidants, which are important for enhancing immunity. This study compared the effects of supplementation with vitamin C, vitamin E, or ALA on the antioxidant defense system and the expression of immune-related genes under oxidative stress induced by dexamethasone (DEX) in broilers. In total, 240 one-day-old female Recessive White Rock chickens were assigned randomly to either a basal diet (control group) or basal diet supplemented with vitamin C (200 mg/kg diet), vitamin E (100 mg/kg), or ALA (500 mg/kg) for 28 d starting from hatching. At 21 d of age, birds fed the ALA-supplemented diet had the highest plasma total antioxidant capacity (T-AOC) and superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-PX) enzyme activities, and the lowest plasma malondialdehyde (MDA) activity, as well as the lowest mRNA gene expression levels of interferon gamma (IFN-γ) and lipopolysaccharide-induced tumor necrosis factor-alpha factor (LITAF). At 23 d of age, the broilers in the 3 treatment groups were injected in the thigh muscle with DEX for 3 alternating days. In addition, the control group was divided into 2 equal groups, in which one was injected with saline and the other was injected with DEX. At 28 d of age, the DEX-ALA group (P < 0.05) had the highest activity levels for T-AOC, T-SOD, and GSH-PX in the plasma and liver (P < 0.05), and the greatest reduction in the MDA level. Dietary ALA significantly decreased the mRNA expression levels of the interleukin 1 β (IL-1β), IL-6, IFN-γ, and LITAF genes compared with the other groups during oxidative stress by DEX. In conclusion, this study suggests that in broilers, ALA is more effective for normalizing the oxidative stress induced by DEX than vitamin C or vitamin E.

Genital basal cell carcinoma, a different pathogenesis from sun-exposed basal cell carcinoma? A case-control study of 30 cases

BACKGROUND

Genital basal cell carcinoma (BCC) accounts for <1% of all BCCs. We aimed to elucidate the pathogenesis of genital BCC.

METHODS

We retrospectively evaluated cases of pathologically diagnosed genital BCC between 1990 and 2016 in an Asian tertiary referral center. The control group was composed of consecutive cases, from 2016, of BCCs occurring in sun-exposed areas. Presence of human papillomavirus (HPV) was evaluated by polymerase chain reaction (PCR). Immunohistochemical p16 and p53 staining was performed and analyzed.

RESULTS

We found 33 genital BCCs (33/1837, 1.8%) over 26 years. The mean follow-up duration was 30.0 ± 33.2 months. Genital BCCs had a larger size (14.05 vs 8.92 mm, P = 0.014), more common presence of ulcers (61.3% vs 32.0%, P = 0.035), shorter epidermal p53 clone (0.33 vs 1.20 mm, P = 0.007), and high p53 expression levels. Most cases (29/30, 96.7%) showed negative or faint spotty p16 staining. Patient age, tumor depth, presence of pigment, or histology subtype did not differ significantly. Thirty genital BCCs were negative for HPV.

CONCLUSIONS

HPV infection is mostly likely not involved in genital BCC pathogenesis. A greater level of p53 expression in genital BCCs implicates pathways other than ultraviolet (UV)-specific p53 mutations in their pathogenesis.

Different molecular subtypes of breast invasive ductal carcinoma

This study aims to analyze the clinical characteristics of breast invasive ductal carcinoma (BIDC) in patients with different molecular subtypes and identify possible correlation to prognosis. miR- 10b expression level was detected using real-time quantitative polymerase chain reaction (RT-PCR). Tissue sections were collected and stained using the immunohistochemical method. The samples were grouped into human epidermal growth factor receptor 2, (HER2) overexpression, Triple negative, Luminal A and Luminal B groups. Age, tumor size, breast cancer molecular subtype, clinical stage, miR-10b positive expression, positive expression of Ki-67 and survival rate of patients diagnosed with BIDC were analyzed. The expression of miR-10b was down-regulated in the breast carcinoma tissues. Age and clinical stage were distinctly different among patients with different molecular subtypes of BIDC (p less than 0.05). Tumor size was not remarkably different (p less than 0.05) among different subtypes. The positive expression rate of miR-10b was lowest in patients with Luminal B BIDC; the positive expression of Ki-67 was in different correlation with the expression of different receptors, and there was a remarkable difference (p less than 0.05); moreover, the survival rate of patients with Luminal A and B BIDC was significantly higher compared to patients with other molecular subtypes (p less than 0.05). Clinical characteristics and prognosis of BIDC vary among different molecular subtypes. This study provides valuable input on BIDC therapy.

[Identification and analysis of the proteins interacted with Prestin in cochlear outer hair cells of guinea pig]

Objective: To explore the regulation and mechanism of Prestin protein by identifying the proteins interacted with Prestin in cochlear outer hair cell(OHC) and analyzing their biological function. Methods: Co-immunoprecipitation combined mass spectrometry technology was used to isolate and identify the proteins interacted with Prestin protein of OHC, bioinformatics was used to construct Prestin protein interaction network. The proteins interacted with Prestin in OHC of guinea pig were determined by matching primary interaction mass spectrometry with protein interaction network, and annotated their functions. Results: The results of co-immunoprecipitation combined with mass spectrometry showed that 116 kinds of credible proteins could interact with Prestin. By constructing Prestin protein interaction network, matching the results of mass spectrometry and analyzing of sub-cellular localization, eight kinds of proteins were confirmed that they interacted with Prestin directly, namely EEF2, HSP90AB1, FN1, FLNA, EEF1A1, HSP90B1, ATP5A1, and ERH, respectively, which were mainly involved in the synthesis and transportation, transmembrane folding and localization, structural stability and signal transduction of Prestin protein. Conclusion: EEF2, HSP90AB1, FN1, FLNA, EEF1A1, HSP90B1, ATP5A1 and ERH provide molecular basis for sensory amplification function of OHCs by participating in biotransformation, transmembrane folding and localization, signal transduction and other biological processes of Prestin protein.

[Gene mutations from 511 myelodysplastic syndromes patients performed by targeted gene sequencing]

Objective: To study the characteristics of gene mutations in Chinese myelodysplastic syndromes (MDS) patients. Methods: A total of 511 Chinese patients with MDS performed 112-gene targeted sequencing were retrospectively analyzed. Results: Eighty-three distinct mutant genes were found in 511 patients with MDS. Amongst these, the most frequent mutations was associated with epigenetics (50%) , followed by spliceosome (37%) , signal transduction (34%) , transcription factors (24%) and cell cycle/apoptosis (17%) . 439 subjects (86%) had at least one gene mutation. The mean number of mutations in refractory anemia with unilineage dysplasia (RCUD) was 1.25, refractory anemia with multilineage dysplasia (RCMD) was 1.73, refractory anemia with ring sideroblasts (RARS) was 2.79, refractory anemia with excess blasts-1 (RAEB-1) was 2.22, RAEB-2 was 2.34, MDS with isolated 5q- was 2.67, MDS, unclassified (MDS-U) was 2.00. U2AF1 mutant subjects were more likely to have isolated+8[Q<0.001, OR=4.42 (95% CI 2.23-8.68) ]and less likely to have complex karyotypes[Q=0.005, OR=0.22 (95% CI 0.04-0.72) ]. According to the number of gene mutations, all subjects were categorized into three groups, namely group with 0-1 mutation, with 2 mutations and with three or more mutations. There was a significant difference in overall survival (OS) among three groups (P=0.041) . Conclusion: About 90% patients with MDS have at least one gene mutation. Genes associated with epigenetics and spliceosome are most common mutated genes in MDS. The increased numbers of gene mutations accompany with disease evolution and associate with poor prognosis.

S-1 chemotherapy and intensity-modulated radiotherapy after D1/D2 lymph node dissection in patients with node-positive gastric cancer: a phase I/II study

BACKGROUND

This phase I/II clinical trial investigated S-1 administered with intensity-modulated radiotherapy (IMRT) as adjuvant therapy for node-positive gastric cancer. Patients had undergone radical resection and D1/D2 lymph node dissection.

METHODS

In phase I, patients received adjuvant chemoradiotherapy of IMRT (45 Gy in 25 fractions) with concurrent S-1 administered on a dose-escalation schedule to determine the recommended dose (RD). In phase II, the safety and efficacy of the RD of S-1 combined with IMRT were assessed.

RESULTS

We consecutively enrolled 73 patients (56 men; median age, 53 years; range, 29-73 years) and the phase I portion of the study included 27 patients. The RD of S-1 administered concomitantly with IMRT was 80 mg m^-2 day^-1 orally, twice daily. The phase II analysis included 52 patients (46 new patients plus 6 from phase I). 8 patients (15.4%) developed grade 3 or 4 toxicities. There were 21 recurrence events and 15 deaths (1 bowel obstruction, 14 gastric cancer). Three-year disease-free survival and overall survival were 62.2% (95% confidence interval (CI), 48.5-75.9) and 70.0% (95% CI, 56.3-83.7), respectively. The median time to recurrence was 17.5 months (range, 3.8-42.0). The median time from recurrence to death was 7.0 months (range, 1.5-28.7).

CONCLUSIONS

S-1 combined with IMRT adjuvant chemoradiotherapy is safe and efficacious for advanced gastric cancer.

Impact of selective and nonselective beta-blockers on the risk of severe exacerbations in patients with COPD

Background

There is conflicting information regarding the effects of selective and nonselective beta-blocker treatment in patients with COPD.

Participants and methods

This nested case–control study used the Taiwan National Health Insurance Research Database. We included COPD patients who used inhalation steroid and beta-blockers between 1998 and 2010. From this cohort, there were 16,067 patients with severe exacerbations included in the analysis and 55,970 controls matched on age, sex, COPD diagnosis year, and beta-blockers treatment duration by risk set sampling.

Results

For the selective beta-blocker users, the current users had a lower risk of severe exacerbations than the nonusers (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.85–0.96). In contrast, for the nonselective beta-blocker users, the current users had a higher risk of severe acute exacerbations than the nonusers (OR, 1.21; 95% CI, 1.14–1.27). A higher risk of severe exacerbation during increasing mean daily dose or within about the initial 300 days was found in nonselective beta-blockers, but not in selective beta-blockers. One selective beta-blocker, betaxolol, had a significantly lower risk of severe exacerbations (OR, 0.75; 95% CI, 0.60–0.95). Two nonselective beta-blockers (labetalol and propranolol) were associated with a significantly higher risk of exacerbations (OR, 1.49; 95% CI, 1.32–1.67 for labetalol; OR, 1.16; 95% CI, 1.10–1.23 for propranolol).

Conclusion

Selective beta-blockers can be cautiously prescribed for patients with COPD and cardiovascular disease (CVD), however, nonselective beta-blockers should not be prescribed for patients with COPD. Betaxolol may be the preferred choice of suitable selective beta-blocker for patients with COPD, however, labetalol and propranolol should be avoided for patients with COPD.

Open-Label Allopregnanolone Treatment of Men with Fragile X-Associated Tremor/Ataxia Syndrome

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder affecting approximately 45% of male and 16% of female carriers of the FMR1 premutation over the age of 50 years. Currently, no effective treatment is available. We performed an open-label intervention study to assess whether allopregnanolone, a neurosteroid promoting regeneration and repair, can improve clinical symptoms, brain activity, and magnetic resonance imaging (MRI) measurements in patients with FXTAS. Six patients underwent weekly intravenous infusions of allopregnanolone (2-6 mg over 30 min) for 12 weeks. All patients completed baseline and follow-up studies, though MRI scans were not collected from 1 patient because of MRI contraindications. The MRI scans from previous visits, along with scans from 8 age-matched male controls, were also included to establish patients' baseline condition as a reference. Functional outcomes included quantitative measurements of tremor and ataxia and neuropsychological evaluations. Brain activity consisted of event-related potential N400 word repetition effect during a semantic memory processing task. Structural MRI outcomes comprised volumes of the hippocampus, amygdala, and fluid-attenuated inversion recovery hyperintensities, and microstructural integrity of the corpus callosum. The results of the study showed that allopregnanolone infusions were well tolerated in all subjects. Before treatment, the patients disclosed impairment in executive function, verbal fluency and learning, and progressive deterioration of all MRI measurements. After treatment, the patients demonstrated improvement in executive functioning, episodic memory and learning, and increased N400 repetition effect amplitude. Although MRI changes were not significant as a group, both improved and deteriorated MRI measurements occurred in individual patients in contrast to uniform deterioration before the treatment. Significant correlations between baseline MRI measurements and changes in neuropsychological test scores indicated the effects of allopregnanolone on improving executive function, learning, and memory for patients with relatively preserved hippocampus and corpus callosum, while reducing psychological symptoms for patients with small hippocampi and amygdalae. The findings show the promise of allopregnanolone in improving cognitive functioning in patients with FXTAS and in partially alleviating some aspects of neurodegeneration. Further studies are needed to verify the efficacy of allopregnanolone for treating FXTAS.

[Systematic evaluation of the influence of endometrial stimulation on pregnancy outcome in the patients with artificial insemination]

Objective: The association between endometrial stimulation and the intrauterine insemination outcome remains to be a controversial issue, for there being all kinds of conflicting data in the existing literatures. We conducted a Meta-analysis case to verify the relations between endometrial stimulation and intrauterine insemination (IUI). Methods: The articles had been searched in the following online databases: MEDLINE, CNKI, VIP, Wan Fang, EMBASE and the Cochrane Library. All of the statistics quoted for our studies have been published in English or Chinese from Jan, 2000 to May, 2016. Among the 6 studies included in this Meta-analysis, all of them used a case - control design. All the 6 studies evaluated a total of 1349 participants, including 734 cases of endometrial injury. Results: The results of the Meta-analysis showed that patients with endometrial stimulation were more likely to receive clinical pregnancy than those who did not. Compared with the control group, the clinical pregnancy rate of experiment group was higher (RR=0.88, 95% CI: 0.82-0.95, P=0.001), while the differences between their abortion rate (RR=0.72, 95% CI: 0.37-1.4, P=0.33) and multiple pregnancies rate (RR=0.78, 95% CI: 0.3-2.01, P=0.60) were insignificant. Conclusions: Endometrial stimulation could help increase the pregnancy rate in IUI cycles, while the abortion rate and multiple pregnancies rate would not be raised.

[Clinical value of fluorescence in situ hybridization positive of exfoliated urothelial cells in urothelial carcinoma]

OBJECTIVE

To analyze the clinical pathologic characteristics of cases with fluorescence in situ hybridization (FISH) positive of exfoliated urothelial cells, so as to evaluate the clinical utility of FISH in the diagnosis of urothelial carcinoma (UC).

METHODS

A total of 271 cases of FISH positive in Department of Urology of Peking University First Hospital from Apr. 2012 to Sep. 2015 were recruited in this study. Retrospective analysis was made on their clinical data. For FISH analysis, labeled probes specific for chromosomes 3, 7, 17, and the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy. The positive predict values (PPV) of all the techniques were analyzed.

RESULTS

Of the 271 patients, 207 cases were UC, 7 cases were non-UC, and 57 cases were benign diseases. The PPV of FISH in detecting UC was 76.4%, while the 95% confidence interval (CI) 71.3% to 81.5%. In the cohort of FISH positive, this value was similar to that of urinary cytology (PPV 86.8%, 95% CI: 78.5%-95.0%). The PPV of FISH was lower than that of cystoscopy and ureteroscopy (PPV 96.1%, 95% CI: 91.7%-100.0%). There were significant differences between this study and the PPV of FISH reported abroad (PPV 53.9%, χ²=33.048, P<0.001). Of all the UC with FISH positive, bladder cancer showed an earlier pathological stage versus renal pelvic carcinoma and ureteral carcinoma, with significance (χ²=5.894, P=0.015, and χ²=13.601, P<0.001, respectively). However, no difference was found in the size, pathological stage and pathological grade of tumors between the urinary cytology positive group and the urinary cytology negative group. The rate of high-grade UC in ureteral carcinoma of FISH positive was 92.3%, much higher than that of ureteral carcinoma reported domestically.

CONCLUSION

The PPV of FISH in detecting UC is higher relatively, with a better clinic value for Chinese patients. The ureteral carcinoma with FISH positive obtains a higher pathological grade, which is of great guiding significance for UC.

[Effect of microRNA-106b on the invasion and proliferation of trophoblasts through targeting MMP-2]

Objective: To investigate the expression of microRNA-106b (miR-106b) in the placentas of patients with pre-eclampsia and its relationship with matrix metallopeptidase (MMP) -2, and its effect on the invasion and proliferation of trophoblasts. Methods: (1) Placental tissues were collected from patients with mild pre-eclampsia (mPE, n=30), severe pre-eclampsia (sPE, n=30) and normal pregnant women (n=40). Human choriocarcinoma cell lines JAR and JEG3 were assigned to the miR-106b mimics group, the mimics negative control group, the miR-106b inhibitor group and the inhibitor negative control group, respectively. (2) The target gene of miR-106b(such as MMP-2) was predicted by bioinformatics. Dual-luciferase reporting system was used to verify the regulation of miR-106b on the expression of MMP-2. (3) The expressions of miR-106b and MMP-2 were measured by quantitative real-time PCR (qRT-PCR) and western blot. (4) Cell proliferation was determined by MTT assay. (5) Invasive activities in each group were assessed by cell transwell invasion assays. Results: (1) Predicting result of bioinformatics indicated that MMP-2 was one of the target genes of miR-106b. Dual-luciferase activity assay demonstrated that MMP-2 was the direct target of miR-106b (P<0.01) .(2) The results of qRT-PCR.①The expression of miR-106b in the placentas of mPE, sPE, normal pregnant women were 2.89±0.04, 1.96±0.03, 1.01±0.03, respectively (P<0.05). And the expression of MMP-2 mRNA in the placentas of mPE, sPE, normal pregnant women were 1.87±0.05, 0.69±0.03, 2.78±0.03, respectively (P<0.05). ②The expression of miR-106b in the JAR cell line in the miR-106b mimics group, the mimics negative control group, the miR-106b inhibitor group and the inhibitor negative control group were 2.39±0.03, 1.03±0.04, 0.73±0.03, 1.11±0.04, respectively (P<0.05). And its expression in the JEG3 cell line were 2.17±0.04, 1.18±0.04, 0.61±0.03 and 1.22±0.03, respectively (P<0.05). ③The expression of MMP-2 mRNA in the JAR cell line in the miR-106b mimics group, the mimics negative control group, the miR-106b inhibitor group and the inhibitor negative control group were 0.45±0.15, 1.02±0.03, 2.28±0.03, 1.11±0.03, respectively (P<0.05). And its expression in the JEG3 cell line were 0.58±0.03, 1.25±0.15, 2.25±0.03, 1.21±0.03, respectively (P<0.05). (3) The results of western blot. ①The expression of MMP-2 protein in the placentas of mPE, sPE, normal pregnant women were 1.63±0.04, 0.55±0.03, 2.82±0.03, respectively (P<0.05). ②The expression of MMP-2 protein in the JAR cell line in the miR-106b mimics group, the mimics negative control group, the miR-106b inhibitor group and the inhibitor negative control group were 0.41±0.03, 0.97±0.03, 2.25±0.03, 1.01±0.03, respectively (P<0.05). And its expression in the JEG3 cell line were 0.53±0.03, 1.20±0.03, 2.31±0.04, 1.19±0.03, respectively (P<0.05). (4) miR-106b could inhibit the proliferation of JAR and JEG3 cells, cell proliferation rates in the miR-106b mimics group were lower than that in the mimics negative control group (P<0.05). And cell proliferation rate in the miR-106b inhibitor group was higher than the inhibitor negative control group (P<0.05). (5) The numbers of JAR cell that passed the membrane in the miR-106b mimics group, the mimics negative control group. The miR-106b inhibitor group and the inhibitor negative control group were 61±15, 79±13, 134±13, 80±12, respectively(P<0.05). And the numbers of JEG3 cell that passed were 57±12, 71±15, 128±15, 70±14, respectively (P<0.05). Conclusion: The miR-106b could inhibit the invasion and proliferation of JAR and JEG3 cells through targeting MMP-2, and have a relationship with the pathogenesis of pre-eclampsia.

[Clinical presentation of Kleine-Levin syndrome]

Objective: To analyze the clinical features of Kleine-Levin syndrome (KLS) patients. Methods: Clinical data of 44 patients with KLS of the Sleep Center of Peking University People's Hospital from January 2002 to July 2013 were systematically reviewed. The predisposing factors and clinical presentations were summarized, and compared with the data from a Western KLS study with a large subjects number. Nocturnal polysomnography (PSG) and multiple sleep latency test (MSLT) were conducted during relapse and remission period, respectively. HLA-DQB1*0602 gene were screened and analyzed. Results: Among the 44 patients, 28(63.6%) were men and 16(36.4%) were women, with a mean age of (18.3±8.9) years old. Most patients developed the symptoms during adolescence. Infection or fever was the most common trigger for episode. The main clinical presentations were 44(100.0%) hypersomnia, 31(70.5%) forgetfulness, 26(59.1%) decreased appetites, 24(54.5%) juvenile behavior, 18(40.9%) depression, etc. Compared with the Western study, it showed that our patients had decreased instead of increased appetite. The PSG testing did not have remarkable findings. MSLT showed mean sleep latency was significantly shorter during relapse than during remission [(10.4±5.4) vs (15.3±3.4) min, P=0.009]. HLA-DQB1*0602 was positive in 12 of 40(30.0%) patients, which was similar to the data in the Chinese population. Conclusions: KLS has various clinical characteristics. The presentation of appetite may be different between Chinese and western KLS patients.

Identification of 19 loci for reproductive traits in a local Chinese chicken by genome-wide study

Reproductive traits have long been studied and have an important influence on chicken breeding. To identify quantitative trait loci affecting reproductive traits, a genome-wide analysis of a Chinese chicken breed was performed to analyze age at first egg body weight at first egg, first egg weight, egg weight at the age of 300 days, egg weight at the age of 462 days, egg number at the age of 300 days, egg number between the ages of 300 and 462 days and egg number at the age of 462 days. Nineteen SNPs related to reproductive traits were presented (P < 1.80E-6). Nine of the 19 SNPs had a significant effect on BWF, six SNPs were significantly associated with egg weight, and four SNPs were significantly associated with egg number. These SNPs were located near to or in 17 genes including FAM184B, HTT, KCNH7, CDC42BPA, KCNIP4, GJA5, CBFB, and GPC6. The present results may be beneficial for reproductive research and may be used in marker-assisted selection in future studies. These results could potentially benefit further breeding programs, especially in Jinghai Yellow Chicken.

The efficacy and safety of SGLT2 inhibitors for adjunctive treatment of type 1 diabetes: a systematic review and meta-analysis

To assess the efficacy and safety of the SGLT-2 inhibitors as adjunct therapy to insulin in T1DM, clinical trials indexed in PubMed, Cochrane Library, EMbase from inception through April 5, 2016. A meta-analysis was conducted on trials of SGLT-2 inhibitors in patients with T1DM on insulin therapy using RevMan 5.3 software. Of the 371 articles identified, ten met eligibility criteria. Seven clinical trials including four randomized controlled trials and 581 patients were included. Compared with the control group, SGLT-2 inhibitors group had significantly reduced fasting plasma glucose by 0.69 mmol/L [1.32; 0.07], glycosylated hemoglobin A1C by 0.37% [0.54; 0.20], body weight by 2.54 kg [3.48; 1.60] and total daily insulin dose by 6.22 IU [8.04; 4.40]. The total incidence of adverse events (AEs), hypoglycemia, and genital and urinary infections were also similar to placebo, while an increased incidence of diabetic ketoacidosis (DKA) (n = 16) was seen in SGLT-2 inhibitors group. The present study demonstrates that SGLT-2 inhibitors are effective as adjunct therapy to insulin in T1DM, heralding improved glycemic control, reduced body weight and total daily insulin dose without an increase in total AEs, hypoglycemia, or genital and urinary infections. However, the risk of DKA should be carefully monitored in future clinical trials.

[Prognostic value of JAK2, MPL and CALR mutations in Chinese patients with primary myelofibrosis]

目的

评价JAK2、MPL和CALR基因突变在中国原发性骨髓纤维化（PMF）患者中的预后意义。

方法

回顾性分析402例PMF患者的临床资料及JAK2、MPL和CALR基因突变，应用Kaplan-Meier、Log-rank和Cox回归模型进行相关预后因素分析。

结果

402例PMF患者中男209例，女193例，中位年龄55(15~89）岁。JAKV617F基因突变189例（47.0%），MPLW515基因突变13例（3.2%），CALR基因突变81例（20.1%）[1型突变30例（37.0%），2型突变48例（59.3%），少见型突变3例（3.7%）]，119例（29.6%）未检测到JAK2、MPL和CALR基因突变。单因素分析显示，2型CALR突变或未检测到JAK2、MPL和CALR基因突变的患者中位生存期（74个月）短于检测到JAK2、MPL或1型及少见型CALR基因突变的患者（168个月）[HR=2.990（95% CI 1.935~4.619），P <0.001]。因此，将基因突变类型分为预后不良组（2型CALR突变和未检测到JAK2、MPL和CALR基因突变）和预后良好组（JAKV617F、MPLW515、1型及少见型CALR基因突变）。经多因素分析提出了中国PMF患者的动态国际预后积分系统（DIPSS-Chinese）分子预后积分系统，各参数赋值如下：DIPSS-Chinese低危组0分，中危组1分，高危组2分，2型CALR突变或未检测到JAK2、MPL和CALR基因突变积1分。402例患者中，低危组（0分）132例（32.8%），中危-1组（1分）143例（35.6%），中危-2组（2分）106例（26.4%），高危组（3分）21例（5.2%）。低危组中位生存时间未达到，中危-1组为156(95% CI 117~194）个月，中危-2组为60(95% CI 28~91）个月，高危组为22（95% CI 10~33）个月，总生存差异具有统计学意义（P<0.001）。DIPSS-Chinese分子预后积分系统较DIPSS-Chinese有更准确的预测能力（−2 log似然比分别为855.6和869.7，P=0.005）。

结论

在中国PMF患者中，2型CALR突变和未检测到JAK2、MPL和CALR突变是独立的不良预后因素，DIPSS-Chinese分子预后积分系统有更好的预测价值。