Fluorescence microscopy of H&E stained cervical biopsies to assist the diagnosis and grading of CIN

The effect of local photodynamic therapy with 5-aminolevulinic acid in treating different grades of cervical intraepithelial neoplasia

BACKGROUND

Cervical intraepithelial neoplasia (CIN) is a precursor lesion of cervical cancer. Traditional treatments for CIN might have negative effects on cervical anatomical structure and physiological function. Topical 5-aminolevulinic acid photodynamic therapy (5-ALA PDT) is a novel, non-invasive targeted therapy for intraepithelial lesions. This study aims to evaluate and compare the efficacy and safety of 5-ALA PDT for different grades of CIN.

METHODS

A retrospective study of 183 patients aged 19-50 with histologically confirmed CIN and receiving ALA-PDT was conducted. ALA-PDT was performed with 20% ALA thermosensitive gel and irradiation at a wavelength of 635 nm and density of 80-100 J/cm². ALA-PDT was conducted every 7-10 days for 4-6 times. Patients were followed up three, six, nine, and twelve months after treatment. The effect was evaluated through HPV genotyping, ThinPrep cytology test (TCT), and colposcopy-directed biopsy.

RESULTS

The HPV clearance rate was 71.0% (130/183) at the six-month follow-up and 84.5% (147/174) at the 12-month follow-up. The complete lesion remission (CR) rate was 90.2% (165/183). No statistically significant differences concerning the CR rate (P>0.05) or HPV clearance rates (P>0.05) were observed in CIN I, CIN II, and CIN III. In women with CIN III, gland involvement was revealed to be associated with a significantly lower HPV clearance rate (63.16% vs. 92.60%, P= 0.036) at the 12-month follow-up. Our study showed that the atypical vessels seemed to be a risk factor for HPV clearance rate in the CIN II group at six-month follow-up, although the difference was not statistically significant (P= 0.089). During the follow-up, 13 cases had persistent lesions (7.1%), four cases recurred (2.3%), and none of the patients progressed. The study also showed that the efficacy of PDT in the treatment of patients with CIN III involving glands was comparable to that of CKC (P>0.05).

CONCLUSIONS

ALA-PDT is an effective andsafe treatment for CIN, and responseis unaffected by the grade of lesions. However, for patients with atypical vessels and glandular involvement, the effect of PDT seems to be poorer.

Effectiveness and immune responses of focused ultrasound ablation for cervical intraepithelial neoplasia

PURPOSE

To investigate the safety, efficacy, and the immune responses of focused ultrasound in cervical intraepithelial neoplasia (CIN).

METHODS

Patients with biopsy-confirmed CIN were recruited for focused ultrasound treatment and asked to return during 3-6 and 6-12 months post-treatment to receive cervical cytology, high-risk human papilloma virus (HPV) detection, and colposcopy. The effective rate was evaluated within 3-6 months, whereas the recurrence rate was evaluated within 6-12 months. Cervicovaginal lavage and cervical tissue were sampled before and 3-6 months after treatment. The expression of interferon gamma (IFN-γ), endoplasmic reticulum aminopeptidase 1 (ERAP1), human leucocyte antigen I (HLA-I), cluster of differentiation 4 (CD4), and cluster of differentiation 8 (CD8) in the cervical tissue were observed by immunohistochemistry. Immunoglobulin A (IgA) and interleukin 10 (IL-10) levels in the cervicovaginal lavage were detected by enzyme-linked immunosorbent assay. Comparisons were made in immune analyte levels before and after treatment.

RESULTS

We analyzed the results of 154 patients. The effective rate at 3-6 months was 96.8%. The recurrence rate at 6-12 months was 2.0%. The eradication rate of HPV was 72.4% at 3-6 months and 81.0% at 6-12 months. No serious adverse reactions and complications were observed. After treatment, a higher expression of ERAP1 was observed (p < 0.05). Significant down-regulation of IgA and IL-10 were detected (each p < 0.05). However, the expression of CD4, CD8, HLA-I, as well as the release of IFN-γ, did not reach statistical significance (each p > 0.05).

CONCLUSIONS

Focused ultrasound is an effective and safe therapy for treating CIN, which could improve the local immune milieu of the cervix to some extent.

A Computationally Virtual Histological Staining Method to Ovarian Cancer Tissue by Deep Generative Adversarial Networks

Histological analysis to tissue samples is elemental for diagnosing the risk and severity of ovarian cancer. The commonly used Hematoxylin and Eosin (H&E) staining method involves complex steps and strict requirements, which would seriously impact the research of histological analysis of the ovarian cancer. Virtual histological staining by the Generative Adversarial Network (GAN) provides a feasible way for these problems, yet it is still a challenge of using deep learning technology since the amounts of data available are quite limited for training. Based on the idea of GAN, we propose a weakly supervised learning method to generate autofluorescence images of unstained ovarian tissue sections corresponding to H&E staining sections of ovarian tissue. Using the above method, we constructed the supervision conditions for the virtual staining process, which makes the image quality synthesized in the subsequent virtual staining stage more perfect. Through the doctors' evaluation of our results, the accuracy of ovarian cancer unstained fluorescence image generated by our method reached 93%. At the same time, we evaluated the image quality of the generated images, where the FID reached 175.969, the IS score reached 1.311, and the MS reached 0.717. Based on the image-to-image translation method, we use the data set constructed in the previous step to implement a virtual staining method that is accurate to tissue cells. The accuracy of staining through the doctor's assessment reached 97%. At the same time, the accuracy of visual evaluation based on deep learning reached 95%.

A simple method based on confocal microscopy and thick sections recognizes seven subphases in growth plate chondrocytes

This manuscript reports a novel procedure to imaging growth plate chondrocytes by using confocal microscopy. The method is based on fixed undecalcified bone samples, in-block staining with eosin, epoxy resin embedding and grinding to obtain thick sections. It is simple, inexpensive and provides three-dimensional images of entire chondrocytes inside their native lacunae. Quantitative analysis of volume, shape and cytoplasm density of chondrocytes at different strata of the growth plate allowed to objectively grade chondrocytes of the growth plate in seven different clusters. These seven categories of chondrocytes were subsequently evaluated by immunohistochemistry of some well-defined molecular landmarks of chondrocyte differentiation. Furthermore, immunohistochemical analysis of proteins responsible for ionic changes and water transport allowing chondrocyte swelling during hypertrophy was also performed. Results obtained indicate that four subphases can be defined in the pre-hypertrophic zone and three subphases in the hypertrophic zone, a fact that raises that chondrocytes of the growth plate are less homogeneous than usually considered when different zones are defined according to subjective cell morphological criteria. Results in the present study provide a technological innovation and gives new insights into the complexity of the process of chondrocyte differentiation in the growth plate.

Perioperatively Inhaled Hydrogen Gas Diminishes Neurologic Injury Following Experimental Circulatory Arrest in Swine

This study used a swine model of mildly hypothermic prolonged circulatory arrest and found that the addition of 2.4% inhaled hydrogen gas to inspiratory gases during and after the ischemic insult significantly decreased neurologic and renal injury compared with controls. With proper precautions, inhalational hydrogen may be administered safely through conventional ventilators and may represent a complementary therapy that can be easily incorporated into current workflows. In the future, inhaled hydrogen may diminish the sequelae of ischemia that occurs in congenital heart surgery, cardiac arrest, extracorporeal life-support events, acute myocardial infarction, stroke, and organ transplantation.

Downregulation of Krüppel‑like factor 1 inhibits the metastasis and invasion of cervical cancer cells

Cervical cancer is one of the most common malignancies that seriously threatens women's health. Krüppel‑like factors (KLFs) have been reported to be associated with the progression of cervical cancer. The role of KLF1 in cervical cancer, which still remains unclear, was investigated in the present study. The expression of KLF1 was detected in different cervical cell lines by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) and western blotting. Cell proliferation, metastasis and invasion were respectively detected by Cell Counting Kit‑8, wound healing and transwell assays. Associated factor expression was also detected by RT‑qPCR and western blotting. In addition, the phosphorylation levels of phosphatidylinositol‑3‑kinase (PI3K) and protein kinase B (Akt) were determined by western blot analysis. The results revealed that KLF1 expression was promoted in SiHa, Caski and C4‑1 cervical cancer cells. However, KLF1 knockdown suppressed cell proliferation, metastasis and invasion in SiHa cervical cancer cells. KLF1 knockdown also inhibited the expressions of Ki67, metastasis‑associated antigen 1 and matrix metalloproteinase (MMP)‑2. KLF1 knockdown promoted the expressions of nonmetastatic clone 23 type 1 and tissue inhibitor of metalloproteinase‑2, and the expression of MMP‑9 was promoted slightly as well. In addition, KLF1 knockdown inhibited the PI3K/Akt signaling pathway. Hence, it was concluded that KLF1 promoted metastasis and invasion via the PI3K/Akt signaling pathway in cervical cancer cells.