A comprehensive prognostic analysis of cause-specific mortality in patients with ovarian serous cystadenocarcinoma using a competing-risks model: a case study of the SEER database

OBJECTIVE

This retrospective study employed a competing-risks analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) database to identify precise prognostic factors associated with ovarian serous cystadenocarcinoma (OSCC) in patients.

PATIENTS AND METHODS

Patients with OSCC during 2004-2015 were identified in the SEER database, and their clinicopathological, demographic, and survival data were examined. Univariate analysis using Gray's test and the cumulative incidence function was used to evaluate the prognoses of events of interest. The multivariate analysis involved several models, including the Cox proportional hazards, Fine-Gray, and cause-specific (CS) hazard function models, to estimate the hazard functions of competing risks. Hazard ratios were analyzed to identify the reliability of the prognostic factors.

RESULTS

Among the 10,400 individuals diagnosed with OSCC, 5,713 died from the illness, and 1,125 died from other causes. The cumulative incidence rate of events of interest was found to be significant for ethnicity, age at diagnosis, histological grade, American Joint Committee on Cancer (AJCC) stage, chemotherapy and surgery status, tumor size, marital status, and local lymph node metastases (p<0.05). The multivariate analysis revealed that ethnicity, histological grade, surgery and chemotherapy status, age at diagnosis, AJCC stage, marital status, and distant metastases were independent prognostic factors in the Cox model (p<0.05). Finally, the Fine-Gray and CS models demonstrated that ethnicity, histological grade, surgery and chemotherapy status, age at diagnosis, AJCC stage, tumor size, marital status, and combination summary stage were all identified as independent prognostic factors (p<0.05).

CONCLUSIONS

This study determined the risk factors for OSCC using a competing risk analysis model established by the SEER database. The findings can help clinicians understand OSCC better and provide more accurate medical support to affected patients.

[Screening results and genetic analysis of neonatal tetrahydrobiopterin deficiency in Hainan Province from 2007 to 2019]

A total of 1 295 516 dried blood spots were collected from newborns in Hainan Province from 2007 to 2019 who participated in the screening of neonatal diseases, and 43 cases of hyperphenylalaninemia were diagnosed. Among the 43 cases, 8 cases were confirmed to have tetrahydrobiopterin deficiency (4 males and 4 females). The incidence of tetrahydrobiopterin deficiency among newborns in Hainan Province was 6.2/1 million. Six mutations in the PTS gene were detected among 7 cases; the mutations were as follows: c.317C>T, c.286G>A, c.259C>T, c.155A>G, c.84+291A>G and c.83+1777T>G. A homozygous mutation at c.41T>C site of QDPR gene was detected in one case. Overall, it's found that the incidence of tetrahydrobiopterin deficiency in newborn populations in Hainan Province is low, and PTS gene mutations account for the largest proportion of cases of tetrahydrobiopterin deficiency within the study population.

[Screening of phenylketonuria and analysis of phenylalanine hydroxylase gene in 380 996 newborns from Hainan province]

Objective: To investigate the incidence of phenylketonuria and distribution characteristics of phenylalanine hydroxylase (PAH) gene in newborns from Hainan province. Methods: Dry blood spot specimens of heels from 380 996 newborns in Hainan province from January 2017 to December 2019 were collected. Phenylalanine (Phe) concentrations in these dry blood spots were measured by the fluorescence method to screen phenylketonuria (PKU). A second dry blood spot sample will be collected if suspicious samples were detected after initial screening. Tandem mass spectrometry were used to detect the concentrations of Phe and tyrosine. Urine samples of the suspected newborns were sent out for urotrexate spectrum analysis and tetrahydrobiopterin loading test. PCR and flow-through rapid hybridization method were employed to detect PAH gene mutations. Meanwhile, peripheral blood samples of suspicious newborns of PKU and their parents were collected to perform gene sequencing. Results: Among the 380 996 newborns, 39 were suspected and 14 were diagnosed with PKU, including 11 cases of PAH deficiency and 3 cases of tetrahydrobiopterin deficiency. Of 14 confirmed cases, there were 8 male cases and 6 female cases. In the newborn population of Hainan province, the annual incidence of PKU was 1.22/100 000. Thirteen PAH gene mutations were detected in confirmed cases: c.728G>A, c.158G>A, c.1238G>C, c.611A>G, c.1068C>A, c.706+5G>A, c.740G>T, c.1081A>T, c.793T>G, c.1223G>A, c.721C>T, c.331C>T and c.1174T>A. Conclusions: PKU has a high incidence in newborn population of Hainan province in the past three years. The PAH gene has a wide spectrum of mutations. Two rare mutations were also found: c.793T>G and c.706+5G>A.

A mobile telephone-based interactive self-care system improves asthma control

The self-management of asthma can improve clinical outcomes. Recently, mobile telephones have been widely used as an efficient, instant personal communication tool. This study investigated whether a self-care system will achieve better asthma control through a mobile telephone-based interactive programme. This was a prospective, controlled study in outpatient clinics. From 120 consecutive patients with moderate-to-severe persistent asthma, 89 were eventually recruited for the study, with 43 in the mobile telephone group (with a mobile telephone-based interactive asthma self-care system). In the mobile telephone group, mean ± sem peak expiratory flow rate significantly increased at 4 (378.2 ± 9.3 L·min⁻¹; n = 43; p = 0.020), 5 (378.2 ± 9.2 L·min⁻¹; n = 43; p = 0.008) and 6 months (382.7 ± 8.6 L·min⁻¹; n = 43; p = 0.001) compared to the control group. Mean±sem forced expiratory volume in 1 s significantly increased at 6 months (65.2 ± 3.2% predicted; n = 43; p < 0.05). Patients in the mobile telephone group had better quality of life after 3 months, as determined using the Short Form-12® physical component score, and fewer episodes of exacerbation and unscheduled visits than the control group. Patients in the mobile telephone group significantly increased their mean daily dose of either systemic or inhaled corticosteroids compared with the control group. The mobile telephone-based interactive self-care system provides a convenient and practical self-monitoring and -management of asthma, and improves asthma control.

MMP-1(-1607G) polymorphism as a risk factor for fibrosis after pulmonary tuberculosis in Taiwan

SETTING

Several matrix metalloproteinase (MMP) polymorphisms favouring the development of lung fibrosis after pulmonary tuberculosis (TB) have been described.

OBJECTIVE

To investigate the association of MMP-1, MMP-9 and MMP-12 polymorphisms with the development of fibrosis in pulmonary TB.

DESIGN

We studied 49 normal subjects and 98 TB patients. We analysed the association between MMP polymorphisms and clinical indices of lung fibrosis by serial chest radiography for 1 year after completion of treatment.

RESULTS

The frequency of the MMP-1(-1607G) polymorphism was significantly higher in TB patients with moderate to advanced pulmonary fibrosis than in those with minimal to mild fibrosis. Having at least one -1607G MMP-1 polymorphism increased the risk of moderate and advanced fibrosis respectively by 5.04 (95%CI 1.25-20.30) and 9.87 (95%CI 2.39-40.88) fold. There was no association of MMP-9(-1562T) and MMP-12(Asn357Ser) polymorphisms with lung fibrosis. The production of MMP-1 from monocytes stimulated by interleukin-1 beta was increased in subjects with the 1G allele genotype compared to the 2G/2G genotype.

CONCLUSIONS

Patients with MMP-1(-1607G) polymorphism are more vulnerable to more extensive lung fibrosis 1 year after anti-tuberculosis treatment. This may be related to increased MMP-1 activity, leading to enhanced destruction of the matrix with subsequent fibrosis.

Predictive factors for mortality among non-HIV-infected patients with pulmonary tuberculosis and respiratory failure

OBJECTIVES

To determine predictive factors for mortality among pulmonary tuberculosis (PTB) patients without human immunodeficiency virus (HIV) infection and in need of mechanical ventilation (TBMV).

METHODS

From July 2004 to December 2005, 612 respiratory failure patients requiring mechanical ventilation were admitted to the intensive care unit (ICU) of Chang Gung Memorial Hospital, Taipei, Taiwan. Of these, 59 non-HIV-infected patients had active PTB as the primary cause. Mortality rates were measured in TBMV patients and predictors were investigated. Incidence of treatment delay for nosocomial pneumonia was compared between survivors and fatalities.

RESULTS

Of the 59 patients with TBMV, 40 (67.8%) died in the ICU. Multi-organ failure syndrome (OR 8.59, 95%CI 1.85-101.27) and nosocomial pneumonia (OR 5.77, 95%CI 1.33-44.36) were independently associated with in-hospital mortality. Treatment delay >24 h for nosocomial pneumonia was significantly more frequent among fatalities than among survivors (19/26, 73.1% vs. 0/3, 0%; P = 0.033).

CONCLUSION

Nosocomial pneumonia in TB patients with respiratory failure is associated with a poor prognosis; this appears to be further aggravated by delays in appropriate treatment. Measures to prevent nosocomial pneumonia should be carefully instituted and treatment for nosocomial pneumonia should be started promptly among such patients.

Apoptosis-dependent and -independent mechanisms mediate the phagocytic recognition/clearance of the HL60-A1 transfectants with prolonged survival

OBJECTIVE

The phagocytic recognition and clearance of the recruited inflammatory cells with prolonged survival play a pivotal role in relieving tissue inflammation and maintaining tissue homeostasis. Transgenic mice expressing Bcl-2 in mature neutrophils demonstrated that Bcl-2 attenuated neutrophil apoptosis, while the homeostasis of the neutrophil population was essentially unaffected. This result suggests that clearance of neutrophils with prolonged survival operates independently from apoptosis. Owing to the constitutive and inducible expression of Bcl-2 homologue, A1 in human neutrophils and the intolerance of preparation for the isolated human neutrophils with prolonged survival, the human promyelocytic HL60-A1 transfectants were established to study the mechanism of phagocytic recognition/clearance of the cells with prolonged survival.

MATERIALS AND METHODS

The non-apoptotic cells with prolonged survival were enriched by serum withdrawal for five days and negatively isolated by annexin V-binding beads. Then, the cells were labeled with a fluorogenic marker. Monocyte-derived macrophages (MDM) were co-cultured to perform the phagocytosis assay, and flow cytometry was employed to determine the phagocytic index.

RESULTS

In the serum-free condition, the phagocytic index of HL60-A1 transfectants was little different from that of the HL60-EGFP control, despite showing a significantly lower degree of apoptosis. While the phagocytic index of HL60-EGFP control was significantly correlated with the degree of apoptosis, the index of the HL60-A1 transfectants was less relevant to it. The phagocytic index for the annexin V-positive cells did not distinguish the two cell types. However, the phagocytic index for the annexin V-negative cells from the HL60-A1 transfectants was increased with age in days. Preincubation of MDM with the scavenger receptor inhibitor, Oxi-LDL, and the inhibitory antibodies against alphavbeta3, CD14 and CD36 surface molecules could attenuate the phagocytic recognition of the annexin V-positive HL60 cells but not the annexin V-negative A1 transfectants with prolonged survival.

CONCLUSIONS

This study thus suggests that a mechanism unrelated to apoptosis exists, which mediates the phagocytic clearance of the non-apoptotic cells with prolonged survival and may be associated with A1 function in the myeloid cells.

Neutrophil adherence to lung epithelial cells induce interleukin-8 release

BACKGROUND

Neutrophil recruitment to the lungs and transmigration through the pulmonary epithelium to reach the respiratory tract are characteristics of airway inflammation. Interleukin-8 (IL-8) plays a critical role in the recruitment of neutrophils to epithelial cells. We investigated the effect of neutrophil adherence to epithelial cells on cytokine secretion.

METHODS

The production of IL-8 from cultured A549 epithelial cells was assayed and neutrophil adherence assay in the presence or absence of interferon-gamma (IFN-gamma) plus tumor necrosis factor-alpha (TNF-alpha) plus interleukin-1 beta (IL-1 beta) stimulation was studied on cultured A549 epithelial cells. The role of an adhesion molecule in the modulation of neutrophil adherence was examined by pretreatment with intercellular adhesion molecule-1 (ICAM-1) blocking antibody.

RESULTS

There was an increase in IL-8 release from epithelial cells that was time-dependent and in the magnitude of neutrophil adherence to the epithelial cells. Stimulation of epithelial cells with IFN-gamma +TNF-alpha +IL-1 beta significantly increased IL-8 release and neutrophil adherence. The spontaneous or IFN-gamma +TNF-alpha +IL-1 beta-induced IL-8 release was significantly augmented after the addition of neutrophils. The inhibition of neutrophil adherence to epithelial cells by ICAM-1 blocking antibody downregulated the augmented release of IL-8 with or without IFN-gamma +TNF-alpha +IL-1 beta stimulation. Placing a membrane filter on cultured epithelial cells to prevent neutrophil adherence significantly decreased IL-8 release from epithelial cells with IFN-gamma +TNF-alpha +IL-1 beta stimulation.

CONCLUSION

Our results indicate that lung epithelial cells not only provide a harboring site for neutrophils to be activated, but also amplify the neutrophil sequestration in the lung by releasing IL-8. Moreover, the release of IL-8 is dependent on the adherence between neutrophils and lung epithelial cells.

Numerical chromosome alterations in colorectal carcinomas detected by fluorescence in situ hybridization. Relationship to 17p and 18q allelic losses

This study concerns DNA ploidy, numerical changes of chromosomes 7, 8, 10, 17 and 18, and allelic losses at chromosomes 17p13.3 (flanking the p53 gene) and 18q21 (location of the DCC gene) in 31 freshly resected colorectal tumours. Cytological smears were used to determine DNA ploidy by image analysis, and chromosome numbers by fluorescence in situ hybridization (FISH) using chromosome-specific pericentromeric alpha-satellite DNA probes. Allelic losses were assessed by Southern blotting and by the polymerase chain reaction loss of heterozygosity method. Approximately 50% of the tumours were aneuploid. There was heterogeneity with respect to chromosome numbers, but gains and losses of chromosomes, or both, were detected in all carcinomas examined, including 10 that were nonaneuploid by image analysis. Trisomy 7 was found in 74% of the tumours, and monosomy of chromosome 18 in 32%. Allelic loss at chromosome 17p13.3 was evident in 13 of 26 informative cases, and only one case exhibited monosomy 17. In comparison monosomy 18 was found in 10 cases; 7 of them corresponded to approximately half of the cases with allelic loss within the DCC gene, and the other three were noninformative. These findings indicate that the loss of one chromosome 18 is an important mechanism producing allelic deletion of the DCC gene in colorectal carcinomas. Our data also suggest that monosomy 18 is a useful indicator for studying colorectal cancer progression on a cell by cell basis.

[Biomechanics of traction for treatment of lumber disc prolapse]

The intervertebral distance in 31 prolapsed discs under traction increased on the average by 1.34 mm, but in normal discs 0.87 mm. Of 47 prolapsed discs without traction, 29 had negative intradisc pressure, 10 zero, and 8 positive. The total average value of the pressure before traction was -1.3 kPa. Under lumber traction, the pressure decreased in 30 discs, unchanged in 8, and increased in 9, with the average value being -3.2 kPa. The intradisc pressure in 7 normal discs was contrary to the pressure in the prolapsed disc. The difference between the two groups was highly significant (P < 0.01). The pressure unchanged when the intervertebral distance of prolapsed disc unchanged under traction, but the pressure decreased as the distance increased in most cases under traction.

Coupled suturing: a new technique for microvascular anastomosis

The left carotid artery of 12 Sprague-Dawley rats was sectioned and anastomoses immediately performed utilizing a new technique termed coupled suturing. Patency and constriction were assessed immediately postoperatively and at 1, 2, and 3 weeks. Specimens were also evaluated by light microscopy and scanning electron microscopy. Vessels healed well with excellent patency and edge eversion. With the development of a specialized needle, coupled suture could prove to be a reasonable alternative to current methods of anastomosis. Its main advantage is better intimal eversion, which decreases the risk of thrombosis.

[Experimental observations on acrylic bone cement containing antitumor drugs]

By methods of human osteosarcoma cell culture in vitro, 3H-TdR isotope incorporation, gas chromatography and animal test, experimental observations were made on acrylic bone cement containing antitumor drugs. The results were as follows: 1. BLMA5, DACT, Ara-c, CDDP, and ADM were more thermostable. It is possible that these drugs can endure the polymerizing heat of bone cement. 2. The effective release of BLMA5, Ara-c and DACT from bone cement persisted over 2 months. 3. Scanning electron microscopy revealed that drug particles in the bone cement decreased or disappeared after immersion of the cement in tissue culture medium or implantation of it in animal bones. This shows that drug particles can be released from bone cement in vitro or in vivo 4. Animal experimental demonstrated that the bone cement containing BLMA5 or Ara-c had no effect on the healing of soft tissue, and the injury in local bone and bone marrow adjacent to the bone cement was slight and could recover in 4-8 weeks. 5. The release of residual monomer from polymerized bone cement continued as long as one month. Although the residual monomer inhibited the growth of tumor cells slightly during the early stage, it was far from being as effective as medicated bone cement.