Predicting therapeutic response to neoadjuvant immunotherapy based on an integration model in resectable stage IIIA (N2) non-small cell lung cancer

OBJECTIVE

Accurately predicting response during neoadjuvant chemoimmunotherapy for resectable non-small cell lung cancer (NSCLC) remains clinically challenging. In this study, we investigate the effectiveness of blood-based tumor mutational burden (bTMB) and a deep learning (DL) model in predicting major pathologic response (MPR) and survival from a phase II trial.

METHODS

Blood samples were prospectively collected from 45 stage IIIA (N2) NSCLC patients undergoing neoadjuvant chemoimmunotherapy. An integrated model, combining the CT-based DL score, bTMB, and clinical factors, was developed to predict tumor response to neoadjuvant chemoimmunotherapy.

RESULTS

At baseline, bTMB were detected in 77.8% (35 of 45) of patients. Baseline bTMB ≥11 Muts/Mb was associated with significantly higher MPR rates (77.8% vs. 38.5%, p = 0.042), and longer disease-free survival (DFS, p = 0.043), but not overall survival (p = 0.131), compared to bTMB < 11 Muts/Mb in 35 patients with bTMB available. The developed DL model achieved an area under the curve (AUC) of 0.703 in all patients. Importantly, the predictive performance of the integrated model improved to an AUC of 0.820 when combining the DL score with bTMB and clinical factors. Baseline circulating tumor DNA (ctDNA) status was not associated with pathological response and survival. Compared to ctDNA residual, ctDNA clearance before surgery was associated with significantly higher MPR rates (88.2% vs. 11.1%, p < 0.001) and improved DFS (p = 0.010).

CONCLUSIONS

The integrated model shows promise as a predictor of tumor response to neoadjuvant chemoimmunotherapy. Serial ctDNA dynamics provide a reliable tool for monitoring tumor response.

Expression of FOXO3 in the skin follicles of goose embryos during embryonic development

1. The Forkhead box O3 (FOXO3) transcription factor is a crucial regulator in controlling cell metabolism, proliferation, apoptosis, migration and response to oxidative stress. However, FOXO3 has not previously been studied much in the embryonic skin follicles of geese.2. This study used Zhedong white geese (Anser cygnoides), Jilin white geese (Anser cygnoides) and Hungarian white geese (Anser anser). The feather follicle structure in the dorsal skin during embryonic stages was examined with haematoxylin and eosin (HE) and Pollak staining. The FOXO3 protein content in the embryonic dorsal skin from feather follicles was detected using western blotting and quantitative real-time PCR.3. The mRNA expression level of FOXO3 in the dorsal skin of Jilin white geese was highly expressed on embryonic day 23 (E23; P < 0.01), while mRNA expression of FOXO3 was highly expressed in the feather follicle of Hungarian white geese at E28 (P < 0.01). The expression of FOXO3 protein mainly concentrated in the early embryonic phase among these goose breeds (P < 0.05). This suggested that FOXO3 plays a crucial role in the development and growth of embryonic dorsal skin of feather follicles. The location of the FOXO3 protein was determined using the IHC technique, which further verified the effect of FOXO3 in the dorsal skin for feather follicles during embryogenesis.4. The study demonstrated the differential expression and localisation of the FOXO3 gene among different goose species. It was speculated that the gene could potentially improve goose feather follicle development and feather-related traits and provide a basis for further understanding of FOXO3 function in the dorsal tissue of goose embryos.

Brief Report: Acetaminophen Reduces Neoadjuvant Chemoimmunotherapy Efficacy in Patients With NSCLC by Promoting Neutrophil Extracellular Trap Formation: Analysis From a Phase 2 Clinical Trial

Introduction

Neoadjuvant chemoimmunotherapy has recently been the standard of care for resectable locally advanced NSCLC. Factors affecting the neoadjuvant immunotherapy efficacy, however, remain elusive. Metabolites have been found to modulate immunity and associate with immunotherapeutic efficacy in advanced tumors. Therefore, we aimed to investigate the impact of plasma metabolites on the pathologic response after neoadjuvant chemoimmunotherapy.

Methods

Patients with stage IIIA (N2) NSCLC who underwent neoadjuvant chemoimmunotherapy in a prospective phase 2 clinical trial (NCT04422392) were enrolled. Metabolomic profiling of the plasma before treatment was performed using liquid chromatography-mass spectrometry. A Lewis lung carcinoma mouse model was further used to investigate the underlying mechanisms. Proteomics and multiplexed immunofluorescence of the mice tumor were performed.

Results

A total of 39 patients who underwent three cycles of anti-programmed cell death-protein 1 (anti-PD-1) (sintilimab) and chemotherapy were included. The level of acetaminophen (APAP) was found to be significantly elevated in patients who did not achieve major pathologic response. The level of APAP remained an independent predictor for major pathologic response in multivariate logistic analysis. In the Lewis lung carcinoma mouse model, combination of APAP and anti-PD-1 treatment significantly reduced the treatment efficacy compared with anti-PD-1 treatment alone. Proteomics of the tumor revealed that myeloid leukocyte activation and neutrophil activation pathways were enriched after APAP treatment. Tumor microenvironment featuring analysis also revealed that the combination treatment group was characterized with more abundant neutrophil signature. Further multiplexed immunofluorescence confirmed that more neutrophil extracellular trap formation was observed in the combination treatment group.

Conclusions

APAP could impair neoadjuvant chemoimmunotherapy efficacy in patients with NSCLC by promoting neutrophil activation and neutrophil extracellular trap formation.

Frozen sections accurately predict the IASLC proposed grading system and prognosis in patients with invasive lung adenocarcinomas

INTRODUCTION

The International Association for the Study of Lung Cancer (IASLC) newly proposed grading system for lung adenocarcinomas (ADC) has been shown to be of prognostic significance. Hence, intraoperative consultation for the grading system was important regarding the surgical decision-making. Here, we evaluated the accuracy and interobserver agreement for IASLC grading system on frozen section (FS), and further investigated the prognostic performance.

METHODS

FS and final pathology (FP) slides were reviewed by three pathologists for tumor grading in 373 stage I lung ADC following surgical resection from January to June 2013 (retrospective cohort). A prospective multicenter cohort (January to June 2021, n = 212) were included to confirm the results.

RESULTS

The overall concordance rates between FS and FP were 79.1% (κ = 0.650) and 89.6% (κ = 0.729) with substantial agreement in retrospective and prospective cohorts, respectively. Presence of complex gland was the only independent predictor of discrepancy between FS and FP (presence versus. absence: odds ratio, 2.193; P = 0.015). The interobserver agreement for IASLC grading system on FS among three pathologists were satisfactory (κ = 0.672 for retrospective cohort; κ = 0.752 for prospective cohort). Moreover, the IASLC grading system by FS diagnosis could well predict recurrence-free survival and overall survival for patients with stage I invasive lung ADC.

CONCLUSIONS

Our results suggest that FS had high diagnostic accuracy and satisfactory interobserver agreement for IASLC grading system. Future prospective studies are merited to validate the feasibility of using FS to match patients into appropriate surgical type.

Utility of 18F-FDG PET/CT uptake values in predicting response to neoadjuvant chemoimmunotherapy in resectable non-small cell lung cancer

INTRODUCTION

Reliable predictive markers are lacking for resectable non-small cell lung cancer (NSCLC) patients treated with neoadjuvant chemoimmunotherapy. The present study investigated the utility of SUV_max values acquired from PET/CT to predict the response to neoadjuvant chemoimmunotherapy for resectable NSCLC.

MATERAL AND METHODS

SUV_max, clinical and pathological outcomes, were collected from patients in 5 hospitals. Patients who received dynamic PET/CT surveillance were divided into cohorts A (chemoimmunotherapy) and B (chemotherapy), respectively, while cohort C (chemoimmunotherapy) comprised patients undergoing post-therapy PET/CT. Associations between SUV_max and major pathologic response (MPR) were evaluated through receiver operating characteristic (ROC) curves.

RESULTS

A total of 129 cases with an MPR rate of 46.5 % was identified. In neoadjuvant chemoimmunotherapy, ΔSUV_max% (AUC: 0.890, 95 % CI: 0.761-0.949) and post-therapy SUV_max (AUC: 0.933, 95 % CI: 0.802-0.959) could accurately predict MPR. On the contrary, the baseline SUV_max was not associated with MPR (p = 0.184). Furthermore, an independent cohort C proved that post-therapy SUV_max could serve as an independent predictor (AUC: 0.928, 95 % CI: 0.823-0.958). In addition, robust predictive performance could be observed when we use the optimal cut-off point of both ΔSUV_max% (54.4 %, AUC: 0.912, 95 % CI: 0.824-0.994) and post-therapy SUV_max (3.565, AUC: 0.912, 95 % CI: 0.824-0.994) in neoadjuvant chemoimmunotherapy. The RNA data revealed that the expression of PFKFB4, a key enzyme in glycolysis, was positively correlated with SUV_max value and tumor cell proliferation after neoadjuvant chemoimmunotherapy.

CONCLUSION

These findings highlighted that the ΔSUV_max% and remained SUV_max were accurate and non-invasive tests for the prediction of MPR after neoadjuvant chemoimmunotherapy.

Integrative effects based on behavior, physiology and gene expression of tritiated water on zebrafish

Tritium is a water-soluble hydrogen isotope that releases beta rays during decay. In nature, tritium primarily exists as tritiated water (HTO), and its main source is nuclear power/processing plants. In recent decades, with the development of nuclear power industry, it is necessary to evaluate the impact of tritium on organisms. In this study, fertilized zebrafish embryos are treated with different HTO concentrations (3.7 × 10³ Bq/ml, 3.7 × 10⁴ Bq/ml, 3.7 × 10⁵ Bq/ml). After treatment with HTO, the zebrafish embryos developed without evident morphological changes. Nevertheless, the heart rate increased and locomotor activity decreased significantly. In addition, RNA-sequencing shows that HTO can affect gene expressions. The differentially expressed genes are enriched through many physiological processes and intracellular signaling pathways, including cardiac, cardiovascular, and nervous system development and the metabolism of xenobiotics by cytochrome P450. Moreover, the concentrations of thyroid hormones in the zebrafish decrease and the expression of thyroid hormone-related genes is disordered after HTO treatment. Our results suggest that exposure to HTO may affect the physiology and behaviors of zebrafish through physiological processes and intracellular signaling pathways and provide a theoretical basis for ecological risk assessment of tritium.

Comparison of pharmacokinetics of tilmicosin in healthy pigs and pigs experimentally infected with Actinobacillus pleuropneumoniae

Aim: To compare the pharmacokinetic profiles of tilmicosin, administered orally at a single dose of 20 mg/kg bodyweight, in healthy pigs and in pigs experimentally infected with Actinobacillus pleuropneumoniae. Methods: Twelve healthy crossbred pigs, aged approximately 8 weeks, were randomly assigned to uninfected and infected groups, with six pigs per group. Pigs in the infected group were inoculated intranasally with a bacterial suspension of A. pleuropneumoniae containing approximately 10⁸ cfu. Each pig received a single oral dose of 20 mg/kg bodyweight of tilmicosin, given 3-4 hours after inoculation in infected pigs. Blood samples were collected before drug administration and up to 48 hours after tilmicosin administration. Concentrations of tilmicosin in plasma samples were determined by HPLC. Throughout the experimental period pigs were observed for signs of inappetence and clinical abnormalities. After sampling was complete pigs were subject to euthanasia and samples collected for gross and histopathology as well as microbiology. Results: Infected pigs showed signs of bradykinesia, nasal discharge dyspnoea, and coughing 1 hours after inoculation and A. pleuropneumoniae was cultured from the lungs of all infected pigs postmortem. Comparing pharmacokinetic parameters in uninfected and infected pigs, the maximum plasma concentration of tilmicosin was higher in uninfected pigs (1.17 (SD 0.17) vs. 0.96 (SD 0.17) µg/mL), the time to reach maximum concentration was shorter (1.53 (SD 0.23) vs. 2.40 (SD 0.37) hours), and the half-life of the absorption phase and half-life of the elimination phase were both shorter (0.66 (SD 0.08) vs. 1.00 (SD 0.27) hours) and (12.93 (SD 0.96) vs. 16.53 (SD 0.55) hours), respectively. The apparent volume of distribution was smaller in uninfected than infected pigs (1.91 (SD 0.22) vs. 2.16 (SD 0.21) L/kg). The relative bioavailability of tilmicosin in infected relative to uninfected pigs was 108.6 (SD 9.71)%. Conclusions and clinical relevance: The results of this study indicate that A. pleuropneumoniae infection significantly changed certain pharmacokinetic parameters of tilmicosin in pigs. In infected pigs tilmicosin exhibited a longer drug persistence and a better extent of absorption. These results indicate that it is necessary to monitor and adjust the dose of tilmicosin administration during the presence of pleuropneumonia. It is expected that this can optimise clinical efficacy and help avoid the development of resistance.

TGF-beta receptor II in epithelia versus mesenchyme plays distinct roles in the developing lung

Transforming growth factor (TGF)-beta signalling plays important roles in regulating lung development. However, the specific regulatory functions of TGF-beta signalling in developing lung epithelial versus mesenchymal cells are still unknown. By immunostaining, the expression pattern of the TGF-beta type II receptor (TbetaRII) was first determined in the developing mouse lung. The functions of TbetaRII in developing lung were then determined by conditionally knocking out TbetaRII in the lung epithelium of floxed-TbetaRII/surfactant protein C-reverse tetracycline transactivator/TetO-Cre mice versus mesenchyme of floxed-TbetaRII/Dermo1-Cre mice. TbetaRII was expressed only in distal airway epithelium at early gestation (embryonic day (E)11.5), but in both airway epithelium and mesenchyme from mid-gestation (E14.5) to post-natal day 14. Abrogation of TbetaRII in mouse lung epithelium resulted in retardation of post-natal lung alveolarisation, with markedly decreased type I alveolar epithelial cells, while no abnormality in prenatal lung development was observed. In contrast, blockade of TbetaRII in mesoderm-derived tissues, including lung mesenchyme, resulted in mildly abnormal lung branching and reduced cell proliferation after mid-gestation, accompanied by multiple defects in other organs, including diaphragmatic hernia. The primary lung branching defect was verified in embryonic lung explant culture. The novel findings of the present study suggest that transforming growth factor-beta type II receptor-mediated transforming growth factor-beta signalling plays distinct roles in lung epithelium versus mesenchyme to differentially control specific stages of lung development.

Reproduction and cytogenetic characterization of interspecific hybrids derived from Cucumis hystrix Chakr. x Cucumis sativus L

Interspecific hybrids between Cucumis hystrix Chakr. (2n = 2 x = 24) and Cucumis sativus L. (2n = 2 x = 14) were produced by means of F(1) (2n = 19) embryo rescue and subsequent chromosome doubling. The hybridity was confirmed by genomic in situ hybridization (GISH) and chromosome analysis. The amphidiploid (2n = 38) was self-pollinated and backcrossed to cucumber resulting in lines with improved crossability to C. sativus. Examination of shape, stainability, and germination rate of pollen grains and yield as a function of mature fruit set per ten pollinated flowers indicated a tendency for increased fertility in BC(1)S(1) progeny when compared to F(1) and amphidiploid offspring. Cytogenetic characterization of F(1) and amphidiploid progeny was performed. Generally normal meioses produced viable pollen grains, and fertilization resulted in partial fertility restoration in amphidiploid progeny. Chromosome anomalies such as "frying-pan trivalent", chromosome lagging and spindle mis-orientation were also observed. In most of the PMCs of the F(1) diploid hybrid progeny, 19 univalents were observed at diakinesis and MI. In the amphidiploid, more than 90% of the configurations at MI consisted of the predicted 19 bivalents and less than 5% contained multivalents [trivalents (2.3%) + quadrivalents (0.3%)], suggesting the presence of preferential pairing, and a distinctive parental genome as well. The chiasmata observed between homoeologous chromosomes further demonstrated the introgression of the C. hystrix genome into that of C. sativus.

Effect of re-feeding after starvation on biomechanical properties in rat small intestine

Luminal nutrients are essential for maintaining the structural and functional integrity of the gut. Starvation induces pronounced structural and biomechanical remodelling in the rat small intestine. The present work was done to study the recovery process after resumption of food intake. Twenty-five Wistar rats were allocated to five groups. Four groups fasted for 7 days but had free access to water. One of these groups served as fasted controls and was killed at the end of the fast. The other three groups were re-fed for 2, 4 and 7 days before they were euthanised. The fifth group had free access to food during the whole study (fed controls). The intestinal no-load state, zero-stress state and the stress-strain relationship during distension were studied. The intestinal segments were cut transversely into a series of short ring-shaped segments to obtain the no-load state. Each ring was cut in the radial direction to obtain the zero-stress state. The rats regained the lost body weight (22%) by the 7th day of re-feeding. The lost duodenal mass (40%) and jejunal mass (25%) were regained by the 2nd day whereas the lost mass from ileum (18%) was regained by the 4th day. The fasting-induced morphometric changes were normalised by re-feeding on the 2nd day in the duodenum and jejunum, and on the 4th day in the ileum. The longitudinal stress-strain curves shifted to the right after fasting and shifted back within two days following re-feeding (P<0.05). The circumferential stress-strain curves in the fasted or re-fed rats changed in a similar though less pronounced way. Normal values were reached within 4-7 days for the circumferential direction. In conclusion, fasting-induced biomechanical and structural remodelling were normalised by re-feeding in a time- and location-dependent way.

Tetramethylpyrazine inhibits phytohemagglutinin-induced upregulation of ICAM-1 and LFA-1 mediated leukocyte adhesion

The aim of this work was to study the effects of tetramethylpyrazine (TMP) on the interaction between lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesive molecule-1 (ICAM-1) by micropipette technique. A pair of cells, i.e., a human lymphocyte or a S KW-3 cell (human T cell leukemia), LFA-1 was expressed on which cellular surfaces, and a RBC coupled with ICAM-1, were the carriers for LFA-1 and ICAM-1. The adhesion probabilities of this pair of cells were mediated by specific interactions between ICAM-1 and LFA-1. Phytohemagglutinin (PHA) stimulation resulted in the significant increase in the adhesion probability compared to the resting lymphocyte. TMP treatment can inhibit such increase and even make the adhesion probability lower than the resting state. While the LFA-1 expression has not changed significantly with PHA stimulation or with TMP treatment, which indicated that TMP inhibiting effects was realized by a possible conformation change.

[A simulating study of biophysical features along meridians on a gel model]

A physical model was used to study the mechanism of specific biophysical features along the classic acupuncture meridian lines. A sol channel within a gel bed was made by a resistance string heating during electrification. A saline channel was produced by withdrawing some fibers in the gel bed and injecting saline into the gaps. A hydraulic resistance instrument composed by two pressure transducers was used to measure the hydraulic resistance across the two kinds of channels. The impedance on both channels was measured by a four-electrode impedance instrument with 5 KHz constant current. A vibration generator was put on one set of the channel to produce about 50 Hz sound waves. The signal was detected by a crystal pickup on the other set of the channel to examine the transmission of the wave along the two kinds of channels. The results showed that the low hydraulic resistance appeared on saline channel while no such feature on sol channel. Both channels showed low impedance while saline channel had more marked low impedance than control area. There was a better transmission of sound wave along saline channel while a bad transmission along the sol channel. The results suggest that the specific biophysical feature along meridians may be caused by a continuous rich distribution of interstitial fluid which mainly contains salt, water and protein.

[Expression property of adhesive molecule ICAM-1 on vitro-cultured pulmonary microvascular endothelial cells under the stimuli of asthmatic serum]

It has been recognized only in the past 15 years that the major pathological mechanism of asthma is inflammation, which has a hallmark of focal leukocyte extravasation. The different recruitment behaviors of inflammatory cells depend on the expression of specific adhesive molecules on both leukocytes and endothelial cells (EC). Intercellular cellular adhesion molecule-1(ICAM-1) plays a major role. In the previous detailed in-vivo study of asthmatic models, we have proved the significant pathological increase of both the leukocyte-endothelium adhesion phenomenon and the ICAM-1 expression in the tissues of asthmatic lung. It may be due to an ICAM-1 accumulation on the microvascular endothelial cells and thus an enhancement of adhesion force during the course of disease. In this study, endothelial cells were obtained from rats by mechanical isolation of lung tissues and in vitro culture on glass. Confluent endothelial cells were incubated with serum collected from rat blood of normal and asthmatic models and were used for in vitro study of endothelial cell adhesion. The effect of pathological serum stimulation was examined on the expression of ICAM-1 of the pulmonary microvascular endothelial cells (PMEC). The expression of ICAM-1 on PMEC was measured by indirect immuno-fluorescence with flow cytometry. We found that the surface expression of ICAM-1 was obviously increased on serum-incubated EC as compared with that on the culture solution-incubated one, and that asthmatic serum increased the expression of ICAM-1 on EC to a peak in 4 hours and then decreased it rapidly, the expression level remained the same in the whole course when EC was treated with culture solution or normal serum.

[Epidemiological effects of live attenuated hepatitis A vaccine (H(2)-strain): results of A 10-year observation]

OBJECTIVE

To assess the long-term epidemiological effects after a mass vaccination program, using live attenuated hepatitis A vaccine (H(2)-strain).

METHODS

Shengsi county and Jiaojiang city in Zhejiang province were chosen where high incidence rate of hepatitis A was observed. Mass vaccination program of H(2)-strain vaccine was carried out on 1 - 15 year olds. Cohort studies included two groups were carried out in Shengsi. Cases reported program on hepatitis A was under the national standard on clinical diagnosis and partly through laboratory monitor of anti-HAV IgM and IgG, ELISA and Abbott EIA. Population size was estimated by the yearly reports of census bureau of the county and the city. Serum tests including neutralization test, immune-recall responses, and anti-HAV IgG were performed 10 years after the initial immunization.

RESULTS

The morbidity of hepatitis A was significantly different between vaccinated groups and non-vaccinated groups (P < 0.01) in the cohort study. The protective efficacy in the site was 100 percent. There was a significantly negative correlation of regression between vaccine coverage and hepatitis A morbidity. In both sites, hepatitis A incidence rate showed decrease of 94.5% and 90.3% in whole population, with 96.9% and 97.9% in 1 - 15 year olds respectively. Neutralization test showed that 63.8% of the serum negative to ELISA after vaccination could still neutralize certain HAV. Immune-recall response after the booster was seen in vaccine group with 80.2% positive rate of anti HAV-IgG, 10 years after immunization among vaccinees in both sites. Not a single hepatitis A case was identified.

CONCLUSION

Live attenuated hepatitis A vaccine seemed to have obviously long-term epidemiological effects.

Biomechanical and morphometric properties of the arterial wall referenced to the zero-stress state in experimental diabetes

Morphometric and passive biomechanical properties were studied in isolated segments of the thoracic and abdominal aorta, left common carotid artery, left femoral artery and the left pulmonary artery in 20 non-diabetic and 28 streptozotocin (STZ)-induced diabetic rats. The diabetic and non-diabetic rats were divided into groups living 1, 4, 8, and 12 weeks after the induction of diabetes (n = 7 for each diabetic group) or sham injection (n = 5 for each group). The mechanical test was performed as a distension experiment where the proximal end of the arterial segment was connected via a tube to the container used for applying pressures to the segment and the distal end was left free. The vessel diameter and length were obtained from digitized images of the arterial segments at pre-selected pressures and at no-load and zero-stress states. Circumferential and longitudinal stresses (force per area) and strains (deformation) were computed from the length, diameter and pressure data and from the zero-stress state data. The zero-stress state was obtained by cutting vessel rings radially causing the rings to open up into a sector. Diabetes was associated with pronounced morphometric changes, e.g., wall thickness. With respect to the biomechanical data, the opening angle increased and reached a plateau in 4 weeks after which it decreased again (p < 0.05). The opening angle was smallest in the thoracic aorta and largest in the pulmonary artery. Furthermore, it was found that the circumferential stiffness of the arteries studied increased with the duration of diabetes. In the longitudinal direction significant differences were found 8 weeks after injection of STZ in all arteries except the pulmonary artery. In the 12 weeks group, the femoral artery was stiffest in the circumferential direction whereas the thoracic aorta was stiffest in the longitudinal direction. The accumulated serum glucose level correlated with the arterial wall thickness and elastic modulus (correlation coefficient between 0.56 and 0.81).

Absolute and convective instabilities of the natural convection in a vertical heated slot

The spatiotemporal instability of a natural convection flow in vertical heated slot is studied theoretically. The two unstable modes, secondary cell and traveling wave, are illustrated to be absolute and convective instabilities, respectively. Using a model to simulate the temperature gradient in the center of the slot, we propose an interpretation of the mechanism controlling the reverse transition of flow patterns, and explain the temperature fluctuation observed after the reverse transition in terms of the traveling wave mode.

[Surgical resection of giant hemangioma]

OBJECTIVE

Through the operative experiences in 45 cases of giant hemangioma, it is elucidated that the operative procedure for hemangioma is an effective, radical method of treatment.

METHODS

1. Preoperative DSA can establish the diagnosis, delineate the range of lesion and facilitate the design of operation. 2. "Dissection over the false capsule" is applied in the operation. 3. The operative wound, is repaired with a plastic procedure.

RESULTS

Of the 45 patients primary cure was obtained in 27, and secondary cure in 13 with effective rate of 89 percent. The followed-up was as long as 8 years with excellent results.

CONCLUSIONS

The establishment of operative scheme is chiefly based on preoperative DSA, and the success is fundamentally determined by complete dissection over the so-called "false capsule" around the tumour during operation. This procedure can totally remove the tumour, eliminate recurrence and fulfil the purpose of radical resection, which is worthy of wide application.

[Separation of thoracopagus conjoined twins]

OBJECTIVE

To sam up the experience in diagnosis and separation of a thoracopagus conjoined twins.

METHODS

Thoracopagus twin boys were admitted for evaluating possible separation and repair at age of 21 days. X-rays, CT, MRI, and ultrasound scan of torso showed separate and normal gastrointestinal and biliary tracts, little shared vasculature, but shared pericardium, diaphragm and liver parenchyma. The chest junctions were at the sternums and the most inferior two pairs of the ribs. One twin (twin A) had a protruding heart with VSD and ASD.

RESULTS

The infants were separated successfully at age of 45 days. The chest defect of twin A was closed with aid of a polyester pericardial patch graft and a silicon supporter. Managing anesthesia met some difficulty in understanding of the anatomical and physiological consequences of the complex anomaly. They are had brain edema and multiple system organ failures after separation, and were cured under intensive care. They are alive and well 6 months after surgery.

CONCLUSIONS

Careful preoperative evaluation proper anesthesia and surgical technique, and postoperative care are essential to the successful separation of the conjoined twins.

Urinary N-acetyl-beta-D-glucosaminidase isoenzymes as biomarker of renal dysfunction caused by cadmium in a general population

N-Acetyl-beta-D-glucosaminidase (NAG) and its isoenzymes in urine have been studied in a population group residing in a polluted area in China. The area studied was contaminated by industrial wastewater from a nearby smelter that discharged cadmium-polluted wastewater into a river used for the irrigation of rice fields. Cadmium concentrations in rice were 3.70, 0.51, and 0.07 mg/kg for the highly and moderately polluted areas and the control area, respectively. Cadmium concentrations in urine exceeded 5 microgram/liter in the majority of subjects in the most highly polluted area. There was a marked dose-dependent increase in NAG and NAG B content of urine related both to urinary cadmium and to the calculated cadmium uptake. It is concluded that urinary NAG and its isoenzymes could serve as a sensitive biomarker of renal dysfunction in cadmium-exposed populations. The mechanisms underlying the increase in NAG and its isoenzymes after cadmium exposure need to be studied further.

[Study on comprehensive assessment in selection of special work personnel]

A comprehensive assessment method combining fuzzy set theory with traditional approaches is introduced. Method of index assessment and comprehensive assessment along with a fuzzy assessment model are presented. As an example, three fuzzy algorithms are used to assess 6 candidates. Calculated results show that the combination of fuzzy logic and experience of experts is feasible and can deal with unprecise information more effectively as well as the aggregation of fuzzy information and precise data. The new method described in this paper is accurate and the speed of decision-making is much improved as compared with the conventional approaches.

Biological monitoring of cadmium exposure and renal effects in a population group residing in a polluted area in China

In an area of China, not previously studied in detail concerning cadmium pollution and possible adverse effects on the kidney of exposed populations, concentrations of cadmium in urine as an indicator of renal accumulation of cadmium was studied and related to indicators of renal dysfunction in order to examine if a relationship could be documented. Cadmium concentrations in urine were analysed by graphite furnace atomic absorption spectrometry and urinary beta-2 microglobulin (UBM) and albumin (UALB) were measured as indicators of renal dysfunction, Rice samples and urine samples were obtained from three areas in Zhejiang province, China, representing a highly exposed area, a medium exposed area and a control area, respectively. Cadmium concentrations in rice were 3.70, 0.51 and 0.072 mg/kg for the heavily, medium polluted areas and the control area, respectively. Cadmium concentrations in urine (geometric means) were 10.7, 1.62 and 0.40 micrograms/l in the high, medium and control areas respectively. There was a clear increase in UBM and UALB in the heavily exposed group in comparison to the control group and a slight increase in the medium exposed group. There was a statistically significant dose-response relationship between cadmium in urine and beta 2-microglobulin excretion in urine, which is similar to what has previously been reported in other countries. The findings constitute the first report concerning a dose-response relationship in this population group in Zhejiang province in China.

Alteration of left ventricular diastolic function during coronary angioplasty-induced ischemia: a color M-mode Doppler study

OBJECTIVES

The aim of this study was to assess the effects of ischemia on diastolic function by analyzing flow propagation velocity with color M-mode Doppler echocardigraphy.

BACKGROUND

Color M-mode Doppler echocardiography has been proposed as a method of assessing left ventricular filling.

METHODS

Color M-mode Doppler echocardiography and measurement of hemodynamic data were performed simultaneously at baseline and during angioplasty-induced ischemia. Tau was compared with flow propagation velocity. Late diastolic indexes, left ventricular pressure and flow cessation time were also investigated.

RESULTS

During ischemia, left ventricular relaxation rate (tau) increased, whereas flow propagation velocity decreased, from (mean +/- SD) 46.8 +/- 10 ms to 72.6 +/- 18.3 ms and from 59.8 +/- 15.8 cm/s to 30 +/- 8 cm/s, respectively (all p < 0.0001). The maximal slowing of flow propagation velocity was observed 20 to 30 s after the beginning of the inflation, coexisting with a notch on the ascending limb of the negative rate of rise of the left ventricular pressure (dP/dt) curve. Flow propagation velocity was correlated with tau both at baseline (r = 0.53, p < 0.05) and during inflation (r = 0.53, p < 0.03). Left ventricular end-diastolic pressure increased during ischemia from 13.5 +/- 8 mm Hg at baseline to 27.5 +/- 7 mm Hg, while a premature cessation of the entering flow occurred -13.8 +/- 23 ms before the next Q wave onset, compared with 4.5 +/- 19.6 ms after the Q wave onset at baseline (all p < 0.0001).

CONCLUSIONS

The analysis of flow propagation velocity showed that early filling is highly dependent on left ventricular relaxation rate, particularly through the phenomenon of asynchrony. During ischemia, the premature cessation of late filling is associated with increased diastolic pressures.

[A study on the newly designed platysma myocutaneous flap and its clinical applications]

From 1978 to 1991, the platysma myocutaneous flap of different designs was used to treat 69 patients with tumor extirpation defects of temporomandibular ankylosis. The conventional platysma myocutaneous flap was used to repair buccal defects. The combined platysma and sternocleidomastoid myocutaneous flap was used to reconstruct the tongue and the floor of the mouth. The innovated platysma myocutaneous flap, i.e. folded platysma myocutaneous flap was used to reconstruct the temporomandibular joint capsule for true ankylosis. All the procedure was completed in one stage and the operative results were satisfactory.