Prostaglandin F2α synthase promotes oxaliplatin resistance in colorectal cancer through prostaglandin F2α-dependent and F2α-independent mechanism

BACKGROUND

Oxaliplatin (Oxa) is the first-line chemotherapy drug for colorectal cancer (CRC), and Oxa resistance is crucial for treatment failure. Prostaglandin F2α synthase (PGF2α) (PGFS), an enzyme that catalyzes the production of PGF2α, is involved in the proliferation and growth of a variety of tumors. However, the role of PGFS in Oxa resistance in CRC remains unclear.

AIM

To explore the role and related mechanisms of PGFS in mediating Oxa resistance in CRC.

METHODS

The PGFS expression level was examined in 37 pairs of CRC tissues and paracancerous tissues at both the mRNA and protein levels. Overexpression or knockdown of PGFS was performed in CRC cell lines with acquired Oxa resistance (HCT116-OxR and HCT8-OxR) and their parental cell lines (HCT116 and HCT8) to assess its influence on cell proliferation, chemoresistance, apoptosis, and DNA damage. For determination of the underlying mechanisms, CRC cells were examined for platinum-DNA adducts and reactive oxygen species (ROS) levels in the presence of a PGFS inhibitor or its products.

RESULTS

Both the protein and mRNA levels of PGFS were increased in the 37 examined CRC tissues compared to the adjacent normal tissues. Oxa induced PGFS expression in the parental HCT116 and HCT8 cells in a dose-dependent manner. Furthermore, overexpression of PGFS in parental CRC cells significantly attenuated Oxa-induced proliferative suppression, apoptosis, and DNA damage. In contrast, knockdown of PGFS in Oxa-resistant HCT116 and HCT8 cells (HCT116-OxR and HCT8-OxR) accentuated the effect of Oxa treatment in vitro and in vivo. The addition of the PGFS inhibitor indomethacin enhanced the cytotoxicity caused by Oxa. Treatment with the PGFS-catalyzed product PGF2α reversed the effect of PGFS knockdown on Oxa sensitivity. Interestingly, PGFS inhibited the formation of platinum-DNA adducts in a PGF2α-independent manner. PGF2α exerts its protective effect against DNA damage by reducing ROS levels.

CONCLUSION

PGFS promotes resistance to Oxa in CRC via both PGF2α-dependent and PGF2α-independent mechanisms.

Evaluation of ITGB1 expression as a predictor of the therapeutic effects of immune checkpoint inhibitors in gastric cancer

BACKGROUND

Gastric cancer (CC) is a disease with high incidence and mortality rate. Immunotherapy is an important method for gastric cancer while lack of effective predictor. Integrins play an important role in the development. We aimed to explore the predictive value of β1 integrin (ITGB1) as a predictor of immunnotherapy in gastric cancer.

METHODS

Differential expression analysis was conducted using the Gene Expression Profiling Interactive Analysis (GEPIA) 2.0 and GEO databases. GEPIA data were used to evaluate the prognostic value of ITGB1 in gastric cancer (GC). Transcriptomic and clinical data of GC and normal tissues were downloaded from The Cancer Genome Atlas database, and the TIMER database was used to evaluate the association between ITGB1 and immune infiltration. Time-dependent receiver operating characteristic (ROC) curve analysis was used to determine the prognostic value of ITGB1. To verify ITGB1 expression at the protein level, immunohistochemical staining was conducted. In addition, to analyze the correlation of ITGB1 with PD-1 and PD-L1, we examined levels of PD-1 and PD-L1 by IHC and determined the predictive value of ITGB1 for anti-PD-1 therapy in GC by ROC curve analysis.

RESULTS

Compared with normal tissues, analysis of GEPIA and data at protein levels showed significantly higher expression of ITGB1 in GC. In addition, higher expression of ITGB1 was associated with worse pathological G-staging and tumor T-staging, which suggested that ITGB1 is a risk factor for poor prognosis in GC. The level of ITGB1 expression was positively correlated with CD8 + T cells, neutrophils, macrophages, and dendritic cells. ITGB1 expression was also correlated with PD-L1 expression, and this was further verified at the protein level by immunohistochemical analysis. The area under the ROC curve was 0.808.

CONCLUSION

ITGB1 may be a promising prognostic biomarker and effective predictor for anti-PD-1 therapy in GC.

TRIAL REGISTRATION

Retrospectively registered.

[Y-box-binding protein 1 mediates sorafenib resistance via the extracellular signal regulated-protein kinase pathway in hepatoma cells]

Objective: To investigate the effect and possible mechanism of Y-box-binding protein 1 (YB-1) on sorafenib resistance in hepatoma cells. Methods: Lentiviral vectors with YB-1 overexpression and knockdown were constructed, respectively, to stimulate human hepatoma cell lines (HepG2 and Huh7) alone or in combination with sorafenib.The overexpression part of the experiment was divided into four groups: overexpression control group (Lv-NC), YB-1 overexpression group (Lv-YB-1), overexpression control combined with sorafenib resistance group (Lv-NC+sorafenib), YB-1 overexpression combined with sorafenib resistance group (Lv-YB-1 + sorafenib). The knockdown part of the experiment was also divided into four groups: knockdown control group (Lv-shNC), YB-1 knockdown group (Lv-shYB-1), knockdown control combined with sorafenib resistance group (Lv-shNC + sorafenib), YB-1 knockdown combined with sorafenib resistance group (Lv-shYB-1 + sorafenib). The occurrence of cell apoptosis was detected by TUNEL. The protein expression levels of phosphorylated (p)-ERK and ERK, key proteins in the extracellular regulatory protein kinase (ERK) signaling pathway, were detected by Western blot and quantified by ImageJ software. Subcutaneous tumorigenesis experiments were performed in nude mice. The effect of YB-1 on the efficacy of sorafenib was verified in vivo. The comparison between the two sets of data was carried out by an independent sample t-test. One-way ANOVA was used for comparisons between the three groups of data above. Results: Sorafenib had accelerated the occurrence of apoptosis in hepatoma cells, while YB-1 overexpression had inhibited cell apoptosis, and at the same time also inhibited the apoptosis-accelerating impact of sorafenib. On the contrary, YB-1 knockdown accelerated cell apoptosis and amplified the induction effect of sorafenib on apoptosis. Furthermore, sorafenib resistance had down-regulated p-ERK levels (HepG2: Lv-NC 0.685 ± 0.143, Lv-NC + sorafenib 0.315 ± 0.168, P < 0.05; Huh7: Lv-NC 0.576 ± 0.078, Lv-NC + sorafenib 0.150 ± 0.131, P < 0.01), whereas YB-1 overexpression had inhibited sorafenib resistance p-ERK reduction (HepG2: Lv-NC + sorafenib 0.315 ± 0.168, Lv-YB-1 + sorafenib 0.688 ± 0.042, P < 0.05; Huh7: Lv-NC + sorafenib 0.150 ± 0.131, Lv-YB-1 + sorafenib 0.553 ± 0.041, P < 0.05). YB-1 knockdown further increased sorafenib-induced p-ERK downregulation (HepG2: Lv-shNC + sorafenib 0.911 ± 0.252, Lv-shYB-1 + sorafenib 0.500 ± 0.201, P < 0.05; Huh7: Lv-shNC + sorafenib 0.577 ± 0.082, Lv-shYB-1 + sorafenib 0.350 ± 0.143, P < 0.05), which was further verified in naked mice (Lv-shNC + sorafenib 0.812 ± 0.279, Lv-shYB-1 + sorafenib 0.352 ± 0.109, P < 0.05). Conclusion: YB-1 mediates the occurrence of sorafenib resistance via the ERK signaling pathway in hepatoma cells.

Potential role of circulating exosome miRNAs in left ventricular remodeling of patients with ST-segment elevation myocardial infarction

Background

Left ventricular remodeling (LVR) in patients with ST-segment elevation myocardial infarction (STEMI) may lead to poor prognosis in which circulating exosome miRNAs play a critical role. The aim of the present study is to identify specific exosome miRNAs for LVR in patients with STEMI.

Method

Plasma exosome miRNAs were assessed in 20 patients (90% male, mean age of 66.95±1.65 years) 3–6 months after STEMI and 24 healthy individuals (83% male, mean age of 33.2±0.93 years) by using qPCR. Of the 20 patients, 8 had post-STEMI LVR according to echocardiographic evaluation, and the others did not. Clinical biochemical data including total cholesterol, HDL-C, LDL-C, LDH and NT-pro-BNP were collected from the patients with STEMI at same time as exosome miRNAs assessment. Specific exosome miRNAs for LVR were identified by using qPCR. Correlations between the dysregulated exosome miRNAs and the clinical biochemical parameters in patients with STEMI were analyzed using spearman correlation test.

Results

Five exosome miRNAs including hsa-miR-181a-3p (p&lt;0.05, fold change = 0.59), let-7d-3p (p=0.01, fold change = 0.51), hsa-miR-224-5p (p&lt;0.01, fold change = 0.11), hsa-miR-23a-3p (p&lt;0.01, fold change = 1.42) and miR-874-3p (p&lt;0.01, fold change = 0.48) were dysregulated in the post-STEMI patients comparing with the healthy individuals. Among them, the exosome miR-181a-3p (p=0.01, fold change = 0.09) and let-7d-3p (p=0.01, fold change = 0.16) were significantly lower expressed in patients with LVR compared to those without (Figure 1). There was no significant difference in expression of the other three miRNAs between patients with and without LVR. Exosome hsa-miR-874-3p positively associated with LDH (p&lt;0.01, r=0.50) in all the patients with STEMI. In vitro cell culture confirmed that the miR-874-3p mimics upregulated expression of apoptosis related gene BMF (p&lt;0.05, fold change = 1.7) in cardiomyocyte. Exosome hsa-miR-23a-3p and hsa-miR-224-5p positively correlated with both HDL-C (p&lt;0.01, r=0.61; p=0.02, r=0.50) and LDL-C (p=0.02, r=0.50; p&lt;0.05, r=0.52) in all patients with STEMI. No correlation between the dysregulated exosome miRNAs and cholesterol or NT-ProBNP was observed (Figure 2).

Conclusions

Circulating exosome miR-181a-3p and let-7d-3p might play a potential role in LVR in patients 3–6 months after STEMI. Exosome hsa-miR-874-3p might be associated with cardiomyocyte injury. Hsa-miR-23a-3p and hsa-miR-224-5p demonstrated an activity in regulation of lipid metabolism and biosynthesis in patients with STEMI.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): This work was supported by grants from the 3×3 Clinical Scientist Fund of Sun Yat-sen Memorial Hospital

Establishment and validation of a computer-assisted colonic polyp localization system based on deep learning

BACKGROUND

Artificial intelligence in colonoscopy is an emerging field, and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas. Several deep learning-based computer-assisted detection (CADe) techniques were established from small single-center datasets, and unrepresentative learning materials might confine their application and generalization in wide practice. Although CADes have been reported to identify polyps in colonoscopic images and videos in real time, their diagnostic performance deserves to be further validated in clinical practice.

AIM

To train and test a CADe based on multicenter high-quality images of polyps and preliminarily validate it in clinical colonoscopies.

METHODS

With high-quality screening and labeling from 55 qualified colonoscopists, a dataset consisting of over 71000 images from 20 centers was used to train and test a deep learning-based CADe. In addition, the real-time diagnostic performance of CADe was tested frame by frame in 47 unaltered full-ranged videos that contained 86 histologically confirmed polyps. Finally, we conducted a self-controlled observational study to validate the diagnostic performance of CADe in real-world colonoscopy with the main outcome measure of polyps per colonoscopy in Changhai Hospital.

RESULTS

The CADe was able to identify polyps in the test dataset with 95.0% sensitivity and 99.1% specificity. For colonoscopy videos, all 86 polyps were detected with 92.2% sensitivity and 93.6% specificity in frame-by-frame analysis. In the prospective validation, the sensitivity of CAD in identifying polyps was 98.4% (185/188). Folds, reflections of light and fecal fluid were the main causes of false positives in both the test dataset and clinical colonoscopies. Colonoscopists can detect more polyps (0.90 vs 0.82, P < 0.001) and adenomas (0.32 vs 0.30, P = 0.045) with the aid of CADe, particularly polyps < 5 mm and flat polyps (0.65 vs 0.57, P < 0.001; 0.74 vs 0.67, P = 0.001, respectively). However, high efficacy is not realized in colonoscopies with inadequate bowel preparation and withdrawal time (P = 0.32; P = 0.16, respectively).

CONCLUSION

CADe is feasible in the clinical setting and might help endoscopists detect more polyps and adenomas, and further confirmation is warranted.

Y-box binding protein 1 augments sorafenib resistance via the PI3K/Akt signaling pathway in hepatocellular carcinoma

BACKGROUND

Sorafenib is the first-line treatment for patients with advanced hepatocellular carcinoma (HCC). Y-box binding protein 1 (YB-1) is closely correlated with tumors and drug resistance. However, the relationship between YB-1 and sorafenib resistance and the underlying mechanism in HCC remain unknown.

AIM

To explore the role and related mechanisms of YB-1 in mediating sorafenib resistance in HCC.

METHODS

The protein expression levels of YB-1 were assessed in human HCC tissues and adjacent nontumor tissues. Next, we constructed YB-1 overexpression and knockdown hepatocarcinoma cell lines with lentiviruses and stimulated these cell lines with different concentrations of sorafenib. Then, we detected the proliferation and apoptosis in these cells by terminal deoxynucleotidyl transferase dUTP nick end labeling, flow cytometry and Western blotting assays. We also constructed a xenograft tumor model to explore the effect of YB-1 on the efficacy of sorafenib in vivo. Moreover, we studied and verified the specific molecular mechanism of YB-1 mediating sorafenib resistance in hepatoma cells by digital gene expression sequencing (DGE-seq).

RESULTS

YB-1 protein levels were found to be higher in HCC tissues than in corresponding nontumor tissues. YB-1 suppressed the effect of sorafenib on cell proliferation and apoptosis. Consistently, the efficacy of sorafenib in vivo was enhanced after YB-1 was knocked down. Furthermore, KEGG pathway enrichment analysis of DGE-seq demonstrated that the phosphoinositide-3-kinase (PI3K)/protein kinase B (Akt) signaling pathway was essential for the sorafenib resistance induced by YB-1. Subsequently, YB-1 interacted with two key proteins of the PI3K/Akt signaling pathway (Akt1 and PIK3R1) as shown by searching the BioGRID and HitPredict websites. Finally, YB-1 suppressed the inactivation of the PI3K/Akt signaling pathway induced by sorafenib, and the blockade of the PI3K/Akt signaling pathway by LY294002 mitigated YB-1-induced sorafenib resistance.

CONCLUSION

Overall, we concluded that YB-1 augments sorafenib resistance through the PI3K/Akt signaling pathway in HCC and suggest that YB-1 is a key drug resistance-related gene, which is of great significance for the application of sorafenib in advanced-stage HCC.

REC8 promotes tumor migration, invasion and angiogenesis by targeting the PKA pathway in hepatocellular carcinoma

REC8 is a member of the cohesin family, and its abnormal activation has been detected in cancer cells. This study explored the role and possible mechanism of REC8 in hepatocellular carcinoma (HCC). A total of 40 pairs of HCC and adjacent tissues were collected, and the clinical significance of REC8 expression in HCC was evaluated. REC8 expression in human HCC tissues and HCC cell lines was investigated by quantitative real-time PCR, Western blotting, immunohistochemistry and immunofluorescence staining. The biological functions of REC8 in HCC cell lines were detected by wound-healing assay, Matrigel invasion assay and tube formation assay. The proteins interacting with REC8 were identified by mass spectrometry after immunoprecipitation screening. There was a correlation between the high expression of REC8 and positive alpha-fetoprotein levels. The expression level of REC8 protein in HCC tissues was higher than that in adjacent tissues. REC8 has mainly located in the nucleus of HCC tissue cells and HCC cell lines, but it was expressed in the cytoplasm of adjacent normal tissue cells and hepatocytes. The results of wound healing, transwell invasion and tubular formation assays indicated that the overexpression of REC8 accelerated the metastasis of HCC in vitro; however, metastasis was suppressed after REC8 was silenced by small interference RNA. A total of 57 differentially expressed proteins were identified by mass spectrometry, and it was found that REC8 and PKA RII-α staining was colocalized in the nucleus. The expression levels of MMP-9 and VEGF-C were decreased after treatment with the PKA inhibitor H89. Overall, REC8 promotes the migration, invasion and angiogenesis of HCC cells through the PKA pathway.

[Transnasal endoscopic surgery of choanal atresia after radiotherapy for nasopharyngeal carcinoma]

Objective: To discuss the effect of endoscopic dilatation and plasty for choanal atresia after radiotherapy for nasopharyngeal carcinoma. Methods: Nineteen patients with choanal atresia who were admitted to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Nanchang University from Jan. 2011 to Dec. 2018 were reviewed, with 12 males and 7 females aging from 33 to 59 years old. All of the patients had a history of radiotherapy for nasopharyngeal carcinoma and were confirmed by electronic nasopharyngoscope and nasopharyngeal imaging. Among 19 patients, there were 3 cases of unilateral occlusion and 16 cases with bilateral atresia, and all of them were membranous atresia. All patients received the transnasal endoscopic surgery of resecting partial vomer bone while trying to keep normal mucosa tissues and using the septonasal mucoperiosteal flap to repair under general anesthesia. One week after operation, the patients were told to do physiological saline nasal irrigation and received regular clean and observation under endoscope. Descriptive statistical method was used to analyze the outcome. Results: The patients were followed up for 1 year postoperatively by electronic nasopharyngoscopic examination. There was no failure case in all the 19 patients including 16 patients with a wide choana and 3 patients had narrowing of the choana (<50%), with adequate and satisfactory airway. Conclusions: Transnasal endoscopic surgery was an effective treatment for choanal atresia after radiotherapy for nasopharyngeal carcinoma. Application of septonasal mucoperiosteal flap for repairing nasal and nasopharyngeal mucosa would avoid recurrence.

[Five cases of optic neuropathy associated with varicella zoster virus infection]

Objective: To investigate the clinical characteristics, treatment and prognosis of optic neuropathy associated with varicella zoster virus (VZV). Methods: Five cases of optic neuropathy associated with VZV infection from Department of Neurology between January 1, 2014 and March 31, 2019 were retrospectively collected. The clinical manifestations, treatment and prognosis were analyzed. Results: There were 7 eyes involved in 5 cases, 3 cases (3/5) involved only one eye, and 2 cases (2/5) involved both optic nerves. During the follow-up time, no recurrence was found. Severe visual impairment occurred in 4 eyes (4/7) and non-severe visual impairment in 3 eyes (3/7). Visual acuity improved significantly in 1 eye (1/7), turned better in 2 eyes (2/7), and remained unchanged in 4 eyes (4/7). In acute phase, abnormal signals of optic nerve and/or sheath were observed on MR images. Case 3 received antiviral and hormone therapy on the second day after the onset of the disease, and the visual acuity recovered well; the other 4 cases had poor prognosis. Conclusions: Head and face VZV infection can cause serious optic neuropathy, leading to severe visual dysfunction, and poor prognosis, but recurrence is rare. Early intravenous administration of antiviral drugs (acyclovir is the best) and hormones are recommended for VZV infection in this area. It is best to use drugs within 72 hours in order to avoid and reduce secondary optic neuropathy as far as possible.

[Saccadic abnormalities and clinical significance in patients with neuromyelitis optica spectrum disorder]

Objective: To characterize the ocular saccadic abnormality in neuromyelitis optica spectrum disorder (NMOSD) patients, and explore the relationship between ocular saccadic abnormality and the overall disability and visual function state. Methods: For the 110 consecutive NMOSD patients who visited the Department of Neurology of Beijing Tongren Hospital from July 2015 to July 2017, a 120 Hz spatial resolution infrared video nystagmus system was used to perform a quantitative horizontal saccade examination. All patients were assessed for overall disability status using the extended disability status scale (EDSS). The subjective visual function status was evaluated using the National Eye Institute-Visual Function Questionnaire (NEI-VFQ 25) and the 10-item neuro-ophthalmic supplement questionnaire (Suppl. 10). Results: A total of 68 (61.8%) of 110 NMOSD patients had horizontal saccadic abnormalities, including 50 cases (45.5%) with abnormal saccade latency, 34 cases (30.9%) with abnormal saccade accuracy and 22 cases (20.0%) with abnormal speed. Patients with abnormal saccade had more intracranial lesions and higher EDSS scores than those with normal eye movements (P=0.006 and P<0.001, respectively). Patients with abnormal saccade had lower Supp.10 scores than the normal patient (P=0.004), while there was no significant difference of NEI-VFQ 25 scores between the two groups (P=0.079). Conclusions: The horizontal saccadic abnormality is common in the NMOSD patients, and the overall disability status and visual function-related quality of life are worse. Quantitative horizontal saccade examination can provide important information on intracranial lesions and neuronal function impairment, and thus it should be emphasized in clinical settings.

TGR5 promotes cholangiocarcinoma by interacting with mortalin

Takeda-G-protein-receptor-5 (TGR5) is a G-protein-coupled receptor (GPCR) activated by bile acids, and mortalin is a multipotent chaperone of the HSP70 family. In the present study, TGR5 was detected by immunohistochemistry (IHC) in extrahepatic cholangiocarcinoma (ECC) specimens, and TGR5 expression in ECC tissues and adjacent tissues was compared. In vitro TGR5 was overexpressed and knocked down in human intrahepatic cholangiocarcinoma (ICC) cell line RBE and human extrahepatic cholangiocarcinoma (ECC) cell line QBC-939 to observe its effects on the biological behavior of cholangiocarcinoma (CC) cells, including proliferation, apoptosis and migration. In vivo xenograft model was constructed to explore the role of TGR5 in CC growth. Proteins that interacted with TGR5 were screened using an immunoprecipitation spectrometry approach, and the identified protein was down-regulated to investigate its contribution to CC growth. The present study demonstrated that TGR5 is highly expressed in CC tissues, and strong TGR5 expression may indicate high malignancy in CC. Furthermore, TGR5 promotes CC cell proliferation, migration, and apoptosis resistance. TGR5 boosts CC growth in vivo. In addition, TGR5 combines with mortalin and regulates mortalin expression in the CC cell line. Mortalin participates in the TGR5-induced increase in CC cell proliferation. In conclusion, TGR5 is of clinical significance based on its implications for the degree of malignancy in patients with CC. Mortalin may be a downstream component regulated by TGR5, and TGR5 promotes cholangiocarcinoma at least partially by interacting with mortalin and upregulating its expression. Both TGR5 and mortalin are positive regulators, and may serve as potential therapeutic targets for CC.

[Renal clear cell carcinoma transferred to infratemporal fossa and pterygopalatine fossa: A case report]

SummaryRenal clear cell carcinoma is prone to distant metastasis, especially in the head and neck, but it is rare to transfer to infratemporal fossa and pterygopalatine fossa. We reported a 62-year-old male patient with complains of numbness and burning sensation on the left side of the face for more than 3 months. Left kidney removal was performed 8 years ago due to renal cancer. Preoperative enhancement CT showed a large blood-rich occupation in the left nasopharyngeal and pterygopalatine with adjacent paranasal sinus and skull base bone destruction. Under the general anesthesia, the anterior lacrimal recess approach was used for tumor resection. Preoperative interventional embolization of the feeding artery, intraoperative pathology, frozen section showed metastasis of renal cell carcinoma, and postoperative immunohistochemical examination, confirmed metastatic renal clear cell carcinoma（infratemporal fossa and pterygopalatine fossa）. The patients were transferred to the oncology department for further radiotherapy and chemotherapy.

[Clinical analysis of 36 cases of idiopathic intracranial hypertension complicated with iron deficiency anemia]

Objective: To investigate the clinical features, imaging findings and prognosis of idiopathic intracranial hypertension (IIH) patients complicated with iron deficiency anemia (IDA). Methods: A total of 307 cases of IIH patients hospitalized in Beijing Tongren Hospital were retrospectively screened between January 1, 2011 and February 28, 2018. There were 49 anemia cases (15.96%) and 45 IDA cases (14.66%), respectively. Finally, 36 IDA patients were enrolled. The clinical characteristics, imaging findings, treatment and prognosis of these patients were analyzed. Results: IIH combined with IDA was more common in women of childbearing age (34/36). There were 30 obese and overweight cases (83.33%), with multiple subacute or chronic course of disease. The visual symptoms in the early IIH patients were first diagnosed in the Department of Ophthalmology. The first symptom was headache with/without visual symptoms (27 cases (75%)). Head MRI detected empty sella or partial empty sella, and 2 cases of venous sinus thrombosis were found in DSA examination. Of the 34 female patients, 24 had simple menometrorrhagia or menstrual disorder. All patients were given methyl acetate to reduce the intracranial pressure and iron therapy. Five patients received low molecular weight heparin-warfarin sequential treatment, 5 cases underwent gynecologic surgery and 2 male cases received hemorrhoid operation. There were 7 cases underwent lumbar cisterna-peritoneal shunt for visual impairment. During the follow-up, intracranial pressure decreased and visual function of patients improved significantly. Conclusions: IIH is frequently found in obese or overweight women at childbearing age and IDA may be an important cause of IIH. IIH can cause serious irreversible visual impairment. Therefore, early identification and active treatment should be performed. Correction of anemia can significantly improve the clinical symptoms of IIH. Operation should be employed for IIH patients with poor visual function or rapid progress, in order to reduce intracranial pressure and improve prognosis as soon as possible.

Overexpression of the immediate early response 5 gene increases the radiosensitivity of HeLa cells

The effects of the immediate early response 5 (IER5) gene on the sensitivity of HeLa cells to radiation remain unclear. In the present study, stably transfected HeLa cells resulting in the knockdown or overexpression of IER5 were investigated. In addition, xenografts of normal, IER5-silenced and -overexpressed HeLa cells were injected into nude mice and examined. The results demonstrated that the radiosensitivity of the IER5-overexpressed HeLa cells was significantly increased compared with that of the normal and IER5-silenced cells. The upregulation of IER5 effectively decreased cell proliferation and IER5 silencing promoted cell proliferation compared with that in the normal HeLa cells. Following irradiation of the cells with IER5 knockdown, cell cycle was arrested at the G₂/M phase and an increase in the proportion of S phase cells was observed. By contrast, the overexpression of IER5 led to an increase in the proportion of G₁ phase cells. Furthermore, the upregulation of IER5 inhibited tumor growth in vivo. The present findings demonstrate that the IER5 gene affects the radiosensitivity of HeLa cells and serves an important role in cell proliferation, suggesting that this gene may be a potential radiotherapeutic target in cervical cancer.

[Relationship between the level of estrogen, calcium and phosphorus concentration in serum with benign paroxysmal positional vertigo]

Objective:To investigate relationship between the level of estrogen, calcium and phosphorus concentration in serum with benign paroxysmal positional vertigo(BPPV). Method:A total of 84 patients with idiopathic BPPV were enrolled in the experimental group, including 32 non-menopausal women, 24 menopausal women, and 28 males; 83 healthy people without vertigo and vestibular disease were selected as the control group consisted with 32 non-menopausal women, 24 menopausal women and 27 males. The levels of estradiol, serum calcium and serum inorganic phosphorus were measured in all participants. The difference of estrogen level, serum calcium and serum inorganic phosphorus concentration between the experimental group and the control group was analyzed by t test. Result:The total number, age distribution and gender composition of the experimental group and the control group were basically paired, and the age difference was not statistically significant (P=0.71). The overall estrogen level in the experimental group was lower than that in the control group (P<0.01). Among them, the female group's estrogen level, menopausal female estrogen level and male estrogen level in the experimental group were lower than the control group (P<0.01); there was no significant difference in serum calcium and serum inorganic phosphorus concentration between the experimental group and the control group (P=0.55, 0.11, respectively). Conclusion:The decrease of estrogen level may be a risk factor for idiopathic BPPV. The relationship between serum calcium and serum inorganic phosphorus concentration and BPPV needs further study.

Cell-free miR-17-5p as a diagnostic biomarker for gastric cancer inhibits dendritic cell maturation

Purpose

Gastric cancer (GC) patients display aberrant miRNA expression and defective dendritic cell function. However, the role of cancer cell-derived oncomiR in GC detection and dendritic cell (DC) maturation remains largely elusive.

Methods

Candidate miRNAs were selected by deep sequencing (8 GC plasma samples vs 8 control plasma samples; 8 GC tissues vs 8 adjacent normal gastric tissues) and confirmed by PCR with 164 plasma samples and 72 formalin-fixed paraffin-embedded GC tissue samples. Their diagnostic performance was evaluated by receiver operating characteristic curve. Cy3 fluorescence signals in DCs, exposed to conditioned medium obtained from BGC-823 cells pre-transfected with Cy3-miR-17-5p, were determined by flow cytometry and visualized by confocal microscopy. Functional and phenotypical alterations of DCs were assayed when DCs were transfected with miR-17-5p in vitro.

Results

Deep sequencing and RT-PCR confirmed that five shared miRNAs were upregulated in plasma and tissue samples of GC patients. Cell-free miR-17-5p was superior to others in GC detection with an area under the curve of 0.82, and correlated with lymphatic metastasis and poor overall survival. GC cell-shuttled miR-17-5p can be delivered to immature DCs, and they significantly inhibited LPS-stimulated phenotypic maturation by diminishing the expression of maturation markers (MHC II, CD80 and CD86 molecules). In line with those alterations in the phenotypic markers, functional experiments demonstrated that miR-17-5p triggered an inhibitory effect on DCs endocytic activity and decreased tumor necrosis factor-α and IL-12 secretion, while enhancing IL-10 production. Mixed lymphocyte reaction showed that miR-17-5p inhibited the T cell stimulating effect of DCs and favored regulatory T cells expansion.

Conclusion

GC cell-derived miR-17-5p is a potential biomarker for GC detection. Taken up by DCs, miR-17-5p weakened antitumor immune responses via inhibiting the maturation of dendritic cells.

The role of the apoptosis-related protein BCL-B in the regulation of mitophagy in hepatic stellate cells during the regression of liver fibrosis

The clearance of activated hepatic stellate cells (HSCs) by apoptosis is critical for the reversibility of hepatic fibrosis. Mitochondrial homeostasis is regulated by mitophagy, which is an efficient way of clearing injured mitochondria that plays an important role in apoptosis. However, the role of mitophagy in apoptosis in HSCs and hepatic fibrosis is still unclear. Here, we show that mitophagy is enhanced in parallel with increased apoptosis in hepatic stellate cells during the reversal of hepatic fibrosis. The inhibition of mitophagy suppressed apoptosis in HSCs and aggravated hepatic fibrosis in mice. In contrast, the activation of mitophagy induced apoptosis in HSCs. Furthermore, we confirmed that BCL-B, which is a member of the BCL-2 family, is a regulator mediating mitophagy-related apoptosis. The knockdown of BCL-B resulted in increased apoptosis and mitophagy in HSCs, while the overexpression of BCL-B caused the opposite effects. BCL-B inhibited the phosphorylation of Parkin (a key regulator of mitophagy) and directly bound phospho-Parkin. Altogether, enhanced mitophagy promotes apoptosis in HSCs during the reversal of hepatic fibrosis. BCL-B suppresses mitophagy in HSCs by binding and suppressing phospho-Parkin, thereby inhibiting apoptosis. BCL-B-dependent mitophagy is a new pathway for the regulation of apoptosis in HSCs during the regression of hepatic fibrosis.

Clearing away defective mitochondria helps destroy cells in the liver that contribute to tissue scarring; the signaling pathway involved offers a new therapeutic target. Hui-Qing Jiang and colleagues from the Hebei Institute of Gastroenterology in Shijiazhuang, China, induced liver fibrosis in mice and showed that as the animals recovered and the damage to their liver tissue was reversed, injured mitochondria were cleared from fibrosis-causing cells in tandem with the cells’ controlled destruction. Experimentally inhibiting the process of mitochondrial clearance also inhibited cell death and aggravated fibrotic scarring in the mice. The researchers identified a signaling pathway that regulates mitochondrial cleanup and, in turn, also controlled cell death. Targeting this pathway offer a potential new therapeutic strategy for reversing liver fibrosis in patients.

[A case of facial paralysis caused by granulocytic sarcoma of the external auditory canal]

Summary A male patients at 11 years of age, was hospitalized for the right ear pain and mouth deviation for five days on August 30, 2016, accompanied by right hypophasis, right ear hearing loss, tinnitus, without otorrhea and vertigo. Patient was diagnosed as acute promyelocytic leukemia in 2008. After standardized chemotherapy, it was completely relieved and the blood and bone marrow images were almost restored to normal. Physical examination: The skin of the right external auditory canal is obviously swollen, without rupture on the surface, and the tympanic membrane cannot be seen. The drooping of the left angle of the mouth, the right eyelid is not closed completely, the right nasolabial groove and forehead line is shallower. House-Brackmann facial nervous system Ⅲ. Routine blood: the leucocyte 10.31×10⁹/L, more than in the normal range. Pure tone measurement showed that right ear conductive deafness, air-bone conduction difference of each frequency range 50 to 75 dB.Mastoid CT showed that right mastoid gasification is good, the right external auditory canal, middle ear cavity and mastoid airway are filled with low-density soft tissue shadows, the bone wall of the external auditory canal was not significantly enlarged or damaged. The auditory bone is intact, surrounded by a large number of soft tissue shadows, no obvious abnormalities in the inner ear. Primary diagnosis: Middle ear cholesteatoma (right);External auditory canal tumor (right);Peripheral facial paralysis (right).

Surgical Management of Plantar Melanoma: A Retrospective Study in One Center

Cutaneous melanoma is a highly malignant skin tumor, and in China, the planta pedis is a commonly involved site. The sites of plantar melanomas are a challenge to reconstruct after wide excision. Our experience with surgical management of melanomas was based on the 4 different anatomic subunits of the planta pedis. From January 1, 2002 to December 31, 2016, 35 patients who had had plantar melanoma had undergone surgical treatment in our clinic. The tumor locations were as follows: the toe in 6, the ball of the foot in 5, the arch in 15, and the heel in 9. Surgical management involved extended resection of the tumor, repair of defects with skin grafts or flaps, and inguinal lymphadenectomy. The skin flaps included a residual toe flap, an anterograde or retrograde medial plantar flap, and a retrograde sural neurocutaneous vascular flap. Of the 35 cases of flaps and skin grafts, 33 (94.29%) survived, and the wounds had healed by first intention. After a follow-up period of 6 months to 7 years, 24 patients (68.57%) were free of local and systemic disease and 30 patients (85.71%) were ambulatory using shoes, and all the flaps and skin grafts showed a good appearance. The personalized surgical treatments we used for melanoma in the planta pedis resulted in overall satisfactory outcomes and adequate disease clearance, and allowed the patients to resume normal lives. The function of the foot was maintained or restored to the greatest possible degree, and the patients' quality of life improved postoperatively.

[Clinical and immunological characteristics and predicted factors of vision outcome in patients with acute severe bilateral optic neuritis]

Objective: To analyze the clinical and immunological characteristics of acute severe bilateral optic neuritis, and to explore the predictive factors of vision outcome and relapse so as to save visual function and avoid or alleviate vision disability. Methods: Forty-eight inpatients confirmed with acute severe bilateral optic neuritis from January 2013 to June 2015 were included and followed up. The clinical features, immunological findings, optic nerve imaging, visual function outcome and predictors of relapse were statistically analyzed. Results: Acute severe bilateral optic neuritis accounted for 7.3% of the total number of optic neuritis in the same period. There were 35 cases (72.9%) with monophasic course, and 13 cases (27.1%) with recurrence or other central nervous system involvement during the follow-up period; 11 (22.9%) in 48 patients with positive AQP4-IgG; AQP4-IgG-positive patients had a higher recurrence rate (P<0.001) and poorer visual function prognosis (P=0.034) than antibody-negative patients; the baseline visual acuity (P=0.004), early treatment response (P=0.012) and number of involved optic nerve segments (P=0.016) were associated with end point visual function. Positive AQP4-IgG(OR 13.486, 95% CI 1.971-16.263)and combining with other autoimmune antibodies (OR 5.591, 95% CI 1.502-15.621)were independently associated with relapse. Conclusions: Acute severe bilateral optic neuritis is not unusual and may cause blindness or visual disability. The positive rate of AQP4-IgG and the recurrence rate of the disease are low in our study. The necessity for long-term immunotherapy requires individual consideration. The baseline visual acuity, involved segment number of optic nerve and response to early treatment are associated with prognosis of visual function. Patients with AQP4-IgG positive and other autoimmune antibodies are easy to relapse. Whether the antibody-negative bilateral optic neuritis is a heterogeneous disease and the relationship with classic NMO or NMOSD deserve further research.

Fisetin Exerts Antioxidant and Neuroprotective Effects in Multiple Mutant hSOD1 Models of Amyotrophic Lateral Sclerosis by Activating ERK

Oxidative stress exhibits a central role in the course of amyotrophic lateral sclerosis (ALS), a progressive neurodegenerative disease commonly found to include a copper/zinc superoxide dismutase (SOD1) gene mutation. Fisetin, a natural antioxidant, has shown benefits in varied neurodegenerative diseases. The possible effect of fisetin in ALS has not been clarified as of yet. We investigated whether fisetin affected mutant hSOD1 ALS models. Three different hSOD1-related mutant models were used: Drosophila expressing mutant hSOD1^G85R, hSOD1^G93A NSC34 cells, and transgenic mice. Fisetin treatment provided neuroprotection as demonstrated by an improved survival rate, attenuated motor impairment, reduced ROS damage and regulated redox homeostasis compared with those in controls. Furthermore, fisetin increased the expression of phosphorylated ERK and upregulated antioxidant factors, which were reversed by MEK/ERK inhibition. Finally, fisetin reduced the levels of both mutant and wild-type hSOD1 in vivo and in vitro, as well as the levels of detergent-insoluble hSOD1 proteins. The results indicate that fisetin protects cells from ROS damage and improves the pathological behaviors caused by oxidative stress in disease models related to SOD1 gene mutations probably by activating ERK, thereby providing a potential treatment for ALS.

piR-823 contributes to colorectal tumorigenesis by enhancing the transcriptional activity of HSF1

Piwi-interacting RNAs (piRNAs), a novel class of small non-coding RNAs, were first discovered in germline cells and are thought to silence transposons in spermatogenesis. Recently, piRNAs have also been identified in somatic tissues, and aberrant expression of piRNAs in tumor tissues may be implicated in carcinogenesis. However, the function of piR-823 in colorectal cancer (CRC) remains unclear. Here, we first found that piR-823 was significantly upregulated in CRC tissues compared with its expression in the adjacent tissues. Inhibition of piR-823 suppressed cell proliferation, arrested the cell cycle in the G1 phase and induced cell apoptosis in CRC cell lines HCT116 and DLD-1, whereas overexpression of piR-823 promoted cell proliferation in normal colonic epithelial cell line FHC. Interestingly, Inhibition of piR-823 repressed the expression of heat shock protein (HSP) 27, 60, 70. Furthermore, elevated HSPs expression partially abolished the effect of piR-823 on cell proliferation and apoptosis. In addition, we further demonstrated that piR-823 increased the transcriptional activity of HSF1, the common transcription factor of HSPs, by binding to HSF1 and promoting its phosphorylation at Ser326. Our study reveals that piR-823 plays a tumor-promoting role by upregulating phosphorylation and transcriptional activity of HSF1 and suggests piR-823 as a potential therapeutic target for CRC.

[Clinical observation and related factors analysis of neonatal asphyxia complicated with retinal hemorrhage]

Objective: To observe and analyze related factors of neonatal asphyxia complicated with retinal hemorrhage. Methods: It was a retrospective case series. Seven hundred and twenty-one cases with neonatal asphyxia after 72 hours of birth were enrolled in this study. Fundus examination was performed on these newborns using the third generation wide-angle digital retina imaging system (RetCamⅢ), and the bleeding level was divided into level I, level Ⅱ and level Ⅲ. The conditions of the newborn and the mother during pregnancy were correlatively analyzed. The other factors were also analyzed including delivery mode, birth weight, gestational age, gender, grade of neonatal asphyxia, scalp hematoma, intracranial hemorrhage, fetal intrauterine distress, mother's age and antenatal complications. Single factor χ(2) test and multivariate logistic regression analysis were used to screen and judge risk factors causing retinal hemorrhage related to neonatal asphyxia. Results: In 721 cases of neonatal asphyxia, retinal hemorrhage was found in 204 newborns (28.29%). The hemorrhage was at level Ⅰ in 77 cases (37.75%) , at level Ⅱ in 38 cases (18.63%) and at level Ⅲ in 89 cases (43.63%) . Four cases also had vitreous hemorrhage. Asphyxia was mild in 673 infants (93.34%) and severe in 48 infants (6.66%). The difference in the degree of retinal hemorrhage between the patients with mild and severe asphyxia was significant (χ(2)=22.336, P=0.000). When asphyxia was aggravated, the degree of retinal hemorrhage increased. Relative factors analysis showed that delivery mode (χ(2)=158.643, P<0.05), gestational age (χ(2)=24.522, P<0.05), birth weight (χ(2)=11.916, P<0.05) and grade of neonatal asphyxia (χ(2)=19.809, P<0.05) had correlations with retinal hemorrhage. Logistic regression analysis indicated that grade of neonatal asphyxia and delivery mode were risk factors of retinal hemorrhage in neonatal asphyxia (OR=0.304, 0.085). Conclusion: The incidence of retinal hemorrhage in neonatal asphyxia was 28.29%. The degree of neonatal asphyxia and delivery mode may play roles in the occurrence of retinal hemorrhage in newborns with asphyxia. With aggravation of asphyxia, the degree of retinal hemorrhage may increase. (Chin J Ophthalmol, 2017, 53: 358-362).

Bile acid receptor TGR5 overexpression is associated with decreased intestinal mucosal injury and epithelial cell proliferation in obstructive jaundice

Bile acids stimulate intestinal epithelial proliferation in vitro. We sought to investigate the role of the bile acid receptor TGR5 in the protection of intestinal epithelial proliferation in obstructive jaundice. Intestinal tissues and serum samples were obtained from patients with malignant obstructive jaundice and from bile duct ligation (BDL) rats. Intestinal permeability and morphological changes in the intestinal mucosa were observed. The functions of TGR5 in cell proliferation in intestinal epithelial injury were determined by overexpression or knockdown studies in Caco-2 and FHs 74 Int cells pretreated with lipopolysaccharide (LPS). Internal biliary drainage was superior to external biliary drainage in recovering intestinal permeability and mucosal histology in patients with obstructive jaundice. In BDL rats, feeding of chenodeoxycholic acid (CDCA) decreased intestinal mucosa injury. The levels of PCNA, a marker of proliferation, increased in response to CDCA feeding and were paralleled by elevated TGR5 expression. CDCA upregulated TGR5 expression and promoted proliferation in Caco-2 and FHs 74 Int cells pretreated with LPS. Overexpression of TGR5 resulted in increased PCNA, cell viability, EdU incorporation, and the proportion of cells in S phase, whereas knockdown of TGR5 had the opposite effect. Our data indicate that bile acids promote intestinal epithelial cell proliferation and decrease mucosal injury by upregulating TGR5 expression in obstructive jaundice.

[Clinical analysis of two cases of imported children Zika virus infection in China]

OBJECTIVE

To analyze the clinical characteristics, outcome and diagnosis of two cases of imported children Zika virus infection in China.

METHOD

A retrospective analysis was performed on clinical characteristics, treatment and outcome of two cases of imported children with Zika virus infection in February 2016 in Enping People's Hospital of Guangdong.

RESULT

Two cases of children with imported Zika virus infection resided in an affected area of Venezuela, 8-year-old girl and her 6 year-old brother. The main findings on physical examination included the following manifestations: fever, rash, and conjunctivitis. The rash was first limited to the abdomen, but extended to the torso, neck and face, and faded after 3-4 d. The total number of white blood cells was not high and liver function was normal. The diagnosis of two cases of Zika virus infection was confirmed by the expert group of Guangdong Provincial Center for Disease Control and Prevention, according to the epidemiological history, clinical manifestations and Zika virus nucleic acid detection results.Treatment of Zika virus infection involves supportive care. Two Zika virus infection children had a relatively benign outcome.

CONCLUSION

At present, Zika virus infection in children is an imported disease in China. No specific therapy is available for this disease. Information on long-term outcomes among infants and children with Zika virus disease is limited, routine pediatric care is advised for these infants and children.

[Clinical diagnosis and treatment progress of acute otitis externa]

Acute otitis externa(AOE) is defined as diffuse inflammation of the external ear canal skin or subdermis occurred in 3 weeks,which sometimes may also involve the pinna or tympanic membrane.Clinical manifestations include:otalgia,itching,fullness,sometimes with hearing loss.The hallmark sign of AOE is tenderness with movement of the tragus or pinna AOE Often occurs in adults or children older than age of 2,while little morbidity in children under the age of 2.Lifetime incidence is up to 10% in a persons life.Recently,a lot of different versions of the AOE clinical practice guidelines were published abroad.In this review ,the etiology,diagnose,therapy,prevention,are comprehensive described,which on the basis of evidence-based medicine.

[The progress of stem cells in the treatment of olfactory dysfunction]

Olfactory dysfunction is one of the common diseases in the Department of Otorhinolaryngology. Although the olfactory nerve has ability to regenerate in human central nervous system, if the damage involves nerve, only a few patients can restore the olfactory function. At present, there is no satisfactory treatment for sensorineural olfactory dysfunction. Therefore, it is urgent to explore new and effective method for treating sensorineural olfactory dysfunction. The progress of stem cells in the treatment of olfactory dysfunction is reviewed in this article.

Knockdown of Astrocyte Elevated Gene-1 Inhibits Activation of Hepatic Stellate Cells

BACKGROUND

Astrocyte elevated gene-1 (AEG-1) is a positive regulator of tumorigenesis and a valuable prognostic marker of a diverse array of cancers, including liver cancer; however, the relationship between AEG-1 and hepatic fibrogenesis is not known.

OBJECTIVE

The objective of this study was to explore the expression of AEG-1 during hepatic fibrogenesis and determine how AEG-1 regulates the profibrogenic phenotype of hepatic stellate cells (HSCs).

METHODS

The levels of AEG-1 were monitored in the fibrotic livers and transforming growth factor-β (TGF-β)- or lipopolysaccharide (LPS)-stimulated HSCs. The expression of AEG-1 was knocked down by lentivirus-mediated short hairpin RNA in HSCs, and collagen expression, proliferation assays, apoptosis induction studies, and migration assays were simultaneously conducted in vitro.

RESULTS

AEG-1 expression was increased in the fibrotic livers. At the cellular level, TGF-β or LPS stimulation, which caused HSC activation, induced AEG-1 expression in HSC-T6 and primary rat HSCs (P < 0.05). Knockdown of AEG-1 inhibited collagen I and α-smooth muscle actin expression (P < 0.05), reduced cell proliferation (P < 0.05) and motility (P < 0.05), and induced cell apoptosis (P < 0.05) in HSCs. This antifibrotic effect caused by lack of AEG-1 was associated with the inactivation of PI3K/Akt and the mitogen-activated protein kinase pathway.

CONCLUSIONS

Knockdown of AEG-1 suppressed the activation of HSCs by modulating the phenotype and inducing apoptosis. AEG-1 might be a potential target in treatment of hepatic fibrosis.

Cannabinoid receptor 2 and several digestive system diseases

The endocannabinoid system is made up of endocannabinoid, cannabinoid receptor type 1 (CB1) and cannabinoid receptor type 2 (CB2). A multitude of physiological effects and putative pathophysiological roles have been proposed for the endogenous cannabinoid system in the gastrointestinal tract, liver, pancreas and tumors. This paper aims to review the endocannabinoid system and the relations of CB2 with irritable bowel syndrome, inflammatory bowel disease, pancreatitis, hepatic disease and digestive system tumors.

Surgical management of venous malformation in soft tissue with the guidance of magnetic resonance imaging and percutaneous sinus angiography/three-dimensional computed tomography imaging

BACKGROUND

Venous malformation (VM) is a common vascular malformation in soft tissue. Surgical management plays an important role in its treatment. The location, extent, and adjacent anatomy of the lesion are crucial information for the safety of operation. This study introduces the application of magnetic resonance imaging and percutaneous sinus angiography/three-dimensional computed tomography imaging in gathering above information.

METHODS

A retrospective analysis was made in the patients with venous malformation from January 2012 to June 2014 in our clinic. All patients underwent magnetic resonance imaging and percutaneous sinus angiography/three-dimensional computed tomography imaging. The location, extent of the lesion, its draining veins, and the relationship with around tissues were showed. Surgical management was carried out in the lesions which were well defined, located in the superficial fascia without important vessels and nerves across it. The wound was repaired by skin flap or skin graft.

RESULTS

A total of 13 patients underwent complete surgical removal of the lesions, including five type I venous malformations and eight type II venous malformations. Ten lesions were removed by undermining dissection, and the wound was repaired by the undermined flap. Three superficial lesions were removed together with the skin over it, and the wound was repaired by the skin graft. In the six months to two years of follow-up period, none of the recurrence of the lesion was observed.

CONCLUSION

Magnetic resonance imaging and percutaneous sinus angiography/three-dimensional computed tomography imaging can display abundant morphological details of venous malformation, which are helpful for the surgical management.

Kasabach-Merritt phenomenon in Chinese children: Report of 19 cases and brief review of literature

Kasabach-Merritt phenomenon (KMP) is life-threatening, charactered by the profound thrombocytopenia and consumptive coagulopathy associated with vascular tumors. The therapy of KMP still remains challenging. In this study, we retrospectively analyzed the clinical data of KMP treated in Nanjing Children's Hospital and Jinling Hospital, China, and brief reviewed the literature on KMP. From Jan. 2005 to Dec. 2014, a total of 19 cases of KMP were enrolled into this study. Laboratory results showed that seven patients had typical disseminated intravascular coagulation (DIC), and others were atypical DIC. CT scanning showed the low-density tumor with obvious intensification in enhanced scanning, and the large distorted arteries in association with the tumor. After the admission, the patients received the infusion of platelets and the applying of dipyridamole, steroids, and other necessary drugs. Eight patients underwent complete surgical removal of the tumor, or partial removal with subsequent chemotherapy of vincristine. Three patients underwent only the chemotherapy of vincristine. Eight patients underwent the intralesional injection of absolute ethanol. Pathological examination showed eighteen samples were kaposiform hemangioendothelioma, and one tufted agioma. In our cases, six patients died from extensive hemorrhage and subsequent multiple organ failure. The others survived. In conclusion, KMP in Chinese children has typical symptoms. Kaposiform hemangioendothelioma is the most frequent vascular tumor associated with KMP. The individual treatments with surgical management, chemotherapy with vincristine, and intralesional injection of absolute ethanol can achieve good results in most of the patients with KMP.

Surgical management of giant neurofibroma in soft tissue: a single-center retrospective analysis

Neurofibroma, a common benign tumor in soft tissue, continues to grow, and often appears to be giant. In this study, we retrospectively analyzed the surgical treatment of 26 patients with giant neurofibromas in our clinic in the past 10 years from Jan. 2004 to Dec. 2013. The tumors were located in the head (n = 10), trunk (n = 9), limbs (n = 5), and multi-sites (n = 2). According to the location and extent of the lesion, as well as the adjacent anatomy, surgical management was performed to partially (n = 15) or almost completely (n = 11) resect the tumor. The wounds were repaired by skin flap or skin graft. Among them, one child with a giant tumor in the scalp underwent three times of skin expander treatment, and acquired complete removal of the tumor finally without baldness. Eleven cases underwent the interventional embolization of tumor's nutrient arteries, which successfully reduced the bleeding in operation. Most of the skin flap and skin graft survived well. After operation, the appearance of the patients and the function of the limbs were improved largely. In conclusion, for the giant neurofibroma, surgical treatment effectively reduces the tumor burden, rehabilitates the appearance and function, and so improves the quality of life. Skin expandor and interventional embolization of nutrient artery can be used when appropriate.

Protective effect of curcumin on intestinal mucosal barrier in rats with obstructive jaundice

AIM: To investigate the protective action of curcumin on small intestinal mucosal barrier in rats with obstructive jaundice.

METHODS: Thirty-six male SD rats were randomly divided into a sham operated group (SO), an obstructive jaundice group (OJ) and a curcumin treatment group (Cur). Using a light microscope, small intestinal tissue morphological changes were observed, the intestinal villus height and mucosal thickness were measured, the levels of plasma endotoxin were determined by limulus reagent method, the levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by radioimmunoassay, intestinal diamine oxidase (DAO) activity was determined by spectrophotometric method, and the expression of nuclear factor kappa B (NF-κB) and intercellular adhesion molecule-1 (ICAM-1) was detected by immunohistochemical method.

RESULTS: In the OJ group, intestinal villi were disordered, sparse and showed fracture and edema, and intestinal mucosal atrophy, epithelial cell necrosis and shedding, and inflammatory cell infiltration were observed. Intestinal mucosal changes in the Cur group were significantly reduced compared with the OJ group: intestinal villi were neatly arranged, intestinal mucosa was thickened, villous edema was mild, there was no obvious epithelial cell loss, and inflammatory cell infiltration was reduced. Compared with the SO group, the levels of endotoxin, TNF-α and IL-6 in the OJ group were significantly increased (P < 0.01), and the intestinal DAO activity, intestinal villus height and mucosal thickness were significantly decreased (P < 0.01). Compared with the OJ group, the levels of endotoxin, TNF-α and IL-6 in the Cur group were significantly decreased (P < 0.05 or 0.01), and the intestinal DAO activity, intestinal villus height and mucosal thickness were significantly increased (P < 0.05). Compared with the SO group, the expression of NF-κB and ICAM-1 in the OJ group was significantly up-regulated (P < 0.01); however, the expression of NF-κB and ICAM-1 in the Cur group was significantly down-regulated compared with the OJ group (P < 0.05 or 0.01).

CONCLUSION: Curcumin protects against intestinal mucosal barrier injury in rats with obstructive jaundice possibly by inhibiting expression of NF-κB, TNF-α, IL-6 and ICAM-1.

Cirrhosis with infective endocarditis: Report of two cases

Epidemiological studies have shown that the incidence of infective endocarditis (IE) has dropped, but it is not clinically rare. If not treated timely, the patients will suffer from a high risk of mortality. Early prevention, timely diagnosis, rational use of antimicrobial drugs and proper operation timing are important for decreasing the fatality rate. Cirrhotic patients are prone to low immunity and intestinal bacterial translocation. When unexplained fever, septicemia, new heart murmurs or the changes of primary heart murmurs are noted clinically, the physicians should pay attention to IE, and blood culture and cardiac ultrasound are needed to establish a diagnosis.

Identification of miRNAs that specifically target tumor suppressive KLF6-FL rather than oncogenic KLF6-SV1 isoform

The Krüppel like factor 6 (KLF6) gene encodes multiple protein isoforms derived from alternative mRNA splicing, most of which are intimately involved in hepatocarcinogenesis and tumor progression. Recent bioinformatics analysis shows that alternative mRNA splicing of the KLF6 gene produces around 16 alternatively spliced variants with divergent or even opposing functions. Intriguingly, the full-length KLF6 (KLF6-FL) is a tumor suppressor gene frequently inactivated in liver cancer, whereas KLF6 splice variant 1 (KLF6-SV1) is an oncogenic isoform with antagonistic function against KLF6-FL. Compelling evidence indicates that miRNA, the small endogenous non-coding RNA (ncRNA), acts as a vital player in modulating a variety of cellular biological processes through targeting different mRNA regions of protein-coding genes. To identify the potential miRNAs specifically targeting KLF6-FL, we utilized bioinformatics analysis in combination with the luciferase reporter assays and screened out two miRNAs, namely miR-210 and miR-1301, specifically targeted the tumor suppressive KLF6-FL rather than the oncogenic KLF6-SV1. Our in vitro experiments demonstrated that stable expression of KLF6-FL inhibited cell proliferation, migration and angiogenesis while overexpression of miR-1301 promoted cell migration and angiogenesis. Further experiments demonstrated that miR-1301 was highly expressed in liver cancer cell lines as well as clinical specimens and we also identified the potential methylation and histone acetylation for miR-1301 gene. To sum up, our findings unveiled a novel molecular mechanism that specific miRNAs promoted tumorigenesis by targeting the tumor suppressive isoform KLF6-FL rather than its oncogenic isoform KLF6-SV1.

Percutaneous sinus angiography and three-dimensional CT imaging showing morphological and draining features of venous malformations in soft tissue

OBJECTIVE

Venous malformation (VM) is a common vascular malformation in soft tissue. Its morphological and draining features, relationship with main vein, and hemodynamics in the lesion are not completely clear till now. Above information is important for choice of treatment.

METHODS

From January 2012 to December 2013, 23 patients were enrolled into this study. Percutaneous puncture into the lesion was made and contrast media was injected into venous sinus. Immediately after that CT scan was performed, and repeated several minutes later. Then three-dimensional imaging was performed to show the morphology and draining veins of VMs, and the relevant main veins. The hemodynamics in the lesion was also evaluated.

RESULTS

All patients underwent successful examination. Three-dimensional imaging showed an irregular shape of VM. Based on the draining features, VMs were classified into three types: (1) Type I (7/23): malformation without visible draining vein; (2) Type II (10/23): malformation with normal draining vein; (3) Type III (6/23): malformation with abnormal dilated draining vein. The flow in type I VMs was slow. Contrast media retained in the lesion for more than 1 day. The flow in type III VMs was fast. Contrast media flowed away rapidly. The flow of type II VMs was between type I and type III. According to above information and adjacent anatomy, all patients received suitable treatment, including sclerotherapy with absolute ethanol and bleomycin A5, intralesional copper wires retention, surgical removal, and combinational therapy of the above methods.

CONCLUSIONS

This procedure can clearly show the morphological and draining features of VM and its relationship with main vein, and further evaluate the hemodynamics in the lesion, which are helpful for the choice of treatment.

Management of periorbital hemangioma by intralesional glucocorticoids and systemic propranolol: a single-center retrospective study

Periorbital hemangioma may lead to the vision impairment so effective treatment should be adopted in time. In this study, we made a retrospective analysis of intralesional glucocorticoids and systemic propranolol in the management of periorbital hemangioma. From Jan. 2006 to Dec. 2013, twenty-five children with periorbital hemangioma were enrolled into this study. Among them, sixteen children accepted intralesional injection of compound betamethasone preparation. Eight children accepted systemic propranolol. One child accepted both of the two treatments. The follow-up period ranged from 6 months to 60 months. The results showed that in the patients with intralesional compound betamethasone preparation, 13/16 patients' tumors involuted completely. 3/16 patients' tumors didn't involute completely at the end of follow-up. In the patients with systemic propranolol, 8/8 patients' tumors involuted almost completely. One patient didn't respond to intralesional glucocorticoids, and so switched to systemic propranolol, which lead to the involution of tumor finally. The adverse effects in the patients with intralesional glucocorticoids included local soft tissue atrophy, local ulcer, and Cushing-like manifestations, which occurred in three patients respectively. In the patients with systemic propranolol, mild diarrhoea occurred in one child. According to our observation, both of intralesional glucocorticoids and systemic propranolol achieved good results in the management of periorbital hemangioma. Systemic propranolol showed superiority in efficacy and safety. We recommend systemic propranolol as the first-line therapy. However, for the children who can't tolerate systemic propranolol, intralesional glucocorticoids still is a feasible choice.

Multiple myeloma misdiagnosed as acute pancreatitis: A cases report

As the most common form of malignant plasma cell disease, multiple myeloma is also known as myeloma, plasma cell myeloma or Kahler's disease. The incidence of multiple myeloma has gradually increased in recent years, but the diagnosis is often difficult due to various clinical manifestations and multiple affected organs. In this article, we report a case of multiple myeloma in a patient with abnormal accumulation of plasma cells in bone marrow, elevated level of a monoclonal protein in serum and urine, bone pain, renal injury, anemia, skull fractures and, intriguingly, high level of amylase in blood and urine. Although it was initially misdiagnosed as acute pancreatitis, the patient is finally diagnosed with multiple myeloma. Clinicians will benefit from this case in terms of how to improve diagnosis rate and avoid misdiagnosis.

Pathogenesis of intestinal barrier dysfunction in obstructive jaundice

Intestinal mucosal barrier is a key structure that normally prevents the passage of harmful molecules across the mucosa and into the circulation, including mechanical barrier, immunological barrier, biological barrier and chemical barrier. Obstructive jaundice (OJ) is frequently associated with infectious complications, mainly due to sepsis and renal dysfunction. The key events in the pathophysiology of these complications are endotoxemia of gut origin and increased intestinal permeability because of intestinal barrier dysfunction, as demonstrated in experimental and clinical studies. However, the mechanisms involved in this phenomenon remain obscure. Here we review recent progress in understanding the pathogenesis of intestinal barrier dysfunction in OJ.

Pathological characteristics of chronic hepatitis B in HBeAg-positive and HBeAg-negative patients: An analysis of 158 cases

AIM: To find the differences in liver histopathology between HBeAg-positive and HBeAg -negative patients with chronic hepatitis B (CHB), and to analyze their relationship with clinical data.

METHODS: CHB patients ( n = 158) who were admitted to the Second Hospital of Hebei Medical University for a liver biopsy from January 2005 to December 2012 were enrolled. They were divided into an HBeAg-positive ( n = 86) and an HBeAg-negative group ( n = 72) based on the presence of HBeAg or not. Gender, age, alanine aminotransferase (ALT) and HBV DNA viral load were recorded and statistically analyzed with SPSS l3.0.

RESULTS: The age differed significantly between the HBeAg-positive group and HBeAg-negative group (t = -7.50, P < 0.01), although there was no statistically significant difference in sex ratio between the two groups (χ² = 0.10, P > 0.05). A significant difference was noted in the constituent ratio of liver fibrosis stages between the two groups (χ² = 20.79, P < 0.01). The fibrosis stage score in HBeAg-positive women was lower than that in men (1.48 ± 0.69 vs 2.09 ± 1.29, P < 0.05). For HBeAg-positive patients, both inflammation grade and fibrosis stage scores were significantly higher in the > 40 years age group than in the 30-40 years age group and < 30 years age group (2.93 ± 1.03 vs 2.09 ± 1.27, 2.16 ± 0.69; 2.67 ± 1.23 vs 1.86 ± 1.25, 1.65 ± 0.99, all P < 0.05). For HBeAg-negative patients, fibrosis stage score was significantly lower in the < 30 years age group than in the 30-40 years age group and > 40 years age group (1.57 ± 0.98 vs 2.73 ± 1.37, 3.03 ± 1.06, both P < 0.05). In the HBeAg-positive group, there was a positive correlation between age and inflammation grade or fibrosis stage score (r = 0.30, 0.34, both P < 0.01). In the HBeAg-negative group, there was also a positive correlation between age and inflammation grade or fibrosis stage score (r = 0.26, 0.34, both P < 0.05). In the HBeAg-positive group, ALT levels were positively correlated with inflammation grade or fibrosis stage score (r = 0.32, 0.24, both P < 0.05). In the HBeAg-negative group, ALT levels were positively correlated inflammation grade score (r = 0.33, P < 0.01). There was a significant difference in the constituent ratio of viral load between the two groups of patients (χ² = 38.63, P < 0.01). The positive rate of HBV DNA was significantly higher in the HBeAg-positive group (73/86) than in the HBeAg-negative group (37/72). In the HBeAg-positive group, viral load was negatively correlated with inflammation grade score (r = -0.25, P < 0.05). In the HBeAg-negative group, viral load was positively correlated with inflammation grade or fibrosis stage score (r = 0.40, 0.43, both P < 0.05).

CONCLUSION: There is a certain correlation between gender, age, ALT and HBV DNA viral load and liver pathological changes in both HBeAg-positive and -negative CHB patients. Liver injury may sometimes be heavier in HBeAg-negative CHB patients than in HBeAg-positive CHB patients.

High expression of IL-6, NF-κB and ICAM-1 in the intestinal mucosa is associated with intestinal mucosal injury in patients with obstructive jaundice

AIM: To observe the morphology and ultrastructure changes in the intestinal mucosa in patients with obstructive jaundice, and to investigate the relationship between the expression of interleukin-6 (IL-6), nuclear factor κB (NF-κB) and intercellular adhesion molecule-1 (ICAM-1) and intestinal mucosal injury.

METHODS: TThe morphology and ultrastructure changes in the intestinal mucosa in patients with obstructive jaundice were observed by light microscopy and electron microscopy, respectively. The expression of IL-6, NF-κB and ICAM-1 in the intestinal mucosa was detected using immunohistochemistry.

RESULTS: Light microscopy analysis revealed that, in patients with obstructive jaundice, the intestinal villi were arranged disorderly and became shorter or absent, the intervals of villi were widened, and necrosis of the enterocytes and glands were visible. Electron microscopy analysis showed that, although the junctional complexes appeared intact, the microvilli were loose, the enterocytes became flat, the mitochondria swelled up and even become vacuolated, and the mitochondrial cristae collapsed. In addition, it could be seen that bacteria were attached to the mucosa surface. The expression of IL-6, NF-κB and ICAM-1 in patients with obstructive jaundice was increased significantly compared with controls (IL-6: 0.18 ± 0.02, vs 0.13 ± 0.01, P < 0.05; NF-κB: 0.23 ± 0.01 vs 0.19 ± 0.03, P < 0.05; ICAM-1: 0.17 ± 0.01 vs 0.13 ± 0.02, P < 0.05).

CONCLUSION: Intestinal mucosal injury in patients with obstructive jaundice is associated with high expression of IL-6, NF-κB and ICAM-1.

Treatment of isolated gastric varices by balloon-occluded retrograde transvenous obliteration using lauromacrogol: An analysis of 23 cases

AIM: To evaluate the efficacy and safety of lauromacrogol in treating isolated gastric varices by balloon-occluded retrograde transvenous obliteration (BRTO).

METHODS: The clinical data for 23 patients who were diagnosed with isolated gastric varices with gastrorenal shunt and treated by BRTO using lauromacrogol from November 2009 to September 2012 were retrospectively analyzed. The clinical efficacy, safety and complications of this procedure were evaluated.

RESULTS: The procedure was successful in 21 cases. Hypotension and sinus bradycardia were observed intraoperatively in three cases and disappeared when the balloon was withdrawn. No complications such as ascites and hepatorenal function exacerbation occurred after the operation. Endoscopic examination at 3 mo after the procedure showed that varices disappeared in 13 cases, remarkably decreased in size in 6 cases, and had no significant changes in 2 cases. During 3 to 18 mo of follow-up, no bleeding was observed.

CONCLUSION: BRTO using lauromacrogol is effective and safe in treating isolated gastric varices with gastrorenal shunt.

RRKIP overexpression inhibits hepatic stellate cell adhesion to extracellular matrix

AIM: To investigated the role of Raf kinase inhibitor protein (RKIP) in the adhesion of hepatic stellate cells (HSCs) to extracellular matrix (ECM).

METHODS: HSCs (LX-2 cell line) were cultured and infected with an adenovirus vector carrying RKIP (RKIP-AD) or the control adenovirus vector (GFP-AD). Green fluorescence was detected under an inverted fluorescence microscope to assess the infection efficiency. The number of virus particles required was calculated as the cell count × multiplicity of infection (MOI). RKIP protein expression was investigated by Western blot. Infected cells were adjusted to a density of 1×10⁵ cells/mL, plated in dishes cultured with matrigel, type I collagen, and fibronectin. LX-2 cells were cultured for 1 h in a humidified atmosphere of 5% CO₂ and 95% air at 37 ℃. The cells were fixed in 4% paraformaldehyde and stained with crystal violet. Cells in each field were viewed under light microscopy and positively stained cells were counted.

RESULTS: The infection efficiency of RKIP-AD or GFP-AD reached 80%-90%. Adenovirus-mediated gene transfection at a MOI of 5 was employed for subsequent experiments. In the RKIP-AD group, RKIP expression was significantly higher than that in the control group (3.47 ± 0.02 vs 1.74 ± 0.13, P < 0.05). RKIP overexpression reduced the number of HSC adhered to matrigel (80 ± 14 vs 152 ± 4, P < 0.05), type I collagen (70 ±13 vs 138 ± 36, P < 0.05) and fibronectin (133 ± 27 vs 276 ± 106, P < 0.05) compared to the control group.

CONCLUSION: RKIP overexpression inhibits HSC adhesion to ECM.

Curcumin ameliorates hydrogen peroxide-induced epithelial barrier disruption by upregulating heme oxygenase-1 expression in human intestinal epithelial cells

BACKGROUND

Disruption of epithelial tight junctions (TJ) followed by loss of barrier function is of crucial importance in the pathogenesis of a variety of gastrointestinal disorders. Heme oxygenase-1 (HO-1), which can be induced by curcumin (Cur), provides protection against various forms of oxidative stress.

AIMS

The protective effect of Cur on oxidative stress-induced intestinal barrier disruption in human intestinal epithelial cells was elucidated in this study.

METHODS

H(2)O(2)-induced Caco-2 enterocytic monolayers were incubated in the presence or absence of Cur and/or zinc protoporphyrin (ZnPP). The trans-epithelial electrical resistance (TEER) and the flux of sodium fluorescein in the filter-grown Caco-2 cell monolayers were measured. The expression and localization of the TJ protein occludin and zonula occluden-1 (ZO-1) were evaluated by western blot and immunofluorescence microscopy. The mRNA and protein levels of HO-1 were analyzed by real-time PCR and western blot.

RESULTS

Cur attenuated H(2)O(2)-induced disruption of paracellular permeability (TEER 52.02 ± 10.15% vs 22.71 ± 3.11%; sodium fluorescein flux 12.41 ± 2.19% vs 32.00 ± 4.97%, P < 0.05) and induced HO-1 mRNA (6.64 ± 0.48 vs 3.22 ± 0.28, P < 0.05) and protein (291.00 ± 9.17% vs 99.00 ± 10.00%, P < 0.05) expression in Caco-2 cells. After administration of H(2)O(2), occludin and ZO-1 proteins were restored by Cur (occludin 175.67 ± 29.50% vs 53.67 ± 24.19%, P < 0.05; ZO-1 139.67 ± 33.71% vs 36.00 ± 15.88%, P < 0.05) and this effect was blocked by HO-1 inhibitor, ZnPP (occludin 54.67 ± 10.02% vs 168.33 ± 36.47%, P < 0.05; ZO-1 50.00 ± 15.13% vs 117.67 ± 38.81%, P < 0.05).

CONCLUSION

Cur protects human intestinal epithelial cells against H(2)O(2)-induced disruption of TJ and barrier dysfunction via the HO-1 pathway.

Role of the endocannabinoid system in the pathogenesis of cirrhosis

The endocannabinoid system is made up of endocannabinoid, cannabinoid receptor type 1 (CB1) and cannabinoid receptor type 2 (CB2). Many studies have found that hepatic myofibroblasts and vascular endothelial cells express more CB1 and CB2 in the development of chronic liver disease. There is a close relationship between the endocannabinoid system and liver fibrosis and cirrhosis. This paper aims to review recent advances in understanding the role of the endocannabinoid system in the pathogenesis of fatty liver disease, liver fibrosis and cirrhosis complications.

Ultrasound-assisted compatible in situ hydrolysis of sugarcane bagasse in cellulase-aqueous-N-methylmorpholine-N-oxide system for improved saccharification

To fully exploit the benefits of N-methylmorpholine-N-oxide (NMMO) in lignocelluloses bioconversion, a compatible system was established for efficient in situ saccharification of cellulose in NMMO-aqueous media in which the NMMO is able to activate and solubilize the cellulose, and the cellulases possess high stability and activity. Cellulase retained its original activity after being pre-incubated in 15% and 20% (w/v) NMMO solutions. After optimization of reaction parameters, high saccharification rate (96.5%) was obtained in aqueous-NMMO media by ultrasound assisted treatment of cellulose. The viscosity and FTIR analysis revealed that NMMO-treated cellulose under ultrasonic condition was porous and amorphous, which led to improved saccharification. The addition of trifle lignin in lower concentration improved the saccharification efficiency of sugarcane bagasse, while higher concentration interferes with hydrolysis. In conclusion, these findings provided great implications to develop a continuous process NMMO-cellulases system for transformation of native biomass.

Expression of TRX and TXNIP in patients with ulcerative colitis

AIM: To detect the expression of thioredoxin (TRX) and thioredoxin-interacting protein (TXNIP) in peripheral blood and colonic mucosa of patients with ulcerative colitis (UC) and to analyze their relationship with UC disease severity.

METHODS: Colonic mucosa and venous blood samples were collected from 29 patients with UC. According to the Sutherland activity index, the patients were divided into two groups: patients with mild to moderate disease (n = 17, group A) and those with severe disease (n = 12, group B). Meanwhile, samples from 25 normal persons were used as controls (group C). The expression of TRX and TXNIP in the colonic mucosa was detected by immunohistochemistry, and serum levels of TRX and TXNIP were determined by ELISA. Statistical analysis was carried out to analyze the correlation between expression of TRX/TXNIP and UC severity.

RESULTS: Serum levels of TRX and TXNIP were lowest in group C, followed by groups A and B. Serum levels of TRX and TXNIP showed no significant differences between groups A and C (both P > 0.05), but differed significantly among the three groups (P < 0.05). The expression of TRX in the colonic mucosa was lowest in group C, followed by groups A and B, while a reverse trend was observed for the expression of TXNIP. Significant differences were found in the expression of TRX and TXNIP between any of the two groups (all P < 0.05). Serum levels of TRX and TXNIP were correlated with the severity of UC activity (r = 0.421, 0.439; both P < 0.01). Expression of TRX and TXNIP in the colonic mucosa was also correlated with the severity of UC activity (r = 0.940, -0.940; both P < 0.01).

CONCLUSION: There is a significant correlation between TRX/TXNIP expression and the severity of UC. TRX and TXNIP may be involved in the pathogenesis of UC via mechanisms associated with oxidative stress.