Effect of beinaglutide combined with metformin versus aspart 30 with metformin on metabolic profiles and antidrug antibodies in patients with type 2 diabetes: a randomized clinical trial

Objective

This prospective study aimed to evaluate the effect of beinaglutide combined with metformin versus aspart 30 with metformin on metabolic profiles and antidrug antibodies (ADAs) in patients with type 2 diabetes (T2D).

Methods

A total of 134 eligible participants were randomly assigned to the test group and the control group. Patients in the test group were treated with beinaglutide and metformin, whereas patients in the control group were randomly treated with aspart 30 and metformin, with a follow-up period of 6 months. The metabolic profiles and ADAs over 6 months were evaluated.

Results

After 6 months, 101 (75.37%) patients completed the study. Compared with the control group, the beinaglutide group had significant reductions in 2-h postprandial blood glucose (2hBG) and low blood glucose index (LBGI). Glycated hemoglobin (HbA1c) decreased in both groups relative to baseline. In the test group, one had treatment-emergent beinaglutide ADAs. Significant reductions in triglycerides (TG), non-fasting TG, weight, waist circumference (WC), and body mass index (BMI) were observed. The values of insulin sensitivity index (HOMA-IR) were decreased to a statistically higher degree with beinaglutide treatment.

Conclusion

Beinaglutide reduces metabolic dysfunction, LBGI, and weight in patients of T2D with a low risk of ADAs. Beinaglutide may offer the potential for a disease-modifying intervention in cardiovascular disease (CVD).

Clinical trial registration

www.chictr.org.cn, identifier ChiCTR2200061003.

Telemedicine-assisted structured self-monitoring of blood glucose in management of T2DM results of a randomized clinical trial

BACKGROUND

This prospective study aimed to compare telemedicine-assisted structured self-monitoring of blood glucose(SMBG) with a traditional blood glucose meter (BGM) in adults of type 2 diabetes mellitus (T2DM).

METHODS

Adult participants with T2DM were assigned to an intervention group or a control group. The patients in the intervention group received a connected BGM with real-time data submission as well as individual needs-based tele-coaching to address and improve motivation and daily diabetes self-management. The patients in the control group received a traditional BGM. Changes in glycated hemoglobin(HbA1c), low blood glucose index(LBGI), and diabetes self-management behaviors were analyzed.

RESULTS

The study demonstrated the superiority of the telemedicine-assisted structured SMBG versus the traditional BGM for improving HbA1c. Additionally, the telemedicine-assisted SMBG reduced the risk of hypoglycemia and enhanced diabetes self-management behaviors, as differences in the LBGI and the Diabetes Self-Management Questionnaire(DSMQ) results between the groups after 6 months were found to be significant.

CONCLUSIONS

Telemedicine-assisted structured SMBG helps physicians and patients to achieve a specific level of glycemic control and reduce hypoglycemia. The use of coaching applications and telemedicine-assisted SMBG indicated beneficial effects for T2DM self-management, which may help limit disease progression.

TRIAL REGISTRATION

Chinese Clinical Trail Registry No: ChiCTR2300072356 on 12/06/2023. Retrospectively registered.

Spontaneous rupture of the spleen at full term during pregnancy: a case report

Spontaneous rupture of the spleen during pregnancy is a rare, fatal disease. This condition is easily misdiagnosed as uterine rupture, placental abruption, or other obstetric diseases; and if a timely diagnosis is not made and effective treatment instituted, serious sequelae rapidly develop, including hemorrhagic shock and maternal and fetal death. Here, we report a case of spontaneous splenic rupture in a woman in her third trimester of pregnancy. Furthermore, through a literature review, we discuss the possible presentations, symptoms, and causes of splenic rupture during pregnancy, in the hope of facilitating the early diagnosis and treatment of this condition.

Effect of Benaglutide on Gut Microbiota and Fecal Metabolites in Patients with Type 2 Diabetes Mellitus

Objective

Benaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) that has been approved in the treatment of type 2 diabetes mellitus (T2DM). It is known to lead to significant weight loss, and it is hypothesized that changes in gut microbiota may play a significant role in such weight loss. However, it is unclear how gut microbiota and metabolites change as a result of benaglutide treatment.

Methods

Healthy participants and patients with T2DM were included in this study. They received differentiated treatments, and stool specimens were collected separately. These stool specimens were subjected to 16S ribosomal RNA amplicon and metagenomic sequencing to create fecal metabolomic profiles. The diversity of gut microbiota and metabolic products in the stools of each participant was analyzed.

Results

The data showed that Faecalibacterium prausnitzii was abundant in the gut microbiota of the control group, which was entirely made up of healthy individuals; however, it showed a statistically significant decrease in patients with T2DM treated with metformin alone, while no significant decrease was observed in patients treated with metformin combined with benaglutide. A metagenomic analysis revealed that benaglutide could improve the fecal microbiota diversity in patients with T2DM. Furthermore, there was a statistically significant correlation between the changes in the metabolites of patients with T2DM and the changes in their gut microbiota (including F. prausnitzii) after treatment with metformin and benaglutide.

Conclusion

These findings suggest that the weight-reducing effect of benaglutide is attributed to its ability to normalize the gut microbiota of patients with T2DM, particularly by increasing the abundance of F. prausnitzii.

Exogenous Insulin Antibody Syndrome in Patients with Type 2 Diabetes

Background

Exogenous insulin antibody syndrome (EIAS) is an immunological disorder caused by circulating insulin antibodies (IAs), featuring hypersensitivity to exogenous insulin and insulin resistance. With the wide use of recombinant human insulin and insulin analogs, there has been a significant proliferation of EIAS.

Case Report

We describe two cases of diabetes mellitus (DM) with hyperinsulinemia and high serum levels of IAs. They had never been exposed to methimazole, glutathione, lipoic acid, and other sulfhydryl drugs, but they all received insulin treatment. The patient in case 1 had recurrent hypoglycemia before hospitalization. A prolonged oral glucose tolerance test (OGTT) showed hypoglycemia with inappropriately high insulin levels. The patient in case 2 was hospitalized for diabetic ketosis. An OGTT indicated hyperglycemia with hyperinsulinemia and low levels of C-peptide. IAs induced by exogenous insulin in the two patients with DM were positive at high titers, prompting a diagnosis of another condition-EIAS.

Conclusion

We discussed the differences between these two cases of EIAS in clinical manifestations and treatment and summarized all patients of EIAS treated in our department to date.

Suboptimal blood pressure control and associated risk for cardiovascular mortality among stroke survivors in China

Background

Elevated blood pressure (BP) is associated with substantial morbidity and mortality in stroke survivors. China has approximately 7.5 million stroke survivors, and accounts for one third of stroke mortality worldwide, but little is known about the prevalence and management of elevated BP as well as its effect on cardiovascular death at the national level.

Purpose

We aim to describe the prevalence and treatment of elevated BP and assess the cardiovascular mortality attributable to elevated BP among stroke survivors in China.

Methods

Based on 3 million participants aged 35–75 years from all 31 provinces in mainland China recruited from September 2014 through August 2019, we assessed the prevalence and treatment of elevated BP (systolic BP ≥140mmHg or diastolic BP ≥90mmHg) among those with self-reported stroke. Cardiovascular death was recorded before December 31st 2019. The age- and sex- specific population attributable fractions of cardiovascular death from elevated BP were estimated based on hazard ratios derived by Cox regression analysis.

Results

Among 91,628 stroke survivors, the mean (SD) age was 62 (8) years, 49% were male sex. The median (IQR) stroke duration was 4 (2,7) years. 61.3% of the individuals had elevated BP, and the prevalence increased with age (from 47.6% at 35–44 years of age to 64.7% at 65–75 years of age) and was slightly higher in rural area (63.2%) than urban area (58.8%). 32.7% of the overall population were treated, and 23.4% of those with elevated BP were treated. Among stroke survivors, elevated BP accounted for 26% of cardiovascular death at 35–75 years of age, and about one third at 35–54 years of age. The age- and sex- specific results were shown in the Table.

Conclusions

In this nationwide cohort of stroke survivors from China, over 60% had elevated BP, and about one third were treated. Elevated BP was associated with particularly substantial cardiovascular mortality for young and middle-aged stroke survivors. National strategies targeting elevated BP are required to improve the prognosis of stroke survivors in China.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Key Research and Development Program from the Ministry of Science and Technology of China Age- and sex-specific HRs and PAFs

Atherosclerotic cardiovascular risk and simulation of lipid-lowering therapy in China

Background

Lipid-lowering therapy is a key strategy to reduce atherosclerotic cardiovascular disease (ASCVD) risk. However, little is known about the burden of lipid-lowering therapy in China.

Purpose

We aim to simulate the proportion of individuals in need of different lipid-lowering therapy regimens to reach diverse low-density lipoprotein cholesterol (LDL-C) goals based on the ASCVD risk stratification.

Methods

We used the data from China PEACE Million Persons Project, a national screening project covering 31 provinces in China. The ASCVD risk stratifications and LDL-C goals were based on the 2016 Chinese Guideline for the Management of Dyslipidemia in Adults. Stepwise lipid-lowering therapy (atorvastatin 20 mg, add-on ezetimibe and add-on evolocumab) was simulated by a Monte Carlo model based on individual's LDL-C level.

Results

We included 2,876,272 participants (89.7% of the screened) who were not receiving lipid-lowering therapy (mean age 55.8±9.9 years; 60.5% women). The proportion of participants at low, moderate, high and very high ASCVD risk were 57.9%, 17.5%, 22.3% and 2.3%, respectively. In individuals at low or moderate risk, 10.5% did not reach the goal of LDL-C<3.4mmol/L; after statin simulation, 99.8% met the goal. In high-risk patients, 49.0% did not reach LDL-C<2.6mmol/L; after statin monotherapy (82.7%), add-on ezetimibe (10.6%) and add-on evolocumab (6.7%), 99.7% met the goal. In very-high-risk patients, 72.2% did not reach LDL-C<1.8mmol/L; while 99.1% met the goal after all patients received the simulation: statin monotherapy (76.5%), add-on ezetimibe (13.0%) and add-on evolocumab (10.5%). In a total of 609,489 participants (21.2% of the overall participants) needing lipid-lowering therapy, 88.5% required statin monotherapy and 11.5% additional non-statin therapy (Figure).

Conclusions

Moderate-intensity statin therapy is pivotal in the lipid-lowering therapy in China; nearly 10% in need of lipid-lowering therapy required additional non-statin therapy.

Funding Acknowledgement

Type of funding sources: None.

[Comparison of the accuracy of predicting prognosis of brain function in patients after cardiopulmonary cerebral resuscitation with two kinds of electroencephalogram techniques combined with neuron-specific enolase]

Objective: To compare the accuracy of electroencephalography (EEG) grading or amplitude-integrated electroencephalography (aEEG) grading combined with NSE in predicting brain function prognosis after cardiopulmonary cerebral resuscitation (CPR) in adults. Methods: The patients who were admitted to Fujian Medical University Union Hospital after CPR from January 2015 to June 2019 were enrolled. Demographic data, Glasgow coma scale (GCS), blood neuron specific enolase (NSE), EEG grading and aEEG grading were collected. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients at 3 months after CPR. Accordingly, the patients were divided into two groups: favorable prognosis group and poor prognosis group, and relevant parameters were compared between the two groups. The predictive ability of EEG grading or aEEG grading combined with NSE for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve. Results: A total of 57 patients were enrolled, with 34 males and 23 females. The average age was (65±19) years old. In terms of Young EEG scales, there was 16 grade 1 cases (28.1%), 24 grade 2-5 cases (42.1%) and 17 grade 6 cases (29.8%), respectively. As for aEEG grading, there was 11 grade Ⅰ cases (19.3%), 25 grade Ⅱ cases (43.9%) and 21 grade Ⅲ cases (36.8%), respectively. There was no significant difference of age, sex, length of stay between the two groups (all P>0.05). However, there was significant difference of EEG grading scale, aEEG grading, GCS grading and NSE between the two groups (all P<0.05). The area under curve (AUC) of NSE, EEG grading and aEEG grading for predicting brain function prognosis was 0.81, 0.82 and 0.85, respectively (all P<0.01). In aEEG grading combined with NSE group, the AUC of was 0.92, and the optimal cut-off point was 4.5, with a sensitivity of 95.8% and a specificity of 79.0%. In EEG grading combined with NSE group, the AUC was 0.90, and the optimal cut-off point was 3.6, with a sensitivity of 92.1% and a specificity of 77.0%. Conclusions: aEEG grading combined with NSE is more accurate in predicting prognosis in patients with cardiopulmonary cerebral resuscitation when compared to EEG grading. Considering its feasibility, aEEG grading combined with NSE is more suitable for clinical application.

[Consistency of ALK Ventana-D5F3 immunohistochemistry interpretation in lung adenocarcinoma among Chinese histopathologists]

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer's protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion: There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.

[In vitro study of apical negative pressure irrigation on apical extrusion and E. faecalis elimination]

PURPOSE

To compare the efficiency of negative pressure irrigation and conventional syringe irrigation and evaluate the possibility as a new way of irrigation.

METHODS

In vitro silicone socket model was used to simulate the resistance of apical flow by apical surrounding tissues. The in vitro efficacy on apical extrusion and E.faecalis elimination between negative pressure irrigation and conventional syringe irrigation was compared. SPSS 17.0 software package was used for statistical analysis.

RESULTS

Negative pressure irrigation extruded less (P<0.05), and was more effective in E.faecalis elimination(P<0.05) than conventional syringe.

CONCLUSIONS

Negative pressure irrigation is a promising irrigation technique during root canal therapy.

[Optimization of delivering minimum Gd-DTPA at the posterior upper point on tympanic medial wall and hT2W-3D-FLAIR sequence for detecting endolymphatic hydrops]

Objective: To optimize delivery of gadolinium-diethylenetriamine pentaacetic acid(Gd-DTPA) at the posterior upper point on tympanic medial wall and heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery (hT2W-3D-FLAIR) sequence, and to implement the technique of detecting endolymphatic hydrops using gadolinium-enhancement MRI. Methods: Thirteen patients with periphery vertigo, who visited Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Changhai Hospital during June and December of 2017, were enrolled in the study.0.10-0.20 ml of Gd-DTPA in various dilutions (10, 20, and 40-fold) were delivered at the posterior upper point on tympanic medial wall using a soft-tipped tympanic suction and drug-spraying needle through an artificially perforated tympanic membrane. Inner ear MRI was performed at 8, 24 h after Gd-DTPA administration using a 3T MR machine in combination with a 20-channel Tim 4G head/neck coil and the sequence of hT2W-3D-FLAIR to detect the gadolinium-enhancement signal within the inner ear and possible endolymphatic hydrops. The scanning time was either 8 min 35 s or 15 min 11 s. Results: Efficient inner ear uptake of Gd-DTPA was detected and induced high signal to noise ratio of MRI in patients receiving targeted delivery of 0.15-0.20 ml of 10-fold diluted contrast agent at the posterior upper point on tympanic medial wall. At 8 h after delivery, significant uptake was detected in the scala tympani and vestibuli of hook region and basal turn of the cochlea, and perilymhatic compartment of the vestibule. At 24 h after delivery, the distribution of Gd-DTPA became homogenous in each turn of the cochlea and perilymphatic compartment of the vestibule. However, obvious individual variance existed in the inner ear uptake when 0.10 ml of 40-fold diluted Gd-DTPA was delivered. Efficient inner ear uptake and high quality images that generated in patients receiving 0.10, 0.15, and 0.20 ml of 20-fold Gd-DTPA demonstrated endolymphatic hydrops with minor individual variance. There was insignificant difference in the enhancement signal of inner ear between 0.15 and 0.10 ml groups when Gd-DTPA was diluted at 20-fold except for the signal of semicircular canal of 0.15 ml group (190.00±53.95 vs 165.50±42.13, t=2.61, P<0.05). There was insignificant difference in the image quality between 8 min 35 s and 15 min 11 s canning time. Various degrees of endolymphatic hydrops were detected in 7 cochleae and 11 vestibule, and both simultaneous cochlear and vestibular endolymphatic hydrops were detected in 4 ears. Cochlear endolymphatic hydrops was detected in all the 3 patients with definite Meniere's disease, and 2 of them had combined cochlear and vestibular endolymphatic hydrops. Endolymphatic hydrops was not detected in patients with possible Meniere's disease nor with symptoms of superior semicircular canal dehiscence. Conclusion: Targeted delivery of 0.10 ml with 20-fold diluted Gd-DTPA (total dosage of 5 μmol) at the posterior upper point on tympanic medial wall in combination with 8 min 35 s scanning time hT2W-3D-FLAIR sequence for inner ear MRI in a 3T MR machine is a clinically practical method to detect endolymphatic hydrops, and reduce the requirement for MRI hardware.

[Clinicopathological characteristics of adult T cell leukemia/lymphoma]

Objective: To investigate the clinical presentation, clinicopathologic features, diagnosis and differential diagnosis of adult T cell leukemia/lymphoma (ATLL). Methods: Four cases of ATLL from Fujian Cancer Hospital between October 2017 and May 2018 were analyzed using hematoxylin-eosin and immunohistochemical stains and polymerase chain reaction (PCR) for HTLV-1 provirus genes. The relevant literature was reviewed. Results: There were two males and two females, age range 38-80 years. All patients were from coastal cities of Fujian province. Clinical presentations including lymphadenopathy, hepatomegaly and splenomegaly were detected in most patients; skin lesion, hypercalcemia and lymphocytosis were also commonly detected.Histologically, there was diffuse effacement of the normal architecture by tumor cells infiltration. The inflammatory background is usually sparse, with scanty eosinophils. The atypical lymphoid cells were typically medium to large sized with pronounced nuclear pleomorphism, irregular nuclei, chromatin clumping and prominent nucleoli. Blast-like cells with transformed nuclei were present in variable proportions. Giant cells with convoluted or cerebriform nuclear contours may be present. Rare cases may be composed predominantly of anaplastic tumor cells. Characteristic "flower cells" with large multi-lobated nuclei can be seen. The tumor cells were strongly positive for CD2, CD3, CD5, CD4 and CD25, but negative for CD7, CD8 and cytotoxic molecules (including TIA-1, Granzyme B and perforin). In three cases, the large transformed cells were positive for CD30. In one case, the anaplastic large cells were diffusely and strongly positive for CD30. All cases were negative for EBER, but positive for HTLV-1 provirus. Conclusions: ATLL is a rare type of T cell lymphoma with unique clinical and pathological features, and should be distinguished from peripheral T cell lymphoma, NOS, ALK negative anaplastic large cell lymphoma and mycosis fungoides. Hypercalcemia, systemic disease, characteristic "flower cells" and specific immunophenotypic profile of CD3(+), CD4(+), CD25(+), and CD7(-) are highly suggestive. However, ATLL can only be confirmed if the presence of HTLV-1 provirus.

[Clinicopathologic features and expression of OCT4 protein in testicular diffuse large B cell lymphoma]

Objective: To evaluate the expression of OCT4 and SALL4 in testicular diffuse large B-cell lymphoma (DLBCL), and the utility of an immunohistochemical (IHC) panel of OCT4, SALL4 and CD20 in the differential diagnosis of DLBCL and GCT of the testis. Methods: Eighteen cases of testicular DLBCL were selected.IHC method was used to detect the protein expression of CD20, CD3, CD5, CD10, bcl-6, MUM1, Ki-67, bcl-2, c-MYC, OCT4 and SALL4. Results: Among the 18 cases, CD20 and PAX5 were strongly and diffusely expressed in all cases, while CD21, CD3, cyclinD1, SALL4, CD117 and PLAP were all negative. CD5, bcl-2 and c-myc were expressed in 3, 16 and 8 cases, respectively. Ki-67 proliferation index ranged from 40%-95%. Bcl-2 and c-MYC were co-expressed in seven cases. Four cases were GCB-DLBCL and the remaining 14 cases were non-GCB-DLBCL, according to Hans algorithm. Nuclear OCT4 expression was present in two cases, which demonstrated moderate expression in >50% of neoplastic cells. Univariate analysis showed that clinical stage, CD5 and OCT4 expression were relevant to prognosis. Multivariate Cox regression analysis further confirmed that clinical stage, CD5 and OCT4 were independent prognostic factors in patients with testicular DLBCL. Conclusions: Care should be exercised in using OCT4 as the sole marker of germ cell differentiation in the testis. The association of OCT4 and CD5, bcl-2 co-expression raises the question of whether OCT4 expression in DLBCL may reflect more aggressive biology.

[Microcystic, elongated and fragmented invasive pattern in endometrial adenocarcinoma: a clinicopathologic analysis of 72 cases]

Objective: To investigate the clinicopathologic features of microcystic, elongated and fragmented (MELF) pattern invasion of endometrial adenocarcinoma. Methods: HE and immunohistochemistry staining method were used to analysis morphologic features and immunophenotype of 72 patients of endometrial adenocarcinoma with MELF pattern invasion, and chi-square test was used to analysis the clinicopathologic features. Results: The mean age of 72 patients was 54 years (40 to 70 years). Thirty-two patients were pre-menopausal and 40 were post-menopausal. According to the FIGO staging system (2014), 32 cases(44.4%)were at stage Ⅰ, 22 cases(30.6%)at stage Ⅱ, 17 cases(23.6%)at stage Ⅲ and 1 case(1.4%) at stage Ⅳ. Microscopically, MELF invasion showed microcystic, elongated slit-like or fragmented glands in myometrium and their lining cells usually were cube or flat, as well as the single or clusters of eosinophilic tumor cells mimicking histocytes. In addition, a fibromyxoid or inflammatory stromal response was often present.Immunohistochemical staining showed that MELF invasion was positive for p16, CA125 and CA19-9, but negative for ER, PR and p53.Compared with non-MELF pattern invasion, significant differences were noted in menopause pausimenia, FIGO stages, deep invasion into myometrium, lymph metastasis, lymphovascular space invasion (LVSL), serum CA125 and CA19-9 in patients with MELF pattern invasion (all P<0.05). Conclusions: MELF pattern invasion of endometrial adenocarcinoma is characterized by advanced FIGO stage, deep myoinvasion, high metastasis rate to lymph node and LVSL. Pathologists should recognize the MELF invasion and evaluate the depth of myometrium of infiltration and LVSL with special attention to the presence of MELF invasion with necessary immunohistochemistry for more accurate pathological diagnosis.

[Expression of PDGFRA and CMYC in extranodal NK/T-cell lymphoma and their prognostic implications]

Objective: To investigate the relationship between expression of PDGFRA/CMYC and clinicopathologic features of extranodal NK/T-cell lymphoma. Methods: Fifty-four cases of extranodal NK/T-cell lymphoma were included in the study.Immunohistochemistry was used to detect the expression of CD20, CD2, CD3, CD56, TIA1, GrB, Ki-67, PDGFRA and CMYC.In situ hybridization was performed to detect the presence of EBV encoded small RNA (EBER). Fifty cases of nasopharyngeal mucosal lymphoid tissue hyperplasia were used as normal control. Results: Among 54 cases of ENKTL, CD2, CD3, GrB, and TIA1 were expressed in all the tumors. CD56 was expressed in 47 cases (81.0%) and CD20 was not detectable in any cases. Ki-67 proliferative index expression of > 60% was found in 45 cases (83.3%). In situ hybridization for EBER was positive in all cases (100%). The positive expression rates of PDGFRA and CMYC in extranodal NK/T-cell lymphomas were 51.9%(28/54) and 53.7%(29/54), respectively, much higher than those in nasopharyngeal mucosal lymphoid tissue hyperplasia (0, P<0.05). There was a positive correlation between PDGFRA and CMYC (r=0.295, P<0.05). The expression of CMYC was correlated with clinical efficacy (P<0.05), but not with gender, age, Ann Arbor stage, B symptoms and therapeutic regimen (all P>0.05). The expression of PDGFRA was correlated with B symptoms (P<0.05), while not with gender, age, Ann Arbor stage, therapeutic regimen and clinical efficacy (all P>0.05). The co-expression of PDGFRA and CMYC was not correlated with gender, age, Ann Arbor stage, B symptoms, therapeutic regimen and clinical efficacy (P>0.05). Univariate analysis showed that the stage, clinical efficacy, CMYC protein and the co-expression of PDGFRA and CMYC were significantly correlated with the prognosis. The overall survival of the patients with CMYC positive expression was shorter than of that of the patients with negative expression (P<0.05). Multivariable Cox regression analysis further confirmed that clinical stage, CMYC protein expression, and the co-expression of PDGFRA and CMYC were independent prognostic factors in patients with extranodal NK/T-cell lymphoma. Conclusion: CMYC protein, and the co-expression of PDGFRA and CMYC can be as an independent prognostic factor in patients with extranodal NK/T-cell lymphoma and influence the prognosis of patients.

[Clinicopathologic analysis of extranodal Rosai-Dorfman disease of breast: a report of 12 cases]

OBJECTIVE

To investigate the clinicopathologic features, diagnosis and differential diagnosis of extranodal Rosai-Dorfman disease(RDD)of the breast.

METHODS

Twelve cases of extranodal RDD of the breast were analyzed using hematoxylin-eosin stain and immunohistochemical staining.The morphological features and immunophenotype were observed by light microscopy, accompanied with a review of the literature.

RESULTS

Twelve cases of extranodal RDD of the breast are presented. The patients were women and their ages ranged from 15 to 55 years (mean =37 years). Except one patient with involvement of the right breast and ipsilateral axillary lymph nodes, other eleven patients' disease confined to the breast. Seven cases located in the right breast, the other five cases in the left breast. Microscopically, it showed a typical morphology, characterized by diffuse infiltration of large histiocytes, lymphocytes and plasmocytes that formed irregular nodular structure with light and dark appearance under microscope. Spindling of histiocytosis often arranged in a vague storiform with prominent fibrosis, accumulation of foamy histiocytes and scattered atypical nuclei. The characteristic histocytes and emperipolesis could not be seen obviously in extranodal RDD of the breast.Immunohistochemical staining showed histocytes were strongly positive for S-100 protein, CD68 and CD163, while negative for CD1a.

CONCLUSIONS

Extranodal RDD of the breast is very rare. Because of unconspicuous emperipolesis and lack of specificity in clinic and images, extranodal RDD of the breast is easy to be misdiagnosed as other histiocytosis. The microscopic differential diagnosis includes idiopathic granulomatous mastitis, infective granulomas, langerhans cell histiocytosis, IgG4 related sclerosing disease, Erdheim-Chester disease, benign fibrous histiocytoma, malignant fibrous histiocytoma and Hodgkin Lymphoma. Light and dark appearance under microscope is the important clue in diagnosis of extranodal RDD in breast. Immunohistochemistry is also helpful.

[Efficacy of biventricular pacing on preventing heart failure in patients with high degree atrioventricular block (BIVPACE-AVB Trial)]

OBJECTIVE

To investigate the long-term effect of biventricular (BIV) and right ventricular apical (RVA) pacing on cardiac function in patients with high-degree atrioventricular block (AVB) and left ventricular ejection fraction(LVEF)over 35%.

METHODS

A total of 118 consecutive patients with high-degree AVB in six hospitals from East China between May 2009 and December 2012 were enrolled in this randomized, double-blind and parallel controlled study. Patients were randomly assigned to BIV and RVA pacing with or without LV lead on after one-week cardiac resynchronization therapy (CRT). Cardiac function including New York Heart Association(NYHA), 6 minute walking distance (6MWD), Minnesota living with heart failure (MLHF) score, LVEF, left ventricular end-diastolic volumes/diameters (LVEDV/LVEDD) and other echocardiography parameters, as well as N-terminal pro-B-type natriuretic peptide (NT-proBNP)were assessed at 6 months and 12 months.

RESULTS

A total of 114 patients were successfully implanted with CRT. Cardiac function was significantly improved after one-week BIV pacing (n=57) compared with pre-CRT: rate of patients with NYHA Ⅲ (25.44%(29/114) vs. 9.65%(11/114)), MLHF score (17.1±13.6 vs. 26.9±21.6), 6MWD ((315.4±121.8)m vs. (291.8±102.9)m) and NT-proBNP (157.0(70.0, 639.0) ng/L vs. 444.7(144.0, 1 546.0)ng/L, all P<0.05). In BIV group, 6MWD extended from (314.8±142.7)m to (332.7±117.5)m at 6 months (P<0.05), LVEF increased from (60.7±7.9)% at 1 week to (56.6±10.7)% at 6 months(P<0.05), both LVEDV and LVEDD decreased at 12 months compared with at 1 week ((116.2±39.5)ml vs. (131.4±49.6)ml and (50.2±5.6)mm vs. (52.5±6.8)mm, P<0.05). In RVA group (n=57), 6MWD increased at 6 months compared that at 1week ((342.4±109.9)m vs. (310.2±105.1)m, P<0.05), NT-proBNP was higher at 12 months than that at 1 week (349.5(191.8, 884.3)ng/L vs. 127.0(70.3, 336.7)ng/L, P<0.05). Compared with RVA group, BIV group had a bigger shrink in LVEDV decrease at 12 months was more significant in BIV group ((-16.68±24.30)ml vs. (9.09±29.30)ml, P<0.05).

CONCLUSIONS

Cardiac pacing could acutely improve the cardiac function in patients with high-degree AVB and LVEF over 35%. Improvements on cardiac function and remodeling are more significant after 12-month BIV pacing than that of RVA pacing. Clinical Trail Registry: Chinese Clinical Trial Registry, ChiCTR-TRC-10000832.

Torsional electromechanical systems based on carbon nanotubes

Carbon nanotubes (CNTs) are among the most highly studied nanomaterials due to their unique (and intertwined) mechanical and electrical properties. Recent advances in fabrication have allowed devices to be fabricated that are capable of applying a twisting force to individual CNTs while measuring mechanical and electrical response. Here, we review major results from this emerging field of study, revealing new properties of the material itself and opening possibilities for advances in future devices.

First Report of Twig Canker on Peach Caused by Phomopsis amygdali in China

During May and June of 2009, canker and twig dieback were observed with 30 to 40% incidence in trees in one peach orchard in Nanhui of Shanghai (cv. YuLu juicy peach) and one orchard (cv. JingXiu yellow peach) in Jiaxin of Zhejiang Province, China. Cankers were generally centrally positioned on the nodes at the base of shoots with sunken, reddish brown/tan-to-silver symptoms. Blight was also observed on a few shoots (1). Five samples were collected from each orchard and isolations were conducted on potato sucrose agar (PSA). Ten isolates were obtained and all had white mycelia on PSA. Black pycnidia, formed in culture, produced two types of conidia: hyaline, fusiform alpha conidia and hyaline, string-like beta conidia. Alpha conidia varied from 5.0 to 6.3 × 1.5 to 2.5 μm and beta conidia ranged from 20 to 25 × 1.2 to 1.5 μm. Morphological characteristics suggested the identity of the fungal isolates to be Phomopsis amygdali. To confirm pathogenicity, an inoculum suspension was made from one isolate (10⁶ conidia/ml) and was sprayed until runoff onto five twigs with buds. Inoculated twigs were maintained at 26°C and 100% relative humidity in a growth chamber with a 12-h period of fluorescent light daily. Twigs inoculated with sterilized water were included as noninoculated controls. After 4 days, dark brown lesions appeared around buds on inoculated twigs. No symptoms were observed on the control twigs. Constriction cankers were reproduced and P. amygdali was reisolated from the lesions. To confirm the identity of the pathogen, total genomic DNA was extracted with the cetyltrimethylammoniumbromide (CTAB) method from the mycelia of two isolates from YuLu juicy peach and Jinxiu yellow peach (2). PCR was performed with universal primers ITS1 (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 (5'-TCCTCCGCTTATTGATATGC-3') to amplify a DNA fragment of approximately 550 bp. The PCR products were purified and sequenced in both directions (Sangon Biotech (Shanghai) Co., Ltd., China). The sequences (GenBank Accession Nos. HQ632013 and HQ632014) shared 98.9% identity with each other (MegAlign software; DNASTAR, Madison, WI). A comparison of these two sequences with those in GenBank showed that the sequences had the highest nucleotide similarity (99%) with P. amygdali isolate FAU1052 from peach in the southeastern United States (Accession No. AF102998). To our knowledge, this is the first report of P. amygdali causing twig canker on peach in China and will provide useful information for developing effective control strategies. References: (1) D. F. Farr et al. Mycologia 91:1008, 1999. (2) M. A. Saghai-Maroof et al. Proc. Natl. Acad. Sci. USA. 81:8014, 1984.

First Report of Tomato yellow leaf curl virus Infecting Cowpea in China

Tomato yellow leaf curl virus (TYLCV) is a devastating pathogen of tomato that causes significant yield losses in many tropical and subtropical regions (1). In China, this virus was first found in 2006 on tomato in Shanghai (2). In October 2008, chlorotic yellow leaves of cowpea (Vigna sinensis) were observed in Qingpu, Shanghai, China with 15 to 20% incidence in plants in high tunnels. Large populations of whiteflies were observed in association with the diseased cowpea. The disease agent was transmitted to cowpea (and tomato) by whiteflies, which resulted in chlorotic yellow leaves on cowpea (yellow leaf curl symptoms on tomato) that were identical to those observed in the field. On the basis of the suspected insect vector, symptomology, and severe epidemics of tomato yellow leaf curl disease (TYLCD) in Shanghai in recent years, Tomato yellow leaf curl virus was suspected as the causal agent. Total DNA was extracted from four symptomatic cowpea samples. PCR was performed with specific primers V416 (5'-CAAGGCACAAACAAGCGACG-3') and C1287 (5'-CTCAACTTCCGAATTTGGACGAC-3') to amplify a 872-bp DNA fragment of the viral coat protein (CP) gene and an amplicon of the expected size was obtained in all four samples but not from healthy leaf samples. The PCR products were sequenced and the sequences were identical among samples. Primers TYLCV-F (5'-CAGGAGGCAGCCAAGTATGAG-3') and TYLCV-R (5'-ACTAATGCCTGTTCYTTCATTCC-3') (Y = C or T/U) were designed on the basis of the sequence (Accession No. HM804856) and reported (Accession No. FM163463) CP gene to amplify the full-length viral DNA of cowpea isolate (CN:SH:Cowpea:08). The sequence was determined to be 2,781 nucleotides long (Accession No. GU434143). A comparison of the sequence with those in GenBank shows that the cowpea isolate has the highest nucleotide sequence identity (99%) with TYLCV isolate XH2 from tomato in Xinghua, Jiangsu, China (Accession No. GU111505). To our knowledge, this is the first report of TYLCV infecting cowpea in China and also the first report in the world. References: (1) H. Czosnek and H. Laterrot. Arch. Virol. 142:1391, 1997. (2) J. B. Wu et al. Plant Dis. 90:1359, 2006.

First Report of Cucurbit chlorotic yellows virus Infecting Melon in China

In October 2007, symptoms of chlorosis on the upper leaves and a bright yellow color on the lower leaves were observed sporadically on hami melon (Cucumis melo cv. Xuelihong) in a high tunnel in Nanhui of Shanghai, China. Disease progresses from initial mottling of leaves into leaves that are completely yellow with the veins remaining green. The oldest leaves develop symptoms first, so these leaves have a pronounced even yellow color. In October 2009, these symptoms were found in all melons produced in the suburbs of Shanghai. These symptoms were similar to those caused by Cucurbit yellow stunting disorder virus (CYSDV) and Cucurbit chlorotic yellows virus (CCYV) (1-3). Twelve samples from symptomatic melons were collected in the Jiading, Nanhui, Fengxian, and Chongming districts of Shanghai for virus diagnosis. Large populations of whiteflies were observed in association with the diseased cucurbit crops. Total RNA was extracted with Trizol reagents (Invitrogen, Carlsbad, CA). We used random primers (9-mer) for reverse transcription-PCR. Extracts were for CYSDV using specific primers CYSDV-CP-F (5'-ATGGCGAGTTCGAGTGAGAA-3') and CYSDV-CP-R (5'-TCAATTACCACAGCCACCTG-3') to amplify a 756-bp fragment of coat protein gene and CCYV using specific primers CCYV-HSP-F1 (5'-TGCGTATGTCAATGGTGTTATG-3') and CCYV-HSP-R1 (5'-ATCCTTCGCAGTGAAAAACC-3') to amplify a 462-bp fragment of the HSP gene (1). CYSDV was not found in all samples. The expected 462-bp target fragment of CCYV was obtained in all samples but not from any of the healthy controls. All the 462-bp PCR products were cloned to pGEM-T vector (Promega, Madison, WI) and sequenced. All sequences obtained were homologous. A comparison of the submitted sequence (GenBank Accession No. HQ148667) with those in GenBank showed that the sequence had 100% nucleotide identity to the Hsp70h sequences of (CCYV) isolates from Japan (Accession Nos. AB523789 and AB457591) (1,4), Taiwan (Accession No. HM120250) (2), and mainland of China (Accession Nos. GU721105, GU721108, and GU721110). CCYV is a new member of the genus Crinivirus, first discovered in Japan in 2004 (4) and reported in Taiwan in 2009 (2). To our knowledge, this is the first report of CCYV on melon in China. References: (1) Y. Gyoutoku et al. Jpn. J. Phytopathol. 75:109, 2009. (2) L.-H. Huang et al. Plant Dis. 94:1168, 2010. (3) L. Z. Liu et al. Plant Dis.94:485, 2010. (4) M. Okuda et al. Phytopathology 100:560, 2010.

Androgens induce oxidative stress and radiation resistance in prostate cancer cells though NADPH oxidase

Androgen deprivation therapy (ADT) facilitates the response of prostate cancer (PC) to radiation. Androgens have been shown to induce elevated basal levels of reactive oxygen species (ROS) in PC, leading to adaptation to radiation-induced cytotoxic oxidative stress. Here, we show that androgens increase the expression of p22^phox and gp91^phox subunits of NADPH oxidase (NOX) and ROS production by NOX2 and NOX4 in PC. Pre-radiation treatment of 22Rv1 human PC cells with NOX inhibitors sensitize the cells to radiation similarly to ADT, suggesting that their future usage may spare the need for adjuvant ADT in PC patients undergoing radiation.

A dynamic micro-CT scanner based on a carbon nanotube field emission x-ray source

Current commercial micro-CT scanners have the capability of imaging objects ex vivo with high spatial resolution, but performing in vivo micro-CT on free-breathing small animals is still challenging because their physiological motions are non-periodic and much faster than those of humans. In this paper, we present a prototype physiologically gated micro-computed tomography (micro-CT) scanner based on a carbon nanotube field emission micro-focus x-ray source. The novel x-ray source allows x-ray pulses and imaging sequences to be readily synchronized and gated to non-periodic physiological signals from small animals. The system performance is evaluated using phantoms and sacrificed and anesthetized mice. Prospective respiratory-gated micro-CT images of anesthetized free-breathing mice were collected using this scanner at 50 ms temporal resolution and 6.2 lp mm(-1) at 10% system MTF. The high spatial and temporal resolutions of the micro-CT scanner make it well suited for high-resolution imaging of free-breathing small animals.

Magnetic resonance imaging in determination of myocardial ischemia and viability: comparison with positron emission tomography and single-photon emission computed tomography in a porcine model

BACKGROUND

In patients with chronic left ventricular dysfunction, the size of the viable cardiac muscle is correlated with the prognosis and the outcome of myocardial revascularization.

PURPOSE

To evaluate the diagnostic value of various imaging techniques in determination of myocardial ischemia and viability.

MATERIAL AND METHODS

A chronic myocardial ischemia animal model was established, in which 10 pigs underwent magnetic resonance imaging (MRI), positron emission tomography (PET), and single-photon emission computed tomography (201Tl SPECT) before and 1-2 months after modeling. The size of myocardial ischemia and necrosis was judged, and the imaging manifestations were compared with pathologic findings.

RESULTS

Seven of the 10 animals completed all examinations uneventfully. On dobutamine-stressed cine MRI, 10 (8.93%) segments were found to be akinetic. Perfusion was abnormal in 34 (30.35%) segments. Delayed hyperenhancement was observed in 12 (10.71%) segments. PET detected myocardial necrosis in 17 (15.18%) segments, and SPECT detected myocardial necrosis in nine (8.04%) segments. Histological examination with triphenyltetrazolium chloride (TTC) showed pale necrosis in 14 (12.50%) segments. The number of necrotic segments detected by PET was significantly greater than that by contrast-enhanced MRI (chi2 = 5, P = 0.0253, kappa = 0.8028) and cine MRI (chi2 = 7, P = 0.0082, kappa = 0.7079). It was also greater than that by TTC (chi2 = 3, P = 0.0833, kappa = 0.8879), although the difference was statistically insignificant. The number of necrotic segments detected by SPECT was significantly smaller than that by TTC (chi2 = 5, P = 0.0253, kappa = 0.7590), as was the number of necrotic segments detected by cine MRI (chi2 = 4, P = 0.0455, kappa = 0.8100). There was no statistically significant difference in the detection of necrotic segments between contrast-enhanced MRI and TTC (chi2 = 2, P = 0.1573, kappa = 0.9130).

CONCLUSION

Cardiac MRI can determine viable myocardium and clearly delineate the location and degree of myocardial necrosis. PET slightly overestimates the extent of the necrotic myocardium and is unable to distinguish transmural necrosis from subendocardial necrosis.

First Report of Anthracnose Fruit Rot of Strawberry Caused by Colletotrichum acutatum in China

In 2004, fruits showing dark and sunken necrotic lesions were observed on strawberries (Fragaria × ananassa Duch. cv. Mei No. 3) in a field in Shanghai, China. All isolates obtained from the infected fruits easily produced orange spore masses and developed orange colonies with orange reverse colony color; none formed setae or the ascigerous stage in culture or on the host. The conidia were hyaline, straight and fusiform, 8 to 16 × 2.5 to 4 μm, and produced melanized, ellipsoid, ball- or pear-shaped appressoria at the end of germ tubes. These isolates were similar to those described for Colletotrichum acutatum J. H. Simmonds. To confirm pathogenicity of the isolate, inoculum suspension with 4 × 10⁶ conidia/ml was sprayed onto 10 fruiting strawberry plants until runoff. The inoculated plants were maintained at 25°C and 100% relative humidity in a growth chamber with a 12-h period of fluorescent light daily. Plants inoculated with sterilized water were controls. After 3 days, dark brown lesions appeared in the leaves, petioles, and fruits of all inoculated plants. The symptoms were similar to those observed on the strawberry fruit from which the isolate was originally isolated. The pathogen was consistently reisolated from the symptomatic fruit. No symptoms were observed on the control plants. To our knowledge, this is the first report of C. acutatum as the casual agent of anthracnose fruit rot of strawberry in China.

[Condition and mechanism of formation of mummy in Shanghai region]

To investigates the condition and the mechanism of the formation of mummy in Shanghai region. Three cases of mummy were normaly examinated. It showed that the formation condition of mummy were influenced by season, scene, and the corpse keeping methods etc. In warm and damp southern region in Shanghai, the mummy formation depended on lower temperature, dry environment season, dehydrated and hunger before death, and interfered factors like ventilating and turning over corpse frequently.

The prevalence and spectrum of alpha and beta thalassaemia in Guangdong Province: implications for the future health burden and population screening

AIM

Thalassaemia is a good candidate disease for control by preventive genetic programmes in developing countries. Accurate population frequency data are needed for planning the control of thalassaemia in the high risk Guangdong Province of southern China.

METHODS

In total, 13397 consecutive samples from five geographical areas of Guangdong Province were analysed for both haematological and molecular parameters.

RESULTS

There was a high prevalence of carriers of alpha thalassaemia (8.53%), beta thalassaemia (2.54%), and both alpha and beta thalassaemia (0.26%). Overall, 11.07% of the population in this area were heterozygous carriers of alpha and beta thalassaemia. The mutation spectrum of alpha and beta thalassaemia and its constitution were fully described in this area. This study reports the true prevalence of silent alpha thalassaemia in the southern China population for the first time. In addition, two novel mutations that give rise to alpha thalassaemia, one deletion resulting in beta thalassaemia, and a rare deletion (--(THAI) allele) previously unreported in mainland China were detected. The frequency of the most common mutation, the Southeast Asian type of deletion (--(SEA), accounting for 48.54% of all alpha thalassaemias) was similar to the total of two alpha(+) thalassaemia deletions (-alpha(3.7) and -alpha(4.2), accounting for 47.49% of alpha thalassaemia).

CONCLUSION

Both alpha and beta thalassaemia are widely distributed in Guangdong Province of China. The knowledge gained in this study will enable the projected number of pregnancies at risk to be estimated and a screening strategy for control of thalassaemia to be designed in this area.

Cloning and expression of human HBP1, a high mobility group protein that enhances myeloperoxidase (MPO) promoter activity

Factors which regulate transcription in immature myeloid cells are of great current interest for the light they may shed upon myeloid differentiation. In the course of screening for transcription factors which interact with the human myeloperoxidase (MPO) promoter we, for the first time, identified and cloned the cDNA and genomic DNA for human HBP1 (HMG-Box containing protein 1), a member of the high mobility group of non-histone chromosomal proteins. HBP1 cDNA was initially cloned from rat brain in 1994, but its presence in human cells or in myeloid tissue had not been described previously. The sequence of human HBP1 cDNA shows 84% overall homology with the rat HBP1 cDNA sequence. We have subsequently cloned the gene, which is present as a single copy, 25 kbp in length. Northern blotting reveals a single 2.6 kb mRNA transcript which is expressed at higher levels in human myeloid and B lymphoid cell lines than in T cell lines tested and is present in several non-myeloid human cell lines. Comparison of the mRNA and genomic sequences reveals the gene to contain 10 exons and 9 introns. The sequence of human HBP1 mRNA contains a single open reading frame, which codes for a protein 514 amino acids in length. The amino acid sequence specified by the coding region shows 95% homology with the rat HBP1 protein. The human protein sequence exhibits a putative DNA-binding domain similar to that seen in rat HBP1 and shows homology with the activation and repressor domains previously demonstrated in the rat protein. We have expressed human HBP1 protein both in vitro and in prokaryotic and eukaryotic cells. The expressed fusion protein binds to a sequence in a functionally important region within the basal human MPO promoter. In transient co-transfection experiments HBP1 enhances MPO promoter activity. Human HBP1 appears to be a novel transcription factor which is likely to play an important role in regulating transcription in developing myeloid cells.

Identification of an upstream enhancer containing an AML1 site in the human myeloperoxidase (MPO) gene

Myeloperoxidase (MPO) is an important antibacterial enzyme found only in granulocytes and monocytes. The human MPO gene is transcribed early during myelogenesis but MPO RNA synthesis ceases at the end of the promyelocyte stage of myeloid maturation. We recently identified a basal MPO promoter and several adjacent cis-elements in the proximal 5'-flanking region of this gene. Transfection studies using constructs containing several kb of 5'-flanking MPO DNA revealed the presence of a DNA segment located between bp (base pair) -4200 and bp -3800 with enhancer activity for the endogenous basal MPO promoter. Deletion studies revealed the core enhancer activity to lie between bp -4100 and bp -3844. The percentage enhancement of promoter activity is greater in MPO-expressing myeloid cells than in MPO-non-expressing myeloid cells or non-myeloid cells. Furthermore. the enhancer confers TPA- or DMSO-responsiveness upon either endogenous or exogenous promoters. DNase I footprinting and transfection experiments identified an AML1 site as a functionally important element within the enhancer. Gelshift competition and supershift experiments demonstrated the binding of the alpha subunit of the transcription factor AML1 to this site in HL-60 cells. This distal enhancer appears likely to play an important role in the control of MPO transcription during myeloid differentiation.

Identification and functional analysis of multiple murine myeloperoxidase (MPO) promoters and comparison with the human MPO promoter region

Myeloperoxidase (MPO) is an important component of the oxidative antibacterial defense system of granulocytes. Mammalian MPO gene expression has been most extensively studied in human and murine cells. Transcription of the human MPO gene appears to begin at a single initiation site and we have recently described the isolation and characterization of the corresponding human MPO promoter. On the other hand, MPO transcripts in murine myeloid cells show several distinct 5'-termini, suggesting the existence of multiple murine MPO promoters. However, significant levels of endogenous murine MPO promoter activity have not been demonstrated heretofore, although several murine MPO enhancers have been described. We now report the identification and preliminary functional characterization of four distinct murine MPO promoters. Sequence comparison of the human and murine MPO promoter regions reveals homologues of three out of four of these murine promoters within the human MPO gene. However, only one of these sites appears to be functionally active in human myeloid cells, possibly because of the interposition of Alu sequences between the putative promoter sites in the human gene.

Transferrin receptor distribution and iron deposition in the hepatic lobule of iron-overloaded rats

Under the condition of obvious iron-overload, there is a zonal hemosiderin (iron) deposition in hepatic lobules. The deposition is heaviest in the periportal (zone 1) and lightest in the perivenous (zone 3) hepatocytes. However, the mechanism for this pattern of iron deposition is obscure. Hepatic tissues from control, iron-deficient or iron-overloaded Wistar rats were used to study its pathogenesis. Iron-deficiency was induced by a low iron regimen. Iron-overload was produced by repeated intraperitoneal injections of ferric nitrilotriacetate (Fe(3+)-NTA) for 1-4 months. Liver tissues of the rats were immunohistochemically and histochemically stained for transferrin receptor (TfR), transferrin (Tf), ferritin (Ft), and iron. The staining intensity of TfR, Tf and Ft increased in hepatocytes of iron-deficient rats and decreased in that of the iron-overloaded in comparison with the control rats. TfR staining was strong in zone 1, with gradual transition into weak staining in zone 3 hepatocytes of the rat liver. TfR located primarily on the hepatocyte membrane. Tf had both membranous and cytoplasmic distribution. Many hepatocytes in group B had strong cytoplasmic Tf staining. Conversely, only a few hepatocytes had weakly stained cytoplasmic Tf in group C. Hepatocytes and Kupffer cells were Ft positive in control rats. Ft was distributed only in the cytoplasm. The staining intensity of Ft was stronger in zone 3 than in zone 1 hepatocytes of iron-deficient rats. In iron-overloaded rats, the iron deposition was severe in zone 1 and mild in zone 3 hepatocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphologic features in esophageal squamous cell carcinoma of young adults in north China

BACKGROUND

North China has an adjusted annual mortality rate of more than 100 per 100,000 persons for esophageal squamous cell carcinoma (SCC). However, its occurrence in young adults is considered uncommon.

METHODS

The clinical data and surgically resected specimens of 1033 cases of esophageal SCC were analyzed from the archives of an university hospital in Hebei, North China. There were 76 (7.4%) specimens from young adults (aged 35 years younger, Group 1) in the sample, and the clinicopathologic findings of these patients were compared with those of patients older than 35 years of age (Group 2, N = 957).

RESULTS

The mean age was 31.1 years for Group 1 and 52.2 years for Group 2. The male-to-female ratio was 3.0 and 2.3, respectively (P < 0.01). The 2-year survival rates were 42.1% for Group 1 and 54.0% for Group 2 (P < 0.05). The 10-year survival rates were 9.2% and 14.5%, respectively. Group 1 patients had more diffuse infiltrative growth (P < 0.025). Poorly differentiated SCC and vessel invasion were also common in Group 1. Conversely, Group 2 had more cases with fibrocollagenous stroma around the tumor (P < 0.001) and obvious germinal center hyperplasia in the regional lymph node (P < 0.05).

CONCLUSION

The prognosis of young adults with esophageal SCC was worse than that of their older counterpart.

Selective iron deposition in pancreatic islet B cells of transfusional iron-overloaded autopsy cases

Pancreatic islets of 36 autopsy cases with transfusional iron-overload were examined. Immunohistochemical and histochemical stainings were used to clarify the relationship between blood transfusion and iron deposition in the islet. Disease of the lymphohemopoietic system (leukemia, lymphoma, aplastic anemia) or liver (carcinoma and/or cirrhosis) accounted for 86.1% of the patients' main diagnosis. Sixteen of them had slight hemosiderin deposition (Group 1), twenty cases had severe hemosiderin deposition (Group 2). Another ten cases were used as controls (Group 3). The cases had a similar age distribution to Group 1 and 2, with neither blood transfusion nor hemosiderin deposition. The volume of blood transfusion was 6.1 +/- 3.6, 17.5 +/- 12.2 L for Groups 1 and 2, respectively. The plasma glucose was 137.8 +/- 54.4 and 170.6 +/- 108.4 mg/dL, respectively. Four cases in Group 1 and 14 cases in Group 2 had glycosuria. The number of islet cells with hemosiderin increased with the enlargement of transfusion volume (r = 0.664, P < 0.001). Plasma glucose also related with the percentage of hemosiderin positive islet cell (r = 0.386, P < 0.025). In severely iron-overloaded cases, hemosiderin was selectively deposited in B cells of the islet. It was concluded that large amounts of blood transfusions for non-congenital disease can induce selective hemosiderin deposition and impairment of pancreatic B cell that may result in hyperglycemia and diabetes mellitus of the patients.