[Evaluation of the predictive effect of PD-L1 expression on survival in early triple-negative breast cancer]

Objectives: To find the prognostic factors related to early triple-negative breast cancer to optimize the therapeutic strategies, and explore the influence of programmed cell death ligand-1(PD-L1)expression in early triple-negative breast cancer on its prognosis, so as to provide support for clinical treatment decisions. Methods: Early triple-negative breast cancer patients treated at the National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences during 1st June, 2009 and 31st Oct, 2015 were enrolled in this study. All the clinicopathological data of patients were collected, and the paraffin sections of the surgical specimens were stained with estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2, secreted protein acidic and rich in cysteine (SPARC), androgen receptor, PD-L1 and other antibodies by the immunohistochemical method. Kaplan-Meier survival and Cox regression curves were used for survival analysis of relevant clinical and pathological results and nomogram survival prediction models were established to explore the influence of relevant factors on the prognosis. Results: A total of 205 patients with triple-negative breast cancer were enrolled. Ninety patients (43.9%) were PD-L1 positive. The median follow-up time was 63 months. Thirty-seven patients were relapsed or recurrent and 16 patients were dead. The 5-year disease-free survival (DFS) rate and overall survival (OS) rate were 86.1% (95% CI: 81.4%-90.8%) and 93.6% (95% CI: 91.0%-97.6%), respectively, in the general population. Univariate Cox regression analysis showed that PD-L1 expression and lymph node metastasis were correlated with DFS and OS (P<0.05). In multivariate analysis, PD-L1 expression was an independent influencing factor of DFS, with PD-L1 positive patients possessing a significant survival benefit in DFS (HR=0.31, 95% CI: 0.13-0.73). Lymph node metastasis was an independent influencing factor of OS, and OS was significantly shortened in patients with positive lymph node metastasis (HR=3.24, 95% CI: 1.15-9.17). PD-L1, lymph node metastasis, menopausal status, Ki-67 index and adjuvant chemotherapy regimen were included to establish the 1- and 3-year DFS and OS nomogram prediction models, resulting in C indices of 0.698 and 0.748, respectively. Conclusions: PD-L1 expression is a predictive biomarker of good prognostic factor in triple-negative breast cancer patients. DFS is significantly prolonged in PD-L1 positive patients and OS also shows a prolongation trend. The nomogram prognosis prediction models have reference values for adjuvant chemotherapy in this patient group.

[Evaluation of the efficacy and safety of combination of gemcitabine and nedaplatin for patients with HER-2 negative metastatic breast cancer]

Objective: To assess the therapeutic efficacy and safety of the gemcitabine combined with nedaplatin (GN) chemotherapy for metastatic human epidermal growth factor receptor-2 (HER-2) negative breast cancer patients. Methods: Forty-five patients with HER-2 negative recurrent metastatic breast cancer who had received prior adjuvant or neoadjuvant therapy with anthracycline and/or taxanes were enrolled. All the patients received GN regime from January 2014 to February 2019. The therapeutic efficacy was evaluated according to response evaluation criteria in solid tumors (RECIST) 1.1. The adverse response was evaluated and monitored according to common terminology criteria for adverse events (CTCAE). The progression-free survival (PFS) and overall survival (OS) and prognostic factors were also analyzed. Results: All of the 45 patients received 4 course GN, 1 of them achieved complete response, 21 achieved partial response. The objective response rate was 48.9 (95% CI: 33.7%-64.1%). Grade 3-4 hematological toxicities include leukopenia occurred in 10 (22.2%) of patients, neutropenia in 13 (28.9%) patients, and thrombocytopenia in 8 (17.6%) patients. The grade 3-4 hematological toxicities mainly manifested as nausea and vomiting, and the incidence was 4.4% (2/45). Among the 45 patients, 34 died, the median PFS was 5.1 (95% CI: 3.9-6.1) months and the median OS was 17.6 (95% CI: 13.1-20.9) months. Conclusion: The combination of gemcitabine and nedaplatin is an effective and tolerable treatment for metastatic breast cancer patients previously treated with anthracyclines and/or taxanes.

[Diagonistic and prognostic analysis of olfactory neuroblastoma]

Objective:To explore the therapeutic effect and prognostic risk factors of olfactory neuroblastoma. Methods:Retrospective analysis of clinical data of 31 patients with olfactory neuroblastoma. The Kaplan-Meier method was used for survival analysis to calculate the overall survival rate and progress-free survival rate. Results:All 31 patients underwent surgical treatment and 7 patients died, of which 4 patients died of simple intracranial invasion and 3 patients died of concurrent distant metastasis （lung and spinal cord）. The average death time was 40.7 （20-57） months. Statistical analysis showed that craniocerebral invasion （P=0.035）, age ≥60 years （P=0.042）, and Ki-67≥20%（P=0.018） were closely related to the poor prognosis. It is speculated that the increase of T staging and modified Kadish staging are also predictors of poor prognosis. The 1-year and 5-year overall survival rates were 100.0% and 72.5%, and the 1-year and 5-year progress-free survival rates were 87.8% and 33.6% after first surgery. Conclusion:Surgery combined with radiotherapy and chemotherapy are the main treatments for olfactory neuroblastoma, but postoperative recurrence and metastasis are common. About 22.6% of the patients died during the follow-up. Advanced age, intracranial invasion and Ki-67≥20% are closely related to poor prognosis. The tumor was completely removed by the initial surgery and restricted in nasal cavity and sinuses are the key factors for a good prognosis.

[Physical activity intervention for non-alcoholic fatty liver disease in children]

Non-alcoholic fatty liver disease is chronic steatosis of the liver in children and adolescents under 18 years of age, which is related to insulin resistance, obesity and dyslipidemia. Non-alcoholic fatty liver is the most common cause of liver disease in children, and lifestyle interventions such as diet or exercise are usually recommended as a treatment. Compared with dietary restriction that may affect growth and development, physical training has become the main form of treatment for children with non-alcoholic fatty liver disease. This article summarizes the aspects of physical training intervention for non-alcoholic fatty liver disease in children.

[Clinical characteristics and surgical treatment analysis of paranasal ossifying fibroma]

Objective:To analyze the clinical features and discuss the treatment of ossifying fibroma in the nasal cavity and sinuses. Method:The patients were performed surgical treatment after admission. 6 cases were treated by endoscopic transnasal approach with image guidance system to resect the mass, 8 cases were operated by simple endoscopic approach, tumor resection was performed via endoscopic surgery with external approach in 2 cases, and endoscopic surgery combined with modified Caldwell-Luc procedure in 1 case. 1 patient was operated through labiolingual groove approach. Result:The intraoperative blood loss of ossified fibroma patients was large, with an average blood loss of 550ml. All the patients were followed up for 6 months to 8 years, 15 patients with complete resection had no recurrence after surgery, and 3 patients with partial resection survived with tumor. Conclusion:Ossifying fibroma in the nasal cavity and sinuses can be completely resected by nasal endoscopic surgery with less trauma and good effect. Transnasal endoscopic surgery assisted by image navigation system can protect important structures in lesions involving orbital cardboard and anterior skull base. Nasal endoscopic surgery combined with small eyebrow incision approach is feasible for ossifying fibroma invading frontal sinus. Ossifying fibroma, which requires adequate preoperative evaluation and blood preparation is prone to bleeding, and lesions with rich blood supply need preoperative interventional therapy.

[An investigation of the fertility needs of young patients with breast cancer]

Objective: To investigate the fertility needs and outcome of pregnancy in patients with young breast cancer in China. Methods: A retrospective cross-sectional investigation was conducted on 374 young breast cancer women from Cancer Hospital, Chinese Academy of Medical Sciences. Young patients with breast cancer were defined as patients who got initial diagnosis of breast cancer at age no more than 40 years old. We conducted a questionnaire survey and collected clinical data from medical chart. Logistic regression model was used to analyze the possible factors influencing patients' fertility intention. Results: 308 young women with breast cancer completed questionnaires, and the response rate was 82.4%. 81 patients (26.3%) had fertility needs after diagnosis. Of them, 6 cases took active measures to preserve fertility. 72 patients (23.4%) received fertility counseling during treatment. 7 patients were successfully pregnant, including four cases who delivered normally. Multivariate logistic regression analysis showed that patients under 35 years old (OR=4.81), bachelor degree or above (OR=3.26), receiving breast-conserving surgery (OR=2.15) and childless patients (OR=3.03) were more likely to have fertility needs after diagnosis of breast cancer (all P<0.05). Conclusions: The fertility needs of young breast cancer women in China are gradually increasing. Healthcare providers associated with tumor patients should actively offer corresponding fertility consultation and individualized diagnosis and therapy plans for patients with fertility needs.

Significance of Glutamate Racemase for the Viability and Cell Wall Integrity of Streptococcus iniae

Streptococcus iniae is a pathogenic and zoonotic bacterium responsible for human diseases and mortality of many fish species. Recently, this bacterium has demonstrated an increasing trend for antibiotics resistance, which has warranted a search for new approaches to tackle its infection. Glutamate racemase (MurI) is a ubiquitous enzyme of the peptidoglycan synthesis pathway that plays an important role in the cell wall integrity maintenance; however, the significance of this enzyme differs in different species. In this study, we knocked out the MurI gene in S. iniae in order to elucidate the role of glutamate racemase in maintaining cell wall integrity in this bacterial species. We also cloned, expressed, and purified MurI and determined its biochemical characteristics. Biochemical analysis revealed that the MurI gene in S. iniae encodes a functional enzyme with a molecular weight of 30 kDa, temperature optimum at 35°C, and pH optimum at 8.5. Metal ions, such as Cu2+, Mn2+, Co2+ and Zn2+, inhibited the enzyme activity. MurI was found to be essential for the viability and cell wall integrity of S. iniae. The optimal growth of the MurI-deficient S. iniae mutant can be achieved only by adding a high concentration of D-glutamate to the medium. Membrane permeability assay of the mutant showed an increasing extent of the cell wall damage with time upon D-glutamate starvation. Moreover, the mutant lost its virulence when incubated in fish blood. Our results demonstrated that the MurI knockout leads to the generation of S. iniae auxotroph with damaged cell walls.

[Demographic characteristics and canalith repositioning efficacy in 907 patients with typical benign paroxysmal positional vertigo]

AbstractObjective:To review the demographic characteristics and canalith repositioning efficacy in 907 patients with typical benign paroxysmal positional vertigo(BPPV). Method: The demographic characteristics of 907 patients with typical BPPV were statistically analyzed. According to the type of BPPV, patients were treated with the appropriate repositioning maneuver, and the clinical efficacy of repositioning maneuver was analyzed and summarized. Result: Nine hundred and seven patients of BPPV with typical nystagmus were elected in this study. 585 out of 907 were female and 322 out of were male, and the mean age was 53.10±14.25(13 to 89) years. The lesion located to the posterior semiCIrcular canal was 489 patients(53.9%), horizontal semiCIrcular canal was 312 patients(34.4%), anterior semiCIrcular was 63 patients(6.9%), and multiple semiCIrcular was 43 patients(4.8%). According to Kaplan-Meier survival analysis curve, the median cure time for the modified Semont and Epley repositioning maneuver in PC-BPPV groups was 3 days, and there was no significant difference in survival curves between the two repositioning maneuver. Meanwhile, the median cure time for Barbecue and Li horizontal canal quick repositioning maneuver groups was 3 days, and 1 day for Gufoni repositioning maneuver group in HC-BPPV groups. And there was no significant difference in survival curves among the three repositioning maneuver. In the AC-BPPV, 7 cases, 31 cases, 57 cases, 58 cases were cured with the Li anterior canal quick repositioning maneuver in the 1st day, the 3rd day, 1 week later, and 1 month later, and 5 cases lost to be follow-up. According to Kaplan-Meier survival analysis curve, the median cure time for the Li anterior canal quick repositioning maneuver in AC-BPPV groups was 3 days. Conclusion:Repositioning maneuver represents a simple, safe, rapid and effective approach to the treatment of BPPV. Therefore, repositioning maneuver should be choice for the BPPV treatment.

[Short-term outcomes of Li's repositioning maneuver of different age groups patients of horizontal semicircular canal canalithiasis benign paroxysmal positional vertigo]

Objective:To analyse whether there is statistical difference between different age group short-term outcomes of horizontal semicircular canal canalithiasis benign paroxysmal positional vertigo (HC-BPPV) patients treated by Li's repositioning maneuver.Method:Since October 2009 to July 2017, we included 169 unilateral HC-BPPV patients treated by Li's repositioning maneuver. Then we recorded and analyse 3-day and 1-week outcomes.Result:Three-day efficacy rates of youth, middle aged, young elderly and elderly patients were 97.9%,93.9%,90.9% and 90.% (P=0.136), respectively. Rates of 1-week efficacy were 100.0%,98.5%,97.7%and 100.0% (P=0.799),respectively. There was no statistical difference.Conclusion:Treated by Li's repositioning maneuver,HC-BPPV patients of different age groups can both get good short-term outcomes without statistical difference.

Aberrant expression of miR-663 and transforming growth factor-β1 in nasal polyposis in children

The aim of the present study was to investigate the expression of microRNA (miR)-663 and its regulatory effects on the pathogenesis of nasal polyposis in children. Nasal polyp tissue, as well as serum and peripheral blood eosinophils were collected from 35 children diagnosed with nasal polypectomy between August 2013 and August 2015. As a control, the inferior nasal concha, serum and peripheral blood eosinophils were collected from 46 patients with nasal septal deviation complicated by inferior turbinate hypertrophy or patients with simple inferior turbinate hypertrophy who had undergone surgical removal of the inferior nasal concha. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to measure the expression of miR-663 and transforming growth factor-β1 (TGF-β1) in the nasal polyp tissue, serum and peripheral blood eosinophils of patients with nasal polyposis and controls. Western blotting was used to measure the expression of TGF-β1 protein in nasal tissue and eosinophils and an enzyme-linked immunosorbent assay was used to measure serum level of TGF-β1 protein. A dual luciferase reporter assay was used to determine whether TGF-β1 was a target gene of miR-663. Compared with the control group, levels of TGF-β1 mRNA and protein were significantly increased in all three types of specimens from pediatric patients with nasal polyposis (P<0.05). miR-663 expression was significantly decreased in nasal polyp tissue and peripheral blood eosinophils (P<0.05). The dual luciferase reporter assay confirmed that TGF-β1 was a target gene of miR-663. The current study suggests that the upregulation of TGF-β1 may be associated with the downregulation of miR-663 in nasal polyposis in children. miR-663 may have regulatory effects on the pathogenesis of nasal polyposis by regulating TGF-β1 and may be developed as a genetic marker of nasal polyposis in children.

Nonreciprocal Linear Transmission of Sound in a Viscous Environment with Broken P Symmetry

Reciprocity is a fundamental property of the wave equation in a linear medium that originates from time-reversal symmetry, or T symmetry. For electromagnetic waves, reciprocity can be violated by an external magnetic field. It is much harder to realize nonreciprocity for acoustic waves. Here we report the first experimental observation of linear nonreciprocal transmission of ultrasound through a water-submerged phononic crystal consisting of asymmetric rods. Viscosity of water is the factor that breaks the T symmetry. Asymmetry, or broken P symmetry along the direction of sound propagation, is the second necessary factor for nonreciprocity. Experimental results are in agreement with numerical simulations based on the Navier-Stokes equation. Our study demonstrates that a medium with broken PT symmetry is acoustically nonreciprocal. The proposed passive nonreciprocal device is cheap, robust, and does not require an energy source.

[Clinical characteristics and short term outcome of very old benign paroxysmal positional vertigo patients]

Objective:To provide evidence and strategy for treatment of very old patients with benign paroxysmal positional vertigo (v-BPPV) by retrospective analysis of v-BPPV patients. Method:According to the criteria, 19 v-BPPV patients were collected, aging from 80 to 91 years old, including 10 horizontal semicircular canal BPPV (HC-BPPV), 4 posterior semicircular canal (PC-BPPV) and 5 mutiple semicircular canal BPPV patients. PC-BPPV patients were treated by Epley or Li maneuver, and HC-BPPV patients were treated by Barbecue or Li maneuver. Each patient was treated twice, with an interval of 5 to 10 minutes. Result:Rates of 3-day cure and efficacy were 63.16% and 94.74%, respectively. Rates of 1-week cure and efficacy were 89.47% and 100.00%, respectively. Conclusion:v-BPPV can have good outcomes via proper treatment. Age should not influence BPPV outcomes, while we should pay more attention to v-BPPV patients' physiclal status and systematic diseases which may increase risk to diagnosis and treatment.

[A randomized controlled trial on short-term efficacy of the modified Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo]

Objective:To observe the short-term efficacy of modified Semont maneuver for posterior canal benign paroxysmal positional vertigo (PC-BPPV)Method:This was a prospective randomized controlled trial on 130 PC-BPPV patients. Subjects were randomized divided into two groups: modified Semont (65 patients),and Epley(65 patients).Each maneuver was repeated twice,and the presence of sequelae,nystagmus and vertigo on positional testing were evaluated 3rd day and 1 week after treatment.Result:Five patients were lost to follow up (all five in the modified Semont group),and three patients failed to complete treatment (all three in the Epley group). The sequelae at the 3rd day and one week after modified Semont maneuver were 27 and 9,while 41 and 15 in Epley group. The efficacy rates at the 3rd day and one week after modified Semont maneuver were 91.7% and 98.3%,and 91.9% and 96.8% in Epley group retrospectively. The sequelae and short-term effective rate of patients in modified Semont group was no difference when compared with that in Epley group (P>0.05).Conclusion:Modified Semont maneuver represents a simple rapid and effective approach to the treatment of posterior canal benign paroxysmal positional vertigo.

Astragalus polysaccharides improve cardiomyopathy in STZ-induced diabetic mice and heterozygous (SOD2+/-) knockout mice

Oxidative stress plays an important role in the development of diabetic cardiomyopathy. In the present study, we determined whether the effect of astragalus polysaccharides (APS) on diabetic cardiomyopathy was associated with its impact on oxidative stress. Streptozotocin (STZ)-induced diabetic mice and heterozygous superoxide dismutase (SOD2+/-) knockout mice were administered APS. The hemodynamics, cardiac ultrastructure, and the apoptosis, necrosis and proliferation of cardiomyocytes were assessed to evaluate the effect of APS on diabetic and oxidative cardiomyopathy. Furthermore, H₂O₂ formation, oxidative stress/damage, and SOD activity in cardiomyocytes were evaluated to determine the effects of APS on cardiac oxidative stress. APS therapy improved hemodynamics and myocardial ultrastructure with reduced apoptosis/necrosis, and enhanced proliferation in cardiomyocytes from both STZ-induced diabetic mice and heterozygous SOD2+/- knockout mice. In addition, APS therapy reduced H₂O₂ formation and oxidative stress/damage, and enhanced SOD activity in both groups of mice. Our findings suggest that APS had benefits in diabetic cardiomyopathy, which may be partly associated with its impact on cardiac oxidative stress.

Effect of inulin-type fructans on blood lipid profile and glucose level: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND/OBJECTIVES

This systematic review and meta-analysis was performed to assess the effects of inulin-type fructans (ITF) on human blood lipids and glucose homeostasis associated with metabolic abnormalities, including dyslipidemia, overweight or obesity, and type-2 diabetes mellitus (T2DM).

SUBJECTS/METHODS

The MEDLINE, EMBASE and Cochrane Library databases were systematically searched for randomized controlled trials (RCTs) before January 2016. Human trials that investigated the effects of ITF supplementation on the lipid profile, fasting glucose and insulin were included using Review Manager 5.3.

RESULTS

Twenty RCTs with 607 adult participants were included in this systematic review and meta-analysis. In the overall analysis, the supplementation of ITF reduced only the low density lipoprotein-cholesterol (LDL-c) (mean difference (MD): -0.15; 95% confidence interval (CI): -0.29, -0.02; P=0.03) without affecting the other endpoints. Within the T2DM subgroup analysis, ITF supplementation was positively associated with a decreased fasting insulin concentration (MD: -4.01; 95% CI: -5.92, -2.09; P<0.0001) and increased high density lipoprotein-cholesterol (HDL-c) (MD: 0.07; 95% CI: 0, 0.14; P=0.05). Moreover, a reduced fasting glucose tendency was identified only in the T2DM subgroup (MD: -0.42; 95% CI: -0.90, 0.06; P=0.09). There was a potential publication bias, and few trials were available for the T2DM subgroup analysis.

CONCLUSIONS

In summary, the use of ITF may have benefits for LDL-c reduction across all study populations, whereas HDL-c improvement and glucose control were demonstrated only in the T2DM subgroup. Thus, additional, well-powered, long-term, randomized clinical trials are required for a definitive conclusion. Overall, ITF supplementation may provide a novel direction for improving the lipid profile and glucose metabolism.

Combined two foot flaps with iliac bone graft for reconstruction of the thumb

The purpose of this report was to retrospectively review the results of reconstruction of the thumb by use of combined two foot flaps with an iliac bone graft. From 2009 to 2014, nine patients with traumatic amputation of the thumb had their thumbs reconstructed. The two flaps were based on one pedicle. All flaps survived completely. Patients were followed for a mean of 15.6 months (range, 6-35 months). The appearance of the reconstructed thumb was comparable to a normal one, except for one thumb which required debulking. The appearance of the nail was satisfactory without deformity. The range of joint motion was satisfactory. The two point discrimination of the pulp ranged from 6 mm to >15 mm. The Michigan Hand Questionnaire outcome score was a mean of 76.2 ± 11.3 points and the Maryland foot rating score a mean of 94.8 ± 3.4 points. The combined two foot flaps with iliac bone graft might provide an option for the reconstruction of the thumb.

LEVEL OF EVIDENCE

III.

Sex Influences on the Penetrance of IL-1β and IL-1RN Genotypes for Rheumatoid Arthritis in the Chinese Population

Polymorphism (variable number of tandem repeats) in the second intron of the interleukin-1 receptor antagonist ( IL-1Ra) gene and two single nucleotide polymorphisms at positions −511 and +3954 of the IL-1β gene may be associated with an increased risk of rheumatoid arthritis (RA). This study used sex stratification to investigate a correlation of the three genetic polymorphisms with the risk of RA, on patients with RA and healthy controls. Polymerase chain reaction (PCR) and polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) were performed. The frequencies of the IL-1β+ 3954 allele and genotype in female patients were significantly different compared with the controls; but in males, only the frequency of the IL-1β+ 3954 allele was different. The frequency of the IL-1RN genotype in patients was not statistically different compared with the controls; however, the frequency of IL-1RN allele in female patients was different. The association of the three polymorphisms with the susceptibility to RA appears to be significantly affected by gender.

One-stop microfiber spinning and fabrication of a fibrous cell-encapsulated scaffold on a single microfluidic platform

This paper provides a method for microscale fiber spinning and the in situ construction of a 3D fibrous scaffold on a single microfluidic platform. This platform was also used to fabricate a variety of fibrous scaffolds with diverse compositions without the use of complicated devices. We explored the potential utility of the fibrous scaffolds for tissue engineering applications by constructing a fibrous scaffold encapsulating primary hepatocytes. The cells in scaffold were cultured over seven days and maintained higher viability comparing with 3D alginate non-fibrous block. The main advantage of this platform is that the fibrous structure used to form a scaffold can be generated without damaging the mechanically weak alginate fibers or encapsulated cells because all procedures are performed in a single platform without the intervention of the operator. In addition, the proposed fibrous scaffold permitted high diffusion capability of molecules, which enabled better viability of encapsulated cells than non-fibrous scaffold even in massive cell culture.

[Endoscopic endonasal approach resection for anterior skull base, pterygopalatine fossa and infratemporal fossa tumors: retrospective analysis of 73 patients]

OBJECTIVE

To summarize the clinical experience with endoscopic transnasal resection of nasal skull- base neoplasms, which involved anterior skull base, pterygopalatine fossa, nfratemporal fossa.

METHOD

Clinical data from 73 patients performed on endoscopic transnasal resection of nasal skull-base neoplasms were analyzed retrospectively.

RESULT

Total tumor removal was obtained in 54 cases, subtotal removal in 19 cases. In 16 cases of benign tumor, the postoperative survival rate was 100%; Malignancy in 57 cases, of which 16 patients were died, and half-year survival rate was 71.9%.

CONCLUSION

Endoscopic endonasal approach be able to fully reveal and re- moval of lesions involving the anterior skull base, pterygopalatine fossa and infratemporal fossa. The approach is feasible and safe.

Mutant p53 gain-of-function induces epithelial-mesenchymal transition through modulation of the miR-130b-ZEB1 axis

The tumor suppressor gene p53 has been implicated in the regulation of epithelial–mesenchymal transition (EMT) and tumor metastasis by regulating microRNA (miRNA) expression. Here, we report that mutant p53 exerts oncogenic functions and promotes EMT in endometrial cancer (EC) by directly binding to the promoter of miR-130b (a negative regulator of ZEB1) and inhibiting its transcription. We transduced p53 mutants into p53-null EC cells, profiled the miRNA expression by miRNA microarray and identified miR-130b as a potential target of mutant p53. Ectopic expression of p53 mutants repressed the expression of miR-130b and triggered ZEB1-dependent EMT and cancer cell invasion. Loss of an endogenous p53 mutation increased the expression of miR-130b, which resulted in reduced ZEB1 expression and attenuation of the EMT phenotype. Furthermore, re-expression of miR-130b suppressed mutant p53-induced EMT and ZEB1 expression. Importantly, the expression of miR-130 was significantly reduced in EC tissues, and patients with higher expression levels of miR-130b survived longer. These data provide a novel understanding of the roles of p53 gain-of-function mutations in accelerating tumor progression and metastasis through modulation of the miR-130b–ZEB1 axis.

Potential role of soluble B7-H3 in liver immunopathogenesis during chronic HBV infection

Immune-mediated mechanisms have been implicated in liver pathogenesis and subsequent progression in hepatitis B virus (HBV) infection. Costimulatory molecules, the important regulators of immune responses, participate in the regulation of liver pathology in HBV infection. However, the role of B7-H3 (CD276, a new member of B7 family) in this process has not been investigated. In this study, we detected abundant soluble B7-H3 (sB7-H3) in the plasma of patients with chronic HBV infections. The increase of the plasma B7-H3 was associated with the progression of liver cirrhosis and accompanied by decreased expression of B7-H3 on hepatocytes. The identification analysis suggests that the plasma B7-H3 might be derived from the membrane-bound B7-H3 on hepatocytes. A functional study showed that immobilized (4Ig) B7-H3Ig fusion protein could inhibit TCR-induced proliferation and IFN-γ secretion of T cells, which could be partially blocked by soluble B7-H3flag fusion protein. These results suggest that the reduced expression of B7-H3 in the livers might temper the inhibition of T-cell responses mediated by B7-H3 expressed on hepatocytes and thus promote the hepatic inflammation and hepatitis progression in the chronic HBV-infected patients.

PARP-1 deficiency blocks IL-5 expression through calpain-dependent degradation of STAT-6 in a murine asthma model

BACKGROUND

We recently showed that poly(ADP-ribose)polymerase-1 (PARP-1) may play a role in allergen (ovalbumin)-induced airway eosinophilia, potentially through a specific effect on IL-5 production. We also reported that while IL-5 replenishment promotes reversal of eosinophilia in lungs of PARP-1(-/-) mice, IL-4 or Immunoglobulin E replenishment do not, suggesting a potentially significant regulatory relationship between PARP-1 and IL-5.

OBJECTIVE

To explore the mechanism by which PARP-1 regulates IL-5 production and to determine how PARP-1 inhibition blocks allergen-induced eosinophilia.

METHODS

This study was conducted using a murine model of allergic airway inflammation and primary splenocytes.

RESULTS

PARP-1 knockout-associated reduction in IL-5 upon allergen exposure occurs at the mRNA level. Such an effect appears to take place after IL-4 receptor activation as PARP-1 inhibition exerted no effect on JAK1/JAK3 activation. Signal transducer and activator of transcription-6 (STAT-6) protein was severely downregulated in spleens of PARP-1(-/-) mice without any effect on mRNA levels, suggesting an effect on protein integrity rather than gene transcription. Interestingly, the degradation of STAT-6 in PARP-1(-/-) mice required allergen stimulation. Additionally, PARP-1 enzymatic activity appears to be required for STAT-6 integrity. The downregulation of STAT-6 coincided with mRNA and protein reduction of GATA-binding protein-3 and occupancy of its binding site on the IL-5 gene promoter. IL-4 was sufficient to induce STAT-6 downregulation in both PARP-1(-/-) mice and isolated splenocytes. Such degradation may be mediated by calpain, but not by proteasomes.

CONCLUSION

These results demonstrate a novel function of PARP-1 in regulating IL-5 expression during allergen-induced inflammation and explain the underlying mechanism by which PARP-1 inhibition results in IL-5 reduction.

Abstract P1-01-17: Comparative Analysis of Metastatic Tumor Cells within the Sentinel Lymph Nodes of Breast Cancer Patients Utilizing a Novel Approach

Background and Objective: The intrinsic high false negative rate associated with intraoperative analysis of SLN may result in a second surgical procedure for the patient. We attempt to improve the intraoperative and the pathologic and molecular evaluation of SLN by utilizing novel immunobead methods for detection and assessment of tumor cell expression of Her2, CD44 and Muc1.

Methods: During the operation of breast cancer patients, gived sentinel lymph node biopsy firstly, and the SLN will each be divided in four quadrants, and two quadrants (B,C) will be brought to the pathologist for routine intraoperative analysis and further immunhistochemical (H&E and CK) examination often 2 mm thick sections of each quadrant.

The other (A,D) quadrants will be immediately mechanically disaggregated and filtered in order to remove stromal elements and cellular debris. The resulting cell suspension will be incubated with 4.5 µm magnetic beads coated with MOC31 antibody, and simultaneously with different nonmagnetic, fluorescent microparticles coated with either anti-Her2, anti-CD44, or anti-Muc1 by flow-cytometry.

Results: 62 cases from 2009.1 to 2009.9 in our hospital has been studied, and results as follows: 1. Immunomagnetic evaluation of alive tumor cells in SLNs is rapidly and easily performed using the MOC-31 antibody that binds to the vast majority of breast cancer cells. The novel technologies will demonstrate higher detection sensitivity (96%) and lower false negative rate (4.0%). 2. For the intraoperative frozen HE staining, the sensitivity was 68%, false negative rate was 32%; and for CK-IHC, the sensitivity was 76.0%, and the false negative rate was 24%. 3.To compare to standard intraoperative procedures and histopathologic techniques of analyzing the SLN to that of the novel approach, it could get higher sensitivity (96%vs 68%,P=0.023;96%vs76%,P=0.049), lower false negative rate (4%vs32% ,P=0.023;4%vs24%,P=0.049) and higher micrometastasis detection rate. 4.Expession of Her2,CD44 and Muc1 in SLN is 32.5%±2.2%,83.4± 4.1% and 86.6%±3.4%, and each has positively correlated with the expression of that in primary tumor (P&lt;0.5).

Conclusion: Our novel approach that utilizing immunobead detection of metastatic breast cancer cells, and simultaneously characterize the isolated cells for membrane markers coated with antibodies targeting Her2, Muc1 or CD44 by flow-cytometry, has rapid speed and high accuracy. Compared to traditional HE and CK-IHC, it has higher sensitivity and lower false negative rate, and could be used more widely and easily. Expression of CD44, Her2 and Muc1 in sentinel lymph nodes were positively correlated with the expression of those in primary tumor. It is suggested that the three biomarkers above could predict metastasis of sentinel lymph nodes, and maybe direct treatment after operation.

Influence of strain and pressure to the effective refractive index of the fundamental mode of hollow-core photonic bandgap fibers

We investigate the phase sensitivity of the fundamental mode of hollow-core photonic bandgap fibers to strain and acoustic pressure. A theoretical model is constructed to analyze the effect of axial strain and acoustic pressure on the effective refractive index of the fundamental mode. Simulation shows that, for the commercial HC-1550-02 fiber, the contribution of mode-index variation to the overall phase sensitivities to axial strain and acoustic pressure are respectively approximately -2% and approximately -17%. The calculated normalized phase-sensitivities of the HC-1550-02 fiber to strain and acoustic pressure are respectively 1 epsilon(-1) and -331.6 dB re microPa(-1) without considering mode-index variation, and 0.9797 epsilon(-1) and -333.1 dB re microPa(-1) when mode-index variation is included in the calculation. The latter matches better with the experimentally measured results.

Impacts of microRNA-215 on cell proliferation and chemotherapy resistance in colon cancer and osteosarcoma

2542

Background: Translational control plays a key role in resistance to anti-cancer drug treatment. MicroRNAs regulate gene expression at the post-transcriptional level, mainly by interacting with 3'-UTR of their mRNA targets. Methods: miR-215 was ectopically expressed by transient transfection in both human colon cancer cell lines and osteosarcoma cell lines. The impact of miR-215 on cell proliferation, cell cycle control, chemosensitivity and down stream targets were characterized. The expression of miR-215 in colorectal cancer specimens and normal adjacent tissues was quantified by real time-qRT-PCR analysis. Results: In this study, we discovered that miR-215 down-regulates the expression of both dihydrofolate reductase (DHFR) and thymidylate synthase (TS), two of the most important chemotherapeutic targets, in human osteosarcoma U-2 OS and colon cancer HCT-116 (wt-p53) cell lines. Cells with elevated miR-215 expression are more resistant to DHFR inhibitor methotrexate (MTX) or TS inhibitor Tomudex (TDX) treatment. Ectopically over-expressing miR-215 triggers reduced cell proliferation and increased G2 arrest, at least in part, through the induction of p53 and p21. miR-215 transfected cells with reduced proliferating phenotype were resist to MTX or TDX treatment due to deceased cell cycle in S phase. The expression of endogeneous miR-215 was highly elevated in CD133+/HI CD44+/HI colon cancer stem cells compared to CD133- CD44- colon cancer cells, suggesting that tumor stem cells may be avoiding cellular and DNA damage caused by chemotherapy with a reduced proliferating phenotype mediated by certain miRNAs such as miR-215. The elevated expression of miR-215 in colon cancer stem cells with slow proliferation rate and resistance to chemotherapy further supports the role of miR-215 in cell proliferation and chemotherapy resistance. Conclusions: miR-215 may have a unique potential as a novel therapeutic target and biomarker candidate in cancer.

No significant financial relationships to disclose.

Hollow-core photonic bandgap fiber polarizer

Broadband, compact in-fiber polarizers were fabricated using a pulsed CO(2) laser to modify the air holes along one side of the hollow-core photonic bandgap fibers. The polarizers have lengths from 3 to 6 mm and exhibit a polarization extinction ratio of better than 20 dB over a wavelength range larger than 100 nm at approximately 1,550 nm.

DNA sequencing by the dideoxy method

In the basic dideoxy sequencing reaction, an oligonucleotide primer is annealed to a single-stranded DNA template and extended by DNA polymerase in the presence of four deoxyribonucleoside triphosphates (dNTPs), one of which is 35S-labeled. The reaction also contains one of four dideoxyribonucleoside triphosphates (ddNTPs), which terminate elongation when incorporated into the growing DNA chain. After completion of the sequencing reactions, the products are subjected to electrophoresis on a high-resolution denaturing polyacrylamide gel and then autoradiographed to visualize the DNA sequence. Three variations of the dideoxy sequencing procedure are currently in use and are presented in this unit. In the "labeling/termination" procedure, primer chains are initially extended and labeled in the absence of terminating ddNTPs, whereas in the traditional "Sanger" procedure, labeling and termination of primer chains occur in a single step. A recent variation of the dideoxy sequencing method is thermal cycle sequencing in which the reaction mixture, containing template DNA, primer, thermostable DNA polymerase, dNTPs, and ddNTPs, is subjected to repeated rounds of denaturation, annealing, and elongation steps. The resulting linear amplification of the sequencing products allows much less template DNA to be used and eliminates independent primer annealing and template denaturation steps, which are required for the labeling/termination or Sanger procedures. The use of automated fluorescent sequencers for four-color dideoxy DNA sequencing is also described in detail.

Synergistic antitumor efficacy and altered gene expression signature in breast cancer cells treated with immunotoxins and cyclosporin A

13505

Background: Immunotoxins (ITs) has shown limited clinical success related to liver toxicity and development of anti-IT antibodies. To delay the immune response we tested combinations of ITs and the Cyclosporin A (CsA). we have shown that one IT, currently in a phase I/II clinical trial, acts by inducing apoptosis and protein synthesis inhibition, but gene expression analysis of IT treated cells has never been reported. Hence, we also studied changes in gene expression induced by ITs alone and the effects of adding (CsA) on both treatment efficacy and gene expression signature. Methods: Human MA-11 breast cancer cells were treated in vitro with antiEGFR- and antiEPCAM-based ITs alone and in combinations with CsA. Therapeutic efficay was assessed by MTS cell viability assay. Total RNA from untreated and treated cells was isolated and CodeLink Uniset Human 20 k Oligo Bioarray (GE Healthcare, Amersham Biosciences, NJ), containing approximately 20,289 gene probes, was used to generate gene expression profiles. Gene expression analysis was carried out using GeneSpring software version 7.2 using One-way ANOVA with p<0.05. Comparisons of gene list across different groups were performed using Venn Diagrams. Results: Combination therapy produced remarkable synergistic effects in MA-11 cells in vitro and in metastasis models in vivo. Moreover, in conventional rats receiving repeated injections of ITs and CsA the formation of anti-IT antibodies was virtually abrogated. Changes in gene expression profiles induced by the ITs alone and in combination with CsA were evaluated to elucidate the underlying molecular mechanisms for the synergistic effects. The ITs each induced specific changes in expression of some apoptosis-related genes but also fogenes in pathways unrelated to apoptosis and protein synthesis. The addition of CsA induced up- or down-regulation of a number of interesting non-immune-associated genes Conclusions: Important shortcomings for successful clinical use of ITs may be overcome by combination therapy with CsA. The possibility for further improvement is provided by results of gene profiling studies identifying therapy-induced genes belonging to different cell signaling pathways.

No significant financial relationships to disclose.

Non-coding microRNA hsa-let-7g as a novel chemoresponse biomarker for S-1 in colon cancer

13513

Background: MicroRNAs (miRNAs) are small non-cording RNAs (∼ 22 nucleotide) that regulate gene expression by suppressing their target mRNAs at post-transcriptional level. Previous studies from our group have identified a number of dis-regulated miRNAs due to the loss of p53 tumor suppressor in cancer cell lines. As part of the efforts to further investigate the in vivo biological significance of these miRNAs, the expression of both hsa-let-7g and hsa-miR-200c were investigated using formalin-fixed paraffin embedded (FFPE) colon cancer specimens to evaluate the potential correlation with chemosensitivity and tumorigenesis. Methods: Forty-six patients with recurrent or residual colon cancer lesion assessable were treated with 5-FU based antimetabolite S-1. This includes twenty-one pair of tumor and normal samples. Total RNAs were isolated from these samples FFPE specimens (contains either > 90% normal or > 90% tumor tissue). cDNAs were synthesized using primers specific for hsa-let-7g, hsa-miR-200c and internal control 5S. The expression levels of each particular miRNAs were quantified using real time qRT-PCR analysis. The expression level of each miRNAs was quantified by measuring the difference of threshold cycle (CT) of candidate miRNAs and internal control 5S (Δ-CT). Results: The expression level of hsa-let-7g was significantly higher in tumor tissues compare to normal tissues (p=0.0026; Wilcoxon test). In the forty-six tumor tissues, the expression level of hsa-let-7g in disease response group (patients group of complete response, partial response and no change after chemotherapy) was significantly lower than the disease progression group (p=0.03; Mann-Whitney test). The expression of hsa-miR-200c was significantly over-expressed in tumor tissues compare to normal tissues (p=0.0001; Wilcoxon test). Although hsa-let-7g is strongly associated with patient’s response to S-1 treatment, it is not a prognostic factor for predicting survival. Conclusion: hsa-let-7g and hsa-miR-200c may be associated with tumorigenesis in colon cancer. In addition, hsa-let-7g may be a significant indicator for chemoresponse to S-1 based chemotherapy.

No significant financial relationships to disclose.

Chemo-response biomarker discovery via expression profiling using soft-tissue sarcoma xenografts

9569

Background: Soft-tissue sarcoma (STS) constitute a heterogeneous group of tumours of mesenchymal origin. Whereas the mainstay of treatment has been surgery and radiation, these tumours are generally considered as quite chemoresistant. However, it is well known that subgroups of patients benefit from chemotherapy. Markers that could predict drug response would therefore be beneficial for the management of this malignancy. We have previously established panel of 17 unique human soft tissue xenografts, representing 7 different histological subgroups and assessed their responsiveness to doxorubicin, ifosfamide, etoposide, and cisplatin. We wanted to utilize these xenografts as a model system to discover for novel candidate marker genes for STS chemo-response. Methods: GE Uniset Human 20K microarrays were used to obtain gene expression profiles from the each xenografts. One-way ANOVA test with a Benjamini-Hochberg multiple test correction allowing a false discovery rate of 5% was used to identify genes with significantly differential expression. Results: Doxorubicin, ifosfamide, etoposide and cisplatin were efficient in 6/17, 10/17, 1/17 and 7/17 xenografts respectively. However, in the expression profiles obtained none of the genes showed significantly correlation with chemo-responsiveness to any of the drugs. Two of the xenografts, TAX 1 and TAX 2, both originate from a malignant fibrous histiocytoma (MFH) in the same patient, but show strikingly different sensitivity to ifosfamide (TAX1 resistant, TAX2 sensitive). When triplicate hybridizations of TAX1 and 2 were compared, 294 genes met the above criteria. In addition we identified a subset of 122 genes that were flagged absent in one of the specimens, present in the other. Among genes with an already described role in mediating drug resistance are GST-pi and glutathione peroxidase. Taken together, these results indicate that discovery of general response markers in STSs may be difficult due to the heterogeneity of the different subgroups constituting this malignancy. Conclusions: Gene expression profiling of the TAX 1 and TAX 2 xenografts revealed a number of interesting candidate marker genes for ifosfamide sensitivity of MFH. This list of genes will be further refined by validation in clinical samples.

No significant financial relationships to disclose.

MBD4 and SEI1 as new prognostic markers in colorectal cancer patients receiving adjuvant 5-fluorouracil

20085

Background: Previous studies from our laboratory have identified a number of marker genes associated with chemosensitivity to 5-fluorouracil (5-FU). In this study, the in vivo significance of several marker genes in terms of prognostic potential were evaluated using colorectal cancer patient samples treated with 5-FU based therapy. Eight marker genes were selected based on their functional roles and significant fold changes in expression. They are SERTA domain containing 1(SEI1), Ribonucleotide reductase M2 polypeptide (RRM2), Origin recognition complex, subunit 6 homolog-like (ORC6L), Eukaryotic translation initiation factor 4E (EIF4E), Thymidylate Synthase (TS), SET and MYND domain containing 3 (SMYD3), Dickkopf homolog 4 (DKK4) and Methyl-CpG binding domain protein 4 (MBD4). Methods: Forty eight snap frozen clinical colorectal samples (24 normal and 24 paired colorectal cancer patient samples) were selected with detailed clinical follow-up information. cDNAs were synthesized and the expression levels of marker genes were quantified via qRT-PCR analysis. The statistical significance of these markers for disease prognosis was evaluated using two tailed paired T-test. Kaplan-Meier survival curve was generated and analyzed by Logrank test. Results: Based on the quantitative expression analysis, RRM2 (p = 0.0001, 95% CI, 2.0 to 4.5), ORC6L (p = 0.0001, 95% CI, 1.8 to 4.6), EIF4E (p = 0.0002, 95% CI, 0.3 to 0.9), TS (p = 0.0005, 95% CI, 0.7 to 2.2) and SMYD3 (p = 0.0001, 95% CI, 0.8 to 1.5) was over-expressed in tumor tissues. However, the expression of SEI1 was decreased in tumors (p = 0.02, 95% CI, 0.1 to 1.3), consistent with the function of SEI1 as a potential tumor suppressor. Kaplan-Meier survival analysis indicated that MBD4 is a significant prognostic factor for patient’s survival (p = 0.03). MBD4 was a key protein involved in DNA methylation. The expression of TS was associated with tumor stage as it had significant higher expression level in UICC stage I and II compared to stage IV patients (p = 0.03). Conclusion: MBD4 may be potential novel prognostic markers for predicting patient survival for colorectal cancer.

No significant financial relationships to disclose.

Noncoding miRNAs as novel prognostic factor for 5-fluorouracil adjuvant therapy in colorectal cancer

3609

Background: The roles of non-coding miRNAs in tumorgenesis are just emerging. miRNAs regulate gene expression at post-transcriptional level by influencing translation efficiency of their target mRNAs. Previous studies from our laboratory have identified a number of miRNAs that were dis-regulated in colon cancer cell lines related to the loss of p53 tumor suppressor gene. In this study, the in vivo significance of some of these miRNAs was further evaluated using clinical samples. Ten miRNAs (hsa-let-7b, hsa-let-7g, hsa-miR-15b, hsa-miR-181b, hsa-miR-191, hsa-miR-200c, hsa-miR-26a, hsa-miR-27a, hsa-miR-30a-5p and hsa-miR-30c) were evaluated for their potential prognostic value in colorectal cancer patients receiving 5-fluorouracil (5-FU) based therapy. Methods: Forty eight snap frozen clinical colorectal samples (24 normal and 24 paired colorectal cancer patient samples) were selected with detailed clinical follow-up information. RNAs were isolated from these samples using TRIzol reagent. After cDNA synthesis with miRNA specific primers, the expression levels of 10 miRNAs were quantified via qRT-PCR analysis. The statistical significance of these markers for disease prognosis was evaluated using two tailed paired T-test. Kaplan-Meier survival curve was generated and followed by Logrank test. Result: Among the ten miRNAs, hsa-miR-15b (p=0.02), hsa-miR-181b (p=0.01), hsa-miR-191 (p=0.03) and hsa-miR-200c (p=0.005) were significantly over-expressed in tumors compared to normal colorectal samples. Kaplan-Meier survival analysis indicates that hsa-miR-200c was a significant prognostic marker for predicting patient’s survival (p=0.01). The patients (n=15) with higher hsa-miR-200c expression had shorter survival interval (median survival = 26 months) compared to patients (n=9) with lower expression (median survival = 38 months). Conclusions: Some of these miRNAs may function as oncogenes due to their over-expression in tumors. Hsa-miR-200c may be a potential novel prognostic factor for 5-FU based chemotherapy in colorectal cancer.

No significant financial relationships to disclose.

Gene expression profiles classifies the responsiveness of human osteosarcoma to doxorubicin, cisplatin and ifosfamide

9534

Background: Despite the increased survival rates of osteosarcoma patients attributed to adjuvant chemotherapy, at least one third of the patients still succumb to their disease. Furthermore, ultra-aggressive combination chemotherapy is associated with considerable acute and long term toxicity. This is of particular concern in patients who may be cured by a simpler and less toxic regimens or do not have micrometastatic disease. Hence, further improvements in the management of osteosarcoma seemingly depend on diagnostic and prognostic tools that may allow for a more risk adapted and individualized treatment. Methods: We have used GE Uniset Human 20K microarrays to obtain gene expression profiles from a panel of ten unique human osteosarcoma xenografts. For each of the three drugs doxorubicin, cisplatin or ifosfamide the xenografts were grouped according to their response to chemotherapy, resistant, weakly sensitive or sensitive. For each individual drug, a one-way ANOVA test with a Benjamini and Hochberg multiple test correction allowing a false discovery rate of 5% (doxorubicin, cisplatin) or 2% (ifosfamide) was used to identify genes with significantly differential expression. In addition a 2-fold cut off was applied to exclude smaller but yet significant differences. Results: For doxorubicin and cisplatin, respectively 59 and 120 genes met these criteria. The expression levels of 25 genes overlapped between these two groups. For ifosfamide, 148 genes were selected, for 5 of them the expression overlapped with cisplatin sensitivity related genes. In the lists, genes involved in mediating and regulating apoptosis were abundant, such as regulators of TGF signaling, ubiquitin mediated protein degradation and members of the immediate early response protein family. Several genes which products interact with components of the cytoskeleton were also identified. Conclusion: We have used a unique strategy to screen for potential chemosensitivity markers by utilizing xenografts as training sets.

No significant financial relationships to disclose.

Properties of elliptical-core two-mode fiber

Polarization and modal birefringence of elliptical-core two-mode fibers are investigated. Wavelengths corresponding to zero group delay difference (GDD) between the two spatial modes and between the orthogonal polarizations are computed when the fiber parameters, i.e., the relative core/cladding index difference and the ratio of major over minor axis, are varied. Simple relationships between the zero GDD wavelengths and fiber parameters are obtained. With proper fiber design, zero GDD between the two spatial modes and the two orthogonal polarizations can be achieved at the same wavelength.

[Endoscopic optic nerve decompression in traumatic visual loss]

OBJECTIVE

To review our experience of treatment of optic nerve decompression in traumatic visual loss by using endoscopic technique.

METHOD

Fourteen cases patients with traumatic visual loss were undergone endoscopic optic nerve decompression. All patients were followed up for 3-18 months.

RESULT

Eight cases had improved visual acuity, and 6 cases did not. No complication had happened.

CONCLUSION

Endoscopic optic nerve decompression is an appropriate technique for patients with traumatic visual loss. Even though high-dose steroid treatment has failed, optic nerve decompression may improve visual acuity.

A tissue sealant based on reactive multifunctional polyethylene glycol

A rapidly gelling synthetic tissue sealant was developed from tetra-succinimidyl and tetra-thiol-derivatized polyethylene glycol (PEG). The two reagents were dissolved in aqueous buffers at 20% (w/v) solids and sprayed on the tissue site, with the use of a sprayer/mixer device. Good adhesion to collagen membranes, PTFE grafts, and carotid artery was observed in vitro. In a burst test on collagen membranes with a 2-mm orifice defect, the gel sustained fluid pressures of 125 +/- 36 mm Hg (n = 18), fivefold greater than capillary blood pressure and one-half that observed in hypertension. On 0.4-mm-diameter puncture defects in PTFE grafts, pressures of 390-490 mm Hg were sustained, and on 0.6-0.9-mm puncture defects in carotid arteries, pressures of 490 to 840 mm Hg were sustained. In vitro data corresponded to results in vivo, where bleeding in rabbit arteries was stopped immediately in five out of six trials. A significant reduction in time to hemostasis and blood loss, compared to controls, was observed. Carotid artery and subcutaneous implant data in rabbits showed that the formula was compatible with biological tissue. Rapid gelling and effective sealing were dependent on the presence of active succinimidyl ester and thiol groups on PEG. HPLC and chemical substitution methods were useful in predicting whether batches of derivatized PEG would perform satisfactorily.