[Primary ovarian squamous cell carcinoma: clinicopathological features and prognostic analysis of fifteen cases]

Objective: To assess the clinical features and treatment outcomes in patients with primary ovarian squamous cell carcinoma (POSCC). Methods: Fifteen patients with primary ovarian squamous cell carcinoma diagnosed from January 2009 to December 2018 in Cancer Hospital of the University of Chinese Academy of Sciences were collected. The expression of p16, hMLH1, hMSH2, hMSH6 and PMS2 in POSCC was detected by immunohistochemistry, and the status of high-risk human papillomavirus (HPV) by RNAscope test. Results: Squamous cell carcinoma with different degrees of differentiation was found in 15 cases, including three cases with high differentiation and 12 cases with medium to low differentiation. There were four cases with in situ squamous cell carcinoma, four cases with teratoma, one case with endometrial carcinoma/atypical hyperplasia, and one case with endometriosis. p16 was expressed in five cases (5/15), indicating coexisting high-risk HPV infection. There was no high-risk HPV infection in the remaining 10 cases, and p16 staining was negative. There was no deficient mismatch repair protein in all cases. The overall survival time (P=0.038) and progression free survival (P=0.045) of patients with high-risk HPV infection were longer than those without HPV infection. Conclusions: POSCC is more commonly noted in postmenopausal women and often occurs unilaterally. Elevated serological indexes CA125 and SCC are the most common finding. Morphologically, the tumors show variable degrees of differentiation, but the current data suggest that the degree of differentiation cannot be used as an independent prognostic index. High-risk HPV infection may be associated with the occurrence of POSCC, and that the prognosis of POSCC patients with HPV infection is better than that of patients without infection.

[Different criteria of metabolically healthy obesity and its effects on the prevalence]

The problem of obesity is getting serious. However, recent studies have shown that obesity is not necessarily harmful to health, thus the concept of metabolically healthy obesity is proposed. So far, no standard definition/criterion had been set up for metabolically healthy obesity. Through searching related literature on metabolically healthy obesity worldwide, different diagnostic criteria were reviewed, and compared with the difference of prevalence as well. The aim of the study is to provide reference for the precise prevention of obesity in China.

Case report of a KIT-mutated melanoma patient with an excellent response to apatinib and temozolomide combination therapy

Malignant melanoma is one kind of malignant disease which has high rates of mortality, metastasis, and poor prognosis. The therapeutic landscape is rapidly changing with the development of novel agents in recent decades, such as anti-PD-1 agents, anti-CTLA-4 agents, and BRAF inhibitors. However, since most of these novel agents are very expensive, not all patients can afford them. Apatinib is a novel oral small-molecule tyrosine kinase inhibitor targeting the intracellular domain of vascular endothelial growth factor receptor 2 (VEGFR-2) and may also be effective on Ret, c-KIT, and c-src. Temozolomide (TMZ) is a second-generation alkylating agent and a cytotoxic drug for melanoma treatment. In this work, we reported a case of metastatic melanoma with an excellent response to apatinib/TMZ combination therapy with progression-free survival for more than one year. This patient showed high expression of CD117, VEGFR-3, and KIT mutation in exon 11, suggesting that apatinib may induce clinical response via inhibiting VEGFR and c-KIT. Apatinib/TMZ combination therapy could be a new option for the treatment of advanced melanoma with KIT mutation.

Application of a cervical low incision in the functional neck dissection of thyroid papillary carcinoma

The present study aimed to discuss the advantage of the application of a cervical low incision for functional neck dissection in patients with thyroid papillary carcinoma. The study was a retrospective analysis of 87 thyroid papillary carcinoma patients; cervical low incision in the functional neck dissection was applied for 47 cases and the classic ‘L’ incision was applied for 40 cases. The different integrity, surgical time, blood loss and the aesthetic property of the incision were compared between the cervical low incision and the classic ‘L’ incision for lateral neck dissection of thyroid cancer. The postoperative pathological diagnosis was that the average total amount and the region II lymph nodes of the unilateral neck dissection were 33 and 10 for the cervical low incision group, and 32 and 11 for the classic ‘L’ incision group, respectively (P>0.05). The average unilateral neck dissection times were 87 and 58 min for the cervical low incision group and the classic ‘L’ incision group, respectively (P<0.05). The blood loss of the cervical low incision group was 67 ml, while the loss for the classic ‘L’ incision group was 61 ml (P>0.05). The postoperative incision of the cervical low incision group was smaller and more concealing. Additionally, the cosmetic deformities were milder for an inconspicuous cervical scar, and the sensation was improved for the patients in comparison with the classic ‘L’ incision group. These results suggest that the application of cervical low incision for functional neck dissection in thyroid papillary carcinoma patients aids in reducing postoperative complications, without increasing recurrence rates. Therefore, the classic ‘L’ incision can be replaced by the cervical low incision.

[Detection of micrometastases and its clinical significance in sentinel and non-sentinel lymph nodes from early cervical carcinoma]

OBJECTIVE

To investigate the clinical significance of micrometastasis detection in sentinel lymph nodes (SLN) from patients with early cervical carcinoma.

METHODS

Thirty patients with early cervical carcinoma were studied to identify SLN intraoperatively using methylene blue. One lymph node was removed randomly from palpable SLN and other pelvic lymph nodes (nSLN) in each patient, so 268 lymph nodes were collected and cut into two halves, one half of the lymph node was used to analyze the expression of cytokeratin 19 (CK19) mRNA by real-time fluorescence quantitative polymerase chain reaction to determine the presence of micrometastasis, the other half was examined by routine histology with HE staining.

RESULTS

67 SLNs were detected in 28 cases (93.3%). Pelvic lymph nodes of 6 cases were confirmed pathological metastasis. The sensitivity of SLN detection was 66.7%, the accuracy rate was 96.4%, and the false negative rate was 16.7%. Among 268 lymph nodes (including 9 lymph nodes with pathological metastasis) detected by real-time fluorescence quantitative polymerase chain reaction, 68 lymph nodes were pathological negative but had micrometastasis, accounting for 26.3% (68/259) in pathologically negative lymph nodes. Among 24 patients with pathological negative lymph nodes, 16 cases had micrometastasis, accounting for 66.7% in those patients. Among 16 patients with micrometastasis, SLN of 3 cases were negative, but nSLN were micrometastasis, so the SLN false-negative rate rose to 18.2%. There were no significant relationships between pelvic lymph nodes micrometastasis and perivascular space involvement, deep stromal invasion and tumor grade (all P > 0.05). The micrometastasis rate of nSLN in patients with SLN micrometastasis was 100%, significantly higher than that in the patients with SLN non-micrometastasis (27.3%, P < 0.01).

CONCLUSIONS

Real-time fluorescence quantitative polymerase chain reaction is a sensitive method to detect SLN micrometastasis. SLN micrometastasis may be an effective complement to SLN pathology to predict nSLN metastasis. Pelvic lymph nodes micrometastases have no significant relationship with pathological risk factors in cervical cancer and prognosis of patients.

Incidence of ischaemic and haemorrhagic stroke and the association with smoking and smoking cessation: a 10-year multicentre prospective study in China

OBJECTIVES

To examine the effects of cigarette smoking and smoking cessation on the incidence of ischaemic and haemorrhagic stroke in a multicentre prospective cohort study among Chinese.

STUDY DESIGN

A multicentre population-based prospective cohort study.

METHODS

The incidence of, and deaths from, stroke were monitored among 26,607 participants (12,560 men and 14,047 women) who were enrolled in 1986 and free from stroke until 2000. Cox's proportional hazard model was performed to obtain the hazard ratio (HR) of cigarette smoking for stroke risk after adjustment for major confounders.

RESULTS

After an average of 9.5 years of follow-up, 1108 subjects developed stroke. The excess risk of all types of stroke (total stroke) among male current smokers [HR 1.39, 95% confidence interval (CI) 1.15-1.67] was mainly due to a significantly elevated risk of ischaemic stroke (HR 1.49, 95% CI 1.17-1.90). A significantly increased risk for total stroke and ischaemic stroke was observed among men who smoked >15 cigarettes/day and men who had smoked for >25 years. The rate of smoking cessation was very low among Chinese men (7.2%) and women (1.5%). Smoking cessation did not appear to reduce the risk of haemorrhagic stroke, but may reduce the risk of ischaemic stroke; however, the possibility that this result was due to chance cannot be excluded (HR 0.74, 95% CI 0.26-2.08).

CONCLUSION

This study confirmed that cigarette smoking is a major determinant for the incidence of ischaemic and haemorrhagic stroke in Chinese men, and emphasizes the need for improved strategies to help people quit smoking.

[Methylation status of CDH1 gene in preoperative abdominal lavage of patients with gastric cancer and its clinical significance]

OBJECTIVE

To explore the association between the progression of gastric cancer and the aberrant methylation of CDH1 gene in preoperative abdominal lavage fluid.

METHODS

Real-time methylation-specific polymerase chain reaction(qMSP) was used to investigate the methylation status of the CDH1 gene promoter 5'-CpG islands from preoperative abdominal lavage fluid in 92 patients with gastric cancer. The associations between methylation of CDH1 genes and clinicopathologic features and prognosis were investigated.

RESULTS

Among the 92 patients with gastric cancer, aberrant methylation of CDH1 gene was detected in 45(48.9%) patients, including total aberrant methylation in 12(13.0%) cases and partly aberrant methylation in 33(35.9%) cases. Significant associations were found between CDH1 methylation status and tumor size, growth pattern, differentiation, lymphovascular invasion, infiltration depth, lymph node metastasis, distant metastasis, and clinical staging(all P<0.05). However, there were no significant associations between CDH1 methylation status with gender, age, tumor location, or Helicobacter pylori infection(all P>0.05). The median progression-free survival was 20 months for CDH1 methylation group and 38 months for non-methylated group, and the difference was statistically significant(P<0.01). Cox model analysis revealed that CDH1 methylation status in preoperative peritoneal lavage fluid was an independent factor associated with postoperative survival in patients with gastric cancer(P=0.000, RR=332.88, 95%CI:21.71-5105.07).

CONCLUSIONS

The aberrant methylation of 5'-CpG of CDH1 gene promoter is common in gastric cancer. The examination of CDH1 methylation status of abdominal lavage should be considered in the progression of gastric cancer.

Hypermethylation-modulated downregulation of RASSF1A expression is associated with the progression of esophageal cancer

BACKGROUND AND AIMS

Chromosome 3p21 is an important locus harboring critical tumor suppressor genes (TSGs) implicated in the pathogenesis of multiple tumors including esophageal carcinoma (EC). Aberrant promoter methylation is a fundamental mechanism of inactivation of TSGs in cancer. RASSF1A, a candidate tumor suppressor gene, recently cloned from the lung tumor locus at 3p21.3, is frequently inactivated by hypermethylation of its promoter region in a number of malignancies. We undertook this study to investigate the methylation status of RASSF1A and its significance in esophageal squamous cell carcinoma (ESCC).

METHODS

Real-time RT-PCR and real-time methylation-specific PCR (real-time MSP) were used to detect RASSF1A expression and the methylation status of the RASSF1A promoter, respectively, in 124 primary ESCC tissues.

RESULTS

Hypermethylation, partial methylation and unmethylation of the promoter region of RASSF1A were detected in 56 (45.2%), 23 (18.6%) and 45 (36.2%) of 124 ESCC samples, respectively. Unmethylation of the promoter region of RASSF1A was detected in 119 (96%) of the 124 corresponding noncancerous tissues. Five (4.0%) of 124 noncancerous tissues showed partial methylation. The presence of hypermethylation was statistically associated with loss of RASSF1A mRNA expression in primary ESCC (p <0.05). There were statistically significant correlations between the presence of hypermethylation and regional lymph node involvement (p=0.000), histological differentiation (p=0.009) and tumor stage (p=0.000).

CONCLUSIONS

Our results suggest that RASSF1A may be one of the ESCC-related TSGs located at 3p21, and hypermethylation of the CpG island promoter of the RASSF1A is associated with the progression of ESCC.

Longitudinal study of blood pressure and stroke in over 37,000 People in China

As part of a longitudinal study performed in urban China, 37,655 subjects were evaluated for stroke risk factors, including having their blood pressure measured in a standard fashion. The cohort was followed for 3.5 years during which time 427 subjects experienced incident strokes--221 ischemic, 203 hemorrhagic, and 3 undefined. Both systolic and diastolic blood pressure were significantly related to risk of stroke and stroke type. Associations were stronger for systolic than diastolic blood pressure. These results emphasize the importance of systolic blood pressure, as opposed to diastolic, as a risk factor for stroke. In this study, the risk of stroke is increased by about 25% with each 10 mm Hg increase in systolic blood pressure.

Prevention of stroke in urban China: a community-based intervention trial

BACKGROUND AND PURPOSE

Stroke has been the second leading cause of death in large cities in China since the 1980s. Meanwhile, the prevalences of hypertension and smoking have steadily increased over the last 2 decades. Therefore, a community-based intervention trial was initiated in 7 Chinese cities in 1987. The overall goal of the study was to evaluate the effectiveness of an intervention aimed at reducing multiple risk factors for stroke. The primary study objective was to reduce the incidence of stroke by 25% over 3.5 years of intervention.

METHODS

In May 1987 in each of 7 the cities, 2 geographically separated communities with a registered population of about 10 000 each were selected as either intervention or control communities. In each community, a cohort containing about 2700 subjects (>/=35 years old) free of stroke was sampled, and a survey was administered to obtain baseline data and screen the eligible subjects for intervention. In each city, a program of treatment for hypertension, heart disease, and diabetes was instituted in the intervention cohort (n approximately 2700) and health education was provided to the full intervention community (n approximately 10 000). A follow-up survey was conducted in 1990. Comparisons of intervention and control cohorts in each city were pooled to yield a single summary.

RESULTS

A total of 18 786 subjects were recruited to the intervention cohort and 18 876 to the control cohort from 7 cities. After 3.5 years, 174 new stroke cases had occurred in the intervention cohort and 253 in the control cohort. The 3.5-year cumulative incidence of total stroke was significantly lower in the intervention cohort than the control cohort (0.93% versus 1.34%; RR=0.69; 95% CI, 0.57 to 0.84). The incidence rates of nonfatal and fatal stroke, as well as ischemic and hemorrhagic stroke, were significantly lower in the intervention cohort than the control cohort. The prevalence of hypertension increased by 4.3% in the intervention cohort and by 7.8% in the control cohort. The average systolic and diastolic blood pressures increased more in the control cohort than in the intervention cohort. Among hypertensive individuals in the intervention cohort, awareness of hypertension increased by 6.7% and the percentage of hypertensives who regularly took antihypertensive medication increased 13.2%. All of these indices became worse in the control cohort. The prevalence of heart diseases and diabetes increased significantly in the both cohorts (P<0.01). The prevalence of consumption of alcohol increased slightly, and that of smoking remained constant in both cohorts.

CONCLUSIONS

A community-based intervention for stroke reduction is feasible and effective in the cities of China. The reduction, due to the intervention, in the incidence of stroke in the intervention cohort was statistically significant after 3.5 years of intervention. The sharp reduction in the incidence of stroke may be due to the interventions having blunted the expected increase in hypertension that accompanies aging as well as to better and earlier treatment of hypertension, particularly borderline hypertension. Applied health education to all the residents of the community may have prevented some normotensive individuals from developing hypertension and improved overall health awareness and knowledge.

[Modulation of norepinephrinergic control of hypothalamus preoptic areas on hibernation bouts in ground squirrels (Citellus dauricus)]

In our previous work, it was shown that hibernation could be enhanced by injection of 6-hydroxydopamine (6-OHDA, 200 micrograms) into the lateral cerebral ventricle of ground squirrels by destructing norepinephrine (NE) nerve terminals in brain areas including hypothalamus, cerebral cortex, hippocampus and periaqueductal gray matter of middle brain. In order to identify the specific area contributing for the modulation of NE system on hibernation, small doses of 6-OHDA (4 micrograms) were microinjected bilaterally into medial preoptic hypothalamus (MPA), lateral preoptic hypothalamus (LPA) and ventromedial hypothalamic nucleus (VMH). The results showed: (1) Depletion of NE on MPA may facilitate hibernation. (2) Little effect was seen by microinjection of 6-OHDA into LPA. (3) The effect of 6-OHDA on VMH was similar to that on MPA, through the mechanism remains to be investigated.

A case-control study on the environmental risk factors of Parkinson's disease in Tianjin, China

Using a case-control method, we studied the role of environmental risk factors and viral infection in the development of Parkinson's disease (PD) in China. Ninety-three PD patients and 186 controls were investigated with a questionnaire and from most of them, blood was taken to test the antibody levels of four virus (measles, rubella, HSV-1, CMV) IgG. The study result showed that positive family history, living near rubber plants, drinking river-water were associated with an increased risk of developing PD. In contrast, living in small cities, drinking well-water, drinking hard-liquor frequently, were associated with a decreased risk for PD. PD cases and controls did not differ with respect to other factors investigated including smoking and viral infection. These findings suggest that some environmental factors may be related to the development of PD, but further standardized studies will be required to confirm our results.

[Delayed hemothorax after chest injuries. Report of 31 cases]

Thirty-one patients with delayed hemothorax were treated. The time from trauma to hemothorax formation ranged from 2 to 30 days. The patients with chest injuries accompanied by multiple rib fracture, potential vascular injuries and foreign body retention the thoracic cavity were observed closely. The diagnosis, pathogenesis and treatment were discussed.

Regional anesthesia for microsurgery in China: a review

Between June 1968 and December 1985, a total of 1185 microsurgical operations were performed at the No. 6 Municipal Hospital, Shanghai. These included 500 reimplantations of amputated hands or fingers, 271 free transfers of toes, 96 free transfers of fibula, 63 free transfers of muscle, 34 reconstructions of hands, and 88 ENT procedures. The anesthetic methods used were brachial plexus block 401 (33.8%), cervical epidural block 232 (19.6%), general anesthesia 193 16.3%), double catheter lumbar and cervical epidural block 149 (12.6%), brachial plexus plus lumbar epidural block 123 (10.4%), lumbar epidural block alone 64 (5.4%), and acupuncture 22 (1.9%). Anesthesia in microsurgical operations must provide good operating conditions for very prolonged periods, devoid of any vasospasm and preferably with a degree of vasodilatation to facilitate vascular anastomosis.