[The long-term efficacy of metformin in megestrol acetate-based fertility-sparing treatment for patients with endometrial atypical hyperplasia and endometrioid endometrial cancer]

Objective: To assess the long-term efficacy of metformin in megestrol acetate (MA)-based fertility-sparing treatment for patients with endometrial atypical hyperplasia (EAH) and endometrioid endometrial cancer (EEC). Methods: The randomized controlled trail study was conducted from October 2013 to October 2017 in the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Patients with EAH or EEC were firstly stratified according to pathology, and randomized to receive MA (160 mg orally, daily) plus metformin (500 mg orally, three times a day) or MA (160 mg orally, daily). Baseline data between two groups of patients were compared. Estimates of time to complete remission (CR) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier method. Cox proportional-hazards regression model was used to estimate hazard ratios (HR) of related factors for recurrence-free survival. Quantitative data were represented by M (Q1, Q3). Results: A total of 150 patients were included, and 76 patients were allocated to receive MA plus metformin with the age of 32.5 (28.0, 36.0), while 74 patients received MA alone with the age of 32.0 (28.0, 36.0). By the end of follow-up period, 96.7% (n=145) of patients achieved complete remission, with a median follow-up time of 57.7 (26.7, 70.5) months. The median CR time for the MA plus metformin group and the MA alone group were 6.3 (3.5, 8.3) months and 6.8 (4.0, 9.3) months, respectively (P=0.193), with 2-year cumulative CR rate of 98.6% and 98.5%, respectively (P=0.879). The median time of RFS was 28.1 (12.5, 57.3) months for the MA plus metformin group and 33.3 (14.1, 62.5) months for the MA alone group (P=0.213), with a cumulative RFS rate of 61.9% and 65.8%, respectively (P=0.560). In the subgroup of non-obese (body mass index<28 kg/m2) patients with EAH, the median RFS times were 25.7 (7.6, 60.3) months and 47.3 (17.5, 64.8) months for the MA plus metformin group and the MA alone group, respectively (P=0.033), with a cumulative RFS rate of 57.5% and 80.6%, respectively (P=0.029). According to Cox proportional hazards regression analysis, undergoing assisted reproductive treatment (HR=2.358, 95%CI: 1.069-5.204, P=0.034) was identified as an independent risk factor for recurrence-free survival after complete remission of endometrial lesions. Conclusion: The long-term follow-up outcome indicates that there is no significant difference in CR time and RFS time between MA plus metformin therapy and MA alone therapy for patients with EAH or EEC.

[Fertility-preserving treatment outcomes in endometrial cancer and atypical hyperplasia patients with different molecular profiles]

Objective: To investigate the impact of molecular classification and key oncogenes on the oncologic outcomes in patients with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) receiving fertility-preserving treatment. Methods: Patients with EC and AEH undergoing progestin-based fertility-preserving treatment and receiving molecular classification as well as key oncogenes test at Obstetrics and Gynecology Hospital, Fudan University from January 2021 to March 2023 were reviewed. Hysteroscopic lesion resection and endometrial biopsy were performed before initiating hormone therapy and every 3 months during the treatment to evaluate the efficacy. The risk factors which had impact on the treatment outcomes in EC and AEH patients were further analyzed. Results: Of the 171 patients analyzed, the median age was 32 years, including 86 patients with EC and 85 patients with AEH. The distribution of molecular classification was as follows: 157 cases (91.8%) were classified as having no specific molecular profile (NSMP); 9 cases (5.3%), mismatch repair deficient (MMR-d); 3 cases (1.8%), POLE-mutated; 2 cases (1.2%), p53 abnormal. No difference was found in the cumulative 40-week complete response (CR) rate between the patients having NSMP or MMR-d (61.6% vs 60.0%; P=0.593), while the patients having MMR-d had increased risk than those having NSMP to have recurrence after CR (50.0% vs 14.4%; P=0.005). Multi-variant analysis showed PTEN gene multi-loci mutation (HR=0.413, 95%CI: 0.259-0.658; P<0.001) and PIK3CA gene mutation (HR=0.499, 95%CI: 0.310-0.804; P=0.004) were associated with a lower cumulative 40-week CR rate, and progestin-insensitivity (HR=3.825, 95%CI: 1.570-9.317; P=0.003) and MMR-d (HR=9.014, 95%CI: 1.734-46.873; P=0.009) were independent risk factors of recurrence in EC and AEH patients. Conclusions: No difference in cumulative 40-week CR rate is found in the patients having NSMP or MMR-d who received progestin-based fertility-preserving treatment, where the use of hysteroscopy during the treatment might be the reason, while those having MMR-d have a higher risk of recurrence after CR. Oncogene mutation of PTEN or PIK3CA gene might be associated with a lower response to progestin treatment. The molecular profiles help predict the fertility-preserving treatment outcomes in EC and AEH patients.

Potential of Polyethyleneimine as an Adjuvant To Prepare Long-Term and Potent Antifungal Nanovaccine

Background

Candida albicans infections are particularly prevalent in immunocompromised patients. Even with appropriate treatment with current antifungal drugs, the mortality rate of invasive candidiasis remains high. Many positive results have been achieved in the current vaccine development. There are also issues such as the vaccine's protective effect is not persistent. Considering the functionality and cost of the vaccine, it is important to develop safe and efficient new vaccines with long-term effects. In this paper, an antifungal nanovaccine with Polyethyleneimine (PEI) as adjuvant was constructed, which could elicit more effective and long-term immunity via stimulating B cells to differentiate into long-lived plasma cells.

Materials and Methods

Hsp90-CTD is an important target for protective antibodies during disseminated candidiasis. Hsp90-CTD was used as the antigen, then introduced SDS to "charge" the protein and added PEI to form the nanovaccine. Dynamic light scattering and transmission electron microscope were conducted to identify the size distribution, zeta potential, and morphology of nanovaccine. The antibody titers in mice immunized with the nanovaccine were measured by ELISA. The activation and maturation of long-lived plasma cells in bone marrow by nanovaccine were also investigated via flow cytometry. Finally, the kidney of mice infected with Candida albicans was stained with H&E and PAS to evaluate the protective effect of antibody in serum produced by immunized mice.

Results

Nanoparticles (NP) formed by Hsp90-CTD and PEI are small, uniform, and stable. NP had an average size of 116.2 nm with a PDI of 0.13. After immunizing mice with the nanovaccine, it was found that the nano-group produced antibodies faster and for a longer time. After 12 months of immunization, mice still had high and low levels of antibodies in their bodies. Results showed that the nanovaccine could promote the differentiation of B cells into long-lived plasma cells and maintain the long-term existence of antibodies in vivo. After immunization, the antibodies in mice could protect the mice infected by C. albicans.

Conclusion

As an adjuvant, PEI can promote the differentiation of B cells into long-lived plasma cells to maintain long-term antibodies in vivo. This strategy can be adapted for the future design of vaccines.

[Influence of setting time on bond strength of different bioactive pulp capping materials with dental adhesive]

OBJECTIVE

To investigate influence of setting time on bond strength of different bioactive pulp capping materials with self-etch or etch-and-rinse adhesive.

METHODS

Sixty specimens were prepared for each of the three tested capping materials, namely mineral trioxide aggregate (MTA), iRoot BP Plus (BP) and iRoot FS (FS). Specimens of each material were divided into three groups and bonded at three setting time points of the materials respectively: initial setting time (4 h for MTA, 2 h for BP and 20 min for FS), 24 h after application and 7 d after application. The specimen surfaces of each group were treated with self-etch mode or etch-and-rinse mode of one universal adhesive (Single Bond Universal, SBU) (n=10). The bonding area was restricted to a round area with 3 mm diameter, on which composite cylinders were build up with flowable composite and light cured completely. The shear bond strength was tested immediately with a shear strength tester and fracture mode was observed under stereo microscope and recorded. The mean shear bond strength for each group was analyzed with SPSS 19.0 software ANOVA method. The surface morphology of each material was observed after setting and acid treatment under scanning electron microscope.

RESULTS

There was no significant difference among the three tested materials at either initial setting point or 7 d after application (P<0.05). The bond strength of MTA was significantly higher than those of BP and FS 24 h after application in both bonding modes (P<0.05). For all the three tested materials, shear bond strength was significantly higher for complete setting group than for initial setting group of the same material (P<0.05). Under scanning electron microscope, the characteristic crystal patterns could be observed on the three bioactive materials surfaces after complete setting, the size of which was bigger for MTA than for BP and FS. These features were lost to some extent after self-etch primer application or phosphoric acid etching.

CONCLUSION

Based on the present results, adequate bond strength can be obtained for FS at initial setting time, which is comparable with BP and MTA. This implies that clinically composite restoration can be placed over bioactive direct capping materials after shortened initial setting process in one visit.

Soil contamination and plant uptake of heavy metals at polluted sites in China

We investigated heavy metal contamination in soils and plants at polluted sites in China including some with heavy industries, metal mining, smelting and untreated wastewater irrigation areas. We report our main findings in this paper. The concentrations of heavy metals, including Cd and Zn, in the soils at the investigated sites were above the background levels, and generally exceeded the Government guidelines for metals in soil. The concentrations of metals in plants served to indicate the metal contamination status of the site, and also revealed the abilities of various plant species to take up and accumulate the metals from the soil. Substantial differences in the accumulation of heavy metals were observed among the plant species investigated. Polygonum hydropiper growing on contaminated soils in a sewage pond had accumulated 1061 mg kg(-1) of Zn in its shoots. Rumex acetosa L. growing near a smelter had accumulated more than 900 mg kg(-1) of Zn both in its shoots and roots. Therefore these species have potential for phytoremediation of metal-contaminated sites. Our results indicate the need to elucidate the dynamics of soil metal contamination of plants and the onward movement of metal contaminants into the food chain. Also our results indicate that the consumption of rice grown in paddy soils contaminated with Cd, Cr or Zn may pose a serious risk to human health, because from 24 to 22% of the total metal content in the rice biomass was concentrated in the rice grain. Platanus acerifolia growing on heavily contaminated soil accumulated only very low levels of heavy metals, and this mechanism for excluding metal uptake may have value in crop improvement. Sources of metal entering the environmental matrices studied included untreated wastewater, tailings or slurries and dust depositions from metal ore mining, and sewage sludge. Pb, Zn or Cd concentrations declined with the distance from metal smelter in accordance with a good exponential correlation (R2>0.9), and this shows that metal dust deposition is an important contributor to metal contamination of soils.

Responses of legume and non-legume crop species to heavy metals in soils with multiple metal contamination

Field and glasshouse investigations were conducted on the responses of two legumes (field pea and fodder vetch) and three non-leguminous crops (maize, wheat and rapeseed) to the heavy metals Cd, Cr, Zn, Pb, Cu and Mn in soil with multiple metal contamination. In general, the results indicate that the two legumes and wheat were more susceptible to soil metals than were rapeseed and maize. The dry matter yields of field pea, wheat, fodder vetch, rapeseed and maize decreased by up to 169, 123, 113, 93 and 68%, respectively, in metal-contaminated soil. Among the crops, maize had the highest concentrations of Mn, Zn and Cd, rapeseed had the highest concentrations of Cr, the concentration of Cu was highest in fodder vetch, and wheat was the highest accumulator of Pb. The bioconcentration factors (BCF) of the metals decreased as the soil metal loading rates increased except for Cr in fodder vetch and Cd in wheat, whose BCF increased as the metal loading rate increased. Significant linear correlations were found between plant and soil metal concentrations. Patterns of metal distribution in plant parts varied with different crops and metals, with more Cd and Cu accumulating in the grain of wheat than of maize, suggesting that growing wheat would represent a higher risk of food contamination than growing maize in Cd- or Cu-contaminated soil. The results suggest that on sites with multiple metal contamination, growing maize and rapeseed would be safer than growing wheat or legumes. However, maize could perhaps be used for phytoremediation of lightly contaminated soils, providing that the crop residues were safely disposed of.

Ki-ras point mutation and p53 expression in human pancreatic cancer: a comparative study among Chinese, Japanese, and Western patients

The aim of this study was to clarify features of Ki-ras point mutation (PM) and p53 expression in Chinese pancreatic cancer and to compare those with that in other countries. Dot blot hybridization and immunohistochemical methods were performed in 59 Chinese patients. The results showed that Ki-ras PMs at codon 12 and p53 expression were frequent in this group. No relationships were found between Ki-ras PM alone and p53 expression alone, and clinicopathological parameters, including age, gender, clinical stage, and histological grade and classification in Chinese patients. However, their cooperation was significantly associated with a poor prognosis in this group. Comparison showed that there were significant differences in the overall frequency and substitution of Ki-ras PM and in the ratio of transition:transversion in pancreatic cancer among various countries. In addition, the effect of Ki-ras PM and p53 expression on a poor prognosis of pancreatic cancer may be different among various countries. These findings suggested that not only Ki-ras PM and p53 expression are frequent in Chinese pancreatic cancer, but also a gene component to pancreatic cancer may be different between Asian and Western pancreatic cancer. In addition, it seems that cooperation of Ki-ras PM and p53 expression may predict a poor prognosis in Chinese patients with pancreatic cancer.

Management of extracranial carotid artery aneurysms: 17 years' experience

OBJECTIVES

a retrospective review of seventeen-year (1980-1996) experience of the management of extracranial carotid artery aneurysms.

PATIENTS AND METHODS

sixty-six aneurysms of extracranial carotid artery were seen in 63 patients. The diagnosis was confirmed by angiography in 51 patients and duplex ultrasonography in twelve. Twenty-eight (42%) patients had an atherosclerotic aneurysm, twenty-two (33%) had false aneurysms secondary to trauma, nine were congenital and seven were mycotic. All underwent aneurysm resection with saphenous-vein-graft interposition as the most common means of reconstruction.

RESULTS

one death occurred due to septicaemia in a diabetic patient with a mycotic aneurysm, giving an operative mortality of 1.5%. One patient had an immediate hemiparesis after carotid artery ligation, and three had a hemiparesis within 48 hours of operation (6.1%). After a change in technique to avoid a residual carotid stump, no further neurological problems were encountered in the following 28 patients.

CONCLUSION

extracranial carotid aneurysms may be successfully managed with resection and reconstruction with autogenous saphenous vein. End-to-side anastomosis avoids a blind-ending stump which may be the source of emboli.

Epidermal growth factor and its receptor as prognostic indicators in Chinese patients with pancreatic cancer

The expression of epidermal growth factor (EGF) and its receptor (EGFR) was studied immunohistochemically in fifty-seven Chinese patients with primary invasive ductal carcinoma (IDC) of the pancreas. The frequency of expression of EGF and EGFR was 73.7% and 68.4%, respectively. The frequency of their co-expression was 61.4%. No significant relationships were seen between the expression of EGF and its receptor and the patients' age, gender, site of the tumor, stage, and grade. Positive co-expression of EGF and EGFR was significantly associated with the poor prognosis. The median survival of the EGF(-)EGFR(-) group for 17.2 months was longer than that of the EGF(+)EGFR(+) group for 9.7 months (p = 0.02), as well as that of the other groups of EGR(+)EGFR(-), EGF(-)EGFR(+), and EGF(+)EGFR(+) for 9.9 month (p = 0.03). These results suggested that EGF and EGFR were frequently expressed in Chinese patients with IDC of the pancreas. Their co-expression may be a useful prognostic indicator for pancreatic cancer.

Comparative study of p53 expression in primary invasive ductal carcinoma of the pancreas between Chinese and Japanese

Previous studies reported different frequencies of p53 expression between Japanese and Americans or Europeans. The present study was designed to clarify whether there is a significant difference in p53 expression and its clinical implications between Chinese and Japanese patients with primary invasive ductal carcinoma (IDC) of the pancreas. p53 expression was studied in 39 Chinese and 47 Japanese patients, and immunostaining with the SAB method was performed using anti-p53 monoclonal antibody (DO-1) in formalin-fixed and paraffin-embedded specimens. Clinical data were analyzed according to the International Union Against Cancer classification. p53 expression was seen in 71.8% of Chinese and in 48.9% of Japanese patients with IDCs of the pancreas (p < 0.05). The Chinese patients were significantly younger than the Japanese ones (p < 0.05), but there were no significant correlations between p53 immunoreactivity and age, gender, stage, and histopathological grade in separate analyses of the Chinese and Japanese patients. A comparison between them showed that in patients younger than 55 and 65 years old, the incidence of p53 expression was markedly lower in Japanese than in Chinese (p < 0.05). In Japanese patients, those with a p53-positive pancreatic cancer had a significantly lower survival rate than those with a p53-negative tumor, but there was no correlation between p53 expression and the prognosis of Chinese patients. The frequency of p53 expression in IDC of the pancreas is higher in Chinese than in Japanese patients, and the effect of p53 expression on prognosis is different between Chinese and Japanese patients.

[The clinical features of 160 cases of acute sodium silicon fluoride poisoning]

160 cases of acute sodium silicon fluoride poisoning due to accidental intake are reported in this paper. Owing to the great amount of the chemical taken, the onset was abrupt and the digestive symptoms were prominent and severe. Twelve cases had acute gastritis or acute ulceration as shown by gastroscopy. The cardiovascular findings were notable. Ninety-six cases had abnormal electro-cardiographic findings. Abnormal heart rhythm and S-T segment changes were the main findings. These changes were positively correlated with the toxin amount of fluoride. Two cases died from sudden arrest of heart beat. Lung, kidney, liver, and brain functions were also impaired. The authors suggested diagnostic criteria and control procedures.