Malignant Transformation of a Borderline Ovarian Tumor With Pulmonary and Pleural Metastases After Years of Latency: A Case Report and Literature Review.

Borderline ovarian tumor (BOT) refers to a distinct tumor of the ovary of epithelial origin and typically has a favorable prognosis. However, these tumors are not exempt from risks of recurrence and malignant transformation, which can arise from the remaining ovarian tissue, peritoneal implants, or distant localization. Here, we report a case of a mucinous BOT with multiple pulmonary cystic nodules without evidence of pulmonary metastasis even after two fine needle biopsies. Staging surgery was performed, and no evidence of peritoneal implants or invasion to adjacent organs found. At the end of the 7-year monitored follow-up after surgery, the pulmonary lesions were found to be increased in size. The transbronchial lung biopsy and pleural biopsy confirmed transformation into malignant mucinous adenocarcinoma with pleural metastasis. In the current case, we observed potential pulmonary metastasis of the BOT with malignant transformation and a latency as long as 7 years, which reminds us that multiple pulmonary cystic changes in patients with BOTs should be screened carefully to evaluate the pulmonary involvement of BOTs and potentially false-negative results after fine needle biopsy. Thus, a thorough check-up for complete staging of the disease and a close long-term follow-up to monitor potential recurrence and malignant transformation are advised.

Endoscopic submucosal dissection of tracheal deep benign fibrous histiocytoma using hybrid knife.

Deep benign fibrous histiocytoma (FH) is an uncommon and poorly recognized tumor that arises in subcutaneous or deep soft tissue. Deep benign FH of the trachea is even more rare. Deep benign FH recurs in approximately 20% of cases, so surgical resection is the recommended treatment for FH. However, some patients are afraid of the trauma and potential complications from the resection of tracheal tumors, so they do not accept surgical resection. With the development of interventional pulmonology, bronchoscopic intervention plays a key role in the treatment of benign tracheal tumors. Novel tools have emerged in interventional pulmonology and optimized the traditional techniques. Here, we report a case of deep benign FH of the trachea with broad base relapse after electrocautery with snare, argon plasma coagulation (APC) and radiotherapy. It was treated successfully by endobronchial resection with a hybrid knife (HK) and APC. The HK is a hybrid device that combines an electrocautery knife with a water jet in one instrument. Submucosal injection and circumferential cutting and dissection of lesions as well as coagulation of bleeding can be performed only with the HK. During the 6 months follow-up, the deep benign FH of the trachea did not relapse. In the case reported herein, the HK enabled submucosal injection and circumferential cutting and dissection of lesions as well as access to submucosal lesions to gain further adequate APC treatment, thereby allowing a better clinical response than that achieved by traditional electrocautery with snare and APC. In conclusion, the HK with a water jet is a feasible and effective endoscopic method for management for benign or low-grade malignant neoplasms of the trachea, especially those with a wide base and submucosal involvement.

Sonic hedgehog signaling regulates hypoxia/reoxygenation-induced H9C2 myocardial cell apoptosis.

The sonic hedgehog (Shh) signaling pathway has been reported to protect cells against hypoxia/reoxygenation (H/R) injury; however, the role of Shh and relevant molecular mechanisms remain unclear. In the present study, the rat cardiomyoblast cell line H9C2 was subjected to hypoxia and serum-starvation for 4 h. Cells were subsequently reoxygenated using 95% O2 and 5% CO2. Reverse transcription-quantitative polymerase chain reaction was performed to quantify the expression of Shh mRNA, while cell apoptosis was assessed using flow cytometry. Caspase-3 activity and p53 expression were measured by western blotting and an MTT assay was subsequently used to assess cell viability. In addition, reactive oxygen species levels were measured using dichlorofluorescein and H/R-induced changes in the activation of superoxide dismutase, catalase, phosphorylated-endothelial nitric oxide synthase, phosphorylated-protein kinase B (Akt) and mammalian target of rapamycin activation were assessed using western blotting. H/R treatment decreased the cell viability of H9C2 cells, but activated endogenous Shh signaling. The activation of Shh signaling protected H9C2 myocardial cells from H/R-induced apoptosis and restored cell viability. In the present study, Shh signaling was demonstrated to serve a protective role against H/R by activating the phosphoinositol 3-kinase (PI3K)/Akt pathway and promoting the expression of anti-oxidant enzymes to ameliorate oxidative stress. In summary, Shh signaling attenuated H/R-induced apoptosis through via the PI3K/Akt pathway.

Glucagon-like peptide-1 protects against cardiac microvascular endothelial cells injured by high glucose.

OBJECTIVE: To investigate the protective effect of glucagon-like peptid-1 (GLP-1) against cardiac microvascular endothelial cell (CMECs) injured by high glucose. METHODS: CMECs were isolated and cultured. Superoxide assay kit and dihydroethidine (DHE) staining were used to assess oxidative stress. TUNEL staining and caspase 3 expression were used to assess the apoptosis of CMECs. H89 was used to inhibit cAMP/PKA pathway; fasudil was used to inhibit Rho/ROCK pathway. The protein expressions of Rho, ROCK were examined by Western blot analysis. RESULTS: High glucose increased the production of ROS, the activity of NADPH, the apoptosis rate and the expression level of Rho/ROCK in CMECs, while GLP-1 decreased high glucose-induced ROS production, the NADPH activity and the apoptosis rate and the expression level of Rho/ROCK in CMECs, the difference were statistically significant (P<0.05). CONCLUSIONS: GLP-1 could protect the cardiac microvessels against oxidative stress and apoptosis. The protective effects of GLP-1 are dependent on downstream inhibition of Rho through a cAMP/PKA-dependent manner, resulting in a subsequent decrease in the expression of NADPH oxidase.

The effects of subclinical hypothyroidism on serum lipid level and TLR4 expression of monocyte in peripheral blood of rats.

OBJECTIVE: To observe effect of subclinical hypothyroidism (SCH) on serum lipid level and expression of toll-like receptor 4 (TLR4) in rats' peripheral blood mononuclear cells (PBMC). METHODS: Fifty Wistar female rats were divided into three groups: normal control (NC group; n=10), sham group (n=10), and L-T-4 (L-thyroxine) group (n=30, with thyroidectomy, fed with rich-calcium water after operation. 5 weeks later, abdominal subcutaneous injection of L-T-4: 0.95 µg/100g/d). 8 weeks later, the rats were killed then the peripheral blood was collected to determine the levels of serum thyroid-stimulating hormone (TSH), total thyroid hormone (TT4), total cholesterol (TC) and low density lipoprotein cholesterin (LDL-C). Rats in L-T-4 group were divided into normal lipid (NL) group) and high lipid (HL) group) according to lipid value of NC group. Monocytes were separated from blood to determine TLR4 expression by flow cytometry. RESULTS: In NL and HL groups TSH were higher than in NC and Sham groups (p<0.05). TT4 have no significant differences (p>0.05). TLR4, TLR4 mRNA, NF-κB (p65) were increased (p<0.05). TNF-α, IL-6 and IL-1ß were higher than in NC and sham groups (p<0.01). There were no significant differences of TLR4, TLR4 mRNA, NF-κB (p65), TNF-α, IL-6 and IL-1ß expression between NL and HL groups (p>0.05). CONCLUSION: TLR4, TLR4 mRNA, NF-κB (p65) of PBMC and TNF-α, IL-6, IL-1ß expression in serum were all increased in SCH rats, which was not related to serum dyslipidemia.

Ginkgo biloba extract reducing myocardium cells apoptosis by regulating apoptotic related proteins expression in myocardium tissues.

The Bax, cyt-c and caspase-3 proteins play an important role in regulating the myocardial apoptosis. Although very little is known about the specific signal pathways modulated by Ginkgo biloba extract (GBE), it seems advisable to suppose that GBE-induced antiapoptotic effect might be attributed to the regulation of the expression of these proteins. Our aim was to investigate whether GBE could attenuate ischemia/reperfusion-induced apoptosis in cardiac myocytes and its potential mechanisms. In the myocardium ischemia reperfusion (IR) rat model, treatment of GBE (400 mg/kg) significantly decreased the cardiomyocyte cell apoptosis and myocardium infarction. Immunohistochemical analysis showed that GBE significantly inhibited I/R-induced increase of myocardial Bax, caspase-3, and cyt-c proteins expression. Western blot analysis confirmed results of immunohistochemical analysis. It is most likely that multiple pathways are involved in IR-induced apoptosis in rat myocardium cells. Therefore, these results demonstrate that GBE exhibits significant protective effect against myocardial I/R injury in rat heart, which is related to down-regulate Bax, cyt-c and caspase-3. Bcl-2 overexpression might prevent IR-induced apoptosis by inhibiting cytochrome c release from the mitochondria and block activation of caspase-3.

[A comparison of clinical features between patients with idiopathic pulmonary fibrosis combined with emphysema and without emphysema].

OBJECTIVE: To investigate the differences of clinical features, pulmonary function tests, chest imaging and prognosis between patients with idiopathic pulmonary fibrosis (IPF) combined with emphysema and without emphysema. METHODS: Of the 117 patients diagnosed as IPF for the first time in the First Affiliated Hospital of China Medical University from January 2002 to January 2007, 23 cases met the diagnostic criteria for combined pulmonary fibrosis and emphysema (CPFE). Thirty-three cases with isolated IPF from 2002 to 2003 were selected as the control group. Clinical characteristics, pulmonary function indexes, PaO2, bronchoalveolar lavage fluid (BALF) results and survival time were retrospectively analyzed and compared between the 2 groups. RESULTS: The smoking indexes (pack-years)were significantly higher in the CPFE group (28 ± 18) compared with the IPF group (18 ± 16), t = 2.10, P < 0.05. No significant difference was observed between the 2 groups in terms of age, gender and the percentage of smokers. The CPFE group showed significantly lower FEV1/FVC% [(77 ± 7)%, (83 ± 8)%, t = 3.55, P < 0.05] and D(L)CO% pred [(44 ± 12)%, (54 ± 16)%, t = 2.48, P < 0.05] compared to those of the IPF group, while TLC%pred was significantly higher in the CPFE group [(77 ± 11)%, (64 ± 12)%, t = 3.93, P < 0.05]. VC% pred and PaO2 showed no significant difference between the 2 groups. The total cell count, the percentages of macrophages, neutrophils, lymphocytes and eosinophils in BALF showed no significant difference between the 2 groups. There was no significant difference in median survival time between the 2 groups. CONCLUSION: Smoking was an important risk factor for IPF combined with emphysema. The pulmonary function of IPF combined with emphysema is characterized by a mild abnormality in the lung volume but a significant decrease in the diffusing capacity. Combined emphysema has no influence on the survival time of patients with IPF.

(R C,S Fe)-1-[3,5-Bis(trifluoro-meth-yl)phen-yl]-3-{1-[2-(diphenyl-phosphan-yl)ferro-cen-yl]eth-yl}thio-urea (unknown solvate).

In the molecule of the the title compound, [Fe(C5H5)(C28H22F6N2PS)], the absolute configuration is R C ,SFe . The dihedral angle between the trifluoro-methyl-substituted phenyl ring and the thio-urea plane is 41.8 (9)°. The iron atom is bound to the cyclo-penta-dienyl rings in the typical η(5)-manner in a close to eclipsed conformation. The crystal structure features N-H⋯S hydrogen bonds, with the S atom as an acceptor for both N-H groups, forming a layered arrangement parallel to (1-10). The two -CF3 groups are each disordered over two positions with refined occupancy rates for the major components of 0.66 (7) and 0.55 (5). The crystal was grown from mixed solvents (n-hexane and ethyl acetate). These solvents are disordered in the crystal and the resulting electron density was found to be uninterpretable. The solvent contribution to the structure factors was taken into account by back-Fourier transformation of all density found in the disordered solvent area using the SQUEEZE routine in PLATON [Spek (2009 ▶). Acta Cryst. D65, 148-155]. The formula mass and density do not take account of the solvent.