Dissecting spatial heterogeneity and the immune-evasion mechanism of CTCs by single-cell RNA-seq in hepatocellular carcinoma.

Little is known about the transcriptomic plasticity and adaptive mechanisms of circulating tumor cells (CTCs) during hematogeneous dissemination. Here we interrogate the transcriptome of 113 single CTCs from 4 different vascular sites, including hepatic vein (HV), peripheral artery (PA), peripheral vein (PV) and portal vein (PoV) using single-cell full-length RNA sequencing in hepatocellular carcinoma (HCC) patients. We reveal that the transcriptional dynamics of CTCs were associated with stress response, cell cycle and immune-evasion signaling during hematogeneous transportation. Besides, we identify chemokine CCL5 as an important mediator for CTC immune evasion. Mechanistically, overexpression of CCL5 in CTCs is transcriptionally regulated by p38-MAX signaling, which recruites regulatory T cells (Tregs) to facilitate immune escape and metastatic seeding of CTCs. Collectively, our results reveal a previously unappreciated spatial heterogeneity and an immune-escape mechanism of CTC, which may aid in designing new anti-metastasis therapeutic strategies in HCC.

[An analysis of risk factors for postpartum cardiac events in pregnant women with heart disease].

OBJECTIVE: To investigate the risk factors for postpartum cardiac events in pregnant women with heart diseases and to provide prenatal counseling for them. METHODS: A retrospective analysis was made in cases of pregnant women with heart diseases admitted to the surgical intensive care unit (SICU) of Anzhen Hospital from May 2004 to May 2012. Data were used to identify univariate and multivariate predictors for postpartum cardiac events. RESULTS: A total of 190 patients ( ≥ 20 weeks gestation) were enrolled in the study with 134 (70.5%) of congenital heart disease, 30(15.8%) of rheumatic heart disease, 10 (5.3%) of cardiomyopathy, 2 (1.1%) of peripartum cardiomyopathy and 14 (7.4%) of hypertensive heart disease. Postpartum cardiac events were observed in 42 cases with the incidence of 22.1%. A total of 7 cases resulted in death with the mortality rate of 3.7%. Among them, 5 cases were dead of circulatory collapse and pulmonary hypertensive crisis postpartum, while the other 2 cases with secondary pulmonary infection were died of respiratory and circulatory collapse. The baseline parameters of New York Heart Academy(NYHA)>1, left ventricular ejection fraction(LVEF)<50%, use of cardiac drugs and pulmonary artery hypertension (PAH)>80 mm Hg(1 mm Hg = 0.133 kPa) were the independent predictors for postpartum cardiac events by univariate and multivariate logistic regression analysis. CONCLUSIONS: The incidence of postpartum cardiac events is high in pregnant women with heart diseases. Pulmonary artery hypertension and heart failure are the main causes of death.

[Case-control study on Hennipen external rotation procedure for reduction of 28 patients with acute anterior shoulder dislocation].

OBJECTIVE: To introduce the characteristics and its clinical effects of Hennipen external rotation procedure for reduction of acute anterior shoulder dislocation. METHODS: From March 2007 to March 2010, 72 patients with acute anterior shoulder dislocation were treated with manipulative reduction in our department. All the patients were divided into two groups: the Hippocratic group with 44 patients receiving regular Hippocratic procedure, and the Hennipen group with 28 patients receiving Hennipen external rotation procedure. Clinical manifestation and radiology were used to diagnose. After reduction procedures, external fixation was applied for another 3 to 4 weeks. The reduction course, complication and function recovery at follow-up were recorded and compared. The student test was used to analyze the difference between groups. RESULTS: Thirty-two patients in the Hippocratic group and 3 in Hennipen received intravenous anesthesia. Manipulation time of the Hippocratic group ranged from 2 to 5 minutes with a mean of (3.9 +/- 1.2) minutes, obviously different from that of Hennipen,which ranged from 0.5 to 2 minutes with a mean of (1.3 +/- 0.7) minutes. Complications occurred in 2 cases of the Hippocratic group and none of the Hennipen group. The UCLA scores of shoulder joint at follow-up were 34.2 +/- 2.1 and 33.8 +/- 1.0 respectively in two groups, with no significant difference. CONCLUSION: Compared with Hippocratic procedure, Hennipen external rotation procedure is easier to manipulate, bring less complications and the same effect. It is worth further clinical applications.