A Clinical Tool to Predict the Microvascular Invasion Risk in Patients with Hepatocellular Carcinoma.

BACKGROUND: Microvascular invasion (MVI) plays an important role in tumor progression. The aim of this study is to establish and validate an effective hematological nomogram for MVI prediction in hepatocellular carcinoma (HCC). METHODS: A retrospective study was performed in a primary cohort that includes 1306 patients clinicopathologically diagnosed with HCC, and a validation cohort contained 563 continuous patients. Univariate logistic regression was used to assess the association between variables included both clinicopathologic factors and coagulation parameters (prothrombin time, activated partial thromboplastin time, fibrinogen, and thrombin time [TT]) and MVI. Multiple logistic regression was used to construct a prediction nomogram. We tested the accuracy of the nomogram by discrimination and calibration, and then plotted decision curves to assess the benefits of the nomogram-assisted decisions in a clinical context. RESULTS: In the two cohorts, patients without MVI had the longest overall survival (OS), compared the OS with MVI. The multivariate analysis indicated that age, sex, tumor node metastasis (TNM) stage, aspartate aminotransferase, alpha fetoprotein, C-reactive protein, and TT were identified as significant independent predictors of MVI of HCC patients. The Hosmer-Lemeshow test showed good point estimate associated P value between predicted risk and observed risk across the deciles. Moreover, the calibration performance of the nomogram risk scores in each decile of the primary cohort was within 5 percentage points of the mean predicted risk score, and in the validation cohort, the observed risk in 90% decile was within 5 percentage points of the mean predicted risk score. CONCLUSIONS: A noninvasive and easy-to-use nomogram was established and may be used to predict preoperative MVI in HCC.

Patients with Asian-type DEL can safely be transfused with RhD-positive blood.

Red blood cells (RBCs) of Asian-type DEL phenotype express few RhD proteins and are typed as serologic RhD-negative (D-) phenotype in routine testing. RhD-positive (D+) RBC transfusion for patients with Asian-type DEL has been proposed but has not been generally adopted because of a lack of direct evidence regarding its safety and the underlying mechanism. We performed a single-arm multicenter clinical trial to document the outcome of D+ RBC transfusion in patients with Asian-type DEL; none of the recipients (0/42; 95% confidence interval, 0-8.40) developed alloanti-D after a median follow-up of 226 days. We conducted a large retrospective study to detect alloanti-D immunization in 4045 serologic D- pregnant women throughout China; alloanti-D was found only in individuals with true D- (2.63%, 79/3009), but not in those with Asian-type DEL (0/1032). We further retrospectively examined 127 serologic D- pregnant women who had developed alloanti-D and found none with Asian-type DEL (0/127). Finally, we analyzed RHD transcripts from Asian-type DEL erythroblasts and examined antigen epitopes expressed by various RHD transcripts in vitro, finding a low abundance of full-length RHD transcripts (0.18% of the total) expressing RhD antigens carrying the entire repertoire of epitopes, which could explain the immune tolerance against D+ RBCs. Our results provide multiple lines of evidence that individuals with Asian-type DEL cannot produce alloanti-D when exposed to D+ RBCs after transfusion or pregnancy. Therefore, we recommend considering D+ RBC transfusion and discontinuing anti-D prophylaxis in patients with Asian-type DEL, including pregnant women. This clinical trial is registered at www.clinicaltrials.gov as #NCT03727230.

Combined determination of Epstein-Barr virus-related antibodies and antigens for diagnosis of nasopharyngeal carcinoma.

BACKGROUND AND OBJECTIVE: With the development of molecular biology in recent years, many indexes for detecting Epstein-Barr virus (EBV) have been developed. This study was to evaluate the diagnostic value of combined determination of EBV-related antibodies and antigens, including VCA-IgA, EA-IgA, EBV-DNase antibody and EBV-DNA, in diagnosing nasopharyngeal carcinoma (NPC). METHODS: Serum and plasma samples from 160 untreated NPC patients and 76 healthy donors were collected. VCA-IgA and EA-IgA in the serum samples were detected by immunoenzyme staining method. Raji cells were stimulated by ortho-butanoic acid and croton oil to detect EBV-DNase antibody. The content of EBV-DNA in the plasma samples was detected by real-time fluorescence quantitative polymerase chain reaction (RQ-PCR). The diagnostic values of the indexes for NPC were evaluated. RESULTS: The sensitivity and specificity for diagnosing NPC were 90.0% and 89.5% for VCA-IgA, 75.0% and 94.7% for EA-IgA, 76.3% and 90.8% for EBV-DNase antibody, 68.8% and 88.2% for EBV-DNA, and 98.8% and 84.2% for combined determination. The positive rates of VCA-IgA and EA-IgA had no relationship with clinical stage of NPC (p > 0.05); nevertheless, the positive rates of EBV-DNase antibody and EBV-DNA were related with clinical stage (p < 0.05). CONCLUSIONS: The sensitivity of VCA-IgA and the specificity of EA-IgA are the highest while detecting solely. Combined determination could improve the diagnostic sensitivity and accuracy for NPC. EBV-DNase antibody and EBV-DNA could be helpful to evaluate the course of disease and classify the clinical stage of NPC.

[Influence of selenium-rich rice on transformation of umbilical blood B lymphocytes by Epstein-Barr virus and Epstein-Barr virus early antigen expression].

BACKGROUND & OBJECTIVE: Selenium (Se), an antioxidant, is an essential trace element to human body. It can be used as an anti-aging agent and a tumor cell proliferation inhibitor. To further investigate the effect of selenium in cancer prevention, the authors observed the influence of Se-rich rice extract on the transformation of umbilical blood B lymphocytes stimulated by Epstein-Barr virus (EBV) and expression of EBV early antigen(EBV-EA) in Raji cells. METHODS: (1) Se-rich rice and general rice extract (dilution of 1:4 or 1:8) were added to mixture of EBV, and then umbilical blood mononuclear cells were added. Lymphoblasts transformation test was then performed. The inhibition rate of B lymphocytes transformation was calculated. (2) Raji cells stimulated by butyrate and croton oil were incubated with Se-rich rice extract. The EBV-EA positive expression rate and the inhibition rate were counted using indirect immunological flurescence method. RESULTS: The transformation of umbilical blood B lymphocytes stimulated by EBV was significantly inhibited by Se-rich rice extract at a concentration of 0.11 g/ml (1:8 diluted). The inhibition rate was 83.4% (P < 0.01), which was significantly higher than that of the control rice (63.1%) (P < 0.05). Se-rich rice extract showed significant inhibition on EBV-EA in Raji cells. As the extract concentration was at 0.016 microgram/ml, 0.078 g/ml, and 0.388 microgram/ml, the inhibition rates of EA were 2.85%, 12.88%, and 20.75%, respectively. CONCLUSION: The transformation of umbilical blood B lymphocytes stimulated by EB virus and expression of EBV-EA in Raji cells may be significantly inhibited by Se-rich rice extract, suggesting that Se-rich rice can be used for preventing nasopharyngeal carcinoma.