[Diagnosis and treatment status of perioperative anemia in patients with gastrointestinal neoplasms: a multi-center study in Hubei Province].

Objective: To investigate the incidence and treatment of perioperative anemia in patients with gastrointestinal neoplasms in Hubei Province. Methods: The clinicopathological data of 7 474 patients with gastrointestinal neoplasms in 62 hospitals in 15 cities (state) of Hubei Province in 2019 were collected in the form of network database. There were 4 749 males and 2 725 females. The median age of the patients was 62 years (range: 17 to 96 years). The hemoglobin value of the first time in hospital and the first day after operation was used as the criterion of preoperative anemia and postoperative anemia. Anemia was defined as male hemoglobin <120 g/L and female hemoglobin <110.0 g/L, mild anemia as 90 to normal, moderate anemia as 60 to <90 g/L, severe anemia as <60 g/L. The t test and χ2 test were used for inter-group comparison. Results: The overall incidence of preoperative anemia was 38.60%(2 885/7 474), and the incidences of mild anemia, moderate anemia and severe anemia were 25.09%(1 875/7 474), 11.37%(850/7 474) and 2.14%(160/7 474), respectively. The overall incidence of postoperative anemia was 61.40%(4 589/7 474). The incidence of mild anemia, moderate anemia and severe anemia were 48.73%(3 642/7 474), 12.20%(912/7 474) and 0.47%(35/7 474), respectively. The proportion of preoperative anemia patients receiving treatment was 26.86% (775/2 885), and the proportion of postoperative anemia patients receiving treatment was 14.93% (685/4 589). The proportions of preoperative anemia patients in grade ⅢA, grade ⅢB, and grade ⅡA hospitals receiving treatment were 26.12% (649/2 485), 32.32% (85/263), and 29.93% (41/137), and the proportions of postoperative anemia patients receiving treatment were 14.61% (592/4 052), 22.05% (73/331), and 9.71% (20/206). The proportion of intraoperative blood transfusion (16.74% (483/2 885) vs. 3.05% (140/4 589), χ²=434.555, P<0.01) and the incidence of postoperative complications (17.78% (513/2 885) vs. 14.08% (646/4 589), χ²=18.553, P<0.01) in the preoperative anemia group were higher than those in the non-anemia group, and the postoperative hospital stay in the preoperative anemia group was longer than that in the non-anemia group ((14.1±7.3) days vs. (13.3±6.2) days, t=5.202, P<0.01). Conclusions: The incidence of perioperative anemia in patients with gastrointestinal neoplasms is high. Preoperative anemia can increase the demand for intraoperative blood transfusion and affect the short-term prognosis of patients. At present, the concept of standardized treatment of perioperative anemia among gastrointestinal surgeons in Hubei Province needs to be improved.

[Association of GMF-ß expression with Ki-67 and its significance in the prognostic evaluation of astrocytoma].

Objective: To clarify the correlation of the expression of glia maturation factor-ß (GMF-ß) with Ki-67 in astrocytoma, and to investigate the prognostic implications of combined detection of GMF-ß and Ki-67. Methods: One hundred and forty human astrocytoma samples (WHO Ⅱ-Ⅳ grade) were collected at Southwest Hospital, Army Medical University (the Third Military Medical University), China from 2006 to 2009. Clinicopathological information and 3-year follow-up data were collected. Expression of GMF-ß and Ki-67 was detected by single and double immunohistochemical staining, then the association of GMF-ß expression with Ki-67 and its significance in prognostic evaluation of astrocytoma were statistically analyzed. Results: GMF-ß expression in astrocytoma cells was correlated to both tumor grade and Ki-67 (both P<0.05); Kaplan-Meier survival analysis showed that GMF-ß and Ki-67 expression were negatively correlated to the 3 year-survival rates, respectively (both P<0.01). Further analysis demonstrated that the two factors were co-influenced on survival, showing a trend of "GMF-ßlow Ki-67low>GMF-ßhigh Ki-67low>GMF-ßlow Ki-67high>GMF-ßhigh Ki-67high" in 3-year survival rate with significant intergroup differences (P<0.05, P<0.01). Conclusions: GMF-ß expression is positively associated with Ki-67 in astrocytoma. Combined detection of GMF-ß and Ki-67 can predict prognosis of patients with glioma.

[Spatial distribution of canine echinococcosis in Inner Mongolia Autonomous Region from 2012 to 2018].

OBJECTIVE: To investigate the distribution and changing trend of canine echinococcosis in Inner Mongolia Autonomous Region, so as to provide the scientific evidence for prevention and control of canine echinococcosis in high-risk areas of Inner Mongolia Autonomous Region. METHODS: All data pertaining to Echinococcus infections in canine feces and sampling survey of human echinococcosis were collected from the echinococcosis-endemic foci of Inner Mongolia Autonomous Region from 2012 to 2018, and the prevalence of Echinococcus infections was investigated in dogs and humans. In addition, the spatial distribution characteristics and clusters of canine echinococcoses were identified. RESULTS: A total of 164 139 canine fecal samples were detected in the echinococcosis-endemic foci of Inner Mongolia Autonomous Region from 2012 to 2018, and there were 2 136 fecal samples positive for Echinococcus coproantigens. The positive rates of Echinococcus coproantigens were 0.54% to 1.73% in dogs from 2012 to 2018, with a tendency towards a decline seen in the prevalence of Echinococcus infections in dogs (χ2 = 108.83, P < 0.01), and there was a significant difference in the positive rate of Echinococcus coproantigens in dogs among years (χ2 = 155.27, P < 0.01). Three-dimensional trend analysis showed that canine echinococcosis was mainly concentrated in east of central Inner Mongolia Autonomous Region, and a high prevalence was detected in New Barag Right Banner and Sonid Right Banner. The global spatial distribution of canine echinococcosis appeared a random pattern in Inner Mongolia Autonomous Region from 2012 to 2018 (Moran's I > 0, P > 0.05), and there were "high-high" and "high-low" clusters of canine echinococcosis in local areas. The prevalence of human echinococcosis was 0.08%, and there was a significant difference in the prevalence among regions (χ2 = 147.61, P < 0.01), with a high prevalence seen in West Ujimqin Banner, Jarud Banner and New Barag Right Banner. In addition, the prevalence of human echinococcosis correlated positively with the Echinococcus coproantigen-positive rate in dogs (r = 0.52, P < 0.01). CONCLUSIONS: The prevalence of Echinococcus infections shows an overall tendency towards a decline in dogs in Inner Mongolia Autonomous Region from 2012 to 2018, with a high prevalence found in New Barag Right Banner and Sonid Right Banner. Human echinococcosis is concentrated in clusters of canine echinococcosis, where health education and targeted control interventions requires to be intensified.

[Epidemic situation of human echinococcosis in Inner Mongolia Autonomous Region: a sampling survey from 2012 to 2017].

OBJECTIVE: To investigate the epidemiological characteristics of human echinococcosis in Inner Mongolia Autonomous Region, so as to provide evidence for the development of the precision control strategy of human echinococcosis in the region. METHODS: A sampling survey of human echinococcosis was conducted in 28 banners (counties, districts) of Inner Mongolia Autonomous Region from 2012 to 2017, and the epidemiological characteristics were descriptively analyzed. RESULTS: A total of 90 058 residents were examined for echinococcosis in 28 banners (counties, districts) of Inner Mongolia Autonomous Region from 2012 to 2017, and 71 patients were detected with echinococcosis, with a detection rate of 0.08%. No echinococcosis cases were identified in 8 banners (counties), and there were 6 banners (counties) with echinococcosis prevalence of 0.1% to 1%, and 14 with prevalence of 0 to 0.1%. The echinococcosis prevalence was significantly greater in women (0.11%) than in men (0.05%) (χ2 = 10.09, P = 0.001), and the highest prevalence was detected in patients at ages of over 50 years (38 cases, 53.52%). In addition, the highest echinococcosis prevalence was detected in herdsmen (0.14%), or in primary school children (0.13%). CONCLUSIONS: Human echinococcosis is widely, but lowly prevalent in Inner Mongolia Region, with a diverse density of infections. Echinococcosis has remarkable characteristics of regional and population clusters in Inner Mongolia Region, and the management of echinococcosis requires to be reinforced in key regions and populations.

[Spatial distribution characteristics of reported echinococcosis patients in Inner Mongolia Autonomous Region from 2013 to 2018].

OBJECTIVE: To investigate the spatial distribution patterns and changing tendency of reported echinococcosis patients in Inner Mongolia Autonomous Region from 2013 to 2018, so as to provide the evidence for the management of echinococcosis in high-risk areas. METHODS: All data pertaining to echinococcosis patients in Inner Mongolia Autonomous Region were captured from the National Notifiable Communicable Disease Reporting System from 2013 to 2018 and analyzed using a spatial epidemiological method. RESULTS: The incidence of reported echinococcosis was 0.22 to 0.41 per 100 000 in Inner Mongolia Autonomous Region from 2013 to 2018, and the number of banner reporting echinococcosis patients increased from 24 in 2013 to 39 in 2018. The highly prevalent areas of echinococcosis were mainly concentrated in West Ujimqin Banner (the highest incidence, 19.23 per 100 000), East Ujimqin Banner (the highest incidence, 12.93 per 100 000) and New Barag Right Banner (the highest incidence, 11.66 per 100 000). Three-dimensional trend analysis showed that the areas with high incidence of reported echinococcosis were mainly located in central by eastern parts of Inner Mongolia Autonomous Region. There was a positive spatial autocorrelation in the number of echinococcosis patients, and the cases appeared a clustering distribution (Moran's I > 0, P < 0.05), with "high-high" and "low-high" regions. CONCLUSIONS: The reported echinococcosis patients show a spatial aggregation in Inner Mongolia Autonomous Region, and the hotspot areas are mainly concentrated in Xilingol League and Chifeng City, in which targeted control interventions for Inner Mongolia Autonomous Region are recommended to be intensified.

Screening and analysis on the differentially expression genes between diploid and autotetraploid watermelon by using of digital gene expression profile / Triagem e análise da expressão diferencial dos genes entre melancia diplóide e autotetraplóide através do perfil de expressão gênica digital

Abstract Synthetic polyploids are key breeding materials for watermelon. Compared with diploid watermelon, the tetraploid watermelon often exhibit wide phenotypic differences and differential gene expression. Digital gene expression (DGE) profile technique was performed in this study to present gene expression patterns in an autotetraploid and its progenitor diploid watermelon, and deferentially expressed genes (DEGs) related to the abiotic and biotic stress were also addressed. Altogether, 4,985 DEGs were obtained in the autotetraploid against its progenitor diploid, and 66.02% DEGs is up-regulated. GO analysis shows that these DEGs mainly distributed in 'metabolic process', 'cell' and 'catalytic activity'. KEGG analysis revealed that these DEGs mainly cover 'metabolic pathways', 'secondary metabolites' and 'ribosome'. Moreover, 134 tolerance related DEGs were identified which cover osmotic adjustment substance, protective enzymes/protein, signaling proteins and pathogenesis-related proteins. This study present the differential expression of stress related genes and global gene expression patterns at background level in autotetraploid watermelons. These new evidences could supplement the molecular theoretical basis for the better resistance after the genome doubling in the gourd family.

Resumo Poliploides sintéticos são materias fundamentais para melhoramento genético da melancia. Comparativamente ao seu homólogo diploide, a melancia tetraploide apresenta amplas diferenças genotípica e fenotípica e diferença de expressão gênica. A expressão gênica digital ou DGE (digital gene expression) foi utilizada neste estudo para representar o perfil de expressão gênica da melancia autotetraploide e seu progenitor diploide e a expressão diferencial de genes relacionados ao estresse biótico e abiótico. Os resultados mostraram que 4.985 DEGs foram observados no organismo autotetraploide, sendo que, deste total, 66.02%foram supra-regulados. A análise de ontologia gênica (GO) mostrou que estes DEGs estão relacionados principalmente com processos metabólicas, célula e atividade catalítica, abrangendo de acordo com a análise de genes e genoma (KEGG) rotas metabólicas, metabolismo secundário e ribossomos. Além disso, 134 genes de defesa foram identificados, abrangendo substâncias de ajuste osmótico, enzimas/proteínas de proteção, proteínas sinalizadoras e proteínas relacionadas à patogênese. Este estudo mostrou a expressão diferencial de genes relacionados ao estresse e o perfil global de expressão gênica de melancia autotetraploide, estes resultados podem complementar, a nível molecular, o entendimento do fator resistência após a duplicação do genoma em cucurbitáceas.

[Pulmonary extranodal natural killer/T-cell lymphoma: clinical analysis of three cases].

Objective: To improve the understanding of pulmonary involvement of extranodal natural killer/T-cell lymphoma (ENKTL) by analyzing the clinical manifestations, imaging and pathological features of this disease. Methods: Three cases of ENKTL, proven by pathological diagnosis in Fuzhou General Clinical Medical College of Fujian Medical University, were retrospectively analyzed. Results: All of the 3 cases were males, aged 74, 61 and 49 years, respectively. The main clinical symptoms included cold and fever. One patient had nasal congestion and runny nose. Chest CT showed multiple lung nodules (n=3), masses (n=2) and patchy shadows (n=2), with irregular lesions and clear boundaries. The 3 cases had been misdiagnosed as community acquired pneumonia, and treated with intravenous injection of moxifloxacin. ENKTL was confirmed by CT-guided percutaneous biopsy with immunohistochemical staining, which showed that 3 cases were positive for CD(56), CD(2), in situ hybridization for EBV encoded RNA (EBER), while negative for CD(20), and 2 cases were positive for CD(3), Granzyme B; and 1 case was positive for T-cell intracytoplasmic antigen-1. All 3 patients received chemotherapy, but 2 patients died, one of rejection 1 month later after bone marrow transplantation. One patient had improved after chemotherapy with follow-up. Conclusion: ENKTL should be considered when patients presented with fever, multiple lung nodules or consolidations which were non-responsive to antibiotics. Lung biopsy was the key to diagnosis.

Screening and analysis on the differentially expression genes between diploid and autotetraploid watermelon by using of digital gene expression profile.

Synthetic polyploids are key breeding materials for watermelon. Compared with diploid watermelon, the tetraploid watermelon often exhibit wide phenotypic differences and differential gene expression. Digital gene expression (DGE) profile technique was performed in this study to present gene expression patterns in an autotetraploid and its progenitor diploid watermelon, and deferentially expressed genes (DEGs) related to the abiotic and biotic stress were also addressed. Altogether, 4,985 DEGs were obtained in the autotetraploid against its progenitor diploid, and 66.02% DEGs is up-regulated. GO analysis shows that these DEGs mainly distributed in 'metabolic process', 'cell' and 'catalytic activity'. KEGG analysis revealed that these DEGs mainly cover 'metabolic pathways', 'secondary metabolites' and 'ribosome'. Moreover, 134 tolerance related DEGs were identified which cover osmotic adjustment substance, protective enzymes/protein, signaling proteins and pathogenesis-related proteins. This study present the differential expression of stress related genes and global gene expression patterns at background level in autotetraploid watermelons. These new evidences could supplement the molecular theoretical basis for the better resistance after the genome doubling in the gourd family.

MicroRNA-1294 targets HOXA9 and has a tumor suppressive role in osteosarcoma.

OBJECTIVE: MicroRNA-1294 (miR-1294) was reported to act as a tumor suppressor in several cancers. However, the biological function of miR-1294 in osteosarcoma (OS) has not been investigated. We, therefore, investigated the clinical significance and underlying mechanisms of miR-1294 in OS. PATIENTS AND METHODS: Quantitative Real-Time-Polymerase Chain Reaction (qRT-PCR) was conducted to detect the levels of miR-1294. Targets of miR-1294 were validated by luciferase reporter assay and Western blot. In vitro functional assays were performed to investigate the effects of miR-217 on cell proliferation and invasion. RESULTS: We found miR-1294 was downregulated in OS tissues and cell lines. Downregulation of miR-1294 has a significant negative impact on the overall survival of OS patients. Overexpression of miR-1294 suppresses OS cell proliferation and invasion in vitro. Then, luciferase reporter assay validated Homeobox A9 (HOXA9) was a downstream target of miR-1294. Expression patterns of miR-1294 were inversely correlated with HOXA9 in OS tissues, strengthening the findings from the luciferase reporter assay. Further functional assays revealed that overexpression of HOXA9 could reverse the inhibition effects of miR-1294 on cell proliferation and invasion. CONCLUSIONS: These results suggested miR-1294 functions as a tumor suppressor in OS progression by targeting HOXA9.

MiR-216a-3p promotes differentiation of BMMSCs into ACE II cells via Wnt/ß-catenin pathway.

OBJECTIVE: To explore whether miR-216a-3p could promote differentiation of bone marrow mesenchymal stem cells (BMMSCs) into type II alveolar epithelial cells (ACE II) via Wnt/ß-catenin pathway, thereby alleviating neonatal respiratory distress syndrome (NRDS). MATERIALS AND METHODS: BMMSCs were directionally differentiated into ACE II cells. Expressions of ACE II cell-specific transcription factors Occludin, KGF, CK18, SpA, SpB, and SpC were detected at the different time points after cell differentiation. Enzyme-linked immunosorbent assay (ELISA) was applied to detect inflammatory factors in the culture medium, including interleukin-1 (IL-1), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and Interferon-α (INF-α). After overexpression or knockdown of miR-216a-3p in BMMSCs, expressions of ACE II cell-specific transcription factors and inflammatory factors were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blot. Rescue experiments were carried out after DKK-1 treatment in BMMSCs. RESULTS: Expressions of ACE II cell-specific transcription factors Occludin, KGF, CK18, SpA, SpB, and SpC were elevated with the prolongation of cell differentiation. Overexpression of miR-216a-3p elevated levels of pro-inflammatory factors (IL-1, TNF-α, and INF-α) and reduced anti-inflammatory factor (IL-10). Expressions of ACE II cell-specific transcription factors Occludin, KGF, CK18, SpA, SpB, and SpC were remarkably increased at 7 d and 14 d compared to those detected at 1 d. Overexpression of miR-216a-3p in BMMSCs downregulated Wnt3a expression. The regulatory effect of miR-216a-3p on BMMSCs differentiation was partially reversed by DKK-1 treatment. CONCLUSIONS: Knockdown of miR-216a-3p induces differentiation of BMMSCs into ACE II cells through Wnt/ß-catenin pathway, thereby alleviating NRDS.

MYC is a positive regulator of choline metabolism and impedes mitophagy-dependent necroptosis in diffuse large B-cell lymphoma.

The activation of oncogenes can reprogram tumor cell metabolism. Here, in diffuse large B-cell lymphoma (DLBCL), serum metabolomic analysis revealed that oncogenic MYC could induce aberrant choline metabolism by transcriptionally activating the key enzyme phosphate cytidylyltransferase 1 choline-α (PCYT1A). In B-lymphoma cells, as a consequence of PCYT1A upregulation, MYC impeded lymphoma cells undergo a mitophagy-dependent necroptosis. In DLBCL patients, overexpression of PCYT1A was in parallel with an increase in tumor MYC, as well as a decrease in serum choline metabolite phosphatidylcholine levels and an International Prognostic Index, indicating intermediate-high or high risk. Both in vitro and in vivo, lipid-lowering alkaloid berberine (BBR) exhibited an anti-lymphoma activity through inhibiting MYC-driven downstream PCYT1A expression and inducing mitophagy-dependent necroptosis. Collectively, PCYT1A was upregulated by MYC, which resulted in the induction of aberrant choline metabolism and the inhibition of B-lymphoma cell necroptosis. Referred as a biomarker for DLBCL progression, PCYT1A can be targeted by BBR, providing a potential lipid-modifying strategy in treating MYC-High lymphoma.

Pharmacologic analyses of four chicken melanocortin-4 receptor mutations.

The melanocortin-4 receptor (MC4R) is a critical regulator of mammalian food intake and energy expenditure, with receptor activation resulting in decreased food intake and increased energy expenditure. Recently, studies on role of MC4R in regulation of food intake have been extended to other species, such as chicken. Functional study of mutant MC4Rs is important in proving the causal link between MC4R mutation and production traits. Herein, we cloned chicken MC4R (cMC4R) complementary DNA and generated 4 mutant cMC4Rs (Q18H, G21R, S76L, and L299P) by site-directed mutagenesis and measured their expression by flow cytometry. Pharmacologic characteristics were analyzed with binding and signaling assays using 3 agonists. We showed that G21R had decreased cell surface and total expression (P < 0.05), whereas the other 3 mutants had similar total and cell surface expression levels as wild-type cMC4R. The 4 mutants had either decreased (Q18H, G21R, S76L; P < 0.05) or no (L299P) binding to radiolabeled [Nle(4), D-Phe(7)]-α-melanocyte-stimulating hormone (MSH). In signaling assays, Q18H was constitutively active. Q18H, G21R, and S76L had decreased responses to α-MSH stimulation (P < 0.05). L299P had decreased basal and ligand-stimulated signaling (P < 0.01). Nle(4), D-Phe(7)-MSH was the most potent agonist for cMC4R and therefore would be better suited for further in vivo studies. We conclude that the cloned cMC4R was a functional receptor and provided detailed functional data for these mutations, contributing to a better understanding of cMC4R variants associated with production traits.

Bioinformatic analysis of potential candidates for therapy of inflammatory bowel disease.

OBJECTIVE: Inflammatory bowel diseases (IBDs) including ulcerative colitis (UC) and Crohn's disease (CD) increased the risk for developing colorectal cancer. However, there is no effective therapy for IBDs. The aim of this study was to identify potential therapeutic targets for inflammatory bowel disease (IBD) and explore the possible mechanism underlying this disease. MATERIALS AND METHODS: Gene expression profile GSE6731 was downloaded from Gene Expression Omnibus database, which included 9 UC samples and 19 CD samples. Differentially expressed genes (DEGs) between affected colon tissues and non-affected tissues were identified in UC and CD group. Then, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways analysis of DEGs were performed. Modules in the protein-protein interaction (PPI) network were identified, and significant node genes were selected. RESULTS: Total 619 DEGs including 285 up-regulated genes and 334 down-regulated genes were identified in UC group and total 1159 DEGs of CD including 585 up-regulated genes and 574 down-regulated genes were selected. Module was selected from PPI network. From the PPI network and module, DEGs of mitogen-activated protein kinase 3 (MAPK3), N-myc downstream regulated 1 (NDRG1) and major histocompatibility complex, class II, DR alpha (HLA-DRA) have high degree. CONCLUSIONS: MAPK3, NDRG1 and HLA-DRA may play key roles in the progression and development of IBD. They may be used as specific therapeutic targets in the treatment of IBD. However, further experiments are still needed to confirm our results.

Antitumor components from an actinomycete strain 6011W.

Three bioactive compounds that inhibited nucleoside transport were isolated from the cultured broth of Streptoverticillium sp. 6011W. The structures of those compounds were characterized as cinnamamide, N-(tetrahydro-2-oxo-3-thienyl)-acetamide and benzamide, respectively. They all inhibited radiolabeled thymidine transport into Ehrlich carcinoma cells, with IC50 values of 30.4, 97.2 and 85.4 microM, respectively. When administered i.p., cinnamamide not only inhibited the growth of transplanted tumors but also reduced the number of lung metastases in mice bearing Lewis lung carcinoma. The results suggest that nucleoside transport inhibition assay is a valuable model to search for antitumor agents of natural origin.

[Carcinoembryonic antigen assay in serum and pleural effusion of pulmonary malignancies and benign lesions].

Levels of carcinoembryonic antigen(CEA)in the serum and pleural effusion in malignancies (65) and benign (25) of lung were determined. There are 20 cases of adenocarcinoma, 16 undifferentiated carcinoma, 7 squamous cell carcinoma, 4 alveolar carcinoma, 12 unclassified carcinoma, 1 polymorphous adenoma, 1 mesothelioma, 1 thymoma, 1 metastatic cancer from kidney and 2 metastatic breast cancer. In the benign lesions, there are 20 tuberculosis, 2 heart failure, 1 pneumonia, 1 empyema and 1 cirrhosis. The mean of the CEA level in the serum of lung cancer group was 12.63 ng/ml as compared with that of the tuberculosis group, 3.01 ng/ml (P less than 0.01). The level of CEA in pleural fluid in the lung cancer group was 57.30 ng/ml as compared with that of tuberculosis group, 5.55 ng/ml (P less than 0.01). The content of CEA in the serum and pleural fluid in lung cancer group was remarkably different (P less than 0.01). CEA level in the serum of adenocarcinoma is the highest (mean 15.51 ng/ml). If we set 5 ng/ml as the margin of normal CEA level in serum, the positive rate for cancer would be 54.2%. It is suggested that the margin of CEA normal value be set at 10 ng/ml for the pleural fluid. Higher readings may imply cancer.