Rotation of the uterus to obtain a lower transverse incision in the posterior wall in a cesarean section: a case report and literature review.

OBJECTIVE: To demonstrate that cesarean section with a transverse incision at the lower posterior wall of the uterus is suitable for some special obstetric cases. CASE REPORT: A 35-year-old primigravida with a previous surgical history of laparoscopic myomectomy underwent elective cesarean section at 39 weeks and 2 days of gestation. During surgery, there were severe pelvic adhesions and engorged vessels on the anterior wall. Considering safety, we rotated the uterus 180 degrees and made a lower transverse incision on the posterior wall. The infant was healthy and the patient had no complications. CONCLUSIONS: A low transverse incision in the posterior uterine wall is safe and effective when the incision of the anterior wall encounters a dilemma, especially in patients with severe pelvic adhesions. We recommended this approach should be done in selected cases.

Review the progression of ovarian clear cell carcinoma from the perspective of genomics and epigenomics.

Ovarian clear cell carcinoma (OCCC) is a rare subtype of epithelial ovarian cancer with unique molecular characteristics, specific biological and clinical behavior, poor prognosis and high resistance to chemotherapy. Pushed by the development of genome-wide technologies, our knowledge about the molecular features of OCCC has been considerably advanced. Numerous studies are emerging as groundbreaking, and many of them are promising treatment strategies. In this article, we reviewed studies about the genomics and epigenetics of OCCC, including gene mutation, copy number variations, DNA methylation and histone modifications.

MIL-101-Cr/Fe/Fe-NH2 for Efficient Separation of CH4 and C3H8 from Simulated Natural Gas.

Adsorptive separation based on porous solid adsorbents has emerged as an excellent effective alternative to energy-intensive conventional separation methods in a low energy cost and high working capacity manner. However, there are few stable mesoporous metal-organic frameworks (MOFs) for efficient purification of methane from other light hydrocarbons in natural gas. Herein, we report a series of stable mesoporous MOFs, MIL-101-Cr/Fe/Fe-NH2, for efficient separation of CH4 and C3H8 from a ternary mixture CH4/C2H6/C3H8. Experimental results show that all three MOFs possess excellent thermal, acid/basic, and hydrothermal stability. Single-component adsorption suggested that they have high C3H8 adsorption capacity and commendable selectivity for C3H8 and C2H6 over CH4. Transient breakthrough experiments further certified the ability of direct separation of CH4 from simulated natural gas and indirect recovery of C3H8 from the packing column. Theoretical calculations illustrated that the van der Waals force proportional to the molecular weight is the key factor and that the structural integrity and defect can impact separation performances.

Phosphatidylserine released from apoptotic cells in tumor induces M2-like macrophage polarization through the PSR-STAT3-JMJD3 axis.

BACKGROUND: Understanding how the tumor microenvironment is shaped by various factors is important for the development of new therapeutic strategies. Tumor cells often undergo spontaneous apoptotic cell death in tumor microenvironment, these apoptotic cells are histologically co-localized with immunosuppressive macrophages. However, the mechanism by which tumor cell apoptosis modulates macrophage polarization is not fully understood. In this study, we aimed to explore the tumor promoting effects of apoptotic tumor cells and the signal pathways involved. METHODS: Apoptotic cells and macrophages in tumors were detected by immunohistochemical staining. Morphological analysis was performed with Giemsa staining. Lipids generated from apoptotic cells were detected by liquid chromatography-mass spectrometry. Phosphatidylserine-containing liposomes were prepared to mimic apoptotic cells. The expression of protein was determined by real-time PCR, immunohistochemistry enzyme-linked immunosorbent assay and Western blotting. Mouse malignant ascites and subcutaneous tumor models were designed for in vivo analysis. Transgenic mice with specific genes knocked out and inhibitors specific to certain proteins were used for the mechanistic studies. RESULTS: The location and the number of apoptotic cells were correlated with that of macrophages in several types of carcinomas. Phosphatidylserine, a lipid molecule generated in apoptotic cells, induced polarization and accumulation of M2-like macrophages in vivo and in vitro. Moreover, sustained administration of phosphoserine promoted tumor growth in the malignant ascites and subcutaneous tumor models. Further analyses suggested that phosphoserine induced a M2-like phenotype in macrophages, which was related to the activation of phosphoserine receptors including T-cell immunoglobin mucin 4 (TIM4) and the FAK-SRC-STAT3 signaling pathway as well as elevated the expression of the histone demethylase Jumonji domain-containing protein 3 (JMJD3). Administration of specific inhibitors of these pathways could reduce tumor progression. CONCLUSIONS: This study suggest that apoptotic cell-generated phosphoserine might be a notable signal for immunosuppressive macrophages in tumors, and the related pathways might be potential therapeutic targets for cancer therapy.

Dual mTORC1/2 inhibitor AZD2014 diminishes myeloid-derived suppressor cells accumulation in ovarian cancer and delays tumor growth.

Mechanistic target of rapamycin (mTOR) forms two distinct complexes, mTOR complex 1 (mTORC1) and mTORC2. Here we investigated the antitumor effect of dual mTORC1/2 inhibitor AZD2014 on epithelial ovarian cancer (EOC) and its potential effect on immunosuppressive myeloid-derived suppressor cells (MDSCs). Immunohistochemical analysis of mTORC1 and mTORC2 was performed on a human ovarian cancer tissue microarray. High mTORC2 expression level was associated with shorter survival in EOC, whereas mTORC1 was not correlate with patients' prognosis. AZD2014 suppressed mTOR signaling pathway in ovarian cancer cells, inhibited proliferation and induced G1-phase cell cycle arrest and apoptosis. In tumor-bearing mice, AZD2014 treatment limited tumor growth, reduced peritoneal ascites, and prolonged survival. AZD2014 specifically reduced MDSCs migration and accumulation in EOC peritoneal fluid but not in the spleen. Moreover, subsequent AZD2014 treatment after cisplatin chemotherapy delayed EOC recurrence. Collectively, we observed that high mTORC2 expression level in EOC indicated a poor prognosis. Remarkably, in tumor-bearing mice, AZD2014 diminished MDSC accumulation and delayed tumor growth and recurrence.

Assessment of safety margin after microwave ablation of stage I NSCLC with three-dimensional reconstruction technique using CT imaging.

OBJECTIVE: To assess the ablative margin of microwave ablation (MWA) for stage I non-small cell lung cancer (NSCLC) using a three-dimensional (3D) reconstruction technique. MATERIALS AND METHODS: We retrospectively analyzed 36 patients with stage I NSCLC lesions undergoing MWA and analyzed the relationship between minimal ablative margin and the local tumor progression (LTP) interval, the distant metastasis interval and disease-free survival (DFS). The minimal ablative margin was measured using the fusion of 3D computed tomography reconstruction technique. RESULTS: Univariate and multivariate analyses indicated that tumor size (hazard ratio [HR] = 1.91, P < 0.01; HR = 2.41, P = 0.01) and minimal ablative margin (HR = 0.13, P < 0.01; HR = 0.11, P < 0.01) were independent prognostic factors for the LTP interval. Tumor size (HR = 1.96, P < 0.01; HR = 2.35, P < 0.01) and minimal ablative margin (HR = 0.17, P < 0.01; HR = 0.13, P < 0.01) were independent prognostic factors for DFS by univariate and multivariate analyses. In the group with a minimal ablative margin < 5 mm, the 1-year and 2-year local progression-free rates were 35.7% and 15.9%, respectively. The 1-year and 2-year distant metastasis-free rates were 75.6% and 75.6%, respectively; the 1-year and 2-year disease-free survival rates were 16.7% and 11.1%, respectively. In the group with a minimal ablative margin ≥ 5 mm, the 1-year and 2-year local progression-free rates were 88.9% and 69.4%, respectively. The 1-year and 2-year distant metastasis-free rates were 94.4% and 86.6%, respectively; the 1-year and 2-year disease-free survival rates were 88.9% and 63.7%, respectively. The feasibility of 3D quantitative analysis of the ablative margins after MWA for NSCLC has been validated. CONCLUSIONS: The minimal ablative margin is an independent factor of NSCLC relapse after MWA, and the fusion of 3D reconstruction technique can feasibly assess the minimal ablative margin.

A large subchorionic hematoma in pregnancy: A case report.

INTRODUCTION: Subchorionic hematoma (SCH) is a rare type of intrauterine hematoma, usually with limited impact on fetuses and pregnant women. But massive hematoma causes significant space occupying effect, affects blood supply of the fetus and finally may lead to fetus demise. PATIENT CONCERNS: In this case report, we reported a 22-year-old pregnant woman presented to our hospital with complaint of irregular lower abdominal pain. DIAGNOSIS: Ultrasonography and magnetic resonance imaging confirmed an intrauterine mass with a compressed growth-restricted fetus. INTERVENTIONS: The patient underwent diseases induced labor after confirmation of fetus demise by ultrasonography. OUTCOMES: Histopathological examination of the mass revealed a SCH. CONCLUSION: Though small SCH can be found in quite a few pregnant women and is usually harmless, enormous hematoma can result in adverse pregnancy outcomes. It may be difficult, in some cases, to differentiate it from uterine tumors or placental tumors by means of ultrasonography and magnetic resonance imaging, especially when the mass is hyperechoic under ultrasonography. This case report stresses the importance of regular examinations of pregnant women.

The prognostic value of pretreatment inflammatory biomarkers in primary angiosarcoma.

BACKGROUND: Recent studies have suggested a significant relationship between inflammatory indexes such as the neutrophil-to-lymphocyte ratio (NLR) and survival outcomes in various cancers. The aim of the present study was to evaluate the prognostic value of 6 pretreatment inflammatory markers in patients with primary angiosarcoma (AS) which is a rare and highly malignant type of soft tissue sarcoma. METHODS: Fifty-six patients diagnosed with primary AS at West China Hospital between August 2009 and July 2016 were retrospectively enrolled. The value of each biomarker was calculated for its correlation with patients' overall survival. RESULTS: The low tumor grade, tumor size <5 cm, metastatic status, surgical treatment and low level of monocyte-to-lymphocyte ratio, NLR and lactate dehydrogenase (LDH) were correlated with better survival outcome in univariate analyses. In multivariate analyses, high levels of NLR (HR 2.673, 95% CI 1.253-5.703, p=0.011) and LDH (HR 2.964, 95% CI 1.464-5.998, p=0.003) were selected as independent prognostic factors. CONCLUSION: This study identifies the elevated pretreatment levels of NLR and LDH as prognostic markers in patients with primary AS.

[Predictive value of ODI, SBI and SF-36 in patients with recurrent lumbar disc herniation undergoing reoperation].

OBJECTIVE: To evaluate the predictive value of ODI, SBI and SF-36 in patients with recurrent lumbar disc herniation undergoing reoperation. METHODS: The patients of recurrent lumbar disc herniation underwent surgical treatment from June 2013 to December 2015 were enrolled in the study. Patients were assigned to A, B, C groups according to the excellent, good, poor of clinical efficacy, and divided into training set and test set by 70:30 ratio according to random number table. we use ordered Logistic regression to construct prediction model, and test set to verify the effect of the model and calculate the accuracy of the model. RESULTS: Both ODI and SBI were lower in group A and group B than group C, and the SF-36 scale was significantly higher than group C (P<0.05). The predictive efficacy model by ordered Logistic regression construction showed that the ODI coefficient was 0.67, the SF-36 coefficient was -0.43, and the SBI coefficient was 0.52. In the group A with excellent clinical efficacy, the prediction accuracy rate of the model was 80%; in the group B with good clinical efficacy, the prediction accuracy rate was 76.92% and in the group C with poor clinical efficacy, the prediction accuracy rate was 44.44%. CONCLUSIONS: Comprehensive consideration of ODI, SBI and SF-36 to construct a clinical prediction model for patients with recurrent intervertebral disc herniation after surgery can better predict patients' prognosis. It has a value for clinical application.

Retracted Article: Application of 3D printing technology in orthopedic medical implant - Spinal surgery as an example.

Additive manufacturing has been used in complex spinal surgical planning since the 1990s and is now increasingly utilized to produce surgical guides, templates, and more recently customized implants. Surgeons report beneficial impacts using additively manufactured biomodels as pre-operative planning aids as it generally provides a better representation of the patient's anatomy than on-screen viewing of computed tomography (CT) or magnetic resonance imaging (MRI). Furthermore, it has proven to be very beneficial in surgical training and in explaining complex deformity and surgical plans to patients/parents. This paper reviews the historical perspective, current use, and future directions in using additive manufacturing in complex spinal surgery cases. This review reflects the authors' opinion of where the field is moving in light of the current literature. Despite the reported benefits of additive manufacturing for surgical planning in recent years, it remains a high niche market. This review raises the question as to why the use of this technology has not progressed more rapidly despite the reported advantages - decreased operating time, decreased radiation exposure to patients intraoperatively, improved overall surgical outcomes, pre-operative implant selection, as well as being an excellent communication aid for all medical and surgical team members. Increasingly, the greatest benefits of additive manufacturing technology in spinal surgery are custom-designed drill guides, templates for pedicle screw placement, and customized patient-specific implants. In view of these applications, additive manufacturing technology could potentially revolutionize health care in the near future.

Retraction: Application of 3D printing technology in orthopedic medical implant - Spinal surgery as an example.

[This retracts the article on p. 168 in vol. 5, PMID: 32782982.].

The association between HOTAIR polymorphisms and cancer susceptibility: an updated systemic review and meta-analysis.

OBJECTIVES: This work aims to explore whether HOX transcript antisense intergenic RNA (HOTAIR) polymorphisms are associated with cancer susceptibility. MATERIALS AND METHODS: A comprehensive search was conducted for literature published from January 2007 to July 2017. The pooled odds ratios (ORs) and the corresponding 95% CIs were calculated using the Revman 5.2 software. Eighteen articles of 36 case-control studies were enrolled including six HOTAIR polymorphisms and 10 cancer types. RESULTS: The results showed that cancer risk was elevated in recessive mutation of rs12826786 (TT vs CC+CT: OR =1.55, 95% CI =1.19, 2.03; TT+CT vs CC: OR =1.23, 95% CI =1.04, 1.46; TT vs CC: OR =1.67, 95% CI =1.24, 2.24; T vs C: OR =1.24, 95% CI =1.09, 1.40) and rs920778 (TT vs CC+CT: OR =1.73, 95% CI =1.30, 2.30; TT+CT vs CC: OR =1.40, 95% CI =1.16, 1.70; TT vs CC: OR =1.83, 95% CI =1.25, 2.68; T vs C: OR =1.37, 95% CI =1.18, 1.59), while the results for polymorphisms of rs7958904, rs4759314, rs874945, and rs1899663 were insignificant. The stratified results for Chinese population were consistent with the overall group analysis. CONCLUSION: Our meta-analysis showed that HOTAIR polymorphisms of rs12826786 and rs920778 were correlated with increased cancer risk, while rs7958904, rs4759314, rs874945, and rs1899663 were not. More studies with different types of cancer are needed to confirm the findings.

Interaction between Angiotensin II and Insulin/IGF-1 Exerted a Synergistic Stimulatory Effect on ERK1/2 Activation in Adrenocortical Carcinoma H295R Cells.

The cross talk between angiotensin II (Ang II) and insulin has been described mainly in cardiovascular cells, hepatocytes, adipocytes, and so forth, and to date no such cross talk was reported in adrenal. In this study, we examined the interaction between Ang II and insulin/IGF-1 in ERK and AKT signaling pathways and expression of steroidogenic enzymes in H295R cells. Compared to the control, 100 nM Ang II increased phospho-ERK1/2 approximately 3-fold. Insulin (100 nM) or IGF-1 (10 nM) alone raised phospho-ERK1/2 1.8- and 1.5-fold, respectively, while, after pretreatment with 100 nM Ang II for 30 min, insulin (100 nM) or IGF-1 (10 nM) elevated phospho-ERK1/2 level 8- and 7-fold, respectively. The synergistic effect of Ang II and insulin/IGF-1 on ERK1/2 activation was inhibited by selective AT1 receptor blocker, PKC inhibitor, and MEK1/2 inhibitor. Ang II marginally suppressed AKT activation under the basal condition, while it had no effect on phospho-AKT induced by insulin/IGF-1. Ang II significantly stimulated mRNA expression of CYP11B1 and CYP11B2, and such stimulatory effects were enhanced when cells were cotreated with insulin/IGF-1. We are led to conclude that Ang II in combination with insulin/IGF-1 had an evident synergistic stimulatory effect on ERK1/2 activation in H295R cells and the effect may be responsible for the enhanced steroid hormone production induced by Ang II plus insulin/IGF-1.

Advantages of CyberKnife for inoperable stage I peripheral non-small-cell lung cancer compared to three-dimensional conformal radiotherapy.

This study was conducted to compare the clinical curative effect and acute radiation lung reactions between CyberKnife (CK) and three-dimensional conformal radiotherapy (3DCRT) treatment for inoperable stage I peripheral non-small-cell lung cancer (NSCLC). We retrospectively analyzed 68 patients with inoperable stage I peripheral NSCLC between 2012 and 2013 in our institution. The CK patients were treated with 42-60 Gy in three fractions, while the 3DCRT patients were treated with a total of 60 Gy, at 2 Gy per fraction. The patients were followed up and the clinical outcome was evaluated according to the Response Evaluation Criteria in Solid Tumours. We assessed the presence of acute radiation pneumonitis and pulmonary function status by thoracic scan and pulmonary function tests following CK and 3DCRT treatment. The binary univariate logistic regression analysis demonstrated that treatment method and forced expiratory volume in 1 sec/forced vital capacity (FEV1/FVC) prior to treatment (pre-FEV1/FVC) were the main factors affecting the risk of radiation pneumonitis. The analysis of these factors through multivariate logistic regression method demonstrated that treatment method for grade 1 and 2 [odds ratio (OR)= 7.866 and 11.334, respectively) and pre-FEV1/FVC for grade 1, 2 and 3 (OR = 5.062, 11.498 and 15.042, respectively) were significant factors affecting the risk of radiation pneumonitis (P<0.05). The 68 patients were divided into two subgroups using the threshold of pre-FEV1/FVC selected by the receiver operating characteristic curve. There were significant differences between the 3DCRT and CK treatment in both the pre-FEV1/FVC <68% and ≥68% subgroups for radiation pneumonitis (P=0.023 and 0.002, respectively). There was no statistically significant change in FVC, FEV1 and carbon monoxide diffusion capacity (DCLO) in the CK group, whereas there was a decrease in DCLO in the 3DCRT group. The complete remission rate was 40 vs. 34.2% at 1 year in the CK and 3DCRT groups, respectively. In conclusion, in this cohort of patients with inoperable stage I peripheral NSCLC, CK appears to be a safe and superior alternative to conventionally fractionated radiotherapy.

Prognostic value of FDG uptake in primary inoperable non-small cell lung cancer.

The purpose of this study was to assess the prognostic value of 18F-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) in therapy for non-small cell lung cancer (NSCLC) and to further analyze the possible risk factors contributing to overall survival (OS) and progression-free survival (PFS). We retrospectively analyzed fifty patients between June 2007 and June 2010 with NSCLC who underwent positron emission tomography/computed tomography. We examined the correlation of the maximum standardized uptake value (SUVmax) in FDG-PET of the primary tumor with other possible factors. The FDG uptake in the primary tumor was also compared for the different Union for International Cancer Control (UICC) staging groups and further correlation was analyzed. We divided the patients into two groups by the receiver operating characteristic curve of SUVmax: SUVmax < 5.45 (low-SUV) and ≥ 5.45 (high-SUV). The prognostic value of each parameter for OS and PFS was determined by using univariate and multivariate analysis. There were significant correlations between SUVmax and Tumor length, N stage, UICC stage, histologic differentiation (r = 0.298, 0.855, 0.345, 0.435). The comparison between the low- and high-SUV groups was evaluated. Statistically significant differences were found in the SUVmax of the primary tumors among different UICC staging groups, and the correlation between stages I-II and stages III-IV for OS and PFS was also statistically significant. Univariate analysis showed that performance status (PS-ZPS score), histologic differentiation, UICC stages, and SUVmax of the primary tumor were significantly associated with OS and PFS. Multivariate logistic analysis showed that histologic differentiation and SUVmax of primary tumor might be considered as significant predictive factors for OS and PFS in patients with NSCLC. Our results showed that there was a significant relationship between the SUVmax of the primary tumor and OS and PFS. FDG uptake by the primary tumor may be an independent outcome predictor for patients with NSCLC.

A study on the effect of aqueous extract of Lobelia chinensis on colon precancerous lesions in rats.

This paper studies the effects of Lobelia chinensis on colon precancerous lesions and on colonic epithelial proliferation and apoptosis in DMH-induced rats. After two weeks of feeding, 50 Wistar rats were randomly divided into five groups, namely the normal group, model group, Lobelia chinensis low-dose group, medium-dose group and high-dose group. Lobelia chinensis was made into ACF model, and administered to experimental groups for 10 consecutive weeks. Control group was given equivalent amount of normal saline. After feeding for 10 weeks, the rats in each group were sacrificed and the changes in colonic ACF number of rats in experimental groups were observed, and the inhibition rates were calculated. The results showed that among the rats fed for 24 h and 48 h, the number of apoptotic cells in colonic crypts of rats in DMH group did not differ significantly from the control group, while the difference was obvious between the control group and Lobelia chinensis treatment groups. The medium and high doses, that is, 0.45 g/kg and 1.35 g/kg can significantly inhibit ACF formation (P<0.01). The inhibition rates of low, medium and high doses were 8.12%, 59.42% and 65.44%, respectively.